Characterization of radon levels in soil and groundwater in the North Maladeta Fault area (Central Pyrenees) and their effects on indoor radon concentration in a thermal spa

Publication date: September 2018
Source:Journal of Environmental Radioactivity, Volume 189
Author(s): V. Moreno, J. Bach, M. Zarroca, Ll. Font, C. Roqué, R. Linares
Radon levels in the soil and groundwater in the North Maladeta Fault area (located in the Aran Valley sector, Central Pyrenees) are analysed from both geological and radiation protection perspectives. This area is characterized by the presence of two important normal faults: the North Maladeta fault (NMF) and the Tredós Fault (TF). Two primary aspects make this study interesting: (i) the NMF shows geomorphic evidence of neotectonic activity and (ii) the presence of a thermal spa, Banhs de Tredós, which exploits one of the several natural springs of the area and needs to be evaluated for radiation dosing from radon according to the European regulation on basic safety standards for protection against ionizing radiation. The average soil radon and thoron concentrations along a profile perpendicular to the two normal faults — 22 ± 3 kBq·m⁻³ and 34 ± 3 kBq·m⁻³, respectively — are not high and can be compared to the radionuclide content of the granitic rocks of the area, 25 ± 4 Bq·kg⁻¹ for ²²⁶Ra and 38 ± 2 Bq·kg⁻¹ for ²²⁴Ra. However, the hypothesis that the normal faults are still active is supported by the presence of anomalies in both the soil radon and thoron levels that are unlikely to be of local origin together with the presence of similar anomalies in CO2 fluxes and the fact that the highest groundwater radon values are located close to the normal faults. Additionally, groundwater ²²²Rn data have complemented the hydrochemistry data, enabling researchers to better distinguish between water pathways in the granitic and non-granitic aquifers. Indoor radon levels in the spa vary within a wide range, [7–1664] Bq·m⁻³ because the groundwater used in the treatment rooms is the primary source of radon in the air. Tap water radon levels inside the spa present an average value of 50 ± 8 kBq·m⁻³, which does not exceed the level stipulated by the Spanish Nuclear Safety Council (CSN) of 100 kBq·m⁻³ for water used for human consumption. This finding implies that even relatively low radon concentration values in water can constitute a relevant indoor radon source when the transfer from water to indoor air is efficient. The estimated effective dose range of values for a spa worker due to radon inhalation is [1–9] mSv·y⁻¹. The use of annual averaged radon concentration values may significantly underestimate the dose in these situations; therefore, a detailed dynamic study must be performed by considering the time that the workers spend in the spa.



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A case of mucinous cystic neoplasm of the gallbladder

Abstract

The patient was a 70-year-old woman in whom examination revealed a high level of carbohydrate antigen 19-9. Abdominal ultrasonography and computed tomography (CT) revealed a multilocular cystic lesion compressing the gallbladder. CT indicated the presence of a multilocular cystic tumor (67 × 68 × 72 mm) in contact with the right hepatic lobe. Intraoperative findings indicated that the cyst diameter was 8.5 × 6.0 cm, and the cyst was continuous with the gallbladder. The gallbladder was resected along with the cyst. The cyst was multilocular and originated from the cystic duct and gallbladder wall. The cyst wall contained cuboidal to columnar mucin-producing epithelial cells and ovarian-like stroma (OS). The final diagnosis was mucinous cystic neoplasm (MCN) of the gallbladder with low-grade dysplasia. In the 2010 WHO classification of tumors of the digestive system, MCN have been newly defined as a type of hepatobiliary tract epithelial neoplasms. MCN of the gallbladder with OS is extremely rare. Only three cases have been published in the literature. The presence of OS is necessary for diagnosis of MCN.

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Effect of resistance training and protein intake pattern on myofibrillar protein synthesis and proteome kinetics in older men in energy restriction

Abstract

We determined how the pattern of protein intake and resistance training (RT) influenced longer-term (2-wk) integrated myofibrillar protein synthesis (MyoPS) during energy restriction (ER). MyoPS and proteome kinetics were measured during 2-wk of ER alone and 2-wk of ER plus RT (ER + RT) in overweight/obese older men. Participants were randomized to consume dietary protein in a balanced (BAL: 25% daily protein/meal x 4 meals) or skewed (SKEW: 7:17:72:4% daily protein/meal) pattern (n = 10/group). Participants ingested D₂O during the consecutive 2-wk periods, and skeletal muscle biopsies and serum were obtained at the beginning and conclusion of ER and ER + RT. Bulk MyoPS (i.e. synthesis of the myofibrillar protein sub-fraction) and the synthetic rates of numerous individual skeletal muscle proteins were quantified. Bulk MyoPS was not affected by protein distribution during ER or ER + RT (ER: BAL = 1.24 ± 0.31%/d, SKEW = 1.26 ± 0.37%/d; ER+RT: BAL = 1.64 ± 0.48%/d, SKEW = 1.52 ± 0.66%/d) but was ∼26% higher during ER+RT than ER (P = 0.023). The synthetic rates of 175 of 190 contractile, cytosolic and mitochondrial skeletal muscle proteins, as well as synthesis of muscle-derived proteins measured in serum, creatine kinase M-type (CK-M) and carbonic anhydrase 3 (CA-3), were higher during ER+RT than ER (P < 0.05). In addition, the synthetic rates of CK-M and CA-3 measured in serum correlated with the synthetic rates of proteins obtained via muscle sampling (P < 0.05). This study provides novel data on the skeletal muscle adaptations to RT and dietary protein distribution.

This article is protected by copyright. All rights reserved

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Association of post-traumatic stress symptom severity with Health-related Quality of Life and self-reported functioning across 12-months after Severe Traumatic Brain Injury

Publication date: Available online 12 March 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Colin M. Bosma, Nashwa Mansoor, Chiara S. Haller
ObjectiveThe present study investigated the relationship between Post-traumatic stress (PTS) symptom severity and Health-related Quality of Life (HRQoL) after severe Traumatic Brain Injury (TBI).DesignLongitudinal prospective multi-center, cohort study on severe TBI in Switzerland (2007-2011). Injury severity was determined using the Abbreviated Injury Score of the Head region (HAIS), following clinical assessment and initial computed tomography (CT).SettingBaseline data was gathered at time/location of the accident. Longitudinal assessments were done at 3, 6, and 12 months post-injury at the hospital, the rehabilitation unit, and/or the patients living facility.ParticipantsA total of 109 patients with severe TBI were included in the analyses.InterventionsNot applicable.Main Outcome Measurea) HRQoL (SF-12, physical and mental component scales, respectively), b) Self-reported emotional, cognitive, and interpersonal functioning (Patient Competency Rating Scale for Neuro-Rehabilitation [PCRS-NR]).ResultsMultilevel models for patients age >50 and ≤50 respectively, revealed significant negative associations between PTS symptom severity and interpersonal functioning (p≤50 = .002; p>50 = <.001). Among patients ≤ 50 years, PTS symptom severity was significantly associated with total functioning (p = .001) and emotional functioning (p = .0006). Among all patients, PTS symptom severity was significantly associated with cognitive functioning (p = <.001) and mental HRQoL (p = .01).ConclusionFindings indicate that PTS symptoms after severe TBI are negatively associated with HRQoL and emotional, cognitive, and interpersonal functioning.



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Rehabilitation utilization for falls among community-dwelling older adults in the United States in the National Health and Aging Trends Study

Publication date: Available online 12 March 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Briana L. Moreland, Laura L. Durbin, Judith D. Kasper, Thelma J. Mielenz
ObjectivesTo determine the characteristics of community-dwelling older adults receiving fall-related rehabilitation. Injurious falls cost billions of dollars each year in the United States and these costs are expected to rise. Fall-related rehabilitation can presumably decrease this burden. More needs to be known about the characteristics of older adults utilizing fall-related rehabilitation services.DesignCross-sectional analysis of the fifth round (2015) of the National Health and Aging Trends Study (NHATS). Fall-related rehabilitation utilization was analyzed using weighted multinomial logistic regression with standard errors adjusted for the sample design.SettingIn-person interviews of a nationally representative sample of community-dwelling older adults.Participants7,062 Medicare beneficiaries from NHATS.InterventionsNot ApplicableMain Outcomes MeasuresRehabilitation utilization categorized into fall-related rehabilitation, other rehabilitation, or no rehabilitation.ResultsFall status (single fall OR=2.96, CI: 1.52, 5.77; recurrent falls OR=14.21, CI: 7.45, 27.10), fear of falling (OR=3.11, CI: 1.90, 5.08), poor Short Physical Performance Battery scores (score 0 OR=6.62, CI: 3.31, 13.24; score 1-4 OR=4.65, CI:2.23, 9.68) and hip fracture (OR=3.24 CI: 1.46, 7.20) were all associated with receiving fall-related rehabilitation. Lower education level (less than high school diploma compared to 4-year college degree OR=0.21, CI: 0.11, 0.40) and Hispanic ethnicity (OR=0.37, CI: 0.15, 0.87) were associated with not receiving fall-related rehabilitation.ConclusionHispanic older adults and older adults who are less educated are less likely to receive fall related rehabilitation. Recurrent fallers followed by those who fell once in the past year were more likely to receive fall related rehabilitation than are older adults who have not had a fall in the past year.



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Differential Expression Profiling of Microspores During the Early Stages of Isolated Microspore Culture Using the Responsive Barley Cultivar Gobernadora

In barley, it is possible to induce embryogenesis in the haploid and uninucleate microspore to obtain a diploid plant that is perfectly homozygous. To change developmental fates in this fashion, microspores need to engage in cellular de-differentiation, interrupting the pollen formation, and restore totipotency prior to engaging in embryogenesis. In this work, we used the barley cultivar Gobernadora to characterize the transcriptome of microspores prior to (day 0) and immediately after (days 2 and 5) the application of a stress pretreatment. A deep RNA-seq analysis revealed that microspores at these three time points exhibit a transcriptome of ~14k genes, ~90% of which were shared. An expression analysis identified a total of 3,382 differentially expressed genes (DEGs); of these, 2,155 and 2,281 DEGs were respectively identified when contrasting expression at days 0 and 2 and at days 2 and 5. These define 8 expression profiles in which DEGs share a common up- or down-regulation at these time points. Up-regulation of numerous glutathione S-transferase and heat shock protein genes as well as down-regulation of ribosomal subunit protein genes was observed between days 0 and 2. The transition from microspores to developing embryos (days 2 vs 5) was marked by the induction of transcription factor genes known to play important roles in early embryogenesis, numerous genes involved in hormone biosynthesis and plant hormonal signal transduction in addition to genes involved in secondary metabolism. This work sheds light on transcriptional changes accompanying an important developmental shift and provides candidate biomarkers for embryogenesis in barley.

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Fast Ordered Sampling of DNA Sequence Variants

Explosive growth in the amount of genomic data is matched by increasing power of consumer grade computers. Even applications that require powerful servers can be quickly tested on desktop or laptop machines if we can generate representative samples from large data sets. I describe a fast and memory efficient implementation of an on-line sampling method developed for tape drives 30 years ago. Focusing on genotype files, I test the performance of this technique on modern solid-state and spinning hard drives, and show that it performs well compared to a simple sampling scheme. I illustrate its utility by developing a method to quickly estimate genome-wide patterns of linkage disequilibrium (LD) decay with distance. I provide open-source software that samples loci from several variant format files, a separate program that performs LD decay estimates, and a C++ library that lets developers incorporate these methods into their own projects.

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Tight Regulation of Srs2 Helicase Activity Is Crucial for Proper Functioning of DNA Repair Mechanisms

Proper DNA damage repair is one of the most vital and fundamental functions of every cell. Several different repair mechanisms exist to deal with various types of DNA damage, in various stages of the cell cycle and under different conditions. Homologous recombination is one of the most important repair mechanisms in all organisms. Srs2, a regulator of homologous recombination, is a DNA helicase involved in DNA repair, cell cycle progression and genome integrity. Srs2 can remove Rad51 from ssDNA, and is thought to inhibit unscheduled recombination. However, Srs2 has to be precisely regulated, as failure to do so is toxic and can lead to cell death. We noticed that a very slight elevation of the levels of Srs2 (by addition of a single extra copy of the SRS2 gene) leads to hyper-sensitivity of yeast cells to methyl methanesulfonate (MMS, a DNA damaging agent). This effect is seen in haploid, but not in diploid, cells. We analyzed the mechanism that controls haploid/diploid sensitivity and arrived to the conclusion that the sensitivity requires the activity of RAD59 and RDH54, whose expression in diploid cells is repressed. We carried out a mutational analysis of Srs2 to determine the regions of the protein required for the sensitization to genotoxins. Interestingly, Srs2 needs the HR machinery and its helicase activity for its toxicity, but does not need to dismantle Rad51. Our work underscores the tight regulation that is required on the levels of Srs2 activity, and the fact that Srs2 helicase activity plays a more central role in DNA repair than the ability of Srs2 to dismantle Rad51 filaments.

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10. Phenotypic variability in motor neuron disease: Site of onset and patterns of disease spread

The clinical heterogeneity across motor neuron disease (MND) is well known, and largely attributed to differences in the relative mix of upper (UMN) and lower motor neuron (LMN) dysfunction, site of onset, and rate of disease progression. These differences hold prognostic significance and clues to patterns of disease spread. Objective understanding of motor dysfunction across these clinical phenotypes is thus pivotal for unravelling disease pathogenesis and mechanisms underpinning disease spread.

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11. Studying human neurophysiology using the mouse tail!

Non-invasive threshold-tracking techniques have been used in vivo to probe the biophysical basis of many neuromuscular conditions in human subjects. However, there are ethical and practical limitations to the study of human subjects, and mouse models provide an alternative and complementary path. Transgenic mouse models and the use of mice during drug development make them attractive targets for axonal excitability studies.

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P04-Spatial geometric analysis in sleep polysomnographic data

The study is devoted to data processing methods in automatic sleep polysomnography (PSG) analysis. The idea is in using covariance matrices a carrier of a discriminative information. In the study, we are challenging with a problem of sleep stage classification. We are trying to solve that problem using spatial geometric analysis. For experiments, we took data from seven patients; data were recorded in National Institute of Mental Health. Artifact-free segments were extracted from the data. The covariance matrix was obtained for each segment.

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21-Brain network activity during reading and writing of Czech words and nonwords

We used fMRI to identify the neural networks involved in processing Czech words and nonwords during reading aloud and writing to dictation. Activation in language areas and domain-general networks - dorsal attention (DAN), frontotparietal control (FPC), and default mode network (DMN) - were compared.

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13. Threshold-tracking TMS without an MEP

Transcranial magnetic stimulation (TMS) is a useful tool for quantifying cortical hyperexcitability in ALS. Short-interval intracortical inhibition (SICI) measures the suppression of descending corticomotoneuronal volleys by GABA-ergic inhibitory interneurons. Threshold-tracking TMS (tt-TMS) studies were developed to overcome the marked variability of motor evoked potentials (MEPs); tt-TMS "tracks" the stimulus intensity required to just evoke a small target MEP. Despite the success of studies using the tt-TMS technique, fasciculations can complicate recordings.

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4. Median/ulnar nerve ultrasound cross-sectional area ratio in ALS

It has been shown that hand muscle wasting in amyotrophic lateral sclerosis (ALS) preferentially affects the thenar muscles, with relative sparing of the hypothenar muscles. This so-called "split-hand" is clinical sign that can be used to differentiate ALS from mimic disorders, and is thought to be caused by a difference in nerve excitability between median and ulnar nerve. The split-hand phenomenon has been largely discussed in regard to neurophysiological finding, but no studies performed comparing median and ulnar nerve size using ultrasound.

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01-High frequency oscillations – A revolution in electroencephalography?

From its very birth in 1924, the clinical electroencephalography (EEG) underwent a relatively smooth evolution, in which the most important milestones have been digitalization and introduction of advanced methods for mathematical analyses of EEG signals. In the clinical practice however, we still evaluate the same curves as Hans Berger did almost one century ago, and their visual analysis remains a gold standard for all the time of EEG method's utilization. Nevertheless, in the last decade we faced a convincing proofs of existence and practical contribution of the piece of information hidden in the EEG curve, about which we had no idea till the of the 20th century.

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25-Influence of vestibular neurectomy on posture of the head and shoulder

The aim of this study was quantitative evaluation of vestibular head tilt in 3 D. Patients after vestibular neurectomy served as model of acute unilateral vestibular failure.

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02-EEG in nonconvulsive status epileptisus (NCSE)

Nonconvulsive status epilepticus (NCSE) is a serious acute situation in neurology which is not always identified. It covers a heterogenous group of electrophysiological situations. The diagnosis of NCSE requires an electroencephalogram (EEG), since clinical signs and symptoms are often nonspecific. As EEG patterns are not always unequivocal, no reliable diagnostic test exists. To simplify the diagnosis, Salzburg EEG Criteria for NCSE were formulated in 2013, with clinical validation still in progress.

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P08-Diffusion kurtosis imaging detects early microstructural changes in dorsal motor nucleus of vagus in intragastric rotenone mouse model of Parkinson’s disease

The aim was to determine whether diffusion kurtosis imaging (DKI-MRI) could detect changes in dorsal motor nucleus of vagus (DMV) in mice who received chronic administration of rotenone. This may help in early diagnosis of patients with Parkinson's disease.Mice received vehicle (VEH) or rotenone (ROT) intragastrically for 4 months. DKI scanning was performed at 2, 3 and 4 months. ROI analysis was used to compare kurtosis and diffusivity parameters in GM regions. WM tracts were investigated using the tract-based spatial statistics.

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03-Falls in temporal lobe epilepsy

Falls are not supposed to be common signs of temporal lobe epilepsy (TLE). The main aim of this study was to identify a group of patients with known history of unexpected falls which could not be explained by presence of ictal asystole or concomitant heart disesase.

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9. Upper motor neuron dysfunction and neuropsychological profile in PLS: Another entrant on the ALS-FTD spectrum

Primary lateral sclerosis (PLS), a rare upper motor neuron disorder, remains a debated entity as an upper motor neuron extreme form of amyotrophic lateral sclerosis (ALS) or a distinct disease. It is now well established that ALS and frontotemporal dementia (FTD) lie on two ends of the frontal neurodegenerative spectrum. While early descriptions of PLS excluded cognitive dysfunction, there is accumulating evidence of varying degrees of frontal lobe deficits accompanying structural and functional changes in the brain in PLS.

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04-Local synchrony in EEG as a marker of epileptogenic zone

Approximately a 1/3 of epileptic patients suffer from pharmacoresistant epilepsy. The surgery is often the only possible treatment, which brings a need for finding epileptogenic zone. The task is intricate in non-lesional patients in whom magnetic resonance imaging is uninformative. Our goal is to find a set of non-invasive imaging methods that would find the epileptogenic zone. We show first results with Local Synchrony (LS) method, that evaluates functional connectivity between cortical areas in short distances.

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23-Prenatal stress, mood, and gray matter volume in young adulthood

This study aimed to determine whether prenatal stress, measured by the number of stressful life events during the first 20 weeks of pregnancy, might relate to mood dysregulation and altered brain structure in young adulthood. Participants included 93 mother – offspring pairs from a community-based birth cohort from the Czech Republic (European Longitudinal Study of Pregnancy and Childhood; ELSPAC-CZ). MRI analyses focused on overall cortical gray matter (GM) volume and GM volume of cortical regions previously associated with major depression.

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05-qEEG predictors of response to antidepressive treatment with ketamine

Time-course of ketamine effect was assessed in depressive patients by QEEG to elucidate changes associated with treatment and to assess potential predictors of response.

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P02-Brain-mapping on animal models

Electroencephalography (EEG) is a method that reflects the electrical activity of the brain. Changes in electrical activity can be reflected also in 2D or 3D maps Measurements of brain electrical activity in animals are essential for the validation of the pharmaco-effect on the brain. The translational approach using similar methods for quantitative EEG needs to be analysed in animal models.We measured nine brains of Wistar rats using dental X-ray. We compared these values with the model from atlas (3d Brain Atlas Reconstructor).

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06-Diagnostic substantiation and current possibilities of VEPS examination

The aim of this introductory lecture is to point out that despite the intensive use of modern imagine techniques (MRI, OCT, etc.), the diagnostic applications of visual evoked potentials (VEPs) need not be obsolete, if not preferable in many cases. This objective, fully non-invasive, low-cost electrophysiological method can detect functional problems of the optic pathway and various brain cortical areas even before a development of the first displayable morphological changes.For the increased sensitivity of VEPs, it is necessary to use a larger spectrum of visual stimuli (activating quite selectively different subsystems of the visual pathway and visual cortex) compared to standards recommended by ISCEV or IFCN.

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07-Connectivity of the anterior insula differentiates participants with first-episode schizophrenia spectrum disorders from controls: A machine-learning study

Early diagnosis of schizophrenia might reduce the negative impact of the untreated disease. Progressive functional/structural changes were repeatedly detected using classical between-group statistics. However, these findings have been due to their low sensitivity and specificity not clinically useful. Machine learning methods are able to learn from the data and make predictions on the individual level, which might have a diagnostic potential. We performed a classification of patients with the first episode of schizophrenia (FES) and healthy controls (HC) from the resting state functional connectivity (rsFC) and fractional anisotropy (FA) using machine learning on 1:1 age and sex matched samples of 63/63 patients/HC (rsFC) and 77/77 (DTI).

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Contents

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Utility of preoperative 3-D simulation of laparoscopic lateral pelvic lymph node dissection for advanced rectal cancer: Surgical outcomes of 10 initial cases

Abstract

Introduction

Laparoscopic lateral pelvic lymph node dissection (LPLD) is technically challenging because of the complicated anatomy of the pelvic wall. To overcome this difficulty, we introduced preoperative 3-D simulation. The aim of the study is to investigate the usefulness of preoperative 3-D simulation for the safe conduct of laparoscopic LPLD for rectal cancer.

Methods

After undergoing colonoscopy, patients were brought to the radiology suite where multi-detector row CT was performed. Three-dimensional images were constructed at a workstation and showed branches of the iliac artery and vein, ureter, urinary bladder, and enlarged lymph nodes. All members of the surgical team participated in preoperative simulation using the 3-D images.

Results

A total of 10 patients with advanced lower rectal cancer and enlarged lateral pelvic lymph nodes underwent laparoscopic unilateral LPLD after total mesorectal excision, tumor-specific mesorectal excision, or total proctocolectomy. Four of the 10 patients (40%) had variations in pelvic vascular anatomy. The median operative time for unilateral LPLD was 91 min (range, 66–142 min) and gradually declined, suggesting a good learning curve. The median number of lateral pelvic lymph nodes harvested was nine (range, 3–16). The median estimated blood loss was 13 mL (range, 10–160 mL). No conversion to open surgery or intraoperative complications occurred. No patient had major postoperative complications.

Conclusion

Preoperative 3-D simulation may be useful for the safe conduct of laparoscopic LPLD, especially for surgeons with limited prior experience.

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Preserved somatosensory discrimination predicts consciousness recovery in unresponsive wakefulness syndrome

Unresponsive Wakefulness Syndrome (UWS) is a disorder of consciousness (DOC) characterized by spontaneous eye opening in the absence of consistent behavioral responses to external stimuli. When reproducible verbal or motor signs of awareness are detected, the clinical condition is defined as Minimally Conscious State (MCS). In clinical practice, different bedside assessment tools are used to detect purposeful behavior and discriminate between DOCs. Among them, the Coma Recovery Scale-Revised (CRS-R, Kalmar and Giacino, 2005) is considered the most sensitive tool.

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Necrolytic acral erythema leading to diagnosis of chronic hepatitis C

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Study of the standard direct costs of various techniques of advanced endoscopy. Comparison with surgical alternatives

The complexity of endoscopy has carried out an increase in cost that has a direct effect on the healthcare systems. However, few studies have analyzed the cost of advanced endoscopic procedures (AEP).

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Number of Advanced Adenomas on Index Colonoscopy: Important risk factor for Metachronous Advanced Colorectal Neoplasia

Although the patients with multiple advanced adenomas (AA) in index colonoscopy may have an increased risk for subsequent advanced colorectal neoplasia (CRN), the current guidelines do not consider this factor. We aimed to compare the risk of metachronous advanced CRN according to the number of AAs.

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Necrolytic acral erythema leading to diagnosis of chronic hepatitis C

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Study of the standard direct costs of various techniques of advanced endoscopy. Comparison with surgical alternatives

The complexity of endoscopy has carried out an increase in cost that has a direct effect on the healthcare systems. However, few studies have analyzed the cost of advanced endoscopic procedures (AEP).

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Number of Advanced Adenomas on Index Colonoscopy: Important risk factor for Metachronous Advanced Colorectal Neoplasia

Although the patients with multiple advanced adenomas (AA) in index colonoscopy may have an increased risk for subsequent advanced colorectal neoplasia (CRN), the current guidelines do not consider this factor. We aimed to compare the risk of metachronous advanced CRN according to the number of AAs.

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One Child's Food Fight: A Case Study of Oral Immunotherapy Treatment for Food Allergies

The prevalence of food allergy has risen dramatically in the last two decades. Primary care providers encounter food-allergic children on a daily basis. Although the standard of care has traditionally been strict avoidance of the allergen and advisement to carry an epinephrine autoinjector in case of an accidental exposure resulting in a severe reaction, food allergy research has progressed in the past decade concerning various immunotherapies that may provide an alternate treatment strategy. Oral immunotherapy (OIT), performed under the supervision of an allergist, is the most widely studied of these therapies.

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Improving Care of Inner-City Children with Poorly Controlled Asthma: What Mothers Want You to Know

Low-income caregiver perspectives on asthma management are understudied but may illuminate strategies to improve care delivery and child outcomes.

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Perioperative Pain Assessment in a 14-Year-Old Boy with Lumbar Disc Herniation

This case report illustrates the value of a comprehensive perioperative pain assessment composed of quantitative sensory testing and self-reported measures that highlight the impact of pain experienced by a 14-year-old boy suffering from chronic low back pain and sciatica. Before surgery, the pain assessment revealed inefficient endogenous inhibitory pain control with presence of temporal summation of pain. The severe pain was constant and lasted for 18 months. The patient was in a high-anxiety state, and reported significant functional disability and poor sleep quality.

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Integration of the Nurse Practitioner Into Your Child Abuse Team

Child maltreatment is a leading cause of childhood morbidity in the United States, often leading to lifelong adverse health consequences. Currently, there is a nationwide shortage of child abuse pediatricians (CAPs), resulting in many unfilled child abuse positions throughout the United States. In addition, the number of future CAPs currently in fellowship training will meet neither the current need for CAPs nor provide replacements for the senior CAPs who will be retiring in the next 5 to 10 years.

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California Casualty helping first responders with their home security

California Casualty wants to help first responders protect important items and hard-to replace collectibles with the "Better Safe Than Sorry" Work Hard/Play Hard Sweepstakes for 2018. Enter now at www.contest4heroes.com. The deadline to enter is November 12, 2018, with winners announced in December. Three winners will each receive $2,250 to purchase the Liberty Colonial Safe of their choice ...

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Firefighters rescue teen trapped 350 feet inside cave

Firefighters secured the girl with a harness after she became stuck while on a school field trip

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Sialic Acid Binding Immunoglobulin-Like Lectin-1 mRNA in Peripheral Blood Leukocytes Is Related to Chance of Relapse in Graves’ Disease

Clinical Thyroidology, Volume 30, Issue 2, Page 69-73, February 2018.


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RAI Ablation Has Decreased for Low-Risk Thyroid Cancers in California

Clinical Thyroidology, Volume 30, Issue 2, Page 85-87, February 2018.


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Patient Age Is Associated with Papillary Thyroid Cancer Mortality Only in Patients with BRAF V600E Mutation

Clinical Thyroidology, Volume 30, Issue 2, Page 53-55, February 2018.


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Surgeon-Performed Ultrasound Is Important in the Preoperative Nodal Assessment of Patients with Potential Thyroid Malignancy

Clinical Thyroidology, Volume 30, Issue 2, Page 77-79, February 2018.


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Current ATA Thyroid Cancer Guidelines Are Poor Predictors of the Extent of Thyroidectomy

Clinical Thyroidology, Volume 30, Issue 2, Page 56-58, February 2018.


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Editorial: What's Ahead for Clinical Thyroidology in 2018

Clinical Thyroidology, Volume 30, Issue 2, Page 51-52, February 2018.


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Does a Patient with a Normal FT4 but a TSH of 7 or Higher Have An Increased Risk of Cardiac Complications After Percutaneous Coronary Artery Interventions?

Clinical Thyroidology, Volume 30, Issue 2, Page 59-61, February 2018.


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Levothyroxine May Decrease the Risk of Miscarriage in Women with High TPOAb Titers, Older Age, and Female Infertility Cause

Clinical Thyroidology, Volume 30, Issue 2, Page 74-76, February 2018.


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Targeted Therapy Offers a Glimmer of Hope for Patients with Anaplastic Thyroid Cancer Even Outside of a Clinical Trial

Clinical Thyroidology, Volume 30, Issue 2, Page 62-65, February 2018.


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Ultrasound Shear Wave Elastography May Help Reduce Frequency of Fine-Needle Biopsy in Low-Risk Thyroid Nodules

Clinical Thyroidology, Volume 30, Issue 2, Page 80-84, February 2018.


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A Low-Iodine Diet During Methimazole Treatment Worsens Graves’ Disease Outcomes

Clinical Thyroidology, Volume 30, Issue 2, Page 66-68, February 2018.


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U.S. Newborn Screening Programs for Congenital Hypothyroidism Vary Widely

Clinical Thyroidology, Volume 30, Issue 2, Page 88-89, February 2018.


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Synthesis and Evaluation of 2-[18F]Fluoroethyltriazolesuberohydroxamine Acid for Histone Deacetylase in a Tumor Model as a Positron Emission Tomography Radiotracer

Cancer Biotherapy and Radiopharmaceuticals, Ahead of Print.


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Astragalus Saponins and Liposome Constitute an Efficacious Adjuvant Formulation for Cancer Vaccines

Cancer Biotherapy and Radiopharmaceuticals, Volume 33, Issue 1, Page 25-31, February 2018.


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Inhibition of STAT6/Anoctamin-1 Activation Suppresses Proliferation and Invasion of Gastric Cancer Cells

Cancer Biotherapy and Radiopharmaceuticals, Volume 33, Issue 1, Page 3-7, February 2018.


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A New Era of Cancer Biotherapy and Radiopharmaceuticals

Cancer Biotherapy and Radiopharmaceuticals, Volume 33, Issue 1, Page 1-2, February 2018.


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Comparative Evaluation of Using NOTA and DOTA Derivatives as Bifunctional Chelating Agents in the Preparation of 68Ga-Labeled Porphyrin: Impact on Pharmacokinetics and Tumor Uptake in a Mouse Model

Cancer Biotherapy and Radiopharmaceuticals, Volume 33, Issue 1, Page 8-16, February 2018.


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miR-155 Affects Osteosarcoma MG-63 Cell Autophagy Induced by Adriamycin Through Regulating PTEN-PI3K/AKT/mTOR Signaling Pathway

Cancer Biotherapy and Radiopharmaceuticals, Volume 33, Issue 1, Page 32-38, February 2018.


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Development of a 99mTc-Labeled CXCR4 Antagonist Derivative as a New Tumor Radiotracer

Cancer Biotherapy and Radiopharmaceuticals, Volume 33, Issue 1, Page 17-24, February 2018.


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Medic Mindset Podcast: Paramedic reflects on her first year in EMS

In some episodes of Medic Mindset, Ginger Locke interviews paramedics who she affectionately calls the "medic-next-door." Their stories are universally relatable to paramedics everywhere. She asks that they share anonymously so they can share freely. In this episode, she interviews a paramedic about her first year working in a busy urban 911 system. The discussion includes: Which types ...

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EMS Today 2018 Quick Take: Drone use in EMS and public safety

CHARLOTTE, N.C. — In a session at EMS Today 2018, presenters provided attendees with the latest research and real-world applications of drones in EMS, and how they could benefit public safety agencies in the future. Andreas Claesson, PhD, RN, EMT-P, researcher, Karolinska Institute's Centre for Resuscitation Science, Sweden, presented his research and development of unmanned aerial vehicles ...

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A real EMS career ladder for the paramedic profession

It's no secret – the EMS community is hemorrhaging people. As the economy improves, more and more opportunities, with better compensation, are available. Credentials such as registered nurse, physician assistant and several allied health professions – all of which typically pay 30-50 percent more than paramedic salaries in most communities – are within reach of motivated paramedics ...

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EMT revives dog with CPR in middle of sled race

Musher and EMT Frank Moe suspended his racing to perform CPR on an opponent's dog who collapsed after choking on a piece of ice

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Free active shooter response course offered to support first responders

EMS1 and EMS1 Academy partner to provide training

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EMS Index looks at key performance metrics nationwide

A national database examining five metrics in evidence-based care gives EMS a framework to improve tactics, efficiency, outcomes and resource allocation

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Firefighter son saves firefighter dad after cardiac arrest

Les Morgan's son, Assistant Chief Kyle Morgan, jumped into action when Les went into cardiac arrest while on a call

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Study: Cardiac arrest survival doubles when bystanders use AEDs

An American Heart Association study found that the longer it takes responders to arrive, the greater a patient benefits from a bystander-administered AED shock

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Agile Interoperable Solutions to demonstrate core and mobile core technologies at IWCE Expo this week

Washington — Agile Interoperable Solutions (AIS), the leading provider of interoperable communications solutions that enable public and private organizations to achieve seamless connectivity in the most challenging environments, will be exhibiting at the International Wireless Communications Expo (IWCE 2018) at the Orange County Convention Center in Orlando, Florida. The show will be taking place ...

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Pulsara honored as “Best of 2017” in the 16th Annual Mobile Star Awards™

Leading communications platform honored in the category of Mobile Healthcare Innovation.

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CrewCare designed to gain insight into first responder stress

LAKEVILLE, Minn. — ImageTrend, Inc. announces the availability of CrewCare™, a free mobile app for all first responders. It was created in response to the growing concerns about stress and mental health awareness within the first responder industry. The app is designed to help gain insight into life factors that may play a role in anxiety, burnout, depression, PTSD and suicide, which are ...

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Center Promotes Patient Safety Awareness Week March 11 -17th

Forum-headlines efforts to improve patient safety across the continuum of care

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Emergency Reporting releases a free web app for customers to easily track fuel usage on the go

FuelER, the unique new web app for Emergency Reporting customers, is the latest example of the company's dedication to making the lives of first responders easier with their innovative Fire and EMS Records Management Software.

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Self-Formation Assessed by Cumulative Summation Test Does Not Reach Recommended Thresholds for Optical Diagnosis of Colorectal Polyps ≤ 7 mm

Abstract

Background and Aims

Accurate optical diagnosis of diminutive polyps would allow implementing a resect and discard strategy. We evaluated the learning curve of a single training session followed by self-education in subjects with no endoscopic experience.

Methods

Learning curves were evaluated in 38 subjects employing learning curve–cumulative summation (LC‐CUSUM) tests, with each participant attending one training session regarding narrow band imaging and optical diagnosis and then individually assessing 100 lesions, receiving feedback after each diagnosis. Diagnostic accuracy was subsequently evaluated in 180 patients with lesions ≤ 7 mm. Evaluators predicted each polyp's histology and recommended a surveillance interval. Determinants of accuracy were explored using regression analysis.

Results

According to the LC‐CUSUM curve, 20 evaluators (52.6%) reached diagnostic competence after 57 lesions (IQR 55–76.5). During the diagnostic performance assessment, 11,666 diagnoses and 6840 follow-up recommendations were generated. Considering high confidence diagnoses, accuracy was 81.3% (80.5–82.1%), negative predictive value (NPV) for rectosigmoid adenomas 78.6% (76.4–80.6%), and sensitivity for adenomas 86.6% (85.8–87.4%). Two (5.3%) evaluators reached a ≥ 90% accuracy, 3 (7.9%) presented a NPV for rectosigmoid adenomas ≥ 90%, and 18 (47.4%) a sensitivity for adenomas ≥ 90%. Multivariable logistic regression showed high confidence and size ≥ 5 mm as the strongest predictors of accuracy. Fifteen (39.5%) evaluators recommended a correct or reduced follow-up interval in over 90% of subjects.

Conclusions

Self‐formation after a single training session did not allow most evaluators to reach the required accuracy. LC-CUSUM tests did not identify competent evaluators. Despite these results, 86.7% of follow-up intervals would have been corrected or reduced.

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Cryotherapy and Radiofrequency Ablation for Eradication of Barrett’s Esophagus with Dysplasia or Intramucosal Cancer

Abstract

Background and Aims

Endoscopic ablation therapy has become the mainstay of treatment of Barrett's associated dysplasia and intramucosal cancer (IMC). The widely available techniques for ablation are radiofrequency ablation (RFA) and cryotherapy. Our aim was to compare eradication rates of metaplasia and dysplasia with both these modalities.

Patients and Methods

Retrospective review of prospectively collected database of patients who underwent endoscopic therapy for Barrett's dysplasia or IMC from 2006 to 2011 was performed. Demographic features, comorbidities, and endoscopic data including length of Barrett's segment, hiatal hernia size, interventions during the endoscopy and histological results were reviewed.

Results

Among 154 patients included, 73 patients were in the RFA and 81 patients were in the cryotherapy group. There was complete eradication of intestinal metaplasia (CE-IM) in 81 (52.6%), complete eradication of dysplasia (CE-D) in 133 (86.4%), and persistent dysplasia or cancer in 19 patients (12.3%). Compared to RFA, cryotherapy patients were found to be older and less likely to have undergone endoscopic mucosal resection. On multivariate analysis, patients who underwent RFA had a threefold higher odds of having CE-IM than those who underwent cryotherapy (odds ratio [OR] 2.9, 95% confidence interval [CI] 1.4–6.0, p = 0.004), but CE-D were similar between the two groups (OR 1.7, 95% CI 0.66–4.3, p = 0.28).

Conclusions

Endoscopic therapy is highly effective in eradication of Barrett's associated neoplasia. Patients who underwent cryotherapy were equally likely to achieve CE-D but not CE-IM than patients who underwent RFA. Patient characteristics and preferences may effect choice of treatment selection and outcomes.

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Presence of Melena in Obscure Gastrointestinal Bleeding Predicts Bleeding in the Proximal Small Intestine

Abstract

Background and Aims

Melena is a symptom of upper gastrointestinal bleeding and usually indicates bleeding proximal to the ligament of Treitz. However, whether melena predicts bleeding in the proximal small intestine in patients with obscure gastrointestinal bleeding (OGIB) is unknown and the objective of this study.

Methods

A retrospective cohort study of consecutive patients undergoing capsule endoscopy for OGIB between July 2009 and May 2016 was conducted. Subjects were categorized based on the presence of melena, and the primary outcome was identification of a bleeding source within the proximal 2/3 of the small intestine. Multi-variable regression was performed to control for confounders.

Results

During the study, 288 patients met the eligibility criteria. Subjects with melena accounted for 37.1% of the cohort and were more likely to be older (mean age 66.9 vs. 63.9, p = 0.0457), take warfarin (15.1 vs. 9.4%, p = 0.0122), and have a lower 12-month hemoglobin nadir (7.3 vs. 8.3 g/dL, p = 0.0002). On crude analysis, 56.1% of patients with melena had a bleeding source within the proximal small intestine compared to 34.8% for those without (RR 1.61, 95% CI 1.24–2.09, p = 0.0004). On multi-variable analysis, the presence of melena doubled the odds of finding a bleeding site within the proximal small intestine (OR 1.97, 95% CI 1.17–3.33, p = 0.010).

Conclusions

The presence of melena doubles the odds of finding a bleeding site within the proximal small intestine among patients with OGIB, and deep enteroscopy, if performed before a capsule study, should begin with an antegrade approach in these patients.

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Persistence of Circulating Hepatitis C Virus Antigens-Specific Immune Complexes in Patients with Resolved HCV Infection

Abstract

Background

Our recent study indicated the possible presence of detectable hepatitis C virus antigens (HCV-Ags) after denaturation of sera with resolved HCV (R-HCV) infection. The present study determined and characterized persistent HCV-Ags-specific immune complexes (ICs) in these patients.

Methods

Sixty-eight sera with R-HCV and 34 with viremic HCV (V-HCV) infection were tested for free and IC-bound HCV-Ags using HCV-Ags enzyme immunoassay (EIA), the presence of HCV-Ags-specific ICs by immunoprecipitation and Western blot (IP–WB), HCV ICs containing HCV virions using IP and HCV RNA RT-PCR, and correlation of HCV ICs with clinical presentation in these patients.

Results

Using HCV-Ags EIA, we found 57.4% of sera with R-HCV infection were tested positive for bound, but not free HCV-Ags. Using pooled or individual anti-HCV E1/E2, cAg, NS3, NS4b, and/or NS5a to precipitate HCV-specific-Ags, we confirmed persistent HCV-Ags ICs specific to various HCV structural and non-structural proteins not only in V-HCV infection, but also in R-HCV infection. Using IP and HCV RNA PCR, we then confirmed the presence of HCV virions within circulating ICs in V-HCV, but not in R-HCV sera. Multivariable analysis indicated significant and independent associations of persistent circulating HCV-Ags-specific ICs with both age and the presence of cirrhosis in patients with R-HCV infection.

Conclusions

Various HCV-Ag-specific ICs, but not virions, persist in 57.4% of patients who had spontaneous or treatment-induced HCV clearance for 6 months to 20 years. These findings enriched our knowledge on HCV pathogenesis and support further study on its long-term clinical relevance, such as extrahepatic manifestation, transfusion medicine, and hepatocarcinogenesis.

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Pronounced Coronary Arteriosclerosis in Cirrhosis: Influence on Cardiac Function and Survival?

Abstract

Background

The relation between excessive alcohol consumption and coronary arteriosclerosis has remained controversial. The etiology of cirrhosis has been considered a substantial risk factor for development of arteriosclerotic lesions. The coronary artery calcium-score derived from coronary CT angiography is a robust marker of coronary arteriosclerosis.

Aims

To study the burden of coronary arteriosclerosis in cirrhotic patients of various etiologies and association to cardiac dysfunction and survival.

Methods

Fifty-seven patients with cirrhosis without cardiovascular disease underwent coronary CT angiography, tissue Doppler echocardiography, electrocardiogram and registration of clinical and biochemical characteristics.

Results

In patients with cirrhosis the median coronary artery calcium-score was increased in comparison with age and race-adjusted healthy reference values (men: 328 vs. 9 HU and women: 136 vs. 0 HU; p < 0.001). Moreover, the coronary artery calcium-score in alcohol-related cirrhosis was significantly higher than in nonalcohol-related cirrhosis (362 vs. 46 HU, p < 0.001). Coronary artery calcium-score correlated with age (p = 0.002) but not with established cardiovascular risk factors including smoking, type 2 diabetes, hypertension, gender, or hypercholesterolemia. Coronary artery calcium-score was associated with diastolic dysfunction, lateral e´ (p = 0.025), but not with other markers of cardiac dysfunction. During a median follow-up of 25 months 12 patients (21%) died but coronary artery calcium-score was not associated with survival.

Conclusions

Coronary arteriosclerosis was particular extensive in patients with alcoholic cirrhosis. However, the current results suggest that coronary arteriosclerosis only have limited influence on cardiac function and survival. Surprisingly, no other established risk factors apart from age seemed to interfere with coronary arteriosclerosis in cirrhotic patients.

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Fecal Fatty Acid Profiling as a Potential New Screening Biomarker in Patients with Colorectal Cancer

Abstract

Background

The fatty acid profile of the fecal metabolome and its association with colorectal cancer (CRC) has not been fully evaluated.

Aims

We aimed to compare the fecal fatty acid profiles of CRC patients and healthy controls.

Methods

We enrolled 26 newly diagnosed CRC patients and 28 healthy individuals between July 2014 and August 2014 from our institute. Long- and short-chain fatty acids were extracted from fecal samples and analyzed using gas chromatography–mass spectrometry.

Results

Regarding fecal long-chain fatty acids, the levels of total ω-6 polyunsaturated fatty acids and, particularly, of linoleic acid (C18:2ω-6) were significantly higher in male CRC patients than in healthy men (2.750 ± 2.583 vs. 1.254 ± 0.966 µg/mg feces, P = 0.040; 2.670 ± 2.507 vs. 1.226 ± 0.940 µg/mg feces, P = 0.034, respectively). In addition, the levels of total monounsaturated fatty acid and, particularly, of oleic acid (C18:1ω-9) were significantly higher in male CRC patients than in healthy men (1.802 ± 1.331 vs. 0.977 ± 0.625 µg/mg feces, P = 0.027; 1.749 ± 1.320 vs. 0.932 ± 0.626 µg/mg feces, P = 0.011, respectively). However, those differences were not shown in female gender. The level of fecal short-chain fatty acids was not different between CRC patients and healthy controls.

Conclusions

There were changes in the profiles of fecal fatty acid metabolomes in CRC patients compared to healthy controls, implying that fecal fatty acids could be used as a novel screening tool for CRC.

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Assessment of Serum sTREM-1 as a Marker of Subclinical Inflammation in Diarrhea-Predominant Patients with Irritable Bowel Syndrome

Abstract

Background

Irritable bowel disease (IBS) is viewed upon as a functional disorder of subclinical inflammatory changes in recent years, and there is no reliable biomarker. Triggering receptor expressed on myeloid cells 1 (TREM-1), also produced in a soluble form (sTREM-1), is involved in the activation of inflammatory cascades of intracellular events and may play a role in pathogenesis of IBS.

Aim

To investigate whether serum sTREM-1 level can be used as a marker of subclinical inflammation in D-IBS.

Methods

Abdominal pain was quantified by a validated questionnaire. Expression level of TREM-1 in colonic mucosa as well as sTREM-1 level in serum was also detected. Furthermore, we investigated the involvement of TREM-1-associated macrophage activation in IBS-like visceral hypersensitivity.

Results

No evidence for obvious inflammation was found in D-IBS patients. Serum sTREM-1 level in D-IBS patients was significantly higher than that in HCs, which was also significantly correlated with abdominal pain scores. We showed a marked increase in the proportion of TREM-1-expressing macrophages in D-IBS, which was significantly correlated with abdominal pain scores. Functionally, gadolinium chloride (GdCl₃), a macrophage selective inhibitor, or LP17, the TREM-1-specific peptide, significantly suppressed the visceral hypersensitivity in trinitrobenzene sulfonic acid (TNBS)-treated mice with IBS-like visceral hypersensitivity.

Conclusions

Serum sTREM-1 level is significantly higher in D-IBS patients and positively correlates with abdominal pain, which may be initiated by TREM-1-associated macrophage activation, indicating the existence of subclinical inflammation in D-IBS. Therefore, serum sTREM-1 is a potential marker of subclinical inflammation in D-IBS.

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Evaluation of Patients with an Apparent False Positive Stool DNA Test: The Role of Repeat Stool DNA Testing

Abstract

Background

There is uncertainty as to the appropriate follow-up of patients who test positive on multimarker stool DNA (sDNA) testing and have a colonoscopy without neoplasia.

Aims

To determine the prevalence of missed colonic or occult upper gastrointestinal neoplasia in patients with an apparent false positive sDNA.

Methods

We prospectively identified 30 patients who tested positive with a commercially available sDNA followed by colonoscopy without neoplastic lesions. Patients were invited to undergo repeat sDNA at 11–29 months after the initial test followed by repeat colonoscopy and upper endoscopy. We determined the presence of neoplastic lesions on repeat evaluation stratified by results of repeat sDNA.

Results

Twelve patients were restudied. Seven patients had a negative second sDNA test and a normal second colonoscopy and upper endoscopy. In contrast, 5 of 12 subjects had a persistently positive second sDNA test, and 3 had positive findings, including a 3-cm sessile transverse colon adenoma with high-grade dysplasia, a 2-cm right colon sessile serrated adenoma with dysplasia, and a nonadvanced colon adenoma (p = 0.045). These corresponded to a positive predictive value of 0.60 (95% CI 0.17–1.00) and a negative predictive value of 1.00 (95% CI 1.00–1.00) for the second sDNA test. In addition, the medical records of all 30 subjects with apparent false positive testing were reviewed and no documented cases of malignant tumors were recorded.

Conclusions

Repeat positive sDNA testing may identify a subset of patients with missed or occult colorectal neoplasia after negative colonoscopy for an initially positive sDNA. High-quality colonoscopy with careful attention to the right colon in patients with positive sDNA is critically important and may avoid false negative colonoscopy.

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Relationship Between Abdominal Symptoms and Fructose Ingestion in Children with Chronic Abdominal Pain

Abstract

Background

Limited valid data are available regarding the association of fructose-induced symptoms, fructose malabsorption, and clinical symptoms.

Aim

To develop a questionnaire for valid symptom assessment before and during a carbohydrate breath test and to correlate symptoms with fructose breath test results in children/adolescents with functional abdominal pain.

Methods

A Likert-type questionnaire assessing symptoms considered relevant for hydrogen breath test in children was developed and underwent initial validation. Fructose malabsorption was determined by increased breath hydrogen in 82 pediatric patients with functional abdominal pain disorders; fructose-induced symptoms were quantified by symptom score ≥2 and relevant symptom increase over baseline. The results were correlated with clinical symptoms. The time course of symptoms during the breath test was assessed.

Results

The questionnaire exhibited good psychometric properties in a standardized assessment of the severity of carbohydrate-related symptoms. A total of 40 % (n = 33) had malabsorption; symptoms were induced in 38 % (n = 31), but only 46 % (n = 15) with malabsorption were symptomatic. There was no significant correlation between fructose malabsorption and fructose-induced symptoms. Clinical symptoms correlated with symptoms evoked during the breath test (p < 0.001, r² = 0.21) but not with malabsorption (NS). Malabsorbers did not differ from non-malabsorbers in terms of symptoms during breath test. Symptomatic patients had significantly higher pain and flatulence scores over the 9-h observation period (p < 0.01) than did nonsymptomatic patients; the meteorism score was higher after 90 min.

Conclusions

Fructose-induced symptoms but not fructose malabsorption are related to increased abdominal symptoms and have distinct timing patterns.

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Fusobacterium nucleatum Potentiates Intestinal Tumorigenesis in Mice via a Toll-Like Receptor 4/p21-Activated Kinase 1 Cascade

Abstract

Background

The underlying pathogenic mechanism of Fusobacterium nucleatum in the carcinogenesis of colorectal cancer has been poorly understood.

Methods

Using C57BL/6-Apc^Min/+ mice, we investigated gut microbial structures with F. nucleatum, antibiotics, and Toll-like receptor 4 (TLR4) antagonist TAK-242 treatment. In addition, we measured intestinal tumor formation and the expression of TLR4, p21-activated kinase 1 (PAK1), phosphorylated-PAK1 (p-PAK1), phosphorylated-β-catenin S675 (p-β-catenin S675), and cyclin D1 in mice with different treatments.

Results

Fusobacterium nucleatum and antibiotics treatment altered gut microbial structures in mice. In addition, F. nucleatum invaded into the intestinal mucosa in large amounts but were less abundant in the feces of F. nucleatum-fed mice. The average number and size of intestinal tumors in F. nucleatum groups was significantly increased compared to control groups in Apc^Min/+ mice (P < 0.05). The expression of TLR4, PAK1, p-PAK1, p-β-catenin S675, and cyclin D1 was significantly increased in F. nucleatum groups compared to the control groups (P < 0.05). Moreover, TAK-242 significantly decreased the average number and size of intestinal tumors compared to F. nucleatum groups (P < 0.05). The expression of p-PAK1, p-β-catenin S675, and cyclin D1 was also significantly decreased in the TAK-242-treated group compared to F. nucleatum groups (P < 0.05).

Conclusions

Fusobacterium nucleatum potentiates intestinal tumorigenesis in Apc^Min/+ mice via a TLR4/p-PAK1/p-β-catenin S675 cascade. Fusobacterium nucleatum-induced intestinal tumorigenesis can be inhibited by TAK-242, implicating TLR4 as a potential target for the prevention and therapy of F. nucleatum-related colorectal cancer.

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Determinants and Outcomes of Hospice Utilization Among Patients with Advance-Staged Hepatocellular Carcinoma in a Veteran Affairs Population

Abstract

Background

Hospice provides integrative palliative care for advance-staged hepatocellular carcinoma (HCC) patients, but hospice utilization in HCC patients in the USA is not clearly understood.

Aims

We examined hospice use and subsequent clinical course in advance-staged HCC patients.

Methods

We conducted a retrospective study on a national, Veterans Affairs cohort with stage C or D HCC. We evaluated demographics, clinical factors, treatment, and clinical course in relation to hospice use.

Results

We identified 814 patients with advanced HCC, of whom 597 (73.3%) used hospice. Oncologist management consistently predicted hospice use, irrespective of HCC treatment [no treatment: OR 2.25 (1.18–4.3), treatment: OR 1.80 (1.10–2.95)]. Among patients who received HCC treatment, hospice users were less likely to have insurance beyond VA benefits (47.2 vs. 60.0%, p = 0.01). Among patients without HCC treatment, hospice users were older (62.2 [17.2] vs. 60.2 [14.0] years, p = 0.05), white (62.1 vs. 52.9%, p = 0.01), resided in the Southern USA (39.5 vs. 31.8%, p = 0.05), and had a performance score ≥ 3 (41.9 vs. 31.8%, p = 0.01). The median time from hospice entry to death or end of study was 1.05 [2.96] months for stage C and 0.53 [1.18] months for stage D patients.

Conclusions

26.7% advance-staged HCC patients never entered hospice, representing potential missed opportunities for improving end-of-life care. Age, race, location, performance, insurance, and managing specialty can predict hospice use. Differences in managing specialty and short-term hospice use suggest that interventions to optimize early palliative care are necessary.

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Role of Laparoscopic-Assisted Gastric Per-oral Endoscopic Pyloromyotomy in Refractory Gastroparesis

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Hemolysis in Alcoholic Liver Disease: Zieve’s Syndrome

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Landing a GI Fellowship: The Match and the Map

Abstract

Background

Based on the location of training programs, internal applicants and local applicants were defined as applicants who attended the same training institution and trained in local areas (i.e., state, division, and region), respectively. While being an internal applicant does influence fellowship matching success for some specialties, gastroenterology fellowship program directors do not rank this consideration in the top half of their priority list. There is no published evidence about the frequency that internal applicants and local applicants match in US gastroenterology training program.

Aim

To find the proportion of gastroenterologists who were internal applicants and local applicants during the graduation years 2010–2019.

Methods

Online search in Doximity was conducted to obtain postgraduate training information of gastroenterologists with the graduation years 2010–2019. Programs were classified into nine divisions and four regions per United States Census Bureau. We used confidence level 95% and margin of error 2% to calculate sample size.

Results

In total, 1489 physicians (N = 1489) were included. The proportion of internal applicants was 39.56% of the sample size. The proportions of gastroenterologists who attended IM residency programs in the same state, same division, and same region were 53.06, 60.64, and 71.93%, respectively.

Conclusion

A large proportion of gastroenterologists were either internal applicants or local applicants. Further research is necessary to better understand the reasons behind these trends and whether the bias against external or geographically distant fellowship candidates is intended or unintended, as these data have broad implications for GI fellowship candidate residency program and geography choices.

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Treatment of Chronic Hepatitis C Virus Infection in Children: A Position Paper by the Hepatology Committee of European Society of Paediatric Gastroenterology, Hepatology and Nutrition

ABSTRACTObjectives:In 2017, the European Medicines Agency and the Food and Drug Administration approved the use of the fixed-dose combination of ledipasvir/sofosbuvir and of the combination of sofosbuvir and ribavirin for treatment of adolescents (12–17 years or weighing >35 kg) with chronic hepatitis C virus (HCV) genotype 1, 4, 5, and 6 and genotype 2 and 3 infections, respectively. Although trials with direct-acting antivirals are ongoing for younger children, the only available treatment in the United States and Europe for those 35 kg) with chronic hepatitis C virus (HCV) genotype 1, 4, 5, and 6 and genotype 2 and 3 infections, respectively. Although trials with direct-acting antivirals are ongoing for younger children, the only available treatment in the United States and Europe for those

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CFTR Protein Function Modulation Therapy Is Finally Targeting Cystic Fibrosis-related Gastrointestinal Disease

No abstract available

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Pharmacokinetics of Sucralose and Acesulfame-Potassium in Breast Milk Following Ingestion of Diet Soda

ABSTRACTObjective:The aim of this study was to determine sucralose and acesulfame-potassium (ace-K) pharmacokinetics in breast milk following maternal ingestion of a diet soda.Methods:Thirty-four exclusively breast-feeding women (14 normal-weight, 20 obese) consumed 12 ounces of Diet Rite Cola, sweetened with 68-mg sucralose and 41-mg ace-K, before a standardized breakfast meal. Habitual non-nutritional sweeteners intake was assessed via a diet questionnaire. Breast milk was collected from the same breast before beverage ingestion and hourly for 6 hours.Results:Owing to one mother having extremely high concentrations, peak sucralose and acesulfame-potassium concentrations following ingestion of diet soda ranged from 4.0 to 7387.9 ng/mL (median peak 8.1 ng/mL) and 299.0 to 4764.2 ng/mL (median peak 945.3 ng/mL), respectively.Conclusions:Ace-K and sucralose transfer into breast milk following ingestion of a diet soda. Future research should measure concentrations after repeated exposure and determine whether chronic ingestion of sucralose and acesulfame-potassium via the breast milk has clinically relevant health consequences. Objective: The aim of this study was to determine sucralose and acesulfame-potassium (ace-K) pharmacokinetics in breast milk following maternal ingestion of a diet soda. Methods: Thirty-four exclusively breast-feeding women (14 normal-weight, 20 obese) consumed 12 ounces of Diet Rite Cola, sweetened with 68-mg sucralose and 41-mg ace-K, before a standardized breakfast meal. Habitual non-nutritional sweeteners intake was assessed via a diet questionnaire. Breast milk was collected from the same breast before beverage ingestion and hourly for 6 hours. Results: Owing to one mother having extremely high concentrations, peak sucralose and acesulfame-potassium concentrations following ingestion of diet soda ranged from 4.0 to 7387.9 ng/mL (median peak 8.1 ng/mL) and 299.0 to 4764.2 ng/mL (median peak 945.3 ng/mL), respectively. Conclusions: Ace-K and sucralose transfer into breast milk following ingestion of a diet soda. Future research should measure concentrations after repeated exposure and determine whether chronic ingestion of sucralose and acesulfame-potassium via the breast milk has clinically relevant health consequences.

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Omes of Inflammatory Bowel Disease: A Primer for Clinicians

Recent advances in high-throughput laboratory technologies and bioinformatics tools are redefining how we view inflammatory bowel disease (IBD). Instead of 2 diseases, we now see a diverse set of molecular subtypes. Large-scale investigation of the genome, exome, transcriptome, proteome, metabolome, microbiome, and epigenome are providing transformative insights into the pathophysiology of IBD, with the promise of accurately predicting prognosis and targeting therapy. Understanding these tools and their application is crucial to navigating the molecular era of IBD. This review aims to help the IBD clinician understand, appreciate, and eventually incorporate this coming paradigm shift to improve the care of children with IBD.

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Response to Letter: How Much Free Sugars Intake Should Be Recommended for Children Younger Than 2 Years Old?

No abstract available

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Reasoning Beyond the Potential Use of Exclusive Enteral Nutrition and Other Specified Diets in Children With Ulcerative Colitis

The incidence of inflammatory bowel disease (IBD) is steadily on the rise in Western and in developing countries paralleling the increase of westernized diets, characterized by high protein and fat as well as excessive sugar intake, with less vegetables and fiber. Furthermore, nutrition is involved in several aspects of pediatric IBD, ranging from disease etiology to induction and maintenance of remission of disease. Exclusive enteral nutrition (EEN) has been shown to induce remission, including in patients with isolated colonic disease, and leads to mucosal healing in Crohn disease. One hypothesis for the beneficial effect of this modality is exclusion of dietary components thought to cause dysbiosis or impair innate immune mechanisms such as the mucous layer, intestinal permeability or colonization and adherence with adherent-invasive Escherichia coli. Although there is not yet definitive data illustrating a role for EEN in the management of active ulcerative colitis (UC), there are several lines of evidence that illustrate that dietary interventions may be helpful. In particular, the key mechanisms of the activity of EEN (namely, changes in the intestinal microflora in Crohn disease) are likely also relevant to UC. Furthermore, the use of EEN in pediatric UC patients may add to a better bone health. Prospective studies are now required to evaluate the role of EEN in UC in children.

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Laparoscopic management of gastric perforation secondary to mesenteroaxial volvulus in a patient with laparoscopic adjustable gastric banding

Abstract

A 54-year-old woman was admitted to the emergency department with a 2-week history of alimentary vomiting. She had undergone laparoscopic adjustable gastric banding 6 years earlier. CT revealed a mesenteroaxial gastric volvulus and ischemia on the gastric wall. Emergent diagnostic laparoscopy was performed, and severe peritonitis and gastric necrosis caused by volvulation was found. After band removal, a fundal perforation was noted, but a viable lesser curvature enabled laparoscopic sleeve gastrectomy to be performed. The postoperative course was uneventful. Laparoscopic adjustable gastric banding is considered a safe and effective method for the surgical treatment of obesity, but it is associated with a number of complications, such as pouch dilatation and band slippage. Although infrequent, ischemic complications are life-threatening conditions that require urgent surgery. This is the first report of this unusual complication managed laparoscopically.

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Tying modified clinch knots during single-incision laparoscopic surgery

Abstract

Introduction

Recent advances in single-incision laparoscopic surgery (SILS) have caused increased difficulties when tying knots because of the limited working space. Although extracorporeal knot-tying techniques may be a practical alternative choice in SILS, it is not always appropriate. For example, sliding resistance may be encountered when tying knots for a Z-shaped suture, and it could damage the sutured tissue.

Materials and Surgical Technique

The clinch knot is a kind of slipknot that has been historically used by fishermen. We modified it for SILS so that it has a locking mechanism caused by knot deformation. We apply pre-tied modified clinch (MC) knots in the peritoneal cavity with a needle driver. After the suture, the needle is pulled through the knot and exits out the trocar. After the MC knot has been tightened, locking is achieved by pulling the other end of the axial thread and folding the thread in an acute angle. Because both ends of the suture thread leave the trocar together, every step can be carried out quickly through a single trocar. The MC knot can also be used to tie knots for Z-shaped sutures because of its short sliding distance. Twelve simple interrupted sutures and 55 Z-shaped sutures were tied by MC knot in SILS. All knots were successfully tied, and the mean required time to tie a knot was 27 s.

Discussion

The MC knot is feasible knot-tying procedure especially for a Z-shaped suture during SILS.

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Issue Information

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Laparoscopic versus abdominal sacrocolpopexy for treatment of multi-compartmental pelvic organ prolapse: A systematic review

Abstract

Laparoscopic sacrocolpopexy (LSC) is attracting increasing attention as a minimally invasive surgery that provides excellent therapeutic effects on apical vaginal prolapse. However, its therapeutic effects on multi-compartmental pelvic organ prolapse (POP) remain unclear. Therefore, the aim of this review was to evaluate the efficacy of LSC on multi-compartmental POP compared with abdominal sacrocolpopexy (ASC). We extracted three articles on randomized controlled trials that compared LSC and ASC. A total of 247 patients (123 for LSC, 124 for ASC) were evaluated. There was no evidence of recurrence or reoperation in either group for the apical vaginal compartment. Regarding recurrence within the anterior vaginal compartment, there were no significant between-group differences in either of the two randomized controlled trials targeting vaginal vault prolapse. In contrast, in the randomized controlled trial targeting POP including cases with uteruses, there were more recurrent POP with grade II or more in the LSC group than in the ASC group (11/60 [18.3%] vs 1/60 [1.6%], P = 0.004). Reoperation for the posterior vaginal compartment was performed in three cases (2.5%) in the LSC group and in one case (0.8%) in the ASC group. The combined repeat surgery and mesh removal surgery rate was higher in the LSC group (8/119 [6.7%]) than in the ASC group (2/121 [1.7%], P = 0.049). LSC has an excellent therapeutic effect and is comparable to ASC for the treatment of apical prolapse. However, cystocele recurrence, repeat surgery of the posterior compartment, and mesh-related complications were more frequent in patients who had undergone LSC.

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Laparoscopic surgery using a Gigli wire saw for locally recurrent rectal cancer with concomitant intraperitoneal sacrectomy

Abstract

Introduction

Previous reports indicated the effectiveness of surgical resection for locally recurrent rectal cancer (LRRC). Most cases with posterior invasion patterns require concomitant sacrectomy to secure negative histologic margins, although this is a highly invasive procedure. Here, we present a new minimally invasive laparoscopic surgical technique for LRRC with concomitant sacrectomy.

Materials and Surgical Technique

A 64-year-old man presented with LRRC on the surface of the sacral bone. He underwent laparoscopic abdominoperineal resection with concomitant sacrectomy below the S4 vertebra. The surgical procedure, including sacrectomy, was performed laparoscopically. The distance between the estimated resection line (below the S4 vertebra) and sacral promontory was measured by preoperative imaging. Intraoperatively, a flexible ruler was employed to determine the resection line. Securing adequate space dorsal to the sacral bone was indispensable for placement of the Gigli wire saw. After the Gigli wire saw was positioned, bilateral caudal trocars were used to remove the ends of the wire. Then, the sacral bone was cut by the linear reciprocating motion of the Gigli wire saw. Pathologically confirmed curative resection was achieved. The procedure was successfully performed without transfusion or intraoperative complications. The operation time was 757 min, and blood loss volume was 890 ml. There were no severe postoperative complications. The patient is alive and well with no evidence of recurrence at 58 months after surgical resection of LRRC.

Discussion

Our newly developed technique demonstrates that laparoscopic intraperitoneal sacrectomy using a Gigli wire saw is a safe and useful procedure to facilitate resection of LRRC.

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Biliary stricture due to a migrated suture after laparoscopic distal gastrectomy

Abstract

Benign biliary strictures have a broad spectrum of etiologies. There have been no reported cases, however, of a biliary stricture secondary to a migrated suture after laparoscopic distal gastrectomy (LDG). Here, we report one such case. The patient was a 60-year-old man who underwent LDG with Roux-en-Y reconstruction for early gastric cancer. Pathology revealed early cancer (T1N0M0) with a curative resection. Two years after LDG, the patient was found to have elevated hepatobiliary enzymes. After further workup, the new diagnosis was invasive cholangiocarcinoma (T2N0M0), and the patient underwent pancreaticoduodenectomy. Intraoperatively, a monofilament nylon suture was found in the center of a biliary stricture; this suture was previously used for duodenal closure during LDG. Histologically, the bile duct with stricture showed chronic inflammation and fibrosis. Despite no evidence of invasive carcinoma on pathology, a small lesion of adenocarcinoma in situ was found in the superior common hepatic duct.

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Feasibility of a novel tacking method of securing mesh in transabdominal preperitoneal inguinal hernia repair: Secure tacking against recurrence

Abstract

Introduction

Postoperative chronic pain is an important outcome of hernia surgery. In laparoscopic hernia surgery, either fixation outside the trapezoid of disaster or no fixation is recommended to avoid postoperative pain. To avoid recurrence are transabdominal preperitoneal (TAPP) hernia repair, the myopectineal orifice must be covered with mesh during TAPP, but lifting or shrinking of the mesh can lead to recurrence. The aim of this study was to evaluate the feasibility of a novel technique for mesh fixation to prevent the mesh from lifting off.

Methods

After the preperitoneal space was created during TAPP, the anatomy of the lateral cutaneous nerve of the thigh or the femoral branch of the genitofemoral nerve within the trapezoid of disaster was checked. The mesh was tacked at the trapezoid of disaster without nerve injury, and the mesh was fixed with circumferential tacking. We call this procedure secure tacking against recurrence (STAR). We treated 391 adult patients (478 hernias) with TAPP repair; novel tacking was used in some patients (STAR group, 236 hernias). The results of the STAR group were retrospectively compared with those of patients in whom we did not use this novel tacking (conventional group, 242 hernias).

Results

There was no postoperative chronic pain in either group. There were no cases of hernia recurrence in the STAR group, but there were four cases of hernia recurrence in the conventional group (0% vs 1.7%, P = 0.047). These four recurrences consisted of indirect hernia and mesh lifting on the lateral side.

Conclusion

The STAR procedure is feasible and safety as a standard procedure for securing the mesh during TAPP.

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Exploration of assistive technology for uniform laparoscopic surgery

Abstract

Introduction

Laparoscopic surgery is less invasive than open surgery and is now common in various medical fields. However, laparoscopic surgery is more difficult than open surgery and often requires additional time for the operator to achieve mastery. Therefore, we investigated the use of assistive technology for uniform laparoscopic surgery.

Methods

We used the OpenCV2 library for augmented reality with an ArUco marker to detect and estimate forceps positioning. We used Sense HAT as the gyro sensor. The development platforms used were Mac OS X 10.11.3 and Raspberry Pi 3, model B.

Results

By attaching the ArUco marker to the needle holder, we could draw a line vertically to the marker. When the needle was held, a cube could be imagined, and both the needle and lines could be used to determine the appropriate position. By attaching the gyro sensor to the camera, we could detect its angle of rotation. We obtained stabilized images by rotating the image by the detected degrees; this was possible for any camera position.

Conclusions

Assistive technology allowed us to obtain consecutive converted images in real time and may be readily applicable to clinical practice.

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Conventional laparoscopic appendectomy versus double-incision, three-port laparoscopic appendectomy: A 1-year randomized controlled trial

Abstract

Introduction

Management of appendicitis has evolved dramatically in the last 120 years, from McBurney's large incision to minimally invasive laparoscopic appendectomy to hardly noticeable incisions with SILS. As a bridge between conventional laparoscopic surgery and SILS, double-incision laparoscopic surgery further minimizes the invasiveness of laparoscopic surgery by reducing the number of incisions. This study aimed to establish the efficacy of double-incision, three-port laparoscopic appendectomy (DILA) as an alternative to conventional three-port laparoscopic appendectomy.

Methods

A total of 60 patients were divided randomly into two groups: the conventional laparoscopic appendectomy (CLA) group and the DILA appendectomy group. Demographics, diagnostic history, additional intraoperative findings, and duration of operation were recorded. Postoperative pain after 6 h and 24 h and cosmetic outcome after the surgery were also evaluated. Statistical analysis was done using Fisher's exact test, χ² test, and Student's t-test.

Results

No significant difference was observed in demographic and clinical characteristics in either group (P > 0.05). No significant difference in mean postoperative pain was observed between the two groups at 6 h (P = 0.62) or 24 h (P = 0.484). However, patients in the DILA group were more satisfied with their cosmetic outcomes than those in the CLA group (P = 0.04). The mean operative time was 26.4 min in the CLA group and 27.6 min in the DILA group (P = 0.62).

Conclusion

DILA can be performed with operative outcomes that are equivalent to CLA but with superior cosmetic outcomes.

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Visceral obesity is a significant risk factor for incisional hernia after laparoscopic colorectal surgery: A single-center review

Abstract

Introduction

Although laparoscopic surgery uses relatively small incisions, incisional hernia after surgery is not uncommon. However, the incidence of incisional hernia and its risk factors are not well known. The purpose of our study was to investigate risk factors for incisional hernia after laparoscopic colorectal cancer surgery.

Methods

The study group consisted of 212 patients who underwent laparoscopic colorectal cancer surgery at Hiroshima Prefectural Hospital between November 2008 and October 2013. Diagnosis of incisional hernia was performed by postoperative CT. The visceral fat area (VFA) and subcutaneous fat area at the level of the umbilicus were calculated using an image analysis system. For statistical analysis, Fisher's exact test or Student's t-test were used for univariate analysis, and logistic regression analysis was used for multivariate analysis. The cut-off value for risk factors was calculated from the receiver–operator curve.

Results

Incisional hernia was observed in 18 patients (8.5%). On univariate analysis, female sex (P = 0.04), older age (P = 0.02), subcutaneous fat area (P < 0.01), VFA (P = 0.02), and BMI >25 kg/m² (P < 0.01) were significant risk factors for incisional hernia. The predictive cut-off values were as follows: age, 72 years; subcutaneous fat area, 110 cm²; VFA, 110 cm²; and albumin concentration, 3.9 g/dL. On multivariate analysis, a VFA >110 cm² (P < 0.01) and female sex (P = 0.01) were retained as independent risk factors for incisional hernia.

Conclusion

After laparoscopic colorectal cancer surgery, a higher VFA and female sex are independent risk factors for incisional hernia.

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Is the laparoscopic approach appropriate for pediatric subhepatic appendicitis?

Abstract

Introduction

Subhepatic appendicitis in children is an unusual condition that can be challenging for the pediatric surgeons to treat. The aim of our study was to compare the outcomes of laparoscopic appendectomies based on the position of the appendix.

Methods

The data of 1736 patients who had undergone laparoscopic appendectomy in our tertiary center were retrospectively reviewed. We compared two groups: subhepatic location (n = 56) and non-subhepatic location (n = 1680). A P-value of less than 0.05 was considered statistically significant.

Results

There was no statistically significant difference between the demographic variables of the groups. More than half of the subhepatic appendicitises were gangrenous (44.6%) or perforated (16.1%), whereas most of the non-subhepatic appendicitises were phlegmonous (56.9%). Extracorporeal ligation of the appendix was the preferred technique in both the subhepatic and non-subhepatic groups (69.6% and 89.8%, respectively). The subhepatic group had a statistically significant higher incidence of technical difficulties (1.6%) and abdominal drain (18.6%) than the non-subhepatic group, as well as a longer operative time and hospital stay. However, intraoperative and postoperative complications were similar in both groups.

Conclusion

Laparoscopic subhepatic appendectomy is safe and does not lead to increased complications. However, the technique is made difficult by the fact that the appendix is an atypical location, and the rate of complicated appendicitis is higher.

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Laparoscopic surgery with urinary tract reconstruction and bowel endometriosis resection for deep infiltrating endometriosis

Abstract

Deep infiltrating endometriosis (DIE) is the most severe form of endometriosis. It causes chronic pelvic pain, severe dysmenorrhea, deep dyspareunia, dyschezia, and dysuria, markedly impairing the quality of life of women of reproductive age. A number of randomized controlled trials on surgical and medical treatments to reduce the pain associated with endometriosis have been reported, but few have focused on this in DIE. DIE causes not only pain but also functional invasion to the urinary organs and bowel, such as hydronephrosis and bowel stenosis. In addition to DIE resection, surgical treatment involves adhesion separation as well as resection and reconstruction of the urinary organs and bowel; high-level skills are required. The severity of DIE should be evaluated preoperatively as accurately as possible. Using ENZIAN in conjunction with the AFS (The revised American Fertility Society classification of endometriosis) classification makes a more detailed assessment of DIE possible. The operative procedures used for laparoscopic resection of urinary DIE and reconstruction of the urinary organs are chosen based on the type of lesion (intrinsic/extrinsic) and length of stenosis. In addition to ureteroneocystostomy, the psoas bladder hitch and Boari bladder flap procedures are applied when necessary to extend the urinary tract. Bowel resection for bowel endometriosis is classified into classic segmental resection and conservative approaches (shaving/discoid). When these procedures are employed, it is advisable to work in consultation with urologists and gastroenterologists and to inform the patients of the associated risks and outcomes. Furthermore, postoperative medication is essential because it is difficult to conduct repeated surgeries.

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Prospective diagnostic study on the use of narrow-band imaging on suspicious lesions during colonoscopy examination

Abstract

Introduction

Colonoscopy is the gold standard to detect colorectal neoplasm. Narrow-band imaging (NBI) has a good diagnostic accuracy to differentiate between neoplastic and non-neoplastic colorectal lesions. This study explores the diagnostic validity of NBI colonoscopy as well as its associated factors related to neoplastic and non-neoplastic colorectal lesions.

Methods

This study enrolled 100 patients in a single-center tertiary teaching hospital. Patients presented for screening colonoscopy, and those with suspicious colorectal lesions were included in this study. During colonoscopy, the most suspicious lesion in each patient was analyzed using the NBI system based on Sano's classification. Each lesion was biopsied for histopathological analysis, the gold standard. Endoscopic images were captured electronically. The sensitivity, specificity, and diagnostic accuracy of NBI colonoscopy were assessed. Other associated factors related to neoplastic and non-neoplastic lesions were analyzed accordingly.

Results

The sensitivity and specificity of the NBI were 88.2% and 71.9%, respectively. The area under the receiver–operator curve was 0.801, indicating that NBI has a good ability to differentiate between disease and non-disease. There are significant associations between histopathological examination outcomes and both presenting symptoms, especially weight loss, and lesion site, even after other variables were controlled (P < 0.05).

Conclusion

The NBI system in colonoscopy was capable of distinguishing neoplastic from non-neoplastic colorectal lesions. It indicates an acceptable level of agreement with histopathology, the gold standard. However, the role of NBI in screening and surveillance in Malaysia still needs further evaluation and exploration.

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