Thrombocytopenia, anasarca, fever, reticulin fibrosis, and organomegaly (TAFRO) syndrome is a unique clinicopathologic variant of multicentric Castleman's disease that has recently been identified in Japan. Previous reports have shown that affected patients typically respond to immunosuppressive therapy, such as prednisolone and tocilizumab. However, the optimal treatment for refractory TAFRO syndrome, which can be fatal, remains unclear. We herein report a case of tocilizumab-resistant TAFRO syndrome successfully treated with cyclosporin A, indicating that cyclosporine A may be an alternative therapy for refractory TAFRO syndrome.

Background: Effective new anti-human cytomegalovirus (HCMV) agents and regimens need to be developed. We examined the anti-HCMV properties of crude extract (True World Extract of Bambuseae sasa [TWEBS]) and five compounds (p-coumaric acid, 3-hydroxy-4-methoxyben-zaldehyde [vanillin], p-hydroxybenzaldehyde, 3-hydroxypyridine and 4',5,7-trihydroxy-3',5'-dimethoxyflavone [tricin]), isolated from Sasa albo-marginata, a bamboo known in Japan as Sasa. Methods: Among TWEBS and five compounds screened in a plaque reduction assay, four showed anti-HCMV activity in the MRC-5 human embryonic fibroblast cell line. The anti-HCMV mechanisms of the TWEBS was examined by western blot analysis using primary antibody specific for an immediate early (IE) antigen of HCMV, for a structural late antigen of HCMV and for β-actin. Results: Treatment of cells with ⩾0.001% of TWEBS inhibited the observable cytopathic effects of HCMV on infected cells. Western blot analysis demonstrated that TWEBS decreased the expression of IE antigen and late antigen of HCMV in the infected cells. Next, we examined the anti-HCMV properties of five compounds isolated from TWEBS. In a viral plaque reduction assay, tricin showed dose-dependent inhibitory properties with a 50% effective concentration of 0.17 µug/ml (selective index =1,205.8). Conclusions: The hot water extract (TWEBS) of Sasa albo-marginata, with tricin isolated from it, has anti-HCMV activity in MRC-5 cells. TWEBS and/or tricin are a novel compound with potential anti-HCMV activity. Future studies should evaluate these findings in vivo.

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PICCs were safely inserted in about 90% of terminally ill cancer patients within about 20 minutes. Although 30% of the patients experienced transient mild procedure-related distress, more than 90% of the patients felt that the parenteral route was more comfortable and convenient after the procedure. PICCs may provide a safe, comfortable, and convenient alternative for terminally ill cancer patients, if placement of the PICC is individualized to the patient situation and after alternatives are considered. Further studies are needed to compare the superiority of the PICC and traditional subcutaneous route to clarify what types of patients are the most suitable for each procedure.

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Tricin was indicated to possess anti-influenza virus activity and to ameliorate body weight loss and survival rate of influenza-A-virus-infected mice. Tricin is a novel compound with potential anti-influenza virus activity in vitro and in vivo.

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