Relation of Gallbladder Motility to Viscosity and Composition of Gallbladder Bile in Patients with Cholesterol Gallstones

Background/Aims: Increased viscosity and supersaturation of cholesterol in gallbladder bile, as well as an impaired motility of the gallbladder, are considered to be important factors in the pathogenesis of cholesterol gallstones. However, the relation of these parameters has not yet been determined. Material and Methods: Bile viscosity (mPa.s) was measured by rotation viscosimetry and the composition of gallbladder bile was determined using standard methodology. Gallbladder motility was calculated as ejection fraction in percent of total volume 45 min after a test meal using ultrasonography in patients with gallstones prior to elective cholecystectomy. Results: The study included 35 patients with cholesterol gallstones. Viscosity of gallbladder bile ranged between 0.9 and 12.5 mPa.s (median 2.2 mPa.s) and an ejection fraction of the gallbladder of 55.4 +/- 18.3% (mean +/- SD) was determined. No significant correlation (r = 0.19, p < 0.2) between the 2 parameters could be calculated. Analysis of the composition of gallbladder bile revealed a positive correlation of all components to biliary viscosity but not to the motility of the gallbladder, with the exceptions of a negative correlation (r = 0.39, p < 0.02) between mucin concentration and the ejection fraction at 45 min after the test meal. Conclusions: The motility of the gallbladder appears to be unrelated to the viscosity of gallbladder bile or gallbladder bile composition. The negative correlation between the ejection fraction of the gallbladder and mucin concentration of gallbladder bile suggests that chronic inflammation of the gallbladder wall is associated with both an impaired motility of the gallbladder and increased mucin release into gallbladder bile. Copyright (C) 2009 S. Karger AG, Base

Alkamides from Anacyclus pyrethrum L. and their in vitro antiprotozoal activity

In our ongoing study to evaluate the antiprotozoal activity of alkamides from Asteraceae, a dichloromethane extract from the roots of Anacycluspyrethrum L. showed a moderate in vitro activity against the NF54 strain of Plasmodium falciparum and against Leishmaniadonovani (amastigotes, MHOM/ET/67/L82 strain). Seven pure alkamides and a mixture of two further alkamides were isolated by column chromatography followed by preparative high performance liquid chromatography. The alkamides were identified by mass- and NMR-spectroscopic methods as tetradeca-2E,4E-dien-8,10-diynoic acid isobutylamide (anacycline, 1), deca-2E,4E-dienoic acid isobutylamide (pellitorine, 2), deca-2E,4E,9-trienoic acid isobutylamide (3), deca-2E,4E-dienoic acid 2-phenylethylamide (4), undeca-2E,4E-dien-8,10-diynoic acid isopentylamide (5), tetradeca-2E,4E,12Z-trien-8,10-diynoic acid isobutylamide (6), and dodeca-2E,4E-dien acid 4-hydroxy-2-phenylethylamide (7). Two compounds-undeca-2E,4E-dien-8,10-diynoic acid 2-phenylethylamide (8) and deca-2E,4E-dienoic acid 4-hydroxy-2-phenylethylamide (9)-were isolated as an inseparable mixture (1:4). Compounds 3, 4, and 5 were isolated from Anacycluspyrethrum L. for the first time. While compounds 4 and 5 were previously known from the genus Achillea, compound 3 is a new natural product, to the best of our knowledge. All isolated alkamides were tested in vitro for antiprotozoal activity against Plasmodium falciparum, Trypanosomabruceirhodesiense, Trypanosomacruzi, and Leishmaniadonovani and for cytotoxicity against L6 rat skeletal myoblasts

SCIL - Symbolic Constraints in Integer Linear Programming

We describe SCIL. SCIL introduces symbolic constraints into branch-and-cut-and-price algorithms for integer linear programs. Symbolic constraints are known from constraint programming and contribute significantly to the expressive power, ease of use, and efficiency of constraint programs

The social role of C-reactive protein point-of-care testing to guide antibiotic prescription in Northern Thailand

New and affordable point-of-care testing (POCT) solutions are hoped to guide antibiotic prescription and to help limit antimicrobial resistance (AMR)—especially in low- and middle-income countries where resource constraints often prevent extensive diagnostic testing. Anthropological and sociological research has illuminated the role and impact of rapid point-of-care malaria testing. This paper expands our knowledge about the social implications of non-malarial POCT, using the case study of a C-reactive-protein point-of-care testing (CRP POCT) clinical trial with febrile patients at primary-care-level health centres in Chiang Rai province, northern Thailand. We investigate the social role of CRP POCT through its interactions with (a) the healthcare workers who use it, (b) the patients whose routine care is affected by the test, and (c) the existing patient-health system linkages that might resonate or interfere with CRP POCT. We conduct a thematic analysis of data from 58 purposively sampled pre- and post-intervention patients and healthcare workers in August 2016 and May 2017. We find widespread positive attitudes towards the test among patients and healthcare workers. Patients’ views are influenced by an understanding of CRP POCT as a comprehensive blood test that provides specific diagnosis and that corresponds to notions of good care. Healthcare workers use the test to support their negotiations with patients but also to legitimise ethical decisions in an increasingly restrictive antibiotic policy environment. We hypothesise that CRP POCT could entail greater patient adherence to recommended antibiotic treatment, but it could also encourage riskier health behaviour and entail potentially adverse equity implications for patients across generations and socioeconomic strata. Our empirical findings inform the clinical literature on increasingly propagated point-of-care biomarker tests to guide antibiotic prescriptions, and we contribute to the anthropological and sociological literature through a novel conceptualisation of the patient-health system interface as an activity space into which biomarker testing is introduced

Assessment of cardiac rejection by MR-imaging and MR-spectroscopy

Background: Detection of cardiac rejection is a major problem in cardiac transplantation. The gold standard is, and remains, endomyocardial biopsy. Purpose: Evaluation of MR-imaging and MR-spectroscopy for detection of cardiac rejection. Methods: Orthotopic cardiac transplantation (HTX) was performed in 13 pigs (body weight 30 kg). All animals obtained immunosuppressive (triple) therapy for 1 week after the operation. Thereafter immunosuppression was stopped to induce cardiac rejection. MRI and MRS (1.5 Tesla General Electrics Signa) were performed pre- and post-operatively on days 10, 17, 24 and 31. The degree of rejection was determined post-operatively using endomyocardial biopsy (Texas grading score). Results: (1) MR-imaging: LV function remained unchanged after HTX. LV mass increased (+42%; P<0.05) with cardiac rejection. (2) MR-spectroscopy: a marked reduction in the ratio of phosphocreatine and adenosine triphosphate, respectively, to inorganic phosphate was observed in the rejecting hearts. (3) Histologic grading confirmed cardiac rejection after stopping immunosuppression. The Texas score was 5.7±0.8 at autopsy. Conclusions: MR-imaging and MR-spectroscopy allow the detection of changes associated with cardiac rejection. Both techniques are correlated with histologic rejection. However, endomyocardial biopsy remains the gold standard for reliable detection of cardiac rejectio

The ecoinvent Database: Overview and Methodological Framework (7 pp)

Introduction: This paper provides an overview on the content of the ecoinvent database and of selected metholodogical issues applied on the life cycle inventories implemented in the ecoinvent database. Goal, Scope and Background: In the year 2000, several Swiss Federal Offices and research institutes of the ETH domain agreed to a joint effort to harmonise and update life cycle inventory (LCI) data for its use in life cycle assessment (LCA). With the ecoinvent data-base and its actual data v1.1, a consistent set of more than 2'500 product and service LCIs is now available. Method: Nearly all process datasets are transparently documented on the level of unit process inputs and outputs. Methodological approaches have been applied consistently throughout the entire database content and thus guarantee for a coherent set of LCI data. This is particularly true for market and trade modelling (see, for example, electricity modelling), for the treatment of multi-out-put and of recycling processes, but also for the recording and reporting of elementary flows. The differentiation of diameter size for particulate matter emissions, for instance, allows for a more comprehensive impact assessment of human health effects. Data quality is quantitatively reported in terms of standard deviations of the amounts of input and output flows. In many cases qualitative indicators are reported additionally on the level of each individual input and output. The information sources used vary from extensive statistical works to individual (point) measurements or assumptions derived from process descriptions. However, all datasets passed the same quality control procedure and all information relevant and necessary to judge the suitability of a dataset in a certain context are provided in the database. Data documentation and exchange is based on the EcoSpold data format, which complies with the technical specification ISO/TS 14048. Free access to process information via the Internet helps the user to judge the appropriateness of a dataset. Concluding Remarks: The existence of the ecoinvent database proves that it is possible and feasible to build up a large interlinked system of LCI unit processes. The project work proved to be demanding in terms of co-ordination efforts required and consent identification. One main characteristic of the database is its transparency in reporting to enable individual assessment of data appropriateness and to support the plurality in methodological approaches. Outlook: Further work on the ecoinvent database may comprise work on the database content (new or more detailed data-sets covering existing or new economic sectors), LCI (modelling) methodology, the structure and features of the data-base system (e.g. extension of Monte Carlo simulation to the impact assessment phase) or improvements in eco-invent data supply and data query. Furthermore, the deepening and building up of international co-operations in LCI data collection and supply is in the focus of future activitie

Assessment of cardiac rejection by MR-imaging and MR-spectroscopy

Background: Detection of cardiac rejection is a major problem in cardiac transplantation. The gold standard is, and remains, endomyocardial biopsy. Purpose: Evaluation of MR-imaging and MR-spectroscopy for detection of cardiac rejection. Methods: Orthotopic cardiac transplantation (HTX) was performed in 13 pigs (body weight 30 kg). All animals obtained immunosuppressive (triple) therapy for 1 week after the operation. Thereafter immunosuppression was stopped to induce cardiac rejection. MRI and MRS (1.5 Tesla General Electrics Signa) were performed pre- and post-operatively on days 10, 17, 24 and 31. The degree of rejection was determined post-operatively using endomyocardial biopsy (Texas grading score). Results: (1) MR-imaging: LV function remained unchanged after HTX. LV mass increased (+42%; P<0.05) with cardiac rejection. (2) MR-spectroscopy: a marked reduction in the ratio of phosphocreatine and adenosine triphosphate, respectively, to inorganic phosphate was observed in the rejecting hearts. (3) Histologic grading confirmed cardiac rejection after stopping immunosuppression. The Texas score was 5.7±0.8 at autopsy. Conclusions: MR-imaging and MR-spectroscopy allow the detection of changes associated with cardiac rejection. Both techniques are correlated with histologic rejection. However, endomyocardial biopsy remains the gold standard for reliable detection of cardiac rejection

How context can impact clinical trials : a multi-country qualitative case study comparison of diagnostic biomarker test interventions

Background Context matters for the successful implementation of medical interventions, but its role remains surprisingly understudied. Against the backdrop of antimicrobial resistance, a global health priority, we investigated the introduction of a rapid diagnostic biomarker test (C-reactive protein, or CRP) to guide antibiotic prescriptions in outpatient settings and asked, “Which factors account for cross-country variations in the effectiveness of CRP biomarker test interventions?” Methods We conducted a cross-case comparison of CRP point-of-care test trials across Yangon (Myanmar), Chiang Rai (Thailand), and Hanoi (Vietnam). Cross-sectional qualitative data were originally collected as part of each clinical trial to broaden their evidence base and help explain their respective results. We synthesised these data and developed a large qualitative data set comprising 130 interview and focus group participants (healthcare workers and patients) and nearly one million words worth of transcripts and interview notes. Inductive thematic analysis was used to identify contextual factors and compare them across the three case studies. As clinical trial outcomes, we considered patients’ and healthcare workers’ adherence to the biomarker test results, and patient exclusion to gauge the potential “impact” of CRP point-of-care testing on the population level. Results We identified three principal domains of contextual influences on intervention effectiveness. First, perceived risks from infectious diseases influenced the adherence of the clinical users (nurses, doctors). Second, the health system context related to all three intervention outcomes (via the health policy and antibiotic policy environment, and via health system structures and the ensuing utilisation patterns). Third, the demand-side context influenced the patient adherence to CRP point-of-care tests and exclusion from the intervention through variations in local healthcare-seeking behaviours, popular conceptions of illness and medicine, and the resulting utilisation of the health system. Conclusions Our study underscored the importance of contextual variation for the interpretation of clinical trial findings. Further research should investigate the range and magnitude of contextual effects on trial outcomes through meta-analyses of large sets of clinical trials. For this to be possible, clinical trials should collect qualitative and quantitative contextual information for instance on their disease, health system, and demand-side environment. Trial registration: ClinicalTrials.gov Identifiers NCT02758821 and NCT01918579

Smart linkification of content within applications

When a user initiates text selection within an application, the operating system can examine text content displayed within the application to predict text selection bounds along with a possible destination application for the selected text. Until the user initiates selection, there may be no indication that a piece of text content might be actionable. Further, the functionality may not work as intended in cases where application developers implement a custom operation for the input mode utilized for passing the text content and associated action from one application to another. With user permission, this disclosure applies regular expression parsing and neural network processing to the text portion of the on-screen content to detect text entities that might be actionable by the OS or other applications on the device. After merging the actionable text entities identified via either of the two techniques, the corresponding text is presented, e.g., by underlining the corresponding text and linking it to invoke the corresponding action

Prevention of neointimal proliferation by immunosuppression in synthetic vascular grafts

Objective: Immunosuppressive agents have been proposed to reduce neointimal hyperplasia in synthetic vascular grafts. Thus, the purpose of the present study was to evaluate the safety and efficacy of rapamycins (systemic vs. local vs. oral administration) and mycophenolate mofetil (MMF) to reduce intimal hyperplasia in infrarenal synthetic vascular grafts of the rat. Methods: Fifty-four Wistar rats (250 g) completed the study after a synthetic vascular graft (ePTFE, Gore-tex, 2 mm diameter, 10 mm length) was implanted end-to-end in the infrarenal aorta. The animals were divided into three groups: group 1 consisted of 12 control animals, group 2 consisted of 37 rats receiving rapamycins, either per os (RAD, 1.5 or 3 mg/kg), intraperitoneally (RPM, 1.5 or 3 mg/kg) or locally (RPM soaking of the graft); and in group 3 (n = 5), MMF (40 mg/kg) was administered orally. The animals were followed weekly with weight controls and signs of toxicity for 30 (n = 37) and 60 (n = 17) days, respectively. All animals were sacrificed and underwent histological examination at completion of the study. Results: All animals survived in groups 1 and 3, but five died in group 2. The weight gain was normal in all groups, except for the subgroup 2a receiving high dose rapamycins orally. All rats in group 3 suffered from diarrhea, whereas animals receiving high dose rapamycins showed toxic signs (hair loss, wound healing problems). Histological examination showed a significant increase in intimal hyperplasia in group 1 (0.03±0.01 and 0.14±0.05 μm after 30 and 60 days, respectively; P < 0.01). Rapamycins in either application or dosage had no significant effect on intimal hyperplasia. Conclusions: Local or systemic administration of rapamycins has no effect on intimal hyperplasia in synthetic vascular grafts. In contrast, toxic signs with weight loss were observed in animals treated with high dose rapamycins, but not in those treated with MMF. Thus, in the rat model, immunosuppresssion with rapamycins or MMF cannot be recommended for the prevention of intimal hyperplasia in the synthetic vascular graft mode