Does rigid bronchoscopy induce bacterial translocation? An experimental study in rats

BACKGROUND: Although some reports suggest that bronchoscopy induces bacterial translocation (BT), the mechanisms of BT remain unclear. OBJECTIVE: We aimed to assess whether bronchoscopy or hypoxemia during bronchoscopy is responsible for BT. METHODS: We evaluated 24 rats divided into three subgroups: the control group (group 1, n = 8); the rigid bronchoscopy group (group 2, n = 8), and the group receiving bronchoscopy + mechanical ventilation (group 3, n = 8). Oxygen saturation (SaO(2)) was measured during the bronchoscopic procedure. Blood and tissue cultures from mesenteric lymph nodes (MLNs), liver, spleen and cecal contents were obtained 24 h following bronchoscopy. RESULTS: In group 2, SaO(2) was significantly lower than in groups 1 and 3 (p < 0.01). In group 2, BT significantly increased (6/8, 75%; p < 0.01 vs. group 1, and p < 0.05 vs. group 3). The main site of translocation was MLNs (6/8, 75%) in group 2, while BT was detected in only 1 rat in group 3 (1/8, 12.5%). CONCLUSION: Hypoxemia during rigid bronchoscopy resulted in intestinal mucosal damage in a rat model. Hypoxemia may have been the trigger for BT from the intestine following bronchoscopy.     

Superantigen-SEA gene modified tumor vaccine for hepatocellular carcinoma:An in vitro study

AIM:To construct an eukaryotic superantigen gene expressionvector containing the recombinant gene of SEA and CD80molecule transmembrane region (CD80TM),and to expressstaphylococcus enterotoxin A (SEA) on the membrane ofhepatocellular carcinoma (HCC) cell to form a superantigengene modified tumor vaccine for HCC.METHODS:SEA and linker-CD80TM gene were amplifiedthrough PCR from plasmid containing cDNA of SEA and CD80.Gene fragments were then subcloned into the multiplecloning sites of retroviral vector pLXSN.Recombinant plasmidwas transferred into HepG2 cells mediated with lipofectamine,positive clones were selected in culture medium containingG418.RT-PCR and indirect immunofluorescence studiesconfirmed that SEA was expressed specifically on HCC cellmembrane.INFγ-ELISPOT study demonstrated that SEAprotein was expressed on the membrane of HCC cells.Cytotoxicity of HepG2-SEA primed CTLs (SEA-T) wasanalyzed by ~(51)Cr release assay.T cells cultured with rhIL-2(IL-2-T) were used as control.RESULTS:Restriction digestion and sequence analysesconfirmed the correctness of length,position and orientationof inserted fusion genes.SEA was expressed on the surfaceof HepG2 cells,HepG2-SEA had strong stimulating effect onproduction of HepG2 specific CTL (P<0.001).SEA-T hadenhanced cytotoxicity to HepG2 cells (P<0.05).CONCLUSION:Tumor cell membrane expressed superantigencan be used to reinforce the immune effect of tumor cellvaccine for HCC,which provides a new method of theenhanced active immunotherapy for HCC.     

Does exercising before or after a meal affect energy balance in adolescents with obesity?

Background and aimExercise timing has been suggested to affect appetite and energy intake (EI). The aim of this study was to examine the impact of exercising immediately before or after a meal on EI, appetite sensations and food reward (FR) in adolescents with obesity.Methods and resultsSeventeen adolescents with obesity completed 3 experimental sessions (randomized controlled trial): rest + lunch (CON); exercise + lunch (EX-MEAL); lunch + exercise (MEAL-EX). The exercise consisted of cycling 30 min at 65%V̇O_2peak. Outcomes included ad libitum EI (weighed lunch and dinner), FR (Leeds Food Preference Questionnaire at pre- and post-combination of exercise/rest and lunch, and pre-dinner) and appetite sensations (visual analogue scales). EI was not different between conditions. Compared with CON, relative EI at lunch was lower in EX-MEAL and MEAL-EX (p ≤ 0.05) and daily only in MEAL-EX (p < 0.01). Postprandial fullness was higher in EX-MEAL compared to CON. Compared with CON, both EX-MEAL and MEAL-EX attenuated the increase in wanting for sweet food and reduced explicit liking for fat.ConclusionsThese preliminary results suggest that exercising immediately before or after a meal produce few differences in appetite and have small beneficial effects on overall energy balance in adolescents with obesity, as well as on FR.Clinical trialsNCT03967782.     

Does retention matter? Treatment duration and improvement in drug use

Aim This study examines whether there is a minimum threshold, continuous or non‐linear relationship between the duration of addiction treatment and improvements in drug use. Design Longitudinal cohort study of 62 drug treatment units and 4005 clients in the US National Treatment Improvement Evaluation Study, fielded from 1993 to 1995. Subjects Baseline and 1‐year follow‐up interviews with clients in methadone maintenance, out‐patient non‐methadone, short‐term residential and long‐term residential treatment programs. Measures Improvement in drug use is the difference between the client‐reported peak frequency of drug use (in days per month) in the year prior to the baseline interview minus the peak frequency in the year after discharge. Primary drug, and overall use of the major illicit drugs (heroin, cocaine powder, crack cocaine, and marijuana) are considered separately. Results Controlling for multiple factors, treatment duration had a positive linear relationship with primary drug use improvement among methadone clients and an inverted‐U‐shaped relationship with overall and primary drug use improvements among out‐patient and long‐term residential clients. Improvement with longer duration is greatest for long‐term residential clients. Conclusions Contrary to previous arguments for a sharp retention threshold for onset of treatment effects, we find smooth curves relating treatment duration to drug use improvements in methadone maintenance, out‐patient non‐methadone and long‐term residential modalities. These relationships are effectively linear for durations typically observed in single treatment episodes, but unusually long retention in out‐patient non‐methadone and long‐term residential units appear steadily less predictive of improvement.     

Does the use of electronic devices provoke the carpal tunnel syndrome (CTS) symptoms and functional impairment? A cross-sectional study

IntroductionAs electronic devices usage escalates, public's concerns are raised on whether specific hand activities while using electronics can lead to median nerve problems.Aim of the workThis study was conducted to assess the association, prevalence and risk factors for carpal tunnel syndrome (CTS) symptoms among electronic devices users.Patients and methodsThis study was conducted among a general population of Riyadh, Saudi Arabia with a total of 800 distributed Arabic self-administered questionnaire including the socio-demographic, patterns of electronic devices use and a standardized questionnaire “Boston Carpal Tunnel Questionnaire (BCTQ).” Common risk factors were excluded, such as diabetes mellitus, rheumatoid arthritis, thyroid disease, gout, current pregnancy, cervical and hand problems.ResultsThe response rate was 88.9% and the male: female was 0.5:1. Data analysis revealed that nearly 50% of all participants were moderately sever symptomatic. Out of which 42.4% were medically free with no apparent risk factors for CTS, and the rest had severe symptoms. Symptoms suggestive of CTS were significantly associated with younger age, female gender, higher body mass index (BMI) and occupation. However, there was no proven association with the patterns of electronic devices use. The functional status was significantly associated with age, gender, BMI and occupation.ConclusionThere was no significant association between the patterns of electronic devices use and CTS symptoms. The high prevalence of CTS symptoms necessitates awareness programs, especially among the young population. Although this work did not prove the association, further studies with confirmatory clinical testing are recommended.     

Does in vitro fertilisation increase type 2 diabetes and cardiovascular risk?

Since the first in-vitro fertilisation (IVF) birth in 1978, the number of children born by assisted reproductive technologies (ART) continues to increase worldwide. However, the safety issues surrounding these procedures remain controversial, and the long term impact on human health is unknown. There is emerging evidence to indicate that IVF may predispose individuals to increased incidence of obesity, elevated blood pressure, fasting glucose and triglycerides and subclinical hypothyroidism. However, few studies have been conducted to date and the underlying mechanisms are unclear. This review will summarize the existing evidence in animal models and in humans, and will discuss epigenetic alterations, which may link manipulation of the pre-implantation embryo with increased risk of the later development of obesity, insulin resistance, type 2 diabetes and cardiovascular disease in offspring. Since these diseases are the leading cause of mortality and can be delayed or prevented by lifestyle modification, prospective follow up studies in IVF born adults are now urgently required to determine the degree of risks utilizing gold standard measures in human and animal models.     

Does leflunomide have a role in giant cell arteritis? An open-label study

Clinical Rheumatology - Glucocorticoid monotherapy has been the mainstay treatment of giant cell arteritis (GCA) for decades. We aimed to evaluate the role of leflunomide as a steroid-sparing agent...     

Is omitting pouchography before ileostomy takedown safe after negative clinical examination in asymptomatic patients with pelvic ileal pouch? An observational study

Background

When restorative proctocolectomy (RPC) is performed, a temporary diverting loop ileostomy is often fashioned and usually closed 2–3?months later. Pouchography is used to assess pouch integrity, although its benefits have been questioned and no definitive data support its routine use. Our aim was to assess the utility of pouchography before ileostomy closure in patients with a negative clinical examination.

Methods

We retrospectively reviewed our database of patients who underwent ileostomy takedown between 1987 and 2010. Two hundred and thirty-two patients were identified who underwent RPC with a W- or J-pouch for ulcerative colitis or familial adenomatous polyposis. Twenty-one patients underwent RPC without diversion. Twenty-four symptomatic patients were excluded from the study. Only asymptomatic patients with a normal clinical examination were enrolled. One patient was lost at follow-up. Hence, 186 patients were considered suitable for evaluation. Patients undergoing ileostomy closure without any radiological examination were assigned to Group A (n?=?132); those operated on after a preoperative pouchography to Group B (n?=?54).

Results

Pouchography was normal in 49 (90.7?%) Group B patients. None of the 5 (9.3?%) Group B patients with an abnormal radiographic examination experienced complications. Negative pouchography did not exclude future problems. Patients of both groups experienced similar early functional impairments. Failure occurred in 3 (2.3?%) Group A patients and in 2 (3.7?%) patients of the pouchography group.

Conclusions

Pouchography may be safely omitted before ileostomy takedown if there is no clinical or endoscopic evidence of pelvic sepsis or ileo–anal anastomotic complications, even in very young patients, provided clinical and endoscopic follow-up is carefully performed. All anomalies detected were already suspected clinically.     

Does the use of new intracoronary interventional devices prolong radiation exposure in the cardiac catheterization laboratory?

Objectives. The aim of this study was to the duration of radiation exposure associated with new percutaneous coronary interventional devices with that associated with convention balloon angioplasty.Background. Radiation exposure levels has been documented to be higher with coronary balloon angioplasty than with routine diagnostic coronary angiography. However, the effect of new interventional devices on radiation exposure has not been studied.Methods. Fluoroscopic and cineangiographic data from the Mayo Clinic cardiac catheterization laboratory data base of patients having single-segment coronary intervention during a recent 46-month period were retrospectively analyzed. Of 897 patients studied, 646 underwent balloon angioplasty, 138 directional coronary atherectomy (42 with adjunctive balloon angioplasty), 76 excimer laser angioplasty (50 with adjunctive balloon angioplasty) and 37 placement of an intracoronary stent (16 emergencies).Results. Duration of fluoroscopy during balloon angioplasty was 24 ± 18 min, which was longer than with directional atherectomy (18 ± 8 min; p = 0.001). Fluoroscopy time was 25 ± 17 min with laser angioplasty and 29 ± 15 min with elective stent placement (neither time was significantly different from that with balloon angioplasty). When atherectomy or laser angioplasty was performed with adjunctive balloon angioplasty or if emergency intracoronary stent placement was performed, the duration of fluoroscopy was significantly prolonged compared with balloon angioplasty alone.Conclusions. Fluoroscopy duration is not prolonged with the use of new interventional coronary devices compared with conventional angioplasty unless adjunctive balloon angioplasty is used or emergency stent placement is required.     

Antithyroid drug regimens before and after 131I-therapy for hyperthyroidism: evidence-based?

BACKGROUND: In view of the new national guideline on thyroid dysfunction, the evidence base for current practice as well as the new guideline is assessed with regard to the use of antithyroid drugs (ATDs) before and after radioiodine (131I) therapy. METHODS: In December 2006, we surveyed 16 hospitals by telephone about different aspects of their antithyroid drug regimen: all eight academic centres and eight nonacademic teaching hospitals. The literature was searched for an evidence-based answer to each question in the inquiry. RESULTS: 13 of 16 hospitals (81%) use antithyroid drugs for pretreatment before 131I. ATDs are discontinued on average four days before 131I or diagnostic scan. However, 27% stop only three days beforehand, which may diminish the effect of 131I. Propylthiouracil (PTU) is also withdrawn four days before 131I, although the literature shows that PTU diminishes the effect of 131I even if it is stopped 15 days beforehand. Resumption of ATDs after 131I to prevent thyrotoxicosis is common practice (81%). One hospital (6%) never restarts ATDs, two (13%) only by indication. Adjunctive treatment consists of combination therapy in 93%, is usually resumed within two days after 131I therapy, and then continued for two to six months. Routine adjunctive treatment is not evidence-based and may be limited to a high-risk subset, especially elderly patients (>70 years) and patients with cardiac comorbidity. Resumption of ATDs within five to seven days after 131I may diminish the effect of 131I. CONCLUSION: Antithyroid drug regimens in the Netherlands are heterogeneous. The evidence base of current practice and the new guideline are discussed.     

Does glutamine reduce bacterial translocation? A study in two animal models with impaired gut barrier

 Failure of intestinal barrier function and subsequent translocation of bacteria from the gut are believed to play a decisive role in the development of systemic septic complications, for example, following major trauma or major abdominal surgery. This study evaluated: (a) the effect of glutamine on colonic microcirculation and electrophysiological parameters reflecting gut barrier function, (b) the translocation of live bacteria to extraintestinal organs, and (c) disease outcome in two animal models with impaired gut barrier function. Severe acute pancreatitis or colitis was induced in rats randomized for therapy with or without glutamine (0.5 g/kg daily). After 48 h one animal group was prepared for intravital microscopy of colonic capillary blood flow and electrophysiological measurement of gut permeability; another was killed after 96 h for histological and microbiological examination. In animals with pancreatitis, glutamine (Gln) supplementation significantly improved gut permeability, i.e., Gln increased colonic transmucosal resistance from 67±7 to 92±3 Ω/cm² and decreased mannitol flux through the epithelium by 53%. Capillary blood flow in the colonic mucosa was improved by 25%. The prevalence of pancreatic infections was reduced from 86% in animals on standard parenteral nutrition to 33% in animals given the Gln-enriched diet (P<0.05); mortality decreased by 32%. In colitis, Gln had no significant effect on these parameters except for improving colonic capillary blood flow in colon segments not adjacent to the major injury site. Glutamine supplementation improves colonic capillary blood flow, stabilizes gut permeability, and reduces secondary pancreatic infections and mortality in severe rodent pancreatitis, but it is not helpful in colitis. This confirms previous reports that glutamine stabilizes gut barrier function only in certain diseases. Our experimental data strongly suggest that acute pancreatitis (rather than colitis) is one of the diseases with gut barrier dysfunction in which glutamine substitution may be helpful to reduce bacterial translocation and should therefore be tested in a controlled clinical trial. Accepted: 16 March 1999     

Decrease in LDL size in HIV-positive adults before and after lopinavir/ritonavir-containing regimen: an index of atherogenicity?

BACKGROUND: Hypertriglyceridemia (HTG) is frequently observed during highly active antiretroviral therapy (HAART) including protease inhibitor. Apolipoprotein (apo) CIII could be involved in this HTG by inhibition of triglyceride (TG) hydrolysis, which leads to the occurrence of small dense low density lipoprotein (sdLDL), a recognized cardiovascular risk factor. OBJECTIVE: To characterize the influence of lopinavir/ritonavir-containing regimen on lipoprotein profile. DESIGN AND METHODS: 24 antiretroviral-experienced HIV infected adults (including 14 patients in therapeutic interruption of at least 2 months) and 14 HIV uninfected healthy controls were enrolled. Serum lipid parameters (total cholesterol (TC), HDL-C, LDL-C, TG, apoA1, apoB, apoCIII), lipoprotein composition and LDL size were determined before initiation of lopinavir/ritonavir-containing regimen, and at 1 and 3 months thereafter. RESULTS: At baseline an atherogenic lipid profile was evidenced, characterized by a moderate HTG associated to a smaller mean LDL size (25.16 vs 25.93 nm, P<0.001), an enrichment in TG of LDL (11.4 vs 6.0%, P<0.01) and a high prevalence of sdLDL (75 vs 7%, P<0.01) when compared to controls. After 1 month of lopinavir/ritonavir-containing regimen, a significant reduction of LDL size (24.81 vs 25.16 nm, P<0.05) and a significant increase in cholesterol total (5.53 vs 4.49 mmol/l, P<0.001), in TG (4.20 vs 2.01 mmol/l, P<0.001), in apoA1 (1.28 vs 1.11 g/l, P<0.001), in apoB (1.08 vs 0.94 g/l, P<0.01), in apoCIII (0.16 vs 0.10 g/l, P<0.001), in TG percentage in LDL (14.4 vs 11.4, P<0.05) and in TG percentage in HDL (10.2 vs 8.3, P<0.05) were observed. CONCLUSIONS: Advanced stage of HIV infection is associated with an atherogenic lipid profile including a high prevalence of sdLDL. Lopinavir/ritonavir-containing regimen accentuates the reduction of LDL size. Since fibrates decrease TG and increase LDL size, they appear as a logical option to manage HAART-induced HTG.     

Proteomic study of salivary peptides and proteins in patients with Sjögren's syndrome before and after pilocarpine treatment

OBJECTIVE: To investigate the effect of pilocarpine on the salivary peptide and protein profile in patients with primary Sj?gren's syndrome (SS) and to study the differences between patients with primary SS, patients with SS associated with other rheumatic diseases, and healthy control subjects. METHODS: Saliva specimens were obtained from 9 primary SS patients, 9 secondary SS patients, and 10 healthy controls. Samples were analyzed for levels of 62 different salivary proteins using high-performance liquid chromatography coupled with mass spectrometry using a spectrometer equipped with an electrospray ionization source. In 6 of the primary SS patients, saliva was collected at 30 minutes, 60 minutes, and 24 hours after taking 5 mg of pilocarpine. RESULTS: Before pilocarpine, approximately 60% of salivary proteins in samples from primary SS patients were not identifiable or showed lower levels than those in healthy controls. After 30-60 minutes following pilocarpine treatment, approximately one-third of the less represented proteins was found in a similar percentage of primary SS patients and controls. Almost all of the proteins that were detectable at lower levels in primary SS patients compared with controls reached levels similar to those in controls at 30-60 minutes after pilocarpine. The parotid gland proteins had the best response to pilocarpine. Primary SS patients were characterized by higher alpha-defensin 1 levels and by the presence of beta-defensin 2. Secondary SS patients showed an intermediate protein profile between that of the primary SS patients and the controls. CONCLUSION: Pilocarpine partially restored the levels and numbers of identifiable proteins in saliva from patients with primary SS. Higher levels of alpha-defensin 1 and the presence of beta-defensin 2 in the saliva of patients with primary SS could be markers of oral inflammation in this patient group.