A novel Fc receptor for IgA and IgM is expressed on both hematopoietic and non-hematopoietic tissues

By contrast to well-defined Fc gamma and Fc epsilon receptors, the structural and functional characteristics of Fc mu receptor are unclear. We have recently described a novel mouse Fc receptor, designated Fc alpha/mu receptor, and its human homologue, which bind both IgM and IgA. Here we show that the Fc alpha/mu receptor is expressed on mature, but not immature, B lymphocytes and acquires the ability to bind IgM and IgA antibodies after stimulation of B lymphocytes. Moreover, stimulation with phorbol 12-myristate 13-acetate increased endocytosis of IgM-coated microparticles mediated by the Fc alpha/mu receptor expressed on pro-B cell line Ba/F3 cells. We also show that the Fc alpha/mu receptor is expressed in secondary lymphoid organs, such as lymph node and appendix, kidney and intestine, suggesting an important role of the receptor for immunity in these organs.     

Clinical utility of an endoscopic ultrasound-guided rendezvous technique via various approach routes

Background

The endoscopic ultrasound-guided rendezvous techniques (EUS-rendezvous) provide reliable biliary access after failed endoscopic retrograde cholangiopancreatography (ERCP) cannulation. We evaluated the clinical utility of an EUS-rendezvous technique using various approach routes.

Methods

Patients undergoing EUS-rendezvous for biliary access after failed bile duct cannulation in ERCP were included. EUS-rendezvous was performed via three approach routes depending on the patient’s condition: transgastric, transduodenal in a short endoscopic position, or transduodenal in a long endoscopic position. The main outcomes were the technical success rates. Secondary outcomes were procedure time and complications.

Results

Fourteen patients (median age, 77 years) underwent EUS-rendezvous for biliary access resulting from failed biliary cannulation. The reasons for biliary drainage were malignant biliary obstruction in five patients and choledocholithiasis in nine. Transgastric, transduodenal in a short position, and transduodenal in a long position EUS-rendezvous was performed in five, five, and four patients, respectively. Bile duct puncture occurred in the left intrahepatic duct in four patients, right hepatic duct in one, middle common bile duct in four, and lower common bile duct in five. The technical success rate was 100 %. In four patients, the approach route was modified from transduodenal in a short position to transduodenal in a long position or transgastric route. The median procedure time was 81 min. One case each of biliary peritonitis and pancreatitis occurred and were managed conservatively.

Conclusions

EUS-rendezvous provided safe and reliable transpapillary bile duct access after failed ERCP cannulation. The selection of the appropriate approach routes, depending on patient condition, is critical.     

Axin2+ Peribiliary Glands in the Periampullary Region Generate Biliary Epithelial Stem Cells That Give Rise to Ampullary Carcinoma

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Prenatal Diagnosis in High Risk Pregnancies for Zellweger Syndrome

Zellweger syndrome is a lethal disorder. At present, no effective therapies are known for the patients of Zellweger syndrome. Recently a typical case of Zellweger syndrome in Japan was observed. In spite of intensive care, the patient died at the age of 3 months. Following this, the parents requested prenatal diagnosis for their following two pregnancies.
We investigated levels of very long chain fatty acids (VLCFA), levels of bile acids in amniotic fluid and immunoblotting of peroxisomal β-oxidation enzymes in cultured amniocytes. We report that immunoblotting using cultured amniocytes is an effective method for prenatal diagnosis of Zellweger syndrome. Furthermore, if we use immunoblotting for prenatal diagnosis, we can discriminate pseudoZellweger syndrome from pseudoneonatal adrenoleucodystrophy.
Following prenatal diagnosis, two healthy babies were delivered. After birth, no abnormal levels of VLCFA in either serum or red blood cell membranes were confirmed. In this paper, we report that we can diagnose a healthy fetus in a high risk pregnancy for Zellweger syndrome.     

Role of nurses for donor's families: current issue of organ transplant in the United States

To define the roles of donor coordinators (certified procurement transplant coordinators; CPTCs), we visited University of Florida Colleges of Nursing and Medicine and certified procurement transplant interviewed (CPTCs) and clinical specialists in pediatric critical care. Recipients were dealt with certified clinical transplant coordinators (CCTCs). These coordinators are certified by taking examinations to see if they are equipped with specialized knowledge and communication skills. The small number of organs available for transplant poses a serious problem. In many cases, medical personnel are not proficient enough to recommend organ donations to the family members of potential donors. Thus, the role of CPTC includes education of health professionals. In one study, 95% of the donor family members felt that hospital staff members explained about transplantation well, while 67% of the nondonor family members felt the same. The concept of "brain death" was not fully understood by some of the latter. The timing and place of discussion as well as the skill levels of medical staffs (preferably CPTCs) were important in receiving the consent. It is necessary for the donor family members to understand the concept of "death". Communications between the hospital staff and family members are critical. In Japan, there is no solid foundation for pediatric organ transplantation. Specialized nurses in pediatrics are limited. Further, there is meager certification programs for CPTCs or CCTCs. Under the present state, nurses in ICU and pediatric wards may act as potential coordinators. Education of these nurses will be critical to increase the number of pediatric organ transplantation.