Contraindications for video capsule endoscopy

Video capsule endoscopy(VCE) has been applied in the last 15 years in an increasing field of applications. Although many contraindications have been put into perspective, some precautions still have to be considered. Known stenosis of the gastrointestinal tract is a clear contraindication for VCE unless surgery is already scheduled or at least has been considered as an optional treatment modality. In patients with a higher incidence of stenosis, as in an established diagnosis of Crohn's disease, clinical signs of obstruction, prior radiation or surgical small bowel resection, a preceding test with the self-dissolving patency capsule can override this contraindication. Endoscopic placement of the capsule should be considered in patients with swallowing disorders to avoid aspiration. Esophageal or gastric motility disorders may require endoscopic capsule transport or application of prokinetics if the real-time viewer proofs delayed transit. In pregnant women, VCE should be restricted to urgent cases where diagnosis cannot be postponed after delivery, as data on safety are missing. There is theoretical and clinical evidence that patients with implanted cardiac devices such as a pacemaker, cardioverters or left heart assist devices, can safely undergo VCE in spite of still existing contraindication by manufacturers. Children from the age of 2 years have safely undergone VCE. Although video capsules are not proven safe with magnetic resonance imaging(MRI), first single cases of patients incidentally undergoing MRI with an incorporated capsule have been reported, showing susceptibility artifacts but no signs of clinical harm.

Analysis on Common Compatibility Contraindications of Breviscapine for Injection

[Objectives]To analyze the common compatibility contraindications of breviscapine for injection,and to provide references for clinical rational drug use.[Methods]The pH distribution of the combined drugs in the report on the compatibility contraindications of breviscapine for injection and was analyzed.[Results]Breviscapine for injection may become turbid or precipitated when mixed with drugs whose pH are lower;it can make the liquid discoloration in a strong alkaline solution.[Conclusions]Breviscapine for injection should not be combined with drugs whose pH are lower,especially drugs with pH lower than 4.2.Breviscapine for injection should not be used with drugs with strong alkaline.It is recommended to use Breviscapine for injection separately.

Diagnostic endoscopic ultrasonography:Assessment of safety and prevention of complications

Endoscopic ultrasonography (EUS) has gained wide acceptance as an important, minimally invasive diagnostic tool in gastroenterology, pulmonology, visceral surgery and oncology. This review focuses on data regarding risks and complications of non-interventional diagnostic EUS and EUS-guided fine-needle biopsy (EUS-FNB). Measures to improve the safety of EUS und EUS-FNB will be discussed. Due to the specific mechanical properties of echoendoscopes in EUS, there is a low but noteworthy risk of perforation. To minimize this risk, endoscopists should be familiar with the specific features of their equipment and their patients' specific anatomical situations (e.g., tumor stenosis, diverticula). Most diagnostic EUS complications occur during EUS-FNB. Pain, acute pancreatitis, infection and bleeding are the primary adverse effects, occurring in 1% to 2% ofpatients. Only a few cases of needle tract seeding and peritoneal dissemination have been reported. The mortality associated with EUS and EUS-FNB is 0.02%. The risks associated with EUS-FNB are affected by endoscopist experience and target lesion. EUS-FNB of cystic lesions is associated with an increased risk of infection and hemorrhage. Peri-interventional antibiotics are recommended to prevent cyst infection. Adequate education and training, as well consideration of contraindications, are essential to minimize the risks of EUS and EUS-FNB. Restricting EUS-FNB only to patients in whom the cytopathological results may be expected to change the course of management is the best way of reducing the number of complications.

Five years' experience with capsule endoscopy in a single center

Capsule endoscopy (CE) is a novel technology that facilitates highly effective and noninvasive imaging of the small bowel. Although its effi cacy in the evaluation of obscure gastrointestinal bleeding (OGIB) has been proven in several trials, data on uses of CE in different small bowel diseases are rapidly accumulating in the literature, and it has been found to be superior to alternative diagnostic tools in a range of such diseases. Based on literature evidence, CE is recommended as a first-line investigation for OGIB after negative bi-directional endoscopy. CE has gained an important role in the diagnosis and follow-up of Crohn's disease and celiac disease and in the surveillance of small bowel tumors and polyps in selected patients. Capsule retention is the major complication, with a frequency of 1%-2%. The purpose of this review was to discuss the procedure, indications, contraindications and adverse effects associated with CE. We also review and share our five-year experience with CE in various small bowel diseases. The recently developed balloon-assisted enteroscopies have both diagnostic and therapeutic capability. At the present time, CE and balloon-assisted enteroscopies are complementary techniques in the diagnosis and management of small bowel diseases.

Overview of Pharmacological Research on Adonis L.

On the basis of extensive literature retrieval, the species, composition, pharmacology, clinical application, contraindication of Adonis L. were reviewed in this paper, to provide data for the its further development and utilization.

Liver transplantation for Wilson disease

The aim of this paper is to review the current status of liver transplantation (LT) for Wilson disease (WD), focusing on indications and controversies, especially in patients with neuropsychiatric disease, and on identification of acute liver failure (ALF) cases related to WD. LT remains the treatment of choice for patients with ALF, as initial presentation of WD or when anti-copper agents are stopped, and for patients with chronic liver disease progressed to cirrhosis, unresponsive to chelating medications or not timely treated with copper chelating agents. The indication for LT in WD remains highly debated in patients with progressive neurological deterioration and failure to improve with appropriate medical treatment. In case of Wilsonian ALF, early identification is key as mortality is 100% without emergency LT. As many of the copper metabolism parameters are believed to be less reliable in ALF, simple biochemical tests have been proposed for diagnosis of acute WD with good sensitivity and specificity. LT corrects copper metabolism and complications resulting from WD with excellent 1 and 5 year survival. Living related liver transplantation represents an alternative to deceased donor LT with excellent long-term survival, without disease recurrence. Future options mayinclude hepatocyte transplantation and gene therapy. Although both of these have shown promising results in animal models of WD, prospective human studies are much needed to demonstrate their long-term beneficial effects and their potential to replace the need for medical therapy and LT in patients with WD.

Neoadjuvant treatment strategies for hepatocellular carcinoma

The incidence of hepatocellular carcinoma(HCC)remains high globally.Surgical treatment is the best treatment for improving the prognosis of patients with HCC.Neoadjuvant therapy plays a key role in preventing tumor progression and even downstaging HCC.The liver transplantation rate and resectability rate have increased for neoadjuvant therapy.Neoadjuvant therapy is effective in different stages of HCC.In this review,we summarized the definition,methods,effects,indications and contraindications of neoadjuvant therapy in HCC,which have significance for guiding treatment.

Liver transplantation in adults:Choosing the appropriate timing

Liver transplantation is indicated in patients with acute liver failure,decompensated cirrhosis,hepatocellular carcinoma and rare liver-based genetic defects that trigger damage of other organs.Early referral to a transplant center is crucial in acute liver failure due to the high mortality with medical therapy and its unpredictable evolution.Referral to a transplant center should be considered when at least one complication of cirrhosis occurs during its natural history.However,because of the shortage of organ donors and the short-term mortality after liver transplantation on one hand and the possibility of managing the complications of cirrhosis with other treatments on the other,patients are carefully selected by the transplant center to ensure that transplantation is indicated and that there are no medical,surgical and psychological contraindications.Patients approved for transplantation are placed on the transplant waiting list and prioritized according to disease severity.Thus,the appropriate timing of transplantation depends on recipient disease severity and,although this is still a matter of debate,also on donor quality.These two variables are known to determine the "transplant benefit"(i.e.,when the expected patient survival is better with,than without,transplantation) and should guide donor allocation.

不合理静脉用药医嘱分析与药学干预研究

目的通过对不合理静脉用药医嘱的分析及药学干预,促进临床合理用药。方法选取2019年7月―2019年12月我院静配中心调剂的消化内科、神经内科和胃肠外科等病区的静脉用药医嘱进行逐一分析并统计分类。结果药师共计审核医嘱216043条,发现不合理医嘱603条。不合理用药的类型主要为溶媒选择、药物浓度、给药途径、配伍禁忌及其他,同时分别举例加以阐述。结论针对静脉用药不合理使用问题采取有效干预措施,药师借助合理用药软件进行医嘱审核,以保障患者用药安全。

Psychological evaluation and follow-up in liver transplantation

An increasingly number of transplant centers have integrated a psychological assessment within their protocol for evaluation of patients being considered for transplantation.This paper highlights the psychological criteria for inclusion or exclusion for listing,briefly discusses the psychological dynamics of patients,and addresses possible psychotherapy and pharmacological therapy,before and after transplant.

Ayurveda perspective and global scenario of Wet cupping therapy-a comprehensive review

Wet cupping is a simple and minor procedure practiced in Ayurveda and various traditional medicine system worldwide.In Ayurveda wet cupping therapy is practiced under the scope of Raktamo Kshana(therapeutic bloodletting)which is adopted to remove vitiated Rakta(blood).The present work is aimed to explore the wet cupping therapy from Ayurveda perspective along with global scenario.In this review,classical Ayurveda text and PubMed,Cochrane library,science direct,Google scholar and DHARA database were scrutinized for worldwide work on wet cupping therapy.The Ayurveda science can utilize these researches in completing its lost knowledge and also provide integrative effort in re-validation and enrichment of WCT which are required at large for greater benefit of the mankind.The method of WCT application,principles,indications,contraindications,complications and probable mode of action from Ayurveda perspective and global scenario were introduced and summarized.

Garlic:Medicinal Plant and Natural Aromatic Condiment

Objective:To relate the presence of active metabolites with therapeutic effects of the Allium sativum L whose common name is Garlic,as well as its contraindications and adverse reactions and its use as condiment.Methods:Searching about the topic in the last 5 years and present a general view of the Allium sativum L whose common name is Garlic.Conclusions:Technological prevision was based on the search of articles in the Virtual Library in Health(BVS)and using the key words“medicinal plants”/“spice”/Allium sativum L/garlic/adverse reactions and contraindications,and the association among them.

Percutaneous endoscopic gastrostomy:Indications,technique,complications and management

Percutaneous endoscopic gastrostomy (PEG) is the preferred route of feeding and nutritional support in patients with a functional gastrointestinal system who require long-term enteral nutrition. Besides its well-known advantages over parenteral nutrition, PEG offers superior access to the gastrointestinal system over surgical methods. Considering that nowadays PEG tube placement is one of the most common endoscopic procedures performed worldwide, knowing its indications and contraindications is of paramount importance in current medicine. PEG tubes are sometimes placed inappropriately in patients unable to tolerate adequate oral intake because of incorrect and unrealistic understanding of their indications and what they can accomplish. Broadly, the two main indications of PEG tube placement are enteral feeding and stomach decompression. On the other hand, distal enteral obstruction, severe uncorrectable coagulopathy and hemodynamic instability constitute the main absolute contraindications for PEG tube placement in hospitalized patients. Although generally considered to be a safe procedure, there is the potential for both minor and major complications. Awareness of these potential complications, as well as understanding routine aftercare of the catheter, can improve the quality of care for patients with a PEG tube. These complications can generally be classified into three major categories: endoscopic technical difficulties, PEG procedure-related complications and late complications associated with PEG tube use and wound care. In this review we describe a variety of minor and major tube-related complications as well as strategies for their management and avoidance. Different methods of percutaneous PEG tube placement into the stomach have been described in the literature with the “pull” technique being the most common method. In the last section of this review, the reader is presented with a brief discussion of these procedures, techniques and related issues. Despite the mentioned PEG tube placement complications, this procedure has gained worldwide popularity as a safe enteral access for nutrition in patients with a functional gastrointestinal system.

Liver transplantation for acute hepatic failure due to chemotherapy-induced HBV reactivation in lymphoma patients

Hepatitis B （HBV） reactivation induced by chemotherapy is problem encountered recently in the management of malignant diseases. Chemotherapy-induced HBV reacti- vation may ultimately lead to terminal acute liver failure. Liver transplantation （LT） currently remains the only definitive treatment option for such cases, but is generally denied to patients suffering from malignancy. Here, the authors describe 2 cases of cancer-free and HBV graft renfection-free survival after LT performed for terminal liver failure arising from HBV reactivation induced by chemotherapy for advanced stage lymphoma. These 2 cases, and some other reports in the literature, may suggest that patients suffering from hematologic malignan- cies and terminal liver disease can be considered for LT if the prognosis of their hematologic malignancy is good.

Try Analyzing the Usage of Monkshood in Gynecology

This paper centers on the usage of monkshood in gynecology and tries to analyze why monkshood is rarely mentioned in nowa days' teaching

Colonoscopy a True Therapeutic Icon

Colonic polypectomy remained the first colonoscopic therapeutic intervention which was successfully accomplished with the help of an early snare. This therapeutic procedure was executed by Dehyle in Europe and Shinya in USA in 1971 [1]. Thus, these two colonoscopists acquired the pioneer’s position of therapeutic colonoscopy. Now the colonoscopy has achieved a special status in treating colorectal diseases because of its unique therapeutic aspect. The common uses of therapeutic colonoscopy are broadly classified in to the four major categories because of its unique therapeutic properties. These uses include resection and ablation, hemostasis, decompression with or without recanalization and foreign body extraction. Colonic perforation remained an absolute contraindication to therapeutic colonoscopy which is analogous to diagnostic colonoscopy. Good Communication plays a vital role in accomplishment of successful therapy with the help of colonoscopy. Consent process remained a complex process which should be well organized and tailored as per patient’s needs. There are lot of advancements in colonoscopy in recent years and many new procedures and treatment modalities have become available to treat colorectal diseases with the help of colonoscope. The recent advancement in colonoscopy has led to having many novel techniques. This therapeutic colonoscopy has made a significant change in current colorectal cancer management as polyps can be treated in the early stage, thus reducing the incidence of colorectal cancer. This is the basis of the United Kingdom existing bowel screening program, which is only feasible because of colonoscopy-induced interventions. The successful uses of these techniques obviate the need for a major surgical operation and colorectal disease can be treated with minimally invasive colonoscopic methods. These attributes make colonoscopy a true therapeutic icon.

Obesity Management-Bariatric Surgery vs Lifestyle Modification

Role of Bariatric surgery for obesity is briefly outlined. Selection criteria, contraindications, evaluations of patients before surgery, types of bariatric surgery with their merits and demerits are discussed. Results of lifestyle modifications is compared with that of bariatric surgery.

Colonoscopy a Real Diagnostic Paragon

Diagnostic colonoscopy acquires the status of gold standard investigation for evaluation of colonic problems. Formally, colonoscopy was first initiated in June 1969 in America. Colonoscopic history can be traced back to 1958. Matsunaga from Japan was the pioneer as he used a gastrocamera which was the start of colonoscopic era. Flexible sigmoidoscopy was later introduced in 1963. Existing colonic perforation and refusal of a fully compos mentis patient, remain absolute contraindications to diagnostic colonoscopy. Bowel Perforation, although less common, is a disastrous complication of colonoscopy. It is a basic right of any patient who has been offered a colonoscopic procedure to have appropriate, clear and concise information about colonoscopy. Consent literally means permission or an agreement which is granted by a patient to a health care individual to receive examination, test, treatment or intervention. Colonoscopic consent process should be valid and has voluntary, fully informed and capacity aspects as its integral components. There were a lot of oppositions against colonoscopy at that time. It was believed to be dangerous and unnecessary exercise by many surgeons. Time has proved that to be a wrong perception. It is now believed to be an extremely useful diagnostic modality. It is safe procedure in experienced hands and provides valuable clinical information. Colonoscopy is not a pleasant investigation as it is usually related with pain and discomfort by patients;fortunately, good analgesia and safe conscious sedation make this hostile but worthwhile procedure tolerable to patients.Today colonoscopy has kept its status of the gold standard investigation in diagnosing bowel cancer and has prime role in the assessment of majority of large bowel symptoms. Colonoscopy also retains the status of being an investigation with highest sensitivity and specificity, out of all available diagnostic modalities, for identifying adenomatous polyps and now it has acquired a unique status of being a diagnostic paragon.

Oral anti-coagulants use in Chinese hospitalized patients with atrial fibrillation

Background:Oral anti-coagulants(OAC)are the intervention for the prevention of stroke,which consistently improve clinical outcomes and survival among patients with atrial fibrillation(AF).The main purpose of this study is to identify problems in OAC utilization among hospitalized patients with AF in China.Methods:Using data from the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation(CCC-AF)registry,guideline-recommended OAC use in eligible patients was assessed.Results:A total of 52,530 patients with non-valvular AF were enrolled from February 2015 to December 2019,of whom 38,203 were at a high risk of stroke,9717 were at a moderate risk,and 4610 were at a low risk.On admission,only 20.0%(6075/30,420)of patients with a diagnosed AF and a high risk of stroke were taking OAC.The use of pre-hospital OAC on admission was associated with a lower risk of new-onset ischemic stroke/transient ischemic attack among the diagnosed AF population(adjusted odds ratio:0.54,95%confidence interval:0.43-0.68;P<0.001).At discharge,the prescription rate of OAC was 45.2%(16,757/37,087)in eligible patients with high stroke risk and 60.7%(2778/4578)in eligible patients with low stroke risk.OAC utilization in patients with high stroke risk on admission or at discharge both increased largely over time(all P<0.001).Multivariate analysis showed that OAC utilization at discharge was positively associated with in-hospital rhythm control strategies,including catheter ablation(adjusted odds ratio[OR]11.63,95%confidence interval[CI]10.04-13.47;P<0.001),electronic cardioversion(adjusted OR 2.41,95%CI 1.65-3.51;P<0.001),and anti-arrhythmic drug use(adjusted OR 1.45,95%CI 1.38-1.53;P<0.001).Conclusions:In hospitals participated in the CCC-AF project,>70%of AF patients were at a high risk of stroke.Although poor performance on guideline-recommended OAC use was found in this study,over time the CCC-AF project has made progress in stroke prevention in the Chinese AF population.Registration:ClinicalTrials.gov,NCT02309398.

Traditional Chinese Medicine and Traditional Indonesian Medicine:A Comparative Review of Herbal Medicines Restricted in Pregnancy

The decline in birth rates has become a very serious problem in various parts of the world.Many countries have implemented national programs for increasing birth rates,one of which involves the use of traditional medicine as an alternative solution.Among the fast-growing traditional medicines,traditional Chinese medicine(TCM)and traditional Indonesian medicine(TIM)have attracted a lot of demand globally.Here,we analyzed and compared the herbal medicines from TCM and TIM that must be avoided by pregnant women for preventing miscarriage and maintaining safety during pregnancy and the postpartum period.This review uses data from official reports from the respective government and national and international electronic databases for analysis.Although TCM and TIM have their own characteristics of treatment,they also have some similarities in concept and treatment,especially those related to herbal medicines.This review can be used as a reference base to help pregnant women consume herbal medicines at appropriate conditions and doses.