The Keio Journal of Medicine
Online ISSN : 1880-1293
Print ISSN : 0022-9717
ISSN-L : 0022-9717
Volume 57, Issue 4
Displaying 1-6 of 6 articles from this issue
REVIEWS
  • Paul J. Martin
    2008 Volume 57 Issue 4 Pages 177-183
    Published: December 25, 2008
    Released on J-STAGE: March 10, 2009
    JOURNAL FREE ACCESS
    Hematopoietic cell transplantation (HCT) is frequently complicated by graft-versus-host disease (GVHD). During the past three decades, experimental studies and clinical observations have elucidated the pathophysiology of acute GVHD, but the biology of chronic GVHD is much less well understood. Recommendations of the NIH Consensus Development Project on Criteria for Clinical Trials in Chronic GVHD have begun to standardize the diagnosis and clinical assessment of the disease. These criteria have emphasized the importance of qualitative differences, as opposed to time of onset after HCT, in making the distinction between acute and chronic GVHD. Experimental studies have generated at least four theories to explain the pathophysiology of chronic GVHD. These theories include 1) thymic damage and defective negative selection of T cells generated from marrow progenitors after HCT, 2) aberrant production of transforming growth factor-β, 3) auto-antibody production, and 4) deficiency of T-regulatory cells. Recent studies in humans have corroborated a possible role for each of these mechanisms in humans. No animal model fully replicates all of the features of chronic GVHD in humans, and it appears likely that multiple biological mechanisms account for the diverse features the disease. Chronic GVHD may represent a "syndrome" with diverse causes among individual patients. In the future, it might become possible to tailor specific therapeutic interventions for patients as individually needed for each distinct pathophysiologic mechanism involved in development of the disease.
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  • Ihor V. Yosypiv
    2008 Volume 57 Issue 4 Pages 184-189
    Published: December 25, 2008
    Released on J-STAGE: March 10, 2009
    JOURNAL FREE ACCESS
    The renin-angiotensin system (RAS) plays a critical role in kidney development. Mutations in the genes encoding components of the RAS or pharmacological inhibition of RAS in mice or humans cause a spectrum of congenital abnormalities of the kidney and urinary tract (CAKUT). The observed defects include renal vascular abnormalities, abnormal glomerulogenesis, renal papillary hypoplasia, hydronephrosis, aberrant ureteric bud (UB) budding, duplicated collecting system and renal tubular dysgenesis. Little is known about the potential role of Ang II and its receptors in the morphogenesis of the UB and renal collecting system. This review emphasizes a novel role for the RAS in the development of the UB, collecting ducts and renal medulla. We observe that UB and surrounding stroma express angiotensinogen and Ang II AT1 receptors (AT1R) in vivo. Ang II stimulates UB cell branching in collagen gel cultures in vitro and induces UB morphogenesis in intact whole embryonic metanephroi grown ex vivo. In contrast, treatment of metanephroi with the AT1R antagonist candesartan inhibits UB branching. In addition, Ang II induces tyrosine phosphorylation of the epidermal growth factor receptor (EGFR) in UB cells. Furthermore, Ang II-stimulated UB morphogenesis is abrogated by inhibition of EGFR tyrosine kinase activity. In summary: 1) Ang II, acting via the AT1R, stimulates UB branching; 2) This process depends on tyrosine phosphorylation of the EGFR. Together, these data indicate that cooperation of AT1R and EGFR signaling performs essential functions during renal collecting system development via control of UB branching morphogenesis.
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ORIGINAL ARTICLES
  • Ghasemali Khorasani, Seyed Jalal Hosseinimehr, Peyman Zamani, Maryam G ...
    2008 Volume 57 Issue 4 Pages 190-195
    Published: December 25, 2008
    Released on J-STAGE: March 10, 2009
    JOURNAL FREE ACCESS
    The aim of this study was to evaluate the efficacy of pollen of saffron extract cream in the treatment of thermal induced burn wounds and to compare its results with silver sulfadiazine (SSD) in rats. Animals were divided into four groups and administrated a topical cream including control, base, saffron (20%) or SSD (1%) at 24 hour after a burn injury that was induced by hot water. In special days, according to a pre-planned schedule, animal's weight, wound size, as well as skin histo-pathology were determined in different groups under topical treatments. On day 25, average size of wound was 5.5, 4, 0.9 and 4.1 cm2 in control, base, saffron and silver groups. The wound size of saffron group was significantly smaller than other groups. Histological comparison has shown that saffron significantly increased re-epithelialization in burn wounds, as compared to other cream-treated wounds. Although the exact mechanism of saffron is unclear, anti-inflammatory and antioxidant effects of saffron may have contributed to the wound healing. The results of this study raise the possibility of potential efficacy of saffron in accelerating wound healing in burn injuries.
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  • Yukihiro Hara
    2008 Volume 57 Issue 4 Pages 196-204
    Published: December 25, 2008
    Released on J-STAGE: March 10, 2009
    JOURNAL FREE ACCESS
    Purpose: The purpose of this study was to examine the incidence, factors, and effects of antiplatelet and anticoagulant agents on sub-acute and chronic ischemic stroke patients during the rehabilitation phase for rates of deep venous thrombosis (DVT) from the perspective for rehabilitation medicine.
    Methods: In this study of 272 patients undergoing rehabilitation for completed cerebral infarction, multiple circumference measurements of calf and thigh along with presence or absence of symptoms (congestion, swelling, skin redness, warmth, pain, pigmentation, fever and/or Homan sign or Luck's sign) documented in the physical examination were recorded in all patients. Patients with these symptoms suggestive of DVT were included for D-dimer assay and venous duplex ultrasonography to confirm presence of DVT.
    Results: DVT was documented in 24 patients (8.8%), most of whom displayed distal DVT on the hemiparetic side. A significant association was seen between occurrence of DVT and more severe lower limb paresis, manifesting as gait disturbance, severe calf muscle spasticity, use of ankle-foot orthosis (AFO). A significant increase in development of DVT was associated with severe spasticity in hemiparetic calf muscles (odds ratio (OR) 28.2; 95% confidence interval (CI), 6.9-113.5). Cilostazol seemed to be the only effective antiplatelet drug for preventing DVT in cerebral infarction patients.
    Conclusion: Incidence of DVT in the rehabilitation phase following stroke was not low, which was predominant as distal DVT on the hemiparetic side. Lower limb paresis, gait disturbance, calf muscle spasticity and use of AFO contributed to occurrence of DVT. It is likely that micro-injuries in the venous endothelium due to spasticity and AFO might cause DVT. Cilostazol seems effective for protecting against venous endothelial damage following DVT.
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  • Norihiro Okamoto
    2008 Volume 57 Issue 4 Pages 205-210
    Published: December 25, 2008
    Released on J-STAGE: March 10, 2009
    JOURNAL FREE ACCESS
    Purpose: To evaluate the correlations of anatomical parameters between dynamic pelvic CT (D-PCT) and conventional defecography (CD) for patients with rectal prolapse.
    Material and Methods: Anatomical parameters in multislice CT scanning of the pelvis performed at rest and during simulated defecation (D-PCT) were studied with those of CD to evaluate the correlations in both methods for 10 patients with rectal prolapse.
    Result: The correlation coefficients of the pubococcygeal line and the pubosacral line were r=0.6 and r=0.8 respectively. The length from anal verge to pubococcygeal line and to the pubosacral line showed a good correlation of r=0.7. The length of puborectal muscle showed a good correlation of r=0.8. Anorectal angle was significantly well correlated between two methods (r=0.9, p<0.05). The lengths of anococcygeal length and anosacral length showed a good correlation.
    Conclusion: The anatomical parameters measured by D-PCT were well correlated with those by CD. D-PCT might be an alternative tool for anatomical evaluation of the anorectal region in patients with rectal prolapse.
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  • Hirotoshi Ohara, Kazuo Kishi, Tatsuo Nakajima
    2008 Volume 57 Issue 4 Pages 211-216
    Published: December 25, 2008
    Released on J-STAGE: March 10, 2009
    JOURNAL FREE ACCESS
    Rectangular flaps on the rat or mouse dorsum are frequently used for flap survival elongation research. However, since rectangular flaps are purely random, the survival rate varies among individuals. A reliable animal flap model with low individual variation is desirable for flap survival research, especially in the angiogenic field. We investigated the survival rate of paired flaps in the rat dorsum containing 3 vascular territories in each flap, and determined their usefulness for flap elongation research.
    Two symmetrical adjoining rectangular flaps (11×3 cm each) were drawn on the rat dorsum. Two days after material injection, flaps were elevated with only the deep circumflex iliac vessels as the vascular pedicle. Flaps were immediately sutured back and the flap survival area was measured 7 days after the operation. The control group (n = 9) had saline solution injected in both flaps. The bone marrow group (n = 8) had bone marrow injected in the right flap, and saline solution injected in the left flap.
    In the control group, the survival rate of the paired flaps was not statistically different (right flap, 89.0±5.6%; left flap, 89.3±4.5%). In the bone marrow group, the survival rate between the bone marrow injected flap (89.9±3.7%), and the saline flap (84.8±4.3%) was statistically different.
    The rat dorsal paired island skin flap model shows low difference in flap survival rate and uses an internal control. This is a suitable model for flap survival elongation research.
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