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Aim In order to determine the most reliable reporting style for prothrombin time (PT) in patients with liver disease, we examined the correlations between the plasma antigen levels of clotting factors and the PT activity percent or two international normalized ratios (INR), and compared the inter-reagent variation among these PT reporting styles. Methods The PT was measured in 81 patients with liver diseases, including acute liver failure (ALF) (n = 10), acute liver injury (n = 52), chronic hepatitis (n = 8) and liver cirrhosis (n = 11), and in 75 warfarin-treated patients and 32 healthy volunteers. The PT of each plasma sample was determined with four commercial thromboplastins using an automated photo-optical coagulometer. For individual thromboplastin reagents, a locally determined international sensitivity index (local ISI) was derived using plasma obtained from healthy volunteers, warfarin-treated patients and liver disease patients. The INRW and INRLD were calculated using the corresponding local ISI. The PT activity percent was calibrated according to the Lineweaver-Burk equation. The PT values were compared with the plasma antigen levels of clotting factors X, II and VII measured using the enzyme-linked immunoassay method. Results The plasma factor X level was selected as the gold standard for measuring the synthetic liver function among the three clotting factors due to its significant relationship (P = 0.007) with the prognosis of ALF. The INRLD exhibited the closest correlation to the factor X level (r = 0.723-0.759), with the smallest inter-reagent variation among these reporting styles. Conclusion The INRLD is the most appropriate PT reporting style for use in patients with liver disease.

Aim: The aim of this study was to examine the safety and efficacy of endoscopic submucosal dissection (ESD) for early gastric cancer based on approximately 10 years’ experience. Methods: Endoscopic submucosal dissection was performed in 1272 patients with early gastric cancer (1657 lesions). We examined en bloc resection rate, curative resection rate, local recurrence rate, procedure time, and complications. Results: The overall en bloc resection rate was 98.6% for all lesions treated by ESD. The median procedure time of the operation was 54.3 minutes (range 5 - 632 min). The incidence of positive horizontal and vertical margins was 3.8% and 4.0%, respectively. The incidence was 2.5% each for perforation and postoperative bleeding. There were no deaths related to ESD. Local recurrence was observed in 10 lesions (0.06%). Conclusion: Since the procedure time and incidence of complications have been reduced, endoscopic submucosal dissection has been considered a standard treatment for early gastric cancer.

A nationwide statistical survey of 4226 dialysis facilities was conducted at the end of 2010, and 4166 facilities (98.6%) responded. The number of new patients introduced into dialysis was 37,512 in 2010. This number has decreased for two consecutive years since it peaked in 2008. The number of patients who died in 2010 was 28,882, which has been increasing every year. The number of patients undergoing dialysis at the end of 2010 was 298,252, which is an increase of 7591 (2.6%) compared with that at the end of 2009. The number of dialysis patients per million at the end of 2010 was 2329.1. The crude death rate of dialysis patients in 2010 was 9.8%, and has been gradually increasing. The mean age of the new patients introduced into dialysis was 67.8 years and the mean age of the entire dialysis patient population was 66.2 years. Regarding the primary disease of the new patients introduced into dialysis, the percentage of patients with diabetic nephropathy was 43.6%, which is a slight decrease from that in the previous year (44.5%). Patients with diabetic nephropathy as the primary disease accounted for 35.9% of the entire dialysis patient population, which approaches the percentage of patients with chronic glomerulonephritis as the primary disease (36.2%). The percentage of patients who had undergone carpal tunnel release surgery (CTx) was 4.3%, which is a slight decrease from that at the end of 1999 (5.5%). The decrease in the percentage of patients who had undergone CTx was significant among the patients with dialysis durations of 20-24 years (1999, 48.0%; 2010, 23.2%). A total weekly Kt/V attributable to peritoneal dialysis and their residual functional kidney was 1.7 or higher for 59.4% of patients who underwent peritoneal dialysis.

Background:Carnitine (CA) is an important key substance for lipid metabolism and serum CA levels change in patients with various diseases. Although liver cirrhosis (LC) is known as a representative cause of secondary CA deficiencies, the exact levels of serum CA in LC patients remains a controversial issue. The aim of the present study was to reevaluate the serum CA levels in LC patients, with a particular focus on the relationship between serum CA levels and liver and renal function. Methods:Seventy-one patients with LC (51 males, 20 females; median age 63.0 years) were examined. Fasting serum Total-CA (T-CA), Free-CA (F-CA) and Acyl-CA (Ac-CA) levels were measured using an enzymatic cycling method and were evaluated according to their relationships with liver and renal dysfunction. Results:The levels (mean ± standard deviation, μmol/L) of serum T-CA, F-CA and Ac-CA (72.9±19.1, 55.3±14.0 and 17.6±7.2 respectively) in LC patients were almost within normal range (T-CA: 45.0-91.0; F-CA: 36.0-74.4 and Ac-CA: 6.0-23.0 respectively). Approximately 11% of patients had serum T-CA levels

Prototheca zopfii is an achlorophyllic alga that causes bovine mastitis, resulting in a reduction in milk production and the secretion of thin, watery milk with white flakes. This study evaluated the use of an ELISA system for distinguishing cows with mastitis due to P. zopfii genotype 2 from healthy cows and cows with chronic candidal mastitis. We also investigated the transitional changes of specific antibody titers in healthy cows injected with inactivated P. zopfii genotype 2 cells. The ELISA system exhibited the highest sensitivity (94%) and specificity (100%) for chronic protothecal mastitis when the positive cutoff value was set at 43.4 ELISA units. Anti-protothecal IgG titers were positive in all cows after they were inoculated with inactivated P. zopfii genotype 2 cells. These results indicated that ELISA detection of anti-protothecal IgG in serum provided specificity and sensitivity sufficient for diagnosing protothecal mastitis. Thus, an ELISA system incorporating this specific antiserum is expected to be valuable for definitive field-based diagnosis of bovine mastitis due to P. zopfii genotype 2.

Since 2009, the peritoneal dialysis (PD) registry survey has been carried out as part of the annual nationwide survey conducted by the Statistical Survey Committee of the Japanese Society for Dialysis Therapy with the cooperation of the Japanese Society for Peritoneal Dialysis. In this report, the current status of PD patients is presented on the basis of the results of the survey conducted at the end of 2012. The subjects were PD patients who lived in Japan and participated in the 2012 survey. Descriptive analysis of various items was performed, which included the current status of the combined use of PD and another dialysis method such as hemodialysis (HD) or hemodiafiltration (HDF), the method of exchanging dialysate, the use of an automated peritoneal dialysis (APD) machine, and the rates of peritonitis and catheter exit-site infection. From the results of the facility survey in 2012, the number of PD patients was 9514, a decrease of 128 from 2011. Among the entire dialysis patient population, 3.1% were PD patients, a decrease of 0.1%. Among the studied patients, 347 had a peritoneal catheter and underwent peritoneal lavage, 175 were started on PD in 2012 but introduced to other blood purification methods in the same year, and 1932 underwent both PD and another dialysis method such as HD or HDF. The percentage of patients who underwent PD and another dialysis method increased with PD vintage:1 year, 4.8%; 1 to2 years, 9.2%; 2 to4 years, 16.3%; 4 to8 years, 32.0%; and ≥8 years, 47.5%. The percentage of PD patients who completely manually exchanged the dialysate was 29.8%. The percentages of PD patients who used a double-bag exchange system with ultraviolet-light irradiation and those who used the same system but with a sterile connecting device were 54.7 and 13.9%, respectively. The percentage of patients on PD for1 year using an APD machine was 43.4%, and it decreased with a PD vintage of ≥2 years. The mean rate of peritonitis was 0.22 per patient per year. The mean rate of catheter exit-site infections was 0.36 per patient per year.

Aim Problems in patients with minimal hepatic encephalopathy (MHE) include episodes such as falls and deficient driving skills, without any recognition of neurophysiological dysfunction. Patients with MHE are also more likely to develop overt hepatic encephalopathy. However, there is not yet any interventional strategy for MHE involving nutritional management. We conducted a preliminary study to investigate the proportion of positive MHE and the effects of nutritional management on MHE. Methods Patients with viral liver cirrhosis and abnormal neuropsychological tests were included. Nutritional consultations were conducted periodically by a dietitian, who recommended 30–35 kcal with 1.0–1.5 g of protein/kg of ideal bodyweight/day. The primary end-point was to evaluate the proportion of patients who recovered from MHE. The secondary end-point was to evaluate the improvement in the patients' quality of life (QOL). Results Thirty-two (30.1%) of 106 patients were diagnosed with MHE. Nineteen patients were enrolled in the study. Eleven of 19 patients became non-MHE after 4 weeks, and 13 of 19 patients (68.4%, P

The aim of this study was to evaluate the reliability of direct determination of trace and major element concentrations in plasma samples from wild (six hawksbill, nine green, and nine loggerhead) and captive sea turtles (25 howksbill, five green, and three loggerhead) in Okinawa, Japan. The particle induced X-ray emission method allowed detection of 23 trace and major elements (Al, As, Br, Ca, Cl, Cr, Cu, Fe, Hg, K, Mg, Mn, Mo, Ni, P, Pb, S, Se, Si, Sr, Ti, Y, and Zn). The wild sea turtles were found to have high concentrations of As and Pb in plasma compared with captive, but there were no significant changes in the Al and Hg concentrations. Loggerhead sea turtles were found to have significantly higher accumulation of As and Pb in plasma in comparison to other species. These findings may be useful when adjusting environmental and species-related factors in severely polluted marine ecosystems. Our results indicate that measuring the plasma As and Pb concentrations in wild sea turtles might be of help to assess the level of pollution in marine ecosystems, keeping in mind that loggerhead sea turtles had been shown to have higher levels of As and Pb in plasma.

Infection with Helicobacter pylori (HP) is common in many parts of the world. While most patients are asymptomatic, it causes peptic ulcer disease and malignancy in some of them. Other rare conditions have occasionally been reported in association with this infection. We report a case of hypertrophic gastropathy caused by HP in a 52-year-old asymptomatic patient. He was found to have marked enlargement of the gastric mucosal folds on radiological imaging and endoscopy. A gastric mucosal biopsy showed HP colonization associated with neutrophilic inflammation. After exclusion of neoplasia, other infections and infiltrative disorders, HP was thought to be the cause of the gastric fold hypertrophy. The patient responded well to HP eradication therapy, with normalization of the gastric mucosal folds. HP infection should be considered in the differential diagnosis of hypertrophic gastropathy and treated accordingly.

Aim: The Japanese Nutritional Study Group for Liver Cirrhosis (JNUS) was assembled in 2008 with the support of a Health Labor Sciences Research Grant from the Ministry of Health, Labor and Welfare of Japan. The goal of the study group was to propose new nutritional guidelines for Japanese patients with liver cirrhosis (LC), with the aim of preventing hepatocellular carcinoma. Methods: Between 2008 and 2010, the member investigators of JNUS conducted various clinical and experimental studies on nutrition on LC. These included anthropometric studies, a questionnaire study on daily nutrient intake, clinical trials, experimental studies using animal models, re-evaluation of previous publications and patient education. Over this 3-year period, the group members regularly discussed the nutritional issues related to LC, and a proposal was finally produced. Results: Based on the results of JNUS projects and discussions among the members, general recommendations were made on how Japanese patients with LC should be managed nutritionally. These recommendations were proposed with a specific regard to the prevention of hepatocarcinogenesis. Conclusion: The new JNUS guidelines on nutritional management for Japanese patients with LC will be useful for the actual nutritional management of patients with LC. The JNUS members hope that these guidelines will form the basis for future discussions and provide some direction in nutritional studies in the field of hepatology.

Results: Calves with CHD had significantly larger VHS values and higher plasma cTnI concentrations (P < .001) compared to control. Creatine kinase activity was not different between the control and CHD groups of calves. Diagnostic cutoffs of VHS and plasma cTnI for discrimination of groups were 8.9 vertebrae and 0.035 ng/mL, respectively. The cTnI concentration in plasma was significantly correlated with VHS (r 2 =0.512, P < .001). Conclusion and Clinical Relevance: Our results suggest that determination of plasma cTnI concentrations in calves with clinical signs compatible with CHD might prove useful as a guide to quantify cardiac remodeling associated with increased cardiac size.

The present study assessed the direct effects of IFNs on human astrocytes. Human astrocytes were exposed to human recombinant IFNs, and the proliferation of cells was measured. Type I IFN receptor mRNA and protein expression, the phosphoprotein levels of signaling molecules including JNK, ERK1/2, IκB, p38MAPK, Stat3, and the expression of cytokines were determined respectively. In addition, cellular glucose consumption was measured as well as Glut-1 protein and activation of GSK-3β/mTOR signal were determined. The expression of Type I IFN receptor was detected in cultured human astrocytes. 2 IU/ml IFNα2a and IFNα2b significantly decreased the proliferation of human astrocytes respectively, compared to control. IFNβ had no significant effect on the proliferation of the cells. The phosphorylation of JNK stimulated by all IFNs detected was more pronounced and sustained than ERK1/2 and IκB. No effects were observed on the activation of p38MAPK and Stat3. Moreover, Treatment with IFNα, especially with IFNα2b, decreased glucose consumption and stimulated phosphorylation of GSK-3β and mTOR, but decreased the expression of Glut-1. In contrast, IFNβ had no significant effect on either glucose consumption or activation of GSK-3β/mTOR signals. INFα2b significantly decreased the levels of IL-8 whereas the levels of GM-CSF were increased. The present study demonstrates direct inhibitory effects of IFNα on cell proliferation, cell signaling and glucose utilization in human astrocytes.

In this study, a large-scale field study was performed in order to distinguish between the contribution of the municipal solid waste incinerator and small clustered industrial waste incinerators in Fuchu city. The dioxin concentrations when only the municipal solid waste incinerator was being operated were found to range from 0.047 to 0.090 pg TEQ/m(3). The dioxin concentrations when only the clustered small industrial waste incinerators were being operated ranged from 0.085 to 0.25 pg TEQ/m(3). The concentrations in ambient air were more strongly affected by the clustered industrial waste incinerators than the municipal solid waste incinerator. Furthermore, the predicted concentrations by an atmospheric dispersion simulation model were consistent with the measured concentrations. From these results, the dioxin concentrations in ambient air were attributed primarily to the clustered small industrial waste incinerators.

Variations in concentrations of herbicide bromobutide (RS)-2-bromo-N-(α,α-dimethylbenzyl)-3,3-dimethylbutyramide, and its metabolite bromobutide-debromo, N-(α,α-dimethylbenzyl)-3,3-dimethylbutyramide were investigated in soils from three paddy fields used for rice farming at 24 weeks after application. The bromobutide concentration was maximum within 24 h after application. That of bromobutide-debromo was maximum within 5-7 days of application. Each gradually decreased to below detection limits at 12-22 weeks after application. Bromobutide was detected up to 76-104 days after application in the paddy soils, whereas bromobutide-debromo was detected up to 125 days after application. The bromobutide composition was higher than 90 % within 6 days of application, decreasing to less than 5 % by 125 days of application. The decrease of bromobutide amount in the soil was inferred as the first-order reaction. The bromobutide half-life was calculated as 12-21 days (16 days mean) during 18-104 days following application.

Behavior of the herbicide bromobutide, (RS)-2-bromo-N-(α,α-dimethylbenzyl)-3,3-dimethylbutyramide, in paddy water and soil after application to paddy fields was investigated to evaluate the degradation to bromobutide-debromo, N-(α,α-dimethylbenzyl)-3,3-dimethylbutyramide, and runoff of the herbicide. The respective maximum concentrations of bromobutide and the metabolite were 1,640–2,230 and 11.1–15.8 μg/L in the paddy water, and 2,210–4,140 μg/kg dry and 74–119 μg/kg dry in the paddy soil, respectively. The runoff ratios of the applied bromobutide from the paddy fields were calculated as 28 ± 16%. The respective mean values of the half-lives of bromobutide in the paddy water and the soil were 2.7 ± 0.34 days and 6.9 ± 2.6 days, respectively.

The aim of this study was to evaluate the reliability and effectiveness of direct determination of trace and major element concentrations in bronchoalveolar lavage fluid samples from Holstein calves with Mycoplasma bronchopneumonia (n = 21) and healthy controls (n = 20). The samples were obtained during bronchoscopy using a standard examination method. A total of 18 elements (aluminum, bromine, calcium, chlorine, chromium, copper, iron, potassium, magnesium, manganese, molybdenum, nickel, phosphorous, sulfur, silicon, strontium, titanium, and zinc) were detected by particle-induced X-ray emission. The average bromine, iron, potassium, magnesium, and phosphorous concentrations were higher in calves with bronchopneumonia than in controls (p < 0.05). They were found to have higher amounts of calcium and zinc, and a higher zinc–copper ratio than that in healthy calves (p < 0.001). Based on the receiver operating characteristics curves, we propose a diagnostic cutoff point for zinc–copper ratio for identification of Mycoplasma pneumonia of 8.676. Our results indicate that assessment of the elemental composition of broncholaveolar lavage fluid is a promising diagnostic tool for Mycoplasma bronchopneumonia.

A nationwide statistical survey of 4196 dialysis facilities was conducted at the end of 2009, and 4133 facilities (98.5%) responded. The number of patients undergoing dialysis at the end of 2009 was determined to be 290 661, an increase of 7240 patients (2.6%) compared with that of 2008. The number of dialysis patients per million at the end of 2009 was 2279.5. The crude death rate of dialysis patients from the end of 2008 to the end of 2009 was 9.6%. The mean age of the new patients introduced into dialysis was 67.3 years old and the mean age of the entire dialysis patient population was 65.8 years old. Primary diseases such as diabetic nephropathy and chronic glomerulonephritis for new dialysis patients, showed a percentage of 44.5% and 21.9%, respectively. Based on the facilities surveyed, 84.2% of the facilities that responded to the questionnaire satisfied the microbiological quality standard for dialysis fluids for the Japanese Society for Dialysis Therapy (JSDT), with an endotoxin concentration of less than 0.05 EU/mL in the dialysis fluid. Similarly, 98.2% of the facilities surveyed satisfied another standard of the society of a bacterial count of less than 100 cfu/mL in the dialysis fluid. The facility survey indicated that the number of patients who were treated by blood purification by both peritoneal dialysis and extracorporeal circulation, such as hemodialysis, was 1720. Among the total number of patients, 24.8% were satisfied with the management target recommended in the treatment guidelines for secondary hyperparathyroidism. These standards are set by the JSDT, based on the three parameters, i.e. serum calcium concentration, serum phosphorus concentration, and serum intact parathyroid hormone concentration. According to the questionnaire, 9.8% of the patients were considered to have a complication of dementia.

The aim of this study was to evaluate the relationships between carapace parameters as indicators of age and plasma elements in 25 captive hawksbill sea turtles. Particle-induced X-ray emission allowed detection of 23 trace and major elements. There were significant but weak correlations between the virtual carapace surface area and plasma bromide (r = -0.552, P

Acoustic radiation force impulse (ARFI) imaging is a new technology used to determine liver elasticity. We report the case of a patient that survived hyperacute-type acute liver failure (ALF) and who showed a dramatic change in the value of shear wave velocity (SWV) measured by ARFI, which corresponded with the severity of her liver damage. The value of SWV increased significantly up to 3.6 ± 0.3 m/s during the encephalopathy phase and then decreased along with the recovery of liver function, the blood flow of the right portal vein, and the liver volume. These findings suggest the value of SWV in ALF as a reliable marker of liver tissue damage. Further investigations of the pathophysiological significance of SWV in ALF are warranted. © 2011 Wiley Periodicals, Inc. J Clin Ultrasound 40:99–104, 2012

BACKGROUND: The prognosis of advanced hepatocellular carcinoma (HCC) remains poor, particularly among patients with portal vein tumor thrombosis (PVTT). This study evaluated the efficacy of combined 5-fluorouracil and pegylated interferon (PEG-IFN) α-2b in patients with advanced HCC. METHODS: Subjects comprised 59 HCC patients with PVTT treated using subcutaneous administration of PEG-IFNα-2b (50-100 μg on day 1 of each week for 4 weeks) and intra-arterial infusion of 5-fluorouracil (250 mg/d for 5 hours on days 1-5 of each week for 4 weeks). One treatment cycle lasted 4 weeks. The current therapy was discontinued in patients with progressive disease (PD). For responses other than PD, treatment was repeated for ≥1 cycle. The primary efficacy endpoint was the objective early response rate. Secondary efficacy endpoints were progression-free survival (PFS) and overall survival. RESULTS: Objective early response rate was 73.0%. Cumulative PFS rates were 67.4% at 6 months, 30.2% at 12 months, 25.9% at 18 months, and 20.7% at 24 months. Median PFS was 9.7 months. Cumulative survival rates were 82.4% at 6 months, 73.6% at 12 months, 52.8% at 24 months, and 44.0% at 36 months. Median survival time was 29.9 months. All adverse reactions were controllable by temporary suspension of treatment. Serious complications and treatment-related deaths were not observed. CONCLUSIONS: Although a prospective randomized controlled trial using a larger population of patients with advanced HCC is needed to evaluate combination therapy with 5-fluorouracil and PEG-IFNα-2b, this new combination therapy may be useful for patients with advanced HCC. Cancer 2011. © 2011 American Cancer Society.

Aim: In Japan, the indication for liver transplantation in patients with acute liver failure (ALF) is currently determined according to the guideline published in 1996. However, its predictive accuracy has fallen in recent patients. Thus, we attempted to establish a new guideline. Methods: The subjects were 1096 ALF patients enrolled in a nationwide survey. All patients showed a prothrombin time

Magnetic carbonaceous materials were produced by carbonization of a cation exchange resin loaded with ferrous or ferric iron and activation using sieved oyster shell as the activation agent. The magnetic carbonaceous material with the maximum magnetic flux density on every axis (ESS-1) was obtained from the ferric-loaded resin by carbonization at 700 °C, followed by activation with the oyster shell at 900 °C, and magnetization. A separate step of carbonization and activation appears to cause more of a reduction reaction of Fe to form γ-Fe 2 O 3 . The Fe compound in the magnetic carbonaceous material was identified from the XRD pattern as mainly γ-Fe 2 O 3 . The magnetic flux density on every axis increased linearly as the amount of the oyster shell increased. Moreover, the adsorption ability of the products was evaluated for pesticides and metal ions. Both ESS-1 and a carbonaceous material obtained from the resin without ferric ion (RC) appear to have the highest adsorption ability for lead. Furthermore, the adsorption ability of ESS-1 might decrease by blockages of the pores with the loaded Fe compounds.

Notch signaling is often and aberrantly activated by hypoxia during tumor progression; however, the exact pathological role of hypoxia-induced Notch signaling in tumor metastasis is as yet poorly understood. In this study, we aimed to define the mechanism of Notch ligand activation by hypoxia in both primary tumor and bone stromal cells in the metastatic niche and to clarify their roles in tumor progression. We have analyzed the expression profiles of various Notch liagnds in 779 breast cancer patients in GEO database and found that the expression of Jagged2 among all five ligands is most significantly correlated with the overall- and metastasis-free survival of breast cancer patients. The results of our immunohistochemical (IHC) analysis for Jagged2 in 61 clinical samples also revealed that both Jagged2 and Notch signaling were strongly up-regulated at the hypoxic invasive front. Activation of Jagged2 by hypoxia in tumor cells induced EMT and also promoted cell survival in vitro. Notably, a γ-secretase inhibitor significantly blocked Notch-mediated invasion and survival under hypoxia by promoting expression of E-cadherin and inhibiting Akt phosphorylation. Importantly, Jagged2 was also found to be up-regulated in bone marrow stroma under hypoxia and promoted the growth of cancer stem-like cells by activating their Notch signaling. Therefore, hypoxia-induced Jagged2 activation in both tumor invasive front and normal bone stroma plays a critical role in tumor progression and metastasis, and Jagged2 is considered to be a valuable prognostic marker and may serve as a novel therapeutic target for metastatic breast cancer.

Summary Background Aortoesophageal fistula (AEF) is an uncommon condition that presents a problem in therapy because of the high rate of morbidity and mortality associated with its surgical management and the uniformly fatal outcome of medical treatment. In this article we describe a case of secondary AEF after endoluminal stent grafting of the thoracic aorta, which was observed by only conservative management and followed up for 14 months with no signs of recurrent hemorrhage or chronic mediastinitis. Case Report A 54-year old man with hepatocellular carcinoma (HCC) was admitted to our hospital because of tarry stool. He had a history of traumatic aneurysm, and undergone segmental replacement with a stent graft three years ago. After admission, Esophagogastroduodenoscopy and computed tomography identified AEF. He was treated conservatively, because his stage of HCC was advanced. Oral intake was prohibited, and the patient received proton pump inhibitors, intravenous hyperalimentation and antibiotics. Afterwards, no signs of hemorrhage were observed. Although oral intake was resumed after that, another bleeding event or development of mediastinitis was not observed. Subsequently, He was received chemotherapy for advanced HCC, and we observed downstaging of his advanced HCC. Conclusions Although we observed 14 months survival in our case under conservative management of secondary AEF, it seems that the treatment of secondary AEF should do the operative management.

The transportation of high-viscosity fluid and solid–liquid mixtures is required in various settings, such as food plants and petroleum plants, and in various fields, including the civil engineerin...

Background. The small intestine has been considered to be a highly difficult organ to visualize in imaging examinations due to its anatomical location compared with the stomach and the colon. In recent years, many imaging modalities have become available, such as CT enterography, MR enterography, capsule endoscopy (CE), and double-balloon endoscopy (DBE).Patients and Methods. DBE was performed in the postoperative intestines of 91 patients (128 DBE examinations) at Iwate Medical University between 2004 and 2010. There were 61 male and 30 female patients, and their mean age was 69.7 years (range: 30–80 years).Results. A total of 124 DBE examinations were performed with endoscope insertion into the reconstructed intestines. The endoscope reached the blind end in 115 of 124 examinations, (92.7%). There were 17 patients with obscure gastrointestinal bleeding in whom 30 DBE examinations were performed. The bleeding site was identified in 12 patients (70.6%). Nine patients underwent endoscopic treatment. Hemostasis was achieved in all patients.Conclusion. DBE is very useful modality for the assessment and application of endotherapy to areas of the small bowel which have been altered by surgery.

We investigated an optimal maintenance problem for a condition monitoring system that is formulated as a partially observable Markov decision process. In almost all previous research, the optimal control limit policy with respect to totally positive of order 2 (TP2) ordering of the state probability vectors was derived using the property of posterior probability. We call this approach “Approach PP.” Attempts to achieve an optimal control limit policy based on stochastic increasing (SI) ordering, which is weaker than TP2 ordering, ran into a difficulty. That is, the SI property of the posterior probability vectors could not be obtained, and this property is needed to derive results expected using Approach PP. We investigated the conditions for the SI property of posterior probability vectors and derived a necessary and sufficient condition that cannot be further relaxed when we try to derive an optimal control limit policy based on SI ordering using Approach PP. This condition is that the condition...

This study aimed to investigate whether a small volume of 7.2% hypertonic saline solution with 6% dextran 70 (HSD) is superior to mannitol in vasodilatation of encephalic vessels in the dogs using magnetic resonance imaging (MRI). Fifteen healthy 2.4 ± 0.9 year-old purpose-bred male Beagle dogs were assigned to receive 5 mL/kg of isotonic saline solution (ISS) as control, 20% mannitol or HSD infusion at a flow rate of 20 mL/kg/hours via right cephalic vein.Venous blood samples were collected immediately before fluid infusion (pre) and every 15 minutes until 120 minutes after the initiation of fluid infusion. Immediately after collection of each blood sample, T1 and T2-weighted magnetic resonance imaging recordings were undergone. Immediately after HSD infusion, the area of the cross-section of superior sagittal sinus was significantly greater than that of beagles in the other groups (p < 0.001), reaching the 2.09 ± 0.25 times prevalue. During the 120 minutes period of observation after the initiation of fluid infusion, HSD infusion significantly reduced the area of the cross-section of CSF compared with the mannitol group ((p < 0.001). Our results indicate that HSD induced a rapid and strong reduction in the area of the cross-section of CSF more than mannitol did. Therefore, it is suggested that 5 mL/kg of HSD might be superior to isovolume of mannitol in inducing vasodilatation in the dog.

Aim: Carnosic acid (CA) inhibits adipogenesis in vitro. The present study evaluated the therapeutic effects of CA in ob/ob mice. Methods: The experimental animals were given a standard chow diet with or without CA for 5 weeks. Bodyweight gain and food intake were measured during this period. Magnetic resonance imaging analysis, histological examination, serum chemistry analysis and intraperitoneal glucose tolerance test (IPGTT) were all performed. Results: The mice fed CA experienced significant weight loss and reduced visceral adiposity, in addition to significantly reduced serum triglyceride (TG) and cholesterol levels. Importantly, CA had a dramatic effect on the liver by reducing the hepatic TG content, thus decreasing serum alanine aminotransferase levels. In addition, IPGTT revealed that CA significantly improved glucose tolerance. Conclusion: These data suggest that CA is a novel therapeutic agent for obesity-related non-alcoholic fatty liver disease.

This study evaluated the efficacy of combined 5-fluorouracil (5-FU) and pegylated interferon (PEG-IFN) α-2b in patients with advanced hepatocellular carcinoma (HCC).Fifty patients with portal vein tumor thrombosis were enrolled. Of these, 21 patients were treated using subcutaneous administration of PEG-IFNα-2b and intra-arterial infusion of 5-FU (5-FU/PEG-IFN group), 12 patients were treated using intramuscular administration of IFNα-2b and intra-arterial infusion of 5-FU (5-FU/IFN group), and 17 patients received intra-arterial infusion chemotherapy with lipiodol-cisplatin (CDDP) suspension (CDDP group).The objective early response rate was significantly higher in the 5-FU/PEG-IFN group than in the 5-FU/IFN or CDDP groups (71.4 vs. 8.3% and 17.6%, respectively; P0.0001). Cumulative survival rates at 6 and 12 months were 83.8 and 77.8% in the 5-FU/PEG-IFN group, 60.8 and 16.2% in the 5-FU/IFN group, and 58.4 and 12.5% in the CDDP group, respectively. The cumulative survival rate was significantly higher in the 5-FU/PEG-IFN group than in the other 2 groups (P = 0.0272). Serious complications and treatment-related deaths were not observed in any of the 3 groups.Although a prospective randomized controlled trial using a larger population of patients with advanced HCC is needed to evaluate combination therapy with 5-FU and PEG-IFNα-2b, this new combination therapy may be useful for patients with advanced HCC.

Objective—To assess the usefulness and reliability of a milk-flow measurement technique and the values obtained in unobstructed teats and teats with teat canal stenosis in dairy cows. Animals—16 Holstein cows. Procedures—Teats were assessed via hand milking and classified as unobstructed or partially obstructed. Partially obstructed teats were further categorized according to the anatomic location of the obstruction via ultrasonography into teat canal obstruction (TCO) and obstruction at the proximal portion of the teat canal (Fürstenberg rosette obstruction [FRO]) The milk-flow characteristics of the teat canal were assessed by measuring the intracisternal pressure at the start (PSL) and at cessation (PCL) of leakage of an infused solution. Results—The PSL and PCL values among unobstructed teats were not significantly different between lactating and nonlactating cows nor among quarters. In assessment of test-retest intrarater reliability, a high degree of correlation was detected for PSL (correlation coefficient, 0.94; 95% confidence interval, 0.90 to 0.96) and PCL (correlation coefficient, 0.92; 95% confidence interval, 0.86 to 0.95). Teats with TCO and FRO had higher PSL and PCL values, compared with unobstructed teats. Teats with FRO had significantly higher PSL but lower PCL than teats with TCO. Conclusions and Clinical Relevance—Results indicated the usefulness and reliability of the technique in assessing the milk-flow characteristics of the teat canal. The milk-flow pattern of teats with teat canal stenosis varies depending on the location of obstruction. This technique may be a valuable tool in evaluating the effectiveness of teat canal surgery. (Am J Vet Res 2010;71:1123-1126)

In recent years, due to the increasing prevalence of upper gastrointestinal endoscopy, there have been an increasing number of reports on duodenal adenoma and early stage cancer. However, endoscopic techniques for the resection of duodenal adenomas are difficult, due to the anatomical features of the duodenum, and the long distance to the lesion. There have only been a few reports on the use of endoscopic techniques for duodenal adenomas compared to those focused on the stomach and large intestine. For duodenal adenomas, we used a conventional endoscope for lesions proximal to the major duodenal papilla, and a short-type double balloon endoscope for lesions distal to the papilla. The en-bloc resection rate was 93.8%. There was only one case of microperforation. Endoscopic manipulation is considered difficult in the deep areas of the duodenum, but double balloon endoscopy enabled stable manipulation and successful resection of the tumor in the majority of cases.

Nitrate concentrations in 326 recent vegetables and berries sold in Niigata, located in central Japan, were investigated. Maximum nitrate concentrations of 6600 mg kg−1 were detected in samples of komatsuna (Brassica campestris var. perviridis) and mizuna (B. campestris L.). Mean concentrations ranged from 4 mg kg−1(blueberry) to 3500 mg kg−1 (mizuna). Concentrations in spinach ranged from 10 to 6000 mg kg−1 (mean 1500 mg kg−1). Nitrate intake from spinach and Japanese radish (Raphanus sativus) were estimated to be 0.7 and 0.8 mg kg−1 day−1, respectively. These values are equivalent to 19% and 23% of the acceptable daily intake (ADI). Nitrate intake at the 90th percentile was estimated to be 1.3 mg kg−1 day−1 (35% of the ADI) from spinach and 1.6 mg kg−1 day−1 (43% of the ADI) from Japanese radish.

The HfO2 films were prepared on the ITO/polyimide substrate using alkoxy-derived precursor solutions at low temperature. The HfO2 films prepared by UV-assisted process using the precursor solution modified with diethanolamine had smooth surface and RMS roughness values of HfO2 film were 1.2nm. The electrical properties of HfO2 films were improved by optimization of preparation condition. The leakage current density at 1V was below 10-5A/cm2. The dielectric constant was about 20. The loss tangent was below 0.1.

The subjects of this study were 208 patients who underwent endoscopic hemostasis at the Department of Gastroenterology and Hepatology, Iwate University between January 2004 and December 2008. There were 153 men and 55 women with a mean age of 65.3 years. Among them, 181 patients underwent endoscopic hemostasis in the stomach or duodenum and were divided into the peptic ulcer and artificial ulcer groups. The following were retrospectively analyzed: success rates of endoscopic hemostasis, rates of rebleeding, and devices used during treatment. The overall success rate of endoscopic hemostasis was 97.2%. Hemostasis was achieved in 98.2% of the cases with peptic ulcer bleeding and in 88.9% of the cases with artificial ulcer bleeding. Monotherapy (one hemostatic device) was used in 141 cases (77.9%), combination therapy (multiple hemostatic devices) was used in 39 cases (21.5%), and primary hemostasis was used in one case (0.6%) because of blood flow reduction during the observation period. A heat probe was used in 145 cases (80.1%), making it the most frequently used device. Endoscopic hemostasis is very effective for nonvariceal upper gastrointestinal bleeding.

Aim: To evaluate changes in liver function parameters and risk factors 1 year after percutaneous radiofrequency ablation (RFA) therapy in patients with hepatocellular carcinoma (HCC). Methods: Subjects in this retrospective study comprised 45 patients with HCC who underwent RFA therapy (RFA alone, n = 25; transcatheter arterial embolization therapy before RFA, n = 20) and showed no recurrence of HCC 1 year after RFA. Serial changes in serum total bilirubin, albumin, prothrombin time and Child–Pugh score (CPs) were evaluated before and after RFA. In addition, Cox proportional hazards regression analysis was used to clarify risk factors for aggravation of liver function after RFA therapy. Results: Serum albumin levels showed a significant decrease from before (3.6 ± 0.4 g/dL) to 12 months after RFA therapy (3.2 ± 0.4 g/dL; P ≤ 0.05). CPs was significantly increased from before (6.4 ± 1.4) to both 6 months (6.8 ± 1.9; P ≤ 0.05) and 12 months after RFA (6.9 ± 2.0; P ≤ 0.05). Based on stepwise multivariate analysis, CPs of 9 or more before RFA was selected as a significant risk factor for long-term aggravation of liver function after RFA. Conclusion: Liver function parameters, particularly serum albumin level, gradually and dominantly decreased in HCC patients with grade B and C according to the CPs classification over the course of 1 year after RFA therapy. A CPs of 9 or more represents a major risk factor for the aggravation of liver function after RFA therapy.

Background and Aim: This prospective control study examined whether supplementation with branched-chain amino acid (BCAA)-enriched nutrients can help maintain and improve residual liver function and nutritional status in cirrhotic patients with hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA). Methods: Subjects were 49 patients with hepatitis C-related HCC who underwent RFA. Two groups were formed: BCAA group (BCAA-enriched nutrient, aminoleban EN) and controls (standard diet only). Event-free survival rate, liver function tests, and Short Form (SF)-8 scores were evaluated in both groups before and one year after RFA. Energy metabolism using indirect calorimetry was measured before and after 3 months. Results: Complete data were obtained from 35 patients (BCAA group, n = 20; controls, n = 15). Six events (death, recurrence of HCC, rupture of esophageal varices and liver failure) occurred during the observation period, but frequencies of these events did not differ between groups. Event-free survival rate tended to be higher in the BCA group than in controls. Among the parameters of liver function, serum albumin level was only significantly increased over 6 months, and remained at similar values for one year (P

We aimed to clarify the relationship between plasma-free amino acid (PFAA) profiles and the Crohn’s disease (CD) activity index (CDAI) in patients with CD. Methods: We measured fasting PFAA concentrations in 29 patients with CD and their correlation with disease activity. Results: In all patients, significant correlations were noted between CDAI and concentrations of valine, methionine, leucine, histidine, tryptophan, alanine, tyrosine, total amino acids (TAAs), nonessential amino acids (NEAAs), essential amino acids (EAAs), and branched-chain amino acids (BCAAs). In patients with the ileo-colonic type of CD, significant correlations were noted between CDAI and valine, histidine, tryptophan, glutamine, TAA, NEAA, EAA, and BCAA. In ileal type, significant correlations were observed between CDAI and threonine, valine, histidine, serine, and glycine. In colonic type, significant correlations were noted between CDAI and valine, histidine, tryptophan, TAA, NEAA, EAA, and BCAA. Conclusions: In patients with CD, plasma amino acids appear to be associated with disease activity.

To evaluate the antinociceptive, sedative and cardiopulmonary effects of subarachnoid and epidural administration of xylazine-lidocaine in xylazine-sedated calves.Prospective, crossover study.Six clinically healthy Holstein calves.The calves were allocated randomly to receive two treatments, subarachnoid or epidural xylazine (0.025 mg kg(-1))-lidocaine (0.1 mg kg(-1)) diluted to a total volume of 5 mL with physiological saline. Prior to either epidural or subarachnoid injection, sedation was induced in all calves by intravenous administration of 0.1 mg kg(-1) xylazine. The quality and duration of antinociception and sedation were monitored. Areas of the cranial abdomen, umbilicus, and caudal abdomen were evaluated for antinociception using pinprick tests with a scoring system of 0-3 (0, none; 1, mild; 2, moderate; 3, complete). Sedation was assessed by using a 4-point scale (0, none; 1, mild; 2, moderate; 3, deep). The following cardiopulmonary variables were monitored: heart rate (HR), respiratory rate (f(R)), mean arterial pressure (MAP), blood pH, arterial partial pressure of oxygen (PaO(2)), partial pressure of carbon dioxide (PaCO(2)), bicarbonate (HCO(3)), base excess (BE), and oxygen saturation (SaO(2)).Xylazine sedation and subarachnoid xylazine-lidocaine resulted in significantly higher nociceptive block than the epidural technique. Moreover, subarachnoid xylazine-lidocaine induced a significantly longer duration of complete antinociception (median [IQR]) in the cranial abdomen (15.0 [15.0-30.0] versus 7.5 [1.3-10.0] minutes; p0.05) and umbilicus (45.0 [32.5-57.5] versus 10.0 [6.3-17.5] minutes; p0.05) compared with epidural xylazine-lidocaine. There was moderate sedation with both techniques. In both treatments, blood pH, MAP and PaO(2) decreased significantly, and PaCO(2) increased significantly during anaesthesia. No change was evident in HR, f(R), HCO(3,) BE, or SaO(2).The subarachnoid injection provided better quality and longer duration of antinociception than epidural administration of the same doses of xylazine-lidocaine in xylazine-sedated calves, while cardiopulmonary depressant effects were observed with both regimens.

Background: Many studies have estimated the prevalence of anti-hepatitis C virus (HCV) antibody among hemodialysis (HD) patients; however, the prevalence of HCV core antigen—which indicates the presence of chronic HCV infection—is not known.Methods: Standardized prevalence ratios (SPRs) for anti-HCV antibody and HCV core antigen among HD patients (n = 1214) were calculated on the basis of data from the general population (n = 22 472) living in the same area.Results: The prevalences of anti-HCV antibody and HCV core antigen were 12.5% and 7.8%, respectively, in male hemodialysis patients, and 8.5% and 4.1% in female hemodialysis patients. The SPRs (95% confidence interval) for anti-HCV antibody and HCV core antigen were 8.39 (6.72–10.1) and 12.9 (9.66–16.1), respectively, in males, and 5.42 (3.67–7.17) and 8.77 (4.72–12.8) in females.Conclusions: The prevalences of chronic HCV infection among male and female HD patients were 13-fold and 9-fold, respectively, those of the population-based controls. Further studies should therefore be conducted to determine the extent of chronic HCV infection among HD patients in other populations and to determine whether chronic HCV infection contributes to increased mortality in HD patients.

The HfO2 films prepared from alkoxy-derived precursor solution chemically modified with diethanolamine. The effects of UV irradiation on the HfO2 films were investigated. The UV irradiation using low pressure mercury lamp (LPML) was effective for the organics decomposition in the film and densification. The uniform and smooth HfO2 films were obtained. The refractive index of HfO2 films was enhanced.

The large scale SSPS (Space Solar Power System) needs large reflection mirrors for sunlight concentration. To use film mirror in space, the mirror must have lightweight structures and resistive to harsh space environment. The wavelength selective filter to avoid heat is a dielectric multilayer film which has FGM structure. In this article, we will report the development of a lightweight wavelength selective mirror and wavelength selection on the solar light excitation laser.

Background: We analysed the association of the 5′ nontranslated region (5′NTR), nonstructural proteins 2B and 2C of the hepatitis A virus (HAV) genome, whose mutations have previously been shown to be important for enhanced replication in cell culture systems, in order to align all our data and examine whether genomic differences in HAV are responsible for the range of clinical severities. Methods: Our accumulated HAV strains of 5′NTR [nucleotide(nt) 200 and 500], entire 2B and 2C from 25 Japanese patients with sporadic hepatitis A, consisting of seven patients with fulminant hepatitis (FH), five with severe acute hepatitis (AHs) and 13 with self-limited acute hepatitis (AH), in whom the sequences of all three regions were available, were subjected to phylogenetic analysis. Results: Fulminant hepatitis patients had fewer nucleotide substitutions in 5′NTR, had a tendency to have more amino acid (aa) substitutions in 2B and had fewer aa substitutions in 2C than AH patients. Four FH and two AHs with a higher viral replication were located in the near parts of the phylogenetic trees, indicating the association between the severity of hepatitis A and genomic variations in 5′NTR, 2B and 2C of HAV. Conclusions: Our study suggests that genetic variations in HAV not in one specific region but in 5′NTR, 2B and 2C might cooperatively influence replication of the virus, and thereby affect virulence. Viral factors should be considered and examined when discussing the mechanisms responsible for the severity of hepatitis A.

Tumor necrosis factor α plays an important role in the pathogenesis of Crohn’s disease (CD). The effects of infliximab on gastrointestinal bleeding in CD have not yet been fully evaluated. Herein we describe three CD cases who presented with gastrointestinal bleeding and received infliximab treatment. In case 1, double-balloon endoscopy showed a large ulcer with several irregularly shaped ulcers in the terminal ileum; 8 weeks after infliximab administration, complete healing of all lesions was observed. In case 2, double-balloon endoscopy showed linear ulcers and mucosal edema in the jejunum and ileum; 5 weeks after infliximab administration, all lesions were decreased in size and were healed. In case 3, double-balloon endoscopy revealed ulcerations and stenosis in the terminal ileum; 12 weeks after infliximab administration, ulcer healing and an increased diameter of the ileal stenosis were observed. These three cases have been receiving ongoing infliximab maintenance therapy and are currently symptom-free. Infliximab thus appears to be useful for treatment of gastrointestinal bleeding in CD patients.

A randomized, double-blind, multicenter study (ETV-047) was conducted to evaluate the dose-response relationship of entecavir and compare its antiviral activity and safety with lamivudine in Japanese patients with chronic hepatitis B (CHB).One hundred thirty-seven nucleoside-naive adult patients with CHB were randomized to once-daily oral doses of entecavir 0.01, 0.1, or 0.5 mg or lamivudine 100 mg for 24 weeks. The primary efficacy end point used to evaluate the dose-response relationship was mean change from baseline in serum hepatitis B virus (HBV) DNA level at week 22, as determined by polymerase chain reaction assay.Entecavir demonstrated a clear dose-response relationship, with mean change from baseline in serum HBV DNA level of -3.11, -4.77, and -5.16 log(10) copies/ml with entecavir 0.01, 0.1, and 0.5 mg, respectively. Entecavir 0.5 mg was superior to lamivudine 100 mg for the mean change in HBV DNA level (-5.16 vs. -4.29 log(10) copies/ml; P = 0.007). The overall incidence of adverse events was comparable between treatment groups. Two patients discontinued treatment because of adverse events (one with liver cirrhosis [entecavir 0.5 mg] and one with grade 4 serum alanine aminotransferase (ALT) elevation, nausea, and malaise [lamivudine 100 mg]). Serum ALT flares were observed in four patients; flares were associated with 2 log(10) reductions or more in HBV DNA level and resolved without dose interruption.Entecavir 0.01-0.5 mg is well tolerated and produces a dose-dependent reduction in viral load in nucleoside-naive Japanese patients with CHB. Compared with lamivudine 100 mg, entecavir 0.1 mg demonstrated noninferiority and entecavir 0.5 mg was superior in this population.