The most important factors in determining the outcomes of patients with traumatic brain injury (TBI) is the degree of severity and types of primary brain damage, and the secondary damage to the brain such as low-oxygen and low-blood pressure et al. For severe TBI patients, prompt and appropriate decompression to reduce intracranial pressure (ICP) and ICU management are commonly required. The second edition of "Guidelines for the Management of Severe Head Injury" was published by the Japan Society of Neurotraumatology (JSNT) in 2006. These guidelines include a wide range of topics in the management for severe TBI, from prehospital care, primary care, ICU management and surgical treatment. The essence of extended decompression and neuroprotection for TBI is also focused in the JNST Guidelines. The pathophysiological event in the acute stage of severe TBI is quite variable ; therefore, an appropriate individual based approach in ICU management is necessary under experienced medical teams.

BACKGROUND/AIMS: We recently identified recessive mutations in the solute carrier organic anion transporter family member 2A1 gene (SLCO2A1) as causative variants of chronic enteropathy associated with SLCO2A1 (CEAS). The aim of this study was to evaluate SLCO2A1 protein expression in the intestinal tissues of patients with CEAS, intestinal Behçet's disease (BD), simple ulcer (SU), and Crohn's disease (CD). METHODS: Immunohistochemical staining using a polyclonal anti-SLCO2A1 antibody was performed on the resected intestinal specimens from 13 cases of CD, 9 cases of intestinal BD/SU, and 3 cases of CEAS. The extent of SLCO2A1 expression was determined by counting positively-staining vascular endothelial cells and scored as 0 (no cells), 1 (1%–30% cells), 2 (31%–60%), or 3 (>60%). The intensity of SLCO2A1 expression was scored either as 0 (negative), 1 (intermediate), or 2 (strong). The extent score and intensity score were summed for the final score of 0, 2, 3, 4, or 5. RESULTS: SLCO2A1 protein expression was observed in 1 of 3 cases of CEAS (33%), all 13 cases of CD (100%), and all 9 cases of BD/SU (100%). The mean final expression scores of CEAS, CD, and BD/SU were 1.6 (range, 0–5), 4.8 (range, 4–5), and 4.3 (range, 4–5), respectively. The final expression score in CEAS was significantly lower than in CD (P=0.03). CONCLUSIONS: Immunohistochemical staining of the SLCO2A1 protein is considered useful to distinguish CEAS from other inflammatory bowel diseases.
Behcet Syndrome ; Crohn Disease ; Endothelial Cells ; Humans ; Immunohistochemistry ; Inflammatory Bowel Diseases* ; Ulcer

BACKGROUND/AIMS: We recently identified recessive mutations in the solute carrier organic anion transporter family member 2A1 gene (SLCO2A1) as causative variants of chronic nonspecific multiple ulcers of the small intestine (chronic enteropathy associated with SLCO2A1, CEAS). The aim of this study was to investigate the gastroduodenal expression of the SLCO2A1 protein in patients with CEAS and Crohn’s disease (CD). METHODS: Immunohistochemical staining for SLCO2A1 was performed with a polyclonal antibody, HPA013742, on gastroduodenal tissues obtained by endoscopic biopsy from four patients with CEAS and 29 patients with CD. RESULTS: The expression of SLCO2A1 was observed in one of four patients (25%) with CEAS and in all 29 patients (100%) with CD (p < 0.001). The three patients with CEAS without SLCO2A1 expression had a homozygous splice-site mutation in SLCO2A1, c.1461+1G>C (exon 7) or c.940+1G>A (exon 10). The remaining one CEAS patient with positive expression of SLCO2A1 had compound heterozygous c.664G>A and c.1807C>T mutations. CONCLUSIONS: Immunohistochemical staining for SLCO2A1 in gastroduodenal tissues obtained by endoscopic biopsy is considered useful for the distinction of CEAS from CD.
Biopsy ; Crohn Disease* ; Humans ; Immunohistochemistry ; Intestine, Small ; Ulcer