Objevtives: To explore the relationship between ? aminobutyric acid (GABA) and the proliferation or differentiation of jejunal epithelial cells. Methods: Immunohistochemical expression of GABA, glutamate decarboxylase (GAD, including two isoforms, GAD65 and GAD67) was investigated in rat jejunum. Meanwhile, double staining was performed with GAD65 immunohistochemistry followed by lectin histochemistry of fluorescent wheat germ agglutinin. Furthermore, cell kinetics was evaluated by immunohistochemistry using a monoclonal antibody to proliferating cell nuclear antigen (PCNA). Results: Immunoreactive GABA and GAD65 were distributed in the villi of jejunum, while GAD67 was negative in epithelial cells. Strong positive staining of GABA and GAD65 was mainly localized along the brush border of jejunal villi. In addition, there existed a few GABA and GAD65 strong positive cells scattering in upper portion of the jejunal villi. Double staining showed that immunoreactive GAD65 was not found in goblet cells. PCNA staining nucleoli were found in the lower and the middle portions of the jejunal crypts. Therefore, GABA and GAD65 were expressed in maturation or functional zone. Conclusion: It suggests that GABA might be involved in the regulation of differentiation and maturation of epithelial cells in rat jejunum.

Objective：An actual-condition survey was conducted to verify the validity of reference values of higher brain function necessary for patients with brain injury to resume automobile driving.　Subjects：Of the 74 patients admitted to the Tokyo Metropolitan Rehabilitation Hospital between November 1, 2008 and November 30, 2012, who underwent evaluation using the hospital's automobile driving resumption system at the time of discharge, 71 patients with brain injury who were judged capable of resuming driving were included in this study. Methods：Questionnaires were sent at least 1 year after discharge, to determine whether the subjects had actually resumed automobile driving. Subjects were classified by admission date into two groups：1）A provisional reference group that included patients admitted between November 2008 and November 2011 who had resumed driving；and 2) verification group that included patients who had been admitted between December 2011 and November 2012 and had resumed driving. The relationship between results on the higher brain function test for the verification group and provisional reference values was investigated. Results：The provisional reference value group included 29 patients, and the verification group included 13 patients. In the verification group, the results of 9 patients with brain injury on the higher brain function test were within provisional reference values. Conclusion：The results of the paper-based test are a reliable predictor of whether a patient is capable of resuming driving, but do not represent an absolute standard. Therefore, the safety of resuming driving should be investigated on a case-by-case basis.

Objective : We conducted a fact-finding survey for the consecutive past 3 years to establish whether inpatients with brain injury who had wished to resume driving after discharge from our hospital had in fact resumed driving after discharge. The survey included both driving status and information about collisions. Methods : Patients who had been evaluated for resumption of driving and were discharged more than 1 year ago were sent a fact-finding survey questionnaire aimed at establishing whether they were currently driving. The patients who had resumed driving (resumers) were compared with those who had not resumed driving (non-resumers). From the questionnaire results we investigated driving status and whether collisions had occurred. Results : We obtained effective responses from 40 of the 54 people (48 males, 6 females) who were sent the questionnaire ; the collection rate was 74.1%. Of these, twenty-nine people had resumed driving, all were male. There were no significant differences between the resumers and non-resumers in higher brain function tests. In regard to driving ability, hemiparesis impairments were significantly milder in the resumers than in the non-resumers. Two respondents had hit posts or walls within the year. All these collisions occurred when parking. One respondent had a collision while driving along a road. Conclusion : We hope to provide patients with useful and appropriate information on resuming driving so that we can support them in a safe return to the driving environment.

A 72-year-old man who suddenly felt an excessive thirst and developed pollakisuria and high fever on Sept. 29, 2001. A general practitioner initially diagnosed him as having urinary tract infection on the same day. Vomiting and unconscionsnes occurred on Oct. 3. He was brought to our hospital by ambulance. Laboratory data on admission showed plasma glucose of 1110 mg/dl, blood pH of 7.167 and HCO3- of 7.6mmol/L, and positive urinary ketone bodies, compatible with diabetic ketoacidosis. Serum amylase was elevated, but he had no symptoms of acute pancreatitis. Insulin therapy was started immediately and hyperglyvemia was improved. He has never had diabetes mellitus and his HbA1c was normal (5.3%). His urinary C-peptide was very low (2.4 μg/day) and diabetes-related autoantibodies including anti-GAD, IA-2 antibodies and ICA were negative. So his case was diagnosed as fulminant type 1 diabetes mellitus. Fulminant type 1 diabetes, which has been brought to light by Dr Imagawa’s group, is characterized by near-nomal HbA1c despite diabetic ketoacidosis, rapid loss of insulin secretion and absence of diabetes-related autoantibodies.Great care is needed to recognize the patients with fulminant type 1 diabetes among the elderly with symptoms of urinary tract infection. Here, we reported the case of an aged man who developed aypical fulminant type 1 diabetes.
Diabetes Mellitus, Insulin-Dependent ; Diabetes Mellitus ; symptoms <1> ; Type 1 ; Urinary tract infection

A 37-year-old man who had received graft replacement of right iliac artery 20 years ago was admitted to our hospital because of massive intestinal hemorrhage. CT scan and angiogram showed a pseudoaneurysm originating from a graft anastomosis and the case was diagnosed as aorto-enteric fistula. Emergency operation was performed. Following aneurysmectomy and direct closure of split anastomosed portions, colostomy was performed in descending colon. Femorofemoral artery bypass was made as an extra-anatomical bypass. Fortunately, he has been successfully treated and is doing well now. The most important point for the rescue of cases of aneurysm-enteric fistula is to consider such cases of intestinal hemorrhage after the arterial graft replacement in the abdomen.

OBJECTIVE: Fat-mass and obesity-associated (FTO) gene is known to be involved in the pathophysiology of obesity and a single-nucleotide polymorphism (SNP) rs9939609 of FTO gene is repeatedly confirmed to be associated with body mass index (BMI) and obesity. The aim of this study is to elucidate effects of FTO gene polymorphism on BMI in Japanese patients with schizophrenia and healthy subjects. METHODS: Three hundred fifty one patients with schizophrenia and 342 age- and sex-matched healthy subjects participated in the study. Information on BMI and antipsychotic medication was also collected from patients and healthy subjects. Genotype of the FTO SNP rs9939609 was determined by TaqMan SNP Genotyping Assays. RESULTS: There was no significant difference in BMI between patients and healthy subjects. No significant difference in BMI was observed among any medications. We observed no significant difference in rs9939609 allele frequencies between patients and healthy subjects. There was a significant difference in BMI between healthy subjects with risk (AA or TA) genotypes and those with TT genotype. We also observed a significant positive correlation between the number of risk allele (A allele) and BMI in healthy subjects. CONCLUSION: Our study suggested that FTO rs9939609 polymorphism might have some impacts on the BMI in healthy subjects, but might not have same impacts on the BMI of patients with schizophrenia.
Alleles ; Asian Continental Ancestry Group ; Body Mass Index ; Gene Frequency ; Genotype ; Humans ; Obesity ; Schizophrenia

Background/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) using a 19-gauge needle is an efficient sampling method for the diagnosis of lymphadenopathy. This study compared 19-gauge conventional and Franseen needles for the diagnosis of lymphadenopathy and classification of malignant lymphoma (ML). Methods: Patient characteristics, number of needle passes, puncture route, sensitivity, specificity, and accuracy of cytology/histology for lymphadenopathy were analyzed in patients diagnosed with lymphadenopathy by EUS-FNA using conventional or Franseen needles. Results: Between 2012 and 2022, 146 patients met the inclusion criteria (conventional [n=70] and Franseen [n=76]). The median number of needle passes was significantly lower in the conventional group than in the Franseen group (3 [1–6] vs. 4 [1–6], p=0.023). There were no significant differences in cytological/histological diagnoses between the two groups. For ML, the immunohistochemical evaluation rate, sensitivity of flow cytometry, and cytogenetic assessment were not significantly different in either group. Bleeding as adverse events (AEs) were observed in three patients in the Franseen group. Conclusions Both the 19-gauge conventional and Franseen needles showed high accuracy in lymphadenopathy and ML classification. Considering sufficient tissue collection and the avoidance of AEs, the use of 19-gauge conventional needles seems to be a good option for the diagnosis of lymphadenopathy.

Ulcerative colitis (UC) is 1 of the 2 major phenotypes of chronic inflammatory bowel disease (IBD), which afflicts millions of individuals throughout the world with debilitating symptoms that impair function and quality of life. Further, IBD often affects women during childbearing age. Indeed, UC activity frequently increases during pregnancy, and the medications used to induce remission may adversely affect the health of the mother and the unborn child. We report successful induction of a remission in a UC case who experienced a flare-up in the first trimester of pregnancy. Upon relapse, she was treated with steroids and adsorptive granulomonocytapheresis (GMA) with the Adacolumn plus tacrolimus. This combination therapy induced a stable remission that was maintained during her entire pregnancy. She gave birth to a healthy child at 36 weeks of pregnancy with no maternal or fetal complications. Our experience indicates that GMA, as a non-drug therapeutic intervention with a favorable safety profile, plus tacrolimus might be a relevant treatment option for patients with active IBD during pregnancy. A future study of a large cohort of pregnant patients should strengthen our findings.
Child ; Cohort Studies ; Colitis, Ulcerative* ; Female ; Humans ; Inflammatory Bowel Diseases ; Mothers ; Parturition ; Phenotype ; Pregnancy Trimester, First ; Pregnancy* ; Quality of Life ; Recurrence ; Steroids ; Tacrolimus* ; Ulcer*

Objective: Lenvatinib is an oral multitarget tyrosine kinase inhibitor (mTKI) and is recommended for patients with advanced hepatocellular carcinoma (HCC) with Child-Pugh A liver function, who are not amenable to surgical resection, locoregional treatment, or transcatheter arterial chemoembolization. Hepatogastric fistula is a rare complication with a poor prognosis in patients with HCC. Previous reports on fistula formation during mTKI therapy for HCC were all associated with sorafenib. Here, we report the first case of recurrent hepatogastric fistula during lenvatinib therapy for advanced HCC managed using an over-the-scope clip (OTSC).Patient: We present the case of a 73-year-old man with alcoholic liver cirrhosis who was treated for multiple HCC for 7 years. HCC was treated using repetitive transcatheter arterial chemoembolization, radiofrequency ablation, and sorafenib. Owing to disease progression, lenvatinib treatment was started. During lenvatinib treatment, recurrent hepatogastric fistulas developed. An OTSC was useful for fistula closure and prevention of recurrence.Results: The major cause of fistula formation is considered to be the direct invasion of HCC; however, HCC treatment might also be a contributing factor in our case. In addition, OTSC was useful for fistula closure.Conclusion: Clinicians should be aware of the fatal complications during HCC treatment.