Search

A decision prohibiting student access to coronial autopsies in Auckland, New Zealand, was recently discussed in the British Medical Journal (O’Grady, 2003). Clinical and ethical implications aside, the prohibition brought an end to the Breakfast Club, a remarkable community of post-mortem learning. Over 20 years of voluntary attendance at autopsy, this group of students established a self-directed curriculum based around daily encounters at the post-mortem table. The success of the group testifies to the ongoing value of the autopsy as a medical teaching medium in the current era.

Interstitial cells of Cajal (ICC) generate slow waves. Disrupted ICC networks and gastric dysrhythmias are each associated with gastroparesis. However, there are no data on the initiation and propagation of slow waves in gastroparesis because research tools have lacked spatial resolution. We applied high-resolution electrical mapping to quantify and classify gastroparesis slow-wave abnormalities in spatiotemporal detail.Serosal high-resolution mapping was performed using flexible arrays (256 electrodes; 36 cm(2)) at stimulator implantation in 12 patients with diabetic or idiopathic gastroparesis. Data were analyzed by isochronal mapping, velocity and amplitude field mapping, and propagation animation. ICC numbers were determined from gastric biopsy specimens.Mean ICC counts were reduced in patients with gastroparesis (2.3 vs 5.4 bodies/field; P.001). Slow-wave abnormalities were detected by high-resolution mapping in 11 of 12 patients. Several new patterns were observed and classified as abnormal initiation (10/12; stable ectopic pacemakers or diffuse focal events; median, 3.3 cycles/min; range, 2.1-5.7 cycles/min) or abnormal conduction (7/10; reduced velocities or conduction blocks; median, 2.9 cycles/min; range, 2.1-3.6 cycles/min). Circumferential conduction emerged during aberrant initiation or incomplete block and was associated with velocity elevation (7.3 vs 2.9 mm s(-1); P = .002) and increased amplitudes beyond a low base value (415 vs 170 μV; P = .002).High-resolution mapping revealed new categories of abnormal human slow-wave activity. Abnormalities of slow-wave initiation and conduction occur in gastroparesis, often at normal frequency, which could be missed by tests that lack spatial resolution. Irregular initiation, aberrant conduction, and low amplitude activity could contribute to the pathogenesis of gastroparesis.

Introduction Gastric smooth muscle layers are electrically excited by slow waves. In the normal stomach, slow waves propagate longitudinally in ring wavefronts from the upper corpus to the distal antrum. Circumferential propagation does not appear to occur, likely because there is no excitable tissue available circumferentially in these rings. However, rapid circumferential propagation has been observed in isolated gastric tissues and during gastric pacing. In this study, the propagation profiles of slow wave behaviors in diabetic gastroparesis were defined at high resolution (HR). The hypothesis was that circumferential propagation occurs during dysrhythmia, presenting a novel marker of gastric electrical dysfunction. Methods HR (multi-electrode) mapping was performed in 7 patients with diabetic gastroparesis undergoing laparotomy for stimulator implantation. Anterior serosal recordings were taken using flexible PCB arrays (256 electrodes; 4 mm spacing; 36cm2), and activation mapping was performed. Velocity fields were calculated using a finite difference approach incorporating a Gaussian filter smoothing function. Amplitudes were calculated using a peak-trough detection algorithm. Longitudinal and circumferential propagation data from corpus recordings were compared with Student's t-test. Means±SEM are reported. Results Atypical or dysrhythmic propagation was observed in 6/7 patients, including incomplete conduction block, complete block with escape, ectopic pacemaking in the corpus and antral tachygastria (freq range: 2.7-4.2 cpm). Circumferential propagation was associated with all of these events (circumferential velocity 6.6 ± 0.9 mm/s vs longitudinal velocity 2.9 ± 0.2 mm/s; p

Escherichia coli (O111:B4) and afterwards re-incubated for 24h in LPS-free culture medium (washout) to verify the persistency of muscular alterations. Reactive oxygen species (ROS), GSH content, mitochondrial membrane potential and apoptosis weremeasured by cytofluorometry; phospho-NF-KB p65 by ELISA and biological activity by scanning micrometry. Results are expressed as mean±SE and analysed by ANOVA, p

abundant GIT epithelial expression of mShisa during development. We also confirm its upregulation at all stages of GIT development using RT-PCR. In addition, we demonstrate that FGFr2b expression pattern is co-distributed with mShisa in the developing GIT. Conclusion: Our data shows the abundant epithelial expression of mShisa and its up-regulation at all stages of GIT development. Furthermore, mShisa is known to bind Fgf receptors in the endoplasmic reticulum and Golgi complex where Fgf receptors are known to undergo posttranscriptional modification. Our findings suggest a potential regulatory role of mShisa on the FGF10/Fgfr2b signaling pathway.

The motility of the stomach is coordinated by an electrical activity termed “slow waves”, and slow-wave dysrhythmias contribute to motility disorders. One major method for clinically evaluating gastric dysrhythmias has been electrogastrography (EGG); however, the clinical utility of EGG is limited partly due to the uncertainty regarding its electrophysiological basis. In this study, a multiscale model of gastric slow waves was generated from a biophysically based continuum description of cellular electrical events, coupled with a subject-specific human stomach model and high-resolution electrical mapping data. The model was then applied using a forward-modeling approach, within an anatomical torso model, to define how slow wave activity summates to generate the EGG potentials. The simulated EGG potentials were shown to be spatially varying in amplitude (0.27–0.33 mV) and duration (9.2–15.3 s), and the sources of this variance were quantified with respect to the activation timings of the underlying slow wave activity. This model constitutes an improved theory of the electrophysiological basis of the EGG, and offers a framework for optimizing the placement of EGG electrodes, and for interpreting the EGG changes occurring in disease states.

For many years asthmatic patients have been told to avoid using feather filled pillows on their beds, although there is no evidence to support this practice. Strachan and Carey's case-control study is the first to have directly challenged this assumption.1 This study showed that, after exclusion of asthmatic subjects whose bedding had been changed because of their disease, pillows with synthetic fillings were a risk factor for severe asthma. In the light of this finding, we have compared pillows with synthetic and feather fillings for their content of Der p I, the major allergen of the house dust mite Dermatophagoides pteronyssinus. In December 1995 we took dust samples from nine pairs of pillows and analysed them for Der p I. Each pair consisted of one feather filled pillow and one …