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The present study aimed to elucidate the association between post-vascular–phase (Kupffer-phase) images from contrast-enhanced ultrasonography (CEUS) with perfluorobutane microbubbles and metastatic recurrences after the resection of hepatocellular carcinoma (HCC). The study examined 73 patients with solitary HCC ≤5 cm in diameter who underwent CEUS before resection. HCC was defined as irregular type (including an irregular defect on Kupffer-phase images) or non-irregular type. Intrahepatic metastatic recurrence was defined as >3 intrahepatic recurrences. Metastatic recurrence included both extrahepatic and intrahepatic recurrences. Frequencies of microscopic portal invasion and intrahepatic metastasis were significantly higher in the irregular group than in the non-irregular group. Cumulative 5-y metastatic recurrence rates in the irregular and non-irregular groups were 43% and 7% (p = 0.028), respectively. Multivariate analyses identified Kupffer-phase findings as a factor significantly related to metastatic recurrence. In conclusion, HCCs with an irregular defect during Kupffer-phase CEUS are characterized by more frequent microscopic vascular invasion and intrahepatic metastasis and are significantly associated with metastatic recurrence after resection.

To clarify the alterations in lower intestinal microflora induced by gastric acid reduction, the dynamics of 12 major genera or groups of bacteria comprising the microflora in feces and colonic contents were examined by quantitative real-time PCR in proton pump inhibitor-treated rats and in asymptomatic human subjects with hypochlorhydria. In both rat and human experiments, most genera or groups of intestinal microflora (facultative and obligate anaerobes) proliferated by gastric acid reduction, and marked and significant increases in the Lactobacilli group and Veillonella, oropharyngeal bacteria, were observed. In rats, potent gastric acid inhibition led to a marked and significant increase of intestinal bacteria, including the Bacteroidesfragilis group, while Bifidobacterium, a beneficial bacterial species, remained at a constant level. These results strongly indicate that the gastric acid barrier not only controls the colonization and growth of oropharyngeal bacteria, but also regulates the population and composition of lower intestinal microflora.

An Evaluation of Risk Factors for Inadequate Cytology Using Contrast-Enhanced Harmonic Endoscopic Ultrasound in Endoscopic Ultrasound-Guided Fine Needle Aspiration of Suspected Pancreatic Malignancy Masahiro Itonaga*, Kazuki Ueda, Hiroko Terada, Takashi Tamura, Yasunobu Yamashita, Hiroki Maeda, Takao Maekita, Mikitaka Iguchi, Hideyuki Tamai, Jun Kato, Masao Ichinose Second Department of Internal Medicine, Wakayama Medical University, Wakayama City, Japan [OBJECTIVES] Contrast-enhanced harmonic endoscopic ultrasound(CH-EUS) is useful for differential diagnosis of pancreatic mass lesions, but risk factors for inadequate cytology using this modality in endoscopic ultrasound-guided fine needle aspiration(EUS-FNA) remain unclear. The present study aimed to evaluate the role of CH-EUS in EUS-FNA. [METHODS] Generally, CH-EUS is evaluated in the perfusion phase (60-90 s after contrast agent infusion), but we performed evaluations in the early phase (10-30s after contrast agent infusion) and categorized into two patterns: Pattern A, homogeneous enhancement; and Pattern B, heterogeneous enhancement with partial hypoenhancement. We selected typical Pattern A and Pattern B cases of pancreatic ductal adenocarcinoma that had undergone surgery and performed histopathological examinations with hematoxylin and eosin staining and immunohistochemical staining. Compared with Pattern A, the Pattern B case showed necrotic or fibrous lesions and fewer vessels. The Pattern A case showed tumor cells homogeneously, but the Pattern B case showed few tumor cells in the necrotic or fibrous regions and tumor cells were distributed heterogeneously. We thus hypothesized that accuracy of EUS-FNA would differ between Patterns A and B. From January 2009 to July 2012, a total of 61 patients with suspected pancreatic malignancy were included. After CH-EUS was performed, we performed EUSFNA at the center of each mass. Risk factors for inadequate cytology were evaluated retrospectively. [RESULTS] Male:female ratio was 36:25, mean ( standard deviation) age was 68.8 8.96 years, mean lesion size was 37.6 15.3 cm, head:body or tail ratio was 28:33; 19G/22G ratio was 37/24; number of passes was 2.77 1.28 and Pattern A:B ratio was 23:38. FNA was successfully performed in all cases and adequate samples for histological examination were obtained in 53 of the 61 cases (86.9%). Only Pattern B was identified as a significant risk factor for inadequate cytology (p 0.02) using the 2-test and Student’s t-test. [CONCLUSION] As expected, accuracy in EUS-FNA differed significantly between Patterns A and B. We expect CH-EUS to improve the diagnostic value of EUS-FNA if regions of hypoenhancement on CH-EUS are avoided.

[Background and aims] Elderly and/or cirrhotic patients with hepatitis C virus (HCV) infection are at high risk of adverse events during interferon-based therapy. This study evaluated the efficacy, safety, and predictors of response of low-dose pegylated interferon alpha 2a (PEGIFN-α-2a) monotherapy in elderly and/or cirrhotic patients infected with genotype 2 HCV or genotype 1 low HCV level. [Methods] Fifty-six elderly and/or cirrhotic patients with genotype 2 HCV or genotype 1 low viral load ( 70,000/mm3 is needed for safety. RVR can predict SVR precisely.

Background and aims: Aberrant DNA methylation observed in the atrophic gastritis with the past infection of Helicobacter pylori (H. pylori) is associated with the risk of gastric cancer, mainly intestinal-type. In contrast, DNA methylation in gastric mucosae at risk of diffusetype gastric cancer is not fully known. We have found that the subjects with severe gastric mucosal inflammation identified by serum markers have higher risk of the development of diffuse-type gastric cancer. Thosewho showedH. pylori antibody titer >500U/mL, pepsinogen (PG) II >30 ng/mL, or PG I >70 ng/mL and PG I/II ratio 500 U/mL) and high levels of PG II (>30 ng/mL). The methylation levels were also severely altered in the subjects with serum PG I >70 ng/mL and PG I/II ratio

BACKGROUND: Recently, there has been a growing body of evidence suggesting a relationship between H. pylori gastritis and hypoferritinemia or IDA . AIM: To systematically review the role of H. pylori infection in hypoferritinemia and IDA, and to perform a meta-analysis of case-control studies. METHODS: Selection of studies: Case-control studies comparing a) the prevalence of H. pylori infection in patients with and without IDA/hypoferritinemia, and b) the prevalence of IDA/hypoferritinemia in patients with and without H. pylori infection. Search strategy: electronic and manual bibliographical searches. Data synthesis: Meta-analysis combining the Odds Ratios (OR). RESULTS: a) Eight studies compared the prevalence of H. pylori infection in patients with (637 patients) and without (2,305 patients) IDA, showing a higher prevalence of H. pylori infection in anaemic patients (34% vs. 22%; OR=1.6; 95%CI= 1.26-2.03). Only one study compared the prevalence of infection in patients with and without hypoferritinemia (29% vs. 19%; p