Increased numbers of immature plasma cells in peripheral blood specifically overexpress chemokine receptor CXCR3 and CXCR4 in patients with ulcerative colitis

Ulcerative colitis (UC) is a chronic inflammatory bowel disease featuring infiltration by plasma cells producing immunoglobulins. We have reported previously the specific and significant proliferation of immature plasma cells in the inflamed colonic and pouch mucosa of UC patients. The aim of this study was to characterize peripheral blood immature plasma cells and the migration mechanisms of such immature plasma cells to inflamed sites in UC. The characteristics of peripheral blood immature plasma cells and chemokine receptor expression were examined by flow cytometry. Expression of mucosal chemokine was quantified using real-time reverse transcription-polymerase chain reaction and immunohistochemistry. The number of peripheral blood immature plasma cells was significantly higher in patients with active UC and active Crohn's disease (CD) than in healthy controls. The proportion of immature plasma cells was correlated positively with clinical activities of UC and CD. Many peripheral blood immature plasma cells were positive for CXCR3, CXCR4, CCR9 and CCR10. Expression of CXCR3 and CXCR4 in UC patients was significantly higher than in controls. CXCL9, CXCL10 and CXCL11 mRNA levels in colonic mucosa of inflamed IBD were higher than in controls. Immunofluorescence study also showed abundant CXCR3-positive immature plasma cells in the inflamed colonic mucosa of UC. Increased numbers of immature plasma cells may migrate towards inflammatory sites of UC via the CXCR3 axis, and may participate in UC pathogenesis.

Associations between weight change since 20 years of age and sleep-disordered breathing among male truck drivers

BACKGROUND

Limited evidence for association of weight gain with sleep-disordered breathing (SDB) has been produced for Asian populations whose body mass index (BMI) levels are lower than in western countries.

OBJECTIVE

The aim of this study was to examine weight change since 20 years of age and risk of SDB among Japanese.

DESIGN

Retrospective cohort study.

SUBJECTS

This study includes a large sample of 5320 male Japanese truck drivers aged 30-69 years.

MEASUREMENTS

The respiratory disturbance index (RDI) was selected as an indicator of SDB, and it was estimated with a one-night sleep test using an airflow monitor, and the Epworth Sleepiness Scale (ESS) was used to estimate excessive daytime sleepiness.

RESULTS

Respiratory disturbance and sleepiness were more prevalent among men with BMI of 25.0-29.9 and > or =30.0 kg/m(2) than among those with BMI of 18.5-24.9; multivariable odds ratios (ORs) were 1.8(1.5-2.0), P<0.001 and 4.4(3.5-5.5), P<0.001 for RDI > or =10, and 1.2(0.9-1.4), P=0.18 and 1.5(1.1-2.1), P=0.02 for ESS > or =11, respectively. Compared with men showing BMI changes within +/-1.0, the respective multivariable ORs for those with BMI changes of 3.0-4.9 and > or =5.0 were 1.4(1.2-1.6), P<0.001 and 2.4(2.0-2.9), P<0.001 for RDI > or =10, and 1.2(0.9-1.6), P=0.22 and 2.0(1.5-2.6), P<0.001 for ESS > or =11. The corresponding ORs for weight gain of > or =10.0 kg compared with weight change less than +/-5.0 kg were 2.0(1.7-2.4), P<0.001 for RDI > or =10 and 1.5(1.2-2.0), P=0.002 for ESS > or =11. Similar trends were observed for RDI > or =20.

CONCLUSION

Our results suggest that an increase in BMI of > or =5 kg/m(2) or weight gain of > or =10 kg is a risk factor for SDB and excessive daytime sleepiness among Japanese truck drivers.

Nocturnal intermittent hypoxia and the development of type 2 diabetes: the Circulatory Risk in Communities Study (CIRCS)

AIMS/HYPOTHESIS

Although the associations between obstructive sleep apnoea and type 2 diabetes mellitus have been reported in cross-sectional design studies, findings on the prospective association between the two conditions are limited. We examined prospectively the association between nocturnal intermittent hypoxia as a surrogate marker of obstructive sleep apnoea and risk of type 2 diabetes.

METHODS

A total of 4,398 community residents aged 40 to 69 years who had participated in sleep investigation studies between 2001 and 2005 were enrolled. Nocturnal intermittent hypoxia was assessed by pulse-oximetry and defined by the number of oxygen desaturation measurements < or =3% per h, with five to <15 per h corresponding to mild and 15 events or more per h corresponding to moderate-to-severe nocturnal intermittent hypoxia, respectively. The development of type 2 diabetes was defined by: (1) fasting serum glucose > or =7.00 mmol/l (126 mg/dl); (2) non-fasting serum glucose > or =11.1 mmol/l (200 mg/dl); and/or (3) initiation of glucose-lowering medication or insulin therapy. Multivariable model accounted for age, sex, BMI, smoking status, current alcohol intake, community, borderline type 2 diabetes, habitual snoring, excessive daytime sleepiness, sleep duration and (for women) menopausal status.

RESULTS

By the end of 2007, 92.2% of participants had been followed up (median follow-up duration [interquartile range] 3.0 [2.9-4.0] years) and 210 persons identified as having developed diabetes. The multivariable-adjusted hazard ratio (95% CI) for developing type 2 diabetes was 1.26 (0.91-1.76) among those with mild nocturnal intermittent hypoxia and 1.69 (1.04-2.76) among those with moderate-to-severe nocturnal intermittent hypoxia (p = 0.03 for trend).

CONCLUSIONS/INTERPRETATION

Nocturnal intermittent hypoxia was associated with increased risk of developing type 2 diabetes among middle-aged Japanese.

Cross-cultural comparison of the sleep-disordered breathing prevalence among Americans and Japanese

The aim of the present study was to compare the prevalence of sleep-disordered breathing among Hispanic and white Americans and Japanese. A 1-night sleep study using a single-channel airflow monitor was performed on 211 Hispanics and 246 Whites from the Minnesota field centre (St Paul, MN, USA) of the Multi-Ethnic Study of Atherosclerosis (MESA), and 978 Japanese from three community-based cohorts of the Circulatory Risk in Communities Study (CIRCS) in Japan. The respiratory disturbance index and sleep-disordered breathing, defined as a respiratory disturbance index of > or =15 events x h(-1), were estimated. The prevalence of sleep-disordered breathing was higher in males (34.2%) than females (14.7%), and among Hispanics (36.5%) and Whites (33.3%) than among Japanese (18.4%), corresponding to differences in body mass index. Within body mass index strata, the race difference in sleep-disordered breathing was attenuated. This was also true when body mass index was adjusted for instead of stratification. The strong association between body mass index and sleep-disordered breathing was similar in Japanese and Americans. The prevalence of sleep-disordered breathing was lower among Japanese than among Americans. However, the association of body mass index with sleep-disordered breathing was strong, and similar among the race/ethnic groups studied. The majority of the race/ethnic difference in sleep-disordered breathing prevalence was explained by a difference in body mass index distribution.

Long-term efficacy of Helicobacter pylori eradication in patients with idiopathic thrombocytopenic purpura: 7-year follow-up prospective study

Helicobacter pylori eradication is useful for improvement of a half of patients with idiopathic thrombocytopenic purpura (ITP), but its long-term therapeutic efficacy has not been elucidated. We investigated the long-term efficacy of H. pylori eradication in 30 cases with ITP that were included in our previous study regarding the association between H. pylori infection and ITP. Twenty-one cases were positive and nine cases were negative for H. pylori infection. H. pylori eradication therapy including secondary regimen was successful in 20 cases, half (responder) of whom showed ITP remission 1 month later. Nine responders could be followed up for a long time and did not show re-infection of H. pylori. Eight of nine needed no medication except for eradication therapy. Another case remained in remission for 1 year but thereafter needed a steroid therapy due to the recurrence. Eight nonresponders could be followed up for a long time. All these cases showed a bad clinical course even though they received the other post-treatments including steroid therapy. Three of nine H. pylori-negative cases underwent eradication therapy after obtaining the written informed consent, but none of them showed improvement. Of these three cases, two cases could be followed up. Only one case remained a remission although receiving corticosteroid as a post-treatment. Conditions of H. pylori-negative ITP cases were usually unstable for a long time. H. pylori eradication has a short-term efficacy for about half of H. pylori-positive ITP patients, and the responders to the eradication therapy may receive a long-term clinical benefit without other therapies.

Angularly-dispersed optical parametric amplification of optical pulses with one-octave bandwidth toward monocycle regime

We demonstrated experimentally the generation of 65-microJ, 5.8-fs optical pulses with an ultrabroad bandwidth (540-1000 nm) by the use of a double-pass angularly-dispersed non-collinear optical parametric amplifier. We also confirmed up to the 95-microJ output from the amplifier when seed pulses were not pre-compensated for. Furthermore, we confirmed that the broadband pump pulses brought in the broader gain bandwidth (from 520 to 1080 nm) than numerical estimation based on CW-pump approximation. To the best of our knowledge, this is the system with the broadest gain bandwidth.

Validation of a single-channel airflow monitor for screening of sleep-disordered breathing

A simple screening method for sleep-disordered breathing (SDB) is desirable for primary care practices. In the present study, a simple monitor, which utilises a new type of flow sensor and a novel algorithm, was prospectively validated. Home recording for 2 nights with the monitor only, followed by in-laboratory recording with the monitor together with polysomnography, were carried out in consecutive patients (n = 100) suspected of SDB. A subjective sleep log was also recorded. The signal was analysed using power spectral analysis, which yielded the flow respiratory disturbance index (flow-RDI). There was no recording failure at home. The reproducibility of the flow-RDI between the 2 nights at home was high (intraclass correlation coefficient = 0.92). The sensitivity and specificity of the in-laboratory flow-RDI to diagnose SDB were 0.96 and 0.82, 0.91 and 0.82, and 0.89 and 0.96, for apnoea/hypopnoea index (AHI) > or =5, > or =15 and > or =30 events x h(-1), respectively. The diagnostic ability in low-severity subgroups (female, normal weight, AHI <15 events x h(-1)) was almost comparable to that in the entire group. Excluding subjective waking time on the sleep log from the recording time had no significant effect on the flow-RDI. The single-channel monitor is considered feasible for ambulatory sleep disordered breathing monitoring because of its easy applicability, high reproducibility and relatively high agreement with polysomnography results.

A novel rat model to determine interaction between reflux oesophagitis and bronchial asthma

BACKGROUND

Several studies have shown a strong association between reflux oesophagitis (RO) and bronchial asthma (BA). The precise mechanisms of interaction between RO and BA are uncertain, possibly due to lack of animal models.

AIMS

We established a novel rat model and examined pathogenic interaction of RO and BA.

METHODS

RO and BA were induced in Brown-Norway rats by ligating the transitional region between the forestomach and the glandular portion and wrapping the duodenum near the pylorus, and by ovalbumin (OVA) sensitisation and challenge with OVA aerosol. Rats were divided into four groups: control, RO, BA, and RO+BA. OVA-induced airway inflammation was assessed by the number of infiltrating cells and cytokine levels in bronchoalveolar lavage fluid (BALF). Oesophageal lesion index, histology and expression of cytokine mRNA, as determined by real-time RT-PCR, were also examined.

RESULTS

Significant increases in the number of cells, especially eosinophils, and IL13 but not IFN-gamma concentration in BALF were observed in the RO+BA group compared with the BA group. These enhancements of OVA-induced airway inflammation were prevented by treatment with rabeprazole. Although the oesophagitis lesion index in the RO+BA group did not differ from that in the RO group, eosinophilic infiltration in the oesophageal submucosa and levels of mRNA expression of cytokines such as IL5, IL10, IL13, and RANTES were significantly increased.

CONCLUSION

We established a novel rat model of RO and BA, and found significant interactions of the two diseases. This model thus appears to be useful for examining the association between gastro-oesophageal reflux disease and bronchial asthma.

Non-steroidal anti-inflammatory drug-induced small intestinal damage is Toll-like receptor 4 dependent

BACKGROUND

Enterobacteria and cytokines both play roles in the pathophysiology of NSAID-induced enteropathy. Toll-like receptor (TLR) 4 recognises lipopolysaccharide (LPS), resulting in activation of an inflammatory cascade via the accessory protein MyD88.

AIMS

To investigate role of TLR4 in inflammatory responses in indomethacin-induced enteropathy.

METHODS

Indomethacin was administered p.o. to non-fasting rats and mice to induce small intestinal damage. The extent of such damage was evaluated by measuring the injured area stained dark blue with Evans blue. Rats were given antibiotics (ampicillin, aztreonam or vancomycin) p.o., or intraperitoneal LPS (a TLR4 ligand) or neutralising antibodies against neutrophils, tumour necrosis factor (TNF)-alpha, or monocyte chemotactic protein (MCP)-1. Furthermore, the intestinal ulcerogenicity of indomethacin was examined in TLR4-mutant, TLR4(-/-), and MyD88(-/-) mice.

RESULTS

Indomethacin induced small intestinal damage with an increase in expression of TNF-alpha and MCP-1 in both rats and mice. Antibodies against neutrophils, TNF-alpha and MCP-1 inhibited the damage by 83%, 67% and 63%, respectively, in rats. Ampicillin and aztreonam also inhibited this damage, and decreased the number of Gram-negative bacteria in the small intestinal contents of the rat. However, vancomycin, which exhibited no activity against Gram-negative bacteria, had no preventive effect against this damage. Administration of LPS 1 h after indomethacin aggravated the damage, whereas LPS pretreatment inhibited it with reduction of expression of TLR4 and cytokines. In TLR4-mutant mice, the damage and cytokine expression were markedly inhibited. TLR4(-/-) and MyD88(-/-) mice were also resistant to the damage.

CONCLUSIONS

Indomethacin may injure the small intestine through a TLR4/MyD88-dependent pathway.

Interleukin-10 gene transfer to peritoneal mesothelial cells suppresses peritoneal dissemination of gastric cancer cells due to a persistently high concentration in the peritoneal cavity

Interleukin (IL)-10 has potent biological properties including an inhibitory action on the proliferation and metastasis of various cancer cells. However, it is difficult to maintain a high concentration of this cytokine as it has a short half life. In this study, we evaluated whether peritoneal mesothelial cells (PMCs) could be suitable for maintaining a high concentration of IL-10 using adenoviral gene transfer. We also evaluated the therapeutic effects of an intraperitoneal injection with adenoviral vector containing mouse IL-10 gene (Ad-mIL-10) using a mouse peritoneal dissemination model of MKN45 gastric cancer cells. We demonstrated that in vitro transfection efficiency of a recombinant adenovirus containing the bacterial beta-galactosidase gene (Ad-LacZ) was approximately 10-fold higher for primarily isolated PMCs than MKN45. The entire peritoneum was transfected until 3 weeks after an intraperitoneal Ad-LacZ injection. Ad-mIL-10 treatment increased intraperitoneal IL-10 levels until 3 weeks after treatment, and then significantly inhibited peritoneal cancer growth by inhibiting angiogenesis. This treatment also improved cachexia and prolonged mice survival. We thus concluded that IL-10 gene transfer in PMCs could be a new strategy for the prevention of peritoneal dissemination of gastric cancer due to the resulting persistently high IL-10 concentration in the peritoneal cavity.

Comparison of gastrointestinal symptoms and psychological factors of functional dyspepsia to peptic ulcer or panic disorder patients

Symptoms of functional dyspepsia (FD) may look like those of peptic ulcers or panic disorders. But, there is no comparative data between the symptoms of peptic ulcers or panic disorders.

METHODS

To evaluate general symptoms, we used the previously validated questionnaires: 1. the Gastrointestinal Symptom Rating Scale (GSRS), 2. the Self-Rating Depression Scale (SDS), 3. the State-Trait Anxiety Inventory (STAI), and 4. the Coping Inventory for Stressful Situations (CISS). Ninety-six patients with FD (ulcer-like, dysmotility-like, and nonspecific: 28.1 %, 41.7 %, and 30.2 %) diagnosed according to the Rome II criteria, 24 peptic ulcer patients, 21 panic disorders, and 50 healthy controls were enrolled in this study.

RESULTS

Total GSRS score of FD was higher than controls (12.8 +/- 1.2 vs. 5.9 +/- 0.7), and similar to peptic ulcers. Ratio over than a cut-off SDS score of FD was higher than controls (28 % vs. 11 %), although it was lower than panic disorders (65 %). Ratios over than cut-off scores of state- and trait-anxiety of FD were higher than controls (74 % and 62 % vs. 50 % and 36 %) and tended to be higher than peptic ulcers. Positive ratio of state-anxiety scores of FD was similar to panic disorders. As these scores increased, morbidity rate of FD (FD/FD+control) increased (P for trend <0.01). Among CISS scores, task-oriented coping scores of FD tended to be low compared to controls, but emotion-oriented coping scores of FD and controls were significantly lower than panic disorders.

CONCLUSION

Severity of gastrointestinal symptoms but not anxiety of FD was similar to peptic ulcers. Psychological scales of FD were also similar to panic disorders except for the emotion-oriented coping. These findings suggested that the complicated pathogenesis of FD was similar to but not completely consistent with peptic ulcers or panic disorders.

Effect of mechanical processing of corn silage on in vitro ruminal fermentation, and in situ bacterial colonization and dry matter degradation

Rumen fermentation and bacterial colonization of mechanically processed corn silage were evaluated in a series of in vitro and in situ experiments using ruminally cannulated cows. Data from rumen-simulated continuous culture (Rusitec) showed that total VFA concentration was increased (P < 0.001) by feeding processed corn silage, while pH was reduced (P < 0.001) and ammonia nitrogen remained unchanged (P > 0.05). Mechanical processing enhanced the in situ rate and extent of dry matter disappearance for corn stems and kernels, respectively (P < 0.05). It also enhanced in situ, the initial attachment of rumen bacteria responsible for corn digestion, as monitored by real-time PCR. The16S rDNA copy numbers of amylolytic and lipolytic bacteria, such as Succinivibrio dextrinosolvens, Ruminobacter amylophilus and Anaerovibrio lipolytica, attached to corn kernels were increased for processed corn silage (P < 0.05), in particular at 2 h after the start of incubation. In addition, corn stemattached cellulolytic and hemicellulolytic bacteria, such as Fibrobacter succinogenes, ruminococci and Eubacterium ruminantium, increased in 16S rDNA copy numbers for processed corn silage (P < 0.05). This was observed for the initial incubation period from 10 min to 2 h. These results demonstrate more rapid attachment and heavier colonization of rumen bacteria to the processed compared with the unprocessed silage, which facilitates ruminal digestion and fermentation. Key words: Corn silage, mechanical processing, rumen fermentation, bacteria, attachment

Are gastroprotective drugs useful for gastric ulcer healing: re-evaluation using current ICH E9 guidelines

Most of the gastroprotective drugs which had been marketed in Japan were considered to have insufficient rationale for use as ulcer treatments. Such drugs may have a crucial role in maintaining mucosal integrity by the mechanisms other than inhibition of acid secretion. We re-evaluated the effect of gastroprotective drugs on gastric ulcer healing using current ICH E9 guidelines. We collected reports of pivotal trials on healing rate of gastric ulcer with 9 kinds of gastroprotective drugs submitted in New Drug Applications. In the comparative trial of cetraxate vs. placebo, the healing rate of gastric ulcer at 8-week endoscopy in the cetraxate was significantly higher than that in the placebo groups (88.6% and 62.2%, p = 0.0062). Non-inferiority to cetraxate was confirmed for 8 kinds of gastroprotective drugs. In conclusion, the superiority of cetraxate over placebo and non-inferiority to cetraxate for 7 drugs was established in the respect of effect on ulcer healing.

Automatic detection of sleep-disordered breathing from a single-channel airflow record

Single-channel airflow monitors developed for screening of sleep-disordered breathing (SDB) have conflicting results for accuracy. It was hypothesised that the analytical algorithm is crucial for the performance and the present authors tried to develop a novel computer algorithm. A total of 399 polysomnography (PSG) records were employed, including a thermal sensor signal. The first 100 records were used in the development of the algorithm and the remainder for validation. In addition, 119 PSG records, including a thermocouple signal and a nasal pressure signal, were used for the validation. The algorithm was designed to obtain a time series (flow-power) using power spectral analysis, which expresses fluctuation in the airflow signal amplitude. From the time series the algorithm detects transient falls of the flow-power and calculates flow-respiratory disturbance index (RDI), defined as the number of falls per hour. In the validation group, the areas under receiver operating characteristic curves for diagnosis of SDB (apnoea/hypopnoea index > or =5) were 0.96, 0.95 and 0.95, for the records of the thermal sensor, thermocouple and nasal pressure system, respectively. The diagnostic sensitivity/specificity ratios of the flow-RDI were 96/76, 88/80 and 97%/77%, respectively. The present results suggest that a single-channel airflow monitor can be used to detect sleep-disordered breathing automatically if the analytic algorithm is optimised.

G-protein beta-3 subunit C825T polymorphism, sodium and arterial blood pressure: a community-based study of Japanese men and women

Epidemiological evidence on gene-environment effects of the G-protein beta-3 subunit C825T polymorphisms and sodium on blood pressure in the free-living general population is limited. We examined the associations between the C825T polymorphism and blood pressure levels, stratified by the sodium variables estimated by 24-h urinary sodium excretion and a dietary questionnaire, among 1,471 men and women aged 30-74 from a community in Japan. Our a priori hypothesis was that individuals with the 825T allele have elevated blood pressure among subjects with a high sodium intake. Among the whole group, the systolic blood pressure level was +2.2 mmHg (p = 0.10) higher in TT than CC genotype individuals after adjustment for sex, age, antihypertensive medication use, body mass index, and alcohol consumption. This difference was more evident among individuals with low sodium excretion (+4.5 mmHg, p = 0.01), low present sodium intake (+3.2 mmHg, p = 0.11), and low past sodium intake (+4.8 mmHg, p = 0.02). No associations were observed among those with high sodium variables. Our results indicate that the G-protein beta-3 subunit C825T polymorphism is associated with higher systolic blood pressure levels in a large free-living Japanese population, and more specifically in women with a low sodium intake. This finding helps to explain part of the discrepancy between the previously reported genetic association among different ethnic groups.

Naïve (CD4+CD45RA+) T cell subpopulation is susceptible to various types of hazardous substances in the workplace

To find the most susceptible lymphocyte subpopulation with exposure to various occupational hazardous substances, we reanalyzed our previous data. We measured T, B and natural killer NK cell subpopulations by means of flowcytometry among workers who were exposed to aromatic amines, chromate, mercury lead and organic-solvents. The exposed/non-exposed ratio was defined as the mean value of the absolute number of lymphocyte subpopulations in the exposed workers divided by the corresponding value of the non-exposed control group in 5 studies reported previously by us. The ratio of CD4+CD45RA+ T cells in all the exposed groups examined in this study was less than 1.0, and the mean of these ratio was 0.77, which was the lowest among lymphocyte subpopulations examined. The mean ratio was 1.06 for CD4+CD29+ T cells, 0.91 for CD4+ T cells, 0.99 for CD8+ T cells, 0.93 for CD3+ T cells, 0.99 for CD19+B cells, 0.96 for CD57-CD16+ NK cells, 0.82 for CD57+CD16+ NK cells, 1.25 for CD57+CD16- NK cells and 0.89 for total lymphocytes. With regard to the difference between exposed and non-exposed workers the estimated overall difference in the mean absolute number of CD4+CD45RA+ T cell subpopulation between exposed and non-exposed workers among five studies was -135 ((% confidence interval, CI: (-194,-75)) cells/mm3 (p<0.01). In conclusion, naïve (CD4+CD45RA+) T cell subpopulation was the most susceptible to the effects of various toxic substances as compared with other lymphocyte subpopulations. This lympohocyte subpopulation may be useful for monitoring immune system of workers exposed to various types of substances in the workplace.

TGF-beta signaling pathway: its role in gastrointestinal pathophysiology and modulation of ulcer healing

Gastrointestinal ulcer healing is a complex process, involving cell migration, proliferation, angiogenesis and extracellular matrix deposition, all ultimately leading to reconstruction of tissue architecture within the ulcer scar. These processes are controlled by growth factors, cytokines and hormones. Transforming growth factor-beta (TGF-beta), one of the multifunctional peptide growth factors, has been reported to positively regulate gastrointestinal ulcer healing. Although TGF-beta inhibits cell proliferation in a variety of cells, it induces cell migration, angiogenesis, and enhances extracellular matrix production necessary for gastrointestinal ulcer healing. TGF-beta exerts its action by binding to its transmembrane serine/threonine kinase receptors, which in turn triggers activation of various intracellular signaling pathways. Smads are intermediate effector proteins that play key roles in biological activities of TGF-beta by transmitting the signals from the cell surface directly into the nucleus and initiating transcription. New insight into the mechanisms underlying TGF-beta-Smad modulation of gastrointestinal ulcer healing will likely enhance our understanding of the mechanisms controlling the healing processes of gastrointestinal ulcers.

Type 2 diabetes and risk of non-embolic ischaemic stroke in Japanese men and women

AIMS/HYPOTHESIS

The aim of this study was to examine the relationship between type 2 diabetes and risk of ischaemic stroke in Asian populations.

METHODS

We conducted a 17-year prospective cohort study in 10,582 Japanese individuals (4287 men and 6295 women) aged 40-69 years living in five communities in Japan. All subjects were free of stroke and CHD at baseline. Diabetes was defined as a fasting glucose level of >/=7.0 mmol/l, a non-fasting glucose of >/=11.1 mmol/l, or receiving medication for diabetes.

RESULTS

The risk of non-embolic ischaemic stroke was approximately two-fold higher in diabetic subjects than in subjects with normal glucose levels. The multivariate relative risk after adjustment for age, community, hypertensive status, BMI, triceps and subscapular skinfold thickness (TSF and SSF), and other known cardiovascular risk factors was 1.8 (95% CI 1.0-3.2) for men and 2.2 (1.2-4.0) for women. This excess risk was primarily observed among non-hypertensive subjects and individuals with higher values for measures of adiposity (BMI, TSF and SSF values above the median), particularly those with higher values for SSF. The association between non-embolic ischaemic stroke and glucose abnormality was particularly strong among non-hypertensive subjects with higher SSF values: the multivariate relative risk was 1.9 (1.0-3.7) for borderline diabetes and 4.9 (2.5-9.5) for diabetes.

CONCLUSIONS/INTERPRETATION

In this cohort, type 2 diabetes was a significant risk factor for non-embolic ischaemic stroke, particularly in non-hypertensive and non-lean individuals. Due to the nationwide decrease in blood pressure and increase in mean BMI among the Japanese population, with current levels approaching those observed in Western countries, the impact of glucose abnormalities on risk of ischaemic stroke represents a forthcoming public health issue in Japan.

Indomethacin, but not Helicobacter pylori, inhibits adaptive relaxation in isolated guinea-pig stomach

Nonsteroidal anti-inflammatory drugs (NSAIDs) and Helicobacter pylori (H. pylori) are major factors in gastritis and peptic ulcer However, the role of NSAIDs and H. pylori infection in dyspepsia remains unclear. Gastric adaptive relaxation may be related to the pathogenesis of functional dyspepsia because the response is often disturbed in dyspeptic patients. In this study, we investigated the effects of indomethacin or H. pylori water extracts on gastric adaptive relaxation. This experiment was performed using the modified method of Desai et al. Isolated guinea-pig stomach in an organ bath was monitored for intragastric pressure and volume. Adaptive relaxation was induced by gastric luminal distention. The effects of indomethacin and H. pylori on gastric relaxation were tested in this system. Indomethacin (> 1 x 10(-5) M) significantly inhibited adaptive relaxation. Indomethacin (> 3 x 10(-6) M) induced gastric relaxation in a dose-dependent fashion. However, aspirin at a concentration sufficient for cyclooxygenase (COX)-1 inhibition did not induce gastric relaxation. Preincubation with N-nitro-L-arginine methyl ester, a nitric oxide (NO)-synthase inhibitor, inhibited indomethacin-induced gastric relaxation. Adaptive relaxation was not affected by H. pylori water extracts. In conclusion, indomethacin inhibited adaptive relaxation via prior gastric relaxation. NO production, but not COX-1 inhibition, may be involved in this effect of indomethacin. H. pylori water extracts may not have direct effects on adaptive relaxation. Inhibition of adaptive relaxation may be one of the major mechanisms underlying NSAID-induced dyspepsia.

Comparison of the effects of rebamipide with those of cimetidine on chronic gastritis associated with Helicobacter pylori in Mongolian gerbils

BACKGROUND AND AIMS

The effects of rebamipide on chronic gastritis associated with Helicobacter pylori have not been well-defined. We compared these effects of rebamipide with those of cimetidine in Mongolian gerbils infected with H. pylori.

METHODS

Mongolian gerbils with or without H. pylori were divided into 10 groups 6 weeks after inoculation and fed diets containing a drug (rebamipide or cimetidine) or control diet. All animals were sacrificed 4 weeks after grouping. Their stomachs were examined for histology, colonization by H. pylori, myeloperoxidase activity (myeloperoxidase), production of neutrophil chemokine (CINC/KC) and tumour necrosis factor-alpha (TNF-alpha), and serum gastrin levels.

RESULTS

H. pylori colonized all of the inoculated animals. Neither rebamipide nor cimetidine decreased myeloperoxidase activity, but each reduced wet stomach weight in H. pylori-infected animals. The amount of increase in CINC/KC and TNF-alpha in gastric tissue caused by H. pylori infection was decreased by treatment with rebamipide or cimetidine. H. pylori infection increased serum gastrin levels, and this increase was significantly enhanced by cimetidine but not rebamipide.

CONCLUSIONS

Rebamipide may improve H. pylori-infected chronic gastritis by preventing the production of inflammatory cytokines and chemokines, as does cimetidine, but may be preferable to cimetidine for long-term administration for treatment of H. pylori-infected chronic gastritis due to its effect on serum gastrin levels.

Long-term follow up study of vertical HTLV-I infection in children breast-fed by seropositive mothers

Infection of Human T-lymphotropic virus type-I (HTLV-I) was investigated by long-term follow up surveys of mother's milk-fed infants. HTLV-I infections of infants via seropositive mother's milk, that is, anti-HTLV-I antibody-positive infants, increased in number up to the age 2, but no infants became antibody-positive thereafter. Infants who had became antibody positive by age 2 remained so at age 11-12. HTLV-I infection via feeding with mother's milk was established by the age 2. While in epidemiologic surveys an increase of the anti-HTLV-I antibody-positive rate has been reported, this survey revealed that after acquisition of HTLV-I from breast feeding, there was no further horizontal transmission prior to puberty.