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Background Societal stress derived from an event that affects the whole society, e. g., a natural disaster, provides a unique, indirect way of determining the relationship between psychological stress and peptic ulcer disease in humans. In this study, we investigated the changing patterns of the incidence of peptic ulcers before and after the Great East Japan earthquake, which occurred on 11 March, 2011. Methods Clinical data of patients with peptic ulcers were retrospectively collected during the 3 months after the earthquake (2011) from 7 major hospitals in the middle of the stricken area, and were compared with the data for the same period of the previous year (2010). The eligible subjects were classified into four groups according to Helicobacter pylori infection status and intake of nonsteroidal anti-inflammatory drugs (NSAIDs). Results The incidence of all types of peptic ulcers was 1.5-fold increased after the earthquake, and in particular, the incidence of hemorrhagic ulcers was 2.2-fold increased; the gastric ulcer/duodenal ulcer ratio in hemorrhagic ulcers was also significantly increased ( p  < 0.05). Regarding the etiology of the peptic ulcers, the proportion of non- H. pylori and non-NSAID ulcers was significantly increased, from 13 % in 2010 to 24 % in 2011 after the earthquake ( p  < 0.05). Conclusion In addition to the increased incidence of peptic ulcers, compositional changes in the disease were observed after the Great East Japan earthquake. The significant increase in the proportion of non- H. pylori and non-NSAID ulcers after the earthquake indicated that psychological stress alone induced peptic ulcers in humans independently of H. pylori infection and NSAID intake.

Background We have reported that the total number of peptic ulcers (PUs) had increased 1.5-fold after the Great East Japan Earthquake compared with those of the previous year, and that hemorrhagic ulcers were more prominently increased by 2.2-fold. The aim of this study is to determine the risk factors for bleeding ulcers after the Great East Japan Earthquake. Methods Clinical data of all peptic ulcer subjects endoscopically detected at the 7 major hospitals in the middle of the stricken area during the 3 months after the earthquake were retrospectively collected. Based on endoscopic and laboratory findings, peptic ulcer cases were divided into 227 bleeding ulcer cases and 102 non-bleeding controls. Other than ordinary risk factors for bleeding ulcers, the refugee shelter was included in the analysis as a unique confounder after the earthquake. Multiple logistic regression analyses were used to adjust for potential confounders. Results Eighty-seven (27 %) of 329 PUs emerged from refuge shelters, and the majority (76 of 87) of PUs occurring in such shelters was the bleeding type. Multivariate regression showed that residence in a shelter was a strong risk factor for ulcer bleeding with OR (95 % CI): 4.4 (2.1–9.6, p  < 0.0001), independent of the progressiveness of ulcer diseases. Conclusions Accommodation in a refugee shelter can be a strong risk factor for ulcer bleeding after a large-scale disaster. Since acid-suppressive drugs are supposed to decrease the risk for stress-induced ulcer bleeding, our results will encourage effective use of a limited medical resource in such catastrophic events.

Background: We investigated the characteristic features and treatment of hemorrhagic peptic ulcers after the Great East Japan Earthquake, which occurred on 11 March 2011. Methods: Clinical data of patients with hemorrhagic peptic ulcers were retrospectively collected during the 3 months after the earthquake from seven major hospitals in the middle of the stricken area, and were compared with those during the same period of the previous year. Results: After the earthquake, the number of hemorrhagic ulcers increased 2.2 fold as compared with the previous year, and gastric ulcers were significantly more frequent compared with duodenal ulcers (p <0.05) and more often presented multiple forms (p <0.05). Nonetheless, the proportion of re-bleeding cases after hemostasis treatment (8% in 2010 vs. 5% in 2011) or total mortality rate (2.5% in 2010 vs. 1.2% in 2011) was rather lower after the earthquake compared with that of the previous year. Conclusion: We clarified that post-disaster hemorrhagic ulcers existed frequently in the stomach, often as multiple ulcers at the same time. The Great East Japan Earthquake and Tsunami caused many cases of hemorrhagic ulcer. However, because of the high success rate of endoscopic hemostasis, the mortality remained as low as in the previous year. Our present study provides important information for large-scale disasters which can occur anywhere.

We present a detailed investigation of photometric, spectroscopic, and polarimetric observations of the Type II SN 2023ixf. Earlier studies have provided compelling evidence for a delayed shock breakout from a confined dense circumstellar matter (CSM) enveloping the progenitor star. The temporal evolution of polarization in the SN 2023ixf phase revealed three distinct peaks in polarization evolution at 1.4 days, 6.4 days, and 79.2 days, indicating an asymmetric dense CSM, an aspherical shock front and clumpiness in the low-density extended CSM, and an aspherical inner ejecta/He-core. SN 2023ixf displayed two dominant axes, one along the CSM-outer ejecta and the other along the inner ejecta/He-core, showcasing the independent origin of asymmetry in the early and late evolution. The argument for an aspherical shock front is further strengthened by the presence of a high-velocity broad absorption feature in the blue wing of the Balmer features in addition to the P-Cygni absorption post-16 days. Hydrodynamical light-curve modeling indicated a progenitor mass of 10 M ⊙ with a radius of 470 R ⊙ and explosion energy of 2 × 1051 erg, along with 0.06 M ⊙ of 56 Ni, though these properties are not unique due to modeling degeneracies. The modeling also indicated a two-zone CSM: a confined dense CSM extending up to 5 × 1014 cm with a mass-loss rate of 10−2 M ⊙ yr−1 and an extended CSM spanning from 5 × 1014 to at least 1016 cm with a mass-loss rate of 10−4 M ⊙ yr−1, both assuming a wind-velocity of 10 km s−1. The early-nebular phase observations display an axisymmetric line profile of [O i], redward attenuation of the emission of Hα post 125 days, and flattening in the Ks-band, marking the onset of dust formation.

Pulmonary hypertension is a fatal rare disease that causes right heart failure by elevated pulmonary arterial resistance. There is an unmet medical need for the development of therapeutics focusing on the pulmonary vascular remodeling. Bioactive lipids produced by perivascular inflammatory cells might modulate the vascular remodeling. Here, we show that ω-3 fatty acid-derived epoxides (ω-3 epoxides) released from mast cells by PAF-AH2, an oxidized phospholipid-selective phospholipase A2, negatively regulate pulmonary hypertension. Genetic deletion of Pafah2 in mice accelerate vascular remodeling, resulting in exacerbation of hypoxic pulmonary hypertension. Treatment with ω-3 epoxides suppresses the lung fibroblast activation by inhibiting TGF-β signaling. In vivo ω-3 epoxides supplementation attenuates the progression of pulmonary hypertension in several animal models. Furthermore, whole-exome sequencing for patients with pulmonary arterial hypertension identifies two candidate pathogenic variants of Pafah2 . Our findings support that the PAF-AH2-ω-3 epoxide production axis could be a promising therapeutic target for pulmonary hypertension. Pulmonary hypertension is a fatal disease that causes right heart failure due to pulmonary artery stenosis. Here, the authors find that ω-3 epoxides produced by the phospholipase PAF-AH2 in mast cells regulate pulmonary vascular remodeling.

During colonoscopy, estimation of the depth of invasion in early colorectal lesions is crucial for an adequate therapeutic management and for such task, magnifying chromoendoscopy (MCE) has been proposed as the best in vivo method. However, validation in large-scale studies is lacking. The aim of this prospective study was to clarify the effectiveness of MCE in the diagnosis of the depth of invasion of early colorectal neoplasms in a large series. A total of 4,215 neoplastic lesions were evaluated using MCE from October 1998 to September 2005 at the National Cancer Center Hospital, Tokyo, Japan. Lesions were prospectively classified according to the clinical classification of the pit pattern: invasive pattern or non-invasive pattern. All lesions were histopathologically evaluated. There were 3,371 adenomas, 612 intramucosal cancers (m-ca), 232 submucosal cancers (sm-ca): 52 sm superficial (sm1) and 180 sm deep cancers (sm 2-3). Among lesions diagnosed as invasive pattern, 154 out of 178 (86.5%) were sm2-3, while among lesions diagnosed as non-invasive pattern, 4,011 out of 4,037 (99.4%) were adenomas, m-ca, or sm1. Sensitivity, specificity and diagnostic accuracy of the invasive pattern to differentiate m-ca or sm1 (< 1000 microm) from sm2-3 (> or = 1000 microm) were 85.6%, 99.4%, and 98.8%, respectively. The determination of invasive or non-invasive pattern by MCE is a highly effective in vivo method to predict the depth of invasion of colorectal neoplasms.

Inflammatory aneurysms (IAs) are characterized by the thickening of the arterial wall and fibrosis of periarterial tissues. Immunoglobulin G4 (IgG4)-related disease (IgG4-RD) is related to IAs, and about half of IA cases are considered IgG4-related. Although some cases of inflammation after endovascular aneurysm repair (EVAR) have been reported, its relationship with the serum levels of IgG4 has rarely been discussed. Here, we report on a patient diagnosed with and treated for an IA with elevated serum levels of IgG4 following EVAR. An 83-year-old man presented with a bilateral common iliac artery aneurysm. We observed no inflammatory features in his vital signs, laboratory test results, or computed tomography (CT) images. The patient was diagnosed with a non-inflammatory bilateral common iliac artery aneurysm. EVAR was performed using an infrarenal bifurcated stent graft (diameter, 31 mm; length, 15 cm; GORE EXCLUDER AAA Endoprosthesis (WL Gore & Associates, Inc., Flagstaff, AZ, USA)), with an ipsilateral limb stent graft (diameter, 12 mm; length, 7 cm; GORE EXCLUDER) deployed in the left external iliac artery and a contralateral limb stent graft (diameter, 12 mm; length, 14 cm; GORE EXCLUDER) deployed in the right external iliac artery. The patient was discharged in good condition. However, signs of inflammation were observed approximately one month after EVAR. CT images demonstrated the periarterial thickening of the common iliac arteries, and 18F-fluorodeoxyglucose positron emission tomography-CT revealed increased metabolic activity overlying the thickened periarterial tissue. The serum levels of IgG4 and soluble interleukin-2 receptor (sIL-2R) were elevated. The patient underwent steroid therapy based on the suspicion of IgG4-related IA of the common iliac arteries, resulting in reductions of inflammatory signs and periarterial thickening. However, when steroids were reduced, hydronephrosis, periarterial thickening, and increased serum IgG4 and sIL-2R levels were observed. The patient was diagnosed with a relapsed IA and treated with an increased steroid dosage. IAs may occur following EVAR. Steroid therapy may be an effective treatment for post-EVAR IAs, similar to common IAs. Long-term follow-up is desirable to monitor patients for the recurrence of inflammation during the treatment of post-EVAR IAs.

For a prospective solution of effective recycling of gypsum board wastes, the present study was conducted to evaluate applicability of reclaimed gypsum as stabilizing agent for improvement of soft clayey ground. A series of unconfined compression tests and needle penetration tests were conducted to understand the fundamental properties of reclaimed gypsum and gypsum treated soils and the durability in water. An important finding was strength decrease in relation to mixing time of gypsum and soil. This may attribute to excessive mixing that caused breakage of the promptly hardened gypsum treated clay. In addition, from sounding and laboratory tests on the stabilized ground by shallow mixing method with different execution conditions, it was found that the strength of stabilized ground appeared in an early stage and that the hardening effect of cement that was used in combination with gypsum continued in a longer period. Regarding an environmental aspect, a specific amount of cement could have restrained leaching fluorine satisfactorily under the standard level in the field by adopting suitable mixing proportions based on the laboratory mixing test results. For practical application, the mixing procedure was a major factor of strength growth when hemihydrate gypsum was used to stabilize soft clayey ground.

ObjectiveTo assess whether follow-up colonoscopy after polypectomy at 3 years only, or at 1 and 3 years would effectively detect advanced neoplasia (AN), including nonpolypoid colorectal neoplasms (NP-CRNs).DesignA prospective multicentre randomised controlled trial was conducted in 11 Japanese institutions. The enrolled participants underwent a two-round baseline colonoscopy (interval: 1 year) to remove all neoplastic lesions. Subsequently, they were randomly assigned to undergo follow-up colonoscopy at 1 and 3 years (2-examination group) or at 3 years only (1-examination group). The incidence of AN, defined as lesions with low-grade dysplasia ≥10 mm, high-grade dysplasia or invasive cancer, at follow-up colonoscopy was evaluated.ResultsA total of 3926 patients were enrolled in this study. The mean age was 57.3 (range: 40–69) years, and 2440 (62%) were male. Of these, 2166 patients were assigned to two groups (2-examination: 1087, 1-examination: 1079). Overall, we detected 29 AN in 28 patients at follow-up colonoscopy in both groups. On per-protocol analysis (701 in 2-examination vs 763 in 1-examination group), the incidence of AN was similar between the two groups (1.7% vs 2.1%, p=0.599). The results of the non-inferiority test were significant (p=0.017 in per-protocol, p=0.001 in intention-to-treat analysis). NP-CRNs composed of dominantly of the detected AN (62%, 18/29), and most of them were classified into laterally spreading tumour non-granular type (83%, 15/18).ConclusionAfter a two-round baseline colonoscopy, follow-up colonoscopy at 3 years detected AN, including NP-CRNs, as effectively as follow-up colonoscopies performed after 1 and 3 years.

Increase in saturated fatty acid (SFA) content in membrane phospholipids dramatically affects membrane properties and cellular functioning. We sought to determine whether exogenous SFA from the diet directly affects the degree of membrane phospholipid unsaturation in adult hearts and if these changes correlate with contractile dysfunction. Although both SFA-rich high fat diets (HFDs) and monounsaturated FA (MUFA)-rich HFDs cause the same degree of activation of myocardial FA uptake, triglyceride turnover, and mitochondrial FA oxidation and accumulation of toxic lipid intermediates, the former induced more severe diastolic dysfunction than the latter, which was accompanied with a decrease in membrane phospholipid unsaturation, induction of unfolded protein response (UPR), and a decrease in the expression of Sirt1 and stearoyl-CoA desaturase-1 (SCD1), catalyzing the conversion of SFA to MUFA. When the SFA supply in the heart overwhelms the cellular capacity to use it for energy, excess exogenous SFA channels to membrane phospholipids, leading to UPR induction, and development of diastolic dysfunction.