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Helicobacter pylori (H. pylori) is a highly prevalent bacterium in our environment, directly involved in various upper digestive tract diseases, such as gastritis, peptic ulcer, and gastric cancer. Several molecules activating the immune system have been reported to be involved in containing H. pylori infection. This study is aimed at analyzing the mRNA expression of the cytokines IFN-γ, IL-17, IL-10, TGF-β, IL-6, IL-22, IL-23, and IL-33; transcription factors T-bet, RORC, and FOXP3; enzymes ARG1, ARG2, and NOS2; and neuropeptides VIP and TAC and their respective receptors VIPR1 and TACR1 in the stomach lining of patients with severe digestive disorders. One hundred and twenty six patients have been evaluated, presenting with symptoms in the upper digestive tract, with the clinical indication for an Upper Digestive Endoscopy exam. Two fragments of the mucosa of the gastric body and antrum have been collected for anatomopathological examination and to analyze the expression of enzymes, cytokines, and transcription factors using qPCR. Expression of the ARG1 gene was seen as significantly higher in the group of patients with chronic inactive gastritis than in the control group. Expression of the TGF-β gene and its FOXP3 transcription factor was significantly higher in the group of chronic inactive gastritis patients than in the control. Expression of IFN-γ, IL-17, IL-10, and TGF-β and the transcription factors, T-bet and RORC, in the presence or absence of H. pylori showed no significant difference. However, the expression of FOXP3 was significantly lower in H. pylori-positive patients than that in H. pylori-negative patients. ARG1 and Treg profile appeared to be modulating the inflammatory process, protecting patients from the tissue lesions with chronic inactive gastritis. Furthermore, we suggest that IL-33 may be a crucial mediator of the immune response against an infection, after gastric mucosal damage.

Chronic constipation in children and adolescents is relatively common and a reason for consultation with pediatricians and proctologists. Most cases respond to medical treatment. Advanced cases of megacolon and megarectum can be treated surgically by Duhamel technique.This case report describes a 15-year-old patient with chronic intestinal constipation refractory to clinical treatment associated with megacolon and megarectum, which was surgically treated. Resumo: A constipação intestinal crônica em crianças e adolescentes é relativamente comum e motivo de consultas a pediatras e coloproctologistas. A maioria dos casos responde ao tratamento clínico. Casos avançados de megacolon e megarreto podem ser tratados cirurgicamente através da cirurgia de Duhamel.Este relato de caso descreve um paciente de 15 anos de idade com quadro de constipação intestinal crônica refratária ao tratamento clínico associada a megacolon e megarreto, o qual foi tratado cirurgicamente. Keywords: Megacolon, Megarectum, Duhamel, Palavras-chave: Megacolon, Megarreto, Duhamel

Objectives Galectins are mediators that play an important role in the inflammatory response and in this study we analyzed the expression of Galectins (Gal) −1, −3 and −9 in biopsies of the gastric antrum of patients with upper gastrointestinal symptoms. Methodology: 44 patients with upper digestive tract symptoms were evaluated, and underwent Upper Digestive Endoscopy examination. Sections of the gastric antrum were fixed in buffered formaldehyde at 4% in order to perform the anatomopathological examination and immunohistochemical analysis for Galectins-1, −3 and −9 expression. Fresh sections of gastric antrum were used for DNA extraction and evaluation of Helicobacter pylori ( H. pylori ). P values < 0.05 were considered statistically significant. Results Gal-1 was significantly more expressed on stroma than epithelium (p < 0.0001), whereas Gal-3 and Gal-9 were more expressed on epithelium (p < 0.0001). Gal-3 was found to be significantly higher in the stroma of patients with H. pylori infection, mainly on Cag-A positive H. pylori (p < 0.0001). Gal-9 was down modulated in stroma of patients with chronic gastritis. Conclusion Up modulation of Gal-3 expression was associated with H. pylori infection and down modulation of Gal-9 with the inflammatory process of chronic gastritis. [ABSTRACT FROM AUTHOR]

Transcatheter aortic valve replacement (TAVR) required precise knowledge of the anatomic dimensions and physical characteristics of the aortic valve, annulus, and aortic root. Most groups currently use angiography, transthoracic echocardiography (TTE), or transesophageal echocardiography (TEE) to assess aortic annulus dimensions and anatomy. However, multislice computed tomography (MSCT) may allow more detailed 3-dimensional assessment of the aortic root. Twenty-six patients referred for TAVR underwent MSCT. Scans were also obtained for 18 patients after TAVR. All patients underwent pre- and postprocedural aortic root angiography, TTE, and TEE. Mean differences in measured aortic annular diameters were 1.1 mm (95% confidence interval 0.5, 1.8) for calibrated angiography and TTE, -0.9 mm (95% confidence interval -1.7, -0.1 mm) for TTE and TEE, -0.3 mm (95% confidence interval -1.1, 0.6 mm) for MSCT (sagittal) and TTE, and -1.2 mm (95% confidence interval -2.2, -0.2 mm) for MSCT (sagittal) and TEE. Coronal systolic measurements using MSCT, which corresponded to angiographic orientation, were 3.2 mm (1st and 3rd quartiles 2.6, 3.9) larger than sagittal systolic measurements, which were in the same anatomic plane as standard TTE and TEE views. There was no significant association between either shape of the aortic annulus or amount of aortic valve calcium and development of perivalvular aortic regurgitation. After TAVR, the prosthesis extended to or beyond the inferior border of the left main ostium in 9 of 18 patients (50%), and in 11 patients (61%), valvular calcium was <5 mm from the left main ostium. In conclusion, MSCT identified that the aortic annulus was commonly eccentric and often oval. This may in part explain the small, but clinically insignificant, differences in measured aortic annular diameters with other imaging modalities. MSCT after TAVR showed close proximity of both the prosthesis and displaced valvular calcium to the left main ostium in most patients. Neither eccentricity nor calcific deposits appeared to contribute significantly to severity of paravalvular regurgitation after TAVR. [ABSTRACT FROM AUTHOR]

STUDY OBJECTIVE:s: To compare the clinical management and health outcomes of men and women after admission with acute coronary syndromes, after adjusting for disease severity, sociodemographic, and cardiac risk factors. DESIGN: Prospective national survey of acute cardiac admissions followed up by mailed patient questionnaire two to three years after initial admission. SETTING: Random sample of 94 district general hospitals in the UK. PATIENTS: 1064 patients under 70 years old recruited between April 1995 and November 1996. MAIN RESULTS: Of the 1064 patients recruited, 126 (11.8%) died before follow up. Of the 938 survivors, 719 (76.7%) completed a follow up questionnaire. There were no gender differences in the use of cardiac investigations during the index admission or follow up period. However, male patients with hypertension were more likely to undergo rehabilitation compared with female hypertensive patients (OR 2.01, 95% CI 0.85 to 4.72). Men were also more likely to undergo coronary artery bypass grafting (CABG) than women (OR 1.90, 95%CI 1.21 to 3.00), but there was no gender difference in the use of revascularisation overall (p=0.14). An indirect indication that the gender differences in CABG were not attributable to bias was provided by the lack of gender differences in health outcomes, which implies that patients received the care they needed. CONCLUSIONS: Despite the extensive international literature referring to a gender bias in favour of men with coronary heart disease, this national survey found no gender differences in the use of investigations or in revascularisation overall. However, the criteria used for selecting percutaneous transluminal coronary angioplasty compared with CABG requires further investigation as does the use of rehabilitation. It is unclear whether the clinical decisions to provide these procedures are made solely on the basis of clinical need. [ABSTRACT FROM AUTHOR]

Objective: To develop and test a cardiac prevention and rehabilitation programme for achieving sustained lifestyle, risk factor, and therapeutic targets in patients presenting for the first time with exertional angina, acute coronary syndromes, or coronary revascularisation.Design: A descriptive study.Setting: A hospital based 12 week outpatient programme.Interventions: A multiprofessional family based programme of lifestyle and risk factor modification.Main Outcome Measures: Non-smoking status, body mass index, blood pressure, plasma cholesterol, use of prophylactic drugs.Results: 158 patients (82% of 194 possible cases) were recruited over 15 months, with 72% completing the programme. Targets for achieving non-smoking status, blood pressure < 140/90 mm Hg, and total cholesterol < 4.8 mmol/l were achieved in 92%, 73%, and 62%, respectively, and the proportion on aspirin, beta blockers, and lipid lowering treatment was 95%, 58%, and 64% on referral back to general practice for continuing care.Conclusions: A comprehensive cardiac prevention and rehabilitation programme can be offered to all patients presenting for the first time with coronary heart disease, including those with exertional angina who are normally managed in primary care. Lifestyle, risk factor, and therapeutic targets can be successfully achieved in most patients with such a hospital based programme. [ABSTRACT FROM AUTHOR]

Background: Low to moderate alcohol consumption is associated with reduced mortality, primarily due to a reduction in coronary heart disease (CHD). Conversely, heavy drinking increases mortality, mainly due to haemorrhagic stroke and non-cardiovascular diseases. It is important to identify the threshold of alcohol consumption above which the balance of risk and benefit becomes adverse. We examine the relationship between reported alcohol consumption, cardiovascular disease (CVD) risk factors, a 10-year CHD risk score and hypertension in women.Methods: In all, 14 077 female employees aged 30-64 years, underwent screening for CVD risk factors. Information was available on a range of personal and lifestyle factors, including height, weight, blood pressure, lipids, lipoproteins, apolipoproteins and blood glucose. Age-adjusted means were computed for the risk factors in each of five groups of reported alcohol intake: <1 (non-drinkers), 1-7, 8-14, 15-21, > or = 22 units/week. The relationships between alcohol and a derived coronary risk score and hypertension were also examined.Results: Increasing consumption was associated with an age-adjusted increase in high density lipoprotein cholesterol (HDL-C) and apolipoprotein A1 (both P < 0.001), a decline in body mass index, total cholesterol (TC), TC/HDL-C ratio, low density lipoprotein cholesterol (LDL-C) and apolipoprotein B (all P < 0.001), and no trend in triglycerides (P = 0.06), lipoprotein (a) (P = 0.09) or fasting glucose (P = 0.14). Except for LDL-C (P = 0.06) the relationships remained statistically significant after adjustment for possible confounders. Compared to non-drinkers, there was a decrease in 10-year CHD risk with increasing consumption, with the greatest reduction in risk in women consuming 1-7 units/week, odds ratio (OR) = 0.79, (95% CI: 0.72-0.87), and an increase in the prevalence of hypertension among those consuming 15-21 units/week, OR = 1.68, (95% CI: 1.14-2.46).Conclusions: This study provides biological support for an inverse association between alcohol intake and CHD in women, associated with favourable changes in lipid and lipoprotein risk factors. Women consuming 1-14 units/week had a reduction in CHD risk, but there was an increased prevalence of hypertension among those consuming > or = 15 units/week. These data suggest that, in terms of the reduced risk of CVD, women should be advised to restrict their alcohol consumption to < or = 14 units/week. [ABSTRACT FROM AUTHOR]