Serum Level of Biliary Glycoprotein I,a Determinant of Cholestasis,of Similar Use as γ-Glutamyltranspeptidase

Biliary glycoprotein I (BGP I), a constituent of normal bile and serum, is a glycoprotein (mol. wt. ~ 90,000) containing about 40% carbohydrate. Serum BGP I (S-BGP I) was determined by means of a double-antibody radioimmunoassay in patients with liver and gastrointestinal disease and in healthy individuals. The serum levels of five liver enzymes (aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase (S-ALP), γ-glutamyltranspeptidase (S-GT), and lactic dehydrogenase), bilirubin (total and conjugated), and bile acids (cholic and chenodeoxycholic acid) were determined in parallel. Healthy individuals had 0.5 ± 0.3 mg/l of S-BGP I (mean ± 2 S.D.; range, 0.2-0.9 mg/l). Most patients with liver disease (chronic hepatitis, alcoholic cirrhosis, primary biliary cirrhosis) had elevated levels, up to 5-10 times the upper reference limit, whereas most patients with gastrointestinal disease (ulcerative colitis, Crohn's disease, other GI diseases) had normal values. In patients with liver disease S-BGP I was positively correlated (p < 0.0005) to S-GT. In primary biliary cirrhosis a positive correlation (p < 0.005) between S-BGP I and S-ALP was also obtained. All other comparisons between S-BGP I and the other liver function tests showed non-significant correlations. It is concluded that S-BGP I is a determinant of cholestasis of similar use as S-GT.     

CpG DNA: trigger of sepsis, mediator of protection, or both?

Unmethylated CpG motifs are prevalent in bacterial but not vertebrate genomic DNAs and activate immune cells that express the TLR9 receptor. This triggers the production of reactive oxygen species and the secretion of proinflammatory cytokines and chemokines. Under some conditions these effects can result in the systemic inflammatory response syndrome. Under other conditions, the immune stimulatory effects of CpG motifs can protect against pathogen challenge and initiate prophylactic and therapeutic innate and adaptive immune responses.     

Systematic review of nephrotoxicity of drugs of abuse, 2005–2016

Background

The United States is faced with an unprecedented epidemic of drug abuse. Every year thousands of Americans visit the emergency departments all over the country with illicit drug related complaints. These drugs have been known to be associated with a range of renal pathologies, from reversible acute kidney injuries to debilitating irreversible conditions like renal infarction. So far, no comprehensive study or systematic review has been published that includes the commonly used street drugs and designer drugs with potential nephrotoxic outcomes.

Methods

We conducted a systematic review of published case reports, case series, and cross sectional studies of nephrotoxicities related to drugs of abuse. Literature review was conducted using PubMed/Medline from January 1, 2005 -December 31, 2016 to search for publications related to drug abuse with a defined renal outcome. Publications which reported renal injury in relation to the use of illicit drugs were selected, specifically those cases with raised creatinine levels, clinically symptomatic patients, for instance those with oliguria and proven renal biopsies.

Results

A total of 4798 publications were reviewed during the search process and PRISMA flow chart and Moose protocol regarding systematic reviews were followed. 110 articles were shortlisted for the review. A total of 169 cases from case reports and case series, and 14 case studies were analyzed. Renal manifestations of specific illicit drug abuse were included in this review.

Conclusion

Based on the evidence presented, a wide range of renal manifestations were found to be associated with drug abuse. If the trend of increasing use of illicit drug use continues, it will put a significant percentage of the population at an elevated risk for poor renal outcomes. This study is limited by the nature of the literature reviewed being primarily case reports and case series.

     

Treatment of Crohn’s disease of inflammatory,stenotic, and fistulizing phenotypes

Opinion statement The heterogeneous nature of Crohn’s disease (CD) is reflected in the diversity of treatment options available for individual patients. The stratification of CD patients into more homogeneous groups based on disease location and disease behavior may provide clinicians with a more focused approach to therapeutic decision-making. Uncomplicated disease behaviors are typically treated medically. When complications arise and patterns of disease become more aggressive, combined medical and surgical approaches are often necessary and yield favorable results. The surgical management of CD can be as complex as the disease itself, and should involve a surgeon who professes a special expertise in inflammatory bowel disease. Progress in our understanding of the role of the interaction between the environment and the immune system in disease development has led to major advancements in the area of CD therapeutics. Current therapies target the various elements of the inflammatory cascade implicated in the pathogenesis of CD. The anti-inflammatory properties of the pharmacologic therapies presented in this review vary from actions that are extremely broad to those that are cellular or cytokine specific. Maximizing the efficacy of CD-directed therapies while minimizing their toxicity remains the principal objective in developing management strategies for CD patients. Maintaining good quality of life and maximizing adherence to therapies are also important considerations. Despite the various therapeutic options available for CD patients, chosen therapies should be based on the overall treatment goal for individual patients. Therapeutics can be broadly categorized as induction therapies (goal to treat active disease) and maintenance therapies (goal to prevent relapse of disease).     

A Prospective,Randomized, Multicenter,Controlled Study of the Safety of Seprafilm® Adhesion Barrier in Abdominopelvic Surgery of the Intestine

INTRODUCTION: Seprafilm® adhesion barrier (Seprafilm®) has been proven to prevent adhesion formation after abdominal and pelvic surgery. This article reports safety results, including the postoperative incidence of abdominal and pelvic abscess and pulmonary embolism, from a large, multicenter trial designed to evaluate the safety and effectiveness of Seprafilm® for reduction of adhesion-related postoperative bowel obstruction after abdominopelvic surgery. METHODS: A total of 1,791 patients participated in this prospective, randomized, multicenter, multinational, single-blind, controlled study in patients undergoing abdominopelvic surgery, the majority of whom had inflammatory bowel disease. Just before closure of the abdomen, patients were randomized to a Seprafilm® or no-treatment control group. Patients received an average of 4.4 and as many as 10 Seprafilm® adhesion barriers applied to organs and tissue surfaces that sustained direct surgical trauma and to suspected adhesiogenic surfaces. Complications that occurred within the first month after surgery were evaluated. RESULTS: During the safety evaluation period, the difference between the Seprafilm® and control groups for the incidence of abscess (4 vs. 3 percent, respectively) or pulmonary embolism (<1 percent in both groups) was not statistically significant (P > 0.05). Foreign body reaction was not reported in either group. Fistula (2 vs. <1 percent) and peritonitis (2 vs. <1 percent) occurred more frequently (P 0.05) in the Seprafilm® group. In a subpopulation of patients in whom Seprafilm® was wrapped around a fresh bowel anastomosis, leak-related events, which included anastomotic leak, fistula, peritonitis, abscess, and sepsis, occurred more frequently (P 0.05). There were no other differences in the incidence, severity, or causative relationship of complications between study groups. CONCLUSIONS: This study confirmed the safety of Seprafilm® adhesion barrier with respect to abdominal abscess, pelvic abscess, and pulmonary embolism when administered to patients undergoing abdominopelvic surgery. Foreign body reaction was not reported for any patient. However, wrapping the suture or staple line of a fresh bowel anastomosis with Seprafilm® should be avoided, because the data suggest that this practice may increase the risk of sequelae associated with anastomotic leak.     

Medical Prevention of Barrett’s Esophagus: Effects of Statins,Aspirin, Non-aspirin NSAIDs,Calcium, and Multivitamins

Digestive Diseases and Sciences - Barrett’s esophagus (BE) is a complication of gastroesophageal reflux disease (GERD) that is a precursor to esophageal adenocarcinoma. There is limited...     

Movements and home range of a common species of tree–shrew,Tupaia glis,surrounding houses of otoacariasis cases in Kuantan,Pahang, Malaysia

ObjectiveTo document movement patterns, home range, nesting behaviour and social organization of 5 individuals (3 males and 2 females) of a common species of tree-shrew, Tupaia glis (T. glis) surrounding houses of otoacariasis cases.MethodsEach shrew was fitted with a transmitter chip radio-collar which operates between the frequencies of 154.13 MHz to 154.21 MHz. Each transmitter was then tracked with a Portable Telemetry Receiver (Sirtrack, New Zealand) fitted with a 3-element Yagi antenna. Collared shrews were located using standard methods of ground-based triangulation. Each location was taken from at least 2 directional fixes and a minimum of 3 compass bearings. Fixes were taken hourly for each collared individual from the time of emergence from nest (beginning of activity) till time of entry into the nest (end of activity) every day for 5 to 7 continuous days. Three series of radio telemetry observations were carried out. The bearings, time and positions of an observer were recorded and later plotted on a graph paper in order to derive coordinates of the collared animal. [These coordinates then analyzed using Ecological Software Solutions (Biotas Version 1.03)].ResultsNests were found in a jack fruit tree, long bushes, and 2 houses. Daily telemetry detections demonstrated 2 individuals of different sex having nests (or a nest) in the same house. All shrews emerged from and returned to their nests between 0601 to 0659 hours and 1901 to 1959 hours, respectively. Both the time of exit from and entry into nest were the same between sexes (P>0.05). Their average total active period was 4.90 to 7.00 hours with a total daily travel distant of 270 m to 382 m. A male and a female shrew can move as far as 3 285 m and 4 591 m, respectively. Active movements of T. glis were during daytime. They regularly entered some houses in the area during day and night except for one individual which visited during daytime only. The sizes of home range and core area for the shrews were 2.00–3.40 ha and 0.05–0.42 ha, respectively. Generally, the mean home range size of females was 20.8% larger than that of males. Females covered a 15.4% slightly higher daily movement range compared to males.ConclusionsThis is the first radio telemetry study in Malaysia to monitor movements and home range of shrews carrying ticks on their body. It demonstrates that shrews are potential carriers of ticks from wild into the houses and their compounds based on their total active periods spent moving around from fruit orchards, secondary forest, plantations and other vegetations to trees in compound of 4 to 7 houses and vice versa. There are also evidences showing shrews have close contact with humans.     

Abstracts of the 27th Annual Conference of APASL,March 14–18, 2018, New Delhi,India

Background and aims

Spontaneous bacteremia is a poorly characterized infection in patients with cirrhosis. We compared the incidence of mortality and acute kidney injury in patients with spontaneous bacterial peritonitis and spontaneous bacteremia, and identified risk factors for mortality and acute kidney injury in patients with spontaneous bacteremia.

Methods

We performed a retrospective cohort study of patients with cirrhosis and spontaneous bacteremia or spontaneous bacterial peritonitis from 2008 to 2016 at Hospital Italiano, Buenos Aires. We compared the cumulative incidence of acute kidney injury and death between the two infections, and identified risk factors for these outcomes in patients with spontaneous bacteremia.

Results

Seventy-one patients with spontaneous bacteremia and 55 patients with spontaneous bacterial peritonitis were included. Most infections were nosocomial. Overall, 26% of bacteria were resistant and 11% multi-resistant. We found no significant association between acute kidney injury [subhazard ratio (sHR) 1.05 (95% confidence interval, CI 0.67–1.63, p = 0.83)] or death [sHR 1.15 (95% CI 0.60–2.20, p = 0.68)] and type of spontaneous infection in multivariate analyses adjusting for basal Model for End-Stage Liver Disease (MELD) score. In patients with spontaneous bacteremia, baseline MELD score was independently associated with acute kidney injury [sHR 1.07 (95% CI 1.03–1.11, p = 0.001)] and death [sHR 1.07 (95% CI 1.02–1.15, p = 0.03)].

Conclusions

Short-term acute kidney injury and mortality rates were similar in patients with spontaneous bacteremia and spontaneous bacterial peritonitis. Risk assessment of patients with spontaneous bacteremia can be performed with baseline MELD score.

     

Disorders of Blood Pressure Regulation—Role of Catecholamine Biosynthesis,Release, and Metabolism

Catecholamines (epinephrine and norepinephrine) are synthesised and produced by the adrenal medulla and postganglionic nerve fibres of the sympathetic nervous system. It is known that essential hypertension has a significant neurogenic component, with the rise in blood pressure mediated at least in part by overactivity of the sympathetic nervous system. Moreover, novel therapeutic strategies aimed at reducing sympathetic activity show promise in the treatment of hypertension. This article reviews recent advances within this rapidly changing field, particularly focusing on the role of genetic polymorphisms within key catecholamine biosynthetic enzymes, cofactors, and storage molecules. In addition, mechanisms linking the sympathetic nervous system and other adverse cardiovascular states (obesity, insulin resistance, dyslipidaemia) are discussed, along with speculation as to how recent scientific advances may lead to the emergence of novel antihypertensive treatments.     

Efficacy of pramipexole in the treatment of Parkinson's disease:a multi-center,randomized,double-blind,bromocriptine-control trial

Objective To investigate the efficacy and safety of pramipexole in the treatment of Parkinson's disease. Methods A total of 208 Parkinson's patients with wearing off participated in a multi-center, 12-week randomized, bromocriptine-controlled, double blind, doubledummy and parallel-group trial. The efficacy of pramipexole was assessed according to the patient's diary card and using the Unified Parkinson's Disease Rating     

Randomized,double-blind,placebo-controlled trial of eight-week course of recombinant α-interferon for chronic non-A,non-B hepatitis

Forty-nine Japanese patients were enrolled in a randomized, placebo-controlled, doubleblind trial of -interferon for chronic non-A, non-B hepatitis: 24 patients received 3 million units of recombinant human alpha -interferon (-2a) thrice weekly for eight weeks, and 25 patients received placebo in a similar schedule. The mean serum alanine aminotransferase (ALT) dropped from 155±91 (sd) to 69±72 during interferon treatment, but remained unchanged (158±140 to 147±130) during placebo treatment (P<0.001). Serum ALT level fell to the normal range in 29% of interferon-treated patients, but in only 4% of placebo-treated patients. Pre- and posttreatment liver biopsies were obtained in all but one case. Average histological activity indices (HAI) were markedly improved in the interferon-treated group (9.5±3.7 to 7.0±4.3), but were unchanged in the placebo group (8.5±4.3 to 8.5±4.9). In addition, we compared the efficacy of interferon treatment between anti-hepatitis C virus (HCV) antibody positive and negative groups. Biochemical and histological improvements were similar and statistically significant in patients with and without antibody to hepatitis C virus. These data indicate that a eight-week course of -interferon induces biochemical and histological improvement in more than half the patients with chronic non-A, non-B hepatitis.This study was supported by a grant from Japanese Ministry of Health and Welfare.