Polyclonal Immunoglobulin Recovery after Autologous Stem Cell Transplantation Is an Independent Prognostic Factor for Survival Outcome in Patients with Multiple Myeloma

We retrospectively analyzed multiple myeloma (MM) patients who underwent autologous stem cell transplantation (ASCT) without maintenance therapy to assess the impact of recovery of normal immunoglobulin (Ig) on clinical outcomes. The recovery of polyclonal Ig was defined as normalization of all values of serum IgG, IgA, and IgM 1 year after ASCT. Among 50 patients, 26 patients showed polyclonal Ig recovery; 14 patients were in ≥complete response (CR) and 12 remained in non-CR after ASCT. The patients with Ig recovery exhibited a significantly better progression-free survival (PFS, median, 46.8 vs. 26.7 months, p = 0.0071) and overall survival (OS, median, not reached vs. 65.3 months, p < 0.00001) compared with those without Ig recovery. The survival benefits of Ig recovery were similarly observed in ≥CR patients (median OS, not reached vs. 80.5 months, p = 0.061) and non-CR patients (median OS, not reached vs. 53.2 months, p = 0.00016). Multivariate analysis revealed that non-CR and not all Ig recovery were independent prognostic factors for PFS (HR, 4.284, 95%CI (1.868–9.826), p = 0.00059; and HR, 2.804, 95%CI (1.334–5.896), p = 0.0065, respectively) and also for OS (HR, 8.245, 95%CI (1.528–44.47), p = 0.014; and HR, 36.55, 95%CI (3.942–338.8), p = 0.0015, respectively). Therefore, in addition to the depth of response, the recovery of polyclonal Ig after ASCT is a useful indicator especially for long-term outcome and might be considered to prevent overtreatment with maintenance therapy in transplanted patients with MM

Continuing mind for primary care medicine as total family care mailing list (TFC-ML) group

There were historically two great doctors for primary care (PC) medicine in Japan. They are Dr. Shigeaki Hinohara and Dr. Yoshikazu Tasaka. Tasaka was always active in medical treatment, organizational management, postgraduate education, and information dissemination using the Internet, and started Total Family Care Mailing List (TFC-ML) in 1998. TFC-ML included medical information with his comments every day for long. Even after his death in 2007, TFC-ML activity has been continued by many voluntary PC physicians. His TFC mind has been transmitted to future PC physicians. His inspiration may often come to TFC members for better total family care

カンセツ リウマチ ニ タイスル メトトレキセート チリョウチュウ ニ コウド ノ ハンケッキュウ ゲンショウ オ キタシ シボウ シタ 5レイ ノ ケントウ

Background : Methotrexate （MTX） is placed as an anchor drug of treatment for rheumatoid arthritis （RA）. However, many cases suffered from side effects of MTX such as interstitial pneumonia and hematological toxicity. We investigated ５ cases that died of severe pancytopenia under treatment with low-dose MTX for RA. Methods : We reviewed the clinical features of ５ cases that developed severe pancytopenia and were transferred to Tokushima Prefectural Central Hospital under treatment with low-dose MTX for RA from ２０１１-２０１５. Results : All the cases were women, and were under treatment with low-dose MTX. The periods of medication of MTX were not clear. All the cases had renal insufficiency, and had a severe infection induced by pancytopenia and some cases developed disseminated intravascular coagulation （DIC）. At once we started intensive care, but all patients died in a short term. Conclusions : Women, the elderly, and renal insufficiency can be risk factors of severe pancytopenia induced by MTX even if low dosage. We should carefully treat these patients with MTX

Label-free creatinine optical sensing using molecularly imprinted titanium dioxide-polycarboxylic acid hybrid thin films: a preliminary study for urine sample analysis

Creatinine (CR) is a representative metabolic byproduct of muscles, and its sensitive and selective detection has become critical in the diagnosis of kidney diseases. In this study, poly(acrylic acid) (PAA)-assisted molecularly imprinted (MI) TiO2 nanothin films fabricated via liquid phase deposition (LPD) were employed for CR detection. The molecular recognition properties of the fabricated films were evaluated using fiber optic long period grating (LPG) and quartz crystal microbalance sensors. Imprinting effects were examined compared with nonimprinted (NI) pure TiO2 and PAA-assisted TiO2 films fabricated similarly without a template. In addition, the surface modification of the optical fiber section containing the LPG with a mesoporous base coating of silica nanoparticles, which was conducted before LPD-based TiO2 film deposition, contributed to the improvement of the sensitivity of the MI LPG sensor. The sensitivity and selectivity of LPGs coated with MI films were tested using CR solutions dissolved in different pH waters and artificial urine (near pH 7). The CR binding constants of the MI and NI films, which were calculated from the Benesi–Hildebrand plots of the wavelength shifts of the second LPG band recorded in water at pH 4.6, were estimated to be 67 and 7.8 M−1, respectively, showing an almost ninefold higher sensitivity in the MI film. The mechanism of the interaction between the template and the TiO2 matrix and the film composition was investigated via ultraviolet–visible and attenuated total reflectance Fourier-transform infrared spectroscopy along with X-ray photoelectron spectroscopy analysis. In addition, morphological studies using a scanning electron microscope and atomic force microscope were conducted. The proposed system has the potential for practical use to determine CR levels in urine samples. This LPG-based label-free CR biosensor is innovative and expected to be a new tool to identify complex biomolecules in terms of its easy fabrication and simplicity in methodology

Genetic Associations for Activated Partial Thromboplastin Time and Prothrombin Time, their Gene Expression Profiles, and Risk of Coronary Artery Disease

Activatedpartialthromboplastintime (aPTT) and prothrombintime (PT) are clinical tests commonly used to screen for coagulation-factor deficiencies. One genome-wide association study (GWAS) has been reported previously for aPTT, but no GWAS has been reported for PT. We conducted a GWAS and meta-analysis to identify genetic loci for aPTT and PT. The GWAS for aPTT was conducted in 9,240 individuals of European ancestry from the Atherosclerosis Risk in Communities (ARIC) study, and the GWAS for PT was conducted in 2,583 participants from the Genetic Study of Three Population Microisolates in South Tyrol (MICROS) and the Lothian Birth Cohorts (LBC) of 1921 and 1936. Replication was assessed in 1,041 to 3,467 individuals. For aPTT, previously reported associations with KNG1, HRG, F11, F12, and ABO were confirmed. A second independent association in ABO was identified and replicated (rs8176704, p = 4.26 × 10−24). Pooling the ARIC and replication data yielded two additional loci in F5 (rs6028, p = 3.22 × 10−9) and AGBL1 (rs2469184, p = 3.61 × 10−8). For PT, significant associations were identified and confirmed in F7 (rs561241, p = 3.71 × 10−56) and PROCR/EDEM2 (rs2295888, p = 5.25 × 10−13). Assessment of existing geneexpression and coronaryarterydisease (CAD) databases identified associations of five of the GWAS loci with altered geneexpression and two with CAD. In summary, eight genetic loci that account for ∼29% of the variance in aPTT and two loci that account for ∼14% of the variance in PT were detected and supported by functional data

320列CTを用いた冠動脈プラークの組織性状診断：IB-IVUSとの比較

博士(医学)岐阜大学(Gifu University