Pathophysiology of gastric acid secretion in patients with chronic renal failure: influence of Helicobacter pylori infection

OBJECTIVES: The incidence of gastroduodenal diseases is high in patients with chronic renal failure (CRF). However, gastric acidity in CRF has been reported to range in level from low to high. Moreover, it remains unknown whether Helicobacter pylori infection influences gastric acidity in such patients. Thus, we aimed to clarify the pathophysiological perturbation in gastric acidity and to determine the influence of H. pylori infection in CRF. DESIGN: Case-control study. SETTING: A university hospital. SUBJECTS: Twenty-seven patients with CRF and 24 control patients, presenting with either gastrointestinal symptoms, positive faecal occult blood, or anaemia (haemoglobin <10 g dL(-1)). MEASURES: The patients underwent gastroduodenal endoscopy with simultaneous determination of H. pylori infection. Gastric ammonium concentration, serum pepsinogen I and II, and basal gastrin level were measured. Thereafter, gastric acid secretion was monitored by 24-h intragastric acidity measurement with calculation of pH-3 holding time (%) (hours showing pH>3/24 h). RESULTS: In the CRF group, pH-3 holding time of H. pylori (+) subgroup was significantly greater than that of H. pylori (-) subgroup (71.2 +/- 32.4% vs. 32.8 +/- 30.0%, mean +/- SD; P=0.03). Pepsinogen I/II ratio was inversely correlated with pH-3 holding time in the control and CRF groups. Gastric ammonium concentration in CRF/H. pylori (+) subgroup (14.1 +/- 9.2 mmol L(-1)) was significantly higher than in CRF/H. pylori (-) (2.5 +/- 2.7 mmol L(-1); P=0.002) and control/H. pylori (+) subgroups (6.1 +/- 4.2 mmol L(-1); P=0.01). Serum gastrin level was significantly higher in the CRF group than in the control group (297 +/-343 pg mL(-1) vs. 116 +/- 69 pg mL(-1); P=0.02) as a whole. However, there was no significant correlation between serum creatinine and gastrin levels in the CRF group. Gastrin level in CRF/H. pylori (+) subgroup was significantly higher than in CRF/H. pylori (-), control/H. pylori (+), and control/H. pylori (-) subgroups (423 +/-398 pg mL(-1) vs. 113 +/- 79, 124 +/- 78, and 96 +/-43 pg mL(-1), respectively; P=0.01-0.03). Significant positive correlations amongst pH-3 holding time, ammonium and gastrin concentrations were found in the CRF group, but not in the control group. CONCLUSIONS: CRF without H. pylori infection primarily shows a tendency for high gastric acidity, but without hypergastrinaemia. Persistent H. pylori infection in CRF leads to decreased acidity and, consequently, to fasting hypergastrinaemia via a feedback mechanism. The hypoacidity in CRF with H. pylori infection appears to result from neutralization of acid by ammonia as well as from gastric atrophy. Thus, H. pylori infection status critically determines perturbation in gastric acidity and fasting gastrin level in CRF.     

Isolation and Properties of RNA Replicases Induced by SP and FI Phages

New RNA replicases were isolated and purified from Escherichia coli Q13 infected with SP or FI phages showing different serological properties. These replicases showed a template specificity different from that of Qbeta replicase.     

Analysis of BRCAness with multiplex ligation-dependent probe amplification using formalin-fixed and paraffin-embedded pancreatic ductal adenocarcinoma tissue obtained via endoscopic ultrasound-guided fine-needle aspiration biopsy

Background/Objectives

A breakthrough in chemotherapy for pancreatic ductal adenocarcinoma (PDAC) may be achieved using precision medicine, which involves identifying cases that are highly likely to respond to a certain treatment and then performing that treatment. BRCAness has been receiving attention as a novel predictor of anticancer drug sensitivity in PDAC, making the screening of BRCAness paramount.

Anterior pituitary function before and after treatment in twenty-three patients with isolated adrenocorticotropic hormone (ACTH) deficiency reported in Japan (author's transl)

Anterior pituitary function in 23 patients (16 men and 7 women, aged 27 to 68) with isolated ACTH deficiency was analyzed. Four were our own cases while the other 19 cases were ascertained by questionnaire. Both the baseline TSH levels and the peak TSH responses to TRH were high before treatment in more than half the cases but were normalized after treatment. This abnormality was found in patients younger than 50. The peak prolactin responses to TRH were excessive before and after treatment in three-fourths of the cases but decreased after treatment. The peak HGH responses to ITT were excessive in 3 patients before treatment an increased after treatment in 5 out of 6 cases. The peak LH and FSH responses to LH-RH were low or high in 20-30% of cases, but these abnormal responses were reduced to half after treatment. These results demonstrate that many disorders of the anterior pituitary function were found in patients with isolated ACTH deficiency but that these disorders became normal after treatment.     

Dissecting aneurysm during pregnancy and the puerperium

According to Schnitker, Mandel, Hirst and their associates, approximately half of the dissecting aneurysms in women under 40 years of age are associated with pregnancy. This significant relationship between dissecting aneurysm and pregnancy has been discussed by considering hemodynamic stress and also the hormonal changes of pregnancy. In this report, we describe five patients with dissecting aneurysm during pregnancy or the puerperium, review the literature and discuss the influence of pregnancy on the pathogenesis of this disease.     

Subclinical Hypothyroidism Is Associated With Adverse Prognosis in Heart Failure Patients

Background

It is widely recognized that overt hyper- as well as hypothyroidism are potential causes of heart failure (HF). Additionally it has been recently reported that subclinical hypothyroidism (sub-hypo) is associated with atherosclerosis, development of HF, and cardiovascular death. We aimed to clarify the effect of sub-hypo on prognosis of HF, and underlying hemodynamics and exercise capacity.

Inhibitory effect of prostaglandin E1 on intimal thickening following photochemically induced endothelial injury in the rat femoral artery

The inhibitory effect of prostaglandin E₁, which has an anti-platelet action and a vasodilating action via intracellular cyclic AMP elevation, was studied on intimal thickening in the rat femoral artery. A segment of the femoral artery was occluded by a platelet and fibrin-rich thrombus due to photochemical reaction between systemically administered Rose Bengal and transluminal green light which causes endothelial injury followed by platelet adhesion and aggregation at the site of photochemical reaction. Three weeks after endothelial injury, intimal thickening occurred at the irradiated site. Prostaglandin E₁ (0.3 μg/kg per min), administered as a continuous infusion 10 min before photochemical reaction significantly (P<0.05) prolonged the time to occlusion of the femoral artery. In a separate experiment, prostaglandin E₁ (0.3 μg/kg per min) administered as a continuous infusion for 7 days just after endothelial injury significantly (P<0.05) inhibited intimal thickening compared with a control group. In cultured rat-derived vascular smooth muscle cells, prostaglandin E₁ produced concentration-dependent inhibition of migration and proliferation, stimulated by platelet-derived growth factor. These results suggest that prostaglandin E₁ may be effective in preventing vascular restenosis after vascular surgery and angioplasty.     

Whole-body vibration training improves the walking ability of a moderately impaired child with cerebral palsy: a case study

[Purpose] Strength training is recommended for children with cerebral palsy. However, it is difficult for moderately impaired children with cerebral palsy, who require crutches for ambulation, to participate in this type of training. The purpose of this study was to investigate whether whole-body vibration training is an effective method of strengthening in a moderately impaired child with cerebral palsy. [Subject and Methods] This report describes an 8-year-old Japanese boy with cerebral palsy, who was ambulatory with crutches. The subject participated in physical therapy twice a week for 5 weeks. Whole-body vibration training was selected to complement the standing practice. The patient’s crutch-walking ability, gross motor function, and spasticity were evaluated. [Results] The number of steps and walking duration were reduced in a 5-m walk test with crutches and gross motor function was improved. Further, the spasticity was reduced. [Conclusion] Whole-body vibration training is an effective physical therapy intervention in moderately impaired children with cerebral palsy, who are unable to walk without crutches.Key words: Cerebral palsy, Whole-body vibration, Walking ability