Medico-legal implications for the colon perforation during colonoscopy.

Colon perforation is the most serious complication of colonoscopy, and tends to be considered as malpractice. The aim of this study was to identify the characteristics and causes of medical accidents by analyzing lawsuit cases on colon perforation during colonoscopy. We collected judgment results that were ruled from 2005 to 2015 using the keyword 'colonoscopy' in the 'Korea's Written Judgment Public Reading System' of the Supreme Court, and extracted the cases of colon perforation. Characteristics of medical accidents and the decisions of courts were analyzed from written judgments. Twenty-two lawsuits were analyzed. Most cases were ruled in favor of the plaintiff (n = 20). The allegations against defendants, as filed by the plaintiffs, were performance error (n = 22), improper monitoring after colonoscopy (n = 7), and a lack of informed consent (n = 8). The median compensation was 9335.47 US dollars; this is about 130 times the cost of a single colonoscopy in Korea. The greater the intestinal damage, the greater the amount of compensation (p = 0.016). The time interval from procedure to diagnosis of perforation was most frequently 24 h later (n = 9). It is important to educate patients completely about the symptoms of colon perforation and to guide them to contact medical institutions immediately when symptoms occur. In addition, doctors should explain sufficiently the possibility of perforation before colonoscopy to the patient, and not the caregiver, and get informed consent.

Frameworks for evaluating health research capacity strengthening: a qualitative study.

BACKGROUND: Health research capacity strengthening (RCS) projects are often complex and hard to evaluate. In order to inform health RCS evaluation efforts, we aimed to describe and compare key characteristics of existing health RCS evaluation frameworks: their process of development, purpose, target users, structure, content and coverage of important evaluation issues. A secondary objective was to explore what use had been made of the ESSENCE framework, which attempts to address one such issue: harmonising the evaluation requirements of different funders. METHODS: We identified and analysed health RCS evaluation frameworks published by seven funding agencies between 2004 and 2012, using a mixed methods approach involving structured qualitative analyses of documents, a stakeholder survey and consultations with key contacts in health RCS funding agencies. RESULTS: The frameworks were intended for use predominantly by the organisations themselves, and most were oriented primarily towards funders' internal organisational performance requirements. The frameworks made limited reference to theories that specifically concern RCS. Generic devices, such as logical frameworks, were typically used to document activities, outputs and outcomes, but with little emphasis on exploring underlying assumptions or contextual constraints. Usage of the ESSENCE framework appeared limited. CONCLUSIONS: We believe that there is scope for improving frameworks through the incorporation of more accessible information about how to do evaluation in practice; greater involvement of stakeholders, following evaluation capacity building principles; greater emphasis on explaining underlying rationales of frameworks; and structuring frameworks so that they separate generic and project-specific aspects of health RCS evaluation. The third and fourth of these improvements might assist harmonisation.

Mentoring, training and support to global health innovators: a scoping review.

Global health innovators must navigate substantial complexities to successfully develop, implement and sustain global health innovations with impact through application of an Integrated InnovationTM approach. We sought to examine the nature of the literature and evidence around mentoring, training and support of global health innovators. We conducted a scoping review searching eight databases with terms capturing different kinds of innovation and support. Assessment of relevance and mapping was completed by two reviewers, with interpretation by the review team. Twenty-eight relevant papers provided perspectives on fostering global health innovators and innovation. Fifteen included empirical data on supports to global health innovators involving a wide range of innovators. Eight included documentation of outcomes but without designs to determine effectiveness. The diverse mentoring, training and support activities included: business incubators, support organizations and centres for entrepreneurship, technology transfer and intellectual property management, internship programs for business skill development, initiatives to bridge industry and researchers, and platforms for South-led innovation for global health. We propose the cultivation of a pipeline of global health innovators to increase the number of appropriate, sustainable innovations with impact in global health. Further empirical work on how to effectively support global health innovators is needed.

Double staining immunohistochemistry.

This article summarized immunohistochemistry methods generally used in research laboratories and clinic including direct immune staining, indirect immune staining, enzyme method, fluorescence method, APC method and PAP method.

Immunoglobulin kappa and immunoglobulin lambda are required for expression of the anti-apoptotic molecule Bcl-xL in human colorectal cancer tissue.

OBJECTIVE: Aberrant expression of immunoglobulin (Ig) by cancer cells has been documented in a number of malignant tumors but its biological significance is unclear. Cancer cells overexpress anti-apoptotic molecules such as Bcl-xL. The present study aimed to examine the role of expression of Ig light-chain Igk and Iglambda in maintaining the high levels of Bcl-xL in colorectal cancer cells. MATERIAL AND METHODS: Thirty patients with colorectal cancer were recruited to this study. Expression of Igk, Iglambda and Bcl-xL in surgically removed cancer tissue was examined by immunohistochemistry and/or flow cytometry. Using the HT29 cell line as a study platform, RNA interference (RNAi) was employed to knock out the genes of Igk and Iglambda in the cancer cell line; the expression of Bcl-xL in HT29 cells was subsequently analyzed. RESULTS: Human colorectal cancer cells, but not normal colorectal tissue, expressed both Igk and Iglambda in the cytoplasm. High levels of Bcl-xL were detected in cancer cells. Using RNAi to knock out the genes of Igk and/or Iglambda, Bcl-xL expression in HT29 cells was significantly suppressed and the cells became apoptotic. CONCLUSION: The results suggest that expression of Igk and Iglambda is required to stabilize Bcl-xL expression in cancer cells.

Expression of integrin alphavbeta6 in the intestinal epithelial cells of patients with inflammatory bowel disease.

BACKGROUND AND AIMS: The prevalence of inflammatory bowel disease (IBD) is about 0.05% in industrialized countries. The pathogenesis of IBD remains to be further understood. The present study aims to elucidate the expression of integrin αvß6 in the intestinal mucosa of patients with IBD. MATERIALS AND METHODS: Colonic biopsy was obtained from a group of IBD patients. The expression of αvß6 in the intestinal mucosa was detected by Western blotting. Human colonic epithelial cell line T84 cells were stimulated by microbial antigen flagellin. The expression of αvß6 in T84 cells was evaluated by quantitative RT-PCR and Western blotting. RESULTS: The levels of αvß6 in the intestinal mucosa were much lower than it in normal control subjects. The serum levels of myeloperoxidase (MPO) were higher in IBD patients that were negatively correlated with the levels of αvß6 in the intestinal mucosa. The expression of αvß6 was detectable in T84 cells at naοve status that could be upregulated by exposure to microbial antigen flagellin. Pretreatment with MPO dramatically suppressed the expression of αvß6 in T84 cells. CONCLUSIONS: We conclude that the expression of αvß6 was suppressed in IBD intestinal mucosa, which could be resulted from the high levels of MPO.