Genetic Polymorphism of the CCK Gene in Patients With Alcohol Withdrawal Symptoms

Background: Cholecystokinin (CCK) is considered to play an important role in the central nervous system via its interaction with other neurotransmitters such as dopamine, serotonin, gamma-aminobutyric acid, substance P, and enkephalins. We investigated the relationship between the C to T substitution in the Spl binding cis-element of the CCK gene promoter region (at position −45 numbered from initiation codon) and alcohol withdrawal symptoms. Methods: We examined 214 Japanese men with alcoholism (93 with delirium tremens, 49 with hallucination, 38 with seizure, and 93 with none of these symptoms) and 98 age-matched Japanese male controls by using a polymerase chain reaction-based single strand conformational polymorphism analysis. Results: Patients who displayed hallucination were significantly more likely to possess the C allele than control subjects (X² = 8.17, p = 0.017, Bonferroni correction: p = 0.064). In addition, we investigated the influence of CCK gene polymorphism on alcohol consumption among the control subjects but found no significant relationship. Conclusions: Our data suggested that the C allele at −45 locus of the CCK gene was higher in patients with hallucination than the control group at a rate that was not quite significant after Bonferroni correction for multiple testing.     

Ultrastructure of the three anterior cruciate ligament bundles

The anterior cruciate ligament (ACL) can be morphologically separated into not only two, but three bundles: the anteromedial‐medial bundle (AM‐MB), the anteromedial‐lateral bundle (AM‐LB), and the posterolateral bundle (PLB). Our hypothesis was that the three bundles differ in their microstructures. The purpose of this study was to clarify the microstructural differences among the three bundles. The normal ACLs of six fresh frozen cadavers were harvested. After the AM‐MB, AM‐LB, and PLB were identified, their fibril structures were analyzed using a transmission electron microscope. The fibril orientation, distribution pattern, and the mass average diameter of the fibrils (MAD) were compared among the AM‐MBs, AM‐LBs, and PLBs. The AM‐MB and AM‐LB fibrils were arranged mostly in the longitudinal direction, while the PLB fibrils were not aligned in a uniform direction. The fibril diameter distribution pattern of AM‐MBs showed a bi‐modal pattern due to the existence of small‐diameter (30‐40 nm) and large‐diameter fibrils (70‐80 nm), while that of the AM‐LBs and PLBs had a unimodal pattern with one prominent high peak at a diameter of 50‐60 nm. The mean MAD of the AM‐MBs (83.2 ? 11.2 nm) was significantly larger than that of the PLBs (66.8 ? 7.7 nm), while it showed no significant difference compared to that of the AM‐LBs (77.6 ? 12.3 nm). The three ACL bundles have different ultrastructures. The AM‐MB predominantly includes thick, uni‐directionally oriented fibrils like tendons, while the PLB consists of thinner, multi‐directionally oriented fibrils. The AM‐LB shows an intermediate structure between the AM‐MB and the PLB. Clin. Anat. 28:910–916, 2015. © 2015 Wiley Periodicals, Inc.     

Need for pancreatic stenting after sphincterotomy in patients with difficult cannulation

AIM: To investigate the need for pancreatic stenting after endoscopic sphincterotomy (EST) in patients with difficult biliary cannulation.METHODS: Between April 2008 and August 2013, 2136 patients underwent endoscopic retrograde cholangiopancreatography (ERCP)-related procedures. Among them, 55 patients with difficult biliary cannulation who underwent EST after bile duct cannulation using the pancreatic duct guidewire placement method (P-GW) were divided into two groups: a stent group (n = 24; pancreatic stent placed) and a no-stent group (n = 31; no pancreatic stenting). We retrospectively compared the two groups to examine the need for pancreatic stenting to prevent post-ERCP pancreatitis (PEP) in patients undergoing EST after biliary cannulation by P-GW.RESULTS: No differences in patient characteristics or endoscopic procedures were observed between the two groups. The incidence of PEP was 4.2% (1/24) and 29.0% (9/31) in the Stent and no-stent groups, respectively, with the no-stent group having a significantly higher incidence (P = 0.031). The PEP severity was mild for all the patients in the stent group. In contrast, 8 had mild PEP and 1 had moderate PEP in the no-stent group. The mean serum amylase levels (means ± SD) 3 h after ERCP (183.1 ± 136.7 vs 463.6 ± 510.4 IU/L, P = 0.006) and on the day after ERCP (209.5 ± 208.7 vs 684.4 ± 759.3 IU/L, P = 0.002) were significantly higher in the no-stent group. A multivariate analysis identified the absence of pancreatic stenting (P = 0.045; odds ratio, 9.7; 95%CI: 1.1-90) as a significant risk factor for PEP.CONCLUSION: In patients with difficult cannulation in whom the bile duct is cannulated using P-GW, a pancreatic stent should be placed even if EST has been performed.     

The impact of rituximab in ABO‐incompatible pediatric living donor liver transplantation: The experience of a single center

Previous studies have demonstrated the safety of ABO‐incompatible pediatric LDLT using preoperative plasmapheresis and rituximab; however, no reports have described the timing and dosage of rituximab administration for pediatric LDLT. This study aimed to describe a safe and effective dosage and timing of rituximab for patients undergoing pediatric ABO‐incompatible LDLT based on the experience of our single center. A total of 192 LDLTs in 187 patients were examined. These cases included 29 ABO‐incompatible LDLTs in 28 patients. Rituximab was used beginning in January 2004 in recipients older than two yr of age (first period: 375 mg/m² in two cases; second period: 50 mg/m² in two cases; and 200 mg/m² in eight cases). Two patients who received 375 mg/m² rituximab died of Pneumocystis carinii pneumonia and hemophagocytic syndrome. One patient who received 50 mg/m² rituximab required retransplantation as a consequence of antibody‐mediated complications. All eight patients administered 200 mg/m² survived, and the mean CD20⁺ lymphocyte count was 0.1% at the time of LDLT. In the preoperative management of patients undergoing pediatric ABO‐incompatible LDLT, the administration of 200 mg/m² rituximab three wk prior to LDLT was safe and effective.     

Risk-adjusted increases in medical resource utilization associated with health care-associated infections in gastrectomy patients

Rationale, aims and objectives  Quantifying the impact of health care-associated infections (HAIs) on medical resource utilization is necessary for payers and providers to appropriately allocate limited resources for interventions. However, previous studies tend to involve single institutions and do not take into account patient and practice variations between several hospitals. The objective of this study was to conduct a multi-institutional risk-adjusted comparison of HAI-associated impact on medical resources in gastrectomy patients in Japan.
Methods  Health care-associated infections were identified using a combination of International Classification of Diseases-10 codes and antibiotic utilization patterns in 1058 gastrectomy patients from 10 Japanese hospitals. Multiple linear regression models and risk adjustment were used to analyse the impact of HAIs on: (1) total hospital costs; (2) antibiotic costs; and (3) post-surgical length of stay (LOS).
Results  Overall HAI incidence for the database was 20.3%, with a range of 8.8–29.6% among the 10 hospitals. Regression models showed that HAIs were significantly associated with increases in all three indicators. Risk-adjusted comparisons revealed that HAIs were associated with an increase of US$2767 (range: US$1035–6513) in overall hospital cost, US$202 (US$98.8–764.6) antibiotic costs and 10.6 (4.7–24 days) post-surgical LOS days.
Conclusions  Even after adjusting for patient characteristics and other variables, there was still a high degree of variation observed in the impact of HAIs on total hospital costs and antibiotic costs from a third-party payer's perspective and post-surgical LOS among the 10 hospitals. This information can increase the efficiency of allocation of resources for interventions to reduce HAIs.     

A long-term follow-up of Japanese mother and her daughter with Blau syndrome: Effective treatment of anti-TNF inhibitors and useful diagnostic tool of joint ultrasound examination

Blau syndrome (BS) is an autosomal dominant autoinflammatory disease associated with NOD2 gene mutations. It is characterized by arthritis, skin rash, and uveitis. Here, we report contrasting outcomes of a daughter and her mother with BS. Their long-term follow-up revealed the efficacy of anti-tumor necrosis factor inhibitor (TNF) with respect to BS. Joint findings of BS feature tenosynovitis over articular synovitis on ultrasonography. BS might be one of the differential diagnoses of juvenile idiopathic arthritis and rheumatoid arthritis.     

Gastric glomus tumor resection using laparoscopic endoscopic cooperative surgery: A case report

Gastric glomus tumors are rare submucosal mesenchymal neoplasms that are difficult to diagnose preoperatively. We present a case of a 60-year-old woman who was diagnosed with a gastric glomus tumor using endoscopic ultrasonography-guided fine-needle aspiration biopsy. The tumor was successfully resected with laparoscopic endoscopic cooperative surgery (LECS). LECS could be an effective method for the resection of gastric glomus tumors.