Wound healing process is highly organized, regulated and orchestrated by cellular and molecular basis. As for biology, wound healing is very much attractive to multi-subspecialty fields of both basic and clinical medicine. Clinical problems of wound healing also extend a single sub-specialty of medicine, not only surgeries but internal-, social-, psychological- medicine. Thorough comprehension of clinical and futuristic approaches for this complex entity is recommended. Based upon a number of clinical experiences of wound-related problems, starting with burns, trauma to chronic intractable wounds and subsequent unfavorable scar formation, the clinically relevant evaluations for wound healing is presented including life-saving modalities, minimizing the scar formation or scarless wound healing, prognosis predictors. Also, clinical related-basic research brought about regenerative medical solutions using artificial dermis, cytokine and adult stem cells. Acute and chronic difficult wound healing should be holistically approached and "emergency primary wound healing center" will be most appreciated for any form of biological, chemical, nuclear and radiation-related issues. In this context, Nagasaki University may be able to play a pivotal role in global view point.

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The Roux limb is the most commonly used procedure for hepato-biliary surgery in pediatric cases. Notwithstanding, the postoperative status of the limb has not been well described. In this report, our group attempted to observe the Roux limb ultrasonically after performing a Roux-en-Y jejunostomy. Hepatic porto-jejunostomy and hepatico-jejunostomy were performed in 2 patients with biliary atresia and 4 patients with congenital bile duct dilatation, respectively. The Roux limb was observed by real-time ultrasonography from postoperative day (POD) 1 to POD 12. The wall thickness and luminal diameter of the Roux limb were measured, and the movement of the limb was observed. In the 2 hepatic porto-jejunostomy patients, the wall thickness was increased on POD 1 but thereafter improved from PODs 3 to 6. The lumen of the Roux limb was difficult to describe in one of the patients because of an inadequate amount of bile flow. Cooperative peristalsis appeared on PODs 4 to 6 following the commencement of irregular movement from PODs 2 to 3. In the 4 hepatico-jejunostomy patients, the wall thickness was increased by POD 1 but improved from PODs 2 to 6. Cooperative peristalsis appeared on PODs 4 to 5 following the commencement of irregular movement. In conclusion, ultrasound examination is useful for observing the postoperative morphological aspects of the Roux limb.

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Macrophage migration inhibitory factor (MIF) is a pro-inflammatory cytokine essential for delayed hypersensitivity in vivo, and is involved in bronchiolitis obliterans and late rejection in lung transplantation. We tested here whether neutralization of MIF using anti-MIF antibody prevents such a response. We examined the MIF mRNA expression level and changes in allograft tracheal epithelium and intraluminal obstruction in a rat allograft model. Lewis rat (RT1^l) underwent heterotopic tracheal transplantation from Brown Norway rats (RT1ⁿ) in the omentum. Anti-MIF antibody was injected in the peritoneum. Rats were divided into three groups (non-treated allograft, allograft treated with normal rabbit IgG and allograft treated with anti-MIF antibody). Implants were harvested on days 7 or 21 for histological analysis. MIF mRNA expression was higher in the allograft at days 7 and 21 than in the isograft. The epithelium in non-treated allograft was almost absent at day 7. The epithelial height in the anti-MIF-treated graft was higher than that in normal IgG-treated grafts. The intraluminal space was mostly replaced by granulation tissue at day 21 in the untreated group. The proportion of obliterans was lowest in the anti-MIF group, the second lowest in the untreated group and the third lowest in the normal IgG-treated grafts, and the difference was significant (p<0.001) between the first two groups. Our results indicate that anti-MIF antibody suppresses allogenic tracheal rejection.

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Variability of clinical samples with respect to cell types and quality makes it indispensable to normalize mRNA quantification by real-time reverse transcription-polymerase chain reaction (RT-PCR). The objective of the present study was to elucidate the influence of the difference in RNA integrity and the expression status of control genes commonly used. To compare the expression status of GAPDH, β-actin, PBGD and 18S rRNA in different cell samples, real-time RT-PCR by the LightCycler Technology was applied. The relevance of the above-mentioned normalization by control gene was evaluated through the practical measurement of survivin using normal lymphocytes from 19 healthy donors, adult T-cell leukemia (ATL) cells from 30 patients with ATL and 27 cell line cells. The mRNA integrity was found to be tolerable for absolute quantification when the preservation rate of 28S and 18S rRNA within total RNA was at least 30%. The expression status of control genes was prominently variable with the expression difference of 4-fold in β-actin, 20-fold in GAPDH, 30-fold in 18S rRNA and 66-fold in PBGD among the different cell types, normal lymphocytes, chronic and acute ATL cells, ATL cell lines, other hematopoietic cell lines and solid tumor cell lines. The survivin mRNA data normalized by such a control gene were influenced by the expression variability of the control genes. These results indicate that the control genes can be used to correct for sample-to-sample variation within the same cell types, but they are not always relevant for normalization in the distinct cell types.

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We herein present the case of a 68-year-old male with a duodenocolic fistula originating from ascending colon cancer in the blind loop, which was resected by a right hemicolectomy with pancreaticoduodenectomy. The present case achieved 14 months of disease-free survival after the operation. There have been reported, in the literature in Japanese and English, a total of 26 cases including the present one that have undergone a right hemicolectomy with pancreaticoduodenectomy for right-sided colon cancer with duodenocolic fistulae. The survival periods in these cases ranged from 5 months to 12 years after the operation. Thirteen patients survived for over 1 year. A right hemicolectomy with pancreaticoduodenectomy for locally advanced right-sided colon cancers with duodenal invasion could be expected to yield long-term survival if peritoneal and distant metastases are not present.

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The incidence of spontaneous seroconversion of hepatitis B surface antigen (HBsAg) in the natural history of patients with chronic hepatitis B virus (HBV) infection is considered to be low in patients aged under 40 years. The clinical course and outcome of chronic HBV infection are complex and heterogeneous, and may be influenced by many factors such as HBV genotype, viral mutations, gender, age, host immune status, other viral co-infections, and alcohol consumption. We encountered a Japanese woman in whom HBsAg seroconversion had occurred when she was 32 years old, 3 years after she had given birth without any anti-viral therapy. In this case, alcohol intake, pregnancy and delivery may have affected the host-virus interaction.

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Primary effusion lymphoma (PEL) is a rare type of lymphoma occurring in HIV-seropositive persons. Since the tumor cells frequently harbor human herpes virus (HHV)-8 DNA, the virus is thought to be causative. We here report an instructive case of PEL in an HIV-seronegative elderly. The neoplastic cells in the fluid showed unusual morphology with multi-lobulated nuclei. They expressed CD19, CD20, CD79a and SmIgD/M_κ, but not CD3, CD30 or CD23. The IgH gene was clonally rearranged based on the results of Southern blotting and PCR for CDR3. In addition to the IgH clonality, the TCR_γ-chain gene was also in the clonal rearrangements. Neither HHV8 nor EBV was detected in the cells. The bcl-6 and IgH chimeric transcripts were evident. Conclusively, our case suggests the following two points: first, the bcl-6/IgH translocation may be associated with the pathogenesis of unusual PEL without HIV or HHV-8; and second, unusual PEL may be an extra-nodal spectrum of diffuse large-cell lymphoma with neoplastic cells harboring the bcl-6/IgH translocation and dual rearrangements of antigen receptor genes.

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