Treatment of portosystemic shunt-borne hepatic encephalopathy in a 97-year-old woman using balloon-occluded retrograde transvenous obliteration:A case report

BACKGROUND Hyperammonemia and hepatic encephalopathy are common in patients with portosystemic shunts.Surgical shunt occlusion has been standard treatment,although recently the less invasive balloon-occluded retrograde transvenous obliteration(B-RTO)has gained increasing attention.Thus far,there have been no reports on the treatment of portosystemic shunts with B-RTO in patients aged over 90 years.In this study,we present a case of hepatic encephalopathy caused by shunting of the left common iliac and inferior mesenteric veins,successfully treated with B-RTO.CASE SUMMARY A 97-year-old woman with no history of liver disease was admitted to our hospital because of disturbance of consciousness.She had no jaundice,spider angioma,palmar erythema,hepatosplenomegaly,or asterixis.Her blood tests showed hyperammonemia,and abdominal contrast-enhanced computed tomography revealed a portosystemic shunt running between the left common iliac vein and the inferior mesenteric vein.She was diagnosed with hepatic encephalopathy secondary to a portosystemic shunt.The patient did not improve with conservative treatment:Lactulose,rifaximin,and a low-protein diet.B-RTO was performed,which resulted in shunt closure and improvement in hyperammonemia and disturbance of consciousness.Moreover,there was no abdominal pain or elevated levels of liver enzymes due to complications.The patient was discharged without further consciousness disturbance.CONCLUSION Portosystemic shunt-borne hepatic encephalopathy must be considered in the differential diagnosis for consciousness disturbance,including abnormal behavior and speech.

Usefulness of vonoprazan,a potassium ion-competitive acid blocker,for primary eradication of Helicobacter pylori

AIM To investigate usefulness of triple therapy with vonoprazan,a potassium ion-competitive acid blocker and antibiotics,for Helicobacter pylori(H.pylori) eradication.METHODS The H.pylori eradication rate was examined in 2507 patients(2055 undergoing primary eradication and 452 undergoing secondary eradication,excluding patients with subtotal gastrectomy) at the Japanese Red Cross Kyoto Daiichi Hospital from March 2013 to September 2015.For patients treated from March 2013 to February 2015,a proton pump inhibitor(PPI) was used to reduce acid secretion,while vonoprazan was used after March 2015.The success rates of the 2 regimens(PPI + amoxicillin + clarithromycin/metronidazole,or vonoprazan + amoxicillin + clarithromycin/metronidazole) were compared.RESULTS The success rate of primary H.pylori eradication was significantly higher in the vonoprazan group.When stratified by the underlying disease,a significant increase of the H.pylori eradication rate was observed in patients with chronic gastritis.A significantly lower H.pylori eradication rate was observed in younger patients compared to older patients in the PPI group,but there was no difference according to age in the vonoprazan group.On the otherhand,the success rate of secondary eradication was similar at approximately 90% in both groups.CONCLUSION Vonoprazan is very useful for primary eradication of H.pylori,and may become a first-line acid secretion inhibitor instead of PPIs.

Effect of Root-Zone Temperature on Growth and Quality of Hydroponically Grown Red Leaf Lettuce (Lactuca sativa L. cv. Red Wave)

Soil temperature influences crop growth and quality under field and greenhouse conditions;however, precise investigation using controlled cultivation systems is largely lacking. We investigated effects of root-zone temperatures on growth and components of hydroponically grown red leaf lettuce (Lactuca sativa L. cv. Red Wave) under a controlled cultivation system at 20&degC. Compared with ambient root-zone temperature exposure, a 7-day low temperature exposure reduced leaf area, stem size, fresh weight, and water content of lettuce. However, root-zone heating treatments produced no significant changes in growth parameters compared with ambient conditions. Leaves under low root-zone temperature contained higher anthocyanin, phenols, sugar, and nitrate concentrations than leaves under other temperatures. Root oxygen consumption declined with low temperature root exposure, but not with root heating. Leaves of plants under low rootzone temperature showed hydrogen peroxide production, accompanied by lipid peroxidation. Therefore, low temperature root treatment is suggested to induce oxidative stress responses in leaves, activating antioxidative secondary metabolic pathways.

Dual therapy for third-line Helicobacter pylori eradication and urea breath test prediction

We evaluated the efficacy and tolerability of a dual therapy with rabeprazole and amoxicillin (AMX) as an empiric third-line rescue therapy. In patients with failure of first-line treatment with a proton pump inhibitor (PPI)- AMX-clarithromycin regimen and second-line treatment with the PPI-AMX-metronidazole regimen, a third-line eradication regimen with rabeprazole (10 mg q.i.d.) and AMX (500 mg q.i.d.) was prescribed for 2 wk. Eradication was confirmed by the results of the 13C-urea breath test (UBT) at 12 wk after the therapy. A total of 46 patients were included; however, two were lost to followup. The eradication rates as determined by per-protocol and intention-to-treat analyses were 65.9% and 63.0%,respectively. The pretreatment UBT results in the subjects showing eradication failure; those patients showing successful eradication comprised 32.9 ± 28.8 permil and 14.8 ± 12.8 permil, respectively. The pretreatment UBT results in the subjects with eradication failure were significantly higher than those in the patients with successful eradication (P = 0.019). A low pretreatment UBT result (≤ 28.5 permil) predicted the success of the eradication therapy with a positive predictive value of 81.3% and a sensitivity of 89.7%. Adverse effects were reported in 18.2% of the patients, mainly diarrhea and stomatitis. Dual therapy with rabeprazole and AMX appears to serve as a potential empirical third-line strategy for patients with low values on pretreatment UBT.

Elevated Root-Zone Temperature Modulates Growth and Quality of Hydroponically Grown Carrots

Air and soil temperatures strongly influence the growth and quality of crops. However, in root vegetables, such as carrot, few experiments aimed at regulating growth and quality by manipulating root-zone temperature have been reported. We investigated the effect of root-zone temperatures (20&degC, 25&degC, 29&degC, and 33&degC) on carrot growth and components using a hydroponic system. High root-zone temperatures for 14 days reduced shoot and rootgrowth and water content. In contrast, total phenolic compounds and soluble-solid content increased in tap roots under high-temperature treatment. Root oxygen consumption was upregulated after 7 days under high-temperature treatment. These results suggest that high root-zone temperatures induce drought-like stress responses that modulate carrot biomass and components. High root-zone temperature treatments administered to hydroponically grown crops may be a valuable tool for improving and increasing the quality and value of crops.

Rebamipide promotes healing of colonic ulceration through enhanced epithelial restitution

AIM:To investigate the efficacy of rebamipide in a rat model of colitis and restitution of intestinal epithelial cells in vitro.METHODS:Acute colitis was induced with trinitrobenzene sulfonic acid(TNBS)in male Wistar rats.Rats received intrarectal rebamipide treatment daily starting on day 7 and were sacrificed on day 14 after TNBS administration.The distal colon was removed to evaluate the various parameters of inflammation.Moreover,wound healing assays were used to determine the enhanced restitution of rat intestinal epithelial(RIE)cells treated with rebamipide.RESULTS:Intracolonic administration of rebamipide accelerated TNBSinduced ulcer healing.Increases in the wet weight of the colon after TNBS administration were significantly inhibited by rebamipide.The wound assay revealed that rebamipide enhanced the migration of RIE cells through phosphorylation of extracellular signalregulated kinase(ERK)and activation of Rho kinase.CONCLUSION:Rebamipide enema healed intestinal injury by enhancing restitution of RIE cells,via ERK activation.Rebamipide might be a novel therapeutic approach for inflammatory bowel disease.

Synergistic Effects of a Night Temperature Shift and Methyl Jasmonate on the Production of Anthocyanin in Red Leaf Lettuce

The production of a secondary metabolite such as anthocyanin is coordinately regulated by plant intrinsic factors and influenced by multiple environmental factors. In red leaf lettuce, the red pigment component anthocyanin is important for the commercial value of the crop, but its synchronous regulation by multiple factors is not well understood. Here, we examined the synergistic effects of a night temperature shift and methyl jasmonate (MJ) on the production of anthocyanin in red leaf lettuce. Low or high night temperature treatment for 3 days just before harvesting induced the production of anthocyanin without affecting plant biomass. Temperature-dependent activation of anthocyanin accumulation was accelerated by treating with MJ. Night temperature shifts and MJ triggered oxidative stresses in leaves, as indicated by hydrogen peroxide accumulation and lipid peroxidation. Interestingly, these oxidative stresses were more evident in leaves simultaneously treated with both a high night temperature and MJ. The activity of the superoxide dismutase (SOD) was increased alongside the elevation of oxidative stress. Taken together, these results indicate that the combined treatment of a night temperature shift with MJ may accelerate anthocyanin production by increasing the levels of oxidative stress to the leaves of red leaf lettuce.

Partial Purification and Characterization of the Rat Parotid Gland Protein Kinase Catalyzing Phosphorylation of Matured Destrin at Ser-2

Destrin, also called actin-depolymerizing factor (ADF), exists in resting parotid tissue as phosphorylated (inactive) and dephosphorylated (active) forms, and β-adrenergic stimulation of this tissue induces dephosphorylation of destrin. It is suggested that destrin dephosphorylation is involved in cortical F-actin disruption observed in parallel with β-agonist-induced amylase secretion. At present, the phosphorylation/dephosphorylation mechanism of destrin in parotid tissue is not known. We previously detected, in a crude rat parotid extract, a constitutively active protein kinase catalyzing phosphorylation of destrin;however, its identification has been hampered by difficulty in its enrichment. The purpose of this study was to explore a simple purification method(s) for this enzyme. To this end, we first developed a high-throughput dot-blot assay for the kinase with an anti-phosphodestrin antibody and then studied its purification by column chromatography on several media. We found that the kinase could be partially purified by sequential chromatography on DEAE-cellulose, phenyl-Sepharose, and hydroxyapatite columns. In each chromatography, however, the kinase could be eluted, at the cost of resolution, only by sharp increases in the elution power of the eluent;gradual increases in the elution power resulted in unacceptably poor recovery. We confirmed that enzymatic properties of the kinase were not basically altered during the purification. Further purification of the kinase was achieved by native polyacrylamide gel electrophoresis (PAGE), which resolved the kinase activity into two bands and separated the activity from most proteins (the kinase activity after PAGE was detected with destrin-coated polyvinylidene difluoride membranes and the anti-phosphodestrin antibody). The two bands seem to constitute the major destrin-phosphorylating activity in the resting rat parotid gland. We here report its partial purification and characterization together with the detection methods.

Development of vesicovaginal fistula caused by vaginal adenosis: A case report

Introduction: Vaginal adenosis is one of the rare diseases of the vagina, and almost all patients are asymptomatic. We report a case of spontaneous vaginal adenosis, which caused vesicovaginal fistula. Case Presentation: Our patient was a 25-year-old Japanese woman. She was admitted to our hospital, and her chief complaint was continuous urine flow from the vagina. We found a tumor with a vesicovaginal fistula in her vagina. Subsequent cytological analysis of vaginal smears showed a normal vaginal mucosa. The patient underwent tumor resection and a fistula patch. Pathological diagnosis was adenosis of the vagina, even though the patient had no known history of intrauterine diethylstilbestrol exposure or Müllerian developmental abnormalities. Conclusion: The clinical course of our case was a malignant tumor, which invasively bored a hole in the vaginal wall forming a vesicovaginal fistula, even though it was a benign lesion. Therefore, overzealous treatment should be avoided in this case.

Pummerer-type Functionalization of Aryl and Alkenyl Selenoxides

1 Introduction Heteroatom-stabilized carbenium ions have been widely recognized as potential electrophilic reagents.However,in contrast with the extensive works on thionium ion series,the highly labile character of selenoxide functionalities has caused serious limitation in the synthetic use in spite of their wide potentiality as synthetic equivalents of electrophilic selonium ions.In this paper,novel generation of selonium ions and the synthetic uses of the species for Pummerer-typeα-functionalization and for cycloaddition by using the novel dienophilic behavior ofπ-conjugated selonium cations.

Use of cone-shaped polypropylene mesh for perineal herniorrhaphy in dogs

Unilateral or bilateral perineal hernia results from the failure of the muscular pelvic diaphragm,and is commonly observed in male dogs.This study aimed to investigate the outcome of herniorrhaphy technique with the cone-shaped polypropylene mesh in dogs with perineal hernia.1 Materials and Methods Between October 2008 and July 2012,39 dogs(71 perineal hernias)underwent herniorrhaphy with polypropylene mesh(PROLENE MeshJohnson&Johnson)formed in the shape of a cone.The apex of corn-shaped mesh was inserted into the hernia region,and the bottom was sutured to sacrotuberous ligament,internal obturator muscle,external anal sphincter and residual coccygeal muscle.