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Background and study aims Adenoma detection rate (ADR) appears to decrease as the number of consecutive hours performing procedures increases, and eye strain may be a contributing factor. Ambient light may improve symptoms of eye strain, but its effects have yet to be explored in the field of gastroenterology. We aim to determine if using ambient lighting during screening colonoscopy will maintain ADRs and improve eye strain symptoms compared with low lighting. Methods At a single center, retrospective data were collected on colonoscopies performed under low lighting and compared to prospective data collected on colonoscopies with ambient lighting. Eye fatigue surveys were completed by gastroenterologists. Satisfaction surveys were completed by physicians and staff. Results Of 498 low light and 611 ambient light cases, 172 and 220 adenomas were detected, respectively ( P â=â0.611). Under low lighting, the ADR decreased 5.6â% from first to last case of the day ( P â=â0.2658). With ambient lighting, the ADR increased by 2.80â% ( P â=â0.5445). The difference in the overall change in ADR between first and last cases with ambient light versus low light was statistically significant (8.40â% total unit change, P â=â0.01). The average eye strain scores were 8.12 with low light, and 5.63 with ambient light ( P â=â0.3341). Conclusions Performing screening colonoscopies with ambient light may improve the differential change in ADR that occurs from the beginning to the end of the day. This improvement in ADR may be related to improvement in operator fatigue. The effect of ambient light on eye strain is unclear. Further investigation is warranted on the impact of ambient light on symptoms of eye strain and ADR.
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A 49-year-old man presented with abdominal pain and rectal bleeding for two days associated with a 50-pound unintentional weight loss. History was notable for hypertension, chronic kidney disease, obesity, gout, and acute cholecystitis status post cholecystectomy. Computed tomography (CT) of the abdomen and pelvis showed rectal wall thickening. Colonoscopy showed proctitis with superficial ulcerations. In the setting of renal insufficiency, malabsorption, and low-voltage QRS complexes on electrocardiogram (ECG), amyloidosis was considered in the differential diagnosis. Rectal and renal biopsies with subsequent retrospective staining of gallbladder tissue confirmed amyloid deposition. Gastrointestinal involvement of amyloidosis is relatively uncommon. Particularly, amyloid deposition in the gallbladder and rectum is very rare. The development of AA amyloidosis in our patient may have been related to gout, obesity, and the presence of a heterozygous complex variant for the MEFV (familial Mediterranean fever) gene. Awareness of this atypical presentation of amyloidosis is important, as additional staining of biopsy samples is necessary, and diagnosis allows for directed treatment.
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Background and objective Fluoroscopy during endoscopic retrograde cholangiopancreatography (ERCP) is associated with radiation exposure and related health risks. Either the physician or the radiology technologist can activate fluoroscopy during ERCP. The aim of this study was to determine if physician-controlled fluoroscopy is associated with decreased fluoroscopy time, which may correspond to less radiation exposure to patients and staff. Methods We conducted a single-center, retrospective study; data were collected on ERCP performed using physician-controlled and technologist-controlled fluoroscopy. Fluoroscopy time, procedure complexity level, and Stanford Fluoroscopy Score were compared between the two groups. Results The median fluoroscopy time significantly differed between the two groups with 108 seconds for physician-controlled and 146 seconds for technologist-controlled procedures (p=0.004). The ratio of median fluoroscopy time to procedure complexity level was significantly lower in the physician-controlled group at 73.0 seconds compared to 97.0 seconds in the technologist-controlled group (p=0.002). The ratio of median fluoroscopy time to Stanford Fluoroscopy Score was 25.5 seconds in the physician-controlled group compared to 39.3 seconds in the technologist-controlled group, which was also statistically significant (p<0.001). A subgroup analysis of physicians with advanced training in ERCP also showed a significantly reduced median fluoroscopy time to Stanford Fluoroscopy Complexity Score ratio: 25.5 seconds for physician-controlled versus 35.0 seconds for technologist-controlled (p=0.001). Conclusion The ERCP technique with physician-controlled fluoroscopy may be associated with shorter fluoroscopy time. This may correspond to decreased radiation exposure to patients compared to radiology technologist-controlled fluoroscopy. Further investigations with larger, prospective studies are warranted.
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Herpes simplex esophagitis (HSE) represents a rare entity in immunocompetent patients and has infrequently been described in association with eosinophilic esophagitis (EoE). Causality in this rare association remains a debated topic. We present a case of HSE occurring in an immunocompetent adult with EoE and review the literature in support of EoE induced mucosal disruption predisposing to increased risk of HSE.
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GOO is often the first sign of advanced upper gastrointestinal neoplasms. The most common neoplasms associated with GOO include gastric, pancreatic, and biliary tract cancers. Urinary tract urothelial carcinoma has been a rarely documented cause of GOO.
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Pseudomonas aeruginosa is an opportunistic Gram-negative pathogen known to cause enterocolitis in children, amongst other types of infections. Pseudomonas aeruginosa has been widely reported as a cause of antibiotic-associated diarrhea in adult immunocompromised hosts. We present an 81-year-old previously healthy female as the first reported case of Pseudomonas aeruginosa antibiotic-associated diarrhea in an immunocompetent host in the United States.
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Isoproterenol is known to cause insulin resistance and is often used to treat bradyarrhythmias from atrioventricular block. We report a case of isoproterenol induced diabetic ketoacidosis in a 77-year-old female patient treated with isoproterenol for atrioventricular block prior to insertion of permanent pacemaker. Diabetic ketoacidosis (DKA) developed within hours of starting an isoproterenol drip, and there were no other precipitating factors at that time. DKA resolved quickly after discontinuing isoproterenol and starting insulin drip. DKA is a common complication of diabetes mellitus, with about 140,000 hospital admissions for DKA in 2009. While the rate of DKA has increased by nearly 50% between 1988 and 2009, the rate of mortality has decreased. There are many causes of diabetic ketoacidosis, such as medication noncompliance, infection, pancreatitis, stroke, myocardial infarction, and many others. Isoproterenol may lead to diabetic ketoacidosis by increasing insulin resistance.
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Several series of thieno[2-3-b]pyridine analogues were synthesized and screened for inhibitory activity against eukaryotic elongation factor-2 kinase (eEF2-K). Modifications around several regions of the lead molecules were made, with a ring fusion adjacent to the nitrogen on the thienopyridine core being critical for activity. The most active compound 34 shows an IC(50) of 170 nM against eEF2-K in vitro.
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Quinasa del Factor 2 de Elongación/antagonistas & inhibidores , Quinasa del Factor 2 de Elongación/metabolismo , Inhibidores Enzimáticos/química , Inhibidores Enzimáticos/farmacología , Piridinas/química , Piridinas/farmacología , Línea Celular Tumoral , Supervivencia Celular/efectos de los fármacos , Humanos , Concentración 50 Inhibidora , Relación Estructura-ActividadRESUMEN
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective therapy for Parkinson's disease; however, the mechanism whereby DBS ameliorates the symptoms of Parkinson's disease remains an area of intense research. In the present study, we investigated the hypothesis that the neurotransmitter glutamate is released within the STN during high-frequency stimulation (HFS) of the STN. Direct measurements of extracellular glutamate concentration in the STN were made using a dual enzyme-based electrochemical sensor. The studies were carried out in ketamine/xylazine anesthetized rats placed in a Kopf stereotaxic head frame. Various electrical stimulations (100-micros cathodic pulses; 100-3000 microA; 10- to 1000-Hz frequency; 5-s to 60-min stimulus durations) using bipolar stimulating electrodes were delivered to the STN. Stimulation of the STN elevated the concentration of glutamate in the STN. The concentration of glutamate rose quickly during HFS, remained elevated for the duration of stimulation, and descended slowly towards baseline upon cessation of stimulation. Elevation of the extracellular concentration of glutamate in the STN may be an important mechanism whereby DBS in the STN improves the symptoms of Parkinson's disease. Furthermore, our data argue against the hypothesis that DBS works primarily by electrotonic inhibition of the stimulated structure.