scholarly journals Gastric Electrical Stimulation for Treatment of Refractory Gastroparesis: the Current Approach to Management

2021 ◽  
Vol 23 (2) ◽  
Author(s):  
Aaron Shanker ◽  
Mohammad Bashashati ◽  
Ali Rezaie
Keyword(s):  
Electrical Stimulation ◽  
Large Scale ◽  
Treatment Options ◽  
Current Approach ◽  
Gastric Electrical Stimulation ◽  
Effective Management ◽  
Treatment Pathway ◽  
Gastric Emptying Time ◽  
Cardinal Symptoms ◽  
The Impact

Abstract Purpose of Review Gastroparesis is one of the more challenging entities in the landscape of gastroenterology, posing difficulties for both patients and physicians with regard to effective management and therapies. In this article, we reviewed various gastroparesis treatment options, with an emphasis on gastric electrical stimulation (GES). Recent Findings GES has demonstrated a significant reduction of cardinal symptoms in refractory gastroparetic patients, particularly nausea and vomiting, across multiple studies. However, GES has not been shown to conclusively decrease gastric emptying time in these patients. Such finding has led the investigators to analyze the impact of combining GES with pyloroplasty. While this treatment pathway is nascent, its results thus far reveal an amplified improvement of gastroparesis symptomatology in addition to significant reduction of gastric transit, compared to GES by itself. Summary Limited treatment choices are available for refractory gastroparesis. Combining GES with pyloroplasty holds promise but requires further assessment in large-scale trials to fully evaluate the risks and benefits.

scholarly journals Gastric Electrical Stimulation with the Enterra System: A Systematic Review

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Nikhil Lal ◽  
Sam Livemore ◽  
Declan Dunne ◽  
Iftikhar Khan
Keyword(s):  
Systematic Review ◽  
Electrical Stimulation ◽  
Preoperative Assessment ◽  
Gastric Electrical Stimulation ◽  
Current Evidence ◽  
Cochrane Library ◽  
Symptom Improvement ◽  
System A ◽  
Gastric Emptying Time

Background. Gastric electrical stimulation (GES) is a surgically implanted treatment option for refractory gastroparesis.Aim. To systematically appraise the current evidence for the use of gastric electrical stimulation and suggest a method of standardisation of assessment and follow-up in these patients.Methods. A systematic review of PubMed, Web of Science, DISCOVER, and Cochrane Library was conducted using the keywords including gastric electrical stimulation, gastroparesis, nausea, and vomiting and neuromodulation, stomach, central nervous system, gastric pacing, electrical stimulation, and gastrointestinal.Results. 1139 potentially relevant articles were identified, of which 21 met the inclusion criteria and were included. The quality of studies was variable. There was a variation in outcome measures and follow-up methodology. Included studies suggested significant reductions in symptom severity reporting over the study period, but improvements in gastric emptying time were variable and rarely correlated with symptom improvement.Conclusion. The evidence in support of gastric electrical stimulation is limited and heterogeneous in quality. While current evidence has shown a degree of efficacy in these patients, high-quality, large clinical trials are needed to establish the efficacy of this therapy and to identify the patients for whom this therapy is inappropriate. A consensus view on essential preoperative assessment and postoperative measurement is needed.

scholarly journals Scalable analysis of multi-modal biomedical data

GigaScience ◽  
2021 ◽  
Vol 10 (9) ◽  
Author(s):  
Jaclyn Smith ◽  
Yao Shi ◽  
Michael Benedikt ◽  
Milos Nikolic
Keyword(s):  
Data Integration ◽  
Large Scale ◽  
Treatment Options ◽  
Complex Data ◽  
Biomedical Data ◽  
Data Types ◽  
Large Scale Data Processing ◽  
Scalable Analysis ◽  
Targeted Medicine ◽  
The Impact

Abstract Background Targeted diagnosis and treatment options are dependent on insights drawn from multi-modal analysis of large-scale biomedical datasets. Advances in genomics sequencing, image processing, and medical data management have supported data collection and management within medical institutions. These efforts have produced large-scale datasets and have enabled integrative analyses that provide a more thorough look of the impact of a disease on the underlying system. The integration of large-scale biomedical data commonly involves several complex data transformation steps, such as combining datasets to build feature vectors for learning analysis. Thus, scalable data integration solutions play a key role in the future of targeted medicine. Though large-scale data processing frameworks have shown promising performance for many domains, they fail to support scalable processing of complex datatypes. Solution To address these issues and achieve scalable processing of multi-modal biomedical data, we present TraNCE, a framework that automates the difficulties of designing distributed analyses with complex biomedical data types. Performance We outline research and clinical applications for the platform, including data integration support for building feature sets for classification. We show that the system is capable of outperforming the common alternative, based on “flattening” complex data structures, and runs efficiently when alternative approaches are unable to perform at all.

scholarly journals The Challenge of Informed Consent and Return of Results in Translational Genomics: Empirical Analysis and Recommendations

2014 ◽  
Vol 42 (3) ◽  
pp. 344-355 ◽  
Author(s):  
Gail E. Henderson ◽  
Susan M. Wolf ◽  
Kristine J. Kuczynski ◽  
Steven Joffe ◽  
Richard R. Sharp ◽  
...  
Keyword(s):  
Genome Sequencing ◽  
Large Scale ◽  
Treatment Options ◽  
Return Of Results ◽  
Clinical Settings ◽  
Exploratory Research ◽  
Whole Exome ◽  
National Human ◽  
Study Participants ◽  
The Impact

Large-scale sequencing tests, including whole-exome and whole-genome sequencing (WES/WGS), are rapidly moving into clinical use. Sequencing is already being used clinically to identify therapeutic opportunities for cancer patients who have run out of conventional treatment options, to help diagnose children with puzzling neurodevelopmental conditions, and to clarify appropriate drug choices and dosing in individuals. To evaluate and support clinical applications of these technologies, the National Human Genome Research Institute (NHGRI) and National Cancer Institute (NCI) have funded studies on clinical and research sequencing under the Clinical Sequencing Exploratory Research (CSER) program as well as studies on return of results (RoR). Most of these studies use sequencing in real-world clinical settings and collect data on both the application of sequencing and the impact of receiving genomic findings on study participants. They are occurring in the context of controversy over how to obtain consent for exome and genome sequencing.

Gastric peroral endoscopic pyloromyotomy versus gastric electrical stimulation in the treatment of refractory gastroparesis: a propensity score-matched analysis of long term outcomes

Endoscopy ◽  
2020 ◽  
Vol 52 (05) ◽  
pp. 349-358 ◽  
Author(s):  
Shanshan Shen ◽  
Hui Luo ◽  
Cicily Vachaparambil ◽  
Parit Mekaroonkamol ◽  
Mohamed M. Abdelfatah ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Propensity Score ◽  
Clinical Response ◽  
Propensity Score Matching ◽  
Treatment Options ◽  
Gastric Electrical Stimulation ◽  
Clinical Response Rate ◽  
Clinical Recurrence ◽  
Idiopathic Gastroparesis

Background Gastric peroral endoscopic pyloromyotomy (G-POEM) and gastric electrical stimulation (GES) have been reported as treatment options for refractory gastroparesis. In this study, we compared the long term clinical outcomes of G-POEM versus GES in the treatment of such patients. Methods We retrospectively evaluated 111 consecutive patients with refractory gastroparesis between January 2009 and August 2018. To overcome selection bias, we used propensity score matching (1:1) between G-POEM and GES treatment. The primary outcome was the duration of clinical response. Results After propensity score matching, 23 patients were included in each group. After a median follow-up of 27.7 months, G-POEM had a significantly better and longer clinical response than GES (hazard ratio [HR] for clinical recurrence 0.39, 95 % confidence interval [CI] 0.16 – 0.95; P = 0.04). The median duration of response was 25.4 months (95 %CI 8.7 – 42.0) in the GES group and was not reached in the G-POEM group. The Kaplan – Meier estimate of 24-month clinical response rate was 76.6 % with G-POEM vs. 53.7 % with GES. GES appeared to have little effect on idiopathic gastroparesis (HR for recurrence with G-POEM vs. GES 0.35, 95 %CI 0.13 – 0.95; P = 0.05). The incidence of adverse events was higher in the GES group (26.1 % vs. 4.3 %; P = 0.10). Conclusion Among patients with refractory gastroparesis, clinical response was better and lasted longer with G-POEM than with GES. The positive outcomes with G-POEM are likely to derive from the superior clinical response in patients with idiopathic gastroparesis. Further studies are needed to confirm these findings.

scholarly journals A derivation error that affects carbon balance models exists in the current implementation of the modified Arrhenius function

2020 ◽  
Author(s):  
Bridget Murphy ◽  
Joseph R. Stinziano
Keyword(s):  
Carbon Balance ◽  
Large Scale ◽  
Arrhenius Equation ◽  
Temperature Response ◽  
Carbon Fluxes ◽  
Current Approach ◽  
Carbon Gain ◽  
List Type ◽  
The Impact ◽  
Temperature Responses

SummaryUnderstanding biological temperature responses is crucial to predicting global carbon fluxes. The current approach to modelling temperature responses of photosynthetic capacity in large scale modelling efforts uses a modified Arrhenius equation.We rederived the modified Arrhenius equation from the source publication from 1942 and uncovered a missing term that was dropped by 2002. We compare fitted temperature response parameters between the correct and incorrect derivation of the modified Arrhenius equation.We find that most parameters are minimally affected, though activation energy is impacted quite substantially. We then scaled the impact of these small errors to whole plant carbon balance and found that the impact of the rederivation of the modified Arrhenius equation on modelled daily carbon gain causes a meaningful deviation of ~18% day−1.This suggests that the error in the derivation of the modified Arrhenius equation has impacted the accuracy of predictions of carbon fluxes at larger scales since >40% of Earth System Models contain the erroneous derivation. We recommend that the derivation error be corrected in modelling efforts moving forward.

scholarly journals Scalable Analysis of Multi-Modal Biomedical Data

2020 ◽  
Author(s):  
Jaclyn M Smith ◽  
Yao Shi ◽  
Michael Benedikt ◽  
Milos Nikolic
Keyword(s):  
Data Integration ◽  
Large Scale ◽  
Treatment Options ◽  
Complex Data ◽  
Biomedical Data ◽  
Data Types ◽  
Large Scale Data Processing ◽  
Scalable Analysis ◽  
Targeted Medicine ◽  
The Impact

Targeted diagnosis and treatment options are dependent on insights drawn from multi-modal analysis of large-scale biomedical datasets. Advances in genomics sequencing, image processing, and medical data management have supported data collection and management within medical institutions. These efforts have produced large-scale datasets and have enabled integrative analyses that provide a more thorough look of the impact of a disease on the underlying system. The integration of large-scale biomedical data commonly involves several complex data transformation steps, such as combining datasets to build feature vectors for learning analysis. Thus, scalable data integration solutions play a key role in the future of targeted medicine. Though large-scale data processing frameworks have shown promising performance for many domains, they fail to support scalable processing of complex datatypes. To address these issues and achieve scalable processing of multi-modal biomedical data, we present TraNCE, a framework that automates the difficulties of designing distributed analyses with complex biomedical data types. We outline research and clinical applications for the platform, including data integration support for building feature sets for classification. We show that the system is capable of outperforming the common alternative, based on flattening complex data structures, and runs efficiently when alternative approaches are unable to perform at all.

scholarly journals Gastric Electrical Stimulation Increases The Proliferation of Interstitial Cells of Cajal and Alters Enteric Nervous System in Diabetic Rats

2020 ◽  
Author(s):  
Cai Wang ◽  
Hui Zhang ◽  
Le Zhao ◽  
Tao Gao ◽  
Xia Liu ◽  
...  
Keyword(s):  
Nervous System ◽  
Electrical Stimulation ◽  
Enteric Nervous System ◽  
Interstitial Cells Of Cajal ◽  
Interstitial Cells ◽  
Diabetic Rats ◽  
Gastric Electrical Stimulation ◽  
Enteric Neurons ◽  
Cells Of Cajal ◽  
The Impact

Abstract Background: Lack of interstitial cells of Cajal (ICC) and neuropathy were the most possible pathological mechanisms of diabetic gastroparesis. Gastric electrical stimulation (GES) is a promising way to treat gastroparesis. The aims of the present study were to explore the impact of GES on ICC together with enteric neurons in diabetic rats and the possible mechanisms involved.Methods: Sixty rats were randomized into the normal rats, diabetic rats (DM), diabetic rats with sham GES (DM+SGES), and three diabetic rats with GES (DM+GES1, DM+GES2 and DM+GES3). The proliferation of ICC and expressions of 5-HT2B, nNOS, CHAT, PGP9.5 and GDNF were evaluated by immunofluorescence staining or Western blot. The expressions of 5-HT in blood and tissue were determined by ELISA.Results: (1) The proliferation of ICC was hardly observed in the DM group together with the DM+SGES group but increased in the three DM+GES groups. (2) The expression of 5-HT2B was decreased in the DM group and enhanced in the DM+GES groups. Similarly, the expressions of 5-HT in the blood and distal stomach tissue were increased in the DM+GES groups. (3) Both nNOS labeled neurons and CHAT positive neurons were reduced in myenteric plexus of the DM group, while plenty of these neurons were observed the DM+GES groups. (4) The expression of GDNF protein in the diabetic rats was down-regulated, while GES increased the expression of GDNF.Conclusion: GES improves the proliferation of ICC possibly related with 5-HT/5-HT2B signal pathway, and alters enteric nervous system 52 partly though the GDNF expression.

Surgery for Lung Cancer and the Consequences for the Swallow

2016 ◽  
Vol 1 (13) ◽  
pp. 162-168
Author(s):  
Pippa Hales ◽  
Corinne Mossey-Gaston
Keyword(s):  
Lung Cancer ◽  
Treatment Options ◽  
Vocal Cord Palsy ◽  
Subsequent Treatment ◽  
Physiological Reserve ◽  
Palliative Phase ◽  
And Function ◽  
The Impact ◽  
Swallow Function

Lung cancer is one of the most commonly diagnosed cancers across Northern America and Europe. Treatment options offered are dependent on the type of cancer, the location of the tumor, the staging, and the overall health of the person. When surgery for lung cancer is offered, difficulty swallowing is a potential complication that can have several influencing factors. Surgical interaction with the recurrent laryngeal nerve (RLN) can lead to unilateral vocal cord palsy, altering swallow function and safety. Understanding whether the RLN has been preserved, damaged, or sacrificed is integral to understanding the effect on the swallow and the subsequent treatment options available. There is also the risk of post-surgical reduction of physiological reserve, which can reduce the strength and function of the swallow in addition to any surgery specific complications. As lung cancer has a limited prognosis, the clinician must also factor in the palliative phase, as this can further increase the burden of an already compromised swallow. By understanding the surgery and the implications this may have for the swallow, there is the potential to reduce the impact of post-surgical complications and so improve quality of life (QOL) for people with lung cancer.

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