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| 1.
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Takami, Akiyoshi ; Asakura, Hidesaku ; Koshida, Kiyoshi ; Namiki, Mikio ; Nakao, Shinji ; 高見, 昭良 ; 朝倉, 英策 ; 越田, 潔 ; 並木, 幹夫 ; 中尾, 眞二
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金沢大学医薬保健研究域医学系<br />We report the cases of 3 patients with advanced renal cell carcinoma who underwent reduced-intensity
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allogeneic stem cell transplantation. In 2 partial responders, histologic analyses of metastases revealed prominent accumulation of CD8+ T cells and degenerative changes of clear cell carcinoma, suggestive of induction of tumor-specific cytotoxic T lymphocytes.
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| 2.
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Nguyen Thi, Mai Anh ; Hosokawa, Kohei ; Yoroidaka, Takeshi ; Maruyama, Hiroyuki ; Espinoza, J. Luis ; Elbadry, Mahmoud I. ; Md, Mohiuddin ; Tanabe, Mikoto ; Katagiri, Takamasa ; Nakagawa, Noriharu ; Arima, Nobuyoshi ; Kashiwase, Koichi ; Saji, Hiroh ; Ogawa, Seishi ; Nakao, Shinji ; 細川, 晃平 ; 片桐, 孝和 ; 中尾, 眞二
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金沢大学医薬保健研究域医学系 Graduate School of Medical Sciences<br />The loss of killer cell immunoglobulin-like receptor-ligands (KI
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R-Ls) due to the copy number neutral loss of heterozygosity of chromosome 6p (6pLOH) in leukocytes of patients with acquired aplastic anemia (AA) may alter the susceptibility of the affected leukocytes to NK cell killing in vivo. We studied 408 AA patients, including 261 who were heterozygous for KIR-Ls, namely C1/C2 or Bw6/Bw4, for the presence of KIR-L-missing (KIR-L[-]) leukocytes. KIR-L(-) leukocytes were found in 14 (5.4%, C1, n= 4, C2, n=3, and Bw4, n= 7) of the 261 patients, in whom corresponding KIR(+) licensed NK cells were detected. The incidence of 6pLOH in the 261 patients (18.0%) was comparable to that in 147 patients (13.6%) who were homozygous for KIR-L genes. The percentages of HLA-lacking granulocytes (0.8-50.3%, median 15.2%) in the total granulocytes of the patients with KIR-L(-) cells were significantly lower than those (1.2-99.4%, median 55.4%) in patients without KIR-L(-) cells. KIR2DS1 and KIR3DS1 were only possessed by three of the 14 patients, two of whom had C2/C2 leukocytes after losing C1 alleles. The expression of the KIR3DS1 ligand HLA-F was selectively lost on KIR-L(-) primitive hematopoietic stem cells (HSCs) derived from 6pLOH(+) iPS cells in one of the KIR3DS1(+) patients. These findings suggest that human NK cells are able to suppress the expansion of KIR-L(-) leukocytes but are unable to eliminate them partly due to the lack of activating KIRs on NK cells and the low HLA-F expression level on HSCs in AA patients.<br />Embargo Period 6 months
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| 3.
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Nakao, Shinji ; Ishiyama, Ken
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Embargo Period 12 months
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Ishiyama, Ken ; Yamazaki, Hirohito ; Senda, Yasuko ; Yamauchi, Hiromasa ; Nakao, Shinji
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金沢大学医薬保健研究域医学系 <br />東京都立大塚病院 血液内科（輸血科）<br />Leuconostoc is a Gram-positive coccus characterized by its resistance to
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glycopeptide antibiotics. Generally, this bacterium is susceptible to β-lactam antibiotics; however, here we present a leukemia patient who developed leuconostoc bacteremia during antimicrobial therapy with carbapenem. The appropriate choice of antibiotics at optimal doses enables leuconostoc infection to be overcome, even in compromised hosts. We report 3 cases of leuconostoc bacteremia: the leukemia case which was successfully treated, along with discussions of two other cases with malignancies. © 2010 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases.
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| 5.
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新屋, 智之 ; 笠原, 寿郎 ; 藤村, 政樹 ; 丹保, 裕一 ; 田森, 俊一 ; 曽根, 崇 ; 中尾, 眞二 ; Araya, Tomoyuki ; Kasahara, Kazuo ; Fujimura, Masaki ; Tanbo, Yuichi ; Tamori, Shunichi ; Sone, Takashi ; Nakao, Shinji
概要:
金沢大学医薬保健研究域医学系<br />Background. Skeletal muscle metastases from lung cancer are considered to be extremely rare. We enco
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untered 3 cases of lung cancer associated with skeletal muscle metastases on initial medical examination or during disease progression. Cases. Case 1: A 46-year-old man was trismic due to metastasis of lung adenocarcinoma to the lateral pterygoid muscle. He was resistant to radiotherapy and chemotherapy, and died 9 months after the occurrence of symptoms. Case 2: A 57-year-old man had a large cell lung carcinoma or poorly differentiated lung adenocarcinoma. He had metastasis to the right femoral muscle in addition to multiple metastases to many other organs. His disease was also resistant to any treatment, and died 7 months after he became symptomatic. Case 3: A 64-year-old man with adenocarcinoma had a single metastasis to the biceps muscle. He died 3 months after the diagnosis of muscle metastasis due to resistance to therapy. Conclusion. Upon diagnosis of tumorous lesions of skeletal muscles, whole body examination and subsequent percutaneous biopsy of muscle involvement are required to determine the possibility of skeletal muscle metastasis of lung cancer. 背景.肺癌の骨格筋転移は極めて稀とされているが,今回我々は,初診時もしくは経過中に骨格筋転移を来した非小細胞肺癌の3症例を経験した.症例.症例1は46歳男性,肺腺癌の外側翼突筋転移のために開口障害を来した.放射線及び化学療法に対して抵抗性であり,原疾患の悪化により症状発現から約9ヶ月の経過で死亡した.症例2は57歳男性,肺大細胞癌もしくは低分化腺癌の症例で右大腿部の筋転移に加え,他臓器への広範な転移を認めた.治療抵抗性で症状出現より約7ヶ月の経過で死亡した.症例3は64歳男性,腺癌の症例で,右上腕二頭筋に転移を来し,治療抵抗性の経過で筋転移出現より約3ヶ月で死亡した.結論.骨格筋の腫瘤性病変の診断の際には転移性悪性腫瘍,特に肺癌の骨格筋転移を念頭に置き,全身精査と病変部位の生検により速やかな確定診断が必要と考えられた.
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| 6.
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Yoshimoto, Akihiro ; Nakamura, Hiroyuki ; Fujimura, Masaki ; Nakao, Shinji
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金沢大学医薬保健研究域医学系<br />Objective: To evaluate severe community-acquired pneumonia (SCAP) patients in an intensive care unit
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(ICU) with regard to risk factors for mortality and to compare ICU patients with matched non-ICU patients to evaluate whether our judgement for ICU admission was appropriate or not. Materials and methods: During a 7-year period, all patients with CAP who were admitted to the ICU were examined. They underwent clinical and radiographic evaluations, and two commonly used severity of illness scores were also calculated using the Simplified Acute Physiological Score (SAPS) and the Acute Physiology and Chronic Health Evaluation (APACHE) II methods. To detect risk factors for ICU admission using existing guidelines, each study patient was matched with two patients hospitalized in a general medical ward. Results: Seventy-two patients were identified during the study period. Their mean age was 72.9 years, and 35 patients (48.6%) subsequently died. For the univariate analysis, there were significant differences with the pulse rate ≥130/min, blood urea nitrogen ≥30 mg/dl, multilobar shadow, SAPS ≥43, APACHE II ≥23, and the occurrence of septic shock between the survivors and those who died. For the multivariate analysis, septic shock (p=0.0005, odds ratio of 26.6) and blood urea nitrogen ≥30 mg/dl (p=0.037, odds ratio of 5.38) were associated with mortality. Regarding the characteristics of different clinical predictions for ICU admission, the revised American Thoracic Society criteria might have been the most accurate. Conclusion: Septic shock was associated with high mortality, which is a more accurate and higher predictor of mortality than was physical examination, laboratory or radiographic findings.
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| 7.
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Takato, Hazuki ; Yasui, Masahide ; Ichikawa, Yukari ; Fujimura, Masaki ; Nakao, Shinji ; Zen, Yoh ; Minato, Hiroshi
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金沢大学医薬保健研究域医学系<br />Recently, great attention has been drawn to IgG4-related diseases such as autoimmune pancreatitis (A
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IP) sclerosing sialadenitis, retroperitoneum fibrosis, sclerosing cholangitis. IgG4-related diseases are characterized by high serum IgG4 concentrations, sclerosing inflammation with numerous IgG4-positive plasma cells, and steroid sensitivity irrespective of their organs of origin. In this report, we describe a case of nonspecific interstitial pneumonia, in which possible involvement of IgG4 was suggested. The patient was 59-year-old man, who was found to have bilateral interstitial pneumonia. Laboratory tests revealed that he had antinuclear antibody and a high serum IgG4 concentration. Pathological examination of the video-assisted thoracic surgery biopsy taken from the right lower lobe showed interstitial thickening associated with lymphoplasmacytic infiltration containing many IgG4-positive plasma cells. He was effectively treated by corticosteroid. The present case had many clinical and clinicopathologic similarities to systemic IgG4-related autoimmune disease. There have been no descriptions on isolated interstitial pneumonia with IgG4-positive plasma cell infiltration. This case suggested that IgG4-related disorders could also occur in the lung, and interstitial pneumonia may be a pulmonary manifestation of systemic IgG4-related autoimmune disease © 2008 The Japanese Society of Internal Medicine.
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| 8.
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Watanabe, Kazuyoshi ; Fujimura, Masaki ; Kasahara, Kazuo ; Yasui, Masahide ; Myou, Shigeharu ; Kita, Toshiyuki ; Watanabe, Akira ; Nakao, Shinji
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金沢大学医薬保健研究域医学系<br />A 21-year-old woman presented with acute progressive dyspnea. Chest computed tomography (CT) reveale
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d diffuse bilateral infiltrates. Based on the results of transbronchial lung biopsy (TBLB) and bronchoalveolar lavage fluid (BALF) and her clinical course, she was diagnosed as having acute eosinophilic pneumonia. We suspected that the disease was related to smoking because she had started smoking ten days before the onset of symptoms. Therefore, a cigarette-smoking challenge test was done with the patient's informed consent. After the challenge, eosinophilic pneumonia was documented by BALF and TBLB findings, which were similar to those detected on admission, without significant radiographic findings.
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| 9.
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Kita, Toshiyuki ; Fujimura, Masaki ; Sone, Takashi ; Inuzuka, Kanako ; Myou, Shigeharu ; Nakao, Shinji
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金沢大学医薬保健研究域医学系<br />Background and Objective: The purpose of this study was to evaluate the relationship between the wal
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l structure assessed by using endobronchial ultrasonography (EBUS) and bronchial hyperresponsiveness in patients with asthma. Methods: Twenty-four patients with stable asthma and 11 individuals without asthma were studied. EBUS was performed with a radial 20-MHz ultrasonic probe inserted into the intermediate bronchus undergoing flexible bronchoscopy to assess the airway wall structure. The percentage of airway wall thickness {WT%; defined as [(ideal outer diameter-ideal luminal diameter)/ideal outer diameter] × 100} was determined by EBUS. We measured bronchial hyperresponsiveness to methacholine [the provocative concentration of methacholine causing a decrease of 20% or more in forced expiratory volume in 1 s (PC20)]. Results: Percentage wall thickness measured by EBUS was significantly greater in patients with asthma than that in subjects without asthma (P < 0.01). The evaluation of the laminar structure using EBUS indicated that the thickness of the second layer in patients with asthma was greater than that in subjects without asthma (P < 0.05). PC20 was negatively correlated with the thickness of the second layer (r=0.52, P < 0.01) but was not significantly correlated with other layers in patients with asthma. Conclusions: The evaluation of the bronchial mural structure using EBUS might be advantageous for assessing the relationship between airway wall remodeling and bronchial hyperresponsiveness. © 2010 Lippincott Williams & Wilkins.
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| 10.
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Katagiri, Takamasa ; Shiobara, Shintaro ; Nakao, Shinji ; Wakano, Miki ; Muranaka, Eriko ; Kuba, Nahoko ; Furukawa, Tatsuo ; Tsukada, Junichi ; Takeda, Hiroko ; Aizawa, Yoshifusa ; Harada, Mine
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金沢大学大学院医学系研究科<br />We determined the alleles of five polymorphic molecules including HA-1 and four adhesion molecules fo
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r 106 patients transplanted with HLA-identical stem cell grafts and investigated the association of mismatches as correlates of relapse and graft-versus-host disease (GVHD). All 106 recipients underwent stem cell transplantation (SCT) after myeloablative conditioning between 1985 and 2002. Risk status of disease at SCT was standard (n = 63) and high (n = 42). After SCT, 36, 49 and 33 developed acute GVHD, chronic GVHD and relapsed, respectively. Our patients relapsed at rates of 16.7 and 38.6% with one or more and without incompatibilities (P = 0.013). The relapse rates of patients with CD62L, CD31 codon 563, CD31 codon 125, HA-1 and CD49b incompatibilities were 5.9, 11.8, 15.4, 16.0 and 33.3%, respectively. The frequency of acute GVHD did not differ regardless of incompatibilities. In standard-risk group, the accumulated relapse rates of 19 and 44 patients with and without minor histocompatibility antigen incompatibility were 22% and unexpectedly 66%, respectively (P = 0.02). The probability of 12-year survival was 88% in the former and 66% in the latter patients (P = 0.03). Our data suggest that incompatibility of CD62L, CD31 codon 563 and CD31 codon 125 contributes to a graft-versus-leukemia effect rather than to GVHD, resulting in prolonged survival after HLA-identical SCT.
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