Correction: Development of electrochemical sensors for quick detection of environmental (soil and water) NPK ions

[This corrects the article DOI: 10.1039/D4RA00034J.].

Development of electrochemical sensors for quick detection of environmental (soil and water) NPK ions

All over the world, technology is becoming more and more prevalent in agriculture. Different types of instruments are already being used in this sector. For the time being, every farmer is trying to produce more crops on a piece of land. Eventually, soil loses its nutrients; however, to grow more crops, farmers use more fertilizers without knowing the proper conditions of the soil in real time. To overcome this issue, many scientists have recently focused on developing electrochemical sensors to detect macronutrients, i.e., nitrogen (N), phosphorus (P), and potassium (K), in soil or water rapidly. In this review, we focus mainly on the recent developments in electrochemical sensors used for the detection of nutrients (NPK) in different types of samples. As it is outlined, the use of smart and portable electrochemical sensors can be helpful for the reduction of excess fertilizer and can play a vital role in maintaining suitable conditions in soils and water. We are optimistic that this review can guide researchers in the development of a portable and suitable NPK detection system for soil nutrients.

Imperatorin from the aerial parts of Cleome viscosa L.: a characterization study and evaluation of the antibacterial activity

Cleome viscosa L., a member of the family Cleomaceae, is a potential medicinal plant, known for several bioactive properties such as: anticancer, antidiabetic, antioxidant, anti-inflammatory, antimicrobial, wound healing, etc. Our study aimed to isolate a bioactive compound and assess its antibacterial activity. The crystal compound imperatorin was isolated and reported for the first time from the aerial parts of C. viscosa. The isolation was made using silica gel (100-200 mesh) column chromatography. The structure of imperatorin was investigated through single-crystal XRD, unit cell molecules, FTIR, and ESI-MS spectral analysis. The results validated imperatorin's triclinic crystal structure and P2i/c distance group. The electronic structure was also calculated (4.28/6.21 D) along with the frontier molecular orbital, dipole moment, atomic charges, and electrostatic map of particles in gaseous stage and active site. Imperatorin showed highest activity at 40 µg/mL concentration against Gram + ve bacteria: Staphylococcus aureus (3 ± 0.2 mm), Bacillus subtilis (3 ± 0.6 mm), and Gram -ve bacteria: Klebsiella pneumoniae (3 ± 0.2 mm), Escherichia coli (5 ± 0.2 mm). The study highlights that the compound can be isolated in larger quantities as the plant is easily available across the tropics.

Nanostructured wearable electrochemical and biosensor towards healthcare management: a review

In recent years, there has been a rapid increase in demand for wearable sensors, particularly these tracking the surroundings, fitness, and health of people. Thus, selective detection in human body fluid is a demand for a smart lifestyle by quick monitoring of electrolytes, drugs, toxins, metabolites and biomolecules, proteins, and the immune system. In this review, these parameters along with the main features of the latest and mostly cited research work on nanostructured wearable electrochemical and biosensors are surveyed. This study aims to help researchers and engineers choose the most suitable selective and sensitive sensor. Wearable sensors have broad and effective sensing platforms, such as contact lenses, Google Glass, skin-patch, mouth gourds, smartwatches, underwear, wristbands, and others. For increasing sensor reliability, additional advancements in electrochemical and biosensor precision, stability in uncontrolled environments, and reproducible sample conveyance are necessary. In addition, the optimistic future of wearable electrochemical sensors in fields, such as remote and customized healthcare and well-being is discussed. Overall, wearable electrochemical and biosensing technologies hold great promise for improving personal healthcare and monitoring performance with the potential to have a significant impact on daily lives. These technologies enable real-time body sensing and the communication of comprehensive physiological information.

Label free flexible electrochemical DNA biosensor for selective detection of Shigella flexneri in real food samples

An effective tool for early-stage selective detection of the foodborne bacterial pathogen Shigella flexneri (S. flexneri) is essential for diagnosing infectious diseases and controlling outbreaks. Here, a label-free electrochemical DNA biosensor for monitoring S. flexneri is developed. To fabricate the biosensor, detection probe (capture probe) is immobilized on the surface of poly melamine (P-Mel) and poly glutamic acid (PGA), and disuccinimidyl suberate (DSS) functionalized flexible indium tin oxide (ITO) electrode. Anthraquinone-2-sulfonic acid monohydrate sodium salt (AQMS) is used as a signal indicator for the detection of S. flexneri. The proposed DNA biosensor exhibits a wide dynamic range with concentration of the targets ranging from 1 × 10^-6 to 1 × 10^-21 molL^-1 with a limit of detection (LOD) of 7.4 × 10^-22 molL^-1 in the complementary linear target of S. flexneri, and a detection range of 8 × 10¹⁰-80 cells/ml with a LOD of 10 cells/ml in real S. flexneri sample. The proposed flexible biosensor provides high specificity for the detection of S. flexneri compared to other target signals such as discrete base mismatches and different bacterial species. The developed biosensor displayed excellent recoveries in detecting S. flexneri in spiked food samples. Therefore, the proposed biosensor can serve as a model methodology for the detection of other pathogens in a broad span of industries.

Development of a hematite nanotube and tyramine-based drug carrier against drug-resistant bacteria Klebsiella pneumoniae

In this study, hematite nanotube (HNT) and tyramine-based advanced nano-drug carriers were developed for inhibiting the growth of Klebsiella pneumoniae (K. pneumoniae). The HNT was synthesized by following the Teflon line autoclaved assisted hydrothermal process and tyramine was incorporated on the surface of the HNT to fabricate the formulated nano-drug. The nano-drug was prepared by conjugating meropenem (MP) on the surface of Tyramine-HNT and characterized using different techniques, such as scanning electron microscopy (SEM), attenuated total reflection Fourier transform infrared (ATR-FTIR), etc. Furthermore, the drug-loading efficiency and loading capacity were measured using a UV-vis spectrometer. The pH, amount of Tyr, and HNT required for drug loading were optimized. A controlled and gradual manner of pH-sensitive release profiles was found after investigating the release profile of MP from the carrier drug. The antibacterial activity of MP@Tyramine-HNT and MP was compared through the agar disc diffusion method which indicates that antibacterial properties of antibiotics are enhanced after conjugating. Surprisingly, the MP@Tyramine-HNT exhibits a minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of K. pneumoniae lower than MP itself. These results indicate the nanocarrier can reduce the amount of MP dosed to eradicate K. pneumoniae.

Exogenous Postharvest Application of Calcium Chloride and Salicylic Acid to Maintain the Quality of Broccoli Florets

The importance of broccoli (Brassica oleracea var. italica) consumption has increased in recent years due to its significant amount of anticarcinogenic and antioxidant compounds, as well as its many vitamins. However, broccoli florets are a highly perishable product which rapidly senesce and turn yellow after harvest, resulting in losses in nutritional and bioactive compounds. Thus, in this study, we evaluated the effect of postharvest exogenous of salicylic acid (SA) and calcium chloride (CaCl₂) and their combination on the quality of broccoli florets stored at 5 °C for 28 days to minimize the rapid senescence of broccoli florets. Samples treated with 2 mM SA alone or in combination with 2% CaCl₂ showed lower weight loss and lower losses of chlorophyll content, vitamin C, phenolic compounds, carotenoids, flavonoids, and glucosinolates compared with the control samples. Additionally, antioxidant activity was maintained by either SA or SA + CaCl₂ treatments while peroxidase activity was decreased. For higher quality and lower losses in antioxidant compounds of broccoli florets during refrigerated storage at 5 °C, SA + CaCl₂ treatment could be helpful for up to 21 days.

Phytochemical Characterization and Utilization of Dried Red Beetroot (Beta vulgaris) Peel Extract in Maintaining the Quality of Nile Tilapia Fish Fillet

Phytochemicals derived from agro-industrial waste materials could be employed as functional food additives and natural antioxidants to replace their synthetic counterparts, which are increasingly being rejected. The current study aims to assess total phenolic compound (TPC), flavonoids, betalain contents, and antiradical scavenging using DPPH and IC50% of dried red beetroot peel (DRBP) extract at different concentrations of 50, 80, 100, 150, and 200 mg/100 mL t. In addition, a characterization of phenols and flavonoids was conducted using HPLC. The second part of this study aims to utilize aqueous DRBP extract in preserving Nile Talipia fish fillet at two concentrations of 80 and 100 mg/100 mL water, compared with 200 ppm of BHT (butylated hydroxytoluene) and control at 5 °C for 10 days. The DRBP aqueous extract was found to have a high concentration of TPC (832 mg/100 g), flavonoids (234 mg/100 g) and betalains (535 mg/100 g) compounds, resulting in a potential antioxidant activity. The IC50% for the extract was detected at 80 mg/100 mL extract. DRBP aqueous extract showed an excellent preservative effect on the fish fillet. Fish fillet samples treated with DRBP extract at a concentration of 100 mg/100 mL were superior in reducing TBA (thiobarbituric acid) increase compared with other treatments at the end of cold storage. Overall, the study showed that red beetroot extracts can act as a natural preservative agent due to their significant antioxidant activity, providing healthy and safe food to consumers.

APPLICATION OF EDIBLE FILM AND COATING BASED ON ALOE VERA GEL FOR PRESERVATION OF PHYSICOCHEMICAL PROPERTIES OF PHYSALIS PERUVIANA L. FRUITS

The calyx removing of Physalis peruviana  fruits for production of fresh cut fruit makes its shelf life shorter. So, Aloe vera gel (AV) used as edible film and coating for increasing the fruit shelf life of fresh cut Physalis fruit. The physical parameter of prepared AV films was investigated such as: Thickness, water vapor permeability (WVP) and water solubility. The current study evaluates the effect of AV film and coating for maintain the Physalis peruviana fruits without calyx at 5±1°C and 95 % RH for 30 days. AV gel film was effective in controlling the fungal decay. which recorded the lowest value (4%) and reduced deterioration in all other physicochemical properties of Physalis fruit comparing with control. This study showed that the AV gel could be suitable for producing an edible film and coating with good physical characteristics such as low WVP (0.0037g/m2.h.mmHg). AV's low WVP appeared to have a great impact on maintaining post-harvest quality especially reducing the percentage of weight loss of coated fruit during storage.

Sunroot snack bar: Optimization, characterization, consumer perception, and storage stability assessment

This study reports the evolution of phenolics, inulin content, proximate composition, hardness, and sensory characteristics of an inulin-rich healthy snack bar (The Sunroot Snack Bar) over 90 days of storage in refrigerated and room temperature storage. A response surface methodology (RSM) with a central composite rotatable design was first employed for optimizing the concentrations of sunroot, potato, and oats. The optimum selected concentrations of sunroot, potato, and oat were 53.99, 37.88, and 5 g, respectively, and a quadratic model was found to yield the best fit. Analysis of variance revealed that a higher sunroot content resulted in more firmness of the bar and higher overall acceptability in sensory trials. Sunroot snack bar samples without flavor (control), sunroot snack bar with cheese flavor (S1), and sunroot snack bar with olive flavor (S2) were then tested for sensory, chemical, phytochemicals, and microbial contents among control, S1, and S2 samples over a 90-day shelf-life study. Results showed no significant (p < .05) changes in these contents on addition of flavor. An increase in microbial load and the appearance of a bitter taste after 30 days of fresh sunroot storage were observed. No microbial growth was observed in all sunroot snack bar samples during storage at 4°C, while some microbial growth was observed at 25°C for 90 days. It was inferred that the high-quality shelf life of the sunroot bar was 90 days at 4°C, which was shortened to a month if the bars were preserved at 25°C. There was a significant phenolic and inulin content loss at 25°C compared with 4°C in total phenolic component. Based on the results of sensory evaluation, online questionnaire of customer experience, and cost analysis, this study successfully used sunroot tubers for the production of snack bars as a promising new raw material, which was introduced healthily with a suitable price for such product compared with other products in the market.

Development of an advanced DNA biosensor for pathogenic Vibrio cholerae detection in real sample

Due to the epidemics of emerging microbial diseases worldwide, the accurate and rapid quantification of pathogenic bacteria is extremely critical. In this work, a highly sensitive DNA-based electrochemical biosensor has been developed to detect Vibrio cholerae using gold nanocube and 3-aminopropyltriethoxysilane (APTES) modified glassy carbon electrode (GCE) with DNA carrier matrix. Electrochemical impedance spectroscopy (EIS), cyclic voltammetry (CV), Fourier transform infrared spectroscopy (FTIR), scanning electron microscope (SEM) experiments were performed to interrogate the proposed sensor at each stage of preparation. The biosensor has demonstrated high sensitivity with a wide linear response range to target DNA from 10^-8 to 10^-14 (R²= 0.992) and 10^-14 to 10^-27 molL^-1 (R²= 0.993) with a limit of detection (LOD) value of 7.41 × 10^-30 molL^-1 (S/N = 5). The biosensor also exhibits a selective detection behavior in bacterial cultures that belong to the same and distant genera. Moreover, the proposed sensor can be used for six consecutive DNA assays with a repeatability relative standard deviations (RSD) value of 5% (n = 5). Besides, the DNA biosensor shows excellent recovery for detecting V. cholerae in poultry feces, indicating that the designed biosensor could become a powerful tool for pathogenic microorganisms screening in clinical diagnostics, food safety, and environmental monitoring.

Utilization of sugarcane bagasse aqueous extract as a natural preservative to extend the shelf life of refrigerated fresh meat

Abstract This study aimed to investigate the extraction of total phenolic compounds of sugarcane bagasse using various solvents. In addition, the Sugarcane Bagasse Water Extract (SBWE) was used in refrigerated fresh meat as natural preservative. The fresh meat was dipped into water solutions containing various phenolic compounds concentrations (T1:125, T2:250 and T3:500 ppm). During 10 days of storage at 4 °C for all the treated samples were compared with untreated one. The results revealed that SBWE showed relevant values of total phenolic compounds (17.90 mg/g) and total flavonoids content (4.50 mg/g), as well as 45.90% of antioxidant content. On the other hand, microbiological examination and sensory evaluation have turned out to be the best treatment for T3:500 ppm. The SBWE showed an antibacterial impact on Staphylococcus sp. and a reduction in the Total Plate Count and in the group of Psychrotrophs. The shelf-life of refrigerated fresh meat treated with SBWE by dipping it into water solutions was also extended to more than 10 days.

Novel determination of spa gene diversity and its molecular typing among Staphylococcus aureus Iraqi isolates obtained from different clinical samples

Staphylococcus aureus is the most frequent agent causing nosocomial infections in Baghdad hospitals. This study aimed to determine S. aureus methicillin resistance, spa gene typing and phylogenic analysis in Iraqi S. aureus isolates. Two hundred samples including clinical (n = 100) and environmental (n = 100) specimens were collected. S. aureus isolates were identified using multiplex PCR amplification of femA and mecA (for methicillin-resistant S. aureus (MRSA) strains) genes. The spa gene was also amplified. Sequence alignment and identification of spa types was then obtained. Of 74 studied S. aureus isolates, 61 (82.43%) harboured the mecA gene (p < 0.001). A spa gene variation was detected in 41 (67.2%) of 61 (p 0.0011) MRSA and 6 (46.15%) of 13 methicillin-susceptible S. aureus isolates. Amino acid sequence analysis revealed a great change in amino acid pattern among local isolates compared to National Center for Biotechnology Information control. Some of the MRSA isolates had high-level similarity with t10214. No genetic relationship with the infection sources was observed. None of the environmental isolates had spa gene variations. Most S. aureus isolates were MRSA. The spa gene variations was significantly higher among clinical isolates. spa sequencing showed different tandem repeats in local MRSA isolates compared to global spa types. We conclude that there was no outbreak in hospital settings in the city of Baghdad. However, our data suggest that isolates from the hospital environment are highly clonal.

The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry

Aims 

The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.

Methods and results 

Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.

Conclusion 

The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.

Evaluation of 4-methyl-2-[(2-methylbenzyl) amino]-1,3-thiazole-5-carboxylic acid against hyperglycemia, insulin sensitivity, and oxidative stress-induced inflammatory responses and β-cell damage in the pancreas of streptozotocin-induced diabetic rats

4-Methyl-2-[(2-methylbenzyl) amino]-1,3-thiazole-5-carboxylic acid (bioactive compound (BAC)), a novel thiazole derivative, is a xanthine oxidase inhibitor and free radical scavenging agent. Effects of BAC on hyperglycemia, insulin sensitivity, oxidative stress, and inflammatory mediators were evaluated in streptozotocin (STZ)-induced neonatal models of non-insulin-dependent diabetes mellitus (NIDDM) rats where NIDDM was induced in neonatal pups with single intraperitoneal injection of STZ (100 mg/kg). The effect of BAC (10 and 20 mg/kg, p.o.) for 3 weeks was evaluated by the determination of blood glucose, oral glucose tolerance test (OGTT), HbA1c level, insulin level, insulin sensitivity, and insulin resistance (IR). Furthermore, inflammatory mediators (tumor necrosis factor-alpha and interleukin-6) and oxidative stress were estimated in serum and pancreatic tissue, respectively. Significant alteration in the level of blood glucose, OGTT, HbA1c, insulin level, insulin sensitivity, in addition variation in the antioxidant status and inflammatory mediators, and alteration in histoarchitecture of pancreatic tissue confirmed the potential of BAC in STZ-induced neonatal models of NIDDM rats. Pretreatment with BAC restored the level of glucose by decreasing the IR and increasing the insulin sensitivity. Furthermore, BAC balanced the antioxidant status and preserved the inflammatory mediators. Histological studies of pancreatic tissues showed normal architecture after BAC administration to diabetic rats. Altogether, our results suggest that BAC successfully reduces the blood glucose level and possesses antioxidant as well as anti-inflammatory activities. This leads to decreased histological damage in diabetic pancreatic tissues, suggesting the possibility of future diabetes treatments.

An Evaluation of the Result of Fenestration and Discectomy for the Treatment of Prolapsed Lumber Intervertrebal Disc (PLID)

The aim of this study is to asses the result of fenestration and discectomy for the treatment of PLID. This Prospective quasi experimental study was conducted on 29 Patient of PLID with different ages at Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh from July 2014 to June 2016. Post Operative outcome was assessed through Modified Macnab Criteria & Visual Analogue Score (VAS). The mean age of patient were 38.14±9.20 years and ranging from 24 to 55 years. The mean age of male was 37.21±9.72 years and female patient was 39.90±8.32 years. Overall subjective assessment of this study revealed that 79.2% patients had excellent functional outcome, 13.8% good and 6.9% fair and there was no poor functional outcome a according to modified Macnab criteria.

Transcriptome of a specialized extra-embryonic cell, teratocyte, and its host immunosuppressive role revealed by ex vivo RNA interference

The specialized wasp cells teratocytes (TCs) are derived from the embryonic serosal membrane of some parasitic hymenopteran insects. As a parasitic factor, TCs are multifunctional in host regulation, such as host nutritional deprivation, immunosuppression and developmental arrest; however, little is understood about their genetic constituents. The present study provides a comprehensive view of the genes expressed by TCs through a transcriptome analysis based on RNA sequencing technology. The assembled 34 686 contigs (>200 base pairs) were annotated into different functional categories, indicating a distinct distribution in gene transcripts compared with those of haemocytes and fat body. The TC transcriptome contained components of insulin signalling and biosyntheses of juvenile hormone and 20-hydroxyecdysone. TCs also expressed various groups of digestive enzymes, indicating that they have nutritional role for the growing parasitoid larvae in parasitism. Furthermore, through this transcriptome analysis two kinds of immunosuppressive serine protease inhibitors (serpins) and Rho GTPase-activating proteins (RhoGAPs) were annotated. To determine the biological functions of these factors, we devised ex vivo RNA interference (RNAi) by conducting knockdown of gene expression in in vitro-cultured TCs followed by injection of the treated TCs to test insects. Ex vivo RNAi revealed that some serpins and RhoGAPs expressed in TCs inhibited host cellular immunity. This study reports a transcriptome of the unique TC animal cell and its immunosuppressive genetic factors using ex vivo RNAi technology.

Combining ability study in waterlogged tolerant maize (Zea mays L.)

Combining ability was studied for kernel yield and yield components in a 8×8 diallel cross of waterlogged tolerant maize. Significant general and specific combining ability variances were observed for all the characters studied. Additive genetic variance was preponderant in plant height, ear height, ear length, ear diameter, and kernel weight and non-additive gene action was involved in days to silking, number of kernels per ear and kernel yield. The parental lines E-31 and E-79 were found to be the best general combiners for yield. The good combining parents for different traits could be used in hybridization to improve yield and other desirable traits as donor parents for the accumulation of favourable genes. The cross combinations, E 31× E 40, E 31× E 64, E 31× E 79, E 38× E 40, E 58× E 79, E 63× E 79, E 64 × E 79 showing significant and positive sca effects can be used for commercial hybrid variety development after verifying them at different locations. DOI: http://dx.doi.org/10.3329/bjar.v39i2.20430 Bangladesh J. Agril. Res. 39(2): 283-291, June 2014

Thyroid and bone: macrophage-derived TSH-β splice variant increases murine osteoblastogenesis

It is now firmly established that TSH may influence the physiology and patho-physiology of bone by activating osteoblasts and inhibiting osteoclast activity resulting in relative osteoprotection. Whether this influence is directly exerted by pituitary-derived TSH in vivo is less certain, because we have previously reported that the suppression of pituitary TSH does not remove such protection. Here, we have characterized the functional relevance of a novel form of the TSH-β subunit, designated TSH-βv, known to be produced by murine bone marrow cells. We found that fresh bone marrow-derived macrophages (MØs) preferentially produced TSH-βv and, when cocultured with CHO cells engineered to overexpress the full-length TSH receptor, were able to generate the production of intracellular cAMP; a phenomenon not seen in control CHO cells, such results confirmed the bioactivity of the TSH variant. Furthermore, cocultures of MØs and osteoblasts were shown to enhance osteoblastogenesis, and this phenomenon was markedly reduced by antibody to TSH-β, suggesting direct interaction between MØs and osteoblasts as observed under the electron microscope. These data suggest a new paradigm of local modulation of bone biology by a MØ-derived TSH-like molecule and raise the question of the relative contribution of local vs pituitary-derived TSH in osteoprotection.

Robotic hepatobiliary surgery: update on the current status

An update on the current status of robotic hepatobiliary surgery based on a review of the available literature. A literature search was performed using the PubMed database with search phrases "robotic hepatectomy", "robotic liver resection", "robotic liver surgery", "robotic hepatobiliary surgery", and "robotic biliary reconstruction". We selected articles with high volume case series or case controlled series. As a result of our literature search we will focus on the 9 major articles on robotic liver resection (RLR) with 235 patients undergoing RLR for a total of 244 liver resections. In addition a brief update on robotic biliary reconstruction will also be presented based on the above articles and recent review articles. Indications for robotic liver resection included both benign (N.=72, 29.5%) and malignant disease (N.=172, 70.5%). The most common indication was colorectal liver metastasis (N.=87, 50.6%) and hepatocellular carcinoma (N.=57, 33%). The most common type of resection was subsegmental (N.=55, 22.5%), with a significant number of major hepatectomies (N.=80, 32.8%). Overall conversion rate was 7.8%, with majority converted to open (N.=18) and one converted to hand assisted. The overall complication rate was 11.8% (N.=29). No perioperative mortality was reported. Preliminary results show that robotic assisted laparoscopic hepatobiliary surgery has materialized as a new technique that combines the advantages of laparoscopy with the dissection, suturing and articulation of robotics. This more closely approximates open surgery. The preliminary data demonstrates that RLR can be applied in major hepatobiliary centers safely. Future comparative studies are needed to determine if this is of significant benefit over current open techniques.

Efficacy of ornithine-alpha-ketoglutarate (OKGA) as a dietary supplement in growing rats

New substrates of potential benefit to critically ill patients receiving traditional nutritional support have been suggested to meet organ or tissue specific needs. The addition of an anabolic stimulus during nutritional support therefore appears to be a reasonable adjunct to augment protein synthesis. The purpose of this investigation was to evaluate the efficacy of the neutral salt ornithine alphaketoglutarate (OKGA) as a dietary supplement to promote growth in young rats by enhancing protein metabolism. A group of 16 male Sprague-Dawley rats (150-170g) were housed in individual metabolic cages and after dark-light cycle adaptation were fed ad libitum an oral liquid diet for 7 days. Half of the animals were given the control diet and the other half was fed a test diet. This isonitrogenous test diet contained the control diet with 2.3% of nitrogen (N) replaced by N from OKGA. Daily weight, food intake and urinary excretions of N, creatinine, urea, orotic acid, polyamines and amino-acids were determined. At the end of 7 days of free-feeding, the rats were sacrificed and blood was collected for free amino-acids. Rats fed the OKGA supplemented diet consumed 16% more diet, retained 11% more nitrogen and gained 15% more weight. The accelerated protein metabolism is reflected in the changes in plasma and urinary free amino-acid levels. Enhanced protein anabolism is evident from the increased urinary excretion of polyamines in the OKGA fed rats. The increased ratio of urinary urea N to total N and the decreased orotic acid excretion in OKGA fed rats suggests thata NH(4)(+) was efficiently diverted through urea cycle. It is concluded that in growing rats, supplementing isonitrogenous diet with OKGA significantly stimulates food intake compared to controls. This results in better weight gain and improvement in protein metabolism.

Marginal ulceration after laparoscopic gastric bypass: an analysis of predisposing factors in 260 patients

BACKGROUND

Marginal ulceration after Roux-en-Y gastric bypass (RYGB) is diagnosed in 1% to 16% of patients. The factors predisposing patients to marginal ulceration are still unclear.

METHODS

A total of 260 patients who underwent laparoscopic RYGB were retrospectively reviewed. Data regarding demographics, comorbidities, body mass index (BMI), Helicobacter pylori infection, gastrojejunal (GJ) anastomotic leaks, postoperative bleeding, operative time, type of suture material, and marginal ulcer formation were collected. Fisher's exact test was used for statistical analysis of discrete variables, and Student's t-test was used for continuous variables. Statistical significance was set at an alpha of 0.05.

RESULTS

The overall marginal ulceration rate was 7%. Demographic data (age, gender distribution, BMI) did not differ significantly between patients who experienced marginal ulceration and those who did not (p > 0.05). Similarly, technical factors (choice of permanent or absorbable suture for the GJ anastomosis, attending as primary surgeon, robotic GJ, operative time, postoperative hematocrit drop) were not statistically different between the two groups (p > 0.05). Finally, the prevalence of comorbidities (diabetes, hypertension, obstructive sleep apnea, musculoskeletal complaints, dyslipidemia, gastroesophageal reflux disease [GERD] and peptic ulcer disease [PUD]) did not differ significantly between the two groups (p > 0.05). However, preoperative H. pylori infection, although adequately treated, was twice as common among the patients who had marginal ulceration (32%) as among those who did not (12%) (p = 0.02). All the patients who experienced marginal ulcers had complete resolution of symptoms with proton pump inhibitors and sucralfate. No reoperations were required for marginal ulceration.

CONCLUSION

Helicobacter pylori may potentiate marginal ulcer formation. The authors hypothesize that H. pylori damages the mucosal barrier in a way that persists postoperatively, which may precipitate marginal ulceration even when the organism has been medically eradicated.

Circulating concentrations of high-molecular-weight adiponectin are increased following Roux-en-Y gastric bypass surgery

AIMS/HYPOTHESIS

In addition to weight loss, bariatric surgery for severe obesity dramatically alleviates insulin resistance. In this study, we investigated whether circulating concentrations of the high-molecular-weight (HMW) form of adiponectin are increased following gastric bypass surgery. The HMW form is implicated as the multimer responsible for adiponectin's hepatic insulin-sensitising actions.

SUBJECTS AND METHODS

We studied 19 women who were undergoing Roux-en-Y gastric bypass surgery. Studies were conducted prior to, and 1 and 12 months after surgery.

RESULTS

One month after surgery, total plasma adiponectin concentrations were unchanged. Nevertheless, increases in both HMW (by 40+/-15%, p=0.006) and the proportion of adiponectin in the HMW form (from 40+/-2 to 50+/-2%, p<0.0001) were observed. At 12 months, total and HMW adiponectin concentrations were increased by 58+/-8% and 118+/-21%, respectively (both p<0.001). The majority (80%) of the increase of total adiponectin was due to an increase of the HMW form. After adjustment for covariates, increases of HMW and total adiponectin at 12 months were correlated with the decrease of fat mass (HMW, p=0.0076; total, p=0.0302). In subjects with improved insulin sensitivity at 12 months after surgery (n=18), the increase of HMW, but not that of total adiponectin, predicted the relative decrease of insulin resistance (HMW: p=0.0044; total: p=0.0775, after adjustment for covariates).

CONCLUSIONS/INTERPRETATION

These data suggest that the reduction of fat mass following gastric bypass surgery is an important determinant of the increase of HMW adiponectin concentrations, which in turn is associated with and may contribute to the resulting improvement of insulin sensitivity.

Robot-assisted laparoscopic Roux-en-Y gastric bypass

BACKGROUND

Robotic surgery promises to extend the capabilities of the minimally invasive surgeon. The aim of this study was to examine the feasibility of robotic surgery in the setting of laparoscopic gastric bypass.

METHODS

The Zeus robotic surgical system was used in 50 laparoscopic gastric bypass procedures. The learning curve was staged to add complexity to the robotic tasks as experience grew. Robotic setup time, robotic operative time, total operative time, and operative outcomes were tracked prospectively.

RESULTS

We observed a significant decrease in the robotic setup time. Our robotic learning curve demonstrated decreased operative time, even as more complex tasks were accomplished. Total operative time also decreased significantly over the series. There were no complications in our series that could be attributed to the robotic technique.

CONCLUSIONS

Robot-assisted laparoscopic Roux-en-Y gastric bypass is safe. The steadiness and extra degrees of freedom of surgical robotic systems may improve the accuracy of laparoscopic tasks. The learning curve for robot-assisted laparoscopic Roux-en-Y gastric bypass is significant but manageable.

Training the novice in laparoscopy. More challenge is better

BACKGROUND

Virtual reality simulation is effective in training the novice to perform basic laparoscopic skills.

METHODS

Using the Minimally Invasive Surgery Training--Virtual Reality (MIST-VR) trainer, 27 honors high school students were tested at the easy level, prospectively randomized to eight training sessions at the easy (group A, n = 14) or medium (group B, n = 13) level, then retested at the easy level.

RESULTS

Both groups were statistically similar at baseline. All scores improved significantly (50.1% to 81.3%) over the period of training (p < 0.05). Although the group A scores were significantly better than the group B scores throughout training (p < 0.05), on final testing at the easy level, group B surpassed group A for all the tasks except TransferPlace (p = 0.054).

CONCLUSIONS

Virtual simulation is an effective laparoscopic training method for the novice, providing significant improvement in skill levels over a relatively short period. More challenging training seems to predict greater improvement over time and better final skill levels.

Iliac and femoral artery occlusion by thromboemboli from an abdominal aortic aneurysm in the setting of blunt abdominal trauma

The abdominal aorta is injured infrequently in blunt trauma to the abdomen. When injury does occur, aortic rupture, dissection, and traumatic aneurysm most commonly result. An aneurysmal abdominal aorta would appear to be at increased risk for injury from blunt abdominal trauma. This case report appears to be the first description of iliac and femoral artery occlusion by thromboemboli dislodged from an atherosclerotic abdominal aortic aneurysm at the time of a motor vehicle accident. We believe that this peripheral embolization was caused by direct compression of the abdominal aortic aneurysm by a seatbelt.

An audit of low dose triple therapy for eradication of Helicobacter pylori

AIMS

Standard triple therapy remains the recommended first line treatment for Helicobacter pylori in New Zealand. The real eradication rate achieved in busy hospital clinics may be different from data obtained from clinical trials outside of New Zealand.

METHODS

One hundred and thirty patients with proven H pylori infection (by at least two tests) were treated with low dose triple therapy (DeNol 1 qid, tetracycline 250 mg qid and metronidazole 200 mg qid for 2 weeks; dosing with meals and at night); 83 were given a standard prescription for triple therapy (dispensed in bottles) and 47 were given a medication pack with times of dosing clearly marked. Eradication was proven by a negative 13C urea breath test at least 4 weeks after finishing treatment.

RESULTS

Follow up urea breath test was obtained in 120 patients (92%). The eradication rate for separate bottles was 79% and for the medication pack 76%. Compliance was estimated to be greater than 90% in 92% of patients who attended for followup. H pylori culture and sensitivity results were available for 41 patients. Overall rate of metronidazole resistance was 32%. The eradication rate for metronidazole sensitive strains was 89% and for resistant strains 46%. Mild side effects were reported in 10% and moderate side effects in 10%. No patient stopped treatment because of side effects. There was no effect of age, ethnicity, smoking, alcohol intake, pretreatment with H2-antagonists or endoscopic diagnoses on eradication rates.

CONCLUSION

The low dose triple therapy has an acceptable real eradication rate. The most important determinant of success was metronidazole resistance. The eradication rate was not improved by using medication packs.

Diagnostic tests for Helicobacter pylori--can they help select patients for endoscopy?

AIM

Dyspepsia is a common symptom and some selection process for endoscopy is required. This study seeks to determine if noninvasive tests for Helicobacter pylori could be useful as a screening test to help select patients for endoscopy.

METHODS

Consecutive patients attending for upper gastrointestinal endoscopy were interviewed prior to endoscopy and the endoscopic diagnoses was recorded. The presence of Helicobacter pylori infection was assessed by serology. Some patients also had a 13C urea breath test or rapid urease test (CLO test).

RESULTS

436 consecutive patients were evaluated. The endoscopy findings were normal in 44%, 29% had reflux oesophagitis, 18% had duodenal ulcer, duodenitis or gastric ulcer and 9% had other diagnoses. 54.8% of patients were positive for Helicobacter serology. Using either the CLO test or 13C urea breath test as the confirmatory test for the diagnosis of Helicobacter pylori, the sensitivity of the serology test was 96% and 91% respectively and the specificity was 66.6 and 82%. Patients with negative serology and no history of recent NSAID or aspirin use comprised 34% of the total with dyspepsia or reflux symptoms. There were no gastric or duodenal ulcers in this group.

CONCLUSION

The serology test may have some potential or the initial evaluation of dyspepsia. These tests need to be prospectively evaluated in general practice.

Adjuvant recombinant human growth hormone normalizes plasma amino acids in parenterally fed trauma patients

BACKGROUND

The addition of an anabolic stimulant during intensive nutrition therapy in trauma patients seems to be a reasonable adjuvant for minimizing muscle-mass erosion. The plasma free amino acid pattern is the mirror of the net amino acid metabolism, and we have measured the progressive changes resulting from recombinant human growth hormone therapy in trauma victims during nutritional repletion in the early catabolic flow phase of injury.

METHODS

In 20 severely injured (injury severity scale = 31 +/- 2), highly catabolic, and hypermetabolic adult multiple-trauma patients, we have measured the fasting (day 0) plasma amino acid levels (48 to 60 hours after injury before starting the nutrition therapy) and their progressive changes during 7 days of IV nutrition support (total parenteral nutrition, 1.1 x resting energy expenditure calories, 250 mg of nitrogen per kilogram per day) with or without adjuvant recombinant human growth hormone. Group H (n = 10) randomly received daily recombinant human growth hormone (0.15 mg of Somatropin per kilogram per day) and Group C (n = 10) received the vehicle of infusion.

RESULTS

Hypoaminoacidemia of trauma is normalized by infusion of recombinant human growth hormone, which indicates its anabolic nature, and this is confirmed in the cumulative nitrogen balance (-281 +/- 139 mg of nitrogen per kilogram per 7 days compared with -809 +/- 151 mg of nitrogen per kilogram per 7 days without recombinant human growth hormone; p < or = .005). This improved nitrogen retention is also reflected in the significantly low blood urea nitrogen levels in the recombinant human growth hormone group, which represents the efficient utilization of the infused amino acids for synthesis of proteins. Elevated plasma insulin-like growth factor-1 levels in Group H compared with those in Group C may also account for this altered amino acid metabolism.

CONCLUSIONS

Recombinant human growth hormone treatment in combination with conventional total parenteral nutrition in the immediate posttraumatic period improved nitrogen metabolism and normalized the plasma free amino acid levels.

Critical flicker frequency of mentally retarded and normal persons

Critical flicker frequency (CFF) of 40 men, 20 mentally retarded whose mean age was 22.0 yr. and 20 normal whose mean age was 21.5 yr., was measured under binocular viewing using the Lafayette Visual Perception Control with a display unit. Subjects had been previously tested for visual acuity and color blindness. Analysis showed a significant difference in CFF between mentally retarded persons and normal individuals, the former having lower CFF than the latter. This finding suggests lower perceptual sensitivity of the mentally retarded persons. Further research with provision for EEG recordings is suggested.

Influence of diet with or without amino acids on polyamine excretion in multiple trauma victims

Elevated levels of urinary polyamines (PA) in severely injured trauma patients are further enhanced by total parenteral nutrition (TPN) that contains both glucose and amino acids (AAs). Since TPN solutions contain arginine, the AA precursor of PA, it is not certain whether the increased urinary PA are due to this substrate. Nutritional factors can evidently modify PA metabolism. We measured the daily excretion of the PA, putrescine (PU) and spermidine (SD) in 18 multiply injured (injury severity score [ISS], 32 +/- 2), hypermetabolic (resting energy expenditure [REE]/basal energy expenditure [BEE], 1.41 +/- 0.06), and highly catabolic (daily N loss, 17.2 +/- 1.8 g N/d) acute trauma patients for 5 days in the early flow phase of injury. The patients were fed only maintenance fluids without calories or nitrogen for the first day 60 to 72 hours after injury, and then were randomized to receive glucose alone ([GLUC] 4.1 mg/kg/min, 80% measured REE, n = 8) or the same amount of glucose with AAs (TPN, 275 mg N/kg/d, n = 10) for the following 4 days. There was no significant difference in the enhanced daily PA excretion either in the free or acetylated form between the two dietary regimens. The addition of AAs in the TPN mixture did not seem to further stimulate PA metabolism in the trauma patients. The source of the nutrient content of the diet appears to be important for enhancing total PA excretion in critically ill patients.

Relative nutritional efficacy of arginine and ornithine salts of alpha-ketoisocaproic acid in traumatized rats

The relative dietary efficacy of arginine alpha-ketoisocaproate (AKIC) and ornithine alpha-ketoisocaproate (OKIC) is evaluated in a rat (Sprague-Dawley) trauma (bilateral femur fracture) model. Both control and traumatized rats were starved for 2 d and then pair-fed for 2 or 4 d one of three liquid diets: diet 1 was a basic casein diet; diets 2 and 3 were the basic diet in which 10% of nitrogen was replaced by AKIC or OKIC nitrogen, respectively. Irrespective of the diet, the protein-efficiency ratio, defined as the gain in body weight per grams nitrogen consumed, was 27% less in traumatized rats than in control rats. More improvement in apparent nitrogen balance, particularly in traumatized rats, was seen with the AKIC supplement. Plasma amino acid patterns demonstrated stimulation of net protein synthesis with AKIC and not with OKIC. Dietary supplementation with AKIC may be beneficial to promote nitrogen economy in trauma victims.

Altered tissue polyamine levels due to ornithine-alpha-ketoglutarate in traumatized growing rats

All cells contain significant amounts of polyamines (PA), and their concentrations are highly regulated. Metabolic activity within a tissue may be reflected in the amount of intracellular PA. Since trauma involves accelerated death and regeneration of tissues, the related levels of PA in extracellular and intracellular fluids may reflect altered protein metabolism. Trauma induces an increased excretion of urinary PA, and the tissues responsible for this whole-body activity are not known. During posttraumatic nutritional management, supplementation with ornithine-alpha-ketoglutarate (OKG) seems to improve nitrogen economy. The present study evaluates the significance of muscle, liver, and intestine PA responses in traumatized (bilateral femur fractures) rats to the feeding of an isonitrogenous liquid diet supplemented with or without OKG. Uninjured control rats were pair-fed with respective traumatized rats. After 2 days of starvation and 4 days of feeding, the traumatized and control rats were killed and the tissues were excised and analyzed. Starvation decreases and refeeding increases urinary PA excretion. Trauma-induced PA response is predominantly seen in muscle tissues, and this may be responsible for parallel increases in PA excretion. Liver PA responses show a varying tendency confirming the increased protein synthetic activity due to trauma. Intestine has the highest intracellular PA levels, and there is a general smaller (statistically insignificant) increase in all the individual PA contents due to trauma. OKG supplementation augments tissue and urine PA responses in control rats; however, in trauma rats muscle PA levels show very little change, although nitrogen retention is significantly better (88% to 77%). Mechanistic studies are needed to evaluate the significances of the time-dependent, injury-induced, individual intracellular PA levels.

Duodenal ulcer relapse after eradication of Helicobacter pylori

Thirty-six patients with healed duodenal ulcers, 27 infected with Helicobacter pylori and nine uninfected, were followed for up to 12 months to determine the rate of ulcer relapse. Eight patients withdrew over the follow up period. At one year, 15 of 20 (75%) infected patients and one of eight (13%) uninfected patients had relapsed, p less than 0.05. Eradication of H pylori favourably influences the natural history of duodenal ulcer recurrence. Significant patient morbidity may be prevented by using measures to eradicate H pylori during or after duodenal ulcer healing.

Critical flicker frequency under monocular and binocular conditions

Critical flicker frequency of 40 undergraduate students, 20 men and 20 women whose mean age was 19.3 yr., was measured under monocular and binocular viewing conditions, using the Lafayette Visual Perception Control with Display Unit. Half of the subjects received monocular treatment first and binocular treatment second, and the other half received the treatments in the reversed order. A 2-min. rest was allowed between these treatments. Analysis shows that mean CFF under the monocular condition was significantly lower than that under binocular conditions. The findings were discussed in terms of visual constraint and eye strain and fatigue under the monocular viewing condition.

Tightly spiral shaped bacteria in the human stomach: another cause of active chronic gastritis?

Tightly spiral shaped Gram negative bacteria were seen in the gastric biopsies obtained from two patients undergoing gastroscopy. Active chronic gastritis was present in both patients and one patient also had gastric ulceration. Attempts to culture the organism by a number of methods were unsuccessful but positive urease results were obtained in both patients. Both patients were treated with colloidal bismuth subcitrate. Biopsies taken after treatment showed resolution of infection and histological gastritis. These results suggest that Helicobacter pylori is not the only organism associated with chronic active gastritis in man.

Effects of fasting on visual flicker fusion

Two experiments are reported which investigated the effects of fasting on visual flicker fusion (VFF). In Exp. 1 the VFF of 40 undergraduate students, 20 men and 20 women, whose mean age was 22.5 yr., was measured in nonfasting conditions 1 to 2 weeks before and in fasting conditions during the Muslim fasting month of Ramadan. In Exp. 2 the VFF of a comparable group of 15 men and 15 women, whose mean age was 23.2 yr., was measured in a different month in both fasting and nonfasting conditions. Subjects were assigned randomly to these two conditions. Analysis shows that fasting reduced VFF significantly in both experiments. This finding indicates that fasting is likely to reduce perceptual sensitivity. The results were explained in terms of fatigue and physical exhaustion effects produced by fasting.

Glutamine and ornithine-alpha-ketoglutarate but not branched-chain amino acids reduce the loss of muscle glutamine after surgical trauma

The concentration of free glutamine in skeletal muscle decreases characteristically after surgical trauma. In animal studies a correlation between muscle protein synthesis and the glutamine concentration is reported. For pharmaceutical reasons, commercially available amino acid solutions do not contain glutamine. Therefore, at present, postoperative total parenteral nutrition does not provide glutamine. Several modifications of the composition of the amino acid solutions given in total parenteral nutrition have been evaluated recently. Ornithine-alpha-ketoglutarate preserves muscle protein synthesis and spares nitrogen after elective surgery, and an extra supply of branched-chain amino acids improves muscle protein synthesis in animals. Patients undergoing elective abdominal surgery (n = 33) received isocaloric (135 kJ/kg body weight/24 h) and isonitrogenous (0.2 g N/kg body weight/24 h) total parenteral nutrition for three days immediately following surgery. Administration of glutamine and ornithine-alpha-ketoglutarate as part of the amino acid supply reduced the loss of muscle glutamine from 40% to 25% (P less than .05). Additional supplementation of branched-chain amino acids produced no such effect, however, as compared with the control group. Further clinical trials including glutamine and ornithine-alpha-ketoglutarate are advocated.

Polyamine levels as biomarkers of injury response in polytrauma victims

Enhanced protein mobilization and synthesis are common responses to severe trauma. The hypothesis that extracellular polyamine levels could be valid biomarkers for these responses has been investigated. The three polyamines, spermidine, spermine and their precursor putrescine are directly involved in cell growth/death kinetics through regulation of protein metabolism. The lack of tissue uptake of extracellular polyamines and their rapid conjugation and excretion make them excellent biomarkers of variations in cellular kinetics. The polyamine levels in plasma and urine of severely traumatized patients were measured during the early "flow" phase of injury and compared with unstressed normals. Significantly elevated urinary levels of free and total putrescine and spermidine indicate the increase in the protein synthesis and breakdown rates, respectively, in polytrauma patients. Urinary spermidine level correlates well with other known parameters of protein catabolism, such as isotopically measured whole body protein breakdown rate in the basal state and 3-methylhistidine excretion and nitrogen loss in the basal condition and during nutritional therapy. Whole-body protein synthesis rate positively correlates with putrescine levels in urine. Based on these observations, urinary levels of the polyamines spermidine and putrescine may be applied as valid biomarkers of protein breakdown and synthesis rates, respectively, both for the existing pathology of severe trauma and for the response to nutritional therapy.

Campylobacter pylori infection in biopsy specimens of gastric antrum: laboratory diagnosis and estimation of sampling error

Campylobacter pylori infection was sought in 382 consecutive patients referred for upper gastrointestinal endoscopy. Five antral biopsy specimens were taken from each patient: one was inserted into a CLO-test to detect the urease activity of C pylori, two were sent for histological analysis where multiple sections were stained by the Warthin-Starry silver method, and two were sent for microbiological evaluation by Gram stain and culture. A patient was deemed to be infected when C pylori was cultured or seen in either the histological sections or the Gram stain of the biopsy smear. One hundred and seventy four (46%) patients were infected. Culture, Gram stain, histological examination and the CLO-test showed sensitivities of 92%, 87%, 93% and 90%, respectively. In 27 (15%) infected patients an uneven distribution of C pylori was seen between samples in the biopsy pair sent for histology. Examination of multiple sections stained with Warthin-Starry silver was more sensitive at detecting infection (93%) than examination of multiple sections from only one biopsy specimen (84%). Fifty seven of 80 patients, biopsied a median seven days (range 5 to 55) after completing colloidal bismuth subcitrate treatment, were still infected with C pylori. There was no decrease in the sensitivities of the above tests to detect infection after treatment. It is concluded that at least two antral biopsy specimens should be examined when attempting to diagnose C pylori infection by histological methods.

Tightly spiral shaped bacteria in gastric antrum: are they urease positive?

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Treatment of Campylobacter pylori gastritis: a pilot study using pirenzepine dihydrochloride (Gastrozepin) and three formulations of colloidal bismuth subcitrate (De-Nol)

Antral biopsies were obtained to detect Campylobacter pylori infection in 382 patients referred for gastroscopy. One hundred and seventy four patients (46%) were infected. Infection was strongly associated with histological gastritis (p less than 0.001), but there was no association between histological antral gastritis and the appearance of the gastric antrum during gastroscopy. Because it has been suggested that the lower relapse rate for duodenal ulcer following colloidal bismuth subcitrate (CBS) is due to suppression of C pylori we investigated different formulations and dosing of CBS for their efficacy in clearing C pylori. Seventy four infected patients were prospectively assigned to therapy with pirenzepine (11 patients) or one of four regimens of CBS; one swallow tablet 4 times a day (11 patients); two swallow tablets twice daily (16 patients); two buffered swallow tablets twice daily (14 patients); or two chew tablets twice daily (22 patients). All patients treated with pirenzepine and one CBS swallow tablet 4 times a day were still infected after treatment. Infection was not detected in 16 patients taking twice daily doses of CBS; 8 (50%), 3 (21%) and 5 (23%) patients taking two standard, buffered or chew tabs twice daily respectively. Improvement of histological gastritis was observed only in those patients apparently cleared of C pylori (p less than 0.01) and this was due to a decrease in polymorphonuclear leukocytes. Nine patients apparently cleared of the infection were rebiopsied 44-137 days following treatment and 6 (66%) were found again to be infected. This study suggests that suppression of C pylori may vary with the formulation and dosing of CBS.(ABSTRACT TRUNCATED AT 250 WORDS)

Idiopathic giant cell myocarditis: case report

Idiopathic giant cell myocarditis has not been previously reported from Australasia; a typical case is presented, and the clinical and pathological findings discussed. Possible aetiologies are discussed in the light of positive serology to coxsackie B viruses.

The lupus anticoagulant, pulmonary thromboembolism, and fatal pulmonary hypertension

A patient with a circulating lupus anticoagulant in the absence of systemic lupus erythematosus developed recurrent deep venous thromboses and pulmonary emboli. Pulmonary emboli recurred despite prolonged oral anticoagulant therapy and resulted in fatal pulmonary arterial hypertension. Extended anticoagulant therapy alone may not prevent recurrent thromboembolism in patients with a lupus anticoagulant. Pulmonary thromboembolism may be an important factor in the pathogenesis of pulmonary hypertension in patients with a lupus anticoagulant.

Rhinocerebral mucormycosis complicating poorly controlled diabetes mellitus: case report

We report a case of rhinocerebral mucormycosis in a patient with poorly controlled diabetes mellitus. The pathology, clinical features, diagnosis and treatment of this disorder are discussed.