Systematic review with meta-analysis: the prevalence of bile acid malabsorption in the irritable bowel syndrome with diarrhoea.

BACKGROUND: Irritable bowel syndrome is a widespread disorder with a marked socioeconomic burden. Previous studies support the proposal that a subset of patients with features compatible with diarrhoea-predominant IBS (IBS-D) have bile acid malabsorption (BAM). AIM: To perform a systematic review and meta-analysis to assess the prevalence of BAM in patients meeting the accepted criteria for IBS-D. METHODS: MEDLINE and EMBASE were searched up to March 2015. Studies recruiting adults with IBS-D, defined by the Manning, Kruis, Rome I, II or III criteria and which used 23-seleno-25-homotaurocholic acid (SeHCAT) testing for the assessment of BAM were included. BAM was defined as 7 day SeHCAT retention of <10%. We calculated the rate of BAM and 95% confidence intervals (CI) using a random effects model. The methodological quality of included studies was evaluated using the Quality Assessment for Diagnostic Accuracy Studies (QUADAS-2). RESULTS: The search strategy identified six relevant studies comprising 908 individuals. The rate of BAM ranged from 16.9% to 35.3%. The pooled rate was 28.1% (95% CI: 22.6-34%). There was significant heterogeneity in effect sizes (Q-test χ(2)  = 17.9, P < 0.004; I(2)  = 72.1%). The type of diagnostic criteria used or study country did not significantly modify the effect. CONCLUSIONS: These data provide evidence that in excess of one quarter of patients meeting accepted criteria for IBS-D have bile acid malabsorption. This distinction has implications for the interpretation of previous studies, as well as contemporaneous clinical practice and future guideline development.

The first five days: field and laboratory investigations during the early stages of the equine influenza outbreak in Australia, 2007.

Until August 2007, Australia was one of only three countries internationally recognised to be free of equine influenza (EI). This report documents the diagnosis of the first cases of EI in Australian horses and summarises the investigations that took place over the next 5 days. During that time, a multifocal outbreak was identified across eastern New South Wales and south-eastern Queensland. The use of an influenza type A pan-reactive real-time reverse transcription polymerase chain reaction allowed rapid confirmation of suspect cases of EI.

Intracellular protein binding to asbestos induces aneuploidy in human lung fibroblasts.

Exposure to the natural mineral fiber asbestos causes severe lung-damaging fibrosis and cancer, yet it continues to be used as an industrial insulating material throughout the world. When cultured human lung cells are exposed to asbestos, individual fibers are engulfed into the cytoplasm where they induce significant mitotic aberrations leading to chromosomal instability and aneuploidy. The mechanisms of how asbestosis ultimately leads to lung cancer remain unclear. However, our experiments indicate that intracellular asbestos fibers induce aneuploidy and chromosome instability by binding to a subset of proteins that include regulators of the cell cycle, cytoskeleton, and mitotic process. Moreover, precoating of fibers with protein complexes efficiently blocked asbestos-induced aneuploidy in human lung cells without affecting their uptake by cells. These results provide new evidence that asbestos fibers can contribute to significant spindle damage and chromosomal instability by binding to proteins needed for the assembly and regulation of the cytoskeleton or the cell cycle.

Posterior to anterior transglenoid pins: anatomy at risk.

Pneumothorax was noted after an arthroscopic procedure during which a small guidewire overpenetrated the glenoid from a posterior-superior direction. This anatomic study was undertaken to determine the structures at risk from pins overpenetrating from the posterior-superior aspect and to determine whether scapulothoracic position altered the risk. The glenoid was intentionally overpenetrated with wooden dowels from the posterior-superior aspect of the glenoid in seven fresh cadaveric shoulders. The dowels were placed arthroscopically using the Suretac instrumentation (Acufex Microsurgical, Mansfield, MA). The specimens were planed, and the relationship of these wooden pins to vital structures was evaluated. In all specimens, the dowels entered the thoracic cavity between the first and second ribs, regardless of scapular position. The pins consistently passed posterior to the neurovascular bundle but were precariously close, with an average distance to the closest neurovascular structure of 7.4 mm (range, 1 to 19 mm). Scapular position did not seem to affect this relationship.

Enteritis associated with Yersinia pseudotuberculosis infection in a buffalo.

A week after transport a 4 month old buffalo calf developed diarrhoea. Its condition gradually deteriorated and it died. Necropsy revealed acute haemorrhagic enteritis and enlarged mesenteric lymph nodes. Haemorrhages and numerous microabscesses were detected in the lamina propria of the small intestine associated with colonies of Gram negative bacteria. Yersinia pseudotuberculosis was isolated from the small intestine and from mesenteric lymph node. Enteritis caused by Y pseudotuberculosis does not appear to have been reported previously in buffalo in Australia.

Survival and valve failure after aortic valve replacement.

A prospective evaluation of 412 consecutive patients undergoing isolated aortic valve replacement between January 1982 and December 1985 was performed in an attempt to identify the determinants of survival and valve failure. A variety of valves were inserted to permit a prospective evaluation of alternative valves including: Björk-Shiley mechanical (n = 37), Ionescu-Shiley pericardial (n = 261), Hancock pericardial (n = 78), and Carpentier-Edwards porcine (n = 36). Thirteen patients died in the hospital (3.2%) and 47 patients died in the follow-up period producing an actuarial survival of 81% +/- 3% at 48 months. Survival was independently predicted by advancing age, preoperative New York Heart Association functional class, and the presence of endocarditis (p less than 0.05 by Cox regression analysis). The majority of patients were symptomatically improved (New York Heart Association class I or II: 21% preoperative, 88% postoperative). Freedom from structural valve dysfunction, prosthetic valve endocarditis, and reoperation for valve-related complications were 95% +/- 2%, 95% +/- 2%, and 92% +/- 2% at 48 months, respectively. These valve-related complications occurred more frequently in younger patients and in those with a Hancock pericardial valve (freedom from structural valve dysfunction, 89% +/- 5%; prosthetic valve endocarditis, 84% +/- 9%; reoperation, 78% +/- 10%; p less than 0.05 by Cox regression). Freedom from thromboembolism was 88% +/- 2% at 48 months; it was significantly lower in patients with a preoperative thromboembolic event and was not influenced by the type of prosthesis inserted. Freedom from anticoagulant-related hemorrhage was 85% +/- 8% at 48 months and was not influenced by any preoperative factors.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic valve replacement with a small prosthesis.

A small aortic prosthesis can be inserted in selected patients with excellent symptomatic improvement. A prospective evaluation was performed on 321 consecutive patients undergoing isolated aortic valve replacement between January 1982 and December 1984. Smaller prostheses (19 or 21 mm, predominantly pericardial valves, 132 patients) were inserted in older patients (p = .0001), women (p = .0001), smaller patients (body surface area: p = .0001), and patients with aortic stenosis (p = .0001). Twelve patients died in-hospital (3.7%) and 33 died during the follow-up period, producing an actuarial survival of 80% +/- 4% at 48 months. Survival was independently predicted by advancing age (p = .009), the preoperative NYHA functional class (p = .04) but not valve size (p = .28). Eighty-nine percent of patients were NYHA class I or II postoperatively compared with 22% preoperatively. Symptomatic recovery was similar for those with smaller size valves. Postoperative Doppler echocardiography in 57 patients revealed significant differences in aortic valve areas and gradients between the valve sizes. The 19 mm pericardial valves had the smallest areas (1.0 +/- 0.3 cm2) and the highest gradients (34 +/- 20 mm Hg). The aortic valve gradient was significantly related to cardiac output and valve size (p = .0001 by analysis of covariance). Linear regression analyses were used to estimate the aortic valve gradient during exercise (a 50% increase in cardiac output). The estimated exercise gradient was disturbingly high for the 19 mm valves (55 +/- 16 mm Hg), but the estimated exercise gradients for the 21, 23, and 25 mm valves were similar, all below 30 mm Hg. Aortic valve replacement with a small prosthesis resulted in excellent symptomatic improvement and acceptable resting valve gradients. However, a 19 mm prosthesis may produce prohibitive gradients during exercise, which may limit symptomatic recovery and should be avoided in active patients.