Inflammatory bowel diseases (IBD) are thought to be caused by a complex interaction of genetic, immunological, and environmental factors. Why is it that once an IBD develops it lasts a long time? Considering this simple question, we propose that coliotogenic memory CD4+T cells that remember the prototype of the disease in each patient are formed in IBD at the onset, and, perceiving them as “benign T-cell leukemia”-like lifelong memory CD4+T cells that hematogenously spread throughout the body, we thus propose that systemic circulating colitogenic memory CD4+T cells would be an ideal target for the treatment of IBD. Accordingly, selective depletion of colitogenic memory CD4+T cells by leukocytapheresis and blockade of circulation of colitogenic memory CD4+T cells by a newly developed immunosuppressant, FTY720, may be associated with dramatic efficacy and a marked reduction of inflammatory cytokines produced by activated leucocytes. We here describe the immunological pathogenesis focusing on the generation of circulating colitogenic memory CD4+T cells and the possible logics of leukocytapheresis and FTY720 for the treatment of IBD.
Reform of preclinical medical education in Japan requires changes in the curriculum to make it more clinically focused and interactive. At present, course content in Anatomy is usually designed and taught with little or no clinical direction and involves a heavy emphasis on by-rote learning to memorize often minor facts that have little importance in clinical medicine. As a result, the content is boring, it is learned solely for the purpose of passing exams and it is promptly forgotten, with little sense of its need in clinical practice. Successful reform of the curriculum in Anatomy requires two critical changes. The first is that content must be made interesting to students by emphasizing its clinical importance, through a close collaboration between preclinical and clinical departments, Thus, the Surgical Faculty must be incorporated in the organization and teaching of the Anatomy curriculum. Core content can thereby be pared down to only what is considered essential to provide a foundation for the later clinical years, and the clinical importance of that content will, in turn, be self-evident to students. The second change that must be implemented is to make the learning process more appealing to the students. This can be facilitated by the use of any of several commercial IT programs that make learning in Anatomy both dynamic and engaging. These dual strategies will considerably enhance the learning of one of the most basic subjects in the medical school and ensure that the review and retention of the material are enhanced.
Sensorineural hearing loss (SNHL) is one of the most common disabilities in human, and genetics is an important aspect for SNHL, especially in children. In recent 10 years, our knowledge in genetic causes of SNHL has made a significant advance, and now it is used for diagnosis and other clinical practices. Hereditary hearing loss can be classified into syndromic and nonsyndromic hearing loss. As the nonsyndromic deafness genes, more than 100 loci for deafness genes have been determined, and more than 40 genes were identified. Furthermore, more than 300 forms of syndromic hearing loss have been characterized, and each syndrome may have several causative genes. In childhood hearing loss, early educational intervention is required in addition to medical intervention for normal development of speech and language. In addition, even severe to profound hearing loss may be restored very effectively by hearing aids or cochlear implants. Because of these features of SNHL, genetic testing has exceptionally high value in the medical practice for hereditary hearing loss. Several strategies are used for genetic testing of SNHL for accurate and efficient identification of the genetic causes, and the results were used for explanation of the cause, prediction of auditory features, prevention of deafness, management of associated symptoms, determination of therapy, and genetic counseling. Identification of damaged cells in the inner ear and the underlying mechanism by genetic testing undoubtedly facilitates development and introduction of novel and specific therapies to distinct types of SNHL.
Objective: To study the activities of daily living (ADL) structure of patients with Duchenne muscular dystrophy (DMD). Design: Cross-sectional survey. Subjects: Seventy-two patients with DMD (mean [SD] age, 17.2 [8.1] years), recruited in 160-bed regional center for neuromuscular disease. Methods: We assessed 72 participants with the Functional Independence Measure (FIMSM), and determined the difficulty order of the FIMSM items with the percentage of patients who were independent (6 or 7) for each FIM item (% independence). Results: The ADL of patients with DMD had an order in terms of difficulty. For the motor subscale, the most difficult item was stairs, and the easiest item was locomotion. On the cognitive subscale, problem solving was the most difficult item. When we compared item difficulty between patients <15 years of age and those ≥15 years, the % independence was lower in the older age group for all motor items. The decrease in the % independence of the eating item with age was significant; however bladder management was well maintained. Conclusions: ADL of patients with DMD has a specific difficulty order. The order of difficulty is based on the relative level of independence/dependence. The difficulty order was maintained, although the structure of ADL changed with age.
The arterial switch operation (ASO) has evolved into the treatment of the choice for most forms of transposition of the great arteries (TGA). Despite advancement in the technical aspects of the procedure, certain anatomical variations of the coronary arteries are still considered as surgical risks. We have recently employed a novel technique for coronary artery reconstruction in ASO to achieve further improvement of coronary transfer in cases with complex coronary anatomy. The technical key of the procedure is that reconstruction of the coronary arteries is preceded by neo-aortic anastomosis. After neo-aortic reconstruction is accomplished, the neo-aorta is temporarily distended with removal of the cross-clamp. The distended neo-aorta informs us its postsurgical geometry, which facilitates accurate assessment for the optimal site of coronary button transfer. The technique was feasible in 13 of 15 children who were consecutively treated by our group between 2003 and 2008. All patients recovered uneventfully and no coronary perfusion issue has occurred during the follow-up period. However, the complex anatomy of the coronary arteries in two children was not amenable to this technique. One with double loops (1RL; 2Cx) accompanied by side-by-side relationship of the great arteries underwent the open trapdoor technique, while the other with intramural coronary artery underwent the Imai method, that is one of procedure in which the coronary arteries are left in situ. The coronary re-implantation after neo-aortic reconstruction is promising to minimize postsurgical coronary ischemia and suitable for most ASO cases. However, various modifications of coronary transfer are required in a few variations of the coronary anatomy and we have to pursue further technical refinement of coronary artery transfer in ASO.
We would like to report the case of a patient with fibroma of the omentum that resembled an ovarian tumor in the pelvis. Since primary tumours of the omentum are rare, there is a paucity of information about the biology of such tumors in the basic texts and literature. An ultrasound examination of the patient revealed a mass, likely of ovarian origin, which consisted of liquid and solid components. It was suspected to be a malignant ovarian tumor. However, laparotomy demonstrated it was an omental tumor. This case shows that it can be difficult to pre-operatively diagnose omental fibromas because of their close resemblance to ovarian tumors.