Progressing takayasu arteritis successfully treated by common carotid-internal carotid crossover bypass grafting: technical case report.

OBJECTIVE: This report describes a unique case of Takayasu arteritis with occlusion of the left common carotid artery (CCA) and the right internal carotid artery (ICA), which was successfully treated by right CCA-left ICA crossover bypass grafting using the saphenous vein. The histological findings of the original occluded prosthetic graft are also described. CLINICAL PRESENTATION: A 63-year-old woman with a history of Takayasu arteritis was admitted to our hospital with a history of progressive dizziness, frequent syncopal attacks, and repetitive blurred vision in the left eye. She had undergone repeat transthoracic bypass surgeries, including grafting with the use of a Gore-Tex (W.L. Gore & Associates, Inc., Flagstaff, AZ) prosthesis between the left external ilioaxillary bypass and the left CCA. However, cerebral angiography demonstrated total occlusion of the left CCA, the right ICA, and the bilateral subclavian arteries. On admission, I-iodoamphetamine single-photon emission computed tomography showed a decreased cerebrovascular reactivity to acetazolamide in the bilateral cerebral hemispheres. Moreover, cerebral angiography revealed an occlusion of the Gore-Tex graft, whereas the left ICA was opacified through the retrograde filling in the left external carotid artery. INTERVENTION: Crossover bypass grafting was performed using the saphenous vein between the right CCA and the left ICA. The Gore-Tex graft was partially removed, and myointimal hypertrophy with an inflammatory response around the wall was found histologically. The postoperative course was uneventful. A normalized cerebrovascular reserve in both cerebral hemispheres was demonstrated on I-iodoamphetamine single-photon emission computed tomography. CONCLUSION: Although it is not frequently indicated, crossover bypass grafting using the saphenous vein between bilateral carotid arteries is considered to be a feasible alternative procedure in patients with Takayasu arteritis.This is a non-final version of an article published in final form in Neurosurgery, 65(5), pp.1178-1179; 2008

Treatment with buckwheat bran extract prevents the elevation of serum triglyceride levels and fatty liver in KK-Ay mice.

Buckwheat powder or protein has been shown to decrease the total serum cholesterol level in non-diabetic mice or rats. However, the lipid-lowering effect of buckwheat bran extract (BBE) in diabetic mice has not been fully elucidated. KK-Ay mice that received six-week treatment with BBE showed decreased body weight and liver weight compared to those of control (vehicle) mice. However, there was no significant difference in food intake. BBE treatments prevented liver triglyceride accumulation and decreased the serum level of triglycerides. In addition, mRNA expression levels lipogenic enzyme genes, fatty acid synthase, acetyl-coenzyme a oxidase and stearyl-coenzyme a desaturase 1, but not those of β-oxidized enzyme genes, were decreased in BBE-treated mice. Level of transcription factors ChREBP and SREBP1c, transcripts of lipogenic genes, were also decreased in BBE-treated mice. These results suggest that chronic treatment with BBE derivatives could have beneficial effects on hypertriglycemia in patients with type 2 diabetes mellitus

Role of Regulatory T Cells in Tumor-Bearing Mice Treated with Allo-Hematopoietic Stem Cell Transplantation Plus Thymus Transplantation

We recently developed a new allogeneic hematopoietic stem cell transplantation method (allo-HSCT) combined with thymus transplantation (TT) from the same donor (allo-HSCT + TT). This method induces elevated T cell function with mild graft-versus-host disease (GVHD) in comparison to conventional HSCT alone and HSCT + donor lymphocyte infusion (DLI). This new method is effective against several intractable diseases, including malignant tumors, for which conventional treatments are ineffective. Regulatory T (Treg) cells play an important role in the enhanced graft-versus-tumor (GVT) effect and reduction of GVHD, thus leading to longer survival. Replacement and reduction of elevated Treg cells by donor-derived allo-Treg cells from the transplanted thymus may play one of crucial roles in the effect. This review discusses the role of Treg cells in a tumor-bearing mouse model treated with allo-HSCT + TT

Correlation of Loss of CD4 T Cells with Plasma Levels of Both Soluble Form Fas (CD95) and Fas Ligand (FasL) in HIV-Infected Infants

Fas and Fas ligand (FasL), members of the TNFR and TNF families of molecules involved in apoptosis, respectively, are expressed in membrane-associated as well as soluble forms. Soluble Fas (sFas) and sFasL were evaluated in sequential samples from 16 HIV-infected and 11 HIV-exposed uninfected infants at ages 0–13 months. Regardless of the state of infection, age-dependent decreases in peripheral CD4 T cell counts and increases in sFas and sFasL were noted. However, decreases of the percentage CD4 T cells were more prominent in HIV-infected infants, and this was correlated significantly with increased plasma levels of sFas and sFasL (P = 0.002 and 0.004, respectively). Moreover, the levels of sFas in HIV-infected infants were found to be directly correlated with plasma HIV RNA (P = 0.03) and were significantly increased as early as age <1 month and prior to the onset of CD4 T cell decline. In uninfected infants, there was no such correlation between CD4 counts and the levels of sFas/sFasL. Plasma levels of sFas and sFasL may thus be important indicators of disease progression in perinatal HIV infection

Expressions of Fas (Cd95) and Fas Ligand in HIV Infected Individuals

To gain insights into mechanisms of accelerated lymphocyte apoptosis in HIV disease, we evaluated the expression of membrane bound Fas ligand (FasL) and Fas in PBMC and soluble forms of FasL (sFasL) and Fas (sFas) in plasma from HIV+ individuals and HIV− healthy volunteers. Surface FasL was detectable on monocytes, but poorly so on lymphocytes. Unexpectedly, monocytes expressed less FasL in HIV+ patients than in HIV− volunteers. Levels of sFasL in plasma of HIV+ individuals were elevated and correlated with plasma HIV RNA burden. Levels of sFas in plasma of HIV+subjects were also elevated and correlated with Fas expression in apoptotic lymphocytes. Finally, culture-induced lymphocyte apoptosis of HIV+ subjects was enhanced by anti-Fas agonistic Ab, but was not inhibited by anti-FasL blocking Abs. These results suggest that significant dysregulation of both Fas and FasL occurs in HIV infection, and that this contributes to increased sensitivity of lymphocytes to undergo apoptosis

「科学ジャーナリズム」はジャーナリズムの言葉で語れるか

第Ⅵ部　一般論文 第2章保坂直紀［読売新聞社科学部