Anorectal motility in patients with achalasia of the esophagus: recognition of an esophago-rectal syndrome

BACKGROUND: During my study of constipation, I encountered patients who had achalasia of the esophagus (AE) as well. The possibility of an existing relationship between the 2 conditions was studied. METHOD: Investigations to study the anorectal motility in 9 AE patients included: the intestinal transit time, anorectal manometry, rectoanal inhibitory reflex, defecography and electromyography (EMG) of external anal sphincter and levator ani muscle. Anorectal biopsy was done. The study comprised 8 healthy volunteers as controls. RESULTS: 6/9 AE patients had constipation presenting as strainodynia (excessive prolonged straining at stool). Rectocele was present in 4 of them. The 6 constipated patients showed significantly high rectal neck pressure (p < 0.05), absent rectoanal inhibitory reflex and aganglionosis in the anorectal biopsy. The EMG revealed diminished activity in 4 of the 6 constipated patients. The remaining 3 patients with AE had normal anorectal function. Heller's myotomy with Nissen's fundoplication improved the dysphagia, but not the constipation which was, however, relieved after performance of anorectal myectomy. CONCLUSION: The high incidence of constipation with AE postulates a relationship between the 2 conditions. Both have the same pathologic lesion which is aganglionosis. This study is preliminary and requires further studies on a larger number of patients

Abnormal expression of p27kip1 protein in levator ani muscle of aging women with pelvic floor disorders – a relationship to the cellular differentiation and degeneration

BACKGROUND: Pelvic floor disorders affect almost 50% of aging women. An important role in the pelvic floor support belongs to the levator ani muscle. The p27/kip1 (p27) protein, multifunctional cyclin-dependent kinase inhibitor, shows changing expression in differentiating skeletal muscle cells during development, and relatively high levels of p27 RNA were detected in the normal human skeletal muscles. METHODS: Biopsy samples of levator ani muscle were obtained from 22 symptomatic patients with stress urinary incontinence, pelvic organ prolapse, and overlaps (age range 38–74), and nine asymptomatic women (age 31–49). Cryostat sections were investigated for p27 protein expression and type I (slow twitch) and type II (fast twitch) fibers. RESULTS: All fibers exhibited strong plasma membrane (and nuclear) p27 protein expression. cytoplasmic p27 expression was virtually absent in asymptomatic women. In perimenopausal symptomatic patients (ages 38–55), muscle fibers showed hypertrophy and moderate cytoplasmic p27 staining accompanied by diminution of type II fibers. Older symptomatic patients (ages 57–74) showed cytoplasmic p27 overexpression accompanied by shrinking, cytoplasmic vacuolization and fragmentation of muscle cells. The plasma membrane and cytoplasmic p27 expression was not unique to the muscle cells. Under certain circumstances, it was also detected in other cell types (epithelium of ectocervix and luteal cells). CONCLUSIONS: This is the first report on the unusual (plasma membrane and cytoplasmic) expression of p27 protein in normal and abnormal human striated muscle cells in vivo. Our data indicate that pelvic floor disorders are in perimenopausal patients associated with an appearance of moderate cytoplasmic p27 expression, accompanying hypertrophy and transition of type II into type I fibers. The patients in advanced postmenopause show shrinking and fragmentation of muscle fibers associated with strong cytoplasmic p27 expression

Comparison of Psychological Distress between Type 2 Diabetes Patients with and without Proteinuria

We investigated the link between proteinuria and psychological distress among patients with type 2 diabetes mellitus (T2DM). A total of 130 patients with T2DM aged 69.1±10.3 years were enrolled in this cross-sectional study. Urine and blood parameters, age, height, body weight, and medications were analyzed, and each patient’s psychological distress was measured using the six-item Kessler Psychological Distress Scale (K6). We compared the K6 scores between the patients with and without proteinuria. Forty-two patients (32.3%) had proteinuria (≥±) and the level of HbA1c was 7.5±1.3%. The K6 scores of the patients with proteinuria were significantly higher than those of the patients without proteinuria even after adjusting for age and sex. The clinical impact of proteinuria rather than age, sex and HbA1c was demonstrated by a multiple regression analysis. Proteinuria was closely associated with higher psychological distress. Preventing and improving proteinuria may reduce psychological distress in patients with T2DM

History of oceanic front development in the New Zealand sector of the Southern Ocean during the Cenozoic--a synthesis

The New Zealand sector of the Southern Ocean (NZSSO) has opened about the Indian-Pacific spreading ridge throughout the Cenozoic. Today the NZSSO is characterised by broad zonal belts of antarctic (cold), subantarctic (cool), and subtropical (warm) surface-water masses separated by prominent oceanic fronts: the Subtropical Front (STF) c. 43deg.S, Subantarctic Front (SAF) c. 50deg.S, and Antarctic Polar Front (AAPF) c. 60deg.S. Despite a meagre database, the broad pattern of Cenozoic evolution of these fronts is reviewed from the results of Deep Sea Drilling Project-based studies of sediment facies, microfossil assemblages and diversity, and stable isotope records, as well as from evidence in onland New Zealand Cenozoic sequences. Results are depicted schematically on seven paleogeographic maps covering the NZSSO at 10 m.y. intervals through the Cenozoic. During the Paleocene and most of the Eocene (65-35 Ma), the entire NZSSO was under the influence of warm to cool subtropical waters, with no detectable oceanic fronts. In the latest Eocene (c. 35 Ma), a proto-STF is shown separating subantarctic and subtropical waters offshore from Antarctica, near 65deg.S paleolatitude. During the earliest Oligocene, this front was displaced northwards by development of an AAPF following major global cooling and biotic turnover associated with ice sheet expansion to sea level on East Antarctica. Early Oligocene full opening (c. 31 Ma) of the Tasmanian gateway initiated vigorous proto-circum-Antarctic flow of cold/cool waters, possibly through a West Antarctic seaway linking the southern Pacific and Atlantic Oceans, including detached northwards "jetting" onto the New Zealand plateau where condensation and unconformity development was widespread in cool-water carbonate facies. Since this time, a broad tripartite division of antarctic, subantarctic, and subtropical waters has existed in the NZSSO, including possible development of a proto-SAF within the subantarctic belt. In the Early-early Middle Miocene (25-15 Ma), warm subtropical waters expanded southwards into the northern NZSSO, possibly associated with reduced ice volume on East Antarctica but particularly with restriction of the Indonesian gateway and redirection of intensified warm surface flows southwards into the Tasman Sea, as well as complete opening of the Drake gateway by 23 Ma allowing more complete decoupling of cool circum-Antarctic flow from the subtropical waters. During the late Middle-Late Miocene (15-5 Ma), both the STF and SAF proper were established in their present relative positions across and about the Campbell Plateau, respectively, accompanying renewed ice buildup on East Antarctica and formation of a permanent ice sheet on West Antarctica, as well as generally more expansive and intensified circum-Antarctic flow. The ultimate control on the history of oceanic front development in the NZSSO has been plate tectonics through its influence on the paleogeographic changes of the Australian-New Zealand-Antarctic continents and their intervening oceanic basins, the timing of opening and closing of critical seaways, the potential for submarine ridges and plateaus to exert some bathymetric control on the location of fronts, and the evolving ice budget on the Antarctic continent. The broad trends of the Cenozoic climate curve for New Zealand deduced from fossil evidence in the uplifted marine sedimentary record correspond well to the principal paleoceanographic events controlling the evolution and migration of the oceanic fronts in the NZSSO

Run-time Energy and Time Management for Intermittent LoRaWAN Communications

Intermittent computing, utilising non-volatile memory (NVM) to maintain system state during power outages, addresses the unpredictability of energy harvesting (EH) in Internet of Things (IoT) systems. However, challenges persist, notably in ensuring energy-aware task-based operations and accurate timekeeping during system shutdowns, which impede real-time data collection. To address this, the paper presents an energy and time management unit (ETMU) for intermittent systems, which facilitates task-based operations and timekeeping capabilities using multi-harvest energy sources. This ETMU adjusts energy storage and operating voltage at run-time, meeting the energy needs of specific tasks and startup times while preserving crucial system information during power outages. Furthermore, this ETMU incorporates an ultra-low power real-time clock (RTC), ensuring independent and accurate timekeeping during system power outages.The proposed ETMU is integrated into an intermittent system designed for ultrasonic water flow measurements to demonstrate its functionality. This system incorporates three energy harvesters and utilizes the LoRaWAN communication protocol for data transmission and time synchronization. Experimental results demonstrate the efficient management of intermittent LoRaWAN communications and precise timekeeping for data collection

Capacitive Sensors based on Recycled Carbon Fibre (rCF) Composites

Recycled carbon fibre (rCF) composites are increasingly being explored for applications such as strain sensing, manufacturing of automobile parts, assistive technologies, and structural health monitoring, due to their properties, economic and environmental benefits. The high conductivity of carbon and its wide application for sensing, makes rCF very attractive for integrating sensing into passive structures. In this paper, capacitive sensors have been fabricated using rCF compo-sites of varying compositions. First, we investigated the suitability of recycled carbon fibre pol-ymer composites for different sensing applications. As a proof of concept, we fabricated five touch/proximity sensors and three soil moisture sensors, using recycled carbon fibre composites and their performances compared. The soil moisture sensors were realized using rCF as elec-trodes. This makes them corrosion-resistant and more environmental-friendly compared to conventional soil moisture sensors realized using metallic electrodes. The results of the touch/proximity sensing show an average change in capacitance (ΔC/C~34) for 20mm and (ΔC/C~5) for 100mm, distances of a hand, from the active sensing region. The results of the soil moisture sensors show a stable and repeatable response, with a high sensitivity of ~116pF/ml of water in the linear region. These results demonstrate their respective potential for touch/proximity sensing, as well as smart and sustainable agriculture

Succinct Interactive Oracle Proofs: Applications and Limitations

\textit{Interactive Oracle Proofs} (IOPs) are a new type of proof-system that combines key properties of interactive proofs and PCPs: IOPs enable a verifier to be convinced of the correctness of a statement by interacting with an untrusted prover while reading just a few bits of the messages sent by the prover. IOPs have become very prominent in the design of efficient proof-systems in recent years. In this work we study \textit{succinct IOPs}, which are IOPs in which the communication complexity is polynomial (or even linear) in the original witness. While there are strong impossibility results for the existence of succinct PCPs (i.e., PCPs whose length is polynomial in the witness), it is known that the rich class of NP relations that are decidable in small space have succinct IOPs. In this work we show both new applications, and limitations, for succinct IOPs: \begin{itemize} \item First, using one-way functions, we show how to compile IOPs into zero-knowledge \textit{proofs}, while nearly preserving the proof length. This complements a recent line of work, initiated by Ben~Sasson~\etal{}~(TCC, 2016B), who compile IOPs into super-succinct zero-knowledge \textit{arguments}. Applying the compiler to the state-of-the-art succinct IOPs yields zero-knowledge proofs for bounded-space NP relations, with communication that is nearly equal to the original witness length. This yields the shortest known zero-knowledge proofs from the minimal assumption of one-way functions. \item Second, we give a barrier for obtaining succinct IOPs for more general NP relations. In particular, we show that if a language has a succinct IOP, then it can be decided in \textit{space} that is proportionate only to the witness length, after a bounded-time probabilistic preprocessing. We use this result to show that under a simple and plausible (but to the best of our knowledge, new) complexity-theoretic conjecture, there is no succinct IOP for CSAT. \end{itemize

The Ethics of Ethics Reviews in Global Health Research: Case Studies Applying a New Paradigm

With increasing calls for global health research there is growing concern regarding the ethical challenges encountered by researchers from high-income countries (HICs) working in low or middle-income countries (LMICs). There is a dearth of literature on how to address these challenges in practice. In this article, we conduct a critical analysis of three case studies of research conducted in LMICs.We apply emerging ethical guidelines and principles specific to global health research and offer practical strategies that researchers ought to consider. We present case studies in which Canadian health professional students conducted a health promotion project in a community in Honduras; a research capacity-building program in South Africa, in which Canadian students also worked alongside LMIC partners; and a community-university partnered research capacity-building program in which Ecuadorean graduate students, some working alongside Canadian students, conducted community-based health research projects in Ecuadorean communities.We examine each case, identifying ethical issues that emerged and how new ethical paradigms being promoted could be concretely applied.We conclude that research ethics boards should focus not only on protecting individual integrity and human dignity in health studies but also on beneficence and non-maleficence at the community level, explicitly considering social justice issues and local capacity-building imperatives.We conclude that researchers from HICs interested in global health research must work with LMIC partners to implement collaborative processes for assuring ethical research that respects local knowledge, cultural factors, the social determination of health, community participation and partnership, and making social accountability a paramount concern