Risk Management for Gastrointestinal Endoscopy in Elderly Patients: Questionnaire for Patients Undergoing Gastrointestinal Endoscopy

More elderly patients now undergo gastrointestinal endoscopy following recent advances in endoscopic techniques. In this study, we conducted a high-risk survey of endoscopies in Japan, using a questionnaire administered prior to upper gastrointestinal tract endoscopy (UGITE), and identified anticholinergic agents and glucagon preparations as high-risk premedication. We also evaluated the cardiovascular effects of anticholinergic agents and glucagon through measurements of plasma levels of human atrial natriuretic peptide (hANP) and human brain natriuretic peptide (hBNP). The subjects were 1480 patients who underwent UGITE. Nurses administered a pre-endoscopy questionnaire, questioning subjects regarding heart disease, hypertension, glaucoma, and urinary difficulties as risk factors for anticholinergic agents, and Diabetes mellitus as a risk factor for glucagon preparations. Evaluation of subjects divided into under 65 and over 65 age groups revealed that in subjects aged 65 and over, risk factors for anticholinergic agents were significantly more high than those for glucagon. Analysis of the cardiovascular effects of anticholinergic agents and glucagon, in the elderly patients showed that hANP levels were significantly higher following administration of anticholinergic agents, but the change was not significant for glucagon premedication. Taking a detailed history before UGITE with the aid of a questionnaire at the same time as informed consent is obtained, is extremely useful in terms of risk management and selection of the appropriate premedication

Model transport studies utilizing lecithin spherules : I. Critical evaluations of several physical models in the determination of the permeability coefficient for glucose

1. 1. For the purpose of quantifying the transport of drugs across phospholipid membranes in complex aqueous liposome dispersions, solute release experiments were conducted with different initial boundary conditions so that sensitive tests of appropriate physical models could be made.2. 2. Simple physical models which assume monosize or multisize single membrane controlled solute transport failed to provide a reasonable agreement between the experimental data and the theory.3. 3. A systematic evaluation of all the parameters which could introduce uncertainties then revealed that the monosize-multiconcentric models are generally in satisfactory agreement with the experimental transport data. These findings suggest that these models may be used in the reliable determinations of effective bulk permeability coefficients. Calculations using the multisize-multiconcentric models and comparisons between the monosize and multisize-multiconcentric models showed that the assumption in which the particle size distribution is neglected is a good one.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/34108/1/0000390.pd

Combined treatment with dipeptidyl peptidase 4 (DPP4) inhibitor sitagliptin and elemental diets reduced indomethacin-induced intestinal injury in rats via the increase of mucosal glucagon-like peptide-2 concentration.

The gut incretin glucagon-like peptide-1 (GLP-1) and the intestinotropic hormone GLP-2 are released from enteroendocrine L cells in response to ingested nutrients. Treatment with an exogenous GLP-2 analogue increases intestinal villous mass and prevents intestinal injury. Since GLP-2 is rapidly degraded by dipeptidyl peptidase 4 (DPP4), DPP4 inhibition may be an effective treatment for intestinal ulcers. We measured mRNA expression and DPP enzymatic activity in intestinal segments. Mucosal DPP activity and GLP concentrations were measured after administration of the DPP4 inhibitor sitagliptin (STG). Small intestinal ulcers were induced by indomethacin (IM) injection. STG was given before IM treatment, or orally administered after IM treatment with or without an elemental diet (ED). DPP4 mRNA expression and enzymatic activity were high in the jejunum and ileum. STG dose-dependently suppressed ileal mucosal enzyme activity. Treatment with STG prior to IM reduced small intestinal ulcer scores. Combined treatment with STG and ED accelerated intestinal ulcer healing, accompanied by increased mucosal GLP-2 concentrations. The reduction of ulcers by ED and STG was reversed by co-administration of the GLP-2 receptor antagonist. DPP4 inhibition combined with luminal nutrients, which up-regulate mucosal concentrations of GLP-2, may be an effective therapy for the treatment of small intestinal ulcers

Spawning ecology of Girella punctata and G. leonina (Perciformes: Girellidae) in the coastal waters of the Izu Peninsula, Japan

The girellid fishes, Girella punctata and G. leonina, are commercially important fishes in Japan, but interspecific differences in their spawning ecology are unclear. In the present study, seasonal variations in the species composition and gonadosomatic index (GSI) were examined for G. punctata and G. leonina collected from the coastal waters of the Izu Peninsula, in order to clarify the spawning ecology of these two species. Both adults and juveniles were genetically identified by PCR-RFLP using mtDNA. The GSI of G. punctata showed markedly high values (>15.0) in April, whereas the GSI values of G. leonina were constantly low (<0.5). This result suggests that the coastal area of the Izu Peninsula is utilized as a spawning ground by G. punctata but not by G. leonina. Juveniles of G. punctata mostly appeared from May to July, whereas those of G. leonina appeared during the longer period from January to June. Juveniles of G. punctata born in the study area are inferred to settle to the sea bottom around the spawning ground after a one-month planktoninc life phase, whereas G. leonina juveniles are likely to be immigrants from another area