Expression of p63 and p16 in primary and recurrent pterygia

Background p63 and p16 have been described as stem-cell markers of squamous epithelium. In an attempt to obtain new insights into the pathogenesis of pterygium, this study aims to evaluate the relationship between p63 and p16 expression in primary and recurrent pterygia.Methods Samples of primary (n=56) and recurrent (n=14) pterygia and normal bulbar conjunctival tissue (n=11) were submitted to immunohistochemical study to evaluate the expression of p63 and p16 in these tissues.Results Most of the cells stained for p63 were located in the basal layer of the normal conjunctiva, in the lower two-thirds of the epithelium of primary pterygia, and throughout all epithelial layers of recurrent pterygia. In normal conjunctivae, p16 expression was rarely expressed. Primary and recurrent pterygium groups exhibited increased p16 expression, with cytoplasmic staining in the primary group, and cytoplasmic or nuclear staining in the recurrent group.Conclusion The overexpression of p63 and p16 observed in the present study reinforces likelihood of involvement of these genes in the pathogenesis of pterygium, perhaps related to the intense cellular turnover with substitution of superficial epithelial cells by less differentiated forms. This loss of normal cellular differentiation of the epithelial layers could explain the high rates of recurrence overall in the recurrent pterygia.Research supported by FAEPA and CAPES.     

Bowel frequency and defecatory patterns in children: a prospective nationwide survey.

BACKGROUND & AIMS: Very little is known about several aspects of bowel habits in the general pediatric population and the aim of this nationwide survey was to assess bowel frequency and modalities of defecation in children. METHODS: The survey was conducted by 58 pediatricians who were selected randomly and distributed evenly throughout Italy. The following items were reported by each pediatrician in a standardized questionnaire: sociodemographic data, frequency and modalities of bowel evacuation, and anorectal disorders. RESULTS: The response rate of available completed questionnaires was distributed evenly for the 1-year age group and was 94% (number of patients, 2680; 1-2 years, 442; females, 49.8%). Mean bowel frequency did not vary in the first 2 years of life, it decreased (P = .00001) after the second year, and remained stable until the 12th year; it did not differ between sexes. Mean bowel frequency was reduced significantly in children, both in those younger or older than 2 years, with a positive history of constipation in the parents (P = .00002). Bowel frequency was inversely correlated with the number of persons living and the number of rooms in the child's house (P < .05, P = .008, respectively). Stool consistency, duration of evacuation, and frequency of episodes of painful defecation showed an inverse relationship (P < .001) with bowel frequency. Bowel frequency was significantly lower (P < .001) in children with anorectal disorders. CONCLUSIONS: In Italian children, bowel frequency does not differ between sexes but it differed between the first 2 years of life and age older than 2. Anorectal disorders increase as bowel frequency decreases.     

Complete mesh migration into the small bowel after incisional hernia repair: a case report and literature review

Introduction: Mesh migration into the intestine is very rare after incisional hernia repair.

Case report: We report the case of transmural mesh migration from the abdominal wall into the small bowel presenting as recurrent small bowel obstruction 18 years after repeated surgical repair of an incisional ventral hernia. At surgery, a mesh was found inside the resected ileal loop.

Discussion: Mesh migration into the intestine is a possible, although very rare, complication after incisional hernia repair with nonabsorbable meshes. It tends to occur late with obstructive symptoms, especially if the small intestine is involved. Avoiding the direct contact between the mesh and the intestinal wall may help to reduce this complication.     

Medial contact and smaller plantar loads characterize individuals with Patellofemoral Pain Syndrome during stair descent

ObjectivesTo investigate plantar pressure distribution in individuals with and without Patellofemoral Pain Syndrome during the support phase of stair descent.DesignObservational case–control study.Participants30 young adults with Patellofemoral Pain Syndrome and 44 matched controls.Main outcome measuresContact area, peak pressure and pressure–time integral (Novel Pedar-X system) were evaluated in six plantar areas (medial, central and lateral rearfoot; midfoot; medial and lateral forefoot) during stair descent.ResultsContact area was greater in the Patellofemoral Pain Syndrome Group at medial rearfoot (p = 0.019) and midfoot (p < 0.001). Subjects with Patellofemoral Pain Syndrome presented smaller peak pressures (p < 0.001).ConclusionThe pattern of plantar pressure distribution during stair descent in Patellofemoral Pain Syndrome subjects was different from controls. This seems to be related to greater medial rearfoot and midfoot support. Smaller plantar loads found in Patellofemoral Pain Syndrome subjects during stair descent reveal a more cautious motor pattern in a challenging task.     

Mechanisms of gastroesophageal reflux in children with sequelae of birth asphyxia

Patterns of childhood gastroesophageal reflux (GER) have been studied extensively; however, the mechanisms underlying its occurrence in neurologically impaired children (NIC) are poorly understood. Concurrent esophageal manometry and pH monitoring was conducted in 10 un-operated children (7 male; mean age: 59.5 months) with sequelae birth asphyxia and esophagitis. Reflux episodes were scored when esophageal pH decreased to <4 for at least 5s. When the rate of decrease of lower esophageal sphincter (LES) pressure was >1mmHg/s, the decrease of LES pressure was defined as LES relaxation. The time relationship of the pharyngeal manometric swallowing signal to LES relaxation onset was then evaluated in order to distinguish between LES relaxations associated with swallowing (type II or III, associated with one or more swallows, respectively) and those that occurred independently of swallowing (type I). Results: Esophageal manometry and pH monitoring were conducted for a mean duration of 91.5min. Basal LES pressure averaged (+/-SD) 9.2+/-4.8mmHg; in 4 of 10 patients (40%) the LES pressure was largely undetectable, varying between 0 and 2mmHg. Mean LES pressure was inversely correlated with age (r=0.7, P=0.02). The total number of reflux episodes/h averaged 32.1+/-12.1 LES pressure reached 0mmHg in 98% of reflux episodes. Type I LES relaxations were present in 3.15+/-1.1 reflux episodes/h, whereas type II LES relaxation occurred in 2.3+/-2.4 episodes/h. Acid reflux episodes appeared during absent basal LES tone periods, without phasic LES relaxations, in 74%. Conclusions: Absent basal LES tone is the main mechanism of GER in a subgroup of NIC, especially in older children. Transient LES relaxation, the most common known event associated with acid reflux in neurologically normal children, seems to precede a minority of reflux events in NIC.     

Muscarinic receptor/G-protein coupling is reduced in the dorsomedial striatum of cognitively impaired aged rats

Behavioral flexibility, the ability to modify responses due to changing task demands, is detrimentally affected by aging with a shift towards increased cognitive rigidity. The neurobiological basis of this cognitive deficit is not clear although striatal cholinergic neurotransmission has been implicated. To investigate the possible association between striatal acetylcholine signaling with age-related changes in behavioral flexibility, young, middle-aged, and aged F344 X Brown Norway F1 rats were assessed using an attentional set-shifting task that includes two tests of behavioral flexibility: reversal learning and an extra-dimensional shift. Rats were also assessed in the Morris water maze to compare potential fronto-striatal-dependent deficits with hippocampal-dependent deficits. Behaviorally characterized rats were then assessed for acetylcholine muscarinic signaling within the striatum using oxotremorine-M-stimulated [(35)S]GTPγS binding and [(3)H]AFDX-384 receptor binding autoradiography. The results showed that by old age, cognitive deficits were pronounced across cognitive domains, suggesting deterioration of both hippocampal and fronto-striatal regions. A significant decline in oxotremorine-M-stimulated [(35)S]GTPγS binding was limited to the dorsomedial striatum of aged rats when compared to young and middle-aged rats. There was no effect of age on striatal [(3)H]AFDX-384 receptor binding. These results suggest that a decrease in M2/M4 muscarinic receptor coupling is involved in the age-associated decline in behavioral flexibility.     

Laparoscopic correction of enterocele associated to stapled transanal rectal resection for obstructed defecation syndrome

Background and aims  

We report our experience of concomitant laparoscopic treatment for enterocele and stapled transanal rectal resection (STARR) for rectocele and/or rectal prolapse in patients with complex obstructed defecation syndrome (ODS).