Helicobacter pylori infection: old and new.

Helicobacter pylori is a spiral-shaped bacterium that grows in the digestive tract and may be present in more than half of the world's population. The clinical features of Helicobacter pylori range from asymptomatic gastritis to gastrointestinal malignancy. Mucosa-associated lymphoid tissue (MALT) lymphoma is a low-grade B-cell marginal zone lymphoma and Helicobacter pylori has been detected in more than 75% of the patients with MALT lymphoma. Many tests for the detection of Helicobacter pylori are available, including antibody tests, urea breath tests, stool antigen tests and endoscopic biopsies. The eradication of Helicobacter pylori usually prevents the return of ulcers and ulcer complications even after appropriate medications such as PPIs are stopped. The eradication of Helicobacter pylori is important in the treatment of the rare condition of the stomach known as MALT lymphoma. The treatment of Helicobacter pylori to prevent stomach cancer is controversial. Confirmation of eradication is recommended in associated ulcers, persistent dyspepsia despite a test-and-treat approach, MALT lymphoma, and previous treatment for early-stage gastric cancer. The urea breath test and stool antigen test can be used to confirm the eradication and should be performed at least 4 weeks after the completion of therapy. Several diseases have been reported to be associated with Helicobacter pylori infection, including hematologic diseases, such as ITP, idiopathic iron deficiency anemia and vitamin B12 deficiency. There is a positive trend in the association between Helicobacter pylori infection and neurodegenerative disorders and new data showed a reduced risk of death due to stroke and lung cancer but an increased risk of preeclampsia in infected women, which requires further investigations.

[Therapeutic approach in patients with age-related macular degeneration and cataract]. / Atitudinea terapeutica la pacientii cu degenerescenta maculara legata de vârsta si cataracta.

Management of the patient with coexisting cataract and AMD presents unique challenges to the cataract surgeon, the retina specialist, and the patient. A common clinical scenario is the patient in whom both the cataract and macular pathology appear to be contributing to decreased visual acuity. As with any surgery, the expectations from cataract removal must be evaluated thoroughly and understood clearly by both the patient and the cataract surgeon. Most patients with AMD who undergo cataract surgery feel that the surgery is worthwhile, and they report improvement of visual function and quality of life. In patients with mild AMD, improvement in central visual acuity and attainment of driving vision are realistic and achievable goals. In an eye with central disciform scarring or geographic atrophy there may be potential for improvement in color discrimination, contrast, or clarity of peripheral vision. In cases of dense cataract obscuring macular detail, cataract removal may be necessary to allow for adequate biomicroscopy and angiography, especially in an eye that may be at high risk for the development of choroidal neovascularization. It is often challenging to estimate the relative impact on visual impairment made by the lens opacities and the macular changes and the benefits and risks of cataract surgery in eyes with AMD should be carefully evaluated. Is cataract surgery justified in these patients? Does cataract surgery aggravate AMD in some patients?

The cytokine response to physical activity and training.

Cytokines are soluble glycoproteins that are produced by and mediate communication between and within immune and nonimmune cells, organs and organ systems throughout the body. Pro- and anti-inflammatory mediators constitute the inflammatory cytokines, which are modulated by various stimuli, including physical activity, trauma and infection. Physical activity affects local and systemic cytokine production at different levels, often exhibiting striking similarity to the cytokine response to trauma and infection. The present review examines the cytokine response to short term exercise stress, with an emphasis on the balance between pro- and anti-inflammatory mechanisms and modulation of both innate and specific immune parameters through cytokine regulation. The effects of long term exercise on cytokine responses and the possible impact on various facets of the immune system are also discussed, with reference to both cross-sectional and longitudinal studies of exercise training. Finally, the validity of using exercise as a model for trauma and sepsis is scruti- nised in the light of physiological changes, symptomatology and outcome, and limitations of the model are addressed. Further studies, examining the effect of exercise, trauma and infection on novel cytokines and cytokine systems are needed to elucidate the significance of cytokine regulation by physical activity and, more importantly, to clarify the health implications of short and long term physical activity with respect to overall immune function and resistance to infection.

Exercise elevates plasma levels but not gene expression of IL-1beta, IL-6, and TNF-alpha in blood mononuclear cells.

Physical activity induces a subclinical inflammatory response, mediated in part by leukocytes, and manifested by elevated concentrations of circulating proinflammatory cytokines, including interleukin (IL)-1beta, IL-6, and tumor necrosis factor-alpha (TNF-alpha). However, the source of the cytokines that appear during exercise remains unknown. In this study, we examined exercise-induced changes in plasma cytokine concentrations and their corresponding mRNA expression in peripheral blood mononuclear cells. Ten healthy [peak oxygen uptake = 48.8 +/- 6.5 (SD) ml. kg(-1). min(-1)] but untrained men [age = 25 +/- 5 (SD) yr] undertook 3 h of exercise (cycling and inclined walking) at 60-65% peak oxygen uptake. Circulating leukocyte subset counts were elevated during and 2 h postexercise but returned to normal within 24 h. Plasma concentrations of IL-1beta, IL-6, and TNF-alpha peaked at the end of exercise and remained elevated at 2 h (IL-6) and up to 24 h (IL-1beta and TNF-alpha) postexercise. Cytokine gene expression in circulating mononuclear cells was measured by using the reverse transcriptase-polymerase chain reaction; mRNA accumulation did not change with exercise. In conclusion, mRNA accumulation of IL-1beta, IL-6, and TNF-alpha in circulating mononuclear cells is not affected by 3 h of moderate endurance exercise and does not seem to account for the observed increases in plasma cytokines.

Impact of three different types of exercise on components of the inflammatory response.

It was hypothesized that muscle injury would be greater with eccentric than with all-out or prolonged exercise, and that immune changes might provide an indication that supplements the information provided by traditional markers such as creatine kinase (CK) or delayed-onset muscle soreness. Eight healthy males [mean (SE): age = 24.9 (2.3) years, maximum oxygen consumption (VO2(max)) = 43.0 (3.1) ml x kg(-1) x min(-1)] were each assigned to four experimental conditions, one at a time, using a randomized-block design: 5 min of cycle ergometer exercise at 90% VO2(max) (AO), a standard circuit-training routine (CT), 2 h cycle ergometer exercise at 60% VO2(max) (Long), or remained seated for 5 h. Blood samples were analyzed for CK, natural killer (NK) cell counts (CD3(-)/CD16(+)56(+)), cytolytic activity and plasma levels of the cytokines interleukin (IL)-6, IL-10, and tissue necrosis factor alpha (TNF-alpha). CK levels were only elevated significantly 72 h following CT. NK cell counts increased significantly during all three types of exercise, but returned to pre-exercise baseline values within 3 h of recovery. Cytolytic activity per NK cell was not significantly modified by any type of exercise. Prolonged exercise induced significant increases in plasma IL-6 and TNF-alpha. We conclude that the lack of correlation between traditional markers of muscle injury (plasma CK concentrations and muscle soreness rankings) and immune markers of the inflammatory response suggests that, for the types and intensities of exercise examined in this study, the exercise-induced inflammatory response is modified by humoral and cardiovascular correlates of exercise.

A new sterile bicarbonate dialysis solution for use during cardiopulmonary bypass.

Adding a dialysis filter to the perfusion circuit at the end of cardiopulmonary bypass (CPB) has become an accepted means of reducing potassium rapidly and safely. Rapid removal of solute requires a dialysate for diffusion, and peritoneal dialysis solutions have been the standard because of availability, although occasionally normal saline or bicarb/ saline mixtures are used. Cardioplegia solution is high in glucose as well as potassium and, with many diabetic patients undergoing CPB, it is desirable to minimize glucose loads. In this prospective cohort study, six patients received a commercially available sterile bicarbonate dialysate prepared in a point of care fashion. From the cardiovascular data base, four control patients (receiving lactate based dialysis solution during CPB) were matched for age, surgery type, body surface area (BSA), and pump duration for each of the six patients receiving bicarbonate dialysate. All of the control patients were dialysed against lactate buffered peritoneal dialysis solution. Plasma levels of potassium, glucose, and bicarb were measured before and after dialysis for each dialysate. Plasma potassium, glucose, and bicarb were not significantly different at start of dialysis. The lactate dialysate (LD) group received a mean of 17.4+/-7.7 L of lactate containing dialysate versus 14.6+/-4.7 L of bicarbonate dialysate (BD) (p = 0.41). After dialysis, potassium had been reduced to a similar degree in both groups, but plasma glucose levels had increased during LD while they fell during BD, and bicarbonate levels fell during LD while they rose during BD. Use of a commercially available sterile bicarbonate dialysate can safely help to lower plasma potassium during CPB and preserve more physiologic levels of glucose and bicarbonate.

Blood urea levels 30 minutes before the end of dialysis are equivalent to equilibrated blood urea.

The steady decline in blood urea during high efficiency hemodialysis is followed by a rebound phase after dialysis in which the level of urea rises to an equilibrium value (Ct + 30) that may be up to 20% higher than the immediate post dialysis (Ct) concentration. The artificially low urea concentration immediately after dialysis leads to an overestimate of the efficiency of the dialysis calculated by Kt/V if the true equilibrium blood concentration of urea is not used in the calculation by the single-pool urea kinetic model. The measurement of equilibrium urea concentration requires a blood sample approximately 30 min after hemodialysis, which is an encumbrance on dialysis patients. This study was undertaken to determine whether an intradialytic sample taken 30 min before the end of dialysis (Ct - 30) may be representative of the equilibrium sample, and to compare the Kt/V using the Ct - 30 and Ct + 30 samples. Thirty-six patients were studied and blood urea concentrations were measured half an hour before the end of dialysis (Ct - 30), at the end of dialysis (Ct), and half an hour after the end of dialysis (Ct + 30). Kt/V (Daugirdas method) was calculated using urea concentration 30 min before the end of dialysis (Kt/Vt - 30) and was compared with Kt/V calculated using equilibrium urea concentration (Kt/Vt + 30). There were no significant differences between the Kt/Vt - 30 and the KtVt + 30 (1.25 versus 1.22, p = 0.65). The correlation between Kt/Vt - 30 and Kt/Vt + 30 was excellent with r2 = 0.93, regression y = 1.05 x -0.033. Kt/Vt - 30 also compared favorably with the Kt/V double pool method (Kt/Vdp) described by Daugirdas (1.25 versus 1.19, p = 0.23). Using the Ct - 30 to calculate Kt/V by the percent urea reduction methods of jindal (Kt/Vpru) decreases the Kt/V value by 0.14 on average, but it remains significantly higher than the Daugirdas method. The authors conclude that calculations using urea concentration 30 min before the end of dialysis improves the accuracy of dose estimation in high efficiency dialysis, without inconveniencing the patient.