Wheat alkylresorcinol increases fecal lipid excretion and suppresses feed efficiency in mice depending on time of supplementation.

OBJECTIVE: The regular consumption of whole grains is linked to a lower likelihood of developing metabolic disorders. We previously found that chronic supplementation with wheat alkylresorcinols (ARs) prevents obesity and its associated metabolic symptoms induced by a high-fat high-sucrose diet (HFHSD) in mice. The aim of this study was to examine the time-of-day-dependence of these effects in mice. METHODS: Eight-wk-old male C57 BL/6 J mice were individually housed under a 12-h light/dark cycle (Zeitgeber time; ZT0, lights on; ZT12, lights off) and given access to a HFHSD from ZT12-16 (activity onset) and ZT20-24 (activity offset) to respectively represent breakfast and dinner times for 3 wk. Thereafter, the HFHSD was replaced with the same diet containing 0.4% ARs at either ZT12-16 or ZT20-24 for 8 wk. Control mice received the HFHSD without ARs at both feeding times. RESULTS: Supplementation with ARs significantly suppressed feed efficiency when given at breakfast, but not at dinner. ARs consumed at breakfast increased fecal lipid content and decreased the expression of Fat/Cd36 in enterocytes that enhances lipid uptake, but did not affect hepatic and blood lipid levels. The consumption of ARs at breakfast also upregulated the expression of Irs1, a key gene for insulin signaling in white adipose tissue and attenuated elevated blood leptin levels induced by the diet. This led to high scores for the homeostasis model assessment of insulin sensitivity, and the adiponectin/leptin ratio, a negative index of adipose tissue dysfunction. CONCLUSIONS: These findings suggested that ARs ameliorate feed efficiency by decreasing dietary lipid absorption more effectively at the time of activity onset than offset. Further studies are needed to elucidate the molecular mechanism of the time-of-day-dependent effects of ARs on diet-induced metabolic disorders.

Simple, Precise, and Less Biased GMO Quantification by Multiplexed Genetic Element-Specific Digital PCR.

BACKGROUND: To provide the consumer with choices of genetically modified organisms (GMO) or non-GMO, official food labeling systems were established in many countries. Because the threshold GMO content values were set to distinguish between "non-GMO" and "GMO" designations, GMO content quantification methods are required for ensuring the appropriateness of labeling. OBJECTIVE: As the number of GMOs is continuously increasing around the world, we set out to develop a low-cost, simple and less biased analytical strategy to cover all necessary detection targets. METHODS: Digital PCR methods are advantageous compared to the conventional quantitative real-time PCR methods. We developed a digital PCR-based GMO quantification method to evaluate the GMO content in maize grains. To minimize the analytical workload, we adopted multiplex digital PCR targeting the 35S promoter and the nopaline synthase terminator, which are genetic elements commonly introduced in many GMOs. RESULTS: Our method is significantly simpler and more precise than the conventional real-time PCR-based methods. Additionally, we found that this method enables quantification of the copy number of GMO DNA without double counting multiple elements (35S promoter and nopaline synthase terminator) tandemly placed in a recombinant DNA construct. CONCLUSION: This is the first report on the development of a genetically modified maize quantification method using a multiplexed genetic element-specific digital PCR method. The tandem effect we report here is quite useful for reducing the bias in the analytical results. HIGHLIGHTS: Multiplexed genetic element-specific digital PCR can simplify weight-based GMO quantification and thus should prove useful in light of the continuous increase in the number of GM events.

Use of a social jetlag-mimicking mouse model to determine the effects of a two-day delayed light- and/or feeding-shift on central and peripheral clock rhythms plus cognitive functioning.

Social jetlag (SJL) is defined as the discrepancy between social and biological rhythms and calculated by the difference between the midpoint of sleep time on working-days and free-days. Previous human and mouse studies showed SJL is positively related to evening chronotype and significantly related to smoking habit, cardiovascular risk, cognitive ability, and that SJL-mimicking conditions, simulating the real lifestyle situation of SJL in many humans, disrupt the regularity of estrous cycles of female animals. The effects of SJL-mimicking conditions on circadian rhythms and cognitive function and the reasons why the discrepancy between social and biological rhythms is involved in SJL have not yet been investigated. Therefore, in this study, we utilized a mouse model of SJL-mimicking conditions - 6-hour delayed-light/dark (LD) conditions for 2 days and normal-LD conditions for the following 5 days - applied for several weeks during which biological rhythms were monitored. Circadian rhythms of central and peripheral clocks and metabolism of the mice under the SJL-mimicking condition were always delayed for 2-3 hours compared with those under the normal-LD condition. Moreover, SJL-mimicking conditions impaired their cognitive function using a novel object recognition test. Only the delayed timing of either the light phase of the LD or of feeding for 2 days, comparable to the free-days situation of humans, delayed the circadian staging of rhythms the following 5 days. Furthermore, sleep deprivation during the early mornings for 5 days, which is comparable to early rise times experienced by humans on working-days and does affect the staging of circadian rhythms (circadian misalignment schedule), delayed the locomotor activity rhythms the next 2 days, comparable to free-days in humans, which is similar to the lifestyle rhythm of the evening chronotype. Our results demonstrated that the circadian misalignment schedule for 5 days changed the locomotor activity rhythms the following 2 days to the evening chronotype, that light- and/or feeding-shift conditions for 2 days exacerbate SJL, and that SJL-mimicking conditions delay the metabolic rhythm and cause cognitive impairment.

Effects of onion extract containing concentrated cysteine sulfoxides on sleep quality: a randomized, double-blind, placebo-controlled, crossover study.

The objective of this randomized, double-blind, placebo-controlled, crossover study was to examine the effects of onion extract containing concentrated cysteine sulfoxides on improving sleep quality. In total, 30 healthy men and women who were dissatisfied with their sleep consumed the test food sample (onion extract tablets) for 5 days. The delta power during non-rapid eye movement sleep and the delta power per minute in the first sleep cycle increased significantly with the intake of onion extract containing concentrated cysteine sulfoxides compared with the intake of placebo. A significant decline in sleep latency was also observed. Salivary α-amylase level, a stress indicator, decreased significantly with the intake of onion extract containing concentrated cysteine sulfoxides compared with the intake of placebo. These findings indicate that onion extract containing concentrated cysteine sulfoxides alleviates stress, improves the quality of sleep and promotes smooth transition into sleep.

Effects of Whole Grain Wheat Bread on Visceral Fat Obesity in Japanese Subjects: A Randomized Double-Blind Study.

Metabolic syndrome is a risk factor for cardiovascular diseases and has become increasingly common in Japan. Epidemiological studies show inverse associations between intake of whole wheat grains and metabolic syndrome, but few dietary intervention trials have investigated the effect of whole wheat grain consumption. It was investigated whether a diet in which refined wheat bread (RW diet) was substituted by whole grain wheat bread (WW diet) would reduce visceral fat obesity in Japanese subjects. A randomized double-blind placebo-controlled intervention study was conducted in 50 Japanese subjects with body mass index (BMI) ≥ 23 kg/m2. Subjects were randomly assigned WW (WW group) or RW diets (RW group) for 12 weeks. Blood samples and computed tomography scans were obtained every 6th week. The WW group showed decrease (-4 cm2) in visceral fat area (VFA) (p < 0.05), whereas the RW group showed no significant changes. These time-dependent changes were significantly different between the groups. WW diet led to significant and safe reductions in VFA in subjects with BMI ≥ 23 kg/m2. WW diet may contribute to preventing visceral fat obesity.

Deaths Associated With Brotizolam Poisoning From a Single Drug Overdose: Four Reported Cases.

Brotizolam is a short-acting hypnotic in the benzodiazepine family, and fatal poisonings by an overdose of brotizolam are rare. This report describes 4 cases of deaths associated with brotizolam poisoning from a single drug overdose. The ages ranged from 51 to 90 years, and the postmortem interval between death and tissue sampling was 1.5 to 2.5 days. These deaths were classified as 1 homicide and 3 suicides. The concentration of the brotizolam ranged from 0.05 to 0.21 mg/L in the blood samples. Ethanol, which could cause mild alcohol intoxication, was detected in the blood samples from 2 cases. Postmortem examinations did not find any significant pathologic conditions, except for a case of death by drowning in a bathtub due to brotizolam poisoning. These 4 cases suggest that a brotizolam overdose should not be underestimated in terms of its fatal effects, particularly when situations involve alcohol intoxication, injury subsequent to the poisoning, or underlying medical conditions including aging.

Polyporus and Bupleuri radix effectively alter peripheral circadian clock phase acutely in male mice.

In mammals, daily physiological events are precisely regulated by an internal circadian clock system. An important function of this system is to readjust the phase of the clock daily. In Japan, traditional herb medicines, so-called crude drugs (Shoyaku), are widely used for many diseases, and some are reported to affect circadian clock impairment, suggesting that some of them might have an ability to modify clock gene expression rhythms. Therefore, from selected 40 crude drugs, finding candidates that control the circadian clock phases was the first purpose of this study. As there are several crude drugs used for liver- and/or kidney-related diseases, the second aim of the present study was to find some crude drugs affecting liver/kidney circadian clock in vivo. To assess phase changes in the daily circadian rhythm, bioluminescence from the core clock gene product Period 2 was continuously monitored in mouse embryonic fibroblasts in vitro and in some peripheral tissues (kidney, liver, and submandibular gland) of PERIOD2::LUCIFERASE knock-in mice in vivo. In our screening, Polyporus and Bupleuri radix were found to be good candidates to effectively manipulate the peripheral circadian clock phase acutely, with stimulation time-of-day dependency in vitro as well as in vivo. Interestingly, Polyporus and Bupleuri radix are traditional herb medicines use for treating edema and promoting diuresis, and for chronic hepatitis, respectively. These crude drugs may be therefore good modulators of the circadian peripheral clocks including liver and kidney, and circadian clock genes become new molecular targets for these crude drugs.

Age-related circadian disorganization caused by sympathetic dysfunction in peripheral clock regulation.

The ability of the circadian clock to adapt to environmental changes is critical for maintaining homeostasis, preventing disease, and limiting the detrimental effects of aging. To date, little is known about age-related changes in the entrainment of peripheral clocks to external cues. We therefore evaluated the ability of the peripheral clocks of the kidney, liver, and submandibular gland to be entrained by external stimuli including light, food, stress, and exercise in young versus aged mice using in vivo bioluminescence monitoring. Despite a decline in locomotor activity, peripheral clocks in aged mice exhibited normal oscillation amplitudes under light-dark, constant darkness, and simulated jet lag conditions, with some abnormal phase alterations. However, age-related impairments were observed in peripheral clock entrainment to stress and exercise stimuli. Conversely, age-related enhancements were observed in peripheral clock entrainment to food stimuli and in the display of food anticipatory behaviors. Finally, we evaluated the hypothesis that deficits in sympathetic input from the central clock located in the suprachiasmatic nucleus of the hypothalamus were in part responsible for age-related differences in the entrainment. Aged animals showed an attenuated entrainment response to noradrenergic stimulation as well as decreased adrenergic receptor mRNA expression in target peripheral organs. Taken together, the present findings indicate that age-related circadian disorganization in entrainment to light, stress, and exercise is due to sympathetic dysfunctions in peripheral organs, while meal timing produces effective entrainment of aged peripheral circadian clocks.

High-Speed Atomic Force Microscopy Reveals Loss of Nuclear Pore Resilience as a Dying Code in Colorectal Cancer Cells.

Nuclear pore complexes (NPCs) are the sole turnstile implanted in the nuclear envelope (NE), acting as a central nanoregulator of transport between the cytosol and the nucleus. NPCs consist of ∼30 proteins, termed nucleoporins. About one-third of nucleoporins harbor natively unstructured, intrinsically disordered phenylalanine-glycine strings (FG-Nups), which engage in transport selectivity. Because the barriers insert deeply in the NPC, they are nearly inaccessible. Several in vitro barrier models have been proposed; however, the dynamic FG-Nups protein molecules themselves are imperceptible in vivo. We show here that high-speed atomic force microscopy (HS-AFM) can be used to directly visualize nanotopographical changes of the nuclear pore inner channel in colorectal cancer (CRC) cells. Furthermore, using MLN8237/alisertib, an apoptotic and autophagic inducer currently being tested in relapsed cancer clinical trials, we unveiled the functional loss of nucleoporins, particularly the deformation of the FG-Nups barrier, in dying cancer cells. We propose that the loss of this nanoscopic resilience is an irreversible dying code in cells. These findings not only illuminate the potential application of HS-AFM as an intracellular nanoendoscopy but also might aid in the design of future nuclear targeted nanodrug delivery tailored to the individual patient.

Quantification of DNA fragmentation in processed foods using real-time PCR.

DNA analysis of processed foods is performed widely to detect various targets, such as genetically modified organisms (GMOs). Food processing often causes DNA fragmentation, which consequently affects the results of PCR analysis. In order to assess the effects of DNA fragmentation on the reliability of PCR analysis, we investigated a novel methodology to quantify the degree of DNA fragmentation. We designed four real-time PCR assays that amplified 18S ribosomal RNA gene sequences common to various plants at lengths of approximately 100, 200, 400, and 800 base pairs (bp). Then, we created an indicator value, "DNA fragmentation index (DFI)", which is calculated from the Cq values derived from the real-time PCR assays. Finally, we demonstrated the efficacy of this method for the quality control of GMO detection in processed foods by evaluating the relationship between the DFI and the limit of detection.

Wheat alkylresorcinols reduce micellar solubility of cholesterol in vitro and increase cholesterol excretion in mice.

Epidemiological studies have shown that the consumption of whole grains can reduce risk for metabolic disorders. We recently showed that chronic supplementation with wheat alkylresorcinols (ARs) prevents glucose intolerance and insulin resistance with hepatic lipid accumulation induced in mice by a high-fat high-sucrose diet (HFHSD). This study examines the effects of ARs on the micellar solubility of cholesterol in vitro, as well as the effects of transient AR supplementation on faecal lipid excretion and plasma lipid levels in mice. We found that ARs formed bile micelles with taurocholate independently of phospholipids, and dose-dependently decreased the micellar solubility of cholesterol in a biliary micelle model. Transient AR supplementation with HFHSD increased faecal cholesterol and triglyceride contents and decreased plasma cholesterol concentrations. These suggest that one underlying mechanism through which ARs suppress diet-induced obesity is by interfering with the micellar cholesterol solubilisation in the digestive tract, which subsequently decreases cholesterol absorption.

In vivo dose response and in vitro mechanistic analysis of enhanced immunoglobulin A production by Lactobacillus plantarum AYA.

Secretory immunoglobulin A (IgA) mediates the mucosal immune system, which provides the first line of defense against inhaled and ingested pathogenic bacteria and viruses. Lactobacillus plantarum AYA increases the IgA level of Peyer's patch (PP) cells, but the recommended amount of consumption and the mechanism of action remains unclear. Better understanding of these is essential to development of L. plantarum AYA for use in functional foods. Therefore, we investigated the dose-response effect (in vivo) and mechanism (in vitro) of IgA enhancement induced by L. plantarum AYA. In the small intestine of the mice fed a diet containing 0.03% or 0.3% of L. plantarum AYA powder for 4 weeks, the IgA levels were significantly increased. Thus, it is suggested that the recommended amount of consumption of L. plantarum AYA is about 0.72 mg per day. In addition, the bacterial cell wall fraction significantly enhanced the IgA production level of murine PP cells in the in vitro assay. The ability of whole cells and the cell wall fraction to enhance IgA levels was significantly inhibited by an anti-Toll-like receptor-2 (TLR-2) antibody, which suggests that the cell wall fraction of L. plantarum AYA increases the IgA level via TLR-2. These findings indicate that L. plantarum AYA is a potential functional food source that maintains mucosal immunity.

Entrainment of the mouse circadian clock by sub-acute physical and psychological stress.

The effects of acute stress on the peripheral circadian system are not well understood in vivo. Here, we show that sub-acute stress caused by restraint or social defeat potently altered clock gene expression in the peripheral tissues of mice. In these peripheral tissues, as well as the hippocampus and cortex, stressful stimuli induced time-of-day-dependent phase-advances or -delays in rhythmic clock gene expression patterns; however, such changes were not observed in the suprachiasmatic nucleus, i.e. the central circadian clock. Moreover, several days of stress exposure at the beginning of the light period abolished circadian oscillations and caused internal desynchronisation of peripheral clocks. Stress-induced changes in circadian rhythmicity showed habituation and disappeared with long-term exposure to repeated stress. These findings suggest that sub-acute physical/psychological stress potently entrains peripheral clocks and causes transient dysregulation of circadian clocks in vivo.

Wheat alkylresorcinols suppress high-fat, high-sucrose diet-induced obesity and glucose intolerance by increasing insulin sensitivity and cholesterol excretion in male mice.

BACKGROUND: Epidemiologic studies have shown that the consumption of whole grains can reduce the risk of type 2 diabetes mellitus, cardiovascular disease, and all-cause mortality. However, the underlying mechanisms remain a matter of debate. OBJECTIVE: We aimed to determine the effects of wheat bran-derived alkylresorcinols on diet-induced metabolic disorders in mice. METHODS: We fed C57BL/6J mice a normal refined diet or a high-fat, high-sucrose diet [29.1% fat, 20.7% protein, 34.0% carbohydrates containing 20.0% sucrose (w/w)] alone (FS) or containing 0.4% (wt:wt) alkylresorcinols (FS-AR) for 10 wk. RESULTS: The alkylresorcinols suppressed FS-induced increases in body weight by 31.0% as well as FS-induced hepatic triglyceride accumulation (means ± SEMs: 29.6 ± 3.18 and 19.8 ± 2.42 mg/g tissue in the FS and FS-AR groups, respectively), without affecting energy intake. We measured circadian changes in blood metabolic hormones and found that FS-induced hyperinsulinemia (5.1 and 2.1 µg/L at night in the FS and FS-AR groups, respectively) and hyperleptinemia (21.6 and 10.8 µg/L at night in the FS and FS-AR groups, respectively) were suppressed by alkylresorcinols. Glucose and insulin tolerance tests showed that alkylresorcinols significantly reduced fasting blood glucose concentrations (190 ± 3.62 and 160 ± 8.98 mg/dL in the FS and FS-AR groups, respectively) and suppressed glucose intolerance as well as insulin resistance induced by the FS diet. Furthermore, alkylresorcinols significantly increased insulin-stimulated hepatic serine/threonine protein kinase B phosphorylation compared to the FS diet (+81.3% and +57.4% for Ser473 and Thr308, respectively). On the other hand, pyruvate and starch tolerance tests suggested that alkylresorcinols did not affect gluconeogenesis and carbohydrate digestion, respectively. Alkylresorcinols significantly increased fecal cholesterol excretion by 39.6% and reduced blood cholesterol concentrations by 30.4%, while upregulating the expression of hepatic cholesterol synthetic genes such as sterol regulatory element binding protein 2 (Srebf2) and 3-hydroxy-3-methylglutaryl-Coenzyme A synthase 1 (Hmgcs1). CONCLUSIONS: These findings suggest that wheat alkylresorcinols increase glucose tolerance and insulin sensitivity by suppressing hepatic lipid accumulation and intestinal cholesterol absorption, which subsequently suppresses diet-induced obesity in mice.

Oral administration of the AYA strain of Lactobacillus plantarum modulates expression of immunity-related genes in the murine Peyer's patch: a DNA microarray analysis.

We performed comprehensive transcriptome analysis of Peyer's patches to elucidate the effects of oral administration of Lactobacillus plantarum strain AYA in mice. Using microarray analysis, we identified 124 upregulated and 144 downregulated genes for four weeks after the start of dietary supplementation with AYA. Gene Ontology analysis revealed that the genes for immune function were enriched in the upregulated gene set.

Oral administration of Lactobacillus plantarum strain AYA enhances IgA secretion and provides survival protection against influenza virus infection in mice.

The mucosal immune system provides the first line of defense against inhaled and ingested pathogenic microbacteria and viruses. This defense system, to a large extent, is mediated by the actions of secretory IgA. In this study, we screened 140 strains of lactic acid bacteria for induction of IgA production by murine Peyer's patch cells. We selected one strain and named it Lactobacillus plantarum AYA. We found that L. plantarum AYA-induced production of IL-6 in Peyer's patch dendritic cells, with this production promoting IgA(+) B cells to differentiate into IgA-secreting plasma cells. We also observed that oral administration of L. plantarum AYA in mice caused an increase in IgA production in the small intestine and lung. This production of IgA correlated strongly with protective ability, with the treated mice surviving longer than the control mice after lethal influenza virus infection. Our data therefore reveals a novel immunoregulatory role of the L. plantarum AYA strain which enhances mucosal IgA production and provides protection against respiratory influenza virus infection.

An endogenous reference gene of common and durum wheat for detection of genetically modified wheat.

To develop a method for detecting GM wheat that may be marketed in the near future, we evaluated the proline-rich protein (PRP) gene as an endogenous reference gene of common wheat (Triticum aestivum L.) and durum wheat (Triticum durum L.). Real-time PCR analysis showed that only DNA of wheat was amplified and no amplification product was observed for phylogenetically related cereals, indicating that the PRP detection system is specific to wheat. The intensities of the amplification products and Ct values among all wheat samples used in this study were very similar, with no nonspecific or additional amplification, indicating that the PRP detection system has high sequence stability. The limit of detection was estimated at 5 haploid genome copies. The PRP region was demonstrated to be present as a single or double copy in the common wheat haploid genome. Furthermore, the PRP detection system showed a highly linear relationship between Ct values and the amount of plasmid DNA, indicating that an appropriate calibration curve could be constructed for quantitative detection of GM wheat. All these results indicate that the PRP gene is a suitable endogenous reference gene for PCR-based detection of GM wheat.

Fatal vascular injury as a result of operations: experience of two surgery-related autopsies.

We experienced two autopsy cases of unexpected death during surgical operation. Case 1 was a 60-year-old male. Salvage esophagectomy was performed from the right side of the thrax. After dissection of the lymph node, blood pressure decreased suddenly. Emergency thoracotomy was done for diffuse hemothorax in the left thoracic cavity. The patient died despite aggressive hemostasis. Autopsy findings revealed that the operator dissected the left subclavian artery instead of the lymph nodes. Case 2 was a 60-year-old male with advanced thyroid cancer with pelvic metastasis. Surgical removal of the sacrum was attempted for pain relief. The operation was interrupted because of massive hemorrhage from the iliac veins. After the operation, the patient's left leg quickly became necrotic. Despite the bypass grafting from the right to the left femoral artery, the patient died of reperfusion injury. Autopsy revealed ligation of the left common iliac artery along with the accompanying vein. The leg necrosis was thought to have resulted from the vascular ligation. In these two cases, the demonstration and elucidation of the causes of deaths were required with medicolegal autopsies. However, it proved difficult to visualize the operated vessels in detail. In autopsy investigations related to surgical operations, detailed information of the clinical course is valuable and should be provided by the operators themselves, as well as being obtained from clinical charts.

[Statistical investigation on cases associated with medical implication in administrative autopsy within the 23 wards of Tokyo: the role of the medical examiner system in investigation of cases associated with medical implication].

Actual circumstances of administrative autopsies which proved connections between medical implication and death had not been very clear in the past. Therefore, using the records of administrative autopsies performed from 2003 to 2005 at Tokyo Medical Examiner's Office, this study looked into the cases in which a certain level of connection between medical implication and death was proved or suspected. This study dealt with 877 cases. The largest age group among the male was the one between 65 and 74, and the number of female cases increased as the age increased. The percentage of the studied cases among all the administrative autopsy cases has become larger after 2004. As regarding medical departments for implication, "internal medicine" had the largest number of the cases, and "unknown", "psychiatry", and "emergency" followed in order. 30 percent were being hospitalized during the final medical consultations, and the percentage went up to just over 60 when the deaths during and on the day after the final consultations were added to the figure. Regarding the causes of death, the great majority was natural death, and the other causes were 'unknown', 'fall', and 'asphyxia'. Also, about 80 percent of the natural deaths were caused by circulatory, gastroenteric and respiratory diseases. Contradictions between clinical and forensic diagnoses were found in approximately 10 percent of the cases. In any case, medical examiners are to diagnose the causes of deaths by autopsy, not to evaluate the quality and safety of medical treatment. But if the quality and safety of medical treatment could be improved through the diagnoses of administrative autopsy, the medical examiner system would function practically as a part of administration for health and welfare. However, as it handles not only deaths by medical treatment but also all the other types of unnatural deaths, the system can also deal with other social problems, for which the correct causes of death must be diagnosed initially. It is socially very unhealthy to focus only on death associated with medical implication, as other types of unnatural death could be seen as relatively less important. Therefore, it is considered that the medical examiner system is effective for investigation of a variety of unnatural death as well as cases associated with medical implication.

Novel zoom endoscopy technique for diagnosis of small flat gastric cancer: a prospective, blind study.

BACKGROUND & AIMS: During gastroscopy we frequently encounter flat reddened lesions in the stomach. Making a correct diagnosis of flat small early gastric cancer is dependent not on endoscopic diagnosis, but on histopathologic diagnosis of biopsy specimens alone. We investigated the diagnostic accuracy of magnified endoscopic findings for differentiating between reddened mucosa caused by gastritis and flat reddened gastric cancer, prospectively and blindly. METHODS: A total of 603 consecutive patients were examined by upper-gastrointestinal zoom endoscopy and the prevalence of each of the following magnified endoscopic findings, which already had been reported as characteristic for differentiated carcinoma, was recorded: (1) presence of a demarcation line between the reddened lesion and the surrounding mucosa, (2) disappearance of the regular subepithelial capillary network pattern, and (3) presence of an irregular microvascular pattern within the flat reddened lesion. Patients with known gastric carcinomas were excluded from this study. RESULTS: A total of 158 flat reddened lesions from 158 patients were detected. Pathologically, 144 flat reddened lesions showed only gastritis, whereas 14 lesions were newly diagnosed as carcinoma. Regarding diagnostic accuracy for carcinoma, the negative predictive values of the presence of a demarcation line and disappearance of the regular subepithelial capillary network pattern were 100% and 100%, respectively, and the diagnostic accuracy of the irregular microvascular pattern was 98.7%. CONCLUSIONS: The novel zoom endoscopic findings based on microvascular architecture are very useful for making a differential diagnosis between flat early gastric carcinoma and gastritis.