Digestive diseases and sciences
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Inflammatory bowel disease frequently begins during childhood or adolescence. Current tests and procedures for diagnosing and monitoring inflammatory bowel disease are invasive, uncomfortable and costly. Fecal calprotectin is an inflammatory marker tested in several studies including pediatric patients with inflammatory bowel disease. ⋯ The fecal calprotectin test could be used for supporting diagnosis or confirming relapse of inflammatory bowel disease in pediatric patients. A positive result could confirm the suspicion of either inflammatory bowel disease diagnosis or inflammatory bowel disease relapse, due to the high sensitivity of the test, but a negative result should not exclude these conditions, due to its moderate specificity.
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Hospital-acquired pneumonia after an endoscopic submucosal dissection (ESD) can prolong the patient's stay in the hospital, leading to greater healthcare costs. However, little is known of the characteristics and risk factors associated with this complication. ⋯ Deep sedation under continuous propofol infusion with opioid injection during ESD may be a risk factor for pneumonia.
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Review
Probiotic/synbiotic therapy for treating critically ill patients from a gut microbiota perspective.
The gut is an important target organ for stress caused by severe insults such as sepsis, trauma, burn, shock, bleeding and infection. Severe insult to the gut is considered to have an important role in promoting infectious complications and multiple organ dysfunction syndrome. These are sequelae of interactions between deteriorated intestinal epithelium, the immune system and commensal bacteria. ⋯ Probiotic, prebiotic and synbiotic treatment has been shown to be a promising therapy to maintain and repair the gut microbiota and gut environment. In the critically ill, such as major abdominal surgery, trauma and ICU patients, synbiotic therapy has been shown to significantly reduce septic complications. Further basic and clinical research would clarify the underlying mechanisms of the therapeutic effect of probiotic/synbiotic treatment and define the appropriate conditions for use.
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Alpha-fetoprotein detection is currently mainly used in clinic for diagnosis of primary hepatocellular carcinoma (HCC). However, its sensitivity and specificity are not satisfying. Approximately 60-80 % of patients with HCC have an established background of chronic infection with hepatitis B virus (HBV). ⋯ Our results suggest that serum miR-18a might serve as a novel and potential noninvasive biomarker for HBV-related HCC screening.
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Randomized Controlled Trial
Nonanesthesiologist-administered propofol versus midazolam and propofol, titrated to moderate sedation, for colonoscopy: a randomized controlled trial.
Nonanesthesiologist-administered propofol (NAAP) is controversial due to deep sedation concerns. ⋯ Moderate sedation was feasible with both NAAP regimens. Drug synergy in the midazolam plus propofol sedation regimen promotes a deeper and longer moderate sedation, improving patient satisfaction rates but prolonging early recovery time (Clinical Trials gov NCT01428882).