Nanocavity tuning and formation controlled by the phase change of sub-micron-square GST patterns on Si photonic crystals

It has been well established that photonic crystal nanocavities with wavelength sized mode volume enable various integrable photonic devices with extremely small consumption energy and small footprint. In this study, we explore the possibility of non-volatile functionalities employing photonic crystal nanocavities and phase change material, Ge2Sb2Te5 (GST). Recently, non-volatile photonic devices based on GST have attracted significant interest and are expected to enable energy-efficient photonic processing, especially for optical computing. However, the device size and the area of GST in previous studies have been rather large. Here, we propose and fabricate Si photonic crystal nanocavities on which submicron-square GST patterns are selectively loaded. Because of the strong light confinement, extremely small area of GST is sufficient to manipulate the cavity mode. We have succeeded to fabricate 30-nm-thick and several-100nm-square GST blocks patterned at the center of photonic crystal cavity with a high alignment accuracy. We confirmed that the resonant wavelength and Q-factor of cavity modes are controlled by the phase change of GST. Moreover, cavity formation controlled by submicron-sized GST is also demonstrated by GST-loaded photonic-crystal line-defect waveguides. Our approach in which we place sub-micron-sized GST inside a photonic crystal nanocavity is promising for realizing extremely energy-efficient non-volatile integrable photonic devices, such as switches, modulators, memories, and reconfigurable novel devices.

Reconstruction methods for and cosmetic evaluation of external nasal tumour resections: flap versus graft

Nose reconstruction is challenging given the three-dimensional structure and free edge, and various methods have been reported. In general, local flaps provide cosmetic outcomes that are better than those following skin grafts, but there are no published comparative studies on Asians. To determine whether local flaps or skin grafts may optimally be used to reconstruct external nasal defects among Asians. We retrospectively collected data on patients who underwent external nasal tumour resection and reconstruction by 14 plastic surgeons in eight Japanese institutes from 2009 to 2021. The cosmetic results were scored by 14 surgeons using anonymized preoperative and six-month postoperative photographs. Scores for each reconstruction method were statistically evaluated. In total, 86 cases were enrolled; 57 received local flaps and 29 received skin grafts. Most local flaps showed better outcomes compared to skin grafts, but this was not the case for nasolabial and forehead flaps. Notably, local flaps placed in the nasal ala tended to be less successful than flaps placed elsewhere; only the bilobed flap scored better than skin grafts. The defect site did not affect the results of skin grafts. For Asians requiring nasal reconstruction, local flaps provide better cosmetic outcomes than skin grafts, except for those in the nasal ala. Skin grafts may be a good alternative when the bilobed flap is unavailable for the nasal ala.

Characteristics and outcome of suspected cerebrovascular disease in dogs: 66 cases (2009-2016)

OBJECTIVES

To characterise the clinical signs of suspected cerebrovascular disease in dogs.

MATERIALS AND METHODS

Medical records of one hospital were searched from November 2009 to December 2016 for dogs that suffered of cerebrovascular disease. We diagnosed cerebrovascular disease based on acute onset, clinical signs and magnetic resonance imaging findings. The medical history, clinical signs, concurrent disease, area of infarction, cerebrospinal fluid results, month at onset and outcome were investigated in the cerebrovascular disease group and in a control group (dogs with brain disorders other than cerebrovascular disease).

RESULTS

A total of 122 CVD cases were extracted from the 5312 patients that visited during the study period. Of these 122 cases, 66 (1.2%) matched the subject selection criteria of our study and were included in the analysis. Forebrain infarction was observed in 51 of 66 cases, of which 24 (47.1%) suffered from seizures. The number of dogs diagnosed with cerebrovascular disease was disproportionately high in August (nine of 59 cases) and December (13 of 59 cases). In the outcome survey, deterioration was observed in 11 of 55 cases.

CLINICAL SIGNIFICANCE

Seizure is an important clinical sign of cerebrovascular disease in dogs. There was a significant seasonal variation in the number of dogs diagnosed with cerebrovascular disease in Japan. Clinical features observed in this report differ from those of previous reports and highlight the need for additional research in this area.

Negative pressure wound therapy for broncho-pleural fistula with collapsed lung

We present a case of the broncho-pleural fistula with a collapsed lung that was developed 2 weeks after right lower lobectomy. The patient urgently underwent open-window thoracostomy. However, the residual lung remained collapsed. To expand the lung and close the broncho-pleural fistula, negative pressure wound therapy was initiated 20 days after the procedure. The lung expanded within a few days, and the residual thoracic cavity gradually contracted. Subsequently, 2.5 months later, the remaining thoracic cavity was successfully closed using omentoplasty. No recurrence of the broncho-pleural fistula was observed for 1 year. If the lung could be inflated to reduce dead space in the thoracic cavity, broncho-pleural fistula with collapsed lung may be treated with bronchial stump coverage and negative pressure wound therapy.

Functional engineered heart tissue cultured in a rotating wall vessel bioreactor improve cardiac function in the distressed rat heart

Introduction

How to construct massive cardiac tissue and culture it with functional improvement may be crucial as cardiomyogenesis in failed heart. We previously presented that dynamic culture in a rotating wall vessel (RWV) bioreactor could provide a better culture environment for maintenance of the engineered 3D cardiac tissue. However, it is unknown about the effect of the tissue cultured in a RWV bioreactor on engraftment and improvement of function in the distressed rat heart.

Hypothesis

We hypothesized that the engineered 3D cardiac tissue cultured in a RWV bioreactor could improve its engraftment and lead recovery of cardiac function in rat infarction model.

Methods

We made engineered cardiac tissue by seeding 2.0 × 106 human induced pluripotent stem cell derived cardiomyocytes on the PLGA fiber sheet. It was cultured in the RWV bioreactor for seven days (RWV group). For the control, static culture has been done. After in vitro assessment, these tissues were transplanted to myocardial infarction model nude rats (sham, control, and RWV group, n=10, respectively) and cardiac performance was evaluated by ultrasonography. Four weeks after transplantation, we evaluated their hearts by histological analysis.

Results

The RWV group demonstrated maturation of cardiomyocytes evidenced by significantly higher expression of Troponin T (TnT), sarcomeric α actinin (SAA), connexin 43 (Cx43) and myosin heavy chain 7 (MYH7) than the control by Western blots (TnT; 2.7±1.0 vs. 1.0±0.4, p<0.01, SAA; 2.1±0.7 vs. 1.0±0.2, p<0.01, Cx 43; 2.0±0.6 vs. 1.0±0.1, p<0.05, MYH7; 10.9±2.7 vs. 1.0±0.1, p<0.01). In the culture supernatant, the concentration of cytokines related to angiogenesis was significantly higher in the RWV group than in the control (VEGF; 29.6±7.4 vs. 12.2±4.3pg/ml, p<0.01, HGF; 72.7±9.9 vs. 42.6±5.9pg/ml, p<0.01). Four weeks after transplantation, the left ventricular ejection fraction was significantly improved in the RWV group than in the control (RWV vs. control; 47±4.9 vs. 38±6.9%, p<0.01). On histological analysis, more engineered cardiac tissue survived in the RWV group than in the control (RWV vs. control; 7/10 vs. 3/10, p=0.18). A vascular-like structure double-stained with isolectin B4 and smooth muscle actin was partially observed in the transplanted tissue. LV remodeling exhibiting extracellular collagen deposition (fibrotic area, RWV vs. control; 17±4.3 vs. 24±5.2%, p<0.05) and cardiomyocyte hypertrophy (RWV vs. control; 16±1.7 vs. 18±2.1μm, p<0.05) was significantly attenuated in RWV group than in the control. Neovascularization was significantly noted in the RWV group compared with the control (capillary density, RWV vs. control; 545±113 vs. 356±92, p<0.01).

Conclusion

Functional engineered 3D cardiac tissue cultured in a RWV bioreactor could induce angiogenesis and improved its engraftment, leading significant improvement of cardiac function in rat infarction model.

Dynamic culture in a RWV bioreactor

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Japan Society for the Promotion of Science

Imperceptible magnetic sensor matrix system integrated with organic driver and amplifier circuits

Artificial electronic skins (e-skins) comprise an integrated matrix of flexible devices arranged on a soft, reconfigurable surface. These sensors must perceive physical interaction spaces between external objects and robots or humans. Among various types of sensors, flexible magnetic sensors and the matrix configuration are preferable for such position sensing. However, sensor matrices must efficiently map the magnetic field with real-time encoding of the positions and motions of magnetic objects. This paper reports an ultrathin magnetic sensor matrix system comprising a 2 × 4 array of magnetoresistance sensors, a bootstrap organic shift register driving the sensor matrix, and organic signal amplifiers integrated within a single imperceptible platform. The system demonstrates high magnetic sensitivity owing to the use of organic amplifiers. Moreover, the shift register enabled real-time mapping of 2D magnetic field distribution.

Prevalence and Conditions of Urinary Incontinence among the Elderly

In Japan, elderly disorders and diseases have markedly increased in recent years, because of rapid aging and an increasing number of older persons. The situation is creating serious social and community problems. These disorders, particularly dysuria and urinary incontinence (UI), disturb the quality of life (QOL) in latelife. Few reports on UI have been published, but precise investigation into the community level remains to be made. Our presentation is the development, implementation and evaluation of elderly UI in Kumamoto Prefecture. This study includes 2,304 people (male: 856, female: 1,448), over 65 years of age, living in two different communities; one is an urban (K) and the other is a typical rural area (S). The rate of UI was in homebound elderly persons, male: 4.7%, female: 11.3%, and in nursing home residents, male: 16.2%, female: 23.2%. The condition of UI was: almost Urinary Urgency in male (61.5%), and Stress Incontinence (such as, caused by coughing, sneezing, and exercise) in female (46.3%). The influence of UI on the activity of daily life was investigated. Most of the male cases were giving concerns for family and community. In contrast, females hesited to participate in group excursions and outdoor exercise, and had a tendency to live alone or indoors. However, most persons (81.5%) with UI did not visit a physician. From this investigation, we conclude that a community health care program and public support system are essential for proper understanding and solution of the elderly UI problem.

Wireless EEG patch sensor on forehead using on-demand stretchable electrode sheet and electrode-tissue impedance scanner

A wireless electroencephalogram (EEG) sensor using a stretchable electrode sheet and electrode-tissue impedance measurement module is presented herein. The sensor can be attached to the forehead using biocompatible gel with the electrode sheet. The sensor is compactly designed for 3 cm × 9 cm × 6 mm with weight of 12 g. Impedance scanning circuit is also proposed to evaluate the skin surface condition before EEG measurements. We developed the impedance scanning board for 3 cm × 5 cm × 3 mm, with weight of 5.6 g. Results show that the proposed system demonstrates a promising performance in diagnosing the Alzheimer's disease using frequency domain analysis.

Successful conservative treatment outcomes and clinical characteristics of congenital hypoplasia of the extensor tendon central slip

Congenital hypoplasia of the extensor tendon central slip is a rare entity. This article describes the clinical characteristics in a series of 22 fingers in 16 patients (mean age: 10 months), and the outcomes of conservative treatment. Nine of 22 fingers were classified as slender or hypoplastic. Treatment with bracing was successful in 21 digits, resulting in full active extension of the proximal interphalangeal joint at a mean of 8.5 months after treatment. Bracing was unsuccessful in one digit, in which operative treatment resulted in a successful outcome. Some residual deformity was observed in ten fingers after a mean follow-up period of 2 years and 1 month. Congenital hypoplasia of the central slip can be treated successfully by the conservative hand bracing when worn with full compliance. Treatment time is extended by the infrequent application of the hand brace or in the case of hypoplastic slender fingers.

LEVEL OF EVIDENCE

IV.

Epithelioid sarcoma-like hemangioendothelioma on the chest wall

Epithelioid sarcoma-like hemangioendothelioma is a rare vascular neoplasm that usually occurs in the distal extremities of young adults. Although the overall behavior of this neoplasm is usually indolent with a low risk of distant metastasis, the risk of local recurrence is significant. Therefore, initial surgical treatment with an adequate margin is important to improve the prognosis. However, epithelioid sarcoma-like hemangioendothelioma is frequently misdiagnosed. A preoperative misdiagnosis could result in resection without a sufficient margin. Herein, we describe a 68-year-old man with epithelioid sarcoma-like hemangioendothelioma on the chest wall, which was treated by wide resection despite difficulties with the preoperative diagnosis.

Incidence and risk factors for herpes zoster in patients undergoing liver transplantation

BACKGROUND

Herpes zoster (HZ) is the most common manifestation of latent varicella zoster virus reactivation, which occurs naturally as a result of aging or in immunocompromised patients. Solid organ transplant recipients are at increased risk for HZ owing to their chronic immunosuppression. Although several reports investigated risk factors for the development of HZ in heart or renal transplantation, data in liver transplantation (LT) are limited.

METHODS

We evaluated clinical data retrospectively in 377 adult patients undergoing LT between January 2005 and December 2012 in our institution. We analyzed the incidence rate of HZ and the standardized incidence ratio (SIR) by comparing with the general Japanese population. We additionally investigated risk factors for HZ after LT.

RESULTS

HZ developed in 27 (7.16%) of the 377 patients after LT. The incidence rate of HZ after LT was 17.83 per 1000 person-years, which was significantly higher than in the general Japanese population (SIR = 4.61; 95% confidence interval [CI], 4.13-5.14). Multivariate analysis showed that older age (hazard ratio [HR] = 3.95; P < 0.001) and exposure to mycophenolate mofetil (HR = 3.03; P = 0.007) were independent risk factors for HZ after LT.

CONCLUSIONS

This is the first and largest study, to our knowledge, to investigate the incidence rate of HZ and risk factors for development of HZ after LT in the Japanese population. Further investigations to focus on immunosuppressive regimens to reduce the risk for HZ incidence in this high-risk population could establish a new protocol of immunosuppression after LT.

Split-gate organic field-effect transistors for high-speed operation

Split-gate organic field-effect transistors have been developed for high-speed operation. Owing to the combination of reduced contact resistance and minimized parasitic capacitance, the devices have fast switching characteristics. The cutoff frequencies for the vacuum-evaporated devices and the solution-processed devices are 20 and 10 MHz, respectively. A speed of 10 MHz is the fastest device reported so far among solution-processed organic transistors.

Relaxation dynamics of photoexcited excitons in rubrene single crystals using femtosecond absorption spectroscopy

The relaxation dynamics of an exciton in rubrene was investigated by femtosecond absorption spectroscopy. Exciton relaxation to a self-trapped state occurs via the coherent oscillation with 78 cm(-1) due to a coupled mode of molecular deformations with phenyl-side-group motions and molecular displacements. From the temperature dependence of the decay time of excitons, the energy necessary for an exciton to escape from a self-trapped state is evaluated to be ~35 meV (~400 K). As a result, a self-trapped exciton is stable at low temperatures. At room temperature, excitons can escape from a self-trapped state and, subsequently, they are dissociated to charged species. The exciton dissociation mechanism is discussed on the basis of the results.

Liver transplantation for hepatitis C from donation after cardiac death donors: an analysis of OPTN/UNOS data

Donation after cardiac death (DCD) liver transplantation is increasing largely because of a shortage of organs. However, there are almost no data that have specifically assessed the impact of using DCD livers for HCV patients. We retrospectively studied adult primary DCD liver transplantation (630 HCV, 1164 non-HCV) and 54 129 donation after brain death (DBD) liver transplantation between 2002 and 2009 using the UNOS/OPTN database. With donation after brain death (DBD) livers, HCV recipients had significantly inferior graft survival compared to non-HCV recipients (p < 0.0001). Contrary to DBD donors, DCD livers used in HCV patients showed no difference in graft survival compared to non-HCV patients (p = 0.5170). Cox models showed DCD livers and HCV disease had poorer graft survival (HR = 1.80 and 1.28, p < 0.0001, respectively). However, the hazard ratio of DCD and HCV interaction was 0.80 (p = 0.02) and these results suggest that DCD livers on HCV disease do not fare worse than DCD livers on non-HCV disease. The graft survival of recent years (2006-2009) was significantly better than that in former years (2002-2005) (p = 0.0482). In conclusion, DCD liver transplantation for HCV disease showed satisfactory outcomes. DCD liver transplantation can be valuable option for HCV related end-stage liver disease.

Computer-assisted system for diagnosis of Alzheimer disease using data base- independent estimation and fluorodeoxyglucose- positron-emission tomography and 3D-stereotactic surface projection

BACKGROUND AND PURPOSE

Recently, voxel-based statistical parametric images have been developed as additional diagnostic tools for AD. However these methods require the generation of a data base of healthy brain images. The purpose of this study was to produce and evaluate an automatic method using a data base-independent estimation system for the diagnosis of mild AD.

MATERIALS AND METHODS

We retrospectively selected 66 subjects, including 33 patients with early AD and 33 age-matched healthy volunteers. Individual brain metabolic images were obtained by using FDG-PET. These were transformed by using 3D-SSP. We then produced CADDIES, which compares the parietal and sensorimotor metabolic counts by using t tests. If parietal metabolism was significantly lower than the sensorimotor metabolism, the subject was automatically diagnosed as having AD. The FDG-PET images were also analyzed by using a previous automatic diagnosis system (CAAD) that is dependent on the construction of a "normal data base" of healthy brain images. Diagnostic performance was compared between the 2 methods.

RESULTS

The CADDIES demonstrated a sensitivity of 88%, specificity of 79%, and accuracy of 85%, while the CAAD system demonstrated a sensitivity of 70%, specificity of 94%, and accuracy of 82%. The area under the ROC curve of CADDIES was 0.964. The areas under ROC curves of the CAAD method in the parietal and posterior cingulate gyri were 0.843 and 0.939, respectively.

CONCLUSIONS

The CADDIES method demonstrated a diagnostic accuracy similar to that of the CAAD system. Our results indicate that this method can be applied to the detection of patients with early AD in routine clinical examinations, with the benefit of not requiring the generation of a normal data base.

Clinical outcome of carpal tunnel release with and without opposition transfer

We studied the clinical outcome in 24 patients (25 hands) with carpal tunnel syndrome characterized by severe thenar muscle atrophy, who were treated by open carpal tunnel release alone (10 hands) or with simultaneous opposition transfer (15 hands). We also compared the surgical results in patients younger or older than 65 years. Pain and numbness improved after open carpal tunnel release but more so in younger patients. Activities of daily living also improved with and without opposition transfer; however, certain activities such as fastening hooks or buttons, using chopsticks and turning a key in a lock improved more with opposition transfer. Grip strength did not improve, with or without opposition transfer, regardless of the patients' ages. Pinch strength improved more with opposition transfer.

Differential diagnosis of dementia with Lewy Bodies and Alzheimer Disease using combined MR imaging and brain perfusion single-photon emission tomography

BACKGROUND AND PURPOSE

Diagnostic performance by MR imaging or by SPECT alone in discriminating DLB patients from AD patients has been estimated previously. However, the performance of a combination of MR imaging and SPECT has not yet been evaluated. Our aim was to evaluate the usefulness of combining MR imaging and SPECT to discriminate mild DLB from AD.

MATERIALS AND METHODS

Nineteen patients with mild DLB and 19 age- and cognitive decline-matched patients with mild AD underwent both SPECT and MR imaging. Hippocampal, occipital, and striatal volume and SPECT count ratios were compared. Linear discriminant and ROC analyses were performed by using the parameters of striatal volume and the occipital SPECT ratio.

RESULTS

The striatal volume ratio in the DLB group was significantly lower than that in the AD group. The occipital SPECT ratio in the DLB group was lower than that in the AD group. The mean area under the ROC curve from combined MR imaging and SPECT (AUC = 0.898) was higher than that from MR imaging (AUC = 0.679) or SPECT (AUC = 0.798) alone.

CONCLUSIONS

By combining MR imaging and SPECT, we were able to distinguish patients with mild DLB from those with AD with a high level of accuracy. Our findings suggest that combining MR imaging and SPECT modalities is a useful and practical approach for diagnostically differentiating DLB from AD.

Correlation of hENT1 expression with response and survival in non-small cell lung cancer patients treated with gemcitabine-containing chemotherapy

e22032

Background: The most active gemcitabine uptake has been found via the human equilibrative nucleoside transporter 1 (hENT1). This study was to explore the prognostic impact of the hENT1 on response and survival in Non-small lung cancer (NSCLC) patients treated with gemcitabine-containing chemotherapy. Methods: We developed polyclonal antibody for hENT1. Then we stained hENT1 expression by immunohistochemical analysis in 24 biopsy samples of NSCLC which was formaline-fixed, paraffin- embedded tissues. We were treated with gemcitabine alone or gemcitabine-containing chemotherapy until third-line regimen. Results: They comprised 16 males and 8 females with a median age of 63 years (range 45–82 years). Seventeen patients had adenocarcinomas, six had squamous-cell carcinomas, and one had a large-cell carcinoma. All patients were treated with gemcitabine- containing chemotherapy, with 9, 12, and 3 patients receiving this as a first-, second-, and third-line therapy, respectively. The hENT1-positive staining in NSCLC samples was significantly associated with response to gemcitabine-containing chemotherapy (Fisher's exact test, P<0.05). Responses to gemcitabine-containing chemotherapy were evident in none of the seven patients with no hENT1 expression. Further 3 years survival differed by hENT1 staining: 714 days for hENT1-positive, 316 days for hENT1-negative (HR 2.86; 95%CI 1.13–15.16, P<0.05). Conclusions: While there are some determinants for gemcitabine sensitivity, hENT1 expression may be a predictive maker for the response and survival to gemcitabine-containing chemotherapy in NSCLC.

No significant financial relationships to disclose.

Electrical properties of individual ZnO nanowires

The electrical properties of individual ZnO nanowires were investigated for two methods of fabricating nanowire-electrode junctions. The number of carriers in the nanowires was increased by electrostatically doping them by applying a gate voltage. The nanowires were chemically doped by introducing impurities during growth. The Ga-doped nanowires had a linear current-voltage relationship over a wide voltage region. The nanowire-electrode junctions were formed either by using lithography to form electrodes on the nanowire or by using an AFM probe to move a nanowire onto prepared electrodes. With both methods, electrodes made of Ga-doped ZnO were found to make better electrical contact with the nanowire than those made of Ti/Au.

Potentiation of glucocorticoid receptor (GR)-mediated signaling by the immunosuppressant tacrolimus in rheumatoid synoviocytes

OBJECTIVE

The immunosuppressant tacrolimus is known to enhance many aspects of glucocorticoid. In this study, we investigated the effects of tacrolimus on glucocorticoid receptor (GR) signaling using rheumatoid fibroblast-like synoviocytes (RA-FLS).

METHODS

The nuclear translocation of GR was analyzed by immunocytochemistry. The DNA binding activity of p65 was assayed by a functional ELISA kit using nuclear extracts. GR-associated FK506-binding protein-51 (FKBP-51) was analyzed by Western blotting following immunoprecipitation of glucocorticoid receptor (GR) complexes.

RESULTS

High concentrations (10-7M) of Dexamethasone (Dex) induced GR translocation to the nucleus in RA-FLS. However, the nuclear GR translocation did not occur with low concentrations of Dex (10-9M). Tacrolimus treatment of RA-FLS results in potentiation of GR translocation to the nucleus even in the presence of a low concentration of Dex (10-9M). GR-associated FKBP-51 decreased after tacrolimus treatment. Furthermore, tacrolimus also decreased the IL-1Beta-induced DNA binding activity of p65, a subunit of NF-KappaB, in the presence of 10-9 M of Dex.

CONCLUSION

These data suggest that tacrolimus exerts anti-inflammatory properties by potentiating the GR signaling through the GR-immunosuppressant-binding proteins (immunophilins) interaction and its nuclear transport in rheumatoid synovium.

A sieve electrode as a potential autonomic neural interface for bionic medicine

We examined the applicability of a sieve electrode to the autonomic nervous system as a potential neural interface for bionic medicine. We developed, using a Si-semiconductor process, a sieve electrode having a square diaphragm (1 mm in one side, 12 microm in thickness) with 30-81 penetrating square holes (50-100 microm in one side). In the first protocol, we implanted the sieve electrode to the vagal nerve in rats. One hundred and twenty days after the implantation, cuff electrodes were attached to the vagal nerve proximal and distal to the sieve electrode under halothane anesthesia. The evoked action potential was recorded from the sieve electrode by nerve stimulation via the cuff electrodes. The evoked action potential was also recorded from the cuff electrodes by nerve stimulation via the sieve electrode. In the second protocol, we implanted the sieve electrode to the renal sympathetic nerve in rabbits. Forty days after the implantation, the spontaneous action potential or sympathetic nerve activity was recorded under pentobarbital anesthesia. In conclusion, we were able to record the evoked and spontaneous action potentials using the sieve electrode. The sieve electrode will provide a useful neural interface for recording and stimulating the autonomic nervous system.

Sirolimus conversion after liver transplantation: improvement in measured glomerular filtration rate after 2 years

METHODS

We reviewed our prospectively maintained database of 2005 liver transplantations. Therapy was either started de novo or converted from calcineurin inhibitors (CNIs) to sirolimus as the main immunosuppressive agent for nephrotoxicity or rejection. Glomerular filtration rate (GFR) was determined with iodine 125-labeled sodium isthalamate (Glofil-125), and serum creatinine concentration was obtained before and 3 months after transplantation, and yearly in both groups. Sirolimus levels were 10 to 15 ng/mL in patients at less than 3 months after transplantations and 5 to 10 ng/mL in the remaining patients. All patients received mycophenolate mofetil as maintenance therapy.

RESULTS

Data for 29 patients in the de novo group and 35 in the conversion group were reviewed. Patients in the de novo group demonstrated an acute cellular rejection rate of 17.2%, 40% of which were steroid resistant. In this group, 48.2% discontinuation of sirolimus was necessary because of adverse effects. Patients in the conversion group demonstrated an acute cellular rejection rate of 2.8% and a 34.3% rate of sirolimus discontinuation. Seventeen (56.7%) patients at 1 year and 8 (44.4%) patients at 2 years demonstrated continued improvement in GFR. In the conversion group, case-control analysis did not demonstrate a significant difference in GFR and serum creatinine concentration (P > .05) at 1 and 2 years after conversion. At the time of review, no patients in the conversion group required hemodialysis.

CONCLUSIONS

Conversion to sirolimus therapy is an effective strategy in improving renal function in patients with CNI-induced nephrotoxicity and can be done without increased rejection. Most of our patients (65.7%) tolerated sirolimus conversion. Of these, 56.7% and 44.4% demonstrated continued increase in GFR with the CNI-free regimen at 1 and 2 years, respectively. Long-term, large-population, prospective, randomized, controlled studies should further validate these results.

A case of toe macrodactyly treated by application of a vascularised nail graft

Macrodactyly is a relatively rare congenital abnormality of the fingers and toes and is difficult to treat. We report a new method for treating toe macrodactyly in which a nail with a vascularised pedicle is raised, the toe is shortened to an appropriate length, and the nail transferred to an aesthetically appropriate proximal site. Although this technique is of a higher level of difficulty than conventional procedures involving pedicled nail flaps, allows aesthetically more favourable nail reconstruction by single-stage operation.

Glomerulocystic kidney in a domestic dog

Glomerulocystic kidney was diagnosed in a 5-year-old female Shiba dog, which died from chronic renal failure with convulsions, vomiting and diarrhoea. Haematological examination revealed non-regenerating anaemia, azotaemia and high serum creatinine. Grossly, both kidneys were mildly atrophic with multiple small cysts in the cortex. Histopathological examination revealed marked dilatation of Bowman's space, often with glomerular atrophy or loss, and mild interstitial fibrosis. Bowman's basement membranes (BMs) were tortuous and thickened, with patchy calcification. Glomerulo-tubular junctions in the urinary pole side of the kidneys had a stenotic appearance associated with thickening of Bowman's BMs and calcification. Focal interstitial fibrosis around the glomerulo-tubular junction was also found. Continuity with the proximal tubule was evident in cystic glomeruli. Ultrastructurally, marked thickening of Bowman's BMs with many granular deposits in the urinary pole side was observed. The findings indicate that glomerular cystic changes may have developed as a consequence of glomerulo-tubular junctional stenosis due to thickened Bowman's BMs and focal periglomerular fibrosis in the urinary pole side of the kidneys.

Renal Dysplasia with Unilateral Renal Agenesis in a Dog

This report describes a renal dysplastic lesion associated with renal agenesis in a 3-year-old dog with chronic renal failure. Haematological examination revealed non-regenerative anaemia, azotaemia, increased creatinine and hyperphosphataemia. At necropsy, the right kidney and right ureter could not be identified. The left kidney was slightly enlarged, with a reduced cortico-medullary ratio. Histologically, the medulla of the left kidney had persistent mesenchyme and primitive tubules (tall pseudostratified columnar epithelium), dilated collecting ducts lined by flattened epithelium, and adenomatoid proliferation of cuboidal epithelium; fetal or immature glomeruli could not be identified. To our knowledge, this is the first report of a renal dysplastic lesion with unilateral agenesis in animals.