Post-transplant donor-specific anti-HLA antibodies with a higher mean fluorescence intensity are associated with graft fibrosis in pediatric living donor liver transplantation

The roles of post-transplant anti-HLA donor specific antibody (DSA) in pediatric liver transplantation (LT), including therapeutic strategies, remain controversial. This study aimed to identify the risks of post-transplant DSA for graft fibrosis progression in pediatric living donor LT (LDLT). We retrospectively evaluated 88 LDLT pediatric cases between December 1995 and November 2019. DSAs were assessed with single antigen bead test. Graft fibrosis was histopathologically scored with METAVIR and the centrilobular sinusoidal fibrosis system. Post-transplant DSAs were detected in 37 (52.9%) cases at 10.8 (1.3–26.9) years post-LDLT. The histopathological examination of 32 pediatric cases with post-transplant DSA revealed that 7 (21.9%) with a high DSA-MFI (≥9,378) showed graft fibrosis progression (≥F2). No graft fibrosis was observed in the subjects with a low DSA-MFI. The risk factors for developing graft fibrosis in pediatric cases with post-transplant DSA were an older graft age (>46.5 years old), lower platelet count (<10.7 × 104/ml) and higher Fib4 index (>0.7807, recipient age; >1.8952, donor age). Limited efficacy of additional immunosuppressants was observed in DSA positive pediatric cases. In conclusion, pediatric cases with a high DSA-MFI and risk factors should undergo a histological examination. The appropriate treatment for post-transplant DSA in pediatric LT needs to be determined

AGN number fraction in galaxy groups and clusters at z < 1.4 from the Subaru Hyper Suprime-Cam survey

One of the key questions on active galactic nuclei (AGN) in galaxy clusters is how AGN could affect the formation and evolution of member galaxies and galaxy clusters in the history of the Universe. To address this issue, we investigate the dependence of AGN number fraction ($f_{\rm AGN}$) on cluster redshift ($z_{\rm cl}$) and distance from the cluster center ($R/R_{\rm 200}$). We focus on more than 27,000 galaxy groups and clusters at $0.1 < z_{\rm cl} < 1.4$ with more than 1 million member galaxies selected from the Subaru Hyper Suprime-Cam. By combining various AGN selection methods based on infrared (IR), radio, and X-ray data, we identify 2,688 AGN. We find that (i) $f_{\rm AGN}$ increases with $z_{\rm cl}$ and (ii) $f_{\rm AGN}$ decreases with $R/R_{\rm 200}$. The main contributors to the rapid increase of $f_{\rm AGN}$ towards high-$z$ and cluster center are IR- and radio-selected AGN, respectively. Those results indicate that the emergence of the AGN population depends on the environment and redshift, and galaxy groups and clusters at high-$z$ play an important role in AGN evolution. We also find that cluster-cluster mergers may not drive AGN activity in at least the cluster center, while we have tentative evidence that cluster-cluster mergers would enhance AGN activity in the outskirts of (particularly massive) galaxy clusters.Comment: 16 pages, 21 figures, and 2 tables, accepted for publication in PAS

Risk Factors for Mortality From Aortic Aneurysm and Dissection: Results From a 26‐Year Follow‐Up of a Community‐Based Population

Background Aortic aneurysm rupture and acute aortic dissection are life‐threatening conditions and represent an ever‐growing public health challenge. Comprehensive epidemiologic investigations for their risk factors are scant. We aimed to investigate risk factors associated with mortality from aortic diseases through analysis of a community‐based Japanese cohort. Methods and Results IPHS (Ibaraki Prefectural Health Study) comprises 95 723 participants who took part in municipal health checkups in 1993. Factors considered for analysis included age, sex, body mass index, blood pressure, serum lipids (high‐density lipoprotein [HDL] cholesterol, non‐HDL cholesterol, and triglycerides), diabetes, antihypertensive and lipid‐lowering drug use, and smoking and drinking habits. Cox proportional hazards models were applied to evaluate the associations between these variables and mortality from aortic diseases. During the median 26‐year follow‐up, 190 participants died of aortic aneurysm rupture, and 188 died of aortic dissection. An increased multivariable hazard ratio (HR) for mortality from total aortic diseases was observed for high systolic blood pressure (1.61 [1.00–2.59]), diastolic blood pressure (2.95 [1.95–4.48]), high non‐HDL cholesterol (1.63 [1.19–2.24]), low HDL cholesterol (1.86 [1.29–2.68]), and heavy (>20 cigarettes/day) smoking habit (2.46 [1.66–3.63]). A lower multivariable HR was observed for diabetes (0.50 [0.28–0.89]). Conclusions Smoking habit, higher systolic blood pressure and diastolic blood pressure levels, higher non‐HDL, and lower HDL cholesterol levels were positively associated with mortality from total aortic diseases, whereas diabetes was inversely associated

Staging of gastric cancer with the Clinical Stage Prediction score

Abstract Background Chemotherapy with or without surgery is the first-line treatment for stage III/IV gastric cancer, while surgery is the first-line treatment for stage I/II gastric cancer. Accordingly, it is important to distinguish between stage III/IV and stage I/II gastric cancer, but clinical staging is less accurate than pathological staging. This study was performed to develop a clinical score that could distinguish stage III/IV gastric cancer from stage I/II gastric cancer. Methods We reviewed 2722 patients who underwent gastrectomy at our hospital from January 1996 to December 2015. As pretreatment factors potentially related to tumor stage, we assessed age, sex, tumor markers, tumor diameter, tumor location, tumor histology, and macroscopic type. Factors showing significance on multivariate analysis were used to develop the Clinical Stage Prediction score (CSP score), and a cutoff value for the score was determined by receiver operating characteristics analysis. Results According to multivariate analysis, clinical factors associated with stage III/IV disease were elevation of the carcinoembryonic antigen level, tumor diameter ≥ 60 mm, circumferential gastric involvement, esophageal infiltration, mucinous adenocarcinoma, and macroscopic types 2–4. The CSP score was obtained by weighting these factors according to the non-standardized β-coefficient. Receiver operating characteristics analysis indicated that the optimum cutoff value of the CSP score was 17 points. Among 1042 patients with a CSP score ≥ 17 points, 820 patients (78.7%) had stage III/IV gastric cancer. Conversely, among 1680 patients with a CSP score < 17 points, 1547 patients (92.1%) had stage I/II gastric cancer. When discrimination of stage III/IV gastric cancer from stage I/II gastric cancer by the CSP score was assessed, the sensitivity was 78.7%, specificity was 92.1%, positive predictive value was 86.0%, and negative predictive value was 87.5%. Conclusions The CSP score can be helpful for differentiating stage III/IV gastric cancer from stage I/II gastric cancer based on pretreatment clinical factors

Solid pseudopapillary neoplasm of the pancreas after living-donor liver transplantation

Background: Solid pseudopapillary neoplasm of the pancreas has been classified by the World Health Organization as a low-grade malignant tumor with potential to metastasize. The standard treatment for this neoplasm is complete surgical resection. However, it is not always feasible to perform a complex procedure such as pancreaticoduodenectomy or distal pancreatectomy, espe-cially for patients with a history of hepato-biliary-pancreatic surgery. In such cases, the treat-ment strategy must consider the patient's postoperative quality of life. We herein report a case of solid pseudopapillary neoplasm of the pancreas following living-donor liver transplantation.Case presentation: The patient was a 13-year-old girl who had undergone the Kasai procedure for biliary atresia at 140 days of age. She thereafter underwent living-donor liver transplanta-tion because of recurrent cholangitis and progressive jaundice. Her repeated history of cholan-gitis had caused narrowing of the portal vein. Therefore, the portal vein was reconstructed us -ing the donor's ovarian vein as an interposition graft. At 13 years of age, a mass was identified at the head of the pancreas. Biopsy was performed and the patient was diagnosed with solid pseudopapillary neoplasm of the pancreas. Surgical resection was planned, and three options were considered: pancreaticoduodenectomy, duodenum-preserving pancreatic head resection, and enucleation. Considering the complications associated with radical surgery, tumor enucle-ation was performed. The patient developed a postoperative pancreatic fistula that required prolonged fasting and drainage. She began a low-fat diet on postoperative day 15. Because the pancreatic fistula was well controlled with a low-fat diet, the patient was discharged on postop-erative day 51 after she and her parents had received dietary guidance. At the time of this writ-ing, 1 year had passed since the enucleation with no evidence of recurrence.Conclusions: We have herein reported a case of solid pseudopapillary neoplasm of the pancreas after living-donor liver transplantation. Although a radical operation such as pancreaticoduo- denectomy or distal pancreatectomy is preferable from an oncological perspective, enucleation should be considered for patients with high surgical risk