The utility of diagnostic tests in irritable bowel syndrome patients: a systematic review

The aim of this study was to determine the pretest probability of organic GI disease and the accuracy of diagnostic tests for organic GI disease in patients who meet symptom-based criteria for irritable bowel syndrome (IBS). METHODS : After a comprehensive literature search for studies examining the accuracy of diagnostic tests for organic GI disease among patients who meet symptom-based criteria for IBS, two independent observers qualitatively assessed the methodology of selected studies and extracted data. Data on the pretest probability of organic GI disease in this population and the accuracy of currently recommended diagnostic tests were converted to descriptive tables. RESULTS : Among patients meeting symptom-based criteria for IBS, the pretest probability of inflammatory bowel disease, colorectal cancer, or infectious diarrhea is less than 1%. Currently recommended diagnostic tests rarely identify organic GI disease in patients fulfilling symptom-based criteria for IBS. However, the pretest probability of celiac disease in patients meeting symptom-based criteria for IBS was 10 times higher than the prevalence of celiac disease in the general population. CONCLUSION : There is insufficient evidence to recommend the routine performance of a standardized battery of diagnostic tests in patients who meet symptom-based criteria for IBS. Based upon the increased pretest probability of celiac disease, routine performance of serological tests for celiac disease may be useful in this patient population, though additional study is needed in this area.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72511/1/j.1572-0241.2002.07027.x.pd

Cryospray ablation (CSA) in the palliative treatment of squamous cell carcinoma of the esophagus

BACKGROUND: Esophageal carcinoma is the ninth most prevalent cancer worldwide with squamous cell carcinoma (SCCA) and adenocarcinoma accounting for the vast majority of new cases (13,900 in 2003). Cure rates in the U.S. are less than 10%, similar to lung cancer. More than 50% of patients with esophageal carcinoma present with unresectable or metastatic disease, are not surgical candidates, or display disease progression despite the addition of neoadjuvant chemoradiotherapy to surgery. Need for improved palliation exits. CASE PRESENTATION: This case describes a 73-year-old African American male who presented with recurrent squamous cell carcinoma (SCCA) of the esophagus who has a achieved complete remission for 24 months via endoscopic cryospray ablation. CONCLUSION: Endoscopic cryo spray ablation warrants further investigation as a palliative treatment modality for esophageal cancer. This is the first reported case in the medical literature

Pathogen-specific risk of chronic gastrointestinal disorders following bacterial causes of foodborne illness

BACKGROUND: The US CDC estimates over 2 million foodborne illnesses are annually caused by 4 major enteropathogens: non-typhoid Salmonella spp., Campylobacter spp., Shigella spp. and Yersinia enterocoltica. While data suggest a number of costly and morbid chronic sequelae associated with these infections, pathogen-specific risk estimates are lacking. We utilized a US Department of Defense medical encounter database to evaluate the risk of several gastrointestinal disorders following select foodborne infections. METHODS: We identified subjects with acute gastroenteritis between 1998 to 2009 attributed to Salmonella (nontyphoidal) spp., Shigella spp., Campylobacter spp. or Yersinia enterocolitica and matched each with up to 4 unexposed subjects. Medical history was analyzed for the duration of military service time (or a minimum of 1 year) to assess for incident chronic gastrointestinal disorders. Relative risks were calculated using modified Poisson regression while controlling for the effect of covariates. RESULTS: A total of 1,753 pathogen-specific gastroenteritis cases (Campylobacter: 738, Salmonella: 624, Shigella: 376, Yersinia: 17) were identified and followed for a median of 3.8 years. The incidence (per 100,000 person-years) of PI sequelae among exposed was as follows: irritable bowel syndrome (IBS), 3.0; dyspepsia, 1.8; constipation, 3.9; gastroesophageal reflux disease (GERD), 9.7. In multivariate analyses, we found pathogen-specific increased risk of IBS, dyspepsia, constipation and GERD. CONCLUSIONS: These data confirm previous studies demonstrating risk of chronic gastrointestinal sequelae following bacterial enteric infections and highlight additional preventable burden of disease which may inform better food security policies and practices, and prompt further research into pathogenic mechanisms

Repeat treatment with rifaximin is safe and effective in patients with diarrhea-predominant irritable bowel syndrome

Background & AimsFew treatments have demonstrated efficacy and safety for diarrhea-predominant irritable bowel syndrome (IBS-D). A phase 3, randomized, double-blind, placebo-controlled trial was performed to evaluate the safety and efficacy of repeat treatment with the nonsystemic antibiotic rifaximin.MethodsThe trial included adults with IBS-D, mean abdominal pain and bloating scores of 3 or more, and loose stool, located at 270 centers in the United States and Europe from February 2012 through June 2014. Those responding to a 2-week course of open-label rifaximin 550 mg 3 times daily, who then relapsed during an observation phase (up to 18 weeks), were randomly assigned to groups given repeat treatments of rifaximin 550 mg or placebo 3 times daily for 2 weeks. The primary end point was percentage of responders after first repeat treatment, defined as a decrease in abdominal pain of ≥30% from baseline and a decrease in frequency of loose stools of ≥50% from baseline, for 2 or more weeks during a 4-week post-treatment period.ResultsOf 1074 patients (44.1%) who responded to open-label rifaximin, 382 (35.6%) did not relapse and 692 (64.4%) did; of these, 636 were randomly assigned to receive repeat treatment with rifaximin (n = 328) or placebo (n = 308). The percentage of responders was significantly greater with rifaximin than placebo (38.1% vs 31.5%; P = .03). The percentage of responders for abdominal pain (50.6% vs 42.2%; P = .018) was significantly greater with rifaximin than placebo, but not stool consistency (51.8% vs 50.0%; P = .42). Significant improvements were also noted for prevention of recurrence, durable response, and bowel movement urgency. Adverse event rates were low and similar between groups.ConclusionsIn a phase 3 study of patients with relapsing symptoms of IBS-D, repeat rifaximin treatment was efficacious and well tolerated. ClinicalTrials.gov ID: NCT01543178

Testing peatland water-table depth transfer functions using high-resolution hydrological monitoring data

Transfer functions are now commonly used to reconstruct past environmental variability from palaeoecological data. However, such approaches need to be critically appraised. Testate amoeba-based transfer functions are an established method for the quantitative reconstruction of past water-table variations in peatlands, and have been applied to research questions in palaeoclimatology, peatland ecohydrology and archaeology. We analysed automatically-logged peatland water-table data from dipwells located in England, Wales and Finland and a suite of three year, one year and summer water-table statistics were calculated from each location. Surface moss samples were extracted from beside each dipwell and the testate amoebae community composition was determined. Two published transfer functions were applied to the testate-amoeba data for prediction of water-table depth (England and Europe). Our results show that estimated water-table depths based on the testate amoeba community reflect directional changes, but that they are poor representations of the real mean or median water-table magnitudes for the study sites. We suggest that although testate amoeba-based reconstructions can be used to identify past shifts in peat hydrology, they cannot currently be used to establish precise hydrological baselines such as those needed to inform management and restoration of peatlands. One approach to avoid confusion with contemporary water-table determinations is to use residuals or standardised values for peatland water-table reconstructions. We contend that our test of transfer functions against independent instrumental data sets may be more powerful than relying on statistical testing alone

The Maine Tidal Power Initiative: Transdisciplinary sustainability science research for the responsible development of tidal power

The Maine Tidal Power Initiative (MTPI), an interdisciplinary team of engineers, marine scientists, oceanographers, and social scientists, is using a transdisciplinary sustainability science approach to collect biophysical and social data necessary for understanding interactions between human and natural systems in the context of tidal power development in Maine. MTPI offers a unique opportunity to better understand how group structure and process influence outcomes in transdisciplinary sustainability science research. Through extensive participant observation and semi-structured interviews we: (1) describe MTPI’s organizational structure; (2) examine MTPI’s research approach and engagement with stakeholders from different sectors of society (i.e., industry, government, and the local community); and (3) identify challenges and opportunities for involving different disciplinary expertise and diverse stakeholders in transformational sustainability science research. We found that MTPI’s holistic mission, non-hierarchical structure, and iterative stakeholder engagement process led to important benefits and significant challenges. Positive outcomes include knowledge development, a transferable research framework, shared resources, personal reward, and a greater understanding of the local environment and community. Challenges identified include balancing diverse interests and priorities, maintaining engagement, managing stakeholder relationships, and limited resources. Lessons learned from the process of integrative collaborative research in Maine can offer guidance on what should be considered when carrying out similar transdisciplinary sustainability science projects in other research contexts

Effects of a novel climate on stress response and immune function in painted turtles (Chrysemys picta)

Climate change may subject animals to increasingly stressful environmental conditions, which could have negative physiological consequences if stress levels are elevated for long periods. We conducted a manipulative experiment to determine the effects of a novel climate on stress levels and immune function in a model reptile species, the painted turtle. We collected turtles from four populations across the species' geographic range and housed them in a common-garden in one population's local climate. We measured levels of the stress hormone corticosterone and tested two aspects of innate immune function, bactericidal capacity and natural antibody agglutination, at the time of capture (baseline) and three additional time points over 1 year. The four populations did not differ in corticosterone levels over the course of 1 year, and corticosterone levels were also similar at each sampling period except that post-hibernation corticosterone levels were significantly lower than the previous three time points. Furthermore, we found no evidence that elevated corticosterone depressed immune function in the painted turtle. Our study suggests that turtles exposed to novel climatic conditions did not display a detectable stress response, nor did the novel climate depress immune function in the transplanted populations. Therefore, in terms of innate immune function, turtles may be relatively resilient to at least small changes in climatic conditions.Fil: Refsnider, Jeanine M.. University Of California Berkeley; Estados UnidosFil: Palacios, María Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Centro Nacional Patagónico.; ArgentinaFil: Reding, Dawn M.. Luther College. Department of Biology; Estados UnidosFil: Bronikowski, Anne M.. Iowa State University. Department of Ecology, Evolution and Organismal Biology.; Estados Unido

The kinematic identification of a thick stellar disc in M31

We present the first characterization of a thick disc component in the Andromeda galaxy (M31) using kinematic data from the DEIMOS multi-object spectrograph instrument on Keck II. Using 21 fields in the South West of the galaxy, we measure the lag of this component with respect to the thin disc, as well as the dispersion, metallicity and scale length of the component. We find an average lag between the two components of =46.0+/-3.9km/s. The velocity dispersion of the thick disc is sigma_{thick}=50.8+/-1.9km/s, greater than the value of dispersion we determine for the thin disc, sigma_{thin}=35.7+/-1.0km/s. The thick disc is more metal poor than the thin disc, with [Fe/H]_{spec}=-1.0+/-0.1 compared to [Fe/H]_{spec}=-0.7+/-0.05 for the thin disc. We measure a radial scale length of the thin and thick discs of h_r=7.3+/-1.0 kpc and h_r=8.0+/-1.2 kpc. From this, we infer scale heights for both discs of 1.1+/-0.2 kpc and 2.8+/-0.6 kpc, both of which are ~2--3 times larger than those observed in the Milky Way. We estimate a mass range for the thick disc component of 2.4x10^{10}Msun< M_{*,thick} <4.1x10^{10}Msun. This value provides a useful constraint on possible formation mechanisms, as any proposed method for forming a thick disc must be able to heat (or deposit) at least this amount of material.Comment: 22 pages, 17 figures. Minor revisions made to text following referee report. Accepted for publication in MNRA

Modeling autosomal dominant Alzheimer's disease with machine learning

INTRODUCTION: Machine learning models were used to discover novel disease trajectories for autosomal dominant Alzheimer's disease. METHODS: Longitudinal structural magnetic resonance imaging, amyloid positron emission tomography (PET), and fluorodeoxyglucose PET were acquired in 131 mutation carriers and 74 non-carriers from the Dominantly Inherited Alzheimer Network; the groups were matched for age, education, sex, and apolipoprotein ε4 (APOE ε4). A deep neural network was trained to predict disease progression for each modality. Relief algorithms identified the strongest predictors of mutation status. RESULTS: The Relief algorithm identified the caudate, cingulate, and precuneus as the strongest predictors among all modalities. The model yielded accurate results for predicting future Pittsburgh compound B (R2  = 0.95), fluorodeoxyglucose (R2  = 0.93), and atrophy (R2  = 0.95) in mutation carriers compared to non-carriers. DISCUSSION: Results suggest a sigmoidal trajectory for amyloid, a biphasic response for metabolism, and a gradual decrease in volume, with disease progression primarily in subcortical, middle frontal, and posterior parietal regions