Botulinum toxin in gastric submucosa reduces stimulated HCl production in rats

BACKGROUND: Botulinum toxin blocks acetylcholine release from nerve endings and acts as a long term, reversible inhibitor of muscle contraction as well as of salivary, sweat gland, adrenal and prostatic secretions. The aim of the present study is to investigate whether gastric submucosal injection of botulinum toxin type A reduces stimulated gastric production of HCl. METHODS: Sixty-four rats were randomized in two groups and laparotomized. One group was treated with botulinum toxin-A 10 U by multiple submucosal gastric injections, while the second group was injected with saline. Two weeks later, acid secretion was stimulated by pyloric ligation and acid output was measured. Body weight, food and water intake were also recorded daily. RESULTS: HCl production after pyloric ligation was found to be significantly lower in botulinum toxin-treated rats (657 ± 90.25 micromol HCl vs. 1247 ± 152. P = 0.0017). Botulinum toxin-treated rats also showed significantly lower food intake and weight gain. CONCLUSIONS: Botulinum toxin type A reduces stimulated gastric acidity. This is likely due either to inhibition of the cholinergic stimulation of gastric parietal cells, or to an action on the myenteric nervous plexuses. Reduction of growth and food intake may reflect both impaired digestion and decreased gastric motility

Credible knowledge: A pilot evaluation of a modified GRADE method using parent-implemented interventions for children with autism

Abstract Background Decision-making in child and youth mental health (CYMH) care requires recommendations that are developed through an efficient and effective method and are based on credible knowledge. Credible knowledge is informed by two sources: scientific evidence, and practice-based evidence, that reflects the "real world" experience of service providers. Current approaches to developing these recommendations in relation to CYMH will typically include evidence from one source or the other but do not have an objective method to combine the two. To this end, a modified version of the Grading Recommendations Assessment, Development and Evaluation (GRADE) approach was pilot-tested, a novel method for the CYMH field. Methods GRADE has an explicit methodology that relies on input from scientific evidence as well as a panel of experts. The panel established the quality of evidence and derived detailed recommendations regarding the organization and delivery of mental health care for children and youth or their caregivers. In this study a modified GRADE method was used to provide precise recommendations based on a specific CYMH question (i.e. What is the current credible knowledge concerning the effects of parent-implemented, early intervention with their autistic children?). Results Overall, it appeared that early, parent-implemented interventions for autism result in positive effects that outweigh any undesirable effects. However, as opposed to overall recommendations, the heterogeneity of the evidence required that recommendations be specific to particular interventions, based on the questions of whether the benefits of a particular intervention outweighs its harms. Conclusions This pilot project provided evidence that a modified GRADE method may be an effective and practical approach to making recommendations in CYMH, based on credible knowledge. Key strengths of the process included separating the assessments of the quality of the evidence and the strength of recommendations, transparency in decision-making, and the objectivity of the methods. Most importantly, this method combined the evidence and clinical experience in a more timely, explicit and simple process as compared to previous approaches. The strengths, limitations and modifications of the approach as they pertain to CYMH, are discussed

HAM56 antibody: a tool in the differential diagnosis between colorectal and gynecological malignancy.

HAM56, a monoclonal antibody first used to identify macrophages and endothelial cells, also stains many carcinomas (except those arising in the digestive tract). This property is useful in the differentiation between primary ovarian and metastatic colonic carcinomas in the ovary, or between gynecological (ovarian and endometrial) and colonic implants and lymph node metastases. This distinction is important as the prognoses of colorectal and gynecological malignancies differ significantly. Sixteen primary ovarian carcinomas (10 with peritoneal implants and 3 with lymph node metastases), eight cases of primary colonic carcinomas (four metastatic to ovary, four with peritoneal implants, and four with lymph node metastases), and three primary endometrial carcinomas, all with metastases to the ovary, were immunostained with the HAM56 antibody using the ABC immunoperoxidase technique. Linear membranous immunostaining was considered positive, whereas staining of mucin and debris was regarded as negative. Using these parameters, 15/16 ovarian primaries, 9/10 ovarian implants, 3/3 ovarian lymph node metastases, and 3/3 endometrial primaries and their ovarian metastases were positive. Colonic primaries, their ovarian metastases, peritoneal implants, and lymph node metastases were all negative. It is concluded that the HAM56 antibody is a useful tool in the distinction between colorectal and ovarian malignancies in those cases where the routine histological appearance may be ambiguous