bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary Amyloidosis Presenting as Small Bowel Encapsulation
Authors: Jones Jennifer , Van Rosendaal Guido , Cleary Cynthia , Urbanski Stefan , Woodman Richard C
Published: March 2016

Amyloidosis is a pathological process which encompasses a spectrum of diseases that result from extracellular deposition of pathological fibrillar proteins. Clinical presentations vary depending on the organs involved. There is no documented case of amyloidosis presenting as small bowel encapsulation. A previously healthy 62-year-old man developed a small bowel obstruction in 1997. At surgery, a peculiar membrane encasing his entire small bowel was discovered. This appeared to have no vascularity and was removed without difficulty, exposing a grossly normal bowel. Histopathology revealed thick bands of collagen overlying the peritoneal surface, which was congo red positive and showed apple green birefringence. The findings were consistent with encapsulating peritonitis due to amyloidosis. There was no history or symptoms of any chronic inflammatory condition and he became symptom-free postoperatively. An abdominal fat pad biopsy failed to demonstrate amyloidosis. Endoscopic duodenal biopsies revealed classical primary amyloidosis. Quantitative immunoglobulins, lactate dehydrogenase, C3, C4 and beta-2 microglobulin were normal. Protein electrophoresis identified monoclonal paraprotein, immunoglobulin G lambda 3.7 g/L. Bone marrow biopsy and aspirate revealed only a mild plasmacytosis (5% to 10%). Echocardiogram and skeletal survey were normal. He had mild proteinuria. Complete blood count, C-reactive protein, calcium, albumin and total protein were normal. No specific therapy was instituted. In January of 1998 the patient remained asymptomatic with no gastrointestinal, cardiovascular or constitutional symptoms. He had developed nephrotic range proteinuria (3.95 g/24 h), microalbuminuria, hypoalbuminemia and a renal biopsy consistent with renal amyloidosis. In 1999 there was an increase in the monoclonal paraprotein (6.2 g/L). The remaining investigations were normal except for an echocardiogram which showed left ventricular hypertrophy but a normal ejection fraction and no diastolic dysfunction. He went on to have high-dose chemotherapy and an autologous stem cell transplant in September, 2000. He has subsequently developed renal insufficiency. To our knowledge this is the first reported case of primary amyloidosis presenting as small bowel obstruction from encapsulating peritonitis.
Canadian Association of Gastroenterology 2004 Strategic Plan
Authors: Sherman Philip M , Fedorak Richard N , Leddin Desmond , Wallace John L
Published: March 2016

Presented below is the Canadian Association of Gastroenterology (CAG) five year Strategic Plan for July 2004 to June 2009. The Strategic Plan represents an extension of the organization's original 1993 Strategic Plan (1), and directly reflects input from the membership provided via a Strategic Planning Needs Analysis undertaken in the fall of 2002 (2).
Summary of the 2002 CAG Strategic Planning Survey
Authors: Sherman Philip M , Daniels Sandra M , Fedorak Richard N
Published: March 2016

In thisJournal, we have recently highlighted the progress of the Canadian Association of Gastroenterology (CAG) in meeting the goals and objectives outlined in the first Strategic Plan developed in 1993 (1). In September 2002, a Strategic Planning survey was mailed to all members of the CAG (a copy of the cover letter and survey are present for viewing on the CAG Web site www.cag-acg.org/whatsnew/strat_plann_surv.htm. The results of the responses to this survey were collated and presented to the Past Presidents of the CAG at a retreat held during the summer of 2003. These findings were then employed to develop a Strategic Plan for the CAG to guide its progress and development over the next five to ten years. A subsequent issue of this Journal will include a presentation of the CAG 2004 Strategic Plan, which was finalized and approved by the CAG Governing Board during the annual fall meeting in October 2003.
Failure to Improve Parameters of Lactose Maldigestion using the Multiprobiotic Product VSL3 in Lactose Maldigesters: A Pilot Study
Authors: Yesovitch Rose , Cohen Albert , Szilagyi Andrew
Published: March 2016

Lactose maldigestion is a common genetic trait in up to 70% of the world's population. In these subjects, the ingestion of lactose may lead to prebiotic effects which can be confirmed by measurement of breath hydrogen. After a period of continuous lactose ingestion, colonic bacterial adaptation is measurable as improved parameters of lactose digestion. There may be inherent benefits in this process of adaptation which may protect against some diseases. We attempt to link therapeutically beneficial probiotics (VSL3, Seaford Pharmaceuticals Inc, Ontario) with improvement in parameters of lactose maldigestion. Two groups of five subjects with maldigestion were fed one or four packets of VSL3 (one packet containing 450x109live bacteria) before testing and then 17 days later. A 50 g lactose challenge was carried out before and after feeding. While there was a trend toward increasing rather than reducing of summed breath hydrogen, no statistically significant changes were observed between results from before testing and those from testing 17 days later. The authors conclude that direct consumption of the probiotic VSL3 may not improve parameters of lactose maldigestion without metabolic activation. In its present format, therefore, the test for colonic adaptation cannot be used to demonstrate direct bacterial embedding with VSL3.
cagA-Seropositive Strains ofHelicobacter pyloriIncrease the Risk for Gastric Cancer more than the Presence ofH pyloriAlone
Authors: Chiba Naoki
Published: March 2016

Huang et al have performed a meta-analysis to determine the relationship betweencagA seropositivity (by serology and polymerase chain reaction) and the risk of gastric cancer. An extensive review of the literature identified no previous systematic overviews. The authors identified 16 studies involving 2284 cases and 2770 controls. The overall prevalence of Helicobacter pylori was 77.7% in cases and 63.1% in controls. Tests forcagA were positive in 62.8% of cases and 37.5% of controls. Thus,H pyloriandcagA seropositivity significantly increased the risk for gastric cancer, by 2.28 (95% CI 1.71 to 3.05) and 2.87 (95% CI 1.95 to 4.22), respectively. In patients withH pylori, those who were infected by acagA-positive strain had a slightly higher risk of gastric cancer, with an odds ratio of 1.64 (95% CI 1.21 to 2.24). The authors also found that patients infected withH pyloriwith or withoutcagA seropositivity had an increased risk of noncardia gastric cancer, but not of cancer of the gastric cardia. They concluded thatcagA-positive strains confer a greater risk of gastric cancer than does H pylori infection alone.
Maintenance of Certification and Gastroenterology
Authors: Switzer Connie M
Published: March 2016

William Osler said (1): "If the license to practice meant the completion of his education how sad it would be for the practitioner, how distressing to his patients!"
Say Goodbye and Say Hello: The Transition from Pediatric to Adult Gastroenterology
Authors: Pinzon Jorge L , Jacobson Kevan , Reiss John
Published: March 2016

Pediatric and adult gastroenterologists have identified an important issue to be addressed which entails the process of transition of care for youth affected by chronic gastrointestinal disorders. The adolescent years are a time of change and development, and may be significantly affected by conditions such as Crohn's disease or ulcerative colitis. Health care providers need to advocate and provide comprehensive, developmentally appropriate care for youth and families to facilitate the transition from the pediatric to the adult setting. The present article will review important aspects of the transition from the pediatric to the adult care health system.
Second-Generation Recombinant Hemoglobin Molecules Do Not Stimulate Sphincter of Oddi, Gallbladder, or Duodenal Motility in the Australian Brush-Tailed Possum
Authors: Takahata Shunichi , Konomi Hiroyuki , Schloithe Ann C , Toouli James , Saccone Gino TP
Published: March 2016

BACKGROUND:Several studies have investigated the effects of hemoglobin-based oxygen carriers on gastrointestinal motility. Diaspirin cross-linked hemoglobin reduces sphincter of Oddi trans-sphincteric flow and increases duodenal motility in the Australian brush-tailed possum, effects attributed to nitric oxide (NO) scavenging. Recently, second-generation recombinant hemoglobin molecules with reduced NO scavenging ability have been developed.

AIM:To determine the effects of two second-generation recombinant hemoglobin solutions and the prototype recombinant hemoglobin with high NO binding, on duodenal and biliary motility in the Australian brush-tailed possum.

METHOD:Blood pressure; duodenal, sphincter of Oddi and gallbladder motility; and trans-sphincteric flow were recorded. The effects of recombinant hemoglobin or human serum albumin (control) solutions on these parameters were investigated. Each solution was infused intravenously at 1 mL/kg/min to deliver 250 mg/kg or 500 mg/kg.

RESULTS:Duodenal contraction frequency was stimulated by the high dose of prototype recombinant hemoglobin, but not by a comparable dose of second-generation recombinant hemoglobin. The induced duodenal activity occurred in the later phase of the experimental period. In contrast, biliary motility and trans-sphincteric flow were not altered by any hemoglobin solution. The high dose of all the hemoglobin solutions elevated blood pressure, whereas the low dose solutions did not alter any parameter measured.

CONCLUSION:At the doses studied, the second-generation recombinant hemoglobin with reduced NO binding capacity did not significantly alter duodenal and biliary motility, supporting the need for further studies to evaluate their potential usefulness as blood substitutes.
Medical Management of Variceal Bleeding in Patients with Cirrhosis
Authors: Abraldes Juan G , Dell'Era Alessandra , Bosch Jaime
Published: March 2016

Bleeding from gastroesophageal varices is a frequent and often deadly complication of cirrhosis. The key factor in the natural history of esophageal varices is increased portal pressure, which in cirrhosis is due to the combination of increased hepatic vascular resistance and increased portal collateral blood flow. The maintenance and aggravation of this situation leads to the progressive dilation of the varices and thinning of the variceal wall, until the tension exerted by the variceal wall exceeds the elastic limit of the vessel, leading to variceal hemorrhage. Mortality from a variceal bleeding episode has decreased in the last two decades from 40% to 20% due to the implementation of effective treatments and improvement in the general medical care. Initial treatment should include adequate fluid resuscitation and transfusion to maintain the hematocrit at 25% to 30%, and prophylactic antibiotics (norfloxacin or amoxicillin-clavulanic acid). It is currently recommended that a vasoactive drug be started at the time of admission. Drug therapy may be started during transferal to hospital by medical or paramedical personnel and maintained for up to five days to prevent early rebleeding. Terlipressin, a vasopressin derivative, is the preferred agent because of its safety profile and proven efficacy in improving survival. Somatostatin is as effective as terlipressin, but may require higher than the usually recommended dosage. Octreotide is effective in conjunction with endoscopic therapy, but is the second choice because it has not been shown to reduce mortality. Vasopressin may be used where terlipressin is not available, but should be given in combination with transdermal nitroglycerin. Endoscopic elastic band ligation is the recommended endoscopic treatment, but injection sclerotherapy is still employed in many centres for active variceal bleeding. Failures of medical therapy (drugs plus endoscopic therapy) should undergo a second course of endoscopic therapy before proceeding to transjugular intrahepatic portosystemic shunt or, in rare occasions, to portosystemic shunt surgery. Administration of recombinant activated factor VII may decrease the number of treatment failures among patients with advanced liver failure (Child-Pugh class B and C).
The Canadian Association of Gastroenterology Education Committee Report
Authors: Bridges Ronald J
Published: March 2016

I am pleased to provide an update regarding the activities and future directions of the Canadian Association of Gastroenterology (CAG) Education Committee. The mandate of the CAG Education Committee is to facilitate, develop and promote excellence as it pertains to educational initiatives for the Canadian gastroenterology community. Professional education has long remained a priority of the CAG - a fact well recognized by the membership. The 2002 CAG Strategic Planning Survey showed that members rate Canadian Digestive Diseases Week (CDDW) as the most important CAG service, on par with Digestive Diseases Week regarding its usefulness (1). CDDW 2004 offered delegates a variety of basic science and clinical symposia, the popular and well received 'Breakfast with the Expert' sessions and a comprehensive Postgraduate Course reviewing key developments in gastroenterology, nutrition and hepatology.
Benzocaine-Induced Methemoglobinemia: A Condition of which all Endoscopists Should Be Aware
Authors: Armstrong C , Burak KW , Beck PL
Published: March 2016

Methemoglobinemia is a rare complication that can occur with the use of benzocaine-containing compounds. Two cases of methemoglobinemia are reported, and the pathophysiology and treatment of methemoglobinemia are reviewed. Both patients received topical 20% benzocaine spray before endoscopy. Immediately following the procedure, there was a reduction in O2saturation assessed by pulse oximetry that was refractory to O2therapy. Dramatic peripheral and central cyanosis developed. O2saturation measured by pulse oximetry ranged from 83% to 87% on O2by nasal prongs and 100% O2by a nonrebreathing mask. Both patients were mildly confused and one patient complained of a significant headache. The diagnosis of methemoglobinemia was considered and arterial blood gas sampling was performed. In both patients, the arterial blood had a chocolate brown colour. A methemoglobin level of 48% and 18% was noted in patient 1 and patient 2, respectively. Both patients were treated with methylene blue, resulting in a significant improvement with gradual normalization of their O2saturation within 10 min to 30 min. The use of benzocaine spray may not markedly alter the patient's perception of endoscopy and thus, the routine use of these agents should be questioned. If such agents are used, the physician must be aware of this association to prevent a delay in the diagnosis and management of this rare, but potentially lethal, condition.
Toward a Better Understanding of the Role ofHelicobacter pyloriInfection as a Cause of Dyspepsia
Authors: Lin Frank YH , Sherman Philip M
Published: March 2016

The relationship between gastric inflammation caused byHelicobacter pyloriinfection and symptoms of dyspepsia remains controversial (1). Using a murine model of gastric infection, Bercik et al provide new insights into the mechanism underlying such interactions. Gastric sections from Balb/c mice infected withH pylori, strain SS-1, were used for both histological evaluation and studies of neuromuscular physiology. Acute infection (two weeks) caused an antral-predominant polymorphonuclear cell infiltrate that was superceded by a corpus-predominant mononuclear and macrophage infiltrate in chronic infection (three to 16 months).
The World Congress of Gastroenterology: Montreal, Quebec, 379 September 12-14, 2005
Authors: Patel Dilip G
Published: March 2016

The World Gastroenterology Organization, or OMGE, is a federation of 93 national societies and associations of gastroenterology representing over 50,000 members worldwide. One of its major missions is to organize and present a World Congress of Gastroenterology (WCOG) every four years. Member societies, just as with Olympic committee members, vote after a formal bidding process and the winner hosts the next meeting. We have received that honour and privilege of hosting the WCOG in Montreal in September 2005. With privilege comes responsibilities, and that goes for every man and woman who cares for the future of gastroenterology in Canada.
Canadian Association of Gastroenterology Clinical Practice Guidelines: The Use of Infliximab in Crohn's Disease
Authors: Panaccione Remo , Fedorak Richard N , Anmais Guy , Bernstein Charles N , Bitton Alain , Croitoru Ken , Enns Robert , Feagan Brian , Fishman Marty , Greenberg Gordon , Griffiths Anne , Marshall John K , Rasul Imran , Sadowski Daniel , Seidman Ernest , Steinhart Hillary , Sutherland Lloyd , Walli Eric , Wild Gary , Williams C Noel , Zachos Mary
Published: March 2016

These guidelines are presented as a follow-up to the original Canadian Association of Gastroenterology Clinical Practice Guidelines: The use of infliximab in Crohn's disease, published in the Canadian Journal of Gastroenterology (1). The original guidelines represented publications between 1998 and 2000. The current guidelines have been updated to reflect knowledge gained from two pivotal randomized clinical trails, with the use of infliximab in the maintenance of inflammatory Crohn's disease in remission (2) and in the maintenance of fistulous Crohn's disease in remission (3).
Survival and Prognostic Factors in Patients with Hepatocellular Carcinoma Treated by Percutaneous Ethanol Injection: A 10-Year Experience
Authors: Mazzanti Roberto , Arena Umberto , Pantaleo Pietro , Antonuzzo Lorenzo , Cipriani Greta , Neri Bruno , Giordano Clara , Lanini Fabio , Marchetti Serena , Gentilini Paolo
Published: March 2016

The treatment of early and intermediate stage hepatocellular carcinoma (HCC) is still debated. Surgical treatments are considered to be the only curative procedures available, and only for a minority of patients. Percutaneous ethanol injection (PEI) is an established technique for the ablation of HCC nodules, and shows survival rates similar to those of resection. The efficacy of PEI in patients with biopsy-proven viral cirrhosis and small to intermediate inoperable HCC was evaluated. One hundred twenty-seven patients (85 men, 42 women, mean age 63 years, range 51 to 92 years, 115 hepatitis C virus-positive, 12 hepatitis B virus-positive) were enrolled between January 1993 and December 2002. They all underwent a standard PEI procedure and were prospectively followed-up. Overall median survival rate was 28 months (range six to 112 months). The following parameters were associated with a significantly longer survival: nodule diameter smaller than 30 mm (P=0.0480), the presence of a perinodular boundary (P=0.0008), serum alpha-fetoprotein less than 20 ng/mL (P=0.0104), a Child-Pugh A class score (PÃ0.0001) or a Cancer of the Liver Italian Program score of 0 (PÃ0.0001) and the presence or absence of small esophageal varices (P=0.013). The 19 patients with all these favourable characteristics showed an overall median survival of 61 months. An alpha-fetoprotein below 20 ng/mL was associated with significantly longer disease-free survival (P=0.0009). The Child-Pugh and Cancer of the Liver Italian Program scores were effective in predicting prognosis of these patients. In conclusion, PEI still represents a safe and economically sound treatment for HCC.
Simmering Innards: Does Irritable Bowl Syndrome Have an Immunological Basis?
Authors: Andrews Christopher N , Shaffer Eldon A
Published: March 2016

Not so long ago, physicians construed the irritable bowel syndrome (IBS) as being a neurotic trait: it was all in the head. Today most clinicians believe that the main abnormality lies in the brain (and spinal cord), which reacts abnormally to stimuli from the gut. Recent studies are identifying a basis for these neural changes - low grade inflammation in the gut - which may play a key role in IBS.
Hepatorenal Syndrome: Are We Doing Better?
Authors: Wong Florence
Published: March 2016

This is a retrospective study assessing the accuracy of diagnosis, clinical features and outcome of patients coded with a medical record diagnosis of hepatorenal syndrome (HRS) between 1988 and 1998 in a tertiary care centre in Canada. The authors found that, of the 46 patients whose medical records revealed a diagnosis of HRS, only 27 patients (59%) fulfilled the criteria for the diagnosis of HRS defined by the International Ascites Club (IAC) (1). Most patients with HRS were middle-aged men with decompensated alcoholic cirrhosis, jaundice and hepatic encephalopathy. Infection (48%), gastrointestinal bleeding (33%) and overly aggressive paracentesis (27%) were the major precipitants of renal failure. Once HRS developed, the mortality rate was high (93%), with multiorgan failure being the most common cause of death. The authors concluded that diagnostic accuracy is paramount for studies of HRS. In addition, decompensated alcoholic cirrhosis remains the main predisposing factor for HRS, with various other factors precipitating its development.
Patterns of Use of Endoscopic Retrograde Cholangiopancreatography in a Canadian Province
Authors: Hilsden Robert J , Romagnuolo Joseph , May Gary R
Published: March 2016

BACKGROUND:Data on current endoscopic retrograde cholangiopancreatography (ERCP) practice patterns drawn from large population-based samples are limited.

METHODS:Patterns of ERCP use were determined using billing records for ERCP, sphincterotomy, stone extraction or stent placement performed between April 1, 1994 and March 31, 2002 in Alberta from a population-based administrative database. Age-sex adjusted rates (per 1000 population) were calculated using the 1991 Canadian population as the standard.

RESULTS:The eight-year average ERCP rate was 0.98 without evidence of an increasing or decreasing trend over time. The ERCP rate was 0.85 in men and 1.12 in women. Significant regional variation in ERCP rates was seen, ranging from a low of 0.64 to a high of 1.27. The proportion of procedures that were therapeutic increased from 33% in 1994 to 70% in 2001. The likelihood of a procedure being considered therapeutic varied with the age and sex of the patient as well as the health region in which the procedure was performed.

CONCLUSIONS:The ERCP rate remained relatively stable over an eight-year time period, but the proportion of procedures that were therapeutic increased dramatically. Important regional variation in ERCP rates and therapeutic procedures exists.
Advanced Colon Cancer Before the Age of 20 Years: A Case for Extension of the Current Colonscopy Surveillance Guidelines in Hereditary Nonpolyposis Colorectal Cancer Syndrome
Authors: Wong Victor K , Yoshida Eric M , Ryan Anthony G , Ho Stephen GF , Salh Baljinder
Published: March 2016

BACKGROUND:Hereditary nonpolyposis colorectal cancer (HNPCC) currently accounts for between 2% to 6% of all colorectal adenocarcinomas. Controversies exist regarding the current guidelines for colonoscopic screening for colon cancer.

CASE REPORT:A case of colon cancer in a young Japanese man with a family history of colon cancer that did not meet the criteria for HNPCC is reported. A malignant pelvic mass discovered shortly before his 20th birthday prompted a colonoscopy. The findings at colonscopy determined that the patient and his family fulfilled the criteria of HNPCC.

CONCLUSION:Before finding a pelvic mass metastatic from adenocarcinoma of the ascending colon, this patient was clearly outside of the current guidelines for HNPCC screening. It is suggested that in similar patients, even if they do not fulfill all the criteria for HNPCC, it would be appropriate to consider screening well before the recommended lower age.
Clinical Trials in Chronic Liver Disease - What Do They Achieve?
Authors: Heathcote Jenny
Published: March 2016

The past 30 years have seen rapid growth in the number of clinical trials in liver disease; due mostly to effective drug discovery programs by the pharmaceutical industry. The advantages associated with therapeutic trials in chronic liver disease, or any other disease for that matter, go far beyond potential benefit to the individual patient, other beneficiaries include the treating physician, the sponsoring agency and their investors, the institution/university and the general public. But there is always a downside to any experiment. The disadvantages and advantages of clinical trials in liver disease are the topics for this discussion.
CAG Research Committee Report: Another Stellar Year for Canadian GI Research
Authors: McKay Derek M
Published: March 2016

The goal of the Research Committee is to build, in collaboration with the Canadian Institutes of Health Research (CIHR) and the Canadian Association of Gastroenterology (CAG) partners, Canadian capacity and expertise in the discipline of gastroenterology and nutrition, and to promote excellence in research. As chair of the CAG Research Committee, it is my privilege to update the CAG membership andThe Canadian Journal of Gastroenterologyreadership on the activities of the CAG Research Committee (2003-2004), in what has been yet another outstanding year for investment in gastrointestinal (GI) research in Canada.
Deadaption and Readaptation with Lactose, But No Cross-Adaptation to Lactulose: A Case of Occult Colonic Bacterial Adaptation
Authors: Szilagyi Andrew , Cohen Albert , Vinokuroff Christina , Ahman Darakhshan , Nathwani Usha , Yesovitch Samara
Published: March 2016

The standard 3 h breath hydrogen (3hBH2) test distinguishes lactose maldigesters from lactose digesters. However, multiple factors impact on BH2and care is needed to exclude a priori variables. When these factors are controlled, a negative BH2test implies lactase persistent status or lactase nonpersistent status with colonic adaptation. A case of a Sicilian man who tested negative (lactase persistent status confirmed) on an initial 50 g lactose challenge is described. It was observed that he consumed 28.1 g lactose/day before testing. He subsequently underwent five additional challenge tests in the course of the next 10 months. In four tests the dose intake of lactose was varied upon instruction, and in the fifth test a 30 g lactulose challenge was carried out. It was demonstrated that on radically decreasing lactose intake, a full lactase nonpersistent status was unmasked. Output of 3hBH2varied inversely with daily lactose intake. Finally, at a time when he was readapted to lactose, there was no discernible adaptation to lactulose challenge. It was concluded that 'occult' colonically adapted subjects may contribute to negative BH2tests. There is a relationship between variation in lactose intake and the results of BH2testing. Finally, there was no cross-adaptation to lactulose challenge when lactose was used as the adapting sugar.
Hemochromatosis Patients as Voluntary Blood Donors
Authors: Power Tara E , Adams Paul C
Published: March 2016

The present study was designed to investigate hemochromatosis patients' suitability as blood donors as well as their perceptions and experience with the current public donation system. Participants were gathered from a list of current hemochromatosis patients (n=120) and members of the Canadian Hemochromatosis Society (n=1000). Of the 1120 surveys mailed out to these groups, 801 surveys were returned completed. The sample respondents had a mean age of 57.44 years (SD=12.73; range 19 to 87 years), and 57% were men. It was found that 20% (160) of the respondents have donated blood since their diagnosis; however, only 12% of the respondents indicated that they use voluntary blood donation as a means of maintaining their iron levels. Forty per cent of the respondents indicated that they had been refused from voluntary donation. Despite the fact that in May 2001 the Canadian Blood Services, in collaboration with the Canadian Hemochromatosis Society, began a promotion campaign to encourage hemochromatosis patients to become voluntary blood donors, the present study found that 15% of the respondents reported having been refused from the voluntary blood donation service due to the diagnosis of hemochromatosis. With respect to quality of life, it was found that individuals who donate blood were generally healthier with respect to physical functioning and bodily pain, however, these findings may indicate that hemochromatosis patients who are healthier are better able to donate at public blood banks, rather than that voluntary blood donation has an effect on the donors' physical functioning over phlebotomy clinic users. These study findings suggest that although there may be other medical factors limiting individuals from donating, hemochromatosis patients are interested in being voluntary blood donors and this potential resource is currently under-used.
Bacterial Infections in Cirrhosis
Authors: Garcia-Tsao Guadalupe
Published: March 2016

Hospitalized patients with cirrhosis are at increased risk of developing bacterial infections, the most common being spontaneous bacterial peritonitis (SBP) and urinary tract infections. Independent predictors of the development of bacterial infections in hospitalized cirrhotic patients are poor liver synthetic function and admission for gastrointestinal hemorrhage. Short term (seven-day) prophylaxis with norfloxacin reduces the rate of infections and improves survival and should therefore be administered to all patients with cirrhosis and variceal hemorrhage. Cirrhotic patients who develop abdominal pain, tenderness, fever, renal failure or hepatic encephalopathy should undergo diagnostic paracentesis, and those who meet the criterion for SBP (eg, an ascites neutrophil count greater than 250/mm3) should receive antibiotics, preferably a third-generation cephalosporin. In addition to antibiotic therapy, albumin infusions have been shown to reduce the risk of renal failure and mortality in patients with SBP, particularly in those with renal dysfunction and hyperbilirubinemia at the time of diagnosis. Patients who recover from an episode of SBP should be given long term prophylaxis with norfloxacin and should be assessed for liver transplantation.
Isolated Splenic Vein Thrombosis: An Unusual Cause and Review of the Literature
Authors: Köklü Seyfettin , Köksal Aydın , Yolcu Ömer , Bayram Gürsel , Sakaoğulları Zişan , Arda Kemal , Şahin Burhan
Published: March 2016

Isolated obstruction (mainly due to thrombosis) of the splenic vein usually results in left-sided portal hypertension and isolated fundal varice formation. This syndrome is a rare cause of gastrointestinal bleeding. Pancreatic diseases are among the most common etiologies of splenic vein obstruction. Renal disorders are rarely reported as a cause of splenic vein thrombosis. In the present article, a case of a 26-year-old woman with a perirenal abscess presenting with gastrointestinal bleeding as a complication of an isolated splenic vein thrombosis is described. The thrombosis could not be visualized with ultrasonography and angiography because of its extremely proximal localization. Fundal varices disappeared following splenectomy and nephrectomy. Follow-up at one year revealed the patient to be well both clinically and endoscopically.
CAG Research Update
Authors: McKay Derek
Published: March 2016

Some exciting developments and changes have occurred since the May report from the Canadian Association of Gastroenterology (CAG) Research Committee, which I am pleased to share with you.
An Update from the Clinical Affairs Portfolio
Authors: Barkun Alan
Published: March 2016

The Clinical Affairs portfolio reflects the most direct interests of the majority of the membership and focuses on issues related to patient care. It encompasses the Endoscopy, Hepatobiliary/Transplant, Liaison, Pediatric, Practice Affairs and Regional Representation Committees. The portfolio is overseen by Dr Alan Barkun, Chair of Clinical Affairs. Its committees have been very busy spearheading a number of initiatives over the past six months, while contributing to a number of projects undertaken by other committees of the Canadian Association of Gastroenterology (CAG).
ASA, NSAIDs, Coxibs and Colorectal Cancer Prevention — How Far Have We Come?
Authors: Fishman Martin
Published: March 2016

This paper described a nested case-control study on all Quebec patients over 65 years of age who underwent total colonic imaging or surgery for colorectal cancer (CRC) during a specified six-month period without similar testing in the preceding year. Information from the provincial government database was collected for each subject to estimate the consumption of prescription acetylsalicylic acid (ASA), standard nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2- specific inhibitors (coxibs) during the previous year. Of 2568 subjects, 730 were found to have at least one adenoma (but not carcinoma) and 129 were found to have CRC (with or without adenoma). Patients with and without adenoma or carcinoma were compared for type, amount and duration of drug exposure to determine if there was a protective effect. Rofecoxib and NSAIDs were associated with reduced incidence of colorectal adenoma (CRA), and these drugs and celecoxib protected against CRA and CRC.
Mechanisms of Nonsteroidal Anti‐Inflammatory Drug‐Induced Gastrointestinal Injury and Repair: A Window of Opportunity for Cyclooxygenase‐Inhibiting Nitric Oxide Donors
Authors: Perini Rafael , Fiorucci Stefano , Wallace John L
Published: March 2016

Nonsteroidal anti‐inflammatory drugs (NSAIDs) cause damage in the upper gastrointestinal (GI) tract by impairing the ability of the mucosa to resist and respond to injury. Many of these effects of NSAIDs can be attributed to their ability to suppress mucosal prostaglandin synthesis. Selective inhibitors of cyclooxygenase (COX)‐2 are less likely to disrupt mucosal defence and do not interfere with platelet aggregation. Thus, their use is associated with a reduced incidence of serious GI adverse events; however, a significant risk of such events still persists. At least in animal models, selective COX‐2 inhibitors interfere with ulcer healing to the same extent as conventional NSAIDs. In contrast, COX‐inhibiting nitric oxide donors (CINODs) produce anti‐inflammatory and analgesic effects comparable or superior to those of NSAIDs, but with greatly reduced GI toxicity. Unlike NSAIDs and selective COX‐2 inhibitors, CINODs do not interfere with ulcer healing. Moreover, because CINODs suppress the activity of both COX‐1 and COX‐2, they do not share with selective COX‐2 inhibitors the lack of cardioprotection afforded by significant suppression of platelet aggregation. Because of their safety profile, CINODs may be particularly useful for long term prevention applications, such as for colon cancer, cardiovascular disease and Alzheimer′s disease.
Somatostatin versus octreotide in the treatment of patients with gastrointestinal and pancreatic fistulas
Authors: Leandros Emanuel , Antonakis Pantelis T , Albanopoulos Konstantinos , Dervenis Chris , Konstadoulakis Manousos M
Published: March 2016

BACKGROUND AND PURPOSE:Gastrointestinal and pancreatic fistulas are characterized as serious complications following abdominal surgery, with a reported incidence of up to 27% and 46%, respectively. Fistula formation results in prolonged hospitalization, increased morbidity/mortality and increased treatment costs. Conservative and surgical approaches are both employed in the management of these fistulas. The purpose of the present study was to assess, evaluate and compare the potential clinical benefit and cost effectiveness of pharmacotherapy (somatostatin versus its analogue octreotide) versus conventional therapy.

PATIENTS AND METHODS:Fifty-one patients with gastrointestinal or pancreatic fistulas were randomized to three treatment groups: 19 patients received 6000 IU/day of somatostatin intravenously, 17 received 100 µg of octreotide three times daily subcutaneously and 15 patients received only standard medical treatment.

RESULTS:The fistula closure rate was 84% in the somatostatin group, 65% in the octreotide group and 27% in the control group. These differences were of statistical significance (P=0.007). Overall mortality rate was less than 5% and statistically significant differences in mortality among the three groups could not be established. Overall, treatment with somatostatin and octreotide was more cost effective than conventional therapy (control group), and somatostatin was more cost effective than octreotide. The average hospital stay was 21.6 days, 27.0 and 31.5 days for the somatostatin, octreotide and control groups, respectively.

CONCLUSIONS:Data suggest that pharmacotherapy reduces the costs involved in fistula management (by reducing hospitalization) and also offers increased spontaneous closure rate. Further prospective studies focusing on the above parameters are needed to demonstrate the clinicoeconomic benefits.
Talk Is Cheap: The Impact of Consultation. Commentary on the Article
Authors: Marshall John K
Published: March 2016

Most recommendations for managing irritable bowel syndrome emphasize the positive roles of patient education and reassurance (1), but the impact and value of these approaches are difficult to assess. Therefore, a recent paper by Ilnyckyj et al (2) is both relevant and reassuring. This well designed study used Manitoba Health administrative databases to track health resource utilization, before and after a standardized gastroenterology consultation, by a consecutive cohort of patients with Rome I irritable bowel syndrome (IBS) attending an academic tertiary care clinic. Subjects also completed standardized survey instruments at the time of the consultation, one year and two years later to assess physical morbidity, psychological function and pain severity. During the two years of follow-up, the authors observed a reduction from baseline in the use of health resources for gastrointestinal diagnoses, but no change in consumption of resources for other indications. While pain was improved at follow-up, other measures of physical and psychological health were unchanged.
Ethical Issues in Canadian Gastroenterology: Resluts of a Survey of Canadian Gastroenterology Trainees
Authors: Malhotra Kenneth , Ottaway Clifford A
Published: March 2016

BACKGROUND:Specialty-specific bioethical education is a mandated component of gastroenterology training programs in Canada, but no gastroenterology-specific bioethical curriculum is available.

PURPOSE:To assess the relative importance of a variety of bioethical issues to the practice of gastroenterology.

METHOD:A convenience sample of Canadian gastroenterology residents and staff was surveyed at a national meeting for Canadian gastroenterology trainees. They were asked to indicate their opinions of the relative importance of 24 different bioethical issues in their practice of gastroenterology.

RESULTS:Respondents made distinctions in the relevance of different bioethical issues to the practice of gastroenterology and there was substantial concordance in the rankings indicated by residents and staff. Truth telling, consent and the capacity to give consent, and consent with regard to specific endoscopic procedures were ranked by both residents and staff as most important to their practice of gastroenterology. In contrast, the issue of euthanasia and assisted suicide was ranked near the bottom of the list by both residents and staff. The results differ in some respects from the key ethical questions identified by opinion leaders in gastroenterology.

INTERPRETATION:Gastroenterology residents and staff identify some topics as much more relevant than others to the practice of gastroenterology. It is proposed that this can provide a framework for developing a gastroenterology-specific bioethical curriculum, and that there is an important opportunity for developing a joint program through collaboration among gastroenterology training programs across Canada.
Diagnosis of a Bleeding Dieulafoy Lesion on Computed Tomography and Its Subsequent Embolization
Authors: Penner Robert M , Owen Richard J , Williams C Noel
Published: March 2016

Dieulafoy lesions are a potentially serious cause of gastrointestinal bleeding. Because they may bleed intermittently, and only be endoscopically evident during hemorrhage, their diagnosis can be challenging. This is the first case to be reported in the English literature of a patient with a Dieulafoy lesion diagnosed during computed tomography (CT) examination. Reduced acquisition times required for multislice helical CT allow the application of CT angiography in the diagnosis of gastrointestinal bleeding. CT scans are now widely used in the diagnostic algorithm for acute gastrointestinal hemorrhage, and the present case illustrates that with fortuitous timing, they can provide critical information and an opportunity for selected angiography and coil embolization.
Effects of Chronic Dopamine D2R Agonist Treatment and Polysialic Acid Depletion on Dendritic Spine Density and Excitatory Neurotransmission in the mPFC of Adult Rats
Authors: Castillo-Gómez Esther , Varea Emilio , Blasco-Ibáñez José Miguel , Crespo Carlos , Nacher Juan
Published: March 2016

Dopamine D2 receptors (D2R) in the medial prefrontal cortex (mPFC) are key players in the etiology and therapeutics of schizophrenia. The overactivation of these receptors contributes to mPFC dysfunction. Chronic treatment with D2R agonists modifies the expression of molecules implicated in neuronal structural plasticity, synaptic function, and inhibitory neurotransmission, which are also altered in schizophrenia. These changes are dependent on the expression of the polysialylated form of the neural cell adhesion molecule (PSA-NCAM), a plasticity-related molecule, but nothing is known about the effects of D2R and PSA-NCAM on excitatory neurotransmission and the structure of mPFC pyramidal neurons, two additional features affected in schizophrenia. To evaluate these parameters, we have chronically treated adult rats with PPHT (a D2R agonist) after enzymatic removal of PSA with Endo-N. Both treatments decreased spine density in apical dendrites of pyramidal neurons without affecting their inhibitory innervation. Endo-N also reduced the expression of vesicular glutamate transporter-1. These results indicate that D2R and PSA-NCAM are important players in the regulation of the structural plasticity of mPFC excitatory neurons. This is relevant to our understanding of the neurobiological basis of schizophrenia, in which structural alterations of pyramidal neurons and altered expression of D2R and PSA-NCAM have been found.
Traumatic Isolated Trapezium Dislocation without Fracture: A Case Report and Review of the Literature
Authors: Kenyon Robert M. , Kelly Enda G. , Padinjarathala Benny
Published: March 2016

Isolated dislocation of the trapezium is an uncommon injury. There are sixteen cases to date reported in the literature. The management of these cases has varied from complete excision to open or closed reduction, with or without percutaneous wiring. This paper presents a case of an isolated dislocation of the trapezium without fracture, managed with closed reduction and percutaneous wiring, resulting in a good functional outcome.
Methylation Status of SP1 Sites within miR-23a-27a-24-2 Promoter Region Influences Laryngeal Cancer Cell Proliferation and Apoptosis
Authors: Wang Ye , Zhang Zhao-Xiong , Chen Sheng , Qiu Guang-Bin , Xu Zhen-Ming , Fu Wei-Neng
Published: March 2016

DNA methylation plays critical roles in regulation of microRNA expression and function. miR-23a-27a-24-2 cluster has various functions and aberrant expression of the cluster is a common event in many cancers. However, whether DNA methylation influences the cluster expression and function is not reported. Here we found a CG-rich region spanning two SP1 sites in the cluster promoter region. The SP1 sites in the cluster were demethylated and methylated in Hep2 cells and HEK293 cells, respectively. Meanwhile, the cluster was significantly upregulated and downregulated in Hep2 cells and HEK293 cells, respectively. The SP1 sites were remethylated and the cluster was significantly downregulated in Hep2 cells into which methyl donor, S-adenosyl-L-methionine, was introduced. Moreover, S-adenosyl-L-methionine significantly increased Hep2 cell viability and repressed Hep2 cell early apoptosis. We also found that construct with two SP1 sites had highest luciferase activity and SP1 specifically bound the gene cluster promoter in vitro. We conclude that demethylated SP1 sites in miR-23a-27a-24-2 cluster upregulate the cluster expression, leading to proliferation promotion and early apoptosis inhibition in laryngeal cancer cells.
An Advanced Orthotopic Ovarian Cancer Model in Mice for Therapeutic Trials
Authors: Zhang Ying , Luo Li , Zheng Xueling , Yu Tinghe
Published: March 2016

A nude mouse received subcutaneous injection of human ovarian cancer cells HO-8910PM to form a tumor, and then the tumor fragment was surgically transplanted to the ovary of a recipient mouse to establish an orthotopic cancer model. Tumors occurred in 100% of animals. A mouse displayed an ovarian mass, ascites, intraperitoneal spread, and lung metastasis at natural death. The mean survival time was34.1±17.2days, with median survival time of 28.5 days. The findings indicated that the present mouse model can reflect the biological behavior of advanced human ovarian cancers. This in vivo model can be used to explore therapeutic means against chemoresistance and metastasis, and an effective treatment would prolong the survival time.
Analysis and Improvement of Key Distribution Scheme for Secure Group Communication
Authors: Luo Jia Ning , Yang Ming Hour
Published: March 2016

In a secure group communication, messages between a group coordinator and members are protected by session keys. If a group’s membership changes, the session keys should be updated to insure forward secrecy and backward secrecy. Zhou and Huang proposed a key-updated scheme based on ciphertext-policy attribute encryption algorithm to improve the security of key-update mechanism, but their scheme is vulnerable: a malicious group member may send forged key-update messages to control the group. In this paper, we analyze the vulnerability in Zhou and Huang’s scheme and propose an enhanced scheme. In our scheme, only the group initiator can update group keys and the verification of key-update mechanism is improved to prevent malicious insiders from controlling the group. We also give a security and performance analysis of our scheme.
Multivariate Analysis of Confined Groundwater Hydrochemistry of a Long-Exploited Sedimentary Basin in Northwest China
Authors: Zhang Xuedi , Qian Hui , Wu Hao , Chen Jie , Qiao Liang
Published: March 2016

A series of environmental and geological problems have been caused by overexploitation of confined aquifers (i.e., deep groundwater) in the Yinchuan region, northwest China. Accordingly, the characteristics of confined water were analyzed and collected from 33 sampling wells in spring of 2011, to determine the factors that influenced the composition and evolution of confined water, using principal component analysis (PCA), correlation analysis, groundwater evolution, and mineral dissolution/precipitation analysis. PCA showed that the hydrochemistry of confined water is controlled mainly by the dissolution of minerals, mixing between the confined aquifer and polluted phreatic water, and effects of ion exchange in the study area. The following management actions recommended were essential, in order to enable the sustainable exploitation of confined water: (1) gradually decreasing the amount of groundwater pumped from confined aquifer in the central part of the depression cone, (2) upgrading the quality of phreatic water, and (3) increasing artificial recharge of the groundwater system by flood waters in the Helan leaning pluvial plain.