Simethicone use during gastrointestinal endoscopy: Position statement of the Gastroenterological Society of Australia

Concern has been raised regarding the use of simethicone, a de‐foaming agent, during endoscopic procedures. Following reports of simethicone residue in endoscope channels despite high level disinfection, an endoscope manufacturer recommended that it not be used due to concerns of biofilm formation and a possible increased risk of microorganism transmission. However, a detailed mucosal assessment is essential in performing high‐standard endoscopic procedures. This is impaired by bubbles within the gastrointestinal lumen. The Gastroenterological Society of Australia's Infection Control in Endoscopy Guidelines (ICEG) Committee conducted a literature search utilizing the MEDLINE database. Further references were sourced from published paper bibliographies. Following a review of the available evidence, and drawing on extensive clinical experience, the multidisciplinary ICEG committee considered the risks and benefits of simethicone use in formulating four recommendations. Published reports have documented residual liquid or crystalline simethicone in endoscope channels after high level disinfection. There are no data confirming that simethicone can be cleared from channels by brushing. Multiple series report benefits of simethicone use during gastroscopy and colonoscopy in improving mucosal assessment, adenoma detection rate, and reducing procedure time. There are no published reports of adverse events related specifically to the use of simethicone, delivered either orally or via any endoscope channel. An assessment of the risks and benefits supports the continued use of simethicone during endoscopic procedures. Strict adherence to instrument reprocessing protocols is essential.     

Astrocyte activation and altered metabolism in normal aging,age-related CNS diseases,and HAND

Journal of NeuroVirology - Astrocytes regulate local cerebral blood flow, maintain ion and neurotransmitter homeostasis, provide metabolic support, regulate synaptic activity, and respond to brain...     

Integration of Genomic and Transcriptional Features in Pancreatic Cancer Reveals Increased Cell Cycle Progression in Metastases

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Shame: An Acute Stress Response to Interpersonal Traumatization

This paper conceptualizes shame as an acute stress response to an unacceptable view of oneself mediated through another’s perspective. After reviewing the developmental antecedents and ontogenetic role of shame, the author first illustrates how shame may induce a depressive paralysis and self-hurtful intent when the goal of reconciliation is thwarted. She then addresses how shame ignited by narcissistic injury can mobilize aggressive behavior toward others, motivated by a need to restore the self.

The goals of this paper are to demonstrate that the configurations of shame are manifestations of interpersonal traumatization, to define them as predictable stress responses that activate specific goal-directed behaviors, and to propose the use of these conceptualizations in the empirical study of interpersonal traumatization.