Atypical familial Mediterranean fever developed in a long-term hemodialysis patient.

Familial Mediterranean Fever (FMF) is usually an autosomal recessive autoinflammatory disease characterized by recurrent attacks of fever and serositis. FMF develops before the age of 20 years in 90% of patients. It has intervals of 1 week to several years between attacks, which leads to renal dysfunction-amyloidosis. We report a case of atypical FMF that developed in a long-term hemodialysis patient. A 65-year-old Japanese female undergoing hemodialysis for 32 years was referred to our hospital with a fever of unknown origin (FUO) following cervical laminoplasty. The fever occurred as recurrent attacks accompanied by oligoarthralgia of the left hip and knee. We suspected FMF because of recurrent self-limited febrile attacks, although the patient showed atypical clinical features such as late-onset and highly frequent attacks. After receiving treatment, she achieved a complete response to colchicine. Therefore, a diagnosis of FMF was made based on the Tel-Hashomer criteria, which was confirmed by genetic testing. The case suggests that FMF may be of note in long-term hemodialysis patients developing FUO.

Delayed Bleeding Following Cold Snare Polypectomy for Small Colorectal Polyps in Patients Taking Antithrombotic Agents.

BACKGROUND: This study compared the incidence of delayed bleeding following 2 methods of cold snare polypectomy for colorectal polyps in patients taking antithrombotic agents. METHODS: Patients undergoing cold snare polypectomy for colorectal polyps ≤10 mm without discontinuation of antithrombotic agents were enrolled. This was a retrospective study of a prospectively collected cohort based on a historical comparison of 2 time periods. A traditional cold snare was used between January 2012 and December 2013 and a dedicated cold snare was used between January 2014 and December 2015. Patients' and polyps' characteristics, antithrombotic agents used, the snare used, the number of clips used, and adverse events were documented from a hospital online database. Delayed bleeding was defined as bleeding that required endoscopic treatment within 2 weeks after polypectomy. The submucosal layer of the resected polyps (6 to 10 mm) was histologically examined for the presence of injured arteries. RESULTS: A total of 172 patients having 370 eligible polyps were enrolled; traditional cold snare group, N=100 (212 polyps) and dedicated cold snare group, N=72 (158 polyps). The patients' and polyps' characteristics were similar between the 2 groups. Hemostatic clips were used more often with the traditional than dedicated cold snares [33/100 (33%) vs. 13/72 (18%), P=0.044]. Delayed bleeding following cold snare polypectomy occurred in 1.2% (2/172); 0% (0/72) with dedicated snare versus 2% (2/100) with the traditional snare (P=0.63). The presence of histologically demonstrated injured submucosal arteries with the dedicated cold snare was significantly less than with the traditional cold snare [4.1% (4/98) vs. 16% (17/105), P=0.009]. CONCLUSIONS: Colorectal polyps ≤10 mm can be removed without an increase in delayed bleeding using dedicated cold snare polypectomy in patients taking antithrombotic agents.

Comparison between endoscopic mucosal resection and hot snare resection of large nonpedunculated colorectal polyps: a randomized trial.

BACKGROUND AND STUDY AIMS: It is unclear whether endoscopic mucosal resection (EMR) or hot snare resection is better for resecting large nonpedunculated polyps. The aim of this study was to determine a cutoff size of nonpedunculated neoplastic colorectal polyps at which the risk of incomplete resection differed between EMR and hot snare resection. PATIENTS AND METHODS: Patients with nonpedunculated neoplastic polyps (10 - 25 mm in diameter) were randomly assigned to undergo endoscopic resection using EMR (52 patients with 63 polyps) or hot snare resection (52 patients with 62 polyps). EMR included submucosal injection of saline before resection. The primary outcome measure was the proportion with complete polyp resection determined by histopathology. The secondary outcome was total procedure time. RESULTS: Patient characteristics were similar between groups. EMR achieved complete resection more frequently than hot snare resection (89 % vs. 73 %; P = 0.02), particularly for polyps ≥ 20 mm (75 % [9 /12] vs. 18 % [2 /11]; P = 0.006). A complete resection rate of > 90 % was achieved for polyps of size < 19 mm with EMR, and for polyps of size ≤ 14 mm with hot snare resection. In multivariate analysis, incomplete resection was associated with hot snare resection (odds ratio [OR] 2.8, 95 % confidence interval (95 %CI) 1.0 - 8.3; P = 0.04) and polyp size ≥ 15 mm (OR 4.0, 95 %CI 1.3 - 14; P = 0.01). Total procedure time was shorter with hot snare resection than with EMR (mean 14.8 min vs. 17.2 min; P < 0.001). CONCLUSIONS: EMR and hot snare resection appear to achieve similar complete resection rates for polyps up to 14 mm; however, EMR may be superior for larger polyps, particularly for those ≥ 20 mm.Registered at Clinicaltrials.gov: NCT 01950117.

Determination of the cut-off score of an endoscopic scoring method to predict whether elderly patients with dysphagia can eat pureed diets.

AIM: To identify the cut-off value for predicting the ability of elderly patients with dysphagia to swallow pureed diets using a new endoscopy scoring method. METHODS: Endoscopic swallowing evaluation of pureed diets were done in patients ≥ 65 years with dysphagia. The Hyodo-Komagane score for endoscopic swallowing evaluation is expressed as the sum (0-12) of four degrees (0-3) with four parameters: (1) salivary pooling in the vallecula and piriform sinuses; (2) the response of glottal closure reflex induced by touching the epiglottis with the endoscope; (3) the location of the bolus at the time of swallow onset assessed by "white-out" following swallowing of test jelly; and (4) pharyngeal clearance after swallowing of test jelly. We used receiver operating characteristic (ROC) curve analysis to retrospectively analyze the association between the total score and successful oral intake of pureed diets. RESULTS: One hundred and seventy-eight patients were enrolled including 113 men (63%), mean age 83 years (range, 66-98). One hundred and twenty-six patients (71%) were able to eat pureed diets during the observation period (mean ± SD, 19 ± 14 d). In ROC analysis, the cut-off value of the score for eating the pureed diets was 7 (sensitivity = 0.98; specificity = 0.91). CONCLUSION: The Hyodo-Komagane endoscopic score is useful to predict the ability to eat pureed diets in elderly patients with dysphagia.

Development of a multiple-field-of-view multiple-scattering polarization lidar: comparison with cloud radar.

We developed a multiple-field-of-view multiple-scattering polarization lidar (MFMSPL) to study the microphysics of optically thick clouds. Designed to measure enhanced backscattering and depolarization ratio comparable to space-borne lidar, the system consists of four sets of parallel and perpendicular channels mounted with different zenith angles. Depolarization ratios from water clouds were large as observed by MFMSPL compared to those observed by conventional lidar. Cloud top heights and depolarization ratios tended to be larger for outer MFMSPL channels than for vertically pointing channels. Co-located 95 GHz cloud radar and MFMSPL observations showed reasonable agreement at the observed cloud top height.

Comparison of newly found polyps after removal of small colorectal polyps with cold or hot snare polypectomy.

BACKGROUND AND STUDY AIMS: There are limited data regarding polyp recurrence following cold or hot snare polypectomy for small colorectal polyps. The aim of this study was to evaluate the prevalence of newly found polyp after cold or hot snare polypectomy and the predictive factors. PATIENTS AND METHODS: This was a retrospective case-control study at a single municipal hospital. Patients undergoing cold or hot snare polypectomy for colorectal polyps≤8 mm included in a previous study (Digestion 2011; 84:78) were enrolled. Newly found polyps were defined as polyps detected at follow-up colonoscopy within 3 years. Predictive factors for new polyps were assessed by multivariate analysis using logistic regression. RESULTS: A total of 72 patients (female 22, mean age 68) with 184 polyps were enrolled. Eighty-nine polyps (mean size±SD, 5.3±2 mm) were resected with cold snare while 95 polyps (mean size 5.5±6 mm) were resected with hot snare polypectomy. Twenty-four new polyps (<5 mm) were found at follow-up. No polypectomy scars were detected in the vicinity of the new polyps. The prevalence of new polyps was similar (i.e., cold vs. hot snare polypectomy; 23% vs. 19%, P=0.68). Multivariate analysis revealed that the removal of ≥4 polyps was an independent predictor associated with new polyps (odds ratio:7.8, 95% confidence interval: 2.1-32, P=0.0022). CONCLUSIONS: Diminutive polyps were newly found with similar prevalence after cold or hot snare polypectomy, but there were no recurrent polyps detected.

Total synthesis of (+)-muconin.

(+)-Muconin (1), isolated from the leaves of Rollinia mucosa (Jacq.) Baill. (Annonaceae), is a sequential THF/THP-possessing acetogenin that exhibits potent and selective in vitro cytotoxicity toward pancreatic and breast tumor cell lines. In this study, a new route was established for obtaining (+)-muconin (1) starting with (-)-muricatacin (2), a compound recently synthesized via the novel alpha-C-H hydroxyalkylation and alpha'-C-H oxidation of tetrahydrofuran.

Synthesis of (--)-Muricatacin via alpha- and alpha'-C-H bond functionalization of tetrahydrofuran.

(--)-Muricatacin, a potent cytotoxic (4R,5R)-5-hydroxyheptadecan-4-olide, has been synthesized through alpha-C--H hydroxyalkylation and alpha'-C--H oxidation of tetrahydrofuran. This study presents a novel method for C--H bond functionalization as a means for preparing gamma-(hydroxyalkyl)-gamma-butyrolactones.