The Rome III Criteria for the Diagnosis of Functional Dyspepsia in Secondary Care Are Not Superior to Previous Definitions

BACKGROUND & AIMS: Although the Rome III criteria for functional dyspepsia were defined 7 years ago, they have yet to be validated in a rigorous study. We addressed this issue in a secondary-care population. METHODS: We analyzed complete symptom, upper gastrointestinal (GI) endoscopy, and histology data from 1452 consecutive adult patients with GI symptoms at 2 hospitals in Hamilton, Ontario, Canada. Assessors were blinded to symptom status. Individuals with normal upper GI endoscopy and histopathology findings from analyses of biopsy specimens were classified as having no organic GI disease. The reference standard used to define the presence of true functional dyspepsia was epigastric pain, early satiety or postprandial fullness, and no organic GI disease. Sensitivity, specificity, and positive and negative likelihood ratios (LRs), with 95% confidence intervals (CIs), were calculated. RESULTS: Of the 1452 patients, 722 (49.7%) met the Rome III criteria for functional dyspepsia. Endoscopy showed organic GI disease in 170 patients (23.5%) who met the Rome III criteria. The Rome III criteria identified patients with functional dyspepsia with 60.7% sensitivity, 68.7% specificity, a positive LR of 1.94 (95% CI, 1.69-2.22), and a negative LR of 0.57 (95% CI, 0.52-0.63). In contrast, the Rome II criteria identified patients with functional dyspepsia with 71.4% sensitivity, 55.6% specificity, a positive LR of 1.61 (95% CI, 1.45-1.78), and a negative LR of 0.51 (95% CI, 0.45-0.58). The area under a receiver operating characteristics curves did not differ significantly for any of the diagnostic criteria for functional dyspepsia. CONCLUSIONS: In a validation study of 1452 patients with GI symptoms, the Rome III criteria performed only modestly in identifying those with functional dyspepsia, and were not significantly superior to previous definitions

On the Linkage between Antarctic Surface Water Stratification and Global Deep-Water Temperature

The suggestion is advanced that the remarkably low static stability of Antarctic surface waters may arise from a feedback loop involving global deep-water temperatures. If deep-water temperatures are too warm, this promotes Antarctic convection, thereby strengthening the inflow of Antarctic Bottom Water into the ocean interior and cooling the deep ocean. If deep waters are too cold, this promotes Antarctic stratification allowing the deep ocean to warm because of the input of North Atlantic Deep Water. A steady-state deep-water temperature is achieved such that the Antarctic surface can barely undergo convection. A two-box model is used to illustrate this feedback loop in its simplest expression and to develop basic concepts, such as the bounds on the operation of this loop. The model illustrates the possible dominating influence of Antarctic upwelling rate and Antarctic freshwater balance on global deep-water temperatures

Prevalence of Dyspepsia in Individuals with Gastro-Esophageal Reflux-Type Symptoms in the Community: A Systematic Review and Meta-Analysis

Background & Aims: Dyspepsia and gastro-esophageal reflux are highly prevalent in the general population, but they are believed to be separate entities. We conducted a systematic review and meta-analysis to estimate the prevalence of dyspepsia in individuals with gastro-esophageal reflux symptoms (GERS), and to quantify overlap between the disorders. Methods: We searched MEDLINE, EMBASE, and EMBASE Classic databases to identify population-based studies reporting the prevalence of dyspepsia and GERS in adults, defined using specific symptom-based criteria or based on answers to questionnaires. We calculated pooled prevalence values, according to study location and criteria used to define weekly GERS or dyspepsia, as well as odds ratios (ORs) with 95% CIs. The degree of overlap between dyspepsia and GERS was examined. Results: Of 14,132 papers evaluated, 79 reported prevalence of weekly GERS. Nineteen of these study populations, comprising 111,459 participants, also reported the proportion of individuals with dyspepsia. The prevalence of dyspepsia in individuals with weekly GERS was 43.9% (95% CI, 35.1–52.9%). The pooled OR for dyspepsia in individuals with weekly GERS, compared with those without, was 6.94 (95% CI, 4.33 to 11.1). The OR for dyspepsia in individuals with weekly GERS was significantly higher in all geographical regions studied and for all diagnostic criteria. The pooled degree of overlap between dyspepsia and GERS was 25.9% (95% CI, 19.9%–32.4%). Conclusion: The odds of dyspepsia in individuals with weekly GERS is almost 7-fold that of individuals without GERS; dyspepsia and GERS overlap in more than 25% of individuals. Reasons for this remain speculative, but might include shared pathophysiological mechanisms or residual confounding factors. However, patients with GERS should be questioned about co-existent dyspepsia, to optimize treatment approaches

The mid-depth circulation of the northwestern tropical Atlantic observed by floats

Author Posting. © The Author(s), 2009. This is the author's version of the work. It is posted here by permission of Elsevier B.V. for personal use, not for redistribution. The definitive version was published in Deep Sea Research Part I: Oceanographic Research Papers 56 (2009): 1615-1632, doi:10.1016/j.dsr.2009.06.002.A comprehensive analysis of velocity data from subsurface floats in the northwestern tropical Atlantic at two depth layers is presented: one representing the Antarctic Intermediate Water (AAIW, pressure range 600–1050 dbar), the other the upper North Atlantic Deep Water (uNADW, pressure range 1200–2050 dbar). New data from three independent research programs are combined with previously available data to achieve blanket coverage in space for the AAIW layer, while coverage in the uNADW remains more intermittent. Results from the AAIW mainly confirm previous studies on the mean flow, namely the equatorial zonal and the boundary currents, but clarify details on pathways, mostly by virtue of the spatial data coverage that sets float observations apart from e. g. shipborne or mooring observations. Mean transports in each of five zonal equatorial current bands is found to be between 2.7 and 4.5 Sv. Pathways carrying AAIW northward beyond the North Brazil Undercurrent are clearly visible in the mean velocity field, in particular a northward transport of 3.7 Sv across 16° N between the Antilles islands and the Mid- Atlantic Ridge. New maps of Lagrangian eddy kinetic energy and integral time scales are presented to quantify mesoscale activity. For the uNADW, mean flow and mesoscale properties are discussed as data availability allows. Trajectories in the uNADWeast of the Lesser Antilles reveal interactions between the Deep Western Boundary Current (DWBC) and the basin interior, which can explain recent hydrographic observations of changes in composition of DWBC water along its southward flow.MOVE was funded by the Bundesministerium fu¨r Bildung und Forschung (grants 03F0246A and 03F0377B) as well as by the Deutsche Forschungsgemeinschaft (grant SE815/21), NBC by the National Science Foundation through grants OCE 97-29765 and OCE 01-36477, and SAMBA was fully supported by Ifremer

The state of the Martian climate

60°N was +2.0°C, relative to the 1981–2010 average value (Fig. 5.1). This marks a new high for the record. The average annual surface air temperature (SAT) anomaly for 2016 for land stations north of starting in 1900, and is a significant increase over the previous highest value of +1.2°C, which was observed in 2007, 2011, and 2015. Average global annual temperatures also showed record values in 2015 and 2016. Currently, the Arctic is warming at more than twice the rate of lower latitudes

SERS-based monitoring of the intracellular pH in endothelial cells:the influence of the extracellular environment and tumour necrosis factor-alpha

The intracellular pH plays an important role in various cellular processes. In this work, we describe a method for monitoring of the intracellular pH in endothelial cells by using surface enhanced Raman spectroscopy (SERS) and 4-mercaptobenzoic acid (MBA) anchored to gold nanoparticles as pH-sensitive probes. Using the Raman microimaging technique, we analysed changes in intracellular pH induced by buffers with acid or alkaline pH, as well as in endothelial inflammation induced by tumour necrosis factor-alpha (TNF alpha). The targeted nanosensor enabled spatial pH measurements revealing distinct changes of the intracellular pH in endosomal compartments of the endothelium. Altogether, SERS-based analysis of intracellular pH proves to be a promising technique for a better understanding of intracellular pH regulation in various subcellular compartments.This work was supported by the National Center of Science (grant PRELUDIUM DEC-2012/05/N/ST4/00218) and by the European Union from the resources of the European Regional Development Fund under the Innovative Economy Programme (grant coordinated by JCET-UJ, no. POIG.01.01.02-00-069/09). We also thank the University of Edinburgh School of Chemistry for the Neil Campbell Travel Award for supporting LJ. We also thank Joanna Jalmuzna from the Department of Mathematics and Computer Sciences, Jagiellonian University in Krakow for fitting the calibration curve using Gnuplot software

Integration of the Pleasant Events and Activity Restriction Models: Development and Validation of a “PEAR” Model of Negative Outcomes in Alzheimer's Caregivers

This study examined an activity restriction/pleasurable activities mismatch model for psychosocial and health-related outcomes. A total of 108 spousal caregivers of patients with Alzheimer's Disease (AD) were assessed for their experience of social and recreational activities over the past month as well as their perception of how restricted they were for engaging in social and recreational activities. Participants were divided into three groups based on their reported activities and activity restriction: HPLR=High Pleasant Events+Low Activity Restriction (i.e., reference group; N=28); HPHR/LPLR=Either High Pleasant Events+High Activity Restriction or Low Pleasant Events+Low Activity Restriction (N=43); LPHR=Low Pleasant Events+High Activity Restriction (N=37). We hypothesized that participants reporting low pleasant events combined with high activity restriction (LPHR) would demonstrate greater disturbance relative to other two groups in multiple outcome domains, including: (a) greater mood disturbance, (b) greater use of negative coping factors, (c) reduced use of positive coping strategies, (d) reduced report of psychological resource factors (e.g., personal mastery, self-efficacy), and (e) increased report of subjective health difficulties (e.g., sleep disturbance). Results generally supported our hypotheses, suggesting that assessment of both constructs is important for best predicting quality of well-being in AD caregivers, and potentially for establishing maximal effect in behavior therapy for caregivers

Una enfermedad lejana: la información sobre poliomielitis y síndrome post-polio en la prensa hispanolusa, 1995-2009

Se explora el cambio en la percepción social de la polio en la Península Ibérica a través del análisis de contenidos, entre 1995 y 2009, de dos periódicos de gran tirada. La desaparición en la agenda periodística de la polio y de las personas que viven con sus secuelas influyó en el olvido de la misma en la agenda pública. La poliomielitis se vinculó a la pobreza y la ignorancia en países lejanos, susceptibles de acciones de cooperación, siendo objeto de atención solo cuando es percibida como amenaza para Occidente, vinculada a crisis sanitarias o en un sentido metafórico. Así, el síndrome post-polio fue invisibilizado en el caso portugués y débilmente representado en España por el movimiento asociativo