Effect of ginger Effect of ginger on gastric motility and symptoms of functional dyspepsiaon gastric motility and symptoms of functional dyspepsia

AIM:To evaluate the effects of ginger on gastric motility and emptying,abdominal symptoms,and hormones that influence motility in dyspepsia.METHODS:Eleven patients with functional dyspepsia were studied twice in a randomized double-blind manner.After an 8-h fast,the patients ingested three capsules that contained ginger(total 1.2 g) or placebo,followed after 1 h by 500 mL low-nutrient soup.Antral area,fundus area and diameter,and the frequency of antral contractions were measured using ultrasound at frequent intervals,and the gastric half-emptying time was calculated from the change in antral area.Gastrointestinal sensations and appetite were scored using visual analog questionnaires,and blood was taken for measurement of plasma glucagon-like peptide-1(GLP-1),motilin and ghrelin concentrations,at intervals throughout the study.RESULTS:Gastric emptying was more rapid after ginger than placebo [median(range) half-emptying time 12.3(8.5-17.0) min after ginger,16.1(8.3-22.6) min after placebo,P ≤ 0.05].There was a trend for more antral contractions(P = 0.06),but fundus dimensions and gastrointestinal symptoms did not differ,nor did serum concentrations of GLP-1,motilin and ghrelin.CONCLUSION:Ginger stimulated gastric emptying and antral contractions in patients with functional dyspepsia,but had no impact on gastrointestinal symptoms or gut peptides.

Predictors of rebleeding after initial hemostasis with epinephrine injection in high-risk ulcers

AIM: To identify the predictors of rebleeding after initial hemostasis with epinephrine injection (EI) in patients with high-risk ulcers. METHODS: Recent studies have revealed that endoscopic thermocoagulation, or clips alone or combined with EI are superior to EI alone to arrest ulcer bleeding. However, the reality is that EI monotherapy is still common in clinical practice. From October 2006 to April 2008, high-risk ulcer patients in whom hemorrhage was stopped after EI monotherapy were studied using clinical, laboratory and endoscopic variables. The patients were divided into 2 groups: sustained hemostasis and rebleeding. RESULTS: A total of 175 patients (144, sustainedhemostasis; 31, rebleeding) were enrolled. Univariate analysis revealed that older age (≥ 60 years), advanced American Society of Anesthesiology (ASA) status (category Ⅲ , Ⅳ and Ⅴ ), shock, severe anemia (hemoglobin < 80 g/L), EI dose ≥ 12 mL and severe bleeding signs (SBS) including hematemesis or hematochezia were the factors which predicted rebleeding. However, only older age, severe anemia, high EI dose and SBS were independent predictors. Among 31 rebleeding patients, 10 (32.2%) underwent surgical hemostasis, 15 (48.4%) suffered from delayed hemostasis causing major complications and 13 (41.9%) died of these complications. CONCLUSION: Endoscopic EI monotherapy in patients with high-risk ulcers should be avoided. Initial hemostasis with thermocoagulation, clips or additional hemostasis after EI is mandatory for such patients to ensure better hemostatic status and to prevent subsequent rebleeding, surgery, morbidity and mortality.

Clinical characteristics and prognostic factors of splenic abscess:A review of 67 cases in a single medical center of Taiwan

瞄准：在 19 年的一个时期期间在台湾的一个医学中心分析脾的脓肿的 67 个盒子。方法：从 1986 年 1 月到 2004 年 12 月，有脾的脓肿的 67 个病人的一个总数为回顾的学习被注册。临床的特征，内在的疾病，有机体系列，治疗学的方法， APACHE II 分数，和死亡率被分析。结果：与 54.1+/-14.1 年的吝啬的年龄有 41 男性和 26 女性。为 28.4% 的多重脾的脓肿(MSA ) 报道和在 71.6% 病人的独居的脾的脓肿。57 个病人(35.8%) 中的 26 个有额外的脾的脓肿，与肝(34.6%) 的领先的地点。微生物学文化在血文化在 58 个病人(86.6%) 是积极的，与 71.8% 并且 93.5% 在脓肿文化。与肺炎杆菌(22.4%) 的领先的病原体，支配的克否定杆菌(GNB ) 感染(55.2%) 由克跟随了积极球菌(GPC ) 感染(31%) 。脾切除术在 26 被执行在 21 的病人(38.8%) ，经皮的排水或渴望(31.3%) ，和在 20 个病人(29.9%) 独自一个的抗菌素治疗。最后， 67 个病人中的 12 个到期了(17.9 %) 。由统计，感染 GNB 的怒气是可能的与 GPC (P=0.036 ) 与感染相比开发多发性脓肿。有 GNB 感染(P=0.009 ) 和多发性脓肿(P=0.011 ) 的病人与 GPC 感染和独居的脓肿比病人经历了更高的死亡率。12 的吝啬的 APACHE II 分数到期了病人(16.3+/-3.2 ) 比 55 幸存(7.2+/-3.8 )(P【0.001 ) 的显著地高。结论：MSA， GNB 感染，和高 APACHE II 分数是差的预示的因素。当这些风险因素是在场的时，早外科的干预应该被鼓励。

Endosonographic surveillance of 1-3 cm gastric submucosal tumors originating from muscularis propria

AIM To observe the natural course of 1-3 cm gastric submucosal tumors originating from the muscularis propria(SMTMPs).METHODS By reviewing the computerized medical records over a period of 14 years(2000-2013), patients with 1-3 cm gastric SMTMPs who underwent at least two endoscopic ultrasound(EUS) examinations were enrolled. Tumor progression was defined as a ≥ 1.2 times enlargement in tumor diameter observed during EUS surveillance. All patients were divided into stationary and progressive subgroups and further analyzed. We also reviewed the patients in the progressive subgroup again in 2016.RESULTS A total of 88 patients were studied, including 25 in the progressive subgroup. The mean time of EUS surveillance was 24.6 mo in the stationary subgroup and 30.7 mo in the progressive subgroup. Risk factors for tumor progression included larger tumor size and irregular border. Initial tumor size > 14.0 mm may be considered a cut-off size for predicting tumor progression. Seventeen patients underwent surgery, of whom 13 had gastrointestinal stromal tumors(GISTs) and 4 had leiomyomas. Tumor progression was found only in patients with GISTs. All of the tumors exhibited benign behaviors without metastasis until 2016.CONCLUSION Most 1-3 cm gastric SMTMPs(71.6%) are indolent. Tumor progression was found only in GISTs, and it is a good predictor for differentiating GISTs from leiomyomas. Predictors of tumor progression include larger tumor size(> 14.0 mm) and irregular border.

Serum hepatitis B surface antigen levels predict treatment response to nucleos(t)ide analogues

Quantification of hepatitis B surface antigen(HBsAg)has been suggested to be helpful in the management of chronic hepatitis B(CHB)patients.Nucleos(t)ide analogs(NAs)are the therapy of choice for CHB and are used in the majority of CHB patients.NAs are able to induce hepatitis B virus(HBV)viral suppression,normalization of alanine aminotransferase(ALT)levels,and improvement in liver histology.Automated quantitative assays for serum HBsAg have recently become available,facilitating standardized quantification of serum HBsAg.This has led to increased interest in the clinical application of quantitative serum HBsAg for predicting therapeutic response to NAs.Recent studies have shown that a decline in serum HBsAg levels in patients receiving peginterferon may signal successful induction of immune control over HBV,and can therefore be used to predict therapeutic response.NA treatment typically induces a less rapid decline in HBsAg than interferon treatment;it has been estimated that full HBsAg clearance can require decades of NA treatment.However,a rapid HBsAg decline during NA therapy may identify patients who will show clearance of HBsAg.Currently,there is no consensus on the clinical utility of serum HBsAg monitoring for evaluating patient responses to NA therapy.This review focuses on recent findings regarding the potential application of HBsAg quantification in the management of CHB patients receiving NA therapy.

Pseudoachalasia in a patient after truncal vagotomy surgery successfully treated by subsequent pneumatic dilations

Pseudoachalasia 是一个困难的条件让临床医生甚至由测压法，放射学的研究或内视镜检查法区分开来与自发的弛缓不能。它的病原学通常与肿瘤被联系。在大多数情况中，诊断在外科的探索以后被做。疾病的建议致病被看作远侧的食管的机械阻塞或在盒子的多数影响 meyenteric 丛的禁止的神经原的恶意的渗入。外科作为 pseudoachalasia 的一个原因被报导了。我们报导受不了 pseudo-achalasia 在树干的迷走神经切断术以后引起的 deglutination 混乱的一个 70 岁的人。病人在九年的后续和从在灵魂膨胀以后的 pseudoachalasia 的食道的活动性地位的完全的恢复以后是没有症状的。我们也考察了 pseudoachalasia 的文学。

Swab culture monitoring of automated endoscope reprocessors after high-level disinfection

AIM:To conduct a bacterial culture study for monitoring decontamination of automated endoscope reprocessors(AERs) after high-level disinfection(HLD).METHODS:From February 2006 to January 2011,authors conducted randomized consecutive sampling each month for 7 AERs.Authors collected a total of 420 swab cultures,including 300 cultures from 5 gastroscope AERs,and 120 cultures from 2 colonoscope AERs.Swab cultures were obtained from the residual water from the AERs after a full reprocessing cycle.Samples were cultured to test for aerobic bacteria,anaerobic bacteria,and mycobacterium tuberculosis.RESULTS:The positive culture rate of the AERs was 2.0%(6/300) for gastroscope AERs and 0.8%(1/120) for colonoscope AERs.All the positive cultures,including 6 from gastroscope and 1 from colonoscope AERs,showed monofloral colonization.Of the gastroscopeAER samples,50%(3/6) were colonized by aerobic bacterial and 50%(3/6) by fungal contaminations.CONCLUSION:A full reprocessing cycle of an AER with HLD is adequate for disinfection of the machine.Swab culture is a useful method for monitoring AER decontamination after each reprocessing cycle.Fungal contamination of AERs after reprocessing should also be kept in mind.

Expression and prognostic role of molecular markers in 99 KIT-positive gastric stromal tumors in Taiwan Residents

瞄准：为了阐明，象肿瘤那样的三个分子的标记的预示的角色和关系压制，增殖或基因 p53 房间原子抗原(PCNA ) 和在胃的基质肿瘤的 Ki-67。方法：108 的一个总数通过手术 resected 胃的平滑肌肿瘤标本从 1987 年 1 月被收集到 1999 年 12 月。Immunohistochemical 研究与 p53， PCNA，和 Ki-67 的抗体在 108 个 CD117 积极的肿瘤中的 99 个的石蜡节上被执行。三个分子的标记的 Immunoreactivity 被把索引标记记录(李， %) 并且为临床病理和幸存关联被分析。结果：99 个盒子，染色的免疫表明 52 个病人(52.5%) 有 p53，并且 37 个病人(37.3%) 有 Ki-67 免疫反应(定义为李的 】10%) 。所有病人(100%) 有 PCNA 免疫反应从 12% ～ 93% 李，划分了成由高或低中部。统计表明三个标记的李断然相关到对方(P【0.01 ) 并且到显微镜的肿瘤有丝分裂的计数(P【0.001 ) 。由联合，有 】=2 标记的病人(积极或高) 在肿瘤有早肿瘤复发(P【0.001 ) 和相反的结果(P【0.001 ) 。Univariate 分析显示有肿瘤尺寸 】5 厘米(P=0.003 ) 的病人，肿瘤有丝分裂 】5/50 HPF (P【0.001 ) ， p53 免疫反应(P=0.001 ) ， Ki-67 免疫反应(P=0.026 ) ，高级李普克纳(P=0.015 ) 和男性(P=0.036 ) 是为早疾病复发的六个预言者。随后多，变量分析表明有丝分裂的计数，肿瘤尺寸，和 p53 免疫反应是为免费的疾病和外套的三个独立预示的因素病人的幸存。由为组织的三个独立预示的因素的联合，我们发现更高的肿瘤再发率(P【0.001 ) 和更短的幸存(P【0.001 ) 与增加因素在组存在。结论：我们首先在大意提供三个分子的标记的预示的价值和连接。三个因素(p53，肿瘤尺寸，和肿瘤有丝分裂) 的联合比任何单个因素提供预后的更强大的预言。

Trousseau's syndrome in a patient with advanced stage gastric cancer

Patients with cancer are at high risk for thrombotic events,which are known collectively as Trousseau's syndrome. Herein,we report a 66-year-old male patient who was diagnosed with terminal stage gastric cancer and liver metastasis and who had an initial clinical presentation of upper gastrointestinal bleeding. Acute ischemia of the left lower leg that resulted in gangrenous changes occurred during admission. Subsequent angiography of the left lower limb was then performed. This procedure revealed arterial thrombosis of the left common iliac artery with extension to the external iliac artery,the left common iliac artery,the posterior tibial artery,and the peroneal artery,which were occluded by thrombi. Aspiration of the thrombi demonstrated that these were not tumor thrombi. The interesting aspect of our case was that the disease it presented as arterial thrombotic events,which may correlate with gastric adenocarcinoma. In summary,we suggested that the unexplained thrombotic events might be one of the initial presentations of occult malignancy and that thromboprophylaxis should always be considered.