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SUMMARY BackgroundThe importance of interactions between the host and gut microbiota in the pathogenesis of irritable bowel syndrome (IBS) is becoming increasingly apparent. Probiotics offer a potential new treatment for IBS, but current results are conflicting, largely as a result of poorly designed trials and nonstandardisation of outcome measures.

Background: The effects of providing ventilatory assistance to patients with severe chronic obstructive pulmonary disease (COPD) during a high intensity outpatient cycle exercise programme were examined. Methods: Nineteen patients (17 men) with severe COPD (mean (SD) forced expiratory volume in 1 second (FEV 1 ) 27 (7)% predicted) underwent a 6 week supervised outpatient cycle exercise programme. Ten patients were randomised to exercise with ventilatory assistance using proportional assist ventilation (PAV) and nine (two women) to exercise unaided. Before and after training patients performed a maximal symptom limited incremental cycle test to determine peak work rate (Wpeak) followed by a constant work rate (CWR) test at 70% of Wpeak achieved in the baseline incremental test. Minute ventilation (VE), heart rate, and arterialised venous plasma lactate concentration [La

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Postoperative acute kidney injury (AKI) increases morbidity and mortality after liver transplantation (LT). Novel methods of assessing AKI including cystatin C (CyC) and neutrophil gelatinase-associated lipocalin (NGAL) have been identified as potential markers of AKI. We compare the ability of standard renal markers (serum creatinine [sCr], estimated glomerular filtration rate [eGFR] and intensive therapy unit organ failure scores with CyC and NGAL to predict AKI within the first 48 hours after LT. 95 patients (median age 50 [interquartile range ¼ 41-59], 60% male) underwent LT (25% with acute liver failure). AKI was defined according to the Acute Kidney Injury Network criteria. Severe AKI was classified as !stage 2. NGAL (urine [u] and plasma [p]) and CyC concentrations taken immediately after transplantation on admission to the Liver Intensive Care Unit were compared with standard markers of renal function. Predictive ability was assessed using the area under the curve generated by receiver operator characteristic analysis (AUROC) and logistic regression. Day 0 sCr, uNGAL, pNGAL, CyC, and eGFR predicted AKI as did SOFA (Sequential Organ Failure Assessment) and APACHE II (Acute Physiology and Chronic Health Evaluation II) scores. APACHE II and pNGAL were the most powerful predictors of severe AKI (APACHE II AUROC ¼ 0.87 [0.77-0.97], P < 0.001; pNGAL AUROC ¼ 0.87 [0.77-0.92], P < 0.001). Using multivariate logistic regression, APACHE II (odds ratio 1.64/point [95% confidence interval ¼ 1.22-2.21, P ¼ 0.001] and pNGAL [odds ratio ¼ 1.01/ng/mL [95% confidence interval ¼ 1.00-1.02], P ¼ 0.002) retained independent significance. A ''renal risk score'' using APACHE II > 13 and pNGAL > 258 ng/mL was calculated with a score of !1 having a 100% sensitivity and 76% specificity for severe AKI. In conclusion, a combination of NGAL and APACHE II predicts AKI with high sensitivity and specificity after LT. Liver Transpl 16:1257-1266, 2010. V C 2010 AASLD.Received March 14, 2010; accepted July 15, 2010.Renal dysfunction is common after liver transplantation (LT). The incidence of acute renal failure complicating the posttransplant period varies between 48% and 94% 1 and affects both short-term and long-term outcome. Mortality in those requiring renal replacement therapy (RRT) may be as high as 40% at 90 days, rising to 54% at 1 year.2 Although many risk factors for developing renal dysfunction posttransplant have been investigated, the greatest impact on outcome is in patients who develop de novo renal impairment, especially in those who require RRT.2 Patients with low glomerular filtration rates (GFR) at 1 month post-LT are also at risk of developing severe renal dysfunction at 5 years post-LT 3 and the need for dialysis in LT recipients has been reported to be as high as 18% at 5 years.

Even moderate obesity leads to endothelial dysfunction. In severely obese subjects, FMD is normalized by weight loss. This improvement in FMD is associated with a decline in inflammatory markers, blood pressure and insulin. The improvement in FMD occurred despite patients remaining significantly obese. These results suggest that an integrated approach to improving endothelial function in obese humans may be necessary.

Clinically significant ammonia clearance can be achieved in adult patients with hyperammonaemia utilizing continuous VVHF. Ammonia clearance is closely correlated with ultrafiltration rate. HF was associated with a fall in arterial ammonia concentration.

Abstract. Mangoni AA, Sherwood RA, Swift CG, Jackson SHD (Guy's, King's, and St Thomas' School of Medicine, King's College London, UK). Folic acid enhances endothelial function and reduces blood pressure in smokers: a randomized controlled trial. J Intern Med 2002; 252: 497-503.Objective. Cigarette smoking is associated with increased plasma homocysteine concentrations, endothelial dysfunction and arterial stiffening. Homocysteine per se induces endothelial dysfunction and arterial stiffening and might account, at least partly, for the vascular abnormalities observed in smokers. We sought to determine whether folic acid supplementation, by reducing plasma homocysteine concentrations, enhanced endothelial function and reduced arterial stiffness in smokers. Design. Double-blind, randomized controlled, parallel-group, trial. Setting. Academic medical centre. Subjects. A consecutive sample of 24 healthy cigarette smokers (age 37.8 ± 2.5 years, mean ± SEM). Intervention. Subjects were randomly assigned to 4-week folic acid 5 mg day )1 or placebo. Main outcome measures. The following were measured before and after treatment: (i) peripheral vasoreactivity (forearm arterial blood flow, FABF) during intra-arterial administration of endotheliumdependent (acetylcholine 1.5, 4.5 and 15 lg min )1 ) and endothelium-independent (sodium nitroprusside 1, 2 and 4 lg min )1 ) vasodilators; (ii) carotidfemoral pulse-wave velocity (PWV); (iii) blood pressure (BP).Results. Folic acid reduced homocysteine concentrations (10.8 ± 0.6 vs. 8.2 ± 0.5 lmol L )1 , P < 0.001) and enhanced endothelium-dependent vasodilatation during each acetylcholine infusion rate (ratio between the FABF in the infused and control arm during increasing infusion rates at baseline 1.09 ± 0.03 vs. 1.41 ± 0.09 after treatment, P < 0.01; 1.39 ± 0.07 vs. 1.83 ± 0.12, P < 0.01; 1.65 ± 0.16 vs. 2.72 ± 0.36, P < 0.05) whilst endothelium-independent vasodilatation was unaffected. A significant fall in BP was also observed (mean BP 88 ± 2 vs. 83 ± 1 mmHg, P < 0.01). By contrast, PWV did not significantly change (8.4 ± 0.3 vs. 7.8 ± 0.4 m s )1 ). No significant changes in plasma homocysteine concentrations, FABF, BP, and PWV were observed in the placebo group. A multiple regression analysis showed that changes in folic acid plasma concentrations independently predicted both FABF changes during maximal acetylcholine-mediated vasodilatation (P < 0.01) and BP changes (P ¼ 0.01). Conclusions. Short-term folic acid supplementation significantly enhanced endothelial function and reduced BP in young chronic smokers. These effects were largely independent from the homocysteine lowering effects. Thus, a simple, nontoxic, and relatively inexpensive vitamin intervention might be useful in primary cardiovascular prevention in this high-risk group.