The effectiveness of endoscopic submucosal dissection (ESD) has been increasingly reported. However, studies addressing the safety and application value of ESD in elderly patients with early gastric ...cancer (EGC) were still lacking. This meta-analysis was intended to evaluate the feasibility and safety of ESD in elderly patients with EGC.
A systematic search was conducted in PubMed, EBSCO, Cochrane Library, EMBASE, and Web of Science. Studies were screened out if data of elderly and non-elderly gastric cancer patients were reported separately. The qualities of included studies were assessed using Newcastle-Ottawa Quality Assessment Scale. The pooled odd ratios (ORs) with 95 % confidence intervals (CIs) were calculated. Statistical analysis was conducted using the Review Manager 5.2 (Cochrane Collaboration, Oxford, UK).
Nine studies (eight in Japan, one in China), including a total of 30,100 lesions, met the inclusion criteria. The "en bloc" and histological complete resection rates of the elderly and non-elderly groups were similar OR, 0.98, 95 % CI, 0.56 to 1.71; P = 0.93 and OR, 0.79, 95 % CI, 0.58 to 1.07; P = 0.13, respectively. As for procedure-related complications, similar perforation rates OR, 1.19, 95 % CI, 0.94 to 1.51; P = 0.15, and bleeding rates OR, 1.13, 95 % CI, 0.83 to 1.56); P = 0.43 between the elderly and non-elderly groups were observed. Whereas, the elderly patients had a higher procedure-related pneumonia rate compared with non-elderly ones OR, 2.18, 95 % CI, 1.55 to 3.08; P < 0.01.
The ESD procedure appears to be a safe technique in elderly patients with EGC while appropriate approach should be taken to avoid procedure-related pneumonia.
Nuclear JAK2: Form and Function in Cancer Qian, Cui‐Juan; Yao, Jun; Si, Jian‐Min
Anatomical record (Hoboken, N.J. : 2007),
September 2011, 2011-Sep, 2011-09-00, 20110901, Volume:
294, Issue:
9
Journal Article
•The viability of using DCLs in partially encased composite columns is examined.•PEC columns’ stiffness and ultimate strength are less influenced by the incorporation of DCLs.•Post-peak behavior is ...negatively affected by DCLs, thus closer link spacing is needed.•A uniaxial constitutive model is proposed for the concrete core of PEC columns.
Steel-concrete composite members incorporating demolished concrete lumps (DCLs) have been devised to provide an innovative alternative means of recycling old concrete. Field applications have demonstrated those members’ potential. In this study the aforementioned recycling method is applied to steel-concrete partially encased composite (PEC) columns. To evaluate the viability of this new solution, a comparative experimental campaign was implemented to investigate the behavior of eleven large-scale PEC columns containing different content of DCLs under axial compression. The key parameters considered were replacement ratio of DCLs, steel flange thickness, spacing of transverse links, the source of DCLs.
Overall, the initial stiffness and axial load-carrying capacity of the PEC columns containing up to 33% DCLs were found to be comparable to those of the columns cast with new concrete alone. Nevertheless, a more rapid load drop right after the peak was observed for the columns containing DCLs when the link spacing equaled or exceeded half the column section depth. To remedy this, a maximum link spacing limit of 0.3d (d = the column section depth) is recommended for the columns containing DCLs. An analytical model is then developed to reproduce the full-range axial response of the PEC columns. The model accounts for the gain in strength due to concrete encasement and the loss due to flange buckling. It also attempts to capture the columns’ descending branch with recourse to the concept of compression fracture energy. Applicable to both types of PEC columns (i.e. containing DCLs or not), the proposed model exhibits a good accuracy, evidenced by comparing the prediction results against a set of test data compiled in this study.
To systematically assess the effect of metformin on colorectal cancer (CRC) risk and mortality in type 2 diabetes mellitus (T2DM) patients. We conducted a systematic search of PubMed, Web of Science, ...and the Cochrane Library databases for relevant articles before August 2015. Two investigators identified and extracted data independently. We adopted adjusted estimates to calculate summary estimates with 95% confidence interval (CI) using either a fixed-effects or a random-effects model. Subgroup and sensitivity analyses were conducted to evaluate the robustness of the pooled results. The risk of publication bias was assessed by examining funnel plot asymmetry as well as Begg test and Egger test. Fifteen studies on CRC incidence and 6 studies on CRC survival were finally included in our meta-analysis. The pooled odds ratio (OR) of observational studies illustrated that a slight 10% reduction of CRC incidence was associated with metformin use (OR = 0.90, 95% CI: 0.85-0.96). Furthermore, the pooled hazard ratio (HR) revealed an improved survival outcome for metformin users in CRC patients compared to nonusers (HR = 0.68, 95% CI: 0.58-081). There was no publication bias across studies. Our meta-analysis demonstrated that metformin therapy could slightly reduce CRC incidence and moderately improve the survival outcomes in patients with T2DM. More prospective studies are warranted to certify this protective association.
The viability of using recycled coarse aggregate (RA) and demolished concrete lumps (DCLs) in manufacturing concrete products have been demonstrated in previous studies and practical applications but ...their environmental impacts have not been compared. In this study, we conducted a life cycle assessment (LCA) on prefabricated components made from three recycling strategies, including the recycled aggregate concrete (RAC) strategy (only using RA), the recycled lump concrete (RLC) strategy (only using DCLs), and the recycled lump/aggregate concrete (RLAC) strategy (simultaneously using DCLs and RA). To identify the environmental impacts of these strategies, twenty-four designed scenarios were investigated with a varying RA replacement ratio (0%, 30%, 50%, and 70%), a changing DCL replacement ratio (0%, 20%, and 30%), and two targeted compressive strength of structural component (25 MPa and 35 MPa). An artificial neural network was implemented to estimate the raw materials consumption of those 24 scenarios. In our LCA, the environmental impacts were evaluated through four indicators. The numerical results show that the RLC and RLAC strategies exhibit a relatively lower environmental burden than the RAC strategy among all scenarios due to the utilization of DCLs. Sensitivity analysis also proved that the location of the recycling plant is a critical factor in the selection of the recycling strategy for an optimal environmental benefit. Our study confirmed the advantage of simultaneously using DCLs and RA in the design and fabrication of recycled concrete products from an environmental perspective, paving the way to further exploit the RLAC product as an alternative solution for a sustainable built environment in the near future.
•Environmental impacts of three strategies for recycling waste concrete are compared.•Artificial neural network is used to determine the mix proportions of new concrete.•Simultaneously using demolished concrete lumps and recycled aggregates is the best.•Impact of using demolished concrete lumps is greater than using recycled aggregates.•Location of recycling plant is an essential factor for choosing suitable strategy.
Ideal bowel preparation for colonoscopy requires complete removal of fluid and foam from the colon. Polyethylene glycol (PEG) is widely used for bowel preparation, with antifoaming agents such as ...simethicone commonly used in combination with PEG. Data on the effect of simethicone on the adenoma detection rate (ADR) were limited. This study therefore aimed to investigate whether preprocedure simethicone could increase the ADR.
This was a prospective, multicenter, endoscopist-blinded randomized controlled trial involving consecutive patients who underwent colonoscopy in six centers in China. Patients were randomly assigned to one of two groups: PEG plus simethicone or PEG alone. The primary outcome was ADR; secondary outcomes were quality of bowel preparation, measured by the Boston bowel preparation scale (BBPS) and bubble scores.
583 patients were included. More adenomas were detected in the PEG plus simethicone group than in the PEG alone group (ADR 21.0 % vs. 14.3 %,
= 0.04; advanced ADR 9.0 % vs. 7.0 %,
= 0.38). The mean number of adenomas detected was 2.20 ± 1.36 vs. 1.63 ± 0.89 (
= 0.02). Patients in the PEG plus simethicone group showed better bowel cleansing efficacy: BBPS ≥ 6 in 88.3 % vs. 75.2 % (
< 0.001) and bubble scores of 1.00 ± 1.26 vs. 3.98 ± 2.50 (
< 0.001). Abdominal bloating was reported less frequently in the PEG plus simethicone group (7.8 % vs
19.7 %,
< 0.001) than in the PEG alone group.
Combined use of PEG and simethicone is associated with a significantly increased ADR in a Chinese population.
Gastric cancer remains one of the major health problems worldwide. Chemotherapy is an important therapeutic modality for gastric cancer, but the success rate of this treatment is limited because of ...chemoresistance. The ubiquitously expressed transcription factor NF-κB has been suggested to be associated with chemoresistance of gastric cancer. Agents that can either enhance the effects of chemotherapeutics or overcome chemoresistance to chemotherapeutics are needed for the treatment of gastric cancer. Curcumin, a component of turmeric, is one such agent that has been shown to suppress NF-κB and increase the efficacy of chemotherapy. In this study, we investigated whether curcumin can reverse chemoresistance by downregulating NF-κB in human gastric cancer cells. SGC-7901 human gastric cancer cells was treated with chemotherapeutics (etoposide and doxorubicin) or by combined application of curcumin and chemotherapeutics. The viability of SGC-7901 cells was measured by MTT assay. Apoptosis of SGC-7901 cells was detected using the TUNEL and Annexin V/PI methods. The protein levels of NF-κB were analyzed by immunocytochemical staining. EMSA was used to confirm the increased nuclear translocation of RelA. The protein levels of p-IκBα, Bcl-2 and Bcl-xL were analyzed by Western blotting. The chemotherapeutics (etoposide and doxorubicin) suppressed the growth of SGC-7901 cells, in a time-dose-dependent manner. Use of curcumin in addition to these agents can suppress cell growth further (inhibitory rate: doxorubicin vs. doxorubicin + curcumin, 33% vs. 45%, p<0.05; etoposide vs. etoposide + curcumin, 35% vs. 48%, p<0.05). Furthermore, chemotherapeutics induced apoptosis of SGC-7901 cells and activated NF-κB. The combination of curcumin and chemotherapeutics induced apoptosis of SGC-7901 cells further, attenuated the activation of NF-κB, and reduced expression of the NF-κB-regulated anti-apoptotic gene products Bcl-2 and Bcl-xL. Curcumin potentiates the antitumor effects of chemotherapeutics in gastric cancer by suppressing NF-κB and NF-κB-regulated anti-apoptotic genes.
To evaluate the outcomes of furazolidone- and amoxicillin-based quadruple therapy for treatment of
(
) infection and identify predictors of failed eradication.
Patients with
infection treated with ...furazolidone, amoxicillin, bismuth, and proton pump inhibitor therapy (January 2015 to December 2015) who received the
C-urea breath test > 4 wk after treatment were evaluated. Demographic and clinical data including prior
treatment attempts, medication adherence, alcohol and cigarette consumption during therapy, and treatment-related adverse events were recorded by reviewing medical records and telephone surveys.
eradication rates for overall and subgroups were evaluated. Multivariate analysis was performed to identify independent predictors of failed
eradication.
Of the 992 patients treated and retested for
infection, the overall eradication rate was 94.5% 95% confidence interval (CI): 94.1%-95.9%.
eradication rate of primary therapy was 95.0% (95%CI: 93.5%-96.5%), while that of rescue therapy was 91.3% (95%CI: 86.8%-95.8%). Among the 859 patients who completed the study protocol, 144 (17%) reported treatment-related adverse events including 24 (3%) leading to premature discontinuation. On multivariate analysis, poor medication adherence adjusted odds ratio (AOR) = 6.7, 95%CI: 2.8-15.8, two or more previous
treatments (AOR = 7.4, 95%CI: 2.2-24.9), alcohol consumption during therapy (AOR = 4.4, 95%CI: 1.5-12.3), and possibly smoking during therapy (AOR = 1.9, 95%CI: 0.9-4.3) were associated with failed
eradication.
Furazolidone- and amoxicillin-based quadruple therapy for
infection in an area with a high prevalence of clarithromycin resistance demonstrated high eradication rates as primary and rescue therapies with a favorable safety profile. Patient education targeting abstinence from alcohol during therapy and strict medication adherence may further optimize
eradication.
To investigate the relationship between H pylori infection, blood ammonia concentration and hepatic encephalopathy (HE), and the effect of H pylori eradication in cirrhotic patients.
From July 2003 ...to January 2005, 457 cirrhotic patients in five regions of Zhejiang Province were enrolled. Patients were evaluated for demographics, number connection test, H pylori infection, liver impairment, blood ammonia concentration and HE. Patients with H pylori infection were given 1 wk therapy with omeprazole plus clarithromycin and tinidazole. (14)C urea breath test was performed and mental symptoms and blood ammonia level were reassessed after bacterium eradication.
Overall H pylori infection rate was 60.6%, and HE occurred in 47.5% of cirrhotic patients. Subclinical HE (SHE) was detected in 55 of 117 cirrhotic patients. Blood ammonia concentration in H pylori negative (n = 180) and positive (n = 277) cirrhotic patients was 53.8 +/- 51.4 and 78.4 +/- 63.6 mumol/L, respectively (P < 0.01), which was significantly reduced to 53.5 +/- 37.7 mumol/L after bacterium eradication (n = 126) (P < 0.01). Blood ammonia was 97.5 +/- 81.0 mumol/L in H pylori-positive cirrhotic patients, and this did not significantly change in those with persistent infection after H pylori eradication (n = 11). HE was more frequently observed in patients with H pylori infection than in those without (58.5% vs 30.6%, P < 0.01). HE rate significantly dropped to 34.1% after H pylori eradiation (P < 0.01). H pylori prevalence significantly differed among cirrhotic patients with HE (74.4%), SHE (69.1%), and those without HE (53.2%) (P < 0.05). Blood ammonia level was significantly different among cirrhotic patients with HE (94.5 +/- 75.6 mumol/L), SHE (59.9 +/- 49.2 mumol/L), and without HE (47.3 +/- 33.5 mumol/L) (P < 0.05). Logistic regression analysis showed that blood ammonia concentration, Child-Pugh stage, upper gastrointestinal bleeding, electrolyte disturbance, and urea nitrogen were risk factors for HE.
H pylori infection is an important factor for inducing high blood ammonia concentration and HE in cirrhotic patients. H pylori eradication may be helpful for treatment and prevention of HE.
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