Supplementary Material for: Eppikajutsuto Protects against Food Allergy Induced by Ovalbumin in a Murine Model

<p><b><i>Background:</i></b> Currently, there are no efficient medications available for the prevention and treatment of food allergy (FA). Herbal medicines, including traditional Japanese Kampo medicines (TJKMs), are promising therapeutic drugs. <b><i>Methods:</i></b> We screened 18 TJKMs for treatment of FA symptoms in a mouse FA model induced by ovalbumin (OVA). BALB/c mice were sensitized intraperitoneally by an OVA/aluminum hydroxide gel mixture followed by 4 booster doses of oral OVA and FA symptom induction by 50 mg of OVA. TJKMs were orally administered for 28 days from the day of sensitization to the day before FA symptom induction. Evaluated FA symptoms included a decrease in body temperature and allergic diarrhea. Allergic sensitization was determined by plasma OVA-specific IgE levels. Cytokine mRNA levels in mesenteric lymph nodes, plasma mouse mast cell protease-1, and the number of mast cells in the small and large intestines were analyzed. Additionally, the therapeutic effect of the TJKM eppikajutsuto (EJT) on mast cell degranulation was determined in active anaphylaxis and passive cutaneous anaphylaxis models. <b><i>Results:</i></b> EJT effectively prevented FA symptoms. Although OVA-specific IgE levels and the intestinal mast cell numbers were not different between the EJT-treated and untreated FA mice, plasma mMcpt1 and IL-4 levels were lower in EJT-treated FA mice than untreated FA mice. EJT could alleviate symptoms in both active and passive anaphylaxis models. <b><i>Conclusion:</i></b> EJT prevented OVA-induced FA symptoms in a mouse model, suggesting that EJT might exert its therapeutic activity via IL-4 suppression and the inhibition of mucosal mast cell degranulation.</p

Supplementary Material for: Laparoscopic Bladder-Preserving Surgery for Enterovesical Fistula Complicated with Benign Gastrointestinal Disease

Enterovesical fistula (EVF) is a relatively uncommon condition that is associated with severe morbidity. Minimally invasive and organ-preserving surgery should be performed in the case of EVF caused by benign diseases. We applied laparoscopic bladder-preserving surgery (LBPS) for EVF caused by benign gastrointestinal disease. Here, we report a surgical technique for LBPS. Patient and instrument port positioning are similar to those used in laparoscopic colorectal surgery. Dissection around the fistula is performed along the intestine as distant from the bladder as possible. If there is sufficient area around the intestinal portion of the fistula, it is isolated and resected using a linear stapler. If this approach is not possible, the intestinal fistula is sharply dissected as far away from the bladder as possible. LBPS for EVF was performed in 4 patients and included 3 direct sharp dissections and 1 stapling dissection. Three of the 4 patients did not require any further treatment for the bladder, and all procedures were feasibly accomplished under laparoscopic conditions. In conclusion, LBPS is feasible in cases of EVF caused by benign gastrointestinal disease, and we suggest that it should be the first choice of intervention in such cases

Supplementary Material for: Dialysis Amyloid Deposition in the Aortic Valve and Its Association with Aortic Stenosis

<b><i>Background:</i></b> The relationship between dialysis amyloid (DA) deposition in the aortic valve (AV) and aortic stenosis (AS) is unknown. <b><i>Methods:</i></b> This was a cross-sectional study. AV specimens of dialysis patients (median vintage: 8.8 years) consecutively collected from cardiac surgeries (n = 56) or autopsies (n = 13) were examined by a board-certified pathologist blinded to clinical data. DAs were considered to be present if deposits were stained both by Congo red with apple-green birefringence under polarized light and by anti-β2-microblobulin antibody. Degree of deposition was graded as follows: Amyloid (-), no deposit; Amyloid (1+), occasional small deposits; Amyloid (2+), multiple small to large deposits or a single large deposit. Calcification was defined as a calcified deposit with a diameter >1 mm in the specimen. Severe AS (sAS) was defined as a mean gradient >50 mm Hg by echocardiogram. We examined the proportion of DAs and the association between DAs and the sAS. <b><i>Results:</i></b> DAs were present in 71% (n = 49) of specimens and primarily co-localized with calcification. Non-dialysis related amyloid was found in one specimen. After excluding this specimen, sAS was associated with ‘Amyloid (1+) and Calcification >1 mm' and ‘Amyloid (2+) and Calcification >1 mm' (vs. ‘Amyloid (-) and Calcification ≤1 mm', odds ratios (ORs): 13.5 and 34.2, respectively). Furthermore, after adjustment for covariates, sAS was found to be associated with ‘Amyloid (2+) and Calcification >1 mm' (OR: 24.3). <b><i>Conclusions:</i></b> DA deposition in the AV was prevalent among dialysis patients. DA deposition with accompanying calcification might contribute to the severity of AS

Supplementary Material for: Clinicopathological Characteristics, Surgery and Survival Outcomes of Patients with Duodenal Gastrointestinal Stromal Tumors

<i>Background:</i> Duodenal gastrointestinal stromal tumors (GISTs) are a rare subset of GISTs (3-5%), and their clinicopathological features have not been fully described. The purpose of this retrospective study was to examine these characteristics and compare the operative procedures. <i>Methods:</i> Twenty-five patients with duodenal GIST underwent complete resection, local resection (LR) or pancreaticoduodenectomy (PD) from 1990 to 2014 at our 2 hospitals. We analyzed patient characteristics, treatments, histological examinations, postoperative complications and survival outcomes. <i>Results:</i> Twelve patients (48%) with no symptoms were incidentally diagnosed for unrelated reasons. Sixteen patients (64%) had c-<i>kit</i> mutations while 6 (24%) were wild-type, including 4 with a history of neurofibromatosis type 1. Comparing LR (n = 16) and PD (n = 9), the recurrence-free survival rate was significantly worse for PD. On multivariate analysis, however, tumor size was an independent and significant prognostic factor, but not operative procedure. There was no body weight change with LR, but body weight decreased by 7% with PD.<i>Conclusion:</i> Duodenal GISTs had different characteristic genetic mutations compared to other GISTs. LR for duodenal GISTs appears to be oncologically and nutritionally feasible