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Background & aimsInflammatory bowel disease (IBD) has familial aggregation in African Americans (AAs), but little is known about the molecular genetic susceptibility. Mapping studies using the Immunochip genotyping array expand the number of susceptibility loci for IBD in Caucasians to 163, but the contribution of the 163 loci and European admixture to IBD risk in AAs is unclear. We performed a genetic mapping study using the Immunochip to determine whether IBD susceptibility loci in Caucasians also affect risk in AAs and identify new associated loci.MethodsWe recruited AAs with IBD and without IBD (controls) from 34 IBD centers in the United States; additional controls were collected from 4 other Immunochip studies. Association and admixture loci were mapped for 1088 patients with Crohn's disease, 361 with ulcerative colitis, 62 with IBD type unknown, and 1797 controls; 130,241 autosomal single-nucleotide polymorphisms (SNPs) were analyzed.ResultsThe strongest associations were observed between ulcerative colitis and HLA rs9271366 (P = 7.5 × 10(-6)), Crohn's disease and 5p13.1 rs4286721 (P = 3.5 × 10(-6)), and IBD and KAT2A rs730086 (P = 2.3 × 10(-6)). Additional suggestive associations (P < 4.2 × 10(-5)) were observed between Crohn's disease and IBD and African-specific SNPs in STAT5A and STAT3; between IBD and SNPs in IL23R, IL12B, and C2orf43; and between ulcerative colitis and SNPs near HDAC11 and near LINC00994. The latter 3 loci have not been previously associated with IBD, but require replication. Established Caucasian associations were replicated in AAs (P < 3.1 × 10(-4)) at NOD2, IL23R, 5p15.3, and IKZF3. Significant admixture (P < 3.9 × 10(-4)) was observed for 17q12-17q21.31 (IZKF3 through STAT3), 10q11.23-10q21.2, 15q22.2-15q23, and 16p12.2-16p12.1. Network analyses showed significant enrichment (false discovery rate

Summary: Background: Crohn's disease requires effective patient‐clinician communication for successful illness and medication management. Shared decision making (SDM) has been suggested to improve communication around early intensive therapy. However, effective evidence‐based SDM interventions for Crohn's disease are lacking, and the impact of SDM on Crohn's disease decision making and choice of therapy is unclear. Aim: To test the impact of SDM on choice of therapy, quality of the decision and provider trust compared to standard Crohn's disease care. Methods: We conducted a multi‐site cluster randomised controlled trial in 14 diverse gastroenterology practices in the US. Results: A total of 158 adult patients with Crohn's disease within 15 years of their diagnosis, with no prior Crohn's disease complications, and who were candidates to receive immunomodulators or biologics, participated in the study. Among these, 99 received the intervention and 59 received standard care. Demographics were similar between groups, although there were more women assigned to standard care, and a slightly shorter disease duration among those in the intervention group. Participants in the intervention group more frequently chose combination therapy (25% versus 5% control, p < 0.001), had a significantly lower decisional conflict (p < 0.05) and had greater trust in their provider (p < 0.05). Conclusions: With rapidly expanding medication choices for Crohn's disease and slow uptake of early intensive therapy, SDM can personalise treatment strategies and has the potential to move the field of Crohn's disease management forward with an ultimate goal of consistently treating this disease early and intensively in appropriate patients. Trial Registration: Evaluating a Shared Decision Making Program for Crohn's Disease, ClinicalTrials.gov Identifier NCT02084290 https://clinicaltrials.gov/ct2/show/NCT02084290. [ABSTRACT FROM AUTHOR]

During a 44-month period, 105 Medtronic model 6972-58 polyurethane-insulated, bipolar ventricular pacing leads were implanted, of which 16 failed clinically at a mean of 20.5 months post-implant. Pacing dysfunction presented as either intermittent or complete loss of sensing and/or capture and, rarely, oversensing. Thirteen of the 16 patients were asymptomatic, and problems were detected in 11 instances during routine telephonic surveillance. At the time of lead replacement, low or widely fluctuating lead resistance values and high current drain were uniformly observed. The single lead capable of total extraction revealed rupture of both internal and external insulation. A brief summary of the currently much-discussed "polyurethane controversy" is presented, and the issue of patient management is discussed. [ABSTRACT FROM AUTHOR]

Our experience with over one-thousand pacemaker implantations resulting in almost 28.000 patient pacing months is reviewed. Data are presented regarding changing indications for pacing, experience with numerous pacemaker types, patient survival, comparative mortality of sick sinus syndrome and complete heart block, and telephone surveillance. Consistent with some previous reports, there were high one- and two-year post-implant mortality rates, and advanced age at implant was associated with decreased survival. Males had a significantly higher mortality rate. The period reported covers the transition from utilization of mercury-zinc batteries to lithium power cells and other new technology; significant differences were observed in device reliability and patient mortality when comparing these eras. Certain patients evidenced disparate survivals, the most notable difference being seen in those who received their primary implants prior to 1976 and subsequent implants of more modern units. [ABSTRACT FROM AUTHOR]

The capabilities of a mini-computer-oriented permanent pacemaker information system are described. Extensive patient and pacer functional data. are maintained in readily accessible files which may be displayed on a CRT terminal or printed out. Selective sorting of stored information may be accomplished according to any desired set of inclusive or exclusive criteria. Intelligent, comprehensive patient follow-up has been greatly facilitated through application of the system. In view of the rapidly expanding pacemaker population, it is suggested that cooperative regional networks operating with come parable information storage and retrieval structures will provide the only means for adequate patient surveillance and compilation of necessary pacemaker data. [ABSTRACT FROM AUTHOR]

Nausea and vomiting can result from a wide variety of organic and psychogenic disorders. In evaluating these symptoms, a thorough history with careful attention to their duration and relation to meals, as well as to concomitant drug use and underlying chronic medical problems, often will point to the correct diagnosis. A wide variety of diagnostic modalities exist, including radiographic studies, endoscopy, radionuclide methods of assessing gastrointestinal motility, and imaging studies of the central nervous system. These techniques must be used wisely and are not all required to elucidate the etiology in every patient. Treatment can be symptomatic but is directed at the underlying pathological process whenever possible. Recently developed gastrointestinal "prokinetic" agents have helped to improve the course of patients with identifiable motility disorders. [ABSTRACT FROM AUTHOR]

The applicability of a computerized, on-line, breath-by-breath nitrogen washout technique to respiratory studies in newborn infants is described. Reproducibility and accuracy of the system are entirely comparable to standards previously established in adult studies. Methodology allows simple, rapid, and direct assessment of a newborn infant's functional residual capacity, the uniformity of inspired gas distribution, and longitudinal time changes in these parameters. Studies in 40 normal infants < 2 to 128 hours of age have confirmed some previously published findings, but do not support the concept of very early establishment of optimal ventilatory distribution. Coupled with hemodynamic and blood gas studies, results obtained by this technique can provide a thorough evaluation of an infant's cardiopulmonary status. It is anticipated that such studies will provide valuable help in guiding and assessing results of ventilatory assistance and pharmacologic interventions in the respiratory distress syndrome. [ABSTRACT FROM AUTHOR]