Recently regenerative medicine has made enormous progress, and various artificial skins are being developed as composite cultured skin. Among them, hybrid artificial skin contains living fibroblasts that are cultured on a scaffold derived from animals, such as cows, pigs and rats. Such material from animals inevitably contains the potential risk of infection, from agents both known and unknown. Therefore, we have developed a three-dimensional (3D) model cultured dermis based on non-biogenic peptide hydrogel scaffolding. To make the cultured dermis, human dermal fibroblasts derived from newborns were mixed with the peptide hydrogel, dispensed into the insert, and cultivated for a maximum of 2 weeks in D-MEM. We evaluated samples of the cultured dermis by HE staining, AZAN staining, and immunohistochemistry staining for human type I collagen. The fibroblasts appeared foam-like evenly distributed in the 3D structure of the peptide hydrogel. In addition, the presence of human type I collagen confirmed by immunocytochemistry suggests that the fibroblasts in the peptide hydrogel were functional. Peptide hydrogel consists of standard amino acids (1%) and 99% water. Under physiological conditions, the peptide components self-assemble into a 3D hydrogel that exhibits a nanometer-scale fibrous structure. Peptide hydrogel is a synthetic matrix that is used to create defined 3D microenvironments for a variety of cell culture experiments. Peptide hydrogel is biocompatible, resorbable, and devoid of animal-derived material and pathogens. We have developed a model three-dimensional (3D) cultured dermis using peptide hydrogel as a scaffold with the potential for clinical application. In this study, we investigated the method to produce cultured dermis with peptide hydrogel as the scaffold, and demonstrated the survival and functional manifestation of fibroblasts in peptide hydrogel.

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The purpose of this study was to clarify the onset of cervical myelopathy and cervical spondylotic radiculopathy as well as what influence the anatomy of the cervical spine and cervical nerves have on their onset and occurrence of various types of disease state. We conducted imaging and morphological measurements on specimens of cervical spine of Japanese people, focusing attention on the running of intervertebral foramen and dorsal nerve rootlets of the cervical spine. The subjects were cervical spine specimens from 12 cadavers (7 males and 5 females, age at the time of death ranged from 48 to 93 years with a mean of 71 years) obtained at Showa University School of Dentistry in 2005 and 2006. Specimens were prepared by removing the atlas through the 1^st thoracic vertebra from the cadavers, then resecting the soft tissue such as muscles to expose the cervical spine in whole circumference. The removed cervical spine specimens, from 1^st to 7^th cervical spines, were imaged by volume scan of radiographic helical CT at 0.6 mm spacial resolution, and their images were stored as DICOM data. Image measurement on the vertebral body, vertebral foramen, and intervertebral foramen was conducted based on DICOM data. Furthermore, macroscopic observation and measurement were conducted on the dorsal nerve rootlets of cervical spine specimens. The image measurement of cervical spine specimens showed that the intervertebral foramen at C5/6 was the narrowest, followed by C3/4, C4/5, C6/7, and C2/3, respecting. With regard to angles in the frontal section and horizontal section of the groove for the spinal nerve, there was no significant difference in the angle between the right and the left. In the frontal section, the angle was about 63° at C3, about 57° at C4, about 52° at C5, and about 55° at C6, showing a significantly acute angle at C5, while in the horizontal section, it was about 54° at C3, about 59° at C4, about 63° at C5 and C6, showing a significantly obtuse angle at C5 and C6 compared with at C3. The measurement at the merging section of the dorsal spinal nerve root showed that the width was about 7.0 to 7.5 mm at C3 through C6 and about 6.5 mm at C7 which was significantly low, while the cephalocaudal length was about 12.5 mm at C3, about 11.5 mm at C4, about 12 to 13 mm at C5, about 11.5 mm at C6, about 10.5 mm at C7, and about 10 mm at C8; there was a difference between the right and the left at C5, whereas no difference was observed between the right and the left at C3, C4, C6, C7, and C8. The incidence angle from the inlet of intervertebral foramen of the dorsal spinal nerve root toward the superior part of the spine indistinct a gradual obtuse angle at C3 through C5, whereas the angle gradually become an acute angle at C6 or below. The incidence angle in the inferior part was obtuse at C4 and C5, and acute at C6 or below, showing that the distance obliquely running within the dura mater tended to be short in the dorsal nerve rootlets at C4 and C5. Based on the above results, it was considered that the anatomy of the intervertebral foramen of the cervical spine and the difference by level at the origin of dorsal root have an influence on the onset of cervical myelopathy and cervical spondylotic radiculopathy as well as the occurrence of various types of disease states.

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To assess the spread of carbapenem-resistant Enterobacteriaceae, we examined the susceptibility of 1950 clinical isolates collected at our hospital during 2005 and identified 10 isolates (0.5%) showing resistant phenotype. Among the isolates, 6 of 142 Serratia marcescens (4.2%), 1 of 360 Klebsiella pneumoniae (0.3%), 1 of 215 Enterobacter cloacae (0.5%), 1 of 14Providencia rettgeri (7.1%), and 1 of 13 Enterobacter spp. (7.7%) were metallo-β-lactamase-producing strains, confirmed by ceftazidime-mercaptopropionic acid double-disk synergy tests. The presence of bla_IMP gene in the 10 isolates was verified by PCR analysis. Sequencing of PCR products revealed that isolates of E. cloacae, K. pneumoniae and P. rettgeri carried bla_IMP-1 and isolates of S. marcescens and Enterobacter spp. carried bla_IMP-11. Genome type analysis by pulsed field gel electrophoresis showed that 5 of 6 S. marcescens isolates were identical, although the 5 strains were isolated from different wards and at intervals of months. The above results indicate a possible nosocomial colonization of the bacteria harboring bla_IMP-11 and therefore surveillance of such a resistant gene is required to control their spread.

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The brachial plexus block is a method of analgesia suitable for surgery of the shoulder and arms. The brachial plexus block is usually used with an ultrasound guide for arm surgery; this method is safe and reliable. Because this method is also used after general anesthesia, the patient does not feel any pain. We report a 66-year-old female who underwent amputation of the left forearm. For analgesia and measurements of postoperative phantom limb pain, we performed a continuous brachial plexus block (subclavian approach) by catheter insertion. Management during and after the operation was successful.

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A 93-year-old man was referred to our hospital due to shortness of breath. Computed tomographic scans revealed bilateral pleural effusion, but lymphadenopathy was not found. Pleural effusion specimens contained numerous atypical cells possessing indented nuclei and moderate amounts of basophilic cytoplasm containing numerous small round vacuoles. Flow cytometric analyses of the cell surface demonstrated that these cells were positive for CD19 and CD20. Southern blot analysis revealed a clonal rearrangement of the immunoglobulin heavy chain gene, and chromosome analysis showed near-tetraploid karyotype accompanied with structural aberrations. Human herpes virus (HHV) -8/Kaposi's sarcoma-associated herpes virus (KSHV) was not identified within the nuclei of the cells by immunostaining, and a serologic test for human immunodeficiency virus (HIV) was negative. The value of IgG was 2560 mg/dl. Furthermore, serum electrophoresis revealed the existence of an M-component of 36.1%, and serum immunoelectrophoresis showed that the component was a IgG-κ type monoclonal protein. Bence Jones proteinuria was not detected. On the other hand, the ratio of plasma cells in the bone marrow was 5.0%, and a bone lesion was not found. Base on these results, we diagnosed this patient with HIV-, HHV-8/KSHV- negative primary effusion lymphoma (PEL) . We concluded that the monoclonal proteins are produced in lymphoma cells because flow cytometric analyses showed that these cells express IgG and κ-chain within cytoplasm. To our knowledge, this is the first report of a PEL showing monoclonal proteinemia.

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A 59 years-old woman underwent an appendectomy for acute appendicitis at 8 years of age. She became aware of a mass in the right lower quadrant in February 2006 and had a gynecology checkup in March. Abdomen magnetic resonance imaging showed a 6 cm tumor in the cecum. Endoscopic examination revealed an elevated lesion with an indistinct border in cecum. The biopsy result was group 3. Abdominal ultrasonography and abdomen computerized tomography showed one metastasis tumor 1 cm in size the liver. Finally, we diagnosed myxopoiesis cancer occurred from remnant appendix or the cecum. The histopathological view indicated appendiceal cancer. We report a case of appendiceal cancer occurred from a remnant appendix 51 years after an appendicectomy.

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