Usefulness and safety of 0.4% sodium hyaluronate solution as a submucosal fluid "cushion" for endoscopic resection of colorectal mucosal neoplasms: A prospective multi-center open-label trial

<p>Abstract</p> <p>Background</p> <p>Sodium hyaluronate (SH) solution has been used for submucosal injection in endoscopic resection to create a long-lasting submucosal fluid "cushion". Recently, we proved the usefulness and safety of 0.4% SH solution in endoscopic resection for gastric mucosal tumors. To evaluate the usefulness of 0.4% SH as a submucosal injection solution for colorectal endoscopic resection, we conducted an open-label clinical trial on six referral hospitals in Japan.</p> <p>Methods</p> <p>A prospective multi-center open-label study was designed. A total of 41 patients with 5–20 mm neoplastic lesions localized in the colorectal mucosa at six referral hospitals in Japan in a single year period from December 2002 to November 2003 were enrolled and underwent endoscopic resection with SH. The usefulness of 0.4% SH was assessed by the <it>en bloc </it>complete resection and the formation and maintenance of mucosal lesion-lifting during endoscopic resection. Safety was evaluated by analyzing adverse events during the study period.</p> <p>Results</p> <p>The usefulness rate was high (82.5%; 33/40). The following secondary outcome measures were noted: 1) steepness of mucosal lesion-lifting, 75.0% (30/40); 2) intraoperative complications, 10.0% (4/40); 3) time required for mucosal resection, 6.7 min; 4) volume of submucosal injection, 6.8 mL and 5) ease of mucosal resection, 87.5% (35/40). Two adverse events of bleeding potentially related to 0.4% SH were reported.</p> <p>Conclusion</p> <p>Using 0.4% SH solution enabled sufficient lifting of a colorectal intramucosal lesion during endoscopic resection, reducing the need for additional injections and the risk of perforation. Therefore, 0.4% SH may contribute to the reduction of complications and serve as a promising submucosal injection solution due to its potentially superior safety in comparison to normal saline solution.</p

Lifestyle factors affecting gastroesophageal reflux disease symptoms: a cross-sectional study of healthy 19864 adults using FSSG scores

<p>Abstract</p> <p>Background</p> <p>Gastroesophageal reflux disease (GERD) is a very common disorder worldwide, comprised of reflux esophagitis (RE) and non-erosive reflux disease (NERD). As more than half of GERD patients are classified into the NERD group, precise evaluation of bothersome epigastric symptoms is essential. Nevertheless, compared with many reports targeting endoscopic reflux esophagitis, large-scale studies focusing on GERD symptoms have been very scarce.</p> <p>Methods</p> <p>To elucidate lifestyle factors affecting GERD symptoms, 19,864 healthy adults in Japan were analyzed. Sub-analyses of 371 proton pump inhibitor (PPI) users and 539 histamine H₂-receptor antagonist (H₂RA) users were also performed. Using the FSSG (Frequency Scale for the Symptoms of GERD) score as a response variable, 25 lifestyle-related factors were univariately evaluated by Student's <it>t</it>-test or Pearson's correlation coefficient, and were further analyzed with multiple linear regression modelling.</p> <p>Results</p> <p>Average FSSG scores were 4.8 ± 5.2 for total subjects, 9.0 ± 7.3 for PPI users, and 8.2 ± 6.6 for H₂RA users. Among the total population, positively correlated factors and standardized coefficients (β) for FSSG scores are inadequate sleep (β = 0.158), digestive drug users (β = 0.0972 for PPI, β = 0.0903 for H₂RA, and β = 0.104 for others), increased body weight in adulthood (β = 0.081), dinner just before bedtime (β = 0.061), the habit of midnight snack (β = 0.055), lower body mass index (β = 0.054), NSAID users (β = 0.051), female gender (β = 0.048), lack of breakfast (β = 0.045), lack of physical exercise (β = 0.035), younger age (β = 0.033), antihyperglycemic agents non-users (β = 0.026), the habit of quick eating (β = 0.025), alcohol drinking (β = 0.025), history of gastrectomy (β = 0.024), history of cardiovascular disease (β = 0.020), and smoking (β = 0.018). Positively correlated factors for PPI users are female gender (β = 0.198), inadequate sleep (β = 0.150), lack of breakfast (β = 0.146), antihypertensive agent non-users (β = 0.134), and dinner just before bedtime (β = 0.129), whereas those for H₂RA users are inadequate sleep (β = 0.248), habit of midnight snack (β = 0.160), anticoagulants non-users (β = 0.106), and antihypertensive agents non-users (β = 0.095).</p> <p>Conclusions</p> <p>Among many lifestyle-related factors correlated with GERD symptoms, poor quality of sleep and irregular dietary habits are strong risk factors for high FSSG scores. At present, usual dose of PPI or H₂RA in Japan cannot fully relieve GERD symptoms.</p

Nursing Interventions of Diabetes Mellitus 2 in Patients with Dementia

The world’s population is ageing. Statistically, elderly people are more predisposed to diabetes mellitus 2 (DM2) and dementia compared to younger age groups. The prevalence of diabetes mellitus 2 and dementia in elderly population has been increasing globally every year. The relations between the two conditions have been studied by many researchers, however, available guidelines and recommendations to guide healthcare professionals for caring patients with DM2 and dementia are crucially lacking. The purpose of this thesis was to describe nursing interventions of diabetes mellitus 2 in patients with dementia, and to identify the challenges of these nursing interventions. The research questions were: “What are the nursing interventions in the care of the patients with DM2 and dementia?” and “What are the challenges and effects of dementia on nursing interventions for DM2?”. The method used in this thesis was a descriptive literature review with an inductive content analysis. The aims of descriptive literature review were to fill a research gap in this topic and to give comprehensive understanding about the nursing interventions of DM2 and dementia for nurses. A literature search was conducted on chosen databases (CINAHL, Pub-Med, ProQuest). A total of 5 articles were critically and carefully chosen for the inductive content analysis. The effects of dementia on DM2 self-management and its challenges were explored thoroughly. The findings showed a link between hypoglycemia and dementia and explored pharmacological therapeutic approach for DM2 patients with dementia. It also highlighted various nursing interventions for self-management support, addressing patient-centered nursing approach and family engagement in self-management. There is a need for further studies to establish effective evidence-based nursing interventions that address both DM2 and dementia

Novel image-enhanced endoscopy with i-scan technology

i-scan technology is the newly developed image-enhanced endoscopy technology from PENTAX, Japan. This consists of three types of algorithms: surface enhancement (SE), contrast enhancement (CE), and tone enhancement (TE). SE enhances light-dark contrast by obtaining luminance intensity data for each pixel and applying an algorithm that allows detailed observation of a mucosal surface structure. CE digitally adds blue color in relatively dark areas, by obtaining luminance intensity data for each pixel and applying an algorithm that allows detailed observation of subtle irregularities around the surface. Both enhancement functions work in real time without impairing the original color of the organ, therefore, SE and CE are suitable for screening endoscopy to detect gastrointestinal tumors at an early stage. TE dissects and analyzes the individual RGB components of a normal image. The algorithm then alters the color frequencies of each component and recombines the components to a single, new color image. This is designed to enhance minute mucosal structures and subtle changes in color. TE works in real time and consists of three modes such as TE-g for gastric tumors, TE-c for colonic tumors, and TE-e for esophageal tumors. TE is suitable mainly for detailed examination of the lesions that are detected in a screening endoscopy. i-scan technology leads us to easier detection, diagnosis and treatment of gastrointestinal diseases