Σάββατο, 23 Φεβρουαρίου 2019

Transjugular aspiration liver biopsy performed by hepatologists trained in HVPG measurements is safe and provides important diagnostic information

Transjugular liver biopsy (TJLB) represents an alternative to percutaneous liver biopsy especially in patients with impaired coagulation and ascites.

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Impact of Inflammatory Bowel Diseases on working life: a French nationwide survey

Inflammatory bowel diseases (IBD) affect working-age patients. Data was lacking concerning the impact on working life.

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Diagnosis of chronic anaemia in gastrointestinal disorders: A guideline by the italian association of hospital gastroenterologists and endoscopists (AIGO) and the italian society of paediatric gastroenterology hepatology and nutrition (SIGENP)

Anaemia is a common pathologic condition, present in almost 5% of the adult population. Iron deficiency is the most common cause; other mechanisms can be involved, making anaemia a multi-factorial disorder in most cases. Anaemia being a frequent manifestation in the diseases of the gastrointestinal tract, patients are often referred to gastroenterologists. Furthermore, upper and lower endoscopy and enteroscopy are pivotal to the diagnostic roadmap of anaemia. In spite of its relevance in the daily clinical practice, there is a limited number of gastroenterological guidelines dedicated to the diagnosis of anaemia.

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Resection rates and safety profile of cold vs. hot snare polypectomy in polyps sized 5–10 mm and 11–20 mm

Hot snare (HS) is widely used for the resection of adenomas >5 mm. The cold snare (CS) has a better safety profile and is more cost- effective. The aims of this study were to evaluate effectiveness and safety of CS polypectomy (CSP) compared to HS polypectomy (HSP) for adenomas sized 5–10 mm and 11–20 mm.

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Deep ulcerative esophagitis: A rare presentation of gastrointestinal actinomycosis



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ESOPHAGEAL DIVERTICULUM AFTER PERORAL ENDOSCOPIC MYOTOMY: THINK ABOUT IT IF THE SYMPTOMS CHANGE



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Endoscopy in acute variceal bleeding: Not always the sooner, the better?



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Lights and shadows in the assistance to digestive diseases: lessons learned finally?



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DAAs prevent HCC – the plot thicken...



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Incidence, Prevalence, and Causes of Death of Patients with Autoimmune Hepatitis: A Nationwide Register-Based Cohort Study in Finland

Epidemiological studies of autoimmune hepatitis are scarce and often based on single centre registries.

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FXR deficiency and alcoholic liver disease: Tissue is the issue



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The crucial need of internal control validation in the normalization of circulating microRNAs



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The utility of the pretracheal stethoscope in detecting ventilatory abnormalities during propofol sedation in children

Abstract

Background

Monitoring of ventilation with capnography or a stethoscope is recommended because the detection of ventilatory abnormalities can be significantly delayed by the use of pulse oximetry alone in patients receiving supplemental oxygen. The aim of this study was to evaluate the diagnostic performance of the pretracheal stethoscope with pulse oximetry and capnography in detecting adverse respiratory events during propofol sedation in non‐intubated children. We hypothesized that use of the pretracheal stethoscope would facilitate earlier detection of adverse respiratory events.

Methods

Prospective observational study of children undergoing procedural sedation at a pediatric sedation program. A pretracheal stethoscope, pulse oximetry and nasal capnography were attached at the discretion of the sedation nurse and provider to monitor ventilation.

Results

We enrolled 104 patient encounters (mean recorded time, SD 8.3 +/‐ 5.3 minutes) from February 2015 to March, 2017. The pretracheal stethoscope was the first monitor to detect adverse events in 64% (25/39) of patients compared to 18% (7/39) for capnography and 15% (6/39) for pulse oximetry. Auscultation performed best at detecting upper airway obstruction but capnography and pulse oximetry performed best at detecting hypoventilation.

The positive predictive value for detecting a true ventilation abnormality and 95% CI of the pretracheal stethoscope, pulse oximetry, and capnography was 100% (90% ‐ 100%), 18% (10% ‐ 31%), and 27% (18% ‐ 38%) respectively. The negative predictive value and 95% CI of the pretracheal stethoscope, pulse oximetry, and capnography was 88% (82%‐ 92%), 68% (59% ‐ 75%), and 70% (61% ‐ 78%) respectively.

Limitations are short observation time, non‐standardized application of respiratory monitors, and too much focus on auscultation.

Conclusion

A pretracheal stethoscope in conjunction with capnography and pulse oximetry detects most sedation related adverse events first. Auscultation performed best at detecting upper airway obstruction but capnography and pulse oximetry performed best at detecting hypoventilation.

This article is protected by copyright. All rights reserved.



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Association between perioperative surgical home implementation and transfusion patterns in adolescents with idiopathic scoliosis undergoing spinal fusion

Abstract

Background

Blood transfusions in patients with adolescent idiopathic scoliosis after fusion have been associated with increased morbidity, mortality, and cost.

Objective

The aim of this study was to evaluate the association between implementation of blood‐conservation strategies within the perioperative surgical home on transfusion rates for patients with adolescent idiopathic scoliosis undergoing spinal fusion.

Methods

213 patients (44 pre‐perioperative surgical home, 169 post‐perioperative surgical home) who underwent posterior spine fusion for adolescent idiopathic scoliosis between June 23, 2014, and July 30, 2017, were enrolled in this case control study. The perioperative surgical home implemented in March 2015 involved evidence‐based perioperative interventions to create a standardized clinical pathway including judicious use of crystalloid management, restrictive transfusion strategy, routine use of cell saver, and standardized administration of anti‐fibrinolytics. The primary outcome was odds of perioperative transfusion. Secondary outcomes included volumes of crystalloid, albumin, cell saver, packed red blood cells as well as calculated blood loss. Other variables that were documented included antibrinolytic total dose, mean arterial pressure, temperature, laboratory values, intrathecal morphine dosing, and surgical time. Statistical methods include t test and logistic regression.

Results

For the post‐perioperative surgical home, the odds of perioperative transfusion were 0.30 (95% CI 0.13–0.70), as compared to pre‐perioperative surgical home. In terms of secondary outcomes, calculated blood loss was significantly lower in the post‐perioperative surgical home patients (27.0 ml/kgmL pre‐perioperative surgical home vs. 22.8mL/kg post‐perioperative surgical home; mean difference = ‐0.24 (‐0.44, ‐0.04)). Although no difference was noted in amount of intraoperative cell saver or albumin administered, a reduction was noted in mean intraoperative crystalloid given post‐perioperative surgical home (41.4 mL/kg ± 20.4 mL/kg pre‐perioperative surgical home vs. 28.0mL/kg ± 13.7 mL/kg post‐perioperative surgical home; log mean difference = 0.37 (95%CI 0.21 – 0.53), P <0.001). Post‐perioperative surgical home patients also had a significantly higher temperature nadir (mean difference=‐0.47 (95%CI ‐0.70 – ‐0.23); P <0.001), received a significantly higher total antifibrinolytic dose (mean difference=‐3939 (95%CI ‐5364 ‐ ‐2495); P <0.001), and were exposed to shorter surgical times (mean difference=0.72 (95%CI 0.36 – 1.09); P <0.001).

Conclusions

Implementation of blood‐conservation strategies as part of a perioperative surgical home for patients with adolescent idiopathic scoliosis undergoing posterior spine fusion resulted in significant decrease in perioperative blood transfusions.

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Evening high‐intensity interval exercise does not disrupt sleep or alter energy intake despite changes in acylated ghrelin in middle‐aged men

New Findings

What is the central question of this study?

High‐intensity interval exercise (HIIE) is recommended to be avoided within 4 h of bedtime due to potential sleep disruptions which may affect appetite‐related hormone interactions and subsequent energy intake. Yet, the interactions between sleep and appetite following early evening HIIE has not been previously explored.

What is the main finding and its importance?

We show that HIIE can be performed in the early evening without subsequent sleep disruptions and may favourably alter appetite‐related hormone concentrations. Nonetheless, perceived appetite and energy intake do not change with acute HIIE regardless of time‐of‐day.

Abstract

Many adults remain inactive, despite exercise benefits for sleep and appetite, due to increased time‐restraints. Methods to improve exercise compliance include preferential time‐of‐day or engaging in short‐duration, high‐intensity interval exercise (HIIE). Hence, this study aimed to compare effects of HIIE time‐of‐day on sleep and appetite. Eleven inactive men undertook sleep monitoring to determine baseline (BASE) sleep stages and exclude sleep disorders. On separate days, participants completed 30 min HIIE (60 s work at 100% V̇O2peak: 240 s rest at 50% V̇O2peak) in the 1) morning (MORN; 0600–0700 h), 2) afternoon (AFT; 1400–1600 h) and 3) early evening (EVEN: 1900–2000 h). Measures included appetite‐related hormones (acylated ghrelin, leptin, peptide tyrosine tyrosine), and glucose pre‐exercise, 30 min post‐exercise, and next morning; overnight polysomnography (PSG; sleep stages); and actigraphy, self‐reported sleep and food diaries for 48 h post‐exercise. There were no between‐trial differences for total sleep time (p = 0.46). Greater stage N3 sleep was recorded for MORN (23 ± 7%) compared to BASE (18 ± 7%; p = 0.02); however, no between‐trial differences existed (p > 0.05). Rapid eye movement (REM) sleep was lower and non‐REM sleep was higher for EVEN compared to BASE (p ≤ 0.05). At 30 min post‐exercise, ghrelin was higher for AFT compared to MORN and EVEN (p = 0.01); while glucose was higher for MORN compared to AFT and EVEN (p ≤ 0.02). No between‐trial differences were found for perceived appetite (p ≥ 0.21) or energy intake (p = 0.57). Early evening HIIE can be performed without subsequent sleep disruptions and reduces acylated ghrelin. However, perceived appetite and energy intake appear to be unaffected by HIIE time‐of‐day.

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Nox5: Molecular biology and pathophysiology

Abstract

Nicotinamide adenine dinucleotide phosphate (NADPH) oxidases (Nox), comprise 7 family members (Nox1‐5, duox1/2) and are major producers of reactive oxygen species (ROS) in mammalian cells. ROS are critically involved in cell signalling and function. While all Noxs share structural homology comprising six transmembrane domains with two heme‐binding regions and a NADPH‐binding region on the intracellular C‐terminus, their regulatory systems, mechanisms of activation and tissue distribution differ. This explains the diverse function of Noxs. Of the Noxs, Nox5 is unique in that rodents lack the gene, it is regulated by Ca2+, it does not require NADPH oxidase subunits for its activation and it is not glycosylated. Nox5 localises in the perinuclear and ER regions of cells and traffics to the cell membrane upon activation. It is tightly regulated through numerous post‐translational modifications and is activated by vasoactive agents, growth factors and pro‐inflammatory cytokines. The exact pathophysiological significance of Nox5 remains unclear but it seems to be important in the physiological regulation of sperm motility, vascular contraction and lymphocyte differentiation and Nox5 hyperactivation has been implicated in cardiovascular disease, kidney injury and cancer. The field of Nox5 biology is still in its infancy, but with new insights into its biochemistry and cellular regulation, discovery of the Nox5 crystal structure and GWAS studies implicating Nox5 in disease, the time is now ripe to advance Nox5 research. This review provides a comprehensive overview of our current understanding of Nox5, from basic biology to human disease, and highlights the unique characteristics of this enigmatic Nox isoform.

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Factors Impacting Adherence to Diabetes Medication Among Urban, Low Income Mexican-Americans with Diabetes

Abstract

Mexican-Americans carry a high burden of type 2 diabetes and are disproportionately affected by diabetes related mortality and morbidity. Poor adherence to medication is an important barrier to achieving metabolic control and contributes to adverse health outcomes and health disparities. Little is known about barriers and facilitators to medication adherence among Mexican-Americans with diabetes. This is a qualitative study of semi-structured interviews with a sample of 27 adults (25 Mexican-Americans and 2 Latinos of other origin) with self-reported type 2 diabetes who were recruited as part of a church-based, randomized controlled trial for diabetes self-management education in a low-income, immigrant neighborhood of Chicago. Face-to-face, in-depth interviews were conducted (one in English and 26 in Spanish), audio-recorded, transcribed verbatim, and professionally translated. Systematic qualitative methods were used to analyze interviews. All 27 participants were Latino, and 25 were of Mexican descent. Participants' mean age was 57 years, 81% were female, 69% had an annual income less than $20,000 and 48% had no health insurance. Mean A1C level was 8.6% and mean systolic blood pressure was 125 mmHg. The majority of participants (85%) reported using oral diabetes medication and 35% reported taking insulin. 76% reported being affiliated with one of the two partnering catholic churches based in the South Lawndale neighborhood of Chicago, also known as Little Village. Concerns regarding effectiveness and negative impact of diabetes medication were prevalent and expressed by 13 (48%) of 27 participants. Dissatisfaction with ineffective provider communication and not being able to pay for medication were other important barriers to adherence and were expressed by 7% and 11% of participants, respectively. Family support, for example, family members assisting in organizing medications in boxes and reminding participants to take them, was reported by 15% of participants and emerged as an important facilitator to medication adherence. There is a gap in research on factors influencing adherence to diabetes medication among Mexican-Americans. Our study suggests that concerns regarding negative impact of diabetes medication and concerns regarding effectiveness are prevalent barriers to adherence. These barriers can be addressed through educational efforts targeting patients and clinicians by specifically including content on beliefs that lead to poor adherence in diabetes self-management interventions for patients and continuing medical education for providers and by developing interventions that engage family members as a support system for medication adherence.



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Actigraph assessment for measuring upper limb activity in unilateral cerebral palsy

Detecting differences in upper limb use in children with unilateral cerebral palsy (UCP) is challenging and highly dependent on examiner experience. The recent introduction of technologies in the clinical envi...

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Enhanced radiocesium uptake by rice with fermented bark and ammonium salt amendments

Publication date: June 2019

Source: Journal of Environmental Radioactivity, Volume 202

Author(s): Xiaotong Sun, Shizusa Kobayashi, Ai Tokue, Hideyuki Itabashi, Masanobu Mori

Abstract

There are ongoing problems with radioactive cesium (Cs) contaminated agricultural soil after the Fukushima Daiichi Nuclear Power Plant accident. In this study, the behavior of Cs uptake by rice plants grown in soil sprayed with fermented bark amendment (FBA) was investigated. In rice cultivation by pot, the application of FBA resulted in the acceleration of Cs uptake by rice plants. This might be related to the reduction of oxidation reduction potential in the soil caused by spraying FBA. Also, when 0.1 wt% ammonium sulfate was used as a fertilizer in Cs-contaminated soil, the bioconcentration factor (BCF) of Cs taken up into rice straw was 1.4-times higher than that in soil sprayed with FBA. The Cs uptake effect was further enhanced by the combination of 1 wt% FBA with 0.1 wt% ammonium sulfate to soil where the BCF was enhanced to 1.8-times higher than that in soil sprayed with FBA alone. The enhanced uptake into rice was likely because of accelerated uptake of leachable forms of Cs based on the cation-exchange to NH4+ in soil; this was confirmed by the Cs fractionation by sequential extraction procedures. The phytoremediation capability of rice is considered to be lower than that of commonly used phytoremediation plants, but supplementation with FBA and ammonium salt could enhance Cs accumulation even for low-efficiency phytoremediation plants.



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Reply to Carson and Collins: Comment on: “Challenging Conventional Paradigms in Applied Sports Biomechanics Research”



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The Society for Craniofacial Genetics and Developmental Biology 41st Annual Meeting

The mission of the Society for Craniofacial Genetics and Developmental Biology (SCGDB) is to promote education, research, and communication about normal and abnormal development of the tissues and organs of the head. The SCGDB welcomes as members undergraduate students, graduate students, postdoctoral researchers, medical and dental practitioners, scientists, and academicians who possess an interest in craniofacial biology. Each year our members come together to share their novel findings, build upon, and challenge current knowledge of craniofacial biology.



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