Wire-loop lesion is associated with serological immune abnormality, but not renal prognosis, in lupus nephritis.

BACKGROUND: Wire-loop lesion (WL) is one of the active lesions of lupus nephritis (LN). However, few reports have focused on the clinicopathological relationships of WL to serological immune abnormality and renal prognosis. METHODS: We enrolled 126 Japanese LN patients subjected to renal biopsy in 11 hospitals from 2000 to 2018. In patients with class III or IV of the International Society of Nephrology/Renal Pathology Society classification, we retrospectively compared clinicopathological findings between those with WL (WL+ group) and without WL (WL- group) to detect factors associated with WL. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate of <60 mL/min/1.73m2 for more than three months. We also compared these findings between those with CKD (CKD+ group) and without CKD (CKD- group) at the last visit to investigate factors associated with renal prognosis. RESULTS: Of 126 patients, 100 (79.4%) were classified as class III or IV. WL was found in 36 (36.0%) of them. Although the renal function did not differ, the WL+ group had a higher titre of serum anti-dsDNA antibodies and lower serum complement 3 levels than the WL- group. Linear regression analysis revealed a significant association only between anti-dsDNA antibodies and WL (ß = 0.27, 95% confidence interval (CI) 0.001-0.100, p = 0.01). Of these patients, 69 were tracked for 59.6 ± 55.1 months. Kaplan-Meier analysis showed no difference in renal prognosis between these groups. Next, the CKD+ group included 15 (22.1%) patients. They were older and had higher frequencies of hypertension and hyperuricaemia, serum creatinine (Cr) level, glomerulosclerosis, interstitial inflammation, interstitial fibrosis and tubular atrophy than the CKD- group at the time of renal biopsy. The frequency of WL was not significantly different. Cox regression analysis revealed significant associations of CKD with hypertension, hyperuricaemia, serum Cr level at the time of renal biopsy clinically and with tubular atrophy histologically. CONCLUSIONS: WL was associated with serum anti-dsDNA antibodies but not with renal prognosis, suggesting that WL reflects immune abnormality but is not an independent factor predictive of renal prognosis in LN.

Vero/BC-F: an efficient packaging cell line stably expressing F protein to generate single round-infectious human parainfluenza virus type 2 vector.

A stable packaging cell line (Vero/BC-F) constitutively expressing fusion (F) protein of the human parainfluenza virus type 2 (hPIV2) was established for production of the F-defective and single round-infectious hPIV2 vector in a strategy for recombinant vaccine development. The F gene expression has not evoked cytostatic or cytotoxic effects on the Vero/BC-F cells and the F protein was physiologically active to induce syncytial formation with giant polykaryocytes when transfected with a plasmid expressing hPIV2 hemagglutinin-neuraminidase (HN). Transduction of the F-defective replicon RNA into the Vero/BC-F cells led to the release of the infectious particles that packaged the replicon RNA (named as hPIV2ΔF) without detectable mutations, limiting the infectivity to a single round. The maximal titer of the hPIV2ΔF was 6.0 × 10(8) median tissue culture infections dose per ml. The influenza A virus M2 gene was inserted into hPIV2ΔF, and the M2 protein was found to be highly expressed in a human lung cancer cell line after transduction. Furthermore, in vivo airway infection experiments revealed that the hPIV2ΔF was capable of delivering transgenes to hamster tracheal cells. Thus, non-transmissible or single round-infectious hPIV2 vector will be potentially applicable to human gene therapy or recombinant vaccine development.

Efficacy of diffusion-weighted magnetic resonance imaging in detecting infected cysts in a case of polycystic kidney disease.

Hepatic and/or renal cyst infection is a major complication in patients with polycystic kidney disease. In many cases, drainage of infected cysts is necessary, although accurate detection of infected cysts from among the numerous hepatic or renal cysts present is often difficult, because the findings of infected cysts on computed tomography and T1- and T2-weighted magnetic resonance imaging resemble those of normal cysts. We describe here a case of polycystic kidney disease complicated by hepatic cyst infection. On diffusion-weighted magnetic resonance imaging (DWMRI), which is occasionally used in the diagnosis of cerebral abscesses, infected hepatic cysts showed higher signal intensity than other cysts, facilitating differentiation of the cysts requiring drainage from numerous other cysts. Infected cysts showed a marked decrease of the apparent diffusion coefficient (ADC) values compared with those of normal cysts. DWMRI was very effective in detecting infected cysts in our patient and may be of value in other such cases with polycystic kidney disease.

Organochlorine pesticides (OCPs), dioxin-like polychlorinated biphenyls (dl-PCBs), polychlorinated dibenzo-p-dioxins and polychlorinated dibenzo furans (PCDD/Fs) in edible fish from Lake Volta, Lake Bosumtwi and Weija Lake in Ghana.

Organochlorine pesticides (OCPs), dioxin-like polychlorinated biphenyls (dl-PCBs), polychlorinated dibenzo-p-dioxins and polychlorinated dibenzo furans (PCDD/Fs) were measured by a high resolution gas chromatograph-high resolution mass spectrometer (HRGC/HRMS) in selected edible fish from three freshwater bodies, Lake Volta, Lake Bosumtwi and Weija Lake in Ghana. The levels of organochlorine pesticides measured in this study were generally low. The highest concentration of OCPs was measured for dichlorodiphenyltrichloroethane compounds (DDTs) (p,p'-DDT, o,p'-DDT, p,p'-DDE, o,p'-DDE, p,p'-DDD and o,p'-DDD), followed by chlordane compounds (CHLs) (trans-chlordane, cis-chlordane, trans-nonachlor and cis-nonachlor), hexachlorobenzene (HCB) and gamma-hexachlorocyclohexane (γ-HCH). The relatively high ratio of p,p'-DDT/p,p'-DDE in tilapia and catfish with an extremely high value in catfish purchased from a local market at Madina, a suburb of Accra, however, suggests the fresh contamination of technical DDT in Ghana. Although PCDD/Fs and dl-PCBs showed relatively low levels, the concentrations are, however, comparable with recent data of some developed countries. There is a potential health risk from DDTs, PCDD/Fs and dl-PCBs for the general population of Ghana because fish is one of their important protein sources. It is therefore necessary to estimate the total intake of DDTs, PCDD/Fs and dl-PCBs, and to assess the health risks for the general population of Ghana.

Proposal for a new clinical entity, IgG4-positive multiorgan lymphoproliferative syndrome: analysis of 64 cases of IgG4-related disorders.

BACKGROUND: Mikulicz's disease (MD) has been considered as one manifestation of Sjögren's syndrome (SS). Recently, it has also been considered as an IgG(4)-related disorder. OBJECTIVE: To determine the differences between IgG(4)-related disorders including MD and SS. METHODS: A study was undertaken to investigate patients with MD and IgG(4)-related disorders registered in Japan and to set up provisional criteria for the new clinical entity IgG(4)-positive multiorgan lymphoproliferative syndrome (IgG(4)+MOLPS). The preliminary diagnostic criteria include raised serum levels of IgG(4) (>135 mg/dl) and infiltration of IgG(4)(+) plasma cells in the tissue (IgG(4)+/IgG+ plasma cells >50%) with fibrosis or sclerosis. The clinical features, laboratory data and pathologies of 64 patients with IgG(4)+MOLPS and 31 patients with typical SS were compared. RESULTS: The incidence of xerostomia, xerophthalmia and arthralgia, rheumatoid factor and antinuclear, antiSS-A/Ro and antiSS-B/La antibodies was significantly lower in patients with IgG(4)+MOLPS than in those with typical SS. Allergic rhinitis and autoimmune pancreatitis were significantly more frequent and total IgG, IgG(2), IgG(4) and IgE levels were significantly increased in IgG(4)+MOLPS. Histological specimens from patients with IgG(4)+MOLPS revealed marked IgG(4)+ plasma cell infiltration. Many patients with IgG(4)+MOLPS had lymphocytic follicle formation, but lymphoepithelial lesions were rare. Few IgG(4)+ cells were seen in the tissue of patients with typical SS. Thirty-eight patients with IgG(4)+MOLPS treated with glucocorticoids showed marked clinical improvement. CONCLUSION: Despite similarities in the involved organs, there are considerable clinical and pathological differences between IgG(4)+MOLPS and SS. Based on the clinical features and good response to glucocorticoids, we propose a new clinical entity: IgG(4)+MOLPS.

Electromyographic analysis of deltoid muscle fatigue during abduction on scapular and frontal planes.

The aim of the study was to compare the fatigue rates of the deltoid muscle portions in the scapular and frontal planes. Ten healthy men without shoulder muscle impairment took part in the study. They performed isometric arm abduction for 30 seconds against a resistance of load cell while the electromyographic data were collected. The electromyographic data were transformed by the Fast Fourier Transform, to obtain the median power frequency (MDPF). The changes in MDPF of the three deltoid portions in the scapular and frontal planes were compared. The acromialis and spinalis portions fatigued during the exercises. The clavicularis portion presented no fatigue. A statistically significant difference occurred between the clavicularis and the other two portions (P < 0.05). No differences were found when the planes were compared. It represents to practice no preferential order during rehabilitation. Moreover, the acromialis and spinalis portions fatigue, although the clavicularis portion did not fatigue. The actions of other muscles of the shoulder girdle can explain this fact. Moreover, these two portions need more attention to avoid fatigue during exercises. In general, therapeutic strategies for injured patients should not only be directed towards increased force, but also towards fatigue control during shoulder exercises.

Theory of dielectric micro-sphere dynamics in a dual-beam optical trap.

We investigate the dynamics of an array of polystyrene micron-sized spheres in a dual-beam fiber-optic trap. Experimental results show non-uniform equilibrium particle spacing and spontaneous self-sustained oscillation for large particle numbers. Results are analyzed with a Maxwell- Stress Tensor method using the Generalized Multipole Technique, where hydrodynamic interactions between particles are included. The theoretical analysis matches well with the experimentally observed equilibrium particle spacing. The theory shows that an offset in the trapping beams is the underlying mechanism for the oscillations and influences both the oscillation frequency and the damping rate for oscillations. The theory presented is of general interest to other systems involving multi-particle optical interactions.

Clonal relationship between infiltrating immunoglobulin G4 (IgG4)-positive plasma cells in lacrimal glands and circulating IgG4-positive lymphocytes in Mikulicz's disease.

Mikulicz's disease (MD) is gaining acceptance as an immunoglobulin G4 (IgG4)-related disease characterized by bilateral lacrimal and salivary gland swelling. The aetiology of MD and other IgG4-related diseases is still unclear. The present work was performed to study the clonality of infiltrating IgG4-positive plasma cells in lacrimal glands and circulating peripheral blood cells in patients with MD, and compare the clonal relationship between infiltrating and circulating IgG4 positive cells. Total cellular RNA was extracted from the lacrimal glands and peripheral blood in five MD patients. Reverse transcription polymerase chain reaction was performed with primers specific for activation-induced cytidine deaminase (AID) and for Ig VH and IgG4. Sequences of Ig VH were compared with the structure of Ig VH of the lacrimal glands and the peripheral blood cells. AID was expressed to varying degrees in lacrimal glands of all MD patients. Most IgG4-positive cells infiltrating lacrimal glands and in peripheral blood were polyclonal, although several clonally related pairs were detected. In one patient, two of the circulating IgG4 VH4-59 clones shared identical CDR3 sequences with the clones within the lacrimal glands. In conclusion, while most tissue-infiltrating and circulating IgG4-positive cells in MD are polyclonal, some clonally related IgG4 positive cells exist between lacrimal gland and peripheral blood, accounting for the clinical features of MD as an IgG4-related disease involving multiple organs.

Endocapillary proliferative glomerulonephritis with crescent formation and concurrent tubulointerstitial nephritis complicating retroperitoneal fibrosis with a high serum level of IgG4.

Renal lesions of IgG4-related disease have been reported recently. Most of them are tubulointerstitial nephritis, and a definite glomerulonephritis complicating IgG4-related disease is very rare. We report here a case of definite glomerulonephritis and concurrent tubulointerstitial nephritis complicating retroperitoneal fibrosis with a high serum level of IgG4. A 68-year-old Japanese woman was referred to our hospital for investigation of anasarca. We diagnosed her disease as a nephrotic syndrome and left hydroureteronephrosis due to retroperitoneal fibrosis. Her laboratory data revealed a high serum level of IgG4, renal injury, hypoproteinemia, hypocomplementemia, a positive finding of circulating immunocomplex (CIC), and negative findings ofautologous antibodies suggesting systemic lupus erythematosus (SLE) or Sjögren's syndrome (SS). A diagnosis of SLE or SS could not be made clinically. Right renal biopsy revealed endocapillary proliferative glomerulonephritis with crescent formation and concurrent tubulointerstitial nephritis. Infiltration of plasma cells in interstitium was more conspicuous than seen with ordinary tubulointerstitial nephritis, and in most of them IgG4 was positive. We placed a percutaneous nephrostomy catheter in her left kidney, and prescribed prednisolone and cyclosporine. The responses to prednisolone and cyclosporine therapies were very good. Further studies are needed to clarify the relationship between glomerulonephritis and IgG4-related disease. However, when considering renal lesions of IgG4-related disease, we think that hypocomplementemia, a positive finding of CIC, negative findings of autologous antibodies suggesting SLE or SS, conspicuous interstitial infiltration of IgG4-positive plasma cells, and a good response to steroid or immunosuppressant therapy are key points.

Virulence factors of avian pathogenic Escherichia coli strains isolated from chickens with colisepticemia in Japan.

The virulence factors of avian pathogenic Escherichia coli (APEC) isolated in Japan were investigated. Serogroups O, serotypes K1 and K5, and genes cva C, iss, iutA, papA, tsh, and usp, which have been thought to be related to virulence, were examined for their association with E. coli strains isolated from diseased and healthy chickens. The frequently recognized serogroups O1, O2, and O78 were found in 56 of 125 (44.8%) strains of diseased chickens (APEC) versus 13 of 100 (13.0%) strains of healthy chickens (commensal E. coli), a significant difference at risk ratio < 0.01. Although iss, iutA, and tsh were widely distributed in the APEC irrespective of O serogroup, papA, usp, and the K1 serotype were detected in serogroup O2 of APEC. The kfiD gene related to the K5 capsule and VT, LT, and ST genes related to exotoxins were not detected in any strains examined.

Catecholamine-induced stimulation of growth in Vibrio species.

AIMS: To evaluate the effect of norepinephrine (NE) and related compounds on the growth of bacteria, we have examined the effect of the neuroendocrine hormone NE and related compounds on the growth of Vibrio parahaemolyticus and other human-pathogenic Vibrio species (Vibrio cholerae, Vibrio vulnificus, and Vibrio mimicus). METHODS AND RESULTS: The effects on bacterial growth were examined using the serum-based medium and viable cells were counted using agar plates. We have shown that NE and its related compounds stimulate growth of V. parahaemolyticus in serum-based medium. This NE-induced growth stimulation was dependent upon the presence of transferrin. NE also stimulated growth of V. mimicus, but not V. cholerae and V. vulnificus. CONCLUSIONS: These results suggest that the Vibrio species differ in their ability to respond to NE. SIGNIFICANCE AND IMPACT OF THE STUDY: It is possible that NE and related compounds modulate the pathogenicity of V. parahaemolyticus and V. mimicus.

Confiabilidade intra e interobservador da análise cinemática angular do quadril durante o teste sentar e alcançar para mensurar o comprimento dos isquiotibiais em estudantes universitários / Intra and interobserver reliability of angular kinematic analysis of the hip joint during the sit-and-reach test to measure hamstring length in university students

CONTEXTUALIZAÇÃO: O teste sentar e alcançar (TSA), utilizado para mensurar flexibilidade da coluna lombar e músculos isquiotibiais (IT), é mais adequado quando realizado concomitante à mensuração do ângulo da articulação do quadril (AAQ). OBJETIVO: Avaliar a confiabilidade intra e interobservadores do TSA na mensuração do comprimento dos IT por meio da análise cinemática angular. MÉTODO: Participaram 50 universitários (X= 21,5 anos; DP= 1,5) sem alterações musculoesqueléticas. Foram utilizados: banco padrão do TSA com porta para avaliar a ação dos gastrocnêmios no TSA e câmera fotográfica digital posicionada sobre um tripé. Marcadores cutâneos foram posicionados na: espinha ilíaca ântero-superior e trocânter maior. Realizaram-se duas aquisições de imagem: uma com porta fechada - PF e outra, aberta - PA. Para testar a confiabilidade intra e interobservadores foram utilizados: coeficiente de correlação intraclasse (CCI) - efeito aleatório com um fator - e teste de concordância de Bland e Altman (d = diferença média entre as medidas) com os respectivos intervalos de confiança de 95 por cento (IC 95 por cento). RESULTADOS: Os testes de confiabilidade intra-observador do AAQ foram: CCIpf = 0,97 - IC95 por cento [0,95;0,99] e Bland e Altman d = -0,02 - IC95 por cento [-0,11;0,07]; CCIpa= 0,98 - IC95 por cento [0,96;0,99], d = -0,01 - IC95 por cento [-0,11;0,08]. Para confiabilidade interobservador: CCIpf =0,96 - IC95 por cento [0,94;0,98] e d = -0,07 - IC95 por cento [-0,19;0,03]; CCIpa=0,96 - IC95 por cento [0,93;0,98] e d = -0,06 - IC95 por cento [-0,19;0,52]. CONCLUSÃO: Os testes intra e interobservador (PF e PA) da avaliação do AAQ, pela análise cinemática, apresentaram alta confiabilidade. A técnica é de fácil aplicação (necessita apenas do banco TSA padrão e câmera fotográfica) e fornece à prática clínica um método confiável para mensurar os IT pela cinemetria.

BACKGROUND: The sit-and-reach test (SRT) is used to measure the flexibility of the lumbar spine and hamstring muscles and is better when the hip joint angle (HJA) is measured concomitantly. OBJECTIVE: To assess the intra and interobserver reliability of the SRT for measuring hamstring muscle length through angular kinematic analysis. METHOD: Fifty university students (X= 21.5 years; SD= 1.5) without musculoskeletal abnormalities took part. A standard SRT bench with a door (to assess the action of the gastrocnemius muscles) and a digital photographic camera positioned on a tripod were used. Skin markers were placed on the anterosuperior iliac spine and greater trochanter. Two images were recorded: one with the door closed (DC) and another with the door open (DO). To test the intra and interobserver reliability, the intraclass correlation coefficient (ICC) (random effect with one factor) and the Bland and Altman concordance test (d= mean difference between measurements) were used, with the respective 95 percent confidence intervals (95 percent CI). RESULTS: The intraobserver reliability of the HJA test was: ICCdc= 0.97 (95 percent CI [0.95;0.99]) and Bland and Altman d = -0.02 (95 percent CI [-0.11;0.07]); ICCdo = 0.98 (95 percent CI [0.96;0.99]), d = -0.01 (95 percent CI [-0.11;0.08]). For the interobserver reliability: ICCdc= 0.96 (95 percent CI [0.94;0.98]) and d = -0.07 (95 percent CI [-0.19;0.03]); ICCdo= 0.96 (95 percent CI [0.93;0.98] and d = -0.06 (95 percent CI [-0.19;0.52]. CONCLUSION: The intra and interobserver reliability tests (DC and DO) for HJA assessment using kinematic analysis showed high reliability. The technique is easy to apply (only requiring a standard SRT bench and a photographic camera) and provides a reliable method for measuring hamstring muscles using kinematic analysis in clinical practice.

Positron emission tomography in relation to Noguchi's classification for diagnosis of peripheral non-small-cell lung cancer 2 cm or less in size.

BACKGROUND: F-18 fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) scanning has become a critically important tool in diagnosis and management of non-small-cell lung cancer. However, the effectiveness of (18)F-FDG-PET as a diagnostic tool for small-sized lung cancer is controversial. The purpose of this study was to examine the accuracy of( 18)F-FDG-PET in relation to Noguchi's classification in the diagnosis of small peripheral non-small-cell lung cancer. METHODS: Between January 2003 and April 2006, 150 patients with peripheral lung lesions who were undergoing chest computed tomography (CT),( 18)F-FDG-PET, and operation were analyzed. RESULTS: Eighty-three patients had malignant lesions, and 67 patients had benign lesions. PET had a sensitivity, specificity, positive predictive value, and negative predictive value of 75.9%, 64.1%, 72.4%, and 68.3%, respectively. In 37 patients with peripheral lung cancer measuring 2.0 cm or less in the greatest diameter, the sensitivity was 51.4% and the specificity was 51.9%. Among them, all 4 cases of Noguchi type A adenocarcinoma [localized bronchioloalveolar carcinoma (LBAC)], 4 of 5 type B and 8 of 17 type C were false negative, while 9 of 11 (81.8%) types D, E, and F (invasive carcinomas without a BAC component) were true positive. CONCLUSION: The accuracy of( 18)F-FDG-PET is generally low in distinguishing malignancy from benign lesions in small lesions (<2.0-cm diameter). The significance of PET as a diagnostic tool is small, especially when the tumor has a ground-glass component at a high rate. The sensitivity of PET is high in small invasive carcinomas without a BAC component, but it is difficult to distinguish carcinoma from benign tumor from its image.

Increased susceptibility to apoptosis in CD45(+) myeloma cells accompanied by the increased expression of VDAC1.

Expression of CD45 is quite variable in human myeloma cells and cell lines, such as U266, and CD45(+) U266 proliferates in response to a growth factor, interleukin-6. Here, we show that CD45(+) myeloma cell lines were more sensitive to various apoptotic stimuli, such as oxidative stress and endoplasmic reticulum (ER)-stress, than CD45(-) cells. Reactive oxygen species and calcium ion seemed to be involved in the susceptibility to apoptosis of CD45(+) U266. The activation of the src family kinases associated with CD45 phosphatase played an important role in the augmented apoptosis in CD45(+) U266 by oxidative stress. These results indicate that the CD45-expression renders myeloma cells competent for not only mitogenic but also apoptotic stimuli, resulting in either proliferation or apoptosis of CD45(+) myeloma cells dependently upon the circumstantial stimuli. Furthermore, voltage-dependent anion channel (VDAC) 1 was identified as a gene highly expressed in CD45(+) U266 by cDNA subtraction. The increased expression of VDAC1 seemed to augment the sensitivity to the ER-stress because the VDAC1-transfected U266 was more susceptible to the thapsigargin-induced apoptosis. Thus, CD45 expression accompanied by the increased VDAC1 expression sensitizes myeloma cells to the various extracellular stimuli that trigger apoptosis via the mitochondrial pathways.

Adeno-associated virus vector-mediated interleukin-10 gene transfer inhibits atherosclerosis in apolipoprotein E-deficient mice.

Inflammation is a major contributor to atherosclerosis by its effects on arterial wall biology and lipoprotein metabolism. Interleukin-10 (IL-10) is an anti-inflammatory cytokine that may modulate the atherosclerotic disease process. We investigated the effects of adeno-associated virus (AAV) vector-mediated gene transfer of IL-10 on atherogenesis in apolipoprotein E (ApoE)-deficient mice. A murine myoblast cell line, C2C12, transduced with AAV encoding murine IL-10 (AAV2-mIL10) secreted substantial amounts of IL-10 into conditioned medium. The production of monocyte chemoattractant protein-1 (MCP-1) by the murine macrophage cell line, J774, was significantly inhibited by conditioned medium from AAV2-mIL10-transduced C2C12 cells. ApoE-deficient mice were injected with AAV5-mIL10 into their anterior tibial muscle at 8 weeks of age. The expression of MCP-1 in the vascular wall of the ascending aorta and serum MCP-1 concentration were decreased in AAV5-mIL10-transduced mice compared with AAV5-LacZ-transduced mice. Oil red-O staining of the ascending aorta revealed that IL-10 gene transfer resulted in a 31% reduction in plaque surface area. Serum cholesterol concentrations were also significantly reduced in AAV5-mIL10-transduced mice. To understand the cholesterol-lowering mechanism of IL-10, we measured the cellular cholesterol level in HepG2 cells, resulting in its significant decrease by the addition of IL-10 in a dose-dependent manner. Furthermore, IL-10 suppressed HMG-CoA reductase expression in the HepG2 cells. These observations suggest that intramuscular injection of AAV5-mIL10 into ApoE-deficient mice inhibits atherogenesis through anti-inflammatory and cholesterol-lowering effects.

Long-term efficacy of immunoadsorbent plasmapheresis in a patient with Budd-Chiari syndrome due to antiphospholipid syndrome: case report with nine-year follow-up.

We describe the safety and efficacy of long-term immunoadsorbent plasmapheresis (IAPP) with dextran sulfate-cellulose bead columns in antiphospholipid syndrome (APS). IAPP was administered to a 38-year old male Japanese patient with APS with Budd-Chiari syndrome (BCS), who had presented with refractory lower leg skin ulcers and arterial and venous thromboses including BCS. After hepatic vein transluminal angioplasty was performed, the combination of corticosteroid, aspirin and IAPP was administered because of an underlying bleeding tendency related to liver dysfunction. From February 1994 to February 2003, a total of 228 procedures were performed. No further thrombosis-related symptoms or bleeding have occurred for more than nine years, suggesting that IAPP with dextran sulfate cellulose columns is safe and effective for APS in preventing additional thrombotic events. This IAPP supplements anticoagulation, antiplatelet, corticosteroid and immunosuppressant therapies.