Gabapentin reduces rectal mechanosensitivity and increases rectal compliance in patients with diarrhoea-predominant irritable bowel syndrome

BACKGROUND

Gabapentin has been shown to reduce elements of central sensitization in human experimental hyperalgesia. It remains uninvestigated whether gabapentin has beneficial effects for irritable bowel syndrome associated with visceral hypersensitivity.

AIMS

To evaluate the effects of gabapentin on sensory and motor function of the rectum in patients with diarrhoea-predominant irritable bowel syndrome.

METHODS

Forty patients with diarrhoea-predominant irritable bowel syndrome completed this randomized, double-blind, placebo-controlled, parallel-grouped study. All patients received a barostat study and were subsequently randomized for 5-day treatment with gabapentin 300 mg/day and then 600 mg/day or placebo. On day 6, after subjects had their morning dose, the barostat experiment was repeated.

RESULTS

The threshold pressures for bloating, discomfort and pain significantly increased after gabapentin, but not after placebo. Significant increase in the pressure and corresponding wall tension inducing discomfort or pain were observed in the gabapentin group, but not in the placebo group. Rectal compliance significantly increased after gabapentin, but not after placebo. The postprandial increase of rectal tone was not affected by gabapentin.

CONCLUSION

Our results show that gabapentin reduces rectal sensory thresholds through attenuating rectal sensitivity to distension and enhancing rectal compliance in diarrhoea-predominant irritable bowel syndrome patients. The clinical efficacy of this drug in irritable bowel syndrome patients warrants investigation.

CT halo sign: the spectrum of pulmonary diseases

The CT halo sign indicates ground glass attenuation surrounding a pulmonary nodule on CT. Although it was initially proposed as an early, specific finding of invasive pulmonary aspergillosis, it can be caused by many other pathological conditions such as infection, neoplastic and inflammatory diseases. The halo of ground glass attenuation pathologically represents pulmonary haemorrhage, tumour infiltration, or non-haemorrhagic inflammatory processes. Although non-specific, this sign is important because the clinical setting and associated radiological features may give a clue to the differential diagnosis. In this review, we demonstrate the spectrum of pulmonary diseases showing the "CT halo sign" on thin-section CT and discuss their radiological and clinical features.

A concept of dietary dipeptides: a step to resolve the problem of amino acid availability in the early life of vertebrates

The premise that a dietary dipeptide approach will improve the understanding of amino acid utilization in the fastest-growing vertebrate, the teleost fish, was tested by examining the muscle free amino acid (FAA) pool and enzyme activities, in concert with growth response, when dietary amino acids were provided in free, dipeptide or protein molecular forms. We present the first evidence in fish that, in response to a synthetic dipeptide diet, muscle FAA varies as a result of both growth rate and amino acid availability of specific peptides. We demonstrate significantly diminished muscle indispensable FAA (3-10-fold) in rainbow trout alevins fed a dipeptide-based diet compared with a protein-based diet. The dipeptide-based diet did not contain proline, resulting in 10-27-fold less muscle free proline and hydroxyproline in alevins. The response of alevins fed FAA-based or peptide-based diets can be indicative of collagen turnover (Hyp/Pro ratio) and showed significant differences between dietary treatments. Pyrroline-5-carboxylate (P5C) reductase activity was detected, suggesting that P5C may ameliorate proline deficiency, but synthesis from glutamate could not maintain free proline levels in muscle. This finding will provide an impetus to test whether proline is conditionally indispensable in young fish, as in mammals and birds. This study shows that amino acids given entirely as dipeptides can sustain fish growth, result in muscle FAA and enzyme responses in line with dietary levels and identify growth-limiting amino acids. The understanding of these factors necessitates a diet formulation that will improve the accuracy of determining amino acid requirements in the early life stages of vertebrates.

Method of generalized projections algorithm for image-based reduction of artifacts in radial imaging

This work describes the method of generalized projections (MGP) as an image-based, postprocessing method to correct for phase inconsistencies caused by echo misalignments in radial imaging. Computer simulations show that MGP can correct for echo shifts, constant phase, and amplitude errors, but the accuracy of the correction is limited, and this accuracy is reduced by the addition of more degrees of freedom. In phantom experiments, MGP performed better than magnitude filtered backprojection and anti-parallel projections correction.

Pathophysiology and treatment of functional dyspepsia

Functional dyspepsia is a highly prevalent symptom complex and a heterogenous disorder. Recent studies showed potential associations between specific pathophysiologic disturbances and dyspeptic symptoms. Delayed gastric emptying reported in about 30% of patients with functional dyspepsia is associated with the symptoms of postprandial fullness, nausea, and vomiting. Impaired gastric accommodation present in 40% of functional dyspepsia patients is found to be associated with early satiety. Hypersensitivity to gastric distension is observed in 37% of functional dyspepsia patients and associated with the symptoms of postprandial pain, belching, and weight loss. Psychosocial factors and altered response to duodenal lipids or acid have also been identified as pathophysiologic mechanisms. Therapeutic options are still limited but targeted therapy directed at the underlying pathophysiology seems desirable. Thus, efforts to further elucidate underlying pathophysiologic mechanisms and identify the appropriate patient population using some type of pathophysiologic testing will be required.

Creation and enlargement of atrial defects in congenital heart disease

Transcatheter creation and enlargement of interatrial defects (IAD) may improve hemodynamics; however, procedural outcomes have not been well defined. Hospital records were reviewed for children who underwent percutaneous procedures to create and enlarge an IAD and were grouped as follows: (1) right and (2) left heart obstructive lesions, (3) left atrial (LA) decompression during left heart assist, (4) failing Fontan circulation, and (5) miscellaneous. Forty-five children (mean age, 3.4 +/- 4.7 years; 30 (67%) male) were identified. In group 1 (n = 6), all achieved endpoints of right atrial (RA) decompression (n = 2), improved left ventricular filling (n = 3), or improved arterial saturations (n = 1). In group 2 (n = 18), mean LA pressure decreased (21 +/- 6 to 13 +/- 5 mmHg, p < 0.001) and arterial saturations increased (61 +/- 13% to 78 +/- 11%, p < 0.001). All except 2 patients achieved definitive repair, further palliation (n = 9), or heart transplantation (HTX) (n = 7). In group 3 (n = 5), the LA was decompressed (21 to 13 mmHg, p = 0.03) in all, and all except 1 patient survived to HTX (n = 2) or full recovery (n = 2). In group 4 (n = 11), of 7 patients with a low cardiac output syndrome after surgery, despite improved atrial shunting, 3 died and 1 required a HTX. In group 5 (n = 5), RA decompression (n = 1) or improved arterial saturation (n = 4) was achieved in all. Overall, 5-year HTX free survival was 75%. Mechanical ventilation before the procedure (p < 0.001), the need for a blade septostomy (p = 0.002), and higher LA pressures after the procedure (p = 0.04) independently predicted mortality or the requirement for HTX. Transcatheter optimization of an atrial communication can help optimize treatment strategies and has a low procedural risk.

Simultaneous multislice imaging with slice-multiplexed RF pulses

A method for simultaneous multislice imaging is presented that uses a multislice RF pulse that imparts a different linear phase profile to each slice. During readout, slices are unaliased by using extra slice-select gradient lobes, which rephase and dephase individual slices one at a time. Compared to other simultaneous slice methods, this method avoids distortion by slice-select gradients, and does not require extra views or additional hardware. However, because one echo per slice is required, the method requires a longer read period. This can cause non-ideal rephasing of the individual slices due to susceptibility gradients, which manifests itself as crosstalk between slices. There is also a concomitant increase in the minimum TR of the sequence. The method is demonstrated with phantom and in vivo images using gradient-echo and spin-echo versions.

A method of generalized projections (MGP) ghost correction algorithm for interleaved EPI

Investigations into the method of generalized projections (MGP) as a ghost correction method for interleaved EPI are described. The technique is image-based and does not require additional reference scans. The algorithm was found to be more effective if a priori knowledge was incorporated to reduce the degrees of freedom, by modeling the ghosting as arising from a small number of phase offsets. In simulations with phase variation between consecutive shots for n-interleaved echo planar imaging (EPI), ghost reduction was achieved for n = 2 only. With no phase variation between shots, ghost reduction was obtained with n up to 16. Incorporating a relaxation parameter was found to improve convergence. Dependence of convergence on the region of support was also investigated. A fully automatic version of the method was developed, using results from the simulations. When tested on in vivo 2-, 16-, and 32-interleaved spin-echo EPI data, the method achieved deghosting and image restoration close to that obtained by both reference scan and odd/even filter correction, although some residual artifacts remained.

Effect of diets containing gossypol on blood parameters and spleen structure in tilapia, Oreochromis sp., reared in a recirculating system

The high cost of fish meal in tilapia diets warrants the potential use of cottonseed meal (CSM) as an alternative source of high quality protein. The effects of varying levels of CSM (0, 25, 50, 75 and 100%) as fish meal protein replacement on growth, blood parameters, spleen characteristics, free and bound gossypol in blood plasma, haemoglobin and haematocrit were determined in tilapia. Gossypol (C(30)H(30)O(8)) is a polyphenolic substance found in cottonseed that has known toxic effects in fish. Tilapias (n = 219, average weight = 11.3 +/- 3.9 g) were randomly distributed into 15, 32-L glass aquaria, representing five dietary treatments and three replicates per treatment. Each aquarium containing 13-16 fish was supplied with thermoregulated, recirculating water (27 +/- 1 degrees C) at 1 L min(-1) flow rate and photoperiod was constant (12 h L/12 h D). Fish fed 25-50% CSM protein replacement showed similar body weights and total lengths as the controls at the completion of the 16-week trial. Fish fed 75 and 100% CSM protein replacement showed a significant decline in body weight and total length. Fish fed 25-100% CSM protein replacement had significantly lower haematocrit and haemoglobin (ANOVA/LSD, P < 0.05) compared with levels in controls. The decline was most prominent in groups fed diets with 50-100% CSM protein replacement. Total and free gossypol concentrations of blood plasma significantly increased with increasing levels of CSM replacement (P < 0.05). No gossypol was found in blood plasma of fish from the control group. The occurrence of immature and abnormal erythrocytes was significantly greater among fish fed 75 and 100% CSM diets compared with fish fed 0-50% CSM diets. Spleen-somatic index (spleen weight/body weight x 100) did not differ between control fish and fish fed 50-100% CSM diets. Spleen abnormalities, such as large depositions of haemosiderin and melanin pigments and proliferation of melano-macrophage centres, lymphocytic depletion of the white pulp areas (hypocellularity), and presence of vacuoles and necrotic areas were observed among fish fed 50-100% CSM protein diets. In general, the pathological effects of gossypol in tilapia (low haemoglobin and haematocrit levels, abundance of immature red blood cells or polychromatocytes, abnormal spleen morphology) were similar to the effects of vitamin E and/or vitamin C deficiencies observed in other studies.

The Smallest Vertebrate, Teleost Fish, Can Utilize Synthetic Dipeptide-Based Diets

In vitro studies of brush-border intestinal transport of dipeptides and cytoplasmic hydrolysis in fish suggest that these processes could be key mechanisms in the absorption and utilization of nutrients for growth. However, in vivo experimentation to study the nutritional importance of these processes was needed. We compared three dietary formulations based on free, peptide and protein sources of amino acids. Our results were the first to show that a synthetic dipeptide (PP)-based diet could support growth in the early stages of ontogenesis of a teleost fish, rainbow trout (Oncorhynchus mykiss), whereas a free amino acid (FAA)-based diet failed. We found that fish fed an FAA-based diet had an increased rate of ammonia excretion [1.78 +/- 0.19 mmol NH(3)-N/(kg body wt.h)], compared with fish fed a PP-based diet [1.25 +/- 0.07 mmol NH(3)-N/(kg body wt.h)], suggesting that deamination is involved in the metabolism of dietary FAA. Teleost fish are known to obtain a high proportion of total energy from protein, compared with higher vertebrates. However, we found that feeding trout alevins a PP-based diet increased postprandial oxygen consumption for 2 to 24 h, whereas other treatments decreased 24-h postprandial metabolism. This may indicate that peptide metabolism is less efficient than protein metabolism. Juvenile rainbow trout differed from alevins in their response to FAA- and PP-based diets. These observations strongly suggest that intestinal dietary peptide transport and hydrolysis could support protein synthesis and growth in vertebrates that respond poorly to FAA-based diets. We conclude that nutrient administration may be improved by manipulating dietary peptide composition and peptide/protein ratios, leading to better utilization of synthetic peptides, with nutritional and therapeutic implications for all vertebrates.

Alternative complement activity and resistance to heat stress in golden shiners (Notemigonus crysoleucas) are increased by dietary vitamin C levels in excess of requirements for prevention of deficiency signs

Golden shiners (Notemigonus crysoleucas) require a dietary source of ascorbic acid (AA) for growth or survival, depending on diet composition. However, no quantitative requirements of golden shiners for AA for growth, health or survival have been determined, and specific deficiency signs have not been observed. The purpose of this study was to determine the effects of different dietary levels of AA on the growth and health of golden shiners fed diets containing 0-218.5 mg AA/kg diet for 10-16 wk. Weight gain, survival and gross deformities were assessed at 10 wk. The remaining fish were fed the same diets from wk 11-16; hematology and alternative complement activity were then assessed and a subset of live fish from each tank was exposed to elevated temperature. Gross deformities appeared in fish fed 0 mg AA/kg diet at 9 wk. The 19.5 mg AA/kg diet was sufficient to prevent the deformities and optimize survival, whereas growth did not differ among treatments. Fish fed 40.3 mg of AA/kg diet had a higher survival rate than fish fed 0 or 19.5 mg AA/kg diet after exposure to elevated temperatures (34-35.5 degrees C). Alternative complement activity and visceral AA concentrations were greater in fish fed diets with 218.5 mg AA/kg than in all other groups. The results indicate that the dietary requirement of AA for golden shiners increases in response to heat stress, and that the alternative complement activity (one index of immune competence) was strongly enhanced in fish fed a diet with approximately 10 times the amount of AA required to prevent deficiency signs.

Magnetic resonance imaging with stepped B(0) fields

This paper introduces the concept of imaging with stepped magnetic fields within the main B(0) field. The resonance frequency within each step is separated from the next by an amount greater than the imaging bandwidth. Each step thus gives rise to a separate imaging region enabling simultaneous imaging over multiple slices without aliasing. The auxiliary magnetic field regions are produced by coil inserts. The principle is illustrated using simple coil designs which introduce up to two steps into the main B(0) field. Phantoms placed in each uniform region were successfully imaged simultaneously with no aliasing.

Interaction between vitamins C and E affects their tissue concentrations, growth, lipid oxidation, and deficiency symptoms in yellow perch (Perca flavescens)

We have conducted studies with juvenile yellow perch (Perca flavescens) over a period of 20 weeks to address the question of the interaction between water- and lipid-soluble antioxidant vitamins. Fish (2.25+/-0.14 g) were divided into twelve groups, and triplicate groups were fed one of four casein-based, semi-purified diets formulated to contain low or high vitamin E levels of either 5 or 160 mg/kg without or with vitamin C supplementation (250 mg/kg). Diets were designated as -C-E, -C+E, +C-E, or +C+E, respectively. The fish fed the +C+E diet showed significantly higher weight gain, feed intake, and feed efficiency than the groups fed vitamin C-deficient diets. Total ascorbate concentrations of liver were significantly higher in fish fed vitamin C-supplemented diets than in fish fed the vitamin C-deficient diet after 16 and 20 weeks. The liver alpha-tocopherol concentrations were increased by supplemental vitamin C in vitamin E-deficient dietary groups which indicates a sparing or regenerating effect of vitamin C on vitamin E. Fish fed vitamin C-deficient diets (-C-E and -C+E) exhibited severe deficiency symptoms, such as scoliosis, lens cataracts, anorexia, and haemorrhages. The cumulative mortality was significantly higher in the -C-E groups. The thiobarbituric acid-reactive substances value was significantly higher in blood plasma of fish fed a diet unsupplemented with both vitamins. The findings in the present study with yellow perch support the hypothesis that vitamin C regenerates and/or spares vitamin E in vivo.

Development of Gerontological Nursing Curriculum Model

PURPOSE

This study was conducted to develop gerontological curriculum model which reflects the need of Korean society.

METHOD

Three round Delphi survey method was applied to find consensus of gerontological nursing competencies (knowledge, attitudes and skills) for graduates of nursing schools from the panel of gerontological nursing practice experts. Important concepts in gerontological nursing were delineated from literature review and discussions of gerontological nursing educators. Based on these results the gerontological nursing curriculum model was developed and course structure outlined by the researchers as a group.

RESULT

As the result of delphi survey, 32 items of knowledge, 29 items of attitude, and 21 items of skill were identified. The curriculum model constructed around a cube with three plane- functional capacity levels, settings, and nursing practice. Specific knowledge, attitudes and skills for gerontological theory and practicum course were suggested. Competency items were assigned to theory and/or practice.

CONCLUSION

A curriculum model for gerontological nursing has been developed by a group of gerontological nursing educators. The curriculum model should be further tested and developed with detailed theory and practicum course outline and textbooks.

High-performance liquid chromatographic determination of gossypol and gossypolone enantiomers in fish tissues using simultaneous electrochemical and ultraviolet detectors

There is a need to measure dietary transfer of gossypol and its metabolite, gossypolone in aquatic animals because of common use of cottonseed meal as a feed ingredient and fertilizer. The analytical method for gossypol and gossypolone enantiomers, therefore, becomes important. HPLC techniques have been developed by using mainly UV detection. We simultaneously used both UV and electrochemical (EC) detectors, and found that each individual detector has its own advantage which can increase accuracy and ease of identification. EC detection (2.5 and 50 ng/ml) exhibited a significantly lower detection level for both gossypol and gossypolone enantiomers than the UV detection (40 and 300 ng/ml) in the rainbow trout tissues, while UV detectors showed more stable detection than EC. We were able to detect a very low concentration of each gossypol enantiomer by EC but not UV detection especially in seminal plasma. For the first time gossypolone enantiomers were quantified in fish tissues by HPLC and its method was described. The technique, simultaneous adoption of both UV and EC detectors, could be helpful for a very low concentration of gossypol and/or gossypolone enantiomers in tissues of other animals and humans.

Gossypol and gossypolone enantiomers in tissues of rainbow trout fed low and high levels of dietary cottonseed meal

Gossypol is an antifertilizing agent in males and females. However, gossypol and its metabolite, gossypolone, have also gained interest because of their anticarcinogenic activities. This paper examines for the first time both enantiomers of tissue gossypol and gossypolone in mature rainbow trout fed two diets containing low (15%) and high (60%) levels of cottonseed meal (CM) for 9 months. The gossypol concentration was highest in liver followed by kidney, intestine, testis, blood plasma, stomach, and muscle. Gossypol was detected in muscles of fish fed low- and high-CM diets (0.31 +/- 0.03 and 1.95 +/- 0.59 microg of total gossypol/g, wet basis, respectively). The (+)-gossypol enantiomer was predominantly retained in all tissues. The ratio of (-)- to total gossypol ranged from 30 to 44% in fish fed the high-CM diet and from 23 to 30% in fish fed the low-CM diet except for muscle tissue (44%). Higher gossypolone concentrations were found in intestine than in liver. Gossypolone, however, was not detected in blood plasma, muscle, and testis of fish fed the low-CM diet. The ratio of gossypolone to gossypol was highest in muscle (1.75), followed by intestine (1.59), stomach (1.50), kidney (0.43), liver (0.34), testis (0.28), and blood plasma (0.27). This study indicated that the retention of the (-)-gossypol enantiomer is dependent on dietary concentrations and that the oxidative conversion of gossypol to gossypolone occurs more actively in the digestive tract and muscle than in other tissues in rainbow trout.

Image-based EPI ghost correction using an algorithm based on projection onto convex sets (POCS)

This work describes the use of a method, based on the projection onto convex sets (POCS) algorithm, for reduction of the N/2 ghost in echo-planar imaging (EPI). In this method, ghosts outside the parent image are set to zero and a model k-space is obtained from the Fourier transform (FT) of the resulting image. The zeroth- and first-order phase corrections for each line of the original k-space are estimated by comparison with the corresponding line in the model k-space. To overcome problems of phase wrapping, the first-order phase corrections for the lines of the original k-space are estimated by registration with the corresponding lines in the model k-space. It is shown that applying these corrections will result in a reduction of the ghost, and that iterating the process will result in a convergence towards an image in which the ghost is minimized. The method is tested on spin-echo EPI data. The results show that the method is robust and remarkably effective, reducing the N/2 ghost to a level nearly comparable to that achieved with reference scans.

Incisional hernia after corrective omentectomy for peritoneal dialysis catheter malposition

Laparotomic correction with or without omentectomy is occasionally required for malposition of a peritoneal dialysis (PD) catheter. We reviewed the incidence of incisional hernia following laparotomic PD catheter correction with or with omentectomy. From January 1996 to December 1998, PD catheters were implanted by non open-dissection technique using a trocar in 148 patients. Laparotomy for PD catheter malposition was required in 20 of the 148 patients. Omentectomy was performed simultaneously in 11 patients. After laparotomy, the wound was closed with interrupted or continuous layered polyglycolidelactide polymer sutures. Dialysis was resumed after the third or fourth day. Incisional hernia developed in 30% (6/20) of all patients undergoing laparotomy, but in none of the patients not undergoing laparotomy. The incidence increased when omentectomy was performed [5/11 (45.5%) vs 1/9 (11.1%)]. Multiparity, female sex, and laparotomy at a later time also predisposed to development of incisional hernia. Among the patients with incisional hernia, 2 patients showed multiple recurrences and 1 patient showed later leakage; PD catheters were lost in these patients. Another 3 patients continued continuous ambulatory peritoneal dialysis (CAPD) without a recurrence. The results suggest that incisional hernia is prevalent following laparotomic PD catheter correction, especially when omentectomy is performed simultaneously. Situations that seem to increase the risk of incisional hernia--inevitably encountered during corrective laparotomic omentectomy--are discussed. An evaluation is necessary concerning whether omentectomy acts as an independent risk factor for incisional hernia, and whether incisional hernia occurs more frequently when omentectomy is performed after a period on CAPD as compared with when it is performed at the time of PD catheter implantation. Laparotomic omentectomy should be performed as a last resort for the correction of PD catheter malposition.

Fast two-dimensional MR imaging by multiple acquisition with micro B(0) array (MAMBA)

A new method for acquiring MR data in two dimensions is described. This is achieved by combining coils into an array so as to produce a unique local magnetic field within each coil when placed within the B(0) field of a standard MRI scanner. In this way each known location of a coil is associated with a unique resonant frequency. Each coil now represents a location of a pixel in the plane, and after Fourier transformation of the signal the resulting frequency spectrum gives immediately the spin distribution in the plane of the array. In effect, the two-dimensional spatial distribution is frequency encoded without the use of switched gradients or phase encoding. As only static fields are used, this technique offers the potential of fast imaging. Furthermore, signals from different locations would also be inherently time-registered. Initial experiments to demonstrate the principle are described, using a square array of 5 by 5 coils. The currents in the coils were determined by using a genetic algorithm. Echoes from pellet phantoms placed in the array were acquired using standard spin-echo sequences with gradients switched off. The results are promising, with the spectra showing generally good resolution between peaks, enabling localisation in up to half the pixels. Technical difficulties are discussed and possible applications are outlined.

Hepatoprotective effects of Platycodon grandiflorum on acetaminophen-induced liver damage in mice

The protective effects of an aqueous extract from the roots of Platycodon grandiflorum A. DC (Campanulaceae), Changkil (CK), on acetaminophen (APAP)-induced hepatotoxicities and the possible protective mechanisms involved were investigated in mice. Pretreatment with CK prior to the administration of APAP significantly prevented the increase in serum alanine aminotransferase and aspartate aminotransferase activity and hepatic lipid peroxidation in a dose-dependent manner. APAP-induced hepatotoxicity was also essentially prevented as evidenced by liver histopathology. Hepatic glutathione levels and glutathione-S-transferase activities were not affected by treatment with CK alone, but pretreatment with CK protected the APAP-induced depletion of hepatic glutathione levels. The effects of CK on cytochrome P450 (P450) 1A2 and 2E1, the major isozymes involved in APAP bioactivation, were investigated. In microsomal incubations, CK effectively inhibited P450 lA2-dependent methoxyresorufin O-deethylase activities and the P450 2E1-dependent p-nitrophenol and aniline hydroxylase. The results suggest that the protective effects of CK against the APAP-induced hepatotoxicity may, at least in part, be due to its ability to block P450-mediated APAP bioactivation.