Maricela Diaz-Sotomayor

Maltase-glucoamylase modulates gluconeogenesis and sucrase-isomaltase dominates starch digestion glucogenesis.

Objectives: Six enzyme activities are needed to digest starch to absorbable free glucose; 2 luminal &agr;-amylases (AMY) and 4 mucosal maltase-glucoamylase (MGAM) and sucrase-isomaltase (SI) subunit activities are involved in the digestion. The AMY activities break down starch to soluble oligomeric dextrins; mucosal MGAM and SI can either directly digest starch to glucose or convert the post-&agr;-amylolytic dextrins to glucose. We hypothesized that MGAM, with higher maltase than SI, drives digestion on ad limitum intakes and SI, with lower activity but more abundant amount, constrains ad libitum starch digestion. Methods: Mgam null and wild-type (WT) mice were fed with starch diets ad libitum and ad limitum. Fractional glucogenesis (fGG) derived from starch was measured and fractional gluconeogenesis and glycogenolysis were calculated. Carbohydrates in small intestine were determined. Results: After ad libitum meals, null and WT had similar increases of blood glucose concentration. At low intakes, null mice had less fGG (P = 0.02) than WT mice, demonstrating the role of Mgam activity in ad limitum feeding; null mice did not reduce fGG responses to ad libitum intakes demonstrating the dominant role of SI activity during full feeding. Although fGG was rising after feeding, fractional gluconeogenesis fell, especially for null mice. Conclusions: The fGNG (endogenous glucogenesis) in null mice complemented the fGG (exogenous glucogenesis) to conserve prandial blood glucose concentrations. The hypotheses that Mgam contributes a high-efficiency activity on ad limitum intakes and SI dominates on ad libitum starch digestion were confirmed.

Bilateral Ovarian Krukenberg Tumor in a Full-Term Pregnancy

Objective. Krukenberg tumors in pregnancy are very rare and their management can present a dilemma for the obstetrician gynecologist. Case Report. We present the case of a G3P2002 who presented to us and the 38 weeks gestation with bilateral massive Krukenberg tumors. Despite at surgery and chemotherapy she died 3 months postpartum. Conclusion. Early detection followed by surgery and chemotherapy could possibly result in a favorable outcome with such patients.

Utility of the pulsatility index of the uterine arteries and human chorionic gonadotropin in a series of cases of placenta accreta

The conservative management of retained placenta accreta has been proposed as an alternative option in selected cases. Three patients under conservative management of placenta accreta were followed using the pulsatility index of the uterine arteries and the β fraction of human chorionic gonadotropin to determine the degree of vascularity between the uterus and the placenta. In this series of cases of conservative management of placenta accreta, the pulsatility index of the uterine arteries showed a better correlation with the uteroplacental circulation than serum β fraction of human chorionic gonadotropin.

954 Carbohydrate Digestion in Congenital Sucrase Isomaltase Deficient and Recurrent Abdominal Pain Children Assesed by 13C- Starch Breath Test

BACKGROUND: Intestinal allograft rejection is a severe complication in small bowel transplantation. Identifying involved pathogenetic mechanisms might make it possible to predict or even prevent rejection and intestinal graft failure. Rejection resembles Crohns disease (CD) clinically and histopathologically. We investigated the role of CD-associated genetic loci, including NOD2 variants in rejection and graftfailure. METHODS: 99 recipients and 71 donors from the University of Nebraska Medical Center, USA were genotyped for three NOD2 variants and single nucleotide polymorphisms in IBD5, ATG16L1, IRGM, MST1, IL23R, STAT3 and JAK2. Genotypes were related to clinical outcomes rejection, graftfailure and patient-survival using Kaplan-Meier curves and log-rank analysis. RESULTS: Only the MST1 riskallele was more frequent in recipients compared to donors (30,8% and 20,4%, p=0,032). For the other loci, including NOD2, allelic distribution was equal within the two groups. No single locus was significantly associated with rejection, graftfailure or patientsurvival. There is no significant difference in clinical endpoints whether the recipient has a low or high number of risk alleles. Individuals receiving a donorgraft with ≤5 riskalleles in total, have decreased rejection-free survival compared to ≥6 riskalleles (p=0,040), but increased patient three-year survival (mortality: 4/19 and 16/29, p=0,016). CONCLUSIONS: In this relatively large cohort, we could not confirm the association of NOD2, with rejection and graftfailure. Furthermore we found no association of seven other CD-loci with clinical endpoints. However, patients receiving a donorgraft with six or more risk alleles have decreased three-year survival, but -surprisinglyincreased rejection-free survival.