Case report: Endoscopic Hemoclip treatment for massive hematemesis caused by a Dieulafoy's lesion on duodenal papilla caused acute pancreatitis.

Background: Dieulafoy's lesion is an uncommon cause of hemorrhage of the digestive tract. It often presents with urgent and massive bleeding usually leading to shock, even death. Dieulafoy's lesions have been reported throughout the digestive tract but which occurred on duodenal papilla were particularly rare and presented challenges in the choice of hemostasis. Case presentation: A 66-year-old man with melena for 2 days was admitted. Gastrointestinal endoscopy revealed blood clots covering the duodenal papilla with oozing blood. During the procedure of trying to place a plastic stent into the duodenal papilla first, the hemorrhage began to present pulsating bleeding. The patient went into shock. With consent, two titanium clips were inserted to clamp the bleeding site to stop the bleeding. The patient complained of epigastric pain 14 h after the endoscopy. An abdominal CT scan showed signs of acute pancreatitis. Endoscopy was performed to remove the titanium clips and showed a vessel stump on the duodenal papilla. The patient was discharged from the hospital on the 14th day and followed for 6 months with no recurrence. Conclusion: This case was diagnosed with a Dieulafoy's lesion on the duodenal papilla, which has rarely been reported. Hematemesis was stopped by clamping the vessel stump with titanium clips but caused acute pancreatitis. Reviewing the treatment, electrocoagulation might be a better choice, and life support treatment, including central vena catheterization and an adequate supply of blood products, should be prepared in advance to provide extra time for the stent placement or vascular intervention treatment.

Shift patterns, physical exercise, and Type 2 diabetes mellitus (T2DM): a prospective cohort study in China.

To examine the relationships between different shift patterns and Type 2 diabetes mellitus (T2DM) risk, and determine whether physical exercise reduced the incidence of T2DM in shift workers in the oil industry. Baseline data were collected from participants in May 2013 who were then followed for 4 years in a prospective cohort study. The cohort initially consisted of 3,002 workers and ultimately included 2,827 people. Baseline and follow-up questionnaires were sent to participants every 2 years (in May 2015 and May 2017) to update medical and lifestyle information during the follow-up period. The risk of T2DM among two shift workers [relative risk (RR) = 3.442, 95% CI: 1.904-6.799)], three shift workers (RR = 2.534, 95% CI: 1.484-4.571), and four shift workers (RR = 4.230, 95% CI: 2.680-7.518) was higher than that among day workers. An increasing trend was observed with respect to T2DM risk, with the lowest risk in three shift workers, moderate risk in two shift workers, and highest risk in four shift workers. In the interactive analysis between shift work and physical exercise, taking part in mild physical exercise increased the risk of T2DM for workers. Four shift workers who took part in mild physical exercise had an increased risk of T2DM. The relative excess risk due to interaction (RERI) was 33.769 (0.398-67.140). The attributable proportion due to interaction [API (%)] was 0.704 (0.529-0.880). The synergy index (SI) was 3.563 (1.900-6.683). Shift work is significantly correlated with increased incidence of T2DM. Risk of T2DM is lowest risk in three shift workers, moderate in two shift workers, and highest in four shift workers. Shift workers who participated in moderate and severe physical exercise had reduced risk of developing T2DM.

This study investigated the role of different shift patterns and physical exercise on type 2 diabetes mellitus (T2DM) risk factors of shift workers. We hypothesized that shift patterns would be correlated with the incidence of type 2 diabetes and that physical exercise would reduce the risk of type 2 diabetes. We studied 2,827 workers using a cohort study design following for 4 years. The study sample consisted of 1,249 fixed-day-shift workers, 650 three-shift workers, 297 two-shift workers, and 631 four-shift workers. We found that compared with fixed day shift workers, alternating shift workers were at an increased risk for developing T2DM. And moderate and severe physical exercise reduced the risk of T2DM in shift workers. We concluded that physical exercise is associated with decreased type 2 diabetes risk in shift workers, particularly when physical exercise is moderate and severe. The findings of the current study may assist enterprise management departments in developing diabetes interventions among shift workers.

The relationships of shift work, hair cortisol concentration and dyslipidaemia: a cohort study in China.

BACKGROUND: Currently, cardiovascular disease is the leading cause of death, and dyslipidaemia is an independent and modifiable major risk factor. Previous studies on shift work with dyslipidaemia and hair cortisol concentration (HCC) have yielded conflicting results. The aim of this study was to clarify the association between shift work, dyslipidaemia, and HCC. We further explored the mediating effect of HCC. METHODS: In this cohort study, baseline data were collected from participants in May 2013. The cohort included 2170 participants- 1348 shift workers and 822 non-shift workers- who were followed up for 6 years with four questionnaire surveys from July 2014, October 2015, and May to December 2019. Hair samples were collected from 340 participants during the baseline period for HCC testing with an automated radioimmunoassay. Dyslipidaemia was defined using the National Cholesterol Education Program Adult Treatment Panel III diagnostic criteria. RESULTS: Shift workers had a higher risk of dyslipidaemia than workers on the fixed day shift (two-shift RR = 1.408, 95% CI: 1.102-1.798; three-shift RR = 1.478, 95% CI: 1.134-1.926; four-shift RR = 1.589, 95% CI: 1.253-2.015). Additionally, shift workers had higher HCC levels than fixed day shift workers, with geometric mean concentration (GMC) ± geometric standard difference (GSD) = 2.625 ± 2.012 ng/g, two-shift GMC ± GSD = 3.487 ± 1.930 ng/g, three-shift GMC ± GSD = 2.994 ± 1.813 ng/g, and four-shift GMC ± GSD = 3.143 ± 1.720 ng/g. High HCC was associated with a high incidence of dyslipidaemia. After controlling for confounding factors, this study showed that HCC played a role in mediating dyslipidaemia in shift workers and accounted for 16.24% of the effect. CONCLUSIONS: Shift work was linked to increased risk of dyslipidaemia compared with fixed day shift work. Higher HCC was associated with a higher prevalence of dyslipidaemia. HCC had a significant mediating effect on dyslipidaemia in shift workers.

Relationships among N,N-dimethylformamide exposure, CYP2E1 and TM6SF2 genes, and non-alcoholic fatty liver disease.

OBJECTIVE: This study aimed to examine the relationships among N, N-dimethylformamide (DMF) exposure, cytochrome P4502E1 (CYP2E1) single nucleotide polymorphisms (SNPs) (rs2031920, rs3813867, rs6413432), transmembrane 6 superfamily member 2 (TM6SF2) SNP rs58542926 and non-alcoholic fatty liver disease (NAFLD). METHODS: Baseline data were collected from participants who were then followed for 5 years in a prospective cohort study. The cohort initially consisted of 802 workers and ultimately included 660 people, all of whom underwent annual occupational health examinations from 2010 to 2015. RESULTS: The above-threshold group (≥7.3 mg/m³ adjusted relative risk (RR)= 3.620, 95%CI 2.072-6.325) was significantly more likely to develop NAFLD than the below-threshold group (<7.3 mg/m³). The TM6SF2 SNP rs58542926 CT (adjusted RR=3.921, 95% CI 2.329-6.600, P = 0.000) and CT+TT (adjusted RR=4.385, 95% CI 2.639-7.287, P = 0.000) genotypes were risk factors for NAFLD, as compared with the TM6SF2 rs58542926 CC genotype. Each dose group (below-threshold group and above-threshold group) interacting with the genotype of TM6SF2 SNP rs58542926 had an adjusted RR from 7.764 (95% CI 3.272-18.420, P = 0.000) to 24.022 (95% CI 8.971-64.328, P = 0.000). The T allele of rs58542926 in the TM6SF2 gene may be a risk factor for susceptibility to DMF-induced NAFLD. CONCLUSION: Polymorphisms of TM6SF2 SNP rs58542926 may play an important role in susceptibility to NAFLD after exposure to DMF.

Massive gastrointestinal bleeding caused by a Dieulafoy's lesion in a duodenal diverticulum: A case report.

BACKGROUND: Dieulafoy's lesion is a rare vascular abnormality characterized by a small abnormally dilated artery that runs a tortuous course in the submucosa. There is usually no ulcer present in Dieulafoy's lesions and the overlying mucosa is most often normal. Bleeding caused by a Dieulafoy's lesion is usually urgent, massive, life-threatening and prone to recurrence. Dieulafoy's lesions have been reported throughout the digestive tract although the majority of them have been found in the upper digestive tract especially the stomach and duodenum. However, a Dieulafoy's lesion occurring inside a duodenal diverticulum is very rare. CASE SUMMARY: A 74-year-old Asian male with epigastric pain, hematemesis and melena was admitted to our clinic. Before admission, the patient had vomited 500 mL of dark red blood, and passed 200 g of black tarry stool. Conservative management was first undertaken as the patient had not been fasting. However, hemorrhage recurred and the patient went into shock. Urgent endoscopy was performed and a diverticulum of 1.8 cm × 1.2 cm × 0.8 cm was found on the anterior wall of the descending duodenum. The diverticulum was covered with a blood clot. After the clot was removed, an artery stump was observed in the diverticulum with a diameter of 2-3 mm. Two titanium hemostatic clips were inserted to clamp the vessel stump. The patient was discharged 7 d post-endoscopy and followed for 6 mo with no recurrence. CONCLUSION: This case was diagnosed with a Dieulafoy's lesion inside a duodenal diverticulum which has rarely been reported. Hematemesis was stopped by clamping the vessel stump with titanium clips. No complications occurred.

Comparison on the Growth Variability of Vibrio parahaemolyticus Coupled With Strain Sources and Genotypes Analyses in Simulated Gastric Digestion Fluids.

Vibrio parahaemolyticus is a food-borne pathogen that causes pathogenic symptoms such as diarrhea and abdominal pain. Currently no studies have shown that either pathogenic and non-pathogenic V. parahaemolyticus possess growth heterogeneity in a human environment, such as in gastric and intestinal fluids. The tlh gene is present in both pathogenic and non-pathogenic V. parahaemolyticus strains, while the tdh and trh genes are only present in pathogenic strains. This study firstly applied simulated human gastric fluids to explore growth variability of 50 strains of V. parahaemolyticus at 37°C. The bacterial growth curves were fitted by primary modified Gompertz model, and the maximum growth rate (µ max ), lag time (LT), and their CV values were calculated to compare the stress response of pathogenic and non-pathogenic V. parahaemolyticus to simulated human gastric fluids. Results showed that the simulated human gastric fluids treatment significantly increased the µmax of pathogenic strains and shortened the lag time, while decreased the µmax of non-pathogenic strains and prolonged the lag time. Meanwhile, the CV values of genotypes (tlh +/tdh +/trh -) evidently increased, showing that the pathogenic genotype (tlh +/tdh +/trh -) strains had strong activity to simulated gastric fluids. All of the results indicated that the V. parahaemolyticus strains exhibited a great stress-resistant variability and growth heterogeneity to the simulated gastric fluids, which provides a novel insight to unlock the efficient control of pathogenic V. parahaemolyticus.

Leaf area and photosynthesis of newly emerged trifoliolate leaves are regulated by mature leaves in soybean.

Leaf anatomy and the stomatal development of developing leaves of plants have been shown to be regulated by the same light environment as that of mature leaves, but no report has yet been written on whether such a long-distance signal from mature leaves regulates the total leaf area of newly emerged leaves. To explore this question, we created an investigation in which we collected data on the leaf area, leaf mass per area (LMA), leaf anatomy, cell size, cell number, gas exchange and soluble sugar content of leaves from three soybean varieties grown under full sunlight (NS), shaded mature leaves (MS) or whole plants grown in shade (WS). Our results show that MS or WS cause a marked decline both in leaf area and LMA in newly developing leaves. Leaf anatomy also showed characteristics of shade leaves with decreased leaf thickness, palisade tissue thickness, sponge tissue thickness, cell size and cell numbers. In addition, in the MS and WS treatments, newly developed leaves exhibited lower net photosynthetic rate (Pn), stomatal conductance (Gs) and transpiration rate (E), but higher carbon dioxide (CO 2 ) concentration in the intercellular space (Ci) than plants grown in full sunlight. Moreover, soluble sugar content was significantly decreased in newly developed leaves in MS and WS treatments. These results clearly indicate that (1) leaf area, leaf anatomical structure, and photosynthetic function of newly developing leaves are regulated by a systemic irradiance signal from mature leaves; (2) decreased cell size and cell number are the major cause of smaller and thinner leaves in shade; and (3) sugars could possibly act as candidate signal substances to regulate leaf area systemically.

5-hydroxymethylcytosine loss is associated with poor prognosis for patients with WHO grade II diffuse astrocytomas.

Currently, the reliable prognostic biomarkers for WHO grade II diffuse astrocytomas (DA) are still limited. We investigated the relations between the level of 5-Hydroxymethylcytosine (5hmC), an oxidated production of 5-methylcytosine (5mC) by the ten eleven translocated (TET) enzymes, and clinicopathological features of glioma patients. With an identified anti-5hmC antibody, we performed immunohistochemistry in 287 glioma cases. We detected that 5hmC variably reduced in most gliomas and 5hmC reduction was closely associated with higher pathological grades and shortened survival of glioma patients. In multivariate analysis, 5hmC had no independent prognostic value in the entire patient cohort. However, multivariate analysis within subtypes of gliomas revealed that 5hmC was still a prognostic marker confined to DA. In addition, we detected that IDH1 mutation by DNA sequencing was associated with favorable survival within DA. Lastly, we detected that the combination of 5hmC/KI67 was a useful prognostic marker for restratification of DA.

Organizational factors influencing health information technology adoption in long-term-care facilities.

Long-term care (LTC) is an important sector of the health care industry. However, the adoption of health information technology (HIT) systems in LTC facilities lags behind that in other sectors of health care. Previous literature has focused on the financial and technical barriers. This study examined the organizational factors associated with HIT adoption in LTC facilities. A survey of 500 LTC facilities in Texas enabled researchers to compile HIT indexes for further statistical analyses. A general linear model was used to study the associations between the clinical/administrative HIT indexes and organizational factors. The empirical outcomes show that the size of an LTC facility has a significant association with HIT adoption. Rural LTC facilities, especially freestanding ones, adopt less HIT than their urban counterparts, whereas freestanding LTC facilities have the lowest HIT adoption overall. There is not enough evidence to support ownership status as a significant factor in HIT adoption. Some implications are proposed, but further research is necessary.

Funding alternatives in EHR adoption: beyond HITECH incentives and traditional approaches.

The meaningful use incentives under HITECH may be inadequate to address the financial challenges many hospitals face in implementing electronic health records (EHRs). Hospitals can fill the capital gap between EHR costs and available funds by exploring other potential funding sources. These sources include additional grants, funding permissible under EHR regulations, vendor financing, and tax benefits under IRS Section 179.