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The objective of this study is to evaluate the beneficial effect of karanjin for the treatment of experimental colitis. Colitis was induced in the Balb/c mice by rectal administration of 2% solution of 2,4,6-trinitrobenzenesulfonic acid (TNBS) in 50% methanol. Karanjin (>98% pure) was administered in two different concentrations 100 and 200 mg/kg and sulfasalazine (100 mg/kg) as reference for 7 consecutive days to colitic mice. On the 8 day, mice were euthanized and degree of inflammation was assessed by macroscopic, microscopic, histology and biochemical estimation of myeloperoxidase (MPO), nitric oxide (NO), malondialdehyde (MDA), catalase (CAT), superoxide dismutase (SOD), and reduced glutathione (GSH) level were measured. Karanjin significantly and dose dependently ameliorate the macroscopic damage, histological changes such as cellular infiltration, tissue necrosis, mucosal and submucosal damage as compared to the TNBS control group. Karanjin reduces the activity of MPO, depressed MDA, and NO level and helps in restoring the level of CAT, SOD, and GSH to normal when compared to the TNBS colitis group. Result of the present study indicates that karanjin has the potential to cure colitis induced by intracolonic administration of TNBS.

Robotic single-site hysterectomy (RSSH) has emerged as a novel surgical approach for the treatment of endometrial cancer and atypical endometrial hyperplasia (AEH). Current research regarding the benefits of RSSH compared to robotic multiport hysterectomy (RMPH) for these indications has been inconclusive. Our team sought to compare surgical outcomes between these two approaches of robotic hysterectomy via systematic review and meta-analysis to ensure optimal surgical practices. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Checklist guided our review. MEDLINE, Clinicaltrials.gov, and Cochrane Library were searched, yielding 59 results. Articles were filtered by title and abstract and then reviewed in full for inclusion and exclusion criteria. Inclusion criteria required that (1) studies compared outcomes for RSSH and RMPH, (2) hysterectomy was indicated for endometrial cancer or hyperplasia with atypia, and (3) studies were available in English. Excluded studies (1) compared single-site and multiport laparoscopic approaches, (2) compared robotic approaches to laparoscopic or abdominal (open) techniques, and (3) employed hysterectomy for benign conditions. Publication bias was assessed using the Egger Regression Correlation analysis. Four studies complied with the selection criteria, comprising 138 patients in the RSSH group and 259 in the RMPH group. Similar outcomes were noted across all measures, including conversion rate (relative risk [RR] = 1.84 and confidence interval [CI] = 0.99-3.43), blood loss (Cohen's = 1.05 and = 18.62), operating time (Cohen's = 0.29 and = 4.38), and length of hospital stay (Cohen's = 1.06 and = 3.86). Publication bias was deemed minimal as indicated by Egger regression values of less than 0.05. These findings suggest that either a surgical approach or AEH with the proper standard of care can provide patients with endometrial cancer.

The aim was to investigate the nephroprotective effect of combination of aliskiren (ASK), a direct renin inhibitor and pentoxifylline (PTX), inhibitor of tumor necrotic factor-alpha (TNF-alpha), in rat remnant kidney model of chronic kidney disease (CKD). Nephrectomized (NPX) rats were treated with ASK (10 mg/kg, p.o.), PTX (100 mg/kg, p.o.), and combination of PTX + ASK once daily for 28 days. We have performed analysis of various renal injury parameters after 4 weeks of treatment. Treatment with PTX, ASK and combination showed significant improvement in urea, creatinine and total protein in plasma when compared with vehicle treated group in NPX rats. ASK and combination of PTX + ASK elicited significant reduction in blood pressure but PTX alone did not produce blood pressure reduction. ASK treatment showed significant elevation in TNF-alpha, whereas PTX and ASK + PTX showed significant reduction in TNF-alpha in plasma. Histopathologically, the extent of the kidney injury was similar in NPX + vehicle and NPX + ASK-treated rats. PTX and ASK + PTX-treated group showed lesser extent of kidney injury. There was good correlation of mRNA expression levels of kidney injury molecule-1 and bradykinin B1 receptor data with histopathological findings in kidney samples and elevated TNF-alpha levels in plasma. We conclude that combination of PTX + ASK may be better therapeutic intervention for nephroprotection in CKD patients.

Abstract Objective: To test the hypothesis that minor chronic insults such as smoking, chronic bronchitis, and two persistent bacterial infections may be associated with increases in C reactive protein concentration within the normal range and that variations in the C reactive protein concentration in turn may be associated with levels of cardiovascular risk factors and chronic coronary heart disease. Design: Population based cross sectional study. Setting: General practices in Merton, Sutton, and Wandsworth. Subjects: A random sample of 388 men aged 50-69 years from general practice registers. 612 men were invited to attend and 413 attended, of whom 25 non-white men were excluded. The first 303 of the remaining 388 men had full risk factor profiles determined. Interventions: Measurements of serum C reactive protein concentrations by in house enzyme linked immunosorbent assay (ELISA); other determinations by standard methods. Coronary heart disease was sought by the Rose angina questionnaire and Minnesota coded electrocardiograms. Main outcome measures: Serum C reactive protein concentrations, cardiovascular risk factor levels, and the presence of coronary heart disease. Results: Increasing age, smoking, symptoms of chronic bronchitis, Helicobacter pylori and Chlamydia pneumoniae infections, and body mass index were all associated with raised concentrations of C reactive protein. C Reactive protein concentration was associated with raised serum fibrinogen, sialic acid, total cholesterol, triglyceride, glucose, and apolipoprotein B values. C Reactive protein concentration was negatively associated with high density lipoprotein cholesterol concentration. There was a weaker positive relation with low density lipoprotein cholesterol concentration and no relation with apolipoprotein A I value. C Reactive protein concentration was also strongly associated with coronary heart disease. Conclusion: The body's response to inflammation may play an important part in influencing the progression of atherosclerosis. The association of C reactive protein concentration with coronary heart disease needs testing in prospective studies. Key messages Factors that determine levels of inflammatory mediators in the normal general population have not been explored, nor has their relation to cardio- vascular risk factors Among 50-69 year old men many environmental and lifestyle risk factors for cardiovascular disease are associated with raised serum concentrations of C reactive protein Circulating concentrations of lipids, glucose, and clotting factors are also associated with serum C reactive protein concentrations The body's response to inflammation may influence the development of atherosclerosis

To study the effects of two different classes of drugs in sephadex-induced lung inflammation using rats and explore the potential mechanism (s). Effects of dexamethasone (0.3 mg/kg, p.o.) and rosiglitazone (10 mg/kg, p.o.) treatments were evaluated up to 3 days in sephadex challenged rats. 72 h postsephadex administration, broncho-alveolar lavage fluid (BALF) was collected for cell count and cytokine estimation. Lung tissues were harvested for gene expression and histopathology. Dexamethasone treatment resulted in significant inhibition of lymphocytes, monocytes, eosinophils and neutrophils, whereas rosiglitazone inhibited eosinophils and neutrophils only. Further, dexamethasone reduced the elevated levels of prostaglandin E2 (PGE2) and leukotriene B4 (LTB4) after sephadex challenge while rosiglitazone significantly reduced the PGE2 levels without altering LTB4 in the BALF. Hydroxyproline content in rat lung homogenate was significantly reduced with dexamethasone treatment but not with rosiglitazone. Both the drugs were found to suppress matrix metallo proteinase 9, whereas only dexamethasone showed inhibition of tumor necrosis factor-alpha and up-regulation of tissue inhibitor of metalloproteinase 3 (TIMP-3) expression and preserved the broncho-alveolar microstructure. Our results revealed that up-regulation of TIMP-3 corroborated well with dexamethasone mediated inhibition of collagen degradation and restoration of alveolar micro-architecture.

IntroductionAcute upper gastrointestinal bleeding (AUGIB) remains a critical medical emergency with high mortality rates. This study investigated the impact of over-the-scope clips (OTSC) on rebleeding and mortality rates in AUGIB compared to conventional endoscopic treatment.MethodsA prospective database was used to identify patients treated with OTSC for AUGIB at a tertiary care university hospital. A propensity score-matched cohort was created from patients treated with conventional endoscopic therapies. Patient demographics, lesion characteristics, and Forrest classification were recorded. Outcomes were compared between groups, focusing on 7- and 30-day rebleeding rates and 30-day mortality. A post-hoc analysis examined the relationship between OTSC deployment position and rebleeding risk.ResultsThe study included 1,023 AUGIB episodes over 5 years, with 112 high-risk lesions treated with OTSC and 109 matched controls treated with conventional therapy. Lesions were predominantly located in the duodenum (71%), followed by the stomach (21%) and esophagus (8%). Peptic ulcers were the most common cause (81.5%). Forrest classifications were distributed as 1a (18%), 1b (27%), 2a (32%), and 2b (23%).OTSC treatment significantly reduced 7-day (3.1% vs 19.7%, p<0.01) and 30-day (6.8% vs 25.5%, p<0.01) rebleeding rates compared to conventional therapy. Haemorrhage-related mortality was also significantly lower in the OTSC group (1.3% vs 4.9%, p=0.02). Post-hoc analysis revealed that visible clip teeth after deployment were associated with increased rebleeding risk (OR 6.8, p<0.01).ConclusionEndoscopic treatment using over-the-scope clips significantly reduces rebleeding and mortality rates in acute upper GI bleeding, demonstrating superior efficacy compared to conventional endoscopic therapies. Large-scale multicentre studies are needed to further confirm the impact of using OTSC on outcomes in AUGIB.

IntroductionThere has been an increase in the mandated data entries required for an endoscopy report in the UK. There is also a significant push to increase efficiency in endoscopy units, however, there has been very little focus on modernising endoscopy reporting software to facilitate this. HICCS endoscopy in partnership with NHS endoscopy users have developed a modernised interface to allow more intuitive reporting in a more streamlined manner. The aims of this study were to see if the new HICCS V9 user interface allowed faster data entry to allow quicker endoscopy reporting.MethodsTwo endoscopist currently using HICCS V8 were given a 1-day familiarisation with the new HICCS V9 reporting software at the University Hospital Southampton. Over a 2-week period, 20 of their endoscopy sessions (4 hours of activity, 10 points) were selected to have procedures reported using both the previous HICCS V8 and the new HICCS V9. The endoscopist alternated in a sequential manner between which reporting system to start with to avoid familiarisation being a factor for faster entry for the second report. The time it took from the start of the data entry to generating the report was noted as the reporting times.ResultsA total of 107 procedures were undertaken in the study period. 72 colonoscopies and 45 gastroscopies with 41% of procedures having a therapeutic intervention. There was a 25% reduction in reporting time for colonoscopy in HICCS V9 compared HICCS V8 (2min 37s v 3min 30s, p=<0.01) and a 19% reduction in gastroscopy (1min45 secs v 2min10 sec). A total of 83 minutes were saved during the study period with HICCS V9.ConclusionThe new HICC V9 software significantly cut downs endoscopy reporting times by up to 25%. The time saved could be used to deliver more direct clinical care or even facilitate increase in endoscopy capacity. More collaborative work needs to be undertaken between software providers and end users to allow even more efficient reporting.

Ectopic pregnancies (EPs) involve the implantation of a gestational sac outside of the uterine cavity and are commonly described based on the implantation location, with most occurring within the fallopian tubes. There are a wide variety of known risk factors for EP; however, a less commonly acknowledged hypothesis includes intraperitoneal transmigration of sperm, ovum, and/or embryos. Comparatively, there are few published case reports illustrating this phenomenon, and there have been no known published case reports supporting this hypothesis involving patients without congenital uterine abnormalities. This case describes a 26-year-old G6P1132 female with a history of salpingostomy and unilateral partial salpingectomy secondary to prior EP presenting with a noncommunicating fimbrial EP likely resulting from intraperitoneal transmigration of sperm. This patient failed medical management of fimbrial EP and underwent successful surgical intervention with diagnostic laparoscopy and fimbriectomy. This case report ultimately contributes to ongoing research supporting the transmigration of gametes or embryos as a cause of EP, particularly in situations where a noncommunicating fallopian tube may still allow implantation and fertilization. Given the rising recurrence rates with each subsequent EP, implementing complete salpingectomies instead of partial salpingectomies may help lower the risk of future occurrences, even in patients who wish to preserve future fertility.

These guidelines provide a practical and evidence-based resource for the management of patients with Barrett's oesophagus and related early neoplasia. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was followed to provide a methodological strategy for the guideline development. A systematic review of the literature was performed for English language articles published up until December 2012 in order to address controversial issues in Barrett's oesophagus including definition, screening and diagnosis, surveillance, pathological grading for dysplasia, management of dysplasia, and early cancer including training requirements. The rigour and quality of the studies was evaluated using the SIGN checklist system. Recommendations on each topic were scored by each author using a five-tier system (A+, strong agreement, to D+, strongly disagree). Statements that failed to reach substantial agreement among authors, defined as >80% agreement (A or A+), were revisited and modified until substantial agreement (>80%) was reached. In formulating these guidelines, we took into consideration benefits and risks for the population and national health system, as well as patient perspectives. For the first time, we have suggested stratification of patients according to their estimated cancer risk based on clinical and histopathological criteria. In order to improve communication between clinicians, we recommend the use of minimum datasets for reporting endoscopic and pathological findings. We advocate endoscopic therapy for high-grade dysplasia and early cancer, which should be performed in high-volume centres. We hope that these guidelines will standardise and improve management for patients with Barrett's oesophagus and related neoplasia.

IntroductionThere have been no significant improvements in the outcomes of upper gastrointestinal (GI) bleeding over the last few years. The aim of this study was to determine whether the use of the OVESCOTMover the scope clip (OTSC) was associated with a lower rebleed-rate and mortality compared to conventional endoscopic therapy.MethodsConsecutive episodes of upper GI haemorrhage treated with the OTSC were identified from a prospective database in a UK tertiary centre over a 3-year period. Treatment with OTSC was delivered for patients with high-risk features or failed conventional endoscopic therapy.Over the same time period, all patients with upper GI haemorrhage treated with conventional endoscopic therapy were retrospectively identified, and a propensity score-matched cohort was assembled. Patient demographics, 7-day re-bleed rate, 30-day re-bleed rate and 30-day mortality rates were compared. T-test and Pearson’s Chi-square statistic were used to statistically describe the results.Results617 episodes of upper GI haemorrhage were identified requiring endoscopic intervention over three years. 71 high-risk lesions were treated in the OTSC group, vs 89 high-risk lesions in the matched control group (conventional endoscopic therapy).The sites of lesions treated with the OTSC included oesophagus (10%), stomach (22%) and duodenum (68%). The lesions were described as Forrest 1a-18%, 1b-33%, 2a-32%, 2b-17%. Pathology included ulcers (78.9%), Mallory-Weiss tears (9.6%) Dieulafoy (7.0%) post-angiographic coil ulcer (1.4%) post- EMR (1.4%) anastomotic bleed (1.4%).Compared to the control group, the OTSC group had lower 7-day re-bleeding rate (19.3% vs 2.8%, p< 0.01) and a lower 30-day re-bleeding rate (25.0% vs 7.0%, p< 0.01). There was a trend toward reduction in all-cause mortality in the OTSC group (14.8% vs 8.5%, p=0.20) but a significantly lower haemorrhage related mortality in the OTSC group (4.5% vs 1.4%, p=0.02).ConclusionsThis is one of the largest series of patients treated with OTSC for upper GI haemorrhage, demonstrating a significant reduction in both early and late rebleeding in addition to haemorrhage related mortality and thus needs to part of the treatment armamentarium.