bluuebunny/crossref_metadata_2025 huggingface dataset:
Enteropathogenic and EnterohemorrhagicEscherichia coliInfections: Emerging Themes in Pathogenesis and Prevention
Authors: Vallance Bruce A , Chan Crystal , Robertson Marilyn L , Finlay B Brett
Published: March 2016

EnteropathogenicEscherichia coli(EPEC) and enterohemorrhagicE coli(EHEC) are important causes of infectious diarrhea, particularly among pediatric populations. While EPEC is a significant health threat in the developing world, EHEC causes sporadic but deadly outbreaks of hemorrhagic colitis and hemolytic-uremic syndrome in North America and other developed areas. The present review discusses emerging themes in the pathogenesis of EPEC and EHEC, including the discovery and characterization of novel bacterial proteins that are injected by the pathogen into host cells. Recent advances have also been made in the development of relevant animal models, while bacterial virulence factors are being investigated as potential vaccination targets for humans and animals. It is hoped that these new areas of study will not only further our knowledge of the pathogenesis of EPEC- and EHEC-induced disease but also provide opportunities for reducing infection rates and improving treatment options in the future.
Endoscopic Evaluation of the Small Intestine
Authors: Shields Steven J , van Dam Jacques
Published: March 2016

Technological achievements in the area of endoscope design and development have resulted in instruments capable of advancing beyond the reach of simple gastroscopes. Such instruments, known as enteroscopes, form the bases of small bowel endoscopy. Recent widespread use of enteroscopes have contributed significantly to the understanding of small intestinal pathology and improved the ability to diagnose and treat patients with intestinal bleeding sources.
Early Relief of Upper Gastrointestinal Dyspeptic Symptoms: A Survey of Empirical Therapy with Pantoprazole in Canadian Clinical Practice
Authors: Armstrong David , Kazim Farouk , Gervais Marcel , Pyzyk Myron
Published: March 2016

BACKGROUND: Upper gastrointestinal symptoms attributable to gastroesophageal reflux disease or peptic ulcer are common, but the outcome of proton pump inhibitor therapy in clinical practice is not well documented.

AIM: To assess the range of upper gastrointestinal acid-related symptoms in clinical practice and the rapidity of their response to pantoprazole (40 mg daily), after seven days of therapy.

METHODS: A total of 726 Canadian physicians (65.3% family physicians) recorded a working diagnosis and alarm features in eligible patients, who then recorded the severity of eight upper gastrointestinal symptoms in a daily symptom diary during the first week of therapy.

RESULTS: Complete data were obtained from 2273 (37.3% male) of 3261 patients; physicians diagnosed reflux esophagitis alone (66.9%), peptic ulcer (9.7%), other upper gastrointestinal disorders (12.3%) and reflux esophagitis with another diagnosis (11.1%). Alarm features were common (29.6%), but a history of gastrointestinal blood loss was rare (less than 1%). Mean daytime heartburn scores decreased from 2.59 to 1.40, and epigastric pain scores decreased from 2.54 to 1.56 over the first week (P<0.00001); the proportions of patients who became symptom-free were 68.1% and 55.4%, respectively. Decreased mean symptom scores were also observed for acid regurgitation (2.21 to 1.35), bloating (2.47 to 1.57), nausea (2.03 to 1.36), slow digestion (2.51 to 1.56) and burping (2.56 to 1.69). The percentage of patients with severe or very severe symptoms decreased from 53.5% to 13.8% at day 7. The physician’s initial diagnosis was not predictive of outcome.

CONCLUSIONS: In a predominantly primary care population with upper gastrointestinal acid-related symptoms, proton pump inhibitor therapy produces prompt symptomatic relief in most patients. Potential alarm symptoms are common, and further research is required to determine the absolute risk of alarm symptoms and their implications for empirical therapy.
Are Patients Informed When They Consent to ERCP?
Authors: O’Sullivan Sinead , Crippen Craig , Ponich Terry
Published: March 2016

BACKGROUD: Only the British Society of Gastroenterology has published consent guidelines that are inclusive for endoscopic retrograde cholangiopancreatography (ERCP). Previous research has shown that there are variations in the information discussed with patients who are undergoing ERCP.

PURPOSE: To examine the informed consent practices for ERCP in Ontario.

METHODS: A self-report questionnaire was sent to ERCP endoscopists in Ontario, who were identified through a pre-existing database. The 14-item questionnaire included questions pertaining to the risks, benefits and alternatives discussed, how consent was obtained and whether the consent process was modified for patients older than 75 years.

RESULTS: Of the 82 surveys sent, 36 responses were received, with three respondents indicating that they no longer performed ERCP; the total response rate was 40%. Ninety-four per cent of those who responded noted that they obtained written consent, and 6% obtained verbal consent. When discussing risks with their patients, 91% of respondents always mentioned pancreatitis, 88% always mentioned bleeding, 73% always mentioned perforation and 30% always mentioned the risk of infection; only 24% always mentioned the possibility of being allergic to the contrast agent, and 73% rarely or never mentioned death. When dealing with patients older than 75 years, 38% of respondents tended to be more brief in their explanations, 31% gave the same details in their explanation and 31% gave more detailed information than they gave to younger patients. Seventy-nine per cent mentioned the possibility of diagnostic failure and 82% mentioned the possibility of therapeutic failure, while only 27% mentioned the possibility of missing a diagnosis.

CONCLUSIONS: Variability exists in terms of ‘important information’ given to patients undergoing ERCP. Standard informed consent guidelines specific to ERCP may help endoscopists uphold their responsibility to the patient, enhance patient understanding and reduce the risk of liability.
Self-Reported Awareness and Use ofInternational Classification of DiseaseCoding of Inflammatory Bowel Disease Services by Ontario Physicians
Authors: Farrokhyar Forough , McHugh Kevin , Irvine E Jan
Published: March 2016

RATIONALE: Population and health services research can be performed by linkage analysis of administrative data. However, the robustness of study results is determined by the accuracy of the diagnostic coding.

OBJECTIVES: To estimate the awareness, use and accuracy of theInternational Classification of Diseases, Ninth Revision(ICD-9) coding by physicians providing services for patients with Crohn’s disease (CD) and ulcerative colitis (UC).

METHODS: All Ontario gastroenterologists and a 10% random sample of internists, pediatricians, pediatric or general surgeons, and family physicians were surveyed by postal questionnaire to estimate the frequency and 95% CI of using codes 555 or 556 when billing for CD- and UC-related services, respectively.Χ2tests were used for between-group comparisons.

RESULTS: Of the physicians who were surveyed, 67.7% (416 of 614) responded; 258 of 391 (66%) who were still practising in Ontario saw patients with inflammatory bowel disease (IBD), and 54% had more than 10 IBD patients; 86.5% (95% CI 82.4% to 90.6%) were familiar with ICD-9 codes, and 91.4% (95% CI 88.1% to 95.6%) used the codes 555 (CD) or 556 (UC) for billing. Rates of ICD-9 use did not differ by sex but were used more frequently by those graduating after 1981 (P<0.02). Gastroenterologists used ICD-9 IBD codes 555 or 556 significantly more often than all other physicians (P=0.001). Most (more than 75%) Ontario physicians used ICD-9 IBD codes always or frequently when billing for IBD-related services. Few (10%) used these codes to bill for non-IBD-related problems.

CONCLUSIONS: These data suggest that there is acceptable use and accuracy of ICD-9 diagnostic coding for CD and UC services – comparable with results from studies of other diseases. Administrative data may thus be used to undertake epidemiological studies in IBD in Ontario.
The Role of Radiological Imaging in the Diagnosis of Acute Appendicitis
Authors: Albiston E
Published: March 2016

Several strategies have been employed to improve the accuracy of the diagnosis of appendicitis and to reduce the associated perforation rate. Because clinical algorithms have been disappointing, many physicians resort to radiological modalities. Plain abdominal x-rays are nonspecific, barium enema examination has relatively low accuracy, scintigraphy scans require considerable time and are difficult to interpret, and magnetic resonance imaging is relatively unstudied. The most promising modalities are graded compression sonography and computed tomography. In expert hands, these techniques can achieve a high degree of accuracy. Nevertheless, most published studies have been marred by methodological difficulties. Moreover, ultrasound is more useful in detecting than in ruling out appendicitis. The radiological criteria for acute appendicitis, the accuracy of various imaging modalities and the limitations of the available research are described.
Gallbladder Polyps: Epidemiology, Natural History and Management
Authors: Myers Robert P , Shaffer Eldon A , Beck Paul L
Published: March 2016

Polypoid lesions of the gallbladder affect approximately 5% of the adult population. Most affected individuals are asymptomatic, and their gallbladder polyps are detected during abdominal ultrasonography performed for unrelated conditions. Although the majority of gallbladder polyps are benign, most commonly cholesterol polyps, malignant transformation is a concern. The differentiation of benign from malignant lesions can be challenging. Several features, including patient age, polyp size and number, and rapid growth of polyps, are important discriminating features between benign and malignant polyps. Based on the evidence highlighted in this review, the authors recommend resection in symptomatic patients, as well as in asymptomatic individuals over 50 years of age, or those whose polyps are solitary, greater than 10 mm in diameter, or associated with gallstones or polyp growth on serial ultrasonography. Novel imaging techniques, including endoscopic ultrasonography and enhanced computed tomography, may aid in the differential diagnosis of these lesions and permit expectant management.
Motion –Helicobacter pyloriCauses or Worsens GERD: Arguments against the Motion
Authors: McColl Kenneth EL
Published: March 2016

Data from large epidemiological studies show thatHelicobacter pyloriis less prevalent in patients with gastroesophageal reflux disease (GERD) than in control subjects. The more virulent cagA-positive strains of the organism are also less commonly seen in patients with erosive esophagitis and in those with Barrett's esophagus than in those with less severe forms of GERD. Although the relationship betweenH pyloriand gastric physiology is complex, the organism has little effect on acid secretion in most North American or Western European subjects, and has a net suppressive effect, especially in elderly subjects, in other parts of the world. Thus, the organism has a potential protective effect against GERD, which is exacerbated by gastric acidity.H pylorihas no proven effect on other gastric factors that might provoke reflux, including delayed gastric emptying or inappropriate relaxation of the gastric fundus. Two well-designed interventional studies have found that eradication ofH pylorieither provoked GERD or had no effect. A third smaller study, which seemed to demonstrate that persistent infection was associated with GERD, was flawed, in that the two treatment groups were not comparable. The evidence thus does not support the idea thatH pyloriinfection provokes or aggravates GERD.
Motion – Patients with Primary Sclerosing Cholangitis Should Undergo Early Liver Transplantation: Arguments for the Motion
Authors: Lee Young-Mee
Published: March 2016

Primary sclerosing cholangitis (PSC) is a condition of unknown etiology that causes progressive inflammation, fibrosis and obliteration of the intrahepatic and extrahepatic biliary tree. There is no medical cure, and ursodeoxycholic acid and other drugs have not been shown to affect the natural history of the disease. Endoscopic dilation is of value only in the relief of symptoms and complications related to dominant strictures. Cholangiocarcinoma occurs in a substantial minority of cases, especially those with ulcerative colitis and cirrhosis, and is often not clinically apparent before surgery. There are no good serologic tests for early cancers. Because this tumour has such a dismal prognosis, some authorities recommend that liver transplantation be undertaken before its development. This procedure is the only curative option for PSC, and excellent survival rates have been reported. There is evidence that early transplantation, before end stage liver disease or cholangiocarcinoma have developed, improves the survival and quality of life of patients with PSC. Because it is the only procedure of proven benefit, patients with PSC should be considered for liver transplantation early in the course of the disease.
Motion-Genetic Testing is Useful in the Diagnosis of Nonhereditary Pancreatic Conditions: Arguments Against the Motion
Authors: Cohn Jonathan A
Published: March 2016

Mutations of two genes, the cystic fibrosis transmembrane conductance regulator gene (CFTR) and the pancreatic secretory trypsin inhibitor gene (PSTI), are associated with an increase in the risk of idiopathic chronic pancreatitis. Persons who have mutations of bothCFTRalleles (one severely and one mildly affected) are especially susceptible to this disease. Because these compound heterozygotes have sufficient residualCFTRfunction, they do not develop cystic fibrosis lung disease. OnePSTImutation, N34S, independently increases the risk of pancreatitis. Thus, the risk of pancreatitis is greatest among individuals who areCFTRcompound heterozygotes and who also have thePSTImutation. Nonetheless, most people withCFTRandPSTImutations do not develop pancreatitis. This fact indicates that environmental influences and gene-gene interactions also affect pancreatitis risk. AlthoughCFTRandPSTIgenetic testing can identify persons at an increased risk of pancreatitis, there are several reasons why the routine screening of individuals with nonhereditary pancreatitis is not recommended at this time: most disease-associated mutations are not detected by readily available techniques, genetic counselling guidelines do not exist, most patients with mutations do not develop pancreatitis and the results of testing do not affect the clinical management of pancreatitis.
Canadian Association of Gastroenterology - Canadian Institutes of Health Research-Pharmaceutical Partner* Postdoctoral Operating Fellowship Programme: An Outstanding Success that Continues to Excel!
Authors: McKay Derek M , Daniels Sandra
Published: March 2016

The Canadian Association of Gastroenterology (CAG) postdoctoral fellowship programme was initiated in 1992 with the goal of promoting excellence in Canadian gastroenterological research. With backing from multiple pharmaceutical partners and the Canadian Institutes of Health Research, 87 fellows were funded over the next ten years for a total investment of $8,730,101. Between 1992 and 2000, fellows authored 247 articles; 176 being original research articles, 31 (17.5%) of which appeared in journals with impact factors of greater than 10. As testament to the program’s success in developing young scientists, 31 former fellows (36%) have progressed to faculty positions. The fellowship programme continues to be an outstanding success and the flagship of CAG research activities.
Motion-Computerized Tomographic Colography is a Better Method for Screening for Polyps: Arguments for the Motion
Authors: Pineau Benoit C
Published: March 2016

Colorectal cancer is an important public health problem that is amenable to prevention and early treatment. Traditional screening techniques - fecal occult blood testing, flexible sigmoidoscopy, barium enema and colonoscopy - each have limitations in terms of diagnostic accuracy, cost and/or patient acceptability. Compliance with recommendations for screening has been poor, in part, because of negative perceptions about the available modalities. Virtual colonoscopy, or computerized tomographic colography, is a minimally invasive technique that safely evaluates the entire colon and does not require sedation. Thorough cleansing as well as immobilization and air insufflation of the colon is crucial to a successful examination. Sensitivity and specificity rates are reasonable, compared with conventional colonoscopy, and it has been shown that the latter technique can be averted in over two-thirds of cases, with few false-negative examinations. Most patients find virtual colonoscopy more acceptable than the conventional technique, and would prefer it if a repeat procedure were warranted. An economic analysis that found that computerized tomographic colography was less cost effective than conventional colonoscopy did not consider the indirect costs of the latter, which is an important limitation. Virtual colonoscopy is a novel radiological technique that may revolutionize screening for colorectal cancer.
Renal Impairment after Spontaneous Bacterial Peritonitis: Incidence and Prognosis
Authors: Coral Gabriela Perdomo , Alves de Mattos Angelo
Published: March 2016

BACKGROUND/AIMS: Spontaneous bacterial peritonitis (SBP) is an important complication in cirrhotic patients. The aim of the present study was to assess the incidence, predictive factors and prognosis for renal impairment (RI) after SBP in cirrhotic patients from southern Brazil.

METHODS: Of the 1030 hospitalizations evaluated, 114 episodes of SBP were diagnosed in 94 patients (mean age 49 years; 76.59% men). SBP diagnosis was established when the ascitic fluid polymorphonuclear cell count was equal to or greater than 250 cells/mm³. Five cases were excluded. The variables assessed as possible predictors of steady or progressive RI were blood urea nitrogen and creatinine levels before the diagnosis of SBP; type of infection, antibiotic prophylaxis, first episode or recurrent SBP, presence of gastrointestinal bleeding and hepatic encephalopathy during hospitalization, SBP resolution, Child-Pugh classification, levels of blood pressure, ascitic fluid and blood polymorphonuclear cell count, bacteriological data (positive and negative ascitic fluid culture), albumin, bilirubin, sodium and prothrombin time at the moment of diagnosis.

RESULTS: The incidence of SBP was 11.07%. In 61 (55.96%) episodes, SBP was associated with RI (transient in 57.37%; steady in 19.67%; and progressive in 22.95%). The mortality rate associated with progressive RI was 100%; 58.33% with steady RI; and 2.85% with transient RI. The mortality rate in patients with or without RI was 36.07% and 6.25%, respectively (P<0.001). The level of creatinine (greater than or equal to 1.3mg/dL) before the diagnosis of SBP and the rate of infection resolution were the only predictors of RI in the multivariate analysis.

CONCLUSIONS: RI after SBP is a common complication, and indicates a poor prognosis for this infection. High levels of creatinine before infection and the rate of infection resolution are independent predictors of RI.
The Canadian Association of Gastroenteroloy - Are You a Member Yet?
Authors: Paré Pierre , Pearson David , Vergnolle Nathalie
Published: March 2016

Since its inception in 1962, the Canadian Association of Gastroenterology (CAG) has grown from a handful of physicians into an impressive and diverse membership of almost 1000 (Figure 1). Remaining true to the philosophy of its founders, the Association is a multidisciplinary organization comprised of gastroenterologists, hepatologists, pediatricians, surgeons, radiologists, internists, clinical and basic scientists, nurses, research coordinators, residents, medical students and representatives of industry. Members share the common goals of supporting and engaging in the study of the digestive tract in health and disease, and promoting the advancement of gastroenterology by providing leadership in patient care, research, teaching and continuing professional development.
Intestinal Thromboangiitis Obliterans in a Woman: A Case Report and Discussion of Chronic Ischemic Changes
Authors: Medlicott Shaun AC , Beaudry Paul , Morris Gary , Hollaar Gwen , Sutherland Francis
Published: March 2016

Although traditionally regarded as a disease of distal extremities, mesenteric vasculature can also manifest thromboangiitis obliterans (TAO). There are 31 cases of intestinal TAO in the English literature and the majority of subjects are male. However, cases of women with TAO are becoming more common, coinciding with an increased incidence of smoking in this sex. We describe the sixth case of a female patient with classic extremity manifestations paralleled by paroxysms of abdominal angina. Intestinal TAO can mimic extremity disease of smoldering chronic ischemia punctuated by unpredictable acute episodes of gangrene. In the present case, chronic ischemia manifested as partial bowel obstruction due to stricture deformity of the ileum and profound adipocyte atrophy of mesentery.
The Establishment of a National Tissue Bank for Inflammatory Bowel Disease Research in Canada
Authors: Collins Stephen M , McHugh Kevin , Croitoru Ken , Howorth Micheal
Published: March 2016

The Crohn’s and Colitis Foundation of Canada (CCFC) has established a national bank for tissue, serum and blood from patients with inflammatory bowel disease (IBD). Investigators from across the country submit material to the bank together with clinical data. Investigators may access their own patient information from the bank for their own study purposes, but the distribution of tissue is restricted to specific CCFC-funded projects. Currently, tissues are being collected from newly diagnosed, untreated IBD patients to support a recent initiative aimed at characterizing microbes in colonic and ileal biopsies from such patients. In the future, criteria for the submission of tissue will be tailored to specific research questions. This bank is believed to be the first national bank of its kind dedicated to research in Crohn’s disease and ulcerative colitis.
Appendiceal Carcinoids In Crohn’s Disease
Authors: Freeman Hugh J
Published: March 2016

Earlier investigations demonstrate an increased risk for colon cancer in Crohn's disease. For other intestinal neoplasms, such as carcinoids, studies are limited. In Crohn's disease, repeated endoscopic and imaging studies along with intestinal resections may facilitate clinical recognition of neoplastic diseases, including appendiceal neoplasms. To date, however, only sporadic cases of appendiceal carcinoids have been described in Crohn's disease. In the present study, in a single clinician database of 1000 Crohn's disease patients, three of the 441 patients who had undergone intestinal resection had appendiceal carcinoids, all of which were pathologically confirmed. All were observed in female patients and were not suspected before surgical treatment. In one case, even though management was not altered, the tumour had already invaded serosal fat indicating a potential for more advanced disease. In this series, a carcinoid tumour was found in a resection specimen during a later clinical case review and another was a microcarcinoid, implying that these tumours may be overlooked in Crohn's disease. The percentage detected in the entire database (0.3%) exceeds the reported rates of detection of appendiceal carcinoids after removal of the appendix for appendicitis, as well as the rate of detection of appendiceal carcinoids in autopsy studies. This percentage would be higher if only those having an intestinal resection were considered (0.68%). Additional studies are needed to further define this risk of appendiceal carcinoids in Crohn's disease.
Octreotide for Enterocutaneous Fistulas of Crohn’s Disease
Authors: Lavy A , Yasin K
Published: March 2016

Crohn’s disease is a chronic, life-long disease and has many troublesome complications. Fistulas are a part of Crohn’s disease, and although there are many therapeutic modalities used in treating these fistulas they are only partially successful. As we are still very far from being able to cure it, the aim is to improve the patients’ quality of life and to reduce the iatrogenic harm that may be caused by various treatment modalities. Somatostatin is an inhibitor of intestinal secretion and has been used to treat pancreatic and surgical fistulas. Therefore, we decided to treat enterocutaneous fistulas using somatostatin.

METHODS: Five patients with Crohn’s disease were treated with four daily injections of 300 µg octreotide. The total period of treatment was eight weeks.

RESULTS: Closure of fistulas was achieved in four of the five patients.

CONCLUSION: Somatostatin may have a role in treating Crohn’s disease enterocutaneous fistulas and may prevent surgery or prolonged immunosuppressive therapy.
Role of Na+/H+Exchanger Isoform-1 in Human Inflammatory Bowel Disease
Authors: Khan Islam , Siddique Iqbal , Al-Awadi Farida M , Mohan Krishna
Published: March 2016

BACKGROUND: Na+/H+exchanger (NHE) is responsible for a net uptake of sodium chloride and water from the gastrointestinal tract and maintains electrolyte and water homeostasis. However, its status in human inflammatory bowel disease such as ulcerative colitis (UC) and Crohn’s disease (CD) remains poorly understood.

OBJECTIVES: To investigate the role of NHE-1 isoform in human CD and UC.

METHODS: Expression of NHE-1 protein and messenger ribonucleic acid and sodium pump activity were examined in the colonic biopsy samples taken from UC (n=11) and CD (n=13) patients using enhanced chemiluminescence-Western blot analysis, reverse transcription polymerase chain reaction and spectrophotometry. Subjects presenting with abdominal pain and endoscopically normal colon served as normal controls (n=11). Myeloperoxidase (MPO) activity and histology were performed to confirm tissue inflammation.

RESULTS: MPO activity increased significantly (P<0.05) in both UC and CD patients compared with the normal controls. Parallel to MPO activity profile, there was also a significantly higher infiltration of inflammatory cells in both cases. P-nitrophenylphosphatase activity, a marker of the sodium pump, remained unchanged in CD but increased significantly (P<0.05) in UC compared with the normal controls. On the contrary, the level of NHE-1 protein and messenger ribonucleic acid was significantly decreased (P<0.05) in both cases, whereas the internal control, a-actin remained unaltered.

CONCLUSIONS: These findings demonstrate a transcriptionally regulated suppression of NHE-1 in both UC and CD. This NHE-1 suppression may reduce an uptake of sodium chloride and water from the inflamed colonic lumen and thus contribute to diarrhea and neuromuscular alterations in these conditions.
Use of LARA-urea Breath Test in diagnosis ofHelicobacter pyloriInfection in Children and Adolescents: A Preliminary Study
Authors: Day Andrew S , van Zanten Sander Veldhuyzen , Otley Anthony R , Best Linda , Griffiths AnneMarie , Sherman Philip M
Published: March 2016

BACKGROUND: An accurate diagnosis ofHelicobacter pyloriinfection in children currently relies upon histological assessment or culture of gastric biopsies obtained at endoscopy. Noninvasive testing would permit simpler assessment of children with dyspeptic symptoms. The primary aim of the present study was to prospectively evaluate a novel urea breath testing method in children undergoing diagnostic assessment of dyspeptic symptoms and secondarily to consider the roles of other noninvasive tests in these children.

METHODS: Laser associated ratio analysis (LARA)-13C urea breath testing was performed on children presenting with upper gastrointestinal symptoms for diagnostic endoscopy. Serum and stool were collected for performance of serology and stool antigen testing, respectively. Histology and culture of endoscopic biopsies of the gastric antrum were used to establishH pyloriinfection status.

RESULTS: Eight (36%) of 22 children wereH pylori-positive by histology or culture of gastric biopsies. Urea breath testing showed a sensitivity of 75%, but specificity of 100%. The deletion of a test meal from the urea breath test protocol in eight patients did not alter the utility of the test. Serology provided sensitivity of 87.5%, but a specificity of only 75%. Stool antigen testing in eight available samples provided sensitivity of 50% and specificity of 100%.

CONCLUSIONS: The LARA-urea breath testing method provided less sensitivity in this group of children than suggested from previous studies. However, urea breath testing in children is easy to complete and provides rapid noninvasive results. Breath testing protocols require standardization; for instance, the addition of a test meal may not be necessary in older children. Although noninvasive tests for the presence ofH pyloriin children may provide accurate results and can be considered for use in the initial assessment of dyspeptic children, further work is required to establish the most accurate testing methods.
Waiting-List Induced Proctitis: The Hydrogen Peroxide Enema
Authors: Gan S Ian , Price Lawrence M
Published: March 2016

Hydrogen peroxide is a widely available disinfectant that has been reported to cause colitis. We report a case of a 67-year-old man who presented with an acute proctitis caused by a self-inflicted 3% hydrogen peroxide enema. The patient’s intention was to cure himself of a recently diagnosed prostate cancer, because the waiting list for oncological consultation was deemed too long. The pathogenesis of hydrogen peroxide mucosal injury and a review of the literature is discussed.
Impact of Protocol-Based Guidelines on the Management and Outcome of Acute Upper Gastrointestinal Hemorrhage in a District General Hospital
Authors: Anwar RM , Dhanji A , Fish A , Singh S
Published: March 2016

A prospective audit of acute upper gastrointestinal (GI) hemorrhage was conducted between January and September 2000 at Frimley Park Hospital to determine the impact of introducing an upper GI bleeding protocol based on Rockall’s initial risk scoring system. Fifty-seven patients and 52 patients were in the pre- and postprotocol phases of the study respectively. Fifty per cent (28) of the patients in the first phase and 40% (21) of the patients in the second phase belonged to the high risk group. In the preprotocol phase, endoscopy was performed in 86% (49) of cases with 60% of patients having an esophogastroduodenoscopy within 24 h. Thirty-three per cent of the high risk group failed to have an endoscopic examination within 24 h. Only two of 57 patients required surgery and the mortality was 14%. In the postprotocol phase, endoscopy was performed in 79% (42) of patients and 68% (36) patients had endoscopy within 24 h. Only four of 21 patients belonging to the high risk group had their endoscopy after 24 h of the admission. Patients were better monitored and mortality was reduced to 7.5%. Reduction of mortality from upper GI hemorrhage followed the introduction of an agreed protocol based on risk scoring.
Abdominal Pain as the Initial and Sole Clinical Presenting Feature of Systemic Lupus Erythematosus
Authors: Chung Henry V , Ramji Alnoor , Davis Jennifer E , Chang Sylvia , Reid Graham D , Salh Baljinder , Freeman Hugh J , Yoshida Eric M
Published: March 2016

Classically, a diagnosis of systemic lupus erythematosus (SLE) is dependent on renal, rheumatological, cutaneous and neurological target organ damage with supporting serological markers. A previously healthy 26-year-old Japanese woman whose only manifestation of otherwise occult SLE was severe abdominal pain is reported. A computed tomographic scan of the abdomen revealed thickened loops of small bowel, endoscopic findings were nonspecific and jejunal biopsy revealed a nonspecific enteritis. Laboratory studies revealed lymphopenia, hypocomplementemia, a positive antinuclear antibody, a weakly positive anti-Smith and a strongly positive anti-double stranded DNA. There was a prompt symptomatic recovery with immunosuppressive therapy. The authors’ experiences, and a review of the literature suggest that a diagnosis of SLE should be considered in young Asian women who present with significant but clinically enigmatic gastrointestinal illness.
Motion-Cyclo-oxygenase-2 Selective Nonsteroidal Anti-Inflammatory Drugs are as Safe as Placebo for the Stomach: Arguments for the Motion
Authors: Hunt Richard H
Published: March 2016

Traditional nonsteroidal anti-inflammatory drugs (NSAIDs) are known to cause gastritis, gastric and duodenal ulcers, and gastrointestinal (GI) blood loss, as well as alterations in small bowel permeability. Patients at a high risk for these complications include those who are older than 60 years of age, those with a previous history of complicated peptic disease and bleeding, and those who take high dose or multiple NSAIDs, including low dose aspirin, corticosteroids or anticoagulants. The introduction of selective inhibitors of cyclo-oxygenase-2 (COX-2) has provided effective treatment of inflammatory arthritis and musculoskeletal pain, with dramatic reductions in the risk of GI adverse events. The two most widely prescribed coxibs are celecoxib and rofecoxib, and others are being developed. Endoscopic studies have revealed that coxibs are only half as likely to induce upper GI ulceration than are traditional NSAIDs, and are as safe as placebo. Furthermore, the newer drugs do not cause excessive blood loss from the GI tract and do not affect small bowel permeability. The Vioxx Gastrointestinal Outcomes Research Study (VIGOR) revealed that the incidence of myocardial infarction was significantly lower with naproxen than rofecoxib, although this study was not designed to look at this endpoint. Coxibs are an important addition to the pharmacotherapy of inflammatory disease.
6-Mercaptopurine and Inflammatory Bowel Disease: Hidden Ground for the Cytomegalovirus
Authors: Hookey LC , Depew W , Boag A , Vanner S
Published: March 2016

6-Mercaptopurine (6-MP) and azathioprine are important drugs for the treatment of inflammatory bowel disease (IBD) but their actions suppress host defense against infection. A challenging case of a 19-year-old female patient with quiescent Crohn’s disease maintained with 6-MP presenting with dyspnea and a normal chest exam and x-ray is presented. She became ventilator-dependent and only after numerous investigations was diagnosed with cytomegalovirus (CMV) pneumonitis. A systematic literature review of CMV infections in IBD patients was performed. The present case is the first report of a patient with quiescent IBD maintained on 6-MP who developed CMV pneumonitis. Other reports have identified patients with active disease on multiple immunosuppressants who developed CMV pneumonitis and also highlight the risk of CMV colitis in refractory IBD. The authors review the approach to the diagnosis of CMV infections in IBD patients with atypical pneumonia and colitis and highlight the importance of considering CMV infection in these settings.
Octreotide Treatment of Massive Hemorrhage due to Cytomegalovirus Colitis
Authors: Andrews Christopher N , Beck Paul L
Published: March 2016

Cytomegalovirus (CMV)-associated colitis can result in abdominal pain, diarrhea, significant blood loss and perforation. The standard therapy for CMV colitis includes supportive measures and antiviral medications. Severe hemorrhage due to CMV colitis often necessitates surgical resection. We present a case of a patient who was undergoing chemotherapy for acute B-cell lymphoblastic leukemia and developed significant abdominal pain and diarrhea followed by massive hematochezia. Colonoscopy showed numerous actively bleeding deep ulcers in the cecum. A provisional diagnosis of CMV colitis was made and she was started on ganciclovir. Histological assessment confirmed the diagnosis of CMV colitis. She continued to bleed profusely per rectum over the following five days, passing up to 1 L to 1.5 L of blood per day. She required 10 units of packed red blood cells over this time period. The patient refused surgical intervention and after discussion of possible options, octreotide was instituted. Her blood loss stopped almost immediately and she required no further transfusions. She tolerated the medication well and was discharged home at a later date in stable condition. This is the first reported case of the use of octreotide in the treatment of massive hematochezia from CMV colitis.
Elastofibromatous Polyp of the Sigmoid Colon - A Case Report and Review of Gastrointestinal Elastofibromas
Authors: Vesoulis Z , Ravichandran Pars , Agamanolis Dimitri , Roe Duane
Published: March 2016

Elastofibromatous change in the gastrointestinal tract is a rarely reported, usually polypoid lesion of unknown etiology with submucosal stromal change that may mimic amyloid deposition. The constituent amorphous material of the polyp stroma has distinctive features that permit an accurate assessment and diagnosis including: distribution of the material predominantly in the submucosa; distinctive fibrillar and granular appearance of the deposits; thick, irregular, haphazardly arranged bundles of elastic fibres positive for Verhoeff’s elastic stain; ultrastructural fibres with an electron dense curvilinear or beaded appearance; lack of amyloid type vascular wall deposits; and lack of amyloid congophilia or crystal violet metachromasia.The clinical, light microscopic, histochemical and ultrastructural characteristics of this deposited material are reviewed in detail in the present report of a patient who presented with an asymptomatic polypoid lesion of the sigmoid colon. Other reported cases are summarized, and their clinical and pathological features are compared with the current case.
Motion – Cyclo-oxygenase-2 Selective Nonsteroidal Anti-Inflammatory Drugs are as Safe as Placebo for the Stomach: Arguments Against the Motion
Authors: Maetzel Andreas
Published: March 2016

Cyclo-oxygenase (COX) exists in two isoforms, COX-1 and COX-2, that direct the synthesis of prostaglandins, prostacyclin and thromboxane. Traditional nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit both isoenzymes, resulting in damage to the mucosa of the stomach and duodenum, but also in cardioprotection. Selective COX-2 inhibitors are less likely to damage the upper gastrointestinal tract, as has been shown by large, randomized, controlled trials. Specifically, the newer agents are superior to ibuprofen and naproxen in this regard, but celecoxib and diclofenac were not significantly different in patients who were not also taking low-dose acetylsalicylic acid. These studies did not include a placebo arm, however, and controlled comparisons of COX-2 inhibitors with placebo have not enlisted enough subjects to demonstrate conclusively that they are equally safe. Selectivity for the COX-2 isoform affords protection against upper gastrointestinal toxicity possibly at the expense of the cardioprotective effect of traditional NSAIDs. This might explain the higher rate of nonfatal myocardial infarction in patients who aregiven rofecoxib compared with naproxen. A traditional NSAID, combined with either misoprostol or a proton pump inhibitor, is still a suitable alternative to selective COX-2 inhibitors for the treatment of arthritis.
The Clinical and Pathological Presentation of Thyroid Nodules in Children and the Comparison with Adult Population: Experience of a Single Institution
Authors: Solymosi Tamas , Lukacs Toth Gyula , Budai Laszlo , Gal Istvan
Published: March 2016

The clinical and pathological presentation of thyroid nodules among younger and adult patients was compared in an iodine-deficient (ID) region. Data of 3,010 consecutive patients younger than 20 years and 3,010 patients older than 20 years were compared. The proportion of nodular goiters (22.8% versus 39.3%), the ratio of surgically treated nodules (33.2% versus 15.2%), and the proportion of malignant nodules (4.3% versus 2.1%) among diseased patients differed significantly between the two groups (younger versus adult). Nine papillary and 1 medullary carcinoma were found among children, while 15 papillary, 2 follicular, 1 insular, 1 anaplastic, and 1 medullary carcinomas occurred among adults. The ratio of follicular adenoma to hyperplastic nodules (3 : 1 to 1 : 1.67), the proportion of follicular variant (77.8% versus 26.7%), T4 tumors (77.8% versus 33.3%), and tumors with lymph node metastasis (88.9% versus 66.7%) were significantly higher among younger papillary carcinoma patients. No malignancies occurred among spongiform and central type cysts. Similarly to iodine-sufficient regions, more nodules are malignant and carcinomas have a clinically more aggressive presentation in children in comparison with adult patients in ID. Taking the significantly greater proportion of adenomas and the lack of follicular carcinoma into account, a conservative approach has to be considered in follicular tumors among children.
Preparation and Characterization of Acrylic Primer for Concrete Substrate Application
Authors: Negim El-Sayed , Aisha Nurlybayeva , Mun Grigoriy A. , Iskakov Rinat , Irmukhametova Galiya S. , Sakhy Mussylmanbek
Published: March 2016

This study dealt with the properties of acrylic primer for concrete substrate using acrylic syrup, made from a methyl methacrylate monomer solution of terpolymers. Terpolymer systems consisting of methyl methacrylate (MMA), 2-ethylhexyl acrylate (2-EHA), and methacrylic acid (MAA) with different chemical composition ratios of MMA and 2-EHA were synthesized through bulk polymerization using azobisisobutyronitrile (AIBN) as initiator. The terpolymer composition is characterized by FTIR,1H NMR, DSC, TGA, and SEM. The glass transition temperature and the thermal stability increased with increasing amounts of MMA in the terpolymer backbone. The effect of chemical composition of terpolymers on physicomechanical properties of primer films was investigated. However, increasing the amount of MMA in terpolymer backbone increased tensile and contact angle of primer films while elongation at break, water absorption, and bond strength are decreased. In particular, the primer syrup containing 65% 2-EHA has good bonding strength with concrete substrate around 1.1 MPa.
Formulation of the Settling Velocity of Small Particles Initially Situated inside an Inclined Vortex
Authors: Sánchez Urbano
Published: March 2016

Both the estimation of the time that small heavy particles remain inside a 3D vortex and the estimation of the average settling velocity of those particles are some important features in many practical situations. Previous works focused on the case of a horizontal 2D vortex. In this paper, we simulate the dynamics of heavy particles initially situated inside a three-dimensional vortex obtaining a formula for their average settling velocity. In a previous paper we obtained the trajectories of the particles and a formula that provides the time that they need to escape,Te⁎. This work simulates and analyses the escape process, and its main result is the obtaining, from numerical simulation, of a theoretical formulation of the average settling velocityVz⁎and its relationship with the elapsed time. We prove that the permanence time is of the order ofdp⁎-10(withdp⁎particle diameter) and that the average settling velocity is of the order ofTe⁎-1/5for sufficiently small particles. Some applications of the settling velocity formula developed in this work would be the design of mixture devices, the design of particle separation devices, and the prediction of the settling of pollutant particles, seeds, and pollen.
Development and Coverage Evaluation of ZigBee-Based Wireless Network Applications
Authors: Ding Fei , Song Aiguo
Published: March 2016

Network coverage is one of the basic issues for information collection and data processing in ZigBee-based wireless sensor networks. Each node may be randomly distributed in a monitoring area, reflecting the network event of tracking in ZigBee network applications. This paper presents the development and coverage evaluation of a ZigBee-based wireless network application. A stack structure node available for home service integration is proposed, and all data of sensing nodes with an adaptive weighted fusion (AWF) processing are passed to the gateway and through the gateway to reexecute packet processing and then reported to the monitoring center, which effectively optimize the wireless network to the scale of the data processing efficiency. The linear interpolation theory is used for background graphical user interface so as to evaluate the working status of each node and the whole network coverage case. A testbed has been created for validating the basic functions of the proposed ZigBee-based home network system. Network coverage capabilities were tested, and packet loss and energy saving of the proposed system in longtime wireless network monitoring tasks were also verified.
Prognostic Value of Neutrophil-Related Factors in Locally Advanced Cervical Squamous Cell Carcinoma Patients Treated with Cisplatin-Based Concurrent Chemoradiotherapy
Authors: Wang Yan-Yang , Bai Zhou-Lan , He Jian-Li , Yang Yan , Zhao Ren , Hai Ping , Zhe Hong
Published: March 2016

The aim of this study was to explore the relationship between neutrophil-related factors, including neutrophil-lymphocyte ratio (NLR) and the responses of neutrophil to granulocyte colony-stimulating factors (RNG), and the prognosis of patients with locally advanced cervical squamous cell carcinoma (LACSCC) undergoing cisplatin-based concurrent chemoradiotherapy (CCCRT). A total of sixty LACSCC patients were enrolled in this study. We analyzed the association of NLR or RNG with clinicopathologic characteristics of these patients. The prognostic factors were evaluated by univariate and multivariate survival analysis. The optimal cut-off value of the NLR was determined to be 2.0 for the overall survival (OS). A higher level of the NLR was associated with younger age (P=0.017) and higher baseline platelet count (P=0.040). NLR was identified to be the only independent prognostic factor for OS by multivariate analysis (P=0.037). The median RNG was 3.01, with a range of 1.19–16.84. RNG level was significantly associated with lymph node metastasis of these patients (P=0.023). And higher RNG was identified as being a closely independent poor prognostic factor for OS (P=0.055). This study showed that NLR and RNG may be used as potential biomarkers for survival prediction in patients with LACSCC receiving CCCRT.
Renal Allograft Torsion: US and CT Imaging Findings of a Rare Posttransplant Complication
Authors: Dewan Rohit , Dasyam Anil K. , Tan Henke , Furlan Alessandro
Published: March 2016

Vascular torsion is a rare renal transplant complication which requires prompt diagnosis and surgery to salvage allograft function. We report here a case of renal allograft torsion with interesting imaging findings on unenhanced CT and color Doppler ultrasound. A 60-year-old woman with a history of pancreas and kidney transplant presented to the emergency room with nausea, vomiting, abdominal pain, and minimal urine output. Unenhanced CT of the abdomen demonstrated an enlarged and malrotated renal allograft with moderate hydronephrosis. Color Doppler ultrasound demonstrated lack of vascularity within the allograft. The patient was taken urgently to the operating room where the renal allograft was found twisted 360 degrees around the vascular pedicle. After the allograft was detorsed, the color of the kidney returned and the Doppler signals for arterial flow improved. Intraoperative biopsy showed no evidence of infarct or acute cellular rejection. The detorsed kidney was surgically fixed in position in its upper and lower poles. Follow-up ultrasound 1 day later demonstrated normal blood flow to the renal allograft and the serum level of creatinine returned to normal.