The role of magnetic sphincter augmentation in the treatment of gastroesophageal reflux disease.

PURPOSE OF REVIEW: Magnetic sphincter augmentation (MSA) has been designed as a less disruptive and more standardized laparoscopic surgical procedure than fundoplication for patients with early stage gastroesophageal reflux disease (GERD). We analyzed the more recent literature in search of updates regarding indications, technique, perioperative management, and long-term outcomes. RECENT FINDINGS: Over the years, the procedure of MSA has evolved to including full hiatus repair rather than relying on the preservation of the phreno-esophageal ligament. Restoring the mechanical synergy between the lower esophageal sphincter and the crural diaphragm has the potential to further enhance the antireflux barrier. The adoption of this approach has led to expand the indications from early stage disease to different scenarios including patients with high esophageal acid exposure, atypical symptoms, large hiatal hernias, Barrett's esophagus, postbariatric surgery, and previously failed fundoplication. SUMMARY: MSA has a favorable side-effect profile and is highly effective in reducing typical reflux symptoms, medication dependency, and esophageal acid exposure. Excellent outcomes have been confirmed over a 12-year follow-up, indicating that the operation has the potential to prevent GERD progression. Further studies are needed to confirm the cost-effectiveness of this procedure in patients with more advanced disease-stage and prior gastric surgery. A randomized control trial comparing MSA with fundoplication could raise the level of evidence and the strength of recommendation.

Ethical Treatment of Invasive and Native Fauna in Australia: Perspectives through the One Welfare Lens.

The One Welfare concept is proposed to guide humans in the ethical treatment of non-human animals, each other and the environment. One Welfare was conceptualized for veterinarians but could be a foundational concept through which to promote the ethical treatment of animals that are outside of direct human care and responsibility. However, wild-living animals raise additional ethical conundrums because of their multifarious values and roles, and relationships that humans have with them. At an open facilitated forum, the 2018 Robert Dixon Memorial Animal Welfare Symposium, a panel of five experts from different fields shared their perspectives on "loving and hating animals in the wild" and responded to unscripted questions from the audience. The Symposium's objectives were to elucidate views on the ethical treatment of the native and invasive animals of Australia and to identify some of the resultant dilemmas facing conservationists, educators, veterinarians and society. Here, we document the presented views and case studies and synthesize common themes in a One Welfare framework. Additionally, we identified points of contention that can guide further discourse. With this guide in place, the identification and discussion of those disparate views was a first step toward practical resolutions on how to manage wild-living Australian fauna ethically. We concluded that there was great utility in the One Welfare approach for any discourse about wild animal welfare. It requires attention to each element of the triple bottom line and ensures that advocacy for one party does not vanquish the voices from other sectors. We argue that, by facilitating a focus on the ecology in the context of wild animal issues, One Welfare is more useful in this context than the veterinary context for which it was originally developed.

4-ethoxymethylphenol: a novel phytoestrogen that acts as an agonist for human estrogen receptors.

Estrogen is the natural agonist of the estrogen receptor (ER). However, certain plant-derived compounds or phytoestrogens have been identified that mimic estrogens and act as agonists and/or antagonists of ERs, depending on subtype and target tissue. Using thin layer chromatography (TLC), gas chromatography-mass spectrometry (GC-MS), and proton nuclear magnetic resonance (1H-NMR), we identified a simple phenol, 4-ethoxymethylphenol (4EM), found in Maclura pomifera that acts as an agonist of ER-alpha and ER-beta in HeLa and MCF-7 cells. To study the effect of 4EM on ER-alpha and ER-beta activity, we performed transient transfection assays and showed that 4EM activated ER-dependent gene transcription in a dose-dependent manner on both ER subtypes and this activity was inhibited by trans-4-hydroxytamoxifen (4HT). Further, 4EM-mediated transcription in ER-alpha, like estrogen, was enhanced in the presence of coactivators, steroid receptor coactivator-1 (SRC-1), CREB binding proteins (CBP), and E6-associated protein (E6-AP). We found that 4EM was specific for ER and did not activate transcription of the progesterone receptor.