Search

Background: Mechanisms for how Helicobacter pylori infection affects risk of gastroesophageal reflux disease (GERD) and Barrett's esophagus are incompletely understood and might differ by sex. Methods: In a case–control study nested in the Melbourne Collaborative Cohort Study with 425 GERD cases and 169 Barrett's esophagus cases (identified at 2007–2010 follow-up), we estimated sex-specific odds ratios for participants who were H. pylori seronegative versus seropositive at baseline (1990–1994). To explore possible mechanisms, we (i) compared patterns of H. pylori-induced gastritis by sex using serum pepsinogen-I and gastrin-17 data and (ii) quantified the effect of H. pylori seronegativity on Barrett's esophagus mediated by GERD using causal mediation analysis. Results: For men, H. pylori seronegativity was associated with 1.69-fold [95% confidence interval (CI), 1.03–2.75] and 2.28-fold (95% CI, 1.27–4.12) higher odds of GERD and Barrett's esophagus, respectively. No association was observed for women. H. pylori-induced atrophic antral gastritis was more common in men (68%) than in women (56%; P = 0.015). For men, 5 of the 15 per 1,000 excess Barrett's esophagus risk from being seronegative were mediated by GERD. Conclusions: Men, but not women, who were H. pylori seronegative had increased risks of GERD and Barrett's esophagus. A possible explanation might be sex differences in patterns of H. pylori-induced atrophic antral gastritis, which could lead to less erosive reflux for men. Evidence of GERD mediating the effect of H. pylori on Barrett's esophagus risk among men supports this proposed mechanism. Impact: The findings highlight the importance of investigating sex differences in the effect of H. pylori on risk of GERD and Barrett's esophagus in future studies.

Summary Purpose The authors present a case series of 30 male patients who presented with primary epispadias between 1989 and 2002 and looked at their long-term outcomes. Objectives (1) What procedures and operations did these patients require following their original surgery? (2) What were their outcomes as adults in terms of continence, cosmesis, and sexual function? Materials and methods Primary male epispadias patients who had gone through transition into Adolescent and Adult Urology services were identified retrospectively from electronic patient records. Results The authors identified 30 male patients with a median follow-up of 18.5 years. Twenty-four had penopubic epispadias, and six had penile epispadias. All initial surgery took place between 9 and 48 months. Twenty-eight patients needed further surgery over the follow-up period, 26 had surgery for continence, and 12 required revision surgery. At follow-up, 15 patients were continent voiding per urethra, nine patients reported stress leakage with volitional urethral voiding, six patients were using a Mitrofanoff to void, and four of these had an ileocystoplasty. Nineteen patients had documentation on their feelings toward cosmetic outcome; 17 expressed concern. Twenty-one patients had documentation about sexual function; 20 had normal erections with six reporting chordee and nine reporting retrograde ejaculation. No patients were recorded to have fathered any children. Discussion There are only a few published studies looking at long-term outcomes of genitourinary reconstruction in primary male epispadias and their sexual function in adulthood. The majority of this patient cohort required surgery to improve their continence and had more than one continence procedure. There is limited data on continence outcomes in the literature with small cohorts and rates varying between 40 and 100% at 10-year follow-up. Despite corrective surgery, nearly all the patients were concerned about their genital appearance. Other studies have shown similar outcomes in terms of patient satisfaction and sexual function. The limitations of this work are that the information was gathered retrospectively from the electronic patient record and validated instruments on outcomes were not used. Conclusions The study outcomes will be useful for clinicians who are counseling patients and parents regarding what to expect as adults. Type of epispadias Total number Number requiring continence surgery (%) Number of continent patients voiding through native urethra (%) Penopubic 24 21 (86) 10 (40) Midshaft 3 2 (66) 2 (67) Distal 3 1 (33) 3 (100)

Currently, molecular testing in colorectal cancer (CRC) is aimed at detecting Lynch syndrome and predicting response to anti–epidermal growth factor receptor (EGFR) therapies. However, CRC is a complex disease, with at least 3 molecular pathways of carcinogenesis. The importance of the EGFR signaling pathway in colorectal carcinogenesis is underscored by the availability of anti-EGFR monoclonal antibodies for the treatment of some metastatic CRCs. Potentially, mutations in any of the genes in the EGFR signaling pathway may be associated with prognosis and may predict response to anti-EGFR or other targeted therapies. Although not currently the standard of care, molecular testing of CRCs is expanding to include mutational analysis of the genes in the EGFR pathway, in addition to more widely performed tests for identifying cancers with high microsatellite instability. Multiplex molecular prognostic panels for therapeutic decision making in stage II CRCs also represent expanding use of molecular testing for this common cancer. Upon completion of this activity you will be able to: The ASCP is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The ASCP designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit ™ per article. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This activity qualifies as an American Board of Pathology Maintenance of Certification Part II Self-Assessment Module. The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose. Questions appear on p 1008. Exam is located at [www.ascp.org/ajcpcme][1]. [1]: http://www.ascp.org/ajcpcme

Archaeological work preceding a housing development revealed mid-Devensian (MIS 3) deposits preserved in a geological fault, a graben feature, on an interfluve plateau. Rare evidence for Early Upper Palaeolithic open-air occupation was characterised by a scant lithic signature of the Lincombian-Ranisian-Jerzmanowician (LRJ) leaf-point techno-complex of the North European plain. The lithics included a complete leaf-point, another broken example with traces of impact damage, and knapping debitage indicating leaf-point maintenance. The site also preserved good evidence for an open-air hyaena den with abundant faunal remains. Discrete bone clusters were present, some of which probably represent meat caches for hyaena cubs in the burrows and scrapes of a maternity den. It is suggested that the hominins targeted the den site to forage the stored food. Their occupation is associated with a group of spirally-fractured wild horse bones thought to be the result of marrow extraction by humans, and these have been dated to 44,290–42,440 calibrated years before present (44.3–42.5 kyr calbp), comparable to the date range of continental LRJ sites. The early date of the LRJ techno-complex corresponds with that of the oldest Neanderthals in northern Europe, but possibly overlaps with the recently reported early dates for anatomically modern humans. However, it is concluded that the oldest Early Upper Palaeolithic technology in northern Europe was the product of final Neanderthals.

Summary Introduction Bladder calculi are a known complication of bladder augmentation. Open cystolithotomy remains the preferred option for treating large or multiple stones. Increasingly, however, minimal access techniques have been used. Reports of Mitrofanoff cystolitholapaxy are rare and have been limited to adults. This study presented a two centre series of children treated by cystolitholapaxy via the Mitrofanoff/Monti channel. Materials and methods With institutional approval the current study retrospectively reviewed and identified 14 patients, on a prospective database, who underwent Mitrofanoff cystolitholapaxy to treat bladder calculi at two independent institutions in the UK and Chile between 2004 and 2016. It looked at patient demographics, surgical technique, stone clearance and recurrence, as well as leak or catheterisation difficulties of the Mitrofanoff/Monti channel post-procedure. Results Fourteen patients underwent Mitrofanoff cystolitholapaxy during the period 2004–2016. One patient was excluded due to lack of follow-up. The remaining 13 patients were aged 5–22 (median 14) years at the time of the procedure. Their underlying diagnoses were four neuropathic bladders, four bladder exstrophy, four cloacal exstrophy and one posterior urethral valve. Patients underwent augmentation cystoplasty at a median age of 5 (range 1–15) years, using ileum in 10 and sigmoid colon in three. The channel for clean intermittent catheterisation was an appendix Mitrofanoff in nine and a Monti channel in four. An Amplatz sheath was placed through the Mitrofanoff to allow safe access to the bladder for treating the stones (see Summary Table). Recurrent stones were treated using the same technique. Stone and channel outcomes were analysed for each procedure. There were 22 procedures in 13 patients; five (38%) patients had recurrent stones. Median time to recurrence was 6 months. There were no immediate complications. Stone clearance was confirmed by ultrasound and abdominal x-ray at 3–6 months after the procedure. Median follow-up was 15 (range 3–53) months. There were no leaks or difficulties catheterising the channel on follow-up. Discussion This was the first series of Mitrofanoff/Monti cystolitholapaxy for the treatment of calculi in augmented bladders of paediatric patients. Previous concerns about damaging the continence mechanism of the conduit appeared to be unwarranted. The use of an Amplatz sheath protected the continence system from repeated instrumentation, and permitted free backflow of irrigation and rapid clearance of stone fragments. Recurrence of stones occurred in 38%, which was in keeping with rates reported in the wider literature. Conclusion Mitrofanoff cystolitholapaxy was safe, and with appropriate care did not result in leakage or difficulty catheterising. Summary Table . Amplatz sheath Number No sheath 4 18 Ch 13 20 Ch 3 26 Ch 1 28 Ch 1 Fragmentation method Number Swiss Lithoclast 12 Grasper 6 Laser 1 No fragmentation (lift-out) 3 Retrieval method Number Grasping forceps 18 2.4 Ch basket 4 Operative details.

Research on appropriate technologies and infrastructures to support water reuse has progressed rapidly over recent decades and there are now a wide range of source - treatment - reuse options for planners to choose from. Although the economics of water reuse schemes favours application to new developments rather than retrofit projects, there are few studies which have sought to address strategic option selection issues for large developments. The potential advantages of using treatment and reuse systems in new developments require an understanding of the relationships between a wide variety of social, environmental, technological, and operational factors. The operational effectiveness and economic efficiency of specific technology choices will vary as a function of network configuration, wastewater characteristics, how different technologies respond to dynamic loading (variability of feed strength and flow) and potential spiking, as well as equipment reliability, climate and household behaviour. Using a commercially available software package, the study reports the design and implementation of a low resolution simulation tool to explore sustainable water management options for a live case study site in the south of England (a peri-urban development of 4,500 new homes) with particular reference to opportunities for rainwater harvesting, and water reuse.

Facing the increase of environmental concern in the water treatment field, stakeholders need reliable decision support tools to assess environmental performances of urban and industrial wastewater systems. To discuss how life cycle assessment (LCA) can be applied to wastewater treatment projects, such an assessment has been performed through a case study on a full-scale plant. Methodological issues that had to be dealt with are briefly exposed. Five life cycle impact assessment (LCIA) methods have been used: CML 2000, Eco Indicator 99, EDIP 96, EPS and Ecopoints 97. Consistent assessment between these methods has been obtained for greenhouse effect, resources depletion and acidification. Eutrophication is correctly estimated if one looks at the potential impact of a treatment scenario but not at the characterization of the eutrophication state of a specific receiving stream. Work is needed concerning human toxicity as large discrepancies are noticed between the impact assessment methods.

Publisher Summary The degrees of freedom (DOFs) for any unconstrained, rigid object in 3-dimensional space are six, three of which are translational and three rotational. When considering several, for example, N-linked segments of the body, however, the DOFs are less than 6N, because the segments are constrained translationally by being joined to each other and the joints are not always of the ball-and-socket type that allows three rotational DOFs. This chapter discusses some recent ideas advanced in the literature addressing the resolution of kinematic redundancy and presents some of the preliminary findings concerning rules governing the motions of the legs, trunk, and arm for reaching movements of the hand to targets that necessitate trunk bending. It focuses on the selection of the combination of joint rotations—that is, on the resolution of redundancy at the kinematic level that can add another layer of redundancy to the problem of movement control.

Electromyogram responses to loads applied about the elbow joint were examined in two normal subjects who had been instructed to “resist”, “reverse”, “yield”, or “assist” flexing or extending torque steps whose directions could be predictable or unpredictable. In a postural regulation task (“resist-a load”), three agonist EMG response occurred: M1 (25- to 50-ms latency to peak), M2 (50 to 100 ms), and thereafter a more variable “late response”. Making the direction of the torque step unpredictable did not markedly alter the temporal pattern or amplitude of these responses. In contrast, a “yield-to-load” task set decreased M1 and M2 from the resist level and suppressed late responses entirely. EMG responses during movement initiation (“reverse-a-load” task) resembled those when resisting for the first 100 ms; but late responses were bigger, lasted longer, and moreover were delayed when torque direction was unpredictable. When assisting passive movement (“assist unload”), responses tended to be smaller than those in the reverse task, particularly M1 and M2. Making torque direction unpredictable delayed late responses, but not M1 and M2. We conclude that EMG responses peaking before 100 ms (M1 and M2) are primarily dependent on postural drive and secondarily on voluntary control. The late third response (M3, merging into “voluntary” activity) is primarily dependent on task set. Two patients with mild Parkinson symptoms were tested. Their EMG patterns differed from those of normal subjects primarily in having reduced late responses in all tasks, and by a 10-Hz modulation of EMG activity, triggered by load onset.

Intracortical recording microelectrodes were chronically implanted in the precentral gyrus of a monkey to determine the frequency range in which the firing pattern of a single neuron could be operantly conditioned. Single-unit activity attributed to an individual neuron was observed for as long as 28 days. The total range of neuronal firing frequency of a single neuron was divided into eight equal zones, each specified by a separate target and cursor light. The cursor light was controlled by the neuronal firing rate to provide visual feedback. During each trial two different target lights were presented to the animal in succession and both had to be matched to obtain a reward. During a period of 99 days, 280 neuronal conditioning runs were conducted using 28 different neurons. In roughly 79% of these runs, the monkey was able to modulate successfully the firing rate of a cortical neuron between two frequency bands on command and was also able to adjust the rate to several different frequency bands.

Evidence is presented for preprogramming of a certain type of arm movement made by chronic Cebus monkeys in execution of a self-paced step tracking task. Accuracy of guiding a handle into mechanically undetectable target areas depended on adequate auditory or visual target cues or on consistent practice without cues. “Continuous” movements made in one step retained their original learned amplitudes, revealing their preprogrammed mode of execution. In contrast, “discontinuous” movements, made in successive small steps, over- or undershot for many trials, until residual cues were used by the animals. Monkeys that were well trained to the use of continuous movements retained their use during cue deprivation, while others substituted discontinuous movements.