Development and characterization of chloroplast microsatellite markers for Cryptomeria japonica D. Don

We developed 17 chloroplast microsatellite markers, which consisted of seven mononucleotide microsatellites with a minimum repeat number of 10 and 10 dinucleotide microsatellites with a minimum repeat number of six, from the complete chloroplast genomic sequence of Cryptomeria japonica. A survey of 45 C. japonica individuals showed the number of alleles ranging from two to 11 alleles and a diversity index ranging from 0.085 to 0.895. Consequently, the 45 C. japonica individuals were divided into 39 haplotypes. These markers will be useful genetic markers in the gene flow analysis and population genetics of C. japonica.

Outcomes of 23- and 25-gauge transconjunctival sutureless vitrectomies for idiopathic macular holes

BACKGROUND/AIMS

To assess the outcomes of 23-gauge sutureless transconjunctival vitrectomies (TSV), as compared with 25-gauge TSV in macular hole surgeries.

METHODS

A retrospective, consecutive, interventional case series of 47 eyes with idiopathic macular holes treated by 23- or 25-gauge TSV were analysed.

RESULTS

The operative time was 37.2 (SD 8.9) min with 23-gauge TSV and 34.2 (8.7) min with 25-gauge TSV (p = 0.388). The anatomical success rate was 96% with 23-gauge TSV and 92% with 25-gauge TSV (p>0.999). The logarithm of the minimum angle of resolution of best-corrected visual acuity (BCVA) at the sixth postoperative month was 0.19 (0.16) with 23-gauge TSV and 0.19 (0.25) with 25-gauge TSV (p = 0.521). Postoperative improvement in BCVA was comparable between the two TSVs. IOP on postoperative day 1 was lower with 25-gauge TSV (12.3 (4.9) mm Hg) than with 23-gauge TSV (17.4 (5.8) mm Hg) (p = 0.036). Complications included retinal break, intraoperative bleeding and slippage of the infusion cannula with 23-gauge TSV, while retinal detachment and postoperative hypotony occurred in the 25-gauge TSV group (p = 0.570).

CONCLUSION

23-gauge TSV appears to be as safe and effective as 25-gauge TSV in macular hole surgery.

PlGF-1 and VEGFR-1 pathway regulation of the external epithelial hemato-ocular barrier. A model for retinal edema

VEGF is considered as an important factor in the pathogenesis of macular edema. VEGF induces the rupture of the blood retinal barrier and may also influence the retinal pigment epithelial (RPE) outer retinal barrier. The aim of this work was to analyze the influence of the VEGF receptor pathways in the modulation of the RPE barrier breakdown in vitro and in vivo. The ARPE19 human junctions in culture are modulated by VEGF through VEGFR-1 but not through VEGFR-2. PlGF-1, that is a pure agonist of VEGFR-1, is produced in ARPE-19 cells under hypoxic conditions and mimics VEGF effects on the external retinal barrier as measured by TER and inulin flux. In vivo, the intravitreous injection of PlGF-1 induces a rupture of the external retinal barrier together with a retinal edema. This effect is reversible within 4 days. VEGF-E, that is a pure agonist of VEGFR-2, does not induce any acute effect on the RPE barrier. These results demonstrate that PlGF-1 can reproduce alterations of the RPE barrier occurring during diabetic retinopathy.

Carbon dioxide microbubbles-enhanced sonographically guided radiofrequency ablation: treatment of patients with local progression of hepatocellular carcinoma

PURPOSE

The aim of our study was to evaluate the usefulness of percutaneous radiofrequency ablation (RFA) using CO2 microbubbles-enhanced sonography for patients with local tumor progression of hepatocellular carcinoma (HCC).

MATERIALS AND METHODS

The tumors of 14 patients with local progression of HCC were treated with CO2 microbubbles-enhanced RFA ablation via a catheter that had been placed in the hepatic artery. We assessed tumor detectability and technical effectiveness. The mean follow-up period was 14.1 months.

RESULTS

Only 6 of the tumors could be found on conventional sonography, whereas 14 tumors were detected on CO2 microbubbles-enhanced sonography. These 14 lesions were successfully treated with RFA guided by CO2 microbubbles-guided sonography. Technical effectiveness was complete in all patients. No serious complications were observed, and there was no local tumor progression during the follow-up period.

CONCLUSION

RFA guided by CO2 microbubbles-guided sonography is a feasible technique for treating local progression of HCC lesions that cannot be adequately depicted by conventional sonography.

Evaluation of immunosuppressive regimens in ABO-incompatible living kidney transplantation--single center analysis

Several protocols allow the successful ABO incompatible living-related kidney transplantation (ABO-ILKT), yet no single method has emerged as the best. We have made several substantial changes to our ABO-ILKT protocol over the past decade and a half and have attempted to determine whether the changes in immunosuppressive agents have resulted in a better outcome. We used methylprednisolone (MP), cyclosporine (CsA), azathioprine (AZ), antilymphocyte globulin (ALG) and deoxyspergualine (DSG) in the 105 cases of ABO-ILKT (group 1) between 1989 and 1999, and MP, tacrolimus (FK506), mycophenolate mofetil (MMF) in the 117 cases of ABO-ILKT (group 2) between 2000 and 2004. We compared the patient and graft survival rates as well as the incidence rate of acute rejection in these two eras, when different regimens were used. There were significant differences in the 1- and 5-year graft survival rates between groups 1 and 2 (1-year: 78% in group 1 vs. 94% in group 2; 5-year: 73% in group 1 vs. 90% in group 2, p = 0.008). Also, a higher incidence rate of acute rejection was significantly observed in group 1 (50/105, 48%) than in group 2 (18/117, 15%) (p < 0.001). We conclude that the FK/MMF combination regimen provides excellent graft survival results in ABO-ILKT.

Placental growth factor-1 and epithelial haemato-retinal barrier breakdown: potential implication in the pathogenesis of diabetic retinopathy

AIMS/HYPOTHESIS

Disruption of the retinal pigment epithelial (RPE) barrier contributes to sub-retinal fluid and retinal oedema as observed in diabetic retinopathy. High placental growth factor (PLGF) vitreous levels have been found in diabetic patients. This work aimed to elucidate the influence of PLGF-1 on a human RPE cell line (ARPE-19) barrier in vitro and on normal rat eyes in vivo.

METHODS

ARPE-19 permeability was measured using transepithelial resistance and inulin flux under stimulation of PLGF-1, vascular endothelial growth factor (VEGF)-E and VEGF 165. Using RT-PCR, we evaluated the effect of hypoxic conditions or insulin on transepithelial resistance and on PLGF-1 and VEGF receptors. The involvement of mitogen-activated protein kinase (MEK, also known as MAPK)/extracellular signal-regulated kinase (ERK, also known as EPHB2) signalling pathways under PLGF-1 stimulation was evaluated by western blot analysis and specific inhibitors. The effect of PLGF-1 on the external haemato-retinal barrier was evaluated after intravitreous injection of PLGF-1 in the rat eye; evaluation was by semi-thin analysis and zonula occludens-1 immunolocalisation on flat-mounted RPE.

RESULTS

In vitro, PLGF-1 induced a reversible decrease of transepithelial resistance and enhanced tritiated inulin flux. These effects were specifically abolished by an antisense oligonucleotide directed at VEGF receptor 1. Exposure of ARPE-19 cells to hypoxic conditions or to insulin induced an upregulation of PLGF-1 expression along with increased transcellular permeability. The PLGF-1-induced RPE cell permeability involved the MEK signalling pathway. Injection of PLGF-1 in the rat eye vitreous induced an opening of the RPE tight junctions with subsequent sub-retinal fluid accumulation, retinal oedema and cytoplasm translocation of junction proteins.

CONCLUSIONS/INTERPRETATION

Our results indicate that PLGF-1 may be a potential regulation target for the control of diabetic retinal and macular oedema.

Endovascular stent placement for isolated spontaneous dissection of the superior mesenteric artery: report of a case

Spontaneous dissection of the superior mesenteric artery (SMA) is rare and has been reported only sporadically. The therapeutic options are either a surgical approach, which is the most frequently adopted, or simple observation. We present a patient with acute abdominal pain due to superior mesenteric artery dissection who was successfully treated by percutaneous endovascular stent placement.

Recurrence of primary hepatic carcinoid tumor in the remnant liver 13 yr after resection

We report here a case of primary hepatic carcinoid tumor (PHCT) recurring in the remnant liver 13 yr and 10 mo after first resection. A 70-yr-old man developed four hypervascular tumors in the liver in December 2003. He had undergone curative left-lobe hepatectomy for PHCT in February 1990. Histopathological examination of the tumor biopsy specimen showed that the tumor was composed of uniform round-to-oval cells with solid arrangement and the tumor cells stained positive for chromogranin A, synaptophysin, and neuron-specific enolase. We diagnosed this case as an intrahepatic metastasis of PHCT with a long latency period, based on the fact that no primary site of carcinoid tumor could be found despite intensive examination and the immunohistochemical findings of the resected tumors were essentially same as those of PHCT in 1990. Although PHCT is reported to have a more favorable prognosis than other hepatic cancer or metastatic carcinoid tumor in the liver, long-term observation is recommended.

Optimal scan timing for coronal enhancement of hypervascular hepatocellular carcinomas and correlation with tumor size: evaluation with four-phase CT hepatic arteriography

PURPOSE

Our aim was to evaluate coronal enhancement of hypervascular hepatocellular carcinomas (HCCs) on four-phase CT hepatic arteriography (CTHA).

MATERIALS AND METHODS

This study included a total of 86 hypervascular HCCs. Four-phase CTHA images were acquired at 10 sec, 35 sec, 60 sec, and 85 sec after the initiation of contrast medium injection. The rate of coronal enhancement on each phase of CTHA of HCCs was analyzed. The rate of coronal enhancement on each phase of CTHA of HCC was also compared with nodule size.

RESULTS

All HCCs showed tumor enhancement on phase-one CTHA. The appearance rates of coronal enhancement on phases-two, -three, and -four CTHA were 87.2%, 67.4%, and 53.4%, respectively. The appearance rates of coronal enhancement of small HCCs on phases-two, -three, and -four CTHA were 91.1%, 53.6%, and 30.5%, respectively; those of non-small HCCs were 80.0%, 93.3%, and 96.7%, respectively. On phase-two CTHA, the presence of coronal enhancement was higher in small HCCs than in non-small HCCs. On phases-three and -four CTHA, the presence of coronal enhancement was significantly higher in non-small HCCs than in small HCCs.

CONCLUSION

The optimal phase for achieving coronal enhancement depended on tumor size.

Excellent outcome of ABO-incompatible living kidney transplantation under pretransplantation immunosuppression with tacrolimus, mycophenolate mofetil, and steroid

INTRODUCTION

ABO-incompatible living kidney transplantation (LKT) has been performed to widen the indications for kidney transplantation. Since 2001, using a 7-day period of pretransplantation immunosuppression with tacrolimus (FK) plus mycophenolate mofetil (MMF) plus methylprednisolone (MP), we have observed a marked reduction in acute humoral/vascular rejection without any serious complications.

PATIENTS AND METHODS

Forty-five adult patients underwent ABO-incompatible LKT at our institute between January 2000 and September 2002. There were 20 men and 25 women of mean age 33 years. Plasmapheresis was performed to remove anti-AB antibodies prior to kidney transplantation. In 2000, 13 patients were treated with FK plus MMF plus MP without 7-day pretransplantation immunosuppression (group 1). Since January 2001, we have administered FK (0.1 mg/kg/d) plus MMF (1-2 g/d) plus MP (125 mg/d) concomitantly with plasmapheresis starting from 7 days before transplantation in 32 patients (group 2). Splenectomy was performed at the time of kidney transplantation in all patients.

RESULTS

Patient survival rate was 100% in both treatment groups. Graft survival rate was 92% and 97% in groups 1 and 2, respectively. One patient in group 1 lost the graft due to severe pancreatitis and 1 patient in group 2, due to severe humoral rejection. The incidence of acute rejection was 56% and 19% in group 1 and group 2, respectively. No patient experienced any lethal infectious complication.

CONCLUSION

Pretransplantation immunosuppression for 7 days using FK, MMF, and MP in ABO-incompatible LKT provides an excellent outcome without severe infectious complications.

Primary mucosa-associated lymphoid tissue (MALT) lymphoma of the trachea: a case of surgical resection and long term survival

Primary malignant lymphoma of the trachea is rare. The case history is presented of a 44 year old woman with a mucosa-associated lymphoid tissue (MALT) lymphoma of the trachea who was treated with a tracheal resection and reconstruction. The patient has been free from the disease for 53 months, which confirms the favourable prognosis of MALT lymphoma following local treatment.

Flowering response of rice to photoperiod and temperature: a QTL analysis using a phenological model

In this study we have attempted to quantify the thermal and photoperiodical responses of rice (Oryza sativa L.) flowering time QTLs jointly by a 'date-of-planting' field experiment of a mapping population, and a 'phenological model' analysis that separately parameterizes the two responses, based on daily temperature, daily photoperiod and flowering date. For this purpose, the 'three-stage Beta model', which parameterizes the sensitivity to temperature (parameter alpha), the sensitivity to photoperiod (parameter beta), and earliness under optimal conditions (10 h photoperiod at 30 degrees C) (parameter G), was applied to 'Nipponbare' x 'Kasalath' backcross inbred lines that were transplanted on five dates. QTLs for the beta value were detected in the four known flowering time QTL (Hd1, Hd2, Hd6 and Hd8) regions, while QTLs for the G value were detected only in the Hd1 and Hd2 regions. This result was consistent with previous reports on near-isogenic lines (NILs) of Hd1, Hd2 and Hd6, where these loci were involved in photoperiod sensitivity, and where Hd1 and Hd2 conferred altered flowering under both 10 and 14 h photoperiods, while Hd6 action was only affected by the 14 h photoperiod. Hd8 was shown to control photoperiod sensitivity for the first time. Interestingly, Hd1 and Hd2 were associated with a QTL for the alpha value, which might support the previous hypothesis that the process of photoinduction depends on temperature. These results demonstrate that our approach can effectively quantify environmental responses of flowering time QTLs without controlled environments or NILs.

Impact of positive PRA on the results of ABO-incompatible kidney transplantation

INTRODUCTION

Due to the continuing shortage of cadaveric donors in Japan, ABO-incompatible living kidney transplantation (LKT) is being performed. It is well known that highly sensitized patients with positive panel reactive antibodies (PRA) often present with acute rejection. Therefore, we examined the impact of a positive PRA on the results of ABO-incompatible LKT.

MATERIALS AND METHODS

One hundred seventy-seven recipients underwent ABO-incompatible LKT between January 1989 and March 2003. Of these patients, 37 who had been examined for PRA before transplantation were included in this study. There were 25 men and 12 women of mean age 37.3 years. Plasmapheresis was performed to remove anti-ABO antibodies before transplantation. During the induction phase, methylprednisolone, azathioprine, or mycophenolate mofetil and cyclosporine or tacrolimus were used for immunosuppression. Splenectomy was performed at the time of kidney transplantation in all patients. PRA was measured using FlowPRA by flow cytometer.

RESULTS

Eight of the 37 patients had a positive PRA before transplantation (class I, 5; class II, 1; class I and class II, 2). The incidence of acute rejection was 37.9% in the patients with a negative PRA and 37.5% in patients with a positive PRA. One patient with a negative PRA and one patient with a positive PRA lost grafts due to acute rejection.

CONCLUSIONS

Positive PRA may not increase the incidence of acute rejection in ABO-incompatible LKT because plasmapheresis and splenectomy are performed to eliminate anti-ABO antibody.

Microscopic examination of the urine helps to confirm the recovery of acute tubular necrosis after cadaveric renal transplantation: a case report

INTRODUCTION

Delayed graft function due to acute tubular necrosis (ATN) is frequently seen in kidney transplants from non-heart-beating donors. However, only a biopsy can be used to assess the severity of ATN. Therefore, we studied the validity of microscopic findings in tubular epithelial cells (TECs) from urine as a means to monitor ATN.

MATERIALS AND METHODS

The first voided urine in the morning was examined for the appearance and nuclear cytoplasmic (N/C) ratio of the TECs, using a murine staining with URO-3 monoclonal antibody to detect proximal tubular cells (PTCs).

CASE

A 58-year-old man underwent cadaveric kidney transplantation in January, 2003 using tacrolimus, mycophenolate mofetil, and prednisone following basiliximab induction therapy. His graft did not function immediately; needle biopsy was performed on day 17. The pathological findings showed severe ATN without evidence of acute rejection. A large quantity of TECs was seen in his urine between days 7 and 14. After day 28, TECs with a large N/C ratio and that were URO-3 antibody-positive were detected. Urine volume increased gradually and hemodialysis was not necessary after day 36.

CONCLUSION

The presence of URO-3-positive TECs with large N/C ratios suggests the reconstruction of PTCs. Therefore, it may be useful to monitor TEC findings to assess the severity ATN after cadaveric kidney transplantation.

Transplantation of pediatric cadaveric kidneys into adult or pediatric recipients

In Japan, nationwide cadaveric organ sharing for kidney transplantation by the Japan Organ Transplant Network (JOTN) has operated since April 1995. This study retrospectively analyzed the long-term results of single pediatric donor kidneys transplanted into adult or pediatric recipients at a single center. From March 1983 to December 2002, 281 cadaveric renal allografts were transplanted at our center, including, 17 recipients of cadaveric kidneys from donors aged less than 16 years. We divided these 17 recipients into two groups: 10 adult recipients (group 1; G1) and seven pediatric recipients (group 2; G2). HLA-AB, -DR mismatches were 1.3 +/- 1.3, 0.7 +/- 0.5 in G1 and 2.6 +/- 1.3, 1.4 +/- 0.8 in G2, respectively (P < .05 for both). The end of the observation of this study was March 2003. Among G1, two recipients died with functioning grafts and one died after graft loss. Among G2, no recipients died. Patient survival rates at 1 and 5 years were 90% and 80% in G1 and 100% and 100% in G2, respectively. At the end of the observation in this study, five recipients among G1 and six recipients among G2 had functioning grafts. Graft survival rates at 1 and 5 years were 90% and 80% in G1 and 85.7% and 85.7% in G2, respectively. Our results demonstrate that transplantation of pediatric cadaveric kidneys into pediatric recipients was excellent compared to adult recipients in terms of survival. Priority to pediatric patients should be given especially in cases of pediatric donors.

QTLs for branching, floret formation, and pre-flowering floret abortion of rice panicle in a temperate japonica x tropical japonica cross

A large panicle with numerous florets is essential for improving rice ( Oryza sativa L.) yield. Rice panicle size is determined by such underlying morphogenetic processes as: (1) primary branch formation on the panicle axis; (2) floret formation on the primary branches (mainly determined by the secondary branch formation); and (3) pre-flowering abortion of florets in the panicle. We examined QTLs for these processes to understand how they are integrated into panicle size. We developed 106 backcross-inbred lines (BC1F4) from a cross between 'Akihikari' (a temperate japonica) and 'IRAT109' (a tropical japonica) and constructed a genetic map. One QTL detected on chromosome 2, with a large effect (R=0.30) on the number of florets per panicle, affected both primary branch formation on the panicle axis and floret formation on the primary branches. In addition, three QTLs that affect only one of these two processes were identified on chromosomes 4, 9, and 11, each having a subsidiary effect on the number of florets per panicle (R2=0.04-0.07). QTLs for pre-flowering floret abortion were detected at three different regions of the genome (chromosomes 1, 10, and 11). This is the first report on QTLs for pre-flowering floret abortion in grasses. The absence of a co-location between QTLs suggests that floret formation and abortion are not directly linked causally. These results demonstrate that studying the partitioning of panicle size into these underlying morphogenetic components would be helpful in understanding the complicated genetic control of panicle size.

Embolization of the replaced common hepatic artery before surgery for pancreatic head cancer: report of a case

We report the case of a patient with pancreatic head cancer, whose replaced common hepatic artery (RCHA) arose from the superior mesenteric artery (SMA). We performed preoperative embolization of the RCHA, after which the liver blood flow was well maintained by the left gastric artery. The patient underwent a radical operation involving en bloc resection of the RCHA without any serious complications.

Percutaneous radiofrequency ablation for unresectable large hepatic tumours during hepatic blood flow occlusion in four patients

AIM

To evaluate percutaneous radiofrequency (RF) ablation therapy for unresectable large hepatic tumours combined with regional interruption of hepatic blood flow, and to assess the safety and efficacy of this procedure.

MATERIALS AND METHODS

Four patients with hepatic tumours were enrolled in this study. Patients were treated by a single session of RF ablation during occlusion of both hepatic artery and hepatic vein. Tumour size ranged from 45-57 mm (mean 50.2 mm). Initial therapeutic efficacy was evaluated with helical computed tomography (CT) performed within 9 days after the treatment. CT or magnetic resonance imaging (MRI) was performed every 2-3 months thereafter.

RESULTS

The largest axis of coagulated lesions after the ablation was 50-60 mm (mean 56.5 mm) in diameter. The ablation therapy was considered complete in three patients; after a mean follow-up of 12.7 months, CT and MRI revealed complete destruction of their tumours. One patient required further treatment. No severe complications occurred.

CONCLUSION

Although further studies are needed, in this limited clinical trial a local ablation area exceeding 50 mm in diameter was achieved safely.

Retroperitoneoscopic live donor nephrectomy: Extended experience in a single center

INTRODUCTION

Retroperitoneoscopic live donor nephrectomy (RPLDN) was performed because it is considered to be less invasive than open live donor-nephrectomy (OLDN) or transperitoneal laparoscopic live donor nephrectomy.

PATIENTS AND METHODS

Between July 2001 and May 2003, 118 consecutive live donor kidney grafts were procured using RPLDN or OLDN. The patients who underwent RPLDN were divided into 2 groups: an initial group 1 (n = 38) and a subsequent group 2 (n = 48).Thirty-two patients who underwent OLDN during the same period were used as controls (group 3). The patients were placed in the lateral position. Three retroperitoneoscopic ports were inserted. The kidneys were retrieved through a 5-cm flank incision just below the 11th rib in group 1. In group 2, a 5-cm Pfannenstiel incision was used to extract the kidney.

RESULTS

The operative time was 307 +/- 88 minutes, 245 +/- 42 minutes, and 215 +/- 70 minutes in groups 1, 2, and 3, respectively (group 1 vs group 2 or 3, P < .01). The mean postoperative pentazocine (painkiller) requirements were 12 mg, 4.4 mg, and 22 mg in groups 1, 2, and 3, respectively (group 2 vs group 1 or 3, P < .01). The hospital stay was 6.6 +/- 1.6, 4.9 +/- 0.7, and 7.0 +/- 0.1 days in groups 1, 2, and 3, respectively (group 2 vs group 1 or 3, P < .01). There were no serious complication, such as massive bleeding or bowel injury.

CONCLUSIONS

RPLDN may be safer and less invasive than open donor nephrectomy.

Analysis of cause of death with a functioning graft: A single-center experience

INTRODUCTION

After the introduction of new immunosuppressants, such as tacrolimus and mycophenolate mofetil, we have achieved excellent results for kidney transplantation with a low acute rejection rate. Currently, nonimmunological factors are considered to be the main cause of graft loss for long-term transplant patients. In this study, we analyzed the cause of death with a functioning graft.

PATIENTS AND METHODS

We performed 1375 cases of living kidney transplantation (LKT) and 219 cases of cadaveric kidney transplantation (CKT) between January 1983 and December 2002. Of these patients, 86 LKT patients and 19 CKT patients died with a functioning graft.

RESULTS

The mean duration of graft function was 4.8 +/- 4.5 years. The incidence of the causes of death were: infection, 24%; stroke, 17%; cardiovascular disease, 16%; malignant disease, 15%; hepatic failure, 11%; gastric ulcer, 4%; and accident/suicide 2%. Five- and 10-year graft survivals for LKT were 80.2 and 62.0%, respectively. The corresponding values for patients (with the exception of the patients who died with a functioning graft) was 83.0% and 66.1%, respectively. The 5- and 10-year graft survival rates for cadaveric kidney transplants were 70.8% and 48.9%, respectively. The corresponding values for patients (with the exception of the patients who died with a functioning graft) were 75.3% and 52.6%, respectively.

CONCLUSION

To prevent death with a functioning graft, management of vascular disorders such as stroke and cardiovascular disease, malignant disease, and infectious disease is crucial for kidney transplant patients.