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Background The role of autophagy-related markers as the prognostic factor of post-operative hepatocellular carcinoma (HCC) recurrence remained controversial. Methods Overall, 535 consecutive HCC patients undergoing curative resection from 2010 to 2014 were followed and classified with early (ER

As with other types of architecture in the process of modernization, Taiwanese school buildings entail a basic problem that must be resolved – ″what type of architectural form″ is capable of representing modernized school architecture. This paper uses the creation and identification of ″cultural symbols″ as themes, first organizing the close relationship between the development of Taiwanese architectural forms in different periods and symbolism; then, for the post-921 earthquake period, a number of aboriginal elementary schools located in mountainous villages in Taiwan are used as case studies to demonstrate that Taiwanese aboriginal school buildings have already developed from the shallow and crude operations of image symbolism to ″space type″ analogized architectural models. Then, case analysis is used to show that forms derived from cultural prototypes have different degrees of perception due to different autonomous identification and conversion methods applied by architects to cultural symbols.

BACKGROUND: Indoxyl sulphate (IS) and p-cresylsulphate (PCS) are uremic toxins with similar protein-binding, dialytic clearance, and proinflammatory features. Few studies have evaluated the possible associations between these solutes and coronary artery disease (CAD) in type 2 diabetes (T2D) patients. METHODS: A hospital-based case control study was performed. A total of 209 T2D patients were divided into two groups based on the presence/absence of significant CAD (≥50% luminal reduction). Serum total PCS and IS levels were measured using the Ultra Performance LC System. The relationship between total PCS and IS levels were investigated. Coronary calcium scores and the modified Gensini score were analyzed. RESULTS: Serum total PCS and IS levels were significantly higher in patients with both T2D and significant CAD, than in non-diabetic control subjects and T2D patients without CAD (all p < 0.05). Logistic regression analysis revealed independent and significant associations between the two solutes and CAD status. Serum total PCS, IS, and numbers of diseased vessels were elevated in groups with estimated glomerular filtration rate (eGFR) of 60-89 ml/min/1.73 m2 and below. Also, serum total PCS and IS levels were significantly associated with eGFR, coronary calcium scores, Gensini score, adipocytokines (adiponectin, visfatin, and leptin), and total white blood cell count. CONCLUSIONS: Serum total PCS and IS levels were elevated in patients with T2D and CAD. These increases were associated with renal function deterioration, inflammation, and coronary atherosclerosis.

A significant number of patients with chronic kidney disease (CKD) have cardiac abnormalities, and left ventricular systolic dysfunction (LVSD) is a common manifestation. p-Cresylsulfate (PCS), a protein-bound uraemic retention solute, is known to cause endothelial dysfunction and possibly plays a role in coronary atherosclerosis. Furthermore, the associations among serum total PCS, major adverse cardiovascular events, all-cause mortality, and QTc prolongation have also been found in previous studies. We thus investigated the association of total PCS and CKD with LVSD in the clinical setting.We included 403 consecutive patients with stable angina. To evaluate LV function, all patients underwent echocardiography. To measure the serum total PCS concentrations and estimated glomerular filtration rate (eGFR), blood samples were obtained.Multiple regression analysis showed that left atrium diameter, left ventricular mass index, end diastolic interventricular septal thickness, left ventricular end-systolic diameter, left ventricular end-systolic volume, stroke volume, left ventricular end-systolic volume index, left ventricular ejection fraction (LVEF), and the interventricular septum/posterior wall of the left ventricle were independently associated with total PCS (all p0.05). In addition, a significantly decreased LVEF was present in patients with lower and higher serum total PCS and with CKD, and with higher serum total PCS and without CKD than from those with lower serum total PCS concentrations and without CKD (p=0.004). In the multivariate logistic regression analysis, when patients without CKD and lower PCS were used as reference group, patients with the higher total PCS concentration and without CKD had an odds ratio of 3.59 for the risk of LVSD, the lower total PCS concentration and with CKD had an odds ratio of 3.89 for the risk of LVSD, and the higher total PCS concentration and with CKD had an odds ratio of 4.04 for the risk of LVSD (p=0.039, p=0.038, and p=0.020, respectively).High serum concentrations of total PCS or CKD, or both, represent an increased risk of impaired LV systolic function in stable angina patients.

Pruritus is a common and distressing symptom that affects patients with chronic kidney disease (CKD). Indoxyl sulfate (IS) and p-cresylsulfate (PCS) are uremic toxins with similar protein binding, dialytic clearance, and proinflammatory features. Pruritus in CKD may correlate better with uremic toxins than the glomerular filtration rate (GFR), suggesting that uremic toxins either in the central nervous system or peripherally may play an important role in the pathophysiology.We sought to investigate the potential contribution of serum total IS and PCS to the pathogenesis of pruritus.The serum levels of total IS and PCS concentrations were measured in all patients by using the Ultra Performance LC System. The characteristics of pruritus were assessed using a visual analog scale score and an interview questionnaire.Among the 320 CKD patients, 35% had pruritus. The patients with pruritus were older and had a higher frequency of diabetes mellitus, higher uric acid, calcium, phosphorus, creatinine, high-sensitivity C-reactive protein, and total IS and PCS levels, and lower albumin concentrations and estimated GFR (eGFR) than those without pruritus. Increasing concentrations of total PCS were independently and significantly associated with pruritus. Multiple logistic regression analysis revealed total PCS as an independent association factor for pruritus, even after full adjustment of known biomarkers. Furthermore, serum total PCS levels were positively associated with calcium, phosphorus, blood urea nitrogen, creatinine, and white blood cell count, and negatively associated with eGFR, hemoglobin, and hematocrit.Our results indicate that total PCS may play a role in the pathogenesis of pruritus.

This paper aims to discuss the methods of form production in Le Corbusier’s housing design from a typological point of view and to explore his composite principles of rational housing. Specifically, this paper looks at how Le Corbusier produced spatial variety and unity by applying composite principles to housing design and production. We will take the Quartier Fruges housing project in Pessac as a case study. Here Le Corbusier applied his cellular concept to housing, creating a new typology that first appeared in sketches for this project. Le Corbusier’s numerically-based production rules governed the development of each unit’s space, while the constructive rules of the housing project’s five housing types show how Le Corbusier dealt with the demands of modern housing, and innovated design solutions which can be applied to the spatial design of today’s housing. Finally, this paper looks at how Le Corbusier dealt with the spatial characteristics of these five housing types under different conditions.

Mobile IPv6 is a novel technology that supports mobile Internet communications. When a mobile node approaches another scalable domain, such as another ISP or mobile network company, serious problems occur such as registration delay and transmission latency owing to the binding update that the mobile node registers back to its original home agent. This work attempts to construct a scalable mobile IPv6 global network anycast by dynamically determining the nearest home agent to the current home agent for registration and transmission. This scheme is called Global Dynamic Home Agent Discovery (GDHAD). This investigation also performed and evaluated an anycast simulation to find how to obtain the best performance.

When network techniques advance dramatically, network applications merge broadly into the daily lives of people. More electrical appliances now contain tiny embedded systems that support network interfaces within the home due to the great advances in IC design and semiconductor device manufacturing. Remotely controlling an information appliance (IA) in a home network has become a major request for nowadays consumers. IPv6 plays an important role because of the enormous number of device network interfaces needed in the home network around the world. In our work, a protocol that automatically integrates the user interface and command transmission is proposed. The proposed method also allows IA to acquire its domain name automatically without manual configuration. Through this initial automatic message communication protocol, users can "plug and play" the IA device with its unique ID.

Pre-amorphization implantation (PAI) of various energy and dosage are used on Ni-Silicide formation, which has achieved amorphism-like NiSi films. The electric characteristic, physical morphology and metallurgical of the NiSi were identified by sheet resistance, grazing incident X-ray diffraction (GIXRD), and selected-area electron diffraction (SAD) analysis. Result shows that lower energy and higher dosage of ion implantation can get amorphism-like NiSi film.

Brunner's gland hamartoma is an uncommon intestinal tumor, most frequently located in the duodenal bulb. We report the endoscopic sonographic (EUS) appearances in 2 cases of Brunner's gland hamartoma. In 1 case, EUS revealed a heterogeneous hypoechoic pedunculated mass, 1.7 cm in diameter, arising from the mucosal and submucosal layers of the wall of the duodenal bulb. Multiple anechoic large and small cystic areas were demonstrated in the tumor. In the other case, EUS revealed a 1.4- x 0.9-cm pedunculated mass with an echogenicity higher than that of the muscular layer and lower than that of the mucosa, arising from the submucosal layer of the duodenal bulb wall. Multiple small anechoic areas were demonstrated in the tumor. We believe that both EUS patterns are typical for Brunner's gland hamartomas.

Background Secreted frizzled-related protein 5 (Sfrp5), an endogenous inhibitor of wingless-type MMTV integration site family (Wnt) signalling, is an anti-inflammatory adipokine whose expression is perturbed in models of obesity and type 2 diabetes mellitus (T2DM). Wnt member 5a (Wnt5a) is a representative ligand, and recent reports suggest that Wnt5a is involved in inflammatory diseases and metabolic disorders. The aim of this study was to investigate whether plasma Wnt5a and Sfrp5 levels are altered in patients with T2DM. Methods Plasma Sfrp5 and Wnt5a concentrations were measured through enzyme-linked immunosorbent assay in type 2 diabetic and nondiabetic subjects. Results A total of 82 patients with T2DM and 42 nondiabetic subjects were studied. Plasma Sfrp5 levels were found to be elevated in patients with T2DM (9.4 ± 9.0 vs 7.4 ± 10.9 ng/mL, p = 0.006). In contrast, Wnt5a levels were decreased (6.8 ± 12.6 vs 9.1 ± 4.0 ng/dL, p

To demonstrate the gastroesophageal junction with a real-time, transabdominal sonography through the window of left lobe of liver, the normal sonographic pattern and the thickness of the wall of abdominal esophagus were determined. The detection rate of the normal pattern in 30 control subjects was 93%, the normal thickness of the wall being 3.8 +/- 1.2 mm (range 2 mm to 5 mm). In 7 patients with severe acute esophageal inflammation, the thickness was 7.6 +/- 2.1 mm (range 5 mm to 10 mm). In 6 patients with an invading lesion in the gastroesophageal junction due to malignancy, the thickness of the wall was more than 10 mm in each case. This preliminary study indicates that the sonographic detection of gastroesophageal junction through the liver window can be included in routine abdominal sonography. An increased thickness of the wall needs further study to find the cause of the thickening.

A novel technique for technical-scale continuous purification of proteins is presented. It is based on the combined use of functionalized magnetic nano-particles and an Aqueous Micellar Two-Phase System featuring the non-ionic surfactant, Eumulgin ES, which undergoes temperature induced phase separation at ∼25°C. In the first step, conducted below the transition temperature (i.e. 15°C), the magnetic sorbent particles are added into the single dispersed phase and bind the protein of interest. Next, on raising the temperature to 30°C the protein-laden magnetic particles partition strongly into the micelle-rich top phase of the micellar two-phase system that's formed. The magnetically susceptible top phase is then continuously separated from the micelle-poor phase in a flowthrough tailor-made magnetic extractor featuring a permanent magnet providing an upwardly acting magnetic force. This separation device was shown to be effective for continuous separation of a wide range of differently sized magnetic particle sorbents (i.e. from 2μm diameter to as small as 25nm) from a 10% (w/w) Eumulgin ES system; high separation efficiencies were recorded for the phase-forming surfactant (87 to >98%), and all magnetic sorbent particles tested (95-99.9%). Finally, protein purification by continuous magnetic extraction was demonstrated at 15L scale for the recovery of an antibody fragment, A33 Fab', from a crude extract of Escherichia coli periplasm. Nearly 70% of the A33 Fab' initially present in the extract at 15.6% of the total protein content was recovered in a 2-fold concentrated and highly purified (>98%) state. Further, the amounts of magnetic sorbent and phase-forming surfactant lost in the process were very small; thus recycling of both components into subsequent rounds of continuous magnetic extraction is highly feasible.

Secreted frizzled-related protein 5 (Sfrp5), an endogenous inhibitor of wingless-type MMTV integration site family (Wnt) signalling, is an anti-inflammatory adipokine whose expression is perturbed in models of obesity and type 2 diabetes mellitus (T2DM). Wnt member 5a (Wnt5a) is a representative ligand, and recent reports suggest that Wnt5a is involved in inflammatory diseases and metabolic disorders. The aim of this study was to investigate whether plasma Wnt5a and Sfrp5 levels are altered in patients with T2DM.Plasma Sfrp5 and Wnt5a concentrations were measured through enzyme-linked immunosorbent assay in type 2 diabetic and nondiabetic subjects.A total of 82 patients with T2DM and 42 nondiabetic subjects were studied. Plasma Sfrp5 levels were found to be elevated in patients with T2DM (9.4 ± 9.0 vs 7.4 ± 10.9 ng/mL, p = 0.006). In contrast, Wnt5a levels were decreased (6.8 ± 12.6 vs 9.1 ± 4.0 ng/dL, p0.001). Increasing concentrations of Sfrp5 were independently and significantly associated with T2DM. Multiple logistic regression analysis revealed Sfrp5 as an independent association factor for T2DM, even after full adjustment of known biomarkers. In a multiple linear regression analysis, only the fasting glucose level was positively associated with the plasma Sfrp5 level.Our results indicate that Sfrp5 may play a role in the pathogenesis of T2DM.

Visfatin (also known as pre-B cell colony-enhancing factor) is increased in patients with chronic kidney disease and has been linked with coronary atherosclerosis. Given that it has been reported that visfatin plays a role in endothelial dysfunction in chronic kidney disease patients, we examined associations between visfatin levels and several markers related to atherosclerosis.The association between visfatin and atherosclerotic risk factors was studied in 173 chronic kidney disease patients (130 men and 43 women). Serum levels of visfatin were measured by the enzyme-linked immunosorbent assay.With increasing visfatin tertiles, patients proved to have a larger number of vessels with stenosis and a higher likelihood of coronary artery disease, as well as having incrementally lower estimated glomerular filtration rate and serum albumin and higher total leukocyte, neutrophil, and monocyte counts; high-sensitivity C-reactive protein; and brain natriuretic peptide levels. Visfatin showed significant positive correlations with low-density lipoprotein cholesterol, uric acid, blood urea nitrogen, creatinine, brain natriuretic peptide, E-selectin, total leukocyte count, neutrophil count, and high-sensitivity C-reactive protein, and a significant negative correlation with estimated glomerular filtration rate and albumin. Only E-selectin was independently associated with visfatin in multiple linear regression analysis.This study indicates that plasma visfatin levels are significantly higher in the presence of coronary artery disease and are correlated with E-selectin levels, which suggest that increased plasma visfatin may be involved in the pathogenesis of coronary atherosclerosis in CKD patients.

Cardiovascular disease is prevalent among patients with chronic kidney disease (CKD). Patients with CKD have elevated levels of p-cresylsulfate (PCS), which has been linked with cardiovascular mortality in this population. The aim of this study was to evaluate the clinical significance of CKD in coronary artery disease (CAD) patients and to investigate whether a significant correlation exists between CKD, total PCS and poor clinical outcomes in CAD patients.We assessed the occurrence of major adverse cardiac events (MACEs) among 340 consecutive CAD patients who enrolled in a disease management program after the patients were discharged from the hospital. CKD was defined as an estimated glomerular filtration rate (eGFR) of60 ml/min per 1.73 m(2).Kaplan-Meier analysis revealed that CKD and high total PCS levels (1.66 mg/L) were significantly associated with the occurrence of MACE. A multivariate Cox hazard regression model revealed that the predictive independent risk factor for the occurrence of MACE was high total PCS level (relative risk = 1.387). We divided the patients with or without CKD and high or low total PCS levels into 4 groups according to their eGFR and total PCS levels, respectively. The hazard ratio for MACE in the group with both CKD and high total PCS level was 1.721, relative to the group without CKD that had low total PCS level (p=0.005).A high serum level of total PCS may be a predictor of elevated risk of MACE in CAD patients with low eGFR.

Background Lamivudine has been widely used in chronic hepatitis B patients with hepatic decompensation, but its use is limited by drug resistance. This outcome research aimed to investigate the comparative efficacy and safety of entecavir versus lamivudine in decompensated patients. Methods Between November 2004 and February 2010, 126 consecutive treatment-naive patients received either entecavir ( n=53) or lamivudine ( n=73) for decompensated chronic hepatitis B. All patients presented with both hyperbilirubinaemia and coagulopathy. Primary outcome was mortality within 1 year; secondary outcomes included liver-related mortality, biochemical and virological response, and improvement of hepatic dysfunction. Results Both treatment groups were comparable in baseline characteristics. A total of 19 (35.8%) entecavir and 33 (45.2%) lamivudine receivers expired within 1 year, respectively ( P=0.29, log rank test). Age (hazard ratio [HR] 1.04 per year, 95% CI 1.01, 1.06), cirrhosis (HR 2.07, 95% CI 1.02, 4.23), and international normalized ratio for prothrombin time (HR 1.44, 95% CI 1.20, 1.74) were independent baseline predictors for all-cause mortality. Antiviral therapy was also unrelated to liver-specific death. However, more patients taking entecavir tended to attain aminotransferase normalization (76.5% versus 52.5%; P=0.05) and viral DNA undetectability (100% versus 58.3%; P=0.06). Moreover, entecavir was associated with significantly greater reduction of the model for end-stage liver disease scores (median 10.0 versus 4.3; P=0.02). Overall, 3 (7.5%) lamivudine but no entecavir users acquired drug resistance in 1 year ( P=0.25). Conclusions Entecavir as compared with lamivudine is similar in the effect on short-term mortality but is associated with greater clinical improvement among chronic hepatitis survivors who recovered from hepatic decompensation.

This paper proposes a firework search for location aided routing enhancement (FLARE) in mobile ad-hoc networks. The proposed protocol, FLARE, is a location aided, beaconless, and pure reactive topology based routing protocol. FLARE uses a firework search framework to cope with node mobility and can adapt to highly dynamic network topologies. The firework search framework is based on a distributed differential relay which is a beaconless and reactive mechanism. In the firework search framework, nodes follow the distributed differential relay to forward a request to an estimated destination location when it needs to repair a broken route. If the destination has moved away the estimated location, a node near the estimated location initiates a firework search to find the destination. To maintain the occupied locations, we also introduce a fundamental reactive location service with the destination oriented location update and the location estimation. Comparing to the existing location services, such fundamental location service is more efficient because it produces much less overhead. The simulation results show that FLARE is more efficient with higher packet delivery ratio and less overhead in comparison with AODV, DSR and GPSR+HLS.

We investigated the associations of surgeons' emotional intelligence and surgeons' empathy with patient-surgeon relationships, patient perceptions of their health, and patient satisfaction before and after surgical procedures. We used multi-source approaches to survey 50 surgeons and their 549 outpatients during initial and follow-up visits. Surgeons' emotional intelligence had a positive effect (r = .45; p < .001) on patient-rated patient-surgeon relationships. Patient-surgeon relationships had a positive impact on patient satisfaction before surgery (r = .95; p < .001). Surgeon empathy did not have an effect on patient-surgeon relationships or patient satisfaction prior to surgery. But after surgery, surgeon empathy appeared to have a significantly positive and indirect effect on patient satisfaction through the mediating effect of patients' self-reported health status (r = .21; p < .001). Our study showed that long-term patient satisfaction with their surgeons is affected less by emotional intelligence than by empathy. Furthermore, empathy indirectly affects patient satisfaction through its positive effect on health outcomes, which have a direct effect on patients' satisfaction with their surgeons.

Because of the dynamic network topology, routingbecomes a challenging problem in MANET. Many geographicschemes are proposed to improve routing performance butcause the challenges in geographic routing when deal with thetopological problems such as a hole in the network and thelocation maintenances. In this paper we propose a geographicscheme with location update (GLU) for ad hoc routing. An adhoc on demand routing protocol for MANET is also providedby applying GLU (AOR-GLU). AOR-GLU inherits topologybased routing that only maintains an active route but repairsthe route by using geographic scheme to prevent the cost offlooding. The proposed protocol adopts a destination orientedmechanism to maintain occupied locations and eliminates theadditional overhead of a location service. The simulationresults show that the proposed routing protocol is moreefficient by achieving higher packet delivery ratio andproducing less overhead in comparing with AODV, DSR andOGPR.

Introduction Hepatoid adenocarcinoma is a special type of extrahepatic alpha-fetoprotein-producing adenocarcinoma, which has a morphologic similarity to hepatocellular carcinoma. We report a patient with underlying hepatitis B virus infection and hepatoid adenocarcinoma with liver metastasis mimicking hepatocellular carcinoma. Case presentation We present the case of a 56-year-old Chinese female with underlying hepatitis B virus infection, who was found to have multiple hepatic tumors by abdominal ultrasound and an elevated level of serum alpha-fetoprotein. Hepatocellular carcinoma was considered based on the image findings, the elevated level of serum alpha-fetoprotein. and underlying hepatitis B virus infection. Moreover, the subsequent endoscopy revealed gastric tumor. However, the tumor histology of the stomach and liver revealed glandular adenocarcinoma with hepatoid foci. The final diagnosis is hepatoid adenocarcinoma of the stomach with liver metastasis. Conclusion Hepatoid adenocarcinoma is an aggressive tumor with liver metastasis being the first clinical manifestation of the neoplasm. Hepatoid adenocarcinoma of the stomach with liver metastasis should be considered in older patients with elevated serum alpha-fetoprotein and multiple hepatic tumors with underlying chronic liver disease. An upper gastrointestinal endoscopy should be performed to exclude the possibility of hepatoid adenocarcinoma originating from the stomach to avoid potential misdiagnosis and inappropriate therapy.

Purpose: Circulating levels of visfatin, a ubiquitous adipokine, may reflect both the severity of plaque as well as degree of plaque stabilization in acute myocardial injury. The purpose of this study was to test whether the level of visfatin is associated with the occurrence of major adverse cardiovascular events (MACEs) in patients with acute ST-elevation myocardial infarction (STEMI). Methods: Consecutive patients (n=185) with acute STEMI were prospectively enrolled in the study. ELISA was used to measure plasma visfatin concentrations. Composite MACEs included death, recurrent myocardial infarction, target lesion revascularization or re-advanced heart failure. Results: Plasma visfatin levels were significantly higher in composite MACE patients than in non-MACE patients. A multivariate Cox hazard regression model revealed that the predictive independent risk factors for the occurrence of composite MACEs were visfatin level (relative risk = 1.04) and age (relative risk = 6.05). When patients were grouped according to their plasma visfatin levels, composite MACEs occurred more frequently in patients presenting with high visfatin levels. Moreover, Kaplan-Meier analysis revealed that high visfatin levels were significantly associated with the occurrence of composite MACEs. Conclusions: The level of plasma visfatin may be associated with risk of composite MACEs in STEMI patients, and may be useful for risk stratification.

Mobile IPv6 is a novel technology that supports mobile Internet communications. When a mobile node approaches another scalable domain, such as another ISP or mobile network company, serious problems occur such as registration delay and transmission latency owing to the binding update that the mobile node registers back to its original home agent. This work attempts to construct a scalable mobile IPv6 global network anycast by dynamically determining the nearest home agent to the current home agent for registration and transmission. This scheme is called global dynamic home agent discovery (GDHAD). This investigation also performed and evaluated an anycast simulation to find how to obtain the best performance

CPE-based IPsec VPNs have been widely used to provide secure private communication across the Internet. As the bandwidth of WAN links keeps growing, the bottleneck in a typical deployment of CPE-based IPsec VPNs has moved from the last-mile connections to the customer-edge security gateways. In this paper, we propose a clustering scheme to scale the throughput as required by CPE-based IPsec VPNs. The proposed scheme groups multiple security gateways into a cluster using a transparent self-dispatching technique and allows as many gateways to be added as necessary until the resulting throughput is again limited by the bandwidth of the last-mile connections. It also includes a flow-migration mechanism to keep the load of the gateways balanced. The results of the performance evaluation confirm that the clustering technique and the traffic-redistribution mechanism together create a transparent, adaptive, and highly scalable solution for building high-performance IPsec VPNs.

The diagnosis of impacted foreign body in the colon is usually delayed until the complications such as perforation or abscess formation occur. Here we describe a patient who presented with diffuse abdominal pain due to the impaction of a dental prosthesis in the hepatic flexure of the colon. The dental prosthesis, which was inadvertently swallowed, was successfully removed under colonoscopy. Unexplained abdominal pain should alert the clinician to the possibility of foreign body ingestion and further therapeutic colonoscopy may replace or lessen the need for surgical procedures to extract foreign bodies from the colon.

The aim of this study was to determine the efficacy of a 1-week low-dose proton pump inhibitor-based triple therapy without further acid suppression for cure of Helicobacter pylori infection and the ulcer healing in peptic ulcer disease.Patients with endoscopically proven peptic ulcers who were H. pylori positive participated in this study. All patients were treated for 1 week with omeprazole 20 mg b.d., clarithromycin 250 mg b.d. and tinidazole 500 mg b.d., then patients were treated randomly for another 4 weeks with either omeprazole 20 mg once daily (OCM-O group; n = 40) or without acid suppressing agents (OCM group; n = 39). Patients were investigated endoscopically for H. pylori and ulcer status before treatment, four weeks (week 5) and 8 weeks later (week 9) after anti-H. pylori treatment. H. pylori infection was assessed by rapid urease test and histology.The eradication rates of H. pylori were 72.5% (95% CI: 59-86%) and 76.3% (95% CI: 63-90%) by intention-to-treat analysis and by per protocol analysis respectively in the OCM-O group and were 87.2% (95% CI: 77-98%) and 97.1% (95% CI: 92-100%) by intention-to-treat analysis and by per protocol analysis respectively in the OCM group (p0.05 in per protocol analysis). In respect to ulcer healing status at week 5, 89.5% (34/38) of patients in the OCM-O group and 80% (28/35) of patients in the OCM group had healed ulcers; at week 9, 86.8% (33/38) of patients in the OCM-O group and 88.6% (31/35) of patients in the OCM group had healed ulcers (p = NS). When the ulcer status was analyzed in relation to the H. pylori status, at week 5 ulcer had healed in 84.4% (54/64) of patients with clearance of H. pylori infection and in 88.9% (8/9) of those with persistent infection. At week 9, ulcer healing increased up to 93.8% (60/64) of patients with clearance of H. pylori infection and decreased to 44.4% (4/9) of patients with persistent infection. The adverse events (20%) were mild in these two treatment groups and no patients required discontinuation of the study medications.Continuation of antisecretory drug therapy beyond a one-week low-dose triple therapy consisting of omeprazole, clarithromycin and tinidazole is actually excessive regarding eradication efficacy and peptic ulcer healing.

Colonic adenomatous polyps are premalignant lesions; early recognition and use of a polypectomy for these polyps can reduce the occurrence of colorectal cancer. The purposes of this study were to evaluate the complications of polypectomy and the relationship between the morphology and size of colonic polyps and their histology.Data on colonic polyps from 324 patients who received a polypectomy between April 1998 and December 2001 were collected. These included 207 men and 117 women, ranging in age between 17 and 86 years old, and who had had a colonoscopy or sigmoidoscopic examination. A polypectomy was performed on those colonic polyps discovered, and their morphology, size, and histology were analyzed.The histological findings of these polyps included adenoma, carcinoma, hyperplastic, and inflammatory polyps. One and a half percent (n = 6) were carcinomas, all of which belonged to the Yamada III or IV polyp group and were more than 1 cm in size, except for 1 polyp which was 0.7 cm. One case was complicated by colon perforation, and 2 cases experienced mild bleeding with no need for a blood transfusion or hospitalization.Morphology and size are closely related to the malignant change in colonic polyps. Colonic polyps with a size greater than 1 cm and classified as Yamada type III or IV have a higher potential for malignant change, and a polypectomy should be considered when they are discovered. A polypectomy is a safe procedure with only minor complications.

Eosinophilic gastroenteritis (EG) is an unusual disorder. It is characterized by eosinophil infiltration of the gut wall histologically and is manifested by gastrointestinal (GI) symptoms clinically. This disease entity preferentially affects the stomach and proximal small intestine. Mucosal layer disease is the most common form of this uncommon disease. We present a case of EG with transmural distal small intestinal and proximal colonic involvement whose clinical symptoms included watery diarrhea, abdominal pain, and body weight loss. Colonoscopy showed non-specific colitis in the proximal colon. Small bowel series showed diffuse jejunal dilatation with wall thickening and rigidity. Abdominal computed tomography also showed a thickened bowel wall with partial ileus and ascites. Diagnosis was established through endoscopic biopsy and ascites paracentesis, while at the same time excluding the possibility of parasite infection. Treatment with prednisolone produced a dramatic response. A high index of suspicion in cases of peripheral eosinophilia with concomitant GI symptoms is needed for the early diagnosis of this uncommon disease.

Background: Double pylorus can occur as either a congenital abnormality or an acquired complication of peptic ulcer disease. There has been no report of long-term follow-up of a large series of patients treated for double pylorus.The objective of this study was to determine the course of double pylorus in 20 patients by serial endoscopic examination. Methods: Among 102,958 endoscopic examinations conducted from 1987 to 1999, a diagnosis of double pylorus was made in 20 patients, 18 of whom were followed from 2 months to 10 years. The demographics, clinical presentations, and outcome, as well as endoscopic patterns of double pylorus, were retrospectively reviewed. The rates of ulcer recurrence and symptoms were estimated and compared. Results: Most fistulous rings were located on the lesser curve of the gastric antrum (75%). Evolution from an original ulcer to fistula was observed in 9 patients. The fistula disappeared in 1 patient, remained open in 12, and converged with the normal pyloric ring in 5 patients. One or more associated systemic diseases and extensive treatment with various drugs were noted in 12 patients. Eradication of Helicobacter pylori in infected patients resulted in a lower percentage of patients with symptoms (36% vs. 100%) and ulcer recurrence (55% vs. 100%) compared with uninfected patients, but the differences were not statistically significant. Conclusion: In this study, fistula closure did not occur in the majority of patients. Associated systemic diseases and extensive use of medications might be important factors in persistence of double pylorus. Eradication of Helicobacter pylori was not beneficial in terms of relief of symptoms, prevention of ulcer recurrence, and fistula closure. Surgical intervention should be considered for patients with refractory symptoms, recurrent ulcers, and other complications. (Gastrointest Endosc 2001;54:464-70.) Double pylorus (DP), a form of gastroduodenal fistula, consists of a short accessory canal from the distal stomach to the duodenal bulb such that the gastric antrum and bulb become connected by 2 openings separated by a septum or bridge. The fistula usually arises from the lesser curve of the gastric antrum and enters the superior aspect of the duodenal bulb. In most cases, DP is an acquired complication of ulcer disease. However, some cases have been reported in which DP was evidently a congenital anomaly.1-5 The first case of DP was detected endoscopically.6 To date, there have been sporadic reports of more than 100 cases. Most patients responded well to medical treatment regardless of whether the fistula was open or closed. However, about 20% of the patients underwent surgery because of refractory symptoms or other complications.3,5,7,8 There is no long-term follow-up study of DP.3,5,7-9 The association of DP with other systemic diseases8,9 and Helicobacter pylori infection9 is not well characterized. The clinical findings were reviewed in 20 patients with DP identified from among 102,958 endoscopic procedures performed over a period of 12 years. The pathogenesis of this disease and the effect of H pylori eradication therapy are also discussed. The aims of this study were to provide further insight into the pathogenesis of DP and to develop a treatment strategy for this condition.

Purpose: Indoxyl sulfate (IS) is linked to endothelial damage, NF-κB activation and induced development of atherosclerosis. The purpose of this study was to investigate the relationship between serum IS levels and the severity of coronary artery stenosis. In addition, the relationship among IS and various cardiovascular risk factors was also explored. Methods: Serum IS concentrations were measured using ultra performance liquid chromatography in 191 consecutive patients presenting with stable angina. The associations between serum IS levels and angiographic indexes of the number of diseased vessels, modified Gensini scores and calcium scores were determined. Results: Patients with significant coronary artery stenosis were found to have higher serum IS levels than patients with normal coronary arteries. Using multivariate analysis, serum IS levels were found to be independently associated with the presence and severity of coronary artery disease (CAD). Furthermore, statistically significant correlation was observed between the serum IS levels and age, Agatston calcium score, volume calcium score, modified Gensini score, coronary lesions, coronary disease and Framingham-10 year risk score. Conclusion:This study indicates that serum IS levels are significantly higher in the presence of CAD and correlate with the severity of the disease and coronary atherosclerosis scores, which suggest that increased serum IS may be involved in the pathogenesis of coronary atherosclerosis.

Background Patients with a history of cardiovascular disease are at high risk of developing secondary major adverse cardiac events (MACE). This study aimed to identify independent predictors of MACE after hospital admission which could be used to identify of high-risk patients who may benefit from preventive strategies. Methods This study included 1,520 consecutive patients with coronary artery disease (CAD) (654 with acute coronary syndrome (ACS) and 866 with elective percutaneous coronary intervention (PCI) patients) who received PCI and/or stenting. MACE was defined as all-cause mortality or rehospitalization for a cardiovascular- related illness. Cardiovascular-related illnesses included heart failure, reinfarction (nonfatal), recurrence of angina pectoris and repeat PCI or coronary artery bypass graft. Results During a mean follow-up period of 32 months, 558 of the 1,520 patients developed at least one MACE. Cox regression analysis showed that the baseline clinical and biochemical variables which associated with MACE were age, being illiterate, a widow or widower, and/or economically dependent, having triple vessel disease, stent implantation, anemia, and/or diabetes mellitus, waist to hip ratio (WHR), diastolic blood pressure, fasting glucose, total cholesterol, high-density lipoprotein cholesterol (HDL-C), creatinine, estimated glomerular filtration rate (eGFR), red blood cell count, hemoglobin, hematocrit, and mean corpuscular-hemoglobin concentration (MCHC) in ACS patients, and age, malnourished, and/or economically dependent, taking hypoglycemic medication, having triple vessel disease, stent implantation, anemia, diabetes mellitus, and/or hypertension, WHR, fasting glucose, HDL-C, uric acid, creatinine, eGFR, high-sensitivity C-reactive protein, mean corpuscular volume, and MCHC in elective PCI patients. Using multivariate Cox regression analysis, we found the MACE’s independent factors are triple vessel disease, stent implantation, hypertension, and eGFR in ACS patients, and having triple vessel disease, stent implantation, hypertension, and uric acid in elective PCI patients. Conclusions Having triple vessel disease, stent implantation, hypertension, and eGFR or uric acid independently predicted MACE in patients with CAD after long-term follow-up. Fortunately, these factors are modifiable and should be identified and monitored early.

Background Primary hepatic carcinoid tumor (PHCT) is very rare and difficult to diagnose before biopsy or operation. We report a patient with a small PHCT and review cases in the literature. Case presentation A 48-year-old Chinese female with underlying hepatitis B virus (HBV) infection was found to have a low echoic hepatic nodule by abdominal ultrasound. Tumor markers were negative. Dynamic liver computed tomography scans showed enhancement of the nodule in the arterial phase and early washout in the portal phase. Hepatocellular carcinoma (HCC) was considered based on the image findings and underlying HBV infection. However, the tumor biopsy revealed a malignant neoplasm that originating from neuroendocrine cells. Pre-operative and intra-operative investigations for the possible other origin of carcinoid tumor were negative, so PHCT was confirmed. Conclusion A small and asymptomatic PHCT is extremely rare. PHCT should be one of the differential diagnoses in patients with small hepatic tumor, even in regions with high prevalence of HBV infection and HCC. Pre-operative biopsy is necessary to avoid misdiagnosis even when HCC is highly suspected clinically.