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Monoclonal gammopathy of undetermined significance is one of the most common pre-malignant disorders. IgG and IgA monoclonal gammopathy of undetermined significance are precursor conditions of multiple myeloma; light-chain monoclonal gammopathy of undetermined significance of light-chain multiple myeloma; and IgM monoclonal gammopathy of undetermined significance of Waldenström’s macroglobulinemia and other lymphoproliferative disorders. Clonal burden, as determined by bone marrow plasma cell percentage or M-protein level, as well as biological characteristics, including heavy chain isotype and light chain production, are helpful in predicting risk of progression of monoclonal gammopathy of undetermined significance to symptomatic disease. Furthermore, alterations in the bone marrow microenvironment of monoclonal gammopathy of undetermined significance patients result in an increased risk of venous and arterial thrombosis, infections, osteoporosis, and bone fractures. In addition, the small clone may occasionally be responsible for severe organ damage through the production of a monoclonal protein that has autoantibody activity or deposits in tissues. These disorders are rare and often require therapy directed at eradication of the underlying plasma cell or lymphoplasmacytic clone. In this review, we provide an overview of the clinical relevance of monoclonal gammopathy of undetermined significance. We also give general recommendations of how to diagnose and manage patients with monoclonal gammopathy of undetermined significance. Copyright© Ferrata Storti Foundation. Open access.

Udgivelsesdato: 2009

The stress-strain relationship is determined by the inherent mechanical properties of the intestinal wall, the geometric configurations, the loading conditions and the zero-stress state of the segment. The purpose of this project was to provide morphometric and biomechanical data for rat duodenum, jejunum and ileum. The circumferential strains were referenced to the zero-stress state. Large morphometric variations were found along the small intestine with an increase in the outer circumferential length and luminal area and a decrease in wall thickness in distal direction. The serosal residual strain was tensile and decreased in distal direction (P < 0.05). The mucosal residual strain was compressive and the absolute value decreased in distal direction (P < 0.001). The stress-strain experiments showed that the duodenum was stiffest. All segments were stiffest in longitudinal direction (P < 0.05). In conclusion, axial variation in morphometric and biomechanical properties was found in the small intestine. The zero-stress state must be considered in future biomechanical studies in the gastrointestinal tract.

Objective: To investigate the eff ects of Changruntong Decoction (CRT ) on the colonic remodeling in rat with diabetes induced by streptozotocin (STZ). Methods: 40 SD male rats were randomly divided into normal control group, diabetes model group (DM), high-dose Changruntong decoction group (T1) and low-dose Changruntong Decoction group (T2), with 10 rats in each group. Except for the normal control group, all rats were induced by STZ for establishing the diabetes model. The rats in the treatment groups were gavaged with diff erent doses of Changruntong Decoction. The body weight was measured regularly. At the end of experiment, three 1-2 mm rings were cut from mid-piece colon that were used for the no-load and zero-stress state tests, while the remainder of the mid-piece colon were used for the step-wise distension test. The morphometric data, such as the circumferential length, the wall thickness and the opening angle were measured from the no-load and zero-stress state tests. Circumferential and longitudinal stresses and strains were computed from the pressure, length and diameter of mid-piece colon after step-wise distension test. Results: The body weight in DM group, T1 group and T2 group was all signifi cantly lower than that in control group (P

Objective: To study the effect of Chinese medicine Changruntong (CRT) on expression of TGF-β1 and TGF-β1 receptor and the association between with biomechanical remodeling of colon in the diabetic rats. Methods: Forty male SD rats were randomly divided into normal, model, low-dose and high-dose group. Diabetes was induced by a single tail vein injection of streptozotocin (STZ) (40mg/kg). CRT (T1, high dosage: 50g/kg; T2, low dosage: 25g/kg) was given intragastric administration once daily for 60 days. Blood glucose level and body weight were measured. The expressions of TGF-β1 and TGF-β1 receptor were detected in different layers of the colon by immunohistochemistry method. Morphological and biomechanical parameters such as wet weight, wall thickness, spread angle, residual strain, and stress-strain of the colon wall were taken from the previous study. Linear regression analysis was accepted to study association between TGF-β1 and TGF-β1 receptor expressions with the histomorphometric and biomechanical parameters. Results: It was demonstrated that the expressions of TGF-β1 and TGF-β1 receptor in different colon layers in the model group were significantly higher than those in normal group (P

Background and aims: The lower esophageal sphincter (LES) regulates transport of ingested substances from the esophagus to the stomach. However, little is known about the muscle fiber distribution and the spatial arrangement. Diffusion tensor magnetic resonance imaging (DT-MRI) can reveal microscopic details about tissue architecture. The aims of this study were to quantitatively describe the muscle fiber arrangement in the 3D model of the LES region. Methods: A 50kg pig was sacrificed during deep anesthesia. After tissue fixation, a 7x7x7cm3 tissue block including the distal esophagus, the proximal stomach, and the diaphragmatic crura was prepared for DT-MRI scanning. The fiber angles were computed in the LES region. Results: The fibers were distributed heterogeneously across the muscle layer of the LES region. In the proximal LES region, the fibers showed a helical crossing pattern with fiber angles changing from ±77 to ±15 degrees from longitudinal muscle layer (LM) to circumferential muscle layer (CM). The gastroesophageal flap valve (GEV) was found in the distal LES region and the fibers throughout the GEV layer were circumferentially distributed. In the distal LES region outside the GEV, the muscle fibers transferred from axial direction with fiber angle distribution peaks at around ±70 in LM to the oblique direction with fiber angles peaks at -47.3 degree in CM. Conclusions: This is the first study that quantitatively demonstrated the smooth muscle fiber distributions along the LES region and the fiber transition through the LES wall. The results on the myoarchitecture structure from this study will be useful for further computer modeling of the LES region.

Objectives. To evaluate relations between human coronary artery distensibility and vessel wall morphology assessed by histomorphometry. Methods. Coronary artery pressure-cross-sectional area relations and distensibility were studied in excised autopsy hearts by means of a balloon-based impedance planimetric technique 2 cm from the aortic orifice of the arteries. Later the hearts were perfusion fixed at 100 mm Hg and cross-sectioned 17, 20, and 23 mm distal to the aortic orifice. The areas of lumen, intima, and media were measured. Results. Nineteen LAD's and 15 RCA's from 25 hearts (12 women and 13 men) were investigated. The age of the subjects was 48 to 97 years (mean 73.8 years). A non-linear relation was found between pressure and cross-sectional area (according with the function y = a + bx0.5) and between pressure and distensibility. No differences between the curves of LAD and RCA were found. Subjects' age was positively correlated with wall thickness (r=0.44, p-2 vs. 3.6±0.7·10-2 kPa-1, p

The aim of the study was to determine factors of importance for the duration of treatment of physiotherapy patients. A material of 363 patients answered questions about personal and social data and their disease. The following was related to prolonged treatment (greater than 47 days): 1) young, unmarried students. There was twice as many boys as girls. 2) Patients with psychosomatic disease. The ratio between men and women was 1, and the main symptom was headache. 3) Patients with generalized disease. This study did not reveal whether prolonged treatment is due to an ineffective treatment or whether other factors are of importance. However, we doubt the effect of physiotherapy in patients with psychosomatic disease.

Functional Electrical Stimulation (FES) is a controlled use of electrical stimulation of muscle contractions to obtain function. FES is utilised today in the treatment of spinal cord injured individuals for diaphragmatic pacing, bladder and bowel management, ejaculation, walking and hand function, as well as conditioning. We present The Freehand System, which consists of implanted electrodes to arm and hand muscles. This system has now been implanted in the first two Nordic tetraplegics. Candidates are tetraplegics with C5-6 lesions. After implantation it may take 6-8 months before the tetraplegic person can expect to use The Freehand System completely in daily life. The tetraplegic individual can choose between two grasps. The Freehand System can for some few very physically disabled tetraplegics be a good aid to increase their level of activities of daily living and independence. Continued development in the coming years may broaden the indications with benefit for more individuals.

Systemic treatment with epidermal growth factor (EGF) induce growth of the large intestine. The aim of this study was to investigate the morphological properties early in the course of EGF-induced large intestinal growth. The effects of systemic EGF treatment on the morphological properties at the zero-stress state along the large intestine were investigated. EGF-treated rats and control rats were allocated into group with EGF treatment for 2, 4, 7, and 14 days (N = 6 for each EGF treatment group except N = 4 for the 14-day group). The controls had saline injected (N = 3 for each group). The excised large intestine was subdivided into four segments: the ascending colon, transverse colon, descending colon, and rectum. The length and weight of each segment was measured. The zero-stress state was obtained by cutting rings of the large intestine radially, and the opening angle was measued on video images. The thickness and cross-sectional area of the mucosa and muscle layers, and the inner and outer circumference were measured. The total colon length did not increase, whereas the weight of the large intestine, muscosal thickness and mass, and inner and outer circumference increased significantly (P < 0.05). The increase was most prominent in the proximal colon after 7 days of EGF treatment. Later no further morphological changes were observed, except for a decrease in mucosal thickness in most segments and in mucosal cross-sectional area in the descending colon. In the controls and during the first week of EGF treatment, the opening angle was approximately 100 degrees. After 14 days the opening angle increased significantly in the ascending and transverse colon to approximately 172 and 135 degrees (P < 0.05). In conclusion, this study demonstrates that systemic EGF treatment caused remodeling of the morphology of the zero-stress state in the large intestine in a time-dependent manner. The growth was most pronounced in the ascending and transverse colon and involved mainly the mucosal layer.

AIM:To measure the time-dependent (viscoelastic) behavior in the change of the small intestinal opening angle and to test how well the behavior could be described by the Kelvin model for a standard linear solid.METHODS:Segments from the duodenum, jejunum, and ileum were harvested from 10 female Wistar rats and the luminal diameter, wall thickness, and opening angle over time (theta(t)) were measured from rings cut from these segments.RESULTS:Morphometric variations were found along the small intestine with an increase in luminal area and a decrease in wall thickness from the duodenum to the ileum. The opening angle obtained after 60 min was highest in the duodenum (220.8+/-12.9 degrees) and decreased along the length of the intestine to 143.9+/-8.9 degrees in the jejunum and 151.4+/-9.4 degrees in the ileum. The change of opening angle as a function of time, fitted well to the Kelvin model using the equation theta(t)/theta(o) = [-eta exp (-lambda t)] after the ring was cut. The computed creep rate lambda did not differ between the segments. Compared to constant calculated from pig aorta and coronary artery, it showed that alpha agreed well (within 5%), eta was three times larger than that for vascular tissue, and lambda ranged +/-40% from the value of the pig coronary artery and was a third of the value of pig aorta.CONCLUSION:The change of opening angle over time for all the small intestine segments fits well to the standard linear spring-dashpot model. This viscoelastic constant of the rat small intestine is fairly homogenous along its length. The data obtained from this study add to a base set of biomechanical data on the small intestine and provide a reference state for comparison to other tissues, diseased intestinal tissue or intestinal tissue exposed to drugs or chemicals.