Digital workflow for image-guided immediate implant placement by using the socket-shield technique and custom abutment in the esthetic area.

Marginal bone loss around immediately placed implants may compromise esthetic outcomes in the anterior maxilla. The relatively recent socket-shield technique of partial extraction therapy has been described as being useful to maintain the structure of peri-implant tissues. The present technique report introduced a digital workflow to perform image-guided implant placement after partial extraction therapy. In this technique, digital 3-dimensional images are used to plan and orient the flapless surgical procedure and to digitally design a custom abutment based on the natural emergence profile as segmented from the tooth to be extracted.

Early identification of bleeding in trauma patients: external validation of traumatic bleeding scores in the Swiss Trauma Registry.

BACKGROUND: Early identification of bleeding at the scene of an injury is important for triage and timely treatment of injured patients and transport to an appropriate facility. The aim of the study is to compare the performance of different bleeding scores. METHODS: We examined data from the Swiss Trauma Registry for the years 2015-2019. The Swiss Trauma Registry includes patients with major trauma (injury severity score (ISS) ≥ 16 and/or abbreviated injury scale (AIS) head ≥ 3) admitted to any level-one trauma centre in Switzerland. We evaluated ABC, TASH and Shock index (SI) scores, used to predict massive transfusion (MT) and the BATT score and used to predict death from bleeding. We evaluated the scores when used prehospital and in-hospital in terms of discrimination (C-Statistic) and calibration (calibration slope). The outcomes were early death within 24 h and the receipt of massive transfusion (≥ 10 Red Blood cells (RBC) units in the first 24 h or ≥ 3 RBC units in the first hour). RESULTS: We examined data from 13,222 major trauma patients. There were 1,533 (12%) deaths from any cause, 530 (4%) early deaths within 24 h, and 523 (4%) patients who received a MT (≥ 3 RBC within the first hour). In the prehospital setting, the BATT score had the highest discrimination for early death (C-statistic: 0.86, 95% CI 0.84-0.87) compared to the ABC score (0.63, 95% CI 0.60-0.65) and SI (0.53, 95% CI 0.50-0.56), P < 0.001. At hospital admission, the TASH score had the highest discrimination for MT (0.80, 95% CI 0.78-0.82). The positive likelihood ratio for early death were superior to 5 for BATT, ABC and TASH. The negative likelihood ratio for early death was below 0.1 only for the BATT score. CONCLUSIONS: The BATT score accurately estimates the risk of early death with excellent performance, low undertriage, and can be used for prehospital treatment decision-making. Scores predicting MT presented a high undertriage rate. The outcome MT seems not appropriate to stratify the risk of life-threatening bleeding. TRIAL REGISTRATION: Clinicaltrials.gov, NCT04561050 . Registered 15 September 2020.

Digital workflow for low-cost 3D-printed custom healing abutment based on emergence profile CBCT segmentation.

Several protocols have been used with computer-aided design and computer-aided manufacture (CAD-CAM) prostheses after image-guided implant surgery based on a prosthetically driven surgical plan. For delayed approaches, a CAD-CAM custom healing abutment can be manufactured before the surgery and installed immediately after implant placement. However, information on the use of emergence profile segmentation on which to base the digital design and on the use of low-cost 3-dimensional printers to produce custom healing abutments are lacking. The purpose of this article was to present a fully digital workflow to digitally design and 3-dimensionally print custom healing abutments with a biocompatible light-polymerizing resin based on the natural emergence profile of the tooth to be replaced.

Digital workflow for definitive immediately loaded complete-arch CAD-CAM implant-supported prosthesis in 3 appointments without using intraoral scanning.

This article presents a rapid technique for the accurate transfer of implant positions immediately after image-guided surgery to enable the immediate installation of a definitive complete-arch implant-supported prosthesis with an implant biological width of 3 mm within 3 appointments. A sleeveless copy of the implant surgical guide is magnetically connected to a reference guide to ensure the accurate capture of cylindrical titanium transfer abutments. In the laboratory, the sleeveless guide with the splinted transfer abutments attached is used to generate a definitive cast to be scanned with a desktop scanner. The resulting digital definitive cast is then combined with the original meshes of the prosthetically driven virtual treatment plan to enable a definitive computer-aided design and computer-aided manufactured prosthesis to be fabricated and installed with passive fit.

Searching for biomarkers of early detection of 2,4-D effects in a native tree species from the Brazilian Cerrado biome.

Biodiversity in the Brazilian Cerrado biome has been declining sharply with the continued expansion of agriculture and the excessive use of herbicides. Thus, the aim of this study was to evaluate the morphophysiological and biochemical responses in Dipteryx alata plants to various doses of the herbicide 2,4-D. Specific biomarkers that characterize the phytoindicator potential of this species were determined. Gas exchange, chlorophyll a fluorescence, photosynthetic pigments, and the activities of antioxidant enzymes and cellulase were performed after 24, 96 and/or 396 hours after 2,4-D application (HAA). The herbicide caused higher antioxidant enzymatic activity 24 HAA and damage to the photosynthetic machinery after 96 HAA. Reduction in gas exchange, chlorophyll content, and photochemical traits were observed. Increased respiratory rates, non-photochemical quenching, and carotenoid concentrations in 2,4-D-treated plants were important mechanisms in the defense against the excess energy absorbed. Furthermore, the absence of leaf symptoms suggested tolerance of D. alata to 2,4-D. Nevertheless, changes in the photosynthetic and biochemical metabolism of D. alata are useful as early indicators of herbicide contamination, especially in the absence of visual symptoms. These results are important for early monitoring of plants in conserved areas and for preventing damage to sensitive species.

Junior Doctor Experiences and Challenges in Obtaining Surgical Informed Consent: A Qualitative Systematic Review and Meta-Ethnography.

INTRODUCTION: Surgical informed consent (SIC) to procedures is necessary to ensure patient autonomy is adequately respected. It is also necessary to protect doctors, and their institutions, from claims of negligence. While SIC is often acquired by senior consultants, it also commonly falls to the junior doctors on a team to ensure SIC is adequately acquired and documented. A growing body of literature suggests that junior doctors are not sufficiently educated about the legal and practical issues concerned with obtaining medical consent. This may open up this cohort, and their hospitals, to medico-legal liability. AIMS: to provide a systematic review of the qualitative literature on junior doctors' experiences and challenges in consenting surgical patients and to synthesize evidence on this issue in order to guide policy-makers in the medicolegal and medical education spheres. METHODS: a systematic review of qualitative literature was performed. Analysis of the literature was guided by Noblit and Hare's seven-step approach to meta-ethnography, with the final synthesis presented as a thematic analysis of the literature. CONCLUSION: This research concludes that a significant proportion of SIC is likely to be acquired by junior doctors, many of whom are Post-Graduate Year (PGY) 1-2 and who lack adequate training and education. This cohort face challenges in assessing capacity, in ensuring adequate disclosure related to surgical procedures, and in adequately documenting consent. This may impact the validity of any SIC they acquire. Medical educators and policy-makers should be aware of these issues when creating policies impacting SIC, and when designing surgical education programs for medical students and junior doctors alike.

Can light intensity modulate the physiological, anatomical, and reproductive responses of soybean plants to water deficit?

Little is known about the role of light intensity in modulating plant responses to stress due to water deficit (WD). Thus, the objective of this study was to determine the WD and contrasting irradiance effects on the physiology, anatomy, and grain yield of soybean plants. The experimental design was a randomized block in a growth chamber and a 2 × 2 factorial treatment arrangement: 90% (well-watered, WW) and 40% (WD) of soil field capacities (FC); and 750 (medium irradiance, MI) and 1500 (higher irradiance, HI) µmol (photons) m-2  s-1 irradiance. The WD caused a lower photosynthetic rate - as well as observed in the light curve and in the relative parameters, such as apparent quantum efficiency -, less investment in shoot biomass and pollen grain germination, resulting in lower grain yield. However, there was an increase in non-photochemical energy dissipation, a higher concentration of total soluble sugars, proline, and malondialdehyde. The WD + MI-soybean plants developed thicker spongy parenchyma (related to higher mesophilic conductance of CO2 ). In the WW + HI condition the palisade parenchyma was thicker, conferring maintenance of photosynthetic efficiency. In addition, there was an increase in the activity of superoxide dismutase, catalase, peroxidase, and ascorbate peroxidase antioxidant enzymes in leaves due to HI, regardless of FC. This induced higher energy expenditure, reflected in the reduction of the number of leaf and branches, leaf area, dry mass of leaves and stem in the WW + HI. Interestingly, these strategies of osmotic adjustment, photoprotection, and antioxidant defenses act together in the WD + HI.

Design, synthesis and antibacterial activity of chalcones against MSSA and MRSA planktonic cells and biofilms.

Staphylococcus aureus is the one of the most successful modern pathogens. The same bacterium that lives as a skin and mucosal commensal can be transmitted in health-care and community-settings and causes severe infections. Thus, there is a great challenge for a discovery of novel anti-Staphylococcus aureus compounds, which should act against resistant strains. Herein, we designed and synthesized a series of 17 chalcones, substituted by amino group on ring A, which were evaluated against methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus MRSA planktonic cells. The antibacterial potency was improved by substituents on ring B, which were designed according to Topliss' manual method. 4-bromo-3'-aminochalcone (5f) was the most active, demonstrating minimum inhibitory concentration (MIC) values of 1.9 µg mL-1 and 7.8 µg mL-1 against MSSA and MRSA, respectively. The association of 5f with vancomycin demonstrated synergistic effect against MSSA and MRSA, with Fractional Inhibitory Concentration Index (FICI) values of 0.4 and 0.3, respectively. Subinhibitory concentration of 5f inhibited the MSSA and MRSA adhesion to human keratinocytes. Chalcone 5f was able to reduce MSSA and MRSA biofilm formation, as well as acts on preformed biofilm in concentration-dependent mode. Scanning electron microscopy analyses confirmed severe perturbations caused by 5f on MSSA and MRSA biofilm architecture. The acute toxicity assay, using Galleria mellonella larvae, indicated a low toxic effect of 5f after 72 h, displaying lethality of 20% and 30% at 7.8 µg mL-1 and 78.0 µg mL-1, respectively. In addition, the antibacterial activity spectrum of 5f indicated action against planktonic cells of Enterococcus faecalis (MIC = 7.8 µg mL-1), Acinetobacter baumannii (MIC = 15.6 µg mL-1) and Mycobacterium tuberculosis (MIC = 5.7 µg mL-1). Altogether, these results open new avenues for 5f as an anti-Staphylococcus aureus agent, with potential applications as antibacterial drug, adjunct of antibiotics and medical devices coating.

Do fungicides affect the physiology, reproductive development and productivity of healthy soybean plants?

Fungicides are widely used to control diseases in soybean crops. We hypothesized that fungicides applied to healthy soybean plants compromise the plant's physiology, affect the reproductive process and reduce crop productivity. We aimed to evaluate the photosynthetic process, pollen grain viability and yield components of soybean plants exposed to three commercial fungicides. The experiment was performed twice using soybean cultivar SYN 1378C, disease-free plants, with four treatments: i) control treatment (without any fungicide application); ii) cyproconazole 150 g L-1 + difenoconazole 250 g L-1 (CPZ + DFZ; 250 mL ha-1; without adjuvant); iii) azoxystrobin 300 g Kg-1 + benzovindiflupyr 150 g Kg-1 (AZB + BZP; 200 g ha-1; Nimbus® adjuvant (Syngenta)); and iv) propiconazole 250 g L-1 + difenoconazole 250 g L-1 (PPZ + DFZ; 150 mL ha-1; without adjuvant) in both soybean pre-bloom (V8) and bloom (R1) developmental stages. The experimental design was randomized blocks with four replicates. Phytotoxicity, gas exchange and chlorophyll a fluorescence traits, pollen grain viability, pollen grain germination, flower abortion and soybean production components were evaluated. The fungicides did not affect the physiological traits, pollen grain germination and crop yield.

Digital workflow for CAD-CAM custom abutments of immediate implants based on natural emergence profile of the tooth to be extracted.

The aim of this report is to present a digital workflow technique to design a customized abutment for provisionalization of an immediate-placed implant based on the natural emergence profile of the tooth to be extracted. The workflow involves the combination of intraoral and CBCT scans, from which three-dimensional (3D) reconstructions of soft tissue and alveolar bone, as well as of the tooth to be extracted are obtained and exported as STL files. The files are imported to a computer-aided design (CAD) software, in which a virtual wax-up and custom abutment design are performed considering the natural emergence profile of the patient's tooth prior to extraction. Since the customized abutment is digitally designed, it can also be used as a scan body, to be directly scanned intraorally after soft tissue healing around an interim implant restoration. The custom abutment digitally designed can be then produced by milling zirconia with an optimally chosen color, in accordance with the aesthetic needs of the patient.

The 4-Hour Cairns Sepsis Model: A novel approach to predicting sepsis mortality at intensive care unit admission.

BACKGROUND: Sepsis commonly causes intensive care unit (ICU) mortality, yet early identification of adults with sepsis at risk of dying in the ICU remains a challenge. OBJECTIVE: The aim of the study was to derive a mortality prediction model (MPM) to assist ICU clinicians and researchers as a clinical decision support tool for adults with sepsis within 4 h of ICU admission. METHODS: A cohort study was performed using 500 consecutive admissions between 2014 and 2018 to an Australian tertiary ICU, who were aged ≥18 years and had sepsis. A total of 106 independent variables were assessed against ICU episode-of-care mortality. Multivariable backward stepwise logistic regression derived an MPM, which was assessed on discrimination, calibration, fit, sensitivity, specificity, and predictive values and bootstrapped. RESULTS: The average cohort age was 58 years, the Acute Physiology and Chronic Health Evaluation III-j severity score was 72, and the case fatality rate was 12%. The 4-Hour Cairns Sepsis Model (CSM-4) consists of age, history of renal disease, number of vasopressors, Glasgow Coma Scale, lactate, bicarbonate, aspartate aminotransferase, lactate dehydrogenase, albumin, and magnesium with an area under the receiver operating characteristic curve of 0.90 (95% confidence interval = 0.84-0.95, p < 0.00001), a Nagelkerke R2 of 0.51, specificity of 0.94, a negative predictive value of 0.98, and almost identical odds ratios during bootstrapping. The CSM-4 outperformed existing MPMs tested on our data set. The CSM-4 also performed similar to existing MPMs in their derivation papers whilst using fewer, routinely collected, and inexpensive variables. CONCLUSIONS: The CSM-4 is a newly derived MPM for adults with sepsis at ICU admission. It displays excellent discrimination, calibration, fit, specificity, negative predictive value, and bootstrapping values whilst being easy to use and inexpensive. External validation is required.

Biochemical and physiological impacts of zinc sulphate, potassium phosphite and hydrogen sulphide in mitigating stress conditions in soybean.

Soybean is the most widely grown oilseed in the world. It is an important source of protein and oil which are derived from its seeds. Drought stress is a major constraint to soybean yields. Finding alternative methods to mitigate the water stress for soybean is useful to maintain adequate crop yields. The aim of this study was to evaluate the morpho-physiological, biochemical and metabolic changes in soybean plants in two ontogenetic stages, under exposure to water deficit and treatment with zinc sulphate (ZS), potassium phosphite (PP) or hydrogen sulphide (HS). We carried out two independent experiments in the V4 and R1 development stages consisting of the following treatments: well-watered control (WW, 100% maximum water holding capacity, MWHC), water deficit (WD, 50% MWHC), PP + WW, PP + WD, HS + WW, HS + WD, ZS + WW and ZS + WD. The experimental design consisted of randomized blocks with eight treatments with five replicates. Morphological, physiological and metabolic analyses were performed 8 days after the start of the treatments for both experiments. We identified two tolerance mechanisms acting in response to compound application during water stress: the first involved the upregulation of antioxidant enzyme activity and the second involved the accumulation of soluble sugars, free amino acids and proline to facilitate osmotic adjustment. Both mechanisms are related to the maintenance of the photosynthetic parameters and cell membrane integrity. This report suggests the potential agricultural use of these compounds to mitigate drought effects in soybean plants.

Improving water use efficiency by changing hydraulic and stomatal characteristics in soybean exposed to drought: the involvement of nitric oxide.

A variety of cellular responses is needed to ensure the plants survival during drought, but little is known about the signaling mechanisms involved in this process. Soybean cultivars (EMBRAPA 48 and BR 16, tolerant and sensitive to drought, respectively) were exposed to the following treatments: control conditions (plants in field capacity), drought (20% of available water in the soil), sodium nitroprusside (SNP) treatment (plants irrigated and treated with 100-µM SNP [SNP-nitric oxide (NO) donor molecule], and Drought + SNP (plants subjected to drought and SNP treatment). Plants remained in these conditions until the reproductive stage and were evaluated for physiological (photosynthetic pigments, chlorophyll a fluorescence and gas exchange rates), hydraulic (water potential, osmotic potential and leaf hydraulic conductivity) and morpho-anatomical traits (biomass, venation density and stomatal characterization). Exposure to water deficit considerably reduced water potential in both cultivars and resulted in decrease in photosynthesis and biomass accumulation. The addition of the NO donor attenuated these damaging effects of water deficit and increased the tolerance index of both cultivars. The results showed that NO was able to reduce plant's water loss, while maintaining their biomass production through alteration in stomatal characteristics, hydraulic conductivity and the biomass distribution pattern. These hydraulic and morpho-anatomical alterations allowed the plants to obtain, transport and lose less water to the atmosphere, even in water deficit conditions.

Dipteryx alata, a tree native to the Brazilian Cerrado, is sensitive to the herbicide nicosulfuron.

The expansion of land use for agricultural interests and the excessive use of herbicides are among the causes of biodiversity losses in the Brazilian Cerrado biome. Therefore, we aimed to test the hypothesis that Dipteryx alata Vogel, a common species in this biome, is sensitive to nicosulfuron because of its high phytotoxicity. We evaluated physiological, biochemical and morphological responses in D. alata plants exposed to increasing doses of the herbicide. Young plants were transplanted to 10 L pots containing substrate composed of soil and sand (2:1) after fertilization. After an acclimation period, the following doses of nicosulfuron were applied: 0 (control), 6, 12, 24, 48, and 60 g a.e. ha-1. The experiment was conducted in a randomized block design factorial scheme with six doses of nicosulfuron, three evaluation times, and five replicates per treatment. The effects of the herbicide were assessed by measuring gas exchange, chlorophyll a fluorescence, photosynthetic pigments, membrane permeability, antioxidant enzymes and acetolactate synthase. Nicosulfuron altered the photosynthetic machinery and enzymatic metabolism of D. alata. Reductions in physiological traits, increased catalase and ascorbate peroxidase activities, enhanced malondialdehyde concentrations rate of electrolyte leakage and decreased acetolactate synthase activity in response to nicosulfuron all suggest that D. alata is sensitive to this herbicide.

Potential of calcium nitrate to mitigate the aluminum toxicity in Phaseolus vulgaris: effects on morphoanatomical traits, mineral nutrition and photosynthesis.

Common bean (Phaseolus vulgaris) cultivation occurs mainly in regions with acidic soils, where high aluminum (Al) concentration is a major constraint to crop production. In this study, we evaluated tolerance and sensitivity traits to Al exposure and calcium (Ca) deficiency in bean plants, and determined the efficiency of Ca to mitigate the toxic Al effects. Two bean cultivars (BRS Estilo and Campos Gerais) were grown in three soil conditions: (I) soil liming with calcium hydroxide Ca(OH)2 and Al unavailable (-Al+Ca); (II) fertilized soil with calcium nitrate [Ca(NO3)2·4H2O] and Al available (+Al+Ca); and (III) soil without Ca addition and Al available (+Al-Ca). At the beginning of the reproductive stage, we evaluated the photosynthetic processes, mineral nutrition, and leaf anatomy and morphological traits of plants. The photosynthetic parameters were good tools for monitor Al sensitivity in bean. +Al+Ca soil treatment mitigated the deleterious effects of Al on growth and mineral nutrition of both bean cultivars. However, Ca did not prevent the toxic effects of Al on leaf anatomy. Al stress and Ca deficiency caused negative effects on nutrient content, photosynthetic activity and leaf anatomy of bean plants. Calcium mitigated Al toxicity, primarily in the Campos Gerais cultivar, showing the potential to improve bean crop productivity in acid soils.

Ricinus communis as a phytoremediator of soil mineral oil: morphoanatomical and physiological traits.

Rapid growth in the oil industry has been accompanied concomitant increases in risks of spills or leaks triggered by natural or anthropogenic causes that cause soil changes and plant damage. Bio-scavenging and phytoremediation plants are important tools for identifying pollutants and mitigating environmental damage. The objective of this study was to evaluate the phytoremediation potential of Ricinus communis cultivated in soils contaminated with mineral oil, and to determine the possible visual, anatomical and physiological effects. R. communis seeds were pre-germinated in individual pots containing Red Latosol contaminated with Lubrax Essential SL (15W-40) mineral oil at concentrations of 0 (control), 5, 10, and 15 g kg-1. After exposure to treatments, emergency evaluations were performed, and after 45 days of cultivation, visual, morphoanatomical, physiological and oil removal effects were evaluated. There was no difference in emergence showed between treatments. Visual effects were characterized by necrosis and chlorosis formation in R. communis, evidenced on the 45th day of cultivation in all treatments tested, followed by parenchymal tissue alterations with collapsed cell formation and damage to photosynthesis with increasing doses. We found that R. communis removed up to 81% of hydrocarbons in soils, classifying it as potential phytoremediator of contaminated soils. The strong correlation between the variables suggests that R. communis can be used as an indicator of pollutant action.

Fully Digital Workflow with Magnetically Connected Guides for Full-Arch Implant Rehabilitation Following Guided Alveolar Ridge Reduction.

This technique report describes a fully digital workflow in which two surgical guides (i.e. one for alveolar bone reduction and the other for implant placement) are magnetically connected to ensure stability during full-arch implant surgery following guided bone reduction. Digital prosthesis design as well as virtual bone reduction and implant planning are developed from the superimposition of facial, intraoral and CBCT scans. With this technique, different surgical guides and interim poly(methylmethacrylate) (PMMA) fixed prosthesis are precisely connected with magnets after being digitally designed and 3D-printed. As a result, such magnetic connection allows for satisfactory stability of the implant surgical guide, as well as of the interim fixed PMMA fixed prosthesis during capture of screw-retained abutments.

Factors influencing breast cancer outcomes in Australia: A systematic review.

PURPOSE: This systematic review evaluates factors influencing breast cancer outcomes for women treated in Australia, facilitating the exploration of disparities in breast cancer outcomes for certain groups of women in Australia. METHOD: A systematic literature search was performed using MEDLINE and Scopus focusing on breast cancer in Australia with outcome measures being breast cancer survival and recurrence with no restrictions on date. Risk of bias was assessed using Cairns Assessment Scale for Observational studies of Risk factors (CASOR). RESULTS: Fifteen quantitative studies were included: two were high quality, 11 were intermediate quality, and two were low quality. Traditional risk factors such as invasive tumour type, larger size, higher grade and stage, lymph node involvement and absence of hormone receptors were found to be associated with breast cancer mortality. Being younger (<40 years old) and older (>70 years old), having more comorbidities, being of lower socioeconomic status, identifying as Aboriginal or Torres Strait Islander, living in more rural areas or having a mastectomy were factors found to be associated with poorer breast cancer outcomes. CONCLUSION: Despite the heterogeneity of the studies, this review identified significant risk factors for breast cancer mortality and recurrence. The use of this data would be most useful in developing evidence-based interventions and in optimising patient care through creation of a prediction model. PROSPERO REGISTRATION: CRD42017072857.

Symptoms and diagnostic criteria of acquired Megacolon - a systematic literature review.

BACKGROUND: Acquired Megacolon (AMC) is a condition involving persistent dilatation and lengthening of the colon in the absence of organic disease. Diagnosis depends on subjective radiological, endoscopic or surgical findings in the context of a suggestive clinical presentation. This review sets out to investigate diagnostic criteria of AMC. METHODS: The literature was searched using the databases - PubMed, Medline via OvidSP, ClinicalKey, Informit and the Cochrane Library. Primary studies, published in English, with more than three patients were critically appraised based on study design, methodology and sample size. Exclusion criteria were studies with the following features: post-operative; megarectum-predominant; paediatric; organic megacolon; non-human; and failure to exclude organic causes. RESULTS: A review of 23 articles found constipation, abdominal pain, distension and gas distress were predominant symptoms. All ages and both sexes were affected, however, symptoms varied with age. Changes in anorectal manometry, histology and colonic transit are consistently reported. Studies involved varying patient numbers, demographics and data acquisition methods. CONCLUSIONS: Outcome data investigating the diagnosis of AMC must be interpreted in light of the limitations of the low-level evidence studies published to date. Proposed diagnostic criteria include: (1) the exclusion of organic disease; (2) a radiological sigmoid diameter of ~ 10 cm; (3) and constipation, distension, abdominal pain and/or gas distress. A proportion of patients with AMC may be currently misdiagnosed as having functional gastrointestinal disorders. Our conclusions are inevitably tentative, but will hopefully stimulate further research on this enigmatic condition.