Considered on a daily basis, cell concentration increased roughly

Considered on a daily basis, cell concentration increased roughly exponentially up to the bloom peak, but closer inspection revealed that the increases generally occurred when the direction of water flow was into the estuary, suggesting the source

of the bloom was offshore. “
“The idea that evolutionary models should minimize plastid endosymbioses has dominated Pembrolizumab ic50 thinking about the history of eukaryotic photosynthesis. Although a reasonable starting point, this framework has not gained support from observed patterns of algal and plant evolution, and can be an obstacle to fully understanding the modern distribution of plastids. Empirical data indicate that plastid losses are extremely uncommon, that major changes in plastid biochemistry/architecture are evidence of an endosymbiotic event, and that comparable selection pressures can lead to remarkable convergences in algae with different endosymbiotic origins. Such empirically based generalizations can provide a more realistic philosophical framework for interpreting complex and often contradictory results from phylogenomic investigations of algal evolution. “
“The volvocine green algal genus Volvox includes ∼20 species with diverse sizes (in terms of both diameter and cell number), morphologies, and developmental programs. Y-27632 Two suites of characters are shared among distantly related

lineages within Volvox. The traits characteristic

of all species of Volvox—large (>500) numbers of small somatic cells, much smaller numbers of reproductive cells, and oogamy in sexual reproduction—have three MCE公司 or possibly four separate origins. In addition, some species have evolved a suite of developmental characters that differs from the ancestral developmental program. Most multicellular volvocine algae, including some species of Volvox, share an unusual pattern of cell division known as palintomy or multiple fission. Asexual reproductive cells (gonidia) grow up to many times their initial size and then divide several times in rapid succession, with little or no growth between divisions. Three separate Volvox lineages have evolved a reduced form of palintomy in which reproductive cells are small and grow between cell divisions. In each case, these changes are accompanied by a reduction in the rate of cell division and by a requirement of light for cell division to occur. Thus, two suites of characters—those characteristic of all Volvox species and those related to reduced palintomy—have each evolved convergently or in parallel in lineages that diverged at least 175 million years ago (mya). “
“Four clonal cultures of the unarmored dinoflagellate Takayama acrotrocha (J. Larsen) de Salas, Bolch et Hallegraeff were established from Singapore coastal water on October 20, 2004, and January 1, 2007, for a HAB monitoring project.

All experiments were repeated Data from three replicates were an

All experiments were repeated. Data from three replicates were analysed by one-way analysis of variance (anova) using spss statistical software (SPSS Inc., Chicago, IL, USA). Fisher’s least significant differences (LSD, P ≤ 0.05) were determined to compare differences between means. Data are presented as the mean ± standard error of means.

There is no significant difference in disease index of Gankezaomi and Ganmibao at 4 and 5 days after inoculation. Disease index of Gankezaomi was significantly lower (P ≤ 0.05) than Ganmibao in all other days (Table 1). H2O2 significantly accumulated (P ≤ 0.05) in inoculated resistant and susceptible cultivars and peaked at 24 hai, but was greater selleck products in the resistant cultivar (Fig. 1). Higher accumulation of H2O2 was directly inhibiting pathogen invasion or may function as a signal to trigger other defence responses including PR genes expression, cross-linking of cell wall and lignin biosynthesis (Hancock et al. 2007). Basavaraju et al. (2009) found that H2O2 accumulation in sorghum inhibited penetration by Colletotrichum sublineolum. Similar results were found in the interaction between cowpea and Colletotrichum gloeosporioides, tomato and Colletotrichum coccodes (Denny et al. 2002; Barreto et al. 2007). CAT activity significantly increased (P ≤ 0.05) in C. lagenarium inoculated leaves and peaked at 24 hai (Fig. 2).

The higher activity of CAT was important for the reduction of H2O2 to water. Inoculation with C. lagenarium significantly increased (P ≤ 0.05) APX activity and AsA levels in both cultivars (Fig. 3a,b). Inoculation with C. lagenarium also significantly increased (P ≤ 0.05) the activity of GR and levels PD0325901 of GSH in resistant and susceptible cultivars (Fig. 4a,b). Both GR activity and GSH levels were

consistently higher in the resistant cultivar. APX, GR, AsA and GSH play central roles in the AsA–GSH cycle that regulates cellular oxidative balance to protect cells from oxidative damage (Li et al. 2010). medchemexpress Inoculation with C. lagenarium significantly increased (P ≤ 0.05) the activity of POD (Fig. 5), CHT (Fig. 6) and GLU (Fig. 7). The peak activity of POD (72 hai), CHT (72 hai) and GLU (48 hai) was significantly higher (P ≤ 0.05) in leaves of the resistant cultivar. POD is thought to be involved in H2O2-mediated cross-linking of phenolic wall components and preventing pathogen invasion (Ribeiro et al. 2006). The results agreed to Avdiushko et al. (1993) who found that POD activity increased after inoculating cucumber plants with C. lagenarium. Expression of higher levels of CHT and GLU has been shown to provide enhanced resistance to fungal pathogens by hydrolysing fungal cell walls and by releasing elicitors that activate other defence responses (van Loon et al. 2006). The activity of PAL was stable in uninoculated resistant and susceptible leaves but significantly increased (P ≤ 0.05) in both cultivars by 24 hai and peaked 72 hai (Fig. 8). Inoculation also significantly increased (P ≤ 0.

Also, adding an assessment of appetite in this population should

Also, adding an assessment of appetite in this population should be included. The

presence of malnutrition is another associated factor that can impair HRQL in patients with cirrhosis.[12] According to the results of this study, there were no differences in nutritional status in patients with MHE or in those without MHE. Nevertheless, a significant reduction was noted in the appetite of patients with MHE according to severity of the disease (Child–Pugh score). The Child–Pugh index has been considered not only a risk factor for developing complications such as MHE,[30] it has also been associated with Dabrafenib the loss of appetite and HRQL in patients with cirrhosis. The results of this study suggest that both MHE and appetite have a negative effect on HRQL in patients with decompensated cirrhosis. Considering

that the present study is the first to explore appetite in patients with MHE, more studies are needed to prove the consistency of this association. Malnutrition is present in 20–84% of the patients with liver disease.[22] Changes in appetite are more frequent in patients with liver cirrhosis compared with the general population, and have been associated with lower concentrations of zinc, vitamin A, magnesium, α- and β-carotene.[48] Zinc deficiency has been PLX 4720 associated as a risk factor for developing hepatic encephalopathy and its supplementation MCE has been used in the treatment of OHE;[49] however, the results to date are inconclusive. In a survey from Spain, 59% of hepatologists did not diagnose MHE.[37] In the USA, 26% of gastroenterologists surveyed believed MHE should not be tested for.[50] In Mexico, testing is not done routinely during clinical practice. It appears that a timely diagnosis and treatment of MHE would improve HRQL[42, 43] and reduce the risk of developing OHE.[38] In addition,

treatment with lactulose is a cost-effective strategy, because in a period of 5 years, it would prevent an estimated 202 car accidents, generating a saving of $US 8.5 million.[39] The results of this study show that MHE and a reduction in appetite are associated with deterioration in HRQL in patients with decompensated cirrhosis. The authors thank Montserrat Ferrer for allowing the adaptation of the validated Spanish version of CLDQ for a Mexican population. This study was supported by grants from the Mexican Institute of Social Security (FIS/IMSS/PROT/G11/973). “
“Background and Aim:  Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is an accurate method for cytological confirmation of pancreatic malignancy, but it has been unknown whether its diagnostic accuracy for pancreatic lesions was affected by their size, location, or size of needles. Our aim was to investigate the accuracy of EUS-FNA for suspected pancreatic malignancy in relation to these factors, especially to the size of lesions.

Cirrhosis, either by clinical evidence or biopsy, was present in

Cirrhosis, either by clinical evidence or biopsy, was present in 14% of the entire cohort. The median AST was 41 IU/L (standard deviation [SD] = 22) and median ALT 56 IU/L (SD = 36). An elevated alkaline phosphatase level with normal aminotransferase levels defined by local laboratory reference

ranges was found in 4% and a positive AMA in 4% of patients. There was no association between an isolated alkaline phosphatase elevation and a positive AMA. Of those with a biopsy at any time, 54% had ≥34% steatosis, 47% had Selleckchem Talazoparib ≥grade 2 lobular inflammation, 66% had ballooning, 57% met the criteria for “definite” NASH, and 31% had bridging hepatic fibrosis or cirrhosis. The major differences between those with contemporaneous liver biopsies and those without was the lower prevalence of diabetes and

hypertension, lower glucose, lower HDL cholesterol, higher triglycerides, and less advanced fibrosis in the contemporaneous biopsy group. The contemporaneous liver biopsy group included all of the PIVENS patients, who did not, by definition, have diabetes or cirrhosis. Interestingly, the prevalence of the metabolic syndrome as defined by the NCEP ATP-III criteria was similar in all groups despite the group differences in individual components that define the metabolic syndrome. Aminotransferase levels were also higher in the contemporaneous biopsy group, possibly Roxadustat ic50 reflecting more patients with lower enzyme levels because MCE公司 of “burnt out” NASH in the setting of advanced fibrosis in the other groups. Further analyses of the study cohort focused on the subgroup with contemporaneous

liver biopsies. Factors associated with definite NASH in patients with NAFLD and contemporaneous liver biopsies are shown in Table 2. Patients with NASH were more likely to be women, have diabetes, and meet the NCEP criteria for the metabolic syndrome; they also had significantly higher levels of AST, ALT, GGT, triglycerides, HbA1c, HOMA-IR, and lower levels of HDL cholesterol compared to those without definite NASH. Patients with NASH also had significantly more steatosis, lobular inflammation, ballooning, and fibrosis as well as higher NAFLD Activity Scores. Portal inflammation was more likely to be greater than mild in those with definite NASH. There were no differences between the two groups in age, BMI, waist circumference, acanthosis nigricans, or self-identified Hispanic ethnicity. Interestingly, autoantibodies were found more often in those without definite NASH compared to those with NASH. Overall, the same factors associated with definite NASH were also significantly associated with ballooning. This may reflect the dominant role that the presence of ballooning has in establishing a diagnosis of definite NASH. The value of using ALT levels to screen for NASH in patients with NAFLD was examined using three different cutoffs for the upper reference range.

, 2009) The reuse of nests constructed in previous years has bee

, 2009). The reuse of nests constructed in previous years has been well documented in many bird species: cavity breeders (Rendell & Verbeek, 1996; Václav Nutlin-3a in vivo et al., 2011), passerines (Bergin, 1997; Cavitt, Pearse & Miller, 1999), cliff-nesting raptors (Ontiveros, Caro & Pleguezuelos, 2008;

Burnham, Burnham & Newton, 2009) and forest raptors (Krüger, 2002; Saga & Selås, 2012). Nest building has long been considered energetically costly and these costs can be reduced considerably if old nests are reused. By reusing an old nest, birds can devote their energies to foraging and egg production (Rendell & Verbeek, 1996). Moreover, the reuse of nest-sites by birds has important consequences for the viability of the population structure (Václav et al., 2011). However, the strategy of nest reuse has not been shown to have a positive influence on breeding success (Cavitt et al., 1999; Redmond, Murphy & Dolan, 2007) and old nests are more likely to carry diseases or ectoparasites due to the old material (Rendell & Verbeek, 1996). Moreover, high quality individuals, which are also most likely to have a CP-868596 price high reproductive output (Espie et al., 2004), should therefore be most likely to build new nests. In raptor populations, many studies focus on the causes of breeding site settlements in terms of inadvertent social

information, such as conspecific attraction and public information using colonial raptors (Sergio & Penteriani, 2005; Mateo-Tomás & Olea, 2011). However, there is much less information about the influence of old nests on reuse patterns and reproductive output (Krüger, 2002; Zhou et al., 2009; Kochert & Steenhof, 2012). In this paper, we study nest reuse and building patterns and their effects on reproductive output in two raptor species in a protected Mediterranean forest in southeastern Spain: the booted eagle

Aquila pennata (Gmelin, 1788) and the common buzzard Buteo buteo (Linnaeus, 1758). These species are particularly well suited to this type of study for Dimethyl sulfoxide the following reasons: (1) both species are territorial and may have a number of nests per territory, (2) old nests are relatively abundant and in most cases clearly visible, and (3) the species frequently reuse nests and show high territorial reoccupancy rates (Pagán, Martínez & Calvo, 2009; Jiménez-Franco et al., 2013). The selection of breeding sites is widely regarded as a hierarchical process, whereby individuals make choices at varying spatial scales, ranging from the regional, down to habitat type, and finally nest site (Citta & Lindberg, 2007). In this study, we consider two spatial scales in the nest site selection processes of forest raptor species. At a habitat-level scale, we considered whether the chosen territory was new (first colonization in the timescale of the study, which implies nest building) or old (at least one nest existed in the territory). In old territories, we considered both the processes of nest construction and nest reuse.

Although iPSC-derived HE expressed

Although iPSC-derived HE expressed /www.selleckchem.com/products/emd-1214063.html a number of liver genes, we were also keen to assess their liver-specific function in culture. An important functional marker for HE is the production and export of serum proteins. We assessed iPSC-HE production of these key serum proteins and measured their levels by ELISA (Fig. 3). In all lines tested, we detected substantial amounts of alpha-fetoprotein, transthyretin, fibronectin, and fibrinogen at levels equivalent to those reported for HE derived

from hESCs.5 In order to further functionally validate, iPSC-derived HE was assessed for its metabolic ability. The cytochrome P450 enzymes are critical in drug metabolism, and CYP1A2 and CYP3A4 are key enzymes. The function of these CYP450 components

were examined, and importantly, all lines exhibited CYP1A2 and CYP3A4 activity as assessed by the generation of a luminescent metabolite (Fig. 4). CYP1A2 metabolism was similar between lines PGP9f-iPS1 and NMF-iPS6, but was higher in line JDM-iPS1, whereas we observed only slight variation with CYP3A4 metabolism in check details all three lines tested. Here, we demonstrate for the first time the derivation of HE from human iPSCs of both sexes and two ethnicities. The iPSC-derived HE was functionally equivalent to hESC-derived HE, and interestingly, all iPSC lines tested so far showed higher efficiency to form functional HE. The generic ability of iPSCs to form HE in response to our model5 has not been observed with hESCs in deriving efficient levels of HE. Therefore, one could speculate Methocarbamol that this is due to the consistent manner in which the iPSCs were reprogrammed and may play an important role in their developmental potential. It also suggests that iPSCs may prove a more valuable and uniform starting material for derivation of HE, than are hESCs, which show dramatic line-to-line variability in susceptibility to individual lineage differentiation. Such a resource has the ability to revolutionize the manner in which we define drug metabolism, and model liver disease and human liver development. Because iPSC-derived HE can be differentiated in vitro, an unlimited supply of ethically and genetically diverse HE models can be obtained. This will become

a powerful resource allowing the study of ethnic/polymorphic variation on xenobiotic metabolism involving poor metabolizers (e.g., CYP2C9/warfarin) and disease genotypes (e.g., alpha-1-antitrypsin). In addition, the ability to model liver development in vitro will allow the development of novel biomarkers for both disease and the identification of stage-specific markers during the differentiation process.12 An iPSC library could be developed through identification and reprogramming of human fibroblasts displaying metabolically different features for key polymorphisms. Presently, the ability to model the human liver and disease using hESCs or PHHs is limited by the number of stem cell lines available and the ability to produce functional HE from individual ESC lines.

Although iPSC-derived HE expressed

Although iPSC-derived HE expressed selleck compound a number of liver genes, we were also keen to assess their liver-specific function in culture. An important functional marker for HE is the production and export of serum proteins. We assessed iPSC-HE production of these key serum proteins and measured their levels by ELISA (Fig. 3). In all lines tested, we detected substantial amounts of alpha-fetoprotein, transthyretin, fibronectin, and fibrinogen at levels equivalent to those reported for HE derived

from hESCs.5 In order to further functionally validate, iPSC-derived HE was assessed for its metabolic ability. The cytochrome P450 enzymes are critical in drug metabolism, and CYP1A2 and CYP3A4 are key enzymes. The function of these CYP450 components

were examined, and importantly, all lines exhibited CYP1A2 and CYP3A4 activity as assessed by the generation of a luminescent metabolite (Fig. 4). CYP1A2 metabolism was similar between lines PGP9f-iPS1 and NMF-iPS6, but was higher in line JDM-iPS1, whereas we observed only slight variation with CYP3A4 metabolism in MG-132 research buy all three lines tested. Here, we demonstrate for the first time the derivation of HE from human iPSCs of both sexes and two ethnicities. The iPSC-derived HE was functionally equivalent to hESC-derived HE, and interestingly, all iPSC lines tested so far showed higher efficiency to form functional HE. The generic ability of iPSCs to form HE in response to our model5 has not been observed with hESCs in deriving efficient levels of HE. Therefore, one could speculate Montelukast Sodium that this is due to the consistent manner in which the iPSCs were reprogrammed and may play an important role in their developmental potential. It also suggests that iPSCs may prove a more valuable and uniform starting material for derivation of HE, than are hESCs, which show dramatic line-to-line variability in susceptibility to individual lineage differentiation. Such a resource has the ability to revolutionize the manner in which we define drug metabolism, and model liver disease and human liver development. Because iPSC-derived HE can be differentiated in vitro, an unlimited supply of ethically and genetically diverse HE models can be obtained. This will become

a powerful resource allowing the study of ethnic/polymorphic variation on xenobiotic metabolism involving poor metabolizers (e.g., CYP2C9/warfarin) and disease genotypes (e.g., alpha-1-antitrypsin). In addition, the ability to model liver development in vitro will allow the development of novel biomarkers for both disease and the identification of stage-specific markers during the differentiation process.12 An iPSC library could be developed through identification and reprogramming of human fibroblasts displaying metabolically different features for key polymorphisms. Presently, the ability to model the human liver and disease using hESCs or PHHs is limited by the number of stem cell lines available and the ability to produce functional HE from individual ESC lines.

joint inflammation, and intra-muscle bleeds vs other regional pa

joint inflammation, and intra-muscle bleeds vs. other regional pain syndromes. To assess painful musculoskeletal episodes in adult haemophiliacs, we used rapid MSKUS,

employing grey scale and power Doppler examination. Forty episodes in 30 adult haemophiliacs were evaluated. Thirty three of the 40 episodes were patient-reported as ‘bleeding’, five as ‘arthritis-type’ pain and two as ‘undecided’. Of the 33 bleeding reports, only 12 were confirmed by MSKUS; the other episodes revealed other pathology. In contrast, three of five perceived arthritis flares were reclassified as bleeds. Similarly, physician assessment was incorrect in 18 of 40 instances. Swelling and warmth were present in approximately half of confirmed bleeding and non-bleeding episodes, and therefore not useful clinically. Few of the painful episodes were symptom controlled at the time of MSKUS. Management changed based on objective imaging findings in Selleck GDC973 >70% of episodes, which resulted in symptom improvement >60% of the time. Significant discrepancies exist between MSKUS findings and patient/physician-perceived pain classification as bleeding or other musculoskeletal symptoms. Current practice of prescribing clotting factor or conservative measures based on pain perception seems inadequate

and suggests that point-of-care imaging should be included into modern haemophilia care. “
“Many patients with haemophilia find protocol (PWH) live with persistent end-stage arthritis, as a result of multiple joint haemarthrosis, and experience daily pain. For these people, pain becomes a central aspect of life. The aim of this study was to use mechanical pain thresholds (MPT) to characterize

HSP90 pain perception in different PWH groups. The groups tested were characterized by age, previous bleeding into joints, Hemophilia Joint Health Score (HJHS) and PAIN perception score in the HJHS scoring. A total of 23 PWH (haemophilia A) were included in this study (10 children, 13 adults). A total of 12 PWH suffered from repeated bleeding into some of the tested joints. Data were compared to those collected from 15 age-matched control subjects. The most significant differences in MPTs were found when the PWH were compared to the controls, based on the differences in PAIN score (PAIN score 1 and 2) in all the tested joints, except for the right knee. Similarly, the difference in MPT in ankle joints was confirmed when PWH with and without bleeding were compared to controls. Summarizing the outcomes, we can emphasize the potential usefulness of MPT as an objective tool in evaluating the pain of PWH. “
“Summary.  There are currently limited data on the use of endometrial ablation in the treatment of heavy menstrual bleeding (HMB) in women with inherited bleeding disorders (IBDs). A retrospective review of prospectively collected data was performed.

Genetic links to hemochromatosis were first reported in 1976 and,

Genetic links to hemochromatosis were first reported in 1976 and, in 1996, a strong association was reported with the C282Y mutation in the HFE gene. Knowledge of the relationship between the mutation and excessive iron absorption is incomplete but involves up-regulation of the

divalent metal transporter protein, low levels of a polypeptide called hepcidin and up-regulation of a basolateral transport protein called ferroportin. Organs with the highest levels of transferrin receptors are at highest risk for damage by free radicals released by non-transferrin bound iron (free iron). Despite these important developments, most patients are treated by regular venesection, usually removal of 400-500 ml of blood that contains approximately BGB324 manufacturer 250 mg of iron. The patient illustrated PF-2341066 below was a woman, aged 53, who was investigated because of malaise and intermittent abdominal pain. On examination, she appeared to have prominent skin pigmentation. Liver function tests were abnormal and her serum ferritin was elevated at 834 µg/l. She subsequently developed symptoms of adrenal insufficiency and was commenced on steroid replacement therapy. Genetic testing revealed a homozygous C282Y mutation

while her liver biopsy showed grade 4 iron deposition mainly around the portal tracts. This has been highlighted in Figure 1 using a Perl’s stain. She did not have cirrhosis. Venesection on 41 occasions over 2 years resulted in a fall in ferritin to 28 µg/l. Over the subsequent 2 years, venesection was performed on 6 occasions and was associated with a serum ferritin of <50 µg/l. A liver biopsy acetylcholine was repeated 5 years after diagnosis and was normal without any evidence of iron deposition

(Perl’s stain, Figure 2). In hemochromatosis, the number of venesections required to achieve iron depletion is variable but, in one large study, the mean number was 85. Initially, all patients should have venesection at least once per week and, after iron depletion, at intervals of 1-3 months. There is now clear evidence that iron depletion improves prognosis. For example, in the absence of cirrhosis, treated patients with hemochromatosis have a similar life expectancy to that in the general population. Contributed by “
“Esophageal strictures can be caused by acid, radiation, eosinophilic esophagitis (EoE), and caustic injury. Food impaction in a young man warrants evaluation for eosinophilic esophagitis. Savary dilation is the most cost-effective therapy. Stricture dilation should be cautious (rule of threes) early on, especially in caustic, radiation and EoE strictures. Complex/resistant strictures may require steroid injections, incisional therapy, and stent placement. Complications of stricture treatment are rare. “
“We read with great interest the article by Bangarulingam et al.

Genetic links to hemochromatosis were first reported in 1976 and,

Genetic links to hemochromatosis were first reported in 1976 and, in 1996, a strong association was reported with the C282Y mutation in the HFE gene. Knowledge of the relationship between the mutation and excessive iron absorption is incomplete but involves up-regulation of the

divalent metal transporter protein, low levels of a polypeptide called hepcidin and up-regulation of a basolateral transport protein called ferroportin. Organs with the highest levels of transferrin receptors are at highest risk for damage by free radicals released by non-transferrin bound iron (free iron). Despite these important developments, most patients are treated by regular venesection, usually removal of 400-500 ml of blood that contains approximately Buparlisib nmr 250 mg of iron. The patient illustrated Selleckchem Selinexor below was a woman, aged 53, who was investigated because of malaise and intermittent abdominal pain. On examination, she appeared to have prominent skin pigmentation. Liver function tests were abnormal and her serum ferritin was elevated at 834 µg/l. She subsequently developed symptoms of adrenal insufficiency and was commenced on steroid replacement therapy. Genetic testing revealed a homozygous C282Y mutation

while her liver biopsy showed grade 4 iron deposition mainly around the portal tracts. This has been highlighted in Figure 1 using a Perl’s stain. She did not have cirrhosis. Venesection on 41 occasions over 2 years resulted in a fall in ferritin to 28 µg/l. Over the subsequent 2 years, venesection was performed on 6 occasions and was associated with a serum ferritin of <50 µg/l. A liver biopsy FER was repeated 5 years after diagnosis and was normal without any evidence of iron deposition

(Perl’s stain, Figure 2). In hemochromatosis, the number of venesections required to achieve iron depletion is variable but, in one large study, the mean number was 85. Initially, all patients should have venesection at least once per week and, after iron depletion, at intervals of 1-3 months. There is now clear evidence that iron depletion improves prognosis. For example, in the absence of cirrhosis, treated patients with hemochromatosis have a similar life expectancy to that in the general population. Contributed by “
“Esophageal strictures can be caused by acid, radiation, eosinophilic esophagitis (EoE), and caustic injury. Food impaction in a young man warrants evaluation for eosinophilic esophagitis. Savary dilation is the most cost-effective therapy. Stricture dilation should be cautious (rule of threes) early on, especially in caustic, radiation and EoE strictures. Complex/resistant strictures may require steroid injections, incisional therapy, and stent placement. Complications of stricture treatment are rare. “
“We read with great interest the article by Bangarulingam et al.