Clinical lung transplantation in Japan: Current status and future trends

The first successful lung transplantation (LTx) was performed in 1983. Since then, more than 10 000 LTx have been performed in the world, with approximately 1000 new cases each year in recent years. Lung transplantation is established as the ultimate treatment for end-stage pulmonary diseases. Clinical application of LTx was delayed in Japan because of difficulty in acceptance of brain death. The Japanese Brain Death Act (JBDA) for organ transplantation was enforced in October 1997. Now, LTx from a brain-dead cadaver donor (BDCD) becomes a clinical option for end-stage lung diseases in this country. Four LTx centers were selected and the registration of candidates for LTx started in August 1998. In total, up until May 2001, 51 patients had been registered on a waiting list. Patients’ diseases for LTx in Japan are different from those in the US and Europe. So far, primary pulmonary hypertension (PPH; n = 23), idiopathic pulmonary fibrosis/interstitial pneumonia (IPF/IIP; n = 8), lymph- angioleiomyomatosis (LAM; n = 7) and bronchiectasis (BE; n = 6) are the major indications for LTx in Japan. Fourteen patients (27%) have died while waiting for LTx and only eight patients (14%) have received lung allografts. The BDCD are quite precious and, thus far, only 13 donors have become available after enforcement of the JBDA. Although the average utilization of BDCD for LTx was reported to be only 10–20%, positive utility of marginal donors in Japan has led to a higher rate (five of 13; 36%). Six LTx were performed from five BDCD. These included five single LTx (LAM n = 3; IPF/IIP n = 2) and one bilateral LTx (PPH n = 1). Because there are few BDCD in Japan, living-donor lobar LTx (LDLTx) is thought to be the optimal choice for selected patients. Eight LDLTx (BE n = 2; bronchiolitis obliterans n = 2; IPF/IIP n = 2; LAM n = 1; and PPH n = 1) have been performed. All recipients who received a LTx in Japan are alive and doing well at present.     

SERMs: current status and future trends

Selective estrogen receptor modulators, or SERMs, are a class of compounds that can act as estrogen receptor (ER) agonists in some tissues while acting as ER antagonists in others. SERMs are being evaluated and used to treat and prevent such diseases as breast cancer, osteoporosis, and cardiovascular disease. Currently, three primary SERMs are used clinically, which include tamoxifen, toremifene (triphenylethylenes), and raloxifene (a benzothiophene). Tamoxifen and toremifene have beneficial effects on bone and serum lipids, and are currently used to treat breast cancer. Both have stimulatory effects on the uterus. Raloxifene, indicated for the treatment and prevention of osteoporosis, also has beneficial effects on bone and serum lipids, but does not stimulate the uterus. All three are associated with venous thromboembolism and hot flashes. New SERMs to treat and prevent breast cancer, osteoporosis, and cardiovascular disease are undergoing clinical development, including idoxifene, droloxifene, ospemifene, lasofoxifene, arzoxifene, and MDL 103,323.     

Machine learning applications in the diagnosis of leukemia: Current trends and future directions

Machine learning (ML) offers opportunities to advance pathological diagnosis, especially with increasing trends in digitalizing microscopic images. Diagnosing leukemia is time‐consuming and challenging in many areas globally and there is a growing trend in utilizing ML techniques for its diagnosis. In this review, we aimed to describe the literature of ML utilization in the diagnosis of the four common types of leukemia: acute lymphocytic leukemia (ALL), chronic lymphocytic leukemia (CLL), acute myeloid leukemia (AML), and chronic myelogenous leukemia (CML). Using a strict selection criterion, utilizing MeSH terminology and Boolean logic, an electronic search of MEDLINE and IEEE Xplore Digital Library was performed. The electronic search was complemented by handsearching of references of related studies and the top results of Google Scholar. The full texts of 58 articles were reviewed, out of which, 22 studies were included. The number of studies discussing ALL, AML, CLL, and CML was 12, 8, 3, and 1, respectively. No studies were prospectively applying algorithms in real‐world scenarios. Majority of studies had small and homogenous samples and used supervised learning for classification tasks. 91% of the studies were performed after 2010, and 74% of the included studies applied ML algorithms to microscopic diagnosis of leukemia. The included studies illustrated the need to develop the field of ML research, including the transformation from solely designing algorithms to practically applying them clinically.     

Vasculitis research: Current trends and future perspectives

We discuss recent and prospective research in small and large vessel vasculitis. Large cohorts of Takayasu arteritis (TA) have been recently published from across the world, clarifying our understanding of this uncommon disease. Novel open‐ended approaches like large‐scale genotyping, proteomics and metabolomics have helped gain novel insights into TA, giant cell arteritis (GCA) and anti‐neutrophil cytoplasmic antibody‐associated vasculitis (AAV). Recent advances in the imaging of TA and GCA offer promise for earlier diagnosis and better monitoring of response to therapy. Although two randomized controlled trials of abatacept and tocilizumab failed to meet their primary end‐points, successful large‐scale studies of abatacept and tocilizumab in GCA hold promise for better disease control. While cyclophosphamide has revolutionized the management of AAV, increasing use of rituximab as an alternative induction regimen, as well as use of novel approaches involving reduced or no corticosteroid use for AAV and alternative agents such as avacopan (a complement 5a receptor antagonist) hold promise for lesser toxic induction regimens in the future. Increasingly, the risk of cardiovascular events and comorbidities such as osteoporosis are being recognized as factors affecting long‐term prospects of patients with vasculitis. There is a shift in emphasis to utilize patient‐reported outcomes to more accurately gauge the impact of vasculitides and their treatment.     

Current status of schistosomiasis in Indonesia

Schistosomiasis japonica is currently endemic in three very isolated areas in Central Sulawesi Province, Indonesia. Integrated schistosomiasis control programmes implemented in the Lindu and Napu Valleys during the period of 1982–2005 have successfully reduced the prevalence of schistosomiasis from 37% to 1% in Napu Valley and from 37% to 0.6% in Lindu Valley. Human prevalence surveys reveal that the prevalence tended to increase during the period of 2008–2011. The average prevalence fluctuated between 0.3% and 4.8% in Napu Valley and between 0.8% and 3.2% in Lindu Valley. During this period, the percentage of rats that were infected fluctuated between 7.9% and 18.2% in Napu Valley and between 6.7% and 9.8% in Lindu Valley. The average percentage of infected snails was 2.6% and 2.1% in the Napu and Lindu Valleys, respectively. In 2008, schistosomiasis was also found in a separate but adjacent place, i.e. Bada Valley. The prevalence of schistosomiasis in endemic villages in this area was 0.8% in 2008 and 5.9% in 2010, while the percentage of infected snails was 1% in 2010. These contemporary data clearly indicate a trend of increasing schistosomiasis prevalence in the three endemic areas in Central Sulawesi.     

诺如病毒实验室诊断现状与展望

诺如病毒是引起非细菌性急性胃肠炎的主要病因,常常引起严重的公共卫生与食品安全问题。诺如病毒基因组的多样性及其它们不断的进化和变异为临床诊断及疫苗研制带来了挑战。本文就诺如病毒实验室诊断方法的研究进展作一综述,包括从传统经典的核酸检测到应用纳米、芯片等高新技术的多重核酸定量检测和高通量测序平台,以及体外成功培养的报道等等。这些新技术的成功运用将推动诺如病毒实验室诊断的新发展,以满足临床诊疗及疫苗研制的新需求。     

Noninvasive diagnosis of periportal fibrosis in schistosomiasis mansoni: A comprehensive review

Schistosomiasis mansoni is a neglected disease and key public health problem, mainly due to its high prevalence, the scarcity of public policies, and the severity of some clinical forms. Periportal fibrosis (PPF) is the commonest complication of chronic schistosomiasis mansoni and its diagnosis requires different techniques. Even though wedge biopsy of the liver is considered the gold standard, it is not justified in non-surgical patients, and percutaneous liver biopsy may be informative but does not have sufficient sensitivity. Noninvasive PPF tests mostly include biological (serum biomarkers or combined scores) or physical assessments (imaging assessment of fibrosis pattern or tissue stiffness). Moreover, imaging techniques, such as ultrasound, computed tomography, magnetic resonance imaging, and elastography are applied not only to support the diagnosis of schistosomiasis, but also to assess and detect signs of portal hypertension and organ damage due to chronic schistosomiasis. A combination between a comprehensive history and physical examination with biomarkers for liver fibrosis and imaging methods seems to offer the best approach for evaluating these patients. In addition, understanding their strengths and limitations will allow a more accurate interpretation in the clinical context and can lead to greater accuracy in estimating the degree of fibrosis in patients with Schistosomiasis mansoni (S. mansoni) infection. This review will discuss the different noninvasive methods that are currently available for the evaluation of PPF in S. mansoni infection, and their application, advantages, and limitations in clinical practice.     

Glioblastoma in the elderly: Current and future trends

Data from a prospective trial large enough to provide a reliable analysis of outcome and prognostic factors in elderly patients with glioblastoma (GBM) are not yet available in the literature. Extensive tumor removal appears to offer patients the best possible chance of a speedy neurological recovery. Adequate radiotherapy (RT) should always be given to elderly patients if they have undergone gross total debulking and have maintained a good performance status. It is, however important to bear in mind that the risk of long-term cognitive impairment may be higher in patients on high-dose RT and that a short course of accelerated RT can achieve the same survival. Rather than being ruled out on principle, chemotherapy should be considered on the basis of an accurate assessment of the factors that might compromise the individual patient's tolerance to drugs administered. Temozolomide appears to be the best available chemotherapy in this population of patients.     

Islet transplantation: Current status and future directions

Pancreatic islet transplantation has gone a long way to finally enter the armamentarium of today’s clinicians for the battle against diabetes. The proof of principle has been made and current clinical islet transplant trials need to further refine this attractive treatment modality. We review the post-Edmonton era, the selection of islet transplant recipients, the production of islet grafts, and the need for immunosuppression and procedure-related risks. The success of islet transplantation and expansion of clinical trials with islet networks are also discussed.     

Liver bioengineering: Current status and future perspectives

The present review aims to illustrate the strategies that are being implemented to regenerate or bioengineer livers for clinical purposes. There are two general pathways to liver bioengineering and regeneration. The first consists of creating a supporting scaffold, either synthetically or by decellularization of human or animal organs, and seeding cells on the scaffold, where they will mature either in bioreactors or in vivo. This strategy seems to offer the quickest route to clinical translation, as demonstrated by the development of liver organoids from rodent livers which were repopulated with organ specific cells of animal and/or human origin. Liver bioengineering has potential for transplantation and for toxicity testing during preclinical drug development. The second possibility is to induce liver regeneration of dead or resected tissue by manipulating cell pathways. In fact, it is well known that the liver has peculiar regenerative potential which allows hepatocyte hyperplasia after amputation of liver volume. Infusion of autologous bone marrow cells, which aids in liver regeneration, into patients was shown to be safe and to improve their clinical condition, but the specific cells responsible for liver regeneration have not yet been determined and the underlying mechanisms remain largely unknown. A complete understanding of the cell pathways and dynamics and of the functioning of liver stem cell niche is necessary for the clinical translation of regenerative medicine strategies. As well, it will be crucial to elucidate the mechanisms through which cells interact with the extracellular matrix, and how this latter supports and drives cell fate.     

Automated differential leucocyte counting: Present status and future trends

Conclusion Finally, it must not be forgotten that the DLC is only one aspect of examination of the blood film. Morphological abnormalities of the erythrocytes or platelets, rouleaux, cryoglobulin deposits, even an unexpected finding of malaria parasites might point to the diagnosis and help solve an otherwise obscure problem. Indeed, perhaps the greatest value of performing a manual DLC is that it ensures that the blood film has been examined adequately to reveal morphological anomalies. It would be a retrograde step if automated procedures resulted in abandonment of blod film screening. Thus, whatever the future of the DLC and its automation, microscopic examination of the blood film by a qualified haematologist should remain as the basis of good haematological practice.     

Colon capsule endoscopy: Current status and future directions

Colon capsule endoscopy(CCE; Pill Cam Colon; Given Imaging; Yoqneam, Israel) is a minimally invasive wireless technique for the visualization of the colon. With the recent introduction of the second generation colon capsule the diagnostic accuracy of CCE for polyp detection has significantly improved and preliminary data suggest it may be useful to monitor mucosal inflammation in patients with inflammatory bowel disease. Limitations include the inability to take biopsies and the procedural costs. However, given the potentially higher acceptance within an average risk colorectal cancer(CRC) screening population, its usefulness as a screening tool with regard to CRC prevention should be further evaluated.     

肝纤维化实验室诊断现状及展望

以肝组织中细胞外基质(ECM)成分异常过度沉积为特征的肝纤维化是临床多种急、慢性肝病的常见病理转归。由于早期肝纤维化具有可逆转性,因此在这一阶段的诊断对整个疾病的进程和疗效至关重要。但目前肝纤维早期诊断仍是临床一大难题。回顾这一领域的发展,肝纤维化的诊断从辅助诊断如血液生化、超声、影像学检查及病理组织学检查到临床诊断包括 Child-Pough分级,病理组织学检查目前仍是诊断的金标准, 但鉴于组织学检查固有的缺陷如系损伤性检查、不能动态检测重复进行、存在取材差异等,非损伤性血液生化检测仍是临床实践中最为方便、最为经济并能重复进行的检查手段。理想的肝纤维化临床生化指标应符合以下标准。 1．具有肝组织特异性,与其它组织器官无明确相关性。 2．具有良好的检测敏感性以检测肝组织轻微的纤维化形成或纤维降解。 3．不仅可反映ECM成分的代谢转化,而且应能反映纤维化形成、纤维降解及ECM的沉积量。 4．具有明确的代谢半衰期及分泌排泄途径以便对血清中水平高低的变化作出合理的解释。     

Anal cancer treatment:Current status and future perspectives

Anal cancers(AC)are relatively rare tumors.Their incidence is increasing,particularly among men who have sex with other men due to widespread infection by human papilloma virus.The majority of anal cancers are squamous cell carcinomas,and they are treated according to stage.In local and locally advanced AC,concomitant chemoradiation therapy based on mitomycin C and 5-Fluorouracil(5-FU)is the current best treatment,while metastatic AC,chemotherapy with 5-FU and cisplatin remains the gold standard.There are no indications for induction or maintenance therapies in locally advanced tumors.Many novel strategies,such as targeted therapies,vaccination,immunotherapy and photodynamic therapy are in clinical trials for the treatment of AC,with promising results in some indications.     

血吸虫病监测现状及研究进展

血吸虫病是一种严重危害人民身体健康的人畜共患螺传寄生虫病。血吸虫病流行于亚洲、非洲及拉丁美洲76个国家和地区的广大农村,全世界有2亿人受其危害[1]。血吸虫病与其中间宿主钉螺的地理分布一致,有严格的地方性。我国血吸虫病流行区分布在长江流域及其以南的12个省、自治区、直辖市,在流行类型、流行程度上存在着较大差异。有计划、连续、系统地开展血吸虫病监测,不仅成为流行病学研究的内容,更是有效开展预防和控制血吸虫病工作的重要组成部分。国外文献无论是综合疾病监测还是单病种监测中有关血吸虫病的报道都极为少见。我国则在几十…     

Current status and future of lung transplantation

Lung transplantation has been performed successfully outside Japan since 1983 in patients with end-stage lung disease. More than 9,000 lung transplants have been reported in The Registry of the International Society for Heart and Lung Transplantation. In contrast, a transplant law became effective in Japan only recently, and four universities were designated as official lung transplant centers (Okayama, Osaka, Kyoto and Tohoku Universities). In October 1998, the first successful living-donor lobar lung transplantation was performed at Okayama University. Since then, seven lung transplants (four from living donors and three from cadaveric donors) have been successfully performed in Japan. Although lung transplantation offers acceptable prospects for 5-year survival, chronic rejection and donor shortage remain to be major problems. In an effort to address the donor shortage issue, living-donor lobar lung transplantations have been performed with satisfactory intermediate survival and functional results.