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Summary: Clinicians' evaluations of older adults sometimes reveal inconsistencies between objective and subjective dental status. This study investigated which factors contribute both to good objective masticatory function (OMF) and the poor subjective masticatory function (SMF) that often becomes a clinical issue. Study participants included 635 elderly community‐dwelling Japanese adults who underwent a comprehensive geriatric health examination in 2012. SMF was assessed with a question from the Kihon Checklist on eating difficulties (poor or good). OMF was assessed by a colour‐changing gum (poor or good). Also investigated were age, sex, depressive symptoms, instrumental activities of daily living (I‐ADLs), number of people who joined the participant at dinner, grip strength, usual walking speed, number of remaining teeth, number of functional teeth and their occlusal force. The group with good OMF and good SMF, defined as group 1, and the group with good OMF but poor SMF, group 2, were compared. Logistic regression analyses confirmed that the number of remaining and functional teeth participants had was statistically unrelated to differences between OMF and SMF. Instead, differences were related to stronger depressive symptoms (OR = 1.67, CI = 1.14‐2.44), less ability to conduct I‐ADL activities (OR = 0.73, CI = 0.59‐0.91), slower usual walking speeds (OR = 0.18, CI = 0.06‐0.58) and less occlusal force (OR = 0.99, CI = 0.99‐1.00). Depressive symptoms, I‐ADLs, and physical function are shown to be significantly related to divergence between objective and subjective masticatory function in elderly Japanese. This suggests that dissociations between objective and subjective dental evaluations of elderly adults indicate need for assessment of their mental and physical function. [ABSTRACT FROM AUTHOR]

Background Enteric glial cells ( EGCs) play important roles in enteric integrity and regulation of gastrointestinal function. However, whether EGCs undergo pathophysiological changes in stress-associated gastrointestinal disorders is unknown. We investigated structural and functional alterations in colonic EGCs and their roles in colonic contraction in an irritable bowel syndrome ( IBS) model. Methods As a chronic stress, male Wistar rats underwent 3-h maternal separation during postnatal days 2-14. As an acute stress, we used water-immersion stress (4 h) in adulthood (at 8 weeks). We quantitatively and morphologically evaluated enteric neurons and EGCs using whole-mount longitudinal muscle-myenteric plexus preparations. Colonic contraction was analyzed with electrical field stimulation ( EFS). Key Results Glial fibrillary acidic protein ( GFAP) expression and the number of total, cholinergic, and nitrergic neurons were unchanged in maternally separated rats with acute stress (combined stress: an IBS model) compared with controls. However, the density of GFAP-positive EGC processes that apparently overlapped with the neurons and the extent of bulbous swelling of terminals increased according to the stress intensity: control, acute stress, maternal separation, and combined stress. EFS-induced colonic contractions were significantly greater in the combined stress rats than in controls. Higher dose of fluorocitrate, a selective inhibitor of EGC metabolism, was required to inhibit both EFS-induced contraction and EGCs activation in the combined stress rats than in controls. Conclusions & Inferences Colonic EGCs exhibited structural alterations according to the stress intensity. EGCs were associated with stress-induced colonic hyper-contraction in the combined stress rats, which may underlie the pathogenesis of IBS. [ABSTRACT FROM AUTHOR]

Background The features of proton pump inhibitor-responsive oesophageal eosinophilia ( PPI- REE) are similar to those of eosinophilic oesophagitis (EoE), but PPI- REE demonstrates symptomatic and histological responses to PPI therapy. Several studies have shown that basophils play a crucial role in the pathogenesis of allergic diseases. Aim To identify and compare basophil infiltration in the oesophageal epithelium in patients with EoE, PPI- REE, gastroesophageal reflux disease ( GERD) and normal oesophagus (controls). Methods Biopsy specimens from 43 patients, including 12 with EoE, 11 with PPI- REE, 10 with GERD and 10 normal oesophagus, were analysed. Immunohistochemistry was performed to quantify the number of basophils and mast cells in the oesophageal epithelium. Double immunofluorescence staining for thymic stromal lymphopoietin ( TSLP) and basophils was performed. Patients with EoE were treated with swallowed fluticasone. Results There were no differences in clinical, endoscopic or histological features between patients with EoE and PPI- REE. There were more basophils and mast cells in patients with EoE and PPI- REE than in patients with GERD and control subjects. Basophil infiltration of the oesophageal epithelium in patients with EoE was higher than that in patients with PPI- REE (3.6 ± 2.8 per high power field vs. 1.2 ± 0.9 per high power field respectively; P = 0.02); however, there was no significant difference in mast cell infiltration between the two groups. TSLP was highly expressed in the oesophageal epithelium in areas infiltrated by basophils. Steroid therapy significantly decreased intraepithelial basophils in patients with EoE. Conclusion Basophils may play an important role in the pathogenesis of eosinophilic oesophagitis. [ABSTRACT FROM AUTHOR]

Int J Dent Hygiene , 2011; 159-162 DOI: 10.1111/j.1601-5037.2010.00448.x Kanda N, Soga Y, Meguro M, Tanabe A, Yagi Y, Himuro Y, Fujiwara Y, Takashiba S, Kobayashi N. Discovery of a patient with strongly suspected bullous pemphigoid in a ward by oral health care providers. Oral health care providers may discover systemic diseases incidentally from signs observed in the oral cavity. Here, we report a case in which oral health care providers in a hospital discovered a patient with strongly suspected bullous pemphigoid (BP), which is a relatively rare but important disease, in a ward. The patient was a 78-year-old Japanese woman admitted to our hospital because of severe Alzheimer's disease. We discovered recurrent ulcers in the oral mucosa and skin when performing oral care in her ward. Biopsy could not be performed safely because of involuntary biting. We performed blood tests for anti-BP180-NC16a antibody, which is autoantibody specific for BP. The patient had a very high anti-BP180-NC16a antibody titre. We consulted a dermatologist regarding her clinical course and the clinical features of the oral mucosa and skin along with blood test results. BP was very strongly suspected. In cases in which oral health care providers suspect their patients may have BP, appropriate examination and provision of information to the doctor are important. Oral health care providers should have knowledge about systemic diseases, the signs of which appear in oral cavity to avoid missing important systemic diseases. [ABSTRACT FROM AUTHOR]

Irritable bowel syndrome (IBS) is a common gastrointestinal disease. Detailed clinical characteristics of patients with different IBS subtypes have not been well established. Our aim was to examine the prevalence and risk factors of IBS and its subtypes in Japanese adults. We performed a cross-sectional study of Japanese workers who visited a clinic for a routine health check-up and asked them to fill out a self-report questionnaire. Irritable bowel syndrome and its subtypes were defined by ROME III criteria. A logistic regression model was used to identify risk factors. Irritable bowel syndrome was present in 367 (13.5%) of 2717 eligible subjects; 79 had IBS with constipation (IBS-C); 102 had IBS with diarrhea (IBS-D); 89 had mixed IBS (IBS-M); and 97 had unsubtyped IBS (IBS-U). Irritable bowel syndrome was significantly associated with young age [odds ratio (OR) = 0.87, 95% confidence interval (CI) 0.80-0.95], female gender (OR = 1.78, 95% CI 1.38-2.29), low body mass index (BMI) (OR = 0.95, 95% CI 0.92-0.99), and the presence of allergic disease (OR = 2.19, 95% CI 1.40-3.54). Analysis of IBS subtypes revealed that IBS-C was associated with young age and female gender; IBS-D with young age, low BMI, and drinking habit; IBS-M with female gender, smoking habits, and allergic diseases; and IBS-U with age, female gender, and allergic diseases. Irritable bowel syndrome was common and associated with young age, female gender, low BMI, and presence of allergic diseases in Japanese adults. Several differences were noted between the risk factors among different IBS subtypes. [ABSTRACT FROM AUTHOR]

Objective: Although the implementation of routine screening for distress is desirable, doing so is difficult in today's busy clinical oncology practice. We developed the 'Distress Screening Program in Ambulatory Care' (DISPAC program) as a practical means of screening for and facilitating the treatment of major depression and adjustment disorders in cancer patients. This study assessed the feasibility and usefulness of the DISPAC program in actual clinical situations.Methods: As part of the DISPAC program, nurses administered a psychological screening measure, the Distress and Impact Thermometer (DIT), to consecutive cancer patients visiting an outpatient clinic in the waiting room. The attending physician then recommended psycho-oncology service referral to all positively screened patients. We compared the proportion of patients referred to a psycho-oncology service during the DISPAC period with the usual care period.Results: Of the targeted 491 patients treated during the DISPAC period, 91.9% (451/491) completed the DIT; the results were positive in 37.0% (167/451), recommendations for referrals were given to 93.4% (156/167), and 25.0% (39/156) accepted the referral. Ultimately 5.3% (26/491) of the targeted patients were treated by psycho-oncology service as having major depression or adjustment disorders, a significantly higher proportion than during the usual care period (0.3%; p<0.001). The nurses required 132+/-58 s per person to administer the DIT.Conclusions: The DISPAC program is useful for facilitating the care of cancer patients with psychological distress. Nevertheless, the acceptance of referrals by patients and the reduction of the burden placed on nurses are areas requiring improvement. Copyright (c) 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Although many investigators previously reported the sympathovagal effect of spinal anaesthesia, there is no information about the sympathovagal effects of supplementation with fentanyl. The aim of this study was to evaluate the sympathovagal effects of intrathecal or intravenous fentanyl added to spinal anaesthesia. Methods: One hundred and twenty patients undergoing elective transurethral surgery under spinal anaesthesia were randomly allocated to receive intrathecally either isobaric bupivacaine alone (Group B), bupivacaine supplemented with intrathecal (Group Ft) or with intravenous fentanyl (Group Fv). Heart rate variability was estimated using the MemCalc method (Tarawa, Suwa Trust, Japan) before and after spinal anaesthesia. Results: In all groups, spinal anaesthesia significantly decreased low frequency/high frequency (LF/HF) as a marker of sympathovagal balance. However, patients in Group B with a low block height developed a marked increase in LF/HF after spinal anaesthesia, which was attenuated in Group Ft. Meanwhile, intravenous fentanyl did not attenuate this response. Conclusion: We conclude that sympathetic activation observed in patients with a low block height was attenuated by intrathecal fentanyl but not by intravenous fentanyl. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to determine whether pre-operative heart rate variability (HRV) estimated using the newly developed MemCalc method predicts hypotension after spinal anaesthesia (SA). Method: Fifty-two patients with American Society of Anesthesiologists physical status I or II, aged 38–84 years, scheduled to undergo elective transurethral surgery were investigated in this study. Ultra short-term entropy (UsEn) as a non-linear index of HRV was estimated before and after SA using the MemCalc method. The patients were then assigned to two groups (Group LO and HI) according to pre-operative UsEn. SA was performed by intrathecal injection of 17.5 mg of isobaric bupivacaine via interlumbar spaces L3-4 or L4-5. After SA, the haemodynamic fluctuations were recorded and compared between the two groups. Results: SA significantly decreased LF/HF (a ratio of the low frequency component of HRV to that of the high frequency component) but did not affect UsEn. The percentage decrease in systolic blood pressure (SBP) after SA was 11.4 (9.9)% in group HI, whereas it was 17.5 (9.8)% in group LO ( P < 0.05). Furthermore, the number of patients who developed hypotension was significantly higher in group LO. Conclusion: SA significantly decreased LF/HF without affecting UsEn. Patients with a low UsEn developed a greater decrease in SBP after SA. Furthermore, the incidence of hypotension after SA was higher in patients with a low UsEn. [ABSTRACT FROM AUTHOR]

Background and purpose:α1-Adrenoceptor antagonists are extensively used in the treatment of hypertension and lower urinary tract symptoms associated with benign prostatic hyperplasia. Among the side effects, ejaculatory dysfunction occurs more frequently with drugs that are relatively selective for α1A-adrenoceptors compared with other drugs of this class. This suggests that α1A-adrenoceptors may contribute to ejaculation. However, this has not been studied at the molecular level.Experimental approach:The physiological contribution of each α1-adrenoceptor subtype was characterized using α1-adrenoceptor subtype-selective knockout (KO) mice (α1A-, α1B- and α1D-AR KO mice) since the subtype-specific drugs available are only moderately selective. We analysed the role of α1-adrenoceptors in the blood pressure and vascular response as well as ejaculation by determining these variables in α1-adrenoceptor subtype-selective KO mice and in mice with all their α1-adrenoceptor subtypes deleted (α1-AR triple-KO mice).Key results:The pregnancy rate was reduced by 50% in α1A-adrenoceptor KO mice, and this reduction was dramatically enhanced in α1-adrenoceptor triple-KO mice. Contractile tension of the vas deferens in response to noradrenaline was markedly decreased in α1A-adrenoceptor KO mice, and this contraction was completely abolished in α1-adrenoceptor triple-KO mice. This attenuation of contractility was also observed in the electrically stimulated vas deferens.Conclusions and implications:These results demonstrate that α1-adrenoceptors, particularly α1A-adrenoceptors, are required for normal contractility of the vas deferens and consequent sperm ejaculation as well as having a function in fertility.British Journal of Pharmacology (2007) 152, 332–340; doi:10.1038/sj.bjp.0707366; published online 2 July 2007 [ABSTRACT FROM AUTHOR]

Background Few studies have compared the efficacy of proton pump inhibitors in resolving the symptoms of non-erosive reflux disease (NERD) and of erosive gastro-oesophageal reflux disease (GERD) in Japan. Aim To investigate and compare the efficacy of 4-week course of rabeprazole 10 mg/day on symptom resolution in NERD and erosive GERD in Japan. Methods The modified Los Angeles classification was used to grade endoscopically GERD in patients with heartburn (Grades N and M: NERD, Grades A and B: mild reflux oesophagitis (RO), and Grades C and D: severe RO). Rabeprazole 10 mg/day was administered for 4 weeks to 180 patients who kept symptom diaries. Results Complete relief of the symptoms was achieved in 35.8% of the NERD group and 55.4% of the erosive GERD group (mild RO: 51.1% and severe RO: 77.8%). Rabeprazole was significantly more effective in erosive GERD than in NERD patients. Among the NERD subgroups (Grades N and M), no difference in symptom improvement was observed. Conclusions Four-week, rabeprazole 10 mg/day acid suppression therapy was effective in resolving symptoms in Japanese GERD patients. This therapy was more effective in erosive GERD than in NERD patients, and in those with severe RO than in those with mild RO. [ABSTRACT FROM AUTHOR]

The objective of this study was to compare linear and non-linear analysis of heart rate variability (HRV) in terms of correlation with haemodynamic fluctuation during induction of general anaesthesia. Pre-operatively, HRV was estimated by the MemCalc method in 114 patients scheduled for general anaesthesia. After anaesthesia was induced with propofol, fentanyl and vecuronium bromide, tracheal intubation was performed. Haemodynamic fluctuations during induction of anaesthesia were recorded and the correlation between pre-operative HRV and haemodynamic fluctuation was examined using logistic regression analysis. As an index of non-linear analysis of HRV, ultra short-term entropy (UsEn) correlated better with blood pressure fluctuation than did the ratio of the power of low frequency component of HRV to that of high frequency component (LF/HF). In contrast, although LF/HF significantly correlated with heart rate increase caused by tracheal intubation, the correlation between UsEn and heart rate fluctuation was not significant. [ABSTRACT FROM AUTHOR]

Background Degranulated mast cells may be missed by histochemical and immunohistological techniques, making the histological assessment of activated mast cells difficult. Aim To use a novel mast cell surface antigen 1 (MASA-1) to detect activated mast cells. Methods Surgical samples of human intestine were obtained from 15 patients with ulcerative colitis (UC), 14 patients with Crohn's disease (CD) and 11 controls. Frozen sections were cut and MASA-1 was detected and quantified by enzyme immunohistology. Immunohistological double staining with anti-MASA-1 and either anti-CD68 or anti-c-Kit antibody was also performed. Results The number of MASA-1-positive cells was significantly higher in the submucosal layer and muscularis propria in patients with CD than in patients with UC or controls. The number of MASA-1-positive cells was significantly higher in the muscularis propria in patients with UC in highly inflamed colon compared with controls and less inflamed colon. Human intestinal MASA-1-positive cells are not from the macrophage lineage and showed heterogeneous expression of c-Kit. Conclusion The increased number of mast cells in the submucosa and muscularis propria in patients with CD suggests that the involvement of activated mast cells in transmural inflammatory responses possibly including tissue remodelling. [ABSTRACT FROM AUTHOR]

Background Atrophic and inflammatory changes in the gastric mucosa are commonly observed in Japanese patients with functional dyspepsia. However, detailed data regarding the correlation between the severity of these changes and the symptoms of functional dyspepsia are not available. Aim To evaluate grading scales of gastric atrophy and inflammation, severity of clinical symptoms, and gastric emptying in patients with functional dyspepsia. Methods Ninety-three patients with dyspepsia were enrolled. The severity of gastric atrophy was graded through serological and histological examination, and gastric inflammation was evaluated histologically. Clinical symptoms were evaluated on the Gastrointestinal Symptoms Rating Scale, including subscales for abdominal pain, acid reflux, diarrhoea, indigestion and constipation. Gastric emptying half-time was measured using a radioisotope technique. Results Helicobacter pylori infection and gastric inflammation influenced neither clinical symptoms nor gastric emptying time. However, a correlation was observed between gastric atrophy as graded by serological examination and indigestion ( R = 0.31, P = 0.01). Histological examination also showed a correlation between gastric atrophy and abdominal pain and indigestion ( R = 0.31, P = 0.04 and R = 0.35, P = 0.02 respectively). Conclusion Gastric atrophy associated with H. pylori infection may be partly responsible for the clinical symptoms experienced by patients with functional dyspepsia. [ABSTRACT FROM AUTHOR]

A Bombyx EST cDNA database was searched using the Drosophila takeout gene and nine cDNAs were obtained. The homology search suggested that these genes are widespread in insects and organize a large gene family, and that they have hydrophobic ligands. A phylogenetic tree indicated that the genes are first divided into two large groups, juvenile hormone binding protein and other protein genes, and the latter group diversified within a short time at an early stage. The expression study of five Bombyx genes indicated that they are expressed in various tissues and are regulated by development and feeding conditions. The Bombyx genes might have roles related to the regulation of metabolism, growth or development related to nutritional conditions. [ABSTRACT FROM AUTHOR]

: Several studies in Western countries showed that proton-pump inhibitors are superior to histamine2-receptor antagonists or placebo in the treatment of non-erosive gastro-oesophageal reflux disease. The efficacy of acid-suppressive drugs for non-erosive gastro-oesophageal reflux disease in Japan, in which the prevalence ofHelicobacter pyloriinfection is higher compared with Western countries, is unknown.: To compare the efficacy of famotidine and omeprazole in Japanese patients with non-erosive gastro-oesophageal reflux disease by a prospective randomized multicentre trial.: A total of 98 patients received either famotidine 20 mg b.d. (n = 48) or omeprazole once daily (n = 50). Frequency of gastro-oesophageal reflux disease symptoms and health-related quality of life were evaluated at baseline and after 4 weeks of treatment. Complete relief was defined as no gastro-oesophageal reflux disease symptoms during the 7-day interval in week 4.: Complete relief was achieved in 23 (48%) of patients receiving famotidine and 28 (56%) of patients treated with omeprazole. In the famotidine group, complete relief rate inH. pylori-negative patients was significantly lower thanH. pylori-positive patients (35% vs. 64%). Both famotidine and omeprazole improved most scales of health-related quality of life. Omeprazole significantly improved reflux score irrespective ofH. pyloriinfection while famotidine significantly improved reflux score inH. pylori-positive patients but not inH. pylori-negative patients.: Omeprazole is more effective than famotidine for the control of gastro-oesophageal reflux disease symptoms inH. pylori-negative patients, while similar efficacy is observed inH. pylori-positive patients with non-erosive gastro-oesophageal reflux disease. [ABSTRACT FROM AUTHOR]

: The association between cure of Helicobacter pylori infection and the development of gastro-oesophageal reflux disease is controversial. : To examine the prevalence of symptomatic GERD (sGERD) in Japanese patients with peptic ulcer disease after successful eradication and identify associated factors affecting sGERD development. : We retrospectively examined 72 patients (40 gastric ulcer and 32 duodenal ulcer) with successful eradication. Associated factors such as age, gender, drinking and smoking habits, body mass index, presence of gastric atrophy and hiatal hernia were analysed. : Seven (9.7%) of 72 peptic ulcer patients newly developed sGERD. There were no differences in mean age, gender, smoking habit, drinking habit, body mass index, or presence of gastric atrophy and hiatal hernia between the sGERD and non-sGERD groups, while the proportion of subjects aged over 70 was significantly higher in the sGERD than the non-sGERD group. Six of 40 patients with gastric ulcer newly developed sGERD while only one of 32 patients with duodenal ulcer developed it. : Approximately 10% of Japanese patients with peptic ulcer disease newly developed sGERD after cure of H. pylori infection. Age > 70 years was associated with development of sGERD. Eradication in patients in this age group should be carefully determined. [ABSTRACT FROM AUTHOR]

: Mitogen-activated protein (MAP) kinases, including extracellular signal-regulated kinases (ERK),c-Jun NH2-terminal kinases (JNK) and p38 MAP kinase (p38 MAPK) are important intermediates of the signal-transduction pathway from the cell surface to the nucleus. Expression of cyclooxygenase (COX)-2, associated with proliferation, apoptosis or both of gastrointestinal cancer cells, is mediated through MAP kinase families. However, the correlation between respective MAP kinase signals and COX-2 in the proliferation of gastric and colon cancer cells has not been well elucidated. : We examined the effect of selective inhibitors of MAP kinases and COX-2 on serum-induced proliferation of gastric (MKN45) and colon (HT29) cancer cells. : After 24-h serum starvation, cancer cells were stimulated with 2% serum and COX-2 inhibitors (NS398 10 µmol/L, or etodolac 100 µmol/L) or 1 h after preincubation with inhibitors for ERK (PD98059 20 µmol/L) or p38 MAPK (SB203580 10 µmol/L). Phosphorylated MAP kinases and COX-2 protein were evaluated by Western blotting, and the proliferation of cancer cells was estimated by 3H-thymidine incorporation. Transcription factors nuclear factor-κB and CREB were assayed by an electorophoretic mobility shift assay. : Serum increased the proliferation of MKN45 and HT29 cells by 280% and 200%, respectively, compared with the control levels (100%). In both cancer cells, phosphorylated MAP kinases were increased within 30 min after stimulation. PD98059 and SB203580 inhibited the serum-induced proliferation of MKN45 by 21% and 51% and of HT29 by 81% and 69%, respectively. NS398 and etodolac inhibited the proliferation of HT29 by 21% and 41%, respectively, but not that of MKN45. PD98059 and SB203580 also suppressed serum-induced expression of COX-2 protein in HT29 cells. In addition to the activation of MAP kinases and COX-2, activities of nuclear factor-κB and CREB were also increased during HT29 cell proliferation. : These results suggest that the correlation of MAP kinases with COX-2 induction for cell proliferation differs between MKN45 and HT29 cells. [ABSTRACT FROM AUTHOR]

Summary 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-α (TNF-α), 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-α 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. [ABSTRACT FROM AUTHOR]

Summary Background : In Helicobacter pylori infection, the effect of short-term triple therapy with proton pump inhibitor plus two antibiotics on gastric ulcer healing is not well known. Aim : To compare 1-week triple therapy with 8-week proton pump inhibitor therapy on gastric ulcer healing in infected patients. Patients and methods : We randomly assigned 120 patients with H. pylori and gastric ulcers to proton pump inhibitor plus amoxicillin and clarithromycin for 1 week (n = 61) or proton pump inhibitor alone for 8 weeks (n = 59), with endoscopic assessment of ulcer healing 8 weeks after the start of treatment. Results : Triple therapy eradicated H. pylori in 51 patients [intention-to-treat, 84%; 95% confidence interval (CI), 75–93%]. At 8 weeks, gastric ulcers were healed in 30 patients given triple therapy (49%; 95% CI, 37–62%) and in 49 patients given proton pump inhibitor (83%; 95% CI, 73–93%, P < 0.001). Healing rates in the triple therapy and proton pump inhibitor-only groups were 89% and 100%, respectively, for ulcers of < 1.0 cm in diameter, 54% and 77% for ulcers of 1.0 to < 1.5 cm in diameter, and 5% and 77% (P < 0.001) for ulcers of ≥ 1.5 cm in diameter. Conclusions : One-week triple therapy healed most ulcers of < 1.0 cm, but not ulcers of ≥ 1.5 cm. Short-term therapy is effective for gastric ulcers of < 1.0 cm, but, for larger ulcers, follow-up therapy to suppress acid is needed. [ABSTRACT FROM AUTHOR]

Background: Ornithine decarboxylase (ODC), a rate-limiting enzyme of polyamine biosynthesis, mediates epithelial cell proliferation and plays a critical role in the optimal repair of gastric mucosal damage. Several studies have shown that Helicobacter pylori inhibits the growth and proliferation of gastric cells in vitro . Aim: To test whether H. pylori extract affects ODC mRNA expression and its enzyme activity in gastric cells and to examine the partial characterization of the molecule responsible for this effect. Methods: Human gastric cells (MKN-45) were used. Bacterial extracts from various E. coli or H. pylori strains, namely (1) cagA[sup +] , vacA[sup +] , CagA[sup +] , VacA[sup +] ; (2) cagA[sup +] , vacA[sup +] , CagA[sup +] VacA[sup –] ; or (3) cagA[sup –] , vacA[sup +] , CagA[sup –] , VacA[sup –] were added to the cells. Cell proliferation was assessed by [[sup 3] H]-thymidine incorporation, viability by MTT assay and LDH release test, ODC enzyme activity by [sup 14] CO[sub 2] counts from L-[1[sup 14] C]ornithine, and ODC mRNA by Northern blotting. Results: H. pylori and E. coli extract did not affect viability of gastric cells. H. pylori extract, especially extracts containing a protein greater than 50 kDa, significantly inhibited proliferation and ODC activity of gastric cells while E. coli extract had no effect. Inhibition of ODC activity was found in extracts of all H. pylori strains, irrespective of CagA and VacA protein expression. Serum stimulation induces an increase in ODC mRNA while H. pylori extract did not affect ODC mRNA expression. Conclusion: High molecular weight (greater than 50 kDa) proteins of H. pylori extract without CagA or VacA protein inhibited proliferation and ODC activity of human gastric cells, but did not affect ODC mRNA expression, suggesting that inhibition of ODC activity is regulated at the post-transcriptional level. [ABSTRACT FROM AUTHOR]

Background: Epidermal growth factor (EGF), which binds to EGF receptors (EGF-R), stimulates oesophageal epithelial cell proliferation, enabling rapid repair after mucosal injury. In the normal human oesophageal epithelium, EGF-R expression is present and confined to the basal layer. Aim: To examine histological changes in and dynamics of EGF-R expression during healing after acid reflux oesophagitis in a rat model. Methods: Gastric acid reflux oesophagitis was induced in Wistar rats by ligation of the pylorus and the transitional region between the forestomach and the grandular portion for 5 h, followed by release of both ligations. Rats were killed 7 and 14 days after production of oesophagitis to examine macroscopic and histological changes as well as dynamics of EGF-R expression. Epithelial cell proliferation was assessed by bromodeoxyuridine (BrdU) uptake, and expression of EGF-R mRNA and protein by RT–PCR and Western blotting or immunohistochemistry. Results: Gastric acid reflux induced erosive and ulcerative mucosal lesions in the lower and middle part of the oesophagus. These lesions were healed by 14 days and histologically showed thickening of the oesophageal epithelium from 41.11 ± 3.09 μm in controls to 142.73 ± 11.59 μm (P < 0.001) in ligated rats, as well as elongation of papillae and basal cell hyperplasia. The number of BrdU-positive cells among basal cells on day 14 was significantly increased from 7.1 ± 0.8/field in controls to 30.9 ± 3.0/field in ligated rats. Expression of EGF-R mRNA and protein was significantly increased on day 14 and most basal cells were immunohistochemically positive in both BrdU and EGF-R staining. Conclusion: Acid reflux-induced oesophageal injury caused basal cell hyperplasia with an increase in cell proliferation and EGF-R expression. Activation of EGF-R gene and protein in response to acid reflux-induced injury may facilitate mucosal healing. These results suggest that... [ABSTRACT FROM AUTHOR]

Abstract Aims The present study examines the relationship between markers of endothelial dysfunction and diabetic neuropathy or consequent neuropathic foot ulceration in patients with Type 2 diabetes mellitus. Methods We studied 65 Type 2 diabetic patients including 25 diabetic patients without neuropathy, 27 with neuropathy but no history of foot ulceration, and 13 with neuropathic ulceration. Plasma concentrations of von Willebrand factor (vWF) and soluble thrombomodulin (TM), measures of endothelial dysfunction, were determined by enzyme immunoassays. We performed various tests quantifying aspects of diabetic neuropathy including vibration perception threshold (VPT; for sensory neuropathy), coefficient of variation of R–R intervals (CVR–R ; for cardiac autonomic neuropathy), and cold-induced vasodilation in the great toe for peripheral sympathetic neuropathy. Results CVR–R and cold-induced vasodilation were significantly diminished in patients with neuropathic foot ulceration compared with patients with neuropathy but no history of foot ulceration. Plasma vWF concentrations were positively correlated with VPT and cold-induced vasodilation test, and were inversely correlated with CVR–R . Multivariate analysis disclosed that VPT and percentage vasodilation were independent factors for plasma vWF. Plasma vWF was significantly elevated in patients with foot ulceration compared with patients without neuropathy or those with neuropathy but not foot ulceration. However, plasma TM concentrations did not differ between the three groups. Conclusions Diabetic patients with neuropathic foot ulceration had severe impairment of cardiac autonomic and peripheral sympathetic nerves. Elevation of vWF in plasma was associated with neuropathic foot ulceration, linking endothelial dysfunction to foot ulceration. [ABSTRACT FROM AUTHOR]

Interleukin-1β (IL-1β) participates in cell growth, differentiation and apoptosis via activation of several kinases in a variety of cells. Mitogen-activated protein (MAP) kinases are important intermediates of the signal transduction pathway from the cell surface to the nucleus, leading to activation of transcription factors. There are no reports on the effect of IL-1β on these pathways in gastric epithelial cells. To investigate whether IL-1β activates MAP kinases [extracellular signal-regulated kinases (ERKs), c-Jun NH[sub2]-terminal kinases (JNKs) and p38 MAP kinase (p38 MAPK)] and nuclear factor (NF)-κB, a transcription factor, in gastric epithelial cells (RGMI). Activity of ERKs was detectable at 10 min, peaked at 20 min, and continued at increased levels until 40 min. Activity of both JNKs and p38 MAPK were detectable during 5–20 min, and then decreased within 40 min. Activation of NF-κB occurred at 30 min, and increased activity continued for 6h. Interleukin-1 IL-1β activated MAP kinases and NF-κB in RGMI cells. The activation induced by this cytokine may play an important role in the initiation of the inflammatory process in gastric mucosa. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about a study which clarifies how respiration influences the feasibility of subclavian venous catheterization.

Heart rate variability (HRV) was investigated using a new technique for time series analysis combining the maximum entropy method and non-linear least squares method – the ‘MemCalc method’–in patients undergoing general anesthesia with sevoflurane and fentanyl for elective surgery. As the occurrence of junctional rhythm coincided with the measurement of these variables in two patients, we successfully evaluated the entropy, low (LF) and high (HF) frequency component of the HRV during junctional rhythm and found that the occurrence of junctional rhythm is associated with marked decreases in the entropy, LF and HF of HRV. When evaluating autonomic control of the heart using HRV analysis, the decrease in HRV caused by the occurrence of junctional rhythm must be taken into account. [ABSTRACT FROM AUTHOR]

A response from the author of the article regarding the oesophageal basophil infiltration which was significantly higher in patients with eosinophilic oesophagitis (EoE) and those individuals with proton pump inhibitor-responsive oesophageal eosinophilia (PPI-REE) in the 2015 issue is presented.

A letter to the editor is presented in response to the article "A marked decrease in heart rate variability associated with junctional rhythm during anesthesia with sevoflurane and fentanyl," by Y. Fujiwara, Y. Asakura, Y. Shibata, K. Nishiwaki and T. Komatsu.

A letter to the editor is presented about the anesthetic management of infra-inguinal vascular reconstruction surgery.

A letter to the editor is presented about the attitude towards red blood cell transfusion for bleeding at childbirth in women.

A letter to the editor is presented wherein the analysis of World Health Organization's three-step analgesic ladder for management of neuroleptic malignant syndrome is being performed with a medical case.