Mechanisms of triglyceride metabolism in patients with bile acid diarrhea

Bile acids(BAs) are essential for the absorption of lipids. BA synthesis is inhibited through intestinal farnesoid X receptor(FXR) activity. BA sequestration is known to influence BA metabolism and control serum lipid concentrations. Animal data has demonstrated a regulatory role for the FXR in triglyceride metabolism. FXR inhibits hepatic lipogenesis by inhibiting the expression of sterol regulatory element binding protein 1c via small heterodimer primer activity. Conversely, FXR promotes free fatty acids oxidation by inducing the expression of peroxisome proliferator-activated receptor α. FXR can reduce the expression of microsomal triglyceride transfer protein, which regulates the assembly of very low-density lipoproteins(VLDL). FXR activation in turn promotes the clearance of circulating triglycerides by inducing apolipoprotein C-Ⅱ, very low-density lipoproteins receptor(VLDL-R) and the expression of Syndecan-1 together with the repression of apolipoprotein C-Ⅲ, which increases lipoprotein lipase activity. There is currently minimal clinical data on triglyceride metabolism in patients with bile acid diarrhoea(BAD). Emerging data suggests that a third of patients with BAD have hypertriglyceridemia. Further research is required to establish the risk of hypertriglyceridaemia in patients with BAD and elicit the mechanisms behind this, allowing for targeted treatment.

Intestinal endometriosis-A rare cause of colonic perforation

Endometriosis is the ectopic growth of viable endometrium outside the uterus, affecting approximately 7% of females. It commonly affects pelvic structures including the bowel. Perforation of the colon by endometriosis is very rare and the patients generally present with an asymptomatic or painful pelvic mass, often in the left iliac fossa. Our patient presented acutely unwell and her symptoms were more suggestive of pyelonephritis or diverticulitis. We therefore report an unusual cause of acute abdomen. The purpose of the following case report is to elucidate certain diagnostic and therapeutic problems of the disease, concerning both surgeons and gynaecologists. In summary, intestinal endometriosis should be considered in the differential diagnosis of all post-menarche women with episodic gastrointestinal symptoms. A past history of endometriosis or co-existent gynaecological symptoms should increase the index of suspicion, and taparoscopy prior to formal laparotomy should be considered. Our patient, in retrospect, had a history of mild endometriosis, but we feel that this case serves as a reminder of a rare, but important, differential diagnosis of acute abdomen in females.

From 2-dimensional to 3-dimensional: Overcoming dilemmas in intestinal mucosal interpretation

The purpose of this review is to provide a definitive account of small intestinal mucosal structure and interpretation. The coeliac lesion has been well known, but not well described to date and this review aims to identify the interpretative difficulties which have arisen over time with the histological assessment of coeliac disease. In early coeliac interpretation, there were significant inaccuracies, particularly surrounding intraepithelial lymphocyte counts and the degree of villous flattening which occurred in the tissue. Many of these interpretive pitfalls are still encountered today, increasing the potential for diagnostic errors. These difficulties are mostly due to the fact that stained 2-dimensional sections can never truly represent the 3-dimensional framework of the intestinal tissue under investigation. Therefore, this review offers a critical account occasioned by these 2-dimensional interpretative errors and which, in our opinion, should in general be jettisoned. As a result, we leave a framework regarding the true 3-dimensional knowledge of mucosal structure accrued over the 70-year period of study, and one which is available for future reference.

一种小便收集垫的改良方法:随机临床的试验

目的:尿样本常受到严重的混合生长菌污染,本实验目的在于评估小便收集垫(UCP)这种改良方法对于降低疑有尿路感染(UTI)患儿的尿标本污染的能力。方法:2岁以下的发热患儿随机使用两种UCP方法,相同的UCP放在尿布里直到尿液完全浸透(单一UCP组); 每30 min更换一个新的UCP直到尿液浸透(更换UCP 组)。两组都使用湿度敏感声音报警器。

毛细支气管炎患者的RSV测试:何种鼻咽采样方法最佳

Lower nasal swab and higher nasopharyngeal aspirate samples were compared for RSV immunofluorescence and pain score in infants hospitalised with acute bronchi olitis. The nasal swab procedure was significantly less painful but was negative in approximately one third of RSV positive cases.

Microscopic enteritis:Bucharest consensus

Microscopic enteritis(ME) is an inflammatory condition of the small bowel that leads to gastrointestinal symptoms,nutrient and micronutrient deficiency.It is characterised by microscopic or sub-microscopic abnormalities such as microvillus changes and enterocytic alterations in the absence of definite macroscopic changes using standard modern endoscopy.This work recognises a need to characterize disorders with microscopic and submicroscopic features,currently regarded as functional or non-specific entities,to obtain further understanding of their clinical relevance.The consensus working party reviewed statements about the aetiology,diagnosis and symptoms associated with ME and proposes an algorithm for its investigation and treatment.Following the 5th International Course in Digestive Pathology in Bucharest in November 2012,an international group of 21 interested pathologists and gastroenterologists formed a working party with a view to formulating a consensus statement on ME.A five-step agreement scale(from strong agreement to strong disagreement) was used to score 21 statements,independently.There was strong agreement on all statements about ME histology(95%-100%).Statements concerning diagnosis achieved 85% to 100% agreement.A statement on the management of ME elicited agreement from the lowest rate(60%) up to 100%.The remaining two categories showed general agreement between experts on clinical presentation(75%-95%) and pathogenesis(80%-90%) of ME.There was strong agreement on the histological definition of ME.Weaker agreement on management indicates a need for further investigations,better definitions and clinical trials to produce quality guidelines for management.This ME consensus is a step toward greater recognition of a significant entity affecting symptomatic patients previously labelled as non-specific or functional enteropathy.

Genotoxicity Induced by Low Dose and Mixed Exposure to Haloacetaldehydes,an Emerging Class of Drinking Water Disinfection By-products

Haloacetaldehydes(HALs)are the third largest disinfection by-products(DBPs)class by mass in drinking water.Most of them alone in high doses are more cytotoxic and genotoxic than regulated DBPs.However,the toxic effects of mixed exposure to HALs at environmentally relevant levels are still unknown.Given that genotoxicity is critical for risk assessment,we employed multiple genotoxic tests including the Salmonella typhimurium revertant mutation assay(Ames assay),the single cell gel electrophoresis(SCGE)assay,the cytoplasmic blocking micronucleus(CBMN)assay,and theγ-H2AX assay to investigate the genotoxicity of HALs based on the HALs concentrations and components detected in the finished drinking water of Shanghai,China.The results demonstrated the concentrations of HALs were low,ranging from 0.04µg/L to 4.47µg/L,and the total concentration was 10.85µg/L.Although the mutagenicity of HALs was negative even at 1000-fold concentrations in the real world,mixed exposure to 100 and 1000-fold concentrations HALs resulted in DNA and chromosomal damage in human hepotocyte(HepG2)cells.HALs significantly increased the levels of reactive oxygen species(ROS)andγ-H2AX and activated nuclear factor erythroid-derived factor 2-related factor 2(NRF2)pathway-related protein expressions in HepG2 cells.The antioxidant NAC could ameliorate NRF2 pathway-related protein expression and DNA damage caused by HALs,suggesting that the genotoxicity of mixed exposure to HALs involved cellular oxidative stress and NRF2 pathway activation.

Robust direct power control based on the Lyapunov theory of a grid-connected brushless doubly fed induction generator

This paper deals with robust direct power control of a grid-connected bmshless doubly-fed induction generator（BDFIG）. Using a nonlinear feedback lineariza- tion strategy, an attempt is made to improve the desired performances by controlling the generated stator active and reactive power in a linear and decoupled manner. There- fore, to achieve this objective, the Lyapunov approach is used associated with a sliding mode control to guarantee the global asymptotical stability. Thus, an optimal operation of the BDFIG in sub-synchronous operation is obtained as well as the stator power flows with the possibility of keeping stator power factor at a unity. The proposed method is tested with the Matlab/Simulink software. Simulation results illustrate the performances and the feasibility of the designed control.