Curriculum for neurogastroenterology and motility training: A report from the joint ANMS-ESNM task force.

Although neurogastroenterology and motility (NGM) disorders are some of the most frequent disorders encountered by practicing gastroenterologists, a structured competency-based training curriculum developed by NGM experts is lacking. The American Neurogastroenterology and Motility Society (ANMS) and the European Society of Neurogastroenterology and Motility (ESNM) jointly evaluated the components of NGM training in North America and Europe. Eleven training domains were identified within NGM, consisting of functional gastrointestinal disorders, visceral hypersensitivity and pain pathways, motor disorders within anatomic areas (esophagus, stomach, small bowel and colon, anorectum), mucosal disorders (gastro-esophageal reflux disease, other mucosal disorders), consequences of systemic disease, consequences of therapy (surgery, endoscopic intervention, medications, other therapy), and transition of pediatric patients into adult practice. A 3-tiered training curriculum covering these domains is proposed here and endorsed by all NGM societies. Tier 1 NGM knowledge and training is expected of all gastroenterology trainees and practicing gastroenterologists. Tier 2 knowledge and training is appropriate for trainees who anticipate NGM disorder management and NGM function test interpretation being an important part of their careers, which may require competency assessment and credentialing of test interpretation skills. Tier 3 knowledge and training is undertaken by trainees interested in a dedicated NGM career and may be restricted to specific domains within the broad NGM field. The joint ANMS and ESNM task force anticipates that the NGM curriculum will streamline NGM training in North America and Europe and will lead to better identification of centers of excellence where Tier 2 and Tier 3 training can be accomplished.

Anaerobic Threshold by Mathematical Model in Healthy and Post-Myocardial Infarction Men.

The aim of this study was to determine the anaerobic threshold (AT) in a population of healthy and post-myocardial infarction men by applying Hinkley's mathematical method and comparing its performance to the ventilatory visual method. This mathematical model, in lieu of observer-dependent visual determination, can produce more reliable results due to the uniformity of the procedure. 17 middle-aged men (55±3 years) were studied in 2 groups: 9 healthy men (54±2 years); and 8 men with previous myocardial infarction (57±3 years). All subjects underwent an incremental ramp exercise test until physical exhaustion. Breath-by-breath ventilatory variables, heart rate (HR), and vastus lateralis surface electromyography (sEMG) signal were collected throughout the test. Carbon dioxide output (V˙CO2), HR, and sEMG were studied, and the AT determination methods were compared using correlation coefficients and Bland-Altman plots. Parametric statistical tests were applied with significance level set at 5%. No significant differences were found in the HR, sEMG, and ventilatory variables at AT between the different methods, such as the intensity of effort relative to AT. Moreover, important concordance and significant correlations were observed between the methods. We concluded that the mathematical model was suitable for detecting the AT in both healthy and myocardial infarction subjects.

Avaliação do controle autonomico da frequencia cardiaca e determinação do limiar de anaerobiose em homens saudaveis e coronariopatias / Evaluation of autonomic heart rate control and determination of anaerobic threshold among healthy and coronary heart-disead men

Avaliar a frequencia cardiaca (FC) e sua variabilidade (VFC) em repouso e durante teste de exercicio fisico dinamico descontinuo tipo degrau (TEFDD-d) em homens saudaveis sedentarios (SS) e infartados ativos (IA); determinar e comparar o limiar de anaerobiose (LA) dos grupos estudados. Metodologia: forma estudados 10 SS (52,5 anos)e 6 IA (59,2 anos) em repouso nas posicoes supino e sentado e em TEFDD-d realizado em cicloergometro, iniciando na potencia com decrescimo de 5 W e acrescimo de 5 W. A Fc (bpm) e os intervalos R-R (iR-R) em ms foram captados batimento a batimento em repouso e em TEFDD-d. Foram calculados os indices RMSSD dos iR_r e a FC media das condicoes de repouso e do trecho estavel de cada nivel de potencia. O LA foi determinado aplicando o modelo semiparametrico aos dados de Fc. Os testes estatisticos utilizados forma Wilcoxon, Mann Whitney e Friedmann, nivel de significancia p < 0,05. Resultados: Em repouso os valores de RMSSD dos iR-R e da FC nao atingiram diferencas estatisticas significativas entre os grupos, ja os SS apresentaram diferencas significativas nos valores de Fc durante a mudanca postural. No nivel potencia do LA ambos os grupos nao apresentaram reducoes significativas da VFC em comparacao com 25 W. Conclusao: nossos resultados sugerem que a atividade fisica regular realizada pelos IA contribuiu para manter a capacidade aerobica como modulacao autonomica da FC similares a dos SS

Identification of anaerobic threshold using heart rate response during dynamic exercise.

The objective of the present study was to characterize the heart rate (HR) patterns of healthy males using the autoregressive integrated moving average (ARIMA) model over a power range assumed to correspond to the anaerobic threshold (AT) during discontinuous dynamic exercise tests (DDET). Nine young (22.3 +/- 1.57 years) and 9 middle-aged (MA) volunteers (43.2 +/- 3.53 years) performed three DDET on a cycle ergometer. Protocol I: DDET in steps with progressive power increases of 10 W; protocol II: DDET using the same power values as protocol 1, but applied randomly; protocol III: continuous dynamic exercise protocol with ventilatory and metabolic measurements (10 W/min ramp power), for the measurement of ventilatory AT. HR was recorded and stored beat-to-beat during DDET, and analyzed using the ARIMA (protocols I and II). The DDET experiments showed that the median physical exercise workloads at which AT occurred were similar for protocols I and II, i.e., AT occurred between 75 W (116 bpm) and 85 W (116 bpm) for the young group and between 60 W (96 bpm) and 75 W (107 bpm) for group MA in protocols I and II, respectively; in two MA volunteers the ventilatory AT occurred at 90 W (108 bpm) and 95 W (111 bpm). This corresponded to the same power values of the positive trend in HR responses. The change in HR response using ARIMA models at submaximal dynamic exercise powers proved to be a promising approach for detecting AT in normal volunteers.

Identification of anaerobic threshold using heart rate response during dynamic exercise

The objective of the present study was to characterize the heart rate (HR) patterns of healthy males using the autoregressive integrated moving average (ARIMA) model over a power range assumed to correspond to the anaerobic threshold (AT) during discontinuous dynamic exercise tests (DDET). Nine young (22.3 ± 1.57 years) and 9 middle-aged (MA) volunteers (43.2 ± 3.53 years) performed three DDET on a cycle ergometer. Protocol I: DDET in steps with progressive power increases of 10 W; protocol II: DDET using the same power values as protocol 1, but applied randomly; protocol III: continuous dynamic exercise protocol with ventilatory and metabolic measurements (10 W/min ramp power), for the measurement of ventilatory AT. HR was recorded and stored beat-to-beat during DDET, and analyzed using the ARIMA (protocols I and II). The DDET experiments showed that the median physical exercise workloads at which AT occurred were similar for protocols I and II, i.e., AT occurred between 75 W (116 bpm) and 85 W (116 bpm) for the young group and between 60 W (96 bpm) and 75 W (107 bpm) for group MA in protocols I and II, respectively; in two MA volunteers the ventilatory AT occurred at 90 W (108 bpm) and 95 W (111 bpm). This corresponded to the same power values of the positive trend in HR responses. The change in HR response using ARIMA models at submaximal dynamic exercise powers proved to be a promising approach for detecting AT in normal volunteers.

Avaliação da variabilidade da frequencia cardíaca em repouso de homens saudáveis sedentários e de hipertensos e coronariopatias em treinamento físico / Resting heart rate variability in sedentary healthy men and in in trained men with hipertension and coronary heart disease

O objetivo deste estudo foi avaliar e comparar a variabilidade da frequencia cardiaca(VFC) em repouso supino e sentado de 10 homens de meia idade saudaveis (SA), 9 hipertensos (HA) e 9 com infarto do miocardio (IM), com idade media de 52, 62 e 56 anos, respectivamente. Os voluntarios SA nao praticavam atividade fisica frequentemente e os voluntarios HA e IM participavam de um programa de treinamento fisico aerobico (TFA) ha aproximadamente 3 anos. A frequencia cardiaca (FC) e os intervalos R-R(iR-R - ms) foram coletdos durante 900 s nas posicoes supina e sentada, e os voluntarios foram orientados a manter-se em repouso. Para a analise dos dados de dominio do tempo (DT), foi utilizado o indice RMSSD dos iR-R (ms). Para o dominio da frequencia (DF), foi aplicado um modelo auto-regressivo e obtidas as bandas de frequencia muito baixa (MBF), baixa (BF) e alta (AF), sendo os componentes BF e AF expressos em unidades normalizadas e na razao BF/AF. Foram utilizados os testes estatisticos nao-parametricos de Wilcoxon, de kruskall-Wallis e pos-hoc de Dunn. O nivel de significancia foi de a=5(por cento). Nao foram observadas diferencas estatisticamente significativas nos indices de VFC, avaliados no DT e no DF nas condicoes supino e sentado, nas comparacoes inter e intragrupo. Os resultados que a ausencia de diferencas entre os grupos estudados pode estar relacionada aos efeitos do do TFA realizadopelos HA e IM, comparativamente aos SA

Eleven novel APC mutations identified in Portuguese FAP families.

Germline mutations of the adenomatous polyposis coli (APC) gene are responsible for familial adenomatous polyposis (FAP), an autosomal dominant predisposition to colorectal cancer. In the present study we screened all of the exons of the APC gene in individuals belonging to 85 Portuguese FAP families. We here report eleven novel mutations which are predominantly frameshifts or single base substitutions, resulting in premature stop codons. Hum Mutat 16:178, 2000.

[Essential thrombocythemia. Therapy with interferon alfa]. / Trombocitemia essencial. Terapêutica com alfa interferão.

A clinical case of essential thrombocythaemia is presented to demonstrate good therapeutic response to subcutaneous Alpha-2b Interferon in a dosage of 3 x 10(6) units, three times a week. Based on this case and on a literature research we propose that Alpha-2b Interferon is a legitimate alternative to alkylating agents or radioactive phosphorus (32P), showing identical efficacy and less Leukemogen effect.

Stationary vs. mapping manometry in evaluating dysphagia.

Two methods are used to assess esophageal motility. The mapping technique uses catheter withdrawal at 1 cm steps until the entire esophagus is evaluated. A simpler method is commonly used that involves keeping the catheter stationary for the entire evaluation. We compared these 2 techniques in 30 patients referred for the evaluation of dysphagia. Emphasis was placed on the distal 10 cm of the esophagus because this is the primary location of esophageal motility disorders. There was excellent correlation between techniques for mean distal amplitude (r = 0.945), mean distal duration (r = 0.942), and percentage of non-peristaltic contractions (r = 0.967). The overall manometry diagnosis was similar by both methods in 27 (90%) patients. Three patients had different manometry diagnoses resulting from use of the two techniques. However, the change in diagnosis was only clinically important in one patient in whom the mapping technique identified a segmental motility disorder that had been missed by the stationary technique. Stationary manometry had a 94% sensitivity and 93% specificity rate for identifying motility disorders compared to mapping manometry. We conclude that stationary manometry is a simple and accurate method for evaluating esophageal pressures and distal disorders. Only those patients with normal results of stationary studies may benefit by further mapping to identify rare segmental motility disorders.