The onset of ulcerative colitis upon Helicobacter pylori eradication in a 72-year-old woman: report of a rare case with a 3-year follow-up.

BACKGROUND: Epidemiological studies suggest an inverse association between H. pylori infection/exposure and inflammatory bowel disease prevalence/incidence, however, there are no reports of individual patients who developed a "non-transient" ulcerative colitis (UC) following H. pylori eradication. CASE PRESENTATION: We report a case of a 72-year-old female with an elderly-onset UC developed upon H. pylori eradication and a 3-year follow-up of the progression to steroid-dependent colitis complicated with enteropathic arthritis and final containment of the disease with golimumab. In our patient, H. pylori eradication was associated with the development of pancolitis that evolved into clinically, endoscopically, and pathohistologically confirmed UC. CONCLUSIONS: The case of our patient provides a unique clinical context for a growing body of literature suggesting molecular mechanisms involved in the interaction of genes, environment, and microbiota to be of critical importance in the etiopathogenesis of UC, and thus, provides a valuable set of complementary translational information for preclinical and epidemiological research on the topic.

Allogeneic expanded adipose-derived stem cells in the treatment of rectovaginal fistulas in Crohn's disease.

AIM: Crohn's disease (CD)-related rectovaginal fistulas (RVFs) are rare, challenging to treat and associated with a high morbidity. Due to a significant lack of data, we aimed to analyse the safety and feasibility of allogeneic adipose-derived stem cells (ASCs) in the treatment of CD-related RVF. METHOD: Four consecutive patients with CD-related RVF underwent treatment with expanded allogeneic ASCs extracted from a healthy donor in a tertiary referral centre in 2019. None of the patients had an intestinal diversion at the time of the treatment. Follow-up was performed 6 months postoperatively. RESULTS: The median operation time was 45 min with a median hospital stay of 3 days. No intra-operative complications occurred. Three patients (75%) developed recurrent RVF after a median follow-up of 19 days. Two patients required surgical treatment including loose seton drainage due to discharge and pain. One patient developed recurrence of symptoms after 10 days, but refused further surgical therapy. Only one patient (25%) showed healing of the RVF, with re-epithelialization of both the vaginal and rectal opening and absence of clinical symptoms. CONCLUSION: Expanded allogeneic ASC therapy represents a novel safe treatment option for CD-associated RVF. Although efficacy appears limited, further controlled studies are required to draw robust conclusions.

Photocatalytic degradation of methylene blue under natural sunlight using iron titanate nanoparticles prepared by a modified sol-gel method.

The aim of this work was to synthesize semiconducting oxide nanoparticles using a simple method with low production cost to be applied in natural sunlight for photocatalytic degradation of pollutants in waste water. Iron titanate (Fe2TiO5) nanoparticles with an orthorhombic structure were successfully synthesized using a modified sol-gel method and calcination at 750°C. The as-prepared Fe2TiO5 nanoparticles exhibited a moderate specific surface area. The mesoporous Fe2TiO5 nanoparticles possessed strong absorption in the visible-light region and the band gap was estimated to be around 2.16 eV. The photocatalytic activity was evaluated by the degradation of methylene blue under natural sunlight. The effect of parameters such as the amount of catalyst, initial concentration of the dye and pH of the dye solution on the removal efficiency of methylene blue was investigated. Fe2TiO5 showed high degradation efficiency in a strong alkaline medium that can be the result of the facilitated formation of OH radicals due to an increased concentration of hydroxyl ions.

Characterizing plasma with emission tomography-Feasibility study on synthetic and experimental data.

We present a feasibility study on different tomographic algorithms to overcome the issues of finite sets of projection data, limited viewing angles, and noisy data, which cause the tomographic reconstruction to be an ill-posed inversion problem. We investigated three approaches: single angle Abel inversion, two angle approach, and multiple angle 2D plasma tomography. These methods were tested on symmetric and asymmetric sample functions and on experimental results from a supersonic flowing argon microwave plasma sustained in a cylindrical quartz cavity. The analysis focused on the afterglow region of the microwave flow where a plasmoid-like formation was observed. We investigated the effects of the uniform random noise added to the simulated data by applying smoothing techniques. The quality of reconstructed images was assessed by using peak signal-to-noise ratio and universal quality image measures. The results showed that the Abel inversion approach could be employed only when the system is radially symmetric, while the systems with slight asymmetry could be reconstructed with the two angle approach. In the complete absence of symmetry, full 2D tomographic reconstruction should be applied. The data analysis showed that the best results were obtained by employing either the filtered back projection or the simultaneous algebraic reconstruction technique. The total variation minimization method proved to be the best denoising technique. Each approach was used to obtain the spatial distributions of argon excited states taken at three positions along the plasmoid-like structure. The results indicated that the plasma was asymmetric with argon populating the cavity surface.

Factors associated with improvement of quality of life among parents of children with atopic dermatitis: 1-year prospective cohort study.

BACKGROUND: Previous studies exploring the impact of atopic dermatitis (AD) in children focused on factors associated with parental quality of life at one point in time. OBJECTIVE: To examine factors associated with change of quality of life among parents of children affected with AD. METHODS: The study cohort comprised 98 parent-children pairs treated for AD at the Clinic of Dermatovenereology; however, 18 parents (18.4%) were lost to follow-up after 1 year. Children were assessed with SCORing Atopic Dermatitis Index (SCORAD) and Children Dermatology Life Quality Index (CDLQI) or the Infants' Dermatitis Quality of Life Index (IDQOL), depending on their age. Parents filled in socio-demographic questionnaire and Dermatitis Family Impact Questionnaire (DFI). After 1 year, both children and parents were reassessed using the same AD-related battery of questionnaires. RESULTS: After follow-up, a significant improvement in the average total DFI score was observed, especially for domains of fatigue/exhaustion, emotional distress and impact of helping in child treatment. Lower baseline SCORAD, greater improvement of SCORAD over follow-up, better CDLQI/IDQOL at baseline, greater improvement in CDLQI/IDQOL over follow-up, not having asthma and having older child with AD were associated with better parental quality of life after 1 year of follow-up. Parental higher education level, shorter AD duration, better baseline SCORAD and greater improvement in CDLQI/IDQOL over follow-up were associated with greater improvement in parental life quality over 1 year of follow-up. CONCLUSION: Contributors to parental quality of life after 1 year included clinical features of AD and child's comorbidity (asthma), but also the perception of child's quality of life and its improvement.

XUV-driven plasma switch for THz: new spatio-temporal overlap tool for XUV-THz pump-probe experiments at FELs.

A simple and robust tool for spatio-temporal overlap of THz and XUV pulses in in-vacuum pump-probe experiments is presented. The technique exploits ultrafast changes of the optical properties in semiconductors (i.e. silicon) driven by ultrashort XUV pulses that are probed by THz pulses. This work demonstrates that this tool can be used for a large range of XUV fluences that are significantly lower than when probing by visible and near-infrared pulses. This tool is mainly targeted at emerging X-ray free-electron laser facilities, but can be utilized also at table-top high-harmonics sources.

Sleep in critically ill, mechanically ventilated patients with severe sepsis or COPD.

BACKGROUND: The standard method for scoring polysomnographic (PSG) sleep is insufficient in the intensive care unit (ICU). A modified classification has been proposed, but has not been tested in specific groups of ICU patients. We aimed firstly to (1) use the modified classification to describe sleep in two groups of ICU patients: a severe sepsis group and a chronic obstructive pulmonary disease (COPD) group, and (2) to compare sleep stage distribution in the groups; secondly to compare the PSG findings with nurses' sleep evaluation. METHODS: Non-sedated mechanically ventilated patients with severe sepsis or COPD completed up to 20-hours PSG recording in each patient. A modified classification for scoring sleep in ICU was used for scoring the PSGs. Sleep assessment by nurses was done at 15 minutes intervals. RESULTS: We included 16 patients with severe sepsis and 17 patients with COPD. Half of the patients in the severe sepsis group and 59% in the COPD group had atypical sleep. We found significantly different sleep stage distribution in the two groups, with the COPD group having a higher proportion of atypical sleep (54.4% vs 48.7%, P < .0001). No correlation between nurse sleep assessment and PSG was found in cases of atypical sleep (P < .0001). CONCLUSION: Normal PSG sleep characteristics as defined by standard classification are absent in many conscious, non-sedated critically ill patients on mechanical ventilation. Nurse sleep evaluation does not correlate with PSG if atypical sleep is present in the PSG, which limits the reliability of subjective sleep assessment in this patient population.

Update on the management of Barrett's esophagus in Austria.

BACKGROUND: Barrett's esophagus (BE) is the premalignant manifestation of gastroesophageal reflux disease (GERD). Radiofrequency ablation (RFA) with and without endoscopic resection (ER) is a novel treatment for BE. METHODS: Here we present a single-center update of the recommendations of a recent (June 2015) interdisciplinary expert panel meeting on the management of BE with dysplasia as well as cancer-positive and cancer-negative BE. We conducted a PubMed search of studies published in 2016 and 2017 on the topic of BE and RFA. RESULTS: Our update reconfirms that BE positive for T1a cancer as well as low- and high-grade dysplasia justifies the use of RFA ± ER, offering an 80-100% rate of BE clearance. RFA ± ER of dysplastic BE is tenfold more effective for cancer prevention when compared with surveillance. Risk factors for recurrence and follow-up treatments include baseline histopathology (dysplasia/T1a cancer), esophagitis, hiatal hernia >3 cm, smoking habits, BE segments >3 cm, and >10 years of GERD symptoms. A baseline diagnosis for dysplasia and T1a cancer should include a second expert pathologist opinion. Recent data justify the use of RFA for nondysplastic BE only in controlled clinical trials. Antireflux surgery can be offered to those with function-test-proven, GERD-symptom-positive BE before, during, or after RFA ± ER. Additionally, there is growing evidence that the intake of a sugar-rich diet is positively correlated with the development of GERD, BE, and cancer. CONCLUSION: RFA ± ER should be offered for dysplastic BE and T1a cancer after ER as well as for nondysplastic BE with additional risk factors in controlled trials. Antireflux surgery can be offered to patients with function-test-proven GERD-symptom-positive BE. Diet considerations should be included in the management of GERD and BE.

Apoptosis of keratinocytes and serum DNase I activity in patients with cutaneous lupus erythematosus: relationship with clinical and immunoserological parameters.

BACKGROUND: Dysregulation of apoptosis has an important role in the induction of autoimmunity. OBJECTIVE: To evaluate the influence of keratinocyte apoptosis and deoxyribonuclease I (DNase I) activity on the clinical and immunoserological parameters of cutaneous lupus erythematosus (CLE). METHODS: We studied 69 CLE patients (39 with discoid LE (DLE), 12 with subacute CLE (SCLE), 12 with acute and 6 with intermittent CLE). Thirty of sixty-nine patients fulfilled criteria for systemic LE (SLE). Apoptotic index (AI) was evaluated immunohistochemically in lesional and non-lesional, photoprotected skin. Serum DNase I activity, antichromatin and anti-ENA antibodies were measured by ELISA. Disease activity was determined by SLEDAI-2K, SLICC/ACR, CLASI and RCLASI. RESULTS: AI in lesions was higher than in non-lesional skin (P < 0.001). There was no difference in AI between CLE and SLE patients. Patients with SCLE had higher lesional AI than patients with DLE (P < 0.05). We found a positive correlation between the lesional AI with CLASI A (P < 0.05) and RCLASI D (P < 0.05). CLE and SLE patients had significantly lower DNase I activity than healthy controls (P < 0.001). Patients with normal DNase I activity and low AI had significantly lower CLASI A than patients with decreased DNase I activity and/or elevated AI (P < 0.05). CONCLUSIONS: Increased keratinocyte apoptosis characterizes lesions of all CLE forms, especially of SCLE. AI correlates with CLE markers of acute and chronic inflammation. Normal level of apoptosis and DNase I activity simultaneously reduce the level of acute inflammation in CLE. Serum DNase I activity and AI might be important biomarkers in the evaluation of CLE patients.

Receptive speech in early implanted children later diagnosed with autism.

INTRODUCTION: Incidence of children with autism spectrum disorder (ASD) is rising through the years with estimated 1 in 68 in the US in 2014. This incidence is also rising in the population of congenitally deaf children. Favorable outcome after early cochlear implantation is expected due to plasticity and reorganization capacity of brain in infants and toddlers, but outcomes could be significantly modified in children with diagnosed ASD. Current methods of screening for autism have difficulties in establishing diagnosis in children who have both autism and other developmental delays, especially at such an early age. The aim of the study was to assess the development of auditory perception and speech intelligibility in implanted children with profound congenital hearing loss who were diagnosed with ASD comparing to those who were typically developing. MATERIAL AND METHODS: Fourteen children underwent cochlear implantation; four were later diagnosed with ASD and ten were typically developing. All children underwent intensive postoperative speech and hearing therapy. The development of auditory perception and speech intelligibility was assessed using the Categories of Auditory Performance (CAP) and the Speech Intelligibility Rating (SIR) during the 5-years follow-up. RESULTS: In children later diagnosed with ASD, auditory processing developed slowly. Depending on the individual capabilities, by the age of six they could identify environmental sounds or discriminate speech sounds. Speech Intelligibility in children with ASD was at best rated as category 2, with very little or no progress up to the age of six, despite extensive speech and language therapy. Communication skills were strongly affected by a degree of autistic features expression. CONCLUSION: Preoperative psychological assessment in congenitally deaf infants should be expanded by the use of validated instruments for early detection of autism. The possibility of developing ASD should be kept in mind by all professionals involved in programs for cochlear implantation.

Cardiac Nitric Oxide Synthases and Na⁺/K⁺-ATPase in the Rat Model of Polycystic Ovary Syndrome Induced by Dihydrotestosterone.

Nitric oxide synthases (NOSs) and Na(+)/K(+)-ATPase are enzymes essential for regular functioning of the heart. Since both enzymes are under insulin and androgen regulation and since insulin action and androgen level were disturbed in polycystic ovary syndrome (PCOS), we hypothesized that cardiac nitric oxide (NO) production and sodium/potassium transport would be deteriorated in PCOS. To test our hypothesis we introduced animal model of PCOS based on dihydrotestosterone (DHT) treatment of female Wistar rats and analyzed protein expression, phosphorylation or subcellular localization of endothelial NOS (eNOS), inducible NOS (iNOS) and alpha subunits of Na(+)/K(+)-ATPase in the heart. Obtained results indicate that DHT treatment significantly decreased cardiac eNOS protein level and activating phosphorylation at serine 1,177, while inhibitory phosphorylation at threonine 495 was increased. In contrast to expression of eNOS, iNOS protein level in the heart of DHT-treated rats was significantly elevated. Furthermore, cardiac protein level of alpha 1 subunit of the ATPase, as well as its plasma membrane content, were decreased in rats with PCOS. In line with this, alpha 2 subunit protein level in fraction of plasma membranes was also significantly below control level. In conclusion, DHT treatment impaired effectiveness of NOSs and Na(+)/K(+)-ATPase in the female rat heart. Regarding the importance of NO production and sodium/potassium transport in the cardiac contraction and blood flow regulation, it implicates strong consequences of PCOS for heart functioning.

[APPROACH TO PATIENTS WITH GASTROINTESTINAL BLEEDING].

In the developed Western countries, despite the accumulation of knowledge about the causes and treatment of gastrointestinal bleeding, as well as the experience of gastroenterologists-endoscopists using sophisticated endoscopic devices, the number of hospitalizations and mortality rates has not declined as expected. The most likely explanations are the following: aging population, increased prevalence of alcoholic liver cirrhosis, gastroesophageal reflux disease and obesity, Helicobacter pylori antibiotic resistance, using dual anti-aggregation therapy, anticoagulants, and excessive use of nonsteroidal anti-inflammatory drugs. The aim of this paper is to show the incidence and the most common signs and symptoms of gastrointestinal bleeding. The aim is also to present initial clinical evaluation, diagnostic methods, the main causes of gastrointestinal bleeding, endoscopic hemostatic modalities and treatment of bleeding from the upper and lower gastrointestinal tract. Using the MEDLINE and Ovid databases, we searched the meta-analyses and systematic reviews published in English during the 2005-2015 period. Meta-analyses included results of randomized, double-blind studies on adults treated for gastrointestinal bleeding. Included were guidelines of the European and American Society of Gastroenterological Endoscopy, as well as recent expert work. In this review, we bring the state-of-the-art on gastrointestinal bleeding, new classification of gastrointestinal bleeding from the upper, mid and lower gut, controversy of nasogastric tube placement, use of prokinetic agents and inhibitor proton pumps in acute gastrointestinal bleeding from the upper tract, restrictive transfusion strategy, useful clinical stratification of the severity of bleeding, indications for hospitalization and outcome of using the clinical bleeding score, proper use of gastroprotection in patients at a high risk of peptic ulcer, the need of initial endoscopy, variceal assessment in newly diagnosed liver cirrhosis, primary and secondary prophylaxis of variceal bleeding, new endoscopic hemostatic modality, and radiological and surgical treatment of gastrointestinal bleeding. The educational nature of this review could serve for establishing Croatian guideline for the management of gastrointestinal bleeding.

Rapid eye movement sleep behavior disorder as an outlier detection problem.

OBJECTIVE: Idiopathic rapid eye movement (REM) sleep behavior disorder is a strong early marker of Parkinson's disease and is characterized by REM sleep without atonia and/or dream enactment. Because these measures are subject to individual interpretation, there is consequently need for quantitative methods to establish objective criteria. This study proposes a semiautomatic algorithm for the early detection of Parkinson's disease. This is achieved by distinguishing between normal REM sleep and REM sleep without atonia by considering muscle activity as an outlier detection problem. METHODS: Sixteen healthy control subjects, 16 subjects with idiopathic REM sleep behavior disorder, and 16 subjects with periodic limb movement disorder were enrolled. Different combinations of five surface electromyographic channels, including the EOG, were tested. A muscle activity score was automatically computed from manual scored REM sleep. This was accomplished by the use of subject-specific features combined with an outlier detector (one-class support vector machine classifier). RESULTS: It was possible to correctly separate idiopathic REM sleep behavior disorder subjects from healthy control subjects and periodic limb movement subjects with an average validation area under the receiver operating characteristic curve of 0.993 when combining the anterior tibialis with submentalis. Additionally, it was possible to separate all subjects correctly when the final algorithm was tested on 12 unseen subjects. CONCLUSIONS: Detection of idiopathic REM sleep behavior disorder can be regarded as an outlier problem. Additionally, the EOG channels can be used to detect REM sleep without atonia and is discriminative better than the traditional submentalis. Furthermore, based on data and methodology, arousals and periodic limb movements did only have a minor influence on the quantification of the muscle activity. Analysis of muscle activity during nonrapid eye movement sleep may improve the separation even further.

Further in vitro evaluation of antiradical and antimicrobial activities of phytol.

The antiradical activity of phytol was evaluated by electron paramagnetic resonance towards hydroxyl radical (·OH), superoxide anion radical (·O2(-)), methoxy radical (·CH2OH), carbon-dioxide anion radical (·CO2(-)), as well as towards nitric-oxide radical (·NO) and 2,2-diphenyl-1-picrylhydrazyl (·DPPH) radical. It reduced the production of all tested radicals showing more promising activity against ·CO2(-), ·CH2OH and ·DPPH radicals (56%, 50% and 48%, respectively) in comparison with ·NO, ·O2(-) and ·OH radicals (38%, 23% and 15%, respectively). The antimicrobial activity of phytol was evaluated by the microdilution method against eight bacterial and eight fungal strains. To varying degrees, it was proven to be active against all tested bacteria and fungi (MIC 0.003-0.038 mg/mL and MBC 0.013-0.052 mg/mL, MIC 0.008-0.016 mg/mL and MFC 0.090-0.520 mg/mL, respectively). According to the obtained results, medical foods containing phytol may support development of new therapies for heart disease.

Postnatal neuronal apoptosis in the cerebral cortex: physiological and pathophysiological mechanisms.

In the first week of postnatal life of all examined mammalian species, there is a wave of apoptosis in the cerebral cortex, accounting for a loss of up to 30% of neuronal content from birth to adulthood. In this review we examine recent advances in the understanding of this curious phenomenon. We survey the phenomenological literature and elaborate a putative relationship between the formation of active neuronal networks and selective apoptosis of non-participatory neurons. The underlying reason for this apoptotic wave remains unclear, but molecular mechanisms are starting to be elucidated that account for its mechanism, including a role for insulin-like growth factor I (IGF-1) and the Rho GTPases RhoA and RhoB. In addition, we discuss pathophysiological situations in which a variety of common drugs used either recreationally or for medical purposes, or pharmacological blockade of N-methyl-d-aspartate receptor (NMDAR) function, can also cause massive levels of apoptosis in this same developmental window. Experimentation linking molecular causes of developmental and pathophysiological apoptosis in postnatal cerebral cortex is discussed.

Case-control design as investigative approach to assessing cancer etiology: development and future perspectives.

The case-control method evolved out of analyses of series of cases. The analytic form of the case-control study can be found in the 19th century medical literature, but did not appear to be viewed as a special or distinct methodology. The first modern case-control study was the Janet Lane-Claypon's study of breast cancer in 1926, but the design was used only sporadically in medicine until 1950, when 4 published casecontrol studies linked smoking and lung cancer. These 1950s studies synthesized the essential elements of the case-control comparison, produced a conceptual shift within epidemiology, and laid the foundation for the rapid development of the case-control design in the subsequent half century. The powerful consistency of these case-control studies, and the replication of their findings in later prospective studies, promoted the general acceptance of the case-control study as a scientific tool in clinical research. Newer case-control studies have benefited from the advances in design, execution and analysis since 1950s. These advances include more rigorous selection and matching of case and control population, improved interviewing techniques, location of the design within a general framework of epidemiologic strategies for relating exposure to disease, understanding of the measures of effect, and application of increasingly sophisticated statistical procedures to findings. This review traces the development and future perspectives of the case-control design to assessing cancer etiology. With illustrations drawn primarily from the literature on its use and the value of its results to unravelling the etiology of malignant diseases, we tried to explore if the case-control approach firmly ensconced in epidemiology as investigational tool and rivals in importance the more straightforward cohort approach.

Separation mechanisms of Co(III) complexes with EDTA-type ligands during salting-out TLC on impregnated and non-impregnated silica gel.

A separation mechanism of eight Co(III) complexes with ethylenediaminetetraacetate-type ligands belonging to two series during salting-out thin-layer chromatography on silica gel is investigated. The sorbent is impregnated with five poly(ethylene glycol)s with different molecular masses, and ammonium sulphate solutions are used as mobile phase. Additionally, on non-impregnated sorbent, mobile phases containing one of eight salts with ions of different lyotropic properties are used: kosmotropic Mg(2+) accompanied with SO(4)(2-) (kosmotrope), Cl(-) (border), NO(3)(-) (chaotrope), ClO(4)(-)(chaotrope), Cl(-) of Li(+) (kosmotrope), Na(+) (border), K(+) (chaotrope) and NH(4)(+) (chaotrope). Salting-out and salting-in effects were observed depending on salt nature. The combined retention mechanism of specific H-bonding and nonspecific hydrophobic interactions is proposed.