Evaluation of hepatic transport function by hepatobiliary scintigraphy

The transport kinetics of [99mTc]-pyridoxyl-5-methyltryptophan were studied by three-compartment model analysis for hepatobiliary scintigraphy in 45 patients with chronic viral liver diseases. Three-compartment model analysis was studied using the time-activity curves of the regions of the heart, liver, and biliary tract and intestine (excretory compartment). The k12 (hepatic uptake rate constant), k21 (hepatic efflux rate constant), and ke1 (hepatic excretion rate constant) were calculated by the nonlinear least-squares method. Among the three parameters obtained by model analysis, k12 values more prominently differed among diseases and correlated well with blood tests such as total bilirubin, total bile acids, or 15 min retention of ICG. In conclusion, three-compartment model analysis of the hepatic handling of [99mTc]-pyridoxyl-5-methyltryptophan is useful in evaluating hepatic transport function. k12 is the most sensitive parameter for this.     

Effect of N,N-Dimethylglycine on Homocysteine Metabolism in Rats Fed Folate-Sufficient and Folate-Deficient Diets

Objective This study aimed to investigate the effects of N,N-dimethylglycine (DMG) on the concentration and metabolism of plasma homocysteine (pHcy) in folate-sufficient and folate-deficient rats. Methods In this study, 0.1％ DMG was supplemented in 20％ casein diets that were either folate-sufficient (20C) or folate-deficient (20CFD). Blood and liver of rats were subjected to assays of Hcy and its metabolites. Hcy and its related metabolite concentrations were determined using a liquid chromatographic system. Results Folate deprivation significantly increased pHcy concentration in rats fed 20C diet (from 14.19 ± 0.39 μmol/L to 28.49 ± 0.50 μmol/L; P < 0.05). When supplemented with DMG, pHcy concentration was significantly decreased (12.23 ± 0.18 μmol/L) in rats fed 20C diet but significantly increased (31.56 ± 0.59 μmol/L) in rats fed 20CFD. The hepatic methionine synthase activity in the 20CFD group was significantly lower than that in the 20C group; enzyme activity was unaffected by DMG supplementation regardless of folate sufficiency. The activity of hepatic cystathionine β-synthase (CBS) in the 20CFD group was decreased but not in the 20C group; DMG supplementation enhanced hepatic CBS activity in both groups, in which the effect was significant in the 20C group but not in the other group. Conclusion DMG supplementation exhibited hypohomocysteinemic effects under folate-sufficient conditions. By contrast, the combination of folate deficiency and DMG supplementation has deleterious effect on pHcy concentration.     

Relationship between Preoperative Neuroradiological Findings and Intraoperative Bulbocavernosus Reflex Amplitude in Patients with Intradural Extramedullary Tumors

The current study aimed to evaluate the relationship between preoperative neuroradiological findings and intraoperative bulbocavernosus reflex (BCR) amplitude in patients with intradural extramedullary tumors. A total of 24 patients with lesions below the 12th thoracic vertebra were included in the analysis. Objective and subjective urinary symptoms were investigated using data obtained from medical records and the core lower urethral symptom score (CLSS) questionnaire. The lesion compression rate was evaluated with MRI. In the epiconus-to-conus medullaris (Epi-CM) group, BCR amplitude changes were found to be correlated with the compression rate (p <0.05). The preoperative CLSS of the group with a BCR amplitude of <50% was worse than that of the group with ≥50% (p <0.01). The group did not experience symptom improvement 6 months postoperatively based on the CLSS. The preoperative CLSS of the group with compression rate of ≥80% on imaging was worse than that of the group with <80% (p <0.05). In the group with preoperative compression rate of ≥80%, CLSS at 1 month and 6 months postoperatively was improved as compared to preoperative CLSS (p <0.01, p <0.05). Hence, BCR amplitude changes are associated with the degree of lesion compression on preoperative images and pre- and postoperative urinary symptoms. Patients with intradural extramedullary Epi-CM lesions with strong compression are likely to present with low BCR amplitude and worsened postoperative symptoms. It is considered that the risk of postoperative urinary symptoms increases even with careful surgical manipulation under these conditions.     

Clinical trial: comparison of alendronate and alfacalcidol in glucocorticoid-associated osteoporosis in patients with ulcerative colitis

Background  Bone loss is often observed in patients with ulcerative colitis, particularly if they require glucocorticoids.
Aim  To determine whether the bisphosphonate, alendronate, is safe and effective in preserving bone mass compared to the active vitamin D3, alfacalcidol, in ulcerative colitis patients receiving glucocorticoids.
Methods  Thirty-nine patients with ulcerative colitis and treated with glucocorticoids were randomized to receive alendronate (5 mg/day) or alfacalcidol (1 μg/day) daily for 12 months. Loss of bone mass was evaluated by bone mineral density, bone resorption by urinary N -telopeptide for type I collagen, and bone formation by serum bone alkaline phosphatase.
Results  Alendronate, but not alfacalcidol, significantly increased bone mineral density in the lumbar spine. Alendronate decreased serum bone alkaline phosphatase levels, but alfacalcidol did not. Urinary N -telopeptide for type I collagen levels decreased in both groups, but were significantly lower in the alendronate group. There were no significant differences in the adverse events in the two groups.
Conclusion  Our study indicates that alendronate is a safe, well-tolerated and more effective therapy than alfacalcidol for preventing glucocorticoid-associated bone loss in patients with ulcerative colitis.