Cortical differences in diverticular disease and correlation with symptom reports

Background Recent studies have shown that the brain of patients with gastrointestinal disease differ both structurally and functionally from that of controls. Highly somatizing diverticular disease (HSDD) patients were also shown to differ from low somatizing (LSDD) patients functional-ly. This study aimed to investigate how they differed structurally. Methods Four diseases subgroups were studied in a cross-sectional design: 20 patients with asympto-matic diverticular disease (ADD), 18 LSDD, 16 HSDD, and 18 with irritable bowel syn-drome. We divided DD patients into LSDD and HSDD using a cutoff of 6 on the Patient Health Questionnaire 12 Somatic Symptom (PHQ12-SS) scale. All patients underwent a 1-mm isotropic structural brain MRI scan and were assessed for somatization, hospital anxiety, depression, and pain catastrophizing. Whole brain volumetry, cortical thickness analysis and voxel-based morphometry were carried out using Freesurfer and SPM. Key Results We observed decreases in grey matter density in the left and right dorso-lateral prefrontal cortex (dlPFC), and in the mid-cingulate and motor cortex, and increases in the left (19, 20) and right (19, 38) Brodmann Areas. The average cortical thickness differed overall across groups (P=0.002) and regionally: HSDD>ADD in the posterior cingulate cortex (P=0.03), HSDD>LSDD in the dlPFC (P=0.03) and in the ventro-lateral PFC (P<0.001). The thickness of the anterior cingulate cortex and of the mid-prefrontal cortex were also found to correlate with Pain Catastrophizing (Spearman's ρ=0.24, P=0.043 uncorrected and Spearman's ρ=0.25, P=0.03 uncorrected). Conclusion & Inferences This is the first study of structural grey matter abnormalities in diverticular disease patients. The data shows brain differences in the pain network

BIOSMART - Política agroambiental, sistemas silvopastoriles, biodiversidad y cambio climático

BIOSMART1 es un proyecto interdisciplinario e internacional con duración de 3 años dedicado al estudio de la implementación de sistemas silvopastoriles (SSP)2 y otros esquemas agroambientales en la Amazonía colombiana en pro de la sociedad, el medio ambiente y la economía local. El proyecto Paisajes Sostenibles para la Amazonía, liderado por el CIAT3 fue uno de los esquemas estudiados. Los métodos de investigación incluyeron entrevistas semiestructuradas, sondeos telefónicos, grupos focales, juegos de percepción de riesgo, modelación de cambios en el uso del suelo y ecología de campo. Aspiramos a una mejor comprensión de estos sistemas para apoyar los objetivos de desarrollo sostenible relacionados con la erradicación de la pobreza, el impulso del desarrollo rural, el logro de una producción pecuaria neto cero carbono y la conservación de los bosques y la biodiversidad

A pilot study of visceral fat and its association with adipokines, stool calprotectin and symptoms in patients with diverticulosis

BackgroundComplications of diverticular disease are increasingly common, possibly linked to increasing obesity. Visceral fat could contribute to the development of symptomatic diverticular disease through its pro-inflammatory effects.ObjectiveThe study had 2 aims. A) to develop a semi-automated algorithm to measure abdominal adipose tissue from 2-echo magnetic resonance imaging (MRI) data B) to use this to determine if visceral fat was associated with bowel symptoms and inflammatory markers in patients with symptomatic and asymptomatic diverticular disease.DesignAn observational study measuring visceral fat using MRI together with serum adiponectin, leptin, stool calprotectin and patient-reported somatisation and bowel habit. Setting Medical and imaging research centres of a university hospital. Participants MRI scans were performed on 55 patients after an overnight fast measuring abdominal subcutaneous and visceral adipose tissue volumes together with small bowel water content (SBWC). Blood and stool samples were collected and patients kept a 2 week stool diary and completed a somatisation questionnaire.Main Outcome MeasuresDifference in the volume of visceral fat between symptomatic and asymptomatic patients.ResultsThere were no significant differences in visceral (p = 0.98) or subcutaneous adipose (p = 0.60) tissue between symptomatic and asymptomatic patients. However measured fat volumes were associated with serum adipokines. Adiponectin showed an inverse correlation with visceral adipose tissue (VAT) (Spearman ρ = -0.5, p = 0.0003), which correlated negatively with SBWC (ρ = -0.3, p=0.05). Leptin correlated positively with subcutaneous adipose tissue (ρ = 0.8, p 25 kgm-2) showed a moderate correlation between calprotectin and VAT (ρ = 0.3, p = 0.05). Somatization scores were significantly higher in symptomatic patients (p < 0.0003).ConclusionsIncreasing visceral fat is associated with lower serum adiponectin and increased faecal calprotectin suggesting a pro-inflammatory effect which may predispose to the development of complications of diverticulosis

BIOSMART Agri-environmental policy, silvopastoral systems, biodiversity, and climate change

BIOSMART1 is a 3-year interdisciplinary and international project focused on studying the implementation of silvopastoral systems (SPS)2 and other agrienvironmental schemes in the Colombian Amazon for the benefit of society, the environment, and the local economy. These schemes include the Sustainable Amazonian Landscapes project led by CIAT.3 Our methods include semi-structured interviews, telephone surveys, focus groups, risk-perception games, land-use change modeling, and ecological fieldwork. Our aims are to improve understanding of these systems to support sustainable development goals around eradication of poverty, boosting rural development, achieving net-zero carbon farming, and conserving forests and biodiversity

Protocol of a randomized controlled trial of the effectiveness of physician education and activation versus two rehabilitation programs for the treatment of Whiplash-associated Disorders: The University Health Network Whiplash Intervention Trial

Background: Whiplash injuries are an important public health problem that is associated with significant disability and high health care utilization. Recent cohort studies suggest that physician care may be the most effective treatment for patients with whiplash-associated disorders. However, these findings have not been tested in a randomized controlled trial. The purpose of this study is to determine which of physician care or two rehabilitation programs of care is most effective in improving recovery of patients with recent whiplash associated disorders. Methods and Design: We designed a pragmatic randomized clinical trial. A total of 444 participants (148 in each of three arms) who reside in Southern Ontario, Canada will be recruited from a large insurer. We will include individuals who are 18 years of age or older and who are diagnosed with Grade I or II Whiplash-associated Disorders. Participants will be randomized to physician-based education and activation or one of two rehabilitation programs of care currently in use in Ontario. Our primary outcome, self-rated global recovery and all secondary outcomes (neck pain intensity, whiplash disability, health-related quality of life, depressive symptomatology and satisfaction with care) will be measured at baseline by a trial coordinator and at 6 weeks, 3, 6, 9 and 12 months follow-up by an interviewer who is blind to the participants' baseline characteristics and treatment allocation. We will also collect information on general health status, other injuries, comorbidities, expectation of recovery, work status, pain coping, legal representation, and co-interventions. The primary intention-to-treat analysis will compare time to recovery between the three interventions. This trial will have 90% power at an alpha of 0.05 to detect a 20% difference in the rate of perceived recovery at one year. Secondary analyses will compare the health outcomes, rate of recurrence and the rate of adverse events between intervention groups. Conclusion: The results of this study will provide the public, clinicians and policy makers much needed evidence on the effectiveness of common approaches used to manage whiplash-associated disorders. © 2008 Côté et al; licensee BioMed Central Ltd

The effect of three different (-135-degrees-C) whole body cryotherapy exposure durations on elite rugby league players

Background: Whole body cryotherapy (WBC) is the therapeutic application of extreme cold air for a short duration. Minimal evidence is available for determining optimal exposure time. Purpose: To explore whether the length of WBC exposure induces differential changes in inflammatory markers, tissue oxygenation, skin and core temperature, thermal sensation and comfort. Method: This study was a randomised cross over design with participants acting as their own control. Fourteen male professional first team super league rugby players were exposed to 1, 2, and 3 minutes of WBC at -135°C. Testing took place the day after a competitive league fixture, each exposure separated by seven days. Results: No significant changes were found in the inflammatory cytokine interleukin six. Significant reductions (p<0.05) in deoxyhaemoglobin for gastrocnemius and vastus lateralis were found. In vastus lateralis significant reductions (p<0.05) in oxyhaemoglobin and tissue oxygenation index (p<0.05) were demonstrated. Significant reductions (p<0.05) in skin temperature were recorded. No significant changes were recorded in core temperature. Significant reductions (p<0.05) in thermal sensation and comfort were recorded. Conclusion: Three brief exposures to WBC separated by 1 week are not sufficient to induce physiological changes in IL-6 or core temperature. There are however significant changes in tissue oxyhaemoglobin, deoxyhaemoglobin, tissue oxygenation index, skin temperature and thermal sensation. We conclude that a 2 minute WBC exposure was the optimum exposure length at temperatures of -135°C and could be applied as the basis for future studies