Although immune function is a factor in cases of sepsis with high mortality, it cannot be measured at the bedside. We investigated blood cytokines and the capacity of nucleated blood cells (NBCs) to produce cytokines (IL-6, 8, 10) using clinical data from septic patients, and considered how this was related to the patient outcome. This study targeted thirty patients suffering from severe sepsis or septic shock. Peripheral whole blood was collected prior to treatment for sepsis, 6 hours after such treatment, and again at 24 hours post-initiation. Residual peripheral blood was placed into laboratory dishes and exogenous lipopolysaccharide (LPS) was added (10 ng/mL). The capacity of NBCs to produce cytokines was calculated using the ratio of each cytokine before (nonLPS) and after (s-LPS) in vitro LPS stimulation (s-LPS/non-LPS). The ratio of these cytokines exhibited significant negative correlations with a higher APACHE II scores. The APACHE II score was significantly associated with a poor outcome, but there was no correlation with outcome for any other clinical data. A higher APACHE II score could be used to indirectly estimate immunoparalysis in the clinical setting.

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Background: Pacing induced atrial fibrillation (AF) has been shown to induce significant increases in sympathetic and parasympathetic neurons in dogs, and the efficacy of cardiac autonomic denervation by ganglionated plexi (GP) has been shown to increase the freedom from recurrence of AF. We compared the GP response to high-frequency stimulation (HFS) in patients with and without AF. Methods: The responses to HFS (20 Hz, 25 mA, 10 ms) at 5 left atrial GP sites were evaluated in 24 patients with AF (paroxysmal: 11, persistent AF: 5) and 16 patients with left side accessory pathways . Results: Vagal responses (> 50% increase in RR interval) to HFS were more frequently observed in patients with AF (Table). Conclusions: AF increases left atrial cardiac autonomic nervous system activity, which may contribute to the adjunct role of GP ablation following pulmonary vein isolation

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Background: Similar clinical outcomes have been demonstrated following pulmonary vein (PV) isolation (I) by radiofrequency catheter and cryoballoon ablation (CBA) in patients with paroxysmal atrial fibrillation (PAF). However, no comparison of the clinical outcome in patients with PAF and persistent AF (PerAF) by CBA has been reported to date. The purpose of this study was to compare the efficacy of PVI in patients with PAF and PerAF. Methods: CBA based PVI using a second-generation 28-mm balloon was performed in 58 patients with PAF and 32 with PerAF. Follow-up (FU) was based on outpatient clinic visits at 1, 3, 6, and 12 months, which included Holter electrocardiograms and ambulatory event electrocardiograms. Results: The freedom from atrial tachyarrhythmia recurrences following a single cryoballoon ablation in patients with PAF and PerAF did not differ significantly between the PAF and PerAF patients over a relatively shorter follow-up period, as estimated by the Kaplan-Meir method. Conclusion: CB-based PVI had similar efficacy for both PAF and PerAF.

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背景：慢性腎不全に対する血液透析 (HD) 施行 症例には心房細動 (AF) の合併率が高いが，抗不整脈薬 の使用は困難な場合が多い．そこで，著者らは HD 症例 に合併した AF に対するカテーテルアブレーションの有 効性と問題点につき検討した． 対象：AF を合併した HD 6 症例と非 HD 症例の AF 12 症例を対照とし，カテーテルアブレーションを施行し， その成績及び合併症を検討した． 結果：AF 再発率は HD 症では 33.3％，非 HD 症例は 41.7％と有意差を認めなかった ( p = 0.3904)．一方，ア ブレーションに伴う合併症は HD 症例で 4 症例（穿刺部 の血腫 2 症例，仮性動脈瘤 1 症例，輸血を施行した大量 の鼻出血 1 症例）見られたのに対し，非 HD 症例では見 られなかった ( p = 0.0197)． 結語：HD 症例に合併する心房細動に対するカテーテ ルアブレーション治療は非 HD 症例同様に有効な治療手 段であるが，血管合併症には留意する必要が有る．

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背景：心房細動 (AF) に対する高周波 (RF), cryoballoon (CB), hotballoon (HB) による肺静脈隔離 (PVI) が心臓自律神経活動に及ぼす効果を検討した． 対象及び方法：AF に対する RF (n = 18)，CB (n = 31)， HB (n = 16) による PVI 症例で PVI 前後に左房 (LA) 自律 神経叢 (GP) を刺激を施行し，迷走神経反射 (VR) の有無 を検討し，さらに，心拍数および心拍数変動を比較検討 した． 結果：RF-PVI 群，CB-PVI 群，HB-PVI 群で GP 刺激 による VR が 72％，73％，78％で消失した．術後の心 拍数は CB-PVI，HB-PVI 群で有意に増加したが，RFPVI 群では差を認めなかった．心拍数変動の高周波成分 (HF)，低周波成分 (LF)/HF には各群とも PVI 前後で差を 認めなかった． 結語：PVI 後早期の心拍数変動は RF, CB, HB の３群 間で同等であったが，心拍数は CB, HB 群において有意 に増加した．PVI 後早期の心臓自律神経活動評価におい て，心拍数増加がバルーンを使用したアブレーションと カテーテルアブレーションとの違いであった．

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Optical microscopes are indispensable for modern medical practice and biomedical research. Though the basic design of modern microscopes was developed over 100 years ago, their optical quality has not been examined by modern physicians. In this study, we compared the optical functions of antique German microscopes with those of modern microscopes, using various samples including HE stained frog tissues, Gram-stained peripheral blood cultures and test slides of permanent silica preparations. Of great interest, the objective lenses of old microscope showed good resolution and contrast that were almost comparable to modern ones. However, the narrow field of view and the lack of lighting units were major disadvantages of these antique microscopes. In conclusion, the optical qualities of the late 19^th and early 20^th century microscopes were sufficient to support the great discoveries by hunters of microorganisms and great pathologists.

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Teratoma is the most common germ cell tumor (GCT) of the ovary. Recently, much has been learned regarding the pathogenesis of GCT from a molecular biology perspective. Based on molecular biological findings, 12p gain, and isochromosome 12p (i(12p)), unlike testicular postpubertal teratoma, most ovarian teratomas are derived from benign germ cells in a parthenogenetic-like process. Furthermore, it is known that somatic-type malignant tumors, such as cancer and sarcoma, rarely arise from dermoid cysts. Herein, we present the case of a patient diagnosed with a malignant neuroepithelial component arising from a mature teratoma. Fluorescence in situ hybridization (FISH) revealed that i(12p) was detected in the malignant component but was absent from the teratomatous portion.

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症例は 37 歳．子宮筋腫，右卵巣子宮内膜症性 嚢胞のため偽閉経療法後に腹腔鏡手術を施行し，再発予 防で黄体ホルモン療法を継続していた．1 年後の健康診 断で右気胸を指摘され，内科を受診，虚脱が小さく，症 状も安定しており経過観察とした．その後再発を繰り返 したため呼吸器外科に紹介となった．胸腔鏡下手術を施 行し，横隔膜に病理学的に子宮内膜症を認めた．現在も 黄体ホルモン療法を継続しており再発を認めていない．

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