bluuebunny/crossref_metadata_2025 huggingface dataset:
India's “Informal Sector”: Demystifying a Problematic Concept
Authors: Kerswell Timothy , Pratap Surendra
Published: March 2016

In both academic and activist discourse, particularly with regard to India, the concept of the informal sector has come to prominence, particularly after India's liberalization. This article demystifies the idea of the informal sector in India, revealing the multilayered existence of various groups of workers in vulnerable positions which are by no means inevitable or permanent but rather are the product of India's history and political economy. Accordingly, it is the case that certain interventions have the potential to transform the lives of India's unorganized workers, but such policy would need to target the specific needs of each unorganized group of workers. We argue that the concept and discourse of the informal sectors imply the permanence of unorganized, unregulated work. Conceptualizing Indian labor in this way leads to a position that the state should provide support and welfare measures to help workers survive at a bare minimum level of subsistence, but also to a fundamental failure to address the structural and specific causes of workers’ vulnerabilities.
Personal and situational variables associated with wind turbine noise annoyance
Authors: Michaud David S. , Keith Stephen E. , Feder Katya , Voicescu Sonia A. , Marro Leonora , Than John , Guay Mireille , Bower Tara , Denning Allison , Lavigne Eric , Whelan Chantal , Janssen Sabine A. , Leroux Tony , van den Berg Frits
Published: March 2016

The possibility that wind turbine noise (WTN) affects human health remains controversial. The current analysis presents results related to WTN annoyance reported by randomly selected participants (606 males, 632 females), aged 18–79, living between 0.25 and 11.22 km from wind turbines. WTN levels reached 46 dB, and for each 5 dB increase in WTN levels, the odds of reporting to be either very or extremely (i.e., highly) annoyed increased by 2.60 [95% confidence interval: (1.92, 3.58), p < 0.0001]. Multiple regression models had R2's up to 58%, with approximately 9% attributed to WTN level. Variables associated with WTN annoyance included, but were not limited to, other wind turbine-related annoyances, personal benefit, noise sensitivity, physical safety concerns, property ownership, and province. Annoyance was related to several reported measures of health and well-being, although these associations were statistically weak (R2 < 9%), independent of WTN levels, and not retained in multiple regression models. The role of community tolerance level as a complement and/or an alternative to multiple regression in predicting the prevalence of WTN annoyance is also provided. The analysis suggests that communities are between 11 and 26 dB less tolerant of WTN than of other transportation noise sources.
Brazil bill would legalize renegade cancer pill
Authors: Escobar Herton
Published: March 2016

Government races to put “fosfo” through clinical testing.
Bacillus Calmette-Guérin reactivation as a sign of incomplete Kawasaki disease
Authors: Novais Cristina , Fortunato Fabiana , Bicho Anabela , Preto Luísa
Published: March 2016

Kawasaki disease (KD) is an acute, self-limited, systemic vasculitis of unknown aetiology, extremely rare in infants younger than 6 months old. Younger infants are more likely to present with incomplete KD (IKD) and are at higher risk of developing coronary abnormalities. An early and specific clinical sign, not included in the classical diagnosis criteria, but that can be very useful in the diagnosis of KD, is the reaction at the Bacillus Calmette-Guérin (BCG) inoculation site. We describe a case of a 4-month-old boy, fully immunised, whose BCG scar reactivation led to the diagnosis of IKD. This case-report emphasises the importance of BCG site reactivation in establishing a diagnosis of IKD that clinicians should be aware of, especially in countries where BCG vaccination is still part of the immunisation schedule.
A curious case of stress fracture in a transsexual athlete
Authors: Richardson Tom , Grant Michael , Chandran Prakash
Published: March 2016

Femoral neck stress fractures in young healthy individuals are rare and occur in those who take part in physical training with repetitive loading and those with osteoporosis. Bone density is related to sex hormone status, which is artificially manipulated during gender reassignment. Conflicting evidence currently exists on the effect of cross sex hormone treatment on bone density, with no literature suggesting a link between hormone treatment in gender reassignment and stress fractures. Our aim is to highlight the potential risk of stress fractures amongst transsexual patients receiving cross sex hormones as part of gender reassignment. The patient presented with groin pain after competing in a running event. Despite a number of risk factors, there was a delay in diagnosis, which could have led to complications compromising outcome. Femoral neck stress fractures should be considered in the differential diagnosis of transsexual patients receiving hormone treatment with non-specific groin/thigh pain following exercise.
Effects of electrical stimulation on meat quality of bison striploin steaks and ground patties
Authors: Ding C. , Rodas-González A.R. , López-Campos Ó. , Galbraith J. , Juárez M. , Larsen I.L. , Jin Y. , Aalhus J.L.
Published: March 2016

As bison is characteristically dark in colour, this study was conducted to determine if high-voltage electrical stimulation (HVES) could improve the colour and other quality characteristics in bison, similar to positive effects of HVES previously observed in beef. Forty bison bull carcasses were split and HVES (400 V peak, 5 ms pulses at 15 pulses s−1for 30 s) was applied to the right sides and subsequently evaluated for grade characteristics, metabolic activity, and quality characteristics. The bison carcasses used in this study had a wide range of lean and fat, with minimal marbling. In the present study, HVES had no effect on bison quality traits, sensory attributes, retail display characteristics, nor the glycolytic metabolites (P > 0.05) except lactate. Inherent differences in muscle fibre type or physical carcass differences may have influenced the response to the electrical parameters used in the present study and merits further investigation.
Conclusion: recommendations and findings of the RED SEED working group
Authors: Harris A. J. L. , Carn S. , Dehn J. , Del Negro C. , Guđmundsson M. T. , Cordonnier B. , Barnie T. , Chahi E. , Calvari S. , Catry T. , de Groeve T. , Coppola D. , Davies A. , Favalli M. , Ferrucci F. , Fujita E. , Ganci G. , Garel F. , Huet P. , Kauahikaua J. , Kelfoun K. , Lombardo V. , Macedonio G. , Pacheco J. , Patrick M. , Pergola N. , Ramsey M. , Rongo R. , Sahy F. , Smith K. , Tarquini S. , Thordarson T. , Villeneuve N. , Webley P. , Wright R. , Zakšek K.
Published: March 2016

RED SEED stands for Risk Evaluation, Detection and Simulation during Effusive Eruption Disasters, and combines stakeholders from the remote sensing, modelling and response communities with experience in tracking volcanic effusive events. The group first met during a three day-long workshop held in Clermont Ferrand (France) between 28 and 30 May 2013. During each day, presentations were given reviewing the state of the art in terms of (a) volcano hot spot detection and parameterization, (b) operational satellite-based hot spot detection systems, (c) lava flow modelling and (d) response protocols during effusive crises. At the end of each presentation set, the four groups retreated to discuss and report on requirements for a truly integrated and operational response that satisfactorily combines remote sensors, modellers and responders during an effusive crisis. The results of collating the final reports, and follow-up discussions that have been on-going since the workshop, are given here. We can reduce our discussions to four main findings. (1) Hot spot detection tools are operational and capable of providing effusive eruption onset notice within 15 min. (2) Spectral radiance metrics can also be provided with high degrees of confidence. However, if we are to achieve a truly global system, more local receiving stations need to be installed with hot spot detection and data processing modules running on-site and in real time. (3) Models are operational, but need real-time input of reliable time-averaged discharge rate data and regular updates of digital elevation models if they are to be effective; the latter can be provided by the radar/photogrammetry community. (4) Information needs to be provided in an agreed and standard format following an ensemble approach and using models that have been validated and recognized as trustworthy by the responding authorities. All of this requires a sophisticated and centralized data collection, distribution and reporting hub that is based on a philosophy of joint ownership and mutual trust. While the next chapter carries out an exercise to explore the viability of the last point, the detailed recommendations behind these findings are detailed here.
Simit
Authors: Kjolstad Fredrik , Kamil Shoaib , Ragan-Kelley Jonathan , Levin David I. W. , Sueda Shinjiro , Chen Desai , Vouga Etienne , Kaufman Danny M. , Kanwar Gurtej , Matusik Wojciech , Amarasinghe Saman
Published: March 2016

With existing programming tools, writing high-performance simulation code is labor intensive and requires sacrificing readability and portability. The alternative is to prototype simulations in a high-level language like Matlab, thereby sacrificing performance. The Matlab programming model naturally describes the behavior of an entire physical system using the language of linear algebra. However, simulations also manipulate individual geometric elements, which are best represented using linked data structures like meshes. Translating between the linked data structures and linear algebra comes at significant cost, both to the programmer and to the machine. High-performance implementations avoid the cost by rephrasing the computation in terms of linked or index data structures, leaving the code complicated and monolithic, often increasing its size by an order of magnitude.

In this article, we present Simit, a new language for physical simulations that lets the programmer view the system both as a linked data structure in the form of a hypergraph and as a set of global vectors, matrices, and tensors depending on what is convenient at any given time. Simit provides a novel assembly construct that makes it conceptually easy and computationally efficient to move between the two abstractions. Using the information provided by the assembly construct, the compiler generates efficient in-place computation on the graph. We demonstrate that Simit is easy to use: a Simit program is typically shorter than a Matlab program; that it is high performance: a Simit program running sequentially on a CPU performs comparably to hand-optimized simulations; and that it is portable: Simit programs can be compiled for GPUs with no change to the program, delivering 4 to 20× speedups over our optimized CPU code.
On inequality by Harry G. Frankfurt
Authors: Dimeo Robert
Published: March 2016

Visual summary of a fascinating book in which the author, Harry G. Franksfurt, addresses the question whether or not it is an appropriate societal goal to reduce income inequality or focus on reducing poverty. Frankfurt argues that these are different goals and ultimately sides with the latter.
Digital humanities, digital hegemony
Authors: Martin John D. , Runyon Carolyn
Published: March 2016

The digital humanities represent, for many researchers, the potential for extending their research in terms of audience, scope, methods, and opportunity for interdisciplinary collaboration. Ideally, this potential should also extend access to cultural engagement and preservation for marginalized groups. In practice, the reality may be quite different for projects that focus on diverse racial, gender, ethnic, and cultural heritage. In this short article we discuss preliminary findings from a study of patterns in U.S. federal funding for digital humanities projects, with particular focus on cultural heritage and archival projects. Through the lens of funding and access, we raise some questions about whether the digital humanities can represent a shift from old hegemonies or run the risk of expressing them in a new technological paradigm.
Privacy and brain-computer interfaces
Authors: Wahlstrom Kirsten , Fairweather N. Ben , Ashman Helen
Published: March 2016

Brain-Computer Interfaces (BCIs) interpret neural activity, applying it to the control of external devices. As BCIs approach market viability, ethical implications come under consideration. This paper identifies potential privacy disruptions. BCI literature is reviewed in order to identify a BCI typology likely to support a privacy analysis. The typology describes the active, reactive, passive and hybrid types of BCI and, where possible, includes examples that are further classified as existing, prospective or speculative. A review of privacy theory supports an analysis that juxtaposes privacy theory and BCI technologies. The analysis finds that while all four types of BCI have potential for disrupting privacy, disruptions are more likely to arise from the use of reactive, passive and hybrid BCIs. Limitations and directions for future research close the paper.
Transcutaneous electrical acupoint stimulation alleviates adverse cardiac remodeling induced by overload training in rats
Authors: Yang Yi , Yang Xi , Dong Yuchen , Chen Ning , Xiao Xiang , Liu Hua , Li Zhanghua , Chen Yanfang
Published: March 2016

Electroacupuncture has been shown previously to alleviate cardiac ischemia-reperfusion injury. Overload training (OT) exercise can result in profound cardiac damage and remodeling. In this study, we aimed to examine whether transcutaneous electrical acupoint stimulation (TEAS), a novel noninvasive and low-risk alternative to electroacupuncture, could counteract short-term OT-induced cardiac remodeling, fibrosis, autophagy, and apoptosis. Sixty rats were randomly divided into eight groups ( n = 7 or 8/group): control, regular exercise, OT, OT plus low-, moderate- or high-frequency TEAS preconditioning, OT plus moderate-frequency TEAS postconditioning, or transcutaneous electrical nonacupoint stimulation (TENAS) preconditioning. The cardiac weight index (heart weight/body weight) was determined. Left ventricular morphology was examined by hematoxylin and eosin staining. Cardiac fibrosis and apoptosis were determined by Masson's trichrome and TUNEL staining, respectively. The presence of autophagosomes was observed by transmission electron microcopy. The expressions of autophagic markers (LC3 II/I and Beclin-1) were determined by Western blot. The results showed that 1) OT induced adverse cardiac structure changes but did not affect the cardiac weight index; 2) OT increased cardiac fibrosis and apoptosis and induced autophagosome formation with upregulated LC3 II/I and Beclin-1 expression; 3) TEAS preconditioning effectively alleviated OT-induced cardiac structure changes, fibrosis, apoptosis, and autophagy; 4) TEAS preconditioning produced better protective effects than TEAS postconditioning or TENAS preconditioning. Our results demonstrate that TEAS preconditioning protects the heart from OT-induced cardiac injury/remodeling, probably by inhibition of fibrosis, autophagy, and apoptosis.
Summary of an International and a Regional Symposium: Acid‐Related Diseases ‐ Improving Treatment Options
Authors: Thomson ABR
Published: March 2016

The author examines the clinical impact of findings from a key international workshop on acid peptic disorders, “Appropriate acid suppression for the healing of acid‐related diseases,” and from an important meeting which summarized results of a cross‐Canada study of the symptomatic treatment of dyspepsia due to esophagitis and duodenal ulcer disease.
Endoscopic Laser Treatment for Rectosigmoid Villous Adenoma: Factors Affecting the Results
Authors: Brunetaud JM , Maunoury V , Cochelard D , Boniface B , Cortot A , Paris JC
Published: March 2016

Endoscopic laser treatment is now commonly used for palliation of advanced digestive cancers in nonsurgical candidates. lt has also been used for treatment of benign rectosigmoid villous adenoma. The present work reports the long term results in 387 patients with benign rectosigmoid villous adenomas revealed by biopsy. Patients included 39% who had contraindications to surgery, 19% who had a tumour recurrence after a nonlaser treatment, 41 % for whom surgical resection appeared to be too drastic for a tumour found benign on biopsy, and 1 % who refused surgery. Two types of wavelength were used: the 1.06 µm infrared light from the Nd:YAG laser and the green light from the argon laser or the Nd:YAG frequency doubled laser. In some patients, both wavelengths were used. Treatment was completed in 343 patients. Total tumour destruction was achieved in 92.8% of patients, a carcinoma was detected in 6.4% on biopsy specimens obtained during laser treatment and benign villous tissue persisted in 0.8%. During the average 30-month follow-up period of the patients with total tumour destruction , 16% had a recurrence. Treatment was well-tolerated with a complication race of 2.3% (one patient with a perforation, one with hemorrhage and seven with stenosis requiring dilation). Circumferential extension of the tumour base was the only factor affecting the duration of treatment, the rate of cancers detected during treatment and the rate of complications. Recurrence rate after initial treatment was higher in patients treated for a recurrence after a previous nonlaser treatment than in patients treated only by laser (P<0.01). It was also higher when the initial histology showed low grade dysplasia as opposed to high grade dysplasia (P<0.01) and when the tumour was located in the lower or middle rectum rather than in the upper rectum or sigmoid (P<0.01). Direct cost of laser treatments was estimated to be 28 to 40% of the surgery charges for lesions of identical size in the authors’ hospital and 31 to 69%, at UCLA Center for the Health Sciences. Because treatment is long and difficult and cancer rate is high, endoscopic laser therapy should be limited in patients with a circumferential villous adenoma to nonsurgical candidates. Risk of complications following surgery has to be balanced against risk of undetected carcinoma and the indication for endoscopic laser treatment should be discussed case by case.
The Social Toll of Inflammatory Bowel Disease
Authors: Farmer Richard G
Published: March 2016

Inflammatory bowel disease (IBD) – ulcerative colitis and Crohn’s disease – has become one the most important chronic digestive disorders found in the younger population. As a result of the nature of the illness, with remission and exacerbation of the inflammatory process, there has been increasing concern regarding the costs, both financial and social, of IBD. There have been attempts to quantify disease activity and to assess the results of treatment and the ability of the patient to function in society. As a result, there has been an increased interest in the ‘social toll’ of IBD. Begi1ming in 1988, and using a direct interview technique, ambulatory patients with IBD were evaluated for quality of life at the Cleveland Clinic Foundation. Included were patients whose disease had been present for about 10 years, and both surgical and nonsurgical patients. The interview questionnaire consisted of 47 items in four categories: functional/economic, social/recreational, affect/life in general and medical/symptoms. Patients with ulcerative colitis had better quality of life than those with Crohn’s disease and patients without surgery had better quality of life than those who had undergone surgery. Over the ensuing five‐year period, it was shown that quality of life measures are of value in assessing the results of medical and surgical therapy, and the measures frequently give information not usually obtained by physicians and have implications for quality assurance and outcome measurement.
Sedation for Colonoscopy: A Double-Blind Comparison of Diazepam/Meperidine, Midazolam/Fentanyl and Propofol/Fentanyl Combinations
Authors: Kostash Mark A , Johnston Richard , Bailey RJ , Konopad Elsie M , Guthrie Lorraine P
Published: March 2016

Rate of recovery and incidence of complications were compared among three intravenous sedation techniques for colonoscopy. Sixty patients were randomized to receive diazepam and meperidine, midazolam and fentanyl, or propofol and fentanyl with a continuous infusion of propofol. Patients were sedated to a standard end-point using a double-blinded technique. There were no differences in rate of recovery or incidence of minor side effects among the three groups. The techniques were equally effective in providing sedation and analgesia for colonoscopy. All groups developed significant oxygen desaturation measured by continuous pulse oximetry. Over 20% of patients required supplemental oxygen due to persistent desaturation below 85% following administration of sedatives. The authors conclude that oxygen should be administered to all patients undergoing colonoscopy.
Lifestyle Issues in Inflammatory Bowel Disease – Smoking
Authors: Benoni Cecilia
Published: March 2016

During the pa t decade, smoking habit has been identified as a major exogenous factor in inflammatory bowel disease (IBD). It is associated not only with the development of the disease but al o with the clinical course in established disease. IBD combines absolute opposites as smoking is associated with Crohn’s disease and nonsmoking or former smoking with ulcerative colitis. The first reports of a negative association between smoking and ulcerative colitis were based on independent, clinical observations; from those studies a positive association was found between smoking and Crohn’s disease. Epidemiological studies that followed consistently showed that smokers have a reduced risk of ulcerative colitis and an increased risk of Crohn’s disease and that exsmokers have an increased risk of ulcerative colitis. In ulcerative colitis, but not in Crohn’s disease, a dose‐response pattern has been demonstrated. Changes in clinical course, in disease severity and extension, and in recurrence rate indicate substantial clinical effects of smoking with a protective effect of smoking in ulcerative colitis and an aggravating effect in Crohn’s disease. There are also indications of smoking’s effects on changes in IBD epidemiology and sex distribution. The biological explanation to the finding is unknown. Smoking may aggravate Crohn’s disease by vascular effects. Theories on the protective effect in ulcerative colitis include effects on immune and inflammatory response, on mucus and on intestinal permeability. Possibly, beneficial effects in ulcerative colitis are exerted by nicotine but further studies are needed. Due to overall negative effects of smoking, IBD patients should not smoke. It seems, however, reasonable to give individual advice in patients with ulcerative colitis who have experienced a beneficial effect of ·making considering both current health status and life situation.
Therapeutic Options for Patients Bleeding with Peptic Ulcers
Authors: Thomson ABR
Published: March 2016

It is likely that the best outcome for the patient with an acute upper gastrointestinal bleed (GIB) includes early diagnosis: for a bleeding lesion with a high risk of rebleeding, in an older patient with systolic h.ypotension or in a person with multiple medical problems. Early therapeutic endoscopy with meticulous control of intragastric pH will Likely achieve the best outcome. The ideal pH criterion to stop bleeding or to prevent recurrence is unknown. An algorithm is presented to guide the clinical management of patients with GIB, and to focus on important questi.ons for future therapeutic studies.
Intestinal Lymphangiectasia Secondary to Neuroblastoma
Authors: Reifen RM , Sherman PM
Published: March 2016

An eight month-old infant presented with a 10-day history of vomiting and diarrhea, and a one-week history of swelling of the lower extremities. Laboratory evaluations revealed hypoproteinemia and lymphocytopenia due to protein-losing enteropathy. Peroral small bowel biopsy showed intestinal lymphangiectasia. Subsequent onset of unexplained ecchymosis and obstructive jaundice resulted in additional studies which revealed an omental neuroblastoma as the underlying etiology of the infant’s symptoms. This report emphasizes the importance of considering secondary, obstructive causes for lymphangiectasia and protein-losing enteropathy.
Detection of Antibody against Helicobacter pylori in the Saliva of Patients with Dyspepsia
Authors: Clancy Robert L , Cripps Allan W , Taylor Diana C , McShane Lois A , Webster Victor J
Published: March 2016

There is a need to develop noninvasive assays to detect Helicobacter pylori infection in the gastric mucosa, Current dogma predicts that the presence of antibody within saliva should accurately reflect contemporary colonization of the gut mucosa. This study examined the clinical value of a saliva enzyme‐linked immunoadsorbent assay (ELISA) for anti‐H pylori antibody, compared with the serum ELISA assay, and found the sensitivity of the saliva assay was 89%, specificity 94%, accuracy 93%, positive predictive value 89% and negative predictive value 94%. Assessment following eradication therapy demonstrated that salivary antibody was a more sensitive indicator of colonization than was serum antibody. The immunoglobulin G antibody in saliva correlated best with colonization, and regression analysis was most consistent with a local production of antibody. These results indicate that detection of antibody in saliva contributes to diagnosis and management of H pylori infection.
Update of Immunomodulatory Therapy for Inflammatory Bowel Disease
Authors: Bernstein Charles N
Published: March 2016

For several decades corticosteroids were the only potent immunomodulatory agents effective and available for active inflammatory bowel disease (IBD). The past decade ha seen an enhanced knowledge of the immune response in lBD and a better understanding of how common immunomodulatory agents work. Furthermore, more specific mediators of the abnormal immune response have been identified, so that therapy can be more targeted. Purine analogues have proven efficacy in achieving and maintaining remission in both Crohn’s disease and ulcerative colitis. Methotrexate has proven efficacy in active Crohn’s disease. Both of these classes of drugs requires weeks to months of treatment before any benefit is seen. Intravenous cyclosporine is efficacious in acute severe ulcerative colitis and can settle active disease within days of administration. It is unclear whether oral cyclosporine offers any advantage at maintaining remission, once achieved. Oral cyclosporine in Crohn’s disease has been proven to be ineffective at either achieving or maintaining remission; however, intravenous cyclosporine in Crohn’s disease has not been rigorously tested. Newer immunomodulatory agents have been designed for specific targets. and in particular monoclonal antibodies that block the effects of interleukin‐1, tumour necrosis factor‐alpha and the T cell receptor are available for clinical trials. We are in an era of expanding therapeutic approaches to these diseases, including the refined use of readily available agent, the development of newer, more targeted agents and a broader understanding of how agents may be effectively used simultaneously or sequentially.
The Two-Tier Fecal Occult Blood Test: Cost-Effective Screening
Authors: Rae Andrew J , Cleator Iain GM
Published: March 2016

The two-tier test represents a strategy combining HO Sensa and Hemeselect fecal occult blood tests (FOBTs) with the aim of greater specificity and consequent economic advantages. If patients register a positive result on any HO Sensa guaiac test, they are once again tested by a hemoglobin-specific Hemeselect test. This concept was applied to a multicentre study involving persons 40 years or older. One component of the study enrolled 573 high risk patients while the second arm recruited an additional 1301 patients (52% asymptomatic/48% symptomatic) stratified according to personal history and symptoms. The two-tier test produced fewer false positives than traditional tests in both groups evaluated in the study. In the high risk group, specificity (88.7% for two-tier versus 80.6% for Hemoccult and 69.5% for HO Sensa) was higher and false positive rates were lower (11.3% for two-tier versus 19.5% for Hemoccultand 30.5% for HO Sensa) for the two-tier test versus Hemoccult and HO Sensa FOBTs (95% CI for all colorectal cancers [CRCs] and polyps greater than 1 cm, α=0.05 ). No significant differences in sensitivity were observed between tests in the same group. Also, in the high risk group, benefits of the two-tier test outweighed the costs. Due to the small number of cancers and polyps in the second arm of the study, presentation of data is meant to be descriptive and representative of trends in a ‘normal’ population. Nevertheless, specificity of the two-tier test was higher (96.8% for two-tier versus 87.2% for Hemoccult and 69.5% for HO Sensa) and false positive rate lower (3.2% for two-tier versus 12.8% for Hemoccult and 22.3% for HO Sensa) than either the Hemoccult or HO Sensa FOBT (95% CI for all CRCs and polyps greater than 1 cm). This initial study, focusing on the cost-benefit relationship of increased specificity, represents a new way of economically evaluating existing FOBTs.
Ulcerative Colitis in the Chinese Population of Vancouver, British Columbia
Authors: Chaun Hugh , Freeman Hugh J
Published: March 2016

The clinical records of 22 Chinese patients with ulcerative colitis (UC) seen in Vancouver, British Columbia from 1975 to 1989 were reviewed. There was a predominance of males, with a male to female ratio of 1.75:1. The age range at diagnosis was 14 to 67 years (mean 38.9). Eighteen of the 22 patients were immigrants, and one was a visitor from Hong Kong. The age at diagnosis of the three Canadian-born patients (14, 26 and 26 years old) was less than the mean age at diagnosis of the immigrant group. The immigrants had resided in Canada for a mean of 9.3 years before developing symptoms of UC. Despite the rarity of UC in Hong Kong, 59% of the Chinese patients in this series were Hong Kong immigrants. This study demonstrates that UC is not as uncommon a disease in Chinese as had been previously perceived. Adequate time is apparently necessary for exposure to environmental factors in the pathogenesis of UC. The opportunity for continued study of defined ethnic immigrant populations in North America may yield useful information related to environmental factors that may be important in the etiology and pathogenesis of UC.
Omeprazole Inhibits Acetylsalicylic Acid-Modified Histamine Stimulation of Acid Secretion in Rabbit Gastric Glands
Authors: Brosseuk Daniel T , Cleator Iain GM , Rae Andrew J , Wankling Gilbert
Published: March 2016

The effects of misoprostol and omeprazole on basal-, histamine- and acetylsalicylic acid (ASA)-induced gastric acid secretion by isolated rabbit gastric glands were studied. The authors found that ASA at a concentration of 2.4×10-3 M significantly inhibited acid secretion in the isolated gastric glands to 65% of basal levels, and that ASA at a concentration of 2.4×l0-2 M significantly inhibited the histamine stimulation of acid secretion to 78% of maximal. Misoprostol inhibited acid secretion to 76% of basal acid secretion, while omeprazole inhibited secretion to 58% of basal values. Misoprostol inhibited the ASA-modified histamine stimulation to 82% of maximal stimulation. In contrast, omeprazole was able to inhibit the ASA-modified histamine stimulation to 48% of maximal. This omeprazole inhibition of secretagogue-induced acid production reduced acid secretion to levels below basal secretion, indicating that neither histamine nor ASA (at the concentrations used), alone or in combination, had any stimulatory effect in the presence of omeprazole. Misoprostol is the recommended drug of choice for prevention and treatment of nonsteroidal anti-inflammatory drug (NSAID)-induced gastrointestinal mucosal injury. In vitro results suggest that omeprazole appears to treat this condition more effectively if gastric acid secretion is a necessary prerequisite for NSAID-induced mucosal injury.
Primary Biliary Cirrhosis in HLA-Identical Twin Sisters
Authors: Freeman Hugh J , Bailey Robert J
Published: March 2016

Human leukocyte antigen (HLA)-identical twin sisters with chronic liver disease were evaluated. Both had a childhood history of transient jaundice suggestive of a possible infectious cause. Subsequent studies in both siblings at age 51 years revealed antimitochondrial antibody-positive primary biliary cirrhosis. This report documents HLA-identical twins with primary biliary cirrhosis, providing added evidence for a genetically determined abnormal immune response in this liver disorder, possibly to a specific viral or other environmental factor.
Laparoscopic Techniques: What is the Role in Inflammatory Bowel Disease?
Authors: Hull Tracy L
Published: March 2016

Laparoscopic cholecystectomy has quickly become the preferred technique for removing the gallbladder. Real advantages in the area of laparoscopic gallbladder removal have spurred interest towards other areas of laparoscopic surgery. There has been interest in laparoscopic bowel surgery but this approach has not gained popularity as quickly as gallbladder surgery. Reasons surround the fact that the bowel is a continuous organ (versus an end organ like the gallbladder) laden with bacteria and it has a rich blood supply. These differences make laparoscopic bowel surgery more difficult and challenging. If inflammatory bowel disease (IBD) is considered, the indications to approach surgery laparoscopically fall into two categories: current and future indications. The current indications are diagnostic laparoscopy, fecal diversion, limited bowel resections with extracorporeal anastomosis and stoma closures. Future indications include laparoscopic subtotal colectomy and laparoscopic assisted pelvic pouch procedures. As experience is gained and laparoscopic instruments are modified and refined for bowel surgery, intracorporeal anastomosis and more extensive bowel resections will be feasible. Currently laparoscopic bowel surgery can be done in select circumstances for problems associated with IBD. It has yet to be proven if doing the surgery laparoscopically provides advantages for bowel surgery as has been demonstrated with gallbladder surgery. Prospective studies are underway to answer these questions.
Pouchitis – What’s new in etiology and management
Authors: Nicholls R John
Published: March 2016

Pouchitis requires a clear clinicopathological definition. There are many conflicting data concerning etiology. It is linked to an initial diagnosis of ulcerative colitis by clinical association and occurrence of extra‐alimentary manifestations, histologically and by macrophage types and inflammatory mediators. Evidence for a bacteriological cause comes from response to metronidazole, increased counts of intramucosal bacteria in pouchitis and the possible association of hypochlorhydria. Most studies have, however, shown no specific bacterial pathogen or luminal bacterial count differences in pouches with or without pouchitis. Abnormal fecal bile salt concentrations have been reported. Stasis and evacuation efficiency of the pouch are not associated with pouchitis in most studies. Reduced mucosal bloodflow may be associated perhaps leading to increased permeability to toxins causing activation of interleukin‐1, platelet‐activating factor (PAF) and tumour necrosis factor (TNF). PAF may be increased in pouchitis. Pouchitis may respond to allopurinol. Volatile short chain fatty acids (VSFA) may be reduced in ileal reservoirs compared with straight ileoanal segments and in pouchitis. The response of pouchitis to administered VSFA is, however, variable. Glutamine administration may help. There is evidence that intraepithelial T lymphocytes are reduced. Crypt cell turnover is higher in colitic than in polypotic pouches. Mucosal morphological changes of villous atrophy and inflammation occur early after relapsing polychondritis and may predict future susceptibility to pouchitis. Early mucosal biopsy appears to have prognostic value. Metronidazole and antibiotics (amoxicillin/potassium clavulanate, ciprofloxacin) may be effective although in a controlled trial of the former there was little advantage over placebo. The results of treatment using VSFA, glutamine, allopurinol sucralfate and anti‐inflammatory agents, including aminosalicylic acid (5‐ASA) and steroids, is reviewed. Assessment of efficacy is difficult because the definition of pouchitis is not standardized, there may be more than one clinical type and studies may not be controlled. Failure of medical treatment may require surgical defunctioning or removal of the pouch.
Risk Factors for Hepatitis C Virus Infection in Canadian Patients with Chronic Type C Hepatitis
Authors: Minuk GY , Wong WWS , Kaita KDE , Rosser BG
Published: March 2016

Previous reports from the United States indicate that as many as 40% of patients with chronic hepatitis C virus (HCV) have no identifiable risk factor for HCV infection. To determine whether the same is true of Canadian patients with chronic HCV the records of 89 anti‐HCV positive patients referred to the authors′ tertiary care centre for evaluation of liver disease were reviewed. Each patient had been specifically asked about the following risk factors: previous blood transfusions; intravenous drug abuse; homosexual activity; sexual promiscuity (multiple sexual partners or a history of sexually transmitted diseases); tattoos made with nonsterile techniques; and ear piercing using nonsterile techniques. The results of the study revealed that 76 of 89 patients (85%) had at least one risk factor for HCV exposure, 38 (43%) had only one risk factor, 19 (21%) had two, 12 (14%) had three and the remaining three patients (3%) had four. The most common risk factor was a history of intravenous drug abuse (30 of 89 patients, 34%) followed by sexual promiscuity (28, 32%), previous blood transfusions (21, 24%), tattoos (17, 19%), homosexual contacts (seven, 8%) and ear piercing (five, 6%). Contrary to a recent report identifying sexual contact as an independent risk factor for HCV infection, only four cases (5%) were found where sexual promiscuity was identified as the only risk factor. In conclusion, these findings indicate that a possible source of HCV infection can be identified in a large majority of Canadians referred to an urban centre with chronic HCV infection.
Evaluation of IgA and IgG Serology for the Detection ofHelicobacter pyloriInfection
Authors: Fallone Carlo A , Wild Gary E , Goresky Carl A , Barkun Alan N
Published: March 2016

BACKGROUND: Serology is a safe, simple and noninvasive means of determining the presence ofHelicobacter pylori. Reported sensitivity and specificity, however, have varied tremendously, and it is not clear whether positive serology reflects previous infection (treated within the past one to two years) or ongoing infection.

OBJECTIVES: To assess the usefulness of two commercial kits to detect both ongoingH pyloriinfection and eradication. The kits, Pyloriset EIA-A and EIA-G, use enzyme immunoassay techniques to estimate immunoglobulin (Ig) A and IgG antibody titres, respectively.

PATIENTS AND METHODS: Consenting adult patients referred for upper endoscopy underwent antral biopsies for histology and a serum sample for serological testing. The serum samples were divided into three groups: group 1 - 17 samples from patients withH pyloridetected histologically; group 2 - 13 samples from patients with negative histology and no recent (less than three months) eradication therapy; and group 3 - six samples from patients in whomH pylorihad been successfully eradicated one month before serological testing. The ability of IgA and IgG serology to differentiate between the presence or absence ofH pyloriinfection was assessed using contingency table analysis. Ideal titre cut-offs were determined using receiver operating characteristic curve analysis.

RESULTS: The ideal cut-off titres for IgA and IgG were 300 and 900 U, respectively. The sensitivity for IgA was 82% (95% CI: 57-96), specificity 85% (55-98) and diagnostic accuracy 83% (65-94). For IgG, the sensitivity, specificity and diagnostic accuracy were 76% (95% CI: 50-93), 85% (55-98) and 80% (61-92), respectively. IgA levels one month posteradication (group 3) were significantly lower (P<0.05) than the titres from theH pyloripositive patients (group 1), whereas IgG levels were not.

CONCLUSIONS: Serology is a simple, noninvasive method ofH pyloridetection exhibiting good diagnostic accuracy. The Pyloriset EIA-A assay has test performance characteristics similar to the Pyloriset EIA-G. At one month posteradication therapy IgA, but not IgG, detection may be a good method of assessing disappearance ofH pylori.
Use of the 14C Breath Test in the Treatment of Helicobacter pylori
Authors: Rae AJ , Belzberg A , Cleator IGM , Caglar M
Published: March 2016

Fifty‐two patients with gastric disorders referred to the same physician over the course of one year were endoscoped, biopsied and given a 14C breath test to identify Helicobacter pylori. Sensitivity, specificity and accuracy of the 14C breath test were found to be 83%, 89% and 87%, respectively, when taking biopsy results as the `gold standard′. These figures rose to 85%, 93% and 89%, respectively, when the first five cases were not included, representing a ‘learning curve’ associated with the development of cut‐off levels for the breath test. In five cases, persons were biopsied and given a breath test at least one month later, making 10 comparisons possible. Biopsy and breath test corresponded in nine of 10 comparisons (90%). In two of four false negatives (14C breath test negative but biopsy positive) only scant numbers of helicobacter organisms were found. In one of three false positives (14C breath test positive but biopsy negative) acute inflammation of the duodenal biopsied material was detected. Also, double eradication therapy (omeprazole 20 mg bid and amoxicillin trihydrate 1000 mg bid), administered in all three false positive cases, was followed by 14C breath testing six weeks later, which indicated normal scores or absence of the organism.
Alagille Syndrome: Resolution of Xanthomas
Authors: Leonard NJ , Dias V , Parsons HG
Published: March 2016

Alagille syndrome is a rare autosomal dominant disorder characterized by chronic cholestasis due to paucity of intrahepatic biliary ducts, characteristic facies, peripheral pulmonary stenosis, ocular posterior embryotoxon and skeletal abnormalities. Very little information is available on the cholestatic, lipid and lipoprotein profiles in individuals with Alagille syndrome. The course of xanthomatosis and the lipid‐lipoprotein profile of a 15‐year‐old male with incomplete Alagille syndrome with marked xanthomatosis and extremely elevated cholesterols secondary to cholestasis is reported. He showed gradual resolution of xanthomas beginning at age 12 years with a concurrent reduction in his total serum cholesterol. The lipid studies showed that the majority of cholesterol was found in low density lipoprotein (LDL) with lesser amounts in lipoprotein (Lp)‐X, a lipoprotein precursor complex seen in patients with cholestasis, and high density lipoprotein (HDL). With resolution of xanthomas, LDL and Lp‐X decreased while HDL‐cholesterol and apolipoprotein (Apo) A‐I increased. Gamma glutamyltransferase and bilirubin decreased but remained 15‐ and threefold elevated, respectively.
Indications and Contraindications to Reconstructive Surgery in Ulcerative Colitis
Authors: Johnston David
Published: March 2016

Surgical treatment is often needed for patients with ulcerative colitis because of toxic dilation, intractability or risk of cancer. Precise diagnosis is vital to exclude Crohn′s disease and infective colitis, although patients with `indeterminate′ colitis often do well after reconstructive surgery. Restorative proctocolectomy, in which the anal sphincter is preserved and a pelvic ileal reservoir is used as a substitute for the rectum, is the standard surgical procedure, supplanting panproctocolectomy with ileostomy. Ileorectal anastomosis should also be considered, but is only suitable for patients with relative rectal sparing, and meticulous sigmoidoscopic follow‐up is essential. For toxic dilation, colectomy with ileostomy and mucous fistula is recommended, proctectomy and reconstruction being deferred until the patient is fitter. For most patients, the entire colon and rectum are removed and a pelvic ileal reservoir is anastomosed to the anus. Many types of reservoir have been proposed, but randomized trials are few, and it seems that the J pouch is as good as the S or W pouches, and technically is simpler. The operative mortality of restorative proctocolectomy worldwide has been about 1%, thanks largely to the routine use of a temporary defunctioning ileostomy. A one‐stage procedure without ileostomy is permissible if the patient is relatively fit and the surgeon is in attendance for 10 days after operation, but omission of the ileostomy certainly increases the risk to life and the postoperative morbidity, and should thus not be done in debilitated patients or in those on high dose steroids. Resection of the mucosal lining of the anal canal above the dentate line (`mucosal proctectomy′) was formerly routine, but leads to diminished sphincter pressure and sensation, such that preservation of the entire motor and sensory sphincteric complex is now advocated by many authors. Omission of mucosal stripping renders the procedure technically simpler and quicker, and is associated with better sphincter function, with less fecal leakage. However, a small rim of inflamed mucosa may then be left above the anal transitional zone which theoretically could lead to risk of recurrent inflammation or even predispose to malignant change.
Release Profile of Salofalk 750 mg Tablets
Authors: Ho Vincent , Blair Joan E , Cohen Zane , McLeod Robin S
Published: March 2016

This study determined the release profile of Salofalk 750 mg tablets (Axcan Pharma), an enteric‐coated 5‐aminosalicylic acid (5‐ASA) preparation. Twenty‐one ileostomates were divided into two groups and studied. Group 1 consisted of 10 subjects (five males, five females, mean age 39 years) who had a mean length of 65 cm of small bowel resected or out of circuit. Group 2 consisted of 11 subjects (eight males, three females, mean age 59 years) whose small bowel was intact. Following an overnight fast and collection of baseline samples, one Salofalk tablet was ingested. Ileostomy effluent and urine were collected for 24 h. Plasma samples were collected hourly for 6 h, then at 8, 12 and 24 h. All subjects ate standardized meals. All samples were stored at ‐‐10 degrees C and 5‐ASA and N‐ac‐5‐ASA (a metabolite of 5‐ASA) were measured by high performance liquid chromatography. The mean intestinal transit time was not statistically different between the groups but the mean ileostomy effluent output was higher in group 1 versus group 2 (10.9 versus 13.1 h, P=0.4; 918 versus 606 mL, P=0.05). The mean peak plasma concentrations of 5‐ASA and N‐ac‐5‐ASA were not significantly different (6.12 and 5.42 µ g/ mL, P=0.8, respectively, in group 1 versus 6.75 and 6.66 µ g/mL, P=0.8 in group 2). On average, 33.1% of the ingested dose was recovered in the ileostomy effluent in group 1 versus 21.2% in group 2 (P=0.06) whereas the mean recovery in urine was 40.9% in group 1 but 62.9% in group 2 (P=0.001). These results suggest that 5‐ASA is released in the small bowel. There was decreased absorption of 5‐ASA and increased recovery of 5‐ASA in the ileostomy effluent of subjects who had a small bowel resection.