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We herein report an extremely rare case of adenocarcinoma of the minor duodenal papilla (MiDP) which was successfully treated by endoscopic mucosal resection (EMR). An asymptomatic 84-year-old man underwent upper gastrointestinal endoscopy, which revealed a slightly elevated lesion at the MiDP. The biopsy findings were suggestive of adenocarcinoma. Computed tomography, magnetic resonance images and endoscopic ultrasonography did not reveal pancreatic tumor infiltration nor any apparent distant metastases. Therefore, we treated the lesion using EMR with complete resection. No recurrence or metastasis has been detected at 13 months after EMR. Total resection of the MiDP can thus serve as a relatively safe and simple treatment.

INTRODUCTION: During the coronavirus disease 2019 pandemic, whether endoscopy generates aerosols needs to be determined. METHODS: In patients undergoing upper gastrointestinal endoscopy with an enclosure covering their heads, 0.3-10-µm aerosols were measured for 60 seconds before, during, and after endoscopy by an optical counter. Whether aerosols increased in the situation with and without endoscopy was examined. RESULTS: The analysis included 103 consecutive patients undergoing endoscopy and 90 control patients. Aerosols increased significantly during endoscopy compared with the control group. Body mass index and burping were significant factors related to increased aerosols during endoscopy. DISCUSSION: Upper gastrointestinal endoscopy was an aerosol-generating procedure.

Background Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) as a treatment for patients with acute cholecystitis has been shown to obtain high technical and clinical success rates and a low recurrence rate. However, the safety of EUS-GBD for patients receiving antithrombotic therapy (ATT) has not been proven. The aim was to evaluate the safety and efficacy of EUS-GBD in patients receiving ATT. Methods Twelve patients with acute cholecystitis associated with gallstones who were receiving antithrombotic therapy and underwent EUS-GBD were enrolled in this retrospective study. Patients with grade II or III cholecystitis who had failed endoscopic transpapillary GBD (ETGBD) or developed recurrence after multiple ETGBD procedures underwent urgent drainage by EUS-GBD. The primary outcome was the rate of bleeding complications after the procedure and the secondary outcomes were the technical and clinical success rates, complications, and recurrence. Results Eleven (91.6%) patients underwent EUS-GBD with continuation of ATT (at least 1 agent). Five of 12 patients (41.7%) were receiving more than 1 agent for ATT. The rate of bleeding complications was 0% and the technical success rate was 100%, even though some patients had high-grade (severe) cholecystitis and/or several underlying diseases. Early complications were found in 2 (16.7%) patients. The clinical success rate was 91.7% (11/12). There were no recurrences of cholecystitis during the follow-up period (mean 261 [range 5-650] days). Conclusions EUS-GBD yielded high technical and clinical success rates and a low recurrence rate. No patients receiving ATT developed bleeding complications. EUS-GBD might be a good option for patients on ATT.

Aim. To analyze the risks of preoperatively produced donor-specific antibody (DSA) in liver transplantation.Methods. DSA was assessed using direct complement-dependent cytotoxicity (CDC) and anti-human globulin- (AHG-) CDC tests, as well as the Luminex Single Antigen assay. Among 616 patients undergoing blood type identical or compatible living donor liver transplantation (LDLT), 21 patients were positive for CDC or AHG-CDC tests, and the preserved serum from 18 patients was examined to determine targeted Class I and II antigens. The relationships between the mean fluorescence intensity (MFI) of DSA and the clinical outcomes were analyzed.Results. Patients were divided into 3 groups according to the MFI of anti-Class I DSA: high (11 patients with MFI > 10,000), low (2 patients with MFI < 10,000), and negative (5 patients) MFI groups. Six of 11 patients with high Class-I DSA showed positive Class-II DSA. Hospital death occurred in 7 patients of the high MFI group. High MFI was a significant risk factor for mortality (). Univariate analysis showed a significant correlation between MFI strength and C4d deposition ().Conclusions. HLA Class I DSA with MFI > 10,000 had a significant negative effect on the clinical outcome of patients with preformed DSA in LDLT.

Adult living donor liver transplantation (LDLT) was developed against the background of a scarcity of deceased donors and has a number of disadvantages leading to in-hospital mortality, such as marginal donors and grafts and recipients suffering from severe conditions. We have thus developed surgical and medical innovations to overcome these disadvantages. The present study analyzes the causes of death and factors affecting in-hospital mortality in adult recipients of LDLT. Between November 1994 and December 2007, 576 consecutive adult patients underwent LDLT at a single medical center. Overall in-hospital mortality was 18.9%. The peak rate was 55.6% in 1996, and the rate gradually decreased thereafter to 4.4% in 2007. The most frequent cause of death was infection (62.5%), which was followed by rejection (15.7%) and nonseptic multiple-organ failure (8.9%). Being intensive care unit-bound before the operation, ABO blood type incompatibility, an absence of postoperative enteral nutrition, and a Model for End-Stage Liver Disease score of 25 or higher were independent risk factors for in-hospital mortality. In ABO-identical and ABO-compatible cases, retransplantation and a positive lymphocyte crossmatch test were additional independent risk factors. In conclusion, even aggressive efforts, preoperative conditions such as being intensive care unit-bound, a high Model for End-Stage Liver Disease score, retransplantation, and a positive lymphocyte crossmatch test are still risk factors. Enteral nutrition could be a promising strategy to improve adult LDLT.

We retrospectively reviewed our 10-year experience with living donor liver transplantation (LDLT) in 30 consecutive patients with end-stage primary sclerosing cholangitis (PSC) to determine long-term patient and graft survival and risk factors for recurrence of PSC. For strict diagnosis of recurrence, patients with hepatic artery thrombosis (n = 2), ABO blood type incompatible transplantation (n = 3), and postoperative survival shorter than 1 year (n = 5) were excluded from the study, leaving 20 patients for analysis. Recurrence was diagnosed in 11 patients 26-71 months after transplantation. Multivariate analysis showed that cytomegalovirus diseases within 3 months after transplantation and related donors were independent risk factors for recurrence. When the effects on recurrence were compared among donor-recipient relationships, there were significant differences, especially between nonrelated donors and parents. Multivariate analysis showed that age was an independent risk factor for time to graft loss. Cytomegalovirus prophylaxis and avoidance of related donors are important in reducing PSC recurrence, although this is a preliminary report with limitations due to the small number of patients. LDLT for young patients with PSC using grafts from their parents might have to be avoided where deceased donor liver transplantation is available.

Experimental and numerical studies have been performed for the cure process of solid rubber. Styrene-butadiene rubber (SBR) packed in a cylindrical mold of inner diameter 74.6 mm, was heated by one-dimensional, transient heat conduction from the mold. Radial temperature profile and also radial distributions of the degree of cure were measured after the prescribed heating time was reached. Two methods for the mold temperature control were adopted. One is that the heating is continued at a constant temperature until the uniform temperature profile across the rubber was observed. The other is that the heating was cut off before the uniform profile was formed in order to study the effects of residual heat on the cure process. Numerical prediction was performed for the distributions of the temperature and degree of cure. Heat conduction equation for one-dimensional, transient heat transfer is coupled to the cure kinetics of the SBR. Heat generation term, expressed as a function of cure rate and the total heat generation due to cure reaction, is introduced to account for the effect of heat liberated during the process. Results of the prediction showed a good agreement of the measured profiles of the temperature and the degree of cure.

A prediction method of the degree of cure is presented for the curing process of styrene-butadien rubber packed in a cylindrical mold with relatively large size. Heat conduction equation for one-dimensional, transient heat transfer is coupled to the cure kinetics of the rubber. Heat generation term, expressed as a function of the cure rate and the total heat generation due to the cure reaction, is introduced to account for the effect of heat liberated during the process. Two experimental methods for the mold temperature control are examined. One is that the heating is continued at a constant temperature until the uniform temperature profile across the rubber is observed. The other is that the heating was cut off before the uniform temperature profile was formed in order to study the effects of residual heat on the cure process. The two experimental cure data sets can be correlated by the present prediction method to a mean absolute deviation of 11.5%.

The copper-catalyzed regioselective allylic cyanation of allylic compounds with trimethylsilyl cyanide (TMSCN) is described. Copper(I) iodide (CuI), copper(I) cyanide (CuCN) and copper(II) chloride (CuCl2) are shown to effectively catalyze the cyanation of various allylic substrates to afford the corresponding allylic cyanides in good yields and high regioselectivities. The reaction in the presence of 2,2,6,6-tetramethyl-1-piperidinyloxy free radical (TEMPO) reveals that the cyanation proceeds via a radical pathway.

Biliary atresia (BA) is a neonatal obstructive cholangiopathy characterized by a fibrosclerosing obliteration of the extrahepatic bile duct. The aim of this study was to investigate the relationship between human leukocyte antigens (HLA) and susceptibility to BA. We retrospectively analyzed 392 Japanese patients with BA and without extrahepatic anomalies who underwent living donor liver transplantations at our institute. Healthy Japanese volunteers (n = 828) served as normal controls. A significant positive association was observed between BA and HLA-DR2 (39.0% of patients vs. 30.4% of controls, odds ratio = 1.46, p = 0.029). Two-locus analyses disclosed that DR2 was not independently associated with BA, but the increased frequency of HLA-A24 and -B52 reflected the linkage disequilibrium between -A24, -B52, and -DR2. Moreover, the frequency of the haplotype HLA-A24-B52-DR2 was significantly higher in patients with BA than in the general Japanese populations described in the literature (odds ratio = 2.20, p = 0.00124). These results indicate that the gene for BA susceptibility is in close linkage disequilibrium with the HLA-A24-B52-DR2 haplotype observed in the Japanese population. We speculate that a gene at the locus close to HLA plays an important role in the pathogenesis of BA.

Evening primrose oil, which includes GLA, is one of the most popular of many treatments available for PMS. It has been reported that diagnosis of PMS on the basis of prospective daily rating is essential. However, few studies on alleviation by GLA of the symptoms of PMS have been performed using prospective daily rating. We examined the alleviating effect of GLA on symptoms of PMS diagnosed by prospective daily rating. Twenty-eight women diagnosed with PMS consumed vegetable oil containing about 180 mg/day of GLA for three luteal phases in a randomized, double-blind, parallel protocol, and were examined for duration and severity of PMS symptoms. Levels of DGLA in plasma phospholipid were significantly lower in women with PMS than in those without it (DGLA, P < 0.01) before treatment regardless of phase in menstrual cycle. After GLA administration, the levels of GLA and DGLA in plasma phospholipid in the GLA group were significantly higher than those both in the placebo group and before treatment. Improvement of the duration and severity of PMS symptoms as a whole, as well as that of irritability, was significantly more pronounced in the GLA than in the placebo group. These findings indicate that GLA can be effective for treating the symptoms of PMS, and that GLA and DGLA in plasma phospholipid may play a role in the onset of PMS.

Living-donor liver transplantation (LDLT) is now an important option for the treatment of patients with end-stage or irreversible liver disease. We have previously reported the quantities of blood required for transplantation in 772 cases of LDLT performed from June 1990 to March 2002 at Kyoto University Hospital. In the present study we retrospectively analyzed the preoperative factors associated with massive blood losses during LDLT. The patients were divided into two groups, with the upper quartile was defined as the high blood loss (HBL) group and the lower three quartiles as the low blood loss (LBL) group. Preoperative variables between the groups were compared and statistically analyzed by chi-square analysis or the Mann-Whitney U-test. Results showed that predictors of HBL were age ( 2.0g/dl), T-Bil (>10.0g/dl), D-Bil (>10.0g/dl), Cre (>1.0g/dl) and BUN (>30.0g/dl); pre-operative hospitalization; re-transplantation; and diagnosis (Biliary atresia, Budd-Chiari syndrome). In conclusion, particular care against the possibility of massive intra-operative blood loss should be taken in patients with low age, anemia, severe liver dysfunction, and renal dysfunction.

For centralized blood services, the establishment of intelligent systems to secure the quality of blood products is mandatory. One such responsibility is to control the temperature of blood products, because inappropriate storage conditions can ultimately pose a life-threatening risk to a patient. Although blood refrigerators have their own thermometer and record system, alarms are apt to be ignored and records are not well documented. In September 2002, we have established a centralized computer system to check the temperature of fifteen refrigerators at a blood service and two at a certain ward. Temperatures are remotely recorded, and when abnormalities occur, computer systems issue an alarm to staff at the blood service. In total, 107 records generated for one year were analyzed. One case involved the malfunction of the external cooling unit, while the remaining 106 with abnormally high temperature were caused by incomplete closure of refrigerator doors. When staff receive an alarm, they immediately check the records of the computer system, and then contact the ward or a 24-hour service company if needed. In conclusion, this computer system for temperature survey is useful in securing the quality of blood products and can save staff time by reducing troublesome tasks.

We conducted a double-blind, controlled study to investigate the effects of prolonged ingestion of margarine containing medium-chain triglycerides (MCT-M) on serum lipids, apolipoprotein and vitamin A levels, and on postprandial thermogenesis, compared with those of margarine containing long-chain triglycerides (LCT-M). Healthy subjects (n = 26, Body Mass Index 22.6 ± 3.3 kg/m2, mean ± SD) were divided into two groups and ingested 1950-2400 kcal/day of energy, 59-69 g/day of total fat, and 42 g/day of test margarine (15 g/day of MCT or LCT) for 4 weeks. Intake of medium-chain fatty acids was significantly greater with the MCT-M diet (14.2 ± 0.4 g/day, mean ± SD) than with the LCT-M diet (0.2 ± 0.0 g/day) during the 4-week period. There were no significant differences in the blood concentrations of lipids, lipoproteins, apolipoproteins, retinol, glucose, insulin, ketone, hemocytes and electrolytes, or in measures of liver and renal function, between the diet groups. After prolonged ingestion of MCT-M, consumption of an MCT-M meal led to a significant increase in postprandial O2 consumption compared with an LCT-M meal (after 30 min: MCT-M 45 ± 7 ml/min vs. LCT-M 30 ± 7 ml/min; mean ± SE). In conclusion, we suggest that the influences of ingestion of MCT-M for 4 weeks on serum lipids, lipoproteins, apolipoproteins, retinol, ketones, plasma glucose and liver and renal function were similar to those of LCT-M. We also suggest that the prolonged ingestion of 15 g of MCT in healthy humans did not attenuate the postprandial thermogenesis caused by meals containing 5 g of MCT. From these suggestions, MCT-M have a possibility of being efficient foodstuff for preventing obesity in healthy humans.

We commenced a 24-hour blood service in collaboration with staff of the Departments of Laboratory Medicine and Clinical Pathology from April, 2003 in Kyoto University Hospital. Eight months after commencing a 24-hour blood service, we reviewed our experiences by obtaining opinions from technicians of the Departments of Laboratory Medicine and Clinical Pathology. This paper discusses considerations important for establishment of a 24-hour blood service.While orders for blood testing varied in number during night-duty hours, there were 137 calls-for-help from technicians of the Departments of Laboratory Medicine and Clinical Pathology to those of the Department of Transfusion Medicine from April to December, 2003. Approximately half of these calls concerned problems with the computer system and automated blood testing apparatus, followed by information regarding requests from physicians and blood testing results. Technicians of the Department of Transfusion Medicine were in some cases requested to visit the requesting site, but the percent frequency of calls-for-help per blood testing order gradually decreased. The establishment of a 24-hour blood service resulted in a marked decrease in wasted blood products and provided efficient blood transfusion therapy. However, a number of problems concerning working conditions remain unresolved.

RATIONALE Idiopathic retroperitoneal abscesses are insidious, occult illnesses with high mortality if inadequately drained. Endoscopic ultrasound-guided drainage is an alternative to percutaneous or surgical drainage, it is not widely performed for retroperitoneal abscesses other than peripancreatic fluid collection. PATIENT CONCERNS We present a 76-year-old Japanese woman with abdominal pain, high fever, and a history of rheumatism on treatment with immunosuppressants. DIAGNOSES The patient was diagnosed with idiopathic retroperitoneal abscess based on results obtained from her clinical course and findings on computed tomography. INTERVENTIONS We performed Endoscopic ultrasound-guided drainage. After we performed needle puncture via the descending portion of the duodenum, the fistula was expanded using a dilator, and a double-pigtail stent and endoscopic nasobiliary drainage tube were inserted. OUTCOMES The patient was kept nil by mouth, together with intravenous antibiotic therapy, and repeated washing of the abscess cavity with saline was performed. After that, we confirmed disappearance of the cavity, and, after removing the tubes, commenced oral feeding. We were able to avoid surgery in this immunosuppressed patient. LESSONS Endoscopic ultrasound (EUS)-guided abscess drainage can be overall considered a safe and useful procedure. We also propose the double-stent method, with both internal and external stents, for the treatment of idiopathic retroperitoneal abscesses.

BACKGROUND AND OBJECTIVES: Prostate cancer (PCa) is one of the most common cancers and leading cause of cancer-related deaths in men. Mass screening has been carried out since the 1990s using prostate-specific antigen (PSA) levels in the serum as a PCa biomarker. However, although PSA is an excellent organ-specific marker, it is not a cancer-specific marker. Therefore, the aim of this study was to discover new biomarkers for the diagnosis of PCa. MATERIALS AND METHODS: We focused on urine samples voided following prostate massage (digital rectal examination [DRE]) and conducted a peptidomic analysis of these samples using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF/MS(n)). Urinary biomaterials were concentrated and desalted using CM-Sepharose prior to the following analyses being performed by MALDI-TOF/MS(n): 1) differential analyses of mass spectra; 2) determination of amino acid sequences; and 3) quantitative analyses using a stable isotope-labeled internal standard. RESULTS: Multivariate analysis of the MALDI-TOF/MS mass spectra of urinary extracts revealed a 2331 Da peptide in urine samples following DRE. This peptide was identified as a C-terminal PSA fragment composed of 19 amino acid residues. Moreover, quantitative analysis of the relationship between isotope-labeled synthetic and intact peptides using MALDI-TOF/MS revealed that this peptide may be a new pathognomonic biomarker candidate that can differentiate PCa patients from non-cancer subjects. CONCLUSION: The results of the present study indicate that the 2331 Da peptide fragment of PSA may become a new pathognomonic biomarker for the diagnosis of PCa. A further large-scale investigation is currently underway to assess the possibility of using this peptide in the early detection of PCa.

For clarification of the in vivo antioxidant effect of sesame extracts (rich in lignan glycosides) on lipid peroxidation, determination was made of thiobarbitulic acid (TBA), phosphatidylcholine hydroperoxides (PCOOH) and hepatic activity of superoxide dismutase (EC 1.15.1.1; SOD). Male wistar rats were fed experimental diets containing sesame extracts for 2 week and killed 24 hours after injection of diethyldithiocarbamic acid (DDC), an SOD inhibiter. Blood and livers were then collected and hepatic TBA was determined 24 hour after DDC injection and the values were found significant. Heptic TBA of rats fed sesame extracts was significantly less than that of DDC injected rats. PCOOH in rats fed sesame extracts was about half that of DDC injected rats. Sesame extracts (rich in lignan glycosides) would thus appear to protect lipids from peroxidation in vivo.

Eicosapentaenoic (EPA) and docosahexaenoic acids (DHA) were distributed mainly in the sn-1 and 3 positions of seal oil triglyceride and in the sn-2 position of fish oil triglyceride. In Expt. 1, the structural distribution of EPA and DHA in lymph triglyceride of rats given seal or fish oils was similar to the distribution in the administered oils. In Expt. 2, seal oil-rich or fish oil-rich fats having constant polyunsaturated/monounsaturated/saturated fatty acids and n-6/n-3 polyunsaturated fatty acids ratios were fed to rats for 3 weeks. Seal oil more effectively reduced plasma and liver triglyceride than fish oil. Ratio of the productions of aortic prostacyclin and platelet thromboxane A2 stimulated by thrombin was significantly higher in rats fed seal oil than in those fed fish oil. The results suggested that the different intramolecular distribution of EPA and DHA in dietary fat affected lipid metabolism differently in rats.

Stable lipid microspheres (LM) and lipid nanospheres (LN) with average diameters of 200 nm and 50 nm, respectively, were used to encapsulate an lipophilic antitumor agent, 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU). LM and LN containing BCNU (lipo BCNU and s-lipo BCNU, respectively) were prepared by homogenizing a soybean oil solution of BCNU with egg yolk lecithin, and their antitumor activity via the intravenous route was tested against L1210 leukemia in mice and compared with that of BCNU dissolved in saline. Both lipo-BCNU and s-lipo BCNU showed significantly enhanced antitumor activity with reduced toxicity, when compared with the corresponding doses of BCNU alone. These results suggest that LM and LN may be suitable carriers for lipophilic antitumor agents and may enhance their efficacy.

This paper describes a method of reaction time in agility using the bioelectrical impedance, which is not affected by either the measurement items or measurement site that is closer. In this study, the measurement is made for two items, the jumping reaction test and the bar-gripping reaction test. Reaction time, movement time, and total time are defined based on the waveforms of the lower leg electrical impedance and the forearm electrical impedance. Results are compared to the reaction time and the total time obtained by the traditional method. The results using the proposed method almost agreed with the results of the traditional method, and it is verified that the proposed method can be used to measure the reaction time. It should be noted that reaction time and movement time can be separated from total time for the bar-gripping test; this has been impossible in the traditional method. The ability to separate types of time is of use in an experiment in alcohol drinking conditions; results of this experiment are presented. It is expected that the proposed method will be applied to various measurements in such fields as measurement of physical fitness, sport training, and rehabilitation.

Complement degradation product C4d has become an important marker of humoral or antibody-mediated rejection in renal and heart allograft biopsies. Although there have been several reports on the detection of C4d in liver allografts, the significance of C4d in liver transplantation and its relationship with humoral rejection are still not clear. We investigated the frequency and pattern of C4d staining in liver allograft biopsies with reference to preoperative lymphocyte crossmatch tests, which detect donor-reactive lymphocyte antibody. Survival rates at 5 years were 77% for crossmatch-negative patients and 53% for crossmatch-positive patients (P=0.009). In crossmatch-negative patients, reproducible positive staining was obtained in 28 of 86 (33%) biopsies taken within 90 days after transplantation and 33 of 96 (34%) biopsies 90 days or after transplantation. Most C4d staining was observed in the portal areas, and no clear correlation was observed between C4d positivity and histological diagnosis. In crossmatch-positive patients, 9 of 11 (82%) biopsies showed positivity for C4d. C4d stained perivenular areas as well as portal areas. Histology of crossmatch-positive patients included acute rejection and cholangitis, but did not include periportal changes that were seen in humoral rejection in ABO-incompatible liver transplantation. In summary, focal C4d deposition was seen in various types of liver allograft injury and had little clinical impact on crossmatch-negative patients, but extensive C4d staining in crossmatch-positive patients may be associated with humoral rejection and poor graft survival.

High anti-blood group A or B (anti-A/B) immunoglobulin G (IgG) haemagglutination titres are associated with poor graft survival in ABO-unmatched liver transplantation. We have previously reported that the surface plasmon resonance (SPR) method can be used to measure anti-A/B IgG levels in the plasma very quickly and quantitatively. The aim of this study was to brush up this SPR method. The anti-A/B IgG antibodies (Abs) were purified from the plasma of healthy volunteers by affinity chromatography and used to establish standard curves for the SPR and flow cytometry (FCM) methods. The haemagglutination test tube (TT), FCM and SPR methods were then used to measure the changes over time in the anti-A/B IgG titres of 25 ABO-unmatched living donor liver transplantation (LDLT) recipients. The standard curve permitted the SPR values for the anti-A/B IgG titres to be expressed in microg mL(-1) units. The SPR measurements of the anti-A/B IgG levels in the LDLT recipients correlated very well with the FCM values, whereas the TT values correlated poorly with either method. Furthermore, the SPR method accurately detected the effects of plasma exchange. In conclusion, the SPR method is an accurate, time- and labour-saving method for measuring anti-A/B IgG titres that can be easily standardized.

Although the effectiveness of rituximab has been reported in ABO blood group (ABO)-incompatible (ABO-I) organ transplantation, the protocol is not yet established. We studied the impact of the timing of rituximab prophylaxis and the humoral immune response of patients undergoing ABO-I living donor liver transplantation (LDLT), focusing on clinicopathological findings and the B-cell subset. From July 2003 to December 2005, 30 adult patients were treated with hepatic artery infusion (HAI) protocol without splenectomy for ABO-I LDLT. A total of 17 patients were treated only with HAI (no prophylaxis), and the other 13 were treated with rituximab prophylaxis at various times prior to transplantation. For B-cell study of the spleen, another 4 patients undergoing ABO-I LDLT both with HAI after prophylaxis and eventual splenectomy, and 3 patients with ABO-compatible LDLT with splenectomy were enrolled. The mortality of the 30 patients with HAI, without splenectomy, and with/without rituximab prophylaxis was 33% and the main cause of death was sepsis. Peripheral blood B cells were completely depleted, anti-donor blood-type antibody titer was lower, and clinical and pathological antibody-mediated rejection was not observed in patients with prophylaxis earlier than 7 days before transplantation (early prophylaxis). Early rituximab prophylaxis significantly depleted B cells and memory B cells in the spleen but not in lymph nodes. On the other hand, B cells and memory B cells increased and memory B cells became dominant during antibody-mediated rejection. In conclusion, early prophylaxis with rituximab depletes B cells, including memory B cells, in the spleen and is associated with a trend toward lower humoral rejection rates and lower peak immunoglobulin (Ig)G titers in ABO-I LDLT patients. Liver Transpl 13:579–588, 2007. © 2007 AASLD.

We retrospectively determined the correlation of results of lymphocyte crossmatch tests by direct complement-dependent cytotoxicity, to the outcomes of 585 consecutive ABO-identical and human leukocyte antigen (HLA)-mismatched living donor liver transplants (LDLTs) (male:female=276:309; median age, 18 years). Crossmatch test results were positive in 14 recipients (2.4%). Patient survival at eight years in the crossmatch-positive group was significantly lower than in the crossmatch-negative group (positive group, 56.3%; negative group, 77.6%; P=0.014). The survival at five years of the crossmatch-positive group was significantly lower than the negative group in both older recipients (>or=18 years of age: positive group, 41.7%; negative group, 76.4%; P=0.0065), and female recipients (positive group, 37.5%; negative group, 81.9%; P=3.3x10). We conclude that antidonor antibodies have adverse effects on the clinical outcome of LDLTs, and that being female and/or older aged (>or=18 years of age) are risk factors for LDLT.

We found previously that the ingestion of margarine containing medium-chain triacylglycerols (MCT) resulted in a significant increase in postprandial thermogenesis when compared with long-chain triacylglycerols (LCT). Diets that included margarine containing MCT and LCT were compared for 12 weeks in 73 subjects to investigate the effects on body weight, body fat, areas of subcutaneous and visceral fat, serum total cholesterols, triglycerides, lipoproteins, plasma glucose, serum insulin, total ketone bodies, and the activities of aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyltranspeptidase. We conducted a double-blind, controlled study and used blended rapeseed oil and soybean oil (LCT) as a comparison. Two groups ingested 2100-2400 kcal/day of energy, 65-73 g/day of total fat, and 14 g/day of test margarine (5 g/day of MCT or LCT). The subjects on the MCT diet demonstrated significant decreases in body fat weight (- 3.8 +/- 2.4 kg vs - 2.4 +/- 1.7 kg; MCT vs LCT, mean +/- SD), subcutaneous fat (- 38.2 +/- 29.9 cm(2) vs - 22.6 +/- 19.3 cm(2)), and visceral fat (- 12.2 +/- 11.2 cm(2) vs - 1.6 +/- 12.8 cm(2)) after 12 weeks. There were no clinical differences in measured blood parameters. We suggest that the postprandial increase in thermogenesis and control of postprandial triglyceride levels may explain these results.

It has been previously shown that a diet containing medium-chain triacylglycerols (MCT) leads to less body fat accumulation as compared to a diet containing long-chain triacylglycerols (LCT). We investigated the involvement of diet-induced thermogenesis in the accumulation of body fat in rats fed a diet containing MCT. Twelve male Wistar rats were administered 1 g of MCT or LCT by gavage, and their oxygen consumption was measured for 6 h (experiment 1). Forty male Wistar rats were fed a diet containing 10% MCT or LCT for 6 wk, and their body composition was determined (experiment 2). In experiment 1, oxygen consumption increased to a greater extent after MCT administration than after LCT administration. Diet-induced thermogenesis was significantly (0.67 +/- 0.14 kcal) larger after the administration of 1 g of MCT. In experiment 2, there were no differences in food intake or carcass protein content between the LCT group and MCT group. However, carcass fat and intra-abdominal fat content were significantly lower in rats fed MCT than in those fed LCT. We calculated that ingestion of 1 g of MCT decreased body fat by 0.94 +/- 0.27 kcal relative to the ingestion of LCT. These results suggest that the larger diet-induced thermogenesis observed in rats fed MCT, compared to that of those fed LCT, is one of the main factors involved in the suppression of body fat accumulation in rats fed MCT.

The objective of this study was to investigate effects of dietary medium-chain triacylglycerols (MCTs) on serum lipid levels, liver function, and hepatic fat accumulations in healthy men. Eleven subjects consumed 2200-2600 kcal daily, of which 70-80 g was fat; the fat included 40 g of MCTs or else 40 g of long-chain triacylglycerols (blended vegetable oil). The diet was followed for 4 weeks in this controlled double-blind study. At the end of the experiment, significant differences were not found in the concentrations of serum total cholesterol, very low density lipoprotein cholesterol, low density lipoprotein cholesterol, and high density lipoprotein cholesterol between the groups. Serum triglycerol levels were not significantly different in the groups. Adverse effects from ingestion of MCTs on liver functions, the liver-to-spleen ratio on computed tomography (an index of fatty liver), or results of blood tests were not seen. The results suggest that the long-term effects of dietary MCTs on serum cholesterol were similar to those of unsaturated fatty acids found abundantly in vegetable oil, and that consumption of MCTs in the amount of 40 g/day for a month does not cause liver fat accumulation or liver dysfunction.

Triacylglycerols containing medium- and long-chain fatty acids (TML) have medium- and long-chain fatty acids in the same molecule. The effects of dietary TML on serum lipid levels and body fat were studied in six young men belonging to a university rowing club. A double-blind crossover study was performed in which for 3 wk the subjects ingested a liquid diet containing 20 g/d of soybean oil or TML in addition to their regular diets. Throughout the study, they were asked to keep their usual lifestyle, including diet and physical activity. The body composition of the subjects was measured weekly. Blood samples were taken at 0, 2, and 3 wk of each treatment period. There was no significant difference in energy intake between the soybean oil diet period and the TML diet period. The rate of variation of serum triacylglycerol concentration was significantly lower after a consumption of the TML liquid diet for 3 wk compared with the soybean oil liquid diet. The rate of variation of body fat mass was also significantly lower after a consumption of the TML liquid diet for 3 wk compared with the soybean oil liquid diet. However, the serum cholesterol concentration did not change significantly during either dietary treatment. These results suggest that TML, compared with soybean oil, may have the potential to prevent hypertriglyceridemia and obesity caused by consumption of a high-fat diet.

We investigated the effect of long-term ingestion of dietary medium-chain triacylglycerols (MCT) on body weight and fat in humans. Using a double-blind, controlled protocol, we assessed the potential health benefits of MCT compared with long-chain triacylglycerols (LCT) in 78 healthy men and women [body mass index (BMI)or = 23 kg/m(2): n = 26 (MCT), n = 30 (LCT); BMI23 kg/m(2): n = 15 (MCT), n = 7 (LCT)]. Changes in anthropometric variables, body weight and body fat during the 12-wk MCT treatment period were compared with those in subjects consuming the LCT diet. The subjects were asked to consume 9218 kJ/d and 60 g/d of total fat. The energy, fat, protein and carbohydrate intakes did not differ significantly between the groups. Body weight and body fat in both groups had decreased by wk 4, 8 and 12 of the study. However, in the subjects with BMIor = 23 kg/m(2), the extent of the decrease in body weight was significantly greater in the MCT group than in the LCT group. In subjects with BMIor = 23 kg/m(2), the loss of body fat in the MCT group (-3.86 +/- 0.3 kg) was significantly greater than that in the LCT group (-2.75 +/- 0.2 kg) at 8 wk. In addition, in subjects with BMIor = 23 kg/m(2), the decrease in the area of subcutaneous fat in the MCT group was significantly greater than that in the LCT group at wk 4, 8 and 12. These results suggest that the MCT diet may reduce body weight and fat in individuals (BMIor = 23 kg/m(2)) more than the LCT diet.

The concentration of prostate specific antigen (PSA) in serum was measured in 20 brothers or sons in 10 families in which the father and son or brothers had prostate cancer using the E test TOSOH IIPA. The patients were between 32 and 70 years old with a mean age of 48.2 years. The PSA value was between 0.4 and 19.5 ng/ml with a mean value of 3.4 ng/ml. Five patients (25%) had PSA values exceeding the cut-off value of 4.0 ng/ml. After obtaining their consent, systematic prostate needle biopsy by transrectal ultrasonography was performed on 3 patients (15%). Prostate cancer was detected in all of them. Among them 2 patients were brothers, and since the other two brothers already had prostate cancer, all four brothers were confirmed to have prostate cancer. This is the first report of a familial prostate cancer in four brothers in Japan. In the western countries where the incidence of prostate cancer is higher than that in Japan, studies have been performed on the risk factors. Family history is one of the most important risk factors. In Japan, the incidence of prostate cancer is increasing rapidly. Moreover, patients with a prostate cancer family history are expected to increase. In such cases, prostate cancer screening should be performed aggressively from a young age.

A 28-year-old man was referred to Gunma University Hospital for his hard nodule in his left testis. Ultrasonography showed hyperechoic mass with irregular margin. Serum tumor marker levels were within normal limit. Calcified element of mature teratoma or burned-out tumor was suspected. Left inguinal orchiectomy specimen showed epidermoid cyst of the testis with calcified capsule. We reported this case with some discussion on the treatment of epidermoid cyst of the testis.

Eleven patients with ureteral stone disease were treated transurethrally using a rigid uretero scope and ultrasonic lithotriptor. From this experience, we consider that most ureteral stones can be removed through this procedure alone or in combination with percutaneous nephrolithotripsy.