Effects of changes in skeletal muscle mass on the prognosis of pediatric malignant solid tumors.

PURPOSE: This study aims to clarify the relationship between changes in skeletal muscle mass during treatment and prognosis of pediatric malignant solid tumors. METHODS: Patients with pediatric malignant solid tumors who were treated at Kyushu University Hospital from 2007 to 2017 were divided into two groups: the progression-free survival (PFS) group and the relapse/death (R/D) group; the psoas major muscle volume (PMV) was then compared. We also measured the PMV and psoas muscle area (PMA) of pediatric patients with no complications who underwent surgery for acute appendicitis (control) and compared the values with those of patients with malignant tumors. RESULTS: No significant differences were observed in the PMV and PMA between patients with appendicitis and those with malignant tumors. Significant differences were found in the rate of change in PMV between the PFS (1.424) and R/D groups (1.071) (P = 0.0024). When the cut-off value of the rate of change in the PMV was 1.20, patients whose rate of change in PMV was ≥ 1.20 had longer PFS (P = 0.0231) and overall survival (P = 0.0229) than those whose rate of change was < 1.20. CONCLUSION: Pediatric patients with malignant solid tumors and increased skeletal muscle mass during treatment have a good prognosis.

Successful management of Wilms tumor accompanied by traumatic renal injury: a case report.

When a tumor and trauma coexist, the treatment strategy must be established while considering their interaction. We herein report a 5-month-old girl with Wilms tumor complicated by blunt renal trauma. She was involved in a traffic accident and had hemorrhagic shock due to renal bleeding. We performed hemostasis by transcatheter arterial embolization. Ten days later, we extirpated the potential malignant tumor and left kidney. We were able to complete the surgery without rupture or major bleeding. Postoperative histopathology confirmed Wilms tumor. In the year since she received postoperative chemotherapy, there has been no recurrence. When we were deciding the treatment strategy, we first had to determine how much the renal trauma had affected the tumor staging. The second issue was when to extirpate the tumor after managing the trauma. There are no standard criteria for such situations at present, so we referred to the criteria concerning the bed rest period in cases of traumatic kidney injury and previous case reports and decided to wait over a week from the injury treatment to perform surgery. As a result, we were able to remove the tumor completely without any rupture or major bleeding.

Acetylcholinesterase staining for the pathological diagnosis of Hirschsprung's disease.

Hirschsprung's disease (HD) is a congenital disease manifesting various degrees of functional bowel obstruction caused by the absence of enteric ganglion cells, which are usually absent in the colonic segment of the HD patient. Because the aganglionic segment of HD always includes the rectum, pathological diagnosis can be made using a rectal sample. HD should be diagnosed as early as possible because serious complications, such as acute enterocolitis or toxic megacolon, can develop without a definitive diagnosis and appropriate treatment. In the mid-1900s, HD was diagnosed by HE staining of specimens obtained by full-thickness biopsy. Since then, the combination of rectal mucosal biopsy and rubeanic acid-amplificated AChE staining has been brought about by the following milestones: the discovery that the submucosal plexus and the intermuscular plexus had the same level of nerve migration; the findings of research on acetylcholine (ACh) and acetylcholinesterase (AChE) in the intestinal tract; and the establishment of a rubeanic acid amplification method. Consequently, the diagnostic rate of HD improved dramatically in the 1980s. This review outlines the history of diagnostic methods for HD, the roles of ACh and AChE in the intestine, and the method of AChE staining.

Psychosocial Consequences Among Nurses in the Affected Area of the Great East Japan Earthquake of 2011 and the Fukushima Complex Disaster: A Qualitative Study.

OBJECTIVE: The goal of this study was to assess the psychosocial consequences among nurses affected by the Great East Japan Earthquake in order to identify their coping strategies and explore possible countermeasures against complex disasters. METHODS: In 2012, we conducted a qualitative study and screened participants for posttraumatic stress disorder (PTSD). RESULTS: Thirty-eight nurses participated in this study. The result showed a relatively high proportion of probable PTSD (39%). Thirty-two conceptual codes emerged from the data and were grouped into 8 categories: "initial acute stress," "acute stress turning chronic," "chronic physical and mental fatigue," "occupational stress," "fear of the impact of radiation on children's health," "occupational satisfaction," "positive influences of the disaster experiences," and "impact of mutual care through interpersonal cognition." CONCLUSIONS: The study reveals that mutual care may have a positive impact in assisting recovery and enhancing the psychological well-being of nurses. We suggest that disaster management should take into consideration the conflict between professional and family responsibilities. In the light of the chronic impact of the nuclear crisis, enhanced support for interpersonal relationships and human resources, as well as appropriate safety precautions, is urgently needed to help affected nurses. (Disaster Med Public Health Preparedness. 2019;13:519-526).

Radiosensitivity of human haematopoietic stem/progenitor cells.

The haematopoietic system is regenerative tissue with a high proliferative potential; therefore, haematopoietic stem cells (HSCs) are sensitive to extracellular oxidative stress caused by radiation and chemotherapeutic agents. An understanding of this issue can help predict haematopoietic recovery from radiation exposure as well as the extent of radiation damage to the haematopoietic system. In the present study, the radiosensitivity of human lineage-committed myeloid haematopoietic stem/progenitor cells (HSPCs), including colony-forming unit-granulocyte macrophage, burst-forming unit-erythroid and colony-forming unit-granulocyte-erythroid-macrophage-megakaryocyte cells, which are contained in adult individual peripheral blood (PB) and fetus/neonate placental/umbilical cord blood (CB), were studied. The PB of 59 healthy individual blood donors and the CB of 42 neonates were investigated in the present study. HSPCs prepared from PB and CB were exposed to 0.5 or 2 Gy x-irradiation. The results showed that large individual differences exist in the surviving fraction of cells. In the case of adult PB, a statistically significant negative correlation was observed between the surviving fraction observed at a dose of 0.5 Gy and the age of the blood donors; however, none of these correlations were observed after 2 Gy x-irradiation. In addition, seasonal and gender variation were observed in the surviving fraction of CB HSPCs. The present results suggest that there are large individual differences in the surviving fraction of HSPCs contained in both adult PB and fetus/neonate CB. In addition, some factors, including the gender, age and season of birth, affect the radiosensitivity of HSPCs, especially with a relatively low-dose exposure.

Effect of the umbilical cord blood acid-base status and gas values on the yield of mononuclear cells and CD34⁺ cells.

AIM: To investigate the influence of umbilical cord blood (CB) acid-base status and gas values on the yield of mononuclear cells and CD34⁺ cells, pH, pCO2, pO2, HCO3⁻ and base excess were measured in arterial CB samples obtained from normal full-term deliveries. The relationship of these values with the yield of mononuclear cells and CD34⁺ cells detected in venous CB was analyzed. MATERIAL AND METHODS: A total of 145 CB units were collected from full-term vaginal deliveries at a single hospital. Immediately after delivery, a segment of the umbilical cord was double clamped, and arterial CB was analyzed to determine the acid-base status and gases. Venous CB was collected in a sterile collection bag and processed for cell separation within 24 h of collection. The relationship between umbilical arterial acid-base status, each gas value, and the yield of mononuclear cells and CD34⁺ cells was analyzed. RESULTS: Statistically significant correlations were observed between the net weight of CB and the total mononuclear and CD34⁺ cell counts. In addition, there was a negative correlation between the mononuclear cell counts and pH, but a positive correlation between the mononuclear cell counts and pCO2. However, no significant differences were observed between the primipara and multipara groups in terms of the net weight of CB, total mononuclear cell counts and total CD34⁺ cell counts. CONCLUSION: The findings of the present study show that the mononuclear cell counts are correlated with arterial CB pH and pCO2, suggesting the involvement of fetal hypoxia on the yield of mononuclear cells.

Quality-assessments of characteristics of placental/umbilical cord blood associated with maternal age- and parity-related factor.

Umbilical cord blood (CB) has been widely used for unrelated allogeneic stem cell transplantation. It is important to determine the quality of CB units to avoid frequent problem of limited cell yields. However, no practical and/or optimum obstetric factors to predict them are yet available. This study analyzed the relationship between maternal/neonatal obstetric factors and the laboratory parameters of CB units to identify the optimum factors associated with a high yield of total nucleated cells (TNC). Primiparae in their early 30s may be one of the first selection criteria for CB donors to obtain higher yield of TNC.

Relationship between radiosensitivity of human neonatal hematopoietic stem/progenitor cells and individual maternal/neonatal obstetric factors.

Hematopoietic stem/progenitor cells (HSPCs) in placental/umbilical cord blood (CB), which is neonatal peripheral blood, have increasingly been used for hematopoietic stem cell transplantations. It is likely HSPCs are sensitive to extracellular oxidative stresses, such as ionizing radiation and redox-directed chemotherapeutic agents. However, the radiosensitivity of HSPCs and neonatal hematopoietic system remains unclear. This study investigated the potential relationship between the radiosensitivity of HSPCs in CB, which was obtained from singleton and full-term deliveries, and maternal/neonatal obstetric factors. Freshly prepared CB CD34(+) cells exposed to 2 Gy X-irradiation were assayed for hematopoietic progenitor cells such as colony-forming unit-granulocyte-macrophage (CFU-GM), burst-forming unit-erythroid (BFU-E), colony-forming unit-granulocyte-erythroid-macrophage-megakaryocyte (CFU-Mix), and colony-forming unit-megakaryocyte (CFU-Meg). As a result, the neonatal weight, placental weight, CB volume, total low-density (LD) cells, and CD34(+) cells showed mutually significant positive correlations. The CB volume and total LD cells showed a significant reverse correlation with the surviving fraction of CFU-Meg. The surviving fraction of CFU-GM in spring (March-May) was significantly higher than that in autumn (September-November). The surviving fraction of CFU-Meg in the spring was significantly lower than that in the autumn. Male neonates showed a significantly higher surviving fraction of CFU-GM than female neonates. Contrarily, females showed a significantly higher surviving fraction of CFU-Meg than males. The present results suggest that the obstetric factors, such as the season of birth and neonatal gender, influence the radiosensitivity of neonatal hematopoiesis.

Correlations between the detection of stress-associated hormone/oxidative stress markers in umbilical cord blood and the physical condition of the mother and neonate.

AIM: The objective of this study was to assess the correlations between the detection of stress-associated hormone/oxidative stress markers in umbilical cord blood (CB) and the physical condition of the mother and neonate. METHODS: CB units collected from normal vaginal deliveries were analyzed for various biochemical markers, some stress-associated hormones, such as progesterone, cortisol, adrenocorticotropic hormone (ACTH), corticotrophin releasing factor (CRF) and oxidative stress marker 8-hydroxy-deoxyguanosine (8-OHdG), respectively. RESULTS: The progesterone concentration closely correlated with Apgar score, hemoglobin, maternal smoking and insulin concentration, respectively. In particular, its concentration in the non-smoker group and Apgar score 10 points group was significantly lower in comparison to the smoker group and Apgar score 8 points group, respectively. Cortisol concentration correlated significantly with the number of parities, pre-pregnancy body mass index (BMI), and increase of neonatal weight and height per day, respectively. In particular, its concentration in deliveries of males and first babies was significantly higher in comparison to female deliveries and second babies, respectively. In addition, a significant correlation was observed between the duration between spontaneous/artificial membrane rupture time and delivery time and the ACTH concentration. However, no significant relationship was observed between maternal/neonatal factors and CRF concentration and 8-OHdG concentration, respectively. A significant negative correlation was observed between cortisol and 8-OHdG concentration. CONCLUSION: CB stress-associated hormone/oxidative stress markers strongly reflect maternal and neonatal condition at the time of delivery.

Influence of obstetric factors on the yield of mononuclear cells, CD34+ cell count and volume of placental/umbilical cord blood.

AIM: Placental/umbilical cord blood (CB) has been used increasingly not only for transplantations, but also in the field of life science research. However, little information is available on the biological characteristics of CB units collected in rural areas because no medical facilities are affiliated with CB banks. Little attention has been paid to the collection of CB units in rural areas compared to CB collected in metropolitan areas. CB is a precious source for life science research due to the recent low birth rate in Japan. Therefore, to efficiently utilize CB units, the purpose of the present study was to investigate the optimum obstetric factors associated with a higher yield of mononuclear/CD34(+) cells per CB unit. METHODS: CB units were collected at a single hospital (Hirosaki National Hospital). A total of 126 CB units from 105 vaginal deliveries and 21 cesarean section deliveries were available for cell separation within 24 h. Mononuclear low-density (LD) cells were separated using Ficoll-Paque and then processed for CD34(+) cell enrichment using magnetic cell sorting. Associations between the maternal/neonatal factors and the yield of LD/CD34(+) cells were analyzed. RESULTS: Despite the larger net weight of CB collected from cesarean section deliveries, the total number of LD cells collected from vaginal deliveries was significantly higher than that collected from cesarean section deliveries. The total number of LD cells per CB unit from primigravidae was significantly higher compared with that collected from from multigravidae. CONCLUSION: CB units from vaginal deliveries of primigravidae may be more favorable because they contain a higher yield of mononuclear cells.

Maternal and neonatal factors associated with the high yield of mononuclear low-density/CD34+ cells from placental/umbilical cord blood.

Placental/umbilical cord blood (CB) contains nucleated cells and hematopoietic stem/progenitor cells (CD34(+) cells). However it is difficult to predict the number of nucleated/CD34(+) cells in each CB before cell processing. Despite many previous studies from institutes affiliated with CB banks in metropolitan areas, little information is available regarding the characteristics of CB units from other medical facilities. The purpose of the present study was to analyze the maternal/neonatal factors on the yield of cells in CB units. A total of 176 CB units were obtained from single-birth and normal vaginal deliveries. Mononuclear low-density (LD) cells were separated using Ficoll-Paque within 24 hrs after CB collection and then processed for the purification of CD34(+) cells. A multiple linear regression analysis was performed to assess the correlations between the yield of cells and maternal/neonatal factors including maternal age, gravid status, duration of labor, gestational age, neonatal height and weight, cord length, and meconium in the amniotic fluid. The total LD cells per CB unit had a weak positive correlation with the maternal age of primigravidae. The total LD cells per CB unit from the primigravidae aged > or = 25 were significantly higher than those from the primigravidae aged < or = 24. The total CD34(+) cells per CB unit from the 1-gravidae were significantly higher than those from the 2-gravidae and 3-gravidae, respectively among all donors. These results indicate that the CB units from the primigravidae aged > or = 25 are more likely to contain higher yield of LD/CD34(+) cells.