Natural Underwater Bioadhesive Offering Cohesion Modulation via Hydrogen Bond Disruptor: A Highly Injectable and in Vivo Stable Remedy for Gastric Ulcer Resolution.

Injectable bioadhesives are attractive for managing gastric ulcers through minimally invasive procedures. However, the formidable challenge is to develop bioadhesives that exhibit high injectability, rapidly adhere to lesion tissues with fast gelation, provide reliable protection in the harsh gastric environment, and simultaneously ensure stringent standards of biocompatibility. Here, a natural bioadhesive with tunable cohesion is developed based on the facile and controllable gelation between silk fibroin and tannic acid. By incorporating a hydrogen bond disruptor (urea or guanidine hydrochloride), the inherent network within the bioadhesive is disturbed, inducing a transition to a fluidic state for smooth injection (injection force <5 N). Upon injection, the fluidic bioadhesive thoroughly wets tissues, while the rapid diffusion of the disruptor triggers instantaneous in situ gelation. This orchestrated process fosters the formed bioadhesive with durable wet tissue affinity and mechanical properties that harmonize with gastric tissues, thereby bestowing long-lasting protection for ulcer healing, as evidenced through in vitro and in vivo verification. Moreover, it can be conveniently stored (≥3 m) postdehydration. This work presents a promising strategy for designing highly injectable bioadhesives utilizing natural feedstocks, avoiding any safety risks associated with synthetic materials or nonphysiological gelation conditions, and offering the potential for minimally invasive application.

Analysis of risk factors associated with endoscopic retrograde cholangiopancreatography for patients with liver cirrhosis: a multicenter, retrospective, clinical study.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is the endoscopic modality of choice for the treatment of biliary and pancreatic diseases. However, patients with cirrhosis, particularly those with decompensated cirrhosis, are believed to be at increased risk for complications associated with ERCP. There is a paucity of literature describing the outcomes of ERCP for patients with cirrhosis. This study aimed to investigate the outcomes of ERCP for cirrhosis patients, especially adverse events, and evaluated its safety and efficacy. METHODS: We performed a multicenter, retrospective study of all patients at Beijing Friendship Hospital affiliated to Capital Medical University, Xijing Hospital affiliated to Air Force Military Medical University, Beijing Youan Hospital affiliated to Capital Medical University, and the Fifth Medical Center of the People's Liberation Army General Hospital from June 2003 to August 2019. The adverse events of inpatient ERCP for patients with ( n  = 182) and without liver cirrhosis (controls; n  = 385) were compared. RESULTS: A total of 567 patients underwent ERCP between January 2003 and December 2019 were enrolled in this study. Compared to patients without cirrhosis, patients with cirrhosis were at higher risk for postoperative complications (odds ratio [OR], 4.172; 95% confidence interval [CI], 1.232-7.031; P  < 0.001) such as postoperative pancreatitis (OR, 2.026; 95% CI, 1.002-4.378; P  = 0.001) and cholangitis (OR, 3.903; 95% CI, 1.001-10.038; P  = 0.036). The main indications for ERCP for patients with cirrhosis in this study included choledocholithiasis (101 cases; 55.5%), benign bile duct strictures (46 cases; 25.3%), and malignant bile duct strictures (28 cases; 15.4%). Among them, 23 patients (12.6%) underwent balloon dilation and 79 patients (43.4%) underwent sphincterotomy. Of the patients with cirrhosis, delayed bleeding occurred in ten patients (5.5%), postoperative pancreatitis occurred in 80 patients (44.0%), and postoperative cholangitis occurred in 25 patients (13.7%). An additional multivariate analysis showed that the total bilirubin (TBIL) level (OR, 4.58; 95% CI, 2.37-6.70) and Child-Pugh score of C (OR, 3.11; 95% CI, 1.04-5.37) were risk factors for postoperative complications in patients with cirrhosis. CONCLUSIONS: Compared with the general population of patients undergoing ERCP, patients with cirrhosis were more prone to postoperative pancreatitis and cholangitis. TBIL levels and Child-Pugh scores were risk factors for postoperative complications in patients with cirrhosis.

Efficacy of single- versus split-dose polyethylene glycol electrolyte solution for morning colonoscopy: A randomized controlled study.

BACKGROUND: Split-dose (SPD) regimen has been proved more effective than a single-dose (SID) regimen for various drug preparations; however, limited data have focused on morning colonoscopy. We implemented this study to compare the bowel cleanliness and tolerability of a same-day SID versus SPD 2 L polyethylene glycol electrolyte solution (PEG) for morning colonoscopy. METHODS: Patients undergoing morning colonoscopy were randomized into two groups, SID or SPD. In the SID group, patients had to complete 2 L PEG between 4 and 6 am on the day of colonoscopy. In the SPD group, patients had to complete 1 L PEG between 8 and 9 pm on the day before followed by another 1 L PEG between 5 and 6 am on the day of colonoscopy. Colonoscopy was performed between 8 and 12 am under anesthesia. Investigators and endoscopists were blinded to the allocation. The primary end point was the effectiveness of bowel cleansing according to the Boston Bowel Preparation Scale (BBPS). The secondary outcomes were polyp detection rate, compliance, tolerability, and patient satisfaction. RESULTS: Overall, there were 147 and 148 patients in the SID and SPD group, respectively. The SPD group had a better quality of bowel preparation than the SID group with a total BBPS score of 7.25 ± 1.53 versus 6.71 ± 1.65 (P = 0.005). No difference in the polyp detection rate was noted, although more polyps were detected in the SPD group. More patients felt acceptable with the bowel preparation regimen in the SPD group compared to the SID group (76% vs. 65%, P = 0.03). The adverse events were more commonly observed in the SID group, presented as nausea and vomiting. CONCLUSION: For morning colonoscopy, split-dose 2 L PEG is superior to single-dose 2 L PEG by improved bowel preparation, better tolerability, and patient satisfaction.

[Terminal-restriction fragment length polymorphism analysis of diversity of mucosa-associated microbiota in patients with Crohn's disease].

OBJECTIVE: To explore the differences of colonic mucosal-associate bacterial diversity between the patients with Crohn's disease (CD) and healthy controls. METHODS: Eight CD patients and 23 healthy controls were recruited from September 2010 to December 2011 at West China Hospital. One biopsy were taken from cecum of every patient with CD and healthy control by endoscopic examination. The diversity of colonic mucosa-associated microbiota was detected by terminal-restriction fragment length polymorphism (T-RFLP) . Hierarchical cluster analysis were performed to compare the similarity of microbial communities between CD patients and healthy controls. Differences of bacterial diversity between two groups were also evaluated. The difference of predominant terminal-restrict fragments (T-RF) were analyzed and the bacterium predicted by predominant T-RFs were identified according to MiCA database. RESULTS: Hierarchical cluster analysis showed that the mucosal microbial community of CD patients differed from healthy controls. And there were more similarities in the samples of same group than that of different groups. Compared with healthy control group, the richness of mucosal microbiota in CD patients was lower (HaeIII:7 ± 4 vs 10 ± 8, P = 0.048; MspI+HaeIII:20 ± 10 vs 24 ± 12, P = 0.036). Shannon-Wiener index of CD patients was lower than healthy control (1.7 ± 0.7 vs 2.0 ± 0.5, P = 0.220) with no significant difference. Species evenness and Simpson index of CD patients were significantly greater than healthy controls (0.84 ± 0.14 vs 0.77 ± 0.13, P = 0.045; 0.25 ± 0.16 vs 0.22 ± 0.15, P = 0.038) . The T-RF of 37, 40 and 66 bp digested with MspI enzyme predominated in CD patients. Relative quantitative analysis showed 35 bp T-RF digested with MspI was significantly higher in CD patients than that in healthy controls (36.8% (23.0%, 55.4%) vs 14.3% (9.5%, 19.5%), P = 0.001), and 74, 141, 486, 490 bp T-RFs were all significantly lower than healthy controls (3.2% (1.3%, 5.1%) vs 10.2% (5.4%, 17.3%), P = 0.001; 4.5% (1.7%, 7.1%) vs 10.8% (5.9%, 21.1%), P = 0.007; 4.2% (1.6%, 5.3%) vs 7.6% (5.9%, 9.3%), P = 0.022; 3.6% (2.4%, 6.1%) vs 18.3% (9.9%, 43.2%), P = 0.008). The mucosal bacterial community composition in CD patients was predominated by Firmicutes, Proteobacterium and Actinobacterium. Compare with healthy control, Bacteroides were significantly reduced in CD patients while Firmicutes (e.g. Enterobacter sp.) and Actinomycetaceae significantly increased. CONCLUSIONS: Dysbiosis of mucosal microbiota occurs in CD with decreases of richness and biodiversity. Increased Enterobacter sp., Actinobacterium and decreased Bacteroides may play an important role in the pathogenesis of CD.

[A retrospective analysis of azathioprine in the treatment of 24 patients with refractory ulcerative colitis].

OBJECTIVE: To evaluate the efficacy and safety of azathioprine (AZA) in the treatment of refractory ulcerative colitis (UC). METHODS: Retrospective analysis of the clinical improvement, endoscopic improvement and mucosal healing rate, inflammation marker improvement after AZA administration and its safety in 24 refractory UC patients were performed, who were recruited between January 2007 and December 2011 in West China Hospital, Sichuan University, China. RESULTS: Twenty-four patients were enrolled, with a median age of 36 years old and a median course of 4 years. Among them, 14 cases were moderate UC and 10 cases were severe UC. The patients were treated with AZA in a dose of (1.23 ± 0.34) mg×kg(-1)×d(-1) from 7 weeks to 42 months. Efficacy was judged by Mayo disease activity index. At 3 months, 6 months and 1 year after treatment, the effective rates were 73.9% (17/23), 81.8% (18/22) and 14/16 respectively, and the remission rates were 17.4% (4/23), 54.5% (12/22) and 12/16 respectively. Both ESR and C reactive protein level after treatment for 6 months and 1 year were significantly lower than those before treatment [(9.3 ± 8.9) mm/1h, (10.9 ± 7.3) mm/1h vs (22.3 ± 10.7) mm/1h; 2.5(1.0-22.3) mg/L, 2.3(1.0-28.0) mg/L vs 18.4(3.6-137.0) mg/L; all P < 0.05]. Corticosteroid withdrawal rates at 3 months and 1 year after AZA treatment were 16/18 and 15/16, respectively. At 6 months and 1 year after AZA treatment, the endoscopic improvement rates were 85.7% (18/21) and 13/15 respectively; the endoscopic remission rates were 61.9% (13/21) and 11/15 respectively; and the mucosal healing rates were 61.9% (13/21) and 11/15 respectively. Adverse effects were occurred in 8 patients. Leukopenia was the most common adverse effect, followed by liver function injury, alopecia and epigastric discomfort. CONCLUSIONS: AZA is effective in the treatment of refractory UC patients with a low dose of (1.23 ± 0.34) mg×kg(-1)×d(-1), especially in the steroid withdrawing, maintaining remission and mucosal healing without severe adverse effects.

[Primary intestinal non-Hodgkin's lymphoma: a retrospective study of 85 cases].

OBJECTIVE: To review the clinical characteristics and treatment outcomes of primary intestinal non-Hodgkin's lymphomas (PINHL) and analyze the differences between T-cell and B-cell lymphomas. METHODS: The characteristics of PINHL patients treated in our hospital between January 2003 and December 2010 were reviewed for their clinical manifestations, diagnosis, endoscopic findings, treatments and outcomes. RESULTS: Eighty-five cases of PINHL meeting the Dawson's criteria were identified. The median age of the patients at the time of diagnosis was 52 years and the male: female ratio was 3.05:1; 58 cases (68.2%) had B-lineage and 27 cases (31.8%) had T-cell lineage lymphomas. Compared to those with B-cell lymphoma, patients with T-cell lymphomas showed a younger age of disease onset (32 vs 56 years, P<0.01) and presented with a greater incidence of such symptoms as fever, hematochezia, diarrhea and night sweats (P<0.05); T-cell lymphoma showed more multifocal and ulcerative/ulcero-infiltrative lesions under endoscope with a longer diagnosis time (4 vs 2 months, P<0.01) and a greater likeliness of misdiagnosis (16/27 vs 12/58, P<0.01) and poor prognosis. Extranodal NK/T-cell lymphoma was the most common type of T-cell lymphomas. CONCLUSION: In our cases, T-cell lymphoma appeared to be more common than B-cell lymphoma with a younger onset age, more difficult diagnosis, a greater likeliness of misdiagnosis, poorer prognosis and more extranodal NK/T-cell lymphoma.

[Effects of ginsenoside Rg1 on expression of insulin-like growth factor-1 in brain of rats with brain contusion].

OBJECTIVE: To study the effects of ginsenoside Rg1 on the expression of insulin-like growth factor-1 (IGF-1) in the brain of rats after the experimental brain contusion. METHODS: A total of twenty-six Wistar rats were randomly divided into normal control group (n=2), untreated group (n=8) and ginsenoside Rg1 group (n=16). Brain injuries were induced in rats by a mechanical striking device. The brain tissues were extracted at different times after brain injury (6th hour, 12th hour, 2nd day, 6th day), then the expression of IGF-1 in brain tissue was examined by immunohistochemical method. RESULTS: In comparison with the normal control group, the expression of IGF-1 in the brain tissues was increased in the untreated group after the brain contusion (P<0.05). The expression of IGF-1 in brain tissues in ginsenoside Rg1 group was significantly increased as compared with the untreated group (P<0.05). CONCLUSION: Ginsenoside Rg1 enhances the recovery of the contused brain through increasing the expression of IGF-1.