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

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

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

No abstract available

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

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

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

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

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Incidence and Genetic Bases of Nitrofurantoin Resistance in Clinical Isolates of Two Successful Multidrug-Resistant Clones of Salmonella enterica Serovar Typhimurium: Pandemic “DT 104” and pUO-StVR2

Microbial Drug Resistance , Vol. 0, No. 0.


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Small world brain network characteristics during EEG Holter recording of a stroke event

Several studies revealed that cerebral ischemia provokes transient or permanent disruption of functional connections both locally and distantly from the lesion. Recently, brain connectivity has been described using graph theory, a mathematical approach which depicts the brain as a network in order to simplify its complex topology. The human brain consists of complex inhibitory and excitatory circuits located in specialized areas, which are engaged in sharing and integrating information with a time-varying interplay at resolution in the millisecond range.

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Rethinking blinking: No cognitive modulation of reflex eye protection in early onset blindness

The neurological consequences of blindness have been widely studied. One area that has escaped attention however, is the effect of blindness on defensive reflexes that subserve the protection of vision. The hand-blink reflex (HBR) provides an excellent method to address this topic because the modulation of its brainstem circuitry has been clearly characterised, and it can be easily interrogated with non-invasive methods. The HBR is elicited by electrical stimulation of the median nerve at the wrist, and consists in a rapid contraction of the orbicularis oculi muscles, with a clear defensive value for the eyes (Valls-Solé et al.

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