Post-prandial reactive hypoglycaemia and diarrhea caused by idiopathic accelerated gastric emptying: a case report

RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are.Abstract Introduction The majority of cases of post-prandial reactive hypoglycemia are considered idiopathic. Abnormalities of B-cell function and glucose regulation by insulin and glucagon have been postulated as causes but associated gastrointestinal dysfunction has not been reported. We report the first case of accelerated gastric emptying associated with post-prandial reactive hypoglycemia, abdominal bloating and diarrhea. We consider that gastric dysmotility is an important cause of this condition as treatment of the underlying abnormal gastric emptying allows effective control of symptoms. Case presentation A 20-year-old Caucasian woman presented with post-prandial fatigue, sweating, nausea, faintness and intermittent confusion, which had led to pre-syncope and syncope on occasions. She also experienced marked abdominal bloating and diarrhea over the same period. These episodes responded to oral administration of sweet drinks. Her symptoms were ameliorated by modification of her diet. Conclusion This is an original case report of the association of idiopathic accelerated gastric emptying with post-prandial reactive hypoglycemia and diarrhea. Family physicians, endocrinologists and gastroenterologists often consult patients with a constellation of post-prandial symptoms, which are considered to be idiopathic in most cases. This case indicates that gastric dysmotility might be the primary cause of these symptoms in some patients and, if found, offers a therapeutic target which in our case was successful.Peer Reviewe

Idiopathic accelerated gastric emptying presenting in adults with post-prandial diarrhea and reactive hypoglycemia: a case series.

RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are.INTRODUCTION: We have previously reported the association of gastrointestinal and hypoglycemic symptoms, with idiopathic accelerated gastric emptying. We now report the first series of six similar cases. CASE PRESENTATIONS: Patient 1: A 24-year-old Caucasian man presented to our facility with a six-month history of post-prandial nausea, flatulence, bloating, abdominal discomfort and associated diarrhea. He had associated episodes of fatigue, sweating, anxiety, confusion and craving for sweet foods. Patient 2: A 52-year-old Caucasian woman presented to our facility with a 15-year history of post-prandial bloating, abdominal pain and diarrhea, often associated with nausea, severe sweating, and fatigue. Patient 3: An 18-year-old Caucasian woman presented to our facility with a nine-year history of post-prandial diarrhea, abdominal bloating and pain. There was associated nausea, tremor, lethargy, and craving for sweet foods. Patient 4: A 77-year-old Caucasian woman presented to our facility with a four-month history of epigastric distension, pain after eating and a change in bowel habit. She experienced intermittent severe diarrhea and marked fatigue, nausea and sweating. Patient 5: A 23-year-old Caucasian woman presented to our facility with a two-year history of early satiety, and diarrhea after eating. She also complained of feeling faint and weak between meals, when she became cold and clammy, and on several occasions lost consciousness during these episodes. Patient 6: A 64-year-old Caucasian woman presented to our facility with a 10-year history of nausea, early satiety and profound bloating followed by diarrhea. All symptoms predominantly occurred in the first three hours after eating, when she felt faint, lethargic, and had a craving for sweet foods. In all cases, symptoms were alleviated or resolved by taking sweet food or drink and response to treatment was 90% or greater in all cases. CONCLUSIONS: This series extends our description of this new clinical syndrome. All patients responded well to treatment for accelerated gastric emptying. Clinicians in the disciplines of endocrinology, gastroenterology, neurology and general practice are likely to find this information useful as they will consult patients with some or all of these symptoms and in a proportion of these patients idiopathic accelerated gastric emptying may be present and provide a useful avenue for therapeutic intervention

How Engineering Standards are Interpreted and Translated for Middle School

In this exploratory study we examined the alignment of Next Generation Science Standards (NGSS) middle school engineering design standards with lesson ideas from middle school teachers, science education faculty, and engineering faculty (4–6 members per group). Respondents were prompted to provide plain language interpretations of two middle school Engineering Design performance expectations and to provide examples of how the performance expectations could be applied in middle school classrooms. Participants indicated the challenges and benefits of implementing these performance expectations and indicated personal experiences that helped them to interpret the performance expectations. Quality of lessons differed depending on the performance expectation being addressed. Generally, respondents were better able to generate ideas that addressed the paradigm of students ‘‘analyz[ing] data from tests to determine similarities and differences among several design solutions’’ than having students ‘‘define the criteria and constraints of a design problem.’’ A notable finding was the scarcity of quality engineering lesson ideas. The greatest proportion of lessons were categorized as Vague and/or Overly Broad. It appears that NGSS engineering design standards can too easily be decoded in an excessively expansive manner, thus resulting in indefinite ideas that are difficult to translate into classroom practice

Interventions for treating cholestasis in pregnancy (Review)

BACKGROUND: Obstetric cholestasis has been linked to adverse maternal and fetal/neonatal outcomes. As the pathophysiology is poorly understood, therapies have been empiric. The first version of this review, published in 2001, and including nine randomised controlled trials involving 227 women, concluded that there was insufficient evidence to recommend any of the interventions alone or in combination. This is the first update. OBJECTIVES: To evaluate the effectiveness and safety of therapeutic and delivery interventions in women with cholestasis of pregnancy. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (20 February 2013) and reference lists of identified studies. SELECTION CRITERIA: Randomised controlled trials that compared two intervention strategies for women with a clinical diagnosis of obstetric cholestasis. DATA COLLECTION AND ANALYSIS: The review authors independently assessed trials for eligibility and risk of bias. We independently extracted data and checked these for accuracy. MAIN RESULTS: We included 21 trials with a total of 1197 women. They were mostly at moderate to high risk of bias. They assessed 11 different interventions resulting in 15 different comparisons.Compared with placebo, ursodeoxycholic acid (UDCA) showed improvement in pruritus in five (228 women) out of seven trials. There were no significant differences in instances of fetal distress in the UDCA groups compared with placebo (average risk ratio (RR) 0.67; 95% confidence interval (CI) 0.22 to 2.02; five trials, 304 women; random-effects analysis: T² = 0.74; I² = 48%). There were significantly fewer total preterm births with UDCA (RR 0.46; 95% CI 0.28 to 0.73; two trials, 179 women). The difference for spontaneous preterm births was not significant (RR 0.99; 95% CI 0.41 to 2.36, two trials, 109 women).Two trials (48 women) reported lower (better) pruritus scores for S-adenosylmethionine (SAMe) compared with placebo, while two other trials of 34 women reported no significant differences between groups.UDCA was more effective in improving pruritus than either SAMe (four trials; 133 women) or cholestyramine (one trial; 84 women), as was combined UDCA+SAMe when compared with placebo (one trial; 16 women) and SAMe alone (two trials; 68 women). However, combined UDCA+SAMe was no more effective than UDCA alone in regard to pruritus improvement (one trial; 53 women) and two trials (80 women) reported data were insufficient to draw any conclusions from. In one trial comparing UDCA and dexamethasone (83 women), a significant improvement with UDCA was seen only in a subgroup of women with severe obstetric cholestasis (23 women).Danxiaoling significantly improved pruritus in comparison to Yiganling. No significant differences were seen in pruritus improvement with other interventions.Eight trials reported fetal or neonatal deaths, with two deaths reported overall (both in the placebo groups).Women receiving UDCA and cholestyramine experienced nausea, vomiting and diarrhoea. Guar gum caused mild abdominal distress, diarrhoea and flatulence during the first days of treatment. Women found charcoal suspension unpleasant to swallow. Dexamethasone caused nausea, dizziness and stomach pain in one woman.One trial (62 women) looked at the timing of delivery intervention. There were no stillbirths or neonatal deaths in 'early delivery' or the 'await spontaneous labour' group. There were no significant differences in the rates of caesarean section, meconium passage or admission to neonatal intensive care unit between the two groups. AUTHORS' CONCLUSIONS: Different approaches to assessing and reporting pruritus precluded pooling of trials comparing the effects of UDCA versus placebo on pruritus, but examination of individual trials suggests that UDCA significantly improves pruritus, albeit by a small amount. Fewer instances of fetal distress/asphyxial events were seen in the UDCA groups when compared with placebo but the difference was not statistically significant. Large trials of UDCA to determine fetal benefits or risks are needed.A single trial was too small to rule in or out a clinically important effect of early term delivery on caesarean section.There is insufficient evidence to indicate that SAMe, guar gum, activated charcoal, dexamethasone, cholestyramine, Salvia, Yinchenghao decoction (YCHD), Danxioling and Yiganling, or Yiganling alone or in combination are effective in treating women with cholestasis of pregnancy

Enhanced Engraftment of a Very Low-Dose Cord Blood Unit in an Adult Haemopoietic Transplant by Addition of Six Mismatched Viable Cord Units

The report describes the feasibility of the addition of multiple viable HLA-mismatched unrelated cord blood units, to a low cell number matched unrelated cord, to assist clinical engraftment. An ablative stem cell transplant was performed in an adult with relapsed acute lymphoblastic leukaemia (ALL), using a single HLA-matched cord blood unit (mononuclear cell dose 0.8 × 107), supported by six mismatched cord blood units (one unit per 10 kg recipient weight). No adverse reaction occurred following the infusion of mismatched units and engraftment of the suboptimal-dose matched unit occurred rapidly, with no molecular evidence of engraftment of mismatched cords. Early molecular remission of ALL was demonstrated using a novel PCR for a mitochondrial DNA mutation in the leukaemic clone. The cell dose of the matched cord was well below that recommended to engraft a 70 kg recipient. We suggest that a factor or factors in the mismatched cords enhanced/supported engraftment of the matched cord

Conversion of a non-selective adenosine receptor antagonist into A3-selective high affinity fluorescent probes using peptide-based linkers

Advances in fluorescence-based imaging technologies have helped propel the study of real-time biological readouts and analysis across many different areas. In particular the use of fluorescent ligands as chemical tools to study proteins such as G protein-coupled receptors (GPCRs) has received ongoing interest. Methods to improve the efficient chemical synthesis of fluorescent ligands remain of paramount importance to ensure this area of bioanalysis continues to advance. Here we report conversion of the non-selective GPCR adenosine receptor antagonist Xanthine Amine Congener into higher affinity and more receptor subtype-selective fluorescent antagonists. This was achieved through insertion and optimisation of a dipeptide linker between the adenosine receptor pharmacophore and the fluorophore. Fluorescent probe 27 containing BODIPY 630/650 (pKD = 9.12 ± 0.05 [hA3AR]), and BODIPY FL-containing 28 (pKD = 7.96 ± 0.09 [hA3AR]) demonstrated clear, displaceable membrane binding using fluorescent confocal microscopy. From in silico analysis of the docked ligand-receptor complexes of 27, we suggest regions of molecular interaction that could account for the observed selectivity of these peptide-linker based fluorescent conjugates. This general approach of converting a non-selective ligand to a selective biological tool could be applied to other ligands of interest

The HYSPIRI Decadal Survey Mission: Update on the Mission Concept and Science Objectives for Global Imaging Spectroscopy and Multi-Spectral Thermal Measurements

The NASA HyspIRI mission is planned to provide global solar reflected energy spectroscopic measurement of the terrestrial and shallow water regions of the Earth every 19 days will all measurements downlinked. In addition, HyspIRI will provide multi-spectral thermal measurements with a single band in the 4 micron region and seven bands in the 8 to 12 micron region with 5 day day/night coverage. A direct broadcast capability for measurement subsets is also planned. This HyspIRI mission is one of those designated in the 2007 National Research Council (NRC) Decadal Survey: Earth Science and Applications from Space. In the Decadal Survey, HyspIRI was recognized as relevant to a range of Earth science and science applications, including climate: "A hyperspectral sensor (e.g., FLORA) combined with a multispectral thermal sensor (e.g., SAVII) in low Earth orbit (LEO) is part of an integrated mission concept [described in Parts I and II] that is relevant to several panels, especially the climate variability panel." The HyspIRI science study group was formed in 2008 to evaluate and refine the mission concept. This group has developed a series of HyspIRI science objectives: (1) Climate: Ecosystem biochemistry, condition & feedback; spectral albedo; carbon/dust on snow/ice; biomass burning; evapotranspiration (2) Ecosystems: Global plant functional types, physiological condition, and biochemistry including agricultural lands (3) Fires: Fuel status, fire frequency, severity, emissions, and patterns of recovery globally (4) Coral reef and coastal habitats: Global composition and status (5) Volcanoes: Eruptions, emissions, regional and global impact (6) Geology and resources: Global distributions of surface mineral resources and improved understanding of geology and related hazards These objectives are achieved with the following measurement capabilities. The HyspIRI imaging spectrometer provides: full spectral coverage from 380 to 2500 at 10 nm sampling; 60 m spatial sampling with a 150 km swath; and fully downlinked coverage of the Earth's terrestrial and shallow water regions every 19 days to provide seasonal cloud-free coverage of the terrestrial surface. The HyspIRI Multi-Spectral Thermal instrument provides: 8 spectral bands from 4 to 12 microns; 60 m spatial sampling with a 600 km swath; and fully downlinked coverage of the Earth's terrestrial shallow water regions every 5 days (day/night) to provide nominally cloud-free monthly coverage. The HyspIRI mission also includes an on-board processing and direct broadcast capability, referred to as the Intelligent Payload Module (IPM), which will allow users with the appropriate antenna to download a subset of the HyspIRI data stream to a local ground station. These science and science application objectives are critical today and uniquely addressed by the combined imaging spectroscopy, thermal infrared measurements, and IPM direct broadcast capability of HyspIRI. Two key objectives are: (1) The global HyspIRI spectroscopic measurements of the terrestrial biosphere including vegetation composition and function to constrain and reduce the uncertainty in climate-carbon interactions and terrestrial biosphere feedback. (2) The global 8 band thermal measurements to provide improved constraint of fire related emissions. In this paper the current HyspIRI mission concept that has been reviewed and refined to its current level of maturity with a Data Products Symposium, Science Workshop and NASA HWorkshop is presented including traceability between the measurements and the science and science application objectives

Surface Zeta Potential and Diamond Seeding on Gallium Nitride Films.

The measurement of ζ potential of Ga-face and N-face gallium nitride has been carried out as a function of pH. Both of the faces show negative ζ potential in the pH range 5.5-9. The Ga-face has an isoelectric point at pH 5.5. The N-face shows a more negative ζ potential due to larger concentration of adsorbed oxygen. The ζ potential data clearly showed that H-terminated diamond seed solution at pH 8 will be optimal for the self-assembly of a monolayer of diamond nanoparticles on the GaN surface. The subsequent growth of thin diamond films on GaN seeded with H-terminated diamond seeds produced fully coalesced films, confirming a seeding density in excess of 1011 cm-2. This technique removes the requirement for a low thermal conduction seeding layer like silicon nitride on GaN