75 research outputs found

    Bacterial infections in cirrhosis: Role of proton pump inhibitors and intestinal permeability

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    Background Cirrhotic patients are at considerable risk for bacterial infections, possibly through increased intestinal permeability and bacterial overgrowth. Proton pump inhibitors (PPIs) may increase infection risk. We aimed to explore the potential association between PPI use and bacterial infection risk in cirrhotic patients and potential underlying mechanisms in complementary patient and animal models. Materials and methods Bacterial overgrowth was determined in jejunum of 30 rats randomly allocated to 6-week PPI treatment, gastrectomy or no treatment. In 84 consecutive cirrhotic patients, bacterial infection risk was prospectively assessed and related to PPI use. Intestinal permeability was determined by polyethylene glycol (PEG) test in nine healthy individuals and 12 cirrhotic patients. Results Bacterial overgrowth was much more common in jejunum of rats treated with PPI or gastrectomy compared with nontreated rats. Twenty-four patients (29%) developed a bacterial infection during a median follow-up of 28months. Although PPI users tended to experience infection more often than patients without PPI therapy, PPI use was not an independent predictor of bacterial infection (HR 1路2, 95% CI 0路5-3路0, P=0路72), after correction for Child-Pugh class (HR 3路6, 95% CI 1路5-8路7, P=0路004) and age (HR 1路05, 95%CI 1路01-1路09, P=0路02). In cirrhotic patients, 24-h urinary recovery of PEGs 1500 and 3350 was significantly higher compared with healthy controls. Conclusions Although in our animal model PPIs induced intestinal overgrowth, stage of liver disease rather than PPI use was the predominant factor determining infection risk in cirrhotic patients. Increased intestinal permeability may be a factor contributing to infection risk

    Medicine in words and numbers: a cross-sectional survey comparing probability assessment scales

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    Contains fulltext : 56355.pdf ( ) (Open Access)Background / In the complex domain of medical decision making, reasoning under uncertainty can benefit from supporting tools. Automated decision support tools often build upon mathematical models, such as Bayesian networks. These networks require probabilities which often have to be assessed by experts in the domain of application. Probability response scales can be used to support the assessment process. We compare assessments obtained with different types of response scale. Methods / General practitioners (GPs) gave assessments on and preferences for three different probability response scales: a numerical scale, a scale with only verbal labels, and a combined verbal-numerical scale we had designed ourselves. Standard analyses of variance were performed. Results / No differences in assessments over the three response scales were found. Preferences for type of scale differed: the less experienced GPs preferred the verbal scale, the most experienced preferred the numerical scale, with the groups in between having a preference for the combined verbal-numerical scale. Conclusion / We conclude that all three response scales are equally suitable for supporting probability assessment. The combined verbal-numerical scale is a good choice for aiding the process, since it offers numerical labels to those who prefer numbers and verbal labels to those who prefer words, and accommodates both more and less experienced professionals.8 p

    Small bowel motility affects glucose absorption in a healthy man

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    WST臉P. Celem pracy by艂o wyja艣nienie zwi膮zku pomi臋dzy motoryk膮 dwunastnicy i jelita cienkiego a wch艂anianiem glukozy oraz ustalenie wp艂ywu zmiany motoryki jelita cienkiego na wch艂anianie glukozy po zastosowaniu substancji prokinetycznej - cizaprydu. MATERIA艁 I METODY. W badaniu wzi臋艂o udzia艂 7 zdrowych m臋偶czyzn, kt贸rych 艣rednia wieku wynosi艂a 22 lata. W spos贸b randomizowany badani otrzymywali cizapryd 10 mg 3 razy dziennie lub placebo, przez 3 dni. Po 2 tygodniach powtarzano pr贸b臋 z drugim preparatem. Rano 3 dnia badania wykonywano manometri臋 z u偶yciem 18-kana艂owego cewnika, wprowadzonego do dwunastnicy. Przez 30 minut badani otrzymywali przez cewnik p艂ynn膮 od偶ywk臋 (3 kcal/min), a nast臋pnie bolus analogu glukozy (3-OMG, 3-O-metyloglukoz臋). W celu oceny kinetyki wch艂aniania oznaczano w osoczu st臋偶enia 3-OMG. WYNIKI. Pole pod krzyw膮 st臋偶enia 3-OMG w pierwszych 30 minutach po podaniu dojelitowym by艂o zale偶ne od liczby ruch贸w robaczkowych rozchodz膮cych si臋 ortodromowo (r = 0,49, p < 0,05), ale nie wykazano zwi膮zku ze st臋偶eniem szczytowym, czasem do osi膮gni臋cia st臋偶enia szczytowego ani frakcj膮 wch艂oni臋t膮. 艢rednia amplituda ruch贸w robaczkowych by艂a wy偶sza przy podawaniu cizaprydu ni偶 placebo (p < 0,05), ale powr贸t motoryki w okresie mi臋dzyposi艂kowym, liczba ruch贸w robaczkowych i ich propagacja oraz charakterystyka wch艂aniania 3-OMG by艂y podobne przy stosowaniu cizaprydu i placebo. W obu typach leczenia propagacja ruch贸w robaczkowych w ponad 60% wynosi艂a jedynie 1,5 cm. WNIOSKI. Absorpcja glukozy w jelicie cienkim cz艂owieka wi膮偶e si臋 z propagacj膮 aktywno艣ci skurczowej jelita w zakresie kr贸tkich odcink贸w. Cizapryd zwi臋ksza amplitud臋 ruch贸w robaczkowych, ale nie wp艂ywa na ich organizacj臋 ani na wch艂anianie 3-OMG.INTRODUCTION. To investigate the relationship between duodenojejunal motor activity and glucose absorption and to evaluate the effect of modification of duodenojejunal motility on glucose absorption by using the prokinetic drug cisapride. MATERIAL AND METHODS. We examined seven healthy males, mean age 22 years, who were treated with cisapride 10 mg t.i.d. and placebo during 3 days in a randomized order, with a 2-week time interval. Duodenojejunal manometry was performed after each treatment on the morning of day 3, using an 18-lumen catheter. A liquid nutrient (3 kcal/min) was administered intraduodenally for 30 min, followed by a bolus of the glucose analog 3-O-methylglucose (3-OMG). Plasma 3-OMG concentrations were measured to assess absorption kinetics. RESULTS. The area under the 3-OMG concentration curve in the first 30 min after infusion was related to the number of antegrade propagated pressure waves (r = 0.49, P < 0.05), but not to the peak concentration, time to peak, and absorption fraction. The mean amplitude of pressure waves was higher during cisapride than placebo (P < 0.05), but the reoccurrence of interdigestive motility, numbers of pressure waves, and propagated pressure waves, as well as 3-OMG absorption characteristics, were not significantly different between the two treatments. During both treatments > 60% of antegrade propagated pressure waves were propagated over a very short distance (1.5 cm). CONCLUSIONS. Glucose absorption in the human small intestine is related to short-traveling propagated intestinal contractile activity. Cisapride increases the amplitude of pressure waves, but does not affect the organization of pressure waves or the absorption of 3-OMG

    Asymmetry in the renewal of molecular classes of phosphatidylcholine in the rat-erythrocyte membrane

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    1. 1. Rat-blood phospholipids were labeled in vivo with [32P]phosphate. The erythrocytes were treated with phospholipase A2 plus sphingomyelinase to discriminate between the labeling patterns of the phospholipids from the inner and outer layer of the membrane. 2. 2. The specific activities of the more unsaturated classes of phosphatidylcholine were higher in the outer layer of the erythrocyte membrane than in the inner layer. The disaturated class, however, had the highest specific activity in the inner layer. 3. 3. After incubating 32P-labeled erythrocytes in unlabeled plasma, the labeling pattern recovered in the molecular classes of plasma phosphatidylcholine was very similar to that of the phosphatidylcholines in the outer layer of the erythrocyte membrane. 4. 4. It is proposed that the exchange of phosphatidylcholines between plasma and the outer layer of the erythrocyte is mainly responsible for the renewal of the unsaturated phosphatidylcholines of the erythrocyte, and that the acylation activity of the erythrocyte is directed towards the formation of disaturated phosphatidylcholines at the inside of the membrane

    Asymmetry in the renewal of molecular classes of phosphatidylcholine in the rat-erythrocyte membrane

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    1. 1. Rat-blood phospholipids were labeled in vivo with [32P]phosphate. The erythrocytes were treated with phospholipase A2 plus sphingomyelinase to discriminate between the labeling patterns of the phospholipids from the inner and outer layer of the membrane. 2. 2. The specific activities of the more unsaturated classes of phosphatidylcholine were higher in the outer layer of the erythrocyte membrane than in the inner layer. The disaturated class, however, had the highest specific activity in the inner layer. 3. 3. After incubating 32P-labeled erythrocytes in unlabeled plasma, the labeling pattern recovered in the molecular classes of plasma phosphatidylcholine was very similar to that of the phosphatidylcholines in the outer layer of the erythrocyte membrane. 4. 4. It is proposed that the exchange of phosphatidylcholines between plasma and the outer layer of the erythrocyte is mainly responsible for the renewal of the unsaturated phosphatidylcholines of the erythrocyte, and that the acylation activity of the erythrocyte is directed towards the formation of disaturated phosphatidylcholines at the inside of the membrane

    Bone healing during lower limb lengthening by distraction epiphysiolysis

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    A study of limb lengthening by distraction epiphysiolysis in the rabbit tibia is presented. A special external distraction device was developed that allowed 10 mm lengthening of the leg. Bone formation in the elongated zone was studied by computed tomography and [99mTc] methylene diphosphate (MDP) scintigraphy. Computed tomography showed bone formation proceeding for several weeks after the end of the distraction period, followed by a decrease in the amount of bone during a remodeling phase leading to the formation of a solid cortical structure. The uptake of [99mTc]MDP increased parallel to, but preceeding the actual accretion of bone, followed by a decrease during the bone remodeling phase. Uptake of the tracer will partly reflect bone metabolism, but other factors, like trauma, determine much of the uptake
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