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Rosendal Wolff posted an update 6 months, 2 weeks ago
The esophageal diverticulum is a protruding pouch in a weak portion of the esophageal lining. Previously, our team has reported an endoscopic tunneling technique (STESD) for diverticulum treatment. However, it does not perform well for the diverticulum located in the upper esophagus, where most diverticulum locates. Herein we reported a new endoscopic technique, called endoscopic Transversal Incision and Longitudinal Septostomy (TILS). TILS provides both larger operational spaces and complete septostomy and can be done on most types of the diverticulum, including the Zenker’s Diverticulum. © 2020 S. Karger AG, Basel.BACKGROUND Nonlife-threatening headaches account for 3% of emergency department (ED) admissions, with social and economic negative consequences. We aim to investigate clinical features and risk factors of nonlife-threatening headache patients referring to ED versus those referring to headache outpatient clinics. METHODS During 6 months, we promptly reevaluated in our headache unit (HU) patients discharged from ED. We compared the clinical characteristics of patients who referred to ED with those of HU outpatients visited in the same time interval. Discriminant Function Analysis and Correspondence Analysis were used to determine risk factors for ED referral. RESULTS We recruited 49 post-ED patients and 126 outpatients. The main reasons for ED admission were poor response to acute treatment and aura-related symptoms. Headache diagnoses made in ED were generally not confirmed later (overall concordance of 47%), except for cluster headache (CH) and migraine with aura (MA). ED patients complained higher headache intensity, longer duration, and prolonged aura compared to outpatients. Aura was the main risk factor associated with ED admission on statistical models, while less prominent risk factors were sex, age, and years from migraine onset. PF-00835231 CONCLUSIONS ED patients presented a more severe headache clinical phenotype compared with outpatients. Headache diagnosis remains difficult in the emergency setting and is more easily achieved for the headache forms with standout features, such as MA or CH. According to statistical models, the aura is the most important risk factor for ED admissions. © 2020 S. Karger AG, Basel.Cathemeral primates perform significant amounts of activity during the daylight and dark portions of the 24-h cycle. Most brown lemurs have been reported to be cathemeral. A previous study reported that brown lemurs in Ankarafantsika National Park (ANP) shift their activity pattern from being cathemeral in the dry season to being diurnal in the wet season. From July 2015 to March 2016, we collected data on active behaviour of brown lemurs over 46 full-day and 33 full-night observations, distributed evenly between the dry and wet seasons. This study examined the abiotic factors that potentially allow this seasonal shift from cathemeral to diurnal activity. We analysed the effects of day length (time from sunrise to sunset), nocturnal luminosity, and climatic factors on the diurnal and nocturnal activities of the brown lemurs in ANP using generalized linear mixed models. We found that the brown lemurs were cathemeral regardless of season. Their diurnal activity increased with increasing day length and at high hof brown lemurs according to the great seasonal variation in tropical dry forests. © 2020 S. Karger AG, Basel.BACKGROUND Postoperative insulin resistance (PIR) is a common response after colorectal surgery and an independent risk factor for recovery. Preoperative oral carbohydrate (POC) has been known to reduce PIR. Herein, we investigated whether its mechanism of action involves AMP-activated protein kinase (AMPK) and mTOR/S6K1/insulin receptor substrate-1 (IRS-1) pathways. METHODS Patients undergoing colorectal cancer resection were randomly assigned to a POC, fasting, or placebo group. The exclusion criteria were association with diseases or intake of medication affecting insulin sensitivity. Pre- and postoperative insulin resistance, and protein phosphorylation of AMPK, mTOR, and IRS-1 in the rectus abdominis muscle were evaluated. RESULTS From January 2017 to December 2017, 70 patients were randomized and 63 were evaluated. No difference was found in the clinical and operative characteristics among the 3 groups. In the POC group, the levels of blood glucose, blood insulin, and homeostasis model assessment of insulin resistance were significantly lower in the POC group than the fasting and placebo groups, and the insulin sensitivity index was significantly higher. The phosphorylation of AMPK in the POC group was significantly higher than that in the other 2 groups, whereas the phosphorylation of mTOR and IRS-1 was significantly lower. CONCLUSION PIR involves AMPK and mTOR/S6K1/IRS-1 pathways. POC reduces PIR by the stimulation of AMPK, which suppresses the phosphorylation of mTOR/IRS-1 and attenuates PIR after colorectal resection. © 2020 S. Karger AG, Basel.INTRODUCTION AND OBJECTIVE Neutrophil gelatinase-associated lipocalin (NGAL), a glycoprotein released by renal tubular cells, can be used as a marker of early tubular damage. We evaluated plasma NGAL level utilization for the identification of acute kidney injury (AKI) among ST-elevation myocardial infarction (STEMI) patients undergoing primary coronary intervention (PCI). METHODS 131 STEMI patients treated with PCI were prospectively included. Plasma NGAL levels were drawn prior to PCI (0 h) and 24 h afterwards. AKI was defined per KDIGO criteria of serum creatinine increase. Receiver-operating characteristic (ROC) methods were used to identify optimal sensitivity and specificity for the observed NGAL range. RESULTS Overall AKI incidence was 14%. NGAL levels were significantly higher for patients with AKI at both 0 h (164 ± 42 vs. 95 ± 30; p 120 ng/mL) predicted AKI with 80% sensitivity and specificity (AUC 0.881, 95%, CI 0.801-0.961, p less then 0.001). In a multivariate logistic regression model, NGAL levels were independently associated with AKI at 0 h (OR 1.044, 95% CI 1.013-1.076; p = 0.005) and 24 h (OR 1.018, 95% CI 1.001-1.036; p = 0.04). CONCLUSIONS Elevated NGAL levels, suggesting renal tubular damage, are independently associated with AKI in STEMI patients undergoing primary PCI. © 2020 S. Karger AG, Basel.