Nevarikozinio kraujavimo iš viršutinės virškinimo trakto dalies gydymo rekomendacijos

Laimas Jonaitis, Kęstutis Adamonis, Jonas Valantinas, Juozas Stanaitis, Limas Kupčinskas Nevarikozinis kraujavimas iš viršutinės virškinimo trakto dalies yra dažna ir gyvybei grėsminga būklė, kurios diagnostikai ir gydymui reikia turėti žinių ir patirties. Šios patologijos diagnostika ir gydymas labai svarbus skubiosios pagalbos, intensyviosios terapijos skyrių gydytojų, endoskopuotojų, gastroenterologų ir chirurgų kasdieniame darbe. Straipsnyje pateikiamos Lietuvos gastroenterologų draugijos ekspertų posėdyje apsvarstytos tarptautiniu mastu priimtos rekomendacijos, stengiantis jas pritaikyti prie Lietuvos medicinos įstaigų situacijos. Recommendations for managing patients with nonvariceal gastrointestinal bleeding Laimas Jonaitis, Kęstutis Adamonis, Jonas Valantinas, Juozas Stanaitis, Limas Kupčinskas Nevarikozinis kraujavimas iš viršutinės virškinimo trakto dalies yra dažna ir gyvybei grėsminga būklė, kurios diagnostikai ir gydymui reikia turėti žinių ir patirties. Šios patologijos diagnostika ir gydymas labai svarbus skubiosios pagalbos, intensyviosios terapijos skyrių gydytojų, endoskopuotojų, gastroenterologų ir chirurgų kasdieniame darbe. Straipsnyje pateikiamos Lietuvos gastroenterologų draugijos ekspertų posėdyje apsvarstytos tarptautiniu mastu priimtos rekomendacijos, stengiantis jas pritaikyti prie Lietuvos medicinos įstaigų situacijos

Budesonide as induction therapy for incomplete microscopic colitis: A randomised, placebo‐controlled multicentre trial

Background and aims: Incomplete microscopic colitis (MCi) is a subtype of microscopic colitis (MC). Budesonide is recommended as a first-line treatment for MC. However, randomised trials on efficacy of treatment in MCi are missing. We therefore performed a randomised, placebo-controlled trial to evaluate budesonide as induction therapy for MCi. Methods: Patients with active MCi were randomly assigned to either budesonide 9 mg once daily or placebo for 8 weeks in a double-blind, double-dummy design. The primary endpoint was clinical remission, defined as a mean of <3 stools/day and a mean of <1 watery stool/day in the 7 days before week 8. Results: Due to insufficient patient recruitment, the trial was discontinued prematurely. The intention-to-treat analysis included 44 patients (21 budesonide and 23 placebo). The primary endpoint of clinical remission at week 8 was obtained by 71.4% on budesonide and 43.5% on placebo (p = 0.0582). All clinical secondary endpoints were in favour of budesonide. Budesonide decreased the number of soft or watery stools (16.3 vs. 7.7, p = 0.0186) and improved health-related quality of life for all four dimensions of the short health scale. Adverse events with a suspected relation to study drug were reported in one patient in the budesonide group and two patients in the placebo group. Neither serious nor severe adverse events occurred during the double-blind phase. Conclusions: Budesonide decreased the frequency of soft or watery stools and improved the patients' quality of life significantly in MCi, but the primary endpoint was not met due to the low sample size (type 2 error). Budesonide was safe and well tolerated during the 8-weeks treatment course

Dynamics in Circulating y -55Proinflammatory Biomarkers for Prognostic Assessment of Patients With Advanced HCC – A Substudy From the SORAMIC Trial

Introduction: Prediction of response to treatment in patients with advanced hepatocellular carcinoma (HCC) may assist in the selection of personalized management. Objective: This exploratory analysis of the palliative arm of the SORAMIC trial (ClinicalTrials.gov NCT01126645) evaluated the prognostic potential of basal and dynamic changes in systemic levels of interleukin 6 (IL-6), interleukin 8 (IL-8), systemic vascular endothelial growth factor (VEGF), and lipopolysaccharide (LPS). Methods: We evaluated the correlations between overall survival (OS) and concentrations of IL-6, IL-8, VEGF, and LPS at follow-up approximately 7-9 weeks after treatment initialization (FU) compared to baseline (BL) in 90 patients treated either with 90Yttrium (90Y) microspheres combined with sorafenib (n = 44) or with sorafenib (n = 46) alone. Results: Changes in IL-6 concentration during treatment showed correlations with the outcome. An increase in IL-6 concentration of less than 16.8 pg/mL over baseline readings was associated with better survival [median OS 16.3 months compared with 8.9 months (p = 0.0354)]. Correlations with survival were not observed for VEGF or LPS concentrations at baseline, at FU, or changes between these time points. Conclusions: Changes in IL 6 serum levels at 7-9 weeks after treatment initialization but not in IL 8, VEGF, or LPS add important information on the outcome of advanced HCC patients treated palliatively within the SORAMIC trial

Helicobacter pylori Diagnostic Tests Used in Europe : Results of over 34,000 Patients from the European Registry on Helicobacter pylori Management

Funding Information: This study was funded by Richen; however, clinical data were not accessible and the company was not involved in any stage of the Hp-EuReg study (design, data collection, statistical analysis, or manuscript writing). We want to thank Richen for their support. This project was promoted and funded by the European Helicobacter and Microbiota Study Group (EHMSG), the Spanish Association of Gastroenterology (AEG) and the Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd). The Hp-EuReg was co-funded by the European Union programme HORIZON (grant agreement number 101095359) and supported by the UK Research and Innovation (grant agreement number 10058099). The Hp-EuReg was co-funded by the European Union programme EU4Health (grant agreement number 101101252). Acknowledgments We want to especially thank Sylva-Astrik Torossian for her assistance in language editing. Natalia García Morales is the first author who is acting as the submission’s guarantor. All authors approved the final version of the manuscript.Peer reviewedPublisher PD

Role of compliance in Helicobacter pylori eradication treatment : Results of the European Registry on H. pylori management

Peer reviewe

Review - Helicobacter pylori and non-malignant upper gastrointestinal diseases

This review takes into account recent publications focusing on the relationship between Helicobacter pylori infection and non-malignant diseases of the upper gastrointestinal tract. The authors have summarized current knowledge on associations between the H pylori infection and non-malignant upper GI conditions including gastroesophageal reflux disease (GERD), Barrett's esophagus, eosinophilic esophagitis (EOE), peptic ulcer disease (PUD), H pylori gastritis, celiac disease and functional dyspepsia. In the field of GERD, current data focusing on different locations of H pylori infection detect significant differences between antrum- and corpus predominant gastritis explainable by different changes in acid secretion in different gastric niches. High volume studies from Sweden and Brazil underline the safety of H pylori eradication concerning the risk of Barret's esophagus or adenocarcinoma. The relationship betweenH pylori infection and EOE remains uncertain, but current data supports the concept of expected positive and protective effects of H pylori exposure reducing the risk of EOE. Analyzing biomarkers might be helpful to identify subjects under risk for the development of precancerous lesions after H pylori infection, where microRNAs, IL-9 and IL-4, and also Tc17/9 and Th17/9 and microbiota profiles showed promising results to identify subgroups under risk

Erozinį stemplės uždegimą sergantiesiems dvylikapirštės žarnos opalige predisponuoja gastroezofaginio refliukso ligos simptomai, rūkymas ir vyresnis amžius, bet ne Helicobacter pylori išnaikinimas (vienerių metų stebėjimo studija)

It remains unclear whether the Helicobacter pylori eradication may cause or provoke gastroesophageal reflux disease. Therefore, we aimed to elucidate the role of H. pylori eradication and other factors in the development of erosive esophagitis in patients with duodenal ulcer. Materials and methods. We enrolled 183 H. pylori-positive duodenal ulcer patients without erosive esophagitis. Final endoscopy was performed 12 months later or in case if ulcer relapse was suspected. H. pylori was diagnosed by the urease test and histology if the results of at least one of the tests were positive. A total of 142 patients were assigned to the eradication treatment. The control group included 41 volunteers – 20-mg omeprazole b.i.d. for 4 weeks was administered. Results. A total of 150 patients completed the study. Of the 119 patients, 70 (58.8%) were cured from H. pylori, and in 49 (41.2%) of patients, treatment of H. pylori was unsuccessful. All 31 controls remained H. pylori-positive. At the final endoscopy, erosive esophagitis was found in 19 (12.7%) patients. Erosive esophagitis developed in 8 (11.4%) successfully eradicated patients, in 9 (18.4%) unsuccessfully treated patients, and in 2 (6.5%) controls (P>0.05 comparing the groups). Multivariate logistic regression analysis revealed 3 factors at baseline, which were significant (P<0.05) in predicting the occurrence of erosive esophagitis: age more than 43 years (OR, 4.96; 95% CI, 1.47–16.71), nonerosive gastroesophageal reflux disease (OR, 3.96; 95% CI, 1.34–11.68), and smoking (OR, 3.17; 95% CI, 1.01–9.17). Conclusions. H. pylori eradication did not influence the incidence of erosive esophagitis in patients with duodenal ulcer during a one-year follow-up period. Pre-existing nonerosive gastroesophageal reflux disease, smoking, and older age are important predictors of de novo development of erosive esophagitis

Biobased lubricating greases

The totally renewable and biodegradable lubricants are welcomed in most applications were contact with ground water or soil is expected. Usage of environmentally friendly lubricants decreases the negative consequences if some accidents or high amount of leakage occurs. In the current study the new kinds of lubricating grease thickeners are suggested. The totally renewable products like monoglycerides, stearic acid and bee wax are investigated as thickeners. Rapeseed oil is used as base oil. The properties as penetration, dropping point temperature and lubricity are investigated. The results show that investigated materials are suitable for environmentally friendly lubricating grease production. The limitations of such lubricants are discussed with some recommendationsVytauto Didžiojo universitetasŽemės ūkio akademij

Research into tribological properties biological oils

Biologinės alyvos yra gaminamos iš biologinės, dažniausiai augalinės, kilmės žaliavų ir gali būti naudojamos kaip aplinkai nekenksmingos alyvos, kurios lengvai suyra. Oksidacijai sulėtinti naudotas Lubrizol firmos antioksidantas 5150C (0,3 %), 0 aliejų tepamosioms savybėms pagerinti - Lubrizol firmos antidiliminis priedas 5034A. Naudota 0,2 %, 1 %, 2 % ir 3 % priedo koncentracija. Koncentracija pasirinkta atsižvelgiant į gamintojų rekomendacijas.Tyrimai atlikti keturių rutulių trinties mašina esant 150 N ir 300 N apkrovai. Tyrimai parodė, kad daugeliu atvejų antidiliminis priedas labai pagerina tiek rapsų, tiek ir saulėgrąžų aliejų dilimo slopinimo savybes. Skirtumą sudarė tik saulėgrąžų aliejus su mažu antidiliminio priedo kiekiu (0,2 %), bandant 150 N apkrova. Visais atvejais bandant mažos priedo koncentracijos aliejus trinties nuostoliai buvo didesni už gryno aliejaus. Tai rodo, kad kai priedo koncentracija yra per maža, priedai, konkuruodami su baziniu aliejumi, nepakankamai efektyviai adsorbuojasi ant trinties paviršiaus. Esant 150 N ir 300 N apkrovoms didžiausias efektyvumas gautas RA ir SA modifikuojant 2 % antidiliminio priedo. Didinant antidiliminio priedo koncentraciją iki 3 % didesnio slopinimo nenustatyta. Atliktų tyrimų duomenimis rapso ir saulėgrąžų aliejus, modifIkuotas antioksidantu 5150C (0,3%) ir antidiliminiu priedu 5034A (2 %), lyginant su analogiška etalonine biologine alyva pasižymi geresnėmis tepamosiomis savybėmisBiolubricants are derived from bioresorses usually vegetable raw materials, can be used as no hazard and easily biodegradable lubricants. For inhibition of oil oxidation 0,3 % of Lubrizol antioxidant 5150C was used. Tribological properties of vegetable oils were improved using Lubrizol antiwear additive 5034A. The concentration of used antiwear additive was 0,2%, 1 %, 2 % and 3 %. The concentrations taken considering recommends of manufacturer. Four-ball trobometer was used for tribological tests. The load of 150N ir 300N was employed. The result shows that mostly presents of antiwear additive in sunflower and rapeseed oils increase the oil ability to protect the surfaces against wear. The difference rise when sunflower oil modified with low content (0,2 %) of antiwera additive in the 150 N regime. In all cases the fiction was higher using low content of antiwear additive in comparison with pure rapeseed oil. This fact show that in the case of low content of antiwear additive it can not make effective adsorption layer due to competition with base oil. The best result in rapeseed and sunflower oils obtained using 2 % of antiwear additive for both 150 N and 300 N loads. Increase in the contentment of antiwear additive till 3 % do not show any better result. The results show that tribological properties of rapeseed and sunflower oils modified with antioxidant 5150C (0,3%) ant antiwear 5034A (2%) additives are better in comparison with commercial biolubricantVytauto Didžiojo universitetasŽemės ūkio akademij

Rapsų aliejaus modifikavimas laisvomis riebalų rūgštimis

Griežtėjant pasaulio ir Europos Sąjungos aplinkosaugos reikalavimams vis daugiau dėmesio skiriama aplinkai draugiškų alyvų tyrimui, gamybai ir naudojimui. Ieškoma būdų, kaip sumažinti alyvų daromą žalą aplinkai, taip pat ir pačių alyvų gamybos savikainą. Abu šiuos tikslus galima įgyvendinti alyvų gamyboje naudojant efektyvias natūralias medžiagas. Šiame darbe buvo tirta natūralaus trintį ir dilimą mažinančio priedo ADX 18, gauto laisvųjų riebiųjų rūgščių pagrindu, įtaka rapsų aliejaus tepamosioms savybėms. Tyrimai atlikti standartiniu keturių rutulių metodu, naudotos 150 ir 300 N apkrovos. Gauti rezultatai rodo, kad tirtas priedas pagerina rapsų aliejaus tepamąsias savybes, tačiau esant skirtingiems apkrovų režimams jo efektyvumas skiriasi. Mažos apkrovos sąlygomis tirti mišiniai dilimą mažina efektyviau už etaloninę alyvą, o didelės apkrovos sąlygomis jų dilimo slopinamosios savybės nėra pakankamos. Tepant tirtu priedu modifikuotu rapsų aliejumi trintis tiek didelės, tiek mažos apkrovos sąlygomis yra mažesnė nei tepant etalonine alyva. Tirtą tepamąją medžiagą naudojant mažų apkrovų sąlygomis, mechanizmai būtų patikimai apsaugoti nuo dilimo ir sumažėtų trinties nuostoliaiPresently strickt World and European environmental requirements made force on research, manufacture and use of environmentally friendly lubricants. Scientists lucking for the ways to reduce harm of lubricants to environment and the cost of lubricants too. Both these problems can be solved using efficient natural lubricating materials. In current study the natural free fatty acid additive ADX 18 was used to reduce friction and wear lubricating with rapeseed oil. Tests were performed with standard four ball tribometer. The load was 150 N and 300 N. The results show positive influence of free fatty acid additive. However the effect in different loads is not equal. In the low loads (150 N) the wear reduction effect of additive is superior in comparison with reference oil. In the high loads (300 N) the wear reduction ability is not sufficient. Nevertheless the friction in both loads is less in comparison with the reference. The use of free fatty acid loaded rapeseed oil can reduce friction and wear in mechanisms with low load conditionVytauto Didžiojo universitetasŽemės ūkio akademij