Hasil untuk "Diseases of the digestive system. Gastroenterology"

Robert S. Sandler, James E. Everhart, Mark Donowitz et al.

Yusuke Ohara, Yohei Owada, Jaejeong Kim et al.

Objectives: Surgical-site infections (SSIs) are the most common complication after stoma closure. We propose a new method for wound closure using the subcutaneous large-bite buried suture (SLBS) technique and a closed suction drain (CSD). In this study, we aimed to investigate the efficacy of a combination of the SLBS technique and a CSD to prevent superficial SSIs following stoma closure. Methods: We retrospectively analyzed patients who underwent stoma closure between January 2019 and July 2022. Primary closure of the stomal site was performed using the SLBS technique and a CSD for wound closure. The CSD was placed until postoperative day 7. The occurrence of superficial postoperative SSIs was also evaluated. Results: In total, 67 patients were included in the study. Within 30 days postoperatively, nine patients (13%) developed superficial SSIs. Considering the type of stoma, only 1 (2%) of 45 patients with ileostomy showed superficial SSIs, whereas 8 (36%) of 22 patients with colostomy showed superficial SSIs. Univariate analysis of the risk factors associated with the occurrence of superficial SSIs revealed that colostomy (p < 0.001) and hand-sewn anastomosis were significant risk factors (p = 0.019). Multivariate analysis of the risk factors associated with the occurrence of superficial SSIs revealed that colostomy was significant risk factor (p = 0.003). Conclusions: This new method of stoma closure is feasible for preventing superficial SSIs, especially in ileostomy closure.

Xiaolan Huang, Nan Jia, Yan Zhang et al.

Abstract Background Cognitive-Behavior Therapy (CBT) is the validated non-pharmacological treatment for chronic pain in pediatric patients. While some suggested CBT were comparable to the usual care in reducing children’s functional abdominal pain. This meta-analysis was designed to systematically review the literature for RCTs that investigated the efficacy of CBT in children with functional abdominal pain (FAP). Methods PubMed, Embase, and the Cochrane library were searched for papers published up to October 2022. Studies applying different CBT delivery methods (in-person, web-based, phone-based) were included in this meta-analysis to evaluate the comprehensive effectiveness of CBT compared with usual care. Weighted and standardized mean difference with the 95% confidence intervals were used for the synthesis of the results. Primary outcome was the decrease of functional disability inventory (FDI) and the secondary outcomes were the decrease of severity in pain intensity, depression, anxiety, gastrointestinal symptoms, and improvement in physical quality of life (QoL). Results A total of 10 RCTs with 1187 children were included in the final analysis. The results showed that CBT resulted in better effect in reducing functional disability inventory (SMD=-2.282, 95%CI: -4.537 to -0.027, P = 0.047), pain intensity (SMD=-0.594, 95%CI: -1.147 to -0.040, P = 0.036), and improving QoL (SMD = 14.097, 95%CI: 0.901 to 27.292, P = 0.036) compared with the control groups. Comparable effects were observed in the severity of depression (SMD=-0.493, 95%CI: -1.594 to 0.608, P = 0.380), anxiety (SMD=-0.062, 95%CI: -0.640 to 0.517, P = 0.835), and gastrointestinal symptoms (SMD=-1.096 95%CI: -2.243 to 0.050, P = 0.061) between CBT and usual treatment. Conclusions We observed the differences in post-treatment FAP and pain intensity for children receiving CBT compared with children receiving treatment as usual. CBT in the setting of FAP demonstrates promising developments and highlights the need for future research.

Xiangming Ma, Fei Tian, Jian Li et al.

Background/Aims: Ketogenic diet (KD) may benefit patients with liver cancer, but the underlying mechanism of its anti-cancer effect remains an open issue. This work aimed to explore the influence of simulated KD on the proliferation and migration of cultured hepatoma cells. Materials and Methods: The low-glucose medium supplemented with β-hydroxybutyrate (BHB-Glow) was utilized to simulate clinical KD treatment. Western blot was utilized for detecting the expression of glycolysis-related proteins, Seahorse XF96 for oxygen consumption rate (OCR) and extracellular acidification rate (ECAR), and ELISA for insulin content. Expression of FOXC2 in liver cancer cells was analyzed by bioinformatics and qPCR. Cell Count Kit-8 (CCK-8) testing kit was utilized for testing cell viability. Results: KD treatment significantly reduced the expression of glycolysis-related proteins in Huh-7 cells, inhibited insulin production in β islet cells, reduced ECAR, and increased OCR. FOXC2 was significantly up-regulated in Huh-7 cell line, and sh-FOXC2 hindered the proliferation and migration of Huh-7 cells. The exogenous addition of insulin promoted the malignant progression of Huh-7 cells. Together, the medium simulating KD environment strengthened the protection of liver cancer cells by reducing insulin production and down-regulating FOXC2 expression. Conclusion: This study confirmed through in vitro cell experiments that KD could inhibit the proliferation and migration of liver cancer cells by targeting down regulation of insulin and FOXC2 expression, providing new theoretical basis for the treatment of liver cancer patients.

Toni M. Jackson, Simone Howard, Uchenna Agbim et al.

Han Hee Lee, Siddharth Singh

Yoshiaki Kimoto, Rikimaru Sawada, Susumu Banjoya et al.

Toshiyuki Wakatsuki, Tomohiko Mannami, Shinichi Furutachi et al.

Abstract Objectives The Glasgow‐Blatchford score (GBS) is a widely used risk assessment tool for patients with upper gastrointestinal bleeding. However, it only identifies a relatively low proportion of patients at low risk for adverse events and poor outcomes. We developed a simple diagnostic algorithm combining the GBS and nasogastric aspirate and evaluated its diagnostic performance. Methods A total of 115 consecutive patients with suspected nonvariceal upper gastrointestinal bleeding who underwent nasogastric tube placement and upper endoscopy at our emergency department were prospectively evaluated. We compared the diagnostic accuracy of the GBS and our algorithm for predicting high‐risk endoscopic lesions (HRELs) using receiver operating characteristic curve analysis. Results Thirty‐five patients had HRELs. Compared with the GBS, our algorithm showed superior performance with respect to the prediction of HRELs (area under the curve, 0.639 and 0.854, respectively; p < 0.001). With set optimal threshold values, the algorithm identified a significantly higher proportion of patients who did not have HRELs than the GBS (23.5% vs. 2.6%, p < 0.001). Conclusions The novel algorithm has improved the diagnostic performance of the GBS and predicted more patients who did not have HRELs than the GBS alone. After further validation, it may be a useful tool for making clinical management decisions for patients with nonvariceal upper gastrointestinal bleeding.

Reben Raeman

Beth A. McCormick, John M. Inadomi

Kei Murakami, Daizen Hirata, Kengo Haraguchi et al.

Abstract Objectives Since carbonized clots and tissue (debris) tend to adhere firmly to the tip of the endoscopic submucosal dissection (ESD) knife as the procedure proceeds, manual removing the firm debris is often challenging and time‐consuming. Recently, effective ultrasonic cleaning for other medical devices has been reported. The aim of the present study was to clarify whether ultrasonic cleaning is effective in removing the debris on the insulation‐tipped diathermic (IT) knife‐2. Methods This study was an ex‐vivo experimental randomized study. A total of 40 IT knife‐2 knives with debris on their tip surfaces were prepared and randomly assigned to two groups (Group A and Group B). The knives in Group A were cleaned using the conventional scrubbing method for 30 s (conventional cleaning method), while those in Group B were cleaned using a combined method of scrubbing for 20 s and ultrasonic cleaning for 10 s (combined ultrasonic cleaning method). The tip electrode of the knife after cleaning was photographed under a microscope (40x). The 40 images of the knives were evaluated by independent three endoscopists and two clinical engineers using the five‐step evaluation criteria ranging from cleaning score 1 (dirty) to 5 (clean). Results The mean cleaning score of 3.78 (range: 2.33–4.67) in Group B was significantly higher than that of 1.68 (range: 1.00–2.83) in Group A. Conclusions The combined ultrasonic cleaning method could remove debris adhering to the IT knife‐2 more effectively than the conventional cleaning method. Ultrasonic cleaning may be applied for real‐world ESD.

Vijay P. Singh, Bara El-Kurdi, Christopher Rood

Ravinder K. Mittal

Anisa Shaker

Ayman Fouad, Wael Aref, Ahmed Elshenawy et al.

Abstract Background Nogo-B is one of the members of the reticulon family. Nogo-B influences the proliferation of the hepatic stellate cells inducing liver fibrotic changes. We aimed at measuring the serum levels of Nogo-B in patients with chronic liver disease (CLD) with different etiologies. Ninety subjects were included, 18 of them were normal healthy individuals and 72 had liver disease (fibrosis/cirrhosis) with different etiologies: post-hepatitis C infection, post-hepatitis B infection, NASH, and autoimmune hepatitis. Serum Nogo-B was assessed using ELISA. Patients were subdivided according to the Child-Pugh score into 3 groups: group 1—Child A (24 patients); group 2—Child B (24 patients); and group 3—Child C (24 patients). Results Serum Nogo-B levels were found to be significantly higher in patients (1477.92 ± 1113.50) when compared with healthy control (301.28 ± 180.87) (p < 0.001). There was a statistically significant difference in serum Nogo-B level between the three sub-groups of patients (p < 0.001). A positive correlation was found between serum Nogo-B and MELD score (r = 0.46, p-value < 0.001). However, there was no correlation found between Nogo-B and FIB-4 index or APRI score. There was a significant positive correlation between serum Nogo-B level and coagulation profile and serum bilirubin. An inverse correlation was found between serum Nogo-B with serum albumin. A ROC curve was done to examine the validity of Nogo-B in the diagnosis of liver cirrhosis, and the area under the curve was found to be 0.979, a cutoff value of 600 with a sensitivity of 97.2% and a specificity of 94.4% (p-value < 0.001). Conclusion Nogo-B had a high value in the identification of patients with any severity of CLD. There is a highly significant correlation between Nogo-B and the synthetic function of the liver; it could be used as a measure of hepatic functional reserve.

Lakshmikanth L. Chikkamenahalli, Pankaj J. Pasricha, Gianrico Farrugia et al.

The Fellows of the Collegium Ramazzini

Background: Workers whose occupations put them in contact with infected persons and the public are at increased risk of COVID-19 infection. Recommendations: The Collegium Ramazzini calls on governments at all levels to protect worker health by strengthening public health systems; maintaining comprehensive social insurance systems; establishing policies that presume all COVID-19 infections in high-risk workers are work-related; enforcing all occupational health standards; and developing pandemic preparedness plans. The Collegium Ramazzini calls on all employers – large and small, public and private – to protect the health of all workers by developing disease preparedness plans; implementing basic infection control measures; establishing disease identification and isolation policies; reducing hazardous exposures; supporting personal protective equipment (PPE) programs; and restricting unnecessary travel. Conclusion: Governments and employers have legal obligations to protect worker health. They are not relieved of these duties during pandemics.

L. Granel-Villach, M. Gil-Fortuño, C. Fortea-Sanchis et al.

Introduction and aim: Normally, the bile ducts are sterile, but up to 4.2% of healthy persons can present with positive cultures. Certain circumstances favor that situation, such as gallstones or biliary tree manipulation. The aim of the present study was to determine the factors that influence the presence of bacteriobilia, as well as its implications for clinical practice. Materials and methods: A prospective study was conducted on bile cultures from patients that underwent cholecystectomy at our hospital center within the time frame of 2013 to 2015. Results: The study included 196 patients (42.3% women and 57.7% men) that underwent either open or laparoscopic cholecystectomy and in whom bile fluid samples were taken. The clinical, epidemiologic, and laboratory test characteristics of the patients were analyzed, as well as the surgical indication (urgent surgery or programmed surgery). With respect to microbiology, 47% of the bile cultures were positive: 56.5% presented with one microorganism, 25% with two, and 18.5% with three or more. Conclusion: Microbiologic bile analysis should not be systematically performed, given that its result is relevant only in cases that present with demonstrated risk factors. However, in those cases, said analysis is essential to establish adequate antibiotic treatment, in relation to activity spectrum and duration, to prevent complications and an increase in microbial resistance. Resumen: Introducción y objetivo: Las vías biliares son normalmente estériles, aunque puede existir cultivo positivo hasta en un 4,2% de las personas sanas. Existen ciertas circunstancias que lo favorecen como pueden ser las litiasis o la manipulación de la vía biliar. El objetivo del estudio fue determinar los factores que influyen en la presencia de bacteriobilia, así como su implicación en la práctica clínica. Material y métodos: Estudio prospectivo de los cultivos de bilis obtenidos de los pacientes colecistectomizados en nuestro centro desde 2013 a 2015. Resultados: Se recogieron un total de 196 pacientes, 42,3% mujeres y 57,7% hombres a los que se había realizado colecistectomía tanto abierta como laparoscópica tomando muestra del líquido biliar. Se analizaron las características clínicas, epidemiológicas y analíticas de los pacientes, así como la indicación quirúrgica (cirugía urgente o programada). Respecto a la microbiología en un 47% los cultivos de bilis recogidos fueron positivos: 56,5% con un microorganismo, 25% con dos y 18,5% con tres o más. También se incluyeron los antibióticos empleados tanto para tratamiento como para profilaxis. Conclusión: El análisis de la microbiología de la bilis no debería realizarse de forma sistemática, ya que solamente en casos en los que se demuestren los factores de riesgo estudiados su resultado puede llegar a ser relevante. En estos mismos casos también resulta imprescindible para establecer un tratamiento antibiótico adecuado tanto en lo referente al espectro como a la duración del mismo, con el fin de evitar complicaciones y el aumento de resistencias.

Christopher Kasia, Anoop Appannagari, Anjali Joshi et al.

Background and Aim Wireless capsule endoscopy (WCE) has become an increasingly utilized imaging modality for the evaluation of gastrointestinal bleeding. There is a paucity of data evaluating the safety and use of WCE in patients with implantable cardiac devices. Methods A retrospective chart review of all patients who had a WCE at Loyola University Medical Center in Maywood, IL, USA completed between January 2007 and December 2016 identified patients with internal cardiac devices and obscure gastrointestinal bleeding. Patient WCE footage was viewed in its entirety before creating a final report to ensure no gaps in footage and video quality. Results No patient complaints were documented during the 8‐h procedure duration, and there were no cardiac abnormalities noted on telemetry. There were no device‐related complications documented in the 30‐day postprocedure time period. Postprocedure analysis of the WCE recordings demonstrated no interference in WCE image quality (loss of images or gaps in video) or duration. Conclusions There is no significant interference between WCE and implantable cardiac devices, and it appears to be safe to use.

Arvind Bamanikar, Swapnil Patil, Shivam Sharma

Extra nodal site of non–Hodgkin’s lymphoma is mostly in the gastrointestinal tract. Large intestine is rarely affected compared with stomach or small bowel. The colon is affected in 0.4% of cases approximately. High index of suspicion is required to establish the diagnosis, since there may be no specific signs. Here we report a case of a 28-year-old male, who presented with diarrhea , abdominal pain and weight loss of 2-month duration and diagnosed as non-Hodgkin’s lymphoma (NHL) of the cecum as B-cell lymphoma, unclassified (BCLU) according to World Health Organization (WHO) guidelines.