Fundamental studies on the peripheral leucocyte culture and its clinical application

With an improved method of tissue culture of peripheral leucocytes of our own design, the authors carried out systematic observations on the peripheral leucocyte culture from the normal, various kinds of leukemias, leukemoid reactions, and hypoplastic anemia. As for the culture method we have devised a method of silicon oil coating on the blood containers, a method which will least affect the cell function as compared with the conventional culture method. As the results we have found that the tissue growth in the case of peripheral leucocyte culture of normal persons ceases after six-hour culture and also we have recognized a peculiar finding, a growth like a corona-shape, in which an empty space appears in the inner part of growth area along with the lapse of time. In every leukemic case, without presenting growth area like a corona, the cell density is high and the outer zone of growth area becomes sharply demarcated as in the case with bone-marrow culture and also the growth continues even after 12 hours. At this instance we have noticed many mitoses of immature cells. Moreover, the maturation of immature cells has been observed and it has also been possible to distinguish to what type these immature cells belonged. In the leukemoid reaction no growth pattern Characteristic to the leukemia can be recognized, and at a glance it can easily be differentiated from the leukemia. In the case of hypoplastic anemia although the growth area is like that of the normal presenting a corona-like shape, the cell density is lower and the function of leucccytes is lesser than the normal. From these results we believe that the peripheral leucocyte culture is clinically useful.</p

Resection or transplant‐listing for solitary hepatitis C‐associated hepatocellular carcinoma: an intention‐to‐treat analysis

AbstractObjectivesThe relative roles of liver resection (LR) and liver transplantation (LT) in the treatment of a solitary hepatocellular carcinoma (HCC) remain unclear. This study was conducted to provide a retrospective intention‐to‐treat comparison of these two curative therapies.MethodsRecords maintained at the study centre for all patients treated with LR or listed for LT for hepatitis C‐associated HCC between January 2002 and December 2007 were reviewed. Inclusion criteria required: (i) an initial diagnosis of a solitary HCC lesion measuring ≤ 5 cm, and (ii) Child–Pugh class A or B cirrhosis. The primary endpoint analysed was intention‐to‐treat survival.ResultsA total of 75 patients were listed for transplant (LT‐listed group) and 56 were resected (LR group). Of the 75 LT‐listed patients, 23 (30.7%) were never transplanted because they were either removed from the waiting list (n = 13) or died (n = 10). Intention‐to‐treat median survival was superior in the LR group compared with the LT‐listed group (61.8 months vs. 30.6 months), but the difference did not reach significance. Five‐year recurrence was higher in the LR group than in the 52 LT patients (71.5% vs. 30.5%; P < 0.001).ConclusionsIn the context of limited donor organ availability, partial hepatectomy represents an efficacious primary approach in properly selected patients with hepatitis C‐associated HCC

Decreases in the Serum VLDL-TG/Non-VLDL-TG Ratio from Early Stages of Chronic Hepatitis C: Alterations in TG-Rich Lipoprotein Levels

BACKGROUND: The liver secretes very-low-density lipoproteins (VLDLs) and plays a key role in lipid metabolism. Plasma total triglyceride (TG) level variations have been studied in patients with hepatitis C virus (HCV)-related chronic hepatitis (CH-C). However, the results of these studies are variable. A homogenous assay protocol was recently proposed to directly measure the TG content in VLDL (VLDL-TG) and VLDL remnants. METHODOLOGY/PRINCIPAL FINDINGS: Using the assay protocol, we determined serum VLDL-TG levels in 69 fasting patients with biopsy-proven HCV-related chronic liver disease and 50 healthy subjects. Patients were classified into stages F0-F4 using the 5-point Desmet scale. Serum total TG levels in patients with non-cirrhotic (F1-F3) CH-C did not demonstrate significant differences compared with healthy subjects, but serum VLDL-TG levels did demonstrate significant differences. Mean serum VLDL-TG levels tended to decrease with disease progression from F1 to F4 (cirrhosis). Compared with healthy subjects, serum non-VLDL-TG levels significantly increased in patients with stages F2 and F3 CH-C; however, we observed no significant difference in patients with liver cirrhosis. Furthermore, the serum VLDL-TG/non-VLDL-TG ratio, when taken, demonstrated a significant decrease in patients with CH-C from the mildest stage F1 onward. CONCLUSIONS/SIGNIFICANCE: The decrease in serum VLDL-TG levels was attenuated by increase in non-VLDL-TG levels in patients with non-cirrhotic CH-C, resulting in comparable total TG levels. Results of previous studies though variable, were confirmed to have a logical basis. The decrease in the serum VLDL-TG/non-VLDL-TG ratio as early as stage F1 demonstrated TG metabolic alterations in early stages of CH-C for the first time. The involvement of TG metabolism in CH-C pathogenesis has been established in experimental animals, while conventional TG measurements are generally considered as poor indicators of CH-C progression in clinical practice. The serum VLDL-TG/non-VLDL-TG ratio, which focuses on TG metabolic alterations, may be an early indicator of CH-C

ミゾリビンによる急性尿酸性腎症とメソトレキサートによる骨髄抑制を併発した1例

症例は83歳,男性.近医で関節リウマチの診断で加療(プレドニゾロン2mg,メソトレキサート(MTX)4mg),他に高尿酸血症,高血圧で加療中であった.当院へ入院13日前にミゾリビン(MZ)150mg追加投与された.入院2日前に食欲不振と全身倦怠感で近医を受診,尿素窒素99.5mg/dl,クレアチニン7.8mg/dlと急性腎不全を認めたため当院へ紹介入院した.入院時の検査所見で尿酸26.5mg/dLと著明な高尿酸血症を認めMZによる急性尿酸性腎症と診断した.そのためMZ及び尿酸の除去を目的に緊急血液透析を施行した.尿酸値及び腎機能は速やかに改善した.しかし,入院後より血小板及び白血球数の減少を認めた.骨髄検査では骨髄異形成症候群様であり,MZに加えMTXの関与を推測された.その後汎血球減少も改善している.本症例はMZの血中濃度も高くMZの排泄遅延による高尿酸血症のため急性腎不全を合併し更に腎機能の増悪がMTXによる無効造血を発症した可能性が考えられた.MZと尿酸も血液透析により体外への除去が可能でありMZによる急性尿酸性腎症の場合は早急な血液透析が有効である.An 83-year-old man was diagnosed with rheumatoid arthritis at a nearby hospital for which he was administered methotrexate (MTX) and prednisolone. Thirteen days before admission, he had started mizoribine (MZ) 150mg. Two days before admission to our hospital, he was admitted to a nearby hospital for appetite loss and general fatigue. Laboratory tests showed renal dysfunction at nearby hospital, and he was consequently admitted to our hospital for further examination. On admission, we reasoned that renal dysfunction had resulted from hyperuricemia during MZ administration because the serum concentration of uric acid (26.5mg/dL) and MZ (trough level, 5.14μg/mL) were markedly elevated. Accordingly, MZ treatment was terminated, and hemodialysis was initiated. The patient subsequently showed an improvement in his condition and renal function recovered. However, pancytopenia developed soon after admission, and bone marrow aspiration showed myelodysplastic syndrome-like lesions. We suspected MTX and MZ to be the main cause of pancytopenia. Because the onset of acute renal failure had been attributed to MZ, it was conjectured that the dose of MTX was too high. Therefore, MTX administration was cancelled, and pancytopenia ameliorated. In cases of transient renal dysfunction with MZ, it is necessary to consider discontinuation of MZ and initiation of hemodialysis

Practice Patterns and Outcomes for Pediatric ANCA Vasculitis Transplant Recipients in a National Cohort

BACKGROUND: Anti-neutrophil cytoplasmic autoantibody (ANCA) vasculitis is a rare condition in pediatric patients. Little is known about practice patterns and outcomes of pediatric transplant patients. The purpose of our study was to examine differences in patient characteristics, immunosuppression, and long-term graft outcomes between ANCA and non-ANCA vasculitis recipients. METHODS: We used the Scientific Registry of Transplant Recipients to evaluate pediatric ANCA vasculitis recipients between the ages of 1 and 22 years old from 1991 to 2017 and compared them to non-ANCA vasculitis patients during the same time cohort in the USA. RESULTS: A total of 26,431 transplant recipients were identified, of these, 337 with ANCA vasculitis. Mean 1-year eGFR was 62.46 and 64.92 ml/min/1.73 m (p = 0.002), and mean 5-year eGFR was 57.95 and 59.38 ml/min/1.73 m (p = 0.18) between the non-ANCA and ANCA groups, respectively. Five-year graft survival was similar in both groups (non-ANCA 75.5 vs. ANCA 78.6%; p = 0.19). Of those with graft loss within the ANCA group, only 0.6% was secondary to disease recurrence (p = 0.14). CONCLUSIONS: Kidney transplant is a safe treatment modality for children with ANCA-related kidney failure. ANCA patients have comparable graft survival when compared to the general transplant population with a low risk of recurrence. Thymoglobulin was used in a higher proportion within the ANCA group compared to the non-ANCA group. Tacrolimus, mycophenolate mofetil/mycophenolic acid, and steroids were the predominant maintenance immunosuppression used in both groups. A higher resolution version of the Graphical abstract is available as Supplementary information

Acute Kidney Injury and the Compensation of Kidney Function After Nephrectomy in Living Donation

Acute kidney injury (AKI) incidence is growing rapidly, and AKI is one of the predictors of inpatient mortality. After nephrectomy, all the patients have decreased kidney function with AKI and recover from AKI. However, the characteristic and behavior of AKI is different from usual AKI and compensatory kidney function has been well known in the postoperative setting, especially in living donors. In this review, we have focused on the compensation of kidney function after nephrectomy in living donors. We discuss factors that have been identified as being associated with kidney recovery in donors including age, sex, body mass index, remnant kidney volume, estimated glomerular filtration rate, and various comorbidities

Nonlinear optical spectra having characteristics of Fano interferences in coherently coupled lowest exciton biexciton states in semiconductor quantum dots

Optical nonlinear effects are examined using a two-color micro-photoluminescence (micro-PL) method in a coherently coupled exciton-biexciton system in a single quantum dot (QD). PL and photoluminescence excitation spectroscopy (PLE) are employed to measure the absorption spectra of the exciton and biexciton states. PLE for Stokes and anti-Stokes PL enables us to clarify the nonlinear optical absorption properties in the lowest exciton and biexciton states. The nonlinear absorption spectra for excitons exhibit asymmetric shapes with peak and dip structures, and provide a distinct contrast to the symmetric dip structures of conventional nonlinear spectra. Theoretical analyses with a density matrix method indicate that the nonlinear spectra are caused not by a simple coherent interaction between the exciton and biexciton states but by coupling effects among exciton, biexciton and continuum states. These results indicate that Fano quantum interference effects appear in exciton-biexciton systems at QDs and offer important insights into their physics

Outcomes of Liver Transplantation Using Machine Perfusion in Donation After Cardiac Death vs Brain Death in the US

BACKGROUND: Liver transplant (LT) outcomes using machine perfusion (MP) in donation after brain death (DBD) is promising, but the LT outcomes of MP in donation after cardiac death (DCD) is limited in the US. The aim of this study was to compare LT outcomes of MP between DCD and DBD. STUDY DESIGN: We analyzed data from the United Network for Organ Sharing between 2016 and 2021 among adult LT recipients. Propensity score matching was performed to assess the outcomes between DCD and DBD. RESULTS: A total of 380 LTs (295 from DBD and 85 from DCD) were performed using MP. When compared with DBD, DCD group had older median recipient age (61 vs 58 years, p = 0.03), higher prevalence of diabetes (41% vs 28%, p = 0.02), lower model for end-stage liver disease score (17 vs 22, p \u3c 0.01), longer wait time (276 vs 143 days, p \u3c 0.01) and younger median donor age (40 vs 51 years, p \u3c 0.01). The most common primary diagnosis was alcohol-related liver disease, and hepatocellular carcinoma was more common in the DCD group (22% vs 13%). On survival analysis, 1-year overall/graft survivals (DCD 95.4% vs DBD 92.1%, p = 0.54; DCD 91.7% vs DBD 89.8%, p = 0.86) were the same. After propensity score matching, overall/graft survivals were the same. In Cox regression analysis, DCD was not an independent risk factor of mortality (hazard ratio 0.80; 95% CI 0.25 to 2.52; p = 0.70) and graft failure (hazard ratio 0.58; 95% CI 0.17 to 1.97; p = 0.38). CONCLUSIONS: In transplant recipients who underwent LT using MP, posttransplant outcomes of overall and graft survival were similar among DCD and DBD cohorts