Search

Earthquakes in active-folding zones often trigger long-lasting landform changes. Since an underground structure closely follows the motion of its surrounding soils and rocks even after it was damaged in an intense earthquake, experts in charge of reconstruction have to wait until they are convinced that the soils and rocks have been stabilized. Kizawa tunnel was seriously cracked during the 23 October 2004 Mid-Niigata Earthquake. The upper half of the tunnel's cross-section near the north mouth shifted about 0.5 m sideways. Since a ring-shaped cross-section of a tunnel sustains the surrounding soil pressure, this crack pattern seemed to be serious. The authors collaborated with the Nagaoka Regional Development Bureau, Niigata Prefectural Government, in investigating the causes of the damage and in conducting long-term observation of the soils and rocks. This paper summarizes some findings for rational rehabilitations through the investigations.

Purpose: The aim of this study is to investigate the mechanism of long-term acceptance of ABO-incompatible renal allograft. Methods: Thirty-four ABO-incompatible kidney transplant recipients with blood group O were entered in this study. Eighteen and 16 recipients received a blood group B (B-to-O) and A1 (A1-to-O) allograft, respectively. Sixteen (O-to-O) recipients were control subjects. The titers of blood group antibodies were measured before pre-conditioning and following transplantation. Blood group antigens were stained in 32 graft biopsy specimen. Results: In 18 (B-to-O) and 16 (A1-to-O) recipients, only anti-B and anti-A1 antibodies, respectively, were significantly suppressed compared with those in 16 (O-to-O) more than 1 year post-transplantation. In eight (B-to-O) and seven (A1-to-O) recipients, only anti-B and anti-A1 antibodies, respectively, were significantly suppressed 1 year post-transplantation, compared with those pre-conditioning. Blood group antigens were stained with same intensity and pattern in any biopsy specimen under all conditions. There was no significant deposition of IgG and IgM in any biopsy specimen. These suggested that production of anti-donor blood group antibodies appeared to be specifically suppressed in long-term stable ABO-incompatible kidney transplant recipients. Conclusion: Accommodation of ABO-incompatible kidney transplantation could be explained by donor-specific blood group antibody suppression.

病院内輸血部門システムを新たに構築した. 構築した輸血部門システムを自動輸血検査機器と双方向通信が可能な接続をした. この接続により, 検査依頼情報を部門システムから自動輸血検査機器へ直接送り込む事, 逆に自動輸血検査機器から検査結果情報を部門システムのデータベースに直接保存する事が可能になった.このシステムを導入した結果, 検体情報の記載間違いや, 検査台帳の記載間違い等の事務的エラーが回避出来, 検査室人員が確保され, 輸血部単独での24時間体制を確立する事が可能になった.

We performed 84 ABO-incompatible kidney transplants at Toho University since 1989, with plasmapheresis and exchange replacing AB blood group plasma as pre-conditioning to reduce anti-donor blood group antibodies. Our current immunosuppression protocol consists of basiliximab, MMF, steroid, and cyclosporine or tacrolimus, including splenectomy. Overall patient/ graft survival rates (n=84) were 95/93 at one year, 94/92 at 3 years, 87/80 at 5 years, 87/75 at 7 years, and 83/67 at 10 years. The outcomes are similar to those of ABO-compatible living donor transplants. We have achieved 100% graft and patient survival rates (n=48) for the 7 years since January 1997. Our findings suggest that post-conditioning is not necessary to control titers of anti-donor blood group antibodies or to overcome acute humoral rejection. Infection control is critical in achieving good outcomes in ABO-incompatible transplants. We found that only anti-donor blood group antibodies in blood group O recipients of ABO-incompatible kidneys were specifically suppressed one year after transplantation. This appeared to be a type of accommodation in which there was no immunological response despite the co-existence of donor antigen and antibody, and might have been caused by down-regulation of B cells to produce anti-donor antibody.