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85). After eliminating the highly prevalent nondysplastic samples, the interobserver agreement was still moderate to good (best overall κ=0.50; best paired κ=0.72). Notable differences were seen between the pathologists with a high-volume and low-volume practice (best overall κ=0.61 and 0.41, respectively). The agreement in the diagnosis of dysplasia in IBD endoscopic biopsies may have been undervalued over time. This is the first study evaluating pathologists' diagnostic robustness in this field. The results suggest that examining a large volume of samples is the key factor to increase the consistency in the diagnosis and gradation of IBD-related dysplasia.PURPOSE To determine improvement of near visual acuity by bilateral multifocal aspheric LASIK treatments in presbyopic patients. SETTING Goethe-University, Frankfurt, Germany. DESIGN Prospective, non-randomized trial. METHODS Thirty presbyopic patients underwent laser in situ keratomileusis (LASIK) treatment with a multifocal aspheric ablation profile using an excimer laser (PresbyMAX). The first 15 patients received a multifocal aspheric ablation profile combined with micro-monovision. For the consecutive 15 patients, less depth of focus (DOF) was included on the distance eye (hybrid). OUTCOME PARAMETERS Uncorrected (UDVA) and corrected distance visual acuity (CDVA), uncorrected (UIVA) and distance-corrected intermediate visual acuity (DCIVA), and uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuity; manifest refraction spherical equivalent (MRSE); subjective quality of vision; and spectacle independence RESULTS Binocular CDVA changed from -0.16±0.10 logarithm of the minimum angle of resolution (logMAR) preoperatively to 0.05±0.20 logMAR UDVA and -0.06±0.14 logMAR CDVA (p = 0.000, p = 0.001) 1 year postoperatively. Near visual acuity improved from 0.47±0.13 logMAR (DCNVA) and 0.48±0.26 logMAR (UNVA) to 0.19±0.19 logMAR (DCNVA, p less then 0.001) and 0.05±0.15 logMAR (UNVA, p less then 0.001). The hybrid- and the µ-monovision group did not differ statistically except for a better DCNVA in the µ-monovision patients (0.21±0.15 logMAR vs 0.34±0.17 logMAR, p=0.034). Of the hybrid- and µ-monovision patients, 21 (72%) and 12 (41%) had a binocular CDVA and UDVA of 20/20 or better, 8 (28%) patients lost 1 line of CDVA, 3 (10%) lost 2 lines, 4 (14%) lost 3, and 2 (7%) lost 4 lines of CDVA. CONCLUSIONS The PresbyMAX laser seemed to satisfy most of the patients even though they experienced a loss of CDVA. The gain of near visual acuity and therefore reported less need of spectacles appeared to compensate for this loss.The earth's atmosphere has warmed by about 1°C compared with preindustrial temperature. This is producing changes in the earth's climate and weather which have implications for gastrointestinal health and disease. Climate change will exacerbate current challenges with regard to provision of adequate nutrition and access to clean water. An increase in high rainfall events, flooding and droughts will be associated with an increase in enteric infections and hepatitis. Changes in habitat may result in altered distribution of gastrointestinal illness such as Vibrio cholera. Climate change will force migration between countries, and within countries, and will drive relocation from rural to urban areas, further straining sanitation and clean water provision. The infrastructure required to the delivery of gastrointestinal care is vulnerable to extreme weather events which will become more frequent. The Gastroenterology community needs to join the debate on climate change by organizing, educating, advocating, and supporting our political leaders as they face the enormous challenges posed by global warming.BACKGROUND Surgery is considered to be the best treatment for recurrent hidradenitis suppurativa (HS). Varying recurrence rates have been reported in the literature. OBJECTIVE To provide an up-to-date systematic review of the complete literature for different excision strategies and their recurrence rates in HS. METHODS A systematic literature search of the complete available literature and a meta-analysis of proportions were performed on the included studies. RESULTS Of a total of 1,593 retrieved articles, 125 were included in the analysis. Most of these studies were retrospective with 8 prospective analyses and one randomized controlled trial (RCT). The techniques described were divided into partial excision (PE) and wide excision (WE), described in 33 and 97 included studies, respectively. find more The average estimated recurrences were 26.0% (95% confidence interval [CI], 16.0%-37.0%) for PE and 5.0% (95% CI, 3.0%-9.0%) for WE (p less then .01). Female sex (p = .016) and HS caudal of the umbilicus (p = .001) were significantly associated with the overall recurrence rate. Quality of evidence was poor, and the reporting of results was mostly heterogeneous. CONCLUSION This systematic review showed higher recurrence rates when it was not intended to resect affected HS tissue with a radical margin. There is a need for more RCT's and uniformly reported treatment outcomes.OBJECTIVES Frailty and sarcopenia are known risk factors for adverse liver transplant outcomes and mortality. We hypothesized that frailty or sarcopenia could identify the risk for common serious transplant-related adverse respiratory events. METHODS For 107 patients (74 men, 33 women) transplanted over 1 year, we measured frailty with gait speed, chair stands, and Karnofsky Performance Scale (KPS) and sarcopenia with Skeletal Muscle Index on computed tomography at L3. We recorded the stress-tested cardiac double product as an index of cardiac work capacity. Outcomes included days of intubation, aspiration, clinical pneumonia, reintubation/tracheostomy, days to discharge, and survival. We modeled the outcomes using unadjusted regression and multivariable analyses controlled for (i) age, sex, and either Model for End-Stage Liver Disease-Na (MELDNa) or Child-Turcotte-Pugh scores, (ii) hepatocellular carcinoma status, and (iii) chronic obstructive pulmonary disease and smoking history. Subgroup analysis was performed for living donor liver transplant and deceased donor liver transplant recipients. RESULTS Gait speed was negatively associated with aspiration and pulmonary infection, both in unadjusted and MELDNa-adjusted models (adjusted odds ratio for aspiration 0.10 [95% confidence interval [CI] 0.02-0.67] and adjusted odds ratio for pulmonary infection 0.12 [95% CI 0.02-0.75]). Unadjusted and MELDNa-adjusted models for gait speed (coefficient -1.47, 95% CI -2.39 to -0.56) and KPS (coefficient -3.17, 95% CI -5.02 to -1.32) were significantly associated with shorter intubation times. No test was associated with length of stay or need for either reintubation or tracheostomy. DISCUSSION Slow gait speed, an index of general frailty, indicates significant risk for post-transplant respiratory complications. Intervention to arrest or reverse frailty merits exploration as a potentially modifiable risk factor for improving transplant respiratory outcomes.BACKGROUND Various multimodal analgesic approaches have been proposed for spine surgery. The authors evaluated the effect of using a combination of four nonopioid analgesics versus placebo on Quality of Recovery, postoperative opioid consumption, and pain scores. METHODS Adults having multilevel spine surgery who were at high risk for postoperative pain were double-blind randomized to placebos or the combination of single preoperative oral doses of acetaminophen 1,000 mg and gabapentin 600 mg, an infusion of ketamine 5 µg/kg/min throughout surgery, and an infusion of lidocaine 1.5 mg/kg/h intraoperatively and during the initial hour of recovery. Postoperative analgesia included acetaminophen, gabapentin, and opioids. The primary outcome was the Quality of Recovery 15-questionnaire (0 to 150 points, with 15% considered to be a clinically important difference) assessed on the third postoperative day. Secondary outcomes were opioid use in morphine equivalents (with 20% considered to be a clinically important chabapentin, combined with intraoperative infusions of lidocaine and ketamine, did not improve recovery in patients who had multilevel spine surgery.OBJECTIVE The use of the radial approach in coronary angiography or percutaneous coronary intervention has increased owing to its advantages over the femoral approach such as rapid patient mobilization and improved patient comfort. However, radial artery spasm (RAS) that occurs during the procedure is a crucial factor in transradial approach failure and access site switch. Asymmetric dimethylarginine (ADMA) is a naturally occurring, modified amino acid that inhibits nitric oxide (NO) production. High ADMA levels may reduce arterial elasticity especially in small arteries like the radial artery. This study aimed to evaluate the relationship between ADMA levels and RAS in radial artery access. METHODS This study included 155 patients (89 males and 66 females) who underwent transradial coronary angiography between January 2016 and June 2016. The ADMA level in the plasma was determined using a quantitative sandwich enzyme immunoassay technique. RESULTS RAS was observed in 16 of the 155 patients (10.1%). The RAS was found to be more frequent in female patients (17.9% for women vs. 4.4% for men, p=0.019). The plasma concentration of ADMA in the RAS group was significantly higher than that in the control group [22.1 ng/mL (12.1-37.8) vs. 9.2 ng/mL (5.9-14.8), p less then 0.001]. Moreover, the plasma concentration of ADMA was significantly higher in patients with RAS among female patients [20.4 ng/mL (12.1-44.9) vs. 9.9 ng/mL (6.2-16.6); p=0.002] and among male patients [25.2 ng/mL (13.7-35.4) vs. 8.2 ng/mL (5.9-12.8); p=0.007]. Binary logistic regression analysis of all patients showed that ADMA concentration was the only predictor for RAS (odds ratio=1.142; 95% confidence interval=1.061-1.228; p less then 0.001). CONCLUSION It was found that the ADMA concentration of the patients in the RAS group was elevated compared to that of controls. The findings indicated that elevated ADMA concentrations could predict RAS that may occur.Premature ventricular contractions (PVCs) is one of the most common situations in the current cardiology practice. Although PVCs are generally benign in people without any structural heart disease, they may be associated with left ventricular dysfunction, cardiomyopathy, and, rarely, sudden death. Recently, there has been a considerable research in the pathophysiology of PVC, several clinical presentations in different situations, new proposals of successful diagnostic methods, and treatment modalities. Finally, the American College of Cardiology Electrophysiology Council has published a special report that deals with all the aspects of PVC. We reviewed the important points from this report that can be reflected in our daily practice.OBJECTIVE Obesity is associated with increased cardiovascular (CV) mortality and morbidity. Bariatric surgery (BS) is currently an established therapeutic approach for severely obese patients. Carotid intima-media thickness (CIMT) and brachial artery flow-mediated dilation (FMD) provide important prognostic information beyond traditional CV risk factors. This study aimed to examine the effect of bariatric surgery-induced weight loss on CIMT and brachial artery FMD in morbidly obese patients. METHODS A total of 23 morbidly obese patients (40.4±5.6 years, 13 females) were examined before and after BS for 1 year with 3-month periods. CIMT, FMD, body composition, and metabolic parameters were determined. RESULTS All the patients exhibited significant weight loss following BS (p less then 0.001). Carotid intima-media thickness reduction was not significant from baseline to 6 months (p=0.069), but at 9 months (p=0.004), it became significant. Similarly, the difference between the preoperative and 6-month FMD assessments was not significant (p=0.