Application of Different Anastomotic Methods for a Patient with Crohn\u27n Disease : Long-term Endoscopic Appearances of Hand-sewn Versus Biofragmentable Anastomosis Ring Method

After resection for ileocecal or ileocolonic Crohn\u27s disease (CD), anastomotic recurrence is common, and roughly one half of the cases who undergo hand-sewn anastomoses require further surgery for suture line recurrence. The other anastomoses methods, stapled anastomoses, had been compared with that of patients having hand-sewn anastomoses. But the type of anastomosis, whether stapled or hend-sewn, did not affect the rates of symptomatic or operative recurrence. A compression anastomosis device consisting of a biofragmentable anastomosis ring (VALTRAC^[○!R]) is used with new anastomosis methods, and no fragments remain in the anastomosis unlike with other anastomotic materials. There have been few reports regarding the employment of VALTRAC^[○!R] methods for anastomoses of patients with CD. We reported a 30-year-old male with a 14-year history of CD. In 1991, he was referred to our hospital for surgery because of stenoses of the ileum and terminal ileum, and underwent ileocecal resection. Ileocolic anastomosis was performed with a hand-sewn method. In 1996, the patient was referred to our hospital again for surgery because of an ileoileal fistula and multiple stenoses in the ileum and the anastomosis. Resection of the previous anastomosis was performed. Next, ileocolic anastomosis was performed using a VALTRAC^[○!R] method. Comparisons of the long-term appearance of two different anastomoses (one hand-sewn and the other done by VALTRAC^[○!R] methods) of the same portion of the intestine in the patient were reported herein

Subcutaneous Single Injection Digital Block with Epinephrine

The aim of this study was to investigate the anesthetic effect and risk of epinephrine for subcutaneous single injection digital block. Either 3.0 mL 1.0% Lidocaine or a 3.0 mL 1.0% Lidocaine with (1 : 100,000) epinephrine was injected into the subcutaneous space at the middle point of the palmar digital crease of the 18 middle fingers of 9 healthy volunteers. The SpO2 of the fingers decreased to a maximum of 97. No subjects showed any symptoms of ischemic injury. The time to anesthesia for the fingers was significantly shorter (P < 0.05), and the duration of anesthesia was significantly longer (P < 0.01) for the fingers in the epinephrine group. In conclusion, a subcutaneous single injection digital blocks with 3.0 mL of 1.0% Lidocaine and (1 : 100,000) epinephrine were safe, reducing the time to the onset of anesthesia, while also markedly prolonging the anesthesia

Frequent Loss of Genome Gap Region in 4p16.3 Subtelomere in Early-Onset Type 2 Diabetes Mellitus

A small portion of Type 2 diabetes mellitus (T2DM) is familial, but the majority occurs as sporadic disease. Although causative genes are found in some rare forms, the genetic basis for sporadic T2DM is largely unknown. We searched for a copy number abnormality in 100 early-onset Japanese T2DM patients (onset age <35 years) by whole-genome screening with a copy number variation BeadChip. Within the 1.3-Mb subtelomeric region on chromosome 4p16.3, we found copy number losses in early-onset T2DM (13 of 100 T2DM versus one of 100 controls). This region surrounds a genome gap, which is rich in multiple low copy repeats. Subsequent region-targeted high-density custom-made oligonucleotide microarray experiments verified the copy number losses and delineated structural changes in the 1.3-Mb region. The results suggested that copy number losses of the genes in the deleted region around the genome gap in 4p16.3 may play significant roles in the etiology of T2DM

Clinical course of Capnocytophaga canimorsus bacteremia from acute onset to life crisis.

Capnocytophaga canimorsus bacteremia can present without signs of sepsis just after onset. For patients with fever, discerning the history of an animal bite is crucial. If it is positive for a dog bite, antibiotic treatment should be started

Development of cosmic x-ray polarimeter

We present a performance study of a cosmic X-ray polarimeter which is based on the photoelectric effect in gas, and sensitive to a few to 30 keV range. In our polarimeter, the key device would be the 50 μm pitch Gas Electron Multiplier (GEM). We have evaluated the modulation factor using highly polarized X-ray, provided by a synchrotron accelerator. In the analysis, we selected events by the eccentricity of the charge cloud of the photoelectron track. As a result, we obtained the relationship between the selection criteria for the eccentricity and the modulation factors; for example, when we selected the events which have their eccentricity of > 0.95, the polarimeter exhibited with the modulation factor of 0.32. In addition, we estimated the Minimum Detectable Polarization degree (MDP) of Crab Nebula with our polarimeter and found 10 ksec observation is enough to detect the polarization, if we adopt suitable X-ray mirrors

Plaque REgression with Cholesterol absorption Inhibitor or Synthesis inhibitor Evaluated by IntraVascular UltraSound (PRECISE-IVUS Trial): Study protocol for a randomized controlled trial

AbstractBackgroundAlthough the positive association between achieved low-density lipoprotein cholesterol (LDL-C) level and the risk of coronary artery disease (CAD) has been confirmed by randomized studies with statins, many patients remain at high residual risk of events suggesting the necessity of novel pharmacologic strategies. The combination of ezetimibe/statin produces greater reductions in LDL-C compared to statin monotherapy.PurposeThe Plaque REgression with Cholesterol absorption Inhibitor or Synthesis inhibitor Evaluated by IntraVascular UltraSound (PRECISE-IVUS) trial was aimed at evaluating the effects of ezetimibe addition to atorvastatin, compared with atorvastatin monotherapy, on coronary plaque regression and change in lipid profile in patients with CAD.MethodsThe study is a prospective, randomized, controlled, multicenter study. The eligible patients undergoing IVUS-guided percutaneous coronary intervention will be randomly assigned to receive either atorvastatin alone or atorvastatin plus ezetimibe (10mg) daily using a web-based randomization software. The dosage of atorvastatin will be increased by titration within the usual dose range with a treatment goal of lowering LDL-C below 70mg/dL based on consecutive measures of LDL-C at follow-up visits. IVUS will be performed at baseline and 9–12 months follow-up time point at participating cardiovascular centers. The primary endpoint will be the nominal change in percent coronary atheroma volume measured by volumetric IVUS analysis.ConclusionPRECISE-IVUS will assess whether the efficacy of combination of ezetimibe/atorvastatin is noninferior to atorvastatin monotherapy for coronary plaque reduction, and will translate into increased clinical benefit of dual lipid-lowering strategy in a Japanese population

Impact of Dual Lipid-Lowering Strategy With Ezetimibe and Atorvastatin on Coronary Plaque Regression in Patients With Percutaneous Coronary Intervention The Multicenter Randomized Controlled PRECISE-IVUS Trial

AbstractBackgroundDespite standard statin therapy, a majority of patients retain a high “residual risk” of cardiovascular events.ObjectivesThe aim of this study was to evaluate the effects of ezetimibe plus atorvastatin versus atorvastatin monotherapy on the lipid profile and coronary atherosclerosis in Japanese patients who underwent percutaneous coronary intervention (PCI).MethodsThis trial was a prospective, randomized, controlled, multicenter study. Eligible patients who underwent PCI were randomly assigned to atorvastatin alone or atorvastatin plus ezetimibe (10 mg) daily. Atorvastatin was uptitrated with a treatment goal of low-density lipoprotein cholesterol (LDL-C) <70 mg/dl. Serial volumetric intravascular ultrasound was performed at baseline and again at 9 to 12 months to quantify the coronary plaque response in 202 patients.ResultsThe combination of atorvastatin/ezetimibe resulted in lower levels of LDL-C than atorvastatin monotherapy (63.2 ± 16.3 mg/dl vs. 73.3 ± 20.3 mg/dl; p < 0.001). For the absolute change in percent atheroma volume (PAV), the mean difference between the 2 groups (–1.538%; 95% confidence interval [CI]: –3.079% to 0.003%) did not exceed the pre-defined noninferiority margin of 3%, but the absolute change in PAV did show superiority for the dual lipid-lowering strategy (–1.4%; 95% CI: –3.4% to –0.1% vs. –0.3%; 95% CI: –1.9% to 0.9% with atorvastatin alone; p = 0.001). For PAV, a significantly greater percentage of patients who received atorvastatin/ezetimibe showed coronary plaque regression (78% vs. 58%; p = 0.004). Both strategies had acceptable side effect profiles, with a low incidence of laboratory abnormalities and cardiovascular events.ConclusionsCompared with standard statin monotherapy, the combination of statin plus ezetimibe showed greater coronary plaque regression, which might be attributed to cholesterol absorption inhibition–induced aggressive lipid lowering. (Plaque Regression With Cholesterol Absorption Inhibitor or Synthesis Inhibitor Evaluated by Intravascular Ultrasound [PRECISE-IVUS]; NCT01043380

Development of cosmic x-ray polarimeter

We present a performance study of a cosmic X-ray polarimeter which is based on the photoelectric effect in gas, and sensitive to a few to 30 keV range. In our polarimeter, the key device would be the 50 μm pitch Gas Electron Multiplier (GEM). We have evaluated the modulation factor using highly polarized X-ray, provided by a synchrotron accelerator. In the analysis, we selected events by the eccentricity of the charge cloud of the photoelectron track. As a result, we obtained the relationship between the selection criteria for the eccentricity and the modulation factors; for example, when we selected the events which have their eccentricity of > 0.95, the polarimeter exhibited with the modulation factor of 0.32. In addition, we estimated the Minimum Detectable Polarization degree (MDP) of Crab Nebula with our polarimeter and found 10 ksec observation is enough to detect the polarization, if we adopt suitable X-ray mirrors

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)