Establishment of an asthma model by sensitization with mite antigen alone in C57BL/6J mice

Bronchial asthma is characterized by the bronchial hyperresponsiveness and airway obstruction related to airway smooth muscle contraction. Eosinophilic airway inflammation is involved in its pathogenesis. To reproduce the condition, various animal models have been prepared. However, there are many models that do not reflect the spontaneous history of bronchial asthma onset in humans due to the mouse strain, sensitizing antigen, or administration method. In this study, we prepared a mouse model of which the mechanism is similar to that of human bronchial asthma. Mite Extract-Dermatophagoides farinae (Derf) antigen was transnasally administered to wild-type C57BL/6J mice (WT) 13 times. Subsequently, an airway hypersensitivity test (Mch PC_200), specific antigen exposure test (ΔSRaw), bronchoalveolar lavage (BAL), and blood collection were performed to examine the presence or absence of asthma acquisition and differences in the local pulmonary levels of cytokines/chemokines in comparison with the physiological saline-treated group. In the mite antigen-treated mice (WT/-Derf), bronchial hyperresponsiveness was enhanced, antigen-specific was increased airway resistance in comparison with physiological salinetreated mice (WT/-Saline). In addition, the number of eosinophils in BAL fluid (BALF) was greater. Furthermore, there was a correlation among leukotrienes, eotaxin, and tissue inhibitors of metalloproteinase 1 in BALF, suggesting that the mechanism concerning eosinophilic airway inflammation involving in human bronchial asthma was reproduced. In this study, we successfully established a mouse bronchial asthma model in which the pathogenesis resembles that in humans in comparison with conventional models, using Derf antigen alone and C57BL/6J mice

Comparison of T-Cell Interferon-γ Release Assays for Mycobacterium tuberculosis-Specific Antigens in Patients with Active and Latent Tuberculosis

Through the use of QuantiFERON-TB Gold, a commercial IFN-γ assay, we compared differences in quantitative T-cell responses to Mycobacterium tuberculosis (MTB)-specific antigens [QuantiFERON TB-2G (QFT-2G)] between patients with active tuberculosis (TB) disease and those with latent TB infection (LTBI). The patient group consisted of 180 patients with active TB disease (culture-positive for MTB) and 50 screening contacts with LTBI-positive response to the QFT-2G test. We prospectively performed a tuberculin skin test (TST) and a QFT-2G test for all subjects. The median IFN-γ levels upon the application of both antigens, ESAT-6 and CFP-10, were significantly higher in patients with active TB disease than in those with LTBI. A combined positive response to both antigens occurred at a higher rate in patients with active TB disease than in those with LTBI. There were no significant relationships between the quantitative responses of IFN-γ to both antigens and the maximum induration on TST in both patient groups. We demonstrated significant differences in the quantitative responses of IFN-γ to MTB between patients with active TB disease and those with LTBI in this study. However, there was an overlap in the IFN-γ levels between active TB disease and LTBI groups. Therefore, it would be difficult to use the QFT-2G test to completely discriminate active TB disease from LTBI

急速に増大する腫瘤影を呈した肺Mycobacterium avium症の1例

症例は66歳,男性.慢性閉塞性肺疾患とい草塵肺で経過観察をしていた.6カ月前の胸部CTでは明らかな異常を認めなかったが,新たに左上葉の気腫性病変周囲に腫瘤性病変を認めた.気管支鏡検査にて,局所検体からM.avium が検出されたものの生検で肉芽腫病変を認めなかったため,CTガイド下肺生検を実施した結果,肺MAC症と最終診断した.近年,孤立性腫瘤形成型肺MAC症の症例を散見するようになってきているが,本症例のごとく短期間で急速に増大することもあることから,抗酸菌を含めた肺感染症に対する積極的な検査が必要と思われる.A 66-year-old man was admitted to our hospital for follow-up on chronic obstructive pulmonary disease with a recent-showing abnormal chest shadow. He had received a periodic chest computed tomography (CT) six months prior due to a past history of COPD and Igusa pneumoconiosis. Although there was no mass shadow on the chest CT six months ago, a solitary tumorous shadow appeared surrounding the emphysematous lesions in the left upper lobe. M. avium was detected from local specimens viabronchoscopic examination, but because a granulomatous lesion was not observed, we performed a CT-guided lung biopsy and made a final diagnosis of pulmonary MAC disease. We recently observed that pulmonary MAC disease presents as a solitary tumorous shadow. However, as there are cases of pulmonary MAC disease presenting as a rapidly growing tumorous shadow within a short time, it is necessary to perform aggressive examinations for infectious diseases including an acid-fast bacilli examination

胸部リンパ節病変の診断における超音波気管支内視鏡ガイド 下経気管支針生検(EBUS-TBNA)の有用性

近年,超音波気管支内視鏡ガイド下経気管支針生検(Endobronchial Ultrasonography-guided Transbronchial Needle Aspiration,以下EBUS-TBNA)は縦隔および肺門リンパ節病変に対するアプローチ法として開発され,病理学的および微生物学的な確定診断に用いられる.EBUSTBNAを実施できるか否かの判断や,施行後の診断率には標的リンパ節の大きさや周囲もしくは内部血管などが影響するが,それらに関する報告は少ない.2010年10月～2013年8月に,当科でEBUSを施行した69例のTBNA施行率,診断率,不成功の理由を後方視的に検討した.TBNAを施行できたのは60例であり(87%),そのうち54例(93%)で診断が確定できた.肺癌が42例(67%)と最多で,以下サルコイドーシス7例,他臓器癌のリンパ節転移3例,抗酸菌感染症1例,悪性リンパ腫1例であった.EBUS施行例のリンパ節の直径は21.3±6.0mmで,非確診例の標的リンパ節は有意に小さかった(17.5±3.7vs22.9±5.1mm,p<0.0001).部位別では下部気管傍リンパ節と気管支分岐部リンパ節で実施した症例が多かったが,部位による診断率の差は認めなかった.最終診断率では,肺癌が91%(46例中42例),サルコイドーシスが70%(10例中7例)であった.TBNAの不成功の理由は,「標的リンパ節が小さい」,「血管損傷の可能性が高い」,「患者の鎮静不可」であった.重篤な有害事象は1例も認めなかった.縦隔および肺門リンパ節病変の診断において,EBUS-TBNAは有用であると考えられた.Endobronchial ultrasonography - guided transbronchial needle aspiration (EBUSTBNA) is a new method for tissue biopsy of thoracic lymph node lesion. However, the clinical usefulness of this method and associated issues are still relatively unknown. Sixty-nine cases received EBUS in our hospital between October 2010 and August 2013. The relationship was analyzed between the diagnostic rate and the size or location of the lymph node targeted. TBNA was performed in 60 of the 69 cases, out of those the pathological and microbiological diagnosis were obtained in 54 cases (93%). The final diagnosis consisted of lung cancer in 42 cases (67%) followed by sarcoidosis in 7, metastasis of the other organ\u27s malignancy in 3 and mycobacterium infection in 1, and lastly malignant lymphoma in 1. The mean lymph node diameter was 21.3 ± 6.0 mm, and the inability to obtain the correct diagnosis was significantly smaller than obtaining the correct diagnosis. (17.5 ± 3.7 vs 22.9 ± 5.1 mm, p < 0.0001). In regard to the location of the lymph nodes, "lower paratrachea" and " subcarinal" were common, but was not chief concern with the diagnostic rate. Futhermore, the diagnostic rate was 91% (42 of 46) in lung cancer and 70% (7 of 10) in sarcoidosis. We could not perform EBUS-TBNA because of "small lymphnode" and "high risk of vascular damage" in addition to "insufficient patient\u27s sedation". No severe adverse events had occurred. EBUS-TBNA is useful for the thoracic lymph node lesion diagnosis