Correlation between oesophageal acid exposure and dyspeptic symptoms in patients with nonerosive reflux disease.

Oesophageal acidification induces dyspeptic symptoms in healthy individuals. This study aimed to evaluate the correlation between oesophageal acid exposure and dyspeptic symptoms in patients with nonerosive reflux disease. METHODS: A total of 68 patients with dominant symptoms of heartburn, negative upper gastrointestinal endoscopy and concomitant dyspeptic symptoms participated in the study. The severity of dyspepsia and reflux-related symptoms was evaluated, and 24-h gastro-oesophageal pH-monitoring study was performed in all patients at baseline and after 4 weeks of therapy with esomeprazole 40 mg. RESULTS: Oesophageal basal acid exposure was pathological in 43 patients and normal in 25 patients, with a similar prevalence and severity of individual dyspeptic symptoms in the two groups. A significant correlation between reflux and dyspepsia scores was observed in the subgroup of patients with normal, but not in those with abnormal pHmetry (r=0.4, P=0.04 and r=0.2 P=0.07, respectively). After esomeprazole, a reduction in severity of dyspepsia (>or=50% with respect to baseline) was observed, independent of improvement of reflux-associated symptoms. Improvement in dyspepsia was, however, similar in patients with normal and abnormal basal acid exposure (14/25 vs. 33/43, respectively, P=NS). CONCLUSION: Dyspeptic symptoms coexist in a subset of nonerosive reflux disease patients, but prevalence and severity of the symptoms seems to be independent of oesophageal acid exposure

Trophic effects of sponge feeding within Lake Baikal\u27s littoral zone .2. Sponge abundance, diet, feeding efficiency, and carbon flux

Endemic freshwater demosponges in the littoral zone of Lake Baikal, Russia, dominate the benthic biomass, covering 44% of the benthos. We measured in situ sponge abundance and,orating and calculated sponge-mediated Fluxes of picoplankton (plankton \u3c2 mu m) for two common species, Baikalospongia intermedia and Baikalospongia bacillifera. By means of dual-beam how cytometry, we found retention efficiencies ranging from 58 to 99% for four types of picoplankton: heterotrophic bacteria, Synechococcus-type cyanobacteria, autotrophic picoplankton with one chloroplast, and autotrophic picoplankton with two chloroplasts. By using a general model for organism-mediated fluxes, we conservatively estimate that through active suspension feeding, sponges are a sink for 1.97 g C d(-1) m(-1), mostly from procaryotic cell types. Furthermore, grazing by these extensive sponge communities can create a layer of picoplankton-depleted water overlying the benthic community in this unique lake

Psychology and hereditary angioedema: A systematic review

Background: Hereditary angioedema (HAE) is caused by mutations in the C1 inhibitor (C1-INH) gene Serpin Family G Member 1(SERPING1), which results in either the decreased synthesis of normal C1-INH (C1-INH–HAE type I) or expression of unfunctional C1-INH (C1-INH–HAE type II). In recent studies, emotional stress was reported by patients as the most common trigger factor for C1-INH–HAE attacks. Moreover, patients reported considerable distress over the significant variability and uncertainty with which the disease manifests, in addition to the impact of physical symptoms on their overall quality of life. Objective: We did a systematic review of the literature to shed light on the advancements made in the study of how stress and psychological processes impact C1-INH–HAE. Methods: All of the articles on C1-INH–HAE were analyzed up to December 2019. Both medical data bases and psychological data bases were examined. The keywords (KWs) used for searching the medical and psychological data bases were the following: “hereditary angioedema,” “psychology,” “stress,” “anxiety,” and “depression.” Results: Of a total of 2549 articles on C1-INH–HAE, 113 articles were retrieved from the literature search by using the related KWs. Twenty-one of these articles were retrieved, examined, and classified. Conclusion: Although the literature confirmed that stress may induce various physical diseases, it also warned against making simplistic statements about its incidence that did not take into account the complexity and multicausality of factors that contribute to C1-INH–HAE expression

Does Heterogeneity Exist in Treatment Associations With Renin–Angiotensin–System Inhibitors or Beta-blockers According to Phenotype Clusters in Heart Failure with Preserved Ejection Fraction?

BACKGROUND: We explored the association between use of renin–angiotensin system inhibitors and beta-blockers, with mortality/morbidity in 5 previously identified clusters of patients with heart failure with preserved ejection fraction (HFpEF). METHODS AND RESULTS: We analyzed 20,980 patients with HFpEF from the Swedish HF registry, phenotyped into young–low comorbidity burden (12%), atrial fibrillation–hypertensive (32%), older–atrial fibrillation (24%), obese–diabetic (15%), and a cardiorenal cluster (17%). In Cox proportional hazard models with inverse probability weighting, there was no heterogeneity in the association between renin–angiotensin system inhibitor use and cluster membership for any of the outcomes: cardiovascular (CV) mortality, all-cause mortality, HF hospitalisation, CV hospitalisation, or non-CV hospitalisation. In contrast, we found a statistical interaction between beta-blocker use and cluster membership for all-cause mortality (P = .03) and non-CV hospitalisation (P = .001). In the young–low comorbidity burden and atrial fibrillation–hypertensive cluster, beta-blocker use was associated with statistically significant lower all-cause mortality and non-CV hospitalisation and in the obese–diabetic cluster beta-blocker use was only associated with a statistically significant lower non-CV hospitalisation. The interaction between beta-blocker use and cluster membership for all-cause mortality could potentially be driven by patients with improved EF. However, patient numbers were diminished when excluding those with improved EF and the direction of the associations remained similar. CONCLUSIONS: In patients with HFpEF, the association with all-cause mortality and non-CV hospitalisation was heterogeneous across clusters for beta-blockers. It remains to be elucidated how heterogeneity in HFpEF could influence personalized medicine and future clinical trial design

Effect of Appendectomy on ClinicalCourse of Diverticulosis

Diverticulitis is a common condition where inflammation seems to play a key role in all forms of the disease. Since diverticular disease, in some cases, exhibits clinical and histopathologic similarities with the idiopathic inflammatory bowel disease, could have in common, with these some environmental risk factors, as appendectomy, that could interfere with the natural history of diverticular disease. Since the prevalence and the role of appendectomy in patients with colonic diverticula has not been defined, the aim of this study was to evaluate the prevalence of appendectomy, both in uncomplicated diverticular disease and in patients with diverticulitis. Two hundred and seven consecutive patients with verified diagnosis of diverticular disease of the colon were enrolled. Diagnosis of diverticulitis was defined by means of clinical, colonoscopic, and computerised tomography criteria. Logistic regression was used to describe the relation between the dependent variable (diverticulitis) and several covariates: sex, age (60), BMI (26), and history of appendectomy (emergency or elective appendectomy). We included the first order interactions in the model to assess the effect of each variable for a particular degree of the others covariates. Statistical analysis was performed using SPSS software. Results: The first order interactions did not show a relevant effect (p>0.10) and therefore were excluded from the logistic model. Sex (p=0.88), BMI (p=0.80), elective appendectomy (p=0.17), age (p=0,11), do not affect significantly, either as an independent variable or as a confounder, the risk of development of diverticulitis, and therefore were also excluded from the model. According to the final model the risk of diverticulitis is 4,94 fold higher (95% confidence interval: 1.98 to 12.37) in patients with history of appendectomy with emergency operative treatment, compared with patients without appendectomy or history of elective resection (p<0.001. Conclusions: The risk of diverticulitis does not increase in patients with elective appendectomy, therefore only patients with emergency appendectomy have an increased risk of diverticuliti

Discovering Distinct Phenotypical Clusters in Heart Failure Across the Ejection Fraction Spectrum: a Systematic Review

Review Purpose: This systematic review aims to summarise clustering studies in heart failure (HF) and guide future clinical trial design and implementation in routine clinical practice. Findings: 34 studies were identified (n = 19 in HF with preserved ejection fraction (HFpEF)). There was significant heterogeneity invariables and techniques used. However, 149/165 described clusters could be assigned to one of nine phenotypes: 1) young, low comorbidity burden; 2) metabolic; 3) cardio-renal; 4) atrial fibrillation (AF); 5) elderly female AF; 6) hypertensive-comorbidity; 7) ischaemic-male; 8) valvular disease; and 9) devices. There was room for improvement on important methodological topics for all clustering studies such as external validation and transparency of the modelling process. Summary: The large overlap between the phenotypes of the clustering studies shows that clustering is a robust approach for discovering clinically distinct phenotypes. However, future studies should invest in a phenotype model that can be implemented in routine clinical practice and future clinical trial design. Graphical Abstract: HF = heart failure, EF = ejection fraction, HFpEF = heart failure with preserved ejection fraction, HFrEF = heart failure with reduced ejection fraction, CKD = chronic kidney disease, AF = atrial fibrillation, IHD = ischaemic heart disease, CAD = coronary artery disease, ICD = implantable cardioverter-defibrillator, CRT = cardiac resynchronization therapy, NT-proBNP = N-terminal pro b-type natriuretic peptide, BMI = Body Mass Index, COPD = Chronic obstructive pulmonary disease

Phosphorus species in sequentially extracted soil organic matter fractions

The majority of organic P (Porg) in soil is considered to be part of soil organic matter (SOM) associations, but its chemical nature is largely ‘unresolved’. In this study, we investigated the Porg composition in different SOM fractions of a Gleysol soil using the Humeomics sequential chemical fractionation (SCF) procedure combined with nuclear magnetic resonance (NMR) spectroscopy. In summary, SCF procedure with subsequent NaOH-EDTA extraction of the soil residue extracted a total of 1769 mg P/kgsoil compared to 1682 mg P/kgsoil of a single-step NaOH-EDTA extraction. Approximately 38 % of the extracted Porg was present in the form of the unresolved Porg pool, which was represented by one or two underlying broad signals in the phosphomonoester region of solution 31P NMR spectra. The SCF revealed that phosphomonoesters were recovered in each fraction: 47 % of the unresolved phosphomonoesters were associated with the SOM fraction released by breaking ester bonds (40 %) and ether bonds (7 %), whereas about 30 % of this unresolved Porg pool appeared in the SOM fraction closely associated with the soil mineral phase. Furthermore, the extractability of inositol phosphates (IP) was increased from 312 mg P/kgsoil to 534 mg P/kgsoil (factor 1.7) using the SCF procedure compared to a single-step NaOH-EDTA extraction. Previous studies have reported the presence of IP in molecular size fractions greater than 10 kDa. Our findings on the removal of IP with the fractionation of the SOM could explain the presence of IP in these large associations. We demonstrate that major pools of Porg are closely associated with SOM structures, comprising a diverse array of chemical species and bonding types. These results forward our understanding of Porg stabilisation, P transformation, and P cycling in terrestrial ecosystems towards an association point of view

A Hybrid Global Minimization Scheme for Accurate Source Localization in Sensor Networks

We consider the localization problem of multiple wideband sources in a multi-path environment by coherently taking into account the attenuation characteristics and the time delays in the reception of the signal. Our proposed method leaves the space for unavailability of an accurate signal attenuation model in the environment by considering the model as an unknown function with reasonable prior assumptions about its functional space. Such approach is capable of enhancing the localization performance compared to only utilizing the signal attenuation information or the time delays. In this paper, the localization problem is modeled as a cost function in terms of the source locations, attenuation model parameters and the multi-path parameters. To globally perform the minimization, we propose a hybrid algorithm combining the differential evolution algorithm with the Levenberg-Marquardt algorithm. Besides the proposed combination of optimization schemes, supporting the technical details such as closed forms of cost function sensitivity matrices are provided. Finally, the validity of the proposed method is examined in several localization scenarios, taking into account the noise in the environment, the multi-path phenomenon and considering the sensors not being synchronized

Survival and Prognostic Factors in Cats with Restrictice Cardiomyoathy : A Review of 103 Cases

Restrictive cardiomyopathy (RCM), which approximately accounts for 20% of referred feline (CMs), is a primary myocardial disorder characterized by diastolic dysfunction and a poor prognosis. Large studies focusing on RCM in the cat are scant. The aims of this retrospective study were to describe epidemiological characteristics and to analyze prognostic factors affecting survival in cats with RCM. The clinical archives of the Clinica Veterinaria Gran Sasso (Italy) and of the cardiology unit of DIMEVET (University of Milan, Italy) from 1997 to 2015 were reviewed for all cats diagnosed with RCM based on an echocardiographic exam. The diagnosis was based on distinctive echocardiographic phenotype of left atrial/biatrial enlargement, normal left ventricular (LV) wall thickness, and restrictive LV filling pattern with pulsed Doppler echocardiography. Inclusion criteria were any patient with a complete case record and an echocardiographic diagnosis of RCM. Cats diagnosed with another form of cardiomyopathies CMs, with congenital heart disease, with hypertension or hyperthyroidism or those with incomplete case records were excluded. Follow-up status and cause of death were determined by reviewing the medical records or by phone interviews with the owners. One hundred three cats (61 male and 42 female) were included in the study with a mean age of 10 years (SD 4.45) and a median weight of 3.8 kg (IQR 3.2-5 kg); most of the cats were domestic shorthair (67%) or Persians (18%). Almost all cats were showing clinical signs (96%). Dyspnea was the most common clinical sign, being evident in 82.5% of the cats. Dyspnea was attributable to pleural effusion (PE) in 50 cats, pulmonary edema in 22 cats and both in 13 cats. Hind limb paresis or paralysis due to aortic thromboembolism was evident in 14 cats. Follow-up information was available for 67 cats. Median survival time (MST) in cats with RCM was 133 days. A statistically significant different (p=0.004) MST was identified in cats with dyspnea (68 days) and in cats without dyspnea (731 days). Likewise a statistically significant (p=0.004) different MST was identified in cats with PE (68 days) and in cats without PE (186 days). MST of cats with dyspnea/PE is in this study significantly shorter than MST in cats without dyspnea/PE. The present results confirmed that cats with RCM had short survival time (MST 133 days), but worse prognosis should be prospected to the owner in cats with dyspnea or PE. Better prognosis may be prospected only in cats without dyspnea