Fate of the esophagogastric anastomosis

ObjectiveThe study objective was to evaluate histopathology of the esophagogastric anastomosis after esophagectomy, determine time trends of histologic changes, and identify factors influencing those findings.MethodsA total of 231 patients underwent 468 upper gastrointestinal endoscopies with anastomotic biopsy a median of 3.5 years after esophagectomy. Mean age was 59 ± 12 years, 74% (171) were male, and 96% (222) were white. Seventy-eight percent (179) had esophagectomy for cancer, 13% (30) had chemoradiotherapy, and 13% (30) had prior esophageal surgery. The anastomosis was 20 ± 2.0 cm from the incisors. Anti-reflux medications were used in 59% of patients (276/468) at esophagoscopy. Histopathology was graded as normal (0), consistent with reflux (1), cardia mucosa (2), intestinal metaplasia (3), and dysplasia (4). Repeated-measures nonlinear time-trend analysis and multivariable analyses were used.ResultsGrades 0 and 1 were constant, 5% and 92% at 10 years, respectively. Anti-reflux medication, induction therapy, and higher anastomosis were predictive of less grade 1 histopathology. Grades 2 and 3 increased with time: 12% and 33% at 5 years and 4% and 16% at 10 years, respectively. No variable was predictive of grade 2 or 3 (P > .15) except passage of time. No patient’s condition progressed to dysplasia or cancer.ConclusionsThe esophagogastric anastomosis is subject to gastroesophageal reflux. To minimize histopathologic changes of reflux, the anastomosis should be constructed as high as possible (closer to incisors) and anti-reflux medications prescribed. Surveillance endoscopy, if performed, will document a time-related progression of reflux-related histopathologic changes. However, during surveillance, intestinal metaplasia is uncommon and progression to cancer rare

Bone Marrow Stem Cell Treatment for Ischemic Heart Disease in Patients with No Option of Revascularization: A Systematic Review and Meta-Analysis

PMCID: PMC3686792This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Enhanced Antimicrobial activities of Hybrid ZnMgAlO nanocomposite by soft chemical method

In the present investigation, ZnMgAlO nanoparticles were prepared by soft chemical method.  The synthesized NPs were analyzed by XRD and SEM EDAX. ZnMgAlO crystal structure was confirmed through powder XRD technique as hexagonal wurtzite structure. The surface morphology was analyzed from SEM images. Finally, antimicrobial activity of all the synthesized samples was tested against Bacillus subtilis and Chlamydia trachomatis bacteria and Xylaria hypoxylon, Fistulina hepatica fungus. The observed results showed good anti-bacterial and anti-fungal activities. Â

Effect of exercise intervention on vestibular related impairments in hearing-impaired children

Objective: To analyze the methodological quality and compile the evidence from studies, which examined the efficacy of exercise interventions in the treatment of vestibular-related deficits in hearing-impaired children.Sources: Extensive search of computerized bibliographic databases (MEDLINE, CINHAL, EMBASE, SCOPUS, ISI of web science, Cochrane Library, and AMED) was performed from earliest to February 7, 2011.Data extraction: Potential articles were retained and analyzed by a single investigator to ensure the eligibility criteria. Methodological quality was analyzed using the PEDro scale.Results: Our search yielded 8326 articles. Finally, two potential citations were retained for inclusion after removing duplicates, and excluding articles that do not fulfill the criteria.Conclusion: Exercise programs that enhances the visual–motor and somatosensory abilities that enable substitution are more effective in improving the vestibular related deficits in children with hearing-impairment.Keywords: Vestibular impairment/hypofunction; Exercise/rehabilitation; Hearing impairment; Children; Review (publication type

The Manual Ability Classification System: A Scoping Review

PURPOSE: To examine the use of the Manual Ability Classification System (MACS) and to identify gaps in the literature by conducting a thorough search of existing publications from 2006 to March 2013. METHODS: An extensive literature search included 15 databases, using the search terms Manual Ability Classification System or MACS to retrieve relevant abstracts. RESULTS: A total of 161 articles were identified for final inclusion. The review identified literature that supports the reliability, validity, and stability of the MACS. CONCLUSIONS: The MACS could be considered as a standard classification for children with cerebral palsy on the basis of manual abilities. The MACS can be reliably used for children between 4 and 18 years and adults between 18 and 24 years. The use of the MACS is expected to increase; further work is required to explore the use of the MACS in clinical practice

Cardiac resynchronization therapy in heart failure patients: An update

Heart failure continues to be a major public health problem with high morbidity and mortality rates, despite the advances in medical treatment. Advanced heart failure patients have severe persistent symptoms and a poor quality of life. Cardiac resynchronization therapy (CRT), an invasive therapy which involves synchronized pacing of both right and left ventricles, improves ventricular conduction delay and left ventricular performance. Several clinical trials of CRT in medically refractory heart failure patients with wide QRS (> 120 ms), left ventricular ejection fraction &#163; 35% and New York Heart Association (NYHA) class III and IV have shown improved quality of life, NYHA class, left ventricular ejection fraction and reduced mortality. About 30% of heart failure patients who receive CRT do not respond to treatment. Mechanical dyssynchrony may play a role in identifying patients who may respond better to CRT treatment. However, recent large scale clinical trials PROSPECT and RethinQ have challenged this concept. The role of CRT in heart failure patients with narrow QRS (< 120 ms), NYHA class I and II, atrioventricular nodal ablation in patients with atrial fibrillation and triple site pacing are evolving. Our review discusses the current evidence, indications, upcoming trials and future directions

Brain Neoplasm Classification & Detection of Accuracy on MRI Images

The abnormal, uncontrolled cell growth in the brain, commonly known n as a brain tumor, can lead to immense pressure on the various nerves and blood vessels, causing irreversible harm to the body. Early detection of brain tumors is the key to avoiding such compilations. Tumour detection can be done through various advanced Machine Learning and Image Processing algorithms. Mind Brain tumors have demonstrated testing to treat, to a great extent inferable from the organic qualities of these diseases, which frequently plan to restrict progress. To begin with, by invading one of the body's most significant organs, these growths are much of the time situated past the compass of even the most gifted neurosurgeon. These cancers are likewise situated behind the blood-cerebrum boundary (BBB), a tight intersection and transport proteins that shield fragile brain tissues from openness to factors in the overall flow, subsequently obstructing openness to foundational chemotherapy [6,7]. Besides, the interesting formative, hereditary, epigenetic and micro environmental elements of the cerebrum much of the time render these tumors impervious to ordinary and novel medicines. These difficulties are accumulated by the uncommonness of cerebrum growths comparative with numerous different types of disease, restricting the degree of subsidizing and interest from the drug business and drawing in a moderately little and divided research local area

Predictors of coronary artery disease in patients with left bundle branch block who undergo myocardial perfusion imaging

Background: Due to difficulties in diagnosing coronary ischemia in patients with left bundle branch block (LBBB), identifying clinical characteristics that might help to predict coronary artery disease (CAD) is important. Our study aimed to identify clinical predictors of CAD among patients with and without LBBB who undergo myocardial perfusion imaging (MPI). Methods: All patients with LBBB who underwent MPI (LBBB group) from June 2005 to February 2007 were compared with patients with normal baseline electrocardiography who underwent treadmill MPI (non-LBBB group) during the same period. Results: LBBB patients with CAD were younger and had lower ejection fraction (EF) compared to LBBB patients without CAD. Similarly non-LBBB patients with CAD had lower EF, but did not differ significantly in age compared to non-LBBB patients without CAD. Regression analysis among patients with LBBB showed that EF < 55% was the most significant predictor of CAD, after controlling for other factors. A regression analysis in non-LBBB patients showed that male gender and EF &#163; 55% were significant predictors of CAD. A regression analysis conducted in the combined data of both LBBB and non-LBBB groups showed male gender, EF &#163; 55% and LBBB to be the most significant predictors of CAD. Conclusions: Patients with LBBB have a high probability of CAD based on MPI findings. Patients with LBBB and reduced EF have a much higher likelihood of CAD compared to patients without LBBB and normal EF. Further studies on early invasive approach in patients with LBBB and reduced EF seem warranted