Hirschsprung-associated inflammatory bowel disease: A multicenter study from the APSA Hirschsprung disease interest group

Background/PurposeA small number of Hirschsprung disease (HD) patients develop inflammatory bowel disease (IBD)-like symptoms after pullthrough surgery. The etiology and pathophysiology of Hirschsprung-associated IBD (HD-IBD) remains unknown. This study aims to further characterize HD-IBD, to identify potential risk factors and to evaluate response to treatment in a large group of patients.MethodsRetrospective study of patients diagnosed with IBD after pullthrough surgery between 2000 and 2021 at 17 institutions. Data regarding clinical presentation and course of HD and IBD were reviewed. Effectiveness of medical therapy for IBD was recorded using a Likert scale.ResultsThere were 55 patients (78% male). 50% (n = 28) had long segment disease. Hirschsprung-associated enterocolitis (HAEC) was reported in 68% (n = 36). Ten patients (18%) had Trisomy 21. IBD was diagnosed after age 5 in 63% (n = 34). IBD presentation consisted of colonic or small bowel inflammation resembling IBD in 69% (n = 38), unexplained or persistent fistula in 18% (n = 10) and unexplained HAEC >5 years old or unresponsive to standard treatment in 13% (n = 7). Biological agents were the most effective (80%) medications. A third of patients required a surgical procedure for IBD.ConclusionMore than half of the patients were diagnosed with HD-IBD after 5 years old. Long segment disease, HAEC after pull through operation and trisomy 21 may represent risk factors for this condition. Investigation for possible IBD should be considered in children with unexplained fistulae, HAEC beyond the age of 5 or unresponsive to standard therapy, and symptoms suggestive of IBD. Biological agents were the most effective medical treatment.Level of EvidenceLevel 4     

抑郁症患者与不明原因胸痛的关联性探讨

目的:分析抑郁症与不明原因胸痛间的关联性及其可能机制,为临床疾病的治疗提供参考依据。方法:纳入2012年6月至2014年5月四川省南充精神卫生中心精神科收治的不明原因胸痛患者35例,作为观察组,另选取35例来院进行常规体检的健康志愿者作为对照组,比较两组的抑郁量表评分、抑郁症发生率、血清C反应蛋白(CRP)、白细胞介素6(IL-6)、五羟色胺(5-HT)及外周血中的CD4+、CD8+含量。结果:与对照组比较,观察组的CRP、IL-6、5-HT、CD4+均低于对照组;且观察组的CD8+、抑郁症发生率(31.43%)、轻中度抑郁及重度抑郁患者比例均高于对照组水平,组间对比差异显著(P<0.05)。结论:抑郁症与不明原因胸痛存在一定相关性,推断可能与CRP、5-HT、IL-6等细胞因子有关,也可能与免疫抑制过程有关,在临床诊治中需引起重视。     

Report from the 1st Japanese Urological Association-Japanese Society of Medical Oncology joint conference, 2006: ''A step towards better collaboration between urologists and medical oncologists''

The 1st Japanese Urological Association-Japanese Society of Medical Oncology Joint Conference, titled 'A step towards better collaboration between urologists and medical oncologists', was held to coincide with the 44th Meeting of the Japan Society of Clinical Oncology, Tokyo, in October 2006. The main theme of the conference addressed the need for a subspecialty of medical oncologist within urology to keep abreast of advances in medical oncology. Urologists should become more involved in the postoperative management of urologic cancer. Consensus on the optimal way to move forward in the treatment of urological cancer is needed. The conference featured eight lectures surveying the present status of uro-oncology in Europe, the USA, Korea, Singapore, and Japan; the relationship between surgical oncologists and medical oncologists; global trends and international clinical trials in uro-oncology; and the future of urologic oncology. These were followed by a general discussion titled 'Achieving better collaboration between the surgical oncologist and the medical oncologist.' This report presents a roundup of the 1st Japanese Urological Association-Japanese Society of Medical Oncology Joint Conference.     

conference report: Mental health and intellectual disability: an international perspective

The present paper reports on the inaugural meeting of the Mental Health Special Interest Research Group (SIRG) of the International Association for the Scientific study of Intellectual disability which was held at Fitzwilliam College, Cambridge, UK, in March 1998. The meeting was organized in conjunction with the Ninth Annual SIRG on ageing and intellectual disability. Representatives from North America, several European and Scandinavian countries, Australia, and Israel attended. Two broad themes had been determined prior to the meeting: ‘Improving the detection of mental health problems’ and ‘Research strategies for identifying risk factors for mental health problems’. In the presentations and subsequent discussions, it was apparent that there were extrenely diverse perspectives both across and within the different countries represented. Not only were individuals' experiences very different, but most strikingly, the theoretical frameworks were very diverse. This was partly a function of there being understandable differences in perspectives across disciplines, but at its most marked, there were fundamental differences in the way both intellectual disability and mental health were conceptualized.     

Die Rolle coagulasenegativer Staphylokokken in Mischinfektionen: Assoziationstestungen als in-vitro-Modell

Zusammenfassung Die Zunahme von Infektionen durch hochresistente grampositive Kokken hat in den letzten Jahren vornehmlich auf Intensivstationen zu erheblichen therapeutischen Problemen geführt. Hierbei ist eine Gruppe von Erregern in den Vordergrund getreten, die früher als harmlose Saprophyten galten: coagulasenegative Staphylokokken (CNS). In der vorliegenden Arbeit werden zunächst Daten zur Incidenz in verschiedenen Versorgungsbereichen unserer Klinik und zur Coincidenz mit anderen Erregern auf unserer Intensivstation vorgestellt. Es konnte gezeigt werden, daßS. aureus zwar der zahlenmäßig häufigste grampositive Erreger war, aber CNS sowohl aus Wundabstrichen der Intensivstation als auch aus Blutkulturen deutlich häufiger isoliert werden konnte. Ein gleichzeitiger Nachweis von CNS mitS. aureus und den neun häufigsten Enterobacteriaceae konnte in durchschnittlich 6% erbracht werden. Durch mögliche Interaktionen zwischen unterschiedlichen Erregern kann eine Veränderung der in Einzeltestung beobachteten Resistenzen auftreten. Um dies nachzuweisen, wurden sechs Erregerpaare einzeln und in Assoziation gegen Amoxicillin und Amoxicillin/Clavulansäure getestet. Unter Assoziation wurde das gemeinsame Wachstum zweier Keime unter kontrollierten Bedingungen in Boullionverdünnungsreihen oder einem Laborautomaten zur Resistenztestung (Cobas Bact) verstanden. In allen Fällen zeigte sich, daß die-Lactamasen der CNS in Assoziation die MHK der anderen Erreger deutlich erhöhte, was durch den Zusatz von Clavulansäure verhindert werden konnte. Eine Einzeltestung gibt also bei Mischinfekten mit Beteiligung von-Lactamasebildnern nur einen eingeschränkten Eindruck von der tatsächlichen Resistenzsituation.

---

Role of coagulase negative staphylococci in mixed infections: associative testing as in vitro model

Summary Infections due to coagulase negative staphylococci (CNS) are of growing concern mainly in patients hospitalized in intensive care units (ICU). The ability of CNS to adhere and to grow on plastic devices and resistance to many antibiotics, including oxacillin, contributes to their pathogenicity. Using the computer assisted system of the Medical Microbiology Department, the incidences of different pathogens and the coincidence of CNS with other bacteria were evaluated in a surgical department.Staphylococcus aureus revealed to be the predominant pathogen; however, CNS showed an increasing incidence in wound specimens and blood cultures of patients on the ICU. Coincidence of CNS withS. aureus and the nine most frequent species of gram negative bacteria could be shown in 6%. To investigate the influence of-lactamases produced by CNS in mixed infections, association experiments were performed. Association means a controlled growth of two or even more bacteria in a susceptibility testing system, either a broth dilution method or an automated broth disk elution method (Cobas Bact). The association experiments showed a significant increase of amoxicillin MIC's of the pathogen associated with CNS. Addition of clavulanic acid restored activity of amoxicillin. It could be shown that in mixed infections CNS may contribute to the failure of antibiotic regimens by production of-lactamases.

     

A promoter variant of the ATP-binding cassette transporter A1 gene alters the HDL cholesterol level in the general Japanese population

To investigate the effects of polymorphisms in the ATP-binding cassette transporter A1 (ABCA1) gene on the high-density lipoprotein cholesterol (HDL-C) level and the incidence of myocardial infarction (MI), we performed association studies. Sequence analysis identified 14 polymorphisms in the promoter region of ABCA1. After considering linkage disequilibrium, three polymorphisms in the promoter region and 11 polymorphisms from the JSNP database were determined in 1,880 subjects recruited from the Suita Study, representing the general population in Japan. We evaluated the association between the ABCA1 genotype and HDL-C level adjusted not only for standard factors, but also for genetic factors including ApoA1 and ApoE genotypes. Of the 14 polymorphisms tested, the G(–273)C (P=0.0074), C(–297)T (P=0.0195), and IMS-JST071749 (P=0.0093) polymorphisms were significantly associated with the HDL-C level in the Suita population. We could reconfirm that the G(–273)C genotype was influential in another set of subjects (P=0.0310, n=743). However, the distribution of the ABCA1 G(–273)C genotype in subjects with MI (n=598) was not different from that in the control population (n=801). These results indicate that ABCA1 G(–273)C has a significant effect on the HDL-C level in the general Japanese population, but not on the incidence of MI.     

精神分裂症患者G72基因表达水平的研究

目的 本工作旨在检测精神分裂症（Schizophrenia）患者外周淋巴细胞中G72基因的表达情况，进而探讨G72基因的表达与精神分裂症的相关关系。 方法 工作在56例精神分裂症患者和84名年龄性别相匹配的对照中进行，在新鲜外周血样本中抽提总RNA，反转录成cDNA，基因表达量的检测在ABI Prism7900HT型序列监测系统上进行，采用TaqMan的方法对患者及对照组样本的mRNA进行定量，采集的荧光数据经SDS2.1软件自动处理，每个样本作三次平行检测，取平均值作为该样本的最终定量。数据应用SPSS统计软件进行处理，对组间基因表达水平的差异采用独立样本的T检验，调用本实验室G72基因单核苷酸多态性（SNPs）资料，用单因素方差分析的方法分析SNP与基因表达水平的关联性。结果 1.检测得到G72基因在对照组中的表达量为0.0586±0.0114amol/ng cDNA, 在精神分裂症患者组中的表达量为0.0498±0.0121amol/ng cDNA。2.经显著性检验， G72基因的表达水平在病例和对照组间差异无统计学意义，t=-0.512，df138，P=0.609，95%CI:-4.258~2.506。3.单因素方差分析结果显示，rs947267位置上的SNP与该基因的表达水平无相关，F=0.355，df2，χ2=0.703；而rs2181953位置上的SNP与G72基因表达水平相关联，F=6.275，df2，χ2=0.004。A/A基因型的患者基因表达水平显著高于其他基因型。结论：精神分裂症患者G72基因的表达量总体上较正常人并无显著变化，但rs2181953位置上的基因型会影响精神分裂症患者该基因的表达。