Concepts and prospects of minimally invasive colorectal cancer surgery.

It is important that clinical radiologists understand and appreciate the minimally invasive surgery (MIS) options available to surgeons. Operative technologies are constantly evolving, and accurate, informed interpretation of clinical imaging is essential for optimum surgical management. Concurrent advancements in both MIS and radiological staging have certainly improved treatment decisions and outcomes. This article outlines the history, current concepts, evolving techniques, and future prospects of MIS as it pertains to colorectal cancer surgery.

Pilot study of Biomarkers for predicting effectiveness of ramosetron in diarrhea-predominant irritable bowel syndrome: expression of S100A10 and polymorphisms of TPH1.

BACKGROUND: Serotonin type 3 receptor (5-HT3 R) antagonists are potentially useful therapeutic agents for diarrhea-predominant irritable bowel syndrome (IBS-D). To identify biomarkers predicting effectiveness of the 5-HT3 R antagonist (ramosetron) in IBS-D. METHODS: Irritable bowel syndrome-D Japanese subjects received 2.5 or 5 µg of ramosetron once daily for 4 weeks. Colonic mucosal S100A and tryptophan hydroxylase (TPH) mRNA expression levels were measured before treatment. Genomic DNA was extracted from blood and polymorphisms of TPH1 and TPH2 were analyzed. KEY RESULTS: Forty-two patients (27 men and 15 women, mean age 42 years) with IBS-D were included for analysis. Improvement of IBS symptoms was seen in 26 (61.9%). Baseline S100A10 (p = 0.02) and TPH1 (p = 0.02) expression were significantly higher in the ramosetron responders than in the non-responders. The frequencies of the TPH1 rs4537731G allele in linkage disequilibrium with the TPH1 rs7130929 T allele (11.5% vs 50%, p = 0.003; OR: 12; 95% CI: 2.1-69) along with TPH1 rs211105 C allele (3.8% vs 43.8%, p = 0.0003; OR: 19; 95% CI: 2.1-181) were significantly lower in the responders than in the non-responders. The mean scores of diarrhea at baseline were significantly higher (5.2 vs 3.7, p = 0.005) in patients with TPH1 rs211105 T/T than those with the G allele. CONCLUSIONS & INFERENCES: TPH1 gene polymorphisms and S100A10 expression, which correlate with 5-HT signaling were associated with ramosetron effectiveness in IBS-D, and may possibly lead to prospective identification of the resistance to treatment.

Tissue stem cells and cancer stem cells: potential implications for gastric cancer.

Gastric cancer remains the second leading cause of death in the world today, making the search for its molecular and cellular basis an important priority. Though recognition of the tight link between inflammation and tumorigenesis is centuries old, only recently are the pieces of the etiological puzzle beginning to fall together. Recent advances in gastric stem cell biology appear to be central to this slowly resolving puzzle. At least two types of stem cells may be important. Resident adult or tissue stem cells may, in a chronically inflamed environment, slowly acquire a series of genetic and epigenetic changes that lead to their emergence as ''cancer stem cells''. This scenario has not yet been proven experimentally, although the first step, prospective recognition of a gastric stem cell has recently been conquered. Alternatively, the setting of chronic inflammatory stress and injury may lead to loss of the indigenous gastric stem cells from their niches; bone marrow derived stem cells may then be recruited to and engraft into the gastric epithelium. Such recruited cells have the potential to contribute to the tumor mass. Indeed, evidence supporting this scenario has been published. Here, we review these recent findings and discuss implications for the future.

Tractor overturn concerns in Iowa: perspectives from the Keokuk county rural health study.

Agriculture remains one of the most hazardous industries in the U.S., with tractor overturns producing the greatest number of agricultural machinery-related fatalities. Rollover protective structures (ROPS) and seatbelts effectively reduce tractor overturn deaths. However, a large proportion of tractors in use in American agriculture are older tractors without ROPS and seatbelts. This article describes the tractor-related responses from participants in a population-based study conducted in Keokuk County, Iowa. This study was designed to measure rural and agricultural adverse health and injury outcomes and their respective risk factors. Questionnaires were partially developed from well-documented national surveys. Questions about agricultural machinery use, presence of safety equipment on the machinery, work practices, and attitudes about farm safety were included. Study participants on farms who owned tractors had an average of 3.1 tractors with an average age of 27 years. Only 39% of the 665 tractors had ROPS. Tractor age was associated with the presence of ROPS; 84% of tractors manufactured after 1984 were ROPS-equipped, whereas only 3% of tractors manufactured before 1960 were ROPS-equipped. ROPS-equipped tractors were significantly more common on larger farms and households with higher income. Only 4% of the farmers reported that their tractors had seatbelts and they wore them when operating their tractors. The results of this study support the findings of other studies, which indicate that many older tractors without ROPS and seatbelts remain in use in American agriculture. Until a dramatic reduction in the number of tractors in the U.S. operated without ROPS and seatbelts is achieved, the annual incidence of 120 to 130 deaths associated with tractor overturns will persist.

Helicobacter pylori-induced atrophic gastritis progressing to gastric cancer exhibits sonic hedgehog loss and aberrant CDX2 expression.

BACKGROUND: The loss of sonic hedgehog is an early change that occurs in the mucosa prior to neoplastic transformation and correlates with the type of intestinal metaplasia. Aberrant expression of CDX has also been shown to correlate with the development of intestinal metaplasia. AIM: To examine CDX2 expression in the non-cancerous mucosa of patients with gastric cancer and compared it to CDX2 expression in controls with intestinal metaplasia. METHODS: Sixty patients who had undergone endoscopic mucosal resection for early gastric cancer and 60 gender- and age-matched controls were studied. Two specimens each were obtained from the greater and lesser curves of the corpus and from the greater curve of the antrum. Expression of CDX2 and sonic hedgehog were evaluated by immunostaining. RESULTS: Gastric cancer was associated with a higher frequency of incomplete intestinal metaplasia (OR = 8.3; 95%CI, 3.7-18.9, P < 0.001). CDX2 negatively correlated with sonic hedgehog expression, however, multivariate analysis revealed that CDX2 correlated with the intestinal metaplasia scores. Sonic hedgehog indices were lower and CDX2 staining in the corpus lesser curve was higher in the cancer group than in the controls. Sonic hedgehog indices in the corpus decreased and CDX2 indices in both areas increased in patients in the ascending order of those without intestinal metaplasia, those with complete intestinal metaplasia and those with incomplete intestinal metaplasia (P < 0.001). CONCLUSIONS: Loss of sonic hedgehog expression and aberrant expression of CDX2 correlates with the type of intestinal metaplasia and may play a role in carcinogenesis.

A population based study of reporting patterns and characteristics of men who abuse their female partners.

OBJECTIVE: This study estimates the prevalence of male abusive behavior reported by men and their female partners and identifies characteristics of abusive men. DESIGN: Baseline survey from a population based cohort study of general health. SETTING: A rural county in Iowa, USA. SUBJECTS: 572 men and their cohabitating female partners. MAIN OUTCOME MEASURES: Male-to-female physical, emotional, and sexual abuse reported by either partner. RESULTS: In this cohort, 13.6% of men had performed at least one act of physical abuse and 34.9% emotional abuse. More than 45% of abusive men reported their own behaviors. Alcohol problems, antisocial personality characteristics, depressive symptoms, and financial stress were all positively associated with both physical and emotional abuse, but suicidal thoughts were less likely among abusers. CONCLUSION: Identification of common characteristics of abusive men may predict proclivity towards partner violence and barriers to behavior modification.

ZBP-89-induced apoptosis is p53-independent and requires JNK.

ZBP-89 induces apoptosis in human gastrointestinal cancer cells through a p53-independent mechanism. To understand the apoptotic pathway regulated by ZBP-89, we identified downstream signal transduction targets. Ectopic expression of ZBP-89 induced apoptosis through the mitochondrial pathway and was accompanied by activation of all three MAP kinase subfamilies: JNK1/2, ERK1/2 and p38 MAP kinase. ZBP-89-induced apoptosis was markedly enhanced by ERK inhibition with U0126. In contrast, inhibiting JNK with a JNK1-specific peptide inhibitor or dominant-negative JNK2 expression abrogated ZBP-89-mediated apoptosis. The p38 inhibitor SB202190 had no effect on ZBP-89-induced cell death. Protein dephosphorylation assays revealed that ZBP-89 activates JNK via repression of JNK dephosphorylation. Oligonucleotide microarray analyses revealed that ectopic expression of ZBP-89 downregulated expression of the dual-specificity phosphatase MKP6. Overexpression of MKP6 blocked ZBP-89-induced JNK phosphorylation and PARP cleavage. In addition, ectopic expression of ZBP-89 repressed Bcl-xL and Mcl-1 expression, but had no effect on Bcl-2. Silencing ZBP-89 with small interfering RNA enhanced both Bcl-xL and Mcl-1 expression. Taken together, ZBP-89-mediated apoptosis occurs via a p53-independent mechanism that requires JNK activation.

Identification of risk factors for non-fatal child injury in a rural area: Keokuk County Rural Health Study.

OBJECTIVE: To identify risk factors for non-fatal injury among rural children. DESIGN: Cross sectional health interview survey, 1994-98. SETTING: A rural Iowa county, not adjacent to a metropolitan area. SUBJECTS: Stratified, random sample of households, including all resident children and adults. MAIN OUTCOME MEASURES: Injury episodes in the past 12 months among children aged 0-17 years and the parental and child characteristics associated with these episodes. RESULTS: Of the 621 children in participating households, 137 or 22.1% were injured during the past 12 months. Children age 5-17 on a sports team were 1.88 times (95% confidence interval (CI) 1.07 to 3.31) more likely than other children to be injured. Children age 12-17 who binge drink were 3.50 times (95% CI 1.31 to 9.50) more likely than other children to be injured. Compared with children not on sports teams, girls on teams were 2.26 times (95% CI 1.02 to 5.13) more likely while boys on teams were 1.60 times (95% CI 0.71 to 3.68) more likely to have an injury episode. Compared with children who did not binge drink, girls binge drinking were 8.11 times (95% CI 1.52 to 43.33) more likely while boys binge drinking were 2.19 times (95% CI 0.70 to 6.84) more likely to have an injury episode. CONCLUSIONS: Local studies such as this can provide useful clues regarding the etiology of injury. Some known and some new potential risk factors including behavioral aspects for childhood non-fatal injury in a very rural area were investigated. It is planned to address these cross sectional findings in future longitudinal follow up of this population.

Monitoring the spread of myxoma virus in rabbit Oryctolagus cuniculus populations on the southern tablelands of New South Wales, Australia. I. Natural occurrence of myxomatosis.

A survey of rabbit populations in the southern tablelands of New South Wales, Australia, was carried out to establish the pattern of occurrence of myxomatosis in preparation for a deliberate release of myxoma virus. Myxomatosis was first detected in December and cases were found on most sites through to May. The serological profiles of rabbit populations suggested that their susceptibility to myxoma virus was generally low in winter and highest in spring and summer reflecting the presence of increasing numbers of susceptible young rabbits. This was consistent with the pattern of rabbit breeding, as determined from the distribution of births and reproductive activity in females and males, which occurred maximally in spring and early summer. The serology and age structure of rabbit populations on sites suggested that some rabbit populations can escape an annual myxomatosis epizootic. Although fleas were present on rabbits throughout the year and therefore not considered to be a limiting factor in the spread of myxomatosis, their numbers peaked at times coincident with peak rabbit breeding. It was concluded that mid to late spring was an optimal time for a deliberate release.

Monitoring the spread of myxoma virus in rabbit Oryctolagus cuniculus populations on the southern tablelands of New South Wales, Australia. II. Selection of a strain of virus for release.

To be able to study the dynamics of myxoma virus spread following a release in the field, a strain of virus is required that is both highly transmissible and readily differentiated from other field strains. Eight strains of virus of known virulence for laboratory rabbits and with previously mapped and sequenced restriction fragment length polymorphisms, were used to infect groups of seronegative wild rabbits. Based on these trials, and on the nature of the DNA polymorphism, a virus designated Brooklands/2-93 was chosen as a strain suitable for experimental release. These trials confirmed that resistance to myxomatosis within wild rabbit populations continues to be substantial and that some rabbits are highly resistant. These rabbits probably have little role in transmission of virus. Most of the virus strains tested induced very small or invisible primary lesions at the inoculation site. Thus the secondary skin sites such as eyelids, face and ears may be critical for transmission.

Monitoring the spread of myxoma virus in rabbit Oryctolagus cuniculus populations on the southern tablelands of New South Wales, Australia. III. Release, persistence and rate of spread of an identifiable strain of myxoma virus.

An identifiable strain of myxoma virus was introduced into four local populations of wild rabbits Oryctolagus cuniculus on the southern tablelands of New South Wales (NSW) and its spread in the presence of other field strains was monitored for 6 months. The main vector in this region was considered to be the European rabbit flea Spilopsyllis cuniculi. Each population of rabbits was of a high density and living in groups of warrens covering areas from 59 to 87 hectares. Rabbits occupying centrally located warrens were inoculated with the virus in late September or early October (spring) and the subsequent appearance of myxomatosis across the sites monitored by trapping, shooting and visual observations. Samples, taken from rabbits with myxomatosis, were examined by polymerase chain reaction (PCR) that allowed identification of the introduced strain. On all four sites the introduced virus spread from the inoculated rabbits in the centrally located warrens to rabbits in surrounding warrens. On Sites 1 and 3, this spread continued across the entire site persisting for at least 118 and 174 days respectively. On Sites 2 and 4, the virus was detected for 78 and 62 days respectively and the subsequent inability to detect the introduced virus correlated with the appearance of an unrelated field strain. Using three different methods of calculation, rates of spread ranged from 3.7 to 17.8 m d(-1).

Financial loss and suicidal ideation in a rural community sample.

OBJECTIVE: To examine the prevalence and correlates of suicidal ideation in a community-based rural sample. METHOD: The sample was a random sample of people living in a single county in Iowa. Participants aged 18 or older (n=1617) were asked about suicidal ideation in the past year as well as mood, alcohol use, social support, and stressful life events. RESULTS: About 8.2% of the sample reported suicidal ideation. Depressive symptoms, problems resulting from alcohol use, infrequent social contact and financial loss characterized the suicidal group. CONCLUSION: Depressive symptoms were the strongest correlate of suicidal ideation in this rural sample. In the multivariate analysis, financial loss rather than low income remained a significant correlate of suicidal ideation after controlling for depression. This suggests that change in financial status rather than chronic poverty poses a risk for suicidal ideation.

Gastritis and hypergastrinemia due to Acinetobacter lwoffii in mice.

In mouse models and humans, Helicobacter pylori is associated with an increase in serum gastrin and gastrin-expressing (G) cells with a concomitant decrease in somatostatin-expressing D cells. Inflammation of the gastric mucosa can progress to metaplastic changes in the stomach and to decreased colonization by H. pylori and increased colonization by non-H. pylori organisms. In addition, about 20% of individuals with chronic gastritis are H. pylori negative, suggesting that other organisms may induce gastritis. Consistent with this hypothesis, we report here that Acinetobacter lwoffii causes the same histologic changes as does H. pylori. Gastric epithelial cells were isolated from the entire stomach by an enzymatic method for quantitation by both flow cytometry and morphometric analysis. Two months after mice were inoculated with H. pylori or A. lwoffii, the mucosal T- and B-cell numbers significantly increased. After 4 months of infection, there was a threefold increase in the number of G cells and a doubling in the number of parietal cells. A threefold decrease in the number of D cells occurred in H. pylori- and A. lwoffii-infected mice. Plasma gastrin levels increased after both H. pylori and A. lwoffii infection. Histology revealed the presence of inflammation in the gastric mucosa with both A. lwoffii and H. pylori infection. A periodic acid-Schiff stain-alcian blue stain revealed mucous gland metaplasia of the corpus. Collectively, the results demonstrate that gastritis and hypergastrinemia are not specific for H. pylori but can be induced by other gram-negative bacteria capable of infecting the mouse stomach.

Evidence for insect transmission of rabbit haemorrhagic disease virus.

The spread of rabbit haemorrhagic disease (RHD) virus from quarantine on Wardang Island to mainland Australia in 1995 suggested that insects could be potential vectors. Field observations and laboratory experiments were conducted to address aspects of this hypothesis. Firstly, the variation in insect populations on the island during the field trials was examined. There was approximately a 1,000-fold increase in the number of bushflies, Musca vetustissima, shortly before the spread of the virus. Secondly, M. vetustissima were tested in the laboratory as potential vectors of RHD virus, and it was demonstrated that disease could be transmitted between rabbits by flies. Finally, 13 of 16 insect samples, collected from Wardang Island and from several sites on the mainland following the spread of virus off the island, were positive for the presence of RHD virus by a specific polymerase chain reaction (PCR). Only one sample contained sufficient infectious virus to kill a susceptible rabbit. These data, combined with previously published information on fly biology, suggested that flies, particularly bushflies, may be involved in the transmission of RHD virus. Other possible routes of spread were not assessed in this study.

TNF-alpha and interleukin 1 activate gastrin gene expression via MAPK- and PKC-dependent mechanisms.

Helicobacter pylori and proinflammatory cytokines have a direct stimulatory effect on gastrin release from isolated G cells, but little is known about the mechanism by which these factors regulate gastrin gene expression. We explored whether tumor necrosis factor (TNF)-alpha and interleukin (IL)-1 directly regulate gastrin gene expression and, if so, by what mechanism. TNF-alpha and IL-1 significantly increased gastrin mRNA in canine G cells to 181 +/- 18% and 187 +/- 28% of control, respectively, after 24 h of treatment. TNF-alpha and IL-1 stimulated gastrin promoter activity to a maximal level of 285 +/- 12% and 415 +/- 26% of control. PD-98059 (a mitogen-activated protein kinase kinase inhibitor), SB-202190 (a p38 kinase inhibitor), and GF-109203 (a protein kinase C inhibitor) inhibited the stimulatory action of both cytokines on the gastrin promoter. In conclusion, both cytokines can directly regulate gastrin gene expression via a mitogen-activated protein kinase- and protein kinase C-dependent mechanism. These data suggest that TNF-alpha and IL-1 may play a direct role in Helicobacter pylori-induced hypergastrinemia.

Epidemiology of unintentional adult injury in a rural population.

BACKGROUND: The purpose of this study was to describe the frequency, characteristics, and risk factors of unintentional adult injury in a rural population. METHODS: We interviewed 1,644 adults representing an all-rural county in Iowa. Analyses used bivariate and multivariable logistic regression. RESULTS: Participants' mean age was 53 years, and 54% were women. Twenty-three percent (n = 380) of participants reported an injury during the past 12 months, of which four fifths were treated. Overexertion (25%) and falls (22%) caused nearly half the injuries. Women with high levels of depression symptoms had 1.57 times (95% confidence interval, 1.05-2.33) the prevalence of injury occurrence as did women with low levels of depression symptoms. Men with a CAGE score of 2 or more had between 0.98 and 2.56 times (according to the range of values of the relevant odds ratio 95% confidence interval) the prevalence of injury episode of men without this exposure. CONCLUSION: The association of injury occurrence with alcohol problems is consistent with prior research, but the increased prevalence of injury associated with high levels of symptoms of depression requires further study and explanation.

Metal fume fever: a case report and literature review.

Metal fume fever is a relatively uncommon presentation to the emergency department. Resulting from inhalation of metal oxides, it presents as an acute, self-limiting, flu-like symptom complex often misdiagnosed as a viral illness. We report a case of a 26-year-old male presenting with metal fume fever 4 h after oxycutting galvanized steel. The literature is reviewed with respect to pathogenesis, the common presenting symptom complex, investigations and current accepted management of metal fume fever.