Laboratory medicine for blood transfusion and transplantation medicine

We discussed the usefulness of routine technologies of laboratory medicine in blood transfusion and transplantation medicine. New parameters that can be measured by automated hematology analyzers have been clinically evaluated and proven to be useful so far. Based on our experience, detection systems for fragmented red cells (FRC), immature platelets (immature platelet function, IPF), and hematopoietic progenitor cells (HPC) are useful for the diagnosis of thrombotic microangiopathy, differential diagnosis of thrombocytopenia, and decision regarding the optimal timing to collect peripheral stem cells, respectively. Moreover, IPF were suggested to be an indicator of the platelet transfusion requirement. The establishment of non invasive assaying technology has been eagerly anticipated. We evaluated a hemoglobin measurement tool, and revealed that it might be applicable in predeposited, autologous blood donation. Some adverse transfusion reactions are related to neutrophil activation. Thus, we investigated the effects of serum from patients and blood donors, in the context of adverse reactions, on adhesion molecule expressions of neutrophils from volunteers using flow-cytometry. This kind of simple technology is expected to be useful in future studies to clarify the mechanisms and prevent adverse reactions.     

Regulatory role of B-1 B cells in chronic colitis

According to the 'hygiene hypothesis', enhanced microbial exposure due to early childhood infections leads to a reduction of T(h)2-mediated allergic diseases and inflammatory bowel disease. To begin to elucidate the mechanisms underlying this hypothesis, we studied development of T(h)2-mediated colitis of the TCRalpha knockout (KO) mouse in both a specific pathogen-free (SPF) facility and a conventional (CV) facility. After more than five generations in each facility, TCRalpha KO mice kept in the CV facility developed dramatically less colitis than mice that were kept in the SPF facility. Surprisingly, the suppression of colitis in the CV facility correlated with a significant increase in natural IgM production by B-1 B cells. In contrast, B cell-deficient TCRalpha double-knockout (alphamu DKO) mice maintained in the CV facility continued to develop severe colitis, strongly suggesting that B-1 B cells contributed to the suppression of colitis. Indeed, the adoptive transfer of B-1 B cells isolated from the peritoneal cavity of TCRalpha KO mice (SPF) into alphamu DKO mice (CV) suppressed the development of colitis in the recipient mice. We conclude that B-1 cells play a regulatory role in T(h)2-mediated colitis under non-hygienic conditions, possibly by generating natural antibodies in response to microbial flora.     

Computer-aided diagnosis for the classification of focal liver lesions by use of contrast-enhanced ultrasonography

The authors developed a computer-aided diagnostic (CAD) scheme for classifying focal liver lesions (FLLs) as liver metastasis, hemangioma, and three histologic differentiation types of hepatocellular carcinoma (HCC), by use of microflow imaging (MFI) of contrast-enhanced ultrasonography. One hundred and three FLLs obtained from 97 cases used in this study consisted of 26 metastases (15 hyper- and 11 hypovascularity types), 16 hemangiomas (five hyper- and 11 hypovascularity types) and 61 HCCs: 24 well differentiated (w-HCC), 28 moderately differentiated (m-HCC), and nine poorly differentiated (p-HCC). Pathologies of all cases were determined based on biopsy or surgical specimens. Locations and contours of FLLs on contrast-enhanced images were determined manually by an experienced physician. MFI was obtained with contrast-enhanced low-mechanical-index (MI) pulse subtraction imaging at a fixed plane which included a distinctive cross section of the FLL. In MFI, the inflow high signals in the plane, which were due to the vascular patterns and the contrast agent, were accumulated following flash scanning with a high-MI ultrasound exposure. In the initial step of our computerized scheme, a series of the MFI images was extracted from the original cine clip (AVI format). We applied a smoothing filter and time-sequential running average techniques in order to reduce signal noise on the single MFI image and cyclic noise on the sequential MFI images, respectively. A kidney, vessels, and a liver parenchyma region were segmented automatically by use of the last image of a series of MFI images. The authors estimated time-intensity curves for an FLL by use of a series of the temporally averaged MFI images in order to determine temporal features such as estimated replenishment times at early and delayed phases, flow rates, and peak times. In addition, they extracted morphologic and gray-level image features which were determined based on the physicians' knowledge of the diagnosis of the FLL, such as the size of lesion, vascular patterns, and the presence of hypoechoic regions. They employed a cascade of six independent artificial neural networks (ANNs) by use of extracted temporal and image features for classifying five types of liver diseases. A total of 16 temporal and image features, which were selected from 43 initially extracted features, were used for six different ANNs for making decisions at each decision in the cascade. The ANNs were trained and tested with a leave-one-lesion-out test method. The classification accuracies for the 103 FLLs were 88.5% for metastasis, 93.8% for hemangioma, and 86.9% for all HCCs. In addition, the classification accuracies for histologic differentiation types of HCCs were 79.2% for w-HCC, 50.0% for m-HCC, and 77.8% for p-HCC. The CAD scheme for classifying FLLs by use of the MFI on contrast-enhanced ultrasonography has the potential to improve the diagnostic accuracy in the histologic diagnosis of HCCs and the other liver diseases.     

Identification of a conduction gap of the mitral isthmus by using a novel high-density mapping catheter

Peri-mitral atrial flutter, which is a type of macroreentrant atrial tachycardia circulating around the mitral annulus, was terminated with the guidance of the high-density mapping catheter. A 72-year-old woman with atrial fibrillation and atrial tachycardia presented with symptoms of congestive heart failure. The recurrent peri-mitral atrial flutter following the initial catheter ablation for atrial tachycardia and atrial fibrillation was terminated by radiofrequency application on the gap that was identified using a novel high-density mapping catheter.     

Fos protein-like immunoreactive neurons induced by electrical stimulation in the trigeminal sensory nuclear complex of rats with chronically injured peripheral nerve

Simple movements can be seen as building blocks for complex action sequences, and neural control of an action sequence can be expected to preserve some control features of its constituent blocks. It was previously found that during single-joint elbow movements to a single target, the proprioceptive feedback control is initially suppressed, and we tested this feedback suppression in a two-segment sequence during which subjects momentarily slowed down at an intermediate target at a 30° distance (first segment) and then immediately moved another 30° to the final target (second segment). Either the first or second segment was unexpectedly perturbed; the latency of the earliest response to the perturbation in the muscle surface electromyogram was analyzed. The perturbations were delivered either at the onset of each segment or about 0.1 s later. We found that in both segments, the response latency to the late perturbation was shorter than the latency to the early perturbation, which suggests that the proprioceptive feedback control is suppressed in the beginning of each segment. Next, we determined the latency of the response to unexpected perturbations in 30° movements to a single target. We found that the response latency was not significantly different in the movement to a single target and in each segment in the sequence. This result suggests that the initial suppression of the proprioceptive feedback control in movements to single targets is preserved in movements through intermediate targets and supports the idea of modular organization of neural control of movement sequences.     

Segmental pedicle screw fixation for a scoliosis patient with post-laminectomy and post-irradiation thoracic kyphoscoliosis of spinal astrocytoma

Spinal deformity is an important clinical manifestation after surgery for spinal cord tumors. One-third of patients who receive laminectomies and irradiation of the spinal column develop scoliosis, kyphosis, or kyphoscoliosis. Recent reports indicate good results after scoliosis surgery using segmental pedicle screws and a navigation system, but these reported studies have not included surgery for post-laminectomy kyphosis. Hooks and wires are ineffective in such patients who undergo laminectomy, and there are also high perioperative risks with insertion of pedicle screws because landmarks have been lost. Here, we report on the 5-year follow-up of a 13-year-old male patient with post-laminectomy and post-irradiation thoracic kyphoscoliosis after surgical treatment of spinal astrocytoma. Posterior segmental pedicle screw fixation was performed safely using a computer-assisted technique. The authors present the first case report for treatment of this condition using a navigation system.     

Calculation methods for ventricular diffusion-weighted imaging thermometry: phantom and volunteer studies

A method for the measurement of temperature in the lateral ventricle using diffusion‐weighted imaging (DWI) has been proposed recently. This method uses predetermined arbitrary thresholds, but a more objective method of calculation would be useful. We therefore compared four different calculation methods, two of which were newly created and did not require predetermined thresholds. A rectangular polyethylene terephthalate bottle (8 × 10 × 28 cm³) was filled with heated water (35.0–38.8 °C) and used as a water phantom. The DWI data of 23 healthy subjects (aged 26–75 years; mean ± standard deviation, 50.13 ± 19.1 years) were used for this study. The temperature was calculated using the following equation: T(°C) = 2256.74/ln(4.39221/D) ? 273.15, where D is the diffusion coefficient. The mean ventricular temperature was calculated by four methods: two thresholding methods and two histogram curve‐fitting methods. As a reference, we used the temperature measured at the tympanic membrane, which is known to be approximately 1 °C lower than the brain temperature. The averaged differences in temperature between mercury thermometry and classical predetermined thresholding methods for the water phantom were 0.10 ± 0.42 and 0.05 ± 0.41 °C, respectively. The histogram curve‐fitting methods, however, yielded temperatures a little lower (averaged differences of ?0.24 ± 0.32 and ?0.14 ± 0.31 °C, respectively) than mercury thermometry. There was very little difference in temperature between tympanic thermometry and classical predetermined thresholding methods (+0.01 and ?0.07 °C, respectively). In humans, however, the histogram curve‐fitting methods yielded temperatures approximately 1 °C higher (+1.04 °C and +1.36 °C, respectively), suggesting that temperatures measured in this way more closely approximate the true brain temperature. The histogram curve‐fitting methods were more objective and better matched the estimated brain temperature than did classical predetermined thresholding methods, although the standard deviation was wider in the former methods. Copyright © 2011 John Wiley & Sons, Ltd.     

Altered Gut Flora Are Associated with Septic Complications and Death in Critically Ill Patients with Systemic Inflammatory Response Syndrome

Background

Gut under severe insult is considered to have an important role in promoting infection and multiple organ dysfunction syndrome from the viewpoint of altered intestinal epithelium, immune system and commensal bacteria. There are few reports, however, about the relationship between gut flora and septic complications.

Methods

We analyzed gut flora in patients with systemic inflammatory response syndrome (SIRS) and evaluated key bacteria and their cutoff values for infectious complications and mortality by using classification and regression trees (CART). Eighty-one SIRS patients with a serum C-reactive protein level higher than 10 mg/dL treated in the intensive care unit (ICU) for more than 2 days were included for the study. We quantitatively evaluated nine types of bacteria in fecal samples by plate or tube technique. Two hundred seventy-one samples were analyzed using CART and logistic regression.

Results

The dominant factors for complication of enteritis were the minimum number of total obligate anaerobes and the maximum number of Staphylococcus and Enterococcus. The dominant factors for complication of bacteremia were the minimum numbers of total obligate anaerobes and total facultative anaerobes. The dominant factors for mortality were the numbers of total obligate anaerobes and total facultative anaerobes and age.

Conclusions

A decrease in total obligate anaerobes and an increase in pathogenic bacteria in the gut are associated with septic complications and mortality in patients with SIRS. The altered gut flora may be a potential prognostic marker in SIRS patients.