Two-week treatment with proton pump inhibitor is sufficient for healing post endoscopic submucosal dissection ulcers

AIM:To investigate the optimum period of treatment for post endoscopic submucosal dissection(ESD)ulcers.METHODS:Patients who underwent ESD for gastric cancer were randomized to two groups and treated with esomeprazole 20 mg per day for 4 wk(4W group)or 2 wk(2W group).At 4 wk after ESD,we measured the size of the artificial ulcers by endoscopy and determined the ulcer healing rate,compared with the size of the ESD specimens.This randomized controlled trial study was approved by our ethics committee and registered in the UMIN Clinical Trial Registry.RESULTS:A total of 60 consecutive patients were included in the study.All patients received rebamipide 300 mg per day for 4 wk.One patient in 2W group who showed bleeding within two weeks and received endoscopic treatment was excluded from further analysis.The numbers of patients with ulcers in the healing/scar stage in the 2W and 4W groups at 4 wk after ESD were 20/6 and 28/5,respectively,with no significant difference.The ulcer healing rate in the 2W and 4W groups were 96.1%[95%confidence interval(CI):94.6%-97.55]vs 94.8%(95%CI:92.6%-97.1%),respectively,with no statistical difference(UMIN000006951).CONCLUSION:Two-wk treatment with a proton pump inhibitor is as effective as four-week treatment for healing post ESD ulcers.

在有阴暗胃肠的流血的病人的囊内视镜检查法的计算图象修正的功效

AIM:To investigate whether flexible spectral color enhancement(FICE) improves diagnostic yields of capsule endoscopy(CE) for obscure gastro-intestinal bleeding(OGIB).METHODS:The study subjects consisted of 81 patients.Using FICE,there were three different sets with different wavelengths.Using randomly selected sets of FICE,images of CE were evaluated again by two individuals who were not shown the conventional CE reports and findings.The difference between FICE and conventional imaging was examined.RESULTS:The overall diagnostic yields in FICE sets 1,2,3 and conventional imaging(48.1%) were 51.9%,40.7%,51.9% and 48.1%,respectively,which showed no statistical difference compared to conventional imaging.The total numbers of detected lesions per examination in FICE imaging and conventional imaging were 2.5 ± 2.1 and 1.8 ± 1.7,respectively,which showed a significant difference(P = 0.01).CONCLUSION:The diagnostic yield for OGIB is not improved by FICE.However,FICE can detect significantly more small bowel lesions compared to conventional imaging.

Berberine for prevention of dementia associated with diabetes and its comorbidities:A systematic review

Background: A growing number of epidemiological studies indicate that metabolic syndrome(MetS) and its associated features play a key role in the development of certain degenerative brain disorders, including Alzheimer’s disease and vascular dementia. Produced by several different medicinal plants, berberine is a bioactive alkaloid with a wide range of pharmacological effects, including antidiabetic effects.However, it is not clear whether berberine could prevent the development of dementia in association with diabetes.Objective: To give an overview of the therapeutic potential of berberine as a treatment for dementia associated with diabetes.Search strategy: Database searches A and B were conducted using Pub Med and Science Direct. In search A,studies on berberine’s antidementia activities were identified using “berberine” and “dementia” as search terms. In search B, recent studies on berberine’s effects on diabetes were surveyed using “berberine” and“diabetes” as search terms.Inclusion criteria: Clinical and preclinical studies that investigated berberine’s effects associated with Met S and cognitive dysfunction were included.Data extraction and analysis: Data from studies were extracted by one author, and checked by a second;quality assessments were performed independently by two authors.Results: In search A, 61 articles were identified, and 22 original research articles were selected. In search B, 458 articles were identified, of which 101 were deemed relevant and selected. Three duplicates were removed, and a total of 120 articles were reviewed for this study. The results demonstrate that berberine exerts beneficial effects directly in the brain: enhancing cholinergic neurotransmission, improving cerebral blood flow, protecting neurons from inflammation, limiting hyperphosphorylation of tau and facilitating b-amyloid peptide clearance. In addition, evidence is growing that berberine is effective against diabetes and associated disorders, such as atherosclerosis, cardiomyopathy, hypertension, hepatic steatosis, diabetic nephropathy, gut dysbiosis, retinopathy and neuropathy, suggesting indirect benefits for the prevention of dementia.Conclusion: Berberine could impede the development of dementia via multiple mechanisms: preventing brain damages and enhancing cognition directly in the brain, and indirectly through alleviating risk factors such as metabolic dysfunction, and cardiovascular, kidney and liver diseases. This study provided evidence to support the value of berberine in the prevention of dementia associated with MetS.