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Gastrointestinal (GI) motility is regulated in part by electrophysiological events called slow waves, which are generated by the interstitial cells of Cajal (ICC). Slow waves propagate by a process of "entrainment," which occurs over a decreasing gradient of intrinsic frequencies in the antegrade direction across much of the GI tract. Abnormal initiation and conduction of slow waves have been demonstrated in, and linked to, a number of GI motility disorders. A range of mathematical models have been developed to study abnormal slow waves and applied to propose novel methods for non-invasive detection and therapy. This review provides a general outline of GI slow wave abnormalities and their recent classification using multi-electrode (high-resolution) mapping methods, with a particular emphasis on the spatial patterns of these abnormal activities. The recently-developed mathematical models are introduced in order of their biophysical scale from cellular to whole-organ levels. The modeling techniques, main findings from the simulations, and potential future directions arising fromnotable studies are discussed. [ABSTRACT FROM AUTHOR]

Background Gastrointestinal (GI) surgeries represent a significant proportion of the surgical site infection (SSI) burden in pediatric patients, resulting in significant morbidity. Previous studies have shown that perioperative bundles reduce SSIs, but few have focused on pediatric GI operations. We hypothesized that a GI bundle would decrease SSI rates, length of stay (LOS), and hospital charges. Methods After establishing baseline SSI rates, a GI bundle was created and implemented in November 2014. We prospectively collected data including demographics, procedure type, LOS, inpatient charges, bundle compliance, and SSI development. We analyzed SSI rates, LOS, and charges using process control charts. Results The baseline SSI rate for all GI operations was 3.4%, which increased to 7.1%, then decreased to 4.7%. Midgut/hindgut and stoma closure SSI rates decreased from 11.3% to 8.0% (p < 0.05) and 21.4% to 7.9%, respectively ( p < 0.05). Although overall LOS and charges were unchanged, average LOS for midgut/hindgut surgeries and stoma closures decreased from 20.3 to 13.6 days ( p = 0.015) and 12.6 to 7.9 days ( p = 0.04), respectively. Stoma closure charges decreased from $94,262 to $50,088 ( p = 0.01). Conclusions Our perioperative GI bundle decreased SSI rates, primarily among midgut/hindgut operations. Bundle usage decreased LOS and charges most effectively in stoma closures. Type of study Prognosis Study. Level of evidence Level 2. [ABSTRACT FROM AUTHOR]

Hirschsprung disease (HD) rarely presents as chronic constipation after the newborn period. At our institution, calretinin immunohistochemistry (CAL) is frequently requested by clinicians on rectal mucosal biopsies (RMBs) taken during colonoscopy in older children in whom suspicion for HD is low. We hypothesized that review of these biopsies would frequently reveal ganglion cells (GCs). We reviewed features of mucosal biopsies (November 2013 to September 2015) from children ≥1 year of age on which clinicians had requested CAL on at least one specimen. A total of 93 biopsies with paired CAL from 83 patients were suitable for study (ages 1–18 years, M:F 1.2). Submitted clinical indication was constipation in 62 patients (75%). GCs were found within or subjacent to muscularis mucosa in 63 biopsies (68%), 12 (19%) of which were designated from a specific anatomic site, eg, 2 or 3 cm. In 25 of 63 (40%) cases, GCs were identified on one of the first 3 sections (median 5th, range 1st–54th). Forty-six cases (73%) contained no or <0.5 mm of submucosa (SM, range 0–2 mm). All but one case (62/63, 98%) with identified GCs showed positive CAL staining; a single case showed equivocal staining. Among the 30 biopsies with no observed GCs, none (0%) had >1 mm of SM, and 21 (70%) had no SM. CAL was positive in 28 (93%) and equivocal/weak in 2 (7%); no additional work-up for HD was pursued. The data suggest that H&E sections of RMBs can exclude HD at a specified site in many cases and provide the basis for a future study examining the utility of CAL in RMBs without SM as a means for excluding HD. [ABSTRACT FROM AUTHOR]

Objective: Epidemiological data on genitourinary infections (GUIs) comparing patients with and without type 2 diabetes (T2DM) is scant. We aimed to estimate the incidence of urinary tract infections (UTIs), genital infections (GIs), or any GUI in total and stratified by history of GUI and sex.Research Design and Methods: We identified 39,295 patients in the Kaiser Permanente Northwest health plan with T2DM and an equal number of age and sex matched patients without diabetes. The cohort was followed for up to 9years (2006-2014). We calculated incidence rates and corresponding 95% confidence intervals (CI) of any GUI, UTIs and GIs adjusting for age, sex, race, BMI, presence of chronic kidney disease, annual number of outpatient visits, and diuretic use.Results: Adjusted incidence of any GUI was 97.2/1000person-years (p-y) (95% CI 95.5-98.8) among the T2DM cohort vs. 79.7/1000 p-y (78.3-81.2) among those without diabetes. T2DM was associated with an adjusted 25% increased risk of UTI (rate ratio 1.25, 95% CI 1.22-1.29), a 26% increased risk of GI (1.26, 1.22-1.31) and a 22% increased risk of any GUI (1.22, 1.19-1.25). Incidence rates were lower among those with no GUI history, but the relative risks were similar. Women in both groups had higher incidence rates of GUIs than men.Conclusions: T2DM was associated with increased risks of any GUI, UTIs and GIs. Incidence rates of UTIs were higher than rates of GIs, but the relative risk of GIs was essentially identical. A similar pattern was observed when stratifying by sex.Significance Of the Study: RESEARCH QUESTIONS. [ABSTRACT FROM AUTHOR]

History of present illness: A 75-year-old female presented with jaundice and abdominal pain for 3 weeks. She denied any fevers, confusion, or urinary complaints. On exam, she was afebrile and hemodynamically normal, but had focal tenderness in her right upper quadrant. Her neurologic exam was normal. Significant findings: Computed tomography (CT) was significant for two large gallstones measuring 1.1 centimeters impacted at the level of the pancreatic head with associated common bile duct (CBD) dilatation. Discussion: Choledocholithiasis is characterized by the presence of gallstones in the CBD. As one ages, the common bile duct enlarges, facilitating the passage of a gallstone into the CBD increasing the likelihood of developing choledocholithiasis.1 Complications associated with choledocholithiasis include pancreatitis, biliary cirrhosis, and acute cholangitis. Charcot’s Triad (fever, right upper quadrant pain, and jaundice) is the classic presentation for Acute Cholangitis; however, only 50%-75% of patients have all three symptoms.2 Significant mortality is associated with Reynaud’s Pentad, or the development of fever, right upper quadrant pain, jaundice, hypotension, and altered mental status.3 Sonographic measurement of CBD diameter, from inner wall to inner wall, is often sufficient for the diagnosis. Normal diameter increases 1 mm with every decade of life, with 8.5 mm having been described as the upper limit of normal.4 However, CBD dilatation up to 10 mm after cholecystectomy has been described.5 Sensitivity of an enlarged CBD in diagnosing choledocholithiasis varies from 20%-90%. 6 In some cases, CBD dilatation is not recognized on ultrasound, but is later found on CT imaging. Sensitivity of CT has been documented as high as 65%-93% with specificities approaching 100%.7 Due to lower morbidity and mortality rates, endoscopic retrograde cholangiopancreatography (ERCP) is the preferred modality for decompression of the biliary system. Some studies quote mortality rates of ERCP as low as 4.7%-10% compared to 10%-50% with open surgical decompression.8,9

History of present illness: A 51-year-old male with history of gastroesophageal reflux disease status post multiple endoscopies presented to the emergency department with severe abdominal pain. Paramedics reported the patient appeared diaphoretic on arrival and maintained stable vital signs during transit. The patient reported taking Prilosec that morning before eating breakfast, after which he felt like something was stuck in his throat with abrupt onset of abdominal pain radiating to his back and associated dyspnea, described as “the worst pain of my life.” The patient denied nausea or vomiting. On exam he was diaphoretic, in moderate distress and clutching his chest. He had clear breath sounds bilaterally and normal heart sounds. His abdomen was soft and tender to palpation in the epigastrium without rebound or guarding. Significant findings: CT chest angiogram demonstrated extensive pneumomediastinum (blue outline) with mural thickening (green outline) and mural air within the distal esophagus (purple outline), in addition to adjacent air-fluid levels (yellow outline), suggestive of esophageal perforation, likely consistent with Boerhaave syndrome. Discussion: Esophageal perforation is a life-threatening event often requiring urgent or emergent surgery, which can be delayed due to nonspecific presentations that make it difficult to diagnose.1,2,3 The mortality rate can be as high as 20% and delaying treatment for more than 24 hours doubles this risk.4,5 Iatrogenic causes account for the majority of esophageal perforations (55%-70%), followed by spontaneous rupture (15%), foreign body ingestion (10%-14%), and traumatic perforation (10%-23%).1,2,4 Pain referring directly to the site of perforation is the most common presenting symptom, and can mislead clinicians to focus on other intrathoracic organs of more immediate interest such as the heart and lungs. Intrathoracic and intraabdominal perforations are more severe than cervical perforations and may present with characteristic signs of systemic sepsis such as tachycardia, tachypnea, and fever.6,3 CT esophagography showing pleural effusions, pneumomediastinum, subcutaneous emphysema, hydrothorax, hydropneumothorax, and subdiaphragmatic air are all suggestive of a perforation with a sensitivity and specificity of 78% and 94%.3,7 Primary repair by a trained surgeon remains the most successful treatment option, reducing mortality by up to 70% compared to nonoperative management.1,2,3 More conservative treatment may be considered in select cases of well-contained perforations with minimal contamination.4 The patient in this case underwent emergent primary surgical repair of a distal esophageal perforation and removal of an impacted bezoar with endoscopy. The patient did well post-operatively and was discharged in stable condition.

History of present illness: A 67-year-old man with no past medical history presented to the emergency department with complaints of diffuse abdominal pain, distension, constipation, lack of flatus, diaphoresis, nausea, and vomiting for three days. He denied history of recent trauma. Vital signs were significant only for low-grade fever and tachycardia. Exam revealed a soft, distended abdomen with generalized tenderness to light palpation without peritoneal signs. Prior to computed tomography of the abdomen and pelvis, bedside ultrasound of the abdomen was performed. Significant findings: Bedside ultrasound revealed a large volume of free fluid in the right upper quadrant and in the pelvis. The fluid appeared complex with multiple septations. Its appearance was not consistent with ascites or acute intra-abdominal free fluid due to striations and pockets. Discussion: The patient was taken to the operating room and found to have a 2 cm pre-pyloric gastric perforation and 3-4 liters of pus in the abdomen. Severe intra-abdominal infections as was found in this patient carry a mortality rate of 30-50%.1 In the absence of pneumoperitoneum found on plain films, bedside ultrasound can be used to confirm intestinal paresis and intraperitoneal fluid suggesting a perforated viscous.2 It can also be used with greater sensitivity than radiography (93% vs 79%) to detect pneumoperitoneum itself.3 While computed tomography remains the gold standard for diagnosing intra-abdominal abscesses, bedside ultrasound offers a rapid alternative diagnostic modality that can be particularly useful in the hemodynamically unstable patient. The sensitivity of ultrasound for spontaneous (not post-operative) intra-abdominal abscess is 92% with increased sensitivity for finding abscesses located in the right and left upper quadrant and in the pelvis.4 Although bedside ultrasound was unable to diagnose gastric perforation as the specific etiology for the patient’s intra-abdominal abscess, it provided more than ample information to justify an emergent and most likely life-saving exploratory laparotomy.

History of present illness: A 12-year-old female with no past medical history presented with abdominal pain for 3 months. The pain was intermittent, located at the epigastric region, non-radiating, fluctuating intensity up to 8/10, and had worsened over the past month. She did not have fever, nausea, vomiting, diarrhea, constipation, or blood in her stool. The patient also endorsed hair loss over the same time period and noted that her previously long hair was now short and thin. On exam, patient was noted to have shoulder-length hair, a soft, non-distended abdomen with mild tenderness to the epigastric region, and a 5cm hard mass palpated at the epigastrium. Significant findings: In the abdominal radiograph, a nonspecific and non-obstructive bowel gas pattern with no air-fluid level was noted, however the stomach was distended with soft tissue. The CT abdomen/pelvis revealed a distended stomach with undigested heterogeneous contents (presumed bezoar). Discussion: A bezoar is a mass of incompletely digested material typically originating in the stomach and consisting of vegetable fibers, hair, or drugs.1 Bezoars develop after ingested foreign material accumulates in the gastrointestinal tract due to indigestibility, gastric outlet obstruction, or intestinal stasis. Trichobezoars are comprised of hair and classically form in young females with an underlying psychiatric disorder resulting in the urge to pull one’s hair out (trichotillomania) and swallow it (trichophagia).2,3 Gastric bezoars are rare with an approximate incidence of 0.3 percent of patients undergoing upper endoscopy.4 Patients tend to remain asymptomatic for long periods, but may develop abdominal pain, nausea/vomiting, early satiety, anorexia, and weight loss.5 Complications may include gastrointestinal ulcerations, perforations, intussusception, pancreatitis, obstructive jaundice, and death.6-8 The diagnosis of a gastric bezoar can be made using plain films, ultrasound, or CT, and is confirmed via upper endoscopy.2,9 Management of gastric bezoars should be dictated by its composition and may include chemical dissolution, endoscopic removal, or surgical removal.6,9 Our patient underwent urgent surgical removal of the gastric trichobezoar.

History of Present Illness: A 55-year-old female presented via transfer from a referring hospital with 48 hours of abdominal pain, vomiting and dyspnea. She was found to be in severe distress. Her temperature was 37.5° C (99.5° F), heart rate 130 beats per minute, respiratory rate 47 breaths per minute, blood pressure 80/48, and oxygen saturation of 95% on a non-rebreather mask. She had distended neck veins, diminished breath sounds on the left hemi-thorax, and a distended abdomen. A chest x-ray that had been obtained at the referring hospital was immediately reviewed. The decision was made to intubate the patient. Following intubation, a nasogastric tube was placed with marked improvement in her hemodynamics. An abdomen-pelvis CT was obtained which showed a para-esophageal hernia with the majority of the stomach located in the left hemi-thorax and evidence of a bowel obstruction. Significant findings: Radiography shows a dilated, gas-filled structure that fills nearly the entire left hemi-thorax. Lung markings are visible in the uppermost portion of the left hemi-thorax. There is mediastinal shift to the right. In the visualized portion of the abdomen, dilated loops of bowel are also visualized. This constellation of findings is consistent with a tension gastrothorax. Discussion: Tension gastrothorax is a rare complication of blunt trauma, diaphragmatic hernias, and certain surgical procedures.1,2 Clinically, a tension gastrothorax may mimic that of a tension pneumothorax, making it difficult to diagnose.3,4 Stabilizing treatment includes decompressing the stomach by means of a nasogastric (NG) tube.2 Placement may be difficult due the intra-thoracic position of the stomach leading to kinking of the tube. The attempt to place an NG tube can lead to hyperventilation and air swallowing, which can aggravate gastric distention.4 Failure to decompress the stomach, however, may lead to patient decompensation and cardiac arrest.5 Definitive treatment is surgical repair.2

In order to elucidate the main aspects related to dolphinfish reproduction around Saint Peter and Saint Paul Archipelago, 862 individuals caught in that area by commercial handline fishing were examined between 2007 and 2011. From those specimens, it was possible to assess the sex in 782 specimens (271 males and 511 females) and the levels of gonadal maturation in 536 of them (175 males and 361 females). The fork length (FL) of the examined specimens varied between 27 and 150 cm. Sex ratio found was 1.0 male: 1.9 females, but the difference was not statistically significant in April (χ2=0.08), August (χ2=0.82) and October (χ2=3.63). However, by size interval, sex ratio was 1.0 male: 1.0 female for FL between 120 and 130 cm. The gonadal index showed the highest values in February for males and in April for females. Most spawning-capable specimens were found in February (males 36.4%) and in May (females 42.2%). The length of size-at-50%-maturity (L50) was estimated at 70.66 cm FL for males and 68.60 cm FL for females. The results suggest that the period of highest reproductive activity occurs between April and June.

Tujuan dari penelitian ini adalah untuk mengetahui : ( 1 ) yang model GI , TPS atau hasil pembelajaran konvensional pada prestasi belajar yang lebih baik dalam belajar matematika , (2 ) yang siswa kelas sikap terhadap matematika positif , netral , atau negatif hasil jenis dalam prestasi belajar yang lebih baik dalam matematika , (3 ) pada masing-masing siswa kelas sikap terhadap matematika , yang model GI pembelajaran , TPS atau hasil pembelajaran konvensional pada prestasi belajar yang lebih baik dalam matematika , dan ( 4 ) di masing-masing model pembelajaran , yang siswa kelas sikap terhadap matematika positif , netral , atau negatif hasil jenis dalam prestasi belajar yang lebih baik dalam matematika . Penelitian ini menggunakan metode penelitian eksperimen kuasi dengan desain faktorial 3x3 . Populasinya adalah semua siswa kelas di IKIP PGRI Madiun semester V 2013/2014. Sampel penelitian diambil dengan menggunakan teknik cluster random sampling . Data penelitian dianalisis dengan menggunakan analisis dua arah tidak seimbang varians pada tingkat signifikansi 5 %. Hasil penelitian ini menunjukkan bahwa : ( 1 ) model pembelajaran GI dan TPS menghasilkan prestasi belajar yang baik yang sama dalam matematika , namun kedua hasil dalam prestasi belajar yang lebih baik dalam matematika dibandingkan dengan model pembelajaran konvensional , ( 2) prestasi belajar matematika dengan sikap positif terhadap matematika adalah lebih baik dari itu dengan sikap netral dan negatif terhadap matematics , bahwa dengan sikap netral terhadap matematics adalah lebih baik dari itu dengan sikap negatif terhadap matematika , (3 ) pada masing-masing siswa sikap terhadap jenis matematika , GI dan model pembelajaran TPS hasil dalam pencapaian yang sama baik belajar di matematika , tapi baik mengakibatkan prestasi belajar yang lebih baik dalam matematika daripada model pembelajaran konvensional , (4 ) pada masing-masing model pembelajaran , prestasi belajar dengan sikap positif terhadap matematika matematika adalah lebih baik dari itu dengan netral dan sikap negatif terhadap matematics , bahwa dengan sikap netral terhadap matematics adalah lebih baik dari itu dengan sikap negatif terhadap matematika.

Genetically modified organisms (GMO) are organisms whose genetic modification of heritable genetic material (DNA) is a planned amendment to the unnatural way by applying modern techniques of genetic engineering, or, a gene or genes from one organism are inserted into another organism, what in nature with a natural breeding would never be created. GMOs are a source of modified laboratory food, supplements and various additives. The subject of this research paper is to see the impact of GM food as a threat or a benefit on the health of humans and animals, as well as its application in the Republic of Macedonia. Comparative analysis of scientific research in the field of modern biotechnology science using the technique of genetic engineering has been used in this paper. From the analysis of previous research, there are no official data on possible effects on human health, and animal tests have shown negative effects on their health.

This study shows that a physically decoupled but hydraulically linked design focusing on surface infiltration components (i.e., excluding underdrain and infiltration bed systems) can be the preferred way to have a low-cost and robust stormwater control measure (SCM) system. The SCM under investigation in Philadelphia, PA, is a green infrastructure (GI) and has a mirrored design of two sets of hydraulically linked planters. Each planter has an overflow pipe connected to an underground infiltration bed. The system showed excellent overall performance as no overflow/bypass entering the combined sewer. A large variation of saturated hydraulic conductivity was found for the planter soil, and the planter with lower saturated hydraulic conductivity created surface runoff that overflows to the next planter in line. Due to the linked design, the unexpected deviation of performance of a single planter did not affect overall system performance. The infiltration bed showed great variation in water drawdown rate at different water depth, which could be caused by the possible high heterogeneity of the native soil. The study argued that overflow systems, which handled only about 18% of runoff in this study, can be replaced by slightly larger surface area for lower building cost, lower maintenance cost, and more reliable performance.

Penelitian ini bertujuan untuk mendeskripsikan (1) keefektifan model pembelajaran kooperatif tipe TGT dan GI dan (2) mendeskripsikan perbandingan keefektifan model pembelajaran kooperatif tipe TGT dan GI ditinjau dari ketercapaian standar kompetensi, sikap, dan minat siswa terhadap matematika. Populasi penelitian ini adalah siswa kelas VII SMP Negeri 1 Unter Iwes Sumbawa yang terdiri atas 6 kelas. Dua kelas diambil secara acak sebagai sampel, yaitu kelas VII.3 dan VII.4. Kelas VII.3 belajar dengan model pembelajaran kooperatif tipe TGT, sedangkan kelas VII.4 belajar dengan model pembelajaran kooperatif tipe GI. Data penelitian dianalisis dengan uji One sample t test, uji T2 hoteling’s pada signifikansi 5% dan uji Independent t test. Hasil penelitian menunjukkan bahwa (1) pembelajaran matematika dengan model pembelajaran kooperatif tipe TGT dan GI efektif ditinjau dari ketercapaian standar kompetensi, sikap, dan minat siswa terhadap matematik dan (2) model pembelajaran kooperatif tipe TGT lebih efektif dibandingkan dengan model pembelajaran kooperatif tipe GI ditinjau dari ketercapaian standar kompetensi, sikap, dan minat siswa terhadap matematika. Kata Kunci: pembelajaran kooperatif, TGT, GI, ketercapaian standar kompetensi, sikap, minat. The Effectiveness of Cooperative Learning of TGT and GI Types in Terms of Achievement of Competence Standard, Attitude, Interest Mathematics Abstract This study aims to describe (1) the effectiveness of cooperative learning model of TGT and GI type and (2) describe the comparison between the effectiveness of cooperative learning model of TGT and GI type in terms of achievement of competence standard, attitude, and interest of student toward mathematics. The research population was a Class VII student of SMP Negeri 1 Unter Iwes Sumbawa which consisted of 6 classes. Two classes, namely Class VII.4 and Class VII.3 as the research sample. Class VII.3 learned through the cooperative learning of TGT type and Class VII.4 learned through the cooperative learning of GI type. The data were analyzed using One sample t test, T2 Hoteling’s at the significance level of 5% and Independent t test. The results of the study show that: (1) mathematics learning with cooperative learning model of TGT and GI type is effective in terms of achievement of competence standard, attitude, and interests of student towards mathematic, and (2) cooperative learning model of TGT type is more effective compared with the cooperative learning model of GI type in terms of achievement of competence standard, attitude, and interest of student toward mathematics. Keywords: cooperative learning, TGT, GI, achievement of competency standard, attitude, interest.

High glycaemic index (GI) foods have been proposed to reduce satiety and thus promote overweight and obesity. Generally, potatoes have a high GI, but they also provide many beneficial nutrients and they are a highly important food source globally. In this study, we investigated how a low GI potato affected subjective satiety as compared to a high GI potato. Twenty healthy men (aged 18⁻40 years; body mass index (BMI) 18⁻27 kg/m2) participated in this single-blinded, controlled, randomised crossover trial. On each of the two trial days, the subjects were given a 500-gram portion of either a low or high GI potato variety (Carisma® low GI and Arizona high GI). Subjective appetite sensations were measured at baseline and at +15 min, +45 min, +75 min, +105 min, and +135 min after consumption of the test meal until an ad libitum meal was served at +150 min. No significant differences in the primary endpoint, satiety, were found between the two potato varieties (all p > 0.05). Furthermore, no significant differences were found in the secondary endpoints; hunger, fullness, and prospective food consumption, or ad libitum energy intake (all p > 0.05). In conclusion, the results of this study do not indicate that the GI of potatoes is important for satiety in normal-weight men.

A large outbreak of dengue occurred in Tamil Nadu, South India in 2012 with 12,000 cases and CFR of 0.5%. Molecular characterization of virus present in the sera of dengue patients was undertaken to determine if there were changes in the virus population. All four serotypes were circulating but DENV-1 was dominant, present in 52% of the serotyped samples. Furthermore, the genotype of only DENV-1 had changed; the Asian genotype had displaced the American/African. Phylogenetic analysis revealed that the Asian genotype was introduced from Singapore and shared 99% similarity with viruses, associated with large outbreaks in Singapore and Sri Lanka. We report for the first time the emergence of the Asian genotype of DENV-1 in southern India causing an extensive and severe outbreak. The study proves how movement of DENV can affect dengue outbreaks and underscores the need for close molecular monitoring of DENV. [ABSTRACT FROM AUTHOR]

Background:Cannabinoid hyperemesis syndrome (CHS) is characterized by symptoms of cyclic abdominal pain, nausea, and vomiting in the setting of prolonged cannabis use. The transient receptor potential vanilloid 1 (TRPV1) receptor may be involved in this syndrome. Topical capsaicin is a proposed treatment for CHS; it binds TRPV1 with high specificity, impairing substance P signaling in the area postrema and nucleus tractus solitarius via overstimulation of TRPV1. This may explain its apparent antiemetic effect in this syndrome. Purpose:We describe a series of thirteen cases of suspected cannabis hyperemesis syndrome treated with capsaicin in the emergency departments of two academic medical centers. Methods:A query of the electronic health record at both centers identified thirteen patients with documented daily cannabis use and symptoms consistent with CHS who were administered topical capsaicin cream for symptom management. Results:All 13 patients experienced symptom relief after administration of capsaicin cream. Conclusion:Topical capsaicin was associated with improvement in symptoms of CHS after other treatments failed. [ABSTRACT FROM AUTHOR]

This study focused on decadalvariations of extreme precipitation thresholds within a 50-year period (1961-2010) for 250 stations of Iran's northwest. The 99th percentile was used as the threshold of extreme precipitation. In order to analyze threshold cycles and spatial autocorrelation pattern dominating extreme precipitation thresholds, spectral analysis and Gi (known as HOTSPOT) were used respectively. The results revealed that the highest threshold of extreme precipitation occurred along the Ghoosheh Dagh mountain range. Additionally, in all the five studied decades, the highest positive anomalies were observed in the same region (i.e., the Ghoosheh Dagh). The findings also showed that the intensity of positive spatial autocorrelation pattern of extreme precipitation thresholds experienced a declining trend in recent decades. At the same time, extreme precipitation weighted mean center indicated that they followed an ordered pattern during the studied period. The results of harmonic analysis demonstrated that, in all decades, short-term (2-4 years) and mid-term (4-8 years) cycles of extreme precipitation thresholds were dominated. However, especially the southwest of the studied area, the return period of extreme precipitation thresholds was as long as the studied period, a phenomenon that indicates the existence of a trend in extreme precipitation thresholds of these regions. [ABSTRACT FROM AUTHOR]

Longan ( Dimocarpus longan Lour.) is a subtropical fruit tree of significant economic importance. Flowering is a key event in longan and other fruit trees. In this study, GIGANTEA ( GI) and FLAVIN-BINDING, KELCH REPEAT, F-BOX1 ( FKF1) homologs were cloned from longan and named DlGI and DlFKF1, respectively. Translated sequences of DlGI and DlFKF1 revealed a high homology to GI and FKF1 sequences from other plants. DlGI and DlFKF1 transcript levels varied seasonally in the shoots and leaves during floral bud differentiation of longan. Expression levels of DlGI and DlFKF1 in the shoot tips increased and reached a peak in November which is the time of physiological differentiation of floral buds in longan. Ectopic overexpression of DlGI and DlFKF1 in Arabidopsis resulted in early-flowering phenotypes and adventitious root formation under LD conditions. The expression levels of YUCCA 9 and PIN-FORMED 2 were found to be elevated in DlGI-overexpressing and DlFKF1-overexpressing Arabidopsis plants under LD conditions. These results suggest that both DlGI and DlFKF1 are flowering promoters and they might be involved in the regulation of physiological differentiation of floral buds, inducing floral initiation by affecting endogenous auxin synthesis and transport in longan. Our results will provide more insight into flowering regulation in longan and woody plants. [ABSTRACT FROM AUTHOR]

Introduction:Upper gastrointestinal bleeding (UGIB) is the key emergency situation in clinical endoscopy and is traditionally treated with injection, thermal or through the scope clipping therapy. Mortality rates are in the range of 8–10% and demand new treatment approaches. The Over-The-Scope Clip (OTSC®) has been described as a very effective hemostatic device in UGIB. We compared OTSC with the Padlock™ device in an established pre-clinical setting. Material and methods:Our test-bed consisted of the biohybrid EASIE model using soft silicone tubes, tunneled into the gastric wall and surfacing at a mucosa defect, representing the bleeding site. After successful deployment of the OTSC and Padlock devices on the spurting ulcer bleed (Forrest Ia) the vessel tubes were pressurized with a manometer to 120 mmHg. Tight closure at this pressure was defined as successful hemostasis (primary endpoint).N = 11 procedures were done with each device. Statistical testing was done using Fisher’s exact test. Sample size was adjusted to an assumed α-error of 5% (two-sided test) and a power of 80%. Results:Technically correct placement of the respective hemostatic device was achieved in all procedures. A statistically significant difference was found in the primary endpoint. In OTSC the success proportion was 100%; 11/11 (95% KI 74.1% to 100%); in Padlock it was 0%; 0/11 (95% KI 0%–25.8%). This means that no bleeding was stopped by Padlock. The mean value of perfusion pressure resistance was 300 mmHg (cut-off) for OTSC and 9.2 ± 8.4 mmHg for Padlock. Discussion:Our data on hemostatic function of OTSC coincide with the clinical literature and earlier pre-clinical studies in the EASIE model, which is widely accepted as a realistic and effective simulation system for clinical conditions. The inability of Padlock to stop hemorrhage may be due to design differences and, thus, its limitation in providing tight sealing of the clipped tissue. Conclusion:Different types of endoscope-tip mounted clips have different performances. OTSC consistently stops simulated spurting bleeding, Padlock fails to do so. These differences are statistically significant.ABSTRACT FROM PUBLISHERCopyright of Minimally Invasive Therapy & Allied Technologies is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. [ABSTRACT FROM AUTHOR]

Based on the orthogonality between the used and the unused spreading codes (excess codes) subspaces in one hand and on the restoration of guard interval redundancy of Multicarrier Code Division Multiple Access signal in other hand, we propose joint Carrier Frequency Offset and time domain equalizer estimators. A major difficulty arises from the highly complexity of these methods. Use of an approximation method or an adaptive algorithm has been popular approach to ease problem solving. Our derived methods are found to be good in terms of estimation accuracies, computation complexity, and convergence speed when compared to the block processing algorithms. [ABSTRACT FROM AUTHOR]

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Background This study was to assess effects of carvedilol on ventricular remodeling and expression of β 3 -adrenergic receptor (β 3 -AR) and Gi protein in a rat model of diabetes subjected to myocardial infarction (MI). Methods Rat model of type II diabetes was established by injection of streptozotion. MI was then induced by ligating the left anterior descending coronary artery. Rats were then randomly divided into two groups treated with either placebo (PL) or carvedilol (CA - 10 mg·kg − 1 ·d − 1 ). Additional controls consisted of sham-operated rats with diabetes (DS) and rats fed a normal diet subjected to myocardial infarction (NM). Echocardiographic and hemodynamic studies were performed to assess the structural and functional changes. β 3 -AR and Gi mRNA in the myocardium distal from the infarction region were measured, and β 3 -AR and Gi protein were measured with western blot. Results There were no significant differences in MI size among the three MI groups. In the PL group, LVEDd, LVWI, E/A and CVF were significantly increased, while LVEF and PW% significantly decreased as compared with the DS and NM groups. Compared with the DS group, the expression of β 3 -AR and Gi mRNA and protein in the PL group was significantly increased, however, in the CA group, β 3 -AR and Gi mRNA and protein were decreased. Conclusions The expression of β 3 -AR and Gi mRNA and protein was increased in diabetic rats subjected to MI as compared with rats subject to either condition alone. Carvedilol treatment prevented many of these deleterious effects. [ABSTRACT FROM AUTHOR]

The Cadastral Data Model has been developed as a part of a larger programme to improve products and production environment of the Croatian Cadastral Service of the State Geodetic Administration (SGA). The goal of the project was to create a cadastral data model conforming to relevant standards and specifications in the field of geoinformation (GI) adapted by international organisations for standardisation under the competence of GI (ISO TC211 and OpenGIS) and it implementations.The main guidelines during the project have been object-oriented conceptual modelling of the updated users' requests and a "new" cadastral data model designed by SGA - Faculty of Geodesy - Geofoto LLC project team. The UML of the conceptual model is given per all feature categories and is described only at class level. The next step was the UML technical model, which was developed from the UML conceptual model. The technical model integrates different UML schemas in one united schema.XML (eXtensible Markup Language) was applied for XML description of UML models, and then the XML schema was transferred into GML (Geography Markup Language) application schema. With this procedure we have completely described the behaviour of each cadastral feature and rules for the transfer and storage of cadastral features into the database.

Introduction: A considerable body of evidence has shown that the parental educational level (PEL) as well as health status in early childhood play a significant role in child dental caries. A multicentric European Longitudinal Study of Pregnancy and Childhood (ELSPAC) conducted also in Brno collected a great amount of data from clinical and socio-economic areas related to children's general health. Aim: To assess the relationship between caries experience and gingivitis manifestation in 13-years-olds to 15-years-olds and the PEL of their parents in a retrospective case-series study. Methods: Randomly selected children from an ELSPAC cohort in Brno (n = 780) were orally examined and their dental status (D3MFT [WHO criteria]) and gingivitis were recorded. Data on the PEL were retrieved from the ELSPAC database. Correlations between both DMFT and GI vs PEL were calculated using ANOVA and χ2-test. (Statistica v. 8.0., Statsoft Inc., Tulsa, USA.) Results: Mothers' (but not fathers') educational level significantly negatively correlated with D3MFT scores of children (p < 0.05). Similar correlation between GI and PEL was not found. Conclusion: The study confirmed a significant correlation of the educational level of mothers and caries experience in children (p < 0.05), while the correlation between GI and PEL was not significant.

Despite a considerable amount of data available on the relationship between dietary glycemic index (GI) or load (GL) and cardiovascular disease (CVD) risk factors, in aggregate, the area remains unsettled. The aim of the present review was to summarize the effect of diets differing in GI/GL on CVD risk factors, by examining randomized controlled-feeding trials that provided all food and beverages to adult participants. The studies included a low and high GI/GL diet phase for a minimum of four weeks duration, and reported at least one outcome related to CVD risk; glucose homeostasis, lipid profile or inflammatory status. Ten publications representing five trials were identified. The low GI/GL compared to the high GI/GL diet unexpectedly resulted in significantly higher fasting glucose concentrations in two of the trials, and a lower area under the curve for glucose and insulin in one of the two studies during an oral glucose tolerance test. Response of plasma total, low density lipoprotein and high density lipoprotein cholesterol concentrations was conflicting in two of the studies for which data were available. There was either weak or no effect on inflammatory markers. The results of the five randomized controlled trials satisfying the inclusion criteria suggest inconsistent effects of the GI/GL value of the diet on CVD risk factors.

The aim of this study was to examine the monetary cost of dietary change among pregnant women before and after receiving low glycaemic index (GI) dietary advice. The pregnant women in this study were a subgroup of participants in the Pregnancy and Glycaemic Index Outcomes (PREGGIO) study. Twenty women from the low GI dietary advice group, who had completed their pregnancies, were randomly chosen. All these women had completed three day food records at 12–16 weeks and again around 36 weeks of gestation. Consumer food prices were applied to recorded dietary intake data. The mean ± SD GI of the diet reduced from 55.1 ± 4.3 to 51.6 ± 3.9 (p = 0.003). The daily cost of the diet (AUD) was 9.1 ± 2.7 at enrolment and 9.5 ± 2.1 prior to delivery was not significantly different (p = 0.52). There were also no significant differences in the daily energy intake (p = 0.2) or the daily cost per MJ (p = 0.16). Women were able to follow low GI dietary advice during pregnancy with no significant increase in the daily costs.

History of present illness: A 53-year-old male with a history of daily alcohol abuse presented with sudden onset epigastric pain. The pain radiated to the right upper abdominal quadrant and was associated with shortness of breath and nausea. The patient’s vitals were notable for blood pressure of 181/107 and a heart rate of 124. He was in moderate distress and had a firm, distended abdomen with diffuse tenderness to palpation, without rebound or guarding. Significant findings: In the chest radiograph, there was obvious free air under the both the right diaphragm (above the liver) and the left diaphragm, consistent with pneumoperitoneum. Discussion: A perforated ulcer is a surgical emergency. Overall mortality has been shown to be approximately 6.2%.1 Rapid diagnosis is essential as prognosis improves if treatment is initiated within the first six hours and worsens after 12 hours.2 The sensitivity for detecting pneumoperitoneum on plain radiography ranges from 50%-80%3-8 with specificity of 53%.7 An upright chest radiograph can detect as little as one to two milliliters of air.9,10 If free air is not seen on a posteroanterior (PA) upright chest radiograph, an upright lateral chest radiograph can be obtained, which is more sensitive (98% sensitivity).8,11 About 10%-20% of ruptured ulcers will not present with visible free-air under the diaphragm on plain x-ray.12 In this case, given the free air seen on chest radiograph and peritoneal signs on exam, the patient was taken straight to the operating room for general surgery.