In Vitro Fermentation of Animal and Plant Protein Isolates by the Human Gut Microbiota Under High and Low Carbohydrate Conditions.

SCOPE: There is a lack of research comparing how different protein isolates influence the microbiome, especially when carbohydrate (CHO) availability is varied. The objective is to determine changes in gut microbiota composition and function during fermentation of digested protein isolates under high and low CHO conditions. METHODS AND RESULTS: Protein isolates from beef, egg white, milk, pea, and soy are subjected to in vitro digestion and fermentation with human fecal microbiota. Under low CHO conditions, the microbiota is primarily proteolytic with decreased concentrations of peptides and increased variance among microbial taxa and production of ammonia and branched chain fatty acids by the microbiota. Milk protein not only results in the highest production of butyrate and p-hydroxyphenylacetate but also has high concentrations of deleterious fermentation metabolites. Amino acid composition of the protein isolates is significantly correlated with abundances of many microbial taxa and metabolites, but the correlations are stronger in the low CHO medium. CONCLUSION: This study shows that low CHO conditions increase proteolytic fermentation and result in increased differences in microbiota response to protein isolates. It also showed that amino acid composition is highly associated with microbiota composition and function especially under low CHO conditions.

Toxicity of cadmium on dynamic human gut microbiome cultures and the protective effect of cadmium-tolerant bacteria autochthonous to the gut.

Cadmium (Cd) is a heavy metal toxic to the gut microbiome. In this study, we cultivated two human gut microbiomes (A and B) in bioreactors with Cd at 0 and 20 ppm for 7 days to investigate effects of Cd on the gut microbiome and to isolate Cd-tolerant bacteria autochthonous to the gut. Cd showed profound toxicity, abolishing butyrate production, depleting microbes in microbiome B, and simplifying microbiome A to a small Cd-tolerant community after 2 d of incubation. When spiked into the Cd-sensitive microbiome B, the Cd-tolerant community from microbiome A and isolates from that community worked synergistically with microbiome B to enhance butyrate production and maintained this synergism at Cd concentrations up to 5 ppm. Bacteria isolated from this Cd-tolerant community included Enterococcus faecium, Enterobacter cloacae, Lactococcus lactis, and Lactobacillus taiwanensis species. This work demonstrates a straightforward method for identifying Cd-tolerant bacteria autochthonous to the human gut that synergize with the microbiome to protect against Cd-related loss of butyrate production.

Muscle ultrasound in the assessment of suspected neuromuscular disease in childhood.

One hundred paediatric, muscle ultrasound examinations performed in the evaluation of suspected neuromuscular disease were reviewed. The results were related to the presence or absence of neuromuscular disease in each child assessed. The group comprised 66 males and 34 females, age range 2 months to 16 years (mean 5.3 years). Scans were graded I-IV, according to muscle echogenicity, using Heckmatt's criteria. Thirty-two children had a final diagnosis of neuromuscular disease. The sensitivity of ultrasound in detecting neuromuscular disease was 78% with 91% specificity. The test was more reliable in the sub-group of > 3 years with a sensitivity of 81% and specificity of 96%. There was a significant difference in disease status, (with and without neuromuscular disease), between children with a normal, grade I, scan and those with an abnormal, grade II, III, IV, image (chi-square, P < 0.001, 95% confidence limits 0.54-0.86). Muscle ultrasound is a specific and sensitive investigation for suspected neuromuscular disease in children.

The Sir James Mackenzie Cardiological Society and the American College of Cardiology.

Documents have recently been discovered that detail the origin and emergence of the New York Cardiological Society in 1928 from an earlier local organization that was founded in 1926 and named in honor of the Scottish cardiologist Sir James Mackenzie. These documents shed light on the earliest evolution of antecedent societies to the present American College of Cardiology and provide important insight into the early professional organization of clinical cardiology in the United States.

Measurement of optic nerve sheath diameter by ultrasound: a means of detecting acute raised intracranial pressure in hydrocephalus.

AIM: To evaluate the utility of measuring the optic nerve sheath diameter in children with shunted hydrocephalus, suspected of having raised intracranial pressure. METHODS: 23 children with shunted hydrocephalus were examined, six had well controlled ICP, 17 however manifested symptoms suggestive of intracranial hypertension. A clinical history was taken from all patients and their parents or carers. The shunt valve was examined clinically, and signs of raised intracranial pressure were sought. Ultrasound examination was performed in both eyes to measure the optic nerve sheath diameters 3 mm behind the globe. These measurements were compared with control data obtained from 102 children who attended the radiology department for unrelated renal ultrasound examination. RESULTS: Control data suggested that the upper limit of normal for optic nerve sheath diameter is 4.5 mm (measured 3 mm behind the globe) in patients over 1 year of age, and 4.0 mm in children less than 1 year of age. Those patients with functioning ventriculoperitoneal shunts had a mean optic nerve sheath diameter of 2.9 (SD 0.5) mm; those with raised intracranial pressure had a mean optic nerve sheath diameter of 5.6 (0.6) mm (p<0.0001). These results confirm that optic nerve sheath diameters in excess of the control data are strongly suggestive of raised intracranial pressure. CONCLUSION: The evaluation of the optic nerve sheath diameter is a simple non-invasive procedure, which is a potentially useful tool in the assessment and monitoring of children with hydrocephalus suspected of having raised intracranial pressure.

Ultrasound of the thyroid gland in the newborn: normative data.

OBJECTIVE: To establish reference ranges for thyroid length, breadth, depth, and volume in healthy term Scottish infants. DESIGN: Prospective observational study of 100 (49 male) neonates. Length, breadth, and depth were measured, and the volume of each lobe was calculated using the formula for a prolate ellipsoid (volume = length x breadth x depth x pi/6). RESULTS: All measurements showed gaussian distribution, with no significant differences between the right and the left lobes. Values (mean (SD) range) were: length (cm), 1.94 (0.24) 0.9-2.5; breadth (cm), 0.88 (0.16) 0.5-1.4; depth (cm), 0.96 (0.17) 0.6-2.0; volume (ml), 0.81 (0.24) 0.3-1.7; combined volume (ml), 1.62 (0.41) 0.7-3.3. Although there was no difference in mean volume between right and left lobes, there was considerable variation (-0.8 to + 0.7 ml) between the two lobes in individual babies. CONCLUSIONS: Both lobes should be measured to give a combined volume. Our findings provide a reference against which thyroid hypoplasia or goitre can be evaluated.

The acute paediatric scrotum: the role of colour doppler ultrasound.

Combined grey scale ultrasound and colour Doppler imaging of the acute paediatric scrotum provides a non-invasive means of assessing the structure and perfusion of the testis. Colour flow ultrasound is a sensitive and specific diagnostic tool for differentiating ischaemic pathology (in which blood flow rate is reduced) from inflammatory disease in which it is commonly increased. Using this technique the number of unnecessary surgical explorations of the scrotum can be reduced. The differential diagnosis of acute testicular pathology and the imaging characteristics of each disorder are described. Close collaboration between paediatric surgeons and radiologists is required to determine the optimal clinical and investigational strategy for each child.

Biliary tract dilatation in acquired immune deficiency syndrome.

Biliary tract dilatation without obstruction may result from sclerosing cholangitis, pyogenic cholangitis, or bile duct surgery. This case report describes a patient with AIDS whose biliary tract dilatation was due to cytomegalovirus infection. Such a diagnosis should now be considered in the immuno-suppressed patient who has dilated bile ducts.

Doppler ultrasound in pelviureteric junction obstruction in infants and children.

Six infants and seven children with known pelviureteric junction (PUJ) obstruction (11 unilateral, 2 bilateral) were assessed with Doppler ultrasound before and after diuresis. After intravenous frusemide, there was a significant increase in the resistance index in the interlobar renal arteries of the obstructed kidneys. No such change was detected in the normal kidneys. Five patients were reassessed after pyeloplasty. The Doppler indexes facilitated prediction of those cases with a satisfactory outcome after surgery. Doppler ultrasound with diuresis is useful in the assessment of PUJ obstruction in infants and children and in the postoperative follow-up.

A new case of Myhre syndrome.

Myhre Syndrome is a rare condition associated with mental retardation, short stature, generalized muscle hypertrophy, cardiac defects and a distinct facial appearance. There have only been five reported cases and we now present a sixth, together with a review of the clinical features of this syndrome.

Neuroradiological features of patients with optic nerve hypoplasia.

Optic nerve hypoplasia (ONH) is associated with a wide range of neurological and endocrine disorders. A series of 21 patients is reported. This comprised 17 with ONH in association with manifest neurological and endocrine disturbance, 3 who were blind but who were otherwise normal, and 1 with bilateral impaired visual acuity only. All patients underwent neuroradiological and detailed ophthalmic assessment. A wide range of abnormalities was observed. The most common findings were absent septum pellucidum, hydrocephaly, and porencephaly. Evidence of hypothalamic/pituitary hormone deficiency was present in nine patients, six of whom had demonstrable intracranial radiological abnormalities. All patients except one had bilateral optic nerve hypoplasia. Most patients had poor visual acuities and nystagmus. Astigmatism was also common. Two conditions which have not previously been reported in association with optic nerve hypoplasia were found: an intracranial arachnoid cyst and an intracranial epidermoid cyst.

Effectiveness of amiodarone in resistant arrhythmias.

Amiodarone is used in the treatment of previously drug-resistant supraventricular and ventricular arrhythmias. We report our experience with amiodarone in 8 patients. Five patients had paroxysmal atrial flutter, one had paroxysmal atrial fibrillation, one had supraventricular tachycardia, and one ventricular tachycardia. Considerable improvement, both objectively and subjectively, was observed in all patients. Side effects were as follows: all patients had corneal microdeposits, one developed left bundle branch block which resolved on stopping amiodarone, and one reported constipation and abdominal pains. Six patients have been treated for 10-28 months; 3 developed tolerance at 4-14 months after the introduction of amiodarone therapy, but symptoms improved with increased dosage. It is important to watch for the development of tolerance to this drug.