bluuebunny/crossref_metadata_2025 huggingface dataset:
Novel Respiratory Syncytial Virus-Like Particle Vaccine Composed of the Postfusion and Prefusion Conformations of the F Glycoprotein
Authors: Cimica Velasco , Boigard Hélène , Bhatia Bipin , Fallon John T. , Alimova Alexandra , Gottlieb Paul , Galarza Jose M.
Published: March 2016

Respiratory syncytial virus (RSV) is the leading cause of severe respiratory disease in infants and children and represents an important global health burden for the elderly and the immunocompromised. Despite decades of research efforts, no licensed vaccine for RSV is available. We have developed virus-like particle (VLP)-based RSV vaccines assembled with the human metapneumovirus (hMPV) matrix protein (M) as the structural scaffold and the RSV fusion glycoprotein (F) in either the postfusion or prefusion conformation as its prime surface immunogen. Vaccines were composed of postfusion F, prefusion F, or a combination of the two conformations and formulated with a squalene-based oil emulsion as adjuvant. Immunization with these VLP vaccines afforded full protection against RSV infection and prevented detectable viral replication in the mouse lung after challenge. Analyses of lung cytokines and chemokines showed that VLP vaccination mostly induced the production of gamma interferon (IFN-γ), a marker of the Th1-mediated immune response, which is predominantly required for viral protection. Conversely, immunization with a formalin-inactivated RSV (FI-RSV) vaccine induced high levels of inflammatory chemokines and cytokines of the Th2- and Th17-mediated types of immune responses, as well as severe lung inflammation and histopathology. The VLP vaccines showed restricted production of these immune mediators and did not induce severe bronchiolitis or perivascular infiltration as seen with the FI-RSV vaccine. Remarkably, analysis of the serum from immunized mice showed that the VLP vaccine formulated using a combination of postfusion and prefusion F elicited the highest level of neutralizing antibody and enhanced the Th1-mediated immune response.
Neonatal ventricular fibrillation and an elusive ALCAPA: things are not always as they seem
Authors: Walker Tracie C , Renno Markus S , Parra David A , Guthrie Scott O
Published: March 2016

An anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital cardiac condition that typically presents with poor feeding and failure to thrive from progressive myocardial ischaemia. Previous reports of ALCAPA presenting with ventricular fibrillation (VF) have suggested a causative relationship. In this case, we present a neonate with VF without apparent cause after an extensive evaluation. Following implantable cardioverter-defibrillator placement for presumed idiopathic VF, at which time she also underwent surgical ligation of a patent ductus arteriosus (PDA), the neonate developed haemodynamic instability that ultimately was found to be due to ALCAPA. Numerous echocardiograms had missed the ALCAPA in the setting of mildly elevated pulmonary artery pressure. We discuss the limitations of current ultrasound technology in diagnosing ALCAPA in the setting of pulmonary hypertension and explain why the relationship between this patient's diagnosis of ALCAPA and her episode of VF is not clearly causative.
Assessing simulation-based clinical training: comparing the concurrent validity of students' self-reported satisfaction and confidence measures against objective clinical examinations
Authors: Carter Owen B J , Mills Brennen W , Ross Nathan P , Miles Alecka K , Mould Jonathan M , O'Brien Robert P
Published: March 2016

Introduction

Simulation-based education (SBE) literature is replete with student satisfaction and confidence measures to infer educational outcomes. This research aims to test how well students' satisfaction and confidence measures correlate with expert assessments of students' improvements in competence following SBE activities.

Methods

N=85 paramedic students (mean age 23.7 years, SD=6.5; 48.2% female) undertook a 3-day SBE workshop. Students' baseline competence was assessed via practical scenario simulation assessments (PSSAs) administered by expert paramedics and confidence via a questionnaire. Postworkshop competence and confidence plus self-reported students' satisfaction were remeasured.

Results

PSSA scores increased significantly between baseline and post workshop (35.7%→53.4%, p<0.001), as did students' confidence (55.7%→60.5%, p<0.001), and their workshop satisfaction was high (71.0%). Satisfaction and postworkshop confidence measures were moderately correlated (r=0.377, p=0.001). However, competence improvements were not significantly correlated with either satisfaction (r=−0.107 p=0.344) or change in confidence (r=−0.187 p=0.102).

Discussion

Students' self-reported satisfaction and confidence measures bore little relation to expert paramedics' judgements of their educational improvements. Satisfaction and confidence measures appear to be dubious indicators of SBE learning outcomes.
Anaesthesia and drug interactions in dogs and cats
Authors: Zoff Aurora , Thompson Kate , Senior Mark
Published: March 2016

The increasing use of balanced anaesthetic protocols, as well as more animals that are receiving long‐term medication being presented for anaesthesia, means the potential for drug interactions during anaesthesia is high. It is important to know about the possible deleterious interactions that may occur, both in vitro and in vivo, to ensure optimal patient safety, as well as about the possible beneficial effects that may result from synergistic drug behaviour. This article explains the classification of drug interactions and discusses some common interactions – both positive and negative – that clinicians may face when administering anaesthetic agents to dogs and cats.
Insuring a veterinary practice: (2) Reducing the risk of claims
Authors: Harris Judy
Published: March 2016

The right insurance policy can be an important safeguard for a practice, but choosing the right cover can be a daunting task. In an article in last month's In Practice, Judy Harris explained what to look out for in a policy. In this second article, she discusses ways to reduce the frequency of claims and steps to take when something goes wrong.
Improved quality of patient care through routine second review of histopathology specimens prior to multidisciplinary meetings
Authors: Kuijpers Chantal C H J , Burger Gerard , Al-Janabi Shaimaa , Willems Stefan M , van Diest Paul J , Jiwa Mehdi
Published: March 2016

Aim

Double reading may be a valuable tool for improving quality of patient care by identifying diagnostic errors before final sign-out, but standard double reading would significantly increase costs of pathology. We assessed the added value of intradepartmental routine double reading of histopathology specimens prior to multidisciplinary meetings.

Methods

Diagnoses, treatment plans and prognoses of patients are often discussed at multidisciplinary meetings. As part of the daily routine, all pathology specimens to be discussed at upcoming multidisciplinary meetings undergo prior intradepartmental double reading. We identified all histopathology specimens from 2013 that underwent such double reading and determined major and minor discordance rates based on clinical relevance between the initial and consensus sign-out diagnoses.

Results

We included 6796 histopathology specimens that underwent double reading, representing approximately 8% of all histopathology cases at our institution in 2013. Double reading diagnoses were concordant in 6566 specimens (96.6%). Major and minor discordances were observed in 60 (0.9%) and 170 (2.5%) specimens, respectively. Urology specimens had significantly more discordances than other tissues of origin, Gleason grading of prostate cancer biopsies being the most frequent diagnostic problem. Furthermore, premalignant and malignant cases showed significantly higher discordance rates than the rest. The vast majority (90%) of discordances represented changes within the same diagnostic category (eg, malignant to malignant).

Conclusions

Routine double reading of histopathology specimens prior to multidisciplinary meetings prevents diagnostic errors. It resulted in about 1% discordant diagnoses of potential clinical significance, indicating that second review is worthwhile in terms of patient safety and quality of patient care.
Unilateral autoimmune orchitis with concurrent contralateral testicular atrophy in a two‐year‐old Newfoundland dog
Authors: Donnelly Callum George , Cheong Soon Hon , Gilbert Robert O
Published: March 2016

A two‐year‐old, entire male Newfoundland dog was referred for suspected unilateral cryptorchidism. On examination the dog had two descended testicles, however, the right testis was markedly smaller than the left. Collected ejaculates were consistently azoospermic and leucospermic. The dog was castrated and the testes examined histologically revealing a lyphoplasmacytic orchitis in the left testis and fibrosis with evidence of vascular damage in the smaller right testis. These findings suggest sympathetic contralateral autoimmune testicular disease in the canine, a pathology not reported in the canine species until now.
Diary of a parliamentary intern
Authors: Ridge Anthony
Published: March 2016

Parliamentary intern Anthony Ridge considers antimicrobial resistance and suspects that this year will be a major year for political decisions on this topic.
Consider the workhorse: Nonhomologous end-joining in budding yeast
Authors: Emerson Charlene H. , Bertuch Alison A.
Published: March 2016

DNA double strand breaks (DSBs) are dangerous sources of genome instability and must be repaired by the cell. Nonhomologous end-joining (NHEJ) is an evolutionarily conserved pathway to repair DSBs by direct ligation of the ends, with no requirement for a homologous template. While NHEJ is the primary DSB repair pathway in mammalian cells, conservation of the core NHEJ factors throughout eukaryotes makes the pathway attractive for study in model organisms. The budding yeast, Saccharomyces cerevisiae, has been used extensively to develop a functional picture of NHEJ. In this review, we will discuss the current understanding of NHEJ in S. cerevisiae. Topics include canonical end-joining, alternative end-joining, and pathway regulation. Particular attention will be paid to the NHEJ mechanism involving core factors, including Yku70/80, Dnl4, Lif1, and Nej1, as well as the various factors implicated in the processing of the broken ends. The relevance of chromatin dynamics to NHEJ will also be discussed. This review illustrates the use of S. cerevisiae as a powerful system to understand the principles of NHEJ, as well as in pioneering the direction of the field.
Effects of a non-synonymous CBG gene single nucleotide polymorphism (SNP) on meat-quality traits in Berkshire pigs
Authors: Kwon Seul Gi , Hwang Jung Hye , Park Da Hye , Kim Tae Wan , Kang Deok Gyeong , Kang Kyung Hee , Kim Il-Suk , Ha Jeongim , Kim Chul Wook
Published: March 2016

Corticosteroid-binding globulin (CBG) is a plasma transport protein that has glucocorticoid-binding activity. In the present study, we identified CBG gene expression in several tissues of four pig breeds: Berkshire, Duroc, Landrace, and Yorkshire. Expression of CBG mRNA was detected in the liver of all four breeds, and was the highest in Berkshire pigs. We also found single nucleotide polymorphisms (SNPs) in the CBG gene from Berkshire pigs, including SNP c.919G>A, which corresponds to 307G>R. We analyzed the relationships between this CBG variant and various meat-quality traits. The SNP was significantly associated with backfat thickness, post-mortem pH24h, meat color [CIE a* (redness), CIE b* (yellowness)], water-holding capacity, fat content, moisture content, protein content, cooking loss, and shear force. However, the effects differed by gender: the values were significantly associated with almost all traits in gilts, whereas only cooking loss and shear force were shown significantly in barrows. The variant G allele was associated with decreases in backfat thickness, post-mortem pH24h, CIE a*, fat content, and cooking loss, but with increases in CIE b*, water-holding capacity, moisture content, protein content, and shear force. Because the general correlation between meat-quality traits were not validated in the present study, we suggest that certain SNP might be used in the restrictive application to distinguish meat-quality traits.
Effects of an exogenous enzyme-containing inoculant on fermentation characteristics of barley silage and on growth performance of feedlot steers
Authors: Addah W. , Baah J. , McAllister T.A.
Published: March 2016

This study investigated the effects of an inoculant on silage fermentation, aerobic stability, and the growing and finishing performance of feedlot steers. Whole-crop barley (Hordeum vulgare L.) was chopped, wilted [350–400 g kg−1 dry matter (DM)], and ensiled without (Control) or with (Treated) a bacterial inoculant containing a mixture of Pediococcus pentosaceus, Lactobacillus plantarum, and Propionibacterium freudenreicheii (1.3 × 105 CFU g−1 forage), as well as enzymes applied to fresh forage ensiled in mini or Ag-Bag® silos. Inoculation resulted in a pH decline (P < 0.05) from 6.0 on the day of ensiling to <4.0 after 3 d. In contrast, it required more than 20 d for the pH of the Control silage to fall below 4.0. Inoculant reduced (P < 0.05) the concentration of acetic acid and aerobic stability of silage, as evidenced by a higher (P < 0.05) temperature and pH in aerobically exposed silage. Although the inoculant accelerated pH decline during ensiling, it did not improve the growth performance (P < 0.05) or alter the carcass traits of steers. It is possible that a reduction in the aerobic stability of the inoculated silage may have contributed to this outcome.
Determinants of enrollment in public incentive programs for forest management and their effect on future programs for woody bioenergy: evidence from Virginia and Texas
Authors: Wolde Bernabas , Lal Pankaj , Gan Jianbang , Alavalapati Janaki , Taylor Eric , Burli Pralhad
Published: March 2016

Several federal- and state-sponsored programs, including cost-sharing arrangements, tax incentives, and technical assistance programs, are available to forestland owners, aiming to encourage desired forest management practices and outcomes. However, enrollment rates in such programs are low, and trends of forestland parcelization hint at an even smaller enrollment rate in the future. Therefore, it is important to understand how socioeconomic attributes of forestland owners and past experience with such programs affect the likelihood of enrollment in public incentive programs. Among others, this will help us provide tailored information to forestland owners who are less likely to use these opportunities through extension and outreach programs. Towards this end, we conducted a survey of 1800 forestland owners in Virginia and Texas. Our recursive partitioning, logistic regression, and Cochran–Armitage trend test results suggest that forestland owners who are less likely to enroll in such programs have relatively smaller forestland acreage, a lower level of education, and shorter land ownership tenure. We also find that forestland owners with experience in public incentive programs tend to attach higher importance to potential programs, including those that do not directly benefit them. We also identify threshold values for explanatory variables such as acreage and tenure length.
Sitka black-tailed deer (Odocoileus hemionus sitkensis) adjust habitat selection and activity rhythm to the absence of predators
Authors: Bonnot Nadège C. , Morellet Nicolas , Hewison A.J. Mark , Martin Jean-Louis , Benhamou Simon , Chamaillé-Jammes Simon
Published: March 2016

Although individuals must generally trade off acquisition of high-quality resources against predation risk avoidance, removal of top predators by humans has resulted in many large herbivores experiencing novel conditions where their natural predators are absent. Antipredator behaviors should be attenuated or lost in such a context of relaxed predation pressure. To test this prediction, we analyzed daily and seasonal habitat selection and activity rhythm (both commonly linked to predation risk) of GPS-collared Sitka black-tailed deer (Odocoileus hemionus sitkensis Merriam, 1898) on predator-free islands (British Columbia, Canada). In marked contrast to the behavioral patterns commonly observed in populations subject to predation risk, we documented a very low day–night contrast in habitat selection. Moreover, we observed higher activity during daytime than nighttime, as expected for nonhunted populations. We also showed that resource selection was primarily driven by seasonal variations in resource availability. These results are consistent with the expected attenuation of antipredator behaviors in predation-free environments. However, we also observed marked crepuscular activity peaks, which are commonly interpreted as an antipredator response in ungulates. Our study indicates that large herbivores are able to adjust certain antipredator behaviors under relaxed selection, notably habitat selection and activity rhythm, while others persist despite the long-term absence of predators.
Improved LRC Based on Combined Virtual Training Samples for Face Recognition
Authors: Huang Wei , Wang Xiaohui , Zhu Yinghui , Zheng Gengzhong
Published: March 2016

Lack of training samples always affects the performance and robustness of face recognition. Generating virtual samples is one of effective methods to expand the training set. When the virtual samples are able to simulate the variations of facial images including variations of illuminations, facial postures and the facial expressions, the robustness will be enhanced and the accuracy will be improved obviously in the face recognition problem. In this paper, an improved linear representation-based classification combined virtual samples (ILRCVS) is proposed. First, we design a new objective function that simultaneously considers the information of the virtual training samples and the virtual test sample. Second, an alternating minimization algorithm is proposed to solve the optimization problem of the objective function. Finally, a new classification criterion combined with the virtual training and test sample is proposed. Experimental results on the Georgia Tech, FERET and Yale B face databases show that the proposed method is more robust than three state-of-the-art face recognition methods, LRC, SRC and CRC.
Evacuating from an Unknown Affected Area
Authors: Wei Qi , Tan Xuehou , Jiang Bo , Wang Lijuan
Published: March 2016

We consider the problem of evacuating some people from an unknown convex region. The people do neither have information about the region boundary nor their positions. We seek competitive strategy that achieves a competitive ratio of the evacuation path over the shortest path. In the scenario of general plane, we propose a strategy SOP for one group, and prove that its competitive ratio is 19.64. And we propose a 14.37-competitive strategy STP for two groups. Also, we present efficient strategies in the scenario of grid network. Furthermore, our strategies can be used for guiding the robot to search the boundary of an unknown region.
Noncrossing partitions, fully commutative elements and bases of the Temperley–Lieb algebra
Authors: Gobet Thomas
Published: March 2016

We introduce a new basis of the Temperley–Lieb algebra. It is defined using a bijection between noncrossing partitions and fully commutative elements together with a basis introduced by Zinno, which is obtained by mapping the simple elements of the Birman–Ko–Lee braid monoid to the Temperley–Lieb algebra. The combinatorics of the new basis involve the Bruhat order restricted to noncrossing partitions. As an application we can derive properties of the coefficients of the base change matrix between Zinno’s basis and the well-known diagram or Kazhdan–Lusztig basis of the Temperley–Lieb algebra. In particular, we give closed formulas for some of the coefficients of the expansion of an element of the diagram basis in the Zinno basis.
Diversifying Search Moves in a Shuffled Differential Evolution Algorithm
Authors: Ahandani Morteza Alinia , Sareshkeh Seyyed Sadegh Bibak
Published: March 2016

The shuffled differential evolution (SDE) is a recently proposed version of differential evolution (DE). However the SDE employs several efforts to compensate limited amount of search moves in the original DE, but these efforts are performed by the same operator. To vary search moves of the SDE, this research proposes employing a secondary mutation operator beside of first mutation operator. This new mutation operator can generate some different offspring than those generated by the first one. Experiments demonstrate a better performance of the proposed algorithm than the SDE. In a later part of the comparative experiments, performance comparisons of the proposed algorithm with some modern DE and other evolutionary algorithms reported in the literature confirm a better or at least a competitive performance of our proposed algorithm. Also a real-world optimization problem, namely, Spread Spectrum Radar Polly phase Code Design, is solved to show the wide applicability of the DSDE.
Rebuilding the Leninist Party Rule: Chinese Communist Party under Xi Jinping's Stewardship
Authors: GORE Lance L P
Published: March 2016

In 2015, Xi Jinping tried to restore many Leninist features to the Chinese Communist Party (CCP). He took measures to rebuild the ideological faith, entrench Party organisations with state administration and run the CCP as a meritocracy. “Party groups” (dangzu) are extended to non-governmental, non-profit and other societal organisations. He insisted that party members must observe both formal disciplines and informal norms of the Party, and show loyalty to the leadership.
Chinese Society: Stability and Governance
Authors: ZHAO Litao
Published: March 2016

Chinese society was largely stable in 2015 despite the slower economic growth and the stock market crash. Overall, the Chinese Communist Party (CCP) has prevented local protests from spreading and escalating into a political threat on a national scale. In November 2015, the CCP announced the guidelines for the 13th Five-Year Plan (2016-2020). The shift towards “innovative, coordinated, green, open and shared” development would require more changes in government and society.
Replicated Computational Results (RCR) Report for “Automatic Moment-Closure Approximation of Spatially Distributed Collective Adaptive Systems”
Authors: Lück Alexander
Published: March 2016

“Automatic Moment-Closure Approximation of Spatially Distributed Collective Adaptive Systems” by Feng, Hilston, and Galpin presents detailed simulation analysis results for three models of spatially distributed collective adaptive systems. In this replicated computational results report, the corresponding implementation together with a documentation that was provided to the reviewer by the authors are considered. The software was installed, and new simulation results were generated and compared to the original results. The installation of the software did not result in any problems, and the comparison of the results yielded that the published results are replicable.
Future proofing the digital society
Authors: Shankar Kalpana
Published: March 2016

In this article, I briefly introduce digital curation, discuss some of the successes of the process (and a cautionary tale), and invite readers to contribute articles.
Src kinases play a novel dual role in acute pancreatitis affecting severity but no role in stimulated enzyme secretion
Authors: Nuche-Berenguer Bernardo , Ramos-Álvarez Irene , Jensen R. T.
Published: March 2016

In pancreatic acinar cells, the Src family of kinases (SFK) is involved in the activation of several signaling cascades that are implicated in mediating cellular processes (growth, cytoskeletal changes, apoptosis). However, the role of SFKs in various physiological responses such as enzyme secretion or in pathophysiological processes such as acute pancreatitis is either controversial, unknown, or incompletely understood. To address this, in this study, we investigated the role/mechanisms of SFKs in acute pancreatitis and enzyme release. Enzyme secretion was studied in rat dispersed pancreatic acini, in vitro acute-pancreatitis-like changes induced by supramaximal COOH-terminal octapeptide of cholecystokinin (CCK). SFK involvement assessed using the chemical SFK inhibitor (PP2) with its inactive control, 4-amino-7-phenylpyrazol[3,4-d]pyrimidine (PP3), under experimental conditions, markedly inhibiting SFK activation. In CCK-stimulated pancreatic acinar cells, activation occurred of trypsinogen, various MAP kinases (p42/44, JNK), transcription factors (signal transducer and activator of transcription-3, nuclear factor-κB, activator protein-1), caspases (3, 8, and 9) inducing apoptosis, LDH release reflective of necrosis, and various chemokines secreted (monocyte chemotactic protein-1, macrophage inflammatory protein-1α, regulated on activation, normal T cell expressed and secreted). All were inhibited by PP2, not by PP3, except caspase activation leading to apoptosis, which was increased, and trypsin activation, which was unaffected, as was CCK-induced amylase release. These results demonstrate SFK activation is playing a dual role in acute pancreatitis, inhibiting apoptosis and promoting necrosis as well as chemokine/cytokine release inducing inflammation, leading to more severe disease, as well as not affecting secretion. Thus, our studies indicate that SFK is a key mediator of inflammation and pancreatic acinar cell death in acute pancreatitis, suggesting it could be a potential therapeutic target in acute pancreatitis.
The Natural History of Pancreatic Cancer in Manitoba: A Population Based Study
Authors: Martin Jack , Weinerman Brian H
Published: March 2016

Adenocarcinoma of the pancreas is a virulent malignancy. A retrospective study was undertaken to determine the natural history of the disease in Manitoba, and to examine which facets of the disease might predict survival. A retrospective review of the Manitoba Tumour Registry from January 1987 to December 1989 was performed. Two hundred and fourteen exocrine cases were identified, and known islet cell tumours, lymphomas and sarcomas were excluded. The variables analyzed were age, sex, surgical or radiological stage of disease, pathological differentiation, means of diagnosis and treatment. There were 112 females and 102 males with a median age of 73 years (80% of patients were older than 60 years). The mean survival from time of diagnosis was only six weeks. Univariate analysis identified male sex, advanced stages and poor differentiation as poor prognostic indicators. Multivariate analysis revealed that advanced stage and lack of differentiation were independent prognostic variables. Treatment, which was very selective, was also noted on univariate analysis to be a prognostic indicator but was not used in the multivariate regression analysis. The poor prognosis of all individuals confirms the rationale of trying to develop better treatments for all stages of disease, and stage and pathological differentiation should be taken into account when designing clinical trials.
Endoscopic Variceal Ligation for Treatment of Bleeding Varices
Authors: Goff John S
Published: March 2016

Endoscopic variceal ligation (EVL) was developed as an alternative to endoscopic variceal sclerosis (ES) because of the latter′s high complication rate. The new technique involves placement of small elastic bands around the variceal channels in the distal esophagus. Initial open trials with EVL showed that it was safe and effective therapy for bleeding esophageal varices. EVL can be used emergently to control actively hemorrhaging varices and electively to eradicate varices with repeated sessions. When compareJ directly with results obtained with ES retrospectively and prospectively, EVL is equal or superior in preventing rebleeding while causing many fewer complications. Combining the two techniques may be even more effective than either alone at eradicating varices. Combination therapy has achieved eradication of varices in an average of three sessions, which is one to three fewer sessions than generally reported to achieve eradication with EVL or ES alone. Combination therapy has also been used to control bleeding gastric varices effectively. EVL, alone or with low dose ES, seems to be the safest and most effective endoscopic means for controlling bleeding from esophageal or gastric varices. EVL needs to be evaluated for prophylactic treatment of esophageal varices since its low morbidity profile may make it more suitable than ES for prophylactic treatment.
Lithotripsy of Pancreatic Stones in a Patient with Cystic Fibrosis: Successful Treatment of Abdominal Pain
Authors: Weiss AA , Greig JM , Fache S
Published: March 2016

Endoscopic pancreatic sphincteroromy and removal of pancreatic stones has been helpful in selected cases of patients with chronic pancreatitis. This article reports the case of an 18-year-old native Indian woman with cystic fibrosis who was experiencing pain related to pancreatitis, complicated by pancreatic duct stricture and lithiasis. Subsequent dilation of the pancreatic stricture and lithotripsy of the pancreatic ductal stones successfully eliminated the abdominal pain
Insurance Rating of Patients with Inflammatory Bowel Disease: Report of a Conference on Morbidity and Mortality
Authors: Beck Ivan T , Leddin Desmond J , Lemire Suzanne E , Shaffer Eldon A , Sutherland Lloyd R , Thomson Alan BR , Tremblay Guy
Published: March 2016

Patient members reported to the Crohn’s and Colitis Foundation of Canada (CCFC) about their difficulties to obtain insurance. In 1991, the Lay Board of the CCFC requested its Medical Advisory Board (MAB) to investigate this problem. At that time, insurance ratings could be illustrated by the 1985 edition of Brackenridge’s monograph on life risks. The MAB found that data on mortality were outdated. A conference on morbidity and mortality of inflammatory bowel disease (IBD) was organized by the authors and held in May 1992. Based on questionnaires to patients, evidence provided by invited speakers and the results of small group conferences, it was concluded that patients with IBD have difficulties in obtaining insurance, even though the quality of life and mortality of IBD patients is not very different from that of the general population. However, the mortality rate of the healthy insured population is lower than that of the general population, and thus much lower than that of IBD patients. Patients have a better chance to obtain insurance if there is a close cooperation between the treating physician and the medical officer of the insurance company. Changes have occurred since the conference held in May 1992. The recent edition of Brackenridge’s text (1992) provides a better prognosis but unfortunately unchanged rating for patients with IBD than did the 1985 edition. Close cooperation between the Patient Advisory Committee of the CCFC and the Executives of the Canadian Life Insurance Medical Officers Association may further improve the insurance rating of patients with IBD.
Vitamin E Prevents Cold Wrap Restraint Stress‐Induced Intestinal Fluid Transport Alterations in Rats
Authors: Burdick Scott , Cui Ningren , Empey Lonnie R , Fedorak Richard N
Published: March 2016

Psychological stress may alter gastrointestinal absorptive function by increasing the quantity of intestinal free radicals or by lowering endogenous intestinal free radical scavenging capacity. Vitamin E has been shown to be a potent endogenous antioxidant and free radical scavenger under both physiological and pathological conditions. The purpose of this study was to determine whether cold wrap restraint stress altered in vivo intestinal fluid absorption in rats, and whether vitamin E administration prior to the induction of cold wrap restraint stress could prevent such changes in intestinal secretion. Jejunal, ileal and colonic fluid and electrolyte transport rates were measured in vivo using an isolated loop technique. Cold wrap restraint stress reduced in vivo fluid absorption in the ileum and colon, but not in the jejunum. Administration of vitamin E prior to the cold wrap restraint stress procedure completely prevented this alteration of ileal and colonic fluid absorption.
Effect of Erythromycin on Orocecal Transit Time in Normal Healthy Male Subjects: A Double‐Blind, Placebo Controlled Study
Authors: Minocha Anil , Gallo Steven H
Published: March 2016

OBJECTIVE: To investigate the effect of erythromycin on orocecal transit time (OCTT) in 17 healthy male subjects in a double‐blind, placebo controlled crossover trial.

SUBJECTS AND METHODS: After an overnight fast, each subject received 250 mg erythromycin base, 500 mg erythromycin base or placebo on three different days. A standardized breakfast meal plus 20 g lactulose was administered 30 mins after ingestion of the test dose. Exhaled breath was collected and hydrogen concentration was assessed over 4 h. Hydrogen concentrations over time for each session were analyzed by a generalized logistic function generating a sigmoidal curve. The ‘front’ transit time (T1) was taken as the time when a sustained rise in breath hydrogen concentration was first observed. The midpoint from baseline to peak hydrogen concentration was denoted T2 and represented the time when approximately half of the test meal had reached the cecum.

RESULTS: There was no effect of erythromycin on OCTT. The T1 (mean ± SEM) was 103.2±11.2, 103.3± 15.3 and 70.9±15.9 mins for placebo, 250 mg erythromycin base and 500 mg erythromycin base, respectively (P>0.05). Similarly, the T2 was 113.3±11.3, 113.9± 16.5 and 99.3±15.3 mins for the three regimens.

CONCLUSIONS: Oral administration of erythromycin does not alter OCTT in healthy male subjects.
Critical Review of Diagnostic Methods Used in Chronic Pancreatic Disease
Authors: Beck Ivan T
Published: March 2016

This paper provides a balanced assessment of the various pancreatic function tests and imaging techniques used in the differential diagnosis of chronic pancreatic disease. Function tests that study the digestive capacity of the pancreas (fat absorption of dietary lipids, fluorescein‐ or radiolabelled fats, bentiromide test, etc) have high specificity, but very low sensitivity. This is because 90% of pancreas has to be destroyed before steatorrhea or creatorrhea occurs. Tests that directly measure pancreatic bicarbonate and protein secretion (secretin test, etc) are more accurate and may detect pancreatic dysfunction even before anatomical changes occur. Measurement of pancreatic enzymes in serum or urine, or the decreased decline of serum amino acids during their incorporation into pancreatic enzymes, are not sufficiently sensitive or specific to help diagnose pancreatic disease. Sensitive and specific tumour markers are not yet available. Thus screening tests are not cost‐effective ‐ if they are negative, they do not exclude pancreatic disease; and if positive, they have to be confirmed by more specific tests. Imaging techniques are the most commonly used methods of investigation. The usefulness of abdominal survey films, barium studies, percutaneous transhepatic cholangiography, endoscopic retrograde cholangiopancreatography (ERCP), ultrasonography, computed tomographic scan, magnetic resonance imaging and endoscopic ultrasonography is critically reviewed. Most of the radiological methods can be combined with cytology or biopsy. Histology demonstrating malignancy establishes this diagnosis, but negative biopsies do not exclude malignant tumours. Presently only ERCP and endoscopic ultrasound can diagnose cancers sufficiently early to allow for possible `curative′ surgery, and only endoscopic ultrasound is capable to stage tumours for the assessment of resectability.
Treatment of Severe Acetaminophen–Induced Hepatocellular Injury with Prostaglandin E: Two Case Reports
Authors: Khatchatourian Marina , Vellend Hillar
Published: March 2016

Drugs have long been recognized as culprits in hepatocellular injury. Acetaminophen is one example of a commonly used over‐the‐counter medication that can cause severe centrolobular hepatic necrosis when ingested in large quantities in suicide attempts or unintentional overdoses. Acetaminophen hepatotoxicity is mediated by a toxic reactive metabolite formed from the parent compound by the cytochrome P450 mixed‐function oxidase system of the hepatocyte. Conventional treatment of acetaminophen‐induced liver injury consists of supportive measures and prevention of further drug absorption. In addition, in patients with high serum acetaminophen concentrations, the severity of hepatic necrosis appears to diminish with the timely use of sulfhydryl compounds such as N‐acetyl cysteine. Two patients in whom acetaminophen hepatotoxicity was successfully treated using prostaglandin E1 are described.
Granulomatous Vaginal Ulceration due to Metastatic Cutaneous Crohn′s Disease
Authors: Freeman Hugh J , Kwong Raymond , Sacks Stephen L
Published: March 2016

A 28‐year‐old woman with a prior history of Crohn′s disease was evaluated for painful vaginal ulceration in 1984. Subsequent studies revealed isolated involvement of the vagina with a granulomatous inflammatory process characteristic of metastatic cutaneous Crohn′s disease. Conservative symptomatic treatment was associated with resolution and no subsequent recurrence of genital tract disease.
Dysphagia due to Multiple Esophageal Rings
Authors: Sullivan Stephen N
Published: March 2016

A 27‐year‐old Saudi man with dysphagia due to multiple esophageal rings is reported and the literature reviewed. Dysphagia due to multiple esophageal rings is very rare. Only 15 cases have been reported. The patient is usually male and has had dysphagia for many years when presenting. The cause of the rings is unknown. Theories to explain dysphagia are that the rings are either congenital or an unusual manifestation of gastroesophageal reflux.
Prevalence of Antibody to Hepatitis C Virus in Saudi Blood Donors
Authors: Al-Knawy Bandar , El-Mekki Awad A , Hamdi Jamal , Thiga Raja , Sheikha Anwar
Published: March 2016

The prevalence of antibodies to hepatitis C virus (anti‐HCV) was retrospectively determined using a second generation enzyme immunoassay in 3868 blood donors from the southern part of Saudi Arabia in an area with high prevalence of hepatitis B virus (HBV) infection. Of 3354 Saudis, 48 (1.43%) were seropositive for anti‐HCV. A high prevalence (43 of 204, 21.08%) of anti‐HCV was observed among Egyptian donors compared with Saudis (1.43%) and other nationalities (eight of 310, 2.58%). Furthermore, the prevalence of anti‐HCV antibodies was observed to increase with age, peaking in the 25 to 34 year age group. From this and other studies conducted in different regions of Saudi Arabia, the prevalence of anti‐HCV among Egyptian donors appears to range from 19.2 to 24.5%, and among Saudi donors appears to range from 1.00 to 1.7%, a rate similar to that reported from western countries; this latter rate does not seem to be influenced by the high prevalence of HBV infection in this region.
Management of Stomal Complications
Authors: Nordgren Svante R
Published: March 2016

Creation of an intestinal stoma, be it temporary or permanent, requires good judgement and surgical skill. For the patient the stoma is of constant concern, and a well constructed intestinal stoma can reduce the patient′s physical and psychological stress. Peristomal skin irritation should alert a search for surgical complications. Collaboration with an enterostomal therapist is strongly advised. The probability of revision of an ileostomy during the first 10 years reaches 0.44 in patients with ulcerative colitis (UC) and 0.75 in patients with Crohn′s disease (CD). The most frequently seen complication are stenosis and sliding retraction. Stomal fistulas are seen more frequently in patients with CD than those with UC. Most ileostomy complications can be treated locally, without a laparotomy. The sigmoid colostomy, a stoma of the elderly, is also frequently complicated by stenosis, particularly after postoperative infection and separation at the mucocutaneous junction. Peristomal herniation is extremely common, and some degree of herniation is almost inevitable. There are no randomized studies to determine the best way to construct a colostomy. Bringing the bowel through the rectus muscle is probably superior to lateral to the muscle. Extraperitoneal colostomy does not provide any advantage over the intraperitoneal route. A colostomy stenosis is best managed locally. Infectious complications and hernias require laparotomy and resiting of the stoma.
Effect of Psychoneural Factors on Intestinal Epithelial Function
Authors: Berin M Cecilia , Perdue Mary H
Published: March 2016

Stress has been associated with abnormal gastrointestinal function, including diarrhea and abdominal pain, and stress‐associated gastric ulceration has frequently been documented. Stress can also exacerbate ongoing pathophysiology and often precedes relapses in patients with inflammatory bowel disease or irritable bowel syndrome. The relatively new field of psychoneuroimmunology is involved with the elucidation of mechanisms that explain the link between the central nervous system and immune‐mediated pathophysiology. Recent progress examining the interaction among the nervous system, the immune system and the epithelium of the intestine is discussed, and the evidence for central nervous sysytem control of this interaction is examined.
Inherited Causes of Exocrine Pancreatic Dysfunction
Authors: Durie Peter R
Published: March 2016

The exocrine pancreas is functionally immature at birth. Protease function is probably adequate, but lipase activity approximates 5% to 10% of adult values in the newborn and remains low in infancy. Pancreatic amylase secretion is essentially absent at birth and remains low through the first years of life. Functional disturbances of the exocrine pancreas are less frequent in childhood than in adult life. Causes of pancreatic dysfunction in childhood can be divided in two general categories: hereditary conditions, which directly affect the pancreas; and acquired disorders, in which loss of pancreatic function is a secondary phenomenon. Most inherited causes of pancreatic dysfunction are due to a generalized disorder. Cystic fibrosis is, by far, the most common inherited cause of disturbed pancreatic function among Caucasian children. All other inherited causes of exocrine pancreatic dysfunction (eg, Johanson‐Blizzard syndrome) are uncommon or rare.
Duodenal Obstruction by a Gallstone (Bouveret's Syndrome) Managed by Endoscopic Stone Extraction: A Case Report and Review
Authors: Schweiger Franzjosef , Shinder Rowen
Published: March 2016

Gastric outlet obstruction caused by a large gallstone in the duodenum or pylorus (Bouveret's syndrome) is a rare complication of gallstone disease. The presenting symptoms are often nonspecific and include nausea, vomiting, epigastric pain and a history of gallbladder disease. Although the diagnosis is established only at surgery in many cases, preoperative recognition by imaging techniques and endoscopy is desirable. Surgical treatment aims at removal of the ectopic gallstone, closure of the fistula and cholecystectomy. A case of Bouveret's syndrome is presented where endoscopic extraction of the duodenal gallstone was accomplished providing definitive treatment for this patient.
Cost effectiveness of Alternative Helicobacter pylori Eradication Strategies in the Management of Duodenal Ulcer
Authors: O′Brien Bernie , Goeree Ron , Hunt Richard , Wilkinson Joanne , Levine Mitchell , William Andrew
Published: March 2016

Published data and techniques for decision analysis were used to construct a model to estimate the cost effectiveness of nine alternative strategies for the management of patients diagnosed with uncomplicated duodenal ulcer. Two strategies of intermittent therapy with either ranitidine or omeprazole, one strategy of continuous maintenance treatment with ranitidine, and six strategies for ulcer healing and eradication of Helicobacter pylori infection were considered. Healing time curves were estimated by using published data, allowing for estimation of expected time for acute healing episodes. The expected number of weeks to heal per patient, in a one‐year period, was estimated by combining healing time data with probability of ulcer recurrence. It was found that patients that underwent any of the six H pylori eradication regimens had fewer days with ulcer per year than those who underwent maintenance or intermittent ranitidine. Four eradication regimens had lower costs and better outcomes than ranitidine therapy. In comparing H pylori strategies, the two strategies of omeprazole plus one antibiotic (either amoxicillin or clarithromycin) are more costly than omeprazole plus two antibiotics (specifically amoxicillin and metronidazole or clarithromycin and metronidazole) and result in similar outcomes. Although omeprazole‐based eradication regimens are more costly than ranitidine bismuth triple therapy, they are associated with fewer recurrences of ulcer and days of symptoms. A limitation of the analysis is that it did not incorporate issues of compliance and metronidazole resistance; however, the former concern may be less of an issue as H pylori regimens become simpler and shorter in duration.
Perforation of the Jejunum Secondary to AIDS-Related Gastrointestinal Kaposi's Sarcoma
Authors: Yoshida Eric M , Chan Norman HL , Chan-Yan Clifford , Baird Robert M
Published: March 2016

Intestinal perforation in human immunodeficiency virus-positive patients due solely to Kaposi's sarcoma (KS) has rarely been described. A homosexual man with acquired immunodeficiency syndrome-related KS who presented with an acute abdomen is presented. He was found to have a jejunal perforation through a small KS lesion. There were no infectious organisms identified at the site of perforation.
Role of Intestinal Transit in the Pathogenesis of Gallbladder Stones
Authors: Dowling R Hermon , Veysey Martin J , Pereira Stephen P , Hussaini S Hyder , Thomas Linzi A , Wass John AH , Murphy Gerard M
Published: March 2016

Increasing evidence implicates prolonged intestinal transit (slow transit constipation) in the pathogenesis of conventional gallbladder stones (GBS), and that of gallstones induced by long term octreotide (OT) treatment. Both groups of GBS patients have multiple abnormalities in the lipid composition and physical chemistry of their gallbladder bile - associated with, and possibly due to, an increased proportion of deoxycholic acid (DCA) (percentage of total bile acids). In turn, this increase in the percentage of DCA seems to be a consequence of prolonged colonic transit. Thus, in acromegalic patients OT treatment significantly prolongs large bowel transit time (LBTT) and leads to an associated increase of the percentage of DCA in fasting serum (and, by implication, in gallbladder bile). LBTT is linearly related to the percentage of DCA in fasting serum and correlates significantly with DCA input (into the enterohepatic circulation) and DCA pool size. However, these adverse effects of OT can be overcome by the concomitant use of the prokinetic drug cisapride, which normalizes LBTT and prevents the rise in the percentage of serum DCA. Therefore, in OT-treated patients and other groups at high risk of developing stones, it may be possible to prevent GBS formation with the use of intestinal prokinetic drugs.