iPS細胞化技術を用いた慢性骨髄性白血病幹細胞分画におけるイマチニブ耐性機構の解明

学位の種別: 課程博士審査委員会委員 : (主査)東京大学教授 岡崎 仁, 東京大学教授 長村 文孝, 東京大学准教授 菱川 慶一, 東京大学講師 細谷 紀子, 東京大学講師 河津 正人University of Tokyo(東京大学

Rectus sheath hematoma in an elderly woman under anti-coagulant therapy

Rectal sheath hematoma has been a well-known clinical entity from the ruin of the ancient Greece. It is relatively rare, however, to encounter this abdominal disorder in the clinical setting. Furthermore, the initial symptoms of rectus sheath hematoma are often similar to those of acute abdominal disorders. Therefore, the majority of the patients with rectus sheath hematoma have been treated with operative procedures because of the difficulty of a differential diagnosis from other abdominal disorders. We recently treated a 74-year female diagnosed with rectus sheath hematoma with the anticoagulants after an episode of cerebral infarction. From the findings of the physical examinations, ultrasound, and computed tomography, we could correctly diagnose, and could treat her with completely conservative methods without any invasive techniques. It is stressed that it is important to recognize this entity of rectus sheath hematoma when patients are examineed, after complaining of acute abdominal pain and with evidence abdominal masses in the clinical setting

Repair of incisional hernia with prolene hernia system

A 70-year-old woman was admitted to our hospital with a complaint of bulging in the right lower portion of the abdomen. The bulging was in accordance with an old operative scar for appendicitis. The findings of computed tomography (CT) showed defects in the abdominal muscles and the protrusion of the intestine into the subcutaneous fat. The patient was diagnosed with incisional hernia after appendectomy and underwent are pair of the incisional hernia, using the prolene hernia system double-layer mesh. The patient’s post-operative course was excellent. Recently, the prolene hernia system, double-layer mesh was reported to be effective for groin hernias due to its advantageous protection the recurrence through reinforcement of the patient’s myopectrial orifice. It is suggested that this new device is also useful for small incisional hernias

Perioperative immune responses in cancer patients undergoing digestive surgeries

<p>Abstract</p> <p>Background</p> <p>Th1/Th2 cell balance is thought to be shifted toward a Th2-type immune response not only by malignancy but also by surgical stress. The aim of this study was to estimate perioperative immune responses with respect to the Th1/Th2 balance in patients with gastrointestinal cancer.</p> <p>Methods</p> <p>Ninety-four patients who underwent abdominal surgeries were divided into three groups: gastric resection (n = 40), colorectal resection (n = 34) and hepatic resection (n = 20). Twelve patients undergoing laparoscopic cholecystectomy and 20 healthy subjects were served as control groups. Intracellular cytokine staining in CD4+ T lymphocytes was identified to characterize Th1/Th2 balance. Th1/Th2 balance was evaluated before operation and until postoperative days (POD) 14.</p> <p>Results</p> <p>The preoperative Th1/Th2 ratio was significantly lower in patients with malignancy compared with control. The Th1/Th2 ratio of patients in all groups decreased significantly postoperatively. Th1/Th2 balance on POD 2 in patients with malignancy was significantly decreased compared to patients with laparoscopic cholecystectomy, but there were no significant differences among the four groups on POD 14.</p> <p>Conclusion</p> <p>Patients with malignancy showed an abnormal perioperative Th1/Th2 balance suggesting predominance of a type-2 immune response. Major abdominal surgeries induce a marked shift in Th1/Th2 balance toward Th2 in the early postoperative stage.</p

Experimental study of combined treatment with tacrolimus and donor splenocytes via the portal vein in small bowel transplantation

We previously reported that the combined treatment of perioperative administration of donor splenocytes via the recipient's portal vein (DSPV) and a short-course Tacrolimus significantly prolonged the survival of fully allogenic grafts in rat small bowel transplantation (SBTX). In the present study we examined whether this effect depended on the quantity of the administered alloantigens in DSPV. In addition, we examined the expression of the surface antigen on T cells of the splenocytes and the induced toleragenic factor, according to the tolerant recipients which in our previous report had shown the prolongation of allogenic transplant small bowel graft survival by the combined treatment of DSPV (1×108 donor splenocytes) and a short-course Tacrolimus. Donor splenocytes were prepared from Brown-Norway (BN (RT1n)) rat spleens for Lewis (LEW (RT1l)) recipients. The recipients (n=10), treated with a short course of Tacrolimus (0.5mg/kg, 0 to 3 days postoperatively) only showed graft rejection with an average of 6.3±1.0 days postoperatively. However, the combined treatment, consisting of DSPV of 1×108 donor splenocytes and a short course Tacrolimus significantly prolonged graft survival to 12.7±2.1 days (n=12, P<0.01). DSPV of less than 1×108 donor splenocytes (5×107 cells and 2.5×107) could not prolong the graft or animal survival under a short-course Tacrolimus treatment. In the tolerant recipients, the CD4 and CD8 percentages of splenocytes were not significantly different from those of control rats or recipients that were treated with short-course Tacrolimus alone. Neverthless, the percentage of Tcr-αβ+ cells expressing IL-2 receptor (R) was significantly lower than in either control rats or the recipients with short-course Tacrolimus. In the suppression assay to one-way mixed lymphocyte response, a toleragenic factor was suggested to the present in the serum of the tolerant recipients. In the present study, it was suggested that the effects of the combined treatment of DSPV and short-course Tacrolimus for the prolongation of graft survival in the rat allogenic SBTX should depended on the quantity of the antigens administered into the portal vein. The beneficial effects of this treatment were reflected in the suppression of IL-2R on the recipient's splenocytes, and tolerogenic factor(s) might subsequently be induced in the tolerant recipient's serum

Dissolved methane oxidation and competition for oxygen in down-flow hanging sponge reactor for post-treatment of anaerobic wastewater treatment

Post-treatment of anaerobic wastewater was undertaken to biologically oxidize dissolved methane, with the aim of preventing methane emission. The performance of dissolved methane oxidation and competition for oxygen among methane, ammonium, organic matter, and sulfide oxidizing bacteria were investigated using a lab-scale closed-type down-flow hanging sponge (OHS) reactor. Under the oxygen abundant condition of a hydraulic retention time of 2 h and volumetric air supply rate of 12.95 m(3)-air m(-3) day(-1), greater than 90% oxidation of dissolved methane, ammonium, sulfide, and organic matter was achieved. With reduction in the air supply rate, ammonium oxidation first ceased, after which methane oxidation deteriorated. Sulfide oxidation was disrupted in the final step, indicating that COD and sulfide oxidation occurred prior to methane oxidation. A microbial community analysis revealed that peculiar methanotrophic communities dominating the Methylocaldum species were formed in the DHS reactor operation. (C) 2011 Elsevier Ltd. All rights reserved

Sivelestat Sodium Hydrate ト エンドトキシン キュウチャク リョウホウ トノ ヘイヨウ リョウホウ ガ ユウヨウ デ アッタ ARDS ノ イチレイ

We report here a case of Acute Respiratory Distress Syndrome（ARDS）due to perforation of the sigmoid colon, for which therapy with Sivelestat Sodium Hydrate（SSH, Elaspol）and Polymyxin B-immobilized Direct Hemoperfusion（PMX-DHP）was shown to be effective. An 88-yearold woman was admitted to our hospital because of abdominal pain. Abdominal computed tomography showed free air present in the liver and near the sigmoid colon. These results suggested sigmoid colon perforation, and we performed Hartmann’s operation and drainage. After operation, her blood pressures and the PaO2/FiO2 ratio decreased. The patient was then diagnosed septic shock and ARDS ; and PMX-DHP was performed, followed by the initiation of SSH administration. After therapy, she showed improvements in her conditions of septic shock and ARDS. It is inferred that therapy with PMX-DHP and SSH is effective for ARDS in view of an observed two-fold suppression in vascular endothelial cell damage

ダイチョウ センコウ ショウレイ ニ タイスル エンドトキシン キュウチャク リョウホウ ノ ケントウ

The aim of this retrospective study was to investigate the therapeutic results of Polymyxin Bimmobilized Direct Hemoperfusion（PMX-DHP）for colorectal perforation. The study subjects were 40 patients with colorectal perforation surgically treated from 1993 through 2004, of whom 18 underwent PMX-DHP after operation（P group）and 22 underwent operations only（N group）. Although there was no significant difference between the two groups in the overall mortality rate, the mortality rate for ARDS was significantly lower in the P group than in the N group. There was a statistically significant correlation between the P/F ratio and the time interval from the disease onset（r=－0.590, p=0.0009<0.001）. The time lag from disease onset to operation and the length of PMX-DHP period were significantly longer in the death group than in the survivor group. We anticipate that PMX-DHP for colorectal perforation proves effective in reducing deaths from ARDS. For an effective facilitation of PMX-DHP, the procedure should be started as soon as possible from the onset of the disease