mAb Das-1 recognizes 3’-Sulfated Lewis A/C, which is aberrantly expressed during metaplastic and oncogenic transformation of several gastrointestinal Epithelia

Introduction Multiple previous studies have shown the monoclonal antibody Das-1 (formerly called 7E12H12) is specifically reactive towards metaplastic and carcinomatous lesions in multiple organs of the gastrointestinal system (e.g. Barrett’s esophagus, intestinal-type metaplasia of the stomach, gastric adenocarcinoma, high-grade pancreatic intraepithelial neoplasm, and pancreatic ductal adenocarcinoma) as well as in other organs (bladder and lung carcinomas). Beyond being a useful biomarker in tissue, mAb Das-1 has recently proven to be more accurate than current paradigms for identifying cysts harboring advanced neoplasia. Though this antibody has been used extensively for clinical, basic science, and translational applications for decades, its epitope has remained elusive. Methods In this study, we chemically deglycosylated a standard source of antigen, which resulted in near complete loss of the signal as measured by western blot analysis. The epitope recognized by mAb Das-1 was determined by affinity to a comprehensive glycan array and validated by inhibition of a direct ELISA. Results The epitope recognized by mAb Das-1 is 3’-Sulfo-Lewis A/C (3’-Sulfo-LeA/C). 3’-Sulfo-LeA/C is broadly reexpressed across numerous GI epithelia and elsewhere during metaplastic and carcinomatous transformation. Discussion 3’-Sulfo-LeA/C is a clinically important antigen that can be detected both intracellularly in tissue using immunohistochemistry and extracellularly in cyst fluid and serum by ELISA. The results open new avenues for tumorigenic risk stratification of various gastrointestinal lesions.

Causes of Melena and Effective Examination Strategies in Children

Background and Aim: Melena, or tarry black stool, is not a rare symptom encountered in pediatric clinical practice, and the bleeding source varies from the upper gastrointestinal tract to the small intestine. Endoscopy is effective in identifying bleeding, but it does not always identify the source of bleeding. Endoscopic examination in children is commonly challenging, and there are no detailed reports about the causes of melena in children. This observational study aimed to validate the cause of melena in children and to investigate more effective and less burdensome examination methods.Methods: We retrospectively reviewed the clinical records of 55 patients who underwent examination for melena.Results: In this research, 38 patients had underlying diseases such as malignancy and severe mental and physical disorders. The bleeding source was identified in 39 patients. The most common final diagnosis was duodenal ulcer (n = 22), and the other diagnoses were gastric ulcer, esophagitis, and esophageal varices. The upper gastrointestinal tract was the most common source of bleeding (n = 34). In five patients, the bleeding source was the small intestine. Vomiting, abnormal abdominal ultrasonography findings, and a hemoglobin level of ≤ 3 g/dL than the lower normal limit were significant factors indicating that the bleeding source can be found on esophagogastroduodenoscopy.Conclusions: The upper gastrointestinal tract was the most common bleeding source of melena in children. As in adults, esophagogastroduodenoscopy is the primary endoscopic method of choice. Furthermore, small bowel capsule endoscopy may be useful in identifying the bleeding source in children without upper gastrointestinal lesions.

Protein-losing enteropathy caused by disseminated Mycobacterium avium complex infection in a patient receiving antiretroviral therapy: an autopsy case report

Background Disseminated Mycobacterium avium complex infection is an important indicator of acquired immunodeficiency syndrome (AIDS) in patients with advanced human immunodeficiency virus (HIV) infection. Effective antiretroviral therapy has dramatically reduced the incidence of and mortality due to HIV infection, although drug resistance and poor medication adherence continue to increase the risk of disseminated M. avium complex infection. However, gastrointestinal lesions in cases of disseminated M. avium complex infection resulting in protein-losing enteropathy have been rarely discussed. Therefore, we present a case of protein-losing enteropathy caused by disseminated M. avium complex infection in a patient undergoing antiretroviral therapy. Case presentation A 29-year-old man was diagnosed with AIDS 4 years ago and was admitted for a 10-month history of refractory diarrhea and fever. Despite receiving antiretroviral therapy, the viral load remained elevated due to poor medication adherence. The patient was diagnosed with disseminated M. avium complex infection and started on antimycobacterial drugs 2 years before admission. However, the infection remained uncontrolled. The previous hospitalization 1 year before admission was due to hypoalbuminemia and refractory diarrhea. Upper gastrointestinal endoscopy revealed a diagnosis of protein-losing enteropathy caused by intestinal lymphangiectasia, and treatment with intravenous antimycobacterial drugs did not resolve his intestinal lymphangiectasia. The patient inevitably died of sepsis. Conclusions Clinical remission is difficult to achieve in patients with AIDS and protein-losing enteropathy caused by disseminated M. avium complex infection due to limited options of parenteral antiretroviral drugs. This report highlights the importance of identifying alternative treatments (such as an injectable formulation) for patients who do not respond to antiretroviral therapy due to protein-losing enteropathy with disseminated M. avium complex infection.

Correlation between TCM Syndromes and Type 2 Diabetic Comorbidities Based on Fully Connected Neural Network Prediction Model

Objective. To predict the major comorbidities of type 2 diabetes based on the distribution characteristics of syndromes, and to explore the relationship between TCM syndromes and comorbidities of type 2 diabetes. Methods. Based on the electronic medical record data of 3413 outpatient visits from 995 type 2 diabetes patients with comorbidities, descriptive statistical methods were used to analyze the basic characteristics of the population, the distribution characteristics of comorbidities, and TCM syndromes. A neural network model for the prediction of type 2 diabetic comorbidities based on TCM syndromes was constructed. Results. Patients with TCM syndrome of blood amassment in the lower jiao were diagnosed with renal insufficiency with 95% test sensitivity. The patients with spleen deficiency combined with ascending counterflow of stomach qi and cold-damp patterns were diagnosed with gastrointestinal lesions with 92% sensitivity. The patients with TCM syndrome group of spleen heat and exuberance of heart fire were diagnosed as type 2 diabetes complicated with hypertension with a sensitivity of 91%. In addition, the prediction accuracy of combined neuropathy, heart disease, liver disease, and lipid metabolism disorder reached 70∼90% in TCM syndrome groups. Conclusion. The fully connected neural network model study showed that syndrome characteristics are highly correlated with type 2 diabetes comorbidities. Syndrome location is commonly in the heart, spleen, stomach, lower jiao, meridians, etc., while syndrome pattern manifests in states of deficiency, heat, phlegm, and blood stasis. The different combinations of disease location and disease pattern reflect the syndrome characteristics of different comorbidities forming the characteristic syndrome group of each comorbidity. Major comorbidities could be predicted with a high degree of accuracy through TCM syndromes. Findings from this study may have further implementations to assist with the diagnosis, treatment, and prevention of diabetic comorbidities at an early stage.

Histopathological Distribution of the Gastrointestinal Tract Lesions

Introduction: Gastrointestinal (GI) diseases are common and can affect any portion of the gastrointestinal tract from the mouth to the anus. Diseases can just shows clinical conditions like stomach pain, constipation, diarrhea which can be self- limiting. But sometimes disease may be life-threatening like malignancy. Biopsy is necessary for confirmatory diagnosis and further treatment of the patient. So histopathologic examination is a must for all surgical procedures for confirmation and categorization of GI disorders. Objectives: This study was done to find out the various patterns of lesions of the gastrointestinal tract with its commonest age group and sex involvement Methodology: This was a prospective study of all the surgically resected GI tissue received in the Department of Pathology Histopathology unit in Birat Medical College and Teaching Hospital (BMCTH) from 1st February 2021 to 30 thApril 2021.The hematoxylin and eosin stain slides of the GI tissue received were studied and the lesions were diagnosed on their histomorphology. According to organ, age and sex, the lesions were categorized. The data were entered in Microsoft excel and the percentage value was calculated. Results: Out of the total 344 cases 146(42.44%) were male and 198(57.56%) were female patients. The most common age range for GI lesions was 41 to 60 years comprising of 126(36.62%) of total cases. Maximum numbers of cases 160 (46.50%) were of cholecystectomies followed by appendectomies 95(27.60%). Inflammatory and benign lesions comprised 332(96.51%), 9(2.61%) were malignant tumor and 3(0.88%) were premalignant lesions. The most common inflammatory lesions and malignant tumors were chronic cholecystitis and gastric adenocarcinoma respectively Conclusions: The study identifies that gastrointestinal lesions comprise of the most common biopsies received in the histopathology department. Early diagnosis of premalignant and malignant lesions can improve the overall survival rate of patients.

Macroscopic assessment of protective effect of cryopreserved placenta extract in ibuprofen-induced gastroenterocolonopathy

Background. Over-the-counter use of nonsteroidal anti-inflammatory drugs leads to their uncontrolled consumption among the population, which in some cases makes it impossible to prevent and timely detect adverse drug effects, and their effectiveness does not always satisfy clinicians. The purpose was to characterize the cytoprotective properties of cryopreserved placenta extract according to the condition of the mucous membrane of the proximal (esophagus and stomach) and distal (small and large intestine) parts of the gastrointestinal tract on the model of ibuprofen-induced esophagogastroenterocolonopathy. Mate­rials and methods. In vivo experimental studies were performed on 28 male rats. Subchronic ibuprofen-induced gastrointestinal lesions were reproduced by intragastric administration of ibuprofen to rats at a dose of 310 mg/kg. The condition of the gastrointestinal tract mucous membrane was assessed macroscopically on a scale. Results. The therapeutic and prophylactic efficacy of esomeprazole statistically significantly (р < 0.05) took place in the proximal parts of the gastrointestinal tract but had little effect on the prevalence of ulcerative lesions in the intestine. At the same time, unlike esomeprazole, which is known to have only gastroprotective activity, cryopreserved placenta extract had a cytoprotective effect both in the stomach and in the distal parts of the gastrointestinal tract — small and large intestine. Thus, the prevalence of ibuprofen-induced both entero- and colonopathy on the background of the study of the extract was almost twice lower than in rats that did not receive correction drugs. Conclusions. It is established that the use of cryopreserved placenta extract in the treatment-and-prophylactic mode has comparable to esomeprazole gastroprotective activity. In addition, it was found that the use of the studied cryoextract was accompanied by a decrease in the multiplicity of ulcerative defects in the small and large intestine of rats, by 4.6 and 3.8 times, respectively, compared to the control animals.

Over-Dose Lithium Toxicity as an Occlusive-like Syndrome in Rats and Gastric Pentadecapeptide BPC 157

Due to endothelial impairment, high-dose lithium may produce an occlusive-like syndrome, comparable to permanent occlusion of major vessel-induced syndromes in rats; intracranial, portal, and caval hypertension, and aortal hypotension; multi-organ dysfunction syndrome; brain, heart, lung, liver, kidney, and gastrointestinal lesions; arterial and venous thrombosis; and tissue oxidative stress. Stable gastric pentadecapeptide BPC 157 may be a means of therapy via activating loops (bypassing vessel occlusion) and counteracting major occlusion syndromes. Recently, BPC 157 counteracted the lithium sulfate regimen in rats (500 mg/kg/day, ip, for 3 days, with assessment at 210 min after each administration of lithium) and its severe syndrome (muscular weakness and prostration, reduced muscle fibers, myocardial infarction, and edema of various brain areas). Subsequently, BPC 157 also counteracted the lithium-induced occlusive-like syndrome; rapidly counteracted brain swelling and intracranial (superior sagittal sinus) hypertension, portal hypertension, and aortal hypotension, which otherwise would persist; counteracted vessel failure; abrogated congestion of the inferior caval and superior mesenteric veins; reversed azygos vein failure; and mitigated thrombosis (superior mesenteric vein and artery), congestion of the stomach, and major hemorrhagic lesions. Both regimens of BPC 157 administration also counteracted the previously described muscular weakness and prostration (as shown in microscopic and ECG recordings), myocardial congestion and infarction, in addition to edema and lesions in various brain areas; marked dilatation and central venous congestion in the liver; large areas of congestion and hemorrhage in the lung; and degeneration of proximal and distal tubules with cytoplasmic vacuolization in the kidney, attenuating oxidative stress. Thus, BPC 157 therapy overwhelmed high-dose lithium intoxication in rats.

Histopathological study of gastrointestinal endoscopic biopsies in pediatric patients

Background Non neoplastic GI lesions in pediatrics are variable and differ in types and prevalence among each pediatric age group. Helicobacter pylori is an important pathogen that can cause gastritis and peptic ulcers in adults as well as in children. Celiac disease is a gluten-dependent autoimmune disorder which affects individuals having genetic susceptibility. Eosinophilic gastrointestinal diseases are disorders that primarily affect the gastrointestinal tract with eosinophil-rich inflammation in the absence of known causes for eosinophilia. Inflammatory bowel disease (IBD) is a chronic inflammatory disorder, mainly affecting the gastrointestinal tract with extraintestinal manifestations and associated immune disorders. It seems that it is one of the most common gastrointestinal diseases affecting children in the developed countries. Aim of the work To study different types of paediatric non neoplastic gastrointestinal lesions from gastrointestinal endoscopic biopsies received at the Pathology Department in Ain Shams University hospital during a period of 2 years (2017-2018), and to correlate them with the clinicopathological presentations and endoscopic findings. Patients and Methods A cross sectional study was conducted on all pediatric gastrointestinal biopsies received at Pathology Department in Ain Shams University Hospital during the period of two years (2017- 2018). Only cases with information for all the covariates (n = 580) were selected and the results were statistically analyzed. Results Total 580 pediatric cases were enrolled according to inclusion criteria. Nonspecific gastrointestinal inflammation represented (47.1%), Helicobacter pylori associated gastrointestinal inflammation represented (43.5%), Eosinophilic gastrointestinal disease represented (3.8%), Inflammatory bowel disease (IBD) represented (3.7%), Celiac disease represented (1.9%). Conclusion This is the first study conducted in Ain Shams University Hospitals to assess the different types of pediatric non neoplastic gastrointestinal lesions received with clinicopathological and endoscopic correlation. The most common pediatric non neoplastic GI lesion is Helicobacter pylori infection. The diagnosis of pediatric non neoplastic GI disorder necessitates interdepartmental teamwork between GI pediatricians and pathologists.