First-line eradication for Helicobacter pylori-positive gastritis by esomeprazole-based triple therapy is influenced by CYP2C19 genotype

AIM: To evaluate the effect of first line esomeprazole(EPZ)-based triple therapy on Helicobacter pylori(H. pylori) eradication.METHODS: A total of 80 Japanese patients with gastritis who were diagnosed as positive for H. pylori infection by endoscopic biopsy-based or ^(13)C-urea breath tests were included in this study. The average age of the patients was 57.2 years(male/female, 42/38). These patients were treated by first-line eradication therapy with EPZ 40 mg/d, amoxicillin 1500 mg/d, and clarithromycin 400 mg/d for 7 d. All drugs were given twice per day. Correlations between H. pylori eradication, CYP2C19 genotype, and serum pepsinogen(PG) level were analyzed. This study was registered with the UMIN Clinical Trials Registry(UMIN000009642).RESULTS: The H. pylori eradication rates by EPZbased triple therapy evaluated by intention-to-treat and per protocol were 67.5% and 68.4%, respectively, which were similar to triple therapies with other first-generation proton pump inhibitors(PPIs). The eradication rates in three different CYP2C19 genotypes, described as extensive metabolizer(EM), intermediate metabolizer, and poor metabolizer, were 52.2%, 72.1%, and 84.6%, respectively. The H. pylori eradication rate was significantly lower in EM than non-EM(P < 0.05). The serum PG?Ⅰ?level and PG?Ⅰ/Ⅱ ratio were significantly increased after eradication of H. pylori(P < 0.01), suggesting that gastric atrophy was improved by H. pylori eradication. Thus, first-line eradication by EPZbased triple therapy for patients with H. pylori-positive gastritis was influenced by CYP2C19 genotype, and the eradication rate was on the same level with other firstgeneration PPIs in the Japanese population.CONCLUSION: The results from this study suggest that there is no advantage to EPZ-based triple therapy on H. pylori eradication compared to other firstgeneration PPIs.

Endoscopic snare papillectomy for a solitary Peutz-Jeghers-type polyp in the duodenum with ingrowth into the common bile duct: Case report

Solitary duodenal Peutz-Jeghers(PJ)-type hamartomatous polyps are rare and considered a different disease entity than classic PJ syndrome.We describe the case of an 89-year-old man admitted to our emergency department with symptoms of acute cholangitis,liver dysfunction,and slight jaundice.Magnetic resonance imaging showed multiple signal voids,reflecting choledocholithiasis,and an ovalshaped tumor in the common bile duct(CBD).Following endoscopic retrograde cholangiopancreatography,the patient was diagnosed with a lower CBD tumor 20 mm in diameter.Endoscopic sphincterotomy was performed for choledocholithotomy,resulting in the expulsion of a large tumor with a stalk connected to the papilla of Vater.The tumor was successfully excised en bloc by endoscopic snare papillectomy.Histopathologic examination showed that the tumor was a PJ-type hamartomatous polyp.No mucocutaneous pigmentation of the skin was evident and the patient's family history was negative.Solitary duodenal PJ-type hamartomatous polyps are usually diagnosed incidentally during endoscopy for other indications because most of these tumors are asymptomatic or have nonspecific presentations.To our knowledge,this is the first reported solitary PJ-type polyp with intra-CBD growth treated by endoscopic snare papillectomy.

Tree Network Formation in Poisson Equation Models and the Implications for the Maximum Entropy Production Principle

This paper presents not only practical but also instructive mathematical models to simulate tree network formation using the Poisson equation and the Finite Difference Method (FDM). Then, the implications for entropic theories are discussed from the viewpoint of Maximum Entropy Production (MEP). According to the MEP principle, open systems existing in the state far from equilibrium are stabilized when entropy production is maximized, creating dissipative structures with low entropy such as the tree-shaped network. We prepare two simulation models: one is the Poisson equation model that simulates the state far from equilibrium, and the other is the Laplace equation model that simulates the isolated state or the state near thermodynamic equilibrium. The output of these equations is considered to be positively correlated to entropy production of the system. Setting the Poisson equation model so that entropy production is maximized, tree network formation is advanced. We suppose that this is due to the invocation of the MEP principle, that is, entropy of the system is lowered by emitting maximal entropy out of the system. On the other hand, tree network formation is not observed in the Laplace equation model. Our simulation results will offer the persuasive evidence that certifies the effect of the MEP principle.

Glycolytic Synchronization in Yeast Cells via ATP and Other Metabolites: Mathematical Analyses by Two-Dimensional Reaction-Diffusion Models

Possibilities of synchronized oscillations in glycolysis mediated by various extracellular metabolites are investigated theoretically using two-dimensional reaction-diffusion systems, which originate from the existing seven-variable model. Our simulation results indicate the existence of alternative mediators such as ATP and 1,3-bisphosphoglycerate, in addition to already known acetaldehyde or pyruvate. Further, it is also suggested that the alternative intercellular communicator plays a more important role in the respect that these can synchronize oscillations instantaneously not only with difference phases but also with different periods. Relations between intercellular coupling and synchronization mechanisms are also analyzed and discussed by changing the values of parameters such as the diffusion coefficient and the cell density that can reflect in tercellular coupling strength.

Sufficient noise and turbulence can induce phytoplankton patchiness

Phytoplankton patchiness ubiquitously obser- ved in marine ecosystems is a simple phy- sical phenomenon. Only two factors are required for its formation: one is persistent variations of inhomogeneous distributions in the phytopl- ankton population and the other is turbulent stirring by eddies. It is not necessary to assume continuous oscillations such as limit cycles for realization of the first factor. Instead, a certain amount of noise is enough. Random fluctua-tions by environmental noise and turbulent ad-vection by eddies seem to be common in open oceans. Based on these hypotheses, we pro-pose seemingly the simplest method to simulate patchiness formation that can create realistic images. Sufficient noise and turbulence can induce patchiness formation even though the system lies on the stable equilibrium conditions. We tentatively adopt the two-component model with nutrients and phytoplankton, however, the choice of the mathematical model is not essen-tial. The simulation method proposed in this study can be applied to whatever model with stable equilibrium states including one-com-ponent ones.