Colon perforation in Ehlers-Danlos syndrome: Report of two cases and review of the literature

Two cases of spontaneous perforation of the colon in Ehlers-Danlos syndrome type IV are reported, and eight cases previously reported in the English literature are reviewed. Emergency surgery for acute free colon perforation in patients with Ehlers-Danlos syndrome should be carried out in the following standard manner: exteriorization of the perforation or resection of the involved colon with end colostomy, and either closure of the rectal stump (Hartmann procedure) or distal mucous colostomy. The reported experience although small, indicates that a high incidence of recurrent perforation can be expected if bowel continuity is reestablished. Permanent colostomy status, therefore, appears advisable, despite the young ages of most of the patients.     

Occurrence of aflatoxin M1 in raw milk collected from traditional dairies in Morocco

A survey of the presence of aflatoxin M1 (AFM1) was carried out on eight traditional dairies belonging to four sectors of Fez city situated in the northern center of Morocco. Raw milk samples were collected between October 2009 and September 2010, and analyzed by LC-fluorescence detection after immunoaffinity purification. AFM1 was detected in 13 out of 48 samples (27%) at concentrations ranged between 10 and 100 ng/l. Within these positive samples, four (∼8% of the total) were above the European legislation limit of 50 ng/l. This study revealed a variation of contamination from one sector to another with a higher incidence in milk samples collected in autumn compared to those collected in other seasons suggesting a link between feeding practices, such as the use of silage and AFM1 contamination. This is the first report on AFM1 contamination in raw milk directly collected from Moroccan traditional dairies. The levels of contamination found justify more detailed and continuous monitoring to assess the public health implication and reduce consumers’ exposure to AFM1.     

肺结核患者血浆和胸水中抑瘤素-M检测及临床意义

目的探讨血浆和胸水中抑瘤素-M在肺结核中的变化及其临床意义。方法应用双抗体夹心ELISA法检测24例健康体检者、21例活动性肺结核患者血浆和10例结核性胸膜炎胸水中OSM的水平。结果肺结核患者血浆中OSM水平低于健康对照组,差异有统计意义;结核性胸膜炎患者胸水中OSM高于肺结核患者血浆中OSM水平,差异有统计意义。结论OSM是局部病灶炎症反应的重要作用因子,可能参与了肺结核的免疫发病机制。     

Indigenous Māori perspectives on urban transport patterns linked to health and wellbeing

There is a growing body of research linking urban transport systems to inequities in health. However, there is a lack of research providing evidence of the effect of transport systems on indigenous family wellbeing. We examined the connections between urban transport and the health and wellbeing of Māori, the indigenous people of New Zealand. We provide an indigenous exploration of current urban transport systems, with a particular focus on the impacts of car dependence and the need for culturally relevant travel. We interviewed nineteen Māori participants utilising qualitative research techniques underpinned by an indigenous research methodology (Kaupapa Māori). The data highlighted the importance of accessing cultural activities and sites relevant to ‘being Māori’, and issues with affordability and safety of public transport. Understanding the relationship between indigenous wellbeing and transport systems that goes further than limited discourses of inequity is essential to improving transport for indigenous wellbeing. Providing an indigenous voice in transport decision-making will make it more likely that indigenous health and wellbeing is prioritised in transport planning.     

Inhibitors of Bacillus anthracis edema factor

Edema factor (EF) is a calmodulin (CaM)-activated adenylyl cyclase (AC) toxin from Bacillus anthracis that contributes to anthrax pathogenesis. Anthrax is an important medical problem, but treatment of B. anthracis infections is still unsatisfying. Thus, selective EF inhibitors could be valuable drugs in the treatment of anthrax infection, most importantly shock. The catalytic site of EF, the EF/CaM interaction site and allosteric sites constitute potential drug targets. To this end, most efforts have been directed towards targeting the catalytic site. A major challenge in the field is to obtain compounds with high selectivity for AC toxins relative to mammalian membranous ACs (mACs). 3′-(N-methyl)anthraniloyl-2′-deoxyadenosine-5′-triphosphate is the most potent EF inhibitor known so far (K_i, 10 nM), but selectivity relative to mACs needs to be improved (currently ~5–50-fold, depending on the specific mAC isoform considered). AC toxin inhibitors can be identified in virtual screening studies based on available EF crystal structures and examined in cellular test systems or at the level of purified toxin using classic radioisotopic or non-radioactive fluorescence assays. Binding of certain MANT-nucleotides to AC toxins elicits large direct fluorescence- or fluorescence resonance energy transfer signals upon interaction with CaM, and these signals can be used to identify toxin inhibitors in competition binding studies. Collectively, potent EF inhibitors are available, but before they can be used clinically, selectivity against mACs must be improved. However, several methodological approaches, complementing each other, are now available to direct the development of potent, selective, orally applicable and clinically useful EF inhibitors.     

The M3S-based electric wheelchair for the people with disabilities in Taiwan

Purpose.?This study aims to establish an electronic wheelchair system in Taiwan that conforms to multiple master–multiple slave (M3S) standards. The proposed system could enhance the safety and convenience of people with disabilities.

Material and method.?The M3S-based head-controlled electric wheelchair consists of three parts: (A) the input device, (B) the output device, and (C) the safety device. Head movement can be used as the input control to cause the tilting device to produce a corresponding level of analog voltage (backward & forward/left & right) which is then transmitted to the analogy/digital conversion module to control the output device (wheelchair's motor). Ten subjects with C5 uncompleted spinal cord injury were recruited in the clinical assessment. They were randomly assigned into groups A and B. In the group A, the subjects were assigned to operate the head-controlled wheelchair system with M3S standard before operating the head-controlled wheelchair system without M3S standard. In the group B, the subjects were assigned to operate the head-controlled wheelchair system without M3S standard before operating the head-controlled wheelchair system with M3S standard. Two subjects in the group B drop off due to their personal reasons.

Results.?The time cost for group A in completing tasks 1, 2, and 3 with the M3S and without the M3S were insignificant (p > 0.05). The time cost for completing in group B was insignificant (p > 0.05). Thus, the wheelchair operating time is depended on the proficiency of the subjects, not the M3S standard added.

Discussions and conclusions.?The time cost for subjects to operate the wheelchair was determined by their proficiency, not the M3S standard control added to the system. However, the M3S-based system did realize the safety mechanism and complex auxiliary tools with and without the plug-in and play function.     

Penetrating serosa in human T4aN0M0 gastric carcinoma correlates closely to patients’ worse prognosis after D2 gastrectomy

BACKGROUND AND OBJECTIVE: In both the 7th edition of the UICC staging system for gastric cancer and the 14th edition of the JGCA system, the definition of T4a is “Tumor perforates serosa (visceral peritoneum) without invasion of adjacent structures”. The aim of this study is to investigate the prognostic difference between T4aN0M0 patients with serosa-penetrating and without serosa-penetrating of gastric carcinoma. METHODS: A total of 221 patients with T4aN0M0 gastric carcinoma who underwent D2 resection at our Cancer Center between January 1990 and December 2008 were collected. The cohort included 42 patients with serosa-penetrating and 179 patients without serosa-penetrating. Average follow-up time was 85.5 months. Spearman’s rank correlation, Kaplan-Meier plots and Cox proportional hazards regression model were used to analyze the data. RESULTS: The 5-year survival rate for the patients serosa-penetrating and the patients without serosa-penetrating were 31% and 62% respectively (p<0.05). The relapse rates of these two groups after D2 radical surgery were 16.2% and 59.5%, respectively (p<0.05). The peritoneal dissemination and distant organ/lymph node metastatic rates were 44.8% and 55.2% versus 76.0% and 24.0%, respectively (p<0.05). CONCLUSION: Our findings provide a basis for the concept that serosa-penetrating in T4aN0M0 gastric carcinoma may be important in the acquisition of an aggressive phenotype, suggesting that serosa-penetrating, is an independent factor for poor prognosis of patients with gastric carcinoma.     

Apolipoprotein B synthesis in humans: liver synthesizes only apolipoprotein B-100

Apolipoprotein (apo) B-100 and B-48 are prominent apolipoproteins in VLDL, IDL, and chylomicrons. Organ cultures of normal adult human liver were established to ascertain the form of apo B synthesized by hepatocytes in humans. Human liver was minced and incubated in 15 mL methionine-free RPMI-1640 medium with 10% dialyzed fetal calf serum plus 250 microCi 35S-methionine for eight hours at 37 degrees C. Lipoproteins secreted by the liver were isolated by ultracentrifugation and the content of newly synthesized apo B determined by quantitation of radioactivity in the apoB-100 and apoB-48 bands after separation by 3% NaDodSO4 gel electrophoresis. In the eight-hour period, 2.5% to 3.2% of added 35S-methionine was secreted in TCA-precipitable protein of which 0.34% was apo B. Ninety-nine percent of the apo B in VLDL, IDL, and LDL was in the apo B-100 electrophoretic band. No significant radioactivity was detected in the apo B-48 electrophoretic band. Eighty-nine percent of the total radioactivity of apo B-100 was in VLDL with 3% and 8% in IDL and LDL, respectively. These results establish that adult human liver in organ culture synthesizes apo B-100 but not apo B-48.     

Recognition of left coronary artery fistula to the left and right ventricles by contrast echocardiography

A coronary-cameral fistula was inspected clinically by two-dimensional and pulsed Doppler ultrasound. At cardiac catheterization a fistulous connection between the left coronary artery and the right ventricle was observed. Contrast echocardiography using agitated saline solution injected into the aortic catheter clearly showed the passage of microcavitations into the left and the right ventricles confirming the connection of the fistula to both chambers. Contrast echocardiography is a valuable technique that can help define the site of drainage of coronary artery fistulas.     

Anomalous left coronary artery from the pulmonary artery: significance of associated intracardiac defects

Two patients with anomalous origin of the left main coronary artery from the pulmonary artery had an associated defect (one, critical pulmonary stenosis; the other, ventricular septal defect). They presented with signs and symptoms of the associated defect and the coronary anomaly was unrecognized. Both cases at autopsy lacked the usual large right coronary artery seen with this anomaly. The pathophysiologic features of the combined defects are described, their differences from the isolated anomaly are noted and their relation to surgery is discussed.