Total Mesorectal Excision for Mid-Rectal Cancer Without Anastomosis: Low Hartmann's Operation or Intersphincteric Abdomino-Perineal Excision?

BACKGROUND AND AIMS: In mid-rectal cancer, the low colorectal anastomosis is, although feasible, sometimes avoided. The aim was to compare low Hartmann's procedure with intersphincteric abdomino-perineal excision of the rectum, in patients operated with total mesorectal excision for mid-rectal cancer in whom the low anastomosis was technically feasible but for patient-related reasons undesired. MATERIAL AND METHODS: A total of 64 consecutive patients with mid-rectal cancer who underwent low Hartmann's procedure (n = 34) or intersphincteric abdomino-perineal excision (n = 30) at one colorectal unit were compared regarding patient demography, short-term oncology, surgical outcome at 3 and 24 months, and long-term overall survival. RESULTS: There were no significant differences between intersphincteric abdomino-perineal excision and Hartmann's procedure regarding age, gender distribution, body mass index, preoperative radiotherapy, tumor level, or cancer stages. Operation time was shorter in Hartmann's procedure as compared with intersphincteric abdomino-perineal excision, median 174 and 256 min, (P < 0.001), and intraoperative blood loss was increased, 600 and 500 mL, respectively (P = 0.045). Number of lymph nodes and circumferential resection margin were comparable. In Hartmann's procedure compared with intersphincteric abdomino-perineal excision, the need for reoperation was 24% and 3%, (P = 0.020), complications classified as Clavien-Dindo 3-4 occurred in 32% and 10%, (P = 0.031), pelvic abscess in 21% and 10%, (P = 0.313), and mortality within 90 days was 3% and 0%, respectively, (P = 0.938). In intersphincteric abdomino-perineal excision, the perineal wound was not healed at 3 months in 13%, and in Hartmann's procedure 15% had chronic secretion from the anorectal remnant at 2 years postoperatively. CONCLUSION: The results from this study suggest that intersphincteric abdomino-perineal excision might be an alternative to Hartmann's procedure in patients with mid-rectal cancer, in whom a low colorectal anastomosis is undesired.

[A mobile app for patients suffering from kidney stones]. / Smartphone-App für Patienten mit Nierensteinen.

BACKGROUND AND OBJECTIVES: Kidney stone disease has become an important worldwide socioeconomic issue. However, metaphylaxis fails due to low compliance rates. Therefore, we developed a mobile app (StoneMD: Kidney Stones) for patients with kidney stones to increase compliance in stone metaphylaxis. MATERIALS AND METHODS: To identify the most appropriate design of the app, we searched through the App Store and the Google Play Store and integrated the clinical recommendations of the European Association of Urology (EAU) and the American Urological Association (AUA). To test the value of this app, a questionnaire was developed in which the patient should answer questions about the drinking behavior and the subjective use of the app in the field of metaphylaxis. RESULTS: StoneMD: Kidney Stones offers the opportunity to calculate the individual risk of a new stone episode. In addition, the app offers several features to raise awareness of lifestyle modification, including hydration as metaphylaxis of urolithiasis, reminder of inserted ureteral stents and document the self-measured urine pH. A total of 49 patients participated in the questionnaire: 89.8% (n = 46) of these patients had a smartphone, 73.9% reported a daily intake of <2.5 l, 76.5% of these patients believe that their drinking behavior is positively influenced by the app, 71.7% stated that the app for relapse prevention is more suitable than traditional information brochures, 56.5% want to continue to use the app. CONCLUSIONS: StoneMD: Kidney Stones is the first mobile app for stone metaphylaxis. StoneMD might help to improve patient compliance and might lower the risk of stone formation.

Concurrent Infection of a Young Tourist by Hookworm and Strongyloides Stercoralis During Low Budget Travel in Southeast Asia.

Strongyloidiasis and hookworm infections are neglected helminth diseases widespread in tropical and subtropical areas. In humans, particularly in immunocompromised patients infections potentially may lead to the life-threatening clinical conditions involving the respiratory as well as gastrointestinal systems. The increased number of tourists travelling to tropical regions is associated with more frequent infection with parasites such as Strongyloides and hookworm. The infection takes place when filariform larvae penetrate the skin exposed to soil, than migrate through the lungs and finally reach the intestine. Travelers are often not aware of how they could get infected. Physicians may suspect strongyloidiasis and hookworm infections in tourists with diarrhea returning from endemic areas, especially when an elevated eosinophilia is observed. In the literature there are many reports about the presence of parasites in indigenous communities, but very few are available regarding travelers. This paper describes a dual infection with hookworm and Strongyloides stercoralis in a young female tourist returning from Southeast Asia. To our knowledge, this is the first report of hookworm and Strongyloides stercoralis infection in a tourist from Europe, acquired in an endemic area.

FBXW7 regulates DISC1 stability via the ubiquitin-proteosome system.

Disrupted in schizophrenia 1 (DISC1) is a multi-functional scaffolding protein that has been associated with neuropsychiatric disease. The role of DISC1 is to assemble protein complexes that promote neural development and signaling, hence tight control of the concentration of cellular DISC1 in neurons is vital to brain function. Using structural and biochemical techniques, we show for we believe the first time that not only is DISC1 turnover elicited by the ubiquitin proteasome system (UPS) but that it is orchestrated by the F-Box protein, FBXW7. We present the structure of FBXW7 bound to the DISC1 phosphodegron motif and exploit this information to prove that disruption of the FBXW7-DISC1 complex results in a stabilization of DISC1. This action can counteract DISC1 deficiencies observed in neural progenitor cells derived from induced pluripotent stem cells from schizophrenia patients with a DISC1 frameshift mutation. Thus manipulation of DISC1 levels via the UPS may provide a novel method to explore DISC1 function.

Muscarinic receptor subtype distribution in the central nervous system and relevance to aging and Alzheimer's disease.

Muscarinic acetylcholine receptors (mAChRs) are G proteincoupled receptors (GPCRs) that mediate the metabotropic actions of acetylcholine (ACh). There are five subtypes of mAChR, M1 - M5, which are expressed throughout the central nervous system (CNS) on numerous cell types and represent promising treatment targets for a number of different diseases, disorders, and conditions of the CNS. Although the present review will focus on Alzheimer's disease (AD) and amnestic mild cognitive impairment (aMCI), a number of conditions such as Parkinson's disease (PD), schizophrenia, and others represent significant unmet medical needs for which selective muscarinic agents could offer therapeutic benefits. Numerous advances have been made regarding mAChR localization through the use of subtype-selective antibodies and radioligand binding studies and these efforts have helped propel a number of mAChR therapeutics into clinical trials. However, much of what we know about mAChR localization in the healthy and diseased brain has come from studies employing radioligand binding with relatively modest selectivity. The development of subtype-selective small molecule radioligands suitable for in vitro and in vivo use, as well as robust, commercially-available antibodies remains a critical need for the field. Additionally, novel genetic tools should be developed and leveraged to help move the field increasingly towards a systems-level understanding of mAChR subtype action. Finally, functional, proteomic, and genetic data from ongoing human studies hold great promise for optimizing the design and interpretation of studies examining receptor levels by enabling patient stratification. This article is part of the Special Issue entitled 'Neuropharmacology on Muscarinic Receptors'.

Searching for ivermectin resistance in a Strongylidae population of horses stabled in Poland.

BACKGROUND: There are no available studies describing the possible resistance of strongyles to ivermectin in horses in Poland. One hundred seventy three horses from nine stud farms from South-Western Poland were studied. The effectiveness of ivermectin was studied on the 14th day after ivermectin administration using the fecal egg count reduction test, and a long-term observation of the egg reappearance period was carried out. The fecal study was carried out using a modified McMaster method, which typically detects 20 eggs per gram of stool. The results were subjected to statistical analysis that enabled quantification of the eggs in the stool samples. RESULTS: The study revealed high efficacy of ivermectin on the 14th day after administration without a shortening of the egg reappearance period. CONCLUSION: The results indicate that strongyles resistance to ivermectin in Poland is not a serious problem.

Helminth parasites of an introduced invasive carnivore species, the raccoon ( Procyon lotor L.), from the Warta Mouth National Park (Poland).

We evaluated helminth parasites of the introduced North American raccoon ( Procyon lotor L.) in Poland. From June 2006 to May 2007, 91 raccoon fecal samples were collected in the Warta Mouth National Park situated in western Poland near the Polish-German border. Coprological analyses involved flotation and sedimentation. In total, 7 helminth taxa were identified in the feces: Ancylostoma spp., Baylisascaris procyonis, Capillariidae, Placoconus lotoris, Spirocerca lupi, Strongyloides procyonis, and Echinostoma sp. The parasite assemblage in the raccoon exhibited a low diversity. The results were compared with data from other European and North American studies and suggest a lower prevalence of parasites in newly invaded areas, compared with earlier invaded areas or the native range.

Coprological study on helminth fauna in Eurasian lynx (Lynx lynx) from the Bialowieza Primeval Forest in eastern Poland.

One hundred fecal samples were collected during research on Eurasian lynx ecology and food habits in the Polish part of the Bialowieza Primeval Forest (BPF) from 2001 to 2006. Seventy-three percent of samples contained eggs or larvae of helminths. A total of 10 species of helminths was identified, including 3 Cestoda (Diphyllobothrium latum, Spirometra janickii, and unidentified species of Taeniidae), 1 Trematoda (Alaria alata), and 6 Nematoda (Aelurostrongylus abstrusus, Ancylostoma tubaeforme, Eucoleus aerophilus, Metastrongylus sp., Nematodirus sp., and Toxocara cati). Alaria alata has not been reported previously in lynx. A statistical comparison of the 2 techniques used to isolate eggs, i.e., flotation and sedimentation, indicates that sedimentation was more effective.

[Taeniosis in the lower Silesia province in the 1993 - 1997 years]. / Tasiemczyce w województwie dolnoslaskim w latach 1993 - 1997.

This paper is the result of investigations of taeniosis in inhabitants of four former provinces of the Lower Silesia area in the 1993 - 1997 years. Analysis of frequency taneniosis (according to place of living and sex) confirmed clearly the decrease of tendency of thisparasitosis.

[Helminths fauna of fishes in the Mala Panew river drainage basin]. / Helmintofauna ryb dorzecza Malej Panwi.

A parasitological investigation was made at 420 fishes from 10 species: Perca fluviatilis L., Gymnocephalus cernuus (L.), Gobio gobio (L.), Tinca tinca (L.), Leuciscus idus (L), Noemacheilus barbatulus (L.), Lota lota (L.), Leucaspisus delineatus (HECKELL 843), Blicca biorkna (L.) and Rhodeus sericeus amarus (BLOCH 1782). The fishes were caught over one year period (1995-1996) in the Mala Panew river drainage basin (South Poland). In examined fishes the following parasite species were found: Diplostomum spathaceum (RUDOLPHI 1819)--metacercaria; Tylodelphys podicipina KOZICKA et NIEWIADOMSKA, 1960--metacercaria, Asymphyllodora tincae (MODER 1790); Bunodera luciopercae (MULLER 1776); Triaenophorus nodulosus (PALLAS 1781)--plerocercoid; Proteocephalus cernue (GMELIN 1790); Camallanus lacustris (ZOEGA 1776); Neoechinorhynchus rutili (MULLER 1780); Echinorhynchus borealis (LINSTOW 1901); Acanthocephalus lucii (MULLER 1776) and Pomphorhynchus laevis (MULLER 1776). One species of tapeworm: P. cernue appeared as a new in the parasitefauna of Poland.

[Taeniasis in Wroclaw and Czestochowa provinces]. / Tasiemczyce w województwie Wroclawskim i Czestochowskim.

On the basis of control cards of taeniosis collected in the Sanitary Epidemiological Stations the comparison of the infectivity in 1980-1994 was carried out. Standard parameters environment (town, village), sex and age groups as well as morbidity rates/100,000 inhabitants were taken into consideration. Since 1980 the number of registered cases was reduced from 21.2 in Wroclaw urban populations and 15.5 in rural population as well as 6.3 in Czestochowa urban populations and 2.9 in rural population to 5.0 and 3.3 as well as 1.1 and 0.9, respectively in 1994. More frequent occurrences of taeniosis (6.7 mean morbidity) in Wroclaw than in Czestochowa province (1.4) were noted.