Impact of peroral endoscopic myotomy on the endoscopic pressure study integrated system.

OBJECTIVES: The endoscopic pressure study integrated system (EPSIS) is an endoscopic diagnostic system utilized for evaluation of lower esophageal sphincter function. Although previous studies have determined that EPSIS was effective as a tool for the diagnosis of achalasia, it remains uncertain if EPSIS can detect significant changes before and after peroral endoscopic myotomy (POEM), which is the premier treatment for achalasia. This study aimed to evaluate the effectiveness of EPSIS as an objective diagnostic tool for assessing the clinical effect of POEM. METHODS: We conducted a retrospective analysis of patients who underwent POEM from January 2022 to December 2023. The patients underwent EPSIS preoperatively and 2 months postoperatively. Intragastric pressure (IGP) parameters, including the maximum IGP, IGP difference, and waveform gradient were compared pre- and post-POEM. These parameters also were compared between two groups: the postoperative gastroesophageal reflux disease (GERD) group and the non-GERD group. RESULTS: A total of 50 patients were analyzed. The mean maximum IGP was significantly lower postoperatively than preoperatively (15.0 mmHg vs. 19.8 mmHg, P < 0.001). The mean IGP difference and waveform gradient were also significantly lower postoperatively than preoperatively (8.0 mmHg vs. 12.2 mmHg, P < 0.001; and 0.26 mmHg/s vs. 0.43 mmHg/s, P < 0.001, respectively). The mean postoperative waveform gradient was significantly lower in the GERD group (17 patients, 34%) than in the non-GERD group (33 patients, 66%) (0.207 mmHg vs. 0.291 mmHg, P = 0.034). CONCLUSION: The results supported the use of EPSIS as an effective diagnostic tool for assessing the effect of POEM.

Corilagin ameliorates the extreme inflammatory status in sepsis through TLR4 signaling pathways.

BACKGROUND: Sepsis is one of the serious disorders in clinical practice. Recent studies found toll-like receptors 4 (TLR4) played an important role in sepsis. In this study, we tried to find the influence of Corilagin on TLR4 signal pathways in vitro and in vivo. METHODS: The cellular and animal models of sepsis were established by LPS and then interfered with Corilagin. Real-time PCR and western blot were employed to detect the mRNA and protein expressions of TLR4, MyD88, TRIF and TRAF6. ELISA was used to determine the IL-6 and IL-1ß levels in supernatant and serum. RESULTS: The survival rate was improved in the LPS + Corilagin group, and the mRNA and protein expressions of TLR4, MyD88, TRIF and TRAF6 were significantly decreased than that in the LPS group both in cellular and animal models (P < 0.01). The pro-inflammatory cytokines IL-6 and IL-1ß were greatly decreased in the LPS + Corilagin group both in supernatant and serum (P < 0.01). CONCLUSIONS: Corilagin exerts the anti-inflammatory effects by down-regulating the TLR4 signaling molecules to ameliorate the extreme inflammatory status in sepsis.

Association between albumin-bilirubin score and in-hospital mortality in patients with sepsis: Evidence from two large databases.

Background: The Albumin-Bilirubin (ALBI) score, recommended for assessing the prognosis of hepatocellular carcinoma patients, has garnered attention. The efficacy of ALBI score in forecasting the risk of death in sepsis patients remains limited. We designed two cohort studies to assess the association between ALBI score and in-hospital mortality in patients with sepsis. Methods: A retrospective analysis was conducted utilizing data from the Second Affiliated Hospital of Guangzhou Medical University and the Medical Information Mart for Intensive Care IV(MIMIC-IV). Patients diagnosed with sepsis were included in the analysis. The primary outcome was the in-hospital mortality. Multivariate Cox regression analysis was conducted to assess the independent association between the ALBI score and mortality, with adjustment for potential confounders. Subgroup analysis was conducted to assess the robustness of the findings. Results: The Guangzhou Sepsis Cohort (GZSC) of the Second Affiliated Hospital of Guangzhou Medical University comprised 2969 participants, while the MIMIC-IV database included 8841 participants. The ALBI score were categorized into < -2.60, -2.60∼-1.39, and >-1.39. After adjusting for confounders, a linear relationship was observed between ALBI score and mortality. Patients with a high ALBI grade were associated with higher in-hospital mortality in both the GZSC (HR: 1.52, 95%CI: 1.24-1.87, p < 0.001) and the MIMIC-IV database (HR: 1.57, 95%CI: 1.46-1.70, p < 0.001). Conclusions: A high ALBI score is associated with higher in-hospital mortality among sepsis patients in ICU.

Immunogenicity and protective efficacy of Vibrio vulnificus flagellin protein FlaB in a wound infection model.

Vibrio vulnificus is known as an opportunistic bacterial pathogen that causes primary septicemia and wound infection in humans. Recently, the incidence of wound infection by V. vulnificus is increasing in warm countries. In this study, we examined a vaccine antigen against V. vulnificus in mice. FlaB, a component protein of the V. vulnificus flagellum, was expressed as a recombinant protein, named rFlaB. After immunization of mice with rFlaB, the mice were challenged by subcutaneous inoculation with V. vulnificus. Bacterial burdens in muscular tissue at the infection site in rFlaB-immunized mice were significantly decreased compared with those of control mice. We found that rFlaB immunization can partially suppress proliferation of V. vulnificus at the local infection site.