[A Case of Suspected Non-Occlusive Mesenteric Ischemia following Neoadjuvant Chemotherapy for Esophageal Cancer with an Extremely Poor Prognosis].

Non-occlusive mesenteric ischemia(NOMI)is defined as intestinal ischemia or necrosis with patency of the mesenteric arteries. Here, we report a case of suspected NOMI following neoadjuvant chemotherapy for esophageal cancer with an extremely poor prognosis. A 79-year-old man complained of weight loss and vomiting. Esophagogastroduodenoscopy revealed a tumor extending from the lower intrathoracic esophagus to the gastric cardia. He was diagnosed with esophageal cancer(small cell neuroendocrine carcinoma, T3(AD)N0M0, cStage Ⅱ)accordingly. He received cisplatin and etoposide as neoadjuvant chemotherapy. Tube feeding was initiated due to tumor stenosis. His weight increased rapidly by more than 8 kg on the second day of treatment. He did not display any signs of heart failure, and so continued chemotherapy in conjunction with diuretics. Upon completion of chemotherapy, his continued use of diuretics gradually reduced his weight. On day 7, the patient complained of nausea and experienced a decrease in blood pressure. Bicarbonate Ringer's solution was administered intravenously, but the patient lost consciousness after 3 hours. Plain computed tomography revealed massive gas collections in the portal vein, tumor wall, stomach, and ascending colon. NOMI was strongly suspected. His condition continued to deteriorate, until his demise several hours later. Here, we present the above-mentioned case and discuss the relevant literature.

Effect of exercise intensity and AICAR on isoform-specific expressions of murine skeletal muscle PGC-1α mRNA: a role of ß2-adrenergic receptor activation.

There are three isoforms of peroxisome proliferator-activated receptor-γ coactivator 1α (PGC-1α) mRNA, which promotes mitochondrial biogenesis in skeletal muscles. Compared with PGC-1α-a mRNA, PGC-1α-b or PGC-1α-c mRNA is transcribed by a different exon 1 of the PGC-1α gene. In this study, effects of exercise intensity and 5-aminoimidazole-4-carboxamide-1ß-d-ribofuranoside (AICAR) on isoform-specific expressions of PGC-1α were investigated. All isoforms were increased in proportion to exercise intensity of treadmill running (10-30 m/min for 30 min). Preinjection of ß2-adrenergic receptor (AR) antagonist (ICI 118551) inhibited the increase in PGC-1α-b and PGC-1α-c mRNAs, but not the increase in PGC-1α-a mRNA, in response to high-intensity exercise. Although high-intensity exercise activated α2-AMP-activated protein kinase (α2-AMPK) in skeletal muscles, inactivation of α2-AMPK activity did not affect high-intensity exercise-induced mRNA expression of all PGC-1α isoforms, suggesting that activation of α2-AMPK is not mandatory for an increase in PGC-1α mRNA by high-intensity exercise. A single injection in mice of AICAR, an AMPK activator, increased mRNAs of all PGC-1α isoforms. AICAR increased blood catecholamine concentrations, and preinjection of ß2-AR antagonist inhibited the increase in PGC-1α-b and PGC-1α-c mRNAs but not the increase in PGC-1α-a mRNA. Direct exposure of epitrochlearis muscle to AICAR increased PGC-1α-a but not the -b isoform. These data indicate that exercise-induced PGC-1α expression was dependent on the intensity of exercise. Exercise or AICAR injection increased PGC-1α-b and PGC-1α-c mRNAs via ß2-AR activation, whereas high-intensity exercise increased PGC-1α-a expression by a multiple mechanism in which α2-AMPK is one of the signaling pathways.

Effects of simultaneous intake of soybean protein and diacylglycerol on lipid profiles and body fat accumulation in rats.

Soybean protein (SPI) and diacylglycerol (DAG) are functional components with benefits for lipid metabolism. Since simultaneous intake of such components is expected to exert effects additively and/or synergistically in lifestyle-related diseases, we examined the effects of simultaneous intake of SPI and DAG on lipid profiles. Five-week-old male Wistar rats were fed experimental diets with and without cholesterol for 28 d. In the rats fed cholesterol-free diets, significant interactions between dietary oil and protein were observed in the serum triacylglycerol (TG), hepatic cholesterol, and TG concentrations, whereas in the rats fed cholesterol diets, the serum and hepatic lipid concentrations were significantly lower in rats fed SPI than in those fed casein. Although our results suggest that simultaneous intake of SPI and DAG has slightly ameliorating effects on lipid profiles in rats, simultaneous intake of foods or foods components with similar functions are not necessarily effective.

In Vitro and in Vivo Studies on Anti-Inflammatory Effects of Traditional Okinawan Vegetable Methanol Extracts.

To determine anti-inflammatory effects of traditional Okinawan vegetable methanol extracts, we examined the inflammatory mediators from mouse macrophage by the addition of extracts prepared from two kinds of nishi-yomogi and hosoba-wadan. Moreover, we inspected the impact of extracts using a carrageenin-induced acute inflammatory animal model. In the case of in vitro study, nitric oxide and cytokine concentrations of supernatant were analyzed with Griess reagent and a commercially available enzyme-linked immunosorbent assay kit, respectively. Gene expressions related to the inflammation were extrapolated from the data of real-time polymerase chain reaction. In the case of in vivo study, six-week-old male Sprague Dawley rats were intraperitoneally administered with vegetable extracts, and then developed edema by carrageenin administration on the footpad. The footpad volume was obtained from the difference in volume before and after carrageenin administration. In the case of in vitro study, nitric oxide and tumor necrosis factor-α concentrations of the Kume nishi-yomogi were significantly lower (P < 0.05) than those of other groups, and also interleukin-6 concentration of the Kume nishi-yomogi was significantly lower (P < 0.05) than that of control. The iNOS and COX-2 gene expressions of Kume nishi-yomogi were significantly lower (P < 0.05) than those of other groups. In the case of in vivo study, the footpad volume between groups showed no significant difference; however, the decreased tendency of the footpad volume in Kume nishi-yomogi was observed as compared with other groups. From these results, it is expected that Kume nishi-yomogi extract might have a physiological function in the alleviating inflammation.

Health claim evidence requirements in Japan.

In the early 1980s the Japanese scientific academy defined a functional food as a food having a tertiary or physiologically active function. The current Japanese "Food with Health Claims" include 2 categories. For the first category, "Food with Nutrient Function Claims," the label may be freely used if a product satisfies the standard for the minimum and maximum levels per daily portion usually consumed. The second category is defined as "Food for Specified Health Uses" (FOSHU). FOSHU foods are those that contain dietary ingredients that have beneficial effects on the physiological functions of the human body, maintain and promote health, and improve health-related conditions. Health claims on these foods correspond to the category of "other" function claims of the Codex Alimentarius. However, claims of disease-risk reduction are not currently allowed under FOSHU with an exception for calcium and folic acid. Manufacturers can emphasize the characteristics of their products and promote sales by labeling or claims. Therefore, the labeling should be clear and correct and avoid any chance of misinterpretation. The labeling of health claims on foods should always be based on scientific evidence. Any manufacturer who applies to the government for approval under the FOSHU code for its product must tabulate both published available publications and internal reports on the effectiveness of the product and/or its ingredients and provide a summary of each available publication or report. The tabulation must include in vitro metabolic and biochemical studies, in vivo studies, and randomized controlled trials on Japanese people. The overall philosophy of the Ministry is to maintain and improve the health status of people and to prevent chronic noncommunicable diseases through an approach that involves a well-balanced diet as well as through the use of "health foods" including "Food with Health Claims."

Effects of Medium Chain Triacylglycerols on the Pathological Condition and Energy Bioavailability of Streptozotocin-induced Diabetic Rats.

Diabetes is a disease characterized not only by a high blood glucose level but also by high ketone levels. Medium chain triacylglycerols (MCT) are known as functional lipids, but they are rapidly metabolized to produce ketone bodies. In this study, we examined the effects of MCT intake on the pathological condition and energy bioavailability of diabetic animals. Streptozotocin (STZ)-induced diabetic rats were used as animal models for type I diabetes. The pathological condition was estimated through blood biochemical values, and the energy expenditure was calculated based on the respiratory quotient, which was analyzed using a mass spectrometer.Eight-week-old male STZ-induced diabetic Wistar rats were prepared and fed soybean oil (LCT) or MCT diets for 60 days. The survival rate of rats fed the MCT diet was higher than that of rats fed the LCT diet, although no ameliorating effects in the blood biochemical values were observed. In rats fed the LCT diet, their energy expenditure was much higher than their energy intake, whereas the energy balance was approximately equal in rats fed the MCT diet.These results indicated that energy bioavailability may contribute, at least in part, to the high survival rates in the diabetic MCT group, although MCT intake did not definitely improve the pathological condition of the experimental rats.

Effects of dietary Angelica keiskei on serum and liver lipid profiles, and body fat accumulations in rats.

Angelica keiskei (Ashitaba) is a perennial plant belonging to the Umbelliferae family. Recently, much attention has been focused on Ashitaba products as a so-called health food for the breakdown of cellulite among various physiological benefits of Ashitaba. The current study was carried out to investigate the physiological efficacy of dietary Ashitaba on serum and liver lipid profiles and body fat accumulation in rats. Rats were fed a high-fat diet with various amounts of Ashitaba for 28 d. Perirenal adipose tissue weights of rats fed the x 10 (170 mg/100 g BW) Ashitaba diet were significantly higher (p < 0.05) than those of the control group. Serum triacylglycerol concentrations of rats fed the x 100 (1,700 mg/100 g BW) Ashitaba diet were significantly higher (p < 0.05) than those of the x 1 (17 mg/100 g BW) group. Fecal weights and bile acid excretions of rats fed the x 10 or x 100 Ashitaba diet were significantly higher (p < 0.05) than those of the control group. However, there were no significant differences in the body weight gain, epididymal adipose tissue weight, serum cholesterol or liver lipid concentrations or other biochemical profiles in the serum. Furthermore, even the excessive ingestion of Ashitaba had no significant pathological impact on the liver or kidney. These results indicate that the large intake of Ashitaba products may supply dietary fiber and thus improve gastrointestinal condition through the increased excretion of feces containing high level of bile acids, although even excessive intake of Ashitaba for a short period of 28 d did not show any impact on the decrease in body fat or modification of lipid profiles in this study.

Selective protection of curcumin against carbon tetrachloride-induced inactivation of hepatic cytochrome P450 isozymes in rats.

We investigated the effects of curcumin, a major antioxidant constituent of turmeric, on hepatic cytochrome P450 (CYP) activity in rats. Wistar rats received curcumin-containing diets (0.05, 0.5 and 5 g/kg diet) with or without injection of carbon tetrachloride (CCl(4)). The hepatic CYP content and activities of six CYP isozymes remained unchanged by curcumin treatment, except for the group treated with the extremely high dose (5 g/kg). This suggested that daily dose of curcumin does not cause CYP-mediated interaction with co-administered drugs. Chronic CCl(4) injection drastically decreased CYP activity, especially CYP2E1 activity, which is involved in the bioactivation of CCl(4), thereby producing reactive free radicals. Treatment with curcumin at 0.5 g/kg alleviated the CCl(4)-induced inactivation of CYPs 1A, 2B, 2C and 3A isozymes, except for CYP2E1. The lack of effect of curcumin on CYP2E1 damage might be related to suicidal radical production by CYP2E1 on the same enzyme. It is speculated that curcumin inhibited CCl(4)-induced secondary hepatic CYPs damage through its antioxidant properties. Our results demonstrated that CYP isozyme inactivation in rat liver caused by CCl(4) was inhibited by curcumin. Dietary intake of curcumin may protect against CCl(4)-induced hepatic CYP inactivation via its antioxidant properties, without inducing hepatic CYPs.

Effects of simultaneous intakes of indigestible dextrin and diacylglycerol on lipid profiles in rats fed cholesterol diets.

OBJECTIVE: Indigestible dextrin (IDex) and diacylglycerol (DG) are food components with physiologic effects on lipid metabolism. Because simultaneous intake of dietary components with similar physiologic functions may produce a beneficial decrease in risk factors for lifestyle-related diseases, we investigated the physiologic effects of simultaneous IDex and DG intake. METHODS: Five-week-old male Wistar rats were fed a cholesterol-containing diet with IDex and DG (separately and combined) for 28 d. RESULTS: IDex significantly decreased serum triacylglycerol concentration and increased the length of small intestinal villi, whereas DG produced significant decreases in serum high-density lipoprotein cholesterol concentration and significant increases in liver cholesterol and triacylglycerol concentrations. CONCLUSIONS: IDex intake characteristically decreased serum triacylglycerol concentrations, although no additive or synergistic interaction between DG and IDex was observed. These results indicate that simultaneous intake of food components with similar physiologic functions do not necessarily produce additive or synergistic physiologic benefits.

Anatomic Variations of the Flexor Carpi Radialis Brevis: A Report of Five Cases.

The flexor carpi radialis brevis (FCRB) is a rare, anomalous musculotendinous structure of the wrist. Here, we report five cases of FCRB in a consecutive series of 123 distal radius fractures that were repaired by using volar locking plates.

Effects of structured lipids containing eicosapentaenoic or docosahexaenoic acid and caprylic acid on serum and liver lipid profiles in rats.

The physiological activity and effect on lipid metabolism of four types of structured lipids (SLs), that contain caprylic acid (C8) and either eicosapentaenoic (EPA) or docosahesaenoic acid (DHA), were evaluated in male Wistar rats fed experimental diets containing 7% (wt %) of each SL and 3% (wt %) soybean oil for 28 days. Control rats were fed a diet containing 10% (wt %) soybean oil. The relative perirenal adipose tissue weights of rats fed D-8-8 and 8-D-8 diets were significantly lower than those of other groups. We observed significantly lower serum cholesterol concentrations in rats fed SLs than those of control group over experimental period. The serum lipids concentrations in rats fed diets containing SLs were significantly lower P < 0.05) than those of soybean oil group. The fatty acid compositions of WAT did not reflect the structural differences in the triglyceride. These results suggest that the physiological effects of the SLs used in this study were due to the fatty acids rather than the structural specificity. Therefore, further study will be needed to ascertain the most desirable structural configuration.

Digestion of maize sphingolipids in rats and uptake of sphingadienine by Caco-2 cells.

We investigated the digestion of cerebrosides of plant origin prepared from maize, focusing especially on the digestive fates of trans-4, cis-8- and trans-4, trans-8-sphingadienine, which are common in higher plants. In the small intestinal mucosa and cecal contents of rats, the cerebrosidase activity at pH 5.2 toward the glucosyl linkage in maize cerebrosides (glucosylceramides) was similar to that in cerebrosides of mammalian origin. Similarly, the ceramidase activity toward the amide linkage in ceramides prepared from maize cerebrosides at pH 7.0 was the same as that toward ceramides of mammalian origin. In addition, maize cerebrosides were hydrolyzed to ceramide and free sphingoid bases in the digestive tract of rats after oral administration. To further evaluate the uptake by enterocytes of 4,8-sphingadienine, we used differentiated Caco-2 cells, derived from human colonic carcinoma, as a model of intestinal epithelial cells. The accumulation of sphingoid bases in Caco-2 cells incubated with each isomer of sphingadienine was lower than that after incubation with sphingosine (P < 0.05). Verapamil, a P-glycoprotein inhibitor, increased the accumulation of each sphingadienine but not of sphingosine, suggesting that the efflux of sphingadienine of plant origin, but not sphingosine of mammalian origin, was affected by P-glycoprotein. The digestibility of maize cerebrosides appears similar to that of cerebrosides of mammalian origin, but the metabolic fate of sphingoid bases of plant origin within enterocytes differs from that of sphingosine. Isomers of 4,8-sphingadienine degraded from dietary plant cerebrosides appear to be poorly absorbed from the digestive tract.

Effects of highly purified structured lipids containing medium-chain fatty acids and linoleic acid on lipid profiles in rats.

The purpose of this study is to examine the effects of highly purified structured lipids on serum and liver lipid profiles in rats. We also investigated in vitro hydrolysis of lipid emulsions by porcine pancreas. Hydrolysis rates of medium chain (M)-linoleic (L)-medium chain (M) types were 2 to 3 times higher than those of L-M-L types. The diet containing structured lipids or corn oil was administered to rats for 4 weeks. There were no significant differences in growth and food efficiency. Serum cholesterol levels were significantly lower (P<0.05) in the 2-octanoyl-1,3-dilinoleoyl-glycerol, 2-linoleoyl-1,3-didecanoyl-glycerol, and 2-decanoyl-1,3-dilinoleoyl-glycerol groups than in the corn-oil group. Serum triglyceride levels were significantly lower (P<0.05) in rats fed L-M-L types than those in the other groups. Serum non-esterified fatty acid (NEFA) and beta-hydroxybutylate levels were significantly higher (P<0.01) in rats fed M-L-M types than those of the other groups. These results indicate that the feeding of highly purified L-M-L types could effectively improve serum and liver lipid profiles and that M-L-M types may be a preferable substrate for the pancreas and contribute to energy supply in rats.

External iliac venous aneurysm in a pregnant woman: a case report.

We report an external iliac venous aneurysm in a young pregnant woman who was diagnosed incidentally by ultrasound scanning. The aneurysm was successfully treated by tangential aneurysmectomy and lateral venorrhaphy. Primary iliac venous aneurysm is a rare vascular abnormality. The clinical significance of the disease is unknown. However, embolism, rupture, and thrombosis might occur as they can occur with popliteal venous aneurysm. In fact, three of four reported patients with iliac venous aneurysms had a thromboembolic event. For those reasons, prophylactic treatment is indicated. This is the first patient with an iliac venous aneurysm to be diagnosed without complication.

Efflux of sphingoid bases by P-glycoprotein in human intestinal Caco-2 cells.

The aim of this study was to determine whether sphingoid bases that originated from various dietary sources, such as mammals, plants, and fungi, are substrates for P-glycoprotein in differentiated Caco-2 cells, which are used as a model of intestinal epithelial cells. In Caco-2 cells, the uptake of sphingosine, the most common sphingoid base found in mammals, was significantly higher at physiological temperatures than those of cis/trans-8-sphingenine, trans-4, cis/trans-8-sphingadienine, 9-methyl-trans-4, trans-8-sphingadienine, or sphinganine. Verapamil, a potent P-glycoprotein inhibitor, increased the cellular accumulation of sphingoid bases, except for sphingosine, in a dose-dependent manner. Incubation with 1 microM digoxin for 48 h caused up-regulation of multidrug-resistance (MDR)1 mRNA and decreased the accumulation of sphingoid bases in Caco-2 cells, except for sphingosine. Thus P-glycoprotein probably contributes to the selective absorption of sphingosine from dietary sphingolipids in the digestive tract.