Recent advances in understanding and managing diverticulitis.

In the past few decades, the increasing socioeconomic burden of acute diverticulitis (AD) has become evident, and with the growth of the population age, this significant economic impact will likely continue to rise. Furthermore, recent evidence showed an increased rate of hospital admissions especially evident among women and younger individuals. The natural history and pathophysiology of this clinical condition is still to be fully defined, and efforts continue to be made in the identification of risk factors and the establishment of relative preventive strategies. The actual therapeutic strategies aimed to modulate gut microbiota, such as rifaximin or probiotics, or to reduce mucosal inflammation, such as mesalazine, present a relatively poor efficacy for both the prevention of the first AD episode (primary prevention) and its recurrence (secondary prevention). In the last few years, the main goal achieved has been in the management of AD in that uncomplicated AD can, to a larger extent, be managed in an outpatient setting with no or little supportive therapy, a strategy that will certainly impact on the health costs of this disease. The problem of AD recurrence remains a topic of debate. The aim of this review is to present updated evidence on AD epidemiology and relative open clinical questions and to analyze in detail predisposing and protective factors with an attempt to integrate their possible modes of action into the several pathogenic mechanisms that have been suggested to contribute to this multifactorial disease. A unifying hypothesis dealing with the colonic luminal and extra-luminal microenvironments separately is provided. Finally, evidence-based changes in therapeutic management will be summarized. Because of an ascertained multifactorial pathogenesis of uncomplicated and complicated AD, it is probable that a single ‘causa prima’ will not be identifiable, and a better stratification of patients could allow one to pursue tailored therapeutic algorithm strategies

USING SHIN LENGTH TO DETERMINE KICK PLATE POSITION OPTIMIZES SELECT SWIM START MECHANICS IN ELITE SWIMMERS

The track start kick plate position is often decided by the level of comfort of the swimmer. The purpose of this study was to use shin length as a measure to determine kick plate position and effects on performance. 20 elite swimmers performed 3 starts at 3 kick plate distances (\u3c shin length, shin length, and \u3e shin length). Differences in reaction time, block phase time (BT), flight phase time, flight distance, underwater phase time, time to the 15 m mark, knee flexion and ankle dorsiflexion angles were examined between the positions. BT was significantly different, (F(2,38)=4.264, p=.026). BT was lower when the kick plate distance was one shin’s length versus \u3c shin length (0.691+0.055 vs 0.715+0.056 sec) and \u3e shin length (0.691+0.055 vs 0.698+0.056 sec), p\u3c.05. Shin length is a quick and individualized measure that can be used by coaches to set the kick plate position without compromising performance

EFFECTS OF STANDARDIZING KICK PLATE POSITION ON TRACK START BIOMECHANICS IN ELITE SWIMMERS

Kick plate position in the track start is arbitrary but may influence performance. The purpose of this study was to investigate the influence of standardizing kick plate position based on shin length. 15 elite swimmers performed 3 starts at 3 kick plate positions (\u3c shin length, shin length, and \u3e shin length). Differences in reaction time (RT), block phase time, flight phase time, flight distance, underwater phase time, and time to the 15 m mark were examined between kick plate positions. Only RT was significantly different, (F(2,28)=4.713, p=.017). RT was lower when the kick plate distance was one shin’s length versus \u3c shin length (0.173+0.034vs 0.194+0.061 sec) and \u3e shin length (0.173+0.034 vs 0.195+0.047 sec),

Uso de vehículos como sensores para estimar la intensidad de precipitación

[ES] En este trabajo se propone realizar un estudio basado en simulación donde se analice la viabilidad de usar vehículos como sensores de intensidad de lluvia. Para esto se crearé un modelo de precipitación, el cual alimentará a los nodos (vehículos) del simulador OMNeT++. Se propondrán algoritmos de fusión de información, para mejorar la calidad de los datos recabados, y se estudiará la sobrecarga de la red y la precisión del sistema de predicción.Cicenia Cárdenas, KN. (2015). Uso de vehículos como sensores para estimar la intensidad de precipitación. http://hdl.handle.net/10251/59816TFG

ALK Status Testing in Non–Small-Cell Lung Carcinoma by FISH on ThinPrep Slides with Cytology Material

Introduction:Oncogenic anaplastic lymphoma kinase (ALK) gene rearrangements in non–small-cell lung carcinomas (NSCLC) provide the basis for targeted therapy with crizotinib and other specific ALK inhibitors. Treatment eligibility is conventionally determined by the Food and Drug Administration–approved companion diagnostic fluorescence in situ hybridization (FISH) assay on paraffin-embedded tissue (PET). On limited samples such as fine needle aspiration–derived cytoblocks, FISH for ALK is often uninformative. FISH performed on liquid-based ThinPrep slides (ThinPrep-FISH) may represent a robust alternative.Methods:Two hundred thirty cytology samples from 217 patients with advanced NSCLC, including a consecutive series of 179 specimens, were used to generate matched ThinPrep slides and paraffin cytoblocks. The same ThinPrep slides used for cytologic diagnosis were assessed by standard ALK break-apart two-color probe FISH, after etching of tumor areas. Ultrasensitive ALK immunohistochemistry (IHC) on corresponding cytoblocks [D5F3 antibody, OptiView signal amplification] served as the reference data set.Results:ThinPrep-FISH ALK signals were robust in 228 of 230 cases and not compromised by nuclear truncation inherent in paraffin-embedded tissue–FISH; only two samples displayed no signals. Nine of 178 informative cases (5%) in the consecutive series and 18 of 228 informative cases (7.8%) overall were ALK rearranged by ThinPrep-FISH. In 154 informative matched ThinPrep-FISH and cytoblock-IHC samples, 152 were concordant (10, 6.5% ALK status positive; 142, 92.2% ALK status negative), and two (1.3%) were ThinPrep-FISH positive but IHC negative (sensitivity 100%, specificity 98.6%, overall agreement 98.7%).Conclusion:Detection of ALK gene rearrangements in liquid cytology ThinPrep slides derived from patients with NSCLC can be confidently used for clinical ALK molecular testing

A decade of insertable cardiac monitors with remote monitoring in pediatric patients

Background: Remote monitoring-enabled insertable cardiac monitors (ICMs) are useful tools for arrhythmias and symptom management. This study sought to evaluate the outcome of ICM implantation in a large, heterogeneous cohort of pediatric and young adult patients. Methods: Single centre, retrospective analysis of patients who underwent ICM implantation in 2010–2019. Patients were analysed according to age, symptoms, arrhythmias and underlying heart disease. Results: A total of 200 consecutive patients (58% male), aged 11.5 ± 5.8 years at ICM implantation, were included. Follow-up was 31 ± 18 months. Electrophysiologic study (EPS) was initially performed in 123 patients and was negative in 85%. Patients had no heart disease (57.5%), congenital heart defects (21%), channelopathies (14.5%), cardiomyopathies/heart tumors (8%). The commonest symptoms were syncope/presyncope (45.5%) and palpitations (12.5%). A definite diagnosis was made in 63% of patients (positive diagnosis in 25%, negative in 38%) after 8 (2–19) months of monitoring. EPS results and the presence/absence of an arrhythmia before ICM implantation had no impact on the diagnostic yield. Symptomatic patients as well as patients without structural heart disease showed higher diagnostic yield. Patients with a positive diagnosis underwent pacemaker/implantable cardioverter-defibrillator implantation (13%), pharmacological treatment (10.5%), or catheter ablation (1.5%). Conclusions: In a large cohort of 200 children and young adults, ICMs with remote monitoring showed a high diagnostic yield (63%), especially in symptomatic patients and in patients without structural heart disease

Robotic bronchoscopy for peripheral pulmonary lesions: A multicenter pilot and feasibility study (BENEFIT)

BACKGROUND: The diagnosis of peripheral pulmonary lesions (PPL) continues to present clinical challenges. Despite extensive experience with guided bronchoscopy, the diagnostic yield has not improved significantly. Robotic-assisted bronchoscopic platforms have been developed potentially to improve the diagnostic yield for PPL. Presently, limited data exist that evaluate the performance of robotic systems in live human subjects. RESEARCH QUESTION: What is the safety and feasibility of robotic-assisted bronchoscopy in patients with PPLs? STUDY DESIGN AND METHODS: This was a prospective, multicenter pilot and feasibility study that used a robotic bronchoscopic system with a mother-daughter configuration in patients with PPL 1 to 5 cm in size. The primary end points were successful lesion localization with the use of radial probe endobronchial ultrasound (R-EBUS) imaging and incidence of procedure related adverse events. Robotic bronchoscopy was performed in patients with the use of direct visualization, electromagnetic navigation, and fluoroscopy. After the use of R-EBUS imaging, transbronchial needle aspiration was performed. Rapid on-site evaluation (ROSE) was used on all cases. Transbronchial needle aspiration alone was sufficient when ROSE was diagnostic; when ROSE was not diagnostic, transbronchial biopsy was performed with the use of the robotic platform, followed by conventional guided bronchoscopic approaches at the discretion of the investigator. RESULTS: Fifty-five patients were enrolled at five centers. One patient withdrew consent, which left 54 patients for data analysis. Median lesion size was 23 mm (interquartile range, 15 to 29 mm). R-EBUS images were available in 53 of 54 cases. Lesion localization was successful in 51 of 53 patients (96.2%). Pneumothorax was reported in two of 54 of the cases (3.7%); tube thoracostomy was required in one of the cases (1.9 %). No additional adverse events occurred. INTERPRETATION: This is the first, prospective, multicenter study of robotic bronchoscopy in patients with PPLs. Successful lesion localization was achieved in 96.2% of cases, with an adverse event rate comparable with conventional bronchoscopic procedures. Additional large prospective studies are warranted to evaluate procedure characteristics, such as diagnostic yield. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov; No.: NCT03727425; URL: www.clinicaltrials.gov

The myth and therapeutic potentials of postbiotics

Postbiotics (bioactives) are nonviable metabolites produced by probiotics that exert biological effects on the hosts. The myriad beneficial effects of postbiotics produced by six novel bacteriocinogenic Lactobacillus plantarum strains have been proven extensively since 2004, with the broad bacteriocin inhibitory activity against various pathogens, as they harbor two classes of bacteriocin structural genes (plnEF and pln W). The supplementation of the postbiotics to various animal models has significantly improved serum cholesterol, immune response, overall health, and growth, while suppressing the population of pathogenic bacteria in the digestive tract. Additionally, the postbiotics of these lactobacilli strains demonstrated novel antiproliferation and anticancer activity against various human cancer cell lines by inducing cytotoxicity via apoptotic pathway