Relationships between lower body strength and the energy cost of treadmill walking in a cohort of healthy older adults: a cross-sectional analysis

Abstract

Purpose

Gait speed is associated with survival in older adults and it was suggested that an elevated energy cost of walking (Cw) is an important determinant of gait speed reduction. Thus far, little is known about the factors that contribute to a lower Cw but it was shown that lower body strength training could reduce the Cw. Therefore, the objective of this study was to investigate the relationship between lower body strength and the Cw in a cohort of healthy older adults.

Methods

A total of 48 participants were included in this study (70.7 ± 5.4 years). After a geriatric and a neuropsychological assessment, participants underwent a fitness testing protocol which included a maximal oxygen uptake test, assessment of the Cw at 4 km h⁻¹ on a treadmill, an isokinetic maximal strength test for the ankle, knee and hip joints and a body composition assessment. Relationships between strength variables and the Cw were assessed with partial correlations and linear regression analyses.

Results

Hip extensors and hip flexors peak torque was significantly correlated with the Cw (r = −0.36 and −0.32, respectively; p < 0.05). A tendency towards significance was identified for the ankle plantar flexors (r = −0.25, p = 0.09). Hip extensors peak torque was the only significant neuromuscular parameter included in the linear regression analysis (p < 0.05).

Conclusion

These results show that hip extensors are an important muscle group with regards to the Cw measured on a treadmill in this cohort of healthy older adults.

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Neural, biomechanical, and physiological factors involved in sex-related differences in the maximal rate of isometric torque development

Abstract

Objective

Recent research has reported that lower maximal rate of torque development (dτ/dt _max) exhibited by females, relative to males, during knee extension can be accounted for by normalization to a maximal voluntary contraction (MVC); however, this was not seen in the upper limb.

Purpose

The aim of the current work was to examine the contribution of maximum strength (τ_max), twitch contraction time (CT), muscle fiber condition velocity (MFCV), and rate of muscle activation (Q₃₀) to sex-differences in the dτ/dt _max during maximal isometric dorsiflexion.

Methods

Thirty-eight participants (20 males; 18 females) performed both maximal voluntary and evoked isometric contractions of the tibialis anterior across 3 days. Ten maximal compound muscle action potentials were elicited and subsequently followed by three, 5-s contractions. From the recordings, MFCV, dτ/dt _max, τ_max, CT, electromechanical delay (EMD), root-mean squared (RMS) amplitude, peak-to-peak voltage (Vpp), and Q₃₀ were calculated.

Results

An ANCOVA showed that τ_max accounted for all the sex-differences in dτ/dt _max (p = 0.96). There were no significant differences between groups with respect to MFCV, RMS amplitude, Vpp amplitude, or CT. However, there was a significant sex-difference in dτ/dt _max, τ_max, and Q₃₀. Females had longer evoked EMD times compared with males (15.69 ± 10.57 ms versus 9.95 ± 3.46 ms; p = 0.01), but the voluntary EMD times were not different.

Conclusion

The current research supports the work by Hannah et al. Exp Physiol 97:618–629, (2012) that normalization to MVC in the quadriceps is able to account for all sex-differences in rate of toque development in the lower limb.

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The CgHaa1-Regulon Mediates Response and Tolerance to Acetic Acid Stress in the Human Pathogen Candida glabrata

To thrive in the acidic vaginal tract C. glabrata has to cope with high concentrations of acetic acid. The mechanisms underlying C. glabrata tolerance to acetic acid at low pH remain largely uncharacterized. In this work it is demonstrated the essential role of the CgHaa1 transcription factor (encoded by ORF CAGL0L09339g) in the response and tolerance of C. glabrata to acetic acid. Transcriptomic analysis showed that CgHaa1 regulates, directly or indirectly, the expression of about 75% of the genes activated under acetic acid stress. CgHaa1-activated targets are involved in multiple physiological functions including membrane transport, metabolism of carbohydrates and amino acids, regulation of the activity of the plasma membrane H⁺-ATPase and adhesion. Under acetic acid stress CgHaa1 increased the activity and the expression of the CgPma1 proton pump and contributed to increased colonization of vaginal epithelial cells by C. glabrata. CgHAA1, CgTPO3 and CgHSP30, two identified CgHaa1-activated targets, are herein demonstrated to be determinants of C. glabrata tolerance to acetic acid. The protective effect of CgTpo3 and of CgHaa1 was linked to a role of these proteins in reducing the accumulation of acetic acid inside C. glabrata cells. In response to acetic acid stress, marked differences were found in the regulons controlled by CgHaa1 and by its S. cerevisiae ScHaa1 ortholog, demonstrating a clear divergent evolution of the two regulatory networks. The results gathered in this study significantly advance the understanding of the molecular mechanisms underlying the success of C. glabrata as a vaginal colonizer.

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The First Scube3 Mutant Mouse Line with Pleiotropic Phenotypic Alterations

The vertebrate Scube (Signal peptide, CUB and EGF-like domain-containing protein) family consists of three independent members Scube1-3, which encode secreted cell surface-associated membrane glycoproteins. Limited information about the general function of this gene family is available, and their roles during adulthood. Here, we present the first Scube3 mutant mouse line (Scube3^N294K/N294K) that clearly shows phenotypic alterations by carrying a missense mutation in exon 8, and thus contributes to understand SCUBE3 functions. We performed a detailed phenotypic characterization in the German Mouse Clinic (GMC). Scube3^N294K/N294K mutants showed morphological abnormalities of the skeleton, alterations of parameters relevant for bone metabolism, changes in renal function and hearing impairments. These findings correlate with characteristics of the rare metabolic bone disorder Paget disease of bone (PDB), associated with the chromosomal region of human SCUBE3. In addition, alterations in energy metabolism, behavior and neurological functions were detected in Scube3^N294K/N294K mice. The Scube3^N294K/N294K mutant mouse line may serve as a new model for further studying the effect of impaired SCUBE3 gene function.

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Could small-diameter muscle afferents be responsible for the ergogenic effect of limb ischemic preconditioning?

N/A

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INTERMITTENT PARATHYROID HORMONE ADMINISTRATION ATTENUATES ENDOTHELIAL DYSFUNCTION IN OLD RATS

Aging is an independent risk factor for cardiovascular disease and is characterized by a decline in endothelial function. Parathyroid hormone (PTH) administration has been shown to increase endothelial nitric oxide synthase (eNOS) expression. The purpose of this investigation was to determine the effect of intermittent PTH administration on aortic endothelial function in old rodents. We hypothesized that intermittent PTH administration would improve endothelial function in older rodents. Old (24 mo) and young (4 mo) Fischer-344 rats were given 10 injections of PTH (1-34) (43 μg/kg/day) or phosphate buffered saline (100 μl/day) over 15 days. Endothelium-dependent relaxation of aortic rings in response to acetylcholine (10^-9-10^-5 M) was significantly impaired in old control (OC) compared to young control (YC) as indicated by a reduced area under the curve (AUC, 100 ± 6.28 vs. 54.08 ± 8.3%; P < 0.05) and impaired maximal relaxation (E_max, 70.1 ± 4.48 vs. 92.9 ± 4.38%; P < 0.05). E_max was improved in old animals treated with PTH (OPTH) (OC, 70.1 ± 4.48 vs. OPTH, 85 ± 7.48%; P < 0.05) as well as AUC (OC, 54.08 ± 8.3 vs. OPTH 82.5 ± 5.7%; P < 0.05) while LogEC₅₀ was not different. Endothelial-independent relaxation in response to sodium nitroprusside was not different among groups. Aortic eNOS protein expression was significantly decreased in OC compared to YC (P < 0.05). PTH treatment restored eNOS expression in OPTH animals (P < 0.05). These data suggest PTH may play a role in attenuating age-related impairments in aortic endothelial function.

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Nasal High Flow therapy reduces work of breathing compared to oxygen during sleep in COPD and smoking controls - prospective observational study.

Rationale: Patients with COPD endure excessive resistive and elastic loads leading to chronic respiratory failure. Oxygen supplementation corrects hypoxemia but is not expected to reduce mechanical loads. Nasal High Flow therapy (NHF) supports breathing by reducing dead space but it is unclear how it affects mechanical loads of patients with COPD. Objective: To compare the effects of low-flow oxygen and NHF on ventilation and work of breathing (WOB) in patients with COPD and controls during sleep. Methods: Patients with COPD (n=12) and controls (n=6) were recruited and submitted to polysomnography to measure sleep parameters and ventilation in response to administration of oxygen and NHF. A subset of 6 patients also had an esophageal catheter inserted for measuring WOB. Results: Patients with COPD had similar minute ventilation, but lower tidal volumes than matched controls. Under oxygen, SaO₂ was increased and minute ventilation was reduced in both controls and patients with COPD, but with an increase in transcutaneous CO₂ levels. NHF produced a greater reduction in minute ventilation, and was associated with a reduction in CO₂ levels. While NHF halved WOB, oxygen produced only minor reduction in this parameter. Conclusion: Oxygen produced little changes in WOB, which were associated with CO₂ elevations. On the other hand, NHF produced a large reduction in minute ventilation and WOB with a concomitant fall in CO₂ levels. Our data indicate that NHF improves alveolar ventilation during sleep compared to oxygen and room-air in patients with COPD and therefore can decrease their cost of breathing.

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Gossypiboma with bleeding from fistula to the colon observed by colonoscopy

Abstract

A gossypiboma is a mass of cotton sponge left in the body postoperatively. Here, we report a case of gossypiboma with bleeding through a fistula to the colon, which became clinically evident 24 years after gynecological surgery, and resembled a bleeding diverticulum at colonoscopy. A 67-year-old woman presented with anemia and hematochezia. She had undergone a hysterectomy for myoma uteri 24 years earlier. Colonoscopy showed a deep depressed lesion mimicking a diverticulum with bleeding in the transverse colon. A contrast-enhanced computed tomography was interpreted as revealing a 6-cm thick-walled tumor, containing an air bubble, and a fistula between the mass and the transverse colon. The patient underwent laparotomy, with the preoperative expectation that the mass was a penetrating submucosal tumor. Pathological findings revealed denatured cotton tissues surrounded by reactive tissues to the foreign body. Despite its rarity, gossypiboma should be considered in patients with an intra-abdominal mass who have a history of laparotomy. Gossypiboma can cause fistula to the colon and bleeding. Imaging studies and the clinical course may mimic a malignant tumor.

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Hypoxia and hypercapnia inhibit hypothalamic orexin neurons in rats

Evidence of impaired function of orexin neurons has been found in individuals with cardiorespiratory disorders, such as obstructive sleep apnea (OSA) and sudden infant death syndrome (SIDS), but the mechanisms responsible are unknown. Individuals with OSA and SIDS experience repetitive breathing cessations and/or rebreathing of expired air, resulting in hypoxia/hypercapnia (H/H). In this study, we examined the responses of fluorescently identified rat orexin neurons in the lateral hypothalamus to acute H/H to test if and how these neurons alter their activity and function during this challenge. Experiments were conducted in an in vitro slice preparation using voltage-clamp and current-clamp configurations. H/H (10 min) induced hyperpolarization, accompanied by rapid depression, and finally, cessation of firing activity in orexin neurons. Hypoxia alone had similar but less potent effects. H/H did not alter the frequency of inhibitory glycinergic postsynaptic currents. The frequency of GABAergic currents was diminished but only at 8–10 min of H/H. In contrast, the frequency of excitatory glutamatergic postsynaptic events was diminished as early as 2–4 min of H/H. In the presence of glutamatergic receptor blockers, the inhibitory effects of H/H on the firing activity and membrane potential of orexin neurons persisted but to a lesser extent. In conclusion, both direct alteration of postsynaptic membrane properties and diminished glutamatergic neurotransmission likely contribute to the inhibition of orexin neurons by H/H. These mechanisms could be responsible for the decreased function of orexin in individuals at risk for OSA and SIDS.

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Feedforward compensation for novel dynamics depends on force field orientation but is similar for the left and right arms

There are well-documented differences in the way that people typically perform identical motor tasks with their dominant and the nondominant arms. According to Yadav and Sainburg's (Neuroscience 196: 153–167, 2011) hybrid-control model, this is because the two arms rely to different degrees on impedance control versus predictive control processes. Here, we assessed whether differences in limb control mechanisms influence the rate of feedforward compensation to a novel dynamic environment. Seventy-five healthy, right-handed participants, divided into four subsamples depending on the arm (left, right) and direction of the force field (ipsilateral, contralateral), reached to central targets in velocity-dependent curl force fields. We assessed the rate at which participants developed predictive compensation for the force field using intermittent error-clamp trials and assessed both kinematic errors and initial aiming angles in the field trials. Participants who were exposed to fields that pushed the limb toward ipsilateral space reduced kinematic errors more slowly, built up less predictive field compensation, and relied more on strategic reaiming than those exposed to contralateral fields. However, there were no significant differences in predictive field compensation or kinematic errors between limbs, suggesting that participants using either the left or the right arm could adapt equally well to novel dynamics. It therefore appears that the distinct preferences in control mechanisms typically observed for the dominant and nondominant arms reflect a default mode that is based on habitual functional requirements rather than an absolute limit in capacity to access the controller specialized for the opposite limb.

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Anesthesia Patients with Concomitant Cardiac and Hepatic Dysfunction

Publication date: December 2016
Source:Anesthesiology Clinics, Volume 34, Issue 4
Author(s): Julianne Ahdout, Michael Nurok

Teaser

Anesthesia and surgery in patients with hepatic and cardiac dysfunction poses a challenge for anesthesiologists. It is imperative to optimize these patients perioperatively. Cirrhosis is associated with a wide range of cardiovascular abnormalities. Cirrhotic cardiomyopathy is characterized by blunted contractile responsiveness or systolic incompetence, and/or diastolic dysfunction. In liver disease, anesthetic drug distribution, metabolism, and elimination may be altered. Among patients with liver disease, propofol is a reasonable anesthetic choice and cisatracurium is the preferred neuromuscular blocker. Regional anesthesia should be used whenever appropriate if not contraindicated by coagulopathy, because it reduces the need for systemic analgesia.


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Anesthesia for Patients with Concomitant Sepsis and Cardiac Dysfunction

Publication date: December 2016
Source:Anesthesiology Clinics, Volume 34, Issue 4
Author(s): Abed Abubaih, Charles Weissman

Teaser

Anesthesiologists faced with a patient with sepsis and concurrent cardiac dysfunction must be cognizant of the patient's cardiac status and cause of the cardiac problem to appropriately adapt physiologic and metabolic monitoring and anesthetic management. Anesthesia in such patients is challenging because the interaction of sepsis and cardiac dysfunction greatly complicates management. Intraoperative anesthesia management requires careful induction and maintenance of anesthesia; optimizing intravascular volume status; avoiding lung injury during mechanical ventilation; and close monitoring of arterial blood gases, serum lactate concentrations, and hematology renal and electrolyte parameters. Such patients have increased mortality because of their inability to adequately compensate for the cardiovascular changes caused by sepsis.


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Anesthesia for Patients with Concomitant Hepatic and Pulmonary Dysfunction

Publication date: December 2016
Source:Anesthesiology Clinics, Volume 34, Issue 4
Author(s): Geraldine C. Diaz, Michael F. O'Connor, John F. Renz

Teaser

Hepatic function and pulmonary function are interrelated with failure of one organ system affecting the other. With improved therapies, patients with concomitant hepatic and pulmonary failure increasingly enjoy a good quality of life and life expectancy. Therefore, the prevalence of such patients is increasing with more presenting for both emergent and elective surgical procedures. Hypoxemia requires a thorough evaluation in patients with end-stage liver disease. The most common etiologies respond to appropriate therapy. Portopulmonary hypertension and hepatopulmonary syndrome are associated with increased perioperative morbidity and mortality. It is incumbent on the anesthesiologist to understand the physiology of liver failure and its early effect on pulmonary function to ensure a successful outcome.


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Index

Publication date: December 2016
Source:Anesthesiology Clinics, Volume 34, Issue 4





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Genome-wide analysis of gene expression to distinguish photoperiod-dependent and -independent flowering in Brassicaceae

Abstract

Photoperiod is the most important environmental cue for the regulation of flowering time, a highly important agronomic trait for crop productivity. To help elucidate the photoperiodic control of flowering in Brassicaceae, we performed microarray experiments using species-specific oligo-arrays with the long day (LD) plant Arabidopsis thaliana and the photoperiod-independent plant rapid cycling Brassica rapa (RCBr). Enrichment analysis of the gene ontologies of differentially expressed genes (DEGs) did not uncover clear differences in gene expression between photoperiod-dependent and -independent plants. Most genes that were up-regulated under LD conditions in Arabidopsis were also up-regulated in RCBr. In addition, most genes associated with light signaling and the circadian clock showed similar expression patterns between Arabidopsis and RCBr, implying that most components known to be key regulators in the photoperiodic flowering pathway are not responsible for the photoperiod independence of RCBr. Nonetheless, we identified one clock-associated gene, PSEUDO-RESPONSE REGULATOR9 (PRR9), as a candidate gene explaining the photoperiod independence of RCBr. The mechanism underlying the role of PRR9 in photoperiodic control and genomic polymorphisms should be further explored using different B. rapa species.

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Genome-wide DNA methylation profiles of maternal peripheral blood and placentas: potential risk factors for preeclampsia and validation of GRK5

Abstract

Hypoxic placentation has been considered as a key step for the development of preeclampsia (PE); however, the underlying epigenetic mechanisms are still not fully understood. The purpose of this study is to investigate the whole genome DNA methylation status of PE. A microarray analysis using the Infinium HumanMethylation450 BeadChip assay in the placentas and maternal peripheral blood (PB) from PE patients and normal controls was performed. For validation, a quantitative RT-PCR analysis was used. Maternal PB showed 71 differentially methylated CpG loci (44 hypermethylated and 27 hypomethylated), while placenta revealed 365 loci (37 hypermethylated and 328 hypomethylated) at the statistical significance level of |Δβ| ≥ 0.17 and P ≤ 0.01. Notably, among the candidates showing significant signals, GRK5 (a member of G protein-coupled receptor kinase family that has previously been known to be associated with PE) showed a significantly hypomethylated level in the placentas of PE patients (Δβ = −0.176, P = 2.8 × 10⁻⁵). In the validation for the potential effect of GRK5 methylation on the gene regulation, GRK5 expression was significantly increased in the placentas from PE patients compared to those from controls (P = 0.027). In further GO analysis, genes of MHC class II protein complex showed the most significant differential methylation in the maternal PB of PE patients, while genes of palate development were differentially methylated in the placenta. Although further replication and functional studies are required, our preliminary results suggest that PE has distinct DNA methylation profiles in the maternal PB and placentas, which may provide insight into future research.

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Therapy dog rides along with paramedic

Paramedia and Army veteran Louis Belluomini is accompanied by his service dog, Star, while he works. Read more here.

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Therapy dog rides along with paramedic

Paramedia and Army veteran Louis Belluomini is accompanied by his service dog, Star, while he works. Read more here.

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Therapy dog rides along with paramedic

Paramedia and Army veteran Louis Belluomini is accompanied by his service dog, Star, while he works. Read more here.

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Novum Concepts renamed EMS Relay

DENVER, CO -- Novum Concepts, Inc., the Company sending critical data from the ambulance to the hospital, today announced that the Company will change its name to EMS Relay Inc. EMS Relay connects the EMS agencies to the hospital via a mobile device that sends data/image/video to a device in the emergency room of a hospital. This can include EKG's, injuries, car accidents, strokes and even registration ...

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Therapy dog rides along with paramedic

Paramedia and Army veteran Louis Belluomini is accompanied by his service dog, Star, while he works. Read more here.

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In vitro antifungal effect of Rosmarinus officinalis essential oil on Aspergillus niger

2016-11-04T10-09-26Z
Source: National Journal of Physiology, Pharmacy and Pharmacology
Faïza Baghloul, Roukaya Mansori, Abdelghani Djahoudi.
Background: The development of Aspergillus niger fungi at the surface and in the food products is indeed very often seen, especially in the tins. It is essential to find a solution for a better conservation using natural bioactive molecules such as essential oil (EO) of rosemary. Aims and Objectives: The aim of our study is to detect in vitro the antifungal effect of Rosmarinus officinalis (Rosemary) EO, against the fungal strain A. niger contaminating various food products and responsible for invasive fungal infection. Materials and Methods: The EO of R. officinalis is picked in the city of Tebessa-Algeria, and extracted by steam distillation using a Linkens Nickerson-type device. The chemical analysis is performed by ion-exchange gas chromatography coupled to mass spectrometry. The determination of the activity and the minimal inhibitory concentrations of the EO are performed by the method of incorporation in sabouraud agar medium. Results: We found that the EO contain 14 components, the major one is 1.8 cineol (63.65%), the study of its antifungal activity on selection of a major foods contaminated by A. niger shows an activity on all strains tested with a minimum inhibitory concentration of 0.5%. We also remark a fungistatic effect. Conclusion: Therefore, conclusions of this study can solve the problem of poor preservation of food products and the health risks associated with exposure to mold in particular A. niger food source.


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PRN/Partime Paramedic - City of Everman EMS

Shift based Paramedic slot, MICU ambulance.

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Emergency Medical Technician (0825) - Highlands County

A paraprofessional position responsible for rendering pre-hospital life support functions, other emergency care and rescue services including the operation of the ambulance.

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A study of clinical profile of cardiac dysfunction in patients with HIV infection

2016-11-04T06-12-39Z
Source: International Journal of Research in Medical Sciences
Sarosh Kumar K. K., Jayakumar B., Baiju R..
Background: HIV infection is a major health problem across the entire world including India. The introduction of anti-retroviral therapy (ART) have led to a significant reduction in opportunistic infections and hence increased life expectancy of HIV-infected individuals. This resulted in an increase in prevalence of cardiovascular diseases among these individuals. Aim was to study the clinical profile of cardiac dysfunction in patients with HIV infection and to find whether CD-4 influence on the disease pattern and severity. Methods: This study was a cross sectional study conducted in Sixty HIV infected patients who attended Anti-Retroviral Therapy Centre, Government Medical College, Thiruvananthapuram, Kerala, India during a period of fifteen months. Patients underwent a thorough clinical examination and other relevant investigations including CD-4 count, ECG and transthoracic echocardiography. Results: In our study it was found that cardiac involvement is common even in asymptomatic HIV infected patients. Cardiac manifestations observed were left ventricular diastolic dysfunction (25%), left ventricular hypertrophy (15%), dilated cardiomyopathy (15%), pericardial effusion (13.3%) and mild pulmonary artery hypertension (10%). Cardiac involvement is more common in those with low CD-4 count. Among these conditions Concentric Left Ventricular Hypertrophy had a statistically significant correlation with CD-4 count. Conclusions: We observed that some form of cardiac involvement was common even in asymptomatic HIV infected patients and cardiac involvement was inversely associated with CD-4 Count of the patient. Transthoracic echocardiography is a good non-invasive tool for the early detection of cardiac abnormalities. Cardiac involvement can be easily overlooked in these patients as symptoms can be attributed to associated co morbid illnesses, so every HIV infected patients should undergo a thorough clinical examination and relevant cardiac evaluation at the time of diagnosis and periodically to decrease cardiac associated morbidity and mortality.


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Genetics and Genomics of Ovarian Sex Cord-Stromal Tumors

ABSTRACT

Ovarian sex cord-stromal tumors represent ~8% of malignant ovarian tumors. The most common are granulosa cell tumors (GCT) which account for ~90% of malignant sex cord-stromal tumors. Recent studies have unravelled the key genomic and genetic events contributing to their pathogenesis. Sex cord-stromal tumors are found in the hereditary syndromes: Peutz-Jeghers Syndrome, Ollier disease and Maffucci syndrome, and DICER1 syndrome. Genomic studies have largely been limited to GCT where a number of recurring chromosomal abnormalities (monsomy and trisomy) have been identified although their contribution to pathogenesis remains unclear. In addition to the recurrent DICER1 mutations reported in non-hereditary cases of Sertoli cell and Sertoli-Leydig cell tumors, recurrent somatic mutations in both the juvenile (j) and adult (a) forms of GCT have been reported. Approximately 30% of jGCT contain a somatic mutation, the gsp oncogene, while a further 60% have an activating mutation in the AKT gene. In the case of aGCT, a well characterised mutation in the FOXL2 transcription factor (FOXL2 C134W) is found in almost all cases, which arguably defines the disease, although the molecular events that determine the stage, behaviour and prognosis of aGCT remain to be determined.

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Randomized trial of an uncertainty self-management telephone intervention for patients awaiting liver transplant

Patient Education and Counselling

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Ledipasvir/sofosbuvir with or without ribavirin for the treatment of chronic hepatitis C genotype 1: A pairwise meta-analysis

Journal of Gastroenterology and Hepatology

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Trimming the spare tire: Canola oil may cut belly fat

Pennsylvania State University Health and Medicine News

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Protein content and functional characteristics of serum-purified exosomes from patients with colorectal cancer revealed by quantitative proteomics

International Journal of Cancer

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Tri-comparison of laparoscopic Nissen, Hill, and Nissen-Hill hybrid repairs for uncomplicated gastroesophageal reflux disease

Journal of Gastrointestinal Surgery

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Simeprevir plus sofosbuvir for eight or 12 weeks in treatment-naïve and treatment-experienced hepatitis C virus genotype 4 patients with or without cirrhosis

Journal of Viral Hepatitis

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Effects of topical atorvastatin (2 %) on posthemorrhoidectomy pain and wound healing: A randomized double-blind placebo-controlled clinical trial

World Journal of Surgery

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Minimal hepatic encephalopathy in children with chronic liver disease: Prevalence, pathogenesis, and magnetic resonance-based diagnosis

Journal of Hepatology

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Salvage esophagectomy after failure of definitive radiochemotherapy for esophageal cancer

Journal of Surgical Oncology

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Does a higher cutoff value of lymph node retrieval substantially improve survival in patients with advanced gastric cancer?—time to embrace a new digit

The Oncologist

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Are International Classification of Diseases codes in electronic health records useful in identifying obesity as a risk factor when evaluating surgical outcomes?

The Health Care Manager

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Active salvage chemotherapy versus best supportive care for patients with recurrent or metastatic squamous cell carcinoma of the esophagus refractory or intolerable to fluorouracil, platinum, and taxane

Cancer Chemotherapy and Pharmacology

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Mycophenolate mofetil is a valid option in patients with inflammatory bowel disease resistant to TNF-α inhibitors and conventional immunosuppressants

Digestive and Liver Diseases

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Screening, characterisation and prevention of Hepatitis B virus (HBV) co-infection in HIV-positive children in South Africa

Journal of Clinical Virology

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Early satiety and postprandial fullness in gastroparesis correlate with gastroparesis severity, gastric emptying, and water load testing

Neurogastroenterology & Motility

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Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: A multicenter collaborative study

Gastric Cancer

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Postoperative recurrence and risk factors of colorectal cancer perforation

International Journal of Colorectal Disease

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Oral administration of a recombinant cholera toxin B subunit promotes mucosal healing in the colon

Mucosal Immunology

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Hospital costs of colorectal cancer surgery for the oldest old: A Dutch population-based study

Journal of Surgical Oncology

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Management and outcomes of acute pancreatitis patients over the last decade: A US tertiary-center experience

Pancreatology

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Analysis of the Duodenal Microbiome in Autistic Individuals: Association with Carbohydrate Digestion.

Objectives: There is evidence that symptoms of maldigestion or malabsorption in autistic individuals are related to changes in the indigenous microbiota. Analysis of colonic bacteria has revealed microbial dysbiosis in children with autism; however, characteristics of the duodenal microbiome are not well described. In this study the microbiome of the duodenal mucosa of subjects with autism was evaluated for dysbiosis, bacteria overgrowth and microbiota associated with carbohydrate digestion. The relationship between the duodenal microbiome and disaccharidase activity was analyzed in biopsies from 21 autistic subjects and 19 children without autism. Methods: Microbiota composition was determined by 16S ribosomal RNA gene sequencing, and disaccharidase activity via biochemical assays. Results: Although subjects with autism had a higher frequency of constipation (p

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Training in GI Bleeding Therapeutic Endoscopy: Rethinking Knowledge and Skill Acquisition.

No abstract available

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Perianal Crohn's Disease in a Large Multicenter Pediatric Collaborative.

Background: Although perianal complications of Crohn's disease (CD) are commonly encountered in clinical practice, the epidemiology of perianal CD among populations of children is poorly understood. We sought to characterize the prevalence of perianal disease in a large and diverse population of pediatric CD patients. Methods: We conducted retrospective analyses from a prospective observational cohort, the ImproveCareNow Network (May 2006-October 2014), a multicenter pediatric inflammatory bowel disease quality improvement collaborative. Clinicians prospectively documented physical examination and phenotype classification at outpatient visits. Perianal exam findings and concomitant phenotype change were used to corroborate time of new-onset perianal disease. Results were stratified by age, sex, and race and compared across groups with logistic regression. Cumulative incidence was estimated using Kaplan-Meier analyses and compared between groups with Cox proportional hazard regression models. Results: The registry included 7,076 patients with CD (41% female). Missing/conflicting entries resulted in 397 (6%) patient exclusions. Among the remaining 6,679 cases, 1,399 (21%) developed perianal disease. Perianal disease was more common among males (22%) than females (20%; p=0.013) and developed sooner after diagnosis among those with later rather than early onset disease (p

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Therapeutic Endoscopy for the Control of Non-Variceal Upper Gastrointestinal Bleeding in Children: A Case Series.

Introduction: Gastrointestinal bleeding is one of the most common indications for urgent endoscopy in the pediatric setting. The majority of these procedures are performed for control of variceal bleeding, with very few performed for non-variceal upper gastrointestinal (NVUGI) bleeding. The data on therapeutic endoscopy for NVUGI are very sparse. The aims of our study were to review our experience with NVUGI bleeding, describe technical aspects and outcomes of therapeutic endoscopy, and determine gastroenterology fellows' training opportunities according to the national training guidelines. Methods: We performed a retrospective review of endoscopy database (Endoworks(R), Olympus Inc., Center Valley, PA) from January 2009 to December 2014. The search utilized the following keywords bleeding, hematemesis, melena, injection, epinephrine, cautery, clip, and argon plasma coagulation. The collected data included: demographics, description of bleeding lesion and medical/endoscopic therapy, rate of re-bleeding, relevant laboratories, physical exam, and need for transfusion and surgery. The study was approved by the Institutional Review Board. Results: During the study period 12,737 upper endoscopies (EGDs) were performed. A total of 15 patients underwent 17 EGDs that required therapeutic intervention to control bleeding (1:750 procedures). The mean +/- SD (median) age of patients that required endoscopic intervention was 11.6 +/- 6.0 years (14.0 years). Seven out of 17 patients received dual therapy to control the bleeding lesions. All but 3 patients received medical therapy with intravenous proton pump inhibitor, and three received octreotide infusions. Six of the patients experienced re-bleeding (40%), with 4 out of 6 initially only receiving single modality therapy. Two of these patients eventually required surgical intervention to control bleeding and both patients presented with bleeding duodenal ulcers. There were no cases of aspiration, perforation, or deaths. There were a total of 24 fellows trained in our program during the study period. Less than one therapeutic endoscopy per fellow for NVUGI bleeding was performed. Conclusions: Non-variceal upper GI bleeding requiring therapeutic endoscopic intervention is very rare in pediatrics. A high rate (40%) of re-bleeding was noted with a large proportion (66%) of patients receiving single modality therapy. Two patients required surgical intervention to control bleeding and both presented with bleeding duodenal ulcers. An insufficient number of therapeutic procedures is available for adequate fellow training requiring supplemental simulator and hands-on animal model, or adult endoscopy unit training. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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