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The optimal sintering conditions for LiZr2(PO4)3, a NASICON-type solid electrolyte with high conductivity, were explored. It was also found that these optimum sintering conditions could be efficiently discovered by using Bayesian optimisation.

Demonstrate BO approaches to search for optimal composition with high ionic conductivity efficiently.

Background/Aims: The present study was performed to compare the safety of sedation with propofol during endoscopic submucosal dissection (ESD) for gastric tumors under sedation in the endoscopy room by an endoscopist versus sedation in the operation room by an anesthesiologist. Methods: In total, 638 patients with gastric tumors who underwent ESD from January 2011 to August 2017 at Ureshino Medical Center and Saga Medical Center Koseikan were retrospectively reviewed. The patients were divided into 2 groups: those who underwent ESD in the endoscopy room (Group E, n = 532) and those who underwent ESD in the operation room (Group O, n = 106). Propensity score matching was applied for evaluation. The treatment outcome of ESD and the adverse events of sedation during ESD (desaturation, hypotension, bradycardia, and arrhythmia) were compared between the 2 groups to consider the safety of ESD. Results: The propensity score-matching analysis created 82 matched pairs. Adjusted comparisons between Groups E and O showed similar treatment outcomes of ESD for gastric tumors. There were no significant differences in the treatment outcomes, anesthesia time, and mean propofol dose between the 2 groups. With respect to adverse events, desaturation occurred more often in Group E than Group O (18.3 vs. 3.7%, respectively; p = 0.005). There were no significant differences in other adverse events (hypotension, bradycardia, and arrhythmia) between the 2 groups. Conclusion: Sedation with propofol in the operation room might be required to ensure safer application of ESD for gastric tumors. However, a decrease in the desaturation rate was the only disadvantage of sedation in the endoscopy room.

Rectovaginal fistulas (RVFs) are abnormal connections between the rectum and vagina.A 61-year-old female patient was admitted to the authors' hospital with swelling, extending from the left thigh to the left lower abdomen and crepitus. An axial computed tomography scan showed air in the soft tissue of the left thigh, left buttock, perineal region, and left lower abdomen. Gas gangrene was suspected. Accordingly, the patient was administered meropenem, clindamycin, and vancomycin and underwent emergency debridement. An intraoperative examination revealed necrotizing fasciitis in the left buttock but no inflammatory signs in the thigh. On postoperative day 8, fecal matter was discharged from the patient's vagina, and an RVF was detected by colon fiberscopy. The patient underwent resurfacing surgery with a free skin graft, and a colon stoma was fashioned 15 days after the primary surgery. The patient was discharged on day 14 following surgery with wound healing.The existence of free air in subcutaneous tissue combined with an infection, particularly in the extremities, is generally suggestive of gas gangrene. In the present case, subcutaneous gas was not caused by gas gangrene but rather by air inflow from an RVF. Appropriate treatment of the RVF was necessary to avoid the exacerbation of Fournier's gangrene and prevent necrosis spreading to the thigh.

Introduction Cultured stratified epithelial cell sheets have been clinically utilized as transplantable grafts for the regeneration of epithelial tissues, such as the esophagus, cornea, skin, and intraoral cavity. These cell sheets are expected to gain widespread use as regenerative medicine products and save many patients. For this purpose, establishing and disseminating the stale protocol of fabricating the cell sheet is crucial. The fabrication of cultured stratified epithelial cell sheets consists of many important steps, and since the patients’ epithelial cell conditions vary widely and are sometimes unstable, the qualities of the epithelial cell grafts are likewise potentially unstable. Therefore, in this paper, we report the stable protocol for fabrication of the transplantable cell sheet particularly from patient-derived oral mucosal tissues. Methods Serum extracted from blood and buccal mucosal tissue were collected in Nagasaki University and transported to Tokyo Women's Medical University. Oral mucosal epithelial cells were collected by minimum trypsin method, and this treatment was studied whether to be a critical procedure. After 14 days cultivation, cultured cells were examined whether to be transplantable as cell sheets. Results We successfully transported buccal mucosal tissue and serum without damage and contamination. Oral mucosal epithelial cells were collected with high viability by minimum trypsin method. Finally, we succeeded to stably fabricate oral mucosal epithelial cell sheets in all 10 patients. Conclusions We established a stable protocol for the fabrication of human oral mucosal epithelial cell sheets and their transportation in clinical settings in this study. These methodologies could also be basis for transplantation therapy using cultured cell sheets of various types other than oral mucosal epithelial cell and will contribute largely to the future development of regenerative medicine., Highlights • A stable protocol for fabricating oral mucosal cell sheets.

Inflammatory bowel diseases (IBDs), including ulcerative colitis (UC) and Crohn’s disease (CD), are chronic intestinal diseases of unknown etiology that present with variable disease extents and outcomes. The use of biomarkers for the diagnosis and management of IBDs is considered beneficial. Palmitoleic acid (PO) is an adipose tissue-derived mono-unsaturated free fatty acid that potentially serves as a lipokine in metabolic and inflammatory diseases. The aim of this study was to investigate the significance of PO levels in the serum of patients with UC and CD. The study included patients with UC (n = 22), patients with CD (n = 35), and controls (n = 22). The levels of serum PO were analyzed using gas chromatography. The association of serum PO levels with the clinical features and disease outcomes in IBD was examined. Serum PO levels were significantly higher in patients with CD than in controls, whereas no difference in these levels was observed between patients with UC and controls. Serum PO levels were significantly associated with the CD activity index. Additionally, high serum PO levels were associated with an increased risk of surgical intervention requirement during follow-up. In a pilot study with a few patients, high PO levels were observed in the mesenteric tissue in the active disease site of patients with CD (n = 7) compared with those with colon cancer (n = 6). Elevated serum PO levels might serve as a marker for local inflammation and prognosis in patients with CD., Scientific Reports, 11, art. no. 16260; 2021

Background: Adipocytokines are associated with energy homeostasis and mediate various immune responses and inflammatory processes. Vaspin is a novel adipocytokine that is thought to exhibit anti-inflammatory effects. Aim: We aimed to evaluate serum vaspin levels in inflammatory bowel disease (IBD) and determine its possible associations with the course and to clarify its intestinal localization. Methods: Serum samples were obtained from patients with Crohn's disease (CD; n = 30) and ulcerative colitis (UC; n = 33) and from healthy volunteers (controls; n = 26). Enzyme-linked immunosorbent assays were performed for all patients. Vaspin immunohistochemical staining was performed for intestines affected with IBD. Results: Serum vaspin concentrations were significantly higher in patients with UC than in patients with CD and controls (422.9 ± 361.9 vs. 163.4 ± 116.2 vs. 147.5 ± 89.4 pg/mL, respectively; P < 0.01). There was no difference in the serum vaspin concentrations between the patients with CD and controls. There was also no difference in the serum vaspin concentrations between the patients with active IBD and those with inactive IBD. However, the serum vaspin concentrations of most patients with UC increased after remission induction. Vaspin was expressed in the adipocytes of the mesenteric adipose tissues but not in the epithelial or inflammatory cells of large intestines of the patients with IBD. Conclusions: Serum vaspin concentrations are elevated in patients with UC and increase further after remission induction, suggesting that vaspin may aid the auxiliary diagnosis of UC and may be useful for assessing disease activity in patients., Digestive Diseases and Sciences, 59(2), pp.315-321; 2014

研究ノート, In the 1970s, Language Awareness (LA) was put forward as a "bridging subject" in the UK school curriculum primarily by modern linguists such as Eric Hawkins. It was regarded as a solution to certain problems in UK schools at that time: functional illiteracy in English, difficulty in learning foreign languages, and prejudices in the increasingly multicultural society. This grassroots movement was partially stifled in that the national curriculum of 1988 did not specifically allow for LA or language to be formally taught. But this setback did not mean that the LA movement failed or was useless. LA has developed further since 1988, and the Language Awareness movement has now grown beyond Europe into a global endeavour. At the same time, EU countries have introduced the concept of plurilingualism, to be realized in the context of pluriculturalism, and have begun to conduct language education under the Common European Framework of Reference for Languages (CEFR). This language education policy has brought new potentialities and roles to LA. Today's curriculum developers have a pan-European perspective, and LA now serves not only to develop mother tongue and foreign language competences but also to promote understanding of cultural diversities. Education in the UK is no exception, and a new project, LA in primary schools, is under way.

6-Methoxy-4-quinolone (6-MOQ, 1 ), an oxidation product derived from 5-methoxyindole-3-acetic acid, is a novel fluorophore, which has several useful characteristics for biomedical analysis. Compound 1 has strong fluorescence with a large Stokes’ shift in aqueous media, and the maximum fluorescence excitation and emission wavelengths are 243 nm and 374 nm, respectively. The molar absorptivity at the maximum excitation wavelength and fluorescence quantum yield in aqueous 10% (v/v) methanol are 32 600 L mol −1 cm −1 and 0.38, respectively. The fluorescence intensity of 1 is scarcely affected by changing the medium pH, showing strong fluorescence from pH 2.0 to 11.0. In addition, 1 is highly stable against light and heat, and no degradation was observed at 60 °C for 3 days with exposure to daylight. As a fluorescent labeling reagent, [(6-methoxy-4-oxo-1,4-dihydroquinolin-3-yl)methyl]amine (6-MOQ-NH 2 , 2 ) was synthesized, and determination of carboxylic acids was demonstrated; 50 pmol of standard propionic acid and isobutyric acid were derivatized, and the obtained S/N ratios for 10 fmol (injection amount) of these two acids were 206 and 164, respectively.

The amount of endogenous melatonin in the individual pineal glands of inbred mice has been determined using reversed-phase micro-high-performance liquid chromatography after precolumn oxidation of melatonin to a compound having strong fluorescence. The fluorescent compound was identified as N-[(6-methoxy-4-oxo-1,4-dihydroquinolin-3-yl)methyl]acetamide. The excitation and emission wavelengths of this compound are 245 and 380 nm, respectively, and the fluorescence intensity is 6.8 times greater than that of melatonin. Molar absorptivity and fluorescence quantum yield of this compound are 46,300[L mol(-1)cm(-1)] and 0.31 (245 nm), respectively. The lower quantification limit of melatonin in biological samples using this precolumn oxidation method is 200 amol, and the calibration curve of spiked melatonin is linear from 200 amol to 50 fmol (r>0.999). The sensitivity of the present method is almost 10 times higher than that of the previous method. The values of endogenous melatonin obtained for ICR, C57BL, BALB/c, and AKR mice are 4.7, 6.1, 7.4, and 18.8 fmol/pineal gland, respectively. The amounts of endogenous pineal melatonin of these strains had not been clearly reported due to the poor enzymatic activities for melatonin biosynthesis; this is the first report that clearly demonstrates the existence of endogenous melatonin in these inbred mice.

Endoscopic submucosal dissection (ESD) permits en bloc removal of superficial oesophageal squamous cell carcinoma (ESCC). However, post-procedure stricture is common after ESD for widespread tumours, and multiple endoscopic balloon dilation (EBD) procedures are required. We aimed to evaluate the safety and effectiveness of endoscopic transplantation of tissue-engineered autologous oral mucosal epithelial cell sheets that had been transported by air over a distance of 1200?km in controlling postprocedural oesophageal stricture. Ten patients who underwent complete circular or semicircular ESD for ESCC were transplanted with cell sheets. The safety of the entire process including cell sheet preparation, transport, ESD and cell sheet transplantation was assessed. The incidence of oesophageal stricture, number of EBD sessions, and time until epithelialization were investigated. Each ESD was successfully performed, with subsequent cell sheet engrafting carried out safely. Following cell sheet transplantation, the luminal stenosis rate was 40%, while the median number of EBD sessions was 0. The median post-ESD ulcer healing period was rather short at 36 days. There were no significant complications at any stage of the process. Cell sheet transplantation and preparation at distant sites and transportation by air could be a safe and promising regenerative medicine technology., Scientific Reports, 7, 17460; 2017

Summary Objective Photodynamic diagnosis (PDD) is an imaging technology that is based on the fundamental biological features of cancer cells. Five-aminolevulinic acid (ALA), a precursor of photosensitizing protoporphyrin IX (PpIX) has been applied. In fact, ALA-mediated PDD provides good visualization for certain tumors. However, there have been few studies on clinical application of PDD for gastrointestinal (GI) cancers. This study was aimed to investigate the feasibility of ALA-mediated PDD for navigation of upper GI tumors. Materials and methods Using a newly developed endoscope equipped with a blue laser light excitation, ALA-mediated PDD was conducted in 27 lesions from 23 patients with upper GI tumors including 2 Barrett's intramucosal cancers. ALA solution was given orally 3 h before PDD. All the adenocarcinomas came under clinical stage I, and the tumors were resected endoscopic submucosal dissection and/or laparoscopic surgery. Red fluorescence signal and intensity was assessed as for clinicopathological features of the cases. Results The laser-based endoscopy could detect upper GI tumors as red fluorescent navigation (PDD-positive) in 23 of the 27 lesions. All but one intestinal typed tumors in histopathology were significantly PDD-positive, whereas each signet ring cell carcinoma was PDD-negative. There was a significant difference in tumor size between the PDD-positive and -negative tumors. The elevated lesions emitted significantly more intense fluorescence. Conclusions Fluorescence navigation by ALA-mediated PDD provided sufficient detection of upper GI tumors in particular for the intestinal typed tumors. Thus, ALA-PDD using the blue laser-equipped endoscope offers a promising diagnostic tool.

We treated 48 cases of femoral neck fractures between March 1998 and April 2000. The patients, consisting of 10 males and 38 females with a mean age of 72 years, were treated using compression hip screw (CHS) and cannulated cancellous screw (CCS). The purpose of this study was to investigate their clinical results. The bony union rate was 89% in Garden stages I and II and 72% in stages III and IV. There was a significant difference between bony union and alignment index (P

Sixteen subjects sat in a rotating optokinetic drum and were instructed to stare moving vertical stripes inside of the optokinetic drum. Speeds of the stripes were five visual angles (12, 24, 36, 48, 60 deg/s). EEGs and EOGs were measured. EEG epochs were averaged at onset of slow phases (pursuits) of the optokinetic nystagmus (OKN). The positive component of latency of about 100 ms appeared predominantly at the occipital region of 15 subjects in all conditions. The positive component might be the same as the lambda response that appears in EFRP to a stationary object.

円柱状成型大根を塩水に浸し,体積・質量・密度の変化を測定した.その結果,体積については収縮から膨潤,質量については減少から増加,密度については増加から減少と,それぞれ2つの期間を有することが示された.この塩水浸漬したときの大根の体積及び質量変化を数理モデルで表現するため,はじめに体積変化モデルを提案した.また,質量を体積変化モデルと同形のモデルで表現した.更に,体積および質量変化モデルを用い,密度を求めた結果,計算値は測定値を良く表現することができた.また平衡時の密度は,本実験範囲の条件下で,温度・濃度依存性を有することが示された.本研究で提案するモデルは,過去に例のないものであり,得られた基礎的知見は,塩水浸漬した大根の密度変化を考える上で,有益な指標を与えるものと考える.今後は,他の農産物を供試して本モデルの適用性を調べる予定である.

In southwestern Tokyo the area covered by bamboo forest has expanded by a factor of 2.7 over the last 26 years. This has mainly been due to bamboo (Phyllostachyspubescens) invading secondary broad-leaved forests, probably after these were abandoned. In the first stage, bamboo sprouts develop from rhizomes at the periphery of the broad-leaved forest and then grow very quickly into young culms. In the next phase culm density increases annually, while the existing broad-leaved trees gradually lose their vitality and die. Finally, the broad-leaved forest is completely replaced by bamboo forest. The competitive ability of bamboo, based on its morphological and growth features, is suggested as the causal factor for the invasion: (1) bamboo can invade a neighboring broad-leaved forest by its vigorous rhizomes; (2) young bamboo culms can break through the canopy of broad-leaved trees; (3) bamboo quickly forms a crown in or above the canopy of the broad-leaved forest; (4) bamboo is very tolerant of strong wind and heavy snow accumulation; (5) bamboo culms, being very pliable during strong wind mechanically damage neighbouring broad-leaved trees.

症例は39歳女性.仰臥位呼吸困難を呈し, 胸部X-P上右上縦隔に半月状に突出する異常陰影を認め, CT上気管の圧排像を認めた.F-V曲線では胸郭内気道閉塞パターンを示した.胸腔鏡下生検で脂肪肉腫と診断し開胸摘出した.術後胸郭内気道狭窄は寛解し, 11ヵ月経過し, 再発の微候を認めていない.気道狭窄を伴う縦隔脂肪肉腫の1手術治験例を文献的考察を加え報告した.

長期間無症状で経過し, 検診で偶然発見された縦隔良性奇形腫を経験したので報告する.症例は31歳の女性で, 12歳時学校検診で, 左肺門部異常陰影を指摘されたことがある.入院時症状はなく, 血清CA19-9が高値を呈し, 胸部X線像で左中下肺野の約2/3を占める腫瘤陰影を認めた.胸部CTなどから縦隔奇形腫と判断し, 左後側方第VI肋間開胸にて左横隔神経を一部含む腫瘤をenblockに摘出した.腫瘤摘出後横隔膜縫縮術を加え, 横隔膜挙上の防止を計った.摘出した腫瘍組織の大きさは17×7×10cmであった.病理組織学的検索により巨大な嚢胞性成熟奇形腫で三胚葉の組織要素を含み, 腺腫様の増殖を示す副腎皮質の存在する腫瘍であった.術後血清CA19-9が正常範囲に戻り, しかも縦隔奇形腫において三胚葉成分中副腎皮質腺腫組織を含む症例の報告は余りなく, 興味深い症例と考えられた.

We have assessed levels of surface-expressed complement regulatory proteins, decay-accelerating factor (DAF) and membrane cofactor protein (MCP) on cells from patients with hematological malignancies. Neither malignant cells nor unaffected nucleated blood cells from the patients lacked MCP. On the other hand, complete deficiency of DAF was found in 2/10 of non-Hodgkin's lymphoma (NHL), while none of the 38 patients with acute nonlymphocytic leukemia (ANLL) (14 cases), chronic myelogenous leukemia (CML) (6 cases), acute lymphocytic leukemia (ALL) (12 cases) and chronic lymphocytic leukemia (CLL) (6 cases) lacked DAF. The two patients with DAF-negative NHL had no history of paroxysmal nocturnal hemoglobinuria (PNH), and their peripheral blood cells were DAF-positive. One DAF-negative NHL exhibited T cell markers and the other those of B cell. In both cases, treatment of the DAF-negative lymphoma cells with antibody against MCP (M177) followed by Mg(2+)-EGTA-serum resulted in efficient deposition of homologous C3. These results infer that some NHL specifically lack DAF and, through treatment with M177, are targeted by homologous C3.

Having reached the target lesion, macroscopically complete resection was achieved in 28/31 patients (90%). Full thickness resection was confirmed histologically in 26/ 31 cases (84%). Histological complete resection was achieved in 23/31 cases (74%). No perforations were observed during or after resection. In two cases there was a minor bleeding which was controlled with an injection therapy and two patients developed a post-polypectomy syndrome which was managed with antibiotic therapy. Conclusion: Full thickness resection in the lower gastrointestinal tract with the novel FTRD is feasible and effective. Prospective studies are needed to further evaluate the technique and device. Sa1524 Identification of Esophago-Gastric Junction During Per-Oral Endoscopic Myotomy-Benefit of Indocyanine Green Injection Hitomi Minami*, Hajime Isomoto, Haruhiro Inoue, Shigetoshi Urabe, Hiroyuki Shoji, Hiroko Fukuda, Naoyuki Yamaguchi, Kayoko Matsushima, Yuko Akazawa, Ken Ohnita, Fuminao Takeshima, Kazuhiko Nakao Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan; Digestive Disease Center, Showa University Hospital, Tokyo, Japan Introduction: Per-oral endoscopic myotomy (POEM) has become one of the best therapeutic approaches for esophageal achalasia. During POEM, esophagogastric junction (EGJ) can be estimated from inside of the submucosal tunnel by insertion length of the scope, visualizing palisade vessel, and resistance to the endoscope. However, it is often difficult to accurately recognize the EGJ especially in technically challenging cases such as post-operative cases and sigmoid type esophagus. Therefore, we evaluated the usefulness of indocyanine green (ICG) injection at the cardia for precise identification of EGJ during POEM procedure. Material and Method: Eighty-eight cases (male: female 37: 51) aged from 18 to 85 (mean 51.5) who underwent POEM in our institution between August 2010 and November 2014 were enrolled in the study. Mean duration after symptom onset was 11.7 years (1-50, median 5). POEM was performed according to Inoue’s original procedure under general anesthesia and carbon dioxide gas insufflation. For 36 cases since August 2013, 0.5ml of ICG was injected into submucosal layer at the level of cardia prior to POEM as a marking for precise identification of EGJ. Results of the procedure including operation time, subjective symptom score, esophageal manometry study, and complication rate were compared between ICG injected group and noninjection group. Results: There was no significant difference in patients’ background such as dilation grade, duration after onset, X-ray type, and subjective symptom score before the procedure between both groups. Subjective symptom score (Eckardt score; 0.74 vs 0.70, n.s.), endoscopic feature, and mean lower esophageal sphincter pressure (11.8 vs 18.7 mmHg, n.s.) were remarkably improved after the procedure in both groups. No severe complication such as perforation and mediastinitis was seen. Incidence of symptomatic post-POEM GERD, which was easily controlled by normal dose of PPI, did not differ between both groups. Mean operation time of ICG group was no longer than in without ICG injection group (77.5 vs 91.0 min). Discussion & Conclusion: ICG injection enabled us to precisely identify the EGJ and did not affect on the results of the procedure. Especially in the technically challenging cases such as post-operative cases and sigmoid type with severe tortuosity, green color of ICG was effective in discriminating EGJ. Sa1525 Efficacy and Learning Curve of a New Scissor-Like Device for Endoscopic Submucosal Dissection (ESD) in an Established Experimental Setting Helmut Neumann*, Silke Loffler, Markus F. Neurath, Andreas Naegel Department of Medicine 1, University of Erlangen-Nuremberg, Erlangen, Germany Introduction: ESD has become the standard technique for early cancerous lesions, particularly in Asian countries. However, current limitations of ESD include the relative high complication rate, a distinct learning curve and the need of various devices, resulting in substantial costs of the procedure. Aims: To assess the efficacy and learning curve of a new alligator scissor-like device for ESD that will be officially introduced at DDW. Material & Methods: We performed a prospective ex vivo study. Ex vivo porcine models were utilized in the EASIE endoscopic simulator of interventional endoscopy. Artificial lesions, each 2x2 cm in size, were created in fresh ex vivo porcine stomachs at the fundus, corpus and antrum. Two beginners with less than 10 ESD procedures each participated in the study. All study parameters were independently recorded. ESD was performed after marking of the lesions with the closed ESD-instrument, followed by lifting of the mucosa with submucosal injection of saline. Afterwards, circular incision of the lesions was performed with the new ESD-instrument. For resection, the submucosa was grasped with the scissor-like device, elevated and cut. Resection specimens were retrieved to evaluate if all marks were included (R0). Results: Average size of removed lesions was 35 mm. En-bloc resection rate was 100% and R0 resection rate was 86%. After the initial three cases, R0 resection was achieved in all cases. The total procedure time improves significantly during the study (52.4 minutes versus 21.10 minutes; p! 0.05). One perforation occurred which could be managed with endoclips. Endoscopists satisfaction was high throughout all cases. Conclusion: The new scissor-like device for ESD, www.giejournal.org Vol which will be officially introduced at DDW 2015, seems to be a safe and efficient new instrument for ESD which can relatively easy being learned. Further studies should now focus on in vivo studies to confirm these initial results. Sa1526 Natural Orifice Endoscopic Surgery (NOTES) Techniques for Full Thickness R0 Endoscopic Resection of Deep Seated Subepithelial Tumors (SETs): a Single Center Experience Stavros N. Stavropoulos*, Rani J. Modayil, David Friedel, Collin E. Brathwaite, John Allendorf, James H. Grendell Medicine, Winthrop Univ. Hosp., Roslyn, NY Most UGI SETs are GISTs, potentially malignant tumors. Surgery recommended for suspected GISTsR2 cm and endoscopic surveillance of those!2cm. This approach creates a large burden of surgery and endoscopy for small SETs the majority of which are low risk lesions. Several groups have reported ESD to “excavate” muscularis propria (MP) based SETs. However, such enucleation may leave microscopic residual tumor within the MP and is not applicable to tumors with extraluminal component. Recently, pioneering Asian centers reported two endoscopic techniques that achieve R0 en bloc resection of MP-based SETs: Submucosal Tunnel Endoscopic Resection (STER)an offshoot of POEM utilizing the submucosal tunnel method to ensure secure closure of the full-thickness defect in the wall of the GI tract-, and endoscopic full-thickness resection (EFTR)-direct full thickness resection with closure of the defect with clips or sutures. We report the first series of EFTR and STER in the US. Procedures were performed from 4/2012-11/2014. Lesion location/ size, knives, anesthesia, ASA class, length of procedure, closure technique, histologic diagnosis, adverse events (AEs), and length of stay (LOS) were retrieved from a prospectively maintained database. 44 resections (33 EFTRs, 11 STERs) were performed by a gastroenterologist with 5 years POEM and 8 years ESD experience (SNS). Baseline characteristics seen in Table 1. 20 GISTs, 9 leiomyomas, 1 leiomyosarcoma, 6 other tumors, 8 benign “pseudotumors” (not appreciated on pre-op EUS as benign). Mean 23 mm (10-55). Mean resection time 82 minutes (21-400). 84% of patients were admitted mainly for observation. Complete en bloc resection in 41/44 (91%). Piecemeal resection 2 cases (not tumors). 1 morcelized in stomach for extraction (5 cm GIST). AEs: 2 needle decompression of capnoperitoneum, 5 patients 12-48 hr ICU observation, 1 patient with prolonged stay for pleural effusion requiring chest tube drainage. Two patients with challenging resection were done with laparoscopic overview for immediate assistance that was not needed. 1 pt had a 4-5 mm artery adjacent to the tumor identified by EFTR. We elected to complete the resection laparoscopically. EFTR and STER represent a NOTES alternative to laparoscopic wedge resection. We present the first US series with a large number of EFTR cases. Advantages of these techniques include: 1. Scar-less NOTES approach 2. “Wedge” resection of SETs at locations where laparoscopic “wedge” resection is challenging or impossible such as the GE junction, esophagus and gastric cardia 3. Definitive diagnosis and complete resection obviating any further endoscopic surveillance for low risk lesions. The techniques require advanced skills for closure, resection, hemostasis and control of capnoperitoneum and should be pursued only once ESD mastery has been achieved with surgical back-up. Baseline Characteristics ume 81, No. Procedural Data 5S : 2015 GASTROINTESTINAL E Follow-up

Ghrelin may stimulate gastric motility via the vagal nerve pathway. However, the mechanism of ghrelin-induced changes in gastrointestinal motility has not yet been clearly defined. The present study was designed to investigate whether ghrelin accelerates gastric emptying via capsaicin-sensitive afferent neurones and directly affects the enteric neuromuscular function.Gastric emptying of nutrient solids was assessed after intravenous administration of saline or ghrelin in conscious rats. The effects of ghrelin on gastric emptying were also examined in rats pretreated with capsaicin. Gastric emptying and intestinal transit of non-caloric liquids were evaluated using 51Cr solution. The effects of ghrelin on spontaneous contractile activities of isolated strips from stomach and jejunum were also investigated and the influence of ghrelin on motor responses to carbachol and electrical field stimulation was examined.Ghrelin significantly accelerated gastric emptying of both nutrient solids and non-caloric liquids in conscious rats. The intestinal transit of non-caloric liquids was also enhanced by ghrelin. Pretreatment with capsaicin prevented the ghrelin-induced acceleration of gastric emptying of nutrient solids. Ghrelin did not modulate spontaneous and carbachol-induced contractions of strips of gastric body, gastric antrum and jejunum. However, electrical field stimulation-induced contractions were significantly enhanced by ghrelin in the gastric body.The results suggest that the stimulatory effects of ghrelin on gastric motility are mediated by direct stimulation of the enteric neural pathway and capsaicin-sensitive afferent neurones.

By using phase-contrast microscopy combined with a fluorescent staining technique, the frequency of blast-type atypical lymphocytes (BTALs) appearing in peripheral blood and the phenotypic expression of their surface antigens were studied in 24 patients with schizophrenia, 16 with mood disorder and 14 healthy controls. BTALs were classified as being stimulated or activated cells, morphologically characterized by their large size, dark cytoplasm, a hollow perinuclear containing a few granules and finely dispersed chromatin structures with a few evident nucleoli. A significantly higher number of BTALs were found in the schizophrenic patients compared with healthy control subjects or patients with mood disorder. Further, there was a significant difference in the frequency of BTALs between patients with mood disorder and healthy control subjects. No significant difference in the frequency of BTALs was found between the schizophrenic patients with and without medication. Immunostaining of BTALs revealed that these cells consisted of B, T and non-B, non-T cell subpopulations. Contrary to our expectations, the T cell was only one third of the BTAL population. HLA-DR and CD38 were expressed on most BTALs (> 70%), while CD25, an early activation marker of T cells was rarely found on BTALs (< 0.3%). The differences in activated lymphocyte populations which appeared as morphologically atypical in the circulation among some psychiatric patients and infectious or autoimmune diseases are discussed. This is the first report on populations of BTALs.

Background: Among patients undergoing allogeneic bone marrow transplantation, we previously detected an increase of CD8+S6F1+ and CD8+CD57- cells with the onset of acute graft-versus-host disease. Objective: This study was an attempt to develop a simple laboratory test for graft-versus-host disease. Methods: We analyzed the percentage of the two lymphocyte subsets in the peripheral blood mononuclear cells of healthy volunteers, patients with posttransfusion graft-versus-host disease, and recipients of allogeneic bone marrow transplants. Results: Two patients with posttransfusion graft-versus-host disease showed a high percentage of both subsets. When the graft-versus-host disease pattern was defined as 45% or more CD8+S6F1+ cells and 35% or more CD8+CD57- cells, it was found in none of 17 recipients without acute graft-versus-host disease, 9 of 16 recipients with grade I disease, and 8 of 9 recipients with grade II or worse disease had this pattern. Conclusions: Our test may be useful for the laboratory diagnosis of acute graft-versus-host disease. (J Allergy Clin Immunol 1997;100:S70-72.)

CD59 is a phosphatidyl inositol-anchored protein (which is lost in paroxysmal nocturnal hemoglobinuria (PNH) cells) with the capacity to block the formation of membrane attack complex, and protects host cells from autologous complement-mediated cytolysis. We found a patient with acute promyelocytic leukemia (APL) accompanied by disseminated intravascular coagulation (DIC), the cells of which were CD59-negative. Although the CD59 deficiency in the malignant cells was not related to PNH, we offered the possibility that DIC was induced by APL lysis secondary to the deficiency of CD59.

We have synthesized a series of peptides, which cover almost the whole range of the N-terminal extracellular domain of human 55kDa TNF receptor (55kDa TNF-R). The peptides were examined for the binding activity to TNF by solid phase binding assay and for the inhibition of TNF cytotoxicity to mouse L-M cells. The peptide 159–178 exhibited remarkably higher binding activity to TNF than other peptides did. The specificity of the TNF binding to the peptides was confirmed by their inability to bind other cytokines. The peptide 159–178 also inhibited TNF cytotoxicity. These results indicate that the specific binding site of 55kDa TNF-R to TNF might reside within the peptide segment of amino acid numbers 159 to 178 in the N-terminal extracellular domain.

Levels of the membrane complement regulatory proteins, C3b/C4b receptor (CR1, CD35), membrane cofactor protein (MCP, CD46), and decay-accelerating factor (DAF, CD55), expressed on cells from patients with haematological malignancies and normal subjects were assessed by flowcytometry using the respective monoclonal antibodies (mAbs). All myeloid and most lymphoid leukaemia samples tested were CR1-negative: two of the 42 leukaemia samples expressed minute amounts of CR1. Lack of CR1 in leukaemia cells was confirmed with two mAbs raised against CR1, 31R, and 243R, which recognized different epitopes and induced different degrees of CR1-mediated fluorescent shift on flow-cytometry in granulocytes and erythrocytes. MCP was increased in most chronic myelogenous leukaemia (CML) and chronic lymphocytic leukaemia (CLL), and was also increased in majority of acute nonlymphocytic leukaemia (ANLL), acute lymphocytic leukaemia (ALL) and non-Hodgkin's lymphoma (NHL). Levels of DAF were also high in CML and CLL, and were variable in other types of leukaemia: some were DAF-negative while others expressed extremely high levels of DAF. In CML patients, the high level of MCP and the lack of CR1 were normalized after medical treatment. These results are in agreement with the data obtained with human leukaemia cell lines, and support the hypothesis that CR1 is essentially a differentiated cell antigen and that a high level of MCP reflects some malignant transformation or an immature stage in blood cells.