UroToday- Traditionally, venous involvement, bulky retroperitoneal adenopathy, and large tumors with extracapsular extension have served as relative contraindications to radical nephrectomy performed through a laparoscopic approach. Increased experience and skill with this approach over time has resulted in expanding the indications of laparoscopic surgical techniques to deal with more and more complex surgical issues. Here Kapoor and colleagues report on their experience with laparoscopic management of level I tumor thrombi during laparoscopic radical nephrectomy.
The authors report on 12 patients with level I tumor thrombi that were diagnosed preoperatively. This report differs from previous studies in the literature in that all patients were known to have tumor thrombi preoperatively. Of these 12, 6 were done with a hand assisted laparoscopic technique, primarily because of large tumors with hilar adenopathy precluded a pure laparoscopic approach. Intraoperative laparoscopic ultrasound was used in 4 to delineate the extent of the thrombus to facilitate surgical management of the renal vein. Two cases were electively converted to open surgery due to more extensive venous involvement than perceived preoperatively. Seven of the 12 patients had metastatic disease at the time of surgery and two of these died of progressive disease after surgery, prior to the administration of systemic therapy. Mean blood loss was 200 ml and mean OR time was 220 minutes. The median length of stay was 4 days. There were no intraoperative complications and no positive margins or local recurrences in the series. The authors noted that the hand assisted approach was particularly useful in "milking back" the thrombus prior to application of the vascular stapler.
Increasing use of laparoscopic approaches in the management of renal cell carcinoma has resulted in the development of surgical skills that allow approaches to more complex surgical problems. As a consequence, selected patients with even locally advanced disease can enjoy the decreased morbidity associated with laparoscopic surgery.
Kapoor A, Nguan C, Al-Shaiji TF, Hussain A, Fazio L, Al Omar M, Luke PPW
Urology 68(3): 514-517, 2006.
Reviewed by UroToday Contributing Editor Christopher G. Wood, MD, FACS
UroToday - the only urology website with original content global urology key opinion leaders actively engaged in clinical practice.
To access the latest urology news releases from UroToday, go to:
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Copyright © 2006 - UroToday
суббота, 25 июня 2011 г.
среда, 22 июня 2011 г.
Lubiprostone May Improve Symptom Relief Rates In Adults With IBS-C
A new study demonstrated that the active ingredient in AMITIZA® (lubiprostone), given 8 mcg twice a day, may improve symptom relief rates in adults with irritable bowel syndrome with constipation (IBS-C). These results were presented as a late-breaker at Digestive Disease Week 2007, the largest annual international meeting of digestive disease specialists.
"In this study, patients receiving lubiprostone were nearly twice as likely to achieve an overall response from symptoms of IBS-C compared to those receiving placebo," said Douglas A. Drossman, M.D., primary investigator, UNC Center for Functional GI and Motility Disorders, University of North Carolina, and the Chair of the Rome Committee. "As a result, lubiprostone may represent an important treatment for IBS-C sufferers."
IBS is a condition that affects approximately 58 million Americans and accounts for 25-50 percent of referrals to gastroenterologists. IBS-C symptoms include abdominal pain or discomfort associated with defecation or a change in bowel habits with features of disordered defecation.
Lubiprostone is a novel selective chloride channel activator that has been shown to be effective and well-tolerated in a number of well-controlled clinical trials in patients with chronic idiopathic constipation. Lubiprostone is marketed in the U.S. as AMITIZA, a 24-mcg gelcap that was approved for use for chronic idiopathic constipation in adults on January 31, 2006.
Sucampo Pharmaceuticals expects to submit a supplemental New Drug Application for IBS-C to the U.S. Food and Drug Administration by July 2007.
About the Study for IBS-C (lubiprostone 8 mcg)
In two phase III, multi-center, double-blind, randomized, placebo-controlled trials, 1,171 adults diagnosed with IBS-C (Rome II Criteria) were enrolled and received lubiprostone 8 mcg taken twice daily (783 adults) or placebo (388 adults) over a 12-week period.
Primary efficacy was determined by a unique question: "How would you rate your relief of IBS symptoms (abdominal discomfort/pain, bowel habits and other IBS symptoms) over the past week compared to how you felt before you entered the study"" A 7-point balanced scale with a strict evaluation using the two highest scale points to qualify as a responder was used. Patients were considered monthly responders if they reported at least moderate relief four out of four weeks or significant relief two out of four weeks. To qualify as an overall responder (the measure used in the primary endpoint), patients had to be a monthly responder for at least two out of three months. During the evaluation period, patients discontinuing for any reason or reporting an increase in rescue medication use, lack of efficacy or moderately or significantly worse relief were deemed non-responders. These responder rates may not be comparable to those in other studies since the new scale was more restrictive than those used in previous reports.
The findings demonstrated that patients receiving lubiprostone 8 mcg twice daily were nearly twice as likely to achieve overall response compared to those receiving placebo (lubiprostone 17.9 percent vs. placebo 10.1 percent, P=0.001). There was a similar incidence of serious adverse events (1 percent in each group) and related adverse events (lubiprostone 22 percent vs. placebo 21 percent) compared to placebo. The most common treatment-related adverse events (>5% of patients) were nausea (8 percent vs. 4 percent, respectively), diarrhea (6 percent vs. 4 percent, respectively) and abdominal pain (4 percent vs. 5 percent, respectively).
About Irritable Bowel Syndrome with Constipation (IBS-C)
Irritable bowel syndrome (IBS) is a chronic disorder characterized by abdominal discomfort and pain, and bowel habit changes including symptoms of constipation and/or diarrhea. The condition can significantly interfere with daily activities and reduce patients' quality of life, resulting in absences from school, missed work and reduced productivity.
Three main types include IBS with constipation (IBS-C), with diarrhea (IBS-D) and with mixed symptoms of constipation and diarrhea (IBS-M). In IBS-C, symptoms are present for at least 3 days per month over a 3-month period. Although people with IBS-C report suffering from many of the same symptoms associated with constipation, the presence of abdominal discomfort and pain is what differentiates IBS-C from chronic constipation. Additionally, the hypersensitivity of the gastrointestinal system of individuals with IBS makes them more prone to experience the effects of even mild symptoms of constipation or diarrhea. The condition is approximately 2 to 2.5 times more prevalent in women than men, and women are more likely to report a history of constipation.
About AMITIZA® (lubiprostone) 24 mcg BID for Chronic Idiopathic Constipation
AMITIZA is indicated for the treatment of Chronic Idiopathic Constipation in the adult population. AMITIZA should not be used in patients with a known hypersensitivity to any components of the formulation and in patients with a history of mechanical gastrointestinal obstruction. Patients with symptoms suggestive of mechanical gastrointestinal obstruction should be evaluated prior to initiating AMITIZA treatment.
The safety of AMITIZA in pregnancy has not been evaluated in humans. In guinea pigs, lubiprostone has been shown to have the potential to cause fetal loss. AMITIZA should be used during pregnancy only if the benefit justifies the potential risk to the fetus. Women who could become pregnant should have a negative pregnancy test prior to beginning therapy with AMITIZA and should be capable of complying with effective contraceptive measures.
AMITIZA should not be administered to patients that have severe diarrhea. Patients should be aware of the possible occurrence of diarrhea during treatment. If the diarrhea becomes severe, patients should consult their health professional.
In clinical trials for Chronic Idiopathic Constipation (24 mcg BID), the most common adverse event was nausea (31%). Other adverse events (=5% of patients) included diarrhea (13%), headache (13%), abdominal distention (7%), abdominal pain (7%), flatulence (6%), sinusitis (5%) and vomiting (5%).
For full prescribing information, visit amitiza/.
AMITIZA® is a registered trademark of Sucampo Pharmaceuticals, Inc.
Sucampo Pharmaceuticals, Inc.
Sucampo Pharmaceuticals, Inc., is an emerging pharmaceutical company based in Bethesda, Md. Sucampo Pharmaceuticals was founded in 1996 by Sachiko Kuno, Ph.D., the company's President and Chair of the Board of Directors, and Ryuji Ueno, M.D., Ph.D., Ph.D., the company's Chief Executive Officer and Chief Scientific Officer. Sucampo Pharmaceuticals focuses on the development and commercialization of drugs based on prostones, a class of compounds derived from functional fatty acids that occur naturally in the human body. The therapeutic potential of prostones was first identified by Dr. Ueno. In January 2006, Sucampo Pharmaceuticals received marketing approval from the FDA for its first product, AMITIZA, for the treatment of Chronic Idiopathic Constipation in adults. In October 2004, Sucampo Pharmaceuticals entered into an agreement with Takeda Pharmaceutical Company Limited (Osaka, Japan) to co-promote and market AMITIZA in the United States and Canada. Sucampo Pharmaceuticals' specialized sales force complements the efforts of Takeda by focusing on institutional and long-term care facilities. To learn more about the company and its products, visit sucampo/.
Takeda Pharmaceuticals North America, Inc.
Based in Deerfield, Ill., Takeda Pharmaceuticals North America, Inc. is a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, the largest pharmaceutical company in Japan. In the United States, Takeda currently markets products for diabetes, insomnia, wakefulness and gastroenterology. The company has a robust pipeline with compounds in development for diabetes, cardiovascular disease and other conditions. Takeda is committed to striving toward better health for individuals and progress in medicine by developing superior pharmaceutical products. To learn more about the company and its products, visit tpna/.
About Digestive Disease Week
Digestive Disease Week (DDW) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases, the American Gastroenterological Association (AGA) Institute, the American Society for Gastrointestinal Endoscopy and the Society for Surgery of the Alimentary Tract, DDW takes place May 19-24, 2007, at the Washington Convention Center, Washington, DC. The meeting showcases approximately 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology. For more information, visit ddw/.
New study demonstrates that Lubiprostone may improve symptom relief rates in adults with IBS-C
"In this study, patients receiving lubiprostone were nearly twice as likely to achieve an overall response from symptoms of IBS-C compared to those receiving placebo," said Douglas A. Drossman, M.D., primary investigator, UNC Center for Functional GI and Motility Disorders, University of North Carolina, and the Chair of the Rome Committee. "As a result, lubiprostone may represent an important treatment for IBS-C sufferers."
IBS is a condition that affects approximately 58 million Americans and accounts for 25-50 percent of referrals to gastroenterologists. IBS-C symptoms include abdominal pain or discomfort associated with defecation or a change in bowel habits with features of disordered defecation.
Lubiprostone is a novel selective chloride channel activator that has been shown to be effective and well-tolerated in a number of well-controlled clinical trials in patients with chronic idiopathic constipation. Lubiprostone is marketed in the U.S. as AMITIZA, a 24-mcg gelcap that was approved for use for chronic idiopathic constipation in adults on January 31, 2006.
Sucampo Pharmaceuticals expects to submit a supplemental New Drug Application for IBS-C to the U.S. Food and Drug Administration by July 2007.
About the Study for IBS-C (lubiprostone 8 mcg)
In two phase III, multi-center, double-blind, randomized, placebo-controlled trials, 1,171 adults diagnosed with IBS-C (Rome II Criteria) were enrolled and received lubiprostone 8 mcg taken twice daily (783 adults) or placebo (388 adults) over a 12-week period.
Primary efficacy was determined by a unique question: "How would you rate your relief of IBS symptoms (abdominal discomfort/pain, bowel habits and other IBS symptoms) over the past week compared to how you felt before you entered the study"" A 7-point balanced scale with a strict evaluation using the two highest scale points to qualify as a responder was used. Patients were considered monthly responders if they reported at least moderate relief four out of four weeks or significant relief two out of four weeks. To qualify as an overall responder (the measure used in the primary endpoint), patients had to be a monthly responder for at least two out of three months. During the evaluation period, patients discontinuing for any reason or reporting an increase in rescue medication use, lack of efficacy or moderately or significantly worse relief were deemed non-responders. These responder rates may not be comparable to those in other studies since the new scale was more restrictive than those used in previous reports.
The findings demonstrated that patients receiving lubiprostone 8 mcg twice daily were nearly twice as likely to achieve overall response compared to those receiving placebo (lubiprostone 17.9 percent vs. placebo 10.1 percent, P=0.001). There was a similar incidence of serious adverse events (1 percent in each group) and related adverse events (lubiprostone 22 percent vs. placebo 21 percent) compared to placebo. The most common treatment-related adverse events (>5% of patients) were nausea (8 percent vs. 4 percent, respectively), diarrhea (6 percent vs. 4 percent, respectively) and abdominal pain (4 percent vs. 5 percent, respectively).
About Irritable Bowel Syndrome with Constipation (IBS-C)
Irritable bowel syndrome (IBS) is a chronic disorder characterized by abdominal discomfort and pain, and bowel habit changes including symptoms of constipation and/or diarrhea. The condition can significantly interfere with daily activities and reduce patients' quality of life, resulting in absences from school, missed work and reduced productivity.
Three main types include IBS with constipation (IBS-C), with diarrhea (IBS-D) and with mixed symptoms of constipation and diarrhea (IBS-M). In IBS-C, symptoms are present for at least 3 days per month over a 3-month period. Although people with IBS-C report suffering from many of the same symptoms associated with constipation, the presence of abdominal discomfort and pain is what differentiates IBS-C from chronic constipation. Additionally, the hypersensitivity of the gastrointestinal system of individuals with IBS makes them more prone to experience the effects of even mild symptoms of constipation or diarrhea. The condition is approximately 2 to 2.5 times more prevalent in women than men, and women are more likely to report a history of constipation.
About AMITIZA® (lubiprostone) 24 mcg BID for Chronic Idiopathic Constipation
AMITIZA is indicated for the treatment of Chronic Idiopathic Constipation in the adult population. AMITIZA should not be used in patients with a known hypersensitivity to any components of the formulation and in patients with a history of mechanical gastrointestinal obstruction. Patients with symptoms suggestive of mechanical gastrointestinal obstruction should be evaluated prior to initiating AMITIZA treatment.
The safety of AMITIZA in pregnancy has not been evaluated in humans. In guinea pigs, lubiprostone has been shown to have the potential to cause fetal loss. AMITIZA should be used during pregnancy only if the benefit justifies the potential risk to the fetus. Women who could become pregnant should have a negative pregnancy test prior to beginning therapy with AMITIZA and should be capable of complying with effective contraceptive measures.
AMITIZA should not be administered to patients that have severe diarrhea. Patients should be aware of the possible occurrence of diarrhea during treatment. If the diarrhea becomes severe, patients should consult their health professional.
In clinical trials for Chronic Idiopathic Constipation (24 mcg BID), the most common adverse event was nausea (31%). Other adverse events (=5% of patients) included diarrhea (13%), headache (13%), abdominal distention (7%), abdominal pain (7%), flatulence (6%), sinusitis (5%) and vomiting (5%).
For full prescribing information, visit amitiza/.
AMITIZA® is a registered trademark of Sucampo Pharmaceuticals, Inc.
Sucampo Pharmaceuticals, Inc.
Sucampo Pharmaceuticals, Inc., is an emerging pharmaceutical company based in Bethesda, Md. Sucampo Pharmaceuticals was founded in 1996 by Sachiko Kuno, Ph.D., the company's President and Chair of the Board of Directors, and Ryuji Ueno, M.D., Ph.D., Ph.D., the company's Chief Executive Officer and Chief Scientific Officer. Sucampo Pharmaceuticals focuses on the development and commercialization of drugs based on prostones, a class of compounds derived from functional fatty acids that occur naturally in the human body. The therapeutic potential of prostones was first identified by Dr. Ueno. In January 2006, Sucampo Pharmaceuticals received marketing approval from the FDA for its first product, AMITIZA, for the treatment of Chronic Idiopathic Constipation in adults. In October 2004, Sucampo Pharmaceuticals entered into an agreement with Takeda Pharmaceutical Company Limited (Osaka, Japan) to co-promote and market AMITIZA in the United States and Canada. Sucampo Pharmaceuticals' specialized sales force complements the efforts of Takeda by focusing on institutional and long-term care facilities. To learn more about the company and its products, visit sucampo/.
Takeda Pharmaceuticals North America, Inc.
Based in Deerfield, Ill., Takeda Pharmaceuticals North America, Inc. is a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, the largest pharmaceutical company in Japan. In the United States, Takeda currently markets products for diabetes, insomnia, wakefulness and gastroenterology. The company has a robust pipeline with compounds in development for diabetes, cardiovascular disease and other conditions. Takeda is committed to striving toward better health for individuals and progress in medicine by developing superior pharmaceutical products. To learn more about the company and its products, visit tpna/.
About Digestive Disease Week
Digestive Disease Week (DDW) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases, the American Gastroenterological Association (AGA) Institute, the American Society for Gastrointestinal Endoscopy and the Society for Surgery of the Alimentary Tract, DDW takes place May 19-24, 2007, at the Washington Convention Center, Washington, DC. The meeting showcases approximately 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology. For more information, visit ddw/.
New study demonstrates that Lubiprostone may improve symptom relief rates in adults with IBS-C
Food Poisoning Bacterium Become Resistant To Antibiotics, Thanks To This Protein
A new protein has been identified that promotes the development of
antibiotic resistance in Campylobacter bacteria,
the most commonly recognized source of food poisoning, according to a
study released on June 5, 2008 in the open access journal PLoS
Pathogens.
Campylobacter jejuni is the most common foodbourne
bacterial pathogen in humans, and it is present even in developed
countries. Standard treatment for infection with this bacterium is the
broad-spectrum antimicrobial fluoroquinolone, but the organism has been
found in many strains around the world that are resistant to this
antidote. Previous studies have shown that Campylobacter
is actually highly susceptible to mutation towards antibiotic
resistance, but the reasons behind this trait have been unclear.
To investigate this, researchers from Iowa State University's College
of Veterinary Medicine, led by Dr. Qijing Zhang, employed various
molecular biology techniques to observe the response of Campylobacter
to changes in Mfd, a protein involved in DNA transcription and repair,
in the presence of fluoroquinolone. They found that elimination of this
protein from the bacterium precipitated a 100-fold reduction in the
rate of creation of new strains that were resistant. This indicates
that this protein likely plays an important role in this type of
mutation.
Thusfar, Mfd had not been recognized with the function of promoting
antibiotic resistance. It is possible that other factors influence the
mutation frequency of these and similar organisms, so further study is
necessary to elucidate other influential aspects of this mechanism.
About PLoS Pathogens
PLoS
Pathogens (www.plospathogens)
publishes outstanding original
articles that significantly advance the understanding of pathogens and
how they interact with their host organisms. All works published in
PLoS Pathogens are open access. Everything is immediately available
subject only to the condition that the original authorship and source
are properly attributed. Copyright is retained by the authors. The
Public Library of Science uses the Creative Commons Attribution License.
About the Public Library of Science
The
Public Library of Science (PLoS) is a non-profit organization of
scientists and physicians committed to making the world's scientific
and medical literature a freely available public resource. For more
information, visit plos.
Key Role of Mfd in the Development of Fluoroquinolone
Resistance in Campylobacter jejuni.
Han J, Sahin O, Barton Y-W, Zhang Q
PLoS Pathog 4(6): e1000083.
doi:10.1371/journal.ppat.1000083
Click
Here For Full Length Article
Anna Sophia McKenney
antibiotic resistance in Campylobacter bacteria,
the most commonly recognized source of food poisoning, according to a
study released on June 5, 2008 in the open access journal PLoS
Pathogens.
Campylobacter jejuni is the most common foodbourne
bacterial pathogen in humans, and it is present even in developed
countries. Standard treatment for infection with this bacterium is the
broad-spectrum antimicrobial fluoroquinolone, but the organism has been
found in many strains around the world that are resistant to this
antidote. Previous studies have shown that Campylobacter
is actually highly susceptible to mutation towards antibiotic
resistance, but the reasons behind this trait have been unclear.
To investigate this, researchers from Iowa State University's College
of Veterinary Medicine, led by Dr. Qijing Zhang, employed various
molecular biology techniques to observe the response of Campylobacter
to changes in Mfd, a protein involved in DNA transcription and repair,
in the presence of fluoroquinolone. They found that elimination of this
protein from the bacterium precipitated a 100-fold reduction in the
rate of creation of new strains that were resistant. This indicates
that this protein likely plays an important role in this type of
mutation.
Thusfar, Mfd had not been recognized with the function of promoting
antibiotic resistance. It is possible that other factors influence the
mutation frequency of these and similar organisms, so further study is
necessary to elucidate other influential aspects of this mechanism.
About PLoS Pathogens
PLoS
Pathogens (www.plospathogens)
publishes outstanding original
articles that significantly advance the understanding of pathogens and
how they interact with their host organisms. All works published in
PLoS Pathogens are open access. Everything is immediately available
subject only to the condition that the original authorship and source
are properly attributed. Copyright is retained by the authors. The
Public Library of Science uses the Creative Commons Attribution License.
About the Public Library of Science
The
Public Library of Science (PLoS) is a non-profit organization of
scientists and physicians committed to making the world's scientific
and medical literature a freely available public resource. For more
information, visit plos.
Key Role of Mfd in the Development of Fluoroquinolone
Resistance in Campylobacter jejuni.
Han J, Sahin O, Barton Y-W, Zhang Q
PLoS Pathog 4(6): e1000083.
doi:10.1371/journal.ppat.1000083
Click
Here For Full Length Article
Anna Sophia McKenney
Pfizer Affirms Celebrex Safety in response to withdrawal of Merck's Vioxx
In response to Merck & Co.'s announcement today of the worldwide withdrawal of its COX-2 medicine Vioxx, Pfizer Inc issued the following statement:
Over 27 million patients in the United States have been prescribed Celebrex (celecoxib), which was approved by the U.S. Food and Drug Administration in 1998.
"Pfizer is confident in the long-term cardiovascular safety of Celebrex," said Dr. Joe Feczko, Pfizer's president of worldwide development.
In a recent FDA-sponsored study of 1.4 million patients, those who received Celebrex demonstrated no increased risk of cardiac events.
"Patients taking COX-2 inhibitors may be confused and should speak with their doctors," Dr. Feczko said. "Because of its outstanding long-term safety profile and broad indication base including osteoarthritis, rheumatoid arthritis and acute pain, Celebrex is an appropriate treatment alternative."
Celebrex was the first COX-2 inhibitor, a class of medicine designed to relieve pain without the serious gastrointestinal side effects associated with older non-steroidal anti-inflammatory medicines. In 2001, Pfizer introduced Bextra (valdecoxib), its second COX-2 inhibitor, for use in osteoarthritis and rheumatoid arthritis. Bextra's cardiovascular safety profile is also well established in long-term studies.
Data show that since the introduction of COX-2 inhibitors, the rate of hospitalizations for gastrointestinal events associated with long-term arthritis treatment has declined significantly.
celebrex
View drug information on Bextra; Vioxx.
Over 27 million patients in the United States have been prescribed Celebrex (celecoxib), which was approved by the U.S. Food and Drug Administration in 1998.
"Pfizer is confident in the long-term cardiovascular safety of Celebrex," said Dr. Joe Feczko, Pfizer's president of worldwide development.
In a recent FDA-sponsored study of 1.4 million patients, those who received Celebrex demonstrated no increased risk of cardiac events.
"Patients taking COX-2 inhibitors may be confused and should speak with their doctors," Dr. Feczko said. "Because of its outstanding long-term safety profile and broad indication base including osteoarthritis, rheumatoid arthritis and acute pain, Celebrex is an appropriate treatment alternative."
Celebrex was the first COX-2 inhibitor, a class of medicine designed to relieve pain without the serious gastrointestinal side effects associated with older non-steroidal anti-inflammatory medicines. In 2001, Pfizer introduced Bextra (valdecoxib), its second COX-2 inhibitor, for use in osteoarthritis and rheumatoid arthritis. Bextra's cardiovascular safety profile is also well established in long-term studies.
Data show that since the introduction of COX-2 inhibitors, the rate of hospitalizations for gastrointestinal events associated with long-term arthritis treatment has declined significantly.
celebrex
View drug information on Bextra; Vioxx.
Iowa Department Of Public Health Informa That E.coli Cases Increase
Since late September, 29 cases of Eli O157:H7 and related strains have been reported to IDPH. This compares to an average of 18.4 cases during the same time period over the last five years. Of the 29 cases, 22 involve children ages 12 years and younger. Several of these children have been admitted to the hospital and a few have experienced significant kidney damage as a result of their Eli infection.
All E. coli cases are investigated to determine if there are contaminated food items on the market, or if particular risks exist in a community, such as poorly-chlorinated kiddies' pools. Action is taken by public health officials if there is even a suspicion of increased risk.
The recent Eli cases investigated by IDPH include a small cluster of cases in eastern Iowa. Several things associated with the cases increased the risk of E. coli exposure, such as drinking unpasteurized apple cider, eating fresh, unwashed apples, and eating ground beef. "With the exception of the eastern Iowa cluster, all the other cases have been reported across the state and have no common exposures," said IDPH medical director, Dr. Patricia Quinlisk. "Thus it is important for everyone to be aware of how Eli exposure can occur, and what each person can do to reduce their risk of becoming ill."
Potential sources of Eli contamination include drinking raw, unpasteurized juice or milk; contact with farm animals either in a farm setting or petting zoo; consumption of under-cooked ground meats or of foods contaminated by raw meat juices; and consumption of raw, unwashed produce. Eli can also be transmitted from an ill person to a healthy person, which is why hand washing is very important.
Eli O157:H7 and related strains are bacteria. The main symptom of Eli O157:H7 and similar infections is diarrhea, which may be bloody. Stomach cramps and chills may also occur. Fever is rarely reported. Anyone with symptoms of Eli O157:H7 should consult with his or her health care provider immediately. Approximately 8 percent of cases will develop complications involving the kidneys, especially young children. The infection may also cause a person's blood clotting systems to malfunction.
Eli infections can be prevented:
- Make sure fresh juice or milk has been pasteurized. Even small samples can make a person sick.
- People with diarrhea should not prepare or touch food meant for others.
- Wash hands with soap and water after using the restroom. If soap and water are not available, use an alcohol based hand gel to clean hands.
- When caring for someone with diarrhea, wash your hands after giving any care, and ensure that the ill person's hands are frequently washed, too.
- Cook all ground meats like hamburger thoroughly - to a temperature of 155 F for at least 15-16 seconds, or until juices run clear and no pink is visible.
- Always wash fresh vegetables or fruits thoroughly before eating.
IDPH recommends parents and caregivers become aware of the possible exposures for Eli, and take actions to reduce their own and their children's risk of exposure.
Iowa Department of Public Health
All E. coli cases are investigated to determine if there are contaminated food items on the market, or if particular risks exist in a community, such as poorly-chlorinated kiddies' pools. Action is taken by public health officials if there is even a suspicion of increased risk.
The recent Eli cases investigated by IDPH include a small cluster of cases in eastern Iowa. Several things associated with the cases increased the risk of E. coli exposure, such as drinking unpasteurized apple cider, eating fresh, unwashed apples, and eating ground beef. "With the exception of the eastern Iowa cluster, all the other cases have been reported across the state and have no common exposures," said IDPH medical director, Dr. Patricia Quinlisk. "Thus it is important for everyone to be aware of how Eli exposure can occur, and what each person can do to reduce their risk of becoming ill."
Potential sources of Eli contamination include drinking raw, unpasteurized juice or milk; contact with farm animals either in a farm setting or petting zoo; consumption of under-cooked ground meats or of foods contaminated by raw meat juices; and consumption of raw, unwashed produce. Eli can also be transmitted from an ill person to a healthy person, which is why hand washing is very important.
Eli O157:H7 and related strains are bacteria. The main symptom of Eli O157:H7 and similar infections is diarrhea, which may be bloody. Stomach cramps and chills may also occur. Fever is rarely reported. Anyone with symptoms of Eli O157:H7 should consult with his or her health care provider immediately. Approximately 8 percent of cases will develop complications involving the kidneys, especially young children. The infection may also cause a person's blood clotting systems to malfunction.
Eli infections can be prevented:
- Make sure fresh juice or milk has been pasteurized. Even small samples can make a person sick.
- People with diarrhea should not prepare or touch food meant for others.
- Wash hands with soap and water after using the restroom. If soap and water are not available, use an alcohol based hand gel to clean hands.
- When caring for someone with diarrhea, wash your hands after giving any care, and ensure that the ill person's hands are frequently washed, too.
- Cook all ground meats like hamburger thoroughly - to a temperature of 155 F for at least 15-16 seconds, or until juices run clear and no pink is visible.
- Always wash fresh vegetables or fruits thoroughly before eating.
IDPH recommends parents and caregivers become aware of the possible exposures for Eli, and take actions to reduce their own and their children's risk of exposure.
Iowa Department of Public Health
Data From Clinical Trial Examining Lubiprostone For The Treatment Of Opioid-induced Bowel Dysfunction Presented At Digestive Disease Week Conference
Sucampo Pharmaceuticals, Inc. today announced the presentation of results from a phase 3 clinical trial investigating the use of lubiprostone in non-cancer pain patients with Opioid-induced Bowel Dysfunction (OBD). These results were the subject of an oral presentation at the Digestive Disease Week (DDW) 2010 conference in New Orleans, Louisiana, on May 5, 2010.
Byron Cryer, M.D., the John C. Vanatta III Professor of Medicine at the University of Texas, Southwestern, in Dallas, Texas, who was an investigator in the trial and presented the data at DDW, said, "Opioid-induced Bowel Dysfunction in patients with chronic non-cancer pain is a serious problem. In the Phase 3 results of this study presented here, some patients received relief from constipation without a reduction in their pain medication."
Gayle R. Dolecek, P.D., M.P.H., Senior Vice President, Research & Development, Sucampo Pharmaceuticals, Inc., said, "We were pleased to see these data from the Phase 3 results of lubiprostone in this trial as we believe lubiprostone may represent a future treatment strategy for OBD patients if approved in this patient population."
The results reported are from a randomized, double-blind, placebo-controlled phase 3 clinical trial (known as OBD0631) that assessed the safety and efficacy of lubiprostone (24 mcg twice daily) for the treatment of OBD in patients taking opioids for non-cancer pain. In this trial, patients with OBD were randomized to receive either lubiprostone 24 mcg gel capsules or matching placebo capsules twice a day every day for 12 weeks.
A total of 875 OBD patients with non-cancer pain were randomized into two identically designed phase 3 trials. The data reported at DDW are from one of these trials, in which statistical significance was achieved for the primary endpoint in one study (OBD0631), but not in the other study (OBD632). Statistically significant improvements were seen for eight of the 12 secondary endpoints in study OBD0631. In study OBD0632, statistically significant improvements were noted for two of 12 secondary endpoints.
Among the key results of the OBD0631 trial were:
- The primary efficacy endpoint, the change from baseline in spontaneous bowel movement (SBM) frequency at Week 8 in patients without reduction in dose of study medication, achieved statistical significance (p=0.0226) for patients taking lubiprostone (n=167) compared to placebo (n=169).
- Patients taking lubiprostone achieved a significantly (p=0.02) greater increase in the mean number of SBMs per week in eight of the 12 weeks of the trial, as compared to placebo patients.
- The percentage of patients who achieved a SBM within 24 hours and 48 hours was significantly higher with lubiprostone as compared to placebo (p=0.0126 at 24 hours, and p=0.0360 at 48 hours).
- Statistical significance was achieved for the overall change from baseline in constipation-associated symptom endpoints including: constipation severity (p=0.0006); stool consistency (p
- The most commonly reported adverse events in this trial were nausea, diarrhea, and abdominal distension. Overall 4.6% of patients (3.2% placebo vs. 5.9% lubiprostone) discontinued due to an adverse event.
About the Trial Design
A total of 443 OBD patients enrolled at multiple sites in the U.S. and Canada were randomized into this double-blind, placebo-controlled phase 3 clinical trial and received one 24-mcg gel capsule of lubiprostone or placebo twice a day for 12 weeks. Patients in the trial were administered different opioid pain medications including fentanyl, methadone, morphine, and oxycontin.
AMITIZA® (lubiprostone) for Chronic Idiopathic Constipation in Adults and Irritable Bowel Syndrome with Constipation in Adult Women
AMITIZA® (lubiprostone) is indicated for the treatment of Chronic Idiopathic Constipation (24 mcg twice daily) in adults and for Irritable Bowel Syndrome with Constipation (8 mcg twice daily) in women ?‰? 18 years old.
Important Safety Information
AMITIZA is contraindicated in patients with known or suspected mechanical gastrointestinal obstruction. Patients with symptoms suggestive of mechanical gastrointestinal obstruction should be thoroughly evaluated by the treating healthcare provider to confirm the absence of such an obstruction prior to initiating AMITIZA treatment.
The safety of AMITIZA in pregnancy has not been evaluated in humans. AMITIZA should be used during pregnancy only if the benefit justifies the potential risk to the fetus. Women who could become pregnant should have a negative pregnancy test prior to beginning therapy with AMITIZA and should be capable of complying with effective contraceptive measures.
Patients taking AMITIZA may experience nausea. If this occurs, concomitant administration of food with AMITIZA may reduce symptoms of nausea. Patients who experience severe nausea should inform their healthcare provider.
AMITIZA should not be prescribed to patients that have severe diarrhea. Patients should be aware of the possible occurrence of diarrhea during treatment and inform their healthcare provider if the diarrhea becomes severe.
Patients taking AMITIZA may experience dyspnea within an hour of first dose. This symptom generally resolves within three hours, but may recur with repeat dosing. Patients who experience dyspnea should inform their healthcare provider. Some patients have discontinued therapy because of dyspnea.
In clinical trials of AMITIZA (24 mcg twice daily vs. placebo; N=1113 vs. N=316) in patients with Chronic Idiopathic Constipation, the most common adverse reactions (incidence > 4%) were nausea (29% vs. 3%), diarrhea (12% vs. 4%) were nausea (8% vs. 4%), diarrhea (7% vs. 4%), and abdominal pain (5% vs. 5%).
About Digestive Disease Week (DDW)
DDW is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases, the American Gastroenterological Association (AGA) Institute, the American Society for Gastrointestinal Endoscopy and the Society for Surgery of the Alimentary Tract, DDW takes place May 1 - 5, 2010, in New Orleans. The meeting showcases approximately 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology. For more information, visit ddw.
Source
Sucampo Pharmaceuticals, Inc.
View drug information on Amitiza; OxyContin.
Byron Cryer, M.D., the John C. Vanatta III Professor of Medicine at the University of Texas, Southwestern, in Dallas, Texas, who was an investigator in the trial and presented the data at DDW, said, "Opioid-induced Bowel Dysfunction in patients with chronic non-cancer pain is a serious problem. In the Phase 3 results of this study presented here, some patients received relief from constipation without a reduction in their pain medication."
Gayle R. Dolecek, P.D., M.P.H., Senior Vice President, Research & Development, Sucampo Pharmaceuticals, Inc., said, "We were pleased to see these data from the Phase 3 results of lubiprostone in this trial as we believe lubiprostone may represent a future treatment strategy for OBD patients if approved in this patient population."
The results reported are from a randomized, double-blind, placebo-controlled phase 3 clinical trial (known as OBD0631) that assessed the safety and efficacy of lubiprostone (24 mcg twice daily) for the treatment of OBD in patients taking opioids for non-cancer pain. In this trial, patients with OBD were randomized to receive either lubiprostone 24 mcg gel capsules or matching placebo capsules twice a day every day for 12 weeks.
A total of 875 OBD patients with non-cancer pain were randomized into two identically designed phase 3 trials. The data reported at DDW are from one of these trials, in which statistical significance was achieved for the primary endpoint in one study (OBD0631), but not in the other study (OBD632). Statistically significant improvements were seen for eight of the 12 secondary endpoints in study OBD0631. In study OBD0632, statistically significant improvements were noted for two of 12 secondary endpoints.
Among the key results of the OBD0631 trial were:
- The primary efficacy endpoint, the change from baseline in spontaneous bowel movement (SBM) frequency at Week 8 in patients without reduction in dose of study medication, achieved statistical significance (p=0.0226) for patients taking lubiprostone (n=167) compared to placebo (n=169).
- Patients taking lubiprostone achieved a significantly (p=0.02) greater increase in the mean number of SBMs per week in eight of the 12 weeks of the trial, as compared to placebo patients.
- The percentage of patients who achieved a SBM within 24 hours and 48 hours was significantly higher with lubiprostone as compared to placebo (p=0.0126 at 24 hours, and p=0.0360 at 48 hours).
- Statistical significance was achieved for the overall change from baseline in constipation-associated symptom endpoints including: constipation severity (p=0.0006); stool consistency (p
- The most commonly reported adverse events in this trial were nausea, diarrhea, and abdominal distension. Overall 4.6% of patients (3.2% placebo vs. 5.9% lubiprostone) discontinued due to an adverse event.
About the Trial Design
A total of 443 OBD patients enrolled at multiple sites in the U.S. and Canada were randomized into this double-blind, placebo-controlled phase 3 clinical trial and received one 24-mcg gel capsule of lubiprostone or placebo twice a day for 12 weeks. Patients in the trial were administered different opioid pain medications including fentanyl, methadone, morphine, and oxycontin.
AMITIZA® (lubiprostone) for Chronic Idiopathic Constipation in Adults and Irritable Bowel Syndrome with Constipation in Adult Women
AMITIZA® (lubiprostone) is indicated for the treatment of Chronic Idiopathic Constipation (24 mcg twice daily) in adults and for Irritable Bowel Syndrome with Constipation (8 mcg twice daily) in women ?‰? 18 years old.
Important Safety Information
AMITIZA is contraindicated in patients with known or suspected mechanical gastrointestinal obstruction. Patients with symptoms suggestive of mechanical gastrointestinal obstruction should be thoroughly evaluated by the treating healthcare provider to confirm the absence of such an obstruction prior to initiating AMITIZA treatment.
The safety of AMITIZA in pregnancy has not been evaluated in humans. AMITIZA should be used during pregnancy only if the benefit justifies the potential risk to the fetus. Women who could become pregnant should have a negative pregnancy test prior to beginning therapy with AMITIZA and should be capable of complying with effective contraceptive measures.
Patients taking AMITIZA may experience nausea. If this occurs, concomitant administration of food with AMITIZA may reduce symptoms of nausea. Patients who experience severe nausea should inform their healthcare provider.
AMITIZA should not be prescribed to patients that have severe diarrhea. Patients should be aware of the possible occurrence of diarrhea during treatment and inform their healthcare provider if the diarrhea becomes severe.
Patients taking AMITIZA may experience dyspnea within an hour of first dose. This symptom generally resolves within three hours, but may recur with repeat dosing. Patients who experience dyspnea should inform their healthcare provider. Some patients have discontinued therapy because of dyspnea.
In clinical trials of AMITIZA (24 mcg twice daily vs. placebo; N=1113 vs. N=316) in patients with Chronic Idiopathic Constipation, the most common adverse reactions (incidence > 4%) were nausea (29% vs. 3%), diarrhea (12% vs. 4%) were nausea (8% vs. 4%), diarrhea (7% vs. 4%), and abdominal pain (5% vs. 5%).
About Digestive Disease Week (DDW)
DDW is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases, the American Gastroenterological Association (AGA) Institute, the American Society for Gastrointestinal Endoscopy and the Society for Surgery of the Alimentary Tract, DDW takes place May 1 - 5, 2010, in New Orleans. The meeting showcases approximately 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology. For more information, visit ddw.
Source
Sucampo Pharmaceuticals, Inc.
View drug information on Amitiza; OxyContin.
Spinach E. coli Linked To California Spinach Processor
US government investigators have linked the latest E. coli poisoning outbreak to a spinach processor in San Juan Bautista, California, called Earthbound Farm, owned by Natural Selection Foods LLC. Infected patients have reported consuming other brands made by Natural Selection Foods.
Investigations are still ongoing to check for other sources, according to Dr. David Acheson, Chief Medical Officer, FDA Center for Food Safety and Applied Nutrition.
Natural Selection Foods is recalling all its spinach-containing products. The following products belong to Natural Selection Foods:
-- Bellissima, Dole
-- Cheney Brothers
-- Coastline
-- Cross Valley
-- D'Arrigo Brothers
-- Earthbound Farm
-- Emeril, Sysco
-- Fresh Point
-- Green Harvest
-- Jansal Valley
-- Mann
-- Mills Family Farm
-- Natural Selection Foods
-- Nature's Basket
-- O Organic
-- Premium Fresh
-- President's Choice
-- Pride of San Juan
-- Pro-Mark, Compliments
-- ProAct
-- Rave Spinach
-- Ready Pac
-- River Ranch, Superior
-- Riverside Farms
-- Snoboy
-- Tanimura & Antle
-- The Farmer's Market
-- Trader Joe's
(These products contain spinach)
Shoppers wanting a refund or replacement coupons can call 800-690-3200.
The latest E. coli outbreak was first reported on August 25th. The Food and Drugs Administration (FDA) has issued a nationwide warning, telling people not to buy or consume the said raw spinach products. Even washing will not eliminate the bacteria (boiling will).
So far, the following states have reported human cases of E. coli poisoning (O157:H7 strain):
-- California
-- Connecticut
-- Idaho
-- Indiana
-- Kentucky
-- Maine
-- Michigan
-- Minnesota
-- New Mexico
-- Nevada
-- New York
-- Ohio
-- Oregon
-- Pennsylvania
-- Utah
-- Virginia
-- Washington
-- Wyoming
(Source: CDC - at least 94 cases so far)
The O157:H7 strain of E. coli causes diarrhea (commonly with bloody stools). Some patients can experience fever. Abdominal pain is also common. Most healthy adults make a full recovery within seven days. However, some people, such as young children and the elderly, may develop Hemolytic Uremic Syndrome (a form of kidney failure).
-- Click here for news on this outbreak from the FDA
Investigations are still ongoing to check for other sources, according to Dr. David Acheson, Chief Medical Officer, FDA Center for Food Safety and Applied Nutrition.
Natural Selection Foods is recalling all its spinach-containing products. The following products belong to Natural Selection Foods:
-- Bellissima, Dole
-- Cheney Brothers
-- Coastline
-- Cross Valley
-- D'Arrigo Brothers
-- Earthbound Farm
-- Emeril, Sysco
-- Fresh Point
-- Green Harvest
-- Jansal Valley
-- Mann
-- Mills Family Farm
-- Natural Selection Foods
-- Nature's Basket
-- O Organic
-- Premium Fresh
-- President's Choice
-- Pride of San Juan
-- Pro-Mark, Compliments
-- ProAct
-- Rave Spinach
-- Ready Pac
-- River Ranch, Superior
-- Riverside Farms
-- Snoboy
-- Tanimura & Antle
-- The Farmer's Market
-- Trader Joe's
(These products contain spinach)
Shoppers wanting a refund or replacement coupons can call 800-690-3200.
The latest E. coli outbreak was first reported on August 25th. The Food and Drugs Administration (FDA) has issued a nationwide warning, telling people not to buy or consume the said raw spinach products. Even washing will not eliminate the bacteria (boiling will).
So far, the following states have reported human cases of E. coli poisoning (O157:H7 strain):
-- California
-- Connecticut
-- Idaho
-- Indiana
-- Kentucky
-- Maine
-- Michigan
-- Minnesota
-- New Mexico
-- Nevada
-- New York
-- Ohio
-- Oregon
-- Pennsylvania
-- Utah
-- Virginia
-- Washington
-- Wyoming
(Source: CDC - at least 94 cases so far)
The O157:H7 strain of E. coli causes diarrhea (commonly with bloody stools). Some patients can experience fever. Abdominal pain is also common. Most healthy adults make a full recovery within seven days. However, some people, such as young children and the elderly, may develop Hemolytic Uremic Syndrome (a form of kidney failure).
-- Click here for news on this outbreak from the FDA
News From Journal Of Clinical Investigation Online Early: April 6, 2009
ONCOLOGY: Harnessing immune cells to target skin cancer
One subset of immune cells known to contribute to the immune response that targets tumors is the NK cell subset. Although this suggests that NK cell-based therapeutics have anticancer potential, more information is needed about the interactions between NK cells and human tumor cells if this promise is to be realized. A team of researchers, at The Babraham Institute, United Kingdom, and the University of Catanzaro "Magna Graecia", Italy, has now provided insight into this issue by studying both human metastatic melanomas (aggressive forms of skin cancer that have spread to other sites) and spontaneous mouse melanomas.
The team, led by Francesco Colucci and Ennio Carbone, found that human melanoma cell lines derived from lymph node metastases expressed proteins that interacted with the NK cell protein DNAM-1 and with a group of NK cell proteins known as NCRs. These cell lines were particularly susceptible to being killed by NK cells both in vitro and after being transplanted into mice. Consistent with these data from human cell lines, mouse spontaneous melanomas and melanoma cell lines both expressed proteins that bound DNAM-1 and NCRs. Further, interfering with the interaction of DNAM-1 and NCRs with proteins on melanoma cells reduced NK cell-mediated killing of human and mouse melanoma cells lines in vitro and in vivo. The authors therefore conclude that DNAM-1 and NCRs are critical for NK cell-mediated killing of melanoma cells and suggest that NK cells could be harnessed to prevent melanoma metastasis.
TITLE: NCRs and DNAM-1 mediate NK cell recognition and lysis of human and mouse melanoma cell lines in vitro and in vivo
AUTHOR CONTACT:
Francesco Colucci
The Babraham Institute, Cambridge, United Kingdom.
Ennio Carbone
University of Catanzaro "Magna Graecia", Catanzaro, Italy.
View the PDF of this article at: https://www.the-jci/article.php?id=36022
GASTROENTEROLOGY: The protein Cd1d controls intestinal colonization with bacteria
The intestines of all mammals, including humans, are home to a large number of species of bacteria. The identity of these bacteria affects both the normal functioning of the intestines and the occurrence of immune-mediated intestinal diseases, such as inflammatory bowel disease. Despite the importance of these bacteria, little is known about the host factors that control their colonization of the intestines. However, Edward Nieuwenhuis and colleagues, at Erasmus Medical Center, The Netherlands, have now identified a role for the protein Cd1d in regulating intestinal colonization by bacteria in mice.
In the study, when analyzed under specific pathogen-free or germ-free conditions and compared with Cd1d-sufficient mice, Cd1d-deficient mice exhibited increased colonization of the small intestine following administration of a number of species of bacteria (Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus, or Lactobacillus gasseri) into their stomachs. By contrast, activation of immune cells that bind Cd1d prevented intestinal colonization of specific pathogen-free Cd1d-sufficient mice with P. aeruginosa and E. coli. Further analysis revealed a role for Paneth cells, which are found only in the small intestine, in the process. The authors therefore conclude that Cd1d controls colonization of the intestines with bacteria via a mechanism that involves Paneth cells and suggest that manipulating Cd1d might provide a way to modulate the identity of the bacteria in the intestines.
TITLE: Cd1d-dependent regulation of bacterial colonization in the intestine of mice
AUTHOR CONTACT:
Edward E.S. Nieuwenhuis
Erasmus Medical Center, Rotterdam, The Netherlands.
View the PDF of this article at: https://www.the-jci/article.php?id=36509
PHYSIOLOGY: A link between low oxygen levels and intestinal iron absorption
The only way for iron, which is an essential nutrient, to be taken up by the body is for it to be absorbed by the intestine. Low iron levels can lead to anemia, which is characterized by weakness and fatigue and, in severe cases, heart failure. In a new study, Carole Peyssonnaux and her colleagues at Universit?© Paris Descartes, France, have identified a link between one of the HIF proteins that help cells adapt to low oxygen levels (hypoxia) and iron absorption in the small intestine, which they found was hypoxic. Using transgenic mice, they showed that HIF-2-alpha (but not HIF-1-alpha) helped maintain iron levels in the intestine by regulating expression of the primary iron transporter gene. Furthermore, mice lacking HIF-2-alpha displayed low levels of iron in the blood and liver. The authors therefore conclude that strategies targeting HIF-2-alpha may be useful in treating patients with iron disorders.
TITLE: HIF-2-alpha, but not HIF-1-alpha, promotes iron absorption in mice
AUTHOR CONTACT:
Carole Peyssonnaux
Universit?© Paris Descartes, CNRS (UMR 8104), Paris, France.
View the PDF of this article at: https://www.the-jci/article.php?id=38499
NEPHROLOGY: Fragmenting mitochondria underlie acute kidney failure
Damage to kidney cells known as renal tubular cells is a major cause of acute kidney failure, which is increasing in prevalence. In particular, damage to the energy generating compartments of the cell, which are known as mitochondria, is central to renal tubular cell death. Zheng Dong and colleagues, at the Medical College of Georgia, Augusta, have now provided new insight into the mitochondrial changes that occur in acute rodent kidney injury, information that they hope might provide new avenues of research for those developing drugs to combat this condition.
In the study, analysis of rat renal tubular cells in vitro following exposure to conditions that induce acute kidney injury in vivo, revealed that mitochondria fragmented before the cells died. Furthermore, both knocking down expression of the protein Drp1, which is known to be involved in mitochondrial fission, and blocking its function substantially reduced mitochondrial fragmentation and apoptotic cell death. Consistent with these data, mitochondrial fragmentation was observed in two mouse models of acute kidney injury and treatment with a newly identified pharmacological inhibitor of Drp1 reduced renal tubular cell apoptosis and acute kidney injury.
TITLE: Regulation of mitochondrial dynamics in acute kidney injury in cell culture and rodent models
AUTHOR CONTACT:
Zheng Dong
Medical College of Georgia, Augusta, Georgia, USA.
View the PDF of this article at: https://www.the-jci/article.php?id=37829
Source:
Karen Honey
Journal of Clinical Investigation
One subset of immune cells known to contribute to the immune response that targets tumors is the NK cell subset. Although this suggests that NK cell-based therapeutics have anticancer potential, more information is needed about the interactions between NK cells and human tumor cells if this promise is to be realized. A team of researchers, at The Babraham Institute, United Kingdom, and the University of Catanzaro "Magna Graecia", Italy, has now provided insight into this issue by studying both human metastatic melanomas (aggressive forms of skin cancer that have spread to other sites) and spontaneous mouse melanomas.
The team, led by Francesco Colucci and Ennio Carbone, found that human melanoma cell lines derived from lymph node metastases expressed proteins that interacted with the NK cell protein DNAM-1 and with a group of NK cell proteins known as NCRs. These cell lines were particularly susceptible to being killed by NK cells both in vitro and after being transplanted into mice. Consistent with these data from human cell lines, mouse spontaneous melanomas and melanoma cell lines both expressed proteins that bound DNAM-1 and NCRs. Further, interfering with the interaction of DNAM-1 and NCRs with proteins on melanoma cells reduced NK cell-mediated killing of human and mouse melanoma cells lines in vitro and in vivo. The authors therefore conclude that DNAM-1 and NCRs are critical for NK cell-mediated killing of melanoma cells and suggest that NK cells could be harnessed to prevent melanoma metastasis.
TITLE: NCRs and DNAM-1 mediate NK cell recognition and lysis of human and mouse melanoma cell lines in vitro and in vivo
AUTHOR CONTACT:
Francesco Colucci
The Babraham Institute, Cambridge, United Kingdom.
Ennio Carbone
University of Catanzaro "Magna Graecia", Catanzaro, Italy.
View the PDF of this article at: https://www.the-jci/article.php?id=36022
GASTROENTEROLOGY: The protein Cd1d controls intestinal colonization with bacteria
The intestines of all mammals, including humans, are home to a large number of species of bacteria. The identity of these bacteria affects both the normal functioning of the intestines and the occurrence of immune-mediated intestinal diseases, such as inflammatory bowel disease. Despite the importance of these bacteria, little is known about the host factors that control their colonization of the intestines. However, Edward Nieuwenhuis and colleagues, at Erasmus Medical Center, The Netherlands, have now identified a role for the protein Cd1d in regulating intestinal colonization by bacteria in mice.
In the study, when analyzed under specific pathogen-free or germ-free conditions and compared with Cd1d-sufficient mice, Cd1d-deficient mice exhibited increased colonization of the small intestine following administration of a number of species of bacteria (Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus, or Lactobacillus gasseri) into their stomachs. By contrast, activation of immune cells that bind Cd1d prevented intestinal colonization of specific pathogen-free Cd1d-sufficient mice with P. aeruginosa and E. coli. Further analysis revealed a role for Paneth cells, which are found only in the small intestine, in the process. The authors therefore conclude that Cd1d controls colonization of the intestines with bacteria via a mechanism that involves Paneth cells and suggest that manipulating Cd1d might provide a way to modulate the identity of the bacteria in the intestines.
TITLE: Cd1d-dependent regulation of bacterial colonization in the intestine of mice
AUTHOR CONTACT:
Edward E.S. Nieuwenhuis
Erasmus Medical Center, Rotterdam, The Netherlands.
View the PDF of this article at: https://www.the-jci/article.php?id=36509
PHYSIOLOGY: A link between low oxygen levels and intestinal iron absorption
The only way for iron, which is an essential nutrient, to be taken up by the body is for it to be absorbed by the intestine. Low iron levels can lead to anemia, which is characterized by weakness and fatigue and, in severe cases, heart failure. In a new study, Carole Peyssonnaux and her colleagues at Universit?© Paris Descartes, France, have identified a link between one of the HIF proteins that help cells adapt to low oxygen levels (hypoxia) and iron absorption in the small intestine, which they found was hypoxic. Using transgenic mice, they showed that HIF-2-alpha (but not HIF-1-alpha) helped maintain iron levels in the intestine by regulating expression of the primary iron transporter gene. Furthermore, mice lacking HIF-2-alpha displayed low levels of iron in the blood and liver. The authors therefore conclude that strategies targeting HIF-2-alpha may be useful in treating patients with iron disorders.
TITLE: HIF-2-alpha, but not HIF-1-alpha, promotes iron absorption in mice
AUTHOR CONTACT:
Carole Peyssonnaux
Universit?© Paris Descartes, CNRS (UMR 8104), Paris, France.
View the PDF of this article at: https://www.the-jci/article.php?id=38499
NEPHROLOGY: Fragmenting mitochondria underlie acute kidney failure
Damage to kidney cells known as renal tubular cells is a major cause of acute kidney failure, which is increasing in prevalence. In particular, damage to the energy generating compartments of the cell, which are known as mitochondria, is central to renal tubular cell death. Zheng Dong and colleagues, at the Medical College of Georgia, Augusta, have now provided new insight into the mitochondrial changes that occur in acute rodent kidney injury, information that they hope might provide new avenues of research for those developing drugs to combat this condition.
In the study, analysis of rat renal tubular cells in vitro following exposure to conditions that induce acute kidney injury in vivo, revealed that mitochondria fragmented before the cells died. Furthermore, both knocking down expression of the protein Drp1, which is known to be involved in mitochondrial fission, and blocking its function substantially reduced mitochondrial fragmentation and apoptotic cell death. Consistent with these data, mitochondrial fragmentation was observed in two mouse models of acute kidney injury and treatment with a newly identified pharmacological inhibitor of Drp1 reduced renal tubular cell apoptosis and acute kidney injury.
TITLE: Regulation of mitochondrial dynamics in acute kidney injury in cell culture and rodent models
AUTHOR CONTACT:
Zheng Dong
Medical College of Georgia, Augusta, Georgia, USA.
View the PDF of this article at: https://www.the-jci/article.php?id=37829
Source:
Karen Honey
Journal of Clinical Investigation
A Spoonful Of Sugar Makes The Medicine Go To Work
There will soon be no more bitter pills to swallow, thanks to new research by Leeds scientists: a spoonful of sugar will be all we need for our bodies to make their own medicine.
Professor Simon Carding of Leeds' Faculty of Biological Sciences has adapted bacteria in our own bodies to produce a treatment for Inflammatory Bowel Disease (IBD). Bacteria and viruses have been used before to deliver drugs in this way, but Professor Carding has solved the major problem with this kind of treatment: he uses a sugar to 'switch' the bacteria on and off. By eating the sugar, a patient will set the medicine to work and then can end the treatment simply by stopping consumption of the sugar.
"Current bacteria and virus delivery systems produce their drugs non-stop, but for many treatments there is a narrow concentration range at which drugs are beneficial," said Professor Carding. "Outside of this, the treatment can be counterproductive and make the condition worse. It's vitally important to be able to control when and how much of the drug is administered and we believe our discovery will provide that control."
Professor Carding has modified one of the trillions of bacteria in the human gut so that it will produce human growth factors which help repair the layer of cells lining the colon, so reducing inflammation caused by IBD. But he's also adapted the bacteria so it only activates in the presence of a plant sugar called xylan that is found in tree bark. Xylan is naturally present in food in low concentrations, so by taking it in higher quantities, a patient will be able to produce their own medicine as and when they need it.
"The human gut has a huge number of bacteria, and this treatment simply adapts what's there naturally to treat the disease," said Professor Carding. "We're already looking at using the same technique for colorectal cancer, as we believe we could modify the bacteria to produce factors that will reduce tumour growth. Treatment of diseases elsewhere in the body might also be possible as most things present in the gut can get taken into the blood stream."
The discovery has been patented and is being developed further with support from the University's technology transfer partner, Techtran Group Ltd part of the IP Group plc and the Medical Research Council. The technique has been shown to work in vitro, but the researchers will be testing the treatment over the next twelve months in preparation for clinical trials.
LEEDS UNIVERSITY
Leeds
LS2 9JT
leeds.ac
Professor Simon Carding of Leeds' Faculty of Biological Sciences has adapted bacteria in our own bodies to produce a treatment for Inflammatory Bowel Disease (IBD). Bacteria and viruses have been used before to deliver drugs in this way, but Professor Carding has solved the major problem with this kind of treatment: he uses a sugar to 'switch' the bacteria on and off. By eating the sugar, a patient will set the medicine to work and then can end the treatment simply by stopping consumption of the sugar.
"Current bacteria and virus delivery systems produce their drugs non-stop, but for many treatments there is a narrow concentration range at which drugs are beneficial," said Professor Carding. "Outside of this, the treatment can be counterproductive and make the condition worse. It's vitally important to be able to control when and how much of the drug is administered and we believe our discovery will provide that control."
Professor Carding has modified one of the trillions of bacteria in the human gut so that it will produce human growth factors which help repair the layer of cells lining the colon, so reducing inflammation caused by IBD. But he's also adapted the bacteria so it only activates in the presence of a plant sugar called xylan that is found in tree bark. Xylan is naturally present in food in low concentrations, so by taking it in higher quantities, a patient will be able to produce their own medicine as and when they need it.
"The human gut has a huge number of bacteria, and this treatment simply adapts what's there naturally to treat the disease," said Professor Carding. "We're already looking at using the same technique for colorectal cancer, as we believe we could modify the bacteria to produce factors that will reduce tumour growth. Treatment of diseases elsewhere in the body might also be possible as most things present in the gut can get taken into the blood stream."
The discovery has been patented and is being developed further with support from the University's technology transfer partner, Techtran Group Ltd part of the IP Group plc and the Medical Research Council. The technique has been shown to work in vitro, but the researchers will be testing the treatment over the next twelve months in preparation for clinical trials.
LEEDS UNIVERSITY
Leeds
LS2 9JT
leeds.ac
Bowel Cancer Indicator Should Lead To Better Treatment
STEM cell scientists have developed a more accurate way of identifying aggressive forms of bowel cancer, which should eventually lead to better treatment and survival rates.
The UK-led team, headed by scientists from Durham University and the North East England Stem Cell Institute, (NESCI*), studied tissue samples from 700 colorectal cancer patients and tracked their progress.
They found that patients who had a stem cell marker protein called Lamin A present in their tissue were more likely to have an aggressive form of the disease.
The team concluded that if the marker is detected in the early forms of colorectal cancer, these patients should be given chemotherapy in addition to the surgery normally offered to ensure a better survival predicament.
The team now aims to develop a robust prognostic tool for use in the health service.
The study, funded by the Association for International Cancer Research and NHS Research and Development funds, is published in the open-access scientific journal PLoS ONE.
The Durham University/NESCI scientists worked with colleagues from The James Cook University Hospital, Middlesbrough, and the Departments of Pathology and Epidemiology at the University of Maastricht in the Netherlands.
Bowel cancer is the third most common cancer in the UK, where each year more than 36,000 people are diagnosed with the disease. Worldwide over a million new cases of bowel cancer were diagnosed in 2002.
Almost three-quarters of bowel cancer cases occur in people aged 65 and over. The development of disease is linked with diet, lifestyle and environmental factors. (Source of statistics: Cancer Research UK fact sheet).
In colorectal cancer, there are four key stages of the disease. The stage of a patient's cancer is determined by a series of hospital tests, the results of which inform the treatment they are given.
In the two earlier stages, before the cancer involves the lymph nodes, patients normally have an operation to remove the cancer from the bowel. They are rarely given chemotherapy in addition to the surgery. This is because for many patients, who are often elderly and frail, chemotherapy may cause more harm than benefit. It's therefore critical to know when and in whom it should be used.
However, the new study suggests that around one third of these patients will express the Lamin A stem cell marker, which indicates a more serious form of the cancer. These patients, argue the scientists, should be given chemotherapy to target these stem cells, which should ultimately improve their recovery and survival rates.
Professor Chris Hutchison, of Durham University and NESCI, said: "Currently the hospitals use a standard test to work out how far the cancer has progressed and then they use this to determine the treatment the patient should receive. However, we are potentially able to more accurately predict who would benefit from chemotherapy."
Dr Stefan Przyborski, of Durham University and NESCI, said: "We now aim to carry out more work in this area to develop a prognostic tool which we hope will eventually be for widespread use by the health services in the treatment of bowel cancer."
Professor Robert Wilson, a consultant surgeon and bowel cancer specialist at The James Cook University Hospital, Middlesbrough, said: "We have a very high number of patients with bowel cancer in the north east of England in particular. We know the best treatment for very early and very late disease but there are still a lot of unknowns in-between these two extremes.
"Chemotherapy can be very useful but can have a number of side effects, so we only want to use it where we think there's a good chance it will help. This test will help us determine that."
* 'The North-east England Stem Cell Institute (NESCI) draws together Durham and Newcastle Universities, the Newcastle-upon-Tyne Hospitals NHS Foundation Trust and other partners in a unique interdisciplinary collaboration to convert stem cell research and technologies into cost-effective, ethically-robust 21st century health solutions to ameliorate degenerative diseases, the effects of ageing and serious injury. The Institute has received substantial funding and other support from the Regional Development Agency, One NorthEast and is partly based at the International Centre for Life in Newcastle.' nesci.ac
Lamin A/C Is a Risk Biomarker in Colorectal Cancer.
Willis ND, Cox TR, Rahman-Casa?±s SF, Smits K, Przyborski SA, et al. (2008)
PLoS ONE 3(8): e2988. doi:10.1371/journal.pone.0002988
Please click here to view article online
Public Library of Science
185 Berry Street, Suite 3100
San Francisco, CA 94107
USA
The UK-led team, headed by scientists from Durham University and the North East England Stem Cell Institute, (NESCI*), studied tissue samples from 700 colorectal cancer patients and tracked their progress.
They found that patients who had a stem cell marker protein called Lamin A present in their tissue were more likely to have an aggressive form of the disease.
The team concluded that if the marker is detected in the early forms of colorectal cancer, these patients should be given chemotherapy in addition to the surgery normally offered to ensure a better survival predicament.
The team now aims to develop a robust prognostic tool for use in the health service.
The study, funded by the Association for International Cancer Research and NHS Research and Development funds, is published in the open-access scientific journal PLoS ONE.
The Durham University/NESCI scientists worked with colleagues from The James Cook University Hospital, Middlesbrough, and the Departments of Pathology and Epidemiology at the University of Maastricht in the Netherlands.
Bowel cancer is the third most common cancer in the UK, where each year more than 36,000 people are diagnosed with the disease. Worldwide over a million new cases of bowel cancer were diagnosed in 2002.
Almost three-quarters of bowel cancer cases occur in people aged 65 and over. The development of disease is linked with diet, lifestyle and environmental factors. (Source of statistics: Cancer Research UK fact sheet).
In colorectal cancer, there are four key stages of the disease. The stage of a patient's cancer is determined by a series of hospital tests, the results of which inform the treatment they are given.
In the two earlier stages, before the cancer involves the lymph nodes, patients normally have an operation to remove the cancer from the bowel. They are rarely given chemotherapy in addition to the surgery. This is because for many patients, who are often elderly and frail, chemotherapy may cause more harm than benefit. It's therefore critical to know when and in whom it should be used.
However, the new study suggests that around one third of these patients will express the Lamin A stem cell marker, which indicates a more serious form of the cancer. These patients, argue the scientists, should be given chemotherapy to target these stem cells, which should ultimately improve their recovery and survival rates.
Professor Chris Hutchison, of Durham University and NESCI, said: "Currently the hospitals use a standard test to work out how far the cancer has progressed and then they use this to determine the treatment the patient should receive. However, we are potentially able to more accurately predict who would benefit from chemotherapy."
Dr Stefan Przyborski, of Durham University and NESCI, said: "We now aim to carry out more work in this area to develop a prognostic tool which we hope will eventually be for widespread use by the health services in the treatment of bowel cancer."
Professor Robert Wilson, a consultant surgeon and bowel cancer specialist at The James Cook University Hospital, Middlesbrough, said: "We have a very high number of patients with bowel cancer in the north east of England in particular. We know the best treatment for very early and very late disease but there are still a lot of unknowns in-between these two extremes.
"Chemotherapy can be very useful but can have a number of side effects, so we only want to use it where we think there's a good chance it will help. This test will help us determine that."
* 'The North-east England Stem Cell Institute (NESCI) draws together Durham and Newcastle Universities, the Newcastle-upon-Tyne Hospitals NHS Foundation Trust and other partners in a unique interdisciplinary collaboration to convert stem cell research and technologies into cost-effective, ethically-robust 21st century health solutions to ameliorate degenerative diseases, the effects of ageing and serious injury. The Institute has received substantial funding and other support from the Regional Development Agency, One NorthEast and is partly based at the International Centre for Life in Newcastle.' nesci.ac
Lamin A/C Is a Risk Biomarker in Colorectal Cancer.
Willis ND, Cox TR, Rahman-Casa?±s SF, Smits K, Przyborski SA, et al. (2008)
PLoS ONE 3(8): e2988. doi:10.1371/journal.pone.0002988
Please click here to view article online
Public Library of Science
185 Berry Street, Suite 3100
San Francisco, CA 94107
USA
Suffering From The Symptoms Of Irritable Bowel Syndrome? Medical Experts Say Get Tested For Celiac Disease, Now Easier To Diagnose
Estimates indicate that up to 20 percent of North Americans, possibly as high as 30 per cent in some countries, cope with the painful and debilitating symptoms of irritable bowel syndrome (IBS). According to the American College of Gastroenterology, all patients with symptoms of IBS should be tested for celiac disease, a lifelong hereditary disorder which has some of the same symptoms.
Celiac disease can make IBS symptoms worse. In some cases, it might even be the cause.
There is no cure for IBS. Instead the focus is on a wide variety of treatments to relieve the symptoms, and one of the treatments is a high fibre diet, which includes whole grains and certain cereals. But the only treatment for celiac disease is a gluten free diet for life. Gluten is a protein found in wheat, rye and barley. Because of its sticky characteristics, it can also be found in certain other food products and even in some medications.
At-home Test Kit Now Available
Now there's a simple, accurate way to find out if you're susceptible to celiac disease. For the first time in Canada, Health Canada has approved the Biocard™ Celiac Test Kit, an at-home test that measures gluten antibodies from a fingertip blood sample. The test gives you a high degree of certainty that you are either developing the disease or already have it, but you still need to see your doctor for a confirmation.
What is celiac disease?
Celiac disease occurs when gluten triggers an abnormal response that damages the lining of the small intestine, interfering with your absorption of nutrients. The disease is hereditary and lifelong, and affects people differently. But many of the symptoms of celiac disease are the same for IBS such as diarrhea, bloating and abdominal pain.
Left untreated, celiac disease increases the risk of malnutrition, osteoporosis (because of poor absorption of calcium and vitamin D), infertility, certain digestive cancers and other conditions such as Type 1 diabetes and thyroid disease. Research indicates that in North America, one person out of every 100 has celiac disease, and almost 97 per cent of those affected remain undiagnosed.
Celiac disease affects people differently and not all symptoms are obvious.
Classic celiac symptoms include diarrhea, stomach pain, weight loss and, in children, delayed growth. For others, the symptoms are subtler, such as such as bloating, or excess gas. Fatigue, weakness, joint pain and migraines -- symptoms typically not associated with the gut -- are also reported. Not surprisingly, the diagnosis is often irritable bowel syndrome, anemia, stress or chronic fatigue syndrome.
Average time for correct diagnosis of celiac disease - 12 years: According to a 2007 survey of the Canadian Celiac Association's more than 5000 members, the average time it took to be diagnosed was 12 years. Many reported consulting with three or more doctors before their diagnosis was confirmed.
The Process for Diagnosing Celiac Disease
With the Biocard™ Celiac Test Kit, a person can find out within 10 minutes if they have the antibodies associated with celiac disease. While the test even indicates if the disease is in its early stages, confirming the diagnosis requires a small bowel biopsy in which an endoscope is passed through the mouth into the stomach's upper intestine so that the lining can be examined and a biopsy taken.
The day your diagnosis is confirmed and you start your gluten-free diet, is the day you're on the road to recovery. It could also mark the beginning of your relief from the painful and distressing symptoms common to IBS. Celiac patients on the gluten-free diet with persisting bowel symptoms should seek medical help for other gut-related disorders such as colitis and Crohn's disease.
Information on celiac disease, the Biocard™ Celiac Test Kit, and links to key informational sites can be found at celiachometest. The kit can be purchased online, or at London Drugs, Rexall Pharma Plus, Price Smart, Save on Foods and other major Canadian retail chains.
About 2G Pharma Inc.
Founded by Karina Nelimarkka and Janet Monk, 2G Pharma markets the unique, patient-friendly celiac disease test kit first developed by AniBiotech in Finland. This kit has been redesigned for the Canadian market and is currently the only Health Canada approved point-of-care celiac disease test kit available. Information on celiac disease, the Biocard™ Celiac Test and links to key informational sites can be found at celiachometest.
2G Pharma Inc.
Celiac disease can make IBS symptoms worse. In some cases, it might even be the cause.
There is no cure for IBS. Instead the focus is on a wide variety of treatments to relieve the symptoms, and one of the treatments is a high fibre diet, which includes whole grains and certain cereals. But the only treatment for celiac disease is a gluten free diet for life. Gluten is a protein found in wheat, rye and barley. Because of its sticky characteristics, it can also be found in certain other food products and even in some medications.
At-home Test Kit Now Available
Now there's a simple, accurate way to find out if you're susceptible to celiac disease. For the first time in Canada, Health Canada has approved the Biocard™ Celiac Test Kit, an at-home test that measures gluten antibodies from a fingertip blood sample. The test gives you a high degree of certainty that you are either developing the disease or already have it, but you still need to see your doctor for a confirmation.
What is celiac disease?
Celiac disease occurs when gluten triggers an abnormal response that damages the lining of the small intestine, interfering with your absorption of nutrients. The disease is hereditary and lifelong, and affects people differently. But many of the symptoms of celiac disease are the same for IBS such as diarrhea, bloating and abdominal pain.
Left untreated, celiac disease increases the risk of malnutrition, osteoporosis (because of poor absorption of calcium and vitamin D), infertility, certain digestive cancers and other conditions such as Type 1 diabetes and thyroid disease. Research indicates that in North America, one person out of every 100 has celiac disease, and almost 97 per cent of those affected remain undiagnosed.
Celiac disease affects people differently and not all symptoms are obvious.
Classic celiac symptoms include diarrhea, stomach pain, weight loss and, in children, delayed growth. For others, the symptoms are subtler, such as such as bloating, or excess gas. Fatigue, weakness, joint pain and migraines -- symptoms typically not associated with the gut -- are also reported. Not surprisingly, the diagnosis is often irritable bowel syndrome, anemia, stress or chronic fatigue syndrome.
Average time for correct diagnosis of celiac disease - 12 years: According to a 2007 survey of the Canadian Celiac Association's more than 5000 members, the average time it took to be diagnosed was 12 years. Many reported consulting with three or more doctors before their diagnosis was confirmed.
The Process for Diagnosing Celiac Disease
With the Biocard™ Celiac Test Kit, a person can find out within 10 minutes if they have the antibodies associated with celiac disease. While the test even indicates if the disease is in its early stages, confirming the diagnosis requires a small bowel biopsy in which an endoscope is passed through the mouth into the stomach's upper intestine so that the lining can be examined and a biopsy taken.
The day your diagnosis is confirmed and you start your gluten-free diet, is the day you're on the road to recovery. It could also mark the beginning of your relief from the painful and distressing symptoms common to IBS. Celiac patients on the gluten-free diet with persisting bowel symptoms should seek medical help for other gut-related disorders such as colitis and Crohn's disease.
Information on celiac disease, the Biocard™ Celiac Test Kit, and links to key informational sites can be found at celiachometest. The kit can be purchased online, or at London Drugs, Rexall Pharma Plus, Price Smart, Save on Foods and other major Canadian retail chains.
About 2G Pharma Inc.
Founded by Karina Nelimarkka and Janet Monk, 2G Pharma markets the unique, patient-friendly celiac disease test kit first developed by AniBiotech in Finland. This kit has been redesigned for the Canadian market and is currently the only Health Canada approved point-of-care celiac disease test kit available. Information on celiac disease, the Biocard™ Celiac Test and links to key informational sites can be found at celiachometest.
2G Pharma Inc.
Will Chemotherapy Work? Einstein Researchers Develop Test That May Offer Answer For Colorectal Patients
By measuring the activity of four genes in cancer cells, scientists at the
Albert Einstein College of Medicine of Yeshiva University accurately predicted whether colorectal tumors
are sensitive or resistant to 5-Fluorouracil (5-FU), an important chemotherapy drug. The diagnostic
advance, described in the July 1 issue of Cancer Research, could help doctors make the crucial decision as
to whether a colorectal cancer patient should receive 5-FU or instead be treated surgically or with other
chemotherapy agents.
Several years ago, Dr. Robert Singer and colleagues at Einstein developed a novel microscopy
technique known as fluorescence in situ hybridization (FISH) that allows researchers to see whether a gene
of interest in a single cell is activated (transcribed). In this study, Dr. Singer wanted to see whether FISH
could help in treating patients with colorectal cancer, the second-leading cause of cancer death among men
and women in the U.S.
"Since genes play such a significant role in causing cancer, you'd assume that you might find a
different transcriptional profile in cancers that are sensitive to chemotherapy from those that are resistant,"
says Dr. Singer, professor and co-chair of anatomy and structural biology at Einstein. "The drug 5-
Fluorouracil is a mainstay of chemotherapy for colorectal cancer, but only 30 percent of patients respond to
it-and there's no way to know in advance which patients will benefit and which won't. We showed in this study that applying our FISH technique to colorectal tumors could accurately predict the patients' responses to 5-FU chemotherapy."
The researchers started with 12 "candidate genes" that earlier were found to correlate with response
to 5-FU. They then tested each gene in four different colorectal cancer cell lines (two extremely sensitive to
5-FU and two extremely resistant), using the FISH technique to look for active transcription sites in
individual cells. Various combinations of these genes were then examined in search of a gene expression
pattern that was associated with either resistance or sensitivity to 5-FU. The researchers found a pattern of
four genes that correctly classified each of the four cell lines as either sensitive or resistant to 5-FU.
To see whether their four-gene "signature" would work under clinical conditions, the researchers
obtained biopsy specimens from seven patients who had undergone treatment for colorectal cancer at the
Kimmel Cancer Center in Philadelphia. Then, to predict 5-FU sensitivity or resistance, they measured the
activity of the four genes in several hundred cells from each specimen. (The treatment results for all patients
were known, but the Einstein researchers were "blinded" to the outcomes until later.) For all seven patients,
the gene-expression pattern correctly predicted whether their tumors were sensitive or resistant to 5-FU
chemotherapy.
"Taking a chemotherapy drug that won't help you means not only risking serious side effects but
losing valuable time that would better be spent on a different and more effective treatment option," says Dr.
Singer. "We hope that this four-gene test may ultimately help steer colorectal cancer patients to a treatment
strategy with the best chance for a successful outcome." The next step, he says, is a clinical trial in which
the four-gene pattern will be tested on a larger number of patients.
Other Einstein researchers involved in the study were lead author Rossanna C. Pezo, Saumil J.
Gandhi and Leonard H. Augenlicht. Collaborators also included L. Andrew Shirley and Richard G. Pestell
of Thomas Jefferson University in Philadelphia.
Albert Eisntein College of Medicine
Albert Einstein College of Medicine of Yeshiva University accurately predicted whether colorectal tumors
are sensitive or resistant to 5-Fluorouracil (5-FU), an important chemotherapy drug. The diagnostic
advance, described in the July 1 issue of Cancer Research, could help doctors make the crucial decision as
to whether a colorectal cancer patient should receive 5-FU or instead be treated surgically or with other
chemotherapy agents.
Several years ago, Dr. Robert Singer and colleagues at Einstein developed a novel microscopy
technique known as fluorescence in situ hybridization (FISH) that allows researchers to see whether a gene
of interest in a single cell is activated (transcribed). In this study, Dr. Singer wanted to see whether FISH
could help in treating patients with colorectal cancer, the second-leading cause of cancer death among men
and women in the U.S.
"Since genes play such a significant role in causing cancer, you'd assume that you might find a
different transcriptional profile in cancers that are sensitive to chemotherapy from those that are resistant,"
says Dr. Singer, professor and co-chair of anatomy and structural biology at Einstein. "The drug 5-
Fluorouracil is a mainstay of chemotherapy for colorectal cancer, but only 30 percent of patients respond to
it-and there's no way to know in advance which patients will benefit and which won't. We showed in this study that applying our FISH technique to colorectal tumors could accurately predict the patients' responses to 5-FU chemotherapy."
The researchers started with 12 "candidate genes" that earlier were found to correlate with response
to 5-FU. They then tested each gene in four different colorectal cancer cell lines (two extremely sensitive to
5-FU and two extremely resistant), using the FISH technique to look for active transcription sites in
individual cells. Various combinations of these genes were then examined in search of a gene expression
pattern that was associated with either resistance or sensitivity to 5-FU. The researchers found a pattern of
four genes that correctly classified each of the four cell lines as either sensitive or resistant to 5-FU.
To see whether their four-gene "signature" would work under clinical conditions, the researchers
obtained biopsy specimens from seven patients who had undergone treatment for colorectal cancer at the
Kimmel Cancer Center in Philadelphia. Then, to predict 5-FU sensitivity or resistance, they measured the
activity of the four genes in several hundred cells from each specimen. (The treatment results for all patients
were known, but the Einstein researchers were "blinded" to the outcomes until later.) For all seven patients,
the gene-expression pattern correctly predicted whether their tumors were sensitive or resistant to 5-FU
chemotherapy.
"Taking a chemotherapy drug that won't help you means not only risking serious side effects but
losing valuable time that would better be spent on a different and more effective treatment option," says Dr.
Singer. "We hope that this four-gene test may ultimately help steer colorectal cancer patients to a treatment
strategy with the best chance for a successful outcome." The next step, he says, is a clinical trial in which
the four-gene pattern will be tested on a larger number of patients.
Other Einstein researchers involved in the study were lead author Rossanna C. Pezo, Saumil J.
Gandhi and Leonard H. Augenlicht. Collaborators also included L. Andrew Shirley and Richard G. Pestell
of Thomas Jefferson University in Philadelphia.
Albert Eisntein College of Medicine
Dr. Delbert L. Chumley Elected President Of The American College Of Gastroenterology
Delbert L. Chumley, M.D., FACG, was elected by the membership as the 2010-2011 president of the American College of Gastroenterology (ACG), a national specialty association representing more than 12,000 clinical gastroenterologists and other specialists in digestive diseases. Dr. Chumley officially took his position as president during the College's 75th Annual Scientific Meeting, held this week in San Antonio, which coincidentally is Dr. Chumley's hometown. In this position, Dr. Chumley will direct ACG's programs which include continuing medical education in the clinical, scientific and patient-related skills of gastroenterology, policies involving national and state medical affairs, managed care issues and clinical investigation.
Dr. Chumley is a private practice gastroenterologist who says, "My approach and philosophy to clinical practice is simple: always serve the patient's needs first - and everything else will fall in place." For Dr. Chumley, the art of medicine means that physicians have a primary responsibility to listen to their patients and gain their trust. He considers it a privilege to perform a physical examination on the patient and recommend appropriate diagnostic or treatment options.
"As I witness the effect of computerization, diminishing reimbursement, increasing hassle factors, and implementation of physician extenders, I am deeply concerned that the patient could merely become an 'icon' and that the profession of medicine risks being slowly dismantled," Dr. Chumley said. "Regardless of the pressures of private practice, I try every day to ensure that my patients receive my undivided attention and that they leave my office satisfied and feeling that I listened to and addressed their needs."
Currently, Dr. Chumley is in private gastroenterology practice with Gastroenterology Consultants of San Antonio. Dr. Chumley has served Clinical Professor of Medicine, University of Texas Health Science Center at San Antonio since 1996. Dr. Chumley received his medical degree from the University of Texas Medical Branch in Galveston where he also served his residency and chief residency in internal medicine, followed by a fellowship in gastroenterology. He is board certified in internal medicine and gastroenterology.
Dr. Chumley has served the College with loyalty and distinction for many years: first as Governor from South Texas (1992-1996); then as Trustee (1997-2003, and (2004-2006). He has moved through ACG's leadership ranks, first as Secretary (2006-2007), Treasurer (2007-2008), Vice President (2008-2009), and President-Elect (2009-2010). His active serviceto ACG committees includes: Educational Affairs (1992-1996); Credentials (1994-2001); and Membership (1994-2001, Chair 1999-2001). On behalf of ACG, Dr. Chumley was Co-Chair of the National GI Carrier Advisory Committee (2001-2004). This group oversees and has input into federal Medicare payment issues.
Dr. Chumley is also active in Texas medical organizations, including the Texas Medical Association. He as served as Treasurer of the Texas Society for Gastroenterology and Endoscopy (TSGE) from 1987 to 2004, and President from 2007 to 2009. TSGE is one of the largest and most active state medical societies in gastroenterology. Dr. Chumley directed TSGE postgraduate courses in conjunction with the ACG in 1993, 1994 and 1995. From 2007 to 2008 he served as President of Bexar County Medical Society, the seventh largest county medical association in the nation.
"In light of our changing economic and political environment, among the College's top priorities must be to carefully monitor new health care regulations as they are enacted and to communicate their potential impact to private practitioners. A personal goal in assuming the role of ACG President is to continue to oversee and evaluate the College's investment and revenue policies in order to ensure ACG's financial stability and future growth," Dr. Chumley commented.
Dr. Chumley and his wife, Louise, reside in San Antonio and have three children.
Source:
American College of Gastroenterology (ACG)
Dr. Chumley is a private practice gastroenterologist who says, "My approach and philosophy to clinical practice is simple: always serve the patient's needs first - and everything else will fall in place." For Dr. Chumley, the art of medicine means that physicians have a primary responsibility to listen to their patients and gain their trust. He considers it a privilege to perform a physical examination on the patient and recommend appropriate diagnostic or treatment options.
"As I witness the effect of computerization, diminishing reimbursement, increasing hassle factors, and implementation of physician extenders, I am deeply concerned that the patient could merely become an 'icon' and that the profession of medicine risks being slowly dismantled," Dr. Chumley said. "Regardless of the pressures of private practice, I try every day to ensure that my patients receive my undivided attention and that they leave my office satisfied and feeling that I listened to and addressed their needs."
Currently, Dr. Chumley is in private gastroenterology practice with Gastroenterology Consultants of San Antonio. Dr. Chumley has served Clinical Professor of Medicine, University of Texas Health Science Center at San Antonio since 1996. Dr. Chumley received his medical degree from the University of Texas Medical Branch in Galveston where he also served his residency and chief residency in internal medicine, followed by a fellowship in gastroenterology. He is board certified in internal medicine and gastroenterology.
Dr. Chumley has served the College with loyalty and distinction for many years: first as Governor from South Texas (1992-1996); then as Trustee (1997-2003, and (2004-2006). He has moved through ACG's leadership ranks, first as Secretary (2006-2007), Treasurer (2007-2008), Vice President (2008-2009), and President-Elect (2009-2010). His active serviceto ACG committees includes: Educational Affairs (1992-1996); Credentials (1994-2001); and Membership (1994-2001, Chair 1999-2001). On behalf of ACG, Dr. Chumley was Co-Chair of the National GI Carrier Advisory Committee (2001-2004). This group oversees and has input into federal Medicare payment issues.
Dr. Chumley is also active in Texas medical organizations, including the Texas Medical Association. He as served as Treasurer of the Texas Society for Gastroenterology and Endoscopy (TSGE) from 1987 to 2004, and President from 2007 to 2009. TSGE is one of the largest and most active state medical societies in gastroenterology. Dr. Chumley directed TSGE postgraduate courses in conjunction with the ACG in 1993, 1994 and 1995. From 2007 to 2008 he served as President of Bexar County Medical Society, the seventh largest county medical association in the nation.
"In light of our changing economic and political environment, among the College's top priorities must be to carefully monitor new health care regulations as they are enacted and to communicate their potential impact to private practitioners. A personal goal in assuming the role of ACG President is to continue to oversee and evaluate the College's investment and revenue policies in order to ensure ACG's financial stability and future growth," Dr. Chumley commented.
Dr. Chumley and his wife, Louise, reside in San Antonio and have three children.
Source:
American College of Gastroenterology (ACG)
Potential New Treatment For Ulcerative Colitis Following Discovery
McMaster University researchers have identified a specific chemical that may trigger remission in patients with the debilitating disease of ulcerative colitis.
The team from the Farncombe Family Digestive Health Research Institute has found that people in long-term remission of ulcerative colitis have elevated levels of the same chemical, prostaglandin D2, which they previously found to be important in promoting healing and maintaining remission of the condition in laboratory rats.
"The levels of prostaglandin D2 were only elevated in those patients in long-term remission, and that suggests it is a key factor in preventing new episodes of ulcerative colitis," said John Wallace, director of the Institute and a professor of medicine for the Michael G. DeGroote School of Medicine.
Ulcerative colitis impacts 100,000 Canadians and millions worldwide, but has an unknown cause and limited treatment options. Most people are never cured, and often require surgical removal of the colon.
The discovery may lead to a new treatment for inflammatory bowel disease which would promote production of prostaglandin D2, Wallace said. "It is entirely possible our findings could extend to Crohn's disease as well."
The study by Wallace and post doctoral student Linda Vong with colleagues from the University of Calgary is being published in the prestigious journal Proceedings of the National Academy of Sciences (PNAS) on June 14. Funding for the research was provided by the Canadian Institutes for Health Research and the Crohn's and Colitis Foundation of Canada.
Source:
Veronica McGuire
McMaster University
The team from the Farncombe Family Digestive Health Research Institute has found that people in long-term remission of ulcerative colitis have elevated levels of the same chemical, prostaglandin D2, which they previously found to be important in promoting healing and maintaining remission of the condition in laboratory rats.
"The levels of prostaglandin D2 were only elevated in those patients in long-term remission, and that suggests it is a key factor in preventing new episodes of ulcerative colitis," said John Wallace, director of the Institute and a professor of medicine for the Michael G. DeGroote School of Medicine.
Ulcerative colitis impacts 100,000 Canadians and millions worldwide, but has an unknown cause and limited treatment options. Most people are never cured, and often require surgical removal of the colon.
The discovery may lead to a new treatment for inflammatory bowel disease which would promote production of prostaglandin D2, Wallace said. "It is entirely possible our findings could extend to Crohn's disease as well."
The study by Wallace and post doctoral student Linda Vong with colleagues from the University of Calgary is being published in the prestigious journal Proceedings of the National Academy of Sciences (PNAS) on June 14. Funding for the research was provided by the Canadian Institutes for Health Research and the Crohn's and Colitis Foundation of Canada.
Source:
Veronica McGuire
McMaster University
Plant Offers Scientists New Insights Into Intestinal Cancer
Dutch scientists have gained important new insights into intestinal cancer from studying a plant. The disease is called Peutz-Jeghers Syndrome, a hereditary disorder where people develop intestinal polyps that turn into malignant tumors. "With experiments on these plants we now have a better understanding of how cancer cells react in the human body," says the principle investigator, Maikel Peppelenbosch.
Peppelenbosch, as professor of Cell Biology at the Erasmus MC in Rotterdam, carried out this research for Top Institute Pharma. "A natural process such as cell division occurs in both plants and humans," Prof. Peppelenbosch explains. "Cancer cells that sense they are getting too much food will rapidly multiply. By imitating this process in plants and studying what happens to the plant cells we have learned a great deal about the development of Peutz-Jeghers Syndrome."
Among other things, the investigators found a protein in the plants that could be a target for a medicine. They expect the same protein (p21Rac) may also be disordered in patients with intestinal cancer. "These insights come from a very unexpected angle," says Peppelenbosch.
According to the professor in Cell Biology, these new insights could also be used for another disease, called Tuberous Sclerosis Complex (TSC). It is a serious, rare disease that causes tumors in children. "By imitating the disease in plants, we hope to design a specific therapy eventually," continues Prof. Peppelenbosch.
Universities in Rotterdam, Leiden, Utrecht and Twente, and the biotech company Pepscan are partners in this Top Institute Pharma project.
Source: Top Institute Pharma
Peppelenbosch, as professor of Cell Biology at the Erasmus MC in Rotterdam, carried out this research for Top Institute Pharma. "A natural process such as cell division occurs in both plants and humans," Prof. Peppelenbosch explains. "Cancer cells that sense they are getting too much food will rapidly multiply. By imitating this process in plants and studying what happens to the plant cells we have learned a great deal about the development of Peutz-Jeghers Syndrome."
Among other things, the investigators found a protein in the plants that could be a target for a medicine. They expect the same protein (p21Rac) may also be disordered in patients with intestinal cancer. "These insights come from a very unexpected angle," says Peppelenbosch.
According to the professor in Cell Biology, these new insights could also be used for another disease, called Tuberous Sclerosis Complex (TSC). It is a serious, rare disease that causes tumors in children. "By imitating the disease in plants, we hope to design a specific therapy eventually," continues Prof. Peppelenbosch.
Universities in Rotterdam, Leiden, Utrecht and Twente, and the biotech company Pepscan are partners in this Top Institute Pharma project.
Source: Top Institute Pharma
Physician First In Virginia To Deliver New Cancer Fighting Technique
The world's smallest flexible microscope is diagnosing some big diseases and allowing physicians to treat patients on the spot. Dr. Michel Kahaleh, associate professor of medicine in the Division of Gastroenterology and Hepatology at the University of Virginia Health System, is the only physician in Virginia currently using probe-based confocal laser endomicroscopy (pCLE). pCLE is a technique that lets him view live tissue in real time at the cellular level. This allows the identification of cancer with pinpoint precision and permits precise removal of the diseased tissue.
"Until now, if we found suspicious tissue during one of these diagnostic procedures, we often had to randomly sample it and send it to the laboratory for analysis, which can take up to a week," says Kahaleh. "With pCLE, we can pinpoint the dangerous tissue during the initial diagnostic procedure and remove or treat it the same day."
Kahaleh and his team are using pCLE to more accurately differentiate cancerous and pre-cancerous tissue during colonoscopies, upper endoscopies, and the standard pancreatic and bile duct cancer detection procedure. They also use pCLE to catch and treat gastrointestinal cancers and other GI diseases, including those of the colon, bile duct, pancreas, and esophagus.
"This new imaging tool gives us the opportunity to immediately see changes up to the cell level and potentially gain insights of what may be wrong, thus optimizing patient treatment," Dr. Kahaleh explains.
Kahaleh also believes that this technique represents the future of medicine a future in which doctors and researchers deliver ways to diagnose and treat diseases all at once. He thinks this will save time and reduce trauma for patients while improving efficiency.
Cellvizio is the technology platform that enables the pCLE technique. It is cleared by the Food & Drug Administration for use in the gastrointestinal tract and lungs, and over 5,000 Cellvizio procedures have been completed worldwide to date.
The University of Virginia Health System is among the nation's leading academic research health systems in the country. It combines high-technology, tertiary care for patients from all over the Commonwealth and beyond. UVA Health System has medical programs ranked by U.S. News and World Report as top 50 programs.
Source: University of Virginia Health System
"Until now, if we found suspicious tissue during one of these diagnostic procedures, we often had to randomly sample it and send it to the laboratory for analysis, which can take up to a week," says Kahaleh. "With pCLE, we can pinpoint the dangerous tissue during the initial diagnostic procedure and remove or treat it the same day."
Kahaleh and his team are using pCLE to more accurately differentiate cancerous and pre-cancerous tissue during colonoscopies, upper endoscopies, and the standard pancreatic and bile duct cancer detection procedure. They also use pCLE to catch and treat gastrointestinal cancers and other GI diseases, including those of the colon, bile duct, pancreas, and esophagus.
"This new imaging tool gives us the opportunity to immediately see changes up to the cell level and potentially gain insights of what may be wrong, thus optimizing patient treatment," Dr. Kahaleh explains.
Kahaleh also believes that this technique represents the future of medicine a future in which doctors and researchers deliver ways to diagnose and treat diseases all at once. He thinks this will save time and reduce trauma for patients while improving efficiency.
Cellvizio is the technology platform that enables the pCLE technique. It is cleared by the Food & Drug Administration for use in the gastrointestinal tract and lungs, and over 5,000 Cellvizio procedures have been completed worldwide to date.
The University of Virginia Health System is among the nation's leading academic research health systems in the country. It combines high-technology, tertiary care for patients from all over the Commonwealth and beyond. UVA Health System has medical programs ranked by U.S. News and World Report as top 50 programs.
Source: University of Virginia Health System
New Information Guides Available For Patients Diagnosed With Inflammatory Bowel Disease
To help those with inflammatory bowel disease (IBD) be better informed and involved in managing their disease, the European Foundation of Crohn's & Ulcerative Colitis Associations (EFCCA) has launched a new series of guides titled "Life and IBD". For over one million people across Europe who have it, IBD can be an overwhelming experience with new physicians, medications and terminology.
The guides in the "Life and IBD" series are designed to be personalised so patients can access information appropriate to their life stage and disease severity. The first guide contains useful information about preparing for visits to the doctor, questions to ask one's gastroenterologist and a self-assessment to determine the severity of IBD symptoms. The second guide in the series provides a roadmap for developing an IBD management plan, which gives patients a clear strategy for keeping their IBD symptoms under control. The third guide in the series is intended to help patients understand their illness, what causes it, how it might affect them and their role in managing the illness.
"Often, patients are not sure how to speak openly and honestly about how their IBD is affecting them because of fear of embarrassment," said Marco Greco, Chairman of the EFCCA. "The 'Life and IBD' guides provide tools to help people with IBD keep the lines of communication open with their physician, making them a trusted partner in care."
According to a recent survey conducted by EFCCA, nearly half of physicians in Europe do not ask patients about their quality of life and nearly half of patients do not initiate a conversation about quality of life-related concerns with their physicians. Discussing these concerns can provide important information about effectiveness of treatment, and materials such as the "Life and IBD" guides can help close the communication gap between physicians and patients and provide patients with a feeling of empowerment.
"Crohn's disease and ulcerative colitis are complicated diseases, with a number of varied symptoms, potential complications and treatment options," said Professor Subrata Ghosh, Division on Medicine, Imperial College, London, United Kingdom. "Because no two people with IBD are the same, it's important for patients to work closely with their physicians to ensure their treatment plans are meeting their needs."
For patients, open conversation with their physicians can help ensure their disease does not derail their lives. "I'm often forced to miss work because of my disease," said Alexandra Gliati of Greece, who has Crohn's disease. "It's very important that I stay vigilant in treating my IBD to avoid a flare, and the information found in these guides has helped me talk to my doctor and better manage my disease."
The "Life and IBD" guides can be viewed, downloaded and printed from the EFCCA website, located at LifeAndIBD. "Life and IBD" is supported by Abbott, a global broad-based healthcare company.
About the European Foundation of Crohn's & Ulcerative Colitis Associations
Established in 1993, the EFCCA's mission is to improve the well being of patients with IBD and their partners and families through: working with and for the EFCCA Member National Associations and others throughout all of Europe; facilitating the exchange of information and the promotion of cross-frontier activities; effecting regular contact with the European authorities, doctors, health professionals and organizations and with others worldwide; and the encouragement of scientific research into IBD causes and treatment. EFCCA membership now includes 23 European national Crohn's and colitis patient associations. www.efcca
The guides in the "Life and IBD" series are designed to be personalised so patients can access information appropriate to their life stage and disease severity. The first guide contains useful information about preparing for visits to the doctor, questions to ask one's gastroenterologist and a self-assessment to determine the severity of IBD symptoms. The second guide in the series provides a roadmap for developing an IBD management plan, which gives patients a clear strategy for keeping their IBD symptoms under control. The third guide in the series is intended to help patients understand their illness, what causes it, how it might affect them and their role in managing the illness.
"Often, patients are not sure how to speak openly and honestly about how their IBD is affecting them because of fear of embarrassment," said Marco Greco, Chairman of the EFCCA. "The 'Life and IBD' guides provide tools to help people with IBD keep the lines of communication open with their physician, making them a trusted partner in care."
According to a recent survey conducted by EFCCA, nearly half of physicians in Europe do not ask patients about their quality of life and nearly half of patients do not initiate a conversation about quality of life-related concerns with their physicians. Discussing these concerns can provide important information about effectiveness of treatment, and materials such as the "Life and IBD" guides can help close the communication gap between physicians and patients and provide patients with a feeling of empowerment.
"Crohn's disease and ulcerative colitis are complicated diseases, with a number of varied symptoms, potential complications and treatment options," said Professor Subrata Ghosh, Division on Medicine, Imperial College, London, United Kingdom. "Because no two people with IBD are the same, it's important for patients to work closely with their physicians to ensure their treatment plans are meeting their needs."
For patients, open conversation with their physicians can help ensure their disease does not derail their lives. "I'm often forced to miss work because of my disease," said Alexandra Gliati of Greece, who has Crohn's disease. "It's very important that I stay vigilant in treating my IBD to avoid a flare, and the information found in these guides has helped me talk to my doctor and better manage my disease."
The "Life and IBD" guides can be viewed, downloaded and printed from the EFCCA website, located at LifeAndIBD. "Life and IBD" is supported by Abbott, a global broad-based healthcare company.
About the European Foundation of Crohn's & Ulcerative Colitis Associations
Established in 1993, the EFCCA's mission is to improve the well being of patients with IBD and their partners and families through: working with and for the EFCCA Member National Associations and others throughout all of Europe; facilitating the exchange of information and the promotion of cross-frontier activities; effecting regular contact with the European authorities, doctors, health professionals and organizations and with others worldwide; and the encouragement of scientific research into IBD causes and treatment. EFCCA membership now includes 23 European national Crohn's and colitis patient associations. www.efcca
Medicare Reimbursement Rates Increase For Advanced Biologically-Based Fistula Treatment
Hospitals nationwide will receive six percent higher reimbursement payments for outpatient repair of anal fistulas using Cook Medical's Biodesign® Fistula Plug, a device designed specifically to treat this painful and embarrassing disorder of the lower GI tract. According to new Medicare payment schedules effective January 1st, hospital outpatient surgery departments will receive approximately $2,200 per procedure, while freestanding ambulatory surgery centers will be paid about $1,300 on average1. The new fee levels come at an opportune time, as fistulas continue to affect tens of thousands of patients each year in North America alone.
The Centers for Medicare and Medicaid Services (CMS) regularly review charge data from health care providers to determine future facility reimbursement rates. New Medicare fee schedules, published annually, reflect CMS' goal of establishing appropriate payment rates without creating disincentives that could deprive patients of effective treatment. The actual amount of facility reimbursement depends on a number of factors, including the provider and/or site of service (whether a physician, hospital, or ambulatory service, whether inpatient or outpatient) and the facilities' geographic location. Unlike Medicare, commercial insurance plans do not have a consistent national payment methodology, and fee arrangements between these insurers and health care providers vary considerably.
Since Cook introduced the Biodesign Fistula Plug in 2005, health care providers have increasingly recognized the strong performance of biologic grafts for fistula repair. A fistula is an abnormal channel that develops between body organs or an organ and the skin, often in the intestinal tract. Anal fistulas can develop because of mechanical stress caused by Crohn's disease, colitis, diverticulitis and other inflammatory bowel diseases.2 They leak fluid, interfere with bowel movements and cause discomfort during sitting and moving. Many can be repaired with a simple procedure called a fistulotomy, but approximately 30 percent of anal fistulas are considered complex and require alternative treatments less likely to prevent anal incontinence.
The Biodesign Fistula Plug is the first device designed and FDA cleared specifically for closing anal fistulas. Unlike other forms of treatment, the Biodesign Fistula Plug does not have a risk of sphincter muscle damage, a potential complication of fistulotomy that can cause incontinence. To further optimize procedural outcomes, Cook recently introduced the Biodesign Fistula Plug Set, a collection of accessory tools designed to help physicians achieve best outcomes in use of the Biodesign Fistula Plug. Available now, the Biodesign Fistula Plug Set includes the Biodesign Fistula Plug itself, brush, irrigation catheters, syringe and sutures.
Biodesign communicates with the body, signaling surrounding tissue to grow throughout the biologic scaffold to close the fistula, allowing the body to restore itself. It combines the best attributes of biologic grafts-resistance to infection and complete remodeling-with the added benefits of moderate price, ease of use and widespread availability.
"In thousands of fistula repair procedures around the world, the Biodesign Fistula Plug has achieved significant success rates in treating the most painful and complex fistulas," said Andy Cron, vice president and global business unit leader of Cook Medical's Surgery strategic business unit. "We hope these new reimbursement rates will advance awareness of this important procedure so that more patients suffering from debilitating fistulas can return to an improved quality of life."
About Biodesign
Biodesign is an evolution of soft tissue repair, addressing physicians' needs for an advanced biologic graft. Once implanted, Biodesign communicates with the body, signaling surrounding tissue to grow across the scaffold, allowing the body to restore itself. Biodesign completely remodels into fully vascularized tissue that becomes stronger over time, providing a permanent repair without a permanent material. Biodesign combines the best attributes of biologic grafts-resistance to infection and complete remodeling-with the added benefits of moderate price, ease of use and widespread availability. Introduced by Cook in 1995 and manufactured in the Cook Biotech facility in West Lafayette, Ind., the grafts have been used in more than one million procedures and 97 countries to treat hernias, fistulas, stress urinary incontinence, pelvic organ prolapse and Peyronie's disease, as well as in staple line reinforcement for bariatric surgery, plastic and reconstructive surgery, and wound care. To date, more than 800 peer-reviewed articles have been published on the technology behind Biodesign.
1. This statement reflects the approximate average for Medicare payments and will vary across states depending on local coverage policies.
2. Legall I. Anal fistulas and fissures.
Source:
Cook Medical
The Centers for Medicare and Medicaid Services (CMS) regularly review charge data from health care providers to determine future facility reimbursement rates. New Medicare fee schedules, published annually, reflect CMS' goal of establishing appropriate payment rates without creating disincentives that could deprive patients of effective treatment. The actual amount of facility reimbursement depends on a number of factors, including the provider and/or site of service (whether a physician, hospital, or ambulatory service, whether inpatient or outpatient) and the facilities' geographic location. Unlike Medicare, commercial insurance plans do not have a consistent national payment methodology, and fee arrangements between these insurers and health care providers vary considerably.
Since Cook introduced the Biodesign Fistula Plug in 2005, health care providers have increasingly recognized the strong performance of biologic grafts for fistula repair. A fistula is an abnormal channel that develops between body organs or an organ and the skin, often in the intestinal tract. Anal fistulas can develop because of mechanical stress caused by Crohn's disease, colitis, diverticulitis and other inflammatory bowel diseases.2 They leak fluid, interfere with bowel movements and cause discomfort during sitting and moving. Many can be repaired with a simple procedure called a fistulotomy, but approximately 30 percent of anal fistulas are considered complex and require alternative treatments less likely to prevent anal incontinence.
The Biodesign Fistula Plug is the first device designed and FDA cleared specifically for closing anal fistulas. Unlike other forms of treatment, the Biodesign Fistula Plug does not have a risk of sphincter muscle damage, a potential complication of fistulotomy that can cause incontinence. To further optimize procedural outcomes, Cook recently introduced the Biodesign Fistula Plug Set, a collection of accessory tools designed to help physicians achieve best outcomes in use of the Biodesign Fistula Plug. Available now, the Biodesign Fistula Plug Set includes the Biodesign Fistula Plug itself, brush, irrigation catheters, syringe and sutures.
Biodesign communicates with the body, signaling surrounding tissue to grow throughout the biologic scaffold to close the fistula, allowing the body to restore itself. It combines the best attributes of biologic grafts-resistance to infection and complete remodeling-with the added benefits of moderate price, ease of use and widespread availability.
"In thousands of fistula repair procedures around the world, the Biodesign Fistula Plug has achieved significant success rates in treating the most painful and complex fistulas," said Andy Cron, vice president and global business unit leader of Cook Medical's Surgery strategic business unit. "We hope these new reimbursement rates will advance awareness of this important procedure so that more patients suffering from debilitating fistulas can return to an improved quality of life."
About Biodesign
Biodesign is an evolution of soft tissue repair, addressing physicians' needs for an advanced biologic graft. Once implanted, Biodesign communicates with the body, signaling surrounding tissue to grow across the scaffold, allowing the body to restore itself. Biodesign completely remodels into fully vascularized tissue that becomes stronger over time, providing a permanent repair without a permanent material. Biodesign combines the best attributes of biologic grafts-resistance to infection and complete remodeling-with the added benefits of moderate price, ease of use and widespread availability. Introduced by Cook in 1995 and manufactured in the Cook Biotech facility in West Lafayette, Ind., the grafts have been used in more than one million procedures and 97 countries to treat hernias, fistulas, stress urinary incontinence, pelvic organ prolapse and Peyronie's disease, as well as in staple line reinforcement for bariatric surgery, plastic and reconstructive surgery, and wound care. To date, more than 800 peer-reviewed articles have been published on the technology behind Biodesign.
1. This statement reflects the approximate average for Medicare payments and will vary across states depending on local coverage policies.
2. Legall I. Anal fistulas and fissures.
Source:
Cook Medical
Can Polypectomy Be Performed Without Interruption Of Anticoagulation?
Currently, patients taking anticoagulants to prevent stroke and blood clots are often recommended to stop these medications in order to perform colonoscopy with removal of polyps.
However, interruption of these medications can place patients at risk of stroke and blood clots. A group led by Shai Friedland at the VA Palo Alto hospital in California reported their experience removing small colon polyps without interrupting anticoagulation. Their study was published in the World Journal of Gastroenterology.
Two hundred and twenty five polypectomies were performed in 123 patients. Patients followed a standardized protocol that included stopping warfarin for 36 h to avoid supratherapeutic anticoagulation from the bowel preparation. Patients with lesions larger than 1 cm were generally rescheduled for polypectomy off warfarin. Endoscopic clips were routinely applied prophylactically.
They reported that one patient (0.8%, 95% CI: 0.1%-4.5%) developed major post-polypectomy bleeding that required transfusion. Two others (1.6%, 95% CI: 0.5%-5.7%) had self-limited hematochezia at home and did not seek medical attention. The average polyp size was 5.1 ?± 2.2 mm. They announced that polypectomy can be performed in therapeutically anticoagulated patients with lesions up to 1 cm in size with an acceptable bleeding rate.
Reference: Friedland S, Sedehi D, Soetikno R. Colonoscopic polypectomy in anticoagulated patients. World Journal of Gastroenterology 2009; 15(16): 1973-1976
wjgnet/1007-9327/15/1973.asp
Source:
Lai-Fu Li
World Journal of Gastroenterology
View drug information on Warfarin Sodium tablets.
However, interruption of these medications can place patients at risk of stroke and blood clots. A group led by Shai Friedland at the VA Palo Alto hospital in California reported their experience removing small colon polyps without interrupting anticoagulation. Their study was published in the World Journal of Gastroenterology.
Two hundred and twenty five polypectomies were performed in 123 patients. Patients followed a standardized protocol that included stopping warfarin for 36 h to avoid supratherapeutic anticoagulation from the bowel preparation. Patients with lesions larger than 1 cm were generally rescheduled for polypectomy off warfarin. Endoscopic clips were routinely applied prophylactically.
They reported that one patient (0.8%, 95% CI: 0.1%-4.5%) developed major post-polypectomy bleeding that required transfusion. Two others (1.6%, 95% CI: 0.5%-5.7%) had self-limited hematochezia at home and did not seek medical attention. The average polyp size was 5.1 ?± 2.2 mm. They announced that polypectomy can be performed in therapeutically anticoagulated patients with lesions up to 1 cm in size with an acceptable bleeding rate.
Reference: Friedland S, Sedehi D, Soetikno R. Colonoscopic polypectomy in anticoagulated patients. World Journal of Gastroenterology 2009; 15(16): 1973-1976
wjgnet/1007-9327/15/1973.asp
Source:
Lai-Fu Li
World Journal of Gastroenterology
View drug information on Warfarin Sodium tablets.
What Is Chronic Pancreatitis? What Causes Chronic Pancreatitis?
Chronic pancreatitis is long-term progressive inflammatory disease of the pancreas that leads to permanent deterioration of the structure and function of the pancreas. It is estimated that in Western Europe and North American chronic pancreatitis is diagnosed in 3 to 9 people in every 100,000 each year.
The most common cause is long-term alcohol abuse - it is thought to account for approximately 70% of all cases. The gradual rise in the incidence of chronic pancreatitis in several countries around the globe has been attributed to increasing alcohol consumption and earlier diagnosis.
Chronic pancreatitis results in over 122,000 outpatient visits and 56,000 hospitalizations annually in the USA. Significantly more men than women are affected.
Chronic pancreatitis usually begins in adults aged 40 to 50.
What is the pancreas?
The pancreas is a gland organ that is located in the abdomen, behind the stomach and below the ribcage. It is part of the digestive system and produces important enzymes and hormones that help break down foods. It has an endocrine function because it releases juices directly into the bloodstream, and it has an exocrine function because it releases juices into ducts.
Visit our specialized news section
Gastrointestinal / Gastroenterology News
Enzymes, or digestive juices, produced by the pancreas are secreted into the small intestine to further break down food after it has left the stomach. The gland also produces the hormone insulin and secretes it into the bloodstream in order to regulate the body's glucose or sugar level.
What are the symptoms of chronic pancreatitis?
Pain - the patient may feel pain in the upper abdomen. The pain may sometimes be severe and can travel along the back. It is usually more intense after eating. Some pain relief may be gained by leaning forward or curling into a ball.
Nausea and vomiting - more commonly experienced during episodes of pain.
Constant pain - As the disease progresses the episodes of pain become more frequent and severe. Some patients eventually suffer constant abdominal pain.
As chronic pancreatitis progresses, and the pancreas' ability to produce digestive juices deteriorates, the following symptoms will appear:
Smelly and greasy feces (stools)
Bloating
Abdominal cramps
Flatulence (breaking wind, farting)
Eventually the pancreas may not be able to produce insulin, leading to diabetes type 1, with the following symptoms:
Thirst
Frequent urination
Intense hunger
Weight loss
Tiredness (fatigue)
Blurred vision
What are the causes of chronic pancreatitis?
Chronic pancreatitis is usually the follow-on of repeated episodes of acute pancreatitis which lead to permanent damage of the pancreas.
Acute pancreatitis is caused when trypsin becomes activated within the pancreas. Trypsin is an enzyme produced in the pancreas and released into the intestines where it breaks down proteins as part of the digestive system. Trypsin is inactive until it has reached the intestines. If trypsin becomes activated inside the pancreas it will start to digest the pancreas itself, leading to irritation and inflammation of the pancreas - acute pancreatitis. Alcohol can cause a process which triggers the activation of trypsin inside the pancreas, as can gallstones.
Alcohol misuse causes 70% of chronic pancreatitis cases
People who misuse alcohol and develop acute pancreatitis tend to have repeated episodes, and eventually develop chronic pancreatitis (long-term) - that is why 70% of all chronic pancreatitis cases are caused by alcohol misuse. The repeated bouts of acute pancreatitis eventually take their toll on the pancreas, causing permanent damage, which then becomes chronic pancreatitis - also known as alcoholic chronic pancreatitis.
According to the National Health Service, UK, long-term alcoholic misuse that typically causes chronic pancreatitis consists of about 10 to 15 years of 10 units of alcohol per day or more. A typical 750ml bottle of 12% wine contains 9 units of alcohol. Approximately 5% to 10% of people with long-term alcohol misuse develop chronic pancreatitis.
Experts believe that patients with alcoholic chronic pancreatitis have specific genetic mutations which make them more susceptible to the effects of alcohol.
Idiopathic chronic pancreatitis makes up the bulk of the remaining 30% of cases
When a disease is idiopathic it means there is no known cause or reason to explain why or how it developed. Idiopathic chronic pancreatitis accounts for most of the remaining cases. Most cases of idiopathic chronic pancreatitis start to develop in people aged 10 to 20 years, and those over 50.
Nobody is certain why other age groups are rarely affected. The SPINK-1 and The CFTR genes, types of mutated genes, exist in about 50% of patients with idiopathic chronic pancreatitis. Experts believe these genetic mutations may undermine the functions of the pancreas.
Other much rarer causes include autoimmune chronic pancreatitis in which the person's own immune system attacks the pancreas, heredity pancreatitis where patients have a genetic condition and are born with a faulty pancreas, and cystic fibrosis, another genetic condition which damages certain organs.
How is chronic pancreatitis diagnosed?
There are no reliable tests to diagnose chronic pancreatitis. A doctor will suspect the disease because of the patient's symptoms, history of repeated acute pancreatitis flare-ups, or alcohol abuse.
Blood tests may be useful in checking the blood glucose levels, which may be elevated.
Blood tests for elevated levels of amylase and lipase are not reliable at this stage. Amylase and lipase blood levels rise during the first couple of days of pancreatitis, and then settle back to normal after five to seven days. A patient with chronic pancreatitis would have had the disease for much longer.
Doctors need to have a good look at the pancreas in order to diagnose the disease properly. This will most likely involve:
An ultrasound scan - high frequency sound waves create an image on a monitor of the pancreas and its surroundings.
A CT (computed tomography) scan - X-rays are used to take many pictures of the same area from several angles, which are then placed together to produce a 3-D image. The scan will reveal changes of chronic pancreatitis.
MRCP (magnetic resonance cholangiopancreatography) scan - this scan will show the bile and pancreatic ducts more clearly than a CT scan.
An ERCP (endoscopic retrograde cholangio-pancreatography) scan - an endoscope (thin, flexible tube with a camera at the end) is inserted into the digestive system. The doctor uses ultrasound to guide the endoscope through.
Patients with chronic pancreatitis have an elevated risk of developing pancreatic cancer. If symptoms worsen, especially the narrowing of the pancreatic duct, doctors may suspect cancer. If so, they will order a CT scan, MRI scan, or endoscopic study.
What are the treatment options for chronic pancreatitis?
Lifestyle changes
Patients with chronic pancreatitis will need to undergo some lifestyle changes. These will include:
Stop drinking - giving up drinking will help prevent further damage to the pancreas. It will also contribute significantly towards relieving the pain. Some people may need professional help to quit alcohol.
Stop smoking - smoking is not a cause of pancreatitis, but it can accelerate the progression of the disease.
Diet - the pancreas is involved in digestion; pancreatitis damages the functions of the pancreas. This means that patients with the disease will have difficulty digesting many foods. Rather than three large meals a day, patients will be advised to change to six small meals. It is also better to avoid fatty meals, i.e. to follow a low-fat diet.
A diet plan will either be drawn up by the doctor, or the patient may be referred to a qualified dietitian.
Depending on the extent of pancreatic damage, patients may also have to take artificial versions of some enzymes to aid digestion. These will ease bloating, make the feces less greasy and foul-smelling, and help the abdominal cramps.
Pain - treatment should not only focus on helping ease the pain symptoms, but also depression which is a common consequence of long-term pain. Doctors will usually use a step-by-step approach, in which mild painkillers are prescribed, gradually becoming stronger until the patient responds.
Insulin - the pancreas may stop producing insulin if the damage is extensive. The patient will have developed diabetes type 1. Regular insulin treatment will become part of the treatment for the rest of the patient's life. Diabetes type 1 caused by chronic pancreatitis involves injections, not tablets because most likely the digestive system will not be able to break them down.
Surgery
Severe chronic pain sometimes does not respond to painkilling medications. The ducts in the pancreas may have become blocked, causing an accumulation of digestive juices which puts pressure on them, causing intense pain. Another cause of chronic and intense pain could be inflammation of the head (top section) of the pancreas. The inflammation aggravates the nerve endings.
Endoscopic surgery - a narrow, hollow, flexible tube (endoscope) goes into the digestive system guided by ultrasound. A devise with a tiny deflated balloon at the end is threaded through the endoscope. When it reaches the duct the balloon is inflated, thus widening the duct. A stent is placed to stop the duct from narrowing back.
Pancreas resection - the head of the pancreas is surgically removed. This not only relieves the pain caused by inflammation which was irritating the nerve endings, but it also reduces pressure on the ducts. Three main techniques are used for pancreas resection:
The Beger procedure - this involves resection of the inflamed pancreatic head with careful sparing of the duodenum, the rest of the pancreas is reconnected to the intestines.
The Frey procedure - this is used when the doctor believes pain is being caused by both inflammation of the head of the pancreas as well as the blocked ducts. The Frey procedure adds a longitudinal duct decompression to the pancreatic head resection - the head of the pancreas is surgically removed, and the ducts are decompressed by connecting them directly to the intestines.
Pylorus-sparing pancreaticoduodenectomy (PPPD) - the gall bladder, ducts, and the head of the pancreas are all surgically removed. This is only done in very severe cases of intense chronic pain where the head of the pancreas is inflamed and the ducts are blocked as well. This is the most effective procedure for reducing pain and conserving pancreas function. However, it has the highest risk infection and internal bleeding.
Total pancreatectomy - this involves the surgical removal of the whole pancreas. It is very effective in dealing with the pain. However, the patient will be totally dependent on treatment for some of the vital functions of the pancreas, such as the release of insulin.
Autologous pancreatic islet cell transplantation (APICT) - during the total pancreatectomy procedure a suspension of isolated islet cells is created from the surgically removed pancreas and injected into the portal vein of the liver. The islets cells will function as a free graft in the liver - they will exist in the liver where they produce insulin.
What are the complications of chronic pancreatitis?
Stress, anxiety, depression
The disease may have an effect on the patient's psychological and emotional well being. Constant or recurring pain, which is often severe, may cause distress, anxiety, irritability, stress and depression. It is important for patients to tell their doctors if they are emotionally or psychologically affected. If there is a support group in your area, being able to talk to people who share the same condition may help you feel less isolated and more able to cope.
Pseudocyst
This is a collection of tissue, fluid, debris, pancreatic enzymes, and blood in the abdomen, caused by leakage of digestive fluids escaping from a faulty pancreatic duct. Pseudocysts don't usually cause any problems. However, sometimes they can become infected, cause blockage to part of the intestine, or rupture and cause internal bleeding. If this happens the cyst will have to be surgically drained.
Pancreatic cancer
Even though pancreatic cancer is more common among patients with chronic pancreatitis, the risk is only 1 in 500.
Prevention of chronic pancreatitis
Patients with acute pancreatitis significantly reduce their risk of developing chronic pancreatitis if they give up drinking alcohol. This is especially the case for patients who drink heavily and regularly.
The most common cause is long-term alcohol abuse - it is thought to account for approximately 70% of all cases. The gradual rise in the incidence of chronic pancreatitis in several countries around the globe has been attributed to increasing alcohol consumption and earlier diagnosis.
Chronic pancreatitis results in over 122,000 outpatient visits and 56,000 hospitalizations annually in the USA. Significantly more men than women are affected.
Chronic pancreatitis usually begins in adults aged 40 to 50.
What is the pancreas?
The pancreas is a gland organ that is located in the abdomen, behind the stomach and below the ribcage. It is part of the digestive system and produces important enzymes and hormones that help break down foods. It has an endocrine function because it releases juices directly into the bloodstream, and it has an exocrine function because it releases juices into ducts.
Visit our specialized news section
Gastrointestinal / Gastroenterology News
Enzymes, or digestive juices, produced by the pancreas are secreted into the small intestine to further break down food after it has left the stomach. The gland also produces the hormone insulin and secretes it into the bloodstream in order to regulate the body's glucose or sugar level.
What are the symptoms of chronic pancreatitis?
Pain - the patient may feel pain in the upper abdomen. The pain may sometimes be severe and can travel along the back. It is usually more intense after eating. Some pain relief may be gained by leaning forward or curling into a ball.
Nausea and vomiting - more commonly experienced during episodes of pain.
Constant pain - As the disease progresses the episodes of pain become more frequent and severe. Some patients eventually suffer constant abdominal pain.
As chronic pancreatitis progresses, and the pancreas' ability to produce digestive juices deteriorates, the following symptoms will appear:
Smelly and greasy feces (stools)
Bloating
Abdominal cramps
Flatulence (breaking wind, farting)
Eventually the pancreas may not be able to produce insulin, leading to diabetes type 1, with the following symptoms:
Thirst
Frequent urination
Intense hunger
Weight loss
Tiredness (fatigue)
Blurred vision
What are the causes of chronic pancreatitis?
Chronic pancreatitis is usually the follow-on of repeated episodes of acute pancreatitis which lead to permanent damage of the pancreas.
Acute pancreatitis is caused when trypsin becomes activated within the pancreas. Trypsin is an enzyme produced in the pancreas and released into the intestines where it breaks down proteins as part of the digestive system. Trypsin is inactive until it has reached the intestines. If trypsin becomes activated inside the pancreas it will start to digest the pancreas itself, leading to irritation and inflammation of the pancreas - acute pancreatitis. Alcohol can cause a process which triggers the activation of trypsin inside the pancreas, as can gallstones.
Alcohol misuse causes 70% of chronic pancreatitis cases
People who misuse alcohol and develop acute pancreatitis tend to have repeated episodes, and eventually develop chronic pancreatitis (long-term) - that is why 70% of all chronic pancreatitis cases are caused by alcohol misuse. The repeated bouts of acute pancreatitis eventually take their toll on the pancreas, causing permanent damage, which then becomes chronic pancreatitis - also known as alcoholic chronic pancreatitis.
According to the National Health Service, UK, long-term alcoholic misuse that typically causes chronic pancreatitis consists of about 10 to 15 years of 10 units of alcohol per day or more. A typical 750ml bottle of 12% wine contains 9 units of alcohol. Approximately 5% to 10% of people with long-term alcohol misuse develop chronic pancreatitis.
Experts believe that patients with alcoholic chronic pancreatitis have specific genetic mutations which make them more susceptible to the effects of alcohol.
Idiopathic chronic pancreatitis makes up the bulk of the remaining 30% of cases
When a disease is idiopathic it means there is no known cause or reason to explain why or how it developed. Idiopathic chronic pancreatitis accounts for most of the remaining cases. Most cases of idiopathic chronic pancreatitis start to develop in people aged 10 to 20 years, and those over 50.
Nobody is certain why other age groups are rarely affected. The SPINK-1 and The CFTR genes, types of mutated genes, exist in about 50% of patients with idiopathic chronic pancreatitis. Experts believe these genetic mutations may undermine the functions of the pancreas.
Other much rarer causes include autoimmune chronic pancreatitis in which the person's own immune system attacks the pancreas, heredity pancreatitis where patients have a genetic condition and are born with a faulty pancreas, and cystic fibrosis, another genetic condition which damages certain organs.
How is chronic pancreatitis diagnosed?
There are no reliable tests to diagnose chronic pancreatitis. A doctor will suspect the disease because of the patient's symptoms, history of repeated acute pancreatitis flare-ups, or alcohol abuse.
Blood tests may be useful in checking the blood glucose levels, which may be elevated.
Blood tests for elevated levels of amylase and lipase are not reliable at this stage. Amylase and lipase blood levels rise during the first couple of days of pancreatitis, and then settle back to normal after five to seven days. A patient with chronic pancreatitis would have had the disease for much longer.
Doctors need to have a good look at the pancreas in order to diagnose the disease properly. This will most likely involve:
An ultrasound scan - high frequency sound waves create an image on a monitor of the pancreas and its surroundings.
A CT (computed tomography) scan - X-rays are used to take many pictures of the same area from several angles, which are then placed together to produce a 3-D image. The scan will reveal changes of chronic pancreatitis.
MRCP (magnetic resonance cholangiopancreatography) scan - this scan will show the bile and pancreatic ducts more clearly than a CT scan.
An ERCP (endoscopic retrograde cholangio-pancreatography) scan - an endoscope (thin, flexible tube with a camera at the end) is inserted into the digestive system. The doctor uses ultrasound to guide the endoscope through.
Patients with chronic pancreatitis have an elevated risk of developing pancreatic cancer. If symptoms worsen, especially the narrowing of the pancreatic duct, doctors may suspect cancer. If so, they will order a CT scan, MRI scan, or endoscopic study.
What are the treatment options for chronic pancreatitis?
Lifestyle changes
Patients with chronic pancreatitis will need to undergo some lifestyle changes. These will include:
Stop drinking - giving up drinking will help prevent further damage to the pancreas. It will also contribute significantly towards relieving the pain. Some people may need professional help to quit alcohol.
Stop smoking - smoking is not a cause of pancreatitis, but it can accelerate the progression of the disease.
Diet - the pancreas is involved in digestion; pancreatitis damages the functions of the pancreas. This means that patients with the disease will have difficulty digesting many foods. Rather than three large meals a day, patients will be advised to change to six small meals. It is also better to avoid fatty meals, i.e. to follow a low-fat diet.
A diet plan will either be drawn up by the doctor, or the patient may be referred to a qualified dietitian.
Depending on the extent of pancreatic damage, patients may also have to take artificial versions of some enzymes to aid digestion. These will ease bloating, make the feces less greasy and foul-smelling, and help the abdominal cramps.
Pain - treatment should not only focus on helping ease the pain symptoms, but also depression which is a common consequence of long-term pain. Doctors will usually use a step-by-step approach, in which mild painkillers are prescribed, gradually becoming stronger until the patient responds.
Insulin - the pancreas may stop producing insulin if the damage is extensive. The patient will have developed diabetes type 1. Regular insulin treatment will become part of the treatment for the rest of the patient's life. Diabetes type 1 caused by chronic pancreatitis involves injections, not tablets because most likely the digestive system will not be able to break them down.
Surgery
Severe chronic pain sometimes does not respond to painkilling medications. The ducts in the pancreas may have become blocked, causing an accumulation of digestive juices which puts pressure on them, causing intense pain. Another cause of chronic and intense pain could be inflammation of the head (top section) of the pancreas. The inflammation aggravates the nerve endings.
Endoscopic surgery - a narrow, hollow, flexible tube (endoscope) goes into the digestive system guided by ultrasound. A devise with a tiny deflated balloon at the end is threaded through the endoscope. When it reaches the duct the balloon is inflated, thus widening the duct. A stent is placed to stop the duct from narrowing back.
Pancreas resection - the head of the pancreas is surgically removed. This not only relieves the pain caused by inflammation which was irritating the nerve endings, but it also reduces pressure on the ducts. Three main techniques are used for pancreas resection:
The Beger procedure - this involves resection of the inflamed pancreatic head with careful sparing of the duodenum, the rest of the pancreas is reconnected to the intestines.
The Frey procedure - this is used when the doctor believes pain is being caused by both inflammation of the head of the pancreas as well as the blocked ducts. The Frey procedure adds a longitudinal duct decompression to the pancreatic head resection - the head of the pancreas is surgically removed, and the ducts are decompressed by connecting them directly to the intestines.
Pylorus-sparing pancreaticoduodenectomy (PPPD) - the gall bladder, ducts, and the head of the pancreas are all surgically removed. This is only done in very severe cases of intense chronic pain where the head of the pancreas is inflamed and the ducts are blocked as well. This is the most effective procedure for reducing pain and conserving pancreas function. However, it has the highest risk infection and internal bleeding.
Total pancreatectomy - this involves the surgical removal of the whole pancreas. It is very effective in dealing with the pain. However, the patient will be totally dependent on treatment for some of the vital functions of the pancreas, such as the release of insulin.
Autologous pancreatic islet cell transplantation (APICT) - during the total pancreatectomy procedure a suspension of isolated islet cells is created from the surgically removed pancreas and injected into the portal vein of the liver. The islets cells will function as a free graft in the liver - they will exist in the liver where they produce insulin.
What are the complications of chronic pancreatitis?
Stress, anxiety, depression
The disease may have an effect on the patient's psychological and emotional well being. Constant or recurring pain, which is often severe, may cause distress, anxiety, irritability, stress and depression. It is important for patients to tell their doctors if they are emotionally or psychologically affected. If there is a support group in your area, being able to talk to people who share the same condition may help you feel less isolated and more able to cope.
Pseudocyst
This is a collection of tissue, fluid, debris, pancreatic enzymes, and blood in the abdomen, caused by leakage of digestive fluids escaping from a faulty pancreatic duct. Pseudocysts don't usually cause any problems. However, sometimes they can become infected, cause blockage to part of the intestine, or rupture and cause internal bleeding. If this happens the cyst will have to be surgically drained.
Pancreatic cancer
Even though pancreatic cancer is more common among patients with chronic pancreatitis, the risk is only 1 in 500.
Prevention of chronic pancreatitis
Patients with acute pancreatitis significantly reduce their risk of developing chronic pancreatitis if they give up drinking alcohol. This is especially the case for patients who drink heavily and regularly.
Virulence Factor That Induces Fatal Fungal Infection Identified By Singapore Scientists
Scientists here have found that certain substances from bacteria living in the human intestine cause the normally harmless Candida albicans fungus to become highly infectious.
This discovery by researchers at Singapore's Agency for Science, Technology and Research (A*STAR)'s Institute of Molecular and Cell Biology (IMCB) could possibly lead to the development of novel treatments for immunocompromised patients infected by the fungus.
The team of scientists, led by Associate Professor Wang Yue, a principal investigator at the IMCB, identified peptidoglycan (PGN) - a carbohydrate from bacteria - as a factor responsible for causing the conversion of the otherwise harmless C. albicans to its infectious form.
The research findings were recently published in the current journal Cell Host & Microbe.
Once in the infectious form, the fungus is able to invade surrounding tissues and escape destruction by the body's own immune cells. Since immunocompromised patients such as those with AIDS or those undergoing chemotherapy or radiation treatment are extremely susceptible to fungal-induced systemic infections, this finding offers an important clue to the basis of C. albicans infections.
After confirming the presence of PGN-derived molecules in human blood, the researchers discovered that the fungus is able to "sense" the presence of the same molecules, which are produced in abundance by bacteria residing in the gastrointestinal track. Earlier studies suggested that PGNs can enter the blood stream through the intestinal wall. When direct binding of the PGN-derived molecules to a specific protein in C. albicans takes place, it triggers interactions and "sensing" processes that induce the fungus to start growing long, threadlike tubes called hyphae, hence signifying its conversion to the virulent, life-threatening form.
This is the first time that the identities of the "inducer" and that of its "sensor" in C. albicans have been clearly established.
Said Wang, who has been working on C. albicans for more than eight years, "It has been more than 50 years since human blood was first found to contain molecules that can strongly induce C. albicans infection. In spite of efforts by many laboratories worldwide, the identity of the 'inducer' remained elusive. Thus, we are very excited about being able to help solve this long-held mystery. Finding the PGN sensor in C. albicans is also of great importance, because we can now develop anti-Candida therapies by blocking the sensory mechanism."
According to UNAIDS statistics, the AIDS pandemic claimed an estimated 2.1 million lives in 2007 alone. The latest findings by the Singapore researchers may provide insight for the development of potential anti-Candida therapy in patients suffering from fungal-induced systemic infections.
Previous research breakthroughs by the IMCB team included the discovery of the gene involved in triggering the infectious form of C. albicans, as well as the way in which the gene and its by-products facilitated the transformation process of the fungus.
The research findings described in the press release can be found in the July 17, 2008 print issue of Cell Host & Microbe. The paper is titled, "Bacterial Peptidoglycan triggers Candida albicans hyphal growth by directly activating the adenylyl cyclase Cyr1p."
IMCB:
The Institute of Molecular and Cell Biology (IMCB) is a member of Singapore's Agency for Science, Technology and Research (A*STAR) and is funded through A*STAR's Biomedical Research Council (BMRC). It is a world-class research institute that focuses its activities on six major fields: Cell Biology, Developmental Biology, Structural Biology, Infectious Diseases, Cancer Biology and Translational Research,with core strengths in cell cycling, cell signalling, cell death, cell motility and protein trafficking. Its recent achievements include leading an international consortium that successfully sequenced the entire pufferfish (Fugu) genome. The IMCB was awarded the Nikkei Prize 2000 for Technological Innovation in recognition of its growth into a leading international research centre and its collaboration with industry and research institutes worldwide. Established in 1987, the Institute currently has 35 independent research groups with more than 400 staff members. imcb.a-star.edu.sg
A*STAR:
The Agency for Science, Technology and Research, or A*STAR, is Singapore's lead agency for fostering world-class scientific research and talent for a vibrant knowledge-based Singapore. A*STAR actively nurtures public sector research and development in Biomedical Sciences, Physical Sciences and Engineering, with a particular focus on fields essential to Singapore's manufacturing industry and new growth industries. It oversees 14 research institutes and supports extramural research with the universities, hospital research centres and other local and international partners. At the heart of this knowledge-intensive work is human capital. Top local and international scientific talent drive knowledge creation at A*STAR research institutes. The Agency also sends scholars for undergraduate, graduate and post-doctoral training in the best universities, a reflection of the high priority A*STAR places on nurturing the next generation of scientific talent. a-star.edu.sg
This discovery by researchers at Singapore's Agency for Science, Technology and Research (A*STAR)'s Institute of Molecular and Cell Biology (IMCB) could possibly lead to the development of novel treatments for immunocompromised patients infected by the fungus.
The team of scientists, led by Associate Professor Wang Yue, a principal investigator at the IMCB, identified peptidoglycan (PGN) - a carbohydrate from bacteria - as a factor responsible for causing the conversion of the otherwise harmless C. albicans to its infectious form.
The research findings were recently published in the current journal Cell Host & Microbe.
Once in the infectious form, the fungus is able to invade surrounding tissues and escape destruction by the body's own immune cells. Since immunocompromised patients such as those with AIDS or those undergoing chemotherapy or radiation treatment are extremely susceptible to fungal-induced systemic infections, this finding offers an important clue to the basis of C. albicans infections.
After confirming the presence of PGN-derived molecules in human blood, the researchers discovered that the fungus is able to "sense" the presence of the same molecules, which are produced in abundance by bacteria residing in the gastrointestinal track. Earlier studies suggested that PGNs can enter the blood stream through the intestinal wall. When direct binding of the PGN-derived molecules to a specific protein in C. albicans takes place, it triggers interactions and "sensing" processes that induce the fungus to start growing long, threadlike tubes called hyphae, hence signifying its conversion to the virulent, life-threatening form.
This is the first time that the identities of the "inducer" and that of its "sensor" in C. albicans have been clearly established.
Said Wang, who has been working on C. albicans for more than eight years, "It has been more than 50 years since human blood was first found to contain molecules that can strongly induce C. albicans infection. In spite of efforts by many laboratories worldwide, the identity of the 'inducer' remained elusive. Thus, we are very excited about being able to help solve this long-held mystery. Finding the PGN sensor in C. albicans is also of great importance, because we can now develop anti-Candida therapies by blocking the sensory mechanism."
According to UNAIDS statistics, the AIDS pandemic claimed an estimated 2.1 million lives in 2007 alone. The latest findings by the Singapore researchers may provide insight for the development of potential anti-Candida therapy in patients suffering from fungal-induced systemic infections.
Previous research breakthroughs by the IMCB team included the discovery of the gene involved in triggering the infectious form of C. albicans, as well as the way in which the gene and its by-products facilitated the transformation process of the fungus.
The research findings described in the press release can be found in the July 17, 2008 print issue of Cell Host & Microbe. The paper is titled, "Bacterial Peptidoglycan triggers Candida albicans hyphal growth by directly activating the adenylyl cyclase Cyr1p."
IMCB:
The Institute of Molecular and Cell Biology (IMCB) is a member of Singapore's Agency for Science, Technology and Research (A*STAR) and is funded through A*STAR's Biomedical Research Council (BMRC). It is a world-class research institute that focuses its activities on six major fields: Cell Biology, Developmental Biology, Structural Biology, Infectious Diseases, Cancer Biology and Translational Research,with core strengths in cell cycling, cell signalling, cell death, cell motility and protein trafficking. Its recent achievements include leading an international consortium that successfully sequenced the entire pufferfish (Fugu) genome. The IMCB was awarded the Nikkei Prize 2000 for Technological Innovation in recognition of its growth into a leading international research centre and its collaboration with industry and research institutes worldwide. Established in 1987, the Institute currently has 35 independent research groups with more than 400 staff members. imcb.a-star.edu.sg
A*STAR:
The Agency for Science, Technology and Research, or A*STAR, is Singapore's lead agency for fostering world-class scientific research and talent for a vibrant knowledge-based Singapore. A*STAR actively nurtures public sector research and development in Biomedical Sciences, Physical Sciences and Engineering, with a particular focus on fields essential to Singapore's manufacturing industry and new growth industries. It oversees 14 research institutes and supports extramural research with the universities, hospital research centres and other local and international partners. At the heart of this knowledge-intensive work is human capital. Top local and international scientific talent drive knowledge creation at A*STAR research institutes. The Agency also sends scholars for undergraduate, graduate and post-doctoral training in the best universities, a reflection of the high priority A*STAR places on nurturing the next generation of scientific talent. a-star.edu.sg
ASGE announces grant recipients in annual research awards program
The American Society for Gastrointestinal Endoscopy (ASGE) and the ASGE Foundation announced this year's institutional
winners of medical research grants, as part of the ASGE's annual Research & Outcomes & Effectiveness Awards Program.
The ASGE Research Committee received 31 applications for research project funding last fall and granted a total of $234,700
to the 11 institutions that were chosen to receive grants, including nine from the United States and two from Canada.
"Each grant application undergoes a vigorous peer review process," stated James Scheiman, MD, chair of the ASGE Awards
Committee and a member of the Gastroenterology Division of the University of Michigan.
"With the help of generous donations through the ASGE Foundation, the ASGE provides the opportunity for gastrointestinal
endoscopic investigators to answer key questions regarding the clinical application of new endoscopic technology," Dr.
Scheiman said. He also indicated that a goal of the ASGE Research Committee is to help launch medical research careers for
members of the recipient research teams.
The ASGE Awards Program was initiated in 1985 and has awarded more than $3 million in research dollars. Its objective is to
foster research in gastrointestinal endoscopy both within and outside of academic centers.
The institutions receiving ASGE grants in this 20th year of the program include:
Case Western Reserve University, Cleveland, OH;
The Cleveland Clinic Foundation, Cleveland;
Emory University School of Medicine, Atlanta;
Indiana University School of Medicine, Roudebush VA Medical Center, Indianapolis;
Legacy Health System, Portland;
Massachusetts General Hospital, Boston;
Research Institute of the McGill University Health Center, Montreal;
Sunnybrook & Women's College HSC, Toronto;
University of California, Davis Medical Center, Sacramento;
University of Utah Medical Center, Salt Lake City; and
VA Medical Center, Kansas City;
For information on the ASGE Awards Program, please visit the ASGE website at asge or e-mail to asgegrantsasge/.
Source: American Society for Gastrointestinal Endoscopy, Oak Brook, IL
Robert J. Buzogany - asgenewsmsn
American Society for Gastrointestinal Endoscopy
winners of medical research grants, as part of the ASGE's annual Research & Outcomes & Effectiveness Awards Program.
The ASGE Research Committee received 31 applications for research project funding last fall and granted a total of $234,700
to the 11 institutions that were chosen to receive grants, including nine from the United States and two from Canada.
"Each grant application undergoes a vigorous peer review process," stated James Scheiman, MD, chair of the ASGE Awards
Committee and a member of the Gastroenterology Division of the University of Michigan.
"With the help of generous donations through the ASGE Foundation, the ASGE provides the opportunity for gastrointestinal
endoscopic investigators to answer key questions regarding the clinical application of new endoscopic technology," Dr.
Scheiman said. He also indicated that a goal of the ASGE Research Committee is to help launch medical research careers for
members of the recipient research teams.
The ASGE Awards Program was initiated in 1985 and has awarded more than $3 million in research dollars. Its objective is to
foster research in gastrointestinal endoscopy both within and outside of academic centers.
The institutions receiving ASGE grants in this 20th year of the program include:
Case Western Reserve University, Cleveland, OH;
The Cleveland Clinic Foundation, Cleveland;
Emory University School of Medicine, Atlanta;
Indiana University School of Medicine, Roudebush VA Medical Center, Indianapolis;
Legacy Health System, Portland;
Massachusetts General Hospital, Boston;
Research Institute of the McGill University Health Center, Montreal;
Sunnybrook & Women's College HSC, Toronto;
University of California, Davis Medical Center, Sacramento;
University of Utah Medical Center, Salt Lake City; and
VA Medical Center, Kansas City;
For information on the ASGE Awards Program, please visit the ASGE website at asge or e-mail to asgegrantsasge/.
Source: American Society for Gastrointestinal Endoscopy, Oak Brook, IL
Robert J. Buzogany - asgenewsmsn
American Society for Gastrointestinal Endoscopy
Herbal Medicines For Treatment Of Gastrointestinal Disease
Herbal medicines could benefit patients suffering from gastrointestinal (GI) motility disorders that cannot be treated using conventional drug therapy. In a study published in Neurogastroenterology and Motility, researchers reviewed data on Japanese herbal medicines and found them to be effective in reducing the symptoms of GI disorders such as functional dyspepsia, constipation, and postoperative ileus.
"Japanese herbal medicines have been used in East Asia for thousands of years," says lead researcher Hidekazu Suzuki, Associate Professor at the Keio University School of Medicine. "Our review of the world medical literature reveals that herbal medicines serve a valuable role in the management of patients with functional gastrointestinal disorders."
Many of the drugs used to treat GI motility disorders are ineffective or cause unwanted side effects and, in some cases, this has led to drugs being withdrawn from the market. Herbal medicine is an attractive alternative.
The researchers reviewed data from studies looking at the effect of several different Japanese herbal medicines including the use of Rikkunshi-to, Dai-Kenchu-to, and other herbal medicines. Rikkunshi-to, which is prepared from eight crude herbs, was effective in reducing discomfort caused by functional dyspepsia. Dai-Kenchu-to, a mixture of ginseng, ginger, and zanthoxylum fruit, was beneficial for constipation in children and patients suffering from post-operative ileus - disruption of normal bowel movements following an operation. Another herbal medicine, hangeshashin-to, reduced the severity and frequency of diarrhoea caused by anti-cancer drugs.
In Japan, herbal medicine is manufactured in standardised form with regards to quality and quantity of ingredients. The researchers say the health benefits of standardised formulations of herbal medicines require more rigorous examination, particularly in the Western world.
"There is a mandate to provide accurate data regarding the effectiveness of non-traditional therapy, not only to our patients but also to healthcare providers who face the dilemma of recommending or opposing management strategies that incorporate herbal medicine," says Suzuki.
Full citation: Suzuki, H., Inadomi, J.M. and Hibi, T.; Japanese Herbal Medicine in Functional Gastrointestinal Disorders; Neurogastroenterology and Motility (2009); DOI: 10.1111/j.1365-2982.2009.01290.x
Neurogastroenterology & Motility is the official Journal of the European Society of Neurogastroenterology and Motility, the American Neurogastroenterology & Motility Society and the Functional Brain-Gut Research Group. Edited by Jan Tack, Keith Sharkey and Joseph Szurszewski, it has an ISI Journal Citation Reports® Ranking: 2007 of 14/50 (Gastroenterology & Hepatology) and 68/211 (Neurosciences), and an Impact Factor of 3.364. The field of gastrointestinal motility has undergone phenomenal growth and change in the past three decades since it emerged as a distinct speciality. Neurogastroenterology & Motility provides a forum where current issues and advances relating to the motor function of the GI tract can be presented and discussed. It is of interest to both clinicians and researchers. For further information please visit www3.interscience.wiley/journal/118498177/home
Wiley-Blackwell was formed in February 2007 as a result of the acquisition of Blackwell Publishing Ltd. by John Wiley & Sons, Inc., and its merger with Wiley's Scientific, Technical, and Medical business. Together, the companies have created a global publishing business with deep strength in every major academic and professional field. Wiley-Blackwell publishes approximately 1,400 scholarly peer-reviewed journals and an extensive collection of books with global appeal.
Source
Wiley-Blackwell
"Japanese herbal medicines have been used in East Asia for thousands of years," says lead researcher Hidekazu Suzuki, Associate Professor at the Keio University School of Medicine. "Our review of the world medical literature reveals that herbal medicines serve a valuable role in the management of patients with functional gastrointestinal disorders."
Many of the drugs used to treat GI motility disorders are ineffective or cause unwanted side effects and, in some cases, this has led to drugs being withdrawn from the market. Herbal medicine is an attractive alternative.
The researchers reviewed data from studies looking at the effect of several different Japanese herbal medicines including the use of Rikkunshi-to, Dai-Kenchu-to, and other herbal medicines. Rikkunshi-to, which is prepared from eight crude herbs, was effective in reducing discomfort caused by functional dyspepsia. Dai-Kenchu-to, a mixture of ginseng, ginger, and zanthoxylum fruit, was beneficial for constipation in children and patients suffering from post-operative ileus - disruption of normal bowel movements following an operation. Another herbal medicine, hangeshashin-to, reduced the severity and frequency of diarrhoea caused by anti-cancer drugs.
In Japan, herbal medicine is manufactured in standardised form with regards to quality and quantity of ingredients. The researchers say the health benefits of standardised formulations of herbal medicines require more rigorous examination, particularly in the Western world.
"There is a mandate to provide accurate data regarding the effectiveness of non-traditional therapy, not only to our patients but also to healthcare providers who face the dilemma of recommending or opposing management strategies that incorporate herbal medicine," says Suzuki.
Full citation: Suzuki, H., Inadomi, J.M. and Hibi, T.; Japanese Herbal Medicine in Functional Gastrointestinal Disorders; Neurogastroenterology and Motility (2009); DOI: 10.1111/j.1365-2982.2009.01290.x
Neurogastroenterology & Motility is the official Journal of the European Society of Neurogastroenterology and Motility, the American Neurogastroenterology & Motility Society and the Functional Brain-Gut Research Group. Edited by Jan Tack, Keith Sharkey and Joseph Szurszewski, it has an ISI Journal Citation Reports® Ranking: 2007 of 14/50 (Gastroenterology & Hepatology) and 68/211 (Neurosciences), and an Impact Factor of 3.364. The field of gastrointestinal motility has undergone phenomenal growth and change in the past three decades since it emerged as a distinct speciality. Neurogastroenterology & Motility provides a forum where current issues and advances relating to the motor function of the GI tract can be presented and discussed. It is of interest to both clinicians and researchers. For further information please visit www3.interscience.wiley/journal/118498177/home
Wiley-Blackwell was formed in February 2007 as a result of the acquisition of Blackwell Publishing Ltd. by John Wiley & Sons, Inc., and its merger with Wiley's Scientific, Technical, and Medical business. Together, the companies have created a global publishing business with deep strength in every major academic and professional field. Wiley-Blackwell publishes approximately 1,400 scholarly peer-reviewed journals and an extensive collection of books with global appeal.
Source
Wiley-Blackwell
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