Factors influencing re-bleeding after trans-arterial embolization for endoscopically unmanageable peptic ulcer bleeding.

BACKGROUND/AIMS: Acute peptic ulcer bleeding is the most common cause of non-variceal upper gastrointestinal bleeding (NVUGIB). Endoscopic hemostasis is the standard treatment. However, various conditions complicate endoscopic hemostasis. Transarterial visceral embolization (TAE) may be helpful as a rescue therapy. This study aimed to investigate the factors associated with rebleeding after TAE. METHODS: We retrospectively investigated the records of 156 patients treated with TAE between January 2007 and December 2021. Rebleeding was defined as the presence of melena, hematemesis, or hematochezia, with a fall (>2.0 g/dl) in hemoglobin level or shock after TAE. The primary outcomes were rebleeding rate and 30-day mortality. RESULTS: Seventy patients with peptic ulcer bleeding were selected, and rebleeding within a month after TAE occurred in 15 patients (21.4%). Among the patients included in rebleeding group, significant increases were observed in the prevalence of thrombocytopenia (73.3% vs. 16.4%, p<.001) and ulcers >1 cm (93.3% vs 54.5%, p = .014). The mean AIMS65 (albumin, international normalized ratio, mental status, systolic blood pressure, age >65 years) score (2.3 vs 1.4, p = .009) was significantly higher in the rebleeding group. Multivariate logistic analysis revealed that thrombocytopenia (odds ratio 31.92, 95% confidence interval 6.24-270.6, p<.001) and larger ulcer size (odds ratio 27.19, 95% confidence interval 3.27-677.7, p=.010) significantly increased the risk of rebleeding after TAE. CONCLUSION: TAE was effective in the treatment of patients with high-risk peptic ulcer bleeding. AIMS65 score was a significant predictor of rebleeding after TAE, and thrombocytopenia and larger ulcer size increased the risk of rebleeding after TAE.

Small Bowel Variceal Bleeding in Patients with Liver Cirrhosis Treated with Transarterial Embolization: Case Series.

Small bowel variceal bleeding is a rare cause of gastrointestinal hemorrhage, with clinical manifestations ranging from asymptomatic incidental findings to life-threatening conditions. The diagnosis and management of small bowel bleeding are challenging because of the localization of the lesion and the difficulty of the procedure. Trans-arterial embolization (TAE) is a secure and straightforward method for treating ectopic varices. On the other hand, there have been limited local studies on the outcomes of TAE for patients with small bowel variceal hemorrhage. This paper reports patients diagnosed with small bowel variceal bleeding and treated with TAE.

Fighting Fire or Fighting War: Examining the Framing Effects of COVID-19 Metaphors.

Metaphorical language describing the COVID-19 pandemic as a war has been pervasive in public discourse (e.g. "the pandemic is a war," "the virus is an enemy," and "the vaccine is a weapon"). This study employs an online survey experiment (N = 551 U.S. adults) to examine the impact of war metaphors compared to non-metaphorical literal frames and fire metaphors (e.g. "the pandemic is a wildfire"). War metaphors exhibited little advantage over literal frames across a variety of desirable outcomes (i.e. the adoption of pro-health behaviors against COVID-19, perceived solidarity and collective responsibility to curb the pandemic, and intentions to discuss and share the health news with others). However, this study revealed some benefits of war metaphors over fire metaphors. Compared with fire metaphors, health news featuring war metaphors increased both positive emotions and perceived threats of COVID-19, which in turn promoted pro-health behaviors against COVID-19 and perceived solidarity to cope with the public health crisis. Moreover, positive emotions in response to war metaphors also indirectly encouraged the retransmission of science-based COVID-19 health news. This study thus showcased the benefits and limitations of war metaphors and revealed the mediating roles of perceived threats and positive emotions in explaining war metaphorical framing effects. Implications of using war and fire metaphors for communicating about public health crises are also discussed.

The Effects of Vaccine Efficacy Information on Vaccination Intentions Through Perceived Response Efficacy and Hope.

Response efficacy information indicating the effectiveness of a recommended behavior in risk reduction is an important component of health communication. For example, many messages regarding COVID-19 vaccines featured numerical vaccine efficacy rates in preventing infections, hospitalizations, and deaths. While the relationship between disease risk perceptions and fear has been well established, we know less about the psychological factors involved in communicating vaccine efficacy information, such as response efficacy perceptions and hope. This study examines the effects of numerical vaccine efficacy information and message framing on vaccination intentions and their relationship to perceived response efficacy and hope, using a fictitious infectious disease similar to COVID-19. Findings suggest that communicating a high efficacy rate of the vaccine in preventing severe illness increased perceived response efficacy, which in turn boosted vaccination intention directly and indirectly through increasing hope. Also, fear about the virus was positively associated with hope about the vaccine. Implications of using response efficacy information and hope appeals in health communication and vaccination promotion are discussed.

Yet Again Conversations Matter: The Importance of Interpersonal Discussions, Educational Campaigns, and Advertising on Cannabis-Related Risk Perceptions, Attitudes, and Intentions in At-Risk Young Adults.

The present study seeks to evaluate the relationships between cannabis-related communication and outcomes of interest such as cannabis-related risk perceptions, attitudes, and behaviors among young adults. Young adults who were at risk for cannabis use were surveyed online in 2020. Results showed that exposure to online educational messages was associated with higher intentions of engaging in peer intervention, while exposure to online advertising was related to higher intention to use cannabis. Anti-cannabis interpersonal discussion was associated with increased risk perceptions, less favorable cannabis attitudes, and a higher likelihood of peer intervention. More pro-cannabis interpersonal discussion was associated with decreased risk perceptions, more favorable cannabis attitudes, higher use intention, and decreased likelihood of peer intervention. In addition, pro-cannabis interpersonal discussion mediated the relationship between exposure to advertising and cannabis risk perceptions, intentions to use cannabis, attitudes about cannabis, and the likelihood of peer intervention. In contrast, anti-cannabis interpersonal discussion mediated the relationship between exposure to educational messages online and cannabis risk perceptions and the likelihood of peer intervention. These findings underscore the need to regulate online cannabis marketing and the importance of investing in online education campaigns to increase public understanding of the risks associated with cannabis consumption in young adulthood.

Textual and pictorial enhancement of cannabis warning labels: An Online experiment among at-risk U.S. young adults.

BACKGROUND: This study experimentally examines whether enhanced cannabis warning labels (CWLs) outperform those currently required in the U.S. in improving recall of health risks, emotional responses, and perceived message effectiveness among at-risk young adults. METHOD: We conducted an online national survey-based experiment in October 2020. Young adults aged 18-26 years old and at-risk for cannabis use (N = 523) were randomly assigned in an online experiment, to view either currently required CWLs in California with small font and a composite health risk statement, or enhanced single-theme CWLs with varying textual and pictorial components. We performed linear regression analyses to compare the enhanced with existing CWLs on information recall, negative emotions, and perceived message effectiveness. Furthermore, information recall and negative emotions were examined as parallel mediators to better understand the mechanisms underlying effective textual and pictorial enhancement of CWLs. RESULTS: Compared with currently required CWLs in California, both textually (b = 0.30, p = .011) and pictorially (b = 0.59, p < .001) enhanced CWLs increased recall accuracy. Pictorially enhanced CWLs outperformed their text-only counterparts (b = 0.28, p = .019) in improving information recall. Only pictorially enhanced CWLs improved perceived message effectiveness (b = 0.31, p = .008), which was mediated by negative emotions but not by information recall. CONCLUSIONS: Given rapid expansion of the cannabis industry and declining perception of harm, currently required CWLs in the U.S. such as California's, would benefit from redesign to improve public understanding of health risks and to prevent youth use.

The E3 ligase C-CBL inhibits cancer cell migration by neddylating the proto-oncogene c-Src.

Neddylation is a cellular process that covalently conjugates substrate proteins with the small ubiquitin-like molecule NEDD8. As neddylation is required for fast turnover of proteins in proliferating cancer cells, the neddylation process is currently regarded as a potential target for cancer therapy. However, little is known about the role of neddylation in cancer invasion and metastasis. Unexpectedly, we here found that the neddylation blockade stimulates migration of lung cancer and glioblastoma cells. Mechanistically, C-CBL acts as the E3 ligase for neddylation of the proto-oncogene c-Src. After neddylation, c-Src is poly-ubiquitinated and degraded through the proteasome, which inhibits the PI3K-AKT pathway responsible for cell migration. In human lung cancer tissues, the downregulation of C-CBL was associated with c-Src/AKT, cancer metastasis, and poor survival in patients. Therefore, C-CBL is likely to play a tumor suppressive role by antagonizing a robust oncogenic signaling driven by c-Src. This study provides new insight about the role of neddylation in cancer metastasis. It also implies that the metastasis risk should be carefully evaluated before the clinical application of neddylation inhibitors as anticancer regimens.

Measurement of biological age may help to assess the risk of colorectal adenoma in screening colonoscopy.

AIM: To investigate the clinical utility of biological age (BA) measurement in screening colonoscopy for the detection of colorectal adenomas in the average-risk population. METHODS: A consecutive series of asymptomatic subjects aged ≥ 30 years who underwent colonoscopy in routine check-ups were enrolled. Colorectal adenoma was classified according to size, number, and location. BAs were calculated using the MEDIAGETM Biological Age Measurement System. RESULTS: A total of 2696 subjects were investigated (1876 men and 820 women). The mean chronological age (CA) was 46.0 years and the mean BA was 44.7 years. Metabolic syndrome (MS) was diagnosed in 218 subjects (8.1%). The prevalence of overall colorectal adenoma was 23.1% (622/2,696). When the subjects were divided into four groups based on BA (≤ 39 years; 40-49 years; 50-59 years; ≥ 60 years), the prevalence of colorectal adenoma was increased as BA increased (P < 0.001). Colorectal adenoma located in the proximal colon was more prevalent in the BA-dominant group (BA-CA ≥ 5 years) than the CA-dominant group (CA-BA ≥ 5 years) (P = 0.034). When the subjects were categorized into four groups according to MS and age gap between BA and CA, the incidence of colorectal adenoma increased with MS and BA-dominance (P < 0.05). CONCLUSION: Measurement of BA may help to assess the risk of colorectal adenoma in screening colonoscopy.

Cordyceps militaris Enhances Cell-Mediated Immunity in Healthy Korean Men.

Cordyceps militaris is a mushroom traditionally used for diverse pharmaceutical purposes in East Asia, including China, and has been found to be effective for enhancing immunity through various types of animal testing. The aim of this study is to determine the efficacy of C. militaris for enhancing cell-mediated immunity and its safety in healthy male adults. Healthy male adults were divided into the experimental group (n = 39), given 1.5 g/day of ethanol treated C. militaris in capsules, and the control group (n = 40), given the same number of identical placebo capsules filled with microcrystalline cellulose and lactose for 4 weeks from February 13 to March 14, 2012; the natural killer (NK) cell activity, lymphocyte proliferation index (PI), and T-helper cell 1 (Th1) cytokine cluster (interferon [IFN]-γ, interleukin [IL]-12, IL-2, and tumor necrosis factor [TNF]-α) were measured, along with stability test, at weeks 0, 2, and 4. The C. militaris group showed a statistically significant greater increase in NK200 (P = .0010), lymphocyte PI (P ≤ .0001), IL-2 (P = .0096), and IFN-γ (P = .0126), compared with the basal level, than the placebo group. There was no statistically significant adverse reaction. C. militaris enhanced the NK cell activity and lymphocyte proliferation and partially increased Th1 cytokine secretion. Therefore, C. militaris is safe and effective for enhancing cell-mediated immunity of healthy male adults.

Measurement of antioxidant capacity using the biological antioxidant potential test and its role as a predictive marker of metabolic syndrome.

BACKGROUND/AIMS: Oxidative stress increases the risk of cardiovascular complications of metabolic syndrome (MetS). This study was conducted to examine the difference in antioxidant capacity according to the presence of MetS, and to characterize the association between antioxidant capacity and MetS-related factors. METHODS: We used the biological antioxidant potential (BAP) test to estimate antioxidant capacity. The BAP test has recently been used as an indicator of antioxidant capacity. We measured BAP levels in 45 patients with MetS (mean age, 44.6 ± 1.1 years) and 47 age- and sex-matched controls (mean age, 42.7 ± 1.1 years). To evaluate the association between antioxidant capacity and MetS, adiponectin, high-sensitivity C-reactive protein (hs-CRP), interleukin-6, tumor necrosis factor-α, and homeostatic model assessment for insulin resistance (HOMA-IR), linear regression and logistic analyses were performed. RESULTS: The mean BAP of the MetS group (1,937.3 ± 36.5 µmol/L) was significantly lower than that of the non-MetS group (2,101.7 ± 29.5 µmol/L). Also, the mean BAP was low in persons having low high density lipoprotein and high triglyceride. Reduced antioxidant capacity was significantly associated with adiponectin, HOMA-IR and hs-CRP after adjusting for age and sex. The odds ratios for MetS with BAP, log adiponectin, log HOMA-IR, and log hs-CRP were 0.63 (95% confidence interval [CI], 0.49 to 0.82), 0.22 (0.10 to 0.51), 14.24 (4.35 to 46.58), and 1.93 (1.36 to 2.75), respectively. CONCLUSIONS: Persons with MetS showed reduced antioxidant capacity. We identified relationships between antioxidant capacity measured by BAP test and MetS, as well as MetS-related factors, such as insulin resistance, hs-CRP, and adiponectin.

Endoscopists' view on superficial spreading type of early gastric cancer--endoscopic resection or surgery?

OBJECTIVE: The superficial spreading type of early gastric cancer (EGC) possesses unique features different from other types of EGC. We aimed to elucidate the clinicopathological features of superficial spreading type of EGC. MATERIAL AND METHODS: We analyzed 1455 EGC lesions from 1398 patients who had undergone surgical treatment at Samsung Medical Center from 2000 to 2002. Then the clinicopathological features of 224 superficial-spreading EGC lesions (15.4%) was compared to that of 1231 lesions of a common type of EGC. RESULTS: In the superficial spreading type of EGC, the incidence of undifferentiated type and submucosal invasion were higher than those of common type of EGC (55.4 vs 38.0%, p < .01 and 58.5 vs 37.8%, p < .01, respectively). Lymph node metastasis and lymphovascular invasion were more frequent in superficial spreading type than in common type of EGC (19.2 vs 7.6%, p < .01 and 15.2 vs 7.4%, p < .01, respectively). There was no difference in recurrence rate or 5-year survival rate between the two groups. CONCLUSION: Considering higher risk of submucosal invasion and lymph node metastasis in superficial spreading type, a careful consideration should be done before the application of endoscopic resection to the superficial spreading type of EGC.

Cyclic AMP-mediated long-term facilitation of glycinergic transmission in developing spinal dorsal horn neurons.

cAMP is known to regulate neurotransmitter release via protein kinase A (PKA)-dependent and/or PKA-independent signal transduction pathways at a variety of central synapses. Here we report the cAMP-mediated long-lasting enhancement of glycinergic transmission in developing rat spinal substantia gelatinosa neurons. Forskolin, an adenylyl cyclase activator, elicited a long-lasting increase in the amplitude of nerve-evoked glycinergic inhibitory postsynaptic currents (IPSCs), accompanied by a long-lasting decrease in the paired-pulse ratio in immature substantia gelatinosa neurons, and this forskolin-induced increase in glycinergic IPSCs decreased with postnatal development. Forskolin also decreased the failure rate of glycinergic IPSCs evoked by minimal stimulation, and increased the frequency of glycinergic miniature IPSCs. All of these data suggest that forskolin induces the long-lasting enhancement of glycinergic transmission by increasing in the presynaptic release probability. This pre-synaptic action of forskolin was mediated by hyperpolarization and cyclic nucleotide-activated cation channels and an increase in intraterminal Ca(2+) concentration but independent of PKA. The present results suggest that cAMP-dependent signal transduction pathways represent a dynamic mechanism by which glycinergic IPSCs could potentially be modulated during postnatal development.

[An evaluation of web-based information about Barrett's esophagus in Korea].

BACKGROUND/AIMS: Internet has become an important source of medical information not only for doctors but also patients. However, information available in the Internet may provide wrong or even harmful knowledge to the public. The aim of this study was to evaluate the quality of Internet-based medical information about Barrett's esophagus in Korea. METHODS: The first 50 Internet links were retrieved from the Google using the key word Barrett's esophagus. The quality of information from a total of 49 websites was evaluated using a checklist. RESULTS: Among total 49 sites related to Barrett's esophagus, only 4 sites (8.2%) were made by hospitals or clinics, and 11 sites (22.4%) were for patients. Of the 49 sites, only one web site (2.0%) had all HON CODE principles (authority, complementarity, confidentiality, attribution, justifiability, transparency of authorship, transparency of sponsorship, honesty in advertising and editorial policy). Sixteen Internet links (32.0%) had fair contents for the definition, and 24 links (48.0%) for the diagnosis, and 15 links (30.0%) for the treatment. CONCLUSIONS: Information about Barrett's esophagus was incomplete in the majority of medical web sites. It will bring about confusion in patients who want to get information about Barrett's esophagus from the Internet. There is a need for better evidence-based information about Barrett's esophagus on the web.

Comparison of scoring systems for the prediction of outcomes in patients with nonvariceal upper gastrointestinal bleeding: a prospective study.

The authors aimed to compare the clinical utility of five scoring systems for the prediction of rebleeding and death in patients with nonvariceal upper gastrointestinal bleeding (UGIB). A total of 239 consecutive patients who had undergone endoscopy due to nonvariceal UGIB were prospectively investigated on the basis of five scoring systems (Forrest classification, Rockall scoring system, Cedars-Sinai Medical Centre Predict Index, Blatchford scoring system, and Baylor college scoring system). Thirty-five patients (14.6%) experienced rebleeding and 20 patients (8.4%) died. Comparison of the high-risk categories of the four predictive systems showed that the Forrest classification was superior to the others in predicting rebleeding and death. The Cedars-Sinai Medical Centre Predict Index and the Rockall scoring system showed high positive predictive values for predicting rebleeding and death, respectively. We concluded that the Forrest classification was the most useful scoring system for the prediction of rebleeding and death in patients with nonvariceal UGIB.

[Hepatocellular carcinoma with metastasis to the cavernous sinus of skull base causing ptosis].

The cavernous sinus of skull base is a extremely rare metastastatic site for hepatocellular carcinoma (HCC). A 51-year-old man was diagnosed with HCC by liver biopsy and palliative radiotherapy on HCC including main portal vein was performed. One month later, he was admitted due to sudden onset ptosis. Neurologic findings were normal except for abnormal movement of right eye, and it raised the possibility of abnormality in the right occulomotor, trochlear and the abducens nerves. Contrast-enhanced CT scan of brain showed a mass with homogeneous enhancement involving the right cavernous sinus. T2-weighted axial MR images demonstrated a homogeneous mass with intermediate signal intensity, and contrast-enhanced axial T1-weighted MR images demonstrated a mass with homogeneous enhancement in the right cavernous sinus. We describe a case of HCC metastasis to the cavernous sinus with symptoms of ptosis and disturbance of right eyeball movement.

GABA(B) receptor-mediated presynaptic inhibition of glycinergic transmission onto substantia gelatinosa neurons in the rat spinal cord.

The GABA(B) receptor-mediated presynaptic inhibition of glycinergic transmission was studied from young rat substantia gelatinosa (SG) neurons using a conventional whole-cell patch clamp technique. Action potential-dependent glycinergic inhibitory postsynaptic currents (IPSCs) were recorded from SG neurons in the presence of 3 mM kynurenic acid and 10 microM SR95531. In these conditions, baclofen (30 microM), a selective GABA(B) receptor agonist, greatly reduced the amplitude of glycinergic IPSCs and increased the paired-pulse ratio. Such effects were completely blocked by 3 microM CGP55845, a selective GABA(B) receptor antagonist, indicating that the activation of presynaptic GABA(B) receptors decreases glycinergic synaptic transmission. Glycinergic IPSCs were largely dependent on Ca2+ influxes passing through presynaptic N- and P/Q-type Ca2+ channels, and these channels contributed equally to the baclofen-induced inhibition of glycinergic IPSCs. However, the baclofen-induced inhibition of glycinergic IPSCs was not affected by either 100 microM SQ22536, an adenylyl cyclase inhibitor, or 1 mM Ba2+, a G-protein coupled inwardly rectifying K+ channel blocker. During the train stimulation (10 pulses at 20 Hz), which caused a marked synaptic depression of glycinergic IPSCs, baclofen at a 30 microM concentration completely blocked glycinergic synaptic depression, but at a 3 microM concentration it largely preserved glycinergic synaptic depression. Such GABA(B) receptor-mediated dynamic changes in short-term synaptic plasticity of glycinergic transmission onto SG neurons might contribute to the central processing of sensory signals.

[Effect of glutamine on the non-steroidal anti-inflammatory drug-induced bacterial translocation].

BACKGROUND/AIMS: NSAIDs induce gut damage throughout the entire gastrointestinal tract and bacterial translocation. The aim of this study was to examine if administration of glutamine was able to prevent the NSAID-induced gut damages and bacterial translocation in the animal models. METHODS: Rats were utilized into 5 groups; control group, diclofenac group, and diclofenac with glutamine 0.8, 1.6, and 3.2 g/kg/day group. The animals with glutamine were fed with L-glutamine for 4 days before diclofenac administration. Gut injury was induced by administration of a single dose of diclofenac (80 mg/kg orally). Intestinal permeability (24 hour urinary excretion of phenolsulfonphthalein), enteric aerobic bacterial counts, serum biochemical profiles and bacterial translocation to mesenteric lymph nodes, liver and spleen were measured. RESULTS: Diclofenac caused the increase in intestinal permeability, enteric bacterial count, enteric protein and albumin loss and bacterial translocation. Administration of glutamine reduced the increase in intestinal permeability, protein losing enteropathy, enteric bacterial overgrowth and bacterial translocation induced by diclofenac. CONCLUSIONS: Glutamine may have beneficial effects on NSAID-induced gut damage and bacterial translocation.

The presence of bacteria in the synovial fluid of the temporomandibular joint and clinical significance: preliminary study.

PURPOSE: The objective of this study was to find any relation between the presence of specific bacterial species in the synovial fluid of the temporomandibular joint (TMJ) and clinical parameters. PATIENTS AND METHODS: We studied 43 patients (male-to-female ratio, 1:1.69; average age, 34.37 +/- 14.55 years). Thirty-three patients had a displaced disc in the TMJ (DD group), and 10 patients did not have a displaced disc of the TMJ or any symptom related to TMJ disorders (NDD group). Clinical examinations were made to determine maximum mouth opening, joint sounds, previous trauma history, systemic disease, and TMJ pain. Six bacterial species that were reported in other studies were chosen to evaluate the presence of bacteria in the TMJ for this study. RESULTS: Mycoplasma genitalium was most frequently detected in synovial fluid (86.0%). Staphylococcus aureus, Mycoplasma fermentans/orale, Actinobacillus actinomycetemcomitans, and Streptococcus mitis were detected in 51.2%, 37.2%, 25.6%, and 7.0% of samples, respectively. beta-Hemolytic Streptococcus was not detected. The prevalence of S aureus was significantly higher in the DD group than in the NDD group (P <.05). The patients who had M. fermentans/orale were 5.40 times more likely to be younger than 30 years than were those without M. fermentans/orale (P <.05). Those with M. genitalium were 5.81 times more likely to be female than were those without M. genitalium (P <.05). CONCLUSION: The presence of S. aureus in TMJ synovial fluid was related to TMJ disorder symptoms and clinical parameters seemed to be influenced by bacterial presence in TMJ synovial fluid.