Adiponectin abates atherosclerosis by reducing oxidative stress

Background

We investigated whether the anti-atherosclerosis of adiponectin (APN) relates to the reduction of oxidative stress. We observed the overexpression of adiponectin gene with different titers on atherosclerosis (AS) models of high-fat apolipoprotein E-deficient (ApoE^−/−) mice.

Material/Methods

We divided 48 male ApoE^−/− mice into 4 groups: control group, high-fat diet group, low adiponectin group, and high adiponectin group. The low and high adiponectin group mice were treated with recombinant adenovirus expressing mice adiponectin (Ad-APN) with low-dose adiponectin 1.0×10⁸ p.f.u. and high-dose adiponectin 5.0×10⁸ p.f.u. via the tail every 2 weeks and given a high-fat diet for the last 8 weeks. On the 14^th day after injection, blood samples were obtained from the vena cava.

Results

Along with increased serum adiponectin, serum superoxide dismutase (SOD) activity increased (P<0.05) and concentration of malondialdehyde (MDA) was decreased (P<0.05). Levels of total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) were decreased, especially TC and LDL-C (P<0.05). A real-time fluorescent quantitative polymerase chain reaction test was used to analyze levels of mRNA expression for endothelial nitric oxide synthase (eNOS) and adiponectin in the aorta. Along with increased adiponectin, the mRNA expression of eNOS in the aorta was increased significantly (P<0.05). The lesion formation in the aortic sinus was inhibited by 25% and 31% in the low-APN group and high-APN group, respectively (P<0.05). Along with the increase of adiponectin doses, the damage of atherosclerosis gradually eased. However, the differences between the low-APN group and high-APN group had no statistical significance.

Conclusions

Adiponectin may protect the aorta from atherosclerosis injury by reducing oxidative stress, reducing lesion formation size in the aortic root and reducing TC, TG, and LDL-C in serum. The molecular mechanism may involve preservation of SOD, reducing MDA in serum, and increasing eNOS and adiponectin mRNA expression in the aorta.

Russell body gastritis/duodenitis: a case series and description of immunoglobulin light chain restriction

Russell body esophago-gastro-duodenitis is an unusual form of chronic inflammation, with only 22 cases being reported in PubMed. However, the prevalence and clinical significance remain unknown. This report describes the clinico-pathological characteristics of nine cases of Russell body gastritis (RBG) and one case of Russell body duodentitis (RBD), with nonspecific endoscopic appearance. The Mott cells (plasma cells with Russell bodies) showed κ light chain restriction in eight gastritis cases and λ light chain restriction in the duodentitis case, and there were no histological features that suggested lymphoma. Thus, a diagnosis of monoclonal RBG/RBD was made. Helicobacter pylori infection was found in 55.6% of RBG cases and in the RBD case. And, the clinical follow-up evaluations were uneventful. This report is the first study to describe this benign disease entity with monoclonality on a large-scale basis. In addition, the monoclonality of Mott cells cannot be used as evidence of an existing neoplastic lesion, and taken together, these findings may indicate a reactive process.

Schwannoma of the colon: A case report

Schwannomas are rare tumors originating from the Schwann cells, which form the neural sheath. These tumors occur most frequently in the head, neck, arms and limbs. Primary schwannomas of the colon and rectum are extremely rare; they are usually benign, but in extremely rare cases (2%), they can present with malignant degeneration if not surgically removed. The current study presents the case of a 65-year-old male with blood in the feces who underwent a colonoscopy that revealed an oval-shaped mass covered by ulcerated mucosa. A standard biopsy examination indicated a gelatinous carcinoma, and the patient consequently underwent a laparoscopic resection of the left colon. Histological examination revealed a schwannoma. Immunohistochemistry showed the tumor to be positive for S100 and vimentin, but negative for cluster of differentiation (CD)117, cytokeratin (CK)7, CK20, chromogranin, actin and synaptophysin, with a Ki-67 proliferative index of 3%. Lymph nodes were not involved. Overall, pre-operative biopsy examinations may be difficult for schwannomas, and immunohistochemistry is necessary for the correct diagnosis of this condition. In contrast to gastrointestinal stromal tumors, schwannomas are negative for CD117 and positive for S100 protein and vimentin. A Ki-67 index of ≥5% is strictly correlated with greater tumor aggressiveness. Therefore, the gold standard treatment for schwannomas is oncological radical surgical resection.

The microbiome in inflammatory bowel disease and its modulation as a therapeutic manoeuvre

Inflammatory bowel disease (IBD) is increasing in incidence in both the developed and the developing world. Genetic, immunological and environmental factors are known to be involved. Genome-wide studies have examined the contribution played by host genetics in the development of IBD and have estimated that genetic factors are responsible for about 25 % of the disease risk. Having an IBD-associated genotype does not always lead to development of the disease phenotype, and hence it seems likely that environmental factors are key to triggering development of the disease in genetically susceptible individuals. The gut microbiota contains more cells than its human host, and mounting evidence attests to the importance of the microbiota in the development of several diseases, including IBD, metabolic syndrome and CVD. The present paper reviews the interplay between the microbiota and the mucosal immune system in health and in IBD; and discusses the evidence base for the use of therapeutic modulation of the microbiota to prevent and treat IBD.

Pedicle subtraction osteotomy for the treatment of chin-on-chest deformity in a post-radiotherapy dropped head syndrome: a case report and review of literature

PURPOSE

Chin-on-chest deformity is a rare and severe condition mostly related with ankylosing spondylitis, traumas and/or cervical spine surgery. We present a case of 69 years old woman with a rare form of chin-on-chest secondary to dropped head syndrome (DHS), developed after radiotherapy for Hodgkin disease. In addition, we reviewed the few publications about this specific condition; management and surgical treatment of DHS are discussed.

METHODS

We performed a pedicle subtraction osteotomy (PSO) and stabilization through a posterior approach. Intraoperative monitoring using motor and somatosensory evoked potentials and wake-up test were carried out.

RESULTS

At 19th month follow-up, the patient reported a significant improvement of cervical pain, dysphagia and respiratory difficulty and a complete restoration of the neurological impairment. The achieved correction was successful and the patient was very satisfied by the restoration of forward gaze.

CONCLUSIONS

DHS is a very rare post-radiotherapy complication; there is lack of evidences in literature about its management. The only definitive treatment seems to be surgical intervention. PSO is a valid therapeutic option when fixed chin-on-chest deformity occurs; although it is a demanding technique and it presents high rate of complications, the actual neurological monitoring methods provide more intraoperative safety.

Behavioral testing-related changes in the expression of Synapsin I and glucocorticoid receptors in standard and enriched aged Wistar rats

Our aim was to assess the changes in the Synapsin I and glucocorticoid receptor (GR) expression induced by behavioral testing in the dorsal and ventral hippocampi of standard and enriched aged Wistar rats. The environmental enrichment (EE) was carried out 3h/day over a period of two months and then, the rats were tested in the elevated zero-maze (EZM) and radial-arm water maze (RAWM). Behavioral results showed that, even at an advanced age, EE was able to reduce anxiety-related behaviors and improve the performance in the RAWM. Regarding the neurobiological data, Synapsin I expression in the dorsal CA3, but not in the ventral, was enhanced both in enriched and standard rats when they performed the behavioral testing. Interestingly, the EE exposure was enough to increase Synapsin I in the ventral CA3. The analysis of GR in the dorsal hippocampus showed an increase of this receptor in the dDG both in enriched and standard rats when they performed the behavioral testing, whereas in the dCA1 and dCA3, the effect of the testing depended on the previous housing condition. In the ventral region, we found that the effects of EE were higher because on the one hand, the GR expression induced by the behavioral testing was enhanced in the dSUB, vCA1 and vCA3 when the rats were previously enriched and on the other hand, EE, regardless of the behavioral testing, increased the GR expression in the vDG and vSUB. Therefore, our results suggest that the effect of the behavioral testing on the neurobiological mechanisms studied is different depending on the previous housing condition of aged rats.

Prevalence of microalbuminuria and diagnostic value of dipstick proteinuria in outpatients from HIV clinics in Bukavu, the Democratic Republic of Congo

Background

Microalbuminuria is a marker of early kidney disease and high cardiovascular risk in various populations, including HIV positive patients. However, the diagnostic value of qualitative (dipstick) proteinuria and the burden of microalbuminuria in HIV positive patients living in sub-Saharan Africa are relatively unclear.

Methods

In a cross-sectional study, 235 HIV- positive outpatients were screened for proteinuria in 3 HIV-clinics in Bukavu. A spot urine sample from each subject was tested both by a dipstick and albumin-creatinine-ratio (ACR) assay. The performance of dipstick proteinuria exceeding 1+ was compared with that of microalbuminuria (≥30 mg/g creatinine).

Results

The prevalence of microalbuminuria and dipstick proteinuria ≥ (1+), ≥ (2+) and ≥ (3+) was 11%, 41%, 3.5% and 0.7%, respectively.

Compared to microalbuminuria, the dipstick (proteinuria of 1+ or greater) had an overall sensitivity of 60% and a specificity of 61%. The positive predictive value was 15.4% and the negative predictive value 92.8%.

Conclusion

Proteinuria is highly prevalent in HIV positive patients. The limited sensitivity and specificity of the dipstick to detect significant microalbuminuria make it unattractive as a screening tool in HIV positive patients.

Stroke in patients with occlusion of the internal carotid artery: options for treatment

Ischemic stroke may occur in patients in whom vascular imaging shows the ipsilateral internal carotid artery (ICA) to be occluded. In younger patients this is often due to carotid artery dissection, while in older people this most likely results from cardiac embolism or thrombosis secondary to high-grade stenosis at the carotid bifurcation. Interventional techniques aim at recanalization of the carotid artery for early restoration of cerebral blood flow and secondary prevention of future strokes. In chronic ICA occlusion the ischemic infarct may be related to hemodynamic compromise. In this situation, extracranial-intracranial bypass surgery was introduced, but its role remains still unclear. Ischemic stroke may also occur in patients with a chronic occlusion of the contralateral ICA. This situation demands the usual stroke treatment, but surgical and neuroradiological interventions face a higher risk than unilateral vascular pathology. Medical treatment supports stroke prevention in carotid artery occlusion.

Pouchitis: prevention and treatment

PURPOSE OF REVIEW

Pouchitis, representing a spectrum of disease phenotypes, is the most common long-term complication in patients who have undergone restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). Its management and prevention are challenging.

RECENT FINDINGS

Treatment modalities vary according to phenotypes of pouchitis. The medical therapy of pouchitis remains largely empiric and antibiotic-based. However, patients may develop de-novo chronic antibiotic-refractory pouchitis (CARP) or progress from acute antibiotic-responsive phenotype. Patients with CARP often require alternative medical approaches to routine antibiotics, including the use of oral or topical mesalazine, corticosteroids, and sometimes immunomodulators or biological agents against tumour necrosis factor. There are two strategies to prevent pouchitis, the primary (i.e., the prevention of the initial episode) and secondary (i.e., the prevention of recurrent episodes) prophylaxis. There are scant data in the literature on nutritional aspects.

SUMMARY

We evaluated the efficacy of current strategies of prevention and treatments of pouchitis and propose algorithms, including attention to nutrition wherein data exist.

Down-regulated aquaporin 5 inhibits proliferation and migration of human epithelial ovarian cancer 3AO cells

Background

Recent studies suggested that aquaporins 5 (AQP5) was associated with many kinds of cancers and regulated many processes of various kinds of cancer cells. Our previous studies also demonstrated that AQP5 was highly expressed in epithelial ovarian cancer and contributed to the progress of ovarian cancer.

Methods

Lentivirus for knocking-down the expression of AQP5 was prepared and verified by qPCR and Western blotting. Cell counting kit-8 (CCK8) assay and transwell assay were performed to investigate the role of AQP5 on proliferation and migration of 3AO cells. The effects of down-regulating AQP5 on tumorigenesis were tested by tumor xenografts experiments.

Results

An effective lentivirus silencing AQP5 expression was obtained and used in this study. Down-regulating AQP5 inhibited proliferation and migration of cultured human epithelial ovarian cancer 3AO Cell. Furthermore, interfering of AQP5 during tumorigenesis could efficiently decrease the tumor growth in athymic mice.

Conclusions

These findings altogether suggest that AQP5 regulated multi processes in ovarian carcinogenesis and may be an attractive therapeutic target.

Disrupted calcium homeostasis is involved in elevated zinc ion-induced photoreceptor cell death

Zinc (Zn), the second abundant trace element in living organisms, plays an important role in regulating cell metabolism, signaling, proliferation, gene expression and apoptosis. Meanwhile, the overload of Zn will disrupt the intracellular calcium homeostasis via impairing mitochondrial function. However, the specific molecular mechanism underlying zinc-induced calcium regulation remains poorly understood. In the present study, using zinc chloride (ZnCl2) as a stressor, we investigated the effect of exogenous Zn(2+) in regulating murine photoreceptor cell viability, reactive oxygen species (ROS), cell cycle distribution and calcium homeostasis as well as plasma membrane calcium ATPase (PMCA) isoforms (PMCA1 and PMCA2, i.e., ATP2B1, ATP2B2) expression. We found that the exogenous Zn(2+) in the exposure range (31.25-125.0 μmol/L) results in the overgeneration of ROS, cell cycle arrest at G2/M phases, elevation of cytosolic [Ca(2+)], inactivation of Ca(2+)-ATPase and reduction of both PMCA1 and PMCA2 in 661 W cells, and thus induces cell death. In conclusion, ZnCl2 exposure can elevate the cytosolic [Ca(2+)], disrupt the intracellular calcium homeostasis, further initiate Ca(2+)-dependent signaling pathway in 661 W cells, and finally cause cell death. Our results will facilitate the understanding of cell death induced by the zinc ion-mediated calcium homeostasis disruption.

A rare presentation of retiform hemangioendothelioma in the external auditory canal

Retiform hemangioendothelioma is a rare intermediate or borderline neoplasm of the blood vessels that mostly occurs in extremities. Here we report a unique case of retiform hemangioendothelioma presented in the external auditory canal. 58-year-old male patient presented with the complaint of right ear swelling for 4 years. On examination, a spherical swelling in the right ear was found occluding the view of external auditory canal. The tumor was removed surgically. Intraoperatively, the mass was found attached to the outer part of the right external auditory canal near the root of helix. Histopathology of the resected tumor showed typical features of retiform hemangioendothelioma. In addition, immunohistochemical analysis revealed that tumor was positive for endothelial cell marker CD34 and occasionally positive for cell proliferative marker Ki-67.

An Unusual Left Ventricular Apical Mass

Left ventricular apical masses constitute a rare finding. Imaging properties together with the clinical history of the patient usually allow an etiologic definition. We report a challenging case of an ambiguous left ventricular apical mass of uncertain nature till histological examination. Points of interest were singular clinical history and echocardiographic findings, although not conclusive in hypothesis generating. Furthermore to the best of our knowledge, this is one of the rare attempt to excise a deep left ventricular mass with a mini-invasive surgical approach.

Upper limb erythema nodosum: the first presentation of Crohn's disease

Key Clinical Message

Inflammatory bowel disease can present with extraintestinal features as the patient's only complaint. The erythema nodosum (EN) initially affected the upper limbs only, reminding us that signs do not always present in a classical fashion. The presence of EN should prompt the clinician to look for any underlying cause.

HE4 expression is associated with hormonal elements and mediated by importin-dependent nuclear translocation

Antiestrogens including tamoxifen and fulvestrant have been evaluated as chemotherapeutics for ovarian cancer, particularly in cases of platinum resistant disease. Human epididymis protein 4 (HE4) is highly overexpressed in women with ovarian cancer and overexpression of HE4 has been found to correlate with platinum resistance. However, the role of HE4 in modulating responses to hormones and hormonal therapy has not been characterized in ovarian cancer. Here we demonstrate that 17β-estradiol, tamoxifen, and fulvestrant induce nuclear and nucleolar translocation of HE4 and that HE4 overexpression induces resistance to antiestrogens. HE4 was found to interact with estrogen receptor-α (ER-α), and HE4 overexpression resulted in ER-α downregulation in vitro and in human ovarian cancers. We identified a novel role for importin-4 in governing the nuclear transport of HE4. Treatment with ivermectin, an importin inhibitor, blocked HE4/importin-4 nuclear accumulation and sensitized HE4-overexpressing ovarian cancer cells to fulvestrant and tamoxifen.

Solitary hepatic lymphangioma: a one-case report

Hepatic lymphangiomas, malformations of the liver lymphatic system, are extremely rare conditions in adults. A 41-year-old man presented with right upper abdominal pain for 6 months was introduced in this report. Ultrasound (US) and computed tomography (CT) scan demonstrated a giant cystictumor with a pedunculatedextrahepatic growth pattern. Due to diagnostic uncertainty, a partial hepatectomy was performed and pathological results confirmed the diagnosis of solitary hepatic lymphangioma. In this article, we reviewed the clinical and pathology features, preoperative diagnostic challenges, and treatments of hepaticlymphangiomas.

Regulation of virulence of Entamoeba histolytica

Entamoeba histolytica is the third-leading cause of parasitic mortality globally. E. histolytica infection generally does not cause symptoms, but the parasite has potent pathogenic potential. The origins, benefits, and triggers of amoebic virulence are complex. Amoebic pathogenesis entails depletion of the host mucosal barrier, adherence to the colonic lumen, cytotoxicity, and invasion of the colonic epithelium. Parasite damage results in colitis and, in some cases, disseminated disease. Both host and parasite genotypes influence the development of disease, as do the regulatory responses they govern at the host-pathogen interface. Host environmental factors determine parasite transmission and shape the colonic microenvironment E. histolytica infects. Here we highlight research that illuminates novel links between host, parasite, and environmental factors in the regulation of E. histolytica virulence.

An association study of CASQ1 gene polymorphisms and heat stroke

Although molecular mechanisms of heat stroke under physiological and pathological conditions have not yet been elucidated, a novel disease-associated gene encoding a calcium-binding protein, calsequestrin-1 (CASQ1), was suggested relevant based on results from a transgenic murine model. Here, we show the association between single nucleotide polymorphisms (SNPs) of CASQ1 and physiological parameters for heat stroke from a study involving 150 patients. Pooled DNA from heat stroke patients were subjected to sequencing and 3 SNPs were identified. Genotypes were assigned for all patients according to g. 175A>G, one SNP which leads to a nonsynonymous substitution (N59D) in the first exon of human CASQ1 gene. We analyzed the genotypic data with a linear model based on significance scores between SNP (175A>G) and heat stroke parameters. As a result, we found a significant association between SNP A175G and heat stroke (P<0.05). Further bioinformatics analysis of the 1-Mb flanking sequence revealed the presence of two genes that encode DDB1 and CUL4 associated factor 8 (DCAF8), and peroxisomal biogenesis factor 19 (PEX19), respectively, which might be functionally related to CASQ1. Our results showed that the blood calcium of patients with allele D increased significantly, compared to patients with allele N (P<0.05), which may result from the decreased calcium in muscle, suggesting that N59D in CASQ1 might account for the dysfunction of CASQ1 in calcium regulation during heat stroke.

Alicaforsen: An Emerging Therapeutic Agent for Ulcerative Colitis and Refractory Pouchitis

Pouchitis is a relatively common complication that develops following ileal pouch-anal anastomosis in patients with complicated ulcerative colitis (UC). Both pouchitis and UC share similarities in their development, as well as in the mechanisms involving mediators of the inflammatory process. In the recent years, the discovery and investigation of biological therapies have led to advancement in the management of these disorders, and the continuation of research on this novel area holds strong implications for a future reduction in the use of invasive surgical procedures. Alicaforsen represents one of these emerging therapeutic agents, and has demonstrated promising results in both preclinical and clinical settings. This article reviews the therapeutic effects of alicaforsen for the management of UC and refractory pouchitis, with special emphasis on the mechanism of action of this therapeutic agent and the clinical studies asserting its effectiveness.

Escherichia coli positive infratentorial subdural empyema secondary to mastoiditis and underlying cholesteatoma

Infratentorial subdural empyema is a neurosurgical emergency that is associated with an alarmingly high morbidity and mortality if appropriate management is delayed. It is an important differential to consider when confronted with a patient with a reduced Glasgow Coma Scale, focal neurology and symptoms of raised intracranial pressure in the presence of a head and neck infection. It is also important that the primary team managing these patients is aware of the many pathogens that may be involved, including Escherichia coli. Early recognition, prompt diagnosis, timely involvement of the appropriate multidisciplinary teams, including neurosurgery, otorhinolaryngology, radiology and microbiology should be sought, and urgent intervention are imperative in avoiding a fatal outcome. This article presents a case of E coli-positive infratentorial subdural empyema secondary to mastoiditis due to underlying cholesteatoma, and a review of the pertinent literature.

Hepatic emphysema associated with ultrasound-guided liver biopsy in a dog

An eleven-year-old Chinese Crested Powder Puff dog presented with polydipsia/polyuria, inappetence, diarrhea and vomiting underwent an ultrasound-guided percutaneous liver biopsy. Two days post-biopsy the clinical condition of the dog acutely deteriorated with fever, dyspnea, ataxia and subcutaneous emphysema. Radiographs and ultrasound showed focal severe hepatic emphysema in the region of the previous liver biopsy. Post-mortem examination revealed chronic hepatitis with dissecting fibrosis, acute hepatitis with hemorrhage and in the hindlimb musculature extensive hemorrhage and necrosis. Pure cultures of the gas producing bacteria Clostridium perfringens were isolated in samples from the hind limb musculature. We propose that the hepatic emphysema in the region of the biopsy site was a result of a clostridial infection.

How to get the most from microarray data: advice from reverse genomics

BACKGROUND

Whole-genome profiling of gene expression is a powerful tool for identifying cancer-associated genes. Genes differentially expressed between normal and tumorous tissues are usually considered to be cancer associated. We recently demonstrated that the analysis of interindividual variation in gene expression can be useful for identifying cancer associated genes. The goal of this study was to identify the best microarray data-derived predictor of known cancer associated genes.

RESULTS

We found that the traditional approach of identifying cancer genes--identifying differentially expressed genes--is not very efficient. The analysis of interindividual variation of gene expression in tumor samples identifies cancer-associated genes more effectively. The results were consistent across 4 major types of cancer: breast, colorectal, lung, and prostate. We used recently reported cancer-associated genes (2011-2012) for validation and found that novel cancer-associated genes can be best identified by elevated variance of the gene expression in tumor samples.

CONCLUSIONS

The observation that the high interindividual variation of gene expression in tumor tissues is the best predictor of cancer-associated genes is likely a result of tumor heterogeneity on gene level. Computer simulation demonstrates that in the case of heterogeneity, an assessment of variance in tumors provides a better identification of cancer genes than does the comparison of the expression in normal and tumor tissues. Our results thus challenge the current paradigm that comparing the mean expression between normal and tumorous tissues is the best approach to identifying cancer-associated genes; we found that the high interindividual variation in expression is a better approach, and that using variation would improve our chances of identifying cancer-associated genes.

Unilateral peripheral neuropathic pain: The role of neurodiagnostic skin biopsy

According to the current definition of neuropathic pain (“pain arising as a direct consequence of a lesion or disease affecting the somatosensory system”), the demonstration of a lesion or disease involving the somatosensory system is mandatory for the diagnosis of definite neuropathic pain. Although several methods are currently available for this aim, none is suitable for every type of disease (or lesion). Neurodiagnostic skin biopsy (NSB) is a relatively new technique for the diagnosis of peripheral nerve lesions. It is an objective method, completely independent from the patient’s complaining, based on immunohistochemical staining techniques that allow measurement of the density of the epidermal nerve fibers, currently considered the free nerve endings of small diameter (A-delta and C) afferent fibers. NSB has the important property of being used to investigate the skin, allowing obtaining a diagnosis of small fiber axonal neuropathy of peripheral nerves supplying every body part covered by skin. This feature appears to be very important, particularly in cases of unilateral nerve lesions, because it allows going beyond the possibilities of neurophysiological tests which are available only for a limited number of peripheral nerves. All these characteristics make NSB a precious instrument for the diagnosis of peripheral unilateral neuropathic pain.

One year of infliximab therapy successfully improved a case of refractory pouchitis without the use of antibiotics

A 29-year-old woman with ulcerative colitis underwent total colectomy with ileal-pouch-anal canal anastomosis in 1999. After the surgery, she developed refractory pouchitis. We administered metronidazole, mesalamine and ciprofloxacin; however, her clinical symptoms improved only very slightly. We initiated treatment with infliximab in June 2011 and discontinued the antibiotics. Thereafter, the patient's abdominal symptoms quickly improved. We discontinued the infliximab therapy in June 2012, after which time, the patient's abdominal symptoms remained in remission for 40 weeks, without the use of antibiotics. This report suggests that infliximab is useful not only for improving the clinical symptoms of refractory pouchitis, but also discontinuing antibiotic therapy in such patients.