Tacrolimus and Sirolimus Once Daily Monotherapy Regimen as a Safe and Effective Long-Term Maintenance Immunosuppressive Therapy in Pediatric Liver Transplantation.

BACKGROUND: Long-term efficiency of attenuated immunosuppressive therapies is not well characterized in pediatric liver transplantation (LT). OBJECTIVE: To assess the efficiency of tacrolimus once daily (TAC-OD) and sirolimus once daily (SLR-OD) immunosuppression in pediatric LT. METHODS: We retrospectively evaluated 59 children who underwent LT in our center during 2002 to 2016. Those including children who underwent planned decrease in immunosuppressant dose (stable clinical conditions after 2 years of LT), and those who underwent unplanned decrease in immunosuppressant dose (because of complications such as post-transplant lymphoproliferative disorder [PTLD] and renal failure). RESULTS: 25 of 59 children underwent planned decrease in immunosuppressant dosage (mean±SD duration of 4.5±1.8, range: 3-11 years); 34 had unplanned decrease (mean±SD of 1.3±0.6, range: 0.5-2.6 years). 19 of 25 children with planned conversion received TAC-OD; 6 received SLR-OD (22 with 1 mg/day dose, and 3 with 1 mg every two days). Of 34 children with unplanned conversion, 27 received TAC-OD, 7 SLR-OD (25 children with 1 mg/day, 7 with 1 mg every two days, 1 with 0.5 mg/day TAC, and 1 with 0.5 mg TAC every two days). We found no adverse events including acute or chronic graft rejection, renal insufficiency, infections, PTLDs, or cardiovascular thrombotic events after initiation of the modified immunosuppression in none of the groups. CONCLUSION: TAC-OD or SLR-OD monotherapies are safe and effective for long-term management of LT children with either stable clinical conditions or those with LT complications.

Circulating exosomes and exosomal microRNAs as biomarkers in gastrointestinal cancer.

The most important biological function of exosomes is their possible use as biomarkers in clinical diagnosis. Compared with biomarkers identified in conventional specimens such as serum or urine, exosomal biomarkers provide the highest amount of sensitivity and specificity, which can be attributed to their excellent stability. Exosomes, which harbor different types of proteins, nucleic acids and lipids, are present in almost all bodily fluids. The molecular constituents of exosomes, especially exosomal proteins and microRNAs (miRNAs), are promising as biomarkers in clinical diagnosis. This discovery that exosomes also contain messenger RNAs and miRNAs shows that they could be carriers of genetic information. Although the majority of RNAs found in exosomes are degraded RNA fragments with a length of <200 nucleotides, some full-length RNAs might be present that may affect protein production in the recipient cell. In addition, exosomal miRNAs have been found to be associated with certain diseases. Several studies have pointed out miRNA contents of circulating exosomes that are similar to those of originating cancer cells. In this review, the recent advances in circulating exosomal miRNAs as biomarkers in gastrointestinal cancers are discussed. These studies indicated that miRNAs can be detected in exosomes isolated from body fluids such as saliva, which suggests potential advantages of using exosomal miRNAs as noninvasive novel biomarkers.

Premedication with peppermint oil capsules in colonoscopy: a double blind placebo-controlled randomized trial study.

BACKGROUND: Colonic spasm is an important problem in colonoscopy for endoscopists to advance the colonoscope and visualize the mucosa. STUDY AIMS: In the present study, we evaluated the efficacy of enteric-coated peppermint oil capsules (Colpermin) as an orally administered antispasmodic premedication in colonoscopy. PATIENTS AND METHODS: Sixty-five adult patients undergoing colonoscopy were randomized to receive either Colpermin (n = 33) or placebo capsules (n = 32) as premedication, 4 hours before the procedure. An experienced endoscopist performed colonoscopy. Outcome measures included cecal intubation and total procedure time, spasm score, pain score, endoscopist satisfaction and patients' willingness to repeat colonoscopy. RESULTS: Duration of both total procedure time and cecal intubation time in patients in the Colpermin group were shorter than that in ones in the placebo group. Scores for colonic spasm and pain were significantly lower in the Colpermin group. The endoscopist satisfaction score was higher in the Colpermin group and patients in the Colpermin group were more willing to repeat colonoscopy in the future. CONCLUSIONS: Premedication with Colpermin was beneficial in terms of the time required for cecal intubation and total procedure time, reducing colonic spasm, increasing endoscopist satisfaction and decreasing pain in patients during colonoscopy.

Separation and identification of carotenoids and their oxidation products in the extracts of human plasma.

Eighteen carotenoids as well as vitamin A and two forms of vitamin E (gamma- and alpha-tocopherol) have been separated from extracts of human plasma by high-performance liquid chromatography (HPLC) on reversed-phase and sillca-based nitrile-bonded columns. In the order of chromatographic elution on a C18 reversed-phase column, the carotenoids were identified as (3R,3'R,6'R)-beta, epsilon-carotene-3,3'-diol [(3R,3'R,6'R)-lutein], (3R,3'R)-beta, beta-carotene-3,3'-diol [(3R,3'R)-zeaxanthin], 5,6-dihydroxy-5,6-dihydro-psi,psi-carotene, 3-hydroxy-2',3'-didehydro-beta,epsilon-caroten-3-ol, 3-hydroxy-beta-carotene,psi,psi-carotene, 7,8-dihydro-psi,psi-carotene, beta,psi-carotene, 7,8,7',8'-tetrahydro-psi,psi-carotene, beta,epsilon-carotene, beta,beta-carotene, 7,8,11,12,7',8'-hexahydro-psi,psi-carotene, and 7,8,11,12,7',8'-11',12'-octahydro-psi,psi-carotene. The polar carotenoids, which eluted in the vicinity of lutein and were unresolved on the C18 column, have been separated on a nitrile-bonded column employing isocratic HPLC conditions. In the order of elution, the carotenoids were epsilon,epsilon-carotene-3,3'-dione, 3'-hydroxy-epsilon,epsilon-caroten-3-one, 5,6-dihydroxy-5,6-dihydro-psi,psi-carotene, 3-hydroxy-beta,epsilon-caroten-3'-one, (all-E,3R,3'R,6'R)-lutein, (all-E,3R,3'R)-zeaxanthin, and (all-E,3R,3'S,6'R)-beta,epsilon-carotene-3,3'-diol (3'-epilutein) followed by several geometrical isomers of lutein and zeaxanthin.