bluuebunny/crossref_metadata_2025 huggingface dataset:
Documentation of Rectal Examination Performance in the Clinical Teaching Unit of a University Hospital
Authors: Freeman Hugh James
Published: April 2016

Digital rectal examination is used to evaluate the distal rectum and other organs, including the prostate gland. It may be combined with fecal screening for occult blood loss, and annual performance has been recommended for asymptomatic individuals over age 40 years for cancer screening. In this study, documentation of digital rectal examinations was assessed through a review of hospital medical records of a randomly selected group of 100 patient discharges (55 females and 45 males) from a total of 896 patients admitted through a hospital emergency room to a medical clinical teaching inpatient unit of a university hospital during a six-month period. In this group, 26% were admitted for a gastrointestinal disorder, but only 17% of all hospitalized patients had rectal examinations done by the medical resident house staff and/or attending medical staff directly responsible for the care of these patients. Occult blood testing was done in 15 patients. Pelvic and breast examinations were rarely documented. The majority of rectal examinations (ie, 13 of 17) were ’same sex’ examinations, appeared to be used largely for testing or confirmation of grossly visible blood loss and were never confirmed by attending staff. The presence or absence of nursing staff during examinations was not documented. The prostate examination was normal in one patient but not documented in the other 44 males (ie, 26 patients over age 60 years). In conclusion, rectal examinations (as well as breast and pelvic examinations) were rarely documented in the medical teaching unit by medical resident house staff or their attending staff.
Sphincter of Oddi Function and Dysfunction
Authors: Toouli James , Craig Alexander
Published: April 2016

The sphincter of Oddi (SO) is situated at the junction of the bile and pancreatic ducts where they enter the duodenum, and it serves to regulate the flow of bile and pancreatic juices as well as to prevent the reflux of duodenal contents into the pancreatobiliary system. SO dysfunction relates to either the biliary or pancreatic portions of the sphincter. Distinct clinical syndromes relating to either sphincter segment are recognized. The mechanism of dysfunction remains uncertain, but disruption of neural pathways involved in sphincter function seems likely. SO dysfunction is best diagnosed by manometry, which is able to correctly stratify patient groups and determine therapy. Biliary scintigraphy, which is noninvasive, has shown promise as a screening tool for patients with suspected SO dysfunction. Division of the sphincter is an effective treatment for patients with manometrically proven SO stenosis for either the biliary or pancreatic form of the disorder. Other forms of SO dysfunction may benefit from pharmacotherapy.
Does the Depth of Gastric Ulceration Influence a Modified Dual Therapy with Amoxicilin and Lansoprazole forHelicobacter pylori-Positive Gastric Ulcer?
Authors: Okai Takashi , Ohtsubo Koushiro , Sakai Junta , Watanabe Hiroyuki , Motoo Yoshiharu , Kawashima Atsuhiro , Norio Sawabu
Published: April 2016

PURPOSE: To clarify whether the depth of ulceration evaluated by endoscopic ultrasonography (EUS) influences a modified dual therapy with amoxicillin and lansoprazole for the treatment ofHelicobacter pylori-positive patients with gastric ulcer.

PATIENTS AND METHODS: Twenty-two consecutive cases of gastric ulcer (nine superficial ulcers and 13 deep ulcers) inH pylori-positive patients were studied. Ten of 22 patients received a two-week eradication therapy with amoxicillin 1500 mg/day, lansoprazole 30 mg/day and a new antiulcer agent with features in common with sucralfate, ecabet sodium, 2.0 g/day. They continued to receive the same doses of lansoprazole and ecabet sodium for the next six weeks. The other 12 patients received the same therapy except for those who underwent the four-week amoxicillin treatment. All patients underwent EUS both at the start of the study and eight weeks later. They then received ecabet sodium alone for the next six months as a maintenance therapy, followed by a six-month interval with no treatment. The final endoscopy was done one year afterH pylorieradication therapy was completed to evaluateH pyloristatus and ulcer recurrence.

RESULTS: The rates of endoscopic healing andH pylorieradication in the nine patients with superficial ulcer were 100%, irrespective of the period of amoxicillin treatment. In contrast, the rates of endoscopic evidence of healing andH pylorieradication in the 13 patients with deep ulcer were different for each period of amoxicillin treatment; that is, the rates of reduction in ulcer determined by echo andH pylorieradication in the four patients treated with the two-week amoxicillin course were significantly lower (P=0.03) than those in the nine patients treated with the four-week course.

CONCLUSION: Ulcer depth is likely to influence the success of amoxicillin treatment forH pylori-positive patients with gastric ulcer.
Esophageal Motility Disorders: Current Concepts of Pathogenesis and Treatment
Authors: Kahrilas Peter J
Published: April 2016

Current concepts of esophageal motility disorders are summarized. Primary data sources were located via MEDLINE or cross-citation. No attempt was made to be comprehensive or inclusive of the literature because fewer than 10% of citations are discussed. Instead, emphasis was placed on new developments in diagnosis, therapeutics, and practice patterns. Controlled therapeutic trials and pathophysiological observations are emphasized. Achalasia is a rare disease of failed lower sphincter relaxation and aperistalsis. Diffuse esophageal spasm (DES), an equally rare disease, is defined by non-propagated esophageal contractions. Nonspecific motility disorders, including nutcracker esophagus and hypertensive lower esophageal sphincter, are identified only by manometry and are ten times as prevalent. Neuromuscular pathology is evident only with achalasia (myenteric plexus neurons destruction). Pharmacological therapies have limited efficacy with achalasia; more limited with DES; and none with the nonspecific motility disorders. More efficacious therapies for the nonspecific disorders are directed at associated reflux disease or psychiatric disorders. Pneumatic dilation is effective therapy for achalasia 72% of instances, but frequently requires repeat dilation and is complicated by a 3% perforation rate. Surgical myotomy is effective in 88% of achalasics; morbidity from thoracotomy has been the major limitation but this has been sharply reduced with a laparoscopic approach. In conclusion, although it has been suggested that esophageal motility disorders are distinct clinical entities, critical review of the literature supports this only in the case of achalasia, a disease of well defined pathophysiology, functional disturbance, and therapies. This clarity diminishes progressively for DES and non-specific esophageal motility disorders.
Acid-Induced Esophageal Shortening in Humans: A Cause for Hiatus Hernia?
Authors: Dunne Donal P , Paterson William G
Published: April 2016

BACKGROUND: Hiatus hernia and gastroesophageal reflux disease commonly coexist, and there is pathophysiological evidence that the presence of a hiatus hernia contributes to abnormal acid reflux. However, the cause of hiatus hernia remains unclear. In an animal model, it has been shown that acute acid injury to the esophagus results in esophageal shortening, raising the possibility that reflux esophagitis per se can contribute to the formation of hiatus hernia by inducing esophageal shortening.

AIM: To determine whether luminal acid produces esophageal shortening in humans.

METHODS: Twelve volunteers were each studied on two occasions, one week apart, in a double-blind, crossover trial. The location of the lower esophageal sphincter (LES), as well as the LES resting pressure and axial length were determined at baseline and then again after 20 min of either acid or saline perfusion.

RESULTS: Acid perfusion did not induce significant changes in resting LES pressure but resulted in proximal migration of the LES (ie, esophageal shortening) by an average of 0.5 cm, with the largest proximal migration being 1.8 cm. In contrast, saline perfusion resulted in slight distal migration of the LES (ie, esophageal lengthening).

CONCLUSIONS: Intraluminal acid perfusion causes longitudinal axis shortening of the esophagus and suggests that gastroesophageal acid reflux may contribute to the cause of hiatus hernia.
Epidemiology of the Antibiotic Resistance ofHelicobacter pyloriin Canada
Authors: Fallone Carlo A
Published: April 2016

BACKGROUND: The rate ofHelicobacter pyloriresistance to antibiotics determines the cure rate of treatment regimens containing such antibiotics. AIMS: To review the literature to determine the rates ofH pyloriresistance to metronidazole and clarithromycin in Canada, and whether these rates vary in different regions of Canada.

METHODS: The literature was reviewed extensively for the prevalence of antibiotic-resistantH pyloriin Canada by searching MEDLINE from January 1980 to May 1999, as well as abstracts of the American Gastroenterology Association Digestive Disease Week, Canadian Digestive Disease Week and The EuropeanH pyloriStudy Group Meetings from January 1995 to May 1999.

RESULTS: Eleven studies that estimatedH pyloriresistance to metronidazole resistance and nine that estimated resistance to clarithromycin in Canada were identified. Rates of resistance for metronidazole and clarithromycin varied from 11% to 48% and 0% to 12%, respectively. Studies that obtained their estimates using the E-test and those that did not clearly exclude patients who had undergone previous attempts atH pylorieradication had higher estimates of resistance, accounting for this variability in results.

CONCLUSIONS: The prevalence of primaryH pyloriresistance in Canada appears to be 18% to 22% for metronidazole and less than 4% for clarithromycin. These rates appear to be consistent across the different regions studied in Canada, but many regions have not been studied.
Implications of Antibiotic Resistance in the Management ofHelicobacter pyloriInfection: CanadianHelicobacterStudy Group
Authors: Hunt RH , Smaill FM , Fallone CA , Sherman PM , van Zanten SJ Veldhuyzen , Thomson ABR
Published: April 2016

Eradication ofHelicobacter pylorifrom the gastric and duodenal mucosa is an important clinical goal in the treatment of infected patients with peptic ulcer disease and otherH pylori-associated conditions. Although several oral drug combination regimens are associated with eradication rates of approximately 85% in controlled trials, the success rate in patients infected with a resistant strain ofH pyloriis closer to 75%. Resistance to metronidazole and clarithromycin, which are common components of combination treatment regimens, is of greatest concern. Reported rates ofH pyloriresistance to various antibiotics vary considerably. In Canada, the data documentingH pylorisusceptibility are limited but suggest that resistance to these antibiotics varies geographically and within specific treatment groups. Although susceptibility testing is not a prerequisite for initial treatment of individual patients infected withH pylori, formal efforts to identify and monitor both the causes and prevalence of antibiotic resistance across Canada are a much needed step in the ongoing management of this important infection. Recommended treatment regimens may be useful, even for treating apparently resistantH pyloristrains. However, it is important to understand the mechanisms of the development of resistant strains to manage patients with treatment failure better.
Applications of Recombinant DNA Technology in Gastrointestinal Medicine and Hepatology: Basic Paradigms of Molecular Cell Biology. Part A: Eukaryotic Gene Structure and DNA Replication
Authors: Wild Gary E , Papalia Patrizia , Ropeleski Mark J , Faria Julio , Thomson Alan BR
Published: April 2016

Progress in the basic sciences of cell and molecular biology has provided an exciting dimension that has translated into clinically relevant information in every medical subspecialty. Importantly, the application of recombinant DNA technology has played a major role in unravelling the intricacies related to the molecular pathophysiology of disease. This series of review articles constitutes a framework for the integration of the database of new information into the core knowledge base of concepts related to the pathogenesis of gastrointestinal disorders and liver disease. The goal of this series of three articles is to review the basic principles of eukaryotic gene expression. The first article examines the role of DNA in directing the flow of genetic information in eukaryotic cells.
Investigation of Diarrhea in AIDS
Authors: Mönkemüller Klaus E , Wilcox C Mel
Published: April 2016

Chronic diarrhea is a common problem in patients with acquired immune deficiency syndrome (AIDS), resulting in significant morbidity and potential mortality. In the early stages of immunodeficiency, human immunodeficiency virus (HIV)‐infected patients are susceptible to infection with the same enteric pathogens that cause diarrhea in immunocompetent hosts, but with progressive immunodeficiency, these patients become susceptible to numerous opportunistic disorders. The main factor to consider when tailoring the work‐up of diarrhea in the HIV‐infected patient is the immune status, which is reflected by the total CD4 lymphocyte cell count. A CD4 count of less than 100 cells/µL is significantly correlated with opportunistic disorders. For the HIV‐infected patient with diarrhea, repeated stool studies to investigate for bacteria, ova and parasites should be the first step. When either upper or lower gastrointestinal tract symptoms are present and stool studies are negative, endoscopy directed to the probable organ of involvement is appropriate. If localizing symptoms are absent, the most appropriate next test is sigmoidoscopy with biopsies. Not infrequently, despite extensive evaluation, the cause of diarrhea in patients with AIDS remains unexplained. Recently, the widespread use of highly active antiretroviral therapy, including protease inhibitors, has led to a change in the epidemiology of diarrhea in AIDS patients. As their immune status improves, HIV‐infected patients treated with combination therapy become less prone to opportunistic disorders. However, diarrhea appears to be frequent because several antiretroviral agents can themselves cause diarrhea.
Effects of In Vitro Antibiotic Resistance on Treatment: Bismuth-Containing Regimens
Authors: Chiba Naoki
Published: April 2016

Bismuth compounds remain useful forHelicobacter pylorieradication therapy. These include colloidal bismuth subcitrate (CBS), bismuth subsalicylate (BSS) and, most recently, ranitidine bismuth citrate (RBC). CBS appears to prevent the development of imidazole resistance when coadministered with nitroimidazoles. Traditional triple therapy with bismuth, metronidazole and tetracycline or amoxicillin (BMT/A) only partially overcomes metronidazole resistance. However, the addition of a PPI to bismuth triple therapy largely overcomes established metronidazole resistance if treatment is given for at least one week or more. When RBC rather than PPI is used with clarithromycin, this dual regimen appears to be more effective in preventing the development of secondary clarithromycin resistance. The triple combination of RBC, metronidazole and clarithromycin appears to be effective against metronidazole resistant strains ofH pylori. Thus, overall, there is some evidence that bismuth compounds may prevent the development of antibiotic resistance and that existing antibiotic resistance may at least be partially overcome in vitro and in vivo. With the growing emergence ofH pyloriresistance to metronidazole and clarithromycin, further research to clarify the role of bismuth compounds is required.
The Value of Alarm Features in Identifying Organic Causes of Dyspepsia
Authors: Madsen Lone Galmstrup , Bytzer Peter
Published: April 2016

The unaided clinical diagnosis of dyspepsia is of limited value in separating functional dyspepsia from clinically relevant organic causes of dyspepsia (gastric and esophageal malignancies, peptic ulcer disease and complicated esophagitis). The identification of one or more alarm features, such as weight loss, dysphagia, signs of gastrointestinal bleeding, an abdominal mass or age over 45 years may help identify patients with a higher risk of organic disease. This review summarizes the frequency of alarm symptoms in dyspeptic patients in different settings (such as the community, primary care and specialist clinics). The prevalence of alarm features in patients diagnosed with upper gastrointestinal malignancy or peptic ulcer disease is described. The probability of diagnosing clinically relevant upper gastrointestinal disease in patients presenting with alarm features and other risk factors is discussed. Alarm features such as age, significant weight loss, use of nonsteroidal anti-inflammatory drugs, signs of bleeding and dysphagia may help stratify dyspeptic patients and help optimize the use of endoscopy resources.
A Case of Giant Cell Hepatitis Recurring after Liver Transplantation and Treated with Ribavirin
Authors: Hassoun Ziad , N’Guyen Bich , Côté Jean , Marleau Denis , Willems Bernard , Roy André , Dagenais Michel , Lapointe Réal , Letourneau Richard , Villeneuve Jean-Pierre
Published: April 2016

A patient who underwent orthotopic liver transplantation for giant cell hepatitis with cirrhosis and in whom giant cell hepatitis recurred twice after orthotopic liver transplantation is reported. He was treated with ribavirin with an excellent result. The literature on this subject is reviewed. This observation clearly confirms the efficacy of ribavirin for the treatment of giant cell hepatitis, thus providing evidence for its viral origin.
Gallbladder Carcinomas: An Immunoprognostic Evaluation of P53; Bcl-2; CEA and Alpha-Fetoprotein
Authors: Kanthan R , Radhi JM , Kanthan SC
Published: April 2016

Thep53gene is the most frequently mutated gene in many human cancers, including those of the colon, breast, lung, esophagus, liver and brain. Such genetically mutated tumours are generally associated with progression of the disease and poor clinical outcome. One hundred cases of documented gallbladder carcinomas were reviewed. Twenty-eight cases were randomly selected to evaluate the expression of P53, Bcl-2, carcinoembryonic antigen (CEA) and alpha-fetoprotein, in both the in situ (19 cases) and invasive components (28 cases) of the tumour by the avidin-biotin complex method of immunohistochemistry. These results were correlated with the mean survival intervals in an effort to clarify the progression of the disease and evaluate their role as prognostic markers. Staining to alpha-fetoprotein and Bcl-2 remained consistently negative to weak insignificant staining in both the in situ and invasive components of the tumour in all cases. P53 staining of the invasive part of the tumour was seen in 24 (86%) of the cases and in 17 (89%) of the in situ component. The in situ staining patterns of P53 were not statistically significant in relation to the mean survival. However, in the invasive component, moderate to strong staining tumours, as seen in 15 (54%) cases, were associated with a mean survival of 8.8 months. A similar trend was also observed with staining patterns to CEA. Eighty-nine per cent of the invasive and 84% of the in situ components of the tumour stained positive to CEA. Moderate to strong staining of both the in situ and the invasive components of the tumours was associated with a mean survival of 10.6 months in 76% of cases. This study shows that altered expressions of P53 and CEA are detectable by immunohistochemistry in gallbladder carcinomas. Tumours with increased expression of P53 and CEA of a strong to moderate staining were associated with poor clinical outcomes as evidenced by their mean survival. A stepwise progression of altered CEA and P53 expression may reflect ongoing progression of the disease from the in situ to the invasive phase. However, such trends need to be evaluated in larger numbers and are thus not considered to be true independent prognostic markers.
Target Proteins in Human Autoimmunity: Cytochromes P450 and Udp-Glycoronosyltransferases
Authors: Obermayer-Straub Petra , Strassburg Christian Peer , Manns Michael Peter
Published: April 2016

Cytochromes P450 (CYPs) and UDP-glucuronosyltransferases (UGTs) are targets of autoantibodies in several hepatic and extrahepatic autoimmune diseases. Autoantibodies directed against hepatic CYPs and UGTs were first detected by indirect immunofluorescence as antiliver and/or kidney microsomal antibodies. In autoimmune hepatitis (AIH) type 2, liver and/or kidney microsomal (LKM) type 1 autoantibodies are detected and are directed against CYP2D6. About 10% of AIH-2 sera further contain LKM-3 autoantibodies directed against family 1 UGTs. Chronic infections by hepatitis C virus and hepatitis delta virus may induce several autoimmune phenomena, and multiple autoantibodies are detected. Anti-CYP2D6 autoantibodies are detected in up to 4% of patients with chronic hepatitis C, and anti-CYP2A6 autoantibodies are detected in about 2% of these patients. In contrast, 14% of patients with chronic hepatitis delta virus infections generate anti-UGT autoantibodies. In a small minority of patients, certain drugs are known to induce immune-mediated, idiosyncratic drug reactions, also known as ’drug-induced hepatitis’. Drug-induced hepatitis is often associated with autoantibodies directed against hepatic CYPs or other hepatic proteins. Typical examples are tienilic acid-induced hepatitis with anti-CYP2C9, dihydralazine hepatitis with anti-CYP1A2, halothane hepatitis with anti-CYP2E1 and anticonvulsant hepatitis with anti-CYP3A. Recent data suggest that alcoholic liver disease may be induced by mechanisms similar to those that are active in drug-induced hepatitis. Autoantibodies directed against several CYPs are further detected in sera from patients with the autoimmune polyglandular syndrome type 1. Patients with autoimmune polyglandular syndrome type 1 with hepatitis often develop anti-CYP1A2; patients with adrenal failure develop anti-CYP21, anti- CYP11A1 or CYP17; and patients with gonadal failure develop anti-CYP11A1 or CYP17. In idiopathic Addison disease, CYP21 is the major autoantigen.
Intrafamillial Clustering ofHelicobacter pyloriInfection in Saubi Arabia
Authors: Al-Knawy BA , Ahmed M-Elbagir K , Mirdad S , ElMekki A , Al-Ammari O
Published: April 2016

AIM: To study the pattern ofHelicobacter pyloriinfection among family members in the Saudi population.

METHODS: A cross-sectional, population-based, seroepidemiological study of family members was undertaken in a Saudi population using salivaH pyloriimmunoglobulin (Ig) G antibodies (Helisal kit).

RESULTS: A total of 42 families comprising 271 children and 84 parents were studied (355 subjects; mean age 23 years, SD 19 years) The overall frequencies ofH pyloriIgG antibodies in mothers, fathers and children were 67%, 64% and 23%, respectively. There was no significant difference in the infection rate between mothers and fathers, or between boys and girls. The infection rate among children increased when one or both parents were seropositive, and the infection rate among parents was proportionally related to the number of infected children per family. The frequency ofH pyloriantibodies was significantly higher in spouses of seropositive parents than in spouses of seronegative parents (45% compared with 19.2%).

CONCLUSIONS: These data confirm that the intrafamilial clustering ofH pyloriinfection in Saudi Arabia occurs in a similar pattern to that described in the developed countries, and that living conditions and social conditions lead to person to person transmission ofH pyloriinfection.
Prospective, Controlled, Multicentre Study of Loperimide in Pregnancy
Authors: Einarson A , Mastroiacovo P , Arnon J , Ornoy A , Addis A , Malm H , Koren G
Published: April 2016

BACKGROUND: Loperamide is a synthetic piperidine derivative used for the treatment of both acute and chronic diarrhea. Little is known about its safety and risk in pregnancy. Human data are limited to one surveillance study of Michigan Medicaid patients, with 108 women exposed in the first trimester. In this study there were six major birth defects, three of which were cardiovascular anomalies.

OBJECTIVES: To determine whether loperamide use in pregnancy is associated with an increased risk of major malformations. The secondary end points were rates of minor malformations, spontaneous and therapeutic abortions, and premature births, and mean birth weights.

PATIENTS AND METHODS: Women counselled by five teratogen information centres on the safety and risk of loperamide in pregnancy were followed after delivery and compared with a similar group of women matched for age, smoking, alcohol and other exposures.

RESULTS: One hundred and five follow-ups were completed; 89 of the women were exposed to loperamide in the first trimester of pregnancy. There were no statistically significant differences between the study group and the control group in any of the end points that were analyzed. However, of women who took loperamide throughout their pregnancy, 21 of 105 had babies who were 200 g smaller than babies in the control group.

CONCLUSIONS: The results of this study suggest that the use of loperamide during pregnancy is not associated with an increased risk of major malformations.
Test-and-Treat Strategies forHelicobacter pyloriin Uninvestigated Dyspepsia: A Canadian Economic Anaylsis
Authors: Marshall John K , Armstrong David , O’Brien Bernie J
Published: April 2016

BACKGROUND: Recognition of the pivotal role ofHelicobacter pyloriin the pathogenesis of peptic ulcer disease has revolutionized primary care approaches to dyspepsia. Decision analysis was used to compare the cost effectiveness of empirical ranitidine with a test and treat strategy using eitherH pyloriserology or the13carbon-urea breath test (13C-UBT).

PATIENTS AND METHODS: A cohort of patients under age 50 years presenting with uninvestigated dyspepsia was evaluated. Three initial strategies were compared with respect to direct medical costs and effectiveness in curingH pylori-related ulcers - empirical ranitidine,H pyloriserology and UBT. A one-year time horizon and third-party payer perspective were adopted in a Canadian health care setting.

RESULTS: UBT was more costly than either serology or ranitidine but was the most effective strategy and required the fewest endoscopies. No strategy demonstrated dominance over another in the base case. The incremental cost effectiveness ratio (ICER) of serology versus ranitidine was $118/cure, and sensitivity analysis induced dominance of serology in several plausible scenarios. The baseline ICER of UBT versus serology was $885/cure but showed substantial variation in sensitivity analysis. Each ICER was highly sensitive to variation in the cost of the tests themselves. At a serology cost of $25, UBT became dominant when its cost fell to $39.

CONCLUSIONS: In low risk patients with uninvestigated dyspepsia, testing forH pyloriusing serology appears to be economically attractive.13C-UBT may be a cost effective alternative to serology if local conditions closely approximate the model parameters. Future changes in the costs of serology and13C-UBT may determine the optimal approach.
Intracerebral Hemorrhage, Oxidative Stress, and Antioxidant Therapy
Authors: Duan Xiaochun , Wen Zunjia , Shen Haitao , Shen Meifen , Chen Gang
Published: April 2016

Hemorrhagic stroke is a common and severe neurological disorder and is associated with high rates of mortality and morbidity, especially for intracerebral hemorrhage (ICH). Increasing evidence demonstrates that oxidative stress responses participate in the pathophysiological processes of secondary brain injury (SBI) following ICH. The mechanisms involved in interoperable systems include endoplasmic reticulum (ER) stress, neuronal apoptosis and necrosis, inflammation, and autophagy. In this review, we summarized some promising advances in the field of oxidative stress and ICH, including contained animal and human investigations. We also discussed the role of oxidative stress, systemic oxidative stress responses, and some research of potential therapeutic options aimed at reducing oxidative stress to protect the neuronal function after ICH, focusing on the challenges of translation between preclinical and clinical studies, and potential post‐ICH antioxidative therapeutic approaches.
Discrimination of Nasopharyngeal Carcinoma from NoncancerousEx VivoTissue Using Reflectance Spectroscopy
Authors: Xu Zhihong , Huang Wei , Lin Duo , Wu Shanshan , Chen Maowen , Ge Xiaosong , Lin Xueliang , Sun Liqing
Published: April 2016

Reflectance spectroscopy is a low-cost, nondestructive, and noninvasive method for detection of neoplastic lesions of mucosal tissue. This study aims to evaluate the capability of reflectance spectroscopy system under white light (400–700 nm) with a multivariate statistical analysis for distinguishing nasopharyngeal carcinoma (NPC) from nasopharyngeal benignex vivotissues. High quality reflectance spectra were acquired from nasopharyngealex vivotissues belonging to 18 noncancerous and 19 cancerous subjects, and the combination of principal component analysis-linear discriminant analysis (PCA-LDA) along with leave-one-spectrum-out cross-validation (LOOCV) diagnostic algorithm was subsequently employed to classify different types of tissue group, achieving a diagnostic sensitivity of 73.7% and a specificity of 72.2%. Furthermore, in order to distinguish NPC from nasopharyngeal benignex vivotissues based on reflectance spectra simply, spectral intensity ratios of oxyhemoglobin (R540/R576) were used as an indicator of the carcinogenesis associated transformation in the hemoglobin oxygenation. This tentative work demonstrated the potential of reflectance spectroscopy for NPC detection usingex vivotissue and has significant experimental and clinical value for furtherin vivoNPC detection in the future.
Neutrinoless Double Beta Decay: 2015 Review
Authors: Dell’Oro Stefano , Marcocci Simone , Viel Matteo , Vissani Francesco
Published: April 2016

The discovery of neutrino masses through the observation of oscillations boosted the importance of neutrinoless double beta decay (0νββ). In this paper, we review the main features of this process, underlining its key role from both the experimental and theoretical point of view. In particular, we contextualize the0νββin the panorama of lepton number violating processes, also assessing some possible particle physics mechanisms mediating the process. Since the0νββexistence is correlated with neutrino masses, we also review the state of the art of the theoretical understanding of neutrino masses. In the final part, the status of current0νββexperiments is presented and the prospects for the future hunt for0νββare discussed. Also, experimental data coming from cosmological surveys are considered and their impact on0νββexpectations is examined.
Cloxacillin: A New Cause of Pill-Induced Esophagitis
Authors: Zezos Petros , Harel Ziv , Saibil Fred
Published: April 2016

A large variety of medications can cause pill-induced esophagitis. Herein we present a case of cloxacillin-induced esophagitis. A 66-year-old male presented with an acute onset of epigastric and retrosternal pain on the 5th day of a course of oral cloxacillin prescribed for erysipelas. Initial clinical and imaging assessment was negative and he was sent home. A few days later, he returned with persistent severe retrosternal pain; endoscopy at the same day revealed a normal upper esophagus, several small stellate erosions in the midesophagus, and a normal squamocolumnar junction with a small hiatus hernia. Treatment with esomeprazole 40 mg bid andMucaineRsuspension resulted in complete resolution of his symptoms. Pill-induced esophagitis may be underreported by patients, when symptoms are mild and unrecognized and/or underdiagnosed by the clinicians as a cause of retrosternal pain, odynophagia, or dysphagia. Failure of early recognition may result in unnecessary diagnostic investigations and prolongation of the patient’s discomfort. This case signifies the importance of enhancing clinician awareness for drug-associated esophageal injury when assessing patients with retrosternal pain, as well as the value of prophylaxis against this unpleasant condition by universally recommending drinking enough water in an upright position during ingestion of any oral medication.
Structural Neuroimaging Markers of Cognitive Decline in Parkinson’s Disease
Authors: Hanganu Alexandru , Monchi Oury
Published: April 2016

Cognitive impairment in patients with Parkinson’s disease is a major challenge since it has been established that 25 to 40% of patients will develop cognitive impairment early in the disease. Furthermore, it has been reported that up to 80% of Parkinsonian patients will eventually develop dementia. Thus, it is important to improve the diagnosing procedures in order to detect cognitive impairment at early stages of development and to delay as much as possible the developing of dementia. One major challenge is that patients with mild cognitive impairment exhibit measurable cognitive deficits according to recently established criteria, yet those deficits are not severe enough to interfere with daily living, hence being avoided by patients, and might be overseen by clinicians. Recent advances in neuroimaging brain analysis allowed the establishment of several anatomical markers that have the potential to be considered for early detection of cognitive impairment in Parkinsonian patients. This review aims to outline the neuroimaging possibilities in diagnosing cognitive impairment in patients with Parkinson’s disease and to take into consideration the near-future possibilities of their implementation into clinical practice.
Algorithms for Pallet Building and Truck Loading in an Interdepot Transportation Problem
Authors: Alonso Maria Teresa , Alvarez-Valdes Ramon , Parreño Francisco , Tamarit Jose Manuel
Published: April 2016

This paper deals with the problem of a logistics company that has to serve its customers by first putting the products on pallets and then loading the pallets into trucks. Besides the standard geometric constraints of products not overlapping each other and not exceeding the dimensions of pallets and trucks, in this real problem, there are many other constraints, related to the total weight of the load, the maximum weight supported by each axle, and the distribution of the load inside the truck. Although the problem can be decomposed into two phases, pallet loading and truck loading, we have taken a combined approach, building and placing pallets at the same time. For each position in the truck, a pallet is built and tailored for that position according to the constraints of height and weight. We have developed a GRASP algorithm, in which the constructive algorithm is randomized and an improvement phase is added to obtain high-quality solutions. The algorithm has been tested on two sets of real instances with different characteristics, involving up to 44 trucks. The results show that solutions with an optimal or near optimal number of trucks are obtained in very short computing times.
Liposarcoma of the Spermatic Cord: Impact of Final Surgical Intervention—An Institutional Experience
Authors: Bachmann R. , Rolinger J. , Girotti P. , Kopp H. G. , Heissner K. , Amend B. , Königsrainer A. , Ladurner R.
Published: April 2016

Background. Paratesticular liposarcomas are almost always mistakenly diagnosed as inguinal hernias subsequently followed by inadequate operation.Methods. 14 consecutive patients with paratesticular liposarcoma were retrospectively reviewed. Preoperative management was evaluated. Disease-free and overall survival were determined.Results. In 11 patients primary and in 3 patients recurrent liposarcoma of the spermatic cord were diagnosed. Regarding primary treatment in primary surgical intervention resection was radical (R0) in 7 of 14 (50%) patients, marginal (R1) in 6 (43%) patients, and incomplete with macroscopic residual tumour (R2) in 1 (7%) patient. Primary treatment secondary surgical intervention was performed in 4 patients: resection was radical (R0) in 3 (75%) patients and marginal (R1) in 1 (25%) patient. Regarding secondary treatment in recurrent disease resection was marginal (R1) in 3 patients (100%). Final histologic margins were negative in 10 patients with primary disease (71%) and positive in 4 patients with subsequent recurrent disease. After radical resection disease-free survival rates at 3 years were 100%. Overall survival at 4.5 years (54 (18–180) months) was 64%.Conclusion. An incomplete first surgical step increases the number of positive margins leading to local recurrences and adverse prognoses. Aggressive surgery should be attempted to attain 3-dimensional negative margins.
Induction of Poly(ADP-ribose) Polymerase in Mouse Bone Marrow Stromal Cells Exposed to 900 MHz Radiofrequency Fields: Preliminary Observations
Authors: He Qina , Sun Yulong , Zong Lin , Tong Jian , Cao Yi
Published: April 2016

Background. Several investigators have reported increased levels of poly(ADP-ribose) polymerase-1 (PARP-1), a nuclear enzyme which plays an important role in the repair of damaged DNA, in cells exposed to extremely low dose ionizing radiation which does not cause measurable DNA damage.Objective. To examine whether exposure of the cells to nonionizing radiofrequency fields (RF) is capable of increasing messenger RNA of PARP-1 and its protein levels in mouse bone marrow stromal cells (BMSCs).Methods. BMSCs were exposed to 900 MHz RF at 120 μW/cm2power intensity for 3 hours/day for 5 days. PARP-1 mRNA and its protein levels were examined at 0, 0.5, 1, 2, 4, 6, 8, and 10 hours after exposure using RT-PCR and Western blot analyses. Sham-exposed (SH) cells and those exposed to ionizing radiation were used as unexposed and positive control cells.Results. BMSCs exposed to RF showed significantly increased expression of PARP-1 mRNA and its protein levels after exposure to RF while such changes were not observed in SH-exposed cells.Conclusion. Nonionizing RF exposure is capable of inducing PARP-1.
Proximate Determinants of Fertility in Zambia: Analysis of the 2007 Zambia Demographic and Health Survey
Authors: Chola Mumbi , Michelo Charles
Published: April 2016

The role of proximate determinants in influencing fertility has been well documented worldwide. Bongaarts’ aggregate model of the proximate determinants (which focuses on marriage, contraception, abortion, and sterility) has been widely used to analyse the influence of proximate determinants on fertility. In Zambia, however, there is limited understanding of their effects. Therefore, the aim of this study was to examine the effect of proximate determinants of fertility in Zambia using Bongaarts’ model. This was a cross-sectional analysis of women’s data from the 2007 Zambia Demographic and Health Survey (ZDHS). A total of 7,146 women aged 15 to 49 years participated in the ZDHS. Bongaarts’ model was employed in the data analysis. Results showed that, overall, mean age was 27.8 years and rural-urban distribution was 56% and 44%, respectively. Marriage (40%) and postpartum infecundity (22%) accounted for the largest inhibiting effect on natural fertility from its biological maximum of 19.10. Contraception use accounted for only 3%. Therefore, in order to manage fertility in Zambia, policies and programmes should consider the effects of marriage, postpartum infecundity, and contraception on fertility. Without such targeted interventions, managing and maintaining population growth will remain a challenge in Zambia.
Duodenal Villous Atrophy in a TTG-Negative Patient Taking Olmesartan: A Case Report and Review of the Literature
Authors: Kulai Tasha , Arnason Thomas , MacIntosh Donald , Igoe John
Published: April 2016

Olmesartan, an angiotensin II receptor antagonist used to treat hypertension, is associated with few adverse effects. Here, a case of severe sprue-like enteropathy and acute kidney injury is described in a 68-year-old male taking olmesartan for 3-4 years. He presented to hospital with a five-week history of diarrhea, vomiting, and a 20 lb weight loss. Anti-TTG was negative with a normal IgA. Biopsies of the distal duodenum and duodenal cap revealed marked blunting of the villi with near complete villous atrophy of the biopsies from the bulb. There was an increase in intraepithelial lymphocytes as well as neutrophils in the surface epithelium. The patient’s diarrhea improved upon discontinuation of olmesartan and he returned to his previous weight. Repeat endoscopy four months later demonstrated complete resolution of inflammatory change with normal villous architecture. Long-term olmesartan use is associated with severe sprue-like enteropathy. The mechanism of intestinal injury is unknown. Duodenal biopsy results may mimic other enteropathies such as celiac disease. Physicians should consider medications as potential etiologies of enteropathy.
Purification and Characterization of a Novel Intracellular Sucrase Enzyme ofLeishmania donovaniPromastigotes
Authors: Singh Arpita , Mandal Debjani
Published: April 2016

The promastigote stage ofLeishmaniaresides in the sand fly gut, enriched with sugar molecules. Recently we reported thatLeishmania donovanipossesses a sucrose uptake system and a stable pool of intracellular sucrose metabolizing enzyme. In the present study, we purified the intracellular sucrase nearly to its homogeneity and compared it with the purified extracellular sucrase. The estimated size of intracellular sucrase is ~112 kDa by gel filtration chromatography, native PAGE, and substrate staining. However, in SDS-PAGE, the protein is resolved at ~56 kDa, indicating the possibility of a homodimer in its native state. The kinetics of purified intracellular sucrase shows its higher substrate affinity with aKmof 1.61 mM than the extracellular form having aKmof 4.4 mM. The highly specific activity of intracellular sucrase towards sucrose is optimal at pH 6.0 and at 30°C. In this report the purification and characterization of intracellular sucrase provide evidence that sucrase enzyme exists at least in two different forms inLeishmania donovanipromastigotes. This intracellular sucrase may support further intracellular utilization of transported sucrose.
Cooperation between Trust and Routing Mechanisms for Relay Node Selection in Hybrid MANET-DTN
Authors: Papaj Jan , Dobos Lubomir
Published: April 2016

Today’s mobile networks require integration of the different networks in order to transport data between mobile devices. The main problems of all networks occur if the communication paths are disconnected for a short time. The hybrid MANET-DTN is an evolution of the Mobile Ad Hoc Networks (MANET) and Delay/Disruption Tolerant Network (DTN) and it gives the possibilities of data transport between the disconnected islands of the nodes. The key problem is how to select reliable and secure nodes to transport messages between isolated islands with limited connectivity. The selection of the relay nodes is a critical factor because the data are transported via these devices in hostile environments. Two algorithms for a relay node selection based on trust are introduced. These algorithms are activated if the connections are disrupted. The selected relay nodes transport data across the disconnected environment via store-carry-forward mode. The proposed algorithms enable selecting reliable relay nodes based on collecting routing information and contact history. We introduce the network performance analyses of these algorithms. The main idea of the analyses is studying how the algorithms can affect the behaviour of the routing and forwarding mechanisms in the simulator OPNET modeler.
Evaluation of Antidiabetic and Antihyperlipidemic Effects of Peganum harmala Seeds in Diabetic Rats
Authors: Komeili Gholamreza , Hashemi Mohammad , Bameri-Niafar Mohsen
Published: April 2016

The present study was carried out to investigate the antidiabetic and antihyperlipidemic properties of hydroalcoholic extract of Peganum harmala in streptozotocin-induced diabetic male rats. In an experimental study, 64 normal Wistar albino male rats (200–230 g) were randomly divided into 8 groups. Control and diabetic rats were treated with normal saline and three different doses (30, 60, and 120 mg/kg) of hydroalcoholic extract of Peganum harmala seeds for 4 weeks orally. At the end of treatment, blood samples were taken and glucose, triglycerides, total cholesterol, LDL-c, HDL-c, malondialdehyde (MDA), total antioxidant capacity (TCA), ALT, AST, GGT, bilirubin, and glycosylated hemoglobin (HbA1C) were determined. STZ-induced diabetic rats showed significant changes in the values of glucose, triglycerides, total cholesterol, LDL-c, MDA, TAC, ALT, AST, GGT, bilirubin, and HbA1C in comparison with normal rats. Administration of the extract to diabetic rats resulted in a remarkable decrease in glucose, lipid profiles, MDA, ALT, AST, GGT, bilirubin, and HbA1C levels and increase in TAC relative to diabetic group. The results of this study indicated that hydroalcoholic extract of Peganum harmala seeds possesses antidiabetic and hypolipidemic activities and could be useful in treatment of diabetes.
Synthesis and Characterization of Colloidal CZTS Nanocrystals by a Hot-Injection Method
Authors: Méndez-López A. , Morales-Acevedo A. , Acosta-Silva Y. J. , Ortega-López M.
Published: April 2016

The present study reports the synthesis of colloidal Cu2ZnSnS4(CZTS) nanocrystals (average size ~4–9 nm) by a simple and low cost hot-injection method. These nanocrystals form larger particles with sizes around 40 nm. Oleylamine (OLA) was used as both the solvent and the nanocrystal stabilizer. The effect of the synthesis time on the structural, compositional, morphological, and optical properties was studied. As revealed by XRD, Raman, and TEM measurements all the prepared samples are comprised of both kesterite and wurtzite CZTS nanocrystals. The wurtzite phase contribution reduces as the reaction time is increased. The “bandgap” of the obtained nanoparticles tends to 1.52 eV for the larger synthesis times (24 h) which is suitable for an absorber layer in thin films solar cells.
A Novel Automatic Rapid Diagnostic Test Reader Platform
Authors: Ozkan Haydar , Kayhan Osman Semih
Published: April 2016

A novel automatic Rapid Diagnostic Test (RDT) reader platform is designed to analyze and diagnose target disease by using existing consumer cameras of a laptop-computer or a tablet. The RDT reader is useable with numerous lateral immunochromatographic assays and similar biomedical tests. The system has two different components, which are 3D-printed, low-cost, tiny, and compact stand and a decision program named RDT-AutoReader 2.0. The program takes the image of RDT, crops the region of interest (ROI), and extracts the features from the control end test lines to classify the results as invalid, positive, or negative. All related patient’s personal information, image of ROI, and the e-report are digitally saved and transferred to the related clinician. Condition of the patient and the progress of the disease can be monitored by using the saved data. The reader platform has been tested by taking image from used cassette RDTs of rotavirus (RtV)/adenovirus (AdV) and lateral flow strip RDTs ofHelicobacter pylori(H. pylori) before discarding them. The created RDT reader can also supply real-time statistics of various illnesses by using databases and Internet. This can help to inhibit propagation of contagious diseases and to increase readiness against epidemic diseases worldwide.