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Diabetes can lead to a myriad of microvascular and macrovascular complications – with the leading cause of mortality in diabetes being cardiovascular disease. Low‐density lipoprotein cholesterol, along with non‐high‐density lipoprotein cholesterol and triglycerides are proven, modifiable risk factors for cardiovascular disease. This article will focus on lipid‐lowering agents in individuals with diabetes. It will summarise relevant changes in the latest guidelines for dyslipidaemia and will also review the mechanisms of action of lipid‐lowering agents along with the latest cardiovascular outcomes data specific to individuals with diabetes. Older agents such as statins, ezetimibe, fibrates and nicotinic acid will be reviewed with a focus on new diabetes‐specific evidence. Similarly, a relatively novel agent proprotein‐convertase subtilisin‐kexin type 9 will be reviewed and details around the Pharmaceutical Benefits Scheme criteria governing its usage in Australia will be reported. Finally, this review will touch on agents still on the horizon such as icosapent ethyl, high‐density lipoprotein mimetics, bempedoic acid, omega‐3 free fatty acids, bromodomain and extra‐terminal protein inhibitors and inclisiran – a long‐acting ribonucleic acid interference agent. In the appropriately selected population of individuals with diabetes, these agents can assist to improve further lipid profile and reduce cardiovascular events. [ABSTRACT FROM AUTHOR]

This paper is concerned with effects that arise from the electric charge on the surface of porous colloidal particles. When an external disturbance is applied, for example a change in the concentration of the surrounding electrolyte or an applied electric field, a complicated interaction ensues between the electric field, the liquid pressure field and the ion concentration fields in these particles. In this paper we derive the governing equations for these electrokinetic interactions for a general pore geometry and particle shape, and we present a procedure for solving these equations in the case of a general binary electrolyte. As an illustration, we obtain a new result: a formula for the complex electrical conductivity spectrum of a dilute suspension of porous spheres. [ABSTRACT FROM AUTHOR]

Imidazolium-based ionic liquids have been extensively studied for their ability to dissolve a wide variety of gases and for their potential to be used as separation agents in industrial processes. For many short chain 1-alkyl-3-methylimidazolium bistriflimde salts, CO2 and N2O solublities are very similar. In this work, the solubility of CO2 and N2O has been measured in the lipidic ionic liquid 1-methyl-3-(Z-octadec-9-enyl)imidazolium bistriflimide ([oleyl-mim][NTf2]) at 298 K, 310 and 323 K up to ∼2 MPa. N2O was found to have higher solubility than CO2 under the same conditions, similar to the behavior observed when olive oil, a natural lipid, was the liquid solvent. However, the solubility of each gas on a mole fraction basis is lower in the ionic liquid than in olive oil. Comparison of the gas solubilities on a mass fraction basis demonstrates that CO2 solubility is nearly identical in both liquids; N2O solubility is higher than CO2 for both liquids, but more so in the olive oil. The difference is attributed to the high mass fraction of the olive oil that is lipid-like in character. The differential solubility of N2O/CO2 in this ionic liquid, in contrast to that of shorter chain 1-alkyl-3-methylimidazolium bistriflimide salts, gives physical insight into the solvent properties of this class of ionic liquids and provides further support for their lipid-like character. [ABSTRACT FROM AUTHOR]

We demonstrate herein a facile synthesis of a series of highly-ordered low-melting protic ionic liquids with linear C16–C20 side chains identical to natural fatty acids, which were produced by the S-alkylation of the 2-mercapto-1-methylimidazole (methimazole) ring. There is considerable structural latitude possible when designing highly lipophilic protic ionic liquids that exhibit low Tm values due to the cumulative disruptive effects of thioether and unsaturation on their packing efficiency. Their bulk thermophysical properties, hydrophobicity and cytotoxicity were also determined. [ABSTRACT FROM AUTHOR]

A personal narrative is presented which discusses the author's experience of archaeological finding of bannerstone.

The application of a new class of alkylammonium salts as phase-transfer catalysts was investigated. These salts are tetra(4-thiaalkyl) ammonium bromides, and the key questions of the study focus on how the incorporation of a sulfur atom in the alkyl chains affects the efficacy of the salts as phase-transfer catalysts. Employing the nucleophilic substitution of cyanide for bromide on 1-bromopentane as a model reaction, reaction rate constants and activation energies are evaluated. The kinetic parameters obtained using the tetrathiaalkylammonium salts are compared to those obtained using their tetraalkylammonium analogs. The general trend is that the presence of sulfur in the alkyl chains reduces the reaction rates and increases activation energies. This trend is analyzed both in terms of computational modeling and experimental distribution coefficients to determine the cause of the slower reaction rates. Thiaquats are shown to distribute more into the aqueous phase than traditional quat salts of similar chain length, resulting in lower organic phase concentrations. Quantum calculations indicate stronger ion pairing for the thiaquats, increasing activation energies and slowing reaction rates. Thus, differences in rate enhancements are attributable both to phase distribution and ion pairing effects. [ABSTRACT FROM AUTHOR]

The synthesis of a series of new lipid-inspired ionic liquids through thiol-ene 'click' reaction with a single-step process. This synthesis offers considerable promise as an efficient and orthogonal method to construct structurally diverse imidazolium-type ionic liquids with linear and branched cationic tails, as well as versatility in the placement of the sulfur heteroatom. Profound solvent effect in this ene reaction regioselectivity has been observed. [ABSTRACT FROM AUTHOR]

The article explores the legalities of ombudsman in Great Britain. It highlights the role of the ombudsman in identifying complaints against legal service providers. It points out that the decisions of the ombudsman are final and binding and unappealable while giving the judicial review a challenge. An overview of how the Legal Ombudsman scheme was crafted under the Part 6 of the Legal Services Act 2007 is also offered.

Highlights: [•] We test recent proposals that an uncharged particle can have a non-zero electrophoretic mobility. [•] We show that a steady mobility is impossible because of charge polarisation at the interface. [•] Although motion is possible in an ac field, we show that the uncharged theory does not fit experimental data. [•] Thus the uncharged mobility hypothesis cannot account for standard electrophoresis observations. [ABSTRACT FROM AUTHOR]

The article discusses Great Britain court case R (Emptage) v Financial Services Compensation Scheme (FSCS) which deals with the limitations of judicial deference to regulatory bodies decisions. It states that Charmaine Emptage, owner of a property, sought judicial review of the decision of FSCS, claiming that the FSCS had acted irrationally and misdirected when assessing fair compensation.

An obituary for neurologist Park Spearin is presented.

The Catholic Church proscribes methods of birth control other than sexual abstinence. Although the U.S. Food and Drug Administration (FDA) recognizes abstinence as an acceptable method of birth control in research studies, some pharmaceutical companies mandate the use of artificial contraceptive techniques to avoid pregnancy as a condition for participation in their studies. These requirements are unacceptable at Catholic health care institutions, leading to conflicts among institutional review boards, clinical investigators, and sponsors. Subjects may feel coerced by such mandates to adopt contraceptive techniques inconsistent with their personal situation and beliefs; women committed to celibacy or who engage exclusively in non-heterosexual activities are negatively impacted. We propose principles to insure informed consent to safeguard the rights of research subjects at Catholic institutions while mitigating this ethical conflict. At the same time, our proposal respects the interests of pharmaceutical research agencies and Catholic moral precepts, and fully abides by regulatory guidance. [ABSTRACT FROM AUTHOR]

Abstract: In this paper we set out the mathematical problem for calculating the sound waves generated by a MHz voltage – the ESA effect – for a saturated filtration membrane. Three asymptotic solutions are derived, to help build up an understanding of the physical processes involved, and these solutions are then compared with numerical solutions to the full problem. We illustrate the effect of various parameters on the ESA spectra and discuss the problem of extracting membrane properties from ESA measurements. [Copyright &y& Elsevier]

Alzheimer's disease (AD), the leading cause of dementia worldwide, is characterized by the accumulation of the ββ-amyloid peptide (Aββ) within the brain along with hyperphosphorylated and cleaved forms of the microtubule-associated protein tau. Genetic, biochemical, and behavioral research suggest that physiologic generation of the neurotoxic Aββ peptide from sequential amyloid precursor protein (APP) proteolysis is the crucial step in the development of AD. APP is a single-pass transmembrane protein expressed at high levels in the brain and metabolized in a rapid and highly complex fashion by a series of sequential proteases, including the intramembranous γγ-secretase complex, which also process other key regulatory molecules. Why Aββ accumulates in the brains of elderly individuals is unclear but could relate to changes in APP metabolism or Aββ elimination. Lessons learned from biochemical and genetic studies of APP processing will be crucial to the development of therapeutic targets to treat AD. [ABSTRACT FROM AUTHOR]

Several letters to the editor on the Expanding Medical and Behavioral Resources with Access to Care for Everyone (EMBRACE) health care reform plan that was published in a previous issue are presented.

The Baltimore Longitudinal Study of Aging (BLSA) was established in 1958 and is one the oldest prospective studies of aging in the USA and the world. The BLSA is supported by the National Institute of Aging (NIA) and its mission is to learn what happens to people as they get old and how to sort out changes due to aging from those due to disease or other causes. In 1986, an autopsy program combined with comprehensive neurologic and cognitive evaluations was established in collaboration with the Johns Hopkins University Alzheimer's Disease Research Center (ADRC). Since then, 211 subjects have undergone autopsy. Here we review the key clinical neuropathological correlations from this autopsy series. The focus is on the morphological and biochemical changes that occur in normal aging, and the early neuropathological changes of neurodegenerative diseases, especially Alzheimer's disease (AD). We highlight the combined clinical, pathologic, morphometric, and biochemical evidence of asymptomatic AD, a state characterized by normal clinical evaluations in subjects with abundant AD pathology. We conclude that in some individuals, successful cognitive aging results from compensatory mechanisms that occur at the neuronal level (i.e., neuronal hypertrophy and synaptic plasticity) whereas a failure of compensation may culminate in disease. [ABSTRACT FROM AUTHOR]

Glucose-6-phosphatase catalyzes the hydrolysis of glucose 6-phosphate (G6P) to glucose and inorganic phosphate. It is a multicomponent system located in the endoplasmic reticulum that comprises several integral membrane proteins, namely a catalytic subunit (G6PC) and transporters for G6P, inorganic phosphate, and glucose. The G6PC gene family contains three members, designated G6PC, G6PC2, and G6PC3. The tissuespecific expression patterns of these genes differ, and mutations in all three genes have been linked to distinct diseases in humans. This minireview discusses the disease association and transcriptional regulation of the G6PC genes as well as the biological functions of the encoded proteins. [ABSTRACT FROM AUTHOR]

OBJECTIVE- We explored whether cardiovascular disease (CVD) risk and the effects of fenofibrate differed in subjects with and without metabolic syndrome and according to various features of metabolic syndrome defined by the Adult Treatment Panel III (ATP III) in subjects with type 2 diabetes in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. RESEARCH DESIGN AND METHODS-- The prevalence of metabolic syndrome and its features was calculated. Cox proportional models adjusted for age, sex, CVD status, and baseline A1C levels were used to determine the independent contributions of metabolic syndrome features to total CVD event rates and the effects of fenofibrate. RESULTS-- More than 80% of FIELD participants met the ATP III criteria for metabolic syndrome. Each ATP III feature of metabolic syndrome, apart from increased waist circumference, increased the absolute risk of CVD events over 5 years by at least 3%. Those with marked dyslipidemia (elevated triglycerides ≥2.3 mmol/l and low HDL cholesterol) were at the highest risk of CVD (17.8% over 5 years). Fenofibrate significantly reduced CVD events in those with low HDL cholesterol or hypertension. The largest effect of fenofibrate to reduce CVD risk was observed in subjects with marked dyslipidemia in whom a 27% relative risk reduction (95% CI 9-42, P = 0.005; number needed to treat = 23) was observed. Subjects with no prior CVD had greater risk reductions than the entire group. CONCLUSIONS -- Metabolic syndrome components identify higher CVD risk in individuals with type 2 diabetes, so the absolute benefits of fenofibrate are likely to be greater when metabolic syndrome features are present. The highest risk and greatest benefits of fenofibrate are seen among those with marked hyper triglyceridemia. [ABSTRACT FROM AUTHOR]

To investigate the relation between the loss of substantia nigra (SN) neurons in normal ageing and Parkinson’s disease (PD), we measured the total number and the cell body volume of pigmented (neuromelanin) neurons in the SN. We examined young ( n = 7, mean age: 19.9), middle-aged ( n = 9, mean age: 50.1), and older controls from the Baltimore Longitudinal Study of Aging ( n = 7, mean age: 87.6), as well as PD cases ( n = 8, mean age: 74.8). On random-systematically selected paraffin Nissl-stained sections, we used the Optical Fractionator to estimate the total number of neurons on one side of the SN. Using the Nucleator probe, we measured the volume of these neurons. In young and older controls, we also estimated the total number and volume of tyrosine hydroxylase (TH) positive (+) nigral neurons. We observed a significant loss of pigmented (-28.3%, P < 0.01) and TH (+) (−36.2%, P < 0.001) neurons in older controls compared with younger subjects. Analysis of the size distribution of pigmented and TH (+) neurons showed a significant hypertrophy in older controls compared to young controls ( P < 0.01). In contrast, in PD we observed a significant atrophy of pigmented neurons compared to all control groups ( P < 0.01). These data suggest that neuronal hypertrophy represents a compensatory mechanism within individual SN neurons that allows for normal motor function despite the loss of neurons in normal ageing. Presumably, this compensatory mechanism breaks down or is overwhelmed by the pathological events of PD leading to the onset of the characteristic motor disturbances. [ABSTRACT FROM AUTHOR]

The article presents an epidemiology research into the prevalence and incidence of tuberculosis and human immunodeficiency virus (HIV) comorbidity in the U.S. in the period 1993-2004. An analysis was made of incident tuberculosis cases that were reported to the Centers for Disease Control and Prevention's national public health surveillance system from fifty states and Washington, D.C. The highest comorbidity rates were evident in non-Hispanic blacks, males, U.S.-born individuals, and persons aged 25 to 44 years.

The authors discuss a new study, which they say is a valuable addition to the existing literature on the performance of interferon gamma release assays in serial testing for TB infection. [ABSTRACT FROM AUTHOR]

SUMMARY 1. The aim of the present study was to determine whether anti-oxidant therapy with vitamin E and/or cholesterol-lowering therapy with simvastatin would augment resting forearm blood flow (FBF) and metabolic vasodilation in response to exercise and improve endothelial function in young patients with hypercholesterolaemia. 2. Endothelium-dependent and -independent, nitric oxide (NO)-mediated vasodilation have been shown to be impaired in young, otherwise healthy subjects with hypercholesterolaemia. Recent experimental and clinical studies suggest that vascular function may be improved with anti-oxidant or cholesterol- lowering therapy, although these treatments may be synergistic. 3. We compared FBF at rest, in response to isotonic exercise, the endothelium-dependent vasodilator acetylcholine (ACh), the endothelium-independent vasodilator sodium nitroprusside (SNP) and the NO synthase inhibitor NG-monomethyl-L-arginine (L-NMMA) in 26 young, otherwise healthy volunteers (mean (±SD) age 29±7 years; 14 female, 12 male) with hypercholesterolaemia, before and after 6 months treatment with vitamin E, simvastatin and/or placebo. Treatment was randomized, double-blinded in a 2 × 2 factorial design. Forearm blood flow was measured using venous occlusion plethysmography. 4. Vitamin E therapy increased plasma α-tocopherol from 39.5±9.6 to 75.7±33.8 μmol/L (P < 0.001). Simvastatin reduced total cholesterol from 6.9±1.7 to 4.9±0.8 mmol/L and low- density lipoprotein (LDL) from 4.8±1.7 to 3.0±0.7 mmol/L (both P < 0.001), although total and LDL–cholesterol also decreased slightly in the placebo group. Vitamin E increased resting FBF from 2.1±0.3 to 2.4±0.3 mL/100 mL per min (P = 0.04) and decreased resting forearm vascular resistance from 42.1±4.2 to 36.1±3.4 units (P = 0.01), but the reduction in resting FBF with L-NMMA was not affected. Vasodilation in response to isotonic exercise, ACh and SNP was similar before and after treatment in the placebo, vitamin E, simvastatin and in the combined vitamin E–simvastatin groups. NG-Monomethyl-L-arginine infusion reduced resting FBF and functional hyperaemia in response to exercise and these responses were not altered by treatment. 5. These data suggest that while vitamin E therapy augments resting FBF and reduces forearm vascular resistance in young hypercholesterolaemic subjects, these effects may not be via NO-dependent pathways. Metabolic vasodilation and responses to the NO-mediated vasodilators ACh and SNP were not favourably affected by anti-oxidant or cholesterol-lowering therapy, either alone or in combination. [ABSTRACT FROM AUTHOR]

G6PC2 encodes a glucose-6-phosphatase catalytic subunit that opposes the action of glucokinase in pancreatic islets, thereby modulating the sensitivity of insulin and glucagon secretion to glucose. In mice, G6pc2 is expressed at ~20-fold higher levels in ß-cells than in a-cells, whereas in humans G6PC2 is expressed at only ~5-fold higher levels in ß-cells. We therefore hypothesize that G6PC2 likely influences glucagon secretion to a greater degree in humans. With a view to generating a humanized mouse that recapitulates augmented G6PC2 expression levels in a-cells, we sought to identify the genomic regions that confer differential mouse G6pc2 expression in a-cells versus ß-cells as well as the evolutionary changes that have altered this ratio in humans. Studies in islet-derived cell lines suggest that the elevated G6pc2 expression in mouse ß-cells versus a-cells is mainly due to a difference in the relative activity of the proximal G6pc2 promoter in these cell types. Similarly, the smaller difference in G6PC2 expression between a-cells and ß-cells in humans is potentially explained by a change in relative proximal G6PC2 promoter activity. However, we show that both glucocorticoid levels and multiple differences in the relative activity of eight transcriptional enhancers between mice and humans likely contribute to differential G6PC2 expression. Finally, we show that a mouse-specific non-coding RNA, Gm13613, whose expression is controlled by G6pc2 enhancer I, does not regulate G6pc2 expression, indicating that altered expression of Gm13613 in a humanized mouse that contains both the human promoter and enhancers should not affect G6PC2 function. [ABSTRACT FROM AUTHOR]

Evaluates the efficiency of organizational behavior management in improving the performance of employees in mental institutions. Presentation of the sample, training program and feedback involved in the research; Impact of behavioral management on the performance of patients and care-givers; Factors to be considered in ensuring goal progress.

Identifies a synaptic PDZ domain-containing protein glutamate receptor interacting protein (GRIP) that specifically interacts with the C termini of AMPA glutamate receptors. The ability of GRIP to serve as an adapter protein that links AMPA receptors to other proteins; The possible role in the clustering of AMPA receptors at excitatory synapses in the brain.

One of two little league baseball teams, consisting of boys between the ages of 8 and 12, was taught to hit a baseball using a chaining-mastery program extrapolated from the "Total Golf" (Simek & O'Brien, 1981) program. Following two baseline games and a baseline measurement session, 10 of the 12 boys on the experimental team participated in a chaining-mastery batting program, beginning with slow pitches from close to the batter and progressing to normal speed pitches from the regulation distance. Both game performance and a repeat of the baseline measures following Game 6 showed large increases in the number of hits. The control team showed no such increases. Following Game 6, a program of discrimination training for hitable balls (strikes) was instituted with the experimental team using a mastery approach to produce earlier discriminations of strikes from balls. Number of bases on balls increased for Games 7 through 10 after remaining stable for the first 6 games. For the control team, bases on balls increased during Games 3 through 6, but remained stable for Games 7 through 10. Batting averages revealed similar improvement for the experimental team from a baseline of .250 to .342 for Games 3 through 6, and .369 for Games 7 through 10, and no improvement for the control team (baseline = .281, Games 3 through 6 = .230, Games 7 through 10 = .230). Two members of the experimental team rejected the chaining-discrimination training program in favor of practice in "guided positive fantasy" for batting skills, which was provided by the father of one of the boys. These two boys showed little improvement on the dependent measures. The results suggest that a program of chaining-mastery instruction for batting and discrimination training for pitch selection can be effective in teaching little leaguers to hit. [ABSTRACT FROM AUTHOR]

Focuses on the regulation of gene transcription by insulin. Identification of positive and negative insulin response sequences; Mechanism of insulin action on gene transcription;Insulin-regulated messenger ribonucleic acid stability and translation; Role of carbohydrates and other metabolite in insulin-regulated gene expression.

Examines the effectiveness of behavioral contracting and chaining in improving the performance of a college golf team. Use of behavioral contracting to increase practice time and adherence to a specific training program; Study of 14 college golfers who were placed under successive contingency contracts to go through a chaining-mastery program.

Describes a competitive program of feedback and positive reinforcement designed to increase service quality at an internationally known package delivery company using a baseball analog system. Number of boxes loaded per single missort; Load quality rating; Load retaining percentage.

Presents a study made on the correlation between self-reported levels of burnout and measures of staff activity and behavioral effects of burnout. Two patterns revealed from the activity correlations; Finding that staff engaged in negative client contact would be described as burned out.

Abstract. To estimate rates of hepatotoxicity in the United States among children treated for tuberculosis, we conducted a retrospective survey of health departments and individual practitioners. We received 874 reports suitable for analysis of children treated during 1977 to 1979. A total of 16 hepatotoxic reactions were reported; 14/430 (3.3%) children receiving isoniazid and rifampin had a hepatotoxic reaction, which approximates the rate seen in adults taking these drugs. Half of the reactions occurred during the first month of therapy, and all of the well-documented reactions were noted during the first 10 weeks. Because the likelihood of hepatotoxicity may be increased with higher drug doses, limiting the dose of isoniazid to 10 mg/kg and that of rifampin to 15 mg/kg may help minimize hepatotoxic reactions. Because more serious disease, especially disseminated tuberculosis, may further increase the risk of hepatotoxicity, close monitoring of such children receiving isoniazid and rifampin should help minimize serious hepatotoxicity. Routine biochemical monitoring may not be necessary for all children, eg, those with mild forms of disease and those with normal pretreatment liver function who are treated with lower drug doses. [ABSTRACT FROM AUTHOR]

Study Objective: To determine the effectiveness, toxicity, and acceptability of a 6-month antituberculous regimen compared with a 9-month regimen.Design: A nonblinded, unbalanced, randomized, multicenter clinical trial.Setting: Twenty-two tuberculosis clinics in public health departments and hospitals in the United States.Patients: Patients were eligible if Mycobacterium tuberculosis, isolated from sputum cultures, was susceptible to study drugs. Of 1451 patients enrolled, 75% (617 of 823) assigned to the 6-month regimen and 71% (445 of 628) assigned to the 9-month regimen were eligible.Interventions: Patients took self-administered isoniazid and rifampin daily for 24 weeks (6-month regimen) or 36 weeks (9-month regimen). In addition, patients assigned to the 6-month regimen took self-administered pyrazinamide daily during the first 8 weeks.Results: Patients on the 6-month regimen converted more rapidly than patients on the 9-month regimen (94.6% compared with 89.9% after 16 weeks of therapy, with a difference of 4.7% [95% CI, 0.7% to 8.7%]); had similar rates of adverse drug reactions (7.7% compared with 6.4%, with a difference of 1.3% [95% CI, 0.0% to 4.6%]); had lower noncompliance rates (16.8% compared with 29.2%, with a difference of 12.4% [95% CI, 6.8% to 18.0%]); and had similar relapse rates 96 weeks after completing therapy (3.5% compared with 2.8%, with a difference of 0.7% [95% CI, 0.0% to 3.9%]). A significantly greater proportion of patients assigned to the 6-month regimen successfully completed therapy (61.4% compared with 50.6%; chi 2 = 11.976).Conclusions: Our results suggest that this 6-month regimen is similar in effectiveness, toxicity, and acceptability to the 9-month regimen for treating pulmonary tuberculosis. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Assessment of the clinical presentations and the outcome of tongue tie division under local anesthesia. Materials and methods: Study design: Retrospective study. Setting: Glan Clwyd Hospital. Intervention: All babies had tongue tie division in the ENT outpatient clinic under local anaesthesia between May 2010 and June 2011. Preoperative symptoms and parents’ feedback were determined using questionnaires based on NICE guidelines. Results: 63 infants had tongue tie division in outpatient clinic. Average age of the procedure was 4.1 weeks. Before the procedure, 66.7% of babies had difficulty in breast-feeding. 11.1% had poor growth. 22.2% had limitation in tongue movement. 27.7% of the mothers had breast problems such as cracking and soreness of the nipples. All the preoperative problems were resolved in 98.4%. 77.1% of parents’ comments were positive. They described procedure as quick with minimal distress. 88.9% had no complications following division of tongue tie. Conclusion: Tongue tie division is a simple procedure with minimal complications. It can be undertaken under local anesthesia within first 3 months of life in the outpatient environment. Timely diagnosis, referral and treatment can make a difference in breast-feeding and weight gain. [Copyright &y& Elsevier]