RETRACTED: P444 Shared decision making for switching from oral mesalazine tablets to granules in low adherent inflammatory bowel disease patients.

BACKGROUND: Oral mesalazine effectively induces and maintains remission in inflammatory bowel diseases (IBD) patients. However, adherence to the drug regimen is low. Shared decision-making (SDM) is considered effective in promoting treatment adherence in IBD patients. We used SDM to switch non-adherent IBD patients from oral mesalazine tablets to granules and checked the new adherence rates. METHODS: The IRB of our hospital approved this observational study named 'Evaluation of improvement of adherence by changing oral mesalazine to Pentasa granule in low adherent inflammatory bowel disease patients, IMPACT-PG'. We used the Morisky Medication Adherence Scale (MMAS-8, where an MMAS-8 score of ≥6 indicates good adherence) to assess adherence to oral mesalazine. We met with low adherence patients and explained the benefits and characteristics of mesalazine granules and tablets; we then gave them a choice between continuing with the same pH-dependent mesalazine tablets (with a 20% weight/volume decrease) and switching to oral mesalazine granules (2 g in one stick, 2 g once or twice a day). Primary endpoint was adherence rate in IBD patients with granule or with tablet at 6 months, and secondary endpoint was adherence rate at 12 months. Contributing factors to good adherence to the oral regimen were also examined. The adherence rate was analysed using chi-square test, and contributing factors were determined by multivariate analysis using SPSS ver24. RESULTS: One hundred and eighty-three patients (126 UC and 57 Crohn's colitis patients) were enrolled and examined adherence by MMAS-8 score. Good adherence ratio was 42.6% (78 of 183). Both higher age and low frequency of medication were significantly more common in adherent patients than in non-adherent patients. Odds ratios of age and the frequency of daily medication were 1.057 (95% CI 1.029-1.086; p < 0.0001) and 0.407 (95% CI 0.218-0.759; p = 0.005), respectively. SDM was performed to the 105 low adherence patients. 67% of the low adherence patients (70 of 105) preferred mesalazine granules. Five patients were dropped out until 6 months, as well as 13 patients were dropped out until 12 months. Remission rates at 0, 6, and 24 months were not significantly different between granule and tablet groups. Adherence rates at 6 [67% (44/66) vs. 32% (11 of 34)] and at 12 [72% (43 of 60) vs. 44% (14 of 32)] months were significantly higher in the granule group than in the tablet group. CONCLUSIONS: SDM was effective for switching patients from a mesalazine tablet to a granule regimen, and adherence rates were improved in IBD patients.

Cerebellopontine angle mass mimicking lingual nerve injury after dental implant placement: a case report.

This is a rare case report of a cerebellopontine angle (CPA) mass mimicking lingual nerve injury after a dental implant placement. Lingual nerve injury is a common complication following dental implant placement. CPA masses are likely to cause symptomatic trigeminal neuralgia, and thus can mimic and be easily confused with oral diseases. We experienced a case of CPA mass mimicking lingual nerve injury after dental implant placement. The patient was a 57-year-old Japanese female who complained of glossalgia. She underwent dental implant placement in the mandible before visiting our clinic. Panoramic x-ray radiography revealed no abnormalities; the salivary flow rate by gum test was 7.0 ml/10 min. She was diagnosed with lingual nerve injury and secondary burning mouth syndrome. Vitamin B12 and oral moisturizer did not provide relief; furthermore, numbness in the lower lip emerged. A Semmes Weinstein test demonstrated elevation of her sensitivity threshold. Finally, magnetic resonance imaging revealed a 20-mm diameter mass in the CPA. The patient is now being followed under conservative management. Our experience underscores the importance of including CPA mass in the differential diagnosis of dental diseases.

DNA demethylating agent decitabine increases AQP5 expression and restores salivary function.

Xerostomia is the symptom of oral dryness resulting most frequently, but not exclusively, from salivary gland hypofunction. Because the prevalence of xerostomia may increase with age, it has multiple oral health consequences in aging populations. In the present study, we demonstrate that the in vivo administration of 5-aza-2'-deoxycytidine (5-Aza-CdR; decitabine), a DNA demethylating agent, to the murine aging model C57BL/6CrSlc mice (24 wks old) increased the volumes of salivary flow compared with those of control mice. Western blot analysis and immunohistochemical staining demonstrated the augmented expression of AQP5 protein in the salivary glands of 5-Aza-CdR-treated mice compared with those of control mice. In addition, AQP5 protein expression levels in 5-Aza-CdR-treated old mice (27 wks old) were much higher than those in untreated and young mice (6 wks old). Global methylation levels in the salivary glands were significantly lower in the 5-Aza-CdR-treated mice than in the untreated mice. Moreover, the induction of demethylation in the AQP5 promoter of 5-Aza-CdR-treated mice was stronger than in the control mice. Analysis of our data therefore suggests that a DNA demethylating agent may be a useful drug for restoring hyposalivation in elderly individuals, thereby leading to the resolution of xerostomia.

Imaging patterns of hepatic steatosis on multidetector CT: pearls and pitfalls.

Fatty liver disease is an important cause of chronic liver disease in Western countries. The purpose of this article is to describe and illustrate the diagnostic criteria and various morphological patterns of fatty liver disease on multidetector computed tomography (MDCT) with an emphasis on potential limitations and diagnostic pitfalls.

Prevalence de la transmission perinatale du VIH sous prophylaxie a la Nevirapine a Kinshasa

La transmission verticale du VIH est la cause principale de l'infection pediatrique par le VIH. Plusieurs schemas d'antiretroviraux (ARV) sont utilises dans les programmes de Prevention de la Transmission de la Mere a l'Enfant (PTME) ; allant de la dose unique prophylactique a base de la Nevirapine (NVP); a l'utilisation des Antiretroviraux a Haute Activite Therapeutique (HAART). Dans cette etude nous cherchons a determiner la prevalence de la transmission perinatale du VIH sous monotherapie a la Nevirapine utilisee dans la PTME en Republique Democratique du Congo (RDC). La charge virale a ete dosee par PCR-RNA chez 147 meres seropositives consentantes ainsi que chez leurs enfants. Un premier prelevement de sang veineux a ete effectue a l'entree en salle de travail; un deuxieme a l'accouchement; chez les meres. Concernant les enfants; un prelevement a ete effectue au cordon ombilical et un autre entre 6 et 10 semaines de vie ex utero. De 146 echantillons de sang du cordon; 21 n'ont pas ete analyses; car alteres. Les particules virales ont ete retrouvees dans 19/125 echantillons preleves a la naissance; soit 15;20. Lors du 2ieme prelevement; cette charge virale est devenue indetectable chez 17/19. Seuls 80 enfants ont ete retrouves pour ce deuxieme prelevement. En definitif 67 enfants ont eu des analyses effectuees successivement sur les prelevements du cordon et sur ceux pratiques entre 6 et 10 semaines apres la naissance et 11 etaient infectes; soit 16;40(IC a 95: 8;50-27;50).Ces donnees sont les premieres rapportees en RDC

Analysis of feeding behavior with direct linear transformation.

AIM: The sucking pattern of term infants is composed of a rhythmic alteration of expression and suction movements. The aim is to evaluate if direct linear transformation (DLT) method could be used for the assessment of infant feeding. SUBJECT AND METHODS: A total of 10 gnormalh infants and two infants with neurological disorders were studied using DLT procedures and expression/suction pressure recordings. Feeding pattern of seven gnormalh infants were evaluated simultaneously recording DLT and pressures. The other infants were tested non-simultaneously. We placed markers on the lateral angle of the eye, tip of the jaw, and throat. The faces of infants while sucking were recorded in profile. The jaw and throat movements were calculated using the DLT procedure. Regression analysis was implemented to investigate the relationship between suction and expression pressures and eye-jaw and eye-throat movement. All regression analyses investigated univariate relationships and adjusted for other covariates. RESULTS: Ten gnormalh infants demonstrated higher suction pressure than expression pressure, and their throat movements were larger than jaw movements. Two infants with neurological problems did not generate suction pressure and demonstrated larger movements in their jaw than throat. The simultaneous measurement (n=7) showed a significant correlation, not only between eye-jaw distance and the expression pressure, but also between eye-throat distance and suction pressure. The change in the eye-jaw distance was smaller than the changes in the eye-throat distance in gnormalh infants (p<0.001). CONCLUSIONS: The DLT method can be used to evaluate feeding performance without any special device.

Feeding behaviour of infants with cleft lip and palate.

AIM: To determine whether the feeding behaviour of infants with cleft lip and palate is improved with a type-P teat, which is widely used in Japan by such infants, compared with a standard teat. The difference in intra-oral movements between the type-P teat, modified for the evaluation of feeding behaviour, and an unmodified type-P teat was also compared using ultrasonography. METHODS: In part 1 of the study, 15 infants aged 2 to 3 mo and 7 infants aged 2 wk were evaluated for sucking pressure, expression pressure, frequency and duration of sucking. All the infants had a complete unilateral cleft lip and palate without any other abnormalities. In part 2, an ultrasonographic analysis of intra-oral movement was done for 5 infants enrolled in part 1 of the study. RESULTS: Sucking pressure did not occur in all infants. It was found that feeding efficiency improved with the type-P teat compared with the standard teat. The expression pressure with the type-P teat was significantly higher than that with the standard teat, and the feeding frequency with the type-P teat was lower than that with the standard teat. CONCLUSION: A type-P teat is suitable for infants with cleft lip and palate who have sucking difficulties. However, a type-P nipple with a squeezable bottle does not fully solve the feeding problems of infants with cleft lip and palate. New artificial teats that allow a higher expression pressure are desirable, and the measurement of the expression pressure may be helpful in the evaluation of artificial nipples.

Use of some natural and waste materials for waste water treatment.

A fundamental study was conducted to assess removal and filtration capacity of waste and natural indigenous materials as treatment mediums e.g., shell, limestone, waste paper mixed with refuse concrete, refuse cement, also processed nitrolite, charcoal-bio and charcoal. Under room temperature condition removal of phosphoric, nitric and ammonium-ions, filtration of suspended substance (SS) together with removal of COD in waste water was investigated. Influence of particle size effect for all treatment mediums except for waste paper was pursued. Significant improvement of waste water quality with respect to SS, phosphoric ions and decrease in COD is possible by treating with these filtration mediums. With specific reference to some treatment mediums NO3-N and NH4-N showed reasonable improvement in quality, although generally removal effect was not very significant. Efficacy of treatment was dependent on the particle size of treatment mediums in general, however, nitrolite for NH4--N, charcoal-A for SS and COD, refuse cement mixed with waste paper for PO4 ion removal showed insignificant variability on the particle size effect. Results of this fundamental study demonstrate effectiveness and feasibility for applied application of these proposed waste and naturally available treatment ingredients at lower cost.

Stereopsis-processing regions in the human parieto-occipital cortex.

We performed fMRI on the human parieto-occipital cortex in order to identify the neural processing regions of stereopsis. Visual stimulation for stereopsis was performed with a random-dot stereogram displayed in the image guides of a new binocular visual stimulation device that we developed. Interestingly, regions from the dorsal portion of the occipital lobe to the superior parietal lobule were activated by binocular disparity, while the inferior parietal lobule was not activated. Moreover, these regions were shown as dominant in the right hemisphere. Functional brain mapping revealed that the processing regions of stereopsis were dorsally located in parieto-occipital cortex, and that the superior parietal lobule is an important region for neural processing of human stereopsis.

Number and variations of the red and green visual pigment genes in Japanese men with normal color vision.

PURPOSE: We analyzed the red/green visual pigment genes in color-normal Japanese men to understand the relationship between color anomalies and genetic defects. METHODS: DNA from 120 color-normal Japanese men was subjected to polymerase chain reaction (PCR)-amplification for exons 2-5 of the red/green visual pigment genes and the PCR products were sequenced. The red:green gene ratios were estimated from the sequencing electropherograms of exon 5 and also from MvaI-restriction fragment analysis of the same exon. The first gene and the downstream genes in the pigment gene array were separately analyzed by PCR, direct sequencing, and/or single-strand conformation polymorphisms. RESULTS: The red:green gene ratios estimated from the ratios of peak heights of nucleotides on the sequencing electropherograms coincided with those estimated from the MvaI-restriction fragment analysis. Among the subjects analyzed, they were 1:1 in 43% (n = 52), 1:2 in 41% (n = 49), 1:3 in 6% (n = 7), and 1:>3 in 9% (n = 11). The first gene in the pigment gene arrays was red in all subjects. Only 1 subject (N22) had a green-red hybrid gene. Exons 2 and 4 had 2 haplotypes each, but exon 3 was highly polymorphic. Exon 5 of the green genes had one polymorphism at codon 283 with a frequency of 32%. CONCLUSIONS: The features of visual pigment genes in color-normal Japanese men were revealed. The data and establishing techniques may be useful for analyzing these genes in color-deficient subjects in the Japanese population.

Peptidases play an important role in cataractogenesis: an immunohistochemical study on lenses derived from Shumiya cataract rats.

The role of proteolytic enzymes in Shumiya cataract rats in alterations to lens proteins during cataract formation was studied immunohistochemically using antibodies against exopeptidases, such as lysosomal dipeptidyl peptidase II (DPP II), cytosolic dipeptidyl peptidase III, and soluble and membrane-bound alanyl aminopeptidases, and against cytosolic endopeptidases such as mu- and m-calpains, and 20S proteasome. AlphaB-crystallin was detected as a proteolytic marker in the lenses. A constant immunoreactivity against all the antibodies employed was observed in the lens epithelium independent of the strain and age of the rats. A weak immunoreactivity against exo- and endopeptidases and an intense reactivity against alphaB-crystallin were observed in the lens fibres of control rats at all ages. The immunoreactivity of these peptidases in lens fibres increased with age in cataract rats, but that of alphaB-crystallin decreased. No reactivity against exo- and endopeptidases was seen in the perinuclear region of lenses of control rats at all ages or in Shumiya cataract rats at 8 and 10 weeks of age, but an intense reactivity against these peptidases was observed in the lens perinuclear region of lenses in cataract rats at 12 and 14 weeks of age. AlphaB-crystallin immunoreactivity was observed with ordered striations in the lens perinuclear region of all control rats whereas the striations in this area of cataract rat lens were disorganized. Membrane-bound alanyl aminopeptidase was detected feebly in the lens epithelium and fibres of both types of rat at all weeks of age. These findings indicate that exo- and endopeptidases, except for membrane-bound alanyl aminopeptidase, are expressed intensively and are age-dependent. Conversely, the amount of alphaB-crystallin decreased with age in lens fibres of cataract rats. Calpains (mu- and m-), 20S proteasome, dipeptidyl peptidases II and III and soluble alanyl aminopeptidase are thought to induce lens opacification kinetically during cataract formation in Shumiya cataract rats through the intracellular turnover of lens proteins.

Massive deep vein thrombosis after cesarean section treated with a temporary inferior vena cava filter: a case report.

A 25-year-old woman suffered a massive deep vein thrombus in her left common iliac vein extending to the inferior vena cava after an abdominal cesarean section. The massive and floating inferior vena cava thrombus was considered to pose a high risk of pulmonary thromboembolism. After placement of a temporary inferior vena cava filter via the left brachial vein, thrombolytic therapy and anticoagulation therapy were instituted. The filter successfully prevented pulmonary thromboembolism during thrombolytic therapy. This patient was confined to bed because the filter moved vertically with left shoulder joint abduction. Although a temporary inferior vena cava filter is very useful for the prevention of pulmonary thromboembolism in a patient with deep vein thrombus, the appropriate range of activity for such a patient needs careful consideration.

Detection of female carriers of congenital color-vision deficiencies by visual pigment gene analysis.

PURPOSE: Congenital color-vision deficiencies are frequent among males, 4.7-8.0%, suggesting that female carriers are present at a frequency of 9-15%. The purpose of this study was to determine whether carriers could be detected by analysis of the visual pigment genes. METHODS: DNA from 29 males with congenital color-vision deficiencies, from their mothers, and from 117 randomly-selected females was analyzed. The most upstream genes, the downstream genes, and the most downstream genes in the red/green pigment gene arrays were amplified separately by PCR. Exon 5 of each gene was analyzed by single-strand conformation polymorphisms (SSCP). RESULTS: Analysis of the visual pigment genes suggests that one of the 29 mothers examined is a female protan and two others are carriers of both protan and deutan defects. The remaining 26 mothers were confirmed to be carriers of congenital color-vision deficiencies. Unusual patterns were observed in 15 (13%) of the randomly-selected females; among them, 5 appeared to be protan carriers and at least 4 to be deutan carriers. CONCLUSIONS: Female carriers of congenital color-vision deficiencies can be detected by analysis of the visual pigment genes. Since the proportion of females showing unusual patterns was slightly higher than expected, some must be false-positives and require more detailed examination.

Neural connections of the pontine reticular formation, which connects reciprocally with the nucleus prepositus hypoglossi in the rat.

The pontine reticular formation connected with the nucleus prepositus hypoglossi was studied in the rat using anterograde and retrograde tracer techniques. The area reciprocally connected with the nucleus prepositus hypoglossi was evident in the pontine reticular formation of the rat. The region had intensive reciprocal connections with the ipsilateral subthalamic region, the contralateral pontine reticular formation and the nucleus prepositus hypoglossi. Furthermore, it was confirmed that the region received cholinergic projections mainly from the pedunculopontine tegmental nucleus and the laterodorsal tegmental nucleus, and aminergic projections from the dopaminergic cell groups A13 and A11, noradrenergic cell groups A7, A6 and A5, and the serotoninergic B9 cell group. This region in the rat was considered to be the preoculomotor structure in the function of horizontal gaze corresponding to the paramedian pontine reticular formation in other animals.

Multicenter clinical trial for evaluating methylprednisolone pulse treatment of idiopathic optic neuritis in Japan. Optic Neuritis Treatment Trial Multicenter Cooperative Research Group (ONMRG).

BACKGROUND: A randomized, controlled clinical trial was conducted in 1991 to compare an intravenous megadose of methylprednisolone with a control drug (mecobalamin) for treating acute idiopathic optic neuritis. CASES: Sixty-six cases from 22 clinical centers throughout Japan were examined to evaluate the treatment on visual function parameters, such as visual acuity, visual field, color vision, contrast sensitivity, and critical flicker frequency. OBSERVATIONS: The methylprednisolone pulse treatment group showed faster recovery of visual function, particularly the visual acuity at 1 week (P<.05), Humphrey field analyzer mean deviation at 3 weeks (P<.05), and color vision at 1 week (P<.05). Recovery of contrast sensitivity at several different spatial frequencies was significant in the pulse treatment group at 1 (P<.01), 2 (P<.05), and 4 weeks (P<.05) after the start of treatment. Visual function test results at 12 weeks and 1 year were essentially the same in the two treatment groups. Side effects appeared more frequently in the pulse treatment group than in the control (P<.05). CONCLUSIONS: Pulse treatment does not appear effective for idiopathic optic neuritis even though visual function in the pulse treatment group of this trial recovered more quickly during the initial phase compared to the controls. More effective and specific treatment should be established for optic neuritis.

Baseline features of idiopathic optic neuritis as determined by a multicenter treatment trial in Japan. Optic Neuritis Treatment Trial Multicenter Cooperative Research Group (ONMRG).

BACKGROUND: An optic neuritis treatment trial was conducted at 30 clinical centers in Japan using the same protocol. Patient participation was based on: age range of 14-55 years; acute symptoms indicative of unilateral optic neuritis of unknown or demyelinating origin; visual symptoms of 14-day duration or less; relative afferent pupillary defect in affected eye; and normal or swollen optic disc of affected eye. CASES: Initially, 102 patients qualified for participation; baseline data were obtained for analysis from 70 of these patients. Demographic characteristics of Japanese patients with optic neuritis were clarified and compared with those in a US study. OBSERVATIONS: The incidence of ocular or periocular pain and the presence of periventricular plaques were noted to be lower, and the incidence of disc swelling higher, in the Japanese patients, suggesting racial differences in the characteristics of the disease. Such differences may possibly be related to the lower incidence of multiple sclerosis in Japanese patients. The results of visual function tests were virtually the same in both studies. The nonaffected eyes of more than half the patients showed abnormal mean deviation in Humphrey field analysis, as also noted in the US study. CONCLUSIONS: The baseline clinical features of optic neuritis in the Japanese patients have been defined. Some racial differences in the characteristics of the disease may exist.

Cataract surgery training using pig eyes filled with chestnuts of various hardness.

This method uses pig eyes filled with cooked chestnuts serving as pseudonuclei with the goal of teaching dividing techniques of phacoemulsification and aspiration. The pseudonuclei simulate the various degrees of human lens nuclear sclerosis. The chestnuts are trimmed to lens size. After lens extraction through a self-sealing straight incision from the pig eyes, the chestnuts are inserted in the capsular bag through the incision, which is then sutured. These preparatory procedures were initially performed by experienced surgeons but after practicing phacoemulsification technique several times, inexperienced surgeons were able to complete the entire procedure, allowing them to practice phaco chop, divide and conquer, and nondividing phacoemulsification.

[Diagnosis of magnetic resonance imaging (MRI) for blowout fracture--three advantages of MRI].

INTRODUCTION: Magnetic resonance imaging (MRI) gives a much more detailed picture of the soft tissue than computerized tomography (CT). In blowout fracture cases, it is very easy to observe the incarcerated orbital tissue. SUBJECTS: We performed MRI in 19 blowout fracture cases. RESULTS: After evaluating the images, we found three advantages of MRI. The first is that even small herniation of the orbital contents can easily be detected because the orbital fatty tissue contrasts well around the other tissues in MRI. The second is that the incarcerated tissues can be clearly differentiated because a clear contrast between the orbital fatty tissue and the extraocular muscle can be seen in MRI. The third is that the running images of the incarcerated muscle belly can be observed because any necessary directional slies can be taken in MRI. CONCLUSION: These advantages are very important in the diagnosis of blowout fractures. MRI should be employed in blowout fracture cases in addition to CT.