[Endoscopic variceal ligation and percutaneous transhepatic obliteration difficulty in esophageal variceal bleeding: a case report].

A 48-year-old male patient with a history of alcoholic cirrhosis was admitted to our hospital due to hematemesis with a 7-day history of melena. Emergency esophagogastroduodenoscopy revealed esophageal variceal bleeding. We attempted hemostasis with endoscopic variceal ligation (EVL). The esophageal mucosa was not aspirated into the EVL device although the patient had no history of endoscopic injection sclerotherapy or EVL. Percutaneous transhepatic obliteration (PTO) was performed and esophageal variceal bleeding was successfully hemostasis. PTO is a viable option for refractory esophageal bleeding.

[A case of refractory ascites due to splenic arteriovenous fistula appeared during the course of observation and cured by embolization therapy].

This is a case of a 61-year-old female who presented to our hospital with liver dysfunction without any symptoms. She was diagnosed with splenic arteriovenous fistula. About 8 months later, she visited the hospital again due to abdominal distention and diarrhea. Computerized tomography (CT) revealed splenic aneurysm, dilated splenic vein enhanced in the arterial phase, ascites, and intestinal edema. We considered that these findings were caused by portal hypertension due to splenic arteriovenous fistula. The splenic aneurysm was managed with coil embolization. Completion arteriography revealed the absence of flow into the splenic arteriovenous fistula. Surveillance CT scans at 2 months post-procedure confirmed complete occlusion of the aneurysm and arteriovenous fistula. There was no evidence of splenic infarction. The patient remained asymptomatic 1 year post-procedure. Asymptomatic splenic arteriovenous fistula is rare and needs immediate treatment due to the high probability of deterioration.

Influence of Acute Mental Arithmetic Stress on Taste and Pungency.

Mental stress is a known risk factor for disease. This study investigated changes in sensations of taste and pungency before and after mental stress. Thirty healthy male university students rested for 20 min, performed mental arithmetic tasks for 10 min, and then underwent measurement of changes in their taste and ability to discern pungency. Taste was measured with the "Taste Disk®," and pungency was measured by a filter-paper disc method using capsaicin solution. Subjects were not told the order of the reagent solutions used. To quantify pain sensation, a weak current applied to the central inner forearm skin by a Pain Vision® quantitative pain sensation analyzer was gradually increased. The degree of stress was measured by portable electrocardiography (ECG). During mental stress, the cognitive threshold of salty taste, sweet taste, and bitterness was significantly decreased, whereas the sensations of pungency and forearm skin pain were increased and showed significant correlation. Based on sympathetic nerve activity analyzed with the ECG, the subjects were divided into the mental stress group and non-mental stress group. The mental stress group experienced an increase in the pungency threshold and sensation of forearm skin pain with significantly high correlations obtained, whereas no correlation was found between these factors in the non-mental stress group. Acute mental stress increased the sensitivity to taste but decreased the sensitivity to the sensation of pungency on the tongue and pain on the skin. Sympathetic activity activated by stress may affect taste and the sensation of pungency.

Contrast-enhanced CT for Colonic Diverticular Bleeding before Colonoscopy: A Prospective Multicenter Study.

Purpose To demonstrate the usefulness of precolonoscopy intravenous contrast material-enhanced CT for colonic diverticular bleeding (CDB). Materials and Methods A prospective, multicenter, observational study was performed. Patients with acute-onset hematochezia who were admitted to hospital were included, and those without CDB were excluded. CT was performed before colonoscopy. A Mann-Whitney U test, χ2 test, and multivariable logistic regression analysis were performed to determine the accuracy of CT before colonoscopy. Results A total of 442 patients (mean age, 71.2 years; 302 male patients; 68.3% men) were included between January 2014 and December 2015, and 202 patients were diagnosed as having CDB. The positive extravasation rate during CT was 50 of 202 (24.7%) among all patients and five of nine (55.6%) among patients who underwent CT within 1 hour of the last hematochezia. At multivariable analysis, the interval from the last hematochezia until CT was a predictor of extravasation (beta coefficient, -.0038 ± 0.0014 [standard deviation]). Extravasation at CT had a sensitivity of 38 of 66 (57.6%; 95% confidence interval: 44.8%, 69.7%) and a specificity of 124 of 136 (91.2%; 95% confidence interval: 85.1%, 95.4%) for the prediction of stigmata of recent hemorrhage of diverticula during colonoscopy. The sensitivity was higher in patients who underwent CT examination within 4 hours of hematochezia, compared with those examined after 4 hours (64.7% [33 of 51] vs 33.3% [five of 15]; P < .01). Conclusion Extravasation findings for CT with intravenous contrast material had high specificity for the prediction of stigmata of recent hemorrhage of diverticula during colonoscopy, regardless of the timing of the CT examination. Although the sensitivity was relatively low, it was higher when the CT examination was performed within 4 hours after the last hematochezia. Therefore, urgent precolonoscopy CT may contribute to decision making regarding whether an urgent colonoscopy should be performed.

Management of early gastric cancer with positive horizontal or indeterminable margins after endoscopic submucosal dissection: multicenter survey.

Background and study aims Positive horizontal margins in resected specimens are sometimes encountered after endoscopic submucosal dissection (ESD) for early gastric cancers, and appropriate treatment strategies for these cases are not established. The aim of this study was to evaluate current empirical treatments for patients with positive horizontal or indeterminable margins after ESD. Patients and methods We performed a multicenter survey and data from 14 hospitals were collected. The pooled proportions of positive horizontal or indeterminable margins and those of patients followed up without early intervention were calculated using a logistic-normal random-effects model. For calculating pooled estimates, subgroup analyses of high- and non-high-volume centers were conducted. Results A total of 11,796 ESD cases were enrolled and 229 patients (2 %) had positive horizontal or indeterminable margins. Ninety-eight cases were treated within 30 days of ESD and 131 cases were followed up without early treatments. Pooled estimates of positive margins in high- and non-high-volume centers were 1 % (95 % CI: 1 % - 2 %) and 2 % (95 % CI: 1 % - 4 %), respectively, and were not heterogeneous (P = 0.191). The proportion of patients followed up without early intervention ranged from 30 % to 100 %. The pooled estimate was 68 % (95 % CI: 50 % - 83 %). The pooled estimates of high- and non-high-volume centers were 65 % (95 % CI: 38 % - 85 %) and 72 % (95 % CI: 44 % - 89 %), respectively, and were not heterogeneous (P = 0.692). Conclusion There was insufficient consensus regarding treatment strategies used for early gastric cancer with positive horizontal or indeterminable margins after ESD. Further studies are required to establish a consensus.

Magnetic Separation of Autophagosomes from Mammalian Cells Using Magnetic-Plasmonic Hybrid Nanobeads.

Developments in subcellular fractionation strategies have provided the means to analyze the protein and lipid composition of organelles by proteomics. Here, we developed ultrasmall magnetic-plasmonic hybrid nanobeads and applied them to the isolation of autophagosomes by applying a magnetic field. The beads were chemically synthesized and comprised an Ag/FeCo/Ag core/shell/shell structure with a mean diameter of 15 nm. The Ag core and the FeCo shell conferred imaging and magnetic separation capabilities, respectively. The nanobeads were transfected into mammalian cells by lipofection. Thirty minutes after lipofection, the nanobeads colocalized with Vps26 and subsequently with LC3. Cell lysates were prepared at the appropriate time points and were subjected to magnetic separation. The separated fraction contained LC3-II, transferrin receptor, and LAMP2, but not LC3-I, suggesting that autophagosomes engulfing endosomal origin had been isolated. The magnetic separation process was completed in less than 30 min, providing a rapid method for isolation of autophagosomes. The present organelle isolation technique using the hybrid nanobeads with imaging and magnetic separation capabilities is highly promising for isolation of other types of organelles such as endosomes and endosome-related organelles.

Absence of Sema4D improves oligodendrocyte recovery after cerebral ischemia/reperfusion injury in mice.

Sema4D, originally identified as a negative regulator of axon guidance during development, is involved in various physiological and pathological responses. In this study, we evaluated the effect of Sema4D-deficiency on oligodendrocyte restoration after the cerebral ischemia/reperfusion using direct ligation of the middle cerebral artery followed by reperfusion. In both Sema4D(+/+) wild-type and Sema4D(-/-) null mutant mice, the peri-infarct area showed a decrease in the number of oligodendrocytes at 3 days post-reperfusion. Subsequently, the number of oligodendrocytes was observed to gradually recover in both groups. Sema4D-deficient mice, however, showed an enhanced recovery of oligodendrocytes and an upregulation of oligodendrocyte progenitor cells at days 14 and 28 of reperfusion. Cell proliferation identified by incorporation of bromodeoxyuridine was enhanced in Sema4D(-/-) mice from days 3 to 14 post-reperfusion compared to the Sema4D(+/+) mice. Furthermore, apoptotic cell death of oligodendrocytes was reduced at days 7 post-reperfusion in Sema4D(-/-) mice compared to Sema4D(+/+) mice. These findings indicate that enhanced proliferation of progenitor cells and survival of oligodendrocytes resulted in improved oligodendrocyte recovery in Sema4D(-/-) mice. This may provide a new approach for neurorestorative treatment in patients with stroke, which aims to manipulate endogenous oligodendrogenesis and thereby to promote brain repair after stroke.

In vitro formation of a novel type of membrane vesicles containing Dpm1p: putative transport vesicles for lipid droplets in budding yeast.

A novel type of membrane vesicles was formed in vitro from microsomes of Saccharomyces cerevisiae, which carries Dpm1p, an enzyme involved in dolichol-sugar synthesis, but not a typical secretory cargo. While COPII vesicles formed in vitro were sedimentable by centrifugation at 200,000g(max) for 15 min, the novel vesicles were not. However, they were sedimented by additional centrifugation at the same speed for 1 h. Immunoelectron microscopy showed that the Dpm1p-containing vesicles had small vesicular/saccular structures of around 40-50 nm in diameter. The addition of glycerol-3-phosphate and oleoyl-CoA, substrates for lipid biosynthesis, significantly enhanced the efficiency of vesicle budding in an ATP-dependent fashion. Dpm1p was localized to lipid droplets as well as endoplasmic reticulum. Fluorescence microscopy further showed that Dpm1p-GFP was present in restricted subregions in isolated lipid droplets. The possibility that the vesicles were intermediates from the endoplasmic reticulum to lipid droplets was examined, and their possible role is discussed.

In vitro fusion of plant Golgi membranes can be influenced by divalent cations.

The fusogenic activity of plant Golgi membranes was studied in a cell-free system by assaying lipid mixing and content leakages of fluorescence probes. Golgi membranes from mung bean (Vigna radiata L.) hypocotyl cells fused to liposomes in the absence of any cytosolic proteins and nucleotides. It was demonstrated that the fusion was mediated by integral membrane protein(s), and was influenced by divalent cations (mm). Mg(2+), Ca(2+), and Mn(2+) ions enhanced the lipid mixing by reducing repulsive forces between membranes. In the content leakage assay, Mg(2+) ions also showed a stimulative effect. However, other divalent cations were inhibitory. It is suggested that the fusion system of Golgi membranes comprises at least two components: one that mediates the formation of fusion intermediates prior to pore opening, and one that mediates the subsequent processes. The latter must be sensitive to divalent cations at millimolar concentrations. The fusion of Golgi and biological membranes was induced by divalent cations. We speculated about the biological role of the fusion system studied here.

Transmembrane topography of plasma membrane constituents in mung bean (Vigna radiata L.) hypocotyl cells. II. The large scale asymmetry of surface peptides.

The large scale asymmetry in surface (poly)peptides of the plasma membrane (PM) of mung bean (Vigna radiata L.) hypocotyl cells was investigated by protease and 1 M KCl treatments of PM vesicles obtained by an aqueous two-phase partition technique. Proteases only slightly reduced the protein content of right-side-out PM vesicles and the treatment with 1 M KCl resulted in the dissociation of only a few peripheral proteins from the outer surface of right-side-out PM vesicles, indicating that few surface peptides including peripheral proteins existed on the outer surface. From experiments of the re-partitioning of endomembrane vesicles removed from surface peptides, it was found that the surface peptide content is a factor determining the partitioning, and the hypothesis that sterols are asymmetrically distributed across higher plant PM was proposed. We speculate that asymmetrical properties between the outer and the inner surfaces of plant PM, especially in partitioning in the two-phase system, derive from the asymmetry of the bulk of surface peptides and PM sterols. The comparatively low hydrophilicity of the outer surface of the PM would be important for the partitioning of right-side-out PM vesicles in the upper phase of the two-phase system.