Endoscopic anterior fundoplication with the Medigus Ultrasonic Surgical Endostapler (MUSE™) for gastroesophageal reflux disease: 6-month results from a multi-center prospective trial

BACKGROUND: Both long-term proton pump inhibitor (PPI) use and surgical fundoplication have potential drawbacks as treatments for chronic gastroesophageal reflux disease (GERD). This multi-center, prospective study evaluated the clinical experiences of 69 patients who received an alternative treatment: endoscopic anterior fundoplication with a video- and ultrasound-guided transoral surgical stapler. METHODS: Patients with well-categorized GERD were enrolled at six international sites. Efficacy data was compared at baseline and at 6 months post-procedure. The primary endpoint was a ≥ 50 % improvement in GERD health-related quality of life (HRQL) score. Secondary endpoints were elimination or ≥ 50 % reduction in dose of PPI medication and reduction of total acid exposure on esophageal pH probe monitoring. A safety evaluation was performed at time 0 and weeks 1, 4, 12, and 6 months. RESULTS: 66 patients completed follow-up. Six months after the procedure, the GERD-HRQL score improved by >50 % off PPI in 73 % (48/66) of patients (95 % CI 60-83 %). Forty-two patients (64.6 %) were no longer using daily PPI medication. Of the 23 patients who continued to take PPI following the procedure, 13 (56.5 %) reported a ≥ 50 % reduction in dose. The mean percent of total time with esophageal pH <4.0 decreased from baseline to 6 months (P < 0.001). Common adverse events were peri-operative chest discomfort and sore throat. Two severe adverse events requiring intervention occurred in the first 24 subjects, no further esophageal injury or leaks were reported in the remaining 48 enrolled subjects. CONCLUSIONS: The initial 6-month data reported in this study demonstrate safety and efficacy of this endoscopic plication device. Early experience with the device necessitated procedure and device changes to improve safety, with improved results in the later portion of the study. Continued assessment of durability and safety are ongoing in a three-year follow-up study of this patient group

Influence of Neutron Enrichment on Disintegration Modes of Compound Nuclei

Cross sections, kinetic energy and angular distributions of fragments with charge 6$\le$Z$\le$28 emitted in 78,82Kr+40C at 5.5 MeV/A reactions were measured at the GANIL facility using the INDRA apparatus. This experiment aims to investigate the influence of the neutron enrichment on the decay mechanism of excited nuclei. Data are discussed in comparison with predictions of transition state and Hauser-Feshbach models.Comment: 8 pages, 1 figure, paper presented at the First Workshop on "State of the Art in Nuclear Cluster Physics" 13-16 May, 2008, at Strasbourg, France (SOTANCP2008) and accepted for publication at International Journal of Modern Physics E (Special Issue), Proceedings of SOTANCP2008 (to be published

Epidemiologic and clinical updates on impulse control disorders: a critical review

The article reviews the current knowledge about the impulse control disorders (ICDs) with specific emphasis on epidemiological and pharmacological advances. In addition to the traditional ICDs present in the DSM-IV—pathological gambling, trichotillomania, kleptomania, pyromania and intermittent explosive disorder—a brief description of the new proposed ICDs—compulsive–impulsive (C–I) Internet usage disorder, C–I sexual behaviors, C–I skin picking and C–I shopping—is provided. Specifically, the article summarizes the phenomenology, epidemiology and comorbidity of the ICDs. Particular attention is paid to the relationship between ICDs and obsessive–compulsive disorder (OCD). Finally, current pharmacological options for treating ICDs are presented and discussed

Retrospective evaluation of whole exome and genome mutation calls in 746 cancer samples

Funder: NCI U24CA211006Abstract: The Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC) curated consensus somatic mutation calls using whole exome sequencing (WES) and whole genome sequencing (WGS), respectively. Here, as part of the ICGC/TCGA Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium, which aggregated whole genome sequencing data from 2,658 cancers across 38 tumour types, we compare WES and WGS side-by-side from 746 TCGA samples, finding that ~80% of mutations overlap in covered exonic regions. We estimate that low variant allele fraction (VAF < 15%) and clonal heterogeneity contribute up to 68% of private WGS mutations and 71% of private WES mutations. We observe that ~30% of private WGS mutations trace to mutations identified by a single variant caller in WES consensus efforts. WGS captures both ~50% more variation in exonic regions and un-observed mutations in loci with variable GC-content. Together, our analysis highlights technological divergences between two reproducible somatic variant detection efforts

Theory of the Nudnik: The Future of Consumer Activism and What We Can Do to Stop It

How do consumers hold sellers accountable and enforce market norms? This Article contributes to our understanding of consumer markets in three ways. First, the Article identifies the role of a small subset of consumers—the titular “nudniks”—as engines of market discipline. Nudniks are those who call to complain, speak with managers, post online reviews, and file lawsuits. Typified by an idiosyncratic utility function and certain unique personality traits, nudniks pursue action where most consumers remain passive. Although derided in courtrooms and the court of public opinion, we show that nudniks can solve consumer collective action problems, leading to broad market improvements. Second, the Article spotlights a disconcerting development: sellers’ growing usage of big data and predictive analytics allows them to identify specific consumers as potential nudniks and then disarm or avoid selling to them before they can draw attention to sellers’ misconduct. The Article therefore captures an understudied problem with big data tools: sellers can use these tools to shield themselves from market accountability. Finally, the Article evaluates a menu of legal strategies that would preserve the benefits of nudnik-based activism in light of these technological developments. In the process, we revisit the conventional wisdom on the desirability of form contracts, mandatory arbitration clauses, defamation law, and standing doctrines

Theory of the Nudnik: The Future of Consumer Activism and What We Can Do to Stop It

How do consumers hold sellers accountable and enforce market norms This Article contributes to our understanding of consumer markets in three ways First The Article identifies the role of a small subset of consumers ” the titular ˜nudniks\u27 ” as engines of market discipline Nudniks are those who call to complain speak with managers post online reviews and file lawsuits Typified by an idiosyncratic utility function and personality traits nudniks pursue action where most consumers remain passive Although derided in courtrooms and the court of public opinion we show that nudniks can solve consumer collective action problems thereby leading to broad market improvementsbrbrSecond the Article spotlights a disconcerting development Sellers\u27 growing usage of Big Data and predictive analytics allows them to identify specific consumers as potential nudniks and avoid selling to or disarm them before they can draw attention to sellers\u27 misconduct The Article therefore captures an understudied problem with Big Data tools sellers can use these tools to shield themselves from market accountability brbrFinally the Article evaluates a menu of legal strategies that would preserve the benefits of nudnikbased activism in light of these technological developments In the process we revisit the conventional wisdom on the desirability of form contracts mandatory arbitration clauses defamation law and standing doctrine