Multikinase inhibitor-associated hand-foot skin reaction as a predictor of outcomes in patients with hepatocellular carcinoma treated with sorafenib

AIM To investigate the relationship between the onsets of multikinase inhibitor(MKI)-associated hand-foot skin reaction(HFSR) and prognosis under intervention by pharmacists after the introduction of sorafenib.METHODS We conducted a retrospective study involving 40 patients treated with sorafenib. Intervention by pharmacists began at the time of treatment introduction and continued until the appearance of symptomatic exacerbation or non-permissible adverse reactions. We examined the relationship between MKI-associated HFSR and overall survival(OS) after the initiation of treatment.RESULTS The median OS was 10.9 mo in the MKI-associated HFSR group and 3.4 mo in the no HFSR group, showing a significant difference in multivariate analysis. A multivariate analysis of the time to treatment failure indicated that the intervention by pharmacists and MKI-associated HFSR were significant factors. The median cumulative dose and the mean medication possession ratio were significantly higher in the intervention group than in the non-intervention group. A borderline significant difference was observed in terms of OS in this group.CONCLUSION Intervention by pharmacists increased drug adherence. Under increased adherence, MKI-associated HFSR was an advantageous surrogate marker. Intervention by healthcare providers needs to be performed for adequate sorafenib treatment.

Total Phenolic, Flavonoids, Tannin Content and Antioxidant Power of Some Iranian Pomegranate Flower Cultivars (<i>Punica granatum</i>L.)

Recently, pomegranate (Punica granatum L.) was demonstrated to be high in antioxidant activity and strong in phenolic, flavonoid and tannin contents in its fruit, flower and also aerial part. In this paper six cultivars of Iranian pomegranate flower including Ghojagh, Rabbab, Malas, Shishegap, Danesiah and Golnar have been investigated. The maximum amount of total phenolic was detected in Ghojagh (25.94 mg·GAEg-1) and flavonoid showed the highest content in Danesiah (23.06 mg·CEg-1). The lowest content of these two groups was observed in Golnar (15.19 mg·GAEg-1 and 11.46 mg·CEg-1). Measurement of tannin compounds showed that Rabbab by 2.03% and Golnar by 1.06% have the highest and lowest amount respectively. According to the FRAP method, Ghojagh and Golnar have the highest and lowest antioxidant values respectively (452.53 mmol·g-1 and 123.39 mmol·g-1). As a result of HPLC-DPPH method, Malas and Danesiah have the highest and lowest antioxidant value (116.38 and 97.64 mgVEEg-1).

Trans Fatty Acid Content of Iranian Edible Oils

Clinical and epidemiologic studies showed that among dietary factors the type of fatty acids (FAs) in the diet plays an important role in determining risk of chronic disease. The aim of our study was to determine the levels of Trans FA (TFA) in edible oil samples consumed in Tehran, Iran analyzed by gas chromatograph (GC). The mean of total TFA was 0.45% ranging from (0.11% - 1.61%) for liquid frying oils and 2.92% ranging from (0.46% - 5.40%) for solid oils. The major TFA observed in these two groups was elaidic acid in solid oils. The highest content of total saturated fatty acid (SFA) was detected in solid oils with average of 32.07 and palmitic acid was the major SFA in these four groups. Linoleic and linolenic acid are the most important poly unsaturated fatty acid (PUFA). The variance in the percentage of TFA in the edible oils probably resulted from differences in the type of oils, quality, heating, processing technique and storage condition of the edible oils. The results indicated that, edible oils contain considerable proportions of trans fatty acids. Therefore, it is important to assess the content of TFA in edible oils in Iran.

Evaluation of Abuse Drugs and Clinical Laboratory Tests Variations in Whole Blood ＆ Urine Samples of Abusers

In this study, five hundred urine samples and five hundred blood samples of abusers were examined for the presence of alkaloid substances and abuse drugs in urines and bloods. These numbers of blood and urine samples of addicts in clinics of welfare organization, during detoxification treatment or maintenance treatment were screened for abuse drugs presence. The all of samples were tested through as a view of clinical laboratory methods. Age ranges of female patients were 35 ~ 15 and age range of males patients were 45 ~ 15. All patients filled questionnaire and satisfy forms too. First, all fresh urine and blood samples were examined to confirm presence drugs abuses, depend on their addiction and treatment, so all samples were confirmed by two tests. Then they were examined to other clinical laboratory tests. All data were analyzed by t-test and were Anova one way and two ways of Anova Turkey, and p 〈 0.05 was considered significant. The p-value of this study was p = 0.0001. The results of this study were showed that 4% of abusers had mild increase in hematocrite level and 2% of narcotic drugs abusers had mild lower level of blood sugars than normal range and 4% of participants had increase liver enzymes such ALT （alanine transferase）, AST （aspartat transferase）, ALP （alkaline phosphatease） and 1% of them had renal failure. Although blood level BUN （blood urea nitrogen） and creatinin were examined to evaluation of their renal failure .The results in Tabriz/Iran undrevision of welfare organization clinics were approximately showed that positive results of addiction are in each of urine and blood samples. Because some of abusers directly consumed full long time agonist or partial agonists＇ drugs such as methadone and buprenorphine for their maintenance therapy in clinics. Also doing test on blood samples has high importance in distinguishing and confirmation of drugs abuse in samples. Also in this study we conclude that among all drug analytical methods the cheapest and easiest test to screening opioids and other abuse drugs in urine and blood samples is strip test for rapid diagnosis, also tests on blood samples have high importance as a view point of accuracy to distinguishing of drugs abuse, and serum levels of some other parameters showed all abusers patients situation such as liver and renal dysfimction through clinical laboratory tests.

Distinguishing of Abuse Drugs in Urine and Blood Samples of Abusers in Iran

In this study, one hundred urine samples and one hundred blood samples of abusers were examined for the presence of alkaloid substances and abuse drugs in urines and bloods. These numbers of blood and urine samples referred who addicts in clinics of Welfare Organization, during of detoxification treatment or maintenance treatment were screened for abuse drugs presence. Age ranges of female patients were 35 ± 15 and age range of males patients were 42 ± 18. All patients filled questionnaire and satisfy forms too. All data were analyzed by t-test and were Anowa one way, and P 〈 0.05 was considered significant. The P value of this study was P = 0.000. In this study we conclude that among all drug analytical methods the cheapest and easiest test to screening opioids and other abuse drugs in urine and blood samples is strip test for rapid diagnosis and TLC （thin-layer chromatography） is appropriate confirmation method to drug abuse distinguishing. Also tests on blood samples have high importance as a view point of accuracy to distinguishing of drugs abuse.

Early colonoscopy and urgent contrast enhanced computed tomography for colonic diverticular bleeding reduces risk of rebleeding

BACKGROUND Colonoscopy within 24 h of hospital admission for colonic diverticular bleeding(CDB)is recommended.However,little is known about rates of rebleeding within 30 d.We posited that a group of patients who underwent contrast-enhanced computed tomography(CT)within 4 h of the last hematochezia and colonoscopy within 24 h would experience fewer incidences of rebleeding.AIM To evaluate the outcomes of early colonoscopy for CDB among different groups of patients.METHODS Data from 182 patients with CDB who underwent contrast-enhanced CT and colonoscopy between January 2011 and December 2018 at the study site were retrospectively reviewed.Patients were divided into groups based on the timing of the CT imaging,within or at 4 h were defined as urgent CTs(n=100)and those performed after 4 h were defined as elective CTs(n=82).Main outcomes included rebleeding within 30 d and the identification of stigmata of recent hemorrhage(SRH)(i.e.,active bleeding,non-bleeding visible vessels,or adherent clots).RESULTS In total,182 patients(126 men and 56 women)with median ages of 68.6(range,37-92)and 73.7(range,48-93)years,respectively,underwent CT imaging and colonoscopy within 24 h of the last hematochezia.Patients for whom CT was performed within 4 h of the last hematochezia were included in the urgent CT group(n=100)and patients for whom CT was performed after 4 h were included in the elective CT group(n=82).SRH were identified in 35.0%(35/100)of the urgent CT cases and 7.3%(6/82)of the elective CT cases(P<0.01).Among all patients with extravasation-positive images on CT,SRH was identified in 31 out of 47 patients(66.0%)in the urgent CT group and 4 out of 20 patients(20.0%)in the elective CT group(P<0.01).Furthermore,rates of rebleeding within 30 d were significantly improved in the urgent CT and extravasation-positive cases(P<0.05).Results from the evaluation of early colonoscopy did not show a difference in the ability to detect SRH identification or rebleeding rates.Only cases by urgent CT reduced risk of rebleeding due to the evidence of active bleeding on the image.CONCLUSION To improve rates of rebleeding,colonoscopy is recommended within 24 h in patients with extravasation-positive CT images within 4 h of the last hematochezia.Otherwise,elective colonoscopy can be performed.

Low-Dose of the Sulforaphane Precursor Glucoraphanin as a Dietary Supplement Induces Chemoprotective Enzymes in Humans

Broccoli sprout (BS) supplements have been marketed for over a decade for the promising health beneficial effects of sulforaphane (SFN), which induces Nrf2 signaling and downstream chemoprotective genes, including phase 2 enzymes. Most commercially available BS supplements encapsulate heat-processed BS containing glucoraphanin (GR), which is hydrolyzed to SFN by the intestinal microbiota. However, the absorption behavior of SFN following the intake of such BS supplements is still unclear. Additionally, the GR dose (around 30 mg) recommended by many manufacturers of BS supplements is relatively lower than the effective dose determined in previous intervention studies. The aims of this study were to assess the effects of a single administration of a typical BS supplement containing lower doses of GR (30 or 60 mg from 3 or 6 capsules, respectively) on SFN absorption, and also to assess the serum activities of phase 2 enzymes as possible surrogate markers of the beneficial effects of SFN. Urinary excreted isothiocyanates and dithiocarbamates showed that the SFN absorption following administration of BS supplement was prolonged and varied among individuals, which conforms to the well-known characteristics of intestinal microbiota-mediated SFN absorption. The amount of SFN absorbed increased dose-dependently but not linear fashion (9.27 μmol and 13.5 μmol for 3 and 6 capsules, respectively). There was no significant difference in SFN bioavailability and the number of capsules consumed. Serum activities of phase 2 enzymes glutathione S-transferase (GST) and NAD(P)H: quinone oxidoreductase 1 (NQO1), which have been reported to display “chemoprotected states” in organs such as the liver, were dose-dependently and synchronously elevated (p < 0.05) following BS supplement intake. This suggests that a low dose of GR (30 mg) exerts chemoprotective effects in humans. In conclusion, our findings will be useful in future clinical studies investigating the chemoprotective effects of SFN, and for the development of BS supplement products.

Clinically Relevant Assessment of the Variability of Glycemic Response and Its Affect on Surgical Site Infection Rates?

Purpose: Despite growing interest in perioperative glycemic control, little data existdefining?the optimal value(s) to use to define appropriate glycemic management and the impact on the incidence of surgical site infection (SSI).?The aim of this study?was to assess variation in glycemic response and risk of SSI and hospital stay as defined by themaximum, minimum, and area under the curve for?perioperative glucose in patients undergoing?colectomy. We specifically used standard of care obtained glucose levels to reflect limitations of observations typically used to assess quality of care. Methods: All patients undergoing colectomy from 7/2007?to?6/2008 were assessed for the?maximum and minimum levels of standard of care glucose levels, as well as area under the curve (AUC) for?elevated glucose?perioperatively. These were assessed for patients with and without SSI?(SSI vs nSSI). Results: 183 consecutive patients were evaluated (22 diabetics). The incidence of SSI for?the entire?population was 17/183 (9.3%) without significant difference between the?groups with respect to mean?blood glucose level (SSI-136;nSSI-136). However, the SSI?group had a higher maximum glucose level?(SSI-194;nSSI 162;p??110?mg/dl (SSI-59%;nSSI-62%) or glucose >?150?mg/dl (SSI 6%;nSSI 18%). Conclusions: The data demonstrate that patients with SSI have wider fluctuations inglycemic response?compared to non-SSI when standard of care serum glucose levels?wasreviewed. Therefore, quality program monitoring of glucose impact on SSI should focus on both maximum and minimum levels during the perioperative period to better define process improvement in colectomy patients.

Evaluation of the Application Effect of Short Video Combined with BOPPPS Teaching Mode in Clinical Anesthesia Teaching

Objective:To study the application effect of short video combined with BOPPPS teaching mode in clinical anesthesia practice.Method:48 students assigned to clinical anesthesia in digestive endoscopy of Shanxi Bethune Hospital from July 1,2022 to April 1,2023 were selected as research objects.They were randomly divided into the control group(PowerPoint presentation teaching group)and the observation group(short video combined with BOPPPS teaching group),with 24 students in each group.After the internship,the students’theoretical and technical scores were tested,the effects of the two teaching modes were compared,and the students’satisfaction was investigated.Results:The test scores of students in the observation group were significantly better than those in the control group(P<0.05).The short video combined with BOPPPS teaching mode can significantly improve students’learning interest,operation skills,and memory(P<0.05).The students’satisfaction in the observation group was higher than that in the control group(P<0.05).Conclusion:In clinical practice,the application of short video combined with BOPPPS teaching mode has achieved great effect,which is worth further promotion and research.

Analysis of Closed Claims in the Clinical Management of Rheumatoid Arthritis in Japan

Background： Despite an increasing awareness of the risk of medical errors, few data sources are available to highlight the characteristics and patterns of medical errors in the clinical management of rheumatoid arthritis （RA）. The present study aimed to evaluate medical malpractice claims associated with the management of RA and other atltoimmune connective tissue diseases （ACTDs）. Methods： We analyzed 38 ACTD-associated closed claims extracted from a total of 8530 claims processed between July 2004 and June 2014 by the Tokyo headquarters office of Sompo Japan Nipponkoa Incorporated, a leading malpractice insurer in Japan. Results： RA was the most common ACTD assessed in this study, accounting for 20 cases. Although the male-to-female ratio among these cases was 5：15, in accordance with the general demographic distribution of RA, the proportion of patients older than 60 years （77.8%） was relatively high as the general range of RA susceptibility is 30-50 years. The analysis of allegation types among RA cases revealed statistically significant differences from non-RA cases （Fisher＇s exact test） as well as the following key findings： diagnosis-related allegations were absent （P 〈 0.01 ）, whereas medication-related allegations were distinctively common （P=0.02）. Clinical processes related to the assessment process were most vulnerable to breakdown and leading to negligence identified with subsequent medication-related allegations, particularly among RA cases. Conclusions： The characteristics of malpractice claims associated with RA management, including the high frequency of medication-related allegations, breakdowns in the assessment process, and high claim numbers among patients older than 60 years, suggest the importance of caution exercised by physicians when administering immunosuppressants for the clinical treatment of RA.