Remission Factors for Ustekinumab Treatment of Ulcerative Colitis: A Multicenter Retrospective Study of Real-World Data in Japan.

Ustekinumab (UST) is an anti-IL-12/23p40 monoclonal antibody used to treat inflammatory bowel disease. The aim of this retrospective, multicenter study was to investigate the effectiveness of UST administration in achieving remission in patients with ulcerative colitis (UC) and to determine patient characteristics that influence its effectiveness. Of 88 UC patients who received UST from March 2020 to August 2023, 47 with traceable data and for whom 56 weeks had elapsed since the start of treatment received UST to induce remission. The remission rates at 8 weeks were 66% overall, 73.7% for Bio Naïve (never used biologics/JAK inhibitors), and 60.7% for Bio Failure (used biologics/JAK inhibitors) groups. Remission rates at 56 weeks were 70.2% overall, 73.7% for Bio Naïve, and 67.9% for Bio Failure groups. Ustekinumab showed good mid-to-long-term results in the induction of remission of UC in both Bio Naïve and Bio Failure groups. The group showing remission at 8 weeks had a significantly higher non-relapse or continuation rate (proportion of patients with no worsened symptoms necessitating surgery/drug change) at 56 weeks. Predictive factors for achieving remission after UST in UC were female gender, low body mass index, and low lymphocyte-to-monocyte ratio. Thus, UST is effective for moderate-to-severe UC.

Transgastric Jejunostomy (PEG-J) for Continuous Infusion of Levodopa-Carbidopa Intestinal Gel: An Approach for Parkinson's Disease Treatment.

BACKGROUND Parkinson's disease (PD) is a neurodegenerative disorder that often requires long-term management of motor symptoms. Continuous infusion of levodopa-carbidopa intestinal gel (LCIG) has shown promising results in alleviating motor fluctuations and improving quality of life. This study aimed to evaluate the efficacy and safety of transgastric jejunostomy (PEG-J) as a delivery method for LCIG in a cohort of 43 PD patients. MATERIAL AND METHODS Forty-three PD patients who were candidates for LCIG therapy underwent transgastric jejunostomy to facilitate continuous infusion of LCIG. The primary outcomes assessed were motor symptom improvement, reduction in motor fluctuations, and medication-related adverse events. Secondary outcomes included changes in quality of life, dyskinesia severity, and healthcare resource utilization. RESULTS The results of this study demonstrated significant improvements in motor symptoms, reduction in motor fluctuations, and enhanced quality of life following PEG-J for LCIG infusion. The treatment was generally well-tolerated, with a low incidence of procedure-related complications. Notably, the use of PEG-J allowed for precise and continuous delivery of LCIG, minimizing variations in drug absorption and ensuring consistent therapeutic levels. CONCLUSIONS Transgastric jejunostomy (PEG-J) offers an effective approach for the continuous infusion of LCIG in Parkinson's disease treatment. This method provides a stable and reliable delivery system, leading to improved symptom control and enhanced quality of life for PD patients.

Can a Solitary Juvenile Polyp Be Regarded as a Nonmalignant Polyp?

Juvenile polyps (JPs) are common, developing mostly as solitary, hamartomatous lesions in the colorectum, and principally affect pediatric patients. Solitary JPs are recognized as benign, with a negligible malignant transformation rate. Primary signet ring cell carcinoma is a rare type of colorectal cancer (0.1%-2.6%) that presents mostly at an advanced stage in younger patients and affects the right-sided colon, with extensive lymphatic invasion and peritoneal dissemination, resulting in a poorer prognosis compared with conventional colorectal cancer. We report a rare case of signet ring cell carcinoma in a solitary JP treated with endoscopic mucosal resection.

Solitary schwannoma of the sural nerve: An unusual clinical presentation.

Schwannomas may arise from any peripheral nerve containing Schwann cells. However, sural nerve schwannoma is extremely rare. In this study, a case of solitary schwannoma originating from the sural nerve in a 42-year-old male is presented. Physical examination revealed a 3-cm, elastic-hard, mobile, non-tender mass, while neurovascular examinations, including Tinel's sign, were normal. Magnetic resonance imaging revealed an oval-shaped subcutaneous mass with iso-signal intensity relative to skeletal muscle on T1-weighted sequences. T2-weighted spectral presaturation with inversion recovery sequences showed higher signal intensity peripherally and lower signal intensity centrally, representing a target sign. Contrast-enhanced T1-weighted sequences demonstrated a marked central enhancement of the mass. The tumor was completely enucleated using an intracapsular technique. Histological examination confirmed the diagnosis of a schwannoma, consisting mainly of Antoni A tissue. The patient had no evidence of local recurrence and no neurological deficit at the final follow-up. Although rare, schwannoma should be considered in the differential diagnosis of a well-defined, oval, subcutaneous mass in the posterior aspect of the lower leg.

Collagenous fibroma (desmoplastic fibroblastoma) with trisomy 8 as the sole cytogenetic abnormality.

Collagenous fibroma (desmoplastic fibroblastoma) is a benign fibrous soft tissue tumor that usually occurs in the subcutaneous tissue or skeletal muscle of adults. Recent cytogenetic studies have revealed clonal rearrangements of the chromosomal band 11q12. We present a unique case of collagenous fibroma arising in the right shoulder of a 63-year-old female. Magnetic resonance imaging showed a solid soft tissue mass deeply relative to the deltoid muscle, with low-to-intermediate signal intensity on T1-weighted sequences and low-to-slightly high signal intensity on T2-weighted sequences. Contrast-enhanced fat-suppressed T1-weighted sequences demonstrated heterogenous internal enhancement with rim enhancement. Following an open biopsy, marginal excision of the tumor was performed. Histological examination confirmed the diagnosis of collagenous fibroma. Cytogenetic analysis displayed a simple karyotypic change with trisomy 8. The postoperative course was uneventful, and the patient is doing well without local recurrence two months after the surgery. To the best of our knowledge, this is the first case of collagenous fibroma with trisomy 8 as the sole cytogenetic abnormality.

Simultaneous illumination method: application in a two-channel emission fluorometer with multi-wavelength excitation.

We developed a new illumination method called the simultaneous illumination method. This method does not require synchronization between light sources and sensor signals, which drastically simplifies the instrumentation. As a proof-of-concept, we applied this method to an oceanographic fluorometer. In principle, using this method, one can easily increase the number of characterized emission wavelengths by mounting optical sensors for as many emission wavelengths as needed. Our fluorometer has two emission-wavelength channels and twelve excitation wavelengths. The aim of this prototype is to demonstrate a viable in situ N-channel emission fluorometer with multiple wavelengths of excitation, which has not been previously realized.

[Estimation of glomerular filtration rate by inulin clearance: comparison with creatinine clearance].

Inulin clearance (Cin) is widely believed to be the gold standard of the glomerular filtration rate (GFR). However, in Japan, Cin has not been officially recognized by the Ministry of Health, Labour and Welfare of Japan for clinical use. Creatinine clearance (Ccr) has been used to estimate the renal function of patients, but there have been many studies in which Ccr estimates were GFR falsely high because the metabolism and tubular excretion of creatinine widely varied according to the pathophysiological state of the patient. In the present study, we determined Cin and Ccr simultaneously in 116 adult patients with renal diseases and diabetic mellitus. The clearance study was performed by the modified Wesson's method. The inulin preparation was FFI-1010 (Fuji Yakuhin Co. Ltd.). Inulin in serum and urine was determined by the newly devised enzymatic assay (Toyobo Co. Ltd.), which is specific for inulin. The mean Cin was 35.0 +/- 14.4 ml/min/1.73 m2. The mean Ccr(the enzyme assay) was 63.6 +/- 24.1 ml/min/1.73 m2 and that of the kinetic Jaffe assay was 55.3 +/- 19.3 ml/min/1.73 m2. Mean Ccr/Cin was 1.93 +/- 0.73, 1.69 +/- 0.62, respectively. This ratio was significantly different(p < 0.05) in the degree of reduction of Cin, with values of 2.07 +/- 0.82 (Cin < 40 ml/min/1.73 m2) and 1.64 +/- 0.32(40 < Cin < 80 ml/min/1.73 m2), respectively. Only 8 patients were classified into the same degree of reduced renal function (the Guideline of Japanese Society of Nephrology). The findings of this study suggest that the GFR determined by Ccr could misjudge the renal function of patient and delay the administration of proper treatment of the patient. Introduction of Cin into the clinical field is necessary to avoid this delay.

Elevated levels of serum sulfite in patients with chronic renal failure.

Sulfite, a well known air pollutant, is toxic for humans, especially those with sulfite hypersensitivity. Sulfite is also generated endogenously, during normal metabolism of sulfur-containing amino acids. Mammalian tissues contain the enzyme sulfite oxidase, which detoxifies both endogenous and exogenous sulfite by oxidation to sulfate. Deficiency of sulfite oxidase in humans is fatal, demonstrating its physiologic importance. Nevertheless, information about serum and tissue levels of sulfite in normal and pathologic conditions is limited. Using a sensitive HPLC assay, it is shown here that sera from patients with chronic renal failure (CRF) contain significantly higher amounts of sulfite than those from healthy subjects. Mean +/- SD of serum sulfite in healthy subjects (n = 20) was 1.55 +/- 0.54 microM, whereas those in patients under maintenance hemodialysis (HD patients; n = 44) and CRF patients before introducing dialysis therapy (pre-HD patients; n = 33) were 3. 23 +/- 1.02 microM (P < 0.01) and 3.80 +/- 3.32 microM (P < 0.01), respectively. Among pre-HD patients, serum sulfite was positively correlated with serum creatinine (r = 0.714, P < 0.0001), and negatively with serum albumin (r = -0.407, P = 0.0188), hematocrit (r = -0.524, P = 0.0017), and total cholesterol (r = -0.375, P = 0. 0318). There was no significant association between sulfite and patient age, gender, or leukocyte counts. Multiple regression analysis revealed serum creatinine as the sole independent predictor of serum sulfite levels. Each HD treatment was associated with approximately 27% reduction in serum sulfite levels, suggesting the presence of a dialyzable form in serum. Thus, these results indicate that reduced glomerular filtration is a factor that determines serum sulfite levels. Chronic elevation in serum sulfite levels might contribute to tissue or organ dysfunction in patients with CRF.