Mami Morita

A Distinct Human CD4+ T Cell Subset That Secretes CXCL13 in Rheumatoid Synovium

OBJECTIVE A subset of CD4+ T cells in the synovium of patients with rheumatoid arthritis (RA) produce CXCL13, a chemokine that is crucial for the formation of germinal centers. This study was undertaken to determine the relevance of this population to known subsets of T helper cells and to proinflammatory cytokines, and how these cells are generated. METHODS The expression of Th markers and CXCL13 by CD4+ T cells in RA synovium and the involvement of proinflammatory cytokines in CXCL13 production were assessed. We also investigated whether CXCL13+CD4+ T cells could be newly induced. RESULTS CXCL13+CD4+ T cells in RA synovium were negative for interferon-γ (IFNγ), interleukin-4 (IL-4), IL-17, FoxP3, and CXCR5 and expressed low levels of inducible T cell costimulator, indicating that this population is a distinct human CD4 subset. T cell receptor (TCR) stimulation of CD4+ T cells, obtained from RA synovium with low expression of CXCL13, promptly induced CXCL13 production and addition of proinflammatory cytokines supported the long-term production of CXCL13. These findings indicate that CXCL13-producing CD4+ T cells can be in a memory state ready to be reactivated upon TCR stimulation and that proinflammatory cytokines are involved in persistent CXCL13 production. TCR stimulation of CD4+ T cells from the blood of healthy volunteers, together with proinflammatory cytokine supplementation, induced a population that produced CXCL13, but not IFNγ. Synovial T cells recruited CXCR5+ cells in a CXCL13-dependent manner. CONCLUSION CXCL13-producing CD4+ T cells induced in RA synovium may play a role in the recruitment of CXCR5+ cells, such as B cells and circulating follicular helper T cells, and in ectopic lymphoid neogenesis at sites of inflammation.

Magnifying Endoscopy with Narrow Band Imaging to Determine the Extent of Resection in Transoral Robotic Surgery of Oropharyngeal Cancer

Transoral robotic surgery (TORS) is a less invasive treatment that is becoming popular all over the world. One of the most important factors for achieving success in TORS is the ability to determine the extent of resection during the procedure as the extent of resection in the laryngopharynx not only affects oncological outcomes but also directly affects swallowing and voice functions. Magnifying endoscopy with narrow band imaging (ME-NBI) is an innovative optical technology that provides high-resolution images and is useful in detecting early superficial pharyngeal cancers, which are difficult to detect by standard endoscopy. A 55-year-old male with superficial oropharyngeal cancer has been successfully treated by combining MB-NBI with TORS and MB-NBI was useful in determining the extent of resection. ME-NBI with TORS will make it possible to achieve a higher ratio of minimally invasive treatment in pharyngeal cancer.

Magnifying endoscope with NBI to predict the depth of invasion in laryngo-pharyngeal cancer

To examine if macroscopic classification with a magnifying gastrointestinal endoscope with narrow band imaging (ME‐NBI) is useful in predicting pathological depth of tumor invasion in laryngo‐pharyngeal cancer.

Application of a Novel Vibrating Device for Fine-Needle Aspiration Cytology

Objective: Fine-needle aspiration cytology (FNAC) is a valuable diagnostic technique. However, the procedure involves backand-forth motions of a needle within a mass, which can lead to unexpected complications. We have developed a novel device and sampling techniques that use vibration and rotation instead of backand-forth motions. Methods: The new device consists of a vibrating motor fixed to the stopper of a 5 ml syringe with its piston. A 22-gauge needle attached to the 5 ml syringe is used for FNAC. Samples were obtained from resected specimens using the following four procedures: suction only; suction and vibration for 5 seconds; suction and 180° rotation of the syringe; and suction, vibration for 5 seconds, and 180° rotation of the syringe. Samples were also obtained using the conventional technique. The numbers of well-visualized follicular groups on glass slides were counted to compare the amounts of cellular material obtained using the five different procedures. Next, 415 patients with thyroid nodules underwent ultrasound-guided FNAC to evaluate the rate of inadequacy. Results: Sufficient amounts of material were obtained from resected specimens using suction, vibration and rotation, and using the conventional technique. Inadequate thyroid FNAC material was obtained in 12.3% of cases. Conclusions: The new device and sampling techniques for thyroid FNAC collected sufficient amounts of adequate material and allowed safe and precise control of the device. Our device and sampling techniques are expected to be widely used not only for thyroid FNAC sampling but also for sampling from other anatomical sites.