Aim:The aim of the study was to investigate the incidence of and risk factors for repetition of suicidal behavior within a year after admission for drug overdose in Japan.Methods: Patients admitted to the emergency department of a general public hospital in Tokyo for drug overdose of prescribed medicine and/or over-thecounter drugs between March 2008 and February 2009 were followed up after 1 year. Demographic characteristics, previous suicide attempts, and mental health state were examined by self-report questionnaire and interview at recovery from the initial attempt. Information about suicidal behavior during the follow-up period was obtained from the outpatient psychiatrists by postal questionnaire 1 year after discharge.Results: Of 190 patients admitted to the emergency department, 132 patients answered the questionnaire and had the interview. Information about the follow-up period for 66 patients was obtained. Of the 66 patients, 28 patients attempted suicide again and two patients committed suicide during the 1-year follow-up period. Psychiatric diagnosis of personality disorder and denial of suicidal intent at the time of recovery were associated with increased risk for another suicide attempt. Lethality levels of suicidal behaviors before and after admission were associated with each other. Conclusion:The rate of fatal and non-fatal suicide attempt within a year after admission for selfpoisoning was substantial. Psychiatric diagnosis of personality disorder was a risk factor for repetition of suicide attempt. Clinicians should pay attention to the means of previous suicide attempts even though the patient denies suicidal intent at recovery.

Background Endoscopic remission is associated with better long-term outcomes of ulcerative colitis (UC), and therefore, it is considered a treatment target. However, endoscopy is invasive and frequent monitoring is not feasible. We have reported that bowel ultrasound (BUS) is useful in predicting endoscopic and histologic severity and in determining response to treatment (Sagami S et al, APT 2020 & 2022). However, it is unclear whether BUS can predict the relapse of UC in remission. Methods We conducted a retrospective cohort study enrolling UC patients who underwent BUS from Jul 2018 to Jul 2021 during clinical remission (Patient Reported Outcome-2 ≦ 1 and no rectal bleeding) for at least 3 months and followed for 1 year. Spearman rank correlation coefficient was used to analyse the correlation between BUS and Mayo endoscopic subscore (MES) (evaluation of the most severe part of the colon). The association between BUS findings (bowel wall thickness (BWT), bowel wall flow (BWF), bowel wall stratification (BWS), enlarged lymph nodes), Milan Ultrasound Criteria (MUC = 1.4 × colonic BWT + 2 × colonic BWF (0 = absence, 1 = presence of colour Doppler signal)) (Allocca M et al, UEGJ 2021), MES, CRP and faecal calprotectin (FC) and subsequent clinical relapse was evaluated. Relapse was defined as rectal bleeding score ≧ 1, stool frequency score ≧ 2, or treatment intensification for symptoms. Results A total of 58 patients were included in the study. The median age was 46 years, 37 (63.8%) were male, 39 (67.2%) were pancolitis, and the median disease duration was 116 months. BWT and BWF were moderately correlated with MES but MUC showed a numerically highest coefficiency (0.61) when evaluated for the colon. Overall, 18 patients (31.0%) relapsed within 1 year. Neither BWT, BWF, BWS, enlarged lymph nodes, nor CRP was predictive for relapse. The log-rank test showed MUC > 6.2 (p = 0.019), MES ≥ 1 (p = 0.013), and FC ≥ 250 μg/g (p = 0.040) were associated with a shorter time to relapse. Cox proportional hazards model showed MUC > 6.2 (HR 3.22: 95%CI 1.14-9.08, p = 0.027), MES ≥1 (HR 8.70: 95%CI 1.11-68.1, p = 0.040) had a higher risk of relapse in 1 year. Sensitivity, specificity, PPV, and NPV of MUC > 6.2 for relapses of different time points (3, 6, and 12 months) showed high specificity of 0.90-0.91 and NPV of 0.74-0.90. Interestingly, 4 out of 9 patients with MUC > 6.2 relapsed within 3 months, suggesting MUC > 6.2 is a risk of short-term relapse. Conclusion BUS in UC patients in remission can predict relapse using MUC. In particular, the MUC score ≤ 6.2 is associated with a lower risk of relapse and could be a treatment-target alternative to endoscopic healing.

Background Endoscopy has been used to assess the disease activity of Crohn's disease (CD) but may not be sufficient considering the transmural nature of its inflammation. Bowel ultrasonography (BUS) has been reported to reflect disease activity of CD and long-term outcomes. We performed a prospective study to determine whether BUS can predict short-term clinical response to induction therapy. Methods Consecutive CD patients with active ulcers in endoscopy requiring induction therapy (Anti-TNF antibody, IL-12/23 p40 antibody, integrin inhibitor, prednisolone) were prospectively enrolled at a single center from October 2018 to July 2022. Short-term clinical response was defined by a reduction of Crohn’s disease activity index > 70 at week 8. Ultrasonographic findings (bowel wall thickness (BWT), colour Doppler signal (CDS), and shear wave elastography (SWE) were recorded for the most severely affected segment at baseline, week 1, and 8 and compared between responders and non-responders. Results Seventeen out of 29 patients were classified as responders at week 8. There was no difference in BWT and CDS at baseline, week 1, and 8 between responders and non-responders (Table 1). In contrast, responders had lower baseline SWE compared with non-responders (2.7±0.3 vs. 3.8±0.3, p=0.02). Adjusted by the prior exposure to biologics, the lower SWE at baseline was associated with clinical response at week 8 (adjusted odds ratio associated with 0.1 m/s increase: 0.9, p=0.018) (Table 2). SWE did not change over time regardless of response for 8 weeks. Conclusion Lower intestinal wall stiffness as measured by SWE is an independent predictor of short-term clinical response.

<b><i>Introduction:</i></b> A large proportion of small bowel lesions in Crohn’s disease (CD) may exist beyond the reach of ileocolonoscopy and there is no gold standard imaging modality to screen them, suggesting the need for optimal biomarkers. We aimed to compare the usefulness of C-reactive protein (CRP), faecal calprotectin (FC), and leucine-rich alpha-2 glycoprotein (LRG) in determining small bowel lesions of CD. <b><i>Methods:</i></b> This was a cross-sectional observational study. CRP, FC, and LRG were prospectively measured in patients with quiescent CD who underwent imaging examinations (capsule or balloon-assisted endoscopy, magnetic resonance enterography, or intestinal ultrasound) selected by the physician in clinical practice. Mucosal healing (MH) of the small bowel was defined as a lack of ulcers. Patients with a CD activity index &gt;150 and active colonic lesions were excluded. <b><i>Results:</i></b> A total of 65 patients (27, MH; 38, small bowel inflammation) were analysed. The area under the curve (AUC) of CRP, FC, and LRG was 0.74 (95% confidence interval: 0.61–0.87), 0.69 (0.52–0.81), and 0.77 (0.59–0.85), respectively. The AUC of FC and LRG in a subgroup of 61 patients with CRP &lt;3 mg/L (26, MH; 32, small bowel inflammation) was 0.68 (0.50–0.81) and 0.74 (0.54–0.84), respectively. The cut-off of 16 μg/mL of LRG showed the highest positive predictive value of 1.00 with specificity of 1.00, while negative predictive value was highest (0.71) with sensitivity of 0.89 at the cut-off of 9 μg/mL. <b><i>Conclusion:</i></b> LRG can accurately detect and/or exclude the small bowel lesions with two cut-off values.