Rebleeding Risk of Acute Hemorrhagic Rectal Ulcer: A Multicenter Retrospective Study.

Objective Acute hemorrhagic rectal ulcer (AHRU) is characterized by sudden, painless, and massive bleeding from rectal ulcers. To date, few studies have analyzed the risk factors for AHRU rebleeding. In this study, we clarified the risk factors of rebleeding after initial hemostasis of AHRU through a multicenter study. Methods A total of 149 patients diagnosed with AHRU between January 2015 and May 2020 at 3 medical centers were enrolled. We retrospectively investigated the following factors: age, sex, body mass index (BMI), performance status (PS), Charlson comorbidity index (CCI), comorbidities, medications, laboratory examinations, endoscopic findings, view of the entire rectum on endoscopy, hemostasis method, blood transfusion history, shock, instructions for posture change after initial hemostasis, and clinical course. Results Rebleeding was observed in 35 (23%) of 149 patients. A multivariate analysis showed that significant factors for rebleeding were PS 4 [odds ratio (OR), 5.23; 95% confidence interval (CI)], 1.97-13.9; p=0.001], a blood transfusion history (OR, 3.66; 95% CI, 1.41-9.51; p=0.008), low an estimated glomerular filtration rate (eGFR) levels (OR, 0.98; 95% CI, 0.97-0.99; p=0.001), poor view of the whole rectum on endoscopy (OR, 0.33; 95% CI, 0.12-0.90; p=0.030), and use of monopolar hemostatic forceps (OR, 4.89; 95% CI, 1.37-17.4; p=0.014). Conclusion Factors associated with rebleeding of AHRU were a poor PS (PS4), blood transfusion, a low eGFR, poor view of the whole rectum on endoscopy, and the use of monopolar hemostatic forceps.

Validation of the BEST-J score, a prediction model for bleeding after endoscopic submucosal dissection for early gastric cancer: a multicenter retrospective observational study.

BACKGROUND: A new scoring system, the BEST-J score, using ten risk factors to assign cases to different post-endoscopic submucosal dissection (ESD) risk groups for bleeding, has been shown to be accurate for risk stratification. We first aimed to validate the BEST-J score at four hospitals not specialized in performing ESD and then aimed to identify other risk factors for post-ESD bleeding. METHODS: We evaluated the incidence of post-ESD bleeding in 791 cases of early gastric cancer (EGC) between October 2013 and December 2020 as a retrospective, multi-center observational study conducted at four hospitals. Multivariate logistic regression models to examine the effect of independent variables on post-ESD bleeding firstly included ten possible factors raised by the BEST-J score and secondly included statistically significant (p < 0.01) in univariate analysis. The prediction accuracy of the model was evaluated by receiver-operating characteristic analysis and the areas under the curve (AUC). RESULTS: The incidence of post-ESD bleeding was 4.8% (38/791, 95% confidence interval [CI] 3.4-6.5%). On multivariate analysis, the risk factors were P2Y12 receptor antagonist (odds ratio [OR]: 5.870, 95% CI 1.624-21.219), warfarin (8.382, 1.658-42.322), direct oral anticoagulant (DOAC) (8.980, 1.603-50.322), and tumor location in lower third of stomach (2.151, 1.012-4.571), respectively. When we categorized cases into low-risk by BEST-J score, intermediate-risk, high-risk, and very high-risk groups, the bleeding rates were 2.8%, 7.3%, 12.8%, and 19.0%, respectively. The AUC for our cohort was 0.713 (95% CI 0.625-0.802) for the BEST-J score. In the multivariate analysis in our cohort, the risks were age, body mass index, P2Y12 receptor antagonist, warfarin, DOAC, respectively. DISCUSSION: The BEST-J score is equally accurate in risk stratification of patients with EGC for post-ESD bleeding at non-specialized facilities for ESD as in specialized hospitals. BMI and age may be helpful additional risk factors at hospitals not specialized.

NGF-potentiating vibsane-type diterpenoids from Viburnum sieboldii.

Six new vibsane-type diterpenoids, named neovibsanin O (1), neovibsanin M (2), neovibsanin L (3), (8Z)-neovibsanin M (4), 15-O-methylvibsanin H (5), and 5-epi-15-O-methylvibsanin H (6), were isolated from the leaves of Viburnum sieboldii by bioassay-guided fractionation using NGF-differentiated PC12 cells. The structures of 1-6 were established by analyzing their spectroscopic data and comparing their NMR data with those of previously reported vibsane-type diterpenoids. Compounds 3 and 4, and the known vibsane-type diterpenoids neovibsanins A (7) and B (8) significantly enhanced the neurite outgrowth of NGF-mediated PC12 cells at concentrations ranging from 20 to 40 microM.

Variance analysis of a clinical pathway of video-assisted single lobectomy for lung cancer.

PURPOSE: Clinical pathways have contributed to standardized postoperative management, but analyzing variance is also important to maintain quality control. To evaluate the validity of our own clinical pathway for managing video-assisted lobectomy for lung cancer, we analyzed the variances influencing postoperative recovery. METHODS: Between April 2003 and April 2004, 62 consecutive patients with lung cancer underwent video-assisted single anatomic lobectomy with lymph node dissection. We evaluated 61 of these patients after the exclusion of one, who deviated from the clinical pathway management immediately as a result of serious complications. RESULTS: There were 29 men and 32 women, with an average age of 65.7 years. Complications developed in 29 patients, but there was no operative mortality. The occurrence of variance ranged from 1.6% to 34.4% for each activity and included prolonged supplemental oxygen therapy, out-of routine examination, prolonged epidural anesthesia, and delayed bathing frequently. Complications and an abnormal body mass index were significant and independent clinical factors affecting the increase in variance. CONCLUSIONS: Our original clinical pathway management was tolerable for lung cancer patients undergoing a video-assisted lobectomy. Complications and an abnormal body mass index were significant predictive factors for an increase in variance of our clinical pathway.

New labdane diterpenoids from Hyptis fasciculata.

Two new labdane diterpenoids, 15beta-methoxyfaciculatin (1) and 15alpha-methoxyfaciculatin B (2), together with the previously known methoxynepetaefolin (3), were isolated from a methanol extract of the dried aerial parts of a Brazilian medicinal plant, Hyptis faciculata. Their structures were elucidated by analysis of spectroscopic data. Plausible biogenetic correlation between faciculatins and nepetaefolin is briefly discussed.

Cytotoxic iridoid aldehydes from Taiwanese Viburnum luzonicum.

Four new iridoid aldehydes bearing (E)- or (Z)-p-coumaroyl group, luzonial A (1), luzonial B (2), luzonidial A (3), and luzonidial B (4), were isolated from a methanol extract of the dried leaves of Viburnum luzonicum collected in Kaoshiung, Taiwan and their structures were elucidated by analysis of spectroscopic data. Compounds 1-3 exhibited moderate inhibitory activity against HeLa S3 cancer cells.

Iridoid glucosides and p-coumaroyl iridoids from Viburnum luzonicum and their cytotoxicity.

Four new iridoids glucosides (1-4) and seven new iridoid aglycons (5-11) bearing (E)- or (Z)-p-coumaroyl groups were isolated from a methanol extract of the dried leaves of Viburnum luzonicum collected in Kaoshiung, Taiwan. The structures of the new compounds, named luzonoside A (1), luzonoside B (2), luzonoside C (3), luzonoside D (4), luzonoid A (5), luzonoid B (6), luzonoid C (7), luzonoid D (8), luzonoid E (9), luzonoid F (10), and luzonoid G (11), were elucidated by analysis of spectroscopic data and comparison with values for previously known analogues. Among the iridoids isolated in the present study, glucosides 1 and 2, and their aglycons 5-9, exhibited moderate inhibitory activity against HeLa S3 cancer cells, whereas 3 and 4 showed no cytotoxicity even at 100 microM.