Social inequalities in the use of physiotherapy in women diagnosed with breast cancer in Barcelona: DAMA cohort.

PURPOSE: This study aimed to analyze social inequalities in the use and access of physiotherapy service and its clinical and socio-economic determinants in women diagnosed with breast cancer in the hospital network of Barcelona. METHODS: Data from 2235 women belonging to the mixed (prospective and retrospective) DAMA Cohort were analyzed, including demographic, socio-economic, clinical, and breast cancer treatment outcomes. To determine the influence of such variables on access to physiotherapy, different Poisson regression models with robust variance (obtaining Prevalence Ratios and confidence intervals) were estimated. RESULTS: Although when experiencing different chronic and acute symptoms, only between 20 and 35% of women visited physiotherapist. Two out of 3 women reported to have received insufficient information about medical care and rehabilitation. Age of women, job occupation, education level, having a mutual or private insurance, as well as outcomes related to breast cancer, appear to be factors influencing the access to physiotherapy. CONCLUSIONS: Social and economic inequalities exist on the access to physiotherapy by women diagnosed with breast cancer, which is generally low, and may clearly impact on their functional recovery. Promoting strategies to reduce social bias, as well as improve communication and patient information regarding physiotherapy may be of interest for a better health care in breast cancer diagnosed women.

Exploring the Implications of Inter-Limb Asymmetries on Sprint, Agility, and Jump Performance in Young Highly-Trained Basketball Athletes: Is There a Relevant Threshold?

Background and Objectives: This study aimed to investigate the magnitude of vertical jump inter-limb asymmetries among young highly-trained basketball athletes and to analyze its impact on sport performance, specifically in sprints, agility, and vertical jumps. Materials and Methods: A unilateral countermovement jump (CMJ) was employed to determine Inter-limb Index Asymmetry (IAI) in 320 participants aged from 14 to 18 years, from the Valencia Basket youth academy. IAI was categorized into three groups: 0-9.9%, 10-14.9%, and >15%. The relationship between IAI and performance variables was analyzed through correlation studies (Pearson or Spearman's). The influence of IAI magnitude was assessed using ANOVA or Kruskal-Wallis analysis, with leg dominance as a covariable. SPSS Statistics version 26 was used for analysis. Results: Among all the participants, the mean IAI was 10.6%. Correlation studies revealed non-significant values (p < 0.05) between IAI and sport performance variables. The three IAI magnitude groups did not show statistically significant differences in sprint, agility, and jump outcomes. Leg dominance did not seem to influence performance outcomes, except for unilateral CMJ. Conclusions: The results obtained challenge the assumption that an IAI above 10% negatively affects sprint, agility, or jump performance in young basketball athletes. Notably, the magnitude of IAI did not influence sport performance parameters, suggesting that the 10-15% threshold from previous studies may not be applicable to this population. The study emphasizes the need to understand lower-limb asymmetries in the context of specific sport task performance, considering the potential evolution over time among affected young athletes.

Plasma Biomarkers and Fractional Exhaled Nitric Oxide in the Diagnosis of Eosinophilic Esophagitis.

OBJECTIVES: Eosinophilic esophagitis (EoE) is a chronic disease which requires endoscopy with biopsies for diagnosis and monitoring. We aimed to identify a panel of non-invasive markers that could help identify patients with active EoE. METHODS: In this prospective cohort study, we enrolled 128 children aged 5-18 years old, scheduled for endoscopy for suspected esophageal or peptic disease. On the day of the endoscopy, fractionated exhaled nitric oxide (FeNO) was measured; and blood was collected for peripheral absolute eosinophil count (AEC), plasma amino acids, and plasma polyamine analysis. Patients were grouped into controls (n = 91), EoE in remission (n = 16), or active EoE (n = 21), based on esophageal eosinophilia and history of EoE. RESULTS: AEC was not statistically significant different among the groups compared ( P = 0.056). Plasma amino acids: citrulline (CIT), ß-alanine (ß-ALA), and cysteine (CYS) were higher in active EoE compared to controls ( P < 0.05). The polyamine spermine was lower in active EoE versus controls ( P < 0.05). Receiver operator characteristic (ROC) curve to assess the predictive capability of a combined score made of FeNO, ß-ALA, CYS, and spermine had an area under curve (AUC) of 0.90 (95% CI: 0.80-0.96) in differentiating active EoE from controls and 0.87 (95% CI: 0.74-1.00) when differentiating active EoE from EoE in remission. CONCLUSION: A panel comprising FeNO, 2 plasma amino acids (ß-ALA, CYS) and the polyamine spermine can be used as a non-invasive tool to differentiate active EoE patients from controls.

ALC1/eIF4A1-mediated regulation of CtIP mRNA stability controls DNA end resection.

During repair of DNA double-strand breaks, resection of DNA ends influences how these lesions will be repaired. If resection is activated, the break will be channeled through homologous recombination; if not, it will be simply ligated using the non-homologous end-joining machinery. Regulation of resection relies greatly on modulating CtIP, which can be done by modifying: i) its interaction partners, ii) its post-translational modifications, or iii) its cellular levels, by regulating transcription, splicing and/or protein stability/degradation. Here, we have analyzed the role of ALC1, a chromatin remodeler previously described as an integral part of the DNA damage response, in resection. Strikingly, we found that ALC1 affects resection independently of chromatin remodeling activity or its ability to bind damaged chromatin. In fact, it cooperates with the RNA-helicase eIF4A1 to help stabilize the most abundant splicing form of CtIP mRNA. This function relies on the presence of a specific RNA sequence in the 5' UTR of CtIP. Therefore, we describe an additional layer of regulation of CtIP-at the level of mRNA stability through ALC1 and eIF4A1.

Patient, clinician, and performance-based measures provide different information about clinical symptoms in patients with severe knee osteoarthritis presenting with depressive symptoms: a cross-sectional study.

BACKGROUND AND PURPOSE: Clinical status of subjects with knee osteoarthritis (KOA) is influenced by a complex interaction of several biopsychosocial factors. The use of patient-reported measures (PROM) is considered the gold standard for their evaluation. However, considering that 1 in 5 subjects with KOA present with depressive symptoms, it is necessary to analyse how this psychological domain may influence the subjective perception of PROM. The objective was to study the impact that depressive symptoms have on functional outcome assessments, according to the degree of objectivity of diverse outcome measures. METHODS: Cross-sectional study. Subjects with severe KOA, verified with clinical and radiological symptoms, were assessed with patient-reported (Oxford Knee Score), clinician-reported (knee range of motion), and performance-based (Timed up and go test) measures. The existence of depressive symptoms was assessed with the Yesavage scale, and participants were classified for having no-, mild- or severe-symptoms. Linear correlations (r) and one-way analysis of variance compared groups (95% CI). RESULTS: 244 participants were analysed, of which 75 (30.7%) had depressive symptoms. These symptoms had an inverse moderate association with Oxford Knee Score (r = -0.387). However, the correlation with the Timed up and go test was low (r = 0.176), while there was no correlation with knee ROM (r = -0.087). CONCLUSIONS: This study supports that patient-reported questionnaires may offer biased information on the clinical status of patients with severe knee osteoarthritis who present with depressive symptoms. Consideration of such symptoms may be critical to ensure data collected to accurately reflect patients' capacities and perceptions.

The Effects of Suspension Training on Dynamic, Static Balance, and Stability: An Interventional Study.

Background and Objectives: While suspension training devices are increasingly gaining popularity, there is limited evidence on their effects on balance, and no comprehensive assessment has been conducted. This study aimed to evaluate the effects of a 9-session suspension training program on dynamic and static balance, stability, and functional performance. Materials and Methods: A total of forty-eight healthy adults, aged between 18 and 30, participated in a 9-session suspension training program. The program included exercises targeting upper and lower body muscles as well as core muscles. Balance was comprehensively assessed using various dynamic balance tests, including the Y Balance Test (YBT) as the primary outcome, single-leg Emery test, and sideways jumping test. Static balance was evaluated through the monopedal and bipedal Romberg tests. Changes from baseline were analyzed using a one-way ANOVA test. Results: Thirty-nine participants (mean age: 21.8 years) completed the intervention. The intervention resulted in significant improvements in YBT, jumping sideways, Emery, and 30s-SST scores (p < 0.001). Platform measures indicated enhanced monopedal stability (p < 0.001) but did not show a significant effect on bipedal stability (p > 0.05). Conclusions: Suspension training is a safe and feasible method for improving dynamic balance and functional performance in healthy, untrained young adults. However, it does not appear to significantly impact the ability to maintain a static posture while standing.

Automated detection of the contrast phase in MDCT by an artificial neural network improves the accuracy of opportunistic bone mineral density measurements.

OBJECTIVES: To determine the accuracy of an artificial neural network (ANN) for fully automated detection of the presence and phase of iodinated contrast agent in routine abdominal multidetector computed tomography (MDCT) scans and evaluate the effect of contrast correction for osteoporosis screening. METHODS: This HIPPA-compliant study retrospectively included 579 MDCT scans in 193 patients (62.4 ± 14.6 years, 48 women). Three different ANN models (2D DenseNet with random slice selection, 2D DenseNet with anatomy-guided slice selection, 3D DenseNet) were trained in 462 MDCT scans of 154 patients (threefold cross-validation), who underwent triphasic CT. All ANN models were tested in 117 unseen triphasic scans of 39 patients, as well as in a public MDCT dataset containing 311 patients. In the triphasic test scans, trabecular volumetric bone mineral density (BMD) was calculated using a fully automated pipeline. Root-mean-square errors (RMSE) of BMD measurements with and without correction for contrast application were calculated in comparison to nonenhanced (NE) scans. RESULTS: The 2D DenseNet with anatomy-guided slice selection outperformed the competing models and achieved an F1 score of 0.98 and an accuracy of 98.3% in the test set (public dataset: F1 score 0.93; accuracy 94.2%). Application of contrast agent resulted in significant BMD biases (all p < .001; portal-venous (PV): RMSE 18.7 mg/ml, mean difference 17.5 mg/ml; arterial (AR): RMSE 6.92 mg/ml, mean difference 5.68 mg/ml). After the fully automated correction, this bias was no longer significant (p > .05; PV: RMSE 9.45 mg/ml, mean difference 1.28 mg/ml; AR: RMSE 3.98 mg/ml, mean difference 0.94 mg/ml). CONCLUSION: Automatic detection of the contrast phase in multicenter CT data was achieved with high accuracy, minimizing the contrast-induced error in BMD measurements. KEY POINTS: • A 2D DenseNet with anatomy-guided slice selection achieved an F1 score of 0.98 and an accuracy of 98.3% in the test set. In a public dataset, an F1 score of 0.93 and an accuracy of 94.2% were obtained. • Automated adjustment for contrast injection improved the accuracy of lumbar bone mineral density measurements (RMSE 18.7 mg/ml vs. 9.45 mg/ml respectively, in the portal-venous phase). • An artificial neural network can reliably reveal the presence and phase of iodinated contrast agent in multidetector CT scans ( https://github.com/ferchonavarro/anatomy_guided_contrast_c ). This allows minimizing the contrast-induced error in opportunistic bone mineral density measurements.

Computer-aided craniofacial superimposition validation study: the identification of the leaders and participants of the Polish-Lithuanian January Uprising (1863-1864).

In 2017, a series of human remains corresponding to the executed leaders of the "January Uprising" of 1863-1864 were uncovered at the Upper Castle of Vilnius (Lithuania). During the archeological excavations, 14 inhumation pits with the human remains of 21 individuals were found at the site. The subsequent identification process was carried out, including the analysis and cross-comparison of post-mortem data obtained in situ and in the lab with ante-mortem data obtained from historical archives. In parallel, three anthropologists with diverse backgrounds in craniofacial identification and two students without previous experience attempted to identify 11 of these 21 individuals using the craniofacial superimposition technique. To do this, the five participants had access to 18 3D scanned skulls and 14 photographs of 11 different candidates. The participants faced a cross-comparison problem involving 252 skull-face overlay scenarios. The methodology follows the main agreements of the European project MEPROCS and uses the software Skeleton-ID™. Based on MEPROCS standard, a final decision was provided within a scale, assigning a value in terms of strong, moderate, or limited support to the claim that the skull and the facial image belonged (or not) to the same person for each case. The problem of binary classification, positive/negative, with an identification rate for each participant was revealed. The results obtained in this study make the authors think that both the quality of the materials used and the previous experience of the analyst play a fundamental role when reaching conclusions using the CFS technique.

Fungi: Friend or Foe? A Mycobiome Evaluation in Children With Autism and Gastrointestinal Symptoms.

ABSTRACT: Gastrointestinal (GI) symptoms often affect children with autism spectrum disorders (ASD) and GI symptoms have been associated with an abnormal fecal microbiome. There is limited evidence of Candida species being more prevalent in children with ASD. We enrolled 20 children with ASD and GI symptoms (ASD + GI), 10 children with ASD but no GI symptoms (ASD - GI), and 20 from typically developing (TD) children in this pilot study. Fecal mycobiome taxa were analyzed by Internal Transcribed Spacer sequencing. GI symptoms (GI Severity Index [GSI]), behavioral symptoms (Social Responsiveness Scale -2 [SRS-2]), inflammation and fungal immunity (fecal calprotectin and serum dectin-1 [ELISA]) were evaluated. We observed no changes in the abundance of total fungal species (alpha diversity) between groups. Samples with identifiable Candida spp. were present in 4 of 19 (21%) ASD + GI, in 5 of 9 (56%) ASD - GI, and in 4 of 16 (25%) TD children (overall P = 0.18). The presence of Candida spp. did not correlate with behavioral or GI symptoms (P = 0.38, P = 0.5, respectively). Fecal calprotectin was normal in all but one child. Finally, there was no significance in serum dectin-1 levels, suggesting no increased fungal immunity in children with ASD. Our data suggest that fungi are present at normal levels in the stool of children with ASD and are not associated with gut inflammation.

Effectiveness of Pain Neuroscience Education in Patients with Fibromyalgia: A Systematic Review and Meta-Analysis.

PURPOSE: To assess the effects of pain neuroscience education (PNE) on patients with fibromyalgia in terms of pain intensity, fibromyalgia impact, anxiety, and pain catastrophizing. METHODS: A systematic review with meta-analysis of randomized controlled trials was conducted. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated with RStudio software (RStudio, Boston, MA) for relevant outcomes and were pooled in a meta-analysis with the random effects model. RESULTS: A total of eight studies were included. The meta-analysis showed statistically significant differences in pain intensity with a moderate clinical effect in seven studies at the post-intervention assessment (SMD: -0.76; 95% CI: -1.33 to -0.19; P < 0.05) with evidence of significant heterogeneity (P < 0.05, I2 = 92%), but it did not show statistically significant differences in fibromyalgia impact, anxiety, and pain catastrophizing (P > 0.05). With regard to the follow-up assessment, only the fibromyalgia impact showed significant improvements, with a very small clinical effect in nine studies (SMD: -0.44; 95% CI: -0.73 to -0.14; P < 0.05) and evidence of significant heterogeneity (P < 0.05, I2 = 80%). After the application of a sensitivity analysis with the PNE face-to-face interventions, the meta-analysis showed a significant decrease in pain intensity, with a moderate clinical effect at the post-intervention and follow-up assessments without evidence of significant heterogeneity (P < 0.05, I2 = 10%). CONCLUSIONS: There is low-quality evidence that in patients with fibromyalgia, PNE can decrease the pain intensity in the post-intervention period and the fibromyalgia impact in the follow-up period. However, it appears that PNE showed no effect on anxiety and pain catastrophizing.

A randomized controlled trial assessing the effects of preoperative strengthening plus balance training on balance and functional outcome up to 1 year following total knee replacement.

PURPOSE: To investigate the effects of including balance training in a preoperative strengthening intervention on balance and functional outcomes in patients undergoing total knee replacement (TKR) and compare these effects to those induced by preoperative strengthening and no intervention. METHODS: Eighty-two subjects scheduled for TKR were randomly allocated into the strengthening (ST, n = 28) group: a preoperative lower limb strengthening intervention; the strengthening + balance (ST + B, n = 28) group: same intervention augmented with balance training; and the control group (n = 26). The Berg Balance Scale (BBS) and the function in daily living subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS-ADL) were the primary outcomes. The secondary measures included balance and mobility, self-reported status, and knee function. The outcomes were assessed at baseline, 1 week before surgery, and 2, (primary endpoint), 6 and 52 weeks after surgery. RESULTS: Compared with the controls, the participants in the ST and ST + B groups presented significant improvements from baseline to the end of the preoperative intervention in BBS (p = 0.005) and KOOS-ADL (p < 0.001). At 6 weeks post-surgery, the knee extensor strength values were similar in the two treatment groups and significantly higher than that in the controls. Overall, the participant outcomes in all groups stabilized at 1 year after surgery. CONCLUSION: A preoperative strengthening intervention, regardless of whether it is complemented with balance training, enhances strength but not balance or functional outcomes at 6 weeks after surgery. Patients are expected to present similar performance at 1 year postoperatively, but adequately statistically powered trials are needed to confirm the findings. LEVEL OF EVIDENCE: II. TRIAL REGISTRATION: NCT02995668.

Short- and Mid-Term Impact of Tobacco Smoking on Donor Renal Function Following Living Kidney Donation at a Tertiary Referral Hospital.

BACKGROUND: The negative impact of tobacco smoking on renal function has been widely studied. However, there is limited knowledge about the effect of smoking on pre-operative and post-operative renal function in living kidney donors. OBJECTIVE: The objective of the study was to evaluate the short- and mid-term impact of smoking on donor renal function. METHODS: This is a retrospective study of 308 patients who underwent living donor nephrectomy (LDN) at a tertiary referral hospital. We compared baseline characteristics as well as functional outcomes following LDN according to history of tobacco smoking. Estimated glomerular filtration rate (eGFR) was calculated with the modification of diet in renal disease equation in 6 time periods: pre-operative, 1 week, 1 month, 6 months, 12 months, and 24 months after surgery. We performed a Kaplan-Meier analysis for chronic kidney disease (CKD) outcome and binary logistic regression analysis to identify risk factors associated with CKD at 24 months of follow-up. RESULTS: Among donors, 106 (34.4%) reported a smoking history before nephrectomy. Smoking donors had worse pre-operative eGFR than non-smokers (90 ± 26.3 mL/min/1.73m2 vs. 96 ± 27 mL/min/1.73 m2, respectively; p = 0.02) and lower eGFR at 1 week (p = 0.01), 1 month (p ≤ 0.01), 6 months (p = 0.01), and 12 months (p = 0.01) after LDN. Tobacco smoking (OR 3.35, p ≤ 0.01) and age ≥ 40 years at donation (OR 6.59, p ≤ 0.01) were associated with post-operative development of CKD at 24 months after LDN. CONCLUSIONS: Living kidney donors with a tobacco smoking history had an increased risk of developing chronic kidney disease following nephrectomy. Smoking-cessation strategies should be implemented.

Post-Trial Sustainability and Scalability of the Benefits of a Medical Home for High-Risk Children with Medical Complexity.

OBJECTIVE: To assess the sustainability of the benefits relative to usual care of a medical home providing comprehensive care for high-risk children with medical complexity (≥2 hospitalizations or ≥1 pediatric intensive care unit [PICU] admission in the year before enrollment) after we made comprehensive care our standard practice and expanded the program. STUDY DESIGN: We conducted pre-post comparisons of the rate of children with serious illness (death, PICU admission, or >7-day hospitalization) and health-system costs observed after program expansion (March 2014-June 2015) to those during the clinical trial (March 2011-August 2013) for each of the trial's treatment groups (usual care, n = 96, and comprehensive care, n = 105; primary analyses), and among all children given comprehensive care (nPost-trial = 233, including trial usual care children who transitioned to comprehensive care post-trial and newly enrolled medically complex children, and nTrial = 105; secondary analyses). We also analyzed the findings for the trial patients as a 2-phase stepped-wedge study. RESULTS: In intent-to-treat analyses, rates of children with serious illness and costs were reduced or unchanged post-trial vs trial for the trial's usual care group (rate ratio [RR], 0.36; 95% CI, 0.20-0.64; cost ratio [CR], 0.68; 95% CI, 0.28-1.68), the trial's comprehensive care group (RR, 0.74; 95% CI, 0.39-1.41; CR, 0.67; 95% CI, 0.51-0.89), and among all children given comprehensive care (RR, 0.97; 95% CI, 0.61-1.52; CR, 0.75; 95% CI, 0.61-0.93). Conservative stepped-wedge analyses identified overall benefits with comprehensive care across both study periods (RR, 0.46; 95% CI, 0.30-0.72; CR, 0.64; 95% CI, 0.43-0.99). CONCLUSIONS: Major benefits of comprehensive care did not diminish with post-trial program expansion.

The rationale for combination therapy in patients with aggressive B-cell non-Hodgkin lymphoma: ten questions.

Rituximab plus cyclophosphamide, doxorubicin, vincristine, prednisone immunochemotherapy remains standard of care for first-line treatment of diffuse large B-cell lymphoma (DLBCL). High-dose chemotherapy and stem cell transplantation is offered to most relapsing/refractory patients who respond to salvage therapy. This Q&A review evaluates recommended management strategies for second and subsequent lines of therapy in patients with DLBCL, outlining the relative efficacies of currently available options including novel agents such as ibrutinib and CAR-T cells. The combination of pixantrone and rituximab is currently under investigation as a second-line treatment for patients ineligible for stem cell transplantation, while pixantrone monotherapy is the only therapeutic option approved for multiply relapsed and refractory DLBCL beyond the second line at this time.

Prostate cancer screening in low- and middle-income countries: the Mexican case.

Prostate-specific antigen (PSA)-based early detection for prostate cancer is the subject of intense debate. Implementation of organized prostate cancer screening has been challenging, in part because the PSA test is so amenable to opportunistic screening. To the extent that access to cancer screening tests increases in low- and middle-income countries (LMICs), there is an urgent need to thoughtfully evaluate existing and future cancer screening strategies to ensure benefit and control costs. We used Mexico's prostate cancer screening efforts to illustrate the challenges LMICs face. We provide five considerations for policymakers for a smarter approach and implementation of PSA-based screening.

El uso del Antígeno Prostático Específico (APE) para tamizaje para cáncer de próstata sigue siendo tema de amplio debate. La implementación de estrategias de tamiz organizado de cáncer de próstata ha sido un reto en parte porque la prueba de APE se presta para detección oportunista. A medida que aumenta el acceso a las pruebas de detección de cáncer en los países de ingresos bajos y medianos (PIBM), existe la necesidad urgente de evaluar cuidadosamente las estrategias actuales y futuras de detección oportuna de cáncer para garantizar su beneficio y controlar sus costos. Utilizamos los esfuerzos de tamizaje de cáncer de próstata de México para ilustrar los retos para PIBM. Ofrecemos cinco consideraciones dirigidas a tomadores de decisión que permitan contar con estrategias racionales de implementación de tamizaje para cáncer de próstata basado en el uso de APE.

Neuro-Sliding Control for Underwater ROV's Subject to Unknown Disturbances.

Proposed in this paper is a model-free and chattering-free second order sliding mode control (2nd-SMC) in combination with a backpropagation neural network (BP-NN) control scheme for underwater vehicles to deal with external disturbances (i.e., ocean currents) and parameter variations caused, for instance, by the continuous interchange of tools. The compound controller, here called the neuro-sliding control (NSC), takes advantage of the 2nd-SMC robustness and fast response to drive the position tracking error to zero. Simultaneously, the BP-NN contributes with its capability to estimate and to compensate online the hydrodynamic variations of the vehicle. When a change in the vehicle's hydrodynamics occurs, the 2nd-SMC may no longer be able to compensate for the variations since its feedback gains are tuned for a different condition; thus, in order to preserve the desired performance, it is necessary to re-tune the feedback gains, which a cumbersome and time consuming task. To solve this, a viable choice is to implement a BP-NN control scheme along with the 2nd-SMC that adds or removes energy from the system according to the current condition it is in, in order to keep, or even improve, its performance. The effectiveness of the proposed compound controller was supported by experiments carried out on a mini-ROV.

Infant Colic Represents Gut Inflammation and Dysbiosis.

OBJECTIVE: To dissect potential confounding effects of breast milk and formula feeding on crying + fussing, fecal calprotectin, and gut microbiota in babies with colic. We hypothesized that infant colic is associated with gut inflammation linked to intestinal dysbiosis. STUDY DESIGN: A nested case-control design of 3 of our studies was used to analyze clinical and laboratory data at presentation, comparing babies with colic with controls. All investigators other than the biostatistician were blinded during data analysis. Subjects were recruited based on their age and crying + fussy time. We screened 65 infants, 37 with colic, as defined by Barr diary (crying + fussing time >3 hours daily), who were compared with 28 noncolicky infants. RESULTS: Fecal calprotectin was elevated in babies with colic. For each mode of infant feeding (breast milk, formula, or breast + formula), infants' fecal calprotectin was higher in babies with colic. Infants with colic had similar levels of fecal alpha diversity (richness) when compared with controls, and alpha diversity was lower in breast-fed babies. Beta diversity at the phylum level revealed significant differences in microbial population. A phylum difference resulted from reduced Actinobacteria (95% of which are Bifidobacilli) in babies with colic. Species significantly associated with colic were Acinetobacter and Lactobacillus iners. CONCLUSIONS: Colic is linked with gut inflammation (as determined by fecal calprotectin) and dysbiosis, independent of mode of feeding, with fewer Bifidobacilli. TRIAL REGISTRATION: Clinicaltrials.gov: NCT01279265 and NCT01849991.

Insufflation With Carbon Dioxide During Pediatric Colonoscopy for Control of Postprocedure Pain.

GOALS: To determine if carbon dioxide (CO2) insufflation in children would improve postprocedure pain following colonoscopy in children. BACKGROUND: CO2 insufflation during colonoscopy has been found to reduce postcolonoscopy pain in the adult population, but limited data exist in pediatrics. MATERIALS AND METHODS: We conducted a prospective study with 40 pediatric patients scheduled for outpatient colonoscopy. Patients were enrolled continuously and were randomized to receive CO2 or air insufflation. Patients and colonoscopists were blinded to insufflation method. End tidal CO2 (EtCO2) was documented throughout the procedure. Abdominal pain was established preprocedure then at 1-, 6-, and 24-hour postprocedure. Subject demographics, indications, colonoscopists' year of training, time to cecum, adverse events, and final diagnoses were recorded. RESULTS: Twenty patients were randomized to each group. Patients receiving air had a statistically significant increase in pain from baseline at 1- and 6-hours after colonoscopy (P=0.007 and 0.008). This was not seen in the CO2 group (P=0.740 and 0.289). There was an increase in postprocedure pain in the air group compared with CO2 group at the 1-hour mark (P=0.032). EtCO2 increased during the procedure, regardless of insufflation method, but no difference was seen between groups (P=0.822). CONCLUSIONS: Our results demonstrate that higher levels of pain were reported by patients following air compared with those receiving CO2 insufflation. This is the first study to show CO2 is as safe as air, with no increase in EtCO2 between groups in the pediatric population. CO2 is an effective and safe modality and should be considered for pediatric colonoscopies.