Efficacy of diet restriction with or without probiotic for treatment of patients with IBS-D: Phase I-II clinical trial.

BACKGROUND AND AIM: Diet is a major contributor to irritable bowel syndrome (IBS) and is also a powerful tool for treatment of IBS. This study compared two diets and explored the effectiveness of the diets when combined with a probiotic for treatment of IBS-D patients. METHODS: Phase I, patients were randomized into groups; control, cold/spicy/fried restricted diet (CSF res diet), IgG positive restricted diet (IgG res diet), and a combination both diets (CSF + IgG res diet). Phase II, patients were randomized into IgG res diet + placebo and IgG res diet + probiotic. Both interventions were 12 weeks in duration. Symptom Severity Scale (IBS-D-SSS) and IgG titer were assessed at the beginning and the end of the study. RESULTS: Totals of 214 and 167 patients completed the two parts of the study, respectively. After intervention, IBS-D-SSS and TIgG grade were significantly improved compared to baseline, with results similar to the control group. In general, there were decreases in IBS-D-SSS and TIgG grade that were significantly different among the groups. There were exceptions; no differences were observed for IBS-D-SSS between the IgG res diet and CSF + IgG res diet, or TIgG grade between the CSF res diet, IgG res diet, and CSF + IgG res diet. However, the CSF res diet and IgG res diet had a synergistic effect that decreased IBS-D-SSS and TIgG titer, with a greater contribution by the IgG res diet. Therefore, we evaluated the IgG res diet with either placebo or probiotic and found that IBS-D-SSS and TIgG grade decreased from baseline. There was a significant decrease in IBS-D-SSS with the probiotic but TIgG grade was not significantly different between the IgG diet + placebo and IgG diet + probiotic diet. CONCLUSIONS: Both the CSF res diet and IgG res diet improved IBS symptoms and demonstrated synergy, although the IgG res diet had a greater contribution. Further, when intolerant foods cannot be eliminated from a diet, avoiding uncooked, cold, spicy, fried, and alcoholic foods is a superior choice. The IgG res diet combined with Bifidobacteria was the best dietary choice and may function though a non-IgG pathway.

An SNP at the target site of cid-miR-nov-1043 in the TOLLIP 3' UTR decreases mortality rate in grass carp subjected to ENU-induced mutagenesis following grass carp reovirus infection.

N-ethyl-N-nitrosourea (ENU) selection is a useful technique to generate new mutations that may cause some functional changes in the gene. Through our previous genomic bulked segregant analysis (BSA), one single nucleotide polymorphism (SNP) at the 3' UTR of Toll interacting protein gene (TOLLIP982T>C) was identified in grass carp (Ctenopharyngodon idella) subjected to ENU-induced mutagenesis. We found that the overexpression of cid-miR-nov-1043 mimics significantly suppressed the luciferase activity of the TOLLIP 3' UTR, but TOLLIP982T>C mutation at the target site can decrease the binding affinity between the miRNA cid-miR-nov-1043 and TOLLIP 3' UTR, reducing the inhibition of TOLLIP mRNA transcription in grass carp subjected to ENU-induced mutagenesis. More importantly, we demonstrated that TOLLIP mRNA transcription levels in the gills, liver, kidney and the isolate white cells of the mutant grass carp were significantly (p < 0.01) higher than those in the corresponding tissues from the wild-type grass carp following infection with Grass Carp Reovirus (GCRV) for seven days, while the downstream gene of TOLLIP transforming growth factor ß-activated kinase 1 (TAK1) and TAK1-binding protein 1 (TAB1), were higher expressed in wild-type grass carp. As a negative regulator in the pro-inflammatory pathway of NF-κB, TOLLIP inhibits the excessive inflammation in ENU grass carp after GCRV infection. Consistent with the TOLLIP expression, histopathological results demonstrated more severe inflammation in wild-type grass carp, compared to the TOLLIP982T>C mutant grass carp on the seventh day. Severe inflammation will lead to thoroughly infiltration of chloride and inflammatory cells in the gill filaments. This seriously hindered the exchange of oxygen, which ultimately disrupted blood circulation. Meanwhile, the survival rate of the mutant grass carp was significantly (p < 0.01) higher than that of the wild-type grass carp, indicating that the TOLLIP982T>C mutants showed strong anti-viral abilities. Our results revealed that an SNP in the TOLLIP 3' UTR may contribute to the suppression of serve inflammation subjected to ENU-induced mutagenesis following GCRV infection, which may be helpful for future resistant breeding development of grass carp.

Entrapment of a laryngotracheal topical anesthesia kit during tracheobronchial foreign body removal: a case report.

BACKGROUND: In order to reduce the irritation of the airway during tracheobronchial foreign body (TFB) removal, tracheal surface anesthesia is usually performed using a laryngotracheal topical anesthesia (LTA) kit (LTA20, Highgreen Medical Technology Company, China), but difficulty in withdrawing the LTA kit is rarely reported. We present a case of a difficulty to withdraw the LTA kit due to its entrapment by the movement of a TFB. CASE PRESENTATION: A 1-year-old girl was undergoing TFB removal. After the surgeon completed the tracheal surface anesthesia, the girl suddenly suffered from bucking, leading to the dislodgment of the TFB to the subglottic region, complicating the withdrawal of the LTA applicator. At the same time, the girl's oxygen saturation (SpO2) decreased to 91% and her heart rate dropped from 150 to 100 bpm. Atropine and succinylcholine were administered intravenously immediately, then the surgeon tried to free the TFB by pushing it back into the trachea, after which the LTA applicator was easily withdrawn, and TFB was removed successfully. The girl was discharged from hospital without any complications 2 days later. CONCLUSION: This case report draws our attention to a significant anesthetic clinical consideration during the application of topical anesthesia on the trachea for TFB removal. The possibility of coughing or bucking can lead to migration of the TFB with subsequent airway obstruction, so the depth of anesthesia must be sufficient to prevent harmful reflexes. Also, strong teamwork and good communication are paramount to avoid serious complications.

Familial Nonmedullary Thyroid Carcinoma: A Retrospective Analysis of 117 Families.

BACKGROUND: The first and most important step in characterizing familial nonmedullary thyroid carcinoma (NMTC) is to distinguish the true familial patients, which is the prerequisite for all accurate analyses. This study aimed to investigate whether patients from families with ≥3 first-degree relatives affected with NMTC have different characteristics than patients from families with only two affected members, and to compare these patients with those with sporadic disease. METHODS:: We analyzed the clinicopathological features and prognosis of 209 familial and 1120 sporadic cases of NMTC. Familial patients were further divided into two subgroups: families with two affected members and families with ≥3 affected members. RESULTS:: The familial group had a significantly higher risk of bilateral growth, multifocality, extrathyroidal extension, and lateral lymph node metastasis than the sporadic group (P < 0.05). These main features were also different between the group with ≥3 affected members and the sporadic group. The only difference between the two affected members' group and the sporadic group was incidence of multifocality (P < 0.05). The probability of disease recurrence in patients from families with ≥3 affected members was significantly higher than that in sporadic cases (14.46% vs. 5.27%; P = 0.001), while the probability in patients from families with two affected members was similar to that in sporadic patients (6.35% vs. 5.27%; P = 0.610). The Kaplan-Meier survival analysis showed a statistically significant difference in disease-free survival between the two subgroups (85.54% vs. 93.65%; P = 0.045). CONCLUSIONS:: Patients from families with ≥3 members affected by NMTC have more aggressive features and a worse prognosis than those from families with only two affected members. Patients from families with ≥3 affected first-degree relatives may be considered to have true familial NMTC.

RNase attenuates acute lung injury induced by ischemia-reperfusion in mice.

Treatment with ribonuclease (RNase) reportedly protects the heart after myocardial ischemia-reperfusion (I/R), but its potential effect on lung I/R injury (LIRI) is unknown. Thus, we aim to explore whether RNase treatment would relieve LIRI. Thirty-six C57BL/6J adult male wild-type mice were evenly divided into I/R+RNase (I/R+R) group, I/R group, and sham group. Lung I/R was induced by left pulmonary hilum occlusion for 1h and reperfusion for 2h. All mice were treated with RNase or same dosage of normal saline in advance. After I/R, blood and lung tissues were collected for analysis. The results showed that lung injury scores, wet/dry ratio, expressions of inflammatory cytokines, pulmonary apoptosis, and levels of serum extracellular RNA (exRNA), including microRNAs, were markedly elevated after I/R. However, RNase treatment significantly attenuated cytokine production in both lung tissue and serum and also suppressed pulmonary apoptosis as reflected by TUNEL staining and activated caspase-3. In addition, total serum exRNA levels in the I/R+R group had a downward trend versus the I/R group. In conclusion, the increase of circulating exRNA levels contributed to LIRI in adult mice, which could be relieved by injection of RNase during perioperative window. The potential mechanism is the decrease of serum exRNA level and the suppression of pulmonary inflammation and apoptosis.

Role of Toll-Like Receptor 3 in Lung Ischemia-Reperfusion Injury.

Lung ischemia-reperfusion injury (LIRI) occurs in various clinical situations, such as transplantation, cardio pulmonary bypass, cardiac arrest, and major trauma, leading to significant morbidity and mortality. Despite researchers having spent years of effort to investigate the pathogenesis of pulmonary ischemic injury, the concrete cellular and molecular mechanisms are still unknown. We hypothesized that toll-like receptor (TLR) 3 signaling may play a vital role in inflammation responses, apoptosis, and pulmonary dysfunction during LIRI. Lung ischemia-reperfusion (I/R) mouse model was established by the occlusion of the left pulmonary hilum of adult male C57BL/6J wild-type (WT) and TLR3 deficient (TLR3) mice for 1 h, followed by reperfusion for 2 h. Blood serum and lung tissues of the mice were collected after lung I/R for subsequent experiments. Compared with WT mice, TLR3 mice had better preserved pulmonary function, and significantly attenuated pulmonary cytokines mRNA and protein production after I/R. Pulmonary apoptosis was also inhibited after TLR3 knockout, as indicated by cleaved caspase-3 western blot and terminal deoxynucleotidyl transferase dUTP nick end labeling staining. Levels of serum microRNAs (miRNAs), especially miRNA155, were decreased in the TLR3 I/R group compared with that of the WT I/R group. In conclusion, these data suggest that TLR3 signaling pathway may be a promising target for the treatment of lung I/R injury.

Esophageal/gastric cancer screening in high-risk populations in Henan Province, China.

OBJECTIVE: To summarize the endoscopic screening findings in high-risk population of esophageal and gastric carcinoma and analyze influential factors related to screening. METHODS: In seven selected cities and counties with high incidences of esophageal carcinoma, people at age of 40-69 were set as the target population. Those with gastroscopy contradictions were excluded, and all who were voluntary and willing to comply with the medical requirements were subjected to endoscopic screening and histological examination for esophageal, gastric cardia and gastric carcinoma in accordance with national technical manual for early detection and treatment of cancer. RESULTS: In three years, 36,154 people were screened, and 16,847 (46.60%) cases were found to have precancerous lesions. A total of 875 cases were found to have cancers (2.42%), and among them 739 cases had early stage with an early diagnosis rate is 84.5%. Some 715 patients underwent prompt treatment and the success rate was 81.8%. CONCLUSIONS: In a high-risk population of esophageal and gastric carcinoma, it is feasible to implement early detection and treatment by endoscopic screening. Screening can identify potential invasive carcinoma, early stage carcinoma and precancerous lesions, improving efficacy through early detection and treatment. The exploratory analysis of related influential factors will help broad implementation of early detection and treatment for esophageal and gastric carcinoma.