Kimura disease is characterized by painless subcutaneous masses, usually in the head and neck area as well as serum/tissue eosinophilia and elevated serum IgE levels. Various treatment methods, such as surgical excision, corticosteroids, and radiotherapy, have been suggested, but none of these are considered standard therapy due to high recurrence rates. Dupilumab is a human monoclonal antibody that binds to the alpha subunit of IL-4 receptor for IL-4 and IL-13 and inhibits T helper 2 (Th2) response, which plays an important role in the pathogenesis of allergic diseases, such as atopic dermatitis, asthma, and nasal polyps. Kimura disease has also been shown to increase CD4+Th2 cells and Th2 cytokines. We report a case of a 12-year-old boy who had subcutaneous neck and orbital masses of Kimura disease concurrent with allergic rhinitis, decreased lung function, and IgG subclass deficiency. The masses did not improve with omalizumab or immunomodulatory agents, but resolved with dupilumab. Considering potential side effects of steroids or immunosuppressant agents, dupilumab may be an option for initial treatment with Kimura diseases in children.

The stems of Oplopanax elatus (OE) have long been used to treat inflammatory disorders in herbal medicine, and in the previous investigation, OE was found to possess anti-inflammatory activity in lipopolysaccharide-treated macrophages, RAW 264.7 cell. OE reduces inducible nitric oxide (NO) synthase-induced NO production, and interferes with mitogen-activated protein kinase activation pathways. In the present study, the pharmacological action of the water extract of OE was examined to establish anti-arthritic action, using a rat model of adjuvant-induced arthritis (AIA). The water extract of OE administered orally inhibited AIA-induced arthritis at (100 – 300) mg/kg/day. The paw edema was significantly decreased, in combination with reduced production of pro-inflammatory cytokines. The action mechanism includes an inhibition of MAPKs/nuclear transcription factor-κB activation. These new findings strongly suggest that OE possesses anti-arthritic action, and may be used as a therapeutic agent in inflammation-related disorders, particularly in arthritic condition.
Animals ; Arthritis ; Arthritis, Rheumatoid ; Cytokines ; Edema ; Herbal Medicine ; Macrophages ; Models, Animal ; Nitric Oxide ; Oplopanax ; Protein Kinases ; Rats ; RAW 264.7 Cells ; Water

BACKGROUND AND OBJECTIVES: Implantable cardioverter–defibrillators (ICDs) are indicated in patients with Brugada syndrome (BS), early repolarization syndrome (ERS), or idiopathic ventricular fibrillation (IVF) who are at high risk for sudden cardiac death. The optimal ICD programming for reducing inappropriate shocks in these patients remains to be determined. We investigated the difference in the mean cycle length of tachyarrhythmias that activated either appropriate or inappropriate ICD shocks in these three patient groups to determine the optimal ventricular fibrillation (VF) zone for minimizing inappropriate ICD shocks. SUBJECTS AND METHODS: We selected 41 patients (35 men) (mean age±standard deviation=42.6±13.0 year) who received ICD shocks between April 1996 and April 2014 to treat BS (n=24), ERS (n=9), or IVF (n=8). Clinical and ICD interrogation data were retrospectively collected and analyzed for all events with ICD shocks. RESULTS: Of the 244 episodes, 180 (73.8%) shocks were appropriate and 64 (26.2%) were inappropriate. The mean cycle lengths of the tachyarrhythmias that activated appropriate and inappropriate shocks were 178.9±28.7 ms and 284.8±24.4 ms, respectively (p<0.001). The cutoff value with the highest sensitivity and specificity for discriminating between appropriate and inappropriate shocks was 235 ms (sensitivity, 98.4%; specificity, 95.6%). When we programmed a single VF zone of ≤270 ms, inappropriate ICD shocks were reduced by 70.5% and appropriate shocks were missed in 1.7% of these patients. CONCLUSION: Programming of a single VF zone of ≤270 ms in patients with BS, ERS, or IVF could reduce inappropriate ICD shocks, with a low risk of missing appropriate shocks.
Brugada Syndrome* ; Death, Sudden, Cardiac ; Defibrillators* ; Humans ; Retrospective Studies ; Sensitivity and Specificity ; Shock* ; Tachycardia* ; Ventricular Fibrillation*

A hiccup is caused by involuntary, intermittent, and spasmodic contractions of the diaphragm and intercostal muscles. It starts with a sudden inspiration and ends with an abrupt closure of the glottis. Even though a hiccup is thought to develop through the hiccup reflex arc, its exact pathophysiology is still unclear. The etiologies include gastrointestinal disorders, respiratory abnormalities, psychogenic factors, toxic-metabolic disorders, central nervous system dysfunctions and irritation of the vagus and phrenic nerves. Most benign hiccups can be controlled by traditional empirical therapy such as breath holding and swallowing water. However, though rare, a persistent hiccup longer than 48 hours can lead to significant adverse effects including malnutrition, dehydration, insomnia, electrolyte imbalance, and cardiac arrhythmia. An intractable hiccup can sometimes even cause death. We herein describe a patient with non-small cell lung cancer who was severely distressed by a persistent hiccup.
Arrhythmias, Cardiac ; Breath Holding ; Carcinoma, Non-Small-Cell Lung ; Central Nervous System ; Chlorpromazine ; Contracts ; Deglutition ; Dehydration ; Diaphragm ; Glottis ; Hiccup ; Humans ; Intercostal Muscles ; Lung Neoplasms ; Malnutrition ; Phrenic Nerve ; Reflex ; Sleep Initiation and Maintenance Disorders ; Water

Medtronic CapSureFix MRI 5086 pacing lead (5086; Medtronic, Inc., Minneapolis, MN, USA) has been reported to be associated with increased cardiac perforation and lead dislodgement. This study aimed to compare the incidence of cardiac perforation and lead dislodgement within 30 days after pacemaker implantation between 5086 MRI lead and previous Medtronic CapSureFix Novus 5076 non-MRI pacing lead. This was a nationwide, multicenter retrospective study in which we compared the incidence of adverse events between 277 patients implanted with 5086 lead and 205 patients implanted with 5076 lead between March 2009 and September 2014. Cardiac perforation within 30 days of pacemaker implantation occurred in 4 patients (1.4%) with the 5086 lead and in no patient with the 5076 lead (P = 0.084). Lead dislodgement occurred in 8 patients (2.9%) with the 5086 lead and in 5 patients (2.4%) with the 5076 lead (P = 0.764). On multivariate logistic regression analysis, age was significantly associated with cardiac perforation. Congestive heart failure and implantation of right atrial (RA) lead at RA free wall or septum were significant factors for the incidence of lead dislodgement and lead revision. The incidence of cardiac perforation and lead dislodgement were not statistically different between the patients with 5086 lead and the patients with 5076 lead. However, careful attention for cardiac perforation may be needed when using the 5086 MRI lead, especially in elderly patients.
Aged ; Heart Failure ; Humans ; Incidence ; Logistic Models ; Magnetic Resonance Imaging ; Retrospective Studies

BACKGROUND AND OBJECTIVES: Atrial fibrillation (AF) occurs frequently after successful radiofrequency ablation (RFA) of cavotricuspid isthmus-dependent atrial flutter (CTI-AFL). Renal impairment has been implicated in the development of AF. The purpose of this study is to clarify the impact of impaired renal function on the incidence of AF after RFA of CTI-AFL. SUBJECTS AND METHODS: Between January 2001 and December 2013, 240 non-dialysis patients with no prior history of AF {mean age 55.9+/-15.2 years old; male, 192 (80.0%)} who had undergone successful CTI-AFL ablation were included in the present study. The baseline estimated glomerular filtration rate was calculated, and patients were divided into those with impaired renal function (<60 mL/min/1.73 m2) and those with preserved renal function (> or = 60 mL/min/1.73 m2). The incidence of AF was retrospectively analyzed. RESULTS: 69 (28.8%) patients experienced new onset AF during a median follow-up duration of 26 months (inter-quartile, 7-53). The incidence of AF was significantly higher in patients with impaired renal function than in those with preserved renal function {13/25 (52.0%) versus 56/215 (26.0%), log rank p=0.019}. Age, CHADS2 score, impaired renal function, and left atrial diameter were significantly associated with the incidence of AF in univariate Cox regression analysis. Multivariate analysis showed that age was the only significant predictor of AF incidence (hazard ratio, 1.024; 95% confidence interval, 1.004-1.044, p=0.020). CONCLUSION: Patients with impaired renal function may require careful attention for the incidence of new onset AF following successful RFA of CTI-AFL.
Atrial Fibrillation* ; Atrial Flutter* ; Catheter Ablation* ; Follow-Up Studies ; Glomerular Filtration Rate ; Humans ; Incidence* ; Male ; Multivariate Analysis ; Renal Insufficiency ; Retrospective Studies

Glucose is essential for testicular function; the uptake of carbohydrate-derived glucose by cells is mediated by glucose transporters (GLUTs). In the present study, we investigated the activity of GLUT1 and GLUT3, the two main isoforms of GLUTs found in testes, in the left scrotal and right abdominal testes of a German Shepherd dog. Immunohistochemical analysis showed that GLUT1 immunoreactivity was absent in the scrotal and abdominal testes. In contrast, weak to moderate GLUT3 immunoreactivity was observed in mature spermatocytes as well as spermatids in the scrotal testis. In the abdominal testis, relatively strong GLUT3 immunoreactivity was detected in Leydig cells only and was absent in mature spermatocytes and spermatids. GLUT3 immunoreactivity was significantly decreased in the tubular region of abdominal testis and significantly increased in the extra-tubular (interstitial) region of abdominal testis compared to observations in the each region of scrotal testis, respectively. These results suggest that GLUT3 is the major glucose transporter in the testes and that abdominal testes may increase the uptake of glucose into interstitial areas, leading to an increased risk of developing cancer.
Animals ; Cryptorchidism ; Dogs* ; Glucose Transport Proteins, Facilitative* ; Glucose* ; Leydig Cells ; Male ; Protein Isoforms ; Spermatids ; Spermatocytes ; Testis*