The Role of Rac1 on Carbachol‐induced Contractile Activity in Detrusor Smooth Muscle from Streptozotocin‐induced Diabetic Rats

This study was designed to determine the role of the small GTPase Rac1 on carbachol‐induced contractile activity in detrusor smooth muscle using small inhibitor NSC 23766 in diabetic rats. Rac1 expression in bladder tissue was also evaluated. In the streptozotocin (STZ)‐induced diabetic rat model, three study groups were composed of control, diabetic and insulin‐treated diabetic subjects. The detrusor muscle strips were suspended in organ baths at the end of 8–12 weeks after STZ injection. Carbachol (CCh) (10^?9–10^?4 M) concentration–response curves were obtained both in the absence and in the presence of Rac1 inhibitor NSC 23766 (0.1, 1 and 10 μM). Diabetes‐related histopathological changes and Rac1 expressions were assessed by haematoxylin and eosin staining and immunohistochemical staining, respectively. CCh caused dose‐dependent contractile responses in all the study groups. Rac1 inhibitor NSC 23766 inhibited CCh‐induced contractile responses in all groups, but this inhibition seen in both diabetes groups was greater than in the control group. Histological examination revealed an increased bladder wall thickness both in the diabetes and in the insulin‐treated diabetes groups compared to the control group. In immunohistochemical staining, expression of Rac1 was observed to be increased in all layers of bladder in both diabetic groups compared to the control group. In the diabetic bladders, increased expression of Rac1 and considerable inhibition of CCh‐induced responses in the presence of NSC 23766 compared to those of the control group may indicate a specific role of Rac1 in diabetes‐related bladder dysfunction, especially associated with cholinergic mediated detrusor overactivity.     

Does acid reflux cause pulmonary disease?

BACKGROUND/AIMS: Gastroesophageal reflux is considered as a factor in pulmonary diseases. The aim of this study was to assess whether gastroesophageal reflux is associated with abnormalities in lung function in patients without respiratory disease. METHODS: Forty- four patients with reflux symptoms were studied prospectively. Standardized methods of esophageal manometry and ambulatory 24-h esophageal pH testing were used throughout the study period, along with a standardized reflux and respiratory symptom questionnaire. Spirometric measurements were performed in all patients. RESULTS: Reflux to distal esophagus was observed in 9 patients, to proximal esophagus in 4 and to both distal and proximal in 20 of the 44 patients. Eleven patients revealed reflux neither to distal nor proximal esophagus. Respiratory function tests of these groups showed no significant differences (p>0.05). CONCLUSION: There is no correlation between esophageal acid events and respiratory function tests. There are no data to answer the question of whether or not reflux precedes onset of cough/asthma. Better-designed prospective cohort studies may provide further insight.     

Cotinine levels in serum and bronchoalveolar lavage fluid

Cotinine is a major metabolite of nicotine. This study was planned to investigate the relationship between bronchoalveolar lavage (BAL) fluid cotinine levels and serum cotinine levels in smokers and nonsmokers with various pulmonary diseases and to investigate whether these levels are affected by passive smoking. Serum and BAL fluid cotinine levels were measured in 27 patients. BAL cotinine levels were measured using a sensitive ELISA kit produced to measure cotinine in saliva. Plates were read by microuant (BioTek, USA) micro plate reader. All patient serum cotinine levels were detectable except for one nonsmoker patient. However, BAL fluid cotinine levels were measurable in only 6 patients (two of them were nonsmokers). A significant positive correlation was seen between serum and BAL fluid cotinine levels (r = 0.726; p = 0.000). Serum cotinine levels were significantly higher in present smokers than non-smokers (21.0 +/- 16.01; 5.35 +/- 7.65; p = 0.004). However, there were no significant differences in BAL fluid cotinine levels between smokers and nonsmokers. Passive smoking can increase nicotine metabolites in serum and other body fluids, including BAL fluid. Since BAL fluid and serum cotinine levels were well correlated, there is no need to use invasive procedures, such as bronchoscopy and expensive, time consuming BAL fluid analyses. Serum cotinine levels can give a rough idea of smoking status. BAL fluid cotinine meaurements should be done for only scientific reasons.     

Effect of endoscopic injection therapy with combined cyanoacrylate and lipiodol for bleeding gastric varices: A single center experience

OBJECTIVE: To evaluate the safety and efficacy of the endoscopic injection therapy with combined cyanoacrylate and lipiodol for bleeding gastric fundal varices. METHODS: The medical records of cirrhotic and non-cirrhotic patients who underwent at least one episode of endoscopic application of N-butyl-2-cyanoacrylate-lipiodol mixture for gastric varices at our gastroenterology clinic between October 2004 and January 2010 were reviewed. The technique comprised the dilution of 0.5 mL of cyanoacrylate with 0.5 mL of lipiodol and repeating intravariceal injections of 1.0 mL each until hemostasis was achieved. RESULTS: A total of 66 patients (41 male and 25 female) with gastric varices underwent 86 endoscopic injections of cyanoacrylate for hemostasis. Overall 38 patients (57.6%) had active bleeding during the endoscopic procedure, while the remaining 28 (42.4%) underwent cyanoacrylate under elective conditions. In one patient (1.5%) hemostasis could not be achieved, prompting referral for emergency surgery. The median number of sessions was one (range 1–3). Eleven patients (16.6%) rebled during a median follow-up period of 6.02 months (0.1–62.4 months). There was no bleeding-related death. One patient developed splenic infarction a day after N-butyl-2-cyanoacrylate injection. CONCLUSION: Endoscopic injection therapy combining cyanoacrylate and lipiodol is effective for bleeding gastric fundal varices.     

The long-term effects of lamivudine treatment in patients with HBeAg-negative liver cirrhosis

Introduction In hepatitis B virus (HBV)-related liver cirrhosis, patients with HBV replication show a higher mortality rate than those without. We aimed to investigate the long-term effects of lamivudine on HBV DNA suppression, Child-Pugh score, and survival in patients with hepatitis Be antigen (HBeAg)-negative liver cirrhosis. Methods Sixty-eight patients (51 male, 17 female) diagnosed with HBV-positive liver cirrhosis, who were monitored by the hepatology and liver transplantation outpatient clinics of our hospital between June 1999 and May 2007, were included in the study. Lamivudine (100 mg/day) was administered orally. Follow-up visits were scheduled monthly during the first 3 months, and every 3 months thereafter. Complete blood count, haemostasis, biochemistry (aspartate aminotransferase [AST], alanine aminotransferase [ALT], amylase, urea, creatinine, total bilirubin, direct bilirubin, total protein, albumin), and alpha-foetoprotein were recorded every 3 months. HBV DNA levels, abdominal ultrasound and the Child-Pugh score were evaluated every 6 months. Results Sixty-eight patients (mean age, 52.05±12.6 years) were monitored for 49.51±18.51 months. Basal ALT, HBV DNA levels and Child-Pugh scores were 103.9±73.9 IU/ml, 4133±121,94 IU/ml, and 7.6±2.4, respectively. The ALT normalisation was 59.7% during the first year, 68.2% during the second year and 44.4% during the fifth year. There was a significant decrease in Child-Pugh scores in the first 3 follow-up years when compared with the baseline score (P<0.05). During the treatment, HBV DNA positivity and YMDD mutations were determined in 20 of 68 (29.4%) patients at 46±17.9 months. Nine patients (13.2%) developed hepatocellular carcinoma at 44.8±21.5 months. Thirteen patients (19.1%) died during the treatment due to liver failure or variceal bleeding. Conclusion Lamivudine is beneficial in patients with HBeAg-negative liver cirrhosis in terms of improvement in liver function and enhancement of survival and quality of life. An HBV DNA suppressive effect and improvement in Child-Pugh score were seen especially in the first years. It is important to be aware of YMDD mutation early, as addition of new antivirals is necessary to overcome unwanted results of the mutation.     

Rectal angiolipoma： A case report and review of literature

Angiolipoma is a rare vascular variant of the benign lipomatous tumors and is generally seen in subcutaneous tissues. We report a 70-year-old female with abdominal distension not related to rectal small polypoid mass with peduncule described as angiolipoma by histologically, and review the literature.