Delayed Gastric Emptying After Stapled Versus Hand-Sewn Anastomosis of Duodenojejunostomy in Pylorus-Preserving Pancreaticoduodenectomy: a Randomized Controlled trial

Background

A retrospective analysis indicated that the incidence of delayed gastric emptying (DGE) was less after using a circular stapler (CS) for duodenojejunostomy than that after hand-sewn (HS) anastomosis in pylorus-preserving pancreaticoduodenectomy (PpPD). This randomized clinical trial compared the incidence of DGE postoperative after CS duodenojejunostomy with that of conventional HS anastomosis in PpPD.

Methods

We randomly assigned 101 patients (age 20–80) undergoing PpPD to receive CS duodenojejunostomy (group CS, n?=?50) or HS duodenojejunostomy (group HS, n?=?51) in two Japanese cancer center hospitals between 2011 and 2013. The patients were stratified by institution and size of the main pancreatic duct (<3 or ≥3 mm). The primary endpoint was the incidence of grade B or C DGE according to the international definition with a non-inferiority margin of 5 %. This trial is registered with University hospital Medical Information Network (UMIN) Center: UMIN000005463.

Results

Per-protocol analysis of data on 95 patients showed that grade B or C DGE was found in 4 (8.9 %) of 45 patients who underwent CS anastomosis and in 8 (16 %) of 50 patients who underwent HS anastomosis (P?=?0.015). There were no differences in the overall incidence of DGE (P?=?0.98), passage of the contrast medium through the anastomosis (P?=?0.55), or hospital stays (P?=?0.22).

Conclusions

CS duodenojejunostomy is not inferior to HS anastomosis with respect to the incidence of clinically significant DGE, justifying its use as treatment option.

     

Positron emission tomography: basic principle and radionuclides/probes for metabolic/functional analysis

Positron emission tomography (PET) is a functional imaging modality that can non-invasively visualize the distribution and dynamic movement of injected PET probes. In this article, the basic principle of PET technique is briefly explained followed by the introduction of various positron-emitters and PET probes used in clinical and research settings. With the coincidence detection of a pair of annihilation radiation emitted from positron emitters and the attenuation correction technique, PET can afford highly sensitive and quantitative data for analysis. However, spatial resolution of PET is limited and not suitable for detecting small lesions. In addition, PET image lacks anatomical information, and correct anatomical localization of the detected uptake is sometimes difficult. Most positron emitters are produced by cyclotrons and have very short half-lives. Therefore, PET institution should be equipped with an in-house cyclotron to produce positron emitters as well as the facility to prepare PET probes. Using positron emitters such as C-11, N-13 and O-15, functional/physiological molecules such as water, oxygen gas, carbon dioxide gas and ammonia, can be radiolabeled without modifying the structure or behavior, which makes these molecules suitable for the precise evaluation of physiological function and its deviation under pathological conditions. Although 18F-fluorodeoxyglucose (FDG), a marker of glucose metabolism, is the most commonly used PET probe especially in the field of oncology, many PET probes are available to evaluate various important characteristics such as blood flow, metabolism, tumor hypoxia, and neurotransmitter and receptor conditions, and are applied in the fields of oncology, neurology/psychiatry and cardiology.     

Regional brain imaging of vesicular acetylcholine transporter using o‐[125I]iodo‐trans‐decalinvesamicol as a new potential imaging probe

In this study, the regional rat brain distribution of radioiodinated o‐iodo‐trans‐decalinvesamicol ([¹²⁵I]OIDV) was determined in vivo to evaluate its potential as a single‐photon emission computed tomography (SPECT) imaging probe for vesicular acetylcholine transporter (VAChT). Following intravenous injection, [¹²⁵I]OIDV passed freely across the blood–brain barrier and accumulated in rat brain. The accumulation of [¹²⁵I]OIDV in rat brain was significantly reduced by coadministration of (+/?)‐vesamicol (0.125 µmol). In contrast, the coadministration of σ‐receptor ligands, such as (+)‐pentazocine (0.125 µmol) as a σ‐1 receptor ligand and (+)?3‐(3‐hydroxyphenyl)‐N‐propylpiperidine (0.125 µmol) as a σ‐1 and σ‐2 receptor ligands, barely affected the accumulation of [¹²⁵I]OIDV in rat brain. These findings in vivo were corroborated by autoradiographic analysis ex vivo. The authors found that the tracer binds with pharmacological selectivity to VAChT in rat brain and predicted that it may likewise serve in translational SPECT imaging studies of this marker in the integrity of cholinergic innervations. Synapse 68:107–113, 2014. © 2013 Wiley Periodicals, Inc.     

Magnetic and Transport Properties of New Dual-Phase High-Entropy Alloy FeRhIrPdPt

High-entropy alloys (HEAs) are broadly explored from the perspective of mechanical, corrosion-resistance, catalytic, structural, superconducting, magnetic properties, and so on. In magnetic HEAs, 3d transition metals or rare-earth elements are well-studied compositional elements. We researched a magnetic HEA containing Fe combined with 4d and 5d transition metals, which has not been well investigated, and found a new dual-phase face-centered-cubic (fcc) HEA FeRhIrPdPt. The structural, magnetic, and transport properties were evaluated by assuming that FeRhIrPdPt is a mixture of FeRh₄, FeIr₄, FePd₄, and FePt₄, all with the fcc structure. The dual-phase is composed of a Rh- and Ir-rich main phase and a Pd- and Pt-rich minor one. FeRh₄ and FeIr₄ show spin freezings at low temperatures, while FePd₄ and FePt₄ are ferromagnetic. Two magnetic features can characterize FeRhIrPdPt. One is the canonical spin-glass transition at 90 K, and the other is a ferromagnetic correlation that appears below 300 K. The main and minor phases were responsible for the spin-glass transition and the ferromagnetic correlation below 300 K, respectively.     

Spontaneously regressed granulomatosis with polyangiitis: A case report

A 71-year-old woman presented with chest pain, cough, and back pain. A chest roentgenogram showed multiple nodular shadows in both lungs. She was diagnosed with granulomatosis with polyangiitis (GPA). The multiple nodular shadows in both lungs regressed spontaneously in a few months. There are few reports of spontaneous regression of GPA, and the underlying mechanism is unclear. Neutrophil extracellular traps (NETs) have been recently shown to be involved in GPA. NETs may also be related to the natural regression of GPA.     

Rationale and Design of the Multicenter Trial on Japan Working Group on the Effects of Angiotensin Receptor Blockers Selection (Azilsartan vs. Candesartan) on Diastolic Function in the Patients Suffering from Heart Failure with Preserved Ejection Fraction: J-TASTE Trial

Background

Previous studies suggest that the pathophysiology of heart failure with preserved ejection fraction (HFpEF) is characterized not only by high ventricular stiffness, but also by vascular stiffness. Azilsartan has higher vascular affinity compared with other angiotensin II receptor blockers (ARBs), which were proven to have no beneficial effects on clinical outcomes in patients with HFpEF in earlier clinical trials. We aimed to test the hypothesis that azilsartan may improve left ventricular diastolic function in HFpEF patients with hypertension in this trial.

Methods

The Effects of Angiotensin Receptor Blockers on Diastolic Function in Patients Suffering from Heart Failure with Preserved Ejection Fraction: J-TASTE trial is a multicenter, randomized, open-labeled, and assessor(s)-blinded, active controlled using candesartan, parallel-group clinical trial, to compare changes in left ventricular (LV) diastolic dysfunction between HFpEF patients with hypertension who have received candesartan or azilsartan for 48 weeks. The primary endpoint is the change in early diastolic wave height/early diastolic mitral annulus velocity (E/e’) assessed by echocardiography from the baseline to the end of the study (48 weeks). A total of 190 patients will be recruited into the study.

Conclusions

The design of the J-TASTE trial will provide data on whether differences between the effects of the two tested drugs on LV diastolic function exist in HFpEF patients with hypertension and will improve understanding of the pathophysiological role of vascular stiffness on diastolic function.