BACKGROUND/AIMS: Decreased trough levels of infliximab (TLI) and antibodies to infliximab (ATI) are associated with loss of response (LOR) in Crohn's disease. Two prospective studies were conducted to determine whether TLI or ATI better correlates with LOR (Study 1), and whether TLI could become a predictor of mucosal healing (MH) (Study 2). METHODS: Study 1 was conducted in 108 patients, including those with LOR and remission to compare ATI and TLI in discriminating the 2 conditions based on receiver operating characteristic (ROC) curve analyses. Study 2 involved 35 patients who were evaluated endoscopically. RESULTS: In Study 1, there were no differences between the 2 assays in ROC curve analyses; the TLI cutoff value for LOR was 2.6 µg/mL (sensitivity, 70.9%; specificity, 79.2%), and the ATI cutoff value was 4.9 µg/mL (sensitivity, 65.5%; specificity, 67.9%). The AUROC (area under the ROC curve) of TLI was greater than that of ATI. AUROC was useful for discriminating between the 2 conditions. In Study 2, the TLI was significantly higher in the colonic MH group than in the non-MH group (2.7 µg/mL vs. 0.5 µg/mL, P=0.032). CONCLUSIONS: TLI is better than ATI for clinically diagnosing LOR, and a correlation was observed between TLI and colonic MH.
Antibodies ; Cohort Studies* ; Colon ; Crohn Disease* ; Humans ; Infliximab* ; Prospective Studies* ; ROC Curve ; Sensitivity and Specificity

BACKGROUND/AIMS: Colonic diverticular hemorrhage (DH) was a rare disease until the 1990s, and its incidence has increased rapidly since 2000 in Japan. In recent years, colonic DH has been the most frequent cause of lower gastrointestinal bleeding (LGIB). Nearly all cases of DH are mild, with the bleeding often stopping spontaneously. Some cases, however, require surgery or arterial embolization. In this study, using a cohort at Fukuoka University Chikushi Hospital, we investigated factors associated with severe colonic DH. METHODS: Among patients with LGIB who underwent colonoscopy at our hospital between 1995 and 2013, DH was identified in 273 patients. Among them, 62 patients (22.7%) were defined as having severe colonic DH according to recurrence of bleeding in a short period, and/or the necessity of transfusion, arterial embolization, or surgery. We then evaluated risk factors for severe DH among DH patients in this retrospective cohort. RESULTS: Among the 273 patients with DH, use of non-steroidal anti-inflammatory drugs (NSAIDs) (odds ratio [OR], 2.801; 95% confidence interval [CI], 1.164–6.742), Charlson Risk Index (CRI) ≥2 (OR, 3.336; 95% CI, 1.154–7.353), right-sided colonic DH (OR, 3.873; 95% CI, 1.554–9.653), and symptoms of cerebral hypoperfusion (such as light-headedness, dizziness, or syncope) (OR, 2.926; 95% CI, 1.310–6.535) showed an increased risk of severe DH even after controlling for other factors. CONCLUSIONS: Severe DH occurred in 23% of DH patients, and NSAID use, CRI ≥2, right-sided colonic DH, and symptoms of cerebral hypoperfusion are suggested to be predictors of severe DH.
Anti-Inflammatory Agents, Non-Steroidal ; Cohort Studies ; Colon* ; Colonoscopy ; Dizziness ; Hemorrhage* ; Humans ; Incidence ; Japan ; Rare Diseases ; Recurrence ; Retrospective Studies ; Risk Factors*

To acquire “practical abilities in community health and medical care”, it is necessary to understand the work tasks in the context of welfare and working care facilities and smoothly promote inter-professional work. It is considered that the time when pharmacy students fully understand the outline of “group home”, which is one of the working care facilities, is during the class or practical training period. Therefore, we conducted a questionnaire survey in the context of 4-6th grade students. In addition, to improve the knowledge of students with insufficient comprehension, video lectures were created; comprehension was evaluated in both pre-post-tests. Furthermore, the effectiveness of the video lecture was evaluated based on the analysis of the students’ understanding. The most common cognitive methods and periods for both 4th and 6th graders were “friends/family” and “before entering university”, respectively. As a result of the pre-test, the correct answer rate of each item and the total average score （50.0% and less than 50.0 points, respectively） suggested a low level of understanding regardless of the grade. On the other hand, the correct answer rate of each item and the total average score （70.0% and 70.0 points or more, respectively） in the post-test showed a high degree of understanding; further, they were significantly increased compared to those with respect to the pre-test, indicating the effectiveness of the video lecture. From the above results, we devised a test-linked video lecture that can be used as an effective tool for the understanding of the outline of “group home”.

Background/Aims: Image-enhanced endoscopy can detect superficial oro-hypopharyngeal squamous cell carcinoma; however, reliable endoscopy of the pharyngeal region is challenging. Endoscopy under general anesthesia during transoral surgery occasionally reveals multiple synchronous lesions that remained undetected on preoperative endoscopy. Therefore, we aimed to determine the lesion detection capability of endoscopy under general anesthesia for superficial oro-hypopharyngeal squamous cell carcinoma. Methods: This retrospective study included 63 patients who underwent transoral surgery for superficial oropharyngeal squamous cell carcinoma between April 2005 and December 2020. The primary endpoint was to compare the lesion detection capabilities of preoperative endoscopy and endoscopy under general anesthesia. Other endpoints included the comparison of clinicopathological findings between lesions detected using preoperative endoscopy and those newly detected using endoscopy under general anesthesia. Results: Fifty-eight patients (85 lesions) were analyzed. The mean number of lesions per patient detected was 1.17 for preoperative endoscopy and 1.47 for endoscopy under general anesthesia. Endoscopy under general anesthesia helped detect more lesions than preoperative endoscopy did (p<0.001). The lesions that were newly detected on endoscopy under general anesthesia were small and characterized by few changes in color and surface ruggedness. Conclusions Endoscopy under general anesthesia for superficial squamous cell carcinoma is helpful for detecting multiple synchronous lesions.

In order to perform community health activities during the university festival, pharmacy students gathered data and conducted lectures in the form of small group discussions (SGD). They measured participants’ bone densitometry, and then provided them with information about how to effectively prevent bone disease. The aim of this study is to assess whether students’ lectures on the “prevention of calcium-related disease” led participants in the University Festival to understand the following: (1) the benefits of absorption of calcium, (2) the risks of absorption of calcium, (3) which vegetables are calcium-rich, and (4) the risks of calcium overdose. First, participants responded to pretests comprising questions on the 4 above-mentioned topics. Next, they were subjected to bone density measurement, and pharmacy students explained the importance of “prevention of calcium-related disease.” Finally, participants carried out posttests (with the same contents as the pretests), and received advice based on the results of their posttests and bone densitometry measurements. Total scores on the posttests (98.4 points) were significantly higher than those on the pretests (53.3 points). Based on this, researchers concluded that the pharmacy students’ lectures substantially improved participants’ understandings about “prevention of calcium-related disease.”