Introduction
Appendicectomy may reduce relapses and need for medication in patients with ulcerative colitis, but long‐term prospective data are lacking. This study aimed to analyse the effect of ...appendicectomy in patients with refractory ulcerative colitis.
Methods
In this prospective multicentre cohort series, all consecutive patients with refractory ulcerative colitis referred for proctocolectomy between November 2012 and June 2015 were counselled to undergo laparoscopic appendicectomy instead. The primary endpoint was clinical response (reduction of at least 3 points in the partial Mayo score) at 12 months and long‐term follow‐up. Secondary endpoints included endoscopic remission (endoscopic Mayo score of 1 or less), failure (colectomy or start of experimental medication), and changes in Inflammatory Bowel Disease Questionnaire (IBDQ) (range 32–224), EQ‐5D™ and EORTC‐QLQ‐C30‐QL scores.
Results
A total of 28 patients (13 women; median age 40·5 years) underwent appendicectomy. The mean baseline IBDQ score was 127·0, the EQ‐5D™ score was 0·65, and the EORTC‐QLQ‐C30‐QL score was 41·1. At 12 months, 13 patients had a clinical response, five were in endoscopic remission, and nine required a colectomy (6 patients) or started new experimental medical therapy (3). IBDQ, EQ‐5D™ and EORTC‐QLQ‐C30‐QL scores improved to 167·1 (P < 0·001), 0·80 (P = 0·003) and 61·0 (P < 0·001) respectively. After a median of 3·7 (range 2·3–5·2) years, a further four patients required a colectomy (2) or new experimental medical therapy (2). Thirteen patients had a clinical response and seven were in endoscopic remission. The improvement in IBDQ, EQ‐5D™ and the EORTC‐QLQ‐C30‐QL scores remained stable over time.
Conclusion
Appendicectomy resulted in a clinical response in nearly half of patients with refractory ulcerative colitis and a substantial proportion were in endoscopic remission. Elective appendicectomy should be considered before proctocolectomy in patients with therapy‐refractory ulcerative colitis.
Antecedentes
La apendicectomía puede reducir las recaídas y la necesidad de medicación en pacientes con colitis ulcerosa (ulcerative colitis, UC), sin embargo, faltan datos a largo plazo obtenidos de forma prospectiva. El objetivo de este estudio fue analizar el efecto de la apendicectomía en pacientes con UC refractarios al tratamiento.
Métodos
En esta serie prospectiva de cohortes multicéntrica, a todos los pacientes consecutivos con UC refractaria remitidos para proctocolectomía entre noviembre de 2012 y junio de 2015 se les recomendó en su lugar someterse a una apendicectomía laparoscópica. El criterio de valoración principal fue la respuesta clínica (disminución de ≥ 3 puntos del sistema de puntuación parcial de Mayo que varía de 0 a 9) a los 12 meses y en el seguimiento a largo plazo. Los criterios de valoración secundarios incluyeron la remisión endoscópica (puntuación endoscópica de Mayo ≤ 1), fracaso (colectomía o inicio de medicación experimental) y cambios en el IBDQ (rango 32‐224), EQ‐5D y EORTC‐QLQ‐C30‐QL.
Resultados
En total, 28 pacientes (13 mujeres, mediana de edad 40,5) se sometieron a una apendicectomía. El IBDQ de referencia promedio fue de 127,0; el EQ‐5D 0,65 y el EORTC‐QLQ‐C30‐QL 41,1. A los 12 meses, 13 pacientes presentaban una respuesta clínica, cinco estaban en remisión endoscópica y nueve precisaron colectomía (n = 6) o un nuevo tratamiento médico experimental (n = 3). El IBDQ, EQ‐5D y EORTC‐QLQ‐C30‐QL mejoraron a 167,1 (P < 0,001); 0,80 (P = 0,003) y 61,0 (P < 0,001) respectivamente. Después de una mediana de 3,7 años (rango 2,3‐5,2), otros cuatro pacientes requirieron una colectomía (n = 2) o un nuevo tratamiento médico experimental (n = 2). Trece pacientes presentaron respuesta clínica y siete se encontraban en remisión endoscópica. La mejora del IBDQ, el EQ‐5D y el EORTC‐QLQ‐C30‐QL se mantuvo estable a lo largo del tiempo.
Conclusión
La apendicectomía consiguió una respuesta clínica en casi la mitad de los pacientes con UC refractaria. La apendicectomía electiva debería ser considerada antes que la proctocolectomía en pacientes con UC refractaria al tratamiento.
Appendicectomy may reduce relapses and need for medication in patients with ulcerative colitis, but long‐term prospective data are lacking. In this study, appendicectomy resulted in a clinical response in 13 of 28 patients with therapy‐refractory ulcerative colitis and a substantial proportion were in endoscopic remission. Elective appendicectomy should therefore be considered before proctocolectomy in these patients.
Has promise
MicroRNAs (miRNAs) regulate the biological properties of colorectal cancer (CRC) cells and might serve as potential prognostic factors and therapeutic targets. In this study, we therefore globally ...profiled miRNAs associated with E-cadherin expression in CRC cells in an attempt to identify miRNAs that are associated with aggressive clinical course in CRC patients.
Two CRC cell lines (Caco-2 and HRT-18) with different E-cadherin expression pattern were profiled for differences in abundance for more than 1000 human miRNAs using microarray technology. One of the most differentially expressed miRNAs, miR-200a was evaluated for its prognostic role in a cohort of 111 patients and independently validated in 217 patients of the Cancer Genome Atlas data set. To further characterise the biological role of miR-200a expression in CRC, in vitro miR-200a inhibition and overexpression were performed and the effects on cellular growth, apoptosis and epithelial-mesenchymal transition (EMT)-related gene expression were explored.
In situ hybridisation specifically localised miR-200a in CRC cells. In both cohorts, a low miR-200a expression was associated with poor survival (P<0.05). Multivariate Cox regression analysis identified low levels of miR-200a expression as an independent prognostic factor with respect to cancer-specific survival (HR=2.04, CI=1.28-3.25, P<0.002). Gain and loss of function assays for miR-200a in vitro led to a significantly differential and converse expression of EMT-related genes (P<0.001.) A low expression of miR-200a was also observed in cancer stem cell-enriched spheroid growth conditions (P<0.05).
In conclusion, our data suggest that low miR-200a expression is associated with poor prognosis in CRC patients. MiR-200a has a regulatory effect on EMT and is associated with cancer stem cell properties in CRC.
Aim
The goal of this European Society of Coloproctology (ESCP) guideline project is to give an overview of the existing evidence on the management of diverticular disease, primarily as a guidance to ...surgeons.
Methods
The guideline was developed during several working phases including three voting rounds and one consensus meeting. The two project leads (JKS and EA) appointed by the ESCP guideline committee together with one member of the guideline committee (WB) agreed on the methodology, decided on six themes for working groups (WGs) and drafted a list of research questions. Senior WG members, mostly colorectal surgeons within the ESCP, were invited based on publication records and geographical aspects. Other specialties were included in the WGs where relevant. In addition, one trainee or PhD fellow was invited in each WG. All six WGs revised the research questions if necessary, did a literature search, created evidence tables where feasible, and drafted supporting text to each research question and statement. The text and statement proposals from each WG were arranged as one document by the first and last authors before online voting by all authors in two rounds. For the second voting ESCP national representatives were also invited. More than 90% agreement was considered a consensus. The final phrasing of the statements with < 90% agreement was discussed in a consensus meeting at the ESCP annual meeting in Vienna in September 2019. Thereafter, the first and the last author drafted the final text of the guideline and circulated it for final approval and for a third and final online voting of rephrased statements.
Results
This guideline contains 38 evidence based consensus statements on the management of diverticular disease.
Conclusion
This international, multidisciplinary guideline provides an up to date summary of the current knowledge of the management of diverticular disease as a guidance for clinicians and patients.
Estimates based on the strength, size, and shape of the Atlantic razor clam (Ensis directus) indicate that the animal's burrow depth should be physically limited to a few centimeters; yet razor clams ...can dig as deep as 70 cm. By measuring soil deformations around burrowing E. directus, we have found the animal reduces drag by contracting its valves to initially fail, and then fluidize, the surrounding substrate. The characteristic contraction time to achieve fluidization can be calculated directly from soil properties. The geometry of the fluidized zone is dictated by two commonly-measured geotechnical parameters: coefficient of lateral earth pressure and friction angle. Calculations using full ranges for both parameters indicate that the fluidized zone is a local effect, occurring between 1-5 body radii away from the animal. The energy associated with motion through fluidized substrate-characterized by a depth-independent density and viscosity-scales linearly with depth. In contrast, moving through static soil requires energy that scales with depth squared. For E. directus, this translates to a 10X reduction in the energy required to reach observed burrow depths. For engineers, localized fluidization offers a mechanically simple and purely kinematic method to dramatically reduce energy costs associated with digging. This concept is demonstrated with RoboClam, an E. directus-inspired robot. Using a genetic algorithm to find optimal digging kinematics, RoboClam has achieved localized fluidization burrowing performance comparable to that of the animal, with a linear energy-depth relationship, in both idealized granular glass beads and E. directus' native cohesive mudflat habitat.
Photoplethysmography (PPG) in wearable sensors potentially plays an important role in accessible heart rhythm monitoring. We investigated the accuracy of a state-of-the-art bracelet (Corsano 287) for ...heartbeat detection in cardiac patients and evaluated the efficacy of a signal qualifier in identifying medically useful signals.
Patients from an outpatient cardiology clinic underwent a simultaneous resting ECG and PPG recording, which we compared to determine accuracy of the PPG sensor for detecting heartbeats within 100 and 50 ms of the ECG-detected heart beats and correlation and Limits of Agreement for heartrate (HR) and RR-intervals. We defined subgroups for skin type, hair density, age, BMI and gender and applied a previously described signal qualifier.
In 180 patients 7914 ECG-, and 7880 (99%) PPG-heartbeats were recorded. The PPG-accuracy within 100 ms was 94.6% (95% CI 94.1–95.1) and 89.2% (95% CI 88.5–89.9) within 50 ms. Correlation was high for HR (R = 0.991 (95% CI 0.988–0.993), n = 180) and RR-intervals (R = 0.891 (95% CI 0.886–0.895), n = 7880). The 95% Limits of Agreement (LoA) were −3.89 to 3.77 (mean bias 0.06) beats per minute for HR and −173 to 171 (mean bias −1) for RR-intervals. Results were comparable across all subgroups. The signal qualifier led to a higher accuracy in a 100 ms range (98.2% (95% CI 97.9–98.5)) (n = 143).
We showed that the Corsano 287 Bracelet with PPG-technology can determine HR and RR-intervals with high accuracy in cardiovascular at-risk patient population among different subgroups, especially with a signal quality indicator.
Reviews on Down syndrome do not or only marginally address the issue of kidney and urogenital tract abnormalities, and lower urinary tract dysfunctions. Hence, we performed a meta-analysis of the ...literature. METHODS: A literature search was undertaken in the Library of Medicine, Web of Science and Excerpta Medica. The search algorithm combined various keywords: (Down syndrome OR trisomy 21 OR mongolism) AND (kidney OR urinary tract OR bladder) AND (malformation OR dysfunction OR anomaly OR abnormality OR size). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used.
Eight case-control studies were retained for the final analysis. Three studies addressed the prevalence of kidney and urogenital tract abnormalities: an increased pooled relative risk of 5.49 (95%-CI: 1.78-16.93) was observed in Down syndrome. Penile malformations, obstructive malformations (including urethral valves), dilated urinary tract system, and kidney hypodysplasia were especially common. Three reports addressed the prevalence of lower urinary tract dysfunction: an increased pooled relative risk of 2.95 (95%-CI: 1.15-7.56) was observed. Finally, an autoptic study and an ultrasound study disclosed a reduced kidney size in Down syndrome.
This meta-analysis indicates that abnormalities of the kidney and urogenital tract, lower urinary tract dysfunctions, and a reduced kidney size present with an increased frequency in individuals with Down syndrome.
Abstract
Commercial exploitation often impacts the life-history parameters of iteroparous and semelparous fishes, and prolonged fishing pressure may lead to fisheries-induced evolution. However, ...information is lacking on how fishing exploitation affects short-lived semelparous cephalopods. This study examines the impact of heavy commercial fishing on Illex argentinus and Doryteuthis gahi, two annual squid species around the Falkland Islands in the Southwest Atlantic. Changes in two life-history parameters; size at recruitment and size at maturity, were standardized for sea temperature and analysed in relation to relative biomass indices over 34 years for I. argentinus and 31 years for D. gahi. For both squid species, correlations of these life-history parameters were observed with biomass and temperature, but size at recruitment and size at maturity did not change significantly over the extended periods of their commercial exploitation. Sizes at recruitment and maturity of these short-lived squid appear to remain stable in absence of size selection in their respective fisheries. Both jigs and trawls capture the entire size ranges of squid recruited to the fishing grounds, thus avoiding direct fisheries-induced selection on their size-dependent life-history parameters. With only one cohort/generation at a time present during growth-phase fishery, both squid species studied seem to be more resilient to fisheries-induced changes in sizes at recruitment and maturity than short-lived semelparous fish and squid subjected to terminal fisheries. Instead, these size-dependent life-history traits of squid fished during their growth phase are mainly driven by short-term changes in population density and environment, including ambient temperature.
Introduction
Ambulatory assessment of the heart rate–corrected QT interval (QTc) can be of diagnostic value, for example in patients on QTc-prolonging medication. Repeating sequential 12-lead ...electrocardiograms (ECGs) to monitor the QTc is cumbersome, but mobile ECG (mECG) devices can potentially solve this problem. As the accuracy of single-lead mECG devices is reportedly variable, a multilead mECG device may be more accurate.
Methods
This prospective dual-centre study included outpatients visiting our cardiology clinics for any indication. Participants underwent an mECG recording using a smartphone-enabled 6‑lead mECG device immediately before or immediately after a conventional 12-lead ECG recording. Multiple QTc values in both recordings were manually measured in leads I and II using the tangent method and subsequently compared.
Results
In total, 234 subjects were included (mean ± standard deviation (SD) age: 57 ± 17 years; 58% males), of whom 133 (57%) had cardiac disease. QTc measurement in any lead was impossible due to artefacts in 16 mECGs (7%) and no 12-lead ECGs. Mean (± SD) QTc in lead II on the mECG and 12-lead ECG was 401 ± 30 and 406 ± 31 ms, respectively. Mean (± SD) absolute difference in QTc values between both modalities was 12 ± 9 ms (r = 0.856;
p
< 0.001). In 55% of the subjects, the absolute difference between QTc values was < 10 ms.
Conclusion
A 6-lead mECG allows for QTc assessment with good accuracy and can be used safely in ambulatory QTc monitoring. This may improve patient satisfaction and reduce healthcare costs.
In this review we discuss skeletal adaptations to the demanding situation of pregnancy and lactation. Calcium demands are increased during pregnancy and lactation, and this is effectuated by a ...complex series of hormonal changes. The changes in bone structure at the tissue and whole bone level observed during pregnancy and lactation appear to largely recover over time. The magnitude of the changes observed during lactation may relate to the volume and duration of breastfeeding and return to regular menses. Studies examining long-term consequences of pregnancy and lactation suggest that there are small, site-specific benefits to bone density and that bone geometry may also be affected. Pregnancy- and lactation-induced osteoporosis (PLO) is a rare disease for which the pathophysiological mechanism is as yet incompletely known; here, we discuss and speculate on the possible roles of genetics, oxytocin, sympathetic tone and bone marrow fat. Finally, we discuss fracture healing during pregnancy and lactation and the effects of estrogen on this process.
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