ニホンザル移植心における血管内皮増殖因子の発現

Vascular endothelial growth factor (VEGF) plays important roles in regulating angiogenesis. In chronically rejected cardiac allografts, arterial intimal thickening is formed of proliferative smooth muscle cells (SMCs) with enhanced expression of SMemb, a non-muscle myosin heavy chain isoform. However, the detailed mechanisms of the development of these lesions are almost unknown.Heterotopic cardiac transplantation was performed using Japanese monkeys;the grafts were harvested on day 28.Coronary arteries in the transplanted hearts (n＝5), recipient native hearts (n＝5) and nontransplanted hearts (n＝5) were used for pathological analysis. To evaluate VEGF and SMemb expression,we performed immunohistochemistry and the intensity was semiquantitatively scored. VEGF and SMemb reactivity was localized predominately on vascular endothelial cells and SMCs;no immunoreactivity was detected in native hearts.Using serial sections, expression of VEGF and SMemb was seen to be enhanced in the thickened intima,while this expression was diminished in native hearts.The scores of VEGF and SMemb in the vasculature of transplanted hearts were significantly different from those of native hearts (P＜0.01).These results indicate that VEGF plays a pivotal role in neointimal formation in chronic rejection, and the expression can be a useful marker for the early diagnosis of chronic rejection in cardiac allografts.Article信州医学雑誌 47(5): 393-395(1999)journal articl

広範な気管皮膚瘻に対するオブチュレーター

Tracheal resection is used in cases of advanced thyroid carcinoma invading the trachea,and in some of these cases a large tracheostoma is left temporarily or permanently.We fabricated a tracheal obturator using dental materials and techniques,and applied it in 5 patients with a large and/or irregular tracheostoma.Our experiences showed the fabrication method to be easy and safe.The patients could achieve reasonable speech with the obturator. However, they had to use some devices to retain the prosthesis and some of them complained of discomfort and difficulty while wearing it. From our experiences in 5 patients,we concluded that the obturator is a useful prosthesis for patients with a large and irregular-shaped tracheostoma,although some improvement is still necessary for more comfortable use.Article信州医学雑誌 49(4): 207-212(2001)journal articl

Histological diagnostic criterion for chronic endometritis based on the clinical outcome.

Background:The diagnostic criteria of chronic endometritis remain controversial in the treatment for infertile patients.Methods: A prospective observational study was conducted in a single university from June 2014 to September 2017. Patients who underwent single frozen-thawed blastocyst transfer with a hormone replacement cycle after histological examination for the presence of chronic endometritis were enrolled. Four criteria were used to define chronic endometritis according to the number of plasma cells in the same group of patients: 1 or more (≥ 1) plasma cells, 2 or more (≥ 2), 3 or more (≥ 3), or 5 or more (≥ 5) in 10 high-power fields. Pregnancy rates, live birth rates, and miscarriage rates of the non-chronic endometritis and the chronic endometritis groups defined with each criterion were calculated. A logistic regression analysis was performed for live births using eight explanatory variables (seven infertility factors and chronic endometritis). A receiver operating characteristic curve was drawn and the optimal cut-off value was calculated.Results:A total of 69 patients were registered and 53 patients were finally analyzed after exclusion. When the diagnostic criterion was designated as the presence of ≥ 1 plasma cell in the endometrial stroma per 10 high-power fields, the pregnancy rate, live birth rate, and miscarriage rate were 63.0% vs. 30.8%, 51.9% vs. 7.7%, and 17.7% vs. 75% in the non-chronic and chronic endometritis groups, respectively. This criterion resulted in the highest pregnancy and live birth rates among the non-chronic endometritis and the smallest P values for the pregnancy rates, live birth rates, and miscarriage rates between the non-chronic and chronic endometritis groups. In the logistic regression analysis, chronic endometritis was an explanatory variable negatively affecting the objective variable of live birth only when chronic endometritis was diagnosed with ≥ 1 or ≥ 2 plasma cells per 10 high-power fields. The optimal cut-off value was obtained when one or more plasma cells were found in 10 high-power fields (sensitivity 87.5%, specificity 64.9%).Conclusions:Chronic endometritis should be diagnosed as the presence of ≥ 1 plasma cells in 10 high-power fields. According to this diagnostic criterion, chronic endometritis adversely affected the pregnancy rate and the live birth rate