New Frontiers in Gut Nutrient Sensor Research: Monosodium l-Glutamate Added to a High-Energy,High-Protein Liquid Diet Promotes Gastric Emptying: a Possible Therapy for Patients With Functional Dyspepsia

Functional dyspepsia is a clinical syndrome that features abdominal symptoms centered in the upper abdomen without an organic basis. Three possible mechanisms of gastric dysfunction could be related to functional dyspepsia: 1) delayed gastric emptying, 2) impaired gastric accommodation to food intake, and 3) hypersensitivity to gastric distention. Delayed gastric emptying has been suggested to lead to prolonged antral distension that causes dyspeptic symptoms. Delayed gastric emptying is therefore a focal point of debate about anorexia caused by dyspepsia, and prokinetic agents are often administered in Japan for its treatment. Recently, we found that addition of monosodium l-glutamate (MSG) to a high-energy liquid diet rich in casein promoted gastric emptying in healthy men. Therefore, another potential method to improve delayed gastric emptying could be enhancement of chemosensors that activate the autonomic nervous system innervating the gastrointestinal tract. In conclusion, enrichment with glutamate promoted gastric emptying after intake of a high-protein meal, suggesting that free glutamate is important for protein digestion and that MSG may be helpful for management of delayed gastric emptying in patients with functional dyspepsia.     

Leukocyte-Poor Platelet Concentrates at the Bedside by Filtration through Sepacell-PL

We developed a new filter, 'Sepacell-PL', consisting of a blood administration set for the preparation of leukocyte-poor platelet concentrates at the patient's bedside. This filter is packed with 1.8 microns polyester fibers coated with a new polymer, and has a volume of 14 ml. Sepacell-PL removed more than 99% of the leukocytes while approximately 93% of platelets were recovered from 10 units of platelet concentrates which contained 5 x 10(8) leukocytes and 3 x 10(11) platelets. The functions of pre- and postfiltrated platelets were unchanged. The filtration procedure is very simple, without priming with saline to remove air and wet the filter. Moreover, platelet concentrates can be passed through the filter at a flow rate of 4 ml/min, or at a higher flow rate of 54 ml/min by gravity.     

Hämosiderinbefunde in Leber,Milz und Lunge bei Neugeborenen und Säuglingen

Zusammenfassung Mit der Berliner-Blau-Reaktion wurde histologisch Gehalt und Verteilung von Hämosiderin in Leber, Milz und Lunge bei Totgeburten, Neugeborenen, Säuglingen und Kleinkindern untersucht. Die Untersuchung erstreckte sich auf insgesamt 59 Todesfälle im Alter bis zu 2 Jahren. Der Hämosideringehalt erweist sich als altersabhängig, wobei er mit zunehmendem Lebensalter abnimmt. Fälle von plötzlichem Kindstod lassen keine relevant abweichenden Befunde erkennen. In der Leber ist das Hämosiderin überwiegend läppchenperipher lokalisiert, in der Milz besteht eine diffuse Siderose der roten Pulpa, und in der Lunge finden sich meist nur diskrete intrapleurale sowie septale und perivasale Eisenpigmentablagerungen. Die Wertigkeit dieser Hämosiderinbefunde wird diskutiert.     

Stochastic resonance in auditory steady-state responses in a magnetoencephalogram

OBJECTIVE: To see whether stochastic resonance can be triggered in the auditory steady-state responses (ASSRs) in a magnetoencephalogram (MEG). METHODS: We measured ASSRs to 1kHz sinusoidal tone modulated at 40Hz with various intensities of white noise and obtained its power and degree of phase synchrony. RESULTS: Group statistics showed a significant enhancement in phase synchrony of ASSR by the presence of white noise of appropriate intensity. Tests on individual subjects showed that the data of four out of nine subjects exhibited enhancements in power or phase synchrony. CONCLUSIONS: The ASSRs exhibit stochastic resonance of the so-called I-type (I for information) shown in phase synchrony when responding to modulated sinusoidal sound superimposed with weak white noise. SIGNIFICANCE: The gamma-band component and other oscillatory components in the brain activity have been recently ascribed by some researchers to the result of stochastic resonance caused by internal noise in the brain. Therefore the presence of stochastic resonance in ASSRs may be evidence to the hypothesis that ASSRs are related to the ongoing gamma-band component.     

ENDOSCOPIC NECROSECTOMY UNDER DIRECT VISION AFTER ENDOSCOPIC ULTRASOUND‐GUIDED CYSTGASTROSTOMY FOR ORGANIZED PANCREATIC NECROSIS

A 56‐year‐old man was referred for an enlarging pancreatic pseudocyst that developed after severe acute pancreatitis with gallstones. Abdominal ultrasound showed a huge cystic lesion with a large amount of solid high echoic components. Arterial phase contrast‐enhanced computed tomography scan revealed arteries across the cystic cavity. Stents were placed after endoscopic ultrasound‐guided cystgastrostomy; however, the stents were obstructed by necrotic debris, and secondary infection of the pseudocyst occurred. Therefore, the cystgastrostomy was dilated by a dilation balloon, and a forward‐viewing endoscope was inserted into the cystic cavity. Many vessels and a large amount of necrotic debris existed in the cavity. Under direct vision, all necrotic debris was safely removed using a retrieval net and forceps. One year after this procedure, there was no recurrence. Our case indicates that peripancreatic fat necrosis can cause exposure of vessels across/along the cystic cavity, and blind necrosectomy should be avoided.     

EFFICACY OF AZATHIOPRINE IN MILD OR MODERATE RELAPSE IN CROHN'S DISEASE: CLINICAL AND ENDOSCOPIC EVALUATION

Aim: The present study was aimed at evaluating the efficacy of azathioprine (AZA) in patients with active and relapsing Crohn's disease (CD) and the usefulness of endoscopy in this evaluation. Methods: The 53 patients with active CD treated with AZA at our hospital were subjected to the following retrospective analysis: (i) evaluation of the clinical efficacy of AZA through comparison of the Crohn's disease activity index (CDAI); (ii) analysis of the relationship of the clinical efficacy to the difference in the mean corpuscular volume (MCV); (iii) evaluation of mucosal healing through analysis of the scores of the endoscopic findings in 16 patients; and (iv) analysis of the relapse rate. Results: (i) Among the 53 patients, treatment was rated as having induced complete remission in 22.6%, as being effective in 41.5%, and as being ineffective in 13.3% of patients. The treatment was discontinued in 22.6% of patients. (ii) The post‐treatment MCV was significantly increased after treatment. (iii) When the ulcer score estimated after treatment was compared with that before the start of treatment, a significant improvement of the score was noted. (iv) When the non‐relapse rate after AZA therapy was calculated in the 41 patients followed up for 12 months, it was 84.8%. Conclusion: AZA was shown to cause endoscopic mucosal healing as well as clinical efficacy. In the present study, it was inferred that the efficacy of AZA therapy in CD patients is manifested clinically first and that mucosal healing is an effect that occurs later.     

DIAGNOSIS AND CLINICAL COURSE OF ULCERATIVE GASTRODUODENAL LESION ASSOCIATED WITH ULCERATIVE COLITIS: POSSIBLE RELATIONSHIP WITH POUCHITIS

Background and Aim: Ulcerative colitis (UC) is not only characterized by pathological lesions localized to colonic mucosa, but also to various complications involving other organs, including postoperative pouchitis. Among these complications, diffuse gastroduodenitis with lesions resembling colonic lesions has been reported, albeit rarely. The aim of the present study was to attempt to characterize the lesions of the upper gastrointestinal tract occurring as a complication of UC, and to assess the frequency and clinical course of these lesions. Methods: A total of 322 UC patients who had undergone upper gastrointestinal endoscopy were retrospectively analyzed. We assessed the frequency of endoscopic findings, including diffuse gastroduodenal lesions resembling colonic lesions. Ulcerative gastroduodenal lesion (UGDL) associated with UC was diagnosed if lesions satisfied the following criteria: (i) improvement of the lesions with treatment of UC; and/or (ii) resemblance to UC in pathological findings. Results: UGDL satisfying the aforementioned criteria was found in 15 (4.7%) of 322 patients. All the 15 patients had UGDL accompanied by pancolitis or after proctocolectomy. Frequency in 146 patients with pancolitis was 6.2% (nine patients) and that in 81 patients who had undergone proctocolectomy was 7.4% (six patients). Four patients with diffuse ulcerative upper‐gastrointestinal mucosal inflammation (DUMI) had pouchitis. In all patients except one, the lesions resolved easily with medical treatment. Conclusions: In more than half of the post‐proctocolectomy patients, UGDL was related to the occurrence of pouchitis. The existence of characteristic UGDL must be taken into account in the diagnosis and treatment of UC, and UGDL is possibly related to the occurrence of pouchitis.     

Cerebral microvessel endothelium is producing endothelin

Endothelin, a potent vasoconstrictor peptide, was recently isolated from the supernatant of the cultured endothelia of the porcine aorta and is now supposed to be the most likely candidate for the endothelium-derived contractile factor (EDCF), which is responsible for the endothelium-dependent vasoconstriction by various stimuli. In this study, the production of endothelin by the endothelia of porcine cerebral microvessels was revealed by the Northern blot analysis with porcine endothelin cDNA probe and the enzyme-linked immunosorbent assay (ELISA) with anti-porcine endothelin antibody. Our results raise the possibility that the endothelia of cerebral microvessels regulate the local blood flow within the brain through the production of endothelin.