[Exploration on the treatment method of pericardium meridian for stomach diseases].

The ancient and modern discussions on the treatment of acupoints of the pericardium meridian of hand jueyin and non-acupoints along the meridian for stomach diseases were summarized, and the treatment principle of pericardium meridian for stomach diseases was explored. The relationship between pericardium meridian and stomach was discussed from the three perspectives of heart-stomach correlation, organ-meridian correlation and qi-position correlation. Based on these discussions, the guiding significance of the thoughts of selection effective treatment parts and the theoretical construction for clinical practice was considered and examined.

Role of Gastric Microorganisms Other than Helicobacter pylori in the Development and Treatment of Gastric Diseases.

The microenvironment in the stomach is different from other digestive tracts, mainly because of the secretion of gastric acid and digestive enzymes, bile reflux, special mucus barrier, gastric peristalsis, and so on, which all contribute to the formation of antibacterial environment. Microecological disorders can lead to gastric immune disorders or lead to the decrease of dominant bacteria and the increase of the abundance and virulence of pathogenic microorganisms and then promote the occurrence of diseases. The body performs its immune function through innate and adaptive immunity and maintains microbial balance through the mechanism of immune homeostasis. Microecological imbalance can lead to the invasion of pathogenic microorganisms and damage mucosal barrier and immune system. The coexistence of gastric microorganisms (including viruses and fungi) may play a synergistic or antagonistic role in the pathogenesis of gastric diseases. Probiotics have the ability to compete with intestinal pathogens, increase the secretion of immunoglobulin A (IgA), stimulate the production of mucin, bacteriocin, and lactic acid, regulate the expression and secretion of cytokines, and regulate the growth of microbiota, which all have beneficial effects on the host microbial environment. At present, most studies focused on Helicobacter pylori, ignoring other stomach microbes and the overall stomach microecology. So, in this article, we reviewed advances in human gastric microecology, the relationship between gastric microecology and immunity or gastric diseases, and the treatment of probiotics in gastric diseases, in order to explore new area for further study of gastric microorganisms and treatment of gastric diseases.

Exploration on the treatment method of pericardium meridian for stomach diseases / 中国针灸

The ancient and modern discussions on the treatment of acupoints of the pericardium meridian of hand jueyin and non-acupoints along the meridian for stomach diseases were summarized, and the treatment principle of pericardium meridian for stomach diseases was explored. The relationship between pericardium meridian and stomach was discussed from the three perspectives of heart-stomach correlation, organ-meridian correlation and qi-position correlation. Based on these discussions, the guiding significance of the thoughts of selection effective treatment parts and the theoretical construction for clinical practice was considered and examined.

[Optimization and implementation of clinical trial of acupuncture: reflection on the successful case of acupuncture for postprandial distress syndrome].

Taking the clinical trial of acupuncture in treatment of postprandial distress syndrome as an example, this paper proposes that the acupuncture clinical trial protocol should be optimized in view of acupuncture prescription, acupuncture frequency and outcomes. Besides, the data quality of acupuncture clinical trial should be improved in consideration of data sharing and electronic data capture so as to provide a reference for the majority of researchers to optimize and implement acupuncture clinical trial.

Ontology Engineering for Gastric Dystemperament in Persian Medicine.

OBJECTIVE: Developing an ontology can help collecting and sharing information in traditional medicine including Persian medicine in a well-defined format. The present study aimed to develop an ontology for gastric dystemperament in the Persian medicine. METHODS: This was a mixed-methods study conducted in 2019. The first stage was related to providing an ontology requirements specification document. In the second stage, important terms, concepts, and their relationships were identified via literature review and expert panels. Then, the results derived from the second stage were refined and validated using the Delphi method in three rounds. Finally, in the fourth stage, the ontology was evaluated in terms of consistency and coherence. RESULTS: In this study, 241 concepts related to different types of gastric dystemperament, diagnostic criteria, and treatments in the Persian medicine were identified through literature review and expert panels, and 12 new concepts were suggested during the Delphi study. In total, after performing three rounds of the Delphi study, 233 concepts were identified. Finally, an ontology was developed with 71 classes, and the results of the evaluation study revealed that the ontology was consistent and coherent. CONCLUSION: In this study, an ontology was created for gastric dystemperament in the Persian medicine. This ontology can be used for designing future systems, such as case-based reasoning and expert systems. Moreover, the use of other evaluation methods is suggested to construct a more complete and precise ontology.

Application of a new hyperbaric oxygen therapy protocol in patients with arterial and venous gas embolism due to hydrogen peroxide poisoning.

Hydrogen peroxide (H2O2) ingestion can cause vascular gas embolism (GE). Hyperbaric oxygen therapy (HBO2) is known to improve neurological abnormalities in patients with arterial gas embolism (AGE). Previously, HBO2 based on the U.S. Navy Table 6 diving protocol has been adopted for treating AGE and preventing the progression of portal venous GE, caused by H2O2 ingestion, to AGE. However, the indication and protocol for HBO2 have not been established for GE related to H2O2 ingestion. Herein, we describe a case in which GE caused by H2O2 ingestion was treated using HBO2 with a short protocol. A 69-year-old female patient presented with abdominal pain, vomiting, and transient loss of consciousness after ingesting 35% H2O2. Computed tomography revealed gastric wall and portal venous gas. She was administered an HBO2 protocol with 2.8-atmosphere absolute (ATA) compression for 45 minutes. This was followed by a 2.0-ATA treatment for 60 minutes with a five-minute air break, after which all gas bubbles disappeared. After HBO2 treatment, brain magnetic resonance imaging revealed focal cytotoxic edema lesions; however, the patient was discharged without additional symptoms.

Effect of electroacupuncture at different acupoints in treating rapid gastric emptying: Zusanli (ST36) plus Zhongwan (CV12) versus Zhongwan (CV12) alone.

OBJECTIVE: To evaluate the effect of electroacupuncture on rapid gastric emptying by comparing the effectiveness of electroacupuncture at both Zusanli (ST36) and Zhongwan (CV12) (He-Mu acupoints) versus electroacupuncture at Zhongwan (CV12) alone. METHODS: Sixty-five patients were randomly divided into two groups; 33 patients in the He-Mu acupoints group received electroacupuncture at both Zusanli (ST36) and Zhongwan (CV12), while 32 patients in the single acupoint group received electroacupuncture only at Zhongwan (CV12). Both groups were treated once daily for 30 min, five times per week for 3 weeks. Before and after the 3-week treatment course, patients underwent gastric emptying scintigraphy and were assessed using the Traditional Chinese Medicine (TCM) symptom scale of gastrointestinal diseases. The two groups were compared regarding the percentages of gastric retention at 30 and 60 min and the TCM symptom scores. RESULTS: After the treatment course, the percentages of gastric retention at 30 and 60 min were significantly improved in both groups compared with the pre-treatment values (P < 0.01). The improvement in the gastric retention was significantly better in the He-Mu acupoints group than the single acupoint group at 30 min (P <0.01) and 60 min (P < 0.05). The TCM symptom score was significantly decreased after the treatment course in both groups (P < 0.01). The improvement in the TCM symptom score was significantly better in the He-Mu acupoints group than the single acupoint group (P < 0.01). The total effective rate was 93.55% (29/31) in the He-Mu acupoints group and 77.42% (24/31) in the single acupoint group. The treatment effect was better in the He-Mu acupoints group than the single acupoint group (P < 0.05). CONCLUSIONS: Electroacupuncture at both Zusanli (ST36) and Zhongwan (CV12) or at Zhongwan (CV12) alone is effective in treating rapid gastric emptying. Furthermore, electroacupuncture at both Zusanli (ST36) and Zhongwan (CV12) is more effective than electroacupuncture at Zhongwan (CV12) alone.

Gastroduodenal tuberculosis: a case series and a management focused systematic review.

INTRODUCTION: Gastroduodenal tuberculosis is an uncommon form of abdominal tuberculosis. AREAS COVERED: We report our experience with five cases of gastroduodenal tuberculosis and present results of a systematic review on gastroduodenal tuberculosis regarding clinical presentation, endoscopic, imaging findings, and the diagnostic and therapeutic approach. EXPERT OPINION: The presentation of gastroduodenal tuberculosis is diverse and may include nonspecific abdominal pain or dyspepsia like symptoms apart from gastric outlet obstruction. Endoscopy may show presence of growth, ulcer, narrowing, or fistula on endoscopy. Endoscopic biopsy, well-biopsy, or mucosal resection of an elevated lesion are helpful. On microscopy, granuloma with or without acid fast bacilli positivity can be found. For treatment, standard antitubercular therapy should be given for 6 months. In patients with tight stricture, endoscopic balloon dilatation can be helpful. Surgery is reserved for patient with diagnostic dilemma, refractory stricture, or complications like perforation or fistula. Future research should focus on improving diagnosis with use of modern microbiological techniques like PCR and Xpert MTB/RIF.

Optimization and implementation of clinical trial of acupuncture: reflection on the successful case of acupuncture for postprandial distress syndrome / 中国针灸

Taking the clinical trial of acupuncture in treatment of postprandial distress syndrome as an example, this paper proposes that the acupuncture clinical trial protocol should be optimized in view of acupuncture prescription, acupuncture frequency and outcomes. Besides, the data quality of acupuncture clinical trial should be improved in consideration of data sharing and electronic data capture so as to provide a reference for the majority of researchers to optimize and implement acupuncture clinical trial.

Efectividad y seguridad de ramucirumab en el tratamiento de adenocarcinoma gástrico / Effectiveness and safety of ramucirumab in the treatment of gastric adenocarcinoma

Objetivos: Evaluar la efectividad y seguridad de ramucirumab en el tratamiento de adenocarcinoma gástrico metastático (AGM) o adenocarcinoma de la unión gastroesofágica metastático (AUGEM) en un hospital de clase 5. Métodos: Estudio observacional retrospectivo en el que se incluyeron a todos los pacientes tratados con ramucirumab en el hospital. Se realizó un seguimiento a través de la historia clínica electrónica (HCE) de la que se recogieron edad, sexo, diagnóstico, estado funcional según ECOG y líneas previas de tratamiento. Como variables de efectividad se calcularon la supervivencia libre de progresión (SLP) y supervivencia global (SG). Como variables de seguridad se analizaron los efectos adversos recogidos en la HCE y se categorizaron por gravedad según CTCAE (v.5). Resultados: Se analizó un total de 40 pacientes (20% mujeres) con edad media al inicio del tratamiento de 62,5±12,4 años. Al inicio del tratamiento, el 67,5% de los pacientes tenían ECOG 1. El 78% de los tratamientos con ramucirumab fueron en segunda línea y el 22% en tercera. Respecto a la primera línea, el 100% de los esquemas estaban basados en platino y fluoropirimidinas.EL 90,1% de los pacientes fueron tratados con la combinación de paclitaxel 80 mg/m2 más ramucirumab 8 mg/kg; el resto se trató en monoterapia. Los pacientes recibieron de media 5,1±4,1 ciclos. La SLP fue de 4 (3,1-8,9) meses y la SG fue de 5,8 (4,6-13) meses.En cuanto a la seguridad, el 75,6% de los pacientes (n=31) presentó algún efecto adverso. El efecto adverso más observado fue astenia en el 48,8% de los pacientes (n=20). También se observó: hipertensión (17,1%), rash cutáneo (12,2%), alopecia (12,2%), neutropenia (9,7%), mucositis (9,7%) y náuseas (9,7%). Conclusiones: La SLP fue similar en este estudio a la obtenida en el ensayo clínico pivotal RAINBOW, aunque el valor de la SG obtenida fue de casi la mitad. La seguridad fue similar a la observada en el ensayo clínico mencionado. (AU)

Objetive: To assess the effectiveness and safety of ramucirumab in the treatment of metastatic gastric adenocarcinoma (MGA) or metastatic gastroesophageal junction adenocarcinoma (MGJA) in a class 5 hospital.Methods: Retrospective observational study in which all patients treated with ramucirumab in the hospital were included.A follow-up was carried out through the electronic medical history (HCE) from which age, sex, diagnosis, functional status according to ECOG and previous treatment lines were collected. As effectiveness variables, progression-free survival (PFS) and overall survival (OS) were calculated. As safety variables, the adverse effects recorded in the HCE were analyzed and categorized by severity according to CTCAE (v.5).Results: A total of 40 patients (20% women) with a mean age at the start of treatment of 62.5±12.4 years were analyzed. At the beginning of treatment, 67,5% of patients had ECOG 1.78% of the treatments with ramucirumab were in the second line and 22% in the third. Regarding the first line, 100% of the schemes were based on platinum and fluoropyrimidines.90.1% of the patients were treated with the combination of paclitaxel 80 mg/m2 plus ramucirumab 8 mg/kg; The rest was treated in monotherapy. Patients received on average 5.1±4.1 cycles. The PFS was 4 (3.1-8.9) months and the OS was 5.8 (4.6-13) months.Regarding safety, 75.6% of the patients (n=31) presented some adverse effect. The most observed adverse effect was asthenia in 48.8% of the patients (n=20). It was also observed: hypertension (17.1%), skin rash (12.2%), alopecia (12.2%), neutropenia (9.7%), mucositis (9.7%) and nausea (9.7%).Conclusions: The PFS was similar in this study to that obtained in the pivotal clinical trial RAINBOW, although the value of the OS obtained was almost half. Safety was similar to that observed in the clinical trial. (AU)

Gastric metastasis presenting as an overt upper gastrointestinal bleeding treated with chemoembolisation in a patient diagnosed with papillary thyroid carcinoma.

We present a case of a patient with known papillary thyroid carcinoma presenting with overt upper gastrointestinal bleeding from a metastatic gastric mass. The gastric mass was diagnosed through transnasal endoscopy with tissue biopsies, revealing papillary thyroid carcinoma cells on histopathological studies. Bleeding was persistent despite standard medical therapy. Chemoembolisation of the major feeding vessels of such tumour provided resolution of bleeding.

PCR analysis and specific immunohistochemistry revealing a high prevalence of non-Helicobacter pylori Helicobacters in Helicobacter pylori-negative gastric disease patients in Japan: High susceptibility to an Hp eradication regimen.

BACKGROUND: The clinical significance of non-Helicobacter pylori Helicobacter (NHPH) is still unknown. There are many reports of NHPH-infected patients suffering from gastric diseases. Here, we investigated the polymerase chain reaction (PCR) positivity of NHPH infection in gastric disease patients who were negative for H. pylori (Hp) by the rapid urease test and by pathological observation. MATERIALS AND METHODS: We collected the 296 endoscopically obtained gastric mucosal samples of Hp-negative gastric disease patients diagnosed based on a rapid urease test and pathology from 17 hospitals in Japan from September 2013 to June 2019, and we analyzed the existence of Hp and NHPH by PCR. The samples were also treated by indirect immunohistochemistry using an anti-Helicobacter suis VacA paralog antibody and were observed by confocal laser microscopy. RESULTS: Among the 236 non-Hp-eradicated cases, 49 cases (20.8%) were positive for NHPH. Among them, 20 cases were positive for Helicobacter suis, 7 cases were positive for Helicobacter heilmannii sensu stricto/ Helicobacter ailurogastricus (Hhss/Ha), and the other 22 cases could not be identified. The regional differences in the infection rates were significant. Forty percent of the nodular gastritis cases, 24% of the MALT lymphoma, 17% of the chronic gastritis cases, and 33% of the gastroduodenal ulcer cases were NHPH positive. Forty-five patients had been treated with one of the four types of combinations of a proton pump inhibitor and two antibiotics, and in all of these cases, the NHPH diagnosed by PCR was successfully eradicated. Immunohistochemistry using the Helicobacter suis-specific HsvA antibody coincided well with the PCR results. Among the 29 post-Hp eradication cases, three were NHPH positive, including one Hhss/Ha-positive case. Thus, approx. 20% of the Hp-negative non-Hp-eradicated gastric disease patients treated at 17 hospitals in Japan were infected with NHPH.

Effects of electroacupuncture on stress-induced gastric dysrhythmia and mechanisms involving autonomic and central nervous systems in functional dyspepsia.

Electroacupuncture (EA) is widely used as an effective method to treat stress-related disorders. However, its mechanisms remain largely unknown. The aim of this study was to investigate the effects and mechanisms of EA on gastric slow wave (GSW) dysrhythmia and c-Fos expression in the nucleus of the solitary tract (NTS) induced by stress in a rodent model of functional dyspepsia (FD). Rats in the neonatal stage were treated using intragastric iodoacetamide. Eight weeks later, the rats were implanted with electrodes in the stomach for the measurement of GSW and electrodes into accupoints ST36 for EA. Autonomic functions were assessed by spectral analysis of heart rate variability. Rats were placed for 30 min in a cylindrical plastic tube for acute restraint stress. The involvement of a central afferent pathway was assessed by measuring c-Fos-immunoreactive cells in the NTS. 1) EA normalized restraint stress-induced impairment of GSW in FD rats. 2) EA significantly increased vagal activity (P = 0.002) and improved sympathovagal balance (P = 0.004) under stress in FD rats. 3) In FD rats under restraint stress, plasma norepinephrine concentration was increased substantially (P < 0.01), which was suppressed with EA. 4) The EA group showed increased c-Fos-positive cell counts in the NTS compared with the sham EA group (P < 0.05) in FD rats. Acute restraint stress induces gastric dysrhythmia in a rodent model of FD. EA at ST36 improves GSW under stress in FD rats mediated via the central and autonomic pathways, involving the NTS and vagal efferent pathway.

[Brief analysis of the relationship between "sasa zhenhan" of foot-yangming stomach-meridian syndrome and stomach].

"Sasa zhenhan" is a word describing the syndrome of cold sensation, which is one of the foot-yangming stomach-meridian syndromes. The lesions of stomach and yangming meridian could cause changes of yang qi and superficial symptoms of the interior syndrome, leading to "sasa zhenhan". In this study, the specific manifestation of the "sasa zhenhan" is analyzed from the aspect of word meaning, and the relationship between the "sasa zhenhan" and stomach is further discussed through the perspectives of yang qi and the exterior-interior relationship. In addition, combined with typical clinical case, it is suggested that attention should be paid on the relationship between exterior and interior syndromes, and the clinical application of tongfu and tongyang method (activating yang qi and promoting qi circulation of fu organs) should be strengthened, which could expand the new thinking of clinical treatments for viscera diseases through acupuncture and moxibustion.

Gastric sarcoidosis: Rare revealing feature of systemic sarcoidosis.

Gastric sarcoidosis is clinically manifest in less than 1% of patients with systemic disease. Stomach is the most commonly involved site. Clinical signs are non-specific. We report the case of a female patient presenting with abdominal pain with no associated symptoms. Upper gastrointestinal endoscopy showed mucosal erosions. Biopsy and histological study revealed the presence of a gastric non-caseating granuloma. No other involvement was found and infectious granulomatosis was ruled out. Patient was treated with corticosteroids with substantial improvement. One year later, the patient presented with respiratory symptoms and joint pain. Chest computed tomography showed multiple mediastinal and bilateral hilar lymphadenopathies. It also highlighted the presence of interstitial lung disease and a 1 cm pulmonary nodule. Histological examination of this nodule revealed non-caseating granuloma. Serum angiotensin converting enzyme level was elevated. Lymphocytic alveolitis was diagnosed with bronchoalveolar lavage. Systemic sarcoidosis with gastric involvement was suggested. Patient was treated with corticosteroids and developed a favourable clinical course. Isolated gastric sarcoidosis is a challenging diagnosis. Histological findings are the key to diagnosis. Other granulomatous diseases need to be excluded especially infectious diseases before establishing the diagnosis of sarcoidosis. Corticosteroids are used in treating gastric sarcoidosis, yet no guidelines exist for the treatment of this rare condition.

Time Trends in Healthcare Utilization Due to Self-Reported Functional Diseases of the Stomach.

INTRODUCTION: Cohort studies from referral centers suggest an increasing burden of functional gastric disorders, with frequent emergency room (ER) visits, hospitalizations, or absenteeism. We hypothesized that recruitment from tertiary care sites skews results and thus investigated the burden of these illnesses, using the population-based data of the Medical Expenditure Panel Survey (MEPS). METHODS: Using MEPS data for the years 2000-2015, demographic, economic, healthcare-related, and quality-of-life indicators were extracted for adults reporting the diagnosis of functional gastric diseases to assess trends and to compare results with data from all adults surveyed. RESULTS: Between 2000 and 2015, 2.7 ± 0.2% of the adults surveyed reported a functional gastric illness. Within the period studied, 28.8 ± 2.8% and 17.9 ± 1.6% of this cohort reported ER visits or hospitalizations, respectively. Only a fraction of these persons attributed the ER visits (22.6 ± 0.9%) or admissions (10.9 ± 0.8%) to the functional gastric disorder. Rates remained stable rates during the period studied. Female sex, measures of physical function, comorbidities, and an income below the poverty line were predictors of healthcare utilization. While utilization was stable over time, annual costs increased by 113.9 ± 16.6% during the study period, outpacing the inflation rate of 37.6%. CONCLUSIONS: Persons with functional gastric disorders have significant healthcare needs and face increasing costs of care, largely due to coexisting illnesses. While it is important to recognize this impact, the need for emergency care or hospitalizations remained stable and lower than reported for patients seen in tertiary referral centers, providing reassuring information for patients and providers.

Aetiology, diagnosis, treatment and outcome of traumatic reticuloperitonitis in cattle.

Traumatic reticuloperitonitis (TRP) in cattle is caused by ingested nails, pieces of wire, and other nonmetallic materials that injure the reticular wall. Clinical signs of acute TRP may include anorexia, fever, drop in milk production, rumen atony and tympany, abdominal pain, an arched back, a tucked up and "guarded" abdomen and spontaneous grunting, but may be obscure or absent in chronic cases. Haematological findings alone are not diagnostic, but total and differential white blood cell counts, the concentration of fibrinogen and total protein and the glutaraldehyde coagulation time may indicate inflammation associated with TRP. The clinical examination is aimed at eliciting a grunt in response to foreign body tests such as back grip, pole test or pain percussion. Inflammatory changes of the reticulum and adjacent organs and impairment of reticular motility are characteristic features of TRP and can be detected via ultrasonography. Radiography is the technique of choice for the visualisation of metallic foreign bodies and for monitoring the efficacy of a magnet. Treatment may be conservative or surgical, but in most cases initial treatment is conservative with administration of a magnet and antibiotics. If the cow fails to respond to medical treatment, surgical treatment is the next option other than euthanasia and ideally is carried out after imaging of the reticulum. If this is not feasible, a second magnet and continuation of antibiotic treatment is recommended.