Erosive Eosinophilic Esophagitis in Rumination Syndrome

Rumination syndrome involves bringing up partially digested food into the pharynx voluntarily, followed by reswallowing or expelling. It was discovered in the 17th century; however, knowledge of the disorder has remained sparse until recently. Indeed, the first case of adult rumination in Japan was reported as recently as 2006. Due to this recent increase in awareness, notions about the disease have remained in a state of constant fluctuation. While first believed to be a disease of neurologically-impaired children between 3 and 8 months of age, it is now widely recognized as occurring in men and women of all ages and cognitive abilities. Originally rumination was labeled benign; however, it is now known to cause such complications as weight loss, malnutrition, dental erosions, halitosis, electrolyte abnormalities, abdominal discomfort, weight loss, choking, aspiration, and pneumonia. Similarly, while the absence of gastroesophageal reflux disease was an original criterion for the syndrome, it has been found that many of these patients have evidence of “pathologic gastroesophageal reflux.” Some suggest that thorough upper gastrointestinal workup, such as upper esophageal barium studies and EGD, not be done on children presenting with rumination, despite the presence of abdominal pain or other accompanying gastrointestinal symptoms. We performed a thorough upper gastrointestinal workup on a patient with concurrent rumination syndrome and heartburn, and were intrigued to find erosive eosinophilic esophagitis on EGD. These lesions were successfully treated with a proton pump inhibitor. The following article is a discussion on the starndard of care in Rumination Syndrome. That is, while knowledge of the disease has evolved, the treatment regimen has not

Neurogenic Fever after Acute Traumatic Spinal Cord Injury: A Qualitative Systematic Review.

STUDY DESIGN: Systematic review. OBJECTIVE: To determine the incidence, pathogenesis, and clinical outcomes related to neurogenic fevers following traumatic spinal cord injury (SCI). METHODS: A systematic review of the literature was performed on thermodysregulation secondary to acute traumatic SCI in adult patients. A literature search was performed using PubMed (MEDLINE), Cochrane Central Register of Controlled Trials, and Scopus. Using strict inclusion and exclusion criteria, seven relevant articles were obtained. RESULTS: The incidence of fever of all origins (both known and unknown) after SCI ranged from 22.5 to 71.7% with a mean incidence of 50.6% and a median incidence of 50.0%. The incidence of fever of unknown origin (neurogenic fever) ranged from 2.6 to 27.8% with a mean incidence of 8.0% and a median incidence of 4.7%. Cervical and thoracic spinal injuries were more commonly associated with fever than lumbar injuries. In addition, complete injuries had a higher incidence of fever than incomplete injuries. The pathogenesis of neurogenic fever after acute SCI is not thoroughly understood. CONCLUSION: Neurogenic fevers are relatively common following an acute SCI; however, there is little in the scientific literature to help physicians prevent or treat this condition. The paucity of research underscored by this review demonstrates the need for further studies with larger sample sizes, focusing on incidence rate, clinical outcomes, and pathogenesis of neurogenic fever following acute traumatic SCI

Vitamin B6 Deficiency and Galactose Induced Alterations in Morphology and Osmotic Fragility of Rat Erythrocytes

Recently, red blood cells have been investigated mainly for alterations in ion transporting capacity, membrane bound enzymes or modifications in the structure of its individual constituents in clinical and experimental urolithiasis. However, the implication of such modifications on the physical state or morphology of cells has not been investigated. Scanning electron microscopic studies performed in vitamin B6 deficient and/or galactose fed rat (established hyperoxaluric models) erythrocytes, showed the presence of large number of stomatocytes, spherocytes and other variously deformed cells as compared to discocytic cells seen in normal control group. These changes in shape were in concurrence with red cell osmotic fragility, which decreased both in vitamin B6 deficient and vitamin B6 deficient + galactose fed group (19% and 33% hemolysis at 4 g/l NaCl, respectively) while it increased in galactose control group (73% hemolysis at 4 g/l NaCl) as compared to normal control group (55 % hemolysis at 4 g/l NaCl). These morphological and physical state alterations could be correlated with red blood cells\u27 membrane cholesterol and phospholipid sub-class distribution. These findings suggest that some structural membrane changes occur due to vitamin B6 deficiency and/or galactose feeding, which may be responsible for the altered membrane functions known to be associated with pathogenesis of urolithiasis

The thermal ignition problem in a cube

Steady state solutions for spontaneous thermal ignition in a unit cube are considered. For the unit sphere there are numerous solutions possible: these appear as ``wiggles'' in the bifurcation diagram. For the unit sphere this has been shown analytically. In contrast, for the unit cube analytic solutions are not possible and hence we must resort to numerical methods to determine the corresponding bifurcation diagram. Comparisons between the cube and the sphere are made

Near simultaneous measurements of NO2 and NO3 over tropics by ground-based absorption spectroscopy

The present study concentrates on measurements of NO2 and NO3. NO2 has been measured during twilight period using zenith sky absorption spectrometric technique in the 436 to 448 nm region. NO3 has been measured during night time using direct moon as a source of light in the 655 to 667 nm region. These measurements have been taken at low latitude station, Ahmedabad (23 deg N, 76 deg E), India for the past two years

Examining the effectiveness of technology use in classrooms: A tertiary meta-analysis

Identifying effective literacy instruction programs has been a focal point for governments, educators and parents over the last few decades (Ontario Ministry of Education, 2004, 2006; Council of Ontario Directors of Education, 2011). Given the increasing use of computer technologies in the classroom and in the home, a variety of information communication technology (ICT) interventions for learning have been introduced. Meta-analyses comparing the impact of these programs on learning, however, have yielded inconsistent findings (Andrews, Freeman, Hou, McGuinn, Robinson, & Zhu, 2007; Slavin, Cheung, Groff, & Lake, 2008; Slavin, Lake, Chambers, Cheung, & Davis, 2009; Torgerson & Zhu, 2003). The present tertiary meta-analytic review re-assesses outcomes presented in three previous meta-analyses. Four moderator variables assessed the impact of the systematic review from which they were retrieved, training and support, implementation fidelity and who delivered the intervention (teacher versus researcher). Significant results were found when training and support was entered as a moderator variable with the small overall effectiveness of the ICTs (ES = 0.18), similar to those found in previous research, increasing significantly (ES = 0.57). These findings indicate the importance of including implementation factors such as training and support, when considering the relative effectiveness of ICT interventions

Ceramide remodeling and risk of cardiovascular events and mortality

BackgroundRecent studies suggest that circulating concentrations of specific ceramide species may be associated with coronary risk and mortality. We sought to determine the relations between the most abundant plasma ceramide species of differing acyl chain lengths and the risk of coronary heart disease (CHD) and mortality in community‐based samples. Methods and ResultsWe developed a liquid chromatography/mass spectrometry assay to quantify plasma C24:0, C22:0, and C16:0 ceramides and ratios of these very–long‐chain/long‐chain ceramides in 2642 FHS (Framingham Heart Study) participants and in 3134 SHIP (Study of Health in Pomerania) participants. Over a mean follow‐up of 6 years in FHS, there were 88 CHD and 90 heart failure (HF) events and 239 deaths. Over a median follow‐up time in SHIP of 5.75 years for CHD and HF and 8.24 years for mortality, there were 209 CHD and 146 HF events and 377 deaths. In meta‐analysis of the 2 cohorts and adjusting for standard CHD risk factors, C24:0/C16:0 ceramide ratios were inversely associated with incident CHD (hazard ratio per average SD increment, 0.79; 95% confidence interval, 0.71–0.89; P<0.0001) and inversely associated with incident HF (hazard ratio, 0.78; 95% confidence interval, 0.61–1.00; P=0.046). Moreover, the C24:0/C16:0 and C22:0/C16:0 ceramide ratios were inversely associated with all‐cause mortality (C24:0/C16:0: hazard ratio, 0.60; 95% confidence interval, 0.56–0.65; P<0.0001; C22:0/C16:0: hazard ratio, 0.65; 95% confidence interval, 0.60–0.70; P<0.0001). ConclusionsThe ratio of C24:0/C16:0 ceramides in blood may be a valuable new biomarker of CHD risk, HF risk, and all‐cause mortality in the community

Combustion waves in a model with chain branching reaction and their stability

In this paper the travelling wave solutions in the adiabatic model with two-step chain branching reaction mechanism are investigated both numerically and analytically in the limit of equal diffusivity of reactant, radicals and heat. The properties of these solutions and their stability are investigated in detail. The behaviour of combustion waves are demonstrated to have similarities with the properties of nonadiabatic one-step combustion waves in that there is a residual amount of fuel left behind the travelling waves and the solutions can exhibit extinction. The difference between the nonadiabatic one-step and adiabatic two-step models is found in the behaviour of the combustion waves near the extinction condition. It is shown that the flame velocity drops down to zero and a standing combustion wave is formed as the extinction condition is reached. Prospects of further work are also discussed.Comment: pages 32, figures 2

Towards the probabilistic analysis of small bowel capsule endoscopy features to predict severity of duodenal histology in patients with villous atrophy

Small bowel capsule endoscopy (SBCE) can be complementary to histological assessment of celiac disease (CD) and serology negative villous atrophy (SNVA). Determining the severity of disease on SBCE using statistical machine learning methods can be useful in the follow up of patients. SBCE can play an additional role in differentiating between CD and SNVA. De-identified SBCEs of patients with CD and SNVA were included. Probabilistic analysis of features on SBCE were used to predict severity of duodenal histology and to distinguish between CD and SNVA. Patients with higher Marsh scores were more likely to have a positive SBCE and a continuous distribution of macroscopic features of disease than those with lower Marsh scores. The same pattern was also true for patients with CD when compared to patients with SNVA. The validation accuracy when predicting the severity of Marsh scores and when distinguishing between CD and SNVA was 69.1% in both cases. When the proportions of each SBCE class group within the dataset were included in the classification model, to distinguish between the two pathologies, the validation accuracy increased to 75.3%. The findings of this work suggest that by using features of CD and SNVA on SBCE, predictions can be made of the type of pathology and the severity of disease