Global 30-day morbidity and mortality of surgery for perforated peptic ulcer: GRACE study.

BACKGROUND: There is little international data on morbidity and mortality of surgery for perforated peptic ulcer (PPU). This study aimed to understand the global 30-day morbidity and mortality of patients undergoing surgery for PPU and to identify variables associated with these. METHOD: We performed an international study of adults (≥ 18 years) who underwent surgery for PPU from 1st January 2022 to 30th June 2022. Patients who were treated conservatively or had an underlying gastric cancer were excluded. Patients were divided into subgroups according to age (≤ 50 and > 50 years) and time from onset of symptoms to hospital presentation (≤ 24 and > 24 h). Univariate and Multivariate analyses were carried out to identify factors associated with higher 30-day morbidity and mortality. RESULTS:  1874 patients from 159 centres across 52 countries were included. 78.3% (n = 1467) of the patients were males and the median (IQR) age was 49 years (25). Thirty-day morbidity and mortality were 48.5% (n = 910) and 9.3% (n = 174) respectively. Median (IQR) hospital stay was 7 (5) days. Open surgery was performed in 80% (n = 1505) of the cohort. Age > 50 years [(OR = 1.7, 95% CI 1.4-2), (OR = 4.7, 95% CI 3.1-7.6)], female gender [(OR = 1.8, 95% CI 1.4-2.3), (OR = 1.9, 95% CI 1.3-2.9)], shock on admission [(OR = 2.1, 95% CI 1.7-2.7), (OR = 4.8, 95% CI 3.2-7.1)], and acute kidney injury [(OR = 2.5, 95% CI 1.9-3.2), (OR = 3.9), 95% CI 2.7-5.6)] were associated with both 30-day morbidity and mortality. Delayed presentation was associated with 30-day morbidity [OR = 1.3, 95% CI 1.1-1.6], but not mortality. CONCLUSIONS: This study showed that surgery for PPU was associated with high 30-day morbidity and mortality rate. Age, female gender, and signs of shock at presentation were associated with both 30-day morbidity and mortality.

Variable Eating Patterns: A Potential Novel Risk Factor for Systemic Inflammation in Women.

BACKGROUND: The timing and regularity of eating patterns could play a role in systemic inflammation, as circadian clocks responsible for daily rhythms of inflammatory signaling are entrained by food intake. PURPOSE: To evaluate associations of intra-weekly and weekday-weekend differences in eating timing patterns with high-sensitivity C-reactive protein (hsCRP). METHODS: A community-based sample of 103 U.S. women from the American Heart Association Go Red for Women Strategically Focused Research Network completed a meal-timing questionnaire and provided a blood sample for measurement of hsCRP. Differences in weekday versus weekend eating start time, eating end time, and nightly fasting duration were calculated as eating jetlag metrics. Intra-weekly variability in eating timing patterns was defined by the standard deviation (SD) of these variables. Multivariable linear regression models were used to evaluate cross-sectional associations of eating timing variability metrics with hsCRP. RESULTS: Each additional 30-min difference in weekday-weekend eating end time was related to 13% higher hsCRP (p = .023). Similarly, every 30-min increase in eating end time SD, reflecting greater variability in timing of last eating occasion, was associated with 29% higher hsCRP. Per 1-hr weekday-weekend difference in nightly fasting duration, there was a 45% elevation in hsCRP (p = .003). Every 30-min increase in nightly fasting duration SD, representing greater variability in span of the daily fasting/eating periods, was associated with 46% higher hsCRP. CONCLUSIONS: Variable eating timing patterns were associated with higher hsCRP. Intervention studies are needed to determine whether stabilizing the timing of eating occasions may represent a novel strategy to reduce chronic inflammation.

Clinical and economic evaluations of natalizumab, rituximab, and ocrelizumab for the management of relapsing-remitting multiple sclerosis in Saudi Arabia.

INTRODUCTION: The advent of new disease-modifying therapies (DMTs), such as monoclonal antibodies (mAbs), resulted in significant changes in the treatment guidelines for Multiple sclerosis (MS) and improvement in the clinical outcomes. However, mAbs, such as rituximab, natalizumab, and ocrelizumab, are expensive with variable effectiveness rates. Thus, the present study aimed to compare the direct medical cost and consequences (e.g., clinical relapse, disability progression, and new MRI lesions) between rituximab and natalizumab in managing relapsing-remitting multiple sclerosis (RRMS) in Saudi Arabia. Also, the study aimed to explore the cost and consequence of ocrelizumab in managing RRMS as a second-choice treatment. METHODS: The electronic medical records (EMRs) of patients with RRMS were retrospectively reviewed to retrieve the patients' baseline characteristics and disease progression from two tertiary care centers in Riyadh, Saudi Arabia. Biologic-naïve patients treated with rituximab or natalizumab or those switched to ocrelizumab and treated for at least six months were included in the study. The effectiveness rate was defined as no evidence of disease activity (NEDA-3) (i.e., absence of new T2 or T1 gadolinium (Gd) lesions as demonstrated by the Magnetic Resonance Imaging (MRI), disability progression, and clinical relapses), while the direct medical costs were estimated based on the utilization of healthcare resources. In addition, bootstrapping with 10,000 replications and inverse probability weighting based on propensity score were conducted. RESULTS: Ninety-three patients met the inclusion criteria and were included in the analysis (natalizumab (n = 50), rituximab (n = 26), ocrelizumab (n = 17)). Most of the patients were otherwise healthy (81.72%), under 35 years of age (76.34%), females (61.29%), and on the same mAb for more than one year (83.87%). The mean effectiveness rates for natalizumab, rituximab, and ocrelizumab were 72.00%, 76.92%, and 58.83%, respectively. Natalizumab mean incremental cost compared to rituximab was $35,383 (95% CI: $25,401.09- $49,717.92), and its mean effectiveness rate was 4.92% lower than rituximab (95% CI: -30-27.5) with 59.41% confidence level that rituximab will be dominant. CONCLUSIONS: Rituximab seems to be more effective and is less costly than natalizumab in the management of RRMS. Ocrelizumab does not seem to slow the rates of disease progression among patients previously treated with natalizumab.

Sleep and Diet: Mounting Evidence of a Cyclical Relationship.

Two factors intrinsic to health are diet and sleep. These two behaviors may well influence one another. Indeed, that insufficient sleep adversely impacts dietary intakes is well documented. On the other hand, diet may influence sleep via melatonin and its biosynthesis from tryptophan. Experimental data exist indicating that provision of specific foods rich in tryptophan or melatonin can improve sleep quality. Whole diets rich in fruits, vegetables, legumes, and other sources of dietary tryptophan and melatonin have been shown to predict favorable sleep outcomes. Although clinical trials are needed to confirm a causal impact of dietary patterns on sleep and elucidate underlying mechanisms, available data illustrate a cyclical relation between these lifestyle factors. We recommend adopting a healthful diet to improve sleep, which may further promote sustained favorable dietary practices.

The origin and continuing adaptive evolution of chikungunya virus.

Chikungunya virus (CHIKV) is the responsible agent of chikungunya fever, a debilitating arthritic disease in humans. CHIKV is endemic in Africa and Asia, although transmission cycles are considerably different on these continents. Before 2004, CHIKV had received little attention, since it was only known to cause localised outbreaks in a limited region with no fatalities. However, the recent global reemergence of CHIKV has caused serious global health problems and shown its potential to become a significant viral threat in the future. Unexpectedly, the reemergence is more rapid and is geographically more extensive, especially due to increased intensity of global travel systems or failure to contain mosquito populations. Another important factor is the successful adaptation of CHIKV to a new vector, the Aedes albopictus mosquito. Ae. albopictus survives in both temperate and tropical climates, thus facilitating CHIKV expansion to non-endemic regions. The continuous spread and transmission of CHIKV pose challenges for the development of effective vaccines and specific antiviral therapies. In this review, we discuss the biology and origin of CHIKV in Africa as well as its subsequent expansion to other parts of the world. We also review the transmission cycle of CHIKV and its continuing adaptation to its mosquito vectors and vertebrate hosts. More-complete understanding of the continuous evolution of CHIKV may help in predicting the emergence of CHIKV strains with possibly greater transmission efficiency in the future.

Evening Chronotype Is Associated with Poorer Habitual Diet in US Women, with Dietary Energy Density Mediating a Relation of Chronotype with Cardiovascular Health.

BACKGROUND: An innate preference for later timing of sleep and activity, termed evening chronotype, is linked to poorer cardiovascular health (CVH). However, associations of chronotype with specific health behaviors in US women are not well characterized. Of particular interest is habitual diet, because <1% of US adults meet recommendations for a healthful diet. OBJECTIVES: We aimed to evaluate cross-sectional and prospective associations of chronotype with diet quantity and quality in US women, and to assess whether dietary energy density (ED), a robust predictor of cardiometabolic outcomes, mediates an established chronotype-CVH relation. METHODS: Data were collected from participants in the AHA Go Red for Women Strategically Focused Research Network cohort (aged 20-76 y; 61% racial/ethnic minority) at baseline (n = 487) and 1-y follow-up (n = 432). Chronotype (evening compared with morning/intermediate) and habitual diet were ascertained from the Morningness-Eveningness Questionnaire and an FFQ, respectively. Multivariable-adjusted linear regression models evaluated cross-sectional and prospective associations of chronotype with diet. Causal mediation analyses assessed whether dietary ED mediated a relation between chronotype and CVH, quantified using AHA Life's Simple 7 score, derived from clinical measurements and validated assessments of CVH components. RESULTS: Evening compared with morning/intermediate chronotype was associated with poorer diet quality, including lower intakes of plant protein (cross-sectional: ß = -0.63 ± 0.24, P < 0.01; prospective: ß = -0.62 ± 0.26, P = 0.01), fiber (cross-sectional: ß = -2.19 ± 0.65, P < 0.001; prospective: ß = -2.39 ± 0.66, P < 0.001), and fruits and vegetables (cross-sectional: ß = -1.24 ± 0.33, P < 0.001; prospective: ß = -1.15 ± 0.36, P = 0.001). Evening chronotype was also associated with higher dietary ED at baseline (ß = 0.20 ± 0.05, P = 0.001) and 1 y (ß = 0.19 ± 0.06, P = 0.001). Dietary ED was a partial mediator of the association between evening chronotype and poorer CVH (24.6 ± 9.1%, P < 0.01). CONCLUSIONS: Evening chronotype could contribute to unhealthful dietary patterns in US women, with higher dietary ED partially mediating the relation between eveningness and poorer CVH. Behavioral interventions to reduce dietary ED might mitigate cardiovascular disease risk in women with evening chronotype.

Characterization of Fatty Acids, Polysaccharides, Amino Acids, and Minerals in Marine Macroalga Chaetomorpha crassa and Evaluation of Their Potentials in Skin Cosmetics.

Cosmetic industries are highly committed to finding natural sources of functional active constituents preferable to safer materials to meet consumers' demands. Marine macroalgae have diversified bioactive constituents and possess potential benefits in beauty care products. Hence, the present study was carried out to characterize the biochemical profile of marine macroalga Chaetomorpha crassa by using different techniques for revealing its cosmetic potentials. In results, the FTIR study characterized the presence of different bioactive functional groups that are responsible for many skin-beneficial compounds whereas six and fifteen different important phycocompounds were found in GCMS analysis of ethanolic and methanolic extracts, respectively. In the saccharide profile of C. crassa, a total of eight different carbohydrate derivatives were determined by the HRLCMS Q-TOF technique, which showed wide varieties of cosmetic interest. In ICP AES analysis, Si was found to be highest whereas Cu was found to be lowest among other elements. A total of twenty-one amino acids were measured by the HRLCMS-QTOF technique, which revealed the highest amount of the amino acid, Aspartic acid (1207.45 nmol/mL) and tyrosine (106.77 nmol/mL) was found to be the lowest in amount among other amino acids. Their cosmetic potentials have been studied based on previous research studies. The incorporation of seaweed-based bioactive components in cosmetics has been extensively growing due to its skin health-promoting effects.

Effects of the Cervical Marginal Relocation Technique on the Marginal Adaptation of Lithium Disilicate CAD/CAM Ceramic Crowns on Premolars.

AIM AND OBJECTIVE: To evaluate the effect of cervical margin relocation (CMR) for crowns designed using CAD/CAM technology and fabricated from lithium disilicate (e.max, CAD) before and after aging; and to compare the fracture forces and failure type of the tested crowns. MATERIALS AND METHODS: Mesio-occluso-distal(MOD) cavities 1 mm above the cementoenamel junction(CEJ) were prepared on 40 maxillary first premolars. The teeth were divided into four groups. In group A, all cervical margins (CM) were located 1 mm above the CEJ. However, in both mesial and distal proximal boxes of groups B, C, and D, in addition to the MOD cavities, the CMs were extended 2 mm on both sides below the CEJ apically to simulate the CMR technique. In group B, the mesial and distal proximal boxes were filled with flowable composite, while for group C and group D, specimens were filled with composite resin fillings. To simulate the CMR technique, the cavities were filled with composite layers of 3 mm in two increments. Using the CAD/CAM system, 40 standard crowns were prepared on premolars, then cemented using a dual-curing adhesive cement. Assessments of the marginal integrity of interfaces of the proximal boxes of the cemented crowned teeth were recorded. Statistical differences between groups were analyzed using the ANOVA and Bonferroni's posthoc test. RESULTS: The first null hypothesis was accepted since no statistically significant differences were found in marginal integrity before and after aging (p>0.05), while the second was partially rejected since different fractured force values were recorded and a significant difference was detected between group D and group B. The third hypothesis was rejected because the catastrophic fracture rate was the highest among the four groups. CONCLUSION: The implementation of CMR before and after aging had a good effect on the marginal integrity of CM relocation. The CMR technique with resin luting cement of lithium disilicate crowns is effective and recommended for the restoration in deep proximal boxes of premolars or posterior teeth. CLINICAL SIGNIFICANCE: CAD/CAM-generated e. max all-ceramic crowns with composite as the CMR enable the reconstruction of severely destroyed teeth irrespective of the position of the cavity margins.

Sleep Regularity and Cardiometabolic Heath: Is Variability in Sleep Patterns a Risk Factor for Excess Adiposity and Glycemic Dysregulation?

PURPOSE OF REVIEW: Night-to-night variability in sleep patterns leads to circadian disruption and, consequently, could increase cardiometabolic risk. The purpose of this review is to summarize findings from studies published between 2015 and 2020 examining various measures of night-to-night variability in sleep in relation to metabolic syndrome (MetS), type 2 diabetes (T2D), and their risk factors. We illustrate a potential causal pathway between irregular sleep patterns and T2D, highlighting knowledge gaps along the way. RECENT FINDINGS: Across different measures of sleep variability, irregular sleep patterns were associated with poorer cardiometabolic outcomes. Higher standard deviations (SD) across nights of sleep duration and onset or midpoint of sleep were associated with increased odds of having MetS and clusters of metabolic abnormalities as well as greater adiposity and poorer glycemic control. Conversely, greater regularity of rest-activity patterns related to lower risk for T2D. Social jetlag was associated with glycemic dysregulation, adiposity, T2D, and MetS. These associations are often observed in both metabolically healthy and unhealthy individuals; both higher SD of sleep duration and social jetlag relate to poorer glucose regulation in individuals with diabetes. There is consistent evidence of associations of sleep variability with increased risk for adiposity, glucose dysregulation, T2D, and MetS. Although experimental evidence is needed to determine causation, there is support to recommend stabilizing sleep patterns for cardiometabolic risk prevention.

Variability in Sleep Patterns: an Emerging Risk Factor for Hypertension.

PURPOSE OF REVIEW: In this review, we summarize recent epidemiological data (2014-2019) that examine the association of sleep variability with blood pressure (BP), discuss potential underlying mechanisms, and highlight future research directions. RECENT FINDINGS: Higher standard deviations of sleep duration and sleep-onset timing were not related to BP. However, a higher Sleep Regularity Index score was associated with lower odds of hypertension. Studies on social jetlag, a prevalent form of sleep variability, reported null associations. In contrast, lower interdaily stability in circadian rest-activity rhythms, a measure of invariability in sleep-wake cycles between days and synchronization to light and dark cycles, was associated with higher BP and greater hypertension odds, particularly among non-shift workers. Sleep variability is consistently associated with risk factors for hypertension. Evidence on sleep variability and BP is limited and varies depending on the measure used to characterize day-to-day variability in sleep. Studies that identify and utilize a standard definition of sleep variability, incorporate a 24-h ambulatory BP monitoring, and ensure coinciding timing of sleep and BP measurements are necessary to disentangle these relationships.

Reciprocal Roles of Sleep and Diet in Cardiovascular Health: a Review of Recent Evidence and a Potential Mechanism.

PURPOSE OF REVIEW: This review investigates the potential bi-directional relation between sleep and diet in considering their contribution to cardiovascular health. We further explore the involvement of the gut microbiome in the relationships between poor sleep and dietary intakes and increased cardiovascular disease (CVD) risk. RECENT FINDINGS: There is strong evidence that sleep restriction leads to unhealthy food choices and increased energy intake. The diet may impact sleep, as well. Epidemiological studies show that higher adherence to a Mediterranean dietary pattern predicts healthier sleep. One factor that could underlie these relationships is the gut microbiome. Although data are mixed, there is some evidence that sleep restriction can influence the composition of the gut microbiome in humans. Similarly, Mediterranean diets and other plant-rich diets are related to increased diversity of the microbiota. At present, few studies have investigated the influence of the microbiome on sleep; however, limited evidence from epidemiological and intervention studies suggest that the composition of the microbiome may relate to sleep quality. More research is needed to better understand the role of the microbiome in the multi-directional relationship between sleep, diet, and CVD. There is growing evidence of a bi-directional relationship between sleep and the diet, which could act in concert to influence CVD risk. Diets such as the Mediterranean diet, comprised of high intakes of fruits, vegetables, and other plant-based foods, may promote healthy sleep and beneficial gut microflora. The gut microbiome may then underlie the relation between diet, sleep, and CVD risk.

The Diagnostic Yield of Malignancy Comparing Cytology, FISH, and Molecular Analysis of Cell Free Cytology Brush Supernatant in Patients With Biliary Strictures Undergoing Endoscopic Retrograde Cholangiography (ERC): A Prospective Study.

BACKGROUND: Routine cytology of biliary stricture brushings obtained during endoscopic retrograde cholangiopancreatography (ERCP) has suboptimal sensitivity for malignancy. We compared the individual and combined ability of cytology, fluorescence in situ hybridization (FISH) analysis and PCR-based mutation profiling (MP) to detect malignancy in standard biliary brushings. METHODS: We performed a prospective study of patients undergoing ERCP using histology or 1 year follow-up to determine patient outcomes. MP was performed on free-DNA from biliary brushing specimens using normally discarded supernatant fluid. MP examined KRAS point mutations and tumor suppressor gene associated loss of heterozygosity mutations at 10 genomic loci. FISH examined chromosome specific gains or losses. RESULTS: A total of 101 patients were included in final analysis and 69% had malignancy. Cytology had 26% sensitivity and 100% specificity for malignancy. Using either FISH or MP in combination with cytology increased sensitivity to 44% and 56%, respectively. The combination of all 3 tests (cytology, FISH, and MP) had the highest sensitivity for malignancy (66%). There was no difference in the specificity of cytology, FISH or MP testing when examined alone or in combination. MP improved diagnostic yield of each procedure from 22% to 100%; FISH improved yield to 90%. MP detected 21 malignancies beyond that identified by cytology; FISH detected an additional 13. The combination of FISH and MP testing detected an additional 28 malignancies. CONCLUSIONS: Both MP and FISH are complimentary molecular tests that can significantly increase detection of biliary malignancies when used in combination with routine cytology of standard biliary brush specimens.

Utility of Endoscopic Ultrasound in Evaluating Local Recurrence After Surgery for Pancreatic Cancer.

Pancreatic adenocarcinoma recurrence after surgery (PARaS) is associated with poor outcomes. PARaS is locoregional in 50%-80%, effecting the resection bed and adjacent lymphatics.1-3 Detection of PARaS via endoscopic ultrasound (EUS) is challenging because recurrent malignancy is difficult to distinguish from normal postoperative changes. Diagnosing PARaS is important, because salvage chemotherapy/radiation improves survival.4,5 The purpose of this investigation is to determine the clinical utility of EUS fine-needle aspiration (FNA) in patients with suspected PARaS.

EUS-guided drainage of peripancreatic fluid collections with lumen-apposing metal stents and plastic double-pigtail stents: comparison of efficacy and adverse event rates.

BACKGROUND AND AIMS: Transmural drainage with double-pigtail plastic stents (DPPSs) was the mainstay of endoscopic therapy for symptomatic peripancreatic fluid collections (PPFCs) until the introduction of lumen-apposing covered self-expanding metal stents (LAMSs). Currently, there are limited data regarding the efficacy and adverse event rate of LAMSs compared with DPPSs. METHODS: A retrospective analysis of EUS-guided PPFC drainage at a single tertiary care center between 2008 and 2015 was performed. Patients were classified based on drainage method: DPPSs and LAMSs. Adverse event rates, unplanned endoscopic procedures/necrosectomies, and PPFC resolution within 6 months were recorded. Significant bleeding was defined as necessitating transfusion or requiring endoscopic treatment/radiographic embolization. Subsequent endoscopic procedures were defined as unplanned procedures; stent removals were excluded. RESULTS: A total of 103 patients met inclusion criteria (84 DPPSs, 19 LAMSs). PPFCs were classified as walled-off necrosis (WON) in 23 (14 DPPSs, 9 LAMSs). There were significantly more bleeding episodes in the LAMS group (4 [19%]: 2 splenic artery pseudo-aneurysms, 1 collateral vessel bleed, 1 intracavitary variceal bleed; P = .0003) than in the DPPS group (1 (1%]: stent erosion into the gastric wall). One perforation occurred in the DPPS group. Unplanned repeat endoscopy was more frequent in the LAMS group (10% vs 26%, P = .07). Among retreated LAMS patients in with WON, 5 (56%) had obstruction by necrotic debris. In patients for whom follow-up was available, 67 of 70 (96%) with DPPSs and 16 of 17 (94%) with LAMSs had resolution of PPFCs within 6 months (P = .78). CONCLUSIONS: DPPSs and LAMSs are effective methods for treatment of PPFCs. In our cohort, use of LAMSs was associated with significantly higher rates of procedure-related bleeding and greater need for repeat endoscopic intervention.

Doggy bags and downsizing: Packaging uneaten food to go after a meal attenuates the portion size effect in women.

Serving larger portions leads to increased food and energy intake, but little is known about strategies to moderate this response. This study tested how the effect of portion size on meal intake was influenced by providing the option to take away uneaten food in a "doggy bag" (to-go container). Women were randomly assigned to one of two subject groups: a To-Go Group (n = 27) that was informed before each meal that their leftover food would be packaged to take away after the meal, and a Control Group (n = 26) that was not given this option. In a crossover design, subjects came to the lab once a week for four weeks to eat a dinner composed of five foods. Across meals, the portion size of all foods was varied (100%, 125%, 150%, and 175% of baseline). Results showed that the portion size effect, defined as the trajectory of intake across the weight of food served, differed significantly by subject group (P ≤ 0.025). In the Control Group, increasing the portion size of all foods led to substantial increases in intake (P < 0.0001); for every 100 g added to the baseline portion, women in this group consumed an additional mean (±SEM) of 64 ±â€¯12 g of food and 90 ±â€¯19 kcal, until intake leveled off. In contrast, intake of women in the To-Go Group increased by only 17 ±â€¯12 g and 19 ±â€¯18 kcal for every additional 100 g served; these increases did not differ significantly from zero (P > 0.15). Thus, the effect of portion size on intake was attenuated in the To-Go Group compared to the Control Group. These data indicate that packaging uneaten food after a meal could be an effective strategy to reduce overconsumption from large portions.

Comparing the portion size effect in women with and without extended training in portion control: A follow-up to the Portion-Control Strategies Trial.

Following a 1-year randomized controlled trial that tested how weight loss was influenced by different targeted strategies for managing food portions, we evaluated whether the effect of portion size on intake in a controlled setting was attenuated in trained participants compared to untrained controls. Subjects were 3 groups of women: 39 participants with overweight and obesity from the Portion-Control Strategies Trial, 34 controls with overweight and obesity, and 29 controls with normal weight. In a crossover design, on 4 different occasions subjects were served a meal consisting of 7 foods that differed in energy density (ED). Across the meals, all foods were varied in portion size (100%, 125%, 150%, or 175% of baseline). The results showed that serving larger portions increased the weight and energy of food consumed at the meal (P < .0001), and this effect did not differ across groups. Increasing portions by 75% increased food intake by a mean (±SEM) of 111 ±â€¯10 g (27%) and increased energy intake by 126 ±â€¯14 kcal (25%). Across all meals, however, trained participants had lower energy intake (506 ±â€¯15 vs. 601 ±â€¯12 kcal, P = .006) and lower meal ED (1.09 ±â€¯0.02 vs. 1.27 ±â€¯0.02 kcal/g; P = .003) than controls, whose intake did not differ by weight status. The lower energy intake of trained participants was attributable to consuming meals with a greater proportion of lower-ED foods than controls. These results further demonstrate the robust nature of the portion size effect and reinforce that reducing meal ED is an effective way to moderate energy intake in the presence of large portions.

Does the cost of a meal influence the portion size effect?

Serving larger portions leads to increased intake, but little is known about how the cost of a meal affects this response. Therefore, we tested whether the amount of money paid for a meal influenced the portion size effect at a lunch served in a controlled restaurant-style setting. In a crossover design, 79 adults (55 women; 24 men) came to the lab once a week for 4 weeks to eat a main dish of pasta with side dishes. Across weeks, the meal was varied in two factors: portion size of the main dish (400 g or 600 g) and cost of the meal (US$8 or $16). At discharge subjects completed questionnaires that assessed behaviors thought to influence the response to portion size and cost. Results showed that the portion size of the main dish had a significant effect on meal intake (P < 0.0001). The weight of food consumed at the meal increased by 18 ±â€¯2% (mean ±â€¯SEM 83 ±â€¯11 g) and energy intake increased by 20 ±â€¯2% (133 ±â€¯16 kcal) when the larger portion was served. These effects of portion size did not differ across the two levels of cost (both interactions P > 0.37) nor did meal cost have significant effects on meal intake (both P > 0.24). Subject scores for satiety responsiveness did, however, influence the effect of portion size on food intake (P = 0.0007). Serving larger portions led to increased intake in subjects with lower satiety responsiveness scores (P < 0.0001), but did not affect intake in those with higher scores. In summary, the effect of portion size on intake in a restaurant-style setting was not influenced by meal cost but was attenuated in individuals higher in satiety responsiveness.

Peripancreatic fat necrosis worsens acute pancreatitis independent of pancreatic necrosis via unsaturated fatty acids increased in human pancreatic necrosis collections.

BACKGROUND AND AIMS: Peripancreatic fat necrosis occurs frequently in necrotising pancreatitis. Distinguishing markers from mediators of severe acute pancreatitis (SAP) is important since targeting mediators may improve outcomes. We evaluated potential agents in human pancreatic necrotic collections (NCs), pseudocysts (PCs) and pancreatic cystic neoplasms and used pancreatic acini, peripheral blood mononuclear cells (PBMC) and an acute pancreatitis (AP) model to determine SAP mediators. METHODS: We measured acinar and PBMC injury induced by agents increased in NCs and PCs. Outcomes of caerulein pancreatitis were studied in lean rats coadministered interleukin (IL)-1ß and keratinocyte chemoattractant/growth-regulated oncogene, triolein alone or with the lipase inhibitor orlistat. RESULTS: NCs had higher fatty acids, IL-8 and IL-1ß versus other fluids. Lipolysis of unsaturated triglyceride and resulting unsaturated fatty acids (UFA) oleic and linoleic acids induced necro-apoptosis at less than half the concentration in NCs but other agents did not do so at more than two times these concentrations. Cytokine coadministration resulted in higher pancreatic and lung inflammation than caerulein alone, but only triolein coadministration caused peripancreatic fat stranding, higher cytokines, UFAs, multisystem organ failure (MSOF) and mortality in 97% animals, which were prevented by orlistat. CONCLUSIONS: UFAs, IL-1ß and IL-8 are elevated in NCs. However, UFAs generated via peripancreatic fat lipolysis causes worse inflammation and MSOF, converting mild AP to SAP.

Increasing the size of portion options affects intake but not portion selection at a meal.

In an environment with large portion sizes, allowing consumers more control over their portion selection could moderate the effects on energy intake. We tested whether having subjects choose a portion from several options influenced the amount selected or consumed when all portion sizes were systematically increased. In a crossover design, 24 women and 26 men ate lunch in the lab once a week for 3 weeks. At each meal, subjects chose a portion of macaroni and cheese from a set of 3 portion options and consumed it ad libitum. Across 3 conditions, portion sizes in the set were increased; the order of the conditions was counterbalanced across subjects. For women the portion sets by weight (g) were 300/375/450, 375/450/525, and 450/525/600; for men the portions were 33% larger. The results showed that increasing the size of available portions did not significantly affect the relative size selected; across all portion sets, subjects chose the smallest available portion at 59% of meals, the medium at 27%, and the largest at 15%. The size of portions offered did, however, influence meal intake (P < 0.0001). Mean intake (±SEM) was 16% greater when the largest set was offered (661 ± 34 kcal) than when the medium and smallest sets were offered (both 568 ± 18 kcal). These results suggest that portions are selected in relation to the other available options, and confirm the robust effect of portion size on intake. Although presenting a choice of portions can allow selection of smaller amounts, the sizes offered are a critical determinant of energy intake. Thus, the availability of choices could help to moderate intake if the portions offered are within an appropriate range for energy needs.

Impact of retroflexion vs. second forward view examination of the right colon on adenoma detection: a comparison study.

OBJECTIVES: Although screening colonoscopy is effective in preventing distal colon cancers, effectiveness in preventing right-sided colon cancers is less clear. Previous studies have reported that retroflexion in the right colon improves adenoma detection. We aimed to determine whether a second withdrawal from the right colon in retroflexion vs. forward view alone leads to the detection of additional adenomas. METHODS: Patients undergoing screening or surveillance colonoscopy were invited to participate in a parallel, randomized, controlled trial at two centers. After cecal intubation, the colonoscope was withdrawn to the hepatic flexure, all visualized polyps removed, and endoscopist confidence recorded on a 5-point Likert scale. Patients were randomized to a second exam of the proximal colon in forward (FV) or retroflexion view (RV), and adenoma detection rates (ADRs) compared. Logistic regression analysis was used to evaluate predictors of identifying adenomas on the second withdrawal from the proximal colon. RESULTS: A total of 850 patients (mean age 59.1±8.3 years, 59% female) were randomly assigned to FV (N=400) or RV (N=450). Retroflexion was successful in 93.5%. The ADR (46% FV and 47% RV) and numbers of adenomas per patient (0.9±1.4 FV and 1.1±2.1 RV) were similar (P=0.75 for both). At least one additional adenoma was detected on second withdrawal in similar proportions (10.5% FV and 7.5% RV, P=0.13). Predictors of identifying adenomas on the second withdrawal included older age (odds ratio (OR)=1.04, 95% confidence interval (CI)=1.01-1.08), adenomas seen on initial withdrawal (OR=2.8, 95% CI=1.7-4.7), and low endoscopist confidence in quality of first examination of the right colon (OR=4.8, 95% CI=1.9-12.1). There were no adverse events. CONCLUSIONS: Retroflexion in the right colon can be safely achieved in the majority of patients undergoing colonoscopy for colorectal cancer screening. Reexamination of the right colon in either retroflexed or forward view yielded similar, incremental ADRs. A second exam of the right colon should be strongly considered in patients who have adenomas discovered in the right colon, particularly when endoscopist confidence in the quality of initial examination is low.