Application of complement component 4d immunohistochemistry to ABO-compatible and ABO-incompatible liver transplantation.

Antibody-mediated rejection (AMR) is difficult to diagnose after ABO-compatible or ABO-identical (ABO-C) liver transplantation. To determine whether complement component 4d (C4d) immunostaining would be useful for diagnosing AMR, we compared the results of C4d immunohistochemistry for allograft biopsy samples with assays for anti-donor antibodies performed at the time of biopsy. One hundred fourteen patients with ABO-C grafts and 29 patients with ABO-incompatible (ABO-I) grafts were included. Linear C4d endothelial staining (identifiable with a 4× objective lens) or staining seen in 50% or more of the portal tracts was considered positive. Five of the 114 patients (4%) with ABO-C grafts and 15 of the 29 patients (52%) with ABO-I grafts showed C4d positivity. In the ABO-C cases, C4d positivity in late biopsy samples (≥30 days after transplantation) was associated with stage 2 or higher fibrosis (METAVIR score; P = 0.01) and with the presence of donor-specific anti-human leukocyte antigen DR antibodies (HLA-DR DSAs) with a mean fluorescence intensity > 5000 according to the Luminex single-antigen bead assay (P = 0.04). Conversely, the presence of HLA-DR DSAs was associated with the presence of stage 2 or higher fibrosis, acute cellular rejection, and C4d positivity. During the 2-year follow-up, neither C4d positivity nor HLA-DR DSAs were related to graft loss. Among ABO-I patients, C4d positivity was not associated with allograft dysfunction or fibrosis. Only 3 of the 15 C4d-positive patients (20%) showed periportal hemorrhagic edema, which could be a histological sign of AMR in ABO-I grafts, and they were the only cases associated with elevations in anti-donor A/B antibody titers. In conclusion, C4d endothelial positivity among ABO-C patients is an uncommon event that could be associated with chronic graft damage with or without clinical AMR. C4d positivity is common among ABO-I patients and may not be associated with allograft dysfunction if alloantibody titers are not elevated

On-The-Fly Observing System of the Nobeyama 45-m and ASTE 10-m Telescopes

We have developed spectral line On-The-Fly (OTF) observing mode for the Nobeyama Radio Observatory 45-m and the Atacama Submillimeter Telescope Experiment 10-m telescopes. Sets of digital autocorrelation spectrometers are available for OTF with heterodyne receivers mounted on the telescopes, including the focal-plane 5 x 5 array receiver, BEARS, on the 45-m. During OTF observations, the antenna is continuously driven to cover the mapped region rapidly, resulting in high observing efficiency and accuracy. Pointing of the antenna and readouts from the spectrometer are recorded as fast as 0.1 second. In this paper we report improvements made on software and instruments, requirements and optimization of observing parameters, data reduction process, and verification of the system. It is confirmed that, using optimal parameters, the OTF is about twice as efficient as conventional position-switch observing method.Comment: 11 pages, 13 figures, accepted for publication in PAS

Cbl-b DEFICIENCY AND MACROPHAGE ACTIVATION

We previously reported the potential involvement of casitas B-cell lymphoma-b (Cbl-b) in aging-related murine insulin resistance. Because obesity also induces macrophage recruitment into adipose tissue, we elucidated here the role of Cbl-b in obesity-related insulin resistance. Cbl-b+/+ and Cbl-b-/- mice were fed a high-fat diet (HFD) and then examined for obesity-related changes in insulin signaling. The HFD caused recruitment of macrophages into adipose tissue and increased inflammatory reaction in Cbl-b-/- compared with Cbl-b+/+ mice. Peritoneal macrophages from Cbl-b-/- mice and Cbl-b–overexpressing RAW264.7 macrophages were used to examine the direct effect of saturated fatty acids (FAs) on macrophage activation. In macrophages, Cbl-b suppressed saturated FA-induced Toll-like receptor 4 (TLR4) signaling by ubiquitination and degradation of TLR4. The physiological role of Cbl-b in vivo was also examined by bone marrow transplantation and Eritoran, a TLR4 antagonist. Hematopoietic cell-specific depletion of the Cbl-b gene induced disturbed responses on insulin and glucose tolerance tests. Blockade of TLR4 signaling by Eritoran reduced fasting blood glucose and serum interleukin-6 levels in obese Cbl-b-/- mice. These results suggest that Cbl-b deficiency could exaggerate HFD-induced insulin resistance through saturated FA-mediated macrophage activation. Therefore, inhibition of TLR4 signaling is an attractive therapeutic strategy for treatment of obesity-related insulin resistance

トウイン ニオケル セツジョ フノウ キョクショ シンコウ ショクドウガン ノ チリョウ セイセキ

【背景】遠隔転移のない切除不能局所進行食道癌に対する標準治療は根治的化学放射線療法(CRT)だが，近年Docetaxel/5-FU/ Cisplatin 療法をはじめとした導入化学療法（ICT）からの外科的切除の有用性が報告されている．今回，当院での切除不能局所進行食道癌に対する治療成績について検証した．【対象と方法】2016年から2019年の期間で，当院で治療した切除不能局所進行食道癌9例(リンパ節T4bも含む)を対象とした．【結果】男性：6例，女性：3例．年齢：中央値 64（41-78）歳．腫瘍主占居部位：Ut/Mt/Lt=1/7/1．浸潤臓器:気管/左主気管支/大動脈=2/4/3，cN0/1/2=1/3/5，初回治療: ICT/CRT=7/2であった．初回治療別に検証すると，奏効率:ICT/CRT=5(71.4%)/0(0%)であり，ICTにて奏効が得られた5例は根治切除可能と判断し，4例（80％）でR0切除が得られた．術後合併症は，縫合不全0例，肺炎1例(20%)，反回神経麻痺2例(40%)であった．術後在院日数中央値は16日(13-21)であった．R0切除4例は全例1年以上の生存が得られているが，2例で再発(リンパ節再発1例，肺・リンパ節再発1例)を認めた．R1切除例はCRTを追加し，術後2年無再発生存中である．根治切除を施行していない4例の初回治療からの1年生存率は25％と予後不良であった．【結語】切除不能局所進行食道癌であってもICTを組み入れることでconversion surgeryが安全に施行され，高いR0切除率が得られ，予後の延長に寄与する可能性がある．Background:Recently, the usefulness of surgical resection after induction chemotherapy (ICT) including Docetaxel / 5-FU / Cisplatin therapy for locally advanced esophageal cancer has been reported. Methods:Nine patients with locally advanced unresectable esophageal cancer who underwent multidisciplinary treatment in our hospital from 2016 to 2019 were eligible for this study. Results:The patients’ characteristics included a median age of 64 years; the male/female ratio of 6/3; Tumor main occupancy site Ut / Mt / Lt = 1/7/1; Invading adjacent organs: trachea / left main bronchus / aorta; 2/4/3, Lymph node metastasis (0/1/2); 1/3/5, and initial treatment ICT / CRT; 7/2. Response rate of ICT were 71.4% (5 cases) and that of CRT were 0%. Four patients (80%) of 5 patients who responded to ICT were underwent R0 resection. Postoperative complications were anastomotic leakage in 0 cases, pneumonia in 1 case (20%), and recurrent nerve paralysis in 2 cases (40%). The median length of hospital stay after surgery was 16 days. All 4 cases of R0 resection had survived for 1 year or more. The 1-year survival rate from the initial treatment of 4 patients who did not undergo radical resection was 25%. Conclusion:Conversion surgery after ICT for locally advanced unresectable esophageal cancer may contribute to a high R0 resection rate and better clinical outcomes

『現代日本語書き言葉均衡コーパス』の文境界修正

国立国語研究所 コーパス開発センター 非常勤研究員マンパワーグループ株式会社国立国語研究所 理論・構造研究系 非常勤研究員国立国語研究所 コーパス開発センター 非常勤研究員国立国語研究所 言語資源研究系国立国語研究所 コーパス開発センター 技術補佐員(元)国立国語研究所 コーパス開発センター プロジェクト研究員文部科学省国立国語研究所 言語資源研究系国立国語研究所 言語資源研究系国立国語研究所 言語資源研究系国立国語研究所 言語資源研究系国立国語研究所 言語資源研究系Adjunct Researcher, Center for Corpus Development, NINJALManpower Group Co., LtdAdjunct Researcher, Department of Linguistic Theory and Structure, NINJALAdjunct Researcher, Center for Corpus Development, NINJALDepartment of Corpus Studies, NINJAL(former) Technical Staff, Center for Corpus Development, NINJALPostdoctoral Research Fellow, Center for Corpus Development, NINJALMinistry of Education, Culture, Sports, Science, and TechnologyDepartment of Corpus Studies, NINJALDepartment of Corpus Studies, NINJALDepartment of Corpus Studies, NINJALDepartment of Corpus Studies, NINJALDepartment of Corpus Studies, NINJAL『現代日本語書き言葉均衡コーパス』第1.0版(Maekawa et al. 2014)(以下BCCWJ)には「文境界」の情報がアノテーションされているが,その認定基準の妥当性について従来から様々な指摘がある(小西ほか2014,長谷川2014,田野村2014)。この問題に対処するために,国立国語研究所コーパス開発センターでは2013年から2014年にかけて,BCCWJの修正を行った。本稿ではその修正作業について報告する。第1.0版におけるBCCWJ 文境界情報の問題は,コーパス構築の過程において文境界を含む文書構造タグの整備と形態素列レベルの情報の整備とを並行して行ったために,文字情報を用いる文境界処理にとどまったことに由来する。今回,形態論情報に基づいた文境界基準を策定し,問題の解消を試みた。文境界修正の指針を示すとともに,文境界修正に用いた作業環境と,修正件数について報告する。In December 2011, the National Institute for Japanese Language and Linguistics (NINJAL) released a 100-million-word balanced corpus - the Balanced Corpus of Contemporary Written Japanese (BCCWJ) DVD Version 1.0 - which was compiled from 2006 through 2011. Some users have pointed out some issues concerning sentence delimitation in the BCCWJ. To address these issues, we - NINJAL - performed a complete survey and correction, beginning in 2013 and ending in 2014. This article reports the revision work on sentence delimitation in the BCCWJ. The problems with the BCCWJ DVD Version 1.0 derive from the string-based definition. We could not obtain any morpheme information for the sentence delimitation task because of the task parallelism between sentence delimitation annotation and morpheme annotation. The method used this time was morpheme based. We present the morpheme-based annotation guidelines, annotation environment, and basic statistics of the corpus correction

トウイン ニオケル キョウクウ キョウカ ショクドウ セツジョ ノ ドウニュウ ト タンキ チリョウ セイセキ ノ ケントウ

【背景】食道癌に対する胸腔鏡手術は本邦で広く行われており、施設ごとに手術手技の定型化がなされている.胸腔鏡下手術の利点として拡大視効果や緻密な手術操作が可能となることが挙げられるが、当院でも2016年より腹臥位胸腔鏡下食道手術を導入し、出血の少ない安全かつ確実な郭清を目指し、定型化に向けてその手技を刷新している.【対象と方法】】2016年4月から2019年4月までに当院で施行した胸腔鏡下食道切除38例につき、その短期成績を検討した.【結果】男:女＝32:6、年齢中央値 66歳(41-76)、cStage I / II / III / IVa: 17 / 6 / 13 / 2であった.胸腔内出血量中央値は10ml(0-53)、胸部操作時間中央値は192分(97-478)、胸腔内郭清リンパ節個数中央値は17個(1-42)であった.術後合併症は、縫合不全3例(7.9％)、反回神経麻痺7例(18.4％)、肺炎12例(31.6％)であった.術後在院日数中央値は19日(11-38)であった.導入期からの前半19例では反回神経麻痺を6例(31.6％)に認めたが、後半19例では１例(5.2％)であった(p=0.036).【結語】当院における胸腔鏡下食道切除術は安全に導入、施行可能であった.手術手技が定型化されることで反回神経麻痺を少なくする郭清が可能になると考えられた.Background: Thoracoscopic esophagectomy (TE) is increasingly being used worldwide in patients with esophageal cancer. In this study, we investigated the clinical short-term outcomes of TE performed in patients placed in the prone position. Method: We investigated the surgical and clinical outcomes in 38 patients with esophageal cancer who underwent TE at our hospital between April 2016 and April 2019. Results: Of the 39 patients investigated, 32 were men. Median patient age was 66 (range 41–76) years, the median intraoperative blood loss was 10 (0–53) mL, and the median operation time for thoracoscopy was 192 (97–478) min. The mean operation time for thoracoscopy in the latter group was significantly shorter than that in the former group (188 min vs. 232 min, p=0.013). The following postoperative complications were observed: 7 (18.4%) cases of recurrent nerve palsy, 3 (7.9%) cases of anastomotic leakage, 12 (31.6%) cases of pneumonia, and 0 (0%) cases of chylothorax. The incidence of recurrent nerve palsy was lower in the latter group than in the former group (5.2% vs. 31.6%, p=0.036). Conclusions: TE in the prone position is safe and feasible. As experience performing the procedure increases, the performance of the procedure stabilizes

ノウホウナイ シュッケツ ニ トモナイ シンゴウ キョウド ノ コトナッタ タボウセイ ノウホウ オ テイシタ スイショウエキセイ ノウホウ センシュ ノ 1レイ

症例は33歳，女性．経時的に増大する膵体部嚢胞性病変を認めた．MRIではT1強調画像で低信号を呈する部位とT1強調画像で淡い高信号を呈する，信号強度の異なる大小不同の多房性嚢胞性病変を認め，MRCPおよび超音波内視鏡検査で主膵管拡張および腫瘍と主膵管との交通が疑われた．以上よりmixed typeの膵漿液性嚢胞腺腫を疑ったが粘液性嚢胞腺腫や膵管内乳頭粘液性腫瘍を否定できず，腹腔鏡下脾温存膵体尾部切除術を施行した．病理組織学的検査所見では卵巣様間質は認めず，主膵管交通も認めず，mixed typeの膵漿液性嚢胞腺腫と診断した．膵漿液性嚢胞腺腫は漿液性嚢胞液を有するが，異なった信号強度を呈する多房性嚢胞を有するものはまれである．今回われわれは，信号強度の異なった多房性嚢胞を呈した膵漿液性嚢胞腺腫の1例を経験したので報告する．A 33-year-old woman presented at our hospital with cystic tumor increased over time at pancreatic body. Magnetic resonance image revealed multilocular cysts with different signal intensities, which were mixed to low and slightly high intensities in T1 weighted image. Moreover, the connection of the cyst and main pancreatic duct was suspected by magnetic resonance cholangiopancreatography and endoscopic ultrasonography. We diagnosed as mixed-type serous cystadenoma, yet we could not contradict mucinous cystadenoma and intraductal papillary mucinous neoplasm. Therefore, we performed laparoscopic spleen preserved distal pancreatectomy. Histopathological findings revealed mixed-type serous cystadenoma, and the connection of the cyst and main pancreatic duct was not seen. Serous cystadenoma usually has serous discharge in the cyst and shows uniform signal intensity in the image findings. However, serous cystadenoma with different signal intensities in the multilocular cysts is relatively rare. We described a case of serous cystadenoma of the pancreas with different signal intensities in the multilocular cysts that was treated by laparoscopic surgery

カンサイボウガン ト カンベツ ガ コンナンデアッタ カンケッカンキン シボウシュ ノ １レイ

肝原発の血管筋脂肪腫（angiomyolipoma; AML）は、肝細胞癌と鑑別が困難な場合がある。今回、単発の肝腫瘍に対して肝細胞癌を否定できず切除を行ったが、病理組織学的検査でAMLと診断した一例を経験したので報告する。症例は50歳代の女性。検診にて外側区域の肝腫瘍を指摘され、加療目的に紹介となった。造影CT検査では肝外側区域、門脈臍部に接して2cm大の腫瘍性病変を認め、動脈相で濃染し平衡相でwashoutしていた。腹部MRI検査では同部位にT2強調像で高信号、T1 out of phaseにて若干の信号低下を認めた。Gadolinium-ethoxybenzyl-diethylene-triaminepentaacetic-acid(Gd-EOB-DTPA; EOB) MRIでは動脈相で濃染、門脈相から平衡相にかけてwashoutし、肝細胞相では低信号であった。画像所見から肝細胞癌を疑い、腹腔鏡下肝左葉切除術を施行した。病理組織学的には好酸性紡錘形細胞や淡明～淡好酸性細胞の上皮様配列がみられ、内部に脂肪組織が島状に介在し、また、平滑筋性の厚い壁を持った血管構造も一部存在しており、肝血管筋脂肪腫と診断した。一般に脂肪成分の少ないAMLは、肝細胞癌との鑑別が困難である。最近では、肝静脈への流出血管の有無が鑑別診断に有用であるとの報告が見られるため、これらを注意深く観察すべきと考えられた。Hepatic angiomyolipoma (AML) may be difficult to distinguish from hepatocellular carcinoma. Here we report a resected case of a hepatic AML mimicking hepatocellular carcinoma. The patient was a woman in her 50s referred for further evaluation of a tumor in the left lateral segment of the liver. Contrast-enhanced computed tomography showed a two cm-sized tumor attached with the umbilical portion in the left lateral segment of the liver, which was enhanced in the arterial phase and washed out in the portal venous phase. Abdominal MRI showed a high-intensity tumor on T2-weighted image and a slight decrease of signal intensity on T1 out of phase. The tumor on Gd-EOB-DTPA enhanced MRI displayed high intensity in the arterial phase and washout in the portal venous phase, and low signal intensity in hepatobiliary phase. Based on these imaging findings, we suspected hepatocellular carcinoma and a laparoscopic left lobectomy was performed. Histopathological examination showed spindle and perivascular epithelioid cells and a few fat cells, and immunohistochemical analysis revealed positive staining of HMB-45 and αSMA. The tumor was diagnosed as a hepatic AML. Hepatic AML with a small fatty component is generally difficult to distinguish from hepatocellular carcinoma. More recently, the presence of outflow blood vessels to the hepatic vein has been reported to be useful in the differential diagnosis for AML. These imaging findings should be carefully observed

ドウニュウ カガク リョウホウ ニテ コンチ セツジョ ガ カノウ トナッタ ケイブ ショクドウガン ノ 1レイ

　症例は50歳代，男性．咽頭痛，嚥下障害を主訴に近医受診し，上部消化管内視鏡検査にて頸部食道に1/4周性のtype3病変(squamous cell carcinoma)と食道胃接合部に0-IIa+IIc病変(adenocarcinoma)を指摘され，当院当科紹介となった．造影CT検査にて左頸部に原発巣と一塊となった腫瘤を認め，左総頸動脈及び気管への浸潤を認めた．精査の結果，頸部食道癌cT4bN2M0 cStageIVa，バレット食道腺癌cT1bN0M0 cStageIと診断し，切除不能局所進行食道癌であり導入化学療法の方針とした．DCF(Docetaxel/Cisplatin/5-Fluorouracil) 療法3コースで病変の縮小が得られ，頸部腫瘍は長径37mmから17mmとなり，総頸動脈の浸潤が解除されたため，根治術を行う方針とした．手術は咽頭喉頭食道全摘，頸部縦隔腹部リンパ節郭清，後縦隔経路遊離空腸付加胃管再建，腸瘻造設術を施行した．術中偶発症なく，手術時間846分，出血量670mLであった．病理組織学的検査では，頸部食道癌ypT4aN2M0 ypStegeIII，治療効果Grade 1b，バレット食道癌ypT1b-SM2N0M0 ypStageI，治療効果Grade 1aであった．術後経過は概ね良好で術後9日目より経口摂取を開始し，術後18日目に退院となった．　切除不能局所進行食道癌に対する標準治療は化学放射線療法であるが，近年，DCF療法による導入化学療法後の外科的切除の有用性が報告されている．今回，導入化学療法により根治切除可能であった頸部食道癌，食道腺癌の重複例を経験したため報告する．　A 58-year-old man with sore throat and dysphagia revealed type 3 lesion in cervical esophagus and 0-IIa+IIc lesion in esophagogastric junction on upper gastrointestinal endoscopy. Histopathologic examination of biopsy specimens showed squamous cell carcinoma at cervical esophagus and adenocarcinoma at esophagogastric junction. Computed tomography suggested that the large tumor in left neck infiltrated into the common carotid artery and trachea. According to these findings, we diagnosed locally advanced unresectable cervical esophageal cancer (cT4bN2M0, cStageIVa) and Barret’s esophageal adenocarcinoma (cT1bN0M0, cStageI), and decided to perform induction chemotherapy with Docetaxel, Cisplatin, and 5-Fluorouracil (DCF). After 3 courses of that, the primary tumor decreased from 37 mm to 17 mm as major axis and released infiltration into the common carotid artery. Therefore, we performed conversion surgery, pharyngolaryngectomy and total esophagectomy. Histopathological findings showed cervical esophageal cancer (ycT4aN2M0, ycStageIVa) and Barret’s esophageal adenocarcinoma (ycT1b-SM2N0M0, ycStageI). The postoperative course was uneventful, he resumed eating 9 days after surgery and was discharged 18 days after surgery.　Conversion surgery after induction chemotherapy for locally advanced unresectable esophageal cancer may contribute to radical resection and better clinical outcome