Mucosal Ulceration Research Articles

60-year-old male with rapidly progressive pneumocephalus caused by Clostridium septicum in the setting of an occult colonic adenocarcinoma

BackgroundDisseminated Clostridium septicum infection is an uncommon complication associated with malignancies, particular colonic adenocarcinoma. The organism appears to preferentially colonize large masses in rare individuals and subsequently seed the blood via mucosal ulceration. This has rarely been reported to lead to central nervous system infection and, in several cases, rapidly progressive pneumocephalus. In the few cases reported, this was a universally fatal condition. The current case adds to the reports of this extremely rare complication and provides a unique and complete clinicopathologic characterization with autopsy examination, microscopy, and molecular testing.Case PresentationA 60-year-old man with no known past medical history was discovered having seizure-like activity and stroke-like symptoms. Blood cultures turned positive after six hours. Imaging revealed a large, irregular cecal mass as well as 1.4 cm collection of air in the left parietal lobe that progressed to over 7 cm within 8 h. By the following morning, the patient had lost all neurologic reflexes and died. Post-mortem examination revealed brain tissue with multiple grossly evident cystic spaces and intraparenchymal hemorrhage, while microscopic exam showed diffuse hypoxic-ischemic injury and gram-positive rods. Clostridium septicum was identified on blood cultures and was confirmed in paraffin embedded tissue from the brain by 16 S ribosomal sequencing and from the colon by C. septicum specific PCR.ConclusionsC. septicum is an anaerobic, gram-positive rod that can become invasive and is strongly associated with gastrointestinal pathology including colonic adenocarcinomas. Central nervous system infection with rapidly progressive pneumocephalus is a rarely reported and universally fatal complication of disseminated C. septicum infection.

Case report: a rare presentation of nasal septal perforation due to pyoderma gangrenosum

Background: Pyoderma gangrenosum (PG) is a rare dermatologic non-infectious neutrophilic disease that classically affects the lower extremities and is associated with inflammatory bowel disease. Rarely, it could affect the nasal septum, causing nasal septal perforation. Methods: We reviewed the case of a 52-year-old male patient known to have PG with ongoing nasal septal perforation and reviewed his blood tests, computed tomography scan findings and histologic results. Results: A diagnosis of nasal septal perforation due to PG was confirmed after exclusion of other common aetiologies. This was further supported by the presence of extensive ulceration of the nasal squamous mucosa with inflamed granulation tissue and abscess-like areas. These findings were consistent with the diagnosis of PG based on the histology report. Conclusion: Although nasal septal perforation secondary to PG is considered rare, this presentation should still be kept in mind, especially when other possible causes of nasal septal perforation have been excluded and PG has been already well established.

Aphthous Ulcer–A Rare Effect of Losartan

Abstract: The most common type of oral mucosa ulcer is an aphthous ulcer, which manifests as a painful sore on the mucous membranes of the mouth or genitalia.1 We describe a case of a male patient who was admitted to the hospital due to anorexia, generalized weakness, weight loss, trouble opening the mouth, glossitis, and aphthous ulcers. The patient’s history and recent medication history indicated that the symptoms began to appear when losartan for hypertension was started. The use of losartan was stopped, and the patient’s glossitis and mouth ulcers were treated symptomatically. After 15 days of drug withdrawal, the symptoms began to subside. According to the WHO and Naranjo ADR assessment, Losartan had a “possible” connection with the oral toxicity seen in this patient. Keywords: Aphthous ulcers, Mucous membrane, Glossitis, Losartan, ARBs, FDA.

Management of Recurrent Aphthous Stomatitis: An Indian Expert Consensus.

Recurrent aphthous stomatitis (RAS) is characterized by painful, oral mucosal ulcers with wide range of prevalence ranging from 2 to 78%. Etiology of RAS is idiopathic and multifactorial. There are numerous gaps in assessment and management of RAS and the absence of guidelines or a consensus document makes the treatment further difficult.The aim of this document is to provide an Indian expert consensus for management of RAS. Experts from different specialties such as Otorhinolaryngology, Oral Medicine/Dentistry and Internal Medicine from India were invited for face to face and online meetings. After a deliberate discussion of current literature, evidence and clinical practice during advisory meetings, experts developed a consensus for management of RAS. We identify that the prevalence of RAS may lie between 2 and 5%. In defining RAS, we advocate three or more recurrences of aphthous ulcers per year as criterion for RAS. Investigation should include basic hematological (complete blood count) and nutritional (serum vitamin B12, and iron studies) parameters. Primary aim of treatment is to reduce the pain, accelerate ulcer healing, reduce the recurrences and improve the quality of life. In treating RAS, initial choice of medications is determined by pain intensity, number and size of ulcers and previous number of recurrences. Topical and systemic agents can be used in combination for effective relief. In conclusion, this consensus will help physicians and may harmonize effective diagnosis and treatment of RAS.

Characteristics of the antiulcerogenic activity of cryopreserved placenta extract in acute and chronic lesions of the stomach

To date, Ukraine has registered about 5 million patients with ulcer disease, and the market of drugs with proven anti-ulcer activity exceeds 500 names, but the problem of effective therapy is far from being solved. Cryoextract of the placenta attracted our attention as a new domestic biotechnological anti-ulcer agent.
 The purpose of the study. To characterize the antiulcer activity of cryoextract of human placenta in acute and chronic ulcerogenesis.
 Materials and methods. Studies of antiulcer activity were carried out on 56 male rats weighing 200–220 g in two stages: on the model of acute serotonin ulcerogenesis (28 rats) under the therapeutic and prophylactic regimen of placenta cryoextract and on the model of chronic acetic acid damage to the stomach (28 rats) under the therapeutic regimen application of the specified cryoextract.
 Results and discussion. The study showed that the therapeutic and prophylactic injection of the cryoextract of the placenta shows a pronounced antiulcer activity in the model of serotonin-induced gastric damage, which was indicated by a decrease in the ulcer index by 13.7 times compared to a similar indicator in the group of untreated animals and was 0.3 and 4, respectively. 1. Hemorrhagic lesions of the gastric mucosa occurred twice as often against the background of placenta cryoextract administration, respectively, against the background of esomeprazole administration – in 57.1% of rats, and against the background of placenta cryoextract administration – in 28.6% of rats. It was established that the investigated cryoextract has a cytoprotective effect on the mucous membrane of the stomach against the background of acetic acid damage. This was indicated by a statistically significant (p<0.05) decrease in the ulcer index by 30.0% compared to the indicators of untreated animals.
 Conclusions. It was established that the cryoextract of the human placenta has pronounced antiulcer activity both in acute and chronic experimental ulcerogenesis, which was indicated by a statistically significant decrease in erosions and ulcers of the gastric mucosa.

Voice Correction Treatment Promotes Recovery of Vocal Cord Paralysis Caused by Atypical Ramsay-Hunt Syndrome: A Case Report.

Atypical Ramsay-Hunt syndrome is caused by varicella zoster viruses (VZV), without herpes, herpes is not around the ear, or posterior cranial nerve palsy is the first clinical manifestation. In this case, a 60-year-old male patient with VZV invades the branches of the vagus nerve alone. The initial symptoms were in the pharynx and larynx, which presented as mucosal ulcers and voice disorders. The ear symptoms were only otalgia and auricular herpes, without deafness, tinnitus, or peripheral facial palsy. Herpes and ulcers healed with medication, but voice disorders caused by vocal cord paralysis did not return. Voice correction treatment has been implemented to help restore the movement and closure of the vocal cords, with ultimately good results. After voice correction treatment, the patient recovered without residual nerve palsy complications. Voice correction treatment has been shown to be potentially effective and promising in shortening the recovery period and improving the recovery rate for vocal cord paralysis caused by viral infection.

Acertannin Prevented Dextran Sulfate Sodium-induced Colitis by Inhibiting the Colonic Expression of IL-23 and TNF-α in C57BL/6J Mice.

The present study investigates the effects of acertannin on colitis induced by dextran sulfate sodium (DSS) and changes in the colonic levels of the cytokines interleukin (IL)-1β, IL-6, IL-10, IL-23, tumor necrosis factor (TNF)-α, the chemokine monocyte chemoattractant protein (MCP)-1, and vascular endothelial growth factor (VEGF).We examine the following: inflammatory colitis was induced in mice by 2% DSS drinking water given ad libitum for 7 days. Red blood cell, platelets, and leukocyte counts and hematocrit (Ht), hemoglobin (Hb), and colonic cytokine and chemokine levels were measured. The disease activity index (DAI) was lower in DSS-treated mice orally administered acertannin (30 and 100 mg/kg) than in DSS-treated mice. Acertannin (100 mg/kg) inhibited reductions in the red blood cell count and Hb and Ht levels in DSS-treated mice. Acertannin prevented DDS-induced mucosal membrane ulceration of the colon and significantly inhibited the increased colonic levels of IL-23 and TNF-α. Our findings suggest that acertannin has potential as a treatment for inflammatory bowel disease (IBD).

COVID19 detection in appendix of acute appendicitis in a child: a case report and review of literature

BackgroundGastrointestinal symptoms are one of the most common presentations of Coronavirus disease-19 (COVID-19), even in children. Higher rates of complicated appendicitis have been demonstrated in the era of the COVID-19 outbreak, and it has been recently suggested that acute appendicitis may occur as a complication of COVID-19. However, the relationship between appendicitis and COVID-19 remains unclear.Case presentationA 7-year-old male presented to the pediatric emergency department with 2 days’ history of lower abdominal discomfort and tenderness. On examination, his abdomen was distended with diffuse mild tenderness at the lower abdomen, which was aggravated by movement. He was also tested and was found to be positive for SARS-CoV-2. Computed tomography showed perforated appendicitis with a fecalith. The patient was admitted and laparoscopic appendectomy was successfully performed. Postoperatively, a minor intra-abdominal abscess was present, which successfully treated with antibiotics. Histopathology showed a markedly inflamed appendix with mucosal ulceration and transmural neutrophilic inflammation, which was consistent with phlegmonous appendicitis. Reverse transcription quantitative polymerase chain reaction using a surgically extracted appendix specimen revealed the presence of SARS-CoV-2 virus, which indicated a pathophysiological relationship between appendicitis and COVID-19.ConclusionThe present case will provide further understanding of pediatric patients with concomitant COVID-19 and acute appendicitis.

Novel Double-Layer Dissolving Microneedles for Transmucosal Sequential Delivery of Multiple Drugs in the Treatment of Oral Mucosa Diseases.

The development of transmucosal drug delivery systems is a practical requirement in oral clinical practice, and controlled sequential delivery of multiple drugs is usually required. On the basis of the previous successful construction of monolayer microneedles (MNs) for transmucosal drug delivery, we designed transmucosal double-layer sequential dissolving MNs using hyaluronic acid methacryloyl (HAMA), hyaluronic acid (HA), and polyvinyl pyrrolidone (PVP). MNs have the advantages of small size, easy operation, good strength, rapid dissolution, and one-time delivery of two drugs. Morphological test results showed that the HAMA-HA-PVP MNs were small and intact in structure. The mechanical strength and mucosal insertion test results indicated the HAMA-HA-PVP MNs had appropriate strength and could penetrate the mucosal cuticle quickly to achieve transmucosal drug delivery. The in vitro and in vivo experiment results of the double-layer fluorescent dyes simulating drug release revealed that MNs had good solubility and achieved stratified release of the model drugs. The results of the in vivo and in vitro biosafety tests also indicated that the HAMA-HA-PVP MNs were biosafe materials. The therapeutic effect of drug-loaded HAMA-HA-PVP MNs in the rat oral mucosal ulcer model demonstrated that these novel HAMA-HA-PVP MNs quickly penetrated the mucosa, dissolved and effectively released the drug, and achieved sequential drug delivery. Compared to monolayer MNs, these HAMA-HA-PVP MNs can be used as double-layer drug reservoirs for controlled release, effectively releasing the drug in the MN stratification by dissolution in the presence of moisture. The need for secondary or multiple injections can be avoided, thus improving patient compliance. This drug delivery system can serve as an efficient, multipermeable, mucosal, and needle-free alternative for biomedical applications.

Unusual Cause of Tarry Stool: What Do You Think?

Question: A 52-year-old man, who was in good health, presented with a 4-month history of tarry stool, abdominal pain, and weight loss. The patient denied history of inflammatory bowel disese and recent antibiotic use. His abdomen was soft, with mild periumbilical tenderness. There was no organomegaly. Laboratory studies showed red blood cell count 3.02 × 1012/L (normal range 4.3–5.8 × 1012/L), leukocyte count 6.57 × 109/L (normal range 3.5–9.5 × 109/L), platelet count 347 × 109/L (normal range 125–350 × 109/L), hemoglobin 66 g/L (normal range 130–175 g/L), aspartate transaminase 15 U/L (normal range 15–40 U/L), alanine transaminase 7 U/L (normal range 9–50 U/L), total serum protein 49 g/L (normal range 65–85 g/L), and serum albumin 27 g/L (normal range 40–55 g/L). Urine tests were normal. Esophagogastroduodenoscopy was normal, with multiple biopsies showing no abnormality in histopathology. Colonoscopy revealed patchy erythema throughout the colon without active hemorrhage (Figure A). Eight biopsies were taken from the ascending colon, transverse colon, descending colon, and sigmoid colon. Contrast-enhanced abdominal computed tomography showed thickened and dilated ileal loops (Figure B). A double-balloon retrograde enteroscopy revealed numerous patchy areas of denuded and ulcerated ileal mucosa (Figure C), the outline of which was graphically outlined with methylene blue staining (Figure D). Four biopsies were taken from the ileum. Screening was negative for serum tumor markers and the following autoantibodies: anti–double-stranded DNA, anti-nuclear antibody, anti-SSA/Ro, anti-SSB/La, anti–liver/kidney microsomal type 1, anti–Scl-70, anti–smooth muscle antibody, anti–U1-snRNP, anti-mitochondrial antibodies, anti-SmD1, cytoplasmic anti-neutrophil cytoplasmic antibody, and peri-nuclear anti-neutrophil cytoplasmic antibody. Electrocardiography and chest computed tomographic (CT) scan were normal. Biopsies of the colon and small intestine (hematoxylin and eosin staining) revealed the findings shown in Figure E.

Study of hematoporphyrin monomethyl ether-mediated blue-light photodynamic therapy in the treatment of oral ulcers infected with Staphylococcus aureus: In vivo evaluation.

Clinical suppurative infection is mainly caused by Staphylococcus aureus. Although many antibiotics can be used to kill S. aureus, the resulting resistance problem is difficult to solve. Therefore, it is necessary to seek a new sterilizing method to solve the problem of drug resistance of S. aureus and improve the therapeutic effect of infectious diseases. Photodynamic therapy (PDT) has become an alternative for the treatment of a variety of drug-resistant infectious diseases due to its advantages of non-invasive, specific targeting, and no drug resistance. We have confirmed the advantages and experimental parameters of blue-light PDT sterilization in vitro experiments. This study aimed to treat buccal mucosa ulcer of hamster infected with S. aureus according to the parameters obtained in vitro experiment, and observe the bactericidal effect of hematoporphyrin monomethyl ether (HMME) mediated blue-light PDT in vivo and its therapeutic effect on tissue infection. The results indicated that HMME mediated blue-light PDT can effectively kill S. aureus in vivo and promote the healing of the oral infectious wound.The study findings lay a foundation for carrying out more HMME mediated blue-light PDT sterilizing therapy.

Effects of Transport and Feeding Strategies Before Transportation on Redox Homeostasis and Gastric Ulceration in Horses

Transportation may lead to oxidative stress (OS) and gastric ulceration in horses, and optimal feed management before, or during, transportation is unclear. This study aimed to evaluate the effects of transportation after three different feeding strategies on OS and to explore possible associations between OS and equine gastric ulcer syndrome (EGUS). Twenty-six mares were transported by truck for 12 hours without food or water. Horses were randomly divided into 3 groups; (1) fed 1 hour before departure (BD), (2) fed 6 hours BD, (3) fed 12 hours BD. Clinical examinations and blood collections were performed at approximately 4 hours BD (T0), at unloading (T1), 8 hours (T2) and 60 hours (T3) after unloading. Gastroscopy was conducted prior to departure, and at T1 and T3. Although OS parameters remained in the normal range, transportation was associated with increased reactive oxygen metabolites (ROMS) at unloading (P=0.004), with differences between horses fed 1 hour and 12 hours BD (P < .05). The level of total antioxidant (PTAS) was affected by both transportation and feeding strategy (P = 0.019), with horses fed 1 hour BD demonstrating greater PTAS at T = 0, and a different response in comparison with the other groups and the literature. Nine horses demonstrated clinically significant ulceration of the squamous mucosa at T1 but, although weak correlations were evident between OS parameters and ulcer scores, univariate logistic regression showed no associations. This study suggests that feed management prior to a long journey (12 hours) may affect oxidative balance. Further studies are needed to understand the nexus between feed management before and during transport, transport-related OS and EGUS.

TRPV1 participates in the protective effect of propolis on colonic tissue of ulcerative colitis.

Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) mainly characterized by inflammation, ulceration and erosion of colonic mucosa and submucosa. Transient receptor potential vanilloid 1 (TRPV1) is an important mediator of visceral pain and inflammatory bowel disease. This study aims to investigate the protective effect of water soluble propolis (WSP) on UC colon inflammatory tissue and the role of TRPV1. Male SD rats were randomly divided into 6 groups (n=8): a normal control (NC) group, an ulcerative colitis model (UC) group, a low-WSP (L-WSP) group, a medium-WSP (M-WSP) group, a high-WSP (H-WSP) group, and a salazosulfapyridine (SASP) group. The rats in the NC group drank water freely, and the other groups drank 4% dextran sulfate sodium (DSS) solution freely for 7 d to replicate the ulcerative colitis model. Based on the successful replication of the UC, the L-WSP, M-WSP, and H-WSP groups were given 50, 100, and 200 mg/kg of water-soluble propolis by gavage for 7 d, and the SASP group was given 100 mg/kg of sulfasalazine by gavage for 7 d. The body weight of rats in each group was measured at the same time every day, the fecal traits and occult blood were observed to record the disease activity index (DAI). After intragastric administration, the animals were sacrificed after fasted 24 h. Serum and colonic tissue were collected, and the changes of MDA, IL-6 and TNF-α were detected. The pathological changes of colon tissues were observed by HE staining, and the expression of TRPV1 in colon tissues was observed by Western blotting, immunohistochemistry, and immunofluorescence. The animals in each group that drank DSS freely showed symptoms such as weight loss, decreased appetite, depressed state, and hematochezia, indicating that the model was successfully established. Compared with the NC group, DAI scores of other groups were increased (all P<0.05). MDA, IL-6, TNF-α in serum and colon tissues of the UC group were increased compared with the NC group (all P<0.01), and they were decreased after WSP and SASP treatment (all P<0.01). The results of showed that the colon tissue structure was obviously broken and inflammatory infiltration in the UC group, while the H-WSP group and the SASP group significantly improved the colon tissue and alleviated inflammatory infiltration. The expression of TRPV1 in colon tissues in the UC group was increased compared with the NC group (all P<0.01), and it was decreased after WSP and SASP treatment. WSP can alleviate the inflammatory state of ulcerative colitis induced by DSS, which might be related to the inhibition of inflammatory factors release, and down-regulation or desensitization of TRPV1.

Assessment of Coccinia Indica root extract for antiulcer activity in experimental animals

The objective is to evaluate the anti–ulcer activity of ethanolic extract of root of Coccinia grandis (Linn.), Anti-ulcer activity of the three extract was studied in rats by using pylorus ligated ulcer model and it was subjected to preliminary phytochemical studies for the identification of phytoconstituents and also studied for color, consistency and percentage yield of various extracts. Ranitidine was used as the standard drug for comparison. The animals were sacrificed after 06 hrs after the ligation. Stomach was dissected out and contents were drained into tubes and were centrifuged and volume was noted. The PH of gastric juice was recorded using a PH meter. The contents were subjected for analysis of free and total acidity and Na+, k+ ion concentration. The numbers of ulcers per stomach was noted and severity of ulcers scored. Then the blood samples were collected and subjected to estimation of serum calcium and alkaline phosphatase level. The expected result is to get an anti-ulcer activity of the leaf extracts of Coccinia grandis should owing to the presence of one or more phytoconstituents, which may reduce the acidity of the gastric juice and also prevents the mucosal damage and ulcer formation. The Ethanolic Extract 400mg/kg expected to showed comparable anti ulcer-activity as that of standard Ranitidine.

Observation of the therapeutic effect of apatinib in advanced platinum-resistant recurrent epithelial ovarian cancer

BackgroundApatinib is an oral anti-angiogenic drug that mainly targets vascular endothelial growth factor receptor 2 (VEGFR-2) and is widely used in a variety of solid tumours. The purpose of this study is to evaluate the clinical efficacy and safety of apatinib in patients with advanced platinum-resistant relapsed epithelial ovarian cancer (EOC).MethodsA retrospective analysis was performed, the clinical data of patients with stage IIIC-IV platinum-resistant relapsed EOC between January 2014 and May 2018 were collected. The objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS) were reviewed and evaluated. The propensity score matching (PSM) method was used to determine the final case data included in this study.ResultsAccording to 1:2 propensity matching, 108 patients were finally taken into account: 36 in the apatinib group and 72 in the control group. The follow-up ended in January 2019, and the median follow-up time was 28 months. In the apatinib group, ORR was 30.56% and DCR was 66.67%, whereas in the control group, ORR was 16.67% and DCR was 44.44%. In the apatinib group, median PFS was 6.0 months (95% CI 3.69–8.31) and median OS was 15.8 months (95% CI 6.99–24.6), while in the control group, median PFS was 3.3 months (95% CI 2.44–4.16) and median OS was 9.2 months (95% CI 6.3–12.06); the difference was statistically significant (P < 0.05). Apatinib was more effective than conventional chemotherapy in reducing the risk of PFS [HR 0.40 (95% CI 0.22–0.76), P = 0.0017] and OS [HR 0.40 (95% CI 0.21–0.73), P = 0.002]. Multivariate Cox analysis showed that the course of treatment and decrease in serum CA125 levels are independent risk factors for PFS in patients, while apatinib, the length of treatment course and the location of the lesion are independent risk factors for recurrence affecting the OS of patients. The main grade 3–4 adverse events in the apatinib group were hypertension, hand-foot syndrome, and oral mucosal ulcers, and all adverse events were controllable.ConclusionApatinib was found to be both safe and effective in patients with advanced platinum-resistant relapsed EOC. More in-depth clinical research and applications should be carried out.

Oral microbiota dysbiosis accelerates the development and onset of mucositis and oral ulcers.

With the rapid development of metagenomic high-throughput sequencing technology, more and more oral mucosal diseases have been proven to be associated with oral microbiota shifts or dysbiosis. The commensal oral microbiota can greatly influence the colonization and resistance of pathogenic microorganisms and induce primary immunity. Once dysbiosis occurs, it can lead to damage to oral mucosal epithelial defense, thus accelerating the pathological process. As common oral mucosal diseases, oral mucositis and ulcers seriously affect patients' prognosis and quality of life. However, from the microbiota perspective, the etiologies, specific alterations of oral flora, pathogenic changes, and therapy for microbiota are still lacking in a comprehensive overview. This review makes a retrospective summary of the above problems, dialectically based on oral microecology, to provide a new perspective on oral mucosal lesions management and aims at improving patients' quality of life.

Amoxicillin-docosahexaenoic acid encapsulated chitosan-alginate nanoparticles as a delivery system with enhanced biocidal activities against Helicobacter pylori and improved ulcer healing.

Encapsulation of amoxicillin (AMX) for drug delivery against Helicobacter pylori infection and aspirin-induced ulcers in rat's stomachs was performed using docosahexaenoic acid (DHA)-loaded chitosan/alginate (CA) nanoparticles (NPs) developed by ionotropic gelation method. The physicochemical analyses of the composite NPs were performed by scanning electron microscopy, Fourier transform infrared spectroscopy, zeta potential, X-ray diffraction, and atomic force microscopy. The encapsulation efficiency of AMX was increased to 76% by incorporating DHA, which resulted in a reduction in the particle size. The formed CA-DHA-AMX NPs effectively adhered to the bacteria and rat gastric mucosa. Their antibacterial properties were more potent than those of the single AMX and CA-DHA NPs as demonstrated by the in vivo assay. The composite NPs attained higher mucoadhesive potential during food intake than during fasting (p = 0.029). At 10 and 20 mg/kg AMX, the CA-AMX-DHA showed more potent activities against H. pylori than the CA-AMX, CA-DHA, and single AMX. The in vivo study showed that the effective dose of AMX was lower when DHA was included, indicating better drug delivery and stability of the encapsulated AMX. Both mucosal thickening and ulcer index were significantly higher in the groups receiving CA-DHA-AMX than in the groups receiving CA-AMX and single AMX. The presence of DHA declines the pro-inflammatory cytokines including IL-1β, IL-6, and IL-17A. The synergistic effects of AMX and the CA-DHA formulation increased the biocidal activities against H. pylori infection and improved ulcer healing properties.

Potential Role of Non-Steroidal Anti-Inflammatory Drugs in Colorectal Cancer Chemoprevention for Inflammatory Bowel Disease: An Umbrella Review.

Inflammatory Bowel Disease (IBD) is a category of autoimmune diseases that targets the destruction of the gastrointestinal system and includes both Crohn's Disease and Ulcerative Colitis (UC). Patients with IBD are at a higher risk of developing colorectal cancer (CRC) throughout their lives due to chronically increased inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs) are potential chemopreventative agents that can inhibit the development of CRC in persons without IBD. However, the use of NSAIDs for CRC chemoprevention in IBD patients is further complicated by NSAIDs' induction of damage to the bowel mucosal layer and ulcer formation. There has been a push in new research on chemopreventative properties of certain NSAIDs for IBD. The purpose of this umbrella review is to investigate the potential of low-dose NSAID compounds as chemopreventative agents for patients with IBD. This paper will also suggest future areas of research in the prevention of CRC for patients with IBD.

Gram-scale preparation of quercetin supramolecular nanoribbons for intestinal inflammatory diseases by oral administration

Gastrointestinal (GI) tract, which possesses the largest surface area of mucosa in the body, is easily suffered from inflammatory damages under the exposure of external stimulations. Excessive reactive oxygen species (ROS) production and continuous oxidative stress in intestines can elicit local mucosal injury, accelerate mucosal ulceration, and amplify the inflammatory response. Thereby, antioxidant therapy is a potential strategy against intestinal inflammatory diseases. Herein, we demonstrate the gram-scale preparation of quercetin supramolecular nanoribbons (SNRs) by using free quercetin molecules as the sole building block for preventing and treating intestinal inflammatory diseases. Unlike current clinical medicines, which mainly confront with poor response and severe adverse effects via bloodstream delivery, our quercetin SNRs possess an excellent antioxidant activity in the harsh environments of GI tract, a relative long retention time in GI tract, an admirable metabolism in GI tract without burdening other organs, and a specific adhesion to the inflamed intestinal epithelium via electrostatic interactions. These advantages strongly guarantee the applications of quercetin SNRs as oral medicines for intestinal inflammatory diseases. After establishing the models of intestinal inflammatory diseases caused by irradiation and drug stimulations, our quercetin SNRs exhibit the promising protective and therapeutic effects for radiation-induced acute enteritis and dextran sulfate sodium (DSS)-induced acute colitis. Because the super easy and fast preparation procedure and the nearly 100% loading capacity of quercetin SNRs, the current work provides a supramolecular nanomedicine with great clinical translation potential against intestinal inflammatory diseases.

Epstein–Barr virus positive gastric adenocarcinoma with systemic EBV reactivation in a patient with persistently active systemic lupus erythematosus

Abstract Objectives Epstein–Barr virus (EBV) has been associated with several types of cancers, most often with nasopharyngeal carcinomas and hematological malignancies. It is also suggested that EBV has significant role in the pathogenesis of different types of autoimmune diseases including systemic lupus erythematosus (SEL). The exact mechanisms behind these processes are not elucidated. Case presentation We present a case of a 52-years old female patients with moderately active SLE presenting with severe fatigue, purpuric lesions, alopecia, polyarthritis, mucosal ulcerations, and progressive thrombocytopenia over a period of 10 months. During the work-up, the patient was evaluated for several viral infections. Serology testing showed elevation of anti-EBV, anti-CMV and anti-HSV1/2 IgM antibodies with the presence of IgG antibodies against all mentioned viruses except HSV2. Corticosteroid therapy was escalated, and azathioprine was introduced. Due to the persistence of significant thrombocytopenia and monoclonal IgG sternal puncture was performed. Morphological and immunohistochemical analysis of bone marrow specimen presented infiltration with metastatic deposits of adenocarcinoma and monoclonal plasmacytosis. Esophagogastroduodenoscopy showed multiple prepyloric erosions of gastric mucosa, which were biopsied. Pathohistological analysis demonstrated infiltration of gastric mucosa with diffuse type adenocarcinoma. Further PCR testing of biopsied gastric adenocarcinoma revealed the presence of EBV DNA in carcinoma tissue. The patient was sent to the oncologist for further evaluation. Conclusions Assessment of SLE patients with persistently active disease should include the analysis of the herpesvirus infection status. Reactivations of EBV may be considered as possible trigger for lupus flares and the factor for increased risk of developing malignancies.