Increased number and altered phenotype of lymphatic vessels in peripheral lung compartments of patients with COPD

Background: De novo lymphatic vessel formation has recently been observed in lungs of patients with moderate chronic obstructive pulmonary disease (COPD). However, the distribution of lymphatic vessel changes among the anatomical compartments of diseased lungs is unknown. Furthermore, information regarding the nature of lymphatic vessel alterations across different stages of COPD is missing. This study performs a detailed morphometric characterization of lymphatic vessels in major peripheral lung compartments of patients with different severities of COPD and investigates the lymphatic expression of molecules involved in immune cell trafficking. Methods: Peripheral lung resection samples obtained from patients with mild (GOLD stage I), moderate-severe (GOLD stage II-III), and very severe (GOLD stage IV) COPD were investigated for podoplanin-immunopositive lymphatic vessels in distinct peripheral lung compartments: bronchioles, pulmonary blood vessels and alveolar walls. Control subjects with normal lung function were divided into never smokers and smokers. Lymphatics were analysed by multiple morphological parameters, as well as for their expression of CCL21 and the chemokine scavenger receptor D6. Results: The number of lymphatics increased by 133% in the alveolar parenchyma in patients with advanced COPD compared with never-smoking controls (p < 0.05). In patchy fibrotic lesions the number of alveolar lymphatics increased 20-fold from non-fibrotic parenchyma in the same COPD patients. The absolute number of lymphatics per bronchiole and artery was increased in advanced COPD, but numbers were not different after normalization to tissue area. Increased numbers of CCL21- and D6-positive lymphatics were observed in the alveolar parenchyma in advanced COPD compared with controls (p < 0.01). Lymphatic vessels also displayed increased mean levels of immunoreactivity for CCL21 in the wall of bronchioles (p < 0.01) and bronchiole-associated arteries (p < 0.05), as well as the alveolar parenchyma (p < 0.001) in patients with advanced COPD compared with never-smoking controls. A similar increase in lymphatic D6 immunoreactivity was observed in bronchioles (p < 0.05) and alveolar parenchyma (p < 0.01). Conclusions: This study shows that severe stages of COPD is associated with increased numbers of alveolar lymphatic vessels and a change in lymphatic vessel phenotype in major peripheral lung compartments. This novel histopathological feature is suggested to have important implications for distal lung immune cell traffic in advanced COPD

Frequent Consumption of Vegetables and The Decreased Risk of Ovarian Cancer

A case-control study was conducted to assess the relationship of dietary habits to ovarian cancer. A uniform questionnaire was filled out by 44 ovarian cancer cases hospitalized at Sapporo Medical University or 2 other hospitals in Sapporo between August and norember, 1990. Two hundred twenty individually locality-matched controls were selected from telephone books and sent the same questionnaire ; 156 (70.9%) responded. The conditional logistic regression anal-ysis was used to compare the data of 44 ovarian cancer cases and the 156 individ-ually age-matched controls. Univariate analysis revealed that single marital sta-tus was significantly associated with the increased risk of ovarian cancer (odds ratio, or OR=3.45, 95% confidence interval, or 95%CI 1.13-10.84). Frequent intake of midnight meals was also significantly related to the increased risk (trend, OR=1.56, 95%CI 1.01-2.41), and frequent intake of vegetables other than yellow or red was significantly related to the decreased risk (trend, OR= 0.58, 95%CI 0.37-0.91). These odds ratios concerning dietary habits were not substantially altered even after adjustment for potentially distorting variables such as marital status, the number of parities, and family history for uterine, ovarian, or breast cancer with the multivariate analysis. No other dietary habits, including frequent consumption of meat, fish, or milk, were associated with the increase or decrease of the risk of ovarian cancer

Appearance of remodelled and dendritic cell-rich alveolar-lymphoid interfaces provides a structural basis for increased alveolar antigen uptake in chronic obstructive pulmonary disease.

RATIONALE: The alveolar pathology in chronic obstructive pulmonary disease (COPD) involves antigen-driven immune events. However, the induction sites of alveolar adaptive immune responses have remained poorly investigated. OBJECTIVES: To explore the hypothesis that interfaces between the alveolar lumen and lymphoid aggregates (LAs) provide a structural basis for increased alveolar antigen uptake in COPD lungs. METHODS: Lung samples from patients with mild (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage I), moderate-severe (GOLD II-III), and very severe (GOLD IV) COPD were subjected to detailed histological assessments of adaptive immune system components. Never smokers and smokers without COPD served as controls. RESULTS: Quantitative histology, involving computerised three-dimensional reconstructions, confirmed a rich occurrence of alveolar-restricted LAs and revealed, for the first time, that the vast majority of vascular or bronchiolar associated LAs had alveolar interfaces but also an intricate network of lymphatic vessels. Uniquely to COPD lungs, the interface epithelium had transformed into a columnar phenotype. Accumulation of langerin (CD207)(+) dendritic cells occurred in the interface epithelium in patients with COPD but not controls. The antigen-capturing capacity of langerin(+) dendritic cells was confirmed by increased alveolar protrusions and physical T cell contact. Several of these immune remodelling parameters correlated with lung function parameters. CONCLUSIONS: Severe stages of COPD are associated with an emergence of remodelled and dendritic cell-rich alveolar-lymphoid interfaces. This novel type of immune remodelling, which predicts an increased capacity to respond to alveolar antigens, is suggested to contribute to aggravated inflammation in COPD

Achievement levels of students on clinical nursing practice for chronic illness

実習目標の到達度及び実習目標間の関係を明らかにするために,74名の学生による実習目標の自己評価を分析した｡その結果,実習目標の到達度は,｢自己の看護観や自己成長を培う｣が最も高かった｡そして｢疾患の病態生理や検査･治療についての理解と看護援助｣｢セルフケアに向けた看護援助｣｢危機に直面している患者の看護援助｣などの看護実践面に関する目標が高値を示していた｡学生は目標に沿った看護を実践する中で,経験したひとつひとつのケアを意味づけたり,看護とは何かを探求していったと思われ,それが看護観の形成や自己成長につながっていったものと考えられた｡実習目標間の関係では,各実習目標との間に相関が見られ,それらは信頼性のある妥当な慢性期看護実習の目標であることが確認された｡This paper is designed to demonstrate the relationships between each objective and the students' achievement levels for the objectives of clinical nursing practice. Seventy four students evaluated their own achievement levels related to their clinical nursing practice. Evaluation scores for each objective were analyzed. The following results were obtained: The objective of cultivating the view of nursing and developing themselves had the highest score. Understanding the mechanism of disease, physical examination and treatment, and patient care, understanding nursing care toward patient's self care, and understanding nursing care for patient in crisis had high scores. The students, through their own nursing care, explored the meaning of each care (or each experience) and inquired about the nature of nursing. Their view of nursing and self development was formed from their own various experiences. Correlation among each objective was found. Each for clinical nursing practice has reliability and validity

Sarcopenia and AGEs in type 1 diabetes

Accumulation of advanced glycation end-products (AGEs) is thought to contribute to muscle weakness in a diabetic animal model. Skin autofluorescence is a proposed marker for accumulation of AGEs in the skin. We aimed to investigate the relationship between AGEs accumulation, sarcopenia and muscle function of Japanese patients with type 1 diabetes. A total of 36 patients with type 1 diabetes participated in the present cross-sectional study. Sarcopenia parameters (skeletal muscle mass index and knee extension strength) were compared with subcutaneous AGEs accumulation using skin autofluorescence. The prevalence of sarcopenia and impaired knee extension strength was 16.6% (men 0.0%, women 22.2%) and 47.2% (men 22.2%, women 55.6%), respectively. Knee extension strength was negatively correlated with skin autofluorescence (r² = 0.14, P < 0.05), but not with skeletal muscle mass index. In conclusion, the AGEs accumulation might be one of the reasons of impaired lower limb muscle function in Japanese patients with type 1 diabetes

Radiation Myelopathy Caused by Palliative Radiotherapy and Intrathecal Methotrexate

Radiation myelopathy is a rare, late-stage adverse event that develops following irradiation at or above 50 Gy. Here, we report a case of irreversible paraplegia caused by palliative radiation (20 Gy in 5 fractions) to the spinal cord combined with intrathecal methotrexate (IT-MTX). A 69-year-old man presented with back pain, prompting a diagnosis of acute myeloid leukemia. At the first visit, he complained of muscle weakness and hypoesthesia in both legs; spinal magnetic resonance imaging (MRI) revealed an epidural mass compressing the spinal cord at the fifth to seventh level of the thoracic vertebrae. This was considered to be an extramedullary lesion of leukemia, and he received remission induction therapy including IT-MTX; palliative radiation (20 Gy in 5 fractions) of the epidural mass was initiated the following day. Then, during the course of consolidation therapy, a second IT-MTX was performed after 1 month and a third after 3 months. While the consolidation therapy was complete, yielding remission, he developed sudden paraplegia, as well as bladder and bowel dysfunction (BBD), 10 months later. Spinal MRI showed extensive intramedullary high signal intensity on T2-weighted image, including the irradiation field. It was thought myelopathy was due to irradiation of the spinal cord combined with IT-MTX. He immediately received steroid pulse therapy; however, the paraplegia and BBD did not improve. It is extremely rare for irreversible radiation myelopathy to occur with IT-MTX and palliative radiation to the spinal cord. We believe that even with low-dose palliative radiation, caution is required for combined use with IT-MTX

A autopsy case of biliary fistula to the retroperitoneal space

A seventies age man was admitted complaining of epigastric pain. Computed tomography of the abdomen showed the fluid collection and inflammation in the retroperitoneal space besides pancreas. We suspected acute pancreatitis, and started the treatment by the medications. However, the treatment was not effective. Because we suspected of perforation, we underwent the operation. In the operation, there was a large amount of bile in the retroperitoneal space. We performed intraperitoneal drainage because of uncertain cause. After the operation, he got worse, and died on the ５５th day. The autopsy showed the biliary fistula at right hepatic duct to the retroperitoneal space. The biliary fistula to the retroperitoneal space was very rare case, therefore we must understand the pathological condition due to save the life

Deoxymugineic acid increases Zn translocation in Zn-deficient rice plants

Deoxymugineic acid (DMA) is a member of the mugineic acid family phytosiderophores (MAs), which are natural metal chelators produced by graminaceous plants. Rice secretes DMA in response to Fe deficiency to take up Fe in the form of Fe(III)–MAs complex. In contrast with barley, the roots of which secrete MAs in response to Zn deficiency, the amount of DMA secreted by rice roots was slightly decreased under conditions of low Zn supply. There was a concomitant increase in endogenous DMA in rice shoots, suggesting that DMA plays a role in the translocation of Zn within Zn-deficient rice plants. The expression of OsNAS1 and OsNAS2 was not increased in Zn-deficient roots but that of OsNAS3 was increased in Zn-deficient roots and shoots. The expression of OsNAAT1 was also increased in Zn-deficient roots and dramatically increased in shoots; correspondingly, HPLC analysis was unable to detect nicotianamine in Zn-deficient shoots. The expression of OsDMAS1 was increased in Zn-deficient shoots. Analyses using the positron-emitting tracer imaging system (PETIS) showed that Zn-deficient rice roots absorbed less 62Zn-DMA than 62Zn2+. Importantly, supply of 62Zn-DMA rather than 62Zn2+ increased the translocation of 62Zn into the leaves of Zn-deficient plants. This was especially evident in the discrimination center (DC). These results suggest that DMA in Zn-deficient rice plants has an important role in the distribution of Zn within the plant rather than in the absorption of Zn from the soil