Low-dose acyclovir prophylaxis for the prevention of herpes simplex virus disease after allogeneic hematopoietic stem cell transplantation

BACKGROUND

Currently, acyclovir (ACV) at 1000 mg/day is widely used as prophylaxis in the early phase of hematopoietic stem cell transplant (HSCT) in Japan. However, low-dose ACV (200 mg/day) has been shown to prevent varicella zoster virus reactivation in the middle and late phases of HSCT.

METHODS

Therefore, in this study, we decreased the dose of ACV to 200 mg/day in the early phase after HSCT. We analyzed 93 consecutive herpes simplex virus (HSV)-seropositive patients who underwent allogeneic HSCT for the first time in our center between June 2007 and December 2011.

RESULTS

Before August 2009, 38 patients received oral ACV at 1000 mg/day (ACV1000) until day 35 after HSCT, whereas 55 patients received oral ACV at 200 mg/day (ACV200) after September 2009. We compared the cumulative incidence of HSV infection in the 2 groups. Oral ACV was changed to intravenous administration because of intolerance in 66% and 45% of the patients in the ACV1000 and ACV200 groups, respectively (P = 0.060). The probability of severe stomatitis (Bearman grade II-III) was 76% and 60% in the ACV1000 and ACV200 groups, respectively (P = 0.12). The number of patients who developed HSV disease before day 100 after HSCT was 0 in the ACV1000 group and 2 in the ACV200 group, with a cumulative incidence of 3.6% (P = 0.43). HSV disease in the latter 2 patients was limited to the lips and tongue and was successfully treated with ACV or valacyclovir at a treatment dose.

CONCLUSION

ACV at 200 mg/day appeared to be effective for preventing HSV disease in the early phase after HSCT.

Immune recovery after autologous PBSC transplantation without in vitro graft manipulation for refractory systemic lupus erythematosus

Autologous hematopoietic SCT (ASCT) has been investigated as salvage therapy for refractory systemic lupus erythematosus (SLE). Although immune recovery after ASCT with in vitro purging of lymphocytes has been extensively studied, little information is available about immune recovery after ASCT without in vitro purging. Therefore, we analyzed the immune recovery of a patient who successfully underwent ASCT without in vitro purging for refractory SLE. In addition to the numbers of PBL subsets, T-cell receptor rearrangement excision circles (TRECs) and the T-cell receptor repertoire diversity of both CD4+ and CD8+ T cells were sequentially analyzed. All SLE-related symptoms disappeared within 3 months after ASCT and the serum anti-dsDNA Ab became undetectable. The number of CD4+CD45RO+ memory T cells remained lower than that in healthy adult controls, but the number of CD4+CD45RA+ naïve T cells showed a rapid increase after ASCT. TRECs of both CD4+ and CD8+ T cells were strongly suppressed before ASCT, but consistently increased after ASCT. The T-cell receptor repertoire of CD8+ T cells was skewed before ASCT, but the diversity recovered after ASCT. ASCT with the reinfusion of a large number of autologous T cells did not impair the recovery of naive T cells or resetting of the immune system.

Strategy of circulatory support with percutaneous cardiopulmonary support

We evaluated the efficacy and problems of circulatory support with percutaneous cardiopulmonary support (PCPS) for severe cardiogenic shock and discussed our strategy of mechanical circulatory assist for severe cardiopulmonary failure. We also described the effects of an alternative way of PCPS as venoarterial (VA) bypass from the right atrium (RA) to the ascending aorta (Ao), which was used recently in 3 patients. Over the past 9 years, 30 patients (20 men and 10 women; mean age: 61 years) received perioperative PCPS at our institution. Indications of PCPS were cardiopulmonary bypass weaning in 13 patients, postoperative low output syndrome (LOS) in 14 patients, and preoperative cardiogenic shock in 3 patients. Approaches of the PCPS system were the femoral artery to the femoral vein (F-F) in 21 patients, the RA to the femoral artery (RA-FA) in 5 patients, the RA to the Ao (RA-Ao) in 3 patients, and the right and left atrium to the Ao in 1 patient. Seventeen (56.7%) patients were weaned from mechanical circulatory support (Group 1) and the remaining 13 patients were not (Group 2). In Group 1, PCPS running time was 33.1 +/- 13.6 h, which was significantly shorter than that of Group 2 (70.6 +/- 44.4 h). Left ventricular ejection fraction was improved from 34.8 +/- 12.0% at the pump to 42.5 +/- 4.6% after 24 h support in Group 1, which was significantly better than that of Group 2 (21.6 +/- 3.5%). In particular, it was 48.6 +/- 5.7% in the patients with RA-Ao, which was further improved. Two of 3 patients with RA-Ao were discharged. Thrombectomy was carried out for ischemic complication of the lower extremity in 5 patients with F-F and 1 patient with RA-FA. One patient with F-F needed amputation of the leg due to necrosis. Thirteen patients (43.3%) were discharged. Hospital mortality indicated 17 patients (56.7%). Fifteen patients died with multiple organ failure. In conclusion, our alternate strategy of assisted circulation for severe cardiac failure is as follows. In patients with postcardiotomy cardiogenic shock or LOS, PCPS should be applied first under intraaortic balloon pumping (IABP) assist for a maximum of 2 or 3 days. In older aged patients particularly, the RA-Ao approach of PCPS is superior to control flow rate easily, with less of the left ventricular afterload and ischemic complications of the lower extremity. If native cardiac function does not recover and longer support is necessary, several types of ventricular assist devices should be introduced, according to end-organ function and the expected support period.

Pathological findings of tissue reactivity of gelatin resorcin formalin glue: an autopsy case report of the repair of ventricular septal perforation

A seventy-three-year-old man was treated for ventricular septal perforation with Gelatin Resorcin Formalin (GRF) glue. The patient died of multiple organ failure 36 days after the surgery. In autopsy, macroscopically, the inferior wall was reconstructed successfully by the GRF glue. Furthermore, microscopic study revealed the excellent growth of collagen and elastic fiber where the GRF was glued. No infiltration of inflammatory cells was evident. There have been no reports that the safety and efficacy of GRF glue was pathologically proven in an autopsy case.

Construction and performance test of SGM-TRAIN at UVSOR

A new spherical-grating monochromator with translational and rotational assembly including a normal-incidence mount (SGM-TRAIN) has been constructed at BL5A of the UVSOR facility. The SGM-TRAIN is an advanced version of a constant-length SGM with the following improvements: (i) a wide energy range of 5-250 eV; (ii) a high resolving power; (iii) use of linear and circular polarization; (iv) reduction of second-order light; (v) two computer-controlled driving modes. Part of the performance tests are reported along with a detailed description of the design.

Undulators at HiSOR - a compact racetrack-type ring

A compact racetrack-type 700 MeV storage ring (HiSOR) has been constructed at Hiroshima Synchrotron Radiation Center (HSRC). As the ring was planned for synchrotron radiation research on science and technology using VUV to X-rays up to 5 keV with limited size and cost, the ring was designed (i) to realize a high magnetic field (2.7 T) using conventional dipole magnets for higher critical energy, and (ii) to include two straight sections for insertion devices. A linear undulator (25-300 eV) and a new-type helical/linear undulator were installed at the two straight sections. The latter undulator consists of upper and lower jaws, as in a planar undulator; each jaw consists of one fixed magnet array at the centre and two magnet arrays on both sides. By longitudinal displacement of the side magnet arrays, the phase between the vertical and horizontal magnetic fields, and therefore the polarization (right- or left-circular, elliptical, linear) can be selected. The helical/linear undulator gives almost perfect circular polarization at 4-40 eV in the helical configuration without changing the phase of the magnet arrays, as well as linearly polarized light at 3-300 eV in the linear configuration.

Performance of the YB(66) soft X-ray monochromator crystal at the wiggler beamline of the UVSOR facility

Soft X-ray spectra have been measured using a pair of YB(66)(400) monochromator crystals at the double-crystal monochromator beamline BL7A of the UVSOR facility, where the wiggler radiation has a magnetic field of 4 T. Deformation of the YB(66) crystal due to heat load from the synchrotron radiation is almost negligible. The photon flux is about 10(8) photons s(-1) (100 mA)(-1) in the energy region 1.2-2 keV and the energy resolution is 0.7 +/- 0.1 eV around hnu = 1.5 keV. These results show that the YB(66) crystal is suitable for use as a monochromator crystal. Its application to soft X-ray spectroscopy is discussed.

Performance of a helical undulator of the UVSOR

A helical undulator was installed in the 0.75 GeV storage ring of the UVSOR facility of the Institute for Molecular Science. The undulator was designed to produce the fundamental of the circularly polarized undulator radiation in the energy range 2-43 eV, and the higher harmonics with elliptical polarization in the energy range up to 300 eV. Recently, the first spectrum from the undulator was observed. The performance of the undulator and the obtained spectrum are reported.