5–5 μm wide, 8–17 μm long. Free akinetes with thin coarse cell wall, mostly cylindrical, sometimes bent, pale olive, tan, or yellow-orange, with coarsely granulated content, 5–10 μm wide, 12–28 μm long. Reference strain CCALA 1001. Herbarium voucher BRY37722, sequence KF052617. Isolated from Big Horn Seep, Grand Staircase-Escalante National Monument, Utah, USA. This isolate matches selleckchem the description of C. marchicum (Geitler 1932, p. 823) well.

The only difference is the reported colorless content of akinetes, which was not observed in strains from Grand Staircase-Escalante National Monument. The habitat also matches as well, as it was originally found in aerial habitats in Northern Germany and Latvia, and Big

Horn Seep is a relatively dry hanging garden. Cylindrospermum www.selleckchem.com/products/idasanutlin-rg-7388.html moravicum Johansen et Lukešová sp. nov. (Fig. 5, a–o), Thallus gelatinous to leathery, blue-green in young cultures, becoming slightly yellowish with age, with wet-like surface. Trichomes short or long, flexuous, constricted at the cross walls, isopolar, or heteropolar, slightly motile, 2.7–5 μm wide. Vegetative cells cylindrical, sometimes concave or irregular, isodiametric to longer than wide, pale blue-green, 3.5–7.0 μm long. End cells rounded. Heterocytes forming terminally after trichome fragmentation, solitary, unipored, spherical to cylindrical elongated, with yellow, smooth content, 5.0–9.0(11) μm long, 2.7–6.0 μm wide. Akinetes forming paraheterocytically, solitary, cylindrical, widened toward the end attached to the heterocyte, with colorless to golden-brown, smooth, internally structured or lamellate exospores, (18)22–32 μm long, 9–13 μm wide. Holotype: BRY37714, Monte L. Bean Museum, Provo, Utah. Reference strain: CCALA 993. Sequences available

at NCBI GenBank under numbers KF052607 and KF052608 (operons 1 and 2 respectively). Type locality: cave sediment, Amatérská Cave, Moravian Karst, Czech Republic. Etymology: moravicum = from Moravia. Taxonomic Notes: Differs from all other species in this study by the finely structured exospore, which has a hairy appearance but lacks external manifestation of the hairs/spines, and the apically widened Nintedanib (BIBF 1120) cylindrical akinetes. Also differs from these taxa in the secondary structure of the D1-D1′ helix and V3 helix. Cylindrospermum muscicola SAG 44.79 (Fig. 6, t–w) Colony dark green, with small clusters of biomass, dull surface. Filaments long, coiled, unsheathed. Trichomes motile, constricted at cross walls, 4–5 μm wide. Vegetative cells cylindrical, dark green or blue-green, with parietal thylakoids and finely granulated content, 3.5–7 μm long. End cells rounded. Heterocytes terminal, spherical, or spherical-elongated, with tan, clear cytoplasm, 4–6 μm wide, 4.5–8 μm long. Akinetes not observed.

5–5 μm wide, 8–17 μm long. Free akinetes with thin coarse cell wall, mostly cylindrical, sometimes bent, pale olive, tan, or yellow-orange, with coarsely granulated content, 5–10 μm wide, 12–28 μm long. Reference strain CCALA 1001. Herbarium voucher BRY37722, sequence KF052617. Isolated from Big Horn Seep, Grand Staircase-Escalante National Monument, Utah, USA. This isolate matches selleck screening library the description of C. marchicum (Geitler 1932, p. 823) well.

The only difference is the reported colorless content of akinetes, which was not observed in strains from Grand Staircase-Escalante National Monument. The habitat also matches as well, as it was originally found in aerial habitats in Northern Germany and Latvia, and Big

Horn Seep is a relatively dry hanging garden. Cylindrospermum selleck inhibitor moravicum Johansen et Lukešová sp. nov. (Fig. 5, a–o), Thallus gelatinous to leathery, blue-green in young cultures, becoming slightly yellowish with age, with wet-like surface. Trichomes short or long, flexuous, constricted at the cross walls, isopolar, or heteropolar, slightly motile, 2.7–5 μm wide. Vegetative cells cylindrical, sometimes concave or irregular, isodiametric to longer than wide, pale blue-green, 3.5–7.0 μm long. End cells rounded. Heterocytes forming terminally after trichome fragmentation, solitary, unipored, spherical to cylindrical elongated, with yellow, smooth content, 5.0–9.0(11) μm long, 2.7–6.0 μm wide. Akinetes forming paraheterocytically, solitary, cylindrical, widened toward the end attached to the heterocyte, with colorless to golden-brown, smooth, internally structured or lamellate exospores, (18)22–32 μm long, 9–13 μm wide. Holotype: BRY37714, Monte L. Bean Museum, Provo, Utah. Reference strain: CCALA 993. Sequences available

at NCBI GenBank under numbers KF052607 and KF052608 (operons 1 and 2 respectively). Type locality: cave sediment, Amatérská Cave, Moravian Karst, Czech Republic. Etymology: moravicum = from Moravia. Taxonomic Notes: Differs from all other species in this study by the finely structured exospore, which has a hairy appearance but lacks external manifestation of the hairs/spines, and the apically widened Meloxicam cylindrical akinetes. Also differs from these taxa in the secondary structure of the D1-D1′ helix and V3 helix. Cylindrospermum muscicola SAG 44.79 (Fig. 6, t–w) Colony dark green, with small clusters of biomass, dull surface. Filaments long, coiled, unsheathed. Trichomes motile, constricted at cross walls, 4–5 μm wide. Vegetative cells cylindrical, dark green or blue-green, with parietal thylakoids and finely granulated content, 3.5–7 μm long. End cells rounded. Heterocytes terminal, spherical, or spherical-elongated, with tan, clear cytoplasm, 4–6 μm wide, 4.5–8 μm long. Akinetes not observed.

[110] Isotoribine and CPG10101 both increase interferon secretion, engendering robust polyclonal T-cell responses. The side-effect profiles of these agents are therefore similar to interferon-based regimens. TLR4 antagonists have

also been developed to dampen tissue-damaging immune responses. They have shown promise in colitis and sepsis trials,[111, 112] but their use in HCV has not yet been explored. Given the protective effect of TLR4 SNPs that lead to blunted TLR4 responses in HCV hepatic fibrosis, these agents may have therapeutic benefit in HCV infection. The effects of HCV infection on TLR signaling are complex. Compartmentalization of HCV modulation of TLR signaling means that HCV leads to upregulation of non-specific liver inflammation through stimulation of immune www.selleckchem.com/products/idasanutlin-rg-7388.html cells in an effort to achieve viral clearance. Conversely, suppression of TLR signaling in key antiviral immune effector cells, such as DCs, favors inhibition of inflammation that leads to viral persistence and chronic infection. Preliminary evidence suggests that therapeutic strategies harnessing TLR function

will prove to be useful in HCV infection, while TLR polymorphisms offer a potential tool for prediction of adverse HCV-related outcomes. “
“Patients with colorectal liver metastasis (CRLM) can be cured with surgical Doramapimod in vitro resection. Recent advances in systemic chemotherapy, including molecular target agents, can be used to introduce “conversion surgery” and achieve R0 resection even in patients with initially unresectable CRLM. Furthermore, neoadjuvant chemotherapy also tries to be applied in patients with resectable CRLM to maximize the remnant liver and reduce the residual micrometastasis before surgery. The development of chemotherapy-induced hepatic injuries is increasingly being recognized, including sinusoidal obstructive Aurora Kinase syndrome

(SOS), steatosis, steatohepatitis and biliary sclerosis. Especially, oxaliplatin (L-OHP)-based chemotherapy in clinical settings appears to be primarily associated with SOS. Various reports have tried to demonstrate the rationale of the correlation between L-OHP-based chemotherapy and SOS for the following hepatic surgery. While we can recognize that this pathophysiological disadvantage leads to hepatic dysfunction and the increasing postoperative morbidity, the essential part of this problem including clinical disadvantage, onset mechanism, evaluation systems, and targeted agents for prevention and treatment of SOS continue to be unclear. In this review, we summarize the current experience with hepatic injury induced by L-OHP-based chemotherapy, focusing on SOS-based on clinical and experimental data, in order to assist in the resolution of these identified factors. Finally, the need for reliable methods to identify the risk of SOS, to evaluate SOS status and to predict the safety of surgical treatment in patients with chemotherapy prior to surgery will be emphasized.

[110] Isotoribine and CPG10101 both increase interferon secretion, engendering robust polyclonal T-cell responses. The side-effect profiles of these agents are therefore similar to interferon-based regimens. TLR4 antagonists have

also been developed to dampen tissue-damaging immune responses. They have shown promise in colitis and sepsis trials,[111, 112] but their use in HCV has not yet been explored. Given the protective effect of TLR4 SNPs that lead to blunted TLR4 responses in HCV hepatic fibrosis, these agents may have therapeutic benefit in HCV infection. The effects of HCV infection on TLR signaling are complex. Compartmentalization of HCV modulation of TLR signaling means that HCV leads to upregulation of non-specific liver inflammation through stimulation of immune this website cells in an effort to achieve viral clearance. Conversely, suppression of TLR signaling in key antiviral immune effector cells, such as DCs, favors inhibition of inflammation that leads to viral persistence and chronic infection. Preliminary evidence suggests that therapeutic strategies harnessing TLR function

will prove to be useful in HCV infection, while TLR polymorphisms offer a potential tool for prediction of adverse HCV-related outcomes. “
“Patients with colorectal liver metastasis (CRLM) can be cured with surgical www.selleckchem.com/products/VX-770.html resection. Recent advances in systemic chemotherapy, including molecular target agents, can be used to introduce “conversion surgery” and achieve R0 resection even in patients with initially unresectable CRLM. Furthermore, neoadjuvant chemotherapy also tries to be applied in patients with resectable CRLM to maximize the remnant liver and reduce the residual micrometastasis before surgery. The development of chemotherapy-induced hepatic injuries is increasingly being recognized, including sinusoidal obstructive over syndrome

(SOS), steatosis, steatohepatitis and biliary sclerosis. Especially, oxaliplatin (L-OHP)-based chemotherapy in clinical settings appears to be primarily associated with SOS. Various reports have tried to demonstrate the rationale of the correlation between L-OHP-based chemotherapy and SOS for the following hepatic surgery. While we can recognize that this pathophysiological disadvantage leads to hepatic dysfunction and the increasing postoperative morbidity, the essential part of this problem including clinical disadvantage, onset mechanism, evaluation systems, and targeted agents for prevention and treatment of SOS continue to be unclear. In this review, we summarize the current experience with hepatic injury induced by L-OHP-based chemotherapy, focusing on SOS-based on clinical and experimental data, in order to assist in the resolution of these identified factors. Finally, the need for reliable methods to identify the risk of SOS, to evaluate SOS status and to predict the safety of surgical treatment in patients with chemotherapy prior to surgery will be emphasized.

The cumulative survival rates were significantly different Rapamycin supplier between the SRS (+) and SRS (−) groups and between the SRS (+) and B-RTO groups. The vital prognosis worsened for the SRS (+) group. Conclusions:  The presence of a large splenorenal shunt (portosystemic shunt) was indicated to lower liver function and vital prognosis. B-RTO, which completely obliterates large splenorenal

shunts, inhibited the lowering of hepatic functional reserve and the worsening of vital prognosis, indicating a protective role. Liver pathology and the presence of a large portosystemic shunt each separately result in progressive liver dysfunction and worsen the survival rate. We found that such a pathological condition had occurred due to a large portosystemic shunt, and it should be called ‘portosystemic shunt syndrome. It is well known that portal hypertensive patients develop various collateral pathways (shunts). A splenorenal shunt

(SRS) is a major shunt that is a representative collateral pathway. Gastric fundal varices (GFV) are formed in the course of this collateral pathway. The GFV diagnosed by endoscopy have large SRS at high rates of ≥90%.1 Balloon-occluded retrograde transvenous obliteration (B-RTO)2 is known as an effective treatment mainly for large GFV.3–8 In addition, B-RTO totally obliterates large splenorenal INCB024360 nmr shunts. It is possible to totally eradicate GFV due to this anatomical characteristic as well as to treat hepatic encephalopathy.9–11 There have been reports of short-term improvement of liver function due to increased portal venous blood flow.6,10,12 However, there has not been any report examining the long-term effects of SRS on liver function and survival. In this study, we compared the long-term effects of SRS, a major portosystemic shunt, on

liver selleck kinase inhibitor function and survival in three groups of patients: cirrhotic portal hypertensive patients with SRS and those without SRS, and patients with completely obliterated SRS by B-RTO. The subjects were patients with liver cirrhosis (LC) who were followed up between January 1998 and December 2002 at the Kurume University Hospital. The diagnosis of LC was made comprehensively by physical findings (such as spider angioma, gynecomastia, and palmar erythema), imaging (ultrasonography [US] and computed tomography [CT]), markers for fibrosis (hyaluronic acid and Type IV collagen), and liver biopsy tissue. To examine the long-term liver function changes due to SRS alone, we carefully, strictly, and retrospectively extracted patients with no hepatocellular carcinoma (HCC) in the first 3 years of the follow-up period, patients without antiviral treatment such as interferon or lamivudine, and patients with a Child–Pugh classification13 of A or B. The patient enrollment was done by four experts in this field. Gastric varices were classified according to the Japanese endoscopic classification14 for esophagogastric varices.

Marianna Univ. Yokohama-city Seibu Hopsital, St. Marianna JQ1 Univ. Yokohama-City Seibu Hopsital Objective: Several cases of sporadic cancer, not colitic cancer in the patients with ulcerative colitis were reported. Differential diagnosis is critical, because the first-line therapy is different. Methods: Case: A 47 y/o female was referred to our hospital, after ulcerative colitis was confirmed pathologically. 5-ASA, steroid enema and azathioprine was given, however, the remission stage could not be obtained. On colonoscopy, multiple

inflammatory polyps were seen in the entire colon. A sessile polypoid lesion sized as 5 mm in diameter, surrounded by the inflammatory mucosa, was seen in the hepatic flexure, and biopsy specimen showed adenocarcinoma. Magnifying images with NBI and indigocarmine stain showed IV with partial VI type pit pattern. After obtained fully informed consent, endoscopic mucosal resection (EMR) underwent. Results: Pathological result was as follows: Tubular adenocarcinoma, tub1, pM, Intestinal type; INFb. Alectinib nmr ly0, v0, horizontal margin:-, vertical margin:-. Immunohistological result with p53 and Ki-67 presented that the neoplastic area was seen only on the top of the lesion without any dysplasia in the adjacent area. (“top-down” type) Discussion: It is difficult to distinguish colitic from sporadic cancer only in the endoscopic

images, therefore, histological confirmation is critical. We firstly diagnosed colitic cancer, because the extension of the lesion was entire colon type and the morbidity history was more than 10 years. However, the final result was sporadic cancer with ulcerative colitis. Conclusion: A case report of sporadic early colon cancer in the patient with ulcerative colitis was presented, difficult to differentiate from colitic cancer endoscopically. More cumulative case reports would be mandatory. Key Word(s): 1. colitic cancer; 2. sporadic cancer; 3. ulcerative colitis Presenting Author: HIROKI TANAKA Additional Authors: MAKI MIYAKAWA, RYOSUKE SAKEMI, MASANAO NASUNO, SATOSHI MOTOYA, AKIMICHI IMAMURA

Corresponding Author: HIROKI TANAKA Affiliations: Sapporo Kosei General Hospital, Sapporo Kosei General Hospital, Sapporo Kosei General Hospital, Sapporo Kosei General Hospital, Sapporo Kosei General Hospital Objective: Very check details few studies have reported on Japanese patients with CD who received adalimumab maintenance treatment. We evaluated the effectiveness of adalimumab as a maintenance treatment in patients with CD and the prognostic factors related to the treatment results. Methods: We investigated all patients who were treated with adalimumab for luminal CD between October 2010 and March 2013. The effectiveness of adalimumab maintenance treatment was evaluated using the sustained treatment success rates, which were estimated using the Kaplan–Meier method. Sustained treatment success was defined as a lack of treatment failure.

To address many of these issues, the International Prophylaxis Study Group was formed in 2001 [35]. Pharmacokinetics have become a requisite for prophylactic

Selleck Obeticholic Acid dosing. During the 1990s, it could be shown that shortening of dose interval, keeping trough levels, reduced cost at sustained prophylactic efficacy [36, 37]. Even daily dosing has a potential to be feasible in some patients [38]. Pharmacokinetics have more recently been studied in larger international cohorts [39, 40] and the trend is to personalize dosing according to clinical response and individual pharmacokinetics. Long-acting FVIII and FIX concentrates are under study and have a potential to improve prophylaxis, either by using longer intervals than with traditional products, or by raising trough levels. learn more Longer intervals for dosing would improve convenience and compliance. Raising the trough levels has a potential to dramatically increase the long-term medical effect as even patients

receiving so-called high-dose prophylaxis have substantially reduced levels compared to haemostatically normal people. Cost remains the main hurdle for prophylaxis and therefore perhaps the most important wish for the future, irrespective of the type of concentrate used, is a price reduction Gene therapy and cure of haemophilia will totally change the history, but that is another story. The author stated that he had no interests which might be perceived as posing a conflict or bias. “
“Psychosocial outcomes are important in the perspective of boys with haemophilia. However, health-related quality of life (HRQoL) is based on self-report, and assumes adequate literacy. Yet, literacy

is rarely assessed prior to data collection. This study sought to identify criteria that might indicate the level of literacy of children being recruited for clinical trials and to develop a simple method to prescreen those whose literacy was uncertain. We developed a brief screening tool in the form of two stories, Phosphatidylinositol diacylglycerol-lyase at a grade 3 reading level, followed by comprehension questions. We applied the screening test to a sample of haemophilic boys between the ages of 7 and 13 years to assess their literacy. The data were analysed to determine the best criteria to use in identifying the ability to independently self-report for HRQoL studies. Twenty-four Brazilian boys (7.9–12.8) completed the testing. The results showed that 17 (70.8%) were literate (were able to both read and comprehend), and could complete a questionnaire without assistance. All boys over 11.0 years of age were sufficiently literate. Grade level was not found to be a helpful criterion. We recommend that all children under the age of 11.0 years be prescreened before providing self-reported HRQoL data. Those with limited literacy should be provided assistance to ensure comprehension of the questions. This is important to ensure high-quality data on HRQoL for future clinical trials.

Of note, magnetic suppression of perceptual accuracy profiles using transcranial magnetic stimulation in these patients showed reduced visual suppression correlating with high cortical excitability. A dysfunction in inhibitory pathways is therefore possible. In summary, ictal imaging studies reveal several intriguing changes in the migraineurs’ brain (Table 2). Activations of dorsal pons, substantia nigra, red nucleus, MRF, amygdala, and insula have been reported, while the trigeminal nuclei activity Smad inhibitor decreased after nociceptive stimulation. Blood flow increased in the brainstem, cerebellum, hypothalamus, thalamus, insula,

cingulate cortex, prefrontal cortex, auditory cortex, and visual association cortex. Chronic migraine Talazoparib led to hypometabolism in several cortical areas and to hypermetabolism in the brainstem.

An increasing body of research that employs neuroimaging methods challenges the traditional view of migraine as a nonprogressive, paroxysmal disorder with no CNS abnormalities between attacks. Structural and functional alterations that often correlate with pain duration and frequency have been unveiled in migraineurs during migraine-free states, in part due to imaging advances (see Tables 3 and 4 for lists of structural and functional interictal neuroimaging findings, respectively). Brain Structure and Vasculature.— Numerous conventional MRI studies unequivocally indicate that migraine is associated with an increased risk of stroke and deep white matter lesions in patients of various ages.61 Migraineurs with and without aura have an elevated risk of stroke, and the relative risk is higher in young subjects, smokers, users of oral contraceptive, patients with aura, and those with more frequent attacks.62-64 The Farnesyltransferase increased stroke risk may

be confined to small cerebellar and watershed-zone infarcts.65 Approximately 10% of patients who have migraine with aura and at least one migraine per month have been found to have a posterior circulation stroke.66 Most of these strokes remain asymptomatic, and their clinical significance is unclear. One proposed mechanism underlying this association is endothelial dysfunction. Results from the few known studies that have compared the anterior and posterior cerebral endothelial function are contradictory, mainly due to methodological limitations (eg, CO2-induced vasodilatation vs L-arginine stimulus) and the presence of comorbidities. Most animal studies, however, suggest that the posterior cerebral circulation is subject to more basal vasomotor control to nitric oxide than the anterior cerebral circulation.67 Perko and colleagues68 used transcranial Doppler sonography to determine the posterior cerebral endothelial function in migraine patients.

Of note, magnetic suppression of perceptual accuracy profiles using transcranial magnetic stimulation in these patients showed reduced visual suppression correlating with high cortical excitability. A dysfunction in inhibitory pathways is therefore possible. In summary, ictal imaging studies reveal several intriguing changes in the migraineurs’ brain (Table 2). Activations of dorsal pons, substantia nigra, red nucleus, MRF, amygdala, and insula have been reported, while the trigeminal nuclei activity PARP inhibitor decreased after nociceptive stimulation. Blood flow increased in the brainstem, cerebellum, hypothalamus, thalamus, insula,

cingulate cortex, prefrontal cortex, auditory cortex, and visual association cortex. Chronic migraine Selleck Raf inhibitor led to hypometabolism in several cortical areas and to hypermetabolism in the brainstem.

An increasing body of research that employs neuroimaging methods challenges the traditional view of migraine as a nonprogressive, paroxysmal disorder with no CNS abnormalities between attacks. Structural and functional alterations that often correlate with pain duration and frequency have been unveiled in migraineurs during migraine-free states, in part due to imaging advances (see Tables 3 and 4 for lists of structural and functional interictal neuroimaging findings, respectively). Brain Structure and Vasculature.— Numerous conventional MRI studies unequivocally indicate that migraine is associated with an increased risk of stroke and deep white matter lesions in patients of various ages.61 Migraineurs with and without aura have an elevated risk of stroke, and the relative risk is higher in young subjects, smokers, users of oral contraceptive, patients with aura, and those with more frequent attacks.62-64 The CYTH4 increased stroke risk may

be confined to small cerebellar and watershed-zone infarcts.65 Approximately 10% of patients who have migraine with aura and at least one migraine per month have been found to have a posterior circulation stroke.66 Most of these strokes remain asymptomatic, and their clinical significance is unclear. One proposed mechanism underlying this association is endothelial dysfunction. Results from the few known studies that have compared the anterior and posterior cerebral endothelial function are contradictory, mainly due to methodological limitations (eg, CO2-induced vasodilatation vs L-arginine stimulus) and the presence of comorbidities. Most animal studies, however, suggest that the posterior cerebral circulation is subject to more basal vasomotor control to nitric oxide than the anterior cerebral circulation.67 Perko and colleagues68 used transcranial Doppler sonography to determine the posterior cerebral endothelial function in migraine patients.

When the stent is withdrawn 7 days after insertion, the pancreatic stricture is dilated (Fig. 5c). Short-term Selleck Natural Product Library metallic stenting is useful method for dilating

strictures of the pancreatic duct and shows promise for preventing pancreatic stone recurrence after lithotripsy in patients with pancreatic stricture. We performed the procedure in five patients with advanced chronic pancreatitis, all of whom experiencing successful dilation without recurrence of pancreatic stones during a mean observation period of 45.6 months. We therefore believe that this short-term treatment will prove effective in preventing recurrence of pancreatolithiasis. Recently, Moon et al.[29] reported good results using a self-expandable metallic stent for pancreatic stricture. When those authors inserted a fully covered metallic stent or performed temporary

stenting for 3 months, pancreatic strictures resolved in patients with advanced chronic pancreatitis. Such methods are promising in prevention of stone recurrence after lithotripsy in patients with pancreatic stricture. In our experience, pancreatic ductal carcinoma (PDAC) developed in 6 of 112 patients with pancreatolithiasis (5.4%). Only two Omipalisib of the six patients had resectable stage IB or IIA tumors, illustrating the difficulty of diagnosis at an early stage. Pancreatolithiasis is a high-risk factor for PDAC and has other potential complications, such as pancreatic atrophy and irreversible loss of exocrine and endocrine function. Further, stone recurrence after treatment of pancreatolithiasis is very frequent. Considering the importance of early treatment, diagnostic Cyclin-dependent kinase 3 criteria for chronic pancreatitis were revised in 2009[30] by a study group of the Japanese Ministry of Health, Labour and Welfare for intractable pancreatic diseases, together with the Japan Pancreas Society. The result was a proposed concept of “early chronic pancreatitis.” According to the new criteria, early chronic pancreatitis is diagnosed when more than two of four items suggesting chronic pancreatitis are present together with characteristic early findings by imaging (mainly endoscopic ultrasonography). The four items are repeated upper abdominal pain, abnormal

pancreatic enzyme levels in serum or urine, abnormal pancreatic exocrine function, and continuous heavy drinking of alcohol equivalent to over 80 g/day of pure ethanol. The seven early endoscopic ultrasound (EUS) findings of early chronic pancreatitis (Figs 6, 7) include five parenchymal and two ductal abnomalities: (i) lobularity with honeycombing; (ii) lobularity without honeycombing; (iii) hyperechoic foci without shadowing; (iv) stranding; (v) cysts; (vi) dilated side branches; and (vii) hyperechoic MPD margin. More than two features of these seven EUS findings are required, including at least one of (i) to (iv). The aim of adopting the category of early chronic pancreatitis is prevention of development intractable disease by early treatment. Hirota et al.