Body heat responsive gelation of methylcellulose formulation containing betaine.

We examined a methylcellulose (MC) formulation that gels at body temperature for enteral alimentation. Betaine was found to have a lowering effect on the gelation temperature of the MC solution. The thermal gelation temperature of a body heat-responsive (BHR) gelling MC formulation, consisting of 2% MC, 15% glucose, 1.2% sodium citrate, and 3.5% betaine mixture, was approximately 32 °C, indicating that it could gel in response to body heat. Glucose release from the BHR gels was delayed at 37 °C in an in vitro study. In rats, oral administration of BHR gelling MC formulation delayed an increase in blood glucose and appearance of 13CO2 in expired air in a 13C-acetate breath test in comparison with the control. These results suggested that the BHR gelling MC formulation was gelled in the stomach and delayed gastric emptying after oral administration and glucose in the gels was absorbed slowly.

Combination probiotics may prevent Clostridium difficile infection among elderly patients undergoing an orthopedic surgery.

The incidence of Clostridium difficile infection (CDI) is greater in elderly orthopedic patients. We conducted a retrospective case-control study by selecting elderly patients who underwent proximal femoral fracture surgery to investigate the effect of probiotics on CDI prevention. Cases were diagnosed with CDI by an enzyme-linked immunosorbent assay for C. difficile toxins using frozen stool specimens. The primary method of exposure was receipt of combination probiotics such as Streptococcus faecalis, Bacillus mesentericus, and Clostridium butyricum. The crude odds ratio between developing CDI and receiving combination probiotics was 0.074 (95% CI: 0.010-0.565; p=0.002). Adjunctive combination probiotics among elderly patients who undergo proximal femoral fracture surgery likely reduces the probability of CDI.

Duloxetine and Angiotensin II Receptor Blocker Combination Potentially Induce Severe Hyponatremia in an Elderly Woman.

We encountered a case of syndrome of inappropriate antidiuretic hormone secretion (SIADH) caused by duloxetine, serotonin and norepinephrine reuptake inhibitor (SNRI). A 74-year-old woman complaining of severe lethargy was transferred to our emergency department. Her serum sodium level was 109 mEq/L. Plasma hypo-osmolality with urine normo-osmolality was observed, indicating SIADH. Her essential hypertension had long been treated with telmisartan, and she had just started duloxetine 20 mg/day for chronic musculoskeletal pain 4 days prior to admission. On prescribing duloxetine in the primary care setting, clinicians should be aware of the possibility of duloxetine-induced hyponatremia, particularly in combination with telmisartan.

Silent venous thromboembolism in multiple myeloma patients treated with lenalidomide.

Lenalidomide treatment in combination with dexamethasone and/or chemotherapy is associated with a significant risk of venous thromboembolism (VTE) in patients with multiple myeloma (MM). However, the incidence of asymptomatic VTE in lenalidomide-treated MM patients remains unclear. A total of 80 relapsed and refractory MM patients treated with lenalidomide-containing regimens in a single institution between July 2010 and July 2014 were retrospectively analyzed. Of these, eight patients had asymptomatic VTE before starting lenalidomide. The remaining 72 patients received thromboprophylaxis with low-dose aspirin (100 mg daily) and monitoring of plasma D-dimer levels on each visit. During the median follow-up time of 7.3 months (range 1.0-43.5 months), 29 patients (40.3 %) showed an elevation of D-dimer (≥2.5 µg/mL), and 13 (18.1 %) showed asymptomatic VTE in a lower extremity. Median time to asymptomatic VTE events from initiation of lenalidomide treatment was 3.0 months (range 1.0-13.1 months). All patients having an asymptomatic VTE continued lenalidomide treatment on warfarinization (target international normalized ratio 1.5-2.5), and none of them developed symptomatic VTE. In conclusion, an asymptomatic VTE event occurred in 18 % of Japanese MM patients receiving lenalidomide-containing therapy despite aspirin prophylaxis. Serial monitoring of plasma D-dimer levels and early intervention may help to prevent symptomatic or lethal VTE events.

Effect of caffeine on the body fat and lipid metabolism of rats fed on a high-fat diet.

The intake of caffeine (CF) at 0.025, 0.05 or 0.1% for 21 days progressively reduced the body fat mass and body fat percentage in Sprague-Dawley (SD) rats fed on a high-fat diet with increasing administration level. Moreover, CF increased the serum concentrations of catecholamines and free fatty acids in SD rats orally administered with CF (5 mg/kg). These results suggest that the intake of CF reduced body fat by lipolysis via catecholamines. CF has potential as a functional food ingredient with an anti-obesity action.