Early intestinal obstruction after infliximab therapy in Crohn’s disease

There is scarce knowledge on early intestinal obstruction in Crohn’s disease (CD) after infliximab treatment. Therefore, we describe two cases of early intestinal obstruction in a series of 46 CD patients treated with infliximab. Both our two cases were 21-year-old men with newly diagnosed CD who were diagnosed with perianal disease 2 years previously. They were suffering from diarrhea and abdominal pain, but there were no symptoms indicating bowel obstruction. Radiographic studies revealed stenotic sites in the terminal ileum in both cases. In both cases, infliximab 300 mg was infused, after which their abnormal laboratory data as well as symptoms such as diarrhea and abdominal pain clearly improved. However, on the 11th or 13th day post-treatment, they presented abdominal distension with air-fluid levels on imaging studies. Ileocolonic resection was performed in both cases. Early intestinal obstruction after infliximab therapy is characterized by initial improvement of the symptoms and the laboratory data, which is soon followed by clinical deterioration. This outcome indicates that infliximab is so swiftly effective that the healing process tapers the stenotic site, resulting in bowel obstruction. Thus, although unpleasant and severe, the obstruction cannot be considered as a side effect but rather a consequence of infliximab’s efficacy. CD patients with intestinal stricture, particularly the penetrating type with stricture, should be well informed about the risk of developing intestinal obstruction after infliximab therapy and the eventual need for surgical intervention

Lectin Immunohistochemistry in Human Non-Malignant and Malignant Gallbladder Tissuses

Changes in the lectin binding pattern in non-malignant and malignant gallbladder tissues were examined using the following eight types of carbohydrate binding lectins : Ulex europaeus-1 (UEA-1), Arachis hypogaea (PNA), Griffonia simplicifolia (GS-1), Glycine maximum (SBA), Bauhinia purpurea (BPA), Dolichos biflorus (DBA), Canavalia ensiformis (Con-A), and Triticum vulgare (WGA). We used a total of 109 tissues including 31 normal tissues, 25 metaplasias, and 53 carcinomas. Lectin staining pattern was evaluated using the Hamada\u27s crieria of the following four types : apical type, cytoplasmic type with polarity, cytoplasmic type without polarity, and stromal type. Normal cases showed apical type and cytoplasmic type with polarity, while carcinoma cases revealed cytoplasmic type with or without polarity. In carcinoma cases, GS-I and DBA lectins showed higher immunohistochemical positive rate and more frequent cytoplasmic type with polarity pattern of immunohistochemical localization than the other types of lectins. These results suggest that the GS-I and DBA are the most reliable lectin marker for malignant transformation of the gallbladder tissues. Key words : Lectin, immunohistochemistry, gallbladder carcinoma

産業界の視点から「排出権取引制度」を構想する:Non-Cap Approachの提唱

The industrial community in Japan has not yet fully supported the idea of establishing a greenhouse gas emissions trading system (ETS). It is because they believe that there are at least three fundamental problems. First, the establishing the ETS dose not reduce the gas emissions. All it does is to create new financial products. Second, when emission credits become targets of money game, they might trigger another financial crisis. Third, since under the ETS the government usually sets an upper limit (cap) on each user (all the ETS participants), this controlled economy has a severe impact on the competitiveness of Japanese corporations.For the purpose of resolving those concerns, based upon experiences of the Reitaku Model,which is a virtual market established at a computer program at Reitaku University, we make the following proposals.1 )From the viewpoint of CDM business players, brokers and financial institutions, emission credits are assumed as inventory assets such as financial products. It is because for them credits are items to sell. But from the viewpoint of manufacturers, emission credits allocated by a government are considered to be key factors for business activities, which are different from financial products (and from non-tangible fixed assets).2 )Instead of financial products (or non-tangible fixed assets), we regard emission credits as inventory assets such as materials or stored items. Since those assets turn into expenses through production, marketing or managerial activities, it seems rational to treat emission credits as materials or stored items.3 )If we assume credits as materials or stored items, eventually we will be able to presume that emission credits become invalid within several years (like three years) after allocation. It is because inventory assets like materials are usually destined to deteriorate. For the sake of convenience, at the Reitaku Model we call the first year credits green, the second yellow, and the third red. If credits are not used within three years, then all the red credits will be transferred from holders\u27 account to the clear-off account of the government.4 )Emission credits should not be allocated for free. Therefore, at this Model, users have to purchase them from the government at the beginning of each fiscal year. In addition, at the end of the year, users receive refunds from the government in proportion to how many substantial credits each user has purchased during the year.5 )Making credits allocated by the government inventory assets, steadily lowering the governmental refunds rate, and reducing the total size of emissions credits to offer, the Reitaku Model makes it possible to reduce the total size of greenhouse gas emissions, without imposing any upper limit (cap) on users.If those points are taken into account, three concerns of the industrial community could be resolved.If corporations come to comprehend actual gas emission expenses incurred, they will be able to control cost and thereby reducing gas emissions. For this purpose, credits should be sold to the users at the fired price, ard treated as inventory assets like materials or stored items by the users.If emission credits are set to lose its use value within three years, they could be excluded from money game targets. Based upon this understanding, and in order to calm down frantic money game over emission credits, we propose an idea of making credits invalid within three years after allocation.Third, when those conditions (fare-paying inventory assets with three year expiration) are jointly introduced, the government comes to a point where it does not need to set any upperlimit (cap) on each user. It is because each user will eventually find its own cap (properinventory level) and will continue to lower the upper limit so as to reduce cost. For this reason,those proposals make it possible for Japan to establish a new ETS avoiding the controlled economy

Perturbative QCD Forbidden Charmonium Decays and Gluonia

We address the problem of observed charmonium decays which should be forbidden in perturbative QCD. We examine the model in which these decays proceed through a gluonic component of the $J/\Psi$ and the $\eta_c$, arising from a mixing of $(c\bar c)$ and glueball states. We give some bounds on the values of the mixing angles and propose the study of the $p \bar{p} \to \phi \phi$ reaction, at $\sqrt{s} \simeq 3$ GeV, as an independent test of the model.Comment: 8pages, lateX, DFTT 64-9

Comparative Pathological Study of Coronary Arteriosclerosis in Okinawa, Nagasaki and Akita Prefectures

In order to clarify the degree of coronary arteriosclerosis in Okinawa, we carried out comparative histological study of coronary arteriosclerosis in 418 autopsy cases, ranging from 50 to 79 of age, which were autopsied between 1983 and 1988 in Okinawa, Nagasaki and Akita districts. Coronary artery samples were collected from cases which had arteriosclerosis-related diseases such as ischemic heart diseases, cerebrovascular diseases, diabetes mellitus, renal diseases, and collagen diseases. Arteriosclerotic lesions were prevalently seen in the following order : main trunk of the left coronary artery, right coronary artery and left circumflex artery. Degree of coronary arteriosclerosis was more severe in Akita than in Nagasaki and Okinawa. There was no significant difference in the degree of coronary arteriosclerosis in Okinawa and Nagasaki. Key words : Coronary arteriosclerosis, Okinawa, Nagasaki, Akita

オクタマ ニ オケル シンヨウジュジンコウリン ト コウヨウジュニジリンナイ デノ ノネズミルイコタイグンドウタイ

森林施業に関わる野ネズミ類の役割を明らかにする一環として,林相の異なる針葉樹人工林と広葉樹二次林を跨ぐ形で林内に生息する野ネズミ類を捕獲・放獣する方法により2006年から2009年まで個体群の変動を調査した。その結果,調査対象としたアカネズミ(Apodemus speciosus),ヒメネズミ(Apodemus argenteus)の捕獲個体数は2006年9月には延べワナ数675個で157個体,422回と最高の高密度状態を記録したが,11月から急激な減少が認められ,その後は1年以上ひと月の捕獲個体が数頭という低密度で推移したことから,野ネズミ類個体群にクラッシュが生じたものと判断した。アカネズミとヒメネズミの捕獲個体数の変動を比較すると,それぞれの生息特性を反映して急減の時期に3か月の時間的差異が見られた。しかし,全体的な変動の傾向は両種とも同様の推移を示した。針葉樹林と広葉樹林での生息状況を見ると,アカネズミでは広葉樹林の利用頻度が高く,秋季から冬季にかけて針葉樹林の依存度が増す傾向にあった。ヒメネズミでは針葉樹林のみの利用個体が多いものの,年によっては夏季に広葉樹林のみ利用する個体が増加した。また,いずれの種とも両方の林分を同時に利用している個体は少ないという傾向を得た。行動範囲に関しては,高密度下では大きく,ランダムに分布し,低密度下では小さく,限定的になる傾向が見られた。As a part of clarifying up the role of the forest field mouse, we investigated the fluctuation of the mouse population at an area between a coniferous plantation and a broad-leaved secondary forest in Okutama area, Tokyo. We attempted the capture-recapture method from 2006 to 2009. In September 2006, the captured number of the Apodemus speciosus and A. argenteus surveyed recorded the maximum (157 individuals, 422 caputures in 675 trap night ), but it started decreasing suddenly from November. We judged that a sudden drop occurred in the field mouse population because the captured number of these mice remained low over the next year. Start of the drop in A. argenteus was delayed three months compared to that of A. speciosus. However, both species had a similar population fluctuation tendency. A. speciosus generally used the broad-leaved forest frequently, and they showed increased dependence on the coniferous forest in fall. A. argenteus generally preferred the coniferous forest, but in summer some individuals of both species used only the broad-leaved forest. There were not many individuals whose home ranges extended across both kinds of forests. Home ranges of the field mice tended to be wide and random under a high density situation, but they became narrow and clustered under a low density situation

Novel, Objective, Multivariate Biomarkers Composed of Plasma Amino Acid Profiles for the Diagnosis and Assessment of Inflammatory Bowel Disease

BACKGROUND: Inflammatory bowel disease (IBD) is a chronic intestinal disorder that is associated with a limited number of clinical biomarkers. In order to facilitate the diagnosis of IBD and assess its disease activity, we investigated the potential of novel multivariate indexes using statistical modeling of plasma amino acid concentrations (aminogram). METHODOLOGY AND PRINCIPAL FINDINGS: We measured fasting plasma aminograms in 387 IBD patients (Crohn's disease (CD), n = 165; ulcerative colitis (UC), n = 222) and 210 healthy controls. Based on Fisher linear classifiers, multivariate indexes were developed from the aminogram in discovery samples (CD, n = 102; UC, n = 102; age and sex-matched healthy controls, n = 102) and internally validated. The indexes were used to discriminate between CD or UC patients and healthy controls, as well as between patients with active disease and those in remission. We assessed index performances using the area under the curve of the receiver operating characteristic (ROC AUC). We observed significant alterations to the plasma aminogram, including histidine and tryptophan. The multivariate indexes established from plasma aminograms were able to distinguish CD or UC patients from healthy controls with ROC AUCs of 0.940 (95% confidence interval (CI): 0.898-0.983) and 0.894 (95%CI: 0.853-0.935), respectively in validation samples (CD, n = 63; UC, n = 120; healthy controls, n = 108). In addition, other indexes appeared to be a measure of disease activity. These indexes distinguished active CD or UC patients from each remission patients with ROC AUCs of 0.894 (95%CI: 0.853-0.935) and 0.849 (95%CI: 0.770-0.928), and correlated with clinical disease activity indexes for CD (r(s) = 0.592, 95%CI: 0.385-0.742, p<0.001) or UC (r(s) = 0.598, 95%CI: 0.452-0.713, p<0.001), respectively. CONCLUSIONS AND SIGNIFICANCE: In this study, we demonstrated that established multivariate indexes composed of plasma amino acid profiles can serve as novel, non-invasive, objective biomarkers for the diagnosis and monitoring of IBD, providing us with new insights into the pathophysiology of the disease

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362