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Background and Aims Transcatheter aortic valve implantation (TAVI) is an effective treatment for aortic stenosis (AS) in high-risk patients, such as those who are suffering ESRD on hemodialysis. We previously showed that long-term survival of hemodialysis patients underwent TAVI was lower than that of non-hemodialysis patients but was comparable with that of hemodialysis patients treated with surgical aortic valve replacement. It is known that hemodialysis is a high risk of the bioprosthetic structural valve deterioration (SVD) after valve replacement surgery. Consistently, higher incidence of re-TAVI operation due to restenosis was observed in hemodialysis patients than in non-hemodialysis patients (Odds ratio [OR]:29.4, p In this study, we aimed to identify predictors of SVD in post-TAVI hemodialysis patients. Method From April 2012 to December 2015, 24 patients on hemodialysis were selected to receive TAVI for the treatment of AS in Osaka University Hospital. Demographic and laboratory data at pre- and post-operation were compared between patients who underwent re-TAVI (valve-in-valve) (SVD group) and those who did not (no-SVD group). Results During the follow-up period (maximal 7 years), 4 out of 24 patients required re-TAVI (valve-in-valve) operation because of SVD. Although serum calcium, phosphate, and PTH levels before operation were comparable between SVD group and no-SVD group, serum magnesium levels were significantly lower in SVD group. Lower serum magnesium quartiles were associated with a higher risk of SVD (OR 5.83, p=0.036). While effective orifice area index (EOAi) of aortic valve at 1 week after TAVI was similar between the 2 groups, EOAi improvement at 1 month was significantly poorer in SVD group than in no-SVD group (1.70 ± 0.15 vs 2.50 ± 0.56, p = 0.049). Conclusion The higher incidence of re-TAVI due to SVD in hemodialysis patients could be related with pre-operative low magnesium levels and with one-month post-operative low EOAi improvement. This was a single center observational study, and the number of patients was very small so that our data would not be necessarily applicable for every patient. Further investigation is necessary for identifying a prognostic predictor of SVD, which will lead to the prevention of unfavorable re-operation in hemodialysis patients.

Objectives Stent graft-induced distal re-dissection (SIDR) is a burdensome complication after thoracic endovascular aortic repair (TEVAR) for Type B aortic dissection. We developed a novel method to prevent SIDR by placing a small-diameter short stent graft [Excluder Aortic Extender (Cuff)] at the distal landing zone (DLZ) and reviewed its effectiveness in this study. Methods Ninety patients who underwent TEVAR for Type B aortic dissection using commercially available devices between January 2008 and September 2016 were retrospectively reviewed. Among them, TEVAR with the Cuff technique was performed in 36 (40%) cases, in which a Cuff was placed at the DLZ in the descending aorta prior to the main stent graft deployment to avoid excessive stent graft oversizing at the distal end. The effectiveness of the Cuff technique was assessed by evaluating mid-term clinical results, including the incidence of SIDR. Results Technical success was achieved in all 90 cases. During a median follow-up time of 40.4 months (range 0.2-90.6 months), 8 SIDRs were documented using multidetector computed tomography images. Freedom from SIDR was significantly lower in the Cuff group (Cuff: 100%/5 years vs non-Cuff: 84.6%/5 years; P = 0.04), whereas no difference was observed between both groups in the oversizing rate at the DLZ (19.9 ± 8.5% vs 17.8 ± 9.9%; P = 0.29). Conclusions Placement of a small-diameter short stent graft at the DLZ (Cuff technique) in TEVAR for aortic dissection is an easy procedure that may reduce the incidence of SIDR.

Intergenic splicing, the joining of exons from separate genes, has been observed only rarely in mammals. While the matrilin (MATN) and lysosomal-associated protein transmembrane (LAPTM) genes comprise distinct gene families, we have demonstrated intergenic splicing between two sets of family genes, the matrilin-3 (MATN3) and lysosomal-associated protein transmembrane 4alpha (LAPTM4A), and the matrilin-2 (MATN2) and lysosomal-associated protein transmembrane 4beta (LAPTM4B). The expression pattern and sub-cellular localization of the MATN-LAPTM hybrid transcripts differ from those of the original genes, suggesting unique functions for the products. Our observations indicate that intergenic splicing is a common and well-regulated phenomenon and underscore the fundamental challenges in defining the gene (transcriptional unit). Given these findings, the number of gene in the human genome may be smaller than present estimates suggest.

Diagnosis: Onchocerciasis ("river blindness") and Mansonella species infection. Onchocerciasis, or river blindness, is caused by the filarial parasite Onchocerca volvulus. Onchocerciasis is a major cause of blindness worldwide. 0. volvulus infects 20 million people in West, Central, and East Africa and 1 million people in Central and South America. The infection is characterized by itchy dermatitis, subcutaneous nodules, keratitis, and chorioretinitis [1]. Onchocerciasis is transmitted in rural areas by Simulium species blackflies that breed in rapidly flowing, well-oxygenated rivers and streams, and the high prevalence of infection in agrarian communities located near rivers has led to the common name for the disease, "river blindness" [2, 3]. Microfilariae present in the skin are ingested by the blackflies when they feed, and the microfilariae then develop into infective larvae. Transmission of larvae occurs when the fly takes its next blood meal.

With the development of new technologies in the diagnosis of leukemia, we have modified the method of approaching individual cases. In addition to morphological examination, cytochemistry, immunophenotyping, electron microscopy and cytogenetics are now routinely used for daily practice. Furthermore, various molecular diagnostic methods are being tested, and some are already being used for diagnostic processes. The new technologies have certainly changed the diagnostic approach. When the diagnosis is supported by such multiple diagnostic methods, it is more reliable, reproducible and standardized. The communication among clinical practitioners through accurate diagnosis is valuable from both the therapeutic and prognostic point of view. In this article, the diagnostic method of leukemia is reviewed with an emphasis on practical aspects. Individual details are beyond the scope of this article. Interested readers are referred to the bibliography for more in depth treatment of the various techniques.

Four cases of polycythemia associated with myeloma are described. Three of four had polycythemia vera with IgA monoclonal gammopathy. The possible relationship between chronic myeloproliferative disorder and myeloma is discussed. Review of the literature revealed 11 such cases, four of which had a history of 32P therapy for polycythemia vera.