Grading of Atrophic Gastritis is Useful for Risk Stratification in Endoscopic Screening for Gastric Cancer.

OBJECTIVES: In order to screen for gastric cancer effectively, its interval should be set according to the risk. This study aimed to determine whether risk stratification is possible using the data obtained from medical examination or endoscopic findings. METHODS: First, subjects who underwent both cancer screening and medical examination from 2009 to 2015 and underwent cancer screening once more by 2016 were studied. Data such as the lipid profile and history of smoking obtained during the medical examination, and the grade of atrophy and presence of peptic ulcers were studied using multivariate analysis. Next, subjects who underwent cancer screening twice or more between 2009 and 2015 with or without medical examinations were studied to analyze any correlation between the grade of atrophy and cancer occurrence using univariate analysis. In both studies, the status of Helicobacter pylori (HP) infection was determined. RESULTS: In the multivariate analysis, 9378 subjects were included. Aging, advanced atrophy, presence of ulcers, and uric acid levels were identified as risk factors. Among subjects who underwent successful HP eradication therapy, advanced atrophy and aging were observed to be crucial risk factors. In the univariate analysis, there were 12,941 subjects. Gastric cancer occurred more frequently in the more severe atrophy group (P < 0.001). The annual rate of cancer occurrence in the most severe atrophy group was 0.31%, which was approximately thrice as that in the less atrophy group. CONCLUSIONS: Risk stratification was possible based on endoscopic examination alone. The interval should be set depending on each case.

Acute peri-myocarditis with an unusual initial manifestation of gallbladder edema and a profound eosinophilic surge during convalescence.

A 29-year-old man with fever and right upper quadrant pain was referred to our hospital. Ultrasonography revealed intense gallbladder edema and pericardial effusion. Despite no symptoms and signs related to heart failure, the patient was clinically suspected of cardiac dysfunction related to acute peri-myocarditis based on his symptoms of preceding fever and headache, pericardial effusion, positive troponin T value, elevated B-type natriuretic peptide level, and sequential changes on electrocardiography. With a profound eosinophilic surge (8,022/µL) during convalescence, acute peri-myocarditis and gallbladder edema resolved spontaneously. This case instructively shows that acute peri-myocarditis initially manifests with abdominal symptoms, mimicking acute acalculous cholecystitis. In addition, an extensive review of acute myocarditis cases with peripheral eosinophilia suggests that there is a subgroup characterized by a predilection for young and middle-aged men, concurrence of pericardial effusion, transient eosinophilic surge during convalescence, and favorable outcome.

Copper- and iron-rich matrices in hepatocellular lipofuscin particles of a young male patient: diagnostic ultrastructures for Wilson disease.

A 17-year-old male patient appeared with the biochemical liver damage associated with hypoceruloplasminemia and mild iron overload. Genetic analysis identified a compound heterozygosity of ATP7B responsible for the primary copper toxicosis of Wilson disease without mutations in HFE. A liver specimen consisted of cirrhotic nodules of large-sized hepatocytes with fatty change and those of fat-free small-sized hepatocytes. Histochemically, iron was distributed diffusely in the small-sized hepatocytes, while copper grains appeared in a few of the hepatocytes near the fibrous bands. X-ray microanalysis on the liver tissue fixed with a 0.1% osmium tetroxide solution and embedded in epoxy resin disclosed (1) complex formation of copper with sulfur, and iron with phosphorus in the hepatocyte lipofuscin particles, (2) intraparticle localization of the cuprothionein in the less dense matrix and ferric proteins in the dense matrix, and (3) high affinity of the cuprothionein to lead staining. Considering the fact that ceruloplasmin is the major ferroxidase essential for iron efflux, iron deposits in the hypoceruloplasminemic patients with Wilson disease are not a complication, but a natural event. This study disclosed for the first time the diagnostic ultrastructures of Wilson disease, which might represent different detoxification processes to the reactive metals of copper and iron.

Potent inhibitory effects of black tea theaflavins on off-odor formation from citral.

The present study was conducted to investigate the ability of black tea theaflavins to inhibit the off-odor formation from citral under acidic aqueous conditions. Acidic buffer solutions (pH 3.0) containing citral (10 mg/L) and an inhibitor (0-5 mg/L) were stored at 40 degrees C for 2 weeks. The formation of possible off-odorants p-cresol and p-methylacetophenone in the citral solutions was monitored by high-performance liquid chromatography. A mixture of the theaflavins showed inhibitory effects on the formation of both p-cresol and p-methylacetophenone with 50% inhibitory concentrations (IC(50)) of 0.18 and 0.10 mg/L, respectively. Individual theaflavins and a structurally related compound, purpurogallin, also inhibited the formation of both off-odorants, with the lowest IC(50) values for theaflavin 3,3'-digallate (0.17 and 0.06 mg/L for p-cresol and p-methylacetophenone, respectively). On the other hand, a mixture of green tea catechins and its major constituent, (-)-epigallocatechin gallate, showed relatively high IC(50) values for the formation of p-methylacetophenone (1.29 and 1.28 mg/L, respectively) and showed no inhibitory effect on the formation of p-cresol. The results of the sensory evaluation showed that the off-odor intensity of the stored citral solution was significantly decreased by the addition of the theaflavin mixture at concentrations of 0.5 mg/L and above. In addition, the calculation of the odor activity values (OAVs) for the volatile compounds detected by a gas chromatographic analysis indicated that the total OAVs of the major volatile compounds in the citral solution were significantly decreased by the addition of the theaflavins.

A Japanese family with ferroportin disease caused by a novel mutation of SLC40A1 gene: hyperferritinemia associated with a relatively low transferrin saturation of iron.

Ferroportin disease, autosomal-dominant reticuloendothelial iron overload, may be more prevalent than hemochromatosis in Japan. Hyperferritinemia of 822 ng/ml with 24.8% transferrin saturation of iron was incidentally noted in a 43-year-old man. His iron overload was selective in Kupffer cells of the liver. Subsequently, his father was found to have asymptomatic hyperferritinemia of 2,283 ng/ml with 62.1% saturation. These affected subjects were heterozygous for 1467A>C (R489S) in SLC40A1, and without other mutations of the hemochromatosis genes. Here, we report a Japanese family with ferroportin disease, characterized by hyperferritinemia with relatively low transferrin saturations of iron.

Three patients with middle-age-onset hemochromatosis caused by novel mutations in the hemojuvelin gene.

Hemochromatosis is a genetically heterogeneous condition. Mutations in the recently described hemojuvelin gene were found in patients with juvenile hemochromatosis, who usually manifest clinical signs of iron overload, including cardiomyopathy and hypogonadism, in their teens and early 20s. In this report, we describe three Japanese patients who showed typical clinical and hepatic histological damage compatible with hemochromatosis at around 50 years of age. Genetic analyses showed that all three patients carried mutations in the hemojuvelin gene. The first patient was homozygous for a novel mutation (745G > C [D249H]), and the second and third patients from the same family were homozygous for another novel mutation (934C > T [Q312X]). No mutations in their HFE, hepcidin, transferrin receptor 2, or ferroportin genes were found. One patient had chronic infection with Helicobacter pylori. The age at initial presentation of hemojuvelin-hemochromatosis occurs over a wider range than previously described.

Formation mechanism of p-methylacetophenone from citral via a tert-alkoxy radical intermediate.

The aim of this study was to clarify the formation mechanism of a potent off-odorant, p-methylacetophenone, from citral under acidic aqueous conditions. An acidic aqueous solution (pH 3.0) containing 10 mg/L of citral was stored at 40 degrees C for 2 weeks. Among the compounds detected in the stored citral solution, 4-(2-hydroxy-2-propyl)benzaldehyde was identified for the first time as a degradation product from citral. The formation of p-methylacetophenone and 4-(2-hydroxy-2-propyl)benzaldehyde behaved the same when antioxidants were added to the citral solution. In addition, both compounds were formed by the Fe(2+)-induced decomposition of 8-hydroperoxy-p-cymene, another compound identified in the stored citral solution. These results suggested that both p-methylacetophenone and 4-(2-hydroxy-2-propyl)benzaldehyde can be formed via the same radical intermediate [p-CH3C6H4C(CH3)2O*] that can be derived from the O-O bond homolysis of 8-hydroperoxy-p-cymene. On the other hand, the degradation of 8-hydroperoxy-p-cymene without Fe2+ under acidic aqueous conditions did not yield p-methylacetophenone and 4-(2-hydroxy-2-propyl)benzaldehyde, but the degradation of citral without Fe2+ did. Therefore, other than the decomposition of 8-hydroperoxy-p-cymene, a mechanism to generate the tert-alkoxy radical intermediate was proposed for the formation of p-methylacetophenone and 4-(2-hydroxy-2-propyl)benzaldehyde in the citral solution.

Job Redesign Needs for Aged Workers.

The aim of this paper is to explore and present a proposal for redesigning elements of the workplace for agech workers. The method of research was to observe, record, and measure the actions of sitting workers performing assembly operations on electrical products in the Kani Plant Nagoya Works of Mitsubishi Electric Co. (Japan). The evaluation index used in the experiment was obtained by measuring time motion elements, cycle time per product, and motion velocity waves of elderly workers. Those motion characteristics were then compared to the motion characteristics of young workers. The results led to job redesign elements being identified to reduce handling factors of high difficulty for aged workers and to the necessity to consider a coefficient of correction in Method Time Measurement (MTM) according to differences in the manufactured object's weight.