To clarify the mechanisms of graft failure after umbilical cord blood transplantation, we examined the effects of myeloablative conditioning equivalent irradiation on bone marrow stromal cells. When murine bone marrow stromal HESS-5 cells were irradiated with over 10 Gy, expression of stromal cell-derived factor-1 (SDF-1) and Jagged-1 mRNA was decreased significantly compared with non-irradiated cells. SDF-1 protein was also decreased in culture media supernatant from irradiated HESS-5 cells. Co-culture experiments of irradiated HESS-5 cells with human cord blood CD34+ cells revealed that irradiation up to 20 Gy did not affect the proliferative ability and supporting ability for cord blood CD34+ cells. When HESS-5 cells were irradiated with over 10 Gy, the culture media supernatant obtained from the irradiated cells exhibited diminished chemotactic activity towards umbilical cord mononuclear cells compared with that from non-irradiated cells. In addition, whole-body irradiation with over 10 Gy in mice resulted in an approximate 10% reduction in the number of bone marrow stromal cells. Whole-body irradiation with over 10 Gy also decreased the expression of SDF-1 in bone marrow stroma. Taken together, we demonstrated that myeloablative conditioning equivalent irradiation leads to a decrease in the number of bone marrow stromal cells and the expression of SDF-1. These data suggest that whole-body irradiation for myeloablative conditioning may contribute to graft failure after umbilical cord blood transplantation.
Background and Aim: Cavo-tricuspid isthmus (CTI)-dependent atrial flutter (AFL) can develop in patients who have undergone percutaneous catheter ablation for atrial fibrillation (AF) or during left atrial (LA) ablation for AF. The electrocardiographic (ECG) characteristics of CTI-dependent AFL during LA ablation have not been described in detail. The purpose of this study was to ascertain and describe the ECG features of CTI-dependent AFL occurring during percutaneous LA catheter ablation for AF. Methods and Results: Of 72 patients underwent AF ablation at our institution between January 2011 and December 2012, 33 (45.8%) exhibited CTI-dependent AFL during ablation for AF. Of these 33 patients, 26 and 7 exhibited typical and atypical ECG patterns, respectively. Flutter waves in the inferior leads were biphasic in 5 patients and positive in 2. Conclusions: CTI-dependent AFL during LA ablation for AF often exhibits atypical ECG characteristics. In patients in whom atrial flutter develops during LA ablation, entrainment mapping should be performed at the CTI even if the ECG is uncharacteristic of CTI-dependent AFL.
Introduction: We carried out diffusion tensor imaging (DTI) to detect the corticospinal tract (CST) during deep brain stimulation (DBS) of the subthalamic nucleus (STN), and we examined whether CST-based targeting could provide reliable internal fiducial markers for STN-DBS. Materials and Methods: Twenty-eight patients underwent bilateral simultaneous implantation of DBS electrodes for STN-DBS. We calculated the absolute values of the differences in the coordinates between the implanted DBS electrodes and the CST demonstrated by tractography in each patient at the level 3 mm inferior to the superior border of the red nucleus (RN). We also compared the distance between the implanted DBS electrodes and the estimated target points planned by RN-based and CST-based targeting. Results: The average distance from the center of the CST to the center of the implanted DBS electrode was 7.0 ± 2.3 mm in the x-direction, 2.1 ± 1.3 mm in the y-direction, and -4.3 ± 1.4 mm from the level of the AC-PC line as the z-coordinate. The average distance between the DBS electrode and planned targets estimated by RNbased targeting was 2.5 ± 1.1 mm, and that estimated by CST-based targeting was 3.9 ± 1.6 mm. The variances of these planned targets were not significantly different (p = 0.06, Mann-Whitney U-test). Conclusions: The stereotactic coordinates between the target points of STN and CST were confirmed by CSTbased targeting in this study. The results were not significantly different between RN-based targeting and DTIbased targeting for STN-DBS. The DTI-based targeting method using an internal fiducial marker has a possibility to become a powerful tool in stereotactic surgery.
A 72-year-old male was admitted to our hospital after experiencing dyspnea for 2 months. He had been diagnosed as having stage IV idiopathic pulmonary fibrosis and was started on home oxygen therapy. Three months since pirfenidone therapy was begun after discharge, his forced vital capacity has improved dramatically. Chest CT also showed improvement of the ground-glass opacities. It is possible to control both mild stage and severe stage idiopathic pulmonary fibrosis due to advances with long-term pirfenidone therapy.
Herein, we present a case report of the metastasis of a clear cell renal cell carcinoma (ccRCC) with an eosinophilic cell component to the skin of the submandibular region. An eosinophilic component has not been reported previously in the histological findings of ccRCC. The patient was a 74yearold man who had a painless papula in the right submandibular region. Six years earlier, he had undergone nephrectomy and had been diagnosed with stage 1 ccRCC (pT1a, N0, M0). At the current presentation, the dermis in the resected specimen was composed of a clear cell neoplasm with glycogen deposits. Upon immunohistochemical analysis, the clear cells were found to be positive for CD10 and vimentin. As these findings were similar to those from the nephrectomy specimen, the cutaneous lesion on the skin of the submandibular region was confirmed to be a lesion of the metastatic ccRCC. Even when a lowstage ccRCC with an eosinophilic cell component is diagnosed, critical pathological and clinical examinations are needed because distant metastases may occur to the head and neck region, as in this case. Furthermore, when a skin tumor is found in the head and neck region, metastatic RCC must be considered in the differential diagnosis.
Biological products (Bio) play an extremely important role in the treatment of rheumatoid arthritis (RA). We performed simultaneous bilateral total knee arthroplasty after single administration of Bio to treat the side effects of methotrexate (MTX) in an RA patient who had gait inability due to severe flexion contracture of both knee joints. The problems with this case were: (1) which procedure should be performed first, Bio administration or surgical treatment, and (2) which Bio should be selected for the single administration when MTX cannot be used concomitantly. The 1-year postoperative clinical course for this patient remains favorable, but careful follow-up observation will be necessary in the future.