Use Of Nonsteroidal Anti-inflammatory Agents Research Articles

Results of treatment of endometrial hyperplasia with the use of non-steroidal anti-inflammatory agents against the background of chronic endometritis and without accompanying inflammatory process

The paper examines the treatment results of women with non-atypical hyperplastic endometrial processes with the use of anti-inflammatory drugs for a long time. The purpose of our study was to evaluate the effectiveness of the proposed treatment regimen depending on the type of hyperplastic processes and their connection with chronic inflammatory processes in the endometrium. Material and methods. We examined 101 women, of which 29 women with hyperplastic processes without accompanying chronic endometritis were included in experimental group №1, 49 women with a combination of hyperplastic processes and chronic endometritis were included in experimental group №2, the control group included 23 women with hyperplastic processes without chronic endometritis. The control group received only hormonal therapy, the experimental group №1 received long-term anti-inflammatory nonsteroidal drugs in addition to hormonal correction, the experimental group №2 received a course of broad-spectrum antibiotics in addition to anti-inflammatory drugs. Treatment effectiveness was evaluated 6, 12 and 24 months after hysteroscopy.Results of the study. 24 months after hysteroscopy in the control group, we observed 43.5% recurrence of hyperplastic endometrial processes, while at the same time when using anti-inflammatory therapy with non-steroidal drugs (experimental group No. 1), after 24 months we observed 20.7% recurrence ( p<0.05) and in women with a combination of GE and HE (experimental group No. 2) with the use of anti-inflammatory nonsteroidal drugs and antibiotics, the relapse rate was 22.4% (p<0.05). The results of additional studies and the use of statistical methods have proven that the effectiveness of treatment is related to the applied methods and is not accidental.Conclusions. The use of non-steroidal anti-inflammatory drugs increases the effectiveness of anti-recurrence conservative treatment of women with hyperplastic processes after hysteroscopy.

Erosive footprints

Sodium sulfate/magnesium sulfate/potassium chloride is an osmotic pill laxative recently approved by the U.S. Food and Drug Administration for colonoscopy preparation in adults. During our first week of using this agent, 3 patients undergoing endoscopy and colonoscopy were found to have caustic-appearing gastric ulcers. Two patients had chronic heartburn and associated risk factors. The third case was of a patient with Lynch syndrome undergoing surveillance colonoscopy. No patients had previously known gastric pathologic conditions or use of nonsteroidal anti-inflammatory agents.

Sickle Cell Disease and Kidney

Sickle cell disease causes several kidney manifestations. They include defects in urine concentration, impaired handling of potassium and hydrogen ion, albuminuria, acute kidney injury, and chronic kidney disease to name a few. Glomerular hyperfiltration, tubular hyperfunctioning, endothelial damage from repeated sickling and vaso-occlusive episodes, and iron-induced proinflammatory changes in the glomerular mesangium and tubulointerstitium are some of the mechanisms of kidney damage. Albuminuria is one of the most and common clinical features of kidney disease and progresses with age. Kidney disease in patients with sickle cell is associated with increased mortality. Annual screening for proteinuria starting at age 10 years and limiting the use of nonsteroidal anti-inflammatory agents and the use of angiotensin-converting enzyme inhibitors may help in early detection and delaying the progression of kidney disease. Adequate hydration, angiotensin-converting enzyme inhibitors, and adequate control of sickle cell are the main stay of treatment for albuminuria. The hemoglobin goal for patients with sickle cell nephropathy is lesser (10 g/dL) than that for patients with chronic kidney disease due to other causes given that a higher hemoglobin level increases viscosity and the risk of precipitating vaso-occlusive episodes. A multidisciplinary approach is recommended for managing patients with sickle cell and kidney diseases.

Non-steroidal anti-inflammatory agent use may not be associated with mortality of coronavirus disease 19

Non-steroidal anti-inflammatory drugs (NSAIDs) have been widely used in patients with respiratory infection, but their safety in coronavirus disease 19 (Covid-19) patients has not been fully investigated. We evaluated an association between NSAID use and outcomes of Covid-19. This study was a retrospective observational cohort study based on insurance benefit claims sent to the Health Insurance Review and Assessment Service of Korea by May 15, 2020. These claims comprised all Covid-19-tested cases and history of medical service use for the past 3 years in these patients. The primary outcome was all-cause mortality, and the secondary outcome was need for ventilator care. Among 7590 patients diagnosed with Covid-19, two distinct cohorts were generated based on NSAID or acetaminophen prescription within 2 weeks before Covid-19 diagnosis. A total of 398 patients was prescribed NSAIDs, and 2365 patients were prescribed acetaminophen. After propensity score matching, 397 pairs of data set were generated, and all-cause mortality of the NSAIDs group showed no significant difference compared with the acetaminophen group (4.0% vs. 3.0%; hazard ratio [HR], 1.33; 95% confidence interval [CI], 0.63–2.88; P = 0.46). The rate of ventilator care also did not show significantly different results between the two groups (2.0% vs. 1.3%; HR, 1.60; 95% CI 0.53–5.30; P = 0.42). Use of NSAIDs was not associated with mortality or ventilator care in Covid-19 patients. NSAIDs may be safely used to relieve symptoms in patients with suspicion of Covid-19.

Breast Cancer Risk and Use of Nonsteroidal Anti-inflammatory Agents After a Benign Breast Biopsy.

Over one million women in the United States receive biopsy diagnoses of benign breast disease (BBD) each year, which confer a 1.5-4.0-fold increase in breast cancer risk. Studies in the general population suggest that nonsteroidal anti-inflammatory agents (NSAID) lower breast cancer risk; however, associations among women with BBD are unknown. We assessed whether NSAID use among women diagnosed with BBD is associated with lower breast cancer risk. Participants included 3,080 women (mean age = 50.3 ± 13.5 years) in the Mayo BBD surgical biopsy cohort diagnosed between January 1, 1992 and December 31, 2001 who completed breast cancer risk factor questionnaires that assessed NSAID use, and whose biopsies underwent detailed pathology review, masked to outcome. Women were followed from date of BBD biopsy to breast cancer diagnosis (main outcome) or censoring (death, prophylactic mastectomy, reduction mammoplasty, lobular carcinoma in situ or last contact). Median follow-up time was 16.4 ± 6.0 years. Incident breast cancer was diagnosed among 312 women over a median follow-up of 9.9 years. Regular non-aspirin NSAID use was associated with lower breast cancer risk [HR = 0.63; 95% confidence interval (CI) = 0.46-0.85; P = 0.002] with trends of lower risk (highest tertiles of use vs. nonuse) for greater number of years used [HR = 0.55; 95% CI = 0.31-0.97; P trend = 0.003), days used per month (HR = 0.51; 95% CI = 0.33-0.80; P trend = 0.001) and lifetime number of doses taken (HR = 0.53; 95% CI = 0.31-0.89; P trend = 0.003). We conclude that nonaspirin NSAID use is associated with statistically significant lower breast cancer risk after a BBD biopsy, including a dose-response effect, suggesting a potential role for NSAIDs in breast cancer prevention among patients with BBD.

Malva parviflora extract ameliorates the deleterious effects of a high\xa0fat diet on the cognitive deficit in a mouse model of Alzheimer\u2019s disease by restoring microglial function via a PPAR-\u03b3-dependent mechanism

BackgroundAlzheimer’s disease (AD) is a neuropathology strongly associated with the activation of inflammatory pathways. Accordingly, inflammation resulting from obesity exacerbates learning and memory deficits in humans and in animal models of AD. Consequently, the long-term use of non-steroidal anti-inflammatory agents diminishes the risk for developing AD, but the side effects produced by these drugs limit their prophylactic use. Thus, plants natural products have become an excellent option for modern therapeutics. Malva parviflora is a plant well known for its anti-inflammatory properties.MethodsThe present study was aimed to determine the anti-inflammatory potential of M. parviflora leaf hydroalcoholic extract (MpHE) on AD pathology in lean and obese transgenic 5XFAD mice, a model of familial AD. The inflammatory response and Amyloid β (Aβ) plaque load in lean and obese 5XFAD mice untreated or treated with MpHE was evaluated by immunolocalization (Iba-1 and GFAP) and RT-qPCR (TNF) assays and thioflavin-S staining, respectively. Spatial learning memory was assessed by the Morris Water Maze behavioral test. Microglia phagocytosis capacity was analyzed in vivo and by ex vivo and in vitro assays, and its activation by morphological changes (phalloidin staining) and expression of CD86, Mgl1, and TREM-2 by RT-qPCR. The mechanism triggered by the MpHE was characterized in microglia primary cultures and ex vivo assays by immunoblot (PPAR-γ) and RT-qPCR (CD36) and in vivo by flow cytometry, using GW9662 (PPAR-γ inhibitor) and pioglitazone (PPAR-γ agonist). The presence of bioactive compounds in the MpHE was determined by HPLC.ResultsMpHE efficiently reduced astrogliosis, the presence of insoluble Aβ peptides in the hippocampus and spatial learning impairments, of both, lean, and obese 5XFAD mice. This was accompanied by microglial cells accumulation around Aβ plaques in the cortex and the hippocampus and decreased expression of M1 inflammatory markers. Consistent with the fact that the MpHE rescued microglia phagocytic capacity via a PPAR-γ/CD36-dependent mechanism, the MpHE possess oleanolic acid and scopoletin as active phytochemicals.ConclusionsM. parviflora suppresses neuroinflammation by inhibiting microglia pro-inflammatory M1 phenotype and promoting microglia phagocytosis. Therefore, M. parviflora phytochemicals represent an alternative to prevent cognitive impairment associated with a metabolic disorder as well as an effective prophylactic candidate for AD progression.

Abstract 233: Blood Pressure and Pulse Pressure Differences in Elderly versus Young Patients

Background: Systolic blood pressure and pulse pressure tend to increase with age in the general population, with increase in cardiovascular risk. Whether this holds in treated hypertensive patients remains unknown. Methods: Encounters from a university-based cardiology clinic with broad referral base were analyzed for blood pressure (BP), pulse pressure (PP), and lipids by age in patients with hypertension as a diagnosis. Differences between groups were compared using 2-tailed student t-test. Results: 200 encounters were analyzed: 42% (84) were ≥ 60 years old (average 68 ± 8; elderly); 58% (116) were < 60 years old (average 48 ± 9; young). Systolic BP (SBP) and pulse pressure (PP) were 134 ± 20 mmHg and 55 ± 18 mmHg in elderly compared with 128 ± 18 mmHg and 42 ± 13 mmHg in young, respectively (P < 0.05). Total cholesterol and LDL were 166 ± 35 mg/dL and 92 ± 32 mg/dL in elderly compared with 171 ± 48 mg/dL and 95 ± 38 mg/dL in young, respectively (P = NS). Conclusion: Elderly patients remain at very elevated risk for atherosclerotic cardiovascular events, with mounting healthcare costs. Efforts to improve cardiac risk factors in this vulnerable group are of paramount importance. Higher SBP and PP in the elderly compared to young patients likely reflects increased arterial stiffness, resulting in a wider pulse pressures. Lack of compliance with medications is unlikely since these patients had insurance and their total cholesterol and LDL levels were adequately controlled with medications, not significantly different compared to young patients. White-coat-hypertension is another potential explanation in the elderly. A trend towards higher use of nonsteroidal anti-inflammatory agents (NSAIDs) due to more prevalent arthritis in the elderly may have contributed to the blood pressure difference. Whether prescribing non-NSAID medications would improve compliance with exercise, weight loss, and blood pressure control in elderly patients is subject of further studies.

MODERN VIEWS ON THE ETIOPATHOGENESIS, CLINICAL PATTERN AND TREATMENT OF DYSMENORRHEA

The article is devoted to the subject of topical interest to women of reproductive age. Affecting not only the health of women, but also various aspects of their life, dysmenorrhea is a medical and social problem. The use of nonsteroidal anti-inflammatory agents in this condition is an effective means of pathogenetic therapy that significantly improves the quality of life of women.

Hypertrophic Hypersecretory Protein-losing Gastropathy: A Rare Cause of Gastrointestinal Bleeding

A 56-year-old female presented after one episode of hematemesis. Symptoms were preceded by twenty-four hours of non-bloody, non-bilious emesis. She endorsed one episode of melena. There was lightheadedness, but no abdominal pain. Past medical history was significant for prior cerebrovascular accident for which she was taking full dose aspirin daily. There was no history of liver disease. She was not on anticoagulation and denied use of non-steroidal anti-inflammatory agents. Vital signs were significant for hypotension and tachycardia. Physical exam revealed a cachectic female without abdominal distension or tenderness. Laboratory analysis was significant for hemoglobin 6.4 g/dL, albumin 1.9 g/dL and total protein 3.6 g/dL. There was no protein on urinalysis. The patient was resuscitated and placed on a protein pump inhibitor (PPI) infusion. Esophagogastroduodenoscopy demonstrated giant gastric folds with friability and oozing throughout the gastric cardia, fundus, and body that persisted despite air insufflation with antral sparing [Figure 1]. Gastric pH was 5.0 (on PPI). Gastric endoscopic mucosal resection after banding of the gastric folds revealed mild inactive chronic gastritis with foveolar, parietal and chief cell hyperplasia [Figure 2]. Helicobactor pylori (H. pylori) staining was negative. Fasting serum gastrin level was 294 pg/mL (on PPI). Computed tomography demonstrated diffuse thickening of the gastric folds without evidence of malignancy [Figure 3]. She was diagnosed with hypertrophic hypersecretory protein-losing gastropathy (HHPG) and transitioned to high dose oral PPI without recurrent bleeding. HHPG is a rare clinical entity. The enlargement of gastric folds with hypoalbuminemia can be confused with malignancy or Menetrier's disease, but can be distinguished on full thickness mucosal biopsy. HHPG has foveolar, glandular and parietal cell hyperplasia1. Both diseases can present with nausea, vomiting, abdominal pain and edema. Treatment is not well established but is aimed at controlling symptoms and can include high protein diet, anti-secretory medications, eradication of H. pylori, monoclonal antibodies and in rare cases, gastrectomy1. Bleeding has not been previously described with HHPG, but appears to respond well to twice daily oral PPI.Figure: Esophagogastroduodenoscopy findings of enlarged gastric folds.Figure: Full thickness gastric biopsy demonstrating foveolar, glandular and parietal cell hyperplasia.Figure: Computed tomography demonstrating thickened gastric folds.

Management of Chronic Spontaneous Urticaria in Routine Clinical Practice Following the EAACI/GA(2)LEN/EDF/WAO Guidelines

IntroductionChronic spontaneous urticaria is a prevalent and difficult-to-treat condition that has a very negative impact on patient quality of life. ObjectiveTo describe the epidemiological and clinical characteristics of patients presenting with chronic spontaneous urticaria and the response to treatment administered according to the EAACI/GA(2)LEN/EDF/WAO consensus guideline. Material and methodDescriptive cross-sectional study of all the patients with chronic spontaneous urticaria who consulted a skin allergy unit in the dermatology department of a tertiary hospital in Spain between July 2011 and July 2015. ResultsThe study included 100 patients with chronic spontaneous urticaria; inducible urticaria was present in 45% of cases, and angioedema in 40%. On diagnosis, 53% of patients were taking nonsteroidal anti-inflammatory drugs. All patients were treated with second generation H1-antihistamines, but the standard dose was sufficient in only 18% of cases. Higher doses (up to 4 times the standard dose) achieved control of the urticaria in 74% of the patients studied. Higher doses of second generation H1-antihistamines were required to control the condition in patients with angioedema, and the presence of angioedema was associated with a lack of response to treatment with these drugs (OR, 6.1%; P<.001). One in 4 patients failed to respond to second generation H1-antihistamines and required treatment with omalizumab or ciclosporin to control their condition. ConclusionsDoses of H1-antihistamines higher than the standard dose are required in most cases to achieve control of chronic spontaneous urticaria. Angioedema is associated with failure to respond to treatment with antihistamines. In refractory cases, control of the condition can be achieved with omalizumab or ciclosporin. Patients with chronic spontaneous urticaria do not generally avoid the use of nonsteroidal anti-inflammatory agents.

Manejo de la urticaria crónica espontánea en la práctica clínica diaria siguiendo las indicaciones de la guía EAACI/GA(2)LEN/EDF/WAO

IntroductionChronic spontaneous urticaria is a prevalent and difficult-to-treat condition that has a very negative impact on patient quality of life. ObjectiveTo describe the epidemiological and clinical characteristics of patients presenting with chronic spontaneous urticaria and the response to treatment administered according to the EAACI/GA(2)LEN/EDF/WAO consensus guideline. Material and methodDescriptive cross-sectional study of all the patients with chronic spontaneous urticaria who consulted a skin allergy unit in the dermatology department of a tertiary hospital in Spain between July 2011 and July 2015. ResultsThe study included 100 patients with chronic spontaneous urticaria; inducible urticaria was present in 43% of cases, and angioedema in 40%. On diagnosis, 53% of patients were taking nonsteroidal anti-inflammatory drugs. All patients were treated with second generation H1-antihistamines, but the standard dose was sufficient in only 18% of cases. Higher doses (up to 4 times the standard dose) achieved control of the urticaria in 74% of the patients studied. Higher doses of second generation H1-antihistamines were required to control the condition in patients with angioedema, and the presence of angioedema was associated with a lack of response to treatment with these drugs (OR, 6.1%; P<.001). One in 4 patients failed to respond to second generation H1-antihistamines and required treatment with omalizumab or ciclosporin to control their condition. ConclusionsDoses of H1-antihistamines higher than the standard dose are required in most cases to achieve control of chronic spontaneous urticaria. Angioedema is associated with failure to respond to treatment with antihistamines. In refractory cases, control of the condition can be achieved with omalizumab or ciclosporin. Patients with chronic spontaneous urticaria do not generally avoid the use of nonsteroidal anti-inflammatory agents.

Potential drug-drug interactions among prescriptionsfor elderly patients in primary health care.

Elderly patients are at high risk from drug-drug interactions (DDIs). This study evaluates the potential DDIs in Turkish elderly patients at a primary health care outpatient clinic. Online database systems were used to examine DDIs on the prescriptions of patients (n = 1206). The clinical severity of DDIs was classified by the Lexi-Interact Online database. Of the 5059 prescriptions, 33% were found to have DDIs. We detected 29 (0.9%) A, 380 (11.8%) B, 2494 (77.7%) C, 289 (9%) D, and 18 (0.6%) X risk rating category DDIs among the prescriptions. Prescriptions of female patients and patients aged between 65 and 72 years showed significantly higher number of DDIs. The frequency of DDIs increased both with the number of drugs and combined preparations per prescription. Acetylsalicylic acid and salbutamol were the most frequently prescribed drugs contributing to clinically important DDIs. Additionally, acetylsalicylic acid and escitalopram, which interact with each other, were found on the list of Beers criteria. The most predicted clinical outcomes of DDIs were increase in therapeutic efficacy and adverse/toxic reactions. Conclusions: Prediction of DDIs in elderly patients will provide better prescribing and drug safety. Use of nonsteroidal anti-inflammatory agents, selective serotonin reuptake inhibitors, and beta-2 adrenergic receptor agonists should be closely monitored.

Emphysematous gastritis: a case report

&lt;p&gt;Emphysematous gastritis (EG) is a rare disease entity related to infection of the gastric wall. It is caused by gas-forming pathogens including &lt;em&gt;Enterobacter&lt;/em&gt; species, &lt;em&gt;Clostridium perfringens&lt;/em&gt; and others. EG patients clinically present with symptoms similar to acute abdomen and can have a mortality that can reach up to 80%. Alcoholism was identified as a risk factor for such a disease. Different diseases like diabetes mellitus, ulcerative colitis and use of nonsteroidal anti-inflammatory agents were found to be associated with EG. To date, no clear guidelines regarding EG management, however, early detection and management is crucial to prevent related deaths. In the acute setting, the role of surgery is limited. Surgical interventions might be needed if obstruction of gastric outlet or perforation ensues. Fifty six years old male, heavy smoker, alcoholic with a history of ischemic heart disease, presented to Emergency Department with a complaint of severe epigastric abdominal pain for two days. The patient was vitally stable, conscious, oriented, however, looks in severe pain. His lab investigations were within normal ranges. Computed tomography (CT) of the abdomen was consistent with emphysematous gastritis. To our knowledge, this is the first case of emphysematous gastritis reported in Saudi Arabia using only radiological modality.&lt;/p&gt;

Risk factors and seasonal trends of duodenal ulcer perforation

Background: Strong association has been observed between the use of non-steroidal anti-inflammatory agents (NSAIDs) and perforation of duodenal ulcers. The use of these drugs appears to be the major precipitating factor in currently treated patients. A second risk factor for perforation is immune-suppression, particularly among transplant patients treated with steroids. Other factors include increasing patient age, chronic obstructive lung disease, major burns, and multiple organ system failure. Methods: The study was conducted in the Department of surgery, Basaveshwara teaching and general hospital, Gulbarga, Karnataka, India during the period of November 2011 - September 2013. The diagnosis of duodenal ulcer perforation was that established by the admitting surgeon, based on clinical features and supposed by radiological evidence and confined at operation. Results: It was found that 25% of patients were both smokers and alcoholics. In the present study 26.67% of patients had history of NSAID intake. Conclusions: Duodenal perforation cases were high during winter season.

Abstract 20032: Outpatient Exposure to Potentially Harmful Drugs in Patients With Heart Failure

Background: Several drugs have the potential to cause or decompensate heart failure (HF). Objective: To evaluate the frequency of potentially harmful drug exposure after hospital discharge in patients with heart failure. Methods: This was a retrospective analysis of Blue Cross Blue Shield of Texas (BCBSTX) claims data (2008-2013) which contains information for medical and pharmacy services. We included patients with at least one admission with a primary or secondary diagnosis for heart failure as defined by ICD-9 codes. We then analyzed all pharmaceutical claims for those patients as of day of discharge. Exposure to potentially harmful drugs (PHD) was defined as the use of non-steroidal anti-inflammatory agents (NSAIDS), Thiazolidinediones (TZD), Alpha-blockers (AB), Antiarrhythmic (AA) and non-dihydropyridine calcium channel blockers (non DPCCB) as recorded in pharmaceutical claims using AHFS Pharmacologic-Therapeutic Classification. Results: A total of 35317 discharges with a primary or secondary diagnosis of heart failure were identified, of which we analyzed a subset of 13,926 discharges from a total of 9,784 patients who had pharmacy coverage through BCBSTX. We found that of 5,730 (69%) had a prescription for at least one PHD after discharged. NSAIDS were the most common category 77% (4430) followed by AA 781(13.6%), non DPCCB 322 (5.6%), TZD 103 (1.8%) and AB 94 (1.6%). Most cases were recorded as new prescription claims with a relatively short interval between discharge and prescription. (Table 1) Conclusion: In patients discharged from the hospital with a primary or secondary diagnosis of heart failure, exposure to potentially harmful drugs is not uncommon, especially NSAIDS. Further research to define the consequences of this exposure is needed.

Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 6: Hypertension: A Scientific Statement from the American Heart Association and the American College of Cardiology.

An elevation of blood pressure (BP) in the systemic circulation (hypertension) is the most common cardiovascular condition in the general population and considered to be the most ubiquitous cardiovascular risk factor in competitive athletes. Competitive athletes include those athletes involved in organized sports that typically occur in schools, communities, and professional leagues, including but not limited to intramural and league sports in which medical supervision is typically required. Although most competitive athletes are between the ages of 20 and 40 years, many younger people now participate in competitive athletics. The 2013 update from the American Heart Association using the National Health and Nutrition Examination (NHANES) data from 2007 to 2010 estimates that 9.1% of men aged 20 to 34 years and 6.7% of women of that age are hypertensive, based on having an elevated BP measurement or answering “yes” to the question, “Are you taking antihypertensive medication or were you told that you had hypertension?”1 The prevalence in children and adolescents is estimated to be ≈3.5%, with higher percentages in older and obese children.2 The diagnosis of hypertension is based on the subject having an elevated BP at or above certain levels measured by routine sphygmomanometry under appropriate conditions on at least 2 separate occasions separated by at least 1 week.3 However, BP measurements in the competitive athlete are typically obtained by different healthcare providers, which makes it particularly necessary that the testing conditions be standardized before the diagnosis of hypertension is made. People >18 years of age with a BP >140 mm Hg systolic and/or >90 mm Hg diastolic are considered to have hypertension.3 In children and adolescents, hypertension is defined as average systolic or diastolic BP levels greater than the 95th percentile for sex, age, and height; however, earlier physical maturation of the competitive athlete leaves …

Risk Factors Associated with Rebleeding in Patients with High Risk Peptic Ulcer Bleeding: Focusing on the Role of Second Look Endoscopy.

Re-bleeding after initial hemostasis in peptic ulcer bleeding can be life threatening. Identification of factors associated with re-bleeding is important. The aims of this study were to determine incidence of rebleeding in patients with high risk peptic ulcer bleeding and to evaluate factors associated with rebleeding. Among patients diagnosed as upper gastrointestinal hemorrhage at seven hospitals in Daegu-Gyeongbuk, and one hospital in Gyeongnam, South Korea, from Feb 2011 to Dec 2013, 699 patients diagnosed as high risk peptic ulcer bleeding with Forrest classification above llb were included. The data were obtained in a prospective manner. Among 699 patients, re-bleeding occurred in 64 (9.2 %) patients. Second look endoscopy was significantly more performed in the non-rebleeding group than the rebleeding group (81.8 vs 62.5 %, p < 0.001). In multivariate analysis, use of non-steroidal anti-inflammatory agents, larger transfusion volume (≥5 units), and non-performance of second look endoscopy were found as risk factors for rebleeding in high risk peptic ulcer bleeding. In our study, rebleeding was observed in 9.2 % of patients with high risk peptic ulcer bleeding. Performance of second look endoscopy seems to lower the risk of rebleeding in high risk peptic ulcer bleeding patients and caution should be paid to patients receiving high volume transfusion and on medication with NSAIDs.

Risk factors of diagnostic delay of Crohn's disease and their impact on prognosis

With the rise of the incidence of Crohn's disease, clinicians began to recognize and pay attention to this disease. There is no effective method to cure the Crohn's disease currently, and the complications of the Crohn's disease are numerous and complex. Therefore, early diagnosis and treatment are very important. Due to many factors, the problem of diagnostic delay is widespread. Female patients diagnosed younger than 40 years old, the presence of ileal disease, use of non-steroidal anti-inflammatory agents, smoking history, parental symptoms are risk factors of diagnostic delay of Crohn's disease. Delayed diagnosis might increase the risk of complications, especially intestinal stenosis and operation-related complications. Crohn's disease needs to be early diagnosed and treated to improve the prognosis of patients. Key words: Crohn's disease; Diagnostic delay; Risk factors; Complications

Association of microparticles and neutrophil activation with decompression sickness.

Decompression sickness (DCS) is a systemic disorder, assumed due to gas bubbles, but additional factors are likely to play a role. Circulating microparticles (MPs)--vesicular structures with diameters of 0.1-1.0 μm--have been implicated, but data in human divers have been lacking. We hypothesized that the number of blood-borne, Annexin V-positive MPs and neutrophil activation, assessed as surface MPO staining, would differ between self-contained underwater breathing-apparatus divers suffering from DCS vs. asymptomatic divers. Blood was analyzed from 280 divers who had been exposed to maximum depths from 7 to 105 meters; 185 were control/asymptomatic divers, and 90 were diagnosed with DCS. Elevations of MPs and neutrophil activation occurred in all divers but normalized within 24 h in those who were asymptomatic. MPs, bearing the following proteins: CD66b, CD41, CD31, CD142, CD235, and von Willebrand factor, were between 2.4- and 11.7-fold higher in blood from divers with DCS vs. asymptomatic divers, matched for time of sample acquisition, maximum diving depth, and breathing gas. Multiple logistic regression analysis documented significant associations (P < 0.001) between DCS and MPs and for neutrophil MPO staining. Effect estimates were not altered by gender, body mass index, use of nonsteroidal anti-inflammatory agents, or emergency oxygen treatment and were modestly influenced by divers' age, choice of breathing gas during diving, maximum diving depth, and whether repetitive diving had been performed. There were no significant associations between DCS and number of MPs without surface proteins listed above. We conclude that MP production and neutrophil activation exhibit strong associations with DCS.

Application of Pain Quantitative Analysis Device for Assessment of Postoperative Pain after Arthroscopic Rotator Cuff Repair.

Purpose : The PainVision™ system was recently developed for quantitative pain assessment. Here, we used this system to evaluate the effect of plexus brachialis block on postoperative pain after arthroscopic rotator cuff repair.Methods : Fifty-five patients who underwent arthroscopic rotator cuff repair were included in this study. First 26 cases received no plexus brachialis block (control group), and the next 29 cases received the plexus brachialis block before surgery (block group). Patients completed the visual analog scale at 4, 8, 16, and 24 hours after surgery, and the intensity of postoperative pain was assessed with PainVision™ at 16 hours. The postoperative use of non-steroidal anti-inflammatory agents was also recorded.Results : The pain intensity at 16 hours after surgery assessed by PainVision™ was significantly lower in the block group than in the control group (block, 252.0 ± 47.8, control, 489.0 ± 89.1, P < 0.05). However, there were no differences in the VAS values at 16 hours between the 2 groups (block, 4.3 ± 0.6, control, 5.7 ± 0.4, P = N.S.). The pain intensity and VAS at 16 hours after surgery were highly correlated (r = 0.59, P = 0.006 in the block group and r = 0.62, P = 0.003 in the control group). The effect size of the assessment by PainVision™ was bigger than that of VAS (r=0.31 in VAS and 0.51 in Pain vision).Conclusion : The PainVision™ system could be useful to evaluate postoperative pain because it enables the quantification and comparison of pain intensity independent of individual pain thresholds.