Stepwise Treatment for TAFRO Syndrome.

TAFRO syndrome, a rapidly progressive and fatal disease, is rare, and its etiology remains unknown. It is characterized by thrombocytopenia, anasarca (edema, pleural effusion, and ascites), fever, reticulin fibrosis (or renal insufficiency), and organomegaly with Castleman disease (CD)-like histological features in the lymph nodes. CD is a rare, indolent, lymphoproliferative disorder with no established curative strategies. Most idiopathic multicentric CD cases are controlled with anti-interleukin (IL)-6 therapy (tocilizumab and siltuximab) and/or rituximab. However, it is unclear whether these therapies can be directly applied to treat TAFRO syndrome. Here, we describe stepwise immunotherapy (rituximab induction therapy and cyclosporine maintenance therapy) for two cases of steroid-refractory TAFRO syndrome. A 32-year-old man visited a local hospital with sudden onset of fever and epigastralgia. The diagnosis of TAFRO syndrome was established based on the diagnostic criteria. After rituximab administration, C-reactive protein and IL-6 levels were normalized. However, the ascites persisted, with increased resistance to rituximab. Tocilizumab was also ineffective; therefore, cyclosporine was administered. After the initiation of cyclosporine treatment, the ascites decreased and ultimately disappeared. Twelve months after immunotherapy, the patient remained asymptomatic under cyclosporine maintenance therapy. Similar stepwise immunosuppressive therapy was administered to a 72-year-old man with TAFRO syndrome complicated by renal failure. After rituximab infusion, C-reactive protein was decreased. Although methylprednisolone, rituximab, tocilizumab, and cyclosporine were administered, other laboratory data and clinical symptoms remained unchanged. His level of consciousness subsequently deteriorated due to herpes zoster encephalitis, and he died. We consider the combination of rituximab induction therapy and cyclosporine maintenance therapy to be effective for TAFRO syndrome if initiated at an early stage.

The determination of zinc using flow injection and continuous flow analysis combined with a polymer inclusion film-coated column: Application to the determination of zinc in alloys and commercial lithium chloride.

A column coated with a polymer inclusion film (PIF) containing Aliquat 336 as carrier cast on glass beads packed in a glass tube is described for the separation, preconcentration, and determination of zinc(II) in flow injection analysis (FIA) and continuous flow analysis (CFA) systems. In the FIA method, 200 µL of a sample solution containing 2 mol/L lithium chloride is injected into a 2 mol/L lithium chloride stream. This converts zinc(II) ion into its anionic chlorocomplexes which are then extracted into the Aliquat 336-based PIF by anion exchange. The extracted zinc(II) is then back-extracted into a stream of 1 mol/L sodium nitrate solution and determined spectrophotometrically using 4-(2-pyridylazo)resorcinol as the color reagent. The limit of detection (LOD, S/N = 2) was determined as 0.017 mg/L. The usability of the PIF-based FIA method was demonstrated by the determination of zinc in alloys. The PIF-coated column was also employed successfully in the CFA determination of zinc(II) as an impurity in commercial lithium chloride samples. For this, 2 mol/L commercial lithium chloride solution was passed through the column for a predetermined time period followed by stripping in a stream of 1 mol/L sodium nitrate solution.

Automated rapid solid-phase extraction system for separation and preconcentration of trace elements using carboxymethylated polyethyleneimine-type chelating resin.

An automated system for the rapid separation and preconcentration of trace elements was developed. Carboxymethylated polyethyleneimine 600 (CM-PEI600), which is a partially carboxymethylated polyethyleneimine with a molecular weight of 600 Da, was used as a chelating resin to quantitatively recover trace elements under high-flow-rate conditions. For accurately and precisely determining trace elements, even with a rough control of the sample and eluent flow volumes, an internal standardization technique was employed for the solid-phase extraction and separation. A recovery test of the deionized water-based sample solution was conducted using this system, and good results, with a recovery of 92% or higher, were obtained for 11 elements (Cd, Co, Cu, Fe, Mn, Mo, Ni, Pb, Ti, V, and Zn). Eight elements present in certified groundwater and wastewater reference materials (ES-L-1 and EU-L) were separated and preconcentrated using this system. Almost all the determined values were within their tolerance intervals, and no significant differences were observed between the determined and certified values, demonstrating the validity of this method. The time required for the separation and preconcentration using approximately 100 mL of the sample solution was approximately 6.5 min, and theoretically, the system could be used to preconcentrate 17 samples in an hour because extraction and elution could be conducted simultaneously using two cartridges packed with the chelating resin. Using this system equipped with cartridges packed with CM-PEI600 resin, solid-phase extraction and the separation of multiple elements were performed simultaneously, automatically, and rapidly, enabling the accurate and precise determination of trace elements in environmental water and inorganic salts even by rapidly flowing the sample solutions using peristaltic pumps. Compared to NOBIAS Chelate PA-1, a commercially available chelating resin, the CM-PEI600 resin can recover trace elements even under an extremely high flow rate of approximately 50 mL min-1.

[Survey of patients with advanced-stage Okinawa-type neurogenic muscular atrophy (hereditary motor and sensory neuropathy with proximal dominant involvement: HMSN-P)].

We conducted a survey of 16 Japanese patients (9 males, 7 females) aged 48-70 years in the advanced-stage Okinawa-type neurogenic muscular atrophy (i.e. hereditary motor and sensory neuropathy with proximal dominant involvement: HMSN-P) by a questionnaire asking the patients' disease name notification, acceptance, and expectations for treatment. In amyotrophic lateral sclerosis (ALS), since symptoms such as four-limb motor weakness and respiratory disorder are serious, patients are notified of the disease name at each progression stage. Individuals with HMSN-P exhibit ALS-like severe motor paralysis, but HMSN-P shows autosomal dominant inheritance, and progresses slowly (over >30 years). Many of the present patients who had one parent with the disease were able to predict what their diagnosis would be. However, several patients stated that they could not sleep for several months due to the shock of the diagnosis and their concern about how to explain to their children that the disease is hereditary. All patients in the advanced stage of HMSN-P progress to severe proximal dominant quadriplegia and ultimately need auxiliary tools such as a wheelchair. New developments toward a specific HMSN-P treatment are expected, with methods such as nucleic acid medicine.

Molecular Structure and Vibrational Spectra of Water Molecules Sorbed in Poly(2-methoxyethylacrylate) Revealed by Molecular Dynamics Simulation.

Molecular dynamics (MD) simulations of water sorption in poly(2-methoxyethylacrylate) (PMEA) are carried out to elucidate the hydrogen bonding (H-bonding) structures of the water molecules and the side chains of PMEA. A PMEA model incorporating lone-pair virtual sites on the carbonyl and methoxy oxygens of the side chain of PMEA, which are the key interaction sites in a biocompatible polymer, is newly developed. The PMEA model well reproduces the experimentally observed features in the infrared spectra of the hydrated polymer, as well as the radial distribution function of the water molecules in contact with the polymer, as calculated by ab initio MD simulations. The MD simulation results reveal that water molecules tend to form H-bonds with the carbonyl oxygen and the methoxy oxygen of the side chain of PMEA simultaneously, which enhance the "head-to-tail" stacking structure of the side chains at a low concentration range of water. Further penetration of water into the PMEA structure gradually increases the water-water H-bonding state and promotes the formation of water clusters even below the equilibrium water content.

Risk Factors for and the Prognostic Impact of Pericardial Effusion after Allogeneic Hematopoietic Stem Cell Transplantation.

Pericardial effusion (PE) is a rare complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Although the mechanisms underlying the onset of PE remain unclear, patients with PE after allo-HSCT have poor clinical outcomes. However, the prognostic impact of PE remains controversial, and risk factors have varied among studies. Therefore, we examined contributing as well as prognostic factors for PE. We retrospectively examined 243 patients who underwent allo-HSCT at the Faculty of Medicine, Kagawa University and Takamatsu Red Cross Hospital, Kagawa, Japan between 2000 and 2020. Forty-three patients (18%) were excluded owing to a lack of data on PE, and thus we ultimately analyzed 200 patients. We reviewed the findings of computed tomography (CT) scans, including chest CT, and echocardiography after allo-HSCT. Only cases in which a radiologist or echocardiography technician detected PE were assessed. PE was stratified into localized PE and whole-circumference PE. The median age at transplantation was 52 years (range, 16 to 74 years). The study cohort comprised 106 patients (53%) age more than 50 years, 88 females (44%), and 112 males (56%). Primary diseases were myeloid neoplasms in 122 patients (61%) and lymphoid neoplasms in 78 (39%). The conditioning regimen was myeloablative in 142 patients (71%) and nonmyeloablative in 58 (29%). The median duration of follow-up was 47 months (range, 1 to 209 months). Forty patients developed PE within 100 days; localized in 23 (12%) and whole circumference in 17 (9%). In a multivariate analysis, significant risk factors for the development of PE within 100 days were late neutrophil engraftment (hazard ratio [HR], 5.24; 95% CI, 1.92 to 14.30; P < .01) and thrombotic microangiopathy (TMA) (HR, 8.23; 95% CI, 1.42 to 47.60; P = .02). The incidence of whole- circumference PE correlated with a lower overall survival (OS) rate (HR, 3.10; 95% CI, 1.34 to 7.17; P < .01) and higher nonrelapse mortality (NRM) rate (HR, 2.94; 95% CI, 1.18 to 7.32; P = .02). In the subgroup analysis, significant risk factors for the development of PE within 365 days were late neutrophil engraftment (HR, 3.13; 95% CI, 1.08 to 9.02; P = .04), the occurrence of chronic graft-versus-host disease (GVHD) (HR, 3.57; 95% CI, 1.19 to 10.70; P = .02), and disease recurrence (HR, 4.98; 95% CI, 1.43 to 17.30; P = .01). The development of whole-circumference PE also correlated with a lower OS rate (HR, 3.83; 95% CI, 1.65 to 8.89; P < .01) and a higher NRM rate (HR, 83.21; 95% CI, 17.75 to 390.10; P < .01). The overall occurrence of acute (grade II to IV) GVHD, chronic GVHD, and TMA were 36% (72 of 200), 39% (78 of 200), and 10% (19 of 200), respectively. In the entire cohort, the 3-year OS rate was 55%, and 3-year relapse and NRM rates were 37 and 14%, respectively. The present results demonstrate that risk factors for PE varied according to the time after allo-HSCT, and that whole-circumference PE at any time correlated with lower OS and higher NRM rates. A large-scale prospective study is needed to verify risk factors for PE and clarify whether immunosuppressive interventions based on the onset of PE improve the clinical prognosis of patients.

Applicability of Internal Standardization with Yttrium to the Solid-phase Extraction of Trace Elements in Groundwater and Wastewater Using an Aminocarboxylic Acid-type Chelating Resin.

Internal standardization was applied to the solid-phase extraction of trace elements using the following commercially available aminocarboxylic acid-type chelating resins: InertSep ME-2, NOBIAS Chelate PA-1, and Presep PolyChelate. The concentration of the trace elements in initial sample solution can be calculated by using the ratio of the added amount of the internal standard element, Y, in the initial sample solution to that in the final solution after the solid-phase extraction, which is proportional to the volume of the sample solution passed through the cartridge, and the ratio of the volume of the initial sample solution to that of a blank solution for preparing the calibration curve. In this solid-phase extraction, strict control of the volumes of the sample solution passed through the cartridge and the final solution after the solid-phase extraction is not needed because these are not used in the calculation of the trace element concentration. The solid-phase extraction with the internal standardization using Y could be applied to the separation and preconcentration of some trace elements, namely Cd, Co, Cu, Fe, Ni, Pb, Ti, and Zn in an artificial seawater spiked with the elements and some certified reference materials, EnviroMAT ES-L-1 Ground Water and EU-L-3 Waste Water, without any interference.

International evidence-based consensus diagnostic and treatment guidelines for unicentric Castleman disease.

Castleman disease (CD) includes a group of rare and heterogeneous disorders with characteristic lymph node histopathological abnormalities. CD can occur in a single lymph node station, which is referred to as unicentric CD (UCD). CD can also involve multicentric lymphadenopathy and inflammatory symptoms (multicentric CD [MCD]). MCD includes human herpesvirus-8 (HHV-8)-associated MCD, POEMS-associated MCD, and HHV-8-/idiopathic MCD (iMCD). The first-ever diagnostic and treatment guidelines were recently developed for iMCD by an international expert consortium convened by the Castleman Disease Collaborative Network (CDCN). The focus of this report is to establish similar guidelines for the management of UCD. To this purpose, an international working group of 42 experts from 10 countries was convened to establish consensus recommendations based on review of treatment in published cases of UCD, the CDCN ACCELERATE registry, and expert opinion. Complete surgical resection is often curative and is therefore the preferred first-line therapy, if possible. The management of unresectable UCD is more challenging. Existing evidence supports that asymptomatic unresectable UCD may be observed. The anti-interleukin-6 monoclonal antibody siltuximab should be considered for unresectable UCD patients with an inflammatory syndrome. Unresectable UCD that is symptomatic as a result of compression of vital neighboring structures may be rendered amenable to resection by medical therapy (eg, rituximab, steroids), radiotherapy, or embolization. Further research is needed in UCD patients with persisting constitutional symptoms despite complete excision and normal laboratory markers. We hope that these guidelines will improve outcomes in UCD and help treating physicians decide the best therapeutic approach for their patients.

Potential of Carboxymethylated Polyallylamine as a Functional Group on Chelating Resin for Solid-Phase Extraction of Trace Elements.

New chelating resins immobilizing carboxymethylated polyallylamine (CM-PAA) were prepared by immobilizing PAAs with some molecular weights on methacrylate resins and then carboxymethylating a part of amino groups in the PAAs using various amounts of sodium monochloroacetate. The molecular weight of PAA barely affected both the amount of PAA immobilized on the resin and the relationship between the carboxymethylation (CM) rate and the ratio of the amount of monochloroacetate used in the CM step. The selectivity of CM-PAA resin for solid-phase extraction of trace elements was almost the same as that of a resin immobilizing carboxylymethylated polyethyleneimine; 10 elements, namely Cd, Co, Cu, Fe, Mo, Ni, Pb, Ti, V, and Zn, could be quantitatively recovered over a wide pH range and alkali and alkaline earth elements were scarcely extracted under acidic and neutral conditions. The CM-PAA resin was applicable to the separation and preconcentration of the elements in a certified reference material (Waste Water, EU-L-1) and a real environmental water sample (ground water).

The dipeptidyl peptidase-4 inhibitor, linagliptin, improves cognitive impairment in streptozotocin-induced diabetic mice by inhibiting oxidative stress and microglial activation.

OBJECTIVE: Accumulating epidemiological studies have demonstrated that diabetes is an important risk factor for dementia. However, the underlying pathological and molecular mechanisms, and effective treatment, have not been fully elucidated. Herein, we investigated the effect of the dipeptidyl peptidase-4 (DPP-4) inhibitor, linagliptin, on diabetes-related cognitive impairment. METHOD: Streptozotocin (STZ)-induced diabetic mice were treated with linagliptin (3 mg/kg/24 h) for 17 weeks. The radial arm water maze test was performed, followed by evaluation of oxidative stress using DNP-MRI and the expression of NAD(P)H oxidase components and proinflammatory cytokines and of microglial activity. RESULTS: Administration of linagliptin did not affect the plasma glucose and body weight of diabetic mice; however, it improved cognitive impairment. Additionally, linagliptin reduced oxidative stress and the mRNA expression of NAD(P)H oxidase component and TNF-α, and the number and body area of microglia, all of which were significantly increased in diabetic mice. CONCLUSIONS: Linagliptin may have a beneficial effect on diabetes-related dementia by inhibiting oxidative stress and microglial activation, independently of glucose-lowering.

Thermal Decomposition Behavior of a Chelating Resin Immobilizing Carboxymethylated Polyethyleneimine: Possibility of Estimation of Carboxymethylation Rate.

Chelating resins immobilizing carboxymethylated polyethyleneimine (CM-PEI) with different carboxymethylation rates were prepared. The thermal decomposition behavior of CM-PEI resins was investigated using thermogravimetry-differential thermal analysis/photo ionization-quadrupole mass spectrometry (TG-DTA/PI-QMS) and ion attachment ionization-quadrupole mass spectrometry equipped with direct inlet probe (DIP/IA-QMS). The obtained results suggested that the carboxymethyl group decomposed at relatively low temperature (150 °C - 300 °C); the peak areas at m/z 45 and 59 in TG-DTA/PI-QMS and m/z 58, 70, and 72 in DIP/IA-QMS significantly increased with increasing carboxymethylation rate. These relationships should be useful for estimating the carboxymethylation rate of CM-PEI resin.

Is TAFRO syndrome a subtype of idiopathic multicentric Castleman disease?

Castleman disease (CD) is a rare lymphoproliferative disorder that can be unicentric or multicentric. Multicentric CD (MCD) is further subdivided into human herpesvirus type-8-associated, POEMS syndrome-associated, and idiopathic (iMCD). TAFRO syndrome is a newly identified disorder of unknown etiology characterized by thrombocytopenia, anasarca, fever, reticulin myelofibrosis, renal dysfunction, and organomegaly. The TAFRO syndrome is sometimes regarded as a subtype of iMCD (TAFRO-iMCD), whereas iMCD without TAFRO syndrome is considered "not otherwise specified" (iMCD-NOS). However, a proportion of patients with TAFRO syndrome have been diagnosed without lymph node biopsies (TAFRO syndrome without proven iMCD; TAFRO-w/op-iMCD). To clarify the clinical features of iMCD-NOS, TAFRO-iMCD, and TAFRO-w/op-iMCD, we retrospectively analyzed 220 patients extracted from the database of the Multicenter Collaborative Retrospective Study for Establishing the Concept of TAFRO Syndrome. The patients included 87 with iMCD-NOS, 63 with TAFRO-iMCD, and 19 with TAFRO-w/op-iMCD. Patients in all three groups exhibited anemia, hypoalbuminemia, and elevated serum C-reactive protein and interleukin-6 levels. No significant differences in clinical, laboratory, and prognostic features were noted between the TAFRO-iMCD, and TAFRO-w/op-iMCD groups. However, the iMCD-NOS group exhibited polyclonal hyper-γ-globulinemia. The five-year survival rates of patients in the iMCD-NOS and TAFRO-involved groups were 100% and 66.5%, respectively (dropping markedly during the first few months in the latter). The iMCD-NOS and the TAFRO-iMCD samples typically showed plasma cell and mixed-type histologies, respectively. Thus, iMCD can be classified into two distinct subtypes, iMCD-NOS and TAFRO-iMCD. As such, TAFRO-iMCD and TAFRO-w/op-iMCD may be considered the same entity, requiring prompt diagnosis and intensive care.

Phosphomethylated Polyethyleneimine-immobilized Chelating Resin: Role of Phosphomethylation Rate on Solid-Phase Extraction of Trace Elements.

Chelating resins immobilizing phosphomethylated polyethyleneimine (PM-PEI) with different phosphomethylation (PM) rates were prepared by using different amounts of both phosphonic acid and paraformaldehyde in the phosphomethylation of PEI immobilized on a methacrylate resin as a base resin. The extraction of many elements improved with increasing PM rate; REEs, Be, Fe, Mo, Ti, and V were quantitatively extracted at pH 2. The elution of the elements tended to become difficult with increasing PM rate. When a PM-PEI resin with a PM rate of 0.26 was used, REEs and Be could be eluted using 0.2 mol L-1 EDTA solution adjusted to a pH of 7 and 3 mol L-1 nitric acid, respectively, although the elution of Fe, Mo, Ti, and V was insufficient. The PM-PEI resin could be reused at least 10 times to recover REEs and Be without the influence of any other elements. The PM-PEI resin could be applied to a recovery test using artificial seawater spiked with REEs, except for Sc, Tm, Yb, and Lu, and the separation of the REEs in NIST SRM 1515 Apple Leaves.

International, evidence-based consensus treatment guidelines for idiopathic multicentric Castleman disease.

Castleman disease (CD) describes a group of heterogeneous hematologic disorders with characteristic histopathological features. CD can present with unicentric or multicentric (MCD) regions of lymph node enlargement. Some cases of MCD are caused by human herpesvirus-8 (HHV-8), whereas others are HHV-8-negative/idiopathic (iMCD). Treatment of iMCD is challenging, and outcomes can be poor because no uniform treatment guidelines exist, few systematic studies have been conducted, and no agreed upon response criteria have been described. The purpose of this paper is to establish consensus, evidence-based treatment guidelines based on the severity of iMCD to improve outcomes. An international Working Group of 42 experts from 10 countries was convened by the Castleman Disease Collaborative Network to establish consensus guidelines for the management of iMCD based on published literature, review of treatment effectiveness for 344 cases, and expert opinion. The anti-interleukin-6 monoclonal antibody siltuximab (or tocilizumab, if siltuximab is not available) with or without corticosteroids is the preferred first-line therapy for iMCD. In the most severe cases, adjuvant combination chemotherapy is recommended. Additional agents are recommended, tailored by disease severity, as second- and third-line therapies for treatment failures. Response criteria were formulated to facilitate the evaluation of treatment failure or success. These guidelines should help treating physicians to stratify patients based on disease severity in order to select the best available therapeutic option. An international registry for patients with CD (ACCELERATE, #NCT02817997) was established in October 2016 to collect patient outcomes to increase the evidence base for selection of therapies in the future.

A porous sintered material consisting of Presep PolyChelate as a chelating resin and particulate polyethylene as a thermoplastic binder for solid-phase extraction of trace elements.

Cylinder-type and disk-type sintered materials consisting of Presep PolyChelate, which is a commercially available chelating resin immobilizing carboxymethylated polyethyleneimine as a functional group, and particulate polyethylene as a thermoplastic binder were prepared using a polymer sintering technique. The sintered materials had a continuously porous structure. The sintering process at 130 °C for 20 min did not affect the ability of the chelating resin in the sintered materials; the selectivity of the sintered material was almost the same as that of the particulate chelating resin which was not sintered. The sintering materials could quantitatively extract 11 kinds of trace elements, namely Cd, Co, Cu, Fe, Mn, Mo, Ni, Pb, Ti, V, and Zn, at pH 5.5. When the disk-type sintered material was used, the recoveries of these elements remained almost constant at a flow rate of at least 50 mL min-1; the extracted elements could be eluted using 10 mL of 3 mol L-1 nitric acid at a flow rate of 5 mL min-1. Solid-phase extraction using the disk-type sintered material was applied to the separation and preconcentration of trace elements prior to their inductively coupled plasma atomic emission spectrometric determination. The method was applicable to analyses of certified reference materials (EnviroMAT ES-L-1 ground water and EU-L-3 waste water) and a commercially available table salt.

p66Shc Signaling Mediates Diabetes-Related Cognitive Decline.

Accumlating evidence have suggested that diabetes mellitus links dementia, notably of Alzheimer's disease (AD). However, the underlying mechanism remains unclear. Several studies have shown oxidative stress (OS) to be one of the major factors in the pathogenesis of diabetic complications. Here we show OS involvement in brain damage in a diabetic animal model that is at least partially mediated through an AD-pathology-independent mechanism apart from amyloid-ß accumulation. We investigated the contribution of the p66Shc signaling pathway to diabetes-related cognitive decline using p66Shc knockout (-/-) mice. p66Shc (-/-) mice have less OS in the brain and are resistant to diabetes-induced brain damage. Moreover, p66Shc (-/-) diabetic mice show significantly less cognitive dysfunction and decreased levels of OS and the numbers of microglia. This study postulates a p66Shc-mediated inflammatory cascade leading to OS as a causative pathogenic mechanism in diabetes-associated cognitive impairment that is at least partially mediated through an AD-pathology-independent mechanism.

Tentative diagnostic criteria and disease severity classification for Castleman disease: A report of the research group on Castleman disease in Japan.

OBJECTIVES: To determine the tentative diagnostic criteria and disease severity classification for Castleman disease (CD) and describe the clinical and pathologic features among human herpesvirus 8 (HHV-8) negative idiopathic multicentric CD (iMCD) in the Japanese population. METHODS: We established the working groups for the research of CD in Japan and had meetings to discuss and define the tentative diagnostic criteria and disease severity classification for CD. We subsequently analyzed 142 patients classified into iMCD by using the nationwide Japanese patient registry. RESULTS: We proposed the preliminary diagnostic criteria and disease severity classification for CD based on our discussion. In addition, we made a proposal for the disease activity score. We identified clinical and pathological features of patients with iMCD diagnosed by these diagnostic criteria. In the disease severity classification, 37, 33 and 30% patients were categorized into mild, moderate and severe diseases, respectively. CONCLUSION: This is the first proposal for diagnosis and classification of CD by the Japanese group. Further studies are required to validate whether they can distinguish CD from other inflammatory diseases and to determine their sensitivity and specificity.