Yoshitaka Morimatsu

Overexpression of CD163, CD204 and CD206 on alveolar macrophages in the lungs of patients with severe chronic obstructive pulmonary disease.

We have previously reported that the lungs of patients with very severe chronic obstructive pulmonary disease (COPD) contain significantly higher numbers of alveolar macrophages than those of non-smokers or smokers. M1 and M2 macrophages represent pro- and anti-inflammatory populations, respectively. However, the roles of M1 and M2 alveolar macrophages in COPD remain unclear. Immunohistochemical techniques were used to examine CD163, CD204 and CD206, as M2 markers, expressed on alveolar macrophages in the lungs of patients with mild to very severe COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage I (mild) n = 11, II (moderate) n = 9, III (severe) n = 2, and IV (very severe) n = 16). Fifteen smokers and 10 non-smokers were also examined for comparison. There were significantly higher numbers of alveolar macrophages in COPD patients than in smokers and non-smokers. The numbers and percentages of CD163+, CD204+ or CD206+ alveolar macrophages in patients with COPD at GOLD stages III and IV were significantly higher than in those at GOLD stages I and II, and those in smokers and non-smokers. In patients with COPD, there was a significant negative correlation between the number of CD163+, CD204+ or CD206+ alveolar macrophages and the predicted forced expiratory volume in one second. Overexpression of CD163, CD204 and CD206 on lung alveolar macrophages may be involved in the pathogenesis of COPD.

CD30+ Cells in Lung of Indolent Type Adult T-Cell Leukemia/Lymphoma and Elevated Serum Levels of Soluble CD30 Associated with Acute Crisis and Relapse of Disease

Changes in the serum level of the soluble form of CD30 (sCD30) in a patient with adult T-cell leukemia/lymphoma were monitored throughout the indolent phase, acute crisis, and relapse. The level of sCD30 was elevated prior to the development of laboratory data abnormalities. In addition, the elevated sCD30 level was associated with clinical manifestations in the lung, including malignant pleural effusion, which is a diagnostic criterion of acute crisis. The sCD30 level correlated with clinical aggressiveness, and the lung lesion reoccurred on the same side as the original lesion. These data suggest that microenvironment or minimal residual disease formed in the right lung. Pathological examination of lung biopsy at the indolent phase revealed accumulated CD30+ cells among CD3+CD45RO+ T cells. The serum level of sCD30 correlated with clinical aggressiveness, indicating that the small population of CD30+ cells plays an important role in the progression of adult T-cell leukemia/lymphoma.

3次元型睡眠尺度（3 Dimensional Sleep Scale: 3DSS）―日勤者版―のカットオフ値について：ピッツバーグ睡眠質問票（Pittsburgh Sleep Quality Index: PSQI）による睡眠障害判定を用いた検討

NHKが行っている国民生活時間調査の40年間に及ぶ 調査の中で,一,二を争う発見は睡眠時間の減少である といわれている 1).睡眠外来においては,睡眠時間の減 少に加えて睡眠位相の後退による概日リズム睡眠障害 もここ十数年前から問題となってきており,これらは時 代の流れによる新しい睡眠障害といわれている 2).こう した現代における睡眠問題へ対応するために,我々は 2014年に3次元型睡眠尺度(3 Dimensional Sleep Scale, 以下3DSS)-日勤者版-という新しい睡眠尺度を開発 した 3).従来の睡眠尺度はほぼ睡眠の質的問題・量的問 題に限定し,かつ両者を合わせた総合点で睡眠の評価 を行うものが主流であった.我々の開発した3DSSは24 時間型社会特有の睡眠の位相的問題まで網羅し,さら に位相・質・量を別々に点数化し個人の睡眠状態を評 価できる尺度である.位相・質・量すべて0点から15 点満点で評価し,点数が高いほど睡眠状態が良好であ ると判断する.本尺度を現場でより活用するためには 睡眠障害に対する感度・特異度を求めカットオフ値を 検証していくことが必要とされる.その第一段階とし て,我々はピッツバーグ睡眠質問票(Pittsburgh Sleep Quality Index,以下PSQI)4, 5)の判定に基づいた睡眠障 害の有無を用いて3DSSの推奨されるカットオフ値につ いて追加検討を行ったので報告する.

Massive hemothorax due to rupture of internal thoracic artery aneurysm after vaginal delivery

Arterial aneurysmal rupture is not an uncommon cause of maternal death with mortality being up to 75% (1). The increased tendency of aneurysms to develop or rupture with advancing gestational age suggests that hemodynamic, hormonal, or other physiologic changes of pregnancy may play a role in their formation (2,3). Hereby we describe a patient with life-threatening massive hemothorax due to rupture of internal thoracic artery aneurysm 12 days after uncomplicated vaginal delivery. Because the patient was otherwise healthy, the formation and rupture of the aneurysm is considered as a complication of pregnancy and delivery. The patient recovered without sequelae despite the critical condition because of efficient management. Aneurysmal rupture should be suspected when circulatory collapse developed in pregnant women even in postpartum period.

Present Situation of Wind Turbine in Major European Countries and Outlook of Wind Turbine in Japan

The Renewable energy is a key driver of generating clean energy because it continuously lower air pollution. In particular, the development of wind power energy has been remarkable, and it currently accounts for approximately one-third of renewable electricity. Germany has the largest onshore wind deployment. On the other hand, the United Kingdom is most highly expected to develop offshore wind power. Germany and Denmark have assessed the usefulness of wind turbines, and they benefited from wind energy. Execution of not only environmental impact assessment (EIA) but also health impact assessment (HIA) is an obligation in the United Kingdom, the practice of EIA and HIA is important for the successful construction of wind turbine facilities. We in Japan should learn the method of handling renewable energy systems from major European countries.

Cerebrospinal vascular diseases misdiagnosed as decompression illness: the importance of considering other neurological diagnoses

The diagnosis of decompression illness (DCI), which is based on a history of decompression and clinical findings, can sometimes be confounded with other vascular events of the central nervous system. The authors report three cases of divers who were urgently transported to a hyperbaric facility for hyperbaric oxygen treatment of DCI which at admission turned out to be something else. The first case, a 45-year-old experienced diver with unconsciousness, was clinically diagnosed as having experienced subarachnoid hemorrhage, which was confirmed by CT scan. The second case, a 49-year-old fisherman with a hemiparesis which occurred during diving, was diagnosed as cerebral stroke, resulting in putaminal hemorrhage. The third case, a 54-year-old fisherman with sensory numbness, ataxic gait and urinary retention following sudden post-dive onset of upper back pain, was diagnosed as spinal epidural hematoma; he also showed blood collection in the spinal canal. Neurological insults following scuba diving can present clinically with confusing features of cerebral and/or spinal DCI. We emphasize the importance of considering cerebral and/or spinal vascular diseases as unusual causes of neurological deficits after or during diving.