Mild Acute Graft-Versus-Host Disease Improves Outcomes After HLA-Haploidentical-Related Donor Transplantation Using Posttransplant Cyclophosphamide and Cord Blood Transplantation

Haploidentical-related donor transplantation using posttransplant cyclophosphamide (PTCy-haplo) and cord blood transplantation (CBT) are valid alternatives for patients with hematological malignancies when HLA-matched donor transplantation (MDT) is unavailable. However, the effects of graft-versus-host disease (GVHD) on outcomes after these transplants have not been fully elucidated. Therefore, we evaluated the effects of acute and chronic GVHD on transplant outcomes after PTCy-haplo transplants and compared them with CBT and MDT. We included a total of 914 adult patients with hematological malignancies in the Kyoto Stem Cell Transplantation Group registry who received PTCy-haplo (N = 120), CBT (N = 402), and MDT (N = 392), and achieved neutrophil engraftment. A multivariate analysis revealed that grade I-II acute GVHD improved of overall survival (OS) after PTCy-haplo [hazard ratio (HR) = 0.39, P = 0.018] and CBT (HR = 0.48, P < 0.001), but not after MDT (HR = 0.80, P = 0.267) compared with patients without acute GVHD. Grade I-II acute GVHD had a trend toward reducing the risk of nonrelapse mortality (NRM) after PTCy-haplo (HR = 0.13, P = 0.060) and this positive effect was significant after CBT (HR = 0.39, P = 0.003). A negative impact of grade III-IV acute GVHD on NRM was observed after CBT and MDT, but not after PTCy-haplo. Limited chronic GVHD had a positive impact on OS after CBT and MDT, but not after PTCy-haplo. In conclusion, mild acute GVHD improved outcomes after PTCy-haplo and CBT, and limited chronic GVHD improved outcomes after CBT and MDT. These data indicated that the effects of GVHD on transplant outcomes depended on transplant platforms

Indication and benefit of upfront hematopoietic stem cell transplantation for T-cell lymphoblastic lymphoma in the era of ALL-type induction therapies

Since the introduction of leukemia-type induction therapies for T-cell lymphoblastic lymphoma (T-LBL), improvements in the long-term outcomes of T-LBL have been reported. However, indications for and the appropriate timing of hematopoietic stem cell transplantation (HSCT) have not yet been established. Therefore, we performed a multicenter retrospective cohort study of patients with T-LBL treated using leukemia-type initial therapies to compare the outcomes after HSCT at different disease stages. We enrolled 21 patients with T-LBL from a total of 11 centers, and all patients received hyper-CVAD as a leukemia-type initial regimen. HSCT was performed during the CR1/PR1 (standard disease) stage in 11 patients, while it was completed at a later or non-remission (advanced disease) stage in 10 patients. Following HSCT, the overall survival rate was significantly greater in standard disease than in advanced-disease patients (79.5% vs. 30.0% at 5 years; hazard ratio (HR) 5.97; p = 0.03), with trend to the lower incidence of relapse in the former group (27.3% vs. 60.0% at 5 years; HR 2.29; p = 0.19). A prognostic difference was not detected between cases treated with allogeneic and autologous HSCTs. Our study suggests that frontline HSCT may be a feasible treatment option for T-LBL, even in the era of leukemia-type initial therapy

Etiological factors in primary hepatic B-cell lymphoma

Sixty-four cases of malignant lymphoma involving the liver were examined. Of these, 20 cases were histologically confirmed to be primary hepatic B-cell lymphoma. Twelve of these 20 cases were diffuse large B-cell lymphoma (DLBCL) and eight cases were mucosa-associated lymphoid tissue (MALT) lymphoma. Of the 12 cases of DLBCL, six were immunohistologically positive for CD10 and/or Bcl6 (indicating a germinal center phenotype), six were positive for Bcl2, and five were positive for CD25. Eight of the 12 DLBCL cases (66.7%) and two of the eight MALT lymphoma cases (25%) had serum anti-hepatitis C virus (HCV) antibodies and HCV RNA. The incidence of HCV infection was significantly higher in the hepatic DLBCL cases than in systemic intravascular large B-cell cases with liver involvement (one of 11 cases, 9.1%) and T/NK-cell lymphoma cases (one of 19 cases, 5.3%) (p < 0.01 for both). Two hepatic DLBCL cases (16.7%) had rheumatoid arthritis treated with methotrexate, and four MALT lymphoma cases (50%) had Sjögren’s syndrome, primary biliary cirrhosis, or autoimmune hepatitis; one case in each of these two groups was complicated by chronic HCV-seropositive hepatitis. Although primary hepatic lymphoma is rare, persistent inflammatory processes associated with HCV infection or autoimmune disease may play independent roles in the lymphomagenesis of hepatic B cells

Characteristics of Parents and Their Infants with Autistic Behaviors: Parent-Infant Interaction, Parental Depression, and Parenting Stress

Parents of infants with autistic behaviors frequently face difficulties in childrearing owing to their infants’ behavioral traits. This study aimed to clarify the characteristics of parent-infant interaction, parental depressive symptoms, and parenting stress in the context of infants’ autistic behaviors. We employed a cross-sectional, case-control observational design with a case group of 52 parents and a control group of 56 parents. We measured parent- infant interaction using the Japanese version of the Nursing Child Assessment Teaching Scale, and parental depressive symptoms and parenting stress with the Japanese version of the Center for Epidemiologic Studies Depression Scale and the Japanese Parenting Stress Index Short Form, respectively. There was no significant difference between the two groups regarding parent-infant interaction. Mothers in the case group had significantly higher depressive symptoms than those in the control group (p < .05). Both fathers (p < .05) and mothers (p < .01) in the case group scored significantly higher than the control group on parenting stress. Thus, parents of infants with autistic behaviors have greater mental health problems right from infancy. We suggest that nurses should provide families with appropriate support to promote adaptive parent-infant interaction and prevent the aggravation of parental mental health problems irrespective of Autism Spectrum Disorder diagnoses

Diet Quality and Its Relationship with Weight Characteristics in Pregnant Japanese Women: A Single-Center Birth Cohort Study

Maternal underweight and inadequate gestational weight gain (GWG) are problems in Japan. However, increases in food intake aimed at weight gain alone are not sufficient for mother–child health. This study assessed diet quality based on the 3-day dietary records of pregnant women in an urban area of Japan in order to show the importance of evaluating diet quality, using the Nutrient-Rich Food Index 9.3 (NRF9.3), which is one metric based on nutrition profiling, and the Japanese Food Guide Spinning Top (JFGST). After excluding misreporters of energy intake, we stratified women (n = 91) by pre-pregnancy body mass index (BMI) and determined energy intake, diet quality status, and their relationship with GWG. Intakes of carbohydrate-containing staple foods, vegetable dishes, and fruit were insufficient regardless of BMI. Most of the underweight women with inadequate GWG had insufficient energy intake but high diet quality, as assessed by NRF9.3. In contrast, most women who consumed energy within the recommended range had low diet quality and gained weight at inappropriate levels. These results highlight the importance for pregnant Japanese women to maintain diet quality through a nutrient-dense diet, while simultaneously increasing energy intake after evaluation of their individual diet quality

Metabolic and Immunological Shifts during Mid-to-Late Gestation Influence Maternal Blood Methylation of CPT1A and SREBF1

Mid-to-late gestation is a unique period in which women experience dynamic changes in lipid metabolism. Although the recent intensive epigenome-wide association studies (EWAS) using peripheral leukocytes have revealed that lipid-related traits alter DNA methylation, the influence of pregnancy-induced metabolic changes on the methylation levels of these differentially methylated sites is not well known. In this study, we performed a prospective cohort study of pregnant women (n = 52) using the MassARRAY EpiTYPER assay and analyzed the methylation levels of variably methylated sites, including CPT1A intron 1 and SREBF1 intron 1 CpGs, which were previously verified to be robustly associated with adiposity traits. Although methylation of SREBF1 was associated with body mass index (BMI) and low-density lipoprotein cholesterol at mid-gestation, this association was attenuated at late gestation, which was consistent with the metabolic switch from an anabolic to a catabolic state. However, the BMI association with CPT1A intron 1 methylation appeared to strengthen at late gestation; this association was mediated by pre-pregnancy BMI-dependent change in the leukocyte proportion during mid-to-late gestation. Thus, the methylation of adiposity-related differentially methylated regions was sensitive to metabolic and immunological changes during mid-to-late gestation

養育者が心配する１～ 2 歳児のこわがる対象と行動の分析

PDF【目的】本研究では、１～２歳児の養育者が心配する、子どものこわがるものや場所、子どもの行動について、子どもの月齢、性別ごとの特徴を明らかにすることを目的とした。 【方法】特に先天的な疾患を持たない１～２歳児の養育者1000名を対象に日本語版Infant-Toddler Social and Emotional Assessment（以下、ITSEA）を用いたweb調査を実施した。日本語版ITSEA170項目のうち12項目（A8、A36、A37、A41、A42、B21、B22、B23、C5、E15、E16、E17）に付随する記述回答の内容を調査対象とした。月齢群別（12～17か月、18～23か月、24～29か月、30～35か月）に項目の平均得点について、一元配置分散分析を用いて、男女別の項目の平均得点についてt検定を用いて比較した。記述項目の内容について、こわがるもの、場所などについての設問、子どもの行動についての設問に分けて、月齢群別、男女別の傾向を、テキストマイニングを用いて分析した。抽出した語について、語同士の類似性と共起性を示すJaccard係数を算出し、それに基づく共起ネットワーク図を作成した。 【結果】月齢群別平均得点：A37について、12～17か月児と24～29か月児、18～23か月児と24～29か月児、30～35か月児間で有意な差が見られた。A41について、24～29か月児と12～17か月児、18～23か月児に有意な差が見られた。A42について、12～17か月児と18～23か月児との間、24～29か月児との間、30～35か月児との間で有意な差が見られた。E17について、12～17か月児と18～23か月児、24～29か月児、30～35か月児間で有意な差が見られた。 　男女別平均得点：A41、E17について、男児が女児よりも有意に高い傾向であった。記述内容から抽出された子どものこわがる対象は、「鬼」、「暗い」、「掃除機」、気になる子どもの行動は「頭」、「くるくる回る」、「紙」などであった。 【結論】子どもがこわがる対象として、低月齢では、音の出るものが多く、月齢が上がると、体験に基づくものが対象となっていた。からだをゆする、手をひらひら動かす、頭を打ち付ける、くるくる回るなどの行動は、12～23か月児の方に多く見られ、月齢が上がると減少していた。食べられないものを口に入れたり噛んだりする行動は、12～17か月の児に多く見られ、月齢が上がると減少していた。男女ともに、くるくる回る、噛む、頭を打ち付ける行動は多かったが、男児の方が叩くといった行動が多く、女児は口に入れるといった行動が多かった。月齢、性別ごとのこわがる対象、子どもの行動の特徴を踏まえ、養育者からの相談への対応や事故予防などに活かしていく必要がある