Feasibility of endoscopic retrograde cholangiopancreatography-related procedures in hemodialysis patients

BACKGROUND AND AIM

The opportunities of endoscopic retrograde cholangiopancreatography (ERCP)-related procedure for hemodialysis (HD) patients have been increasing recently. However, the complication rate of ERCPs in HD patients has not been evaluated sufficiently. We aimed to clarify the feasibility of ERCPs in HD patients.

METHODS

We retrospectively reviewed 76 consecutive ERCPs for HD patients between January 2005 and December 2012 in one university hospital and three tertiary-care referral centers. Endoscopic sphincterotomy (EST) was performed in 21 HD patients. We evaluated the incidence and risk factors for complications of all ERCPs and EST in HD patients.

RESULTS

The incidence of pancreatitis, cholangitis, and cardiopulmonary complications for ERCPs in HD patients was 7.9% (6/76), 1.3% (1/76), and 1.3% (1/76), respectively. The mortality rate was 2.6% (2/76), and it occurred after acute pancreatitis in one patient and pneumonia in the other patient. The incidence of hemorrhage and pancreatitis with EST was 19% (4/21) and 4.8% (1/21), respectively. The duration of HD was significantly longer in the patients with hemorrhage after EST than without (19.5 vs 6 years; P = 0.029).

CONCLUSIONS

ERCP is feasible in HD patients. However, EST is not advisable because of the high hemorrhage rate, particularly for patients with a long duration of HD.

Comparison of form in potential functions while maintaining upright posture during exposure to stereoscopic video clips

Visually induced motion sickness (VIMS) is caused by sensory conflict, the disagreement between vergence and visual accommodation while observing stereoscopic images. VIMS can be measured by psychological and physiological methods. We propose a mathematical methodology to measure the effect of three-dimensional (3D) images on the equilibrium function. In this study, body sway in the resting state is compared with that during exposure to 3D video clips on a liquid crystal display (LCD) and on a head mounted display (HMD). In addition, the Simulator Sickness Questionnaire (SSQ) was completed immediately afterward. Based on the statistical analysis of the SSQ subscores and each index for stabilograms, we succeeded in determining the quantity of the VIMS during exposure to the stereoscopic images. Moreover, we discuss the metamorphism in the potential functions to control the standing posture during the exposure to stereoscopic video clips.

Study on improvement of signal detectability considering noise characteristics in medical X-ray images

The purpose of this study is to develop method for improvement of low-contrast signal detectability of general X-ray images used for observing overviews, included noise reduction technique and signal amplification technique, that are difficult to detect in the observing overview. The proposal method consists signal amplification part and noise reduction part. The noise reduction part first identifies and mathematizes the characteristics of the noise attributed to the X-ray imaging system before the subject is imaged. The noise information derived from mathematization is used to remove the noise representing the system noise from the subject image. After noise reduction, all the signals on the subject image with sufficiently reduced noise are amplified by multiplication with an arbitrary coefficient. The feasibility of the proposed method was indicated by three evaluations that were performed vision assessment using the image including the virtual low-contrast signals by four radiological technologists. That of the proposed method was confirmed from results of the evaluations. That of the proposed method was confirmed from results of the evaluations.

Accommodation training in foreign workers

By relaxing the contracted focus-adjustment muscles around the eyeball, known as the ciliary and extraocular muscles, the degree of pseudomyopia can be reduced. This understanding has led to accommodation training in which a visual target is presented in stereoscopic video clips. However, it has been pointed out that motion sickness can be induced by viewing stereoscopic video clips. In Measurement 1 of the present study, we verified whether the new 3D technology reduced the severity of motion sickness in accordance with stabilometry. We then evaluated the short-term effects of accommodation training using new stereoscopic video clips on foreign workers (11 females) suffering from eye fatigue in Measurement 2. The foreign workers were trained for three days. As a result, visual acuity was statistically improved by continuous accommodation training, which will help promote ciliary muscle stretching.

Response of parathyroid hormone to exercise and bone mineral density in adolescent female athletes

BACKGROUND

This study investigates 1) the effects of amount of exercise on levels of serum parathyroid hormone (PTH) and calcium, and 2) the relationship between PTH response and bone mineral density in adolescent female athletes.

SUBJECTS

Twenty-one female athletes on a top-ranked high school basketball team in Japan participated in a one-month intensive basketball program. Subjects were divided into moderate-exercise and strenuous-exercise groups.

METHODS

The amount of exercise was quantified using estimated metabolic equivalent (METs) and exercise hours. Levels of serum intact-PTH and calcium were examined five times: twice before training to establish a baseline (T(-1) and T(0)), once 3rd week of the training period (T(1), once immediately at the end of the program (T(2)), and again one week later(3)). Bone mineral density of forearm (distal-BMD) was measured one week after the end of the program. PTH levels at T(1), T(2) and(3) were regressed on PTH at baseline (T(0)) for both groups and examined for statistical significance. Multiple regression analyses of the changes of PTH and distal-BMD were conducted.

RESULTS

1) Strenuous-exercise subjects showed both increased and decreased PTH levels, while moderate-exercise subjects showed a uniform decrease in PTH throughout the exercise period. 2) Increased PTH was an independent negative predictor of distal-BMD, while high lean body mass, increased serum Ca, and exercise volume were positive predictors.

CONCLUSION

The amount of exercise affects PTH response: moderate exercise suppresses PTH secretion, while strenuous exercise is apt to induce continuous secretion, which has a negative effect on BMD.

The efficacy of transcatheter arterial embolization as the first-choice treatment after failure of endoscopic hemostasis and endoscopic treatment resistance factors

AIM

The aim of this retrospective study was to evaluate the efficacy of transcatheter arterial embolization (TAE) as the first-choice treatment in patients with bleeding peptic ulcer after the failure of endoscopic hemostasis. An additional objective was to clarify endoscopic treatment resistance factors.

METHODS

Between April 2004 and December 2010, 554 patients were admitted to Kasugai Municipal Hospital for necessary endoscopic hemostasis for bleeding gastric ulcer or duodenal ulcer. In the patients for whom endoscopic hemostasis failed, TAE was attempted. If TAE failed, the patients underwent surgery. The backgrounds of the patients in whom endoscopic treatment was successful and in whom it failed were compared.

RESULTS

TAE was attempted in 15 patients (2.7%). In 12 (80.0%) of 15 patients, embolization with coils was successful. In one patient (6.7%), embolization was ineffective. This patient underwent emergent salvage surgery. In two (13.3%) of 15 patients, no extravasation was observed during arteriography. These patients were cured with medication. In two patients, ulcer perforation was observed during endoscopy after rebleeding. These patients underwent surgery. In total, 3 (0.5%) of 554 patients underwent surgery. No recurrent bleeding was observed after TAE. Hemoglobin level <8 g/dL at presentation (P = 0.02), Rockall score ≥7 at presentation (P = 0.002), and Forrest class Ia/Ib at initial endoscopic hemostasis (P < 0.001) were found to be independent significant endoscopic treatment resistance factors.

CONCLUSIONS

TAE is a safe and effective first-choice treatment for patients in whom endoscopic hemostasis has failed.

The effect of adaptive iterative dose reduction on image quality in 320-detector row CT coronary angiography

OBJECTIVE

To evaluate the effect of adaptive iterative dose reduction (AIDR) on image noise and image quality as compared with standard filtered back projection (FBP) in 320-detector row CT coronary angiography (CTCA).

METHODS

50 patients (14 females, mean age 68 ± 9 years) who underwent CTCA (100 kV or 120 kV, 400-580 mA) within a single heartbeat were enrolled. Studies were reconstructed with FBP and subsequently AIDR. Image noise, vessel contrast and contrast-to-noise ratio (CNR) in the coronary arteries were evaluated. Overall image quality for coronary arteries was assessed using a five-point scale (1, non-diagnostic; 5, excellent).

RESULTS

All the examinations were performed in a single heartbeat. Image noise in the aorta was significantly lower in data sets reconstructed with AIDR than in those reconstructed with FBP (21.4 ± 3.1 HU vs 36.9 ± 4.5 HU; p<0.001). No significant differences were observed between FBP and AIDR for the mean vessel contrast (HU) in the proximal coronary arteries. Consequently, CNRs in the proximal coronary arteries were higher in the AIDR group than in the FBP group (p<0.001). The mean image quality score was improved by AIDR (3.75 ± 0.38 vs 4.24 ± 0.38; p<0.001).

CONCLUSION

The use of AIDR reduces image noise and improves image quality in 320-detector row CTCA.

Non-linear analysis of stabilograms with alcoholic intake

Equilibrium function in the cerebellum (vestibulo-cerebellar system) can deteriorate under the influence of alcohol. In the Romberg posture, the center of gravity, which was measured every 50 ms by stabilometry, appeared to shift with alcohol ingestion. In the previous study, a locus in the center of gravity (stabilogram) was converted to values of statistical indices such as area of sway, total locus length, and locus length per unit area, although these indices could not always distinguish between the statokinesigrams sampled from seven healthy young males in sober and intoxicated states. This measurement was made with an AMTI force plate. In this study, "translation error" was estimated in a d-dimensional embedding space in order to compare statokinesigrams recorded before and after the ingestion of doubly diluted brandy in 30 s (1 ≤ d ≤ 10). We succeeded in validating a stochastic differential equation as a mathematical model of the body sway. The randomness in the model was preserved after alcohol intake and significantly increased in the medial/lateral direction. Visual information referred by the postural control system when standing might be interfered by the effects of intoxication, which was regarded as disturbance. This method is considered to be useful to diagnose the disorders of the vestibulocerebellar system.

Mastication Suppresses Initial Gastric Emptying by Modulating Gastric Activity

Because various mastication-related factors influence gastric activity, the functional relationship between mastication and gastric function has not been fully elucidated. To investigate the influence of mastication on gastric emptying and motility, we conducted a randomized trial to compare the effects of mastication on gastric emptying and gastric myoelectrical activity under conditions that excluded the influences of food comminution, taste, and olfaction. A 13C-acetate breath test with electrogastrography and electrocardiography was performed in 14 healthy men who ingested a test meal with or without chewing gum. Autonomic nerve activity was evaluated by fluctuation analysis of heart rate. Gastric emptying was significantly delayed in the ‘ingestion with mastication’ group. Gastric myoelectrical activity was significantly suppressed during mastication and increased gradually in the post-mastication phase. A decrease in the high-frequency power of heart rate variability was observed coincidentally with gastric myoelectrical activity suppression. These findings suggest that initial gastric emptying is suppressed by mastication, and that the suppression is caused by mastication-induced inhibition of gastric activity (UMIN Clinical Trial Registration no. UMIN000005351).

Recurrent atrial fibrillation after high-dose methylprednisolone therapy in a girl with lupus-associated hemophagocytic syndrome

Hemophagocytic syndrome (HPS) is a serious complication of systemic lupus erythematosus (SLE). A 15-year-old female with lupus-nephritis developed HPS. Bone marrow study showed florid thrombophagocytosis. There was no associated infection. High-dose methylprednisolone therapy ameliorated HPS. However, atrial fibrillation (Af) repeated after the infusion and required direct-current cardioversion. No underlying diseases were found in the heart and endocrine system. Chest roentgenogram and echocardiography were normal. Electrocardiogram showed slightly prolonged PR interval in sinus rhythm. Af occurred at high circulating levels of interferon-γ and interleukin (IL)-10, but not IL-6, IL-2, tumor necrosis factor-α, C-reactive protein or catecholamines. This is the first observation that high-dose corticosteroid induced Af in a case of lupus-HPS. Af is unusual in SLE children without cardiac disease, while conduction defect occurs associated with lupus-myocarditis. Lupus-HPS may be an aggressive SLE subset with cardiac involvement. High-dose corticosteroid infusion controls lupus activity, but could disclose the cardiac stress in lupus-HPS patients.

[Analysis of electrogastrography in gastrectomized subjects]

OBJECTIVES

To establish a method for the development of a mathematical model of autonomic activity in gastrointestinal movements and to basically evaluate of the application of the nonlinear analysis method to electrogastrography, we performed feature extraction of electrogastrographic changes in healthy elderly and gastrectomized subjects.

METHODS

The subjects consisted of 9 healthy elderly males and 3 elderly males without constipation who had undergone resection of 2/3 of the stomach. Electrogastrograms were obtained in a sitting position for 30 minutes and in a supine position for 90 minutes. Spectrum analyses of electrographic time series, the maximum Lyapunov exponent for the evaluation of the chaos of dynamic systems forming time series, and translation error for the evaluation of the smoothness of the attractor orbit were performed.

RESULTS

The maximum Lyapunov exponent was a positive number in all analysis intervals in all subjects. This suggests the irregularity of electrogastrograms in gastrectomized subjects. The translation error in the gastrectomized subjects was higher than that in the healthy elderly subjects, showing irregularity. However, as a result of spectrum analysis, gastric electric activity was predominant on electrogastrograms of the healthy elderly subjects, but intestinal electric activity was predominant in the gastrectomized subjects.

CONCLUSIONS

Differentiation between healthy and gastrectomized elderly people is difficult using only one of the spectrum analysis methods, the maximum Lyapunov exponent, or the translation error. However, since the extracted features differed among the 3 analysis methods, differentiation and diagnosis may be possible using a combination of these methods.

[Electrogastrography in the elderly and effect of hot stupes on the solar plexus]

OBJECTIVES

Constipation affects as many as 26% of elderly men and 34% of elderly women and is a problem that has been related to a diminished quality of life. The aim of this study was to investigate the influence of aging on electrogastrograms (EGGs). On the basis of the EGGs of elderly individuals, the effect of hot stupe application on the epigastrium was also evaluated.

METHODS

The first group included 14 healthy, young participants (age, 20-25 years) and the second group comprised 14 healthy, elderly participants (age, 65-76 years). EGGs were obtained for the first 30 min in a sitting position and for the next period (> 150 min) in a supine position. A hot stupe was placed on the epigastrium of each elderly patient 90 min after the postural change. We evaluated EGGs by spectral analysis and nonlinear analysis.

RESULTS

On comparing the gastrointestinal electrical activity of the elderly group with that of the young group, the activity in the former revealed an overall decrease. With hot stupe application, translation error in the elderly individuals was significantly larger than that without hot stupe application (p < 0.01). We also observed a gender-specific characteristic, wherein the gastrointestinal motility of the young women was likely only influenced by postural change. Moreover, the translation error in the EGGs of the elderly individuals increased during hot stupe heating.

CONCLUSIONS

This increase in the translation error suggests that the electrical synergy between the stomach and intestine could be enhanced by the application of a hot stupe. Our findings also indicated that hot stupe application on the epigastrium was effective for improving gastrointestinal motility in elderly individuals.

NEMO mutation as a cause of familial occurrence of Behçet's disease in female patients

Behçet's disease is a chronic, relapsing, multisystem inflammatory disease of unknown etiology. Nuclear factor κB (NF-κB) essential modulator (NEMO) that is required for the activation of NF-κB plays an important role in inflammation. To investigate the role of NEMO in the pathogenesis of Behçet's disease, we analyzed NEMO gene and its expression pattern in tissues in a family with Behçet's disease. We found a heterozygous mutation (1217A> T, D406V) in a 6-year-old girl and her mother. Skewed X-chromosome inactivation was not observed in the peripheral blood mononuclear cells as well as in oral and intestinal mucosa of the patients. Accordingly, there was a significant proportion of peripheral blood monocytes that did not produce sufficient intracellular tumor necrosis factor-α with the stimulation of lipopolysaccharide. Heterozygous NEMO mutation is a cause of familial occurrence of Behçet's disease in female patients.

Diffuse pollution by persistent organic pollutants as measured in plastic pellets sampled from various beaches in Greece

Plastic pellets found stranded on beaches are hydrophobic organic materials and thus, they are a favourable medium for persistent organic pollutants to absorb to. In the present study, plastic pellets are used to determine the diffuse pollution of selected Greek beaches. Samples of pellets were taken from these beaches and were analyzed for PCBs, DDTs, HCHs, and PAHs. The observed differences among pellets from various sampling sites are related to the pollution occurring at each site. Plastic pellets collected in Saronikos Gulf beaches demonstrate much higher pollutant loading than the ones collected in a remote island or close to an agricultural area. Based on data collected in this study and the International Pellet Watch program, pollution in Saronikos Gulf, Greece, is comparable to other heavily industrialized places of the world. The present study demonstrates the potential of pellet watch to be utilized as a detailed-scale monitoring tool within a single country.

[Application of electrogastrography to public health]

In general, gastrointestinal motility tests cause pain; therefore, the establishment of noninvasive methods is desired. Noninvasive methods facilitate the measurement of motility close to the normal physiological state, can provide new findings, and may contribute to the development of associated fields. Electrogastrography (EGG) is a gastrointestinal motility test in which gastrointestinal electric activity is measured. Compared with other gastrointestinal motility measurement methods such as the gastric emptying and internal pressure measurement methods, EGG is noninvasive and allows measurement under minimum restriction; therefore, measurement for a long time is also possible. In addition, since gastrointestinal electric activity, which cannot be quantified using other methods, can be measured, EGG is applicable to the evaluation of the state of the body and pathological conditions, and may provide new findings such as those useful for the prevention of gastrointestinal dysfunction associated with various disorders. EGG is also useful for preventing disorders associated with abnormal gastrointestinal activity such as functional dyspepsia, which has been more frequently observed in recent years, and constipation, which is an extremely frequent complaint in the elderly. Thus, EGG is of marked importance in public health. However, the range of EGG utilizations and applications is still limited at present. Therefore, we outlined the measurement/analysis methods, the advantages and problems of EGG and electrogastroenterography (EGEG), described their clinical importance, and also commented on forefront studies on EGG and evaluated its prospects.