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Background/Aims: Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (EUS-HGS) performed at the intrahepatic bile duct segment 3 (B3) is widely used for biliary drainage. Although performing post-puncture procedures is easier in the intrahepatic bile duct segment 2 (B2) when using a conventional oblique-viewing (OV) EUS scope, this method may cause transesophageal puncture and severe adverse events. We evaluated the safety and efficacy of B2 puncture using a novel OV-EUS scope. Methods: In this single-center retrospective study, we prospectively enrolled and collected data from 45 patients who consecutively underwent EUS-HGS procedures with a novel OV-EUS scope between September 2021 and December 2022 at our cancer center. Results: The technical success rates of B2-EUS-HGS and EUS-HGS were 93.3% (42/45) and 97.8% (44/45), respectively. The early adverse event rate was 8.9% (4/45) with no cases of scope changes or transesophageal punctures. The median procedure time was 13 minutes (range, 5-30). Conclusions: B2-EUS-HGS can be performed safely with the novel EG-740UT (Fujifilm) OV-scope without transesophageal puncture and with a high success rate. B2-EUS-HGS using this novel OV scope may be the preferred strategy for EUS-HGS. [ABSTRACT FROM AUTHOR]

Benign biliary stricture (BBS) is a complication of chronic pancreatitis (CP). Despite endoscopic biliary stenting, some patients do not respond to treatment, and they experience recurrent cholangitis. We report two cases of CP with refractory BBS treated using endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) fistula creation. A 50-year-old woman and a 60-year-old man both presented with obstructive jaundice secondary to BBS due to alcoholic CP. They underwent repeated placement of a fully covered self-expandable metal stent for biliary strictures. However, the strictures persisted, causing repeated episodes of cholangitis. Therefore, an EUS-CDS was performed. The stents were eventually removed and the patients became stent-free. These fistulas have remained patent without cholangitis for more than 2.5 years. Fistula creation using EUS-CDS is an effective treatment option for BBS. [ABSTRACT FROM AUTHOR]

Predicting periparturient disease risk is of immense value to the dairy industry. Periparturient diseases are interrelated with each other; however, predicting the onset risk of these diseases has predominantly been based on a single blood parameter for a single disease. This study examined a new diagnostic method to predict the risk of periparturient diseases. We conducted cluster analysis of multiple blood constituents from 20 Holstein cattle at 1 week post-partum, and the cattle were divided into two groups, A or B. We then compared the periparturient and early-lactation blood constituents of these groups. Group B had significantly higher 3-hydroxybutyric acid concentrations and were suspected to have subclinical ketosis. Group B also had significantly lower calcium concentrations, with a tendency for subclinical hypocalcemia. We also performed discriminant analysis using blood parameters at 1 week post-partum, which grouped the population into the same two groups as the cluster analysis based on three variables: inorganic phosphorus, calcium, and either phospholipids or total cholesterol. We further showed that these discriminant functions could be used to predict the risk of periparturient disease even before parturition. Our results indicate that cluster analysis with multiple blood constituents is useful for predicting periparturient disease risks. [ABSTRACT FROM AUTHOR]

Aims To evaluate the efficacy of measuring subfoveal choroidal thickness in monitoring uveitis activity before and after treatment with infliximab in patients with Behçet’s disease (BD)-associated uveitis. Methods Thirteen patients with BD (23 eyes) were selected for this retrospective observational case study. Subfoveal choroidal thickness was measured during active and remission phases of uveitis by enhanced depth imaging–spectral domain optical coherence tomography (EDI-OCT). In five patients (10 eyes), choroidal thickness was assessed at weeks 0, 2, 6 and 14 after the initiation of infliximab treatment. Results Accompanied by excessive dye leakage from choroidal vessels on indocyanine green angiography, dilation of choroidal vessels was observed in the active phase of uveitis by EDI-OCT and the choroidal thickness was significantly greater than that in the remission phase. Treatment with infliximab significantly reduced the choroidal thickness from week 2 after the first infusion, and the reduced choroidal thickness was maintained thereafter. No correlation was found between choroidal thickness and best corrected visual acuity converted to logarithm of the minimum angle of resolution, but choroidal thickness correlated significantly with anterior and posterior ocular inflammation scores. Conclusions This study indicates that measurement of subfoveal choroidal thickness by EDI-OCT is useful for evaluating the activity of uveitis and the therapeutic efficacy in patients with BD. [ABSTRACT FROM AUTHOR]

We have recently reported breakdown of mucosal immunity in the gut by tetraclorodibenzo-p-dioxin (TCDD). That is, single oral administration of low dose 2,3,7,8-TCDD resulted in a marked decrease in IgA secretion in AhR-dependent manner and impaired oral tolerance in the gut. In the present study, we found TCDD exposure by breast feeding also resulted in decreased level of IgA in the gut. Ig production by B cells by LPS stimulation was not affected by TCDD administration. Instead, particular chemokine receptor expression on B1 cells, a major cell source for intestinal IgA antibody, was decreased in mice treated with TCDD. In consistence with this observation, B1, but not B2 cells from TCDD treated mice showed impaired chemotaxis towards B lymphocyte chemokine (BLC)/CXCL13. In contrast, chemotaxis of intestinal dendritic cells (DCs) towards secondary lymphoid-tissue chemokine (SLC)/CXCL19 was not impaired in mice treated with TCDD. Furthermore, there was no change in the number and profile of inlcsitinal microflora in TCDD-trcatcd mice. These results indicate that TCDD exposure by breast feeding results in breakdown of intestinal mucosal immunity of pups and that it may be attributed in part to impaired B1 cell migration from the peritoneal cavity to intestinal mucosa. [ABSTRACT FROM AUTHOR]

Background/Aims: Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (EUS-HGS) is useful for patients with biliary cannulation failure or inaccessible papillae. However, it can lead to serious complications such as bile peritonitis in patients with ascites; therefore, development of a safe method to perform EUS-HGS is important. Herein, we evaluated the safety of EUS-HGS with continuous ascitic fluid drainage in patients with ascites. Methods: Patients with moderate or severe ascites who underwent continuous ascites drainage, which was initiated before EUS-HGS and terminated after the procedure at our institution between April 2015 and December 2022, were included in the study. We evaluated the technical and clinical success rates, EUS-HGS-related complications, and feasibility of re-intervention. Results: Ten patients underwent continuous ascites drainage, which was initiated before EUS-HGS and terminated after completion of the procedure. Median duration of ascites drainage before and after EUS-HGS was 2 and 4 days, respectively. Technical success with EUS-HGS was achieved in all 10 patients (100%). Clinical success with EUS-HGS was achieved in 9 of the 10 patients (90%). No endoscopic complications such as bile peritonitis were observed. Conclusions: In patients with ascites, continuous ascites drainage, which is initiated before EUS-HGS and terminated after completion of the procedure, may prevent complications and allow safe performance of EUS-HGS. [ABSTRACT FROM AUTHOR]

Background/Aims: Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common and serious complication of endoscopic retrograde cholangiopancreatography. To prevent this event, a unique precutting method, termed opening window fistulotomy, was performed in patients with a large infundibulum as the primary procedure for biliary cannulation, whereby a suprapapillary laid-down H-shaped incision was made without touching the orifice. This study aimed to assess the safety and feasibility of this novel technique. Methods: One hundred and ten patients were prospectively enrolled in this study. Patients with a papillary roof size ≥10 mm underwent opening window fistulotomy for primary biliary access. In addition, the incidence of complications and success rate of biliary cannulation were evaluated. Results: The median size of the papillary roof was 6 mm (range, 3-20 mm). Opening window fistulotomy was performed in 30 patients (27.3%), none of whom displayed PEP. Duodenal perforation was recorded in one patient (3.3%), which was resolved by conservative treatment. The cannulation rate was high (96.7%, 29/30 patients). The median duration of biliary access was 8 minutes (range, 3-15 minutes). Conclusions: Opening window fistulotomy demonstrated its feasibility for primary biliary access by achieving great safety with no PEP complications and a high success rate for biliary cannulation. [ABSTRACT FROM AUTHOR]

The effect of dietary vitamin K3 (VK3) on ruminant animals is not fully investigated. The aim of this study was to examine the effects of dietary VK3 on lactation performance, rumen characteristics, and VK1 and menaquinone (MK, or VK2) dynamics in the rumen, plasma, and milk of dairy cows. Eight Holstein dairy cows in late lactation periods were used in two crossover trials including a control (nontreatment) and a 50 or 200 mg/day (d) VK3 supplementation group. After 14 days, plasma, ruminal fluid, and milk were sampled and their VK1 and MKs contents were measured using fluorescence-high-performance liquid chromatography (HPLC). Milk production was unchanged after feeding 50 mg/day VK3 but marginally decreased after feeding 200 mg/day VK3. The molar ratio of propionate in ruminal fluid was significantly increased on feeding 200 mg/day VK3. Additionally, MK-4 concentrations significantly increased in both plasma and milk after VK3 feeding (50 and 200 mg/day). In ruminal fluid, MK-4 concentrations increased after 200 mg/day VK3 feeding. These results suggest that VK3 may be a good source of MK-4, the biologically active form of VK, in Holstein dairy cows during their late lactation periods. This study provides a basis for understanding the physiological role of VK in dairy cows. [ABSTRACT FROM AUTHOR]

The mechanisms that govern the ability of specific neurons to regenerate their axons after injury are not well understood. In Caenorhabditis elegans, the initiation of axon regeneration is positively regulated by the JNK-MAPK pathway. In this study, we identify two components functioning upstream of the JNK pathway: the Ste20-related protein kinase MAX-2 and the Rac-type GTPase CED-10. CED-10, when bound by GTP, interacts with MAX-2 and functions as its upstream regulator in axon regeneration. CED-10, in turn, is activated by axon injury via signals initiated from the integrin cr-subunit INA-1 and the nonreceptor tyrosine kinase SRC-1 and transmitted via the signaling module CED-2/CrkII-CED-5/Dockl80 -CED-12/ELMO. This module is also known to regulate the engulfment of apoptotic cells during development. Our findings thus reveal that the molecular machinery used for engulfment of apoptotic cells also promotes axon regeneration through activation of the JNK pathway. [ABSTRACT FROM AUTHOR]

Aims To evaluate the prevalence and aetiology of intraocular hypertension (OHT) in granulomatous and non-granulomatous uveitis Methods Medical records of 304 consecutive patients (484 eyes) with uveitis who visited the National Defense Medical Collage Hospital between April 2010 and March 2013 were reviewed retrospectively. OHT irrelevant to glaucomatous changes in optic disc or visual field was investigated. Results OHT was found in 123 eyes (25.4%) of 93 uveitic patients (30.6%); 92% of the eyes had open-angle OHT, 45.6% of which was steroid-induced. The prevalence of OHT was 100% (8/8) in Posner-Schlossman syndrome, 50.0% (10/20) in varicella zoster virus-associated iridocyclitis, 45% (9/20) in scleritis, 34.1% (15/44) in Vogt-Koyanagi-Harada disease, 32.1% (18/56) in Behçet's disease (BD), 23.1% (6/26) in acute anterior uveitis, and 20.2% (19/94) in sarcoidosis. Pupillary block was observed only in non-granulomatous uveitis, but not in granulomatous uveitis. Seventy percent of OHT in granulomatous uveitis cases was inflammation-induced, while 76.7% in nongranulomatous uveitis cases was steroid-induced. Conclusions OHT in non-granulomatous uveitis was mainly steroid-induced open-angle OHT with some cases of angle-closure OHT caused by pupillary block, while that in granulomatous uveitis was mostly inflammationinduced open-angle OHT with no pupillary block-related angle-closure OHT. [ABSTRACT FROM AUTHOR]