The liver is the primary organ for processing nutrients, detoxifying xenobiotics, and excreting bile acids. These essential physiological functions are intricately associated with the structural composition of hepatic tissues. Hepatocytes, the main functional cells of the liver, interconnect to form a complex three-dimensional network of hepatic cords that extends from the periphery to the center of the hepatic lobules. Within these hepatic cords, neighboring hepatocytes create intercellular channel-like structures known as bile canaliculi. These canaliculi serve as pathways through which bile acids are secreted and eventually transported into bile ducts. Tight junctions are integral components of cellular structures that act as barriers and regulate the movement of molecules between cells. In the liver, tight junctions play a crucial role in maintaining the structural integrity of the tissue and in regulating the passage of molecules and ions across hepatocytes and other cells. In addition, tight junctions are essential for establishing and maintaining the polarity of hepatocytes. Because of these important roles, the dysfunction of tight junctions is associated with several liver diseases. In this review, the physiological significance of tight junctions in the liver and their implications in hepatic diseases are described.

Amidst the rising elderly demographic, osteoporotic vertebral fractures (OVF) have become a common condition that orthopedic surgeons in Japan encounter on a daily basis. Most cases are treated conservatively to achieve bony union and improve symptoms, but vertebral collapse and kyphotic deformities can cause neurological deficit and persistent pain, requiring spinal reconstruction surgery, such as anterior spinal column reconstruction and long-extent fixation including the fracture site.

In Japan, the spine reconstruction techniques for OVF include anterior spinal fusion, vertebroplasty combined with posterior spinal fusion (PSF), three-column osteotomy combined with PSF and combined anterior/posterior spinal fusion, each of which has its own advantages and disadvantages.

This paper described the overview of spinal reconstruction surgery for OVF and mentioned the selection of surgical techniques and the extent of fixation required.

Granulocyte-macrophage colony-stimulating factor (GM-CSF) is a pleiotropic cytokine that differentiates myeloid cells, mediates tissue damage, and regulates immune response. We previously reported a case of systemic lupus erythematosus (SLE) complicated by pulmonary alveolar proteinosis (PAP) with neutralizing anti-GM-CSF antibodies (Ab). In the present study, we examined the existence of anti-GM-CSF Ab in connective tissue disease (CTD), including SLE without PAP, its neutralizing activity, and the associated clinical features.

Subjects were active SLE, dermatomyositis (DM)/polymyositis (PM), and vasculitis. Enzyme-linked immunosorbent assay was developed to detect anti-GM-CSF Ab. The neutralizing activity of anti-GM-CSF Ab was examined to check if it blocked the increase in GM-CSF stimulated CD11b expression on neutrophils. Anti-GM-CSF Ab was detected in the sera from 44/63 (69.8%) SLE, 23/49 (46.9%) DM/PM, and 14/27 (51.8%) vasculitis patients. Neutralizing activity was not detected in sera with anti-GM-CSF Ab from patients with SLE without PAP, DM/PM, and vasculitis. In SLE, the absence of anti-GM-CSF Ab was associated with serum low complement. A possible association was found between the presence of the Ab and pulmonary involvement in SLE. In summary, non-neutralizing anti-GM-CSF Ab was frequently found in connective tissue diseases, including SLE. The association between the antibody and the clinical features in SLE suggested the possibility that non-neutralizing anti-cytokine antibodies could modify the disease phenotype.

Objectives: No well-defined guidelines are in place to manage pathologically node-positive (pN1) cases after definitive surgery for localized prostate cancer. We explored the prognostic value of the nodal tumor burden in positive nodes by offsetting the strong impact of the number of positive nodes.

Methods: Of 389 patients who underwent extended pelvic lymph node dissection (PLND) during robot-assisted radical prostatectomy, 50 (12.9%) patients with ≤ 3 positive nodes were enrolled, excluding those who were clinically node-positive or received neoadjuvant androgen deprivation therapy. Detailed investigations concerning the positive nodes with maximum cancer occupancy (MCO) and largest cancer nest (LCN) size were performed, and their associations with biochemical recurrence (BCR)-free survival were analyzed.

Results: After a median follow-up period of 27.5 months, 28 patients were diagnosed with BCR. International Society of Urological Pathology (ISUP) grade group > 3 at prostatectomy, MCO > 80%, and LCN > 2150μm were significant prognostic factors of BCR. Independent prognostic values were maintained in multivariate models with known factors analyzed separately for the above parameters. The BCR-free survival rate decreased with the increasing number of adverse factors, including surgical margins (model using MCO: not reached to the median with zero risk, 39.0 months with one risk, 15.0 months with two risks, and 1.5 months with three risks).

Conclusions: The tumor burden on the positive node provides independent prognostic value for biochemical recurrence and adds a rationale for selecting management options when PLND has been performed for therapeutic intent and diagnosed with ≤ 3 positive nodes.

We conducted a survey on the actual conditions of oral diseases and oral hygiene in Myaungmya district in the remote delta region of Republic of the Union of Myanmar (Myanmar). The total number of subjects surveyed was 1277, 770 aged 12 and older, 507 aged under 12, 583 males, and 694 females. The prevalence of dental caries and gingivitis were 65.4% and 52.9%, respectively in total subjects. The prevalence of dental caries and gingivitis were 62.9% and 53.0%, respectively in two schools attended by children aged 3-17 years. The prevalence of dental caries and gingivitis was 82.4% and 52.1%, respectively, among the villagers, including both infants and the elderly. In each school, early caries of C1 and C2 were predominant, while advanced caries of C3 and C4 were present in a significant number of subjects, although they were progressively less common than those of C1 and C2. The elderly villagers also had a large number of missing teeth. The prevalence of malocclusion was 9.9%, 95 patients (7.4%) had dental crowding, 32 (2.5%) had mandibular prognathism and maxillary prognathism. After recognizing the situation of the oral health condition in Myanmar, we can take appropriate measures for children in Myanmar to maintain oral functions and oral hygiene that support the overall health.

Purpose: The aim of this study was to examine whether abdominal ultrasonography (US) could be used to diagnose fatty liver, hepatic fibrosis, and hepatic tumors in nonalcoholic steatohepatitis (NASH) and nonalcoholic fatty liver disease (NAFLD) model mice, obviating unnecessary autopsies and increasing the efficiency of research.

Methods: Thirty-eight, 19-week-old, male C57BL/6J mice were used to produce NASH and NAFLD group mice and a control group. US was performed on Day 120, and the mice were then autopsied for histopathological examination and to identify hepatic tumors. Relationships of hepatorenal echo contrast (HEC) and the heterogeneity of liver parenchyma (HOLP) on US with histopathological findings were evaluated.

Results: Histopathological examination confirmed fatty degeneration and hepatic fibrosis in the NAFLD and NASH groups, as did US. The correlation coefficient of the HEC ratio and the fat deposition area showed a significant correlation (0.7295, p < 0.01); the HOLP index showed no correlation with the fat deposition area. Sixteen hepatic tumors were confirmed on autopsy, all in the NASH group, in 9 of 15 mice; of the 16 tumors, 13 (81.2%) were seen on abdominal US. The mean diameter of the tumors imaged was 2.2 ± 0.7 mm, and the mean diameter of the tumors not imaged was 2.9 ± 0.9 mm, with no significant difference (p = 0.2017). The tumors that were not imaged were on the liver periphery or protruding outside the liver from the posterior surface.

Conclusion: This study shows that US can confirm the extent of hepatic fatty degeneration and tumor formation in NASH model mice without autopsy.

Introduction: Esophageal varices are usually asymptomatic but can cause major bleeding if they rupture. Treatment with endoscopic procedures like variceal ligation and injection sclerotherapy is common. This study focuses on the efficacy of secondary sclerotherapy and mucosal cauterization following injection sclerotherapy, aiming to prevent variceal recurrence.

Methods: We performed a retrospective statistical review of the cases. 98 patients were included in this study and divided into three groups; ethanolamine oleate (EO) method with/without ligation (EO+/-L) (group A; n = 51), EO+/-L and aethoxysclerol (AS) method (group B; n = 11), and EO+/-L plus AS and the mucosal fibrosing method (MFM) (group C; n = 36).

Results: As there were only 11 cases in group B, it was difficult to conduct a statistical analysis of the three groups. Therefore, a comparative study was conducted between groups A and B (hereinafter referred to as group AB) and group C. There was a clear difference in the rate of recurrent esophageal varices bleeding, 12.2% in group AB and 0% in group C (Exp(B) = 0.022). There was a significant difference in the morphological recurrence rate of esophageal varices, which was 29.0% in the AB group and 11.1% in the C group (p = 0.025). Although further observation is needed due to the different observation periods, a clear difference in survival rate was also observed, 22.7% in the AB group and 5.6% in the C group (p = 0.036).

Conclusions: MFM is useful in preventing recurrence of esophageal varices.

We evaluated whether pre-hospital adrenaline with a dispatched physician is associated with higher proportion of return of spontaneous circulation after out-of-hospital cardiac arrest, compared to pre-hospital care without physician presence. We conducted a retrospective observational study of patients with out-of-hospital cardiac arrest in Japan. Included were patients who were at least 18 years of age, were transported to hospitals by emergency medical service personnel of the Hiroshima City Fire Services between July 2 2018 and December 31 2021, and were administered pre-hospital adrenaline. Data were obtained from transport records written by emergency medical service personnel and medical records created by dispatched physicians from Hiroshima Prefectural Hospital. The primary outcome was the return of spontaneous circulation after out-of-hospital cardiac arrest. We performed multivariable logistic regression analysis using the propensity score as an explanatory variable. Among analyzed 464 patients, 317 patients received resuscitation by "emergency medical service personnel" group, and 147 patients received resuscitation by "emergency medical service personnel and a dispatched physician" group. The time from emergency call to first administration of adrenaline with the presence of a dispatched physician was significantly shorter compared to absence of a pre-hospital physician [25.0 minutes vs. 28.0 minutes, (95% confidence interval: -4.37 to -0.48)]. Adjusted odds ratio of the primary outcome did not differ significantly between groups (1.20; 95% confidence interval: 0.61 to 2.36). The system with a dispatched pre-hospital physician was associated with significantly shorter time to the first pre-hospital administration of adrenaline compared with absence of a pre-hospital physician. There was no significant difference in patient outcomes.

Background: The major allergen in honeybee venom is the enzyme phospholipase A2 (PLA2). To develop new treatments for honeybee venom allergy, it is necessary to elucidate the mechanism underlying allergen immunotherapy. In this study, we first created a PLA2 mouse model of honeybee venom anaphylaxis and then established its desensitized model.

Method: Balb/c mice were subcutaneously sensitized four times with PLA2. Blood was collected before sensitization and serum PLA2-specific IgE antibodies were analyzed by enzyme-linked immuno-sorbent assay (ELISA). Rectal temperature was measured before and 30 min after subcutaneous challenge with PLA2, and blood histamine concentration was measured 30 min after that by ELISA. In addition, the PLA2 mouse model of anaphylaxis was desensitized a total of 20 times over 4 weeks, and rectal temperature and blood histamine concentration were measured before and/or 30 min after subcutaneous challenge with PLA2.

Results: After the second sensitization in the PLA2 mouse model of anaphylaxis, a significant increase in serum PLA2-specific IgE antibody was observed compared with the control group. There was a significant decrease in rectal temperature and an increase in histamine levels in the model mice compared with the controls. In addition, there was no decrease in rectal temperature before and after the challenge with PLA2 in the desensitized mice model, and a decrease in histamine levels in the desensitized mice model compared with that in the non-desensitized one.

Conclusion: We have created a PLA2-desensitized mouse model of anaphylaxis in this study. This model is expected to be useful for an immunological analysis of the response mechanism underlying allergen immunotherapy as well as basic research aimed at developing new treatments.

The patient initially presented at age 86 with memory loss, hallucinations, and violent behavior, including physical aggression toward her husband. Two years prior to hospitalization, she had physical symptoms such as resting tremor and gait disturbance. Despite a diagnosis of unspecified cognitive decline and treatment with quetiapine (increased to 150 mg), her condition worsened, leading to admission to the psychiatric ward. Standard diagnostic procedures, including brain dopamine transporter scintigraphy, confirmed probable dementia with Lewy bodies (DLB). Her aggressive behavior, including physical assault on staff, continued. Traditional treatments, including increased doses of antipsychotics and electroconvulsive therapy (ECT), were initially ineffective. In particular, ECT failed to effectively induce seizures, a common challenge in elderly patients with DLB due to altered electrical activity in the brain. A breakthrough in treatment came with the preoperative administration of 500 mg of caffeine, which effectively eased seizures during ECT. Taken together, these findings indicate that while ECT may be effective at treating DLB symptoms, its efficacy is still uncertain. Thus, individualized approaches, such as preoperative caffeine administration, may be necessary.

Meckel's diverticulum is the most common gastrointestinal anomaly, often remaining asymptomatic but occasionally resulting in bowel obstruction. Herein, we present a case of a 6-year-old girl with an internal hernia caused by Meckel's diverticulum and mesenteric diverticular band as a rare cause of small bowel obstruction. Preoperative imaging diagnosis of this disease has been reported to be difficult. However, a detailed retrospective CT evaluation of the presented case confirmed key diagnostic findings, including identifying Meckel's diverticulum, strangulated small intestine, and findings suggesting ischemia. A meticulous CT evaluation, keeping in mind that internal hernia due to Meckel's diverticulum and mesodiverticular band is a rare cause of small bowel obstruction, is crucial. Such a detailed CT evaluation may contribute to an accurate and rapid preoperative diagnosis.