Clinical utility of cricopharyngeal distensibility measurements during endoscopic myotomy for Zenker's diverticulum.

BACKGROUND AND AIMS: Flexible endoscopic cricopharyngeal myotomy (FECM) allows minimally invasive treatment of patients with Zenker's diverticulum (ZD); however, retreatment rates are substantial. We hypothesized that the functional lumen imaging probe (FLIP) may provide insight into ZD pathophysiology and serve as an intraprocedural guide to adequacy of myotomy. METHODS: We prospectively evaluated 11 ZD patients undergoing FECM and compared the baseline cricopharyngeal (CP) distensibility with 16 control subjects. Intraprocedural CP distensibility was measured immediately pre- and postmyotomy. The CP distensibility index (CP-DI) was defined as a ratio of the narrowest cross-sectional area (nCSA) and the corresponding intrabag pressure at 40 mL distension. Same-procedure myotomy extension was undertaken in a subgroup if threshold distensibility changes were not met. RESULTS: ZD patients had reduced baseline nCSA and CP-DI compared with control subjects, (169.6 vs 227.5 mm2 [P < .001] and 3.8 vs 7.6 mm2/mm Hg [P < .001], respectively). After CP myotomy, both nCSA and CP-DI increased significantly by an average of 74.2 mm2 (95% confidence interval [CI], 35.1-113.3; P = .002) and 2.2 mm2/mm Hg (95% CI, .6-3.8; P = .01), respectively. In the subgroup with no significant change in CP distensibility after initial myotomy (n = 6), myotomy extension resulted in significant increases in both mean nCSA and CP-DI of 66.6 mm2 (95% CI, 16.4-116.8; P = .03) and 1.9 mm2/mm Hg (95% CI, .4-3.3; P = .015), respectively. There were no adverse events. CONCLUSIONS: CP distensibility is reduced in ZD patients and is partially reversible by FECM. An intraprocedural FLIP CP distensibility measurement is safe and sensitive in detecting myotomy-induced changes. These findings support using FLIP to optimize FECM outcome. Further studies are required to derive precise metrics predictive of clinical response.

Effect of time to primary repair on final visual outcome after open globe injury.

BACKGROUND/AIM: Historic data suggest that open globe injuries should be repaired within 12-24 hours to reduce the risk of endophthalmitis. However, endophthalmitis is uncommon when systemic antibiotic prophylaxis is given. It is not clear whether delayed primary repair impacts visual outcomes in other ways or what is the optimum time to repair. We aimed to examine the effect of time to primary repair on visual outcomes. METHODS: This is a retrospective comparative case series including all open globe injuries presenting to the Birmingham Midland Eye Centre between 1 January 2014 and 15 March 2016. Presenting features, mechanism of injury, visual acuity at 6-12 months and demographic data were examined. RESULTS: 56 open globe injuries were repaired, of which sufficient data for analysis were available on 52 cases. The mean time to primary repair was 1 day after injury (range 5 hours to 7 days). Final visual acuity at 6-12 months was related to the presenting visual acuity and the Ocular Trauma Score and to the time between injury and primary repair, with a reduction in predicted visual acuity of logarithm of the minimum angle of resolution of 0.37 for every 24 hours of delay (95% CI 0.14 to 0.6). DISCUSSION: Open globe injuries should be repaired promptly. Presenting visual acuity remains the strongest predictor of outcome; however, delay to primary repair also reduced final visual acuity, and any significant delay from injury to repair is likely to negatively impact final visual outcome.

Health-related quality of life in patients with uveitis.

BACKGROUND/AIMS: To measure health-related quality of life (HRQOL) in patients with uveitis using time trade-off (TTO) and standard gamble (SG) methods of direct utility analysis. METHODS: Consecutive patients attending a tertiary referral uveitis clinic were administered standardised, interview-delivered TTO and SG questionnaires and completed the European Quality of Life Five Dimensions Five Level (EQ5D-5L) questionnaire. Clinical data recorded included best-corrected visual acuity, uveitis anatomical and clinical classifications, duration since diagnosis, disease activity, current medication and any ocular or systemic comorbidities. RESULTS: Two hundred patients with uveitis (124 female, 76 male, median age 54 years) were included. Overall mean TTO utility was 0.831 (95% CI 0.802 to 0.860); mean SG utility was 0.868 (95% CI 0.840 to 0.896) and mean EQ5D-5L utility was 0.742 (95% CI 0.702 to 0.782). There was a negative correlation between visual acuity and mean HRQOL (6/12 or better: TTO 0.86, SG 0.893; 6/15-6/60: TTO 0.662, SG 0.742; worse than 6/60: TTO 0.608, SG 0.712). Poor vision in the better- seeing eye (p=0.004), bilateral disease (p=0.047) and concurrent glaucomatous optic neuropathy (p=0.005) were predictors of poor TTO HRQOL. No correlation was found between HRQOL and duration of diagnosis, a flare of uveitis or being on systemic therapy. Patients with uveitis with poor vision have a TTO value worse than patients with end-stage renal failure on haemodialysis or those with AIDS. CONCLUSION: Loss of vision resulting from uveitis is associated with reduced HRQOL. The TTO and SG utility values appear directly dependent on the degree of vision loss and not on the duration of disease or systemic medications.

Effect of restricted feed intake in broiler breeder hens on their stress levels and the growth and immunology of their offspring.

The prenatal environment has been shown to have significant effects on the lifelong health of offspring in humans and other species. Such effects have not been studied extensively in avian species but could prove important, especially in the case of severe feed restriction imposed on broiler breeder hens to prevent obesity and reduce rate of lay. Feed restriction can potentially affect not only nutrient supply to the embryo but stress hormone levels within the hen. This study investigated the impact of nutrient restriction of the breeder hen on growth rate and immune responses in the progeny with the objective to measure the impact of feed restriction of broiler breeder hens on growth and immune response of the progeny. Broiler breeder hens were feed restricted from 24 wk of age and maintained at three bodyweights; 3.4, 3.6, and 4.0 kg until 43 wk of age and behavioral and physiological measures of stress recorded. Chicks were hatched from each hen treatment and at day 7 vaccinated for infectious bronchitis virus (IBV) and at 16, 18, and 20 d old given an immune challenge of lipopolysaccharide. Growth and immune responses of these birds were then recorded. Sex ratio was affected by hen bodyweight, with a significantly increased proportion of males hatched from heavy hens. Growth rate from 35 to 42 d of age was reduced in male progeny from low bodyweight hens. Female progeny from heavy hens responded to an immune challenge by reduced live weight and increased heterophil: lymphocyte ratio, suggesting a more robust immune response in these birds than in the progeny from lower bodyweight hens. Overall, progeny from heavy hens had increased antibodies at day 35 to the vaccination of IBV compared with progeny of low bodyweight hens, also suggesting an improved immune response in these birds. Breeder hens restricted to the lowest feed level showed behaviors indicative of increased stress (object pecking) and an increased heterophil: lymphocyte ratio. Feed restriction of broiler breeder hens increased indices of stress in hens and resulted in offspring that have reduced growth rate and immune response in a sex-dependent way.

Association of topography with demographic and socioeconomic factors to the compliance and non-compliance of mothers to reproductive health services

@#<p style="text-align: justify;"><strong>BACKGROUND AND OBJECTIVE:</strong> In order to alleviate the reproductive health status of mothers in the Philippines, there should be a better understanding of the factors influencing their compliance to reproductive health services. The study examined the association of topography with demographic and socioeconomic characteristics on the compliance of reproductive health services.</p><p style="text-align: justify;"><strong>METHODOLOGY: </strong>This study analyzed survey data collected in 2017 among mothers in the rural community of Maasin, Iloilo, Philippines. The statistical tools Chi-square, T-test and logistic regression were used to determine the factors associated with the likelihood of mothers to comply with prenatal care, family planning and delivery care services.</p><p style="text-align: justify;"><strong>RESULTS:</strong> There is no significant difference in the number of mothers who comply with prenatal care services and family planning services between lowland and highland barangays. However, mothers from the highland barangays are more likely to have non facility-based delivery (NFBD). Only educational attainment was found to be significantly associated for prenatal services. Only parity was significantly associated with compliance to family planning services. Age, parity, educational attainment and occupation were significantly associated with compliance to delivery care service. The odds of NFBD in the highland area is 2.44 (95% CI: 1.40 to 4.23) times higher as compared to the mothers residing in the lowland area. The odds of NFBD also increases by 7% (95% CI: 3% to 11%) per year increase in age.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> There is a great need to restructure the delivery of reproductive health services to accommodate mothers from highland barangays who still opt for NFBD. Topography, demographic and socioeconomic factors should be considered in developing strategies and implementation of reproductive health care services in the Philippines. Furthermore, the researchers recommend to include in future studies other reproductive health services such as postnatal care in order to fully grasp the reproductive health in the country. </p>

A retrospective cohort study of patients treated with anti-tuberculous therapy for presumed ocular tuberculosis.

BACKGROUND: Uveitis involving the posterior segment is a significant and potentially blinding condition. The diagnosis and treatment of patients with uveitis associated with tuberculosis remains controversial, and commonly, patients are systemically well. Use of the interferon-gamma release assays has added to the controversy, as the significance of a positive test may be uncertain. We aim to report the outcomes of anti-tuberculous treatment in a cohort of patients treated in Birmingham, for presumed "ocular tuberculosis", based on clinical findings, systemic assessment and specific testing for tuberculosis. RESULTS: We found that in our cohort of 41 patients treated between 2010 and 2014, the majority achieved disease-free remission, even in cases where anti-tuberculous treatment was delayed. CONCLUSIONS: Despite controversy, this study strongly supports the use of anti-tuberculous therapy in such patients and highlights the need for formal prospective trials and treatment protocols.

The eye and inflammatory rheumatic diseases: The eye and rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis.

Rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis are associated with potentially sight-threatening inflammatory eye disease. Although the ocular manifestations associated with ankylosing spondylitis and psoriatic arthritis are similar, such as anterior uveitis, this differs from rheumatoid arthritis where dry eye, peripheral ulcerative keratitis and scleritis are the major ocular complications. Apart from causing sight loss, these conditions are painful, debilitating, often recurrent or chronic and may require long-term therapy. Treatments such as ocular lubricant, topical corticosteroid, systemic corticosteroid and systemic immunosuppression are often similar for the underlying systemic disease. Yet for the treatment of the ocular complications, the evidence base is weak. Close collaboration with a rheumatologist is often essential, particularly in the management of these patients.

Isolation and characterization of agar-digesting Vibrio species from the rotten thallus of Gracilariopsis heteroclada Zhang et Xia.

Gracilariopsis heteroclada Zhang et Xia (Gracilariaceae, Rhodophyta) is one of the most studied marine seaweeds due to its economic importance. This has been cultivated extensively on commercial scale in the Philippines and other Asian countries. However, sustainable production of G. heteroclada in the Philippines could not be maximized due to the occurrence of rotten thallus disease. Thus, isolation and characterization of agar-digesting bacteria from the rotten thalli of G. heteroclada was conducted. A total of seven representative bacterial isolates were randomly selected based on their ability to digest agar as evidenced by the formation of depressions around the bacterial colonies on nutrient agar plates supplemented with 1.5% NaCl and liquefaction of agar. Gram-staining and biochemical characterization revealed that isolates tested were gram-negative rods and taxonomically identified as Vibrio parahaemolyticus (86-99.5%) and Vibrio alginolyticus (94.2-97.7%), respectively. It is yet to be confirmed whether these agar-digesting vibrios are involved in the induction and development of rotten thallus disease in G. heteroclada in concomitance with other opportunistic bacterial pathogens coupled with adverse environmental conditions.

Nocturnal oxygen saturation profiles of healthy term infants.

OBJECTIVE: Pulse oximetry is used extensively in hospital and home settings to measure arterial oxygen saturation (SpO2). Interpretation of the trend and range of SpO2 values observed in infants is currently limited by a lack of reference ranges using current devices, and may be augmented by development of cumulative frequency (CF) reference-curves. This study aims to provide reference oxygen saturation values from a prospective longitudinal cohort of healthy infants. DESIGN: Prospective longitudinal cohort study. SETTING: Sleep-laboratory. PATIENTS: 34 healthy term infants were enrolled, and studied at 2 weeks, 3, 6, 12 and 24 months of age (N=30, 25, 27, 26, 20, respectively). INTERVENTIONS: Full overnight polysomnography, including 2 s averaging pulse oximetry (Masimo Radical). MAIN OUTCOME MEASUREMENTS: Summary SpO2 statistics (mean, median, 5th and 10th percentiles) and SpO2 CF plots were calculated for each recording. CF reference-curves were then generated for each study age. Analyses were repeated with sleep-state stratifications and inclusion of manual artefact removal. RESULTS: Median nocturnal SpO2 values ranged between 98% and 99% over the first 2 years of life and the CF reference-curves shift right by 1% between 2 weeks and 3 months. CF reference-curves did not change with manual artefact removal during sleep and did not vary between rapid eye movement (REM) and non-REM sleep. Manual artefact removal did significantly change summary statistics and CF reference-curves during wake. CONCLUSIONS: SpO2 CF curves provide an intuitive visual tool for evaluating whether an individual's nocturnal SpO2 distribution falls within the range of healthy age-matched infants, thereby complementing summary statistics in the interpretation of extended oximetry recordings in infants.

Bioconjugated nanomaterials on devices for infectious disease diagnostics.

The successful use of the nanoscale-dependent properties of nanomaterials on infectious diseases diagnostics devices lies on a well-engineered surface of both the probes and the transducer. Engineering probe and transducer surfaces involve functionalization of nanomaterials, conjugation to biorecognition elements and nanopatterning. This review presents the most common and most promising functional groups, bioconjugation schemes and patterning strategies of nanomaterials on sensing devices and their specific application to infectious pathogen detection.

Hand infection in diabetic patients.

The diabetic hand infection is less reported in the literature. Therefore, it is easily ignored and underestimated resulting in increased morbidity among the diabetic population. Diabetic hand is a rapid in progression, extensive and severe tissue destruction. We analyze the clinical course and outcome of hand infection in diabetic patients. We reviewed all the admissions with hand infection from January 2006-April 2010. Thirty-seven patients were found with associated diabetes mellitus. The demographic data, culture report, number of operations and management, hospital stay and outcome-like amputation were recorded. The average age was 62 years. Pain and swelling were the chief complaints. The cause of infection was varied. The infection was superficial in 13 and deep in 24 patients. Forty-one percent of culture report revealed polymicrobial organism. The increased length of hospital stay, reoperations and amputation were associated with deep infection and polymicrobial organism. Prompt medical and surgical attentions are the most important factors. A proper glycemic control, elevation of the affected extremity, thorough and adequate surgical debridement and appropriate antibiotics are the important considerations when dealing with diabetic hand infection.

Our early experience in surgical and clinical outcome on endoscopic cubital tunnel release: a preliminary result.

Cubital tunnel syndrome is one of the common upper extremity problem encountered. A mild syndrome can be often treated without surgery, but a failure of conservative treatment with constant symptoms or muscle atrophy and weakness requires surgical intervention. Despite the fact that is the second most common nerve entrapment in the upper limb, there is no accepted gold standard in the surgical management. But with the new technique in minimally invasive surgery and available endoscope, it addresses all potential compression sites with good visualisation but with small surgical exposure. The procedure is safe and reliable way to address this problem.

Heterotopic ossification in the middle finger: a case report.

A case of heterotopic ossification developed after traumatic laceration of the middle finger. It is extremely rare for heterotopic ossification to locate in the finger. The diagnosis was accomplished with plain radiographs as well as with MRI and confirmatory study with histopathological microscopic examination which demonstrated nubbin of bone surrounded by fibrovascular connective tissue, and the marrow was predominantly fatty with prominent ectatic vessels and patchy mild lymphocytic infiltrate and gross appearance of partly calcified bony tissue.

Attractor structure discriminates sleep states: recurrence plot analysis applied to infant breathing patterns.

Breathing patterns are characteristically different between infant active sleep (AS) and quiet sleep (QS), and statistical quantifications of interbreath interval (IBI) data have previously been used to discriminate between infant sleep states. It has also been identified that breathing patterns are governed by a nonlinear controller. This study aims to investigate whether nonlinear quantifications of infant IBI data are characteristically different between AS and QS, and whether they may be used to discriminate between these infant sleep states. Polysomnograms were obtained from 24 healthy infants at six months of age. Periods of AS and QS were identified, and IBI data extracted. Recurrence quantification analysis (RQA) was applied to each period, and recurrence calculated for a fixed radius in the range of 0-8 in steps of 0.02, and embedding dimensions of 4, 6, 8, and 16. When a threshold classifier was trained, the RQA variable recurrence was able to correctly classify 94.3% of periods in a test dataset. It was concluded that RQA of IBI data is able to accurately discriminate between infant sleep states. This is a promising step toward development of a minimal-channel automatic sleep state classification system.

Selenium and stereotypies in a mental health setting.

A 24-year-old man was referred with involuntary stereotypies of movement and thinking, of which he seemed unaware. On admission, comprehensive physical screening proved negative except for lowered selenium concentrations. Neuropsychological assessment revealed changes in performance on tests of attention, non-verbal reasoning and executive function consistent with his stereotypies. A review of his movements characterised them as possibly being consistent with non-paroxysmal kinesigenic dyskinesia. A low dose of sulpiride led to improvements in engagement and insight accompanied by modest reductions in movements.

Association of guanine nucleotide-exchange protein BIG1 in HepG2 cell nuclei with nucleolin, U3 snoRNA, and fibrillarin.

BIG1, a brefeldin A-inhibited guanine nucleotide-exchange protein, activates class I ADP-ribosylation factors (ARF1-3) by catalyzing the replacement of bound GDP by GTP, an action critical for the regulation of protein transport in eukaryotic cells. Our earlier report [Padilla PI, Pancheco-Rodriguez G, Moss J, Vaughan M (2004) Proc Natl Acad Sci USA 101:2752-2757] that BIG1 concentrated in nucleoli of serum-starved HepG2 cells prompted us to identify molecules associated with BIG1 in dynamic nucleolar structures. Antibodies against BIG1 or nucleolin coprecipitated both proteins from nuclei, which was abolished by the incubation of nuclei with RNase A or DNase, indicating that the interaction depended on nucleic acids. (32)P labeling of RNAs immunoprecipitated with BIG1 or nucleolin from nuclei revealed bands of approximately 210 bases that also hybridized with U3 small nucleolar (sno)RNA-specific oligonucleotides. Clones of U3 snoRNA cDNAs from the material precipitated by antibodies against BIG1 or nucleolin yielded identical nucleotide sequences that also were found in genomic DNA. Later analyses revealed the presence of fibrillarin, nucleoporin p62, and La in BIG1 and nucleolin immunoprecipitates. Our data demonstrate that BIG1, nucleolin, U3, the U3-binding protein fibrillarin, and the RNA-binding protein La may exist together in nuclear complexes, consistent with a potential role for BIG1 in nucleolar processes. Evidence that BIG1 and nucleolin, but not fibrillarin, can be present with p62 at the nuclear envelope confirms the presence of BIG1 and nucleolin in dynamic molecular complexes that change in composition while moving through nuclei. Nuclear functions of BIG1 remain to be determined.

Intermittent dysphagia for solids associated with a multiringed esophagus: clinical features and response to dilatation.

The entity of the multiringed esophagus, generally presenting in adults as intermittent dysphagia for solids, is relatively uncommon and its pathogenesis is unknown. The goal of this study was to describe the demographic, clinical, and endoscopic features of patients presenting with this condition, their response to esophageal dilatation, and the relationship of multiple esophageal rings to eosinophilic esophagitis. Between 1989 and June 2004, 32 patients at this adult hospital fulfilled the following inclusion criteria: (1) intermittent dysphagia for solids, (2) multiple esophageal rings at endoscopy, and (3) esophageal dilatation(s) performed. Response to esophageal dilatation was measured by need for subsequent dilatations. Seventy-five percent of the patients were male. Median age at onset of dysphagia was 21 years and at presentation 36.5 years. All had multiple rings in the proximal or midesophagus on endoscopy and had undergone a total of 73 esophageal dilatations with no esophageal perforations. Median maximal dilator size was 15 mm; however, 16% developed significant esophageal mucosal tears even with 11-mm dilators. Sixty-six percent required repeat dilatation, with the median time interval before recurrence being 8 months. Eosinophilic esophagitis (mucosal eosinophil count > 20/HPF) was present in 50% of this cohort. From this study we conclude that a multiringed esophagus causing intermittent dysphagia occurs predominantly in young males, responds well to dilatation, but repeated dilatations are often necessary. Dilatation can lead to extensive mucosal tears and should be performed with caution. Eosinophilic esophagitis is commonly but not invariably associated with this entity. Frequent relapse of dysphagia highlights the need for effective pharmacotherapy.