Thrombotic microangiopathy-like disorder after living-donor liver transplantation: A single-center experience in Japan

AIM: To investigate thrombotic microangiopathy (TMA) in liver transplantion, because TMA is an infrequent but life-threatening complication in the transplantation field.

METHODS: A total of 206 patients who underwent living-donor liver transplantation (LDLT) were evaluated, and the TMA-like disorder (TMALD) occurred in seven recipients.

RESULTS: These TMALD recipients showed poor outcomes in comparison with other 199 recipients. Although two TMALD recipients successfully recovered, the other five recipients finally died despite intensive treatments including repeated plasma exchange (PE) and re-transplantation. Histopathological analysis of liver biopsies after LDLT revealed obvious differences according to the outcomes. Qualitative analysis of antibodies against a disintegrin-like domain and metalloproteinase with thrombospondin type 1 motifs (ADAMTS-13) were negative in all patients. The fragmentation of red cells, the microhemorrhagic macules and the platelet counts were early markers for the suspicion of TMALD after LDLT. Although the absolute values of von Willebrand factor (vWF) and ADAMTS-13 did not necessarily reflect TMALD, the vWF/ADAMTS-13 ratio had a clear diagnostic value in all cases. The establishment of adequate treatments for TMALD, such as PE for ADAMTS-13 replenishment or treatments against inhibitory antibodies, must be decided according to each case.

CONCLUSION: The optimal induction of adequate therapies based on early recognition of TMALD by the reliable markers may confer a large advantage for TMALD after LDLT.

Haemolytic action of N-alkylpolymethylenediamines

The haemolytic action of various N-alkyl derivatives (lauryl; C12H25-, myristyl; C14H29-, palmityl; C16H33-) of 1,3-diaminopropane, 1,4-diaminobutane, 1,5-diaminopentane, 1,6-diaminohexane, 1,7-diaminoheptane, 1,8-diaminooctane was examined using rabbit red blood cells. The activities of the various derivatives were compared with those of antiplaque agents commonly used as mouthwashes; cetylpyridinium chloride (CP) and chlorhexidine acetate (CH). The haemolytic activities of these agents were dependent on the length of the N-alkyl chain, whereas the number of methylene groups between the nitrogen atoms had little effect. The order of potency was CP, N-palmityl derivatives, N-myristyl derivatives > N-lauryl derivatives > CH which was similar to the order of the antiplaque effect evaluated in-vitro.

Effects of Salicylate and Other Enhancers on Rectal Absorption of Erythropoietin in Rats

To develop a new treatment for patients with anaemia in which erythropoietin (EPO) can be given without injection, the effects of promoters of the rectal absorption of EPO were studied. Recombinant human (rHu) EPO (5000 units) in a dosing solution or in a rectal suppository was placed in the rectum of healthy rats and changes in serum EPO levels were monitored by an enzyme-linked immunosorbent assay. Without a promoter, rHuEPO was not absorbed. Sodium glycocholate, sodium caprate, and sodium salicylate in the solution of rHuEPO increased the absorption of rHuEPO. Sodium salicylate or sodium caprate in the suppository with rHuEPO also increased its absorption. The bioavailability of rHuEPO in a suppository containing 5% sodium salicylate compared with that by an intravenous injection was 1·2%. rHuEPO given in rectal suppositories containing sodium salicylate and inserted once a day for 6 consecutive days increased erythropoiesis in peripheral blood.

Primary neuroendocrine carcinoma of the hypopharynx: a case report

Primary neuroendocrine carcinoma of the hypopharynx is extremely rare. A 59-year-old man complaining of swollen right cervical lymph node was admitted to our hospital. Although computed tomography, upper endoscopy, and positron emission tomography scan were performed, the primary lesion was unknown. Bilateral neck lymph node dissection was performed and diagnosed as metastasis of neuroendocrine carcinoma. Sixteen months after the first operation, computed tomography scan revealed multiple liver metastases. There was no another metastatic lesion, and hepatectomy with negative margin was performed. Three months after the second operation, a small tumor of the hypopharynx was detected by upper endoscopy, and biopsy revealed neuroendocrine carcinoma. Concurrent chemotherapy (cisplatin + docetaxel) and radiotherapy (60 Gy) were carried out. This therapy was highly effective, and primary lesion disappeared. After the chemoradiotherapy, lung metastasis and bone metastasis emerged and treated by radiotherapy and chemotherapy (cisplatin + irinotecan). These therapies were also effective, but multiple liver metastases appeared. The patient died 39 months after the first surgery. Although neuroendocrine carcinoma is a high-grade malignancy which metastasizes easily, combined treatment strategy may be useful for these patients. We have here reported, with bibliographic consideration, a case in which multimodal treatment was employed for primary hypopharyngeal neuroendocrine carcinoma with distant metastases.

20 FACTORS THAT AFFECT PURITY AND YIELD OF BOVINE SEX-SORTED SPERM

The purposes of these studies were to examine the influence on the yield of sex-sorted sperm by the different size of sorting gate and to evaluate factors that affect the purity of sex-sorted sperm. As the sorting gate was expanded, so the yield of bovine sex-sorted sperm using flow cytometry was increased. At the same time, the purity of sex-sorted sperm became low. In addition, though the sorting gates were the same size, the purity of sex-sorted sperm differed among trials. These observations indicated the existence of factors that affect purity besides the size of sorting gate. To examine the yield of sex-sorted sperm, X-bearing sex-sorted sperm from 4 Holstein bulls were produced repeatedly 34 times by 3 flow cytometers. The sizes of sorting gates were fixed at 40–42%, 44%, and 46%. Each yield of sorting gate at 40–42%, at 44% and at 46% was compared. To evaluate factors that affect purity, X- or Y-bearing sex-sorted sperm were produced by one flow cytometer. These trials were repeated 160 times for the sorting of X-bearing sperm and 45 times for the sorting of Y-bearing sperm. Stepwise multiple regression analysis was used to analyse the relationships between the purity of sex-sorted sperm and the following sorting conditions, the percentage of oriented sperm, the percentage of dead sperm, degree of separation between X-bearing and Y-bearing sperm, the size of sorting gate, event rate, drop drive frequency, drop delay value and drop delay accuracy. The highest yield was acquired by sorting gate at 44%. The number of sex-sorted sperm was increased as sorting gate was expanded, however, the purity became low. The purities of the sperm by some trials using sorting gate at 46% were less than our acceptable lowest purity that was 90%. So that those sperm must be discarded. Therefore the yield of sorting gate at 44% was greater than sorting gate at 46%. Stepwise multiple regression analysis revealed that the factors for increasing purity of X-bearing sex-sorted sperm were the percentage of oriented sperm (P < 0.001), the degree of separation between X-bearing sperm and Y-bearing sperm (P < 0.001), the drop delay accuracy (P < 0.001), the event rate and the drop drive frequency, and the factor for decreasing purity of X-bearing sex-sorted sperm was the size of sorting gate (P < 0.001). On the other hand, the factors for increasing purity of Y-bearing sex-sorted sperm were the percentage of oriented sperm (P < 0.01), the degree of separation between X-bearing sperm and Y-bearing sperm (P < 0.01) and the event rate (P < 0.05), and the factor for decreasing purity of Y-bearing sex-sorted sperm was the size of sorting gate (P < 0.01). From these results, it can be concluded that the purity of sex-sorted sperm was not depend on simply by size of sorting gate but was more completely explained by other sorting conditions.

Recovery of cerebrovascular reserves after stenting for symptomatic carotid artery stenosis

Although a decrease in cerebrovascular reserves (CVR) is known to enhance the risk of stroke, changes in this parameter after carotid artery stenting (CAS) have rarely been investigated. The present study is the first to compare CVR recoveries after applying CAS to patients with symptomatic carotid artery disease. CAS was performed for 31 consecutive patients with symptomatic carotid artery disease. They underwent acetazolamide-challenged single photon emission computed tomography (SPECT) before and after CAS to obtain data on resting stage cerebral blood flow (CBF(rest) values) in various regions of interest (ROIs) defined by a three-dimensional stereotactic ROI template. CVR values on ipsilateral and contralateral hemispheric sides were then calculated based on the CBF(rest) data. The 31 patients were dichotomized into unilateral (n=22) and bilateral (n=9) lesion groups, and no significant between-group differences were observed in CBF(rest) before and after CAS. In the unilateral group, there were no differences in CVR values before and after CAS. In the bilateral group, however, the CVR values significantly increased in nearly all the investigated ROIs on the contralateral side. Also, the hemispheric CVR values on both sides significantly increased after CAS in the bilateral group, while no such increase was observed in the unilateral group. CAS in patients with symptomatic bilateral carotid artery disease has the potential utility for their haemodynamic improvement even on the contralateral hemispheric side.

Progressive familial intrahepatic cholestasis: a single-center experience of living-donor liver transplantation during two decades in Japan

BACKGROUND

Progressive familial intrahepatic cholestasis (PFIC) results in liver cirrhosis. Therefore, some PFIC patients require liver transplantation (LT). Although three types of PFIC have been identified, their etiologies include unknown mechanisms.

PATIENTS

A total of 717 recipients who underwent living-donor LT (LDLT) at <20 yr old were enrolled in this study. Among these recipients, 14 PFIC recipients comprising 11 PFIC type 1 (PFIC1) and three PFIC type 2 (PFIC2) were evaluated.

RESULTS

Three of 11 PFIC1 recipients died, while all three PFIC2 recipients survived. Eight of 11 PFIC1 recipients showed steatosis after LDLT. Among the eight steatosis-positive PFIC1 recipients, seven showed severe steatosis and seven were complicated with steatohepatitis. Nine of 11 PFIC1 recipients showed fibrosis after LDLT, and eight of the nine fibrosis-positive PFIC1 recipients showed severe fibrosis. In contrast to the PFIC1 recipients, the PFIC2 recipients did not show any steatosis or fibrosis after LDLT.

CONCLUSIONS

The clinical courses and outcomes of PFIC1 recipients after LDLT are still not sufficient owing to steatosis/fibrosis, unlike the case for PFIC2 recipients. As PFIC1 patients will require LT during the long-term progression of the disease, further strategy improvements are required for PFIC1 patients.

Progressive familial intrahepatic cholestasis: a single-center experience of living-donor liver transplantation during two decades in Japan

BACKGROUND

Progressive familial intrahepatic cholestasis (PFIC) results in liver cirrhosis. Therefore, some PFIC patients require liver transplantation (LT). Although three types of PFIC have been identified, their etiologies include unknown mechanisms.

PATIENTS

A total of 717 recipients who underwent living-donor LT (LDLT) at <20 yr old were enrolled in this study. Among these recipients, 14 PFIC recipients comprising 11 PFIC type 1 (PFIC1) and three PFIC type 2 (PFIC2) were evaluated.

RESULTS

Three of 11 PFIC1 recipients died, while all three PFIC2 recipients survived. Eight of 11 PFIC1 recipients showed steatosis after LDLT. Among the eight steatosis-positive PFIC1 recipients, seven showed severe steatosis and seven were complicated with steatohepatitis. Nine of 11 PFIC1 recipients showed fibrosis after LDLT, and eight of the nine fibrosis-positive PFIC1 recipients showed severe fibrosis. In contrast to the PFIC1 recipients, the PFIC2 recipients did not show any steatosis or fibrosis after LDLT.

CONCLUSIONS

The clinical courses and outcomes of PFIC1 recipients after LDLT are still not sufficient owing to steatosis/fibrosis, unlike the case for PFIC2 recipients. As PFIC1 patients will require LT during the long-term progression of the disease, further strategy improvements are required for PFIC1 patients.

Coherent transfer of photoassociated molecules into the rovibrational ground state

We report on the direct conversion of laser-cooled 41K and 87Rb atoms into ultracold 41K87Rb molecules in the rovibrational ground state via photoassociation followed by stimulated Raman adiabatic passage. High-resolution spectroscopy based on the coherent transfer revealed the hyperfine structure of weakly bound molecules in an unexplored region. Our results show that a rovibrationally pure sample of ultracold ground-state molecules is achieved via the all-optical association of laser-cooled atoms, opening possibilities to coherently manipulate a wide variety of molecules.

Liver transplantation for congenital biliary dilatation: a single-center experience

BACKGROUND

Congenital biliary dilatation is a rare disease. Although the possibility of refractory cholangitis and/or the frequency of malignant tumors legitimize hepatobiliary surgery, repeated cholangitis and biliary obstruction result in secondary liver cirrhosis even after polysurgery. There are no definitive guidelines on liver transplantation for congenital biliary dilatation.

PATIENTS

A total of 1,101 liver transplantation recipients were enrolled in this study. Eleven patients with congenital biliary dilatation including 5 patients with Caroli's disease were retrospectively analyzed in detail.

RESULTS

Nine of 11 patients underwent initial operations before liver transplantation while 2 patients with Caroli's disease received liver transplantation as initial surgery, with good outcomes. All patients had intractable symptoms caused by liver cirrhosis, and growth delay was considerable in patients aged <20 years. Histopathological analysis of the native liver revealed hepatic fibrosis (≥F2). One patient with ABO incompatibility died. One patient with Caroli's disease accompanied with intrahepatic carcinoma survives 11.8 years after liver transplantation without any recurrences.

CONCLUSIONS

Patients with congenital biliary dilatation with refractory symptoms and complications secondary to liver failure are appropriate candidates for liver transplantation. We suggest that liver transplantation is an effective therapeutic option for patients with congenital biliary dilatation with due consideration to many accompanying factors, such as clinical course, growth delay, image findings and histopathological analysis.

The effect of clinical experience on dentine bonding effectiveness: students versus trained dentists

Clinical successful application of dentine adhesives depends not only on material-related but also on operator-related factors. The purpose of this study was to evaluate the dentine bonding effectiveness of a self-etch composite cement applied by operators with or without clinical experience under well-standardized, randomized and blind conditions. Forty-eight bovine dentine surfaces were randomly divided into two groups. The first group consisted of eight dental students with no clinical experience at all, and the second group consisted of eight dentists with extensive experience in adhesive dentistry (mean experience of 11.4 years). Next, a 4-mm-diameter stainless steel rod (SUS-304) was bonded to the dentine surface using Panavia Fluoro cement (Kuraray Medical Inc., Tokyo, Japan). After application procedures, the specimens were randomized and shear bond-strength measurements were performed by a single blinded operator. Mann-Whitney U test was used to determine statistical differences in bond strength between the two groups, and Kruskal-Wallis was used to determine statistical difference between the student and dentist groups. The means and standard deviations of bond strength were 11.5 +/- 8.1 MPa for the student group and 7.1 +/- 4.3 MPa for the dentist group, respectively. The bond strength of the student group was significantly higher than that of the dentist group. However, the variability in bond strength was significantly higher in the student group, and some specimens failed prior to actual testing (included as 0 MPa). Clinical experience did not have a positive effect on the bonding effectiveness of the self-etch composite cement to dentine.

Nicotinic acetylcholine receptors expressed in the ventralposterolateral thalamic nucleus play an important role in anti-allodynic effects

BACKGROUND AND PURPOSE

Much interest is currently being focused on the anti-nociceptive effects mediated by nicotinic acetylcholine (nACh) receptors, including their location and mechanism of action. The purpose of this study was to elucidate these issues using 5-iodo-3-(2(S)-azetidinylmethoxy)pyridine (5IA), a nACh receptor agonist, and [(125)I]5IA.

EXPERIMENTAL APPROACH

We partially ligated the sciatic nerve of Sprague-Dawley rat to induce neuropathic pain [Seltzer's partial sciatic nerve ligation (PSL) model]. We then examined the changes in nACh receptor density in the CNS using [(125)I]5IA autoradiography and the involvement of nACh receptors in anti-nociceptive effects in the region where changes occurred.

KEY RESULTS

Autoradiographic studies showed that the accumulation of [(125)I]5IA and the number of nACh receptors in the thalamus of PSL rats were increased about twofold compared with those in the sham-operated rats. No change was observed in other brain regions. Rats injected in the ventral posterolateral thalamic nucleus (VPL) with 5IA demonstrated a significant and dose-dependent anti-allodynic effect and this effect was completely antagonized by mecamylamine, injected with 5IA, into the VPL. The blockade of nACh receptors in the VPL by mecamylamine decreased by 70% the anti-allodynic effect of 5IA, given i.c.v. Moreover, mecamylamine given intra-VPL by itself, induced significant hyperalgesia.

CONCLUSIONS AND IMPLICATIONS

Our findings suggest that the nACh receptors expressed in the VPL play an important role in the anti-allodynic effects produced by exogenous and endogenous agonists.

Processing of CD109 by furin and its role in the regulation of TGF-beta signaling

CD109 is a glycosylphosphatidylinositol (GPI)-anchored glycoprotein, whose expression is upregulated in squamous cell carcinomas of the lung, esophagus, uterus and oral cavity. CD109 negatively regulates transforming growth factor (TGF)-beta signaling in keratinocytes by directly modulating receptor activity. In this study, we further characterized CD109 regulation of TGF-beta signaling and cell proliferation. We found that CD109 is produced as a 205 kDa glycoprotein, which is then processed in the Golgi apparatus into 180 kDa and 25 kDa proteins by furin (furinase). 180 kDa CD109 associated with GPI-anchored 25 kDa CD109 on the cell surface and was also secreted into the culture medium. To investigate whether furinase cleavage of CD109 is necessary for its biological activity, we mutated arginine 1273 in the CD109 furinase cleavage motif (amino acid 1270-RRRR-1273) to serine (R1273S). Interestingly, CD109 R1273S neither significantly impaired TGF-beta signaling nor affected TGF-beta-mediated suppression of cell growth, although it was expressed on the cell surface as a 205 kDa protein. Consistent with this finding, the 180 kDa and 25 kDa CD109 complex, but not CD109 R1273S, associated with the type I TGF-beta receptor. These findings indicate that processing of CD109 into 180 kDa and 25 kDa proteins by furin, followed by complex formation with the type I TGF-beta receptor is required for the regulation of TGF-beta signaling in cancer cells and keratinocytes.

Phenotypic spectrum of hereditary neuralgic amyotrophy caused by the SEPT9 R88W mutation

BACKGROUND

Hereditary neuralgic amyotrophy (HNA), also known as hereditary brachial plexus neuropathy, has phenotypic and genetic heterogeneity. Mutations in the septin 9 (SEPT9) gene were recently identified in some HNA patients. The phenotypic spectrum of HNA caused by SEPT9 mutations is not well known.

OBJECTIVE

To characterise the phenotype of a large family of HNA patients with the SEPT9 R88W mutation.

METHODS

We report clinical, electrophysiological, neuroimaging and genetic findings of six HNA patients from a Japanese family.

RESULTS

All 17 neuropathic episodes identified were selectively and asymmetrically distributed in the upper-limb nerves. Severe pain was an initial symptom in 16 episodes (94%). Motor weakness occurred in 15 (88%) and sensory signs in 10 (59%). A minor dysmorphism, hypotelorism, was seen in all. Nerve conduction studies revealed focal demyelination as well as prominent axonal degeneration changes. Needle electromyography revealed chronic neurogenic patterns only in the upper limbs. An MRI study showed a gadolinium-enhanced brachial plexus. The missense mutation c.262C>T; p.R88W was found in exon 2 of SEPT9 in all patients.

CONCLUSIONS

The SEPT9 R88W mutation in this family causes selective involvement of the brachial plexus and upper-limb nerves. Wider and more universal recognition of clinical hallmarks and genetic counselling are of diagnostic importance for HNA caused by the SEPT9 mutation.

Successful stent placement for hepatic venous outflow obstruction in pediatric living donor liver transplantation, including a case series review

HVOO may lead to graft dysfunction in LDLT. Balloon angioplasty is the first treatment for HVOO. However, some cases with recurrent HVOO need multiple interventions and require stent placement. The authors describe a pediatric case with recurrent HVOO requiring multiple stent placements. Her symptoms related to HVOO finally disappeared after the third stenting. A year later, follow-up liver biopsy did not show any dramatic change in perivenular fibrosis. From a review of our pediatric cases with HVOO requiring stent placement, the majority of them lost the grafts, because the timing of stent placement was too late to prevent the progression of fibrosis. In conclusion, stent placement should be considered in select cases of HVOO. Serial liver biopsies evaluating the degree of fibrosis are essential in determining the timing of stent placement.

Daily concurrent chemoradiotherapy with docetaxel (DOC) and cisplatin (CDDP) using superselective intra-arterial infusion via superficial temporal artery for T3 and T4 head and neck cancer: Possibility of organ preservation in advanced head and neck cancer

e17020

Background: Superselective intra-arterial chemotherapy via a superficial temporal artery (HFT method) has become feasible for daily concurrent radiotherapy and chemotherapy for head and neck cancer. We used this novel method for head and neck cancer, and evaluated its efficacy. Treatment consisted of superselective intra-arterial infusions (docetaxel total 60 mg/m2, cisplatin total 100 mg/m2) and concurrent radiotherapy (total 40 Gy) for 4 weeks as preoperative therapy. Thirty-five patients with stage III and IV oral cancer underwent surgery after this treatment, of whom pathological complete response (CR) was obtained in 31 (88.6%). In this study, the possibility of organ preservation in cases of advanced head and neck cancer was evaluated based on this result. Methods: Eligibility included T3 or T4 squamous cell carcinoma of head and neck. Treatment consisted of superselective intra-arterial infusions (docetaxel, total 60 mg/m2, cisplatin, total 150 mg/m2) and concurrent radiotherapy (total 60 Gy) for 6 weeks. Organ preservation was demonstrated in cases when the biopsy specimen of the primary lesion showed grade 3 (non-viable tumor cells present) or grade 4 (no tumor cells present) after the completion of all treatments. Results: Thirty two patients (21 male and 11 female) were eligible for evaluation. A relapse was detected in 11 cases (34.4%): primary sites, 7 cases (21.9%); cervical lymph node and distant metastasis, 2 cases (6.3%); primary site and distant metastasis, 1 case (3.1%); cervical lymph node, 1 case (3.1%). Seven patients (21.9%) died. The Kaplan-Meier method was used to estimate the 3-year and 5-year survival rates, which were 81.3% and 78.1%, respectively, and the 3-year and 5-year locoregional control rates, which were 68.8% and 64.5%, respectively. No major complications such as cerebral infarctions or other neurological complications developed in any patient. Conclusions: These results of the present study demonstrate that this is a promising new treatment strategy for advanced head and neck cancer, thus contributing to patients’ QOL.

No significant financial relationships to disclose.