Helicobacter pylori:A chameleon-like approach to life

Helicobacter pylori(H.pylori)is widely adaptable for colonization in human stomachs in more than half of the world’s population.The microorganism is characterized by an unusual capability of arranging itself in both genotypic and phenotypic ways.Stressing conditions,including antimicrobial agents in sub-inhibitory concentrations,facilitate entering the viable but nonculturable state in which bacterial cells acquire the coccoid form.This morphotype represents an important strategy for bacterial survival in unsuitable conditions and also allows escape from the immune system.H.pylori is capable of forming biofilm outside and inside the host.For the bacterial population,the sessile growth mode represents an ideal environment for gene rearrangement,as it allows the acquiring of important tools aimed to improve bacterial"fitness"and species preservation.Biofilm formation in H.pylori in the human host also leads to recalcitrance to antibiotic treatment,thus hampering eradication.These lifestyle changes of H.pylori allow for a"safe haven"for its survival and persistence according to different ecological niches,and strongly emphasize the need for careful H.pylori surveillance to improve management of the infection.     

Technology-Based Programs to Support Adaptive Responding and Reduce Hand Mouthing in Two Persons with Multiple Disabilities

These two single-case studies assessed the use of microswitch clusters to support adaptive responses and reduce problem behavior with two adults with multiple disabilities. Study I involved a man whose adaptive responses consisted of touching color shapes appearing on a computer screen in front of him and the problem behavior was hand mouthing. Study II involved a woman whose adaptive response consisted of using a napkin to wipe her mouth to reduce drooling effects. Her problem behavior, like for the man, was hand mouthing. Initially, the intervention focused on the adaptive responses, which were followed by preferred stimulation. Then the intervention was extended so that the stimulation for the adaptive responses would be interrupted if the problem behavior appeared during its occurrence. The data of the two studies suggest that the intervention was effective in helping the participants engage in consistent rates of adaptive responses and curb their problem behavior. These findings were analyzed in relation to the characteristics of the intervention approach and its practical implications.     

The Italian Research Group for Gastric Cancer (GIRCG) guidelines for gastric cancer staging and treatment: 2015

Methodology for the diagnosis and staging of early gastric cancer (EGC) has improved in Japan since the development of the gastro-camera and determination of a definition of EGC. Imaging technology has been steadily evolving in the endoscopy field. Improvements in the resolution of standard endoscopy images used in screening and surveillance provide greater opportunities to find gastric cancer earlier. Image enhancement endoscopy (IEE), such as narrow band imaging (NBI), highlights mucosal structures and vascularity. In particular, when NBI is used with magnifying endoscopy, it reveals fine details of subtle superficial abnormalities of EGC that are difficult to recognize using standard white light endoscopy. IEE-assisted magnifying endoscopy has improved the accuracy of the differentiation of superficial gastric cancer as well as delineation of the diseased mucosa. The advanced imaging technology enables precise assessment of the risk of lymph node metastasis of EGC and is widely used to determine indications for endoscopic treatment. It is not an overstatement to say that this has become the basis for the current development and dissemination of endoscopic treatments. Moreover, the resolution of endoscopic imaging has been upgraded to the microscopy level by the development of endomicroscopy, including endocytoscopy and confocal laser endomicroscopy. Endomicroscopy allows real-time histological analysis of living tissue during routine endoscopy and may reduce the number of biopsies needed to reach the correct diagnosis, minimizing the risk of sampling errors.     

Common structural features characterize interstitial intrachromosomal Xp and 18q triplications

Rare intrachromosomal triplications producing partial tetrasomies have been reported for a number of chromosomes. A detailed molecular characterization, necessary to define the mechanism of their formation, has so far been lacking. We report on the detailed clinical, cytogenetic, and molecular characterization of two triplications, one de novo involving chromosome 18q, the other familial on chromosome Xp. The clinical phenotype of the patient with 18q triplication, very likely due to overexpression of one or more of the genes in the region, consists mainly of facial dysmorphisms and developmental delay. The familial Xp triplication does not cause an increase in the number of copies of any gene and is almost certainly a polymorphism. The rearrangements are actually complex duplications/triplications. In both patients, their proximal breakpoints are located within complex segmental duplications, one containing the VCX gene cluster on chromosome Xp, the other the TCEB3 genes on chromosome 18q. A proximal duplicated region is also present in both patients. All junctions we analyzed were formed by non-homologous end joining (NHEJ). The structural features shared between our patients suggest the involvement of a common mechanism in the genesis of interstitial intrachromosomal triplications.     

Heel lance in newborn during breastfeeding: an evaluation of analgesic effect of this procedure

Objectives

The reduction of pain due to routine invasive procedures (capillary heel stick blood sampling for neonatal metabolic screening) in the newborn is an important objective for the so-called "Hospital with no pain". Practices such as skin to skin contact, or breastfeeding, in healthy newborn, may represent an alternative to the use of analgesic drugs. The aim of our work is to evaluate the analgesic effect of breastfeeding during heel puncture in full term healthy newborn.

Methods

We studied 200 healthy full term newborns (100 cases and 100 controls), proposing the puncture to mothers during breastfeeding, and explaining to them all the advantages of this practice. Pain assessment was evaluated by DAN scale (Douleur Aigue Nouveau ne scale).

Results

The difference in score of pain according to the DAN scale was significant in the two groups of patients (p = 0.000); the medium score was 5.15 for controls and 2.65 for cases (newborns sampled during breastfeeding).

Conclusion

Our results confirmed the evidence of analgesic effect of breastfeeding during heel puncture. This procedure could easily be adopted routinely in maternity wards.     

Malleability of the ocular surface in response to mechanical stress induced by orthokeratology contact lenses

PURPOSE: To determine the malleability of the ocular surface by examining the acute effects of local mechanical stress on optical performance, corneal shape, and corneal/epithelial thickness after corneal refractive therapy for myopia and hyperopia (CRT and CRTH). METHODS: Twenty ametropes (spherical equivalent: -2.08 +/- 2.31 D) wore CRT and CRTH lenses in a random order on 1 eye (randomly selected). The lenses were worn for 15, 30, and 60 minutes (randomly ordered, with each period taking place on a different day). Refractive error, aberrations, corneal topography, and corneal/epithelial thickness (using OCT) were measured before and after lens wear. The measurements were performed on the control eyes at the 60-minute visit only. RESULTS: With both CRT and CRTH lens wear, significant changes occurred in many parameters from the 15-minute time point. The refractive error and defocus decreased after CRT lens wear (all P < 0.05) and increased after CRTH lens wear from baseline (all P < 0.05). Astigmatism did not change (both P > 0.05). Higher-order aberrations, including coma and spherical aberration (SA), increased after CRT and CRTH lens wear (all P < 0.05) from baseline, but the signed SA shifted from positive to negative after CRTH lens wear (P < 0.05). The central cornea flattened and the midperiphery steepened after CRT lens wear, whereas the central cornea steepened and paracentral region flattened after CRTH lens wear (P < 0.05). The central cornea swelled less than the midperiphery after CRT lens wear (P < 0.05), whereas the central cornea swelled more than the paracentral region after CRTH lens wear (P < 0.05). The central epithelium was thinner than the midperiphery after CRT lens wear (P < 0.05) and thicker than the paracentral region after CRTH lens wear (P < 0.05). Optical performance, corneal curvature, and epithelial thickness did not change from baseline in the control eyes (all P > 0.05). CONCLUSIONS: CRT lenses for myopia and hyperopia induce significant structural and optical changes in as little as 15 minutes. The cornea, particularly the epithelium, is remarkably malleable, with rapid steepening and flattening possible in little time.     

Ex vivo response to mucosal bacteria and muramyl dipeptide in inflammatory bowel disease

AIM To evaluate how mucosal bacteria impact on the spontaneous and muramyl dipeptide(MDP)-induced inflammation in Crohn's disease(CD) and ulcerative colitis(UC).METHODS Colonic mucosal biopsies were collected from children with active or remissive CD, UC and controls. Two tissue samples were taken from inflamed mucosal segments(in patients with active disease) or from noninflamed mucosa [in patients in remission or in healthy controls(HC)]. Experiments were performed in the presence or absence of antibiotics, to assess whether the disease-associated microbiota can modulate the cytokine response ex vivo. For this purpose, each specimen was half-cut to compare spontaneous and MDP-induced inflammation in the presence of live bacteria(LB) or antibiotics. After 24 h of culture, an array of 17 cytokines was assessed in supernatants. Statistical analyses were performed to find significant differences in single cytokines or in patterns of cytokine response in the different groups. RESULTS We demonstrated that subjects with CD display a spontaneous production of inflammatory cytokines including granulocyte-colony stimulating factor(G-CSF), interleukin(IL) 6, IL8, IL10 and IL12, that was not significantly influenced by the addition of antibiotics. UC specimens also displayed a trend of increased spontaneous secretion of several cytokines, which however was not significant due to broader variability among patients. After the addition of antibiotics, spontaneous IL8 secretion was significantly higher in UC than in controls. In HC, a trend towards the weakening of spontaneous IL8 production was observed in the presence of live mucosal bacteria with respect to the presence of antibiotics. In contrast, in the presence of LB UC showed an increasing trend of spontaneous IL8 production, while MDP stimulation resulted in lower IL8 production in the presence of antibiotics. We also showed that subjects with CD seem to have a lowered production of IL8 in response to MDP in the presence of LB. Only with the addition of antibiotics, likely reducing the contribution of LB, multivariate statistical analysis could identify the combination of measures of G-CSF, tumor necrosis factor alpha, IL4 and IL17 as a good discriminator between CD and UC.CONCLUSION We showed that the presence of LB or antibiotics can significantly influence the inflammatory response ex vivo in inflammatory bowel diseases.