The effect of acetic acid on gastric secretion stimulated by endogenous gastrin in vagally denervated canine fundic pouches

The gastric secretory responses of vagally denervated canine fundic pouches stimulated by endogenous gastrin have been defined following exposure to acetic acid. In order to compare the secretory changes induced by exposing both the resting and the actively secreting mucosa to acetic acid, the organic acid was placed in the pouches either before or 1–1/4 hours after stimulation by a standard meat meal. Exposure to acetic acid caused inhibition of secretion, which was more pronounced when the organic acid was placed in the resting pouches. The organic acid also caused enhanced exchange-diffusion which was reflected by increased exsorption of Na⁺. The outputs of Na⁺ were higher when acetic acid was placed in the actively secreting as opposed to the resting pouches; this was probably a reflection of differences in availability of H⁺. The electrolytic interrelationships in the gastric juice were not altered by exposure of the pouches to acetic acid.Supported by grants-in-aid from the National Heart Institute (HE-03181) and the Institute of General Medical Sciences (GM-15768) of the US Public Health Service.     

Can mycophenolate mofetil be tapered safely in myasthenia gravis? A retrospective,multicenter analysis

Introduction: Mycophenolate mofetil (MMF) is frequently used to treat myasthenia gravis, but there is little information to guide clinicians on the safety of reducing the dose in well‐controlled patients. Methods: This retrospective chart review at 3 institutions identified 92 patients who had undergone MMF taper after achieving either pharmacologic remission or minimal manifestations status. Statistical analysis was performed to assess differences in patient characteristics between patients who had successfully tapered MMF and those who relapsed. Results: Of 92 patients undergoing a taper, 30 relapsed. The relapses were mild, transient, and usually responded to increased MMF dose. MG crisis did not occur. The mean dose at time of relapse was 888 mg/day. Patients with relapses were tapered more quickly (8.4 vs. 62.4 months). Conclusions: Tapering MMF appears safe after years of disease stability. Reducing the dose at a dose of only 500 mg/day every 12 months is recommended. Muscle Nerve 52 : 211–215, 2015     

The challenge of spinal cord injury care in the developing world

Great strides have been made in reducing morbidity and mortality following spinal cord injury (SCI), and improving long-term health and community participation; however, this progress has not been uniform across the globe. This review highlights differences in global epidemiology of SCI and the ongoing challenges in meeting the needs of individuals with SCI in the developing world, including post-disaster. Significant disparities persist, with life expectancies of 2 years or less not uncommon for persons living with paraplegia in many developing countries. The international community has an important role in improving access to appropriate care following SCI worldwide.