Psychosocial stress in nurses with shift work schedule is associated with functional gastrointestinal disorders

Background/Aims

The aim of this study was to investigate the role of psychosocial problems and their associations with rotating shift work in the development of functional gastrointestinal disorders.

Methods

In this cross-sectional observation study, survey was administered to nurses and nurse assistants in a referral hospital. In addition to demographic questions, subjects were asked to complete the Rome III Questionnaire, Pittsburgh Sleep Quality Index and Rome III Psychosocial Alarm Questionnaire.

Results

Responses from 301 subjects were assessed. The overall prevalence of irritable bowel syndrome (IBS) and functional dyspepsia (FD) were 15.0% and 19.6%, respectively. Psychosocial alarms were prevalent in the nursing personnel (74.8% with alarm presence and 23.3% with serious condition) and were more frequent among rotating shift workers (84.7% vs. 74.5% for alarm presence and 28.1% vs. 13.3% for serious condition). The prevalence of both IBS and FD significantly increased with psychosocial risk. An independent risk factor for IBS was serious psychosocial alarm (adjusted odds ratio [aOR], 10.75; 95% confidence interval (CI), 1.30–88.99; P = 0.028). Serious psychosocial alarm was an independent risk factor for FD (aOR, 7.84; 95% CI, 1.98–31.02; P = 0.003). Marriage (aOR 0.30; 95% CI, 0.09–0.93; P = 0.037) was associated with the decreased risk of FD.

Conclusions

The high prevalence of psychosocial stress among nurses who work rotating shifts is associated with the development of functional gastrointestinal disorders.

Clinical and endoscopic characteristics of drug-induced esophagitis

AIM: To investigate clinical, endoscopic and pathological characteristics of drug-induced esophagitis.

METHODS: Data for patients diagnosed with drug-induced esophagitis from April 2002 to May 2013 was reviewed. Patients diagnosed with malignancy, viral or fungal esophagitis were excluded. Clinical, endoscopic and pathological characteristics of patients diagnosed with drug-induced esophagitis were analyzed.

RESULTS: Seventy-eight patients were diagnosed with drug-induced esophagitis. Their mean age was 43.9 ± 18.9 years and 35.9% were male. Common symptoms were chest pain (71.8%), odynophagia (38.5%) and dysphagia (29.5%). The endoscopic location was in the middle third of esophagus in 78.2%. Endoscopic findings were ulcer (82.1%), erosion (17.9%), ulcer with bleeding (24.4%), coating with drug material (5.1%), impacted pill fragments (3.8%) and stricture (2.6%). Kissing ulcers were observed in 43.6%. The main causative agents were antibiotics and non-steroidal anti-inflammatory drugs. All the patients were treated with proton pump inhibitors (PPIs) or sucralfate, and the causative drugs were discontinued. Nineteen patients with drug-induced esophagitis were followed up with endoscopy and revealed normal findings, scars or healing ulcers.

CONCLUSION: Drug-induced esophagitis mainly presents as chest pain, odynophagia and dysphagia, and may be successfully treated with PPIs and discontinuation of the causative drug. Kissing ulcers were observed in 43.6%.

Ileal digestibility of amino acids in meat meal and soybean meal fed to growing pigs

The objective of this experiment was to determine the concentration and digestibility of crude protein (CP) and amino acid (AA) in meat meal (MM), and to compare these values with the respective values in soybean meal (SBM). Six barrows (initial body weight = 66.9±3.8 kg) surgically fitted with a T-cannula at the distal ileum were allotted to a replicated 3×3 balanced Latin square design with 3 diets and 3 periods. Two experimental diets containing test ingredients as the sole source of AA were prepared to estimate the apparent ileal digestibility (AID) for CP and AA by the direct method. An N-free diet was also prepared to estimate basal endogenous losses of CP and AA. All experimental diets contained 5% chromic oxide as an indigestible index. Each period consisted of a 5-d adaptation period and a 2-d of ileal digesta collection period. Ileal digesta samples were collected from 0900 to 1700 on d 6 and 7 of each period. The concentrations of CP, Lys, Met, and Trp in MM and SBM were analyzed to be 64.1, 3.5, 1.1 and 0.6, and 45.6, 2.8, 0.8, and 0.3%, respectively. The AID of all AA except Gly in MM was less (p<0.05) than in SBM. The AID of Lys, Met, and Trp in MM was estimated to be 56.0, 71.7, and 47.1%, respectively. The SID of all AA in MM was less (p<0.05) than in SBM. The SID of Lys, Met, and Trp was 65.1, 79.2, and 78.5%, respectively. In conclusion, the CP and AA contents in MM were greater than those in SBM whereas the ileal digestibility of all AA in MM was less than in SBM.

Feed energy evaluation for growing pigs

Pigs require energy for maintenance and productive purposes, and an accurate amount of available energy in feeds should be provided according to their energy requirement. Available energy in feeds for pigs has been characterized as DE, ME, or NE by considering sequential energy losses during digestion and metabolism from GE in feeds. Among these energy values, the NE system has been recognized as providing energy values of ingredients and diets that most closely describes the available energy to animals because it takes the heat increment from digestive utilization and metabolism of feeds into account. However, NE values for diets and individual ingredients are moving targets, and therefore, none of the NE systems are able to accurately predict truly available energy in feeds. The DE or ME values for feeds are important for predicting NE values, but depend on the growth stage of pigs (i.e., BW) due to the different abilities of nutrient digestion, especially for dietary fiber. The NE values are also influenced by both environment that affects NE requirement for maintenance (NE_m) and the growth stage of pigs that differs in nutrient utilization (i.e., protein vs. lipid synthesis) in the body. Therefore, the interaction among animals, environment, and feed characteristics should be taken into consideration for advancing feed energy evaluation. A more mechanistic approach has been adopted in Denmark as potential physiological energy (PPE) for feeds, which is based on the theoretical biochemical utilization of energy in feeds for pigs. The PPE values are, therefore, believed to be independent of animals and environment. This review provides an overview over current knowledge on energy utilization and energy evaluation systems in feeds for growing pigs.

Comparison of growth performance, carcass characteristics and meat quality of korean local chickens and silky fowl

This study was conducted to compare growth performance, carcass characteristics and meat quality of 4 breeds of local chicken. A total of 480 1-d-old chicks were distributed to 16 pens, with 4 treatments of breed, 4 replicates and 30 chicks per pen. Three Korean local breeds of white-mini broiler, Hanhyup-3-ho, and Woorimatdag, and a breed of silky fowl were raised under identical rearing and feeding conditions for 31-d, 37-d, 36-d, and 59-d, respectively. The BW and feed consumption on a pen basis were weekly measured for all pens, and ADFI, ADG and gain:feed were calculated for each pen. The ADFI and ADG of 3 breeds of Korean local chicken were greater than those of silky fowl (p<0.05). Within the Korean local breeds, ADFI of white-mini broiler was the highest (p<0.05), and ADG of Hanhyup-3-ho and white-mini broiler was the highest (p<0.05). Gain:feed of silky fowl was less than that of the 3 breeds of Korean local chicken. The carcass and breast yield of white-mini broiler were the greater than those of other breeds (p<0.05). The breast meat color (CIE L*, a*, and b*) of 3 breeds of Korean local chicken were higher than that of silky fowl (p<0.05). The breast meat of Hanhyup-3-ho had greater cooking loss (p<0.05), whereas water holding capacity and pH were less than those of other breeds (p<0.05). The color score of 3 breeds of Korean local chicken was higher than that of silky fowl (p<0.05). Woorimatdag had a higher score on tenderness (p<0.05), whereas flavor score was less than that of other breeds (p<0.05). In conclusion, 4 local breeds of chicken have some unique features and seem to have more advantages, and this information can help consumers who prefer healthy and premium chicken meat.

Effect of gastric acid suppressants and prokinetics on peritoneal dialysis-related peritonitis

AIM: To investigate the effect of gastric acid suppressants and prokinetics on peritonitis development in peritoneal dialysis (PD) patients.

METHODS: This was a single-center, retrospective study. The medical records of 398 PD patients were collected from January 2000 to September 2012 and analyzed to compare patients with at least one episode of peritonitis (peritonitis group, group A) to patients who never had peritonitis (no peritonitis group, group B). All peritonitis episodes were analyzed to compare peritonitis caused by enteric organisms and peritonitis caused by non-enteric organisms.

RESULTS: Among the 120 patients who met the inclusion criteria, 61 patients had at least one episode of peritonitis and 59 patients never experienced peritonitis. Twenty-four of 61 patients (39.3%) in group A and 15 of 59 patients (25.4%) in group B used gastric acid suppressants. Only the use of H2-blocker (H2B) was associated with an increased risk of PD-related peritonitis; the use of proton pump inhibitors, other antacids, and prokinetics was not found to be a significant risk factor for PD-related peritonitis. A total of 81 episodes of peritonitis were divided into enteric peritonitis (EP) or non-enteric peritonitis, depending on the causative organism, and gastric acid suppressants and prokinetics did not increase the risk of EP in PD patients.

CONCLUSION: The use of H2B showed a trend for an increased risk of overall PD-related peritonitis, although further studies are required to clarify the effects of drugs on PD-related peritonitis.

Differential diagnosis of Crohn's disease and intestinal tuberculosis in patients with spontaneous small-bowel perforation

BACKGROUND/AIMS

Spontaneous small-bowel perforation caused by Crohn's disease (CD) or intestinal tuberculosis (ITB) is a rare disease entity. We investigated the clinical features and radiologic findings of patients with CD or ITB who presented with a spontaneous small-bowel perforation.

METHODS

Between January 2001 and December 2010, sixty-two patients underwent surgery due to a spontaneous small-bowel perforation, including 21 (33.9%) CD patients and 18 (29.0%) ITB patients. Clinical and radiologic features were compared between CD and ITB patients.

RESULTS

The mean age was significantly lower in CD patients than in ITB patients (p = 0.014). Diarrhea was more common in CD. By contrast, night sweating and a previous history of tuberculosis were more common in ITB. Only 27.8% of patients with ITB had a positive QuantiFERON-TB Gold test. CT findings such as bowel wall thickening of more than 10 mm, omental thickening, and intra-abdominal lymphadenopathy larger than 10 mm were more common among perforations caused by ITB. Mesenteric fat infiltration was a more frequent finding in CD than in ITB.

CONCLUSIONS

Clinical symptoms and radiologic findings may aid in the differential diagnosis between CD and ITB in patients presenting with spontaneous small-bowel perforation.

Effect of midazolam on cardiopulmonary function during colonoscopy with conscious sedation

BACKGROUND AND AIM

Conscious sedation of patients with midazolam reduces anxiety and pain and improves colonoscopy success rates. However, it may lead to adverse effects such as hypoxia and hypotension. The present study investigated the effects of midazolam on cardiopulmonary function during colonoscopy with conscious sedation.

METHODS

Between January 2011 and September 2011, 126 consecutive patients undergoing colonoscopy were enrolled and divided into two groups: (i) sedation with midazolam (midazolam group, n=65); and (ii) no sedation (control group, n=61). Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and peripheral oxygen saturation (SpO(2) ), were recorded before, during and after the endoscopic procedure.

RESULTS

In the midazolam group, SBP and DBP decreased more during colonoscopy than in the control group. However, the frequency of a significant change in SBP was similar in both groups. During colonoscopy, HR and SpO(2) decreased significantly in the midazolam group compared to those in the control group. SpO(2) levels returned to normal after the procedure.

CONCLUSIONS

Midazolam induced decreases in SBP, DBP, HR and SpO(2) during colonoscopy. Clinically significant changes in SBP, HR, and SpO(2) , however, were similar in the midazolam and control groups. These results suggest that midazolam has a tolerable effect on cardiopulmonary function and may be safely used during colonoscopy.

Does diabetes mellitus influence standardized uptake values of fluorodeoxyglucose positron emission tomography in colorectal cancer?

Background/Aims

Hyperglycemia is associated with decreased 2-¹⁸[F]fluoro-2-deoxy-D-glucose (FDG) uptake by tumors assessed by positron emission tomography (PET). In this retrospective study we investigated a comparison of standardized uptake values (SUVs) in patients with primary colorectal cancers who either had diabetes mellitus (DM) or were otherwise healthy.

Methods

The medical records of 397 patients who were diagnosed with colorectal cancer and underwent PET-CT between January 2006 and December 2012 were analyzed. Eighty patients with DM and 317 patients without DM were included. Clinical characteristics were reviewed and maximal standardized uptake values (SUV_max) were calculated in the primary colorectal lesions.

Results

There was no significant difference between tumor SUV_max in DM patients (10.60±5.78) and those without DM (10.92±5.44). In addition, no significant difference was detected between tumor SUV_max in DM patients with glycated hemoglobin (HbA1c) levels <8% (10.34±5.17) and those with HbA1c levels ≥8% (10.61±7.27). The maximum size of the primary colorectal tumor was associated with SUV_max in a linear regression analysis.

Conclusion

The results of this study showed that DM did not influence FDG uptake values in colorectal cancer patients regardless of glucose levels.

Mortality associated with proton pump inhibitors in cirrhotic patients with spontaneous bacterial peritonitis

BACKGROUND AND AIM

The aims of this study were to investigate whether acid suppressive therapy increases the risk of spontaneous bacterial peritonitis (SBP) and to define factors associated with mortality in cirrhotic patients with SBP.

METHODS

Cirrhotic patients who had undergone paracentesis after hospitalization were included. Those patients were divided into two groups according to the presence or absence of SBP. Factors associated with the development of SBP were analyzed. Mortality rates during hospitalization or within 30 days after SBP and the factors associated with mortality were also analyzed.

RESULTS

A total of 1140 patients (median age, 62; men, 75%; model for end-stage liver disease [MELD] score, 17) were included. Five hundred thirty-three patients were identified as having SBP. In the logistic regression, the use of histamine-2 receptor antagonists, the use of proton pump inhibitors (PPIs), a high admission MELD score, and old age were associated with the development of SBP. The use of PPIs within 30 days (adjusted odds ratio [aOR] 1.960; 95% confidence interval [CI] 1.190-3.227; P = 0.008), a higher admission MELD score (aOR 1.054; 95% CI 1.032-1.076; P < 0.001), and hepatocellular carcinoma (aOR 1.852; 95% CI 1.256-2.730; P = 0.002) were associated with mortality after SBP.

CONCLUSIONS

Acid suppressive therapy is associated with the development of SBP in cirrhotic patients with ascites. The use of PPIs is associated with mortality after SBP independent of the severity of the underlying liver disease in our retrospective cohort study.

A simple novel endoscopic successive suture device: a validation study for closure strength and reproducibility

BACKGROUND AND STUDY AIMS

Endoscopic surgical technology has been developing rapidly. Although several successful endoscopic closure devices have already been introduced, only a few of them have demonstrated improvements in closure strength and reproducibility over conventional endoscopic clip closures or hand sutures. The objective of this study was to test the feasibility of a novel successive suturing device (SSD) by measuring closure strength and reproducibility.

MATERIAL AND METHODS

Porcine stomach models were used in this study. Endoclips, full-thickness hand sutures, and the novel SSD sutures were used to close a perforation in the stomach wall, with 10 stomachs being tested for each closure method. Endoclips and SSD sutures were performed using a two-channel endoscope, and the hand sutures were performed from outside of the stomach wall. Air leakage pressure was measured to determine the closure strength and reproducibility of each method.

RESULTS

The mean air leakage pressure of the SSD closure was 62.7 ± 8.2 mmHg. SSD-treated stomachs exhibited significantly greater air leakage pressure than Endoclip-treated stomachs. The standard deviation of bursting pressure in SSD stomachs was found to be significantly smaller than that of hand-sewn stomachs but was not different from that of Endoclip stomachs.

CONCLUSIONS

The consistent closure strength of SSD stomachs demonstrated the reliability and reproducibility of this new closure method. These promising results in closure strength and reproducibility suggest the feasibility of the proposed device for clinical applications.

Digestible and metabolizable energy concentrations in copra meal, palm kernel meal, and cassava root fed to growing pigs

An experiment was conducted to measure DE and ME in copra (Cocos nucifera) meal (CM), palm kernel meal (PKM), and cassava (Manihot esculenta) root (CR) in growing pigs. Eight boars with an initial BW of 67.3 ± 5.8 kg were individually housed in metabolism crates that were equipped with a feeder and a nipple drinker. A replicated 4 × 4 Latin square design was used with 4 dietary treatments, 4 periods, and 8 animals. A basal diet mainly contained corn (Zea mays) and soybean (Glycine max) meal. Three additional diets were formulated to contain 30% of CM, PKM, and CR. All diets contained the same proportion of corn:soybean meal ratio at 4.14:1. The apparent total tract digestibility of energy was 89.5, 84.1, 82.4, and 87.9% (P < 0.001) in the basal, CM, PKM, and CR diets, respectively. The DE in CM and PKM were greater (P < 0.05) than in CR (3440 and 3238 vs. 2966 kcal/kg as-fed). The ME in CM was greater (P < 0.05) than in CR (3340 vs. 2935 kcal/kg as-fed) but not different from the ME in PKM (3168 kcal/kg as-fed). In conclusion, CM and PKM have a higher DE value than CR, and CM has a higher ME value than CR.

Long-term outcome in patients with obscure gastrointestinal bleeding after negative capsule endoscopy

AIM: To investigate long-term outcome in obscure gastrointestinal bleeding (OGIB) after negative capsule endoscopy (CE) and identify risk factors for rebleeding.

METHODS: A total of 113 consecutive patients underwent CE for OGIB from May 2003 to June 2010 at Seoul National University Hospital. Ninety-five patients (84.1%) with a subsequent follow-up after CE of at least 6 mo were enrolled in this study. Follow-up data were obtained from the patients’ medical records. The CE images were reviewed by two board-certified gastroenterologists and consensus diagnosis was used in all cases. The primary outcome measure was the detection of rebleeding after CE, and factors associated with rebleeding were evaluated using multivariate analysis.

RESULTS: Of the 95 enrolled patients (median age 61 years, range 17-85 years), 62 patients (65.3%) were male. The median duration of follow-up was 23.7 mo (range 6.0-89.4 mo). Seventy-three patients (76.8%) underwent CE for obscure-overt bleeding. Complete examination of the small bowel was achieved in 77 cases (81.1%). Significant lesions were found in 38 patients (40.0%). The overall rebleeding rate was 28.4%. The rebleeding rate was higher in patients with positive CE (36.8%) than in those with negative CE (22.8%). However, there was no significant difference in cumulative rebleeding rates between the two groups (log rank test; P = 0.205). Anticoagulation after CE examination was an independent risk factor for rebleeding (hazard ratio, 5.019; 95%CI, 1.560-16.145; P = 0.007), regardless of CE results.

CONCLUSION: Patients with OGIB and negative CE have a potential risk of rebleeding. Therefore, close observation is required and alternative modalities should be considered in suspicious cases.

[Clinicopathologic feature of esophageal submucosal tumors treated by surgical approach]

BACKGROUND/AIMS

Submucosal tumors of the esophagus are rare lesions among all esophageal neoplasms. The purpose of this study was to evaluate the clinicopathologic features of esophageal submucosal tumors treated by surgical approach.

METHODS

We analyzed the clinicopathologic and endoscopic ultrasonographic features of 18 esophageal submucosal tumors which were treated by surgical approach at Boramae Medical Center and Seoul National University Bundang Hospital from January 2005 to June 2012.

RESULTS

The mean age was 48.9 years old and male to female ratio was 2.6 : 1. Asymptomatic patients were most common (77.8%). In endoscopic ultrasonographic finding, the majority tumor arouse in the middle (55.6%) and lower (44.4%) esophagus, and appeared as hypoechoic lesion (72.2%) in the 4th layer (83.3%). The most common indication for surgical approach was unclear biological behavior of the tumor. Minimally-invasive technique using thoracoscopy was applied for the enucleation (83.3%). The mean diameter of the tumor was 5.4 cm, and the final diagnosis was leiomyoma (89.9%) and gastrointestinal stromal tumor (11.1%).

CONCLUSIONS

Leiomyoma was the most common submucosal tumor in esophagus. However, endoscopic ultrasonography was not able to differentiate between leiomyoma and gastrointesinal stromal tumor. For more accurate diagnosis and treatment, minimally-invasive approaches may be suitable for the surgical enucleation of indicated esophageal submucosal tumor.

Comparison of clinical outcomes between endoscopic and radiologic placement of self-expandable metal stent in patients with malignant colorectal obstruction

BACKGROUND/AIMS

This study compared the clinical outcomes between endoscopic and radiologic placement of self-expandable metal stent (SEMS) in patients with malignant colorectal obstruction.

METHODS

In total, 111 patients were retrospectively enrolled in this study between January 2003 and June 2011 at Seoul National University Boramae Hospital. Technical and clinical success rates, complication rates, and stent patency were compared between using an endoscopic (n=73) or radiologic (n=38) method during the SEMS placement procedure.

RESULTS

The technical success rate was higher in the endoscopic method than in the radiologic method (100% [73/73] vs. 92.1% [35/38], respectively; p=0.038). In addition, in 3 of the remaining 35 patients in the radiologic-method group, adjuvant endoscopic assistance was required. In the six patients (including the three aforementioned patients), the causes of technical failure were the inability to pass the guidewire into an obstructive lesion due to a tortuous, curved angulation of the sigmoid or descending colon (n=4), and a difficult approach to a lesion located at the descending or transverse colon (n=2). The clinical success rate, complication rate, and stent patency did not differ significantly between the two methods (p=0.424, 0.303, and 0.423, respectively).

CONCLUSIONS

When the colorectal obstruction had a tortuous, curved angulation of the colon or was located at or proximal to the descending colon, the endoscopic method of SEMS placement appears to be more useful than the radiologic method. However, once SEMS placement was technically successful, the clinical success rate, complication rate, and stent patency did not differ with the method of insertion.

Incidental colonic 18F-fluorodeoxyglucose uptake: do we need colonoscopy for patients with focal uptake confined to the left-sided colon?

BACKGROUND/AIMS

Although access to [18F]2-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography and computed axial tomography (PET/CT) for patients with malignancy has increased, little information is available on the suitability of PET/CT for diagnosis of advanced colonic neoplasms in oncology patients and on the clinical significance of incidental 18F-FDG focal uptake confined to the left-sided colon.

METHODS

Patients who underwent 18F-FDG PET/CT followed, within 90 days, by colonoscopy were identified. Case-control analysis was undertaken to determine whether focal 18F-FDG uptake confined to the left-sided colon was associated with advanced neoplasms in the right-sided colon.

RESULTS

One hundred ninety-five patients with colonic 18F-FDG uptake and 561 without colonic (18)F-FDG uptake were identified. Of the 195 patients with focal colonic 18F-FDG activity, 103 patients (52.8%) had 145 advanced colonic neoplasms, including 58 colon cancers and 11 metastatic cancers. In the detection of advanced colonic neoplasms, the sensitivity, specificity, positive predictive value, and negative predictive value of PET/CT were 54.4, 82.4, 46.9, and 86.3%, respectively. Overall accuracy was 76.2%. Ten (8.0%) of the 125 patients with focal 18F-FDG uptake confined to the left-sided colon had three colon cancers and seven advanced adenomas in the right-sided colon. Case-control analysis revealed that focal 18F-FDG uptake confined to the left-sided colon was associated with an advanced neoplasms in the right-sided colon (OR, 3.02; 95% CI, 1.12-8.13; P = 0.023).

CONCLUSIONS

Colonic focal (18)F-FDG uptake by oncology patients warrants endoscopic verification. Complete colon evaluation by colonoscopy is required, even for patients with focal 18F-FDG uptake confined to the left-sided colon.

[The effects of family history of colorectal cancer on the development of colorectal adenoma]

BACKGROUND/AIMS

Early detection of polyp is important for the prevention of colorectal cancer (CRC). There have been few studies to investigate the relationship between colorectal adenoma and family history of CRC (FHCRC) in Korea. The aim of this study was to identify the relationship between colorectal adenoma and FHCRC.

METHODS

Between March 2009 and September 2010, 225 patients with adenomatous polyps were included. Their medical records with clinical history and size, numbers, histology of polyps were reviewed. Immunohistochemical staining using Bcl-2, Bax, p-AKT, NF-κB, and β-catenin antibodies were performed. We compared the histology of adenoma and expression of immunohistochemical staining according to the existence of FHCRC.

RESULTS

The incidence of colorectal adenoma increased in case of FHCRC (p=0.029). In patients with FHCRC, the mean age of patients was 49 years old and younger than patients without FHCRC. In addition in patients with FHCRC, the incidence of advanced adenoma was significantly higher than in patients without FHCRC (p=0.001). The expression of Bax was significantly lower in patients with FHCRC than without FHCRC (p=0.046).

CONCLUSIONS

There was a tendency for polyp to develop in their younger ages and to be more advanced adenomas in patients with FHCRC. The low expression of Bax, tumor suppressor gene, might be associated with the development of polyps in patient with FHCRC. Therefore, patients with FHCRC may be better to start screening colonoscopy earlier than patient without FHCRC.

Comparison of values for standardized total tract digestibility and relative bioavailability of phosphorus in dicalcium phosphate and distillers dried grains with solubles fed to growing pigs

Two experiments were conducted to compare values for the standardized total tract digestibility (STTD) and the relative bioavailability of P in dicalcium phosphate (DCP) and distillers dried grains with solubles (DDGS) when fed to growing pigs. In Exp. 1, the apparent total tract digestibility (ATTD), the basal endogenous P loss (EPL), and the STTD of P in DCP and DDGS were determined. Eighteen pigs (initial BW: 34.93±1.04 kg) were allotted to 3 cornstarch-based diets in a randomized complete block design and housed individually in metabolism cages. Two diets contained DCP and DDGS, respectively, as the sole source of P and the last diet was a P-free diet that was used to measure EPL from the pigs. Results indicated that the ATTD of P in DCP and DDGS were 86.1 and 58.8%, respectively, and the STTD of P in DCP and DDGS were 93.1 and 63.1%, respectively. The EPL was determined at 174 mg/kg DMI. In Exp. 2, 42 pigs (initial BW: 29.02±2.03 kg) were allotted to 7 dietary treatments in a randomized complete block design. Pigs were housed individually and allowed ad libitum access to feed and water. A basal diet (0.22% P) based on corn, casein, cornstarch, and potato protein concentrate was formulated. Three additional diets were formulated by adding 0.04, 0.08, or 0.12% P from DCP to the basal diet to create diets containing 0.26, 0.30, or 0.34% P. The last 3 diets were formulated by adding 0.04, 0.08, or 0.12% P from DDGS to the basal diet at the expense of cornstarch. Pigs were fed experimental diets for 28 d. They were then euthanized and the third and fourth metacarpals from the right front foot were collected. Metacarpal bone ash and bone P were regressed against P intake for each ingredient and via slope ratio methodology, it was determined that the bioavailability of P in DDGS was 87% relative to that in DCP. It was concluded from this work that the value for relative bioavailability of P in DDGS overestimates the digestibility of P in DDGS and values for the STTD of P, therefore, can not be accurately calculated from values for the relative bioavailability of P. As a consequence, it is necessary to determine the STTD of P in feed ingredients included in diets fed to pigs.

Prediction of response to entecavir therapy in patients with HBeAg-positive chronic hepatitis B based on on-treatment HBsAg, HBeAg and HBV DNA levels

Quantitative hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) assays are emerging as effective tools of on-treatment predictors of response to antiviral agents, in addition to monitoring serum HBV DNA levels. However, the dynamic relationship between quantitative HBsAg, as well as HBeAg and HBV DNA, and the predictability of subsequent clinical outcomes during entecavir (ETV) therapy remain unclear. Eighty-two patients with HBeAg-positive chronic hepatitis B (CHB) received ETV therapy for ≥3 years. Virologic response (VR) after 3 years of ETV therapy was achieved in 73 (89.0%) patients. Among baseline and on-treatment factors, on-treatment HBV DNA levels performed better with respect to the prediction of response than HBsAg and HBeAg levels. Especially, the performance of absolute values of HBV DNA with respect to response was superior to HBV DNA decline from the baseline. The best predictive value was an absolute HBV DNA level of 2.3 log(10) IU/mL at month 6 (areas under the curve [AUROC], 0.977; 95% CI, 0.940-1.000; P < 0.001). HBeAg seroconversion after 3 years of therapy was achieved in 26 (31.7%) patients. On-treatment HBeAg levels performed better with respect to the prediction of seroconversion than HBsAg and HBV DNA levels. The best cut-off value for the HBeAg level at month 12 for the prediction of seroconversion was 0.62 log(10) PEIU/mL. Although the HBsAg level at baseline is often used to predict the antiviral potency of entecavir, on-treatment HBV DNA and HBeAg levels are more helpful for prediction of subsequent clinical outcomes in HBeAg-positive CHB patients with entecavir treatment.

Prediction of response to entecavir therapy in patients with HBeAg-positive chronic hepatitis B based on on-treatment HBsAg, HBeAg and HBV DNA levels

Quantitative hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) assays are emerging as effective tools of on-treatment predictors of response to antiviral agents, in addition to monitoring serum HBV DNA levels. However, the dynamic relationship between quantitative HBsAg, as well as HBeAg and HBV DNA, and the predictability of subsequent clinical outcomes during entecavir (ETV) therapy remain unclear. Eighty-two patients with HBeAg-positive chronic hepatitis B (CHB) received ETV therapy for ≥3 years. Virologic response (VR) after 3 years of ETV therapy was achieved in 73 (89.0%) patients. Among baseline and on-treatment factors, on-treatment HBV DNA levels performed better with respect to the prediction of response than HBsAg and HBeAg levels. Especially, the performance of absolute values of HBV DNA with respect to response was superior to HBV DNA decline from the baseline. The best predictive value was an absolute HBV DNA level of 2.3 log(10) IU/mL at month 6 (areas under the curve [AUROC], 0.977; 95% CI, 0.940-1.000; P < 0.001). HBeAg seroconversion after 3 years of therapy was achieved in 26 (31.7%) patients. On-treatment HBeAg levels performed better with respect to the prediction of seroconversion than HBsAg and HBV DNA levels. The best cut-off value for the HBeAg level at month 12 for the prediction of seroconversion was 0.62 log(10) PEIU/mL. Although the HBsAg level at baseline is often used to predict the antiviral potency of entecavir, on-treatment HBV DNA and HBeAg levels are more helpful for prediction of subsequent clinical outcomes in HBeAg-positive CHB patients with entecavir treatment.

Role of ascites adenosine deaminase in differentiating between tuberculous peritonitis and peritoneal carcinomatosis

AIM: To investigate the usefulness of tumor markers and adenosine deaminase in differentiating between tuberculous peritonitis (TBP) and peritoneal carcinomatosis (PC).

METHODS: A retrospective analysis of data was performed on consecutive patients who underwent peritoneoscopic and abdominal computed tomography (CT) evaluations. Among 75 patients at the Seoul National University Hospital from January 2000 to June 2010 who underwent both tests, 27 patients (36.0%) and 25 patients (33.3%) were diagnosed with TBP and PC, respectively. Diagnosis was confirmed by peritoneoscopic biopsy.

RESULTS: Serum c-reactive protein (7.88 ± 6.62 mg/dL vs 3.12 ± 2.69 mg/dL, P = 0.01), ascites adenosine deaminase (66.76 ± 32.09 IU/L vs 13.89 ± 8.95 IU/L, P < 0.01), ascites lymphocyte proportion (67.77 ± 23.41% vs 48.36 ± 18.78%, P < 0.01), and serum-ascites albumin gradient (0.72 ± 0.49 g/dL vs 1.05 ± 0.50 g/dL, P = 0.03) were significantly different between the two groups. Among tumor markers, serum and ascites carcinoembryonic antigen, serum carbohydrate antigen 19-9 showed significant difference between two groups. Abdominal CT examinations showed that smooth involvement of the parietal peritoneum was more common in the TBP group (77.8% vs 40.7%) whereas nodular involvement was more common in the PC group (14.8% vs 40.7%, P = 0.04). From receiver operating characteristic (ROC) curves ascites adenosines deaminase (ADA) showed better discriminative capability than tumor markers. An ADA cut-off level of 21 IU/L was found to yield the best results of differential diagnosis; sensitivity, specificity, positive predictive value, and negative predictive value were 92.0%, 85.0%, 88.5% and 89.5%, respectively.

CONCLUSION: Besides clinical and radiologic findings, ascitic fluid ADA measurement is helpful in the differential diagnosis of TBP and PC.

Concentrations of analyzed or reactive lysine, but not crude protein, may predict the concentration of digestible lysine in distillers dried grains with solubles fed to pigs

The objectives of this experiment were to evaluate procedures that may be used to predict the concentration of standardized ileal digestible (SID) Lys in distillers dried grains with solubles (DDGS) fed to pigs and to evaluate the accuracy of a published equation to predict SID Lys in DDGS. Twenty-one sources of DDGS were analyzed (as-fed basis) for CP (23.8% to 33.6%; CV = 8.3%), Lys (0.69% to 1.17%; CV = 12.4%), and furosine (0.02% to 0.22%; CV = 91.4%). The concentration of reactive Lys (%, as-fed basis) was calculated as analyzed Lys (%) - furosine (%) ÷ 0.32 × 0.40 and ranged from 0.47% to 1.15% (CV = 20.7%) in the 21 sources of DDGS. Twenty-one diets that each contained 60.0% of 1 source of DDGS as the sole source of CP and AA were formulated. An N-free diet was also formulated and was used to determine basal endogenous losses of CP and AA. Twenty-two barrows with an initial BW of 45.2 kg (SD = 3.1 kg) were fitted with a T-cannula in the distal ileum and allotted to a 22 × 10 Youden square design with the 22 diets and 10 periods. The SID of CP and AA were calculated for each source of DDGS. The SID of CP ranged from 69.8% to 79.6%, and the SID of Lys ranged from 45.3% to 74.1%. The concentration of SID Lys in the 21 samples of DDGS was highly related to the concentration of analyzed Lys (P < 0.001; r(2) = 0.849) and with the concentration of reactive Lys in the samples (P < 0.001; r(2) = 0.898). In contrast, the concentration of SID Lys in the 21 sources of DDGS was not related to the concentration of CP in the samples (P = 0.558; r(2) = 0.021). However, values for SID Lys were in good agreement with values predicted using a published prediction equation. In conclusion, analyzed Lys in DDGS, but not CP, may be used to predict the concentration of SID Lys in DDGS fed to pigs. However, analysis of furosine in addition to Lys and subsequent calculation of reactive Lys improve the prediction accuracy of digestible Lys concentration in DDGS.

Sulfur concentration in diets containing corn, soybean meal, and distillers dried grains with solubles does not affect feed preference or growth performance of weanling or growing-finishing pigs

Four experiments were conducted to investigate the effects of distillers dried grains with solubles (DDGS) and dietary S on feed preference and performance of pigs. In a 10-d feed preference experiment (Exp. 1), 48 barrows (20.1 ± 2.2 kg of BW) were randomly allotted to 3 treatment groups, with 8 replicate pens per treatment and 2 pigs per pen. A control diet based on corn and soybean meal, a DDGS diet containing 20% DDGS, and a DDGS-sulfur (DDGS-S) diet were prepared. The DDGS-S diet was similar to the DDGS diet with the exception that 0.74% CaSO(4) was added to the diet. Two diets were provided in separate feeders in each pen: 1) the control diet and the DDGS diet, 2) the control diet and the DDGS-S diet, or 3) the DDGS diet and the DDGS-S diet. Preference for the DDGS diet and the DDGS-S diet vs. the control diet was 35.2 and 32.6%, respectively (P < 0.05), but there was no difference between the DDGS diet and the DDGS-S diet. In Exp. 2, a total of 90 barrows (10.3 ± 1.4 kg of BW) were allotted to 3 treatments, with 10 replicate pens and 3 pigs per pen, and were fed the diets used in Exp. 1 for 28 d, but only 1 diet was provided per pen. Pigs fed the control diet gained more BW (497 vs. 423 and 416 g/d; P < 0.05) and had greater G:F (0.540 vs. 0.471 and 0.455; P < 0.05) than pigs fed the DDGS or the DDGS-S diet, but no differences between the DDGS and the DDGS-S diets were observed. In a 10-d feed preference experiment (Exp. 3), 30 barrows (49.6 ± 2.3 kg of BW) were allotted to 3 treatment groups, with 10 replicates per group. The experimental procedures were the same as in Exp. 1, except that 30% DDGS was included in the DDGS and DDGS-S diets and 1.10% CaSO(4) was added to the DDGS-S diet. Feed preference for the DDGS and the DDGS-S diets, compared with the control diet, was 29.8 and 32.9%, respectively (P < 0.01), but there was no difference between the DDGS and the DDGS-S diets. In Exp. 4, a total of 120 barrows (34.2 ± 2.3 kg of BW) were fed grower diets for 42 d and finisher diets for 42 d. Diets were formulated as in Exp. 3. Pigs on the control diets gained more BW (1,021 vs. 912 and 907 g/d; P < 0.05) and had greater G:F (0.335 vs. 0.316 and 0.307; P < 0.05) than pigs fed the DDGS or DDGS-S diet, respectively, but no differences between pigs fed the DDGS and the DDGS-S diets were observed. In conclusion, dietary S concentration does not negatively affect feed preference, feed intake, or growth performance of weanling or growing-finishing pigs fed diets based on corn, soybean meal, and DDGS.