bluuebunny/crossref_metadata_2025 huggingface dataset:
Failure of Added Dietary Gluten to Induce Small Intestinal Histopathological Changes in Patients with Watery Diarrhea and Lymphocytic Colitis
Authors: Freeman Hugh James
Published: April 2016

Lymphocytic colitis is a form of microscopic colitis usually characterized by watery diarrhea and often associated with biopsy-defined celiac disease. Two patients with lymphocytic colitis and normal small intestinal biopsies who were administered 40 g of added dietary gluten for four consecutive weeks are presented. Small intestinal biopsies from multiple sites in the proximal small bowel were done after three and four weeks to determine whether pathological changes in latent celiac disease could be induced in these patients with a high gluten-containing diet. In addition, colorectal biopsies were done to determine whether the colitis was sensitive to oral gluten. No alterations in the small intestinal biopsies were detected in either patient and no changes occurred in colitis severity. Although microscopic forms of colitis have been linked to celiac disease, this study indicates that lymphocytic colitis is a heterogeneous clinicopathological disorder that, in some patients, is independent of any gluten-induced intestinal pathological changes.
A Gastroenterologist’s Perspective of The Medical Management of Patients with Crohn’s Disease and Ulcerative Colitis
Authors: Thomson ABR
Published: April 2016

Medical therapy in patients with inflammatory bowel disease (IBD) has specific objectives that need to be remembered when considering any form of intervention. These objectives include to improve the quality of life, to improve symptoms, to improve nutrition and reduce the risk of nutritional deficiencies, to reduce the frequency and severity of recurrences, to reduce complications, including the need for surgery, and to cure the disease. Medical therapy potentially helps to achieve all of these objectives for sufferers of IBD, except the last one – until the pathogenesis of the recurrent or continuous episodes of bowel inflammation is better understood, this last objective will remain "a riddle, wrapped in a mystery, inside an enigma".
A Rare Form of Chronic Granulomatous Disease (Type Iva) Presenting as Inflammatory Bowel Disease
Authors: Sylvester Francisco A
Published: April 2016

Neutrophil dysfunction syndromes can sometimes mimic the clinical and pathological features of inflammatory bowel disease. The case of a 3.5-year-old boy with chronic diarrhea, abdominal pain, poor growth since infancy and microcytic, hypochromic anemia is presented. After an extensive diagnostic evaluation, he was found to have a rare variant (type IVA) of chronic granulomatous disease. His gastrointestinal symptoms markedly improved during therapy with gamma-interferon. Chronic granulomatous disease can present initially with a clinical picture suggestive of chronic intestinal inflammation. Therefore it should be considered in the differential diagnosis of atypical inflammatory bowel disease, both in children and young adults.
A Case of Esophageal Crohn’s Disease Resistant to Corticosteroids but Responsive to Cyclosporine A
Authors: Beck PL , Lay TE
Published: April 2016

Esophageal ulceration is a rare and potentially devastating complication of Crohn’s disease (CD). A 29-year-old male with odynophagia is described. He had no prior history of inflammatory bowel disease, connective tissue disorder or rheumatological disease. He denied symptoms of a recent viral infection and did not have significant human immunodeficiency virus risk factors. He did not have eye, skin, oral or genital lesions. Omeprazole failed to control his symptoms. On endoscopy, large esophageal ulcerations were noted. Biopsies showed active chronic inflammation with granulomatoid changes. Autoimmune, viral and acid-fast bacilli studies were normal. The odynophagia failed to improve, and he subsequently developed right lower quadrant pain and hematochezia. Colonoscopy demonstrated extensive hemorrhagic ileal ulcers, and biopsies were suggestive of CD. The odynophagia did not respond to high dose intravenous steroids and bowel rest. The patient was reluctant to take cytotoxic agents, and thus a course of cyclosporine A was initiated. The patient responded rapidly and was able to tolerate a full diet within 48 h. Repeat gastroscopy was normal. To the authors’ knowledge, this is the first reported case of esophageal CD treated with cyclosporine A.
Ulcerative Colitis, Autoimmune Hemolytic Anemia and Primary Sclerosing Cholangitis in a Child
Authors: Gilmour Susan M , Chait Peter , Phillips M James , Roberts Eve A
Published: April 2016

A 15‐month‐old female who initially presented with autoimmune hemolytic anemia (AIHA) is described. She developed bloody stools and was diagnosed with ulcerative colitis (UC). Investigations of persistent hepatomegaly revealed primary sclerosing cholangitis (PSC). The association of AIHA, UC and PSC has never been reported. All these conditions entail impaired immunoregulation. Patients with a clustering of autoimmune diseases may help to delineate the pathogenesis of UC. Autoimmune phenomena may be prominent in inflammatory bowel disease. UC, in particular, exhibits a high incidence of associated autoimmune diseases including hypothyroidism, PSC, vitiligo and alopecia areata. AIHA is well described in 0.5% to 1.0% of adult UC patients but has not been reported in children with UC.
Therapy of Inflammatory Bowel Disease: A Surgeon’s Perspective
Authors: Cohen Zane
Published: April 2016

Management of patients with inflammatory bowel disease (IBD) can be extremely challenging and difficult. IBD patients, however, must be well aware of all therapy options and must be involved in the decision‐making process. Both medical and surgical therapies have their own resultant toxicity and morbidity which must be taken into consideration. Gastroenterologists and surgeons must come together in their thinking about IBD patients and continue to undertake trials of both medical and surgical therapies in order to determine the best management for any individual patient. Topics including controversies related to the pelvic pouch procedure, stricturoplasty in the management of Crohn’s disease, assessment of trials using methotrexate and cyclosporine, and toxicity of medications and surgery are highlighted.
Antinuclear Antibody-Positive Ticlopidine-Induced Hepatitis
Authors: van Zanten Sander Jo Veldhuyzen , McCormick C William
Published: April 2016

Ticlopidine hydrochloride has been shown to reduce the risk of first or recurrent stroke in patients who have experienced a transient ischemic attack, reversible ischemic neurological deficit, recurrent stroke or first stroke. Severe liver dysfunction is a contraindication for its use. Increase in liver enzymes has been reported with use of this drug, but jaundice is rare. A case of severe ticlopidine-induced hepatitis that was associated with a marked increase in antinuclear antibody (ANA) levels is reported. Physicians prescribing ticlopidine hydrochloride should be aware that a potentially severe acute hepatitis associated with ANA positivity can occur. The drug should be discontinued if signs of liver dysfunction occur.
Hypogammaglobulinemia in a Family with Crohn’s Disease
Authors: Enns Robert , van Rosendaal Guido
Published: April 2016

A 55‐year‐old woman presented with steroid refractory Crohn’s disease. In anticipation of surgical therapy, a protein electrophoresis was done and demonstrated low serum immunoglobulins. Immunoglobulin analysis showed low levels of serum immunoglobulin G, which persisted following surgical therapy despite a clinical remission. A diagnosis of combined variable hypogammaglobulinemia was made and her family was screened for a similar disorder. Four of the six family members known to have Crohn’s disease were discovered to have low serum immunoglobulins. The presented patient was the index case in a family who has both hypogammaglobulinemia and Crohn’s disease. Furthermore, the two disorders in this family appear to be closely linked. Future study of the association between these two disorders may enable a more clear definition of Crohn’s disease pathogenesis.
Survival from Primary Abdominal Lymphoma Presenting with a Mass and Obstructive Jaundice
Authors: Freeman Hugh J , Seal Andrew M
Published: April 2016

A 68‐year‐old female presented with an enlarged and nontender palpable gallbladder and clinical features of obstructive jaundice. Subsequent laboratory investigations confirmed the presence of cholestasis associated with an obstructing mass in the region of the common hepatic duct. Pathological evaluation of the mass revealed a localized abdominal lymphoma. Treatment with chemotherapy and radiation resulted in complete clinical remission (for almost 14 years at the last evaluation). Primary abdominal lymphoma may involve the hilar region and present as a localized mass. Precise tissue diagnosis is essential to permit an aggressive management approach with the potential for significant clinical benefit.
Pathophysiology of Antibiotic Resistance: Clarithromycin
Authors: Taylor Diane E
Published: April 2016

Resistance ofHelicobacter pylorito antibiotics ranges from 3% to 10% and may exceed these levels in some countries. The pathophysiology of clarithromycin resistance is reviewed, including the mode of action by which the antibiotic inhibits protein synthesis and the mechanism of resistance, which involves a mutation at position 2142 or 2143 in the V loop domain of the 23S rRNA genes. Mutations of A2142G confer a higher minimum inhibitory concentration than mutations of A2143G. The former demonstrate cross-resistance to macrolide, lincosamide and streptogramin antibiotics, whereas the latter are susceptible to streptogramin B. In vitro mutagenesis combined with natural transformation were used to create several types of clarithromycin-resistant mutants.H pyloristrains with A2142G and A2143G mutations had a higher growth rate than those with A2142C, A2143 or A2142T mutations. Data from this study indicate why clarithromycin-resistant clinical isolates ofH pyloriare more likely to have A2142G or A2143G mutations and only occasionally A2142C mutations.
Primary Biliary Cirrhosis and Hemolytic Anemia Confusing Serum Bilirubin Levels
Authors: Brackstone M , Ghent Cameron N
Published: April 2016

Hemolysis is observed in more than 50% of patients with cirrhosis. However, there has been little documention of the association of primary biliary cirrhosis with autoimmune hemolytic anemia. Two cases, found within a single practice, of primary biliary cirrhosis coexisting with autoimmune hemolysis and a third case coexisting with hereditary spherocytosis are presented. Anemia in such patients is commonly attributed to chronic disease, and hyperbilirubinemia is attributed to primary biliary cirrhosis. These patients were considered for liver transplantation until the diagnosis of a comorbid hemolytic process was established. This association may be more prevalent than previously recognized. A diagnosis of comorbid hemolysis must always be considered in context with anemia and serum bilirubin levels that rise out of proportion to the severity of the primary biliary cirrhosis.
Small Bowel Review: Part I
Authors: Thomson ABR , Keelan M , Thiesen A , Clandinin MT , Ropeleski MJ , Wild G
Published: April 2016

In the past year, there have been many advances in the area of small bowel physiology and pathology. More than 1500 papers were assessed in preparation for this review. Some were selected and reviewed, with a particular focus on presenting clinically useful information for the practising gastroenterologist. Relevant review articles have been highlighted, and important clinical learning points have been stressed. The topics are varied in scope, and wherever possible show a logical progression from basic physiology to pathophysiology to clinical disorders and management.
Results of Screening First-Degree Relatives of Patients with Colorectal Cancer: A Community Practice Perspective
Authors: Beaudin David J
Published: April 2016

Targeted screening by colonoscopy of asymptomatic first-degree relatives of patients with colorectal cancer (CRC) is promoted as a preventive health activity. This retrospective case control series details the results of this activity in a community-based referral gastroenterology practice. One advanced carcinoma and 22 adenomas in 15 patients were found in 118 individuals screened. Six per cent of those screened had advanced lesions (carcinoma, tubulovillous adenomas or adenomas larger than 1 cm). Colonoscopic screening of asymptomatic first-degree relatives of patients with CRC yields a limited number of clinically significant colonic neoplasms in this practice setting. Further cost-benefit data are needed.
Inflammatory Bowel Disease in Indo-Canadians with and without Antineutrophil Cytoplasmic Autoantibodies
Authors: Freeman Hugh James
Published: April 2016

A sequentially evaluated cohort of Indo-Canadians with either ulcerative colitis or Crohn’s disease were prospectively examined for antineutrophil cytoplasmic autoantibodies (ANCA). Of 84 patients, 62 had ulcerative colitis and 22 had Crohn’s disease. About one-third were born in Canada, and two-thirds were migrants from India or other countries, particularly East African nations. There was a disease-based and geographically based male predominance. The mean age of Canadian-born patients was significantly less than that of those born in other countries. Moreover, for migrants, the mean duration of residence in Canada before developing disease was 8.9 years for Crohn’s disease patients and 13.5 years for ulcerative colitis patients. Moderate to severe disease was present; virtually all those with Crohn’s disease had colonic involvement, and most of those with ulcerative colitis had extensive colonic disease. Overall, 40 of 84 (48%) were seropositive for ANCA, including a majority of those with ulcerative colitis but not Crohn’s disease. In addition, eight had cytoplasmic ANCA, a reported seromarker for extensive colitis. Seropositive and seronegative patients were similar in age, sex, birth or duration of residence in Canada, site and severity of disease, familial history and complications, including pouchitis. This study supports the view that these diseases arise in individuals with a genetic predisposition following exposure to some, as yet unknown, environmental factor.
Synchronous Occurrence of Collagenous and Pseudomembranous Colitis
Authors: Vesoulis Z , Lozanski G , Loiudice T
Published: April 2016

Synchronous collagenous and pseudomembranous colitis has not been previously reported. A 73-year-old woman presented with chronic watery diarrhea and abdominal cramping of six weeks’ duration. Biopsies of the colon revealed findings of collagenous colitis involving the endoscopically normal right colon, and superimposed collagenous and pseudomembranous colitis involving the rectosigmoid colon. Endoscopically, the left colon revealed discrete ulcerative plaques, andClostridium difficiletoxin A assay was positive. The patient partially responded to a three-week regimen of metronidazole, and symptoms resolved completely with subsequent steroid therapy. At follow-up endoscopy four months later, colon biopsies demonstrated persistence of subepithelial collagen but no pseudomembranes. The patient remained asymptomatic during this interval. Collagenous colitis has been reported in association with other inflammatory bowel diseases, including lymphocytic colitis, sprue and idiopathic inflammatory bowel disease. This unique association of collagenous colitis with an endotoxigenic inflammatory bowel disease is presented with a review of related disease features.
Inflammatory Bowel Disease: Progress Towards a Gene
Authors: Heel David A van , Satsangi Jack , Carey Alisoun H , Jewell Derek P
Published: April 2016

The pathogenesis of ulcerative colitis (UC) and Crohn’s disease (CD) is still unknown, but the importance of genetic susceptibility has been clearly shown by epidemiological data from family and twin studies. Linkage studies have identified two susceptibility loci for inflammatory bowel disease (IBD) on chromosomes 12 and 16. Importantly, these linkages have been replicated by independent investigators, and studies of positional candidates within these regions continue, together with fine mapping strategies. Regions of ’suggestive’ linkage on chromosomes 1, 3, 4, 6, 7, 10, 22 and X have also been reported in individual studies. Other important candidate genes investigated include the interleukin-1 receptor antagonist, MUC3 and genes of the human leukocyte antigen (HLA) system. The apparently conflicting data in different studies from around the world may be explained by ethnic differences, case mix and genetic heterogeneity. Replicated class II HLA associations include HLA DRB1*0103 and DR2 (DRB1*1502), involved in UC susceptibility, and HLA DRB1*03 and DR4 as resistance alleles for CD and UC respectively. Animal studies have provided insights from targeted mutations and quantitative trait locus analysis. The goals of continuing research include narrowing the regions of linkages and analysis of candidate genes, and possibly the application of newly developed methods using single nucleotide polymorphisms. Advances in IBD genetics hold the potential to provide knowledge about the disease pathogenesis at the molecular level, with ensuing benefits for clinical practice.
Epidemiology of Hepatocellular Carcinoma
Authors: Yu Mimi C , Yuan Jian-Min , Govindarajan Sugantha , Ross Ronald K
Published: April 2016

Although rare in Canada and the United States, hepatocellular carcinoma (HCC) ranks as the eighth most common cancer in the world. High-risk regions are East and Southeast Asia, and sub-Saharan Africa. Independent of race and geography, rates in men are at least two to three times those in women; this sex ratio is more pronounced in high-risk regions. Rates of HCC in the United States have increased by 70% over the past two decades. Registry data in Canada and Western Europe show similar trends. In contrast, the incidence of HCC in Singapore and Shanghai, China, both high-risk regions, has declined steadily over the past two decades. Among white and black Americans, there is an inverse relationship between social class status and HCC incidence. Chronic infection by the hepatitis B virus (HBV) is by far the most important risk factor for HCC in humans. It is estimated that 80% of HCC worldwide is etiologically associated with HBV. In the United States, although the infection rate in the general population is low, HBV is estimated to account for one in four cases of HCC among non-Asians. Chronic infection by the hepatitis C virus is another important risk factor for HCC in the United States; however, this virus is believed to play a relatively minor role in the development of HCC in Africa and Asia. Dietary aflatoxin exposure is an important codeterminant of HCC risk in Africa and parts of Asia. In Canada and the United States, excessive alcohol intake, cigarette smoking and oral contraceptive use in women also are risk factors for HCC.
Antibiotic Susceptibility and Resistance Testing: An Overview
Authors: Smaill Fiona
Published: April 2016

The results of in vitro antibiotic susceptibility testing can predict the clinical response to treatment and guide the selection of antibiotics. The minimum inhibitory concentration (MIC) of an organism is the lowest concentration of an antibiotic that will inhibit its growth. Bacteria are classified as sensitive, intermediate or resistant based on breakpoint MIC values that are arbitrarily defined and reflect the achievable levels of the antibiotic, the distribution of MICs for the organism and their correlation with clinical outcome. Broth dilution, agar dilution and gradient diffusion (the ’E test’), where twofold serial dilutions of antibiotic are incorporated into tubes of broth, agar plates or on a paper strip, respectively, are different methods to measure the MIC of an organism. The disk diffusion method defines an organism as sensitive or resistant based on the extent of its growth around an antibiotic-containing disk. MIC values are influenced by several laboratory factors. To ensure reproducible results, the laboratory must closely follow methods developed by the National Committee for Clinical Laboratory Standards, which defines standard growth media, incubation temperature and environment, the inoculum and quality control parameters.
Applications of Recombinant Dna Technology in Gastrointestinal Medicine and Hepatology: Basic Paradigms of Molecular Cell Biology. Part B: Eukaryotic Gene Transcription and Post-Transcripional Rna Processing
Authors: Wild Gary E , Papalia Patrizia , Ropeleski Mark J , Faria Julio , Thomson Alan BR
Published: April 2016

The transcription of DNA into RNA is the primary level at which gene expression is controlled in eukaryotic cells. Eukaryotic gene transcription  involves several different RNA polymerases that interact with a host of transcription factors to initiate transcription. Genes that encode proteins are transcribed into messenger RNA (mRNA) by RNA polymerase II. Ribosomal RNAs (rRNAs) and transfer RNAs (tRNAs) are transcribed by RNA polymerase I and III, respectively.  The production of each mRNA in human cells involves complex interactions of proteins (ie, trans-acting factors) with specific sequences on the DNA (ie, cis-acting elements). Cis-acting elements are short base sequences adjacent to or within a particular gene. While the regulation of transcription is a pivotal step in the control of gene expression, a variety of molecular events, collectively known as ’RNA processing’  add an additional level of control of gene expression in eukaryotic cells.
Esophageal Involvement in Wegener’s Granulomatosis: A Case Report and Review of the Literature
Authors: Fallows Glen A , Hamilton Sean F , Taylor Douglas S , Reddy S Bharati
Published: April 2016

Wegener’s granulomatosis is characterized by a granulomatous arteritis involving the upper and lower respiratory tracts, progressive glomerulonephritis and systemic symptoms attributable to small vessel vasculitis. Although multisystemic manifestations are frequent, involvement of the gastrointestinal tract is uncommon. Cases have been reported of intestinal perforation, ulceration and hemorrhage. A patient whose initial presentation of Wegener’s granulomatosis was odynophagia secondary to esophageal vasculitis is described. Endoscopy revealed multiple punched out ulcerations in the esophagus, which resolved with standard therapy for systemic Wegener’s granulomatosis. There are only two previous reports of symptomatic esophageal vasculitis in patients with Wegener’s granulomatosis. These reports illustrate the need to consider odynophagia as a reflection of disease activity as opposed to complications of immunosuppressive therapy.
Genetic Cholestasis: Lessons from the Molecular Physiology of Bile Formation
Authors: Jansen Peter LM , Müller Michael
Published: April 2016

Progressive familial intrahepatic cholestasis (PFIC) is a group of severe genetic cholestatic liver diseases of early life. PFIC types 1 and 2 are characterized by cholestasis and a low to normal serum gamma-glutamyltransferase (GGT) activity, whereas in PFIC type 3, the serum GGT activity is elevated. PFIC types 1 and 2 occur due to mutations in loci at chromosome 18 and chromosome 2, respectively. The pathophysiology of PFIC type 1 is not well understood. PFIC types 2 and 3 are caused by transport defects in the liver affecting the hepatobiliary secretion of bile acids and phospholipids, respectively. Benign recurrent intrahepatic cholestasis (BRIC) is linked to a mutation in the same familial intrahepatic cholestasis 1 locus at chromosome 18. Defects of bile acid synthesis may be difficult to differentiate from these transport defects.Intrahepatic cholestasis of pregnancy (ICP) appears to be related to these cholestatic diseases. For example, heterozygosity in families with PFIC type 3 is associated with ICP, but ICP has also been reported in families with BRIC.In Dubin-Johnson syndrome there is no cholestasis; only the hepatobiliary transport of conjugated bilirubin is affected. This, therefore, is a mild disease, and patients have a normal lifespan.
From Bench to Bedside to Bug: An Update of Clinically Relevant Advances in the Care of Persons withHelicobacter pyloriAssociated Diseases
Authors: Chiba N , Thomson ABR , Sinclair P
Published: April 2016

In-depth meetings of the XIth International Workshop on Gastroduodenal Pathology andHelicobacter pyloriled to the presentation and discussion of extensive new data onH pyloriand its diseases. The mode of transmission ofH pyloriremains unclear, and it remains unknown why only a small proportion of infected individuals develop duodenal or gastric ulcer disease and even fewer develop gastric cancer. The role ofH pylorieradication in persons with uninvestigated dyspepsia remains controversial. New clinical trials ofH pyloritreatment show symptom relief and improvement in the quality of life of persons with functional dyspepsia, especially in those with ulcer-like or reflux-like dyspepsia. Clearly the move is toward symptom-based management of persons with dyspepsia, with fewer endoscopies being needed in the otherwise healthy young dyspeptic patients. It remains controversial whether eradicatingH pyloriin duodenal ulcer or functional dyspepsia increases the risk of subsequent development of gastroesophageal reflux disease. The one-week proton pump inhibitor-based triple regimens remain the gold standard ofH pyloritherapy, but some of the ranitidine bismuth citrate plus two antibiotic regimens also achieve an 80%H pylorieradication rate on an intention-to-treat basis. While the urea breath test remains the noninvasive test of choice, interesting new data are available on the use of stool antigen testing to diagnoseH pyloriinfection. The number ofH pylori-associated gastroduodenal diseases grows to include possible liver, vascular, immune and skin conditions.
T-Cell Lymphoma of the Thyroid Gland in Celiac Disease
Authors: Freeman Hugh J
Published: April 2016

Previous studies have reported the association between celiac disease and T cell lymphoma of the intestine as well as hepatosplenic lymphoma, a specialized peripheral type of T cell lymphoma. In this report, a 66-year-old woman with dermatitis herpetiformis and biopsy-defined celiac disease developed a thyroid mass that proved to be a T cell lymphoma. A T cell lymphoma in the setting of celiac disease appears to be unique. The thyroid gland, due to its shared embryological developmental links with the gastrointestinal tract, is possibly another site of extranodal lymphoma linked to celiac disease.
Consensus Guidelines: Agreement and Debate Surrounding the Optimal Management ofHelicobacter pyloriInfection
Authors: McNamara D , O’Morain C
Published: April 2016

Helicobacter pyloriis a recognized cause of a variety of gastroduodenal pathology. The high prevalence of bothH pyloriinfection and related diseases within the community warrants its consideration as a public health care issue. The availability of reliable and safe noninvasive diagnostic techniques coupled with the development of effective and tolerable treatments has enabled primary health care personnel to manage this infection actively. The role of the primary care physician in the future management ofH pyloriinfection is thus of central importance. The wealth of evidence produced by over 15 years of research intoH pylorihas expanded the list of disease associations and treatment benefits as well as elucidated the pathophysiological mechanisms involved. As a result, there has been a growing need to harmonize this information with clinical practice and to provide direction for the appropriate management by both specialists and general practitioners. Several national guidelines have been produced. The areas relating toH pyloriinfection that they considered and their recommendations vary. In 1994, the National Institutes of Health produced globally accepted recommendations for the management ofH pylori-related peptic ulceration. The broader role ofH pylorias a gastroduodenal pathogen and a public health care issue was not addressed. Recently, European and Canadian consensus guidelines have been published that identified overall management issues, including the role of primary and specialist care, and considered the appropriateness of employing eradication therapy for the spectrum of conditions in whichH pylorihas a direct or indirect association based on the available information. These guidelines, while in agreement regarding many issues, differ considerably in their recommendations for primary health care and regarding central issues such as the management of dyspepsia and gastric cancer. Some variations may reflect differing health care structures as well as the prevalence of both infection and associated diseases. However, the interpretation of evidence produced by recent research contributes to their conflicting statements.
Bismuth-Based Triple Therapy with Bismuth Subcitrate, Metronidazole and Tetracycline in the Eradication ofHelicobacter pylori: A Randomised, Placebo Controlled, Double-Blind Study
Authors: van Zanten Sander Veldhuyzen , Farley Alain , Marcon Norman , Lahaie Raymond , Archambault André , Hunt Richard , Bailey Robert , Owen David , Spénard Jean , Stiglick Alan , Aimola Nick , Colin Patrick
Published: April 2016

OBJECTIVE: To determine the rate ofHelicobacter pylorieradication following bismuth-based triple therapy with colloidal bismuth subcitrate, tetracycline hydrochloride and metronidazole.

PATIENTS AND METHODS: One hundred and eleven patients were randomly assigned, in a two to one ratio, to colloidal bismuth subcitrate 120 mg qid plus metronidazole 250 mg qid plus tetracycline 500 mg qid (Gastrostat), or matching placebo tablets and capsules for 14 days. Presence or absence ofH pyloriwas documented by histology at entry and at least 28 days after treatment. Patients had dyspeptic symptoms with or without a history of peptic ulcer. Patients with any previous attempt(s) at eradication ofH pylori, who used bismuth, antibiotics, H2 receptor antagonists or proton pump inhibitors in the previous four weeks were excluded.

RESULTS: Fifty-three of 59 (90%) patients on bismuth-based treatment and only one of 35 (3%) on placebo achieved eradication by per protocol analysis. Fifty-three of 65 (82%) patients on bismuth-based treatment achieved eradication, while only two of 34 (5%) achieved eradication on placebo by intention to treat analysis. Eradication rates for bismuth-based treatment across sites ranged from 83% to 100%. Only two patients in the bismuth-based treatment group (4%) and one in the placebo group (3%) discontinued treatment because of adverse events.

CONCLUSIONS: Colloidal bismuth subcitrate plus metronidazole plus tetracycline, given in the doses studied for 14 days, is safe and highly effective againstH pyloriinfection and would be appropriate as a first-line therapy for eradication.
Examination of Gastroesophageal Reflux by Transabdominal Ultrasound: Can a Slow, Trickling form of Reflux be Responsible for Reflux Esophagitis?
Authors: Madi-Szabo László , Kocsis György
Published: April 2016

BACKGROUND: Ultrasound can visualize significant portions of the upper and lower esophagus; it is without any instrumental interference in real conditions and displays events in motion.

PURPOSE: To study the events that occur during swallowing and gastroesophageal reflux.

PATIENTS AND METHODS: Group 1 comprised 25 patients with retrosternal complaints, selected for esophageal surface ultrasonography for endoscopic signs of esophagitis. Group 2 comprised 25 patients who underwent initial transabdominal ultrasonography. For 3 to 6 h before ultrasonography, nothing was given by mouth to the 50 patients labelled as having gastroesophageal reflux disease (GERD). Ultrasonography was then performed for 15 to 20 mins after drinking one mouthful of water or tea, or swallowing some saliva to provoke reflux. The events were recorded on videotape rolls. Endoscopy was carried out in all 50 cases; in 46 cases (21 and 25 from groups 1 and 2, respectively), gastric acidity and bacteriology were subsequently examined (test meal). Manometry and pH were not measured to avoid provocation of reflux by the instruments. Thirty patients without any esophageal complaints or signs of esophagitis (though suffering from gastric and duodenal diseases) were designated as the control group (group 3). The available results were compared.

RESULTS: In 32 of 46 patients diagnosed with GERD (69.5% in groups 1 and 2), a special kind of reflux was observed by ultrasonography: a slow, trickling reflux of the gastric content was seen, mostly after swallowing. A fast clearance followed four to six episodes of the trickling reflux, only after an interval of 0.5 to 2 mins. Only fast refluxes and immediate clearance were observed in the control group.

CONCLUSIONS: The observations above may indicate a special form of gastroesophageal reflux, namely, a slow, trickling form of it. It can be responsible for the development of GERD. Fast reflux and immediate clearance are common; however, this special trickling form was observed only in GERD patients. This may explain a number of often contradictory measurements and can make the effect of cisapride more understandable. A test meal is always necessary to distinguish a bilious reflux from an acidic one, because only the latter may require aggresive antacidic treatment.
Peptic Disease in Elderly Patients
Authors: Khaghan Neda , Holt Peter R
Published: April 2016

The increase in life expectancy demands that more attention be given to gastrointestinal problems, such as peptic ulcer disease, in elderly people. This review summarizes many of the physiological changes that have a role in peptic ulcer disease in elderly patients. How Helicobacter pylori infection modifies the course of peptic disease is also reviewed. The clinical presentation of peptic diseases often differs in elderly people, and atypical symptoms are common. Accurate diagnosis requires aggressive endoscopic evaluation. Treatment regimens using H2 receptor antagonists, proton pump inhibitors and regimens to eradicate H pylori may also need to be altered in elderly patients.
Epidemiology of Liver Cancer in Europe
Authors: Bosch F Xavier , Ribes Josepa
Published: April 2016

Liver cancer (LC) ranks fifth in frequency in the world, with an estimated 437,000 new cases in 1990. The estimates are different when LC frequency is analyzed by sex and geographical areas. In developed areas, the estimates are 53,879 among men and 26,939 among women. In developing areas, the estimates are 262,043 in men and 93,961 in women. Areas of highest rates include Eastern and South Eastern Asia, Japan, Africa and the Pacific Islands (LC age-adjusted incidence rates [AAIRs] ranging from 17.6 to 34.8). Intermediate rates (LC AAIRs from 4.7 to 8.9 among men) are found in Southern, Eastern and Western Europe, Central America, Western Asia and Northern Africa. Low rates are found among men in Northern Europe, America, Canada, South Central Asia, Australia and New Zealand (LC AAIRs range from 2.7 to 3.2). In Europe, an excess of LC incidence among men compared with women is observed, and the age peak of the male excess is around 60 to 70 years of age. Significant variations in LC incidence among different countries have been described and suggest differences in exposure to risk factors. Chronic infection with the hepatitis B virus (HBV) and hepatitis C virus (HCV) in the etiology of LC is well established. In Europe, 28% of LC cases have been attributed to chronic HBV infection and 21% to HCV infection. Other risk factors such as alcohol consumption, cigarette smoking and oral contraceptives may explain the residual variation within countries. Interactions among these risk factors have been postulated. New laboratory techniques and biological markers such as polymerase chain reaction detection of HBV DNA and HCV RNA, as well as specific mutations related to LC, may help to provide quantitative estimates of the risk related to each these factors.
Liver Transplantation and Quality of Life
Authors: Rodés J , Navasa M
Published: April 2016

To date, more than 50,000 liver transplantations have been performed around the world; the survival rate five years after transplantation ranges from 60% to 65%. One of the fundamental objectives for liver transplantation teams is to achieve the best possible quality of life (QOL) for the patients. A concise analysis of the methodology used (15 questionnaires) to measure QOL of patients with liver transplants is described. The authors suggest that now is the time to establish a database so that a validated instrument will be available to compare QOL results from all the liver transplantation programs. Liver transplantation is believed to improve QOL, although there are several problems with some of the papers published on this subject. Some studies are retrospective, whereas in others, patients in bad physical conditions are excluded from the study; in quite a few prospective studies, deaths are not included in the data analysis. Finally, the authors provide a brief, concise analysis of late complications and of recurrence of the disease after liver transplantation, which influence QOL.
Small Bowel Obstruction from Internal Hernia as a Complicaton of Colonscopy
Authors: Patterson Robert , Klassen Gerhard
Published: April 2016

After colonoscopy with polypectomy, a patient developed a surgically acute abdomen. Although abdominal radiology did not show free air, a presumptive diagnosis of bowel perforation was made and laparotomy performed. At the time of surgery the colon was normal, and there was no peritoneal contamination. A loop of ileum was discovered incarcerated into an internal paracecal hernia. The bowel was freed, and the operation was completed without need for resection. Several cases of incarcerated inguinal hernia resulting from endoscopy are described in the medical literature; this is the first reported case of an incarcerated internal hernia as a complication of colonoscopy.
Nonalcoholic Steatohepatitis: An Evolving Diagnosis
Authors: Neuschwander-Tetri Brent A
Published: April 2016

Nonalcoholic steatohepatitis (NASH) is a histological diagnosis applied to a constellation of liver biopsy findings that develop in the absence of alcohol abuse. Steatosis, a mixed cellular inflammatory infiltrate across the lobule, evidence of hepatocyte injury and fibrosis are the findings that can be seen. This entity is often identified during evaluation of elevated aminotransferases after exclusion of viral, metabolic and other causes of liver disease. Obesity is a major risk factor for NASH. The role of diabetes is less certain, although evidence is accumulating that hyperinsulinism may play an important pathophysiological role. Patients sometimes suffer from right upper quadrant abdominal pain and fatigue; examination may reveal centripetal obesity and hepatomegaly. Although patients are often discovered because of persistent aminotransferase elevations, these enzymes can be normal in NASH. When they are elevated, the alanine aminotransferase level is typically significantly greater than the aspartate aminotransferase level. This can be particularly helpful for excluding occult alcohol abuse. Imaging studies identify hepatic steatosis when the amount of fat in the liver is significant; however, imaging does not distinguish benign steatosis from NASH. Ultimately a liver biopsy is needed to diagnose NASH. The biopsy may be useful for establishing prognosis based on the presence or absence of fibrosis and for excluding other unexpected causes of liver enzyme elevations. Weight loss is the mainstay of treatment for obese patients. About 15% to 40% of NASH patients develop fibrosis; how many of these cases progress to cirrhosis is unknown, but about 1% of liver transplants are performed with a pretransplant diagnosis of NASH.
Transgenic Technology and the Study of Hepatitis Viruses: A Review of What We Have Learned
Authors: Milich David R
Published: April 2016

Because of the absence of inbred animal models susceptible to infection by the hepatitis B (HBV), C (HCV) and delta (HDV) viruses, and the inability to culture these viruses, a number of investigators have produced transgenic (Tg) mice that express one or all the viral genes. This review attempts to catalogue and characterize the Tg mice produced to date. The topics addressed are HBV, HCV and HDV gene expression and regulation; HBV replication models and factors that inhibit replication; HBV pathogenesis models; HBV tolerance and persistence models; modulation of the immune response to HBV proteins in Tg mice; T cell receptor Tg mice; and models of hepatocellular carcinoma.
An Architecture Offering Mobile Pollution Sensing with High Spatial Resolution
Authors: Alvear Oscar , Zamora Willian , Calafate Carlos , Cano Juan-Carlos , Manzoni Pietro
Published: April 2016

Mobile sensing is becoming the best option to monitor our environment due to its ease of use, high flexibility, and low price. In this paper, we present a mobile sensing architecture able to monitor different pollutants using low-end sensors. Although the proposed solution can be deployed everywhere, it becomes especially meaningful in crowded cities where pollution values are often high, being of great concern to both population and authorities. Our architecture is composed of three different modules: a mobile sensor for monitoring environment pollutants, an Android-based device for transferring the gathered data to a central server, and a central processing server for analyzing the pollution distribution. Moreover, we analyze different issues related to the monitoring process: (i) filtering captured data to reduce the variability of consecutive measurements; (ii) converting the sensor output to actual pollution levels; (iii) reducing the temporal variations produced by mobile sensing process; and (iv) applying interpolation techniques for creating detailed pollution maps. In addition, we study the best strategy to use mobile sensors by first determining the influence of sensor orientation on the captured values and then analyzing the influence of time and space sampling in the interpolation process.
Benefits of Whole‐Body Vibration, as a Component of the Pulmonary Rehabilitation, in Patients with Chronic Obstructive Pulmonary Disease: A Narrative Review with a Suitable Approach
Authors: Sá-Caputo Danubia , Gonçalves Cintia Renata , Morel Danielle Soares , Marconi Eloá Moreira , Fróes Patrícia , Rufino Rogério , Costa Cláudia Henrique , Lopes Agnaldo José , Arnóbio Adriano , Asad Nasser Ribeiro , Marin Pedro Jesus , Furness Trentham , Bernardo-Filho Mario
Published: April 2016

Background. Appropriate management, including pulmonary rehabilitation, associated with correct diagnosis of chronic obstructive pulmonary disease (COPD) in patients can contribute to improving clinical conditions of these patients. Physical activity is recommended for COPD patients. Whole‐body vibration (WBV) is a modality of physical activity. Putting together the biological effects and safe use of WBV, it may be a potentially feasible intervention to add to pulmonary rehabilitation. The purpose of this investigation was to systematically review studies regarding the effects of WBV, as a component of the pulmonary rehabilitation, in patients with COPD. Results. A total of six publications met inclusion for review. There was evidence to support the beneficial use of WBV to improve functional performance of the lower limbs and quality of life. However, the appropriateness of and descriptors of WBV methods were poorly described. Conclusions. The results of this review support the use of WBV as a component of pulmonary rehabilitation to assist management of patients with COPD. However, future research should examine the dose‐response curve and optimal dosing regimen of WBV according to standard reporting recommendations for people with COPD. Such an approach will allow comparison among studies and the potential of meta‐analysis of randomized controlled trials.
Receptivity of Boundary Layer over a Blunt Wedge due to Freestream Pulse Disturbances at Mach 6
Authors: Shi Jianqiang , Tang Xiaojun , Wang Zhenqing , Shi Mingfang , Zhao Wei
Published: April 2016

Direct numerical simulation (DNS) of a hypersonic compressible flow over a blunt wedge with fast acoustic disturbances in freestream is performed. The receptivity characteristics of boundary layer to freestream pulse acoustic disturbances are numerically investigated at Mach 6, and the frequency effects of freestream pulse wave on boundary layer receptivity are discussed. Results show that there are several main disturbance mode clusters in boundary layer under acoustic pulse wave, and the number of main disturbance clusters decreases along the streamwise. As disturbance wave propagates from upstream to downstream direction, the component of the modes below fundamental frequency decreases, and the component of the modes above second harmonic components increases quickly in general. There are competition and disturbance energy transfer between different boundary layer modes. The nose boundary layer is dominated by the nearby mode of fundamental frequency. The number of the main disturbance mode clusters decreases as the freestream disturbance frequency increases. The frequency range with larger growth narrows along the streamwise. In general, the amplitudes of both fundamental mode and harmonics become larger with the decreasing of freestream disturbance frequency. High frequency freestream disturbance accelerates the decay of disturbance wave in downstream boundary layer.
An Efficient Chaotic Map-Based Authentication Scheme with Mutual Anonymity
Authors: Zhou Yousheng , Zhou Junfeng , Wang Feng , Guo Feng
Published: April 2016

A chaotic map-based mutual authentication scheme with strong anonymity is proposed in this paper, in which the real identity of the user is encrypted with a shared key between the user and the trusted server. Only the trusted server can determine the real identity of a user during the authentication, and any other entities including other users of the system get nothing about the user’s real identity. In addition, the shared key of encryption can be easily computed by the user and trusted server using the Chebyshev map without additional burdensome key management. Once the partnered two users are authenticated by the trusted server, they can easily proceed with the agreement of the session key. Formal security analysis demonstrates that the proposed scheme is secure under the random oracle model.
The Influence of Psychiatric Comorbidity on Inpatient Outcomes following Distal Humerus Fractures
Authors: Buller Leonard T. , Best Matthew J. , Alam Milad , Sabeh Karim , Lawrie Charles , Quinnan Stephen M.
Published: April 2016

Background. The influence of psychiatric comorbidity on outcomes following inpatient management of upper extremity fractures is poorly understood. Methods. The National Hospital Discharge Survey was queried to identify patients admitted to US hospitals with distal humerus fractures between 1990 and 2007. Patients were subdivided into 5 groups: depression, anxiety, schizophrenia, dementia, and no psychiatric comorbidity. Multivariable logistic regression analysis identified independent risk factors for adverse events, requirement of blood transfusion, and discharge to another inpatient facility. Results. A cohort representative of 526,185 patients was identified as having a distal humerus fracture. Depression, anxiety, and dementia were independently associated with higher odds of in-hospital adverse events (P<0.001). Depression was associated with higher odds of inpatient blood transfusion (P<0.001). Depression, schizophrenia, and dementia were associated with higher odds of nonroutine discharge to another inpatient facility (P<0.001). Patients with a diagnosis of schizophrenia had a mean of 12 (P<0.001) more days of care than patients with no psychiatric comorbidity. Discussion. Patients with comorbid psychiatric illness who are admitted to hospitals with distal humerus fractures are at increased risk of inpatient adverse events and posthospitalization care.