Study on intelligent syndrome differentiation neural network model of stomachache in traditional Chinese medicine based on the real world.

Stomachache is not only disease name of Traditional Chinese medicine (TCM) but also the clinical symptom. It is a common and multiple diseases. TCM has its particular advantage in clinical treatment of stomachache. Syndrome differentiation is an important concept in TCM practice. The therapeutic process is virtually a nonlinear mapping process from clinical symptom to syndrome diagnosis with processing and seeking rules from mass data. Artificial neutral network has strong learning ability for nonlinear relationship. Artificial neutral network has been widely used to TCM area where the multiple factors, multilevel, nonlinear problem accompanied by a large number of optimization exist.We present an original experimental method to apply the improved third-order convergence LM algorithm to intelligent syndrome differentiation for the first time, and compare the predicted ability of Levenberg-Marquardt (LM) algorithm and the improved third-order convergence LM algorithm in syndrome differentiation.In this study, 2436 cases of stomachache electronic medical data from hospital information system, and then the real world data were normalized and standardized. Afterwards, LM algorithm and the improved third-order convergence LM algorithm were used to build the Back Propagation (BP) neural network model for intelligent syndrome differentiation of stomachache on Matlab, respectively. Finally, the differentiation performance of the 2 models was tested and analyzed.The testing results showed that the improved third-order convergence LM algorithm model has better average prediction and diagnosis accuracy, especially in predicting "liver-stomach disharmony" and "stomach yang deficiency", is above 95%.By effectively using the self-learning and auto-update ability of the BP neural network, the intelligent syndrome differentiation model of TCM can fully approach the real side of syndrome differentiation, and shows excellent predicted ability of syndrome differentiation.

Curcumin: A Potent Protectant against Esophageal and Gastric Disorders.

Turmeric obtained from the rhizomes of Curcuma longa has been used in the prevention and treatment of many diseases since the ancient times. Curcumin is the principal polyphenol isolated from turmeric, which exhibits anti-inflammatory, antioxidant, antiapoptotic, antitumor, and antimetastatic activities. The existing evidence indicates that curcumin can exert a wide range of beneficial pleiotropic properties in the gastrointestinal tract, such as protection against reflux esophagitis, Barrett's esophagus, and gastric mucosal damage induced by nonsteroidal anti-inflammatory drugs (NSAIDs) and necrotizing agents. The role of curcumin as an adjuvant in the treatment of a Helicobacter pylori infection in experimental animals and humans has recently been proposed. The evidence that this turmeric derivative inhibits the invasion and proliferation of gastric cancer cells is encouraging and warrants further experimental and clinical studies with newer formulations to support the inclusion of curcumin in cancer therapy regimens. This review was designed to analyze the existing data from in vitro and in vivo animal and human studies in order to highlight the mechanisms of therapeutic efficacy of curcumin in the protection and ulcer healing of the upper gastrointestinal tract, with a major focus on addressing the protection of the esophagus and stomach by this emerging compound.

Bloating: Avicenna's Perspective and Modern Medicine.

Bloating and abdominal distention are common complaints present in quite a number of organic and functional diseases. An important subject in traditional Persian medicine is digestive disorders, particularly bloating and its etiology. This is a literature review study conducted on The Canon in Medicine written by Avicenna and using the keywords: bloating, gas. In this article, causes for bloating, according to Avicenna, include diet causes, inappropriate lifestyle, gastrointestinal, and miscellaneous reasons. These were compared with causes suggested in modern medicine. Avicenna classifies causes based on the place of origin into upper part of the abdomen (stomach) and intestinal part of the abdomen. Also, 38 medicinal plants used as remedies were listed. Modern scientific data support all bloating causes that have been mentioned in the canon. Obviously, some causes such as uterine disorders and posterior nasal discharge need to be studied further.

[Development and Evaluation of GS-SF for Gastric Stuffiness (Wei PI) Patients Based on Item Response Theory, Computerized Adaptive Testing, and Data Simiuation].

OBJECTIVE: To develop and evaluate the short version of patient reported outcomes (PROs) questionnaire for gastric stuffiness (Wei Pi) patients with modern test theory and technologies, hoping to provide testing tools for related clinical practice and scientific researches with higher quality and less administrative and response burdens. METHODS: Using descriptive study design, clinical data were collected with sociological questionnaire and previous developed full items version of PROs instrument for gastric stuffiness (Wei Pi) patients via field and online surveys between Sep 2011 and Mar 2012. The statistical analysis group identified the termination parameters firstly, and then selected items with discrimination, fitting residual, item information curve (IIC) , item characteristic curve (ICC), and the rank of computerized adaptive testing (CAT) select proportion, etc. After assumption evaluation of item response theory (IRT), IIC, ICC, difficulty coefficient distribution, items-response relation and thresholds, etc. were used for psychometric evaluation of instrument. RESULTS: A total of 331 patients [Ages: 31.99 +/- 10.29 yrs; Male: 186 (56.3%)] were enrolled in statistical analysis. The test termination criterion was Max SE = 0.2 or Max items number =16. After items selection, a 15-item short version of instrument, which contains symptoms facet (8 items) and impact facet (7 items) was generated. With good unidimensionality, local independence, and monotonicity, the IC and ICC in IRT analysis showed good working capability of the questionnaire. The difficulty coefficient distribution and items-response relation were also rational, as well as response thresholds. CONCLUSIONS: The short version of PROs instrument for adult gastric stuffiness (Wei Pi) patients was successfully developed and assessed. The instrument with good methodological and reporting quality could be used in clinical and scientific evaluating their symptoms and impact.

Efficacy of moxifloxacin-based sequential therapy for first-line eradication of Helicobacter pylori infection in gastrointestinal disease.

AIM: To evaluate the efficacy of 14-d moxifloxacin-based sequential therapy as first-line eradication treatment of Helicobacter pylori (H. pylori) infection. METHODS: From December 2013 to August 2014, 161 patients with confirmed H. pylori infection randomly received 14 d of moxifloxacin-based sequential group (MOX-ST group, n = 80) or clarithromycin-based sequential group (CLA-ST group, n = 81) therapy. H. pylori infection was defined on the basis of at least one of the following three tests: a positive (13)C-urea breath test; histologic evidence of H. pylori by modified Giemsa staining; or a positive rapid urease test (CLOtest; Delta West, Bentley, Australia) by gastric mucosal biopsy. Successful eradication therapy for H. pylori infection was defined as a negative (13)C-urea breath test four weeks after the end of eradication treatment. Compliance was defined as good when drug intake was at least 85%. H. pylori eradication rates, patient compliance with drug treatment, adverse event rates, and factors influencing the efficacy of eradication therapy were evaluated. RESULTS: The eradication rates by intention-to-treat analysis were 91.3% (73/80; 95%CI: 86.2%-95.4%) in the MOX-ST group and 71.6% (58/81; 95%CI: 65.8%-77.4%) in the CLA-ST group (P = 0.014). The eradication rates by per-protocol analysis were 93.6% (73/78; 95%CI: 89.1%-98.1%) in the MOX-ST group and 75.3% (58/77; 95%CI: 69.4%-81.8%) in the CLA-ST group (P = 0.022). Compliance was 100% in both groups. The adverse event rates were 12.8% (10/78) and 24.6% (19/77) in the MOX-ST and CLA-ST group, respectively (P = 0.038). Most of the adverse events were mild-to-moderate in intensity; there was none serious enough to cause discontinuation of treatment in either group. In multivariate analysis, advanced age (≥ 60 years) was a significant independent factor related to the eradication failure in the CLA-ST group (adjusted OR = 2.13, 95%CI: 1.97-2.29, P = 0.004), whereas there was no significance in the MOX-ST group. CONCLUSION: The 14-d moxifloxacin-based sequential therapy is effective. Moreover, it shows excellent patient compliance and safety compared to the 14-d clarithromycin-based sequential therapy.

[Relation between dysbacteriosis of Helicobacter pylori and Lactobacillus acidophilus and the pathogenesis of chronic gastropathy patients of Pi-Wei damp-heat syndrome].

Pi-Wei theory is an important component of the basic theory of Chinese medicine. The pathogenesis of Pi-Wei damp-heat syndrome is an important content of Pi-Wei theory. The tongue coating is one of the most important signs reflecting Pi-Wei damp-heat syndrome. From the perspective of microecology and pathogenesis, the microbial disequilibrium caused by quantity changes of Helicobacter pylori (Hp) and Lactobacillus acidophilus (LA) and their interaction in the gastric mucosa and the tongue coating might have certain correlation with "mutual struggle between the evil and the vital qi, the disequilibrium between yin and yang". The pathogenesis features of chronic gastritis patients of Pi-Wei damp-heat syndrome was initially proposed in this article.

Synthesis of fuzzy logic for prediction and medical diagnostics by energy characteristics of acupuncture points.

A great number of reflexologies use ancient concepts that do not coincide with modern medical terminology of anatomy, physiology, and biophysics, substantially reducing the trust of today's physicians in this direction of their profession. Recently, several mathematical models of internal and biological active points of meridian structures interaction have been proposed. These models allowed specification of diseases for which reflex diagnostics and reflex therapy methods are most effective and also increased the efficacy of these procedures. Good results for the prediction and early diagnosis of diseases from the reaction energy of biologically active points (acupuncture points) are obtained using fuzzy logic decision making.

Gastric organo-axial malrotation coexisting respiratory symptoms.

Gastric malrotation is defined as a torsion of stomach around its short or long axis. It is a rare disease in childhood. Gastric malrotation may present either as a surgical emergency or as chronic abdominal symptoms. There is limited data about the respiratory symptoms associated with gastric malrotation. The aim of this study was to review the records of 14 children who presented with respiratory symptoms and diagnosed as gastric organo-axial malrotation. Between August 2005 and August 2007, 14 children diagnosed as having gastric organo-axial malrotation participated in this study. There were 11 boys and three girls with a mean age of 7.1 months. All patients were symptomatic. Presenting symptoms included wheezing in four patients, recurrent pneumonia in four, chronic cough in two, chronic cough and apnea in two, recurrent pneumonia and chronic cough in one, and chronic cough and failure to thrive in one. All of our patients had organo-axial gastric malrotation. Gastroesophageal reflux was found in nine patients (64.2%). Six patients were treated with surgery and antireflux medication and the remaining eight patients with antireflux medication. In conclusion, it is probable that gastric malrotation associated with massive or occult gastroesophageal reflux could be responsible for the respiratory symptoms such as chronic cough, recurrent pneumonia, wheezing, and apnea.

Early experience with unsedated ultrathin 4.9 mm transnasal gastroscopy: a pilot study.

BACKGROUND: Unsedated transnasal gastroscopy is a technique with unverified clinical advantages. OBJECTIVE: To evaluate the efficacy and procedure times with transnasal gastroscopy by physicians with no previous experience in transnasal endoscopy. METHODS: Unsedated transnasal gastroscopy using 4.9 mm ultrathin transnasal gastroscopes with randomization to two different biopsy forceps was prospectively evaluated during a single day in January 2008. The outcomes included patient tolerance (scale: 1, no discomfort; 10, severe discomfort), physician technical assessment (1, excellent; 10, very poor), gastric biopsy quality, adverse events and procedure times. RESULTS: Twenty patients underwent transnasal gastroscopy. Nineteen patients (95%) successfully completed transnasal gastroscopy. The patient-reported mean (+/- SD) overall discomfort level during the procedure was 4.0+/-1.9 compared with a physician-estimated level of 3.2+/-1.7 (P=0.04). Only 10% (n=2) reported they would have preferred sedated over unsedated gastroscopy. Mean total encounter time from anesthesia to discharge was 33.5+/-9.3 min. The time from anesthesia to insertion was 7.0+/-5.3 min and from room exit to discharge 6.2+/-2.9 min. No patients who had gastric biopsies taken (zero of 14) had any of unacceptable quality. The only adverse event was distressing sensations (dyspnea, dizziness) in one patient that started during pre-endoscopy anesthetic application, persisting postendoscopy, but without any abnormalities in vital signs. CONCLUSION: Assuming the adverse event was a rare reaction, early experience with unsedated ultrathin transnasal gastroscopy was an efficient, effective and well-tolerated procedure for evaluation of the upper gastrointestinal tract.

RECOMENDACIONES DE BUENA PRÁCTICA CLÍNICA: Gastropatía por antiinflamatorios no esteroideos / RECOMMENDATIONS FOR GOOD CLINICAL PRACTICE: NSAID gastropathy

La gastropatía por antiinflamatorios no esteroideos (AINE)es una patología frecuente que debemos tener en cuentaante todo paciente que nos consulte por problemas de dispepsiao astenia de larga evolución. Actualmente se cifran en16.500 las muertes anuales por complicaciones por el consumode estos fármacos y en más de cien mil, los ingresoshospitalarios anuales, datos que pueden darnos una idea dela verdadera importancia del problema. Los factores de riesgoimplicados más frecuentemente y que siempre debemostener en cuenta son la edad (mayor de 65 años), la toma conjuntade más de un AINE, la toma de anticoagulantes o corticoides,ISRS o ISRNS, ulcus o gastropatía previos y la existenciade alguna enfermedad concomitante grave. Otroaspecto a tener en cuenta es la erradicación del Helicobacter(H.) pylori, lo que parece que es coste efectivo y reduce elriesgo de complicaciones gastrointestinales (GI). Ante un pacientecon factores de riesgo en el que vayamos a iniciar untratamiento con AINE o ya lo siguiera por cualquier causa,que tuviera un evento GI, debemos, siempre que se pueda,suspender el AINE y testar el H. pylori para erradicarlo sisale positivo y posteriormente reiniciar el tratamiento conAINE más conveniente (si se puede, siempre el menos gastrolesivo)teniendo en cuenta los factores de riesgo GI y cardiovascularesy asociando un protector gástrico. El papel actualde los COX-2, como AINE y con un riesgo de lesión GImenor que los AINE clásicos, debe tenerse también en cuenta,si bien debe barajarse el riesgo cardiovascular del pacienteen la decisión de dicha alternativa terapéutica (AU)

NSAIDs gastropathy is a frequent disease that we shouldtake into account whenever there is a patient who consultsdue to long term dyspepsia or asthenia. Currently there areabout 16,500 deaths a years due to complicatons from consumptionof these drugs and there are more than one hundredthousand hospitalizations per year. This could give usan idea of the true importance of the problem. The most frequentlyinvolved risk factors and those which should also betaken into account are age (older than 65 years), combineduse of an NSAID, anticoagulants or corticosteroids, SSRI orSNRIS, ulcer or previous gastropathy and the existence ofany serious concomitant disease. Another aspect to consideris the eradication of Helicobacter (H.) pylori, where it seemsthat it is cost effective and reduces gastrointestinal complications.When a patient has risk factors and we are going toinitiate NSAID treatment or continue it for any reason, or ifwhen the patient is taking it for any reason, he or she has aGI event, we should always, when possible, suspend theNSAID and test for H. Pylori to see if it is positive and to eradicateit and then reinitiate the best possible NSAID treatment(if possible, always with the least gastrointestinalharm) considering the GI and cardiovascular risk factors andassociating a gastrointestinal protector. The current role ofCOX-2, as NSAID and with a risk of less GI injury than theclassical NSAIDs should also be taken into account althoughthe cardiovascular risk of the patient should be consideredin the decision of the therapeutic alternative (AU)

Diagnosis and treatment of Gardner syndrome with gastric polyposis: a case report and review of the literature.

Gardner syndrome (GS) is an autosomal dominant disease characterized by the presence of colonic polyposis, osteoma and soft tissue tumors. It is regarded as a clinical subgroup of familial adenomatous polyposis (FAP) and may present at any age from 2 mo to 70 years with a variety of symptoms, either colonic or extracolonic. We present a case of a 23-year-old female patient with GS who presented with gastric polyposis and was successively treated with restorative proctocolectomy in combination with ileal pouch anal anastomosis (RPC/ IPAA), ileostomy, ileostomy closure operation, snare polypectomy during 8 mo. After operation, the patient took oral traditional Chinese medicine pills made of Fructus mume and Bombyx batryticatu for about 6 mo. The innutrition and anaemia of this patient were gradually improved. Gastroscopy showed that the remnant gastric polypi gradually decreased and finally disappeared 19 mo after the first operation. The patient had 2-3 times of solid stool per day at the time we wrote this paper.

Hyperplastic polyps of the gastric antrum in patients with gastrointestinal blood loss.

The significance of hyperplastic polyps of the gastric antrum in anemic patients with suspected gastrointestinal bleeding has not been determined. The aim of this study is to evaluate the prevalence and prognosis of such polyps in this patient group. Clinical records of patients referred to our endoscopy lab from November 1999 to February 2003 for the evaluation of iron deficiency anemia or suspected gastrointestinal bleeding were reviewed. There were 987 patients. Fourteen patients (1.4%) had hyperplastic polyps in the gastric antrum. Five of the patients reported melena, but the rest were asymptomatic. Multiple antral polyps were present in seven cases. The largest polyp measured 5.0 cm. Helicobacter pylori infection was present in one patient. All patients were anemic and nine had documented iron deficiency. No follow-up information was available in four patients. Hyperplastic polyps of the gastric antrum are a rare but significant cause of gastrointestinal blood loss in older patients. Removal of the polyps using endoscopic or surgical methods may be required for resolution of the blood loss along with iron supplementation. Gastroenterologists should be aware that hyperplastic polyps of the gastric antrum might result in gastrointestinal blood loss and iron deficiency anemia.

Metabolic predictors of displaced abomasum in dairy cattle.

The objective of this field study was to identify metabolic tests available in clinical practice that identified cows at increased risk of left displaced abomasum (LDA). A technician visited 1044 cows in 20 herds weekly from 1 wk before expected calving until 1 wk postpartum. Cows were assigned a body condition score and samples were collected at each visit for measurement of serum nonesterified fatty acids (NEFA), cholesterol, beta-hydroxybutyrate (BHBA), glucose, urea, calcium, and phosphorus, and a milk sample was collected postpartum for measurement of BHBA. The probability of LDA was modeled with multivariable logistic regression accounting for clustering. There were 53 cases of LDA (incidence risk = 5.1%) and the median time of diagnosis was 11 d in milk. In cows with LDA, mean NEFA concentrations began to diverge from the mean in cows without LDA 14 d before calving, whereas mean serum BHBA concentrations did not diverge until the day of calving. Prepartum, only NEFA concentration was associated with risk of subsequent LDA. Between 0 and 6 d before calving, cows with NEFA concentration > or =0.5 mEq/L were 3.6 times more likely to develop LDA after calving. For prospective application, among samples taken 4 to 10 d before expected calving, the optimum NEFA cut-point remained 0.5 mEq/L. The sensitivity, specificity, and likelihood ratio (LR) were 46%, 82%, and 2.6, respectively. Between 1 and 7 d postpartum, retained placenta, metritis, and increasing serum concentrations of BHBA and NEFA were associated with increased risk of subsequent LDA. However, considered separately, postpartum serum BHBA was a more sensitive and specific test than NEFA concentration. The odds of LDA were 8 times greater in cows with serum BHBA > or =1200 micromol/L (LR = 3.5). Cows with milk BHBA concentration > or =200 micromol/L were 3.4 times more likely to develop LDA. Serum calcium concentration was not associated with LDA. Strategic use of metabolic tests to monitor transition dairy cows should focus on NEFA in the last week prepartum and BHBA in the first week postpartum.

An evaluation of parameters for the detection of subclinical rumen acidosis in dairy herds.

An observational study was conducted in six Danish dairy herds. A specially designed stomach tube was compared to the rumenocentesis technique as part of the monitoring of rumen pH. In contrast to a previous study, the use of the stomach tube appeared to reduce saliva contamination. However, correlation with the rumenocentesis technique was poor ( r = 0.33; p = 0.019) and a linear model could only partly explain variations between either results. The presence of subclinical rumen acidosis (SRA) was evidenced in one herd only, as judged by results obtained by the rumenocentesis technique. The present study revealed some limitations of the rumenocentesis technique in small or medium-sized herds due to difficulties in selecting sufficient numbers of cows in the respective groups at risk. The finding of two apparently clinical normal cows with rumen pH values below 5.0 leads to the consideration that such fluctuations may be temporary and at least does not give rise to clinical symptoms. However, the long-term effect of such fluctuations is not known. In general, primiparous cows seemed more prone to low ruminal pH values (< 6.0), higher ruminal concentrations of short-chain fatty acids, and possibly to metabolic acidosis, than were multiparous cows. Ruminal propionate was the most precise predictor of rumen pH, whereas milk fat percentage varied greatly between lactational groups. Blood lactate dehydrogenase (LDH), beta-hydroxybutyrate (BHB) and fructosamine as well as urine phosphorus excretion and renal net acid-base excretion (NABE) were related to ruminal acid load, but were not predictive of rumen pH. Monitoring of dairy herds for SRA should be performed routinely and employ several diagnostic tools (rumenocentesis, renal NABE determination) as well as specific knowledge of herd management and feeding routines.

Experimental study of the rat for the assessment of barium coating on the gastric mucosa: efficacy of ranitidine and acetylcysteine administration.

PURPOSE: In order to improve the preparation method for barium examination of the stomach by ranitidine and acetylcysteine use, the effect on the rat gastric mucosa caused by the administration of ranitidine and acetylcysteine was studied. MATERIALS AND METHODS: Rat stomach that had been treated with ranitidine or acetylcysteine at different intervals and examined in vivo was excised and coated with a barium suspension. A radiograph was subsequently taken and evaluated in regard to the removal of gastric mucus and imaging of the areae gastricae (AG). The removal of mucus was assessed by six blind observers. The imaging of AG was estimated as a percentage of the imaged AG area per total gastric corpus. RESULTS: No change was seen on the radiograph with ranitidine preparation, while the mucus was distinctly removed and AG well-imaged in the group studied 15 minutes after the peroral administration of acetylcysteine. CONCLUSION: Proper preparation for barium study of the stomach should involve treatment with a mucolytic agent about 15 minutes before the examination. H2-blockers must be used supplementally in the short term.

Rumenocentesis (rumen puncture): a viable instrument in herd health diagnosis.

The use of rumenocentesis as a tool in veterinary practice is to be evaluated; this publication describes the technique and reports results of a field study. From 164 dairy cows samples of ruminal fluid have been collected by means of rumenocentesis. In order to compare reaction of the individuals towards rumenocentesis, reaction has been scored on a five-point scale. In the period after rumenocentesis, the animals were observed and examined clinically in case of any pathologic alteration. To test a possible pain-reducing treatment, two study groups received local anaesthesia, while a third group had been sampled without. About 50% of all animals examined did not show resistance during rumenocentesis, while the rest of the population reacted at different levels. In four animals ruminal fluid sampling was not carried out due too heavy resistance, while six samples showed visible contamination with blood. Local anaesthesia with 2 ml of 2 % lidocaine s. c. and i. m. had influence on reaction of the individual samples, but did not have effect on sample size collected and pathologic alterations post punctionem. In total, 5.5 % of the study population showed alterations at the puncture site as haematomas and abscess forming; in three individuals the general health status was impaired after collection. The authors consider rumenocentesis a viable diagnostic procedure in bovine health diagnostics.

Epigastric appendiceal abscess with spontaneous drainage into the stomach.

The appendiceal abscess is a common complication of acute appendicitis and usually is located in the right lower quadrant of the abdomen. An epigastric appendiceal abscess has never been reported at an unusual location. We experienced an unusual case of a 49-year-old man with an epigastric appendiceal abscess. Initially, this abscess was suspected to be a pancreatic abscess. Abdominal CT scan and barium enema demonstrated a hyperrotated cecum with an appendiceal abscess in the left upper quadrant of the abdomen. An gastroscopy revealed a small fistula-like lesion with purulent coating at the bulging posterior gastric wall. The abscess resolved spontaneously. We believe that the abscess drained into the stomach through a small fistula between the stomach and abscess cavity. There was no recurrence for over 6 months.

Heterotopic pancreas: a difficult diagnosis.

Heterotopic pancreas is a rare disease. We evaluated 17 patients treated surgically at our hospital. Epigastric pain (77%), abdominal fullness (30%), and tarry stools (24%) were the three most frequent symptoms and signs. The lesions were diagnosed as gastroduodenal tumors by gastroduodenoscopy (67%) or upper gastrointestinal series (71%). Among these, only one gastric submucosal tumor was considered to be heterotopic pancreas preoperatively. Three patients were found to have gastric tumor by abdominal ultrasound. Computed tomography, small-intestinal series, barium enema, endoscopic retrograde cholangiopancreatography, angiography, and cholescintigraphy did not help in disclosing lesion. In about half of the patients, the lesions were located at the stomach. Tumor size varied from 1 to 3 cm. Surgical excision relieved symptoms. These findings indicated heterotopic pancreas is still a difficult disease for diagnosis, regardless of the improvements of diagnostic tools and techniques.