bluuebunny/crossref_metadata_2025 huggingface dataset:
Resource Utilization for Acute Lower Gastrointestinal Hemorrhage: The Ontario GI Bleed Study
Authors: Comay Dan , Marshall John K
Published: March 2016

OBJECTIVES: Acute lower gastrointestinal hemorrhage (LGIH) is a common indication for hospitalization. However, there are few published studies of related health care resource utilization. Resource utilization, length of stay (LOS) and direct medical costs were characterized in a cohort of patients admitted for nonmalignant LGIH to centres in Ontario.

METHODS: Consecutive admissions for LGIH were identified at four Ontario hospitals. Profiles of resource utilization, LOS and estimates of direct medical costs were compiled through detailed chart review and adaptation of an administrative database. All centres were participants in the Ontario Case Cost Project. Linear regression models of log-transformed data were constructed to identify demographic variables predictive of LOS and case cost.

RESULTS: Among 124 patients enrolled (mean age 58.8 years) the average case cost was $4,832 (SD $7,187) for 7.5 days in hospital (SD 12.0). Diverticular disease was the bleeding source most often identified (34.6%), followed by hemorrhoids (13.7%) and ischemic colitis (9.7%). Older age and comorbid illness, specifically coronary artery disease (CAD), were associated with both increased LOS and higher case cost in univariate regression analyses. Age persisted as the lone independent predictor of LOS in the multivariate model (P<0.05, R2=0.076), and age and CAD were both independent predictors of cost (P<0.05, R2=0.109) in a stepwise multiple linear regression analysis. Neither sex nor nonsteroidal anti-inflammatory drug use predicted LOS or cost.

CONCLUSIONS: Admissions for acute LGIH are associated with significant resource utilization, particularly among elderly patients with CAD.
Funding the New Biologics – A Health Economic Critique of the CCOHTA Report: Infliximab for the Treatment of Crohn’s Disease
Authors: Mitton Craig R
Published: March 2016

The report of the Canadian Coordinating Office for Health Technology Assessment (CCOHTA) on the use of infliximab in the treatment of refractory Crohn’s disease stated that the medication did not meet ‘conventional standards of cost-effectiveness’. It had several methodological weaknesses, however, including the derivation of the quality-adjusted life-years (QALYs) gained and the interpretation of the incremental cost utility ratios (ICURs). The validity of economic analyses is highly dependent on the underlying assumptions that are made about the implications of health care states and treatments. The authors of the report mapped utilities from three health states, taken from an American study, onto the nine health states that were considered in their economic analysis. The QALYs that were derived might not have been sensitive to small changes in health outcomes. Moreover, the indirect costs of Crohn’s disease and its complications were ignored. Therefore, it is possible that the benefits of infliximab therapy were underestimated. The high ICURs that were quoted in the report do not necessarily mean that infliximab is not valuable, because opportunity costs were not considered. Instead of calculating the ICUR, a preferable approach would be to determine the benefit of this therapy, compared with that which could be derived from alternative uses of the same amount of health care resources. A ‘balance sheet’ approach would allow decision-makers to determine whether the additional cost of infliximab therapy would be justified by the health care gains that it produces. It is inappropriate to assign an arbitrary cut-off point to cost effectiveness, as defined by ICURs, especially when considering new and expensive treatments for severely ill patients who have few other therapeutic alternatives. Because only a small number of patients would require infliximab, the overall expenditure that would be required to make it available may be manageable.
Pancreatic Cancer: Who Benefits from Curative Resection?
Authors: Beger HG , Gansauge F , Leder G
Published: March 2016

Surgical resection is the only chance for cure of pancreatic cancer. Unfortunately, the majority of patients have grossly unresectable disease. Patients with stage I or II disease according to the criteria of the International Union Against Cancer (UICC) should be considered for potentially curative surgery. The goal of surgery is to remove the entire tumour with no residual disease (oncological R0 resection), which requires extensive resection of the surrounding tissues. Even if lymph nodes are histologically free of disease, molecular biological techniques reveal infiltration with cancer cells in 50% of cases. Therefore, extensive local resection combined with radical resection of lymphatic tissue, including lymph nodes around the head of the pancreas, retroperitoneal tissue and neural plexus around the great vessels, affords a longer median survival time than standard resection alone. Even patients with UICC stage III disease can undergo aggressive surgical treatment, but their chances for long term survival are low. Some patients develop severe diarrhea after circumferential removal of nerve tissue around the superior mesenteric artery. Adjuvant radiochemotherapy also provides a modest prolongation of survival. Despite these advances, the prognosis for pancreatic cancer is still poor, and spread of tumour within the peritoneum and to the liver is common postoperatively.
Diagnosis and Treatment of Urinary Tract Complication in Crohn’s Disease: An Experience over 15 Years
Authors: Ben-Ami Haim , Ginesin Yeoshua , Behar Doron M , Fisher Doron , Edoute Yeouda , Lavy Alexandra
Published: March 2016

BACKGROUD: Urinary tract complications in Crohn’s disease are common but treatable, and often present diagnostic and therapeutic dilemmas.

PURPOSE: To determine the incidence of urinary tract complications in patients with Crohn’s disease in Israel and to report an experience over 15 years of patients with Crohn’s disease, with the aim of illustrating the diverse patterns of presentation, and thereby broadening the approach to diagnosis and treatment.

METHODOLOGY: Clinical and radiological findings of 312 patients with Crohn’s disease were reviewed.

RESULTS: Simple cystitis was the most common problem, occurring in 51 patients. The problem seldom required hospitalization and was instead managed in the ambulatory setting. A review revealed that 22 patients with urinary tract complications required hospitalization. Six patients had ileovesical fistulas. In one patient, the colon was also affected. In another patient, radiological and endoscopic studies failed to identify the fistula, which was confirmed during surgery. All six patients were treated surgically. Four patients had ureteral obstructions and hydronephrosis, three of whom responded well to conservative treatment. In one patient, the affected ileal segment was resected. Four patients suffered from retroperitoneal abscess accompanied by urinary symptoms. Twelve patients developed right kidney stones. All of the patients suffered from long-standing Crohn’s disease with bowel resection. Surprisingly, most of the severe complications occurred in men, although 70% of the patients were women.

CONCLUSIONS: Based on these findings, urological complications are not rare in patients with Crohn’s disease, and necessitate a high degree of diligence and periodic urological evaluation.
Sexual Abuse in Irritable Bowel Syndrome: To Ask or Not to Ask – That Is the Question
Authors: Ilnyckyj Alexandra , Bernstein Charles N
Published: March 2016

BACKGROUND: Irritable bowel syndrome (IBS) is a common and costly disorder in Canada. The paucity of medical treatment underscores the importance of examining every element of the management approach. Data exist supporting an increased prevalence of abuse among individuals with IBS. Importantly, the pathophysiology underlying the link between abuse and IBS is increasingly understood. Treatment recommendations by opinion leaders support an abuse inquiry. However, many clinicians view abuse inquiry as an ethical dilemma.

METHOD: Canadian gastroenterologists were surveyed to determine current practice patterns and to identify barriers to inquiry. Barriers cited by clinicians were explored within an ethical context.

RESULTS: Abuse inquiry is not universally practised in Canada. Fifty-four per cent of the membership of Canadian Association of Gastroenterologists responded to the survey. They reported inquiring into abuse histories in approximately 50% of patients with IBS. The frequency of inquiry declined when male patients were considered. The primal barriers cited were time constraints (25%), personal comfort with abuse issues (25%) and lack of resources for addressing the abuse (33%). Importantly, only a minority (10%), cited abuse history as irrelevant to the management of the patient.

INTERPRETATION: Physicians identify significant barriers to pursuing an inquiry into abuse. However, a minority cited ‘clinical irrelevance’ as a primal barrier, the implicit statement being that the abuse history has clinical relevance. This view is consistent with opinion leaders and published treatment recommendations. Therefore, by not inquiring into the abuse history, physicians are not fulfilling their ethical responsibility to the patient. Physicians need to resolve their barriers to inquiry. Furthermore, they need to familiarize themselves with treatment recommendations and include this review in their consultation.
Etiology and Outcome of Acute Liver Failure: Experience from a Liver Transplantation Centre in Montreal
Authors: Tessier Geneviève , Villeneuve Edith , Villeneuve Jean-Pierre
Published: March 2016

BACKGROUND: Acute liver failure is a rare condition in which massive liver injury is associated with the rapid development of hepatic encephalopathy. Although viral hepatitis and drug-induced liver injury are the most common causes, no specific etiology is found in a substantial proportion of cases reported from Europe and the United States.

AIM: To determine the etiology and outcome of patients with acute liver failure in the authors’ institution.

PATIENTS AND METHODS: The charts of 81 consecutive patients admitted to Saint-Luc between 1991 and 1999 were reviewed.

RESULTS: The etiology was viral in 27 cases (33.2%), toxic or drug-induced in 22 (27.2%), of unknown origin in 22 (27.2%) and due to various causes in 10 (12.3%) (autoimmune, vascular, cancer). Of the 81 patients, 16% survived without liver transplantation, and 84% died or underwent liver transplantation. Survival without liver transplantation differed according to the mode of presentation: the survival rate was 27% in patients with hyperacute liver failure, 7% in those with acute liver failure and 0% in those with subacute liver failure. Among the 38 patients who underwent liver transplantation, survival one year after transplantation was 71%. In the 30 patients who died without liver transplantation, the main causes of death were cerebral edema and sepsis.

CONCLUSIONS: Acute liver failure is associated with a high mortality, and liver transplantation is the treatment of choice. In a significant proportion of cases, the etiology remains undetermined and is probably related to yet unidentified hepatotropic viruses.
Pancreatic Cancer: What the Oncologist Can Offer for Palliation
Authors: Moore Malcolm J
Published: March 2016

Because pancreatic cancer has a poor survival rate and only 20% of patients present with potentially resectable disease, a key goal of therapy is to provide palliation. The poor medical condition of many patients interferes with their ability to tolerate traditional chemotherapy. Recently, however, a nucleoside analogue, gemcitabine, has been developed. This drug is more effective than 5-fluorouracil (5-FU), can be used in patients who fail to respond to 5-FU and has only modest toxicity. Combination therapies including gemcitabine and other agents are being tested. Local radiotherapy seems to provide pain relief, but gastrointestinal toxicity is significant. The effect of combined modality therapy (5-FU with radiotherapy) on survival is unclear, and it does not prevent local disease progression. Some novel biological agents, including angiogenesis inhibitors, matrix metalloproteinase inhibitors, antisense compounds, inhibitors of cell signalling such as epidermal growth factor and vascular endothelial growth factor, and inhibitors of oncogene activation, are undergoing phase II and III trials in patients with pancreatic cancer. Among the most promising are farnesyl protein transferase inhibitors, which modulate K-rasfunction. Such an approach is promising for the treatment of pancreatic cancer because this tumour frequently exhibits mutation of therasgene.
Musculoskeletal Injuries among ERCP Endoscopists in Canada
Authors: O’Sullivan Sinead , Bridge Gary , Ponich Terry
Published: March 2016

BACKGROUND: There are few reports in the literature describing musculoskeletal complaints among endoscopists, and none are specific to those who perform endoscopic retrograde cholangiopancreatography (ERCP).

PURPOSE: To examine the current practices of ERCP endoscopists and the prevalence of musculoskeletal injuries.

METHODS: A self-report survey was sent to physicians practising ERCP across Canada identified through a pre-existing database. A second mailing was sent six weeks later to those who did not respond to the first mailing.

RESULTS: Of 162 surveys sent, 122 responses were received, with five respondents indicating that they no longer performed ERCP and three declining to participate. Of the 114 participants, 67% reported at least one musculoskeletal complaint, and 58% reported two or more complaints. Seventy-four per cent attributed their symptoms to endoscopy and/or ERCP, and 79% reported that their condition was aggravated by performing ERCP. The most frequently reported pain symptoms were back pain (57%), neck pain (46%) and hand pain (33%), which are all consistent with the physical risks involved in performing ERCP. Only 51% reported taking regular breaks, and only 25% reported having fluoroscopy tables with adjustable heights. The room designs of the respondents’ ERCP facilities were analyzed for ergonomic considerations: 67% had poor ergonomics and 33% had good ergonomics. Sixty-four per cent reported that they were interested in learning preventive strategies.

CONCLUSIONS: Physicians who perform ERCP develop musculoskeletal injuries and are interested in learning about risk factor modification.
Inhibitory Effects of Polaprezine on the Inflammatory Response toHelicobacter pylori
Authors: Handa Osamu , Yoshida Norimasa , Tanaka Yukiko , Ueda Miho , Ishikawa Takeshi , Takagi Tomohisa , Matsumoto Naoyuki , Naito Yuji , Yoshikawa Toshikazu
Published: March 2016

Helicobacter pylori-infected gastrointestinal mucosa is frequently infiltrated by polymorphonuclear leukocytes (PMN) and monocytes, and these invading cells have been implicated in gastrointestinal mucosal inflammation. To clarify the efficacy of polaprezinc, a chelate compound consisting of zinc and L-carnosine, againstH pylori-induced inflammation including PMN infiltration, the in vitro effects of this drug on interleukin (IL)-8 production by an established gastric cancer cell line (MKN 45 cells) and on PMN-endothelial cell adhesive interactions was investigated. Polaprezinc and zinc sulphate inhibited IL-8 production by MKN 45 cells in response to stimulation withH pyloriwater extract (HPE) in a dose-dependent manner from 10-7M to 10-5M. In addition, the expression of CD11b and CD18 on PMN and PMN-dependent adhesion to endothelial cells elicited by HPE was inhibited by polaprezinc and zinc sulphate in a concentration-dependent manner. L-carnosine did not have any effects on IL-8 production or PMN-endothelial cell interactions. These results suggest that polaprezinc, mainly the zinc component, may inhibitH pylori-induced PMN-mediated gastric inflammation by attenuating CD11b/CD18 expression on PMN and IL-8 production from gastric epithelial cells.
Evolving Concepts of Reflux: The Ups and Downs of the LES
Authors: DeMeester Tom R
Published: March 2016

The common denominator for virtually all episodes of gastroesophageal reflux in health and disease is the loss of the barrier that confines the gastric environment to the stomach. Factors important in the function of the barrier are its pressure, length and position. In early reflux disease, overeating, gastric distention, delayed emptying and aerophagia lead to transient losses of the barrier. A permanent loss results from inflammatory injury to the muscle of the barrier with free flow of gastric juice into the esophageal body and its subsequent injury. Corrective therapy requires augmentation or restoration of barrier function.
Etiology of Dyspepsia: Implication for Empiric Therapy
Authors: Hunt Richard H , Fallone Carlo , van Zanten Sander Veldhuyzen , Sherman Phil , Flook Nigel , Smaill Fiona , Thomson Alan BR , the Canadian Helicobacter Study Group
Published: March 2016

Dyspepsia describes a symptom complex thought to arise in the upper gastrointestinal tract and includes, in addition to epigastric pain or discomfort, symptoms such as heartburn, acid regurgitation, excessive burping or belching, a feeling of slow digestion, early satiety, nausea and bloating. Based on the evidence that heartburn cannot be reliably distinguished from other dyspeptic symptoms, the Rome definition appears to be too narrow and restrictive. It is particularly ill suited to the management of uninvestigated dyspepsia at the level of primary care. In patients presenting with uninvestigated dyspepsia, a symptom benefit is associated with a ‘test and treat’ approach forHelicobacter pyloriinfection. A substantial proportion of those who do not benefit prove to have esophagitis on endoscopy. In those with functional dyspepsia, the benefits ofH pylorieradication, if any, appear to be modest. Hence, a "symptom and treat" acid-suppression trial with proton pump inhibitors, and a ‘test and treat’ strategy forH pyloriare two acceptable empirical therapies for patients with univestigated dyspepsia.
Pancreaticoportal Fistula in Association with Antiphospholipid Syndrome Presenting as Ascites and Portal System Thrombosis
Authors: Chang Li-Hsin , Francoeur Luc , Schweiger Franzjosef
Published: March 2016

Fistulous communication between the pancreas and the portal venous system is extremely rare and is usually a complication of chronic pancreatitis or pancreatic pseudocysts. A patient who presented with abdominal pain and ascites secondary to a pancreaticoportal fistula and portal system thrombosis is described. The diagnosis was made by endoscopic retrograde cholangiopancreatography and confirmed by immediate postprocedure computed tomographic scanning. Laboratory studies identified concomitant antiphospholipid syndrome. The patient responded favourably to supportive medical therapy.
Diagnosis of Constipation in Family Practice
Authors: Ferrazzi Simon , Thompson Grant W , Irvine E Jan , Pare Pierre , Rance Laureen
Published: March 2016

BACKGROUND: Patients who complain of constipation to their family doctor may not be truly constipated. Variability in stool frequency and consistency, and perception of symptoms may lead to inaccurate patient reporting or diagnosis of constipation.

OBJECTIVES: To determine whether patients visiting their family doctor with a complaint of, or diagnosed with, constipation fulfilled the Rome II criteria for functional constipation and had stool characteristics of constipation.

METHODS: A random sample of Canadian family physicians were recruited to enroll a series of adults who complained of, or had received a diagnosis of, constipation during an office visit. Patients were advised of the survey. Those providing written consent were contacted by an independent research firm and forwarded a survey questionnaire that included the Rome II gastrointestinal questionnaire, questions regarding their medical history and questions regarding their demographics. Patients also completed a four-week daily diary recording their bowel habits using the Bristol Stool Form Scale, medication use and satisfaction with treatment. Questionnaire and diary responses were retrieved by telephone.

RESULTS: One hundred eighty-four family physicians enrolled 311 patients, of whom 220 completed the questionnaire. Females comprised 79.5% of the sample and had a mean age of 54.2 years (males 61.6 years; P<0.05). According to the Rome II criteria, 37.3% had functional constipation and 46.8% had irritable bowel syndrome (IBS). Whole gut transit times estimated using the Bristol Stool Scale were similar among those with self-reported constipation, those with Rome II functional constipation and those with Rome II IBS (79.3 h, 85.8 h and 77.4 h, respectively). Almost half of the patients with IBS or functional constipation were taking a pain medication, while nearly one-fifth took antidepressants. Of the medications or remedies taken to treat constipation, patients rated 49.8% of the doses as satisfactory.

CONCLUSIONS: A large proportion of Canadian primary care patients whose presenting complaint or diagnosis was constipation satisfied the Rome II criteria for IBS, with a smaller number defined as functionally constipated. IBS patients tended to be younger than those with functional constipation, and whole gut transit times did not differentiate IBS from functional constipation. Careful questioning of patients who complain of constipation may reveal constipating medication, diarrhea symptoms or IBS.
Intestinal Epithelial Cells as a Source of Inflammatory Cytokines and Chemokines
Authors: Stadnyk Andrew W
Published: March 2016

The intestinal epithelium has long been known to provide nonspecific defences such as mucus, lysozyme and transport of secretory immunoglobulin via the polyimmunoglobulin receptor. In the past decade, the realization emerged that enterocytes secrete molecules (cytokines) that regulate inflammation. As the focus tightened on this new role as sentinel, so has the interest in enterocyte production of cytokines with chemoattractant properties for leukocytes – the chemokines. Neutrophils are a prominent feature of the cellular infiltrate in various inflammatory diseases, and early reports indicated that epithelial cells secrete neutrophil chemoattractants. More recently, it has been shown that the cells also secrete chemokines for monocytes and lymphocytes. Some of these chemokines appear to be important in the uninflamed intestine but become increased during disease. While a great deal of knowledge has been gained regarding the circumstances leading to chemokine production by epithelial cells, the application of this understanding to the treatment of human intestinal diseases is lacking. Closing this gap is necessary to take advantage of emerging therapies aimed at blocking chemokine function.
Small Cell Lung Cancer with Positive Anti-Hu Antibodies Presenting as Gastroparesis
Authors: Moskovitz David N , Robb Kenneth V
Published: March 2016

Lung cancer is the most common cancer in North America. Small cell lung cancer (SCLC) represents 15% to 25% of lung cancers. SCLC commonly relapses, resulting in a 3% to 8% five-year survival rate. The poor prognosis associated with SCLC is partly due to late diagnosis of the disease. Paraneoplastic syndromes can be early manifestations of SCLC. The potential benefit of early diagnosis has prompted investigations into markers of this disease. Some patients may present with predominantly gastrointestinal dysmotility symptoms that have no obvious explanation. Testing for anti-Hu antibodies, as a valuable marker of SCLC, should be considered in the investigation. A case of SCLC with positive anti-Hu antibodies presenting with intestinal pseudo-obstruction is presented. Gastrointestinal dysmotility as a manifestation of paraneoplastic syndrome is reviewed.
2003 CAG Educational Needs Assessment Report
Authors: Leddin Desmond , Daniels Sandra , Sinclair Paul
Published: March 2016

The annual survey of Canadian Association of Gastroenterology (CAG) members’ educational needs was conducted online this past April. One hundred eightyseven individuals (one fifth of the membership) completed the needs assessment. The topic most in demand for future educational events was inflammatory bowel disease, both from the clinical and basic science perspectives. Other highly rated topics were endoscopy, pharmacological therapeutics, celiac disease and pancreatitis/pancreatic disease. Educational materials were judged to be the most valuable component of exhibit areas. Results of the needs assessment were used to shape the 2004 Canadian Digestive Diseases Week (CDDW) program.
Liver Cell Death: Update on Apoptosis
Authors: Bilodeau Marc
Published: March 2016

Hepatocyte cell death is a cardinal feature of almost every liver disease. Apoptosis is a mode of cell death characterized by specific morphological and biochemical features. Over the past decade, the importance of apoptosis has been appreciated, and it is now thought to be the main mode of cell death in liver diseases. The recognition that apoptosis can be modulated by the cell itself or by the extracellular environment has given hope that treatments can be designed to modify the evolution of disease. This article presents an overview of this important phenomenon, as well as models of hepatocyte apoptosis and goals of current research. The significance of apoptosis to the pathophysiology of liver disease is discussed.
Cirrhotic Cardiomyopathy: Does it Contribute to Chronic Fatigue and Decreased Health-Related Quality of Life in Cirrhosis?
Authors: Girgrah Nigel , Reid Graham , MacKenzie Shona , Wong Florence
Published: March 2016

Diminished health-related quality of life (HRQoL) and fatigue have been reported in patients with cirrhosis. The presence of cirrhotic cardiomyopathy and the attendant poor cardiac response to physical stress may affect HRQoL and contribute to fatigue in these patients.

AIMS: To evaluate the contribution of cirrhotic cardiomyopathy to HRQoL and fatigue in ambulatory cirrhotic patients.

METHODS: Thirty ambulatory cirrhotic patients (14 preascitic, Child-Pugh score 5.6±0.3; 16 ascitic, Child-Pugh score 9.1±0.5) underwent cardiopulmonary exercise testing and assessment of HRQoL, fatigue and depressive symptomatology. HRQoL and fatigue scores were correlated with liver disease severity, depressive symptomatology and parameters of cardiac function and exercise physiology.

RESULTS: Subscales of all HRQoL measuring the effect of disease on the ability to perform physical, social and emotional roles were significantly impaired when compared with controls (P<0.001). The impact of fatigue, as assessed by the Fatigue Assessment Inventory, was greater in cirrhotics (4.46 versus 2.53 in healthy age-matched controls, P<0.01). Diminished HRQoL, impact of fatigue and vitality were related to depressive symptoms rather than to cardiac structural and functional abnormalities, which were present in cirrhotic patients. Poorer physical quality of life scores correlated with diminished mental health.

CONCLUSIONS: Depression, rather than the presence of cirrhotic cardiomyopathy, may have contributed to the diminished HRQoL and vitality in patients with cirrhosis with or without ascites.
The Frequency of Vitamin D Deficiency in Adults with Crohn’s Disease
Authors: Siffledeen Jesse S , Siminoski Kerry , Steinhart Hillary , Greenberg Gordon , Fedorak Richard N
Published: March 2016

BACKGROUND: Vitamin D deficiency is a putative, pathogenic cofactor in the increase in osteopenia and osteoporosis seen in patients with Crohn’s disease.

OBJECTIVE: To determine the frequency of low serum 25-hydroxy-vitamin D3 (25-OHD) levels and the associated alterations in bone mineral density in a cohort of adults with Crohn’s disease.

METHODS: 25-OHD levels were determined in 242 consecutive patients with Crohn’s disease seen in two tertiary inflammatory bowel disease referral centres. Bone mineral density was assessed by dual energy x-ray absorptiometry.

RESULTS: Nineteen (8%) patients exhibited vitamin D deficiency (25-OHD less than 25 nmol/L) and 52 (22%) patients exhibited vitamin D insufficiency (25-OHD less than 40 nmol/L). Mean T-scores at the lumbar spine, femoral neck, total hip and ultradistal radius in the group with low 25-OHD did not differ from those of the normal 25-OHD group. Serum alkaline phosphatase and parathyroid hormone levels were higher in the low 25-OHD group than in the normal group. Decreased red blood cell (RBC) folate predicted low 25-OHD in male patients, while smoking, RBC folate and serum iron predicted low 25-OHD in female patients. The rate of low 25-OHD deficiency in the winter was significantly higher than that in the summer (11.9% versus 2.8%, respectively).

CONCLUSION: Vitamin D-deficient Crohn’s disease patients exhibit biochemical evidence of metabolic bone disease, without detectable differences in bone mineral density. Sunlight exposure, nutrition and smoking status were predictors of vitamin D deficiency in this patient cohort.
Lymphocytic and Collagenous Colitis: The Emerging Entity of Microscopic Colitis. An Update on Pathophysiology, Diagnosis and Management
Authors: Abdo Ayman A , Urbanski Stefan J , Beck Paul L
Published: March 2016

Microscopic colitis (MC) encompasses the two morphologically distinct entities of collagenous colitis (CC) and lymphocytic colitis (LC). MC was first described less than 30 years ago but is presently recognized as a relatively common cause of chronic diarrhea in the adult population. Remarkably, up to 10% of adults who have a colonoscopy for the investigation of chronic diarrhea, and have endoscopically normal appearing mucosa, may have MC. Patients with MC generally present with chronic diarrhea, which can be associated with cramping and bloating. Endoscopic and radiological examinations are usually normal. Histological assessment reveals inflammation consisting predominantly of lymphocytic infiltration, and a thickened subepithelial collagen band is diagnostic of CC. Both LC and CC can be associated with autoimmune diseases such as celiac disease, diabetes, arthritis and thyroiditis, yet the mechanisms involved in the pathogenesis remain unclear. Emerging studies suggest that a stepwise approach be taken in the medical management of MC. This approach includes antidiarrheal agents and stopping of any offending agents; budesonide or bismuth subsalicylate; and cholestyramine or 5-acetylsalicylic acid agents. In resistant cases, oral corticosteroids and other immune modulatory therapy have been used.
Hepatocellular Carcinoma Presenting as Right Supraclavicular Lymphadenopathy
Authors: Thorburn Douglas , Sanai Faisal M , Ghent Cameron N
Published: March 2016

Two patients, one with previously undiagnosed liver disease, presenting with right supraclavicular lymphadenopathy were subsequently diagnosed with hepatocellular carcinoma. This presentation has only been previously described once, and the mechanism of this unusual presentation is discussed.
How Can we Battle the Scourge of Diarrhea? 2003 Mckenna Memorial Lecture
Authors: Barrett Kim E
Published: March 2016

Diarrheal diseases exact a considerable toll of morbidity and mortality worldwide, including in developed countries where the incidence of foodborne illness, in particular, may be increasing. This article summarizes the current understanding of the basis of diarrheal illness, focusing particularly on intracellular signaling mechanisms that limit the extent of intestinal epithelial chloride secretion, which may offer new targets for antidiarrheal therapies. Recent information regarding the mechanisms whereby invasive bacteria cause diarrhea is also reviewed along with effects of beneficial bacteria (so-called probiotics) in limiting dysfunction associated with enteric infections. Finally, the author provides some speculations as to the possible benefits to the host of mounting a diarrheal response to an offending pathogen, and possible consequences of the failure of this primitive host defense mechanism.
Sex Differences of Brain Serotonin Synthesis in Patients with Irritable Bowel Syndrome Using α-[11C]methyl-L-tryptophan, Positron Emission Tomography and Statistical Parametric Mapping
Authors: Nakai Akio , Kumakura Yoshikata , Boivin Michel , Rosa Pedro , Diksic Mirko , D’Souza Doreen , Kersey Kathryn
Published: March 2016

BACKGROUND: Irritable bowel syndrome (IBS) is the most common functional bowel disorder and has a strong predominance in women. Recent data suggest that the brain may play an important role in the pathophysiology of IBS in the brain-gut axis. It is strongly suspected that serotonin (5-HT), a neurotransmitter found in the brain and gut, may be related to the pathophysiology of IBS. It is reported that a 5-HT3antagonist is effective only in female patients with diarrhea-predominant IBS.

OBJECTIVE: In the present study, 5-HT synthesis was measured using positron emission tomography, with α-[11C]methyl-l-tryptophan as the tracer, in patients with IBS. The aim of the present study was to compare 5-HT synthesis in the IBS patients with that in the controls, and to compare 5-HT synthesis between male and female IBS patients.

METHODS: Six male and six female nonconstipated IBS patients were scanned. Age-matched healthy volunteers were scanned as controls. Eighty minute dynamic scans were performed. Functional 5-HT synthesis images were analyzed using statistical parametric mapping.

RESULTS: 5-HT synthesis was greater only in the female IBS patients in the right medial temporal gyrus (multimodal sensory association cortex) compared with the female controls (P<0.001).

CONCLUSIONS: The greater brain 5-HT synthesis in the female IBS patients than in the controls may be related to the pathological visceral pain processing of the IBS patients, a larger female predominance of the disorder, and the sex difference of the efficacy of the 5-HT3antagonist in treatment.
A Survey of Canadian Gastroenterologists about the Management of Barrett’s Esophagus
Authors: MacNeil-Covin Lisa , Casson Alan G , Malatjalian Dickran , van Zanten Sander Veldhuyzen
Published: March 2016

The aims of the present study were to determine practice patterns of Canadian gastroenterologists for screening patients with Barrett’s esophagus and to compare current practice patterns with published guidelines. A secondary goal was to evaluate whether gastroenterologists recommend a ’once in a lifetime’ endoscopy for patients with chronic gastroesophageal reflux disease. A structured questionnaire regarding screening for Barrett’s esophagus was sent to members of the Canadian Association of Gastroenterology. The overall response rate was 51% (203 of 396). Of the 203 respondents, 165 (81%) performed endoscopies in adults and form the basis of this report. The majority of Canadian gastroenterologists followed published guidelines, with 62% screening patients without dysplasia every two years. Patients with low grade dysplasia were screened more frequently, with 54% of respondents performing endoscopy every six months, and 35% on a yearly basis. Biopsy protocols showed the greatest variation, with 46% of gastroenterologists taking four-quadrant biopsies at 2 cm intervals along the columnar-lined (Barrett’s) esophagus. Seventy-six per cent of gastroenterologists agreed that all patients with chronic gastroesophageal reflux should have a ’once in a lifetime’ endoscopy to screen for Barrett’s esophagus. The majority of Canadian gastroenterologists follow current guidelines for the management of Barrett’s esophagus and support the concept of ’once in a lifetime’ endoscopy.
Irritable Bowel Syndrome and Health-Related Quality of Life: A Population-Based Study in Calgary, Alberta
Authors: Li Feng Xiao , Patten Scott B , Hilsden Robert J , Sutherland Lloyd R
Published: March 2016

BACKGROUND: Little is known about the health-related quality of life (HRQOL) of nonclinical samples of people with irritable bowel syndrome (IBS) in Canada. In a pilot survey, the impact of IBS on HRQOL using a population-based, urban sample was examined.

METHODS: A random sample of Calgary residents (18 years of age or older), selected by random digit dialing (n=1521), completed a structured questionnaire including ROME II Criteria and Medical Outcomes Study Short-Form 12-Item Health Survey, version 2 (SF-12v2). The mean scale and summary scores of SF-12v2 for those who did and did not meet ROME II criteria and for those who met ROME II criteria with and without visiting a physician in past three months were determined and compared using multiple regression analyses.

RESULTS: Of the 951 households successfully contacted, 590 (62%) were willing to participate, of which 437 (74%) individuals were recruited. One hundred ten IBS cases (81 of which were women) and 327 non-IBS controls (180 of which were women) were identified. All of the eight mean scale scores and the two mean summary scores were significantly lower in people with IBS than in those without, whether or not adjusting for demographics. Forty-four of the 110 IBS cases (40%) sought medical help. Significantly lower mean physical component score and three scale scores (general health, social functioning and role physical) were found in those who sought medical help than in those who did not.

CONCLUSIONS: People with IBS experience significant impairment in HRQOL, including both physical and mental well-being. People with IBS who seek medical help report worse physical health than those who do not, but their mental health is no different.
Acute Recurrent Pancreatitis
Authors: Lehman Glen A
Published: March 2016

History, physical examination, simple laboratory and radiological tests, and endoscopic retrograde cholangiopancreatography (ERCP) are able to establish the cause of recurrent acute pancreatitis in 70% to 90% of patients. Dysfunction of the biliary and/or pancreatic sphincter, as identified by sphincter of Oddi manometry, accounts for the majority of the remaining cases. The diagnosis may be missed if the pancreatic sphincter is not evaluated. Pancreas divisum is a prevalent congenital abnormality that is usually innocuous but can lead to recurrent attacks of acute pancreatitis or abdominal pain. In select cases, endoscopic sphincterotomy of the minor papilla can provide relief of symptoms and prevent further attacks. A small proportion of patients with idiopathic pancreatitis have tiny stones in the common bile duct (microlithiasis). Crystals can be visualized during microscopic analysis of bile that is aspirated at the time of ERCP. Neoplasia is a rare cause of pancreatitis, and the diagnosis can usually be established by computerized tomography or ERCP. A wide variety of medications can also cause recurrent pancreatitis. ERCP, sphincter of Oddi manometry, and microscopy of aspirated bile should be undertaken in patients with recurrent pancreatitis in whom the diagnosis is not obvious.
Acute Cholecystitis and Cholelithiasis Developed after Esophagectomy
Authors: Tachibana Mitsuo , Kinugasa Shoichi , Yoshimura Hiroshi , Dhar Dipok Kumar , Ueda Shuhei , Fujii Toshiyuki , Nakamoto Takeru , Kyriazanos Ioannis , Nagasue Naofumi
Published: March 2016

BACKGROUND: Although the prevalence of gallstone disease after gastrectomy is reported to be high, its prevalence after esophagectomy is scarcely reported.

MATERIALS AND METHODS: Gallbladder disease following an esophagectomy was prospectively evaluated in 237 patients with esophageal cancer by abdominal ultrasonography twice a year up to five years postoperatively. The median follow-up period was 18.6 months.

RESULTS: One patient (0.4%) developed acute acalculous cholecystitis postoperatively, and 13 patients (5.5%) developed gallstone disease during the follow-up period. Nine (69%) of these 13 patients developed gallstone disease within two years, and another two patients developed the disease three years after esophagectomy. Another patient developed gallbladder debris at 35 months postoperatively, and one developed gallbladder polyps at 33 months. Seven of the 13 patients with gallstone disease underwent cholecystectomy between 13 and 125 months after esophagectomy: two developed acute cholecystitis; two had associated common bile duct stones; the remaining three patients had upper abdominal pain. Nine of the 13 patients who developed gallstone disease showed a history of alcoholism, whereas only 81 of 224 patients without gallstone disease had a similar history (P<0.05).

CONCLUSION: A certain number of patients with esophageal carcinoma and a history of alcoholism develop cholelithiasis within three years after esophagectomy, and subsequently undergo cholecystectomy during the follow-up period.
Direct Detection and Identification of Enteroviruses from Faeces of Healthy Nigerian Children Using a Cell-Culture Independent RT-Seminested PCR Assay
Authors: Faleye Temitope Oluwasegun Cephas , Adewumi Moses Olubusuyi , Coker Bamidele Atinuke , Nudamajo Felix Yasha , Adeniji Johnson Adekunle
Published: March 2016

Recently, a cell-culture independent protocol for detection of enteroviruses from clinical specimen was recommended by the WHO for surveillance alongside the previously established protocols. Here, we investigated whether this new protocol will show the same enterovirus diversity landscape as the established cell-culture dependent protocols. Faecal samples were collected from sixty apparently healthy children in Ibadan, Nigeria. Samples were resuspended in phosphate buffered saline, RNA was extracted, and the VP1 gene was amplified using WHO recommended RT-snPCR protocol. Amplicons were sequenced and sequences subjected to phylogenetic analysis. Fifteen (25%) of the 60 samples yielded the expected band size. Of the 15 amplicons sequenced, 12 were exploitable. The remaining 3 had electropherograms with multiple peaks and were unexploitable. Eleven of the 12 exploitable sequences were identified as Coxsackievirus A1 (CVA1), CVA3, CVA4, CVA8, CVA20, echovirus 32 (E32), enterovirus 71 (EV71), EVB80, and EVC99. Subsequently, the last exploitable sequence was identified as enterobacteriophage baseplate gene by nucleotide BLAST. The results of this study document the first description of molecular sequence data on CVA1, CVA8, and E32 strains present in Nigeria. The result further showed that species A enteroviruses were more commonly detected in the region when cell-culture bias is bypassed.
Serum Procalcitonin and Procalcitonin Clearance as a Prognostic Biomarker in Patients with Severe Sepsis and Septic Shock
Authors: Huang Min-Yi , Chen Chun-Yu , Chien Ju-Huei , Wu Kun-Hsi , Chang Yu-Jun , Wu Kang-Hsi , Wu Han-Ping
Published: March 2016

We evaluated the tendency of the plasma concentration and procalcitonin (PCT) clearance (PCTc) to act as biomarkers of prognosis in patients with severe sepsis and septic shock. From 2011 to 2013, we prospectively analyzed patients with sepsis admitted to the intensive care unit (ICU). The serum PCT was evaluated at the time of sepsis diagnosis and again after 48 h (day 3) and 96 h (day 5). PCTc after 48 h (PCTc-day 3) and 96 h (PCTc-day 5) was also calculated to evaluate the prognostic value for survival in patients with sepsis. A total of 48 patients were included. Overall mortality was 16.7% (8 patients). PCTc was higher in survivors than in nonsurvivors, with significant differences on day 3 and day 5 (p=0.033;p=0.002, resp.); however, serum PCT levels on day 1, day 3, and day 5 were not significant prognostic factors for survival. The prognosis of patients with severe sepsis and septic shock may be associated with PCTc. Dynamic changes of PCT reflected as PCTc at 48 h (day 3) and 96 h (day 5) after admission to the ICU may serve as a predictor of survival in critically ill patients with severe sepsis.
Oil and Gas Production Wastewater: Soil Contamination and Pollution Prevention
Authors: Pichtel John
Published: March 2016

During oil and natural gas production, so-called “produced water” comprises the largest byproduct stream. In addition, many oil and gas operations are augmented via injection of hydraulic fracturing (HF) fluids into the formation. Both produced water and HF fluids may contain hundreds of individual chemicals, some known to be detrimental to public health and the environment. Oil and gas production wastewater may serve a range of beneficial purposes, particularly in arid regions, if managed correctly. Numerous treatment technologies have been developed that allow for injection, discharge to the land surface, or beneficial reuse. Although many papers have addressed the effects of oil and gas production wastewater (OGPW) on groundwater and surface water quality, significantly less information is available on the effects of these fluids on the soil resource. This review paper compiles fundamental information on numerous chemicals used and produced during oil and gas development and their effects on the soil environment. Additionally, pollution prevention technologies relating to OGPW are presented. An understanding of the effects of OGPW on soil chemical, physical, and biological properties can provide a foundation for effective remediation of OGPW-affected soils; additionally, sustainable reuse of oil and gas water for irrigation and industrial purposes may be enhanced.
Design and Application of Variable Universe Fuzzy Controller Based on Cat Swarm Optimization
Authors: Pan Haipeng , Jin Dongbin
Published: March 2016

A novel variable universe fuzzy controller based on cat swarm optimization (CSO-VUFC) is proposed to regulate the temperature of the reactor system, which is characterized by nonlinearity, large time delay, and uncertainty. In CSO-VUFC, firstly, corresponding contraction-expansion factors with the function form were, respectively, introduced for the input and output fuzzy universes of the controller. Then, cat swarm optimization was used to optimize the relevant parameter values in the contraction-expansion factor function to achieve the intelligence optimization of the contraction-expansion factors, based on the system performance test function as an evaluation index; the contradiction between the universe adjustment and control accuracy of the fuzzy controller will be effectively solved to achieve the online self-adjustment of the universe. The simulation results indicate that the variable universe adaptive fuzzy control method based on the cat swarm optimization has the features of high precision adjustment, short transient time, and hard real-time.
Dendritic Cells and Their Role in Cardiovascular Diseases: A View on Human Studies
Authors: Dieterlen Maja-Theresa , John Katja , Reichenspurner Hermann , Mohr Friedrich W. , Barten Markus J.
Published: March 2016

The antigen-presenting dendritic cells (DCs) are key to the immunological response, with different functions ascribed ranging from cellular immune activation to induction of tolerance. Such immunological responses are involved in the pathophysiological mechanisms of cardiovascular diseases, with DCs shown to play a role in atherosclerosis, hypertension, and heart failure and most notably following heart transplantation. A better understanding of the interplay between the immune system and cardiovascular diseases will therefore be critical for developing novel therapeutic treatments as well as innovative monitoring tools for disease progression. As such, the present review will provide an overview of DCs involvement in the pathophysiology of cardiovascular diseases and how targeting these cells may have beneficial effects for the prognosis of patients.