Evaluation of the Healing Progress of Pressure Ulcers Treated with Cathodal High-Voltage Monophasic Pulsed Current: Results of a Prospective, Double-blind, Randomized Clinical Trial

OBJECTIVE: To investigate the effectiveness of high-voltage monophasic pulsed current (HVMPC) as an adjunct to a standard wound care for the treatment of Stage II and III pressure ulcers (PrUs). DESIGN: Prospective, randomized, double-blind, controlled clinical study. SETTING: Two nursing and care centers. PATIENTS: Patients with PrUs that did not respond to previous treatment for at least 4 weeks were randomly assigned to the electrical stimulation (ES) group (25 patients; mean age of 79.92 ± 8.50 years; mean wound surface area [WSA] of 10.58 ± 10.57 cm2) or to the control group (24 patients; mean age of 76.33 ± 12.74 years; mean WSA of 9.71 ± 6.70 cm2). INTERVENTIONS: Both the ES and control groups received standard wound care and respectively, cathodal HVMPC (154 microseconds; 100 pulses per second; 0.24 A; 250 μ/s) applied continuously for 50 minutes once a day, 5 times a week, or sham HVMPC. MAIN OUTCOME: Percentage area reduction over 6 weeks of intervention. MAIN RESULTS: In the ES group, there was a statistically significant decrease in WSA after 1 week of treatment (35% ± 30.5%) compared with 17.07% ± 34.13% in the control group (P = .032). After treatment, at week 6, percentage area reduction in the ES group was 80.31% ± 29.02% versus 54.65% ± 42.65% in the control group (P = .046). CONCLUSIONS: Cathodal HVMPC reduces the WSA of Stage II and III PrUs. The results are consistent with the results of other researchers who used HVMPC to treat PrUs

Role of glucuronidation for hepatic detoxification and urinary elimination of toxic bile acids during biliary obstruction

Biliary obstruction, a severe cholestatic condition, results in a huge accumulation of toxic bile acids (BA) in the liver. Glucuronidation, a conjugation reaction, is thought to protect the liver by both reducing hepatic BA toxicity and increasing their urinary elimination. The present study evaluates the contribution of each process in the overall BA detoxification by glucuronidation. Glucuronide (G), glycine, taurine conjugates, and unconjugated BAs were quantified in pre- and post-biliary stenting urine samples from 12 patients with biliary obstruction, using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The same LC-MS/MS procedure was used to quantify intra- and extracellular BA-G in Hepatoma HepG2 cells. Bile acid-induced toxicity in HepG2 cells was evaluated using MTS reduction, caspase-3 and flow cytometry assays. When compared to post-treatment samples, pre-stenting urines were enriched in glucuronide-, taurine- and glycine-conjugated BAs. Biliary stenting increased the relative BA-G abundance in the urinary BA pool, and reduced the proportion of taurine- and glycine-conjugates. Lithocholic, deoxycholic and chenodeoxycholic acids were the most cytotoxic and pro-apoptotic/necrotic BAs for HepG2 cells. Other species, such as the cholic, hyocholic and hyodeoxycholic acids were nontoxic. All BA-G assayed were less toxic and displayed lower pro-apoptotic/necrotic effects than their unconjugated precursors, even if they were able to penetrate into HepG2 cells. Under severe cholestatic conditions, urinary excretion favors the elimination of amidated BAs, while glucuronidation allows the conversion of cytotoxic BAs into nontoxic derivatives

Endoscopist biopsy rate as a quality indicator for outpatient gastroscopy: a multicenter cohort study with validation.

BACKGROUND AND AIMS: The diagnosis of gastric premalignant conditions (GPCs) relies on endoscopy with mucosal sampling. We hypothesized that the endoscopist biopsy rate (EBR) might constitute a quality indicator for EGD, and we have analyzed its association with GPC detection and the rate of missed gastric cancers (GCs). METHODS: We analyzed EGD databases from 2 high-volume outpatient units. EBR values, defined as the proportion of EGDs with ≥1 biopsy to all examinations were calculated for each endoscopist in Unit A (derivation cohort) and divided by the quartile values into 4 groups. Detection of GPC was calculated for each group and compared using multivariate clustered logistic regression models. Unit B database was used for validation. All patients were followed in the Cancer Registry for missed GCs diagnosed between 1 month and 3 years after EGDs with negative results. RESULTS: Sixteen endoscopists in Unit A performed 17,490 EGDs of which 15,340 (87.7%) were analyzed. EBR quartile values were 22.4% to 36.7% (low EBR), 36.8% to 43.7% (moderate), 43.8% to 51.6% (high), and 51.7% and 65.8% (very-high); median value 43.8%. The odds ratios for the moderate, high, and very-high EBR groups of detecting GPC were 1.6 (95% confidence interval [CI], 1.3-1.9), 2.0 (95% CI, 1.7-2.4), and 2.5 (95% CI, 2.1-2.9), respectively, compared with the low EBR group (P < .001). This association was confirmed with the same thresholds in the validation cohort. Endoscopists with higher EBR (≥43.8%) had a lower risk of missed cancer compared with those in the lower EBR group (odds ratio, 0.44; 95% CI, 0.20-1.00; P = .049). CONCLUSIONS: The EBR parameter is highly variable among endoscopists and is associated with efficacy in GPC detection and the rate of missed GCs

Effect of Bitter Melon Aqueous Extract and Pomegranate Oil on Glucose Concentration and Lipid Profile in Blood of Rats – Preliminary Study

Conjugated fatty acids is a term given to a group of polyunsaturated fatty acids with conjugated double bonds systems in their carbon chains. Conjugated linolenic acids (CLnA) are present in seeds of certain plants e.g. α-eleostearic acid (cis-9, trans-11, trans-13 C18:3) in bitter melon (Momordica charantia, Cucurbitaceae) or punicic acid (cis-9, trans-11, cis-13 C18:3) in pomegranate (Punica granatum, Punicaceae), where usually they are most prevalent among fatty acids. Bitter melon and pomegranate have been widely investigated as they are commonly consumed plants which also have been used in traditional medicine, mainly in Asia, for treatment of many diseases, such as diabetes and atherosclerosis.The aim of this study was to evaluate the influence of a diet supplemented with an aqueous extract of bitter melon fruits and/or with pomegranate oil on health status and lipid profile of blood. Sprague-Dawley female rats were divided into four groups with different diet supplementation: pomegranate oil (G), aqueous extract of bitter melon (M), pomegranate oil and aqueous extract from bitter melon (M+G), and control group (C). During the experiment fasting glucose concentration and total cholesterol (TC), HDL, LDL, and triglyceride (TG) concentration were measured in blood collected intravitally from the tail vein.The modifications introduced into the diets did not influence negatively overall health condition of the animals. Bitter melon fruits extract slightly decreased the fasting glucose concentration during the experiment but its action was not statistically significant (p&gt;0.05). Pomegranate oil caused an increase of fasting glucose level in G group (p=0.03657) but in M+G group its influence was diminished by the opposite activity of bitter melon fruits extract (p&gt;0.05). TC was the lowest in G group and it did not change during the time of experiment, which can suggest that the diet supplementation with pomegranate oil prevents the age-related increase in cholesterol level. TC in blood of G group was significantly lower than in other groups in 14th (p=0.01057) and 21st (p=0.01433) weeks respectively. Aqueous extract of bitter melon fruits slightly diminished age-related TG increase, whereas pomegranate oil strongly prevents this tendency, as the TG content in G group was significantly lower than TG content in C and M groups at 14th (p=0.00060) and 21st (p=0.00003) week respectively. Similar activity, although not so pronounced, was visible as far as the M+G group was concerned

A paraconsistent approach to actions in informationally complex environments

Contemporary systems situated in real-world open environments frequently have to cope with incomplete and inconsistent information that typically increases complexity of reasoning and decision processes. Realistic modeling of such informationally complex environments calls for nuanced tools. In particular, incomplete and inconsistent information should neither trivialize nor stop both reasoning or planning. The paper introduces ACTLOG, a rule-based four-valued language designed to specify actions in a paraconsistent and paracomplete manner. ACTLOG is an extension of 4QL(Bel), a language for reasoning with paraconsistent belief bases. Each belief base stores multiple world representations. In this context, ACTLOGs action may be seen as a belief bases transformer. In contrast to other approaches, ACTLOG actions can be executed even when the underlying belief base contents is inconsistent and/or partial. ACTLOG provides a nuanced action specification tools, allowing for subtle interplay among various forms of nonmonotonic, paraconsistent, paracomplete and doxastic reasoning methods applicable in informationally complex environments. Despite its rich modeling possibilities, it remains tractable. ACTLOG permits for composite actions by using sequential and parallel compositions as well as conditional specifications. The framework is illustrated on a decontamination case study known from the literature.Funding Agencies|Polish National Science Centre [2015/19/B/ST6/02589]; ELLIIT Network Organization for Information and Communication Technology; Swedish Foundation for Strategic Research FSR (SymbiKBot Project)</p

Primary Sclerosing Cholangitis In A Patient With Ankylosing Spondylitis And Ulcerative Colitis Successfully Treated With Adalimumab - A Five Year Follow-Up - Case Report

We report a five year follow-up of primary sclerosing cholangitis (PSC) in a 29-year-old man with ankylosing spondylitis (AS) and ulcerative colitis (UC). According to our knowledge, this is the first case report of such coexistence. Endoscopic retrograde cholangiopancreatography (ERCP) and the magnetic resonance cholangiopancreatography (MRCP) confirmed PSC. The sphincterotomy was performed and stent to the common bile duct was inserted. Because of the high activity of AS, treatment with adalimumab was started

Modulation of Mismatch Repair and the SOCS1/p53 Axis by microRNA-155 in the Colon of Patients with Primary Sclerosing Cholangitis

Deficient mismatch repair (MMR) proteins may lead to DNA damage and microsatellite instability. Primary sclerosing cholangitis (PSC) is a risk factor for colitis-associated colon cancer. MiR-155 is suggested to act as a key regulating node, linking inflammation and tumorigenesis. However, its involvement in the chronic colitis of PSC-UC patients has not been examined. We investigated the involvement of miR-155 in the dysregulation of MMR genes and colitis in PSC patients. Colon tissue biopsies were obtained from patients with PSC, PSC with concomitant ulcerative colitis (PSC-UC), uncomplicated UC, and healthy controls (n = 10 per group). In the ascending colon of PSC and PSC-UC patients, upregulated miR-155 promoted high microsatellite instability and induced signal transducer and activator of transcription 3 (STAT-3) expression via the inhibition of suppressors of cytokine signalling 1 (SOCS1). In contrast, the absence of miR-155 overexpression in the sigmoid colon of PSC-UC patients activated the Il-6/S1PR1 signalling pathway and imbalanced the IL17/FOXP3 ratio, which reinforces chronic colitis. Functional studies on human intestinal epithelial cells (HT-29 and NCM460D) confirmed the role of miR-155 over-expression in the inhibition of MMR genes and the modulation of p53. Moreover, those cells produced more TNF&alpha; upon a lipopolysaccharide challenge, which led to the suppression of miR-155. Additionally, exposure to bile acids induced upregulation of miR-155 in Caco-2 cell lines. Thus, under different conditions, miR-155 is involved in either neoplastic transformation in the ascending colon or chronic colitis in the sigmoid colon of patients with PSC. New insight into local modulation of microRNAs, that may alter the course of the disease, could be used for further research on potential therapeutic applications