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Journal of Neurophysiology Mar 2024Nervous systems have evolved to function consistently in the face of the normal environmental fluctuations experienced by animals. The stomatogastric nervous system...
Nervous systems have evolved to function consistently in the face of the normal environmental fluctuations experienced by animals. The stomatogastric nervous system (STNS) of the crab, , produces a motor output that has been studied for its remarkable robustness in response to single global perturbations. Changes in environments, however, are often complex and multifactorial. Therefore, we studied the robustness of the pyloric network in the stomatogastric ganglion (STG) in response to simultaneous perturbations of temperature and pH. We compared the effects of elevated temperatures on the pyloric rhythm at control, acid, or base pHs. In each pH recordings were made at 11°C, and then the temperature was increased until the rhythms became disorganized ("crashed"). Pyloric burst frequencies and phase relationships showed minor differences between pH groups until reaching close to the crash temperatures. However, the temperatures at which the rhythms were disrupted were lower in the two extreme pH conditions. This indicates that one environmental stress can make an animal less resilient to a second stressor. Resilience to environmental fluctuations is important for all animals. It is common that animals encounter multiple stressful events at the same time, the cumulative impacts of which are largely unknown. This study examines the effects of temperature and pH on the nervous system of crabs that live in the fluctuating environments of the Northern Atlantic Ocean. The ranges of tolerance to one perturbation, temperature, are reduced under the influence of a second, pH.
Topics: Animals; Temperature; Pylorus; Ganglia, Invertebrate; Brachyura
PubMed: 38264774
DOI: 10.1152/jn.00483.2023 -
Endoscopy International Open Jan 2024
PubMed: 38250166
DOI: 10.1055/a-2211-9031 -
Case Reports in Gastroenterology 2024Bezoars are masses of indigestible foreign material in the gastrointestinal tract, usually in the stomach. These materials could be indigestible fruits, hair, milk...
INTRODUCTION
Bezoars are masses of indigestible foreign material in the gastrointestinal tract, usually in the stomach. These materials could be indigestible fruits, hair, milk products, or tablets. In children, the most common type of bezoar is trichobezoar (formed from hair).
CASE PRESENTATION
We describe a female patient who has been complaining about deterioration of mood, collapse without losing consciousness, scotomas, and cardiac arrhythmia for 2 years. Based on the results of thyroid hormone, resistance to thyroid hormone (RTH) was suspected. Physical examination during hospitalization revealed a palpable upper abdominal mass. Several diagnostic examinations were performed. The abdominal ultrasound showed acoustic shadowing caused by a pathological structure in the upper abdomen. Therefore, the contrast X-ray of the digestive tract revealed a deficit of contrast with an irregular shape in the stomach body and the pylorus region. Due to these results, a gastroscopy was performed, which revealed a large trichobezoar of the stomach. The trichobezoar was surgically removed without complications.
CONCLUSION
The case presented shows that these nonspecific symptoms and laboratory test suggesting RTH require multi-path diagnostics and the cooperation of many specialists, ultimately giving a surprising diagnosis. It is crucial to interpret diagnostic examinations with regard to the patient's physical condition. Diagnosis of trichobezoar requires a detailed search of causes to avoid another incident.
PubMed: 38249995
DOI: 10.1159/000534548 -
Journal of Pharmacy & Bioallied Sciences 2023Gastroesophageal reflux disease (GERD) is a chronic, relapsing disorder. In this era of modern and fast-track lifestyle and food habits, the incidence of GERD is rapidly...
BACKGROUND
Gastroesophageal reflux disease (GERD) is a chronic, relapsing disorder. In this era of modern and fast-track lifestyle and food habits, the incidence of GERD is rapidly increasing. Currently, proton pump inhibitors (PPIs) are the primary choice of treatment. However, the associated side effects and a high relapse rate give rise to the need to explore alternative therapies.
OBJECTIVE
The study aimed to evaluate HAGE-101912, an herbal combination, in different experimental models of GERD.
METHODS
Antacid activity was assessed based on H/KATPase inhibitory activity of parietal cells using artificial gastric juice. Tonic contraction of the lower esophageal sphincter (LES) was evaluated using an AD Instrument. A GERD model of the pylorus and fundus ligation (preventive and curative models) in rats was selected to assess the efficacy of HAGE-101912 at a dose of 250 mg/kg body weight, and various parameters such as the gastric pH, gastric volume, total acidity, gross esophageal ulcer index, and histopathological changes were evaluated. The prokinetic activity was assessed using the phenol red method.
RESULTS
HAGE-101912 increased the acid-neutralizing capacity ( < 0.001), decreased H/KATPase activity ( < 0.01), and increased the contraction of the LES. In the preventive model, HAGE-101912 significantly reduced the gastric acid volume ( < 0.01), total acidity ( < 0.001), and gross esophageal ulcer index ( < 0.01); increased the gastric acid pH ( < 0.01); and protected the esophageal epithelium. In addition, HAGE-101912 increased gastric emptying and gastrointestinal transit through its prokinetic activity ( < 0.05).
CONCLUSION
HAGE-101912 has a beneficial effect in GERD as it effectively inhibits the H/KATPase, increases the gastric pH, restores the LES function, protects the esophageal epithelium, and increases gastric emptying and transit.
PubMed: 38235047
DOI: 10.4103/jpbs.jpbs_860_21 -
Korean Journal of Clinical Oncology Dec 2023This study shows a case of neoadjuvant chemotherapy application for the management of a 34-year-old male patient diagnosed with invasive intraductal papillary mucinous...
Margin-negative minimally invasive pancreatoduodenectomy following FOLFIRINOX neoadjuvant chemotherapy in invasive intraductal papillary mucinous neoplasm of pancreas: a case report.
This study shows a case of neoadjuvant chemotherapy application for the management of a 34-year-old male patient diagnosed with invasive intraductal papillary mucinous neoplasm (IPMN), for which curative margin-negative resection initially seemed challenging. Five cycles of the FOLFIRINOX regimen (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) were administered preoperatively, resulting in a significant reduction of the intraductal mass size and deformity of the main vessels. The patient subsequently underwent a successful robotic pylorus-preserving pancreatoduodenectomy. Postoperatively, the patient received adjuvant chemotherapy with FOLFIRINOX, and after 5 months, showed no signs of tumor recurrence or specific complications. These findings suggest that neoadjuvant therapy can be a potentially effective strategy even in advanced invasive IPMN. Further research is necessary to establish guidelines for its application.
PubMed: 38229493
DOI: 10.14216/kjco.23014 -
Medicine Dec 2023Extensive endoscopic submucosal dissection (ESD) for gastric adenoma or early cancer can lead to post-ESD stenosis. This may cause a decrease in quality of life and an...
The efficacy of newly proposed gastric open peroral endoscopic myotomy (GO-POEM) in preventing post-endoscopic submucosal dissection stenosis: A comparison with non-GO-POEM group.
Extensive endoscopic submucosal dissection (ESD) for gastric adenoma or early cancer can lead to post-ESD stenosis. This may cause a decrease in quality of life and an increase in medical issues. Therefore, this study examined the safety and effectiveness of gastric open peroral endoscopic myotomy (GO-POEM) in preventing stenosis following ESD. A retrospective investigation was carried out on 31 patients who underwent gastric ESD for > 75% of the lumen in the antrum or pylorus at the Presbyterian Medical Center in Korea between December 2004 and October 2022. The patients were divided into GO-POEM (n = 11) and non-GO-POEM groups (n = 20). The average age of the 31 patients was 73.23 years, and 18 were male. There were no differences in age, sex, location, gross findings, or procedure time between the 2 groups. In the GO-POEM group, only 1 patient (9 %) developed stenosis, compared to 11 patients (55 %) in the control group (P = .02). Multivariate analysis showed that the GO-POEM group had a significantly lower risk of post-ESD stenosis (P < .05). Stenosis symptoms resolved with a single endoscopic balloon dilatation (EBD) in 1 patient in the GO-POEM group. In contrast, 5 of 11 patients with stenosis in the non-GO-POEM group required a median of 2 EBD sessions (range, 1-8). GO-POEM may be an effective and reliable method for preventing stenosis post extensive gastric ESD. Further investigations are necessary to establish its efficacy and safety.
Topics: Humans; Male; Aged; Female; Constriction, Pathologic; Endoscopic Mucosal Resection; Retrospective Studies; Quality of Life; Myotomy; Esophageal Achalasia; Treatment Outcome; Natural Orifice Endoscopic Surgery
PubMed: 38206733
DOI: 10.1097/MD.0000000000036755 -
Cureus Dec 2023Laparoscopic sleeve gastrectomy (SG) is a widely performed bariatric procedure known for its safety and efficacy, yet complications, particularly postoperative leaks,...
Laparoscopic sleeve gastrectomy (SG) is a widely performed bariatric procedure known for its safety and efficacy, yet complications, particularly postoperative leaks, remain a concern. Endoscopic stenting is one of the approaches for leak management that has some complications such as the rare fistula with adjacent organs. Here, we present a unique case of a 56-year-old diabetic female who developed a gastroenteric fistula following endoscopic stent placement for a post-SG leak. The patient had a delayed stent removal, and three weeks later she presented with dysphagia and vomiting in a follow-up appointment. Esophagogastroduodenoscopy (EGD) showed an esophageal stricture and a large gastroenteric fistula that was confirmed by imaging to be a fistula between the pylorus and proximal small bowel. The patient's symptoms improved gradually with conservative management, and imaging showed the resolution of the fistula and associated esophageal stricture. This case highlights the importance of timely stent removal (ideally within 6-8 weeks) and close follow-up with EGD and CT to detect and manage potential complications, while emphasizing the need for further research on optimal stent placement duration.
PubMed: 38196409
DOI: 10.7759/cureus.51143 -
Cureus Jan 2024A 78-year-old woman with a history of idiopathic thoracolumbar scoliosis presented with signs, symptoms, and imaging findings consistent with a gastric outlet...
A 78-year-old woman with a history of idiopathic thoracolumbar scoliosis presented with signs, symptoms, and imaging findings consistent with a gastric outlet obstruction secondary to the rib cage impinging on the pylorus of the stomach. She underwent an operative intervention and intra-operative findings were consistent with severe scoliosis with the right rib cage impinging on the pylorus, causing gastric outlet obstruction. A laparoscopic procedure was performed to pexy the greater curvature of the stomach to the left upper quadrant and a percutaneous endoscopic trans-gastric jejunostomy was inserted at the end. Thoracolumbar idiopathic scoliosis is a relatively benign common condition. However, with the increasing aging population and resultant higher incidence of progression to degenerative scoliosis, more patients are presenting with severe spinal and rib cage deformities that can cause rare intra-abdominal sequelae. We report the first case of a gastric outlet obstruction caused by the rib cage impinging on the pylorus in a patient with severe thoracolumbar scoliosis.
PubMed: 38187033
DOI: 10.7759/cureus.51753 -
Endoscopy May 2024Gastric peroral endoscopic myotomy (G-POEM) is a promising technique for treating refractory gastroparesis. We present the first double-blind randomized study comparing... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Gastric peroral endoscopic myotomy (G-POEM) is a promising technique for treating refractory gastroparesis. We present the first double-blind randomized study comparing the clinical efficacy of G-POEM versus pyloric botulinum toxin injection (BTI).
METHODS
This randomized study, conducted in two expert centers, enrolled patients with refractory gastroparesis, medically managed for >6 months and confirmed by gastric emptying scintigraphy (GES), into two groups, G-POEM versus BTI, with follow-up of 1 year. The primary end point was the 3-month clinical efficacy, defined as a >1-point decrease in the mean Gastroparesis Cardinal Symptom Index (GCSI) score. Secondary end points were: 1-year efficacy, GES evolution, adverse events, and quality of life.
RESULTS
40 patients (22 women; mean age 48.1 [SD 17.4]), with mean symptom duration of 5.8 (SD 5.7) years, were randomized. Etiologies included idiopathic (n=18), diabetes (n=11), postoperative (n=6), and mixed (n=4). G-POEM showed a higher 3-month clinical success than BTI (65% vs. 40%, respectively; =0.10), along with non-significantly higher 1-year clinical success (60% vs. 40%, respectively) on intention-to-treat analysis. The GCSI decreased in both groups at 3 months and 1 year. Only three minor adverse events occurred in the G-POEM group. The GES improvement rate was 72% in the G-POEM group versus 50% in the BTI group (non-significant).
CONCLUSION
G-POEM seems to have a higher clinically relevant success rate than BTI, but this was not statistically demonstrated. This study confirms the interest in treatments targeting the pylorus, either mechanically or chemically, for managing refractory gastroparesis.
Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Botulinum Toxins; Gastric Emptying; Gastroparesis; Gastroscopy; Injections; Pyloromyotomy; Pylorus; Quality of Life; Radionuclide Imaging; Treatment Outcome
PubMed: 38141620
DOI: 10.1055/a-2235-3286