Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026: 07/18/16

Δευτέρα 18 Ιουλίου 2016

Early Post-Hepatoportoenterostomy Predictors of Native Liver Survival in Biliary Atresia.

Objectives: Most infants with biliary atresia (BA) require liver transplantation (LT) following hepatoportoenterostomy (HPE), including those who initially clear jaundice. The aim of this study was to identify clinical and routine laboratory factors in BA infants post-HPE that predict native liver survival at 2 years. Methods: A retrospective cohort study was conducted with 217 BA patients undergoing HPE in Sydney, Australia and Toronto, Canada between January 1986-July 2009. Univariate and multivariate logistic regression using backwards-stepwise elimination identified variables at 3 months post-HPE most associated with 2-year native liver survival. Results: Significant variables (p 45 days, change in length z-scores within 3 months of HPE and center. On multivariate analysis, TB (p 35 g/L (3.5 mg/dL; AUROC 0.7633) to predict 2-year native liver survival. TB and albumin levels 3 months post-HPE defined three Groups (1: TB35 g/L; 2: TB74 [mu]mol/L) with distinct short- and long-term native liver survival rates (log-rank p

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Maternal Infections, Antibiotics and Paracetamol in Pregnancy and Offspring Celiac Disease: A Cohort Study.

Objectives: Infections in pregnancy are common, may affect fetal development and have been linked to offspring autoimmunity. We aimed to determine whether maternal infections, the use of antibiotics and paracetamol in pregnancy are associated with the risk of offspring celiac disease (CD). Methods: The nationwide Norwegian Mother and Child Cohort Study includes 84,274 children born in 2000-2009 with prospectively collected questionnaire data on maternal infections and medication use in pregnancy. CD was identified through questionnaires and the Norwegian Patient Register. Logistic regression yielded odds ratios adjusted for age and sex (aORs). Results: During a median follow-up of 8.5 years, 617 children (0.7%) were diagnosed with CD. The aOR for offspring CD per increase in number of maternal infections was 1.07 (95% confidence interval [CI] = 1.01-1.13), but not significantly increased for categories one infection (1.01 [95%CI = 0.82-1.25]) and >= two infections (1.22 [95%CI = 1.00-1.49]) vs. no infection. We found the same pattern for respiratory tract infections, but not for gastrointestinal infections. The aORs were broadly consistent across pregnancy-periods of exposure. The use of antibiotics and paracetamol was, compared with no use, not associated with offspring CD (aOR = 1.16 [95%CI = 0.94-1.43] and aOR = 1.13 [95%CI = 0.96-1.33], respectively; P-values for trend>0.2). Conclusions: In this large pregnancy cohort we found no clear association between maternal infections in pregnancy and offspring CD, but considering the marginal significance in some of our results maternal infections cannot be ruled out as a risk factor. Reassuringly for both parents-to-be and clinicians, the use of antibiotics and paracetamol in pregnancy were not significant risk factors. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Tacrolimus Exerts Only a Transient Effectiveness in Refractory Pediatric Crohn Disease: a Case Series.

Objectives: Tacrolimus is an immunosuppressive agent that has been proposed in the treatment of severe ulcerative colitis. This study examined the effectiveness and safety of tacrolimus in treating refractory Crohn Disease (CD) colitis in children. Methods: All children treated by oral tacrolimus for CD colitis at a tertiary pediatric center were included in the study. All patients were refractory to steroids and infliximab. Clinical response (decreased PCDAI >15 and PCDAI

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Use of Reticulocyte Hemoglobin Content in the Assessment of Iron Deficiency in Children with Inflammatory Bowel Disease.

Background: Iron deficiency and anemia affect up to 50-75% of inflammatory bowel disease (IBD) patients. Iron deficiency in IBD may be difficult to diagnose because of the effect of inflammation on iron status biomarkers. Thus, there is a need for better methods to accurately determine iron status in IBD. Objective: To investigate the association of inflammation with hemoglobin content of reticulocytes (CHr) and the utility of CHr in comparison to standard iron biomarkers. Design/Methods: We conducted a cross-sectional study of children with IBD. Iron biomarkers [CHr, ferritin, soluble transferrin receptor (sTfR), hepcidin, hemoglobin] were measured along with systemic biomarkers of inflammation [C-reactive protein (CRP), [alpha]1-acid glycoprotein (AGP)]. Spearman correlations were used to evaluate the relationship of inflammation and iron biomarkers. The gold standard for iron deficiency was defined as inflammation-corrected ferritin 8.3 mg/L. Receiver operating characteristic (ROC) curves were used to estimate the prognostic values of all iron biomarkers to identify patients with iron deficiency. Results: We analyzed data in 62 children aged 5 to 8.3 mg/L, 39% using RDW>14.5%, 26% using BIS

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Guideline for the Evaluation of Cholestatic Jaundice in Infants: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN).

Cholestatic jaundice in infancy affects approximately 1 in every 2500 term infants and is infrequently recognized by primary providers in the setting of physiologic jaundice. Cholestatic jaundice is always pathologic and indicates hepatobiliary dysfunction. Early detection by the primary care physician and timely referrals to the pediatric gastroenterologist/hepatologist are important contributors to optimal treatment and prognosis. The most common causes of cholestatic jaundice in the first months of life are biliary atresia (BA, 25-40%) followed by an expanding list of monogenic disorders (25%), plus many unknown or multifactorial (e.g., parenteral nutrition related) causes, each of which may have time-sensitive and distinct treatment plans. Thus, these Guidelines can have an essential role for the evaluation of neonatal cholestasis to optimize care. The recommendations from this clinical practice guideline are based upon review and analysis of published literature as well as the combined experience of the authors. The Committee recommends that any infant noted to be jaundiced after 2 weeks of age be evaluated for cholestasis with measurement of total and direct serum bilirubin, and that an elevated serum direct bilirubin level (direct bilirubin levels >1.0 mg/dl or >17 [mu]mol/L) warrants timely consideration for evaluation and referral to a pediatric gastroenterologist or hepatologist. Of note, current differential diagnostic plans now incorporate consideration of modern broad-based next generation DNA sequencing technologies in the proper clinical context. These recommendations are a general guideline and are not intended as a substitute for clinical judgment or as a protocol for the care of all infants with cholestasis. Broad implementation of these recommendations is expected to reduce the time to the diagnosis of pediatric liver diseases, including BA, leading to improved outcomes. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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A New Old Treatment for Vitamin E Deficiency in Cholestasis.

No abstract available

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Oral Tocofersolan Corrects or Prevents Vitamin E Deficiency in Children with Chronic Cholestasis.

Background/Aims: d-alpha-tocopheryl polyethylene glycol 1000 succinate (Tocofersolan, Vedrop(R)), has been developed in Europe to provide an orally bioavailable source of vitamin E in children with cholestasis. The aim was to analyze the safety/efficacy of Vedrop(R) in a large group of children with chronic cholestasis. Methods: 274 Children receiving Vedrop(R) for vitamin E deficiency or for its prophylaxis were included from 7 European centers. Median age at treatment onset was 2 months and median follow-up was 11 months. Vedrop(R) was prescribed at a daily dose of 0.34 ml/kg (25 IU/kg) of body weight. Three methods were used to determine a sufficient serum vitamin E status: vitamin E; vitamin E/(total cholesterol); vitamin E/(total cholesterol + triglycerides). Results: Before Vedrop(R) therapy, 51% of children had proven vitamin E deficiency, 30% had normal vitamin E status and 19% had an unknown vitamin E status. During the first months of treatment, vitamin E status was restored in the majority of children with insufficient levels at baseline (89% had a normal status at 6 months). All children with a normal baseline vitamin E status had a normal vitamin E status at 6 months. Among children with an unknown vitamin E status at baseline, 93% had a normal vitamin E status at 6 months. A sufficient vitamin E status was observed in 80% of children with significant cholestasis (serum total bilirubin > 34.2 [mu]mol/L). No serious adverse reaction was reported. Conclusions: Vedrop(R) seems a safe and effective oral formulation of vitamin E that restores and/or maintains sufficient serum vitamin E level in the majority of children with cholestasis, avoiding the need for intramuscular vitamin E injections. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Impaired dacarbazine activation and 7-ethoxyresorufin deethylation in vitro by polymorphic variants of CYP1A1 and CYP1A2: implications for cancer therapy.

Objectives: To extend our understanding of how interindividual variability mediates the efficacy of cancer treatment. Materials and methods: The kinetics of dacarbazine (DTIC) N-demethylation by the most frequent polymorphic variants of CYP1A1 (T461N, I462V) and CYP1A2 (F186L, D348N, I386F, R431W, R456H) were characterized, along with kinetic parameters for the O-deethylation of the prototypic CYP1A substrate 7-ethoxyresorufin, using recombinant protein expression and high-performance liquid chromatographic techniques. Results: A reduction of ~30% in the catalytic efficiencies (measured as in-vitro intrinsic clearance, CLint) was observed for DTIC N-demethylation by the two CYP1A1 variants relative to wild type. Although a modest increase in the CLint value for DTIC N-demethylation was observed for the CYP1A2 D348N variant relative to the wild type, the CLint for the F186L variant was reduced and the I386F, R431W, and R456H variants all showed loss of catalytic function. Conclusion: Comparison of the kinetic data for DTIC N-demethylation and 7-ethoxyresorufin O-deethylation indicated that alterations in the kinetic parameters (Km, Vmax, CLint) observed with each of the CYP1A1 and CYP1A2 polymorphic variants were substrate dependent. These data indicate that cancer patients treated with DTIC who possess any of the CYP1A1-T461N and I462V variants or the CYP1A2-F186L, D348N, I386F, R431W, and R456H variants are likely to have decreased prodrug activation, and hence may respond less favorably to DTIC treatment compared with individuals with wild-type CYP1A alleles. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Vascular responsiveness measured by tissue oxygen saturation reperfusion slope is sensitive to different occlusion durations and training status

The reperfusion rate of near-infrared spectroscopy (NIRS)-derived measures of tissue oxygen saturation (StO₂) represent vascular responsiveness. This study examined if the reperfusion slope of StO₂ is sensitive to different ischemic conditions (i.e., a dose-response) and if differences exist between two groups of different fitness levels. Nine healthy trained (T; Age: 25 ± 3 yr; VO_2max: 63.4 ± 6.7 ml kg⁻¹ min⁻¹) and nine healthy untrained (UT; Age: 21 ± 1 yr; VO_2max: 46.6 ± 2.5 ml kg⁻¹ min⁻¹) men performed a series of vascular occlusion tests of different durations (30 s, 1 min, 2 min, 3 min, and 5 min), each separated by 30 min. StO₂ was measured over the tibialis anterior using NIRS, with StO₂ reperfusion slope calculated as the upslope during 10 s following cuff release. The reperfusion slope was steeper in T compared to UT at all occlusion durations (P < 0.05). For the T group, the reperfusion slope for 30 s and 1 min occlusions were less than all longer durations (P < 0.05). The reperfusion slope following 2 min occlusion was similar to 3 min (P < 0.05) but both were less steep than 5 min of occlusion. In UT, the reperfusion slope at 30 s was smaller than all longer occlusion durations (P < 0.05) and 1 min occlusion resulted in a reperfusion slope that was less steep than following 2 min and 3 min (P < 0.05), albeit not different from 5 min (P < 0.05). The present study demonstrated that the reperfusion rate of StO₂ is sensitive to different occlusion durations, and that changes in the reperfusion rate to a variety of ischemic challenges can be used to detect differences in vascular responsiveness between trained and untrained groups.

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Biochemical Characterization of β-Lactamases from Mycobacterium abscessus Complex and Genetic Environment of the β-Lactamase-Encoding Gene

Microbial Drug Resistance , Vol. 0, No. 0.

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Aerobic training prevents oxidative profile and improves nitric oxide and vascular reactivity in rats with cardiometabolic alteration

Cardiovascular disease is the major cause of death worldwide; therefore it is important to understand the natural history of the pathophysiologic process and develop strategies to halt its progression. Thus this study investigated the protective effect of aerobic training on pathophysiological mechanisms involved in subclinical cardiometabolic alterations in a model with constant exposure to a prejudicial agent. Male Wistar rats were divided into a control group (C), which received drinking water, fructose group (F), which was fed 10% fructose in drinking water for 10 wk, and control training (CT) and fructose training groups (FT), in which moderate aerobic training was added in the last 8 wk of the study. Insulin, triacylglycerol, and isoprostane were higher and superoxide dismutase (SOD) was lower in the F group. There was no difference in thoracic aorta histology, but a decreased vascularization was seen in the F group, avoided by training in left ventricle. Regarding vascular function, the F group exhibited increased vasoconstrictory reactivity to phenylephrine. The F group presented impaired vasodilation to acetylcholine. Regarding endothelial nitric oxide synthase (eNOS), the F group presented a lower expression, and phosphorylated eNOS was higher in the trained groups than in their respective control groups. This same pattern was observed for nitric oxide bioavailability, antioxidant protein expression in aorta, left ventricle, and muscle (catalase, SOD, and glutathione peroxidase), serum SOD activity, and muscle mass. These results suggest that exercise training enhanced the antioxidant pathway and, as a consequence, the eNOS pathway, preventing an impairment in vascular vasodilatory capacity.

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Effects of high-intensity interval training and moderate-intensity continuous training on endothelial function and cardiometabolic risk markers in obese adults

We hypothesized that high-intensity interval training (HIIT) would be more effective than moderate-intensity continuous training (MICT) at improving endothelial function and maximum oxygen uptake (Vo_{2 max}) in obese adults. Eighteen participants [35.1 ± 8.1 (SD) yr; body mass index = 36.0 ± 5.0 kg/m²] were randomized to 8 wk (3 sessions/wk) of either HIIT [10 x 1 min, 90-95% maximum heart rate (HR_max), 1-min active recovery] or MICT (30 min, 70–75% HR_max). Brachial artery flow-mediated dilation (FMD) increased after HIIT (5.13 ± 2.80% vs. 8.98 ± 2.86%, P = 0.02) but not after MICT (5.23 ± 2.82% vs. 3.05 ± 2.76%, P = 0.16). Resting artery diameter increased after MICT (3.68 ± 0.58 mm vs. 3.86 ± 0.58 mm, P = 0.02) but not after HIIT (4.04 ± 0.70 mm vs. 4.09 ± 0.70 mm; P = 0.63). There was a significant (P = 0.02) group x time interaction in low flow-mediated constriction (L-FMC) between MICT (0.63 ± 2.00% vs. –2.79 ± 3.20%; P = 0.03) and HIIT (–1.04 ± 4.09% vs. 1.74 ± 3.46%; P = 0.29). Vo_{2 max} increased (P < 0.01) similarly after HIIT (2.19 ± 0.65 l/min vs. 2.64 ± 0.88 l/min) and MICT (2.24 ± 0.48 l/min vs. 2.55 ± 0.61 l/min). Biomarkers of cardiovascular risk and endothelial function were unchanged. HIIT and MICT produced different vascular adaptations in obese adults, with HIIT improving FMD and MICT increasing resting artery diameter and enhancing L-FMC. HIIT required 27.5% less total exercise time and ~25% less energy expenditure than MICT.

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Feed-forward and reciprocal inhibition for gain and phase timing control in a computational model of repetitive cough

We investigated the hypothesis, motivated in part by a coordinated computational cough network model, that second-order neurons in the nucleus tractus solitarius (NTS) act as a filter and shape afferent input to the respiratory network during the production of cough. In vivo experiments were conducted on anesthetized spontaneously breathing cats. Cough was elicited by mechanical stimulation of the intrathoracic airways. Electromyograms of the parasternal (inspiratory) and rectus abdominis (expiratory) muscles and esophageal pressure were recorded. In vivo data revealed that expiratory motor drive during bouts of repetitive coughs is variable: peak expulsive amplitude increases from the first cough, peaks about the eighth or ninth cough, and then decreases through the remainder of the bout. Model simulations indicated that feed-forward inhibition of a single second-order neuron population is not sufficient to account for this dynamic feature of a repetitive cough bout. When a single second-order population was split into two subpopulations (inspiratory and expiratory), the resultant model produced simulated expiratory motor bursts that were comparable to in vivo data. However, expiratory phase durations during these simulations of repetitive coughing had less variance than those in vivo. Simulations in which reciprocal inhibitory processes between inspiratory-decrementing and expiratory-augmenting-late neurons were introduced exhibited increased variance in the expiratory phase durations. These results support the prediction that serial and parallel processing of airway afferent signals in the NTS play a role in generation of the motor pattern for cough.

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Airway mechanics and lung tissue viscoelasticity: effects of altered blood hematocrit in the pulmonary circulation

The contribution of the hematocrit (Hct) of the blood in the pulmonary vasculature to the overall lung mechanics has not been characterized. We therefore set out to establish how changes of the Hct level in the pulmonary circulation affect the airway and lung tissue viscoelastic properties. The Hct level of the blood in an isolated perfused rat lung model was randomly altered. Intermediate (26.5%), followed by low (6.6%) or normal (43.7%), Hct was set in two consecutive sequences. The pulmonary capillary pressure was maintained constant throughout the experiment, and the pulmonary hemodynamic parameters were monitored continuously. The airway resistance (Raw), the viscous (G) and elastic (H) parameters, and the hysteresivity ( = G/H) of the lung tissues were obtained from measurements of forced oscillatory input impedance data. Raw was not affected by the alterations of the Hct levels. As concerns the lung tissues, the decrease of Hct to intermediate or low levels resulted in close to proportional decreases in the viscoelastic parameters G [16.5 ± 7.7% (SD), 12.1 ± 9.5%, P < 0.005] and H (13.2 ± 8.6%, 10.8 ± 4.7%, P < 0.001). No significant changes in were detected in a wide range of Hct, which indicates that coupled processes cause alterations in the resistive and elastic properties of the lungs following Hct changes in the pulmonary circulation. The diminishment of the viscous and elastic parameters of the pulmonary parenchyma following a reduction of blood Hct demonstrates the significant contribution of the red blood cells to the overall lung viscoelasticity.

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The correlation between brain near-infrared spectroscopy and cerebral blood flow in piglets with intracranial hypertension

Cerebral perfusion pressure (CPP) is used as a surrogate for measurement of cerebral blood flow (CBF) but its determination requires that intracranial pressure be directly measured. Near-infrared spectroscopy (NIRS) can noninvasively measure tissue oxygenation. We hypothesized that NIRS would correlate well with CBF, with cerebral metabolism of oxygen (CMRO₂) and glucose and with lactate production as CPP was reduced. Seven anesthetized piglets were subjected to reductions in CPP to 60, 50, 40, 30, and 20 mmHg by infusing an artificial cerebral spinal fluid into the lateral ventricle of the brain. After a period of equilibration, NIRS over the left temporal cortex and regional CBF (microspheres) were measured at each CPP level as well as arterial and internal jugular Pa_O₂, glucose, and lactate. CMRO₂ and glucose consumption and lactate production were calculated by standard formulae. NIRS correlated very well (P < 0.05) with CBF in the left temporal cortex [mean r (95% CI) = 0.95 (0.91-0.99)] and with left hemispheric CMRO₂ [0.94 (0.90–0.98)], glucose consumption [0.87 (0.76–0.97)], and lactate production [0.89 (0.81–0.97)]. The correlation of NIRS with CBF was slightly better (P < 0.05) than that of CPP with CBF [0.89 (0.84–0.94)]. In this model of global cerebral hypertension, NIRS correlated well with CBF and measures of cerebral metabolism, and might be useful as a surrogate for CPP. Further studies are warranted to determine if NIRS is associated with these variables in focal cerebral injury.

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Detection of LINE RT elements in the olive flounder ( Paralichthys olivaceus ) genome and expression analysis after infection with S. parauberis

Abstract

Long interspersed nuclear elements (LINEs) are widely distributed in the vertebrate genome, and can be either beneficial or detrimental to the host genome. Here we identified three members of LINE RT elements in the olive flounder genome. They showed high amino acid sequence identity (89–99 %), and the sequences of LINE reverse transcriptase (RT) in olive flounder are closely related to those of coral grouper, European seabass, and three-spined stickleback. Real-time reverse transcription-polymerase chain reaction analysis indicated that expression of the OF (Olive flounder)-LINE Chr3-1 RT increased more in spleen than in other tissues after treatment with the pathogen Streptococcus parauberis. These data may form the basis for further studies on the function of retroelements in infected olive flounder.

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Seldinger technique for nasal intubation: a case series

Nasotracheal intubation can be both challenging and traumatic, especially in cases of atypical anatomy. We present a series of 3 such cases in which an endotracheal tube introducer (bougie) was used to facilitate successful, atraumatic, nasotracheal intubation via Seldinger technique. The technique described can guide a nasotracheal tube through narrow nasal passages, small pharyngeal spaces, and past acute laryngeal approach angles, all without transoral manipulation of the tube. The technique is easy to perform, uses a routine skill set, and can be advantageous in numerous clinical scenarios.

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The role of vascular endothelial growth factor −634 G/C and its soluble receptor on chronic liver disease and hepatocellular carcinoma

Publication date: Available online 11 July 2016
Source:Arab Journal of Gastroenterology
Author(s): Neneng Ratnasari, Siti Nurdjanah, Ahmad H. Sadewa, Mohammad Hakimi
Background and study aimsThe single nucleotide polymorphism (SNP) of the vascular endothelial growth factor (VEGF) gene −634 G/C (rs2010963) influences the progression of hepatocellular carcinoma (HCC). There have been no studies on the role of VEGF SNP −634 G/C in chronic liver disease (CLD). The aim of the present study was to analyse the correlation between VEGF SNP −634 and the clinical severity of CLD and HCC.Patients and methodsA cross sectional study was conducted on 182 subjects (46 HCC, 39 liver cirrhotic/LC, 38 chronic hepatitis/CH; and 57 healthy subjects). The study was conducted from 2010 to 2014 at the Dr. Sardjito Hospital Yogyakarta, Indonesia. All subjects submitted blood serum for DNA sequencing examination using primer. The clinical data of CLD and HCC were assessed, and sVEGFR-2 was examined in 149 subjects. All data were analysed using STATA programme 11.0.ResultsSignificant differences were observed in genotypic frequency (GG/GC/CC) between HCC, LC, CH and healthy subjects (p=0.004), but though no significant differences were observed between the G>G and C>G genotypic frequencies (p=0.337). The frequency of genotype GG was significantly higher than genotype GC or CC in HCC and was associated with declining of clinical conditions (p<0.05). No significant difference in the distribution genotypes was observed with respect to the level of sVEGFR-2 in the serum. However, we observed a significant correlation between sVEGFR-2 and clinical characteristics in LC and CH (p<0.05).ConclusionGenotype GG of the VEGF SNP −634 is the dominant genotype in severe CLD and HCC. sVEGFR-2 correlates with the disease severity but is not directly associated with the SNP −634 genotype.

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Evaluating the effect of infliximab on the healing of left colonic anastomosis in the presence of intra-abdominal sepsis

Publication date: Available online 11 July 2016
Source:Arab Journal of Gastroenterology
Author(s): Alper Sozutek, Sefa Ozyazici, Tahsin Colak, Suleyman Cetınkunar, Oktay Irkorucu, Onur Bobusoglu, Ahmet Cennet
Background and study aimsInfliximab (IFX) is a chimeric anti-TNF-α body which is effectively used in the treatment of inflammatory bowel diseases and a variety of autoimmune diseases. The effect of IFX on the healing of intestinal anastomosis has been evaluated in several studies, however with conflicting results. Furthermore, the effect of IFX on colonic anastomosis in sepsis has not been evaluated to date. In this study, we aimed to investigate whether IFX has an adverse effect on the healing process of colonic anastomosis either under normal or septic condition.Material and methodThe efficiency of IFX was assessed with respect to anastomotic bursting pressure (ABP), tissue hydroxyproline levels (THL) and histopathological examination of left colonic anastomosis in 40 male rats. The rats were randomly allocated into four groups of 10 rats each as control (C), septic control (SC), control IFX (C-IFX) and septic IFX (S-IFX).ResultsThe anastomotic bursting pressure was measured at 182±19.1, 158±15.4, 161±26.8 and 100±10.3mm/Hg, in C, SC, C-IFX and S-IFX; respectively. IFX administration did not influence the anastomotic strength under normal condition whereas in sepsis significantly induced the reduction of APB. The mean THL was almost similar in both control groups (p=0.87), whilst IFX reduced the level of TH in sepsis comparing with control groups (p=0.01). IFX significantly impaired immune response in sepsis resulting in poor anastomotic healing in S-IFX group.ConclusionOur study demonstrated that IFX had no detrimental effect on the healing of colonic anastomosis under normal condition whilst significantly impaired the healing process in sepsis.

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Haemophagocytic lymphohistiocytosis presenting as neonatal liver failure: A case series

Publication date: Available online 7 July 2016
Source:Arab Journal of Gastroenterology
Author(s): Hala Abdullatif, Nabil Mohsen, Rokaya El-Sayed, Fatma El-Mougy, Hanaa El-Karaksy
Background and study aimHaemophagocytic lymphohistiocytosis (HLH) is a life-threatening clinical syndrome with liver involvement varying from mild dysfunction to severe fulminant failure. The aim of this study was to present a case series of four HLH patients presenting with acute liver failure (ALF) in the neonatal period.Patients and methodsAll four patients were neonates at the onset of symptoms. They presented to Cairo University Pediatric Hospital with ALF; they underwent prompt investigations including determination of ferritin, fibrinogen, and triglyceride levels as part of our ALF workup. Further investigations were tailored according to the associated clinical features and the results of preliminary investigations.ResultsHLH was diagnosed according to HLH-2004 criteria. Three patients fulfilled at least five out of eight criteria. Fever, splenomegaly, elevated ferritin levels, and low fibrinogen levels were present in all patients. The fourth patient had a serum ferritin level >10,000ng/ml, favouring the diagnosis of HLH, despite fulfilling only four out of eight criteria. For three patients, positive consanguinity and previous sibling death were reported, suggesting a genetic aetiology of HLH.ConclusionALF can be the presenting feature of HLH; thus, a high index of suspicion is necessary. Fever is a hallmark, especially in neonates. Diagnosis is important for this potentially treatable condition.

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Acute typhlitis caused by a caecal faecolith

Publication date: Available online 1 July 2016
Source:Arab Journal of Gastroenterology
Author(s): Saleh Abdel-Kader, Suhail Al-Salam, Fikri M. Abu-Zidan
Isolated acute typhlitis caused by a caecal faecolith is extremely rare. Hereby we report such a case. A 30-year-old man presented clinically as acute appendicitis. During open surgery, an inflamed caecal mass was found. A limited colectomy including the mass and grossly health margins was performed. Histopathological examination confirmed that acute typhlitis was caused by an impacted caecal faecolith. The appendix was normal. Faecolith is an extremely rare cause of acute inflammation of the caecum presenting as a mass which is usually treated by limited right hemicolectomy.

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FibroScan, APRI, FIB4, and GUCI: Role in prediction of fibrosis and response to therapy in Egyptian patients with HCV infection

Publication date: Available online 25 June 2016
Source:Arab Journal of Gastroenterology
Author(s): Ayman Yosry, Rabab Fouad, Shereen A. Alem, Aisha Elsharkawy, Mohammad El-Sayed, Noha Asem, Ehsan Hassan, Ahmed Ismail, Gamal Esmat
Background and study aimsMultiple noninvasive methods have been used successfully in the prediction of fibrosis. However, their role in the prediction of response to hepatitis C virus (HCV) antiviral therapy is debatable. The aim of this study was to validate and compare the diagnostic performance of FibroScan, APRI (aspartate aminotransferase (AST)-to-platelet ratio index), FIB4, and GUCI (Göteborg University Cirrhosis Index) for the prediction of hepatic fibrosis and treatment outcome in HCV-infected patients receiving pegylated interferon and ribavirin (PEG-IFN/ribavirin).Patients and methodsThis study included 182 Egyptian patients with chronic HCV infection. They were classified into two groups based on the stages of fibrosis: mild to significant fibrosis (F1–F2) and advanced fibrosis (F3–F4). The APRI, FIB4, and GUCI scores were calculated before the antiviral treatment. The FibroScan was performed for all patients before treatment.ResultsStiffness and FIB4 have greater sensitivity and specificity in detecting advanced fibrosis of 80%, 77% and 88%, 84%, respectively. Based on multivariate regression analysis, FIB4, body mass index (BMI), and alpha-fetoprotein (AFP) level were found to be statistically significant predictors of advanced fibrosis (p-value: 0.000, 0.011, and 0.001, respectively) with odds ratio (OR: 3.184, 1.170, and 1.241, respectively). With respect to virological response, the stiffness, APRI, FIB4, and GUCI were significantly lower in sustained virological responders. However, these are not good predictors of response to PEG-IFN/ribavirin therapy. AFP was the only statistically significant predictor of response (p=0.002) with OR of 1.141 in multivariate regression analysis.ConclusionFibroScan and noninvasive scores such as APRI, FIB4, and GUCI can be used as good predictors of liver fibrosis in chronic hepatitis C. However, they are not good predictors of response to PEG-IFN/ribavirin therapy.

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Evaluation of iron deficiency anaemia for gastrointestinal causes in patients without GI symptoms in high prevalent GI malignancy zones

Publication date: Available online 11 July 2016
Source:Arab Journal of Gastroenterology
Author(s): Showkat A. Kadla, Nisar A. Shah, Muzafar A. Bindroo, Bilal A. Khan, Adil Farooq, Wajeed Yousf, Bilal A. Wani
Background and study aimsGastric cancer is highly prevalent in Kashmir, as are lower gastrointestinal (LGI) malignancies. Colonic cancer, gastric cancer, and coeliac disease are the most important gastrointestinal (GI) causes of iron deficiency anaemia (IDA) worldwide. Approximately 9% of patients with IDA present with a suspicious lesion in the GI tract upon examination. However, the absence of GI symptoms and a possible lesion accounting for blood loss in IDA have not been studied in this zone with a high prevalence of GI malignancy. We aimed to examine IDA patients without GI symptoms to determine the most plausible cause of their blood loss.Patients and methodsA total of 100 patients with IDA and 250 control subjects without IDA and referred for gastrointestinal endoscopy were enrolled in a cross-sectional, comparative study. Patients presenting with a significant lesion proportionate to their anaemia in the upper GI tract were not examined further, if no further strong indications were present.ResultsTwenty-nine patients (29%) were found to have malignancy: 13 with gastric cancer and 16 with colonic malignancies. Other apparent causes of GI blood loss included peptic ulcer disease in 10 (10%) patients, haemorrhoids in 22 (25%), polyps in eight (three in the upper GI tract and five in the LGI tract), gastric erosions in eight (8%), and angiodysplasia, diverticulitis, and trichuriasis in two (2%) each.ConclusionIn light of the high incidence of GI malignancies in this patient group, a low threshold for GI screening as well as mass screening for IDA is needed.

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The prevalence of coeliac disease in patients fulfilling Rome III criteria for irritable bowel syndrome

Publication date: Available online 24 June 2016
Source:Arab Journal of Gastroenterology
Author(s): Sayed A. Shalaby, Moataz M. Sayed, Wesam A. Ibrahim, Sara M. Abdelhakam, Marwa Rushdy
Background and study aimThe clinical presentation of coeliac disease can vary from a classical malabsorption syndrome to more subtle atypical gastrointestinal manifestations similar to irritable bowel syndrome (IBS). The aim of this study was to investigate the prevalence of coeliac disease in Egyptian patients with clinically diagnosed diarrhoea-predominant IBS (according to Rome III criteria).Patients and methodsThis study was conducted on 100 patients with clinically diagnosed diarrhoea-predominant IBS (fulfilling Rome III criteria). They were subjected to complete clinical evaluation, routine laboratory investigations, abdominal ultrasonography and serum anti-tissue transglutaminase antibody (anti-tTG) test as a predictor marker for coeliac disease. All patients who tested positive for serum anti-tTG underwent upper gastrointestinal endoscopy with four to eight biopsy samples collected from the second part of the duodenum.ResultsAll of the studied 100 patients presented with abdominal pain or discomfort, flatulence and diarrhoea. Eight patients (8%) exhibited high levels of serum anti-tTG, and their duodenal biopsy samples satisfied the histopathological criteria of coeliac disease. The studied patients were divided into two groups: Group I comprising 92 patients with IBS and negative anti-tTG results and Group II comprising eight patients with IBS and positive anti-tTG results. A non-significant difference was noted between the two groups in age, gender and duration of abdominal pain (p>0.05). The haemoglobin level was found to be significantly reduced in anti-tTG-positive patients (p<0.01), as was the Na level in anti-tTG-negative patients (p<0.05). A highly statistically significant inverse correlation was noted between anti-tTG and both serum total protein and serum albumin.ConclusionSome symptoms overlap between coeliac disease and IBS. A lack of awareness may lead to a diagnostic delay in these patients.

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Study of the clinical relevance of Helicobacter pylori virulence genes to gastric diseases among Egyptian patients

Publication date: Available online 22 June 2016
Source:Arab Journal of Gastroenterology
Author(s): Mona El-Khlousy, Eiman A. Rahman, Sally Mostafa, Amira Bassam, Heba A. Elgawad, Mohamed S. Elnasr, Mohammad Mohey, Doaa Ghaith
Background and study aimsHelicobacter pylori infection is common in Egypt. It has been associated with gastritis, ulcers and it is a risk factor for gastric cancer. We aimed to study the correlation between the presence of H. pylori virulence factors and the histopathological and endoscopic findings in gastric biopsies.Patients and methodsGastric biopsies from thirty seven patients scheduled for diagnostic endoscopy in Cairo University hospital were included in the study. All gastric biopsies were subjected to histopathological examination and PCR assay for detection of 16S rRNA gene to diagnose H. pylori infection, detection of H. pylori virulence factors by PCR for cagA and vacA genotypes and serological analysis of H. pylori (cagA, vacA, P25, and P19) IgG antibodies by immunoblot assay were done.ResultsH. pylori infection was detected in 23 (62.2%) cases by histopathology while 28/37 (75.7%) were positive for H. pylori 16S rRNA gene by PCR. By PCR seventeen samples out of 37 (45.9%) were positive for cagA gene and five (13.5%) for cag empty site gene.ConclusionThe most common vacA genotype identified was vacA s2m2 genotype in 10 (27.02%). No statistical correlation was found between IgG antibodies against different antigens of H. pylori virulence factors (cagA, vacA, p25, and p19) and the degree of gastritis except for IgG antibodies against the UreA antigen.

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Molecular characterisation of Klebsiella oxytoca strains isolated from patients with antibiotic-associated diarrhoea

Publication date: Available online 22 June 2016
Source:Arab Journal of Gastroenterology
Author(s): Mohammad Yousef Alikhani, Fereshteh Shahcheraghi, Sepideh Khodaparast, Amir Sasan Mozaffari Nejad, Mojgan K. Moghadam, Sayed Fazlollah Mousavi
Background and study aimColitis is a common complication after treatment with antibiotics such as β-lactams, quinolones, and aminoglycosides. Recently, Klebsiella oxytoca has been implicated in this type of diarrhoea. The prevalence and characterisations of K. oxytoca isolated from patients with antibiotic-associated diarrhoea were investigated. The K. oxytoca isolates were also tested for cytotoxin production.Patients and methodsThis study was conducted from May 2011 to Dec 2013. Faecal samples were collected from hospitalised patients receiving antibiotic treatment. Initial cultivation was performed on specific media. The clinical isolates were confirmed by polymerase chain reaction (PCR) using the specific K. oxytoca polygalacturonase (pehX) gene. The double-disc diffusion test was used to detect extended-spectrum beta-lactamase (ESBL)-producing strains. Tracking of ESBL-encoding genes was performed via PCR. The organism was cultured on Hep-2 cell lines for cytotoxin production.ResultsOut of 331 samples collected from patients, 40 were confirmed molecularly to be clinical isolates of K. oxytoca. Fourteen (35%) ESBL-producing strains were isolated using the double-disc diffusion method. Among the molecularly confirmed K. oxytoca isolates, seven (17.5%) tested positive for the blaSHV gene, 12 (30%) for blaTEM, 10 (25%) for blaCTX-M, three (7.5%) for blaOXA, nine (22.5%) for blaCTX-M-15, and seven (17.5%) for blaTEM-1. Five (12%) isolates showed cytotoxin activity below 30%, 12 (30%) strains showed moderate cytotoxin activity between 30% and 60%, and 23 (58%) strains showed cytotoxin activity ⩾60%.ConclusionsThe cytotoxin-producing K. oxytoca is found to be one of the causes of antibiotic-induced colitis. Discontinuing treatment and allowing normal intestinal flora to be established or prescribing appropriate medication after antibiogram can help patients with antibiotic-induced haemorrhagic colitis in a timely manner.

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Risk of cancer in small and diminutive colorectal polyps

The prevalence of cancer in small and diminutive polyps is relevant to "resect and discard" and CT colonography reporting recommendations.We evaluated a prospectively collected colonoscopy polyp database to identify polyps <10mm and those with cancer or advanced histology (high-grade dysplasia or villous elements).Of 32,790 colonoscopies, 15,558 colonoscopies detected 42,630 polyps <10mm in size. A total of 4790 lesions were excluded as they were not conventional adenomas or serrated class lesions.

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Topical Mitomycin C application in the treatment of refractory benign esophageal strictures in adults and comprehensive literature review

Recurrent complex esophageal strictures remain difficult to manage.

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Trabecular architecture in the StW 352 fossil hominin calcaneus

Publication date: August 2016
Source:Journal of Human Evolution, Volume 97
Author(s): Angel Zeininger, Biren A. Patel, Bernhard Zipfel, Kristian J. Carlson
Australopithecus africanus has been interpreted as having a rigid lateral foot. One mechanism contributing to a rigid foot during push-off in humans is a calcaneocuboid joint (CCJ) with limited dorsiflexion and a "close-packed" talocalcaneal joint (TCJ). In contrast, apes likely have a greater CCJ range of motion and lack a close-packed TCJ. Differences in tarsal arthrokinematics may result in different joint loading environments. In Homo sapiens, we tested the hypothesis that dorsal and plantar CCJ and the TCJ show evidence of predictable habitual loading. In Pan troglodytes, Gorilla gorilla, Gorilla beringei, and Papio ursinus, we tested the hypothesis that only the dorsal CCJ shows evidence of predictable loading. Specifically, we predicted similarity in trabecular properties across the dorsal and plantar CCJ in H. sapiens, but dissimilarity in non-humans. Additionally, we investigated trabecular properties of an A. africanus calcaneus (StW 352) to evaluate joint loading patterns in this hominin and ultimately address the evolution of these properties in H. sapiens. Contrary to predictions, the H. sapiens dorsal CCJ has a significantly higher elongation index, bone volume fraction, trabecular thickness, and trabecular number than the plantar CCJ, while trabecular properties in non-humans do not always differ as predicted between regions. H. sapiens exhibits trabecular morphology indicative of less variable TCJ loading than other groups, having the most anisotropic and rod-like struts oriented in line with predicted principal loads. Multivariate analysis shows that the StW 352 dorsal CCJ matches P. ursinus best, while the plantar CCJ matches G. beringei best and the TCJ matches that of G. gorilla best. Overall patterns suggest that the StW 352 calcaneus experienced more variable loading than H. sapiens, but less variable loading than P. troglodytes, G. gorilla, G. beringei, and P. ursinus, consistent with a large range of foot movements, probably reflecting locomotor kinematics that are unlike those of living humans or apes.

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Neotropics provide insights into the emergence of New World monkeys: New dental evidence from the late Oligocene of Peruvian Amazonia

Publication date: August 2016
Source:Journal of Human Evolution, Volume 97
Author(s): Laurent Marivaux, Sylvain Adnet, Ali J. Altamirano-Sierra, Myriam Boivin, François Pujos, Anusha Ramdarshan, Rodolfo Salas-Gismondi, Julia V. Tejada-Lara, Pierre-Olivier Antoine
Recent field efforts in Peruvian Amazonia (Contamana area, Loreto Department) have resulted in the discovery of a late Oligocene (ca. 26.5 Ma; Chambira Formation) fossil primate-bearing locality (CTA-61). In this paper, we analyze the primate material consisting of two isolated upper molars, the peculiar morphology of which allows us to describe a new medium-sized platyrrhine monkey: Canaanimico amazonensis gen. et sp. nov. In addition to the recent discovery of Perupithecus ucayaliensis, a primitive anthropoid taxon of African affinities from the alleged latest Eocene Santa Rosa locality (Peruvian Amazonia), the discovery of Canaanimico adds to the evidence that primates were well-established in the Amazonian Basin during the Paleogene. Our phylogenetic results based on dental evidence show that none of the early Miocene Patagonian taxa (Homunculus, Carlocebus, Soriacebus, Mazzonicebus, Dolichocebus, Tremacebus, and Chilecebus), the late Oligocene Bolivian Branisella, or the Peruvian Canaanimico, is nested within a crown platyrrhine clade. All these early taxa are closely related and considered here as stem Platyrrhini. Canaanimico is nested within the Patagonian Soriacebinae, and closely related to Soriacebus, thereby extending back the soriacebine lineage to 26.5 Ma. Given the limited dental evidence, it is difficult to assess if Canaanimico was engaged in a form of pitheciine-like seed predation as is observed in Soriacebus and Mazzonicebus, but dental microwear patterns recorded on one upper molar indicate that Canaanimico was possibly a fruit and hard-object eater. If Panamacebus, a recently discovered stem cebine from the early Miocene of Panama, indicates that the crown platyrrhine radiation was already well underway by the earliest Miocene, Canaanimico indicates in turn that the "homunculid" radiation (as a part of the stem radiation) was well underway by the late Oligocene. These new data suggest that the stem radiation likely occurred in the Neotropics during the Oligocene, and that several stem lineages independently reached Patagonia during the early Miocene. Finally, we are still faced with a "layered" pattern of platyrrhine evolution, but modified in terms of timing of cladogeneses. If the crown platyrrhine radiation occurred in the Neotropics around the Oligocene–Miocene transition (or at least during the earliest Miocene), it was apparently concomitant with the diversification of the latest stem forms in Patagonia.

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Clinical experiences of the continuous thoracolumbar interfascial plane (TLIP) block

An ultrasound-guided thoracolumbar interfascial plane (TLIP) block is reported as postoperative pain for lumbar vertebra surgery [1,2]. However, TLIP block cannot relieve long-term pain because the reported TLIP block can perform only single injection. This time, we report 2 cases that performed continuous TLIP block for lumbar vertebra surgeries. Case 1 was a 51-year-old woman who underwent lumbar laminoplasty at L3-4. She has had acetaminophen drug allergy and nonsteroidal anti-inflammatory drug allergy.

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Practice guidelines on the use of esophageal manometry – A GISMAD-SIGE-AIGO medical position statement

Patients with esophageal symptoms potentially associated to esophageal motor disorders such as dysphagia, chest pain, heartburn and regurgitation, represent one of the most frequent reasons for referral to gastroenterological evaluation. The utility of esophageal manometry in clinical practice is: (1) to accurately define esophageal motor function, (2) to identify abnormal motor function, and (3) to establish a treatment plan based on motor abnormalities. With this in mind, in the last decade, investigations and technical advances, with the introduction of high-resolution esophageal manometry, have enhanced our understanding and management of esophageal motility disorders.

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Risk of cancer in small and diminutive colorectal polyps

Topical Mitomycin C application in the treatment of refractory benign esophageal strictures in adults and comprehensive literature review

Recurrent complex esophageal strictures remain difficult to manage.

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Reply to “Chronic hepatitis C and diabetes: More questions than answers with the new direct acting antiviral drugs?”

We thank Wynter et al. for the interest showed towards our recent review article [1] on the impact of the sustained virological response (SVR) on diabetes mellitus (DM) in patients with chronic hepatitis C. According to their data, SVR obtained by using DAA agents has negligible effect on concomitant DM; however, the number of patients considered is really too small and the follow up period too short to provide us with conclusive statements. Moreover, they suggest that improvement in insulin resistance observed in HCV+ patients cured by IFN-based therapies+ribavirin is due to the medications themselves rather than viral eradication.

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Practice guidelines on the use of esophageal manometry – A GISMAD-SIGE-AIGO medical position statement

A 10 km time trial running bout acutely increases the number of angiogenic T-Cells in the peripheral blood compartment of healthy males

CD31⁺ T-cells have been documented to possess vasculogenic properties, and have been termed 'angiogenic T-cells' (T_ANG). No study to date has fully characterised the effect of acute exercise on T_ANG cells. Twelve male participants aged 24–45yrs undertook a running 10 km time trial, with peripheral blood samples taken pre-, immediately post- and 1-hour post-exercise for quantification of T_ANG cells and subsequent CXCR4 cell surface expression by flow cytometry. T_ANG cells demonstrated a 102% increase in number in peripheral circulation immediately post-exercise compared to pre-exercise levels, followed by a large egress (50%) from the circulation in total T_ANG cells 1-hour post-exercise. This was due to both CD4⁺ and CD8⁺ T_ANG changes, with CD8⁺ T_ANG cells displaying greater ingress (123%) and egress (52%) compared to CD4⁺ T_ANG cells (ingress: 83%, egress: 37%). CXCR4 cell surface expression intensity was only affected on CD8⁺ T_ANG cells, with a significant increase in cell surface expression immediately post-exercise vs. pre-exercise levels. CD31⁻ T-cells displayed greater redistribution than CD31⁺ T_ANG cells (119% vs. 102%). CXCR4-expressing T_ANG cells showed greater response to acute exercise than CXCR4⁻ cells, which was accompanied by large changes in CXCR4 ligand SDF-1α. The results show that acute exercise increases T_ANG cells in the circulation in response to an acute exercise stressor. Additionally, CXCR4 cell surface expression appears to be increased in response to exercise, which may result from the direct upregulation of CXCR4 on the T-cell surface, or could be due to CD31⁺ T-cells being redistributed into the blood expressing greater levels of CXCR4.

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Angiotensin II control of regional haemodynamics in rats with aortocaval fistula

Regional perfusion is reduced and the renin-angiotensin system is activated in rats with aortocaval fistula. The effects of captopril (angiotensin converting enzyme inhibitor), losartan (AT₁ receptor antagonist), and PD 123319 (AT₂ receptor antagonist) on regional blood flow and vascular conductance were assessed in rats with aortocaval fistula and sham-operated rats. Control of blood flow and vascular conductance by angiotensin II was evaluated by serial bolus injections of captopril, losartan, and PD 123319 in anaesthetized rats. In rats with fistula, PD 123319 significantly decreased, while captopril and losartan increased, mesenteric blood flow. The decrease in mesenteric blood flow by PD 123319 was significantly greater in rats with fistula compared to sham. Captopril and PD 123319 significantly decreased renal blood flow compared to losartan which increased it. In sham rats, captopril and losartan significantly increased, while PD 123319 decreased, mesenteric and renal conductance. In rats with fistula, captopril and losartan significantly increased, while PD 123319 decreased, mesenteric conductance. The significant increase produced by losartan on mesenteric conductance was greater in rats with fistula compared to sham. PD 123319 produced a significantly greater decrease in renal conductance of aortocaval fistula compared to sham rats. Captopril, losartan and PD 123319 did not significantly affect perfusion in hindquarter in rats with fistula or sham. The renin-angiotensin system is more active in the control of regional haemodynamics in rats with aortocaval fistula, and acts as mechanism of maintaining normal arterial blood pressure in these animals. In rats with fistula, AT₁ receptors predominate in regulating regional haemodynamics.

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From focal sepsis to periodontal medicine: A century of exploring the role of the oral microbiome in systemic disease

Abstract

The oral microbiome is established within a few minutes after birth and forms stable multi-species communities that engage in a dynamic equilibrium with the host immune system. Dental caries, endodontic infections and periodontal diseases are bacterially driven diseases that are caused by dysbiotic microbiomes. Over a century ago, the focal infection theory implicated these infections in the etiology of several systemic diseases, ranging from arthritis to neurodegenerative diseases. However, a lack of concrete evidence, combined with the urgency with which clinicians embraced this approach without regard for appropriate case selection, led to its demise within 30 years. In the last decade of the twentieth century, the concept of periodontal medicine was introduced to explain the correlations that were being observed between periodontitis and cardiovascular disease, rheumatoid arthritis, Alzheimer's disease, pulmonary disease, pre-term delivery of low birth weight infants, and metabolic disease. It was proposed that periodontal pathobionts played a causal role in the initiating or exacerbating certain diseases either by direct invasion or by stimulating a florid immune-inflammatory response that extended into the systemic circulation. This review will examine the strength of current evidence in establishing a causal link between oral pathobionts and systemic disease.

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Left-right coordination from simple to extreme conditions during split-belt locomotion in the chronic spinal adult cat

Abstract

Although left-right coordination is essential for locomotion, its control is poorly understood, particularly in adult mammals. To investigate the spinal control of left-right coordination, a spinal transection was performed in six adult cats that were then trained to recover hindlimb locomotion. Spinal cats performed tied-belt locomotion from 0.1 m s⁻¹ to 1.0 m s⁻¹ and split-belt locomotion with low to high (1:1.25-10) slow-fast speed ratios. With the left hindlimb stepping at 0.1 m s⁻¹ and the right hindlimb stepping from 0.2 m s⁻¹ to 1.0 m s⁻¹, 1:1, 1:2, 1:3, 1:4 and 1:5 left-right step relationships could appear. The appearance of 1:2+ relationships was not linearly dependent on the difference in speed between the slow and fast belts. The last step taken by the fast hindlimb displayed longer cycle, stance and swing durations and increased extensor activity, as the slow limb prepared to transition to swing. During split-belt locomotion with 1:1, 1:2 and 1:3 relationships, the timing of stance onset of the fast limb relative to the slow limb and placement of both limbs at contact were invariant with increasing slow-fast speed ratios. In contrast, the timing of stance onset of the slow limb relative to the fast limb and the placement of both limbs at swing onset were modulated with slow-fast speed ratios. Thus, left-right coordination is adjusted by modifying specific parts of the cycle. Results highlight the remarkable adaptive capacity of the adult mammalian spinal cord, providing insight into spinal mechanisms and sensory signals regulating left-right coordination.

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In vivo matching of postsynaptic excitability with spontaneous synaptic inputs during formation of the rat calyx of Held synapse

Abstract

In the adult, principal neurons of the medial nucleus of the trapezoid body (MNTB) are typically contacted by a single, giant terminal called the calyx of Held, whereas during early development a principal neuron receives inputs from many axons. How these changes in innervation impact the postsynaptic activity has not yet been studied in vivo. We therefore recorded spontaneous inputs and intrinsic properties of principal neurons in anesthetized rat pups during the developmental period in which the calyx forms. A characteristic bursting pattern could already be observed at postnatal day (P)2, before the formation of the calyx. At this age, action potentials (APs) were triggered by barrages of summating EPSPs causing plateau depolarizations. In contrast, at P5, a single EPSP reliably triggered APs, resulting in a close match between pre- and postsynaptic firing. Postsynaptic excitability and the size of the largest synaptic events were developmentally matched. The developmental changes in intrinsic properties were estimated by fitting in vivo current injections to a Hodgkin-Huxley-type model of the principal neuron. Our simulations indicated that the developmental increases in I_h, low-threshold K⁺-channels, as well as leak currents contributed to the reduction in postsynaptic excitability, but that low-threshold K⁺-channels specifically functioned as a dampening influence in the near-threshold range, thus precluding small inputs from triggering APs. Together, these coincident changes help to propagate bursting activity along the auditory brainstem, and are essential steps towards establishing the relay function of the calyx of Held synapse.

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Exogenous and endogenous angiotensin-ii decrease renal cortical oxygen tension in conscious rats by limiting renal blood flow

We hypothesised that both exogenous and endogenous angiotensin-II (AngII) can decrease the partial pressure of oxygen (pO₂) in the renal cortex of unrestrained rats, which might in turn contribute to the progression of chronic kidney disease. Rats were instrumented with telemeters equipped with a carbon paste electrode for continuous measurement of renal cortical tissue pO₂. The method reproducibly detected acute changes in cortical oxygenation induced by systemic hyperoxia and hypoxia. In conscious rats, renal cortical pO₂ was dose-dependently reduced by intravenous AngII. Reductions in pO₂ were significantly greater than those induced by equi-pressor doses of phenylephrine. In anaesthetised rats, renal oxygen consumption was not affected, and filtration fraction was increased only in the AngII infused animals. Oxygen delivery decreased by 50% after infusion of AngII and renal blood flow (RBF) fell by 3.3 ml min⁻¹. Equi-pressor infusion of phenylephrine did not significantly reduce RBF or renal oxygen delivery. Activation of the endogenous renin-angiotensin system in Cyp1a1Ren2 transgenic rats reduced cortical tissue pO₂. This could be reversed within minutes by pharmacological AT₁ receptor blockade. Thus AngII is an important modulator of renal cortical oxygenation via AT₁ receptors. AngII had a greater influence on cortical oxygenation than did phenylephrine. This phenomenon appears to be attributable to the profound impact of AngII on renal oxygen delivery. We conclude that the ability of AngII to promote renal cortical hypoxia may contribute to its influence on initiation and progression of chronic kidney disease.

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Congenital heart diseases and their association with the variant distribution features on susceptibility genes

Abstract

Congenital heart disease (CHD), one cause of childhood morbidity and mortality, is mainly triggered by a combination of environmental and genetic factors. Several susceptible genes, such as NKX2-5, GATA4 and TBX5, have been reported as closely related to heart and vessel development. CHD subtypes are classified by diverse clinical phenotypes such as atrial septal defects (ASD), ventricular septal defects (VSD), tetralogy of Fallot (TOF), and Holt-Oram syndrome (HOS). Here, we summarize the associations of the genetic variants in these three genes with CHD subtypes. CHD-associated variants of NKX2-5 locates mainly in the tinman domain and the homeodomain. Mutations in the homeodomain are correlated with ASD and atrioventricular block (AV block) subtypes. VSD-associated variants of GATA4 are mainly at its terminal ends. Variants of TBX5 gene are primarily in exons 3, 4, 5 and 7 and highly associated with HOS subtype. Hence, the variant distribution of NKX2-5, GATA4 and TBX5 are tightly associated with particular CHD subtypes. Further structure modelling analysis revealed that these mutated amino acid residuals are to maintain their DNA binding ability and structural stability. These signify that the structural features of these genes may be used to predict the high risk of CHD subtypes in infants.

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CLOVES syndrome: review of a PIK3CA-Related Overgrowth Spectrum (PROS)

Abstract

Overgrowth syndromes are characterized by global or localized disproportionate growth associated with other anomalies, including vascular malformations and neurological and/or visceral disorders. CLOVES (Congenital Lipomatous asymmetric Overgrowth of the trunk with lymphatic, capillary, venous, and combined-type Vascular malformations, Epidermal naevi, Scoliosis/Skeletal and spinal anomalies) is an overgrowth syndrome caused by mosaic activating mutation in gene PIK3CA, which gives rise to abnormal PI3K-AKT-mTOR pathway activation. These mutations are responsible for the clinical manifestations of the syndrome, which include low- and high-flow vascular malformations, thoracic lipomatous hyperplasia, asymmetric growth, and visceral and neurological disorders. These common anomalies are illustrated with figures from two personal cases. Identification of the clinical and genetic characteristics of CLOVES syndrome is crucial for the differential diagnosis with other overgrowth syndromes, such as Proteus or Klippel-Trenaunay (K-T) syndromes, and for the therapeutic management of the different anomalies. In this context, a new entity comprising different syndromes with phenotypic mutations in PIK3CA has been proposed, designated PIK3CA-Related Overgrowth Spectrum (PROS), with the aim of facilitating clinical management and establishing appropriate genetic study criteria.

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Publication date: August 2016
Source:Clinical Neurophysiology, Volume 127, Issue 8

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Establishing standards for neuronavigated TMS in research and clinical studies

Publication date: August 2016
Source:Clinical Neurophysiology, Volume 127, Issue 8
Author(s): Muthuraman Muthuraman, Chaitanya Venkata Chirumamilla, Sergiu Groppa

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Looking at the muscle to find out what is happening in the brain

Publication date: August 2016
Source:Clinical Neurophysiology, Volume 127, Issue 8
Author(s): Guido Rubboli, Günter Krämer

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Editorial Board

Publication date: August 2016
Source:Clinical Neurophysiology, Volume 127, Issue 8

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Testing brains with burst suppressions

Publication date: August 2016
Source:Clinical Neurophysiology, Volume 127, Issue 8
Author(s): Sampsa Vanhatalo

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Quantitative analysis of surface electromyography: Biomarkers for convulsive seizures

Publication date: August 2016
Source:Clinical Neurophysiology, Volume 127, Issue 8
Author(s): Sándor Beniczky, Isa Conradsen, Ronit Pressler, Peter Wolf
Muscle activity during seizures is in electroencephalographical (EEG) praxis often considered an irritating artefact. This article discusses ways by surface electromyography (EMG) to turn it into a valuable tool of epileptology.Muscles are in direct synaptic contact with motor neurons. Therefore, EMG signals provide direct information about the electric activity in the motor cortex. Qualitative analysis of EMG has traditionally been a part of the long-term video-EEG recordings.Recent development in quantitative analysis of EMG signals yielded valuable information on the pathomechanisms of convulsive seizures, demonstrating that it was different from maximal voluntary contraction, and different from convulsive psychogenic non-epileptic seizures. Furthermore, the tonic phase of the generalised tonic–clonic seizures (GTCS) proved to have different quantitative features than tonic seizures. The high temporal resolution of EMG allowed detailed characterisation of temporal dynamics of the GTCS, suggesting that the same inhibitory mechanisms that try to prevent the build-up of the seizure activity, contribute to ending the seizure.These findings have clinical implications: the quantitative EMG features provided the pathophysiologic substrate for developing neurophysiologic biomarkers that accurately identify GTCS. This proved to be efficient both for seizure detection and for objective, automated distinction between convulsive and non-convulsive epileptic seizures.

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Remodeling of cortical activity for motor control following upper limb loss

Publication date: Available online 16 July 2016
Source:Clinical Neurophysiology
Author(s): Laura Williams, Nikta Pirouz, J.C. Mizelle, William Cusack, Rob Kistenberg, Lewis A. Wheaton
ObjectiveUpper extremity loss presents immediate and lasting challenges for motor control. While sensory and motor representations of the amputated limb undergo plasticity to adjacent areas of the sensorimotor homunculus, it remains unclear whether laterality of motor-related activity is affected by neural reorganization following amputation.MethodsUsing electroencephalography, we evaluated neural activation patterns of formerly right hand dominant persons with upper limb loss (amputees) performing a motor task with their residual right limb, then their sound left limb. We compared activation patterns with left- and right-handed persons performing the same task.ResultsAmputees have involvement of contralateral motor areas when using their sound limb and atypically increased activation of posterior parietal regions when using the affected limb. When using the non-amputated left arm, patterns of activation remains similar to right handed persons using their left arm.ConclusionsA remodeling of activations from traditionally motor areas into posterior parietal areas occurs for motor planning and execution when using the amputated limb. This may reflect an amputation-specific adaptation of heightened visuospatial feedback for motor control involving the amputated limb.SignificanceThese results identify a neuroplastic mechanism for motor control in amputees, which may have great relevance to development of motor rehabilitation paradigms and prosthesis adaptation.

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Chronic pain, quality of life, and functional impairment after surgery due to small bowel obstruction

World Journal of Surgery

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Low-FODMAP rye bread vs. regular rye bread to relieve the symptoms of irritable bowel syndrome

Alimentary Pharmacology and Therapeutics

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Acute pancreatitis: A comparison of intervention rates precipitated by early vs guideline CT scan timing

Clinical Radiology

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Chronic hepatitis C virus infection and the risk for diabetes: A community-based prospective study

Liver International

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Genetic biomarkers associated with anti-TNF treatment response in inflammatory bowel diseases

Alimentary Pharmacology and Therapeutics

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Anti-envelope antibody responses in individuals at high risk of hepatitis C virus who resist infection

Journal of Viral Hepatitis

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Gallstones and bariatric surgery: To treat or not to treat?

World Journal of Surgery

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A randomized phase II Study of FOLFOX With or Without the MET inhibitor onartuzumab in advanced adenocarcinoma of the stomach and gastroesophageal junction

The Oncologist

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Gastric bypass procedure for type 2 diabetes patients with BMI <28 kg/m<sup>2</sup>

Surgical Endoscopy

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Nucleic acid polymers: Broad spectrum antiviral activity, antiviral mechanisms and optimization for the treatment of hepatitis B and hepatitis D infection

Antiviral Research

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Current status of preoperative oesophago-gastro-duodenoscopy (OGD) in bariatric NHS units--a BOMSS survey

Obesity Surgery

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Reconstruction of hypopharyngeal and esophageal defects using a gastric tube after total esophagectomy and pharyngolaryngectomy

Journal for Oto-Rhino-Laryngology, Head and Neck Surgery

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Relationship between ¹⁸F-FDG PET/CT findings and HER2 expression in gastric cancer

The Journal of Nuclear Medicine

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Long-term clinical outcomes of rectal neuroendocrine tumors according to the pathologic status after initial endoscopic resection: A KASID multicenter study

The American Journal of Gastroenterology

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Does IV contrast extravasation on CT in anticoagulant-related rectus sheath and iliopsoas hematoma predict hematoma expansion and patient outcomes

Abdominal Imaging

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Surveillance of patients with long-segment Barrett's esophagus: a multicenter prospective cohort study in Japan

Journal of Gastroenterology and Hepatology

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Sleep quality and obesity in young subjects: A meta-analysis

Obesity Reviews

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Health economic analysis of costs of laparoscopic and open surgery for rectal cancer within a randomized trial (COLOR II)

Surgical Endoscopy

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Acute eosinophilic pneumonia caused by camostat mesilate: The first case report

Respiratory Medicine Case Reports

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EFFECT OF DIFFERENT PROCESSING METHODS ON POLYPHENOLIC CONTENT AND ANTIOXIDANT ACTIVITY OF BROAD BEANS (VICIA FABA)

2016-07-18T01-07-28Z
Source: International Journal of Current Research and Review
Pinki Saini, Priyanka Singh, Shreyasi Dubey, and Ayushi Srivastava.
Objective: The effects of processing on total phenolic components and antioxidant activity in commonly consumed broad bean was investigated. Methods: The raw and processed samples were extracted with 70% methanol and analysed for antioxidant components and antioxidant activity. Results: Processing of legumes caused decrease in total phenolic content when compared to the raw samples. However, the dry heating caused remarkable increase in tannin contents (6.98±0.53 g TAE/100 g extract). The flavanoid and β carotene content was significantly reduced on processing of samples. Raw sample of D. lablab was found to possess the highest DPPH (73.5±2.5%), Reducing power (4.9±0.68 mg ascorbic acid/gm) and Iron chelating capacity than other samples. Conclusion: Maximum retention of antioxidant activity was observed in dry heated samples. Higher correlation was found between phenolic content and chelating capacity (r2=0.945) but a poor correlation with DPPH. Moreover, the content of tannins gave good correlation (r2=0.7450.913) with Iron chelating and DPPH assays.

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IMMUNOHISTOCHEMISTRY STUDY FOR HER-2/NEU EXPRESSION IN LESIONS OF UTERINE CERVIX

2016-07-18T01-07-28Z
Source: International Journal of Current Research and Review
Pramod Sarwade, Sunita Patil, Rajan Bindu.
Objectives: 1. To study expression of HER-2/neu in lesions of uterine cervix by immunohistochemistry. 2. To correlate expression of HER-2/neu with histological type, grade and stage of cervical malignancy. Methods: Total 50 cases were included during the period from October 2013 to October 2015. Immunohistochemical studies were done on formalin-fixed paraffin embedded tissue blocks with HER-2/neu antibody. Results: Out of fifty cases, 10 cases (20%) of adenocarcinoma (ADC), 1 case (2%) of adenosquamous carcinoma, 4 cases (8%) of CIN, 3 cases (6%) of chronic cervicitis, 2 cases (4%) of chronic cervicitis with squamous metaplasia, 30 cases (60%) of squamous cell carcinoma of cervix (SCC). And It Amongst 9 cases of poorly differentiated SCC cases, 2 cases showed 1+ positivity, 2 cases showed 2+ positivity, 1 case showed 3+ positivity. Out of 16 cases of moderately differentiated SCC, 4 cases showed 1+ positivity, 4 cases showed 2+ positivity, 2 cases showed 3+ positivity. Among 5 cases of well differentiated SCC, 2 cases showed 1+ positivity. Out of 10 cases of adenocarcinoma of cervix, 2 cases of well differentiated adenocarcinoma showed 1+ positivity. Each 2 cases of moderately differentiated adenocarcinoma showed 1+ and 2+ positivity. Cervical carcinoma cases with involvement of lymph node and parametrium showed stronger HER-2/neu staining. Conclusion: Higher HER-2/neu expression was noted in malignant lesion as compared to benign lesions. Stronger HER-2/neu expression was noted among higher stage tumors and those with parametrial and lymph node involvement.

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CLINICO-EPIDEMIOLOGICAL PROFILE OF PATIENTS PRESENTING WITH ACUTE POISONING

2016-07-18T01-07-28Z
Source: International Journal of Current Research and Review
Shreya M. Shah, Pratik D. Asari, Anand J. Amin.
Objectives: The present study was conducted with aim to generate the clinico-epidemiological data of Acute Poisoning cases presented at hospital which in turn would be helpful in planning rational use of available resources for prevention and management of poisoning cases. Methods: Observational cross-sectional study was carried out from October, 2013 to March, 2014. Patients of either sex of above 12 years of age of acute poisoning admitted in medicine emergency ward were included. Obtained data were analyzed using descriptive statistics and results were expressed as percentage and mean. Results: Of 340 cases, male and female patients were 216(63.53%) and 124(36.47%) respectively. Male: female ratio was 1.74:1. Most of the cases belonged to the age group of 21-30 years (38.82%). Ingestion was the most common route of exposure (71.47%). Intentional (suicidal) poisoning was recorded in 62.06% cases followed by accidental poisoning (37.94%). Common causes of poisoning were poisonous bites (25.88%) followed by organophosphate (19.41%) and unknown compound (19.41%) ingestion. Commonly observed symptoms were vomiting, local symptoms in cases of bites, altered sensorium, giddiness and breathing difficulty. Average number of days of hospitalization was 5.39 days. Complete recovery and mortality were seen in 66.47% and 16.47% cases respectively. Conclusion: Acute Poisoning is one of the leading causes of hospital admissions and mortalities. High costs of treatment and intensive care burden makes poisoning an important area for further research. The current study has managed to contribute substantial additional information regarding the epidemiology and outcome of poisoning in a tertiary care hospital at a district level.

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STUDY OF OXIDATIVE STRESS PARAMETERS IN TYPE-II DIABETES MELLITUS AND THEIR CORRELATION WITH BLOOD GLUCOSE LEVEL

2016-07-18T01-07-28Z
Source: International Journal of Current Research and Review
Prakash P. Malam, Anand J. Amin, Ashish C. Zala, Vipul M. Navadiya, Dhruv Patel, Dharna A. Patel.
Objective: Increasing evidence has underlined the importance of oxidative stress in the pathophysiology of type-II diabetes mellitus and its contribution to the associated complications. However the correlation between oxidative stress parameters and blood glucose levels is not clearly understood. Method: Present study was done to evaluate the oxidative stress parameters in patients with type-II diabetes mellitus and to check the correlation, if any, between these parameters and blood glucose. Plasma malondialdehyde and superoxide dismutase levels were measured in thirty type-II diabetes mellitus and thirty normotensive subjects. Fasting and post-prandial blood glucose correlation was analyzed by Pearsons correlation. Result: Enhanced oxidative stress was observed in type-II diabetes mellitus subjects as denoted by raised plasma malondialdehyde levels and reduced superoxide dismutase levels. Conclusion: Plasma malondialdehyde correlated positively whereas superoxide dismutase showed negative correlation with blood glucose in type-II diabetes mellitus subjects. No significant correlation was observed between these parameters and blood glucose levels in normotensive controls.

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THE ROLE OF DECOY CELLS IN URINE CYTOLOGY IN DETECTION OF POLYOMAVIRUS INFECTION IN POST RENAL TRANSPLANT PATIENTS

2016-07-18T01-07-28Z
Source: International Journal of Current Research and Review
Pavithra P., Praveen S. Kumar.
Objective: To assess the role of urine cytology as a simple and noninvasive tool in assessment of post renal transplant polyoma virus infection Case Report: Polyoma virus BK can infect the renal transplant patients on immunosuppressive therapy resulting in progressive renal allograft dysfunction and graft loss. We report a case of 42 year old male who underwent renal transplant six weeks ago followed by immunotherapy, had signs of rejection in the immediate post- transplant period for which he was put on antithymocyte globulin. He now presented with dysuria and urine cytology was done. Viral cytopathic effect in the form of enlarged nucleus with basophilic viral intranuclear inclusions and ground glass chromatin known as decoy cells were seen. Conclusion: Urine cytology can be used as a simple and cost effective screening method for monitoring the renal transplant patients for polyoma virus allograft nephropathy

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Πληροφορίες

Δευτέρα 18 Ιουλίου 2016

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