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Chuntao Wang,1 Yanliang Liu,1 Wenyi Guo,1 Xu Zhu,1 Nita Ahuja,2 Tao Fu11Department of Gastrointestinal Surgery II, Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital, Wuhan University, Wuhan, People’s Republic of China; 2Department of Surgery, Yale School of Medicine, New Haven, CT, USABackground: The methylation of microtubule-associated protein tau (MAPT) was first described in patients with Alzheimer’s disease. In this study, we aim to determine if MAPT promoter CpG island is hypermethylated and whether this signature could work as a prognostic marker for patients with stage II colorectal cancer (CRC).Methods: MAPT methylation level and CpG island methylator phenotype (CIMP) status were examined. The prognostic value of MAPT methylation was analyzed using Cox regression analysis.Results: Amongst stage II CRC patients (n=107), hypermethylation of MAPT promoter CpG island was seen in 23.4% of them. MAPT methylation was much more frequent in patients with age ≥60 compared to age

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Luminal distensibility measurement has demonstrated relevance to various disease processes, though its effects on clinical decision-making have been less well understood. This study aims to characterize the clinical impact of impedance planimetry measurement as well as the learning curve associated with its use in the esophagus. A single provider performed distensibility measurement in conjunction with upper endoscopy for a variety of clinical indications with the functional lumen imaging probe (FLIP) over a period of 21 months. Procedural data were prospectively collected and, along with medical records, retrospectively reviewed. Seventy-three procedures (70 patients) underwent esophageal distensibilitymeasurement over the timeline of this study. The most common procedural indications were known or suspected achalasia (32.9%), dysphagia with connective tissue disease (13.7%), eosinophilic esophagitis (12.3%), and dysphagia with prior fundoplication (9.6%). FLIP results independently led to a change in management in 29 (39.7%) cases and supported a change in management in an additional 15 (20.5%) cases. The most common change in management was a new or amended therapeutic procedure (79.5%). Procedural time added by distensibility measurement was greater among earlier cases than among later cases. The median time added overall was 5 minutes and 46 seconds. Procedural time added varied significantly by procedural indication, but changes in management did not. Distensibility measurement added meaningful diagnostic information that impacted therapeutic decision-making in the majority of cases in which it was performed. Procedural time added by this modality is typically modest and decreases with experience. [ABSTRACT FROM AUTHOR]

Background Esophagogastric junction ( EGJ) outflow obstruction ( EGJOO) is characterized by impaired EGJ relaxation with intact or weak peristalsis. Our aims were to evaluate: (i) prevalence, (ii) yield of fluoroscopy, endoscopy, and endoscopic ultrasound ( EUS), (iii) outcomes, and (iv) whether this data differed based on quantitative EGJ relaxation. Methods Studies that met criteria for EGJOO were identified. Demographics, encounters, endoscopy, radiology, treatment decisions, and outcomes were extracted. Key Results Sixty studies were identified. Dysphagia was the most common symptom. Forty patients underwent barium esophagram ( BE): normal (11), hiatal hernia (20), spasm/dysmotility (17), EGJ narrowing (10), compression (2), Schatzki's ring (5), malrotation (1), gastric volvulus (1), mass (1). Esophagogastroduodenoscopy ( EGD) was performed in 41 patients: normal (19), hiatal hernia (13), Schatzki's ring (6), esophagitis (3), esophageal candidiasis (3), mass (1). EUS was performed in 20 patients and was frequently normal. Twenty-two patients underwent intervention. While transient improvement was noted in the majority, persistent improvement was seen in only one of nine patients (dilatation), four of six patients (botulinum toxin), and three patients who underwent per-oral endoscopic myotomy. No patients treated with medical therapy alone had improvement in dysphagia. There was no difference in symptoms or outcomes based on quantitative EGJ relaxation. Conclusions & Inferences The manometric criterion EGJOO defines a heterogeneous clinical group. While BE, EGD, and EUS all provide complementary information, a significant percentage of these studies will be normal. For patients with dysphagia, outcome may depend on EGJ disruption. There were no differences in symptoms our outcomes based on quantitative EGJ relaxation. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To analyze: (i) the effectiveness of CT-guided biopsy for the diagnosis of suspected spinal infections (spondylodiscitis); (ii) identify common causative microorganisms and assess factors that could affect the diagnostic yield. PATIENTS AND METHODS: Forty-five patients undergoing CT-guided biopsy for suspected spinal infection between November 2012 and October 2014 were analyzed. The time from presentation to diagnosis, administration of antibiotics before biopsy, blood culture results, admission C-reactive protein (CRP)/white cell count, presence of fever or neurological deficits, and soft tissue collections on MRI were analyzed. Multivariable logistic regression was performed to determine variables independently associated with a positive biopsy. RESULTS: Eleven (24.4%) patients had positive blood cultures. The first biopsy was positive in 19 (42.2%) patients. Thirty-eight (84.4%) patients had a single biopsy, while seven (15.5%) patients underwent repeat biopsy with a positive yield in one (14.2%) patient. Overall, causative microorganisms were identified in 26 (57.8%) cases. Admission CRP was significantly associated with isolating the causative pathogen from CT-guided biopsy (p<0.001). A soft tissue collection on MRI was associated with identification of a microorganism in blood cultures (p=0.001). CRP was the only independent variable associated with a positive yield on CT-guided biopsy (p=0.007, OR 1.042) and was more likely in patients with CRP>50 (p<0.001). Administration of empirical antibiotics before biopsy did not affect the yield (p=0.572). CONCLUSIONS: A high CRP was a strong predictor of isolation of the causative organism. Repeat CT-guided biopsy was found to have limited value with a low positive yield (14.2%) in our study. [ABSTRACT FROM AUTHOR]

Introduction: We undertook this study to compare the analgesic efficacy of 0.1% bupivacaine and 0.1% ropivacaine with fentanyl using patient controlled epidural analgesia. Materials and methods: 60 parturients of ⩾ 36 weeks of gestation with cephalic presentation in spontaneous labour with cervical dilatation ⩽ 5cms and baseline pain score of ⩽ 30 on visual analogue scale (VAS), were enrolled in the study. Group I received 10 ml bolus of 0.1% bupivacaine with fentanyl 2μg/ml while Group II received 10 ml bolus of 0.1% ropivacaine with fentanyl 2μg/ml followed by patient controlled epidural analgesia (PCEA) using PCA pump. The primary outcome measured was analgesic efficacy using VAS. Results: VAS scores during first and second hour were found to be significantly lower in Group 1 as compared to Group 2 (Figure 1) with a significant difference from their respective baselines. Group II showed a statistically higher total drug consumption and number of boluses used (62.33 ± 26.6 vs 48.47 ± 16.7 and1.40 ± 0.8 vs 2.00 ± 0.8 respectively) as compared to group I (Table 2) (Figure 3). The motor block showed a statistically significant difference at 4th, 5th and 6th hours between the two groups (Figure 4). Conclusion: The present study demonstrated that 0.1% ropivacaine or 0.1% bupivacaine with fentanyl 2μg/ml used during labour analgesia by PCEA were equally effective for controlling the labour pain with more total drug consumption and less motor blockade associated with 0.1% ropivacaine as compared to 0.1% bupivacaine. [ABSTRACT FROM AUTHOR]