Small bowel perforation from a migrated biliary stent:A case report and review of literature

BACKGROUND Bowel perforation from biliary stent migration is a serious potential complication of biliary stents, but fortunately has an incidence of less than 1%.CASE SUMMARY We report a case of a 54-year-old Caucasian woman with a history of Human Immunodeficiency virus with acquired immunodeficiency syndrome, chronic obstructive pulmonary disease, alcoholic liver cirrhosis, portal vein thrombosis and extensive past surgical history who presented with acute abdominal pain and local peritonitis. On further evaluation she was diagnosed with small bowel perforation secondary to migrated biliary stents and underwent exploratory laparotomy with therapeutic intervention.CONCLUSION This case presentation reports on the unusual finding of two migrated biliary stents, with one causing perforation. In addition, we review the relevant literature on migrated stents.     

Elderly patients with non-cardiac admissions and elevated high-sensitivity troponin: the prognostic value of renal function

BACKGROUND High-sensitivity cardiac troponin(hs-cTn) levels are frequently elevated in elderly patients presenting to the emergency department for non-cardiac events. However, most studies on the role of elevated hs-cTn in elderly populations have investigated the prognostic value of hs-cTn in patients with a specific diagnosis or have assessed the relationship between hs-cTn and comorbidities.AIM To investigate the in-hospital prognosis of consecutive elderly patients admitted to the Internal Medicine Department with acute non-cardiac events and increased hs-cTnI levels.METHODS In this retrospective study, we selected patients who were aged ≥ 65 years and admitted to the Internal Medicine Department of our hospital between January 2019 and December 2019 for non-cardiac reasons. Eligible patients were those who had hs-cTnI concentrations ≥ 100 ng/L. We investigated the independent predictors of in-hospital mortality by multivariable logistic regression analysis.RESULTS One hundred and forty-six patients(59% female) were selected with an age range from 65 to 100(mean ± SD: 85.4 ± 7.61) years. The median hs-cTnI value was 284.2 ng/L. For 72(49%) patients the diagnosis of hospitalization was an infectious disease. The overall in-hospital mortality was 32%(47 patients). Individuals who died did not have higher hs-cTnI levels compared with those who were discharged alive(median: 314.8 vs 282.5 ng/L; P = 0.565). There was no difference in mortality in patients with infectious vs non-infectious disease(29% vs 35%). Multivariable analysis showed that age(OR 1.062 per 1 year increase, 95%CI: 1.000-1.127; P = 0.048) and creatinine levels(OR 2.065 per 1 mg/dL increase, 95%CI: 1.383-3.085; P 0.001) were the only independent predictors of death. Mortality was 49% in patients with eGFR 30 mL/min/1.73 m2.CONCLUSION Myocardial injury is a malignant condition in elderly patients admitted to the hospital for non-cardiac reasons. The presence of severe renal impairment is a marker of extremely high in-hospital mortality.     

The Relation between Caffeine Consumption and Endometriosis: An Updated Systematic Review and Meta-Analysis

While the contributing factors leading to endometriosis remain unclear, its clinical heterogeneity suggests a multifactorial causal background. Amongst others, caffeine has been studied extensively during the last decade as a putative contributing factor. In this systematic review and meta-analysis, we provide an overview/critical appraisal of studies that report on the association between caffeine consumption and the presence of endometriosis. In our search strategy, we screened PubMed and Scopus for human studies examining the above association. The main outcome was the relative risk of endometriosis in caffeine users versus women consuming little or no caffeine (<100 mg/day). Subgroup analyses were conducted for different levels of caffeine intake: high (>300 mg/day) or moderate (100–300 mg/day). Ten studies were included in the meta-analysis (five cohort and five case-control studies). No statistically significant association was observed between overall caffeine consumption and risk for endometriosis (RR 1.12, 95% confidence interval (CI) 0.97–1.28, I² = 70%) when compared to little or no (<100 mg/day) caffeine intake. When stratified according to level of consumption, high intake was associated with increased risk of endometriosis (RR 1.30, 95%CI 1.04–1.63, I² = 56%), whereas moderate intake did not reach nominal statistical significance (RR 1.18, 95%CI 0.99–1.40, I² = 37%). In conclusion, caffeine consumption does not appear to be associated with increased risk for endometriosis. However, further research is needed to elucidate the potential dose-dependent link between caffeine and endometriosis or the probable role of caffeine intake as a measurement of other unidentified biases.     

Effects of Deoxynivalenol and Fumonisins on Broiler Gut Cytoprotective Capacity

Mycotoxins are a crucial problem for poultry production worldwide. Two of the most frequently found mycotoxins in feedstuffs are deoxynivalenol (DON) and fumonisins (FUM) which adversely affect gut health and poultry performance. The current knowledge on DON and FUM effects on broiler responses relevant for gut detoxification, antioxidant capacity, and health is still unclear. The aim of this study was to assess a range of selected molecular intestinal biomarkers for their responsiveness to the maximum allowable European Union dietary levels for DON (5 mg/kg) and FUM (20 mg/kg) in broilers. For the experimental purpose, a challenge diet was formulated, and biomarkers relevant for detoxification, antioxidant response, stress, inflammation, and integrity were profiled across the broiler intestine. The results reveal that DON significantly (p < 0.05) induced aryl hydrocarbon receptor (AhR) and cytochrome P450 enzyme (CYP) expression mainly at the duodenum. Moreover, DON and FUM had specific significant (p < 0.05) effects on the antioxidant response, stress, inflammation, and integrity depending on the intestinal segment. Consequently, broiler molecular responses to DON and FUM assessed via a powerful palette of biomarkers were shown to be mycotoxin and intestinal site specific. The study findings could be highly relevant for assessing various dietary bioactive components for protection against mycotoxins.     

A diamino-functionalized silsesquioxane pillared graphene oxide for CO2 capture

In the race for viable solutions that could slow down carbon emissions and help in meeting the climate change targets a lot of effort is being made towards the development of suitable CO₂ adsorbents with high surface area, tunable pore size and surface functionalities that could enhance selective adsorption. Here, we explored the use of silsesquioxane pillared graphene oxide for CO₂ capture; we modified silsesquioxane loading and processing parameters in order to obtain pillared structures with nanopores of the tailored size and surface properties to maximize the CO₂ sorption capacity. Powder X-ray diffraction, XPS and FTIR spectroscopies, thermal analysis (DTA/TGA), surface area measurements and CO₂ adsorption measurements were employed to characterize the materials and evaluate their performance. Through this optimisation process, materials with good CO₂ storage capacities of up to 1.7/1.5 mmol g⁻¹ at 273 K/298 K in atmospheric pressure, were achieved.

Study of the CO₂ uptake performance of silsesquioxane pillared graphene oxide prepared with different pillar loading and way of drying.     

Autologous vein graft-coated stents for the treatment of thrombus-containing coronary artery lesions

Recent studies have shown that stents may have a potential role in the treatment of thrombus-containing lesions. We report on the application of an autologous vein graft-coated stent (AVGCS) as the primary therapeutic modality for acute myocardial infarction in 10 patients. AVGCS delivery and deployment were successful and uneventful. Mean minimal lumen diameter and TIMI trial flow grade increased significantly (from 0.04 ± 0.09 mm pre-AVGCS to 3.02 ± 0.32 mm post-AVGCS, and from 10 patients with flow grade 0–1 pre-AVGCS to 10 patients with flow grade 3 post-AVGCS, respectively). Ten-day angiogram revealed maintenance of the immediate results. Nine patients had a negative exercise stress test 2 mo post-AVGCS, and at a mean follow-up of 30 ± 7 weeks, all 9 were symptom-free. One patient, 3 wk after implantation and while being hospitalized for hypovolemic shock, developed recurrent infarction. These favorable preliminary outcomes suggest that AVGCS may play a useful role in the treatment of thrombus-containing lesions. Cathet. Cardiovasc. Diagn. 40:217–222, 1997. © 1997 Wiley-Liss, Inc.     

Is Chios mastic gum effective in the treatment of functional dyspepsia? A prospective randomised double-blind placebo controlled trial

Background

Herbal remedies are increasingly popular for the treatment of functional dyspepsia. Chios mastic gum is a resinous exudate from the stem of Pistacia lentiscus var. chia. It is a traditional natural remedy used throughout the eastern Mediterranean.The aim of this study was to assess the efficacy of Chios mastic gum in patients with functional dyspepsia.

Methods

One hundred and forty eight patients fulfilling Rome II criteria for functional dyspepsia were randomly assigned to receive either Chios mastic gum 350 mg three times daily or placebo. After 3 weeks of treatment the change from baseline in the severity of symptoms of functional dyspepsia was assessed using the Hong Kong index of dyspepsia. Patients’ global assessment of efficacy was also evaluated.

Results

The symptom score after treatment was significantly lower in the Chios mastic gum than in the placebo group ((14.78 ± 1.78) vs (19.96 ± 1.83)) (p < 0.05). There was a marked improvement of symptoms in 40% of patients receiving placebo and in 77% of patients receiving Chios mastic gum (p < 0.02). Individual symptoms that showed significant improvement with Chios mastic gum were: stomach pain in general, stomach pain when anxious, dull ache in the upper abdomen and heartburn (<0.05 for all four symptoms).

Conclusion

Chios mastic gum significantly improves symptoms in patients with functional dyspepsia compared to placebo.     

Complete agenesis of the infra‐renal aorta

Complete agenesis of the infra‐renal aorta is an extremely rare anatomical variant, and its presence can complicate the accurate interpretation of the aortic sonographic assessment.     

Optimisation of bacterial release from a stable microfluidic-generated water-in-oil-in-water emulsion

Application of droplet microfluidics for the encapsulation of bacteria in water-in-oil-in-water (W/O/W) emulsion allows for production of monodisperse droplets with controllable size. In this study the release of bacteria from W/O/W emulsion, the effect of the double emulsion structure on bacterial growth and metabolic activity, and the stability and mechanism of bacterial release were investigated. W/O/W emulsions were formed using a double flow-focusing junction microfluidic device under controlled pressure to produce droplets of approximately 100 μm in diameter containing an inner aqueous phase (W₁) of about 40–50 μm in diameter. GFP-labelled Escherichia coli (E. coli-GFP) bacteria were encapsulated within the W₁ droplets and the stability of emulsions was studied by monitoring droplet size and creaming behaviour. The double emulsions were stabilised using a hydrophilic (Tween 80) and a lipophilic surfactant (polyglycerol polyricinoleate) and were destabilised by altering the osmotic balance, adding NaCl either in the inner W₁ phase (hypo-osmotic) or outer W₂ phase (hyper-osmotic). The release of E. coli-GFP was monitored by plating on agar whereby the colony form unit (CFU) of the released bacteria was determined while fluorescent microscopy was employed to observe the mechanism of release from the droplets. The release of E. coli-GFP was significantly increased with higher concentrations of NaCl and lower amounts of Tween 80. Microscopic observation revealed a two-step mechanism for the release of bacteria: double W/O/W emulsion droplet splitting to release W₁ droplets forming a secondary double emulsion followed by the collapse of W₁ droplets to release E. coli-GFP into the continuous aqueous phase.

Encapsulation enhanced viability and metabolic activity. Nutrients can cross the oil layer. Bacterial release increased while emulsion stability decreased at high osmotic pressure and low surfactant concentration. Two-step release mechanism observed.     

Exercise and Nutrition Impact on Osteoporosis and Sarcopenia—The Incidence of Osteosarcopenia: A Narrative Review

Osteoporosis and sarcopenia are diseases which affect the myoskeletal system and often occur in older adults. They are characterized by low bone density and loss of muscle mass and strength, factors which reduce the quality of life and mobility. Recently, apart from pharmaceutical interventions, many studies have focused on non-pharmaceutical approaches for the prevention of osteoporosis and sarcopenia with exercise and nutrition to being the most important and well studied of those. The purpose of the current narrative review is to describe the role of exercise and nutrition on prevention of osteoporosis and sarcopenia in older adults and to define the incidence of osteosarcopenia. Most of the publications which were included in this review show that resistance and endurance exercises prevent the development of osteoporosis and sarcopenia. Furthermore, protein and vitamin D intake, as well as a healthy diet, present a protective role against the development of the above bone diseases. However, current scientific data are not sufficient for reaching solid conclusions. Although the roles of exercise and nutrition on osteoporosis and sarcopenia seem to have been largely evaluated in literature over the recent years, most of the studies which have been conducted present high heterogeneity and small sample sizes. Therefore, they cannot reach final conclusions. In addition, osteosarcopenia seems to be caused by the effects of osteoporosis and sarcopenia on elderly. Larger meta-analyses and randomized controlled trials are needed designed based on strict inclusion criteria, in order to describe the exact role of exercise and nutrition on osteoporosis and sarcopenia.