Differential Effect of Light and Dark Period Sleep Fragmentation on Composition of Gut Microbiome and Inflammation in Mice.

Bi-directional interactions amongst the gut microbiota, immune system, and brain function are thought to be critical mediators of health and disease. The role sleep plays in mediating these interactions is not known. We assessed the effects of sleep fragmentation (SF) on the microbiota-gut-brain axis. Male C57BL/6NCrl mice (4 to 5 per cage, fed standard lab chow) experienced SF via mechanical stimulation at 2 min intervals during the light (SF) and dark (DD, dark disturbances) periods. Home cage (HC) controls were undisturbed. After 10 days, fecal samples were collected at light onset, midday, light offset, and midnight. Samples were also collected after 10 days without SF. Subsequently, the mice were randomized across groups and allowed 20 additional days of recovery followed by 10 days of SF or DD. To assess effects on the microbiota, 16S rRNA sequencing was used, and mesenteric lymph nodes (MLNs) and cortex and medial prefrontal cortex were analyzed using cytokine arrays. SF and DD produced significant alterations in the microbiota compared to HC, and DD had greater impact than SF on some organisms. SF produced marked suppression in MLNs of chemokines that regulate inflammation (CCL3, CCL4 and their receptor CCR5) and maintain the immune mucosal barrier (Cxcl13) at the same time that cortical cytokines (IL-33) indicated neuroinflammation. DD effects on immune responses were similar to HC. These data suggest that SF alters the microbiome and suppresses mucosal immunity at the same time that mediators of brain inflammation are upregulated. The translational implications for potential application to clinical care are compelling.

Evaluation of gastrointestinal bleeding: Update of current radiologic strategies.

Gastrointestinal bleeding (GIB) is a common presentation with significant associated morbidity and mortality, the prevalence of which continues to rise with the ever-increasing aging population. Initial evaluation includes an esophagoduodeonscopy and/or colonoscopy, which may fail to reveal a source. Such cases prove to be a dilemma and require collaboration between gastroenterology and radiology in deciding the most appropriate approach. Recently, there have been a number of radiologic advances in the approach to GIB. The purpose of this review is to provide an evidence-based update on the most current radiologic modalities available and an algorithmic approach to GIB.

Computed tomography colonography: ready for prime time for colon cancer screening?

In 2008, results from the landmark American College of Radiology Imaging Network (ACRIN) trial provided evidence supporting the use computed tomography colonography (CTC) as a comparable alternative to colonoscopy for colorectal cancer (CRC) screening. Subsequently, however, the United States Preventive Task Force decided against a recommendation in support of CTC for CRC screening. Following soon after, the Centers for Medicare and Medicaid Services (CMS) made noncoverage decision for the use of CTC in CRC screening. Since that decision, there have been a number of publications on CTC and CRC screening with a strong push from the radiology community to reassess CTC as a viable option. The purpose of this review was to address focused questions concerning the use of CTC in CRC screening, through an analysis of the available scientific evidence in an effort to provide recommendations for clinicians, patients, and payors who may evaluate the role of CTC for CRC screening.

Successful treatment of Salmonella aortitis with endovascular aortic repair and antibiotic therapy.

We report a case of a 77-year-old Asian man with a history significant for type II diabetes mellitus and chronic kidney disease who presented with abdominal pain, nausea, vomiting and a 20-pound weight loss of 3 weeks' duration. Further evaluation revealed an infected mycotic aneurysm and distal abdominal aortitis as a result of Salmonella. This case demonstrates an interesting case of aortitis and a successful therapeutic approach.

An update on the management of implanted cardiac devices during electrosurgical procedures.

To date, the major guidelines for the management of implanted cardiac devices during electrosurgical procedures have come from 1 of several major medical societies.These most recent guidelines are from the ACCF/AHA in 2009, a combined consensus statement from the Heart Rhythm Society and the American Society of Anesthesiologists in 2011, as well as an update from the ASGE in 2007. Tables 1 and 2 summarize the most recent recommendations by society. Further studies are needed so that data can be available for the specialty societies to unify consensus on guidelines on the proper management of patients with implanted cardiac devices.