Tumor necrosis factor receptor-associated factor 3 (TRAF3) is an anti-inflammatory molecule that negatively regulates the non-canonical nuclear factor-κB pathway. Although TRAF3 haploinsufficiency (TRAF3 HI) can influence innate and adaptive immune cells, its effect on inflammatory bowel disease (IBD) development remains unclear. Here, we report the first case of severe early-onset IBD with a novel TRAF3 variant leading to HI, successfully treated with ustekinumab. A 6-year-old girl with a recurrent parotitis, otitis media, tonsilitis, and atopic dermatitis developed IBD involving the stomach, small intestine, and colon. At diagnosis, the immunoglobulin (Ig)G and IgA levels were relatively high, and lymphocyte subsets showed increased counts of plasmablasts, class-switch recombination B cells, and circulating T-follicular helper cells. Treatment with azathioprine and infliximab failed to maintain remission marked by several relapses accompanied by erythema nodosum and arthritis; however, ustekinumab, an anti-interleukin (IL)-12/23p40 antibody, led to long-term clinical remission, normalizing the Ig level and reducing abnormal lymphocyte counts. Whole-exome sequencing revealed a novel heterozygous mutation in TRAF3 [p.(Pro487Leufs*8)], resulting in TRAF3 under-expression. Our case may highlight the contribution of TRAF3 HI to the development of IBD and provide insights into IBD pathophysiology, suggesting the involvement of the IL-12/23-T-follicular helper cell pathway affected by genetic mutations.

OBJECTIVES: The purpose of this study was to investigate the influences of interruption and reinitiation of monthly minodronate therapy on the bone mineral density (BMD) and bone metabolism markers in postmenopausal women with osteoporosis. METHODS: Study patients were included if they had been administered monthly minodronate therapy for ≥6 months, interrupted the therapy, and reinitiated the therapy for ≥12 months. The BMD and bone metabolism markers were assessed at 4 time points: initiation, interruption, reinitiation and 1 year after reinitiation of therapy. RESULTS: A total of 23 patients were enrolled. The mean monthly minodronate treatment period was 23.8 ± 12.9 months following a mean interruption period of 11.9 ± 5.4 months. Once increased by monthly minodronate treatment for 2 years on average, the BMD of lumbar spine and radius did not significantly decrease even after an interruption for 1 year on average. However, the BMD of the femoral neck did decrease after interruption. The BMD of the lumbar spine and radius increased further after 1 year of monthly minodronate retreatment. The BMD of the femoral neck did not change. Once decreased after the treatment for an average of 2 years followed by an interruption for 1 year, bone metabolism markers increased gradually but did not recover to baseline levels. A potent suppressive effect on bone resorption was noted. The change rate was greater for the bone formation marker procollagen 1 N-terminal propeptide. CONCLUSIONS: Monthly minodronate treatment increases BMD and reduces bone metabolism markers. The effect lessens after treatment interruptions, and can be restored by retreatment.
Bone Density ; Bone Resorption ; Female ; Femur Neck ; Humans ; Metabolism ; Osteogenesis ; Osteoporosis ; Procollagen ; Radius ; Retreatment ; Spine

　　With a view to preventing surgical site infection (SSI), administration of antimicrobial agents during surgery should be performed every 3-4 hours after the first administration before surgery begins. In our hospital, the infection control team (ICT) tried to intervene with surgeons and all operating room staff to improve compliance with the administration of antimicrobial agents. The purpose of this study was to evaluate the impact of this intervention by the ICT on correct administration of antimicrobial agents during surgery. In total, 435 surgeries which included ≥ 210 min under anesthesia or 180 min of the operation were analyzed. All antimicrobial agents were first administered within 60 min before the start of surgery. At some point, the ICT intervened, recommending that antimicrobials be administered every 3 h during surgery. The compliance rate (CR) of surgeries for the correct administration of antimicrobial agents was investigated. Differences in CR were evaluated (1) among departments (gastroenterology and general medicine [GM], orthopedic surgery [OR], otorhinolaryngology [OL], gynecology [GY], and urology [UR]), (2) whether intervention of ICT was carried out or not, and (3) in terms of specific procedures (endoscopy and laparoscopy). Total CR was 51.0% (GM: 67.0%, OR: 27.1%, OL: 40.5%, GY: 45.5%, and UR: 37.5%). CR was significantly higher in GM than in any other departments. CR with and without intervention was 69.9% and 42.7%, respectively, and this was statistically significant. CR in endoscopy was 25.8%, which was significantly lower than that in other surgeries (55.2%). CR in laparoscopy was 63.1%, which was significantly higher than that in other surgeries (47.3%). Intervention by the ICT resulted in significant improvement of CR for correct administration of antimicrobial agents. However, CR was low in some situations. This could be improved by more careful dialogue with surgeons and operating room staff.

We have tried surgical pathologic diagnosis using a still image transmission system. The equipment we used was a medical information network system (Telepathology) developed jointly by Inohara Shokai and NTT. During the 9-month period from April to December in 1995, we performed pathological diagnosis on a total of 63 cases received via this system. The cases included 21 stomach cancers, 13 colorectal cancers, 5 breast tumors, 4 lung tumors, 5 thyroid tumors and 3 ovary tumors. Materials presented for pathologic examination were 44 lymph nodes, 20 stumped sections of the lesions and 13 tumor tissues. The correct diagnosis ratio was as high as 93.7%. Improvement in the specimen-making procedure reduced the time required to arrive at a firm diagnosis. However, the quality of images of low magnification is unsatisfactory. It should also be pointed out that there is much room for improvement in the technical skill and knowledge of the persons concerned. Nevertheless, great expectations could be placed on this system. With progress in data transmissions technology, it will find its use more widely.

The positional relation between the point Jingei and the bifurcation of the common carotid artery was investigated with dissection of the neck after inserting a needle into the bilateral Jingei, using nineteen Japanese cadavers. We determined first the position of the point Futotsu as a point in the sternocleidomastoid lying about 10cm lateral to the laryngeal prominence along the neck wrinkle, and defined the location of Jingei in the cadavers as the mid-point between the laryngeal prominence and Futotsu mentioned above. The common carotid artery shows a dilatation, termed the carotid sinus, at its point of division into the external and internal carotid arteries. The needle did not prick the carotid sinus in all of the thirty-eight cases of insertion; it pricked the common carotid artery at a lower level than the carotid sinus in four of these cases, and in the other cases the needle did not prick the vessel, but rather a portion of the neck medial to the vessel at the lower level, similarly as in the former cases. The points of division of the common carotid arteries of the cadavers dissected were all located at a considerably higher level than the laryngeal prominence; the average level was 32.8mm higher than the prominence on the left, with maximum and minimum values of 52 and 11mm, respectively, and 29.9mm upper on the right (maximum and minimum values: 45 and 8mm). Furthermore, it was suggested that the insertion of a needle at the level of the hyoid bone has a higher possibility of reaching the carotid sinus than that at the level of the laryngeal prominence in acupuncture of the sinus.