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Background and Aim: There is no gold standard for making the diagnosis of autoimmune hepatitis (AIH), and the diagnosis of acute onset AIH (A‐AIH) is most challenging. A‐AIH sometimes develops into acute liver failure with poor prognosis if the diagnosis is delayed. Therefore, it is most important for the better prognosis to diagnose non‐severe A‐AIH early and treat appropriately. However, features in the early stage of A‐AIH are unclear. We examined initial characteristics of non‐severe A‐AIH in detail and tried to find novel clinical features for the early diagnosis. Methods: Clinical, biochemical, immunological, radiological, and histological features of 71 patients (54 women, mean age 57.9 ± 14.3 years) with non‐severe A‐AIH admitted to community hospitals between 2001 and 2022 were analyzed retrospectively. Result: Forty‐six had no symptom on onset and liver injuries were discovered by regular medical checkups. The mean duration from onset to consultation was 25.0 ± 29.3 days. Liver histology showed acute hepatitis in 59% and chronic hepatitis in 41%. Patients with symptoms revealed more male sex (P = 0.039), higher alanine aminotransferase (P < 0.001), higher total bilirubin (P < 0.001), and higher rate of histological acute hepatitis (P = 0.0013) than those without symptoms significantly. Male sex, presence of symptoms on onset, occurrence of jaundice in the course, and histological acute hepatitis were correlated. Conclusions: Sixty‐five percent of non‐severe A‐AIH patients were asymptomatic on onset, suggesting that A‐AIH would develop insidiously and present a longer clinical course than that reported. Male patients more often revealed true acute hepatitis clinically, biochemically, and histologically than female ones. [ABSTRACT FROM AUTHOR]

Aim: Diagnosis of acute onset autoimmune hepatitis (A‐AIH) has been difficult in that patients may not have typical clinicopathological features of AIH. In our previous reports of severe and fulminant AIH, two‐thirds of them showed radiological heterogeneity: hepatic heterogeneous hypoattenuation on unenhanced computed tomography (CT) reflecting heterogeneous distribution of massive hepatic necrosis (severe centrilobular necrosis), which would be beneficial for the diagnosis. In the present study, we analyzed non‐severe A‐AIH patients with or without radiological heterogeneity and tried to find novel clinical features for supporting the early diagnosis. Methods: Clinical, biochemical, immunological, radiological and histological features of 42 patients with non‐severe A‐AIH at community hospitals between 2010 and 2020 were analyzed. Results: Of 42, 28 patients on whom CT scans were performed and who could be fully analyzed were enrolled. Five patients showed hepatic heterogeneous hypoattenuation on unenhanced CT. There was no significant difference in clinical, biochemical, immunological and histological features at diagnosis between the two groups according to the presence of radiological heterogeneity, although mean minimum prothrombin time activity during the course was lower in patients with heterogeneity without statistical significance (p = 0.080). All responded to treatment well and achieved initial remission within 3 months. Conclusions: It is possible that patients with non‐severe A‐AIH show radiological heterogeneity reflecting centrilobular necrosis which is one of important diagnostic features of A‐AIH. Accordingly, radiological heterogeneity might be beneficial for the diagnosis of A‐AIH in combination with conventional clinicopathological features if it is detected in the absence of features suggestive of other liver diseases. [ABSTRACT FROM AUTHOR]

Tropical precipitation anomalies show very different patterns over the central‐eastern equatorial Pacific between the developing and decay phases of extreme El Niño despite similar patterns of sea surface temperature (SST) anomalies. Using observational data and atmospheric simulations for 1979–2018, we identified a meridional dipole mode of tropical precipitation variability, called the Pacific precipitation dipole mode (PPDM), which is critical for seasonally varying rainfall patterns related to extreme El Niño. We examined the mechanism of PPDM using a numerical model and found that the seasonal shift of the warm SST band in the eastern equatorial Pacific, when coupled with extreme SST anomalies, causes phase reversal of the PPDM. The PPDM can be regarded as a different manifestation of the El Niño/Southern Oscillation combination mode, as revealed by the surface wind anomalies, which also explains the distinct impact of extreme El Niño events over East Asia. Plain Language Summary: The rainfall patterns over the tropical Pacific are altered by the underling sea surface temperatures (SSTs). The patterns of rainfall anomalies, that is, deviation from climatological mean states, vary between the developing and decay seasons of extreme El Niño, despite similarity in patterns of SST anomalies. Using observational data and atmospheric simulations driven by observed SST for 1979–2018, we identified a meridional dipole mode of tropical rainfall variability that was asymmetric about the equator, called the Pacific precipitation dipole mode (PPDM). PPDM changes the polarity between autumn and spring, before and after the peak of extreme El Niño, and therefore is critical for seasonally varying rainfall patterns related to extreme El Niño. We examined factors that control the polarity of the PPDM by using a mechanistic model of the atmosphere and found that a coupling between SST anomalies associated with extreme El Niño and the seasonal cycle of the warm SST band in the eastern Pacific, migrating between the two hemispheres in a year, causes PPDM to change polarity between autumn and spring. The excitation of PPDM explains a distinct climatic impact over East Asia during extreme El Niño and also a feedback to extreme El Niño. Key Points: The second leading mode of tropical Pacific precipitation variability shows a meridional dipole pattern called the Pacific precipitation dipole mode (PPDM)PPDM amplifies and reverses its sign between developing and decay phases of extreme El Niño, indicating a nonlinear feature of ENSOCoupling between sea surface temperature anomalies and seasonal cycle in the eastern Pacific excites PPDM, which is a manifestation of ENSO combination mode [ABSTRACT FROM AUTHOR]

Background To prevent gastric cancer, a test-and-treat strategy for Helicobacter pylori has been proposed. This retrospective study assessed the clinical features, efficacy and safety of treatment for H. pylori infection in children and adolescents. Methods Questionnaires concerning the clinical features and treatment of H. pylori in children and adolescents were sent to doctors in 2013. It included questions on patient background, H. pylori-associated disease, first- and second-line treatment, success or failure of eradication, resistance to antibiotics, and occurrence of adverse events. In 2014, serious adverse events associated with treatment were analyzed. Results Invitation letters and questionnaires were sent to 1097 doctors, of whom 409 (37.3%) participated. Finally, 332 patients (mean age, 11.6 ± 3.4 years; male, n = 200) treated from 1997 to 2013 were analyzed. H. pylori-associated gastritis, iron deficiency anemia, and duodenal ulcer occurred most frequently. Success rates for first- and second-line treatments were 73.1% and 79.6%, respectively. Seventy-six H. pylori strains were analyzed for resistance to amoxicillin ( AMPC) and clarithromycin ( CAM), and 64 were analyzed for resistance to metronidazole ( MNZ). CAM resistance was most frequent, occurring in 43.4% of patients; that of MNZ was 21.9%. Adverse events were observed in 13.8% of cases. In total, 587 cases of H. pylori infection were analyzed and no serious adverse events were observed. Conclusions Treatment for H. pylori in children and adolescents is safe, but further studies on treatment regimens should be conducted to improve eradication rates and monitor increasing CAM resistance. [ABSTRACT FROM AUTHOR]

Background: Autoimmune hepatitis (AIH) is one of major etiologies of acute liver failure (ALF), and the survival rate without liver transplantation (LT) of patients with fulminant AIH is especially poor worldwide. We investigated the clinicopathological features of infectious complications in autoimmune ALF retrospectively and tried to determine when to continue corticosteroid (CS) treatment or abandon it for LT. Methods: Twenty patients with autoimmune ALF, comprising five severe hepatitis, 13 fulminant hepatitis and two late onset hepatic failure, were analyzed. Results: Corticosteroids were administered to 19 patients. Seventeen infectious complications were observed in 12 patients. The median (range) duration between the introduction of CS and onset of infection was 15 (10–41) days. There were no significant differences in clinicobiochemical features between patients with and without infection. Of 20 patients, eight (40%) recovered without LT, four (20%) received LT and eight (40%) died without LT. Dead or transplanted patients had more advanced liver failure on admission than recovered ones (P < 0.01). Conclusions: Two‐week after the introduction of CS is a critical point for avoiding infectious complications. Therefore, we should have evaluated efficacy of CS and performed LT by then at the latest in case of failure to improve. Highlight Fujiwara and colleagues reveal that the critical point for switching to liver transplantation without infectious complications in autoimmune acute liver failure is two weeks after the start of corticosteroid treatment. It is crucial to evaluate corticosteroid efficacy and, if no improvement is seen, to perform liver transplantation by that time. [ABSTRACT FROM AUTHOR]

Background: There is, as yet, no gold standard for making the diagnosis of acute onset autoimmune hepatitis (A ‐ AIH). Novel histological characteristics have been reported, but etiologies other than AIH could show similar histological pattern. We attempted to determine what clinical characteristics we should consider as A ‐ AIH different from other etiologies, and to whom histological characteristics should be applied for the diagnosis. Methods: Clinical, biochemical, immunological and pathological features of 46 patients (35 women, mean age 55.9 ± 14.2 years) with non ‐ severe A ‐ AIH admitted to a community hospital between 2001 and 2015 were analyzed. Results: Immunoglobulin G level was normal in 28%, and anti ‐ nuclear antibody titer was < × 80 in 28%. Liver histology of 49% showed acute form and 51% chronic one. Centrilobular necrosis/collapse and/or plasma cell accumulation, rosette formation were characteristic for A ‐ AIH. High levels of alanine aminotranferase persisted in 21 patients who could be observed for equal to or more than 4 weeks before the start of treatment. Conclusions: Long persistence of high levels of alanine aminotransferase would be one of clinical features for considering A ‐ AIH along with conventional features. Histological diagnostic features should be applied for such patients. Guidelines for diagnosing A ‐ AIH should be urgently drawn up. Highlight There is no gold standard for the diagnosis of acute onset autoimmune hepatitis. On the basis of their experience with treatment ‐ naïve patients referred without diagnosis after long observation, Fujiwara and colleagues show that persistence of high alanine aminotransferase levels is one of the clinical features suggesting acute onset autoimmune hepatitis. [ABSTRACT FROM AUTHOR]

Aim The outcome of acute liver failure (ALF) is influenced by its etiology, making etiological consideration of ALF important. However, specific etiology could not be identified in 30-40% of adult patients in a Japanese nationwide survey. We examined our patients with severe (SH) and fulminant hepatitis (FH) of indeterminate etiology for the better understanding of ALF. Methods We investigated 106 adult patients with SH or FH including 24 of indeterminate etiology between 2000 and 2013, retrospectively. Results Of 24 patients, 12 were men. Seventeen were SH and seven FH (three FH acute type and four FH subacute type). Eighty-three percent of patients were positive for antinuclear antibody. Seventeen recovered without liver transplantation (LT), two received LT and five died without LT. Histology of 15 patients showed a pattern of acute hepatitis (massive necrosis in four, submassive necrosis in one, severe acute hepatitis in two and acute hepatitis in eight). The involvement of immune-mediated liver injury was histologically suggested in some patients. Conclusion There was no large cluster of etiology in our patients with indeterminate cause. The causes of ALF of indeterminate etiology were the mixture of various minor or rare ones, if precise diagnosis of acute AIH was done. Outcome of our patients with indeterminate cause was not poor if they were treated as early as possible after the diagnosis of severe disease. Careful examination of unknown viral infection, drugs, toxins, undefined metabolic disorders and histology may help detect some of these etiologies. [ABSTRACT FROM AUTHOR]

Background Infection of Helicobacter pylori mainly occurs in childhood. In Japan, incidence of gastric cancer is still high in the senior citizen population, but little is known about the current H. pylori infection status among children or their family members. Methods As a population-based study, the prevalence of H. pylori infection and change in infection status over a 1-year interval in children were determined. Family members of some participants were also invited to participate in the study to determine their infection status. All children of specific ages attending 16 schools in Sasayama, Hyogo Prefecture, were invited to participate. H. pylori infection was determined by the stool antigen test and diagnosis confirmed by polymerase chain reaction and the urea breath test. Results Helicobacter pylori prevalence was 1.9% among 689 children aged 0-8 years in 2010 and 1.8% among 835 children aged 0-11 in 2011. No feco-conversion was observed in 430 children aged 0-8 years (170 were aged 0-4 years) who provided follow-up stool samples after 1 year. The prevalence of infection was 6% (2 of 33) and 38% (6 of 16) in mothers of negative and positive probands ( p = .04), respectively, and 12% (3 of 25) and 50% (8 of 16) ( p = .01), respectively, in fathers. Conclusion Helicobacter pylori prevalence in Japanese children is approximately 1.8%, which is much lower than that reported in Japanese adults. New infection may be rare. Parent-to-child infection is thought to be the main infection route of the infrequent infection for children in Japan. [ABSTRACT FROM AUTHOR]

Background Rapid urine- HpAb is reported to be a reliable test of Helicobacter pylori infection in adults, but there are no data on the application of the test in children. The aim of this study was to evaluate the accuracy of a urine-based enzyme-linked immunosorbent assay (urine- HpELISA) and immunochromatography (rapid urine- HpAb) kit for anti- H. pylori immunoglobulin G antibody in children. We compared its sensitivity and specificity in reference to the 13 C-urea-breath test ( UBT) and H. pylori stool antigen test ( HpSA). Methods In total, 101 Japanese children without significant upper-abdominal symptoms were included (mean age, 7.1 years; range 2-15 years). Their sensitivity and specificity were evaluated in reference to the UBT and HpSA. Results Thirty-seven children were judged H. pylori-positive and 64 negative by the UBT and HpSA. No discrepancy in the results was observed between UBT and HpSA. Urine- HpELISA showed 91.9% sensitivity and 96.9% specificity with an accuracy of 95.0%. Rapid urine- HpAb showed 78.4% sensitivity and 100% specificity with an accuracy of 92.1%. Seven false negative results for rapid urine- HpAb were from children aged younger than 10 years, and their antibody titers of urine- HpELISA were lower than true positives. Conclusions For the diagnosis of H. pylori infection in Japanese children, both tests are non-invasive, inexpensive, reliable and easy-to-perform methods giving satisfactory accuracy, although the sensitivity of the rapid urine- HpAb kit was inferior to that of the urine- HpELISA kit, especially in children aged younger than 10 years, showing relatively low titer of H. pylori antibody. [ABSTRACT FROM AUTHOR]

The soft X-ray beamline BL23SU at SPring-8 has undergone an upgrade with a twin-helical undulator of in-vacuum type to enhance the experimental capabilities of the endstations. The new light source with a fast helicity-switching operation allows not only the data throughput but also the sensitivity in X-ray magnetic circular dichroism (XMCD) to be improved. The operational performance and potential are described by presenting XMCD results of paramagnetic β-US2 measured with a 10 T superconducting magnet. [ABSTRACT FROM AUTHOR]

Background and Aim: Two types of stool antigen tests have been used in the management of Helicobacter pylori infection. Testmate Pylori Antigen enzyme immunoassay (TPAg EIA) is a direct sandwich enzyme immunoassay (EIA) while Testmate Rapid Pylori Antigen (Rapid TPAg) is performed using immunochromatography. The aim of this study was to study the characterization and usefulness of these tests. Methods: Accuracy of both tests was studied using 111 fecal samples obtained from H. pylori-positive or -negative patients. Cross-reactivity was examined with four other Helicobacter spp. and five fecal bacteria in humans. To estimate the sensitivity of both kits, we tested H. pylori clinical strains. We also examined the diagnostic performances of both tests after the storage for 12 months. Results: The accuracy of both Testmate kits was 100% in fecal samples from 111 patients. No cross-reactivity was observed in both Testmate kits in five fecal bacteria and four other Helicobacter spp. TPAg EIA and Rapid TPAg showed positive results in 1342 of 1344, and 483 of 485 clinical strains, respectively. Diagnostic performances was maintained for 12 months when TPAg EIA was stored at 4°C and Rapid TPAg at 30°C. Conclusions: We examined the details of high accuracy of TPAg EIA and Rapid TPAg. The diagnostic performance of both kits was maintained after storage for up to 1 year. The two types of tests would be useful in the management of H. pylori infection. [ABSTRACT FROM AUTHOR]

Background: The diagnosis of autoimmune hepatitis (AIH) is already difficult, and that of acute-onset AIH with atypical features is even more challenging, even though the revised original diagnostic criteria created by an international AIH group were widely accepted and incorporated into clinical practice. Aims: Recently, simplified diagnostic criteria were proposed. We compared the performance parameters of the simplified scoring system in patients with acute-onset AIH and examined its usefulness and limitations. Methods: Fifty-five patients with acute-onset AIH (29 non severe, 14 severe and 12 fulminant) were assessed according to the simplified scoring system and compared with the revised original one. Results: Of the 55 patients, 22 (40%) were diagnosed as ‘definite’AIH, 28 (51%) as ‘probable’ and five (9%) as ‘non diagnostic’ based on the revised original scoring system. By the simplified scoring system, six (11%) were diagnosed as ‘definite’ AIH, 16 (29%) as ‘probable’ and 33 (60%) as ‘nondiagnostic’. Anti-nuclear antibody titres did not differ among the three groups. The immunoglobulin G level was higher in fulminant than in non-severe patients (P = 0.01). Sixty-five percent showed acute hepatitis (massive necrosis, submassive necrosis and severe acute hepatitis) and 35% showed chronic hepatitis. Conclusions: The revised original scoring system performed better in patients with acute-onset AIH than the simplified scoring system. [ABSTRACT FROM AUTHOR]

Background: Triple therapy with amoxicillin, clarithromycin, and a proton-pump inhibitor is a common therapeutic strategy for the eradication of Helicobacter pylori ( H. pylori). However, frequent appearance of clarithromycin-resistant strains is a therapeutic challenge. While various quinones are known to specifically inhibit the growth of H. pylori, the quinone 1,4-dihydroxy-2-naphthoic acid (DHNA) produced by Propionibacterium has strong stimulating effect on Bifidobacterium. We were interested to see whether DHNA could inhibit the growth of H. pylori in in vitro or in vivo experimental setting. Materials and Methods: The minimum inhibitory concentration (MIC) of DHNA was determined by the agar dilution method. The inhibitory action of DHNA on the respiratory activity was measured by using an oxygen electrode. Germ-free mice infected with H. pylori were given DHNA in free drinking water containing 100 μg/mL for 7 days. Results: DHNA inhibited H. pylori growth at low MIC values, 1.6–3.2 μg/mL. Likewise, DHNA inhibited clinical isolates of H. pylori, resistant to clarithromycin. However, DHNA did not inhibit other Gram negative or anaerobic bacteria in the normal flora of the human intestine. Both H. pylori cellular respiration and adenosine 5′-triphosphate (ATP) generation were dose-dependently inhibited by DHNA. Similarly, the culture filtrates of propionibacterial strains inhibited the growth of H. pylori, and oral administration of DHNA could eradicate H. pylori in the infected germ-free mice. Conclusions: The bifidogenic growth stimulator DHNA specifically inhibited the growth of H. pylori including clarithromycin-resistant strains in vitro and its colonization activity in vivo. The bactericidal activity of DHNA was via inhibition of cellular respiration. These actions of DHNA may have clinical relevance in the eradication of H. pylori. [ABSTRACT FROM AUTHOR]

Background: Over the past few years, the profile of Helicobacter pylori infection has changed in Japan. In particular, the relationship between H. pylori and gastric cancer has been demonstrated more clearly. Accordingly, the committee of the Japanese Society for Helicobacter Research has revised the guidelines for diagnosis and treatment of H. pylori infection in Japan. Materials and Methods: Four meetings of guidelines preparation committee were held from July 2007 to December 2008. In the new guidelines, recommendations for treatment have been classified into five grades according to the Minds Recommendation Grades, while the level of evidence has been classified into six grades. The Japanese national health insurance system was not taken into consideration when preparing these guidelines. Results: Helicobacter pylori eradication therapy achieved a Grade A recommendation, being useful for the treatment of gastric or duodenal ulcer, for the treatment and prevention of H. pylori-associated diseases such as gastric cancer, and for inhibiting the spread of H. pylori infection. Levels of evidence were determined for each disease associated with H. pylori infection. For the diagnosis of H. pylori infection, measurement of H. pylori antigen in the feces was added to the tests not requiring biopsy. One week of proton-pump inhibitor-based triple therapy (including amoxicillin and metronidazole) was recommended as second-line therapy after failure of first-line eradication therapy. Conclusion: The revised Japanese guidelines for H. pylori are based on scientific evidence and avoid the administrative restraints that applied to earlier versions . [ABSTRACT FROM AUTHOR]

Background and Aims: Infection with Helicobacter hepaticus is suggested to play a role in the pathogenesis of chronic liver disease in humans. However, reactive antigens among Helicobacter species make the development of an H. hepaticus ELISA test with high specificity difficult. A new monoclonal antibody from a hybridoma clone (HRII-51) showed high specificity to H. hepaticus without cross-reaction to other gastrointestinal bacteria. Methods: The molecular weight of HRII-51 immunoreactive antigen was examined by Western blot of H. hepaticus probed with the monoclonal antibody HRII-51. A HRII-51-immunoreactive antigen capture ELISA was prepared in which the specific antigen was anchored by HRII-51-immobilized ELISA plate. Accuracy of HRII-51 antigen capture ELISA was examined using sera obtained from mice inoculated with Helicobacter species. Specificity of HRII-51 antigen capture ELISA was compared to that of H. hepaticus antigen-based ELISA using human sera with absorption by H. pylori cell lysate. Results: HRII-51 immunoreactive antigen had a molecular weight of 15 kDa. Sensitivity and specificity of HRII-51 antigen capture ELISA were 87.0% and 97.6% in mice inoculated with Helicobacter species. In human sera, modification of the results by absorption with H. pylori lysate was smaller in HRII-51 antigen capture ELISA comparing with H. hepaticus-antigen-based ELISA. Conclusion: Use of the HRII-51 antigen capture ELISA would be a useful approach for the serodiagnosis of H. hepaticus infection in both experimental animals and humans. [ABSTRACT FROM AUTHOR]

Background and Aim: The aim of the present study was to determine whether additional intraductal ultrasound (IDUS) to confirm complete stone clearance decreases the recurrence rate of common bile duct stones for a 3-year period after endoscopic papillotomy (EPT). Methods: IDUS was carried out with a thin-caliber ultrasonic probe (diameter 2.0 mm, frequency 20 MHz) via transpapillary route after stone extraction. If IDUS showed evidence of residual stones and/or sludge, endoscopic management was performed until IDUS examination was negative. A prospective study was conducted on 59 consecutive patients undergoing additional IDUS after stone extraction between January 1996 and May 2003 (IDUS group). The recurrence rate of common bile duct stones was compared with a historical control group (August 1988 to December 1995) consisting of cases that did not undergo IDUS (non-IDUS group). Potential risk factors for recurrence of common bile duct stones were assessed by univariate and multivariate analysis on logistic regression. Results: In 14 of 59 patients (23.7%), IDUS detected small residual stones not seen on cholangiography. The recurrence rate was 13.2% (17 of 129 patients) in the non-IDUS group and 3.4% (two of 59 patients) in the IDUS group ( P < 0.05). Multivariate analysis subsequently identified non-IDUS status as an independent risk factor for recurrence (odds ratio 5.12, 95% CI 1.11–23.52, P = 0.036). Conclusions: Additional IDUS to confirm complete stone clearance after EPT decreases the early recurrence rate of common bile duct stones. [ABSTRACT FROM AUTHOR]

Aim: Helicobacter pylori is known to enhance gastric carcinogenesis induced by chemical carcinogens. We previously demonstrated that infection with H. pylori strain SS1 did not enhance such carcinogenesis in C57BL/6 mice. Whether this result was due to the bacterial strain SS1 or to the experimental host, C57BL/6 mice, should be addressed. Therefore, we examined whether H. pylori strains introduced to the same host (Mongolian gerbils) differed in carcinogenicity. Materials and Methods: H. pylori TN2GF4 strain (CagA(+), VacA(+)) and SS1 strain (CagA functionally(–), VacA(–)) were infected to Mongolian gerbils (n = 126). In the first experiment (induction of gastritis), histologic change in gastric mucosa of gerbils infected by H. pylori (TN2GF4, SS1, vehicle) without N-methyl- N-nitrosourea (MNU) at 1 month or 6 months was assessed. In the second experiment (experimental carcinogenesis), H. pylori (TN2GF4, SS1, vehicle) was inoculated to the gerbils after administration of MNU for 10 weeks, and the number of cancers and histopathologic changes at week 54 were assessed. Results: In the first experiment, activity and inflammation in the TN2GF4 group were significantly greater than in the SS1 group at 1 month, while no significant difference was noted at 6 months. On the other hand, intestinal metaplasia and atrophy were significantly greater with TN2GF4 than with SS1 at 6 months but not at 1 month. In studies on experimental carcinogenesis, microscopically, 47.8% (11/23), 26% (7/26), and 0% (0/26), of animals had gastric adenocarcinoma in the MNU + TN2GF4 group, MNU + SS1 group, and MNU alone group, respectively. Conclusion: Both H. pylori strains, TN2GF4 and SS1, promoted carcinogenesis in Mongolian gerbils. The severity of gastritis and destruction and restoration of gastric mucosa may be related to gastric carcinogenesis. That the SS1 strain significantly accelerated carcinogenesis only in Mongolian gerbils and not in C57BL/6 mice suggests the crucial role of host factors in carcinogenesis by H. pylori infection. [ABSTRACT FROM AUTHOR]

Abstract: Background: Interferon (IFN)-β is known to be involved in the regulation of bone homeostasis. As IFN-α and -β share the same receptor complex and signaling pathway, we speculated that treatment with IFN-α for chronic hepatitis C (CHC) may provide a beneficial effect on bone loss. Methods: Urinary deoxypyridinoline (uDPD) of 41 patients with CHC who had been receiving IFN-α for 24 weeks was examined during the period of observation. Among them, eight patients showed a bone mineral density (BMD) of less than 0.850g/cm2 before IFN therapy and they were examined a BMD again after completion of IFN administration. Relationships between the percentage difference of uDPD after discontinuation of IFN and various factors related to CHC were also examined. Results: A mean uDPD of 7.1±3.4nM/mM creatinine before IFN therapy decreased to 4.5±2.4 in the 4th week and 4.2±2.7 in the 24th week of IFN therapy, respectively (p <0.0001). The reduction in uDPD was more prominent in cases with a lower viral load (p =0.0266). The BMD of the eight patients, which was less than 0.850g/cm2 before IFN therapy, showed significant increase after the end of therapy (p =0.0172). Conclusion: IFN-α can improve bone resorption in CHC patients, especially in those with a lower viral load, and increased BMD. These effects are thought to be a result of direct action of IFN on bone homeostasis. [Copyright &y& Elsevier]

The authors proposed a method for creating a prediction model for dynamically predicting the load curve in a power distribution system whose composition varied day by day, and then validated its effectiveness for comparisons with measured current values. In the results, the authors divided power distribution lines into interval increments using the contract power category composition ratio and then created a prediction model for various interval patterns based on the substantial dependence of the consumer load curve on contract type. Furthermore, when confirming the prediction precision using their model, the authors found that the absolute average error was 7.7 A, with 95% within 30 A. The relative average error rate was confirmed at 9.6%. Upon systematizing the current value prediction method and performing opinion surveys and evaluations of users running trials in the power distribution system operation business, the authors were able to confirm that the prediction precision of their method was sufficient for the system's needs. © 2005 Wiley Periodicals, Inc. Electr Eng Jpn, 153(2): 14–27, 2005; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/eej.20146 [ABSTRACT FROM AUTHOR]

We reviewed the current status of peroral cholangioscopy under duodenoscopic assistance, which allows direct visualization of the bile duct. Direct visual assessment may be a useful adjunct to endoscopic retrograde cholangiopancreatography (ERCP) for distinguishing malignant from benign bile duct lesions. Several clinical studies suggest the efficacy of peroral cholangioscopy for various bile duct lesions. However, solely cholangioscopic examination may be insufficient to confirm accurate differential diagnosis between benign and malignant strictures or tumor extension of bile duct carcinoma. Directed tissue acquisition in biliary strictures by using peroral cholangioscopy is another application that has not been properly studied because of the limited maneuverability of the long babyscope. Further improvement of suitable instruments and cholangioscopes are needed. [ABSTRACT FROM AUTHOR]

Six patients with active Crohn's disease (CD) unresponsive to conventional medications (CM) were treated with Monocyte-granulocytapheresis (M-GCAP). CD patients who scored 200-400 points in Crohn's disease activity index (CDAI) in spite of receiving CM, including enteral nutrition, for at least 2 weeks were enrolled in our double series trial. Each series had 5 weekly M-GCAP and 2 follow-up weeks, and each M-GCAP treated 1,800 ml of patient's peripheral blood. After the 1st series, patients who decreased more than 50 points on the CDAI were deemed responders and enrolled in the second series. Patients with a CDAI score less than 150 points were considered in remission. The patients' quality of life was evaluated using an index (IBDQ) before and after the 1st series. The CDAI was significantly decreased comparing before and after the 1st series (258.2 ± 36.2 vs. 166.5 ± 16.6; P < 0.02). 50% of patients (3/6) responded to the therapy, and one case (16.7%) could be induced to remission. Significant removal was revealed only for white blood cells (25.6 ± 16.9%; P < 0.05), especially granulocytes (29.5 ± 22.5%; P < 0.05). A statistically significant improvement of IBDQ was revealed in the responders' group (162.3 ± 17.2 vs. 189.3 ± 11.5; P < 0.03). M-GCAP could be an effective adjunctive therapy for active CD patients unresponsive to CM allowing them to maintain a high QOL. However, it might be difficult to improve patients who could not be induced to remission after the 1st series by applying another series. J. Clin. Apheresis 19:168-173, 2004. © 2004 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

We report an erythema nodosum (EN) patient whose condition becameapparent during the clinical course of ulcerative colitis (UC).The patient relapsed frequently in spite of taking a high dose adrenocorticalsteroid during his morbidity period of UC. Monocyte-granulocytapheresis(M-GCAP) was combined with 5-aminosalicylic acid 2250 mg/dayperoral and once a day of steroid enema. Monocyte-granulocytapheresiswas performed once a week for 5 weeks, and succeeded in inducingclinical remission for both UC and EN. The immunological and clinical connectionsbetween UC and EN have never been fully elucidated. In this case,because the symptoms of UC and EN revealed parallel improvementafter his inflammatory reaction had been brought under control by combining M-GCAP therapy, we hypothesize that theonset of EN appeared as a result of the patient's long-term,treatment-resistant immuno-disturbance, which first appeared as symptomsof UC. Immunomodulative effects induced by M-GCAP might help tocontrol other chronic non-specific inflammations not concerned withtargeted organ(s). [ABSTRACT FROM AUTHOR]

Abstract Background. Bacteria have different characteristics in stimulation of human neutrophils to produce reactive oxygen species (ROS) and chemokines. This study examined the ability of Helicobacter pylori to induce production of ROS and chemokines by human neutrophils. Methods. H. pylori strains (1.5 × 108 CFU/ml) were cocultured with 5 × 104 neutrophils isolated from healthy subjects. Samples were incubated with human serum with or without IgG antibodies to H. pylori . ROS production was measured using luminol-dependent chemiluminescence (LmCL), and the concentrations of chemokines (IL-8, RANTES, MIP-1α and MCP-1) were measured by ELISA. Results. The mean of the highest LmCL (peak height; PH) value stimulated by H. pylori was 3318 in the absence of serum. PH increased to 4687 when incubated with anti-H. pylori antibody-positive sera (p < .001) but antibody-negative sera did not affect LmCL response. The mean final concentration of IL-8 produced in the absence of serum was 142.6 pg/ml. Increased IL-8 production was seen by addition of antibody positive serum (p < .01). IL-8 production was not significantly correlated with production of ROS. On the other hand, H. pylori stimulation did not induce neutrophil production of RANTES, MIP-1α or MCP-1. Conclusions. H. pylori was capable of inducing IL-8 production by human neutrophils, but not C-C chemokines. Production of C-X-C dominant chemokine by neutrophils is consistent with the pathological characteristics of H. pylori -induced gastritis, where persistent neutrophil infiltration is present. [ABSTRACT FROM AUTHOR]

ABSTRACTBackground.In preparation of the approval of Helicobacter pylori therapy by the Japanese national health system, the board of directors of the Japanese Society for Helicobacter Research decided to prepare guidelines on the diagnosis and treatment of H. pylori infection for physicians in routine medical practice. Methods.A guidelines preparation committee was formed and six meetings were held. Then, in December 1999, a consensus meeting was held in Kobe to obtain the opinions of general practitioners as well as experts from Europe, North America, and Asia. Results.Helicobacter pylori eradication therapy is recommended in gastric or duodenal ulcer patients. Helicobacter pylori eradication therapy is recommended or gastric mucosa associated lymphoid tissue (MALT) lymphoma but it should be done at specialist institutions. The significance of H. pylori eradication therapy is still under evaluation in patients with hyperplastic polyps, chronic atrophic gastritis, non-ulcer dyspepsia and in patients after endoscopic mucosal resection of gastric cancer and after gastrectomy for gastric cancer. When diagnosing H. pylori infection, at least one of the tests requiring endoscopic biopsy (e.g. rapid urease test, histology, or culture) and tests not requiring biopsy (e.g. measurement of H. pylori antibody or urea breath test) should be used. Multiple tests are recommended to increase the accuracy. The drugs of first choice currently covered by the national health insurance system in Japan are: lansoprazole (30 mg) 1 capsule twice daily, amoxicillin (250 mg) 3 capsules twice daily, and clarithromycin (200 mg) 1–2 tablets twice daily. These three drugs should be administered after breakfast and dinner for 1 week. Conclusion.These guidelines are intended for utilization in routine medical practice after the Japanese national health system begins to cover the management of H. pylori infection. [ABSTRACT FROM AUTHOR]

ABSTRACTBackground.Two triple therapies with lansoprazole (LPZ)/amoxicillin (AMPC)/clarithromycin (CAM) for eradication of Helicobacter pylori were studied in multicenter, double-blind fashion to evaluate the eradication rate of H. pylori and safety of eradiation treatment in Japanese patients with H. pylori-positive active gastric ulcers or duodenal ulcers. Methods.Patients were randomly chosen for the control treatment of LPZ 30 mg twice a day (b.i.d.; Group A-LPZ-only) or the test treatments of LPZ 30 mg plus AMPC 750 mg and CAM 200 mg b.i.d. (Group B-LAC200) and LPZ 30 mg, AMPC 750 mg and CAM 400 mg b.i.d. (Group C-LAC400). All eradication treatments lasted for a period of 7 days. Successful eradication was assessed by culture and gastric histology 1 month after completion of the ulcer treatment. Results.The eradication rates of H. pylori in the full analysis set were 0% in Group A-LPZ-only, 87.5% in Group B-LAC200 and 89.2% in Group C-LAC400 for gastric ulcer and, 4.4% in Group A-LPZ-only, 91.1% in Group B-LAC200 and 83.7% in Group C-LAC400 for duodenal ulcer. The eradication rates of Group B-LAC200 and Group C-LAC400 were 89.2% (95% CI: 84.8–93.7%) and 86.4% (95%CI: 81.5–91.3%) in total in the full analysis set, 89% (95% CI: 84.3–93.7%) and 85.3% (95%CI: 80.1–90.5%) in the per protocol set. The eradication rates in Groups B-LAC200 and group C-LAC400 were statistically significantly higher than the rate in Group A-LPZ-only for both gastric ulcer and duodenal ulcer patients (p < .0001 for both). Conclusion.A satisfactorily high H. pylori eradication rate was obtained in Japanese ulcer patients with the triple therapy regimen consisting of LPZ 30 mg, AMPC 750 mg, and CAM 200 mg b.i.d. [ABSTRACT FROM AUTHOR]

Utilizes the postoperative detection of alpha-fetoprotein (AFP) messenger RNA (mRNA) in blood as a predictor for metastatic recurrence of hepatocellular carcinoma. Results of the electrophoresis of nested polymerase chain reaction products; Correlation between the presence of AFP mRNA and metastatic recurrence; Role of serum AFP levels for long-term prognosis after hepatic resection.

ABSTRACT- To elucidate the role of oncogene expression in hepatocarcinogenesis, we examined the expression of 8 cellular oncogenes by dot blot and/or northern blot analysis in neoplastic, cirrhotic and non-cirrhotic human liver tissues obtained at surgery. Significantly higher levels of c-myc gene expression were observed in tissues of hepatocellular carcinoma (HCC) and adjacent cirrhotic tissues than in apparently normal liver tissues or those of chronic hepatitis (normal-chronic hepatitis). There was a tendency to higher c-myc mRNA levels in HCC than in liver cirrhosis. However, when tumorous and adjacent cirrhotic tissues from the same patient were compared, c-myc mRNA levels were not consistently higher in HCC. No significant differences in mRNA levels of c-fos, N-myc, N-ras, Ha-ras, c-erbA, c-erbB and c-abl were observed among the HCC, cirrhosis and normal-chronic hepatitis groups. Although the significance of increased c-myc gene expression in liver cirrhosis and HCC is still not known, it is conceivable that the persistent elevation of c-myc gene expression in cirrhosis contributes to the development of HCC. [ABSTRACT FROM AUTHOR]

Background and Aim: Ecabet sodium is reported to have a bactericidal effect on Helicobacter pylori and inhibit urease activity in vitro. Methods: Seven male volunteers (mean age, 51.3 years; range, 45-55 years) with H. pylori infection were medicated with 1 g ecabet sodium t.i.d. for 4 weeks. The urea breath test (UBT) was performed 10 times per person: before medication, seven times in 2 weeks, and once in the third and fourth weeks. Stool antigen tests (HpSA PLUS and Testmate pylori antigen) were performed five times per person: before medication and weekly during medication. Results: The premedication UBT value ranged from 4.9‰ to 77.4‰ and from 2.9‰ to 44‰ at the end of the treatment period. Not one of the subjects had a negative UBT result during medication. The optical densities of the HpSA and Testmate pylori antigen tests ranged from 0.4 to > 3.0 premedication and from 0.0 to > 3.0 at the end of treatment. HpSA and Testmate pylori antigen were negative in two cases. Conclusions: In this study, ecabet sodium did not effect the results of UBT in volunteers with H. pylori infection. Ecabet sodium may influence stool antigens because in two of seven cases the H. pylori stool antigen tests returned negative results. [ABSTRACT FROM AUTHOR]

Management of patients with malignant biliary obstruction remains controversial. We reviewed our current status of biliary stenting for malignancy. The initial step in our management is endoscopic nasobiliary drainage, which is used not only for preoperative drainage but also to decide whether or not surgery is appropriate treatment. Although a metal stent has a longer patency time than a plastic stent, it costs up to thirty-fold more than the latter in Japan. Therefore, stent selection, metal or plastic, should be dependent on the expected prognosis of each patient with malignant biliary strictures. In the present paper, we also discuss the efficacy of the covered metal stent and stenting for malignant hilar obstruction. [ABSTRACT FROM AUTHOR]

An 18-year-old woman was treated with leukocytapheresis (LCAP) for her combined ulcerative colitis (UC) and aortitis syndrome (AS). Because a close relationship between these two diseases has been suspected based on their etiological and/or pathological findings, we had hypothesized that LCAP, which has satisfactory effects on inflammatory bowel disease such as UC and Crohn's disease might be effective for both her UC and her AS. After informed consent, LCAP therapy was performed once a week for a total of 7 times. Endoscopic remission of the UC was observed. Even though there were no significant improvements in her subjective symptoms of AS such as side-neck pain and dizziness, objective evidence of improvement was obtained when the patient's condition was compared before and after LCAP by angiography, angio-magnetic resonance imaging, and the plethysmogram of her fingertips. These results suggest that LCAP may be valuable as a new adjunct therapy for AS. [ABSTRACT FROM AUTHOR]