Eosinophilic gastroenteritis (EG) is characterized by infiltration of eosinophils into the wall of the digestive tract, and the clinical spectrum seems to depend on the predominant site of eosinophilic infiltration of the wall.
We experienced four cases of EG, and two of them (Cases, 1 and 2) manifested massive ascites, suggesting the principal lesion is located on the serous coat. Case 3 manifested abdominal pain and vomiting, and muscle layer involvement of the duodenum was detected by ultrasonography and CT scan. In case 4, epigastralgia was a main symptom. An endoscopic examination revealed marked redness and erosion of the gastric mucosa associated with massive infiltration of eosinophils. In this case, mucosal involvement seemed to be the main lesion because hypertrophy of the gut wall thickness was not found by ultrasonography and CT scan.
Although the pathogenesis of this disease is obscure, allergic mechanism may play an important role. Three cases had histories of allergic diseases, and steroid therapy resulted in prompt disappearance of symptoms.

Objective：There are few reports on decision-making support at palliative care clinics in designated regional cancer care hospitals. This study clarified the types of decisionmaking support patients with cancer and their families were provided by specialized outpatient palliative care services. Method：We retrospectively examined the medical records of 110 patients who had been referred to the palliative care clinic for home care between April 2012 and March 2014. Results：The median duration of receiving services from the palliative care clinic was 23 days（range：1～492 days）. The mean number of visits to the clinic was 4.7 visits（range：1～29 visits）. A total of 89 patients（80％）needed decision-making support. Of those 89 patients, 33（30％）required support in making a decision about anticancer treatment. Twenty-six（78％）of those 33 patients had just received the diagnosis or were receiving anticancer treatment. Conclusion：The study suggested that decision-making support in early stages is an important role for a palliative care clinic in a designated regional cancer care hospital.

Saffron (Crocus sativus L.) is classified as a beneficial herb in the treatment of “Oketsu,” eliminating blood stagnation. The clinical symptoms of “Oketsu” include feeling cold and arthralgia. The pathological condition of “Oketsu” is considered to be increased blood viscosity and microvascular disorders.However, no useful biomarker has been reported for evaluation of the degree of “Oketsu.” Here, we investigated the clinical effect of saffron on the symptoms of “Oketsu” in patients with autoimmune diseases. At the same time, we measured the plasma levels of platelet factor 4 (PF-4) and beta-thromboglobulin (β-TG) as platelet activation markers. Seventy-one patients (66 women and 5 men, mean age 52.3 ± 16.1) were studied. They were administered saffron (300mg∼900mg) with traditional Kampo medicine. The clinical symptoms of “Oketsu” improved (80.9%, n=38/47) and we measured PF-4 and β-TG in pre-and post-saffron treatment periods. The plasma levels of PF-4 and β-TG significantly decreased after saffron therapy (PF-4 : before 49.6 ± 29.8, after 24.0 ± 19.6ng/ml, β-TG : before 117.5 ± 64.0, after 64.6 ± 47.1ng/ml;paired t-test, p < 0.0001, respectively). These results suggest that saffron is effective in treatment of the symptoms of “Oketsu” in allergy and collagen disease patients. Moreover, PF-4 and β-TG may be useful biomarkers of the degree of “Oketsu.”

Vitamin D (VD) exerts a wide variety of biological actions in addition to its well-known roles in calcium homeostasis. Nutritional VD deficiency induces rachitic abnormalities in growing children and osteomalacia in adults, and it has been proposed to underlie the onset and development of multiple non-communicable chronic diseases. Therefore, the administration of VD or synthetic VD analogues represents a promising therapeutic strategy; indeed, VD and a VD agonist have shown clinical promise in mitigating osteoporosis and symptoms of insufficient calcium intake. However, even though high doses of VD analogues have shown pre-clinical efficacy against several diseases, including cancers, they have not yet had wide-spread clinical success. This difference may be due to limitation of clinical doses in light of the inherent calcemic action of VD. An approach to overcome this problem involves the development of VD analogues with lower calcemic activity, which could be administered in high doses to attenuate the onset and progress of disease. In a similar strategy, selective estrogen receptor modulators have had success as anti-osteoporosis drugs, and they have shown benefit for other estrogen target organs by serving as partial antagonists or agonists of estrogen receptor α. It is thus conceivable to generate synthetic partial antagonists or agonists for the VD receptor (VDR) that would exert beneficial effects on bone and other VD target organs. In this review, we discuss the molecular basis of the development of such synthetic VDR ligands from the viewpoint of roles of VDR in gene regulation.

PURPOSE: Intracranial administration of lipopolysaccharide (LPS) is known to elicit a rapid innate immune response, activate glial cells in the brain, and induce depression-like behavior. However, no study has focused on the changes in glial cells induced by intraperitoneal injection of LPS in vivo.METHODS: Ten adult male Fischer F344 rats underwent [¹¹C]PK11195 PET before and 2 days after intraperitoneal injection of LPS to evaluate the changes in glial cells. The difference in standardized uptake values (SUV) of [¹¹C]PK11195 between before and after injection was determined.RESULTS: There was a cluster of brain regions that showed significant reductions in SUV. This cluster included the bilateral striata and bilateral frontal regions, especially the somatosensory areas.CONCLUSIONS: Changes in activity of glial cells induced by the intraperitoneal injection of LPS were detected in vivo by [¹¹C]PK11195 PET. Intraperitoneal injection of LPS is known to induce depression, and further studies with [¹¹C]PK11195 PET would clarify the relationships between neuroinflammation and depression.
Adult ; Animals ; Brain ; Depression ; Electrons ; Humans ; Immunity, Innate ; Injections, Intraperitoneal ; Lipopolysaccharides ; Male ; Neuroglia ; Positron-Emission Tomography ; Rats ; Rats, Inbred F344

PURPOSE: Intracranial administration of lipopolysaccharide (LPS) is known to elicit a rapid innate immune response, activate glial cells in the brain, and induce depression-like behavior. However, no study has focused on the changes in glial cells induced by intraperitoneal injection of LPS in vivo. METHODS: Ten adult male Fischer F344 rats underwent [¹¹C]PK11195 PET before and 2 days after intraperitoneal injection of LPS to evaluate the changes in glial cells. The difference in standardized uptake values (SUV) of [¹¹C]PK11195 between before and after injection was determined. RESULTS: There was a cluster of brain regions that showed significant reductions in SUV. This cluster included the bilateral striata and bilateral frontal regions, especially the somatosensory areas. CONCLUSIONS Changes in activity of glial cells induced by the intraperitoneal injection of LPS were detected in vivo by [¹¹C]PK11195 PET. Intraperitoneal injection of LPS is known to induce depression, and further studies with [¹¹C]PK11195 PET would clarify the relationships between neuroinflammation and depression.

Objective: The purposes of this trial were to demonstrate the feasibility and effectiveness of the hybrid of intracavitary and interstitial brachytherapy (HBT) for locally advanced cervical cancer patients in the phase I/II prospective clinical trial. Methods: Patients with FIGO stage IB2-IVA uterine cervical cancer pretreatment width of which was ≥5 cm measured by magnetic resonance imaging were eligible for this clinical trial. The protocol therapy included 30–30.6 Gy in 15–17 fractions of whole pelvic radiotherapy concurrent with weekly CDDP, followed by 24 Gy in 4 fractions of HBT and pelvic radiotherapy with a central shield up to 50–50.4 Gy in 25–28 fractions. The primary endpoint of phase II part was 2-year pelvic progression-free survival (PPFS) rate higher than historical control of 64%. Results: Between October 2015 and October 2019, 73 patients were enrolled in the initial registration and 52 patients proceeded to the secondary registration. With the median follow-up period of 37.3 months (range, 13.9–52.9 months), the 2- PPFS was 80.7% (90% confidence interval [CI]=69.7%–88%). Because the lower range of 90% CI of 2-year PPFS was 69.7%, which was higher than the historical control ICBT data of 64%, therefore, the primary endpoint of this study was met. Conclusion The effectiveness of HBT were demonstrated by a prospective clinical study. Because the dose goal determined in the protocol was lower than 85 Gy, there is room in improvement for local control. A higher dose might have been needed for tumors with poor responses.

Most patients on hemodialysis (HD) have left ventricular (LV) remodeling as a result of pressure and volume overload, which may lead to hypertrophy (LVH) and dilation, resulting in heart failure (HF). LV torsion by the inner and outer oblique myocardial bands may contribute in part to the ejection fraction (EF). LV dilation is associated with reduction of torsion. We assessed the hypothesis that LV dilation and decreased torsion at the sub-epicardium assessed by 3-dimensional speckle tracking echocardiography (3D-STE) may cause reduced LVEF in patients on HD. LV volume, strain, and torsion at the sub-endocardium and sub-epicardium were examined using 3D-STE in 76 patients on HD (age 64 ± 2 years) and 22 controls (age 71 ± 9 years). The HD patients were divided into 2 subgroups according to LV size (17 HD with LV end diastolic volume ≥ 70 and 59 HD with volume ＜ 70 mL/m2). Torsion (°/cm) is defined as the difference in the rotation angle between base and apex divided by the length of the LV long axis. LVEF, strain, and torsion at both layers in all HD patients (n = 76) were comparable to those in the controls (torsion at the sub-endocardium: 2.2 ± 0.7 vs 2.4 ± 1.1°/cm) despite increased LV mass and volume. In HD with dilation, LV volume increased and LVEF reduced compared to HD without dilation (LVEF: 63 ± 7, 64 ± 6, 57 ± 9％), with decreased longitudinal strain and torsion at both layers (torsion at sub-epicardium: 1.4 ± 0.7, 1.6 ± 1.0, 1.1 ± 0.6°/cm). There was no significant difference in circumferential strain at the sub-epicardium among the 3 groups. There was some correlation between torsion and EF (r = 0.34, p ＜ 0.01) and end diastolic volume (r = －0.36, p ＜ 0.01). LVEF and torsion at the sub-endocardium and sub-epicardium were reduced in HD with LV dilation, suggesting that volume control is important in HD to prevent HF with reduced EF because of reduced LVEF by LV dilation and oblique myocardial fiber damage at the sub-epicardium.

Objectives: This study aimed to determine the relationship between the number of board-certified physiatrists and the amount of inpatient rehabilitation delivered.Materials and Methods: We analyzed open data from 2017 in the National Database of Health Insurance Claims and Specific Health Checkups of Japan and compared the volume of inpatient rehabilitation services between prefectures to examine regional disparities. We also examined the relationship between the volume of rehabilitation services provided and the number of board-certified physiatrists.Results: The population-adjusted number of inpatient rehabilitation units per prefecture ranged from a maximum of 659,951 to a minimum of 172,097, a disparity of 3.8-fold. The population-adjusted number of board-certified physiatrists was 4.8 in the highest region and 0.8 in the lowest region, a disparity of 5.8-fold. The population-adjusted number of board-certified physiatrists was significantly correlated with the population-adjusted total number of inpatient rehabilitation units (r=0.600, P<0.001). Correlations were between the number of board-certified physiatrists and the number of rehabilitation units in cerebrovascular and orthopedic services, but not in cardiovascular, respiratory, or oncology services.Conclusion: Large regional disparities manifested in the amount of inpatient rehabilitation provided in Japan. An association was found between the number of board-certified physiatrists and rehabilitation units delivered. It may be necessary to train more BCPs in regions with fewer units to eliminate these disparities.

The Trail Making Test (TMT) is a widely used measure of attention impairment. The time needed to complete the TMT (TMT score) is longer with greater impairment of attention in patients with brain diseases. TMT score becomes large in a proportion of patients with minor ischemic stroke. The Japanese version of the TMT- (TMT-J) was published in 2019. The purpose of this study was to clarify serial changes in TMT-J scores in patients with minor ischemic stroke. We retrospectively reviewed the TMT-J scores in those patients who completed the test both 8-14 days and 29-35 days after stroke onset. On initial evaluation, 1 of 21 patients could not complete TMT-J Part A. TMT-J Part A scores had a mean of 67 s and were abnormally large in 45% of the 20 patients who completed this part. Two of these 20 patients could not complete TMT-J Part B. TMT-J Part B scores had a mean of 135 s and were abnormally large in 61% of the 18 patients who completed this part. On second evaluation, scores on Part A and Part B improved in 76% and 73% of patients, respectively. This study demonstrated that abnormal TMT-J scores 8-14 days after onset of minor ischemic stroke improved over time in most patients.