Preclinical studies suggest that neuromodulation with thoracic spinal cord stimulation (SCS) improves left ventricular (LV) function and remodeling in systolic heart failure (HF).
The purpose of this ...study was to evaluate the safety and efficacy of a SCS system for the treatment of systolic HF.
We performed a prospective, multicenter pilot trial in patients with New York Heart Association (NYHA) class III HF, left ventricular ejection fraction (LVEF) 20%-35%, and implanted defibrillator device who were prescribed stable optimal medical therapy. Dual thoracic SCS leads were used at the T1-T3 level. The device was programmed to provide SCS for 24 hours per day (50 Hz at pulse width 200 μs).
We enrolled 22 patients from 5 centers:17 patients underwent implantation of a SCS device and 4 patients who did not fulfill the study criteria served as nontreated controls. No deaths or device-device interactions were noted during the 6-month period in the 17 SCS-treated patients. Fifteen of 17 completed the efficacy endpoint assessments: composite score improved by 4.2 ± 1.3, and 11 patients (73%) showed improvement in ≥4 of 6 efficacy parameters. There was significant improvement in NYHA class (3.0 vs 2.1, P = .002; 13/17 improved); Minnesota Living with Heart Failure Questionnaire (42 ± 26 vs 27 ± 22, P = .026; 12/17 improved); peak maximum oxygen consumption (14.6 ± 3.3 vs 16.5 ± 3.9 mL/kg/min, P = .013; 10/15 improved); LVEF (25% ± 6% vs 37% ± 8%, P<.001; 14/16 improved); and LV end-systolic volume (174 ± 57 vs 137 ± 37 mL, P = .002; 11/16 improved) but not in N-terminal prohormone brain natriuretic peptide. No such improvements were observed in the 4 nontreated patients.
The results of this first-in-human trial suggest that high thoracic SCS is safe and feasible and potentially can improve symptoms, functional status, and LV function and remodeling in patients with severe, symptomatic systolic HF.
We present new Karl G. Jansky Very Large Array radio continuum images of the nuclei of Arp 220, the nearest ultra-luminous infrared galaxy. These new images have both the angular resolution to study ...the detailed morphologies of the two nuclei that power the galaxy merger and sensitivity to a wide range of spatial scales. At 33 GHz, we achieve a resolution of 0.081 x 0.063 and resolve the radio emission surrounding both nuclei. We conclude from the decomposition of the radio spectral energy distribution that a majority of the 33 GHz emission is synchrotron radiation. The spatial distributions of radio emission in both nuclei are well described by exponential profiles. According to the calculations, the nuclei of Arp 220 are only transparent in the frequency range ~5-350 GHz. Our results offer no clear evidence that an active galactic nucleus dominates the emission from either nucleus at 33 GHz.
Summary
Background
Noncoeliac gluten sensitivity (NCGS) is a controversial emerging disorder. Despite reported symptoms related to the ingestion of gluten, NCGS remains a diagnosis based on the ...exclusion of coeliac disease, given the absence of reliable biomarkers.
Aim
To evaluate the prevalence, diagnostic exclusion of coeliac disease and the efficacy of a gluten‐free diet (GFD) for NCGS patients.
Methods
A PubMed search was performed up to December 2014. According to consensus diagnostic criteria, NCGS was defined as self‐reported gluten intolerance, negative coeliac serology and absence of villous atrophy. Studies evaluating the impact of a GFD on patients with irritable bowel syndrome (IBS) were also included.
Results
Prevalence rates of NCGS (0.5–13%) differed widely. Seventeen studies, including 1561 patients (26 children), met the inclusion criteria for NCGS. HLA haplotypes could not be linked to histology normal or lymphocytic enteritis (LE) in 1123 NCGS patients. HLADQ2/DQ8 haplotypes were present in 44% of NCGS patients. After advanced diagnostic techniques in 189 NCGS patients combining LE and HLADQ2/DQ8 haplotypes, 39 (20%) were reclassified as coeliac disease. There was a higher than expected family history of coeliac disease and autoimmune disorders in NCGS patients. A GFD resulted in variable results for variable, but significantly improved stool frequency in HLADQ2 positive diarrhoea‐predominant IBS patients.
Conclusions
Prevalence rates for NCGS are extremely variable. A subset of NCGS patients might belong in the so‐called ‘coeliac‐lite’ disease. The benefit of a GFD for NCGS patients is currently controversial. HLADQ2 positive diarrhoea‐type IBS patients might gain symptom improvement from a GFD.
Aliment Pharmacol Ther 2010; 32: 1392–1397
Summary
Background Lymphocytic duodenosis is defined by normal villous architecture and intraepithelial lymphocytes (IELs) >25 per 100 enterocytes. Such ...patients should not be diagnosed with coeliac disease, solely by histology, as previous retrospective studies have suggested other associations with lymphocytic duodenosis.
Aim To study prospectively the aetiology of lymphocytic duodenosis.
Methods One hundred patients with lymphocytic duodenosis were investigated rigorously for coeliac disease and other known associations for lymphocytic duodenosis by initial investigations of coeliac serology, and exclusion of infection. Of 34 with no explanation for lymphocytic duodenosis, 29 underwent repeat duodenal biopsies following a gluten challenge.
Results Coeliac disease was present in 16% of patients with lymphocytic duodenosis. In the absence of a positive coeliac diagnosis, lymphocytic duodenosis was most commonly associated with drugs (21%), infection (19%), immune dysregulation (4%), inflammatory bowel disease (2%), microscopic colitis (2%), sarcoidosis (1%) and IgA deficiency (1%). Of 34 with no known associations, 18 had symptoms of irritable bowel syndrome (IBS), and in 29 patients investigated with repeat duodenal biopsies, the IEL count returned to normal in 22.
Conclusions In 66% of cases of lymphocytic duodenosis, a known association can be found by further investigations; importantly, 16% will have coeliac disease. In those with no apparent cause, there may be an association with IBS and the IEL count becomes normal on repeat biopsy in 76%.
Summary
Background
Endoscopic balloon dilatation (EBD) is recognised treatment for symptomatic Crohn's strictures. Several case series report its efficacy. A systematic analysis for overall efficacy ...can inform the design of future studies.
Aim
To examine symptomatic (SR) and technical response (TR) and adverse events (AE) of EBD. Stricture characteristics were also explored.
Methods
A systematic search strategy of COCHRANE, MEDLINE and EMBASE was performed. All original studies reporting outcomes of EBD for Crohn's strictures were included. SR was defined as obstructive symptom‐free outcome at the end of follow‐up, TR as post‐dilatation passage of the endoscope through a stricture, and adverse event as the presence of complication (perforation and/or bleeding). Pooled event rates across studies were expressed with summative statistics.
Results
Twenty‐five studies included 1089 patients and 2664 dilatations. Pooled event rates for SR, TR, complications and perforations were 70.2% (95% CI: 60–78.8%), 90.6% (95% CI: 87.8–92.8%), 6.4% (95% CI: 5.0–8.2) and 3% (95% CI: 2.2–4.0%) respectively. Cumulative surgery rate at 5 year follow‐up was 75%. Pooled unweighted TR, SR, complication, perforation and surgery rates were 84%, 45%, 15%, 9% and 21% for de novo and 84%, 58%, 22%, 5% and 32% for anastomotic strictures. Outcomes between two stricture types were no different on subgroup meta‐analysis.
Conclusions
Efficacy and complication rates for endoscopic balloon dilatation were higher than previously reported. From the few studies with 5 year follow‐up the majority required surgery. Future studies are needed to determine whether endoscopic balloon dilatation has significant long‐term benefits.
Background
Paroxysmal gluten‐sensitive dyskinesia (PGSD) in border terriers (BTs) results from an immunologic response directed against transglutaminase (TG)2 and gliadin. Recent evidence suggests ...that PGSD is only one aspect of a range of possible manifestations of gluten sensitivity in the breed.
Hypothesis/Objectives
Gluten sensitivity in BTs is a heterogeneous disease process with a diverse clinical spectrum; to characterize the phenotype of PGSD using TG2 and gliadin autoantibodies as diagnostic markers.
Animals
One hundred twenty‐eight client‐owned BTs with various disorders.
Methods
Prospective study. BTs with paroxysmal episodes and a normal interictal examination were phenotyped using footage of a representative episode and assigned to 3 groups: idiopathic epilepsy (IE), paroxysmal dyskinesia (PD), or other. Owners of each dog completed a questionnaire to obtain information regarding clinical signs. Healthy BTs formed a control group. Serum antibodies against TG2 and AGA were measured in all dogs.
Results
One hundred twenty‐eight BTs were enrolled; 45 with PD, 28 with IE, 35 with other conditions, and 20 controls. Three overlapping phenotypes were identified; PD, signs suggestive of gastrointestinal disease, and dermatopathy. AGA‐IgG concentrations were increased in PD, compared with IE (P = 0.012), controls (P < 0.0001) and other (P = 0.018) conditions. Anti‐canine TG2‐IgA concentrations were increased in PD, compared with IE (P < 0.0001), controls (P < 0.0001) and other (P = 0.012) conditions. Serological markers are highly specific for PGSD but lack sensitivity.
Conclusions
PGSD appears part of a syndrome of gluten intolerance consisting of episodes of transient dyskinesia, signs suggestive of gastrointestinal disease, and dermatological hypersensitivity.
Post-gastrostomy complications range from 8 to 30%. These complications often occur following discharge into the community and may result in hospital readmission. Our unit previously reported a ...readmission rate of 23% in 6 months. There is a paucity of data evaluating community gastrostomy management. We therefore aimed to evaluate the benefits of a dedicated dietetic home enteral feed (HEF) team.
Demographic data, gastrostomy complications, readmission rates and HEF team input was prospectively collected from a cohort of discharged gastrostomy patients over a 1-year period and comparisons made with a similar historical cohort.
A total of 371 complications were encountered in 313 gastrostomy patients during this period, with the commonest complication being over-granulated stoma sites (27%). Of these, 227 hospital admissions were avoided because of direct actions taken by the HEF team. Fifty-nine gastrostomy patients were admitted to the hospital, of which only seven (12%) were specifically for gastrostomy-related problems. Introduction of the HEF team significantly reduced gastrostomy-related hospital readmissions from 23 to 2% (P = 0.0001).
Although patients with gastrostomies may need attention to a variety of complex medical problems, many encounter problems specifically related to their gastrostomy after discharge. This is the largest prospective study demonstrating how dietitians trained in gastrostomy aftercare may optimize the management of gastrostomy complications and reduce unnecessary hospital readmissions.
Background: High magnification chromoscopic colonoscopy (HMCC) permits the in vivo examination of the colorectal pit pattern, which has a high correlation with stereomicroscopic appearances of ...resected specimens. This new technology may provide an “optical biopsy” which can be used to aid diagnostic precision and guide therapeutic strategies. Conflicting data exist concerning the accuracy of this technique when discriminating neoplastic from non-neoplastic lesions, particularly when flat and depressed. Aim: To prospectively examine the efficacy of HMCC for the diagnosis of neoplasia in flat and depressed colorectal lesions using standardised morphological, pit pattern, and histopathological criteria. Clinical recommendations for the use of HMCC are made. Methods: Total colonoscopy was performed on 1850 patients by a single endoscopist from January 2001 to July 2003 using the C240Z magnifying colonoscope. Identified lesions were classed according to the Japanese Research Society guidelines, and pit pattern according to Kudos modified criteria. Pit pattern appearances were then compared with histopathology. Results: A total of 1008 flat lesions were identified. The sensitivity and specificity of HMCC in distinguishing non-neoplastic from neoplastic lesions were 98% and 92%, respectively. However, when using HMCC to differentiate neoplastic/non-invasive from neoplastic/invasive lesions, sensitivity was poor (50%) with a specificity of 98%. Diagnostic accuracy was not influenced by size or morphological classification of lesions. Conclusion: HMCC has a high overall accuracy at discriminating neoplastic from non-neoplastic lesions but is not 100% accurate. HMCC is a useful diagnostic tool in vivo but presently is not a replacement for histology. Requirements for further education and training in these techniques need to be addressed.
Aliment Pharmacol Ther 2011; 33: 689–696
Summary
Background Research suggests a positive association between coeliac disease and tuberculosis (TB), but that research has often been limited to ...in‐patients and small sample size. We examined the relationship between TB and coeliac disease.
Aim To examine the association of TB and coeliac disease.
Methods We collected biopsy data from all pathology departments in Sweden (n = 28) to identify individuals who were diagnosed with coeliac disease between 1969 and 2007 (Marsh 3: villous atrophy; n = 29 026 unique individuals). Population‐based sex‐ and age‐matched controls were selected from the Total Population Register. Using Cox regression, we calculated hazard ratios (HRs) for TB from data in the Swedish national health registers.
Results Individuals with coeliac disease were at increased risk of TB (HR = 2.0; 95% CI = 1.3–3.0) (during follow‐up, 31 individuals with coeliac disease and 74 reference individuals had a diagnosis of TB). The absolute risk of TB in patients with coeliac disease was 10/100 000 person‐years with an excess risk of 5/100 000. Risk estimates were the highest in the first year. Restricting our outcome to a diagnosis of TB confirmed by (I) a record of TB medication (HR = 2.9; 95% CI = 1.0–8.3), (II) data in the National Surveillance System for Infectious Diseases in Sweden (HR = 2.6; 95% CI = 1.3–5.2) or (III) positive TB cultivation (HR = 3.3; 95% CI = 1.6–6.8) increased risk estimates. The positive association between coeliac disease and TB was also observed before the coeliac disease diagnosis (odds ratio = 1.6; 95% CI = 1.2–2.1).
Conclusion We found a moderately increased risk of tuberculosis in patients with coeliac disease.
Historically, variable and transient sources have both surprised astronomers and provided new views of the heavens. Here we report the discovery of an optical transient in the outskirts of the ...lenticular galaxy Messier 85 in the Virgo cluster. With a peak absolute R magnitude of -12, this event is distinctly brighter than novae, but fainter than type Ia supernovae (which are expected in a population of old stars in lenticular galaxies). Archival images of the field do not show a luminous star at that position with an upper limit in the g filter of about -4.1 mag, so it is unlikely to be a giant eruption from a luminous blue variable star. Over a two-month period, the transient source emitted radiation energy of almost 1047 erg and subsequently faded in the optical sky. It is similar to, but six times more luminous at peak than, an enigmatic transient in the galaxy M31 (ref. 1). A possible origin of M85 OT2006-1 is a stellar merger. If so, searches for similar events in nearby galaxies will not only allow study of the physics of hyper-Eddington sources, but also probe an important phase in the evolution of stellar binary systems.
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