腎盂尿管移行部狭窄症に逆行性エンドピエロトミーを行った小児の1例

右腎盂尿管移行部狭窄症の6歳女児に対し, アキュサイス尿管切開バルーン装置(軟性尿管カテーテル, 7Fr)を用いた逆行性エンドピエトロトミーを行いその実用性を検討した.全身麻酔下でアキュサイスカテーテルを膀胱鏡操作下に腎盂内にまで挿入し, 狭窄部を電気的に切開し更に同部位をバルーンで24Frまで拡張した.切開終了後にエンドピエトロトミー用尿管カテーテル(6/10Fr)を留置し, これを8週間後に抜去した.手術時間は45分間で, 患者は術後3日目に退院した.特に手術に関する合併症はなく, 術後8ヵ月目の経静脈性腎盂撮影と利尿レノグラムによる評価で, 水腎症の程度は改善していたTo determine the feasibility of retrograde endopyelotomy in the management of pediatric ureteropelvic junction (UPJ) obstruction, we treated one girl aged 6 years with the Acucise cutting balloon devise for symptomatic UPJ obstruction. The Acucise catheter (7 Fr, flexible) was placed by a cystoscope over a guide wire with fluoroscopic guidance under general anesthesia. After cutting the stenotic area electronically and dilation until 24 Fr for 10 seconds, a 6/10 Fr endopyelotomy ureteral catheter was left in situ for 8 weeks after the operation. Total operating time was 45 minutes and the child was discharged 3 days after the operation. There were no acute complications and short-term, follow-up 8 months after the operative results were satisfactory as determined by intravenous pyelography and diuretic renogram. UPJ obstruction in children may be treated by retrograde endopyelotomy with the Acucise catheter as well as adults. The principal potential advantage of this procedure is reduced morbidity as compared with antegrade endopyelotomy

The inflammatory changes of adipose tissue in late pregnant mice

The infiltration of classically activated macrophages (M1) and alternatively activated macrophages (M2) in subcutaneous adipose tissue (SAT) and parametrial adipose tissue (PAT) was analyzed to investigate whether local inflammatory change in adipose tissue occurs in late pregnancy. C57BL/6N female mice at 6 weeks of age were fed a normal chow diet for 4 weeks prior to mating at 10 weeks of age and were sampled on day 17 of pregnancy. The serum levels of adipokines and biochemical markers were measured using ELISA and enzymatic methods. The identification of M1 and M2 was analyzed by double immunofluorescence with anti-F4/80 and anti-CD11c antibodies. The gene expression of adipokines in adipose tissues was analyzed by quantitative RT-PCR. The pregnant group showed adipocyte hypertrophy, higher macrophage infiltration, and higher M1/M2 in both SAT and PAT compared with the non-pregnant (NP) group. Serum levels of free fatty acids, tumor necrosis factor α (TNFα), interleukin 6 (IL6), and IL10 were higher, and serum levels of adiponectin were lower in the pregnant group than those in the NP group. The gene expressions of CD68, Itgax, CCR2, TNFα, and PAI1 in SAT during pregnancy were significantly higher than those in the NP group, as were the gene expressions of CD68, Emrl, Itgax, MCP1, TNFα, IL6, PAI1, adiponectin, and IL10 in PAT. These results suggest that the low-grade inflammation of adipose tissue indicated by increased macrophage infiltration occurs in late normal pregnancy

２つの出生後早期肥満モデルマウスにおける糖代謝制御の相違について

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カルシウム含有結石マトリックス内蛋白におけるオステオポンチンの同定

蓚酸カルシウム, リン酸カルシウム, 尿酸, リン酸マグネシウムアンモニウムの4種類の結石内マトリックスを, Stains-All染色によりトロンビン分割の有無でオステオポンチン(OPN)の存在を確認した.マトリックス成分は0.1M EDTA溶液で抽出した.その上N末端より20残基のアミノ酸分析を施行した.蓚酸カルシウム, リン酸カルシウムのみOPNが存在し尿酸, リン酸マグネシウムアンモニウム結石内には認めなかった.骨のマトリックスとして骨形成に関わり, 強固にヒドロキシアパタイトと結合するOPNが, カルシウム含有結石形成過程においても重要であるOsteopontin (OPN) has been identified as a matrix protein of calcium oxalate urinary stones by sequencing c-DNA for urinary stone protein. OPN, a phosphoprotein, is susceptible to thrombin digestion and specifically stainable with Stains-All. We examined the matrix in 4 kinds of urinary stones, calcium oxalate dihydrate, calcium phosphate, magnesium ammonium phosphate and uric acid; for the presence of OPN by staining thrombin-digestion and undigested matrix with Stains-All. Matrix was extracted with a 0.1 M ethylenediamine tetraacetic acid (EDTA) solution. Furthermore, the amino acid sequence was determined for the NH2-terminal 20 amino acid residues. OPN was identified in calcium oxalate dihydrate and calcium phosphate stones, but was absent in magnesium ammonium phosphate and uric acid stones. Our findings suggest that OPN, which binds tightly to hydroxyapatite and is related to bone formation as bone matrix, also participates in the formation of calcium-containing urinary stones