Type 2 diabetes mellitus is associated with the fibrosis severity in patients with nonalcoholic fatty liver disease in a large retrospective cohort of Japanese patients

Background

The prevalence of nonalcoholic fatty liver disease (NAFLD) and metabolic syndrome have been increasing worldwide. The associations between metabolic factors and the histologic severity of NAFLD have not yet been clarified. Therefore, we studied the relationships between relevant metabolic factors and the histological severity of NAFLD.

Methods

In a cross-sectional multicenter study conducted in Japan, we examined 1,365 biopsy-proven NAFLD patients. The frequencies of underlying lifestyle-related diseases and their relationships to the NAFLD histology were investigated.

Results

The hepatic fibrosis stages (Stage 0/1/2/3/4) were 22.6/34.1/26.7/14.5/2.1 (%) in the male patients, and 16.2/31.7/23.9/21.6/6.6 (%) in the female patients. Dyslipidemia was present in 65.7 % (hypertriglyceridemia, 45.3 %; increased low-density lipoprotein cholesterol, 37.5 %; decreased high density lipoprotein cholesterol, 19.5 %) of patients. Hypertension was present in 30.2 %, and diabetes mellitus (DM) in 47.3 %. The fibrosis stage increased with age, especially in postmenopausal females. The body mass index was positively correlated with the fibrosis stage. Deterioration of glucose control was positively correlated with the fibrosis stage, this correlation being more prominent in females. Multivariate analysis identified age and DM as significant risk factors for advanced fibrosis. No significant correlation of the fibrosis stage was observed with hypertension. There was a negative correlation between the serum triglyceride levels and the fibrosis stage.

Conclusions

DM appeared to be a significant risk factor for advanced fibrosis in patients with NAFLD, and would therefore need to be properly managed to prevent the progression of NAFLD.     

The prevalence and clinical features of spasmodic dysphonia: A review of epidemiological surveys conducted in Japan

ObjectivesSpasmodic dysphonia (SD) is a rare disease and its epidemiological status is unclear. This review aimed to explore the current prevalence and clinical features of SD in Japan.MethodsWe reviewed Japanese surveys of SD and compared them to surveys reported from other countries. We focused on SD prevalence, clinical features (SD type, sex and age), and treatment modalities.ResultsThe SD prevalence in Japan was 3.5–7.0/100,000, similar to that in Rochester (NY, USA) and Iceland. Adductor SD predominated (90–95%) and females were four-fold more likely to be affected than males. Mean age at onset was approximately 30 years in Japan. Several years elapsed from onset to diagnosis. The most frequent treatment was botulinum toxin injection, and surgical intervention, particularly type 2 thyroplasty is becoming more popular.ConclusionsOur review demonstrated some differences of clinical features of SD in Japan compared with other countries, such as a greater female predominance and younger age of onset. Many physicians and patients may be unfamiliar with the clinical features of SD leading to delayed of diagnosis. Therefore, we proposed diagnostic criteria to facilitate early diagnosis and an appropriate choice of treatment modalities.     

Prognostic Links Between OCT-Delineated Coronary Morphologies and Coronary Functional Abnormalities in Patients With INOCA

ObjectivesWhether there are prognostic links between coronary morphologies and coronary functional abnormalities was examined in ischemia and nonobstructive coronary artery disease (INOCA) patients.BackgroundAlthough INOCA has attracted much attention, little is known about the prognostic impact of coronary morphologies in this disorder.MethodsA total of 329 consecutive INOCA patients were enrolled and underwent spasm provocation testing combined with lactate sampling for diagnosis of epicardial and microvascular spasm (MVS). On the basis of the functional tests, the patients were classified into 4 groups: a control group without epicardial spasm or MVS (n = 32), MVS alone (n = 51), diffuse spasm in ≥2 coronary segments (n = 204), and focal spasm in 1 segment (n = 42). In this population, optical coherence tomography imaging of the left anterior descending coronary artery was performed for evaluation of adventitial vasa vasorum (AVV) and intraplaque neovessels (IPN). Index of microcirculatory resistance was also measured.ResultsMVS frequently coexisted with diffuse (70%) and focal spasm (68%) with a good correlation between AVV and index of microcirculatory resistance (R = 0.353; p = 0.022). For a median follow-up of 1,043 days, focal spasm showed the worst prognosis (log rank p = 0.005), for which IPN was a significant prognostic factor. By contrast, diffuse spasm showed the greatest AVV with an intermediate prognosis. The prognostic value of INOCA was significantly enhanced by adding AVV and IPN to the physiological indices (area under the curve = 0.88 vs. 0.76; p = 0.048).ConclusionsThese results provide the first evidence that there are important prognostic links between coronary morphologies (evaluated by optical coherence tomography) and coronary functional abnormalities in patients with INOCA, indicating the importance of both evaluations in this population.     

Sudden death of a child because of an intestinal obstruction caused by a large congenital mesenteric defect

Transmesenteric hernias are internal hernias caused by a congenital defect in the mesentery. They are rare causes of intestinal obstruction, but most commonly affect the small bowel. We report an unexpected death of an infant with a bowel obstruction caused by a congenital mesenteric defect, which was undiagnosed despite visits to three different hospitals. Mesenteric defects are usually 2-3 cm in diameter. At autopsy, we found an oval, 14 × 7 cm congenital defect in the ileal mesentery through which the small bowel had herniated. Diagnosis of such defects remains difficult, even with currently available imaging techniques. Diagnosis is particularly difficult in infants who usually have nonspecific symptoms. Therefore, it is important that sudden unexpected deaths in children undergo full forensic evaluation to establish the precise cause of death. It is also important for forensic physicians to inform clinicians of the risk of such diseases, particularly in emergency situations.     

Comprehensive review on endoscopic ultrasound-guided tissue acquisition techniques for solid pancreatic tumor

Pancreatic ductal adenocarcinoma is speculated to become the second leading cause of cancer-related mortality by 2030, a high mortality rate considering the number of cases. Surgery and chemotherapy are the main treatment options, but they are burdensome for patients. A clear histological diagnosis is needed to determine a treatment plan, and endoscopic ultrasound (EUS)-guided tissue acquisition (TA) is a suitable technique that does not worsen the cancer-specific prognosis even for lesions at risk of needle tract seeding. With the development of personalized medicine and precision treatment, there has been an increasing demand to increase cell counts and collect specimens while preserving tissue structure, leading to the development of the fine-needle biopsy (FNB) needle. EUS-FNB is rapidly replacing EUS-guided fine-needle aspiration (FNA) as the procedure of choice for EUS-TA of pancreatic cancer. However, EUS-FNA is sometimes necessary where the FNB needle cannot penetrate small hard lesions, so it is important clinicians are familiar with both. Given these recent dev-elopments, we present an up-to-date review of the role of EUS-TA in pancreatic cancer. Particularly, technical aspects, such as needle caliber, negative pressure, and puncture methods, for obtaining an adequate specimen in EUS-TA are discussed.     

Two cases of pure agraphia developed after thalamic hemorrhage

We have observed two cases suffered from left thalamic hemorrhage, that showed pure agraphia. The first case was a 49 year-old, right handed male, who was educated through 11th grade. The CT scan revealed left thalamic hemorrhage with ventricular casting. The second case was a 48 year- old, right handed male, who was educated through 9th grade. The CT scan revealed left thalamic hemorrhage which is smaller than that of the first case, without intraventricular rupture. With a standard neuropsychological evaluation performed at chronic stage, neither cases showed oral language disorder, apraxia and agnosia. On the Wechsler Adult Intelligence Scale, total IQ of the first and second case were 71 and 80 respectively. Each case developed severe writing disorder. The first case showed severe neographism and scrawl, mild literal paragraphia, which were frequently accompanied with perseveration. The second case showed literal paragraphia and no response, but neographism was not detected. The common characteristics of both cases were; 1) intact copy writing. 2) discrepancy between difficulty in writing "Kana" and that in "Kanji". 3) anosognosia of agraphia. The cerebral blood flow study by 123I-IMP Single photon emission computed tomography revealed low perfusion of the left cerebral hemisphere in both cases. From these findings, we concluded that dysfunction of the left cerebral cortex is responsible for producing agraphia in these cases.     

Complexation of Amino‐Acid‐Based Block Copolymers With Dual Thermoresponsive Properties and Water‐Soluble Silsesquioxane Nanoparticles

Smart organic–inorganic hybrids are prepared using non‐covalent interactions between water‐soluble silsesquioxane nanoparticles and two amino acid‐based block copolymers prepared by reversible addition–fragmentation chain transfer (RAFT) polymerization. A block copolymer displaying lower critical solution temperature (LCST) and upper critical solution temperature (UCST) is employed, in which only poly(N‐acryloyl‐4‐trans‐hydroxy‐L ‐proline) segment could interact with the nanoparticles, whereas another poly(N‐acryloyl‐L ‐proline methyl ester) segment shows a thermoresponsive property without any interaction. The complexation of another type of dual thermosensitive block copolymer with two different LCSTs and the silsesquioxane nanoparticles is also investigated.