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Background: Pulmonary vein isolation (PVI) is superior to antiarrhythmics for the management of atrial fibrillation, but repeat ablation is often required for durable rhythm control. Factors influencing first-pass isolation (FPI) and whether FPI predicts durable isolation are not well known., Objective: The study sought to determine factors associated with FPI and rates of chronic reconnection among those with and without FPI at index PVI in patients undergoing repeat ablation., Methods: We retrospectively identified 483 patients at our institution who underwent first-time PVI in 2021. Of these, 63 who had repeat ablation between 2021 and 2023 were included in the study. Logistic regression was used for statistical analysis for predictors of FPI during index PVI., Results: The mean age was 65 years, 67% of patients were male, 90% were White, and 73% had persistent atrial fibrillation. At index PVI, FPI was achieved in 58% of left pulmonary veins (PVs), 48% of right PVs, and 25% of posterior wall isolations. Bilateral FPI was achieved in 35% of patients. At redo PVI, the right superior PV (47%) was most frequently reconnected. Lack of PFI of the right PVs at index PVI was associated with a 14-fold risk of chronic reconnection. Elevated left atrial voltage predicted the absence of FPI of the right PVs but not the left PVs., Conclusion: Increased left atrial voltage predicts a lack of FPI in the right PVs but not in the left PVs. Lack of FPI of right PVs predicts chronic reconnection., (© 2024 Heart Rhythm Society. Published by Elsevier Inc.)

Background: The current standard of practice for cremating patients with cardiac implantable electronic devices (CIEDs) is surgical explantation before cremation to mitigate the risk of device explosion. This surgery may conflict with patient or family beliefs, whereas cremation of CIEDs may create occupational hazards., Objective: This study sought to establish an ex vivo model for screening CIED behavior during cremation., Methods: Seven CIEDs underwent testing including projectile/sound testing, impact testing, and gas analysis. In the projectile test, devices were heated until thermal failure (explosion) and filmed with a high-speed camera and microphone. For impact testing, brick structures were built to assess damage after explosion. Gas chromatography-mass spectrometry identified released gases. Findings were compared with occupational health standards, where available., Results: The implantable loop recorder and leadless pacemaker produced minimal kinetic energy and impact risk with thermal failure. The remaining devices demonstrated explosive disintegration at thermal temperatures <500°C. The pacemakers and implantable cardiac defibrillators produced sound levels >120 dB and resulted in damage to brick structures. Small quantities of benzene and hydrogen fluoride were produced but at quantities within acceptable occupational exposure limits in a cremation chamber., Conclusion: All tested CIEDs experienced explosion at temperatures below crematorium standards. The smallest devices produced minimal risk of damage or injury, suggesting that they may safely remain in situ during cremation, whereas the larger devices produced more kinetic energy, testing chamber damage, and louder explosions, suggesting potential risk with cremation. Cadaveric testing in full-sized cremation chambers is required to determine real-world risk., Competing Interests: Disclosures T.R.M. has received speaker/consulting honoraria from Abbott, Inc and Biosense Webster, Inc and research support from Circa Scientific, Inc and LuxMed Systems. A.D. has received speaker/consulting honoraria from Abbott, Inc, Biosense Webster, Inc, and Biotronik; and research support from Medtronic, Inc, Abbott, Inc, Circa Scientific, Inc, and Biosense Webster, Inc. N.K., P.Z., J.W., and D.K. have no conflicts of interest to disclose., (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Objective: Inpatient suicide remains difficult to predict. This study aimed to identify individual patient predictors to help identify those at greater risk., Methods: This case-control study was undertaken in an independent mental health service in Ireland. Cases were drawn from all admissions to the service between March 2004 and February 2019. Controls were matched for date of admission. Univariate and multivariate analyses were conducted., Results: Thirty-three cases of inpatient suicide were compared to 132 controls. The inpatient suicide rate was 76.2 per 100,000 admissions. The rate of inpatient suicide fell in line with national rates despite less restrictive practices being implemented in the service. Males accounted for 66% of cases. Hanging was the most common method of suicide overall and among male patients, and drowning was the most common among females. Male gender, tertiary referral, an adverse psychosocial event during admission, a period of absence without leave and expressing hopelessness were identified as independent risk factors for inpatient suicide. Substance use, involuntary detention, family history of suicide, and number of previous admissions were not significant., Conclusions: While not highly sensitive, a period of absence without leave, tertiary referral and hopelessness are important predictors of inpatient suicide risk that treating teams should consider in care planning., (© 2024 American Association of Suicidology.)

Competing Interests: TM has received consulting and speaking honoraria from Abbott, Inc, and Biosense Webster, Inc, and research support from LuxMed Systems. AD has received speaking and consulting honoraria from Abbott, Inc, Biosense Webster, Inc, and Biotronik, Inc, and research support from Medtronic and Abbott Inc. The remaining authors report no financial disclosures.

Acclimatization through phenotypic plasticity represents a more rapid response to environmental change than adaptation and is vital to optimize organisms' performance in different conditions. Generally, animals are less phenotypically plastic than plants, but reef-building corals exhibit plant-like properties. They are light dependent with a sessile and modular construction that facilitates rapid morphological changes within their lifetime. We induced phenotypic changes by altering light exposure in a reciprocal transplant experiment and found that coral plasticity is a colony trait emerging from comprehensive morphological and physiological changes within the colony. Plasticity in skeletal features optimized coral light harvesting and utilization and paralleled significant methylome and transcriptome modifications. Network-associated responses resulted in the identification of hub genes and clusters associated to the change in phenotype: inter-partner recognition and phagocytosis, soft tissue growth and biomineralization. Furthermore, we identified hub genes putatively involved in animal photoreception-phototransduction. These findings fundamentally advance our understanding of how reef-building corals repattern the methylome and adjust a phenotype, revealing an important role of light sensing by the coral animal to optimize photosynthetic performance of the symbionts., (© 2023 The Authors. Molecular Ecology published by John Wiley & Sons Ltd.)

The field of nanomedicine demonstrates immense advantages and noteworthy expansion compared to conventional drug delivery systems like tablet, capsules, etc. Despite the innumerable advantages, it holds certain shortcomings in the form of blind spots that need to be assessed before the successful clinical translation. This perspective highlights the foremost blind spots in nanomedicine and emphasizes the challenges faced before the entry into the market, including the need for provision of safety and efficacy data by the regulatory agencies like FDA. The significant revolution of nanomedicine in the human life, particularly in patient well-being, necessitates to identify the blind spots and overcome them for effective management and treatment of ailments., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Mitral regurgitation is a common valvular heart disease with increasing prevalence due to the aging population. In degenerative (primary) mitral regurgitation, medical therapies are limited and the mainstay of treatment is mitral valve surgery. Patients are referred for mitral valve surgery based on the American College of Cardiology/American Heart Association guidelines, which recommend surgery in patients with severe mitral regurgitation. Echocardiography uses multiple parameters that lack reproducibility and accuracy. Studies comparing cardiovascular magnetic resonance (CMR) and echocardiography have shown that CMR is a better predictor of clinical outcome and postsurgical left ventricular remodeling than echocardiography., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Despite being uncommon, speech-induced atrial tachycardias carry significant morbidity and affect predominantly healthy individuals. Little is known about their mechanism, treatment, and prognosis. In this review, we seek to identify the underlying connections and pathophysiology between speech and arrhythmias while providing an informed approach to evaluation and management., (© 2023 Heart Rhythm Society. Published by Elsevier Inc.)

Background: Postprandial metabolomic profiles and their inter-individual variability are not well characterised. Here, we describe postprandial metabolite changes, their correlations with fasting values and their inter- and intra-individual variability, following a standardised meal in the ZOE PREDICT 1 cohort., Methods: In the ZOE PREDICT 1 study ( n = 1002 (NCT03479866)), 250 metabolites, mainly lipids, were measured by a Nightingale NMR panel in fasting and postprandial (4 and 6 h after a 3.7 MJ mixed nutrient meal, with a second 2.2 MJ mixed nutrient meal at 4 h) serum samples. For each metabolite, inter- and intra-individual variability over time was evaluated using linear mixed modelling and intraclass correlation coefficients (ICC) were calculated., Results: Postprandially, 85% (of 250 metabolites) significantly changed from fasting at 6 h (47% increased, 53% decreased; Kruskal-Wallis), with 37 measures increasing by >25% and 14 increasing by >50%. The largest changes were observed in very large lipoprotein particles and ketone bodies. Seventy-one percent of circulating metabolites were strongly correlated (Spearman's rho >0.80) between fasting and postprandial timepoints, and 5% were weakly correlated (rho <0.50). The median ICC of the 250 metabolites was 0.91 (range 0.08-0.99). The lowest ICCs (ICC <0.40, 4% of measures) were found for glucose, pyruvate, ketone bodies (β-hydroxybutyrate, acetoacetate, acetate) and lactate., Conclusions: In this large-scale postprandial metabolomic study, circulating metabolites were highly variable between individuals following sequential mixed meals. Findings suggest that a meal challenge may yield postprandial responses divergent from fasting measures, specifically for glycolysis, essential amino acid, ketone body and lipoprotein size metabolites.

Objectives: To establish a framework by which experts define disease subsets in systemic sclerosis associated interstitial lung disease (SSc-ILD)., Methods: A conceptual framework for subclinical, clinical and progressive ILD was provided to 83 experts, asking them to use the framework and classify actual SSc-ILD patients. Each patient profile was designed to be classified by at least four experts in terms of severity and risk of progression at baseline; progression was based on 1-year follow-up data. A consensus was reached if ≥75% of experts agreed. Experts provided information on which items were important in determining classification., Results: Forty-four experts (53%) completed the survey. Consensus was achieved on the dimensions of severity (75%, 60 of 80 profiles), risk of progression (71%, 57 of 80 profiles) and progressive ILD (60%, 24 of 40 profiles). For profiles achieving consensus, most were classified as clinical ILD (92%), low risk (54%) and stable (71%). Severity and disease progression overlapped in terms of framework items that were most influential in classifying patients (forced vital capacity, extent of lung involvement on high resolution chest CT [HRCT]); risk of progression was influenced primarily by disease duration., Conclusions: Using our proposed conceptual framework, international experts were able to achieve a consensus on classifying SSc-ILD patients along the dimensions of disease severity, risk of progression and progression over time. Experts rely on similar items when classifying disease severity and progression: a combination of spirometry and gas exchange and quantitative HRCT., (© The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Aims: To test the hypothesis that the dispersive patch (DP) location does not significantly affect the current distribution around the catheter tip during radiofrequency catheter ablation (RFCA) but may affect lesions size through differences in impedance due to factors far from the catheter tip., Methods: An in silico model of RFCA in the posterior left atrium and anterior right ventricle was created using anatomic measurements from patient thoracic computed tomography scans and tested the effect of anterior vs. posterior DP locations on baseline impedance, myocardial power delivery, radiofrequency current path, and predicted lesion size., Results: For posterior left atrium ablation, the baseline impedance, total current delivered, current distribution, and proportion of power delivered to the myocardium were all similar with both anterior and posterior DP locations, resulting in similar RFCA lesion sizes (< 0.2 mm difference). For anterior right ventricular (RV) ablation, an anterior DP location resulted in slightly higher proportion of power delivered to the myocardium and lower baseline impedance leading to slightly larger RFCA lesions (0.6 mm deeper and 0.8 mm wider)., Conclusions: An anterior vs. posterior DP location will not meaningfully affect RFCA for posterior left atrial ablation, and the slightly larger lesions predicted with anterior DP location for anterior RV ablation are of unclear clinical significance., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Percutaneous epicardial ventricular tachycardia ablation can decrease implanted cardioverter defibrillator shocks and hospitalizations; proper patient selection and procedural technique are imperative to maximize the benefit-risk ratio. The best candidates for epicardial ventricular tachycardia will depend on history of prior ablation, type of cardiomyopathy, and specific electrocardiogram and cardiac imaging findings. Complications include hemopericardium, hemoperitoneum, coronary vessel injury, and phrenic nerve injury. Modern epicardial mapping techniques provide new understandings of the 3-dimensional nature of reentrant ventricular tachycardia circuits across cardiomyopathy etiologies. Where epicardial access is not feasible, alternative techniques to reach epicardial ventricular tachycardia sources may be necessary., Competing Interests: Disclosure Andre d’Avila receives research funding from Medtronic, Inc, Medtronic, Inc, Biosense Webster, Inc, and Abbott, Inc. All other authors have no relationships to disclose., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Baseline impedance, radiofrequency current, and impedance drop during radiofrequency catheter ablation are thought to predict effective lesion formation. However, quantifying the contributions of local versus remote impedances provides insights into the limitations of indices using those parameters. Methods: An in silico model of left atrial radiofrequency catheter ablation was used based on human thoracic measurements and solved for (1) initial impedance (Z), (2) percentage of radiofrequency power delivered to the myocardium and blood (3) total radiofrequency current, (4) impedance drop during heating, and (5) lesion size after a 25 W−30 s ablation. Remote impedance was modeled by varying the mixing ratio between skeletal muscle and fat. Local impedance was modeled by varying insertion depth of the electrode (ID). Results: Increasing the remote impedance led to increased baseline impedance, lower system current delivery, and reduced lesion size. For ID = 0.5 mm, Z ranged from 115 to 132 Ω when fat percentage varied from 20 to 80%, resulting in a decrease in the RF current from 472 to 347 mA and a slight decrease in lesion size from 5.6 to 5.1 mm in depth, and from 9.2 to 8.0 mm in maximum width. In contrast, increasing the local impedance led to lower system current but larger lesions. For a 50% fat−muscle mixture, Z ranged from 118 to 138 Ω when ID varied from 0.3 to 1.9 mm, resulting in a decrease in the RF current from 463 to 443 mA and an increase in lesion size, from 5.2 up to 7.5 mm in depth, and from 8.4 up to 11.6 mm in maximum width. In cases of nearly identical Z but different contributions of local and remote impedance, markedly different lesions sizes were observed despite only small differences in RF current. Impedance drop better predicted lesion size (R2 > 0.93) than RF current (R2 < 0.1). Conclusions: Identical baseline impedances and observed RF currents can lead to markedly different lesion sizes with different relative contributions of local and remote impedances to the electrical circuit. These results provide mechanistic insights into the advantage of measuring local impedance and identifies potential limitations of indices incorporating baseline impedance or current to predict lesion quality.

Antibiotics, among the most used medications in children, affect gut microbiome communities and metabolic functions. These changes in microbiota structure can impact host immunity. We hypothesized that early-life microbiome alterations would lead to increased susceptibility to allergy and asthma. To test this, mouse pups between postnatal days 5-9 were orally exposed to water (control) or to therapeutic doses of azithromycin or amoxicillin. Later in life, these mice were sensitized and challenged with a model allergen, house dust mite (HDM), or saline. Mice with early-life azithromycin exposure that were challenged with HDM had increased IgE and IL-13 production by CD4 + T cells compared to unexposed mice; early-life amoxicillin exposure led to fewer abnormalities. To test that the microbiota contained the immunological cues to alter IgE and cytokine production after HDM challenge, germ-free mice were gavaged with fecal samples of the antibiotic-perturbed microbiota. Gavage of adult germ-free mice did not result in altered HDM responses, however, their offspring, which acquired the antibiotic-perturbed microbiota at birth showed elevated IgE levels and CD4 + cytokines in response to HDM, and altered airway reactivity. These studies indicate that early-life microbiota composition can heighten allergen-driven Th2/Th17 immune pathways and airway responses in an age-dependent manner., (© 2022. The Author(s), under exclusive licence to Society for Mucosal Immunology.)

Objective: To model the evolution of peak temperature and volume of damaged esophagus during and after radiofrequency (RF) ablation using low power-moderate duration (LPMD) versus high power-short duration (HPSD) or very high power-very short duration (VHPVSD) settings., Methods: An in silico simulation model of RF ablation accounting for left atrial wall thickness, nearby organs and tissues, as well as catheter contact force. The model used the Arrhenius equation to derive a thermal damage model and estimate the volume of esophageal damage over time during and after RF application under conditions of LPMD (30 W, 20 s), HPSD (50 W, 6 s), and VHPVSD (90 W, 4 s)., Results: There was a close correlation between maximum peak temperature after RF application and volume of esophageal damage, with highest correlation (R 2  = 0.97) and highest volume of esophageal injury in the LPMD group. A greater increase in peak temperature and greater relative increase in esophageal injury volume in the HPSD (240%) and VHPSD (270%) simulations occurred after RF termination. Increased endocardial to esophageal thickness was associated with a longer time to maximum peak temperature (R 2  > 0.92), especially in the HPSD/VHPVSD simulations, and no esophageal injury was seen when the distances were >4.5 mm for LPMD or >3.5 mm for HPSD., Conclusion: LPMD is associated with a larger total volume of esophageal damage due to the greater total RF energy delivery. HPSD and VHPVSD shows significant thermal latency (resulting from conductive tissue heating after RF termination), suggesting a requirement for fewer esophageal temperature cutoffs during ablation., (© 2021 Wiley Periodicals LLC.)

Evidence of the impact of the COVID-19 pandemic on health behaviours in the general population is limited. In this retrospective longitudinal study including UK and US participants, we collected diet and lifestyle data pre-pandemic (896,286) and peri-pandemic (291,871) using a mobile health app, and we computed a bidirectional health behaviour disruption index. Disruption of health behaviour was higher in younger, female and socio-economically deprived participants. Loss in body weight was greater in highly disrupted individuals than in those with low disruption. There were large inter-individual changes observed in 46 health and diet behaviours measured peri-pandemic compared with pre-pandemic, but no mean change in the total population. Individuals most adherent to less healthy pre-pandemic health behaviours improved their diet quality and weight compared with those reporting healthier pre-pandemic behaviours, irrespective of relative deprivation; therefore, for a proportion of the population, the pandemic may have provided an impetus to improve health behaviours. Public policies to tackle health inequalities widened by the pandemic should continue to prioritize diet and physical activity for all, as well as more targeted approaches to support younger females and those living in economically deprived areas., (© 2021. The Author(s).)

Environmental and occupational exposure to heavy metals remains one of the major concerns in public health. Increased levels of manganese (Mn) pollution are associated with profound neurotoxic effects, including neurobehavioral deficits and disturbances resembling Parkinson's disease. While Mn absorption is in part mediated by iron transporters, recent studies have shown that the levels of iron transporters are modified by alcohol and that chronic alcohol consumption increases body iron stores. However, it is largely unexplored whether alcohol exposure influences the transport and neurotoxicity of Mn. To address this question, we exposed mice to ethanol (10%; v/v) by drinking water for 4 weeks, during which period MnCl 2 (5 mg/kg) or saline solutions were administered daily by intranasal instillation. Ethanol consumption in mice increased brain Mn levels in a dose-dependent manner after Mn instillation, determined by inductively-coupled plasma mass spectrometry, which was accompanied by up-regulation of iron transporters, as assessed by western blotting and qPCR. In addition, alcohol drinking increased hypoxic response and decreased hepcidin expression, providing the molecular mechanism of increased iron transporters and Mn uptake upon alcohol consumption. Moreover, brain dopamine levels, analyzed by HPLC, were decreased after intranasal Mn instillation, which was worsened by alcohol. Likewise, alcohol-Mn co-exposure synergistically altered dopaminergic protein expression. Finally, alcohol binge-drinking, which resembles alcohol drinking manner in humans, increased brain Mn content along with upregulation of iron transporters. Our study suggests that individuals who consume alcohol may have a higher risk of Mn neurotoxicity upon Mn exposure., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Acacia Seyal gum (ASG), also known as gum Arabic, is an antioxidant-rich soluble fiber. ASG has been reported to have many biological activities, including anticancer, antidiabetic, antiulcer, and immunomodulatory activity. Extraction of bioactive compounds from ASG is commonly performed using conventional extraction methods. However, these techniques have certain limitation in terms of extraction time, energy, and solvent requirements. Ultrasound-assisted extraction (UAE) could be used as an alternative technique to extract bioactive compounds in less time, at low temperature, and with less energy and solvent requirements. In this study, the UAE extraction of ASG was optimized using response surface methodology (RSM). A face-centered central composite design (FCCCD) was used to monitor the effect of different independent factors of ultrasound operation (sonication time, temperature, and solvent ratio) on ASG extraction yield. In addition, screening and characterization of phytochemicals in 60% ethanol ASG extract was carried out using Raman microscopy, Fourier transform infrared spectroscopy (FTIR), and gas chromatography time-of-flight mass spectroscopy (GC-TOFMS) analysis. The results indicated that, under optimal conditions (extraction time 45 min, extraction temperature 40 °C, and solid-liquid ratio of 1:25 g/mL), the yield of ASG was 75.87% ± 0.10. This yield was reasonably close to the predicted yield of 75.39% suggested by the design of experiment. The ANOVA revealed that the model was highly significant due to the low probability value ( p < 0.0001). Raman spectrum fingerprint detected polysaccharides, such as galactose and glucose, and protein like lysine and proline, while FTIR spectrum revealed the presence of functional groups peaks value of alkanes, aldehydes, aliphatic amines, and phenol. GC-TOFMS spectroscopic detected the presence of strong d-galactopyranose, carotenoid, and lycopene antioxidant compounds. In conclusion, this study demonstrated that the UAE technique is an efficient method to achieve a high yield of ASG extracts. The selected model is adequate to optimize the extraction of several chemical compounds reported in this study.

Purpose: Plant-based proteins may have the potential to improve glycaemic and gastrointestinal hormone responses to foods and beverages. The aim of this study was to investigate the effect of two doses of pea protein on postprandial glycaemic, insulinaemic, glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) response following a high-carbohydrate beverage intake in healthy individuals., Methods: In a single-blind, randomised, controlled, repeat measure, crossover design trial, thirty-one participants were randomly assigned to ingest 50 g glucose (Control), 50 g glucose with 25 g pea protein (Test 1) and 50 g glucose with 50 g pea protein (Test 2) on three separate days. Capillary blood samples (blood glucose and plasma insulin measurements) and venous blood samples (GIP and GLP-1 concentrations) were taken before each test and at fixed intervals for 180 min. The data were compared using repeated-measures ANOVA or the Friedman test., Results: Glucose incremental Area under the Curve (iAUC180) was significantly lower (p < 0.001) after Test 2 compared with Control (- 53%), after Test 1 compared with Control (- 31%) and after Test 2 compared with Test 1 (-32%). Insulin iAUC 180 was significantly higher (p < 0.001) for Test 1 (+ 28%) and Test 2 (+ 40%) compared with Control and for Test 2 (+ 17%) compared with Test 1 (p = 0.003). GIP and GLP-1 release showed no clear difference between Control and Pea protein drinks., Conclusion: The consumption of pea protein reduced postprandial glycaemia and stimulated insulin release in healthy adults with a dose-response effect, supporting its role in regulating glycaemic and insulinaemic responses., (© 2021. Springer-Verlag GmbH, DE part of Springer Nature.)

Leukemia is a leukocyte cancer that is characterized by anarchic growth of immature immune cells in the bone marrow, blood and spleen. There are many forms of leukemia, and the best course of therapy and the chance of a patient's survival depend on the type of leukemic disease. Different forms of drugs have been used to treat leukemia. Due to the adverse effects associated with such therapies and drug resistance, the search for safer and more effective drugs remains one of the most challenging areas of research. Thus, new therapeutic approaches are important to improving outcomes. Almost half of the drugs utilized nowadays in treating cancer are from natural products and their derivatives. Medicinal plants have proven to be an effective natural source of anti-leukemic drugs. The cytotoxicity and the mechanisms underlying the toxicity of these plants to leukemic cells and their isolated compounds were investigated. Effort has been made throughout this comprehensive review to highlight the recent developments and milestones achieved in leukemia therapies using plant-derived compounds and the crude extracts from various medicinal plants. Furthermore, the mechanisms of action of these plants are discussed.

Purpose: Inconsistent evidence exists for greater satiety after medium-chain triglycerides (MCT) or conjugated linoleic acid (CLA) compared to long-chain triglycerides (LCT). Furthermore, the mechanisms are poorly understood and effects in people with a healthy weight and those with overweight/obesity have not been compared. This study aimed to compare appetite responses in these groups and examine the mechanisms behind any differences., Methods: Fifteen participants with healthy weight (BMI: 22.7 ± 1.9 kg·m -2 ) and fourteen participants with overweight/obesity (BMI: 30.9 ± 3.9 kg·m -2 ) consumed a breakfast containing either 23.06 g vegetable oil (CON), 25.00 g MCT oil (MCT), or 6.25 g CLA and 16.80 g vegetable oil (CLA). Appetite, peptide YY (PYY), total ghrelin (TG), β-hydroxybutyrate, and gastric emptying (GE) were measured throughout. Energy intake was assessed at an ad libitum lunch and throughout the following ~ 36 h., Results: Neither MCT nor CLA decreased ad libitum intake; however MCT decreased day 1 energy intake (P = 0.031) and the 48-h period (P = 0.005) compared to CON. MCT delayed GE (P ≤ 0.01) compared to CON, whereas CLA did not. PYY and TG concentrations were not different (P = 0.743 and P = 0.188, respectively), but MCT increased β-hydroxybutyrate concentrations compared to CON (P = 0.005) and CLA (P < 0.001). β-hydroxybutyrate concentrations were higher in participants with overweight/obesity (P = 0.009)., Conclusion: Consumption of MCT reduces energy intake in the subsequent 48 h, whereas CLA does not. Delayed gastric emptying or increased β-hydroxybutyrate concentrations may mediate this.

Research has indicated that consuming medium-chain triglycerides (MCT) may be more satiating than consuming long-chain triglycerides (LCT) potentially causing a reduction in energy intake. However not all studies have demonstrated this acute reduction in energy intake and it has yet to be systematically reviewed. Our main objective was to examine how ingestion of MCT influences energy intake, subjective appetite ratings and appetite-related hormones compared to LCT. Web of Science, MEDLINE, CINHAL, and Embase were searched for publications comparing the effect of MCT on appetite (commonly hunger, fullness, desire to eat, and prospective food consumption), appetite-related hormones (pancreatic polypeptide (PP), gastric inhibitory polypeptide (GIP), peptide YY (PYY), glucagon-like peptide-1 (GLP-1), neurotensin, leptin, total ghrelin and active ghrelin) and energy intake to LCT. A random-effects meta-analysis was conducted on studies which examined energy intake. Seventeen studies (291 participants) were included in the systematic review, of which 11 were included in the energy intake meta-analysis. Synthesis of combined data showed evidence of a statistically significant moderate decrease in ad libitum energy intake after both acute and chronic ingestion of MCT compared to LCT when assessed under laboratory conditions (mean effect size: -0.444, 95% CI -0.808, -0.080, p  < 0.017), despite little evidence of any effect of MCT on subjective appetite ratings or circulating hormones. The current evidence supports the notion that MCT decreases subsequent energy intake, but does not appear to affect appetite. Further research is warranted to elucidate the mechanisms by which MCT reduce energy intake.

In the Irish mental healthcare system, voluntarily admitted service users can request to leave hospital at any time. Following engagement with treating clinicians, service users remain as voluntary inpatients, are discharged, discharge themselves against medical advice, or are detained under legislation for the purposes of assessment. While detention conflicts with the principle of autonomy and a human rights-based approach, premature discharge is often associated with negative outcomes including reduced time to readmission, poorer quality of life, increased costs, and suicide. This study is a retrospective review of clinical records to identify factors associated with requests for premature discharge. Considerations of clinicians making the decision to detain the person or to support them through the discharge against medical advice process were also elucidated. Data were collected from clinical records of service users who requested discharge and were subsequently discharged against medical advice or detained involuntarily. Discharge against medical advice represented 3.5% of all discharges. The most frequent reasons for requests for discharge against medical advice were dissatisfaction with treatment, lack of engagement due to addiction, and leaving without notifying staff. Requests for discharge against medical advice frequently occurred out of hours, and nurses were the clinicians most likely to receive such requests., (© 2020 Australian College of Mental Health Nurses Inc.)

Cervical spine damage is common in psoriatic arthritis especially in older forms and it is rarely initiated by symptomatic atloid-axoid instability. Spinal involvement is frequently associated with sacroiliac dysfunction, the cervical spine involvement is observed in 35%-75% of cases with two types of radiological lesion. Upper cervical spine localization often manifests as C1-C2 arthritis, lower cervical spine involvement is manifested by syndesmophytes, ossification of the anterior longitudinal ligament and posterior inter apophyseal osteoarthritis. Our case is about a late onset upper cervical spine instability in a 45-year-old patient who has been treated for 20 years for rheumatism and has checked for paraesthesia's of the four limbs and gait difficulty that have been evolving over the last 3 months and the outcome of this case is that a C1-C2 instability must be systematically checked for in view of the appearance of deficient signs., Competing Interests: The authors declare no competing interests., (Copyright: Teka Maher et al.)

Venous thromboprophylaxis consisting of chemical and/or mechanical prophylaxis is administered to patients undergoing adult spinal deformity (ASD) surgery to prevent venous thromboembolic events. However, the true incidence of venous thromboembolism (VTE) after these surgeries is unknown resulting in weak recommendations and lack of consensus regarding type and timing of prophylaxis in these patients. A systematic literature review was conducted to examine VTE incidence in addition to optimal type and timing of VTE prophylaxis. A detailed search was carried out on Embase, PubMed, and Cochrane Library databases through October 18, 2017, for studies that evaluated venous thromboembolic outcomes, type, and timing of prophylaxis administration among ASD surgery patients who were on VTE prophylaxis. The randomized study was assessed for risk of bias using the Cochrane tool and the observational studies using the Newcastle-Ottawa scale (NOS). The search yielded 1180 studies, and three articles published between 1996 and 2008 met the inclusion criteria. There were 583 surgeries performed on 537 patients with a mean age ranging from 45 to 52 years. Females dominated the study with percentages ranging from 60 to 94% in the different study populations. VTE prophylaxis was initiated before surgery in 87.7% patients and intraoperatively in 12.3% patients. VTE incidence ranged between 0 and 9.1% among the studies. VTE can occur after ASD surgery regardless of the type of prophylaxis, and incidence may be higher when mechanical prophylaxis alone is initiated intraoperatively. Further studies to examine VTE prophylaxis in patients undergoing ASD surgery should be considered.

MSH1 is a plant-specific protein. RNAi suppression of MSH1 results in phenotype variability for developmental and stress response pathways. Segregation of the RNAi transgene produces non-genetic msh1 'memory' with multi-generational inheritance. First-generation memory versus non-memory comparison, and six-generation inheritance studies, identifies gene-associated, heritable methylation repatterning. Genome-wide methylome analysis integrated with RNAseq and network-based enrichment studies identifies altered circadian clock networks, and phytohormone and stress response pathways that intersect with circadian control. A total of 373 differentially methylated loci comprising these networks are sufficient to discriminate memory from nonmemory full sibs. Methylation inhibitor 5-azacytidine diminishes the differences between memory and wild type for growth, gene expression and methylation patterning. The msh1 reprogramming is dependent on functional HISTONE DEACETYLASE 6 and methyltransferase MET1, and transition to memory requires the RNA-directed DNA methylation pathway. This system of phenotypic plasticity may serve as a potent model for defining accelerated plant adaptation during environmental change.

Background: The aims of this retrospective study were to compare the functional and radiological outcomes of primary arthrodesis and open reduction internal fixation (ORIF) for the treatment of complete Lisfranc fracture dislocations., Methods: A retrospective cohort study of 39 patients treated for a complete Lisfranc fracture dislocation, defined as Myerson types A and C2, over a period of 8 years at a level 1 trauma centre was performed. Of these, 18 underwent primary arthrodesis, and 21 ORIF. The primary outcome measures included the American Orthopaedic Foot and Ankle Society score, the validated Manchester Oxford Foot Questionnaire functional tool, and the secondary outcome was the radiological Wilppula classification of anatomical reduction., Results: Significantly better functional outcomes were seen in the primary arthrodesis group. These patients had a mean Manchester Oxford Foot Questionnaire score of 30.1 points, compared with 45.1 for the ORIF group (P = 0.017). Similarly, the mean American Orthopaedic Foot and Ankle Society score was 71.8 points in the fusion group versus 62.5 in the ORIF group (P = 0.14). Functional outcome was dependent on the quality of final reduction (P < 0.001). Primary arthrodesis achieved good initial reduction in 83% cases compared to 62% with ORIF (P = 0.138). There was a loss of reduction quality of 47% in the ORIF group over time., Conclusion: Primary arthrodesis for complete Lisfranc fracture dislocations resulted in improved functional outcomes and quality of reduction compared to open reduction and internal fixation., (© 2019 Royal Australasian College of Surgeons.)

The present study examined whether the combination of medium-chain TAG (MCT) along with exercise suppresses energy intake to a greater extent compared with either intervention alone. Twelve participants consumed a porridge breakfast containing 692·9 kJ of either vegetable or MCT oil on two separate occasions: one followed by rest for 240 min and another followed by rest broken up with 1 h of cycling at 65 % $\dot V$O2peak starting at 120 min. At 240 min, participants consumed a buffet lunch to satiation and recorded their food intake for the rest of the day. Expired air samples (for calculation of energy expenditure (EE)) and subjective ratings of appetite on visual analogue scales were taken every 30 min, and gastric emptying (GE) breath samples were taken every 15 min. No effect of either breakfast or exercise condition was observed on energy intake at any time point (P > 0·05) or no effect was observed on subjective appetite ratings (P > 0·05). Exercise trials resulted in significantly higher EE compared with resting trials (2960·6 kJ, 95 % CI 2528·9, 3392·2; P < 0·001), and MCT increased resting EE over 4 h compared with long-chain TAG (LCT) (124·8 kJ, 95 % CI 13·5, 236·0; P = 0·031). GE was accelerated by exercise, regardless of the breakfast consumed, but delayed by MCT in both resting and exercise trials. The results show that exercise causes energy deficits via increased EE without promoting dietary compensation. MCT has no effect on energy intake or satiety but increases EE under resting conditions. There is no additive effect of MCT and exercise on EE, intake or appetite ratings.

Advances in the study of human DNA methylation variation offer a new avenue for the translation of epigenetic research results to clinical applications. Although current approaches to methylome analysis have been helpful in revealing an epigenetic influence in major human diseases, this type of analysis has proven inadequate for the translation of these advances to clinical diagnostics. As in any clinical test, the use of a methylation signal for diagnostic purposes requires the estimation of an optimal cutoff value for the signal, which is necessary to discriminate a signal induced by a disease state from natural background variation. To address this issue, we propose the application of a fundamental signal detection theory and machine learning approaches. Simulation studies and tests of two available methylome datasets from autism and leukemia patients demonstrate the feasibility of this approach in clinical diagnostics, providing high discriminatory power for the methylation signal induced by disease, as well as high classification performance. Specifically, the analysis of whole biomarker genomic regions could suffice for a diagnostic, markedly decreasing its cost.

Consuming medium-chain triglycerides (MCT) may reduce subsequent energy intake and increase satiety compared to long-chain triglycerides (LCT) but this may be dependent on the physical form in which MCT is ingested. Twenty-nine participants completed four trials where they consumed a breakfast containing either LCT or MCT in solid (Con-S and MCT-S, respectively) or liquid (Con-L and MCT-L, respectively) form. Appetite ratings and gastric emptying (GE) were taken at baseline and at 15 min intervals for 4 h. Energy intake was assessed at an ad libitum meal and via weighed food records for the remainder of the day. Ad libitum energy intake was highest in Con-L (4101 ± 1278 kJ vs. Con-S, 3323 ± 1196; MCT-S, 3516 ± 1058; MCT-L, 3257 ± 1345; p = 0.001). Intake over the whole day was significantly lower in MCT-L (7904 ± 3244) compared to Con-L (9531 ± 3557; p = 0.001). There were significant differences in GE times ( p < 0.05), with MCT breakfasts delaying GE to a greater extent than LCT, and MCT-L having the longest GE times. There were no differences in appetite sensations. MCT reduce subsequent intake without affecting subjective sensations of appetite when consumed in liquid form.

The pentane extract of the Peruvian plant, Lepidium meyenii (Maca), has been demonstrated to possess neuroprotective activity in previous in vitro and in vivo studies (Pino-Figueroa et al. in Ann N Y Acad Sci 1199:77-85, 2010; Pino-Figueroa et al. in Am J Neuroprot Neuroregener 3:87-92, 2011). This extract contains a number of macamides that may act on the endocannabinoid system (Pino-Figueroa et al. in Ann N Y Acad Sci 1199:77-85, 2010; Pino-Figueroa et al., 2011; Dini et al. in Food Chem 49:347-349, 1994). The aim of this study was to characterize the inhibitory activity of four of these maccamides (N-benzylstearamide, N-benzyloleamide, N-benzyloctadeca-9Z,12Z-dienamide, and N-benzyloctadeca-9Z,12Z,15Z-trienamide) on fatty acid amide hydrolase (FAAH), an enzyme that is responsible for endocannabinoid degradation in the nervous system (Kumar et al. in Anaesthesia 56:1059-1068, 2001). The four compounds were tested at concentrations between 1 and 100 μM, utilizing an FAAH inhibitor screening assay. The results demonstrated concentration-dependent FAAH inhibitory activities for the four macamides tested. N-Benzyloctadeca-9Z,12Z-dienamide demonstrated the highest FAAH inhibitory activity whereas N-benzylstearamide had the lowest inhibitory activity. In addition, N-benzylstearamide, N-benzyloleamide, and N-benzyloctadeca-9Z,12Z-dienamide demonstrated time-dependent inhibition when tested after a pre-incubation period, indicating that the mechanism of inhibition for these compounds most likely is irreversible. Of interest, unsaturation in the fatty acid moiety resulted in greater FAAH inhibitory activity. LC/MS/MS analysis demonstrated that FAAH was able to hydrolyze N-benzyloctadeca-9Z,12Z-dienamide, suggesting that N-benzyloctadeca-9Z,12Z-dienamide is also a slow substrate for FAAH. These results provide useful information about the mechanism of action of Lepidium meyenii and may help with the development of new compounds with FAAH inhibitory or modulatory activity.

Iron deficiency is closely associated with altered GABA metabolism and affective behavior. While mutation in the hemochromatosis ( HFE) gene disrupts iron homeostasis and promotes oxidative stress that increases the risk of neurodegeneration, it is largely unknown whether HFE mutation modifies GABAergic homeostasis and emotional behavior. The goal of our study was to investigate the impact of HFE on GABAergic neurochemistry and redox-epigenetic regulation in the brain using H67D HFE-mutant mice that recapitulates the H63D-HFE mutation in humans. H67D mice displayed elevated redox-active iron levels in the brain by 32% compared to age-matched wild-type mice. Moreover, the H67D brain had increased isoprostane and decreased glutathione, indicating elevated oxidative stress. Additionally, the H67D brain had decreased global methylation and attenuated DNA methyltransferase (DNMT) activity. Direct addition of iron to purified DNMT in vitro decreased enzyme activity in a concentration-dependent manner. Last, H67D mice exhibited decreased anxiety-like behavior, which was associated with increased expression of the GABA A receptor α2 subunits by 93%, and these changes were also observed in H67D mice fed a low-iron diet. Taken together, our results suggest a putative role of HFE in regulating labile iron status in the brain, and mutation in H67D perturbs redox-methylation status, contributing to GABAergic dysfunction.-Ye, Q., Trivedi, M., Zhang, Y., Böhlke, M., Alsulimani, H., Chang, J., Maher, T., Deth, R., Kim, J. Brain iron loading impairs DNA methylation and alters GABAergic function in mice.

Dietary fat has been implicated in the rise of obesity due to its energy density, palatability and weak effects on satiety. As fat is a major contributor to overall energy intake, incorporating fat with satiating properties could potentially reduce energy intake. This review outlines the potential mechanisms, as far as we know, by which Medium-Chain Triglycerides (MCT), Conjugated Linoleic Acid (CLA), Short-Chain Fatty Acids (SCFA), Diacylglycerol (DAG), n -3 PUFA, and Small Particle Lipids, exerts their satiating effects. The evidence suggests that the lipid with the most potential to enhance satiety is MCT. SCFA can also promote satiety, but oral administration has been linked to poor tolerability rather than satiety. Data on the appetite effects of CLA is limited but does suggest potential. Research comparing these lipids to each other is also lacking and should be explored to elucidate which of these 'functional lipids' is the most beneficial in enhancing satiety.

Intermittent energy restriction (IER) involves short periods of severe energy restriction interspersed with periods of adequate energy intake, and can induce weight loss. Insulin sensitivity is impaired by short-term, complete energy restriction, but the effects of IER are not well known. In randomised order, fourteen lean men (age: 25 (sd 4) years; BMI: 24 (sd 2) kg/m2; body fat: 17 (4) %) consumed 24-h diets providing 100 % (10 441 (sd 812) kJ; energy balance (EB)) or 25 % (2622 (sd 204) kJ; energy restriction (ER)) of estimated energy requirements, followed by an oral glucose tolerance test (OGTT; 75 g of glucose drink) after fasting overnight. Plasma/serum glucose, insulin, NEFA, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic peptide (GIP) and fibroblast growth factor 21 (FGF21) were assessed before and after (0 h) each 24-h dietary intervention, and throughout the 2-h OGTT. Homoeostatic model assessment of insulin resistance (HOMA2-IR) assessed the fasted response and incremental AUC (iAUC) or total AUC (tAUC) were calculated during the OGTT. At 0 h, HOMA2-IR was 23 % lower after ER compared with EB (P<0·05). During the OGTT, serum glucose iAUC (P<0·001), serum insulin iAUC (P<0·05) and plasma NEFA tAUC (P<0·01) were greater during ER, but GLP-1 (P=0·161), GIP (P=0·473) and FGF21 (P=0·497) tAUC were similar between trials. These results demonstrate that severe energy restriction acutely impairs postprandial glycaemic control in lean men, despite reducing HOMA2-IR. Chronic intervention studies are required to elucidate the long-term effects of IER on indices of insulin sensitivity, particularly in the absence of weight loss.

There is a paucity of data examining the effect of cutlery size on the microstructure of within-meal eating behaviour or food intake. Therefore, the present studies examined how manipulation of spoon size influenced these eating behaviour measures in lean young men. In study one, subjects ate a semi-solid porridge breakfast ad libitum, until satiation. In study two, subjects ate a standardised amount of porridge, with mean bite size and mean eating rate covertly measured by observation through a one-way mirror. Both studies involved subjects completing a familiarisation visit and two experimental visits, where they ate with a teaspoon (SMALL) or dessert spoon (LARGE), in randomised order. Subjective appetite measures (hunger, fullness, desire to eat and satisfaction) were made before and after meals. In study one, subjects ate 8 % less food when they ate with the SMALL spoon (SMALL 532 (SD 189) g; LARGE 575 (SD 227) g; P=0·006). In study two, mean bite size (SMALL 10·5 (SD 1·3) g; LARGE 13·7 (SD 2·6) g; P<0·001) and eating rate (SMALL 92 (SD 25) g/min; LARGE 108 (SD 29) g/min; P<0·001) were reduced in the SMALL condition. There were no condition or interaction effects for subjective appetite measures. These results suggest that eating with a small spoon decreases ad libitum food intake, possibly via a cascade of effects on within-meal eating microstructure. A small spoon might be a practical strategy for decreasing bite size and eating rate, likely increasing oral processing, and subsequently decreasing food intake, at least in lean young men.

Acute graft v host disease (AGVHD) is the main complication and cause of non-relapse mortality following allogenic hematopoietic stem cell transplantion. It occurs when donor immune cells attack host tissues. The three main organs that AGVHD affects are skin, liver and gastrointestinal tract, with one or more organs being involved. Extracorporeal photopheresis (ECP) is a second-line treatment for AGVHD in patients who fail to respond to high-dose steroids. It is an immuno-modulatory rather than immunosuppressive therapy. However, ECP is only available in a limited number of regional centres. This article describes how an ECP outpatient unit developed and implemented a fast-response ECP outreach facility for a referring hospital with the aim of improving access to treatment for this patient group.

Next-generation sequencing refers to a high-throughput technology that determines the nucleic acid sequences and identifies variants in a sample. The technology has been introduced into clinical laboratory testing and produces test results for precision medicine. Since next-generation sequencing is relatively new, graduate students, medical students, pathology residents, and other physicians may benefit from a primer to provide a foundation about basic next-generation sequencing methods and applications, as well as specific examples where it has had diagnostic and prognostic utility. Next-generation sequencing technology grew out of advances in multiple fields to produce a sophisticated laboratory test with tremendous potential. Next-generation sequencing may be used in the clinical setting to look for specific genetic alterations in patients with cancer, diagnose inherited conditions such as cystic fibrosis, and detect and profile microbial organisms. This primer will review DNA sequencing technology, the commercialization of next-generation sequencing, and clinical uses of next-generation sequencing. Specific applications where next-generation sequencing has demonstrated utility in oncology are provided., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

It is well established that the consumption of medium-chain triglycerides (MCT) can increase satiety and reduce food intake. Many media articles promote the use of coconut oil for weight loss advocating similar health benefits to that of MCT. The aim of this study was to examine the effect of MCT oil compared to coconut oil and control oil on food intake and satiety. Following an overnight fast, participants consumed a test breakfast smoothie containing 205kcal of either (i) MCT oil (ii) coconut oil or (iii) vegetable oil (control) on three separate test days. Participants recorded appetite ratings on visual analogue scales and were presented with an ad libitum lunch meal of preselected sandwiches 180min after consumption of the breakfast. The results showed a significant difference in energy and macronutrient intakes at the ad libitum meal between the three oils with the MCT oil reducing food intake compared to the coconut and control oil. Differences in food intake throughout the day were found for energy and fat, with the control having increased food intake compared to the MCT and coconut. The MCT also increased fullness over the three hours after breakfast compared to the control and coconut oils. The coconut oil was also reported as being less palatable than the MCT oil. The results of this study confirm the differences that exist between MCT and coconut oil such that coconut oil cannot be promoted as having similar effects to MCT oil on food intake and satiety., (Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.)

Extracorporeal photopheresis (ECP) has been used for over 35 years in the treatment of erythrodermic cutaneous T-cell lymphoma (CTCL) and over 20 years for chronic and acute graft-versus-host disease (GvHD) and solid organ transplant rejection. ECP for CTCL and GvHD is available at specialised centres across the UK. The lack of prospective randomised trials in ECP led to the development of UK Consensus Statements for patient selection, treatment schedules, monitoring protocols and patient assessment criteria for ECP. The recent literature has been reviewed and considered when writing this update. Most notably, the national transition from the UVAR XTS ® machine to the new CELLEX machine for ECP with dual access and a shorter treatment time has led to relevant changes in these schedules. This consensus statement updates the previous statement from 2007 on the treatment of CTCL and GvHD with ECP using evidence based medicine and best medical practise and includes guidelines for both children and adults., (© 2017 The Authors. British Journal of Haematology published by John Wiley & Sons Ltd.)

The styloid process arising from the temporal bone is normally about 2.5 cm in length. For various reasons, including trauma and inflammation, it may become elongated. This elongated styloid process, when symptomatic with clinical signs and symptoms suggestive of local compression or neuropathic pain, is termed Eagle syndrome. Glossopharyngeal neuralgia is characterized by intermittent shooting sharp pain in the jaw, throat, tongue, and ear. Conservative management includes anticonvulsants, tricyclic antidepressants, and anti-inflammatory agents. Interventional and surgical options are pursued when these fail. Fluoroscopy is usually used to position the needle adjacent to the styloid process for injecting steroid and or local anesthetic. We describe a case of a 41-year-old woman with Eagle syndrome who failed conservative management and subsequently underwent an ultrasound-guided peristyloid steroid injection with short-duration pain relief., (Published 2016. This article is a U.S. Government work and is in the public domain in the USA.)

Background: Few studies have described clinical characteristics of patients subject to an involuntary detention in an Irish context. The Irish Mental Health Act 2001 makes provision under Section 23(1), whereby a person who has voluntary admission status can be detained. Aims This study aimed to describe all involuntary admissions to St Patrick's University Hospital (SPUH) (2011-2013) and to evaluate clinical characteristics of voluntary patients who underwent Mental Health Act assessment during 2011 to determine differences in those who had involuntary admission orders completed and those who did not., Methods: All uses of Mental Health Act 2001 within SPUH 2011-2013 were identified. All uses of Section 23(1) during 2011 were reviewed and relevant documents/case-notes examined using a pro forma covering clinical data, factors recognized to influence involuntary admissions and validated scales were used to determine diagnoses, insight, suicide and violence risk., Results: Over 2011-2013, 2.5-3.8% of all admissions were involuntary with more detained after use of Section 23(1) than Section 14(2). The majority of initiations of Section 23(1) did not result in an involuntary admission (72%), occurred out of hours (52%) and many occurred early after admission (<1 week, 43%). Initiation of Section 23(1) by a consultant psychiatrist (p=0.001), suicide risk (p=0.03) and lack of patient insight into treatment (p=0.007) predicted conversion to involuntary admission., Conclusion: This study predicts a role for patient insight, suicide risk and consultant psychiatrist decision making in the initiation of Mental Health Act assessment of voluntary patients. Further data describing the involuntary admissions process in an Irish setting are needed.

A recently discovered class of endogenous mammalian lipids, branched fatty acid esters of hydroxy fatty acids (FAHFAs), possesses anti-diabetic and anti-inflammatory activities. Here, we identified and validated carboxyl ester lipase (CEL), a pancreatic enzyme hydrolyzing cholesteryl esters and other dietary lipids, as a FAHFA hydrolase. Variants of CEL have been linked to maturity-onset diabetes of the young, type 8 (MODY8), and to chronic pancreatitis. We tested the FAHFA hydrolysis activity of the CEL MODY8 variant and found a modest increase in activity as compared with that of the normal enzyme. Together, the data suggest that CEL might break down dietary FAHFAs.