Is barium esophagram enough? Comparison of esophageal motility found on barium esophagram to high resolution manometry

BackgroundThe aim of the study is to determine if barium esophagram (BE) alone is sufficient to diagnose esophageal dysmotility when compared to the gold standard, high-resolution manometry (HRM).MethodsThis is a retrospective review of patients that underwent laparoscopic fundoplication by two surgeons at a single institution from 10/1/2015-6/29/2019. Patients with large paraesophageal hernias and patients without both BE and HRM were excluded.ResultsForty-six patients met the inclusion criteria. BE was found to be concordant with HRM for esophageal motility in only 21 patients (46%). Setting HRM as the gold standard, BE had a sensitivity of 14% (95% CI: 5%–35%), specificity of 72% (95% CI: 52%–86%), PPV of 30% (95% CI: 11%–60%), and NPV of 50% (95% CI: 35%–66%). The accuracy was 46%, while a McNemar test showed p = 0.028.ConclusionTraditional BE should not be used in place of HRM for assessing pre-operative motility in patients undergoing anti-reflux surgery.     

Treatment of spermagglutination with proteolytic enzymes. I. Sperm motility, vitality, longevity and successful disagglutination

The treatment of antibody-mediated spermagglutination by corticosteroidtherapy has a high incidence of side-effects and sperm washingis often followed by re-agglutination. The possibility of enzymaticdisagglutination was therefore investigated. In the first partof the study the effects of four proteases on sperm motility,vitality and longevity were evaluated. Subtilisin had prohibitivelydetrimental effects even at 10 U/ml. However, chymotrypsin (500U/ml), trypsin (500 U/ml) and papain (50 U/ml) had no adverseeffects. In the second series of experiments one or more ofthese latter three enzymes was found to disagglutinate spermatozoawhich had previously been incubated with sperm-agglutinatingantibody-positive sera in 87% of cases. Although further investigationis required, enzymatic disagglutination may be beneficial forthe treatment of immunologically mediated spermagglutination.     

摄入水温度对儿童胃动力的影响

目的　研究温度对小儿胃动力的影响 .方法　健康儿童 40例 ,随机分为温水组及冷水组 ,每组 2 0例 ,温水组平均年龄为 8.8岁 ,冷水组 10 .5岁 ,两组摄入水的温度分别为37～ 40℃和 4～ 6℃ ,每例饮水 30 0 m L,在 B超下观察两组不同时间点的胃运动及排空情况 .结果　 6 0 min时胃体蠕动频率以温水组 (2 .8± 0 .7)次· min- 1 快于冷水组 (1.5± 0 .5 )次· min- 1 ,但冷水组 90 %及 10 0 %胃腔排空时间明显短于温水组 ,分别为 (19.1± 3.1与 31.9± 7.1)和 (5 2 .5± 3.7与 5 9.5± 3.0 ) min.两组 10 % ,5 0 % ,90 %及 10 0 %胃窦排空时间分别为 (0 .8± 0 .8与 2 .8± 0 .3) ,(4 .5± 3.8与 17.4± 0 .4) ,(17.2± 2 .2与 41.7± 1.8)和 (4 9.2± 3.8与 5 6 .4± 3.6 ) min,冷水组均明显短于温水组 ,胃腔与胃窦残留率与上述结果完全相符 .结论　冷饮可使胃排空加速 ,频繁饮用低温饮料可能干扰胃的正常运动节律 .     

良性上消化道疾病的食管动力学变化

目的：探讨良性上消化道疾病患者食管动力学的变化情况。方法：对３２例良性上消化道疾病患者进行食管测压检查。结果：３４．３８％的病例ＬＥＳＰ减低,８７．５％出现吞咽后同不收缩,５３．１３％出现自发性同步收缩,２８．１３％正常需动收缩完全消失,５０％出现远端食管平均收缩压力减低,５６．２５％出现远端食管低压收缩。结论：本组病例多有远端食管运动功能障碍,以吞咽后同步收缩为主,其与反流性食管炎以及一些临床症     

安胃降逆饮对大鼠胃功能的影响

目的 观察安胃降逆饮对胃功能的影响,分析其镇吐作用机制。方法 采用大鼠离体胃条法测定胃条张力,小鼠粉红排空试验法测定胃排空量和０．１ｍｏｌ／Ｌ ＮａＯＨ滴定法测定胃酸含量。结果安胃降逆饮对大鼠胃肌物基础张力和乙酰胆碱引起的痉挛性收缩有明显抑制作用（Ｐ〈０．０１）,对小鼠胃排空,大鼠胃液量,胃液酸度及总酸度无明显影响（Ｐ〉０．０５）。结论 安胃降逆饮的镇吐作用至少部分是通过抑制胃肠平滑肌蠕动而发挥作     

Gastric Bypass Distal Roux-en-Y Jejunal Interposition with Selective Proximal Vagotomy and Posterior Truncal Vagotomy

Selective proximal vagotomy and posterior truncal vagotomy have been performed in 71 consecutive gastric bypass (GBP) patients from June 1991 to December 1992. Vagotomy was used to prevent or diminish the incidence of marginal ulcer in GBP patients. Anterior and posterior highly selective proximal vagotomy with circular-instrument stapled gastrojejunostomy in patients undergoing GBP distal Roux-en-Y with jejunal interposition had no marginal ulcer complications (minimal follow-up 18 months).     

Velocity of peristaltic propagation in distal esophageal segments

Recent studies of the peristaltic pressure wave have suggested the presence of two sequential but overlapping contraction segments in the distal esophageal body. In this report, propagation velocity of esophageal peristalsis was determined in these segments in normal subjects (N=35) and in patients with high-amplitude peristalsis (nutcracker esophagus,N=25) to see if intersegment differences were present in the normal or abnormal setting. Velocity measurements were made from conventional manometric tracings in two 4-cm regions representing the distal smooth-muscle segments. A novel method of velocity measurement was employed that used regression lines established from contraction onset times. In normal subjects, propagation velocity decreased significantly from the proximal to distal segment (4.9±0.5 cm/sec, vs 3.2±0.2 cm/sec,P<0.01). Velocity also decreased across segments in nutcracker-esophagus patients (5.3±0.6 cm/sec, vs 3.6±0.7 cm/sec,P=0.06), but the difference reached statistical significance only when the subset with highest amplitudes (180 mm Hg) was analyzed separately. Greater variance in velocity in the distal smooth-muscle segment of nutcracker-esophagus patients (P<0.01) was, in part, responsible for this statistical observation. We conclude that normal propagation velocity decreases across regions corresponding to the smooth-muscle contraction segments defined by recent studies of peristalsis, supporting the assumption that they represent separate neuromuscular units. The mechanisms responsible for contraction wave abnormalities in the nutcracker esophagus have a minimal effect on propagation velocity, an effect that is restricted to the distal smooth-muscle segment of the esophageal body.Supported in part by a grant from the United States Public Health Service (AM07130).     

Molecular Human Reproduction: Evidence for {gamma}-aminobutyric acid specific binding sites on human spermatozoa

The possible presence of -aminobutyric acid (GABA) specificbinding sites on human spermatozoa was investigated. Swim-uppreparations of human spermatozoa were incubated with radiolabelledGABA in the presence of unlabelled GABA, alternatively displacersof GABA_A/B receptors and GABA transport proteins. The resultsindicate that GABA specific binding sites are present on thesurface of human spermatozoa, and that these binding sites possiblyindicate the presence of GABA transport proteins. Furthermore,GABA at different concentrations was added to swim-up preparationsof human spermatozoa. Possible effects of GABA on sperm motility,hyperactivation and acrosome reaction were explored. No significantdifferences were observed between treated groups and controlsconcerning motility parameters and hyperactivation. Incubationwith GABA did not cause any increase in spontaneous acrosomereaction. However, spermatozoa treated with the calcium ionophoreA-23187 showed a small but significantly increased ability toundergo the acrosome reaction following preincubation in 10–⁴M GABA (P < 0.05).     

Growth factor regulation of integrin-mediated cell motility

Summary Cell motility, a primary component of tumor cell invasion, is a continuum of sequential events in which the cell extends pseudopodia, forms nascent attachments, assembles and contracts the cytoskeleton, and finally, as it translocates forward, disengages distal adhesions. What triggers cells to move? Substratum contact mediated by integrin adhesion receptors is important, but other signals such as chemokinetic factors appear to be required for continued crawling. It is now apparent that integrins do not simply bind cells to matrix in a Velcrolike fashion, but also are potent signaling molecules. Initial engagement of integrins induces their condensation into focal contacts, forming anchors to the extracellular matrix and discrete signal-transducing complexes on the cytoplasmic surface. A number of growth factors, through either autocrine or paracrine pathways, can activate the cellular machinery that mobilizes the cell. Thus, these two classes of receptors - the integrin receptors that bind specific extracellular adhesion molecules, and growth factor receptors that bind their respective ligands - can regulate cell locomotion. Not surprisingly, there is cross-talk between integrin and growth factor receptors that occurs through their common intracellular signaling pathways. In this way, each receptor type can either amplify or attenuate the other's signal and downstream response. An example of growth factor-induced motility is the epithelial-mesenchymal transition induced by hepatocyte growth factor/scatter factor (HGF/SF). When bound to its receptor, the c-met proto-oncogene product, HGF/SF induces a phenotypic conversion that appears to be an important aspect of tumor progression in malignant carcinomas. The motogenic response produced by HGF/SF in carcinoma cells occurs in discrete steps in which integrins and focal adhesion kinase (p125^FAK) are first recruited to focal contacts. This is rapidly followed by cell spreading, disruption of focal adhesions and cell-cell contacts, and, finally, cell crawling. The precise mechanism by which growth factors such as HGF/SF and its receptor induce this motogenic response and modulate integrin function has not been clearly defined but appears to involve several signaling pathways. Understanding the process by which growth factor and integrin receptors interact and regulate motility may suggest novel targets for therapeutic intervention.     

十一酸睾酮对人精浆蛋白的影响

本文采用SDS—PAGE法,测定7例健康育龄男子在肌肉注射十一酸睾酮(TU)前,用药后l、2、3个月及停药后精子计数恢复正常时的精浆蛋白浓度和组份变化,并结合血清测定激素水平及常规精液分析,以探讨TU对上述指标的影响及其相互关系。结果显示:用药早期精浆总蛋白浓度开始逐步降低,在停药后精子计数恢复正常时仍未达到正常水平。精浆总蛋白浓度的变化与精子活动率、前向运动率及LH呈正相关(r值分别为0.8975、0.7776、0.6406,P<0.01或0.05)。精浆蛋白组份也发生变化,其中51KD、37KD的蛋白条带变化最为明显,其变化除与精子活动率相关外(r=0.9094,P<0.01),其中51KD蛋白条带的变化还与精子前向运动率相关(r=0.7660,P<0.05)。上述结果提示TU可能在抑制生精之前即通过改变精浆蛋白而影响精子的功能,说明单用睾酮(T)的避孕机理是多因素的。