Impact of sex on the incidence of atrial fibrillation in the community setting: a systematic review and meta-analysis

Introduction

Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with significant morbidity and mortality. By 2060, it is estimated that 18 million adults over 55 years will have AF in the European Union, and significant healthcare costs are projected to accompany this substantial increase in prevalence. Sex plays a major role in its pathogenesis, but conflicting results have been reported on whether the risk of new-onset AF differs between men and women.

Purpose

Undertake a systematic review and meta-analysis of epidemiological studies comparing incidence of new-onset AF between men and women in the community setting.

Methods

We searched PubMed Medline and Ovid Embase for longitudinal studies from their inception to March 2021. We selected studies if they presented sex-specific incidence estimates of new-onset AF for participants without a prior history of AF. We assessed the risk of bias from methodological quality using the Newcastle Ottawa Scale (NOS). We pooled data using a random-effects model with inverse-variance weighting approach, and carried out subgroup analyses to explore heterogeneity based on age and sampling population. Risk ratio (RR) and 95% confidence interval (CI) were generated to compare the incidence of new-onset AF between men and women.

Results

A total of 54 prospective cohort studies met the inclusion criteria and were systematically reviewed. Of these, 45 with data on a total of 10,530,623 participants (40% women) were included in the meta-analysis. Pooled analysis demonstrated that men had a statistically significant higher risk of developing new-onset AF than women (RR 1.53; 95% CI 1.42–1.64; p<0.00001) and this result remained robust on sensitivity analysis. The sampling population subgroup analysis suggests that the risk in men could be even higher based on studies that were part of health screening programmes (RR 2.88; 95% CI 2.16–3.83; p<0.00001). However, the age subgroup analysis suggests that no statistically significant difference exists between the sexes beyond 50 years (RR 1.19; 95% CI 0.96–1.46; p=0.11).

Conclusion

This systematic review unequivocally demonstrates that men have a higher risk of new-onset AF than women in the general population. Future research could address the usefulness of screening programmes and provide more empirical evidence for the elderly.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Wolfson Foundation

Pro106Leu MPL mutation is associated with thrombocytosis and a low risk of thrombosis, splenomegaly and marrow fibrosis

The P106L mutation in the human myeloproliferative leukemia virus oncogene (MPL) was shown to be associated with hereditary thrombocythemia in Arabs. The clinical and bone marrow (BM) features of P106L mutation are unknown. Genetic databases at two tertiary hospitals in Saudi Arabia were searched to identify patients with the MPL P106L mutation. Clinical data were collected retrospectively and the BM aspirates and biopsies were independently reviewed by two hematopathologists. In total, 115 patients were included. Median age was 33 years of which 31 patients were pediatric and 65 were female. The mutation was homozygous in 87 patients. Thrombocytosis was documented in 107 patients, with a median platelet count of 667 × 10⁹/L. The homozygous genotype was associated with a higher platelet count. Thirty-three patients had an evaluable BM and clustering of megakaryocytes was observed in 30/33 patients. At the time of last follow-up, 114 patients were alive. The median follow-up was 7.8 years from the time of thrombocytosis. No patients developed disease progression to myelofibrosis. The P106L mutation was associated with marked thrombocytosis at a younger age and with a low risk of thrombosis, splenomegaly, and marrow fibrosis. The BM demonstrated normal or hypocellular marrow with megakaryocyte clusters.

Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy with a History of Previous Surgery of Suicidal Intake of Hydrochloric Acid

A patient with a history of previous abdominal surgery is at increased risk of visceral injury due to adhesion and excessive bleeding, which may require surgical repair. The optimal outcome can be achieved with the inter-professional team, patient care after being discharged from the hospital, and follow-up after surgery for eight weeks. Here we present as case of total abdominal hysterectomy with bilateral salpingo-oophorectomy with a history of previous surgery of suicidal intake of Hydrochloric Acid.

SGLT2 inhibitors in heart failure with preserved and reduced ejection fraction: a systematic review and meta-analysis

Funding Acknowledgements

Type of funding sources: None.

Background

Over the recent months, the scenery of the pharmacological treatment of heart failure has changed. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have become the protagonists, as trial after trial is revealing a prognostic benefit of their use for patients with heart failure (HF). While their clear advantage in heart failure with reduced ejection fraction (HFrEF) has resulted in the addition of SGLT2i in the most recent treatment guidelines 1, the magnitude of their impact in heart failure with preserved ejection fraction (HFpEF) is still debated. With the recent results of EMPEROR-Preserved trial shedding more light into this matter 2, concrete evidence is needed now more than ever to ascertain the role of SGLT2i in the management of HFpEF.

Aims

We performed a systematic review and meta-analysis to evaluate the role of SLGT2i in the management of patients with HF. More specifically, we performed a pre-specified subgroup analysis to assess the impact of this drug class in heart failure with reduced and preserved ejection fraction separately.

Methods

We conducted a systematic search of PubMed, Embase, Cochrane and Web of Science databases from inception to 15th of September. With the primary endpoint being hospitalisation for heart failure (HHF) or cardiovascular death (CVD), we identified 9,493 articles out of which 8 randomised controlled trials and 20,758 patients were included in the meta-analysis 2–9. The hazard ratios (HR) and 95% CI given in each study were used for the meta-analysis. A random-effects model with inverse-variance weights was used to combine the effect measures from all studies on a logarithmic scale. Statistical heterogeneity was assessed using the I² statistic. The statistical analyses were conducted using the Review Manager (RevMan) software (version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014).

Results

The use of SGLT2i was associated with a significant reduction in HHF or CVD both for the patients with heart failure and EF>40% (HR=0.78, 95%CI: 0.69, 0.87; I2 0%) and for the patients with heart failure and EF<40% (HR=0.74, 95%CI: 0.68, 0.81; I2 0%), while for the total population SGLT2i reduced the risk of HHF or CV death by 25% (HR=0.75, 95%CI: 0.70, 0.81; I2 0%) (figure 1). Additionally, a prespecified subanalysis showed that in the specific cohort of patients with heart failure and EF>50%, SGLT2i resulted in 23% lower risk of HHF or CV death (HR=0.77, 95%CI: 0.66, 0.91; I2 22%) (figure 2).

Conclusion

This meta-analysis provides robust evidence that SGLT2i appear to have a prognostic benefit across the spectrum of heart failure subgroups in terms of HHF or CV death. Further large-scale randomised trials examining the role of this drug class in the management of HFpEF would be extremely valuable and might transform the field of therapeutic strategies in this challenging clinical entity.

Dilemma of sigmoid volvulus management

INTRODUCTION

Patients with sigmoid volvulus (SV) are at a high risk of recurrence with increased morbidity and mortality. This study aims to review whether patients with SV underwent definitive surgical treatment after initial endoscopic reduction according to the guidelines, and to compare mortality rate between surgical and conservative management.

METHODS

Retrospective study conducted at East Kent Hospitals University NHS Foundation Trust, included all patients with SV between 2016 and 2018. The primary outcome was 30-day mortality following the initial management of the acute attack. Secondary outcomes were recurrence rate and overall mortality. The median follow-up period was 3 years.

RESULTS

A total of 40 patients were identified with a median age of 82 years; 27 (67%) were males. Of these 40 patients, 6 (15%) had emergency surgery, 26 (65%) received endoscopic decompression only, and 8 (20%) had planned definitive resection; 32 patients (80%) had recurrence and the median interval between any two episodes was 86 days. The mortality rate among patients with ASA grade 3 or 4 in the three groups, elective surgery, emergency surgery and decompression only, was 0%, 25% and 70% respectively, whereas it was 0%, 50% and 33% in those with ASA grade 2. The mortality rate among patients with similar ASA who had a planned surgery was significantly lower compared with those who did not undergo surgery (p=0.003).

CONCLUSIONS

In patients with sigmoid volvulus, regardless of ASA grade, performing early definitive surgery following initial endoscopic decompression resulted in a statistically significant lower mortality rate.

Dilemma of sigmoid volvulus management

INTRODUCTION

Patients with sigmoid volvulus (SV) are at a high risk of recurrence with increased morbidity and mortality. This study aims to review whether patients with SV underwent definitive surgical treatment after initial endoscopic reduction according to the guidelines, and to compare mortality rate between surgical and conservative management.

METHODS

Retrospective study conducted at East Kent Hospitals University NHS Foundation Trust, included all patients with SV between 2016 and 2018. The primary outcome was 30-day mortality following the initial management of the acute attack. Secondary outcomes were recurrence rate and overall mortality. The median follow-up period was 3 years.

RESULTS

A total of 40 patients were identified with a median age of 82 years; 27 (67%) were males. Of these 40 patients, 6 (15%) had emergency surgery, 26 (65%) received endoscopic decompression only, and 8 (20%) had planned definitive resection; 32 patients (80%) had recurrence and the median interval between any two episodes was 86 days. The mortality rate among patients with ASA grade 3 or 4 in the three groups, elective surgery, emergency surgery and decompression only, was 0%, 25% and 70% respectively, whereas it was 0%, 50% and 33% in those with ASA grade 2. The mortality rate among patients with similar ASA who had a planned surgery was significantly lower compared with those who did not undergo surgery (p=0.003).

CONCLUSIONS

In patients with sigmoid volvulus, regardless of ASA grade, performing early definitive surgery following initial endoscopic decompression resulted in a statistically significant lower mortality rate.

1466 Closed Incision Negative Pressure Wound Therapy reduces Surgical Site Infection following Emergency Laparotomy: A Propensity Matched NELA Registry Study

Background

Surgical site infection (SSI) contributes to a significant proportion of post-operative morbidity in people undergoing emergency surgery. Prophylactic closed incision negative pressure therapy (CINPT) has been shown to reduce SSI rates in patients undergoing elective laparotomy however there is limited evidence for their use in the emergency setting. This study aimed to determine whether prophylactic CINPT provides comparable SSI rate to SSD for midline incision following emergency laparotomy.

Method

A registry-based, prospective cohort study was undertaken using data from National Emergency Laparotomy Audit (NELA) database at our centre. The primary outcome measure was SSI as defined by the Centers for Disease Control (CDC) criteria. Secondary outcomes included 30-day post-operative morbidity and grade using Clavien-Dindo (CD) classification and the Comprehensive Complication Index, length of stay, 30-day mortality and readmission rates. CINPT and standard surgical dressing group were compared with respect to peri-operative characteristics and post-operative outcomes. A propensity- score matching (PSM) was performed to mitigate for selection bias.

Results

A total of 1484 patients were identified. Following PSM, a matched cohort of 474 patients were identified with 237 patients in each arm. SSI rate in CINPT cohort was found to be significantly lower compared to the SSD cohort (16.9% vs. 33.8%, p < 0.001). The rate of superficial and deep infections was higher in the standard dressing arm compared to the CINPWT, p < 0.001. There were no overall differences in 30-day morbidity and grade of post-operative complications.

Conclusions

Prophylactic CINPT in the emergency laparotomy is associated with reduced SSI rates.

Bilateral occipital lobe infarct neglect deficit (BLIND) syndrome

Cortical blindness is characterized by loss of vision due to dysfunction of the visual cortices, most commonly secondary to bilateral ischemic infarcts of the occipital lobe. Other causes include surgery such as aortic valve replacement, laryngeal surgery, craniotomy, cerebral angiography, head trauma, and partial seizures. Visual anosognosia is a distinct feature of cortical blindness, wherein patients claim they can see and confabulate visual perceptions, despite loss of sight. We herewith present a rare phenomenon known as Anton Syndrome, an eponym named after the Austrian neurologist and psychiatrist, Gabriel Anton (1858-1933). There are a limited number of cases of Anton's Syndrome in the literature, with only 28 case reports published from 1965-2016. Although he was bestowed a neurologic eponym, Anton was an advocate of eugenics and racial hygiene. He publicly advocated for 'superior breeding' and 'selection' in order to 'build a brave and noble race.' We therefore propose replacing the eponym with Bilateral Occipital Lobe Infarct Neglect Deficit (BLIND) Syndrome, with intention of raising awareness of this unique presentation as well as of the widespread interest in eugenics in the early 1900s amongst physicians, notably Gabriel Anton.

OP0120 DURATION OF CLINICAL EFFICACY FOLLOWING TREATMENT WITH VIB4920 IN SUBJECTS WITH MODERATE TO SEVERE RHEUMATOID ARTHRITIS

Background:

VIB4920 binds CD40 ligand and functionally neutralizes its engagement with CD401. We reported results through Day 85 of a Phase 1b, randomized, double-blind, placebo-controlled study (NCT02780388) in subjects with moderate to severe rheumatoid arthritis (RA) who had an inadequate response to methotrexate (MTX) or other disease modifying anti-rheumatic drugs (DMARDs) or tumor necrosis factor (TNF)-inhibitors1. We showed that at the end of the 12-week treatment period (Day 85), subjects treated with 1000 or 1500 mg VIB4920 (once every 2 weeks) had a clinically meaningful and statistically significant greater reduction in disease activity compared to placebo.

Objectives:

To assess the duration of clinical efficacy following the last dose of VIB4920 in subjects with moderate to severe RA.

Methods:

Subjects in the Phase 1b study (Ph1b) continued to have monthly safety and efficacy assessments between Days 85 and 169, the end of a 12-week follow-up. To estimate the subsequent duration of meaningful clinical improvement, we conducted an observational one-visit study (OS) (EudraCT 2019-002351-42) with the primary endpoint of time from last dose of VIB4920 to start of a new DMARD or biologic therapy or increase in dose of DMARD that was ongoing at Day 169 (ie, rescue therapy).

Results:

At Day 169 of the Ph1b (3 months after the last dose), clinical responses achieved at Day 85 were maintained in the 1000 and 1500 mg cohorts (Figure). Of 24 subjects, 16 (6/12 treated with 1000 mg and 10/12 with 1500 mg) participated in the OS. The median (range) time from Day 169 (last visit) in the Ph1b to the OS was 21.8 (21.2 to 23.1) months in the 1000 mg group and 33.7 (32.3 to 34.8) months in the 1500 mg group. All subjects had taken DMARDs (primarily methotrexate [MTX]) for at least part of this time (Table). Rescue therapy was started in 1/6 (16.7%) subject in the 1000 mg group and 3/10 (30.0%) subjects in the 1500 mg group (Table); median time to rescue could not be estimated due to the limited number of rescues. Two subjects were on no DMARDs at the OS. All subjects, except for 1 in the 1000 mg group, who was rescued with adalimumab, and 2 in the 1500 mg group (no rescue), had active disease (DAS28-CRP ≥ 2.6) at the OS. The median DAS28-CRP at the OS was higher than at Day 169 of the Ph1b but lower than at the Ph1b baseline visit (Table). Two subjects who received 1500 mg and met DAS28-CRP criteria for low disease activity (< 3.2) at Day 169 also met these criteria at the OS without receiving any rescue therapy after a median of nearly 37 months after last treatment. Results from the Patient and Physician Global Assessment VAS showed trends similar to the DAS28-CRP.

Conclusion:

Blocking CD40L with VIB4920 led to prolonged clinical benefit in patients with RA when added to stable background DMARD therapy. The exact duration of benefit could not be defined in this study, but most patients did not require rescue therapy during a prolonged follow-up period, and some patients maintained low disease activity or discontinued DMARDs, suggesting a possible long-term benefit of VIB4920. Interpretation of these data is limited because the OS did not include placebo-treated subjects from the Ph1b. The duration of clinical response needs to be confirmed in prospective, double-blind, placebo-controlled studies.

References:

[1]Karnell JL et al. Sci Transl Med. 2019 Apr 24;11(489).

Summary of ResultsVIB4920 1000 mg N = 6VIB4920 1500 mg N = 10Subjects who received ≥ 1 DMARD at any time between Day 169 of Ph1b and OS6 (100%)10 (100%)Hydroxychloroquine (HCQ)1 (16.7%)0MTX5 (83.3%)9 (90.0%)Leflunomide1 (16.7%)2 (20.0%)Adalimumab1 (16.7%)0Etanercept01 (10.0%)Rescue therapyHCQ, Adalimumab1 (16.7%)0MTX02 (20%)MTX, Leflunomide, Etanercept01 (10%)DAS28-CRP [median (min, max)]Ph1b Baseline5.4 (4.7 – 6.3)4.7 (4.3 - 5.7)Ph1b Day 1692.9 (1.1 – 4.2)2.3 (1.1 - 3.4)OS3.7 (1.1 – 5.5)3.9 (2.3 – 5.6)

Acknowledgements:

The authors thank the study participants and investigators.

Disclosure of Interests:

Omar Ali Shareholder of: I own shares of Viela Bio., Employee of: I am an employee of Viela Bio., Liangwei Wang Shareholder of: I own shares of Viela Bio., Employee of: I am an employee of Viela Bio., Wenjing Xu Shareholder of: I own shares of Viela Bio., Employee of: I am an employee of Viela Bio., Dan Falleroni Shareholder of: I own shares of Viela Bio., Employee of: I am an employee of Viela Bio., Judith Falloon Shareholder of: I own shares of Viela Bio., Employee of: I am an employee of Viela Bio., Gabor Illei Shareholder of: I own shares of Viela Bio., Employee of: I am an employee of Viela Bio.

Bacterial behaviour in the biodegradation of phenol by indigenous bacteria immobilized in Ca-alginate beads

The phenol biodegradation by Ca-alginate immobilized indigenous bacteria was performed in batch system. The effects of some operational parameters were evaluated, including % weight of alginate, calcium and CaCl₂, diameter of spheres; jellification time; solution concentration; adaptation concentration and alginate/cells ratio. The optimal biodegradation conditions were found for 2% and 3% of weight for respectively the sodium alginate and calcium chloride. The hardening time was 30  min and beads diameter of 4 cm. The degradation efficiency of the immobilized strains in these conditions exceeds 800 mg·L^-1. The results show that the mass transfer flow (nutritional intake) which depends on the concentration gradient (dC/dz), the physical-chemical properties of alginate beads through the diffusivity coefficient (D), govern the bacterial kinetics and the spatial and temporal behaviour of bacteria.

Rescue therapy for patients with anti-PD-1-refractory Merkel cell carcinoma: a multicenter, retrospective case series

Merkel cell carcinoma (MCC) is a rare but clinically aggressive cancer with a high mortality rate. In recent years, antibodies blocking the interactions among PD-1 and its ligands have generated durable tumor regressions in patients with advanced MCC. However, there is a paucity of data regarding effective therapy for patients whose disease is refractory to PD-1 pathway blockade. This retrospective case series describes a heterogeneous group of patients treated with additional immune checkpoint blocking therapy after MCC progression through anti-PD-1. Among 13 patients treated with anti-CTLA-4, alone or in combination with anti-PD-1, objective responses were seen in 4 (31%). Additionally, one patient with MCC refractory to anti-PD-1 and anti-CTLA-4 experienced tumor regression with anti-PD-L1. Our report - the largest case series to date describing this patient population - provides evidence that sequentially-administered salvage immune checkpoint blocking therapy can potentially activate anti-tumor immunity in patients with advanced anti-PD-1-refractory MCC and provides a strong rationale for formally testing these agents in multicenter clinical trials. Additionally, to the best of our knowledge, our report is the first to demonstrate possible anti-tumor activity of second-line treatment with a PD-L1 antibody in a patient with anti-PD-1-refractory disease.

TIRADS Interobserver Variability Among Indeterminate Thyroid Nodules: A Single-Institution Study

OBJECTIVES

A high proportion of cytologically indeterminate, Afirma Gene Expression Classifier "suspicious" thyroid nodules are benign. The Thyroid Imaging Reporting and Data System (TIRADS), was proposed by the American College of Radiology in 2017 to help classify thyroid nodules based on ultrasound characteristics in a standardized fashion to guide management. We aim to determine the interobserver variability of TIRADS classification among cytologically indeterminate and Afirma suspicious nodules.

METHODS

We retrospectively queried cytopathology archives for thyroid fine-needle aspiration specimens obtained between February 2012 and September 2016 with associated (1) indeterminate diagnosis, (2) ultrasound imaging at our institution, (3) Afirma suspicious result, and (4) surgery at our institution. We compared the TIRADS variability of the 3 blinded radiologists using intraclass correlation coefficients.

RESULTS

Our cohort consisted of 127 nodules. Intraclass correlation coefficients can be interpreted as follows: less than 0.4, poor; 0.4 to 0.59, fair; 0.6 to 0.74, good; 0.75 to 1.00, excellent. The intraclass correlation coefficients of the raw TIRADS score and category variability was 0.561 (95% confidence interval [CI]: 0.464-0.651) or fair and 0.547 (95% CI, 0.449-0.640) or fair, respectively. When analyzing composition, echogenicity, shape, margin, and echogenic foci, the ICCs were 0.552 (95% CI, 0.454-0.643), fair; 0.533 (95% CI, 0.432-0.627), fair; 0.359 (95% CI, 0.248-0.469), poor; 0.192 (95% CI, 0.084-0.308), poor; and 0.549 (95% CI, 0.451- 0.641), fair, respectively.

CONCLUSIONS

Our results show that among the subset of cytologically indeterminate and Afirma suspicious nodules, TIRADS interobserver variability was fair. Shape and margin criteria were the biggest sources of disagreement. Large prospective studies are needed to evaluate the interobserver variability of TIRADS in this subset of thyroid nodules.

Standard cross-linking versus photorefractive keratectomy combined with accelerated cross-linking for keratoconus management: a comparative study

Purpose

To compare the safety and efficacy of standard 30 min epithelium‐off cross‐linking (CXL) versus photorefractive keratectomy (PRK) combined with accelerated epithelium‐off cross‐linking (AXL) for the treatment of progressive keratoconus (CXL‐Plus).

Methods

This study was a prospective multicentre comparative clinical study. A total of 125 eyes of 75 patients with grade 1 keratoconus and documented progression were divided into two groups. Group A included 58 eyes treated with standard CXL. Group B included 67 eyes treated with combined PRK and AXL. The recorded data included UDVA, CDVA, subjective and objective refraction, keratometry and pachymetry using corneal topographies preoperatively and postoperatively at 3, 6, 12 and 24 months of follow‐up.

Results

In group A, at 24 months of UDVA and CDVA were improved from 1.12 ± 0.38 and 0.58 ± 0.42 to 0.66 ± 0.20 and 0.20 ± 0.12 (LogMAR±SD). The spherical equivalent was reduced from 4.03 ± 1.18 to 1.78 ± 1.04 D. The cylinder reduction was 0.32 ± 0.19 D. In group B, at 24 months of UDVA and CDVA were improved from 1.26 ± 0.52 and 0.68 ± 0.36 to 0.58 ± 0.28 and 0.20 ± 0.16 (LogMAR ± SD). The spherical equivalent was reduced from 4.23 ± 0.95 to 1.92 ± 0.74 D. The cylinder reduction was ±1.76 D.

Conclusion

Surprisingly, standard CXL showed close results to CXL‐Plus at the 24th follow‐up month. Standard CXL acted as a stabilizing procedure associated with a late myopic component reduction. CXL‐Plus acted as a refractive and stabilizing procedure with an early effect on both the myopic and the astigmatic component but no later improvements. Standard CXL seems to be more powerful than AXL in its long‐term effect. Therefore, in the future, we want to test the combination of PRK with standard CXL.

Synthesis of docosahexaenoic acid–loaded silver nanoparticles for improving endothelial dysfunctions in experimental diabetes

Objective:

To investigate the ability of docosahexaenoic acid (DHA)-loaded silver nanoparticles (AgNPs) in facilitating the incorporation of DHA in the cell membrane, improve cell membrane structure, and attenuate endothelial dysfunction in experimental diabetes.

Methods:

DHA/AgNPs were prepared using a nanoprecipitation technique. Fifty male albino rats were used in this study; 10 of them were served as the control group and 40, as the experimental groups, were injected with streptozotocin. Then, the experimental groups were subdivided into diabetic, diabetic treated with DHA, diabetic treated with AgNPs, and diabetic treated with DHA/AgNPs groups.

Results:

DHA/AgNPs have small spherical size as proved from ultraviolet–visible spectroscopy, transmission electron microscope, dynamic light scattering, and scanning electron microscope techniques. Cell membrane cholesterol and triglycerides showed a significant elevation in the diabetic group compared to the control, but treatment with DHA and DHA/AgNPs caused a significant reduction in both. Treatment with AgNPs and DHA/AgNPs caused a significant improvement in asymmetric dimethylarginine and nitric oxide levels compared to the diabetic group. Cell membrane fatty acids showed that omega-6 polyunsaturated fatty acids (PUFAs) were significantly elevated, while omega-3 PUFA were significantly reduced in the diabetic group compared to the control. There is a significant improvement in the levels of fatty acids in all groups after treatment with DHA, silver, or DHA/AgNPs.

Conclusion:

DHA/AgNPs are potent agents for the improvement of diabetic complication and endothelial dysfunction in experimental diabetes.

A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk

OBJECTIVE

We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals.

RESEARCH DESIGN AND METHODS

We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables.

RESULTS

Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002).

CONCLUSIONS

The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.

Recurrent renal cell carcinoma following nephrectomy and ablation therapy: Radiology perspective

Renal cell carcinoma (RCC) is the most common renal malignancy, accounting for approximately 2% of adult malignancies and 4% of new cancer cases in the United States every year. Imaging guided ablative therapy, including radiofrequency (RF) ablation, cryotherapy and microwave has gained popularity over the last decade in treatment of small tumors. Antiangiogenic therapy has set itself to be the standard of care for many patients with metastasis these days. With hope for more research, survival rates of metastatic RCC may increase from a current 2-year survival rate of approximately 20%. Variation in imaging surveillance protocol in terms of frequency, modality, and duration is noted among guidelines developed by several organizations. In this review article, we will discuss follow-up imaging protocols, patterns of RCC recurrence following different modalities of treatment, imaging appearance, as well as usual and unusual sites of metastatic disease.

12th WINFOCUS world congress on ultrasound in emergency and critical care

TABLE OF CONTENTS

A1 Point-of-care ultrasound examination of cervical spine in emergency departmentYahya Acar, Onur Tezel, Necati SalmanA2 A new technique in verifying the placement of a nasogastric tube: obtaining the longitudinal view of nasogastric tube in addition to transverse view with ultrasoundYahya Acar, Necati Salman, Onur Tezel, Erdem CevikA3 Pseudoaneurysm of the femoral artery after cannulation of a central venous line. Should we always use ultrasound in these procedures?Margarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA4 Ultrasound-guided supraclavicular subclavian vein catheterization. A novel approach in emergency departmentMargarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA5 Clinical ultrasound in a septic and jaundice patient in the emergency departmentMargarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA6 Characterization of the eyes in preoperative cataract Saudi patients by using medical diagnostic ultrasoundMustafa Z. Mahmoud, Abdelmoneim SuliemanA7 High-frequency ultrasound in determining the causes of acute shoulder joint painMustafa Z. MahmoudA8 Teaching WINFOCUS Ultrasound Life Support Basic Level 1 for Providers in resource-limited countriesAbbas Ali, Alrayah Mustafa, Ihab Abdelrahman, Mustafa Bahar, Osama Ali, H. Lester Kirchner, Gregor ProsenA9 Changes of arterial stiffness and endothelial function during uncomplicated pregnancyAjda Anzic, Paul LeesonA10 Cardiovascular haemodynamic properties before, during and after pregnancyAjda Anzic, Paul LeesonA11 An old man with generalized weaknessMaryam Bahreini, Fatemeh RasooliA12 Ultrasonography for non-specific presentations of abdominal painMaryam Bahreini, Houman HosseinnejadA13 Introduction of a new imaging guideline for suspected renal colic in the emergency department: effect on CT Urogram utilisationGabriel Blecher, Robert Meek, Diana Egerton-WarburtonA14 Transabdominal ultrasound screening for pancreatic cancer in Croatian military veterans: a retrospective analysis from the first Croatian veteran's hospitalEdina Ćatić Ćuti, Stanko Belina, Tihomir Vančina, Idriz KovačevićA15 The challenge of AAA: unusual case of obstructive jaundiceEdina Ćatić Ćuti, Nadan RustemovićA16 Educational effectiveness of easy-made new simulator model for ultrasound-guided procedures in pediatric patients: vascular access and foreign body managementIkwan Chang, Jin Hee Lee, Young Ho Kwak, Do Kyun KimA17 Detection of uterine rupture by point-of-care ultrasound at emergency department: a case reportChi-Yung Cheng, Hsiu-Yung Pan, Chia-Te KungA18 Abdominal probe in the hands of interns as a relevant diagnostic tool in revealing the cause of heart failureEla Ćurčić, Ena Pritišanac, Ivo Planinc, Marijana Grgić Medić, Radovan RadonićA19 Needs assessment of the potential utility of point-of-care ultrasound within the Zanzibar health systemAbiola Fasina, Anthony J. Dean, Nova L. Panebianco, Patricia S. HenwoodA20 Ultrasonographic diagnosis of tracheal compressionOliviero Fochi, Moreno Favarato, Ezio BonanomiA21 The role of ultrasound in the detection of lung infiltrates in critically ill patients: a pilot studyMarijana Grgić Medić, Ivan Tomić, Radovan RadonićA22 The SAFER Lasso; a novel approach using point-of-care ultrasound to evaluate patients with abdominal complaints in the emergency departmentYoungrock Ha, Hongchuen TohA23 Awareness and use of clinician-performed ultrasound among clinical clerkship facultyElizabeth Harmon, Wilma Chan, Cameron Baston, Gail Morrison, Frances Shofer, Nova Panebianco, Anthony J. DeanA24 Clinical outcomes in the use of lung ultrasound for the diagnosis of pediatric pneumoniasAngela Hua, Sharon Kim, James TsungA25 Effectiveness of ultrasound in hypotensive patientsIsa Gunaydin, Zeynep Kekec, Mehmet Oguzhan AyA26 Moderate-to-severe left ventricular ejection fraction related to short-term mortality of patients with post-cardiac arrest syndrome after out-of-hospital cardiac arrestJinjoo Kim, Jinhyun Kim, Gyoosung Choi, Dowon ShimA27 Usefulness of abdominal ultrasound for acute pyelonephritis diagnosis after kidney transplantationJi-Han LeeA28 Lung ultrasound for assessing fluid tolerance in severe preeclampsiaJana Ambrozic, Katja Prokselj, Miha LucovnikA29 Optic nerve sheath ultrasound in severe preeclampsiaGabrijela Brzan Simenc, Jana Ambrozic, Miha LucovnikA30 Focused echocardiography monitoring in the postoperative period for non-cardiac patientsAsta Mačiulienė, Almantas Maleckas, Algimantas Kriščiukaitis, Vytautas Mačiulis, Andrius MacasA31 POCUS-guided paediatric upper limb fracture reduction: algorithm, tricks, and tipsSharad MohiteA32 Point-of-care lung ultrasound: a good diagnostic tool for pneumonia in a septic patientZoltan Narancsik, Hugon MožinaA33 A case of undergraduate POCUS (r)evolutionSara Nikolić, Jan Hansel, Rok Petrovčič, Una Mršić, Gregor ProsenA34 The Graz Summer School for ultrasound: from first contact to bedside application: three-and-a-half-day undergraduate ultrasound training: résumé after two years of continuous developmentSimon Orlob, Markus Lerchbaumer, Niklas Schönegger, Reinhard KaufmannA35 Usefulness of point-of-care ultrasound in the emergency room in a patient with acute abdominal painAlberto Oviedo-García, Margarita Algaba-Montes, Mayra Patricio-BordomásA36 Use of bedside ultrasound in a critically ill patient. A case reportAlberto Oviedo-García, Margarita Algaba-Montes, Mayra Patricio-BordomásA37 Diagnostic yield of clinical echocardiography for the emergency physicianAlberto Oviedo-García, Margarita Algaba-Montes, Mayra Patricio-BordomásA38 Focused cardiac ultrasound in early diagnosis of type A aortic dissection with atypical presentationChun-I Pan, Hsiu-Yung Pan, Chien-Hung WuA39 Detection of imperforated hymen by point-of-care ultrasoundHsiu-yung Pan, Chia-Te KungA40 Developing a point-of-care ultrasound curriculum for pediatric nurse practitioners practicing in the pediatric emergency departmentSarah Pasquale, Stephanie J. Doniger, Sharon Yellin, Gerardo ChiricoloA41 Use of transthoracic echocardiography in emergency setting: patient with mitral valve abscessMaja Potisek, Borut Drnovšek, Boštjan LeskovarA42 A young man with syncopeFatemeh Rasooli, Maryam BahreiniA43 Work-related repetitive use injuries in ultrasound fellowsKristine Robinson, Clara Kraft, Benjamin Moser, Stephen Davis, Shelley Layman, Yusef Sayeed, Joseph MinardiA44 Lung ultrasonography in the evaluation of pneumonia in childrenIrmina Sefic Pasic, Amra Dzananovic, Anes Pasic, Sandra Vegar ZubovicA45 Central venous catheter placement with the ultrasound aid: two years' experience of the Interventional unit, Division of Intensive Care Medicine, KBC ZagrebAna Godan Hauptman, Marijana Grgic Medic, Ivan Tomic, Ana Vujaklija Brajkovic, Jaksa Babel, Marina Peklic, Radovan RadonicA46 Duplicitas casui: two patients admitted due to acute liver failureVedran Radonic, Ivan Tomic, Luka Bielen, Marijana Grgic MedicA47 A pilot survey on an understanding of Bedside Point-of-Care Ultrasound (POCUS) among medical doctors in internal medicine: exposure, perceptions, interest, and barriers to trainingPeh Wee MingA48 Unusual case of defecation syncopeNur hafiza Yezid, Fatahul Laham MohammedA49 A case report of massive pulmonary embolism; a multidisciplinary approachZainal Abidin Huda, Wan Nasarudin Wan Ismail, W.Yus Haniff W.Isa, Hashairi Fauzi, Praveena Seeva, Mohd Zulfakar Mazlan.

Defining our destiny: trainee working group consensus statement on the future of emergency surgery training in the United Kingdom

The United Kingdom National Health Service treats both elective and emergency patients and seeks to provide high quality care, free at the point of delivery. Equal numbers of emergency and elective general surgical procedures are performed, yet surgical training prioritisation and organisation of NHS institutions is predicated upon elective care. The increasing ratio of emergency general surgery consultant posts compared to traditional sub-specialities has yet to be addressed. How should the capability gap be bridged to equip motivated, skilled surgeons of the future to deliver a high standard of emergency surgical care? The aim was to address both training requirements for the acquisition of necessary emergency general surgery skills, and the formation of job plans for trainee and consultant posts to meet the current and future requirements of the NHS.

Twenty nine trainees and a consultant emergency general surgeon convened as a Working Group at The Association of Surgeons in Training Conference, 2015, to generate a united consensus statement to the training requirement and delivery of emergency general surgery provision by future general surgeons. Unscheduled general surgical care provision, emergency general surgery, trauma competence, training to meet NHS requirements, consultant job planning and future training challenges arose as key themes. Recommendations have been made from these themes in light of published evidence. Careful workforce planning, education, training and fellowship opportunities will provide well-trained enthusiastic individuals to meet public and societal need.

Prevalence of intestinal parasitic infections among communities living in different habitats and its comparison with one hundred and one studies conducted over the past 42 years (1970 to 2013) in Malaysia

Intestinal parasitic infections are among the most common diseases affecting mankind causing major public health problems to billions of people living in developing countries. The aim of this study is to determine the prevalence of intestinal parasites in various communities residing in different habitats in Malaysia and compare the findings with 101 studies conducted over the past 42 years (1970-2013). A cross-sectional study design was conducted with the aid of a questionnaire to collect relevant information about the study population. Faecal samples were examined using the direct smear and formal ether sedimentation techniques. A total of 342 children were examined amongst whom 24.6% were positive for intestinal parasitic infections. Results showed that 32.3% of rural children, 20.6% of urban squatters and 5.4% of children from flats were positive for one or more parasites. The most common parasite encountered was Trichuris trichiura (20.2%) followed by Ascaris lumbricoides (10.5%) and hookworm (6.7%). No case of hookworm was reported in urban children whereas 12.2% of rural children were positive. The most common protozoan parasite detected was Entamoeba coli (3.2%) followed by Giardia intestinalis (1.8%), Entamoeba histolytica (1.8%) and Blastocystis hominis (1.2%). Nearly one-fifth (18.4%) of the children had single infection followed by double (12.0%) and triple infections (1.2%). Orang Asli (indigenous) children (44.3%) had the highest infection rate followed by Indians (20.2%), Malays (14.0%) and Chinese (11.9%). Twenty-eight studies carried out on plantation communities with regards to intestinal parasitic infections in Malaysia from 1970 to 2013 showed a steady decline in the prevalence rate ranging from 95.0% in the seventies to 37.0 % in 2012. Intestinal parasitic infections were more common in Orang Asli communities with prevalence ranging from over 90% in the seventies and fluctuating below 70% in most studies between 2000 to 2013 except for two studies that showed a prevalence of 98.2% and 100%. The prevalence rate among urban squatters, urban residents and those living in flats showed dramatic decrease in prevalence rate.

QTL-based association analyses reveal novel genes influencing pleiotropy of metabolic syndrome (MetS)

OBJECTIVE

Metabolic Syndrome (MetS) is a phenotype cluster predisposing to type 2 diabetes and cardiovascular disease. We conducted a study to elucidate the genetic basis underlying linkage signals for multiple representative traits of MetS that we had previously identified at two significant QTLs on chromosomes 3q27 and 17p12.

DESIGN AND METHODS

We performed QTL-specific genomic and transcriptomic analyses in 1,137 individuals from 85 extended families that contributed to the original linkage. We tested in SOLAR association of MetS phenotypes with QTL-specific haplotype-tagging SNPs as well as transcriptional profiles of peripheral blood mononuclear cells (PBMCs).

RESULTS

SNPs significantly associated with MetS phenotypes under the prior hypothesis of linkage mapped to seven genes at 3q27 and seven at 17p12. Prioritization based on biologic relevance, SNP association, and expression analyses identified two genes: insulin-like growth factor 2 mRNA-binding protein 2 (IGF2BP2) at 3q27 and tumor necrosis factor receptor 13B (TNFRSF13B) at 17p12. Prioritized genes could influence cell-cell adhesion and adipocyte differentiation, insulin/glucose responsiveness, cytokine effectiveness, plasma lipid levels, and lipoprotein densities.

CONCLUSIONS

Using an approach combining genomic, transcriptomic, and bioinformatic data we identified novel candidate genes for MetS.

Prevalence of diabetes in Malaysia and usefulness of HbA1c as a diagnostic criterion

AIM

The prevalence of diabetes mellitus among Malaysians aged ≥ 30 years of age has increased by more than twofold over a 20-year period. This study aimed to determine the current status and to evaluate the diagnostic usefulness of the HbA(1c) cut-off point of 48 mmol/mol (6.5%).

METHODS

Using a two-stage stratified sampling design, participants aged ≥ 18 years were recruited from five zones selected to represent Malaysia. An oral glucose tolerance test was performed on all those not known to have diabetes.

RESULTS

A total of 4341 subjects were recruited. By World Health Organization criteria, the prevalence of diabetes mellitus was 22.9%; of that percentage, 10.8% was known diabetes and 12.1% was newly diagnosed diabetes. Diabetes was most prevalent amongst Indians (37.9%) and Malays (23.8%). Prevalence of new diabetes mellitus was only 5.5% (95% CI 4.9-6.3) when based on the HbA(1c) diagnostic criteria of 48 mmol/mol (6.5%) and, although the cut-off point was highly specific (98.1%), it was less sensitive (36.7%) compared with 45 mmol/mol (6.3%), which showed the optimal sum of sensitivity (42.5%) and specificity (97.4%) in identifying new diabetes mellitus.

CONCLUSION

This study recorded an overall diabetes prevalence of 22.6%, almost a twofold increase from 11.6% reported in 2006. This was likely attributable to the higher prevalence of new diabetes (12.1%) diagnosed following an oral glucose tolerance test. An HbA(1c) of 45 mmol/mol (6.3%) was found to be a better predictive cut-off point for detecting new diabetes in our multi-ethnic population.

Cenozoic tectonics and evolution of the Euphrates valley in Syria

Late Cenozoic tectonics affected the evolution of the Euphrates river valley in northern Syria. Data on the height and composition of terraces and new K–Ar dating of overlying basalts are presented for the area between the Assad Reservoir and the town of Abou Kamal. The presence of the Late Cenozoic Euphrates Fault, longitudinal with respect to the valley, is established by the lower height of the terraces on the NE side of the valley compared with the same terraces on the SW side. Geophysical profiling (dipole axial sounding; correlation refraction method and georadar) across the southern side of the valley (opposite the town of Ar Raqqa) confirms the offset on the fault as >25 m. Movements along the transverse Rasafeh–El Faid fault zone and the Halabiyeh–Zalabiyeh deformation zone have resulted in local uplift and the splitting of river terraces. During the Pliocene–Early Pleistocene, uplift and strong incision of the Euphrates valley propagated from near the Syrian–Turkish border to near the Iraq–Syrian border. The Euphrates began to deposit alluvium onto the pre-existing low-lying Mesopotamian Foredeep at c. 3.5 Ma. Intense incision began by late Late-Pliocene time to form terrace IV. Comparable incision further downstream began during the Early Pleistocene to form terrace III.

Cooperativity between integrin activation and mechanical stress leads to integrin clustering

Integrins are transmembrane receptors involved in crucial cellular biological functions such as migration, adhesion, and spreading. Upon the modulation of integrin affinity toward their extracellular ligands by cytoplasmic proteins (inside-out signaling) these receptors bind to their ligands and cluster into nascent adhesions. This clustering results in the increase in the mechanical linkage among the cell and substratum, cytoskeleton rearrangements, and further outside-in signaling. Based on experimental observations of the distribution of focal adhesions in cells attached to micropatterned surfaces, we introduce a physical model relying on experimental numerical constants determined in the literature. In this model, allosteric integrin activation works in synergy with the stress build by adhesion and the membrane rigidity to allow the clustering to nascent adhesions independently of actin but dependent on the integrin diffusion onto adhesive surfaces. The initial clustering could provide a template to the mature adhesive structures. Predictions of our model for the organization of focal adhesions are discussed in comparison with experiments using adhesive protein microarrays.

Trichosporon fungal arteritis causing rupture of vascular anastamosis after commercial kidney transplantation: a case report and review of literature

This is a case report of a ruptured vascular anastomosis resulting from fungal arteritis in a commercial renal transplantation. The diagnosis was made quite early posttransplantation (at the 18th posttransplant day); this was proved by histopathologic examination and culture of the vessel wall,which showed Trichosporon fungal infection. The patient underwent operation for control of the bleeding and removal of the graft and of the diseased iliac vascular segment. On reviewing the literature, we found 17 reports of fungal arteritis in solid-organ transplant recipients; our case was the first one to report Trichosporon species as the causative agent. Infection could result from surgical or graft contamination or from preexistent infection in the patient. There is a consensus that the standard of care should include removal of the graft and the diseased iliac vascular segment with an appropriate vascular graft, because simple suturing of the disrupted infected anastomosis generally ends with disastrous recurrent rupture. A high index of suspicion is required to ensure both early diagnosis and appropriate treatment to prevent tragic loss of recipient life.

Simvastatin and sildenafil combine to attenuate pulmonary hypertension

Statins have been proposed to be a potential treatment for pulmonary arterial hypertension. If introduced into clinical practice, the statin would have to be used in conjunction with established therapy. We investigated the effects of combining simvastatin with a phosphodiesterase type-5 inhibitor, sildenafil, in the rat model of hypoxia-induced pulmonary hypertension. Rats were allocated to either: 1) a prevention protocol, to receive simvastatin 20 mg x kg(-1) x day(-1) by intraperitoneal injection or sildenafil 75 mg x kg(-1) x day(-1) orally or the combination (or vehicle) for 2 weeks beginning at the start of exposure to hypoxia (10% inspired oxygen); or 2) a treatment protocol, where the same agents were administered in the last 2 weeks of a 4-week period of hypoxia. In both protocols, the combination of sildenafil and simvastatin lowered pulmonary artery pressure and produced a significantly greater reduction in right ventricular hypertrophy and pulmonary vascular muscularisation than either drug alone. Moreover, the combination augmented significantly endothelial nitric oxide synthase expression and cGMP levels in the lung and right ventricle above that produced by either drug independently and resulted in greater inhibition of RhoA activity. These data suggest that simvastatin can be usefully combined with sildenafil in the treatment of pulmonary arterial hypertension to achieve greater therapeutic benefit.

Excitable waves at the margin of the contact area between a cell and a substrate

In this paper, we study a new physical mechanism to generate an activator field which signals the extreme margin of the contact area between an adherent cell and the substrate. This mechanism is based on the coupling between the adhesive bridges connecting the substrate to the cytoskeleton and a cytosolic activator. Once activated by adhesion on the adhesive bridges, this activator is free to diffuse on the membrane. We propose that this activator is part of the mecano-transduction pathway which links adhesion to actin polymerization and, thus, to cellular motility. The consequences of our model are as follows: (a) the activator is localized at the rim of the contact area, (b) the adhesion is reinforced at the margin of the contact area between the cell and the substrate, (c) excitable waves of the activator can propagate along the adhesion rim.

Physical model for membrane protrusions during spreading

During cell spreading onto a substrate, the kinetics of the contact area is an observable quantity. This paper is concerned with a physical approach to modeling this process in the case of ameboid motility where the membrane detaches itself from the underlying cytoskeleton at the leading edge. The physical model we propose is based on previous reports which highlight that membrane tension regulates cell spreading. Using a phenomenological feedback loop to mimic stress-dependent biochemistry, we show that the actin polymerization rate can be coupled to the stress which builds up at the margin of the contact area between the cell and the substrate. In the limit of small variation of membrane tension, we show that the actin polymerization rate can be written in a closed form. Our analysis defines characteristic lengths which depend on elastic properties of the membrane-cytoskeleton complex, such as the membrane-cytoskeleton interaction, and on molecular parameters, the rate of actin polymerization. We discuss our model in the case of axi-symmetric and non-axi-symmetric spreading and we compute the characteristic time scales as a function of fundamental elastic constants such as the strength of membrane-cytoskeleton adherence.

Transport of acetate and sodium in sheep omasum: mutual, but asymmetric interactions

We have studied the transport of acetate across the isolated epithelium of sheep omasum; no net transport was observed (J(ms) approximately = J(sm)) under Ussing chamber conditions. Low mucosal pH (pH 6.4) significantly enhanced J(ms) acetate and the transport rates of acetate increased linearly and significantly (r2=0.99) with the luminal acetate concentration. The presence of another short chain fatty acid (propionate) did not affect J(ms) acetate significantly. Neither addition of 1 mmol l(-1) DIDS to the mucosal side nor HCO3 replacement caused changes of J(ms) acetate; this does not support the assumption of acetate transport via anion exchange. Addition of 1 mmol l(-1) amiloride to the mucosal side significantly decreased acetate fluxes at high mucosal acetate concentration (100 mmol l(-1)) and low pH (6.4) indicating interaction between acetate uptake in the undissociated form, intracellular release of protons and activation of Na+/H+ exchange (NHE). However, the mutual interaction between Na transport via NHE and acetate transport is asymmetric. Stimulation or inhibition of Na transport via NHE is much more pronounced than the corresponding changes of acetate fluxes. Thus, the obtained results support the conclusion that acetate is transported via simple diffusion and probably predominantly in the protonated form, thereby explaining the positive and mutual interaction between Na transport and short chain fatty acids.