Excess CO2 Reductions during CH3 COOH Formation from CH4 and CO2 under Periodic Operation: Downhill Side Reactions in an Uphill Target Reaction under Unsteady Conditions.

Acetic acid (CH3 COOH) formation from methane (CH4 ) and carbon dioxide (CO2 ) is an ideal reaction for chemical production, whereas this reaction possesses a severe thermodynamic limitation. To address this issue, it has been reported that periodic operation allowing a non-equilibrium condition can overcome the thermodynamic limitation. However, although an intrinsic issue of uphill reactions in non-equilibrium conditions generally is occurrence of unfavorable downhill reactions, this issue has seldom been discussed for the CH3 COOH formation under periodic operation. Herein, excess CO2 reductions were found to be the unfavorable downhill reactions possibly occurring in the reaction aiming at CH3 COOH formation under periodically operated CH4 and CO2 feeds. The reaction using an isotopic reactant (i. e., 13 CH4 ) unveiled that excess CO2 reductions to CO and even to CH3 moiety could occur, indicating importance of catalyst development. Furthermore, it was proposed that H2 O vapor introduction into the CO2 feed, which increased the CH3 COOH product, most likely facilitated the reverse reaction of the excess CO2 reductions and thereby is effective to hamper the unfavorable side reaction.

Exothermic methane coupling with ethylene as a hydrogen acceptor toward two-step methane conversion to ethylene.

Exothermic methane coupling with ethylene (ethene) as a hydrogen acceptor (2CH4 + C2H4 → 2C2H6) was proposed as part of a two-step reaction that includes ethane cracking (C2H6 → C2H4 + H2), which is a common industrial process, to provide methane conversion into ethylene as the net reaction (2CH4 → C2H4 + 2H2).

Efficacy and safety of cold forceps biopsy for diminutive pharyngeal neoplasms: Single-center, prospective pilot study.

BACKGROUND: Management of diminutive pharyngeal neoplasms is controversial. Thus, we conducted a single-center, prospective pilot study to investigate the efficacy and safety of endoscopic excision with cold forceps biopsy (CFB) of these lesions. PATIENTS AND METHODS: Thirty-nine lesions endoscopically diagnosed with narrow-band imaging as pharyngeal neoplasms of 3 mm or smaller were excised with CFB using jumbo biopsy forceps (cap diameter 2.8 mm, jaw volume 12.4 mm3 ). The primary outcome was endoscopically determined local remnant/recurrence rate 3 months after CFB. The secondary outcomes were histopathologically determined local remnant/recurrence rate; risk factors associated with the endoscopic remnant/recurrence; and incidence of intraoperative or delayed bleeding and other adverse events. RESULTS: Histological diagnosis of the 39 CFB-excised lesions were: 11 high-grade dysplasia (28.2%), 22 low-grade dysplasia (56.4%), two basal cell hyperplasia (5.1%) and four atypical squamous epithelium (10.3%).Twenty-seven patients (30 lesions) underwent follow-up endoscopy 3 months after CFB; the endoscopic and pathological local remnant/recurrence rate was 20% (6/30; 95% confidence interval (CI), 7.7-36.6%) and 16.7% (5/30; 95% CI, 5.6-34.7%), respectively. Location of the lesion in the hypopharynx was a significant risk factor associated with the endoscopic local remnant/recurrence (P = 0.049). No significant adverse events occurred. CONCLUSIONS: Cold forceps biopsy with jumbo biopsy forceps appears to be a safe and effective technique for excising diminutive pharyngeal neoplasms. Although small, the excised lesions may have a remarkably high frequency of high-grade dysplasia. (Clinical trial registration number: UMIN000037980).

Impact of submucosal saline solution injection for cold snare polypectomy of small colorectal polyps: a randomized controlled study.

BACKGROUND AND AIMS: Cold snare polypectomy (CSP) of small colorectal polyps is widely used. However, the technique is still troubled by insufficient resection depth, which may prevent precise pathologic evaluation. In this study, we investigated whether submucosal injection of saline solution helps to achieve deeper resection in CSP. METHODS: The study was a single-center, prospective, randomized trial. Patients with small (3- to 10-mm diameter) nonpedunculated adenomatous or sessile serrated colorectal polyps were randomly allocated to either conventional CSP (C-CSP) or CSP with submucosal injection (CSP-SI). Primary outcome was the rate of complete muscularis mucosae (MM) resection, defined by the proportion of MM under the tumor more than 80% of the tumor's horizontal dimension. Secondary outcomes were the rates of negative lateral and vertical margins, fragmentation of resected specimens, conversion to hot snare mucosal resection, intraprocedural bleeding, delayed bleeding, and perforation. RESULTS: Two hundred fourteen patients were randomly assigned to the CSP-SI (n = 107) or C-CSP (n = 107) group. The rate of complete MM resection was 43.9% in the CSP-SI group and 53.3% in the C-CSP group, a statistically insignificant difference. The rates of negative lateral margin and vertical margin (42.3% and 56.7%, respectively) in the CSP-SI group were significantly lower than those (58% and 76%) in the C-CSP group (P = .03 and P = .006, respectively). There was no polypectomy-related major bleeding or perforation. CONCLUSIONS: Saline solution injection into the submucosa did not improve the resection depth of CSP of small colorectal polyps, and the method resulted in lower rates of negative lateral and vertical margins of resected lesions. (Clinical trial registration number: UMIN000037980.).

Spatial variation in bird pollination and its mitigating effects on the genetic diversity of pollen pools accepted by Camellia japonica trees within a population at a landscape level.

Bird pollination can vary spatially in response to spatial fluctuations in flowering even within plant populations. In this study, we examined the hypothesis that the spatial variation in bird pollination may induce mitigating effects, which maintains or increases genetic diversity of pollen pools at local sites with low flowering densities. To test this hypothesis, we analyzed the landscape-level genetic effects within a population of Camellia japonica on the pollen pools accepted by individuals in two reproductive years by using genotypes at eight microsatellite loci of 1323 seeds from 19 seed parents. Regression analyses using the quadratic models of correlated paternity between pollen pools against spatial distances between the seed-parent pairs revealed not only local pollination but also some amount of long-distance pollen dispersal. The genetic diversity of pollen pools accepted by seed parents tended to be negatively related to the densities of flowering individuals near the seed parents during winter (when the effective pollination of C. japonica is mediated mostly by Zosterops japonica). We show that the low density of flowering individuals may induce the expansion of the foraging areas of Z. japonica and consequently increase the genetic diversity of pollen pools. This spatial variation in bird pollination may induce the mitigating effects on the C. japonica population. The comparisons between the two study years indicate that the overall pattern of bird pollination and the genetic effects described here, including the mitigating effects, may be stable over time.

Effect of Vonoprazan on Delayed Bleeding after Endoscopic Submucosal Dissection for Gastric Neoplasia among Antithrombotic Drug Users: A Single-Center, Single-Arm Prospective Observational Case Control Study.

Antithrombotic therapy is a major risk factor for delayed bleeding after endoscopic submucosal dissection (ESD) for gastric neoplasia. A potassium-competitive acid blocker, vonoprazan, is expected to prevent delayed bleeding better than conventional proton pomp inhibitors (PPIs), but the evidence is controversial. We sought to clarify the efficacy of vonoprazan for prevention of delayed bleeding after gastric ESD in patients under antithrombotic therapy. We prospectively registered 50 patients who underwent gastric ESD while receiving antithrombotic therapy and vonoprazan in our institution between October 2017 and September 2018. The incidence of delayed bleeding was compared with that in a historical control group of 116 patients treated with conventional PPI. We also evaluated risk factors associated with delayed bleeding. Delayed bleeding was observed in 8 of 50 patients (16.0%), which was not dissimilar from the incidence in the historical control group (12.1%) (p=0.49). In the univariate analysis, age (> 70 years) (p=0.034), multiple antithrombotic drug use (p<0.01), procedure time (> 200 min) (p=0.038) and tumor size (> 40 mm) (p<0.01) were associated with delayed bleeding after gastric ESD, but vonoprazan was not (p=0.49). Vonoprazan may not be more effective than conventional PPIs in preventing delayed bleeding after gastric ESD in patients receiving antithrombotic therapy.

Post-polypectomy bleeding in hot-snare polypectomy of colonic polyps under continued warfarin or short interruption of direct oral anticoagulants.

BACKGROUND: Newly published guidelines of the Japanese Gastroenterological Endoscopy Society (JGES) suggest to consider endoscopic procedures with high risk of bleeding without stopping warfarin and with stopping direct oral anticoagulants (DOACs) only on the day of the procedure. In this study, we aimed to test the validity of these recommendations. PATIENTS AND METHODS: We retrospectively reviewed medical records of 344 patients with anticoagulant therapy who underwent hot-snare polypectomy between January 2012 and October 2018. Patients (n = 132) with interruption of anticoagulants (3-7 days for warfarin and 2-3 days for DOACs before the procedure) and without heparin-bridging were excluded. Among the remaining 212 patients, the incidence of post-polypectomy bleeding was compared between the following 2 patient groups: patients who had interruption of anticoagulants with heparin-bridging (HB group, n = 139) and patients treated according to the new JGES guideline (FG group, n = 73). RESULTS: The rate of post-polypectomy bleeding (PPB) in FG group (9.6%) was not significantly different from that in HB group (12.9%, p = 0.5). In subgroup analysis, the incidence of bleeding in patients with warfarin (12.2%) and with DOAC (6.3%) in FG group was not significantly different from corresponding figures in HB group (14.2%, 0%). In multivariate analysis, number of resected polyps was associated with PPB, but the administration of anticoagulants according to the new guidelines was not a significant risk factor for PPB (p = .98). CONCLUSIONS: Our study affirms the recommendations of JGES for the management of anticoagulants in patients who undergo colonic polypectomy regarding post-polypectomy bleeding.

[Sclerosing mesenteritis diagnosed using computed tomography- and ultrasound-guided needle biopsy -utility of the coaxial technique].

Here, we report the case of an 82-year-old woman with sclerosing mesenteritis diagnosed using needle biopsy under the guidance of computed tomography (CT) and ultrasound (US). The patient manifested appetite loss, weight loss, and epigastric pain. CT of the abdomen and pelvis revealed increased density of the mesentery adjacent to the small bowel along with enlarged lymph nodes. Hence, we suspected sclerosing mesenteritis but also considered malignancies, such as lymphoma. We then performed CT- and US-guided needle biopsy with coaxial technique. We inserted an introducer needle by verifying its location using CT and extracted multiple specimens using a finer needle that passed through the introducer without incident. The collected specimens were adequate and histological diagnosis revealed sclerosing mesenteritis. We treated the patient with corticosteroids, and her symptoms and radiographic findings improved. Thus, the coaxial technique was a useful and minimally invasive tool for the diagnosis of sclerosing mesenteritis.

Risk factors for recurrent bleeding from acute hemorrhagic rectal ulcer.

OBJECTIVES: Acute hemorrhagic rectal ulcer (AHRU) occurs suddenly with painless massive bleeding from rectal ulcers, usually in patients who have severe underlying disorders. The rate of recurrent bleeding from AHRU is high, but there have been few studies on the risk factors for recurrent bleeding. The aim of this study was to identify risk factors for recurrent bleeding from AHRU. METHODS: Among 27,151 patients who underwent colonoscopy from 2006 November to 2017 March in our hospital, 120 patients with AHRU were retrospectively reviewed to identify risk factors for recurrent bleeding. Factors analyzed were: age, sex, Charlson Comorbidity Index (CCI), comorbidities (congestive heart failure, liver cirrhosis, renal failure, respiratory failure, diabetes mellitus and malignancy), medications (antiplatelet drugs, anticoagulants and steroids); endoscopic therapy and endoscopic features of AHRU. RESULTS: Recurrent bleeding from AHRU occurred in 30% of patients (36/120). In multi-variate analysis, individual comorbidities, medications, endoscopic features and endoscopic hemostasis were not significant or independent risk factors for recurrent bleeding. However, a high CCI score (4 or more) was a risk factor (odds ratio, 7.0; 95% confidence interval, 1.8-27.1). Endoscopic hemostasis was performed in 61% (73/120) of AHRU patients, and successful hemostasis was achieved in 99% of the treated patients (72/73). CONCLUSIONS: High CCI score was a predictor of recurrent bleeding from AHRU, but individual comorbidities, medications, endoscopic features or endoscopic hemostasis were not. Endoscopic hemostasis for bleeding from AHRU was achieved in most patients, but the recurrent bleeding rate was high.

Safety of cold polypectomy for small colorectal neoplastic lesions: a prospective cohort study in Japan.

BACKGROUND: Cold polypectomy has been widely accepted for removal of small colorectal polyps. However, no large-scale prospective study exists as for its safety in Japan. We investigated this issue in this single-center, prospective cohort study in a total of 1198 colorectal polyps resected with cold polypectomy. PATIENTS AND METHODS: Four hundred and seventy-four patients who underwent cold polypectomy for colorectal neoplastic lesions less than 10-mm diameter between September 2014 and October 2016 were enrolled. Primary outcome was the incidence of delayed bleeding within 2 weeks after the procedure. Secondary outcomes were the rate of immediate bleeding, perforation, endoscopic en bloc resection, and advanced histology. RESULTS: Cold polypectomy was performed on 1198 polyps in the 474 patients. No delayed bleeding or colonic perforation was observed. Immediate bleeding during the procedure, requiring endoscopic hemostasis, occurred in 97 lesions (8.1%), and all of them were successfully managed endoscopically. The endoscopic en bloc resection rate was 97.2%. Twenty-eight lesions (2.3%) were histologically diagnosed as advanced neoplasia; among them, three lesions were well-differentiated adenocarcinomas, and in two of them, a negative margin was not histologically confirmed. CONCLUSIONS: Cold polypectomy for small colorectal polyps is a safe technique without significant complication, but careful endoscopic diagnosis at cold polypectomy is necessary to identify advanced neoplasia. The reliability of cold polypectomy in excision of polyps with high-grade neoplasia should be established before the procedure becomes standard in the excision of small colorectal polyps. CLINICAL TRIAL REGISTRATION NUMBER: UMIN000014812.

Two cases of acute gastric dilation after radiofrequency catheter ablation for supraventricular arrhythmia.

We describe our experience with two cases of acute gastric dilation after radiofrequency catheter ablation (RFCA) for supraventricular arrhythmia. After the RFCA procedure, patients experienced epigastric pain, abdominal distension, and vomiting. Computed tomography showed marked dilation of their stomachs, but without apparent obstruction of the gastric antrum or the duodenum. Esophagogastroduodenoscopy and upper gastrointestinal series revealed significant gastroparesis. We considered that gastric hypomotility had been induced by vagus nerve injury after RFCA. Peristaltic stimulants effectively improved the patients' symptoms by improving gastric motility. There have been few reports of acute gastric dilation after RFCA in Japan to date, but the possibility of encountering this condition is expected to increase in parallel with the recent increased use of RFCA. Therefore, gastroenterologists should be alert to this rare complication.

Risk factors for active bleeding from colonic angiodysplasia confirmed by colonoscopic observation.

PURPOSE: Colonic angiodysplasia is an important cause of lower gastrointestinal bleeding in the elderly. Here, we investigated the risk factors for bleeding from colonic angiodysplasia seen at endoscopy. METHODS: We conducted a retrospective case-control study by reviewing records of 435 patients with angiodysplasia at colonoscopy from November 2006 to November 2015 in our hospital. To identify risk factors for active bleeding, the following were analyzed: age, sex, comorbidities, use of antithrombotic drugs and non-steroidal anti-inflammatory drugs, and the size and location of the lesions. RESULTS: Among the 435 patients, active bleeding from angiodysplasia was observed at endoscopy in 29 patients (6.7 %). Using multivariate analysis, we identified advanced age (odds ratio 5.15, 95 % confidence interval, 1.61-16.5), comorbidity of heart disease (6.88, 1.04-45.5), use of anticoagulant drug (4.22, 1.21-14.7), multiple lesions (6.67, 1.77-25.2), and small lesions (≤5 mm) (17.7, 4.90-64.0) as independent and significant risk factors for active bleeding. Actively bleeding colonic angiodysplasia lesions were very small in most cases (1-2 mm, 24/29, 83 %) and predominantly located in the right-side colon (26/29, 90 %). All of the 29 patients with active bleeding were successfully and safely treated endoscopically, but re-bleeding occurred in nine patients (31 %, 9/29) during the follow-up period of 2-84 months. CONCLUSIONS: Multiple and small colonic angiodysplasia lesions in patients of advanced age, with heart disease, or receiving anticoagulants have increased risk for bleeding. We should be aware that small colonic angiodysplasia lesions in the right-side colon at colonoscopy in these patients may be a source of bleeding.

Endoscopic ultrasound with double-balloon endoscopy in the evaluation of small-bowel disease.

BACKGROUND: Double-balloon endoscopy (DBE) has become a new standard in enteroscopy. However, it may be difficult to make a diagnosis or plan treatment strategy with endoscopic visualization alone. The addition of endoscopic ultrasonography (EUS) has the potential to improve the ability to establish the diagnosis and develop a treatment strategy. The present study was conducted to assess the feasibility and usefulness of EUS with DBE. METHODS: EUS with DBE was performed in 31 of 891 patients who underwent DBE from July 2004 to March 2011 at Jichi Medical University Hospital. We analyzed the EUS findings for lesions and evaluated the usefulness of EUS considering the following three factors: qualitative diagnostic value for lesions, depth grading of lesions, and evaluation of the structure of severe strictures prior to endoscopic balloon dilation. RESULTS: EUS was performed for 31/32 lesions (97%) in 31 patients. EUS findings were informative for 29/32 lesions (91%). EUS findings were useful for establishing a qualitative diagnosis in 15/25 lesions (60%). EUS findings for depth grading provided useful information for determining the therapeutic strategy in 11/13 lesions (85%). EUS with DBE was useful in the evaluation of strictures for all six lesions (100%). The overall usefulness of EUS with DBE on decision making was 72% (23/32) in this study. CONCLUSIONS: EUS with DBE is feasible and useful. It provides additional information on small-bowel disease and contributes to establishing a precise diagnosis and selection of an appropriate therapeutic strategy.

[Detection of enteric pathogen bacteria with the PCR method from mixed fecal specimens of food handlers].

We developed an assay for rapid, specific detection of Shigella, Salmonella, and verotoxin-producing Escherichia coli O157 using the direct PCR analysis of mixed human fecal specimens. In this study, the sensitivity of the direct PCR assay for 50 mixed human fecal specimen was found to be 1.3, 0.42, and 0.76 colony-forming units/kit for Shigella sonnei, Salmonella Typhimurium, and verotoxin-producing E. coli O157, respectively. We compared the efficiency of the direct PCR method with the conventional direct agar plate method for 5000 fecal specimens from food handlers. The 50 mixed fecal specimens were concentrated to approximately 2.5% in distilled water and were heated to 95 degrees C for 5min. Then, 5 µL of the specimen supernatant was added to 45 µL of the PCR mixture. Direct PCR results were evaluated by melting curve analysis. Among the 5000 fecal specimens from food handlers, Salmonella Infantis was isolated from 1 specimen using the direct agar plate method, and it was positive for the Salmonella gene (stn), as confirmed with the direct PCR method. Shigella, Salmonella, or verotoxin-producing E. coli O157 were not detected in the remaining 4999 fecal specimens with the direct agar plate method. However, Salmonella Enteritidis isolated by the enrichment culture method from 1 fecal specimen was positive for stn. Non-O157 verotoxin-producing E. coli isolated using direct horse blood agar from another fecal specimen was positive for stx. Moreover, enteroinvasive E. coli isolated using direct BTB agar from one fecal specimen was positive for ipaH. We conclude that the direct PCR assay can be applied as a new rapid screening method for personal hygiene among food handlers.

[A case report of endosonography used for the diagnosis of early gastric cancer and gastrointestinal stromal tumor].

A 79-year-old man was referred to our hospital complaining of weight loss. Esophagogastroduodenoscopy revealed a flat, elevated lesion of 30-mm diameter located on the posterior wall of the upper gastric body. The lesion was histologically diagnosed as a well-differentiated adenocarcinoma. Endosonography showed a submucosal tumor under the carcinoma, which was highly suspicious of a gastrointestinal tumor derived from the muscle layer. Adenocarcinoma was diagnosed as an intramucosal lesion, but laparoscopic fundectomy was performed because of the submucosal tumor. Pathological diagnosis was U, less, pType 0-IIa, 18×30 mm, pT1b (SM1), tub2, int, INFa, ly0, v0, pN0, H0, P0, CYX, M0, pStage IA, gastrointestinal stromal tumors, prognostic group 1.

Fabrication of CaFe2O4/TaON heterojunction photoanode for photoelectrochemical water oxidation.

Tantalum oxynitride photoanode is fabricated and modified with calcium ferrite to form a heterojunction anode for a photoelectrochemical water splitting cell. The synthesized powders are loaded sequentially to the transparent conducting glass by electrophoretic deposition, which is advantageous to form a uniform layer and a junction structure. X-ray diffraction, UV-vis diffuse reflectance spectroscopy, scanning electron microscopy, and impedance spectroscopy analysis are conducted to investigate the structural, morphological, and electrochemical characteristics of the anode. The introduction of CaFe2O4 overlayer onto TaON electrode increases the photocurrent density about five times at 1.23 V vs reversible hydrogen electrode without any co-catalyst. Impedance spectroscopy analysis indicates that the junction formation increased photocurrent density by reducing the resistance to the transport of charge carriers and thereby enhancing the electron-hole separation. This photocurrent generation is a result of the overall water splitting as confirmed by evolution of hydrogen and oxygen in a stoichiometric ratio. From the study of different junction configurations, it is established that the intimate contact between TaON and CaFe2O4 is critical for enhanced performance of the heterojunction anode for photoelectrochemical water oxidation under simulated sun light.

Archetype-Cation-Based Room-Temperature Ionic Liquid: Aliphatic Primary Ammonium Bis(trifluoromethylsulfonyl)imide as a Highly Functional Additive for a Hole Transport Material in Perovskite Solar Cells.

Room-temperature ionic liquids (RTILs) have attracted significant attention owing to their unique nature and a variety of potential applications. The archetypal RTIL comprising an aliphatic primary ammonium was discovered over a century ago, but this cation is seldom used in modern RTILs because other bulky cations (e.g., quaternary ammonium-, pyridine-, and imidazole-based cations) are prominent in current major applications, such as electrolytes and solvents, which require low and/or reversible reactivities. However, although the design of materials should change according to the intended application, RTIL designs remain conventional even when applied in unexplored fields, limiting their functions. Herein, RTIL consisting of an archetypal aliphatic primary ammonium (i.e., n-octylammonium: OA) cation and a modern bis(trifluoromethylsulfonyl)imide (TFSI) anion is proposed and demonstrated as a highly functional additive for a 2,2',7,7'-tetrakis(N,N-di-4-methoxyphenylamino)-9,9'-spirobifluorene (Spiro-OMeTAD), which is the most common hole transport material (HTM), in perovskite solar cells (PSCs). The OA-TFSI additive exhibits prominent functions via permanent reactions of the component ions with the PSC components, thus providing several advantages. The OA cations spontaneously and densely passivate the perovskite layer during the HTM deposition process, leading to both suppression of carrier recombination at the HTM/perovskite interface and hydrophobic perovskite surfaces. Meanwhile, the TFSI anions effectively improve the HTM function most likely via efficient stabilization of the Spiro-OMeTAD radical, enhancing hole collection properties in the PSCs. Consequently, PSC performances involving long-term stability were significantly improved using the OA-TFSI additive. Based on the present results, this study advocates that reconsidering the RTIL design, even when it differs from the current major designs yet is suitable for a target application, can provide functions superior to conventional ones. The insights obtained in this work will spur further study of RTIL designs and aid the development of the broad materials science field including PSCs.

Contribution of tree community structure to forest productivity across a thermal gradient in eastern Asia.

Despite their fundamental importance the links between forest productivity, diversity and climate remain contentious. We consider whether variation in productivity across climates reflects adjustment among tree species and individuals, or changes in tree community structure. We analysed data from 60 plots of humid old-growth forests spanning mean annual temperatures (MAT) from 2.0 to 26.6 °C. Comparing forests at equivalent aboveground biomass (160 Mg C ha-1), tropical forests ≥24 °C MAT averaged more than double the aboveground woody productivity of forests <12 °C (3.7 ± 0.3 versus 1.6 ± 0.1 Mg C ha-1 yr-1). Nonetheless, species with similar standing biomass and maximum stature had similar productivity across plots regardless of temperature. We find that differences in the relative contribution of smaller- and larger-biomass species explained 86% of the observed productivity differences. Species-rich tropical forests are more productive than other forests due to the high relative productivity of many short-stature, small-biomass species.

Floating gallbladder strangulation caused by the lesser omentum: report of a case.

Strangulation of the gallbladder by the omentum is extremely rare. We report what to our knowledge is only the second documented case of strangulation of a floating gallbladder by the lesser omentum. A 61-year-old Japanese woman presented to a local hospital after the sudden onset right upper quadrant pain. Her clinical features suggested a gallbladder volvulus, and the patient was referred to our hospital for investigation and treatment. Ultrasonography and computed tomography showed no cholecystolithiasis, but the fundus and body of the gallbladder were markedly swollen without wall thickening, whereas the neck of the gallbladder was normal. A narrowed, twisted area was seen between the body and neck of the gallbladder. Based on these findings, gallbladder volvulus was diagnosed and she underwent emergency laparoscopic cholecystectomy. The fundus and body of the gallbladder were grossly necrotic. The narrowest part of the gallbladder was tightly strangulated by the lesser omentum, but the gallbladder neck was normal. Histopathologic examination of the resected gallbladder showed ischemic changes in the wall of the fundus and body. This case highlights that the clinical features and imaging findings of a gallbladder strangulated by the lesser omentum are similar to those of gallbladder volvulus and that a positive outcome is dependent on a correct diagnosis and prompt surgical management.

[Direct PCR detection of food-borne bacteria from mixed human feces].

Mixed human feces were evaluated for simultaneous direct PCR detection of 3 food-borne bacteria--verotoxin-producing bacteria, Salmonella, and Shigella. Mixed feces concentrated approximately 2.5% in distilled water, were heated at 95 degrees C for 5 min. The heated suspension was then centrifuged and 5 microL of the supernatant poured into a 45 microL PCR mixture prepared to neutralize PCR inhibitors originating in biological samples. As a result of PCR under the above conditions followed by melting curve analysis (MCA), one positive fecal sample containing food-borne bacteria was detected from among 50 mixed fecal samples, showing the same sensitivity as individual cultivation. Results thus indicate that this method enables rapid, reliable, highly sensitive testing of many fecal samples--especially those of personnel handling food, which requires the simultaneous testing of many samples.