Beriberi after gastric bypass surgery in adolescence

We report three cases of dry beriberi in adolescents who underwent gastric bypass surgery for clinically severe obesity. The key to successful treatment of this problem lies in prompt recognition and thiamine supplementation.     

Effect of dietary fat on early morphological intestinal adaptation in a rat with short bowel syndrome

Among factors promoting mucosal hyperplasia after bowel resection, long-chain fatty acids may have a special role. The purpose of the present study was to evaluate the effects of high-fat diet (HFD) on early intestinal adaptation in rats with short bowel syndrome (SBS). Male Sprague-Dawley rats underwent either a bowel transection with re-anastomosis (Sham rats) or 75% small bowel resection (SBS rats). Animals were randomly assigned to one of three groups: Sham rats fed normal chow (Sham-NC); SBS rats fed NC (SBS-NC); and SBS rats fed HFD (SBS-HFD). Rats were killed on days 3 or 14. Body weight and parameters of intestinal adaptation (overall bowel and mucosal weight, mucosal DNA and protein, villus height, and crypt depth) were determined at time of killing. By day 3, SBS-HFD rats demonstrated higher duodenal and jejunal bowel and mucosal weights and ileal villus height and jejunal crypt depth vs SBS-NC rats. By day 14 SBS-HFD rats continued to demonstrate increased duodenal and jejunal bowel weight and duodenal mucosal weight vs SBS-NC animals. We conclude that early exposure to HFD both augmented and accelerated structural bowel adaptation in a rat model of SBS.     

The effect of aprotinin on hypoxia-reoxygenation-induced changes in neutrophil and endothelial function

BACKGROUND AND OBJECTIVE: An acute inflammatory response associated with cerebral ischaemia-reperfusion contributes to the development of brain injury. Aprotinin has potential, though unexplained, neuroprotective effects in patients undergoing cardiac surgery. METHODS: Human neutrophil CD11 b/CD18, endothelial cell intercellular adhesion molecule-1 (ICAM-1) expression and endothelial interleukin (IL)-1beta supernatant concentrations in response to in vitro hypoxia-reoxygenation was studied in the presence or absence of aprotinin (1600 KIU mL(-1)). Adhesion molecule expression was quantified using flow cytometry and IL-1beta concentrations by enzyme-linked immunosorbent assay. Data were analysed using ANOVA and post hoc Student-Newman-Keuls test as appropriate. RESULTS: Exposure to 60-min hypoxia increased neutrophil CD11b expression compared to normoxia (170+/-46% vs. 91+/-27%, P = 0.001) (percent intensity of fluorescence compared to time 0) (n = 8). Hypoxia (60 min) produced greater upregulation of CD11b expression in controls compared to aprotinin-treated neutrophils [(170+/-46% vs. 129+/-40%) (P = 0.04)] (n = 8). Hypoxia-reoxygenation increased endothelial cell ICAM-1 expression (155+/-3.7 vs. 43+/-21 mean channel fluorescence, P = 0.0003) and IL-1beta supernatant concentrations compared to normoxia (3.4+/-0.4 vs. 2.6+/-0.2, P = 0.02) (n = 3). Hypoxia-reoxygenation produced greater upregulation of ICAM- 1 expression [(155+/-3.3 vs. 116+/-0.7) (P = 0.001)] and IL-1beta supernatant concentrations [(3.4+/-0.3 vs. 2.6+/-0.1) (P = 0.01)] in controls compared to aprotinin-treated endothelial cell preparation (n = 3). CONCLUSIONS: Hypoxia-reoxygenation-induced upregulation of neutrophil CD11b, endothelial cell ICAM-1 expression and IL-1beta concentrations is decreased by aprotinin at clinically relevant concentrations.     

The effect of lidocaine on neutrophil CD11b/CD18 and endothelial ICAM-1 expression and IL-1beta concentrations induced by hypoxia-reoxygenation

BACKGROUND: Lidocaine has actions potentially of benefit during ischaemia-reperfusion. Neutrophils and endothelial cells have an important role in ischaemia-reperfusion injury. METHODS: Isolated human neutrophil CD11b and CD18, and human umbilical vein endothelial cell (HUVEC) ICAM-1 expression and supernatant IL-1beta concentrations in response to hypoxia-reoxygenation were studied in the presence or absence of different concentrations of lidocaine (0.005, 0.05 and 0.5 mg mL(-1)). Adhesion molecule expression was quantified by flow cytometry and IL- 1beta concentrations by ELISA. Differences were assessed with analysis of variance and Student-Newman-Keuls as appropriate. Data are presented as mean+/-SD. RESULTS: Exposure to hypoxia-reoxygenation increased neutrophil CD11b (94.33+/-40.65 vs. 34.32+/-6.83 mean channel fluorescence (MCF), P = 0.02), CD18 (109.84+/-35.44 vs. 59.05+/-6.71 MCF, P = 0.03) and endothelial ICAM-1 (146.62+/-16.78 vs. 47.29+/-9.85 MCF, P < 0.001) expression compared to normoxia. Neutrophil CD18 expression on exposure to hypoxia-reoxygenation was less in lidocaine (0.005 mg mL(-1)) treated cells compared to control (71.07+/-10.14 vs. 109.84+/-35.44 MCF, P = 0.03). Endothelial ICAM-1 expression on exposure to hypoxia-reoxygenation was less in lidocaine (0.005 mg mL(-1)) treated cells compared to control (133.25+/-16.05 vs. 146.62+/-16.78 MCF, P = 0.03). Hypoxia-reoxygenation increased HUVEC supernatant IL-1beta concentrations compared to normoxia (3.41+/-0.36 vs. 2.65+/-0.21 pg mL(-1), P = 0.02). Endothelial supernatant IL-1beta concentrations in lidocaine-treated HUVECs were similar to controls. CONCLUSIONS: Lidocaine at clinically relevant concentrations decreased neutrophil CD18 and endothelial ICAM-1 expression but not endothelial IL-1beta concentrations.     

Inhibition of the EGFR and hedgehog signaling pathways demonstrate potent growth inhibition in an animal model of esophageal carcinogenesis

Introduction. Advancements in experimental therapeutics for esophageal cancers have been hampered by the lack of a reliable preclinical model that recapitulates the biology of human cancer, including in vivo growth and metastases. Methods. Bilious reflux was induced by esophago-jejunostomy in Sprague-Dawley rats. Eight of nine SD rats developed squamous or adenosquamous cancers, and three new cell lines were created by in vitro propagation, JA and JB lines from one, and AMY line from the other. We subsequently tested the ability of these cell lines to propagate long-term in vitro and form tumors in vivo. In addition, we determined the effects of small molecule inhibitors of two important oncogenic pathways---the epidermal growth factor receptor (EGFR) and hedgehog (Hh) signaling pathways, in vitro. Relative growth inhibition was measured as described (Berman et al Nature 2003) at 48 and 96 h, using standard MTS assay. Results. JA, JB, and AMY cell lines are able to grow continuously in vitro, with consistent in vivo growth in athymic mice, both as subcutaneous xenografts and as orthotopically implanted tumors at the gastroesophageal serosa (N = 2 mice per line, six of six engrafted each). By histology, the tumors grow in vivo as a well-differentiated keratinizing squamous cell carcinomas. Iressa (gefitinib), an EGFR inhibitor (5 μm), caused significant growth inhibition in all three cell lines (JA > JB > AMY) compared to mock-treated cells, mirrored functionally by down regulation of activated targets of the EGFR pathway, phospho-ERK1/2, and phospho-MEK levels, in the EGFR-inhibited cells. Cyclopamine, an Hh pathway antagonist (dose 6 μm), caused significant growth inhibition in the AMY cell line, but not JA or JB lines; growth inhibition was accompanied by significant down regulation of Hh reporter activity at 24 h in the AMY cells but not JA or JB lines, consistent with specific antagonism of the Hh signaling pathway. Conclusions. We have established a model of esophageal carcinogenesis, with ability for long-term in vitro and in vivo passage and exhibiting pathway-specific antagonistic effects.     

A comparison of Guatemalan and USA nurses' attitudes towards nursing

BACKGROUND: Student nurses from the United States of America (USA) spent 5 weeks working with Guatemalan nurses in an acute care setting in Guatemala. This experience led to a heightened awareness of the global scope of nurses' discontent and a desire to better understand the driving factors and drawbacks to practising nursing in both the USA and Guatemala. AIM: The purpose of this research was to identify those factors that discourage nurses and those that motivate nurses to continue in their practice despite the drawbacks. METHOD: Qualitative interviews using field notes were conducted with five Guatemalan and five USA nurses. Themes were derived through qualitative content analysis. FINDINGS: Nurses in both the USA and Guatemala had similar reasons for choosing and staying in nursing. The different health care systems presented different problems resulting in different discontents. CONCLUSION: The two groups of nurses had much in common, especially in their reasons for staying in nursing. The Guatemalan nurses were most discontent with the lack of resources to treat patients, while the USA nurses focused on work environment drawbacks. IMPLICATIONS FOR PRACTICE: Strategies to support nurses and nursing in developing countries need to be developed and implemented. As nurses reach out to their colleagues in other nations, understanding our commonalities and differences will help us to support each other in improving health throughout the world.     

Pesticide Sales in Low-Income, Minority Neighborhoods

The US EPA has phased-out residential use of two organophosphate pesticides commonly used to control cockroaches-retail sales of chlorpyrifos were scheduled to end on 12/31/01, and diazinon on 12/31/02. In light of recent findings highlighting the associations between pests, pesticides and health, we surveyed stores in low-income, minority neighborhoods in New York City to determine whether the phase-outs have been effective and to assess the availability of alternatives to spray pesticides. In summer 2002, when sales of chlorpyrifos were illegal and diazinon still legal, we surveyed 106 stores selling pesticides. Four percent sold products containing chlorpyrifos and 40 percent sold products containing diazinon. One year later, when sales of both pesticides were to have ended, we surveyed 109 stores selling pesticides in the same neighborhoods and found chlorpyrifos in only one store and diazinon in 18 percent of stores, including 80 percent of supermarkets surveyed. At least one form of lower toxicity pesticides, including gels, bait stations and boric acid was available in 69 percent of stores in 2002. However sprays were most widely available, found in 94 percent of stores in 2002 and less expensive than lower toxicity baits and gels. In a separate survey of storekeeper recommendations conducted in 2002, storekeepers recommended lower toxicity pesticides as the best way to control cockroaches 79% of the time. The EPA's phase-outs have nearly eliminated sales of chlorpyrifos, but the diazinon phase-out appears to be less effective.