[Implant restoration and stomatognathic system rehabilitation]

Stomatognathic system rehabilitation (SSR) is an important component of dental implant therapy, involving multiple disciplines and factors. This article focuses on the importance of clinical issues, such as mandibular position, vertical distance, occlusion and temporomandibular joint in SSR, in order to provide reference for dentists in clinical diagnosis and treatment.

Efficient Spin-to-Charge Conversion via Altermagnetic Spin Splitting Effect in Antiferromagnet RuO_{2}

The relativistic spin Hall effect and inverse spin Hall effect enable the efficient generation and detection of spin current. Recently, a nonrelativistic altermagnetic spin splitting effect (ASSE) has been theoretically and experimentally reported to generate time-reversal-odd spin current with controllable spin polarization in antiferromagnet RuO_{2}. The inverse effect, electrical detection of spin current via ASSE, still remains elusive. Here we show the spin-to-charge conversion stemming from ASSE in RuO_{2} by the spin Seebeck effect measurements. Unconventionally, the spin Seebeck voltage can be detected even when the injected spin current is polarized along the directions of either the voltage channel or the thermal gradient, indicating the successful conversion of x- and z-spin polarizations into the charge current. The crystal axes-dependent conversion efficiency further demonstrates that the nontrivial spin-to-charge conversion in RuO_{2} is ascribed to ASSE, which is distinct from the magnetic or antiferromagnetic inverse spin Hall effects. Our finding not only advances the emerging research landscape of altermagnetism, but also provides a promising pathway for the spin detection.

Exhaled Hydrogen after Lactulose Hydrogen Breath Test in Patient with Duodenal Ulcer Disease-A Pilot Study for Helicobacter-pylori-Associated Gastroduodenal Disease

OBJECTIVES

The precipitating mechanism(s) from the inactive to the active stage of duodenal ulcer disease (DU) is unclear. It has been shown that hydrogen gas from colonic fermentation provides an important energy source for Helicobacter pylori (Hp) colonization. The lactulose hydrogen breath test (LHBT) is a useful tool to assess the small intestinal and/or colon fermentation. This study examines the association(s) between the status of gastroduodenal disease and the result of a lactulose hydrogen breath test (LHBT).

MATERIALS AND METHODS

We enrolled Hp-positive active duodenal ulcer (aDU) patients, inactive DU (iDU) patients and patients with a positive Hp infection without structural gastroduodenal lesion, i.e., simple gastritis (SG Hp+). The patients with simple gastritis without Hp infection (SG Hp-) served as controls. Histological examinations of the gastric mucosa and lactulose hydrogen breath test (LHBT) were performed.

RESULTS

SG Hp+ patients tend to have advanced gastritis (pangastritis or corpus-predominant gastritis) compared with SG Hp- patients (7/29 vs. 0/14, p = 0.08). More iDU patients had advanced gastritis than either the SG Hp+ (7/9 vs. 7/29, p = 0.006) or aDU patients (7/9 vs. 6/24, p = 0.013). In comparison with the aDU patients, the iDU patients were also older (52.1 ± 12.6 vs. 42.2 ± 11.9 years, p = 0.02) and had a lower mean area under the curve value of the LHBT(AUC) (209.1 ± 86.0 vs. 421.9 ± 70.9, p = 0.023).

CONCLUSION

aDU patients with a positive Hp infection have a lower grade of gastric mucosa damage than iDU patients and tend to have a higher level of exhaled hydrogen after LHBT.

[Scan time and accuracy of full-arch scans with intraoral scanners: a comparative study on conditions of the intraoral head-simulator and the hand-held model]

Objective: To comparatively evaluate the scan time and the accuracy of maxillary full-arch scans using four intraoral scanners (IOS) on conditions of the intraoral head-simulator and the hand-held model, and to evaluate the influence of different scanning conditions on digital scan. Methods: A upper dental arch model with melamine-formaldehyde resin teeth and silica gel gingiva that could be fixed on a head simulator was scanned with an optical scanner (ATOS Core) in order to obtain the standard tessellation language dataset as reference. Intraoral scans were performed on the model fixed on the head simulator by three researchers with four IOS [A: TRIOS 3; B: CS 3600; C: CEREC Omnicam; D: iTero]. For each scanner and each researcher, six scans were performed, to obtain the datasets as the head simulator group. And another six scans with each of the four intraoral scanners were performed by each researcher on the hand-held model to obtain the STL datasets as the hand-held group. The scan time were recorded for each scan. In the Geomagic Wrap software, the digital models were trimmed with only the teeth information retained and supreimposed by best fit alignment function and compared to obtain the root mean square (RMS) values of the discrepancies by three-dimensional compare function. The test datasets of each group were compared with the reference dataset for trueness. The six test scanning datasets with the same scanner of the same researcher were cross compared for precision. Mann Whitney U test was used to statistically analyze the difference values of the scan time, trueness and precision of the same intraoral scanner between head simulator group and hand-held group. Results: Compared to the hand-held group, the scan time of A [142(82) s] and D [119(52) s], which two IOS both with handle, were longer in head simulator group [A: 98(28) s; D: 85(22) s] (P<0.01). However there were no significant differences between the two groups for scan time of IOS B and C (P>0.05). For full-arch scan accuracy (trueness and precision), there were no significant differences between the two groups of IOS A and B (P>0.05), while the trueness of C (P<0.05) and the precision of D (P<0.01) were better in head simulator group [C: 112(38) μm; D: 43(13) μm] compared to hand-held group [C: 135(47) μm; D: 53(18) μm]. However, there were no significant differences for the precision of C (P>0.05) and the trueness of D (P>0.05). Conclusions: The scan time and the accuracy of full-arch digital scans with different IOS may be effected by the scan conditions. For in vitro study of intraoral scanning, head-simulator can simulate the intraoral environment of the real patient to some extent. Meanwhile, the position of the dentist and the patient, and also the limited intraoral space during intraoral scanning are also simulated.

Comparison of Endoscopic Submucosal Dissection Application on Mucosal Tumor and Subepithelial Tumor in stomach

Background: Endoscopic submucosal dissection is minimal invasive endoscopic procedure to deal with gastric tumor. Initially, it was developed to resect mucosal neoplasm since 2000 and extended its application to submucosal tumor in the following years. Although the basic ESD skills are similar in gastric mucosal tumor and subepithelial tumor, the success rate, complication may be different between the two types of gastric tumor resection. This retrospective study is conducted to analyze the ESD procedure in gastric mucosal tumor and subepithelial tumor.

Methods: From 2007 to 2016, we reviewed all patients who underwent endoscopic submucosal dissection for gastric mucosal tumor and subepithelial tumor in Kaohsiung Medical University Hospital.

Results: Totally, 35 patients with gastric subepithelial tumor and 41 patients with gastric mucosal tumor received endoscopic submucosal dissection are enrolled. Among 35 patients with subepithelial tumor, 32 (91.4%) patients achieved curative treatment. 1 patient received emergent operation and 2 patients received salvage operation to complete tumor resection. 8 patients (22.9%) occurred perforation and no delay bleeding was found. Among 41 patients with mucosal neoplasm, 30 (71.4%) patients achieved curative treatment. 2 patients received emergent operation and 9 patients received salvage operation to complete tumor resection. 9 patients (21.9%) occurred complication, 6 patients occurred delay bleeding and 3 patients had perforation.

Conclusions: Comparing ESD between gastric mucosal tumor and subepithelial tumor, ESD had similar efficiency in curative treatment. However, ESD in subepethelial tumor encountered higher perforation and lesser delay bleeding.

[New developments and advances in surgery in dental implantology]

Oral implantology has experienced more than half a century of development, the theoretical foundation and clinical technology are becoming more mature. This article elaborates on the establishment of implant timing, implant-related bone augmentation technology, surgical alternatives to bone augmentation technology, implant-related soft tissue augmentation technology, and computer-guided surgery. Provide a reference for a comprehensive understanding of dental implant surgery technology and its new developments.

Panel 7 - Pathogenesis of otitis media - a review of the literature between 2015 and 2019

OBJECTIVE

To perform a comprehensive review of the literature from July 2015 to June 2019 on the pathogenesis of otitis media. Bacteria, viruses and the role of the microbiome as well as the host response are discussed. Directions for future research are also suggested.

DATA SOURCES

PubMed database of the National Library of Medicine.

REVIEW METHODS

PubMed was searched for any papers pertaining to OM pathogenesis between July 2015 and June 2019. If in English, abstracts were assessed individually for their relevance and included in the report. Members of the panel drafted the report based on these searches and on new data presented at the 20th International Symposium on Recent Advances in Otitis Media.

CONCLUSIONS

The main themes that arose in OM pathogenesis were around the need for symptomatic viral infections to develop disease. Different populations potentially having different mechanisms of pathogenesis. Novel bacterial otopathogens are emerging and need to be monitored. Animal models need to continue to be developed and used to understand disease pathogenesis.

IMPLICATIONS FOR PRACTICE

The findings in the pathogenesis panel have several implications for both research and clinical practice. The most urgent areas appear to be to continue monitoring the emergence of novel otopathogens, and the need to develop prevention and preventative therapies that do not rely on antibiotics and protect against the development of the initial OM episode.

[Genetic characteristics and clinical outcomes of pediatric acute myeloid leukemia with NUP98-NSD1 fusion gene]

Objective: To investigate the genetic characteristics and clinical outcomes of pediatric acute myeloid leukemia patients with NUP98-NSD1 fusion gene. Methods: A total of 80 pediatric AML patients were enrolled in this study, and bone marrow specimens were collected at initial diagnosis and relapse. NUP98-NSD1 was screened by fluorescence in situ hybridization (FISH) and PCR. Other laboratory test results and clinical outcomes were further analyzed for the NUP98-NSD1 positive cases. Results: A total of eight patients (10.0%) were positive for NUP98-NSD1, which were all fusions of NUP98 exon12 and NSD1 exon 6. There were two M2, three M4, and three M5 cases according to the French-American-British classification. Seven patients had karyotype results at the time of initial diagnosis, and none of them had complicated karyotype abnormalities. Among these patients, two cases had normal karyotype, three cases had trisomy 8, one case had trisomy 6, and two cases had anomalies involving 9q13 or 9q21. Additional karyotypic abnormalities and clonal evolutions were observed during disease progression or relapse, five cases had 9q13 or 9q32 abnormalities. Five cases (62.5%) were positive with FLT3-ITD mutation. Patients were treated with DAE/NAE/HAE/IA chemotherapy. Three cases did not achieve remission after several courses of chemotherapy, and five cases achieved remission but relapsed in 1 to 19 months. Five cases underwent salvage allogeneic hematopoietic stem cell transplantation (allo-HSCT). Among whom, four died in 40 days to 4 months after transplantation, and one survived 8.5 months till the last follow-up. Conclusions: NUP98-NSD1 is a recurrent genetic abnormality with significant clinical prognostic significance, and this group of disease has unique clinical and genetic characteristics. NUP98-NSD1 should be screened by FISH or PCR for children with AML who are newly diagnosed or refractory and relapsed to identify the high-risk genetic marker.

A selection method of chickens with blue-eggshell and dwarf traits by molecular marker-assisted selection

The blue-eggshell and dwarf traits have an important economic value in poultry production. Using a genetic aggregation-based strategy, the molecular marker-assisted selection technology was jointly used to provide a rapid breeding method for pure strain chickens simultaneously with hens exhibiting the blue-eggshell and dwarf traits. Overall, 80 male dwarf chickens and 1,000 hybrid blue-eggshell hens (F0) were used for the hybridization experiment. Subsequently, the crossing of F1 or F2 chicks was performed in succession. The F1 and F2 chicks were respectively detected by the joint molecular markers of the solute carrier organic anion transporter family, namely, 1B3 (SLCO1B3) and the growth hormone receptor (GHR) genes, which relate to blue-eggshell and dwarf traits. Meanwhile, the selection of blue-eggshell and dwarf phenotypes was used to validate the data obtained by the molecular markers. The results showed that F1 chicks included the heterozygous and wild-type of SLCO1B3, as well as the homozygous (hens) and heterozygous (roosters) of GHR. However, F2 chicks included 3 different genotypes of both SLCO1B3 and GHR. Ultimately, 196 F1 roosters (concurrently with heterozygous genotype of SLCO1B3 and GHR) and 1,073 F1 hens (concurrently with heterozygous genotype of SLCO1B3 and homozygous genotype of GHR) were obtained from the initial 10,040 F1 chicks. Further, 27 F2 roosters and 345 F2 hens, which simultaneously carried the homozygous genotype of SLCO1B3 and GHR, were screened from the initial 6,000 F2 chicks. Data obtained on the blue-eggshell and dwarf phenotypes were consistent with the results by molecular markers. Similarly, the purity verification of the strain obtained through 2 crossing experiments (F0♂ × F2♀ and F2♂ × F2♀) revealed that all chickens had the blue-eggshell and dwarf traits, supporting that the obtained F2 strain was pure. In summary, for the first time, we successfully bred a pure strain chicken with blue-eggshell and dwarf traits by jointly using the molecular markers of the SLCO1B3 and GHR genes. Our study provides a new method for the rapid cultivation of new chicken strains.

Initial experience of fecal microbiota transplantation in gastrointestinal disease: A case series

Current studies have proven the strong association between gut microbiota dysbiosis and the pathogenesis of gastrointestinal diseases. Fecal microbiota transplantation (FMT) from a healthy donor is a promising therapeutic strategy to change and restore composition of the recipient's gut microbiota. Rapidly increasing clinical literatures confirmed the truth of the benefits of FMT on recurrent Clostridium difficile infection (rCDI) and inflammatory bowel disease. This article retrospectively reviewed nine cases (four cases had ulcerative colitis [UC], five cases had rCDI) who received FMT in Kaohsiung Medical University Hospital from April 2016 to November 2018. We summarized the procedure including donor selection, fecal materials preparation, transplantation delivery methods, and clinical outcomes. All of the four UC cases got clinical improvement and four rCDI cases achieved clinical remission after FMT. The other one rCDI case remained positive stool Toxin A+B result after FMT, and got remission after salvage treatment with fidaxomicin. FMT is considered to be a well-tolerated adjuvant treatment for UC and effective salvage treatment for rCDI in our initial experience. Multiple infusions of FMT in UC and rCDI might have exceptional clinical efficiency, and enteral tube insertion could be a useful method to reach this goal and make multiple sessions of FMT easier.

Endoscopic Retrieval of Mis-Swallowed Table Spoon

Mis-swallowed foreign body is a common scenario for endoscopy intervention. Although a long object is rarely seen in our clinical setting, limited published articles could be found for proper retrieval. We hence report a 30-year-old female who mis-swallowed a long table spoon, which was retrieved by a snare from the duodenal second portion with conventional endoscopy.

Predictor of slower gastric emptying in gastroesophageal reflux disease: Survey of an Asian-Pacific cohort

BACKGROUND AND AIM

Asian populations have relatively lower prevalence of gastroesophageal reflux disease and tend to exhibit symptoms of prolonged gastric retention. However, it remains unknown if slower gastric emptying influences its features in Asian countries. We prospectively assessed the potential implications of slower gastric emptying in an Asian-Pacific cohort of gastroesophageal reflux disease by a hospital-based survey.

METHODS

One hundred fifty-two patients of gastroesophageal reflux disease complete the scintigraphic measurement of solid phase of gastric emptying. Clinical symptoms and psychological stress are recorded by self-report questionnaire. The status of Helicobacter pylori infection, blood level of pepsinogen I, and I/II ratio are assessed.

RESULTS

Forty-seven percent and 28% of the patients have slower gastric emptying rate, depending on the incremental defined cut-off values of slower gastric emptying, respectively. Multiple logistic regression analysis indicates that older age and depression score are independently related to slower gastric emptying. Subgroup analysis discloses that patients with slower gastric emptying and higher depression score tend to present with non-erosive esophagitis whereas higher body mass index level and male gender in patients with normal gastric emptying predict the presence of erosive reflux disease.

CONCLUSIONS

Our study cohort of Asian patients indicates distinctive clinical implications of slower gastric emptying in patients with gastroesophageal reflux disease.

[Clinical applications of transcrestal around detached sinus floor elevation technique using osteotomes and sequential drills with stops]

Sinus floor elevation was needed in 11 patients having 15 implant sites with the residual bone height (RBH) was less than 10 mm in the posterior maxillary region from Feb to May 2017. The RBH ranged from 3.10 to 8.34 mm [averaged (6.18±1.60) mm]. RBH<6 mm was observed in 40% implant sites (6 implant sites) and RBH≥6 mm was observed in 60% implant sites (9 implant sites). The thickness of the sinus floor membrane correspond to the implant site measured by cone beam CT (CBCT) ranged from 0.50 to 4.24 mm [averaged (1.21±0.92) mm]. Sequential drills with stops were used to perforate the cortical bone of the sinus floor firstly, then the transcrestal around detached sinus floor elevation technique (TADSFET) was carried with osteotomes. Anorganic bovine bone was used as the augmentation material.Fifteen implants were placed in 15 implant sites. CBCT pictures showed that there was a smooth and continuous tent-shaped apophysis on each lifted site and no air fluid level was observed in the sinus immediately after operation. The mean elevated height of the 15 implant sites was (7.83±1.57) mm (ranged from 5.94 to 11.01 mm). The mean follow-up time was 7.91 months (7-10 months). The survival rate was 100% during the follow up period.

Insights into the management of gastric antral vascular ectasia (watermelon stomach)

Gastric antral vascular ectasia (GAVE) is an uncommon but important cause of chronic gastrointestinal bleeding. It is often associated with systemic diseases such as autoimmune diseases, liver cirrhosis, chronic renal insufficiency and cardiovascular disease. The etiology of GAVE has not been fully explored and remains controversial. Diagnosis is mainly based on endoscopic presentation with flat or raised erythematous stripes radiating from the pylorus to the antrum and resembles a watermelon. Clinical presentation may range from iron-deficiency anemia secondary to occult blood loss, melena to hematemesis. In past decades, many therapeutic modalities including medical, endoscopic and surgical intervention have been introduced for GAVE treatment with variable efficacy. Herein, we review the efficacy and safety of these treatment options for GAVE.

Recent Advances in the Pharmacological Management of Gastroesophageal Reflux Disease

The management of proton pump inhibitor-refractory GERD (rGERD) is a challenge in clinical practice. Since up to one-third of patients with typical GERD symptoms (heartburn and/or acid regurgitation) are not satisfied with proton pump inhibitor (PPI) therapy, new drug development targeting different pathophysiologies of GERD is imperative. At present, no other drugs serve as a more potent acid suppression agent than PPIs. As an add-on therapy, histamine type-2 receptor antagonists, alginates, prokinetics and transient lower esophageal sphincter relaxation inhibitors have some impact on the subgroups of rGERD, but greater effectiveness and fewer adverse effects for widespread use are required. Visceral hypersensitivity also contributes to the perception of GERD symptoms, and neuromodulators including antidepressants play a role in this category. Esophageal pH-impedance monitoring helps to distinguish functional heartburn from true GERD, and psychologic medication and cognitive behavior therapy are further therapy options instead of PPIs.

[Clinicopathologic features of atypical type A thymoma]

Objective: To study the clinicopathologic features, immunophenotype and differential diagnosis of atypical type A thymoma. Methods: Clinicopathologic and follow-up data of three cases of atypical type A thymoma from 2004 to 2016 were reviewed. Immunohistochemical staining was performed. Results: All three patients were male with average age of 59 years. Clinically, the lesions presented as anterior mediastinal masses. Grossly, the tumor ranged in size from 4 to 6 cm in greatest dimension and partially enclosed within fibrous capsule. The cut surface was homogenously fleshy, tan to brown in color, with multinodular and lobulated configurations. Cystic changes and necrosis were seen. Microscopically, the tumor was composed of plump spindle or oval-shaped cells arranged in storiform, microcystic, glandular, rosettes-like and hemangiopericytoma-like histological patterns. The tumor cells showed mild cytological atypia and mitotic activity ranged from 4 to 5/10HPF. Necrosis was present in all tumors. All tumors showed diffuse CK(AE1/AE3), CK19, p63 and vimentin expression. TdT, CK20, CD20, CD5 and CD117 were negative. The proliferative index, as measured with Ki-67, was 15.2% to 26.4%. None of the cases had recurrence or metastases during the follow-up period (9 to 27 months). Conclusions: Atypical type A thymoma presents atypical features including tumor necrosis and increased mitotic activity. However, the implications of such atypical features to the biological behavior of the tumor remain to be determined.

Robotic surgery with high dissection and low ligation technique for consecutive patients with rectal cancer following preoperative concurrent chemoradiotherapy

PURPOSE

We present the preliminary experiences with and short-term outcomes of 50 consecutive patients with rectal cancer who underwent preoperative concurrent chemoradiotherapy (CCRT) followed by robotic surgery by using the high dissection and low ligation technique.

METHODS

Between October 2013 and August 2015, 50 patients with rectal cancer underwent robotic surgery after preoperative CCRT at a single institution. We performed D3 lymph node dissection and low tie ligation of the inferior mesenteric artery (IMA); this technique is referred to as the high dissection and low ligation technique. Clinicopathological features, perioperative parameters, and postoperative outcomes were retrospectively analyzed.

RESULTS

FOLFOX regimen was used for preoperative CCRT in 26 (52 %) patients. Long-course radiotherapy was concurrently administered. A pathological complete response (pCR) was obtained in 14 (28 %) patients. Of the 50 patients, 23 (46 %) patients received intersphincteric resection (ISR) with coloanal anastomosis, 25 (50 %) patients received lower anterior resection (LAR), and 2 (4 %) patients received abdominoperineal resection (APR). Apical nodes were pathologically harvested in 47 (94 %) patients, and the median number of harvested apical lymph nodes was 2 (range, 0-10). The overall complication rate was 24 % (10 patients with 12 episodes), and most complications were mild.

CONCLUSION

Roboic rectal surgery combined with appropriate preoperative CCRT helps in achieving a favorable pCR, circumferential resection margin, and sphincter preservation. Moreover, high dissection and low ligation of the IMA can be safely performed using the da Vinci(®) Surgical System safely which yield favorable short-term clinical outcomes.

[The elementary discussion on digital implant dentistry]

It is a digital age today. Exposed to all kinds of digital products in many fields. Certainly, implant dentistry is not exception. Digitalization could improve the outcomes and could decrease the complications of implant dentistry. This paper introduces the concepts, definitions, advantages, disadvantages, limitations and errors of digital implant dentistry.

Interleukin-17 Impairs Salivary Tight Junction Integrity in Sjögren's Syndrome

Sjögren's syndrome (SS) is an inflammatory autoimmune disease that causes secretory dysfunction of the salivary glands. It has been reported that proinflammatory cytokine interleukin-17 (IL-17) was elevated and tight junction (TJ) integrity disrupted in minor salivary glands from SS patients. However, whether the elevated IL-17 in SS affects TJ integrity and thereby alters the function of salivary gland is unknown. Here, by using nonobese diabetic (NOD) mice as SS model, we found that the stimulated salivary flow rate was significantly decreased in NOD mice. Lymphocyte infiltration was mainly observed in submandibular glands (SMGs), but not parotid glands (PGs), of NOD mice. IL-17 was significantly increased and mainly located in lymphocytic-infiltrating regions in SMGs but not detectable in PGs of NOD mice. Meanwhile, the epithelial barrier function was disrupted, as evidenced by an increased paracellular tracer clearance and an enlarged acinar TJ width in SMGs of NOD mice. Furthermore, claudin-1 and -3 were elevated especially at the basolateral membranes, whereas claudin-4, occludin, and zonula occludens-1 (ZO-1) were reduced in SMGs of NOD mice. Moreover, occludin and ZO-1 were dispersed into cytoplasm in SMGs of NOD mice. However, no change in the expression and distribution of TJ proteins was found in PGs. In vitro, IL-17 significantly decreased the levels and apical staining of claudin-4 and ZO-1 proteins in the cultured SMG tissues, as well as claudin-1, occludin, and ZO-1 in PG tissues. Moreover, IL-17 activated the phosphorylation of IκBα and p65 in SMG cells, whereas pretreatment with NF-κB inhibitor pyrrolidine dithiocarbamate suppressed the IL-17-induced downregulation of claudin-4 and ZO-1 in SMG tissues. Taken together, these findings indicate that IL-17 derived from infiltrating lymphocyte impairs the integrity of TJ barrier through NF-κB signaling pathway, and thus might contribute to salivary gland dysfunction in SS.

Port type is a possible risk factor for implantable venous access port-related bloodstream infections and no sign of local infection predicts the growth of gram-negative bacilli

BACKGROUND

Implantable venous access port (IVAP)-related blood stream infections (BSIs) are one of the most common complications of implantable venous ports. The risk factors and pathogens for IVAP-related BSIs are still controversial.

METHODS

We retrospectively reviewed all patients who received IVAPs at a Hospital in Taiwan from January 1, 2011 to June 31, 2014. Two types of venous port, BardPort® 6.6 fr (Bard port) and Autosuture Chemosite® 7.5 fr (TYCO port) were used. All patients with clinically proven venous port-related BSIs were enrolled.

RESULTS

A total of 552 patients were enrolled. There were 34 episodes of IVAP-related BSIs during the study period for a total incidence of 0.177 events/1000 catheter days. Port type (TYCO vs. Bard, HR = 7.105 (95% confidence interval (CI), 1.688-29.904), p = 0.0075), age > 65 years (HR = 2.320 (95 % CI, 1.179-4.564), p = 0.0148), and lung cancer (HR = 5.807 (95% CI, 2.946-11.447), p < 0.001) were risk factors for port infections. We also found that no local sign of infection was significantly associated with the growth of gram-negative bacilli (p = 0.031).

CONCLUSIONS

TYCO venous ports, age > 65 years, and lung cancer were all significant risk factors for IVAP-related BSIs, and no sign of infection was significantly associated with the growth of gram-negative bacilli.

Erectile Dysfunction in Patients with Sleep Apnea--A Nationwide Population-Based Study

Increased incidence of erectile dysfunction (ED) has been reported among patients with sleep apnea (SA). However, this association has not been confirmed in a large-scale study. We therefore performed a population-based cohort study using Taiwan National Health Insurance (NHI) database to investigate the association of SA and ED. From the database of one million representative subjects randomly sampled from individuals enrolled in the NHI system in 2010, we identified adult patients having SA and excluded those having a diagnosis of ED prior to SA. From these suspected SA patients, those having SA diagnosis after polysomnography were defined as probable SA patients. The dates of their first SA diagnosis were defined as their index dates. Each SA patient was matched to 30 randomly-selected, age-matched control subjects without any SA diagnosis. The control subjects were assigned index dates as their corresponding SA patients, and were ensured having no ED diagnosis prior to their index dates. Totally, 4,835 male patients with suspected SA (including 1,946 probable SA patients) were matched to 145,050 control subjects (including 58,380 subjects matched to probable SA patients). The incidence rate of ED was significantly higher in probable SA patients as compared with the corresponding control subjects (5.7 vs. 2.3 per 1000 patient-year; adjusted incidence rate ratio = 2.0 [95% CI: 1.8-2.2], p<0.0001). The cumulative incidence was also significantly higher in the probable SA patients (p<0.0001). In multivariable Cox regression analysis, probable SA remained a significant risk factor for the development of ED after adjusting for age, residency, income level and comorbidities (hazard ratio = 2.0 [95%CI: 1.5-2.7], p<0.0001). In line with previous studies, this population-based large-scale study confirmed an increased ED incidence in SA patients in Chinese population. Physicians need to pay attention to the possible underlying SA while treating ED patients.

Randomized trial comparing rabeprazole- versus lansoprazole-based Helicobacter pylori eradication regimens

Different types of proton pump inhibitor (PPI)-based triple therapies could result in different Helicobacter pylori eradication rates. This study aimed to compare the efficacy and safety of rabeprazole- and lansoprazole-based triple therapies in primary treatment of H. pylori infection. From September 2005 to July 2008, 426 H. pylori-infected patients were randomly assigned to receive a 7-day eradication therapy with either rabeprazole 20mgbid (RAC group, n=222) or lansoprazole 30mgbid (LAC group, n=228) in combination with amoxicillin 1gbid and clarithromycin 500mgbid. The patients received follow-up esophagogastroduodenoscopy (EGD) and/or (13)C-urea breath test 12-16 weeks later to define H. pylori status. Their personal and medical history, compliance and side effects were obtained by using a standardized questionnaire. Intention-to-treat analysis revealed that the eradication rate was 87.84% in the RAC group and 85.96% in the LAC group (p=0.56). All patients returned for assessment of compliance (100% in the LAC group vs. 99.50% in the RAC group; p=0.32) and adverse events (7.20% in the RAC group vs. 5.70% in the LAC group, p=0.51). Univariate analysis suggested that patients with nonsteroid anti-inflammatory agent (NSAID) use had lower eradication rates than those without (76.71% vs. 88.74%; p=0.006). Our results showed that efficacy and safety were similar in rabeprazole- and lansoprazole-based primary therapies. The influence of NSAID usage on H. pylori eradication needs to be further investigated.

Risk factors for the development of metachronous liver metastasis in colorectal cancer patients after curative resection

BACKGROUND

Metachronous liver metastasis (MLM) occurs in 20-40% of colorectal cancer (CRC) patients following surgical treatment. The aim of the present study was to determine the risk factors affecting the development of MLM in CRC patients following curative resection.

METHODS

A total of 1,356 patients who underwent curative intent resection for CRC were retrospectively studied. Of these patients, those who with 30 days postoperative mortality (n=23), incomplete medical record (n=32), synchronous liver metastasis (n=148) and UICC stage IV (n=54) were excluded, and finally 1,099 patients were analyzed, including 977 patients without liver metastasis and 122 patients with MLM-only. Clinical and pathological records for each patient were reviewed from medical charts. The clinicopathologic characteristics of 1,099 patients were investigated.

RESULTS

The median timing of developing MLM was 13 months with a range of 4 to 79 months. Univariate analysis identified that preoperative serum carcinoembryonic antigen (CEA) level, depth of invasion, lymph nodes metastasis, vascular invasion, and perineural invasion were significantly correlated with the development of MLM (all P<0.05). Meanwhile, a multivariate analysis showed that preoperative serum carcinoembryonic antigen (CEA) level>5 ng/ml (Odds Ratio [OR]=1.591; 95% Confidence Interval [CI], 1.065-2.377; P=0.024), tumor depth (OR=2.294; 95% CI, 1.103-4.768; P=0.026), positive lymph node metastasis (OR=2.004; 95% CI, 1.324-3.031; P=0.001) and positive vascular invasion (OR=1.872; 95% CI, 1.225-2.861; P=0.004) were independent prognostic factors contributing to the occurrence of MLM.

CONCLUSIONS

The present study demonstrates that preoperative serum CEA level, tumor depth, lymph node metastasis, and positive vascular invasion could affect the occurrence of MLM in CRC patients following curative resection, and thus could help to define these high-risk patients who would benefit from enhanced surveillance and therapeutic program(s).

Urine specific gravity as a predictor of early neurological deterioration in acute ischemic stroke

We previously found that a blood urea nitrogen/creatinine (BUN/Cr) ratio>15 is an independent predictor of early neurological deterioration after acute ischemic stroke, which suggests that dehydration may be a cause of early deterioration. The aim of this study was to determine whether urine specific gravity, which is another indicator of hydration status and one that is more easily obtained, is also an independent predictor of early deterioration or stroke-in-evolution (SIE). Demographic and clinical data were recorded at admission from patients with acute ischemic stroke who were prospectively enrolled from October 2007 to June 2010. We compared patients with and without stroke-in-evolution (based on an increase of 3 points or more points on the National Institutes of Health Stroke Scale within 3 days). Univariate and multivariate statistical analyses were carried out. A total of 317 patients (43 SIE and 274 non-SIE) were enrolled; the first 196 patients comprised the cohort of our previous study. The only two independent predictors of early deterioration or SIE were BUN/Cr>15 and urine specific gravity>1.010. After adjusting for age and gender, patients with a urine specific gravity>1.010 were 2.78 times more likely to develop SIE (95% CI=1.11-6.96; P=0.030). Urine specific gravity may be useful as an early predictor of early deterioration in patients with acute ischemic stroke. Patients with urine specific gravity ≤ 1.010 therefore may have a reduced likelihood of early neurological deterioration.

Predictive factors of early relapse in UICC stage I-III colorectal cancer patients after curative resection

BACKGROUND AND OBJECTIVES

To predict the clinicopathologic factors for early relapse of UICC stage I-III colorectal cancer (CRC) patients undergoing curative resection and thus to identify a subgroup of patients who are at high risk for postoperative early relapse.

METHODS

Between January 2001 and June 2007, a total of 778 UICC stage I-III CRC patients who underwent a radical resection and regular follow-up were retrospectively analyzed. Of these 778 CRC patients, 521 colon cancer and 257 rectal cancer cases were analyzed, respectively, to determine the predictors of early relapse postoperatively. These 778 patients were followed-up intensively, and their outcomes were investigated retrospectively.

RESULTS

Out of 521 colon cancer patients, postoperative relapse after primary resection was found in 142 (27.3%) patients, and 77 (54.2%) of 142 recurrent colon cancer patients were classified as postoperative early relapse. Meanwhile, among 257 rectal cancer patients, postoperative relapse was found in 68 (26.5%) patients and 44 (64.7%) of 68 recurrent rectal cancer patients were identified as postoperative early relapse. Forty-nine (63.6%) of 77 early relapsed colon cancer patients were stage III, and likewise, 26 (59.1%) of 44 early relapsed rectal cancer patients were stage III. Univariately, postoperative early relapse of colon cancer patients was significantly correlated with the presence of vascular invasion (P < 0.001), perineural invasion (P < 0.001), high postoperative carcinoembryonic antigen (CEA) level (P = 0.001), and type of surgery (P = 0.016). Using a Cox proportional hazards analysis, the presence of vascular invasion (P = 0.033), perineural invasion (P = 0.005), and high postoperative CEA levels (P = 0.001) were demonstrated to be independent predictors of postoperative early relapse of colon cancer patients, while in rectal cancer patients, both vascular invasion (P = 0.039) and perineural invasion (P = 0.008) were statistically significant predictors of early relapse by univariate analysis. Using a Cox proportional hazards analysis, only perineural invasion (P = 0.043) was an independent factor. Early relapse cases had significant lower overall survival rates than non-early relapse cases either in colon cancer (P < 0.001) or in rectal cancer (P = 0.0091) patients.

CONCLUSIONS

This study suggests that vascular invasion, perineural invasion, and postoperative CEA level may be significant factors for postoperative early relapse of colon cancer; while only perineural invasion is considered to be a significant predictor in rectal cancer patients. Identification of these high-risk UICC stage I-III CRC patients of early relapse is important, and thus could help to define patients with this tumor entity for an enhanced follow-up and therapeutic program.

Oxaliplatin/5-fluorouracil/leucovorin (FOLFOX4) regimen as an adjuvant chemotherapy in the treatment of advanced jejunal adenocarcinoma: a report of 2 cases

OBJECTIVE

To present our clinical experience of 5-fluorouracil/leucovorin/oxaliplatin (FOLFOX4) regimen administered as an adjuvant chemotherapy to 2 patients with advanced jejunal adenocarcinoma.

CASE PRESENTATION AND INTERVENTION

A 55-year-old woman presented with recurrent upper abdominal pain, nausea and vomiting. A small bowel series as well as the abdominal computed tomography scan revealed an irregular narrowing lesion at the proximal jejunum. The patient then underwent an exploratory laparotomy and the jejunal adenocarcinoma with localized peritoneal metastasis was found (R0 resection, T3N1M1, stage IV). Chemotherapy with FOLFOX4 regimen of 12 cycles was initiated after the curative resection. No adverse event was observed during the period of chemotherapy. She has been well without evidence of recurrence for over 20 months postoperatively. The second case was a 77-year-old female presenting with mechanical ileus. Surgical exploration revealed a proximal jejunal adenocarcinoma with regional lymph node involvement (R0 resection, T3N1M0, stage III). She also received the FOLFOX4 chemotherapy of 12 cycles with an uneventful course. No obvious toxicity developed except for temporary grade I peripheral neuropathy and skin eruption. This patient has survived well and has been free of this disease for over 12 months since the operation.

CONCLUSION

This report showed that adjuvant chemotherapy with FOLFOX4 regimen seems effective and well tolerated in these 2 patients with advanced jejunal adenocarcinoma. Further investigation of a large number of patients with long-term follow-up is needed to confirm these findings.

Characteristics of membrane fouling in submerged membrane bioreactor under sub-critical flux operation

Recently, the membrane bioreactor (MBR) process has become one of the novel technologies to enhance the performance of biological treatment of wastewater. Membrane bioreactor process uses the membrane unit to replace a sediment tank, and this can greatly enhance treatment performance. However, membrane fouling in MBR restricts its widespread application because it leads to permeate flux decline, making more frequent membrane cleaning and replacement necessary, which then increases operating and maintenance costs. This study investigated the sludge characteristics in membrane fouling under sub-critical flux operation and also assessed the effect of shear stress on membrane fouling. Membrane fouling was slow under sub-critical flux operation. However, as filamentous microbes became dominant in the reactor, membrane fouling increased dramatically due to the increased viscosity and polysaccharides. A close link was found between membrane fouling and the amount of polysaccharides in soluble EPS. The predominant resistance was the cake resistance which could be minimized by increasing the shear stress. However, the resistance of colloids and solutes was not apparently reduced by increasing shear stress. Therefore, smaller particles such as macromolecules (e.g. polysaccharides) may play an important role in membrane fouling under sub-critical flux operation.

Evaluation of the two immunochromatographic methods for detecting urine and serum IgG antibodies to Helicobacter pylori and comparison of accuracy and clinical utility

BACKGROUND/AIMS

To evaluate the accuracy and clinical utility of two immunochromatographic methods, the STAT-PAK and RAPIRUN tests, in detecting H. pylori antibodies in serum and in urine separately.

METHODOLOGY

130 patients undergoing gastroendoscopy (70 men and 60 women; mean age, 50.6 years) were enrolled in this study. Their H. pylori status was determined based on 4 tests: CLO test, culture, histology and UBT test. The H. pylori positive status was confirmed when the culture was positive, or 2 of the other 3 tests were positive. Serum samples and urine samples were collected. We used the STAT-PAK test for detecting H. pylori antibodies in serum, and read the results 24 hours later. Antibodies were also detected in urine by the RAPIRUN test, with a reading time of 25 minutes. 3 doctors read the results of both tests separately, and a positive result was determined when at least 2 of the doctors read a positive result.

RESULTS

In the STAT-PAK pretest using serum samples from 21 randomly selected patients (16 patients with H. pylori infection and 5 patients without infection), the sensitivity at 1-hour and 24-hour reading time was 18.7% and 37.5%. Specificity in both reading times was the same at 100%. Of 129 patients, 82 (64%) were H. pylori infected and 47 (36%) were uninfected. The sensitivity, specificity, and positive and negative predictive values were 31.7%, 93.6%, 89.6% and 44.0% in the STAT-PAK test with a 24-hour reading time, and 93.9%, 85.1%, 91.6%, 88.8% in the RAPIRUN test. One female was excluded because of an invalid urine test.

CONCLUSIONS

The urine RAPIRUN test is a faster and more accurate office-based test than the serum STAT-PAK test for detecting the H. pylori infection in untreated patients in Taiwan. The non-invasive urine RAPIRUN test can be used as a large scale screening test for H. pylori status, particularly in children, uncooperative patients, those who have a family history of gastric cancer, or patients who can not tolerate the suffering of endoscopic examination.

Multivariate analysis of prognostic determinants for colorectal cancer patients with high preoperative serum CEA levels: prognostic value of postoperative serum CEA levels

High preoperative serum carcinoembryonic antigen (CEA) levels have been well investigated and found to be associated with poor prognosis in patients with colorectal cancer (CRC). However, it has been observed that the outcome varies after curative resection, along with postoperative serum CEA levels; some patients continue to have high postoperative serum CEA levels while postoperative CEA levels return to normal in others. The purpose of this study was to determine the prognostic significance of postoperative serum CEA levels in CRC patients with high preoperative serum CEA levels. Between January 2002 and December 2004, 423 CRC patients underwent operation in our hospital; 181 (42.8%) had high preoperative serum CEA levels and were enrolled in this study. Among the 181 patients, 165 patients had curative resection; the remaining 16 had stage IV disease, so they underwent palliative surgery and were subsequently excluded from analysis. Pre- and postoperative serum CEA levels were measured and analyzed. All patients had curative resection and were divided into two groups according to postoperative serum CEA levels: one group comprised patients with postoperative serum CEA > or = 5 ng/mL (n = 80) and the other group comprised patients with postoperative serum CEA levels < 5 ng/mL (n = 85). Postoperative serum CEA levels were significantly related to location of primary tumors (p = 0.042), lymph node metastases (p = 0.009), TNM stage (p = 0.001), and postoperative relapse (p = 0.004). The results of multivariate analysis showed that both lymph node metastases and high postoperative serum CEA levels (> or = 5 ng/mL) were independent prognostic factors for CRC patients after curative resection. Postoperative serum CEA levels can be a single independent prognostic determinant in CRC patients with high preoperative serum CEA levels. Intensive follow-up and adjuvant therapy may be necessary in CRC patients who continue to have high postoperative serum CEA levels even after curative resection.

The clinical applications and accuracy of 2 rapid near-patient tests in detecting Helicobacter pylori infection

Noninvasive methods for assessing Helicobacter pylori infection status are now an integral part of managing patients with upper gastrointestinal complaints. The aim of this study is to evaluate the feasibility and diagnostic accuracy of 2 rapid tests: a urine-based H. pylori antibody detection method (Rapirun) and a stool-based H. pylori antigen detection method (immunocard STAT! HpSA). The combined use of the mentioned 2 tests was also evaluated, which has not been described in previous similar studies. Urine and stool specimens were collected from patients who were arranged for gastroendoscopic examination. The urine and stool specimens were tested with Rapirun and immunocard STAT! HpSA separately. The estimated reaction time was about 15 to 20 min for the former and 5 to 10 min for the latter. H. pylori infection was confirmed with 4 tests: culture, histology, rapid urease test, and the (13)C-urea breath test. Obtained results from both kits were compared with confirmed results. One hundred twenty patients were eligible for analysis. Of them, 62 tested positive for H. pylori infection and 58 were negative by the confirmation criteria. The urine Rapirun test relative to the confirmed results showed sensitivity, specificity, and accuracy as 87.1% (confidence interval [CI] = 81.1-93.1%), 89.7% (CI = 84.2-95.1%), and 88.3%, respectively. The stool immunocard STAT! HpSA test relative to the confirmed results showed sensitivity, specificity, and accuracy as 96.8% (CI = 93.6-99.9%), 82.8% (CI = 76.0-89.5%), and 90%, respectively. The combined-use method of both tests revealed sensitivity, specificity, and accuracy as 98.4% (CI = 96.1-100%), 81.0% (CI = 74.0-88.1%), and 90%, respectively. These 2 urine and stool tests have a satisfactory accuracy around 90% in detecting H. pylori infection. In consideration of the advantages of cheapness, timesaving, and ease of use, both can be used as rapid near-patient tests in general practice. The combined use of both tests was also promising in detecting H. pylori infection.

Clinical and endoscopic features of non-steroidal anti-inflammatory drug-induced colorectal ulcerations

BACKGROUND AND PURPOSE

Data on the clinical and endoscopic features of non-steroidal anti-inflammatory drug (NSAID)-induced colorectal ulcerations are very limited from Taiwan. We analyzed the clinical manifestations, endoscopic and histologic findings, and outcomes of patients with NSAID-induced colorectal ulcerations in Southern Taiwan.

METHODS

From January 1997 to December 2001, 4200 patients underwent total colonoscopy at a tertiary referral center in Southern Taiwan. We retrospectively analyzed the medical records and endoscopic files. The diagnosis of NSAID colorectal ulceration required the following clinical, histologic and colonoscopic findings: patients presenting with gastrointestinal complaints were taking NSAIDs; presence of colorectal ulcerations confirmed by colonoscopy; no evidence of neoplasm or of specific inflammation in biopsy specimens obtained from the margins of ulcers; no evidence of pathogenic microorganism in cultures of biopsy specimens and stools; no prior history of chronic inflammatory bowel diseases; improvement of ulcers, as confirmed by endoscopy, and improvement of presenting symptoms after the discontinuation of NSAID therapy.

RESULTS

NSAID-induced colorectal ulcerations were diagnosed in 19 (0.45%) of the 4200 patients, including 10 females and 9 males with a mean age of 64.7+/-15.4 years. Of the 19 patients, 13 presented with acute onset of painless rectal bleeding, 4 with nonspecific abdominal distress, and 2 with iron deficiency anemia, weight loss and lower abdominal pain. Colonoscopy revealed ulcerations in the ileocecal region in 11 patients, lesions in the distal rectum in 6, and colonic strictures with circumferential ulcerations on the central rim located in the ileocecal region in 2. Eight patients had comorbidity including renal failure (4), uncomplicated liver cirrhosis (2), and previous cerebrovascular accidents (2). Diclofenac and piroxicam were the most commonly involved drugs. Patients with acute onset rectal bleeding were also being treated with concomitant booster intravenous dose of NSAIDs before the bleeding episode. Most of the patients recovered uneventfully with the discontinuation of NSAID therapy.

CONCLUSIONS

NSAID-induced colorectal ulceration is a clinically significant disease which may be under-recognized. Lower gastrointestinal tract evaluation should be considered in patients who are using NSAIDs and who have acute rectal bleeding, anemia and lower gastrointestinal complaints.

Comparison of 13C-urea breath test values in gastric cancer, peptic ulcer and gastritis

BACKGROUND/AIMS

Results of urea breath test (UBT) are related to the severity of atrophic gastritis and the density of Helicobacter pylori (H. pylori). Recently, it has been reported that low UBT values should be considered to suggest the possibility of gastric cancer. This study compares UBT results in gastric cancer patients with those of peptic ulcer and gastritis patients.

METHODOLOGY

Between October 1998 and May 2000, we have consecutively collected 564 H. pylori-positive patients: 128 gastritis patients, 72 gastric cancer patients, 64 gastric ulcer patients and 300 duodenal ulcer patients. Peptic ulcers were classified into active (A), healing (H), and scar (S) stages. Gastric cancer was classified into early stage (EGCA) and advanced stage (AGCA). The dose of 13C-urea was 50mg, and breath samples were analyzed with a mass spectrometer and the data was evaluated by Mann-Whitney test. The cut-off value was 3.5 per thousand.

RESULTS

The mean UBT values of gastric cancer, gastric ulcer (GU), duodenal ulcer (DU) and gastritis were 16.95 +/- 12.2 per thousand, 16.3 +/- 9.3 per thousand, 15.13 +/- 9.9 per thousand and 20.07 +/- 13.5 per thousand. There were no significant differences in UBT values between gastric cancer and gastric ulcer (p = 0.745), duodenal ulcer (p = 0.3831), or gastritis (p = 0.2953). There were also no significant differences between subgroups of gastric cancer and gastric ulcer. There were significantly higher UBT values in the DU scar stage (p = 0.001) and healing stage (p = 0.0484) than in the active stage.

CONCLUSIONS

We conclude that the UBT value is not a good method for the prediction of gastric cancer. In addition, based on the results of our study, the UBT values may explain the relationship between the natural course of duodenal ulcer and H. pylori infection.

Cutaneous Metastasis from Gastric Adenocarcinoma: A Case Report

Cutaneous metastasis from gastric adenocarcinoma is an infrequent disease entity. When present, it typically signifies disseminated disease with a poor prognosis. We report a case of a 57-year-old male patient with gastric cancer who developed generalized erythematous nodules on the chest, abdomen, back, neck, and four extremities 2 months postoperatively. Results of a skin biopsy disclosed groups of metastatic adenocarcinoma cells in the dermis and subcutaneous tissue, forming clusters and strands in a desmoplastic stroma. Histopathologic examination demonstrated that the cutaneous metastasis was of stomach origin.

Zona pellucida thickness and clinical pregnancy outcome following in vitro fertilization

OBJECTIVE

To investigate possible correlations of ZPT or ZPTV with clinical outcome following in vitro fertilization.

METHODS

Two hundred forty-six embryos were selected for transfer on day 3 with clear image record from 81 IVF-ET cycles. The laser system measurement software was used to measure the ZTP value of each embryo and the ZPTV was computed. Statistical analysis was done using the ANOVA or Chi-square test.

RESULTS

Both ZPT and ZPTV declined with women's age. The mean ZPTV of embryos from patients between 30 and 34 years old was significantly higher than that from patients older than 35 (P<0.001). The ZPTV in pregnancy group was significantly higher than that in nonpregnancy group (P<0.005). The clinical pregnancy rate in the group with ZPTV more than 20% was significantly higher than that in the group with ZPTV less than 20% (P<0.05). The ZPTV of high grade embryos was significantly higher than that of low grade embryos (P<0.001).

CONCLUSIONS

ZPTV rather than ZPT is an effective parameter to evaluate the embryo quality. Increasing the ZPTV may enhance embryo implantation potential.

Comparison of serum and urine ELISA methods for the diagnosis of Helicobacter pylori--a prospective pilot study

BACKGROUND/AIMS

Helicobacter pylori infection has a close relationship with many upper digestive tract diseases, but a gold standard for identifying this infection has not yet been well established, especially in clinical application. There is an increasing interest in non-invasive diagnostic tests. In this study, we will compare two non-invasive tests (ELISA method of urine and serum) in clinical use.

METHODOLOGY

170 patients (82 women, 88 men; mean age 52.4 yr) were included in this study and all underwent gastroendoscopy. None of the patients had received any H. pylori eradication therapy. The H. pylori infection status was evaluated by histology, culture, CLO test, and 13C-UBT. We also collected urine and serum for the ELISA method. H. pylori infection was defined as positive if the culture was positive or if two of the other three tests (histology, CLO test and 13C-UBT) were positive. If all four tests were negative or only one of the other three tests was positive, the result would be interpreted as negative.

RESULTS

Of these 170 patients, 107 (62.94%) were H. pylori infected and 63 (37.06%) were uninfected. The sensitivity, specificity, positive predictive value and negative predictive value of serum ELISA were 96.26%, 74.60%, 86.55%, and 92.16% respectively; while those of urine ELISA were 93.46%, 92.06%, 95.24% and 89.23% respectively. There was no significant difference between these two tests in sensitivity, but urine ELISA has better specificity than serum ELISA significantly.

CONCLUSIONS

Urine ELISA is a better non-invasive test for H. pylori infection than serum ELISA in clinical practice, because no blood need be drawn, it is safer, easier, and more convenient for sampling and has better specificity. Therefore it would be suitable in epidemiological screening of H. pylori infection, especially in young children, older patients and those who cannot cooperate.

Two novel mutations of the glycine receptor gene in a Taiwanese hyperekplexia family

The authors report a Taiwanese family with autosomal recessive hyperekplexia. Two novel mutations, W96C (from the paternal allele) and R344X (from the maternal allele), which are located in exon 4 and exon 7 of the GLRA1 gene, were identified in this family. A series of electrophysiologic investigations were conducted in one of the probands, and the results suggest that the "startle center" is located subcortically.

Effects of ingesting Lactobacillus- and Bifidobacterium-containing yogurt in subjects with colonized Helicobacter pylori

BACKGROUND

Evidence suggests that ingesting lactic acid bacteria exerts a suppressive effect on Helicobacter pylori infection in both animals and humans. Supplementing with Lactobacillus- and Bifidobacterium-containing yogurt (AB-yogurt) was shown to improve the rates of eradication of H. pylori in humans.

OBJECTIVE

We administered AB-yogurt to subjects with asymptomatic H. pylori to test whether the yogurt could inhibit H. pylori growth.

DESIGN

The in vitro inhibition of H. pylori growth was determined by inoculating Lactobacillus acidophilus La5 or Bifidobacterium lactis Bb12 on plates that were inoculated with H. pylori. Assessment of the viability of H. pylori was performed by the mixed culture method with La5 or Bb12. In an intervention study, 59 adult volunteers infected with H. pylori were given AB-yogurt (10(7) colony-forming units of both La5 and Bb12/mL) twice daily after a meal for 6 wk. Eleven subjects positive for H. pylori infection were treated with milk placebo as control subjects. H. pylori bacterial loads were determined with use of the (13)C-urea breath test, which was performed before and 4 and 8 wk after the start of AB-yogurt supplementation.

RESULTS

Bb12 exerted an in vitro inhibitory effect against H. pylori, whereas La5 did not show an effect. Administration of AB-yogurt decreased the urease activity of H. pylori after 6 wk of therapy (P < 0.0001).

CONCLUSION

Regular intake of yogurt containing Bb12 and La5 effectively suppressed H. pylori infection in humans.

Acute hemorrhagic rectal ulcer syndrome: a new clinical entity? Report of 19 cases and review of the literature

PURPOSE

Acute hemorrhagic rectal ulcer syndrome is characterized by sudden onset, painless, and massive hemorrhage from rectal ulcer(s) in patients with serious underlying illnesses. It is a matter of controversy whether acute hemorrhagic rectal ulcer syndrome is a distinct clinical entity. This is the first Asian report on acute hemorrhagic rectal ulcer syndrome to be made outside Japan.

METHODS

From January 1989 to December 1999, 8085 patients underwent total colonoscopy at our institution. We retrospectively analyzed the medical records and colonoscopic files. The diagnosis of acute hemorrhagic rectal ulcer syndrome was made by means of the clinical, histologic, and colonoscopic findings.

RESULTS

Among the 8085 patients, 19 patients (11 males; mean age, 71.2 +/- 10.1 years) were diagnosed with acute hemorrhagic rectal ulcer syndrome, which accounted for 2.8 percent of the patients with massive lower gastrointestinal bleeding. The duration from hospitalization to the onset of massive bleeding ranged from 3 to 14 (mean, 9 +/- 3.3) days. Characteristics of colonoscopic appearance were solitary or multiple rectal ulcer(s), with round, circumferential, geographical, or Dieulafoy-like lesions located within a mean of 4.7 cm +/- 1.5 cm from the dentate line. Histopathologically, the lesions appeared as necrosis with denudation of covering epithelium, hemorrhage, and multiple thrombi in the vessels of the mucosa and underlying stroma, which is considered to be similar to stress-related mucosa injury. Successful hemostasis was obtained in 74 percent (14/19) of patients with direct therapeutic maneuvers. Prognosis was largely dependent on accurate diagnosis and management of the underlying disorders.

CONCLUSIONS

We assert that acute hemorrhagic rectal ulcer syndrome is a rare but important entity and stress that awareness of this clinical entity should lead to a high index of suspicion resulting in early detection, diagnosis, and appropriate therapy.

Low molecular weight protein of Helicobacter pylori and its relation to gastroduodenal diseases

BACKGROUND/AIMS

In Taiwan, CagA and VacA cannot be used as markers to evaluate the risk of developing serious gastroduodenal pathogenesis in the hosts. Recent research suggests that the low molecular weight proteins, 35kDa and 19kDa, in Helicobacter pylori may be related to duodenal ulcers and gastric MALToma (mucosa-associated lymphoid tissue lymphoma) respectively. The aims of this study were to examine the sero-prevalence of antibodies against specific Helicobacter pylori antigen in patients with different gastroduodenal diseases and further to find possible virulence factor(s) associated with the development of clinically relevant disease in Helicobacter pylori-infected subjects in Taiwan.

METHODOLOGY

Sera were obtained from 108 patients, of which 22 had gastric adenocarcinoma, 31 had non-ulcer dyspepsia and 65 had peptic ulcer disease. The sera were analyzed for specific Helicobacter pylori antigen by using one commercial kit (HelicoBlot 2.0, Genelabs Diagnostic, Singapore, HB2.0). Helicobacter pylori infection was confirmed when the culture was positive or when any two of the other three tests (biopsy CLO test, histology and 13C-urea breath test) were positive.

RESULTS

The data showed a high prevalence of CagA and VacA proteins [CagA(+): gastric adenocarcinoma--88.1%, non-ulcer dyspepsia--87.1%, peptic ulcer disease--91%; VacA(+): gastric adenocarcinoma--78.6%, non-ulcer dyspepsia--58.1%, peptic ulcer disease--71.4%] in Taiwan. This is similar to the findings in other Chinese and Taiwanese studies. No significant difference was found among the three groups (P > 0.05) for any Helicobacter pylori protein. We found that antibody responses to the 26.5-kDa and 116-kDa (CagA) antigens were most prevalent in the peptic ulcer disease group. Consequently, we analyzed two special phenotypes, which have simultaneous presence in bands at 116 and 26.5kDa. The phenotype [116-kDa (+) and 26.5kDa(+)] predicted the risk of peptic ulcer disease with 76.7% sensitivity and 62% specificity.

CONCLUSIONS

We confirm the universal prevalence of CagA and VacA-positive Helicobacter pylori infection in Taiwan independent of disease. Although we did not find any single specific Helicobacter pylori protein which could act as an indicator of clinical outcome, we found a possible marker of peptic ulcer disease which may be acceptable. This is the phenotype with simultaneous presence in bands at 116kDa and 26.5kDa protein. Our report differs from some previous reports from other regions. This may reflect differences of race and geography.

The media of rapid urease test influence the diagnosis of Helicobacter pylori

BACKGROUND/AIMS

The influence of different media on the validity of the rapid urease test, including accuracy, reaction time and cost-effectiveness is evaluated.

METHODOLOGY

Biopsies were obtained from the antral and body mucosa of 100 KMUH patients (51 men, 49 women; mean age: 54.0 years, range: 21-79 years old) undergoing gastroendoscopy due to dyspepsia. None of the patients had received any Helicobacter pylori eradicating treatment, nor any other antibiotic or bismuth treatment in the previous one month, nor had they had any type of gastric operation in the past. Helicobacter pylori status was evaluated by seven different tests: culture, histology, home-made rapid urease test, 13C-urea breath test, and three different commercially available rapid urease tests--including the CLO test, the ProntoDry test, and the Pyloriset Urease test. Helicobacter pylori status was defined as positive when the culture was positive or if concordance of two of the other three tests (histology, homemade rapid urease test and 13C-urea breath test) was positive.

RESULTS

Three different rapid urease tests have similar sensitivities (97.3% vs. 100% vs. 100%) and specificities (98.4% vs. 96.8% vs. 98.2%), and accuracy (98.4% vs. 96.8% vs. 98.2%). But the reaction time was longer in the CLO test than for the other two rapid urease tests (22.3 vs. 5.6 vs. 10.1 minutes) (P < 0.05). The ProntoDry test and the Pyloriset Urease test also have more rapid positive rate than CLO test. However, in vitro study, three tests show similar rapidity of positive reaction at different densities of Helicobacter pylori.

CONCLUSIONS

These three tests have practical advantages for physicians who need a rapid and accurate method of diagnosing Helicobacter pylori infections. The ProntoDry test and Pyloriset Urease test have degrees of accuracy similar to the CLO test, but results are obtained more rapidly and they are cheaper. Furthermore, The ProntoDry test can be stored at room temperature and thereby save on the storage expense.

Effects of exogenous corticotropin-releasing factor on antropyloroduodenal motility and appetite in humans

OBJECTIVES

Corticotropin-releasing factor (CRF) has been shown to affect GI motor function and appetite in animals. We have evaluated the effects of exogenous CRF on antropyloroduodenal motility and appetite in humans.

METHODS

On 2 separate days, six healthy volunteers received, in randomized, double-blind fashion, i.v. CRF as a 1.0-microg/kg bolus (0-5 min) followed by a constant infusion (1.0 microg/kg/h) (5-150 min), or an identical volume of saline. At t = 28 min each subject drank 200 ml of a nutrient liquid containing 20 mg/kg of paracetamol. Antropyloroduodenal pressures were measured with sleeve/sidehole manometry and perceptions of appetite by visual analog scales. Venous blood was obtained for measurements of serum cortisol and paracetamol. At t = 150 min the manometric catheter was removed and subjects offered a buffet meal (150-180 min). The amount and macronutrient content of food consumed were quantified.

RESULTS

CRF increased serum cortisol (p < 0.001), the number of isolated pyloric pressure waves (p < 0.05), duodenal pressure waves (p < 0.05), and the percentage of antegrade duodenal pressure waves (p < 0.05). CRF had no significant effect on the number of antral pressure waves, basal pyloric pressure, serum paracetamol concentrations, perceptions of appetite, or food intake.

CONCLUSIONS

Intravenous CRF stimulates phasic pyloric and duodenal pressure waves in humans.