Prolonged intraesophageal pH monitoring with 16-Hr overnight recording

From studies in 43 patients (17 male, 26 female, mean age 51 years), we compared the analysis of the routine complete "24-hr" ambulatory esophageal pH monitoring study to that of the 16-hr overnight interval (4:00 PM to 8:00 AM). The latter included a major meal with an upright postprandial period and a recumbent period. All patients were monitored for at least 20 hr (median = 22.6 hr). The percent distal esophageal pH less than 4.0 and number of reflux episodes were measured for the total, upright, and recumbent periods of both the 16-hr and "24-hr" monitoring times. Significant (P less than 0.001) positive correlations were found for all comparisons between the two monitoring periods including percent time of pH less than 4.0 (total: r = 0.98; upright: r = 0.96) and number of episodes (totals r = 0.97; upright: r = 0.93). Patients were separated into normal and abnormal refluxers based on results of "24-hr" monitoring (pH below 4.0 greater than 4.2% total time; greater than 6.0% upright; greater than 1.2% recumbent). Based on this, sensitivity and specificity for 16-hr monitoring were as follows: total study: 86% and 95%; upright: 80% and 91%; recumbent: 100% for both. Conclusions: (1) a 16-hr overnight pH monitoring period can provide a reliable representation of "24-hr" distal esophageal acid exposure, (2) this shorter monitoring may improve patient acceptability and compliance, and (3) the symptom index was changed in 26.3% of patients using the 16-hr evaluation.     

Abscess caused by vancomycin-resistant Lactobacillus confusus.

Several isolates of vancomycin-resistant Lactobacillus confusus from human sources have been described, but to our knowledge, no well-documented infection attributable to this organism has been published. A thumb abscess caused by this bacterium in a healthy 49-year-old male is reported here. He was successfully treated by surgical drainage and cephalothin.     

Sublingual immunotherapy for hazelnut food allergy: a randomized, double-blind, placebo-controlled study with a standardized hazelnut extract

BACKGROUND: Food allergy may be life-threatening, and patients affected need to receive accurate diagnoses and treatment. Hazelnut has often been implicated as responsible for allergic reactions, and trace quantities can induce systemic reactions. OBJECTIVE: The aim of this study was to evaluate the efficacy and tolerance of sublingual immunotherapy with a standardized hazelnut extract in patients allergic to hazelnut. METHODS: This was a randomized, double-blind, placebo-controlled study. Inclusion criteria were a history of hazelnut allergy and positive skin prick test and double-blind placebo-controlled food challenge results. Patients were then randomly assigned into 2 treatment groups (hazelnut immunotherapy or placebo). Efficacy was assessed by double-blind, placebo-controlled food challenge after 8 to 12 weeks of treatment. Blood samples were drawn for measurement of specific IgE, IgG(4), and serum cytokines before and after treatment. RESULTS: Twenty-three patients were enrolled and divided into 2 treatment groups. Twenty-two patients reached the planned maximum dose at 4 days. Systemic reactions were observed in only 0.2% of the total doses administered. Mean hazelnut quantity provoking objective symptoms increased from 2.29 g to 11.56 g (P = .02; active group) versus 3.49 g to 4.14 g (placebo; NS). Moreover, almost 50% of patients who underwent active treatment reached the highest dose (20 g), but only 9% in the placebo. Laboratory data showed an increase in IgG(4) and IL-10 levels after immunotherapy in only the active group. CONCLUSION: Our data confirm significant increases in tolerance to hazelnut after sublingual immunotherapy as assessed by double-blind, placebo-controlled food challenge, and good tolerance to this treatment.     

Responses of plasma glutamine, free tryptophan and branched-chain amino acids to prolonged exercise after a regime designed to reduce muscle glycogen

Prolonged exercise can elicit a reduction in the plasma glutamine concentration and an increase in the plasma concentration ratio of free tryptophan (FTrp) to branched-chain amino acids (BCAA). The purpose of this investigation was to study the effects of a 60-min bout of vigorous treadmill running with dietary manipulation on plasma concentrations of glutamine, FTrp and BCAA after an exercise and diet regime designed to reduce muscle glycogen. Seven male distance runners [mean (SD) age: 29.3?(2.1) years; ˙VO _2max : 62.7?(3.3) ml?·?kg^?1?·?min^?1] acted as subjects. Each undertook a regime designed to reduce muscle glycogen, then performed a 60-min treadmill run (75% ˙VO _2max ) under two dietary conditions: after a 14-h fast (?fasted) and after ingestion of a high carbohydrate meal (30?kJ?·?kg^?1: 80% carbohydrate, 10% protein, 10% fat) 3?h before running (?fed). Plasma concentrations of glutamine, FTrp, BCAA, free fatty acids (FFA), glycerol and glucose were measured 5?min before and 5?min after the run, under each dietary condition. Plasma glutamine did not change in response to exercise when fasted (P > 0.05), but increased when fed (P = 0.007). Plasma FTrp increased under both dietary conditions (P < 0.001), but the magnitude of this increase was greater when fasted than when fed (P < 0.001). Plasma BCAA did not change under either dietary condition (P < 0.05). Increases in the plasma FTrp/BCAA ratio reflected increases in plasma FFA and glycerol concentrations (P < 0.001; both dietary conditions) and these changes were all greater under fasted conditions when a fall in blood glucose concentration was observed (P = 0.007). These data emphasise the importance of dietary carbohydrate intake between repeated bouts of prolonged exercise on responses of plasma glutamine, FTrp and BCAA during subsequent exercise.     

How Many Swallows Are Required to Establish Reliable Esophageal Peristaltic Parameters in Normal Subjects? An On-Line Computer Analysis

Esophageal manometric parameters are often examined using from four to 10 or more swallows to obtain a manometric profile without addressing the question of the reproducibility of these data. We asked the question of "how much is enough?" by statistically comparing five sets of 10 wet swallows (5 ml) each separated by 20 min in eight volunteers using constant infusion manometry. Peristaltic waves were evaluated for amplitude, duration, and velocity using an on-line computer program. Statistical analyses included analysis of variance and the Newman-Keuls test for uniformity among sets of swallows. The sets of 10 swallows showed no evidence of a training effect over time. Less than 5% of all comparisons (Newman-Keuls) showed significant differences. Using 5% variability outside of 1 SD as a cutoff (95% confidence interval) amplitude of normal wet swallows could be adequately defined by more than or equal to five swallows and velocity by more than or equal to seven swallows. Duration shows the greatest overall variability and required more than or equal to eight swallows for accurate assessment. These data suggest that at least five to eight wet swallows should be performed to describe "typical" manometry parameters for normal subjects.     

Radiologic and manometric correlation in "nutcracker esophagus"

"Nutcracker esophagus" is a newly described esophageal motor disorder seen in some patients with chest pain and/or dysphagia and characterized manometrically by normal primary peristalsis with distal contractions of high amplitude. The radiographic and manometric examinations in 20 patients with nutcracker esophagus were correlated. Normal primary peristalsis was observed radiographically in 16 patients, and a nonspecific motor disorder was diagnosed in the remaining four patients. Mild-to-severe nonspecific tertiary activity was seen in about half of the patients, esophageal wall thickness was normal. It is concluded that nutcracker esophagus is primarily a manometric diagnosis made in the appropriate clinical setting, and that the radiographic findings are normal or nonspecific.     

Does Flavonoid Consumption Improve Exercise Performance? Is It Related to Changes in the Immune System and Inflammatory Biomarkers? A Systematic Review of Clinical Studies since 2005

Flavonoids are attracting increasing attention due to their antioxidant, cardioprotective, and immunomodulatory properties. Nevertheless, little is known about their role in exercise performance in association with immune function. This systematic review firstly aimed to shed light on the ergogenic potential of flavonoids. A search strategy was run using SCOPUS database. The returned studies were screened by prespecified eligibility criteria, including intervention lasting at least one week and performance objectively quantified, among others. Fifty-one studies (54 articles) met the inclusion criteria, involving 1288 human subjects, either physically untrained or trained. Secondly, we aimed to associate these studies with the immune system status. Seventeen of the selected studies (18 articles) assessed changes in the immune system. The overall percentage of studies reporting an improved exercise performance following flavonoid supplementation was 37%, the proportion being 25% when considering quercetin, 28% for flavanol-enriched extracts, and 54% for anthocyanins-enriched extracts. From the studies reporting an enhanced performance, only two, using anthocyanin supplements, focused on the immune system and found certain anti-inflammatory effects of these flavonoids. These results suggest that flavonoids, especially anthocyanins, may exert beneficial effects for athletes’ performances, although further studies are encouraged to establish the optimal dosage and to clarify their impact on immune status.