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  • 1
    Publication Date: 2018-03-14
    Description: Background. Patients with inflammatory bowel diseases could experience mouth and teeth disorders and alterations in psychological mood. Vice versa, the psychological status may influence the presence of oral diseases. Aim. To evaluate in inflammatory bowel disease patients the prevalence of sleep bruxism and its correlation with the presence of oral diseases, quality of sleep, and psychological disturbances. Methods. Patients were consecutively recruited in our clinic and examined for temporomandibular disorders, dental enamel disorders, sleep bruxism, and recurrent aphthous stomatitis by two dentists. Patients also underwent Pittsburgh Sleep Quality Index and Beck Depression Inventory Scale questionnaires. Results. 47 patients and 46 controls were included. Sleep bruxism and enamel wear disorders were more frequent in Crohn’s disease patients when compared with ulcerative colitis patients and controls ( and , resp.). Among groups, no differences were noted for enamel hypoplasia, temporomandibular disorders, recurrent aphthous stomatitis, depression, and quality of sleep. We found a positive correlation between bruxism and temporomandibular disorders (Spearman 0.6, ) and between bruxism and pathological sleep (Pittsburgh Sleep Quality Index 〉 5) (Spearman 0.3, ). Conclusion. Bruxism and enamel wear disorders should be routinely searched in Crohn’s disease patients. Moreover, the attention of healthcare givers to sleep disturbances should be addressed to all inflammatory bowel disease patients.
    Print ISSN: 1687-6121
    Electronic ISSN: 1687-630X
    Topics: Medicine
    Published by Hindawi
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  • 2
    Publication Date: 2018-03-14
    Description: Aims. To explore the risk factors for rebleeding in acute nonvariceal upper gastrointestinal bleeding patients with high-risk stigmata after endoscopic hemostasis and to develop a new scoring system for them. Methods. A retrospective single-center study was conducted from January 2012 to June 2017. The logistic regression model was used to explore risk factors of poor clinical outcomes. Accuracy of new scoring systems was compared with Rockall score (RS) and Glasgow-Blatchford score (GBS) using receiver operating characteristics curve. Results. Two hundred nine patients were included. In multivariate regression analysis, systolic blood pressure, endoscopic hemostasis method, hemoglobin, blood urea nitrogen, and serum creatinine were identified as indicators for rebleeding. New scoring systems with 4 variables and 5 variables based on these 5 risk factors were chosen. The 4-variable scoring system outperformed GBS in predicting rebleeding while 5-variable scoring system outperformed RS and GBS in predicting rebleeding significantly. Score 2 was identified as the best cut-off of these 2 scoring systems. Conclusions. Systolic blood pressure, endoscopic hemostasis method, hemoglobin, blood urea nitrogen, and serum creatinine were all associated with poor clinical outcomes. The new scoring systems had greater accuracy than RS and GBS in predicting rebleeding. Further external validation should be performed to verify the results.
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    Topics: Medicine
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  • 3
    Publication Date: 2018-03-14
    Description: The NICE classification is an international endoscopic classification of colorectal neoplasia through a narrowband spectrum that on the basis of lesion colors, vascular pattern, and structure of the surface of the mucous membrane classifies colorectal neoplasms in three categories: type 1 as hyperplastic lesions, type 2 as adenomas, and type 3 as invasive tumors. The aim of this study was to verify diagnostic accuracy of the NICE classification system compared to the reference standard: histopathological analysis. This retrospective study was conducted by ten physicians on a sequential sample of 418 patients and 735 polyps. The total diagnostic accuracy of the NICE classification system is found to be 76.7%. Optical recognition is significantly better with larger polyps, high-risk lesions (HGIEN), and neoplastic lesions. This research has shown that the NICE classification system is at the moment inferior to histopathological analysis. However, it is noticed that some physicians achieve significantly better results, with the accuracy of diagnosis ranging from 59.5% to 84.2%. These results show that with proper training of physicians and the use of endoscope enhancements to improve image quality, the NICE classification system could in the future potentially replace the histopathological diagnosis process.
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  • 4
    Publication Date: 2018-03-12
    Description: Background. The increase in intra-abdominal pressure (IAP) during closed abdominal hyperthermic intraperitoneal chemotherapy (HIPEC) leads to major haemodynamic changes and potential organ dysfunction. We investigated these effects on hepatic blood flow (HBF) and liver function in patients undergoing HIPEC following cytoreductive surgery and fluid management guided by dynamic preload indices. Methods. In this prospective observational clinical study including 15 consecutive patients, we evaluated HBF by transesophageal echocardiography and liver function by determination of the indocyanine green plasma disappearance rate (ICG-PDR). Friedman’s two-way analysis of variance by ranks and Wilcoxon signed-rank test were performed for statistical analysis. Results. During HIPEC, HBF was markedly reduced, resulting in the loss of any pulsatile Doppler flow signal in all but one patient. The ICG-PDR, expressed as median (interquartile 25–75), decreased from 23 (20–30) %/min to 18 (12.5–19) %/min (). Despite a generous crystalloid infusion rate (27 (22–35) ml/kg/h), cardiac index decreased during the increased IAP period, inferior vena cava diameter decreased, stroke volume variation and pulse pressure variation increased, lung compliance dropped, and there was an augmentation in plateau pressure. All changes were significant () and reversed to baseline values post HIPEC. Conclusion. Despite optimizing intravenous fluids during closed abdominal HIPEC, we observed a marked decrease in HBF and liver function. Both effects were transient and limited to the period of HIPEC but could influence the choice between closed or open abdominal cavity procedure for HIPEC and should be considered in similar clinical situations of increased IAP.
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    Topics: Medicine
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  • 5
    Publication Date: 2018-03-09
    Description: Background. Tanshinone IIA sodium sulfonate (TSS) is known to possess anti-inflammatory effects and has exhibited protective effects in various inflammatory conditions; however, its role in lipopolysaccharide- (LPS-) induced intestinal injury is still unknown. Objective. The present study is designed to explore the role and possible mechanism of TSS in LPS-induced intestinal injury. Methods. Male C57BL/6J mice, challenged with intraperitoneal LPS injection, were treated with or without TSS 0.5 h prior to LPS exposure. At 1, 6, and 12 h after LPS injection, mice were sacrificed, and the small intestine was excised. The intestinal tissue injury was analyzed by HE staining. Inflammatory factors (TNF-α, IL-1β, and IL-6) in the intestinal tissue were examined by ELISA and RT-PCR. In addition, expressions of autophagy markers (microtubule-associated light chain 3 (LC3) and Beclin-1) were detected by western blot and RT-PCR. A number of autophagosomes were also observed under electron microscopy. Results. TSS treatment significantly attenuated small intestinal epithelium injury induced by LPS. LPS-induced release of inflammatory mediators, including TNF-α, IL-1β, and IL-6, were markedly inhibited by TSS. Furthermore, TSS treatment could effectively upregulate LPS-induced decrease of autophagy levels, as evidenced by the increased expression of LC3 and Beclin-1, and more autophagosomes. Conclusion. The protective effect of TSS on LPS-induced small intestinal injury may be attributed to the inhibition of inflammatory factors and promotion of autophagy levels. The present study may provide novel insight into the molecular mechanisms of TSS on the treatment of intestinal injury.
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  • 6
    Publication Date: 2018-03-07
    Description: Background. It has been found that single-nucleotide polymorphisms (SNPs) of microRNA might be involved in the development of inflammatory bowel diseases (IBDs). However, the related retrospective research has not been reported. In this work, we performed a meta-analysis to derive a more precise estimation of the associated relationship. Methods. We searched the studies on the association of SNPs of microRNA with the hereditary susceptibility of IBD in PubMed and Embase; eligible research was selected by screening the abstract and full text. The meta-analysis was performed based on the statistical software Stata 14.0, and besides, the odds ratio and 95% confidence interval were calculated to evaluate the strength of the association. Results. 159 papers were acquired from the PubMed and Embase databases, and five eligible articles containing nine case-control studies were selected. In the study, we first found that the association between miRNA-196a2 rs11614913 and IBD was insignificant. Then, the susceptibility of miRNA-146a rs2910146 to IBD increased significantly in allelic comparison, homozygote model, heterozygote model, and dominant model. Moreover, a positive relationship between miRNA-499 rs3746444 and IBD was identified in the homozygote model. Conclusion. Our findings demonstrated that miRNA-146a rs2910146 (G〉C) polymorphism was associated with the susceptibility to IBD and miRNA-196a2 rs11614913 (T〉C) and miRNA-499 rs3746444 (A〉G) did not reveal an obvious relationship with the IBD susceptibility.
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  • 7
    Publication Date: 2018-03-06
    Description: Background. Nontyphoidal Salmonella infection is a common cause for acute bacterial gastroenteritis in children in China. There have been no reports of the prevalence of lactose intolerance or food allergies in children with nontyphoidal Salmonella infection. The aim of this study was to characterize nontyphoidal Salmonella gastroenteritis in a tertiary children’s hospital and evaluate clinical presentation, lactose intolerance, and food allergies in children with prolonged nontyphoidal Salmonella gastroenteritis. Methods. A retrospective case-series analysis was carried out in a tertiary children’s hospital in Guangzhou, China. We included all infants and children who were diagnosed with nontyphoidal Salmonella gastroenteritis between 1 January 2014 and 31 December 2016. Patients’ clinical features, feeding patterns, laboratory tests, and treatment outcomes were reviewed. Results. A total of 142 infants and children were diagnosed with nontyphoidal Salmonella gastroenteritis. 52.1% of cases occurred in infants ≤ 12 months of age and the majority (89.4%) in children younger than 3 years old. The most common symptoms were diarrhea (100%), fever (62%), and vomiting (18.3%). Salmonella Typhimurium was the predominant serotype, accounting for 82.4%. 91.5% of patients were treated with antibiotics. Forty-one (28.9%) and 9 (6.3%) children improved with a lactose-free diet and hypoallergenic formula, respectively, when diarrhea persisted for more than a week. Conclusions. Salmonella Typhimurium was the predominant serotype. Most patients with nontyphoidal Salmonella gastroenteritis were younger than 3 years old. Lactose intolerance occurred frequently in children with nontyphoidal Salmonella gastroenteritis and dietary modification should be considered when diarrhea is persistent and prolonged.
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  • 8
    Publication Date: 2018-03-06
    Description: Purpose. Pancreatic cancer is a lethal disease and usually is diagnosed at advanced stages of disease. This study assessed the effects of intratumoral ethanol injection using an endoscopic ultrasound (EUS) probe on the control of pancreatic cancer in a mouse orthotopic xenograft model. Materials and Methods. The subcutaneous and orthotopic human pancreatic cancer cell mouse xenograft models were established. Different concentrations of ethanol (0–95%) were injected into subcutaneous xenograft tumors. In the orthotopic tumor model, ethanol was injected into the tumor lesions under the guidance of a high-frequency EUS probe. Tumor volume, relative tumor volume (RTV), and histopathology were evaluated. The serum amylase level was analyzed at baseline and 24 h after treatment in the orthotopic tumor model. Results. Injection of 40–95% ethanol induced tumor necrosis in the subcutaneous tumor model, while there was no statistical difference between the RTVs of the two groups (). In the orthotopic tumor model, the RTV of the 80% ethanol treatment group was less than that of the saline injection group (); and histologically, there was a large area of necrosis observed in the 80% ethanol group. The serum amylase level was slightly elevated at 24 h after injection and returned to the baseline level at 7 days. Conclusion. Injection of 80% ethanol into xenograft tumor lesions of orthotopic pancreatic cancer resulted in tumor necrosis, and the procedure was safe and effective. Future studies will further confirm its antitumor activity as well as assess its safety and feasibility.
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  • 9
    Publication Date: 2018-03-06
    Description: Aims. Gastric cancer (GC) is often diagnosed at an advanced stage; inexpensive and valid biomarkers for GC are still unavailable. We aimed to evaluate the prognosis of the combination of pretreatment red cell distribution width (RDW) and neutrophil-to-lymphocyte ratio (NLR) in patients with GC. Methods. A retrospective analysis from 103 GC patients who were diagnosed at our institution from 2012 to 2016 was performed. Both pretreatment RDW and NLR were calculated based on the recommended cutoff values of 13.4% and 2.755, respectively. Combined values of RDW and NLR (RDW + NLR) stratified patients into a score of 0 (RDW ≤ 13.4% and NLR ≤ 2.755), a score of 1 (RDW 〉 13.4% or NLR 〉 2.755), and a score of 2 (RDW 〉 13.4% and NLR 〉 2.755). Prognostic significances for overall survival (OS) and progression-free survival (PFS) were assessed. Results. Pretreatment RDW + NLR was a significantly independent prognostic factor for OS and PFS. Moreover, high RDW + NLR was strongly related to age, tumor location, TNM stage, CA125, and CA199. In a subgroup analysis for patients with advanced gastric cancer (AGC), we observed that the level of RDW + NLR was markedly associated with OS and PFS. Conclusion. Pretreatment RDW + NLR is a simple, inexpensive, and valid prognostic system to predict the survival in patients with GC, especially AGC.
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  • 10
    Publication Date: 2018-03-06
    Description: The aim of this study was to assess the efficacy of the rectal administration of nonsteroidal anti-inflammatory drugs (NSAIDs) in preventing post-ERCP pancreatitis (PEP). We searched database for randomized controlled trials (RCTs) comparing periprocedural rectal administration of NSAIDs with placebo for the prevention of PEP. The rectal administration of NSAIDs significantly decreased the incidence of PEP in the whole patient population (odds ratio (OR): 0.44, 95% confidence interval (CI): 0.30–0.64, ), high-risk patients (OR: 0.34, 95% CI: 0.19–0.58, ), and all-risk patients (OR: 0.51, 95% CI: 0.31–0.84, ). The incidence of PEP was reduced by indomethacin (OR: 0.54, 95% CI: 0.36–0.82, ) and diclofenac (OR: 0.27, 95% CI: 0.15–0.46, ). The administration of NSAIDs before (OR: 0.42, 95% CI: 0.25–0.73, ) or after (OR: 0.39, 95% CI: 0.27–0.56, ) ERCP reduced PEP. The NSAIDs were associated with a reduction in mild PEP (OR: 0.55, 95% CI: 0.36–0.83, ) and moderate-to-severe PEP (OR: 0.47, 95% CI: 0.28–0.79, ). The rectal administration of NSAIDs reduced the incidence of PEP in high-risk and all-risk patients.
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