Effectiveness of outpatient percutaneous endoscopic gastrostomy replacement using esophagogastroduodenoscopy and propofol sedation

AIM: To evaluate the effectiveness of outpatient percutaneous endoscopic gastrostomy (PEG) replacement using esophagogastroduodenoscopy (EGD) and propofol sedation. METHODS: We retrospectively assessed the outcome and complications of consecutive patients referred for PEG replacement which was performed using EGD under propofol sedation in the outpatient setting. The success rate, the mean dose of propofol, procedure time, EGD findings, discharge time from endoscopy unit, respiratory depression, and complications within 72 h of the procedure were evaluated. In a subset of these patients, the blood concentrations of propofol were measured.RESULTS: All 221 patients underwent successful PEG replacement. The mean dose of propofol was 34 mg (range, 20-60 mg) with a mean procedure time of 5.9 min (range, 3-8 min). Reflux esophagitis (12 patients), gastric ulcer (5), gastric neoplasm (2), and duodenal ulcer (1) were newly diagnosed at replacement. Discharge from endoscopy unit was possible in 100% of patients 45 min after the procedure. Only 3.6% (8) required transient supplemental oxygen. No complications occurred within 72 h of the procedure. During EGD the level of sedation and propofol blood concentrations after administration of propofol (30 mg) in these PEG patients corresponded to those of propofol (60 mg) in middle aged subjects (control).     

Glucagon‐like peptide‐1 secretion by direct stimulation of L cells with luminal sugar vs non‐nutritive sweetener

Aims/Introduction: Oral ingestion of carbohydrate triggers secretion of glucagon‐like peptide (GLP)‐1, which inhibits the postprandial rise in blood glucose levels. However, the mechanism of carbohydrate‐induced GLP‐1 secretion from enteroendocrine L cells remains unclear. In the present study, GLP‐1 secretion was examined by meal tolerance tests of healthy Japanese volunteers. Materials and Methods: Twenty‐one healthy Japanese men participated in the study. The meal tolerance test was performed with modified nutrient compositions, with or without pretreatment with the α‐glucosidase inhibitor acarbose, or with substitution of sucrose with an equivalent dose of sweeteners in the meal. Blood concentrations of glucose, insulin, GLP‐1, and apolipoprotein (Apo) B‐48 were measured. Results: GLP‐1 secretion started concomitant with the increase in blood glucose levels 10 min after meal ingestion. Insulin secretion started at 5 min, before the increase in blood glucose levels, reflecting the contribution of direct nutrient stimulation on the former parameter and neural regulation in the latter. Carbohydrate retention in the gut lumen induced by acarbose pretreatment extended postprandial GLP‐1 secretion and negated the increase in serum ApoB‐48 levels. GLP‐1 secretion was markedly decreased by a reduction in the amount of sucrose in the meal and was not restored by an equivalent dose of sweeteners used to compensate for the sweet taste. Conclusions: The results indicate that direct stimulation of L cells with sugar, but not sweetener, is required for carbohydrate‐induced GLP‐1 secretion. In addition, inhibition of digestion of dietary carbohydrate by α‐glucosidase inhibitors may prevent postprandial hyperglycemia by increasing GLP‐1 secretion and by inhibiting glucose absorption. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00163.x, 2011)     

Origins of Feeding Arteries of Hepatocellular Carcinoma Located Near the Umbilical Fissure of the Left Hepatic Lobe: Angiographic Evaluation

Purpose

To analyze the origins of the feeding arteries of hepatocellular carcinomas (HCCs) near the umbilical fissure of the left hepatic lobe.

Methods

Twenty-eight HCCs with a mean?±?SD tumor diameter of 3.4?±?1.0?cm (range 1–4.4?cm) in contact with the right or left side of the umbilical fissure were treated by superselective transcatheter arterial chemoembolization (TACE). The origins of the tumor-feeding arteries were analyzed with arteriograms and computed tomography or cone-beam computed tomography images obtained during and 1?week after TACE.

Results

Twenty-one HCC lesions were located in segment 3 and seven were located in segment 4. Of 21 tumors in segment 3, 13 (61.9%) were supplied by the lateral inferior subsegmental artery (A3), three (14.3%) by the medial subsegmental artery (A4), three (14.3%) by both A4 and A3, one (4.8%) by a branch arising from the left lateral hepatic artery, and one (4.8%) by a branch of the right gastric artery. In particular, all tumor-feeding branches arising from A4 were the first branch of A4. Of seven tumors in segment 4, four (57.1%) were supplied by A4 and three (42.9%) by A3. In particular, all tumor-feeding branches arising from A3 were the first branch of A3.

Conclusion

This study demonstrates crossover blood supply to HCC lesions located near the umbilical fissure, in addition to direct feeding from a separate branch. In particular, the first branch of the opposite subsegmental artery may feed tumors when crossover blood supply is present.     

Ultraselective arterial embolization of vasa recta using 1.7-French microcatheter with small-sized detachable coils in acute colonic hemorrhage after failed endoscopic treatment

OBJECTIVE: The purpose of this article is to document our experiences with ultraselective arterial embolization to manage acute colonic hemorrhage using a 1.7-French microcatheter with small-sized detachable coils and to discuss the feasibility and clinical efficacy of this new technique. CONCLUSION: We achieved technical success in all four patients with the sole use of short-segment embolization of the long branch of the vasa recta. Our findings suggest that this technique is useful for embolization in cases of colonic hemorrhage.     

Psychological,Social, and Environmental Factors Associated With Utilization of Senior Centers Among Older Adults in Korea

Objectives

The purpose of the study was to examine the relationships among the psychological, social, and environmental factors influencing the utilization of senior centers among older adults in Korea.

Methods

A questionnaire survey was administered to two types of older adults who lived in Seoul, Korea: 262 older adults who used senior centers (3 places) and 156 older adults who did not use senior centers.

Results

Our results showed clearly that the utilization of the senior centers in Korea is affected by higher self-efficacy (odds ratio [OR], 6.08; 95% confidence interval [CI], 3.31 to 12.32), higher perceived benefits (OR, 1.71; 95% CI, 1.16 to 4.36), lower perceived barriers (OR, 6.43; 95% CI, 3.07 to 11.45), higher family support (OR, 4.21; 95% CI, 2.02 to 8.77), and higher support from friends (OR, 4.08; 95% CI, 2.38 to 7.81). The results also showed that participants whose total travel time was 15 to 29 minutes (OR, 2.84; 95% CI, 1.21 to 3.64) or less than 14 minutes (OR, 4.68; 95% CI, 3.41 to 8.41) were more likely to use a senior center than those who had to travel more than 30 minutes.

Conclusions

This study showed that the utilization of senior centers in Korea is affected by psychological, social, and environmental factors, specifically by self-efficacy, perceived benefits, perceived barriers, social support, convenience of transportation, and total travel time to the senior centers. The effects of longer-term utilization of the senior centers by non-users on health-related outcomes in a large population warrant attention.     

Effect of vitrectomy on aqueous VEGF concentration and pharmacokinetics of bevacizumab in macaque monkeys

Purpose. To evaluate the effect of vitrectomy on the concentration of vascular endothelial growth factor (VEGF) and the pharmacokinetics of intravitreally injected bevacizumab in the aqueous humor in cynomolgus macaques. Methods. Pars plana lensectomy and a standard three-port vitrectomy were performed in one eye each of six macaques. After a minimal 12-week healing period, the vitrectomized eyes received an intravitreal injection of bevacizumab (1.25 mg/50 μL). Aqueous humor and venous blood samples were obtained from the macaques just before vitrectomy, just before injection of bevacizumab, on days 1, 3, and 7, and during weeks 2, 4, 6, and 8 after the injection. The bevacizumab and VEGF concentrations were measured by using enzyme-linked immunosorbent assay. Results. The VEGF concentrations in the aqueous humor ranged from 52.6 to 113.9 pg/mL (mean ± standard deviation [SD], 81.7 ± 27.0 pg/mL) before vitrectomy and 20.7 to 72.7 pg/mL (mean ± SD, 51.4 ± 20.5 pg/mL) 3 months after vitrectomy, a difference that reached significance (P = 0.03). The aqueous VEGF concentrations decreased to less than 9.0 pg/mL, the lower limit of detection, in all eyes between 1 and 7 days after injection of bevacizumab. The mean half-life of 1.25 mg intravitreally injected bevacizumab was 1.5 ± 0.6 days (range, 1.0-2.4 days) in the aqueous humor. Conclusions. The VEGF concentration in the aqueous humor decreased and the half-life of the intravitreally injected bevacizumab was shorter in vitrectomized eyes.     

Supplementation with branched-chain amino acids attenuates hepatic apoptosis in rats with chronic liver disease

Branched-chain amino acids (BCAA) can function as pharmacologic nutrients for patients with decompensated cirrhosis. However, the effects of BCAA at the early stage of chronic liver disease are not clear. We hypothesized that early BCAA supplementation would attenuate the progression of chronic liver disease. The present study examined the effects of BCAA supplementation on the progression of chronic liver disease in rats caused by injected carbon tetrachloride (CCl₄). Sprague-Dawley rats were fed with a casein diet (control group) or the same diet supplemented with BCAA (BCAA group) for 11 weeks, and all rats were repeatedly injected with CCl₄. Food intake did not significantly differ between control and BCAA groups during the experimental period. Plasma alanine aminotransferase activities gradually increased during the experimental period in both groups but peaked later in the BCAA group. Liver fibrosis was more evident in the control group. Levels of connective tissue growth factor messenger RNA were significantly lower in the livers of rats in the BCAA group than in the control group. Terminal deoxynucleotidyl transferase–mediated deoxyuridine 5-triphosphate nick end labeling assays found considerably more hepatic apoptosis in the control group. Liver cytosolic cytochrome c levels and expression of the proapoptotic Bax protein in the mitochondrial fraction were significantly lower in the BCAA group than in the control group. These results suggest that supplementation with BCAA delays the progression of chronic liver disease caused by CCl₄ in rats by attenuating hepatic apoptosis.