Gastrointestinal Stromal Tumor of the Stomach with Narrow Stalk-Like Based, Uneven Protruding Appearance Presenting with Severe Acute Anemia despite Small Size

We report the case of a 56-year-old woman who had a gastrointestinal stromal tumor (GIST) of the stomach. She was admitted to our hospital for epigastric pain, nausea, and severe acute anemia (hemoglobin level 4.3 g/dl). Esophagogastroduodenoscopy revealed a narrow stalk-like based, hemorrhagic and uneven protruding lesion in the lesser curvature of the gastric upper corpus. Although the tumor was less than 2 cm in diameter and was probably a benign GIST according to histology, laparoscopy-assisted local resection was needed because the patient had continuous severe anemia and epigastric pain. Histological assessment showed that the elongated spindle-like tumor cells originated from the intrinsic muscle layer, and was shown with growth to the mucosal side, cropping out to the surface in most areas of the protruding lesion. Only a small part of the tumor was within nontumoral gastric mucosa. Most of the tumor cells demonstrated immunoreactivity for KIT and CD34 in the cytoplasm but not for αSMA, S100, and desmin. Mitotic activity (0/50 high power field) and the labeling index for MIB-1 (about 1%) were low. The GIST of the stomach described in this report was a rare case with a narrow stalk-like based, uneven protruding mass presenting with severe acute anemia despite small size

Correlation between magnifying narrow band imaging and histopathology in gastric protruding/or polypoid lesions: a pilot feasibility trial

<p>Abstract</p> <p>Background</p> <p>Several study showed usefulness of microscopic capillaries, seen by magnifying narrow band imaging (NBI) endoscopy for predicting histopathology among superficial depressed or flat elevated gastric neoplasia (GN). Here we assessed the diagnostic efficacy of magnifying NBI for predicting histopathology among gastric protruding/or polypoid lesions.</p> <p>Methods</p> <p>Using endoscopic pictures of magnifying NBI from 95 protruding/or polypoid lesions (19 fundic gland polyps: FGP, 47 hyperplastic polyps: HP, and 29 GN), fine mucosal patterns were classified into four categories: small round, prolonged, villous or ridge, and unclear patterns, and micro vascular patterns were classified into five categories: honey comb, dense vascular, fine net work, core vascular, and unclear patterns.</p> <p>Results</p> <p>Most suggestive micro vascular patterns for predicting FGP, and HP were honeycomb (sensitivity 94.7%, specificity 97.4%), and dense vascular patterns (sensitivity 93.6%, specificity 91.6%), respectively. Fine net work, core vascular, and unclear patterns presented higher specificity (97%, 100%, and 100%) for predicting GN, and diagnostic efficacy of combined of those patterns was favorable (sensitivity 86.2%, specificity 97.0%).</p> <p>Conclusion</p> <p>Micro vascular patterns by using magnifying NBI provides meaningful information for predicting the histopathology of gastric protruding/or polypoid lesions.</p

Structures of the Toad Poison Bufadienolides and Cytotoxicities against Cell Line of Human Liver Cancer PLC/PRF/5

The toad poison bufadienolides having novel steroidal A/B cis and C/D cis structure exhibit a variety of biological activities. To carry out systematic studies on the biological activities of the chinese traditional crude drug "Senso" (Ch\u27 an Su), we investigated its cytotoxicities against cell line of human liver cancer PLC/PRF/5. Our research was extended to studies on relationship the bufadienolide structures and PLC/PRF/5 activities, since the extracts of Ch\u27 an Su and the major bufadienolide showed strong activity for PLC/PRF/5. Natural bufadienolide exhibited a potent cytotoxicity against PLC cell than their isomers and related compounds. Hellebrigenin was most active (IC_ 1.6×10^μg/ml). Other compound at 10^μg/ml level were bufalin-3-acetate, gamabufotalin, bufalin, sillarenin, bufotalin, telocinobufagin, bufalin-3-succinate-tert-butylcarbazoate, cinobufagin, bufalin-3-suberate, desacetyl-bufotalin and digitoxigenin. The 14β-hydroxy derivatives showed the higher activities than 14β, 15β-epoxy, 14α, 15α-epoxy and α-pyrone ring opening compounds (Table 2). We discussed about (1) activities for the colchicine-treated cells (Table 2), (2) dependence of activity with concentration of compounds (Fig. 1) and (3) characterization of activity on classification of compoumds (Fig. 2). On the other hand, the bufadienolides and related compounds were classified into the five groups, A&acd;E. Relationship between structure and activity on each group was discussed in section III. Importance of both D ring structures and 3-substituent structures was found. As a summary, on the relationship between structures and activities, the effects of substitution to the model compounds, e. g. bufalin and resibufogenin were discussed and the results were shown in Table 9 and 10. The most important factors were found to be the α-pyrone ring, 14β-OH or 14β, 15β-epoxy, 19-CHO, 11α-OH and 16β-OAc groups. Activities of cardenolides were more week than those of bufadienolide. In general, the C/D cis compounds showed higher activity than the C/D trans ones. Finally, we discuss about the antineoplastic activities of bufadienolides such as cell line of the KB and HeLa-S3,and the P388 and L1210 lymphocytic leukemia, in the comparison with PLC/PRF/5 activities, in Section IV (Table 11). A tendency of results was similar to those of the anaesthetic action and antiviral activity

Comparison of weighed food record procedures for the reference methods in two validation studies of food frequency questionnaires

Background: Although open-ended dietary assessment methods, such as weighed food records (WFRs), are generally considered to be comparable, differences between procedures may influence outcome when WFRs are conducted independently. In this paper, we assess the procedures of WFRs in two studies to describe their dietary assessment procedures and compare the subsequent outcomes. Methods: WFRs of 12 days (3 days for four seasons) were conducted as reference methods for intake data, in accordance with the study protocol, among a subsample of participants of two large cohort studies. We compared the WFR procedures descriptively. We also compared some dietary intake variables, such as the frequency of foods and dishes and contributing foods, to determine whether there were differences in the portion size distribution and intra- and inter-individual variation in nutrient intakes caused by the difference in procedures. Results: General procedures of the dietary records were conducted in accordance with the National Health and Nutrition Survey and were the same for both studies. Differences were seen in 1) selection of multiple days (non-consecutive days versus consecutive days); and 2) survey sheet recording method (individual versus family participation). However, the foods contributing to intake of energy and selected nutrients, the portion size distribution, and intra- and inter-individual variation in nutrient intakes were similar between the two studies. Conclusion: Our comparison of WFR procedures in two independent studies revealed several differences. Notwithstanding these procedural differences, however, the subsequent outcomes were similar

Safety of Polyethylene Glycol Solution plus Ascorbic Acid for Bowel Preparation for Colonoscopy in Patients with Chronic Kidney Disease

Introduction. Polyethylene glycol-electrolyte lavage solution plus ascorbic acid (PEG-ELS-Asc) has been recommended for colonoscopy, but little is known about the safety of PEG-ELS-Asc in patients with chronic kidney disease (CKD). The aim of this study was to determine its safety and efficacy in CKD patients. Methods. Blood and urine samples prospectively collected before and after same-day bowel preparation for colonoscopy with the conventional volume of PEG-ELS-Asc, vital signs before and after colonoscopy, and adverse events within 30 days postcolonoscopy were analyzed in consenting patients with CKD. The cleansing level was evaluated with the Boston bowel preparation score (BBPS) from colonoscopic findings. Results. Of 57 patients enrolled, 1 was excluded for refusal. Serum bicarbonate significantly dropped, and blood hemoglobin, serum total protein, albumin, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, total bilirubin, and uric acid significantly rose after bowel preparation, although these changes were not clinically important. Only in nondialysis patients did the platelet count and potassium significantly rise, although these changes were not clinically important either. Renal function, such as the urea, creatinine, and estimated glomerular filtration rate, was not significantly altered. An adequate bowel cleansing score, BBPS≥6, was achieved in 94% of patients. The blood pressure and heart rate were not significantly different between before and after colonoscopy in either nondialysis (n=32) or dialysis (n=19) patients. There were no adverse events associated with bowel preparation and colonoscopy within 30 days postcolonoscopy. Conclusions. The conventional volume of same-day bowel preparation with PEG-ELS-Asc may be safe and effective in CKD patients

Clinical response and changes in the fecal microbiota and metabolite levels after fecal microbiota transplantation in patients with inflammatory bowel disease and recurrent Clostridioides difficile infection

Objectives: We determined the efficacy of fecal microbiota transplantation (FMT) and subsequent changes in fecal microbiota and short-chain fatty acid (SCFA) levels in patients with ulcerative colitis (UC), Crohn’s disease (CD), and recurrent Clostridioides difficile infection (rCDI). Methods: A filtered solution of Japanese donor feces was endoscopically administered. The efficacy of FMT was evaluated after 8 weeks using the Mayo score, Crohn’s Disease Activity Index (CDAI), and the absence of diarrhea with stool toxin negativity in patients with active UC, CD, and rCDI, respectively. For fecal microbiota analysis, the 16S ribosomal RNA gene was sequenced, and fecal SCFA levels were measured. Results: Clinical response was achieved in 5/20 (25%), 3/4 (75%), and 4/4 (100%) patients with UC, CD, and rCDI, respectively. Clinical remission was achieved in 4/20 (20%) and 1/4 (25%) patients with UC and CD, respectively. Linear discriminant analysis illustrated that UC responders had lower counts of Clostridium cluster XIVa before FMT and higher counts after FMT. Higher Fusicatenibacter saccharivorans counts in donors were significantly correlated with 8-week clinical remission. Patients with CD exhibited lower Blautia, Dorea, and Eubacterium counts before FMT and higher Collinsella, Dorea, and Eubacterium counts after FMT, accompanied by functional profiles predictive of SCFA fermentation and elevated fecal butyrate concentrations. Patients with rCDI displayed significantly lower abundances of Clostridium clusters IV and XIVa before FMT and higher abundances after FMT accompanied by elevated fecal propionate concentrations. Conclusions: FMT exhibited various efficacy against UC, CD, and rCDI by altering the gut microbiota and SCFA production