Post‐transplant Lymphoproliferative Disorders After Liver Transplantation: A Retrospective Cohort Study Including 1954 Transplants

Post-transplant lymphoproliferative disorders (PTLDs) are life-threatening neoplasms after organ transplantation. Because of their rarity and multiple grades of malignancy, the incidence, outcomes, and clinicopathological features affecting patient survival after liver transplantation (LT) remain unclear. We reviewed 1954 LTs in 1849 recipients (1990-2020), including 886 pediatric (<18 years of age) and 963 adult recipients. The following clinicopathological factors were studied: age, sex, liver etiologies, malignancy grades, Epstein-Barr virus status, performance status (PS), Ann Arbor stage, international prognostic index, and histopathological diagnosis. Of 1849 recipients, 79 PTLD lesions (4.3%) were identified in 70 patients (3.8%). After excluding 3 autopsy cases incidentally found, 67 (45 pediatric [5.1%] and 22 adult [2.3%]) patients were finally enrolled. Comorbid PTLDs significantly worsened recipient survival compared with non-complicated cases (P < 0.001). The 3-year, 5-year, and 10-year overall survival rates after PTLD diagnosis were 74%, 66%, and 58%, respectively. The incidence of PTLDs after LT (LT-PTLDs) was significantly higher (P < 0.001) with earlier onset (P = 0.002) in children, whereas patient survival was significantly worse in adults (P = 0.002). Univariate and multivariate analyses identified the following 3 prognostic factors: age at PTLD diagnosis ≥18 years (hazard ratio [HR], 11.2; 95% confidence interval [CI], 2.63-47.4; P = 0.001), PS ≥2 at diagnosis (HR, 6.77; 95% CI, 1.56-29.3; P = 0.01), and monomorphic type (HR, 6.78; 95% CI, 1.40-32.9; P = 0.02). A prognostic index, the “LT-PTLD score, ” that consists of these 3 factors effectively stratified patient survival and progression-free survival (P = 0.003 and <0.001, respectively). In conclusion, comorbid PTLDs significantly worsened patient survival after LT. Age ≥18 years and PS ≥2 at PTLD diagnosis, and monomorphic type are independent prognostic factors, and the LT-PTLD score that consists of these 3 factors may distinguish high-risk cases and guide adequate interventions

聖隷クリストファー大学リハビリテーション学部における2016 年度ピアレビュー実施状況とアンケート調査結果報告

実践報告Practical reports　本報告では，聖隷クリストファー大学リハビリテーション学部において2016 年度春セメスターに実施したピアレビューの実施方法と実施状況，アンケート調査結果について報告し，ピアレビュー実施の意義と今後の課題について整理をした．アンケート調査の結果から，ピアレビューについて自分では気づけない授業改善に役立つ指摘がもらえたことを「よかった」と感じている教員がほとんどであり，ピアレビューがFD 活動を行っていくうえで有意義な機会となることが確認された．しかし，評価項目の項目内容や項目数，記述方法の工夫，レビュアーの選出やピアレビューの実施にあたりレビュイー，レビュアー双方が負担を生じないために必要な配慮について学部FD 委員会から促す等の改善を要する点も明らかとなった．　The current study describes the method of faculty peer reviews and the status of faculty peer reviews implemented in the spring semester of 2016, and reported the results of a questionnaire survey about the peer reviews, in order to gain insight about the significance of the peer reviews and future issues. The results of the survey showed that most of the faculty members felt that it was good to be able to receive feedback that they would not otherwise have received, as the feedback would be useful in improving the quality of their teaching. The results suggested that the peer reviews would provide a meaningful opportunity in conducting faculty development (FD) activities. However, the results also revealed that improvements were needed about the content and the number of items, rating methods by reviewers, and selection of reviewers. In addition, it would be helpful for the FD committee to encourage peer review to be performed with consideration on reviewer-reviewee relationships so that the peer review process would not become a burden on both the reviewee and the reviewer

Study of Nonthermal Emission from SNR RX J1713.7-3946 with Suzaku

We present results obtained from a series of observations of the supernova remnant RX J1713.7-3946 by the Suzaku satellite. The observations cover about two-thirds of the remnant surface. We successfully detected hard X-rays up to ~ 40 keV from each pointing. The hard X-ray spectra are described by power-law functions with photon indices of ~ 3.0, which are larger than those in the energy region below 10 keV. Connection of the spatially-integrated XIS and HXD spectra clearly reveals a spectral cutoff in the 0.4--40 keV X-ray spectrum. This cutoff is interpreted to correspond to the maximum acceleration energy of electrons emitting synchrotron radiation. The wide-band coverage of Suzaku for the first time allows us to derive the parent electron spectrum in the cutoff region, which shows good agreement with theoretical predictions. The inferred cutoff energy in the spatially-integrated X-ray spectrum indicates that particle acceleration in the remnant is so efficient that it is almost at the theoretical limit, the so-called Bohm limit. Based on the Suzaku data, we present results of multi-wavelength studies from spectral and morphological points of view. The spectral energy distribution favors the hadronic scenario rather than the leptonic scenario. For the morphology studies, we compare the surface brightness maps from the Suzaku XIS and the H.E.S.S. telescope. We confirm the strong correlation between X-ray and TeV gamma-ray emission. In addition to the correlation, we found that in the bright western rim regions the X-ray emission is brighter than expected from the general X-ray to gamma-ray correlation.Comment: 16 pages, 22 figures, accepted for publication in Ap

The ASTRO-H X-ray Observatory

The joint JAXA/NASA ASTRO-H mission is the sixth in a series of highly successful X-ray missions initiated by the Institute of Space and Astronautical Science (ISAS). ASTRO-H will investigate the physics of the high-energy universe via a suite of four instruments, covering a very wide energy range, from 0.3 keV to 600 keV. These instruments include a high-resolution, high-throughput spectrometer sensitive over 0.3-2 keV with high spectral resolution of Delta E < 7 eV, enabled by a micro-calorimeter array located in the focal plane of thin-foil X-ray optics; hard X-ray imaging spectrometers covering 5-80 keV, located in the focal plane of multilayer-coated, focusing hard X-ray mirrors; a wide-field imaging spectrometer sensitive over 0.4-12 keV, with an X-ray CCD camera in the focal plane of a soft X-ray telescope; and a non-focusing Compton-camera type soft gamma-ray detector, sensitive in the 40-600 keV band. The simultaneous broad bandpass, coupled with high spectral resolution, will enable the pursuit of a wide variety of important science themes.Comment: 22 pages, 17 figures, Proceedings of the SPIE Astronomical Instrumentation "Space Telescopes and Instrumentation 2012: Ultraviolet to Gamma Ray

The Quiescent Intracluster Medium in the Core of the Perseus Cluster

Clusters of galaxies are the most massive gravitationally-bound objects in the Universe and are still forming. They are thus important probes of cosmological parameters and a host of astrophysical processes. Knowledge of the dynamics of the pervasive hot gas, which dominates in mass over stars in a cluster, is a crucial missing ingredient. It can enable new insights into mechanical energy injection by the central supermassive black hole and the use of hydrostatic equilibrium for the determination of cluster masses. X-rays from the core of the Perseus cluster are emitted by the 50 million K diffuse hot plasma filling its gravitational potential well. The Active Galactic Nucleus of the central galaxy NGC1275 is pumping jetted energy into the surrounding intracluster medium, creating buoyant bubbles filled with relativistic plasma. These likely induce motions in the intracluster medium and heat the inner gas preventing runaway radiative cooling; a process known as Active Galactic Nucleus Feedback. Here we report on Hitomi X-ray observations of the Perseus cluster core, which reveal a remarkably quiescent atmosphere where the gas has a line-of-sight velocity dispersion of 164+/-10 km/s in a region 30-60 kpc from the central nucleus. A gradient in the line-of-sight velocity of 150+/-70 km/s is found across the 60 kpc image of the cluster core. Turbulent pressure support in the gas is 4% or less of the thermodynamic pressure, with large scale shear at most doubling that estimate. We infer that total cluster masses determined from hydrostatic equilibrium in the central regions need little correction for turbulent pressure.Comment: 31 pages, 11 Figs, published in Nature July