bluuebunny/crossref_metadata_2025 huggingface dataset:
Helicobacter pyloriEradication in Non-Ulcer Dyspepsia: Clearing up the Controversy
Authors: Fallone Carlo A
Published: March 2016

Veldhuyzen van Zanten et al conducted a double-blind, randomized, multicentre study comparing triple therapy forHelicobacter pylorieradication to placebo for the treatment of nonulcer dyspepsia (NUD) symptoms in adult patients (1). Patients had moderate to severe epigastric pain on entry (rated at least a three on a five-point scale for at least three of the previous 14 days). The main outcome measure was the Mean Dyspepsia Summary Score (MDSS), which represents the mean severity of eight dyspepsia symptoms (epigastric pain, belching, heartburn, upper abdominal bloating, flatulence, sour taste, nausea and halitosis). Of the 1143 patients who were screened for this study in 27 centres across Canada, 157 were randomized. H pylori was eradicated in 82% of the active group compared with 6% in the placebo group. Symptoms improved in both groups over the 12-month study period, but there was no difference between the two groups in MDSS (2.34 in active and 2.30 in placebo groups at baseline, compared with 1.68 and 1.67, respectively, at the last visit). Nor were there differences in any of the individual symptoms, in the proportion of patients who achieved a certain MDSS score or in health care utilization, such as physician visits, need for additional prescriptions or days lost from work. The authors concluded that, compared with placebo, therapy forH pyloriproduced no sustained improvement of NUD symptoms.
Practice affairs committee
Authors: Sadowski Dan
Published: March 2016

The Practice Affairs Committee has had a productive year representing the interests of gastroenterologists involved in clinical care. The principle mandate of the committee is to address all issues relevant to the practice of gastroenterology, such as participation in the development of clinical practice guidelines and education programs, and the facilitation of clinical research. A major activity in 2003 was participation in the drafting of several new clinical practice guidelines:

Infliximab and the management of Crohn's disease;

Screening for colorectal cancer; and

Management of gastroesophageal reflux disease.
Disappearance of Crohn's Ulcers in the Terminal Ileum after Thalidomide Therapy
Authors: Hershfield NB
Published: March 2016

A case of intractable Crohn's disease unresponsive to all forms of therapy, including multiple operations and medication, is reported. The patient responded to thalidomide and this has resulted in the disappearance of the disease in the neoterminal ileum. Thalidomide may be a valuable treatment in intractable cases of Crohn's disease. The case is presented in a chronological fashion and endoscopic photographs documenting the disappearance of the disease are presented.
Does Whipworm Increase the Pathogenicity ofCampylobacter jejuni?A Clinical Correlate of an Experimental Observation
Authors: Shin Jennifer L , Gardiner Geoffrey W , Deitel Wayne , Kandel Gabor
Published: March 2016

Campylobacter jejuniis a leading cause of acute diarrhea worldwide, usually mild and self-limiting. No adequate hypothesis has yet been formulated to explain why in an otherwise healthy host this infection is occasionally severe. In a pig model,C jejunihas been shown to be pathogenic only in the presence of swine whipworm. A human case of life-threateningC jejunicolitis leading to toxic megacolon and acute renal failure, associated with concomitant whipworm (Trichuris suis) ova in the feces, is reported. The potential of T suis to potentiateC jejuniin humans deserves further study.
Helicobacter pylori and the Prevention of Gastric Cancer
Authors: Sullivan Terrence , Ashbury Fredrick D , Fallone Carlo A , Naja Farah , Schabas Richard , Hébert Philip C , Hunt Richard , Jones Nicola
Published: March 2016

BACKGROUND: Helicobacter pylori is an important cause of stomach cancer that infects a substantial proportion of the Canadian adult population. H pylori can be detected by noninvasive tests and effectively eradicated by medical treatment. Screening for and treatment of H pylori may represent a significant opportunity for preventive oncology.

METHODS: Cancer Care Ontario organized a workshop held in Toronto, Ontario, on October 24 and 25, 2002, to: review the current state of knowledge regarding H pylori treatment and cancer prevention; determine if there is currently sufficient evidence to consider the promotion of H pylori treatment for the purpose of cancer prevention; identify critical areas for research; and advise Cancer Care Ontario on H pylori and cancer prevention.

RESULTS: Workshop participants developed a number of recommendations for research into the relationship between H pylori and stomach cancer, including determining the prevalence of infection in different regions of Canada, the pathogenetic sequence of carcinogenesis from H pylori infection, and the implementation of a prospective observational study.

INTERPRETATION: Although the rate of H pylori infection is declining in Canada and the treatment of H pylori is generally accepted to be safe, the evidence to date may not warrant the implementation of population screening for H pylori infection to prevent gastric carcinoma in average-risk populations. Rather, a demonstration project is needed to estimate prevalence, evaluate the merits of screening, measure patient compliance and physician participation, develop education materials, establish a registry for monitoring and evaluation, and develop a quality assurance framework.
Biliary Access During Endoscopic Retrograde Cholangiopancreatography
Authors: Carr-Locke David L
Published: March 2016

Several techniques have been developed to facilitate cannulation of the papilla during endoscopic retrograde cholangiopancreatography (ERCP). The position of the endoscope should generally provide a ′straight′ route to the papilla, and the efforts should be directed at shortening the intraduodenal portion of the bile duct. If a guidewire is used, one should be chosen that possesses suitable tip and shaft characteristics, including flexibility, strength, low friction and trackability, but no one device is likely to be suitable for all purposes. The development of guidewires composed of nitinol has revolutionized endoscopic practice. Access papillotomy (′pre‐cut′) can be employed as an alternative to (or in addition to) insertion of a guidewire when cannulation of the major papilla has been unsuccessful. The same techniques may be used to allow deep cannulation of the bile or pancreatic duct after ductography, when fluoroscopy can also be used. The ′needle‐knife′, which must be used carefully because it cuts with even slight tissue contact, is moved in the expected direction of the intramural bile (or pancreatic) duct to gain direct access into the duct. Access papillotomy is a valuable procedure in difficult cases, but is associated with greater risks than standard ERCP techniques (except perhaps for a reduced likelihood of pancreatitis), and is best employed by personnel who have extensive experience with therapeutic endoscopy. Technical details for a variety of clinical situations are described. Success requires application of ′the four Ps′: position, practice, patience and perseverance.
Endoscopic 'Antireflux' Procedures: Not Yet Ready For Prime Time
Authors: Romagnuolo Joseph
Published: March 2016

Gastroesophageal reflux disease affects a significant portion of the North American population on a weekly and daily basis. Options, especially for erosive disease, involve long-term proton pump inhibitors or surgical fundoplication. More recently, a number of endoscopic antireflux techniques have been assessed. These fall into three broad categories: the Stretta (radiofrequency); endoscopic suturing and plication devices; and injectable bulking agents. In the present summary, the literature on these endoscopic techniques is critically reviewed, highlighting the unimpressive efficacy, potential and real complications, and the relevant methodological limitations of the studies. Although they are promising, it is clear that these procedures are still in a preliminary study phase and not ready for 'prime time' clinical use.
Routine Second-Look Endoscopy: Ineffective, Costly, and Potentially Misleading
Authors: Romagnuolo Joseph
Published: March 2016

Despite the best medical and endoscopic efforts, some patients with nonvariceal upper gastrointestinal bleeding suffer recurrences. Because high risk stigmata (visible vessels, active bleeders and adherent clots) often persist despite apparently successful initial hemostasis and have a variable natural history, it would seem reasonable to at least consider a routine second look endoscopy. However, a review of the literature revealed six randomized trials that, in aggregate, do not support such a strategy. In fact, a second look does not appear to be effective and is associated with an increased number of procedures, treatment sessions and possibly retreatment-related complications. In addition, the cointerventions in these trials are already out of date and the potential absolute risk reductions are low when a second look is used with intravenous proton pump inhibitors and/or the application of endoscopic hemoclips or combination endoscopic therapy. Finally, the Forrest classification may provide dangerously misleading estimates of prognosis because it is being used out of context. This review critically analyzes routine second look endoscopy.
Antineoplastic Effects of 5-Aminosalicylates and Potential Cancer Preventive Role in Inflammatory Bowel Disease
Authors: Freeman Hugh J
Published: March 2016

Early studies from tertiary referral centers in the United States and Europe showed that patients with long-standing and extensive inflammatory bowel disease (IBD) have an increased risk of colon cancer. It was subsequently appreciated that the degree of risk depended on the population being studied and on both genetic and environmental factors (eg diet, drugs and prior surgical treatment). Indeed, over the past decade or so, the effects of chronically administered medications, including 5-aminosalicylates (5-ASA), have been explored.
Mycophenolate Mofetil for the Treatment of Autoimmune Hepatitis in Patients Refractory to Standard Therapy
Authors: Devlin Shane M , Swain Mark G , Urbanski Stefan J , Burak Kelly W
Published: March 2016

There are limited therapeutic options available for patients with autoimmune hepatitis in whom conventional treatment fails. A case series of five patients unresponsive to or unable to take azathioprine, 6-mercaptopurine or corticosteroids who were treated with mycophenolate mofetil (MMF) is reported. While on MMF, alanine aminotransferase normalized or remained normal in all patients. MMF had a steroid-sparing effect and histological remission was demonstrated in one patient after seven months of MMF. One patient experienced an uncomplicated episode of pyelonephritis. In conclusion, MMF can effectively induce and maintain remission in refractory autoimmune hepatitis patients.
Endoscopic Perforation Rates at a Canadian University Teaching Hospital
Authors: Misra Tarun , Lalor Eoin , Fedorak Richard N
Published: March 2016

BACKGROUND: Despite advances in training, operative techniques and endoscopic technology, upper and lower endoscopic procedures continue to have potential for intestinal perforation. Perforation rates provided to patients at the time of consent have frequently been derived from historical cohorts and survey datasets.

OBJECTIVE: This study examined the perforation rates of upper and lower endoscopic procedures at a major Canadian tertiary care centre.

METHODS: Inpatient and outpatient gastroscopies and colonoscopies performed during a three year period were evaluated. Endoscopies with perforations occurring within 14 days of procedure were retrospectively isolated using the International Classification of Diseases ‐‐ 9th Revision code descriptions, then retrieved and hand searched to confirm a procedure‐related perforation. Data were extracted to identify risk factors and patient outcomes.

RESULTS: A total of 21,217 endoscopies (13,792 gastroscopies and 7425 colonoscopies) were reviewed. Of these, 359 were identified, isolated and hand searched for confirmation of a perforation event. Eighteen were found to have an endoscopy‐associated perforation. Ten perforations occurred with colonoscopy (0.13%) (incidence, 1.3/1000 procedures), resulting in one death (0.013%) (incidence, 0.13/1000 procedures). Eight perforations occurred with gastroscopy (0.06%) (incidence, 0.6/1000 procedures), resulting in zero mortality. Of colonoscopy procedures the rate of perforation with diagnostic colonoscopy was 0.13% (incidence, 1.3/1000 procedures) and with therapeutic colonoscopy was 0.14% (incidence, 1.4/1000 procedures). Of gastroscopy procedures the rate with therapeutic gastroscopy was 0.15% (incidence, 1.5/1000 procedures). No perforations occurred with diagnostic gastroscopy.

CONCLUSION: Gastroscopy and colonoscopy procedures, especially those with therapeutic maneuvers, continue to carry morbidity and mortality risks associated with perforation.
Complementary and Alternative Medicine Use by Patients with Inflammatory Bowel Disease: Are Canadian Physicians Failing with Conventional Therapy, or Not?
Authors: Bernstein Charles N
Published: March 2016

Hilsden et al conducted a postal survey of members of the Crohn's and Colitis Foundation of Canada (CCFC), gathering data on the use of both conventional therapy and complementary and alternative medicine (CAM). The response rate was 76% (quite good for a mailed survey), although 9% of respondents stated that they did not actually have inflammatory bowel disease (IBD) (their data were excluded from the analysis). The data regarding CAM use were difficult to follow, as there was a blending of past and current reported use of CAM, as well as of CAM use specifically for IBD as opposed to for non-IBD reasons. Current or past use of CAM for IBD was reported by 47% of respondents, and ongoing use for IBD specifically was reported by 24%. It appears that most of the CAM used by IBD patients was not for their IBD. An important finding was that approximately half of IBD patients use CAM either for their IBD or for other reasons. The main CAM used was acidophilus (19%), followed by massage (18%) and flax seed (13%).
Endoscopic Repair of a Colonic Perforation following Polypectomy Using an Endoclip
Authors: Dhalla Sonny S
Published: March 2016

Endoscopic repair using an endoclip device for colonic perforation following polypectomy is described. This is the first case report of a repair following a regular polypectomy-induced perforation described in the English literature.
Synchronous Collagenous Sprue and Enteropathy-Type T Cell Lymphoma: Variants of the Same Disease
Authors: Medlicott SAC , Beck PL , Loken S , Crabtree T
Published: March 2016

A 64-year-old man with treated hypothyroidism had 10 months of diarrhea, abdominal pain, anorexia and recent involuntary 13.6 kg weight loss. He presented to hospital with an acute abdomen that had a radiological correlate of free air under the diaphragm. He was diagnosed with a perforated mid-jejunum due to an ulcerated enteropathy-type T cell lymphoma (ETL), complicating collagenous sprue and cryptic celiac disease. Polymerase chain reaction verified monoclonal g- and b-T cell receptor gene rearrangements in the neoplasm. He had a complete resolution of symptoms when treated with a gluten-free diet in the postoperative period. This is apparently the first report describing collagenous sprue and ETL as synchronous lesions. Because atypical CD8+ lymphocytes are in both the collagenous sprue epithelium and ETL, the implication is that collagenous sprue is a noninvasive component of the ETL.
Vasopressin Antagonists and Dilutional Hyponatremia
Authors: Babatin D Mohamed , Lee Samuel S
Published: March 2016

The paradox of dilutional hyponatremia, as described by Ovid two millennia ago, continues to apply to patients with advanced cirrhosis today: they have unremitting thirst despite vastly increased total body water. Hyponatremia of less than 130 mmol/L occurs in 30% of cirrhotic patients (1), and is mainly due to the reduced capacity of their kidneys to excrete free water.
A Canadian Clinical Practice Algorithm for the Management of Patients with Non-Variceal Upper Gastrointestinal Bleeding
Authors: Barkun Alan , Fallone Carlo A , Chiba Naoki , Fishman Marty , Flook Nigel , Martin Janet , Rostom Alaa , Taylor Anthony ,   for the Nonvariceal Upper GI Bleeding Consensus Conference Group
Published: March 2016

AIM:To use current evidence-based recommendations to provide a user-friendly clinical algorithm for the management of upper gastrointestinal bleeding, adapted to the Canadian environment.

METHODS:A multidisciplinary consensus group of 25 participants representing 11 national societies used a seven-step approach to develop recommendations according to accepted standards. Sources of data included narrative and systematic reviews as well as published and new meta-analyses. A small writing subgroup subsequently created the algorithm.

RESULTS:Recommendations emphasize appropriate initial resuscitation of the patient and a multidisciplinary approach to clinical risk stratification that determines the need for early endoscopy. Early endoscopy allows safe and prompt discharge of selected patients classified as low risk. Endoscopic hemostasis is reserved for patients with high-risk endoscopic lesions. Although monotherapy with injection or thermal coagulation is effective, the combination is superior to either treatment alone. High-dose intravenous proton-pump inhibition is recommended in patients who have undergone successful endoscopic therapy. Routine second-look endoscopy is not recommended. Patients with upper gastrointestinal bleeding secondary to ulcer disease should be tested and treated forHelicobacter pyloriinfection.

CONCLUSIONS:This algorithm should facilitate appropriate risk stratification, use of endoscopic therapy and the appropriate utilization of proton-pump inhibition to optimize the care of patients with upper gastrointestinal bleeding. The algorithm should be customized to the resources of individual medical centres. Its application should be studied with appropriate outcomes recorded and validation performed.
DNA Ploidy and Liver Cell Dysplasia in Liver Biopsies from Patients with Liver Cirrhosis
Authors: El-Sayed Sayed S , El-Sadany Mohamed , Tabll Ashraf A , Soltan Ahmad , El-Dosoky Ibrahim , Attallah Abdelfattah M
Published: March 2016

There is controversy among pathologists when assessing the presence or absence of liver cell dysplasia in liver biopsies taken from cirrhotic patients. The objective of the present study was to determine the DNA ploidy pattern of hepatocytes of patients with liver cirrhosis and its relationship to liver cell dysplasia. A total of 48 male patients diagnosed with liver cirrhosis based on clinical, laboratory and histopathological criteria were included in the study. A liver biopsy was taken from each patient; one part of the biopsy was subjected to histopathology, and the other to flow cytometry. The histopathological examination revealed liver cell dysplasia in 60% of patients with liver cirrhosis (62% of them had large cell dysplasia [LCD] and 38% had small cell dysplasia [SCD]). Abnormal DNA content (aneuploidy) was found in 81.5% of positive liver cell dysplasia specimens and found only in 11.1% of negative liver cell dysplasia specimens, with a statistically significant difference (P<0.001). Aneuploidy was found more commonly in LCD but without significant difference (P>0.05) in comparison with SCD. In conclusion, SCD (similar to LCD) is also associated with aneuploidy and elevated DNA index, and may carry the same risk for progression to hepatocellular carcinoma.
Bacterial Colonization and the Development of Intestinal Defences
Authors: Shi Hai Ning , Walker Allan
Published: March 2016

In humans, intestinal defences develop during gestation and, at full term, have the capacity to respond in an appropriate manner to infectious agents and foreign antigens. Before an active protective response can occur, however, the gut must first be exposed to colonizing bacteria. Colonization with diverse intestinal microbes is necessary for the development of important gut defenses such as the synthesis and secretion of polymeric immunoglobulin A and the generation of a balanced T helper (Th) cell response. Insights into normal immune physiological development of the gut have been made by studying the germ-free animal and intestinal defenses. These studies have provided insights into the physiology of immune responses. Two important immunological functions are the secretion of polymeric immunoglobulin A to protect the intestinal surface against harmful stimuli and inhibition of the systemic response to commensal bacteria and food proteins (eg, oral tolerance) to prevent chronic inflammation. Neither function exists in the germ-free state, but rapidly develops after conventionalization (colonization) of the germ-free animal. In the present review, the importance of bacterial colonization on the appearance of normal mucosal immune function and to the clinical consequences of inadequate colonization to the development of disease will be discussed. For example, excessive Th2 activity can lead to atopy, whereas Th1 predominance is found in conditions such asHelicobacter pylorigastritis and Crohn's disease. With the eradication of infectious diseases in developed countries in the past three decades, the incidence of atopic and autoimmune diseases has increased. This epidemiological observation has been explained by the 'hygiene hypothesis', which suggests that a reduction in microbial burden by public health measures has contributed to an immunological imbalance in the intestine. A family of pattern recognition receptors (Toll-like receptors) on gut lymphoid and epithelial cells mediates innate immune responses to bacterial molecular patterns and, thereby, orchestrates acquired immunity. As the role of bacterial communication within the gut (bacterial-epithelial cross-talk) is clarified, physicians should be able to modulate gut immune responses, for example, by the use of probiotics.
Predicting Residual Rectal Adenocarcinoma in the Surgical Specimen after Preoperative Brachytherapy with Endoscopic Ultrasound
Authors: Romagnuolo Joseph , Parent Josée , Vuong Té , Bélanger Mélanie , Michel René P , Belliveau Paul J , Trudel Judith L
Published: March 2016

BACKGROUND AND STUDY AIMS:A novel brachytherapy (BT) protocol evaluated at McGill University has shown promise in terms of downstaging and achieving high tumour sterilization rates in rectal cancer. Endoscopic ultrasound (EUS) has emerged as the imaging modality of choice for local staging of rectal cancer. However, external beam radiotherapy appears to decrease the accuracy of EUS from 85% to 40%. The aim of the present study was to prospectively evaluate the accuracy of EUS in assessing the response of rectal cancer to BT.

PATIENTS AND METHODS:Thirty-three patients with locally advanced (stage T2 or T3) operable rectal carcinomas were included in an experimental protocol involving a novel conformal technique, using three-dimensional planning, to administer high-dose rate preoperative BT. The 18 patients who were able to have a post-BT EUS exam arranged within two weeks before surgery (eg, four to eight weeks post-BT) were included in this study. Tumour (T)- and lymph node (N)-staging on radial EUS, as well as interpretation of the residual tumour, were assessed prospectively. Pathologists were blinded to the post-BT EUS results.

RESULTS:The mean age was 70 years (SD ±11; range, 52 to 93 years) and 78% of the patients were male. Pre-BT EUS indicated that 16 patients (89%) were stage T3, and two were stage T2. Five patients (28%) had positive nodes (N1) by ultrasound. With BT, the mean maximal wall thickness on EUS decreased from 14 mm to 9.4 mm (PÃ0.001). At the time of surgery, seven of the 18 patients (39%) had no detectable tumour in the resected specimen; one had carcinoma in situ, one was stage T1, one was stage T2, and eight were stage T3. Eleven patients (61%) underwent an abdominoperineal resection, including four of the 11 (36%) with no ultimate evidence of residual carcinoma. Eight patients (44%) were node-positive. The sensitivity, specificity, and positive and negative predictive values of post-BT EUS in predicting residual tumour were 82%, 29%, 64% and 50%, respectively. The post-BT EUS accurately predicted the T-stage in eight (44%) patients; most errors were due to overstaging.

CONCLUSIONS:Rectal cancer T-staging by EUS post-BT is inaccurate, and although it appears sensitive in predicting the presence or absence of residual tumor in rectal adenocarcinoma after preoperative BT, the low predictive values in this setting limit its utility at this time.
Clinical Presentation and Prevalence of Spontaneous Bacterial Peritonitis in Patients with Cryptogenic Cirrhosis and Features of Metabolic Syndrome
Authors: Sorrentino P , Tarantino G , Conca P , Perrella A , Perrella O
Published: March 2016

BACKGROUND:Nonalcoholic steatohepatitis (NASH) may progress to cirrhosis. The prevalence and clinical relevance that spontaneous bacterial peritonitis may have in complicating ascites due to NASH-related cirrhosis have yet to be defined.

METHODS:Among 611 cases of cirrhosis-associated ascites, 45 patients with cryptogenic cirrhosis were retrospectively identified. Of these, 36 patients and a control group of subjects with viral-associated ascites were followed up and compared in a case control study. Information on the onset of ascites, with or without spontaneous bacterial peritonitis, history of risk factors for multimetabolic syndrome, and serological and ascitic laboratory data were compared between groups.

RESULTS:Spontaneous bacterial peritonitis occurred significantly more often in patients with cryptogenic cirrhosis than in equally symptomatic viral controls. The prevalence of obesity, diabetes and spontaneous bacterial peritonitis was significantly higher in patients with cryptogenic cirrhosis. Although liver function was similar in both groups, cryptogenic cirrhosis patients had lower aminotransferase levels. Multivariate analysis identified diabetes, juvenile obesity and spontaneous bacterial peritonitis as independent factors associated with ascites due to cryptogenic cirrhosis.

CONCLUSIONS:Features suggestive of NASH are more frequently observed in patients with ascites and cryptogenic cirrhosis than in age- and sex-matched ascitic patients with well-defined viral etiology. Ascites may be a presenting symptom of NASH-related cirrhosis, and affected patients have a twofold greater risk of spontaneous bacterial peritonitis.
Colorectal Polyposis and Immune‐Based Therapies
Authors: Jacobson-Brown Pearl , Neuman Manuela G
Published: March 2016

The progression from precancerous (adenomatous) colon polyps to malignant colorectal cancer involves the complex actions of various cytokines on T cell proliferation, cell‐cell adhesion, apoptosis and host immunity. A broad spectrum of new treatments, including innovative molecular therapies such as gene therapy and treatment with cytokines, is under experimental and preclinical investigation. Nonsteroidal anti‐inflammatory drugs and selective cyclooxygenase‐2 inhibitors have traditionally been used as inflammation‐reducing agents in cases of colon adenoma. Currently, adjuvant immunotherapies such as recombinant gene therapy and antibody‐cytokine fusion proteins are assuming a more significant role in the management of colorectal neoplasia. Furthermore, advances in antitumour necrosis factor antibodies for the treatment of ulcerative colitis and Crohn′s disease may have potential as chemoprotective agents for the treatment of colon polyposis. The present review aims to discuss the immunological mechanisms underlying colon tumour progression and the molecular and immune‐based therapies that are leading to new methods of prognosis and treatment.
Beyond the Cocoon: Some Plain Talk about Careers
Authors: Hamilton Richard
Published: March 2016

After many years spent in the protected, rather cocoon-like environment of a postgraduate training program, medical residents and fellows can find the prospect of emergence into the real working world somewhat daunting. This is a transition that is best anticipated and planned, recognizing that the life and the responsibilities of a consultant or an academic physician differ from those of a trainee.
Diminutive Colon polyp Coexisting with a Large Lipoma: An Endoscopic 'Rarity'
Authors: Lancet Frederick , Alberti Laura E , Alberti-Flor Juan J
Published: March 2016

Lipomas are the most common nonepithelial tumours of the gastrointestinal tract. In the colon, however, lipomas are uncommon. Herein we report the case of a patient who had a large colonic lipoma with an overlying bleeding diminutive colon polyp that was successfully resected using endoscopic electrocautery.
Serum Beta2-Microglobulin Levels in Hepatitis B e Antigen-Negative Chronic Hepatitits B Patients under Long-Term Lamivudine Monotherapy: Relationship with Virological Breakthrough
Authors: Elefsiniotis Ioannis S , Scarmeas Nikolaos , Glynou Irene , Pantazis Konstantinos D , Kada Helen , Mavrogiannis Christos
Published: March 2016

OBJECTIVES:To evaluate the predictive value of serum beta2-microglobulin (β2m) levels for virological breakthrough in hepatitis B e antigen-negative chronic hepatitis B patients under long term lamivudine monotherapy.

METHODS:Serum β2m levels were calculated at baseline and every three months during lamivudine monotherapy in 25 patients with chronic hepatitis B, using microparticle enzyme immunoassay technology to investigate their association with biochemical, virological and histological outcome data. Cox proportional hazard models were used to investigate the association between serum β2m levels and virological breakthrough.

RESULTS:Seven of 25 (28%), nine of 25 (36%) and 14 of 25 (56%) chronic hepatitis B patients exhibited virological breakthrough at months 12, 24 and 36 of treatment, respectively. All chronic hepatitis B patients who did not show virological breakthrough in the follow-up period exhibited β2m elevation in month 3 of treatment. The duration (in months) of serum β2m elevation was significantly higher in the responders group than the nonresponders group (7.3±2.6 versus 3.8±3.4, P=0.02). In contrast to patients whose serum β2m levels were increased at three months, patients whose β2m levels were decreased had a 4.6 times higher risk of experiencing virological breakthrough (hazards ratio 4.6, 95% CI 1.22 to 17.36). When age, pretreatment serum alanine aminotransferase and hepatitis B virus DNA levels, and grade of liver disease were simultaneously included in the same Cox model, decreased β2m status was still associated with increased risk of virological breakthrough (hazards ratio 12.2, 95% CI 1.28 to 116.8).

CONCLUSIONS:In hepatitis B e antigen-negative chronic hepatitis B patients under long term lamivudine monotherapy, serum β2m levels at three months of treatment, compared with baseline levels, are good predictors of risk for virological breakthrough.
Strongly Positive Tissue Transglutaminase Antibody Assays without Celiac Disease
Authors: Freeman Hugh James
Published: March 2016

Celiac disease is a small bowel disorder characterized by flattened villi and crypt hyperplasia, often with malabsorption. Improvement occurs with a gluten-free diet. Sensitive and specific assays (eg, immunoglobulin A antibodies to tissue transglutaminase [tTG]) that can be quantified appear to be valuable tools for population screening studies. In addition, their use is expanding widely in the clinical practice arena, being employed as a method of case finding. In this evaluation, clinical use of a commercially available test kit was explored. Of 1330 samples submitted to our hospital laboratory by physicians in British Columbia, Alberta and the Yukon Territory (from 1999 to 2003, inclusive), 96 patients (7%) had increased values (normal range greater than 20 units) and markedly increased levels greater than 100 units were detected in 36 patients (3%). Of these, 14 patients (almost 40%) were referred to gastroenterologists in our hospital and all 14 had small intestinal biopsies. Of these, three patients (more than 20%) did not have celiac disease. Two had normal small bowel biopsies and one had unclassified sprue or 'sprue-like' intestinal disease that failed to respond to a gluten-free diet. The other 11 had biopsy-defined celiac disease. While the tTG assay may be a useful predictor of celiac disease, small intestinal biopsy is still required to confirm the diagnosis. In clinical practice, even strongly positive tTG results are not specific in individual patients, do not necessarily correlate with the degree of severity of biopsy change and, as a result, are also unlikely to be useful for monitoring diet compliance.
Management of Polycystic Liver Disease
Authors: Cheung Justin , Scudamore Charles H , Yoshida Eric M
Published: March 2016

Polycystic liver disease (PCLD) is characterized by multiple cysts throughout the liver. Patients may develop chronic intractable symptoms that may be debilitating. Others may develop medical complications that necessitate intervention. There is a variety of nonsurgical and surgical treatment options for symptomatic or complicated PCLD, which range from cyst aspiration and fenestration to liver transplantation. Studies have described variable efficacy and morbidity. Currently, there are no guidelines for the management of PCLD patients and the optimal intervention is controversial. This article reviews the pathogenesis, classification and spectrum of treatment options for PCLD.
Large Multinodular Toxic Goiter: Is Surgery Always Necessary?
Authors: Negro Roberto , Greco Gabriele
Published: March 2016

Patients suffering from multinodular toxic goiter (MNTG) are candidates to thyroidectomy or radioiodine 131I (131I) therapy. Thyroidectomy may be preferable especially when the volume of hyperfunctioning tissue is so large that a single administration of 131I is unlikely to cure the patient in terms of nodule’s volume reduction and thyroid function. We describe the case of a 71-year-old man suffering from thyrotoxic state for the presence of two large hyperfunctioning thyroid nodules. As the patient refused surgery, at first we administered 600 MBq dose of 131I, which was unable to solve hyperthyroidism and local compressive symptoms. Then, before administering another 131I dose, the patient underwent a laser ablation treatment (LAT) in both nodules. After a significant shrinkage due to LAT, the patient received 400 MBq 131I. This procedure was able to definitely cure hyperthyroidism, to induce a significant reduction of nodules’ volume, and to render the patient asymptomatic for compressive symptoms. This case demonstrates that 131I preceded by LAT represents a valid alternative strategy to surgery, even in the presence of two large coexistent hot nodules.
Road-Aware Routing Strategies for Vehicular Ad Hoc Networks: Characteristics and Comparisons
Authors: Qureshi Kashif Naseer , Abdullah Abdul Hanan , Lloret Jaime , Altameem Ayman
Published: March 2016

The tremendous advancement in new wireless technologies has led to a renewed interest in vehicular ad hoc networks. However, due to the high mobility and dynamic nature of vehicular networks, great challenges exist for data delivery. In order to design efficient and smart routing strategies for stable communication, several different types of routing protocols have been integrated. One efficient type is the road-aware routing protocol which is based on road statistics (e.g., traffic density, intersections, and road segments). The main objective of the survey conducted in this paper is to discuss the recent road-aware routing protocols and categorize them according to different aspects. In addition, this review investigates the protocols in terms of their forwarding processes, routing metrics, recovery mechanisms, and performance. Moreover, routing challenges and comparisons are discussed.
Current Practice of Therapeutic Mammaplasty: A Survey of Oncoplastic Breast Surgeons in England
Authors: Aggarwal Shweta , Marla Sekhar , Nyanhongo Donald , Kotecha Sita , Basu Narendra Nath
Published: March 2016

Introduction. Therapeutic mammaplasty (TM) is a useful technique in the armamentarium of the oncoplastic breast surgeon (OBS). There is limited guidance on patient selection, technique, coding, and management of involved margins. The practices of OBS in England remain unknown.Methods. Questionnaires were sent to all OBS involved with the Training Interface Group. We assessed the number of TM cases performed per surgeon, criteria for patient selection, pedicle preference, contralateral symmetrisation, use of routine preoperative MRI, management of involved margins, and clinical coding.Results. We had an overall response rate of 43%. The most common skin resection technique utilised was wise pattern followed by vertical scar. Superior-medial pedicle was preferred by the majority of surgeons (62%) followed by inferior pedicle (34%). Twenty percent of surgeons would always proceed to a mastectomy following an involved margin, whereas the majority would offer reexcision based on several parameters. The main absolute contraindication to TM was tumour to breast ratio >50%. One in five surgeons would not perform TM in smokers and patients with multifocal disease.Discussion. There is a wide variation in the practice of TM amongst OBS. Further research and guidance would be useful to standardise practice, particularly management of involved margins and coding for optimal reimbursement.
HSP27 Alleviates Cardiac Aging in Mice via a Mechanism Involving Antioxidation and Mitophagy Activation
Authors: Lin Shenglan , Wang Yana , Zhang Xiaojin , Kong Qiuyue , Li Chuanfu , Li Yuehua , Ding Zhengnian , Liu Li
Published: March 2016

Aging‐induced cardiac dysfunction is a prominent feature of cardiac aging. Heat shock protein 27 (HSP27) protects cardiac function against ischemia or chemical challenge. We hypothesized that HSP27 attenuates cardiac aging. Transgenic (Tg) mice with cardiac‐specific expression of the HSP27 gene and wild‐type (WT) littermates were employed in the experiments. Echocardiography revealed a significant decline in the cardiac function of old WT mice compared with young WT mice. In striking contrast, the aging‐induced impairment of cardiac function was attenuated in old Tg mice compared with old WT mice. Levels of cardiac aging markers were lower in old Tg mouse hearts than in old WT mouse hearts. Less interstitial fibrosis and lower contents of reactive oxygen species and ubiquitin‐conjugated proteins were detected in old Tg hearts than in old WT hearts. Furthermore, old Tg hearts demonstrated lower accumulation of LC3‐II and p62 than old WT hearts. Levels of Atg13, Vps34, and Rab7 were also higher in old Tg hearts than in old WT hearts. Additionally, old Tg hearts had higher levels of PINK1 and Parkin than old WT hearts, suggesting that mitophagy was activated in old Tg hearts. Taken together, HSP27 alleviated cardiac aging and this action involved antioxidation and mitophagy activation.
Cytotoxicity and Antiproliferative Activity Assay of Clove Mistletoe (Dendrophthoe pentandra(L.) Miq.) Leaves Extracts
Authors: Elsyana Vida , Bintang Maria , Priosoeryanto Bambang Pontjo
Published: March 2016

Clove mistletoe (Dendrophthoe pentandra(L.) Miq.) is a semiparasitic plant that belongs to Loranthaceae family. Clove mistletoe was traditionally used for cancer treatment in Indonesia. In the present study, we examined cytotoxicity of clove mistletoe leaves extracts against brine shrimps and conducted their antiproliferative activity on K562 (human chronic myelogenous leukemia) and MCM-B2 (canine benign mixed mammary) cancer cell lines in vitro. The tested samples were water extract, ethanol extract, ethanol fraction, ethyl acetate fraction, and n-hexane fraction. Cytotoxicity was screened using Brine Shrimp Lethality Test (BSLT). Antiproliferative activity was conducted using Trypan Blue Dye Method and cells were counted using haemocytometer. The results showed that n-hexane fraction exhibited significant cytotoxicity with LC50value of 55.31 μg/mL. The n-hexane fraction was then considered for further examination. The n-hexane fraction of clove mistletoe could inhibit growth of K562 and MCM-B2 cancer cell lines in vitro. The inhibition activity of clove mistletoe n-hexane fraction at concentration of 125 μg/mL on K562 cancer cell lines was 38.69%, while on MCM-B2 it was 41.5%. Therefore, it was suggested that clove mistletoe had potential natural anticancer activity.
Preliminary Study on the Fabrication of Particulate Fuel through Pressureless Sintering Process
Authors: Kim Jong-Hwan , Lee Jung-Won , Kim Ki-Hwan , Lee Chan-Bock
Published: March 2016

U-10wt%Zr spherical particles for use as particulate fuel were prepared by centrifugal atomization and subjected to pressureless sintering, which is one of the simplest powder processing techniques. At sintering temperature of 1100°C for 30 or 60 min, all samples ranging from +50 to −325 mesh showed no apparent bonding between the particles. However, at 1150°C (80 min), all samples formed a bulk body and the microstructures showed apparent sintering stages. Particularly, sample B (50–70 mesh) and sample C (70–100 mesh) showed pore characteristics suitable for a particulate fuel. The results suggest that pressureless sinterability for U-10Zr particulate fuel can be improved by adding small-size (–325 mesh) particles.
Semi-Implicit Algorithm for Elastoplastic Damage Models Involving Energy Integration
Authors: Zhang Ji , Li Jie
Published: March 2016

This study aims to develop a semi-implicit constitutive integration algorithm for a class of elastoplastic damage models where calculation of damage energy release rates involves integration of free energy. The constitutive equations with energy integration are split into the elastic predictor, plastic corrector, and damage corrector. The plastic corrector is solved with an improved format of the semi-implicit spectral return mapping, which is characterized by constant flow direction and plastic moduli calculated at initial yield, enforcement of consistency at the end, and coordinate-independent formulation with an orthogonally similar stress tensor. The tangent stiffness consistent with the updating algorithm is derived. The algorithm is implemented with a recently proposed elastoplastic damage model for concrete, and several typical mechanical tests of reinforced concrete components are simulated. The present semi-implicit algorithm proves to achieve a balance between accuracy, stability, and efficiency compared with the implicit and explicit algorithms and calculate free energy accurately with small time steps.
Development of a Robotic Assembly for Analyzing the Instantaneous Axis of Rotation of the Foot Ankle Complex
Authors: Salb Kelly N. , Wido Daniel M. , Stewart Thomas E. , DiAngelo Denis J.
Published: March 2016

Ankle instantaneous axis of rotation (IAR) measurements represent a more complete parameter for characterizing joint motion. However, few studies have implemented this measurement to study normal, injured, or pathological foot ankle biomechanics. A novel testing protocol was developed to simulate aspects of in vivo foot ankle mechanics during mid-stance gait in a human cadaveric specimen. A lower leg was mounted in a robotic testing platform with the tibia upright and foot flat on the baseplate. Axial tibia loads (ATLs) were controlled as a function of a vertical ground reaction force (vGRF) set at half body weight (356 N) and a 50% vGRF (178 N) Achilles tendon load. Two specimens were repetitively loaded over 10 degrees of dorsiflexion and 20 degrees of plantar flexion. Platform axes were controlled within 2 microns and 0.008 degrees resulting in ATL measurements within ±2 N of target conditions. Mean ATLs and IAR values were not significantly different between cycles of motion, but IAR values were significantly different between dorsiflexion and plantar flexion. A linear regression analysis showed no significant differences between slopes of plantar flexion paths. The customized robotic platform and advanced testing protocol produced repeatable and accurate measurements of the IAR, useful for assessing foot ankle biomechanics under different loading scenarios and foot conditions.
Nontuberculous Mycobacteria Isolated from Tuberculosis Suspects in Ibadan, Nigeria
Authors: Cadmus Simeon Idowu , Diarra Bassirou , Traore Brehima , Maiga Mamoudou , Siddiqui Sophia , Tounkara Anatole , Falodun Olutayo , Lawal Wole , Adewole Isaac Folurunso , Murphy Rob , van Soolingen Dick , Taiwo Babafemi
Published: March 2016

In Nigeria, one of the highest tuberculosis (TB) burdened nations, sputum smear microscopy is routinely employed for TB diagnosis at Directly Observed Treatment Short-Course (DOTS) Centers. This diagnostic algorithm does not differentiateMycobacterium tuberculosiscomplex (MTC) from nontuberculous mycobacteria (NTM). Between December 2008 and January 2009, consecutive patients diagnosed with TB were screened for inclusion at 10 DOTS centers in Ibadan, Nigeria. To verifyMycobacteriumspecies in patients diagnosed, we cultured and identified mycobacterial isolates using PCR, line probe assay, and spoligotyping techniques. From 48 patients screened, 23 met the inclusion criteria for the study. All the 23 study patients had a positive culture. Overall, we identified 11/23 patients (48%) with MTC only, 9/23 (39%) with NTM only, and 3/23 (13%) with evidence of both MTC and NTM. Strains of MTC identified were Latin American Mediterranean (LAM) genotype (n=12),M. africanum(n=1), and the genotype family T (n=1). FourM. avium-intracellulare-M. scrofulaceum complexes, oneM. chelonae complex, oneM. abscessus, and oneM. intracellularewere identified. Our findings underscore the need to incorporate molecular techniques for more precise diagnosis of TB at DOTS centers to improve clinical outcomes and safe guard public health, particularly in TB endemic countries.
The Dynamics of Avian Influenza: Individual-Based Model with Intervention Strategies in Traditional Trade Networks in Phitsanulok Province, Thailand
Authors: Wilasang Chaiwat , Wiratsudakul Anuwat , Chadsuthi Sudarat
Published: March 2016

Avian influenza virus subtype H5N1 is endemic to Southeast Asia. In Thailand, avian influenza viruses continue to cause large poultry stock losses. The spread of the disease has a serious impact on poultry production especially among rural households with backyard chickens. The movements and activities of chicken traders result in the spread of the disease through traditional trade networks. In this study, we investigate the dynamics of avian influenza in the traditional trade network in Phitsanulok Province, Thailand. We also propose an individual-based model with intervention strategies to control the spread of the disease. We found that the dynamics of the disease mainly depend on the transmission probability and the virus inactivation period. This study also illustrates the appropriate virus disinfection period and the target for intervention strategies on traditional trade network. The results suggest that good hygiene and cleanliness among household traders and trader of trader areas and ensuring that any equipment used is clean can lead to a decrease in transmission and final epidemic size. These results may be useful to epidemiologists, researchers, and relevant authorities in understanding the spread of avian influenza through traditional trade networks.