Ultraviolet-induced alloantigen-specific immunosuppression in transplant immunity

After the first observation of the immunosuppressive effects of ultraviolet(UV) irradiation was reported in 1974, therapeutic modification of immune responses by UV irradiation began to be investigated in the context immunization. UV-induced immunosuppression is via the action of regulatory T cells(Tregs). Antigen-specific Tregs were induced by high-dose UV-B irradiation before antigen immunization in many studies, as it was considered that functional alteration and/or modulation of antigen-presenting cells by UV irradiation was required for the induction of antigen-specific immunosuppression. However, it is also reported that UV irradiation after immunization induces antigen-specific Tregs. UV-induced Tregs are also dominantly transferable, with interleukin-10 being important for UV-induced immunosuppression. Currently, various possible mechanisms involving Treg phenotype and cytokine profile have been suggested. UV irradiation accompanied by alloantigen immunization induces alloantigen-specific transferable Tregs, which have potential therapeutic applications in the transplantation field. Here we review the current status of UV-induced antigen-specific immunosuppression on the 40th anniversary of its discovery.     

Comprehensive and innovative techniques for liver transplantation in rats: A surgical guide

AIM: To investigate our learning curves of orthotopic liver transplantation (OLT) in rats and the most important factor for successful surgery. METHODS: We describe the surgical procedures for our rat OLT model, and determined the operator learning curves. The various factors that contributed to successful surgery were determined. The most important surgical factors were evaluated between successful and unsuccessful surgeries.RESULTS: Learning curve data indicated that 50 cases were required for operator tr...     

Survey on attitudes regarding EULAR recommendations for the role of nurses involved in medical care of patients with chronic inflammatory arthritis in Japan

Objective: We seek to evaluate the opinions of nurses and doctors in Japan regarding EULAR recommendations for nurses’ roles in the management of chronic inflammatory arthritis.

Methods: This is a cross-sectional survey within Japan. We randomly selected nurses and doctors engaged in consultation of patients with rheumatoid arthritis (RA) and assessed their agreement and opinions on the feasibility of implementing EULAR recommendations, including potential barriers.

Results: 431 nurses and 128 doctors completed the questionnaire. For both nurses and doctors, levels of feasibility showed statistically significant lower results compared with those of agreement for all items. When compared between nurses and doctors, agreement showed no statistically significant differences, while nurses’ answers were statistically significant lower for feasibility. Insufficient time, staff and knowledge, lack of established procedures and facilities, and lack of an education system for nurses were cited as barriers to the feasibility of implementing EULAR recommendations.

Conclusions: This is the first survey within Japan evaluating opinions regarding EULAR recommendations for nurses’ roles. We found that while agreement was high, feasibility was generally believed to be low. We recommend further research and collaboration between medical professionals in order to implement these recommendations in Japan.     

Noradrenalin-Secreting Retroperitoneal Schwannoma Resected by Hand-Assisted Laparoscopic Surgery: Report of a Case

A 66-year-old woman was admitted to our hospital for investigation of a retroperitoneal mass. She was asymptomatic but her serum noradrenalin and vanillylmandellic acid levels were increased remarkably. Computed tomographic angiography showed a mass in the left side of the superior mesenteric artery (SMA) divergence, 6 × 4 cm in size, supplied mainly by the left adrenal artery. We performed hand-assisted laparoscopic surgery (HALS) using a Cavitron ultrasonic surgical aspirator. Abdominal exploration revealed that the tumor was located in the left side of the SMA root, but was not adhered to the adjacent organs. Her vital signs remained stable during the operation. Microscopic examination revealed a palisade formation, confirming a histopathological diagnosis of degenerated schwannoma (Antoni type B). Immunohistologically, the tumor cells were stained with S-100 protein and neuron-specific enolase. Her noradrenalin level normalized immediately after the operation and she remains in good health 3 years 2 months later.     

Postoperative pain management using subcutaneous fentanyl and ketamine after abdominal gynecologic surgery

BACKGROUND: Subcutaneous opioid is one way of managing postoperative pain in patients undergoing anticoagulant therapy. We have evaluated the safety and the efficacy of postoperative pain management using subcutaneous fentanyl and ketamine after abdominal gynecologic surgery. METHODS: Written informed consent was obtained from 50 ASA physical status 1 or 2 female patients aged between 20 and 65. Patients were randomized to one of 5 groups. Group 1, 2 and 3 received 25, 35 and 50 microg x h(-1) subcutaneous fentanyl infusion, respectively. Group 4 received 25 microg x h(-1) fentanyl and 2 mg x h(-1) ketamine subcutaneously; group 5 received 25 microg x h(-1) fentanyl and 4 mg x h(-1) ketamine subcutaneously. General anesthesia was administered to all patients. Two hours after induction, subcutaneous infusion of fentanyl and ketamine was started in the patients and discontinued 24 hours after the operation. All patients were assessed twice, at 4 hours and at 24 hours after operation. Blood gas analysis was performed. Number of analgesic administration required during the 24 hours after operation was recorded. Groups 1, 2, 3 and groups 1, 4, 5 were evaluated as one group, respectively. Group differences were analyzed by variance analysis. Differences of analgesic administration were analyzed with Kruskal-Wallis test. RESULTS: As to anesthetic requirement during the 24 hours after operation, there were no significant differences among treatment groups. With respect to blood gas analysis, only individuals receiving subcutaneous 25 microg x h(-1) fentanyl and 4 mg x h(-1) ketamine maintained high PaO2 4 hours after the operation (P<0.05). CONCLUSIONS: We recommend administration of 25 microg x h(-1) fentanyl and 4 mg x h(-1) ketamine subcutaneously, which maintains high Pao2 and requires less analgesic.     

Simple,rapid, and automated method for detection of hyperaggregability of platelets using a hematology analyzer

Estimation of hyperaggregability of platelets is important for diagnosis and prevention of vascular events. We have developed and evaluated a simple and rapid method for detection of a hyperaggregable state of platelets by using an Abbott CELL-DYN(R) 4000 hematology analyzer. Citrated blood samples were collected from 62 patients with chronic cerebral infarction (CCI), of whom 19 patients were treated with ticlopidine, and from 9 healthy subjects. Platelet clumps were detected in the scatter plots for white blood cell populations with the hematology analyzer. Platelet clumps were positive in 20 of 43 (46.5%) CCI patients who were not treated with anti-platelet agents but not at all in 9 healthy subjects and in 19 CCI patients treated with ticlopidine. The detection of platelet clumps in citrated blood by the hematology analyzer was proved useful in detecting a platelet hyperaggregability in CCI patients. This method is simple, rapid, and automated and thus should be suitable for routine clinical use for monitoring indications and the efficacy of anti-platelet drugs.     

An elderly case suspected of familial hypocalciuric hypercalcemia subsequent to manifestation of hypercalcemia

Familial hypocalciuric hypercalcemia (FHH) is a relatively rare disease showing autosomal dominant heredity. Despite hypercalcemia, it shows a low urinary calcium excretion rate, and calcium clearance-creatinine clearance ratio. Since the serum calcium level does not increase to more than 12 mg/dl, this disease is basically asymptomatic and is incidentally found on medical examinations in many cases. However, it sometimes presents dangerous hypercalcemia and requires treatment. In this disease, parathyroidectomy is not sufficiently effective to cure hypercalcemia. We encountered a female patient with advanced age who presented marked hypercalcemia. Several examinations suggested FHH. While we had difficulty in controlling the serum calcium level, periodic administration of alendronate sodium hydrate, a bone resorption inhibitor, was effective. In this patient, the serum calcium level was normal on the examination about a year and a half before the appearance of symptoms, and hypercalcemia manifested itself in her advanced age, which is different from the usual course of FHH. This case presumably suggests that the pathophysiology of FHH is varied.     

Development of a novel intrafascicular nerve electrode

Artificial organs could be controlled using autonomic neural signals, because they exhibit rapid responses to physical needs similar to those of natural organs. A nerve electrode must satisfy many requirements to measure autonomous neural signals such as a long lifetime, high signal-to-noise ratio, multichannel recording, simple installation into a nerve fascicle, and good manufacturing productivity. The purpose of our study is to propose and evaluate a novel nerve electrode that satisfies these conditions, which to date has not been developed. A novel intrafascicular nerve electrode was designed, fabricated, and evaluated on autonomic nerves. Conventional extrafascicular and intrafascicular nerve electrodes were fabricated and tested for comparison to our novel intrafascicular nerve electrode. The novel intrafascicular nerve electrode had a 3-week lifetime, whereas the conventional extrafascicular nerve electrode had a 2-week lifetime. The signal-to-noise ratio was improved from 1.6 to 2.0 compared with the conventional extrafascicular nerve electrode. The novel intrafascicular nerve electrode was easier to install into a nerve fascicle and had better manufacturing productivity than the conventional intrafascicular nerve electrode. We succeeded in demonstrating the feasibility of our novel intrafascicular nerve electrode.     

Sonographic appearance of a tear of the lateral internal oblique muscle resulting from cough

During forced respiratory movement such as coughing, complications can occur, including abdominal muscle rupture. We report a case of spontaneous tear of the internal oblique muscle resulting from violent cough diagnosed by sonography. The physiology of cough and the possible pathophysiologic mechanism of this case is discussed.     

Distinct diagnostic criteria of fulminant type 1 diabetes based on serum C-peptide response and HbA1c levels at onset

OBJECTIVE: Diagnostic criteria in fulminant type 1 diabetes, a novel subtype of type 1 diabetes, remain unclear. RESEARCH DESIGN AND METHODS: We analyzed basal and longitudinal changes of serum C-peptide levels during a 75-g oral glucose tolerance test (OGTT) in 125 consecutively recruited patients with type 1 diabetes including fulminant type 1 diabetes (n = 25) and acute-onset type 1 diabetes (n = 100). Discriminating criteria of fulminant type 1 diabetes were examined using receiver-operating characteristic curve analysis and multiple logistic regression analysis. RESULTS: The integrated values of serum C-peptide response during OGTT (SigmaC-peptide) in fulminant type 1 diabetes at onset, 1 year, and 2 years after onset were markedly lower than those in acute-onset type 1 diabetes. None of the patients with fulminant type 1 diabetes had improvement of C-peptide response to OGTT. Fasting C-peptide values at onset in fulminant type 1 diabetes were significantly lower than those in acute-onset type 1 diabetes. We established diagnostic criteria of serum C-peptide and HbA(1c) levels at onset that discriminate fulminant type 1 diabetes from acute-onset type 1 diabetes with high sensitivity and specificity: a criterion in which the levels of both the fasting C-peptide is 相似文献