Παρασκευή, 23 Μαρτίου 2018

Fidget Spinner Ingestion

imageNo abstract available

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Diagnostic Tests in Pediatric Constipation

imageConstipation is one of the most common gastrointestinal symptoms in children. With a median reported prevalence of 12%, it accounts for about 25% of all pediatric gastroenterology consultations. The majority of children experiences functional constipation and do not usually require any diagnostic testing. For those children not responding to conventional medical treatment or in the presence of a more significant clinical picture, however, an accurate instrumental assessment is usually recommended to evaluate either the underlying pathophysiologic mechanisms or a possible organic etiology. The present review analyzes the possible diagnostic investigations for severely constipated children, focusing on their actual indications and their utility in clinical practice. During the last decade, there has been a remarkable increase in our knowledge of normal and abnormal colonic and anorectal motility in children, and a number of different techniques to measure transit and motility have been developed and are discussed in this narrative review.

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Donor Human Milk and Fortifier Use in United States Level 2, 3, and 4 Neonatal Care Hospitals

imageObjective: In 2011, the United States Surgeon General issued a call to action to "identify and address obstacles to greater availability of safe banked donor milk for fragile infants." The purpose of the present study is to analyze patterns in donor human milk (DHM) and fortifier use in level 2, 3, and 4 neonatal facilities in 2015 and to identify factors associated with nonuse. Methods: Data from the 2015 Maternity Practices in Infant Nutrition and Care survey, conducted by the Center for Disease Control and Prevention, were analyzed for questions about feeding practices within neonatal hospitals. Results: The percentage of neonatal facilities that reported using DHM in 2015 was 38.3%, up 74% from 2011. The majority of level 3 and level 4 facilities reported using DHM (65.7% and 73.3%, respectively) and fortifiers (96.1% and 91.9%, respectively). Within DHM-using facilities, a wide range of DHM feeding patterns was reported. The prevalence of DHM use was higher in facilities that had the highest rates of mother's own milk feedings (P 

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Non-invasive Markers of Portal Hypertension: Appraisal of Adult Experience and Potential Utilisation in Children

imagePortal hypertension (PHT) is a significant cause of morbidity and mortality in children with chronic liver disease and portal vein obstruction. Increased portal pressure results in variceal formation along the gastrointestinal (GI) tract resulting in major bleeding. Identifying children with significant PHT who are more likely to suffer GI bleeding has been challenging and the role of surveillance upper GI endoscopy has been debated. This review analyses research done on serum biomarkers and imaging techniques as possible predictors of significant PHT. We evaluated the research performed on adult population, as well as the limited work done on children, to identify promising areas for future research. A literature search was conducted on "PubMed." Several search terms were used including "portal hypertension," "paediatric portal hypertension," "non-invasive markers of portal hypertension," "spleen stiffness," "liver stiffness," "elastography," and "endothelial damage." The articles included were selected based on their relevance to the purpose of our review. The research suggests a combination of several biomarkers, in addition to an imaging technique such as transient elastography or magnetic resonance elastography, would allow for the best prediction of significant varices. The most promising indicators would be those that are applicable in both intra- and extra-hepatic causes of PHT. Further research on these predictors in children with PHT is required to determine their potential role as selection criteria for PHT and stratification of surveillance GI endoscopies.

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Celiac Disease Diagnosis Without Biopsy: Is a 10× ULN Antitransglutaminase Result Suitable for a Chemiluminescence Method?

imageObjectives: 2012 European Society of Pediatric Gastroenterology, Hepatology and Nutrition guidelines allow to establish a celiac disease diagnosis without duodenal biopsy in symptomatic pediatric patients with antitissue transglutaminase (anti-tTG) titers >10 times the upper limit of normal. For some years now, new chemiluminescence immunoassays have been made available: it is important to establish the clinical performance of anti-tTG and to determine the cut-off best suited to predict Marsh ≥2 to avoid gastrointestinal endoscopy not only in children, but also in the adult population. Methods: A total of 2565 patients performed duodenal biopsy from July 2012 to September 2016; we selected all the patients who had undergone QUANTA Flash anti-tTG immunoglobulin A (IgA) within −3 months of duodenal biopsy and before the start of gluten-free diet. A total of 827 patients fulfilled the criteria for selection. Results: Using a cut-off of 20 chemiluminescent unit (CU; area under the curve: 0.995), sensitivity, specificity, positive, and negative predictive value were 98.2%, 98.4%, 97.9%, and 98.6%, respectively. For the correlation with Marsh ≥2, in the pediatric population, positive predictive values (PPV) were 92.1%, 99%, and 100% at 200 CU (10×), 560 CU (28×), and 1000 CU (50×), respectively. In the adult population PPV was 94.2%, 98.2%, and 100% at 200 CU (10×), 350 CU (15×), and 400 CU (20×). Conclusions: Sensitivity, specificity, positive, and negative predictive value of QUANTA Flash h-tTG IgA were excellent. The cut-off providing an optimized PPV for histological lesions compatible for celiac disease (Marsh ≥2) for the QUANTA Flash h-tTG IgA is 350 CU (15×) in adult and 560 CU (28×) in children.

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Long-term Results and Quality of Life Assessment in Biliary Atresia Patients: A 35-Year Experience in a Tertiary Hospital

imageObjectives: To review long-term transplant-free survival and quality of life (QOL) of patients with biliary atresia (BA). Methods: A retrospective study reviewing all patients with Kasai operation between January 1, 1980 and December 31, 2015 was performed to evaluate the transplant-free survival. Subgroup analysis of patients older than 20 years was carried out to assess the QOL using the Short Form-36 Health Survey and incidences of disease-related complications. Comparison between patients with native and transplanted liver was performed using two-tailed independent samples t-test (P value 

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Nutrition in Pediatric Inflammatory Bowel Disease: A Position Paper on Behalf of the Porto Inflammatory Bowel Disease Group of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition

imageBackground and Aims: A growing body of evidence supports the need for detailed attention to nutrition and diet in children with inflammatory bowel disease (IBD). We aimed to define the steps in instituting dietary or nutritional management in light of the current evidence and to offer a useful and practical guide to physicians and dieticians involved in the care of pediatric IBD patients. Methods: A group of 20 experts in pediatric IBD participated in an iterative consensus process including 2 face-to-face meetings, following an open call to Nutrition Committee of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition Porto, IBD Interest, and Nutrition Committee. A list of 41 predefined questions was addressed by working subgroups based on a systematic review of the literature. Results: A total of 53 formal recommendations and 47 practice points were endorsed with a consensus rate of at least 80% on the following topics: nutritional assessment; macronutrients needs; trace elements, minerals, and vitamins; nutrition as a primary therapy of pediatric IBD; probiotics and prebiotics; specific dietary restrictions; and dietary compounds and the risk of IBD. Conclusions: This position paper represents a useful guide to help the clinicians in the management of nutrition issues in children with IBD.

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Well Preserved Renal Function in Children With Untreated Chronic Liver Disease

imageObjectives: On the basis of studies with hepatorenal syndrome, it is widely regarded that renal function is impacted in chronic liver disease (CLD). Therefore, we investigated renal function in children with CLD. Methods: In a retrospective study of 277 children with CLD, renal function was investigated as glomerular filtration rate (GFR) and effective renal plasma flow (ERPF), measured as clearance of inulin and para-amino hippuric acid or clearance of iohexol. The data were analyzed with regard to different subgroups of liver disease and to the grade of damage. Results: Hyperfiltration (>+2 SD of controls) was found in the subgroups of progressive familial intrahepatic cholestasis (44%), glycogenosis (75%), and acute fulminant liver failure (60%). Patients with biliary atresia, most other patients with metabolic disease and intrahepatic cholestasis, and those with vascular anomalies and cryptogenic cirrhosis had normal renal function. Decreased renal function was found in patients with Alagille's syndrome (64% 

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Errata

No abstract available

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Magnetic Resonance Imaging Findings in Neonatal Hemochromatosis

imageBackground: There are limited data on utility of magnetic resonance imaging (MRI) in the assessment of suspected neonatal hemochromatosis (NH). Objectives: The aim of the study was to present our experience with utilization of multi-echo sequence MRI technique in the evaluation of NH and to compare MRI findings in infants with and without NH. Methods: MRI performed for suspected NH were retrospectively reviewed to note the presence and severity of iron deposition (ID) in liver, spleen, pancreas, and kidneys on multi-echo sequences. Findings were compared in infants with and without NH. Results: Of 20 infants (9 boys and 11 girls; median age of 12.5 days) included in the study, 7 of 20 had NH and 13 of 20 were assigned to the non-NH group. Higher degree of pancreatic ID was seen in the NH group (P = 0.001) with 4 of 7 evaluable pancreas showing moderate-to-severe degree and 1 of 7 showing mild degree of ID whereas none of the 13 infants in non-NH group showed moderate or severe degree of pancreatic ID. Even though the severity of hepatic ID was higher in NH group (P = 0.033), variable severity of hepatic ID was seen in both groups with most infants in both groups showing moderate-to-severe degree of ID. The severity of splenic ID was not particularly associated with any group (P = 0.774) but there was no moderate or severe degree of ID in NH. Renal ID was seen in two infants in non-NH group. Conclusions: A moderate-to-severe degree of pancreatic ID seen on MRI tends to be associated with NH and should be sought to establish a timely diagnosis of NH. Presence and severity of hepatic ID cannot be used for differentiation of NH from other causes of neonatal liver failure.

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The Effect of Gluten-free Diet on Clinical Symptoms and the Intestinal Mucosa of Patients With Potential Celiac Disease

imageIn this prospective study, we evaluated the effect of gluten-free diet (GFD) in a cohort of 65 children with potential celiac disease. Patients received GFD for signs/symptoms (N = 47) or parents' choice (N = 18). Most frequent signs/symptoms were low body mass index (36%), recurrent abdominal pain (34%), and diarrhea (19%). Of the 35/47 patients followed-up on GFD, only 54% (19/35) showed a complete clinical response. In 9 of 65 patients an intestinal biopsy was also performed after at least 1 year of GFD. No significant differences were observed in terms of Marsh grade (P = 0.33), lamina propria CD25+ cells (P = 0.80), CD3+ (P = 0.9), and γδ+ (P = 0.59) intraepithelial lymphocytes density and intestinal anti-TG2 deposits (P = 0.60). In conclusion, caution is necessary before attributing all symptoms to gluten in this condition.

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Hepatic Parenchymal Injury in Crigler-Najjar Type I

imageBackground: Crigler-Najjar syndrome type I (CNI) arises from biallelic variants of UGT1A1 that abrogate uridine diphosphate glucuronosyltransferase (UGT1A1) activity resulting in unconjugated hyperbilirubinemia. Historically, liver parenchyma in CNI was considered structurally and histologically normal. Recent review of CNI liver explants revealed fibrosis. Our aim was to investigate the association between hepatic histology and disease phenotype in CNI. Methods: We extracted data from the medical record at the time of liver transplant from 22 patients with CNI at the Children's Hospital of Pittsburgh, and reviewed explant histology. Continuous data were normally distributed, are presented as mean (±1 SD), and analyzed using two-tailed Student t-test. Categorical data were analyzed using the Chi-square test. Results: Both alanine transaminase (ALT; mean 87.4 IU/L) and aspartate transaminase (AST; mean 54.6 IU/L) were elevated. Nine (41%) of 22 explants had significant fibrosis. Pericentral (n = 5), periportal (n = 2), and mixed (n = 2) patterns of fibrosis occurred. A significant difference in mean age of subjects with fibrotic versus non-fibrotic livers (16.1 years vs 10.5 years; P = 0.02) was seen. There were no indices of synthetic liver dysfunction or portal hypertension. Neither a history of gallstone disease nor excess weight appeared to contribute to the development of fibrosis. Conclusions: For the first time, we report a 41% prevalence of clinically silent, yet histologically significant fibrosis among subjects with Crigler-Najjar type 1. Risk for fibrosis appears to accrue with time, indicating that earlier intervention may be prudent whenever considering alternative treatments such as hepatocyte transplant, auxiliary liver transplant, or viral gene therapy.

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Serum 25 Hydroxy Vitamin D Levels in Very Low Birth Weight Infants Receiving Oral Vitamin D Supplementation

imageBackground and Objective: Vitamin D supplementation in preterm infants has been recommended by American Academy of Pediatrics (AAP); however, its efficacy and safety has not been well studied. To study 25-hydroxy vitamin D (25OHD) levels as a marker of vitamin D status of very low birth weight infants while on vitamin D supplementation during neonatal intensive care unit hospitalization. Methods: Retrospective study of preterm infants with birth weight 100 ng/mL. Results: A total of 301 infants were enrolled, 186 very low birth weight (VLBW; 1000–1499 g) infants and 115 extremely low birth weight (ELBW;

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Button Battery Powered Fidget Spinners: A Potentially Deadly New Ingestion Hazard for Children

imageToys entering the marketplace may have unrecognized hazard risks until data on injury become known. The fidget spinner is a new popular toy mass marketed to children and is primarily sold without warning labels. The US Consumer Product Safety Commission has recently issued a formal statement on potential safety concerns related to ingestion of the toy parts and other hazards. Button batteries within this toy pose the greatest danger to children as ingestion can lead to lethal injury. We report 2 cases of children who swallowed a button battery from a fidget spinner, causing severe esophageal injury. Various aspects of this type of ingestion important for clinicians to be aware of are reviewed.

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Endoscopic Transesophageal Drainage of Mediastinal Pseudocyst in a Child

No abstract available

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Gastrointestinal Symptoms of Food Challenge-proven Non-IgE Cow's Milk Allergy Are Dissipated by Early School Age

imageObjectives: The aim of this study was to evaluate the current well-being and dietary restrictions in children 6 years after food challenge-confirmed diagnosis of non-IgE cow's milk protein allergy, compared to peers with gastrointestinal symptoms but negative food challenge. This study aimed to evaluate the diagnostic process retrospectively. Methods: This is an Internet-based survey for mothers whose children underwent 6 years ago the double-blind, placebo-controlled food challenge for cow's milk (CM) because of gastrointestinal symptoms causing suspicion of non-IgE CM protein allergy. Concurrent dietary restrictions, overall well-being, medical history, and retrospective views on the food challenge were queried using a study-specific questionnaire, the Quality of life using PedsQL general score and parental stress with the Parenting Stress Index questionnaire. Result: Mothers of 42 children (23 girls), median age of 6.7 years (range 5.7–8.6), participated in the survey, the response rate was 70%. All children now consumed cow's milk protein. The only food restrictions reported were empirical lactose-free diets in 7 children (17%). One-third of the children in both groups were presently reported to have eating-related issues such as picky eating. Quality of life was good and present parenting stress was average in both groups. The majority of the mothers (87%) felt positive or neutral about the food challenge performed in infancy. Conclusions: The non-IgE CM allergy with gastrointestinal symptoms diagnosed in infancy was a transient condition with good outcome. At an early school age, nearly all children have a good quality of life and a regular diet. The use of the double-blind, placebo-controlled food challenge was well-endorsed.

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Shifting Practice in the Diagnosis of Paediatric Coeliac Disease in English District General Hospitals

No abstract available

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Nutritional State and Feeding Behaviors of Children With Eosinophilic Esophagitis and Gastroesophageal Reflux Disease

imageObjective: As both gastroesophageal reflux disease (GERD) and eosinophilic esophagitis (EoE) are associated with malnutrition and feeding dysfunction, this study compares growth, nutrition, and feeding behaviors in children with GERD and EoE. Methods: Subjects ages 1 to 7 years with GERD or EoE were enrolled in a prospective study. Assessments included length/height, weight, 3-day food diary, serum biomarkers of nutrition, and the Behavioral Pediatric Feeding Assessment Scale. Results: Mean weight-for-length z scores in GERD and EoE children were −0.93 and −1.14 (p = NS) and mean body mass index z scores were 0.29 and −0.13 (P = NS). Vitamin D intake was below the daily recommended intake in GERD subjects. EoE subjects' intake was below daily recommended intake of Vitamin D and calcium. GERD and EoE groups both had normal intake of calories, carbohydrates, proteins, fats, and iron, and normal serum ferritin (25 vs 34 ng/mL), prealbumin (21 vs 20 mg/dL), parathyroid hormone (42 vs 37 pg/mL), and Vitamin D (both 30 ng/mL). Behavioral Pediatric Feeding Assessment Scale problem and frequency scores were similar in GERD and EoE subjects but were higher than those of a historical cohort of healthy controls (Hedges' g of 0.95 and 1.1, respectively). EoE subjects on food allergen restriction diets had significantly less feeding dysfunction than those on regular diets. Conclusions: As a selected group of children with uncomplicated GERD or EoE were without nutritional deficiencies but had maladaptive feeding, providing anticipatory guidance to minimize mealtime challenges, monitoring for improvement, or referring to a feeding therapist, may be beneficial. A trial of food allergen restriction may provide additional benefit for those with EoE.

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Commentary: Button Batteries in Fidget Spinners Is It Time to Push the “Panic Button”?

No abstract available

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Herpes Simplex Virus Esophagitis in Immunocompetent Children: A Harbinger of Eosinophilic Esophagitis?

imageHerpes simplex virus (HSV) is a common cause of infectious esophagitis. The aim of this retrospective study is to identify comorbid and predisposing conditions and sequelae of HSV esophagitis in immunocompetent children. We reviewed 16 cases of HSV esophagitis diagnosed from January 1982 to March 2016. Five patients were immunosuppressed, 11 were immunocompetent and included in the study. Three (27%) had no other significant medical history. Five patients (45%) had repeat biopsies following their HSV infection, which showed eosinophilic infiltrate consistent with current diagnostic criteria of eosinophilic esophagitis (EoE), one of whom had known EoE. Environmental allergies and/or asthma were present in 4 of 5 of these patients. Among the immunocompetent patients, EoE was a comorbidity in almost half, although biopsies at the time of HSV esophagitis did not show diagnostic features of EoE. Clinical follow-up is therefore warranted for immunocompetent children presenting with HSV esophagitis, particularly those with atopic conditions.

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Low Urinary Iodine Concentrations Predict Decreased Fertility

Clinical Thyroidology, Volume 30, Issue 3, Page 135-137, March 2018.


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Highly Sensitive Thyroglobulin Assays Are Reliable Indicators of Persistent Disease in Thyroid Cancer Patients with Thyroglobulin Antibody

Clinical Thyroidology, Volume 30, Issue 3, Page 122-125, March 2018.


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Thyroid Status Has Measurable Effects on Gene Expression in Whole Blood

Clinical Thyroidology, Volume 30, Issue 3, Page 129-131, March 2018.


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Methimazole Has a Dose-Dependent Association With Congenital Malformations, but Switching to PTU in the First Trimester Seems Too Late

Clinical Thyroidology, Volume 30, Issue 3, Page 104-107, March 2018.


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Most “Recurrences” of Thyroid Cancer Represent Persistent Rather Than Recurrent Disease

Clinical Thyroidology, Volume 30, Issue 3, Page 108-111, March 2018.


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No Benefit of Levothyroxine Among Pregnant Hypothyroid and/or Hypothyroxinemic Women on Offspring IQ at Age 9 years

Clinical Thyroidology, Volume 30, Issue 3, Page 100-103, March 2018.


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Thyroseq v3 Molecular Test for Indeterminate Thyroid Nodules Has Improved Sensitivity and Specificity

Clinical Thyroidology, Volume 30, Issue 3, Page 112-114, March 2018.


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Tumor Size and Nodal Stage Predict Recurrence and Timing of Ultrasonography in Papillary Thyroid Carcinoma Patients

Clinical Thyroidology, Volume 30, Issue 3, Page 126-128, March 2018.


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The Baseline Survey of the 294,905 Fukushima Children and Adolescents Reveals a Panorama of Thyroid Ultrasound Features

Clinical Thyroidology, Volume 30, Issue 3, Page 115-118, March 2018.


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Patients with Advanced Lung Cancer in Whom Thyroid Dysfunction Develops During Programmed Death-1 Protein Blockade May Have a Good Prognosis

Clinical Thyroidology, Volume 30, Issue 3, Page 132-134, March 2018.


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Preoperative Ultrasonography Guides the Extent of Thyroidectomy for Papillary Thyroid Cancer

Clinical Thyroidology, Volume 30, Issue 3, Page 119-121, March 2018.


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TSH Has Effects on Peripheral Thyroid Hormone Metabolism That Are Mild but Run Counter to Its Direct Effects on Thyroid Hormone Secretion

Clinical Thyroidology, Volume 30, Issue 3, Page 138-141, March 2018.


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How web-based ePCR provides a long-term solution for Miramar Fire-Rescue

Electronic health records and other reporting tools from ESO Solutions helped streamline documentation at a pioneering Florida agency

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Characterization of GA20ox genes in tall and dwarf types coconut ( Cocos nucifera L.)

Abstract

Coconuts (Cocos nucifera L.) are divided by the height into tall and dwarf types. In many plants the short phenotype was emerged by mutation of the GA20ox gene encoding the enzyme involved in gibberellin (GA) biosynthesis. Two CnGA20ox genes, CnGA20ox1 and CnGA20ox2, were cloned from tall and dwarf types coconut. The sequences, gene structures and expressions were compared. The structure of each gene comprised three exons and two introns. The CnGA20ox1 and CnGA20ox2 genes consisted of the coding region of 1110 and 1131 bp, encoding proteins of 369 and 376 amino acids, respectively. Their amino acid sequences are highly homologous to GA20ox1 and GA20ox2 genes of Elaeis guineensis, but only 57% homologous to each other. However, the characteristic amino acids two histidines and one aspartic acid which are the two iron (Fe2+) binding residues, and arginine and serine which are the substrate binding residues of the dioxygenase enzyme in the 20G-FeII_Oxy domain involved in GA biosynthesis, were found in the active site of both enzymes. The evolutionary relationship of their proteins revealed three clusters in vascular plants, with two subgroups in dicots and three subgroups in monocots. This result confirmed that CnGA20ox was present as multi-copy genes, and at least two groups CnGA20ox1 and CnGA20ox2 were found in coconut. The nucleotide sequences of CnGA20ox1 gene in both coconut types were identical but its expression was about three folds higher in the leaves of tall coconut than in those of dwarf type which was in good agreement with their height. In contrast, the nucleotide sequences of CnGA20ox2 gene in the two coconut types were different, but the expression of CnGA20ox2 gene could not be detected in either coconut type. The promoter region of CnGA20ox1 gene was cloned, and the core promoter sequences and various cis-elements were found. The CnGA20ox1 gene should be responsible for the height in coconut, which is different from other plants because no mutation was present in CnGA20ox1 gene of dwarf type coconut.



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Efficacy of bedside respiratory muscle training in patients with stroke: A randomized controlled trial

Objectives Inspiratory and the expiratory muscles are important for effective respiratory function. This study aimed to investigate the efficacy of bedside respiratory muscle training on pulmonary function and stroke-related disabilities in stroke rehabilitation. Design Patients with stroke (N=40) in a rehabilitation unit were randomly assigned to either the intervention group (N1=20) or control group (N2=20). Both groups participated in a conventional stroke rehabilitation program. During the study period, the intervention group received bedside respiratory muscle training twice a day for three weeks. The respiratory muscle training consisted of (1) a breath stacking exercise, (2) inspiratory muscle training, and (3) expiratory muscle training. The primary outcomes were measures of pulmonary function: forced vital capacity, forced expiratory volume in one second, and peak flow. Secondary outcomes were stroke-related disabilities assessed using the National Institutes of Health Stroke Scale, Modified Barthel Index, Berg Balance Scale, Fugl-Meyer Assessment, the Korean Mini-Mental State Examination, and pneumonia incidence. Results Pulmonary function was significantly improved in the intervention group after 3 weeks of respiratory muscle training (p

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ULTRASONOGRAPHIC IMAGING OF THE MEDIAN NERVE WITH A STRUTHERS LIGAMENT

No abstract available

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Psychophysiology, Ahead of Print.

Psychophysiology, Ahead of Print.


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Hominin hand bone fossils from Sterkfontein Caves, South Africa (1998–2003 excavations)

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Publication date: May 2018
Source:Journal of Human Evolution, Volume 118
Author(s): Travis Rayne Pickering, Jason L. Heaton, Ron J. Clarke, Dominic Stratford
We describe eleven hominin metacarpals and phalanges recovered from Jacovec Cavern and Member 4 of the Sterkfontein Formation between 1998 and 2003. Collectively, the fossils date in excess of 2.0 Ma, and are probably attributable to Australopithecus africanus and/or Australopithecus prometheus. When combined with results of previous studies on Australopithecus postcranial functional morphology, the new data presented here suggest that at least some late Pliocene and/or early Pleistocene hominins from Sterkfontein were arboreally adept. This finding accords with the reconstruction of the site's >2.0 Ma catchment area as well-vegetated and containing significant woody components. In addition, most of the new specimens described here evince morphologies that indicate the hands from which they derived lacked complete modern humanlike manual dexterity, which is integral to the manufacture and use of intentionally shaped stone tools. The absence of lithic artifacts from both stratigraphic units from which the fossils were excavated is consistent with this conclusion.



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Laparoscopic fenestration for a huge symptomatic splenic cyst in a patient with Gaucher’s disease

Abstract

A 34-year-old woman visited our hospital for treatment of a huge splenic cyst with epigastric pain. She had been diagnosed with Gaucher's disease (Type 1) at 3 years of age and had been receiving enzyme replacement therapy (ERT) from 15 years of age. Abdominal MRI showed a low-intensity area, 30 cm in diameter, with a well-defined border on T1-weighted images. The patient underwent laparoscopic fenestration of the huge splenic cyst for relief of worsening epigastric pain caused by the cyst. The cyst contained 2,500 ml of brownish-red fluid. The patient recovered satisfactorily and was discharged on postoperative day 11. Gaucher's disease is an extremely rare metabolic disease; only about 6,000 patients are registered in the International Collaborative Gaucher Group Gaucher Registry. An extremely rare case of a huge symptomatic splenic cyst treated by laparoscopic fenestration in a patient with Gaucher's disease is described.



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Detection of favorable alleles for yield and yield components by association mapping in upland cotton

Abstract

Association mapping based on linkage disequilibrium provides a promising tool for dissecting the genetic basis underlying complex traits. To reveal the genetic variations of yield and yield components traits in upland cotton, 403 upland cotton accessions were collected and analyzed by 560 genome-wide simple sequence repeats (SSRs). A diverse panel consisting of 403 upland cotton accessions was grown in six different environments, and the yield and yield component traits were measured, and 560 SSR markers covering the whole genome were mapped. Association studies were performed to uncover the genotypic and phenotypic variations using a mixed linear model. Favorable alleles and typical accessions for yield traits were identified. A total of 201 markers were polymorphic, revealing 394 alleles. The average gene diversity and polymorphism information content were 0.556 and 0.483, respectively. Based on a population structure analysis, 403 accessions were divided into two subgroups. A mixed linear model analysis of the association mapping detected 43 marker loci according to the best linear unbiased prediction and in at least three of the six environments(− lgP > 1.30, P < 0.05). Among the 43 associated markers, five were associated with more than two traits simultaneously and nine were coincident with those identified previously. Based on phenotypic effects, favorable alleles and typical accessions that contained the elite allele loci related to yield traits were identified and are widely used in practical breeding. This study detected favorable quantitative trait loci's alleles and typical accessions for yield traits, these are excellent genetic resources for future high-yield breeding by marker-assisted selection in upland cotton in China.



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Using ultrasound for firefighter health and wellness programs

Consider incorporating this diagnostic tool into firefighter physicals to support early diagnosis and intervention that can save lives

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Hsp83 regulates the fate of germline stem cells in Drosophila ovary

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Publication date: Available online 22 March 2018
Source:Journal of Genetics and Genomics
Author(s): Dongsheng Chen, Shuang Wang, Xiaoqian Tao, Lijuan Zhou, Jian Wang, Fuling Sun, Mingzhong Sun, Xiaoli Gao




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Asian Journal of Endoscopic Surgery, Ahead of Print.

Asian Journal of Endoscopic Surgery, Ahead of Print.


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Assessment of user voluntary engagement during neurorehabilitation using functional near-infrared spectroscopy: a preliminary study

Functional near infrared spectroscopy (fNIRS) finds extended applications in a variety of neuroscience fields. We investigated the potential of fNIRS to monitor voluntary engagement of users during neurorehabi...

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Recalibrating disparities in perceived and actual balance abilities in older adults: a mixed-methods evaluation of a novel exergaming intervention

Published reports suggest a disparity between perceived and actual balance abilities, a trait associated with increased fall-risk in older adults. We investigate whether it is possible to 'recalibrate' these d...

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Single Balloon–assisted Colonoscopy for Placement of Colonic Manometry Catheters: Initial Experience in Children

Objectives: Colonic manometry is used frequently in children with long standing and difficult to manage constipation to aid in management decisions. Accurate analysis requires placement of the colonic manometry catheter in the colon without looping. This is technically difficult due to the long-standing nature of the constipation in most patients leading to sigmoid and other colonic redundancy. Single balloon colonoscopy has been successfully used in adult in cases of difficult colonoscopy. We report the first series of single balloon–assisted colonoscopy for performing difficult colonoscopy in children and placing colonic manometry catheters. Methods: Retrospective chart review was performed to identify patients undergoing the procedure. All patients had prior preparation with nasogastric golytely. Results: Using the single balloon technique, 36 patients underwent placement of the colonic manometry catheter (ages ranging from 3 to 16 years, weights 12 to 95 kg). Catheter placement was successful in all cases with procedure times of 20 to 105 minutes. No major complications were noted. Conclusions: This is the first reported series of using single balloon–assisted colonoscopy to perform difficult colonoscopy in children and place colonic manometry catheters. It may have other therapeutic implications in children such as removal of polyps or placement of similar catheters. Address correspondence and reprint requests to Rinarani M. Sanghavi, MBBS, MD, FAAP, Children's Medical Center Dallas, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd Dallas, TX 75390 (e-mail: Rina.sanghavi@childrens.com). Received 7 March, 2017 Accepted 4 February, 2018 The authors report noo conflicts of interest. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Province-Wide Biliary Atresia Home Screening Program in British Columbia: Evaluation of First Two Years

Background: Biliary atresia (BA), a rare newborn liver disease, is the leading cause of liver-related death in children. Early disease recognition and timely surgical Kasai hepatoportoenterostomy (KP) offers long-term survival without liver transplant. Universal BA screening in Taiwan using infant stool color cards (ISCCs) has proven effectiveness. We report our experience with ISCC BA screening in a province-wide program in British Columbia (BC). Objectives: To assess program performance and cost from launch April 1, 2014-March 31, 2016. Methods: ISCCs distributed to families upon maternity ward discharge. Parents were instructed to monitor their infant's stool color for one month and contacted the screening center with concerns. The number of live births, ISCC distribution, BA cases, and costs were recorded. Cases with Program screen success had both acholic stool recognition (ISCC screen success) and timely referral for BA. Results: All 126 maternity units received ISCCs. Of 87,583 live births there were 6 BA cases. Of the five cases with ISCC Screen Success three had Program Screen Success. The median KP age in the program screen success and failure groups was 49 (42–52) and 116 (49–184) days respectively. Program sensitivity was 50%, specificity 99%, PPV 4% and NPV 99%. A random sample of 1054 charts at BC Children's Hospital found an ISCC distribution rate of 94%. After a phase-in period, the annual program cost was $30,033.82, and the ISCC cost per birth was $0.68. Conclusions: The screening program has high specificity and distribution with low cost. Successful program case identification had earlier age at KP. Program modifications aim to improve sensitivity. Longer-term studies will determine program impact on health outcomes. Address correspondence and reprint requests to Dr. Richard A. Schreiber, Room K4-200, BC Children's Hospital, 4480 Oak Street, Vancouver, BC, Canada, V6H3V4 (e-mail: rschreiber@cw.bc.ca). Received 9 September, 2017 Accepted 14 February, 2018 List of Authors and his/her Respective Roles: Jessica P. Woolfson: Acquisition, analysis and interpretation of data for the work; Drafting and revising the work for important intellectual content, Final approval of the version to be published; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Richard A. Schreiber: Substantial contributions to the conception or design of the work; analysis, or interpretation of data for the work; Drafting the work or revising it critically for important intellectual content; Final approval of the version to be published; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Alison E. Butler: Acquisition and analysis of data for the work; Drafting the work or revising it critically for important intellectual content; Final approval of the version to be published; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved Interpretation of data for the work. Julie MacFarlane: Acquisition of data for the work; Drafting the work or revising it critically for important intellectual content; Final approval of the version to be published; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Janusz Kaczorowski: Substantial contributions to the conception or design of the work; Drafting the work or revising it critically for important intellectual content; Final approval of the version to be published; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Lisa Masucci: Substantial contributions to the conception or design of the work; Drafting the work or revising it critically for important intellectual content; Final approval of the version to be published; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JP Collet: Substantial contributions to the conception or design of the work; Drafting the work or revising it critically for important intellectual content; Final approval of the version to be published; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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The Use and Safety of A Novel Haemostatic Spray in the Endoscopic Management of Acute Non-Variceal Upper Gastrointestinal Bleeding in Children

Aims and background: Advanced endo-haemostatic technique performance and experience is extremely variable in distribution amongst pediatric endoscopists. Haemostatic spray (Hemospray®), a novel endo-haemostatic topically applied powder has the advantage of extreme ease of use and; hence may lower the threshold of competency required by the endoscopist thereby potentially reducing mortality. The aim of the study is to prospectively evaluate the efficacy and the safety of haemostatic spray in paediatric patients with AUGIB. Methods: Prospective enrolment of children with acute upper gastrointestinal bleeding (AUGIB) (group one) occurred, either as primary therapy or as an adjunct to standard endo-haemostatic therapeutic techniques. Patients were assessed for likely need for endo-haemostatic intervention of >8/24 of the paediatric Sheffield AUGIB score. A follow up endoscopy occurred in those deemed to have clinical need pre-discharge. For comparison, anoher group (group two) of patients,who received conventional endo-haemostatic treatment in the preceding 36 months, were reviewed. Results: A total of 20 applications of hemospray occurred in 17 patients (8 male, median (range) age: 6.5years (2 days-17.75years) and a total of 29 patients were enrolled in group two ((16 male, median (range) age: 5.1 (0.25–17.0)). All patients tolerated haemostatic spray applications with no adverse events. The haemostatic spray group achieved 100% Initial hemostasis with 18% rebleeding rate, although only a 6% failure rate after re-application. In the conventional group, similar 100% initial hemostasis was achieved with 24% re-bleeding rate and 7% failure rate necessitating surgical interventions. Conclusions: This paediatric series suggests that monotherapy with haemostatic spray is as effective as conventional approaches in the management of AUGIB. Address correspondence and reprint requests to Professor Mike Thomson, Centre for Paediatric Gastroenterology, Sheffield Children's Hospital, Weston Bank, Sheffield, S10 2TH, UK (e-mail: mike.thomson@sch.nhs.uk). Received 1 October, 2017 Accepted 17 February, 2018 Author contributions: Study conception and design: Thomson. Application of hemospray: Narula, Rao, Urs, Belsha, Thomson. Acquisition of data: Belsha. Analysis and interpretation of data: Belsha, Thomson. Drafting of manuscript: Thomson. Critical revision: Narula, Rao, Urs, Belsha. Conflict of interest statement: All contributing authors confirm no real or potential conflict of interest to declare. The hospital bought the hemostatic sprays at the correct commercial price. No subsidies were provided at all. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Clinical Remission and Normalization of Laboratory Studies in a Patient with Ulcerative Colitis and Primary Sclerosing Cholangitis Using Dietary Therapy

No abstract available

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The Health Care Transition of Youth With Liver Disease into the Adult Health System: Position Paper from ESPGHAN and EASL

Background: Medical advances have dramatically improved the long-term prognosis of children and adolescents with once-fatal hepatobiliary diseases. However, there is no generally accepted optimal pathway of care for the transition from paediatric care to the adult health system. Aim: The purpose of this position paper is to propose a transition process for young people with paediatric onset hepatobiliary diseases from child-centred to adult-centred healthcare services. Methods: Seventeen ESPGHAN/EASL physicians from 13 countries (Austria, Belgium, France, Germany, Hungary, Italy, the Netherlands, Norway, Poland, Spain, Sweden, Switzerland, and United Kingdom) formulated and answered questions after examining the currently published literature on transition from childhood to adulthood. Pubmed and Google Scholar were systematically searched between 1980 and January 2018. Quality of evidence was assessed by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) system. Expert opinions were used to support recommendations when the evidence was graded weak. All authors voted on each recommendation, using the nominal voting technique. Results: We reviewed the literature regarding the optimal timing for the initiation of the transition process and the transfer of the patient to adult services, principal documents, transition multi-professional team components, main barriers and goals of the general transition process. A transition plan based on available evidence was agreed focusing on the individual young people's readiness and on coordinated teamwork, with transition monitoring continuing until the first year of adult services. We further agreed on selected features of transitioning processes inherent to the most frequent paediatric-onset hepatobiliary diseases. The discussion highlights specific clinical issues that will probably present to adult gastrointestinal specialists and that should be considered, according to published evidence, in the long-term tracking of patients. Conclusions: Transfer of medical care of individuals with paediatric onset hepatobiliary chronic diseases to adult facilities is a complex task requiring multiple involvements of patients and both paediatric and adult care providers. Address correspondence and reprint requests to Prof. Pietro Vajro, MD, Dept of Medicine,Surgery and Dentistry, "Scuola Medica Salernitana", Paediatric Section, University of Salerno, 84022 Baronissi (Salerno), Italy (e-mail: pvajro@unisa.it). Received 6 November, 2017 Accepted 25 February, 2018 Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). Dr Guercio Nuzio is a paediatric expert invited to join this ESPGHAN Committee. Disclaimer: ESPGHAN is not responsible for the practices of physicians and provides guidelines and position papers as indicators of best practice only. Diagnosis and treatment is at the discretion of physicians. Funding sources: None. DISCLAIMER: ESPGHAN is not responsible for the practices of physicians and provides guidelines and position papers as indicators of best practice only. Diagnosis and treatment is at the discretion of physicians. Conflicts of interests: None declared. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Dual Sofosbuvir/Daclatasvir Therapy in Adolescent Patients With Chronic Hepatitis C Infection

Objectives: Dual sofosbuvir/daclatasvir (SOF/DCV) therapy is currently recommended by The European Association for Study of Liver (EASL) as an option for the treatment of chronic hepatitis C virus infection (HCV) in adults for all genotypes; however it is still not considered for patients younger than 18 years old. We aimed to test safety and efficacy of SOF/DCV in adolescent patients 12 to 17 years old with chronic HCV, genotype 4 infection. Methods: We conducted a prospective, uncontrolled, open-label multicenter study. A total of 30 chronic HCV infected adolescents, aged from 12 to 17 years old were included and treated with dual SOF/DCV for 12 weeks. Patients were monitored throughout the treatment and follow-up period for safety and efficacy outcome measures including the sustained virologic response 12 (SVR12) rate. Results: The Intention to treat (ITT) SVR12 rate was 29/30 (96.7%; 95% confidence interval (CI): 83.3 – 99.4%). The only patient who did not achieve SVR12 was lost to follow up after showing viral negativity at the end of treatment visit. While all the remaining 29 patients (100%, 95% CI: 88.3 - 100%) who completed the follow up visits achieved SVR12. All patients showed normalized liver enzymes with normal hematological, liver and renal function tests at the end of the study. No fatalities or treatment-emergent serious or severe adverse events were reported throughout the study. Conclusions: Sofosbuvir/Daclatasvir combined therapy could be a safe and effective treatment in adolescent patients 12 to 17 years old with chronic HCV genotype 4 infection. Address correspondence and reprint requests to Dr. Mostafa Yakoot, MD, Green CRC; 27 Green Street 21121, Alexandria, Egypt (e-mail: yakoot@yahoo.com). Received 6 February, 2018 Accepted 7 March, 2018 Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). The study protocol was reviewed and approved by the Research Ethics Committee of Faculty of Medicine, Alexandria University (IRB00007555) according to the Declaration of Helsinki. All subjects and their parents/guardians gave written informed consent before any treatment interventions were performed. Disclosures of Conflict of Interest: Mortada El-Shabrawi has nothing to disclose; Hisham El Khayat has nothing to disclose, Manal M AbdElgawad and Aml A Mahfouz have nothing to disclose, Sherine Helmy works and has stocks in Pharco Corporate, Mostafa Yakoot and Alaa M Abdo have conducted clinical trials on Pharco products. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Paediatric Intestinal Pseudo-Obstruction: Evidence and Consensus-Based Recommendations from an ESPGHAN-Led Expert Group

Objectives: Chronic intestinal pseudo-obstructive (CIPO) conditions are considered the most severe disorders of gut motility. They continue to present significant challenges in clinical care despite considerable recent progress in our understanding of pathophysiology, resulting in unacceptable levels of morbidity and mortality. Major contributors to the disappointing lack of progress in paediatric CIPO include a dearth of clarity and uniformity across all aspects of clinical care from definition and diagnosis to management. In order to assist medical care providers in identifying, evaluating and managing children with CIPO, experts in this condition within the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition as well as selected external experts, were charged with the task of developing a uniform document of evidence- and consensus-based recommendations. Methods: Ten clinically relevant questions addressing terminology, diagnostic, therapeutic, and prognostic topics were formulated. A systematic literature search was performed from inception to June 2017 using a number of established electronic databases as well as repositories. The approach of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) was applied to evaluate outcome measures for the research questions. Levels of evidence and quality of evidence were assessed using the classification system of the Oxford Centre for Evidence-Based Medicine (diagnosis) and the GRADE system (treatment). Each of the recommendations were discussed, finalized and voted upon using the nominal voting technique to obtain consensus. Results: This evidence- and consensus- based position paper provides recommendations specifically for chronic intestinal pseudo-obstruction in infants and children. It proposes these be termed paediatric intestinal pseudo-obstructive (PIPO) disorders to distinguish them from adult onset CIPO. The manuscript provides guidance on the diagnosis, evaluation, and treatment of children with PIPO in an effort to standardise the quality of clinical care and improve short and long-term outcomes. Key recommendations include the development of specific diagnostic criteria for PIPO, red flags to alert clinicians to the diagnosis and guidance on the use of available investigative modalities. The group advocates early collaboration with expert centres where structured diagnosis and management is guided by a multi-disciplinary team, and include targeted nutritional, medical and surgical interventions as well as transition to adult services. Conclusions: This document is intended to be used in daily practice from the time of first presentation and definitive diagnosis PIPO through to the complex management and treatment interventions such as intestinal transplantation. Significant challenges remain to be addressed through collaborative clinical and research interactions. Address correspondence and reprint requests to Dr. Nikhil Thapar, PhD, BM, MRCPCH, MRCP, BSc, Senior Lecturer and Honorary Consultant in Paediatric Gastroenterology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, United Kingdom (e-mail: n.thapar@ucl.ac.uk). Received 16 August, 2017 Accepted 19 February, 2018 DISCLAIMER: "ESPGHAN is not responsible for the practices of physicians and provides guidelines and position papers as indicators of best practice only. Diagnosis and treatment is at the discretion of physicians". Funding: Guideline development was financially supported by ESPGHAN. No support was received from industry. Conflicts of interest: NT has participated as clinical investigator, and/or advisory board member, and/or consultant, and/or speaker for Danone, Nutricia ELN and Mead Johnson. ES– No conflict of interest. MB has participated as a consultant for Shire, Sucampo, AstraZeneca, Norgine, Coloplast, Danone, Frieslandcampina, Sensus, Novolac. OB – No conflict of interest. JC- No conflict of interest. RDG has participated as a consultant for Shire, Sucampo, Coloplast, and Takeda. CDL has participated as a consultant for Merck, Nestle, Sucampo, IMHealth, QOL. CF has participated as clinical investigator, and consultant for Sucampo. GG – No conflict of interest. CK has received research support and continues to act as a paid consultant and speaker for Medtronic Inc. AS has participated as a clinical investigator, and/or advisory board member, and/or consultant, and/or speaker for Aboca, Angelini, Danone, D.M.G. Italy, Menarini, Miltè, Nestlé, Sucampo, and Valeas. YV has participated as a clinical investigator, and/or advisory board member, and/or consultant, and/or speaker for Abbott Nutrition, Aspen, Biogaia, Biocodex, Danone, Hero, Kabrita, Nestle Nutrition Institute, Nutricia, Mead Johnson Nutrition, Merck, Olygose, Orafti, Phacobel, Rontis, Sari Husada, United Pharmaceuticals, Wyeth and Yakult. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Some Vt. rural cell service, including 911, could end

It will be challenge to find a replacement, state officials said, but they are working on it

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Overview of the NASA 70-day Bed Rest Study

Purpose The purpose of this paper is to provide an overview of the NASA 70-day Bed Rest Study. The integrated complement of investigations and the standardized bed rest environment that served as the platform for this study complement are described. Outcomes of the studies will not be presented here, but will be reported in separate publications. Methods A set of studies running in an integrated fashion along the entire period (pre-, in- and post-bed rest) and utilizing the same subjects is referred in this paper as "the campaign" or "complement". NASA selected 8 individual studies to participate in the 70-day bed rest campaign. These studies were integrated to increase efficiency in the utilization of resources and to share common measures among the investigations. In addition to the individual studies addressing specific aims, a battery of standardized measures was included. Standard measures target a wide range of physiologic systems and represent some of the testing routinely done on astronauts. Bed rest subjects underwent rigorous medical and psychological screening. Standardized conditions included 70 days of bed rest in a 6° head-down tilt position. Subjects' vital signs, body weight and fluid intake and output were measured daily. A standardized diet was provided to ensure consistent nutritional intake across subjects. Exercising subjects were prescribed individualized aerobic and resistance training 6 days per week performed in a horizontal body position. Subjects in the testosterone supplementation countermeasure group received testosterone enanthate injections at 2-week intervals during bed rest. Conclusion Long duration head-down tilt bed rest provided a suitable platform for examining physiologic effects of spaceflight and testing countermeasures in a ground-based model. Integrating studies into a complement is an effective way to support multiple-investigations while minimizing the number of subjects to answer many research questions. Corresponding Author: Lori Ploutz-Snyder, PhD, Dean, School of Kinesiology, Professor, Movement Science, 4170 Observatory Lodge, 1402 Washington Heights, University of Michigan, Ann Arbor, MI 48109-2013, Phone: 734-764-5210. Email: lorips@umich.edu Study infrastructure and operations were supported by the NASA HRP Flight Analogs Project, and the University of Texas Medical Branch, Institute for Translational Sciences – Clinical Research Center (ITS-CRC) through an NIH/NCATS Center for Translational Science Award (UL1TR000071). Individual research studies were supported by the NASA Human Research Program (HRP) and the National Space Biomedical Research Institute. The authors have no conflict of interest to declare. The results of the present study do not constitute endorsement by ACSM. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. Accepted for Publication: 6 February 2018 © 2018 American College of Sports Medicine

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Efficacy of Exercise and Testosterone to Mitigate Atrophic Cardiovascular Remodeling

Purpose Early and consistent evaluation of cardiac morphology and function throughout an atrophic stimulus is critically important for the design and optimization of interventions. This randomized, controlled trial was designed to: 1) characterize the time course of unloading-induced morpho-functional remodeling, and 2) to examine the effects of exercise with and without low dose testosterone supplementation on cardiac biomarker, structural, and functional parameters during unloading. Methods Twenty six subjects completed 70 days of head down tilt bed rest (BR): 9 were randomized to exercise training (Ex), 8 to EX and low dose testosterone (ExT), and 9 remained sedentary (CONT). Exercise consisted of high intensity, continuous, and resistance exercise. Cardiac morphology (left ventricular mass; LVM) and mechanics (longitudinal, radial, and circumferential strain and twist), cardiovascular biomarkers, and cardiorespiratory fitness (VO2peak) were assessed before, during, and following BR. Results Sedentary BR resulted in a progressive decline in LVM, longitudinal, radial, and circumferential strain in CONT, while Ex and ExT mitigated decreases in LVM and function. Twist was increased throughout bed rest in sedentary BR, while after an initial increase at BR7, there were no further changes in twist in Ex and ExT. HDL cholesterol was significantly decreased in all groups compared to pre-bed rest (p

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Myocellular Responses to Concurrent Flywheel Training during 70 Days of Bed Rest

Purpose This investigation evaluated myocellular responses to an integrated resistance and aerobic training program (SPRINT) during 70 days of bed rest. Methods Training was six days per week on a small-footprint gravity-independent flywheel resistance and aerobic device (FLY); three days of maximal flywheel supine quadriceps and calf exercises with continuous rowing separated by 4-6 hours, and three days of interval rowing. Vastus lateralis (VL) and soleus (SOL) muscle biopsies were obtained from eight healthy males (age=28±4 y, BMI=25±3 kg•m−2, VO2max=42±6 ml•kg−1•min−1) before and after 6° head-intrdown tilt bed rest. VL and SOL myosin heavy chain (MHC) I and IIa single muscle fiber size and functional characteristics, as well as overall fiber type distribution, capillarization, and metabolic enzyme activities were evaluated. Results In the VL, MHC I size and power (absolute and normalized) were preserved. MHC IIa fibers hypertrophied (+6%, P

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Acute Effect of Noradrenergic Modulation on Motor Output Adjustment in Men

Purpose To determine the role of noradrenergic modulation in the control of motor output, we compared the acute effect of Reboxetine (REB), a noradrenaline reuptake inhibitor, to a placebo (PLA) on knee extensors motor performance and cortical and spinal excitability. Methods Eleven young males took part in two randomized experiments during which they received either 8 mg of REB or a PLA. The torque produced during a maximal voluntary contraction (MVC) and its variability (i.e. coefficient of variation) during submaximal contractions ranging from 5 to 50% MVC were measured. Paired electrical (PES) and transcranial magnetic stimulation (TMS) were used to assess changes in voluntary activation during MVC, and corticospinal (motor evoked potential - MEP) and spinal excitability (Hoffman (H) reflex) during contraction at 20% MVC. Results MVC torque and torque steadiness increased respectively by 9.5 and 24% on average in REB compared with PLA condition (P

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Comparison between Slow Components of HR and V[Combining Dot Above]O2 Kinetics: Functional Significance

PURPOSE Aerobic exercise prescription is often based on a linear relationship between pulmonary oxygen consumption (V[Combining Dot Above]O2) and heart rate (HR). The aim of the present study was to test the hypothesis that during constant work rate (CWR) exercises at different intensities the slow component of HR kinetics occurs at lower work rate and is more pronounced that the slow component of V[Combining Dot Above]O2 kinetics. METHODS Seventeen male (age, 27±4yr) subjects performed on a cycle ergometer an incremental exercise to voluntary exhaustion and several CWR exercises: 1) moderate CWR exercises (MODERATE), below gas exchange threshold (GET); 2) heavy CWR exercise (HEAVY), at 45% of the difference between GET and V[Combining Dot Above]O2 peak (□); 3) severe CWR exercise (SEVERE), at 95% of Δ; 4) "HRCLAMPED" exercise in which work rate was continuously adjusted to maintain a constant HR, slightly higher than that determined at GET. Breath-by-breath V[Combining Dot Above]O2, HR and other variables were determined. RESULTS In MODERATE, no slow component of V[Combining Dot Above]O2 kinetics was observed, whereas a slow component with a relative amplitude (with respect to the total response) of 24.8±11.0% was observed for HR kinetics. During HEAVY, the relative amplitude of the HR slow component was more pronounced than that for V[Combining Dot Above]O2 (31.6±11.2 and 23.3±9.0%, respectively). During HRCLAMPED the decrease in work rate (~14%) needed in order to maintain a constant HR was associated with a decreased V[Combining Dot Above]O2 (~10%). CONCLUSION The HR slow component occurred at a lower work rate and was more pronounced than the V[Combining Dot Above]O2 slow component. Exercise prescriptions at specific HR values, when carried out for periods longer than a few minutes, could lead to premature fatigue. CORRESPONDING AUTHOR: Simone Porcelli, Institute of Bioimaging and Molecular Physiology, National Research Council, Via Fratelli Cervi 93, Segrate (MI), 20090 Italy, Email: simone.porcelli@ibfm.cnr.it The research study was not funded by any additional resources, institution, or entity. The authors have no conflict of interest, and the results of the present study do not constitute endorsement by the American College of Sport Medicine. The results of this study are presented clearly, honestly, and without fabrication, or inappropriate data manipulation. Accepted for Publication: 12 March 2018 © 2018 American College of Sports Medicine

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Neuromuscular Adaptations to Work-matched Maximal Eccentric vs Concentric Training

It is unclear whether the superiority of eccentric over concentric training on neuromuscular improvements is due to higher torque (mechanical loading) achievable during eccentric contractions or due to resulting greater total work. Purpose To examine neuromuscular adaptations following maximal eccentric versus concentric training matched for total work. Methods Twelve males conducted single-joint isokinetic (180°/s) maximal eccentric contractions of the knee extensors in one leg (ECC-leg) and concentric in the other (CON-leg), 6 sets/session (3–5 sets in the initial 1–3 sessions), 2 sessions/week for 10 weeks. The preceding leg performed 10 repetitions/set. The following leg conducted the equivalent volume of work. In addition to peak torque during training, agonist EMG and MRI-based anatomical cross-sectional area (ACSA) and transverse relaxation time (T2) at mid-thigh as reflective of neural drive, hypertrophy, and edema, respectively, were assessed weekly throughout the training period and pre- and post-training. Whole muscle volume was also measured pre- and post-training. Results Torque and EMG (in trained contraction conditions) significantly increased in both legs after week (W)1 and W4, respectively, with a greater degree for ECC-leg (torque +76%, EMG +73%: post-training) than CON-leg (+28%, +20%). ACSA significantly increased after W4 in ECC-leg only (+4%: post-training), without T2 changes throughout. Muscle volume also increased in ECC-leg only (+4%). Multiple regression analysis revealed that changes (%Δ) in EMG solely explained 53–80% and 30–56% of the total variance in %Δtorque through training in ECC-leg and CON-leg, respectively, with small contributions (+13–18%) of %ΔACSA for both legs. Conclusion Eccentric training induces greater neuromuscular changes than concentric training even when matched for total work, while most of the strength gains during 10-week training is attributable to the increased neural drive. Address for Correspondence: Sumiaki Maeo, Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama 359-1192 Japan, E-mail: smaeo1985@gmail.com, Telephone: +81-429-476945, Fax: +81-429-476945 This work was supported by a Grant-in-Aid for Japan Society for the Promotion of Science Research Fellow (15J03228). The authors declare that there is no conflict of interest, that no companies or manufacturers will benefit from the results of the study, and that the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute endorsement by the American College of Sports Medicine. Accepted for Publication: 11 March 2018 © 2018 American College of Sports Medicine

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Hydroxyhydroquinone impairs fat utilization in mice by reducing nitric oxide availability

Abstract

Habitual consumption of chlorogenic acid compounds (CGAs) from coffee increases fat catabolism and reduces body fat; however, the contribution of roasted coffee remains unclear. Hydroxyhydroquinone (HHQ) impairs the vasodilatory and antihypertensive effects of CGAs by reducing nitric oxide (NO) bioavailability. Since HHQ also reduces fat catabolism, we hypothesized that HHQ does so by decreasing NO availability. Therefore, we investigated the effect of HHQ on energy metabolism in KKAy mice. In HHQ-treated mice, fat oxidation was significantly low and dose-dependent, serum and urinary hydrogen peroxide were high, and plasma NO metabolites and S-nitrosylated liver proteins were low. In HHQ-treated mouse hepatocytes, the palmitate-induced increase in cellular oxygen consumption was negatively affected, and HHQ or L-NAME reduced cellular fatty acid utilization. In conclusion, HHQ can impair fat utilization by reducing NO availability in mice. Protein S-nitrosylation reduction in liver cells after HHQ consumption may be associated with impaired fatty acid oxidation.



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Effect of experience, equipment and fire actions in psychophysiological response and memory of soldiers in actual underground operations

Publication date: Available online 22 March 2018
Source:International Journal of Psychophysiology
Author(s): José Francisco Tornero-Aguilera, Vicente Javier Clemente-Suárez
The present study aimed to analyze the effect of underground operations on the psychophysiological and memory response of soldiers taking into consideration experience, the use of nocturne vision systems and previous combat actions on the psychophysiological response. Seventy participants were recruited and divided in four groups, three experimental groups with different experimental conditions, SNFV (Soldiers No-Fire Night-Vision), SFV (Soldiers Fire Night-Vision), SNFNV (Soldiers No-Fire No Night-Vision), and one control group, CNFV (Control No-Fire Night-Vision). We analyzed modifications in psychophysiological and memory response pre and post an underground operation. The underground operation produced a significant increase (p < 0.05) in blood lactate, blood oxygen saturation, rated perceived exertion, heart rate, cognitive and somatic anxiety and sympathetic modulation in all groups. Groups with higher stress values scored higher incorrect items in the memory post mission questionnaire. The higher psychophysiological activation correlated positively with cognitive impairment and lower memory. We concluded that an underground operation produced an increase in psychophysiological activation and a negative effect on memory, being modulated by previous training and experience. The lack of special equipment as night vision systems in underground operations induced similar stress response than prior combat actions, decreasing conciseness of time.



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The evaluation of the effect of venous diameter measurement by ultrasonography on pain and withdrawal response

Abstract

Purpose

Rocuronium and propofol are used in the induction of anesthesia give discomfort to the patients. We aimed to investigate the relationship between venous diameter measured using ultrasonography, and pain and withdrawal movements after propofol and rocuronium applied with intravenous (IV).

Methods

This prospective-observational study was performed on 142 voluntary patients undergoing surgical operation under general anesthesia. An ultrasonography was used to measure the vein transverse diameter. Patients with a venous transverse diameter of ≤2 mm were classified as group 1 (n = 50), while patients with a diameter of > 2 mm were classified as group 2 (n = 92). The propofol pain was assessed according to the verbal rating scale (VRS). In addition, the withdrawal movements of the rocuronium injection were evaluated using the four-point scale.

Results

There was no difference between the two groups in terms of the demographic data. The patients have pain after propofol 38.2% and withdrawal movements after rocuronium 42.4% were detected. The maximum number of patients without pain after propofol injection (78.2%) and without withdrawal movements after rocuronium (76%) was found to be higher in group 2 (p = 0.001).

Conclusion

In this study, we found a reduction in the incidence and severity of pain and withdrawal movements in intravenous propofol and rocuronium administration through peripheral venous vessels of large diameter. We believe that the clinical drug injection through vessels with large venous diameter with the help of USG may be a non-invasive, simple, and reliable method to reduce pain and withdrawal movements in propofol and rocuronium injections.



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Using a Small Cash Incentive to Increase Survey Response

Abstract

Surveys tend to yield low response rates among human service professionals. This study examined whether a randomly-assigned prepaid $2 incentive increased response rates over time, and was cost-effective for increasing response count, among social workers and volunteer mediators. The incentive was enclosed with a mixed-mode survey of factors related to burnout and intention-to-remain. The incentive increased response rates over time. The effect of the incentive did not differ between mediators and social workers. The $2 incentive was not cost-effective for increasing response count. Implications are discussed for reducing nonresponse bias, decreasing time-to-response, and considering response rate versus response count.



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Endoscopic Management of Difficult Bile Duct Stones

Abstract

Purpose of Review

In 10–15% of the cases, conventional methods for removing bile duct stones by ERCP/balloon-basket extraction fail. The purpose of this review is to describe endoscopic techniques in managing these "difficult bile duct stones."

Recent Findings

Endoscopic papillary large balloon dilation with balloon extraction ± mechanical lithotripsy is the initial approach used to retrieve large bile duct stones. With advent of digital cholangioscopy, electrohydraulic and laser lithotripsy are gaining popularity. Enteroscopy-assisted or laparoscopic-assisted approaches can be used for those with gastric bypass anatomy.

Summary

Difficulties in removing bile duct stones can be related to stone-related factors such as the size and location of the stone or to altered anatomy such as stricture in the bile duct or Roux-en-Y anatomy. Several endoscopy approaches and techniques have described in the recent past that have greatly enhanced our ability to remove these "difficult" bile duct stones.



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Intraoperative blood pressure levels in young and anaesthetised children: are we getting any closer to the truth?

Purpose of review Blood pressure is a basic feature of monitoring during anaesthesia. However, it is very unclear what blood pressures are normal during anaesthesia in children. Furthermore, the clinical consequences of low blood pressure are also uncertain. Similarly, it is unclear when to initiate therapy for hypotension during anaesthesia. This review summarizes the most recent development on the interpretation of blood pressure measurements in children and the relation of low blood pressure to clinical outcome. Recent findings Recently published (multicentre) database studies show that alleged complications of intraoperative hypotension (brain ischaemia, kidney dysfunction, myocardial ischaemia and multiple organ dysfunction) are very rare in children after anaesthesia noncardiac procedures. Furthermore, other studies show that a considerable number of patients have blood pressure lower than a threshold according to the current standards treatment of Paediatric Life Support. Summary The recently published reference tables can guide anaesthesiologist in daily practice to define intraoperative hypotension. However, there are situations in which a higher blood pressure is recommendable and an individual approach is required. Correspondence to Dr Jurgen C. de Graaff, Department of Anaesthesiology, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, P.O. Box 2060, 3000CB Rotterdam, The Netherlands. Tel: +31 10 703 34 58; e-mail: j.degraaff@erasmusmc.nl Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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