BioMed Central

IntroductionWe previously reported the association of gastrointestinal and hypoglycaemic symptoms, with idiopathic accelerated gastric emptying. We now report the first series of six similar cases.Case presentationsPaitent 1: A 24 year old Caucasian male presented with a 6 month history of postprandial nausea, flatulence, bloating, abdominal discomfort and associated diarrhoea. He had associated episodes of fatigue, sweating, anxiety, confusion and craving for sweet foods.Patient 2: A 52 year old Caucasian female presented with a 15 year history of postprandial bloating, abdominal pain and diarrhoea, often associated with nausea, severe sweating, and fatigue.Patient 3: An 18 year old Caucasian female presented with a 9 year history of postprandial diarrhoea, abdominal bloating and pain. There was associated nausea, tremor, lethargy, and craving for sweet foods. Patient 4: A 77 year old Caucasian female presented with a 4 month history of epigastric distension, pain after eating and a change in bowel habit. She experienced intermittent severe diarrhoea and marked fatigue, nausea and sweating.Patient 5: A 23 year old Caucasian female presented with a 2 year history of early satiety, and diarrhoea after eating. She also complained of feeling faint and weak between meals, when she became cold and clammy, and lost consciousness during these episodes on several occasions.Patient 6: A 64-year old Caucasian female presented with a 10 year history of nausea, early satiety and profound bloating followed by diarrhoea. All symptoms predominantly occurred in the first 3 hours after eating, when she felt faint, lethargic, and had a craving for sweet foods.In all cases, symptoms were alleviated or resolved by taking sweet food or drink and response to treatment was 90% or greater in all cases. Conclusion: This series extends our description of this new clinical syndrome. All responded well to treatment for accelerated gastric emptying. Clinicians in the disciplines of endocrinology, gastroenterology, neurology and general practice are likely to find this information useful as they will consult patients with some or all of these symptoms and in a proportion of these patients idiopathic accelerated gastric emptying may be present and provide a useful avenue for therapeutic intervention.

Background: Chromatin structure at a given site can differ between chromosome copies in a cell, and suchimbalances in chromatin structure have been shown to be important in understanding themolecular mechanisms controlling several disease loci. Human genetic variation, DNAmethylation, and disease have been intensely studied, uncovering many sites of allele-specificDNA methylation (ASM). However, little is known about the genome-wide occurrence ofsites of allele-specific histone modification (ASHM) and their relationship to human disease.The aim of this study was to investigate the extent and characteristics of sites of ASHM inhuman embryonic stem cells (hESCs). Results: Using a statistically rigorous protocol, we investigated the genomic distribution of ASHM inhESCs, and their relationship to sites of allele-specific expression (ASE) and DNAmethylation. We found that, although they were rare, sites of ASHM were substantiallyenriched at loci displaying ASE. Many were also found at known imprinted regions, hencesites of ASHM are likely to be better markers of imprinted regions than sites of ASM. Wealso found that sites of ASHM and ASE in hESCs colocalize at risk loci for developmentalsyndromes mediated by deletions, providing insights into the etiology of these disorders. Conclusion: These results demonstrate the potential importance of ASHM patterns in the interpretation ofdisease loci, and the protocol described provides a basis for similar studies of ASHM in othercell types to further our understanding of human disease susceptibility.

Background: Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) predictsadverse prognosis in patients with stable coronary artery disease (CAD). However, theinteraction with conventional risk factors remains uncertain.Our aim was to assess whether the extent of LGE is an independent predictor of adversecardiac outcome beyond conventional risk factors, including left ventricle ejection fraction(LVEF). Methods: We enrolled 376 patients (88% males, 64 +/- 11 years) with stable CAD, who underwent LGEassessment and a detailed conventional evaluation (clinical and pharmacological history, riskfactors, ECG, Echocardiography). During a follow-up of 38 +/- 21 months, 56 events occurred(32 deaths, 24 hospitalizations for heart failure). Results: LGE and LVEF showed the strongest univariate associations with end-points (HR: 13.61[95%C.I.: 7.32-25.31] for LGE [greater than or equal to] 45% of LV mass; and 12.34 [6.80-22.38] for LVEF [less than or equal to] 30%;p < 0.0001). Multivariate analysis identified baseline LVEF, loop diuretic therapy, moderateseveremitral regurgitation and pulmonary hypertension as significant predictors amongconventional risk factors. According to a step-wise approach, LGE showed strong associationwith prognosis as well (5.25 [2.64-10.43]; p < 0.0001). LGE significantly improved the modelpredictability (chi-square 239 vs 221, F-test p < 0.0001) with an additive effect on theprognostic power of LVEF, which however retained its prognostic power (4.89 [2.50-09.56];p < 0.0001). Patients with LGE [greater than or equal to] 45% and/or LVEF [less than or equal to] 30% had much worse prognosiscompared to patients without risk factors (annual event rates of 43% vs 3%; p < 0.0001).Interestingly LGE was a significant predictor when all cause mortality was analyzed as theonly endpoint. Conclusions: This study demonstrates that LGE assessed by CMR is a robust independent non-invasivemarker of prognosis in stable CAD patients. LGE can integrate the available metrics tosubstantially improve risk stratification.

Background: Mosquitoes' response to artificial lights including color has been exploited in trap designs forimproved sampling of mosquito vectors. Earlier studies suggest that mosquitoes are attractedto specific wavelengths of light and thus the need to refine techniques to increase mosquitocaptures following the development of super-bright light-emitting diodes (LEDs) which emitnarrow wavelengths of light or very specific colors. Therefore, we investigated if LEDs canbe effective substitutes for incandescent lamps used in CDC light traps for mosquitosurveillance, and if so, determine the best color for attraction of important Rift Valley Fever(RFV) vectors. Methods: The efficiency of selected colored LED CDC light traps (red, green, blue, violet, combinationof blue-green-red (BGR)) to sample RVF vectors was evaluated relative to incandescent light(as control) in a CDC light trap in two RVF hotspots (Marigat and Ijara districts) in Kenya. Infield experiments, traps were baited with dry ice and captures evaluated for Aedes tricholabis,Ae. mcintoshi, Ae. ochraceus, Mansonia uniformis, Mn. africana and Culex pipiens,following Latin square design with days as replicates. Daily mosquito counts per treatmentwere analyzed using a generalized linear model with Negative Binomial error structure andlog link using R. The incidence rate ratios (IRR) that mosquito species chose other treatmentsinstead of the control, were estimated. Results: Seasonal preference of Ae.mcintoshi and Ae. ochraceus at Ijara was evident with a biastowards BGR and blue traps respectively in one trapping period but this pattern waned duringanother period at same site with significantly low numbers recorded in all colored trapsexcept blue relative to the control. Overall results showed that higher captures of all specieswere recorded in control traps compared to the other LED traps (IRR < 1) although onlysignificantly different from red and violet. Conclusion: Based on our trapping design and color, none of the LEDs outcompeted the standardincandescent light. The data however provides preliminary evidence that a preference mightexist for some of these mosquito species based on observed differential attraction to theselight colors requiring future studies to compare reflected versus transmitted light and theincorporation of colored light of varying intensities.

It is always risky to write a book trying to review such a broad topic on ectoparasites bringingnecessarily an update and some new information. Considering the number of internationalexperts who apparently helped to share their knowledge I was hoping to read about the latesttrials and epidemiological results.

Background: Cardiac and navigator-gated, inversion-prepared non-enhanced magnetic resonanceangiography techniques can accurately depict the renal arteries without the need for contrastadministration. However, the scan time and effectiveness of navigator-gated techniquesdepend on the subject respiratory pattern, which at times results in excessively prolongedscan times or suboptimal image quality. A single-shot 3D magnetization-prepared steadystatefree precession technique was implemented to allow the full extent of the renal arteriesto be depicted within a single breath-hold. Methods: Technical optimization of the breath-hold technique was performed with fourteen healthyvolunteers. An alternative magnetization preparation scheme was tested to maximize inflowsignal. Quantitative and qualitative comparisons were made between the breath-holdtechnique and the clinically accepted navigator-gated technique in both volunteers andpatients on a 1.5 T scanner. Results: The breath-hold technique provided an average of seven fold reduction in imaging time,without significant loss of image quality. Comparable single-to-noise and contrast-to-noiseratios of intra- and extra-renal arteries were found between the breath-hold and the navigatorgatedtechniques in volunteers. Furthermore, the breath-hold technique demonstrated goodimage quality for diagnostic purposes in a small number of patients in a pilot study. Conclusions: The single-shot, breath-hold technique offers an alternative to navigator-gated methods fornon-enhanced renal magnetic resonance angiography. The initial results suggest a potentialsupplementary clinical role for the breath-hold technique in the evaluation of suspected renalartery diseases.

Background: Car tires are important habitats for mosquito development because of the high densitypopulations they can harbor and their presence in urban settings. Water in experimental tireswas treated with one of three insecticides or an untreated control. Aquatic invertebrates weresampled at weekly intervals. Eggs, larval and pupal samples were laboratory-reared toestimate seasonal fluctuations in Aedes aegypti and Ae. albopictus abundance. Results: Spinosad treatments at 1 or 5 ppm (mg a.i./liter) provided 6-8 weeks of effective control ofAe. aegypti, Ae. albopictus, Culex quinquefasiatus and Cx. coronator larvae, both in the dryseason and the rainy season when mosquito populations increased markedly in southernMexico. Spinosad continued to provide partial control of larvae for several weeks after initialrecolonization of treated tires. The larvicidal performance of VectoBac 12AS (Bacillusthuringiensis var. israelensis) was relatively poor with one week of complete control ofAedes spp. larvae and no discernible control of Culex spp., whereas the duration of larvicidalactivity of 1% temephos mineral-based granules was intermediate between those of VectoBacand spinosad treatments. Populations of chironomids, ostracods and Toxorhynchites theobaldiwere generally reduced in spinosad and temephos treatments, but were similar in control andVectoBac treatments. Conclusion: The present study is the first to report spinosad as an effective larvicide against Cx.coronator, which is currently invading the southern United States. These results substantiatethe use of spinosad as a highly effective mosquito larvicide, even in habitats such as unusedcar tires that can represent prolific sources of adult mosquitoes.

Background: Anopheles arabiensis (Diptera: Culicidae) is a potential malaria vector commonly present atlow altitudes in remote areas in Reunion Island. Little attention has been paid to theenvironmental conditions driving larval development and abundance patterns in potentialhabitats. Two field surveys were designed to determine whether factors that discriminatebetween aquatic habitats with and without An. arabiensis larvae also drive larval abundance,comparatively in man-made and naturally occurring habitats. Methods: In an initial preliminary survey, a representative sample of aquatic habitats that would beamenable to an intensive long-term study were selected and divided into positive andnegative sites based on the presence or absence of Anopheles arabiensis larvae.Subsequently, a second survey was prompted to gain a better understanding of biotic andabiotic drivers of larval abundance, comparatively in man-made and naturally occurringhabitats in the two studied locations. In both surveys, weekly sampling was performed torecord mosquito species composition and larval density within individual habitats, as well asin situ biological characteristics and physico-chemical properties. Results: Whilst virtually any stagnant water body could be a potential breeding ground for An.arabiensis, habitats occupied by their immatures had different structural and biologicalcharacteristics when compared to those where larvae were absent. Larval occurrence seemedto be influenced by flow velocity, macrofauna diversity and predation pressure. Interestingly,the relative abundance of larvae in man-made habitats (average: 0.55 larvae per dip, 95%CI[0.3-0.7]) was significantly lower than that recorded in naturally occurring ones (0.74,95%CI [0.5-0.8]). Such differences may be accounted for in part by varying pressures thatcould be linked to a specific habitat. Conclusions: If the larval ecology of An. arabiensis is in general very complex and factors affectingbreeding site productivity sometimes not easy to highlight, our results, however, highlightlower populations of An. arabiensis immatures compared to those reported in comparablestudies conducted in the African continent. Overall, this low larval abundance, resulting fromboth abiotic and biotic factors, suggests that vector control measures targeting larval habitatsare likely to be successful in Reunion, but these could be better implemented by takingenvironmental variability into account.

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As co-editors of Alzheimer's Research and Therapy we would like to highlight several of the major translational research advances that have occurred over the last year, during which a tremendous amount of superb science relevant to the study of Alzheimer's disease (AD) has been published. Our selection is, of course, influenced by our own biases, and selecting particular advances to highlight was challenging. Nevertheless, many major scientific questions relevant to developing better therapies and diagnostics for AD remain. The advances we have chosen to highlight represent evolving areas of research in AD that raise as many questions as they answer, but offer some promise that may help us to reach our shared goal of translating research advances into real advances that benefit patients.

Background: Cerebral palsy is currently one of the major diseases that cause severe paralysis of the nervous system in children; about 9-30% of cerebral palsy patients also have visual impairment, which has no effective treatment thus far. Bone marrow mesenchymal stem cells (BMSCs) have very strong self-renewal, proliferation, and pluripotent differentiation potentials. Therefore, autologous BMSC transplantation has become a novel method for treating cerebral palsy. Methods: An 11-year-old boy had a clear history of dystocia and asphyxia after birth; at the age of 6 months, the family members observed his gaze casting around and noted that he displayed a lack of attention. A brain MRI examination at the age of 7 years showed that the child had cerebral palsy with visual impairment (i.e., posterior visual pathway injury). The patient was hospitalized for 20 days and was given four infusions of intravenous autologous BMSCs. Before transplantation and 1, 6, and 12 months after transplantation, a visual evoked potential test, an electrocardiogram, routine blood tests, and liver and kidney function tests were performed. Results: The patient did not have any adverse reactions or abnormal consequences during hospitalization or postoperative follow-up. After discharge, the patient could walk more smoothly than he could before transplantation; his vision significantly improved 6 months after transplantation, which was also supported by the electrophysiological examinations. Conclusions: The clinical application of BMSCs is safe and effective for improving vision in the treatment of cerebral palsy combined with visual impairment.

Background: Inflammation-induced sensitization of primary afferents is associated with a decrease in K+ current. However, the type of K+ current and basis for the decrease varies as a function of target of innervation. Because glabrous skin of the rat hindpaw is used often to assess changes in nociception in models of persistent pain, the purpose of the present study was to determine the type and extent to which K+ currents contribute to the inflammation-induced sensitization of cutaneous afferents. Acutely dissociated retrogradely labeled cutaneous dorsal root ganglion neurons from naive and inflamed (3 days post complete Freund's adjuvant injection) rats were studied with whole cell and perforated patch techniques. Results: Inflammation-induced sensitization of small diameter cutaneous neurons was associated with an increase in action potential duration and rate of decay of the afterhyperpolarization. However, no changes in voltage-gated K+ currents were detected. In contrast, Ca2+ modulated iberiotoxin sensitive and paxilline sensitive K+ (BKCa) currents were significantly smaller in small diameter IB4+ neurons. This decrease in current was not associated with a detectable change in total protein levels of the BKCa channel alpha or beta subunits. Single cell PCR analysis revealed a significant change in the pattern of expression of alpha subunit splice variants and beta subunits that were consistent, at least in part, with inflammation-induced changes in the biophysical properties of BKCa currents in cutaneous neurons. Conclusions: Results of this study provide additional support for the conclusion that it may be possible, if not necessary to selectively treat pain arising from specific body regions. Because a decrease in BKCa current appears to contribute to the inflammation-induced sensitization of cutaneous afferents, BKCa channel openers may be effective for the treatment of inflammatory pain.

Background: Since the detection of MRSA CC398 in pigs in 2004, it has emerged in livestock worldwide. MRSA CC398 has been found in people in contact with livestock and thus has become a public health issue. Data from a large-scale longitudinal study in two Danish and four Dutch pig herds were used to quantify MRSA CC398 transmission rates within pig herds and to identify factors affecting transmission between pigs. Results: Sows and their offspring were sampled at varying intervals during a production cycle. Overall MRSA prevalence of sows increased from 33% before farrowing to 77% before weaning. Overall MRSA prevalence of piglets was > 60% during the entire study period. The recurrent finding of MRSA in the majority of individuals indicates true colonization or might be the result of contamination. Transmission rates were estimated using a Susceptible-Infectious-Susceptible (SIS-)model, which resulted in values of the reproduction ratio (R0) varying from 0.24 to 8.08. Transmission rates were higher in pigs treated with tetracyclins and beta-lactams compared to untreated pigs implying a selective advantage of MRSA CC398 when these antimicrobials are used. Furthermore, transmission rates were higher in pre-weaning pigs compared to post-weaning pigs which might be explained by an age-related susceptibility or the presence of the sow as a primary source of MRSA CC398. Finally, transmission rates increased with the relative increase of the infection pressure within the pen compared to the total infection pressure, implying that within-pen transmission is a more important route compared to between-pen transmission and transmission through environmental exposure. Conclusions: Our results indicate that MRSA CC398 is able to spread and persist in pig herds, resulting in an endemic situation. Transmission rates are affected by the use of selective antimicrobials and by the age of pigs.

Background: Uncontrolled blood pressure (BP) is a significant contributor of morbidity and even mortality in type 2 diabetes (T2D) patients. This study was done to determine the significant determinants of uncontrolled blood pressure in T2D patients in Malaysia. Methods: Between 1st January 2009 to 31st December 2009, data from 70 889 patients with Type 2 diabetes was obtained from the Adult Diabetes Control and Management Registry for analysis; 303 centers participated in the study. Their demographic characteristics, the nature of their diabetes, their state of hypertension, treatment modalities, risk factors, and complications are described. Based on their most recent BP values, subjects were divided into controlled BP and uncontrolled BP and their clinical determinants compared. Independent determinants were identified using multivariate logistic regression. Results: The mean age of patients at diagnosis of diabetes was 52.3 +/- 11.1 years old. Most were women (59.0%) and of Malay ethnicity (61.9%). The mean duration of diabetes was 5.9 +/- 5.6 years. A total of 57.4% were hypertensive. Of the 56 503 blood pressure (BP) measured, 13 280 (23.5%) patients had BP <130/80 mmHg. Eighteen percent was on > two anti-hypertensive agents. Health clinics without doctor, older age ([greater than or equal to] 50 years old), shorter duration of diabetes (< 5 years), Malay, overweight were determinants for uncontrolled blood pressure (BP [greater than or equal to]130/80mmHg). Patients who were on anti-hypertensive agent/s were 2.7 times more likely to have BP [greater than or equal to]130/80mmHg. Type 2 diabetes patients who had ischaemic heart disease or nephropathy were about 20% and 15% more likely to have their blood pressure treated to target respectively. Conclusions: Major independent determinants of uncontrolled BP in our group of T2D patients were Malay ethnicity, older age, recent diagnosis of diabetes, overweight and follow-up at health clinics without a doctor and possibly the improper use of anti hypertensive agent. More effort, education and resources, especially in the primary health care centres are needed to improve hypertensive care among our patients with diabetes.

IntroductionThe Endotoxin Activity Assay (EAA) is a useful test to risk stratify patients with severe sepsis and assess for Gram negative infection. However, the significance of intermediate levels of EAA (0.4-0.59) at the bedside has not been well elucidated. The purpose of this study was to interpret intermediate EAA levels in clinical practice. Methods: This retrospective observational study included all adult patients with suspected sepsis admitted to our medico-surgical intensive care unit (ICU) in whom EAA was measured from July 2008 to September 2011. Data collected included EAA, white blood cell (WBC) count and differential, C-reactive protein (CRP), procalcitonin (PCT) and bacterial cultures. Data were analyzed by comparative statistics. Results: Two hundred and ten patients were studied. Ninety two (43 %) patients had culture documented gram negative infection. Patients with Gram-negative organisms in cultures had significantly higher EAA levels (0.47, IQR 0.27) than those without any Gram-negative organisms in cultures (0.34, IQR 0.22) (p < 0.0001). For patients with intermediate EAA levels (0.40 to 0.59), PCT levels and presence of left shift of WBC significantly differed between patients with Gram negative organisms in their blood oar other cultures and those who no organisms in any of the cultures (4.9 vs. 1.7 ng/mL, p < 0.05; 57.9 vs. 18.9 %, p < 0.0004, respectively). Conclusions: We confirm that high levels of EAA in our cohort of patients with suspected sepsis is strongly associated with gram negative infection. In those patients with intermediate elevation in EAA levels, use of PCT and WBC differential can provide additional diagnostic value to clinicians at the bedside.

In 2011, the IEEE VisWeek conferences inaugurated a symposium on Biological Data Visualization. Like other domain-oriented Vis symposia, this symposium's purpose was to explore the unique characteristics and requirements of visualization within the domain, and to enhance both the Visualization and Bio/Life-Sciences communities by pushing Biological data sets and domain understanding into the Visualization community, and well-informed Visualization solutions back to the Biological community. Amongst several other activities, the BioVis symposium created a data analysis and visualization contest. Unlike many contests in other venues, where the purpose is primarily to allow entrants to demonstrate tour-de-force programming skills on sample problems with known solutions, the BioVis contest was intended to whet the participants' appetites for a tremendously challenging biological domain, and simultaneously produce viable tools for a biological grand challenge domain with no extant solutions. For this purpose expression Quantitative Trait Locus (eQTL) data analysis was selected. In the BioVis 2011 contest, we provided contestants with a synthetic eQTL data set containing real biological variation, as well as a spiked-in gene expression interaction network influenced by single nucleotide polymorphism (SNP) DNA variation and a hypothetical disease model. Contestants were asked to elucidate the pattern of SNPs and interactions that predicted an individual's disease state. 9 teams competed in the contest using a mixture of methods, some analytical and others through visual exploratory methods. Independent panels of visualization and biological experts judged entries. Awards were given for each panel's favorite entry, and an overall best entry agreed upon by both panels. Three special mention awards were given for particularly innovative and useful aspects of those entries. And further recognition was given to entries that correctly answered a bonus question about how a proposed "gene therapy" change to a SNP might change an individual's disease status, which served as a calibration for each approaches' applicability to a typical domain question. In the future, BioVis will continue the data analysis and visualization contest, maintaining the philosophy of providing new challenging questions in open-ended and dramatically underserved Bio/Life Sciences domains.

Background: Renal cell carcinoma or RCC is one of the common and most lethal urological cancers, with 40% of the patients succumbing to death because of metastatic progression of the disease. Treatment of metastatic RCC remains highly challenging because of its resistance to chemotherapy as well as radiotherapy, besides surgical resection. Whereas RCC comprises tumors with differing histological types, clear cell RCC remains the most common. A major problem in the clinical management of patients presenting with localized ccRCC is the inability to determine tumor aggressiveness and accurately predict the risk of metastasis following surgery. As a measure to improve the diagnosis and prognosis of RCC, researchers have identified several molecular markers through a number of techniques. However the wealth of information available is scattered in literature and not easily amenable to data-mining. To reduce this gap, this work describes a comprehensive repository called Renal Cancer Gene Database, as an integrated gateway to study renal cancer related data.FindingsRenal Cancer Gene Database is a manually curated compendium of 240 protein-coding and 269 miRNA genes contributing to the etiology and pathogenesis of various forms of renal cell carcinomas. The protein coding genes have been classified according to the kind of gene alteration observed in RCC. RCDB also includes the miRNAs dysregulated in RCC, along with the corresponding information regarding the type of RCC and/or metastatic or prognostic significance. While some of the miRNA genes showed an association with other types of cancers few were unique to RCC. Users can query the database using keywords, category and chromosomal location of the genes. The knowledgebase can be freely accessed via a user-friendly web interface at http://www.juit.ac.in/attachments/jsr/rcdb/homenew.html. Conclusions: It is hoped that this database would serve as a useful complement to the existing public resources and as a good starting point for researchers and physicians interested in RCC genetics.

Background: Accumulated evidence reveals that cyclooxygenase-2 (COX-2) was overexpressed in eutopic endometrium of endometriosis, which may play a critical role in the pathogenesis of endometriosis. However, few studies have been performed to explore the molecular mechanisms underlying the abnormal high expression of COX-2 in endometriosis. Considering the fact that a number of recent studies have shown DNA methylation affecting some genes in endometriosis, the present study was therefore aimed to determine whether the observed high expression COX-2 in endometriosis is caused by the hypomethylation of CpG island within the promoter of this gene. Methods: The endometrial tissues were collected from 60 women with endometriosis (endometriosis group) and 20 women without endometriosis (control group). The methylation status of COX-2 was examined by methylation specific PCR. Quantitative real-time RT-PCR was performed to measure COX-2 mRNA level in endometrial tissues. Results: The frequency of promoter hypermethylation of COX-2 was lower in eutopic endometrium of the endometriosis group (41.7%) than that in the control group (75.0%), P < 0.05. COX-2 mRNA level in the eutopic endometrium of the endometriosis group was 2.61-fold higher than that in the control group (P < 0.01). COX-2 mRNA level in unmethylated endometrium of the endometriosis group or the control group was 2.39-fold and 2.66-fold, respectively, higher than that in the methylated endometrium of the same group (P < 0.01). Conclusions: The hypomethylation within the promoter of COX-2 may be responsible for the elevated gene expression in eutopic endometrium of endometriosis.

Sepsis is one of the leading causes of mortality in non-cardiac intensive care units, and the need for markers of progression and severity are high. Also, treatment of sepsis is highly debated and potential new targets of treatment are of great interest. In the previous issue of Critical Care Kumaraswamy and colleagues have investigated whether plasma apolipoprotein M (apoM) is affected during different grades of sepsis, septic shock and systemic inflammatory response syndrome. Interestingly, plasma apoM was significantly decreased in all groups of patients with a relationship to severity of disease. This identifies apoM as a potential new biomarker in sepsis. It also underscores the possibility that altered high-density lipoprotein in sepsis patients can affect the course of disease. Thus, since apoM is the carrier of Sphingosine-1-P (S1P), a molecule with great influence on vascular barrier function, the study presented raises the interest and relevance for further studies of apoM and S1P in relation to sepsis and inflammation.

Background: Nepal Himalayas have been known as a rich source for valuable medicinal plants since Vedic periods. Present work is the documentation of indigenous knowledge on plant utilization as natural remedy by the inhabitants of terai forest in Western Nepal. Methods: Study was conducted during 2010-2011 following standard ethnobotanical methods. Data about medicinal uses of plants were collected by questionnaire, personal interview and group discussion with pre identified informants. Voucher specimens were collected with the help of informants, processed into herbarium following standard methods, identified with the help of pertinent floras and taxonomic experts, and submitted in Department of Botany, Butwal Multiple Campus, Tribhuvan University, Nepal for future references. Results: During the present study 66 medicinal plant species belonging to 37 families and 60 genera has been documented. These plants were used to treat various diseases and ailments grouped under 11 disease categories, with the highest number of species (41) being used for gastro-intestinal disorders, followed by dermatological disorders (34). In the study area the informants' consensus about usages of medicinal plants ranges from 0.93 to 0.97 with an average value of 0.94. Herbs (53 %) were the primary source of medicine, followed by trees (23 %). Curcuma longa (84 %) and Azadirachta indica (76 %) are the most frequently and popularly used medicinal plant species in the study area. Acacia catechu, Bacopa monnieri, Bombax ceiba, Drymaria diandra, Rauvolfia serpentina, and Tribulus terrestris are threatened species which needs to be conserved for future use. Conclusions: The high degree of consensus among the informants suggests that current use and knowledge are still strong, and thus the preservation of today's knowledge shows good foresight in acting before much has been lost. The connections between plant use and conservation are also important ones, especially as the authors note that neither the local inhabitants nor the government is addressing the potential loss of valuable species in this region.