Objective As the lack of reliable treatment for irritable bowel syndrome (IBS) prompts interest in the development of new therapies, we aimed to systematically evaluate the effect of Lactobacillus in treating this disease.
Methods We searched MEDLIINE, PubMed, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials for the period from 1966 to August 2013 for double-blind, placebo-controlled trials investigating the efficacy of Lactobacillus treatment in the management of IBS. The studies were screened for inclusion based on randomization, controls and reported measurable outcomes. We used the Jadad score to assess the quality of the articles. The STATA 11.0 and Revman 5.0 software packages were used for the meta-analysis. The STATA 11.0 software program was also used to assess indicators of publication bias according to Begg's and Egger's tests.
Results Six randomized, placebo-controlled clinical trials met the criteria and were included in the meta-analysis. The Jadad score of the articles was >3, and three articles were of high quality. We analyzed the heterogeneity of the studies and found no heterogeneity in the meta-analysis. In the forest plot, the diamond was on the right side of the vertical line and did not intersect with the line. The pooled relative risk for clinical improvement with Lactobacillus treatment was 7.69 (95% confidence interval: 2.33-25.43, p=0.0008). For adults, the pooled relative risk for clinical improvement with Lactobacillus treatment was 17.62 (95% confidence interval: 5.12-60.65, p<0.00001). For children, the pooled relative risk for clinical improvement with Lactobacillus treatment was 3.71 (95% confidence interval:1.05-13.11, p=0.04). Using the STATA 10.0 and Revman 5.0 software programs, we confirmed that Lactobacillus exhibited significant efficacy in treating IBS.
Conclusion Compared with the placebo, Lactobacillus treatment was found to be associated with a significantly higher rate of treatment responders in the overall population with IBS, without any side effects. As to limitations of the analysis, additional research is needed.

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Objective Published data regarding the association between xeroderma pigmentosum group D XPD Lys751Gln polymorphisms and esophageal cancer (EC) cancer remain controversial. The present meta-analysis aimed to obtain a more precise estimation of the relationship between XPD Lys751Gln polymorphisms and the risk of EC.
Methods All eligible case-control studies of Lys751Gln polymorphisms and susceptibility to EC were selected from PubMed, Web of Science and CNKI up to October 2013. The data were extracted, and pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.
Results A total of 21 case-control studies from 19 reports were assessed in this meta-analysis, including 6,581 cases and 8,251 controls. There was a significant association between the XPD Lys751Gln polymorphism and the risk of esophageal cancer in the overall population (Dominant model: OR=1.30, 95%CI: 1.07-1.57, p<0.05; Lys/Gln vs. Gln/Gln: OR=1.20, 95%CI: 1.05-137, p<0.05; Gln/Gln vs. Lys/Lys: OR=1.76, 95%CI: 1.08-2.85, p=0.02; Recessive model: OR=1.48, 95%CI: 1.06-2.07, p=0.02). Similar results were found when stratified according to the cancer type, ethnicity and control source. However, no associations were found among smokers or drinkers.
Conclusion The results of this meta-analysis suggest that XPD Lys751Gln polymorphisms contribute to susceptibility to EC.

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Objective We evaluated the efficacy and safety of balloon-occluded retrograde transvenous obliteration (B-RTO) performed using absolute ethanol with iodized oil (ET+LPD) and simultaneous endoscopic injection sclerotherapy (EIS) with cyanoacrylate (CA) for gastric varices (GVs).
Methods A total of 16 patients with endoscopically proven high-risk GVs treated using combined B-RTO with ET+LPD and EIS with CA between January 2007 and July 2012 were enrolled.
Results Twelve cases included GVs involving both the cardia and fundus, two cases included fundal varices and two cases included cardiac varices. In terms of the form of GVs, 10 cases involved F2 lesions and six cases involved F3 lesions. The flow vein was the left gastric vein in 13 cases and the posterior gastric vein in three cases. The drainage route was a splenorenal shunt in all cases. The average dose of ET+LPD was 12.0 mL, while that of CA was 2.45 mL. All complications were transient, and no major complications occurred after the procedures. None of the patients experienced bleeding or recurrence of gastric varices after the combined B-RTO and EIS procedures during an average follow-up period of 38.3 months.
Conclusion Combined B-RTO with ET+LPD and simultaneous EIS with CA is considered to be an effective and safe procedure for treating GVs.

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Objective The number of endoscopic submucosal dissection (ESD) procedures for early gastric cancers among patients 75 years of age or older has been increasing. We herein examined both the outcomes and complications of ESD in elderly patients.
Methods We investigated the effects of underlying diseases, lesion characteristics, treatment outcomes and complications during and in the postoperative periods of ESD among elderly patients 75 years of age or older versus non-elderly patients less than 75 years of age.
Patients A total of 318 early gastric cancers in consecutive 307 patients, all of whom underwent ESD for gastric cancer, were included in this study.
Results The number of patients with hypertension and ischemic heart disease was significantly higher in the elderly group than in the non-elderly group. The proportion of lesions with an absolute indication, extended indication or no indication was not significantly different between the groups. During the ESD procedure, the use of atropine sulfate for bradycardia was significantly more frequent in the elderly group. No significant differences were observed between the groups in terms of the treatment for hypertension, oxygen administration or incidence of perforation. In addition, there were no significant differences with respect to oxygen administration, postoperative bleeding or the occurrence of fever and/or pneumonia after the ESD procedure.
Conclusion Although bradycardia was more frequently observed in the elderly patients during ESD in this study, ESD was performed safely and managed appropriately, with infrequent postoperative complications. ESD appears to be effective, even in elderly patients.

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Objective Slow responders to pegylated interferon (Peg-IFN) and ribavirin (RBV) among patients infected with hepatitis C virus (HCV) genotype 1 may benefit from an extended treatment course. The aim of this study was to determine the efficacy of persistent negative serum HCV RNA over 96 weeks during long-term Peg-IFN monotherapy following 72 weeks of combination therapy.
Methods A total of 46 HCV genotype 1-infected slow responders were treated for 72 weeks with Peg-IFN and RBV combination therapy alone (n=25) or additional long-term biweekly treatment with 90 μg of Peg-IFN-α2a (n=21). The criterion for the completion of long-term Peg-IFN monotherapy was defined as the attainment of constantly negative HCV RNA in the serum over 96 weeks during IFN treatment.
Results The patients with sustained negative serum HCV RNA during 96 weeks of IFN treatment had a higher rate of sustained virological response (SVR) than those without (81 vs. 40%, p=0.012). A multivariate analysis identified sustained negativity of serum HCV RNA over 96 weeks of IFN treatment to be a predictive factor for SVR.
Conclusion In the present study, sustained negative serum HCV RNA over 96 weeks during long-term Peg-IFN monotherapy following 72 weeks of combination therapy of Peg-IFN and RBV resulted in beneficial virological outcomes among HCV genotype 1-infected slow responders.

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Objective The majority of cardiologists do not perform spasm provocation tests in patients with non-ischemic heart disease (non-IHD) or non-obstructive coronary artery disease (non-ob-CAD). We herein examined the frequency of provoked spasms in non-IHD and non-ob-CAD patients, including those with atypical chest pain (Aty), valvular heart disease (Val), hypertrophic cardiomyopathy (HCM), congestive heart failure (CHF), and others (Oth).
Methods & Results We performed acetylcholine (ACh) spasm provocation tests over a period of 22 years (1991-2012) among 1,440 patients, including 981 IHD and 459 non-IHD subjects. A total of 43 patients with significant organic stenosis were excluded, and the remaining 416 patients with non-IHD or non-ob-CAD disease were assessed. ACh was injected in incremental doses of 20/50/80 μg into the right coronary artery (RCA) and 20/50/100/(200) μg into the left coronary artery (LCA). Positive coronary spasms were defined as transient luminal narrowing of >99%. Positive coronary spasms were noted in 17.3% of the non-IHDs patients (72/416), compared to 11.4% (15/132), 19% (8/42), 16.7% (5/30), 23.9% (16/67), and 19.3% (28/145), in the patients in the Aty, Val, HCM, CHF, and Oth groups, respectively. The rate of positive provoked spasms was higher in men than women, although not significantly [20.6% (46/223) vs. 13.4% (26/193), ns], and significantly higher in the late period (2001-2012) than in the early period (1991-2000) (36.8% vs. 7.0%, p<0.001).
Conclusion Physicians should perform spasm provocation tests in patients with IHD as well as non-IHD with non-ob-CAD, as one of six non-IHD patients in this study exhibited provoked coronary spasms.

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Genetic variation is thought to contribute to the etiology of hypertension, and E-selectin is a candidate essential hypertension-associated gene.
Objective In this study, we attempted to test the hypothesis that subtle haplotype variants of SELE genes may be sources of essential hypertension in Mongolian and Han populations.
Materials A total of 429 unrelated Mongolian herdsmen and 416 Han farmers were enrolled, including 212 Mongolian essential hypertension (EH) patients, 217 Mongolian normotensives (controls), 200 Han EH patients and 216 Han normotensives (controls).
Methods All nine tag single-nucleotide polymorphisms (SNPs) within the SELE gene were retrieved from HapMap and the genotyping was performed using a polymerase chain reaction (PCR)/ligase detection reaction assay.
Results The distributions of the A-allele frequency of rs3917458 and the C-allele frequency of rs2179172 differed significantly between the hypertensive subjects and controls in the Han population. The frequency of haplotype GGC was significantly higher in the EH group than in the controls in the Mongolian population. In the Han population, a significant difference was observed in the haplotype frequency of TCC between the patients and controls, whereas haplotype ACA was detected significantly less often in the EH subjects than in the controls.
Conclusion Meanwhile, the haplotype TCC in the Han hypertensive patients and the haplotype GGC in the Mongolian patients had independent effects in increasing the risk for EH and maybe used as risk factors for predicting high blood pressure. However, the haplotype ACA had an independent effect in decreasing the risk of hypertension and may be protective in normotensive subjects in the Han population. Therefore, multiple SNPs in combination in SELE may confer a risk of hypertension.

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Objective To evaluate the effects of dietary sodium intake on QT interval dispersion (QTd) in normotensive healthy subjects and assess the protective effects of dietary potassium.
Methods All subjects were sequentially maintained on a protocol with a three-day baseline investigation, seven-day low-salt period (3 g/day (d), NaCL), seven-day salt loading period (18 g/d, NaCL) and a seven-day salt loading with potassium supplementation period (4.5 g/d, KCL). On the last day of each period, 24-hour urine samples were collected, the blood pressure values were measured and an electrocardiogram was recorded. The QT interval, QTd and T peak-T end interval (Tp-Te) were subsequently measured and calculated.
Patients Sixty-four normotensive subjects, men and women, ranging from 28 to 60 years of age, were enrolled.
Results There were no great fluctuations in heart rate after salt loading, whereas the systolic blood pressure (SBP, mmHg) and diastolic blood pressure (DBP, mmHg) increased and the corrected QT interval (QTc), corrected QT interval dispersion (QTdc) and Tp-Te values were significantly prolonged compared to that observed in the low-salt period (SBP, 118.6±13.5 vs. 111.7±11.3, p<0.01; DBP, 76.9±8.6 vs. 71.7±7.7, p<0.01; QTdc, 60.3±19.4 vs. 55.6±19.4, p<0.05; Tp-Te, 83.0±10.1 vs. 79.8±8.5, p<0.01). Surprisingly, all of these changes were reversed by potassium supplementation (SBP, 114.5±12.3 vs.118.6±13.5, p<0.01; DBP, 72.2±7.9 vs.76.9±8.6, p<0.01;QTd, 42.6±15.1 vs. 47.4±19.0, p<0.05; QTdc, 52.2±18.0 vs. 60.3±19.4, p<0.05; Tp-Te, 79.1±8.5 vs. 83.0±10.1, p<0.01).
Conclusion Salt loading prolongs the QT interval, QTd and Tp-Te, while dietary potassium supplementation reverses these alterations. These findings suggest that potassium supplementation may improve variation in the healing time and prevent arrhythmia.

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Objective Previous meta-analyses have demonstrated that lifestyle modification can reduce the blood glucose levels in patients with type 2 diabetes, although the effects of changes in the blood glucose level on impaired glucose tolerance (IGT) remain controversial. This review therefore aimed to determine the efficacy of lifestyle interventions in adults with IGT.
Methods We searched the Medline, Cochrane Library, EMBASE and Science Citation Index databases and reference lists of the included articles. Two independent reviewers extracted the data and assessed the quality of the included studies; a total of nine randomized controlled trials met the inclusion criteria. In addition, we tested for trial heterogeneity and calculated the pooled effects size using the random effects model.
Results The overall interventions were associated with a decline in the 2-hour plasma glucose levels [standardized mean differences (SMD) -0.56; 95% confidence interval (CI), -1.01 to -0.10; I², 96.6%]. Moreover, dietary intervention (SMD -0.53; 95% CI -0.77 to -0.28) and physical intervention (SMD -0.42; 95% CI -0.63 to -0.20) were each associated with a decline in the 2-hour plasma glucose levels compared with that observed in the control participants. The overall interventions were associated with a decline in the fasting plasma glucose (FPG) levels (SMD -0.27; 95% CI -0.38 to -0.15; I² = 47.1%). In addition, physical intervention (SMD -0.25; 95% CI -0.44 to -0.05) and combined dietary and physical intervention were each associated with a decreased FPG level (SMD -0.28; 95% CI -0.44 to -0.12) compared with that observed in the control participants.
Conclusion Lifestyle modification based on physical or dietary interventions or both is associated with improvements in the 2-hour plasma glucose and FPG levels in IGT patients.

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Objective The aim of our study was to investigate clinical and nutritional factors associated with renal involvement in patients with type 2 diabetes.
Patients We performed a cross-sectional study of 71 patients with type 2 diabetes who were being educated at our hospital from September 2006 to February 2008. The patients were divided into two groups; Group I consisted of 40 patients with both an estimated glomerular filtration rate (eGFR) of ≥60 mL/min/1.73 m² and normoalbuminuria, and Group II consisted of 31 patients with either microalbuminuria/overt proteinuria or an eGFR of <60 mL/min/1.73 m². We compared the age, body mass index (BMI), blood pressure, duration from onset of diabetes, use of hypoglycemic agents and insulin, biochemistry data, including HbA1c, pulse wave velocity corrected by blood pressure (PWVc) and the daily intake of several nutrients between the two groups. A multivariate logistic regression analysis was performed to identify factors independently associated with renal involvement.
Results Group II had significantly higher values for BMI, the duration of diabetes, triglycerides, uric acid and PWVc than Group I. Group II tended to have a high salt intake compared to Group I. The multivariate logistic analysis revealed that the daily salt intake, PWVc and uric acid were independent factors associated with renal involvement (odds ratio, 1.15, 1.84 and 2.00; 95% confidence interval, 1.02-1.31, 1.04-3.27 and 1.04-3.85, respectively).
Conclusion Our data suggest that a high salt intake, in addition to arteriosclerosis, is associated with renal involvement in our cohort with type 2 diabetes.

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Objective Radiographic findings in patients with diffuse alveolar hemorrhage (DAH) are usually diffuse and bilateral, although they may occasionally be unilateral. The clinical aspects of predominantly unilateral DAH are not well known. Therefore, our objective was to describe the clinical characteristics of predominantly right-sided DAH.
Methods We retrospectively reviewed data for 460 bronchoalveolar lavage fluid (BALF) samples collected between January 2009 and July 2013. Patients who presented with increasingly hemorrhagic BALF were diagnosed with DAH, and unilateral predominance was determined based on the degree of infiltration on chest radiographs.
Results The records of 54 patients with DAH were evaluated. The leading etiology was pulmonary congestion due to heart failure (n=15). The radiographs showed right-sided infiltration in 18 patients (33%), left-sided infiltration in six patients (11%) and bilateral infiltration in 30 patients (56%). Predominantly right-sided DAH was often caused by pulmonary congestion resulting from heart failure (10 of 18 patients). A multivariate logistic regression analysis revealed a previous history of cardiovascular disease to be the only significant predictor of right-sided DAH (OR 13.1, 95% CI 2.9-95.4).
Conclusion Predominantly right-sided DAH is frequently caused by pulmonary congestion resulting from heart failure and is significantly related to comorbidities with cardiovascular disease.

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Objective Information regarding multiple primary malignancies is important, as it has the potential to clarify etiological factors and may indicate the need to refine patient follow-up to include screening for associated malignancies. Upper aerodigestive tract cancer often develops in patients with smoking-related lung cancer; however, little is known about the frequencies or types of other primary malignancies in patients with non-small cell lung cancer (NSCLC) without a history of smoking.
Methods We retrospectively evaluated the records of patients examined and/or treated for NSCLC at the Institute of Biomedical Research and Innovation between January 2007 and June 2012.
Patients In total, 938 patients, including 599 men (never-smoker/ever-smoker: 35/564) and 339 women (never-smoker/ever-smoker: 236/103), were analyzed.
Results Among the 209 patients (22.3%) with multiple primary malignancies, 151 had a history of smoking and 58 were never-smokers. The most common cancers were gastric (43 cases), colorectal (33 cases), and prostate (29 cases) cancer. Smoking-related cancer was more common in current smokers and ex-smokers for both men and women. Among women with NSCLC, never-smokers were more likely to have thyroid cancer than those with a history of smoking (5.1% vs. 0%, p=0.021).
Conclusion In this study, several differences in malignancies were observed between never-smokers and patients with a history of smoking. Thyroid cancer and NSCLC co-existed in some women without a history of smoking, implicating predisposing factors other than tobacco smoke in the onset of these cancers.

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Objective Chronic fatigue syndrome (CFS) is a disabling condition of unknown etiology, and no definitive therapy has been identified to date. We developed Waon therapy, a form of thermal therapy using a far-infrared dry sauna, and in this study herein examined its feasibility and safety in patients with CFS.
Methods Ten consecutive inpatients with CFS stayed in a 60°C sauna for 15 minutes and then rested on a bed under a blanket for an additional 30 minutes outside the sauna room. The treatments were performed once a day, five days a week for four weeks. Perceived fatigue, the primary outcome measure, was evaluated using a numerical rating scale before, during (two weeks after the commencement of therapy) and after therapy. The pain level, evaluated using a numerical rating scale, mood, assessed using the Profile of Mood States questionnaire, and performance status, assessed using a scale developed for CFS patients were also examined before and after therapy.
Results Perceived fatigue significantly decreased after therapy, although no significant reductions were observed during therapy. In addition, a negative mood, including anxiety, depression and fatigue, and the performance status significantly improved after therapy. However, the levels of pain and vigor did not change significantly. No patients reported any adverse effects during the therapy.
Conclusion These findings suggest that Waon therapy may be a useful and safe treatment for CFS.

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The hallmark of Sweet's syndrome (SS) is the infiltration of mature neutrophils in the upper dermis. We herein report a case of SS with multi-organ involvement. A 32-year-old man presented with fever, anemia and dyspnea. He was given antibiotics, without any improvements. Later, a number of erythematous lesions appeared, accompanied by deteriorating respiratory and cardiovascular functions. A diagnosis of SS was confirmed on a skin biopsy, and the patient was given corticosteroids, the dose of which was reduced after one month. The organ function subsequently deteriorated, and he ultimately died of multi-organ failure. Early recognition of SS with multi-organ involvement is important in patients with SS.

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We herein report the case of a 19-year-old woman with facial diplegia and paresthesias (FDP) preceded by flu-like symptoms. We diagnosed the patient with a regional variant of Guillain-Barré syndrome due to decreased tendon reflexes, albuminocytological dissociation in the cerebrospinal fluid and demyelinating features on nerve conduction studies. The patient also had IgM anti-GalNAc-GD1a antibodies, and treatment with glucocorticoids was effective for treating the facial diplegia, but not paresthesia. Therefore, facial palsy may have a different pathophysiology from paresthesia or other symptoms of FDP, which responds to glucocorticoid therapy.

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