Reduced endogenous secretory RAGE in blood and bronchoalveolar lavage fluid is associated with poor prognosis in idiopathic pulmonary fibrosis

Background The endogenous secretory receptor for advanced glycation end products (esRAGE) is a soluble isoform produced by alternative splicing of the RAGE gene. The isoform has anti-inflammatory properties due to its inhibition of the RAGE/ligand interaction and is reduced in the lung tissue of patients with idiopathic pulmonary fibrosis (IPF). This study aimed to investigate the association of esRAGE serum and bronchoalveolar lavage fluid (BALF) levels with progression of IPF. Methods This study included 79 IPF patients and 90 healthy controls. IPF and control serum esRAGE levels were compared, and the correlation between serum and BALF esRAGE levels was analyzed in 57 IPF patient samples. We also investigated the relationship of esRAGE serum and BALF levels with prognoses and lung function parameters in patients with IPF. Results Serum esRAGE levels in IPF patients were significantly lower than those in healthy controls (162.0 +/- 102.4 ng/ml and 200.7 +/- 107.3 ng/ml,p = 0.009), although the baseline characteristics of age and smoking history were not matched. Serum levels of esRAGE were correlated with BALF esRAGE levels (r(s) = 0.317). The BALF esRAGE levels were also correlated with diffusion capacity for carbon monoxide (r(s) = 0.406). A Kaplan-Meier curve analysis and univariate/multivariate Cox hazard proportion analysis revealed that lower levels of esRAGE in blood and BALF were significantly associated with poorer prognoses in patients with IPF. Conclusions Decreased esRAGE levels in BALF and blood were associated with poor prognoses in patients with IPF. These results suggest that esRAGE could be related to the pathophysiology of IPF and serum esRAGE could be a potential prognostic marker of IPF.Peer reviewe

Demand-side decarbonization and electrification: EMF 35 JMIP study

Japan’s long-term strategy submitted to the United Nations Framework Convention on Climate Change emphasizes the importance of improving the electrification rates to reducing GHG emissions. Using the five models participating in Energy Modeling Forum 35 Japan Model Intercomparison project (JMIP), we focused on the demand-side decarbonization and analyzed the final energy composition required to achieve 80% reductions in GHGs by 2050 in Japan. The model results show that the electricity share in final energy use (electrification rate) needs to reach 37–66% in 2050 (26% in 2010) to achieve the emissions reduction of 80%. The electrification rate increases mainly due to switching from fossil fuel end-use technologies (i.e. oil water heater, oil stove and combustion-engine vehicles) to electricity end-use technologies (i.e. heat pump water heater and electric vehicles). The electricity consumption in 2050 other than AIM/Hub ranged between 840 and 1260 TWh (AIM/Hub: 1950TWh), which is comparable to the level seen in the last 10 years (950–1035 TWh). The pace at which electrification rate must be increased is a challenge. The model results suggest to increase the electrification pace to 0.46–1.58%/yr from 2030 to 2050. Neither the past electrification pace (0.30%/year from 1990 to 2010) nor the outlook of the Ministry of Economy, Trade and Industry (0.15%/year from 2010 to 2030) is enough to reach the suggested electrification rates in 2050. Therefore, more concrete measures to accelerate dissemination of electricity end-use technologies across all sectors need to be established

若年性乳腺線維腺腫

A １２-year-old, premenarchal girl with a rapidly growing breast lump was transferred to our hospital. Ultrasonography revealed a ７．９×７．７×３．３cm large well-circumscribed hypoechoic tumor in the medial region of her right breast. After ２ months of this first visit, the breast lump had enlarged to１０ cm in diameter and was consequently subjected to a wide excision. Size of the tumor was９．５×９．２×３．０cm. Histopathological diagnosis was fibroadenoma without any malignant component. One year after the operation, a new lump with a diameter of４cm was detected in the lateral region of her right breast that had a similar appearance of the previous tumor. The tumor was excised as earlier and diagnosed as fibroadenoma. We present an extremely rare case of a rapidly growing breast fibroadenoma in a premenarchal girl. To the best of our knowledge, there were only ２１ cases reported in Japan. Since the patient is concerned that another asynchronous fibroadenoma might occur, she needs a long-term and careful follow-up

Glucose Metabolism in Cataractous Lens

Since the sorbitol pathway in the lens of a diabetic rat was discovered, the relation between cataract formation and aldose reductase has been studied. We measured glucose, sorbitol and fructose in the human cataractous lens by the gaschromatography. Additionally, we measured sugar and polyols in bovine, pig and rabbit lens. The ratio of sorbitol/glucose is high in rabbit, pig and bovine lens in order. In the human cataractous lens, glucose is increased in accordance with development of cataract. On the other hand, sorbitol content is high in the diabetic lens and low in the senile cataractous lens. The aldose reductase inhibitor may have beneficial effects in the prevention of diabetic cataract formation, but have not the therapeutic effect in the senile cataract

Central nervous system post-transplant lymphoproliferative disorder after allogeneic hematopoietic stem cell transplantation: The Nagasaki transplant group experience

A 17-year-old male received allogeneic transplantation for acute lymphoblastic leukemia, and presented with generalized seizures due to a solitary brain lesion with massive necrosis on day +621. Epstein?Barr virus (EBV) DNA copies were below the cut-off value in plasma. Stereotactic biopsy of the cerebral lesion confirmed the diagnosis of post-transplant lymphoproliferative disorder (PTLD) with large atypical cells positive for CD20 and EBER.In order to diagnose primary central nervous system PTLD, the biopsy should be applied as early as possible when brain lesion with necrosis develops in post-transplant patients regardless of EBV-DNA in plasma

Prediction of POPF using CRP after LG

Purpose : Postoperative pancreatic fistula (POPF) is a serious complication after gastrectomy for gastric cancer. The purpose of this study is to identify the risk factor of POPF and evaluate C-reactive protein on postoperative day 1 (POD1) as the predictor for POPF after laparoscopic gastrectomy (LG). Methods : Between May 2013 and September 2016, 226 patients who underwent LG for gastric cancer were investigated. Patients were divided into 2 groups; POPF group (n = 17) and control group (n = 209). Clinicopathological factors were compared between 2 groups. Results : In POPF group, there are more male patients (p = 0.003) compared with control group. Preoperative factors, such as age, BMI, and prevalence of previous operation and comorbidity showed no significant difference between 2 groups. Regarding tumor factors and perioperative data such as blood loss and operative time, there were also no significant difference between 2 groups. POPF group showed longer postoperative hospital stay, and higher serum CRP level on POD1 (p < 0.0001). Multivariate analysis revealed that high CRP level on POD1 ( ≥ 3mg/dl) was independent risk factor of POPF. Conclusions : High serum CRP level on POD1 can predict the occurrence of POPF

Successful outcome of second allogeneic bone marrow transplantation for blastic plasmacytoid dendritic cell neoplasm with MYC locus rearrangement

A 62-year-old male was diagnosed with blastic plasmacytoid dendritic cell neoplasm (BPDCN) with a MYC rearrangement. Four months after the first unrelated bone marrow transplantation (BMT), he developed the relapsed BPDCN. After the achievement of partial remission following re-induction therapy, he underwent a second BMT from another unrelated donor, and experienced complete remission with grade II acute graft-versus-host disease and moderate chronic graft-versus-host disease. He remains alive in complete remission more than 71 months after the second BMT. These results suggested that donor change at the second transplantation may represent a considerable therapeutic option for patients with relapsed BPDCN

High efficacy of eculizumab treatment for fulminant hemolytic anemia in primary cold agglutinin disease

Letter to the Edito

Transoral surgery for superficial head and neck cancer: National Multi‐Center Survey in Japan

Head and neck cancers, especially in hypopharynx and oropharynx, are often detected at advanced stage with poor prognosis. Narrow band imaging enables detection of superficial cancers and transoral surgery is performed with curative intent. However, pathological evaluation and real-world safety and clinical outcomes have not been clearly understood. The aim of this nationwide multicenter study was to investigate the safety and efficacy of transoral surgery for superficial head and neck cancer. We collected the patients with superficial head and neck squamous cell carcinoma who were treated by transoral surgery from 27 hospitals in Japan. Central pathology review was undertaken on all of the resected specimens. The primary objective was effectiveness of transoral surgery, and the secondary objective was safety including incidence and severity of adverse events. Among the 568 patients, a total of 662 lesions were primarily treated by 575 sessions of transoral surgery. The median tumor diameter was 12 mm (range 1–75) endoscopically. Among the lesions, 57.4% were diagnosed as squamous cell carcinoma in situ. The median procedure time was 48 minutes (range 2–357). Adverse events occurred in 12.7%. Life-threatening complications occurred in 0.5%, but there were no treatment-related deaths. During a median follow-up period of 46.1 months (range 1–113), the 3-year overall survival rate, relapse-free survival rate, cause-specific survival rate, and larynx-preservation survival rate were 88.1%, 84.4%, 99.6%, and 87.5%, respectively. Transoral surgery for superficial head and neck cancer offers effective minimally invasive treatment