BACKGROUND/AIMS: Chronic intestinal pseudo-obstruction (CIPO) is a disorder characterized by recurrent symptoms suggestive of obstruction such as abdominal pain, proximal distension with extremely suppressed motility in the absence of lumen-occluding lesion, whose etiology/pathophysiology is poorly understood. In this study we investigated a functionally obstructive lesion that could underlie symptoms of CIPO. METHODS: We studied colons surgically removed from 13 patients exhibiting clinical/pathological features of pseudo-obstruction but were unresponsive to standard medical treatments. The colons were characterized morphologically, functionally and molecularly, which were compared between regions and to 28 region-matched controls obtained from colon cancer patients. RESULTS: The colons with pseudo-obstruction exhibited persistent luminal distension proximally, where the smooth muscle was hypertrophied with changes in the cell phenotypes. Distinct luminal narrowing was observed near the distal end of the dilated region, close to the splenic flexure, previously referred to as the "transition zone (TZ)" between the dilated and non-dilated loops. Circular muscles from the TZ responded less to depolarization and cholinergic stimulation, which was associated with down-regulation of L-type calcium channel expression. Smooth muscle contractile protein was also downregulated. Myenteric ganglia and neuronal nitric oxide synthase (nNOS) positive cells were deficient, more severely in the TZ region. Interstitial cells of Cajal was relatively less affected. CONCLUSIONS: The TZ may be the principal site of functional obstruction, leading to proximal distension and smooth muscle hypertrophy, in which partial nNOS depletion could play a key role. The neuromuscular abnormalities probably synergistically contributed to the extremely suppressed motility observed in the colonic pseudo-obstruction.
Abdominal Pain ; Calcium Channels, L-Type ; Colon* ; Colon, Transverse ; Colonic Neoplasms ; Colonic Pseudo-Obstruction* ; Constipation* ; Down-Regulation ; Ganglia ; Humans ; Hypertrophy ; Interstitial Cells of Cajal ; Intestinal Pseudo-Obstruction ; Muscle, Smooth ; Muscles ; Nitric Oxide ; Nitric Oxide Synthase Type I ; Phenobarbital ; Phenotype

The multiple correlation coefficient between the values determined by dry weight and those determined by fluorometer was observed with r = 0.96 and the standard error of calibration was 0.034. Using the best calibration data, in order to reconfirm the reliability of the fluorometer results in comparison with those obtained by dry weight on the cell concentration, fedbatch cultures were carried out. The results obtained by fluorometer measurements were in good agreement with those obtained by dry weight. The on-line monitoring of cell concentration by the fermentor system linked to a computer equipped with fluorometer was successfully carried out.
Bioreactors ; Calibration ; Pichia* ; Yeasts*

Therapeutic temperature management (TTM) was strongly recommended by the 2015 International Liaison Committee on Resuscitation as a component of post-resuscitation care. It has been known to be effective in improving the survival rate and neurologic functional outcome of patients after cardiac arrest. In an effort to increase local adoption of TTM as a standard of post-resuscitation care, this paper discusses and makes recommendations on the treatment for local providers.