Endoscopic findings and psychometric abnormalities: what is the relationship in upper endoscopic outpatients?

Background. Psychological disorders are often associated with diseases of the upper digestive tract. Although emotions can influence gastrointestinal function in healthy individuals, psychological setting in upper gastrointestinal patients are unclear. We evaluate the psychological alterations prevalence in outpatients submitted to upper endoscopy. Materials and Methods. A total of 130 patients (50 males and 80 females; mean age 54±17 years) submitted to upper gastrointestinal endoscopy, were enrolled over the period May 2009 - September 2010. Subjects were asked to complete questionnaires before endoscopic examination. Alexithymia, anxiety, depression and coping style were assessed using the Toronto Alexithymia Scale, Spielberger Trait Anxiety Inventory, Beck Depression Inventory and Coping Inventory for Stressful Situations, respectively. Results. Coping impairment, Alexithymia, Anxiety and Depression were found respectively in 80.3%, 25.4%, 24.6% and 17.2%, often in association. Task-oriented, emotion-oriented and avoidance-oriented alterations were found in 41.8%, 40% and 30.6%, respectively. No correlations were demonstrated between diagnosis of upper gastrointestinal disease and psychometric results. Conclusions. In our study, a high prevalence of psychometric alterations in gastrointestinal outpatients was unconnected with endoscopic findings, especially considering coping style alterations. This aspect should be taken into account in patients management and a long-term follow-up should clarify a possible role of these factors in patients prognosis and compliance

Th17, intestinal microbiota and the abnormal immune response in the pathogenesis of celiac disease

Celiac disease (CD) is an autoimmune enteropathy induced by the ingestion of gluten in genetically predisposed individuals who carry the HLA-DQ2 or -DQ8 alleles. The immune response is abnormal in celiac disease with small intestinal epithelial damage via CD8+CD4- intraepithelial lymphocytes. The etiology is multifactorial involving genetic and environmental factors, an abnormal immune response, and intestinal dysbiosis. The innate and acquired T-cell mediated immunity play important roles in the pathogenesis of this disease, particularly CD4+ Th17 cells, which have been shown to have critical functions in host defense against bacterial pathogens and in the inflammatory responses to deamidated gluten peptides. We review what is known about the interaction between immune system and intestinal microbiota in the pathogenesis of celiac disease

Anatomy and physiology in ischaemic heart disease: a second honeymoon?

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Stakeholders in Dance: An Intrinsic Case Study Examining Facilitator Perspectives of Dance with a B-E-A-T

Recreational dance programs with specific behavioral adaptations for individuals with neurodevelopmental disabilities can provide an opportunity for the enjoyment of dance, and potential improvements in motor skills, social skills, or behaviors related to self-efficacy. This intrinsic case study builds on a pilot study of a recreational dance program, Dance with a B-E-A-T (behavior analysis and therapy), with behavioral adaptations for individuals with neurodevelopmental disorders. Facilitators of the program included three graduate students working as behavior therapists. We aimed to discover, through semi-structured interviews, what components facilitators perceived to be effective, components that they perceived to be challenging, successes or challenges with implementation, as well as their overall perceptions of this blended program. A thematic analysis, with a deductive approach, of interview data previously collected from parents of participants in the program was conducted to inform interview questions for facilitators, and to provide the framework for coding facilitator data. A similar thematic analysis was carried out for facilitator interview transcripts. The key themes identified during this analysis included: (1) Blending Recreational Dance and Behavior Therapy as Novel, (2) Benefits of the Program, and (3) Refinements and Recommendations. Facilitators and parents perceived this novel program to have effective components such as individualized behavioral adaptations, and an enjoyable environment with positive social interactions. Recommendations for future programs include refining behavioral components such as thinning the schedule of reinforcement, increasing training for facilitators to address existing barriers to implementation, and extending the length of the program to be consistent with motor development research. This study will add to limited research on recreational dance programs for this population

Biofilm producing Salmonella typhi: Chronic colonization and development of gallbladder cancer

Salmonella enterica subspecies enterica serovar Typhi is the aetiological agent of typhoid or enteric fever. In a subset of individuals, S. Typhi colonizes the gallbladder causing an asymptomatic chronic infection. Nonetheless, these asymptomatic carriers provide a reservoir for further spreading of the disease. Epidemiological studies performed in regions where S. Typhi is endemic, revealed that the majority of chronically infected carriers also harbour gallstones, which in turn, have been indicated as a primary predisposing factor for the onset of gallbladder cancer (GC). It is now well recognised, that S. Typhi produces a typhoid toxin with a carcinogenic potential, that induces DNA damage and cell cycle alterations in intoxicated cells. In addition, biofilm production by S. Typhi may represent a key factor for the promotion of a persistent infection in the gallbladder, thus sustaining a chronic local inflammatory response and exposing the epithelium to repeated damage caused by carcinogenic toxins. This review aims to highlight the putative connection between the chronic colonization by highly pathogenic strains of S. Typhi capable of combining biofilm and toxin production and the onset of GC. Considering the high risk of GC associated with the asymptomatic carrier status, the rapid identification and profiling of biofilm production by S. Typhi strains would be key for effective therapeutic management and cancer prevention

Hemostasis in uncontrolled esophageal variceal bleeding by self-expanding metal stents. A systematic review

Aim: The aim of this systematic review was to evaluate the current reported efficacy and the mortality rate of SEMS treatment in uncontrolled bleeding patients. Background: Esophageal variceal bleeding (EVB) represents a life threatening pathology. Despite the adequate pharmacologic and endoscopic treatment, continuous or recurrent bleeding, named as uncontrolled bleeding, occurs in 10-20% of cases. A new removable, covered, and self-expanding metal stent (SEMS) was proposed to control the variceal bleeding. Materials and methods: The study was conducted according to the PRISMA statement. Studies were identified by searching MEDLINE (1989-present) and SCOPUS (1989-present) databases. The last search was run on 01 July 2015. Results: Nine studies (period range=2002-2015) met the inclusion criteria and were included in quantitative analysis. High rate of SEMS efficacy in controling acute bleeding was observed, with a reported percentage ranging from 77.7 to 100%. In 10% to 20% of patients, re-bleeding occurred with SEMS in situ. Stent deployment was successful in 77.8% to 100% of patients while 11 to 36.5% of patients experienced stent migration. Conclusion: SEMS could be effective and safe in control EVB and can be proposed as a reliable option to ballon tamponed for patient stabilization and as a bridging to other therapeutic approach. Keywords: Nonselective β-blockers, TIPSS, Endoscopic band ligation, Uncontrolled bleeding, Selfexpanding metal stent

Should the host reaction to anisakiasis influence the treatment? Different clinical presentations in two cases

Gastrointestinal anisakiasis is a parasitic infection occurring in people that consume raw or inadequately cooked fish or squid. It is frequently characterized by severe epigastric pain, nausea and vom iting caused by the penetration of the larvae into the gastric wall. Acute gastric anisakiasis with severe chest discomfort is rarely report ed in Italy. On the other hand, gastro-allergic anisakiasis with rash, urticaria and isolated angioedema or anaphylaxis is a clinical entity that has been described only recently. Also, if patients usually develop symptoms within 12 hours after raw seafood ingestion, not always endoscopic exploration can promptly identify the Anisakis larvae. Moreover, some authors consider the prevailing allergic reaction as a natural and effective defense against the parasitic attack. We report two cases of peculiar manifestations of anisakiasis in both acute and chronic forms (severe chest discomfort and anaphylactoid reaction)

How human papillomavirus replication and immune evasion strategies take advantage of the host DNA damage repair machinery

The DNA damage response (DDR) is a complex signalling network activated when DNA is altered by intrinsic or extrinsic agents. DDR plays important roles in genome stability and cell cycle regulation, as well as in tumour transformation. Viruses have evolved successful life cycle strategies in order to ensure a chronic persistence in the host, virtually avoiding systemic sequelae and death. This process promotes the periodic shedding of large amounts of infectious particles to maintain a virus reservoir in individual hosts, while allowing virus spreading within the community. To achieve such a successful lifestyle, the human papilloma virus (HPV) needs to escape the host defence systems. The key to understanding how this is achieved is in the virus replication process that provides by itself an evasion mechanism by inhibiting and delaying the host immune response against the viral infection. Numerous studies have demonstrated that HPV exploits both the ataxia-telangiectasia mutated (ATM) and ataxia-telangiectasia and rad3-related (ATR) DDR pathways to replicate its genome and maintain a persistent infection by downregulating the innate and cell-mediated immunity. This review outlines how HPV interacts with the ATM-and ATR-dependent DDR machinery during the viral life cycle to create an environment favourable to viral replication, and how the interaction with the signal transducers and activators of transcription (STAT) protein family and the deregulation of the Janus kinase (JAK)-STAT pathways may impact the expression of interferon-inducible genes and the innate immune responses

Is long-lasting mucosal elevation the only valid parameter when evaluating a lifting agent?

Stefano Pontone, Simone Manfredelli, Dimitri Krizzuk, Giovanni LeonettiDepartment of Surgical Sciences, “Sapienza” University of Rome, Rome, ItalyDear editorConsidering the relevance of the topic, our attention was strongly attracted by the study reported by Al-Taie et al. This study, based on our experience, begs some questions. Although the limitations of the lifting agent have been correctly identified by the authors, it would be useful to know the timing and details of the procedures used for preparation of blood, plasma, and serum