Flexible Sigmoidoscopy Rather than Colonoscopy Is Adequate for the Diagnosis of Ipilimumab-Associated Colitis.

Objectives: Treatment with ipilimumab, a cytotoxic T lymphocyte antigen-4 approved for metastatic melanoma can result in clinically significant immune-mediated drug injury in the form of colitis. Timely diagnosis and response are essential for optimal management. The aims of our study were to determine the percentage of our patients with ipilimumab-associated colitis in which the colitis could be diagnosed by flexible sigmoidoscopy only and to describe the variations in endoscopic and histologic findings as well as the patients' clinical courses.

Bone marrow-derived cPLA2α contributes to renal fibrosis progression.

The group IVA calcium-dependent cytosolic phospholipase A2 (cPLA2α) enzyme directs a complex "eicosanoid storm" that accompanies the tissue response to injury. cPLA2α and its downstream eicosanoid mediators are also implicated in the pathogenesis of fibrosis in many organs, including the kidney. We aimed to determine the role of cPLA2α in bone marrow-derived cells in a murine model of renal fibrosis, unilateral ureteral obstruction (UUO).

Anaerobic Mycobacterium tuberculosis Cell Death Stems from Intracellular Acidification Mitigated by the DosR Regulon.

is a strict aerobe capable of prolonged survival in the absence of oxygen. We investigated the ability of anaerobic to counter challenges to internal pH homeostasis in the absence of aerobic respiration, the primary mechanism of proton efflux for aerobic bacilli. Anaerobic populations were markedly impaired for survival under a mildly acidic pH relative to standard culture conditions.

Antibiotic Bactericidal Activity Is Countered by Maintaining pH Homeostasis in Mycobacterium smegmatis.

Antibiotics target specific biosynthetic processes essential for bacterial growth. It is intriguing that several commonalities connect the bactericidal activity of seemingly disparate antibiotics, such as the numerous conditions that confer broad-spectrum antibiotic tolerance. Whether antibiotics kill in a manner unique to their specific targets or by a universal mechanism is a critical and contested subject.

Cytosolic phospholipase Aα increases proliferation and de-differentiation of human renal tubular epithelial cells.

The group IVA calcium-dependent cytosolic phospholipase A (cPLAα) enzyme controls the release of arachidonic acid from membrane bound phospholipids and is the rate-limiting step in production of eicosanoids. A variety of different kidney injuries activate cPLAα, therefore we hypothesized that cPLAα activity would regulate pathologic processes in HK-2 cells, a human renal tubular epithelial cell line, by regulating cell phenotype and proliferation. In two lentiviral cPLAα-silenced knockdowns, we observed decreased proliferation and increased apoptosis compared to control HK-2 cells.

The Challenge of Clostridium difficile Infection.

Clostridium difficile infection is a major problem in the United States, resulting in significant morbidity, mortality, and financial costs to the health care system. This commentary provides an update regarding the epidemiology, diagnosis, current recommended management, and challenges surrounding C. difficile infection.

Increased Anesthesia Usage in a Large-Volume Endoscopy Unit: Patient Acuity Is Not the Main Predictor.

Objectives: The use of monitored anesthesia care (MAC) for colonoscopy sedation continues to increase. This study examined trends during a 9-year period in the use of MAC and explored which patient variables may have influenced these trends.

Methods: This was a retrospective review of all colonoscopies performed in our hospital-based endoscopy unit from 2003 through 2012.

Cannabinoid Hyperemesis Syndrome: An Emerging Drug-Induced Disease.

Cannabinoid hyperemesis is a relatively rare but significant adverse effect of chronic marijuana use characterized by severe, cyclic nausea, vomiting, and abdominal pain and marked by compulsive hot-water bathing for temporary symptom relief. A 37-year-old African American male with no significant medical history other than the habitual abuse of marijuana was admitted for intractable nausea, vomiting, and abdominal pain. With the exception of abdominal skin hyperpigmentation and scarring secondary to the direct application of heat through a heating pad, physical examination of the abdomen was unremarkable.

Parenteral immunization with IpaB/IpaD protects mice against lethal pulmonary infection by Shigella.

Shigellosis is an important diarrheal disease, especially among children in the developing world. About 90 million infections with Shigella spp are estimated to appear each year. We previously demonstrated that the type III secretion apparatus (T3SA) proteins IpaB and IpaD are protective antigens when administered intranasally using the mouse lethal pulmonary model.

Intestinal spirochetosis: an enigmatic disease.

Introduction: Intestinal spirochetosis (IS) is a condition in which colonic and appendiceal epithelial cells are colonized by one of two anaerobic spirochetes, either the Brachyspira aalborgi or Brachyspira pilosicoli. There is much debate in the literature as to whether IS is a pathogen or a commensal inhabitant. A recent case of IS at our institution prompted a retrospective database search and review of the literature.

Dental postoperative bleeding complications in patients with suspected and documented liver disease.

Objectives: The aims of this study were to determine the frequency of bleeding complications following dental procedures in patients with known or suspected chronic liver disease and whether international normalized ratio (INR) determination could aid in predicting bleeding complications in these patients.

Patients And Method: We identified 90 patients (mean age: 51 ± 9 years) in this retrospective chart review. Sixty-nine patients had a known history of chronic liver disease and 21 had suspected chronic liver disease.

Clostridium difficile colitis: a retrospective study of incidence and severity before and after institution of an alcohol-based hand rub policy.

Background: Clostridium difficile-associated diarrhea is a leading cause of hospital-acquired diarrhea. We sought to determine whether the institution of a hospital-wide alcohol-based hand rub (ABHR) policy was associated with an increase in the incidence and/or severity of health care facility-onset, health care facility-associated C difficile diarrhea (CDAD).

Methods: We used a retrospective chart review analysis to compare incidence rates of CDAD before and after implementation of the ABHR policy.

Drug-induced liver injury associated with statins.

The "statins," or hydroxymethylglutaryl coenzyme A (HMG-CoA)-reductase inhibitors, are a generally safe class of drugs that are widely used throughout the world and are rarely associated with severe hepatotoxicity. In this article, two cases of severe hepatotoxicity attributed to statin use are presented. In addition, a detailed summary of previously published cases of statin hepatotoxicity and the risks and benefits of statins in patients with chronic liver disease are presented.

Subcutaneously administered Menopur, a new highly purified human menopausal gonadotropin, causes significantly fewer injection site reactions than Repronex in subjects undergoing in vitro fertilization.

Background: The safety and tolerability of a new highly purified, urine-derived human menopausal gonadotropin (hMG) preparation [Menopur] was compared with a currently available hMG [Repronex] in women undergoing in vitro fertilization (IVF).

Methods: This was a randomized, open-label, parallel-group, multicenter study conducted in subjects undergoing IVF. Women (N = 125), 18-39 years of age, underwent pituitary down-regulation with leuprolide acetate beginning 7 days prior to onset of menses and continuing up to the day before hCG administration.

Mixed protocols: multiple ratios of FSH and LH bioactivity using highly purified, human-derived FSH (BRAVELLE) and highly purified hMG (MENOPUR) are unaltered by mixing together in the same syringe.

Background: The use of mixed or blended protocols, that utilize both FSH and hMG, for controlled ovarian hyperstimulation is increasing in use. To reduce the number of injections a patient must administer, many physicians instruct their patients to mix their FSH and hMG together to be given as a single injection. Therefore, the goal of this study was to definitively determine if the FSH and LH bioactivities of highly purified, human-derived FSH (Bravelle) and highly purified hMG (Menopur) were altered by reconstituting in 0.

The Id2 transcriptional repressor is induced by follicle-stimulating hormone and cAMP.

Id (inhibitor of DNA binding/differentiation) proteins repress differentiation and promote cell division by dimerizing with and inhibiting the action of basic helix-loop-helix transcription factors including those that bind to E-box motifs. Of the four characterized Id proteins, only Id2 is found in the nucleus of Sertoli cells that support the development of spermatozoa in the testis. Differential display analysis of rat primary Sertoli cell mRNA identified Id2 as being inducible by forskolin, a stimulator of cAMP production.

Delivery of a cyclic adenosine 3',5'-monophosphate response element-binding protein (creb) mutant to seminiferous tubules results in impaired spermatogenesis.

FSH binding to Sertoli cells is required for optimal production of sperm in mammals. The cAMP response element-binding protein (CREB) is a major mediator of FSH-induced changes in gene expression. To determine whether CREB is required for spermatogenesis, an adenovirus encoding a phosphorylation-defective CREB mutant (AdCREBm1) was used to inhibit CREB activity in Sertoli cells.

Influence of media and thermal shock on sperm capacitation.

To elucidate the influence of medium and thermal shock in inducing sperm capacitation, eight ejaculates were processed as follows. Each ejaculate was divided into three aliquots. To two of the aliquots, an equal volume of saline was added, while TEST-yolk was added to the remaining aliquot.

Effects of urine on the functional quality of human spermatozoa.

Objective: To determine the effect of urine on sperm function and to elucidate the reason by which it may be deleterious.

Design: Prospective controlled in vitro study.

Interactions: Sperm were exposed to various concentrations of pooled urine in Ham's F-10 Medium supplemented with 3.

Unusual presentation of an unusual type of choledochal cyst.

Type II choledochal cysts are rare congenital malformations of the biliary ductal system. We report a case in which a type II choledochal cyst presented as a mass in the porta hepatis without any demonstrable connection with the biliary tree. In the English literature, this is the first described case of this type in the absence of biliary tract malignancy.

Effect of milk-yolk on the fertilizing capacity of spermatozoa.

Pre-incubation of human sperm in egg yolk based medium (TEST-yolk) as well as milk have been shown to improve sperm fertilizing capacity. The purpose of this study was to compare a combination of these two media, called milk-yolk, against the two established media, in order to test for a possible synergistic effect(s) on sperm functions as measured by sperm motility, acrosome reaction and penetration assay. Statistically, no differences have been observed among the three media, except for SPA outcome in milk-yolk, being significantly lower than the corresponding values for the other two media.

The effect of preincubation of human spermatozoa in milk on sperm penetration into zona-free hamster oocytes and on sperm binding to the human zona pellucida.

Objective: To determine whether preincubation of sperm in milk enhances the outcome of sperm penetration assay (SPA) and hemizona assay (HZA) when compared with preincubation in TES and Tris (TEST)-yolk.

Design: Sperm penetration assay and HZA were performed on milk and TEST-yolk preincubated spermatozoa.

Interventions: Ejaculates were washed and divided into two equal aliquots.

Dietary cholesterol and downregulation of cholesterol 7 alpha-hydroxylase and cholesterol absorption in African green monkeys.

In this study, hepatic production of bile acid was considered together with intestinal cholesterol absorption as potential regulatory sites responsive to dietary cholesterol. Sequential liver biopsies were taken from 45 feral African green monkeys studied during three different diet periods. Low-fat Monkey Chow was fed during the baseline period, a cholesterol and fat-enriched diet was then fed for 12 wk during period 2, and finally, after a washout period of 10 wk, three subgroups were fed low-, moderate-, and high-cholesterol diets for 12 mo during period 3.