Delayed gastric emptying in Parkinson's disease

Gastrointestinal symptoms are evident in all stages of Parkinson's disease (PD). Most of the gastrointestinal abnormalities associated with PD are attributable to impaired motility. At the level of the stomach, this results in delayed gastric emptying. The etiology of delayed gastric emptying in PD is probably multifactorial but is at least partly related to Lewy pathology in the enteric nervous system and discrete brainstem nuclei. Delayed gastric emptying occurs in both early and advanced PD but is underdetected in routine clinical practice. Recognition of delayed gastric emptying is important because it can cause an array of upper gastrointestinal symptoms, but additionally it has important implications for the absorption and action of levodopa. Delayed gastric emptying contributes significantly to response fluctuations seen in people on long‐term l ‐dopa therapy. Neurohormonal aspects of the brain‐gut axis are pertinent to discussions regarding the pathophysiology of delayed gastric emptying in PD and are also hypothesized to contribute to the pathogenesis of PD itself. Ghrelin is a gastric‐derived hormone with potential as a therapeutic agent for delayed gastric emptying and also as a novel neuroprotective agent in PD. Recent findings relating to ghrelin in the context of PD and gastric emptying are considered. This article highlights the pathological abnormalities that may account for delayed gastric emptying in PD. It also considers the wider relevance of abnormal gastric pathology to our current understanding of the etiology of PD. © 2013 International Parkinson and Movement Disorder Society     

Arterial vasculopathy in systemic sclerosis: Computerized tomography (CT) angiographic features of macrovascular and microvascular upper limbs arteries

ObjectiveTo describe the CT angiographic findings of arterial vasculopathy in the major vessels as well as medium and micro vascular affection of the whole upper limbs arterial tree in patients with systemic sclerosis (SSc) with and without digital ulceration.MethodsTwenty-two cases with systemic sclerosis (12 limited and 10 diffuse) were recruited for the study. All patients fulfilled the American Rheumatism Association (ACR) criteria for the classification of SSc. For all patients routine laboratory investigations were performed including complete lipid profile. Computed tomography angiography (CTA) studies for the whole upper limb arterial tree were performed for both upper limbs in all cases.ResultsCTA studies showed involvement of subclavian arteries in 3 cases and axillary artery was involved in five cases. Brachial artery was affected in 5 cases. In the forearm the radial artery was affected in 4 cases with bilateral involvement in two cases (6 vessels), while ulnar artery was affected in five cases. Unilateral non visualization of the superficial palmar arch was observed in two cases with limited disease, while thinning out of the vessel wall with poor distal run off in 18 cases. A higher number of arterial vasculopathy was significantly associated with systolic pulmonary artery pressure (P = 0.001).ConclusionsMacrovascular arterial vasculopathy of upper limbs may occur in SSc irrespective of the disease pattern. Major arteries can be affected in association with other medium sized arteries of the forearms and microvascular arterial branches of the hands.     

Combat-related upper extremity injuries: Surgical management specificities on the theatres of operations

This review presents the current surgical management of combat-related upper extremity injuries during the acute phase. The strategy consists of saving the life, saving the limb and retaining function. Surgical tactics are based on damage control orthopaedics techniques of haemorrhage control, wound debridement, and temporary bone stabilization prior to evacuation out of the combat zone. Features of the definitive management of local casualties in battlefield medical facilities are also discussed. In this situation, reconstructive procedures have to take into account the limited resources and operational constraints.     

Excisional biopsy of suspected benign soft tissue tumors of the upper extremity: correlation between preoperative diagnosis and actual pathology

Background

Tumors of the upper extremity are common and mostly benign. However, the prevalence of discordant diagnosis of a solid hand tumor is less studied. The objectives of this retrospective study were (1) to determine the proportion of patients with a different (discrepant or discordant) pathological diagnosis compared to the preoperative diagnosis, (2) to determine the prevalence of the types of pathologies encountered at excisional biopsy for suspected benign tumors, and (3) to determine the types of tumors diagnosed when the surgeon does not make a preoperative diagnosis.

Methods

One hundred and eighty-two suspected benign soft tissue tumors of the upper extremity with a preoperative diagnosis other than ganglion cyst were excised by one of three surgeons over a 10-year period. A preoperative diagnosis was applied for 125 tumors. No preoperative imaging was used.

Results

Only 26 of the 125 tumors (21 %) with a preoperative diagnosis were discrepant. The tumors that were most likely to have a discrepant diagnosis were vascular tumors (32 %) and other less common benign tumors (33 %). Among the entire cohort of 182 tumors, lipomas (19 %), giant cell tumors of tendon sheath (GCTTS; 19 %), and vascular tumors (16 %) were the most frequent pathological diagnoses. Among the 57 tumors that did not have a preoperative diagnosis, most were vascular tumors (23 %), fibromas (14 %), and GCTTS (11 %). One tumor without a preoperative diagnosis was a malignant tumor, but we consider this unusual and possibly spurious.

Conclusions

A hand surgeon’s preoperative diagnosis without imaging is usually correct prior to excision of a mass in the hand. Discrepant diagnoses are usually benign and do not alter treatment. Level of evidence: Prognostic II     

鞘内注射阿片复合纳洛酮对切口痛大鼠痛行为学及血浆胃动素的影响

目的观察鞘内注射吗啡、芬太尼复合小剂量纳洛酮对切口痛大鼠痛行为学及血浆胃动素(MTL)的影响。方法取鞘内置管成功的健康雄性SD大鼠72只,随机分为6组(n=12):生理盐水(NS)组,切口痛(P)组,吗啡(5μg/kg)+芬太尼(0.25μg/kg)组(MFP组),吗啡+芬太尼+纳洛酮1(0.2 ng/kg)、2(1 ng/kg)、3(5 ng/kg)组(MFPN1、2、3组)。后5组行足跖肌切口。各组取其中6只于鞘内置管前24 h(T0)、造模前24 h(T1)、术后1 h(T2)、3 h(T3)、6 h(T4)、24 h(T5)、48 h(T6)、72 h(T7)检测机械缩足阈值(PWMT)与热缩足反射潜伏期(PWTL),剩余6只于术后6h即刻断头处死,取血浆以ELISA法检测MTL浓度。结果 MFPN2组与NS组各时点PWMT差异无统计学意义,而与NS组相比,T2、T5时点PWTL上调(P<0.05),其余各时点差异无统计学意义。P组、MFPN3组与NS组比较,T2、T3、T4时点PWMT、PWTL显著下调(P<0.05)。而MFPN3组与P组比较,T6时点PWMT及T3、T4时点PWTL下调更为显著(P<0.05)。P、MFP、MFPN1、MFPN3组与NS组比较,术后6 h MTL表达下调(P<0.05)。而MFPN2与NS组MTL表达差异无统计学意义。结论鞘内注射1 ng/kg纳洛酮抑制了吗啡+芬太尼对切口痛大鼠血浆MTL表达的影响,并能上调大鼠热辐射痛阈值,增强了阿片类药物的镇痛效果。     

Evaluation of the toxicity of food additive silica nanoparticles on gastrointestinal cells

Silica nanoparticles (NPs) have been widely used in food products as an additive; however, their toxicity and safety to the human body and the environment still remain unclear. As a food additive, silica NPs firstly enter the human gastrointestinal tract along with food, thus their gastrointestinal toxicity deserves thorough study. Herein, we evaluated the toxicity of food additive silica NPs to cells originating from the gastrointestinal tract. Four silica NP samples were introduced to human gastric epithelial cell GES‐1 and colorectal adenocarcinoma cell Caco‐2 to investigate the effect of silica sample, exposure dose and exposure period on the morphology, viability and membrane integrity of cells. The cell uptake, cellular reactive oxygen species (ROS) level, cell cycle and apoptosis were determined to reveal the toxicity mechanism. The results indicate that all four silica NPs are safe for both GES‐1 and Caco‐2 cells after 24‐h exposure at a concentration lower than 100 µg ml^–1. At a higher concentration and longer exposure period, silica NPs do not induce the apoptosis/necrosis of cells, but arrest cell cycle and inhibit the cell growth. Notably, silica NPs do not pass through the Caco‐2 cell monolayer after 4‐h contact, indicating the low potential of silica NPs to cross the gastrointestinal tract in vivo. Our findings indicate that silica NPs could be used as a safe food additive, but more investigations, such as long‐term in vivo exposure, are necessary in future studies. Copyright © 2013 John Wiley & Sons, Ltd.