Effectiveness of cladribine therapy in patients with pulmonary Langerhans cell histiocytosis.

BackgroundPulmonary Langerhans cell histiocytosis (PLCH) is a rare disorder characterised by granulomatous proliferation of CD1a-positive histiocytes forming granulomas within lung parenchyma, in strong association with tobacco smoking, and which may result in chronic respiratory failure. Smoking cessation is considered to be critical in management, but has variable effects on outcome. No drug therapy has been validated. Cladribine (chlorodeoxyadenosine, 2-CDA) down-regulates histiocyte proliferation and has been successful in curbing multi-system Langerhans cell histiocytosis and isolated PLCH.Methods and patientsWe retrospectively studied 5 patients (aged 37¿55 years, 3 females) with PLCH who received 3 to 4 courses of cladribine therapy as a single agent (0.1 mg/kg per day for 5 consecutive days at monthly intervals). One patient was treated twice because of relapse at 1 year. Progressive pulmonary disease with obstructive ventilatory pattern despite smoking cessation and/or corticosteroid therapy were indications for treatment. Patients were administered oral trimethoprim/sulfamethoxazole and valaciclovir to prevent opportunistic infections. They gave written consent to receive off-label cladribine in the absence of validated treatment.ResultsFunctional class dyspnea improved with cladribine therapy in 4 out of 5 cases, and forced expiratory volume in 1 second (FEV1) increased in all cases by a mean of 387 ml (100¿920 ml), contrasting with a steady decline prior to treatment. Chest high-resolution computed tomography (HRCT) features improved with cladribine therapy in 4 patients. Hemodynamic improvement was observed in 1 patient with pre-capillary pulmonary hypertension. The results suggested a greater treatment effect in subjects with nodular lung lesions and/or thick-walled cysts on chest HRCT, with diffuse hypermetabolism of lung lesions on positron emission tomography (PET)-scan, and with progressive disease despite smoking cessation. Infectious pneumonia developed in 1 patient, with later grade 4 neutrocytopenia but without infection.DiscussionData interpretation was limited by the retrospective, uncontrolled study design and small sample size.ConclusionCladribine as a single agent may be effective therapy in patients with progressive PLCH.

AḤVĀL-i MAWT-i ḤUSAYN-‛ALĪ HĀN VA AḤVĀL-i MAWT-i PISAR

Poème masnavī compose de deux parties, l’histoire (qiṣṣa) de la chute, puis de la mort, du vizir Sayyid ‛Alī Hān (f. 7v- 59), assassiné le 9 octobre 1720 et remplacé par Muḥ. Amīn Hān I‛timād al-Dawla. Cette partie compte 919 bayt. La seconde (f. 61- 102v) en compte 763 et raconte les circonstances de la mort de Lāla Laliyān Mal, fils de l’auteur (f. 62), survenue dix mois après, alors qu’il avait 30 ans, et les campagnes militaires de cette période. Cette qiṣṣ̣a aurait été rédigée vers 1723 (f. 102).Une préface en prose (dībāča), rédigée (f. 5v) par Zōrāvar Singh [comparer à Supplément persan 247] occupe les f. 1v à 6v. Celui-ci indique qu’il édita, après sa mort l’œuvre du poète Rāy Kirpārām (f. 3v), et dédie cette édition (f. 2v) au moghol Abū l-Fatḥ Nāṣir al-Dīn Muḥ. Šāh (m. en 1161H./1748). Ce serait Rāy Kirpārām l’auteur des deux qiṣṣa.

Théâtre itinéraire de la Guerre actuelle entre les Turcs, d'une part, les Russes et les Impériaux, d'autre part : carte relative aussi au partage éventuel d'une partie de l'Empire Othoman / par M[onsieur Louis] Brion de la Tour, Ing[énieu]r Géographe du Roi

Échelle(s) : [1:3 400 000 ca] Échelle de Lieues d'une heure, ou de 20 au Degré 80 = [10,4 cm] (d'après échelles graphiques).

Théâtre itinéraire de la Guerre actuelle entre les Turcs, d'une part, les Russes et les Impériaux, d'autre part : carte relative aussi au partage éventuel d'une partie de l'Empire Othoman / par M[onsieur Louis] Brion de la Tour, Ing[énieu]r Géographe du Roi

Échelle(s) : [1:3 400 000 ca] Échelle de Lieues d'une heure, ou de 20 au Degré 80 = [10,4 cm] (d'après échelles graphiques).

Carte statistique de la France électorale : (Chambre de 1839) / par A. Frère de Montizon ; Dédiée à M.Mrs les électeurs

Échelle(s) : [ca 1:2 145 000]

Blood pressure and low-density lipoprotein-cholesterol lowering for prevention of strokes and cognitive decline: a review of available trial evidence.

BACKGROUND AND OBJECTIVES: It is well established by a large number of randomized controlled trials that lowering blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) by drugs are powerful means to reduce stroke incidence, but the optimal BP and LDL-C levels to be achieved are largely uncertain. Concerning BP targets, two hypotheses are being confronted: first, the lower the BP, the better the treatment outcome, and second, the hypothesis that too low BP values are accompanied by a lower benefit and even higher risk. It is also unknown whether BP lowering and LDL-C lowering have additive beneficial effects for the primary and secondary prevention of stroke, and whether these treatments can prevent cognitive decline after stroke. RESULTS: A review of existing data from randomized controlled trials confirms that solid evidence on optimal BP and LDL-C targets is missing, possible interactions between BP and LDL-C lowering treatments have never been directly investigated, and evidence in favour of a beneficial effect of BP or LDL-C lowering on cognitive decline is, at best, very weak. CONCLUSION: A new, large randomized controlled trial is needed to determine the optimal level of BP and LDL-C for the prevention of recurrent stroke and cognitive decline.