Yohei Kitano

Antibacterial action of bile acids against Helicobacter pylori and changes in its ultrastructural morphology: effect of unconjugated dihydroxy bile acid.

Abstract: Although it has been shown that bile acids possess antibacterial activity against Helicobacter pylori, few reports on their activity have been published. We determined the minimum inhibitory concentration at 72 h of various unconjugated and conjugated bile acids against laboratory standard strains and clinical isolates of H. pylori, and studied morphologic changes of H. pylori under the scanning electron microscope during treatment with deoxycholic acid and ursodeoxycholic acid at the minimum inhibitory concentrations for 24 h. We found that only the unconjugated form of dihydroxy bile acid has antibacterial activity. The minimum inhibitory concentration of deoxycholic acid is 200–400 μg/ml, that of chenodeoxycholic acid is similar to that of deoxycholic acid, and that of ursodeoxycholic acid is 400–800 μg/ml. The morphology of H. pylori changed from its primary rodlike shape to a spherical shape with blebs on the cell surface, and was further degraded to an irregularly condensed mass, following an increase in bile acid. This morphologic change in H. pylori was different from the change to a spherical shape caused by amoxicillin. On the basis of these results, it seems that unconjugated dihydroxy bile acid might be a candidate drug for eradication of H. pylori, but further investigations of the clinical usefulness of bile acid for this purpose should be done.

Transnasal ultrathin endoscopy for placement of a long intestinal tube in patients with intestinal obstruction.

BACKGROUND The technical difficulties related to the insertion of a long intestinal tube into the jejunum under fluoroscopy present a considerable problem in patients with an intestinal obstruction. OBJECTIVE To evaluate the usefulness of endoscopic long intestinal-tube placement with the ultrathin esophagogastroduodenoscope (UT-EGD). DESIGN A prospective randomized clinical trial was conducted. PATIENTS Twenty-eight consecutive patients who presented with an intestinal obstruction were included in the study. INTERVENTION The UT-EGD was inserted nasally into at least the second portion of the duodenum or beyond. After a guidewire was introduced through the working channel, with fluoroscopic guidance, the UT-EGD itself was carefully removed with the guidewire left in place. Next, a hydrophilic intestinal tube was advanced over the guidewire into the jejunum, and then the guidewire was removed. MAIN OUTCOME MEASUREMENTS Primary end points are the total procedure time, the radiation exposure time, and the rate of complications, all compared with the conventional method. RESULTS The mean (+/-SD) total procedure time was 18.7 +/- 8.4 minutes for the UT-EGD method and 39.5 +/- 15.0 minutes for the conventional method, with a significant time difference between the 2 methods (P < .0005). The mean (+/-SD) radiation exposure time was also shorter with the UT-EGD method (11.1 +/- 6.0 minutes) than with the conventional method (30.3 +/- 13.7 minutes) (P < .0005). There were no complications, except for mild nasal bleeding with each method. CONCLUSIONS The UT-EGD method has definite advantages in the placement of a long intestinal tube for patients with an intestinal obstruction in comparison with the conventional method.

Quantification of human lithostathine S2-5 forms using the antibody to the N-terminal peptide region.

Lithostathine S2-5 inhibits in vitro crystal growth of CaCO3. We developed an antibody against the peptide region responsible for inhibitory effect to determine whether lithostathine S2-5 levels are different in the pancreatic juice of patients with and without chronic pancreatitis. The antibody against the synthetic peptide of the N-terminal end of lithostathine S2-5 detected lithostathine S2-5 but not lithostathine S 1 or lithostathine extracted from pancreatic calculi. Lithostathine S2-5 was detected in samples of pancreatic juice protein by immunoblotting using the specific antibody. The concentration of lithostathine S2-5 was compared between control and chronic pancreatitis groups. The mean concentrations of lithostathine S2-5 were significantly (p = 0.002) lower in chronic pancreatitis, 16.3 μg/mg of total protein, than in the control, 47.1 μg/mg of total protein. A decreased concentration of lithostathine S2-5 seems to increase the risk of stone formation in the ducts during the course of chronic pancreatitis because of insufficient inhibition of CaCO3, crystal growth.

Tu1052 Prognostic Value of Contrast-Enhanced Ultrasonography in Patients With Small Hepatocellular Carcinoma

Introduction: Epidemiological studies have shown that nonalcoholic fatty liver disease (NAFLD) not only is a possible precursor of cirrhosis, but also has been associated with metabolic syndrome, diabetes and cardiovascular disease. There is a need to find a biomarker which proves to be reliable, non-invasive, and easy to perform in clinical practice. Our aim was to know whether serum alanine aminotransferase (ALT) value is a reliable biomarker of liver fat content in subjects with NAFLD in the general population, and to determine if the current threshold of normality for ALT is appropriate to assess the presence of liver fat in these subjects. Methods: This is a cross-sectional, randomized, prospective, populationbased study. We studied 120 healthy subjects attending health screening centers, alcohol consumption less than 50 g/week. Subjects underwent blood tests including aminotransferases. Viral hepatitis, autoimmune, drugs and others causes of liver disease were excluded. Measurements: quantification of liver fat content by spectroscopy 1H MR with magnetic field strength of 3 tesla. We used a cut off value .5% of liver fat content as the upper limit of normal for the diagnosis of hepatic steatosis (1). Serum ALT levels by commercially available kits. Results: There was an excellent positive correlation between liver fat content and serum levels of ALT (r = 0.73, p ,0.0001). All subjects with ALT values .37 U/L had hepatic steatosis (PPV: 100%) and none of the subjects with ALT ,20 U/L had steatosis (NPV: 100%). ROC curves were created, obtaining that the cutoff value that represents the normal threshold for the diagnosis of NAFLD was ALT: 23 U / L (sensitivity: 94.67%, specificity 73.91%, PPV: 85.84%, NPV: 89.47%). Conclusion: This study shows that serum ALT levels could be a reliable biomarker of NAFLD if the upper limit of normal for ALT is set at 23 U/L.