Adverse effect of donor-specific anti-human leukocyte antigen (HLA) antibodies directed at HLA-DP/-DQ on engraftment in cord blood transplantation

[Background aims] While donor-specific anti-human leukocyte antigen (HLA) antibodies (DSAs) in the recipient before transplantation are associated with graft failure in cord-blood transplantation (CBT), effects of DSAs other than against HLA-A, -B or -DRB1 on transplantation outcomes remained poorly understood. [Methods] We retrospectively analyzed 567 single-unit CBT recipients to evaluate impact of DSAs against HLA-DP and -DQ on CBT outcomes. [Results] Among 143 recipients (25.2%) who had anti-HLA antibodies, nine harbored DSAs against HLA-DP or -DQ. DSAs against HLA-DP or -DQ were associated with a significantly lower neutrophil engraftment rate (55.6% versus 91.8%, P = 0.032) and with a marginally lower platelet engraftment rate (46.7% versus 75.3%, P = 0.128) at day 100 after transplantation, compared with patients without anti-HLA antibodies. Time to neutrophil and platelet engraftment in patients with DSAs for HLA-DP or -DQ was significantly longer than that in patients without anti-HLA antibodies (median, 25 versus 21 days, P = 0.002 in neutrophil; median 61 versus 46 days, P = 0.014 in platelet). Cumulative incidence of bacterial infection at day 100 was significantly greater (88.9% versus 57.1%, P = 0.024), and re-transplant-free survival was marginally lower (55.6% versus 76.8%, P = 0.132) in patients with DSAs against HLA-DP or -DQ, compared with those without anti-HLA antibodies. These findings suggest that DSAs against HLA-DP or -DQ lead to unfavorable engraftment, which may increase risk of bacterial infection, and reduce survival soon after CBT. [Conclusions] Our results suggest the importance of evaluating DSAs against HLA-DP and -DQ in recipients before selecting CB units

シンキン バイヨウ ケンサ ニオケル カンジダ ノ ケンシュツ ニ エイキョウ スル リンショウテキ ヨウイン ノ ケントウ : コウクウ カンソウ ノ カンレン ニツイテ

In order to analyze the clinical factors affecting the fungal culture test, we examined the oral mucosae of 89 individuals with various complaints: pain, xerostomia etc. The subjects, age ranged from 36 to 87 years (mean age: 64.8 ± 11.8). Based on the fungal culture, 56 patients were found Candida-positive, and the remaining 33 patients were Candida-negative. The mean ages of the Candida-positive and -negative groups, respectively, were 67.4 ± 12.0 and 60.5 ± 10.3 years old, with the Candida-positive group being significantly older than Candida-negative group. The Candida-positive group showed a smaller amount of salivary secretion (10.9 ± 5.3 ml/10 min) than the Candida-negative group (13.8 ± 6.0 ml/10 min); this difference was also statistically significant. Patients with Candida infection suffered from different diseases and conditions, including hypertension, gastrointestinal disease, and xerostomia. The above findings suggest that one of the factors in the fungal culture test is dry mouth. Specifically, old age, dry mouth, chronic disease or medication leading to dry mouth were the clinical factors affecting the fungal culture test. However, neither the Candida species detected in the fungal culture nor the clinical appearance of the oral mucosa influenced these clinical features

Clinico-statistical study of HIV patients in clinical dental departments at Tokushima University Hospital

HIV 感染症診療は，免疫不全の原因治療と免疫不全に伴う日和見感染症の管理が2 本柱とされる．日和見感染症の管理という観点から，口腔衛生管理は重要で歯科医師の果たす役割は大きい．われわれは，徳島大学病院歯科診療科を受診した31 例のHIV 感染者の臨床統計的検討を行い，今後増加すると予想されるHIV感染者に対する歯科医療の留意点について考察した．症例は男性29 例，女性2 例で，平均年齢は31.7 ± 12.4歳であった．感染経路は血液製剤による感染が8 例，性感染による感染が23 例であった．31 例中3 例で抗HIV 療法が導入されていなかった．HIV 感染者の合併症の保有率は高く，血友病群ではHCV 感染症（75.0%），C 型肝硬変（37.5%）が多く，性感染症群では梅毒（30.4%），HBV 感染症（21.7%）が多かった．歯科診断では歯周病，う蝕が多かったが，31 例中7 例に口腔粘膜疾患を認めた．歯科治療内容は抜歯処置15 例，歯周治療12 例，修復治療5 例の順に多かった．血友病群の抜歯の際は血液凝固製剤を術前・術後に補充して抜歯を行った． HIV 感染者の歯科医療は，医科と連携し患者個々のHIV 感染症の病態や合併症を把握し，日和見疾患のリスク因子である口腔感染症を治療し，予防する必要がある．そして，患者にHIV 感染症と口腔症状の関連性と定期的な歯科治療の必要性を説明し，患者にあわせた無理のない口腔衛生指導を行いながら，長期的なメインテナンスが必要であると考えられた．To prevent opportunistic infectious disease in HIV patients with immunodeficiency, oral management is important. In order to identify focal points in dental treatment, we studied the 31 HIV patients（ 29 males and 2 females, mean age 31.7±12.4 years） who visited the clinical dental departments of Tokushima University Hospital from 1981 to 2016. Among the 31 cases, 3 cases did not start antiretroviral therapy （ART）. The HIV patients were classified by infection route, producing a hemophilia group （8 cases） and sexually transmitted disease group（ 23 cases）. Clinical complications were different in these two groups: complications in the hemophilia group included hepatitis C virus （HCV） infection （75.0%） and hepatitis C-related cirrhosis （37.5%）, whereas in the sexually transmitted disease group complications included syphilis （30.4%） and hepatitis B virus （HBV） infection （21.7%）. There were many dental caries and periodontal diseases found in the patients. On the other hand, oral mucosal diseases were observed in seven of 31 cases. Dental treatment consisted of tooth extraction in 15 cases, periodontal treatment in 12 cases, and caries treatment in 5 cases. Blood coagulation formulation was supplied during tooth extraction in the hemophilia group. Careful attention must be given according to the condition of each HIV patient during dental treatment, and the risk of opportunistic infection caused by oral infection must be treated and prevented

トクシマ ダイガク ビョウイン セイシンカ シンケイカ ニュウイン カンジャ ニ タイスル コウクウ ケア ノ イギ

For patients with mental diseases, safe food-intake and the maintenance of good oral hygiene become difficult due to a decline in the ability of daily livings. In addition, a majority of patients suffer from the lack of reflection of both deglutition and cough as well as clinical silent aspiration, resulting from the extrapyramidal symptom (EPS) caused by antipsychotics. In this clinical study, we evaluated the oral environment in 10 inpatients with psychiatry neurology, and examined the usefulness of professional oral care. They were divided into 2 groups: the physical restriction group (restriction group) and the non-physical restriction group (control group), followed by the estimation of the conditions of oral hygiene and the days accompanied by fever, one of the symptoms of aspiration-related pneumonia, before and after professional oral care intervention. As a result, restriction group had poor oral hygiene condition as compared to the control group. After professional oral care intervention, oral hygiene condition was significantly improved in the restriction group, and reached to the same levels as in the control group. The days with fever were 7.3 and 5.0 days per month in the restriction group before and after the intervention, respectively. In the control group, those were 0.6 and 0 day per month before and after intervention, respectively. The cause of the difference in days with fever between 2 groups was considered to be the effect of clinical silent aspiration by EPS induced by antipsychotics. The professional oral care contributed to the improvement of the oral hygiene in inpatients with psychiatry neurology, resulting in the reduction of aspiration-related pneumonia. Therefore, the role of dentistry in the field of psychiatry neurology would be inevitable in the future

ノウソッチュウ カンジャ ノ コウクウナイ ショケン ト シカ カイニュウ ノ ユウヨウセイ ニツイテ

We analyzed the need for dental intervention in patients with acute cerebral vascular disorders. In this study, we enrolled 43 individuals in SCU (male: 28, female: 15) in need of oral health management. The mean age of the patients was 68.0 ± 14.9. They had been diagnosed as cerebral infarction, cerebral hemorrhage, subarachnoid hemorrhage, or transient ischemic attack. Thirteen subjects were affected with pneumonia and could not handle self-care management. Furthermore, 10 subjects had poor oral hygiene. There were clearly more pneumonia patients in the intubation group compared to the non-intubation group. In addition, 18 cases (41.9%) needed dental treatment, and 5 cases received dental treatment. Patients with acute stroke had poor oral hygiene with disturbance of consciousness and paralysis, suggesting a possible cause of pneumonia in these patients. Half of patients required dental intervention, indicating that oral management may be necessary for stroke patients to prevent the occurrence of pneumonia

トクシマ ダイガク ビョウイン ニオケル シュウジュツキ コウクウ キノウ カンリ ノ ゲンジョウ ト カダイ

It has been shown that oral hygiene affects the onset of perioperative complications. The usefulness of perioperative oral function management aiming at the outbreak decrease in treatment complications and an early discharge was recognized. As a result, perioperative oral function management fee was founded at revision of medical service fees in Fiscal year 2012. 　In this clinical study, we evaluated the implementation of perioperative oral function management in Tokushima University Hospital. We examined 781 patients, including 563 patients for surgery and 218 patients for chemotherapy and radiotherapy. The mean age of patients was 58.8 ± 12.4 years old. 　The implementation rate of perioperative oral function management was 9.7% in the patients of surgery, and 17.4% in those of chemotherapy and radiotherapy. The highly required medical department was neurosurgery in the patients of surgery, and hematology in those of chemotherapy and radiotherapy. The mean number of tooth present was 21.3 ± 7.1 in the patients of surgery, and 19.8 ± 7.2 in those chemotherapy and radiotherapy. The rate of dental treatment was required in 40.5% of total patients who received surgery, and in 51.4% of patients who received chemotherapy and radiotherapy. The rate of patients who received denture treatment attained to 11.9% of the whole patients receiving surgery, and 13.3% of patients receiving chemotherapy and radiotherapy. 　It was revealed that there were many patients required potential demands in perioperative oral function management, and that there were many patients who need dental or denture treatment. We would like to develop perioperative oral function management by the interprofessional collaboration in health and social care

Critical roles of cold shock domain protein A as an endogenous angiogenesis inhibitor in skeletal muscle

PublisherAngiogenesis is regulated by the local balance between angiogenic stimulators and inhibitors and is maintained by muscle-derived angiogenic factors in ischemic tissues. AIMS: Our objectives were to investigate the effect of cold shock domain protein A (CSDA) as an endogenous angiogenesis inhibitor and to develop a novel strategy of therapeutic angiogenesis by blocking CSDA expression. RESULTS: In human skeletal muscle cells, CSDA was upregulated during hypoxia when cells were damaged and apoptosis was induced. CSDA expression could repress the activity of hypoxia inducible factor-1α and nuclear factor κB, because CSDA can competitively bind the hypoxia response element and the nuclear factor κB-binding element. As a result, vascular endothelial growth factor-A, interleukin-6, and interleukin-8 secretions from skeletal muscle cells were decreased. Further, CSDA depletion increased the secretion level of these angiogenic factors. In a hindlimb ischemia model, transfer of short-hairpin RNA targeting CSDA ameliorated ischemia without direct transfer of angiogenic factors. In this ischemic tissue, vascular endothelial growth factor-A, interleukin-6, and CXCL2 protein levels were increased. INNOVATION AND CONCLUSION: CSDA appears to play a critical role as an endogenous angiogenesis inhibitor in skeletal muscle, and RNA interference targeting of CSDA is a promising gene therapy strategy for treating peripheral arterial disease