LMA® protector™ in patients undergoing laparoscopic surgeries: a multicenter prospective observational study

Background Laryngeal masks airway (LMA) has been increasingly used in surgical patients. However, the use of LMA in laparoscopic surgeries remains controversial. The major concerns include the potential risk of esophageal regurgitation, aspiration, and difficulties to achieve effective ventilation. The aim of this study was to evaluate the safety and effectiveness of the LMA® Protector™ in patients undergoing laparoscopic surgery. Methods Patients aged 18 to 70 years, scheduled for laparoscopic surgeries were included. The insertion time, successful insertion rate, and oropharyngeal leak pressure were measured. Airway complications and airway manipulations during the procedure were documented. Effective ventilation rate was calculated. Visible bloodstains and reflux content in the drainage channel were documented after the removal of LMA® Protector™. Results Three hundred patients were enrolled. The insertion of LMA® Protector™ failed in seven patients resulting with a successful insertion rate of 97.7%. During the maintenance of anesthesia, airway manipulation was required in 19 patients (19/293, 6.48%), in three of whom the LMA was replaced with endotracheal intubation resulting with an effective ventilation rate of 96.7% (290/300). The oropharyngeal leak pressure was 30.18 ± 5.88 cmH2O. Seventy-five patients (25.86%) reported mild sore throat on the first day after surgery. Bloodstains on study devices were noticed in 58 patients (20%). Seventy-five patients (25.86%) reported mild sore throat on the first day after surgery. Gastric reflux was noticed in the drainage tube in 5 patients (1.72%) with no signs of aspiration in any of those patients. Conclusions The LMA® Protector™ was shown to be safe and effective in patients undergoing laparoscopic surgeries. Although minor complications that require no further treatment, no clinically diagnosed aspiration was noticed in our study. Gastric reflux was noticed in the drainage tube in five patients undergoing laparoscopic gynecology surgery. Further research is needed to verify whether LMA® Protector™ is suitable for procedures in Trendelenburg position or other situations that a high risk of gastroesophageal reflux exists. Trial registration The trial was registered at the Chinese Clinical Trial Registry (ChiCTR1800018300, date of registration: September 2018).

Gene Expression in Barrett’s Esophagus Cell Lines Resemble Esophageal Squamous Cell Carcinoma Instead of Esophageal Adenocarcinoma

Esophageal adenocarcinoma (EAC) is strongly associated with Barrett’s esophagus (BE), a pre-malignant condition resulting from gastric reflux. Esophageal squamous cell carcinoma (ESCC), the other major subtype of esophageal cancer, shows strong association with smoking and alcohol intake and no association with gastric reflux. In this study, we constructed and validated gene expression signatures of EAC vs. ESCC tumors using publicly available datasets, and subsequently assessed the enrichment levels of these signatures in commonly used EAC and ESCC cell lines, normal esophageal tissues and normal esophageal cell lines, and primary BE tissues and BE cell lines. We found that unlike ESCC cell lines which were quite similar to primary ESCC tumors, EAC cell lines were considerably different from primary EAC tumors but still more similar to EAC tumors than ESCC tumors, as the genes up in EAC vs. ESCC (EAChi) had considerably lower expression in EAC cell lines than EAC tumors. However, more surprisingly, unlike various normal cell lines (EPC2, Het-1A) which were very similar to various tissues from normal esophagus, BE cell lines (BAR-T, CP-A) were extremely different from primary BE tissues, as BE cell lines had substantially lower levels of EAChi and substantially higher levels of ESCChi gene expression. This ESCC-like profile of the BAR-T remained unaltered even after prolonged exposure to an acidic bile mixture in vitro resulting in malignant transformation of this cell line. However, primary BE tissues had EAC-like gene expression profiles as expected. Only one EAC case from the Cancer Genome Atlas resembled BE cell lines, and while it had the clinical profile and some mutational features of EAC, it had some mutational features, the copy number alteration profile, and the gene expression profile of ESCC instead. These incomprehensible changes in gene expression patterns may result in ambiguous changes in the phenotype and warrants careful evaluation to inform selection of appropriate in vitro tools for future studies on esophageal adenocarcinoma.

Effect of Pistacia atlantica on the elimination of Helicobacter pylori and improvement of gastric reflux in patients with chronic cough: A randomized clinical trial

Background: Pistacia atlantica (P. atlantica) has been associated with beneficial medical effects on gastrointestinal complications. Objective: It was intended to assess the effects of P. atlantica in elimination of Helicobacter pylori (H. pylori) infection and amelioration of gastric reflux and chronic cough. Methods: In this clinical trial study, 100 subjects with H. pylori infection who had the symptoms of gastric reflux and chronic cough were recruited and classified into two intervention and placebo groups, continuing 50 subjects each. The intervention group was administered two 500 mg doses of P. atlantica extract each day. The H. pylori antigen load in stool samples was evaluated using ELISA. The severity of cough and gastric re flux was also determined. Results: The subjects in two groups were age and sex matched and the baseline measurements were similar on the day 0. Nonetheless, it was observed that on the day 14, there was a significant reduction of H. pylori antigen load in the intervention group compared with the placebo group (P = 0.00021). Furthermore, the intensity of chronic cough was reduced significantly in the intervention group (P = 0.0014). The gastric reflux was improved in the intervention group at the end of the study. Conclusion: P. atlantica extract was beneficial in controlling H. pylori infection. It also improved the complications of the infection, like gastric reflux and chronic cough. Hence, it is highly recommended to value natural products, along with traditional antibiotics, in ameliorating H. pylori infection.

Causes of Duodeno-Gastric Reflux as a Surgical Problem

The author points to duodeno-gastric reflux as gastric precancer. In the overwhelming majority of patients, GHD is caused by compression of the lower-horizontal part of the duodenum by the superior mesenteric artery.

Pyloric atresia: authors’ clinical experience and literature review

Introduction. Congenital pyloric atresia is a rare malformation of the stomach outlet which amounts to about 1% of all atresias in the gastrointestinal tract. The gastric outlet atresia may be either isolated or combined with other abnormalities.Material and methods. There are few publications on the surgical treatment of pyloric atresia with extraluminal and intraluminal endoscopic interventions; however, at present information about it is not enough to assess their effectiveness and safety in young children. In literature, one can also find only few detailed reviews on clinical observations of pyloric atresia; most of which describe anatomical type I. Membranectomy and pyloroplasty are used for surgical treatment of pyloric atresia of type I. Surgery for pyloric atresias of types II and III which includes the resection in atresia zone and the formation of anastomosis between the stomach and duodenum causes complications due to the duodeno-gastric reflux in postoperative period. To prevent these complications, there is a surgical technique which was first described by A. Dessanti, et al. and later was modified and detailed by S. Yokoyama. This article is a literature overview on the topic and authors’ own experience in treating pyloric atresia of type II in 2 patients and of type I in one 1 patient.Conclusion. The choice of surgical approach depends on the anatomical type of pyloric atresia. Currently, there is no any unified approach to the surgical treatment of atresia of types II and III. Membranectomy and gastroduodenoanastomosis seem to be the most appropriate surgical techniques to correct this abnormality what has been confirmed by our preliminary findings.

Ehlers-Danlos Syndrome (EDS) : A Common and often Disregarded Cause of Serious Gastrointestinal Complications in Children and Adults

Ehlers-Danlos is a hereditary disease of the whole connective tissue initially described by dermatologists (Tscherchnogobov Moscow 1892, Ehlers, Copenhagen, 1900, Danlos, Paris, 1908). They emphasized the joint hyperlaxity and stretchiness of the skin which has long summed up the clinical expression of this entity. In recent decades, many other manifestations have been described and gradually identified, mainly by rheumatologists (Grahame, London, 1960). Several of them concern the digestive tract, mainly gastric reflux and constipation. They can be the cause of serious accidents: bronchial flooding by gastric reflux or aspiration, intestinal obstruction, hernial constriction, eventration, intestinal rupture, peritonitis of vesicular or appendicular origin, hemorrhages. It is important that gastroenterologists know how to link these manifestations to their etiology in order to adapt treatments, prevent iatrogenic accidents and direct the patients towards the treatment of other manifestations of Ehlers-Danlos disease. Nine clinical signs, including digestive manifestations, allow diagnosis by their significant grouping. The proof of hereditary origin is based on the identification of other identical cases in the family,, even if they are paucisymptomatic. A person affected by the disease systematically transmits the disease to all his children. We have verified this in all our patients.

Research methods of refined oil from peel calamondin (Citrus microcarpa) from Tien Giang Province, Vietnam

The research on extraction and refining of oil was conducted on the calamondin peels purchased in Thu Duc Market. Them originated from the province of Tien Giang in Viet Nam. The purpose of research evaluation of the quality of refined oil by refining methods such as deposition/filtration, crystallization - suctioning of oil, using Na2SO4 – filtering of oil, Na2SO4 - suctioning of oil, second extraction and combination all the above methods. The results showed that the initial moisture content of the material was 77.37%, and dry matter content was 8.46%. Extraction at optimum conditions is 60 minutes, 1/8 of raw material / solvent ratio (w / v), with fresh ingredients and raw material size is small at 1 ÷ 3.5 mm the highest oil content was obtained. The essential oil obtained contain a high content of Limonene (over 85%), which has been shown to be able to inhibit breast cancer, colorectal cancer, control heartburn and gastric reflux, and support the treatment of gallstones containing cholesterol.

Atypical Salmonellosis in a Horse: Implications for Hospital Safety

A 17-year-old Quarter Horse mare was evaluated for colic of 24-hour duration. Clinical signs and diagnostic evaluation were consistent with duodenitis-proximal jejunitis. The horse’s clinical condition deteriorated despite medical treatment and was euthanized. Aerobic culture collected from small intestinal ingesta was positive for Salmonella enterica subsp. enterica serovar Hadar. Salmonella sp. is commonly implicated in nosocomial infections in equine veterinary hospitals usually through feces containing the organism. Considering Salmonella sp. was cultured from the jejunal luminal contents and the large volume of nasogastric reflux that was evacuated in this case, a perceived risk of Salmonella sp. transmission from infected gastric reflux to other hospitalized cases was realized. Infectious agent biosecurity precautions should be undertaken in horses with nasogastric reflux to prevent hospital-acquired transmission.

Clinical and genetic feature sof duodenal ulcer

Purpose of the study. To evaluate the clinical and genetic picture of patients with duodenal ulcer.Materials and research methods. A total of 139 patients with duodenal ulcer were examined. Of these, hereditary predisposition groups (n = 102) and without it (n = 129) were selected, which were examined according to standards, including the analysis of polymorphic variants of IL8 genes (–251T>A; rs4073), IL10 (–627С> A; rs1800872), TNFA (–308G> A; rs1800629), the gene for antagonist to the IL1 receptor (IL1RN (VNTR); rs71941886)) by PCR, investigated the psychological status.Results. Patients with a genetic predisposition were found to have the first blood group, non-compliance with the diet, threshold resistance to stress, lack of family life, the presence of duodeno-gastric reflux, gross deformity of the bulb, increased acidity, men had more frequent night work, smoking, alcohol intake, medium-specific education. In patients, the rs1800872 * AA genotype and the rs1800872 * A allele of the IL10 gene (–627С> A; rs1800872) are markers of the development of duodenal ulcer.Conclusion. Conducting genetic studies of individuals along with clinical examinations contributes to an integrated approach in the management of individuals with duodenal ulcer.