Search

BACKGROUND Cross-matched platelet (cross-matched PLT) transfusion is effective for immune-mediated platelet transfusion refractoriness (PTR), but is more costly and time-consuming for physical cross-match than using standard PLT units. Recent studies have reported the utility of human leucocyte antigens (HLA) virtual cross-matched PLT (HLA-matched PLT) that is defined as HLA-A/B matched or no antibody against donor-specific antigen. Here, we evaluated the effect of HLA-matched PLTs for PTR in post hematopoietic stem cell transplant (HSCT) recipients. STUDY DESIGN AND METHODS Our study included a total of 241 PLTs in 16 patients who underwent HSCT at Okayama University Hospital between 2010 and 2017, receiving either HLA-matched or cross-matched PLTs. We calculated the 24-hour corrected count increments (CCI-24) to evaluate the effect of PLTs. A CCI-24 ≥ 4500 was considered to be a successful transfusion. RESULTS We analyzed 139 cross-matched PLTs and 102 HLA-matched PLTs. In the immune-mediated PTR, the rate of successful transfusion was 60.5% for cross-matched PLT and 63.4% for HLA-matched PLT (p = 0.825). On the other hand, the median CCI-24 for cross-matched PLT transfusions and HLA-matched PLT transfusions were 1856 and 5824 (p

Studies examining risk factors associated with vasovagal reactions (VVRs) during autologous blood donations, especially in younger subjects, have been limited. The aim of the present study was to define risk factors for VVRs during preoperative autologous blood donation in patients, including those younger than 18 years old. We retrospectively analyzed 4192 autologous, preoperative blood donations between 2007 and 2015 at Okayama University Hospital. Eighty-seven (2.08%) of the patients experienced VVRs. VVRs occurred approximately three times as often in patients 0-17 years old (16/320, 5.0%) than in patients 18 years and older (71/3872, 1.8%). In particular, VVRs occurred more frequently in those 10-13 years old, and decreased with older age (P = 0.006). In a univariate analysis, younger age, lower body mass index, lower systolic blood pressure, lower body weight, lower total blood volume, female gender, first-time collection, and higher heart rate were associated with a higher incidence of VVRs. In a multivariate analysis, lower systolic blood pressure (P < 0.001), higher heart rate (P = 0.007), and first-time collection (P = 0.015), remained independent predictors of VVRs. These results emphasize the need for careful attention during blood collection.

岡山大学病院では，1998年に本邦初の生体肺移植が行われて以降2009年3月までに52例の生体肺移植と15例の脳死肺移植の計67例の肺移植が行われた．特に脳死肺移植では，限られた時間内に血液製剤を準備する必要があり，これまでの肺移植における血液製剤使用量から術前準備量について検討を行った． 赤血球製剤の平均準備量は57.4U，平均使用量は33.5U，C/T比（交差試験単位数/輸血血液単位数）1.73であった．FFPの平均準備量は43.3U，平均使用量は19.4Uで，PCの平均準備量は27.7U，平均使用量は19.8Uであった．両肺移植の平均血液使用量が，赤血球製剤37.9U，FFP 21.8U，PC 22.8Uであったのに対し，片肺移植の平均血液使用量は，赤血球製剤11.5U，FFP 7.0U，PC 4.5Uで有意差が認められた．また，赤血球製剤を100U以上準備した症例が5例あり，全て両肺移植で，うち3例が脳死移植であった． 肺移植では，症例毎の癒着の程度の相違等で一律の血液準備量の決定は難しいと考えられるが，今回の肺移植における血液製剤使用量の検討から血液の必要量については，両肺移植か片肺移植であるか，恐らく，人工心肺の使用の有無が大きな因子であることが示唆された．また，緊急の脳死肺移植や大量の血液製剤準備に対応できるよう，日常的に異型適合血の選択を含めた緊急時の対応と診療科等との連携を深めることが必要であると考えられた．

A zinc complex of biladienone forms a dimer in toluene and dichloromethane. Binding of two molecules of amino alcohols and diamines to the dimer occurs cooperatively, with the first binding constant being two orders or three orders of magnitude smaller than the second binding constant. Simple amines such as butylamine did not show such cooperative binding. We suggest the mechanism of cooperative binding, where the amino or hydroxyl group in amino alcohols or diamines prevents the dimer dissociation to result in the less tight binding for the first guest, while the binding of the second ligand caused dimer dissociation to release strain in the intermediate complex.

Tetraarylbiladien-ab-ones bearing various substituents (R) in the para position of the phenyl groups were preprared by coupled oxidation of tetraarylporphyrin iron complexes. The yields of 5,10,15-triaryl-19-aroyl-15-hydroxybiladien-ab-ones were 74% (R = H), 85% (R = OMe), 44% (R = COOMe), and 28% (R = CN). Kinetic studies of the iron porphyrin oxidation revealed that the reaction is accelerated by an electron-withdrawing substituent with the Hammett reaction constant ρ = 0.295. 5,10,15-Triaryl-19-aroyl-15-hydroxybiladien-ab-ones undergo the acid-catalyzed elimination reaction either by acetic acid or by mesoporous silica to afford 5,10,15-triaryl-19-aroylbilatrien-abc-one. The elimination reaction in acetic acid is accelerated by an electron-donating substituent with the Hammett reaction constant ρ = −1.48.

Autologous blood stem cell transplantation (auto-PBSCT) has increasingly been incorporated into the treatment of various malignancies. Auto- PBSCT provides several advantages over auto-BMT, but sometimes requires several collections of PBSC. We have retrospectively analyzed the time requirements and cost effectiveness of PBSC collection in Okayama University Hospital between 1994 and 1997, in which PBSCs were mobilized by chemotherapy and granulocyte colony-stimulating factor in 85 patients. During the 1994-1995 period, PBSCs were collected by apheresis, which was timed by leukocyte count and carried out by attending physicians, and cryopreserved at

症例は生後3カ月の男児。生後2カ月頃より徐々に浮腫が出現し当科入院となった。入院時低蛋白血症，高コレステロール血症，1日尿蛋白10gを認め，ネフローゼ症候群と診断した。腎組織検査はdiffuse mesangial sclerosisであった。ステロイドおよび免疫抑制剤は無効であった。1歳よりACEI (エナラプリル0.06mg/kg/day) 投与を開始したところ尿蛋白は減少し始め，エナラプリル投与を0.2mg/kg/dayまで増加した時点で尿蛋白は消失した。2回目の腎生検 (2歳) では，糸球体硬化病変は進行し，間質への細胞浸潤が増加していた。エナラプリル投与開始2年6カ月後の現在，腎機能は正常範囲を維持し，身体発育，精神運動発達は良好である。またエナラプリルによると考えられる副作用は特に認めていない。したがって本症例のような多剤に抵抗性の乳児ネフローゼ症候群においても，ACEIは試みられるべき治療法と考えられた。

Most patients with X-linked dominant chondrodysplasia punctata (X-DCDP) have whorled, thick, or spiky adherent hyperkeratosis on their whole body. Histopathologically, there are large keratotic plugs of hair follicles where calcium deposits. This is the characteristic finding in this disease. We performed histopathologic examination of skin specimens from two newborn babies with X-DCDP. The desquamated thick scales from the hyperkeratotic lesions had calcium in the center of the keratotic plugs. Histopathologic examination of thick scales is easy and helpful in diagnosing X-DCDP.

Anti-A and/or anti-B antibodies synthesized by lymphoid tissues contained in ABO-mismatched solid organ grafts have been reported to cause hemolytic anemia, but not suppressed red blood cell production. A case of living-donor lobar lung transplantation is presented in which suppression of erythropoiesis was associated with ABO mismatched organ transplantation.