Effects of paternal high-fat diet and maternal rearing environment on the gut microbiota and behavior.

Exposing a male rat to an obesogenic high-fat diet (HFD) influences attractiveness to potential female mates, the subsequent interaction of female mates with infant offspring, and the development of stress-related behavioral and neural responses in offspring. To examine the stomach and fecal microbiome's potential roles, fecal samples from 44 offspring and stomach samples from offspring and their fathers were collected and bacterial community composition was studied by 16 small subunit ribosomal RNA (16S rRNA) gene sequencing. Paternal diet (control, high-fat), maternal housing conditions (standard or semi-naturalistic housing), and maternal care (quality of nursing and other maternal behaviors) affected the within-subjects alpha-diversity of the offspring stomach and fecal microbiomes. We provide evidence from beta-diversity analyses that paternal diet and maternal behavior induced community-wide shifts to the adult offspring gut microbiome. Additionally, we show that paternal HFD significantly altered the adult offspring Firmicutes to Bacteroidetes ratio, an indicator of obesogenic potential in the gut microbiome. Additional machine-learning analyses indicated that microbial species driving these differences converged on Bifidobacterium pseudolongum. These results suggest that differences in early-life care induced by paternal diet and maternal care significantly influence the microbiota composition of offspring through the microbiota-gut-brain axis, having implications for adult stress reactivity.

Effects of paternal high-fat diet and rearing environment on maternal investment and development of defensive responses in the offspring.

Paternal preconception risk factors (e.g. stress, diet, drug use) correlate with metabolic dysfunction in offspring, which is often comorbid with depressive and anxiety-like phenotypes. Detection of these risk factors or deleterious phenotypes informs a female about prevailing ecological demands, in addition to potential adverse environment-induced phenotypes that may be disseminated to her offspring. We examined whether a F0 male rat's prior exposure to an obesogenic high-fat diet (HFD) influences a female's attraction towards a male, subsequent mother-infant interactions and the development of defensive (emotional) responses in the F1 offspring. Females displayed less interest in the HFD exposed F0 males relative to control diet-exposed F0 males. Dams that reared F1 offspring in larger, semi-naturalistic housing provided more licking and grooming and active arched-back-nursing behavior. However, some of these effects interacted with paternal experience. F0 HFD and maternal rearing environment revealed sex-dependent, between group differences in F1 offspring wean weight, juvenile social interactions and anxiety-like behavior in adolescence. Our results show for the first time in mammals that male exposure to HFD may contribute to stable behavioral variation among females in courtship, maternal care, even when the females are not directly exposed to a HFD, and anxiety-like behavior in F1 offspring. Furthermore, when offspring were exposed to a predatory threat, hypothalamic Crf gene regulation was influenced by early housing. These results, together with our previous findings, suggest that paternal experience and maternal rearing conditions can influence maternal behavior and development of defensive responses of offspring.

Effects of Paternal Predation Risk and Rearing Environment on Maternal Investment and Development of Defensive Responses in the Offspring.

Detecting past experiences with predators of a potential mate informs a female about prevailing ecological threats, in addition to stress-induced phenotypes that may be disseminated to offspring. We examined whether prior exposure of a male rat to a predator (cat) odor influences the attraction of a female toward a male, subsequent mother-infant interactions and the development of defensive (emotional) responses in the offspring. Females displayed less interest in males that had experienced predator odor. Mothers that reared young in larger, seminaturalistic housing provided more licking and grooming and active arched back-nursing behavior toward their offspring compared with dams housed in standard housing, although some effects interacted with paternal experience. Paternal predation risk and maternal rearing environment revealed sex-dependent differences in offspring wean weight, juvenile social interactions, and anxiety-like behavior in adolescence. Additionally, paternal predator experience and maternal housing independently affected variations in crf gene promoter acetylation and crf gene expression in response to an acute stressor in offspring. Our results show for the first time in mammals that variation among males in their predator encounters may contribute to stable behavioral variation among females in preference for mates and maternal care, even when the females are not directly exposed to predator threat. Furthermore, when offspring were exposed to the same threat experienced by the father, hypothalamic crf gene regulation was influenced by paternal olfactory experience and early housing. These results, together with our previous findings, suggest that paternal stress exposure and maternal rearing conditions can influence maternal behavior and the development of defensive responses in offspring.

Carcinoid tumor of the cystic duct: case report, literature review and comparison of surgical approaches.

We present the case of a 48-year-old female with a cystic duct carcinoid that was found incidentally upon laparoscopic cholecystectomy. The patient subsequently underwent excision of the cystic duct remnant. This is the tenth reported case of a cystic duct carcinoid and the second reported laparoscopic excision.

Letting the sun set on small bowel obstruction: can a simple risk score tell us when nonoperative care is inappropriate?

Controversy remains as to which patients with small bowel obstruction (SBO) need immediate surgery and which may be managed conservatively. This study evaluated the ability of clinical risk factors to predict the failure of nonoperative management of SBO. The electronic medical record was used to identify all patients with SBO over one year. Clinical, laboratory, and imaging data were recorded. Univariate and multivariable analyses were performed to identify risk factors predicting need for surgery. Cox proportional hazards regression was used to identify risk factors that influence need and timing for surgery. Two hundred nineteen consecutive patients were included. Most patients did not have a prior history of SBO (75%), radiation therapy (92%), or cancer (70%). The majority had undergone previous abdominal or pelvic surgery (82%). Thirty-five per cent of patients ultimately underwent laparotomy. Univariate analysis showed that persistent abdominal pain, abdominal distention, nausea and vomiting, guarding, obstipation, elevated white blood cell count, fever present 48 hours after hospitalization, and high-grade obstruction on computed tomography (CT) scan were significant predictors of the need for surgery. Multivariable analysis revealed that persistent abdominal pain or distention (hazard ratio [HR], 3.04; P = 0.013), both persistent abdominal pain and distention (HR, 4.96; P < 0.001), fever at 48 hours (HR, 3.66; P = 0.038), and CT-determined high-grade obstruction (HR, 3.45; P = 0.017) independently predicted the need for surgery. Eighty-five per cent of patients with none of these four significant risk factors were successfully managed nonoperatively. Conversely, 92 per cent of patients with three or more risk factors required laparotomy. This analysis revealed four readily evaluable clinical parameters that may be used to predict the need for surgery in patients presenting with SBO: persistent abdominal pain, abdominal distention, fever at 48 hours, and CT findings of high-grade obstruction. These factors were combined into a predictive model that may of use in predicting failure of nonoperative SBO management. Early operation in these patients should decrease length of stay and diagnostic costs.

Femoral profunda artery aneurysm as an unusual first presentation of Behcet disease.

Behcet disease is a multisystem inflammatory disorder, rarely found in African Americans. Arterial involvement occurs in less than 8% of patients. Profunda femoral artery aneurysms (PFAAs) are extremely rare and often occur with synchronous aneurysms. We present a case of an African American man diagnosed with Behcet disease from his presentation with PFAA. He was also found to have a synchronous hypogastric artery aneurysm. The patient was immediately treated with corticosteroids and infliximab to control systemic and vascular inflammation, returning 1 month later for surgery. He had a repair of the left PFAA with a common femoral to profunda femoris artery bypass with reversed saphenous vein graft and aneurysmorrhaphy. When a patient presents with an aneurysm in an unusual location, it is important to evaluate for other aneurysms. A careful history and physical examination is also required to see if the aneurysm may be part of an underlying systemic syndrome.

A working model for the extraordinary review of clinical privileges for doctors and dentists in the Australian Capital Territory.

The extraordinary (unplanned) review of clinical privileges is the means by which an organisation can manage specific complaints about individual practitioners' clinical competence that require immediate investigation. To date, the extraordinary review of clinical privileges for doctors and dentists has not been the subject of much research and there is a pressing need for the evaluation and review of how different legislated and non-legislated administrative processes work and what they achieve. Although it seems a fair proposition that comprehensive processes for the evaluation of the clinical competence of doctors and dentists may improve the overall delivery of an organisation's clinical services, in fact, little is known about the relationship between the safety and quality of specific clinical services, procedures and interventions and the efficiency or effectiveness of established methodologies for the routine or the extraordinary review of clinical privileges. The authors present a model of a structured approach to the extraordinary review of clinical privileges within a clinical governance framework in the Australian Capital Territory. The assessment framework uses a primarily qualitative methodology, underpinned by a process of systematic review of clinical competence against the agreed standards of the CanMEDS Physician Competency Framework. The model is a practical, working framework that could be implemented on a hospital-, area health service- or state- and territory-wide basis in any other Australian jurisdiction.

Reproducibility and responsiveness of the Whiplash Disability Questionnaire.

This study continued the validation of a Whiplash Specific Disability Questionnaire (WDQ) that was developed from the Neck Disability Index (NDI) using self-reported disabilities in a group of participants experiencing whiplash-associated disorders [J Manipulative Physiol Ther 14 (1991) 409]. Previous research has established the content, construct and face validity and internal consistency of the WDQ. The aim of this study was to establish the short-term and medium-term test-retest reliability and responsiveness of the WDQ. Participants (n = 63) receiving physiotherapy treatment for WAD were recruited from 30 private physiotherapy practices in Melbourne, Australia. Each participant completed three WDQ questionnaires over a 1-month period, the first two separated by 24 h. The third questionnaire contained an additional item that asked respondents to rate their perceived change in condition over the month. Reproducibility was determined using an intra-class correlation co-efficient. Responsiveness was assessed via correlation with participant perceived change, the effect size, standardised response mean (SRM) and the responsiveness statistic. Results demonstrated excellent short-term test-retest reliability (ICC 0.96). Reproducibility over 1 month was excellent (ICC 0.93). Correlation between change in WDQ score over 1 month and participant perceived change was r(s) = 0.64, the effect size was 0.03, the SRM was 0.08 and the responsiveness statistics were 0.90 (participants who improved) and -1.60 (participants who deteriorated). The minimal detectable change of the WDQ was established at 15 points. These results demonstrate that the WDQ has excellent short- and medium-term reproducibility and responsiveness in a population seeking treatment for WAD.

Validity and internal consistency of a whiplash-specific disability measure.

STUDY DESIGN: Cross-sectional study of patients with whiplash-associated disorders investigating the internal consistency, factor structure, response rates, and presence of floor and ceiling effects of the Whiplash Disability Questionnaire (WDQ). OBJECTIVES: The aim of this study was to confirm the appropriateness of the proposed WDQ items. SUMMARY OF BACKGROUND DATA: Whiplash injuries are a common cause of pain and disability after motor vehicle accidents. Neck disability questionnaires are often used in whiplash studies to assess neck pain but lack content validity for patients with whiplash-associated disorders. The newly developed WDQ measures functional limitations associated with whiplash injury and was designed after interviews with 83 patients with whiplash in a previous study. METHODS: Researchers sought expert opinion on items of the WDQ, and items were then tested on a clinical whiplash population. Data were inspected to determine floor and ceiling effects, response rates, factor structure, and internal consistency. Packages of questionnaires were distributed to 55 clinicians, whose patients with whiplash completed and returned 101 questionnaires to researchers. RESULTS: No substantial floor or ceiling effects were identified on inspection of data. The overall floor effect was 12%, and the overall ceiling effect was 4%. Principal component analysis identified one broad factor that accounted for 65% of the variance in responses. Internal consistency was high; Cronbach's alpha = 0.96. CONCLUSIONS: Results of the study supported the retention of the 13 proposed items in a whiplash-specific disability questionnaire. Dependent on the results of further psychometric testing, the WDQ is likely to be an appropriate outcome measure for patients with whiplash.

Validity of the neck disability index, Northwick Park neck pain questionnaire, and problem elicitation technique for measuring disability associated with whiplash-associated disorders.

The Neck Disability Index (NDI) and Northwick Park Neck Pain Questionnaire (NPQ) were developed to measure self-perceived disability from neck pain, including that which may arise from whiplash injury. However, there is little data specifically concerning their validity for whiplash-associated disorders (WAD). The aim of this study was to assess the validity of the NDI and NPQ as measures of outcome in WAD by comparing them to a patient preference questionnaire, the problem elicitation technique (PET), which identifies problems that are of most importance to the individual patient. A cross-sectional study of 71 patients with varying severity and duration of WAD were recruited from a private physiotherapy practice. All patients completed a standardized self-administered questionnaire that included demographic and clinical details as well as self-perceived pain and severity of symptoms, NDI and NPQ. A trained interviewer administered the PET. Construct validity of the disability measures was examined by determining their correlation with each other and with pain and severity of symptoms by calculating Pearson's correlation coefficients. Content validity of the NDI and NPQ was assessed by comparing the items of both questionnaires to the problems identified by the PET. Participants' mean age was 40.1 years (SD=14.3) and 59 were women (83.1%). Most patients were in WAD category I (n=23, 32.1%), or II (n=42, 59.2%). Mean NDI, NPQ, and PET scores were 40.7 (SD=17.0), 38.7 (SD=15.8), and 160.2 (SD=92.0, range 6.0-509.5), respectively. Correlations between the NDI and PET, NPQ and PET, and NDI and NPQ were r=0.57, 0.56 and 0.88, respectively. The PET identified an average of 7.7 problems per patient (SD=4.2, range 1-17 problems). Problems most commonly identified were work for wages (52.1%), fatigued during the day (50.7%), participation in sports (47.9%), depression (43.7%), drive a car (43.7%), socialize with friends (33.8%), sleep through the night (31.0%), frustration (31.0%), and anger (28.2%). Only three of these problems are included in the NDI (work, driving, and sleeping) and only four are included in the NPQ (work, driving, sleeping, and social activities). While both the NDI and NPQ include some problems that are common in patients with WAD, frequently identified problems, such as emotional and social items are absent. In contrast to the PET, neither instrument captures the full spectrum of disabilities judged to be important by the patient.