Role of antibiotics for treatment of inflammatory boweldisease

Inflammatory bowel disease is thought to be caused by an aberrant immune response to gut bacteria in a genetically susceptible host. The gut microbiota plays an important role in the pathogenesis and complications of the two main inflammatory bowel diseases: Crohn's disease(CD) and ulcerative colitis. Alterations in gut microbiota, and specifically reduced intestinal microbial diversity, have been found to be associated with chronic gut inflammation in these disorders. Specific bacterial pathogens, such as virulent Escherichia coli strains, Bacteroides spp, and Mycobacterium avium subspecies paratuberculosis, have been linked to the pathogenesis of inflammatory bowel disease. Antibiotics may influence the course of these diseases by decreasing concentrations of bacteria in the gut lumen and altering the composition of intestinal microbiota. Different antibiotics, including ciprofloxacin, metronidazole, the combination of both, rifaximin, and anti-tuberculous regimens have been evaluated in clinical trials for the treatment of inflammatory bowel disease. For the treatment of active luminal CD, antibiotics may have a modest effect in decreasing disease activity and achieving remission, and are more effective in patients with disease involving the colon. Rifamixin, a non absorbable rifamycin has shown promising results. Treatment of suppurative complications of CD such as abscesses and fistulas, includes drainage and antibiotic therapy, most often ciprofloxacin, metronidazole, or a combination of both. Antibiotics might also play a role in maintenance of remission and prevention of post operative recurrence of CD. Data is more sparse for ulcerative colitis, and mostly consists of small trials evaluating ciprofloxacin, metronidazole and rifaximin. Most trials did not show a benefit for the treatment of active ulcerative colitis with antibiotics, though 2 meta-analyses concluded that antibiotic therapy is associated with a modest improvement in clinical symptoms. Antibiotics show a clinical benefit when used for the treatment of pouchitis. The downsides of antibiotic treatment, especially with recurrent or prolonged courses such as used in inflammatory bowel disease, are significant side effects that often cause intolerance to treatment, Clostridium dificile infection, and increasing antibiotic resistance. More studies are needed to define the exact role of antibiotics in inflammatory bowel diseases.

Capsule endoscopy in suspected small bowel Crohn's disease:Economic impact of disease diagnosis and treatment

AIM: To model clinical and economic benef its of capsule endoscopy (CE) compared to ileo-colonoscopy and small bowel follow-through (SBFT) for evaluation of suspected Crohn’s disease (CD). METHODS: Using decision analytic modeling, total and yearly costs of diagnostic work-up for suspected CD were calculated, including procedure-related adverse events, hospitalizations, off ice visits, and medications. The model compared CE to SBFT following ileo-colonoscopy and secondarily compared CE to SBFT for initial evaluation. RESULTS: Aggregate charges for newly diagnosed, medically managed patients are approximately $8295. Patients requiring aggressive medical management costs are $29 508; requiring hospitalization, $49 074. At sensitivity > 98.7% and specifi city of > 86.4%, CE is less costly than SBFT. CONCLUSION: Costs of CE for diagnostic evaluationof suspected CD is comparable to SBFT and may be used immediately following ileo-colonoscopy.

Comparison of anti-vascular endothelial growth factors, laser treatments and a combination of the both for treatment of central retinal vein occlusion

AIM：To compare changes in visual acuity and macular edema in patients with central retinal vein occlusion（CRVO）treated with intravitreal injections of bevacizumab,macular grid photocoagulation combined with pan retinal photocoagulation（PRP）,or both（bevacizumab＋grid＋PRP）.· METHODS：Our study is a retrospective cohort clinical study that examined patients that suffered from ischemic CRVO with macular edema.Study inclusion criteria were ischemic CRVO with macula edema and the availability of complete medical records for at least 12 mo after treatment.Excluded were patients with diabetes or any other retinal disease.We reviewed the medical records of patients treated in one ophthalmology departmentcomparing changes in visual acuity and macular edema in patients treated with intravitreal injections of bevacizumab vs those that were treated with macular grid photocoagulation and PRP or both.The main outcome measures were the differences in best corrected visual acuity（BCVA） and in macular thickness,as assessed by optical coherence tomography,between the enrollment and the final follow up visits.· RESULTS：Sixty-five patients met inclusion criteria.There were no statistically significant differences among the three groups in the mean changes in macular thickness as measured by ocular coherence tomography（131.5±41.2,108.6±29.2,and 121.1±121.1,P=0.110）,or in visual acuity（0.128±0.077,0.088±0.057,and 0.095±0.065）,for intravitreal injections,macular grid photocoagulation＋PRP and a combination of the treatments,respectively,P =0.111.The proportions of patients with macular edema after treatment were：26.1%,28.6%,and 14.3%,respectively,P=0.499.· CONCLUSION：Similar benefit was observed for intravitreal injections,laser photocoagulation,or a combined regimen in the treatment of CRVO.A nonstatistically significant trend for reduction in macular edema was observed following combined treatment.

Importance of 3-D image reconstruction of spectraldomain OCT on outcome of grid laser photocoagulation for diffuse diabetic macular edema

AIM:To present the outcome of modified grid laser photocoagulation(GLP)in diffuse diabetic macular edema(DDME)in eyes without extrafoveal and/or vitreofoveal traction.METHODS:Inclusion criteria for the retrospective study were DDME eyes of patients with typeⅡdiabetes mellitus that had≥4 months of follow-up following GLP.Only one eye per patient was analyzed.Using 3-D spectral-domain optical coherence tomography(3-D SDOCT),eyes that had either extrafoveal or vitreofoveal traction,or had been previously treated by an intravitreal medication(s)were excluded.Treated DDME eyes were divided into 4 groups:A)"Classic"DDME that involved the central macula;B)edema did not involve the macular center;C)eyes associated with central epiretinal membrane(ERM);D)DDME that was associated with macular capillary dropout≥2 disc-diameter(DD).RESULTS:GLP outcome in 35 DDME eyes after 4-24(mean,13.1±6.9)months was as follows:Group A)18eyes with"classic"DDME.Following one or 2(mean,1.2)GLP treatments,best-corrected visual acuity(BCVA)improved by 1-2 Snellen lines in 44.4%(8/18)of eyes,and worsened by 1 line in 11.1%(2/18).Central macular thickness(CMT)improved by 7%-49%(mean,26.6%)in77.8%(14/18)of eyes.Causes of CMT worsening(n=4)were commonly explainable,predominantly(n=3)associated with emergence of extrafoveal traction,5-9months post-GLP.Group B)GLP(s)in DDME that did not involve the macular center(n=6)resulted in improved BCVA by 1-2 lines in 2 eyes.However,the central macula became involved in the edema process after the GLP in 3(50%)eyes,associated with an emergence of extrafoveal traction in one of these eyes 4months following the GLP.Group C)GLP failed in all 5eyes associated with central ERM.Group D)GLP was of partial benefit in 2 of 6 treated eyes with macular capillary dropout≥2DD.CONCLUSION:Eyes with DDME that involved the macular center were found to achieve favourable outcomes after GLP(s)during mid-term follow-up,unless complicated pre-GLP or post-GLP by vltreoretinal interface abnormalities,often extrafoveal traction or ERM,or by capillary dropout≥2DD.Prospective studies with larger cohorts are required.

Impact of computed tomography image and contact force technology on catheter ablation for atrial fibrillation

AIM:To investigate the impact of using computed tomography(CT) and contact force(CF) technology on recurrence of atrial tachyarrhythmia after atrial fibrillation(AF) ablation.METHODS: This non-randomized study included 2 groups of patients. All patients had symptomatic recurrent paroxysmal or persistent AF and were treated with at least 1 anti arrhythmic medication or intolerant to medication. The first group included 33 patients who underwent circumferential pulmonary veins isolation(PVI) for AF during 2012 and 2013 guided by CT image integration(Cartomerge, Biosense Webster, Diamond Bar, CA, United States) of left atrium and pulmonary veins into an electroanatomic mapping(EAM) system(CT group) using standard irrigated radiofrequency catheter(Thermo Cool, Carto, Biosense Webster, Diamond Bar, CA, United States) or irrigated catheter with integrated CF sensor(Smart Touch, Carto, Biosense Webster, Diamond Bar, CA, United States). The second group included immediately preceding 32 patients who had circumferential PVI by standard irrigated catheter(Thermo Cool) using only EAM(Carto) system(EAM group). Linear lesions were performed according to the discretion of operator. RESULTS: Sex, age, and persistent AF were not different between groups. PVI was achieved in all patients in both groups. Linear ablations including cavo-tricuspid isthmus and or roof line ablation were not different between groups. Free of atrial tachyarrhythmia during follow-up of 24 mo was significantly higher among CT group compared to EAM group(81% vs 55%; respectively; P = 0.027). When 11 patients from CT group who had ablation using Smart Touch catheter were excluded, the difference between CT group and EAM became non significant(73% vs 55%; respectively; P = 0.16). Sub analysis of CT group showed that patients who had ablation using Smart Touch catheter tend to be more free of atrial tachyarrhythmia compared to patients who had ablation using standard irrigated catheter during follow-up(100% vs 73%; respectively; P = 0.07). Major complications(pericardial effusion, cerebrovascular accident/transient ischemic attack, vascular access injury requiring intervention) did not occurred in both groups.CONCLUSION:These preliminary results suggest that CT image integration and CF technology may reduce the recurrence of atrial tachyarrhythmia after catheter ablation for AF.

Role of microRNA in regulation of myeloma-related angiogenesis and survival

Multiple myeloma(MM)is a malignant disease causedby clonal proliferation of plasma cells that result in monoclonal gammopathy and severe end organ damage.Despite the uniform clinical signs,the disease is very diverse in terms of the nature and sequence of the underlying molecular events.Multiple cellular processes are involved in helping the malignant cells to remain viable and maintain proliferative properties in the hypoxic microenvironment of the bone marrow.Specifically,the process of angiogenesis,triggered by the interactions between the malignant MM cells and the stroma cells around them,was found to be critical for MM progression.In this review we highlight the current understanding about the epigenetic regulation of the proliferation and apoptosis of MM cells and its dependency on angiogenesis in the bone marrow that is carried out by different micro RNAs.

Role of home monitoring with iCare ONE rebound tonometer in glaucoma patients management

AIM: To evaluate intraocular pressure(IOP) measurements and fluctuations using the i Care ONE rebound tonometer(RT-ONE), during home monitoring, in diagnosed and suspected glaucoma patients.METHODS: A retrospective case series of consecutive patients with known glaucoma or glaucoma suspects who were followed-up and treated between January 2016 and January 2017. The study included 80 eyes of 40 patients with a mean age of 59.1±14.6 y(range, 24-78). All patients have undergone 4-5 d of IOP home monitoring with RT-ONE at morning, noon, afternoon, and night time.RESULTS: Baseline mean IOP, as measured in the clinic(8 a.m.-12 p.m.), was 17.4±5.1 mm Hg, compared to RT-ONE home monitoring mean IOP of 15.6±4.1 mm Hg(P=0.002). Mean IOP was significantly lower at noon, afternoon and night times compared to clinic measured IOP and morning measurements(P=0.005). IOP peak measured during home monitoring was significantly higher compared to the clinic measured IOP(21.3±5.6 mm Hg and 17.4±5.1 mm Hg, P<0.001). IOP peaks during home monitoring demonstrated a majority of 47 peaks during morning measurements, compared to 23 at noon, 19 at afternoon and only 12 at night(P<0.001). The home monitoring results led to treatment modification of 44 eyes(55%), treatment regime was insufficient for 40(50%) eyes.CONCLUSION: Home monitoring IOP with RT-ONE can provide good assessment of mean IOP, IOP fluctuations and peaks throughout the hours of the day, which lead to an accurate treatment for glaucoma patients.

Clinical presentation predicts the outcome of patients with colon cancer

AIM: To elucidate the relationship between clinical presentation and outcome. METHODS: A single institution retrospective chart review of patients admitted with the diagnosis of colon cancer. We used univariate and a multivariate analysis to identify symptoms association with mortality. An odds ratio based clinical score was created to evaluate the contribution of the quality of symptoms to outcome. Primary measure of outcome was survival. RESULTS: During the study period, 236 patients met the inclusion criteria. Overall survival was 60.6%, mean follow-up 3.0 years. A bivariate analysis showed that increasing number of symptoms is not associated with mortality. However, a symptom-specific analysis performed using a logistic regression model controlling for age, stage and the duration of complaints revealed that the presence of melena was independently associated with mortality [P = 0.04, odds ratio (OR) 7.4],while rectal bleeding was associated with survival (P = 0.004, OR 3.9). Applying the proposed clinical score to an receiver operating characteristic curve showed that score > 1 had a strong association with mortality. The same logistic regression model was applied. The results showed that a score > 1 was an independent predictor of mortality (P < 0.001) and associated with node-positive disease (P = 0.008). CONCLUSION: The quality of symptoms rather than quantity is correlated with outcome among patients with colon cancer. The proposed clinical scoring system may correctly predict the patient's outcome.

Sub-Grouping Healthy Subjects’ Sensitivity to Pain and Its Relationship to Personality Traits: Results of a Cluster Analysis

Objective: Individual differences in the sensitivity to pain and the factors that may contribute to these differences are well studied. Nevertheless, there is no single test that can reliably classify subjects as being sensitive or insensitive to pain. Methods: In the present study, hierarchical clustering and K-means cluster analysis was used to identify subgroups among 191 healthy subjects (105 females, 86 males) according to their sensitivity to pain. Group determination was based on the subjects’ response to experimental noxious stimuli of heat (pain intensity), cold (cold pain threshold, tolerance, and intensity), and conditioned pain modulation (CPM, tested by co-administering repeated short painful heat stimuli and a conditioning tonic cold pain stimulation). In addition, in order to determine if the subjects in these subgroups differed on personality traits scores on Cloninger’s Tridimensional Personality Questionnaire (TPQ, outcome measure) for the three dimensions of personality: Novelty Seeking (NS);Harm Avoidance (HA);and Reward Dependence (RD) were calculated. Results: Based on pain scores, subjects were grouped as low pain (57%) with a low level of sensitivity in pain parameters, or high pain (43%) cluster members. The high pain had significant higher scores of HA (p = 0.05) and RD (p = 0.05) than the low pain group. Conclusions: This method of sub-grouping may be useful for identifying the mechanisms underlying individual variability in the sensitivity to pain and may point to groups at risk for experiencing high levels of clinical pain.

Patient stress and satisfaction when allowed the presence of an accompanying person during endoscopy

Introduction: Patients undergoing esophagogastroduodenoscopy (EGD) have variable stress and anxiety and therefore commonly receive medications as sedative-anxiolytics. These medications have small but significant risks. To possibly make procedures safer and to increase patient satisfaction, this study aimed to measure the effects of allowing an accompanying person (AP) to be present in the endoscopy suite during EGD. Patients and Methods: Forty-two patients were randomly divided into two groups who would either be or not be offered to have an AP during endoscopy. Spielberger’s well-validated state and trait anxiety evaluations were administered to patients before and after EGD. APs also completed questionnaires as to their reactions after EGD. Results: 84.2% of the patients after EGD recommended accompaniment. Patients who underwent EGD with an AP tended (p < 0.06) to have decreased measurable anxiety compared to patients who were not offered an AP. The benefit was significant for persons with higher levels of anxiety prior to EGD (p < 0.04). Patients undergoing EGD for the first time had significantly more anxiety than those with previous EGD experience (p < 0.034). There was no significant reduction in sedative dosage when APs were present. Conclusions: Offering to permit the presence of an accompanying person during EGD was often shown to improve patient satisfaction and reduce anxiety.

The Management of Maxillary Squamous Cell Carcinoma―A Retrospective Study

Introduction: Squamous cell carcinoma (SCC) is the predominant neoplastic tumor that occurs in the oral cavity. SCC arising from the maxillary gingiva, hard palate and maxillary alveolus is relatively rare. Since soft tissue barrier is thin, the diagnosis of cancer in these regions is usually ulcerative and invasive to the underlying bone already in the early stages of the disease. The aim of the present study was to retrospectively evaluate our data regarding the management of loco-regional lymph nodes and the efficacy of neck dissection in the clinically negative neck when maxillary squamous cell carcinoma is diagnosed. Furthermore, we wish to establish the role of prophylactic neck dissection and T stage from which it should be implemented. Methods: Archival records of oncological patients that were treated for SCC of the maxillary alveolus, hard palate and gingiva were collected. Overall 20 patients met the inclusion criteria, 11 men and 9 women. Average age of first diagnosis was 68 years. Results: At initial examination, 2 patients (10%) had clinically positive lymph nodes and undergone therapeutic neck dissection. The remaining 18 patients had clinically N0 necks. Five patients (28%) had occult positive lymph nodes following prophylactic neck dissection. One of the patients had a primary resection with no neck treatment. This patient eventually developed metastases in the neck two month post-surgery (occult disease). The overall positive lymph nodes in maxillary squamous cell carcinoma were 40% (8/20) with an occult metastasis rate of 33% (6/18). Disease specific mortality was 45% (9/20). Conclusion: In the present study, the majority of patients that were diagnosed with occult metastatic disease were either large tumors (T4, 60%) or with moderate to poor differentiation (mood-poor 80%). We conclude that patients who are present with a high grade (moderate-poor) large or invasive maxillary SCC (T2-T4), a prophylactic selective neck dissection (levels I-III) should be performed.

Treatment of Hip Trochanteric Bursitis Using Hyaluronate Injections

Trochanteric bursitis is a common cause of musculoskeletal pain and often requires medical intervention and should be distinguished from sciatica and irradiating pain of pelvic and spinal origin. Previously, the etiology of the trochanteric pain syndrome was thought to be caused by inflammation. The current study was performed in order to assess the efficacy of trochanteric injections. Methods: 158 patients were treated for trochanteric bursitis (132 females/26 males, range 22 - 88 years). 59b were treated with corticosteroid injection, 60 with hyaluronate and 39 were injected using a combination of both. Patients were followed by the HOOS score for a minimum of 12 months. Results: Pre-operative HOOS scores were similar in all groups. Following injection, the HOOS score increased from 27 ± 4 to 66 ± 2 after six months and 77 ± 4 after a year. At 12-month follow-up, the average score of patients treated by corticosteroids injection was 44 ± 7 compared with 62 ± 8 for the hyaluronate injected group and 64 ± 6 for the combination injection group. Discussion: It appears that injection therapy is highly efficacious for treating trochanteric bursitis. The effect of hyaluronate or hyaluronate and steroid combination appears to be longer lasting than that of steroid alone.

Enlarged and Colored Enhanced 3D Printing of Renal Artery Aneurysms for Improved Imaging and Treatment Planning

Three dimensional printing (3D printing) technology is increasingly used to improve results in many areas of medicine. Physical models produced by this technology allow better appreciation of complex anatomical and pathologic conditions. In cardiovascular medicine and surgery, 3D modeling has been reported to be of help in treatment planning of abdominal aortic aneurysm, especially in cases of complex angulations and branching at the aneurysm neck. Here we report the use of 3D printing in cases of renal aneurysms. Enhanced 3D models of CTA images of renal aneurysms were prepared in house using common and freely available software programs, and an accurate desktop 3D printer. Eight reconstructed models were enlarged by a factor of 2 or more and then differentially painted to delineate normal arteries and aneurysmatic ones. These enhanced 3D solid models allowed visual and tactile inspection for a better appreciation of complex aneurysms. Color enhancement of these models added another dimension of comprehension, even for experienced surgeons and invasive radiologists, and allowed more accurate measurements of branch numbers, distances, and angles in space even with severe tortuosity. Endovascular use of covered stents and embolization techniques could be easily envisioned preoperatively. We conclude that enhanced, enlarged, and colored 3D printed models are a powerful tool for preoperative endovascular treatment planning of complex renal artery aneurysms.

The Effect of Breathing Route on Heart Rate Variability—A within Subject Comparative Study

Background: The effect of traffic related emissions on Heart Rate Variability (HRV) has been previously demonstrated. However, the results of different studies on the relationship between ambient pollutants and specifically carbon monoxide (CO) on HRV are inconclusive and appear to reflect personal differences. The differences in methodology including breathing style and participants under study can possibly attribute to this variability. The aim of the present study is to assess the effect of the breathing route (Nasal/Oral) on the relationship between CO concentration and HRV. Methodology: Forty healthy participants (25 females, 15 males) between the ages of 15 - 50 years were included in the study. The participants strolled in a central bus station, staying for 10 minutes in three designated locations alternating nasal and oral breathing. CO concentration and HRV were continuously monitored. Frequency (LnLF, LnHF, LnLF/HF) and time domain (LnSDNN, LnRMSSD) HRV indices were computed. Analysis: MANCOVA, with HRV indices being the dependent variables and CO, gender and age being the independent variables was employed. Results: Significant interaction effects between breathing route and CO, and breathing route and gender on HRV (LnLF/HF) were found (p = 0.04 and 0.01 respectively). Both CO and age were found to affect LnSDNN and LnRMSSD. Conclusion: Breathing route emerges as a possible modifier of the relationship between air pollution and HRV and thus contributes to interpersonal differences obtained in studies investigating the effect of environmental pollution and HRV.

2010女性急性单纯性膀胱炎和肾盂肾炎临床治疗指南(摘译)

美国感染病学会、欧洲临床微生物与感染病学会共同组织专家对1999年美国感染病学会单纯性尿路感染的指南进行了更新。2010指南更新的重点是治疗女性急性单纯性膀胱炎和肾盂肾炎,仅适用于无已知尿道畸形或合并症的绝经前及未妊娠的女性患者。作者就指南的主要内容进行摘译。

Capsule endoscopy: Improving transit time and image view

AIM: To evaluate the effect of various methods of small bowel preparation on the transit time and the quality of visualization of the entire small bowel mucosa.METHODS: Ninety-five patients underwent capsule endoscopy (CE) by easily swallowing the capsule. They were divided into three study groups according to the preparation used: group A (n = 26) by polyethylene glycol (PEG) liter or with sodium phosphate (SP) 12 h prior to the CE study; group B (n = 29) by erythromycin 1 h prior to the CE study; and group C (n = 40) without any preparation. Visualization ranged from good to satisfactory to poor.RESULTS: The gastric emptying time in the group prepared with erythromycin was shorter but without statistical significance and the small bowel transit time was unaffected. In elderly subjects prepared by PEG or SP, the gastric emptying time was significantly longer (163.7 min, P = 0.05). The transit times of the three sub-groups were not affected by gender or pathology.The grade of cleaning of the entire study group was 3.27±1.1. The erythromycin group presented significantly the worst quality of images (P = 0.05) compared to the other sub-groups. Age, gender, and pathology had no effect on the quality of the cleaning of the small bowel in the sub-groups. One (1.05%) case had no natural excretion.CONCLUSION: Erythromycin markedly reduces gastric emptying time, but has a negative effect on the quality of the image in the small bowel. The preparation of elderly subjects with PEG or SP has a negative effect on the small bowel transit time.

年长男子的生育年龄对生育质量的影响

最近几十年来，妇女生第一胎的年龄越来越大。同样的趋势在男性群体也逐渐表现出来了。母亲年龄对生育、染色体异常、孕期并发症、先天缺陷以及对后代的整体健康的影响已经得到全面的研究，而且这些研究结果已经应用于临床受孕咨询和产前咨询中。但男性的年龄及其对生育结果的影响相对来说得到的关注度较低。本综述的目的是对最近相关文献中父亲年龄对生育结果的影响做一个综合评述。

Clostridium difficile and inflammatory bowel disease: Role in pathogenesis and implications in treatment

Clostridium difficile(C.difficile)is the leading cause of antibiotic associated colitis and nosocomial diarrhea.Patients with inflammatory bowel disease(IBD)are at increased risk of developing C.difficile infection(CDI),have worse outcomes of CDI-including higher rates of colectomy and death,and experience higher rates of recurrence.However,it is still not clear whether C.difficile is a cause of IBD or a consequence of the inflammatory state in the intestinal environment.The burden of CDI has increased dramatically over the past decade,with severe outbreaks described in many countries,which have been attributed to a new and more virulent strain.A parallel rise in the incidence of CDI has been noted in patients with IBD.IBD patients with CDI tend be younger,have less prior antibiotic exposure,and most cases of CDI in these patients represent outpatient acquired infections.The clinical presentation of CDI in these patients can be unique-including diversion colitis,enteritis and pouchitis,and typical findings on colonoscopy are often absent.Due to the high prevalence of CDI in patients hospitalized with an IBD exacerbation,and the prognostic implications of CDI in these patients,it is recommended to test all IBD patients hospitalized with a disease flare for C.difficile.Treatment includes general measures such as supportive care and infection control measures.Antibiotic therapy with either oral metronidazole,vancomycin,or the novel antibiotic-fidaxomicin,should be initiated as soon as possible.Fecal macrobiota transplantation constitutes another optional treatment for severe/recurrent CDI.The aim of this paper is to review recent data on CDI in IBD:role in pathogenesis,diagnostic methods,optional treatments,and outcomes of these patients.

Glycogenic hepatopathy

Background: Glycogenic hepatopathy(GH) is a disorder associated with uncontrolled diabetes mellitus,most commonly type 1, expressed as right upper quadrant abdominal pain, hepatomegaly and increased liver enzymes. The diagnosis may be difficult, because laboratory and imaging tests are not pathognomonic. Although GH may be suggested based on clinical presentation and imaging studies, the gold standard for diagnosis is a liver biopsy, showing a significant accumulation of glycogen within the hepatocytes. GH may be diagnosed also after elevated liver enzymes in routine blood tests. GH usually regresses after tight glycemic control. Progression to end-stage liver disease has never been reported. This review aims to increase the awareness to this disease, to suggest a pathway for investigation that may reduce the use of unnecessary tests, especially invasive ones.Data sources: A Pub Med database search(up to July 1, 2017) was done with the words "glycogenic hepatopathy", "hepatic glycogenosis", "liver glycogenosis" and "diabetes mellitus-associated glycogen storage hepatopathy". Articles in which diabetes mellitus-associated liver glycogen accumulation was described were included in this review.Results: A total of 47 articles were found, describing 126 patients with GH. Hepatocellular disturbance was more profound than cholestatic disturbance. No synthetic failure was reported.Conclusions: GH may be diagnosed conservatively, based on corroborating medical history, physical examination, laboratory tests, imaging studies and response to treatment, even without liver biopsy. In case of doubt about the diagnosis or lack of clinical response to treatment, a liver biopsy may be considered.There is no role for noninvasive tests like fibroscan or fibrotest for the diagnosis of GH or for differentiation of this situation from nonalcoholic fatty liver disease.

Recent advances in bone regeneration using adult stem cells

Bone is a highly vascularized tissue reliant on the close spatial and temporal association between bloodvessels and bone cells. Therefore, cells that participate in vasculogenesis and osteogenesis play a pivotal role in bone formation during prenatal and postnatal periods. Nevertheless, spontaneous healing of bone fracture is occasionally impaired due to insufficient blood and cellular supply to the site of injury. In these cases, bone regeneration process is interrupted, which might result in delayed union or even nonunion of the fracture. Nonunion fracture is difficult to treat and have a high financial impact. In the last decade, numerous technological advancements in bone tissue engineering and cell-therapy opened new horizon in the field of bone regeneration. This review starts with presentation of the biological processes involved in bone development, bone remodeling, fracture healing process and the microenvironment at bone healing sites. Then, we discuss the rationale for using adult stem cells and listed the characteristics of the available cells for bone regeneration. The mechanism of action and epigenetic regulations for osteogenic differentiation are also described. Finally, we review the literature for translational and clinical trials that investigated the use of adult stem cells(mesenchymal stem cells, endothelial progenitor cells and CD34+ blood progenitors) for bone regeneration.