Use of Fecal Occult Blood Testing as a Diagnostic Tool for Clinical Indications: A Systematic Review and Meta-Analysis.

INTRODUCTION: Fecal occult blood tests (FOBTs) are validated only for colorectal cancer (CRC) screening, but are commonly used as a diagnostic test in other clinical settings. We performed a systematic review to assess performance characteristics of FOBT as a diagnostic test for clinical indications. METHODS: Bibliographic databases were searched to identify studies in adult patients with a specific gastrointestinal symptom or condition who underwent FOBT and a reference test and provided data on diagnoses. Our primary end point was sensitivity. Risk of bias was assessed with the QUADAS-2 tool. RESULTS: Twenty-two studies met the inclusion criteria: 12 in iron deficiency anemia (IDA) (5 fecal immunochemical (FIT) and 7 guaiac based), 8 in ulcerative colitis (FIT), and 2 in acute diarrhea (guaiac based). Only 2 studies had low risk of bias on all domains of the QUADAS-2. On meta-analysis, FOBT had a sensitivity of 0.58 (95% confidence interval [CI] 0.53-0.63) and a specificity of 0.84 (95% CI 0.75-0.89) in predicting presumptive causes of IDA at endoscopy, with comparable results for guaiac-based tests and FIT. Sensitivity was higher for CRC (0.83) than non-CRC lesions (0.54). FIT had a sensitivity of 0.72 (95% CI 0.57-0.84) and a specificity of 0.80 (95% CI 0.67-0.89) in predicting endoscopic activity in UC. Sensitivities of FOBT for positive stool culture in acute diarrhea were 0.38 and 0.87. DISCUSSION: Sensitivity of FOBT is poor for IDA: 42% of patients with identifiable causes of IDA had false-negative FOBT. Our results did not show acceptable performance characteristics for FOBT to guide decisions regarding endoscopic evaluation and do not support its use in IDA.

Contraction Reserve With Ineffective Esophageal Motility on Esophageal High-Resolution Manometry is Associated With Lower Acid Exposure Times Compared With Absent Contraction Reserve.

INTRODUCTION: Ineffective esophageal motility (IEM) is a minor motor disorder with potential reflux implications. Contraction reserve, manifested as augmentation of esophageal body contraction after multiple rapid swallows (MRS), may affect esophageal acid exposure time (AET) in IEM. METHODS: Esophageal high-resolution manometry (HRM) and ambulatory reflux monitoring studies were reviewed over 2 years to identify patients with normal HRM, IEM (≥50% ineffective swallows), and absent contractility (100% failed swallows). Single swallows and MRS were analyzed using HRM software tools (distal contractile integral, DCI) to determine contraction reserve (mean MRS DCI to mean single swallow DCI ratio >1). Univariate analysis and multivariable regression analyses were performed to determine motor predictors of abnormal AET in the context of contraction reserve. RESULTS: Of 191 eligible patients, 57.1% had normal HRM, 37.2% had IEM, and 5.8% had absent contractility. Contraction reserve had no affect on AET in normal HRM. Nonsevere IEM (5-7 ineffective swallows) demonstrated significantly lower proportions with abnormal AET in the presence of contraction reserve (30.4%) compared with severe IEM (8-10 ineffective swallows) (75.0%, P = 0.03). Abnormal AET proportions in nonsevere IEM with contraction reserve (32.7%) resembled normal HRM (33.0%, P = 0.96), whereas that in severe IEM with (46.2%) or without contraction reserve (50.0%) resembled absent contractility (54.5%, P ≥ 0.6). Multivariable analysis demonstrated contraction reserve to be an independent predictor of lower upright AET in nonsevere (odds ratio 0.44, 95% confidence interval 0.23-0.88) but not severe IEM. DISCUSSION: Contraction reserve affects esophageal reflux burden in nonsevere IEM. Segregating IEM into severe and nonsevere cohorts has clinical value.

Motivational Interviewing Approach Used by a Community Mental Health Team.

The current study aimed to (a) evaluate the effectiveness of motivational interviewing, as applied by a community mental health team (CMHT) based in Singapore; (b) reduce hospital admissions and length of hospital stay; and (c) improve global functioning and satisfaction of individuals with mental illness. The current study used a quasi-experimental method. A convenience sample of 120 participants was selected from the caseload of the CMHT. Participants received motivational interviewing sessions at least once every month for 1 year. Data on the number of hospital admissions, length of hospitalization, Global Assessment of Functioning, and patient satisfaction were collected at baseline and 6 and 12 months. Participants who underwent the CMHT services with motivational interviewing were more compliant to treatment, resulting in significant reduction in hospitalization and improvement in functionality. Motivational interviewing is effective in facilitating better illness management for patients in the community. Adoption of the motivational interviewing approach may potentially provide significant benefits for psychiatric support services in the community.

Successful dietary changes correlate with weight-loss outcomes in a new dietary weight-loss program.

Background: Currently available behavioral and dietary weight-loss programs lack magnitude and sustainability compared with bariatric surgery. A novel dietary weight-loss program was developed to assist participants in achieving sustainable diet changes by building knowledge and skills in food self-selection. Although the approach worked, a large variation was observed in outcome among participants. Objective: Determine factors affecting weight-loss outcomes among participants to further improve the efficacy of the program. Methods: Participants attended 19 dietary educational sessions during a 1-year intervention which included prescribed homework. Changes in weight, diet, and body composition were assessed. Results: Participants (n = 22) achieved mean body weight loss of -6.49(8.37%, p < 0.001) from baseline at 12 months. Nine participants (41%) achieved weight loss >5% of initial bodyweight; two reached a Body Mass Index 25 kg/m2. A large divergence in weight loss among participants was observed; successful (n = 9) achieved -12.9(9.6)% while unsuccessful achieved -2.03(2.78)%. Dietary protein and fiber density by 24-h records showed a significant and inverse correlation with weight loss (%) throughout the program. Weight loss at 3 months and 12 months showed a strong correlation (r = 0.84). Participants with self-reported depression lost significantly less weight than those without depression at 12 months (p < 0.03). Conclusions: Divergence in weight-loss outcomes among the participants is likely due to a difference in successful dietary implementation. Intra-cohort analysis indicates early weight-loss success and early dietary implementation was predictive of long-term success.

Generation of Membrane-Derived Nanovesicles by Nitrogen Cavitation for Drug Targeting Delivery and Immunization.

Extracellular vesicles (EVs) derived from cell membranes act as therapeutics and targeted drug carriers. However, the production scalability and reproducibility of EVs limit their biomedical applications. In the past few years, our lab has developed a nitrogen cavitation approach to efficiently produce EVs from any types of eukaryotic cells and bacteria. We have demonstrated that EVs derived from differentiated HL-60 cells can improve the treatment of inflammatory diseases. In addition, we have showed an increased survival of animals from bacterial infections by Pseudomonas aeruginosa after the mice were immunized with the nanovesicles derived from Pseudomonas aeruginosa membrane.

A feasibility study to test a novel approach to dietary weight loss with a focus on assisting informed decision making in food selection.

Obesity is a significant contributor to the development of chronic diseases, some of which can be prevented or reversed by weight loss. However, dietary weight loss programs have shortcomings in the success rate, magnitude, or sustainability of weight loss. The Individualized Diet Improvement Program's (iDip) objective was to test the feasibility of a novel approach that helps individuals self-select a sustainable diet for weight loss and maintenance instead of providing weight loss products or rigid diet instructions to follow. The iDip study consisted of 22 dietary improvement sessions over 12 months with six months of follow-up. Daily weights were collected, and a chart summarizing progress was provided weekly. Six 24-hour dietary records were collected, and dietary feedback was provided in the form of a protein-fiber plot, in which protein/energy and fiber/energy of foods were plotted two-dimensionally together with a target box specific to weight loss or maintenance. An exit survey was conducted at 12 months. Twelve (nine female, 46.3±3.1 years (mean±SE)) of the initial 14 participants (BMI>28 kg/m2) completed all sessions. Mean percent weight loss (n = 12) at six and 12 months was -4.9%±1.1 (p = 0.001) and -5.4%±1.7 (p = 0.007), respectively. Weight loss varied among individuals at 12 months; top and bottom halves (n = 6 each) achieved -9.7%±1.7 (p = 0.0008) and -1.0%±1.4 weight loss, respectively. The 24-hour records showed a significant increase in protein density from baseline to final (4.1g/100kcal±0.3 vs. 5.7g/100kcal±0.5; p = 0.008). Although mean fiber density showed no significant change from the first month (1.3g/100kcal±0.1), the top half had significantly higher fiber/energy intake than the bottom half group. The survey suggested that all participants valued the program and its self-guided diet approach. In conclusion, half of the participants successfully lost >5% and maintained the lost weight for 12 months without strict diet instructions, showing the feasibility of the informed decision-making approach.

Nonsteroidal Antiinflammatory Drugs, Anticoagulation, and Upper Gastrointestinal Bleeding.

Advanced age, history of peptic ulcer disease, Helicobacter pylori, coadministration of nonsteroidal antiinflammatory drugs (NSAIDs), corticosteroids, anticoagulation, and antiplatelets are risk factors for gastrointestinal bleeding in the elderly. Awareness of these risks and appropriate use of NSAIDs, particularly in those needing antiplatelet or anticoagulant therapy, is critical to optimal management. Careful selection of elderly patients requiring antiplatelet, anticoagulation, or chronic NSAID therapy for cotherapy with proton pump inhibitors can significantly reduce morbidity and mortality from gastrointestinal bleeding.

B.2.16 is a non-lethal modifier of the Dark82 mosaic eye phenotype in Drosophila melanogaster.

Genetic screens have been used to identify genes involved in the regulation of different biological processes. We identified growth mutants in a Flp/FRT screen using the Drosophila melanogaster eye to identify conditional regulators of cell growth and cell division. One mutant identified from this screen, B.2.16, was mapped and characterized by researchers in undergraduate genetics labs as part of the Fly-CURE. We find that B.2.16 is a non-lethal genetic modifier of the Dark82 mosaic eye phenotype.

Using Media While Interacting Face-to-Face Is Associated With Psychosocial Well-Being and Personality Traits.

Positive face-to-face human interactions are known to benefit well-being. Drawing upon previous work regarding the interference of media (via technological devices or print) in social interaction, the aim of this study was to identify whether using media during face-to-face interaction could potentially limit the positive effect of interaction on well-being. Participants were 437 university students who completed an online survey which assessed media multitasking behaviors, well-being (trait depression, trait anxiety, social anxiety, empathy, and psychological well-being), and personality traits (Big-5 and narcissism). Face-to-face interaction was positively associated with well-being. However, when media use during face-to-face interaction was considered, there was a negative relationship with well-being (more depression, more anxiety, and less psychological well-being). Those who used certain media types, such as phone or video chatting, listening to music, and gaming, while interacting with others, also had lower scores on measures of empathy. Regression analyses showed significant contributions by these media types to empathy levels, even after controlling for age, gender, and personality traits. Face-to-face media multitasking was related to higher levels of narcissism and neuroticism, and lower levels of agreeableness, conscientiousness, and openness. This study provides insight into the possible role of media multitasking during face-to-face interaction on psychosocial outcomes.

Glycosylated hemoglobin level may predict the severity of gastroparesis in diabetic patients.

AIM: To investigate the association between glycemic control represented by glycated hemoglobin (HbA1c) level and the value of 4-h gastric retention on nuclear scan. METHODS: We retrospectively reviewed records of diabetic patients who had 4-h nuclear gastric emptying study, with documented 4-h retention value, between January 1st, 2002 and July 30th, 2014 and had HbA1C level close to the time of the study. We divided our cohort into patients with good glycemic control (HbA1C <7, group A), fair control (7-9, group B), and poor control (>9, group C). The 4-h retention value and symptoms were compared between the 3 groups. RESULTS: Our cohort included 299 patients; mean age was 59 ±â€¯14. The median interval between performing gastric emptying study and measuring HbA1C was 41 days. There were 94 patients in group A (HbA1C 6.1 ±â€¯0.4), 131 patients in group B (HbA1C 7.9 ±â€¯0.5), and 74 patients in group C (HbA1C 10.9 ±â€¯1.6). The mean gastric retention value was different between the three study groups, 8.3% ±17, 11.5% ±19, and 14.4% ±21, respectively (P = .03). CONCLUSION: This is the first study to show that HbA1C level is significantly associated with the 4-h retention value on nuclear gastric emptying scan.

Two-dimensional silicon photonic crystal based biosensing platform for protein detection.

We theoretically and experimentally demonstrate an ultrasensitive two-dimensional photonic crystal microcavity biosensor. The device is fabricated on a silicon-on-insulator wafer and operates near its resonance at 1.58 microm. Coating the sensor internal surface with proteins of different sizes produces a different amount of resonance redshift. The present device can detect a molecule monolayer with a total mass as small as 2.5 fg. The device performance is verified by measuring the redshift corresponding to the binding of glutaraldehyde and bovine serum albumin (BSA). The experimental results are in good agreement with theory and with ellipsometric measurements performed on a flat oxidized silicon wafer surface.

Nodular Regenerative Hyperplasia: A Case of Rare Prognosis.

Introduction: Nodular regenerative hyperplasia (NRH) is a known etiology of noncirrhotic portal hypertension. Cases of biopsy-proven NRH in human immunodeficiency virus (HIV)-positive patients have been described. While these patients often have normal synthetic liver function, several reports described disease progression to liver failure. Case: We here present a 26-year-old woman with history of congenital HIV on antiretroviral therapy complicated by Pneumocystis carinii pneumonia at age 14. CD4 counts have been >300 with undetectable viral load. She was referred to our Hepatology service for evaluation of splenomegaly, elevated liver tests, and thrombocytopenia. On initial presentation, she reported easy bruising and gingival bleeding, and abdominal imaging showed evidence of portal hypertension without associated cirrhosis. Upper endoscopy was significant for large esophageal varices without bleeding stigmata. Liver biopsy showed minimal fibrosis around the portal areas without significant inflammation. The lobules showed focal zones of thin hepatocyte plates on reticulin stain with adjacent areas showing mild regenerative changes. The diagnosis of NRH was made and patient was placed on propranolol for variceal bleeding prophylaxis. Two years later, the patient presented with bleeding gastric varices warranting transjugular intrahepatic portosystemic shunt. Postprocedure course was complicated by mild encephalopathy. Subsequent magnetic resonance imaging showed a 1.7 × 1.3 cm lesion suggestive of hepatocellular carcinoma (HCC). The patient was deemed to be a candidate for liver transplantation, and she is now delisted due to ongoing pregnancy. Conclusion: This report describes the first case of HCC in an HIV patient with NRH. The possible association of NRH with HCC warrants further investigation.

Nanoscale microcavity sensor for single particle detection.

Recently we demonstrated a biosensor based on a two-dimensional photonic crystal microcavity for detection of proteins. We present a theoretical and experimental study of a modified structure for single particle detection. With an active sensing volume of approximately 0.15 microm(3), the device is capable of detecting approximately 1 fg of matter. Its performance is tested with latex spheres with sizes that fall in the size range of a variety of viruses.