KODA score: an updated and validated bowel preparation scale for patients undergoing small bowel capsule endoscopy.

Background and study aims A reliable outcome measure is needed for bowel preparation quality during capsule endoscopy. Currently, no scales are adequately validated. Our objective was to update an existing small bowel preparation score, create a standardized training module, then determine its inter-rater and intra-rater reliability. Patients and methods Modification to produce standardized scoring of an existing small bowel preparation score was performed followed by development of a training module and validation to create the new Korea-Canada (KODA) score. Twenty readers from a range of backgrounds, including capsule endoscopists, gastroenterology fellows, residents, medical students, and nurses rated bowel cleanliness in 25 capsule videos consisting of 1,233 images, in duplicate 4 weeks apart, after completing the training module. Sequential images selected in 5-minute intervals during small bowel transit were rated on a scale between 0-3 based on the amount of visualized mucosa and the degree of obstruction. Reliability was assessed using estimates of intraclass correlation coefficients (ICCs). Results Intraclass correlation coefficients for inter-rater (ICC 0.81, 95 % CI 0.70-0.87) and intra-rater (ICC 0.92, 95 % CI 0.87-0.94) reliability were almost perfect among the 20 readers. Inter-rater reliability ranged between 0.72 (95 % CI 0.57-0.81) and 0.89 (95 % CI 0.79-0.93) for nurses and residents, respectively. Intra-rater reliability was greater than 0.90 for all groups except for nurses, which was still almost perfect (ICC 0.86, 95 % CI 0.79-0.90). Conclusions Almost perfect inter-rater and intra-rater reliability was observed for the KODA score. This simple score could be used for future clinical trials after completion of the training module.

Locally dispersing populations in heterogeneous dynamic landscapes with spatiotemporal correlations. I. Block disturbance.

Locally dispersing populations are generally favorably affected by increasing the scale of habitat heterogeneity because they can exploit contiguous patches of suitable habitat. Increasing the spatial scale of landscape disturbances (such as by applying a pesticide to control an unwanted species) drives down population density because of reasons including dispersal-limited recolonization and the resulting increase in temporal variability. Here, we examine how population density changes as the spatial scale of landscape disturbance increases: does it increase due to increases in spatial correlations in landscape habitat type, or does it decrease due to the various spatial and temporal effects of larger-scale disturbances? We use simulations, mean field approximations, pair approximations, landscape-improved pair approximations (LIPA), and block probabilities to investigate a model of a locally dispersing species on a dynamic landscape with spatiotemporally structured heterogeneous habitat. Pesticide is applied at a given spatial scale, leaving habitat unsuitable for some time before dissipating and allowing the habitat to revert to a suitable state. We found that increasing the spatial scale of disturbances (while keeping the overall disturbance rate fixed) can increase population density, but generally only when landscape turnover is slow relative to population dynamics and when the population is somewhat close to its extinction threshold. Applying control measures at larger spatial scales may allow them to be more effective with the same overall treatment rate. The optimal spatial strategy for applying disturbances depends on both habitat availability as well as the turnover rate of the control measure being used. For the large-scale habitat dynamics in our model, it is possible to analytically calculate spatial correlations in habitat types over arbitrary scales. However, including exact habitat correlations at the triplet scale but approximating population correlations at that scale still neglects information needed to accurately predict simulation results, showing that larger-scale correlations in the population distribution have an important effect on dynamics.

A prospective study of the risk of bacteremia in directed cholangioscopic examination of the common bile duct.

BACKGROUND AND AIMS: The frequency of bacteremia during ERCP with cholangioscopy has not been well studied. There are no formal guidelines regarding antibiotic prophylaxis before ERCP with cholangioscopy. The aim was to estimate the frequency of bacteremia and subsequent infectious adverse events after ERCP with cholangioscopy. METHODS: This prospective nonrandomized study performed in a single tertiary referral center included adult patients who were undergoing ERCP with cholangioscopic examination of the common bile duct. Blood cultures were drawn from patients before the procedure and 5 and 30 minutes after the procedure. Antibiotics were not given before or after the procedure. Patients were followed up after 24 hours and 1 week after the procedure for infectious adverse events. The primary outcome was bacteremia rate, and secondary outcomes were cholangitis rate and adverse events. RESULTS: Fifty-seven patients were enrolled in the study with 60 procedures performed. The first procedure from each patient was considered in the analysis, and thus we included 57 patients with 57 procedures in this study analysis. Postprocedure bacteremia was seen in 5 of 57 procedures (8.8%; 95% confidence interval, 2.9%-19.3%). Four patients were readmitted with cholangitis (7.0%). Bacteremia was more common in patients who had cholangioscopy with biopsy sampling compared with patients who had cholangioscopy without biopsy sampling (P = .011). Cholangitis was significantly more common in patients with bacteremia than in those patients with a negative blood culture (P = .035). CONCLUSION: ERCP with cholangioscopy is associated with a bacteremia rate of 8.8% and a cholangitis rate of 7.0%. Preprocedural antibiotics may be considered before cholangioscopy, especially if tissue acquisition with biopsy sampling is expected. ( CLINICAL TRIAL REGISTRATION NUMBER: NCT01673269.).

Determination of optimal storage temperature and duration for analysis of total and isoenzyme lactate dehydrogenase activities in canine serum and cerebrospinal fluid.

BACKGROUND: Lactate dehydrogenase (LDH) exists as 5 isoenzymes in both serum and cerebrospinal fluid (CSF). Human studies have demonstrated that changes in LDH activity can be correlated with a particular disease. OBJECTIVES: Conflicting reports regarding the stability of LDH made it necessary to determine storage conditions before further study of the diagnostic power of this enzyme's activity can be pursued in dogs. The purpose of this study was to optimize measurement of LDH activity and analysis of its isoenzyme profile in canine serum and CSF through proper storage. METHODS: Serum and CSF were collected from 5 healthy dogs. Samples were stored at 22°C, 4°C, or -20°C for up to 2 months. Total LDH activity was measured spectrophotometrically. Isoenzyme profiles were determined using the QuickGel LDH Isoenzyme technique and densitometric scanning. Retention of > 70% LDH activity in stored samples was considered clinically acceptable. RESULTS: Serum and CSF stored at -20°C retained > 85% of the total LDH activity for 4 weeks, although CSF total LDH activity degraded by > 10% within 24 hours of storage. All serum LDH isoenzymes retained > 85% activity for up to 4 weeks at -20°C. CSF LDH isoenzyme activity degraded rapidly, therefore CSF LDH should be evaluated within 72 hours to assure > 75% of LDH isoenzyme activity. CONCLUSIONS: Proper storage at -20°C can optimize detection of total LDH activity and the LDH isoenzyme profile in canine serum and CSF. This information is important for evaluating the potential usefulness of LDH in veterinary medicine.

Sympathetic cardiac hyperinnervation and atrial autonomic imbalance in diet-induced obesity promote cardiac arrhythmias.

Obesity increases the risk of arrhythmias and sudden cardiac death, but the mechanisms are unknown. This study tested the hypothesis that obesity-induced cardiac sympathetic outgrowth and hyperinnervation promotes the development of arrhythmic events. Male Sprague-Dawley rats (250-275 g), fed a high-fat diet (33% kcal/fat), diverged into obesity-resistant (OR) and obesity-prone (OP) groups and were compared with rats fed normal chow (13% kcal/fat; CON). In vitro experiments showed that both OR and OP rats exhibited hyperinnervation of the heart and high sympathetic outgrowth compared with CON rats, even though OR rats are not obese. Despite the hyperinnervation and outgrowth, we showed that, in vivo, OR rats were less susceptible to arrhythmic events after an intravenous epinephrine challenge compared with OP rats. On examining total and stimulus-evoked neurotransmitter levels in an ex vivo system, we demonstrate that atrial acetylcholine content and release were attenuated in OP compared with OR and CON groups. OP rats also expressed elevated atrial norepinephrine content, while norepinephrine release was suppressed. These findings suggest that the consumption of a high-fat diet, even in the absence of overt obesity, stimulates sympathetic outgrowth and hyperinnervation of the heart. However, normalized cardiac parasympathetic nervous system control may protect the heart from arrhythmic events.