Masafumi Arima

Tofacitinib for refractory interstitial lung diseases in anti-melanoma differentiation-associated 5 gene antibody-positive dermatomyositis

Objective We aimed to determine the outcome of combination therapy with tofacitinib (TOF) in a case series of refractory rapidly progressive interstitial lung disease (ILD) associated with anti-melanoma differentiation-associated 5 gene (MDA5) antibody-positive (Ab+) DM. Patients who had poor prognostic factors and failed to respond to immunosuppressive therapy were selected for TOF treatment. Methods Five patients with anti-MDA5 Ab+ DM-ILD who failed to respond to triple therapy with high dose glucocorticoids, CSA and CYC were given additional TOF (10 mg/day). To identify the poor prognostic factors, data from 15 consecutive patients (seven survived and eight died) with anti-MDA5 Ab+ DM-ILD before induction of TOF were analysed. Results Three poor prognostic factors were identified: serum ferritin level >1000 ng/ml before therapy; ground-glass opacities in all six lung fields before therapy; and worsening of pulmonary infiltrates during therapy. All six patients who had all of the three factors and received triple therapy died before TOF therapy. There were five patients who had all of the three prognostic factors and failed to respond to triple therapy, but were able to receive the combination therapy with TOF; among them, three survived and two died. The survival rate of patients who received TOF was significantly better than that of the historical controls with immunosuppressive therapy before TOF. The patients who received TOF experienced complicated adverse events, particularly viral infection. Conclusion Combination therapy with TOF might have the potential to control refractory anti-MDA5 Ab+ DM-ILD.

Molecular biological analysis in a patient with multiple lung adenocarcinomas: Molecular analysis in lung ADC

The utility of molecular biological analysis in lung adenocarcinoma has been demonstrated. Herein we report a rare case presenting as multiple lung adenocarcinomas with four different EGFR gene mutations detected in three lung tumors. After opacification was detected by routine chest X‐ray, the patient, a 64‐year‐old woman, underwent chest computed tomography which revealed a right lung segment S4 ground‐glass nodule (GGN). Follow‐up computed tomography revealed a 42 mm GGN nodule with a 26 mm nodule (S6) and a 20 mm GGN (S10). Histopathology of resected specimens from the right middle and lower lobes revealed all three nodules were adenocarcinomas. Four EGFR mutations were detected; no three tumors had the same mutations. Molecular biological analysis is a promising tool for the diagnosis of primary tumors in patients with multiple lung carcinomas of the same histotype, enabling appropriate treatment.

Survey on the proper use of an adrenaline auto-injector in 551 Japanese outdoor workers after Hymenoptera stings

Sex Men 1179 (96.6) Women 29 (2.4) Unknown 12 (1.0) Age (years) 10e19 13 (1.1) 20e29 125 (10.2) 30e39 307 (25.2) 40e49 320 (26.2) 50e59 250 (20.5) 60e69 174 (14.3) 70 27 (2.2) Unknown 4 (0.3) Questionnaire 1: A Hymenoptera sting after prescription of an adrenaline autoinjector Yes 551 (45.2) No 662 (54.3) Unknown 7 (0.6) 2: Systemic reaction after a Hymenoptera stingy Yes 65 (11.8) No 475 (86.2) Unknown 11 (2.0) 3: Use of an adrenaline auto-injector after a Hymenoptera stingy Yes 46 (8.3) No 503 (91.3) Unknown 2 (0.4) 4: Hospital visit immediately after use of an adrenaline auto-injectorz Yes 39 (84.8) No 6 (13.0) Unknown 1 (2.2) 5: Re-prescription of an adrenaline auto-injector Yes 701 (57.5) No 146 (12.0) First prescription, before expiration day 356 (29.2)