Therapeutic efficacy of acotiamide in patients with functional dyspepsia based on enhanced postprandial gastric accommodation and emptying: randomized controlled study evaluation by real-time ultrasonography

BACKGROUND

Improvement in subjective symptoms has been reported in functional dyspepsia (FD) patients administered with acotiamide. Improvement was confirmed in meal-related symptoms, such as postprandial fullness, upper abdominal bloating, and early satiety. We examined the mechanism underlying the effects of acotiamide on gastric accommodation reflex (GAR) and gastroduodenal motility in FD patients.

METHODS

Thirty-four FD patients (mean age, 40.4 years) were examined ultrasonographically before and after 14-18 days of acotiamide (100 mg t.i.d.) or placebo administration. To assess GAR, expansion rate in cross-sectional area of the proximal stomach was measured after every 100-mL ingestion, using a straw, of up to 400 mL of a liquid meal (consommé soup, 13.1 kcal; 400 mL) in a supine position. Next, we measured gastric emptying rate (GER), motility index (MI, antral contractions), and reflux index (RI, duodenogastric reflux) to assess gastroduodenal motility. Patients also completed a survey based on the seven-point Likert scale both before and after drug administration.

KEY RESULTS

Of the 37 cases, 19 and 18 were administered with acotiamide and placebo A respectively, significant difference was observed in GAR between the acotiamide and placebo groups (21.7%vs 4.4%) after 400 mL ingestion. GER significantly accelerated after treatment in the acotiamide group (P = 0.012), no significant differences were observed in MI and RI between the two groups. Improvement rates were 35.3 and 11.8% for the acotiamide and placebo groups.

CONCLUSIONS & INFERENCES

Acotiamide significantly enhances GAR and GER in FD patients. Acotiamide may have therapeutic potential for FD patients.

Carbon ion radiotherapy for sacral chordoma

The National Institute of Radiological Sciences in Chiba, Japan has offered carbon ion radiotherapy (CIRT) since 1994 using carbon ion beams generated by the heavy ion medical accelerator in Chiba (HIMAC). The total number of cases treated with the HIMAC exceeded 5000 in July 2009. Here, we present a retrospective analysis of CIRT for sacral chordoma. The study included 95 patients with medically unresectable sacral chordomas treated between 1996 and 2007. The median age of the patients was 66 years. Of all the patients, 84 had not been treated previously and 11 had a locally recurrent tumour following previous resection. The carbon ion dose ranged from 52.8 to 73.6 GyE (median 70.4 GyE) in a total of 16 fixed fractions over 4 weeks. The median clinical target volume was 370 cm(3). The overall survival rate at 5 years for all 95 patients was 86%, and follow-up survival time was 42 months (range, 13-112 months). The 5-year local control rate was 88% and median time to local failure was 35 months (range, 13-60 months). Of the 95 patients, 91% remained ambulatory with or without a supportive device. Two patients experienced severe skin or soft tissue complications requiring skin grafts. 15 patients experienced severe sciatic nerve complications requiring continuing medication. CIRT appears effective and safe in the management of patients with sacral chordoma and offers a promising alternative to surgery.

Carbon-ion radiotherapy: clinical aspects and related dosimetry

The features of relativistic carbon-ion beams are attractive from the viewpoint of radiotherapy. They exhibit not only a superior physical dose distribution but also an increase in biological efficiency with depth, because energy loss of the beams increases as they penetrate the body. This paper reviews clinical aspects of carbon-beam radiotherapy using the experience at the National Institute of Radiological Sciences. The paper also outlines the dosimetry related to carbon-beam radiotherapy, including absolute dosimetry of the carbon beam, neutron measurements and radiation protection measurements.

Carbon ion radiotherapy for malignant melanoma of female genital organs

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Background: Malignant melanoma of the female genital organs is a very rare tumor and resistant to conventional photon radiotherapy. We report six cases of female genital malignant melanoma those were well controlled locally by carbon ion radiotherapy (CIRT). Methods: Between November 2004 and October 2008, six patients with unresectable female genital malignant melanoma were treated with CIRT. Age of the patients ranged from 55 to 80 years (median; 69 years). Four patients had previously untreated locally invasive tumors and other two had locally recurrent tumors after surgery and adjuvant chemotherapy. The tumor located in the vagina (4 patients), both the cervix and the vagina (1 patient), or both the vagina and the vulva (1 patient). Two patients had inguinal lymph node metastasis and two had distant metastases at CIRT. All patients received a total dose of 57.6 gray equivalent (GyE) in 16 fractions over 4 weeks of CIRT. Three patients received chemotherapy using dacarbazine, ACNU, and vincristine after CIRT. Results: The follow-up durations after CIRT were from 9 to 20 months (median; 13 months). No patient developed severe acute toxicity during CIRT. No late toxicity of greater Grade 2 was experienced, while Grade 1 proctitis was observed in a patient. All tumors completely responded to CIRT. No patient developed in-field recurrence. The four patients without distant metastasis were alive with no evidence of disease for 9–20 months after CIRT. The two patients with distant metastases died from metastatic disease 13 and 18 months after CIRT, respectively. Conclusions: CIRT achieved favorable local tumor control without developing severe acute and late toxicity in the treatment of unresectable malignant melanoma of the female genital organs.

No significant financial relationships to disclose.

Adipose tissue fat accumulation is reduced by a single intraperitoneal injection of peroxisome proliferator-activated receptor gamma agonist when given to newly hatched chicks

Peroxisome proliferator-activated receptor gamma (PPARgamma) is a transcription factor that regulates adipocyte differentiation and modulates lipid metabolism in mammals. The aim of the present study was to investigate whether the administration of PPARgamma ligands, adipogenic cocktail, or both to newly hatched chicks regulates adipocyte differentiation in vivo and modulates fat deposition in growing broiler chickens. Levels of PPARgamma, CCAAT/enhancer binding protein alpha, and adipocyte fatty acid-binding protein mRNA in the abdominal fat pad of 7-d-old broiler chicks given a single intraperitoneal dose of troglitazone, a synthetic PPARgamma ligand, at 1 d old were significantly greater than those in control chickens. This suggests administration of troglitazone enhanced adipocyte differentiation in vivo. Adipose tissue weight in 28-d-old chickens similarly administered triolein emulsion containing troglitazone or adipogenic cocktail (i.e., dexamethasone, insulin, isobutyl-methylxanthine, and oleic acid) was also significantly less than that of control chickens. However, there was no significant difference in BW between treated and control chickens. Although BW and carcass composition were not different between troglitazone-treated and control chickens, at 48 d of age abdominal fat pad weight and feed intake were significantly decreased in chickens treated with troglitazone compared with controls. These results demonstrate that a single intraperitoneal injection of troglitazone to newly hatched chicks reduces fat deposition in mature broiler chickens.

Electric field induced nuclear spin resonance mediated by oscillating electron spin domains in GaAs-based semiconductors

We demonstrate an alternative nuclear spin resonance using a radio frequency (rf) electric field [nuclear electric resonance (NER)] instead of a magnetic field. The NER is based on the electronic control of electron spins forming a domain structure. The rf electric field applied to a gate excites spatial oscillations of the domain walls and thus temporal oscillations of the hyperfine field to nuclear spins. The rf power and burst duration dependence of the NER spectrum provides insight into the interplay between nuclear spins and the oscillating domain walls.

Characterization of autonomic dysfunction in patients with irritable bowel syndrome using fingertip blood flow

Fingertip blood flow (FTBF) as measured by laser Doppler flowmetry (LDF) measurement is considered an indicator of sympathetic nerve function. We evaluated autonomic function in patients with irritable bowel syndrome (IBS) by assessing FTBF with both LDF and continuous-wave (cw) Doppler sonography. Firstly, the two methods were compared in 40 healthy volunteers. Next, 59 patients with IBS as well as 118 healthy volunteer controls were studied. In the supine position, FTBF in the right index finger was measured with cw Doppler sonography, whereas FTBF in the left index finger was assessed with LDF. After baseline measurement for at least 5 min, the volunteers received sympathetic stimulation from cold stress applied without notification in the form of an icebag (0 degrees C) upon the left forearm for 1 min. The new cw Doppler sonography method can be used in place of the old LDF method for clinical purposes. FTBF velocity before stimulation (V(pre)) was significantly lower in the IBS group than that in the healthy volunteers (P < 0.01). In addition, the time required for FTBF to return to V(pre) after stimulation was significantly longer in the IBS group than that in the control group. (P = 0.02). Thus, measurement of FTBF with cw Doppler sonography can be useful in the assessment of sympathetic nerve function. The IBS patients showed an abnormal FTBF response suggesting the presence of excess sympathetic activity.