Combination of panobinostat with ponatinib synergistically overcomes imatinib-resistant CML cells

The major mechanism of imatinib (IM) resistance of CML is the reactivation of ABL kinase either through BCR-ABL gene amplification or mutation. We investigated the cytotoxicity of a pan-ABL tyrosine kinase inhibitor, ponatinib, and a pan-histone deacetylase inhibitor, panobinostat, against IM-resistant CML cells in vitro. Two different IM-resistant cell lines, K562/IM-R1 and Ba/F3/T315I were evaluated in comparison with their respective, parental cell lines, K562 and Ba/F3. K562/IM-R1 overexpressed BCR-ABL due to gene amplification. Ba/F3/T315I was transfected with a BCR-ABL gene encoding T315I-mutated BCR-ABL. Ponatinib inhibited the growth of both K562/IM-R1 and Ba/F3/T315I as potently as it inhibited their parental cells with an IC50 of 2-30 nM. Panobinostat also similarly inhibited the growth of all of the cell lines with an IC50 of 40-51 nM. This was accompanied by reduced histone deacetylase activity, induced histone H3 acetylation, and an increased protein level of heat shock protein 70, which suggested disruption of heat shock protein 90 chaperone function for BCR-ABL and its degradation. Importantly, the combination of ponatinib with panobinostat showed synergistic growth inhibition and induced a higher level of apoptosis than the sum of the apoptosis induced by each agent alone in all of the cell lines. Ponatinib inhibited phosphorylation not only of BCR-ABL but also of downstream signal transducer and activator of transcription 5, protein kinase B, and ERK1/2 in both K562/IM-R1 and Ba/F3/T315I, and the addition of panobinostat to ponatinib further inhibited these phosphorylations. In conclusion, panobinostat enhanced the cytotoxicity of ponatinib towards IM-resistant CML cells including those with T315I-mutated BCR-ABL

Mediastinal Tracheostoma for Treatment of Tracheostenosis after Tracheostomy in a Patient with Mucopolysaccharidosis-Induced Tracheomalacia

Background. Treatment of tracheostenosis after tracheostomy in pediatric patients is often difficult. Mucopolysaccharidosis is a lysosomal storage disease that may induce obstruction of the airways. Case Presentation. A 16-year-old male patient underwent long-term follow-up after postnatal diagnosis of type II mucopolysaccharidosis. At 11 years of age, tracheostomy was performed for mucopolysaccharidosis-induced laryngeal stenosis. One week prior to presentation, he was admitted to another hospital on an emergency basis for major dyspnea. He was diagnosed with tracheostenosis caused by granulation. The patient was then referred to our institution. The peripheral view of his airway was difficult because of mucopolysaccharidosis-induced tracheomalacia. For airway management, a mediastinal tracheostoma was created with extracorporeal membrane oxygenation. To maintain the blood flow, the skin incision for the mediastinal tracheal hole was sharply cut without an electrotome. The postoperative course was uneventful, and the patient was weaned from the ventilator on postoperative day 19. He was discharged 1.5 months postoperatively. Although he was referred to another institution because of respiratory failure caused by his primary disease 6 months postoperatively, his airway management remained successful for 1.5 years postoperatively. Conclusion. Mediastinal tracheostomy was useful for treatment of tracheostenosis caused by granulation tissue formation after a tracheostomy

Matrix-Assisted Laser Desorption/Ionization Imaging Mass Spectrometry

Matrix-assisted laser desorption/ionization mass spectrometry (MALDI-MS) is a powerful tool that enables the simultaneous detection and identification of biomolecules in analytes. MALDI-imaging mass spectrometry (MALDI-IMS) is a two-dimensional MALDI-mass spectrometric technique used to visualize the spatial distribution of biomolecules without extraction, purification, separation, or labeling of biological samples. MALDI-IMS has revealed the characteristic distribution of several biomolecules, including proteins, peptides, amino acids, lipids, carbohydrates, and nucleotides, in various tissues. The versatility of MALDI-IMS has opened a new frontier in several fields such as medicine, agriculture, biology, pharmacology, and pathology. MALDI-IMS has a great potential for discovery of unknown biomarkers. In this review, we describe the methodology and applications of MALDI-IMS for biological samples

Internal Radiation Exposure Dose in Iwaki City, Fukushima Prefecture after the Accident at Fukushima Dai-ichi Nuclear Power Plant

As a result of the accident at the Fukushima Daiichi Nuclear Power Plant (FNPP) on 11 March 2011, a huge amount of radionuclides, including radiocesium, was released and spread over a wide area of eastern Japan. Although three years have passed since the accident, residents around the FNPP are anxious about internal radiation exposure due to radiocesium. In this study, we screened internal radiation exposure doses in Iwaki city of Fukushima prefecture, using a whole-body counter. The first screening was conducted from October 2012 to February 2013, and the second screening was conducted from May to November 2013. Study participants were employees of ALPINE and their families who underwent examination. A total of 2,839 participants (1,366 men and 1,473 women, 1-86 years old) underwent the first screening, and 2,092 (1,022 men and 1,070 women, 1-86 years old) underwent the second screening. The results showed that 99% of subjects registered below 300 Bq per body in the first screening, and all subjects registered below 300 Bq per body in the second screening. The committed effective dose ranged from 0.01-0.06 mSv in the first screening and 0.01-0.02 mSv in the second screening. Long-term follow-up studies are needed to avoid unnecessary chronic internal exposure and to reduce anxiety among the residents by communicating radiation health risks

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension

The evaluation of the class about pediatric CPR for parents of patients in NICU

当院NICUでは家庭での事故や緊急時に対応できる教育が必要であると考え,入院した子どもの家族を対象に救急蘇生教室を実施している.本研究の目的は,教室参加者の特徴を知ること,教室前の子どもの心肺蘇生法に関する理解の実態を知ること,教室後のアンケート調査における参加者の反応から,救急蘇生教室の今後の課題を見出すことである.救急蘇生教室では研究グループの医師と看護師が小児に起こりやすい事故と対策,心肺蘇生法の手技の知識を提供し,人形を用いた実技講習を行っている.研究対象は2001年9月～2002年4月に入院した子どもを持つ144家族とした.その中で参加希望のあった42家族(29%)に同意を得,アンケート(回収率100%)を行った.診療録をもとに家族背景について検討し,またアンケート結果から項目毎に集計を行い,またχ2検定及び同等性の検定を用い,以下の結果が得られた.1)低出生体重児で入院日数が28日以上の子どもを持つ家族の参加が多かった.2)参加した母親の年齢,母児同室の有無,育児協力者の有無に有意差は無かった.3)参加前の心肺蘇生に関する知識は少なかった.4)参加者の多くが心肺蘇生法の必要性を重視していた.5)教室後再参加を希望する家族が多かった.小児の心肺蘇生手技習得の場は少なく我々小児医療に携わるものが,教育の場を提供していく必要がある.今後,教室の受講対象を広げた上で充実した教室運営と退院後も繰り返し受訴できるようなシステムづくりが今後の課題である.Our hospital periodically hold the meetings with staff and parents of the patients hospitalized in NICU. Parents learned the risk of domestic accidents in infants including SIDS and practiced pediatric CPR simulations. The Questionnaire revealed that they had little knowledge about pediatric CPR and wanted another opportunity of the meeting