Gastric bacteria as potential biomarkers for the diagnosis of atrophic gastritis.

BACKGROUND: Identification of the risk factors for atrophic gastritis (AG) and prevention of further deterioration of the gastritis are effective approaches to reduce the incidence of gastric cancer. Previous studies found that dysbiosis has been implicated in a wide range of diseases, while the role of gastric bacteria as a biomarker for AG has not been explored. METHODS AND RESULTS: Gastric juices from cases with non-atrophic gastritis (NAG) and AG were collected for investigation of bacterial composition and function. The ß-diversity of microbiota exhibited a significant reduction in AG samples compared with that in NAG samples. Differential abundance analysis revealed that a total of 23 predicted species changed their distributions; meanwhile, all obligate anaerobic bacteria with a relatively high abundance lowered their contents in AG samples. Additionally, the correlation analysis indicated a clear shift in bacterial correlation pattern between the two groups. Functional interrogation of the gastric microbiota showed that bacterial metabolisms associated with enzyme families, digestive system, and endocrine system were downregulated in AG samples. The compositional dissection of "core microbiota" exhibited that oral pathogens, including Porphyromonas gingivalis, Campylobacter gracilis, and Granulicatella elegans, were magnified in AG samples, suggesting that oral diseases may be a trigger factor for early exacerbation of gastritis. Then, the differentially expressed bacteria were used as diagnostic biomarkers for the random forest classifier model for group prediction. CONCLUSIONS: The results showed that bacterial biomarkers could distinguish AG patients from NAG cases with an accuracy of 90% at the genus level.

Outcomes of endoscopic sclerotherapy for jejunal varices at the site of choledochojejunostomy (with video): Three case reports.

BACKGROUND: Hemorrhage associated with varices at the site of choledochojejunostomy is an unusual, difficult to treat, and often fatal manifestation of portal hypertension. So far, no treatment guidelines have been established. CASE SUMMARY: We reported three patients with jejunal varices at the site of choledochojejunostomy managed by endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoacrylate injection at our institution between June 2021 and August 2023. We reviewed all patient records, clinical presentation, endoscopic findings and treatment, outcomes and follow-up. Three patients who underwent pancreaticoduodenectomy with a Whipple anastomosis were examined using conventional upper gastrointestinal endoscopy for suspected hemorrhage from the afferent jejunal loop. Varices with stigmata of recent hemorrhage or active hemorrhage were observed around the choledochojejunostomy site in all three patients. Endoscopic injection of lauromacrogol/α-butyl cyanoacrylate was carried out at jejunal varices for all three patients. The bleeding ceased and patency was observed for 26 and 2 months in two patients. In one patient with multiorgan failure and internal environment disturbance, rebleeding occurred 1 month after endoscopic sclerotherapy, and despite a second endoscopic sclerotherapy, repeated episodes of bleeding and multiorgan failure resulted in eventual death. CONCLUSION: We conclude that endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoacrylate injection can be an easy, effective, safe and low-cost treatment option for jejunal varicose bleeding at the site of choledochojejunostomy.

Mussel-inspired bioactive 3D-printable poly(styrene-butadiene-styrene) and the in vitro assessment of its potential as cranioplasty implants.

Challenges in cranial defect reconstruction after craniotomy arise from insufficient osteogenesis and biofilm infection, which requires novel biomaterials. Herein, we propose a mussel-inspired bioactive poly(styrene-butadiene-styrene) (SBS) as a promising cranioplasty material. The catechol-modified quaternized chitosan (QCSC) was employed in the bio-inert surface of 3D-printed SBS to provide the contact-killing ability against bacterial biofilms. The polydopamine-decorated zeolitic imidazolate framework-8 (pZIF-8) and polydopamine hybrid hydroxyapatite (pHA) were further modified on the surface to further enhance the antibacterial property and osteogenesis activity, effectively killing bacteria by no less than two orders of magnitude and significantly facilitating osteogenic gene expression and mineralization. Due to the lack of research using SBS as a cranioplasty material, we believe that the modified SBS materials developed in this study and the in vitro assessment may be beneficial for developing novel cranioplasty implants.

Features of the Sensorimotor Cortex Altered after Tooth Loss and Subsequent Implant Placement in the Maxilla of Rats.

OBJECTIVE: To investigate the synergistic changes of the astrocytes and neurons in the sensorimotor cortex during the process of implant osseointegration after insertion. METHODS: A total of 75 rats were allocated into three groups (n = 25): non-operated, extraction and implant. The rats in the latter two groups underwent extraction surgery of three maxillary right molars. One month later, the implant group received one titanium implant in the healed extraction socket. The rats were sacrificed on days 1, 3, 7, 14 and 28 after implantation. The brain sections, including sensory centre S1 and motor centre M1, were selected for further immunofluorescence for measurement of the synergistic morphological and quantitative changes of astrocytes and neurons. RESULTS: In layer IV of S1, the number of astrocytes in the implant group showed a descending trend with time; on days 1, 3, 7 and 14, the number of astrocytes in both the extraction group and the implant group was significantly higher than that in the non-operated group, and there was no difference between the extraction group and the implant group; however, on day 28, the number of astrocytes in the implant group was significantly lower than that in the extraction group. In layer V of M1, on days 7, 14 and 28, the number of astrocytes in the implant group was significantly lower than that in the extraction group; on days 14 and 28, the number of astrocytes in the extraction group was significantly higher than that in the non-operated group. In layer IV of S1 or layer V of M1, the number of neurons showed no significant changes between the three groups. CONCLUSION: The astrocytes in the face sensorimotor cortex were activated as a reaction to oral environment changes. This kind of neuroplasticity can be reversed by oral rehabilitation with dental implants. The motor cortex may be intimately related to osseointegration and osseoperception.

[Platelet-riched plasma promotes potential mineralizing capacity of human dental pulp cells in vivo].

OBJECTIVE: To investigate the biocompatibility of human platelet-rich plasma (PRP) and human dental pulp cells (DPCs), and the effect of human platelet-rich plasma on the mineralization of human dental pulp cells in vivo. METHODS: DPCs were isolated from healthy dental pulp, and identified by immunostaining of vimentin and cytokeratin. PRP was obtained from healthy volunteer donors by traditional two-step centrifugation. The forth passage of DPCs and PRP were mixed well and activated, and then transplanted subcutaneously in 5-week female nude mice. The groups which were implanted with PRP alone or DPCs alone were used as controls. The animals were sacrificed after 4 weeks and 8 weeks post-transplantation, and the histological and immunohistostaining examinations were used to evaluate the effect of PRP on the mineralization of DPCs. RESULTS: Immunostaining showed that DPCs were positive for vimentin and negative for cytokeratin. In vivo assay showed that the newly formed mineralized tissues were only found in PRP combined with DPCs group after 4 weeks and 8 weeks, while newly formed tissues were not observed in PRP alone or DPCs alone groups. HE staining showed the mineralized tissues were found in PRP+DPCs samples. Immunohistochemistry staining showed these mineralized tissues were positive for osteopontin(OPN), osteocalcin(OC) and collagen I (COLI). CONCLUSION: PRP had good biocompatibility with DPCs, and could induce the mineralization of DPCs. The study suggests that platelet-rich plasma can be used as a scaffold for pulp capping.

Euglycemic diabetic ketoacidosis caused by dapagliflozin: A case report.

RATIONALE: Diabetic ketoacidosis is a serious and potentially life-threatening acute complication of diabetes mellitus (DM). Euglycemic diabetic ketoacidosis (eDKA) is however challenging to identify in the emergency department (ED) due to absence of marked hyperglycemia, often leading to delayed diagnosis and treatment. eDKA has been recently found to be associated with sodium-glucose cotransporter 2 (SGLT2) inhibitors, one of the newest classes of antidiabetics, though there are very limited reports implicating dapagliflozin as the offending agent in ED patients. Here we report a type 2 diabetic patient who presented to the ED with eDKA secondary to dapagliflozin administration. PATIENT CONCERNS: A 61-year-old Asian female with underlying type 2 DM presented to our ED with body weakness, dyspnea, nausea, vomiting, and mild abdominal pain for the past 2 days. These symptoms were preceded by poor oral intake for 1 week due to severe toothache. Dapagliflozin was recently added to her antidiabetic drug regimen of metformin and glibenclamide 2 weeks ago. DIAGNOSES: Arterial blood gases showed a picture of severe metabolic acidosis with an elevated anion gap, while ketones were elevated in blood and positive in urine. Blood glucose was mildly elevated at 180 mg/dL. Serum lactate levels were normal. Our patient was thus diagnosed with eDKA. INTERVENTION: Our patient was promptly admitted to the intensive care unit and treated for eDKA through intravenous rehydration therapy with insulin infusion. OUTCOMES: Serial blood gas analyses showed gradual resolution of the patient's ketoacidosis with normalized anion gap and clearance of serum ketones. She was discharged uneventfully on day 4, with permanent cessation of dapagliflozin administration. LESSONS: Life-threatening eDKA as a complication of dapagliflozin is a challenging and easilymissed diagnosis in the ED. Such an ED presentation is very rare, nevertheless emergency physicians are reminded to consider the diagnosis of eDKA in a patient whose drug regimen includes any SGLT2 inhibitor, especially if the patient presents with nausea, vomiting, abdominal pain, dyspnea, lethargy, and is clinically dehydrated. These patients should then be investigated with ketone studies and blood gas analyses regardless of blood glucose levels for prompt diagnosis and treatment.