An initial exploration of fatigue as a predictor of quality of life in transplant athletes competing at national and international events.

Supporting organ transplant recipients' quality of life after surgery continues to be of interest to health researchers and applied practitioners. However, literature and guidance on the factors linked to quality of life in transplant recipient athletes remains underreported. This study aimed to identify significant predictors of quality of life in an international sample of organ transplant recipient athletes (N = 99, Mage = 53 ± 14). Adopting a cross-sectional design, we collected the study data during the 2019 World Transplant Games which consisted of demographic items, health, and physical activity-related measures (i.e., task and ego orientation, fatigue severity, assessment of physical activity, physical activity enjoyment). Predictor variables were summarised into three categories: demographic factors, sport-related factors, and levels of fatigue with physical and mental quality of life functioning as the outcome variables. Hierarchical regression analyses exposed fatigue to exert a significant negative influence on both mental and physical quality of life perceptions explaining 49% and 64% of the variance in these variables respectively. Routine measurement and monitoring of transplant athletes' level of fatigue in sport settings are recommended due to the negative bearing on quality of life that may be a potential barrier to sport participation and enjoyment.

Exploring the Impact of Safer Sports Betting Promotion on Social Media: An Experimental Study.

The current study assessed the effectiveness of delivering safer gambling messaging to regular sport bettors on social media. It also assessed whether the content of the message impacted message effectiveness. A 3 × 2 mixed factorial design was employed, with 281 participants randomly assigned to follow one of three Twitter accounts. The accounts either sent out informational messages, self-appraisal messages or emotional self-efficacy messages. Participants reported betting behaviour from the two weeks prior to following the accounts, in addition to during the two-week intervention period, using information from their online gambling accounts. Participants reported readiness to change gambling behaviour pre and post the two-week intervention period. A significant main effect of intervention stage highlighted reductions in betting behaviour and increased readiness to change behaviour. However, there was no significant main effect of condition and no significant interaction between intervention stage and condition upon betting behaviour or readiness to change. The findings suggest receiving safer gambling messages on social media may lead to a reduction in betting behaviour. However, similar reductions in behaviour were observed in the experimental and control conditions. Further research is needed to clarify whether changes in behaviour observed in the current study would extend over a longer period of time.

Tracking online searches for gambling activities and operators in the United Kingdom during the COVID-19 pandemic: A Google Trends™ analysis.

Background: Whilst some research has explored the impact of COVID-19 on gambling behaviour, little is yet known about online search behaviours for gambling during this period. The current study explored gambling-related online searches before, during and after the outbreak of the COVID-19 pandemic in the UK. We also assessed whether search trends were related to Gambling Commission behavioural data over the same period. Methods: Google Trends™ search data, covering thirty months from January 2020 to June 2022, for five gambling activities and five gambling operators were downloaded. Graphical displays of the weekly relative search values over this period were then produced to visualise trends in search terms, with key dates in COVID-19 policy and sporting events highlighted. Cross-correlations between seasonally adjusted monthly search data and behavioural indices were conducted. Results: Sharp increases in internet searches for poker, slots, and bingo were evident during the first lockdown in the UK, with operator searches sharply decreasing over this period. No changes in gambling activity searches were highlighted during subsequent lockdowns, although small increases in operator-based searches were detected. Strong positive correlations were found between search data and industry data for sports betting and poker but not for slots. Conclusions: Google Trends™ data may act as an indicator of population-level gambling behaviour. Substitution of preferred gambling activities for others may have occurred during the first lockdown when opportunities for sports betting were limited. Further research is needed to assess the effectiveness of internet search data in predicting gambling-related harm.

Frequent gamblers' perceptions of the role of gambling marketing in their behaviour: An interpretative phenomenological analysis.

This study explored how frequent gamblers perceive gambling marketing and the role they feel it has in their gambling behaviour. Ten frequent gamblers participated in semi-structured interviews oriented around their experiences of gambling marketing. An interpretative phenomenological analysis of the data led to three overarching themes: exploiting gambling marketing for personal gain; gambling marketing as a test of self-control; and safer gambling messages marketing perceived as ineffective. These themes encapsulated participants' views of gambling marketing as something they could take advantage of to increase their own gambling success. Marketing was also perceived as a test of self-control among self-identified experienced gamblers, although identified as a risk to those who are considered more vulnerable. Finally, safer gambling messages included within marketing was considered ineffective due to perceived insincerity and being seen as an 'afterthought' by marketers. In support of previous research, the current investigation highlights concerning narratives around self-control and perceived risk, as encapsulated within gambling marketing, and these are evident in the perceptions of frequent gamblers. Given gamblers' perceived lack of effectiveness of current safer gambling messages within marketing, future research should explore new avenues for safer gambling promotion.

Comparing football bettors' response to social media marketing differing in bet complexity and account type - An experimental study.

BACKGROUND AND AIMS: The current study aimed to assess how sports bettors respond to advertised bets on social media and whether this differs dependent upon bet complexity and social media account type. METHODS: Employing a 3 × 2 repeated measures design, 145 regular football bettors were recruited to take part in an online study requiring them to rate bets advertised upon social media, providing indications of their likelihood to bet, confidence in the bet and how much they would stake on the bet. Advertised bets differed in terms of complexity (low, medium and high) and each bet was presented separately on both an operator account and an affiliate account. RESULTS: Data analysis highlighted a significant interaction between bet complexity and account type, with bettors rating themselves as being more likely to bet and more confident in bets which were presented on an affiliate account for medium complexity bets but not for low or high complexity bets. DISCUSSION AND CONCLUSIONS: This study provides initial evidence that affiliate marketing of sports betting increases bettor's confidence in certain types of bets. This heightens previously addressed concerns around affiliate marketing, given that affiliates are financially incentivised to attract custom toward gambling operators. Future research should explore risk factors for increased uptake of affiliate marketing, and the impact on gambling behaviour.

Risk factors associated with the colonization of Ontario layer chicken flocks with Brachyspira species.

Brachyspira species are frequent colonizers of the gastrointestinal tract in a variety of domestic animals, including birds. In chickens, Brachyspira species are associated with a clinical condition known as avian intestinal spirochetosis (AIS), a disease characterized by chronic diarrhoea, weight loss, low egg production, and faecal-stained eggs. The purpose of this study was to identify risk factors associated with the presence of Brachyspira species in Ontario layer chicken flocks. Pooled faecal samples were collected from 89 flocks from 58 farms between August 2010 and February 2011; 52 flocks were classified as dirty flocks (history of downgrades for dirty eggs) and 37 were classified as clean flocks (no history of downgrades for dirty eggs). A questionnaire related to management, biosecurity practices, and antimicrobial use was administered prior to sample collection. Using real-time polymerase chain reaction; 63.5% of the dirty flocks and 24.3% of the clean flocks were positive for Brachyspira species. A logistic regression model with a random effect for farm showed that the odds of Brachyspira species for flocks ≥ 60 weeks of age were higher than for flocks ≤ 34 weeks (OR=9.3; P=0.014). The odds of Brachyspira species in flocks housed in A-frame cages with manure curtains (OR=20.0; P=0.002) and flocks from multi-age farms (OR=8.5; P=0.001) were higher than for flocks in cage-stacked houses and from single-age farms, respectively. The odds of Brachyspira species for flocks housed in barns ≥ 30 years old was lower than for flocks housed in barns ≤ 14 years old (OR=0.1; P=0.002). The calculated intra-class correlation coefficient was 5.6 × 10(-14); the notably low proportion of variation among farms after the fixed effects were included in the model suggests that the farm-level variable (multi-age farm) included in the final model accounted for most of the farm-to-farm variation in Brachyspira presence. Therefore, it is recommended that strict biosecurity, and between-flock decontamination efforts to reduce the infection pressure, be followed on farms with multiple flocks of different ages to avoid transmission of the bacteria between flocks.

Expression and function of intestinal hexose transporters after small intestinal denervation.

BACKGROUND: The role of neural regulation in expression and function of intestinal hexose transporters is unknown. The aim of this study is to determine the role of intestinal innervation in gene expression and function of the membrane hexose transporters, SGLT1, GLUT2, and GLUT5 in the enterocyte. We hypothesize that denervation of the small intestine decreases expression of hexose transporters, which leads to decreased glucose absorption. METHODS: Six groups of Lewis rats were studied (n = 6 each) as follows: control, 1 week after sham laparotomy, 1 and 8 weeks after syngeneic (no immune rejection) orthotopic small-bowel transplantation (SBT) (SBT1 and SBT8) to induce complete extrinsic denervation, and 1 and 8 weeks after selective disruption of intrinsic neural continuity to jejunoileum by gut transection and reanastomosis (T/A1 and T/A8). All tissue was harvested between 8 AM and 10 AM. In duodenum, jejunum, and ileum, mucosal messenger RNA (mRNA) levels were quantitated by real-time polymerase chain reaction (PCR), protein by Western blotting, and transporter-mediated glucose absorption using the everted sleeve technique. RESULTS: Across the 6 groups, the relative gene expression of hexose transporter mRNA and protein levels were unchanged, and no difference in transporter-mediated glucose uptake was evident in any region. The glucose transporter affinity (K(m)) and functional transporter levels (V(max)) calculated for duodenum and jejunum showed no difference among the 6 groups. CONCLUSION: Baseline regulation of hexose transporter function is not mediated tonically by intrinsic or extrinsic neural continuity to the jejunoileum.

Hexose transporter expression and function in mouse small intestine: role of diurnal rhythm.

BACKGROUND: Expression and function of hexose transporters vary diurnally in rat small intestine; however, this subject remains unexplored in mice. AIM: The aim of the study was to investigate the diurnal expression and function of hexose transporters SGLT1, GLUT2, and GLUT5 in mouse small bowel. METHODS: Twenty-four c57bl6 mice maintained in a 12-h light/dark room (6 AM: -6 PM: ) were sacrificed at 9 AM: , 3 PM: , 9 PM: , and 3 AM: (n = 6 each). In duodenal, jejunal, and ileal mucosa, total cellular mRNA and protein levels were quantitated by real-time PCR and semiquantitative Western blotting, respectively. The everted sleeve technique measured transporter-mediated glucose uptake at 9 AM: and 9 PM: . RESULTS: mRNA expression of SGLT1, GLUT2, and GLUT5 varied diurnally in all three intestinal segments (p 70% of food intake occurred; glucose transport followed a similar pattern with increased uptake at 9 PM: . CONCLUSION: Hexose transporter expression and function vary diurnally with nocturnal feeding patterns of mice.

Combined transabdominal gastroplasty and fundoplication for shortened esophagus: impact on reflux-related and overall quality of life.

BACKGROUND: Transabdominal gastroplasty for shortened esophagus at the time of fundoplication results in a segment of aperistaltic, acid-secreting neoesophagus above the fundoplication. We hypothesized that transabdominal gastroplasty impairs quality of life (QOL). METHODS: This was a matched paired analysis with retrospective chart review and follow-up questionnaire of 116 patients undergoing transabdominal fundoplication with gastroplasty with 116 matched controls undergoing transabdominal fundoplication alone from January 1997 to June 2005. Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36) and Quality Of Life in Reflux And Dyspepsia (QOLRAD) instruments were used to measure overall and reflux-related QOL. Overall response rate was 75%; including 65 matched pairs used for long-term follow-up and QOL analysis. RESULTS: Groups were similar in age, sex, duration of hospitalization, and complications (p > 0.05). Gastroplasty patients had larger hiatal hernias and were more likely to have undergone a previous fundoplication (p < 0.01). No perioperative deaths or major morbidity occurred in 18% of both groups. Survey respondents were older than nonrespondents (p < 0.01). Complications did not impact response rates (p = 0.11). Median follow-up was 14 months in the gastroplasty group and 17 months in controls (p = 0.02). The groups had similar scores on the SF-36 and QOLRAD (p > 0.05) and similar overall frequency of patient satisfaction, perceived health status, and self-reported symptoms of reflux, dysphagia, bloating, diarrhea, and excessive flatus (p > 0.05). Control patients were more likely to require rehospitalization or reinterventions (p = 0.04). CONCLUSIONS: Transabdominal gastroplasty and fundoplication for shortened esophagus is safe and results in similar overall and reflux-related QOL compared with fundoplication alone.

Effect of Roux-en-Y gastric bypass in obese patients with Barrett's esophagus: attempts to eliminate duodenogastric reflux.

BACKGROUND: To assess the effect of Roux-en-Y gastric bypass (RYGB) at a tertiary referral Center of Excellence for bariatric surgery on the length and presence of dysplasia in morbidly obese patients with Barrett's esophagus (BE). Esophageal reflux of gastroduodenal contents (acid, bile) contributes to the development of BE and progression in the dysplasia-carcinoma sequence. Obese patients have a high prevalence of gastroesophageal reflux and might be at an increased risk of developing BE and esophageal adenocarcinoma. The effect of eliminating duodenogastroesophageal reflux on BE is not known. METHODS: We performed a retrospective review of all patients with pre-existing, biopsy-proven, long-segment (>3 cm) BE undergoing RYGB at our institution. Only patients with >1 year of endoscopic, biopsy-controlled follow-up (mean 34 mo) were included. RESULTS: Five patients (3 men and 2 women) were identified. The mean +/- standard error of the mean preoperative length of BE was 6 +/- 2 cm; 2 patients had low-grade dysplasia and 1 indeterminate dysplasia. At the postoperative follow-up (>1 yr) examinations, the length of BE had decreased in 4 patients; the overall length was 2 +/- 1 cm; and only 1 patient had dysplasia. All patients experienced a decrease in the length of BE (n = 4), complete disappearance of BE (n = 2), or improvement in the degree of dysplasia (n = 3). The body mass index had decreased from 43 +/- 4 kg/m(2) to 33 +/- 3 kg/m(2), and all experienced subjective improvement in reflux symptoms postoperatively. RYGB resulted in complete or partial regression of BE in 4 of 5 patients and improvement in reflux symptoms in all. CONCLUSION: Our results suggest that RYGB might be the procedure of choice in morbidly obese patients with BE requiring surgical treatment for gastroesophageal reflux disease.

Coordinated, diurnal hexose transporter expression in rat small bowel: implications for small bowel resection.

BACKGROUND: Hexose transporter mRNA and protein levels follow a diurnal rhythm in rat jejunum. Their coordinated expression and resultant function throughout the small bowel is not well understood. We hypothesized that hexose transporter levels and glucose absorption follow a coordinated, site-specific diurnal rhythm in rat duodenum and jejunum, but not in ileum. METHODS: Sprague-Dawley rats were housed in a strictly maintained, 12-h, light/dark room [light 6 am to 6 pm] with free access to water and chow. Mucosa was harvested from duodenum, jejunum, and ileum at 3 am, 9 am, 3 pm, and 9 pm, and full thickness 1-cm segments were harvested at 9 am, and 9 pm (n = 6 for each segment at each time point). mRNA levels were determined by reverse-transcription, real-time polymerase chain reaction (n > or = 5), protein levels by semiquantitative Western blotting (n > or = 5), and transporter-mediated glucose uptake by everted sleeve technique (n = 6). RESULTS: mRNA levels of SGLT1 and GLUT5 followed a temporally coordinated, diurnal rhythm in all 3 segments (P < .01), while mRNA for GLUT2 and protein levels for SGLT1 and GLUT2 varied diurnally only in duodenum and jejunum (P > .05) but not in ileum (P > .10). SGLT1 and GLUT5 mRNA induction decreased aborally. Baseline SGLT1 and GLUT5 mRNA levels and SLGT1 and GLUT2 protein levels did not vary aborally (P > .05 for all). GLUT2 mRNA baseline levels were decreased in ileum (P < .01). Glucose uptake varied diurnally in duodenum and jejunum with no difference in ileum. Transporter-mediated glucose uptake was greater in duodenum and jejunum compared with ileum. CONCLUSION: Regulation of hexose absorption in rat small bowel seems to be site-specific and mediated by multiple mechanisms.

Development of a simple model of extrinsic denervation of the small bowel in mouse.

Small bowel transplantation (SBT) is associated with poorly understood enteric dysfunction. The study of SBT in mice is hindered by the technical difficulty of orthotopic SBT in the mouse. Our aim was to develop an easy preparation of extrinsic denervation of the entire jejunoileum in mice as a model of orthotopic SBT. All neurolymphatic tissues accompanying the superior mesenteric artery (SMA) and vein (SMV) were ligated just distal to the middle colic vessels. The SMA and SMV were then stripped of investing adventitia, and the mesentery to jejunum and colon were transected radially. Jejunum and colon were not transected and reanastomosed. To confirm extrinsic denervation 1, 3, and 6 months later, segments of small bowel were stained for protein gene product 9.5 (PGP9.5) and tyrosine hydroxylase (TH). Tyrosine hydroxylase immunoreactive intensity was then quantified using a semiquantitative analysis. Immunohistochemical fluorescence showed persistence of PGP9.5 immunoreactivity confirming enteric nerves in jejunoileum; however, there was no TH immunoreactivity in jejunoileum in denervated mice despite the expected preservation of TH immunoreactivity in the still-innervated duodenum at 1 month. At 3 months, sparse immunoreactivity for TH was present, and by 6 months, reinnervation of TH-containing nerves appeared similar to controls. Quantification of intensity at each time-point further confirmed this trend. This technique in the mouse accomplishes a complete extrinsic denervation of jejunoileum early postoperatively (1 and 3 months); reinnervation occurs by 6 months. This is an easily learned murine model of orthotopic SBT.

Pancreaticobiliary and duodenal perforations after periampullary endoscopic procedures: diagnosis and management.

OBJECTIVE: To review our experience with management of pancreaticobiliary and duodenal (PB/D) perforations after periampullary endoscopic interventions. Although pancreaticobiliary and duodenal perforations after periampullary endoscopic procedures are rare, their management has not been well described. PATIENTS: Individuals who experienced pancreaticobiliary and duodenal perforations. MAIN OUTCOME MEASURES: Comorbidities, interventions performed, mechanism/site of perforation, management, and hospital morbidity/mortality. RESULTS: Seventy-five perforations (0.6%) occurred in 12,427 procedures; 20 perforations (27%) occurred during biliary stricture dilatation, 18 (24%) during diagnostic endoscopic retrograde cholangiopancreatography, and 15 (20%) during management of choledocholithiasis. Perforations were caused by guidewire insertion in 24 patients (32%), sphincterotomy in 11 (15%), passage of the endoscope in 8 (11%), or stent migration in 7 (9%) and were identified during the index procedure in 45 patients (60%). Delayed presentations included pain in 33 patients (44%), leukocytosis in 26 (35%), and/or fever in 13 (17%) and were diagnosed using computed tomography in 19 patients (25%) and abdominal radiography in 10 (13%); 9 cases (12%) were diagnosed more than 24 hours after the procedure. Indications for operative treatment were gaping duodenal perforations and perforations in patients with surgically altered anatomy. Indications for nonoperative management included contained bile duct perforations and focal duodenal perforations. Management was nonoperative in 53 patients (71%) and operative in 22 (29%). Patients with duodenal perforations, higher American Society of Anesthesia status (P<.01 each), and older age (mean +/- SEM, 65 +/- 4 vs 55 +/- 2 years; P = .02) were more likely to require operative management. Hospital stay (mean +/- SEM, 16 +/- 4 vs 4 +/- 1 days; P<.05) and mortality (13% vs 4%; P<.05) were greater in operative patients (P<.05 each). CONCLUSIONS: Most (70%) pancreaticobiliary and duodenal perforations secondary to periampullary endoscopic interventions can be managed nonoperatively. Most biliary perforations can be managed nonoperatively; a requirement for operative treatment increases the mortality rate.

The influence of transabdominal gastroplasty: early outcomes of hiatal hernia repair.

OBJECTIVE: The aim of our study was to review our experience with transabdominal gastroplasty to determine the safety and short-term efficacy of the procedure. METHODS: Retrospective review of all patients that underwent transabdominal hiatal hernia repair with concurrent gastroplasty for shortened esophagus between October 1999 and May 2004. RESULTS: There were 63 patients, 27 men and 36 women. Median age was 68 years. The hiatal hernia was classified as type-I in 6 patients, type-II in 10, type-III in 43, and type-IV in 4. The operative approach was laparoscopic in 44 patients and laparotomy in 19. A Nissen fundoplication was performed in 62 patients and a Toupet fundoplication in 1. Wedge gastroplasty was performed in 47 patients and modified Collis gastroplasty in 16. Median hospitalization was 3 days (range, 2-10). Intraoperative complications occurred in 11 patients (17%). One laparoscopic approach (2%) was converted to laparotomy. Postoperative complications occurred in 12 patients (19%), there were no operative deaths. Median follow-up was 12 months (range, 0 to 64). One patient (2%) was found to have a recurrent hiatal hernia diagnosed 14 months, postoperatively. Functional results were excellent in 41 (68%), good in 6 (10%), fair in 12 (20%), and poor in 1 (2%). CONCLUSION: Transabdominal gastroplasty can be performed safely, with good functional results and a low incidence of recurrent herniation during the short-term follow-up period.

A two-decade spectrum of revisional bariatric surgery at a tertiary referral center.

BACKGROUND: Ineffective weight loss or complications of previous bariatric surgery often require revisional bariatric procedures. Our aim was to define the indications, operative approach, and outcomes of revisional bariatric procedures during 2 decades at a tertiary center. METHODS: From our prospective database (n = 1584), including 1985-2004, 218 patients (14%) underwent revisional bariatric procedures. Follow-up (mean 7 yr, range 1 mo to 19 yr) data obtained from patient records and questionnaires were current for 98%. Patients were grouped according to operative indications: group 1, unsatisfactory weight loss (n = 97); group 2, mechanical/symptomatic complications (n = 95); and group 3, severe nutritional/metabolic problems (n = 26). RESULTS: The operative mortality rate was 0.9% (1 case each of pulmonary embolus and cardiac arrest). The serious operative morbidity rate was 26% (wound infection in 13%, leak in 3%, pulmonary embolus in 2%, anemia/hemorrhage in 2%, pneumonia/prolonged ventilation in 2%, and other in 4%). Of the 218 patients, 94% underwent conversion to, or revision of, Roux-en-y gastric bypass. Group 1 achieved substantial weight reduction with a mean body mass index from 51 +/- 1 to 38 +/- 1 kg/m(2), the complications resolved in 88% of group 2, and the nutritional/metabolic problems resolved in 79% of group 3. Patients who underwent revisional surgery 1990 were more likely to present with mechanical/symptomatic/metabolic complications than for unsuccessful weight loss (P <.001). CONCLUSIONS: Revisional bariatric surgery is safe and effective in experienced centers. Complications (mechanical/symptomatic/nutritional) or unsatisfactory weight loss after primary bariatric procedures can be treated effectively with revision to Roux-en-y gastric bypass.

The malabsorptive very, very long limb Roux-en-Y gastric bypass for super obesity: results in 257 patients.

BACKGROUND: For the past 11 years, we have used a malabsorptive form of Roux-en-Y gastric bypass (RYGB), the "very, very long limb" RYGB, for selected patients with BMIs >50 kg/m(2) and in highly selected patients with BMI <50 kg/m(2). This modified distal gastric bypass establishes a 100-cm common channel (for digestion and absorption) and a "very, very" long Roux limb of 400 to 500 cm. METHODS: To determine long-term efficacy and complications, we followed prospectively 257 consecutive patients; 188 (73%) participated in a postoperative survey. RESULTS: Of the patients, 60% were female; overall age (x +/- SD) was 45 +/- 11 years, and BMI was 61 +/- 11 kg/m(2). Operative mortality was 1% with substantive postoperative morbidity occurring in 13%. Eighty-two percent of patients returning the survey an average of 48 months postoperatively (range, 12 to 148 months) lost >50% of excess body weight; BMI at follow-up was 37 +/- 9 kg/m(2). Resolution of comorbidities included diabetes mellitus (94%), hypertension (65%), sleep apnea (48%), and asthma (30%). Side effects included mild food intolerance (82%), occasional loose or watery stools (71%), nephrolithiasis (16%), and symptomatic steatorrhea (5%). Nine patients (4%) who developed or were developing impending protein/calorie malnutrition required proximal relocation of the enteroenterostomy with symptom resolution. CONCLUSIONS: Overall, 90% were satisfied with the operation, and 93% would recommend it to a friend. The very, very long limb RYGB is relatively safe and effective and has acceptable side effects in the treatment of selected patients with super obesity (BMI >50). Because of the possibility of malabsorptive sequelae, patients should be selected based on degree of medical sophistication, insight, and compliance.

The diurnal periodicity of hexose transporter mRNA and protein levels in the rat jejunum: role of vagal innervation.

BACKGROUND: Protein and messenger RNA (mRNA) levels of the hexose transporters sodium-dependent glucose transporter-1, glucose transporter 2, and glucose transporter 5 follow a (daily) diurnal rhythm in rat jejunum. Because vagal innervation mediates the diurnal activity of other proteins in the rat small bowel, we hypothesized that the diurnal variation of mRNA and protein levels of these hexose transport proteins are mediated by vagal innervation. METHODS: Forty-eight rats kept in a strictly maintained, alternating 12-hour light-dark room underwent either sham laparotomy (n = 24) or bilateral total abdominal vagotomy (n = 24). Four weeks postoperatively, jejunal mucosa was harvested from 6 rats in each group at 3 am, 9 am, 3 pm and 9 pm; mRNA levels were determined by reverse transcription real-time polymerase chain reaction and protein levels by semiquantitative Western blot analysis. Transporter mRNA and protein levels were expressed as a ratio to the corresponding mRNA and protein levels of the stably expressed housekeeping gene glyceraldehyde-6-phosphate dehydrogenase. RESULTS: mRNA and protein levels for all 3 hexose transporters showed diurnal variation in sham controls (P < or = .01 for all). After vagotomy, although mRNA levels of all 3 transporters showed diurnal variation (each P < .01), diurnal variation in all 3 hexose transporter protein levels was abolished (P > .10 for all). CONCLUSIONS: Vagal innervation appears to differentially mediate the diurnal changes in hexose transporter mRNA and protein expression in the rat jejunum by posttranscriptional, and/or posttranslational processes.

Postprandial augmentation of absorption of water and electrolytes in jejunum is neurally modulated: implications for segmental small bowel transplantation.

Postprandial augmentation of absorption of water and electrolytes is believed to occur in the jejunum. Neural mechanisms of control, however, have not been studied in the in situ jejunum or in the transplanted bowel. The aim of this study was to determine if postprandial augmentation of absorption occurs in the in situ jejunum and to evaluate neural mechanisms controlling postprandial jejunal absorption. Based on our previous work, we hypothesized that postprandial augmentation of absorption does not occur in the jejunum in situ and that extrinsic denervation of the jejunum is associated with decreased postprandial absorption. Absorption was studied in an 80 cm, in situ jejunal segment in six dogs by using an isosmolar electrolyte solution alone, or with 80 mmol/L glucose before and after jejunal transection to disrupt intrinsic neural continuity of the study segment with the remaining gut. Net absorptive fluxes of water and electrolytes were measured in the fasted state and after a 400-kcal meal. Another six dogs were studied 3 weeks after our validated model of extrinsic denervation of jejunoileum; identical fasting and postprandial absorptive states were evaluated. Postprandial augmentation of absorption of water and electrolytes did occur in the jejunum (P < 0.03) both in the absence and in the presence of intraluminal glucose. After intrinsic neural transection or extrinsic denervation, no postprandial augmentation of absorption occurred, with or without glucose. Postprandial augmentation of absorption of water and electrolytes occurs in the in situ jejunum. Disrupting intrinsic neural continuity or extrinsic denervation (as after intestinal transplantation) abolishes postprandial augmentation.

Bilateral staged versus bilateral simultaneous thoracotomy in the pediatric population.

AIM: The aim of the study was to evaluate the safety and outcomes of simultaneous bilateral thoracotomy in pediatric patients compared with traditional bilateral staged thoracotomy. METHODS: This is a retrospective review of 30 consecutive patients 18 years or younger undergoing either bilateral staged or bilateral simultaneous thoracotomy between March 1994 and July 2004. Follow-up (mean, 47 months) was available for all patients. RESULTS: Thirty patients (17 boys, 13 girls; average age, 12 years) underwent bilateral staged or bilateral simultaneous thoracotomy. Eighteen patients underwent staged thoracotomy, 9 patients underwent simultaneous thoracotomy, and 3 patients underwent both procedures. Diagnosis included sarcoma (n = 21), Wilms tumor (n = 4), indeterminate pulmonary nodules (n = 3), and germ cell tumor (n = 2). When we compared outcomes for patients undergoing simultaneous versus staged bilateral thoracotomy, mean hospital stay (5.2 vs 10.6 days; P < .002), intensive care unit stay (1 vs 2 nights; P < .0001), days with tube thoracostomy (4 vs 8 days; P < .0005), and time to initiation of adjuvant chemotherapy (13 vs 30 days; P < .05) were all significantly less for patients undergoing bilateral simultaneous thoracotomy. In addition, postoperative complications were less frequent in patients undergoing simultaneous versus staged thoracotomy (0 vs 3 events; P = .25). CONCLUSIONS: In selected patients, bilateral simultaneous thoracotomy is safe and may lessen morbidity and hospital stay while avoiding delay in initiation of adjuvant chemotherapy.