Long-term results of electrical stimulation of the lower esophageal sphincter for the treatment of gastroesophageal reflux disease

BACKGROUND AND STUDY AIMS

In patients with gastroesophageal reflux disease (GERD), temporary electrical stimulation of the lower esophageal sphincter (LES) increases LES pressure without interference with LES relaxation. The aim of the current study was to investigate the safety and efficacy of long term LES electrical stimulation therapy (LES-EST), using a permanently implanted stimulator for the treatment of GERD.

PATIENTS AND METHODS

Patients with GERD who were at least partially responsive to proton pump inhibitors (PPIs) and who had hiatal hernia of ≤ 3 cm and esophagitis of Los Angeles Grade A, B, or C were included in the study. Stimulation electrodes were placed in the LES and a pulse generator (EndoStim LES Stimulation System; EndoStim BV, The Hague, The Netherlands) was implanted laparoscopically. LES stimulation was delivered at 20 Hz, 215 μs, 3 - 8 mA in multiple 30-minute sessions. Patients were evaluated at follow-up using the GERD Health-Related Quality of Life (HRQL) questionnaire, daily symptom and medication diaries, the SF-12 Health Survey, esophageal pH testing, and high resolution manometry.

RESULTS

A total of 24 patients (mean age 53 ± 12 years; 14 men) were implanted and 23 completed the 12-month evaluation. No serious implantation or stimulation-related adverse affects or sensations were reported. Median composite GERD-HRQL score at 12 months was 2.0 (interquartile range [IQR] 0 - 3.0), which was significantly better than baseline scores both on PPI therapy (median 9.0, IQR 6.0 - 10.0; P = 0.002) and off PPIs (median 23.5, IQR 21 - 25.75; P < 0.001). The median percentage of the 24-hour period with esophageal pH < 4.0 at baseline was 10.1 % (IQR 7.7 - 15.5), which was reduced to 3.3 % (1.8 - 6.9) at 12 months (P < 0.001), with 69 % of patients showing either normalization or > 50 % improvement in their distal esophageal pH. At 12 months, 96 % of patients (22/23) were completely off PPI medication.

CONCLUSION

During the long term follow-up of 12 months, LES - EST was safe and effective for the treatment of GERD. There was a significant and sustained improvement in GERD symptoms, reduction in esophageal acid exposure with elimination of daily PPI usage, and no stimulation-related adverse effects.

The proto-oncogene c-myc regulates antibody secretion and Ig class switch recombination

The immune response involves the generation of Ab-secreting cells and memory B cells through a process called terminal B lymphocyte differentiation. This program requires the transcriptional repressor Blimp-1, which inhibits c-myc expression and terminates proliferation. Although the role of c-Myc in cell proliferation is well characterized, it is not known whether it has other functions in terminal differentiation. In this study, we show that c-Myc not only regulates cell proliferation, but it is also essential for Ab-secreting cell function and differentiation in vivo. c-Myc-deficient B lymphocytes hypersecrete IgM and do not undergo Ig class switch recombination (CSR). CSR has been previously linked to proliferation, and in this study we mechanistically link class switching and proliferation via c-Myc. We observed that c-Myc regulates CSR by transcriptionally activating the B cell-specific factor activation-induced cytidine deaminase. By linking cell proliferation and CSR, c-Myc is thus a critical component for a potent immune response.

Factores de riesgo de epilepsia secundaria en niños

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NF-κB, Sp1 and NF-Y as transcriptional regulators of human SND1 gene

Staphylococcal nuclease domain-containing protein 1 (SND1), also called Tudor-SN, is required for many biological events ranging from gene expression to cell growth regulation. Promoter regulation of SND1 gene and its molecular mechanism have remained elusive to date. In this work, we have identified SND1 as a new target gene for NF-κB, Sp1 and NF-Y transcription factors. We isolated and characterized a 3808 bp sequence corresponding to the human SND1 gene promoter (GenBank ID: EF690304). It lacks the typical TATA-box element and contains a CpG island with several Sp1 binding sites at the 3' end, and a highly conserved 300 bp segment with two inverted CCAAT boxes that bind NF-Y, in addition to NF-κB sites and other cis-regulatory elements. Electrophoretic mobility shift assays and chromatin immunoprecipitation experiments confirmed the ability of SND1 promoter to bind NF-κB, Sp1 and NF-Y in vitro and in vivo. Deletion analysis of the 5'-flanking region by luciferase reporter assays, showed the minimum promoter activity 112 base-pair upstream from the transcription start site, and an enhancer region between -112 and -274 bp responsible for the maximal transcriptional activity of the promoter. Site-directed mutagenesis of the CCAAT and GC boxes and the NF-κB elements within the proximal region substantially reduced SND1 promoter activity. Proinflammatory cytokine TNF-α caused an increase of SND1 promoter activity that is mediated, at least in part, via NF-κB as mutation in the NF-κB sites impaired the promoter stimulation. We provide for the first time the characterization of the human SND1 promoter activity and establish a transcriptional network associated to the key transcription factors NF-κB, Sp1 and NF-Y that operates in the control of the SND1 gene expression.

Consumo eléctrico en granjas de ganado ovino lechero de Castilla y León

Para conocer las características del consumo de energía y agua de las explotaciones de ganado ovino lechero de Castilla y León se realizó una auditoría energética a 35 granjas. Se recogieron datos de censo y producción, equipos y horario de funcionamiento (ordeño, enfriamiento, bomba de agua, agua caliente…), maquinaria disponible y consumo de agua. Se calcularon los índices de utilización de la energía por oveja productora y por unidad de leche producida. Aunque existen diferencias en función del tamaño de las explotaciones, el consumo de agua caliente sanitaria se sitúa en 0,42 L por oveja productora al día o 0,29 L por cada litro de leche producido. El consumo medio de electricidad es de 2000 kWh al mes, es decir, casi 50 kWh/oveja y año u 84 kWh por cada 1000 L de leche producida. El ordeño consume 34 kWh/día (más del 40 % del gasto eléctrico diario), seguido del enfriamiento de la leche (30 %) y el calentamiento del agua (12 %). Las explotaciones con variador de velocidad en la bomba de vacío presentaron un menor consumo de electricidad por oveja. Se ha estimado que el consumo total de electricidad representa el 2 % del precio percibido por cada litro de leche vendido.

The association of education with long-term weight change in the EPIC-PANACEA cohort

BACKGROUND/OBJECTIVES

Cross-sectionally, educational attainment is strongly associated with the prevalence of obesity, but this association is less clear for weight change during adult life. The objective of this study is to examine the association between educational attainment and weight change during adult life in the European Prospective Investigation into Cancer and Nutrition (EPIC).

SUBJECTS/METHODS

EPIC is a cohort study with 361,467 participants and up to 10 years of follow-up. Educational attainment was categorized according to the highest obtained school level (primary school or less, vocational secondary training, other secondary education and university). Multivariate mixed-effects linear regression models were used to study education in relation to weight at age 20 years (self-reported), to annual change in weight between age 20 years and measured weight at recruitment, and to annual change in weight during follow-up time.

RESULTS

Higher educational attainment was associated with on average a lower body mass index (BMI) at age 20 years and a lower increase in weight up to recruitment (highest vs lowest educational attainment in men: -60 g per year (95% confidence interval (CI) -80; -40), women -110 g per year (95% CI -130; -80)). Although during follow-up after recruitment an increase in body weight was observed in all educational levels, gain was lowest in men and women with a university degree (high vs low education -120 g per year (95% CI -150; -90) and -70 g per year (95% CI -90; -60), respectively).

CONCLUSIONS

Existing differences in BMI between higher and lower educated individuals at early adulthood became more pronounced during lifetime, which possibly impacts on obesity-related chronic disease risk in persons with lower educational attainment.

Short-term electrical stimulation of the lower esophageal sphincter increases sphincter pressure in patients with gastroesophageal reflux disease

BACKGROUND

Electrical stimulation (ES) of the lower esophageal sphincter (LES) increases resting LES pressure (LESP) in animal models. Our aims were to evaluate the safety of such stimulation in humans, and test the hypothesis that ES increases resting LESP in patients with gastroesophageal reflux disease (GERD).

METHODS

A total of 10 subjects (nine female patients, mean age 52.6 years), with symptoms of GERD responsive to PPIs, low resting LES pressure, and abnormal 24-h intraesophageal pH test were enrolled. Those with hiatal hernia >2 cm and/or esophagitis >Los Angeles Grade B were excluded. Bipolar stitch electrodes were placed longitudinally in the LES during an elective laparoscopic cholecystectomy, secured by a clip and exteriorized through the abdominal wall. Following recovery, an external pulse generator delivered two types of stimulation for periods of 30 min: (i) low energy stimulation; pulse width of 200 μs, frequency of 20 Hz and current of 5-15 mA (current was increased up to 15 mA if LESP was less than 15 mmHg), and (ii) high energy stimulation; pulse width of 375 ms, frequency of 6 cpm, and current 5 mA. Resting LESP, amplitude of esophageal contractions and residual LESP in response to swallows were assessed before and after stimulation. Symptoms of chest pain, abdominal pain, and dysphagia were recorded before, during, and after stimulation and 7-days after stimulation. Continuous cardiac monitoring was performed during and after stimulation.

KEY RESULTS

All patients were successfully implanted nine subjects received high frequency, low energy, and four subjects received low frequency, high energy stimulation. Both types of stimulation significantly increased resting LESP: from 8.6 mmHg (95% CI 4.1-13.1) to 16.6 mmHg (95% CI 10.8-19.2), P < 0.001 with low energy stimulation and from 9.2 mmHg (95% CI 2.0-16.3) to 16.5 mmHg (95% CI 2.7-30.1), P = 0.03 with high energy stimulation. Neither type of stimulation affected the amplitude of esophageal peristalsis or residual LESP. No subject complained of dysphagia. One subject had retrosternal discomfort with stimulation at 15 mA that was not experienced with stimulation at 13 mA. There were no adverse events or any cardiac rhythm abnormalities with either type of stimulation.

CONCLUSIONS & INFERENCES

Short-term stimulation of the LES in patients with GERD significantly increases resting LESP without affecting esophageal peristalsis or LES relaxation. Electrical stimulation of the LES may offer a novel therapy for patients with GERD.

Inflammation marker and risk of pancreatic cancer: a nested case-control study within the EPIC cohort

Background:

Established risk factors for pancreatic cancer include smoking, long-standing diabetes, high body fatness, and chronic pancreatitis, all of which can be characterised by aspects of inflammatory processes. However, prospective studies investigating the relation between inflammatory markers and pancreatic cancer risk are scarce.

Methods:

We conducted a nested case–control study within the European Prospective Investigation into Cancer and Nutrition, measuring prediagnostic blood levels of C-reactive protein (CRP), interleukin-6 (IL-6), and soluble receptors of tumour necrosis factor-α (sTNF-R1, R2) in 455 pancreatic cancer cases and 455 matched controls. Odds ratios (ORs) were estimated using conditional logistic regression models.

Results:

None of the inflammatory markers were significantly associated with risk of pancreatic cancer overall, although a borderline significant association was observed for higher circulating sTNF-R2 (crude OR=1.52 (95% confidence interval (CI) 0.97–2.39), highest vs lowest quartile). In women, however, higher sTNF-R1 levels were significantly associated with risk of pancreatic cancer (crude OR=1.97 (95% CI 1.02–3.79)). For sTNF-R2, risk associations seemed to be stronger for diabetic individuals and those with a higher BMI.

Conclusion:

Prospectively, CRP and IL-6 do not seem to have a role in our study with respect to risk of pancreatic cancer, whereas sTNF-R1 seemed to be a risk factor in women and sTNF-R2 might be a mediator in the risk relationship between overweight and diabetes with pancreatic cancer. Further large prospective studies are needed to clarify the role of proinflammatory proteins and cytokines in the pathogenesis of exocrine pancreatic cancer.

Respiration indices and stability measurements of compost through electrolytic respirometry

An experimental technique for compost stability measurements based on Sapromat electrolytic respirometry was optimised and subsequently applied to a sludge composting process. Anaerobically digested sewage sludge mixed with reed was composted during 90 days in a pilot-scale rotary drum with forced aeration. Periodic solid samples were taken, and a previously optimised respirometric procedure was applied in order to measure the oxygen consumption. The respirometric experiments were made directly with a few grams of solid samples, optimum moisture and 37 °C over a period of 96 h. The results obtained showed how the respiration activity of the sludge decreased during the composting experiment under the specific operating conditions. The specific oxygen uptake rate (SOUR) instant values from the oxygen consumption curves were obtained, and two commonly used respirometric indexes (RI(24) and AT(4)) were calculated for all samples. Both RI(24) (a mean of the SOUR values during the 24 h maximum activity period) and AT(4) (total oxygen consumption after 4 days) were the recommended parameters for the estimation of compost stability by the European Union in the second draft of the Working Document on the Biological Treatment of Biowaste in 2001. Both indexes exponentially decreased with the composting time, and a good linear correlation between them was observed. Final values of RI(24) and AT(4) after 90 days were 600 mg O(2) kg VS(-1) h(-1) and 26 mg O(2) gTS(-1), respectively. We also considered if this technique could be classified as a Dynamic or Static method, the two primary respirometric techniques for measuring compost stability. Supposing that the proposed procedure is considered a dynamic method (no limitations on the amount of oxygen supply), the final RI(24) obtained was compared with the dynamic respiration index (DRI) proposed by the EU (1000 mg O(2) kg VS(-1) h(-1)). Our result indicated that stable compost was obtained after 90 d. However, if a static limit was considered (AT(4) lower than 10 mg O(2) gTS(-1) as proposed by the EU), our result would indicate that more residence composting time would be needed. Taking into account these results, the advantages and disadvantages and the validity of the proposed method are discussed.

Major dietary patterns and risk of coronary heart disease in middle-aged persons from a Mediterranean country: the EPIC-Spain cohort study

BACKGROUND AND AIM

No previous study has assessed the association between major dietary patterns and the risk of coronary heart disease (CHD) in a large cohort from a Mediterranean country.

METHODS AND RESULTS

We studied prospectively 40,757 persons, aged 29-69 years, participating in the Spanish cohort of the EPIC study. Food consumption was collected between 1992 and 1996 with a validated history method. Individuals were followed-up until 2004 through record linkage with hospital discharge registers, population-based registers of myocardial infarction, and mortality registers to ascertain CHD events (fatal and non-fatal acute myocardial infarction or angina requiring revascularization). Two major dietary patterns were identified from factor analysis. The first pattern was labeled as Westernized, because of the frequent consumption of refined cereals and red meat; the second was called the evolved Mediterranean pattern, because of the frequent intake of plant-based foods and olive oil. During a median follow-up of 11 years, 606 CHD events were ascertained. No association was found between the Westernized pattern and CHD risk. In contrast, the score for the evolved Mediterranean pattern was inversely associated with CHD risk (p for trend = 0.0013); when compared with the lowest quintile of the evolved Mediterranean pattern score, the multivariable hazard ratios for CHD were 0.77 (95% confidence interval 0.61-0.98) for the second quintile, 0.64 (95% CI 0.50-0.83) for the third quintile, 0.56 (95% CI 0.43-0.73) for the fourth quintile, and 0.73 (95% CI 0.57-0.94) for the fifth quintile.

CONCLUSION

A Mediterranean diet, as consumed in this study population, was associated with a lower risk of CHD.

Kinetics of forced aerated biodegradation of digested sewage sludge-reed mixtures at different temperatures

This work presents a kinetic analysis of the aerobic biodegradation of anaerobically digested sewage sludge and dried reed mixtures at different temperatures. Batch experiments were conducted in laboratory-scale reactors with temperature (T) control and forced aeration of the solid mixture. The biowaste mixture was treated at four different temperatures: 25, 40, 50 and 60 °C, with moisture controlled and samples taken weekly for carbon (C) and volatile solids (VS) measurements. The duration of experiments was either 90 d (at 25 °C) or 60 d (at 40, 50 and 60 °C). Two different kinetic models were used to fit the carbon mineralisation curves: the 2C model, which considers two organic fractions (biodegradable and non-biodegradable) and the 3C model, which considers three fractions (easily biodegradable, slowly biodegradable and non-biodegradable). In both cases, the kinetic rate constants were calculated by mathematical fitting and were compared with previously reported values. The temperature influence on the rate constants was studied for both models using a T-dependent equation. The calculated kinetic rate constants were in agreement with previously published values, and good fitting of the experimental data was obtained with both models. Similar rate constant values were obtained for mineralisation of the biodegradable fraction (2C model) and the easily biodegradable fraction (3C model). The rate constants for the slowly biodegradable fraction (3C model) were much lower. A good correlation between rate constants and T was observed. Different optimum temperature values were obtained for each rate constant depending on which carbon fraction was degraded. The T-dependent rate constant values obtained could be used for modelling the C mineralisation of real variable-temperature composting processes.

Diabetes mellitus, glycated haemoglobin and C-peptide levels in relation to pancreatic cancer risk: a study within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort

AIMS/HYPOTHESIS

There has been long-standing debate about whether diabetes is a causal risk factor for pancreatic cancer or a consequence of tumour development. Prospective epidemiological studies have shown variable relationships between pancreatic cancer risk and blood markers of glucose and insulin metabolism, overall and as a function of lag times between marker measurements (blood donation) and date of tumour diagnosis.

METHODS

Pre-diagnostic levels of HbA(1c) and C-peptide were measured for 466 participants with pancreatic cancer and 466 individually matched controls within the European Prospective Investigation into Cancer and Nutrition. Conditional logistic regression models were used to estimate ORs for pancreatic cancer.

RESULTS

Pancreatic cancer risk gradually increased with increasing pre-diagnostic HbA(1c) levels up to an OR of 2.42 (95% CI 1.33, 4.39 highest [≥ 6.5%, 48 mmol/mol] vs lowest [≤ 5.4%, 36 mmol/mol] category), even for individuals with HbA(1c) levels within the non-diabetic range. C-peptide levels showed no significant relationship with pancreatic cancer risk, irrespective of fasting status. Analyses showed no clear trends towards increasing hyperglycaemia (as marked by HbA(1c) levels) or reduced pancreatic beta cell responsiveness (as marked by C-peptide levels) with decreasing time intervals from blood donation to cancer diagnosis.

CONCLUSIONS/INTERPRETATION

Our data on HbA(1c) show that individuals who develop exocrine pancreatic cancer tend to have moderate increases in HbA(1c) levels, relatively independently of obesity and insulin resistance-the classic and major risk factors for type 2 diabetes. While there is no strong difference by lag time, more data are needed on this in order to reach a firm conclusion.

Lytic activity of the virion-associated peptidoglycan hydrolase HydH5 of Staphylococcus aureus bacteriophage vB_SauS-phiIPLA88

Background

Staphylococcus aureus is a food-borne pathogen and the most common cause of infections in hospitalized patients. The increase in the resistance of this pathogen to antibacterials has made necessary the development of new anti-staphylococcal agents. In this context, bacteriophage lytic enzymes such as endolysins and structural peptidoglycan (PG) hydrolases have received considerable attention as possible antimicrobials against gram-positive bacteria.

Results

S. aureus bacteriophage vB_SauS-phiIPLA88 (phiIPLA88) contains a virion-associated muralytic enzyme (HydH5) encoded by orf58, which is located in the morphogenetic module. Comparative bioinformatic analysis revealed that HydH5 significantly resembled other peptidoglycan hydrolases encoded by staphylococcal phages. The protein consists of 634 amino acid residues. Two putative lytic domains were identified: an N-terminal CHAP (cysteine, histidine-dependent amidohydrolase/peptidase) domain (135 amino acid residues), and a C-terminal LYZ2 (lysozyme subfamily 2) domain (147 amino acid residues). These domains were also found when a predicted three-dimensional structure of HydH5 was made which provided the basis for deletion analysis. The complete HydH5 protein and truncated proteins containing only each catalytic domain were overproduced in E. coli and purified from inclusion bodies by subsequent refolding. Truncated and full-length HydH5 proteins were all able to bind and lyse S. aureus Sa9 cells as shown by binding assays, zymogram analyses and CFU reduction analysis. HydH5 demonstrated high antibiotic activity against early exponential cells, at 45°C and in the absence of divalent cations (Ca²⁺, Mg²⁺, Mn²⁺). Thermostability assays showed that HydH5 retained 72% of its activity after 5 min at 100°C.

Conclusions

The virion-associated PG hydrolase HydH5 has lytic activity against S. aureus, which makes it attractive as antimicrobial for food biopreservation and anti-staphylococcal therapy.

The association of lifetime alcohol use with measures of abdominal and general adiposity in a large-scale European cohort

BACKGROUND/OBJECTIVES

The relation between lifetime use of alcohol and measures of abdominal and general adiposity is unknown.

SUBJECTS/METHODS

Among 99,381 men and 158,796 women of the European Prospective Investigation into Cancer and Nutrition (EPIC) study, means of waist circumference (WC), waist-to-hip-ratio (WHR) and body mass index (BMI), and odds ratios (OR) for a larger WC than predicted for a given BMI (WClp=positive residuals of gender specific linear regression of BMI on WC) across categories of average lifetime use of alcohol (total, from wine and from beer) were calculated, all adjusted for socio-demographic, lifestyle and health factors.

RESULTS

WC, WHR and BMI in men using lifetime ≤6 g/d alcohol were 95.1 cm, 0.942 and 27.3 kg/m(2), and 96.2 cm, 0.961 and 28.3 kg/m(2) when using >96 g/d. WC and WHR in women was 83.2 cm and 0.813 for ≤6 g/d, and 84.6 cm and 0.830 for >60 g/d, whereas BMI deviated only slightly with the lowest BMI (26.7 kg/m(2)) observed for >6-24 g/d. Compared with ≤6 g/d, OR for a WClp in both genders increased steadily across categories of alcohol use (up to 1.40 (95% confidence interval 1.32, 1.49) in men using >60 g/d and 1.63 (1.54, 1.73) in women using >24 g/d), though increase was higher for alcohol from beer than from wine (P for difference between beer and wine<0.001 (men) and=0.002 (women)).

CONCLUSION

Lifetime alcohol use is positively related to abdominal and general adiposity in men, possibly following the male weight gain pattern; in women, it is positively related only to abdominal adiposity. In this context, beer may contribute additionally to abdominal adiposity.

Lumbricus terrestris L. activity increases the availability of metals and their accumulation in maize and barley

The effect of the earthworm Lumbricus terrestris L. on metal availability in two mining soils was assessed by means of chemical extraction methods and a pot experiment using crop plants. Results from single and sequential extractions showed that L. terrestris had a slight effect on metal fractionation in the studied soils: only metals bound to the soil organic matter were significantly increased in some cases. However, we found that L. terrestris significantly increased root, shoot and total Pb and Zn concentrations in maize and barley for the soil with the highest concentrations of total and available metals. Specifically, shoot Pb concentration was increased by a factor of 7.5 and 3.9 for maize and barley, respectively, while shoot Zn concentration was increased by a factor of 3.7 and 1.7 for maize and barley, respectively. Our results demonstrated that earthworm activity increases the bioavailability of metals in soils.

Composting domestic sewage sludge with natural zeolites in a rotary drum reactor

This work aimed the influence of zeolites addition on a sludge-straw composting process using a pilot-scale rotary drum reactor. The type and concentration of three commercial natural zeolites were considered: a mordenite and two clinoptilolites (Klinolith and Zeocat). Mordenite caused the greatest carbon removal (58%), while the clinoptilolites halved losses of ammonium. All zeolites removed 100% of Ni, Cr, Pb, and significant amounts (more than 60%) of Cu, Zn and Hg. Zeocat displayed the greatest retention of ammonium and metals, and retention efficiencies increased as Zeocat concentration increased. The addition of 10% Zeocat produced compost compliant with Spanish regulations. Zeolites were separated from the final compost, and leaching studies suggested that zeolites leachates contained very low metals concentrations (<1 mg/kg). Thus, the final compost could be applied directly to soil, or metal-polluted zeolites could be separated from the compost prior to application. The different options have been discussed.