"Gastroesophageal reflux disease"

Geoffrey C. Wall is an Associate Professor of Pharmacy Practice in the College of Pharmacy and Health Sciences. He can be contacted at [email protected]: Gastroesophageal reflux disease (GERD) is a pathologic condition of injury to the esophagus caused by regurgitation of gastric or gastroduodenal contents into the lumen of the esophagus. Histopathology of the esophageal mucosa may or may not be present. Gastroesophageal reflux of acid and gastric contents often causes a condition commonly referred to as heartburn. This is characterized as a retro-sternal burning sensation that radiates to the throat and interscapular region. It may be confused, even in the emergency room, with anginal pain or the onset of myocardial infarction; therefore its rapid diagnosis is important. In many patients GERD should be considered a chronic and lifelong illness and maintenance therapy is often needed. Repeated exposure of the esophagus to stomach contents leads to esophagitis. In severe cases, this can actually erode esophageal tissue (erosive esophagitis). In the last five to seven years several new treatment options for GERD have become available. These include antise-cretory agents such as the proton pump inhibitors, and new surgical techniques that have improved Nissen fundoplication safety and efficacy rates(3-4). Clinicians caring for patients with this common disorder need to understand the pathology behind GERD, its common (and uncommon) clinical manifestations, and current treatment options as recommended by the American College of Gastroenterology

Confirmation of SBS 1150+599A As An Extremely Metal-Poor Planetary Nebula

SBS 1150+599A is a blue stellar object at high galactic latitude discovered in the Second Byurakan Survey. New high-resolution images of SBS 1150+599A are presented, demonstrating that it is very likely to be an old planetary nebula in the galactic halo, as suggested by Tovmassian et al (2001). An H-alpha image taken with the WIYN 3.5-m telescope and its "tip/tilt" module reveals the diameter of the nebula to be 9.2", comparable to that estimated from spectra by Tovmassian et al. Lower limits to the central star temperature were derived using the Zanstra hydrogen and helium methods to determine that the star's effective temperature must be > 68,000K and that the nebula is optically thin. New spectra from the MMT and FLWO telescopes are presented, revealing the presence of strong [Ne V] lambda 3425, indicating that the central star temperature must be > 100,000K. With the revised diameter, new central star temperature, and an improved central star luminosity, we can constrain photoionization models for the nebula significantly better than before. Because the emission-line data set is sparse, the models are still not conclusive. Nevertheless, we confirm that this nebula is an extremely metal-poor planetary nebula, having a value for O/H that is less than 1/100 solar, and possibly as low as 1/500 solar.Comment: 19 pages, 6 figures. Accepted for publication in the Astronomical Journa

Plant-Derived Polysaccharide Supplements Inhibit Dextran Sulfate Sodium-Induced Colitis in the Rat

Several plant-derived polysaccharides have been shown to have anti-inflammatory activity in animal models. Ambrotose complex and Advanced Ambrotose are dietary supplements that include aloe vera gel, arabinogalactan, fucoidan, and rice starch, all of which have shown such activity. This study was designed to evaluate these formulations against dextran sulfate sodium (DSS)-induced colitis in rats and to confirm their short-term safety after 14 days of daily dosing. Rats were dosed daily orally with vehicle, Ambrotose or Advanced Ambrotose. On day six groups of rats received tap water or 5% Dextran Sulfate sodium. Ambrotose and Advanced Ambrotose significantly lowered the disease scores and partially prevented the shortening of colon length. An increase in monocyte count was induced by dextran sulfate sodium and inhibited by Ambrotose and Advanced Ambrotose. There were no observable adverse effects after 14-day daily doses. The mechanism of action of the formulations against DSS-induced colitis may be related to its effect on monocyte count

The behaviour of repeat visitors to museums: Review and empirical findings

This study presents a theoretical and operational framework for analysing repeat visit to museums. Starting from the literature on repeat visit in tourism, the specificities of these cultural attractions are made explicit through a review of theoretical and applied works. Consistently with previous contributors, the paper suggests that the analysis of actual past behaviours has to be preferred to the one of attitudes. The application of proper econometric models is also remarked in order to put into account individual profiles. Information coming from three techniques is then used in an integrated way in order to provide a more comprehensive view of the phenomenon. Evidence from an ad hoc survey suggests the necessity to give a greater attention to perceived cultural value during the visit, promoting cultural events during the week and addressed to children, and taking care of those visitors that come from far places also through an integrated tourist supply. © 2013 Springer Science+Business Media Dordrecht

Dwarf Elliptical Galaxies

Dwarf elliptical (dE) galaxies, with blue absolute magnitudes typically fainter than $M_B = -16$, are the most numerous type of galaxy in the nearby universe. Tremendous advances have been made over the past several years in delineating the properties of both Local Group satellite dE's and the large dE populations of nearby clusters. We review some of these advances, with particular attention to how well currently available data can constrain 1) models for the formation of dE's, 2) the physical and evolutionary connections between different types of galaxies (nucleated and nonnucleated dE's, compact E's, irregulars, and blue compact dwarfs) that overlap in the same portion of the mass-spectrum of galaxies, 3) the contribution of dE's to the galaxy luminosity functions in clusters and the field, 4) the star-forming histories of dE's and their possible contribution to faint galaxy counts, and 5) the clustering properties of dE's. In addressing these issues, we highlight the extent to which selection effects temper these constraints, and outline areas where new data would be particularly valuable.Comment: 63p, uuencoded compressed postscript, 2/8 figs included, A&A Review in press, request paper copies from [email protected], STScI 86

Circulating microRNAs in sera correlate with soluble biomarkers of immune activation but do not predict mortality in ART treated individuals with HIV-1 infection: A case control study

Introduction: The use of anti-retroviral therapy (ART) has dramatically reduced HIV-1 associated morbidity and mortality. However, HIV-1 infected individuals have increased rates of morbidity and mortality compared to the non-HIV-1 infected population and this appears to be related to end-organ diseases collectively referred to as Serious Non-AIDS Events (SNAEs). Circulating miRNAs are reported as promising biomarkers for a number of human disease conditions including those that constitute SNAEs. Our study sought to investigate the potential of selected miRNAs in predicting mortality in HIV-1 infected ART treated individuals. Materials and Methods: A set of miRNAs was chosen based on published associations with human disease conditions that constitute SNAEs. This case: control study compared 126 cases (individuals who died whilst on therapy), and 247 matched controls (individuals who remained alive). Cases and controls were ART treated participants of two pivotal HIV-1 trials. The relative abundance of each miRNA in serum was measured, by RTqPCR. Associations with mortality (all-cause, cardiovascular and malignancy) were assessed by logistic regression analysis. Correlations between miRNAs and CD4+ T cell count, hs-CRP, IL-6 and D-dimer were also assessed. Results: None of the selected miRNAs was associated with all-cause, cardiovascular or malignancy mortality. The levels of three miRNAs (miRs -21, -122 and -200a) correlated with IL-6 while miR-21 also correlated with D-dimer. Additionally, the abundance of miRs -31, -150 and -223, correlated with baseline CD4+ T cell count while the same three miRNAs plus miR- 145 correlated with nadir CD4+ T cell count. Discussion: No associations with mortality were found with any circulating miRNA studied. These results cast doubt onto the effectiveness of circulating miRNA as early predictors of mortality or the major underlying diseases that contribute to mortality in participants treated for HIV-1 infection

Development and Validation of a Risk Score for Chronic Kidney Disease in HIV Infection Using Prospective Cohort Data from the D:A:D Study

Ristola M. on työryhmien DAD Study Grp ; Royal Free Hosp Clin Cohort ; INSIGHT Study Grp ; SMART Study Grp ; ESPRIT Study Grp jäsen.Background Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. Methods and Findings A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with >= 3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1: 393 chance of developing CKD in the next 5 y in the low risk group (risk score = 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria. Conclusions Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.Peer reviewe