Yangyin Huowei mixture alleviates chronic atrophic gastritis by inhibiting the IL-10/JAK1/STAT3 pathway.

BACKGROUND: The Chinese medicine Yangyin Huowei mixture (YYHWM) exhibits good clinical efficacy in the treatment of chronic atrophic gastritis (CAG), but the mechanisms underlying its activity remain unclear. AIM: To investigate the therapeutic effects of YYHWM and its underlying mechanisms in a CAG rat model. METHODS: Sprague-Dawley rats were allocated into control, model, vitacoenzyme, and low, medium, and high-dose YYHWM groups. CAG was induced in rats using N-methyl-N'-nitro-N-nitrosoguanidine, ranitidine hydrochloride, hunger and satiety perturbation, and ethanol gavage. Following an 8-wk intervention period, stomach samples were taken, stained, and examined for histopathological changes. ELISA was utilized to quantify serum levels of PG-I, PG-II, G-17, IL-1ß, IL-6, and TNF-α. Western blot analysis was performed to evaluate protein expression of IL-10, JAK1, and STAT3. RESULTS: The model group showed gastric mucosal layer disruption and inflammatory cell infiltration. Compared with the blank control group, serum levels of PGI, PGII, and G-17 in the model group were significantly reduced (82.41 ± 3.53 vs 38.52 ± 1.71, 23.06 ± 0.96 vs 11.06 ± 0.70, and 493.09 ± 12.17 vs 225.52 ± 17.44, P < 0.01 for all), whereas those of IL-1ß, IL-6, and TNF-α were significantly increased (30.15 ± 3.07 vs 80.98 ± 4.47, 69.05 ± 12.72 vs 110.85 ± 6.68, and 209.24 ± 11.62 vs 313.37 ± 36.77, P < 0.01 for all), and the protein levels of IL-10, JAK1, and STAT3 were higher in gastric mucosal tissues (0.47 ± 0.10 vs 1.11 ± 0.09, 0.49 ± 0.05 vs 0.99 ± 0.07, and 0.24 ± 0.05 vs 1.04 ± 0.14, P < 0.01 for all). Compared with the model group, high-dose YYHWM treatment significantly improved the gastric mucosal tissue damage, increased the levels of PGI, PGII, and G-17 (38.52 ± 1.71 vs 50.41 ± 3.53, 11.06 ± 0.70 vs 15.33 ± 1.24, and 225.52 ± 17.44 vs 329.22 ± 29.11, P < 0.01 for all), decreased the levels of IL-1ß, IL-6, and TNF-α (80.98 ± 4.47 vs 61.56 ± 4.02, 110.85 ± 6.68 vs 89.20 ± 8.48, and 313.37 ± 36.77 vs 267.30 ± 9.31, P < 0.01 for all), and evidently decreased the protein levels of IL-10 and STAT3 in gastric mucosal tissues (1.11 ± 0.09 vs 0.19 ± 0.07 and 1.04 ± 0.14 vs 0.55 ± 0.09, P < 0.01 for both). CONCLUSION: YYHWM reduces the release of inflammatory factors by inhibiting the IL-10/JAK1/STAT3 pathway, alleviating gastric mucosal damage, and enhancing gastric secretory function, thereby ameliorating CAG development and cancer transformation.

Cyberpharmacology uncover the mechanism of the total Rhizoma Coptidis extracts ameliorate chronic atrophic gastritis.

ETHNOPHARMACOLOGICAL RELEVANCE: Characterized by inflammation of the gastric mucosa, atrophy of gastric gland cells, and intestinal metaplasia, Chronic Atrophic Gastritis (CAG) is a precancerous lesion disease. In traditional Chinese medicine, Rhizoma Coptidis (RC) is extensively used for treating gastrointestinal disorders, mainly because RC alkaloids-based extracts are the main active pharmaceutical ingredients. Total Rhizoma Coptidis extracts (TRCE) is a mixture of Rhizoma Coptidis extracts from Rhizoma Coptidis with alkaloids as the main components. However, the efficacy and mechanism of TRCE on CAG need further study. AIM OF THE STUDY: To explore the therapeutic effect and underlying mechanisms of action of TRCE on N-methyl-N'-nitro-N-nitrosoguanidine (MNNG)-induced chronic atrophic gastritis (CAG) using network pharmacological analysis. MATERIALS AND METHODS: The amelioration effect of TRCE on CAG was evaluated in MNNG-induced CAG mice. The pathological severity of the mice was evaluated through H&E staining. Detection of gastric mucosal parietal cell loss was conducted using immunofluorescence staining, and serum indices were measured using ELISA. Additionally, the active compounds and drug targets of Rhizoma Coptidis were curated from the STP, SEA, and TCMSP databases, alongside disease targets of CAG sourced from PharmGkb, OMIM, and GeneCards databases. By mapping drug targets to disease targets, overlapping targets were identified. A shared protein-protein interaction (PPI) and drug target network were constructed for the overlapping targets and analyzed for KEGG enrichment. RESULTS: The results of animal experiments demonstrate that TRCE has the potential to improve the CAG process in mice. In conjunction with disease characteristics, cyberpharmacology analysis has identified nine core compounds, 151 targets, 10 core targets, and five significant inflammatory pathways within the compound-target-pathway network. Furthermore, there is a remarkable coincidence rate of 98% between the core compound targets of TRCE and the targets present in the CAG disease database. The accurate search and calculation of literature reports indicate that the coverage rate for 121 predicted core targets related to CAG reaches 81%. The primary characteristic of CAG lies in its inflammatory process. Both predicted and experimental findings confirm that TRCE can regulate ten key inflammation-associated targets (TP53, STAT3, AKT1, HSP90AA1, TNF, IL-6, MAPK3, SRC, JUN, and HSP90AA1) as well as inflammation-related pathways (MAPK, HIF-1, Toll-Like Receptor, IL-17, TNF, and other signaling pathways). These mechanisms mitigate inflammation and reduce gastric mucosal damage in CAG mice. CONCLUSIONS: In conclusion, TRCE was shown to alleviate CAG by modulating TP53, STAT3, AKT1, HSP90AA1, TNF, IL-6, MAPK3, SRC, JUN, and EGFR, as demonstrated by combined network pharmacology and biological experiments. In conclusion, our study provides a robust foundation for future clinical trials evaluating the efficacy of RC in treating CAG.

Effectiveness of serological markers of gastric mucosal atrophy in the gastric precancer screening and in cancer prevention.

BACKGROUND: New markers are needed to improve the effectiveness of serological screening for atrophic gastritis. AIM: To develop a cost-effective method for serological screening of atrophic gastritis with a high level of sensitivity. METHODS: Of the 169 patients with atrophic gastritis, selected by the visual endoscopic Kimura-Takemoto method, 165 showed histological mucosal atrophy using the updated Kimura-Takemoto method. All 169 patients were examined for postprandial levels of gastrin-17 (G17) and pepsinogen-1 (PG1) using GastroPanel® (Biohit Plc, Helsinki, Finland). RESULTS: We used the histological standard of five biopsies of the gastric mucosa, in accordance with the Kimura-Takemoto classification system to assess the sensitivity of G17 in detecting gastric mucosal atrophy. We also compared the morpho-functional relationships between the detected histological degree of gastric mucosal atrophy and the serological levels of G17 and PG1, as the markers of atrophic gastritis. The sensitivity of postprandial G17 was 62.2% for serological levels of G17 (range: 0-4 pmol/L) and 100% for serological G17 (range: 0-10 pmol/L) for the detection of monofocal severe atrophic gastritis. No strong correlation was found between the levels of PG1 and degree of histological atrophy determined by the Kimura-Takemoto classification system to identify the severity of mucosal atrophy of the gastric corpus. In the presented clinical case of a 63-year-old man with multifocal atrophic gastritis, there is a pronounced positive long-term dynamics of the serological marker of atrophy - postprandial G17, after five months of rennet replacement therapy. CONCLUSION: Serological screening of multifocal atrophic gastritis by assessment of postprandial G17 is a cost-effective method with high sensitivity. Postprandial G17 is an earlier marker of regression of atrophic gastritis than a morphological examination of a gastric biopsy in accordance with the Sydney system. Therefore, postprandial G17 is recommended for dynamic monitoring of atrophic gastritis after treatment.

Evaluation of Surgical Outcomes of Zygomatic Implant-Supported Rehabilitation of Atrophic Maxillary Arches - A Prospective Study.

Introduction: Prosthetic rehabilitation with implants in the atrophic edentulous maxilla often requires a bone augmentation procedure to enable implant placement and integration. However, rigid anchorage can also be achieved using long zygomatic implants. The aim of this study was to evaluate the surgical outcomes of rehabilitation of atrophic posterior maxillary ridges with zygomatic implants using the zygomatic success code (ZSC) and derive the success grade for the procedure based on the observed results. Materials and Methods: A total of eight implants were placed in an extrasinus technique based on the zygomatic anatomy-guided approach. The following were evaluated postoperatively - primary stability, maxillary sinus pathology, soft-tissue healing and prosthetic offset. The ZSC score was calculated, and success grading was given with ZSC based on Aparacio et al.,'s guidelines. Results: One implant had Grade 1 mobility and partial maxillary sinus opacification, 25% (n = 2) revealed a mild recession exposing the implant head and 12.5% (n = 1) showed significant recession up to 7 mm. The prosthetic offset of zygomatic implants was scored -1 for all eight implants. Five implants were given a success code of 1/1/1/1 and a success grade of Grade I, two implants were given code 1/1/2/1 with Grade II and one implant 2/2/3/1 and grade III. The results imply that zygomatic implants can be a successful option in maxillary rehabilitation. Discussion: The zygomatic implants, as a graft less and promising solution to the rehabilitation of atrophied maxillary arches, have excellent surgical outcomes with varied advantages.

Slow Mohs Micrographic Surgery and Reconstruction With Artificial Dermis for Atrophic Dermatofibrosarcoma Protuberans: A Case Report.

This case report describes the utility of artificial dermis in reconstruction for atrophic dermatofibrosarcoma protuberans (DFSP) after slow Mohs micrographic surgery (MMS). A 34-year-old man presented as a slowly growing nodule from an atrophic scar on his right chest for over 10 years. The pathology report confirmed the diagnosis of atrophic DFSP. Further magnetic resonance imaging (MRI) revealed a 9.3 cm x 6.5 cm cutaneous-subcutaneous lesion with close contact with the pectoralis major muscle. The patient underwent a slow MMS, and we utilized a rotational flap in combination with synthetic xenogeneic artificial dermis to reconstruct the final 13 cm x 12 cm defect.

The Investigation of B12 Deficiency Leading to the Serendipitous Diagnosis of Gastric Carcinoid Tumour.

Gastric carcinoid is a rare type of gastric malignancy accounting for around 7% of all gastrointestinal neuroendocrine tumours (NETs). While most gastric NETs (gNETs) are readily visible through direct visualisation by upper endoscopy, around 25% of gastric carcinoids are invisible because they are located in the submucosal gastric regions of the body and fundus. gNETs located in the intra-mucosal areas can be identified by gastric mapping; this can be done by taking random gastric biopsies from the antrum, body and fundus. We report a case of a well-differentiated gastric NET type 1 with atrophic gastritis diagnosed on upper endoscopy and pathological immunohistochemistry staining. LEARNING POINTS: The case highlights that not all gNETs are visible under direct endoscopic visualisation.It is essential to understand the different types of gNETs.Understand that both type and size of gNETs impact therapeutic implications and prognosis.

Four-mm-short implants in the rehabilitation of posterior atrophic jaws: A retrospective study on 212 patients with a mean follow-up of 8.02 years.

OBJECTIVE: This study aimed to assess clinical efficacy of 4-mm-short implants in patients with posterior severe vertical bone atrophy in the medium- and long-term follow-up. MATERIALS AND METHODS: Patients rehabilitated with 4-mm-short implants in the posterior atrophic jaws, with a minimum follow-up of 3 years post-loading, were included in the study. Data were collected for eligible patients, and marginal bone loss (MBL) for each implant was evaluated. The research outcomes were implant failure, MBL and complications. RESULTS: A total of 212 patients with 496 implants were included, resulting in a mean follow-up of 8.02 ± 2.17 years. The implant survival rate was 95.36% (95% CI: 93.12%-97.04%). More implant failures were observed in the maxilla (p = .02) and fewer failures were observed in patients undergoing more number of hygienic sessions per year (p < .001). The average MBL after 1-year-loading was 0.47 mm, increasing to 0.59 mm after 10 years; after 3 years no statistically significant increase in MBL was observed. Maxillary implants showed greater bone loss than mandibular ones (p < .001). More frequent professional oral hygiene sessions per year resulted being related with reduced MBL (p < .001). CONCLUSIONS: Four-mm-short implants showed high survival rates with an up to 10-year follow-up. Their use can offer a fixed prosthetic solution for patients with posterior vertical bone atrophy, minimizing surgical invasiveness, rehabilitative times and costs.

Validity of rapid urease test using swab of gastric mucus to mucosal forceps and 13 C-urease breath test: a multicenter prospective observational study.

BACKGROUND: Theoretically, a rapid urease test (RUT) using a swab of the gastric wall (Swab-RUT) for Helicobacter pylori (H. pylori) is safe. However, the validity and utility of Swab-RUT remain unclear. Therefore, we assessed the validity and utility of Swab-RUT compared to RUT using mucosal forceps of the gastric wall (Forceps-RUT) and 13C-urea breath test (UBT). METHODS: This study was a multicenter prospective observational study. When the examinees were suspected of H. pylori infection during esophagogastroduodenoscopy, we performed Swab-RUT and Forceps-RUT continuously. When the examinees were not suspected of H. pylori infection, we performed Swab-RUT alone. We validated the status of H. pylori infection using UBT. RESULTS: Ninety-four examinees were enrolled from four institutions between May 2016 and December 2020 (median age [range], 56.5 [26-88] years). In this study, the sensitivity, specificity, and accuracy of Swab-RUT to UBT were 0.933 (95% confidence interval: 0.779-0.992), 0.922 (0.827-0.974), and 0.926 (0.853-0.970), respectively. The Kappa coefficient of Swab-RUT to UBT was 0.833, and that of Swab-RUT to forceps-RUT was 0.936. No complications were observed in this study. CONCLUSIONS: Swab-RUT is a valid examination for the status of H. pylori infection compared to the conventional Forceps-RUT.

Occurrence and characteristics of endoscopic gastric polyps in patients with autoimmune gastritis (AGAPE study): A multicentric cross-sectional study.

BACKGROUND: Autoimmune gastritis (AIG) leads to increased gastrin (G) levels due to hypo-achlorhydria, providing proliferative stimuli on the gastric mucosa. AIMS: To evaluate the incidence and characteristics of gastric polyps in AIG patients across six tertiary centers in Italy. METHODS: A multicentric, cross-sectional study enrolled patients with AIG diagnosed from January 2000 to June 2023, who underwent at least one endoscopy. Data on demographics, clinical history, biochemical profiles, and endoscopic and histopathological findings were systematically collected. RESULTS: Among 612 AIG patients followed for a median of 4 years, 222 (36.3 %) developed at least one gastric polyp. Of these, 214 were non-endocrine lesions detected in 162 patients, including 151 inflammatory (70.5 %), 29 adenomatous (13.6 %), 18 fundic gland polyps (8.4 %), 13 adenocarcinomas (6.1 %), and one MALT lymphoma. Additionally, 108 patients had gastric neuroendocrine neoplasms (gNENs), with 48 also having non-endocrine polyps. Older age and higher gastrin and chromogranin A levels were associated with polyp occurrence. No differences in OLGA/OLGIM stages or Helicobacter pylori status were noted among patients with and without lesions. CONCLUSION: This large multicentric study underscores the substantial occurrence of gastric polyps in AIG patients, including notable rates of gNENs and adenocarcinomas, emphasizing the importance of proactive endoscopic surveillance and histopathological examination for effective management.

[Prospects for the use of ozone therapy and low-intensity laser therapy in the treatment of atrophic pharyngitis]. / Perspektivy primeneniya ozonoterapii i nizkointensivnoi lazeroterapii pri lechenii atroficheskogo faringita.

Chronic pharyngitis (CP) is one of the most common diseases of the oropharynx. The number of referrals from patients with CP reaches 70% of the total number of referrals to an otorhinolaryngologist. The development of this disease is facilitated by the neuro-reflex factor and a violation of trophic and metabolic processes. It should be noted that of all forms of CP, the greatest impact on the quality of life is noted precisely in atrophic pharyngitis (AP), due to the presence of pronounced subjective sensations from the oropharynx. Many of the modern methods of treatment do not provide a lasting effect due only to the application, superficial local effect on the altered mucous membrane of the posterior pharyngeal wall, without taking into account the changes caused by a violation of trophic processes in the tissue. A promising direction in the treatment of atrophic pharyngitis is the use of a combined technique - ozone therapy and low-intensity laser therapy. The article presents the results of the application of fine-drip irrigation of the mucous membrane of the posterior pharyngeal wall with Ozonide oil in combination with low-intensity laser radiation on the projection of vessels supplying blood to the middle parts of the oropharynx. OBJECTIVE: Improving the effectiveness of treatment of patients with atrophic pharyngitis through the use of ozone therapy and low-intensity laser therapy. MATERIAL AND METHODS: A single-center experimental controlled randomized open-label study of 90 patients with AP aged 18 and over was conducted. All patients were randomly divided into three groups depending on the treatment performed: group I - traditional treatment method (rinsing the oropharynx with antiseptic solutions, the use of tablets for resorption), group II - treatment with ozone therapy (fine drip irrigation of the mucous membrane of the posterior pharyngeal wall with Ozonide oil), group III - treatment with ozone therapy and laser therapy. During the examination of patients, anamnesis collection, examination of ENT organs, cytological and microbiological examination of the mucous membrane of the posterior pharyngeal wall, contact endoscopy of the mucous membrane of the posterior pharyngeal wall were performed. 5-point visual analogue scales (VAS) were used to assess complaints and pharyngoscopic signs. RESULTS: Our results showed a statistically significant improvement in the quality of life of patients with AP (p=0.012), an improvement in the pharyngoscopic picture (p=0.003). The results obtained by us indicate an improvement in microcirculation under the influence of ozone therapy and low-intensity laser radiation. The technique using ozone therapy and low-intensity laser therapy is characterized by a bactericidal and fungicidal effect. There is a decrease in the total contamination of the posterior wall of the oropharynx with pathogenic and saprophytic microflora (there is a decrease in the contamination of the posterior wall of the pharynx with saprophytic and pathogenic microflora (p≤0.05), the differences are statistically significant). The technique using ozone therapy and low-intensity laser therapy has a pronounced anti-inflammatory effect, which was expressed in a decrease in the severity of dyskeratosis and hyperkeratosis. Thus, the use of ozone therapy in combination with laser therapy opens up new prospects for pathogenetically sound and effective treatment of AP.

Treating chronic atrophic gastritis: identifying sub-population based on real-world TCM electronic medical records.

Background and Objective: Chronic atrophic gastritis (CAG) is a complex chronic disease caused by multiple factors that frequently occurs disease in the clinic. The worldwide prevalence of CAG is high. Interestingly, clinical CAG patients often present with a variety of symptom phenotypes, which makes it more difficult for clinicians to treat. Therefore, there is an urgent need to improve our understanding of the complexity of the clinical CAG population, obtain more accurate disease subtypes, and explore the relationship between clinical symptoms and medication. Therefore, based on the integrated platform of complex networks and clinical research, we classified the collected patients with CAG according to their different clinical characteristics and conducted correlation analysis on the classification results to identify more accurate disease subtypes to aid in personalized clinical treatment. Method: Traditional Chinese medicine (TCM) offers an empirical understanding of the clinical subtypes of complicated disorders since TCM therapy is tailored to the patient's symptom profile. We gathered 6,253 TCM clinical electronic medical records (EMRs) from CAG patients and manually annotated, extracted, and preprocessed the data. A shared symptom-patient similarity network (PSN) was created. CAG patient subgroups were established, and their clinical features were determined through enrichment analysis employing community identification methods. Different clinical features of relevant subgroups were correlated based on effectiveness to identify symptom-botanical botanical drugs correspondence. Moreover, network pharmacology was employed to identify possible biological relationships between screened symptoms and medications and to identify various clinical and molecular aspects of the key subtypes using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis. Results: 5,132 patients were included in the study: 2,699 males (52.60%) and 2,433 females (47.41%). The population was divided into 176 modules. We selected the first 3 modules (M29, M3, and M0) to illustrate the characteristic phenotypes and genotypes of CAG disease subtypes. The M29 subgroup was characterized by gastric fullness disease and internal syndrome of turbidity and poison. The M3 subgroup was characterized by epigastric pain and disharmony between the liver and stomach. The M0 subgroup was characterized by epigastric pain and dampness-heat syndrome. In symptom analysis, The top symptoms for symptom improvement in all three subgroups were stomach pain, bloating, insomnia, poor appetite, and heartburn. However, the three groups were different. The M29 subgroup was more likely to have stomach distention, anorexia, and palpitations. Citrus medica, Solanum nigrum, Jiangcan, Shan ci mushrooms, and Dillon were the most popular botanical drugs. The M3 subgroup has a higher incidence of yellow urine, a bitter tongue, and stomachaches. Smilax glabra, Cyperus rotundus, Angelica sinensis, Conioselinum anthriscoides, and Paeonia lactiflora were the botanical drugs used. Vomiting, nausea, stomach pain, and appetite loss are common in the M0 subgroup. The primary medications are Scutellaria baicalensis, Smilax glabra, Picrorhiza kurroa, Lilium lancifolium, and Artemisia scoparia. Through GO and KEGG pathway analysis, We found that in the M29 subgroup, Citrus medica, Solanum nigrum, Jiangcan, Shan ci mushrooms, and Dillon may exert their therapeutic effects on the symptoms of gastric distension, anorexia, and palpitations by modulating apoptosis and NF-κB signaling pathways. In the M3 subgroup, Smilax glabra, Cyperus rotundus, Angelica sinensis, Conioselinum anthriscoides, and Paeonia lactiflora may be treated by NF-κB and JAK-STAT signaling pathway for the treatment of stomach pain, bitter mouth, and yellow urine. In the M0 subgroup, Scutellaria baicalensis, Smilax glabra, Picrorhiza kurroa, Lilium lancifolium, and Artemisia scoparia may exert their therapeutic effects on poor appetite, stomach pain, vomiting, and nausea through the PI3K-Akt signaling pathway. Conclusion: Based on PSN identification and community detection analysis, CAG population division can provide useful recommendations for clinical CAG treatment. This method is useful for CAG illness classification and genotyping investigations and can be used for other complicated chronic diseases.

Prosthodontic criteria for maxillary immediate occlusal loading, surgical classifications of atrophic maxillae, and presentation of a new implant/anatomic classification system for immediate maxillary rehabilitation.

PURPOSE: Immediate full-arch occlusal loading for patients with atrophic edentulous maxillae satisfies critical needs for this specific type of edentulous patient after placement of implants with high levels of primary implant stability. The needs include improved aesthetics, limited immediate improved function, and elimination of removable prostheses. Classification systems exist for edentulous maxillae but they do not include specifics regarding posterior implant placement. In conjunction with anterior implants, posterior implants improve Anterior/Posterior (A/P) spreads, decrease cantilevered segments (CLs), and likely will improve implant and prosthetic success rates. The purposes of this article include presenting a new classification system that outlines the different types of implants now available which will likely achieve the requisite primary stability for immediate fixed rehabilitation. This proposed classification system identifies a relationship between different implant options currently available and the remaining quantity of bone in the first and second maxillary molar zones. MATERIALS AND METHODS: The available literature regarding current classification systems was reviewed. The benefits and limitations of each system were described. The parameters associated with Immediate Occlusal Loading (IOL) for full arch maxillary prostheses include: posterior cantilever lengths of full arch fixed prostheses; existing A/P spread considerations for full arch prostheses; and introduction of a new classification system for atrophic posterior maxillary edentulous ridges were identified. RESULTS: Currently, there are no available classification systems that outline specific implant options for posterior maxillae which will likely achieve the minimum primary stability needed for immediate rehabilitation. A new classification system was proposed where the rationale was to show clinicians that when a certain amount of bone remains in the posterior maxilla, there are specific implants designed to maximize primary stability. High implant primary stability is required for rehabilitation with immediate fixed implant-supported provisional prostheses. The proposed classification system assists clinicians in understanding what implant geometry is available and can be expected to achieve the requisite primary stability for immediate occlusal loading based on the available bone in the posterior maxillary molar zone. CONCLUSIONS: This article reviewed current classification systems for edentulous maxillary patients, as well as clinical parameters required for full arch, immediate occlusal loading.  It also presented a new classification system to assist clinicians in selecting appropriate implants and surgical techniques for immediate fixed rehabilitation of patients with atrophic maxillae.

Comparative Evaluation of the Accuracy of Dynamic Navigation and Free Hand Methods During Zygomatic Implant Placement - A Randomized Controlled Trial.

To assess and compare the precision and predictability of zygomatic implants in atrophic maxilla using conventional and dynamic navigation methods. This study was a randomized controlled clinical trial conducted in patients requiring zygomatic implant placements in the atrophic maxilla. Forty zygomatic implants were placed in systemically healthy individuals. Zygomatic implant placement was done using the freehand technique in the control group, and the test group involved implant placement using a dynamic navigation system, and the entry, apex, and angular deviations were evaluated. The mean deviations at the site of entry (2D) in the navigation system (2.531.42) as compared to the free hand (4.151.29) were statistically significant. The variation in the free-hand group was greater than the navigation method at the apex (3D)(p<0.05). The navigation method had a higher accuracy in angular deviation than the freehand method (4.02±1.80 and 12.67±2.11). Also, the accuracy was checked on the right and left sides in both the conventional and dynamic groups. The dynamic navigation technology had better predictability in terms of accuracy and precision, and it's the need of the hour for clinicians to master this technology and thereby aid in better prognostic level of implant placements.

Chronic Atrophic Autoimmune Gastritis: The Evolving Role of Vitamin D.

Vitamin D possesses a crucial role in preserving bone health, modulating the immune system responses, and supporting various physiological functions throughout the body. Chronic atrophic autoimmune gastritis (CAAG) constitutes an autoimmune condition marked by inflammation and damage to the stomach cells, often resulting in a decreased ability to absorb certain nutrients, including vitamin B12 and iron. Although, vitamin D is not directly affected by this condition, the sufficiency of this micronutrient seems to have important implications for overall health and management of the disease. The aim of the current review was to assess the incidence and related features of vitamin D deficiency in patients with CAAG and to elucidate the complex regulatory role of this nutrient, in an effort to improve patient outcomes. Vitamin D greatly contributes to the regulation of the immune system. In patients with CAAG, the immune system attacks the stomach lining; thus, the maintenance of a healthy and balanced immune response is important. In autoimmune conditions such as CAAG, where inflammation plays a decisive role in disease progression, vitamin D could potentially exert a role in managing and controlling the associated symptoms. Adequate vitamin D levels may help in regulating the immune response and reducing inflammation. In addition, patients with CAAG are at risk of nutrient deficiencies, including vitamin B12 and iron, which can lead to anemia and bone health issues. As vitamin D is critical for calcium absorption and bone health, assurance of sufficient levels of this micronutrient can be beneficial in preventing or mitigating bone-related complications. In conclusion, regular monitoring of vitamin D levels, among other nutrients, and appropriate supplementation, when necessary, can help improve overall health and well-being in these patients.

Pepsinogen I, pepsinogen II, gastrin-17, and Helicobacter pylori serological biomarkers in the diagnosis of precursor lesions of gastric cancer.

Introduction: Atrophic gastritis and intestinal metaplasia are precursor lesions of gastric cancer. The aim of this study was to determine the usefulness of the biomarkers pepsinogen I(PgI), pepsinogen II (PgII), gastrin-17, and H. pylori antibodies in the identification of precursor lesions. Methods: We studied 129 patients with gastric symptoms. The biomarker status was determined using GastroPanel by means of the ELISA-technique. Results: Biomarkers detected atrophy in 14% of the subjects, and 49.6% had positive antibodies for H. pylori. A PgI/PgII ratio < 3 was an important risk biomarker for precursor lesions in our population (OR = 9.171, 95% CI: 1.723-48.799, p = 0.009); however, biomarkers showed low accuracy with histopathological study. Conclusions: In the Western Mexican population, precursor lesions (AG, IM) are common in adults (45%) with dyspepsia but infrequent in children (8%). H. pylori infection was detected in 41.3% of adults and 16.0% of children. Of the studied biomarkers, a PgI/PgII ratio < 3 was an important risk factor for precursor lesions such as AG or IM in our population, with an OR of 9.171 (95% CI: 1.723-48.799, p = 0.009).

Deoxycholic acid inducing chronic atrophic gastritis with colonic mucosal lesion correlated to mucosal immune dysfunction in rats.

The present study aimed to explore the underlying mechanism of bile reflux-inducing chronic atrophic gastritis (CAG) with colonic mucosal lesion. The rat model of CAG with colonic mucosal lesion was induced by free-drinking 20 mmol/L sodium deoxycholate to simulate bile reflux and 2% cold sodium salicylate for 12 weeks. In comparison to the control group, the model rats had increased abundances of Bacteroidetes and Firmicutes but had decreased abundances of Proteobacteria and Fusobacterium. Several gut bacteria with bile acids transformation ability were enriched in the model group, such as Blautia, Phascolarctobacter, and Enterococcus. The cytotoxic deoxycholic acid and lithocholic acid were significantly increased in the model group. Transcriptome analysis of colonic tissues presented that the down-regulated genes enriched in T cell receptor signaling pathway, antigen processing and presentation, Th17 cell differentiation, Th1 and Th2 cell differentiation, and intestinal immune network for IgA production in the model group. These results suggest that bile reflux-inducing CAG with colonic mucosal lesion accompanied by gut dysbacteriosis, mucosal immunocompromise, and increased gene expressions related to repair of intestinal mucosal injury.

Clinical Characteristics of Patients With Previous Helicobacter pylori Infection-Induced Atrophic Gastritis.

AIMS: Patients with atrophic gastritis unrelated to autoimmune gastritis (AIG) and without active Helicobacter pylori (H.pylori) infection or previous eradication therapy are considered to have previous Helicobacter pylori infection-induced atrophic gastritis (PHIG). This study aimed to clarify the clinical characteristics of patients with PHIG. METHODS: Consecutive patients who underwent upper gastrointestinal endoscopy during the study period were enrolled in the study. Pepsinogen and gastrin levels, H. pylori serology, and endoscopic atrophic grade were assessed. Patients were divided into five groups based on their H. pylori status and disease history (PHIG, without H. pylori infection, with active H. pylori infection, with successful H. pylori eradication, and AIG). Their gastric cancer risk status was classified according to the ABC method of serological gastric cancer screening. RESULTS: Of 536 consecutive patients who underwent upper gastrointestinal endoscopy during the study period, 318 were included (31 with PHIG, 77 without H. pylori infection, 101 with active H. pylori infection, 80 with successful H. pylori eradication, and 29 with AIG). Of the 31 patients with PHIG, 21 (68%) were H. pylori-seronegative, and 20 (65%) were classified as group A (normal pepsinogen, H. pylori-seronegative). Patients with PHIG accounted for 90.1% of the patients at high risk for gastric cancer misclassified as group A. The pepsinogen and H. pylori serological profiles of patients with PHIG were similar to those of patients with successful H. pylori eradication more than six years previously. A receiver-operating characteristic curve (ROC) analysis that included 13 patients with AIG and without active H. pylori infection and no previous eradication therapy and 31 patients with PHIG revealed that an endoscopic atrophy grade of O-III or greater according to the Kimura-Takemoto classification can predict AIG. CONCLUSIONS: Two-thirds of the patients with PHIG were misclassified as being at low risk (group A) according to the ABC method, suggesting that endoscopy is necessary for group A patients. The results of the serological evaluation of PHIG indicated that patients with PHIG may have experienced spontaneous H. pylori eradication, possibly because of the use of antibiotics for other conditions. Autoimmune gastritis should be considered in the presence of grade 0-III or greater gastric mucosal atrophy in patients with suspected PHIG, even if the autoantibody and histological findings are not available.

Yiqi Jiedu Huayu decoction inhibits precancerous lesions of chronic atrophic gastritis by inhibiting NLRP3 inflammasome-mediated pyroptosis.

BACKGROUND: Chronic atrophic gastritis (CAG) is a prevalent chronic gastritis usually accompanied by precancerous lesions such as intestinal metaplasia and dysplasia. The increasing application of traditional Chinese medicine in CAG treatment has shown promising results with low side effects and significant efficacy. AIM: To investigate the pharmacological effects of Yiqi Jiedu Huayu decoction (YJHD) on precancerous lesions of CAG. METHODS: A CAG rat model was established by Helicobacter pylori bacteria solution combined with N-methyl-N'-nitro-N-nitrosoguanidine. Histopathological measurements were conducted by hematoxylin-eosin and alcian blue and periodic acid-Schiff staining. Serum levels of inflammatory factors and gastric mucosal-related factors were examined using enzyme-linked immunosorbent assay. Protein and mRNA levels were quantified via western blot and quantitative real-time polymerase chain reaction analysis, respectively. Molecular interaction was verified by chromatin immunoprecipitation (ChIP) assay. RESULTS: YJHD greatly attenuated pathological changes in the gastric mucosa and precancerous lesions in CAG rats. Meanwhile, YJHD treatment reduced serum levels of inflammatory factors [interleukin (IL)-6, tumor necrosis factor-α and C-reactive protein] and increased serum levels of gastric mucosal-related factors (gastrin, pepsin, somatostatin and prostaglandin E2) in CAG rats. In addition, YJHD administration suppressed NLRP3 inflammasome-mediated cell pyroptosis, as well as the activation of TLR4/NF-κB and IL-6/STAT3 signaling pathways. Mechanically, ChIP experiments confirmed that NLRP3 transcription was regulated by TLR4/NF-κB and IL-6/STAT3 signaling. CONCLUSION: Taken together, YJHD alleviated NLRP3 inflammasome formation and pyroptosis of epithelial cells in CAG, potentially through the inactivation of TLR4/NF-κB and IL-6/STAT3 pathways.

An Overview on the Management of Atrophic Acne Scars: The Role of Trifarotene as an Adjunct.

Acne vulgaris is a common, often chronic inflammatory disease that can affect all ages and skin tones. Beyond acute lesions, the sequelae of acne - specifically scarring and dyspigmentation - can be long-lasting, challenging to treat and have substantial psychosocial impact on affected individuals. For acne scarring, treatment modalities include topical, physical, and laser and light therapies, with combination approaches typically yielding optimal outcomes. Trifarotene is a novel fourth generation retinoid with targeted action towards retinoid acid receptor gamma (RAR-γ), the most common isotype found in the epidermis, that has previously been approved for the management of moderate-to-severe facial and truncal acne in individuals over the age of 12 years. Recently, data on trifarotene supports its application in acne scarring. Herein, we provide a succinct review on various treatments for acne scarring and explore how trifarotene and its mechanism of action present an additional topical approach to target atrophic acne scarring.

Treatment of Atrophic Facial Scars Using Polydioxanone Threads: A Case Series.

The appearance of scars affects patients' aesthetic and psychological aspects, as atrophic scars can result from previous surgeries or inflammatory/infectious conditions. Recently, non-surgical techniques have been introduced to improve scar appearance and enhance patient satisfaction. To our knowledge, there has been limited published medical research evaluating the effectiveness of polydioxanone threads in managing facial scars. This report aims to present three cases where scars were managed using these materials in the facial area with a follow-up of six months post-intervention. Based on the three presented cases, it is shown that there was an improvement in the color and texture of the scar, in addition to its reduced size with no sensation of pain or itching after the procedure. These findings suggest that the materials used are promising for effectively treating facial scars.