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Background: Gastro-oesophageal reflux disease (GORD) is, in the main, treated with either proton pump inhibitor (PPI) drugs or a Nissen fundoplication operation. Recently, BARD developed Endocinch, a device used to place sutures just below the oesophagogastric junction (OGJ) to treat GORD. Aim: To evaluate the long term benefit of the Endocinch technique in patients seen up to 12 months post procedure. Patients: Twenty six patients with symptoms of GORD were recruited and had the procedure performed. Four patients were lost to follow up. Methods: Twenty two patients completed their one year follow up. Pre procedure and post procedure (up to 12 months) assessments included symptom scoring (DeMeester), upper intestinal endoscopy, oesophageal manometry and 24 hour oesophageal pH, and completion of quality of life (QOL) questionnaires. Results: Mean age was 39 years (range 22-62). Heartburn symptom score was reduced from a mean value of 19.22 at baseline to 7.5 at 12 months (n=22) (p<0.0001). Regurgitation score reduced from a mean of 2.27 at baseline to 0.86 at 12 months (n=22) (p<0.001). Mean (SEM) pH DeMeester acid score was reduced from 44.1 (4.3) to 33.32 (4.73) (p=0.028) at three month post procedure. Percentage upright acid exposure and number of reflux episodes were also reduced significantly. Use of PPIs was reduced by 64% at 12 months post procedure. All QOL assessments showed significant improvement (p=0.01). All transient post procedure complaints resolved within 72 hours. Conclusion: The Endocinch procedure is an effective and safe outpatient procedure that offers GORD patients significant improvement in symptomatology, QOL, and reduced requirements for PPIs over at least a one year period. [ABSTRACT FROM AUTHOR]

Two chronosequences of unsaturated, buried loess sediments, ranging in age from <10,000 years to >1 million years, were investigated to reconstruct patterns of microbial ecological succession that have occurred since sediment burial. The relative importance of microbial transport and survival to succession was inferred from sediment ages, porewater ages, patterns of abundance (measured by direct counts, counts of culturable cells, and total phospholipid fatty acids), activities (measured by radiotracer and enzyme assays), and community composition (measured by phospholipid fatty acid patterns and Biolog substrate usage). Core samples were collected at two sites 40 km apart in the Palouse region of eastern Washington State, near the towns of Washtucna and Winona. The Washtucna site was flooded multiple times during the Pleistocene by glacial outburst floods; the Winona site elevation is above flood stage. Sediments at the Washtucna site were collected from near surface to 14.9 m depth, where the sediment age was ∼250 ka and the porewater age was 3700 years; sample intervals at the Winona site ranged from near surface to 38 m (sediment age: ∼1 Ma; porewater age: 1200 years). Microbial abundance and activities declined with depth at both sites; however, even the deepest, oldest sediments showed evidence of viable microorganisms. Same-age sediments had equal quantities of microorganisms, but different community types. Differences in community makeup between the two sites can be attributed to differences in groundwater recharge and paleoflooding. Estimates of the microbial community age can be constrained by porewater and sediment ages. In the shallower sediments (<9 m at Washtucna, <12 m at Winona), the microbial communities are likely similar in age to the groundwater; thus, microbial succession has been influenced by recent transport of microorganisms from the surface. In the deeper sediments, the populations may be considerably older than the porewater ages, since microbial transport is severely restricted in unsaturated sediments. This is particularly true at the Winona site, which was never flooded. [ABSTRACT FROM AUTHOR]

Microbial communities along vertical transects in the unsaturated zone were evaluated at five sites in the Pasco Basin, in southeastern Washington State. Sites with contrasting recharge rates were chosen to maximize or minimize the potential for microbial transport. Pore water ages along the vertical transects were established using natural chloride tracers, and ranged from modern to either ∼15,000 yBP (years before present) or ∼30,000 yBP at the two low-recharge sites. Unsaturated flow processes were short-circuited by preferential flow at two of the three high-recharge sites, resulting in rapid movement of water through the vertical transects. Microbial numbers and biomass, based on plate counts, and phospholipid fatty acid (PLFA) concentrations decreased with depth at all sites. The majority (55–90%) of the culturable chemoheterotrophs recovered from most samples were streptomycete bacteria. 16S rRNA gene sequence and MIDI analyses indicated that 75% of the remaining isolates were Gram-positive bacteria (most likely species of Arthrobacter and Bacillus) 25% were Gram-negative bacteria (probably members of several genera in the alpha- and gamma- Proteobacteria). Comparison of microbial communities at low-recharge sites vs. high-recharge sites, where preferential flow occurs, revealed several differences that might be attributed to vertical transport of microbial cells at the high-recharge sites. Plate counts and PLFA analyses indicated that the proportion of streptomycetes, which were abundant at the surface but present in the subsurface as spores, decreased, or remained constant, with depth at the low-recharge sites, but increased with depth at the high-recharge sites. PLFA analyses also indicated that Gram-negative bacteria displayed increased nutrient stress with depth at the high-recharge sites characterized by preferential flow, but not at the low recharge site. This may be a result of advective transport of microbes to depths where it was difficult for them to compete effectively with the established community. Moreover, PLFA community structure profiles fluctuated considerably with depth at the low-recharge sites, but not at the high-recharge sites. This might be expected if transport were distributing the microbial community along the vertical profile at the high-recharge sites. In contrast to the high-recharge sites at which preferential flow occurs, filtration likely prevented vertical transport of microorganisms at the high-recharge site that was characterized by unsaturated flow. [ABSTRACT FROM AUTHOR]