Steroid Therapy and Steroid Response in Autoimmune Pancreatitis

Autoimmune pancreatitis (AIP), a unique subtype of pancreatitis, is often accompanied by systemic inflammatory disorders. AIP is classified into two distinct subtypes on the basis of the histological subtype: immunoglobulin G4 (IgG4)-related lymphoplasmacytic sclerosing pancreatitis (type 1) and idiopathic duct-centric pancreatitis (type 2). Type 1 AIP is often accompanied by systemic lesions, biliary strictures, hepatic inflammatory pseudotumors, interstitial pneumonia and nephritis, dacryoadenitis, and sialadenitis. Type 2 AIP is associated with inflammatory bowel diseases in approximately 30% of cases. Standard therapy for AIP is oral corticosteroid administration. Steroid treatment is generally indicated for symptomatic cases and is exceptionally applied for cases with diagnostic difficulty (diagnostic steroid trial) after a negative workup for malignancy. More than 90% of patients respond to steroid treatment within 1 month, and most within 2 weeks. The steroid response can be confirmed on clinical images (computed tomography, ultrasonography, endoscopic ultrasonography, magnetic resonance imaging, and ¹⁸F-fluorodeoxyglucose-positron emission tomography). Hence, the steroid response is included as an optional diagnostic item of AIP. Steroid treatment results in normalization of serological markers, including IgG4. Short- and long-term corticosteroid treatment may induce adverse events, including chronic glycometabolism, obesity, an immunocompromised status against infection, cataracts, glaucoma, osteoporosis, and myopathy. AIP is common in old age and is often associated with diabetes mellitus (33-78%). Thus, there is an argument for corticosteroid therapy in diabetes patients with no symptoms. With low-dose steroid treatment or treatment withdrawal, there is a high incidence of AIP recurrence (24-52%). Therefore, there is a need for long-term steroid maintenance therapy and/or steroid-sparing agents (immunomodulators and rituximab). Corticosteroids play a critical role in the diagnosis and treatment of AIP.

Oral function and vertical jump height among healthy older people in Japan

OBJECTIVE

Vertical jump height and oral function affect the general muscle condition. This study aimed to evaluate the association between vertical jump height and oral function among healthy older individuals.

BASIC RESEARCH DESIGN

Cross-sectional analytic study.

PARTICIPANTS

231 independent older people (mean age, 74.4 ± 5.6 years) who participated in the Kyoto Elders Physical Fitness Measurement Research Project. Individuals with partial or complete edentulousness who did not use a prosthetic device or complained of oral/maxillofacial pain were excluded from the study.

INTERVENTIONS

Grip strength was measured using a Smedley Hand Dynamometer. To measure masticatory performance, the participants were instructed to chew a gummy jelly on their habitual chewing side (left or right) for 20 s. Occlusal force, contact area, and pressure were also assessed.

MAIN OUTCOME MEASURES

The outcome variable was vertical jump height. The predictor variables were physical status (age, body mass index, and grip strength), oral status (number of present teeth and denture use), and oral function (masticatory performance, occlusal force, occlusal contact area, occlusal pressure, and tongue pressure). These relationships were evaluated with univariate analysis, and then multiple regression analysis was performed with age as the covariate for each male and female participant.

RESULTS

Vertical jump height was significantly associated with grip strength in both men and women. Moreover, in women, it was associated with masticatory performance, occlusal force, and occlusal contact area.

CONCLUSIONS

Vertical jump height was closely associated with oral function among healthy older women.

Ingestion of polyethylene microbeads affects the growth and reproduction of medaka, Oryzias latipes

Research using various species of wild and cultured fish has identified negative effects of short-term exposure to microbeads. Although wild animals might be contaminated with microbeads and/or other pharmaceuticals, data regarding the long-term effects remain limited. To clearly elucidate the effects of microbeads, studies of long-term exposure using animal models are necessary. Our aim was to elucidate the effects of microbeads alone on the growth and fecundity of medaka following long-term exposure (12 weeks). In experiment 1, fish groups (except controls) were temporarily exposed to polyethylene microbeads (10-63 μm diameter) a low dose of 0.065 microbeads-mg/L and high dose of 0.65 microbeads-mg/L. In experiment 2, see-through medaka and fluorescent polyethylene microbeads (10-45 μm diameter) were used to estimate the retention time of ingested microbeads in the digestive tract, which was 4-9 days. The low dose of microbeads did not affect growth but did decrease the number of eggs and the hatching rate. The high dose decreased growth, the number of eggs, and hatching rate. Growth differences were recognized for the first time at 7 weeks, and differences in the number of eggs at 12 weeks. Thus, long-term tests using medaka indicated that microbeads per se exhibit growth inhibition and reproductive toxicity. These effects could be associated with nutritional factors resulting from the long retention time of microbeads in the digestive tract. We also determined the dose that affects only fecundity. This suggests that normal growth of medaka in the wild does not mean the environment is free from microbead contamination. We are thus attempting to identify new biological indexes for monitoring the status of microbead contamination using our system.

A population-based study identifies an association of THBS2 with intervertebral disc degeneration

OBJECTIVE

To clarify the genetic mechanisms underlying intervertebral disc degeneration (IDD), we examined the associations between single-nucleotide polymorphisms (SNPs) and indicated as coefficient of interaction term (IDD) in a general population in Japan.

METHODS

This was a cross-sectional study. In 1,605 participants, C2-3 to L5/S1 in the total spine magnetic resonance imaging (MRI) were evaluated using the Pfirrmann's scoring system. Disc scores of 4 and 5 were defined as IDD. Eight SNPs in eight genes associated with IDD were examined at each disc level, considering the non-genetic risk factors of age, sex, and body mass index (BMI).

RESULTS

The highest odds ratio was found for rs9406328 in the THBS2 gene at disc level T12-L1 (OR 1.27, 95%CI 1.05 to 1.53), and this association was strengthened after adjustment for age using logistic regression (OR 1.37, 95%CI 1.12 to 1.67). Among participants aged <50 years and 50-59, the average IDD score in those with 2 risk alleles of rs9406328 was markedly higher than in those with 0 or 1 risk allele, and the difference is much wider than the elderly participants. It indicates the genetic effect of rs9406328 is stronger in the younger age groups. Finally, multiple linear regression analyses of the association between rs9406328 and IDD, adjusted for age, sex, and BMI at each disc level, showed a statistical interaction between age and the number of risk alleles at C7-T1, T3-4 and T4-T5 as well as T12-L1.

CONCLUSION

CONCLUSION: The association between rs9406328 in THBS2 and IDD was replicated. The contributions of genetic and environmental factors to IDD differed by disc level.

Longevity-associated mitochondrial DNA 5178 C/A polymorphism modifies effect of aging on renal function in male Japanese health checkup examinees: an exploratory cross-sectional study

Background

Mitochondrial DNA 5178 (Mt5178) C/A polymorphism is reportedly associated with longevity in the Japanese population. The objective of this study was to investigate whether Mt5178 C/A polymorphism influences the effect of physiological aging on renal function in male Japanese health checkup examinees.

Methods

A total of 404 male subjects (mean age ± SD, 53.9 ± 7.8 years; range, 29–76 years) were selected from among individuals visiting the hospital for regular medical checkups. After Mt5178 C/A genotyping, a cross-sectional study assessing the joint effects of Mt5178 C/A polymorphism and aging on renal function was then conducted. Renal function was evaluated by estimated glomerular filtration rate (eGFR). Subjects were divided into three age groups (< 50, 50–59, ≥ 60 years).

Results

In simple linear regression analysis, a significant negative association between aging and eGFR was observed in both Mt5178C and Mt5178A genotypic men (P < 0.001 and P = 0.003, respectively). However, in multiple linear regression analysis, a significant effect of aging on reduced eGFR was observed only in Mt5178C genotypic men (P < 0.001). Logistic regression analysis showed that, in the case of reduced eGFR defined as < 75 mL/min/1.73 m², reduced eGFR was dependent on aging in both Mt5178C and Mt5178A genotypic men (P for trend < 0.001 and P for trend = 0.002, respectively). After adjusting for smoking status and alcohol consumption, reduced eGFR was also dependent on aging in both Mt5178C and Mt5178A genotypic men (P for trend < 0.001 and P for trend = 0.014, respectively). However, in reduced eGFR defined as < 90 mL/min/1.73 m², reduced eGFR was dependent on aging only in Mt5178C genotypic men (P for trend < 0.001).

Conclusions

This cross-sectional study suggests that Mt5178 C/A polymorphism modulates the effects of physiological aging on kidney function in Japanese men.

Risk Analysis of Colorectal Post-Polypectomy Bleeding Due to Antithrombotic Agent

BACKGROUND/AIMS

Post-polypectomy bleeding (PPB) is a major complication of colorectal polypectomy, and antithrombotics is one of the major risk factors of PPB. The purpose of this study was to investigate PPB risks with regard to the combinations of antithrombotic agents used.

METHODS

We retrospectively reviewed cases involving colonoscopic polyp resection between September 2002 and December 2014. The risk of PPB was assessed according to patient and lesion factors, including antithrombotic use. Antithrombotics were discontinued before polypectomy.

RESULTS

A total of 6,382 colonoscopies with 12,876 polypectomies were analyzed. PPB occurred in 55 patients (0.9%) and 63 lesions (0.5%). Among patients treated with antithrombotics, heparin bridging (HB) therapy was an independent risk factor of PPB (per patient, 20%, OR 33.1, p < 0.001; per lesion, 9.1%, OR 17.3, p < 0.001) compared to those without antithrombotics (per patient 0.7%; per lesion 0.4%). Among patients without HB, the combination of anticoagulant + antiplatelet agents was significantly associated with PPB (per patient, 5%, OR 7.73, p = 0.007; per lesion, 2.4%, OR 6.31, p = 0.003).

CONCLUSION

HB therapy is a major risk factor for PPB. Among patients without HB, anticoagulant + antiplatelet therapy was a significant risk factor for PPB.

Primary non-ampullary duodenal follicular lymphoma presenting with obstructive jaundice

Primary gastrointestinal follicular lymphoma is a rare disease. Follicular lymphoma does not cause any typical symptoms, although it usually shows the presence of multiple white granules on endoscopy. Few patients with follicular lymphoma present with the initial symptom of jaundice, which is usually associated with follicular lymphomas located in the papilla of Vater. Herein, we present the first case of a duodenal follicular lymphoma that presented with obstructive jaundice despite not being located in the ampulla, and it did not demonstrate the typical endoscopic findings of multiple white granules. A 72-year-old Japanese man with jaundice was referred to our hospital. Imaging revealed a hypovascular lesion extending into the second part of the duodenum and the pancreatic head, and the common bile duct was dilated upstream of the lesion. Biopsy of the lesion was negative for malignancy. Finally, we suspected the lesion as a pancreatic adenosquamous carcinoma, and not a typical pancreatic ductal carcinoma, because the lesion showed no pancreatic duct dilation and had a partially hyperechoic part within. Therefore, we performed pancreaticoduodenectomy. The final diagnosis was a duodenal follicular lymphoma. The findings of this case may assist in distinguishing between atypical follicular lymphoma and jaundice from pancreatic cancer.

Crystallization kinetics of safflower and olive oils during low-temperature storage

The crystallization behaviors of safflower and olive oils were investigated according to changes in volume and transmitted light intensity during isothermal storage at low temperature. The changes between the oils were significantly different even though their fatty acid compositions were similar, with oleic acid accounting for more than 75% (w/w) of the total oil. It was expected that minor components with high melting points would affect the crystallization behaviors of these oils. The crystallization processes of the oils were then analyzed using a kinetic model in which the oil crystallizes through two different processes. It is suggested that although the crystallization behaviors were apparently different, the crystallization mechanisms of these oils are essentially the same.

Clinicopathological characteristics of non-ampullary duodenal tumors and their phenotypic classification

The tumorigenesis of non-ampullary duodenal epithelial tumors (NADETs) might be different between the oral and anal sides of Vater's papilla. We conducted an immunohistological review to elucidate the clinicopathological features according to the tumor location and phenotypic classification. A review of an institutional database identified 121 patients with 125 superficial NADETs. NADETs were histologically evaluated and classified into the intestinal or gastric type based on immunohistochemical analysis. Clinicopathological factors were compared based on the tumor location and phenotype. Logistic regression analysis was performed to identify independent predictors for gastric-type NADETs. According to location analysis, the mucin phenotype was significantly different (oral side, intestinal-type 64.8%, gastric-type 35.3%; anal side, intestinal-type 87.3%, gastric-type 12.7%; P < 0.01). Although the incidence of adenoma was significantly predominant in the intestinal type (75.3%), most gastric-type NADETs were cancerous (64.3%). Notably, most gastric-type NADETs were adenocarcinomas even when the tumor size was ≤0 mm. In multivariate analysis, tumor location on the oral side (odds ratio [OR], 4.42), villous structure (OR, 6.44), and low tumor gland density (OR, 9.49) were independent predictors of gastric-type tumors. Gastric-type NADETs significantly differ from intestinal-type NADETs in terms of tumor location, morphology, and biology.

Giant Brunner's Gland Hyperplasia of the Duodenum Diagnosed by Endoscopic Ultrasonography-guided Fine Needle Biopsy and Treated by Laparoscopic Endoscopic Cooperative Surgery

A 57-year-old female was referred to our department for treatment of a duodenal submucosal tumor (SMT), which had been growing over the last five years. Computed tomography demonstrated a marginally enhanced mass, measuring 36 mm in diameter, containing internal multiple hypovascular areas. Endoscopic ultrasonography-guided fine needle biopsy was performed using a 20-gauge core trap needle, and the specimens showed benign Brunner's glands. She underwent laparoscopic endoscopic cooperative surgery and the SMT was completely removed without any adverse events. Histology of the resected tumor showed Brunner's gland hyperplasia (BGH). BGH is generally a benign lesion. However, an accurate diagnosis is required to avoid overtreatment when it mimics malignancy.

Effect of double-layer structure in intramucosal gastric signet-ring cell carcinoma on lymph node metastasis: a retrospective, single-center study

BACKGROUND

Among all types of gastric cancer (GC), signet-ring cell carcinoma (sig-GC) accounts for 4-17% of cases. The prognosis of early sig-GC is relatively good, with the 5-year survival rate at 99.7%. However, the correlation between histological features and lymph node metastasis (LNM) among pT1a (M) sig-GC remains unclear. Sig-GC often exhibits a double-layer structure (DLS) in the intramucosal layer, demonstrating functional differentiation into the normal gastric gland. Assumedly, the loss of the differentiation makes the DLS deranged, accounting for the occurrence of submucosal invasion and LNM. This study aimed to assess the proportion of DLS, to elucidate the correlation between histological features (including DLS) and LNM status, and to determine the LNM-negative condition in pT1a (M) sig-GC.

METHODS

We reviewed the pathological data of 310 patients with 310 intramucosal sig-GCs who received gastrectomy with lymph node dissection. Immunohistochemistry was performed on all specimens to evaluate the presence of DLS. Furthermore, we review the clinicopathological features, including tumor size, lymphovascular invasion (LVI), ulceration (UL), and DLS results, and then statistically analyze the correlation between these features and LNM status.

RESULTS

Overall, 129 pT1a (M) sig-GCs (42%) were DLS present. The univariate analysis revealed that "Tumor size > 20 mm", "UL present", and "DLS absent" were significant risk factors of LNM. The multivariate logistic regression analysis revealed only "DLS absent" as statistically significant.

CONCLUSIONS

"DLS absent" is a risk factor of LNM detected by the multivariate analysis. In pT1a (M), LVI absent, UL absent, tumor size > 20 mm, sig-GC, no LNM occurred in "DLS present" cases.

A Rare Case of Hypertrophic Gastropathy with Adenocarcinoma Arising from a Gastric-type Adenoma

A 60-year-old man was referred for the investigation of giant gastric folds, life-threatening anemia and hypoproteinemia. A combination of multiple endoscopic procedures derived a clinical diagnosis of protein-losing gastropathy with two gastric adenomas. After two months of alimentary therapy, the patient received total gastrectomy and fully recovered. The final pathological diagnosis was hypertrophic gastropathy of unknown origin with concomitant adenocarcinoma arising from a gastric type adenoma.

Short- and long-term outcomes of endoscopic submucosal dissection for early gastric cancer in the remnant stomach after gastrectomy

BACKGROUND

Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) in the remnant stomach is a minimally invasive treatment. Few studies compared the technical difficulty of ESD involving the suture line and anastomosis, and information on long-term outcomes is insufficient. This study aimed to elucidate the short- and long-term outcomes of ESD for EGC in the remnant stomach.

METHODS

We investigated patients who underwent ESD for EGC in the remnant stomach between September 2002 and March 2016. Clinicopathological data were retrieved to assess en bloc resection rates, complications, and long-term outcomes including overall survival and cause-specific survival.

RESULTS

A total of 136 consecutive patients with 165 lesions resected by 157 ESD procedures were retrospectively evaluated. The en bloc resection rate was 95.5%. Complications included 16 intraoperative perforations (10.2%), 2 delayed perforations (1.3%), and 15 delayed bleeding (9.6%), which were successfully treated with endoscopy. The en bloc resection rate was significantly higher in the suture line group (100%) and the non-anastomosis or suture line group (98.8%) than in the anastomosis group (82.9%). However, the intraoperative perforation rate was significantly higher in the anastomosis group (31.4%) than in other groups. The 5-year overall and cause-specific survival rates were 88.4% and 97.6%, respectively, during a median follow-up period of 50.7 months (interquartile range 30.8-91.3).

CONCLUSIONS

The long-term outcomes of ESD for EGC in the remnant stomach were favorable. However, ESD involving the anastomosis was a technically demanding procedure due to the low en bloc resection rate and high perforation rate.

Rupture of Pseudoaneurysm after Biliary Metallic Stent Placement

Rupture of a pseudoaneurysm (PA) has been reported as a rare but serious adverse event associated with endoscopic biliary stenting. We herein report 2 cases of severe biliary bleeding from a PA that developed 10-14 days after placement of a self-expandable metallic stent (SEMS) for biliary malignancy. The first patient was successfully embolized with endovascular coiling. However, the second patient had wide-spreading cholangiocarcinoma and, despite being treated once by full coiling, developed a second rupture of PA two months after starting systemic chemotherapy. Clinicians should be aware of the possibility of PA and carefully follow stented patients after endovascular treatment.

Safety of tooth extraction in patients receiving direct oral anticoagulant treatment versus warfarin: a prospective observation study

The aim of this study was to compare the safety of tooth extraction in patients receiving direct oral anticoagulants (DOACs) or warfarin without cessation of their antithrombotic treatment. This prospective observational study included 367 patients undergoing tooth extraction (119 receiving DOACs and 248 receiving warfarin). All extractions in DOAC patients were performed 6-7h after taking DOACs in consideration of the half-life in blood under continued antithrombotic treatment. To examine the potential postoperative bleeding risk related to the time of extraction and the drug concentration of blood, activated partial thromboplastin time (APTT) in dabigatran and prothrombin time (PT) in rivaroxaban were measured three times after administration. A total of 390 tooth extractions were performed: 128 in the DOAC patients and 262 in warfarin patients. Postoperative bleeding occurred in four extractions (3.1%) in the DOAC group and in 23 (8.8%) in the warfarin group. There was no statistically significant difference between the two groups (odds ratio: 2.362, 95% confidence interval (CI) 0.819-6.815, p=0.112). APTT and PT prolongation in almost all cases decreased with time after taking the medicine. Our findings suggest that interruption of DOAC therapy is not necessary for tooth extraction if the procedure is performed at least 6h after the last dose.

New precise measurements of muonium hyperfine structure at J-PARC MUSE

High precision measurements of the ground state hyperfine structure (HFS) of muonium is a stringent tool for testing bound-state quantum electrodynamics (QED) theory, determining fundamental constants of the muon magnetic moment and mass, and searches for new physics. Muonium is the most suitable system to test QED because both theoretical and experimental values can be precisely determined. Previous measurements were performed decades ago at LAMPF with uncertainties mostly dominated by statistical errors. At the J-PARC Muon Science Facility (MUSE), the MuSEUM collaboration is planning complementary measurements of muonium HFS both at zero and high magnetic field. The new high-intensity muon beam that will soon be available at H-Line will provide an opportunity to improve the precision of these measurements by one order of magnitude. An overview of the different aspects of these new muonium HFS measurements, the current status of the preparation for high-field measurements, and the latest results at zero field are presented.

Macrocyclisation and functionalisation of unprotected peptides via divinyltriazine cysteine stapling

We report a novel divinyltriazine linker for the stapling of two cysteine residues to form macrocyclic peptides from their unprotected linear counterparts. The stapling reaction occurred rapidly under mild conditions on a range of unprotected peptide sequences. The resulting constrained peptides displayed greater stability in a serum stability assay when compared to their linear counterparts.