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.

Since 2005, one of our clinical technologists has been involved in providing assisted reproductive technology (ART) services ranging from egg retrieval to embryo transfer, which were previously performed only by doctors at our hospital. In 2011, the clinical technologist was certified as a clinical embryologist by the Japanese Society of Clinical Embryologists. Around 2020, insurance coverage for ART related to infertility treatment began to be considered. Consequently, the training and development of ART-supporting clinical technologists became an urgent issue. In response, we developed a training program for ART-supporting clinical technologists that covers egg retrieval assistance, fertilization, culture, embryo freezing/thawing, and embryo transfer. By the end of fiscal year 2022, we had successfully trained two new ARTsupporting clinical technologists, bringing the total to three.

Objective: Antibiogram preparation is important for the proper selection of antimicrobial agent in empiric therapy. It is recommended to prepare the antibiogram separately for inpatients and outpatients. However, the antimicrobial agent susceptibility of bacteria detected from an inpatient is thought to be different when detected at an early date after admission and after a certain period after admission.Methods: In this study, we defined the bacteria detected from an inpatient within 3 days after admission as “brought bacteria” and those over 3 days after admission as “bacteria detected after admission.” Antimicrobial agent susceptibilities of brought bacteria and bacteria detected after admission in our hospital between April 2018 and March 2019 were compared for Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa.Results: The occurrence rate of Escherichia coli producing an extended β-lactamase of bacteria detected after admission was found to be significantly higher compared with that of brought bacteria. The sulbactam/ampicillin susceptibility rate of bacteria detected after admission was significantly lower than that of brought bacteria. The occurrence rate of the two drug-resistant Pseudomonas aeruginosa detected after admission tends to be higher compared with that of brought bacteria.Conclusion: Our findings showed that the susceptibility rate of some drugs differed substantially between brought bacteria and bacteria detected after admission. Therefore, the inpatient’s antibiogram is thought to be prepared by separating bacteria detected at an early date after admission and after a certain period after admission, leading to the proper selection of antimicrobial agent in empiric therapy tailored to a patient’s number of days in the hospital.

Overweight or obesity becomes a worldwide public health issue; the global obesity pandemic. Strategies to effectively prevent overweight and obesity are needed. Slow eating, which involves chewing food slowly and thoroughly, can be an effective strategy to prevent overweight and obesity. Previous studies reported a relationship between rapid eating and overweight. Candidate factors inducing the relationship have been thought to be related to increases in appetite and energy intake through rapid eating, allowing the ingestion of a greater-than-optimal volume of food. While the counter effect of slow eating has been widely known, effects of eating speed on digestion, absorption, and metabolism has yet to be elucidated. If eating speed affects digestion, absorption, and metabolism, eating speed can be a factor explaining the relationship between eating speed and body composition. The present review is to summarize the effects of eating speed on digestion, absorption, and metabolism, consequently suggesting preferable effects of slowly eating on increasing energy expenditure after eating.

Objective: We have used therapeutic drug monitoring (TDM) analysis software to set the initial dose of vancomycin in our hospital.  In contrast, the TDM guideline, in which the initial dose of vancomycin per body weight was set, was published in 2012.  We looked forward with utilizing the TDM guideline in the clinical setting, after which we conducted multiple surveys to determine the important points of the TDM guideline.
Methods: We surveyed patients treated with vancomycin, in whom the initial dose was set using the TDM analysis software and the concordance rate between the vancomycin dose set with the software and that set with the TDM guideline.
Results: The concordance rate of vancomycin dose was 42.1%.  The mean age of the high-dose group (vancomycin dose higher than that recommended by the TDM guideline), was younger than that of the recommended-dose group.  Additionally, the mean body weight of the high-dose group was significantly lower than that of the recommended-dose group.  The corrected creatinine clearance of the low-dose group was significantly lower than that of the recommended-dose group.
Conclusion: Our results suggest that when the initial dose is set after referring the TDM guideline in patients who are not very high age, and having low body weight and decreased renal function, the dose may differ from the dose set by using TDM analysis software.  In addition, since the recommended dose per body weight is a range and not a single value, setting the dose appropriate to target trough concentration is necessary.

To improve the environment of the inpatient ward, we paid attention to the patients' environment related to eating. For this purpose, studies were made to determine what would be the most suitable height of the dining table. In view of the present situation, we started by putting together bed tables in sick rooms. Nine inpatients cooperated in this project. After trial and error, we found the most suitable height of the table. It was 1/3 of the patient's sitting height plus 4 to 5 cm. Next, we tried to make an adjustable table in the dining hall for a patient. Any table in the dining hall did not suit the patient. The result was he was satisfied with it. All the patients said they became able to see foods on the table with ease. They also became able to finish eating faster than before without dropping their food, and did not leave half-eaten. Some patients who had habitually dozed off while eating before did so less frequently.
Table, NOS ; HEIGHT ; Patients ; Eating ; Environment

We report a rare case of a 73-year-old man with abdominal and thoracic aortic aneurysms complicated with Buerger's disease. He complained of abdominal pain, nausea and an abdominal pulsatile mass. Computed tomography and angiography revealed an abdominal aortic aneurysm (58mm in diameter) and a thoracic aortic aneurysm (47mm in diameter). Y graft replacement was performed for abdominal aortic aneurysm. The size of the thoracic aortic aneurysm increased from 47mm to 60mm in 3 years, and hoarseness appeared. We then performed graft replacement of the thoracic aorta. In cases of Buerger's disease, we have to consider perfusion of the extremities when we need extracorporeal circulation, and we must shorten ischemic interval.