A case of BK virus nephropathy and cytomegalovirus infection concurrent with plasma cell-rich acute rejection.

The BK virus is a double-stranded DNA virus to which 90% of adults have been exposed. BK virus infections typically result in an oral or respiratory infection; however, BK virus reactivation is an infectious disease of concern in kidney transplant recipients. The prevalence of BK virus nephropathy (BKN) in kidney transplant recipients is approximately 5%, and most cases occur within one yr after kidney transplantation. Graft survival of BKN is reported to be 30-60%, and the standard treatment strategy for BKN is reducing immunosuppressive therapy and close monitoring for rejection. Viral infection is most common in the early post-transplantation phase, and BKN or acute rejection is one of the major factors involved in graft loss. However, in this report, we describe the successful management of BKN and cytomegalovirus infection concurrent with plasma cell-rich acute rejection.

Successful treatment of nephrotic syndrome caused by recurrent IgA nephropathy with chronic active antibody-mediated rejection three years after kidney transplantation.

Here, we report the successful treatment of a 38-yr-old Japanese man diagnosed with recurrent immunoglobulin A nephropathy (IgAN) with chronic active antibody-mediated rejection (CAAMR), three yr after undergoing living-related donor kidney transplantation. Immediately after transplantation, the allograft function was well maintained with a serum creatinine (S-Cr) level of <1.8 mg/dL. About three yr after transplantation, urine protein excretion had reached 4.59 g/d, and the S-Cr level had increased to more than 2.0 mg/dL. Based on the allograft biopsy, we diagnosed nephrotic syndrome because of recurrence of IgAN with CAAMR. Subsequently, we performed a tonsillectomy, administered three sessions of steroid pulse therapy, and added losartan for the recurrence of IgAN. We also changed his immunosuppressant from mizoribine to mycophenolate mofetil to treat the CAAMR. The nephrotic syndrome improved with the multiple therapeutic approaches; however, the S-Cr level did not decrease below 2.0 mg/dL. We possibly could have performed additional treatments such as rituximab and intravenous immunoglobulin for the CAAMR, but therapeutic strategies for CAAMR have not yet been established.

Successful treatment of recurrent focal segmental glomerulosclerosis combined with calcineurin inhibitor nephrotoxicity four yr after kidney transplantation.

A 31-yr-old Japanese man with end-stage kidney disease caused by primary focal segmental glomerulosclerosis (FSGS) underwent living related kidney transplantation at the age of 26 yr. The allograft functioned well immediately after surgery, and we did not observe histological findings of rejection and recurrent FSGS in protocol biopsies at two months and one yr after transplantation. Four years after transplantation, the urine protein excretion reached 11 g/d, and the serum creatinine increased over 2.5 mg/dL. We diagnosed nephrotic syndrome due to recurrent FSGS with graft dysfunction and confirmed FSGS lesions with severe endothelial injury with an allograft biopsy, associated with calcineurin inhibitor (CNI) nephrotoxicity. Thereafter, we performed plasmapheresis and steroid therapy with subsequent low-density lipoprotein adsorption, combined with the reduction of tacrolimus. The nephrotic syndrome improved dramatically with the multiple therapeutic approaches. Primary FSGS recurs frequently in patients immediately after kidney transplantation. Post-transplant FSGS has various causes, such as recurrent primary disease, obesity, hyperfiltration, donor-related nephrosclerosis, and CNI-induced arteriolopathy. In the case of nephrotic syndrome after kidney transplantation, we should consider not only recurrent FSGS, but also CNI-induced nephrotoxicity to determine the optimal treatment.

[Relapse prevention program for drug addicts in center for mental health and welfare].

The relapse prevention program named TAMARPP is provided for drug addicts at Tama comprehensive center for mental health and welfare. The TAMARPP is a group cognitive therapy based on manual and simple textbook. We are going to present the outline of the TAMARPP, and discuss the effectiveness of this program from the findings of clinical observation on 15 variables. Both of the treatment-retain rate and abstinence rate during the term to attend this program turns is rather high. This textbook-based program appears to be relatively easy for beginner therapists to conduct group sessions and to support drug addicts. The TAMARPP has possibility to prevail to perform in the other public health institutions.

Regional and laminar differences in in vivo firing patterns of primate cortical neurons.

The firing rates of cortical neurons change in time; yet, some aspects of their in vivo firing characteristics remain unchanged and are specific to individual neurons. A recent study has shown that neurons in the monkey medial motor areas can be grouped into 2 firing types, "likely random" and "quasi-regular," according to a measure of local variation of interspike intervals. In the present study, we extended this analysis to area TE of the inferior temporal cortex and addressed whether this classification applies generally to different cortical areas and whether different types of neurons show different laminar distribution. We found that area TE did consist of 2 groups of neurons with different firing characteristics, one similar to the "likely random" type in the medial motor cortical areas, and the other exhibiting a "clumpy-bursty" firing pattern unique to TE. The quasi-regular type was rarely observed in area TE. The likely random firing type of neuron was more frequently found in layers V-VI than in layers II-III, whereas the opposite was true for the clumpy-bursty firing type. These results show that neocortical areas consist of heterogeneous neurons that differ from one area to another in their basic firing characteristics. Moreover, we show that spike trains obtained from a single cortical neuron can provide a clue that helps to identify its layer localization.