Gastro-oesophageal reflux disease: Medical or surgical treatment? Report of an interactive workshop

Gastroesophageal reflux disease (GERD) is the most common disease of the upper gastrointestinal tract. With the introduction of proton pump inhibitors medical treatment of GERD has been significantly improved. However, the development of laparoscopic antireflux surgery resulted in an increasing interest of surgeons in this disease. An interactive meeting was organized in order to develop an agreement between gastoenterologists and surgeons regarding therapeutic decisions and this is the main topic of this paper.     

Beta-defensin genomic copy number is not a modifier locus for cystic fibrosis

Human beta-defensin 2 (DEFB4, also known as DEFB2 or hBD-2) is a salt-sensitive antimicrobial protein that is expressed in lung epithelia. Previous work has shown that it is encoded in a cluster of beta-defensin genes at 8p23.1, which varies in copy number between 2 and 12 in different individuals. We determined the copy number of this locus in 355 patients with cystic fibrosis (CF), and tested for correlation between beta-defensin cluster genomic copy number and lung disease associated with CF. No significant association was found.     

Missense FGFR3 mutations create cysteine residues in thanatophoric dwarfism type I (TD1)

Thanatophoric dwarfism (TD) is a sporadic lethal skeletal dysplasia with micromelic shortening of the limbs, macrocephaly, platyspondyly and reduced thoracic cavity. In the most common subtype (TD1), femurs are curved, while in TD2, straight femurs are associated with cloverleaf skull. Mutations in the fibroblast growth factor receptor 3 (FGFR3) gene were identified in both subtypes. While TD2 was accounted for by a single recurrent mutation in the tyrosine kinase 2 domain, TD1 resulted from either stop codon mutations or missense mutations in the extracellular domain of the gene. Here, we report the identification of FGFR3 mutations in 25/26 TD cases. Two novel missense mutations (Y373C and G370C) were detected in 8/26 and 1/26 TD1 cases respectively. Both mutations created cysteine residues in the juxta extramembrane domain of the receptor. Sixteen cases carried the previously reported R248C (9/26 cases), S249C (2/26 cases) or stop codon FGFR3 mutations (5/26 cases). Our results suggest that TD1 is a genetically homogeneous condition and give additional support to the view that newly created cysteine residues in the extracellular domain of the protein play a key role in the severity of the disease.      

Morphological analysis of degeneration and regeneration of syncytiotrophoblast in first trimester placental villi during organ culture

We have recently shown using dansyl-L-lysine exclusion studies that the release of human chorionic gonadotrophin (HCG) in conjunction with L- lactate dehydrogenase (LDH) from first trimester villi during organ culture is symptomatic of syncytiotrophoblast degeneration. The purpose of this study was to examine chorionic villi at the ultrastructural level in order to determine events occurring during organ culture. The tissue was sampled after 0, 24, 48 and 120 h in culture and processed for electron microscopy. In addition to confirming the previously recorded syncytial degeneration, the electron micrographs showed clearly the generation of a new syncytiotrophoblast layer. The new layer, derived from differentiating cytotrophoblast cells, was largely formed by 48 h and was maintained for at least 120 h in culture. This study demonstrates a model which provides an opportunity to study the differentiation of cytotrophoblast cells whilst they retain their anatomical relationships within the villous structure.      

Cardio-respiratory adjustments and cost of locomotion in school children during backpack walking (the Italian Backpack Study)

The use of a school backpack is one of the possible causes of back pain in children. Oxygen consumption ( ), pulmonary ventilation, and heart rate (f _c) were measured in 35 pre-pubertal subjects [17 girls and 18 boys, mean (SD) age 11.3 (0.6) years]. They took part in a four-step experiment: (1) standing for 5 min, (2) walking at 3 km·h^–1 for 7 min, (3) walking at 3 km·h^–1 for 7 min carrying a school backpack weighing 8 kg, and (4) walking at 7 km·h^–1 for 5 min with no load. The occurrence of back pain in the last 2–3 years and during the last 15 days was assessed for the subjects by means of a questionnaire. Mean (SD) standing was 215 (45) ml^.min^–1 during walking at 3 km·h^–1, 503 (101) ml^.min^–1 during walking without a load, and increased to 541 (98) ml^.min^–1 during walking with a load (P<0.01). Carrying a backpack increased f _c only minimally. The energy cost of walking at 3 km^.h^–1 without the backpack was 10.0 (2.0) ml O₂ ^.m^–1, and with the backpack was 10.8 (1.9) ml O₂ ^.m^–1 (P<0.01). The net energy cost of locomotion was 0.129 (0.032) ml^.kg body mass^–1.m^–1 for the unloaded condition and slightly lower, at 0.123 (0.025) ml^.kg body mass^–1.m^–1 during loaded walking (P<0.05). Ventilation did not change significantly between unloaded and loaded conditions. When the data were assessed according to the occurrence of back pain, the f _c/ slope was significantly lower in children without back pain, even though the net energy cost of locomotion was similar. Overall, these data suggest that the cardiovascular effortrequired for locomotion while carrying a backpack is minimal. However, fatigability and back pain are more likely to take place in less physical performing subjects. Thus, the occurrence of back pain in schoolchildren during locomotion while carrying a backpack may improve with an improvement in their level of fitness. Electronic Publication