Tension Pneumoperitoneum Following Upper Gastrointestinal Endoscopy

Tension pneumoperitoneum is a potentially lethal complication of numerous iatrogenic procedures, including upper gastrointestinal (UGI) endoscopy. We report a 69-year-old man with UGI bleeding who developed tension pneumoperitoneum and cardiac arrest after UGI endoscopy. He was successfully resuscitated with needle decompression. Emergency surgery revealed a perforated gastric ulcer, and subtotal gastrectomy with Billroth II anastomosis was performed. Recovery was smooth and he was discharged from the hospital 18 days later. Tension pneumoperitoneum should be suspected in all patients who develop circulatory collapse with acutely distended abdomen after UGI endoscopy. Early identification relies on a high index of suspicion. Prompt treatment with needle decompression should not be delayed for confirmatory radiography once the clinical diagnosis is made

Interpretable Fully Convolutional Classification of Intrapapillary Capillary Loops for Real-Time Detection of Early Squamous Neoplasia

In this work, we have concentrated our efforts on the interpretability of classification results coming from a fully convolutional neural network. Motivated by the classification of oesophageal tissue for real-time detection of early squamous neoplasia, the most frequent kind of oesophageal cancer in Asia, we present a new dataset and a novel deep learning method that by means of deep supervision and a newly introduced concept, the embedded Class Activation Map (eCAM), focuses on the interpretability of results as a design constraint of a convolutional network. We present a new approach to visualise attention that aims to give some insights on those areas of the oesophageal tissue that lead a network to conclude that the images belong to a particular class and compare them with those visual features employed by clinicians to produce a clinical diagnosis. In comparison to a baseline method which does not feature deep supervision but provides attention by grafting Class Activation Maps, we improve the F1-score from 87.3% to 92.7% and provide more detailed attention maps

Cytomegalovirus enteritis in immunocompetent patients: Report of two cases diagnosed using single-balloon enteroscopy

SummaryCytomegalovirus (CMV) infection of the gastrointestinal tract involves mostly the colon and rectum and mainly develops in immunocompromised patients. CMV infection in the small intestines has rarely been reported in immunocompetent patients. We report two cases of CMV enteritis that developed in immunocompetent patients and involved the ileum and jejunum, respectively. Both of them were diagnosed with single-balloon enteroscopy (SBE) and further confirmed with histopathology. The first case is a 71-year-old woman with a presentation of obscure gastrointestinal bleeding and severe anemia. Neither esophagogastroduodenoscopy nor colonoscopy identified any active bleeding. SBE and biopsy disclosed multiple scattered ulcers in the distal ileum and histopathology confirmed CMV ileitis. The hemorrhage subsided after conservative medical treatment. The second case is a 59-year-old woman with a presentation of progressive abdominal pain. SBE showed diffuse irregularly-shaped ulcers located from the upper to middle jejunum, and CMV jejunitis was confirmed with endoscopic biopsy and histopathological examination. Antiviral therapy was prescribed and her abdominal pain improved gradually. We discuss the clinical manifestations and management strategies of CMV infection that develops in the small intestines of immunocompetent patients. In addition, we highlight the endoscopic characteristics of CMV enteritis and the clinical utilities of SBE in the evaluation of patients with suspected CMV infection of the small intestines

Comparison of a Chinese Herbal Medicine (CCH1) and Lactulose as First-Line Treatment of Constipation in Long-Term Care: A Randomized, Double-Blind, Double-Dummy, and Placebo-Controlled Trial

Many institutionalized patients and their healthcare providers are dissatisfied with current laxative therapy. This study compared therapeutic efficacy, safety, and laxative cost of an herbal formula (CCH1) and lactulose for long stay patients with constipation. In this double-blind, double-dummy, and placebo-controlled trial, we randomized 93 residents with chronic constipation from two long-term care facilities in Taiwan to receive either CCH1 with lactulose placebo or CCH1 placebo with lactulose for 8 weeks, then followed up for 4 weeks without study medication. Both treatments were effective and well tolerated for patients, but CCH1 produced more spontaneous bowel movements, less rectal treatments, less amount of rescue laxative, and lower laxative cost than lactulose during treatment. No significant differences were found in stool consistency, stool amount, global assessment, and safety concerns. In conclusion, our results suggest that CCH1 may have better efficacy and could be used as an alternative option to lactulose in the treatment of constipation in long-term care

Honokiol Blocks Store Operated Calcium Entry in CHO Cells Expressing the M3 Muscarinic Receptor: Honokiol and Muscarinic Signaling

Background: Honokiol, a cell-permeable phenolic compound derived from the bark of magnolia trees and present in Asian herbal teas, has a unique array of pharmacological actions, including the inhibition of multiple autonomic responses. We determined the effects of honokiol on calcium signaling underlying transmission mediated by human M3 muscarinic receptors expressed in Chinese hamster ovary (CHO) cells. Receptor binding was determined in radiolabelled ligand binding assays; changes in intracellular calcium concentrations were determined using a fura-2 ratiometric imaging protocol; cytotoxicity was determined using a dye reduction assay. Results: Honokiol had a potent (EC50 ≈ 5 μmol/l) inhibitory effect on store operated calcium entry (SOCE) that was induced by activation of the M3 receptors. This effect was specific, rapid and partially reversible, and was seen at concentrations not associated with cytotoxicity, inhibition of IP3 receptor-mediated calcium release, depletion of ER calcium stores, or disruption of M3 receptor binding. Conclusions: It is likely that an inhibition of SOCE contributes to honokiol disruption of parasympathetic motor functions, as well as many of its beneficial pharmacological properties

Impaired Efficiency and Resilience of Structural Network in Spinocerebellar Ataxia Type 3

Background: Recent studies have shown that the patients with spinocerebellar ataxia type 3 (SCA3) may not only have disease involvement in the cerebellum and brainstem but also in the cerebral regions. However, the relations between the widespread degenerated brain regions remains incompletely explored.Methods: In the present study, we investigate the topological properties of the brain networks of SCA3 patients (n = 40) constructed based on the correlation of three-dimensional fractal dimension values. Random and targeted attacks were applied to measure the network resilience of normal and SCA3 groups.Results: The SCA3 networks had significantly smaller clustering coefficients (P < 0.05) and global efficiency (P < 0.05) but larger characteristic path length (P < 0.05) than the normal controls networks, implying loss of small-world features. Furthermore, the SCA3 patients were associated with reduced nodal betweenness (P < 0.001) in the left supplementary motor area, bilateral paracentral lobules, and right thalamus, indicating that the motor control circuit might be compromised.Conclusions: The SCA3 networks were more vulnerable to targeted attacks than the normal controls networks because of the effects of pathological topological organization. The SCA3 revealed a more sparsity and disrupted structural network with decreased values in the largest component size, mean degree, mean density, clustering coefficient, and global efficiency and increased value in characteristic path length. The cortico-cerebral circuits in SCA3 were disrupted and segregated into occipital-parietal (visual-spatial cognition) and frontal-pre-frontal (motor control) clusters. The cerebellum of SCA3 were segregated from cerebellum-temporal-frontal circuits and clustered into a frontal-temporal cluster (cognitive control). Therefore, the disrupted structural network presented in this study might reflect the clinical characteristics of SCA3

Endoscopic Submucosal Dissection for Gastric Epithelial Tumors: A Multicenter Study in Taiwan

Background/PurposeEndoscopic submucosal dissection (ESD) is an advanced endoscopic procedure to resect early gastric cancer (EGC). The purpose of this study was to determine the effectiveness and complications of ESD for gastric epithelial tumors in Taiwan.MethodsWe retrospectively analyzed the efficacy and outcome of ESD in patients who received ESD for gastric epithelial tumors between June 2004 and August 2007.ResultsA total of 70 patients with gastric epithelial tumors were treated by ESD. The mean age was 66.5 ±12.9 years (range, 35–84 years). The mean size of the gastric epithelial tumors was 1.85 ± 0.81 cm. The mean size of resected specimens was 3.26 ± 1.39 cm. The one-piece resection rate was 91.4% (64/70). The median operation time was 92.4 minutes. The complicating bleeding and perforation rates were 5.7% (4/70) and 4.3% (3/70), respectively. Emergency surgery was performed for three patients with perforations. The local recurrence rate of gastric cancer was 2.8%. Except for one patient who died of congestive heart failure and another who died of stroke, the remaining 68 patients (97.1%) survived.ConclusionESD is a promising local curative treatment option for EGC in Taiwan but it still carries risks of perforation and bleeding. The education and learning curve of endoscopists will improve the outcome of this procedure

Physicochemical properties of rainbow trout (Oncorhynchus mykiss) filet treated with high-voltage electrostatic field under different storage temperatures

The post-mortem rigid of farmed rainbow trout (Oncorhynchus mykiss) affects the texture of the meat and might even be risky for microorganisms, undermining the popularity of frozen filets among consumers. This study investigated the importance of different conditions (0°C, 4°C, and 25°C for 0–4 days) and physicochemical characteristics of rainbow trout filet storage on fish’s characteristics, freshness, quality, and shelf-life. Results showed that the fish easily underwent rigor mortis and resolution of rigor mortis when stored at 25°C. However, rigor mortis was more likely to occur under storage at 0°C than at 4°C [with 100 kV/m high voltage electrostatic fields (HVEF)] due to low-temperature stimulation, but resolution of rigor mortis began to appear after 24 h of storage at either temperature. The protein solubility and gel strength of fish stored at 25°C continued to decrease due to thermal denaturation, and those of fish stored at 4°C and 0°C also showed a decrease owing to rigor mortis and then an increase when rigor mortis disappeared. The K values increased rapidly at 25°C and reached 61% at 14 h. Under storage at 4°C and 0°C, the K values only slightly increased before resolution of rigor mortis. However, the K-values did not exceed 40% for 4 days post-resolution of rigor mortis. Differential Scanning Calorimetry analysis and tissue sectioning showed that protein denaturation and separation between muscle fibers persisted during storage at various temperatures, most notably at 25°C. It is important to note that storing at 0°C for 96 h did not result in any significant changes in the molecular protein composition. Moreover, the muscle tissue remained in excellent condition compared to storage at 25°C and 4°C. Additionally, there was no significant difference in the total viable count (TVC) and psychrophilic bacteria between storage at 0°C and 4°C, considered safe for food consumption. These promising findings are conveyed in a circular economy based on the food industry, particularly adequate raw materials, stable prices, measures to reduce food loss and waste, and contributing to developing efficient, diverse, and sustainable food processing systems

Taiwanese Dermatological Association consensus for the management of atopic dermatitis

AbstractBackground/ObjectiveThis report describes the 2014 consensus of the Taiwanese Dermatological Association (TDA) regarding the treatment of atopic dermatitis (AD). The TDA consensus is distributed to practices throughout Taiwan to provide recommendations for therapeutic approaches for AD patients to improve their quality of life.MethodsThe information in the consensus was agreed upon by a panel of national experts at TDA AD consensus meetings held on March 16, May 4, and June 29, 2014. The consensus was in part based on the 2013 Asia–Pacific AD guidelines and the guidelines of the American Academy of Dermatology, with modification to reflect the clinical practice in Taiwan.ResultsThe amendments were drafted after scientific discussions focused on the quality of evidence, risk, and benefits; all the consensus contents were voted on by the participating dermatologists, with approval by at least 75% for inclusion.ConclusionThe consensus provides a comprehensive overview of treatment for AD, with some local and cultural considerations for practitioners in Taiwan, especially the use of wet dressings/wraps, systemic immunomodulatory agents, and complementary therapies