A nationwide, multi-center, retrospective study of symptomatic small bowel stricture in patients with Crohn\u27s disease.

BACKGROUND:Small bowel stricture is one of the most common complications in patients with Crohn\u27s disease (CD). Endoscopic balloon dilatation (EBD) is a minimally invasive treatment intended to avoid surgery; however, whether EBD prevents subsequent surgery remains unclear. We aimed to reveal the factors contributing to surgery in patients with small bowel stricture and the factors associated with subsequent surgery after initial EBD.METHODS:Data were retrospectively collected from surgically untreated CD patients who developed symptomatic small bowel stricture after 2008 when the use of balloon-assisted enteroscopy and maintenance therapy with anti-tumor necrosis factor (TNF) became available.RESULTS:A total of 305 cases from 32 tertiary referral centers were enrolled. Cumulative surgery-free survival was 74.0% at 1 year, 54.4% at 5 years, and 44.3% at 10 years. The factors associated with avoiding surgery were non-stricturing, non-penetrating disease at onset, mild severity of symptoms, successful EBD, stricture length < 2 cm, and immunomodulator or anti-TNF added after onset of obstructive symptoms. In 95 cases with successful initial EBD, longer EBD interval was associated with lower risk of surgery. Receiver operating characteristic analysis revealed that an EBD interval of ≤ 446 days predicted subsequent surgery, and the proportion of smokers was significantly high in patients who required frequent dilatation.CONCLUSIONS:In CD patients with symptomatic small bowel stricture, addition of immunomodulator or anti-TNF and smoking cessation may improve the outcome of symptomatic small bowel stricture, by avoiding frequent EBD and subsequent surgery after initial EBD

THE BEHAVIOR OF THE RABBIT AGAINST INFECTION WITH SALMONELLA ABORTIVOEQUINA

The behavior of the rabbit against infection with Salmonella abortivoequina was examined and discussed. The data obtained are summarized as follows : 1. Total 32 rabbits were perorally inoculated with the organisms ranging in number from 50 to 25,000 million. 2. Almost all rabbits revealed the symptoms of the infection. The severity of infection may not coincide with the numder of the organisms inoculated, but depend upon the individual susceptibilities. 3. The main symptoms of the disease in rabbits were rise of temperature (23/32=71.9%) and decrease of body weight (28/32=87.5%). 4. The antibodies generally began to rise after the 4th day following inoculation, and tended to appear in the following delaying order : hemagglutinin, O-and H-agglutinin, precipitin, and CF antibody. 5. After 8 weeks or later the antibodies began to fall. Among them, hemagglutinin and precipitin fell earlier, and CF antibody fell a little later or simultaneously with formers but it persisted in exhibiting a low titer for long period. O-and H-agglutinin fell gradually but in all cases they did not completely disappear during the observation period. 6. It seems to be probable that the rabbits which continued to show high precipitin titers, usually harbored the organisms. 7. The organism was detected most frequently from the mesenteric lymphnode and then in the following descending order : the spleen, submaxillary lymphnode and digestive canal. 8. The increase and decrease of the leucocyte number differ from each other, but it may be said that when febrile attack appears, leucopenia will occur and that when temperature becomes normal, it will turn to leucocytosis. 9. The "shift-to-the-left" of neutrophile leucocytes was evident in almost all cases. 10. Macroscopically, the enlargement of the mesenteric lymphnode and the spleen was observed in parallel with the detection of the organisms. 11. From the above stated results, it may safely be said that the rabbit has a susceptibility considerably similar to that of the horse, especially of foals, to the infection of S. abortivoequina. The author wishes to express his sincere thanks to Prof. HIRATO, the chief of this Department for his kind direction and review of this study, and also to Assist. Prof. SHIMIZU for his helpful criticisms

MULTIPLICATION OF INFECTIOUS CANINE HEPATITIS VIRUS IN HELA CELLS

HeLa cells were capable of supporting partial multiplication of infectious canine hepatitis (ICH) virus, the strain Woc-4. Infective virus grown in HeLa cells was low in titer despite the fact that the virus antigens were detected serologically and by the fluorescent antibody technique. Also deoxyribonucleic acid synthesis was demonstrable by acridine orange staining nearly as much as those detected in dog kidney cells. Thus it was considered that HeLa cells were able to support the synthesis of viral components but could not properly support the stage of assembly. By electron microscopic observation, the virus materials grown in HeLa cells were found to contain many empty, incomplete virus particles

ANTIGENIC RELATIONSHIP AMONG STRAINS OF INFECTIOUS CANINE HEPATITIS VIRUS

An attempt was made to serological classify the infectious canine hepatitis (ICH) virus using 14 strains isolated from U.S.A. and Japan. Human, guinea-pig and chicken erythrocytes were agglutinated by all strains tested and no differences in hemagglutination characteristics were demonstrated. No or spontaneous agglutinations were observed with red blood cells from dog, mouse, rabbit and hamster. Conventional cross-hemagglutination inhibition and -serum neutralization tests were conducted and the "γ" values of the antigenic relationships were calculated by the formula of ARCHETTI & HORSFALL (1950). The lowest "γ" values found were 0.84 and 0.78 respectively suggesting a fairly close antigenic relationship between the strains tested. It appeared from the 14 strains studied that the ICH virus, consists of only one serotype

INTERFERON-LIKE INHIBITOR DETECTED IN CULTURE FLUIDS OF NORMAL HELA CELLS

Normal HeLa cells produced an interferon-like inhibitor against ICH virus and this was demonstrated in cultures of normal HeLa cells when tested in DKC. No interferon was detected in cultures of HeLa cells infected with ICH virus. This interferon-like inhibitor was not sedimented by centrifugation at 36,000 rpm for 90 min and was shown to be non-dialyzable against a pH 2 solution. Its activity was not inactivated by heating at 58℃ for 30 min or by treatment with anti-ICH virus immune serum. Neither DNase nor RNase had any effect on the activity of the inhibitor. However, its activity was largely lost after treatment with trypsin. These properties of the interferon-like inhibitor were similar to those of interferon. However the origin of the interferon-like inhibitor was completely distinct from that of interferon because the former was produced in the cultures of normal HeLa cells

CHARACTERISTICS IN TISSUE CULTURE OF INFECTIOUS CANINE HEPATITIS VIRUS-INDUCED HAMSTER TUMOR CELLS

Characteristics of ICH virus-induced hamster tumor cells serially propagated, in vitro, (referred HT-7 cells) were described. The predominant cell seen in the population of the HT -7 cells at the early passage levels, was the epithelial. However, these cells were replaced, following several passages, by fibroblastic cells. They propagated well in vitro and showed a lack of contact inhibition. Subcultivation of the HT-7 cells was accomplished by growing the cells in the medium with a low calcium content, 0.1 mM. All attempts to isolate infectious virus from the HT-7 cells by using supernatant fluids, lysed cells, and viable cells to inoculate dog kidney cells and Vero cells were negative. The HT-7 cells continuously possessed a virus-specific tumor antigen and their oncogenic potency toward hamsters