The Effect of Special Diets on Weight and Nutritional Intake in Hematological Cancer Patients: A Randomized Study.

Major weight loss and taste changes are well documented in patients with hematological cancer during chemotherapy. We have previously documented, that such patients have preferences for much umami, a little sweet, sour and salt, and no bitter. We wanted to convert these results into real diets. Patients participated in two sensory pilot studies (n = 10), where dishes were tested for preferences before and after chemotherapy. From these results, four dishes were selected and tested on 32 patients in 30 days in a cross-over design. The diets resulted in a beneficial and statistically significant difference in weight development (p = 0.0008), with 1.2 ± 1.9 kg (+2%) in the intervention period and -2.8 ± 5.2 kg (-4%) in the control period. This difference persisted after sensitivity analysis (±10%) P = 0.005. However, the nutritional intake was still low in both periods, and the treatment with cytarabine turned out to be a major confounder as dosage was significantly higher in the control period.

The mesenteric defects in laparoscopic Roux-en-Y gastric bypass: 5 years follow-up of non-closure versus closure using the stapler technique.

BACKGROUND: Internal hernia (IH) is a common complication of laparoscopic Roux-en-Y gastric bypass (LRYGB). Little large-volume data exist on how to handle the mesenteric defects during LRYGB. This study evaluated long-term follow-up (5.5 years) of 2443 patients with primary closure of the mesenteric defects with a stapling device at LRYGB, in comparison with a non-closed group from the same centre. METHODS: All patients (N = 4013) undergoing LRYGB over a 10-year period (2005-2015) at a single institution were evaluated. The mesenteric defects were routinely closed starting June 2010. In total, 1570 non-closure patients and 2443 patients with stapled closure of the defects were prospectively entered and the results analysed. RESULTS: Closure of the mesenteric defects increased surgical time by 4 min and did not affect the 30-day complication rate. IH incidence was significantly lower (2.5%) in the closure group compared with 11.7% in the non-closure group, at 60 months. The relative risk reduction by closing the mesenteric defects was 4.09-fold (95% CI = 2.97-5.62) as calculated using a survival model. CONCLUSIONS: Internal hernia after LRYGB occurs frequently if mesenteric defects are left unclosed. Primary closure with a hernia-stapling device is safe and significantly reduces the risk of internal hernia.

The influence of timing the application of nitrogen fertilizer on early blight (Alternaria solani).

BACKGROUND: Field experiments were carried out in 2016 and 2017 to study the influence of timing the application of nitrogen fertilizer (N-fertilizer) on the susceptibility of potatoes to early blight. We hypothesized that potatoes that receive N-fertilizer as split applications or a one-time application at emergence will have a higher N content and be less susceptible to early blight than those that receive N-fertilizer as a one-time application before planting. N-fertilizer was applied either as a one-time application before planting or at emergence and as split applications. RESULTS: Potatoes that did not receive N-fertilizer were more susceptible to early blight [high area under the disease progress curve (AUDPC)] than those that did receive N-fertilizer (low AUDPC). The timing of N-fertilizer application had a significant effect on the susceptibility of potatoes to early blight. Potatoes that received the entire quantity of N-fertilizer at emergence or as split applications had higher N contents and were less susceptible to early blight than those that received the entire quantity of N-fertilizer before planting. Potatoes that did not receive N-fertilizer had a markedly lower starch yield than potatoes that received N-fertilizer. Potatoes that received the entire quantity of N-fertilizer before planting had a lower starch yield than potatoes that received the entire quantity of N-fertilizer at emergence or as split applications. CONCLUSION: N-fertilizer applied as a one-time application at emergence or as a split application was the best treatment to ensure both high N content and lower attack of early blight, which confirms our hypothesis. © 2018 Society of Chemical Industry.

Population genomics of an outbreak of the potato late blight pathogen, Phytophthora infestans, reveals both clonality and high genotypic diversity.

An outbreak of the potato late blight pathogen Phytophthora infestans in Denmark was characterized in order to resolve the population structure and determine to what extent sexual reproduction was occurring. A standard set of microsatellite simple sequence repeats (SSRs) and single nucleotide polymorphism (SNP) markers generated using restriction site-associated DNA sequencing (RAD-seq) were employed in parallel. A total of 83 individuals, isolated from seven different potato fields in 2014, were analysed together with five Danish whole-genome sequenced isolates, as well as two Mexican individuals used as an outgroup. From a filtered dataset of 55 288 SNPs, population genomics analyses revealed no sign of recombination, implying clonality. In spite of this, multilocus genotypes were unique to individual potato fields, with little evidence of gene flow between fields. Ploidy analysis performed on the SNPs dataset indicated that the majority of isolates were diploid. These contradictory results with clonality and high genotypic diversity may suggest that rare sexual events likely still contribute to the population. Comparison of the results generated by SSRs vs SNPs data indicated that large marker sets, generated by RAD-seq, may be advised going forward, as it provides a higher level of genetic discrimination than SSRs.

Proceedings of the fifth Northern Region Paediatric Colloquium.

The disciplines of medicine, law and ethics frequently impinge upon each other in clinical practice but are seldom given the opportunity to come together in dialogue. It was with this aim that senior professionals from law and medicine met at the fifth Northern Region Paediatric Colloquium. An added dimension to the ethical viewpoint was brought to the meeting by the attendance of local religious leaders for the first time. We report the proceedings of the Colloquium, which adopted the usual format of clinical case presentation followed by discussion.

Correction: Gas sensing performance at room temperature of nanogap interdigitated electrodes for detection of acetone at low concentration.

[This corrects the article DOI: 10.1039/C7RA09441H.].

End-Of-Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported.

Although end-of-life medical spending is often viewed as a major component of aggregate medical expenditure, accurate measures of this type of medical spending are scarce. We used detailed health care data for the period 2009-11 from Denmark, England, France, Germany, Japan, the Netherlands, Taiwan, the United States, and the Canadian province of Quebec to measure the composition and magnitude of medical spending in the three years before death. In all nine countries, medical spending at the end of life was high relative to spending at other ages. Spending during the last twelve months of life made up a modest share of aggregate spending, ranging from 8.5 percent in the United States to 11.2 percent in Taiwan, but spending in the last three calendar years of life reached 24.5 percent in Taiwan. This suggests that high aggregate medical spending is due not to last-ditch efforts to save lives but to spending on people with chronic conditions, which are associated with shorter life expectancies.

Characterization of a selective and potent antagonist of human P2X(7) receptors, AZ11645373.

BACKGROUND AND PURPOSE: The ATP-gated P2X(7) receptor has been shown to play a role in several inflammatory processes, making it an attractive target for anti-inflammatory drug discovery. We have recently identified a novel set of cyclic imide compounds that inhibited P2X(7) receptor-mediated dye uptake in human macrophage THP-1 cells. In this study the actions and selectivity of one of these compounds, AZ11645373, were characterized. EXPERIMENTAL APPROACH: We measured membrane currents, calcium influx, and YOPRO-1 uptake from HEK cells expressing individual P2X receptors, and YOPRO1 uptake and interleukin-1beta release from THP-1 cells in response to ATP and the ATP analogue benzoylbenzoyl ATP (BzATP). KEY RESULTS: AZ11645373 up to 10 microM, had no agonist or antagonist actions on membrane currents due to P2X receptor activation at human P2X(1), rat P2X(2), human P2X(3), rat P2X(2/3), human P2X(4), or human P2X(5) receptors expressed in HEK cells. AZ11645373 inhibited human P2X(7) receptor responses in HEK cells in a non-surmountable manner with K (B) values ranging from 5 - 20 nM, with mean values not significantly different between assays. K (B) values were not altered by removing extracellular calcium and magnesium. ATP-evoked IL-1beta release from lipopolysaccharide-activated THP-1 cells was inhibited by AZ11645373, IC(50) = 90 nM. AZ11645373 was > 500-fold less effective at inhibiting rat P2X(7) receptor-mediated currents with less than 50% inhibition occurring at 10 microM. CONCLUSIONS AND IMPLICATIONS: AZ11645373 is a highly selective and potent antagonist at human but not rat P2X(7) receptors and will have much practical value in studies of human cells.

Mucosal glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide cell numbers in the super-obese human foregut after gastric bypass.

BACKGROUND: Super-obesity, a body mass index>50 kg/m(2), is difficult to treat. Many studies have focused on the anatomic changes of the intestines; the physiologic background is not clearly identified. It is established that Roux-en-Y gastric bypass (RYGB) augments secretion of glucagon-like peptide-1 (GLP-1), peptide tyrosine tyrosine (PYY), and insulin, but other aspects of gut hormone cell function in the alimentary limb are unknown. OBJECTIVE: To study the effects of laparoscopic RYGB on enteroendocrine cells. SETTING: University-affiliated, high-volume bariatric surgery center. METHODS: Eighteen nondiabetic patients were drawn from the present study (NCT 01514799), randomizing between biliopancreatic (BP) limbs of either 60 cm (BP60) or 200 cm (BP200). Demographic characteristics did not differ at baseline or 12 months. Pouch and jejunal biopsies were obtained intraoperatively and using endoscopy at 12 months. Mucosal height and density of hormone-producing cell populations were assessed and mRNA expression measured with real-time polymerase chain reaction. RESULTS: In perianastomotic jejunum, a 4.9-fold increase in GLP-1 cell density was evident 12 months after RYGB, most pronounced in the BP200-group. The densities of glucose-dependent insulinotropic polypeptide (GIP) cells and PYY immunoreactive cells were doubled after 12 months. GIP mRNA was unaffected, but GLP-1 and PYY mRNA were lower 12 months after RYGB. RYGB had no impact on villi length or density of ghrelin-, cholecystokinin-, neurotensin-, secretin-, or serotonin-producing cells after 12 months. Pouch mucosal height and cell densities of ghrelin-, histamine-, serotonin-, and somatostatin-producing cells remained unaffected by RYGB in both groups. CONCLUSIONS: RYGB selectively increased the density of incretin-producing cell populations in the jejunum. This may provide anatomic explanation for the observed increased plasma levels of incretins.

Detection and identification of group B streptococci by use of pigment production.

Pigment production by group B streptococci (GBS) is a useful test for identification of the organisms. The test is positive in 99.5% of beta-haemolytic strains. No false-positives are noted. Non-haemolytic strains do not produce pigment. Islam's media less agar can be used as a one-step broth detector of GBS in mixed cultures. This may have application for the detection of GBS in women in labour. When used as an identification system for GBS, serum-starch broth can be further modified by reduction of serum and starch concentrations by at least 80%.

Early plasma protein and mineral changes after surgery: a two stage process.

Sequential changes in albumin, transferrin, alpha 1-acid glycoprotein, C reactive protein, fibrinogen, copper, iron, and zinc in plasma up to 24 h after hysterectomy were measured. No increases in the concentrations of the acute phase proteins alpha 1-acid glycoprotein, C reactive protein, and fibrinogen were observed until 6 h after the skin incision. These increases were preceded by significant falls at 2-4 h, and this was shown also by albumin, transferrin, iron, zinc, and copper. The ratios of iron and zinc to their binding proteins, transferrin and albumin, did not decrease until 4-6 h and their concentrations remained low for at least 24 h. These patterns suggest that at least two mechanisms operate after trauma. The early fall in the concentrations of the proteins in plasma is consistent with a prompt increase in microvascular permeability. The later decrease in binding of the metals iron and zinc to their transport proteins and the increase in concentrations of the acute phase proteins could be initiated by a common mediator.

Order information in multiple-element comparison.

Although it is possible to specify the elements of a list without regard to the order in which they appear, the same distinction may not be possible when the elements are retrieved from memory. To investigate this issue, we used a recognition task in which two strings of letters are presented sequentially. Subjects were instructed to respond "Same" if the second string contained the same elements as the first, regardless of their position, and to respond "Different" otherwise. Despite the fact that order information is irrelevant in this task, we observed in two experiments that reaction time for Same-item trials increased with the number of positions that the letters were displaced. Neither familiarity of the first string nor the delay between strings changed in the size of this displacement effect. To account for this finding, we propose a model in which comparison time for a given letter pair increases with the position difference of the elements in their respective strings.

Zenker's diverticulotomy using the KTP/532 laser.

Multiple forms of surgical treatment exist for Zenker's diverticulum. Appropriate treatment needs to be tailored based on the needs of the patient and the resources and skills of the surgeon. We have reviewed the available surgical options and presented a series of 10 patients treated with a new technique, the KTP/532 laser diverticulotomy. The diverticulotomy is particularly well-suited to the debilitated patient who cannot tolerate a prolonged operation or a prolonged postoperative recovery. The results of the technique are comparable with those of other forms of diverticulotomy, and it is concluded that the KTP/532 laser is a simple, safe, and effective form of surgical treatment with exciting potential for future use.

Antifungal activity against allergic fungal sinusitis organisms.

A review of more than 50 allergic fungal sinusitis (AFS) patients indicates that most patients experience postoperative recurrences once weaned from oral steroids, leaving a glaring need for improved treatment. Topical antifungal therapy has not been described for AFS, but it could potentially lower fungal antigen loads via postoperative irrigations. No information exists to direct the choice of antifungal agent. The purpose of this study was to identify the appropriate drug to use for postoperative irrigations in AFS patients. Twenty-two fungal cultures grown from 15 AFS patients were studied for in vitro susceptibility to five common antifungal drugs: ketoconazole, amphotericin B, itraconazole, nystatin, and fluconazole. Results demonstrated that ketoconazole and amphotericin B were the most effective. Clinical trials are indicated to evaluate the efficacy of these drugs as a supplement to current AFS treatment.

The rhinology laboratory.

OBJECTIVES: This study seeks to develop a rhinology lab model and to assess its effectiveness for physicians-in-training. STUDY DESIGN: We established a rhinology lab at our institution with simple and affordable modifications to our temporal bone lab. Residents attended a seven-part lecture series and received a list of endoscopic and open procedures to perform on computed tomography (CT)-scanned, vessel-injected cadaver heads. METHODS: After 2 years we asked participating residents to rate their lab experience on a 1-to-10 (disagree-agree) scale. RESULTS: Cumulative scores indicated that residents enthusiastically perceived this additional training as worthwhile (micro=10), while increasing their efficiency (micro=9.5), safety (micro=9.875), and anatomic knowledge (micro=9.875). The lab has opened opportunities for rhinology research, as evidence by one resident publication and another project in progress. Survey feedback has helped develop guidelines for instructor participation in the lab as well as for assigned reading and independent study. CONCLUSIONS: Based on our preliminary experience, we recommend the rhinology lab to all residency programs as an important yet cost-effective means of maintaining education in step with rapidly changing technologies.

Meta-analysis of outcomes of pediatric functional endoscopic sinus surgery.

OBJECTIVE: To create a consensus of outcomes of pediatric functional endoscopic sinus surgery (FESS) and assess its effectiveness and safety. STUDY DESIGN: A meta-analysis of the literature on outcomes of pediatric FESS. METHODS: A meta-analysis of the literature was performed focusing on the number of patients per study, length of follow-up, prospective versus retrospective, and the separation or exclusion of patients with significant underlying systemic diseases (cystic fibrosis and immunodeficiencies). A rating scale based on the above criteria was used to select articles for inclusion. RESULTS: Eight published articles (832 patients) plus unpublished data from the authors' institution (50 patients) were included. The "positive" outcome rates for published, unpublished, and combined data were 88.4%, 92%, and 88.7%, respectively. No statistically significant differences in "positive" outcome existed between all published or unpublished series using a chi-squared test (power = .51, P = .38). The average combined follow-up was 3.7 years, with a major complication rate of 0.6%. CONCLUSION: Pediatric FESS is a safe and effective treatment for chronic sinusitis that is refractory to medical therapy.

Sinus lateralis in endoscopic ethmoidectomy.

OBJECTIVE: To characterize the anatomy of the sinus lateralis and enable a more accurate and safe approach to endoscopic ethmoidectomy. STUDY DESIGN: An anatomic study of 33 cadaver heads providing a prospective evaluation of 50 ethmoid sinuses. The sinus lateralis, in particular, was thoroughly examined and typical variations were classified into four categories. A technique using the sinus lateralis as a critical landmark is described which allows calculated removal of anterior ethmoid cells in a posterior-to-anterior direction, avoiding inadvertent entry into the posterior ethmoid. Prospective evaluation of this technique in 12 pediatric patients found it to be safe and particularly useful for neophyte endoscopic surgeons. METHODS: Endoscopic examination of 50 cadaver sinuses using 0-, 30-, and 70-degree, 4-mm telescopes to dissect the anterior ethmoid. The characteristics of each sinus lateralis were documented. To confirm the endoscopic findings, we grossly examined each specimen. RESULTS: Four different categories of sinus lateralis formation were identified: type I (n = 22), posterosuperior extension to skull base; type II (n = 15), posterior extension to sphenoid face; type III (n = 8), abrupt termination posterior to ethmoid bulla; and type IV (n = 5), extension into posterior ethmoid through dehiscent basal lamella. CONCLUSIONS: The sinus lateralis is a consistent feature of the anterior ethmoid. Type I and II patterns are most conducive to the aforementioned technique. Type III is the most difficult to identify endoscopically, whereas type IV is most apt to encourage an unplanned posterior ethmoidectomy. Regardless of the chosen ethmoidectomy technique, careful assessment of the sinus lateralis should enable more accurate and safe removal of ethmoid disease with reduced complications.

Cochlear implantation in children with enlarged vestibular aqueducts.

OBJECTIVES: This report details our experience with cochlear implantation in children with both profound sensorineural HL (SNHL) and enlarged vestibular aqueducts (EVAs). It seeks to determine if the abnormal anatomy of EVA predisposes to any adverse events during or after cochlear implantation. STUDY DESIGN: A retrospective review. METHODS: Charts were reviewed for details of the procedure, complications, and audiologic outcome. RESULTS: Between 8/25/93 and 9/16/98, 10 children with EVAs received cochlear implants, of whom 8 children (5 males, 3 females; mean age 7.8 y) had audiologic follow-up of at least 6 months. The implant was inserted without difficulty in all patients. Pulsatile clear fluid via the cochleostomy was observed in five patients, but was easily controlled in each instance. There have been no major complications, although two patient had short-lived postoperative vestibular symptoms and one child has experienced an intermittent pulsing sensation in her head. Speech perception measures were obtained using a battery of tests that assessed the children's ability to perceive speech in both open- and closed-set formats. Two patients were excluded because the implant was placed within the last 6 months. Of the remaining eight children identified with EVAs, seven (86%) demonstrated open-set word recognition. CONCLUSIONS: These favorable results may be attributed in part to HL that occurs relatively late in childhood, allowing implantation in postlingual candidates. Cochlear implantation can be safely and effectively performed in children with SNHL associated with EVAs.

Suprastomal granulation tissue and pediatric tracheotomy decannulation.

Although numerous decannulation techniques have been reported, often involving costly sleep studies, repetitive laser procedures, and tracheotomy tube "downsizing," no established standard of care exists. We advocate the following simple, minimally invasive decannulation protocol. After excluding concomitant airway lesions, suprastomal granulation is removed transtomally by an endoscopically guided rongeur. A tracheotomy tube is then fashioned with a fenestration centered in the tracheal lumen. Decannulation occurs if the patient maintains adequate ventilation over a 12- to 24-hour observation period with the fenestrated tracheotomy capped. Over 18 months we prospectively followed 10 consecutive children presenting as potential decannulation candidates. Using the aforementioned technique, nine of 10 patients were successfully decannulated (average follow-up, 11.5 months). The postoperative capped fenestrated tracheotomy trial provides a realistic assessment of preparedness for decannulation. We recommend this protocol as a rapid, efficient, and cost-effective means of achieving decannulation.

Atypical indications for OtoScan laser-assisted myringotomy.

OBJECTIVE: To describe the role of OtoScan laser-assisted myringotomy (OtoLAM) for indications other than chronic otitis media or recurrent acute otitis media. STUDY DESIGN: Cross-sectional review. METHODS: Twenty-seven office-based OtoLAM procedures were performed in 21 patients for "atypical" reasons. The indications included middle ear dysfunction with necessary air travel (n = 10) or hyperbaric oxygen treatment (n = 6), mastoiditis with postauricular cellulitis (n = 2), canal exostosis prohibiting tympanostomy (n = 1), acute otitis media accompanied by seizures (n = 1), and chronic middle ear effusion in a patient with hemophilia (n = 1). RESULTS: In each of the 20 cases available for follow-up, middle ear disease resolved with closure of the laser-assisted myringotomy. At a later date, two patients (10%) underwent another OtoLAM in the opposite ear and four patients (20%) required repeat OtoLAM in the same or both ears. Three patients (15%) ultimately underwent myringotomy tube placement because of recurrent middle ear dysfunction. CONCLUSIONS: Although this report contains preliminary data, the data suggest that OtoLAM may provide an additional option in the care of certain patients who have previously been treated with myringotomy tubes.