Wireless capsule endoscopy: perspectives beyond gastrointestinal bleeding.

Wireless capsule endoscopy (CE) is a technology developed for the endoscopic exploration of the small bowel. The first capsule model was approved by the Food and Drug Administration in 2001, and its first and essential indication was occult gastrointestinal (GI) bleeding. Over subsequent years, this technology has been refined to provide superior resolution, increased battery life, and capabilities to view different parts of the GI tract. Indeed, cases for which CE proved useful have increased significantly over the last few years, with new indications for the small bowel and technical improvements that have expanded its use to other parts of the GI tract, including the esophagus and colon. The main challenges in the development of CE are new devices with the ability to provide therapy, air inflation for a better vision of the small bowel, biopsy sampling systems attached to the capsule and the possibility to guide and move the capsule with an external motion control. In this article we review the current and new indications of CE, and the evolving technological changes shaping this technology, which has a promising potential in the coming future of gastroenterology.

Capsule endoscopy in the small bowel Crohn's disease.

CD is a chronic inflammatory disorder associated to mucosal and transmural inflammation of the bowel wall. It is well known that CD can affect the entire gastrointestinal. Therefore, ileocolonoscopy and biopsies of the terminal ileum as well as of each colonic segment to look for microscopic evidence of CD are the first-line procedures to establish the diagnosis. However, it has been observed that up to 30% of the patients have only small bowel involvement. Evaluation of the small bowel has been made with radiological procedures, barium radiography, and abdominal computed tomography or by ileocolonoscopy or enteroscopy, but they have many recognized limitations. CE is undoubtedly a very useful diagnostic tool proposed to observe small-bowel lesions undetectable by conventional endoscopy or radiologic studies. We review different studies that have been published reporting the use of CE in suspected and evaluation of the extension or the recurrence in CD and also its use in pediatric population and its complications.

Application of colon capsule endoscopy (CCE) to evaluate the whole gastrointestinal tract: a comparative study of single-camera and dual-camera analysis.

BACKGROUND AND STUDY AIMS Colon capsule endoscopy (CCE) was developed for the evaluation of colorectal pathology. In this study, our aim was to assess if a dual-camera analysis using CCE allows better evaluation of the whole gastrointestinal (GI) tract compared to a single-camera analysis. PATIENTS AND METHODS We included 21 patients (12 males, mean age 56.20 years) submitted for a CCE examination. After standard colon preparation, the colon capsule endoscope (PillCam Colon™) was swallowed after reinitiation from its "sleep" mode. Four physicians performed the analysis: two reviewed both video streams at the same time (dual-camera analysis); one analyzed images from one side of the device ("camera 1"); and the other reviewed the opposite side ("camera 2"). We compared numbers of findings from different parts of the entire GI tract and level of agreement among reviewers. RESULTS A complete evaluation of the GI tract was possible in all patients. Dual-camera analysis provided 16% and 5% more findings compared to camera 1 and camera 2 analysis, respectively. Overall agreement was 62.7% (kappa = 0.44, 95% CI: 0.373-0.510). Esophageal (kappa = 0.611) and colorectal (kappa = 0.595) findings had a good level of agreement, while small bowel (kappa = 0.405) showed moderate agreement. CONCLUSION The use of dual-camera analysis with CCE for the evaluation of the GI tract is feasible and detects more abnormalities when compared with single-camera analysis.

Capsule endoscopy in the small bowel Crohn's disease.

CD is a chronic inflammatory disorder associated to mucosal and transmural inflammation of the bowel wall. It is well known that CD can affect the entire gastrointestinal. Therefore, ileocolonoscopy and biopsies of the terminal ileum as well as of each colonic segment to look for microscopic evidence of CD are the first-line procedures to establish the diagnosis. However, it has been observed that up to 30% of the patients have only small bowel involvement. Evaluation of the small bowel has been made with radiological procedures, barium radiography, and abdominal computed tomography or by ileocolonoscopy or enteroscopy, but they have many recognized limitations. CE is undoubtedly a very useful diagnostic tool proposed to observe small-bowel lesions undetectable by conventional endoscopy or radiologic studies. We review different studies that have been published reporting the use of CE in suspected and evaluation of the extension or the recurrence in CD and also its use in pediatric population and its complications.

Wireless capsule pH monitoring: does it fulfil all expectations?

pH monitoring has been used as a diagnostic tool in gastro-oesophageal reflux disease (GERD) for many years. Recent studies have shown that wireless capsule pH monitoring is better tolerated and interferes less with daily activities as compared to traditional catheter-based pH monitoring. Moreover, prolonged recording time (48 h instead of 24 h) is possible with wireless pH monitoring. The main secondary effect of wireless capsule pH monitoring is induction of thoracic discomfort in 10-65% of the patients, which can vary from mild foreign body sensation to severe chest pain. Sensitivity and specificity of wireless capsule monitoring is comparable to that of traditional pH monitoring. It has not been proven yet that better tolerability and a longer recording time increases the diagnostic yield of wireless capsule monitoring in GERD.

Immunomarquage des collagènes I, III et IV, de la laminine et de la fibronectine dans la capsule cristallinienne humaine [Immunolabelling of collagen types I, III and IV, laminin and fibronectin in the human lens capsule].

PURPOSE: To localize collagen types I, III, and IV, laminin and fibronectin in the anterior human lens capsule. MATERIAL AND METHODS: Twenty-one anterior capsules were sampled by capsulorhexis during extracapsular cataract extraction (mean age 71.5). All capsules were labelled by an immunostaining specific for each antibodies. Immunostaining of four capsules was revealed with immunoperoxydase and seventeen using indirect immunofluorescence. RESULTS: Labelling of collagen types I and III was observed throughout the entire thickness of the capsule for each technique, the strongest labelling was found in the base of the epithelial cells with immunofluorescence. Collagen type IV was observed at the base of the epithelial cells whichever technique was used. Laminin could be detected in the inner layer of the capsule, using immunoperoxydase or immunofluorescence. No specific labelling was found for fibronectin using the two techniques. CONCLUSIONS: Different kinds of collagens have been found in capsules, more particularly the type III. The latter does not appear on other ocular basement membrane. Because of this uneven distribution in the capsule's thickness, each collagen might have a specific function.

Fast Blue and Diamidino Yellow as retrograde tracers in peripheral nerves: efficacy of combined nerve injection and capsule application to transected nerves in the adult rat

Capsule application of Diamidino Yellow (DY) to the cut end of the sciatic nerve immediately followed by capsule application of Fast Blue (FB) resulted in approximate to 95% double-labelled dorsal root ganglion neurones (DRGn) and motoneurones (Mn). Nerve injection of DY followed either immediately or 2 months later by capsule application of FB resulted in approximate to 90% double-labelled DRGn and Mn, indicating that DY and FB label similar populations of DRGn and Mn, and that insignificant DY fading occurred during this period. Inversing the order of application, however, i.e. nerve injection of FB followed immediately by capsule application of DY, resulted in double labelling in only approximate to 10% of the DRGn and Mn. These percentages increased to 70% of the DRGn and 60% of the Mn when the FB injection was followed 1 or 2 months after by the DY application, indicating that DY uptake is blocked by recent administration of FB. The results indicate that DY and FB might be useful for sequential labelling before and after nerve injury as a tool to investigate the accuracy of sensory and motor regeneration.

Spectrophotometric method for determination of atazanavir sulfate in capsule dosage form

Two sensitive and simple spectrophotmetric methods were developed for determination of Atazanavir Sulfate in capsule dosage form. The first method was based on the oxidative coupling of ATV with 3-Methyl Benzothiazolin-2-one hydrazone (MBTH). The resulting green product had Λmax of 627.3 nm and was stable for 2 h. The second method was based on the reaction between diazotized drug with N-(1-napthyl)ethylenediamine dihydrochloride (NEDA) in neutral medium to yield yellowish orange product which had Λmax of 517.1 nm. The product was stable for 4 h. Both methods were highly reproducible and had been applied to pharmaceutical preparations.

Effect of incorporation of nutraceutical capsule waste of safflower oil in the mechanical characteristics of corn starch films

Abstract Biodegradable films blends made of safflower oil nutraceutical capsules waste corn starch (20:4, 30:4, 40:4 and 50:4) were prepared. The objective of this study was to evaluate the influence of addition of different concentrations of safflower oil nutraceutical capsule waste in the mechanical properties (tensile strength, elongation at break, Young’s modulus) and thickness of corn starch films. A decrease in tensile strength and Young’s modulus and an increase in elongation at break were observed with the increase in the content of the nutraceutical capsule waste. The results showed that the blends of safflower oil capsules waste-corn starch films demonstrated promising characteristics to form biodegradable films with different mechanical characteristics.

Rôle de la capsule dans la virulence de Streptococcus suis sérotype 2

Thèse diffusée initialement dans le cadre d'un projet pilote des Presses de l'Université de Montréal/Centre d'édition numérique UdeM (1997-2008) avec l'autorisation de l'auteur.

Etude du développement de la réponse humorale dirigée contre la capsule polysaccharidique de Streptococcus suis et Streptococcus du groupe B

Streptococcus suis et Streptococcus du groupe B (GBS) sont deux bactéries encapsulées qui induisent des pathologies similaires chez l’homme et/ou l’animal, incluant septicémies et méningites. La capsule polysaccharidique (CPS) est un facteur de virulence clé de ces deux pathogènes et les anticorps (Ac) anti-CPS présentent un bon potentiel protecteur. Néanmoins, ces molécules sont faiblement immunogéniques et les mécanismes de la génération de la réponse humorale anti-CPS demeurent méconnus. L’objectif principal de cette thèse était d’évaluer les caractéristiques et les mécanismes du développement de la réponse Ac dirigée spécifiquement contre les CPS de S. suis et GBS, ainsi que l’effet de la biochimie de la CPS dans cette réponse. Nous avons étudié S. suis types 2 et 14 et GBS types III et V, dont les CPS présentent plusieurs similarités dans leurs compositions et leurs structures, incluant la présence d’acide sialique, un sucre potentiellement immunosuppresseur, tout en possédant une antigénicité propre. Nous avons tout d’abord analysé la nature de la réponse Ac anti-CPS sérique face à la bactérie entière. Les souris infectées par S. suis développent une réponse très faible (S. suis type 2) voire insignifiante (S. suis type 14) de profil isotypique restreint à l’IgM et sont incapables de monter une réponse mémoire efficace face à une seconde infection. Un profil similaire est obtenu chez le porc infecté par S. suis type 2. On détecte des titres d’IgM anti-CPS significatifs chez les souris infectées par GBS (type III ou V). Toutefois, la magnitude de la réponse reste globalement faible et aucune commutation de classe n’est observée. Nous avons ensuite examiné l’influence de la biochimie de la CPS sur ces profils de réponse en conduisant des expériences avec la CPS hautement purifiée de ces pathogènes. Tandis que la CPS de GBS type III administrée aux souris conserve des propriétés immunogéniques similaires à celles observées durant l’infection par la bactérie intacte, les CPS de S. suis type 2 et GBS type V perdent toute capacité à induire une réponse Ac spécifique. L’analyse de l’interaction in vitro des CPS avec les cellules dendritiques (DC) murines, des acteurs clés dans la détection des pathogènes et l’orchestration des réponses immunitaires subséquentes, révèle que ces molécules stimulent la production de niveaux conséquents de chémokines via différents récepteurs. Néanmoins, les CPS sont inaptes à induire la sécrétion de cytokines et elles interfèrent avec la capacité des DC à exprimer BAFF, une cytokine clé dans la différenciation des lymphocytes B en plasmocytes. L’utilisation de CPS chimiquement désialylées démontre que l’acide sialique ne joue aucun rôle immunosuppresseur majeur dans le développement de la réponse Ac dirigée contre les CPS purifiées de S. suis ou GBS, ni sur l’interaction des CPS avec les DC in vitro, ni sur profil de la réponse in vivo. D’autres propriétés biochimiques intrinsèques à ces CPS seraient responsables de l’inaptitude de l’hôte infecté à monter une réponse Ac adéquate et les identifier constituera un outil précieux pour une meilleure compréhension de l’immunopathogénèse de S. suis et GBS ainsi que pour développer des moyens de lutte efficaces contre ces bactéries.

Repair of lamellar scleral lesions in dogs with preserved equine renal capsule: short report

OBJETIVO: Avaliar o uso da cápsula renal de eqüino preservada em glicerina 98% no reparo de lesões lamelares esclerais em cães. MÉTODOS: Foram utilizados 12 cães, machos e fêmeas, com peso médio de 12kg. Foram realizadas avaliações clínica e morfológica aos 1, 3, 7, 15, 30 e 60 dias de pós-operatório. Após anestesia geral e procedimentos padrões de preparo do campo operatório, foi realizada cantotomia temporal, seguida de incisão conjutival e escleral com área de 0,5x0,5 cm na posição de 1hora, próxima ao limbo. em seguida, um fragmento de mesma dimensão de cápsula renal de eqüino preservada em glicerina, previamente hidratado em solução salina, foi aplicado ao defeito escleral criado sendo fixado com pontos simples isolados com vicryl 7-0®. RESULTADOS: A avaliação clínica revelou blefaroespasmo/fotofobia até o sétimo dia de pós-operatório. Foi observado edema conjuntival até o quinto dia, acompanhado de secreção ocular mucóide, que persistiu até o décimo dia de pós-operatório. Não foram observados sinais clínicos de rejeição do enxerto em todos os animais, em todos os períodos avaliados. Os segmentos anterior e posterior do bulbo ocular não apresentaram sinais de inflamação. A análise morfológica revelou exsudação inflamatória aguda nos períodos precoces e intermediários da avaliação e inflamação crônica nos períodos tardios da observação. Houve incorporação do enxerto ao leito receptor. CONCLUSÃO: Os resultados sugerem que a cápsula renal de eqüino preservada pode ser mais uma alternativa de membrana biológica para o reparo de lesões esclerais lamelares em cães e no homem.