Emerging treatment options for short bowel syndrome: potential role of teduglutide

INTRODUCTION: Current medical management of short bowel syndrome (SBS) involves the use of lifelong parenteral nutrition (PN). Glucagon-like peptide-2 (GLP-2), an important intestinotrophic growth factor has been shown to increase intestinal absorption in SBS through augmentation of post-resection intestinal adaptation. This may lead to the reduction of PN dependence in patients with SBS. AREAS COVERED IN REVIEW: Advancing research of GLP-2 physiology has spurred the growing understanding of the diverse effects of GLP-2. The development of the degradation resistant GLP-2 analog, teduglutide (Gattex(TM), NPS Pharmaceuticals, Bedminster, NJ), has allowed its exploration as a therapeutic agent in a variety of clinical settings. Recent multicenter, placebo-controlled studies of GLP-2 in SBS patients demonstrate meaningful reductions in PN requirements with good safety profiles. The reparative and immunomodulatory effects of teduglutide may also be beneficial in patients with inflammatory bowel disease (IBD). Safety concerns about possible carcinogenic properties during long-term use require ongoing evaluation. SUMMARY: GLP-2 appears to offer a novel adjuvant treatment modality for SBS. Promise for its use in other clinical settings like IBD has been shown in small pilot studies

Airbag-related chest wall burn as a marker of underlying injury: a case report

<p>Abstract</p> <p>Introduction</p> <p>This case of a man who sustained an airbag-induced thoracic injury and burn, highlights the potential harm that can be caused by airbags. It also serves to illustrate that a surface burn which looks small and benign can actually be a surface marker of a more serious injury. Staff working in emergency departments need to be aware of the risk of possible airbag-associated injuries.</p> <p>Case presentation</p> <p>A 65-year-old man was the driver in a frontal collision. He was wearing a seatbelt. The airbag was activated and caused a superficial chest wall burn. Initial chest x-rays were unremarkable but following deterioration in his condition, a computed tomography scan revealed a serious sternal fracture. The location of the fracture was marked on the surface by the burn.</p> <p>Conclusion</p> <p>Airbags can cause significant chest wall injuries and burns. Surface burns at the point of impact should not be dismissed as trivial as the forces involved can cause significant injury. We recommend that all people with chest wall injuries and/or burns due to airbags should have more detailed chest imaging as initial emergency radiographs can be falsely reassuring.</p

Coronary bypass grafting using crossclamp fibrillation does not result in reliable reperfusion of the myocardium when the crossclamp is intermittently released: a prospective cohort study

BACKGROUND: Cross-clamp fibrillation is a well established method of performing coronary grafting, but its clinical effect on the myocardium is unknown. We sought to measure these effects clinically using the Khuri Intramyocardial pH monitor. METHODS: 50 episodes of cross-clamping were recorded in 16 patients who underwent CABG with crossclamp-fibrillation. An Intramyocardial pH probe measured the level of acidosis in the anterior and posterior myocardium in real-time. The pH at the start and end of each period of cross-clamping was recorded. RESULTS: It became very apparent that the pH of some patients recovered quickly while others entirely failed to recover. Thus the patients were split into 2 groups according to whether the pH recovered to above 6.8 after the first crossclamp-release (N = 8 in each group). Initial pH was 7.133 (range 6.974–7.239). After the first period of crossclamping the pH dropped to 6.381 (range 6.034–6.684). The pH in recoverers prior to the second XC application was 6.990(range 6.808–7.222) compared to only 6.455 (range 6.200–6.737) in patient's whose myocardium did not recover (P < 0.0005). This finding was repeated after the second XC release (mean pH 7.005 vs 6.537) and the third (mean pH 6.736 vs 6.376). However prior to separation from bypass the pH was close to the initial pH in both groups (7.062 vs 7.038). CONCLUSION: Crossclamp fibrillation does not result in reliable reperfusion of the myocardium between periods of crossclamping

Contact metamorphism in the Malashan dome, North Himalayan gneiss domes, southern Tibet: An example of shallow extensional tectonics in the Tethys Himalaya

Combined petrographic, structural and geochronological study of the Malashan dome, one of the North Himalayan gneiss domes, reveals that it is cored by a Miocene granite, the Malashan granite, that intruded into the Jurassic sedimentary rocks of Tethys Himalaya. Two other granites in the area are referred to as the Paiku and Cuobu granites. New zircon SHRIMP U-Pb and muscovite and biotite 40Ar-39Ar dating show that the Paiku granite was emplaced during 22.2–16.2 Ma (average 19.3 ± 3.9 Ma) and cooled rapidly to 350–400 °C at around 15.9 Ma. Whole-rock granite chemistry suggests the original granitic magma may have formed by muscovite dehydration melting of a protolith chemically similar to the High Himalayan Crystalline Sequence. Abundant calcareous metasedimentary rocks and minor garnet-staurolite-biotite-muscovite ± andalusite schists record contact metamorphism by three granites that intruded intermittently into the Jurassic sediments between 18.5 and 15.3 Ma. Two stages of widespread penetrative ductile deformation, D1 and D2, can be defined. Microstructural studies of metapelites combined with geothermobarometry and pseudosection analyses yield P–T conditions of 4.8 ± 0.8 kbar at 550 ± 50 °C during a non-deformational stage between D1 and D2, and 3.1–4.1 kbar at 530–575 °C during syn- to post-D2. The pressure estimates for the syn- to post-D2 growth of andalusite suggest relatively shallow (depth of ∼15.2 km) extensional ductile deformation that took place within a shear zone of the South Tibetan Detachment System. Close temporal association between intrusion of the Malashan granite and onset of D2 suggests extension may have been triggered by the intrusion of the Malashan granite

Hypertensive Disorders of Pregnany and Offspring Cardiac Structure and Function in Adolescence

Background-Fetal exposure to preeclampsia is associated with higher blood pressure and later risk of stroke. We aimed to investigate the associations of maternal preeclampsia, gestational hypertension, and maternal blood pressure change in pregnancy with offspring cardiac structure and function in adolescence. Methods and Results-Using data from a prospective birth cohort study, we included offspring who underwent echocardiography (mean age, 17.7 years; SD, 0.3; N=1592). We examined whether hypertensive disorders of pregnancy were associated with offspring cardiac structure and systolic/diastolic function using linear regression. Using multilevel linear spline models (measurement occasions within women), we also investigated whether rate of maternal systolic/diastolic blood pressure change during pregnancy (weeks 8-18, 18-30, 30-36, and 36 or more) were associated with offspring outcomes. Main models were typically adjusted for maternal age, offspring age and sex, prepregnancy body mass index, parity, glycosuria/diabetes mellitus, education, and maternal smoking. Exposure to maternal preeclampsia (0.025; 95% CI, 0.008-0.043) and gestational hypertension (0.010; 0.002-0.017) were associated with greater relative wall thickness. Furthermore, preeclampsia was also associated with a smaller left ventricular end-diastolic volume (-9.0 mL; -15 to -3.1). No associations were found between hypertensive disorders of pregnancy and offspring cardiac function. Positive rate of maternal systolic blood pressure change during weeks 8 to 18 was associated with greater offspring left ventricular end-diastolic volume, left ventricular mass indexed to height2.7, and E/A. Conclusions-Adolescent offspring exposed to maternal preeclampsia had greater relative wall thickness and reduced left ventricular end-diastolic volume, which could be early signs of concentric remodeling and affect future cardiac function as well as risk of cardiovascular disease

Middle to Late Miocene Extremely Rapid Exhumation and Thermal Reequilibration in the Kung Co Rift, Southern Tibet

The Kung Co rift is an approximately NNW striking, WSW dipping normal fault exposed in southern Tibet and is part of an extensive network of active approximately NS striking normal faults exposed across the Tibetan Plateau. Detailed new and published (U-Th)/He zircon and apatite thermochronometric data from the footwall of the early Miocene Kung Co granite provide constraints on the middle Miocene to present-day exhumation history of the footwall to the Kung Co fault. Inverse modeling of thermochronometric data yield age patterns that are interpreted as indicating (1) initiation of normal fault slip at ∼12–13 Ma and rapid exhumation of the footwall between ∼13 and 10 Ma, (2) acceleration of normal fault slip at rates of 21.9–6.9 mm/yr at ∼10 Ma, (3) rapid thermal reequilibration between 10 and 9 Ma, and (4) slow exhumation and/or quiescence from ∼9 Ma to the present day. Hanging glacial valleys in the footwall and fault scarps that cut late Quaternary till and moraine deposits indicate that fault slip continues today. Middle to late Miocene initiation of extension across the Kung Co rift is broadly the same as the documented initiation of EW extension across the south central Tibetan Plateau. Eastward flow of middle or lower crust from beneath Tibet accommodated by northward underthrusting of Indian crust beneath Tibet provides a plausible explanation for the onset of EW extension across the Tibetan Plateau

The use of the triptycene framework for observing O⋯C=O molecular interactions

The triptycene skeleton has been used to measure (1,5) interactions between aldehyde groups, placed at both sp³ centres, and hydroxy or methoxy groups, placed at the respective ortho position on a benzene ring; HO⋯CHO interactions of 2.621–2.624 Å and MeO⋯CHO interactions of 2.528–2.584 Å were observed with the O⋯C vector making angles of 105.3–133.7° with the carbonyl bond. The lack of a competing conjugation with the framework for the electrophilic group is a favourable factor compared to the use of peri-naphthalene systems

Microscopy and chemical analyses reveal flavone-based woolly fibres extrude from micron-sized holes in glandular trichomes of Dionysia tapetodes.

BackgroundDionysia tapetodes, a small cushion-forming mountainous evergreen in the Primulaceae, possesses a vast surface-covering of long silky fibres forming the characteristic "woolly" farina. This contrasts with some related Primula which instead form a fine powder. Farina is formed by specialized cellular factories, a type of glandular trichome, but the precise composition of the fibres and how it exits the cell is poorly understood. Here, using a combination of cell biology (electron and light microscopy) and analytical chemical techniques, we present the principal chemical components of the wool and its mechanism of exit from the glandular trichome.ResultsWe show the woolly farina consists of micron-diameter fibres formed from a mixture of flavone and substituted flavone derivatives. This contrasts with the powdery farina, consisting almost entirely of flavone. The woolly farina in D. tapetodes is extruded through specific sites at the surface of the trichome's glandular head cell, characterised by a small complete gap in the plasma membrane, cell wall and cuticle and forming a tight seal between the fibre and hole. The data is consistent with formation and thread elongation occurring from within the cell.ConclusionsOur results suggest the composition of the D. tapetodes farina dictates its formation as wool rather than powder, consistent with a model of thread integrity relying on intermolecular H-bonding. Glandular trichomes produce multiple wool fibres by concentrating and maintaining their extrusion at specific sites at the cell cortex of the head cell. As the wool is extensive across the plant, there may be associated selection pressures attributed to living at high altitudes