bluuebunny/crossref_metadata_2025 huggingface dataset:
The extent of inflammation is a predictor for pouch‐related complications in ileal pouches in patients with ulcerative or indeterminate colitis
Authors: Tan K.‐K. , Ravindran P. , Young C. J. , Solomon M. J.
Published: March 2014

Aim

Limited data are available on the relationship between the histological features of the resected specimens in patients with ulcerative colitis (UC) or indeterminate colitis (IC) and the outcome of restorative proctocolectomy. The aim of our study was to determine if the histological features of the resected specimen in patients with UC and IC can predict ileal‐pouch‐related outcome.

Method

A review of all patients who had a restorative proctocolectomy created following completion proctectomy or proctocolectomy for UC and IC was performed.

Results

Between 1992 and 2011, 142 patients (132 with UC and 10 with IC) were reviewed. After a median follow‐up of 36 (3–149) months, 51 (35.9%) developed a pouch‐related complication. Forty‐two (29.7%) developed pouchitis while three (2.1%) developed a pouch‐cutaneous fistula. Four (2.8%) had pouch failure, while stricture of the anastomosis was seen in three (2.1%) patients. The presence of extension of the inflammation into the muscularis propria of the resected specimen was associated with an increased risk of pouch‐related complications (P = 0.01). The presence of submucosal oedema was also a significant risk factor (P = 0.03).

Conclusion

The extension of inflammation into the muscularis propria appears to predict pouch‐related complications following restorative proctocolectomy for UC or IC.
LEVERAGED BUYBACKS OF SOVEREIGN DEBT: A MODEL AND AN APPLICATION TO GREECE
Authors: Baglioni Angelo
Published: March 2014

The model presented in this article shows that the outcome of a leveraged buyback of sovereign debt depends on the priority structure of the deal. If the institution lending the funds needed for the buyback is senior, the debtor country benefits from the deal: the government debt is reduced, implying a lower probability of default; at the same time, the deal makes the price of outstanding bonds go down, since their recovery rate declines. The opposite holds if the lending institution is junior. If the loan is underpriced, the implied subsidy is shared between the borrowing country and its bondholders, who can benefit from a price increase of their bonds. This is actually what happened with the buyback of Greek sovereign bonds in 2012, as it is shown in the empirical section. Those results do not depend on the share of country's endowment devoted to debt repayment, which instead plays a crucial role in shaping the outcome of unlevered buybacks. (JEL F34, H63)
Investigating Constituent Order Change With Elicited Pantomime: A Functional Account of SVO Emergence
Authors: Hall Matthew L. , Ferreira Victor S. , Mayberry Rachel I.
Published: March 2014

One of the most basic functions of human language is to convey who did what to whom. In the world's languages, the order of these three constituents (subject [S], verb [V], and object [O]) is uneven, with SOV and SVO being most common. Recent experiments using experimentally elicited pantomime provide a possible explanation of the prevalence of SOV, but extant explanations for the prevalence of SVO could benefit from further empirical support. Here, we test whether SVO might emerge because (a) SOV is not well suited for describing reversible events (a woman pushing a boy) and (b) pressures to be efficient and mention subjects before objects conspire to rule out many other alternatives. We tested this by asking participants to describe reversible and non‐reversible events in pantomime, and we instructed some participants to be consistent in the form of their gestures and to teach them to the experimenter. These manipulations led to the emergence of SVO in speakers of both English (SVO) and Turkish (SOV).
The impact of childhood emotional abuse on violence among people who inject drugs
Authors: Lake Stephanie , Wood Evan , Dong Huiru , Dobrer Sabina , Montaner Julio , Kerr Thomas
Published: March 2014

Introduction and Aims

Childhood emotional abuse is a known risk factor for various poor social and health outcomes. While people who inject drugs (IDU) report high levels of violence, in addition to high rates of childhood maltreatment, the relationship between childhood emotional abuse and later life violence within this population has not been examined.

Design and Methods

Cross‐sectional data were derived from an open prospective cohort of IDU in Vancouver, Canada. Childhood emotional abuse was measured using the Childhood Trauma Questionnaire. We used multivariate logistic regression to examine potential associations between childhood emotional abuse and being a recent victim or perpetrator of violence.

Results

Between December 2005 and May 2013, 1437 IDU were eligible for inclusion in this analysis, including 465 (32.4%) women. In total, 689 (48.0%) reported moderate to severe history of childhood emotional abuse, whereas 333 (23.2%) reported being a recent victim of violence and 173 (12.0%) reported being a recent perpetrator of violence. In multivariate analysis, being a victim of violence (adjusted odds ratio = 1.49, 95% confidence interval 1.15–1.94) and being a perpetrator of violence (adjusted odds ratio = 1.58, 95% confidence interval 1.12–2.24) remained independently associated with childhood emotional abuse.

Discussion and Conclusions

We found high rates of childhood emotional abuse and subsequent adult violence among this sample of IDU. Emotional abuse was associated with both victimisation and perpetration of violence. These findings highlight the need for policies and programmes that address both child abuse and historical emotional abuse among adult IDU. [Lake S, Wood E, Dong H, Dobrer S, Montaner J, Kerr T. The impact of childhood emotional abuse on violence among people who inject drugs. Drug Alcohol Rev 2015;34:4–9]
5‐(2‐aminopropyl)indole: A new player in the drama of ‘legal highs’ alerts the community
Authors: Katselou Maria , Papoutsis Ioannis , Nikolaou Panagiota , Spiliopoulou Chara , Athanaselis Sotiris
Published: March 2014

Issues

5‐(2‐aminopropyl)indole (5‐IT) is a new psychoactive substance, a ‘legal high’, that recently invaded the drug arena in Europe and has already led to numerous intoxications and fatalities. Knowledge upon its pharmacology and toxicity is non‐existent or restricted; the only available information involves very few published scientific articles, official reports from the European Monitoring Centre for Drugs and Drug Addiction and drug abusers' experiences expressed in online drug forums.

Approach

A review of the existing knowledge on 5‐IT is reported, concerning its chemistry and synthesis, its pharmacological and toxicological aspects, as well as information concerning the fatal and toxic consequences of its use. The existing methodologies for the determination of 5‐IT in biological and seized samples as well as its legal status are also presented. All the relative data were gathered through a detailed search of PubMed and the Internet.

Key Findings

No original studies have investigated and/or confirmed its pharmacological properties, acute and chronic toxicity, physiological and behavioural effects or the dependence potential of the drug. Thus, it is difficult to specify the physical effects of 5‐IT in humans. This drug is a phenomenon with global significance for public health as its use can lead to intoxication and fatalities.

Implications

Significant information on 5‐IT is provided for pharmacologists, toxicologists, forensic pathologists and regulatory authorities.

Conclusion

5‐IT is a current public health challenge. Better international collaboration, effective legislation and continuous community alertness are needed to tackle this current growing phenomenon. [Katselou M, Papoutsis I, Nikolaou P, Spiliopoulou C, Athanaselis S. 5‐(2‐aminopropyl)indole: A new player in the drama of ‘legal highs’ alerts the community. Drug Alcohol Rev 2015;34:51–57]
Interaction strengths in balanced carbon cycles and the absence of a relation between ecosystem complexity and stability
Authors: Neutel Anje‐Margriet , Thorne Michael A.S.
Published: March 2014

The strength of interactions is crucial to the stability of ecological networks. However, the patterns of interaction strengths in mathematical models of ecosystems have not yet been based upon independent observations of balanced material fluxes. Here we analyse two Antarctic ecosystems for which the interaction strengths are obtained: (1) directly, from independently measured material fluxes, (2) for the complete ecosystem and (3) with a close match between species and ‘trophic groups’. We analyse the role of recycling, predation and competition and find that ecosystem stability can be estimated by the strengths of the shortest positive and negative predator‐prey feedbacks in the network. We show the generality of our explanation with another 21 observed food webs, comparing random‐type parameterisations of interaction strengths with empirical ones. Our results show how functional relationships dominate over average‐network topology. They make clear that the classic complexity‐instability paradox is essentially an artificial interaction‐strength result.
Evolutionary history underlies plant physiological responses to global change since the last glacial maximum
Authors: Becklin Katie M. , Medeiros Juliana S. , Sale Kayla R. , Ward Joy K.
Published: March 2014

Assessing family‐ and species‐level variation in physiological responses to global change across geologic time is critical for understanding factors that underlie changes in species distributions and community composition. Here, we used stable carbon isotopes, leaf nitrogen content and stomatal measurements to assess changes in leaf‐level physiology in a mixed conifer community that underwent significant changes in composition since the last glacial maximum (LGM) (21 kyr BP). Our results indicate that most plant taxa decreased stomatal conductance and/or maximum photosynthetic capacity in response to changing conditions since the LGM. However, plant families and species differed in the timing and magnitude of these physiological responses, and responses were more similar within families than within co‐occurring species assemblages. This suggests that adaptation at the level of leaf physiology may not be the main determinant of shifts in community composition, and that plant evolutionary history may drive physiological adaptation to global change over recent geologic time.
Distribution patterns ofPacific halibut (Hippoglossus stenolepis) in relation to environmental variables along the continental shelf waters of theUS WestCoast and southernBritishColumbia
Authors: Sadorus Lauri L. , Mantua Nathan J. , Essington Timothy , Hickey Barbara , Hare Steven
Published: March 2014

Knowing howPacific halibut (Hippoglossus stenolepis) distribute in relation to ocean conditions is of primary importance to halibut managers, as they are tasked with estimating stock size and designing effective monitoring programs amidst a changing climate. This research examined near‐bottom environmental data alongside halibut survey catch data for the years 2006–2009 on the continental shelf ofOregon,Washington, and southernBritishColumbia. The objectives of the research were to: (1) characterize summer environmental conditions and halibut distribution; (2) explore ranges and possible tolerance thresholds for halibut in relation to temperature, dissolved oxygen (DO), salinity, andpH; and (3) identify the primary environmental factors affecting distribution of halibut and model the observed relationships. Seasonal hypoxia is an annual feature of the study area and results suggest halibut exhibited an apparentDOminimum threshold of 0.9 mL L−1. Ordinary least squares multiple regression analysis indicated that depth, temperature, andDOwere significant variables in predicting halibut distribution, whereas salinity and bottom type were not. Ambiguity in model results led to the use of two additional analytical methods, geographically weighted regression (GWR) and tree regression, to examine regional variation and the overarching structure of halibut distribution. The three models yielded similar results indicating the importance ofDOand temperature as variables describing structure. TheGWRmodel yielded the best fit of the three when usingDOas a predictor variable, indicating that regional variation is a factor. These results suggest that low, but above‐threshold,DOmay be contributing to catchability differences in the survey.
Functional polymorphisms in the matrix metalloproteinase genes and their association with bladder cancer risk and recurrence: A mini‐review
Authors: Wieczorek Edyta , Wasowicz Wojciech , Gromadzinska Jolanta , Reszka Edyta
Published: March 2014

Molecular pathogenesis of muscle invasive bladder cancer and non‐muscle invasive bladder cancer is incompletely elucidated. It is believed that matrix metalloproteinases, which are involved in the processes of uncontrolled extracellular matrix substrates degradation and participate in modulating the activity of a variety of non‐matrix proteins, can contribute to carcinogenesis. Polymorphisms in the MMP genes associated with unique genomic changes in bladder cancer patients are still being investigated to discover direct links with pathophysiological mechanisms. Because of the functional polymorphisms in the MMP genes, which have a proven or likely effect on their protein expression, they could possibly affect the tumor process. The current mini‐review synthesizes findings regarding the association of genetic polymorphisms in the MMP genes with bladder cancer risk and recurrence in patients. We discuss the current views on the feasibility of genetic polymorphisms in the MMP1, 2, 3, 7, 8, 9 and 12 genes as a risk, and prognostic markers for patients with bladder cancer. The majority of the research described in the present mini‐review proves that the genetic polymorphism in the MMP1 (rs1799750) is the most widely studied, and suggests that the rare genotype, 2G2G, of that gene might show increased susceptibility for bladder cancer, especially among smokers. However, existing statistically significant associations between the genetic polymorphisms in the MMP genes and bladder cancer risk have not been clearly shown, and further studies are necessary in order to positively confirm them or dispel potential false hopes.
Alloimmunization with Cultured Human Stomach Cancer Cell Lines and the Establishment of Human‐Human Hybridomas Producing Monoclonal Antibodies
Authors: Koyama Kotaro , Akiyama Koichi , Kawahara Hiroharu , Egashira Akira , Murakami Hiroki
Published: March 2014

Alloimmunization with the cultured human stomach cancer cell lines MKN‐45 and MKN‐28 was conducted and human‐human hybridomas were established. Living MKN‐45 cells (107 cells per injection) were injected monthly 34 times into one of the authors (K.K.) over 2 years and living MKN‐28 cells (107 cells per injection) were co‐injected 14 times after the 20th injection of MKN‐45 alone. Cultured stomach cancer cells injected subcutaneously into K.K.'s forearm were rejected completely, although they grew transiently at the injection site. All the injections were made voluntarily at the direction of K.K. himself. Two human‐human hybridomas producing monoclonal antibodies reactive with MKN‐45 and MKN‐28 cells, respectively, were separated from a hybridoma of human B‐lymphoblastoid cell line named HO 323/WIL2‐NS and lymphocytes in K.K.'s peripheral blood. One cell line of the hybridoma FMK‐H3 produced IgM‐type monoclonal antibody, and the other line, EMK‐F7, produced IgG‐type antibody. These two human‐human monoclonal antibodies were highly reactive with MKN‐45 and MKN‐28 cells, weakly reactive with MKN‐74 stomach cancer cell line, and not reactive with the other stomach cancer cell lines tested (MKN‐1, MKN‐7, TMK‐1, NUGU‐2, NUGC‐3, NUGC‐4 and KATO‐III).
Synergistic Effect of Radiation on N‐2‐Fluorenylacetamide‐induced Hepatocarcinogenesis in Male ACI/N Rats
Authors: Mori Hideki , Iwata Hitoshi , Morishita Yukio , Mori Yoshio , Ohno Takatoshi , Tanaka Takuji , Sasaki Shunsaku
Published: March 2014

The effect of radiation on chemical hepatocarcinogenesis was examined in 3 groups of male ACI/N rats. In Group I, 21 rats received dietary administration of N‐2‐fluorenylacetamide (FAA) (0.02%) for 16 weeks. Six of the rats were killed at the cessation of FAA exposure. The remaining rats were then given the basal diet until termination (32 weeks). In Group II, 16 rats were given FAA for 16 weeks. The animals were then given radiation (whole body; 3 Gy) and kept on the diet for the subsequent 16 weeks. Thirteen rats of Group III were kept on the basal diet throughout the experiment. They received radiation for 16 weeks after the start of the experiment. Liver tumors were obtained in Groups I and II. The multiplicity of the neoplastic nodules or hepatocellular carcinomas of Group II (6.5 ± 2.5 or 1.4 ± 0.9) was significantly greater than that of Group I (2.9 ± 1.7 or 0.3 ± 0.4, respectively) (P< 0.001). Furthermore, the incidence of hepatocellular carcinoma of Group II (13/16) was also significantly higher than that of Group I (4/15) (P< 0.003). The results clearly indicate a synergistic effect of radiation with FAA on the hepatocarcinogenesis. The effect of radiation in this rat model appeared to be on the early progression of the carcinogenesis.
Establishment and Characterization of Human Pancreatic Cancer Cell Lines in Tissue Culture and in Nude Mice
Authors: Ikeda Yurika , Ezaki Mitsue , Hayashi Itsuro , Yasuda Daisuke , Nakayama Kazumichi , Kono Akira
Published: March 2014

Three human pancreatic cancer cell lines, designated as KP‐1N, KP‐2 and KP‐3 have been established in both tissue cultures and in nude mice. The KP‐1N and KP‐3 tumors were obtained from liver metastases of pancreatic tumors and the KP‐2 tumor was of primary pancreatic origin. The patients' tumors from which KP‐1N and KP‐2 were derived showed characteristics of adenocarcinoma, and the KP‐3 tumor had adenosquamous carcinoma characteristics. Inoculations of samples from surgical specimens into athymic nude mice resulted in tumor formation, with the tumors histologically closely resembling the original neoplasms. Subcutaneous injections of the established cell lines also induced tumor formation and the tumors histologically resembled the original lesion in the cases of KP‐2 and KP‐3 tumors, but the KP‐1N tumors in the mice were histologically different from the surgical specimen. The KP‐1N, KP‐2 and KP‐3 cell lines have been cultured continuously in a medium supplemented with 10% fetal calf serum for more than 20, 21 and 17 months, respectively. The KP‐2 and KP‐3 cell lines produced and released carbohydrate antigen 19‐9 into the spent medium but the KP‐1N cell line did not. KP‐1N and KP‐3, produced liver metastases after intrasplenic injection into nude mice, whereas KP‐2 produced few liver colonies. Cell lines highly metastatic to the liver, KP‐1NLs and KP‐3Ls, were isolated from the liver colonies of KP‐1N and KP‐3, respectively.
Induction of Killer Cells from Lymphocytes in Pleural Effusion of Advanced Lung Cancer Patients
Authors: Inoue Yuji , Shijubo Noriharu , Uede Toshimitsu
Published: March 2014

We analyzed the phenotype and cytotoxic ability of pleural exudative lymphocytes (PLEL) which were obtained from 18 advanced lung cancer patients. Freshly isolated PLEL were mainly CD4(+) T cells and had weak natural killer, autologous tumor killing and lymphokine‐activated killer activities. After cultivation of PLEL with interleukin‐2, cytotoxicity of PLEL against autologous tumor cells was increased at 2 weeks, but it was remarkably reduced at 4 weeks. When PLEL were stimulated by mitomycin C‐treated autologous tumor cells during culture, autologous tumor killing activity of PLEL was significantly enhanced even after 4 weeks of cultivation. Cold target inhibition analysis and binding inhibition assays using monoclonal antibodies indicated that autologous tumor stimulation could induce major histocompatibility complex class I restricted cytotoxic T lymphocytes specific for autologous tumor cells in some cases.
Kinetic Analysis of 5‐Fluorouracil Action against Various Cancer Cells
Authors: Inaba Makoto , Mitsuhashi Junko , Ozawa Shogo
Published: March 2014

Based on our recent kinetic analysis, which made it possible to distinguish between the cell‐killing actions of cell cycle phase‐specific and non‐specific agents, we attempted to elucidate the actions of 5‐fluorouracil (FUra) on three different cancer cell lines. By colony‐forming assay, the concentrations of fluorouridine (FUrd), fluorodeoxyuridine (FdUrd) or FUra giving 90% cell kill (IC90) at various exposure times (texps) were obtained. With P388 cells, the curve of texps‐IC90 for FUrd on a log‐log scale was linear with a slope of — 1, which is typical for cell cycle phase‐nonspecific agents. In contrast, the curve for FdUrd showed a much steeper slope than —1, which is characteristic for cell cycle phase‐specific agents. We found that the curve for FUra was exactly the same as that for FUrd, indicating that the mode of FUra action on P388 leukemia is analogous to that of FUrd. Similar results were observed with human colon and renal cancer cell lines, HT‐29 and KU‐2, although when the cells were exposed to relatively low concentrations of FUra for a long time, a cell cycle phase‐specific action became evident.
A Novel Model of Solitary Hepatic Tumor in Rats Using Ascites Hepatoma AH13: Suitability for Chemotherapeutic Studies
Authors: Tamura Yoshihiro , Sakata Yuh , Tsushima Kenichi , Narushima Seiko , Yamada Yasuhide , Ogasawara Hitoshi , Ito Tohru , Saitoh Soh , Suzuki Hidekazu , Yoshida Yutaka
Published: March 2014

A highly reproducible model of a solitary hepatic tumor in rats using ascites hepatoma AH13 has been developed using a two‐step method which was suitable for quantitative chemotherapeutic studies. Diffuse hepatic metastases were induced first by inoculation of three different ascites hepatomas, AH13, AH130 and AH7974 into the portal vein in a dose‐dependent fashion. Second, the induced hepatic tumor (3×107 cells) was minced into 1×1×4 mm fragments and implanted in the liver of normal rats. In this procedure, the AH13 strain proved best suited for the generation of a solitary hepatic tumor. The growth of the solitary liver tumor using AH13 was highly reproducible. To demonstrate the suitability of this solitary hepatic tumor model for the evaluation of chemotherapy, the tumor‐burdened rats were treated with adriamycin (ADR) and mitomycin C (MMC). The reduction in tumor size was proportional to dosage, and the statistical significance of the differences between the treatment group and control group was proportional to dosage. A synergistic effect of ADR and MMC on the tumor also was demonstrated. This model should prove to be a useful tool for the testing of newly developed treatments of hepatic cancer.
Gene therapy: Recent advances and applications in gastroenterology and hepatology
Authors: OUYANG EDWIN C , WU GEORGE Y
Published: March 2014

Abstract The advantages and disadvantages of viral and non‐viral vectors for gene delivery are reviewed. Advances in systems for introduction of new gene expression are described, including self‐deleting retroviral transfer vectors, chimeric viruses and chimeric oligonucleotides. Systems for inhibition of gene expression are also discussed including antisense oligonucleotides, ribozymes and dominant‐negative genes. Examples of the use of these systems in animal models and clinical trials for gastrointestinal disorders are discussed.
Epidermal growth factor‐stimulated rabbit oesophageal mucosal growth: Role of polyamines
Authors: SAYLES JOHN M , D'ADDIO VICTOR , WANG JIAN‐YING , BASS BARBARA L
Published: March 2014

Abstract Factors operative in oesophageal mucosal growth are poorly characterized. Epidermal growth factor (EGF) has been shown to stimulate mucosal growth throughout the gastrointestinal tract. The present study was performed to test the hypothesis that polyamine biosynthesis is required for stimulation of epithelial growth by EGF in oesophageal mucosa. Using an in vitro explant model, oesophageal mucosal growth was quantified in the presence or absence of EGF and α‐difluoromethylornithine (DFMO), a specific inhibitor of polyamine synthesis. Administration of 50 nmol/L EGF significantly increased the rate of epithelial growth in oesophageal explants. Treatment with DFMO for 3 and 7 days not only depleted the tissue polyamines putrescine, spermidine and spermine, but also significantly impaired mucosal growth. The inhibitory effect of DFMO on mucosal growth was partially but significantly prevented when exogenous putrescine was given. Additionally, stimulation of epithelial growth by EGF was also blocked by depletion of cellular polyamines in DFMO‐treated oesophageal explants. These results indicate that EGF stimulates epithelial growth of oesophageal mucosa at least partly through a process involving polyamine biosynthesis.
Influence of diet, vitamins and chemotherapeutic agents on gastrointestinal cancer
Authors: KOLARS JOSEPH C , KURTH CANDACE L
Published: March 2014

Abstract Dietary influences play a major role in the pathogenesis of most gastrointestinal malignancies. However, it has been difficult to define which dietary components will be most significant for any given individual. In this article we discuss the methodological challenges to research in this field as well as recent observations that have been made on the role of dietary factors in specific digestive tract neoplasms.
Aged gastric mucosa: Mechanisms of vulnerability
Authors: MALCONTENTI‐WILSON CATHY , SCHULZ SONIA , PENNEY ANGELA G , ANDREWS FIONA J , O'BRIEN PAUL E
Published: March 2014

Abstract The incidence, frequency of complications and mortality of gastric ulcer disease are increased four‐fold in the elderly taking non‐steroidal anti‐inflammatory drugs (NSAID). There is controversy as to whether this reflects increased usage of NSAID or specific vulnerability associated with age. We have investigated two possible mechanisms for this increase in gastrointestinal effects in the elderly: (i) increased susceptibility to acute gastrotoxicity; and (ii) reduced adaptation to NSAID, in a model of young (2 month), mature (12 month) and aged (24 month) rats. Aspirin damaged 7.7% of the volume of gastric mucosa in the young rat. In mature and aged rats, this increased to 11.3% (P < 0.002 compared to control) and 21.9% (P < 0.005 compared to control), respectively. Thus, aspirin caused a three‐fold increase in the severity of acute gastric mucosal injury in aged animals. However, indomethacin, ibuprofen and L745 337 did not produce any significant acute gastric mucosal damage in 2‐, 12‐ or 24‐month‐old rats. Significant gastric adaptation to diclofenac treatment occurred in both aged and young rats as measured by gastric mucosal damage. The aged gastric mucosa adapted equally as well as the young gastric mucosa to diclofenac. The findings of this study provide only modest support to the hypothesis of increased vulnerability of the stomach in the aged. Aspirin was associated with greater damage in the aged. Adaptation to diclofenac‐induced damage was not reduced in the aged and there was not an increased susceptibility to damage by the non‐aspirin NSAID tested. The selective cyclo‐oxygenase‐2 inhibitor, L745 337, was the least toxic agent and may represent a group of NSAID which cause fewer gastrointestinal complications in the elderly.
Gastric electrical stimulation in patients with gastroparesis
Authors: CHEN JIAN DZ , LIN ZHIYUE , McCALLUM RICHARD W
Published: March 2014

Abstract As in the heart, there is a pacemaker in the human stomach and it generates myoelectrical activity with a frequency of approximately three cycles per minute. Abnormalities in gastric myoelectrical activity may result in gastric motility disorders, such as gastroparesis. Electrical stimulation of the stomach is achieved by delivering electrical currents via electrodes attached to the smooth muscle of the stomach. Recently, a number of studies on electrical stimulation of the stomach in both humans and dogs have indicated that gastric electrical stimulation with appropriate parameters is able to entrain gastric slow waves and normalize gastric dysrhythmias. This has led some investigators to use gastric electrical stimulation to treat patients with gastroparesis. Previous studies and the current state of the field in gastric electrical stimulation in treatment of gastroparesis will be discussed and summarized.
Gastro‐oesophageal reflux disease and respiratory disease
Authors: KE MEI‐YUN , XU WEN‐BING , ZHONG XU , XIAO GAO‐HUI , WANG ZHI‐FENG , HUANG XI‐ZHEN
Published: March 2014

Abstract An epidemiological survey showed that respiratory symptoms with gastro‐oesophageal reflux (GER) were twice as high as those without GER symptoms. In 46 cases of unknown chronic cough or asthma, 67% had positive oesophageal pH monitoring. Of 34 patients with snoring and reflux symptoms, 16 (47.1%) were confirmed as positive for obstructive sleep apnoea (OSA) and GER. Anti‐reflux therapy significantly improved both GER and OSA.
Gastrointestinal motor function in diabetes mellitus: Relationship to blood glucose concentrations
Authors: HOROWITZ MICHAEL , RAYNER CHRIS , KONG MARIE‐FRANCE , JONES KAREN L , WISHART JUDITH M , SUN WEI‐MING , FRASER ROBERT
Published: March 2014

Abstract The application of novel investigative techniques has established that there is a high prevalence of disordered gastrointestinal motor function in patients with diabetes mellitus and has provided insights into its pathogenesis and clinical significance. Acute changes in the blood glucose concentration, even within the normal postprandial range, affect both gastrointestinal motor function and the perception of sensations arising from the gastrointestinal tract. Gastric emptying is slower during hyperglycaemia and accelerated during hypoglycaemia; the perception of gastric distension is greater during hyperglycaemia than euglycaemia. The pathways mediating the effects of the blood glucose concentration on gut motility and sensation are poorly defined. The rate of gastric emptying is an important determinant of postprandial blood glucose concentrations and there is increasing evidence that gastric emptying can be modulated therapeutically in order to optimize glycaemic control in patients with diabetes.
Functional dyspepsia: New insights into the pathophysiology
Authors: PHUNG NGHI , TALLEY NICHOLAS J
Published: March 2014

Abstract The pathogenesis of functional dyspepsia remains poorly understood. There is increasing evidence pointing to a predominant role of gastroduodenal visceral hypersensitivity in the pathogenesis, where patients have abnormally reduced gastric and small intestinal sensory thresholds. Motor abnormalities observed in subgroups of patients include delayed gastric emptying, antral hypomotility, gastric dysrhythmias, abnormal gastrointestinal reflexes and small intestinal dysmotility, but these may be secondary pheno nena. The central nervous system modifies peripheral visceral afferent pathways and, hente, psychological factors may possibly alter symptom status. Other putative mechanisms include Helicobacter pylori gastritis and gastric acid hypersecretion or sensitivity, but the role of these remain controversial.
Polyamines and cytoskeletal proteins in intestinal epithelial cell migration
Authors: WANG JIAN‐YING
Published: March 2014

Abstract Our previous studies have shown that polyamines are essential for early mucosal restitution in vivo and cell migration in vitro. The current study determines whether cytoskeleton is involved in the process requiring polyamines for the stimulation of cell migration. Treatment with α‐difluoromethylornithine (DFMO), a specific inhibitor of ornithine decarboxylase (ODC), the rate‐limiting enzyme for polyamine synthesis, for 4 days totally inhibited ODC activity and depleted intracellular polyamines in the intestinal epithelial cells (IEC‐6) derived from rat small intestinal crypt cells. Polyamine deficiency resulted in reorganization of F‐actin in migrating cells but had no effect on the concentrations of filamentous actin and β‐actin mRNA. The actin cortex was greatly increased in density and lamellipodia were less extensive. In contrast, non‐muscle myosin I and II levels in DFMO‐treated cells were decreased by 70 and 75%, respectively, and stress fibres were sparse or absent. The most striking feature of DFMO‐treated cells was the appearance of many small punctate foci of myosin II in the cell interior. Migration of DFMO‐treated cells was reduced by 80%. In the presence of DFMO, exogenous polyamine not only returned cytoskeleton levels and distribution towards normal but also restored cell migration to control levels. These results indicate that actin and myosins have a role in polyamine‐dependent epithelial cell migration and may be part of the mechanism that requires polyamines for early mucosal restitution.
Effects of R‐ and S‐enantiomers of chiral non‐steroidal anti‐inflammatory drugs in experimental colitis
Authors: REUTER BRIAN K , MAULEÓN DAVID , WALLACE JOHN L
Published: March 2014

Abstract Prostaglandins appear to play an important role in down‐regulating intestinal inflammation and promoting repair of injury. In experimental colitis, inhibition of prostaglandin synthesis with nonsteroidal anti‐inflammatory drugs (NSAID) leads to marked exacerbation of tissue injury. It has been suggested that the ability of chiral NSAID to inhibit prostaglandin synthesis is completely attributable to the s‐enantiomer, while the r‐enantiomer is a much weaker inhibitor. Thus, it is possible that r‐enantiomers of chiral NSAID will have reduced intestinal toxicity and reduced ability to exacerbate colitis. In the present study, we compared r‐ and s‐enantiomers of two chiral NSAID (flurbiprofen and etodolac) in terms of their ability to exacerbate colitis in the rat. We found that r‐flurbiprofen and r‐etodolac did not exacerbate colitis, in contrast to the s‐enantiomers or racemates. The r‐enantiomers also had significantly less inhibitory activity on prostaglandin synthase. Reduced biliary excretion of r‐etodolac may have also contributed to the lack of detrimental effects in this model. The results support the hypothesis that prostaglandins play an essential role in down‐regulating colonic inflammation and promoting repair.
Differences in Outcome of Transurethral Resection of the Prostate for Benign Prostatic Hypertrophy between Three Diagnostic Categories
Authors: DOLL HELEN A. , BLACK N. A. , McPHERSON K. , WILLIAMS G. B. , SMITH J. C.
Published: March 2014

Summary— As part of a prospective cohort study of 388 men undergoing transurethral resection of the prostate (TURP) for benign prostatic hypertrophy, pre‐operative factors and the outcome of surgery during the first post‐operative year were compared between patients in whom their surgeon felt the principal reason for operating was chronic retention (37%), acute retention (with no chronic retention) (28%), or symptomatic prostatism (with no history of chronic or acute retention) (35%).

Although in many respects the patients in the 3 diagnostic categories were similar, patients with chronic retention were more likely to be younger, of higher social class and to have worse general health. Patients with acute retention were more likely to present with a urinary tract infection and to have electrocardiographic abnormalities, and symptomatic patients presented with more severe urinary symptoms.

Minor differences between the categories with regard to post‐operative morbidity and mortality were not statistically significant at the 5% level. However, some significant differences did exist. Patients with acute retention were more likely to experience urinary and non‐urinary infections and impotence after surgery, while symptomatic patients reported less improvement in their health status as regards pain and social isolation.

These results suggest that the method of categorisation is clinically valid and a necessary distinction to make when auditing TURP.
MemokathR: A Second Generation of Intraprostatic Spirals
Authors: POULSEN A. L. , SCHOU J. , OVESEN H. , NORDLING J.
Published: March 2014

Summary— MemokathR (Engineers & Doctors A/S, Hornbæk, Denmark) is a new intraprostatic spiral composed of titanium nickel alloy with shape memory effect. We describe the use of this spiral in 30 consecutive patients with prostatic outflow obstruction. Their median age was 79 years and all were either in a high risk group for surgery or had refused surgery. The spiral was inserted under sterile conditions via a delivery catheter under ultrasonic guidance. When flushed with hot water (45°C or above) one section of the spiral expands in the prostatic apex and maintains the spiral in position. When cooled with cold water (10°C or below) the spiral becomes supersoft, making removal easy.

With a follow‐up of 0.2 to 9 months (median 3) we report a success rate of 83%. Five patients discontinued treatment, 3 because of urinary retention, 1 because of progressive obstructive symptoms and 1 following persistent urinary incontinence. No migration of the spiral was observed. Encrustations have appeared and seem to be a persistent problem. Most patients were satisfied with the procedure, which provided a quick, safe and effective method of relieving infravesical prostatic obstruction. Follow‐up is short and late complications have yet to be assessed.
The Urolume, a Permanently Implanted Prostatic Stent for Patients at High Risk for Surgery; Results from 5 Collaborative Centres
Authors: WILLIAMS GORDON , COULANGE C. , MILROY E. J. G. , SARRAMON J. P. , RUBBEN H.
Published: March 2014

Summary— Ninety‐six men considered unfit for prostatic surgery underwent the insertion of a permanently implanted super alloy mesh stent (Urolume) at 5 European centres. Ninety were able to void immediately, 2 required a second stent to enable them to void and 4 voided after a period of suprapubic catheter drainage. Seven patients required the subsequent insertion of a further stent to cover the prostatic urethra completely and in 8 cases the stent was removed. Objective and symptomatic evidence of relief of bladder outflow obstruction was shown throughout the period of study. Severe irritative symptoms were seen in the majority of patients for periods of up to 3 months and resulted in removal of the stent in 3. At 12 months, 15 of 27 patients who underwent cystoscopy had complete epithelialisation of the stent and in 11 cases there was more than 70% epithelialisation. Fourteen patients developed encrustation on exposed parts of the stent during follow‐up. This was associated with the development of a urinary infection in 9. The positioning of the stent in subsequent studies has been altered to overcome this problem.
Epinephrine Reduces the Severity of Catheter‐induced Urethral Inflammation by Action at the α2‐adrenoceptors
Authors: LUNDEBERG T. , NORDLING L. , LIEDBERG H. , THEODORSSON E. , EKMAN P.
Published: March 2014

Summary— We have studied the contribution of epinephrine to experimentally induced urethral inflammation in the rat. Inflammation was induced by inserting latex strips into the urethra. The effects of various experimental procedures were assessed according to a 4‐point scale based on histological findings. The results showed that 0.5 mg/kg epinephrine decreased the severity of catheter‐induced urethral inflammation. This effect was blocked by the α2‐adrenergic agonist, yohimbine, but not by α1 (prazosin), β1 (M32 MTC), or β2 (butoxamine) antagonists. The results suggest that the suppressive effect of epinephrine is mediated by action at the α2 adrenergic receptor.
Renal Transplantation in Young Boys with Posterior Urethral Valves: Preliminary Report
Authors: DINNEEN M. D. , FITZPATRICK M. M. , GODLEY M. L. , DICKS‐MIREAUX C. M. F. , RANSLEY P. G. , FERNANDO O. N. , TROMPETER R. S. , DUFFY P. G.
Published: March 2014

Summary— Seven boys (mean age 38 months) with posterior urethral valves underwent renal transplantation between June 1988 and August 1991. Urodynamic studies were performed before transplantation in 6/7 patients. In 4 the investigation indicated bladders of capacity and compliance which were deemed suitable for transplantation. Two patients had poorly compliant bladders; one of these underwent bladder augmentation before engraftment and the other proceeded to transplantation without bladder surgery.

Six patients have functioning renal allografts with a mean follow‐up of 1.3 years and a mean plasma creatinine of 51.6 μmol/l. Mean glomerular filtration rate (ml/min/1.73 m2 SA) 6 months after transplantation was 76.8 and at 1 year it was 84.5. In one patient early rejection was followed by transplant nephrectomy. Careful pre‐operative evaluation is mandatory for a successful outcome of renal transplantation in young boys with posterior urethral valves.
Internal Ureteric Stenting following Pyeloplasty Reduces Length of Hospital Stay in Children
Authors: McMULLIN N. , KHOR T. , KING P.
Published: March 2014

Summary— The advent of totally internal ureteric stents has the potential to reduce hospital stay in paediatric pyeloplasty. Traditionally, discharge from hospital has followed removal of an external transanastomotic drain, usually 5 days to a week post‐operatively. The use of totally internal catheters negates the need for nursing supervision by removing external attachments that a paediatric patient might inadvertently dislodge. The length of hospital stay for pyeloplasty using a Double‐J ureteric stent was compared with our previous method of transanastomotic feeding tube nephrostomy drainage. The results show the use of Double‐J stenting to be advantageous in paediatric pyeloplasty by decreasing considerably the length of hospital stay. This is clearly of benefit to the patient, who returns to the family setting much earlier. Despite the need for an out‐patient endoscopic procedure to remove the stent, savings in treatment costs and improved efficiency of bed use are also achieved.
Denervation techniques
Authors: MADERSBACHER H.
Published: March 2014

The bladder can be denervated at several levels: centrally, at the level of the sacral nerves; peripherally, on the pelvic nerves; or in the bladder, by cutting the relevant structures, by injecting substances toxic to nerves, or by hyperbaric bladder distension. These procedures target the sensory or motor nerves to weaken or to interrupt the detrusor reflex arc. Most of the procedures introduced previously, e.g. bladder trans‐section by open operation, endoscopic or transvesical phenolization, hyperbaric bladder distension, and peripheral denervation of the bladder, have now been abandoned. Although some of these techniques had a high initial success rate in abolishing detrusor overactivity and in controlling incontinence, the relapse rate within 18 months approached 100%. In the early 1950s, much of the denervation surgery was performed on sacral roots and nerves. Nowadays, sacral de‐afferentiation of the bladder by dorsal sacral root rhizotomy of S2–S5, using specialized techniques, either intradurally or at the conal level, has proved to be a very effective procedure for patients with spinal cord injuries and detrusor hyperreflexia, functional low compliance and reflex incontinence, which cannot be managed by any other means. In conclusion, although in ∼ 90% of patients the symptoms of an overactive bladder will be eliminated or improved by conservative methods of treatment, bladder denervation procedures still have a place in the management of these patients. In particular, with these procedures a low‐pressure bladder system can be obtained and urinary continence restored in patients with complete suprasacral spinal cord lesions.
BIOFEEDBACK IN OVERACTIVE BLADDER
Authors: CARDOZO LINDA D.
Published: March 2014

Biofeedback is a form of learning or re‐education in which the participant is retrained within a closed feedback loop. Information about one or more of the patient's normally unconscious physiologic processes is made available to the patient as a visual, auditory, or tactile signal. Objective responses are recorded on a polygraph trace so that they can be easily observed. Subjective responses are more difficult to monitor and it is often difficult to separate these effects of biofeedback from the placebo effect. Biofeedback has been successfully employed in cases of urinary incontinence due to detrusor instability. Indeed, a recent report has shown that biofeedback‐assisted behavioral treatment is more effective than either oxybutynin or placebo in the treatment of urge and mixed urinary incontinence in older, community‐dwelling women. Patients embarking on biofeedback need to be well motivated and intelligent enough to understand what is expected of them. The treatment is time consuming for both the patient and the operator, but the benefits of successful treatment include a reduction in morbidity and side effects associated with other therapies. Biofeedback can be employed as an adjunct to other forms of treatment, such as drug therapy, and is particularly useful in children.
Lower urinary tract symptoms, benign prostatic obstruction and the overactive bladder
Authors: THOMAS A.W. , ABRAMS P.
Published: March 2014

Lower urinary tract symptoms (LUTS), benign prostatic obstruction (BPO), and the overactive bladder have increasing prevalence with age in both men and women (with the obvious exception). The question is, are they interrelated or independently related to age? The specific issue is whether BPO causes the overactive bladder. There are two pieces of evidence that might appear to suggest such a cause and effect. First, the overactive bladder is more common in men than in women of the same age, although physiologically, men are 5–10 years older at the same biological age. Second, the overactive bladder resolves in two‐thirds of individuals after surgical interventions such as transurethral prostatectomy. The symptoms suggestive of an overactive bladder are the most troublesome, even though they may not be the most prevalent. Long‐term follow‐up studies with repeated urodynamic investigations have shown that the incidence of the overactive bladder and its attendant symptoms increases despite there being no deterioration in outlet obstruction over follow‐up periods of 10 and 20 years. These data, and others, indicate that the situation is not as straightforward as some believe. The statement that ‘the overactive bladder is secondary to BPO’ cannot be made, as there are too many unanswered questions and pieces of the puzzle that do not fit. The overactive bladder is undoubtedly associated with BPO, and it leads to the most troublesome LUTS in older men. Epidemiological research, coupled with urodynamic evaluation, may provide further evidence. We also need better and more relevant models (e.g. ageing animals), together with further histological and other biological data before the waters become crystal clear.