Prevalence and pathophysiology of early dumping in patients after primary Roux-en-Y gastric bypass during a mixed-meal tolerance test

Background

Early dumping is a poorly defined and incompletely understood complication after Roux-en-Y gastric (RYGB).

Monoclonal Antibody Specific for TIRC7 Induces Donor-specific Anergy and Prevents Rejection of Cardiac Allografts in Mice

T cell immune response c-DNA (TIRC7) is up-regulated during the early stages of T-cell activation in response to alloantigens. In this study, we analyzed the effects of newly developed monoclonal antibodies (mAb) against TIRC7 in acute cardiac allograft rejection. Fully vascularized heterotopic allogeneic heart transplantation was performed in mice across a full-mismatch barrier (C57Bl/10 into CBA). Recipients received seven injections (day 0-7) of a novel anti-TIRC7 mAb or remained untreated. Graft survival, histology and ex vivo lymphocyte functions were tested. Targeting of TIRC7 with an anti-TIRC7 mAb diminishes lymphocyte infiltration into grafts resulting in delay of morphological graft damage and prolongation of allograft survival. The lymphocytes from anti-TIRC7 mAb-treated animals exhibit hypo-responsiveness without evidence of lymphocyte depletion against the donor allo-antigens. Proliferation and expression of interferon-gamma (IFN-gamma) and tumor necrosis factor-alpha (TNF-alpha) were down-regulated while interleukin-4 (IL-4) and IL-10 expression were spared. Moreover, anti-TIRC7 mAb enhanced up-regulation of CTLA-4 expression but suppressed up-regulation of CD25 on stimulated lymphocytes in vitro and in vivo. Ligation of TIRC7 has important effects on the regulation of co-stimulatory signaling pathways associated with suppressing of T-cell activation. Targeting of TIRC7 may therefore provide a novel therapeutic approach for modulating T cell immune responses during organ transplantation.     

Use of thallium-201 brain SPECT to differentiate cerebral lymphoma from toxoplasma encephalitis in AIDS patients.

PURPOSETo determine whether thallium-201 brain single-photon emission CT could be used to make the distinction between central nervous system lymphoma and toxoplasma encephalitis, which may not be possible by routine MR and CT.METHODSA total of 37 patients with acquired immunodeficiency syndrome who had intracranial mass lesions found during a 9-month prospective study by either MR or CT underwent further evaluation with Tl-201 brain single-photon emission CT.RESULTSTwelve patients had increased intense focal Tl-201 uptake. All of these patients had either biopsy- or autopsy-proven lymphoma. Twenty-five of the patients studied had no Tl-201 brain uptake in the lesion(s); 24 of these patients had toxoplasma encephalitis on clinical follow-up. One patient with no Tl-201 uptake was found by cerebrospinal fluid analysis to have mycobacterium tuberculosis abscess.CONCLUSIONPatients with acquired immunodeficiency syndrome who have intracranial mass lesions on MR or CT may benefit from Tl-201 brain single-photon emission CT because it can help distinguish between lymphoma and infectious lesions such as toxoplasma encephalitis.     

The effect HBOC-201 and sodium nitrite resuscitation after uncontrolled haemorrhagic shock in swine

BackgroundDevelopment of Haemoglobin-based oxygen carriers (HBOCs) as blood substitutes has reached an impasse due to clinically adverse outcomes attributed to vasoconstriction secondary to nitric oxide (NO) scavenging. Studies suggest haemoglobin exhibits nitrite reductase activity that generates NO and N₂O₃; harnessing this property may offset NO scavenging. Therefore, the effects of concomitantly infusing sodium nitrite (NaNO₂) with HBOC-201 were investigated.MethodsSwine underwent uncontrolled liver haemorrhage before receiving up to three 10 min 10 ml/kg infusions of HBOC-201 (HBOC) with or without concurrent NaNO₂ (5.4 μmol/kg [LD NaNO₂] or 10.8 μmol/kg [HD NaNO₂]) or 6% Hetastarch (HEX) with or without HD NaNO₂ during “prehospital” resuscitation (15, 30 and 45 min after injury). Definitive surgical care occurred at 75 min; anaesthetic recovery at 120 min. Animals were euthanised at 72 h.ResultsNaNO₂ temporarily reduced systemic and pulmonary blood pressure increases from HBOC in a dose-dependent fashion. There was no significant effect between groups in indices of tissue oxygenation or survival. Adverse clinical signs requiring humane euthanasia occurred with highest frequency after HBOC + HD NaNO₂ (3 of 4 pigs) and HBOC + LD NaNO₂ (2 of 4 pigs). Gross evidence of pulmonary congestion was observed in 5 of 8 swine receiving a HBOC and NaNO₂ combination compared to 1 of 16 swine receiving HBOC alone, HEX alone, or HEX + NaNO₂. Gross lesions correlated with histological evidence of pulmonary oedema and congestion, and in 2 of 4 HBOC + HD NaNO₂ pigs, pulmonary fibrin thrombi also were found. No other pig had similar evidence of thrombi. Asymmetric pre-resuscitation cardiac index was a potential confounder.ConclusionsA significant interaction between NaNO₂ and HBOC-201 ameliorated HBOC-201 vasoconstrictive effects, consistent with HBOC possessing a nitrite reductase activity that generates vasodilator NO equivalents. Results were relatively equivalent in survival and markers of tissue oxygenation. The highest dose of NaNO₂ was the most effective in reducing HBOC-associated pulmonary and systemic vasoactivity but also with the highest incidence of adverse events. In this model, the transient nature of NaNO₂ in off-setting HBOC-201 vasoconstriction makes it less clinically promising than anticipated and the combination of NaNO₂ and HBOC appear to increase the risk of pulmonary complications in a dose-dependent fashion independently of haemodilutional effects on haemostatic components.     

Biological fixation of hydroxyapatite-coated versus grit-blasted titanium hip stems: a canine study

BACKGROUND: The purpose of the study was to evaluate the influence of a proximal hydroxyapatite (HA) coating in comparison with a grit-blasted titanium surface of an anatomic hip stem in an animal model over a maximum duration of 2 years. METHODS: Thirty adult dogs underwent implantation of either a proximally HA-coated or a grit-blasted anatomic titanium stem. The animals were clinically evaluated for their walking ability, and serial radiographs were taken. The femora were assessed histomorphologically at set time points from 6 weeks to 2 years postoperatively. Undecalcified thin section specimens through the proximal and distal portion of the coating or grit blasting were prepared. The percentage of implant surface with direct bone contact without connective tissue involvement was determined. RESULTS: Radiographically, animals with uncoated prostheses showed characteristic signs of loosening more frequently. Histomorphometrically, an average of 65% of the surface of HA-coated implants had bone contact, but only 14.7% of the surface of grit-blasted prostheses ( p=0.0001). There was no relationship between bone contact and the duration of implantation of the prosthesis, either for the coated or for the uncoated prostheses. HA coating enhances osseointegration of an anatomic hip stem. CONCLUSION: Anatomic stems with rounded design require a surface coating or surface structure, since the mere grit-blasting of the titanium surface does not ensure osseointegration in this animal model.     

Comparative Anatomy of the Subsynovial Connective Tissue in the Carpal Tunnel of the Rat, Rabbit, Dog, Baboon, and Human

The tenosynovium in the human carpal tunnel is connected to the flexor tendons and the median nerve by the subsynovial connective tissue (SSCT). The most common histological finding in carpal tunnel syndrome (CTS), a compression neuropathy of the median nerve, is noninflammatory fibrosis of the SSCT. The relationship, if any, between the fibrosis and nerve pathology is unknown, although some have speculated that a change in the SSCT volume or stiffness might be the source of the compression. Yet, while animal models have been used to study the physiology of nerve compression, so far none have been used to study the relationship of the SSCT pathology to the neurophysiological abnormalities. The purpose of this study was to identify animal models that might be appropriate to study the interaction of SSCT and nerve function in the development of CTS. The front paws of a rat, rabbit, dog, and baboon were dissected. The carpal tunnel anatomy and SSCT of these animals were also examined by light and scanning microscopy and compared to the relevant human anatomy and ultrastructure. The carpal tunnel anatomy and contents of the baboon and rabbit are similar to humans. The canine carpal tunnel lacks the superficial flexor tendons and the rat carpal tunnel is very small. The human, baboon, and rabbit specimens had very similar organization of the SSCT, and content of the carpal canal. We conclude that, while both the baboon and rabbit would be good animal models to study the relationship of the SSCT to CTS, the rabbit is likely to be more practical, in terms of cost and animal care concerns.     

International Spinal Cord Injury Data Sets

STUDY DESIGN: Discussion and development of final consensus. OBJECTIVE: Present the background, purpose, and process for the International Spinal Cord Injury (SCI) Data Sets development. SETTING: International. METHODS: An international meeting on SCI data collection and analysis occurred at a workshop on May 2, 2002, before the combined meeting of the American Spinal Injury Association (ASIA) and the International Spinal Cord Society (ISCoS) in Vancouver, British Columbia, Canada. At this meeting, a process was developed for selection of data elements to be included in International SCI Data Sets. RESULTS: An overall structure and terminology has been developed following the format of the International Classification of Functioning, Disability and Health (ICF). This includes definitions of the Core Data Set, as well as Modules with Basic Questions or Data Sets and Expanded Data Sets. The Core Data Set has been developed and will be presented separately. Working groups for additional modules are being established as well as general guidelines for the development of the modules. CONCLUSION: The presented format should help in developing data sets and modules within various topics related to SCI.     

Evidence for a curvilinear relationship between posttraumatic growth and posttrauma depression and PTSD in assault survivors

Two studies of assault survivors (Ns = 180, 70) examined associations between posttraumatic growth (PTG) and posttrauma psychopathology. Both studies found significant curvilinear associations between PTG and posttraumatic stress disorder, whereas only Study 1 found a curvilinear association between PTG and depression symptom severity. Survivors with no or high growth levels reported fewer symptoms than those who reported moderate growth. Study 1 also investigated potential PTG predictors. Non‐Caucasian ethnicity, religiousness, peritraumatic fear, shame, and ruminative thinking style, assessed at 2 weeks, predicted growth at 6 months. Posttraumatic growth may thus be most relevant in trauma survivors who attach enduring significance to the trauma for their lives and show initial distress. Moderate levels of PTG do not seem to ameliorate posttrauma psychopathology.     

High prevalence of incontinence among young adults with spina bifida: description, prediction and problem perception

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To study the prevalence of incontinence, problem perception and determinants of urinary and faecal incontinence in young adults with spina bifida. SETTING: Nation-wide study in the Netherlands. PARTICIPANTS: A total of 179 of 350 invited patients participated, including 37 patients with spina bifida occulta and 142 with spina bifida aperta, of whom 119 had hydrocephalus; 41% were male and mean age was 20.4 (range 16-25 years). METHODS: Data were collected from interviews, physical examination, neuropsychological tests and medical records. RESULTS: Urinary and faecal incontinence was common in young adults with spina bifida (60.9 and 34.1%, respectively), regardless of the bladder and bowel management they used. The majority of urinary and faecal incontinent patients perceived this as a problem (69.7 and 77.0%, respectively). Spina bifida aperta, hydrocephalus and a level of lesion of L5 or above were associated with patients suffering from urinary and/or faecal incontinence. Predictors of perceiving urinary incontinence as a problem were, in addition to being incontinent, not having hydrocephalus and having a level of lesion of L5 or above. The only predictor of perceiving faecal incontinence as a problem was the frequency of incontinence. CONCLUSION: A majority of young adults with spina bifida suffer from urinary and faecal incontinence and most of them perceive their incontinence as a problem. Therefore, further efforts are important to improve urinary and faecal continence.