Search

Background: Evidence for the effect of minimal acupuncture in infants with colic is limited., Aim: To compare the effect of standardized minimal acupuncture, individualized acupuncture (where traditional acupuncture points were chosen according to the infant's symptoms) and no acupuncture on objective measures of stooling, feeding and sleeping in infants with colic (based on diaries) and perceived changes in these parameters (based on parental questionnaires)., Methods: This was a secondary analysis of a multicentre randomized controlled three-armed trial conducted in four counties in Sweden between January 2013 and May 2015 (ACU-COL). The effect on crying has already been published and showed a decrease in crying time for the acupuncture groups. Infants, 2-8 weeks old, who cried and fussed for more than 3 h/day for more than 3 days/week, and thereby fulfilled the criteria for infantile colic, received four extra visits to their ordinary child health centre. The infants (n = 147) were randomly allocated via a computer-generated list to standardized minimal acupuncture at LI4 for 5 s (group A, n = 48), semi-standardized individual acupuncture with a maximum of five insertions for up to 30 s (group B, n = 49), or no acupuncture (group C, n = 48). The parents and the ordinary staff were blinded. Data were collected using: (1) diaries at baseline, during the two intervention weeks and 1-week follow-up; and (2) questionnaires with quantitative and qualitative components used at the second and fourth visits and during a follow-up telephone call. Outcomes were the changes in frequency of stooling and in hours of sleep per day., Results: There were no differences between groups for stooling, feeding, or sleeping at any time point according to data from the diaries. At the follow-up phone call, more parents in groups A and B (compared to group C) perceived that feeding and sleep had changed and that the symptoms of colic had improved.

Background: Excessive and inconsolable crying behavior in otherwise healthy infants (a condition called infant colic (IC)) is very distressing to parents, may lead to maternal depression, and in extreme cases, may result in shaken baby syndrome. Despite the high prevalence of this condition (20% of healthy infants), the underlying neural mechanisms of IC are still unknown., Methods: By employing the latest magnetic resonance imaging (MRI) techniques in newborns, we prospectively investigated whether newborns' early brain responses to a sensory stimulus (smell) is associated with a subsequent crying behavior., Results: In our sample population of 21 healthy breastfed newborns, those who developed IC at 6 weeks exhibited brain activation and functional connectivity in primary and secondary olfactory brain areas that were distinct from those in babies that did not develop IC. Different activation in brain regions known to be involved in sensory integration was also observed in colicky babies. These responses measured shortly after birth were highly correlated with the mean crying time at 6 weeks of age., Conclusions: Our results offer novel insights into IC pathophysiology by demonstrating that, shortly after birth, the central nervous system of babies developing IC has already greater reactivity to sensory stimuli than that of their noncolicky peers., Impact: Shortly after birth, the central nervous system of colicky infants has a greater sensitivity to olfactory stimuli than that of their noncolicky peers. This early sensitivity explains as much as 48% of their subsequent crying behavior at 6 weeks of life. Brain activation patterns to olfactory stimuli in colicky infants include not only primary olfactory areas but also brain regions involved in pain processing, emotional valence attribution, and self-regulation. This study links earlier findings in fields as diverse as gastroenterology and behavioral psychology and has the potential of helping healthcare professionals to define strategies to advise families.

Infantile colic is a prevalent condition characterised by excessive crying with no effective treatment available. We aimed to evaluate the efficacy of Bifidobacterium breve CECT7263 and a combination of this and Lactobacillus fermentum CECT5716 versus simethicone in reducing the daily time spent crying in colicky infants. A multicentre randomised, open-label, parallel, controlled trial of 28 days was performed in 150 infants who were diagnosed with colic according to the Rome III criteria and who randomly received simethicone (80 mg/day; Simethicone group), B. breve CECT7263 (2×10 8 cfu/day, Bb group), or a combination of L. fermentum CECT5716 and B. breve CECT7263 (1×10 8 cfu/day per strain, Bb+Lf group). The main outcomes were minutes of crying per day and the percentage of reduction in daily crying from baseline. Data were analysed per intention to treat. All treatments significantly decreased the daily crying time at the end of the intervention ( P -time <0.001). However, the infants in the Bb group had significantly decreased crying time from the first week of the study ( P <0.05), whereas the Bb+Lf group and the simethicone group had significantly decreased crying time from the second week ( P <0.05). The percentage of reduction in the minutes of crying from baseline in the Bb group was significantly higher than that in the Simethicone group every week of the intervention (-40.3 vs -27.6% at 1-week; -59.2 vs -43.2% at 2-weeks; -64.5 vs -53.5% at 3-week and -68.5 vs -59.5% at 4-weeks, P <0.05). Additionally, in the Bb group, infants had better night sleep, and parents reported a more positive mood at the end of the intervention. All the products used in the study were safe and well tolerated. In conclusion, the breastmilk-isolated probiotic strain B. breve CECT7263 is a safe and effective treatment for infantile colic, presenting an earlier and more robust effect than the reference prescribed drug, simethicone.

Background: The efficacy of clinical examinations, and hematologic, hemostatic, and serum biochemical assessments to determine appropriate early medical or surgical therapy in Arabian horses with colic have not been well-described., Objectives: We aimed to evaluate clinical and hematologic findings, coagulation-fibrinolytic parameters, and organ dysfunction markers in association with survival in horses with colic., Methods: Seventeen Arabian horses with colic and ten healthy horses were enrolled. After clinical examinations, including heart rates (HRs), capillary refill times (CRTs), abdominal sounds, rectal palpations, and nasogastric (NG) reflux assessments in both healthy and diseased horses, blood samples were collected and hematologic parameters, coagulation indices such as the prothrombin time (PT), activated partial thromboplastin time (APTT), plasma d-dimer (PDD), platelet count, fibrinogen, and hepatorenal biomarkers were measured. Based on the outcomes, horses with colic were divided into survival (10) and nonsurvival (7) groups, and all mentioned parameters were compared with the control group horses., Results: Unlike HRs, CRTs, and abdominal sounds, rectal palpations (57.1%) and NG reflux (28.6%) findings were least sensitive in being able to determine survival. At least three of the five coagulation indices were significantly abnormal (prolonged PT, increased PDD, and decreased plasma fibrinogen) in 71.4% of the horses in the nonsurvival group compared with the control and survival groups. Significantly increased urea, creatinine, and bilirubin levels, and AST activities were also observed in the survival group compared with the control and nonsurvival groups., Conclusions: The combination of prolonged PT, increased PDD, and hypofibrinogenemia could be a reliable predictor of survival in horses with colic. The significant renal and hepatic dysfunctions in nonsurviving horses with colic appeared to be consistent with disseminated intravascular coagulation (DIC) and a grave prognosis., (© 2019 American Society for Veterinary Clinical Pathology.)

Acute abdominal pain (colic) is the most common reason for emergency veterinary treatment in the horse. Consolidation of data through a systematic review is important to inform evidence-based medicine and clinical guidelines, but there are currently no published systematic reviews on colic in the horse. The aim of this study was to identify, categorize and appraise the evidence on factors associated with increased risk of developing abdominal pain (colic) due to gastrointestinal disease in the adult horse. A scoping review was performed to identify and categorize evidence on all risk factors for colic. A systematic review of management-related risk factors was then performed following PRISMA guidelines. Both searches were conducted in Medline, CAB Abstracts and Web of Science databases, and publications were assessed against inclusion and exclusion criteria. For the scoping review, study and participant characteristics of included publications and key results were extracted and tabulated. For the systematic review, cohort, case-control or cross-sectional studies investigating acute abdominal pain in horses within two weeks of management changes were assessed. Study characteristics, participant characteristics and study results of included publications for the systematic review were extracted and tabulated. Included publications were appraised using the Joanna Briggs Institute Critical Appraisal Tools for cohort, case-control and cross-sectional studies. The scoping review search identified 3,756 publications. Fifty eight studies met final inclusion criteria, and 22 categories of risk factors were identified. These were grouped into three broad areas: horse-related factors, management-related factors and environment-related factors. The largest body of evidence related to management change. The systematic review of management change identified 410 publications: 14 met inclusion criteria for analysis. These consisted of one cohort, eight case-control and five cross-sectional studies. The studies were conducted between 1990-2008, and the majority of studies were located in the USA (8/14) or UK (3/14). The risk factors related to management change that were assessed were feed, carer, exercise, pasture, water and housing. The largest bodies of evidence for increased risk of colic associated with management change were changes in feed (5/14 publications) and recent change in housing (3/14). Most studies (8/14) did not meet the JBI criterion on confounding factors. There was marked heterogeneity of study methodologies and measures. This is the first study to use a combined scoping and systematic review to analyse evidence for modifiable risk factors for a common condition in the horse. It provides a comprehensive review that will be a key resource for researchers, veterinary practitioners and horse owners. It identified modifiable risk factors associated with an increased risk of colic which should be a key target for preventative health programmes. The findings from the critical appraisal were used to develop recommendations for future research to improve the quality of evidence-based veterinary medicine., Competing Interests: The authors have declared that no competing interests exist.

A valid, reliable and usable scale is needed for assessing severity of acute abdominal pain in horses. The study aim was to compare three different scales: (1) the equine acute abdominal pain scale (EAAPS); (2) a scale described by Mair and Smith (2005; M and S); and (3) a numerical rating scale (NRS). Forty brief films of horses (35 of colic cases and five of control horses) were randomly presented to 46 equine veterinarians from different countries. Participants, randomly divided into three groups, each used one scale. Five randomly selected films were shown twice for determining intra-observer reliability. Speed, ease of use and face validity of the scales were evaluated based on expert opinion. Response rate was excellent: 89% for the EAAPS (16/18), and 100% for the M and S (18/18) and NRS groups (10/10). The intraclass correlation (ICC) of 0.86 [95% confidence interval (CI); 0.80-0.92] for EAAPS indicated significantly better inter-observer reliability compared to 0.68 for the M and S and 0.71 for the NRS. Moreover, intra-observer reliability of EAAPS (weighted κ 0.95 [95%CI; 0.92-0.98]) was superior to the other scales (weighted κ 0.78, 0.77, for the M and S and NRS, respectively). Other validity measures (convergent, extreme group, predictive validities), usability (time taken to score the films-speed) and the ease of use of the scales were not significantly different. Face validity (endorsement by experts) was better for the M and S scale than for the EAAPS. The EAAPS showed superior reliability, the M and S scale better face validity, with comparable usability and other tests of validity., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: To assess whether infants with colic that resolved before 6 months of age have poorer medium-term outcomes than infants without colic., Study Design: Comparative study of 2 prospective, community-based cohorts of children aged 2-3 years in Melbourne, Australia: children from the Baby Biotics study, with previously diagnosed Wessel criteria of colic without problem crying at 6 months (True Colic Cohort), vs children from the Baby Business trial, without problem crying at 1, 4, and 6 months (No Colic Cohort). Caregiver report of child internalizing and externalizing behaviors (primary outcome), temperament, regulatory (crying/sleeping/feeding) problems, and family functioning at child age 2-3 years was collected. We conducted regression analyses of mean differences/ORs adjusted for child sex, age, social disadvantage, parental education, and maternal mental health., Results: In total, 74% of the original Baby Biotics (n = 124) sample and 75% of the Baby Business (n = 503) sample completed questionnaires. In adjusted analyses, there were no significant differences between the True Colic Cohort (n = 99) and No Colic Cohort (n = 182) in internalizing behavior problems (adjusted mean difference 0.73; 95% CI -3.96 to 5.43, P = .76) or externalizing behavior problems (adjusted mean difference -1.53; 95% CI -6.02 to 2.97, P = .51). There were no statistically significant differences between groups in temperament, parental perception of regulatory problems, or family functioning., Conclusions: Infants with colic whose crying self-resolves do not experience adverse effects regarding child behavior, regulatory abilities, temperament, or family functioning in the medium term. Parents and clinicians can be reassured that infant crying as the result of colic, and related stress, is short-lived and will likely resolve., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Despite the high prevalence of infantile colic, the pathogenesis remains incompletely understood. Cortisol and melatonin hormones affect gastrointestinal system development in several ways, and interestingly, both cortisol and melatonin's circadian rhythms begin around the 3rd month in which infantile colic symptoms start to decrease. We hypothesized that infantile colic might associate with desynchronization of normal circadian rhythms of these hormones. In this study, we aimed to investigate the role of melatonin and cortisol in the pathogenesis of infantile colic., Methods: Patients who were diagnosed as infantile colic according to Wessel's "rule of three" were enrolled in the colic group. We measured the saliva melatonin and cortisol levels of colic group and control group infants. In both groups, the saliva samples were taken in mornings and at evenings, at the time of diagnosis and 6th month., Results: Fifty-five infants finished the study. Melatonin circadian rhythm developed earlier in the control group than the infantile colic group in our study. We found no significant difference between the daily mean cortisol levels. However, infants with colic had flatter daily cortisol slope than controls which pointed out the probability that they had a less clearly defined cortisol rhythm than infants without colic., Conclusions: We found an association between melatonin levels and infantile colic. However, more research is needed to fully understand the role of hypothalamic-pituitary-adrenal axis and hormone's role on infantile colic physiopathology.

Background: Infantile colic is a common condition during early childhood affecting around one of six newborns. The condition is characterized by inconsolable crying and fussing in otherwise healthy and thriving infants. The most used definition is excessive crying for at least three hours a day for at least three days for at least three weeks. The cause of colic is still unknown although many hypotheses and thereby many different treatment modalities have been investigated. Chiropractic care is used increasingly in treatment of infants, including for infantile colic, although the evidence worldwide is sparse. A randomized, controlled trial was designed to evaluate the effect of chiropractic treatment on infantile colic. This paper describes the protocol as well as results from a pilot study examining the acceptability and feasibility of the intervention., Method: The study is designed as a single-blind randomized, controlled trial. The invited families are residents on the Island of Funen and information about the project is distributed from the maternity wards and health visitors. Children at the age of 2-14 weeks with unexplained excessive crying are screened for eligibility and recruited by the primary investigator through home visits. Eligible children are then randomized to chiropractic treatment or control. All children attend in the chiropractor clinic two times a week for two weeks. The parents are unaware of their child's allocation during the project period. The primary outcome measure is change in daily hours of crying based on the parental diaries.The study intends to include 200 children, and the intervention has, during a pilot study, been found acceptable and feasible among families with newborns., Discussion: In a single-blind randomized controlled design we will evaluate the effectiveness of chiropractic treatment on infantile colic. The study will contribute to determine the effect of chiropractic treatment on infantile colic in an area where limited evidence exists. Furthermore, the study aims to explore if subgroups of children with suspected musculoskeletal problems will benefit more from the intervention than others. If they obtain better results, this could imply the need for stratified care., Trial Registration: Clinicaltrials.gov and Identifier: NCT02595515 (registered 2 November 2015)., Competing Interests: See the section ‘Ethics’.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Objective: The aim of this study was to explore the effect of reflexology on infantile colic., Design: A total of 64 babies with colic were included in this study (n = 31: study group; n = 33: control group). Following a pediatrician's diagnosis, two groups (study and control) were created. Sociodemographic data (including mother's age, educational status, and smoking habits of parents) and medical history of the baby (including gender, birth weight, mode of delivery, time of the onset breastfeeding after birth, and nutrition style) were collected. The Infant Colic Scale (ICS) was used to measure the colic severity in the infants. Reflexology was applied to the study group by the researcher and their mother 2 days a week for 3 weeks. The babies in the control group did not receive reflexology. Assessments were performed before and after the intervention in both groups., Results: The groups were similar regarding sociodemographic background and medical history. While there was no difference between the groups in ICS scores before application of reflexology (p > 0.05), the mean ICS score of the study group was significantly lower than that of control group at the end of the intervention (p < 0.001)., Conclusion: Reflexology application for babies suffering from infantile colic may be a promising method to alleviate colic severity.

Background: While biological and behavioral stress response systems are intact in early gestation, preterm infants' behaviors are often more subtle and difficult to interpret compared with full-term infants. They are also more vulnerable for regulatory issues (ie, colic) that are known to impact caregiver-infant interactions. Biobehavioral measures such as behavioral responsivity and heart rate variability (HRV), particularly cardiac vagal tone, may help elucidate preterm infants' stress/regulatory systems., Purpose: To test the hypotheses that preterm infants' consoling behaviors and high-frequency (HF) HRV in the first week of life are significantly associated and they are inverse correlates of future colic risk., Methods/search Strategy: Thirty preterm (mean ± SE = 32.7 ± 0.3 weeks postmenstrual age [PMA]) infants underwent direct NIDCAP (Newborn Individualized Development and Assessment Program) observation during routine care and had HRV measurements during their first week postbirth. Sixty-three percent of mothers completed the Infant Colic Scale at 6 to 8 weeks adjusted postnatal age. Nonparametric tests were used to determine associations among behaviors, HRV, and maternal perceptions of infant colic., Findings/results: Self-consoling behaviors were positively associated with HF-HRV (vagal tone). In addition, stress behaviors were positively associated with low-frequency/high-frequency HRV (sympathetic dominance). Infants who displayed more stress behaviors also demonstrated more self-consoling behaviors. No significant associations were found with colic., Implications for Practice: HF-HRV provides information on the infant's capacity to modulate stress and is a useful, noninvasive measure when behaviors are more difficult to discern., Implications for Research: Further study in a larger sample is needed to determine whether behavioral stress measures and HF-HRV may be useful to determine colic risk.

Infant colic is a distressing condition of unknown etiology. An aberrant gastrointestinal microbiota has been associated, and Lactobacillus reuteri supplementation has been shown to reduce crying and/or fussing time ('crying time') in some infants with colic. The relationship between L. reuteri gut colonization and crying time has not been examined. We investigated the relationship between L. reuteri colonization and fecal microbiota (microbial diversity and Escherichia coli), intestinal inflammation, and crying time in infants with colic, using a subset of 65 infants from the Baby Biotics trial, which randomized healthy term infants aged <13 weeks with infant colic to receive probiotic L. reuteri DSM 17938 (1 × 10 8 colony forming units) or placebo daily for 28 days. We observed an overall reduction in median crying time, regardless of L. reuteri colonization status (n = 14 colonized). There were no differences in E. coli colonization rates or densities, microbial diversity or intestinal inflammation by L. reuteri colonization status. We found that L. reuteri density positively correlated with crying time, and E. coli density negatively correlated with microbial diversity. As density of L. reuteri was associated with increased crying time, L. reuteri supplementation may not be an appropriate treatment for all infants with colic.

Objectives: To determine the association between sensory functioning, sleep, cry/fuss, and feeding behaviors of infants with colic younger than 4 months of age., Methods: Dunn's Infant/Toddler Sensory Profile™ and a modified Barr Baby Day Diary © were used to assess 44 breastfed infants with colic under four months of age. Colic was defined according to Wessel's criteria., Results: Thirty-four of the 44 infants with colic (77%) scored as atypical for sensory processing. Of these, 56% scored atypical for sensory processing on quadrant one (Q1) (Low Registration), with 24%, 65%, and 18% scoring as atypical for sensory processing on Q2 (Sensory seeking), Q3 (Sensory sensitivity), and Q4 (Sensation avoiding), respectively. All infants demonstrating sensation avoiding also scored as Low Threshold. A moderate statistically significant correlation was found between sensation seeking and time spent sleeping (r=0.31; p=0.04). No other statistically significant associations between infant behaviors and their sensory functioning were demonstrated. Overall, infants demonstrating atypical sensory responses (in any quadrant) slept significantly more than infants demonstrating typical sensory responses (mean difference=-67.8min/day; 95% CI=-133.6 to -2.1; p=0.04)., Conclusion: Very limited associations between infant behaviors and sensory functioning were demonstrated, suggesting that sensory functioning may not be a significant factor in the multifactorial nature of infant colic. Further well-designed studies using validated tools for infants with colic are required to determine whether associations between infant behaviors and sensory functioning exist., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Functional disorders of the gastrointestinal tract in infants and children are very frequent. To the most common belong: infant colic, regurgitation and functional constipation. In the year 2016 modified IV Rome criteria of functional gastrointestinal disorders were published. In the current work the authors discuss diagnostic criteria and therapy in regurgitation, rumination syndrome in infants, cyclic vomiting syndrome, infant colic, infant dyschezia and functional constipation in children younger than four years.

Objective: Infant colic (IC) is defined as recurrent and prolonged crying without an obvious cause or evidence of failure to thrive or illness. It is a common problem with a prevalence of 5%-25%. The unknown aetiology results in a wide variety in interventions and use of heterogeneous outcome measures across therapeutic trials. Our aim was to develop a core outcome set (COS) for IC to facilitate and improve evidence synthesis., Design and Setting: Prospective study design; primary, secondary and tertiary care., Methods: The COS was developed using a modified Delphi technique. First, healthcare professionals (HCPs) and parents of infants with IC were asked to list up to five outcomes they considered relevant in the treatment of IC. Outcomes mentioned by >10% of participants were forwarded to a shortlist. In the second round, outcomes on this shortlist were rated and prioritised. The final COS was defined in a face-to-face expert meeting of paediatricians., Results: F of invited stakeholders (133 HCPs and 55 parents of infants with IC) completed both Delphi rounds. Duration of crying, family stress, sleeping time of infant, quality of life (of family), discomfort of infant and hospital admission/duration were rated as most important outcomes in IC, framing the final COS., Conclusions: The use of this COS should serve as a minimum of outcomes to be measured and reported. This will benefit evidence synthesis, by enhancing homogeneity of outcomes, and enable evaluation of success in therapeutic trials on IC. Researchers are strongly encouraged to use this COS when setting up a clinical trial in primary, secondary and/or tertiary care or performing a systematic review on IC., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: The pathophysiology of infantile colic is poorly understood, though various studies report gut microbiota dysbiosis in colicky infants. We aimed to test the hypothesis that colic-related dysbiosis is associated with visceral hypersensitivity triggered by an altered luminal milieu., Methods: Fecal samples from seven colicky and seven non-colicky infants were studied. Fecal supernatants (FS) were infused into the colons of C57/Bl6 mice (n=10/specimen). Visceral sensitivity was subsequently assessed in the animals by recording their abdominal muscle response to colorectal distension (CRD) by electromyography (EMG). Serine and cysteine protease activities were assessed in FS with specific substrates. Infant fecal microbiota composition was analyzed by DNA extraction and 16S rRNA gene pyrosequencing., Key Results: FS from colicky infants triggered higher EMG activity than FS from non-colicky infants in response to both the largest CRD volumes and overall, as assessed by the area under the curve of the EMG across all CRD volumes. Infant crying time strongly correlated with mouse EMG activity. Microbiota richness and phylogenetic diversity were increased in the colicky group, without showing prominent microbial composition alterations. Only Bacteroides vulgatus and Bilophila wadsworthia were increased in the colicky group. Bacteroides vulgatus abundance positively correlated with visceral sensitivity. No differences were found in protease activities., Conclusions & Inferences: Luminal contents from colicky infants trigger visceral hypersensitivity, which may explain the excessive crying behavior of these infants. Additional studies are required to determine the nature of the compounds involved, their mechanism of action, and the potential implications of intestinal microbiota in their generation., (© 2016 John Wiley & Sons Ltd.)

Background: Electrogastrography in conjunction with Fast Fourier transform has limited success in detecting low grade abnormalities in gastric electrophysiological activity owing to the non-stationarity of the signal. Analysis by continuous wavelet transform is suitable for non-stationary signals and was used to analyse EGG activity in babies with and without colic., Methods: Thirty minute postprandial EGG recordings were obtained from 23 sleeping breast-fed infants with clinically validated recurrent colic and 26 breast-fed non-colicky infants. Continuous wavelet transform analysis (CWT) identified three principal frequency components. The mean, standard deviation, and the number of frequency maxima that fell below one standard deviation from the mean were determined for each infant and each frequency., Key Results: Three component frequencies in the ranges 1.4-2.5 cpm, 2.5-4.0 cpm, and 4.0-15 cpm were found in all EGGs. Pairwise comparisons of the characteristics of each of the frequency ranges by univariate analyses showed significant differences between colicky and non-colicky subjects only in the number of maxima in the mid range of frequencies that lay below one standard deviation from the mean. However, CWT based on all frequencies allowed discrimination of the EGGS of colicky from non-colicky babies on a basis of number of frequency maxima below one standard deviation from the mean in the midrange of frequencies and in the mean and standard deviation in the low range of frequencies that was likely a harmonic of the midrange., Conclusions & Inferences: CWT allowed distinction of EGG signals from colicky and healthy babies. The results indicate that colic may result from tardiness in the establishment of coherent propagation of the gastric slow wave in colicky babies., (© 2016 John Wiley & Sons Ltd.)

Background: Infantile colic is a frequent problem in neonates and infants. This review addresses current management including the results for nutrient modifications; soy-based formulas; and prebiotics, probiotics, and synbiotics., Purpose: Given the evidence that there is still an unmet clinical need, as current treatments are incompletely efficacious, we have examined the evidence around three hypothetical mechanisms that could potentially be involved in etiopathogenesis of infantile colic: immaturity of bile acid mechanisms that alter intraluminal and absorptive mechanisms, immaturity in motility and alterations in the microbiome. Understanding these potential mechanisms may lead to the introduction of diagnostic procedures that should enhance the selection or individualization of therapy for infantile colic., Competing Interests: The authors have no relevant conflicts of interest., (© 2016 John Wiley & Sons Ltd.)

Background: Probiotic supplementation to women during pregnancy and lactation can modulate breast milk composition, with immune benefits being transferred to their infants., Aim: The aim of the study was to evaluate the effect of high-dose probiotic supplementation to women during late pregnancy and lactation on cytokine profile and secretory IgA (sIgA) in breast milk and thus to study if differences in breast milk composition can affect lactoferrin and sIgA levels in stool samples of newborns. The safety of maternal probiotic administration on neonatal growth pattern and gastrointestinal symptoms were also evaluated., Methods: In a double-blind, placebo-controlled, randomized trial, 66 women took either the probiotic ( n = 33) or a placebo ( n = 33) daily. Levels of interleukins (IL-6, IL-10 and IL-1β), transforming growth factor-β1 (TGF-β1), and sIgA in breast milk; and the level of sIgA and lactoferrin in newborn stool samples were analyzed at birth and then again at one month of life. Antropometrical evaluation and analysis of gastrointestinal events in newborns was also performed., Results: Probiotic maternal consumption had a significant impact on IL6 mean values in colostrum and on IL10 and TGF-β1 mean values in mature breast milk. Fecal sIgA mean values were higher in newborns whose mothers took the probiotic product than in the control group. Probiotic maternal supplementation seems to decrease incidence of infantile colic and regurgitation in infants., Conclusion: High-dose multi-strain probiotic administration to women during pregnancy influences breast milk cytokines pattern and sIgA production in newborns, and seems to improve gastrointestinal functional symptoms in infants., Competing Interests: The authors declare no conflicts of interest.

Objective: Review the literature on excessive crying in young infants, also known as infantile colic, and its effects on family dynamics, its pathophysiology, and new treatment interventions., Data Source: The literature review was carried out in the Medline, PsycINFO, LILACS, SciELO, and Cochrane Library databases, using the terms "excessive crying," and "infantile colic," as well technical books and technical reports on child development, selecting the most relevant articles on the subject, with emphasis on recent literature published in the last five years., Summary of the Findings: Excessive crying is a common symptom in the first 3 months of life and leads to approximately 20% of pediatric consultations. Different prevalence rates of excessive crying have been reported, ranging from 14% to approximately 30% in infants up to 3 months of age. There is evidence linking excessive crying early in life with adaptive problems in the preschool period, as well as with early weaning, maternal anxiety and depression, attention deficit hyperactivity disorder, and other behavioral problems. Several pathophysiological mechanisms can explain these symptoms, such as circadian rhythm alterations, central nervous system immaturity, and alterations in the intestinal microbiota. Several treatment alternatives have been described, including behavioral measures, manipulation techniques, use of medication, and acupuncture, with controversial results and effectiveness., Conclusion: Excessive crying in the early months is a prevalent symptom; the pediatrician's attention is necessary to understand and adequately manage the problem and offer support to exhausted parents. The prescription of drugs of questionable action and with potential side effects is not a recommended treatment, except in extreme situations. The effectiveness of dietary treatments and use of probiotics still require confirmation. There is incomplete evidence regarding alternative treatments such as manipulation techniques, acupuncture, and use of the herbal supplements and behavioral interventions., (Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Equine spermatozoa from the cauda epididymis were previously collected and frozen, and the fertility was assessed. Most studies were performed on healthy stallions that had undergone routine castration or on the epididymis collected at the abattoir, but there are no studies on the quality of epididymal semen in subjects which have died from colic or which underwent intensive care. The present study was designed to verify whether a severe illness could affect epididymal semen quality and freezability in the stallion. Therefore, epididymal semen characteristics during the freezing process in stallions which had died from colic and in healthy stallions submitted to elective castration were compared. Five stallions that had died from colic (ill stallions [ISs]) and seven stallions that had undergone elective castration (healthy stallions) were castrated, and cauda epididymis spermatozoa were collected and processed. Sperm quality was tested after collection, after washing procedures, at the end of the equilibration (5 °C for 75 minutes), and after freezing/thawing. Sperm quality was measured by objective motility characteristics, membrane and acrosome integrity, and mitochondrial activity. After collection, sperm in ISs showed low kinetic parameters (total motility: 17.3 ± 3%, progressive motility: 6 ± 1%, average path velocity: 57.4 ± 35.4 μm/s, straightness: 74.2%) compared with healthy stallions (total motility: 90.8 ± 3.7%, progressive motility: 70 ± 4%, average path velocity: 118.1 ± 12.6 μm/s, straightness: 82.4%) but demonstrated similar membrane and acrosome integrity (85 ± 2.8% vs. 87.6 ± 3.1%). Sperm kinetic parameters increased after washing procedures and cooling in ISs, reaching comparable values after equilibration (5 °C for 75 minutes) and freezing/thawing. The data reported in this study suggest that the quality of the equine epididymal spermatozoa cryopreserved in stallions that had died from colic was similar to that reported in epididymal sperm after elective castration and was also similar to the data reported in literature for cryopreserved equine semen., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Although recognition of equine pain has been studied extensively over the past decades there is still need for improvement in objective identification of pain in horses with acute colic. This study describes scale construction and clinical applicability of the Equine Utrecht University Scale for Composite Pain Assessment (EQUUS-COMPASS) and the Equine Utrecht University Scale for Facial Assessment of Pain (EQUUS-FAP) in horses with acute colic. A cohort follow-up study was performed using 50 adult horses (n = 25 with acute colic, n = 25 controls). Composite pain scores were assessed by direct observations, Visual Analog Scale (VAS) scores were assessed from video clips. Colic patients were assessed at arrival, and on the first and second mornings after arrival. Both the EQUUS-COMPASS and EQUUS-FAP scores showed high inter-observer reliability (ICC = 0.98 for EQUUS-COMPASS, ICC = 0.93 for EQUUS-FAP, P <0.001), while a moderate inter-observer reliability for the VAS scores was found (ICC = 0.63, P <0.001). The cut-off value for differentiation between healthy and colic horses for the EQUUS-COMPASS was 5, and for differentiation between conservatively treated and surgically treated or euthanased patients it was 11. For the EQUUS-FAP, cut-off values were 4 and 6, respectively. Internal sensitivity and specificity were good for both EQUUS-COMPASS (sensitivity 95.8%, specificity 84.0%) and EQUUS-FAP (sensitivity 87.5%, specificity 88.0%). The use of the EQUUS-COMPASS and EQUUS-FAP enabled repeated and objective scoring of pain in horses with acute colic. A follow-up study with new patients and control animals will be performed to further validate the constructed scales that are described in this study., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Equine colic may be associated with an acute phase response (APR). Measurement of acute phase proteins (APPs) allows the detection of an APR and may help clinicians in monitoring the disease; however, the role of APPs in colic is unclear. This study aimed to evaluate the clinical usefulness of serum amyloid A (SAA), haptoglobin and ferritin in combination with an extended clinicopathological profile in equine colic. The medical records of 54 horses were retrospectively selected. Horses were grouped based on outcome (survivors vs. non-survivors), diagnosis (ischaemic/strangulating vs. non-ischaemic/non-strangulating), and treatment (medical treatment vs. surgery). Laboratory data were compared, and a logistic regression analysis was performed for outcome prediction upon admission. A high percentage of horses had abnormal SAA (29/54), haptoglobin (20/54), and ferritin (31/54) concentrations. In particular, haptoglobin was below the reference interval in 13/54 horses. Non-survivors had significantly decreased haptoglobin and increased ferritin concentrations compared with survivors. The ischaemic/strangulating group had significantly increased creatinine and ferritin and decreased haptoglobin concentrations compared with the non-ischaemic/non-strangulating group. Creatinine was the only significant predictor of mortality in the regression analysis. In conclusion, APPs including SAA, haptoglobin, and ferritin combined with clinicopathological variables may help clinicians to understand the pathogenesis of APR and underline potential complications of equine colic. The reduction in haptoglobin concentration may suggest haemolysis or muscle fibre damage; ferritin may indicate alteration in iron metabolism and tissue damage. Further prospective studies are needed to assess diagnostic and prognostic values of APPs in colic horses., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: There appears to be a perception amongst parents and in popular literature that infantile colic is caused by feeding difficulties. Limited support for this perception is found in scientific literature. Whilst there is scientific evidence that suck, swallow and breathing are key components of successful feeding, these components and the coordination thereof in infants with colic have not been extensively researched., Objective: The objective of the study was to explore the suck, swallow and breathing coordination in infants with infantile colic and compare it with infants without the condition., Method: An assessment protocol for suck, swallow and breathing coordination was compiled from literature. This protocol was performed on a research group of 50 infants, independently diagnosed with infantile colic, and a control group of 28 infants without the condition. All participants were from two rural towns in the North–West province, South Africa, selected with a snowball selection method and strict selection criteria. The study followed a static comparison group design., Results: A significant difference in the key components of feeding and the presence of colic in participants of four age categories were found. The correlation between postural control and the presence of infantile colic were sustained in participants from 2–19 weeks old., Conclusion: Suck, swallow and breathing were found to be significantly associated with infantile colic. The findings should be investigated further. It appears that speech-language therapists may play an expanding role in infantile colic.

Objective: The examination of patients suffering from an acute abdomen routinely comprises both clinical and rectal examinations, and is ever more frequently accompanied by an ultrasonographic abdominal examination. The aim of the study was to compare the findings as defined through rectal examination with the results of the ultrasonographic examination for different forms of colic., Material and Methods: In a retrospective study, the patient records of the Large Animal Clinic of the University of Leipzig from 2012 and 2013 were analysed, and those of horses suffering from colic were included. Diagnoses made through rectal and ultrasonographic examination were grouped and compared with the diagnoses made during colic surgery or pathologic examination, which served as the gold standard. Horses that underwent conservative treatment had a definitive diagnosis assigned only in cases where a pathognostic rectal finding defined the diagnosis. Based on these data, sensitivity, specificity and positive and negative predictive values were calculated for both techniques., Results: Ultrasonography was more sensitive than rectal examination in cases of small intestinal occlusion (97.1% vs. 50.7%), torsion of the large colon in the long axis (63.2% vs. 26.3%) and dislocation of the large colon into the nephrosplenic space (90.9% vs. 72.7%). Rectal examination was more sensitive than ultrasonographic examination in cases of other types of dislocation of the large colon (96.5% vs. 8.8%) and of constipations of the large colon (93.6% vs. 29.8%)., Conclusion and Clinical Relevance: In cases of severe diseases, including small intestinal occlusions and torsions of the large colon, ultrasonography helps to better identify and more precisely diagnose conditions that in most cases require abdominal surgery than rectal examination. Therefore, under hospital conditions, it is highly advisable to include ultrasonography in the routine examination of the equine acute abdomen. However, this technique does not replace the traditional rectal examination, which is superior in the diagnosis of dislocations and constipations of the large colon as well as diseases of the caecum.

The state of homeostasis links in the children with intestinal colic is represented by the following parameters and clinical characteristics. The data of investigated children's contingent with intestinal colic prevailed by following comorbidities: SARS--12 (18.18% ± 4.78%), protein-energy malnutrition--9 (12.85% ± 3.82%), pneumonia--6 (8.57% ± 3.57%), atopic dermatitis--7 (10.00% ±.3.57%). All children have a next complaints: flatulence (100%), in the 62 children (88.57% ± 3.82%) were identificated frequent regurgitation, in the 48 (80.33%)--hyperbilirubinemia. ALT levels were elevated in 25 children (41%) and 31 (51.66%) children had increased levels of AST. IL8 level were elevated in the 40 children (71.42%). The level of antibodies to elastase was greatly increased in all 56 (100%) children.

Colic is generally defined as excessive crying in early infancy and can have negative consequences on the infant as well as on the infant's family life. Excessive crying can result in escalating parental stress levels, abusive caregiver response, increased risk of shaken baby syndrome and parental postpartum depression. In addition to excessive crying, symptoms and descriptors of infant colic include inconsolable crying, screaming, legs drawn up against the abdomen, furrowing of eyebrows, distended abdomen, arched back, passing gas, post-feeding crying and difficulty defecating. There are few well-designed, reproducible, randomized, large-scale studies which demonstrate efficacy of any therapeutic method for colic. An unexplored etiology is that colic is functionally related to a decrease in stooling frequency. Gut distention may periodically result in intensifying discomfort for the infant and in concomitant inconsolable crying. Elimination communication (EC; also known as Natural Infant Hygiene and sometimes referred to as infant potty training, baby-led potty training or assisted infant toilet training) involves the use of cues by which the infant signals to the caregiver that the infant needs to micturate or defecate. Such cues can include types of crying, squirming, straining, wriggling, grimacing, fussing, vocalizing, intent look at caregiver, red face, passing gas and grunting, many of which are the same initial symptoms related to the onset of colicky infant states. A caregiver's attentive and nurturant response to an infant's cues involve uncovering the infant's intergluteal cleft and cradling the infant gently and non-coercively in a supported, secure squatting position. This position will increase the infant's anorectal angle thus facilitating complete defecation. It is hypothesized that effective and timely elimination will cause increased physical comfort for the infant; colic symptoms will concomitantly decrease., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Food allergy is defined as an adverse immune response towards food proteins or as a form of a food intolerance associated with a hypersensitive immune response. It should also be reproducible by a double-blind placebo-controlled food challenge. Many reported that food reactions are not allergic but are intolerances. Food allergy often presents to clinicians as a symptom complex. This review focuses on the clinical spectrum and manifestations of various forms of food allergies. According to clinical presentations and allergy testing, there are three types of food allergy: IgE mediated, mixed (IgE/Non-IgE), and non-IgE mediated (cellular, delayed type hypersensitivity). Recent advances in food allergy in early childhood have highlighted increasing recognition of a spectrum of delayed-onset non-IgE-mediated manifestation of food allergy. Common presentations of food allergy in infancy including atopic eczema, infantile colic, and gastroesophageal reflux. These clinical observations are frequently associated with food hypersensitivity and respond to dietary elimination. Non-IgE-mediated food allergy includes a wide range of diseases, from atopic dermatitis to food protein-induced enterocolitis and from eosinophilic esophagitis to celiac disease. The most common food allergies in children include milk, egg, soy, wheat, peanut, treenut, fish, and shellfish. Milk and egg allergies are usually outgrown, but peanut and treenut allergy tends to persist. The prevalence of food allergy in infancy is increasing and may affect up to 15-20 % of infants. The alarming rate of increase calls for a public health approach in the prevention and treatment of food allergy in children.

Background: Infants' continuous crying is a challenge both for the child and the principal caregiver. However, the links between infants' sleep, crying and cortisol secretion and mothers' well-being and sleep have been scarcely investigated. The aim of the present study was therefore to examine the link between cortisol secretion, crying and sleep of infants characterized by infantile colic (IC) and mothers' psychological well-being and own sleep., Methods: Mothers of 24 infants characterized by IC (mean age = 8 weeks, SD = 1.5 weeks) completed a series of questionnaires regarding the infant's crying and sleeping patterns. Infants' sleep was objectively assessed with actigraphs. Cortisol secretion was measured by means of saliva samples in the mornings after waking. After 4 weeks, infants were assessed once again. Mothers completed questionnaires assessing their psychological well-being (depressive symptoms, family strain) and sleep., Results: Mothers' psychological well-being and sleep was greatly predicted by infants' morning saliva cortisol levels, sleep disruptions and crying intensity, whereas infants' crying duration and volume had low predictive value., Conclusions: Mothers with infants characterized by IC are at increased risk for reporting impaired sleep, developing depressive symptoms and reporting higher family strain. Most importantly, this risk seems to be greater if their infants' sleep is fragmented.

Common bile duct stones frequently accompany gallstones and can be identified by a variety of imaging modalities. Little is known about the time course of dilatation of the common bile duct after acute obstruction or of normalization after spontaneous passage of an obstructing stone. We describe a case showing rapid fluctuations in common bile duct diameter during 72 hours in a patient presenting with epigastric pain and vomiting. Initial emergency bedside ultrasonography revealed a distended gallbladder, a dilated common bile duct (17 mm), and an obstructing stone. Five hours later, ultrasonography performed in the radiology suite showed a normal common bile duct diameter (4 mm) and no obstructing stone. The patient was admitted, and during the course of hospitalization different imaging modalities reported fluctuations in common bile duct measurements, ranging from 4 mm on computed tomography to 14 mm on endoscopic retrograde cholangiopancreatography. This case demonstrates disappearance of an obstructing stone with normalization of a highly distended common bile duct during 5 hours, highlighting that gallstone disease may be highly dynamic, with the possibility of rapid changes of common bile duct diameter. Emergency physicians, who frequently depend on ultrasonography to diagnose biliary disease, should be wary of the potential for rapid changes of sonographic findings in these patients., (Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.)

Context: Gastrointestinal (GI) distress is common during ultrarunning., Purpose: To determine if race diet is related to GI distress in a 161-km ultramarathon., Methods: Fifteen (10 male, 5 female) consenting runners in the Javelina Jundred (6.5 loops on a desert trail) participated. Body mass was measured immediately prerace and after each loop. Runners reported if they had nausea, vomiting, abdominal cramps, and/or diarrhea after each loop. Subjects were interviewed after each loop to record food, fluid, and electrolyte consumption. Race diets were analyzed using Nutritionist Pro., Results: Nine (8 male, 1 female) of 15 runners experienced GI distress including nausea (89%), abdominal cramps (44%), diarrhea (44%), and vomiting (22%). Fluid consumption rate was higher (p = .001) in runners without GI distress (10.9 ± 3.2 ml · kg-1 · hr-1) than in those with GI distress (5.9 ± 1.6 ml · kg-1 · hr-1). Runners without GI distress consumed a higher percentage fat (p = .03) than runners with GI distress (16.5 ± 2.6 vs. 11.1 ± 5.0). In addition, fat intake rate was higher (p = .01) in runners without GI distress (0.06 ± 0.03 g · kg-1 · hr-1) than in runners with GI distress (0.03 ± 0.01 g · kg-1 ·hr-1). Lower fluid and fat intake rates were evident in those developing GI distress before the onset of symptoms., Conclusions: A race diet with higher percentage fat and higher intake rates of fat and fluid may protect ultramarathoners from GI distress. However, these associations do not indicate cause and effect, and factors other than race diet may have contributed to GI distress.

Background: Gastrointestinal (GI) symptoms are common in patients with eating disorders. The aim of this study was to determine, using factor analysis, whether these GI symptom factors (clusters) in eating disorder patients hold true to the Rome II classification of functional gastrointestinal disorders (FGIDs)., Methods: Inpatients in a specialised eating disorder unit completed the Rome II questionnaire. Data from 185 patients were analysed using factor analysis of 17 questions cited as present in 30% to 70% of the patients., Results: Five factors emerged accounting for 68% of the variance and these were termed: 'oesophageal discomfort', 'bowel dysfunction', 'abdominal discomfort', 'pelvic floor dysfunction', and 'self-induced vomiting'. These factors are significantly related to the Rome II FGID categories of functional oesophageal, bowel and anorectal disorders, and to the specific FGIDs of IBS, functional abdominal bloating, functional constipation and pelvic floor dyssynergia. Both heartburn and chest pain were included in the oesophageal discomfort factor. The 'pelvic floor dysfunction' factor was distinct from functional constipation., Conclusions: The GI symptoms common in eating disorder patients very likely represent the same FGIDs that occur in non-ED patients. Symptoms of pelvic floor dysfunction in the absence of functional constipation, however, are prominent in eating disorder patients. Further investigation of the items comprising the 'pelvic floor dysfunction' factor in other patient populations may yield useful results.

Introduction: Sphincter of Oddi dysfunction usually occurs after cholecystectomy, but it can sometimes be detected in patients with intact gallbladder too. The diagnostic value of the non-invasive functional tests is not established in this group of patients and the effects of sphincterotomy on transpapillary bile outflow and gallbladder motility are unknown., Aims: The aim of this study was to determine the effect of endoscopic sphincterotomy on the gallbladder ejection fraction, transpapillary bile outflow and the clinical symptoms of patients with acalculous biliary pain syndrome., Patients and Methods: 36 patients with acalculous biliary pain syndrome underwent quantitative hepatobiliary scintigraphy, and all of them had decreased cholecytokinin-induced gallbladder ejection fraction. The endoscopic manometry of the sphincter of Oddi showed abnormal sphincter function in 26 patients who were enrolled the study. Before and after endoscopic sphincterotomy all patients had ultrasonographic measurement of cholecystokinin-induced gallbladder ejection fraction with and without nitroglycerin pretreatment and scintigraphy was repeated as well. The effects of sphincterotomy on gallbladder ejection fraction and transpapillary biliary outflow were evaluated. In addition, changes in biliary pain score with a previously validated questionnaire were also determined., Results: All 26 patients had decreased gallbladder ejection fraction before sphincterotomy measured with scintigraphy (19+18%) and ultrasound (16+9.7%), which was improved after nitroglycerin pretreatment (48.2+17%; p<0.005). Detected with both methods, the ejection fraction was in the normal range after sphincterotomy (52+37% and 40.8+16.5%), but nitroglycerin pretreatment failed to produce further improvement (48.67+22.2%, NS). Based on scintigraphic examination sphincterotomy significantly improved transpapillary biliary outflow (common bile duct half time 63±33 min vs. 37±17 min; p<0.05). According to results obtained from questionneries, 22 of the 26 patients gave an account of significant symptom improvement after sphincterotomy., Conclusions: Endoscopic sphincterotomy improves cholecystokinin-induced gallbladder ejection fraction, transpapillary biliary outflow as well as biliary symptoms in patients with acalculous biliary pain syndrome and sphincter of Oddi dysfunction. Cholecystokinin-induced gallbladder ejection fraction with nitroglycerin pretreatment, measured with ultrasonography can be useful to select a subgroup of patients who can benefit from sphincterotomy.

When ingested at high rates (1.8-2.4 g·min(-1)) in concentrated solutions, carbohydrates absorbed by multiple (e.g., fructose and glucose) vs. single intestinal transporters can increase exogenous carbohydrate oxidation and endurance performance, but their effect when ingested at lower, more realistic, rates during intermittent high-intensity endurance competition and trials is unknown. Trained cyclists participated in two independent randomized crossover investigations comprising mountain-bike races (average 141 min; n = 10) and laboratory trials (94-min high-intensity intervals followed by 10 maximal sprints; n = 16). Solutions ingested during exercise contained electrolytes and fructose + maltodextrin or glucose + maltodextrin in 1:2 ratio ingested, on average, at 1.2 g carbohydrate·kg(-1)·h(-1). Exertion, muscle fatigue, and gastrointestinal discomfort were recorded. Data were analysed using mixed models with gastrointestinal discomfort as a mechanism covariate; inferences were made against substantiveness thresholds (1.2% for performance) and standardized difference. The fructose-maltodextrin solution substantially reduced race time (-1.8%; 90% confidence interval = ±1.8%) and abdominal cramps (-8.1 on a 0-100 scale; ±6.6). After accounting for gastrointestinal discomfort, the effect of the fructose-maltodextrin solution on lap time was reduced (-1.1%; ±2.4%), suggesting that gastrointestinal discomfort explained part of the effect of fructose-maltodextrin on performance. In the laboratory, mean sprint power was enhanced (1.4%; ±0.8%) with fructose-maltodextrin, but the effect on peak power was unclear (0.7%; ±1.5%). Adjusting out gastrointestinal discomfort augmented the fructose-maltodextrin effect on mean (2.6%; ±1.9%) and peak (2.5%; ±3.0%) power. Ingestion of multiple transportable vs. single transportable carbohydrates enhanced mountain-bike race and high-intensity laboratory cycling performance, with inconsistent but not irreconcilable effects of gut discomfort as a possible mediating mechanism.

Unlabelled: Melatonin is secreted during the night in adults but not in infants. It has a hypnotic effect as well as a relaxing effect on the smooth muscle of the gastrointestinal tract. It is plausible that breast milk, which consists of melatonin, may have an effect on improving infants' sleep and reducing infantile colic. Our first goal was to assess the differences in the prevalence and severity of infantile colic and nocturnal sleep between breast-fed infants and supplement-fed infants. The second was to characterize the profile of melatonin secretion in human breast milk compared to artificial formulas. Ninety-four mothers of healthy 2 to 4-month-old infants filled a questionnaire regarding irritability/potential infantile colic and sleep characteristics. For the second part, we measured melatonin levels in breast milk of five women every 2 h during 24 h and in three samples of commonly used artificial formulas. Exclusively breast-fed infants had a significantly lower incidence of colic attacks (p = 0.04), lower severity of irritability attacks (p = 0.03), and a trend for longer nocturnal sleep duration (p = 0.06). Melatonin in human milk showed a clear circadian curve and was unmeasurable in all artificial milks., Conclusions: Exclusive breastfeeding is associated with reduced irritability/colic and a tendency toward longer nocturnal sleep. Breast milk (nocturnal) consists of substantial melatonin levels, whereas artificial formulas do not. We speculate that melatonin which is supplied to the infant via breast milk plays a role in improving sleep and reducing colic in breast-fed infants compared to formula-fed ones.

Objective: To investigate the associations between use of nicotine replacement therapy (NRT) and smoking during pregnancy and infantile colic in the offspring., Methods: We used data from maternal interviews (from pregnancy and at 6 months post partum) from the Danish National Birth Cohort (1996-2002). We included 63 128 live-born singletons with complete information on nicotine exposure during pregnancy and infantile colic symptoms as recorded at 6 months of age., Results: A total of 46 660 infants (73.9%) were unexposed to nicotine during pregnancy; 207 (0.3%) were exposed to NRT, 15 016 (23.8%) were exposed to smoking, and 1245 (2.0%) to both. A total of 4974 (7.9%) infants fulfilled Wessel's modified criteria for infantile colic. Prenatal nicotine exposure was associated with elevated risk for infantile colic in the offspring. Compared with the unexposed, NRT users had an adjusted odds ratio (OR) (95% confidence interval) of 1.6 (1.0-2.5; P = .03), smokers had OR = 1.3 (1.2-1.4), and women who both smoked and used NRT had OR = 1.6 (1.3-1.9). Partners' smoking was not associated with infantile colic after adjustment for maternal smoking., Conclusions: We corroborated the association between smoking and infantile colic after adjustment for several possible confounders in a large cohort study. Moreover, we found that infants exposed to NRT prenatally had an increased risk for infantile colic of the same magnitude as those exposed to tobacco smoke. Thus, nicotine may play a role in the pathogenesis of infantile colic.

Performance in many team sports is partially dependent on the ability to perform repeatedly at high intensity. Previous research demonstrates that capsaicin (CAP) has physiological and metabolic effects that could influence exercise performance and inflammation. The purpose of this study was to investigate the influence of CAP on performance of and the interleukin-6 (IL-6) response to repeated sprints. Nineteen healthy male experienced athletes, age 18-30 years, participated in a placebo (PCB)-controlled, crossover study. During 1 trial, they consumed 3 g·d(-1) cayenne (25.8 mg·d(-1) CAP) and the other a PCB for days. Directly after the supplementation period, they completed a repeated sprint test (RST) consisting of 15 30-m maximal effort sprints on 35-second intervals with sprint times measured via an electronic dual-beam timing system. Fasted blood draws for IL-6 were taken at baseline before supplementation, 45 minute pre-RST, and immediately post-RST. Rate of perceived exertion (RPE), muscle soreness (MS), and gastrointestinal distress (GD) for 5 symptom subscales were measured 1-minute pretest, during, posttest, and 1-minute posttest. The MS was additionally measured for 3-day posttest. Relative to the PCB, CAP significantly increased the sum of ratings of GD symptoms by 6.3-fold. There was no difference between treatments in fastest or mean sprint time, fatigue, IL-6 response, RPE, or MS. In summary, CAP did not influence repeated sprint performance or the IL-6 response but caused substantial GD. The CAP is not recommended for athletes involved in repeated sprinting.

Aim: To investigate characteristics differentially associated with infants suffering from colicky-crying vs. other infants., Background: The crying baby is the most common presentation in every clinician's office in the first 16 weeks of life. As little agreement exists in the literature, attempts to establish differential diagnosis, aetiology, incidence, risk factors and natural progression in addition to appropriate intervention guidelines are urgently needed., Design: Prospective observational study., Subjects: Infants ≤ 12 months, 159 colicky and 27 non-colicky infants (n = 186) from whom complete data sets were collected., Methods: Parents of infants presented to the clinic completed questionnaires of their infant's characteristics. The data were analysed using logistic regression., Results: Symptoms supporting the diagnosis of colicky-crying infants included 'child flexes/curls legs', 'child has difficulty/discomfort on bowel movement', 'child is more irritable postfeeding', 'child is more irritable when put into cot', 'child appears in pain', 'child wants frequent cuddling', 'family allergy/asthma' and 'child changes from happy to crying in an instant'. A nomogram illustrated if a mother suggests colic as a diagnosis and the infant has the symptoms supporting the diagnosis, then the chances of being a colicky infant rise from the initial prevalence 85% to approximately 98%. If the symptoms are not present, the chances of being a colicky infant drop from 85% to around 3%., Conclusion: Because the literature lacks consensus regarding a gold standard for the diagnosis of the colicky-crying infant, these findings may offer help to the health care practitioner when faced with an excessively crying infant., Relevance to Clinical Practice: It has been hypothesised that there may be multiple reasons for excessive crying in an infant. It is necessary to differentiate between the types of crying infants that present to the clinician to determine the best course of action., (© 2011 Blackwell Publishing Ltd.)

Lack of knowledge about the pathophysiology of infantile colic limits the development of effective drugs and treatment modalities including acupuncture. Acupuncture research has targeted the baby without considering the mother. However, the pathophysiological clues indicate that infantile colic is a shared pathology between the mother and the baby, especially in the case of breastfeeding mothers. A new theory proposed in this paper involves levels of the cytokine tumour necrosis factor α in the mother's milk and its influences on melatonin and serotonin metabolism in the baby as major components of the pathophysiology of infantile colic. These can be normalised by applying acupuncture to the breastfeeding mother alone or also to the baby.

Objective: To identify hemostatic imbalances indicative of an increased risk of intra-abdominal adhesion formation in foals versus adult horses., Animals: Horses with colic undergoing exploratory laparotomy or abdominocentesis as part of a clinical examination (n = 16 foals ≤ 6 months of age and 19 adults ≥ 5 years of age) and horses without colic undergoing herniorrhaphy (15 foals) or euthanasia for noninflammatory and nongastrointestinal disease (10 foals and 20 adults)., Procedures: Paired abdominal fluid and blood samples were collected from each horse into buffered sodium citrate and centrifuged immediately after collection. Supernatants were stored at -80°C, then thawed for measurement of fibrinogen concentration, plasminogen activity, antiplasmin activity, and D-dimer concentration. Supernatant analyte concentrations or activities were compared within age group (foals with and without colic vs adults with and without colic) and within disease status (foals and adults without colic vs foals and adults with colic)., Results: All analyte concentrations or activities in abdominal fluid samples were significantly lower in the noncolic groups than in the colic groups, and none differed between foal and adult groups. Several plasma analyte values differed by disease status and age., Conclusions and Clinical Relevance: The risk of intra-abdominal adhesion formation in the foals in this study did not appear to be attributable to differences in intra-abdominal hemostasis between adult horses and foals. Strategies for initial medical and surgical management of colic in adult horses may be applicable to foals with similar disorders.

Background: The aim was to describe the feeding- and stooling patterns of infants with colic and evaluate the influence of minimal acupuncture., Methods: A prospective, randomized, controlled, blind clinical study was conducted at a private acupuncture clinic in Sweden. 90 otherwise healthy 2-8 weeks old infants, born after gestational week 36, fulfilling the criteria for infantile colic and not medicated with dicyclomine, were included. 81 infants went through a structured program consisting of six visits to the clinic, twice weekly. Infants randomized to receive acupuncture were given minimal, standardized acupuncture for two seconds in LI4. Frequency and size of stooling, as well as duration of, and intervals between, feeding sessions were reported by parents in a diary. Parental assessment of sleep and comments on stooling and side effects were collected in a questionnaire., Results: At baseline when the mean age was five weeks, infants in both groups were fed a median of eight times/day, 148 min/day, with considerable variations. No differences were found between groups in the frequency and duration of feeding during the intervention weeks. Furthermore there were no significant differences between the groups regarding the frequency of stooling, neither at baseline, at which point the infants of both groups had bowel movements 4.2 times/day, nor during the intervention weeks. There was an expected decrease in frequency of stooling in both groups, reaching 2.1 (p = 0.001) in the acupuncture group and 3.1 (p < 0.001) in the control group. The groups differed regarding large bowel movements which decreased linearly in the control group (p = 0.011) but not in the acupuncture group (p = 0.787). More parents in the acupuncture group than in the control group (28% and 15% respectively, p = 0.006) experienced the infant's sleep to be "better" or "much better." No other significant differences were found. However, parents described a normalized stooling and experienced an improvement in colic in their infants more frequently in the acupuncture group than in the control group., Conclusions: Infants with colic in the present study had a higher frequency of stooling than reported internationally in healthy infants. Minimal acupuncture had no major effect on feeding, stooling and sleep, although a minor effect of minimal acupuncture on stooling and sleep cannot be ruled out., Trial Registration: ClinicalTrials.govID NCT00860301.

ST segment elevation of more than 1 mm from the baseline is an electrocardiographic presentation of acute myocardial injury. This phenomenon is not confined only to ischemic injury, and various other etiological factors have been described in relation to ST segment elevation. We report the case of a young man who presented in the emergency department complaining of loin pain. He was subsequently found to have transient ST segment elevation, but a thorough evaluation showed no evidence of coronary artery disease. ST segment elevation is one of the best tools for diagnosing acute myocardial infarction, of which reperfusion therapy is the treatment of choice thus making it important to make the diagnosis as quickly as possible. It is equally important, however, not to misdiagnose acute myocardial infarction, as there are other causes of ST segment elevation. Therefore, we report this unique case of renal pain due to stone causing ST segment elevation.

Background: About 10% of newborn babies have infantile colic which means that they cry more than 3 hours per day. The baby's crying risks disturbing the early parent-child interaction., Objective: This study aimed to illuminate the meaning of being a parent of a baby with infantile colic., Design: An inductive qualitative interview study., Participants and Settings: Twenty-three parents (12 mothers and 11 fathers) seeking help for infantile colic at a Child Health Clinic in south Sweden, having verified in a diary their babies' crying to more than 3 hours/day, were individually interviewed between March 2006 and April 2007. Parents were selected to ensure variation in age and gender and if they were first-time parents., Method: Parent's narratives were analysed using a phenomenological hermeneutic method., Findings: The main theme found was 'Colic overshadows everything'. Tired and worried parents experienced living in an inferno. Both fathers and mothers suffered with their babies, felt powerless and overwhelmed by strong feelings and neglected their other needs. To get through this period, parents used various strategies to ease their baby's pain. Parents forced themselves not to lose control, to keep a stiff upper lip and generally to bear up. Sharing the burden was important. In spite of the suffering, they also felt hope, happiness and gratitude that they had a healthy baby. The results were reflected upon in relation to systems theory, attachment theory and a theory of interpersonal aspects of nursing., Conclusion: It is an important task for professionals to empower parents and help them to endure the colic period and to gain higher self-esteem as parents. By listening to the parents' stories they can better understand their situation, offer support and increase self-efficacy., (© 2010 The Authors. Scandinavian Journal of Caring Sciences © 2010 Nordic College of Caring Science.)

Background: Acalculous biliary pain may be due to gallbladder dyskinesia or sphincter of Oddi (SO) hypertension. These two etiologies are difficult to differentiate because the gallbladder ejection fraction may be low and the SO manometry results may be abnormal in both. Cholecystectomy is advised for patients with biliary dyskinesia, but it often exacerbates biliary pain for patients with SO hypertension. The biliary pain response to relaxation of the SO using botulinum toxin may indicate appropriate treatment for patients with acalculous biliary pain., Methods: The protocol-based management of 25 patients with acalculous biliary pain and two gallbladder ejection fraction estimations less than 40% who had 100 units of botulinum toxin injected into their SO musculature to relax the sphincter has been audited. Patients whose pain was temporarily relieved after botulinum toxin injection were offered endoscopic biliary sphincterotomy, and patients who failed to experience benefit after botulinum toxin injection were assessed for laparoscopic cholecystectomy., Results: Botulinum toxin was injected into the SO of 25 patients, with 11 experiencing temporary biliary pain relief. Of these patients, 10 consented to undergo endoscopic biliary sphincterotomy, with relief of biliary pain in all cases. A total of 14 patients had a negative response to botulinum toxin treatment, with 10 of these patients progressing to laparoscopic cholecystectomy, which resulted in biliary pain relief in eight cases., Conclusion: Botulinum toxin-induced relaxation of the SO may help to direct appropriate therapy for patients with acalculous biliary pain. The data from this study supports the establishment of a randomized clinical trial.

We aimed to analyse infant (birth characteristics, feeding type, faecal enzyme activities) and environmental (maternal smoking, nutrition and psychological status, mother-child bonding, family structure, support for the mother, familial atopy) risk factors for infant colic and to follow infants with respect to physical growth, sleeping status up to 8 months of age in a nested case-control study. 660 mothers who delivered at Dr Zekai Tahir Burak Maternity Hospital, were enrolled within 3-72 h post delivery. Each infant with inconsolable persistent crying and four matched infants with no crying episodes were invited by phone to Hacettepe University Ihsan Doğramacı Children's Hospital at 30-45 days post partum. At 40-55 days, we examined the infants and gave mothers a questionnaire, including crying characteristics of the infants; 47 infants were diagnosed with colic and 142 as non-colic. When the infants were 7-8 months old, another interview was done. The colic group had higher proportions of less-educated (≤ 8 years) and smoking mothers, extended family and families with domestic violence than the non-colic group. The colic group of mothers had significantly higher rates of 'impaired bonding' in the Postpartum Bonding Questionnaire, higher scores on the Edinburgh Postnatal Depression Scale, higher scores for hostility subscales of the Brief Symptom Inventory and a more irregular sleep pattern than the non-colic group. No differences were revealed for faecal enzyme activities. At 7-8 months, the colic group was shorter than the non-colic group. Colic was associated with various perinatal factors (maternal education, smoking habits, cheese consumption, hostility scores and domestic violence) and having colic in infancy negatively affected the sleeping pattern and the height of the infant., (© 2010 Blackwell Publishing Ltd.)

Objective: To investigate whether expression of inflammation-associated genes in leukocytes from horses with gastrointestinal tract (GIT) diseases correlated with the type of disease and outcome., Animals: 10 healthy horses and 50 horses with GIT disease., Procedures: A blood sample was collected from each healthy horse or horse with GIT disease (during admission to the hospital). Leukocytes were isolated, diluted to a standard concentration, and frozen until RNA extraction. Expression of 14 genes associated with inflammation was quantified by use of a real-time quantitative reverse transcription PCR assay. Results were grouped by GIT disease type and disease outcome for comparison., Results: Horses with GIT disease had colic of unknown etiology (n = 8 horses), GIT inflammation or strangulation (19), or nonstrangulating GIT obstruction (23). Among the 45 horses receiving treatment, 38 were discharged from the hospital, and 7 died or were euthanized. Compared with healthy horses, horses with colic of unknown etiology had similar gene expression. Significant differences in expression of the interleukin-8, leukocyte-selectin molecule, matrix metalloproteinase-9, platelet-selectin molecule, mitochondrial superoxide dismutase, Toll-like receptor 4, and tumor necrosis factor-A genes were detected between healthy horses and horses with GIT disease. Significant differences in expression of the interleukin-1 receptor antagonist, interleukin-8, leukocyte-selectin molecule, matrix metalloproteinase-9, platelet-selectin molecule, mitochondrial superoxide dismutase, Toll-like receptor 4, and tumor necrosis factor-A genes were detected among healthy horses and horses grouped by disease outcome., Conclusions and Clinical Relevance: Inflammatory gene expression in leukocytes of horses with GIT disease appeared to be related to disease pathogenesis and prognosis.

Background: Abdominal migraine is a commonly described migraine variant in children and young adults, but associations with Alice in Wonderland syndrome and lilliputian hallucinations are exceptional., Case Presentation: A 20 years-old male experienced frequent and prolonged attacks of abdominal colic associated with autonomic manifestations started at the age of ten. At the age of 17, he additionally described prolonged attacks (>or= 7 days) of distortions of shape, size or position of objects or subjects. He said "Quite suddenly, objects appear small and distant (teliopsia) or large and close (peliopsia). I feel as I am getting shorter and smaller "shrinking" and also the size of persons are not longer than my index finger (a lilliputian proportion). Sometimes I see the blind in the window or the television getting up and down, or my leg or arm is swinging. I may hear the voices of people quite loud and close or faint and far. Occasionally, I experience attacks of migrainous headache associated with eye redness, flashes of lights and a feeling of giddiness. I am always conscious to the intangible changes in myself and my environment". There is a strong family history of common migraine. Clinical examination, brain-MRI and EEG were normal. Transcranial magnetic stimulation and evoked potentials revealed enhanced cortical excitability in multiple brain regions. Treatment with valproate resulted in marked improvement of all clinical and neurophysiological abnormalities., Conclusions: The association between the two migraine variants (abdominal migraine and Alice in Wonderland Syndrome) might have clinical, pathophysiological and management implications. I think this is the first description in the literature.

The diagnosis and therapy planning of high prevalence pathologies such as infantile colic can be substantially improved by statistical signal processing of activity/rest registries. Assuming that colic episodes are associated to activity episodes, diagnosis aid systems should be based on preprocessing techniques able to separate real activity from rest epochs, and feature extraction methods to identify meaningful indices with diagnostic capabilities. In this paper, we propose a two step diagnosis aid methodology for infantile colic in children below 3 months old. Identification of activity periods is performed by means of a wavelet based activity filter which does not depend on the acquisition device (as so far proposed methods do). In addition, symbolic dynamic analysis is used for extraction of discriminative indices from the activity time series. Results on real data yielded 100% sensitivity and 80% specificity in a study group composed of 46 cases and 10 control subjects.

Objective: The aim of our study was to assess the role of Doppler ultrasonography (DU) by resistive index (RI) and the difference of the RI (DeltaRI) in patients with acute unilateral renal obstruction., Patients and Methods: We studied 36 consecutive patients (12 female, 24 male; mean age 45.6 +/- 8.4 years) with suspected renal colic by intravenous pyelography (IVP) and DU with determination of the RI and the Delta RI. A RI of >= 0.70 and a DeltaRI of >= 0.06 were considered suggestive of obstruction. IVP was considered as the "gold standard"., Results: In the studied population, RI was 0.664 +/- 0.060 in the affected kidney site of symptoms and 0.614 +/- 0.025 in the contralateral one, with an overall Delta RI of 0.049 +/- 0.062. At IVP, 14 patients resulted within normal range (Group A; 39%), 6 patients showed lithiasis without obstruction (Group B; 17%), 8 patients showed delayed excretion of the contrast medium (Group C; 22%), and 8 patients showed a functional exclusion of the kidney (Group D; 22%). One-way analysis of variance showed the IVP group significantly related to Delta RI with the highest values in Groups C (DeltaRI of 0.093 +/- 0.051; p<0.001) and D (DeltaRI of 0.116 +/-0.030; p<0.001) in comparison with Group A (DeltaRI of 0.001 +/-0.038) and Group B (DeltaRI of 0.015 +/-0.024). No differences were detected between Groups C and D (p=0.223) and between Groups A and B (p-0.472). DeltaRI measurement with DU permitted to predict the renal obstruction with a sensitivity of 93.8%, a specificity of 95.0% and an accuracy of 94.4%., Conclusions: Intrarenal Doppler ultrasonography represents a sensitive and highly specific test that can significantly contribute to the diagnosis of obstruction in patients with acute renal colic. It should be used as the first line imaging method in suspected acute renal colic, as well as for patients with renal insufficiency, pregnant women or for patients with adverse reactions to contrast media