Yキャク フンゴウブ キョウサク オ ガッペイ シタ チョウ コウレイシャ イ ゼンテキ ノ イチレイ

An 88-year-old male patient was referred to our hospital after being diagnosed with gastric cancer during extensive investigations for anemia. The patient underwent total gastrectomy followed by Roux-en Y reconstruction. An esophagus jejunum anastomosis was performed using a Curbed-Shaft Detachable Head Circular Stapler （25 mm）（CDH25）. An anastomosis of the jejunum was performed approximately 40 cm distal to the esophagus jejunum anastomosis using a Straight Shaft Detachable Head Circular Stapler（21 mm）（SDH21）. A seromuscular suture was applied to each anastomotic site. The patient started oral intake on Day 8 after the operation, and was transferred to the urology department on Day 22 for the treatment of renal cancer. Approximately 2 weeks after the transfer, the patient developed fever above 38℃. CT revealed marked enlargement of the duodenum, suggesting stenosis at the Y anastomotic site. The stenosis was successfully treated by endoscopic balloon dilatation without performing. Here, we report a case with favorable outcome

Phosphorylation of the RSRSP stretch is critical for splicing regulation by RNA-Binding Motif Protein 20 (RBM20) through nuclear localization

RBM20 is a major regulator of heart-specific alternative pre-mRNA splicing of TTN encoding a giant sarcomeric protein titin. Mutation in RBM20 is linked to autosomal-dominant familial dilated cardiomyopathy (DCM), yet most of the RBM20 missense mutations in familial and sporadic cases were mapped to an RSRSP stretch in an arginine/serine-rich region of which function remains unknown. In the present study, we identified an R634W missense mutation within the stretch and a G1031X nonsense mutation in cohorts of DCM patients. We demonstrate that the two serine residues in the RSRSP stretch are constitutively phosphorylated and mutations in the stretch disturb nuclear localization of RBM20. Rbm20 S637A knock-in mouse mimicking an S635A mutation reported in a familial case showed a remarkable effect on titin isoform expression like in a patient carrying the mutation. These results revealed the function of the RSRSP stretch as a critical part of a nuclear localization signal and offer the Rbm20 S637A mouse as a good model for in vivo study

Up-Regulation of P-Glycoprotein Expression in Small Intestine under Chronic Serotonin-Depleted Conditions in Rats

ABSTRACT To investigate the role of serotonin (5-HT), an important neurotransmitter and hormone/paracrine agent in the small intestine, in the transport activity of P-glycoprotein (P-gp), the intestinal transport of quinidine, a P-gp substrate, was examined in 5-HTdepleted rats prepared by intraperitoneal administration of pchlorophenylalanine, a specific inhibitor of tryptophan hydroxylase in 5-HT biosynthesis. In the in vitro transport study, quinidine transport across rat jejunum was significantly enhanced in both the secretory and absorptive directions under 5-HT-depleted conditions, although the secretory transport was still predominant. The electrophysiological study suggested that the quinidine transport via passive diffusion was enhanced presumably through a paracellular route. This might be due to looser tight junctions under 5-HT-depleted conditions. The voltage-clamp technique clearly indicated that the secretory transport of quinidine through the transcellular pathway was also enhanced by the depletion of 5-HT. Furthermore, 5-HT depletion increased verapamil-sensitive secretory transport of quinidine in rat jejunum. These results indicate that the secretory transport of quinidine via P-gp was significantly enhanced under 5-HT-depleted conditions. The level of ATP, an energy source for functioning P-gp, wet weight of jejunum, and total protein level in rat jejunal mucosa were not changed by 5-HT depletion, but the expression of P-gp in the brush-border membrane of rat jejunum was significantly induced, which is partly responsible for the enhancement of P-gp activity under the 5-HT-depleted condition

Increase in intra-abdominal pressure during airway suctioning-induced cough after a successful spontaneous breathing trial is associated with extubation outcome

Abstract Background A patient’s ability to clear secretions and protect the airway with an effective cough is an important part of the pre-extubation evaluation. An increase in intra-abdominal pressure (IAP) is important in generating the flow rate necessary for a cough. This study investigated whether an increase from baseline in IAP during a coughing episode induced by routine pre-extubation airway suctioning is associated with extubation outcome after a successful spontaneous breathing trial (SBT). Methods Three hundred thirty-five (335) mechanically ventilated patients who passed an SBT were enrolled. Baseline IAP and peak IAP during successive suctioning-induced coughs were measured with a fluid column connected to a Foley catheter. Results Extubation was unsuccessful in 24 patients (7.2%). Unsuccessful extubation was 3.40 times as likely for patients with a delta IAP (ΔIAP) of ≤ 30 cm H2O than for those with a ΔIAP > 30 cm H2O, after adjusting for APACHE II score (95% CI, 1.39–8.26; p = .007). Conclusion ΔIAP during a coughing episode induced by routine pre-extubation airway suctioning is significantly associated with extubation outcome in patients with a successful SBT. Trial registration UMIN-CTR Clinical Trial, UMIN000017762. Registered 1 June 2015

Correlation between the valence state of cerium and the magnetic transition in Ce(Ru1-xFex)(2)Al-10 studied by resonant x-ray emission spectroscopy

The correlation between the 4f -conduction electron (c-f) hybridization and the transition temperature T-0 into the unconventional antiferromagnetically (AFM) ordered state in Ce(Ru1-xFex)(2)Al-10 has been investigated. The impact of pressure on the crystal structure and the electronic structure has been measured using x-ray diffraction and resonant x-ray emission spectroscopy at the Ce L-3 absorption edge in a diamond anvil cell. Our results show that the lattice spacings imply some correlation with the disappearance of T-0. Analyses of the measured valence states, however, show only a weak correlation with the corresponding critical disappearance of the AFM order within experimental errors. Our results may be explained by a scenario based on the Kondo-Heisenberg model beyond the conventional Doniach phase diagram