Clostridium difficile enteritis: a new role for an old foe.

Background: Small bowel involvement of Clostridium difficile is increasingly encountered. Data on many management aspects are lacking.

Aim: To synthesis existing reports and assess the frequency, pathophysiology, outcomes, risk factors, diagnosis and management of C.

Behavioural studies of faecal continence in the rat.

Background: A behavioural animal model of faecal continence and/or incontinence would be of value in experimental studies of the mechanisms by which sacral neuromodulation can effect continence mechanisms in humans.

Aim: The aim of this behavioural study was to establish whether the rat, an obligate coprophagic species, exhibits patterns of faecal continence.

Methods: Standard rat cages were modified to consist of a food and drink area, a nesting area and an empty latrine area.

Correlations between colonic crypt mucin chemotype, inflammatory grade and Desulfovibrio species in ulcerative colitis.

Aim: The colonic mucus gel layer is composed of mucins that may be sulphated or sialyated. Sulphated mucins predominate in health while in ulcerative colitis (UC) sulphation is reduced. These differences result directly from inflammatory events.

Circulating fibrocytes and Crohn's disease.

Background: Despite advances in medical therapy, there remains no effective preventive or non-surgical therapeutic option for fibrostenotic Crohn's disease (CD). Symptomatic recurrences are common, necessitating reintervention. Intestinal fibroblasts mediate stricture formation, but their exact source is unclear.

Depth-dependent differences in community structure of the human colonic microbiota in health.

Objective: The aims of this study were to develop techniques for spatial microbial assessment in humans and to establish colonic luminal and mucosal spatial ecology, encompassing longitudinal and cross-sectional axes.

Design: A microbiological protected specimen brush was used in conjunction with a biopsy forceps to sample the colon in nine healthy volunteers undergoing colonoscopy. Terminal Restriction Fragment Length Polymorphism analysis was used to determine the major variables in the spatial organization of the colonic microbiota.

Effect of early membrane removal on the treatment of mandibular class II furcation defects--a controlled clinical trial with re-entry after 12 months.

In a previous study in dogs, the early removal of expanded polytetrafluoroethylene (ePTFE) membrane (2 weeks after placement) showed histomorphometric results (of new bone, cementum and periodontal ligament) similar to that obtained with membrane removal at 4 weeks after placement. This study evaluated the influence of early removal of an ePTFE membrane on the treatment of Class II furcation defects. Twelve patients who provided 12 pairs of mandibular furcation defects were recruited for the study.

The influence of CTGF single-nucleotide polymorphisms on outcomes in Crohn's disease.

Objective: To examine the association between single-nucleotide polymorphisms (SNPs) in CTGF (connective tissue growth factor) and patient outcomes after terminal ileal resection for Crohn's disease.

Background: The primary indication for intestinal resection in Crohn's disease is fibrostenotic terminal ileal disease. CTGF is a cytokine overexpressed in the intestine of patients with Crohn's disease that influences outcomes in other disease processes.

Infiltrating Foxp3(+) regulatory T cells from spontaneously tolerant kidney allografts demonstrate donor-specific tolerance.

Foxp3(+) regulatory T cells (Tregs) have an essential role in immune and allograft tolerance. However, in both kidney and liver transplantation in humans, FOXP3(+) Tregs have been associated with clinical rejection. Therefore, the role and function of graft infiltrating Tregs have been of great interest.

Enhanced suppression of the xenogeneic T-cell response in vitro by xenoantigen stimulated and expanded regulatory T cells.

Background: Strategies to prevent xenograft rejection while minimizing long-term immunosuppression need to be developed for successful xenotransplantaion. Polyclonally expanded human regulatory T cells (Treg) are known to suppress xenogeneic responses in vivo and in vitro. However, the risk of opportunistic infection and malignancy and the requirement for large numbers of Treg for effective suppression remain drawbacks to their clinical application.

Test performance characteristics of quantitative nucleic acid testing for polyomaviruses in kidney and kidney-pancreas transplant recipients.

Screening for polyoma BK virus (BK) using nucleic testing (NAT) is recommended for kidney and kidney-pancreas transplant recipients, but the performance characteristics of quantitative BK NAT at different thresholds of plasma BK viral loads are unclear. We aim to evaluate the diagnostic accuracy of quantitative BK NAT as an add-on test to qualitative polyoma NAT for the diagnosis of BK virus-associated nephropathy (BKVAN) in kidney and kidney transplant recipients. We calculated the test sensitivity, specificity, and predictive values at the different thresholds of plasma BK viral load for BKVAN.

Transplantation of xenogeneic islets: are we there yet?

Beta cell replacement therapy has been proposed as a novel therapy for the treatment of type 1 diabetes. The proof of concept has been demonstrated with successful islet allotransplantation. Islet xenotransplantation has been proposed as an alternative, more reliable, and infinite source of beta cells.

Prognostic significance of tumor budding in rectal cancer biopsies before neoadjuvant therapy.

Tumor budding is an increasingly important prognostic feature for pathologists to recognize. The aim of this study was to correlate intra-tumoral budding in pre-treatment rectal cancer biopsies with pathological response to neoadjuvant chemoradiotherapy and with long-term outcome. Data from a prospectively maintained database were acquired from patients with locally advanced rectal cancer who underwent neoadjuvant chemoradiotherapy.

Randomised controlled trial comparing early home biofeedback physiotherapy with pelvic floor exercises for the treatment of third-degree tears (EBAPT Trial).

Objective: To compare early home biofeedback physiotherapy with pelvic floor exercises (PFEs) for the initial management of women sustaining a primary third-degree tear.

Design: Single centre, randomised trial.

Setting: National Maternity Hospital, Dublin, Ireland.

Multicenter Australian trial of islet transplantation: improving accessibility and outcomes.

Whilst initial rates of insulin independence following islet transplantation are encouraging, long-term function using the Edmonton Protocol remains a concern. The aim of this single-arm, multicenter study was to evaluate an immunosuppressive protocol of initial antithymocyte globulin (ATG), tacrolimus and mycophenolate mofetil (MMF) followed by switching to sirolimus and MMF. Islets were cultured for 24 h prior to transplantation.

A shared vision to prevent heart disease and stroke through united action.

Cardiovascular diseases are the second and fourth leading causes of death in North Carolina, and when combined become the leading killers of North Carolinians. A key strategy for reducing this disease burden and saving lives is to focus on prevention through a combined approach of policy change and program implementation.

National trends in intestinal resection for Crohn's disease in the post-biologic era.

Introduction: Prior international datasets have demonstrated equivocal results in the rate of surgical procedures for the treatment of Crohn's disease (CD) following the introduction of biologic medications. The first biologic medication licensed for use in the Republic of Ireland (ROI) was infliximab in 1999. The current study examined national trends in intestinal resection for CD in the ROI following the introduction of biologic medications.

An unusual left upper quadrant mass: a bronchopulmonary foregut malformation.

We report a case of a lady who presented with epigastric discomfort. Physical examination revealed a large left upper quadrant mass filling the left upper quadrant. Following extensive preoperative evaluation, she underwent resection of this 9 × 10 × 11 centimeter mass with en bloc excision of a portion of the left hemidiaphragm.

Elevated B lymphocyte stimulator levels are associated with increased damage in an Irish systemic lupus erythematosus cohort.

Objective: The overall aim of this study is to identify clinical and serological features that are associated with B lymphocyte stimulator (BLyS) elevation in a homogeneous Caucasian SLE population and thereby identify patients who are most likely to benefit from BLyS blockade.

Methods: Patients with SLE (as per ACR criteria) were recruited. Clinical history, disease activity measures and laboratory measures of disease were recorded.

A comparative study of short- and medium-term outcomes comparing emergent surgery and stenting as a bridge to surgery in patients with acute malignant colonic obstruction.

Background: The use of self-expanding metal stents as a bridge to surgery in the setting of malignant colorectal obstruction has been advocated as an acceptable alternative to emergency surgery. However, concerns about the safety of stenting have been raised following recent randomized studies.

Objectives: The aim of the current study was to compare outcomes.

A survey of current practices used to maintain surgically induced remission following intestinal resection for Crohn's disease.

Background And Aims: Post-operative Crohn's disease (CD) recurrence is common after intestinal resection. The European Crohn's and Colitis Organization has issued guidelines regarding the optimal post-operative management of patients who have undergone intestinal resection for CD. The current study aims to assess the current adjuvant therapy practices of colorectal surgeons and gastroenterologists.

Management of colorectal cancer in patients with inflammatory bowel disease.

Background: This study evaluated the clinicopathological features and survival rates of patients with inflammatory bowel disease who developed colorectal cancer (CRC).

Methods: A retrospective review was performed on a prospectively maintained institutional database (1981-2011) to identify patients with inflammatory bowel disease who developed CRC. Clinicopathological parameters, management and outcomes were analysed.

Unravelling the connections between donor specific antibodies and renal allograft pathology.

The imperfections of early technologies for assessment of human leukocyte antigen (HLA) antibody specificity have been resolved by solid phase micro bead assays, but this has revealed new uncertainties. The relationship between presence of antibody specific for a donor HLA molecule to graft damage and outcomes has had to be re-evaluated. Studies of protocol biopsies have identified a correlation between donor specific antibody and electron microscopy (EM) changes at three months, which do not predict chronic antibody mediated rejection, but that are predicted by EM changes seen on 12-month protocol biopsies.