499 SUSTAINED ESOPHAGEAL CONTRACTIONS (SEC) BY FLIP PROVIDES ADDITIONAL CHARACTERISTICS ON ESOPHAGEAL DYSMOTILITY IN PATIENTS WITH ESOPHAGEAL SYMPTOMS

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
A Nguyen ◽  
J Zhang ◽  
S Harris ◽  
E Podgaetz ◽  
M Ward ◽  
...  
Keyword(s):  
Real Time ◽  
Clinical Symptoms ◽  
Retrospective Chart Review ◽  
Symptom Improvement ◽  
Esophageal Diseases ◽  
Impedance Planimetry ◽  
High Resolution Manometry ◽  
Eckardt Score ◽  
Type Iii Achalasia ◽  
Smooth Muscle Contractions

Abstract   Sustained esophageal contractions (SEC) have previously been described on high frequency esophageal ultrasound, high resolution manometry (HRM), and more recently on real time impedance planimetry with functional lumen imaging probe (FLIP). SEC may demonstrate a discoordination between circular and longitudinal esophageal smooth muscle contractions. The aim of this study was to determine the clinical characterization of SEC as detected on FLIP compared to HRM. Methods We performed a retrospective chart review of patients who underwent both FLIP and HRM at our Center for Esophageal Diseases between May 2017 and November 2019. FLIP endoscopic reports were reviewed for the presence of SECs which were defined as vigorous lumen closure ≥5 seconds at the LES or esophageal body as noted by the endoscopist during the real time FLIP examination of a sedated endoscopy. Primary variables recorded included EGJ distensibility index (EGJ-DI), diameter, and the presence of SECs at the 40 mL and 60 mL fill volumes. HRM diagnosis, clinical symptoms and outcomes were also reviewed. Results Of 165 patients who underwent HRM and FLIP imaging, 64 patients (mean age 53.7 years, 20 male) with SECs were included in the study. Among these patients, HRM demonstrated a wide variety of motility disorders (Figure 1). 40% of those with EGJOO, Type II or Type III achalasia, and all patients with jackhammer esophagus had SECs on FLIP imaging. Of 56 patients with normal motility or IEM, 22 had SECs, and 18 patients underwent an endoscopic intervention. Among those who had an intervention, 11 (61%) reported improvement in symptoms with improvement in Eckardt score from 4.9 to 3.9. Conclusion SECs are frequently present in hypercontractile esophageal disorders. Interestingly, 39% of patients with normal motility or IEM have SECs noted on FLIP, and 82% of these patients had an intervention performed based on FLIP findings with 61% reporting symptom improvement. Overall, 19% of patients with normal motility or IEM improved due to interventions performed based on SECs found on FLIP. Detection of SEC during FLIP imaging can guide treatment aimed at relaxation of esophageal muscles.

505 SURPRISING LACK OF CORRELATION BETWEEN INTEGRATED RELAXATION PRESSURE LEVEL AND SYMPTOM SEVERITY IN PATIENTS WITH ACHALASIA

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
A Nguyen ◽  
J Zhang ◽  
M Ward ◽  
E Podgaetz ◽  
S Leeds ◽  
...  
Keyword(s):  
Weight Loss ◽  
Chest Pain ◽  
Symptom Severity ◽  
Individual Component ◽  
Pearson Correlation ◽  
Esophageal Diseases ◽  
High Resolution Manometry ◽  
Eckardt Score ◽  
Integrated Relaxation Pressure ◽  
The Relationship

Abstract   With high resolution manometry (HRM), achalasia is defined as an elevated integrated relaxation pressure (IRP) and the absence of normal esophageal peristalsis. Since achalasia symptoms are attributed in part to incomplete LES relaxation, IRP values might be expected to directly correlate with symptom severity. The aim of this study was to evaluate the relationship between IRP values and symptom severity assessed by the Eckardt score in patients with achalasia. Methods We searched the database of our Center for Esophageal Diseases for patients who had HRM showing achalasia (IRP > 15 mmHg and absent peristalsis) between May 2017 and August 2019. All patients with achalasia seen in our Center routinely complete the Eckardt score questionnaire evaluating the severity of achalasia symptoms in each of four categories (dysphagia, chest pain, regurgitation and weight loss). Pearson correlation coefficient was used to assess the relationship between median IRP and Eckardt score; an R2 value >0.5 was considered clinically meaningful. Results We identified 91 subjects with achalasia (mean age 62.9 ± 16.5 years; 39 men, 52 women; 27 Type 1, 28 Type 2, 36 Type 3). We found no clinically meaningful correlation between median IRP and the total Eckardt score (R2 = 0.043) (Figure 1). Furthermore, we found no clinically meaningful correlation between median IRP and any individual component of the Eckardt score (dysphagia R2 = 0.008, chest pain R2 = 0.001, regurgitation R2 = 0.035, weight loss R2 = 0.049). Finally, in subgroup analyses we found no clinically meaningful correlation between median IRP and Eckardt scores (total or any of its individual components) for any of the 3 achalasia subtypes. Conclusion We found no clinically meaningful correlation between IRP and total Eckardt score, or between IRP and any individual component of the Eckardt score for patients with achalasia of any type. This suggests that once the IRP value exceeds 15 mmHg, further elevations in IRP have little effect on symptoms, and that factors other than IRP such as esophageal body dysmotility and hypersensitivity might contribute to symptom perception in achalasia.

Is integrated relaxation pressure a promising predictor of effectiveness of peroral endoscopic myotomy for achalasia?

2017 ◽  
Vol 56 (02) ◽  
pp. 111-116
Author(s):  
Hong Jin ◽  
Wei Zhao ◽  
Lili Zhang ◽  
Zhongqing Zheng ◽  
Tao Wang ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Peroral Endoscopic Myotomy ◽  
Symptom Improvement ◽  
Symptom Duration ◽  
Type I ◽  
Type Ii ◽  
Eckardt Score ◽  
Endoscopic Myotomy ◽  
Integrated Relaxation Pressure

Abstract Background Peroral endoscopic myotomy (POEM), first introduced in 2010, appears to be an effective therapy with few complications. This study aimed to find an optimal predictor of POEM outcome in achalasia. Methods We retrospectively assessed 89 patients diagnosed with achalasia who underwent POEM in General Hospital of Tianjin Medical University, from September 2012 to March 2015. Associations of Eckardt score with symptom duration, lower esophageal resting pressure, 4-second integrated relaxation pressure (4s-IRP), and maximum esophageal diameter were assessed before POEM. The most relevant data were progressively grouped to compare symptom improvement after POEM in 85 patients at 1 year follow-up. Results The most significant correlation was found between 4s-IRP and Eckardt score (p < 0.01). The 85 achalasia patients (1-year follow-up after POEM) were divided into 3 groups according to 4s-IRP values; patients with mean 4s-IRP of 25 – 34 mmHg exhibited significantly greater improvement of clinical symptoms compared with the remaining 2 groups (p < 0.05). No significant postoperative difference was noted between types I and II in all patients according to Chicago classification criteria. The 40 patients with 4s-IRP of 25 – 34 mmHg were further divided into 2 subgroups; the 28 patients with type II achalasia responded better to POEM than the 12 with type I disease (p < 0.05). Conclusions 4s-IRP, together with achalasia subtypes, may predict treatment outcome after POEM. Patients with type II achalasia and 4s-IRP of 25 – 34 mmHg may experience more satisfactory remission after POEM.

scholarly journals Impedance planimetry values for predicting clinical response following peroral endoscopic myotomy

Endoscopy ◽  
2020 ◽  
Author(s):  
Robert A. Moran ◽  
Olaya I. Brewer Gutierrez ◽  
Burkhard Rahden ◽  
Kenneth Chang ◽  
Michael Ujiki ◽  
...  
Keyword(s):  
Clinical Response ◽  
Predictive Ability ◽  
Peroral Endoscopic Myotomy ◽  
Predictive Capacity ◽  
Multicenter Cohort Study ◽  
Cross Sectional ◽  
Impedance Planimetry ◽  
Percent Change ◽  
Eckardt Score ◽  
Endoscopic Myotomy

Abstract Background There is growing interest in developing impedance planimetry as a tool to enhance the clinical outcomes for endoscopic and surgical management of achalasia. The primary aim of this study was to determine whether impedance planimetry measurements can predict clinical response and reflux following peroral endoscopic myotomy (POEM). Methods A multicenter cohort study of patients with achalasia undergoing POEM was established from prospective databases and retrospective chart reviews. Patients who underwent impedance planimetry before and after POEM were included. Clinical response was defined as an Eckardt score of ≤ 3. Tenfold cross-validated area under curve (AUC) values were established for the different impedance planimetry measurements associated with clinical response and reflux development. Results Of the 290 patients included, 91.7 % (266/290) had a clinical response and 39.4 % (108/274) developed reflux following POEM. The most predictive impedance planimetry measurements for a clinical response were: percent change in cross-sectional area (%ΔCSA) and percent change in distensibility index (%ΔDI), with AUCs of 0.75 and 0.73, respectively. Optimal cutoff values for %ΔCSA and %ΔDI to determine a clinical response were a change of 360 % and 272 %, respectively. Impedance planimetry values were much poorer at predicting post-POEM reflux, with AUCs ranging from 0.40 to 0.62. Conclusion Percent change in CSA and distensibility index were the most predictive measures of a clinical response, with a moderate predictive ability. Impedance planimetry values for predicting reflux following POEM showed weak predictive capacity.

scholarly journals To hydrate or not to hydrate? The effect of hydration on survival, symptoms and quality of dying among terminally ill cancer patients

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Chien-Yi Wu ◽  
Ping-Jen Chen ◽  
Tzu-Lin Ho ◽  
Wen-Yuan Lin ◽  
Shao-Yi Cheng
Keyword(s):  
Cancer Patients ◽  
Proportional Hazards Model ◽  
Clinical Symptoms ◽  
Terminally Ill ◽  
Good Death ◽  
Artificial Nutrition ◽  
Symptom Improvement ◽  
Terminally Ill Cancer Patients ◽  
Quality Of Dying

Abstract Background Artificial nutrition and hydration do not prolong survival or improve clinical symptoms of terminally ill cancer patients. Nonetheless, little is known about the effect of artificial hydration (AH) alone on patients’ survival, symptoms or quality of dying. This study explored the relationship between AH and survival, symptoms and quality of dying among terminally ill cancer patients. Methods A pilot prospective, observational study was conducted in the palliative care units of three tertiary hospitals in Taiwan between October 2016 and December 2017. A total of 100 patients were included and classified into the hydration and non-hydration group using 400 mL of fluid per day as the cut-off point. The quality of dying was measured by the Good Death Scale (GDS). Multivariate analyses using Cox’s proportional hazards model were used to assess the survival status of patients, the Wilcoxon rank-sum test for within-group analyses and the Mann-Whitney U test for between-groups analyses to evaluate changes in symptoms between day 0 and 7 in both groups. Logistic regression analysis was used to assess the predictors of a good death. Results There were no differences in survival (p = 0.337) or symptom improvement between the hydration and non-hydration group, however, patients with AH had higher GDS scores. Conclusions AH did not prolong survival nor significantly improve dehydration symptoms of terminally ill cancer patients but it may influence the quality of dying. Communication with patients and their families on the effect of AH may help them better prepared for the end-of-life experience.

Diagnosis of neuroschistosomiasis by antibody specificity index and semi-quantitative real-time PCR from cerebrospinal fluid and serum

2014 ◽  
Vol 63 (2) ◽  
pp. 309-312 ◽  
Author(s):  
Georg Härter ◽  
Hagen Frickmann ◽  
Sebastian Zenk ◽  
Dominic Wichmann ◽  
Bettina Ammann ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Real Time ◽  
Real Time Pcr ◽  
Clinical Symptoms ◽  
Diagnostic Procedures ◽  
Lower Limbs ◽  
Antibody Specificity ◽  
Quantitative Real Time Pcr ◽  
Specific Antibodies ◽  
Routine Diagnosis

We describe the case of a 16-year-old German male expatriate from Ghana who presented with obstipation, dysuria, dysaesthesia of the gluteal region and the lower limbs, bilateral plantar hypaesthesia and paraesthesia without pareses. A serum–cerebrospinal fluid (CSF) Schistosoma spp. specific antibody specificity index of 3.1 was considered highly suggestive of intrathecal synthesis of anti-Schistosoma spp. specific antibodies, although standardization of this procedure has not previously been described. Diagnosis was confirmed by detection of Schistosoma DNA in CSF by semi-quantitative real-time PCR at 100-fold concentration compared with serum. Accordingly the two diagnostic procedures, which have not previously been applied for routine diagnosis, appear to be useful for the diagnosis of neuroschistosomiasis. Clinical symptoms resolved following anthelmintic and anti-inflammatory therapy.

Long-term outcomes in patients with schizophrenia treated with risperidone long-acting injection or oral antipsychotics in Spain: Results from the electronic Schizophrenia Treatment Adherence Registry (e-STAR)

2009 ◽  
Vol 24 (5) ◽  
pp. 287-296 ◽  
Author(s):  
J.M. Olivares ◽  
A. Rodriguez-Morales ◽  
J. Diels ◽  
M. Povey ◽  
A. Jacobs ◽  
...  
Keyword(s):  
Observational Study ◽  
Treatment Adherence ◽  
Prospective Observational Study ◽  
Clinical Symptoms ◽  
Retrospective Chart Review ◽  
Treatment Retention ◽  
Severity Scores ◽  
Long Term Treatment ◽  
Long Acting

AbstractBackgroundThe electronic Schizophrenia Treatment Adherence Registry (e-STAR) is a prospective, observational study of patients with schizophrenia designed to evaluate long-term treatment outcomes in routine clinical practice.MethodsParameters were assessed at baseline and at 3 month intervals for 2 years in patients initiated on risperidone long-acting injection (RLAI) (n = 1345) or a new oral antipsychotic (AP) (n = 277; 35.7% and 36.5% on risperidone and olanzapine, respectively) in Spain. Hospitalization prior to therapy was assessed by a retrospective chart review.ResultsAt 24 months, treatment retention (81.8% for RLAI versus 63.4% for oral APs, p < 0.0001) and reduction in Clinical Global Impression Severity scores (−1.14 for RLAI versus −0.94 for APs, p = 0.0165) were significantly higher with RLAI. Compared to the pre-switch period, RLAI patients had greater reductions in the number (reduction of 0.37 stays per patient versus 0.2, p < 0.05) and days (18.74 versus 13.02, p < 0.01) of hospitalizations at 24 months than oral AP patients.ConclusionsThis 2 year, prospective, observational study showed that, compared to oral antipsychotics, RLAI was associated with better treatment retention, greater improvement in clinical symptoms and functioning, and greater reduction in hospital stays and days in hospital in patients with schizophrenia. Improved treatment adherence, increased efficacy and reduced hospitalization with RLAI offer the opportunity of substantial therapeutic improvement in schizophrenia.

scholarly journals 440. Clinical Characteristics of Early Noncritical Hospitalized Patients with Coronavirus Disease 2019 (COVID-19): A Single-Center Retrospective Study in New York City

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S287-S288
Author(s):  
Michelle Lee ◽  
Mona Fayad ◽  
Tarub Mabud ◽  
Paulino Tallon de Lara ◽  
Adiac Espinosa Hernandez ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
York City ◽  
Clinical Laboratory ◽  
Clinical Symptoms ◽  
New York State ◽  
General Medicine ◽  
Retrospective Chart Review ◽  
Clinical Severity ◽  
Study Cohort

Abstract Background COVID-19 first originated in Wuhan, China, in December 2019. As of April 9, 2020, New York State had become the single largest global epicenter of COVID-19. Methods This is a retrospective chart review of the first 33 patients with RT-PCR-confirmed COVID-19 admitted from the emergency department to a general medicine unit in a single academic hospital in New York City between March 11th to March 27th, 2020. Patient’s demographic, clinical, laboratory, radiographic investigations, treatments and clinical outcomes were retrospectively extracted from the electronic medical record and followed until April 10th, 2020. Patients were divided into severe and nonsevere sub-cohorts. Statistics were descriptive in nature. Results The study cohort (median age 68 yr, 67% male) presented with subjective fevers (82%), cough (88%), and dyspnea (76%). The median incubation period was 3 days. Most cases met SIRS criteria upon admission (76%). Patients had elevated inflammatory markers. Patients were treated with antimicrobials, corticosteroids, hydroxychloroquine, and varying levels of supplemental oxygen. Mortality was 15% and 18% of the cohort required intensive care services. Conclusion Patient age, presenting clinical symptoms, comorbidity profile, laboratory biomarkers, and radiographic features are consistent with findings published from China. Severe patients had peaks in inflammatory biomarkers later in the hospitalization, which may be useful to trend. Further studies are necessary to create guidelines to better risk-stratify COVID-19 patients based on clinical severity. Disclosures All Authors: No reported disclosures

scholarly journals 0439 Nonlinear Dynamics Forecasting for Personalize Prognosis of Obstructive Sleep Apnea Onsets

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A168-A169
Author(s):  
T Le
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Real Time ◽  
Dirichlet Process ◽  
Clinical Symptoms ◽  
Risk Indicators ◽  
Dirichlet Process Mixture ◽  
Obstructive Sleep ◽  
Estimated Risk ◽  
Normal States

Abstract Introduction The emphasis on disease prevention, early detection, and preventive treatments will revolutionize the way sleep clinicians evaluate their patients. Obstructive Sleep Apnea (OSA) is one of the most prevalent sleep disorders with approximately 100 millions patients been diagnosed worldwide. The effectiveness of sleep disorder therapies can be enhanced by providing personalized and real-time prediction of OSA episode onsets. Previous attempts at OSA prediction are limited to capturing the nonlinear, nonstationary dynamics of the underlying physiological processes. Methods This paper reports an investigation into heart rate dynamics aiming to predict in real time the onsets of OSA episode before the clinical symptoms appear. The method includes (a) a representation of a transition state space network to characterize dynamic transition of apneic states (b) a Dirichlet-Process Mixture-Gaussian-Process prognostic method for estimating the distribution of the time estimate the remaining time until the onset of an impending OSA episode by considering the stochastic evolution of the normal states to an anomalous (apnea) Results The approach was tested using three datasets including (1) 20 records from 14 OSA subjects in benchmark ECG apnea databases (Physionet.org), (2) records of eight subjects from previous work. The average prediction accuracy (R2) is reported as 0.75%, with 87% of observations within the 95% confidence interval. Estimated risk indicators at 1 to 3 min till apnea onset are reported as 85.8 %, 80.2 %, and 75.5 %, respectively. Conclusion The present prognosis approach can be integrated with wearable devices to facilitate individualized treatments and timely prevention therapies. Support N/A

scholarly journals Determinants of Real-Time fMRI Neurofeedback Performance and Improvement – a Machine Learning Mega-Analysis

2020 ◽  
Author(s):  
Amelie Haugg ◽  
Fabian M. Renz ◽  
Andrew A. Nicholson ◽  
Cindy Lor ◽  
Sebastian J. Götzendorfer ◽  
...  
Keyword(s):  
Machine Learning ◽  
Real Time ◽  
Clinical Symptoms ◽  
Gain Control ◽  
Region Of Interest ◽  
Open Science ◽  
Imagery Task ◽  
Neurofeedback Training ◽  
Brain Signals ◽  
Healthy Participants

AbstractReal-time fMRI neurofeedback is an increasingly popular neuroimaging technique that allows an individual to gain control over his/her own brain signals, which can lead to improvements in behavior in healthy participants as well as to improvements of clinical symptoms in patient populations. However, a considerably large ratio of participants undergoing neurofeedback training do not learn to control their own brain signals and, consequently, do not benefit from neurofeedback interventions, which limits clinical efficacy of neurofeedback interventions. As neurofeedback success varies between studies and participants, it is important to identify factors that might influence neurofeedback success. Here, for the first time, we employed a big data machine learning approach to investigate the influence of 20 different design-specific (e.g. activity vs. connectivity feedback), region of interest-specific (e.g. cortical vs. subcortical) and subject-specific factors (e.g. age) on neurofeedback performance and improvement in 608 participants from 28 independent experiments.With a classification accuracy of 60% (considerably different from chance level), we identified two factors that significantly influenced neurofeedback performance: Both the inclusion of a pre-training no-feedback run before neurofeedback training and neurofeedback training of patients as compared to healthy participants were associated with better neurofeedback performance. The positive effect of pre-training no-feedback runs on neurofeedback performance might be due to the familiarization of participants with the neurofeedback setup and the mental imagery task before neurofeedback training runs. Better performance of patients as compared to healthy participants might be driven by higher motivation of patients, higher ranges for the regulation of dysfunctional brain signals, or a more extensive piloting of clinical experimental paradigms. Due to the large heterogeneity of our dataset, these findings likely generalize across neurofeedback studies, thus providing guidance for designing more efficient neurofeedback studies specifically for improving clinical neurofeedback-based interventions. To facilitate the development of data-driven recommendations for specific design details and subpopulations the field would benefit from stronger engagement in Open Science and data sharing.

scholarly journals Outcomes in treatment-resistant schizophrenia: symptoms, function and clozapine plasma concentrations

2021 ◽  
Vol 11 ◽  
pp. 204512532110371
Author(s):  
Amir Krivoy ◽  
Eromona Whiskey ◽  
Henrietta Webb-Wilson ◽  
Dan Joyce ◽  
Derek K. Tracy ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Clinical Symptom ◽  
Clinical Improvement ◽  
Clinical Symptoms ◽  
Peak Plasma ◽  
Plasma Concentrations ◽  
Symptom Improvement ◽  
Blood Concentrations ◽  
Treatment Refractory ◽  
The Relationship

Background: Clozapine is the only medication licenced for treating patients with treatment-refractory schizophrenia. However, there are no evidence-based guidelines as to the optimal plasma level of clozapine to aim for, and their association with clinical and functional outcome. Objective: We assessed the relationship between clinical and functional outcome measures and blood concentrations of clozapine among patients with treatment-refractory psychosis. Methods: Data were reviewed in 82 patients with treatment-refractory psychosis admitted to a specialised tertiary-level service and treated with clozapine. Analysis focussed on the relationship between clozapine and norclozapine plasma concentrations and the patient’s clinical symptoms and functional status. Results: Clinical symptom improvement was positively correlated with norclozapine plasma concentrations and inversely correlated with clozapine to norclozapine plasma concentrations ratio. Clozapine concentrations showed a bimodal association with clinical improvement (peaks around 350 and 660 ng/ml). Clinical symptom improvement correlated with functional outcomes, although there was no significant correlation between the latter and clozapine or norclozapine plasma concentrations. Conclusion: Clozapine treatment was associated with optimal clinical improvement at two different peak plasma concentrations around 350 and 650 ng/ml. Clinical improvement was associated with functional outcome; however, functionality was not directly associated with clozapine concentrations. A subset of patients may require higher clozapine plasma concentrations to achieve clinical improvement.

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