Corticotropin-releasing factor is present in intestinal tissue of patients with gastrointestinal dysfunction following shock and abdominal surgery

OBJECTIVE

Corticotropin-releasing factor (CRF) is implicated in stress-related gastrointestinal dysfunction, possibly causing gut dysfunction following trauma and surgery. We investigated plasma and intestinal tissue CRF levels and gut function in patients with traumatic shock or those undergoing elective abdominal surgery.

RESEARCH METHODS AND PROCEDURES

In a prospective, parallel, observational study in a university hospital surgical intensive care unit (ICU), 8 shocked patients (systolic blood pressure <90 mmHg and/or acidosis and/or urine output <1 mL/kg/hr and/or requiring >2 L of intravenous fluid resuscitation) undergoing small bowel resection during emergency laparotomy following abdominal injury and 17 stable patients undergoing elective hepatobiliary surgery were included if they required postoperative ICU management. Serial plasma and intestinal CRF was measured and postoperative gastric emptying and intestinal permeability were evaluated.

RESULTS

Plasma CRF was significantly increased in the shocked patients compared with the elective surgery patients at all times. CRF peptide was quantified in intestinal tissue at similar levels in both groups. Intestinal permeability was increased and associated with shock and resuscitation fluid volume. Gastric emptying was retarded and correlated significantly with shock but not with plasma CRF. Delayed gastric emptying in shocked patients was associated with longer ICU stay.

CONCLUSIONS

The novel finding is the presence of CRF in the small bowel of both elective and emergency gastrointestinal surgery patients with concomitant gastrointestinal dysfunction. Circulating CRF is associated with poor gastric emptying, which prolongs ICU stay, whereas shock significantly impairs gastric emptying and gut permeability.

The relationship between blood lead levels and morbidities among workers employed in a factory manufacturing lead-acid storage battery

The present study was carried out to find the relationship between blood lead levels (BLLs) and morbidities among 391 male workers employed in a factory manufacturing lead-acid storage batteries. A predesigned questionnaire was used to collect information on subjective health complaints and clinical observation made during a clinical examination. In addition to monitoring of BLL, other laboratory parameters investigated included hematological and urine-δ-aminolevulinic acid levels. Logistic regression method was used to evaluate the relationship between BLL and morbidities. The BLL among workers was associated with an odd ratio of respiratory, gastrointestinal (GI), and musculoskeletal (MSD) morbidities. Mean corpuscular hemoglobin and packed cell volume variables were associated with respiratory problems. The variables of alcohol consumption and hematological parameters were associated with GI complaints. Systolic blood pressure was related to MSD in workers exposed to Pb during the manufacturing process.

The impact of hypoglycaemia on patients admitted to hospital with medical emergencies

AIMS

To quantify the frequency of biochemical hypoglycaemia in acutely unwell patients in the medical assessment unit and relate this to their subsequent outcomes.

METHODS

A retrospective audit was conducted on all emergency medical patients attending the medical assessment unit between November 2010 and April 2011. Capillary blood glucose measurements were obtained and electronically stored for all patients. Admission details, presence of diabetes, type of diabetes and treatment, length of stay in hospital and death in hospital were obtained from the hospital clinical coding data and electronic discharge summary. The incidence of hypoglycaemia in patients with and without diabetes was quantified. The mean age, length of stay and percentage of death in hospital were compared between groups with and without hypoglycaemia.

RESULTS

One hundred and thirty-eight (9.5%) patients with diabetes and 70 (2.7%) patients without diabetes had an episode of hypoglycaemia in the medical assessment unit. Patients with diabetes and hypoglycaemia on admission had a significantly longer length of stay (mean ± sd) (10.3 ± 11.2 vs. 7.3 ± 9.5 days, P = 0.001) and higher rate of hospital mortality (14.5 vs. 5.2%, P < 0.001) compared with those without hypoglycaemia. Patients without diabetes with hypoglycaemia had a longer length of stay (mean ± sd) (9.1 ± 10.5 vs. 6.7 ± 9.9 days, P = 0.05) and a higher rate of hospital mortality (24.3 vs. 5.4%, P < 0.001) compared with those without hypoglycaemia.

CONCLUSION

Hypoglycaemia is associated with an increased length of stay in hospital and an increased in-hospital mortality rate. Hypoglycaemia may have contributed to the poorer outcome, but would also appear to be a marker of disease severity in unwell patients, especially patients with sepsis.

Vitamin D deficiency in children with a chronic illness-seasonal and age-related variations in serum 25-hydroxy Vitamin D concentrations

Introduction

Children and adolescents with a chronic illness have potential risk factors for vitamin D deficiency. An optimal vitamin D status might have multiple health effects. This study evaluated vitamin D status and its association with age, gender, and season in a large cohort of chronically ill Finnish patients at a tertiary pediatric outpatient clinic. A cross-sectional register-based study was carried out, involving altogether 1351 children (51% boys, age range 0.2–18 years), who visited the outpatient clinic during 2007–2010 and had their vitamin D status (S-25-OHD) determined. A post-doc analysis was conducted to identify predisposing and preventing factors for vitamin D deficiency.

Results

Almost half (47%) of the S-25-OHD values were consistent with subnormal vitamin D status (S-25-OHD <50 nmol/L) while only 12% were >80 nmol/L. Age and season were the most important determinants for S-25-OHD concentration. Mean S-25-OHD concentration differed between age groups (Kruskal-Wallis; p<0.001), adolescents being at highest risk for vitamin D insufficiency. Young age and vitamin D supplementation were preventive factors for deficiency, while non-Finnish ethnic background was a predisposing factor. S-25-OHD showed significant seasonal variation in children older than 6 years. In the whole cohort, S-25-OHD was on average 13 nmol/L higher in summer than in winter, and the prevalence of vitamin D deficiency ( =  S-25-OHD <37.5 nmol/l) varied from 11% in summer to 29% in winter.

Conclusions

The finding that almost half of the studied Finnish children with a chronic illness had suboptimal vitamin D status is alarming. Inferior vitamin D status was noted in adolescents compared with younger children, suggesting that imbalance between intake and requirement evolves with age. Although less common during summer, subnormal vitamin D status was still observed in 28% of those evaluated in summer. Clinicians should identify individuals at risk and actively recommend vitamin D supplementation.

[Apoptosis of neutrophils in the patients with the high risk of peritonitis occurrence after operation for acute diseases of the abdominal organs]

The processes of apoptosis of neutrophils of peripheral blood were studied in 43 patients, who were operated on for an acute abdominal diseases on the first and fourth postoperative day. Dynamic changes of apoptotic processes in neutrophils were established postoperatively. Unfavorable course of early postoperative period in the patients owing primarily high and middle risk of postoperative peritonitis occurrence have coincided with inhibition of the apoptosis processes in neutrophils.

Evaluation of toxicity and single-dose pharmacokinetics of intravenous ursolic acid liposomes in healthy adult volunteers and patients with advanced solid tumors

OBJECTIVE

The purpose of this study was to investigate the maximum tolerated dose (MTD), dose-limiting toxicity (DLT), and pharmacokinetics of ursolic acid liposomes (UAL), as a new drug, in healthy adult volunteers and patients with advanced solid tumors.

METHODS

All subjects received a single-dose of UAL (11, 22, 37, 56, 74, 98, and 130 mg/m(2)) administered as a 4-h intravenous infusion. Toxicity was assessed and plasma samples were analyzed using validated ultra-performance liquid chromatograph/tandem mass spectroscopy method.

RESULTS

A total of 63 subjects including 4 patients and 35 healthy adult volunteers for toxicity study and 24 healthy adult volunteers for pharmacokinetic study were enrolled in this trial. The DLT was encountered at 74, 98, and 130 mg/m(2), and consisted of hepatotoxicity and diarrhea. Other adverse events included grade 1 nausea, grade 2 abdominal distention, grade 1 microscopic hematuria, grade 2 elevated serum sodium, grade 1 vascular stimulation, and grade 1 skin rash. The MTD was 98 mg/m(2). The single-dose pharmacokinetic parameters revealed a linear relationship between C(max), AUC(0→24 h), or AUC(0→∞) and escalated doses.

CONCLUSIONS

The clinical data reported for the first time that UAL had manageable toxicities with MTD of 98 mg/m(2). The DLT were hepatotoxicity and diarrhea. Meanwhile, UAL had a linear pharmacokinetic profile. The registration number of this trial is ChiCTR-ONC-12002385.

Diagnostic utility of computer tomographic enterography for patients presenting with unexplained gastrointestinal symptoms

BACKGROUND/AIMS

Computer tomographic enterography (CTE) is gaining approval for evaluation of small bowel diseases. However, the diagnostic yields of CTE for diseases other than Crohn's disease have not yet been well elucidated. The aim of the present study was to determine the diagnostic utility of CTE and to ascertain the clinical factors predictive of the positive diagnostic rate in patients with unexplained gastrointestinal symptoms or signs.

METHODOLOGY

The clinical and radiological data of 193 patients with unexplained gastrointestinal symptoms that had a CTE examination at Severance Hospital between May 2007 and April 2010 were retrospectively analyzed.

RESULTS

CTE revealed positive findings that explained the symptoms in 51 of the 193 patients (diagnostic yield 26.4%). Positive findings of diagnosis included cancer (12 patients), Crohn's disease (10), intestinal stricture/obstruction (9), small bowel bleeding (7), colitis (6), intestinal Behcet's disease (4), intestinal tuberculosis (2) and intestinal fistula (1). According to univariate analysis, the positive findings of CTE were significantly associated with higher segmentated neutrophil count (p<0.001), higher erythrocyte sedimentation rate (ESR) (p=0.003), higher C-reactive protein (CRP) level (p=0.008) and lower serum albumin level (p=0.037). Multivariate analysis indicated that elevated CRP level was a significant risk factor for the positive findings of CTE (odds ratio 1.950; 95% CI (1.165-3.265), p=0.011).

CONCLUSIONS

The results of this study suggest that CTE could be helpful in patients suffering from unexplained gastrointestinal symptoms that cannot be explained by established examinations, especially those with elevated C-reactive protein levels.

[The alteration of concentration of essential microelements in blood plasma in children with chronic diseases of gastrointestinal tract and having different body mass]

The article deals with the characteristics of alterations of mineral metabolism indicators in children of various age with chronic diseases ofgastrointestinal tract and having body mass of normal and different surplus degrees. The sample consisted of 127 children aged from 6 to 15 years with chronic gastroduodenitis, pancreatitis and cholecystitis. The concentration of bioelements in plasma was determined using the technique of mass spectrometry with inductively coupled plasma. The study established the increase of concentration of molybdenum 4.3 times, chrome--8.4 times and selenium--1.36 times. The revealed bioelemental misbalance impacts the overall health of children and course of disease and hence has to be accounted in case of application of treatment targeted to the correction of mineral metabolism.

Folate in gastrointestinal health and disease

OBJECTIVE

Folate has heterogeneous functions and is involved in several activities in both animal and human body. It is an important constituent of our organism, and its bioavailability is mainly dependent from the correct function of our gastrointestinal tract. Our aim is to describe what happens to folate homeostasis in gastrointestinal health and disease, analyzing the alterations of folate metabolism in some specific conditions of intestinal and liver impairment.

DISCUSSION

Folate absorption and metabolization involve the small intestine and the liver; in conditions of gastrointestinal tract disease (i.e. celiac disease, liver disease) folate function may be compromised with important consequences on the whole organism. Moreover, folate deficiency may produce gastrointestinal alterations too. For this reason, the gastrointestinal tract could be the responsible but also the victim of folate deficiency.

CONCLUSIONS

The presence of folate deficiency should always be assessed in patients with a gastrointestinal disease. Further studies are needed to assess the role of folates in gastrointestinal tract diseases and in other gynecologic, neurologic, psychiatric, cardiovascular, ophthalmic and neoplastic diseases. Folates supplementation could be considered, in the future, as an effective complimentary therapy in several pathologic conditions.

Impact of premature birth and critical illness on neonatal range of plasma amino acid concentrations determined by LC-MS/MS

BACKGROUND

The number of newborns and the number of disorders detected by large-scale screening programs has increased dramatically in the last decade. Newborn screening is a multi-step process requiring confirmatory testing to establish and refine a diagnosis. Whereas screening cutoffs are established to detect all cases of a specific disease, confirmatory testing is performed against a backdrop of many co-morbid conditions and interpretation of results is often not straightforward. The goal of the current study was to define the range of amino acid concentrations encountered in normal, premature, and acutely ill newborns as an aid to the interpretation of follow-up testing for suspicious newborn screens.

MATERIALS AND METHODS

Residual plasma samples from 354 neonates (age 1-10 days) were utilized. 206 samples were from neonates with uncomplicated birth histories and prompt hospital discharge. 98 specimens were derived from a population of children receiving intensive care with diagnoses that included sepsis, respiratory insufficiency, cardiac malfunction/malformation and gastrointestinal complications. 50 samples were from infants born after 32 but before 37 full weeks gestation that were discharged following uneventful hospital courses. 25 amino acids were quantitated by LC-MS/MS and reference intervals determined by non-parametric statistical methods. Distributions were compared using Kruskal-Wallis analyses for independent samples.

RESULTS

The distributions of multiple amino acids in premature and critically ill infants were significantly different than those observed in healthy newborns. Differing distributions were found for phenylalanine, the branched chain amino acids, methionine, glutamine, glutamate, arginine, lysine, α-aminoadipic acid, and β-aminoisobutyric acid. In most cases median values were increased and distributions more positively skewed in premature or ill newborns compared to healthy newborns. In addition, we report neonatal homocitrulline reference intervals for these newborn populations determined by an LC-MS/MS technique that is not confounded by methionine interference.

CONCLUSION

These data provide a basis for improved detection of genetic metabolic disorders in newborns, particularly those born prematurely or with a variety of critical co-morbid conditions.

[Relationship between plasma levels of vasoactive intestinal peptide and feeding intolerance in preterm infants]

OBJECTIVE

To study the changes of plasma vasoactive intestinal peptide (VIP) levels and the relationship of plasma VIP levels with feeding intolerance (FI) in preterm infants.

METHODS

Plasma VIP concentrations were measured using radioimmunoassay in 53 preterm infants with FI 1, 4, 7 and 14 days after birth. Fifty-nine preterm infants without FI served as the control group.

RESULTS

The fasting plasma concentrations of VIP in the FI group 1, 4 and 7 days after birth (129 ± 46, 144 ± 32 and 166 ± 31 pg/mL respectively) were significantly lower than those in the control group (195 ± 63, 197 ± 31 and 205 ± 34 pg/mL respectively) (P<0.05). The increased plasma VIP concentrations were associated with the increased gestational age, age in days and enteral feeding volume in the FI group. By 14 days, the plasma concentrations of VIP in the FI group (198 ± 41 pg/mL) were similar to those in the control group (202 ± 48 pg/mL) (P>0.05). The younger the infant's gestational age, the more prolonged the FI. Plasma levels of VIP on day 1 of life in the FI group were negatively correlated with the duration of FI (r=-0.799, P<0.05).

CONCLUSIONS

Plasma levels of VIP might be related to the development of FI in preterm infants and might serve as a predictor of FI.

Serum level of pepsinogen significantly associated with gastric distress induced by amino-bisphosphonates

To elucidate whether serum levels of pepsinogens are associated with the occurrence of gastrointestinal adverse events induced by amino-bisphosphonates (amino-BP), the serum levels of pepsinogen were measured in amino-BP users. Our results indicate that measurement of pepsinogen I is useful in predicting gastric distress induced by amino-BP in osteoporosis.

INTRODUCTION

To elucidate whether serum levels of pepsinogens are associated with the occurrence of gastrointestinal adverse events induced by amino-BP, the serum levels of pepsinogen I and II were measured in amino-BP users.

METHODS

When the patients complained of gastric distress symptoms during the first 6 months after amino-BP use resulting in discontinuation of the drug, endoscopical examinations were performed to assess whether gastric lesions were present. A total of 223 amino-BP users were enrolled in the study, of which 47 patients refused to take the drug due to gastric distress symptoms. The remaining 176 patients did not complain of any gastric distress.

RESULTS

Among 47 patients, eight patients showed obvious gastric lesions such as gastric or duodenal ulcers and acute gastric mucosal lesions in the endoscopical examination. The remaining 39 patients did not show any gastric lesions. The possible confounding factors, such as a Helicobactor pylori infection or concurrent use of ulcerogenic agents, did cause not affect gastric distress in amino-BP users. The serum pepsinogen I level was significantly associated with severity of the gastric lesion 46.8 ± 27.7, 60.8 ± 32.4, and 103.4 ± 49.2 ng/ml for patients without any gastric distress, with gastric distress accompanied no gastric lesions, and with gastric distress accompanied gastric lesions, respectively.

CONCLUSIONS

ROC analysis revealed that the cutoff value of pepsinogen I for expectation of gastric regions was 76.8 ng/ml. The results clearly indicate that measurement of pepsinogen I may be useful in predicting gastric distress induced by amino-BP in osteoporosis.

[Diamine oxidase as blood biomarker in rats and humans to GI tract toxicity of fluorouracil anti-cancer drugs]

Diarrhea is a side effect of a 5-fluorouracil (5-FU) anti-cancer drug-induced intestinal mucosal disorder, which sometimes becomes more severe. Blood diamine oxidase (DAO; EC1. 4. 3. 6) activity is reported to be significantly correlated with activity in the small intestinal mucosal tissue, and to be a reliable indicator of small intestinal mucosal integrity and maturity. Here, we investigated whether blood DAO activity can be a biomarker for the gastrointestinal (GI) mucosal disorder caused by 5-FU anti-cancer drugs, both in rats and humans. From results of the rat study, the degree of jejunal mucosal disorder caused by the 5-FU anti-cancer drug was well correlated with a decrease in blood DAO activity. Clinically, 12 out of 28 patients (43%) administered 5-FU anti-cancer drug suffered from diarrhea. The plasma DAO activity within one week of the onset of diarrhea significantly decreased compared with that before the administration. Furthermore, before drug administration, plasma DAO activity in patients suffering from diarrhea was higher than those in patients without diarrhea. Although DAO activity differs by the individual, it is a useful biomarker for estimating the degree of intestinal mucosal disorder, and possibly for estimating manifestations of diarrhea induced by 5-FU anti-cancer drug administration.

Relationship between Helicobacter pylori infection estimated by 14C-urea breath test and gender, blood groups and Rhesus factor

The aim of this study was the detection of helicobacter pylori (HP) infection and estimation of this infection relationship with age, gender, blood groups and Rhesus factor, as well as the assessment of the accuracy of the method. A total of 227 patients with gastritis were examined. Blood ABO groups and Rh positivity were determined using standard tests. Infection by HP was proved by (14)C-urea breath test and gastric biopsy. Patients were aged 20-81 years (X=51.7 years) and the presence of HP was not related to the age (P>0.05). From the total number of patients, 25/69 males and 68/158 females were HP positive. There was no significant difference between genders and HP infection (P>0.05). From the 227 investigated patients, 69 (30%) belonged to blood group O, 96 (42%) to A, 40 (18%) to B and 22 (10%) to AB. HP was detected in 27/69 patients with blood group O, 45/96 patients with blood group A, 16/40 patients with blood group B and 5/22 patients with blood group AB. There was no statistically significant difference (P>0.05) in the incidence of HP infection between these groups (proving that HP infection did not depend upon the blood groups). Also, there was no significant correlation between the presence of particular blood group in HP+ patients related to the reported frequency of the blood groups in Serbian population (0--38%, A--42%, B--15%, AB--5%). HP was found in 16/36 Rh- and in 77/191 Rh+ patients without statistical difference (P>0.05). Also, there was no significant correlation of the presence of the Rh factor in the HP positive patients to the frequency of the Rh factor in the Serbian population (84% Rh+ and 16% Rh-). The basic value of the HP+ test was slightly, but not significantly lower in comparison to the HP- patients (P>0.05). On the contrary, test values showed a highly significant difference (P<0.01) in HP+ and HP- patients. In conclusion, in adults HP infection does not depend upon the patient's age, gender, blood group type or Rh factor. In clinical terms, there were 93 true positive (TP), 129 true negative (TN), 5 false negative (FN) and 0 false positive (FP) patients. Sensitivity of the method was 94.9%, specificity 100%, positive predictive value 100%, negative predictive value 96.3% and accuracy 97.8%.

Increased plasma peroxides and serum oxidized low density lipoprotein antibodies in major depression: markers that further explain the higher incidence of neurodegeneration and coronary artery disease

BACKGROUND

Major depression is characterized by a decreased antioxidant status, an induction of the inflammatory and oxidative and nitrosative (IO&NS) pathways and inflammatory-neurodegenerative (I&ND) pathways. This study examines two markers of oxidative stress in depression, i.e. plasma peroxides and serum oxidized LDL (oxLDL) antibodies.

METHODS

Blood was sampled in 54 patients with major depression (mean+/-SD age=43.5+/-11.6 years) and 37 normal volunteers (43.6+/-11.1 years). The severity of illness was measured by means of the Hamilton Depression Rating Scale. The Fibromyalgia and Chronic Fatigue Syndrome Rating Scale was used to measure severity of "psychosomatic" symptoms in depression.

RESULTS

We found significantly higher plasma peroxides (p=0.002) and serum oxLDL antibodies (p=0.0002) in depressed patients as compared to normal controls. There was no significant correlation between both markers and both independently from each other predicted major depression. There were significant correlations between the oxLDL antibodies and the scores on two items of the FF scale, i.e. gastro-intestinal symptoms and headache.

DISCUSSION

The results show that major depression is accompanied by increased oxidative stress and lipid peroxidation. These results further extend the IO&NS pathophysiology of major depression. Since increased peroxides and oxLDL antibodies are predictors of coronary artery disease (CAD) and neurodegeneration, our findings suggest that IO&NS pathways are involved in the increased incidence of both CAD and neurodegeneration in depression.

Antibodies against gonadotropin-releasing hormone (GnRH) and destruction of enteric neurons in 3 patients suffering from gastrointestinal dysfunction

BACKGROUND

Antibodies against gonadotropin-releasing hormone (GnRH) and gastrointestinal dysmotility have been found after treatment with GnRH analogues. The aim of this study was to examine the presence of such antibodies in patients with dysmotility not subjected to GnRH treatment and study the anti-GnRH antibody effect on enteric neurons viability in vitro.

METHODS

Plasma and sera from 3 patients suffering from either enteric dysmotility, irritable bowel syndrome (IBS) or gastroparesis were analysed for C-reactive protein (CRP), and for GnRH antibodies and soluble CD40 by ELISA methods. Primary cultures of small intestinal myenteric neurons were prepared from rats. Neuronal survival was determined after the addition of sera either from the patients with dysmotility, from healthy blood donors, antiserum raised against GnRH or the GnRH analogue buserelin. Only for case 1 a full-thickness bowel wall biopsy was available for immunohistochemical analysis.

RESULTS

All 3 patients expressed antibodies against GnRH. The antibody titer correlated to the levels of CD40 (rs = 1.000, p < 0.01), but not to CRP. Serum from case 3 with highest anti-GnRH antibody titer, and serum concentrations of sCD40 and CRP, when added to cultured rat myenteric neurons caused remarkable cell death. In contrast, serum from cases 1 and 2 having lower anti-GnRH antibody titer and lower sCD40 levels had no significant effect. Importantly, commercial antibodies against GnRH showed no effect on neuron viability whereas buserelin exerted a protective effect. The full-thickness biopsy from the bowel wall of case 1 showed ganglioneuritis and decrease of GnRH and GnRH receptor.

CONCLUSION

Autoantibodies against GnRH can be detected independently on treatment of GnRH analogue. Whether the generation of the antibody is directly linked to neuron degeneration and chronic gastrointestinal symptoms in patients with intestinal dysmotility, remains to be answered.

Effect of fasting on coagulation factors in patients who undergo major abdominal surgery

Major abdominal surgery without preoperative adequate oral intake with some cephalosporins may result in vitamin K deficiency and bleeding tendency. The aim of this study is to clarify the effect of preoperative fasting on postoperative coagulation factors. We prospectively examined 16 patients who underwent major abdominal surgery. Patients were divided into a preoperative fast group (Group F, n = 7, mean period of preoperative fasting 8.7 days) and a control group (Group C, n = 9). We did not administer vitamin K and initiated feeding after the seventh postoperative day. In Group C, prothrombin time (PT) and Factors II, VII, IX, and X levels were decreased after the surgery to within normal limits. In Group F, the PT and Factors II, VII, and X levels were decreased after the surgery. Abnormal lower levels of PT and Factors II, VII, and X were seen in 67, 33, 67, and 67 per cent of patients after the surgery, respectively. Factors VII and X levels were higher than in Group C by the third postoperative day. The protein induced by vitamin K absence or antagonist-II levels in Group F were increased at all postoperative points. Clinicians should realize that preoperative fasting for as little as 1 week can induce precoagulopathy, resulting in postoperative coagulopathy after major surgery.

[Influence of enteral nutrition therapy on serum angiogenic growth factors concentrations in children]

INTRODUCTION

Effectiveness of enteral nutrition therapy is not only connected with improvement of the nutritional status of the patient, but also with its strong anti-inflammatory activity. Angiogenic growth factors play an important role in the early stage of inflammation. Vascular endothelial growth factor (VEGF) and transforming growth factor beta 1 (TGF-beta 1) stimulate the angiogenesis and healing processes. The objective of our study was to assess the influence of the enteral nutrition therapy on the vascular endothelial growth factor (VEGF) and transforming growth factor beta 1 (TGF-beta 1) concentrations in serum in children with different diseases of gastro-intestinal tract, in which enteral nutrition therapy is effective method of treatment.

MATERIAL AND METHODS

Sixty two children (29 boys, 33 girls, mean age: 12.5 yrs, range: 6-18 yrs) and 25 healthy controls were included into the study. The Crohn's disease group (CD) consisted of 25 patients, ulcerative colitis group (UC)-18 patients, acute pancreatitis (AP) group-12 patients and severe malnutrition (N) group-7 patients. Serum VEGF and TGF-beta 1 concentrations were assessed at baseline, before starting and after 2 and 4 weeks of enteral nutrition therapy using ELISA immunoassays (R and D Systems, USA).

RESULTS

Before starting enteral nutrition, we found increased VEGF concentration in CD group (Me = 600 pg/ml) compared to UC group (266.9 pg/ml), AP group (552.6 pg/ml), N group (238.5 pg/ml) and controls (172 pg/ml) (p < 0.05). We found decrease of VEGF concentrations during enteral nutrition in CD, UC and N group and increase in AP at the beginning, followed by decrease to the initial values. Assessing TGF-beta 1, we found its concentration increased before starting enteral nutrition in UC group (37.5 ng/ml) compared to CD group (29.7 ng/ ml) and controls (24.8 ng/ml) (p < 0.05). During enteral nutrition we observed decrease of TGF-beta 1 concentration in UC group and increase in CD group (32,7 ng/ml) and AP group (26,6 ng/ml) (p < 0.05) The best improvement of nutritional status was observed in CD patients compared to N and AP patients.

CONCLUSIONS

Differentiation of serum VEGF and TGF-beta 1 concentrations, what was observed in various gastro-intestinal diseases, reflects different mechanisms of enteral nutrition therapy acting on the inflammatory process. The most efficient therapeutic effect was seen in CD, where stimulation of TGF-beta 1 production was observed.

[Correction of syndrome-associated metabolic disturbances in patients with erosive and ulcerative lesions in the gastroduodenal system]

Correction of syndrome-associated metabolic disturbances in patients with erosive and ulcerative lesions in the gastroduodenal system was achieved by inclusion of moderately mineralized drinking water (Essentuki No 4 and the like), low-sulfide mineral baths, and essential phospholipids in the system of combined sanatorium-and-spa treatment. This approach allowed metabolic status of the patients to be improved and peroxide homeostasis stabilized. Moreover, it had generalized beneficial effect on the pathological process.

[On erythropoietin level formation in the blood under conditions of acute disturbance of cardiac function]

The erythropoietin levels in the blood of 50 patients with myocardial infarction were studied. The control group consisted of 33 patients with gastroenterologic diseases. Increased erythropoietin production in patients with myocardial infarction was caused by blood hypoxia under conditions of keeping kidney erythropoietin function. No dependence was found between manifestation of heaviness of acute heart failure caused by acute myocardial ischemic and hormone production in patients without anemia.

Serum inorganic phosphate in middle-aged men. I. Inverse relation to body weight

Serum inorganic phosphate was determined in 752 men born in 1926. An inverse correlation was found between serum inorganic phosphate levels and body weight. Other parameters of possible relevance to this finding, such as serum calcium, serum albumin, serum lambda-glutamyltransferase, and the occurrence of upper gastrointestinal disorders were analysed, and no correlations to the phosphate level were detected.

[Leptin and food status in gastropancreatoduodenal pathology]

The regulation of weight of a body--is an actual problem of modern medicine. The significant part of patients with pathology of gastro-intestinal tract suffers of an increasing weight of a body. In economically advanced countries, including Russia, on the average each third inhabitant has an increasing weight of a body. Last researches shows, that the adipose tissue is not only a place of storage of power stocks, but also analogue endocryne body. The most part of peptides, participating in regulation of food behaviour, in a place of primary development in adipose cells, has been named adipokines. It is possible to attribute to them leptin. The purpose of our research was specification of influence of leptin level on character of a pathology of gastro-pancreato-duodenal zone. Under our supervision there were patients with diseases of gastro-pancreato-duodenal zone: chronic pancreatitis, duodenal ulcer, gastroduodenitis. It was revealed most increasing value of leptin in the patients with combination of chronic pancreatitis and duodenal ulcer.

[Evaluation of inclusion of specialized carbohydrate-protein product with vitamins and mineral substances in the diet therapy of gastrointestinal and osteopenia diseases]

It has been shown that inclusion of the specialized product containing 50% from recommended daily consumption of calcium, 20%--of protein, 17-60%--of 11 mineral substances and 11 vitamins in the diet of patients suffering from diseases of gastroenteric tract and osteopenia within 6 months lead to increasing of bone mineral density while it has not liquidated the existing vitamin B2 and vitamin D deficiency. The data obtained confirm the expediency of the development of specialized products of the set chemical composition intended for a concrete category of patients, and their inclusion in the diet.

An insight into the relationships between hepcidin, anemia, infections and inflammatory cytokines in pediatric refugees: a cross-sectional study

BACKGROUND

Hepcidin, a key regulator of iron homeostasis, is increased in response to inflammation and some infections, but the in vivo role of hepcidin, particularly in children with iron deficiency anemia (IDA) is unclear. We investigated the relationships between hepcidin, cytokines and iron status in a pediatric population with a high prevalence of both anemia and co-morbid infections.

METHODOLOGY/PRINCIPAL FINDINGS

African refugee children <16 years were consecutively recruited at the initial post-resettlement health check with 181 children meeting inclusion criteria. Data on hematological parameters, cytokine levels and co-morbid infections (Helicobacter pylori, helminth and malaria) were obtained and urinary hepcidin assays performed. The primary outcome measure was urinary hepcidin levels in children with and without iron deficiency (ID) and/or ID anaemia (IDA). The secondary outcome measures included were the relationship between co-morbid infections and (i) ID and IDA, (ii) urinary hepcidin levels and (iii) cytokine levels. IDA was present in 25/181 (13.8%). Children with IDA had significantly lower hepcidin levels (IDA median hepcidin 0.14 nmol/mmol Cr (interquartile range 0.05-0.061) versus non-IDA 2.96 nmol/mmol Cr, (IQR 0.95-6.72), p<0.001). Hemoglobin, log-ferritin, iron, mean cell volume (MCV) and transferrin saturation were positively associated with log-hepcidin levels (log-ferritin beta coefficient (beta): 1.30, 95% CI 1.02 to 1.57) and transferrin was inversely associated (beta: -0.12, 95% CI -0.15 to -0.08). Cytokine levels (including IL-6) and co-morbid infections were not associated with IDA or hepcidin levels.

CONCLUSIONS/SIGNIFICANCE

This is the largest pediatric study of the in vivo associations between hepcidin, iron status and cytokines. Gastro-intestinal infections (H. pylori and helminths) did not elevate urinary hepcidin or IL-6 levels in refugee children, nor were they associated with IDA. Longitudinal and mechanistic studies of IDA will further elucidate the role of hepcidin in paediatric iron regulation.

Gastrointestinal manifestations of dengue infection in adults

This is a retrospective study of the gastrointestinal symptoms, signs and laboratory parameters in adult dengue patients admitted to Kuala Lumpur Hospital from 1st December 2004 to 31st December 2004. Clinical and laboratory parameters that may predict the need for intensive care were investigated. Six hundred sixty-six patients with clinical and biochemical features consistent with dengue infection were identified. Patients were stratified into those who required intensive care and those who were managed in non high dependency wards. Serum alanine aminotransaminase (ALT) levels were normal in 22.8% of patients and 5.9% of patients had acute fulminant hepatitis. More patients with dengue haemorrhagic fever (DHF) had elevated ALT levels as compared to patients with classic dengue fever (DF) (p = 0.012). Patients with DF had a statistically significant lower mean ALT level as compared to patients with DHF. Abdominal pain (p = 0.01) and tenderness (p<0.001), gastrointestinal bleed (p<0.001), jaundice (p<0.001), hepatomegaly (p<0.001) and ascites (p<0.001) were predictors of need for intensive care. We conclude that gastrointestinal manifestations are very common in dengue patients. Presence of abdominal pain and tenderness, gastrointestinal bleed, jaundice, hepatomegaly and ascites can be used to triage patients requiring intensive care.

Features of ciguatera fish poisoning cases in Hong Kong 2004-2007

OBJECTIVE

To review the clinical features and laboratory investigations of ciguatera patients in Hong Kong between 2004 and 2007 in order to show the timely sampling of implicated fish from ciguatera victims and application of validated mouse bioassay for confirming suspected clinical cases of ciguatera.

METHODS

Diagnosis of the ciguatera victims was based on history of coral fish consumption and clinical presentations stated in official guidelines for clinical diagnosis of ciguatera fish poisoning in Hong Kong. Food remnants of coral fish samples were collected swiftly from ciguatera victims between 2004 and 2007 for ciguatoxins (CTXs) analysis.

RESULTS

Major clinical symptoms in ciguatera patients included gastrointestinal and neurological effects including limb numbness and diarrhoea, which developed at 0.5 to 15 hours after consumption of fish. In most cases, neurological symptoms were more common than gastrointestinal symptoms. A broad range of attack rate (10%-100%) was observed in each ciguatera outbreak. Validated mouse bioassay on ether extracts of the food remnant samples confirmed that all were CTXs-positive (<0.5 - 4.3 MU/20 mg ether extract) and directly linked to the corresponding ciguatera cases.

CONCLUSION

Consistency between clinical and laboratory analysis for ciguatera poisoning illustrates the application of laboratory mouse bioassay in a timely fashion for confirming ciguatera poisoning cases and implementing effective public health measures. With further improvement in laboratory techniques, features of ciguatera fish poisoning cases can be better defined. Further studies are needed to determine the risk of each class of CTXs (Pacific-, Indian- and Caribbean-CTXs) in Hong Kong.

[Effect of Zhizhuwan on gastrointestinal peptide concentrations in plasma of diabetic gastroenteropathy with constipation patients]

OBJECTIVE

To determine the therapeutic efficacy and elucidate the probable pharmacological mechanism of Zhizhuwan (ZZ), a known formula for GI/Dysmotility and constipation in Traditional Chinese medicine, in managing constipating diabetes mellitus (DM).

METHOD

Subjects, composed of both males and females, ranged from 55 to 76 years of age, and had constipating DM. Subjects with severe colon, rectum, heart, renal, or hepatic disease, obesity and those on medications known to alter gastrointestinal motility were excluded. 28 healthy subjects were also recruited. The study group (n = 28) received 90 g per day of ZZ and the control group (n = 28) received 30 mg per day of cisapride for a 1 month period. Conservative therapy was similar in both groups and administered by a person blinded to randomization code. Patients were assessed pre-treatment and post-treatment by a blinded interviewer. A constipation visual analogue scale (CVAS) was constructed to evaluate the patients' constipation status. To analyze neuropeptides motilin (MTL), vasoactive intestinal polypeptide (VIP), substance P (SP) levels in plasma, a radioimmunoassay technique was adopted. Data were analyzed for treatment effects using the "t" test.

RESULT

Base line characteristics were similar in both treatment groups. There were significant effects on symptom relief, increases in serum SP level, and decreases in VIP level in both groups (P < 0.05). ZZ was significantly more effective than cisapride in ameliorating patients' subjective symptoms of defecating and stool frequency, and increasing serum SP level (P < 0.05).

CONCLUSION

ZZ is beneficial in constipating DM via increasing SP levels and decreasing VIP levels of serum.

Gastrointestinal symptoms and glycemic control in diabetes mellitus: a longitudinal population study

BACKGROUND

The prevalence of gastrointestinal (GI) symptoms is increased in diabetes, but their natural history is understood poorly and any impact of glycemic control is controversial. We aimed to quantify changes in GI symptom status and glycemic control among a population sample of patients with diabetes.

METHODS

Data on 10 chronic GI symptom complexes were obtained from a validated questionnaire at baseline and after 12 months. Changes in acute and chronic glycemic control were classified as always adequate, variable (deteriorated or improved), or always inadequate; acute glycemic control was assessed by fasting plasma glucose and chronic glycemic control by a validated self-report 5-point graded scale.

RESULTS

Baseline and follow-up data were available in 136 individuals with diabetes (mean age 59 years; 66% males; 95% type 2). The most prevalent GI symptom complexes were abdominal bloating/distension (35%), ulcer-like dyspepsia (35%), and irritable bowel syndrome (27%). Overall, between 7 and 24% reported a change in GI symptoms with the largest change in irritable bowel syndrome (24%), bloating/distension (22%), and ulcer-like dyspepsia (21%). Those who had a change in abdominal bloating (either loss or gain) over 12 months were more likely to have increased their mean fasting plasma glucose (P<0.05). Contrary to expectations, consistently poor self-reported glycemic control was only weakly associated with less persistent abdominal pain (r=-0.2, P=0.03), diarrhea (r=-0.22, P=0.01), and abdominal bloating (r=-0.2, P=0.03). Acute glycemic control was not significantly related to any GI symptoms.

CONCLUSION

We were unable to demonstrate any association between worsening GI symptoms and glycemic control.

Gain and loss of gastrointestinal symptoms in diabetes mellitus: associations with psychiatric disease, glycemic control, and autonomic neuropathy over 2 years of follow-up

OBJECTIVE

To prospectively determine the turnover (gain or loss) of gastrointestinal (GI) symptoms in diabetic subjects in relation to glycemic control, autonomic neuropathy and psychiatric disease over a 2-year follow-up.

METHODS

Type 1 and type 2 diabetic subjects were recruited from the community, as were community controls. Individual GI symptoms were examined by a validated questionnaire and classified as diarrhea, irritable bowel syndrome, upper GI symptoms, and any GI symptoms at baseline, 12 and 24 months. Glycemic control (glycated hemoglobin), autonomic function (using standardized tests), and psychiatric disease (using the Composite International Diagnostic Interview) were also assessed at these time points.

RESULTS

Baseline and 2-year follow-up data were available for 139 diabetic subjects and 55 controls. Glycated hemoglobin at baseline was 7.7% (+/-1.36) in the diabetic group; 5% had severe autonomic dysfunction. There was a significantly higher prevalence of diarrhea in the diabetic subjects. GI symptom turnover varied between 15% and 25% in the diabetic group and was not significantly different from the controls. There was no clear association between turnover of GI symptoms and either glycemic control or autonomic neuropathy. The appearance of depression was associated with gaining of most symptoms apart from irritable bowel syndrome, although the associations did not always reach significance. The univariate results were confirmed after adjusting for age, gender, body mass index, and metformin use.

CONCLUSION

The turnover of GI symptoms in diabetic subjects was not associated with glycemic control but there was a positive association with change in depression.

[Vitamin status and bone mineral density at patients with diseases of gastroenteric tract]

It has been shown that among patients suffering from diseases of a gastroenteric tract and osteopenia the calcium insufficiency estimated on daily calcium urinary excretion and the lowered level of the transport form of vitamin D in blood serum take place more often, than among patients with the same pathologies, but without osteopenia. The most significant risk factors of bone mass decrease at the patients who have transferred operations on organs of digestion are insufficient supply with calcium and vitamin D and the body weight loss.

Myeloperoxidase assay in plasma and peritoneal fluid of horses with gastrointestinal disease

Gastrointestinal disorders, especially strangulating intestinal obstructions, are still a major cause of illness and death in the horse. Circulating lipopolysaccharides may activate both neutrophils and monocytes. The activated neutrophils release myeloperoxidase (MPO), a specific enzyme with strong oxidative activity. The aim of this study was to evaluate MPO concentrations in the plasma and peritoneal fluid (PF) of horses with colic and to check the hypothesis that these concentrations would be higher in a case of strangulating obstruction than in cases of nonstrangulating disease. By using a specific enzyme-linked immunosorbent assay for equine MPO, we determined the MPO concentrations in horses admitted to a clinic for colic. Horses with nonstrangulating or strangulating obstruction of the large intestine (NSLI or SLI), strangulating obstruction of the small intestine (SSI), or inflammatory bowel disease (IBD) were compared with healthy horses. The horses with SLI, SSI, or IBD had significantly higher MPO levels in plasma and PF than did those in the other 2 groups. The mean plasma level was significantly higher in the horses with NSLI than in the healthy horses. High MPO values in PF indicated necrotic bowel. These results show that neutrophil activation occurs during nonstrangulating and strangulating intestinal obstruction in horses and that the plasma and PF MPO concentrations may be a marker of the severity of the disease.

[Haptoglobin, serum amyloid-a and ceruloplasmin concentrations in goats with mixed helminth infection]

In this study, the concentrations of haptoglobin, serum amyloid A and ceruloplasmin were measured in goats with mixed gastrointestinal infections of nematodes and liver trematodes. Twelve patients who were diagnosed as having mixed helminth infection after detection of Trichuris spp., Trichostrongylidae spp. and Fasciola spp. and six healthy controls participated in the study. The concentrations of the acute phase proteins (haptoglobin p< or =0.001; serum amyloid-A p< or =0.05) were significantly higher in the goats with mixed gastrointestinal infection with nematodes and liver trematodes than the control goats. As a result of this study, we determined that the concentrations of haptoglobin and serum amyloid-A increased in goats with mixed helminth infection but further studies of the clinical importance of those increases in relation to prognosis and monitoring therapy of helminthic infections in goats should be made.

The relationship of Helicobacter pylori positivity with age, sex, and ABO/Rhesus blood groups in patients with gastrointestinal complaints in Turkey

BACKGROUND

To determine the magnitude of Helicobacter pylori infection in patients with gastrointestinal complaints in Turkey.

METHODS

We studied 1680 patients with variable gastrointestinal complaints. The H. pylori infection status was determined using C-14 urea breath test (UBT). Overall, 1567 patients (548 male, 1019 female; age range 4-80 years, mean 29.37 +/- 17.30 years) were included in this study. The relationship between H. pylori positivity and age, sex, sociodemographic characteristic, blood groups, and gastrointestinal diagnosis was determined.

RESULTS

H. pylori positivity was found to be 68%. The difference in positivity rates between age groups 4-9 years and other groups was statistically significant (p = .001). H. pylori positivity was 67.7% in males and 68.2% in females (p = .865). H. pylori positivity was 72.1, 65.1, 70, and 68.4% in blood groups A, B, AB, and O (p = .703), and 68.9% and 76.3% in Rh (+) and Rh (-) blood subgroups, respectively (p = .292). There was no statistically significant difference between H. pylori positivity and gastrointestinal diagnosis (p = .980). There was significant association between increased number of household members and low socioeconomic status, and H. pylori positivity (p < .001). Living in rural and suburban area was significantly associated with H. pylori positivity compared with living in urban.

CONCLUSIONS

H. pylori infection positivity rate was 68% in symptomatic subjects in Turkey and the positivity rate was significantly lower at age 4-9 years than the other age groups. It was not related to gender, ABO, and Rh blood groups and gastrointestinal diagnosis. Low socioeconomic conditions and living in rural and suburban area were significantly associated with H. pylori positivity.

Immunohistochemically proven cytomegalovirus end-organ disease in solid organ transplant patients: clinical features and usefulness of conventional diagnostic tests

We studied the main clinical features, outcome, and laboratory parameters in a group of solid organ transplant (SOT) patients with immunohistochemically proven cytomegalovirus (CMV) disease. Confirmed CMV cases were obtained through databases. Demographics, clinical data, transplantation type, immunosuppressive regimens, donor and recipient CMV serostatus, therapy, outcome and laboratory results, pp65 antigenemia, and qualitative polymerase chain reaction (PCR) for CMV were analyzed. From 1995 to 2004, 31 cases with complete medical records were identified. Disease appeared between 24 and 2538 days after transplantation but most cases presented in the first 100 days. Gastrointestinal CMV disease was the most frequent form (71%), while thrombocytopenia was present in 50% of cases, and leukopenia was less common (35.5%). CMV pp65 antigenemia was positive in 58% of patients, but its sensitivity increased to 71% if performed during the first 6 months. A qualitative CMV PCR technique gave similar results during this period (71.4%). Most patients were treated with intravenous ganciclovir (n=25; 80.6%). In 4 cases (19.4%), use of foscarnet alone or a sequential regimen with ganciclovir-foscarnet was deemed necessary. Surgical procedures were necessary in 5 patients (16%). The death rate reached 13%. CMV end-organ disease can be a life-threatening infection in SOT patients. Gastrointestinal disease was the most frequent end-organ disease. CMV antigen detection is best suited for the early period after transplantation.

Treatment of mitochondrial neurogastrointestinal encephalomyopathy with dialysis

OBJECTIVE

To study the effect of continuous ambulatory peritoneal dialysis on nucleoside levels and clinical course in a patient with mitochondrial neurogastrointestinal encephalomyopathy (MNGIE). Patient We studied a patient with genetically verified MNGIE, who prior to treatment had lost weight progressively, developed amenorrhea, vomited multiple times daily, and had abdominal pain. Intervention The patient was treated with peritoneal dialysis for 3 years, and the effect on symptoms and plasma concentrations of thymidine and deoxyuridine were monitored.

RESULTS

Dialysis stopped vomiting and reduced abdominal pain, and the patient gained 5 kg in weight and started to menstruate again. Symptoms returned if dialysis was paused. Dialysis did not affect plasma nucleoside levels.

CONCLUSIONS

This study shows an unambiguous clinical benefit of peritoneal dialysis on gastrointestinal symptoms in MNGIE. Dialysis did not affect nucleoside levels, indicating elevated thymidine and deoxyuridine levels are not solely responsible for the pathogenesis of MNGIE.

Gender differences in gastrointestinal disturbances and plasma concentrations of tafenoquine in healthy volunteers after tafenoquine administration for post-exposure vivax malaria prophylaxis

In an open-label sequential cohort study, we compared gastrointestinal (GI) disturbances and plasma tafenoquine concentrations after administration of single-dose (400mg daily x 3 days; n=76 males, 11 females) and split-dose (200 mg twice daily x 3 days; n=73 males, 13 females) tafenoquine regimens in healthy Australian Defence Force volunteers for post-exposure malaria prophylaxis. The female and male volunteers had comparable demographic characteristics (age, weight, height) in the single- and split-dose treatment groups. GI disturbances were generally mild and self-limiting for both groups. The frequency of nausea and abdominal distress was over two-fold higher in females than in males for both treatment groups. Reporting of GI disturbances in the single-dose group differed significantly between males and females, but this gender difference was not seen for the split-dose group. In those volunteers who experienced GI disturbances, the mean plasma tafenoquine concentrations 12 h after the last dose of tafenoquine were approximately 1.3-fold higher in females than in males (means+/-SD: 737+/-118 ng/ml vs. 581+/-113 ng/ml). These preliminary findings suggest that further studies are required in a larger number of females to determine whether there is a need to reduce the dose of tafenoquine to minimise GI disturbances in females.

[Analytical methods for measuring the content of trace elements in children with chronic gastrointestinal diseases]

Plasma trace elements (TE) were determined by atomic absorption spectrometry with electrothermal atomization and by mass spectrometry with inductively bound plasma. These techniques are highly effective and may be used to determine TE in biological samples. In children, chronic gastrointestinal diseases are accompanied by mineral metabolic disorders. In children with chronic gastrointestinal diseases whose age was 6 to 15 years and whose weight was varying, the scores of some TEs depend on a child's body weight and may be used to evaluate the degree of a pathological process.

Peptide YY(1-36) and peptide YY(3-36): Part II. Changes after gastrointestinal surgery and bariatric surgery

Peptide YY (PYY) is secreted as a 36 amino acid, straight chain polypeptide, and is found in greatest concentrations in the terminal ileum, colon and rectum. After secretion, dipeptidyl peptidase IV (DPP-IV) cleaves the N-terminal Tyrosine-Proline residues from PYY(1-36), producing PYY(3-36). PYY(1-36) acts at all four human Y receptors, Y1, Y2, Y4 and Y5, while PYY(336) is a specific Y2 receptor agonist. PYY participates in the regulation of appetite and weight balance through hypothalamic-based mechanisms. PYY(1-36) stimulates appetite and weight gain through Y1 and Y5 receptors. PYY(3-36) suppresses appetite and stimulates weight loss through Y2 receptors. GI diseases that cause malabsorption increase both basal and meal-stimulated PYY levels. In contrast, obesity decreases both basal and meal-stimulated PYY levels. Mutations in the human PYY and Y2 receptor genes may contribute to the development of obesity. Small bowel resection elevates PYY levels in humans. Colon resections increase PYY levels in animal models but not in man. PYY changes following bariatric operations are incompletely studied. Vertical banded gastroplasty, open Roux-en-Y gastric bypass and jejunoileal bypass significantly elevate basal and meal-stimulated PYY levels. In dogs with Pavlov pouches, Roux-en-Y duodenojejunostomy (duodenal switch) increases PYY levels compared to Roux-en-Y gastrojejunostomy. DPP-IV activity is increased in obese individuals and remains increased after biliopancreatic diversion. Thus, diseases or operations which cause malabsorption, elevate basal and meal-stimulated PYY levels. Bariatric operations also increase basal and meal-stimulated PYY levels. This suggests that the combination of increased PYY levels and elevated levels of DPP-IV observed after bariatric operations may generate increased circulating levels of PYY(3-36), leading to hypothalamic-mediated suppression of appetite and promotion of weight loss through Y2 receptor mediated mechanisms.

Nocturnal secretion of melatonin in patients with upper digestive tract disorders

Recently, the results of many experimental investigations have shown that melatonin possesses gastroprotective properties. On the other hand its role in pathogenesis of upper digestive tract diseases in man still remains unclear. The aim of the study was to investigate nocturnal secretion of melatonin in patients with functional and organic diseases of the upper part of digestive tract. The investigations were carried out in 149 persons, aged 21-51 years, including healthy subjects (group I, n=30), and patients with non-erosive gastroduodenal reflux (NERD, group II, n=24), with gastroesophageal reflux disease (GERD, group III, n=25), with functional dyspepsia (FD, according to the Rome III Criteria, group IV, n=36) and with recurrent duodenal ulcer (DUD, group V, n=34). Diagnoses were established on the basis of endoscopic imaging and histological examination, 24-hour pH-metry and laboratory tests. Melatonin serum concentration was measured with ELISA method. Blood samples were taken for examination in red-lighted room at 10 p.m. and on the following day at 2 and 6 a.m. The highest concentration of melatonin in all examined groups was determined at 2 a.m. The average melatonin concentration in healthy subjects was 34,7 +/- 4,8 pg/ml. In patients with GERD and DUD melatonin concentration was lower than in healthy subjects - 27,2 +/- 8,5 pg/ml and 25,5 +/- 6,2 pg/ml respectively (p < 0,05; p < 0,01). The highest concentration of melatonin was found in patients with NERD and FD - 43,2 +/- 10,8 pg/ml and 42,4 +/- 10,1 pg/ml (p < 0,01; p < 0,05). The findings of this study support the notion that melatonin exerts beneficial influences on the upper digestive tract. It is likely that high or relatively correct secretion of melatonin is sufficient to prevent peptic changes in esophageal and duodenal mucosa.

Are higher vancomycin doses needed in venticle-external shunted patients?

OBJECTIVE

Hydrocephalus is usually resolved by diverting cerebrospinal fluid through a surgically implanted intra-ventricular catheter (shunt). The aim of this study was to characterize vancomycin pharmacokinetic (PK) parameters and optimal dosage in shunted patients under vancomycin treatment.

SETTING

Intensive Care and Neurosurgical Units. University Hospital.

METHODS

Retrospective data of vancomycin blood concentrations, demographics and biochemical parameters, from a Therapeutic Drug Monitoring (TDM) program, in ventricle-external shunted patients (Group A) and controls (Group B) were collected. In all subjects, several blood samples at steady state conditions were drawn. Individual PK parameters such as drug clearance (CL) and volume of distribution (V) were estimated by using an one-compartmental PK model and later, dosage regimens were individually adjusted by Bayesian analysis. The obtained CL and V mean +/- standard deviation were compared between both groups (A versus B). Vancomycin dosage regimens between both groups were also compared.

MAIN OUTCOME MEASURES

Patients demographics, clinical records, creatinine clearance by Cockcroft-Gault, vancomycin blood levels, vancomycin pK parameters and optimal initial IV vancomycin dosage.

RESULTS

Forty-five patients were included in the study: 15 patients in group A and 30 subjects in group B. Significant differences between CL(A) and CL(B) means were observed, while not between V(A) and V(B). In shunted patients, the required vancomycin daily dose to reach target concentrations was significantly higher than the dose needed in the control group (49.25 +/- 12.28 mg/kg/day vs. 31.74 +/- 6.70 mg/kg/day; P < 0.0005).

CONCLUSIONS

Greater vancomycin clearance was found in our shunted patients, thus they required higher vancomycin daily doses compared to the control group. Consequently, vancomycin TDM in shunted patients should be advisable in order to guarantee antibiotic blood concentrations within the recommended therapeutic range.

Infusion of platelets transiently reduces nucleoside overload in MNGIE

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is caused by thymidine phosphorylase (TP) deficiency, which leads to toxic accumulations of thymidine (dThd) and deoxyuridine (dUrd). In this work, we report that infusion of platelets from healthy donors to patients with MNGIE restored transiently circulating TP and reduced plasma dThd and dUrd levels, suggesting that treatments to achieve permanent restoration of circulating TP such as allogeneic stem cell transplantation or gene transfer might be therapeutic.

Allogeneic stem cell transplantation corrects biochemical derangements in MNGIE

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is a multisystemic autosomal recessive disease due to primary thymidine phosphorylase (TP) deficiency. To restore TP activity, we performed reduced intensity allogeneic stem cell transplantations (alloSCTs) in two patients. In the first, alloSCT failed to engraft, but the second achieved mixed donor chimerism, which partially restored buffy coat TP activity and lowered plasma nucleosides. Thus, alloSCT can correct biochemical abnormalities in the blood of patients with MNGIE, but clinical efficacy remains unproven.

Abdominal manifestations in childhood-onset systemic lupus erythematosus

BACKGROUND

Childhood-onset lupus erythematosus is a rare disorder of unknown origin.

OBJECTIVES

To describe the frequency of gastrointestinal manifestations at presentation of systemic lupus erythematosus SLE and at follow-up, and discuss the specific causes of these manifestations.

METHODS

Medical records of 201 patients with childhood-onset SLE followed up in French paediatric nephrological, haematological and rheumatological centres were reviewed and abstracted for gastrointestinal manifestations.

RESULTS

Gastrointestinal involvement was recorded in 39 (19%) children. The median (range) age at the time of initial gastrointestinal manifestations was 11.3 (4.5-16) years. Gastrointestinal symptoms were present at or occurred within 1 month after diagnosis in 32% patients. Abdominal pain was the most frequent symptom, present in 34 (87%) patients. It was mostly related to lupus involvement, especially ascites (n = 14) and pancreatitis (n = 12), more rarely to treatment-induced events (n = 1) or infection (n = 1) and never to events unrelated to SLE. Three children with surgical abdomen underwent a laparotomy before SLE was diagnosed, with a final diagnosis of lupus peritonitis and lupus acalculous cholecystitis. C reactive protein values were <40 mg/l in all but two patients who had surgical abdomen. Abdominal ultrasonography and computed tomography scans were abnormal in 58% and 83% of the evaluated patients, respectively. Corticosteroids, associated with intravenous cyclophospamide in eight patients, led to complete remission of gastrointestinal involvement in 30 of 31 treated patients.

CONCLUSION

Gastrointestinal involvement is common in children with SLE, and is mainly due to primary lupus involvement. Corticoidsteroid treatment should be promptly considered in children with lupus presenting with abdominal pain after infectious disease; side effects of treatment and intestinal perforation have been excluded.