Occurrence of <i>Philometra lateolabracis</i> (Nematoda: Philometridae) in the gonads of marine perciform fishes in the Mediterranean region

Gravid females of the nematode Philometra lateolabracis (Yamaguti, 1935), a parasite of gonads of marine perciform fishes, were found in wild and cultured dusky grouper Epinephelus marginatus (Lowe) from waters near the Balear Islands (Spain, Mediterranean Sea) and Sicily (Italy, Thyrrenean Sea), and in the greater amberjack Seriola dumerili (Risso) in Croatia (south-eastern Adriatic Sea). In wild E. marginatus in Spain, the overall prevalence was 21% and the intensity of infection 1 nematode per fish. The nematodes are briefly described and illustrated. The species Sanguinofilaria jordanoi López-Neyra, 1951, described from the ovary of Epinephelus gigas Brünich from Morocco, is synonymized with P. lateolabracis. This is the first documented record of P. lateolabracis from fishes of the Mediterranean region and its finding in S. dumerili represents a new host record. The possible importance of this pathogenic parasite for cultures of marine perciform fishes in the region is stressed

Microscopic colitis: A review of etiology, treatment and refractory disease

Microscopic colitis is a common cause of chronic, nonbloody diarrhea. Microscopic colitis is more common in women than men and usually affects patients in their sixth and seventh decade. This article reviews the etiology and medical management of microscopic colitis. The etiology of microscopic colitis is unknown, but it is associated with autoimmune disorders, such as celiac disease, polyarthritis, and thyroid disorders. Smoking has been identified as a risk factor of microscopic colitis. Exposure to medications, such as non-steroidal anti-inflammatory drugs, proton pump inhibitors, and selective serotonin reuptake inhibitors, is suspected to play a role in microscopic colitis, although their direct causal relationship has not been proven. Multiple medications, including corticosteroids, anti-diarrheals, cholestyramine, bismuth, 5-aminosalicylates, and immunomodulators, have been used to treat microscopic colitis with variable response rates. Budesonide is effective in inducing and maintaining clinical remission but relapse rate is as high as 82% when budesonide is discontinued. There is limited data on management of steroid-dependent microscopic colitis or refractory microscopic colitis. Immunomodulators seem to have low response rate 0%-56% for patients with refractory microscopic colitis. Response rate 66%-100% was observed for use of anti-tumor necrosis factor (TNF) therapy for refractory microscopic colitis. Anti-TNF and diverting ileostomy may be an option in severe or refractory microscopic colitis

Suspected Blood Indicator to Identify Active Gastrointestinal Bleeding: A Prospective Validation

Background: The suspected blood indicator (SBI) function in the RAPID Reader v8.3 program was designed to quickly identify the presence of blood in video capsule endoscopy. While previous retrospective studies have shown that the SBI function was accurate in detecting the presence of active bleeding in the small bowel, its specificity and sensitivity were poor. Methods: An initial retrospective review (phase 1) compared 115 patients with active gastrointestinal bleeding seen on video capsule endoscopy (VCE) to 115 patients with no active bleeding seen on VCE to produce a highly accurate algorithm. A prospective study (phase 2) was then performed by applying the algorithm to 100 consecutive patients who received VCE for the following indications: obscure bleeding, iron deficiency anemia, melena, and hematochezia. Results: The initial retrospective review found that eight contiguous SBI markers had a specificity of 100% in identifying active gastrointestinal bleeding regardless of the total number of SBI markers, while two or more contiguous SBI markers had a sensitivity of 96.5%. Using a cutoff of eight contiguous SBI markers, the prospective arm found that there was a 100% sensitivity and specificity in detecting active gastrointestinal bleeding (P \u3c 0.001). Conclusions: The SBI function can greatly facilitate the identification of active gastrointestinal bleeding on VCE by using eight contiguous SBI markers as a cutoff for active bleeding

Video Capsule Endoscopy in Patients with Muir-Torre Syndrome

Introduction: Muir-Torre Syndrome (MTS) is a rare, primarily autosomal dominant disorder that is distinguished by having sebaceous skin malignancies in addition to visceral malignancies. The most common form of MTS is a variant of HNPCC. Our aim is to demonstrate the utilization of VCE in patients with MTS as the first line screening method. Methods: Single center, retrospective chart review study of outpatients with MTS who underwent a video capsule endoscopy study between January 2006 and January 2016. Results: Four patients, all women and mean age of 57 years old, with MTS underwent a video capsule endoscopy at our institution. In 75% of the patients, VCE detected polyps at a point in the small bowel which upper endoscopy and colonoscopy did not visualize. Two patients had large jejunal polyps, approximately 20mm in diameter. One patient had multiple 3-20mm sessile polyps from the duodenum to the ileum. On endoscopy, only one of the patients had a polyp detected and it was a 10mm polyp in the stomach which was positive for GIST. With regards to colonoscopy, 2 of the patients had critical findings of colonic mucosa with focal adenomatous changes and cryptitis (high grade dysplasia) and T1 poorly differentiated signet cell carcinoma respectively. Both of these patients underwent total colectomies. Cumulatively, all four of these patients have undergone 17 endoscopies/colonoscopies. Conclusion: MTS is a disorder that needs to be monitored closely as patients have a high propensity of developing gastrointestinal malignancies. Current recommendations are colonoscopies annually starting at ages 20-25 and endoscopies with gastric antrum biopsies starting at ages 30-35. 75% of the patients had lesions in the small bowel that were only picked up by VCE. Failure to detect asymptomatic advanced lesions in the small bowel may have serious consequences. We therefore recommend pan-endoscopy in this rare syndrome

Utilizing Mucosal Protrusion Angles to Discriminate Between True and False Masses of the Small Bowel on Video Capsule Endoscopy

Background: Video capsule endoscopy (VCE) has significantly improved our ability to detect small bowel tumors. However, diagnosing small bowel tumors has remained a challenge due to their low incidence, nonspecific presentations, and the inability to use VCE to biopsy lesions identified during passage through the small bowel. To address this challenge, Girelli et al. developed a novel scoring system called the “smooth, protruding lesions index at capsule endoscopy” (SPICE) to distinguish true submucosal masses from innocent bulges1. In our study, we compared the utility of an additional morphologic criterion, the mucosal protrusion angle, with SPICE scores in detecting true submucosal masses of the small-bowel. Methods: We retrospectively reviewed the charts of 300 patients over the age of 18 who had undergone VCE for suspected small bowel lesions between the years of 2002 and 2017. In total, we analyzed the VCEs of 36 patients. SPICE scores were calculated for each patient as outlined in Girelli et al. and mucosal protrusion angles were measured using a protractor placed on the computer screen. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of both SPICE and protrusion angle. The protrusion angle was defined as the angle between the polyp and surrounding mucosa, and we hypothesized that an angle \u3e 900 suggested an external protrusion while an angle \u3c 900 suggested a submucosal mass or true polyp. Results: 25 patients had true submucosal masses (2 GIST, 6 carcinoid, 5 Peutz-Jeghers, 3 inflammatory polyps, 2 hamartomatous polyps, 1 lymphoma, 1 lipomatous polyp, 2 tubular adenomas, 1 leiomyoma, 1 cavernous hemangioma, 1 hyperplastic polyp, 1 lymphatic nodule), and 10 patients had innocent bulges due to extrinsic compression. True submucosal masses when compared to innocent bulges had an average measured angle of protrusion of 45.70 ± 20.80 vs. 108.60 ± 16.30 (p \u3c 0.0001; unpaired t-test). When compared with SPICE scores, a mucosal protrusion angle \u3c 900 had a higher sensitivity (96.0% vs. 35.0%), specificity (90.0% vs. 82.0%), PPV (96.0% vs. 82.0%) and NPV (90.0% vs. 35.0%). Acute angle of protrusion accurately discriminated between true submucosal masses and extrinsic compression bulges on Fisher’s exact test (p = 0.0001). Conclusion: Protrusion angle is a simple and useful tool for differentiating between true submucosal masses and innocent bulges of the small-bowel. Further prospective studies are needed to validate its utility in minimizing invasive interventions

PCR-based identification of thermotolerant free-living amoebae in Italian hot springs

Several thermal areas, also used for leisure purposes, may represent suitable habitats for free-living amoebae (FLAs), but few studies have been carried out in search for these organisms. The aim of this study was to assess the presence and distribution of FLAs by culture detection and molecular identification, over a one year-round sampling of two sites in Central Italy. Two geothermal springs (Site A and Site B) were investigated for a total of 36 water samples. Four sets of primers were used to amplify FLA DNA from all cultures positive for amoebic growth at both 37&nbsp;°C and 45&nbsp;°C. Overall, 33 (91.6%) water samples produced PCR amplification. Eleven taxa were identified. The array of identified species varied over the sampling period, and differed between the two hot springs, Site A harbouring 11 taxa compared to 5 of site B. However, both sites were characterized by the most common species Vermamoeba vermiformis and Naegleria australiensis. Acanthamoeba genotypes T4 and T15 were found at low frequency. Differences in the composition between the two sites could reflect environmental changes in biotic and chemical/physical parameters. From a public health perspective, the detection of potentially pathogenic amoebae could unveil a potential risk for humans

Computerized 3-dimensional Localization of a Video Capsule in the Abdominal Cavity: Validation by Digital Radiography

Background: Video capsule endoscopy has become the gold standard for examining the small bowel and defining pathological lesions, however, localization of a specific lesion remains largely guesswork. We report the validation of a new 3D localization software using radiological localization in volunteers. Methods: 30 volunteers with no known prior history of gastrointestinal disease swallowed the EC-10 video capsule. A sensor array with six radiopaque markers was placed on the anterior abdominal wall. Once the capsule was visualized to be in the small intestine using a real time viewer, five sets of low dose x-rays were taken every thirty minutes. Distances between sensor points and the capsule were measured on the x-rays to provide X, Y, and Z coordinates and compared with the distances calculated by the software from the same points. Results: Data from 27 of the 30 subjects were suitable for analysis. There were three technical failures. Our study evaluated the accuracy of the “Capsule 3D Track function” which calculated the capsule position based on the signal strength received at the sensor array. The accuracy of the position was compared to the actual position of the capsule as determined by radiographic images obtained during the capsule’s transit through the small bowel. The average error for the software measurement for each of the three coordinates was: X -2.00 cm (SD 1.64 cm), Y -- 2.64 cm (SD 2.39 cm), and Z --2.51 cm (1.83 cm). Conclusion: The localization error reported here is comparable to the existing system for localization, however, it provides localization across all three spatial dimensions which has never been achieved before. The potential utility of this technology is yet to be seen, however, as it needs to now be studied in a prospective clinical trial for patients with suspected small bowel pathology

Geological mapping using high resolution regression modelled soil geochemistry

Geological mapping, the classification of bedrock into distinct identifiable units, has traditionally been conducted at the discretion of the field geologist on the basis of human-observable properties such as those of mineralogical composition and texture. In recent years technological developments have allowed the collection and analysis of ever more advanced quantitative geoscientific datasets. We are now approaching a point where migration of traditional mapping procedures to the digital domain is a feasible reality, with such benefits as consistency, transferability and transparency. One issue that we encounter is that the most geologically informative measurements, such as those of chemical composition, tend to have their sampling density limited by their high cost. Meanwhile, remote sensed data will tend towards extremely high sampling density, but may lack stand-alone geological significance. Nonparametric regression techniques have the potential to negate this issue by modelling the most geologically informative measurements as complex interactions of multiple remote sensed covariates. In this poster we present the use of random forest regression to model soil geochemistry in south west England using remote sensed data, and demonstrate how clustering of the predicted high resolution soil geochemistry is able to differentiate geological units – a process that can be trained to match pre-existing rock classifications. We find that random forest regression based on remote sensed data is capable of predicting element concentrations in soils with superior accuracy to that of ordinary kriging of sparsely sampled point data. Crucially the random forest predictions incorporate the high resolution structure of the remote sensed covariates. This allows geological units, in this case defined purely on the basis of the geochemical composition of their soils, to be mapped with sharp boundaries limited only by the resolution of the remote sensed covariates. It seems likely that such techniques could take centre stage in the future of geological mapping: improving not only on the consistency of classified maps based on human observations, but also allowing the continuous mapping of any geologically constrained variables, such as radon potential, to the best resolution and accuracy that our covariate datasets can support

Theoretical Studies of Electron Transfer in Metal Dimers: XY+→X+Y, Where X, Y=Be, Mg, Ca, Zn, Cd

The electronic matrix element responsible for electron exchange in a series of metal dimers was calculated using ab initio wave functions. The distance dependence is approximately exponential for a large range of internuclear separations. A localized description, where the two nonorthogonal structures characterizing the electron localized at the left and right sites are each obtained self‐consistently, is found to provide the best description of the electron exchange process. We find that Gaussian basis sets are capable of predicting the expected exponential decay of the electronic interactions even at quite large internuclear distances