Impact of physiologically shaped pancreatic stent for chronic pancreatitis.

Endoscopic pancreatic stenting is used to prevent main pancreatic duct obstruction and relieve painful symptoms of chronic pancreatitis. However, the stent typically needs to be exchanged and the rate of adverse events is high. Few studies have evaluated the effect of stent shape on those outcomes. We evaluated the adverse events, stent patency, and total medical cost within 90 days of patients who received an 8.5 French (Fr) physiologically shaped pancreatic stent by comparing these features with those associated with a conventional straight-type stent for ≥ 90 days. The total stent-related adverse event rate was significantly lower for the physiologically shaped pancreatic stent (physiologically shaped, 6.7% [2/30]; straight-type, 50.6% [44/87]; P < 0.001). Stent occlusion was significantly less frequent (P < 0.001) and the total medical costs were significantly lower (P = 0.002) for the physiologically shaped stent. The stent-related adverse event rate was significantly higher for the 10 Fr straight type stent than for the 8.5 Fr physiologically shaped stent (10 Fr, straight-type vs. 8.5 Fr, physiologically shaped: 36.1% [13/36] vs. 6.7% [2/30]; P = 0.007). In conclusion, a physiologically shaped pancreatic stent was superior to a straight-type stent in terms of the patency rate and medical costs.

Severe hyposmia and aberrant functional connectivity in cognitively normal Parkinson's disease.

OBJECTIVE: Severe hyposmia is a risk factor of dementia in Parkinson's disease (PD), while the underlying functional connectivity (FC) and brain volume alterations in PD patients with severe hyposmia (PD-SH) are unclear. METHODS: We examined voxel-based morphometric and resting state functional magnetic resonance imaging findings in 15 cognitively normal PD-SH, 15 cognitively normal patients with PD with no/mild hyposmia (PD-N/MH), and 15 healthy controls (HCs). RESULTS: Decreased gray matter volume (GMV) was observed in the bilateral cuneus, right associative visual area, precuneus, and some areas in anterior temporal lobes in PD-SH group compared to HCs. Both the PD-SH and PD-N/MH groups showed increased GMV in the bilateral posterior insula and its surrounding regions. A widespread significant decrease in amygdala FC beyond the decreased GMV areas and olfactory cortices were found in the PD-SH group compared with the HCs. Above all, decreased amygdala FC with the inferior parietal lobule, lingual gyrus, and fusiform gyrus was significantly correlated with both reduction of Addenbrooke's Cognitive Examination-Revised scores and severity of hyposmia in all participants. Canonical resting state networks exhibited decreased FC in the precuneus and left executive control networks but increased FC in the primary and high visual networks of patients with PD compared with HCs. Canonical network FC to other brain regions was enhanced in the executive control, salience, primary visual, and visuospatial networks of the PD-SH. CONCLUSION: PD-SH showed extensive decreased amygdala FC. Particularly, decreased FC between the amygdala and inferior parietal lobule, lingual gyrus, and fusiform gyrus were associated with the severity of hyposmia and cognitive performance. In contrast, relatively preserved canonical networks in combination with increased FC to brain regions outside of canonical networks may be related to compensatory mechanisms, and preservation of brain function.

[IT network establishment for neuropatients].

On March 11, 2011, big earthquake and subsequent gigantic tsunami killed more than 20,000 peoples in Tohoku area of Japan. Neurological patients were one such victim because they are usually very vulnerable to such a huge tragedy due to their physical disability including artificial ventilator-support. On occasion of the last tsunami, most cases showed "all or nothing" to lose life or to survive, and there were only a little cases who needed emergency surgical treatment. In the very early period, some neurological patients required electric power to keep their lifesupportive ventilator at evacuation house or even at home. In a week to a couple of months, many neurological patients needed continuous supply of their daily drugs which are essential to keep themselves in steady physical conditions and even for keeping their life.Japanese Neurological Society (JNS) began to establish an emergent assistant network system from January 2012 in an attempt of supplying materials, drugs and energy power to neurological patients who require both under a very early period after any natural or political disaster and a later period. For example, JNS is going to apply IT system to connect distant but safer hospitals which accept emergent patients from the center of disastrous place. JNS may also send emergency medical team to the disastrous place to save neurological patients by passing necessary medicine and materials or moving patients to safer hospitals. JNS will make such a tentative program public on our website to collect many other constructive opinions from general member of the society and neurological patients. After getting those opinions, JNS made up the exact team for this purpose after general meeting of JNS on this May 2012.Based on this team, disaster-mimic trial will be performed in Tokyo, Shizuoka, and Kochi where the next big disaster is going to hit the cities.