Tuning beneficial calcineurin phosphatase activation to counterα-synuclein toxicity in a yeast model of Parkinson’s disease

Calcineurin(CN)is a calcium-and calmodulindependent serine/threonine that has been studied in many model organisms including yeast,filamentous fungi,plants,and mammals.Its biological functions range from ion homeostasis and virulence in lower eukaryotes to T-cell activation in humans by human nuclear factors of activated T-cells.CN is a heterodimeric protein consisting of a catalytic subunit,calcineurin A(Cna1p),which contains an active site with a dinuclear metal center,and a regulatory Ca^(2+) binding subunit called calcineurin B(Cnb1p)required to activate Cna1p.The calcineurin B subunit has been highly conserved through evolution:For example,the mammalian calcineurin B shows 54%identity with calcineurin B from Saccharomyces cerevisiae.

Alexander disease:the road ahead

Alexander disease is a rare neurodegenerative disorder caused by mutations in the glial fibrillary acidic protein,a type III intermediate filament protein expressed in astrocytes.Both early(infantile or juvenile)and adult onsets of the disease are known and,in both cases,astrocytes present characteristic aggregates,named Rosenthal fibers.Mutations are spread along the glial fibrillary acidic protein sequence disrupting the typical filament network in a dominant manner.Although the presence of aggregates suggests a proteostasis problem of the mutant forms,this behavior is also observed when the expression of wild-type glial fibrillary acidic protein is increased.Additionally,several isoforms of glial fibrillary acidic protein have been described to date,while the impact of the mutations on their expression and proportion has not been exhaustively studied.Moreover,the posttranslational modification patterns and/or the protein-protein interaction networks of the glial fibrillary acidic protein mutants may be altered,leading to functional changes that may modify the morphology,positioning,and/or the function of several organelles,in turn,impairing astrocyte normal function and subsequently affecting neurons.In particular,mitochondrial function,redox balance and susceptibility to oxidative stress may contribute to the derangement of glial fibrillary acidic protein mutant-expressing astrocytes.To study the disease and to develop putative therapeutic strategies,several experimental models have been developed,a collection that is in constant growth.The fact that most cases of Alexander disease can be related to glial fibrillary acidic protein mutations,together with the availability of new and more relevant experimental models,holds promise for the design and assay of novel therapeutic strategies.

In Hospital Death among under Five Years Children Hospitalized with Meningitis in the Eastern of the Democratic Republic of Congo

Background: Meningitis is a major public health problem needing timely diagnosis, appropriate treatment, prevention and control. Despite the advances in diagnosis and treatment of infectious diseases, meningitis is still considered as an important cause of mortality and morbidity, especially in the paediatric population of lower income countries such as the Democratic Republic of the Congo (DR Congo). In this study, we aimed to analyse the fatality aspect of suspected meningitis among children under five years. Materials and Methods: A prospective, descriptive study was carried out in the Paediatrics departments of four hospitals in the South-Kivu province in the Eastern part of the DR Congo from April 2021 to March 2022. Of the 1386 children enrolled, 251 children were suspected of meningitis. This study captures data generated in the framework of routine medical practice, which includes medical history, clinical diagnosis and results of locally conducted laboratory tests. Results: Throughout the study period, a total of 251 patients (18.1%) aged 1 month to 59 months with suspected meningitis were recruited out of 1386 children hospitalized in the Paediatrics. The fatality among hospitalized children with suspected meningitis during the study period was 27.9%, however the mortality linked to meningitis decreases with age, ranging from 37.5% among children under 2 years to 19.4% among those over 2 years old. Children hospitalized for meningitis with malnutrition as an underlying conditions, had a 3.5 times greater risk of dying. The case fatality rate was higher in transferred and not vaccinated children respectively (2.3 and 2.5 times). We observe that the death occurs early within the first 3 days. Conclusion: Our study noted a higher fatality rate in children with suspected meningitis that could probably be linked to the gape in vaccination and malnutrition as underline condition.

Identified Bacteria and Virus in the Cerebrospinal Fluid of under Five Years Hospitalized Children for Clinical Meningitis at Panzi Hospital in the Eastern Part of DRC

Background: Meningitis remains a leading cause of death among children below 5 years of age in the Democratic Republic of the Congo (DR Congo). Distinguishing children with bacterial meningitis from those with viral meningitis in the emergency department is sometimes difficult. Here we identified bacteria and virus in the cerebral spinal fluid (CSF) of children with meningitis. Material and Methods: This is a prospective, analytical study carried out in the Pediatrics department of Panzi Hospital in the South-Kivu province of DR Congo. Between April 2021 and March 2022, 150 of 251 collected CSF from children aged from 1 to 59 months hospitalised due to clinical meningitis at Panzi referral university hospital, Bukavu, Eastern DR Congo were sent to the Lancet laboratory for bacteria identification by a multiplex real-time PCR assay for detection of the most different viruses and bacterial species causing meningitis. Result: The used multiplex real-time PCR assay allowed us to identify germs in 24.7% of cases (37/150). We isolated bacteria in 25/37 (67.5%) cases, and viruses in 9/37 (24.3%) while virus and bacteria co-infection was detected in 3/37 (8.1%). The most frequently identified bacteria were Streptococcus pneumoniae 14/37 (37.8%) followed by Haemophilus influenzae 6/37 (16.2%). The main virus was cytomegalovirus 5/37 (3.5%). Despite the age, the most found bacterial are common in children from rural areas and unvaccinated children. Bacterial and virus co-infection were identified in 66.7% of children aged between 25 - 60 months, mainly among male children, and in all children from rural areas (100%). The overall case fatality rate was 30% and was very high among cases with co-infection CMV-Pneumococcal (66.7%), followed by Streptococcus pneumoniae (50%). Conclusion: Meningitis remains frequent among children aged from one to 59 months among Bukavu Infants. We noticed that, Children with co-infection with bacteria and viruses might need higher attention when having meningitis symptoms, as this could lead to fatal outcomes. The introduction of molecular techniques, such as multiplex real-time PCR, has the potential to improve diagnosis and patient outcomes.

ICF发展应用：康复学科知识体系与临床工具构建

WHO-FIC-FDRG专家委员会Stucki博士于2008年5月13日访问了中国康复研究中心康复信息研究所,并与WHO-FIC-FDRG专家邱卓英博士及其同事做了广泛交流。Stucki博士就ICF应用于康复科学体系建设以及开发基于ICF核心分类模板相关事宜做了专题讲座。作为《Journal of Rehabilitation Medicine》杂志编委,Stucki博士欣然接受本刊邀请成为本刊的国际编委,并代表德国国际分类家族WHO合作中心—ICF研究分中心(ICF Research Branch of WHO Collaborating Center for the Family of International Classifications,Germany(DMIDI))与中国康复信息研究所建立有关ICF研究国际合作,建立了《Journal of Rehabilitation Medicine》和《中国康复理论与实践》杂志间的学术联系。本专题的英文文章发表于《Journal of Rehabilitation Medicine》,由Stucki教授授权《中国康复理论与实践》杂志以中文形式独家发表。第一篇是由中外专家专门为本刊撰写的特稿。本专题的文章是在相关专家组织下翻译的,内容涉及基于ICF的康复学科体系的建立,面向功能的整合性康复学科体系的发展,从细胞到社会的功能结构分类摸板,基于ICF重新定义康复医学、康复科学和康复服务,以及开发应用于不同康复医疗领域的ICF核心分类等内容。这些研究反应了国际最新的理论和应用发展成果,对于依据ICF这一国际性的功能残疾模式和知识分类标准,建立符合科学发展规律和社会发展要求的学科体系以及实践领域具有十分重要的理论和实践意义。通过出版本专题,希望能使广大康复科技工作者关注国际相关发展,更新有关观念和方法,推动康复科学学科建设和发展,扩大国际合作与交流。鉴于ICF理论与方法相对较新,本专题中很多文章从科学学和方法论角度探讨学科建设和知识体系的构建,有的内容涉及到专业性很强的测量学方法,这些对于专题译校团队的专家学者也是一种挑战。作为当前国际康复界研究发展的热点领域,文章作者、译校者也衷心希望专家和读者就有关问题开展广泛讨论,促进残疾和康复科学发展。本研究相关研究是国家科技部科技基础性工作和社会公益研究专项项目:中国残疾分类系统和评定标准平台研究(2003DIB1J063);国家科技部科技基础性工作和社会公益研究专项项目:中国残疾人功能和健康评定研究(2004DIB5J183)和首都医学发展科研基金:基于ICF架构的功能、残疾和健康评定和研究(2007-3132)支持研究项目。

构建针对人类功能和康复研究的专门学科领域：发展一种从细胞到社会的综合性结构

为了克服康复研究的局限性,需要建立针对康复和相关研究的专门学科领域。基于在基础科学、应用科学和专门学科中的普遍特征,与康复相关的特征以及基于WHO的ICF模型的整合性观点,可以将功能性的生物医学领域划分出5个专门的人类功能和康复研究的学科领域。这些学科结构基于整合性观点,涉及人类功能学科和整合性康复学科,以及部分基于该观念建立的生物学科和生物医学康复学科和工程学,还有处于研究和实践分界边缘的专门康复学科。人类功能学科的目的在于明确人类功能,确定综合性干预目标,以达到人类所体验到的残疾程度最小化。康复中的生物学科的目标是解释身体损伤和修复,并且确定生物医学干预的目标。整合性的康复学科要设计和研究综合性的评定以及干预的方法,这种方法将生物医学的个人的因素以及环境的因素结合起来以达到人类活动的最佳表现。生物医学康复学科和工程研究适于将损伤最小化,包括疾病控制、对人的最佳能力的诊断方法和干预措施。专门康复学科研究如何提供最好的保健以使已经残疾或可能残疾的人在与环境的交互作用中达到和维持最佳功能。将人类功能和康复的研究划分为五个专门的学科领域,可以促进专业培训项目和职业生涯的发展,也可以促进建立人类功能和康复研究的研究架构。

Endocrine impact of Helicobacter pylori:Focus on ghrelin and ghrelin o-acyltransferase

Ghrelin is predominantly produced by the gastric enteroendocrine cell compartment and is octanoylated by the recently discovered ghrelin o-acyltransferase （GOAT） before secretion into the bloodstream. This octanoylation is essential for many of the biological properties of ghrelin including appetite stimulation and anti-inflammatory properties as only the acylated form of ghrelin binds to the ghrelin receptor, the growth hormone secretagogue receptor （GHS-R）. Given the gastric location of ghrelin production, it is perhaps not surprising that insult to the gastric mucosa affects circulating ghrelin levels in humans. Helicobacter pylori （H. pylon） infects more than fifty percent of the world＇s population and once established within the gastric mucosa, can persist for life. Infection is associated with chronic gastritis, gastric atrophy and ulceration, reduced appetite and a lower body mass index （BMI）. The large majority of studies investigating levels of circulating ghrelin and ghrelin expression in the stomach in patients with H. pylori infection indicate that the bacterium has a negative impact on ghrelin production and/or secretion. Eradication of infection restores ghrelin, improves appetite and increases BMI in some studies, however, a causative relationship between H. pylori-associated serum ghrelin decline and food intake and obesity has not been established. Most studies measure total ghrelin in the circulation although the measurement of the ratio of acyl/total ghrelin gives a clearer indication that the ghrelin acylation process is altered during infection and atrophy. GOAT is essential for the production of biologically-active, acyl ghrelin and the impact of H. pylori on GOAT expression and activity will be highly informative in the future.

EUS-guided drainage is more successful in pancreatic pseudocysts compared with abscesses

AIM: To compare the results for endoscopic ultrasound (EUS)-guided drainage of clear fluid pancreatic pseudocysts with the results for abscess drainage. METHODS: All patients referred for endoscopic drainage of a fluid collection were prospectively included. The outcome was recorded. RESULTS: Altogether 26 pseudocysts or abscesses were treated in 25 (6 female) patients. One endoscopist performed the procedures. Non-infected pseudocysts were present in 15 patients and 10 patients had infected fluid collections. The cyst size ranged between 28 cm × 13 cm and 5 cm × 5 cm. The EUS drainage was successful in 94% of the pseudocysts and in 80% of the abscesses (P = 0.04). The complication rate in pseudocysts was 6% and in abscesses was 30% (P = 0.02). Recurrence of a pseudocyst occurred in one patient (4%) after 6 mo; the patient was successfully retreated. CONCLUSION: EUS-guided drainage of pseudocysts is associated with a higher success rate and a lower complication rate compared with abscess drainage.

Diagnosis and treatment of pancreatic exocrine insufficiency

Pancreatic exocrine insufficiency is an important cause of maldigestion and a major complication in chronic pancreatitis.Normal digestion requires adequate stimulation of pancreatic secretion,sufficient production of digestive enzymes by pancreatic acinar cells,a pancreatic duct system without significant outflow obstruction and adequate mixing of the pancreatic juice with ingested food.Failure in any of these steps may result in pancreatic exocrine insufficiency,which leads to steatorrhea,weight loss and malnutrition-related complications,such as osteoporosis.Methods evaluating digestion,such as fecal fat quantification and the13C-mixed triglycerides test,are the most accurate tests for pancreatic exocrine insufficiency,but the probability of the diagnosis can also be estimated based on symptoms,signs of malnutrition in blood tests,fecal elastase 1 levels and signs of morphologically severe chronic pancreatitis on imaging.Treatment for pancreatic exocrine insufficiency includes support to stop smoking and alcohol consumption,dietary consultation,enzyme replacement therapy and a structured follow-up of nutritional status and the effect of treatment.Pancreatic enzyme replacement therapy is administered in the form of enteric-coated minimicro-spheres during meals.The dose should be in proportion to the fat content of the meal,usually 40-50000 lipase units per main meal,and half the dose is required for a snack.In cases that do not respond to initial treatment,the doses can be doubled,and proton inhibitors can be added to the treatment.This review focuses on current concepts of the diagnosis and treatment of pancreatic exocrine insufficiency.

Amyloid-beta peptide and tau protein crosstalk in Alzheimer’s disease

Alzheimer’s disease is a neurodegenerative disease that accounts for most of the 50-million dementia cases worldwide in 2018.A large amount of evidence supports the amyloid cascade hypothesis,which states that amyloid-beta accumulation triggers tau hyperphosphorylation and aggregation in form of neurofibrillary tangles,and these aggregates lead to inflammation,synaptic impairment,neuronal loss,and thus to cognitive decline and behavioral abnormalities.The poor correlation found between cognitive decline and amyloid plaques,have led the scientific community to question whether amyloid-beta accumulation is actually triggering neurodegeneration in Alzheimer’s disease.The occurrence of tau neurofibrillary tangles better correlates to neuronal loss and clinical symptoms and,although amyloid-beta may initiate the cascade of events,tau impairment is likely the effector molecule of neurodegeneration.Recently,it has been shown that amyloid-beta and tau cooperatively work to impair transcription of genes involved in synaptic function and,more importantly,that downregulation of tau partially reverses transcriptional perturbations.Despite mounting evidence points to an interplay between amyloid-beta and tau,some factors could independently affect both pathologies.Thus,the dual pathway hypothesis,which states that there are common upstream triggers causing both amyloid-beta and tau abnormalities has been proposed.Among others,the immune system seems to be strongly involved in amyloid-beta and tau pathologies.Other factors,as the apolipoprotein Eε4 isoform has been suggested to act as a link between amyloid-beta and tau hyperphosphorylation.Interestingly,amyloid-beta-immunotherapy reduces not only amyloid-beta but also tau levels in animal models and in clinical trials.Likewise,it has been shown that tau-immunotherapy also reduces amyloid-beta levels.Thus,even though amyloid-beta immunotherapy is more advanced than tau-immunotherapy,combined amyloid-beta and tau-directed therapies at early stages of the disease have recently been proposed as a strategy to stop the progression of Alzheimer’s disease.

Stage and size using magnetic resonance imaging and endosonography in neoadjuvantly-treated rectal cancer

AIM: To assess the stage and size of rectal tumours using 1.5 Tesla (1.5T) magnetic resonance imaging (MRI) and three-dimensional (3D) endosonography (ERUS). METHODS: In this study, patients were recruited in a phaseⅠ/Ⅱ trial of neoadjuvant chemotherapy for biopsy-proven rectal cancer planned for surgical resection with or without preoperative radiotherapy. The feasibility and accuracy of 1.5T MRI and 3D ERUS were compared with the histopathology of the fixed surgical specimen (pathology) to determine the stage and size of the rectal cancer before and after neoadjuvant chemotherapy. A Philips Intera 1.5T with a cardiac 5-channel synergy surface coil was used for the MRI, and a B-K Medical Falcon 2101 EXL 3D-Probe was used at 13 MHz for the ERUS. Our hypothesis was that the staging accuracy would be the same when using MRI, ERUS and a combination of MRI and ERUS. For the combination, MRI was chosen for the assessment of the lymph nodes, and ERUS was chosen for the assessment of perirectal tissue penetration. The stage was dichotomised into stageⅠ and stage Ⅱ or greater. The size was measured as the supero-inferior length and the maximal transaxial area of the tumour. RESULTS: The staging feasibility was 37 of 37 for the MRI and 29 of 36 for the ERUS, with stenosis as a limiting factor. Complete sets of investigations were available in 18 patients for size and 23 patients for stage. The stage accuracy by MRI, ERUS and the combination of MRI and ERUS was 0.65, 0.70 and 0.74, respectively, before chemotherapy and 0.65, 0.78 and 0.83, respectively, after chemotherapy. The improvement of the post-chemotherapy staging using the combination of MRI and ERUS compared with the staging using MRI alone was significant (P = 0.046). The post-chemotherapy understaging frequency by MRI, ERUS and the combination of MRI and ERUS was 0.18, 0.14 and 0.045, respectively, and these differences were non-significant. The measurements of the supero-inferior length by ERUS compared with MRI were within 1.96 standard deviations of the difference between the methods (18 mm) for tumours smaller than 50 mm. The agreement with pathology was within 1.96 standard deviations of the difference between imaging and pathology for all tumours with MRI (15 mm) and for tumours that did not exceed 50 mm with ERUS (22 mm). Tumours exceeding 50 mm in length could not be reliably measured by ERUS due to the limit in the length of each recording. CONCLUSION: MRI is preferable to use when assessing the size of large or stenotic rectal tumours. However, staging accuracy is improved by combining MRI with ERUS.

Treatment of periodontal patients - current clinical concepts

The main goal of the treatment of patients with periodontitis is to establish adequate infection control. To satisfy demands for acceptable aesthetics and chewing function with good long-term prognosis in patients with periodontitis requires the establishment of adequate infection control. Pocket instrumentation (scaling and root planing with or without flap elevation), combined with effective self-performed supragingival plaque control measures, constitutes the basic treatment modalities.

Role of apoptosis-inducing factor in perinatal hypoxic-ischemic brain injury

Perinatal complications,such as asphyxia,can cause brain injuries that are often associated with subsequent neurological deficits,such as cerebral palsy or mental retardation.The mechanisms of perinatal brain injury are not fully understood,but mitochondria play a prominent role not only due to their central function in metabolism but also because many proteins with apoptosis-related functions are located in the mitochondrion.Among these proteins,apoptosis-inducing factor has already been shown to be an important factor involved in neuronal cell death upon hypoxia-ischemia,but a better understanding of the mechanisms behind these processes is required for the development of more effective treatments during the early stages of perinatal brain injury.In this review,we focus on the molecular mechanisms of hypoxic-ischemic encephalopathy,specifically on the importance of apoptosis-inducing factor.The relevance of apoptosis-inducing factor is based not only because it participates in the caspase-independent apoptotic pathway but also because it plays a crucial role in mitochondrial energetic functionality,especially with regard to the maintenance of electron transport during oxidative phosphorylation and in oxidative stress,acting as a free radical scavenger.We also discuss all the different apoptosis-inducing factor isoforms discovered,focusing especially on apoptosis-inducing factor 2,which is only expressed in the brain and the functions of which are starting now to be clarified.Finally,we summarized the interaction of apoptosis-inducing factor with several proteins that are crucial for both apoptosis-inducing factor functions(prosurvival and pro-apoptotic)and that are highly important in order to develop promising therapeutic targets for improving outcomes after perinatal brain injury.

Intervention to increase physical activity in irritable bowel syndrome shows long-term positive effects

AIM: To assess the long-term effects of physical activity on irritable bowel syndrome(IBS) symptoms and on quality of life, fatigue, depression and anxiety.METHODS: Seventy-six patients from a previous randomized controlled interventional study on increased physical activity in IBS were asked to participate in this long-term follow-up study. The included patients attended one visit in which they filled out questionnaires and they underwent a submaximal cycle ergometer test. The primary end point was the change in the IBS Severity Scoring System(IBS-SSS) at baseline, i.e., before the intervention and at follow-up. The secondary endpoints were changes in quality of life, fatigue, depression and anxiety.RESULTS: A total of 39 [32 women, median age 45(28-61) years] patients were included in this followup. Median follow-up time was 5.2(range: 3.8-6.2) years. The IBS symptoms were improved compared with baseline [IBS-SSS: 276(169-360) vs 218(82-328), P = 0.001]. This was also true for the majority of the dimensions of psychological symptoms such as disease specific quality of life, fatigue, depression and anxiety. The reported time of physical activity during the week before the visit had increased from 3.2(0.0-10.0) h at baseline to 5.2(0.0-15.0) h at follow-up, P = 0.019. The most common activities reported were walking, aerobics and cycling. There was no significant difference in the oxygen uptake 31.8(19.7-45.8) m L per min per kg at baseline vs 34.6(19.0-54.6) m L/min per kg at follow-up.CONCLUSION: An intervention to increase physical activity has positive long-term effects on IBS symptoms and psychological symptoms.

Oxidative and nitrosative stress enzymes in relation to nitrotyrosine in Helicobacter pylori-infected humans

AIM: To compare a possible relation between Helicobacter pylori(H. pylori) and the oxygen- and nitrogen radical system in humans. METHODS: Mechanisms for H. pylori to interfere with the oxygen and nitrogen radical system is of great importance for understanding of the H. pylori persistence and pathogenesis. Biopsies were obtained from the gastric wall of 21 individuals. Ongoing infection with H. pylori was detected using direct analyze from the biopsies using campylobacter-like organism test(CLO-test) and/or by using 14C-urea breath test. The individuals were divided in a negative H. pylori and a positive H. pylori group. Expression in the gastric mucosa of induc-ible nitric oxide syntase(iNOS), nicotinamide adenine dinucleotide phosphate-oxidase(NADPH-oxidase) myeloperoxidase(MPO), and nitrotyrosine were assessed by Western blotting.RESULTS: The individuals who undervent gastroscopy were divided in a H. pylori neg. [n = 13, m/f = 7/6, age(mean) = 39] and a H. pylori pos. group [n = 8, m/f = 5/3, age(mean) = 53]. Using western blot analysis iNOS was detected as a 130 kDa band. The iNOS expression was upregulated in the antrum of H. pylori infected individuals in comparison to the controls, mean ± SD being 12.6 ± 2.4 vs 8.3 ± 3.1, P < 0.01. There was a markedly upregulated expression of MPO in the antrum of H. pylori infected individuals in comparison to the control group without infection. In several of noninfected controls it was not possible to detect any MPO expression at all, whereas the expression was high in all the infected subjects, mean ± SD being 5.1 ± 3.4 vs 2.1 ± 1.9, P < 0.05. The NADPH-oxidase expression was analysed by detecting the NADPH-oxidase subunit p47-phox expression. P47-phox was detected as a 47 kDa band using Western blot, and showed a significantly higher expression of p47-phox in the antrum of the H. pylori infected individuals compared to the controls, mean ± SD being 3.1 ± 2.2 vs 0.3 ± 0.2, P < 0.01. Regarding nitrotyrosine formation, Western blot did not show any significant increase or decrease compared to controls, 7.0 ± 0.9 vs 6.9 ± 1.1, not significant.CONCLUSION: iNOS, MPO and NADPH-oxidase was up-regulated among H. pylori infected. Regarding nitrotyrosine no difference was found. This support an H. pylori related inhibition of radical formation.

Takotsubo triggered by acute myocardial infarction：a common but overlooked syndrome？

Takotsubo cardiomyopathy （TCM） is an acute cardiac syndrome characterized by extensive, but potentially reversible, left ventricular dysfunction in the absence of an explanatory coronary obstruction. Thus, TCM is distinct from coronary artery disease （CAD） and acute myocardial infarction （AMI）. However, substantial evidence for co-existing CAD in some TCM patients exist. Herein, we take this associa-tion one step further and present a case in which the patient simultaneously suffered from AMI and TCM, and in which we believe that a primary coronary event triggered TCM. An 88-year-old female presented with chest pain. Echocardiography revealed apical akinesia with hypercontractile bases. An occluded diagonal branch with suspected acute plaque rupture was identified on the angiogram, but could not explain the extent of akinesia. Cardiac function recovered completely. Thus, this patient adhered to current diagnostic criteria for TCM. TCM is a well-known complication for other conditions associated with somatic stress. It is therefore intuitive to assume that AMI, which also associates with somatic stress and elevated catecholamine, can cause TCM. Our case illustrates that TCM and AMI may occur simulta-neously. Although causality cannot be conclusively inferred from this association, the somatic stress associated with AMI may have caused TCM in this patient.

50 years of scanning electron microscopy of bone——a comprehensive overview of the important discoveries made and insights gained into bone material properties in health,disease,and taphonomy

Bone is an architecturally complex system that constantly undergoes structural and functional optimisation through renewal and repair.The scanning electron microscope (SEM) is among the most frequently used instruments for examining bone.It offers the key advantage of very high spatial resolution coupled with a large depth of field and wide field of view.Interactions between incident electrons and atoms on the sample surface generate backscattered electrons,secondary electrons,and various other signals including X-rays that relay compositional and topographical information.Through selective removal or preservation of specific tissue components (organic,inorganic,cellular,vascular),their individual contribution(s) to the overall functional competence can be elucidated.With few restrictions on sample geometry and a variety of applicable sample-processing routes,a given sample may be conveniently adapted for multiple analytical methods.While a conventional SEM operates at high vacuum conditions that demand clean,dry,and electrically conductive samples,non-conductive materials (e.g.,bone) can be imaged without significant modification from the natural state using an environmental scanning electron microscope.This review highlights important insights gained into bone microstructure and pathophysiology,bone response to implanted biomaterials,elemental analysis,SEM in paleoarchaeology,3D imaging using focused ion beam techniques,correlative microscopy and in situ experiments.The capacity to image seamlessly across multiple length scales within the meso-micro-nano-continuum,the SEM lends itself to many unique and diverse applications,which attest to the versatility and user-friendly nature of this instrument for studying bone.Significant technological developments are anticipated for analysing bone using the SEM.

Impact of gastroesophageal reflux control through tailored proton pump inhibition therapy or fundoplication in patients with Barrett's esophagus

AIM To determine the impact of upwards titration of proton pump inhibition(PPI) on acid reflux, symptom scores and histology, compared to clinically successful fundoplication.METHODS Two cohorts of long-segment Barrett's esophagus(BE) patients were studied. In group 1(n = 24), increasing doses of PPI were administered in 8-wk intervals until acid reflux normalization. At each assessment, ambulatory 24 h p H recording, endoscopy with biopsies and symptom scoring(by a gastroesophageal reflux disease health related quality of life questionnaire, GERD/HRLQ) were performed. Group 2(n = 30) consisted of patients with a previous fundoplication. RESULTS In group 1, acid reflux normalized in 23 of 24 patients, resulting in improved GERD/HRQL scores(P = 0.001), which were most pronounced after the starting dose of PPI(P < 0.001). PPI treatment reached the same level of GERD/HRQL scores as after a clinically successful fundoplication(P = 0.5). Normalization of acid reflux in both groups was associated with reduction in papillary length, basal cell layer thickness, intercellular space dilatation, and acute and chronic inflammation of squamous epithelium. CONCLUSION This study shows that acid reflux and symptom scores co-vary throughout PPI increments in long-segment BE patients, especially after the first dose of PPI, reaching the same level as after a successful fundoplication. Minor changes were found among GERD markers at the morphological level.

Education of Parents When a Child Born with an Imperforate Anus;Does It Improve the Health of the Child?

Objectives: To describe and investigate the value of an education program for parents of children born with an imperforate anus in order to help them cope with the new situation of having a stoma. A comparison is made with a group of parents following routine hospital. A secondary aim was to illuminate the parents’ feelings and concerns in the first month after the birth of the child. Subjects and methods: The program was tested in 20 Vietnamese mothers of babies born with an imperforate anus;10 followed an intervention comprising an education program and 10 the ordinary routine hospital. The study design is both qualitative and quantitative. The mothers were interviewed, using open-ended questions, within a week of their child’s birth and then repeatedly for up to one month. Finally, the conditions of children were accessed on their return to the hospital for the second operation after one month of care at home. The qualitative data were subjected to content analysis. Results: All mothers felt sad and worried in the beginning, but this quickly changed to confidence, particularly among mothers in the intervention group who received education. While at home, mothers in both groups had financial concerns, as they were unable to work as much as expected and also had to buy equipment for colostomy care. The mothers in the control group complained about a lack of knowledge and how it affected the care of their child. The mothers in the intervention group, however, felt confident in their caring even at home. When the families returned for the second operation, the children in the intervention group were significantly healthier, had increased more in weight, and had fewer complications and emergency return visits to hospital compared to the control group. In the control group skin problems around the stoma, diarrhea, bleeding or constipation while at home were reported (p < 0.01). Conclusion: The education improved the care at home resulting in healthier children and more confident parents.