Endocrine cells in the upper gastrointestinal tract in relation to gastrointestinal dysfunction in patients with familial amyloidotic polyneuropathy

Gastrointestinal (GI) dysfunction is a common complication of familial amyloidotic polyneuropathy (FAP). In previous reports, a decreased content of small and large intestinal endocrine cells has been found in patients with FAP and it has been suggested that this may contribute to the development of GI disturbances. The aim of the present study was to investigate the endocrine cell content in the stomach and duodenum of FAP patients, and to correlate the findings with gastric emptying.

Fifteen patients with FAP were included in the study. Twenty-eight subjects with macroscopically and histologically normal mucosa were used as controls for endocrine cell contents and 14 healthy subjects for gastric scintigraphy. The endocrine cells were identified by immunohis-tochemistry and quantified with image analysis. Gastric emptying time was detected by scintigraphy andendoscopy.

The number of chromogranin A-immunoreactive (IR) cells was reduced in all investigated parts of the GI tract except bulbus duodeni. Gastrin/CCK cell content was reduced in duodenum, but tended to be increased in antrum of the stomach (P=0.07). Otherwise, the content of all other endocrine cells types in the upper GI tract was reduced compared with controls. A correlation with malnutrition was found for gastric inhibitory polypeptide and secretin cell content in bulbus duodeni. Gastric scintigraphy disclosed delayed gastric emptying of solid food, but the finding was not correlated to the decreased content of neuroendocrine cells. The severity of endocrine cell depletion was not correlated to duration of GI disturbances.

The present study showed that the endocrine cells of the stomach are affected in FAP patients and that the abnormalities in the upper GI endocrine cells occur early during the course of the disease.     

Screening for C282Y homozygosity in a Norwegian population (HUNT2): The sensitivity and specificity of transferrin saturation

Abstract

Objective. Hereditary hemochromatosis (HH) is a genetic condition characterized by increased iron absorption. Most HH cases are homozygous for the C282Y mutation in the HFE gene, but accurate prevalence data for the Norwegian population is lacking. In population studies, serum transferrin saturation (TS) is commonly used as a screening test. However, the sensitivity and specificity of TS in this setting is not well documented. The purpose of this study was to determine the prevalence of the C282Y mutation in the general population, and to evaluate the diagnostic accuracy of the TS test as a screening criterion for finding C282Y homozygotes. Materials and methods. The hemochromatosis screening study in Nord-Trøndelag county, Norway (the HUNT2 study) comprised 65,238 participants. The HUNT biobank contains biological material and data from the participants, and 5000 individuals were randomly selected. Genotyping of the common HFE gene mutations was successful for 4827 samples, from which TS data existed for 4804 individuals. From these data we calculated the population frequency of the C282Y mutation, and the sensitivity and specificity of TS measurements. Results. The prevalence of C282Y homozygosity in the population was 0.75%. Using 55% (men) and 50% (women) as decision limits, the sensitivity of two consecutive elevated TS measurements was 90.0% for men and 55.0% for women, whereas the specificity was 99.6% and 99.4%, respectively. Conclusion. An unbiased estimate of the C282Y homozygote prevalence in Norway is 0.75%. Two measurements of TS is an accurate screening test for C282Y homozygosity in men, but not in women.     

Abstracts for the 2008 NAEMSP Scientific Assembly

Abstract

Objectives. To date, most patient safety studies have been conducted in relation to the hospital rather than the prehospital setting and data regarding emergency medical services (EMS)-related errors are limited. To address this gap, a study was conducted to gain an in-depth understanding of the views of highly experienced EMS practitioners, educators, administrators, and physicians on major issues pertaining to EMS patient safety. The intent of the study was to identify key issues to give direction to the development of best practices in education, policy, and fieldwork. Methods. A qualitative study was conducted using processes described by Lincoln and Guba (1985) to enhance the quality and credibility of data and analysis. Purposive sampling was used to identify informants with knowledge and expertise regarding policy, practice, and research who could speak to the issue of patient safety. Sixteen participants, the majority of whom were Canadian, participated in in-depth interviews. Results. Two major themes were identified under the category of key issues: clinical decision making and EMS's focus and relationship with health care. An education gap has developed in EMS, and there is tension between the traditional stabilize-and-transport role and the increasingly complex role that has come about through “scope creep.” If, as expected, EMS aligns increasingly with the health sector, then change is needed in the EMS educational structure and process to develop stronger clinical decision-making skills. Conclusion. The results of this study indicate that many individual organizations and health regions are addressing issues related to patient safety in EMS, and there are important lessons to be learned from these groups. The broader issues identified, however, are system-wide and best addressed through policy change from health regions and government.     

Considerations for appraising diagnostic studies of communication disorders

Clinicians have always been aware of the importance of using valid and reliable clinical tests and measures—and of avoiding those that are not. However, the choice of which tests and measures to use is often more a matter of personal preference, arising out of knowledge of a test's psychometric properties and one's experience with the test, rather than being based on a systematic, critical appraisal of assessment tools. This paper proposes a method of critically appraising clinical assessments in the speech and language sciences, for the purpose of deciding whether they are likely to be informative in diagnosing individuals with communication disorders. QUADAS (Quality Assessment of Diagnostic Accuracy Studies)—a 14-item, evidence-based critical appraisal tool (Whiting, Rutjes, Reitsma, Bossuyt,?&?Kleijnen, 2003) originally designed to assess the quality of diagnostic-accuracy studies used in systematic reviews in medicine—is presented, with an example of how it can be applied in the field of communication disorders.     

监视器在CT增强检查中的应用价值

目的:评估监视器在监测增强CT扫描时对比剂外渗中的价值。方法:患者随机分采用监视器组(A组)和未用监视器组(B组),A组8603例,B组7985例,设定对比剂渗出>50ml为重度外渗,对比剂渗出<10ml为轻度外渗,观察A、B两组皮下对比剂外渗程度。结果:A组发生轻度外渗45例,重度外渗1例,B组发生轻度外渗33例,重度外渗18例。两组比较,其差异具统计学意义(P<0.05)。结论:应用监视器可早期发现穿刺、注射处的异常现象,从而防止重度对比剂外渗的发生。     

基于石墨烯-依来铬青蓝R的新型免标记电化学免疫传感器用于CA19-9检测

目的构建石墨烯-依来铬青蓝R(GO-ECR)免标记电化学免疫传感器高灵敏检测CA19-9的新技术。方法化学法合成氧化石墨烯并滴涂于电极表面,通过循环伏安法电沉积制作GO-ECR修饰玻碳电极,在偶联剂EDC和NHS作用下以共价键合方式将CA19-9抗体固定于修饰电极表面,固定的抗体与CA19-9发生免疫反应形成抗原-抗体复合物。铁氰化钾溶液作为检测探针,对比免疫反应前后铁氰化钾响应信号的差异,利用信号降低程度与CA19-9浓度正相关,实现对CA19-9的特异性高灵敏检测。结果该电化学免疫传感器检测CA19-9的线性范围为0.05～500 U/mL,检测限为0.01 U/mL,且能准确测定临床血清样本CA19-9的浓度。结论构建的GO-ECR免标记电化学免疫传感器可以简单、准确、特异地检测CA19-9。     

宫腔镜和经阴道B 超对子宫内膜息肉的诊断价值

目的 探讨宫腔镜和经阴道B超对子宫内膜息肉的诊断价值.方法 选取该院2015年8月到2016年8月 收治的80例已确诊为子宫内膜息肉的患者作为研究对象.先对患者进行经阴道B超,然后再行宫腔镜检查,观察 两种方法的检查结果.结果 经宫腔镜检测,患者确诊为子宫内膜息肉75例,误诊为其他病症4例,经阴道B超检 测,患者确诊为子宫内膜息肉52例,误诊为其他病症6例.宫腔镜的检出率与经阴道B超相比,差异有统计学意义 (P<0.05);患者子宫内膜息肉最少为1处,最多为4处,其中21例为1处有子宫内膜息肉,36例有2处子宫内膜息 肉,14例有3处子宫内膜息肉,9例有4处子宫内膜息肉.宫腔镜中准确检出1处的为21例(100.00%)、2处的为 34例(94.44%)、3处的为12例(85.71%)、4处的为8例(88.89%);经阴道B超中准确检出1处的为13例 (61.90%)、2处的为17例(47.22%)、3处的为11例(78.57%)、4处的为5例(55.56%),二者的分布差异有 统计学意义(P<0.05),且宫腔镜具有较高的准确率.结论 宫腔镜对子宫内膜息肉的诊断效果明显优于经阴道B 超.     

Diagnostic steps in the evaluation of patients with erectile dysfunction

PURPOSE: The necessity for a thorough diagnostic evaluation for erectile dysfunction has been questioned after the availability of effective oral therapies. We determined the impact of the different diagnostic steps on the management strategy for erectile dysfunction. MATERIALS AND METHODS: The study included all patients who presented at an andrology outpatient clinic during a 4-year period. Baseline evaluation included medical and sexual history, blood tests, physical examination and intracavernous injection test. Patients with normal initial screening were evaluated with specific diagnostic procedures. The results were analyzed to identify the diagnostic potential of each screening step separately. RESULTS: Overall 1,644 patients presented at the clinic during the study period, of whom 368 (22.4%) were excluded from study due to severe psychiatric (5.2%) or cardiovascular (2.7%) disease, or to a history of erectile dysfunction less than 3 months in duration (14.5%). In the remaining 1,276 patients with a mean age plus or minus standard deviation of 56 +/- 14 years, and a mean duration of erectile dysfunction of 4.9 +/- 3.4 years medical history revealed erectile dysfunction associated medical conditions in 57%, blood tests identified previously undiagnosed medical conditions in 6.2%, and physical examination and the intracavernous injection test were diagnostic in 13.9% and 2.6%, respectively. Initial screening was negative in 259 cases (20.3%), in which specific diagnostic procedures identified an underlying vascular pathology in 165 (12.9%) and unfavorable penile geometry in 16 (1.3%). The remaining 78 men (6.1%) had no evidence of organic disease. CONCLUSIONS: Baseline diagnostic evaluation for erectile dysfunction can identify the underlying pathological condition or erectile dysfunction associated risk factors in 80% of patients. Such screening may diagnose reversible causes of erectile dysfunction and also unmask medical conditions that manifest with erectile dysfunction as the first symptom. Specific diagnostic procedures may be limited in patients with primary erectile dysfunction or those without risk factors. Such clinical data support previously published guidelines for erectile dysfunction management.