The modified glucose clearance test: a novel non-invasive method for differentiating non-erosive reflux disease and erosive oesophagitis

BACKGROUND

Impaired salivary secretion has been reported to cause abnormal acid clearance from the oesophagus in gastro-oesophageal reflux disease (GERD). However, few studies have explained the differences between non-erosive reflux disease (NERD) and erosive oesophagitis (EO) with respect to salivary secretion. Aim To elucidate these differences, we measured salivary secretion by using the modified glucose clearance test (mGCT).

METHODS

All subjects completed endoscopic examinations, the frequency scale for the symptoms of GERD questionnaire and the mGCT comprising a resting GCT (measured as RGC time) and a chewing-stimulated GCT (SGC time).

RESULTS

Resting glucose clearance time was 18.5 min in control group and significantly longer in NERD and EO groups (28.5 and 39.0 min respectively). SGC time was 6.1 min in control group and 7.2 min in NERD group and significantly longer in EO group (10.2 min) than in the control and NERD groups.

CONCLUSIONS

In the EO group, both resting and stimulated salivary secretions were less than in control group. However, in the NERD group, resting salivary secretion was decreased, but stimulated salivary secretion was similar to that of the control group. Therefore, these results may help in explaining the differences in the pathogenesis of NERD and EO.

Induction of BiP, an ER-resident protein, prevents the neuronal death induced by transient forebrain ischemia in gerbil

Endoplasmic reticulum (ER) stress, which is caused by the accumulation of unfolded proteins in the ER lumen, is associated with stroke and neurodegenerative diseases such as Parkinson's and Alzheimer's diseases. We evaluated the effect of a selective inducer of immunoglobulin heavy chain binding protein (BiP) (BiP inducer X; BIX) against both tunicamycin-induced cell death (in SH-SY5Y cells) and the effects of global transient forebrain ischemia (in gerbils). BIX significantly induced BiP expression both in vitro and in vivo. Pretreatment with BIX at 2 or 5 microM reduced the cell death induced by tunicamycin in SH-SY5Y cells. In gerbils subjected to forebrain ischemia, prior treatment with BIX (intracerebroventricular injection at 10 or 40 microg) protected against cell death and decreased TUNEL-positive cells in the hippocampal CA1 subfield. These findings indicate that this selective inducer of BiP could be used to prevent the neuronal damage both in vitro and in vivo.

A molecular chaperone inducer protects neurons from ER stress

The endoplasmic reticulum (ER) stress response is a defense system for dealing with the accumulation of unfolded proteins in the ER lumen. Recent reports have shown that ER stress is involved in the pathology of some neurodegenerative diseases and cerebral ischemia. In a screen for compounds that induce the ER-mediated chaperone BiP (immunoglobulin heavy-chain binding protein)/GRP78 (78 kDa glucose-regulated protein), we identified BiP inducer X (BIX). BIX preferentially induced BiP with slight inductions of GRP94 (94 kDa glucose-regulated protein), calreticulin, and C/EBP homologous protein. The induction of BiP mRNA by BIX was mediated by activation of ER stress response elements upstream of the BiP gene, through the ATF6 (activating transcription factor 6) pathway. Pretreatment of neuroblastoma cells with BIX reduced cell death induced by ER stress. Intracerebroventricular pretreatment with BIX reduced the area of infarction due to focal cerebral ischemia in mice. In the penumbra of BIX-treated mice, ER stress-induced apoptosis was suppressed, leading to a reduction in the number of apoptotic cells. Considering these results together, it appears that BIX induces BiP to prevent neuronal death by ER stress, suggesting that it may be a potential therapeutic agent for cerebral diseases caused by ER stress.

Detection of venous emboli using Doppler ultrasound

OBJECTIVES

To detect emboli in the venous system using a Doppler ultrasound device with embolism detecting software.

METHODS

Pulmonary embolism (PE) was induced by injecting thrombus through the iliac vein of castrated swine under general anaesthesia. Data recorded from the Doppler system were analysed for high intensity transient signals (HITS) using receiver operating characteristic curves. Four different thrombi (5 or 10mm long and 3 or 5mm in diameter) were then injected to assess the quantitative analysis.

RESULTS

Thrombus could be detected in the venous system by the Doppler ultrasound device with an embolism detecting function. Appropriate confidence level was 60%. If thrombus were assumed to travel at the maximum flow rate (30 cm/s) in the inferior vena cava, the estimated embolism size was 10.4 S.D. 2.8mm for 3mm and 10.8 S.D. 4.9 mm for 5mm, both of which were close to 10mm.

CONCLUSION

Thrombi could be detected as high intensity transient signals in the venous system. The appropriate confidence level was 60%. The size of emboli can be estimated if they are more than 3mm in diameter when the venous flow rate is 30 cm/s or less. Our results suggest that it may be possible to detect emboli in the subclavian vein, axillary vein or inferior vena cava in clinical cases.

Cospeciation in the triplex symbiosis of termite gut protists (Pseudotrichonympha spp.), their hosts, and their bacterial endosymbionts

A number of cophylogenetic relationships between two organisms namely a host and a symbiont or parasite have been studied to date; however, organismal interactions in nature usually involve multiple members. Here, we investigated the cospeciation of a triplex symbiotic system comprising a hierarchy of three organisms -- termites of the family Rhinotermitidae, cellulolytic protists of the genus Pseudotrichonympha in the guts of these termites, and intracellular bacterial symbionts of the protists. The molecular phylogeny was inferred based on two mitochondrial genes for the termites and nuclear small-subunit rRNA genes for the protists and their endosymbionts, and these were compared. Although intestinal microorganisms are generally considered to have looser associations with the host than intracellular symbionts, the Pseudotrichonympha protists showed almost complete codivergence with the host termites, probably due to strict transmissions by proctodeal trophallaxis or coprophagy based on the social behaviour of the termites. Except for one case, the endosymbiotic bacteria of the protists formed a monophyletic lineage in the order Bacteroidales, and the branching pattern was almost identical to those of the protists and the termites. However, some non-codivergent evolutionary events were evident. The members of this triplex symbiotic system appear to have cospeciated during their evolution with minor exceptions; the evolutionary relationships were probably established by termite sociality and the complex microbial community in the gut.

Incidence of Ischemic Complications after Endovascular Treatment for Ruptured Dissecting Vertebral Artery Aneurysms. Comparison between Those Arising Proximal to and Distal to the Origin of the Posterior Inferior Cerebellar Artery

SUMMARY

We analyzed the incidence of ischemic complications after internal trapping for ruptured VA dissecting aneurysms. Between April 2001 and August 2005, nine cases of ruptured VA dissecting aneurysms, five in women, "proximal" or distal (distal type) to the origin of the PICA, were treated by internal trapping in the acute stage after SAH. There were four cases of proximal type and five of distal type. The demographics of the patients were reviewed in the medical charts and radiological findings were evaluated by neuroradiologists. The dissected site was completely obliterated and PICA was preserved in all cases. Follow-up angiography performed five to 19 days after treatment revealed complete obliteration of the aneurysm and patency of the PICA. The incidence of perioprocedural ischemic complications for the PICA-distal type (75%) was higher than that for the PICA-proximal type (20%). Here we retrospectively analyzed and discussed the incidence and mechanisms of ischemic complications.

Involvement of endoplasmic reticulum stress after middle cerebral artery occlusion in mice

The endoplasmic reticulum (ER) plays an important role in ischemic neuronal cell death. ER stress-related markers [immunoglobulin binding protein (BiP)/glucose-regulated protein (GRP) 78, activating transcription factor-4 (ATF-4), and C/EBP-homologous protein (CHOP)] in the striatum and the cortex were investigated after permanent middle cerebral artery occlusion (MCAO) in mice. Using endoplasmic reticulum stress-activated indicator (ERAI) transgenic mice, which show splicing of X-box protein 1 (XBP-1) mRNA as green fluorescence, we monitored the regional changes in fluorescence after MCAO. BiP mRNA (by reverse-transcription polymerase chain reaction [RT-PCR] analysis) was increased in the cortex at 6 h. In immunohistochemical and/or Western blot analysis, the expressions of ER stress-related markers (BiP, ATF-4, and CHOP) were increased in the infarct region, more strongly in the cortex than in the striatum. ERAI fluorescence was observed in the ischemic area starting from 6 and 12 h, respectively, after MCAO, with the peaks at 1 day and the fluorescence co-localized with the 2,3,5-triphenyltetrazolium chloride (TTC)-visible extension of brain infarction. These findings suggest that permanent MCAO induces expression of ER-stress related genes mainly in the periphery of the MCA territory.

Intake of purple sweet potato beverage affects on serum hepatic biomarker levels of healthy adult men with borderline hepatitis

OBJECTIVE

To examine the effect of purple sweet potato (PSP) beverage rich in acylated anthocyanins on serum hepatic biomarkers in healthy Japanese men.

DESIGN

A randomized, double-blind, placebo-controlled, parallel study.

SETTING

Kumamoto in Japan.

SUBJECTS

Healthy adult men (30-60 years) with borderline hepatitis who had one or more of serum gamma-glutamyl transferase (GGT), aspertate aminotransferase (AST) and alanine aminotransferase (ALT) levels over normal ranges, and who were negative for hepatitis virus were openly recruited by an advertisement. Of the 48 persons enrolled, 38 (mean age 43.0 years (30-54 years)) completed the study.

METHODS

The subjects were randomly assigned to the PSP group and the placebo group. During the 8-week intervention, the subjects in the PSP group consumed two bottles of the PSP beverage with acylated anthocyanins (200.3 mg anthocyanins per 125 ml per bottle) per day, and the subjects in the placebo group, two bottles of a placebo beverage (1.7 mg anthocyanins per 125 ml per bottle). All of the data measured were analyzed by two-way repeated measures analysis of variance (ANOVA) with groups and times. The data of the hepatic markers were analyzed using the Dunnett multiple comparison among the time points and t-test between groups at the same time point. Two-sided P<0.05 were defined as the level of significance.

RESULTS

Serum GGT, AST and ALT levels showed interactions (P<0.05) between the beverage groups and time; the others were not affected. The PSP beverage group showed lower hepatic marker levels than the placebo group during the ingestion period, particularly the GGT level (-14.1 IU/l, 95% Confidence intervel (CI) -25.4 to -2.7, P=0.017 at 2 weeks; -16.8 IU/l, 95% CI -36.2 to 2.5, P=0.081 at 4 weeks; -26.7 IU/l, 95% CI -47.6 to -5.7, P=0.014 at 6 weeks and -27.9 IU/l, 95% CI -49.9 to -5.9; P=0.014 at 8 weeks). No correlation between alcohol consumption and each hepatic biomarker level before and after the ingestion was observed.

CONCLUSION

The intake of the PSP beverage significantly decreased the serum levels of hepatic biomarkers, particularly the GGT level, in healthy men with borderline hepatitis.

The Stenting to Internal Carotid Artery Stenosis (ICS) in Petrous Portion. The Evaluation of Plaque Figures in Magnetic Resonance Image

SUMMARY

In the safety stenting, it is important to get to know the characteristics of a plaque. In petrous carotid artery stenosis, it is difficult to know the characteristics of the plaque.We paid our attention to the MPRAGE (Magnetization Prepared Rapid Acquisition with Gradient Echo) method on high resolving power MRI. By the MPRAGE method, low intensity was observed in these lesions of all cases. This result suggested that the plaque in petrous portion was a fibrous plaque. This method is useful to get to know the characteristics of a plaque in petrous portion before endovascular treatment.

Long-term outcomes and predictors of iliac angioplasty with selective stenting: is primary stenting necessary?

Percutaneous transluminal angioplasty (PTA) has become one of the initial treatment options in patients with iliac artery occlusive disease. Stents have been recommended to correct procedural complications and improve long-term patency. Many series advocate routine stent placement after an otherwise uncomplicated PTA (primary stenting) in an attempt to prevent recurrent disease. Currently, many physicians in the United States seem to use stents in the iliac artery more liberally, even on a routine basis. There is little evidence to support this practice, however. It is still unclear whether a stent should be inserted primarily or selectively. This article provides the data from an 11-year experience of angioplasty with selective stenting for iliac artery occlusive lesions and reviews the current literatures on the iliac artery stent placement.

Mitochondrial DNA determines androgen dependence in prostate cancer cell lines

Prostate cancer progresses from an androgen-dependent to androgen-independent stage after androgen ablation therapy. Mitochondrial DNA plays a role in cell death and metastatic competence. Further, heteroplasmic large-deletion mitochondrial DNA is very common in prostate cancer. To investigate the role of mitochondrial DNA in androgen dependence of prostate cancers, we tested the changes of normal and deleted mitochondrial DNA in accordance with the progression of prostate cancer. We demonstrated that the androgen-independent cell line C4-2, established by inoculation of the androgen-dependent LNCaP cell line into castrated mice, has a greatly reduced amount of normal mitochondrial DNA and an accumulation of large-deletion DNA. Strikingly, the depletion of mitochondrial DNA from androgen-dependent LNCaP resulted in a loss of androgen dependence. Reconstitution of normal mitochondrial DNA to the mitochondrial DNA-depleted clone restored androgen dependence. These results indicate that mitochondrial DNA determines androgen dependence of prostate cancer cell lines. Further, mitochondrial DNA-deficient cells formed tumors in castrated athymic mice, whereas LNCaP did not. The accumulation of large deletion and depletion of mitochondrial DNA may thus play a role in the development of androgen independence, leading to progression of prostate cancers.

Intracolony variation of bacterial gut microbiota among castes and ages in the fungus-growing termite Macrotermes gilvus

The fungus-growing termites Macrotermes cultivate the obligate ectosymbiontic fungi, Termitomyces. While their relationship has been extesively studied, little is known about the gut bacterial symbionts, which also presumably play a crucial role for the nutrition of the termite host. In this study, we investigated the bacterial gut microbiota in two colonies of Macrotermes gilvus, and compared the diversity and community structure of bacteria among nine termite morphotypes, differing in caste and/or age, using terminal restriction fragment length polymorphism (T-RFLP) and clonal analysis of 16S rRNA. The obtained molecular community profiles clustered by termite morphotype rather than by colony, and the clustering pattern was clearly more related to a difference in age than to caste. Thus, we suggest that the bacterial gut microbiota change in relation to the food of the termite, which comprises fallen leaves and the fungus nodules of Termitomyces in young workers, and leaves degraded by the fungi, in old workers. Despite these intracolony variations in bacterial gut microbiota, their T-RFLP profiles formed a distinct cluster against those of the fungus garden, adjacent soil and guts of sympatric wood-feeding termites, implying a consistency and uniqueness of gut microbiota in M. gilvus. Since many bacterial phylotypes from M. gilvus formed monophyletic clusters with those from distantly related termite species, we suggest that gut bacteria have co-evolved with the termite host and form a microbiota specific to a termite taxonomic and/or feeding group, and furthermore, to caste and age within a termite species.

Dissecting aneurysm of the vertebral artery developed after microvascular decompression for hemifacial spasm

SUMMARY

We report a rare case of a ruptured de novo dissecting aneurysm induced by ethyl 2-cyanoacrylate. A 39-year-old woman underwent microvascular decompression for left hemifacial spasm. The offending vessel was left posterior inferior cerebellar artery (PICA). Left vertebral artery (VA) was mobilized and affixed to the dura mater with cyanoacrylate to remove pressure of PICA to the root exit zone of the facial nerve. The left VA was found to be intact at the time of the operation. One year later, the patient sufferd subarachnoid haemorrhage (SAH) caused by rupture of a newly-developed dissecting aneurysm of the left VA. Endovascular occlusion of the dissecting site was performed using Guglielmi detachable coils. We suppose mechanical injury and chemical reaction of ethyl 2-cyanoacrylate induced dissecting aneurysm.

Multiple pancreatic metastases from clear cell renal carcinoma: Diagnosis with chemical shift magnetic resonance imaging before surgery

We present a case in which multiple pancreatic tumours were diagnosed as metastatic clear cell renal carcinomas with chemical shift MRI (CSI) before surgery. Radiologists may be unable to recognize the loss of intensity on CSI macroscopically. We believe that it is useful to make subtraction images and calculate signal intensity on CSI, even if the lesions are multiple metastatic tumours.

Characterization of the NADH-linked acetylacetoin reductase/2,3-butanediol dehydrogenase gene from Bacillus cereus YUF-4

A 1.4-kbp DNA fragment, including the NADH-linked acetylacetoin reductase/2,3-butanediol dehydrogenase (AACRII/BDH) gene from the chromosomal DNA of Bacillus cereus YUF-4, was cloned in Escherichia coli DH5alpha after its insertion into pUC119, and the resulting plasmid was named pAACRII119. The AACRII/BDH gene had an open reading frame consisting of 1047 bp encoding 349 amino acids. The enzyme exhibited not only AACR activity, but also BDH activity. However, the gene was not located in a 2,3-butanediol (BD) operon, as is the case in the BDH gene of Klebsiella pneumoniae and that of K. terrigena. In addition, there was no BD-cycle-related enzyme gene in the region surrounding the AACRII/BDH gene. The AACR and BDH activities in E. coli DH5alpha/pAACRII119 were 200-fold higher than those in the original B. cereus YUF-4. The characteristics of the AACRII/BDH from E. coli DH 5alpha/pAACRII119 are similar to those of the AACRII/BDH from B. cereus YUF-4. The AACRII/BDH was considered to belong to the NAD(P)- and zinc-dependent long-chain alcohol dehydrogenase (group I ADH) family on the basis of the following distinctive characteristics: it possessed 14 strictly conserved residues of microbial group I ADH and consisted of about 350 amino acids. The enzymatic and genetic characteristics of AACRII/BDH were completely different from those of BDHs belonging to the short-chain dehydrogenase/reductase family. These findings indicated that the AACRII/BDH could be considered a new type of BDH.

Characteristics of Peripheral Microembolization During Iliac Stenting: Doppler Ultrasound Monitoring

OBJECTIVE

To evaluate the characteristics of distal microembolic signals (MES) during iliac stenting using Doppler ultrasound monitoring.

DESIGN

Prospective clinical study.

METHODS

A 2-MHz probe was used to monitor continuously at the ipsilateral tibioperoneal trunks during technically and hemodynamically successful iliac stenting in 10 patients without infrainguinal occlusive lesion. MESs at guide-wire, balloon, or stent crossing (phase 1), predilatation (phase 2), stent deployment (phase 3), postdilatation (phase 4), and contrast medium or heparinized saline injection (at injection) were analyzed. Differentiation of gaseous emboli from particulate emboli was achieved by calculation of the sample volume length.

RESULTS

No distal embolic complications were observed. Five hundred and forty-one MESs were detected. The MES incidence and intensity in phase 3 were significantly higher than those in phase 1, phase 2, and phase 4 (p<0.05). The MES intensity at injection was significantly higher than that in each of four phases (p<0.0001).

CONCLUSIONS

Both the MES incidence and intensity were highest at stent deployment. Further study is required of microembolism during endovascular procedures in the lower extremities.