Oxalate and silica contents of seven varieties of Napier grass (Pennisetum purpureum)

Oxalate and silica are considered antinutrients. Large quantities of oxalate and silica in plants can interfere with the uptake of essential minerals in ruminants. Therefore, the aim of this study was to compare the total silica and oxalate contents of seven varieties of Napier grass to find out which is best for cultivation. Taiwan, Zanzibar, Pakchong, Purple, Kobe, Indian, and Dwarf Napier grass were grown in a completely randomized design with three replications to determine their soluble oxalate, total oxalate, and silica contents. Plants were harvested at two months of plant maturity. Whole plant of the Dwarf Napier grass contained significantly higher soluble oxalate content than tall varieties. Total oxalate content in whole plant differed significantly among varieties. Dwarf showed the highest total oxalate content (3.23% dry matter (DM)) followed by Kobe (2.61%), Zanzibar (2.60%), Purple (2.44%), Taiwan (2.43%), Indian (2.15%), and Pakchong (1.95%). Regardless of variety, leaf tissue contained significantly higher soluble oxalate and total oxalate than stem tissue. There were no differences in silica content among them. In conclusion, the tall varieties could produce lower levels of soluble oxalate than the Dwarf variety, whereas silica content might not vary among them.Keywords: botanical fractions, mineral bioavailability, ruminant

P6405Potential for drug-drug interaction between vonoprazan and prasugrel on antiplatelet effect assessed by VerifyNow P2Y12 assay in patients with coronary artery disease

Background

Vonoprazan is a potassium-competitive acid blocker increasingly used in Japan to prevent gastrointestinal bleeding in patients under dual antiplatelet therapy (DAPT) after coronary stents implantation. Since cytochrome P450 (CYP) 3A4 is involved in the primary metabolism of vonoprazan and prasugurel, there is a possibility that CYP-mediated drug-drug interaction between them can attenuate the antiplatelet function of prasugrel.

Purpose

The aim of this study was to investigate whether antiplatelet effect of prasugrel could be attenuated upon coadministration with vonoprazan compared to conventional proton pump inhibitors (PPIs).

Method

We evaluated 72 patients (57 males, 67±11 years) with coronary artery disease who were taking either vonoprazan (n=35) or PPIs (n=37) in combination with DAPT (aspirin and prasugrel) after drug-eluting stents implantation. PPIs included 21 esomeprazole, 8 lansoprazole, and 8 rabeprazole. Antiplatelet effects of prasugrel were assessed using VerifyNow P2Y12 assay. Primary measurements were P2Y12 reaction units (PRU) and P2Y12 percent inhibition. High on-treatment platelet reactivity (HPR) on prasugrel was defined as PRU >208. Administration period of vonoprazan or PPIs in combination with DAPT ≤7 days was defined as early administration period.

Results

Median administration period of vonoprazan or PPIs in combination with DAPT was 127 days. There were no significant differences in baseline clinical characteristics between patients with vonoprazan and PPIs. In the analysis for all subjects, patients with vonoprazan showed similar PRU (166±50 vs. 167±64, p=0.93) and percent inhibition (36±18 vs. 38±23, p=0.66) compared to those with PPIs. No significant differences were observed in the prevalence of HPR between patients with vonoprazan and PPIs (17 vs. 30%, p=0.27). In the analysis for patients in early administration period [vonoprazan (n=14) vs. PPIs (n=10)], there were no significant differences in PRU (166±47 vs. 186±82, p=0.45), percent inhibition (33±17 vs. 30±26, p=0.73), and prevalence of HPR (14 vs. 50%, p=0.085) between patients with vonoprazan and PPIs. In addition, the analysis for patients over early administration period [vonoprazan (n=21) vs. PPIs (n=27)] showed that PRU (166±55 vs. 160±57, p=0.73), percent inhibition (37±19 vs. 41±21, p=0.57), and prevalence of HPR (19 vs. 22%, p=1.00) were comparable between patients with vonoprazan and PPIs.

Conclusion

Compared to PPIs, vonoprazan did not exhibit significant inhibitory effects on the antiplatelet activity of prasugrel assessed by VerifyNow assay. These findings suggest that there are possibly no clinically harmful drug-drug interactions between vonoprazan and prasugrel.

P1549Serum soluble Klotho is associated with extent of coronary artery calcification in patients with stable angina pectoris undergoing percutaneous coronary intervention

Background

Klotho, which was originally identified as an aging suppressor, is a key regulator of bone and mineral metabolism. Transmembrane and soluble forms of Klotho protein have been identified. The transmembrane form serves as an obligate co-receptor for fibroblast growth factor 23 (FGF23). However, the physiological importance of soluble form of Klotho has not been determined.

Purpose

The present study aimed to test the hypothesis that circulating soluble Klotho levels can predict the presence or extent of coronary artery calcification (CAC) in patients with coronary artery disease.

Methods

We analyzed CAC of culprit lesions in patients with 75 stable angina pectoris who were not on dialysis and were scheduled for percutaneous coronary intervention (PCI) following intravascular ultrasound (IVUS). Arc and length of each calcium within the culprit lesion was measured by IVUS. The main outcome measure was the calcium index; a volumetric IVUS-derived measure which was calculated as total calcium length/lesion length × maximal calcium arc/360°. Low calcium index was defined as calcium index <0.042 of the first quartile value. Serum Klotho and FGF23 were measured before PCI. Patients were divided into two groups according to median serum Klotho value: low-Klotho (n=37, ≤460 pg/mL) and high-Klotho group (n=38, >460 pg/mL).

Results

Compared with patients with low-Klotho, those with high-Klotho had higher estimated glomerular filtration rate (eGFR) (69±20 vs. 55±16 mL/min/1.73 m2, p<0.001), lower FGF23 levels (51±24 vs. 67±41 pg/mL, p=0.010). Patients with high-Klotho had significantly lower calcium index than those with low-Klotho (0.17±0.21 vs. 0.24±0.23, p=0.043). Serum Klotho levels correlated significantly and inversely with calcium index (r=−0.31, p=0.006). The correlation between Klotho and calcium index was pronounced at analysis in patients with eGFR <60 mL/min/1.73 m2 (r=−0.52, p<0.001). Logistic regression analysis showed that high-Klotho is a sole significant independent factor associated with low calcium index (odds ratio 7.17, p=0.004). Presence of high-Klotho had high sensitivity and negative predictive value for identifying low calcium index (83% and 92%, respectively).

Conclusions

Serum Klotho values were independently and inversely associated with the degree of CAC assessed by IVUS. These findings have important clinical implications for serum Klotho as a biomarker that reflects the extent of CAC.

Usefulness of urinary trypsinogen-2 and trypsinogen activation peptide in acute pancreatitis: A multicenter study in Japan

BACKGROUND

Rapid urinary trypsinogen-2 dipstick test and levels of urinary trypsinogen-2 and trypsinogen activation peptide (TAP) concentration have been reported as prognostic markers for the diagnosis of acute pancreatitis.

AIM

To reconfirm the validity of all these markers in the diagnosis of acute pancreatitis by undertaking a multi-center study in Japan.

METHODS

Patients with acute abdominal pain were recruited from 17 medical institutions in Japan from April 2009 to December 2012. Urinary and serum samples were collected twice, at enrollment and on the following day for measuring target markers. The diagnosis and severity assessment of acute pancreatitis were assessed based on prognostic factors and computed tomography (CT) Grade of the Japanese Ministry of Health, Labour, and Welfare criteria.

RESULTS

A total of 94 patients were enrolled during the study period. The trypsinogen-2 dipstick test was positive in 57 of 78 patients with acute pancreatitis (sensitivity, 73.1%) and in 6 of 16 patients with abdominal pain but without any evidence of acute pancreatitis (specificity, 62.5%). The area under the curve (AUC) score of urinary trypsinogen-2 according to prognostic factors was 0.704, which was highest in all parameter. The AUC scores of urinary trypsinogen-2 and TAP according to CT Grade were 0.701 and 0.692, respectively, which shows higher than other pancreatic enzymes. The levels of urinary trypsinogen-2 and TAP were significantly higher in patients with extended extra-pancreatic inflammation as evaluated by CT Grade.

CONCLUSION

We reconfirmed urinary trypsinogen-2 dipstick test is useful as a marker for the diagnosis of acute pancreatitis. Urinary trypsinogen-2 and TAP may be considered as useful markers to determine extra-pancreatic inflammation in acute pancreatitis.

Clinical practice guideline for post-ERCP pancreatitis

BACKGROUND

Endoscopic retrograde cholangiopancreatography (ERPC) is used for the diagnosis and treatment of pancreatic and biliary diseases. Post-ERCP pancreatitis (PEP) is a complication which needs special care and clinical practice guideline for this morbidity is also needed.

METHODS

The key clinical issues of diagnosis and treatment of PEP were listed and checked, and then the clinical questions were formulated. PubMed (MEDLINE) and Ichushi-web (Japanese medical literature) were used as databases. For the study of diagnostic test accuracy, items similar to QUADAS-2, i.e., random selection from a population to which the diagnostic test is applied, blinding of index tests and reference tests, completeness of reference standard, completeness of test implementations, the same timing of tests, and missing data were assessed as well as the indirectness of the study subjects, index tests, reference standard, and outcomes. Grading of recommendations was determined as strong or weak. In clinical practice, the judgment of attending doctors should be more important than recommendations described in clinical practice guidelines. Gastroenterologists are the target users of this clinical practice guideline. General practitioners or general citizens are not supposed to use this guideline. The guideline committee has decided to include wide clinical issues such as etiological information, techniques of ERCP, the diagnosis, treatments, and monitoring of PEP in this guideline.

RESULTS

In this concise report, we described ten clinical questions, recommendations, and explanations pertaining to risk factors, diagnosis, prognostic factors, treatments, and preventive interventions in the medical practice for PEP.

CONCLUSIONS

We reported here the essence of the clinical practice guideline for PEP.

Valley-dependent spin polarization in bulk MoS2 with broken inversion symmetry

The valley degree of freedom of electrons is attracting growing interest as a carrier of information in various materials, including graphene, diamond and monolayer transition-metal dichalcogenides. The monolayer transition-metal dichalcogenides are semiconducting and are unique due to the coupling between the spin and valley degrees of freedom originating from the relativistic spin-orbit interaction. Here, we report the direct observation of valley-dependent out-of-plane spin polarization in an archetypal transition-metal dichalcogenide--MoS2--using spin- and angle-resolved photoemission spectroscopy. The result is in fair agreement with a first-principles theoretical prediction. This was made possible by choosing a 3R polytype crystal, which has a non-centrosymmetric structure, rather than the conventional centrosymmetric 2H form. We also confirm robust valley polarization in the 3R form by means of circularly polarized photoluminescence spectroscopy. Non-centrosymmetric transition-metal dichalcogenide crystals may provide a firm basis for the development of magnetic and electric manipulation of spin/valley degrees of freedom.

A case of lupus erythematosus profundus with multiple arc-shaped erythematous plaques on the scalp and a review of the literature

A 26-year-old Japanese female presented to us with a 2-year history of multiple arc-shaped erythematous lesions on her scalp and the right side of her forehead. Histopathological examination of two of the lesions showed lobular and septal panniculitis with deposits of IgG in the basement membrane zone. We diagnosed the case as lupus erythematosus profundus, and successfully treated her with 20 mg/day prednisolone. To our knowledge, there has been only one previously reported case of lupus erythematosus profundus with annular-shaped erythematous lesions and six cases with linear configuration.

The proteinase/proteinase-activated receptor-2/transient receptor potential vanilloid-1 cascade impacts pancreatic pain in mice

AIMS

Proteinase-activated receptor-2 (PAR2) and transient receptor potential vanilloid-1 (TRPV1) are co-localized in the primary afferents, and the trans-activation of TRPV1 by PAR2 activation is involved in processing of somatic pain. Given evidence for contribution of PAR2 to pancreatic pain, the present study aimed at clarifying the involvement of TRPV1 in processing of pancreatic pain by the proteinase/PAR2 pathway in mice.

MAIN METHODS

Acute pancreatitis was created by repeated administration of cerulein in conscious mice, and the referred allodynia/hyperalgesia was assessed using von Frey filaments. Injection of PAR2 agonists into the pancreatic duct was achieved in anesthetized mice, and expression of Fos in the spinal cord was determined by immunohistochemistry.

KEY FINDINGS

The established referred allodynia/hyperalgesia following cerulein treatment was abolished by post-treatment with nafamostat mesilate, a proteinase inhibitor, and with capsazepine, a TRPV1 antagonist, in mice. Injection of trypsin, an endogenous PAR2 agonist, or SLIGRL-NH(2), a PAR2-activating peptide, into the pancreatic duct caused expression of Fos protein in the spinal superficial layers at T8-T10 levels in the mice. The spinal Fos expression caused by trypsin and by SLIGRL-NH(2) was partially blocked by capsazepine, the former effect abolished by nafamostat mesilate.

SIGNIFICANCE

Our data thus suggest that the proteinase/PAR2/TRPV1 cascade might impact pancreatic pain, in addition to somatic pain, and play a role in the maintenance of pancreatitis-related pain in mice.

[Combination of irinotecan and Mitomycin C as second-line chemotherapy for patients with unresectable advanced or recurrent gastric cancer in clinical practice]

BACKGROUND

Recently, combination S-1 and CDDP chemotherapy is considered as a standard regimen for unresectable or recurrent gastric cancer. Second-line chemotherapy is reportedly important to improve survival, and combination of Irinotecan and Mitomycin C as second-line chemotherapy has proven effective in phase II study of JCOG 0109-DI.

PURPOSE

We assessed the efficacy of combination of Irinotecan and Mitomycin C as second-line chemotherapy for unresectable and recurrent gastric cancer.

PATIENTS AND METHODS

We treated 12 patients receiving combination of Irinotecan and Mitomycin C as second-line chemotherapy between Nov. 2002 and Apr. 2006.

RESULTS

The response rate was 42% including 2 complete response. Progression-free survival was 6.1 months, and time to progression was 5.4 months. Median survival time after the start of second-line chemotherapy was 11.2 months, and after first-line treatment 20.5 months. One-year survival rate was 50%, and 2-year survival rate was 33%.

CONCLUSION

In our hospital, combination of Irinotecan and Mitomycin C as second-line chemotherapy prolonged median survival time, and seemed to be an effective regimen.

Pancreatic sphincter precutting to gain selective access to the common bile duct: a series of 172 patients

BACKGROUND AND STUDY AIMS

Several precutting techniques have been described in cases of failed access to the common bile duct. We describe our experience with pancreatic sphincter precutting in an upward direction, and report its success rates and complications.

PATIENTS AND METHODS

A total of 172 patients underwent a procedure using this technique between January 1989 and December 2001. The technique consisted of a medium-to-large precut along the midline, above the papillary elevation, using either the common channel or the pancreatic duct in the ampulla of Vater as a guide. The septum between the pancreatic duct and the bile duct was removed and separate openings to the pancreatic and bile ducts were created, followed by complete biliary sphincterotomy.

RESULTS

Biliary cannulation and sphincterotomy was successful in 163 of the 172 study patients (95 %). Mild complications, which were all managed conservatively, occurred in 17 patients (10 %). This complication rate was significantly higher than our complication rate for standard endoscopic sphincterotomy, which was 0.8 % in 1770 patients ( P < 0.0001).

CONCLUSIONS

Pancreatic sphincter precutting is an effective and safe technique for patients in whom selective cannulation of the common bile duct has failed. Further prospective comparative studies of other precutting techniques will better define its clinical value.

Mechanism of pancreatitis caused by ERCP

BACKGROUND

Acute pancreatitis can develop after either ERCP or endoscopic sphincterotomy (ES). The pathogenesis of this complication remains poorly understood.

METHODS

The frequency and severity of acute pancreatitis were retrospectively evaluated after 17,602 ERCP procedures and 3003 ES procedures. Pancreatitis was diagnosed and evaluated according to the scoring system of Ranson and criteria developed in Japan.

RESULTS

Pancreatitis developed after 15 (0.09%) of 17,602 ERCP procedures and 13 (0.43%) of 3003 ES procedures (p = 0.0001, chi-square). The severity of pancreatitis (Ranson score) was less than 3 in 10 cases of ERCP-induced pancreatitis and from 3 to 5 in 5 cases. One (7%) of the 15 patients with ERCP-related pancreatitis died. All 13 patients with ES-induced pancreatitis had a Ranson score of less than 3; none died (p = 0.04, Fisher exact test). The ERCP pancreatitis score (Japanese criteria) beyond 48 hours after the onset of pancreatitis increased in 5 (33%) of the 15 patients with ERCP-induced pancreatitis; the score did not increase in any of the 13 patients with ES-induced pancreatitis (p = 0.04, Fisher exact test).

CONCLUSIONS

Although the frequency of ES-induced pancreatitis is significantly higher than that of post-ERCP pancreatitis, the frequency of severe pancreatitis within 48 hours and worsening of pancreatitis after 48 hours is significantly lower with ES-induced pancreatitis. Our hypothesis is that the lowering of pancreatic intraductal pressure after ES mitigates the severity of postprocedure pancreatitis.

[A case of percutaneous and transpapillary placements of expandable metallic stents in a patient with cholangiocarcinoma at the hilum of the liver]

A 76-year-old woman was admitted with obstructive jaundice. US and MR cholangiopancreatography (MRCP) revealed an inoperative cholangiocarcinoma, 3 cm in diameter at the hilum of the liver, the obstruction of the hepatic duct bifurcation and the separation of bilateral hepatic bile ducts. Percutaneous transhepatic biliary drainage (PTBD) was performed from bilateral hepatic bile ducts. The right PTBD tube was spontaneously extubated. We could not succeed in performing internal biliary drainage across the hilar malignant stricture from a left hepatic bile duct, because of bad angulation. Transpapillary insertion into the common bile duct (CBD) was extremely difficult due to the collapse of the CBD. Endoscopic sphincterotomy (EST) after precutting method was performed. Although we performed the ballooned dilatation of malignant stricture and the insertion of a self-expandable metallic stent (EMS) into a right hepatic bile duct transpapillary. After dilatation of the hilar malignant stricture by the initial EMS, we inserted a guidewire into the CBD through the wire mesh of a stent from the left PTBD tube. We could insert the second EMS from a left hepatic bile duct to the CBD transhepatically, using a dilator and a dilating balloon. Finally, we performed the ballooned dilatation from bilateral hepatic bile ducts to the CBD transpapillary. She was discharged after bilateral internal biliary drainages, successfully.

[An extremely elderly patient with choledocholithiasis and many complications]

It was very difficult to treat a 90-year-old woman for choledocholithiasis with acute obstructive suppurative cholangitis, gallbladder perforation, and a pool of bile in the right perirenal spase. Extracorporeal shockwave lithotripsy (ESWL) was performed after emergency percutaneous transhepatic biliary drainage (PTBD), but we could not perform lithotripsy successfully because of large and hard stones. Although Endoscopic sphincterotomy (EST) was performed using an ultratome by rendezvous method. Lithotripsy was finally successful, after three times endoscopic mechanical lithotripsy (EML) and procedure using an endotriptor for basket impaction. It is very important in advanced aged patients that endoscopic treatment should be performed step by step.

[An elderly case of post-bulbar Dieulafoy's ulcer]

The case is a 79-year-old man who came to our hospital with melena as chief complaint. Emergency endoscopy showed spurting bleeding from a small ulcer. We diagnosed as Post-Bulbar Dieulafoy's ulcer and performed hemostatic procedure with hemostatic clips. The forth endoscopy (7 days after admission) showed fresh clot and oozing bleeding after the third hemostatic clipping. Although we performed hemostatic procedure with the injection therapy of hypertonic saline epinephrine solution (HSE). The effective hemostatic procedure is discussed with reference to some related literature.

[Surgical treatment of secondary chronic colonic pseudo-obstruction]

A 74-year-old woman was admitted to the hospital because of constipation and marked abdominal distension. She had become to be bedridden after cerebral infarction 10 years previously, and was tabescent due to vomiting. A left hemicolectomy and colostomy were performed because conservative therapy seemed to be ineffective. The postoperative course was good and her nutritional status improved.

[A case of endocrine cell carcinoma in the duodenal bulb]

A 73-year-old man was admitted to our hospital due to weight loss and melena. Roentgenograms and endoscopy showed a Borrmann type 2 tumor occupying the entire duodenal bulb. Histological findings of the lesion (H-E stain) showed poorly differentiated adenocarcinoma. Almost the entire specimen showed positive staining granules for Grimelius stain. Ultrastructurally, remarkable endocrine granules covered a layer of the limited membrane (membrane-bound granule) in the tumor cell. We diagnosed endocrine cell carcinoma. Since it was difficult to operate due to age and invasion to the fundus of the gall-bladder and the pancreatic head, we treated this case by chemotherapy.

[A case of Lemmel's syndrome caused by a large diverticular enterolith at the peripapillary portion of the duodenum]

A 93-year-old woman admitted because of epigastralgia. Cholelithiasis, obstructive jaundice, acute suppurative cholangitis and acute pancreatitis were diagnosed on blood chemistry and ultrasonography on admission. We performed emergency PTCD. A calculus 4 cm in diameter was detected at the papilla of Vater and marked dilatation of the common bile duct and pancreatic duct. ESWL was performed because of her age and because endoscopical operation seemed to be difficult. After lithotripsy, PTC and endoscopy demonstrated a diverticulum at the peripapillary portion of the duodenum. Based on analysis of PTC result before and after ESWL, we diagnosed this case as Lemmel's syndrome (obstructive jaundice, acute suppurative cholangitis and acute pancreatitis) caused by a large diverticular enterolith at the peripapillary portion of the duodenum. ESWL treatment of aged patient with an enterolith is safe.

[A case of early duodenal cancer resected by endoscopic polypectomy in the elderly]

Early duodenal cancer has been detected with increasing frequency of endoscopy and the advent of an aging society. Aged patients, however, are often inoperable because of complications due to various underlying diseases. The authors report a case of early duodenal cancer curatively operated by endoscopic polypectomy and refer to related cases in the literature.

[Upper gastrointestinal bleeding in the elderly]

Due to increasing number of the elderly, cases of hematemesis and melena in the aged have been increasing. The authors evaluated 69 such cases over 60 years old in whom emergency endoscopy of the upper digestive tract was carried out because of hematemesis and melena. Twenty cases are diagnosed as gastric ulcer (29%), 12 cases as esophageal ulcer and esophageal erosion (17.4%), 9 as duodenal ulcer (13.0%), 7 as gastric cancer (10.1%), 6 as Mallory-Weiss syndrome (8.7%), 6 as esophageal and gastric varices (8.7%), 4 as acute hemorrhagic gastritis (5.8%), 3 as Dieulafoy's ulcer (4.3%), and one case each of chronic pancreatitis (hemosuccus pancreaticus) and hemorrhage due to gastric angiodysplasia (1.4%). Of these cases, blood transfusion was performed in 46 cases (66.7%), and shock occurred in 27 cases (39.1%). The endoscopical hemostatic procedure was effective for detection of underlying diseases in the aged. Surgery was often impossible because of the rapid deterioration of the systemic condition due to the hemorrhage of the digestive tract.

Light-inducible pigmentation in Portulaca callus; selection of a high betalain producing cell line

We have established a unique betalain pigmentation system in callus cultures that originated from seedlings of Portulaca sp. 'Jewel'. Within three different 'Jewel' lines examined, one line (JR) was clearly superior with regard to callus growth rate and pigment formation. Furthermore, after ten cycles of selection of deeply colored callus patches, the selected clones contained on an average four times the amount of betalain as compared to the non-selected mother line. The colorization was induced by light, but disappeared in the dark. Pigment synthesis was detectable within 30 h after irradiation and showed positive correlation with irradiation periods.

Low-friction hydrophilic surface for medical devices

A hydrophilic polymer surface was developed exhibiting excellent low frictional property, namely slipperiness, when in contact with water or physiological fluid due to the reaction of epoxy-containing poly(vinyl pyrrolidone) with the polyamino compound formed on the surface of the substrate. Epoxy-containing poly(vinyl pyrrolidone) was obtained by the copolymerization of vinyl pyrrolidone as a hydrophilic component, glycidyl acrylate as a binding component to the substrate, and vinyl acetate to preserve the strength of the coating layer. The surface friction coefficient depends on the molecular weight of the coated hydrophilic copolymer. It was demonstrated that a molecular weight of 400,000 or more is essential to achieve excellent low surface friction. Using rabbit models, polyurethane catheters, both with and without the hydrophilic low friction coating, were evaluated for surface friction coefficient and blood compatibility. As a result, in the case of coated catheters, no lesions of the intima of the blood vessels and no thrombus formations on the surfaces of the catheters were observed. However, the non-coated catheters injured the intima of the blood vessels and severe thrombus formation was found on their surfaces.