Interferon Lambda in the Pathogenesis of Inflammatory Bowel Diseases.

Interferon λ (IFN-λ) is critical for host viral defense at mucosal surfaces and stimulates immunomodulatory signals, acting on epithelial cells and few other cell types due to restricted IFN-λ receptor expression. Epithelial cells of the intestine play a critical role in the pathogenesis of Inflammatory Bowel Disease (IBD), and the related type II interferons (IFN-γ) have been extensively studied in the context of IBD. However, a role for IFN-λ in IBD onset and progression remains unclear. Recent investigations of IFN-λ in IBD are beginning to uncover complex and sometimes opposing actions, including pro-healing roles in colonic epithelial tissues and potentiation of epithelial cell death in the small intestine. Additionally, IFN-λ has been shown to act through non-epithelial cell types, such as neutrophils, to protect against excessive inflammation. In most cases IFN-λ demonstrates an ability to coordinate the host antiviral response without inducing collateral hyperinflammation, suggesting that IFN-λ signaling pathways could be a therapeutic target in IBD. This mini review discusses existing data on the role of IFN-λ in the pathogenesis of inflammatory bowel disease, current gaps in the research, and therapeutic potential of modulating the IFN-λ-stimulated response.

Vestibular-Evoked Responses Indicate a Functional Role for Intrinsic Foot Muscles During Standing Balance.

Maintaining standing balance involves multisensory processing and integration to produce dynamic motor responses. Electrical vestibular stimulation (EVS) delivered over the mastoid processes can be used to explore the vestibular control of balance. The purpose of this study was to determine whether intrinsic foot muscles exhibit vestibular-evoked balance responses and to characterize the traits associated with these responses. Electromyography (EMG) of the abductor hallucis (AH), abductor digiti minimi (ADM) and medial gastrocnemius (MG) and anterior-posterior (AP) forces were sampled while quietly standing participants were subjected to a random continuous EVS signal (peak-to-peak amplitude = ±3 mA). The relationship between EVS input and motor output was characterized in both the frequency (coherence) and time (cumulant density) domains. When head orientation was rotated in yaw from left to right, the biphasic cumulant density function was inverted for all muscle (EVS-EMG) and whole-body (EVS-AP forces) balance responses. When vision was occluded, the EVS-EMG and EVS-AP forces coherence function amplitude increased at low frequencies (<2 Hz) and was accompanied by a heightened medium-latency peak amplitude for all muscles as well as the whole-body balance response (AP forces) compared to when static visual cues were present. The enhanced coherence amplitudes at lower frequencies may highlight a mechanism for the increase in postural sway from vision to occluded vision. The current findings indicate that the vestibular control of standing balance can be represented by the intrinsic foot muscles and implicate a postural role for these muscles in modulating quiet standing.

Time-dependent neuromuscular parameters in the plantar flexors support greater fatigability of old compared with younger males.

Older adults are more fatigable than young during dynamic tasks, especially those that involve moderate to fast unconstrained velocity shortening contractions. Rate of torque development (RTD), rate of velocity development (RVD) and rate of neuromuscular activation are time-dependent neuromuscular parameters which have not been explored in relation to age-related differences in fatigability. The purpose was to determine whether these time-dependent measures affect the greater age-related fatigability in peak power during moderately fast and maximal effort shortening plantar flexions. Neuromuscular properties were recorded from 10 old (~ 78 years) and 10 young (~ 24 years) men during 50 maximal-effort unconstrained velocity shortening plantar flexions against a resistance equivalent to 20% maximal voluntary isometric contraction torque. At task termination, peak power, and angular velocity, and torque at peak power were decreased by 30, 18, and 16%, respectively, for the young (p < 0.05), and 46, 28, 30% for the old (p < 0.05) compared to pre-fatigue values with the old exhibiting greater reductions across all measures (p<0.05). Voluntary RVD and RTD decreased, respectively, by 24 and 26% in the young and by 47 and 40% in the old at task termination, with greater decrements in the old (p < 0.05). Rate of neuromuscular activation of the soleus decreased over time for both age groups (~ 47%; p < 0.05), but for the medial gastrocnemius (MG) only the old experienced significant decrements (46%) by task termination. All parameters were correlated strongly with the fatigue-related reduction in peak power (r = 0.81-0.94, p < 0.05), except for MG and soleus rates of neuromuscular activation (r = 0.25-0.30, p > 0.10). Fatigue-related declines in voluntary RTD and RVD were both moderately correlated with MG rate of neuromuscular activation (r = 0.51-0.52, p < 0.05), but exhibited a trend with soleus (r = 0.39-0.41, p = 0.07-0.09). Thus, time-dependent factors, RVD and RTD, are likely important indicators of intrinsic muscle properties leading to the greater age-related decline in peak power when performing a repetitive dynamic fatigue task, which may be due to greater fatigue-related central impairments for the older men than young.

Intraperitoneal aerosolization of bupivacaine is a safe and effective method in controlling postoperative pain in laparoscopic Roux-en-Y gastric bypass.

INTRODUCTION: Obesity is a worldwide problem and has grown in severity in the last few decades making bariatric surgery and, in particular, laparoscopic banding and Roux-en-Y gastric bypass efficacious and cost-effective procedures. The laparoscopic approach has been shown to offer significant healthcare benefits, of particular interests are reports of decreased postoperative pain resulting in a shorter hospital stay and an earlier return to normal activity. However, many patients still experience significant pain, including shoulder tip pain, that require strong analgesia including opiates during their early recovery period. The aims of this study were to establish the safe use of the aerosolization technique in bariatric surgery and to investigate the possible benefits in reducing postoperative pain. METHODS: In this study, fifty patients undergoing laparoscopic gastric bypass were recruited and divided into two groups; control (n = 25) and therapeutic (n = 25). The control group received intraperitoneal aerosolization of 10 mL of 0.9% normal saline while the therapeutic group received 10 mL of 0.5% bupivacaine. All the patients had standard preoperative, intraoperative, and postoperative care. Pain scores were carried out by the nursing staff in recovery and 6 h, 12 h and 24 h postoperatively using a standard 0-10 pain scoring scale. In addition, opiate consumption via patient-controlled analgesia (PCA) was recorded. RESULTS: Aerosolized bupivacaine reduced postoperative pain in comparison to normal saline (p < 0.05). However, PCA usage showed no statistically significant change from the control group. CONCLUSION: The aims of this study were achieved and we were able to establish the safe use of the aerosolization technique in bariatric surgery and its benefits in reducing postoperative pain.