The onset of ulcerative colitis upon Helicobacter pylori eradication in a 72-year-old woman: report of a rare case with a 3-year follow-up.

BACKGROUND: Epidemiological studies suggest an inverse association between H. pylori infection/exposure and inflammatory bowel disease prevalence/incidence, however, there are no reports of individual patients who developed a "non-transient" ulcerative colitis (UC) following H. pylori eradication. CASE PRESENTATION: We report a case of a 72-year-old female with an elderly-onset UC developed upon H. pylori eradication and a 3-year follow-up of the progression to steroid-dependent colitis complicated with enteropathic arthritis and final containment of the disease with golimumab. In our patient, H. pylori eradication was associated with the development of pancolitis that evolved into clinically, endoscopically, and pathohistologically confirmed UC. CONCLUSIONS: The case of our patient provides a unique clinical context for a growing body of literature suggesting molecular mechanisms involved in the interaction of genes, environment, and microbiota to be of critical importance in the etiopathogenesis of UC, and thus, provides a valuable set of complementary translational information for preclinical and epidemiological research on the topic.

Allogeneic expanded adipose-derived stem cells in the treatment of rectovaginal fistulas in Crohn's disease.

AIM: Crohn's disease (CD)-related rectovaginal fistulas (RVFs) are rare, challenging to treat and associated with a high morbidity. Due to a significant lack of data, we aimed to analyse the safety and feasibility of allogeneic adipose-derived stem cells (ASCs) in the treatment of CD-related RVF. METHOD: Four consecutive patients with CD-related RVF underwent treatment with expanded allogeneic ASCs extracted from a healthy donor in a tertiary referral centre in 2019. None of the patients had an intestinal diversion at the time of the treatment. Follow-up was performed 6 months postoperatively. RESULTS: The median operation time was 45 min with a median hospital stay of 3 days. No intra-operative complications occurred. Three patients (75%) developed recurrent RVF after a median follow-up of 19 days. Two patients required surgical treatment including loose seton drainage due to discharge and pain. One patient developed recurrence of symptoms after 10 days, but refused further surgical therapy. Only one patient (25%) showed healing of the RVF, with re-epithelialization of both the vaginal and rectal opening and absence of clinical symptoms. CONCLUSION: Expanded allogeneic ASC therapy represents a novel safe treatment option for CD-associated RVF. Although efficacy appears limited, further controlled studies are required to draw robust conclusions.

XUV-driven plasma switch for THz: new spatio-temporal overlap tool for XUV-THz pump-probe experiments at FELs.

A simple and robust tool for spatio-temporal overlap of THz and XUV pulses in in-vacuum pump-probe experiments is presented. The technique exploits ultrafast changes of the optical properties in semiconductors (i.e. silicon) driven by ultrashort XUV pulses that are probed by THz pulses. This work demonstrates that this tool can be used for a large range of XUV fluences that are significantly lower than when probing by visible and near-infrared pulses. This tool is mainly targeted at emerging X-ray free-electron laser facilities, but can be utilized also at table-top high-harmonics sources.

Factors associated with improvement of quality of life among parents of children with atopic dermatitis: 1-year prospective cohort study.

BACKGROUND: Previous studies exploring the impact of atopic dermatitis (AD) in children focused on factors associated with parental quality of life at one point in time. OBJECTIVE: To examine factors associated with change of quality of life among parents of children affected with AD. METHODS: The study cohort comprised 98 parent-children pairs treated for AD at the Clinic of Dermatovenereology; however, 18 parents (18.4%) were lost to follow-up after 1 year. Children were assessed with SCORing Atopic Dermatitis Index (SCORAD) and Children Dermatology Life Quality Index (CDLQI) or the Infants' Dermatitis Quality of Life Index (IDQOL), depending on their age. Parents filled in socio-demographic questionnaire and Dermatitis Family Impact Questionnaire (DFI). After 1 year, both children and parents were reassessed using the same AD-related battery of questionnaires. RESULTS: After follow-up, a significant improvement in the average total DFI score was observed, especially for domains of fatigue/exhaustion, emotional distress and impact of helping in child treatment. Lower baseline SCORAD, greater improvement of SCORAD over follow-up, better CDLQI/IDQOL at baseline, greater improvement in CDLQI/IDQOL over follow-up, not having asthma and having older child with AD were associated with better parental quality of life after 1 year of follow-up. Parental higher education level, shorter AD duration, better baseline SCORAD and greater improvement in CDLQI/IDQOL over follow-up were associated with greater improvement in parental life quality over 1 year of follow-up. CONCLUSION: Contributors to parental quality of life after 1 year included clinical features of AD and child's comorbidity (asthma), but also the perception of child's quality of life and its improvement.

Sleep in critically ill, mechanically ventilated patients with severe sepsis or COPD.

BACKGROUND: The standard method for scoring polysomnographic (PSG) sleep is insufficient in the intensive care unit (ICU). A modified classification has been proposed, but has not been tested in specific groups of ICU patients. We aimed firstly to (1) use the modified classification to describe sleep in two groups of ICU patients: a severe sepsis group and a chronic obstructive pulmonary disease (COPD) group, and (2) to compare sleep stage distribution in the groups; secondly to compare the PSG findings with nurses' sleep evaluation. METHODS: Non-sedated mechanically ventilated patients with severe sepsis or COPD completed up to 20-hours PSG recording in each patient. A modified classification for scoring sleep in ICU was used for scoring the PSGs. Sleep assessment by nurses was done at 15 minutes intervals. RESULTS: We included 16 patients with severe sepsis and 17 patients with COPD. Half of the patients in the severe sepsis group and 59% in the COPD group had atypical sleep. We found significantly different sleep stage distribution in the two groups, with the COPD group having a higher proportion of atypical sleep (54.4% vs 48.7%, P < .0001). No correlation between nurse sleep assessment and PSG was found in cases of atypical sleep (P < .0001). CONCLUSION: Normal PSG sleep characteristics as defined by standard classification are absent in many conscious, non-sedated critically ill patients on mechanical ventilation. Nurse sleep evaluation does not correlate with PSG if atypical sleep is present in the PSG, which limits the reliability of subjective sleep assessment in this patient population.

Apoptosis of keratinocytes and serum DNase I activity in patients with cutaneous lupus erythematosus: relationship with clinical and immunoserological parameters.

BACKGROUND: Dysregulation of apoptosis has an important role in the induction of autoimmunity. OBJECTIVE: To evaluate the influence of keratinocyte apoptosis and deoxyribonuclease I (DNase I) activity on the clinical and immunoserological parameters of cutaneous lupus erythematosus (CLE). METHODS: We studied 69 CLE patients (39 with discoid LE (DLE), 12 with subacute CLE (SCLE), 12 with acute and 6 with intermittent CLE). Thirty of sixty-nine patients fulfilled criteria for systemic LE (SLE). Apoptotic index (AI) was evaluated immunohistochemically in lesional and non-lesional, photoprotected skin. Serum DNase I activity, antichromatin and anti-ENA antibodies were measured by ELISA. Disease activity was determined by SLEDAI-2K, SLICC/ACR, CLASI and RCLASI. RESULTS: AI in lesions was higher than in non-lesional skin (P < 0.001). There was no difference in AI between CLE and SLE patients. Patients with SCLE had higher lesional AI than patients with DLE (P < 0.05). We found a positive correlation between the lesional AI with CLASI A (P < 0.05) and RCLASI D (P < 0.05). CLE and SLE patients had significantly lower DNase I activity than healthy controls (P < 0.001). Patients with normal DNase I activity and low AI had significantly lower CLASI A than patients with decreased DNase I activity and/or elevated AI (P < 0.05). CONCLUSIONS: Increased keratinocyte apoptosis characterizes lesions of all CLE forms, especially of SCLE. AI correlates with CLE markers of acute and chronic inflammation. Normal level of apoptosis and DNase I activity simultaneously reduce the level of acute inflammation in CLE. Serum DNase I activity and AI might be important biomarkers in the evaluation of CLE patients.

[APPROACH TO PATIENTS WITH GASTROINTESTINAL BLEEDING].

In the developed Western countries, despite the accumulation of knowledge about the causes and treatment of gastrointestinal bleeding, as well as the experience of gastroenterologists-endoscopists using sophisticated endoscopic devices, the number of hospitalizations and mortality rates has not declined as expected. The most likely explanations are the following: aging population, increased prevalence of alcoholic liver cirrhosis, gastroesophageal reflux disease and obesity, Helicobacter pylori antibiotic resistance, using dual anti-aggregation therapy, anticoagulants, and excessive use of nonsteroidal anti-inflammatory drugs. The aim of this paper is to show the incidence and the most common signs and symptoms of gastrointestinal bleeding. The aim is also to present initial clinical evaluation, diagnostic methods, the main causes of gastrointestinal bleeding, endoscopic hemostatic modalities and treatment of bleeding from the upper and lower gastrointestinal tract. Using the MEDLINE and Ovid databases, we searched the meta-analyses and systematic reviews published in English during the 2005-2015 period. Meta-analyses included results of randomized, double-blind studies on adults treated for gastrointestinal bleeding. Included were guidelines of the European and American Society of Gastroenterological Endoscopy, as well as recent expert work. In this review, we bring the state-of-the-art on gastrointestinal bleeding, new classification of gastrointestinal bleeding from the upper, mid and lower gut, controversy of nasogastric tube placement, use of prokinetic agents and inhibitor proton pumps in acute gastrointestinal bleeding from the upper tract, restrictive transfusion strategy, useful clinical stratification of the severity of bleeding, indications for hospitalization and outcome of using the clinical bleeding score, proper use of gastroprotection in patients at a high risk of peptic ulcer, the need of initial endoscopy, variceal assessment in newly diagnosed liver cirrhosis, primary and secondary prophylaxis of variceal bleeding, new endoscopic hemostatic modality, and radiological and surgical treatment of gastrointestinal bleeding. The educational nature of this review could serve for establishing Croatian guideline for the management of gastrointestinal bleeding.

Progressive multifocal leukoencephalopathy associated with mycophenolate mofetil treatment in a woman with lupus and CD4+ T-lymphocyte deficiency.

There is an increase in the number of patients with systemic lupus erythematosus (SLE) reported as developing progressive multifocal leukoencephalopathy (PML) while on intensive immunosuppressive therapy. A 39-year-old HIV-negative woman with a 10-year history of SLE presented with progressive left-side weakness while on maintenance therapy with oral prednisone and mycophenolate mofetil (MMF). On several occasions low CD4+ T-lymphocyte counts were found (68/µL). Brain magnetic resonance imaging (MRI) revealed a large lesion in the right subcortical fronto-parietal region and a smaller one in the left frontal subcortex, corresponding to the PML. In cerebrospinal fluid, polymerase chain reaction (PCR) for JC virus (JCV) was negative, but anti-JCV antibodies were highly positive. Diagnosis of probable PML was made and MMF was withdrawn. The patient's condition improved with marked reduction of left-side weakness and an increase in CD4(+) T-lymphocyte count (141/µL). Follow-up MRI showed regression of lesions and over the next 6 months the patient remained stable. In spite of the grave prognosis associated with PML, SLE patients can have an excellent outcome if immunosuppressants are discontinued as soon as the correct diagnosis is made. SLE patients with associated low CD4(+) T-lymphocyte counts should be monitored for the development of PML during immunosuppressive therapy in particular.

Pseudomyxoma peritonei--case report.

The syndrome pseudomyxoma peritonei is rare, present in only 2/10,000 laparotomies. We report the case of a 58-year-old woman with a primary tumor of the appendix, and secondary involvement of other structures and organs of the abdominal cavity. In our case, we performed maximal surgical reduction of the tumor, with remaining implants on diaphragmatic domes and liver, as we did not have technical conditions to safely perform prolonged surgery which would have included a surgical procedure on the liver and administration of intraoperative chemotherapy. The patient underwent six series of parenteral chemotherapy, but refused the second-look surgery. Even though our patient did not receive intraperitoneal chemotherapy, maximal surgical tumor reduction, and refused second-look surgery, she is still alive and without any major complaints two years after the surgery.

Case-control design as investigative approach to assessing cancer etiology: development and future perspectives.

The case-control method evolved out of analyses of series of cases. The analytic form of the case-control study can be found in the 19th century medical literature, but did not appear to be viewed as a special or distinct methodology. The first modern case-control study was the Janet Lane-Claypon's study of breast cancer in 1926, but the design was used only sporadically in medicine until 1950, when 4 published casecontrol studies linked smoking and lung cancer. These 1950s studies synthesized the essential elements of the case-control comparison, produced a conceptual shift within epidemiology, and laid the foundation for the rapid development of the case-control design in the subsequent half century. The powerful consistency of these case-control studies, and the replication of their findings in later prospective studies, promoted the general acceptance of the case-control study as a scientific tool in clinical research. Newer case-control studies have benefited from the advances in design, execution and analysis since 1950s. These advances include more rigorous selection and matching of case and control population, improved interviewing techniques, location of the design within a general framework of epidemiologic strategies for relating exposure to disease, understanding of the measures of effect, and application of increasingly sophisticated statistical procedures to findings. This review traces the development and future perspectives of the case-control design to assessing cancer etiology. With illustrations drawn primarily from the literature on its use and the value of its results to unravelling the etiology of malignant diseases, we tried to explore if the case-control approach firmly ensconced in epidemiology as investigational tool and rivals in importance the more straightforward cohort approach.

Effects of anthocyanins and anthocyanin-rich extracts on the risk for cancers of the gastrointestinal tract.

Anthocyanins are the largest group of water-soluble pigments in the plant kingdom. Anthocyanins are responsible for most of the red, blue, and purple colors of fruits, vegetables, flowers, and other plant tissues or products. In recent years, numerous studies have shown that anthocyanins display a wide range of biological activities. This review summarises recent literature evidence on the association of anthocyanins and anthocyanin-rich extracts consumption with the risk for gastrointestinal tract cancer, concentrating on the results from in vivo animal model tumor systems, as well as data from human epidemiological studies. Potential cancer chemopreventive activities of anthocyanins were revealed from in vitro studies. In vivo animal model tumor systems showed that dietary anthocyanins inhibit cancers of the gastrointestinal tract. Some epidemiological studies have revealed protective effects of anthocyanins consumption on gastrointestinal cancer risk in humans. Pharmacokinetic data indicate that absorption of anthocyanins into the bloodstream of rodents and humans is minimal, suggesting that they may have little efficacy in tissues other than the gastrointestinal tract and skin. Future studies should be undertaken to determine if the anticancer effects of anthocyanins are due to the parent compounds and/or to their metabolites.

reply: Neurobiologyp25 protein in neurodegeneration.

Yoo and Lubec show that the amount of p25 is decreased in the brains they studied from patients with Alzheimer's disease or Down's syndrome. Their results persuaded us to conduct a more extensive survey of the p25/p35 ratio in AD brains (to be published elsewhere), as the number of samples was small in both of our studies (eight AD brains in our original study and six in theirs). After analysing a further 25 AD brains and those from 25 age-matched controls, we found that p25 levels are consistently higher in AD brains and that the difference is statistically significant (Student's t-test). This is in agreement with our original observations, as well as being consistent with earlier reports of increased Cdk5 kinase activity in AD brain and of increased amounts of p25 in an animal model of neurodegeneration.

Juvenile bullous pemphigoid: the presentation and follow-up of six cases.

BACKGROUND: Juvenile bullous pemphigoid (JBP) is a very rare autoimmune blistering disease. Up to now, 81 cases have been published. OBJECTIVES: To describe clinical, histopathological and immunopathological characteristics of our patients with JBP, their response to therapy and clinical course, and to show the rarity of JBP in our population. STUDY DESIGN: Retrospective study of all patients with JBP diagnosed from 1983 to the end of 2007. The patients were followed from 6 months to 24 years. SETTING: An academic, teaching hospital - Pediatric Dermatology Unit of the Institute of Dermatovenereology, Clinical Center of Serbia, Belgrade. PATIENTS AND METHODS: Six patients with JBP (4 girls and 2 boys) aged 2 to 17 years. The average age at onset of BP was 10 years. The diagnosis was confirmed by histopathological analysis and direct immunofluorescence test. The patients were treated with systemic and topical corticosteroids, and three patients received dapsone. RESULTS: The disease control was achieved after 2 weeks to 2.5 months of therapy. The treatment lasted from 2 weeks to 4.5 months, 1.8 months at the average. The period from the beginning of the disease to complete remission ranged from 1.5 month to 5 years, with a mean value of 14 months. In one boy, the parents interrupted the therapy, and the disease remitted spontaneously after 5 years. CONCLUSION: According to our experience, JBP can spontaneously remit within 5 years. JBP has a relatively indolent course and may be a self-limiting disease. The patients should not be over-treated in order to avoid side-effects of medication.

Characterizing plasma with emission tomography-Feasibility study on synthetic and experimental data.

We present a feasibility study on different tomographic algorithms to overcome the issues of finite sets of projection data, limited viewing angles, and noisy data, which cause the tomographic reconstruction to be an ill-posed inversion problem. We investigated three approaches: single angle Abel inversion, two angle approach, and multiple angle 2D plasma tomography. These methods were tested on symmetric and asymmetric sample functions and on experimental results from a supersonic flowing argon microwave plasma sustained in a cylindrical quartz cavity. The analysis focused on the afterglow region of the microwave flow where a plasmoid-like formation was observed. We investigated the effects of the uniform random noise added to the simulated data by applying smoothing techniques. The quality of reconstructed images was assessed by using peak signal-to-noise ratio and universal quality image measures. The results showed that the Abel inversion approach could be employed only when the system is radially symmetric, while the systems with slight asymmetry could be reconstructed with the two angle approach. In the complete absence of symmetry, full 2D tomographic reconstruction should be applied. The data analysis showed that the best results were obtained by employing either the filtered back projection or the simultaneous algebraic reconstruction technique. The total variation minimization method proved to be the best denoising technique. Each approach was used to obtain the spatial distributions of argon excited states taken at three positions along the plasmoid-like structure. The results indicated that the plasma was asymmetric with argon populating the cavity surface.

Photocatalytic degradation of methylene blue under natural sunlight using iron titanate nanoparticles prepared by a modified sol-gel method.

The aim of this work was to synthesize semiconducting oxide nanoparticles using a simple method with low production cost to be applied in natural sunlight for photocatalytic degradation of pollutants in waste water. Iron titanate (Fe2TiO5) nanoparticles with an orthorhombic structure were successfully synthesized using a modified sol-gel method and calcination at 750°C. The as-prepared Fe2TiO5 nanoparticles exhibited a moderate specific surface area. The mesoporous Fe2TiO5 nanoparticles possessed strong absorption in the visible-light region and the band gap was estimated to be around 2.16 eV. The photocatalytic activity was evaluated by the degradation of methylene blue under natural sunlight. The effect of parameters such as the amount of catalyst, initial concentration of the dye and pH of the dye solution on the removal efficiency of methylene blue was investigated. Fe2TiO5 showed high degradation efficiency in a strong alkaline medium that can be the result of the facilitated formation of OH radicals due to an increased concentration of hydroxyl ions.

Diagnostic value of endosonography scoring systems in the detection of ovarian and endometrial carcinoma.

PURPOSE: To evaluate the diagnostic significance of sonographic scoring systems in the diagnosis of ovarian and endometrial carcinoma. PATIENTS AND METHODS: 357 women with different malignant and benign diseases of the ovary and uterus were divided into 4 groups according to histopathological findings: group A: ovarian carcinoma (n=71); group B: benign ovarian tumors (n=106); group C: endometrial carcinoma (n=60); and group D: benign endometrial diseases in menopause (hyperplasia, polyps, submucosal myoma; n=120). Women were examined using 7 MHz endovaginal probe and were evaluated using 2 different sonographic scoring systems, separately for ovarian and for endometrial carcinoma. Particular morphological characteristics of ovarian carcinoma (tumor size, echo-characterization: solid-cystic, presence of septum, characteristics of tumor capsule and presence of ascites) were evaluated with points 0-2 (total score: 0-10). For endometrial carcinoma we used a clinico-sonographic scoring system, which included evaluation of the endometrial thickness, isthmus-fundus diameter of uterus, number of years in menopause and the presence of risk factors, using scores 0-2 (total score: 0-8). RESULTS: The average age in group A was 48.1 years, and the arithmetic mean of total score 7.25 points. In group C the average age was 64.1 years, and the arithmetic mean of total score 6.38 points. Using both scoring systems, a total score of 6 points had the highest diagnostic reliability in both ovarian (sensitivity 87.3%, specificity 97.5%, test accuracy 91.6%) and endometrial carcinoma (sensitivity 80%, specificity 91.5%, test accuracy 90.9%). CONCLUSION: A total score of 6 and more points presents the gold standard according to which it is possible to diagnose with high accuracy the existence of ovarian and endometrial carcinoma. Shifting towards higher criteria, specificity and positive predictive value rise, but sensitivity, negative predictive value and test accuracy decrease. Shifting towards lower values of total score increases sensitivity and positive predictive value, but decreases specificity, negative predictive value and test accuracy.

Cables links Cdk5 and c-Abl and facilitates Cdk5 tyrosine phosphorylation, kinase upregulation, and neurite outgrowth.

Cyclin-dependent kinase 5 (Cdk5) is a small serine/threonine kinase that plays a pivotal role during development of the CNS. Cables, a novel protein, interacts with Cdk5 in brain lysates. Cables also binds to and is a substrate of the c-Abl tyrosine kinase. Active c-Abl kinase leads to Cdk5 tyrosine phosphorylation, and this phosphorylation is enhanced by Cables. Phosphorylation of Cdk5 by c-Abl occurs on tyrosine 15 (Y15), which is stimulatory for p35/Cdk5 kinase activity. Expression of antisense Cables in primary cortical neurons inhibited neurite outgrowth. Furthermore, expression of active Abl resulted in lengthening of neurites. The data provide evidence for a Cables-mediated interplay between the Cdk5 and c-Abl signaling pathways in the developing nervous system.

Combined FTIR and SEM-EDS study of Bi2O3 doped ZnO-SnO2 ceramics.

The effects of Bi(2)O(3) addition on the phase composition, microstructure and optical properties of ZnO-SnO(2) ceramics were investigated. Starting powders of ZnO and SnO(2) were mixed in the molar ratio 2:1. After adding Bi(2)O(3) (1.0 mol.%) this mixture was mechanically activated for 10 min in a planetary ball mill, uniaxially pressed and sintered at 1300 degrees C for 2 h. Far-infrared reflection spectra were measured (100-1000 cm(-1)). To investigate the occurred differences in FTIR spectra, the Bi(2)O(3)-doped sample was examined more carefully with a Perkin-Elmer FTIR spectrometer (Perkin Elmer, Waltham, MA, USA) connected with a Perkin-Elmer FTIR microscope and itemized points of interest were also studied with SEM-EDS.

Verrucous carcinoma of the foot: a case report.

We present a case of verrucous carcinoma of the foot in a 34-year-old man. This is a rare, locally invasive, well-differentiated, low-grade squamous cell carcinoma, with human papilloma virus as a possible causative agent. It follows a chronic course and mimics a variety of skin lesions, delaying diagnosis by up to 15 years. The definitive diagnosis is made histologically, and treatment by wide local excision is recommended. Our patient underwent wide local excision and partial 5th metatarsal amputation because of invasive disease, local infection, and peripheral vascular disease. There were no postoperative complications. At the 10-year follow-up, there were no signs of tumour recurrence.