Background: Unsedated esophagogastroduodenoscopy (EGD) is simpler and safer than sedated EGD; however, approximately 40% of patients cannot tolerate it. Early identification of patients likely to poorly tolerate unsedated EGD is valuable for improving compliance. The modified Mallampati classification (MMC) has been used to evaluate difficult tracheal intubation and laryngoscope insertion. We tried to assess the efficacy of MMC to predict the tolerance of EGD in unsedated patients. Methods: Two hundred patients who underwent an unsedated diagnostic EGD were recruited. They were stratified according to the view of the oropharynx as either MMC class I + II (good view) or class III + IV (poor view). EGD tolerance was assessed in three ways: gag reflex by endoscopist assessment, patient satisfaction by interview, and the degree of change in vital signs. Results: MMC was significantly correlated to gag reflex (P < 0.001), patient satisfaction (P = 0.028), and a change of vital signs (P = 0.024). Patients in the poor view group had a 3.87-fold increased risk of gag reflex (P < 0.001), a 1.78-fold increased risk of unsatisfaction (P = 0.067), and a 1.96-fold increased risk of a change in vital signs (P = 0.025) compared to those in the good view group. Conclusions: MMC appears to be a clinically useful predictor of EGD tolerance. Patients with poor view of oropharynx by MMC criteria may be candidates for sedated or transnasal EGD.

Background: Aspiration pneumonia is the most common cause of death in patients with percutaneous endoscopic gastrostomy (PEG) and nasogastric tube (NGT) feeding. This study aimed to compare PEG versus NGT feeding regarding the risk of pneumonia, according to the severity of pooling secretions in the pharyngolaryngeal region. Methods: Patients were stratified by endoscopic observation of the pooling secretions in the pharyngolaryngeal region: control group (<25% pooling secretions filling the pyriform sinus), pharyngeal group (25–100% pooling secretions filling the pyriform sinus), and laryngeal group (pooling secretions entering the laryngeal vestibule). Demographic data, swallowing level scale score, and pneumonia requiring hospital admission were recorded. Results: Patients with NGT (n = 97) had a significantly higher incidence of pneumonia (episodes/person-years) than those patients with PEG (n = 130) in the pharyngeal group (3.6 ± 1.0 vs. 2.3 ± 2.1, P < 0.001) and the laryngeal group (3.8 ± 0.5 vs. 2.3 ± 2.2 vs, P < 0.001). The risk of pneumonia was significantly higher in patients with NGT than in patients with PEG (adjusted hazard ratio = 2.85, 95% CI: 1.46–4.98, P < 0.001). Cumulative proportion of pneumonia was significantly higher in patients with NGT than with PEG for patients when combining the two groups (pharyngeal + laryngeal groups) (P = 0.035). Conclusion: PEG is a better choice than NGT feeding due to the decrease in risk of pneumonia requiring hospital admission, particularly in patients with abnormal amounts of pooling secretions accumulation in the pyriform sinus or leak into the laryngeal vestibule.

Gilbert's syndrome is suspected in patients with unconjugated hyperbilirubinemia caused by decreased activity of the UDP-glucuronosyltransferase 1A1 (UGT1A1) gene in the absence of abnormal liver function and hemolysis. The major genetic variants underlying Gilbert's syndrome are TATA-box repeats of the promoter region and exon 1 G211A of the coding region, particularly in Asians. The efficacy of DNA melting curve analysis, however, has not been established for the G211A mutation. For rapid and accurate molecular diagnosis of Gilbert's syndrome, DNA melting curve analysis was evaluated for its genotyping capability not only for TATA-box repeats of the UGT1A1 promoter, but also for G211A of UGT1A1 exon 1. TA repeats within the TATA-box sequence and the exon 1 G211A mutation of the UGT1A1 gene were analyzed by DNA melting curve analysis. To evaluate the assay reliability, direct sequencing or polyacrylamide gel electrophoresis was used as a comparative method. All homozygous and heterozygous polymorphisms of A(TA)7TAA within the TATA-box allele and of exon 1 G211A mutants of the UGT1A1 gene were successfully identified with DNA melting curve analysis. DNA melting curve analysis is, therefore, an effective molecular method for the rapid diagnosis of Gilbert's syndrome, as it detects not only TATA-box polymorphisms but also the exon 1 G211A mutation located within the UGT1A1 gene.

Background STAT3 is a transcriptional factor involved in tumorigenesis and the initiation of cancer stemness property. However, the STAT3‐downstream regulatory gene expressions in the formation of colorectal cancer‐derived tumorsphere is obscure. Methods In this study, RNAseq was used to uncover the potential genes involved in the formation of colorectal HCT116‐ and HT29‐derived stem‐like tumorspheres, whereas HCT116 and HT29 overexpressed CD133. Furthermore, STAT3 was knockdowned and analyzed consequently by RNAseq for picking up the STAT3‐mediated genes associated with tumorspheres formation. Then, qPCR was used for validating the expressions of selected driver genes in EGF treated‐ and in STAT3‐knockdowned HT29 cells. Results We found that 654 genes and 646 genes were up‐regulated in HCT116‐ and HT29‐derived tumorspheres, respectively. There were 103 genes simultaneously increased in both colorectal cancer tumorspheres, including STAT3 selected as a driver gene by NetworkAnalyst (https://www.networkanalyst.ca/). Moreover, there were 139 genes down‐regulated in HT29shSTAT3 cells compared to HT29shLuc cells, 12 of the genes were overlapped with the overexpressed 103 genes from tumorspheres, including NDRG1, ALDOC, BHLHE40, ATF3, C6orf223, JUND, ERRFI1, HK2, ITPKA, PLOD2, IDI1, S100A14 . Among them, BHLHE40, ATF3, ERRFI1, ITPKA, and S100A14 were validated and induced by EGF treatment, that were, otherwise, decreased in HT29shSTAT3 cells. Conclusions We found and validated that STAT3 mediated the formation of colorectal cancer stemness tumorspheres, and STAT3‐downstram BHLHE40, ATF3, ERRFI1, ITPKA, and S100A14 may be involved in stemness property.

A 76‐year‐old female with a history of chronic constipation presented with progressive abdominal pain and blood‐tinged stools at the emergency room. Upon examination, the computed tomography scan revealed bowel obstruction by a huge fecaloma impaction (9 × 7 cm) with focal thickening of the colonic wall and mural enhancement over the rectum. After gently evacuating feces manually followed by enema, subsequent colonoscopy also confirmed a large stercoral ulcer (6 × 5 cm) over the rectum with diffusely edematous and friable, sloughing mucosa. With conservative treatment, her symptoms were relieved uneventfully. Her condition improved and she was discharged after receiving education about constipation management. Constipation in the elderly population is common. However, in this instance, if left untreated, massive ulcer bleeding or perforation could occur. Therefore, such cases should be evaluated with more caution in order to prevent the development of irreversible complications.