genannte norwegische Anthropotoge HALFDaN B~Y~ ha t in ether 1928 erschienenen Schrift (Die K6rperproportionen des Homo caesius. I~gl. Norsk. Vidensk. Selsk. Skr. z927, Nr 6, 273--356 ) die Variationsbreite der nordischen IRasse (Homo caesius) zu bes t immen gesucht, indem er 8I Individuen aus ether gr6f3eren Serie yon Miinnern ausw~hlte, die der norwegischen binnenl~ndischen Bev61kerurlg aJagehOren. Obwohl sie nach ihm eine ziemlich nngleichartige Masse darstellen mit hoher und Meiner K6rpergrOBe, mit t taar und Augenfarben in allen Nuancen mit Ausnahme der dunkelsten, mit ether Kopfform, die yon Dolichocephalie his welt in die Brachycephalie hineinreicbt, rechnet sie BRYN doch alle zur nordischen Rasse, Man k6nne n~imlich unter keinen Umst~nden behaupten, dab diese ,,kleinen Unterschiede\" auf Rassenmischungen beruhten; es set nicht angXngig, einem Ind iv iduum die Zugeh6rigkeit zur nordischen Rasse abzusprechen, well es brachycephal oder breitgesichtig set, ebensowenig wie zwei Sch~idel zu verschiedenen Rassen geh6ren mfiBten, well der eine dolichocephal und schmalgesichtig und der andere brachycephal und breitgesichtig ist. An diese Auffassung, die den Rassebegriff sehr vim wetter faBt, als es im allgemeinen in der Anthropologie iiblich ist, und in den meisten Darstel lungen zum Ausdruck kommt , wird man erinnert, wenn man das ]3ueh WALTER IKRUSES liest (Die Deutschen und ihre Nachbarv61ker. Neue Grundlegung der Anthropologie, l~assen-, Vblker-, S tammeskunde und t(onst i tut ionslehre nebst Ausf~hrungen zur deutschen Rassenhygiene. Leipzig: GeorgThieme 1929. Mit 17 Textabb. und 5 Tat., XIV, 640 S,). BRYN h~ilt an dem Rassebegriff test, wenn er zweifellos anch die Rassegrenzen verwischt. K~USE ist radikaler, er spricht zwar yon der ,,europ~iischen Rasse\", 16st sie abet n icht in eigentliche Unterrassen ant, sondern in V61ker. Das Volk nnd nicht die !~asse ist also hier die Grundlage ether anthropologischen VVertung, und diese Subst i tut ion meint er woht, wenn er yon ether neuen Grundlegung der Anthropologie spricht. Ffir KRUSE ist weder die K6rpergrbBe noch die Kopfform Rassenmerkmal , weil sie in weiten Grenzen schwa~kten nnd in ihren MaBen yon XuBeren Verhltltnissen hochgradig abhXngig seien. Nnr die P igment ie rnng yon Haut , Haa r nnd Auge sieht er Ms verh~iltnism~iBig besti~ndig an, wenn er auch ein Mendeln nnr ftir die Augenfarben anerkennen wi l l Die Vigment ierung t r e t e nnabhXngig yon alien fibrigen Merkmalen auf nnd stfinde in engster Beziehung zn der geographisehen Lage, d. h. znm ~Iima. KR~Js~ stii tzt Mch bet diesen Aufstellungen zum TeiI auf die vorliegende Literatnr, zum Teit auf eigene Erhebungen an etwa ~oooo Personen aus fas t allen Teilen Dentschlands. Altein dieses eigene Material wird nicht so geboten, wie es in anthropoIogischen Arbeiten sonst iiblich ist, so dab es schwer f~illt, sich ein Urteil fiber die Zuverl~issigkeit nnd I)eutbarkei t in der yon dem Verfasser gesuchten Rich tung zu bilden. Es ist fiberall in Raisonnements eingeschlossen, die f iberhaupt ein Charakter is t ikum des Buches sind. Wenn, n m nu t ein Beispiel anzuffihren, behaupte t wird, dab die Kopfform der Neugeborenen in allen Teilen Deutschlands, ob sie nun aus Gebieten einer langk6pfigen oder kurzk6pfigen Bev61kerung s tammen, nahezu die gleiche -mesocephale -w~ire, so bedarf das trotz der angeffihrten Zahlen ether sehr sorgfMtigen NachprtKung, obwohl, selbst wenn dem so w~re, daraus nieht ohne weiteres auf die Belanglosigkeit der Kopfform f~ir die 1Rassenbestimmung geschlossen werden kann. Die Ausfi ihrungen KRUs~s kommen ihrem Kern Anthropologische Mitteitungen. zz9

Das Arteriensystem der Japaner

MRI and MRE for non-invasive quantitative assessment of hepatic steatosis and fibrosis in NAFLD and NASH: Clinical trials to clinical practice

Diagnostic modalities for nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, and associated fibrosis

ACG Clinical Guideline: Small Intestinal Bacterial Overgrowth.

Dyssynergic defecation is common and affects up to one half of patients with chronic constipation. This acquired behavioral problem is due to the inability to coordinate the abdominal and pelvic floor muscles to evacuate stools. A detailed history, prospective stool diaries, and a careful digital rectal examination will not only identify the nature of bowel dysfunction, but also raise the index of suspicion for this evacuation disorder. Anorectal physiology tests and balloon expulsion test are essential for a diagnosis. Newer techniques such as high-resolution manometry and magnetic resonance defecography can provide mechanistic insights. Recently, randomized controlled trials have shown that biofeedback therapy is more effective than laxatives and other modalities, both in the short term and long term, without side effects. Also, symptom improvements correlated with changes in underlying pathophysiology. Biofeedback therapy has been recommended as the first-line of treatment for dyssynergic defecation. Here, we provide an overview of the burden of illness and pathophysiology of dyssynergic defecation, and how to diagnose and treat this condition with biofeedback therapy.

Diagnosis and Treatment of Dyssynergic Defecation

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the United States. While the American Association for the Study of Liver Diseases guidelines define NAFLD as hepatic steatosis detected either on histology or imaging without a secondary cause of abnormal hepatic fat accumulation, no imaging modality is recommended as standard of care for screening or diagnosis. Bedside ultrasound has been evaluated as a non-invasive method of diagnosing NAFLD with the presence of characteristic sonographic findings. Prior studies suggest characteristic sonographic findings for NAFLD include bright hepatic echoes, increased hepatorenal echogenicity, vascular blurring of portal or hepatic vein and subcutaneous tissue thickness. These sonographic characteristics have not been shown to aid bedside clinicians easily identify potential cases of NAFLD. While sonographic findings such as attenuation of image, diffuse echogenicity, uniform heterogeneous liver, thick subcutaneous depth, and enlarged liver filling of the entire field could be identified by clinicians from bedside ultrasound. The accessibility, ease of use, and low-side effect profile of ultrasound make bedside ultrasound an appealing imaging modality in the detection of hepatic steatosis. When used with appropriate clinical risk factors and steatosis involves greater than 33% of the liver, ultrasound can reliably diagnose NAFLD. Despite the ability of ultrasound in detecting moderate hepatic steatosis, it cannot replace liver biopsy in staging the degree of fibrosis. The purpose of this review is to examine the diagnostic accuracy, utility, and limitations of ultrasound in the diagnosis of NAFLD and its potential use by clinicians in routine practices.

Bedside ultrasound in the diagnosis of nonalcoholic fatty liver disease.

Chronic constipation is a common, persistent condition affecting many patients worldwide, presenting significant economic burden and resulting in substantial healthcare utilization. In addition to infrequent bowel movements, the definition of constipation includes excessive straining, a sense of incomplete evacuation, failed or lengthy attempts to defecate, use of digital manoeuvres for evacuation of stool, abdominal bloating, and hard consistency of stools. After excluding secondary causes of constipation, chronic idiopathic or primary constipation can be classified as functional defecation disorder, slow-transit constipation (STC), and constipation-predominant irritable bowel syndrome (IBS-C). These classifications are not mutually exclusive and significant overlap exists. Initial therapeutic approach to primary constipation, regardless of aetiology, consists of diet and lifestyle changes such as encouraging adequate fluid and fibre intake, regular exercise, and dietary modification. Laxatives are the mainstay of pharmacologic treatment for potential long-term therapy in patients who do not respond to lifestyle or dietary modification. After a failed empiric trial of laxatives, diagnostic testing is necessary to understand underlying anorectal and/or colonic pathophysiology. No single test provides a comprehensive assessment for primary constipation; therefore, multiple tests are used to provide complementary information to one another. Dyssynergic defecation, a functional defecation disorder, is an acquired behavioural disorder of defecation present in two-thirds of adult patients, where an inability to coordinate the abdominal, recto-anal, and pelvic floor muscles during attempted defecation exists. Biofeedback therapy is the mainstay treatment for dyssynergic defecation aimed at improving coordination of abdominal and anorectal muscles. A large percentage of patients with dyssynergic defecation also exhibit rectal hyposensitivity and may benefit from the addition of sensory retraining. Our understanding of the pathophysiology of STC is evolving. The advent of high-resolution colonic manometry allows for the improved identification of colonic motor patterns and may provide further insight into pathophysiological mechanisms. In a minority of cases of STC, identification of colonic neuropathy suggests a medically refractory condition, warranting consideration of colectomy. The pathophysiology of IBS-C is poorly understood with multiple etiological factors implicated. Pharmacological advances in the treatment of primary constipation have added therapeutic options to the armamentarium of this disorder. Drug development in the secretagogue, serotonergic prokinetic, and ileal bile acid transporter inhibition pathways has yielded current and future medical treatment options for primary chronic constipation.

Constipation: Pathophysiology and Current Therapeutic Approaches

Chronic constipation is a common, nonmotor, and prodromal symptom in Parkinson’s disease (PD). Its underlying neuropathology may provide pathophysiological insight into PD. Here, we critically review what is currently known about the neuroanatomical and brain-gut interactions, and the origin and progression of Lewy pathology (LP) at three levels—brain/brainstem, spinal cord, and enteric nervous system. Many recent studies have illustrated the challenges of examining LP in tissues obtained from colon biopsies of PD patients. Large-scale epidemiological studies have not confirmed the widely accepted Braakpostula. In this review, we propose an alternative origin and route of spread of LP in PD. We describe novel, noninvasive neurophysiological testing that could advance the understanding of LP and complex bidirectional brain-pelvic floor neural pathways in PD—a true disease model of a neurogastrointestinal disorder. This review may provide the impetus for future studies investigating gut and brain interaction and constipation in PD.

Constipation in Parkinson's Disease: a Nuisance or Nuanced Answer to the Pathophysiological Puzzle?

Background Chronic constipation is a common, heterogeneous disorder with multiple symptoms and pathophysiological mechanisms. Patients are often referred to a gastroenterology provider after laxatives fail. However, there is limited knowledge of the spectrum and management of constipation disorders. Aim To discuss the latest understanding of the spectrum of constipation disorders, tools for identifying a pathophysiologic-based diagnosis in the specialist setting, treatment options and the patient's perspective of constipation. Methods Literature searches were conducted using PubMed for constipation diagnostic criteria, diagnostic tools and approved treatments. The authors provided insight from their own practices. Results Clinical assessment, stool diaries and Rome IV diagnostic criteria can facilitate diagnosis, evaluate severity and distinguish between IBS with constipation, chronic idiopathic constipation and dyssynergic defecation. Novel smartphone applications can help track constipation symptoms. Rectal examinations, anorectal manometry and balloon expulsion, assessments of neuromuscular function with colonic transit time and colonic manometry can provide mechanistic understanding of underlying pathophysiology. Treatments include lifestyle and diet changes, biofeedback therapy and pharmacological agents. Several classes of laxatives, as well as prokinetic and prosecretory agents, are available; here we describe their mechanisms of action, efficacy and side effects. Conclusions Constipation includes multiple overlapping subtypes identifiable using detailed history, current diagnostic tools and smartphone applications. Recognition of individual subtype(s) could pave the way for optimal, evidence-based treatments by a gastroenterology provider.

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Review article: diagnosis, management and patient perspectives of the spectrum of constipation disorders

This review highlights recent work that will lead to near-term advances in the understanding and treatment of gastroparesis (Gp). Major current advancements in the pathophysiology of Gp, include recognition of the SIP syncytium as the pacemaking unit rather than ICC alone and that Gp may be part of a pan-enteric autoimmune and/or autonomic disorder with macrophage imbalance. The development of newer techniques to assess gastric emptying (gastric emptying breath test and wireless motility capsule) and pyloric distensibility (EndoFLIP®) are allowing clinicians better characterization of their patients. In addition to pharmaceutical compounds in the pipeline, neuromodulation and endosurgical techniques, such as G-POEM, may help address refractory Gp. We expect that the 2020 decade will witness exciting developments. Treatments targeting gastrointestinal motility, immunological dysfunction, and inflammatory mediators will be evaluated. We anticipate future studies will be guided by biomarkers correlated with patient outcomes and therapeutic efficacy to establish new paradigms in the management of Gp.

Amol Sharma

Papers

Bedside ultrasound in the diagnosis of nonalcoholic fatty liver disease.

Constipation: Pathophysiology and Current Therapeutic Approaches

Constipation in Parkinson's Disease: a Nuisance or Nuanced Answer to the Pathophysiological Puzzle?

Review article: diagnosis, management and patient perspectives of the spectrum of constipation disorders

Gastroparesis in the 2020s: New Treatments, New Paradigms.