Summary The budding yeast, Saccharomyces cerevisiae, has emerged as an archetype of eukaryotic cell biology. Here we show that S. cerevisiae is also a model for the evolution of cooperative behavior by revisiting flocculation, a self-adherence phenotype lacking in most laboratory strains. Expression of the gene FLO1 in the laboratory strain S288C restores flocculation, an altered physiological state, reminiscent of bacterial biofilms. Flocculation protects the FLO1-expressing cells from multiple stresses, including antimicrobials and ethanol. Furthermore, FLO1+ cells avoid exploitation by non-expressing flo1 cells by self/non-self recognition: FLO1+ cells preferentially stick to one another, regardless of genetic relatedness across the rest of the genome. Flocculation, therefore, is driven by one of a few known “green beard genes”, which direct cooperation towards other carriers of the same gene. Moreover, FLO1 is highly variable among strains both in expression and in sequence, suggesting that flocculation in S. cerevisiae is a dynamic, rapidly-evolving social trait.

Background Celiac disease (CD) is under-diagnosed in the United States, and factors related to the performance of endoscopy may be contributory. Aims to identify newly diagnosed patients with CD who had undergone a prior esophagogastroduodenoscopy (EGD) and examine factors contributing to the missed diagnosis. Methods We identified all patients age ≥18 years whose diagnosis of CD was made by endoscopy with biopsy at our institution (n=316), and searched the medical record for a prior EGD. We compared those patients with a prior EGD to those with without a prior EGD with regard to age at diagnosis and gender, and enumerated the indications for EGD. Results Of the 316 patients diagnosed by EGD with biopsy at our center, 17 (5%) had previously undergone EGD. During the prior non-diagnostic EGD, a duodenal biopsy was not performed in 59% of the patients, and ≥4 specimens (the recommended number) were submitted in only 29% of the patients. On the diagnostic EGD, ≥4 specimens were submitted in 94%. The mean age of diagnosis of those with missed/incident CD was 53.1 years, slightly older than those diagnosed with CD on their first EGD (46.8 years, p=0.11). Both groups were predominantly female (missed/incident CD: 65% vs. 66%, p=0.94). Conclusions Among 17 CD patients who had previously undergone a non-diagnostic EGD, nonperformance of duodenal biopsy during the prior EGD was the dominant feature. Routine performance of duodenal biopsy during EGD for the indications of dyspepsia and reflux may improve CD diagnosis rates.

Dysphagia is a common problem in the elderly population with an especially high prevalence in hospitalized and institutionalized patients. If inadequately addressed, dysphagia leads to significant morbidity and contributes to decreased quality of life. Dysphagia can be categorized as emanating from either an oropharyngeal or esophageal process. A disproportionate number of elderly patients suffer from oropharyngeal dysphagia with a multifactorial etiology. Historically, treatment options have been limited and included mostly supportive care with a focus on dietary modification, food avoidance, and swallow rehabilitation. Nascent technologies such as the functional luminal imaging probe (FLIP) and advances in esophageal manometry are improving our understanding of the pathophysiology of oropharyngeal dysphagia. Recent developments in the treatment of specific causes of oropharyngeal dysphagia, including endoscopic balloon dilations for upper esophageal sphincter (UES) dysfunction, show promise and are expected to enhance with further research. Esophageal dysphagia is also common in the elderly and more commonly due to an identifiable cause. The full breadth of treatment options is frequently unavailable to elderly patients due to comorbidities and overall functional status. However, the increasing availability of less invasive solutions to specific esophageal pathologies has augmented the number of treatment options available to this population, where an individualized approach to patient care is paramount. This review focuses on the evaluation and management of dysphagia in the elderly and delineates how standard and novel therapeutics are contributing to more nuanced and personalized management.

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Receptive anal intercourse and its association with sexually transmitted infections and human papillomavirus-related anal dysplasia has been well studied in various at-risk groups including men who have sex with men. However, the relationship between receptive anal intercourse and its potential complications in patients with inflammatory bowel disease is not fully understood. This narrative review discusses sexually transmitted infections and anal dysplasia in patients with inflammatory bowel disease who engage in receptive anal intercourse and the lack of evidence-based data to guide clinical practice. It addresses the psychosocial effects of stigmatization in these patients and its consequences in the clinical encounter. We review the need for sufficient data on infection, cancer prevention, and precoital and postcoital hygienic practices with hopes that future studies establish standardized guidelines and recommendations.

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To the Editor: Th e majority of patients with celiac disease (CD) in the United States are not diagnosed ( 1 ). Although current guidelines ( 2,3 ) recommend testing patients with iron defi ciency anemia (IDA) for CD, this is infrequently performed ( 4 ).As hypocholesterolemia and low highdensity lipoprotein (HDL) levels are common in CD ( 5,6 ), we studied the value of using HDL levels to identify a high-risk group of IDA patients who may benefi t from CD testing.Th is cross-sectional study compared CD patients who presented with IDA with patients who presented with IDA due to non-CD causes at our medical center between 2000 and 2011. CD patients were identifi ed from an IRB-approved database of 1,450 CD subjects, and were included in the study if they presented with IDA and had a lipid profi le taken at the time of diagnosis. Each CD patient was matched by age and gender with up to three IDA controls selected from a separate IDA database. IDA was defi ned as a hemoglobin level < 12 g / dl for women and < 13 for men with serum ferritin < 30 ng / ml. Th e two groups were compared by univariate analysis using the Student ' s t -test for continuous variables and the χ 2 analysis or Fisher ' s exact test for categorical data as appropriate. Sensitivity, specicity, positive predictive value, and likelihood ratios were calculated for various HDL cutoff levels. A receiver operating characteristic curve analysis of HDL was performed to identify the optimal cutoff value

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