Long-term follow-up of two randomized trials comparing laparoscopic Nissen 360° with anterior 90° partial fundoplication.

BACKGROUND: The side-effects of Nissen fundoplication have led to modifications, including partial fundoplications such as an anterior 90° wrap. Five-year follow-up of two randomized trials suggested fewer side-effects following anterior 90° partial fundoplication, but better reflux control after Nissen fundoplication. However, longer-term outcomes have not been reported. This study combined data from previous trials to determine 10-year outcomes. METHODS: From 1999 to 2003, 191 patients were enrolled in two randomized trials comparing anterior 90° partial versus Nissen fundoplication. Trial protocols were similar, and data were combined to determine long-term clinical outcomes. Patients completed annual questionnaires assessing dysphagia, heartburn, medications, satisfaction and other symptoms. Visual analogue scales (0-10), a composite dysphagia score (0-45) and yes/no responses were used. RESULTS: Of the 191 patients, 152 (79·6 per cent) were available for 10-year follow-up. After anterior 90° fundoplication, patients reported less dysphagia to solids (score 2·03 versus 3·18 for the Nissen procedure; P = 0·037). Heartburn scores were lower after Nissen fundoplication (1·90 versus 2·83 for anterior 90° fundoplication; P = 0·035) and fewer patients required proton pump inhibitors (PPIs) (22 versus 39 per cent respectively; P = 0·035). Satisfaction scores were similar for both anterior 90° and Nissen groups (7·45 versus 7·36 respectively; P = 0·566), and the majority considered their original decision for surgery to be correct (86 versus 84 per cent; P = 0·818). CONCLUSION: After 10 years, both procedures achieved similar success as measured by global satisfaction measures. Patients who had a Nissen fundoplication reported more dysphagia, whereas more heartburn and PPI consumption were reported after anterior 90° fundoplication. Registration numbers: ACTRN12607000298415 and ACTRN12607000304437 (http://www.anzctr.org.au/).

ANTECEDENTES: Para evitar los efectos secundarios de la fundoplicatura de Nissen se han propuesto modificaciones técnicas, incluyendo las fundoplicaturas parciales como la plicatura anterior de 90°. El seguimiento a 5 años de dos ensayos aleatorizados sugiere menos efectos secundarios tras la fundoplicatura anterior de 90°, pero mejor control del reflujo con la fundoplicatura de Nissen. Sin embargo, no se han descrito los resultados a largo plazo. Este estudio combinó datos de dos ensayos previos para determinar los resultados a 10 años. MÉTODOS: Entre 1999 y 2003, se reclutaron 191 pacientes en dos ensayos aleatorizados que comparaban la fundoplicatura parcial anterior 90° versus fundoplicatura de Nissen. Los protocolos de ambos ensayos fueron similares, y los datos se combinaron para determinar los resultados clínicos a largo plazo. Los pacientes completaron cuestionarios anuales que evaluaban disfagia, pirosis, medicaciones, satisfacción y otros síntomas. Se utilizaron escalas analógicas visuales (0-10), una variable compuesta para la puntuación de disfagia (0-45) y respuestas sí/no. RESULTADOS: De los 191 pacientes, 152 (79,6%) pudieron seguirse a los 10 años. Tras la fundoplicatura anterior de 90°, los pacientes refirieron menos disfagia a sólidos (2,03 versus 3,18, P = 0,037). Las puntuaciones de pirosis fueron inferiores tras fundoplicatura de Nissen (2,83 versus 1,90, P = 0,035) y menos pacientes tomaban inhibidores de la bomba de protones (proton pump inhibitors, PPIs; 22% versus 39%, P = 0,035). Las puntuaciones de satisfacción fueron similares para ambos grupos de fundoplicatura anterior 90° y Nissen (7,45 versus 7,36, P = 0,566), y la mayoría consideró su decisión original para la cirugía como correcta (86,1% versus. 83,8%, P = 0,818). Las tasas de reoperación fueron similares (10,0% versus 8,8%). CONCLUSIÓN: Después de 10 años, ambos procedimientos lograron un éxito similar medido con medidas de satisfacción global. Los pacientes con fundoplicatura de Nissen referían más disfagia mientras que los pacientes con fundoplicatura anterior 900 describieron más pirosis y consumo de PPIs.

Thus far but no further: predatory mites do not migrate effectively into strawberry plantations.

Enhancing the performance of predatory mites is often regarded as the best biological control approach towards the spider mite Tetranychus urticae, the main pest of strawberry plantations. Optimizing the colonization of plantations by predators from adjacent areas such as field margins is seen as an important component of conservation biocontrol. We have investigated the factors contributing to enhancing the numbers of predatory mites (Acari: Phytoseidae), such as management of the field margins, vegetation composition and the effect of the presence of woody species. We also tested the penetration of the phytoseiids from the field margins into the crop. In a study carried out in 14 open-field extensively managed strawberry plantations in Poland we found phytoseiids to be abundant in field margins; 14 taxa were discovered. However, only two species Amblyseius andersoni and Euseius finlandicus dispersed a modest distance into the crop. We found that the diversity and densities of the predatory mites were enhanced somewhat by the management type of the field margins; especially the spontaneous vegetation favoured the presence of phytoseiids. However, despite the predatory mites being rather retained in the field margins also significant reduction in numbers of their prey T. urticae was recorded over the course of the year. The low penetration of predatory mites into the main part of the field, indicates that conservation biological control measures in the field margin might not be sufficient on their own to enhance the impact of predatory mites within the main part of the fields.

Correcting transmission losses in short-wave infrared spatially offset Raman spectroscopy measurements to enable reduced fluorescence through-barrier detection.

Spatially offset Raman spectroscopy (SORS) is a proven technique for sub-surface detection. SORS is able to separate Raman signals from a container and its contents, thereby demonstrating application to through-barrier detection for defence and security. Whilst SORS has been demonstrated to reduce fluorescence from the barrier (or surface), fluorescence from the sample (or sub-surface) can still be problematic for some materials when using Raman excitation wavelengths typical in commercially available instrumentation (e.g. 785 nm). Previous work has demonstrated that short-wave infrared (SWIR) excited SORS (e.g. 1064 nm) can reduce fluorescence from the sample and barrier, thereby providing the potential to detect a wider range of materials through a wider range of barriers. In this paper we highlight an additional challenge for detection through some plastic container materials (e.g. high density polyethylene (HDPE) and other opaque plastics) that absorb and scatter both incident and Raman scattered photons in the SWIR band, leading to distortion of the resultant SORS spectrum. The existence of this effect and its impact is explored, along with a potential solution to overcome this challenge that uses multi-wavelength Raman excitation to avoid the detrimental HDPE absorption region.

Internal structure, hygroscopic and reactive properties of mixed sodium methanesulfonate-sodium chloride particles.

Internal structures, hygroscopic properties and heterogeneous reactivity of mixed CH(3)SO(3)Na/NaCl particles were investigated using a combination of computer modeling and experimental approaches. Surfactant properties of CH(3)SO(3)(-) ions and their surface accumulation in wet, deliquesced particles were assessed using molecular dynamics (MD) simulations and surface tension measurements. Internal structures of dry CH(3)SO(3)Na/NaCl particles were investigated using scanning electron microscopy (SEM) assisted with X-ray microanalysis mapping, and time-of-flight secondary ion mass spectrometry (TOF-SIMS). The combination of these techniques shows that dry CH(3)SO(3)Na/NaCl particles are composed of a NaCl core surrounded by a CH(3)SO(3)Na shell. Hygroscopic growth, deliquescence and efflorescence phase transitions of mixed CH(3)SO(3)Na/NaCl particles were determined and compared to those of pure NaCl particles. These results indicate that particles undergo a two step deliquescence transition: first at ∼69% relative humidity (RH) the CH(3)SO(3)Na shell takes up water, and then at ∼75% RH the NaCl core deliquesces. Reactive uptake coefficients for the particle-HNO(3) heterogeneous reaction were determined at different CH(3)SO(3)Na/NaCl mixing ratios and RH. The net reaction probability decreased notably with increasing CH(3)SO(3)Na and at lower RH.

Chromosome 4q31 locus in COPD is also associated with lung cancer.

Chronic obstructive pulmonary disease (COPD) is the single greatest risk factor for lung cancer in smokers and is found in 50-90% of lung cancer cases. The link between COPD and lung cancer may stem in part from the matrix remodelling and repair processes underlying COPD, and the development of epithelial-mesenchymal transition (EMT) that underlies lung carcinogenesis. The Hedgehog-interacting protein (HHIP), which mediates the epithelial response (EMT) to smoking, has been implicated in COPD and lung cancer. Recent genome-wide and candidate gene studies of COPD implicate genetic variants on the chromosomal 4q31 (HHIP/glycophorin A (GYPA)) locus. In a case-control study of smokers with normal lung function, COPD and lung cancer (subphenotyped for COPD), we show the GG genotype of the rs 1489759 HHIP single-nucleotide polymorphism (SNP) and the CC genotype of the rs 2202507 GYPA SNP confers a "protective" effect on COPD (OR 0.59, p = 0.006 for HHIP and OR = 0.65, p = 0.006 for GYPA) and lung cancer (OR = 0.70 (p = 0.05) for HHIP and OR 0.70 (p = 0.02) for GYPA). This study suggests that, in smokers, genetic variants of the 4q31 locus conferring a protective effect for COPD are also protective in lung cancer. We conclude that genetic susceptibility to lung cancer includes COPD-related gene variants.

COPD prevalence is increased in lung cancer, independent of age, sex and smoking history.

Chronic obstructive pulmonary disease (COPD) is a common comorbid disease in lung cancer, estimated to affect 40-70% of lung cancer patients, depending on diagnostic criteria. As smoking exposure is found in 85-90% of those diagnosed with either COPD or lung cancer, coexisting disease could merely reflect a shared smoking exposure. Potential confounding by age, sex and pack-yr smoking history, and/or by the possible effects of lung cancer on spirometry, may result in over-diagnosis of COPD prevalence. In the present study, the prevalence of COPD (pre-bronchodilator Global Initiative for Chronic Obstructive Lung Disease 2+ criteria) in patients diagnosed with lung cancer was 50% compared with 8% in a randomly recruited community control group, matched for age, sex and pack-yr smoking exposure (n = 602, odds ratio 11.6; p<0.0001). In a subgroup analysis of those with lung cancer and lung function measured prior to the diagnosis of lung cancer (n = 127), we found a nonsignificant increase in COPD prevalence following diagnosis (56-61%; p = 0.45). After controlling for important variables, the prevalence of COPD in newly diagnosed lung cancer cases was six-fold greater than in matched smokers; this is much greater than previously reported. We conclude that COPD is both a common and important independent risk factor for lung cancer.

A gene-based risk score for lung cancer susceptibility in smokers and ex-smokers.

BACKGROUND: Epidemiological and family studies suggest that lung cancer results from the combined effects of age, smoking and genetic factors. Chronic obstructive pulmonary disease (COPD) is also an independent risk factor for lung cancer and coexists in 40-60% of lung cancer cases. METHODS: In a two-stage case-control association study, genetic markers associated with either susceptibility or protection against lung cancer were identified. In a test cohort of 439 Caucasian smokers or ex-smokers, consisting of healthy smokers and lung cancer cases, 157 candidate single nucleotide polymorphisms (SNPs) were screened. From this, 30 SNPs were identified, the genotypes (codominant or recessive model) of which were associated with either the healthy smokers (protective) or lung cancer (susceptibility) phenotype. After genotyping of this 30-SNP panel in a second validation cohort of 491 subjects and using the same protective and susceptibility genotypes from our test cohort, a 20-SNP panel was selected on the basis of independent univariate analyses. RESULTS: Using multivariate logistic regression, including the 20 SNPs, it was also found that age, history of COPD, family history of lung cancer and gender were significantly and independently associated with lung cancer. CONCLUSIONS: When numeric scores were assigned to both the SNP and demographic data, and sequentially combined by a simple algorithm in a risk model, the composite score was found to be linearly related to lung cancer risk with a bimodal distribution. Genetic data may therefore be combined with other risk variables from smokers or ex-smokers to identify individuals who are most susceptible to developing lung cancer.

Airflow limitation and survival after surgery for non-small cell lung cancer: Results from a systematic review and lung cancer screening trial (NLST-ACRIN sub-study).

OBJECTIVE: Lung cancer remains the single greatest cause of cancer mortality where surgery for early stage non-small cell lung cancer achieves the greatest survival. While there is growing optimism for better outcomes with screening using annual computed tomography, the impact of co-existing airflow limitation on survival remains unknown. To compare survival in non-small cell lung cancer patients undergoing surgery stratified according to the presence or absence of pre-surgery airflow limitation. MATERIALS AND METHODS: We undertook a systematic literature search of non-screen lung cancer that encompassed studies reported between January 1946 and January 2017. Full-text articles were identified following eligibility scoring, with data extracted and analysed using a standardised analytical method (PRISMA). The results of this systematic review in non-screen lung cancers were compared to real-world results from a lung cancer screening cohort (N = 10,054), where outcomes following surgery could be compared after stratification according to pre-surgery airflow limitation. RESULTS: In the systematic review, 6899 subjects were included from 10 studies; 7 were retrospective, 3 were prospective. Overall survival was 950 (44%) in 2144 people with COPD and 2597 (55%) from 4755 controls (unadjusted P value <0.001). However, the overall meta-analysed random effects odds ratio for overall survival (N = 10) and 5-year survival (N = 4) comparing those with and without COPD was 0.91 (95% CI = 0.84-1.00) and 0.99 (95% CI = 0.79-1.24) respectively. There were no signs of significant heterogeneity (I2 = 19.1%, P = 0.27) nor publication bias as assessed by funnel plot and Egger's test (P = 0.19). In the lung cancer screening sub-study of 10,054 screening participants we found no difference in 5-year survival in those with and without airflow limitation (84% and 81% respectively, P = 0.64). CONCLUSION: Survival after surgery for non-small cell lung cancer is comparable between those with and without spirometry evidence of airflow limitation. This finding was replicated in lung cancer diagnosed during screening.

Lung cancer gene associated with COPD: triple whammy or possible confounding effect?

Recently, several large genome-wide association studies have identified a putative "lung cancer" locus in the nicotinic acetylcholine receptor subunit genes (nAChR) on 15q25. However, these findings may be confounded by the presence of chronic obstructive pulmonary disease (COPD), which is also strongly associated with smoking exposure and lung cancer. This is likely as the prevalence of COPD in lung cancer cohorts is as much as two-fold greater than that reported in smoking control populations (50 versus 20%). The present authors compared the genotype frequencies of the most strongly associated single nucleotide polymorphism (rs16969968) in the alpha5 subunit of the nAChR gene cluster between three matched smoking cohorts. The AA genotype was found to be more frequent and was seen in 437 (16%) lung cancer cases and 445 (14%) COPD cases compared with 475 (9%) healthy smoking controls. More importantly, when 429 lung cancer cases were divided according to spirometry results (performed within 3 months of diagnosis, prior to surgery and in the absence of effusions or collapse), the AA genotype was present in 19 and 11% of cases with and without COPD, respectively. These findings suggest that the association between the alpha5 subunit nicotinic acetylcholine receptor single nucleotide polymorphism and lung cancer may, in part, be confounded by chronic obstructive pulmonary disease.

A Place to Grow? Host Choice and Larval Performance of Microplitis similis (Hymenoptera: Braconidae) in the Host Spodoptera litura (Lepidoptera: Noctuidae).

Host selection is a key stage in the lifecycle of parasitoids, and is critical to both their function in control and to the maintenance of their population. The solitary endoparasitoid Microplitis similis (Hymenoptera: Braconidae) is a potential biological control agent of Spodoptera litura (F.) larvae (Lepidoptera: Noctuidae). In this study, we examined the preference M. similis exhibits for different instars of the host, host instar effects on parasitoid development, and the weight gain and food consumption of different instars of parasitized larvae. In no-choice tests, parasitization rates were highest in second- and early third-instar larvae, and no fourth- or fifth-instar hosts were parasitized. When provided with a choice of first- to late third-instar host larvae, M. similis preferred to parasitize early third-instar host larvae (41%) with a selection coefficient of 0.37. All morphometric features of wasp offspring increased with increasing age of the host at parasitization. A lower proportion of females emerged from first-instar larvae than any other instar. Parasitized S. litura larvae showed a pronounced reduction in food consumption and weight gain. Microplitis similis may have the potential to significantly suppress population growth and the damage caused by S. litura.

Gene by Environment Interaction Linking the Chromosome 15q25 Locus With Cigarette Consumption and Lung Cancer Susceptibility--Are African American Affected Differently?

The majority of lung cancer cases result from complex interactions between smoking exposure, genetic susceptibility and a person's immune response to chronic inflammation or lung remodelling. Epidemiological studies confirm that susceptibility to developing chronic obstructive pulmonary disease (COPD), especially emphysema, is also closely linked to lung cancer susceptibility. Genetic epidemiology studies have consistently reported associations between the chromosome 15q25 locus with lung cancer and COPD. In addition, studies show this locus to be independently associated with cigarette consumption and nicotine addiction in a dose-response manner, primarily at lower levels of cigarette consumption. Studies that measure both cigarette consumption and lung function, together with extensive genotype analysis, will be needed to further unravel these complex relationships.

Frequency of venous thromboembolism in low to moderate risk long distance air travellers: the New Zealand Air Traveller's Thrombosis (NZATT) study.

BACKGROUND: The frequency and role of risk factors for venous thromboembolism related to air travel is uncertain. We aimed to establish the frequency of this disorder in a group of long distance air travellers and to investigate the role of potential risk factors. METHODS: We designed a prospective study into which we recruited individuals aged between 18 and 70 years, travelling for 4 h or more by aircraft. D-dimer measurement was done before and after travel. Participants with a negative D-dimer (<500 ng/L) before travel were included in the study. Those who became D-dimer positive or developed high clinical probability symptoms during the 3 months after travel were investigated with bilateral compression ultrasonography and CT pulmonary angiography. Suspected clinical and thrombophilic risk factors, and use of prophylactic measures, were assessed. FINDINGS: 1000 individuals were recruited, with 878 meeting inclusion criteria and completing the study. All participants travelled at least 10 h, with a mean total duration of air travel of 39 h (SD 12.5). 112 patients underwent radiological assessment on return. Frequency of venous thromboembolism associated with travel was 1.0% (9/878, 95% CI 0.5-1.9), which included four cases of pulmonary embolism and five of deep venous thrombosis. Six patients with venous thromboembolism had pre-existing clinical risk factors, two had a recognised thrombophilic risk factor, two travelled exclusively in business class, five used aspirin, and four wore compression stockings. INTERPRETATION: Our results suggest an association between multiple long distance air flights and venous thromboembolism, even in individuals at low to moderate risk. The role of traditional risk factors and prophylactic measures in air travel-related venous thromboembolism needs further investigation.

Seroprevalence of Helicobacter pylori in Seventh-Day Adventists and other groups in Maryland. Lack of association with diet.

To evaluate the possible role of diet in the transmission of Helicobacter pylori, we compared H pylori seroprevalence among Seventh-Day Adventists (who are vegetarian and abstain from alcohol, caffeine, and meat; n = 94) and two non-Seventh-Day Adventist control groups (n = 168). With the use of an enzyme-linked immunosorbent assay H pylori antigen prepared in a French pressure cell, we found no difference in seroprevalence among these groups; however, seropositivity strongly correlated with age and black race.

Daytime shelter use of individually kept horses during Swedish summer.

In Sweden, no provision for summer shelter to protect horses from heat and insects is required, although access to shelter for horses kept outdoors 24 h during winter is a requirement. This study investigated horses' daytime shelter-seeking behavior in relation to weather conditions and insect activity during a 2-wk period in summer. Eight Warmblood riding horses had access to 2 shelters of different design to test which shelter design is preferred by horses. Furthermore, rectal and skin temperatures and insect-defensive behavior were measured to test whether horses would benefit from the provision of shade. The horses were kept alone in paddocks for 4 d. During 2 d, horses had access to 2 shelters: 1) open shelter with roof and uncovered sides and 2) closed shelter with roof, wind nets on 2 sides, and opaque plastic opposite the entrance. Weather conditions (ambient temperature, relative humidity, solar radiation, wind speed) were recorded every 10 min. The number of insects (flies, mosquitos) was counted from insect traps placed in each shelter and outside. Behavior (shelter use, insect-defensive behavior, locomotion, grazing) was recorded at 5-min intervals between 0900 to 1200 h and 1300 to 1600 h and rectal and skin temperatures were measured at 0800 h, 1200 h, and 1600 h. Data were analyzed with PROC MIXED and GLIMMIX procedure for Generalized Linear Mixed Models. Ambient temperature ranged from 16 to 25°C (average temperature humidity index 65.7 ± 1.4). Five horses preferred the closed shelter and were observed inside up to 2.5 h continuously. Greater wind speed decreased the likelihood of observing horses inside the shelter ( < 0.001), as did lower numbers of flies ( < 0.001). The insect-defensive behaviors, skin shiver and ear flick, were performed less frequently when horses were using the closed shelter ( < 0.001), indicating that they were less disturbed by insects. Thirty-minute shelter use had no effect on rectal and skin temperatures ( > 0.05). Results showed that horses made use of shelters during the summer even when weather conditions were moderate. A shelter with roof and covers on 3 sides was preferred over a shelter with roof only and can reduce insect-defensive behavior.

Helicobacter pylori: the missing link in perspective.

Helicobacter pylori, an organism responsible for a common human infection, may act as a cofactor to produce gastrointestinal disease in a significant minority. The exact mechanisms of transmission are still unclear, but likely involve direct person-to-person spread and fecal-oral or waterborne/environmental transmission. Infection is a necessary condition for the development of duodenal ulcers and chronic nonspecific gastritis. It also likely contributes to the development of gastric ulcers, and the intestinal-type gastric carcinoma, but further studies are needed to confirm these hypotheses. Multiple effective treatment regimens currently exists. We recommend using bismuth, metronidazole, and tetracycline as the initial regimen of choice. Unfortunately, the relative importance of bacterial virulence factors is still unclear when compared with host susceptibility factors, and much knowledge needs to be gained about pathogenesis before vaccine development can proceed.