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Emptying
Kinds of Emptying Terms modified by Emptying Selected AbstractsMITEMCINAL (GM-611), AN ORALLY ACTIVE MOTILIN RECEPTOR AGONIST, IMPROVES DELAYED GASTRIC EMPTYING IN A CANINE MODEL OF DIABETIC GASTROPARESISCLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 7 2008Mitsu Onoma SUMMARY 1The aim of the present study was to evaluate the effects of mitemcinal (GM-611), an orally active motilin receptor agonist, on delayed gastric emptying in a canine model of diabetic gastroparesis and to compare these effects with those of cisapride. 2Moderate hyperglycaemia was induced by a single intravenous injection of a mixture of streptozotocin (30 mg/kg) and alloxan (50 mg/kg). Dogs that maintained moderate hyperglycaemia (fasting plasma glucose 200,300 mg/dL) without insulin treatment were selected and gastric emptying in these dogs was determined by the paracetamol method. 3One year after the onset of diabetes, there was no difference in the gastric emptying of normal and diabetic dogs. However, after 5 years, the diabetic dogs showed delayed gastric emptying. The motor nerve conduction velocity of the tibial nerve was significantly lower in diabetic dogs comapred with normal dogs at both time points. 4Histopathological examination at the end of the study showed that there were fewer nerve fibres in both dorsal vagal and tibial nerves of diabetic dogs comapred with normal dogs. The onset of delayed gastric emptying is thought to have occurred gradually, in parallel with abnormal autonomic nerve function induced by the long period of moderate hyperglycaemia. 5Oral administration of mitemcinal (0.125, 0.25 or 0.5 mg/kg) dose-dependently accelerated delayed gastric emptying, significant at 0.5 mg/kg, in diabetic dogs, whereas cisapride (1, 3 or 10 mg/kg) had no significant effect. These results add to the existing evidence that mitemcinal is likely to be useful for treating diabetic gastroparesis. [source] EFFECTS OF AGAR AND PECTIN ON GASTRIC EMPTYING AND POST-PRANDIAL GLYCAEMIC PROFILES IN HEALTHY HUMAN VOLUNTEERSCLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 11 2007Masaki Sanaka SUMMARY 1Dietary fibre, such as pectin, delays gastric emptying and may enhance post-prandial glucose tolerance. Agar, which is high in fibre content, is widely used in the traditional Japanese diet. Although long-term diet therapy with agar decreases fasting plasma glucose levels in diabetes, knowledge is lacking about the acute effects of agar on gastric emptying and the post-prandial glycaemic profiles. The present study was designed to investigate the acute effects of agar. 2Ten healthy male volunteers were studied on three occasions with three different test meals (450 kcal/500 mL): (i) a fibre-free meal; (ii) a meal with 2.0 g agar; or (iii) a meal with 5.2 g pectin. On each occasion, participants underwent a [13C]-acetate breath test along with serial blood sampling. To quantify gastric emptying, the half [13CO2] excretion time () and the time for maximal [13CO2] excretion rate (tlag) were determined. The post-prandial glycaemic response was expressed as an incremental change from the fasting value at each sampling time. Data were analysed using repeated-measures analysis of variance (anova), followed by a post hoc paired Student's t -test with Bonferroni adjustment. 3The time-course for respiratory [13CO2] excretion differed significantly among the three test meals (P = 0.0004, anova). Compared with the control meal, [13CO2] excretion was significantly lower following consumption of the agar meal (between 40 and 105 min post-prandially; P < 0.025, Student's t -test) and the pectin meal (between 40 and 180 min post-prandially; P < 0.025, Student's t -test). Among the three meals, significant differences were found in (P = 0.002, anova) and tlag (P = 0.011, anova). Compared with the control meal, the agar and pectin meals exhibited a significantly prolonged (P = 0.007 and P < 0.0001, respectively, Student's t -test) and tlag (P = 0.006 and P = 0.002, respectively, Student's t -test). Neither the agar nor pectin meal affected the post-prandial glucose profile. 4In healthy adults, agar and pectin delay gastric emptying but have no impact on the post-prandial glucose response. [source] ,-Synuclein modulation of Ca2+ signaling in human neuroblastoma (SH-SY5Y) cellsJOURNAL OF NEUROCHEMISTRY, Issue 5 2009Nishani T. Hettiarachchi Abstract Parkinson's disease (PD) is characterized in part by the presence of ,-synuclein (,-syn) rich intracellular inclusions (Lewy bodies). Mutations and multiplication of the ,-synuclein gene (SNCA) are associated with familial PD. Since Ca2+ dyshomeostasis may play an important role in the pathogenesis of PD, we used fluorimetry in fura-2 loaded SH-SY5Y cells to monitor Ca2+ homeostasis in cells stably transfected with either wild-type ,-syn, the A53T mutant form, the S129D phosphomimetic mutant or with empty vector (which served as control). Voltage-gated Ca2+ influx evoked by exposure of cells to 50 mM K+ was enhanced in cells expressing all three forms of ,-syn, an effect which was due specifically to increased Ca2+ entry via L-type Ca2+ channels. Mobilization of Ca2+ by muscarine was not strikingly modified by any of the ,-syn forms, but they all reduced capacitative Ca2+ entry following store depletion caused either by muscarine or thapsigargin. Emptying of stores with cyclopiazonic acid caused similar rises of [Ca2+]i in all cells tested (with the exception of the S129D mutant), and mitochondrial Ca2+ content was unaffected by any form of ,-synuclein. However, only WT ,-syn transfected cells displayed significantly impaired viability. Our findings suggest that ,-syn regulates Ca2+ entry pathways and, consequently, that abnormal ,-syn levels may promote neuronal damage through dysregulation of Ca2+ homeostasis. [source] Release-modulating factors strongly affecting steroid diffusion from silicone elastomer,JOURNAL OF PHARMACEUTICAL SCIENCES, Issue 10 2004Harold A. Nash Abstract Investigations were undertaken to determine the cause of decreases over time in the release rate from levonorgestrel (LNG) implants consisting of silicone elastomer tubing filled with crystalline steroid. Emptying and refilling with the same steroid partially restored release rate. Surprisingly, a further increment in release rates was attained if the tubing was briefly irrigated with methanol before refill. Fractional crystallization showed that release-modulating factors could be concentrated in mother liquors and were initially present as impurities. Boiling LNG in ethanol or methanol produced a number of release-modulating factors of which the most prominent was also found in one production lot of LNG. It was identified as 6,-hydroxy-levonorgestrel (6,-OH-LNG). Added to LNG at the 2% level, 6,-OH-LNG decreased the release rate by 27%. © 2004 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 93:2420,2430, 2004 [source] Effect of low-dose cisapride on gastric emptying and QTc interval in preterm infantsACTA PAEDIATRICA, Issue 12 2000C Costalos The aim of the study was a prospective survey of the effects of low-dose cisapride on gastric emptying and QTc interval in very low birthweight infants. Twenty low birthweight infants were studied: mean (SD) gestation 30.5 (2.2) wk; birthweight 1320 (150)g. Gastric emptying was assessed ultrasonically in 15 of these infants, in a randomized blind crossover study, following 24-h low-dose oral cisapride administration (0.1 mg/kg given 8 hourly), or placebo. The QTc interval was also determined in all 20 infants following a 7-d course of cisapride or placebo. Conclusions: Cisapride significantly shortened both gastric emptying time and QTc interval (p < 0.05) compared to placebo. All infants completed the study without any apparent adverse effects. In conclusion, low-dose cisapride administration significantly improves gastric emptying without increasing the QTc interval. [source] Exenatide: a review from pharmacology to clinical practiceDIABETES OBESITY & METABOLISM, Issue 6 2009R. Gentilella Background:, Exenatide is an incretin mimetic that activates glucagon-like-peptide-1 receptors. It blunts the postprandial rise of plasma glucose by increasing glucose-dependent insulin secretion, suppressing inappropriately high glucagon secretion and delaying gastric emptying. Methods:, In seven clinical trials performed in 2845 adult patients with type 2 diabetes mellitus who were inadequately controlled by a sulphonylurea and/or metformin (glycosylated haemoglobin, HbA1c ,11%), or by thiazolidinediones (with or without metformin) and treated for periods from 16 weeks to 3 years, exenatide (5 ,g b.i.d. s.c. for the first 4 weeks of treatment and 10 ,g b.i.d. s.c. thereafter) reduced HbA1c, fasting and postprandial glucose, and body weight dose dependently, and was similar to insulin glargine and biphasic insulin aspart in reducing HbA1c. Body weight diminished with exenatide, whereas it increased with both insulin preparations. Positive effects on the lipid profile and a reduction in C-reactive protein were also recorded with exenatide. Treatment extensions up to 3 years showed that benefits were maintained in the long term. Adverse events were usually mild to moderate in intensity, and generally the frequency decreased with continued therapy. The most common was nausea (whose incidence may be reduced by gradual dose escalation from 5 ,g b.i.d. to 10 ,g b.i.d.), vomiting, diarrhoea, headache and hypoglycaemia (almost exclusively in patients treated with a sulphonylurea). Results and conclusions:, Exenatide is a new, promising therapeutic option for type 2 diabetic patients inadequately controlled by oral agents, before insulin therapy, offering the added benefits of body weight reduction and tight postprandial glucose control. [source] Glucagon-like peptide 1(GLP-1) in biology and pathologyDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 2 2005Juris J. Meier Abstract Post-translational proteolytic processing of the preproglucagon gene in the gut results in the formation of glucagon-like peptide 1 (GLP-1). Owing to its glucose-dependent insulinotropic effect, this hormone was postulated to primarily act as an incretin, i.e. to augment insulin secretion after oral glucose or meal ingestion. In addition, GLP-1 decelerates gastric emptying and suppresses glucagon secretion. Under physiological conditions, GLP-1 acts as a part of the ,ileal brake', meaning that is slows the transition of nutrients into the distal gut. Animal studies suggest a role for GLP-1 in the development and growth of the endocrine pancreas. In light of its multiple actions throughout the body, different therapeutic applications of GLP-1 are possible. Promising results have been obtained with GLP-1 in the treatment of type 2 diabetes, but its potential to reduce appetite and food intake may also allow its use for the treatment of obesity. While rapid in vivo degradation of GLP-1 has yet prevented its broad clinical use, different pharmacological approaches aiming to extend the in vivo half-life of GLP-1 or to inhibit its inactivation are currently being evaluated. Therefore, antidiabetic treatment based on GLP-1 may become available within the next years. This review will summarize the biological effects of GLP-1, characterize its role in human biology and pathology, and discuss potential clinical applications as well as current clinical studies. Copyright © 2005 John Wiley & Sons, Ltd. [source] Incretins and other peptides in the treatment of diabetesDIABETIC MEDICINE, Issue 3 2007J. F. Todd Abstract Glucagon-like peptide-1 (7-36) amide (GLP-1) is a gut hormone, released postprandially, which stimulates insulin secretion and insulin gene expression as well as pancreatic B-cell growth. Together with glucose-dependent insulinotropic polypeptide (GIP), it is responsible for the incretin effect which is the augmentation of insulin secretion following oral administration of glucose. Patients with Type 2 diabetes have greatly impaired or absent incretin-mediated insulin secretion which is mainly as a result of decreased secretion of GLP-1. However, the insulinotropic action of GLP-1 is preserved in patients with Type 2 diabetes, and this has encouraged attempts to treat Type 2 diabetic patients with GLP-1. GLP-1 also possesses a number of potential advantages over existing agents for the treatment of Type 2 diabetes. In addition to stimulating insulin secretion and promoting pancreatic B-cell mass, GLP-1 suppresses glucagon secretion, delays gastric emptying and inhibits food intake. Continuous intravenous and subcutaneous administration significantly improves glycaemic control and causes reductions in both HbA1c and body weight. However, GLP-1 is metabolized extremely rapidly in the circulation by the enzyme dipeptidyl peptidase IV (DPP-IV). This is the probable explanation for the short-lived effect of single doses of native GLP-1, making it an unlikely glucose-lowering agent. The DPP-IV resistant analogue, exenatide, has Food and Drug Administration (FDA) approval for the treatment of Type 2 diabetes and selective DPP-IV inhibitors are under development. Both approaches have demonstrated remarkable efficacy in animal models and human clinical studies. Both are well tolerated and appear to have advantages over current therapies for Type 2 diabetes, particularly in terms of the effects on pancreatic B-cell restoration and potential weight loss. [source] Gastric emptying in diabetes: clinical significance and treatmentDIABETIC MEDICINE, Issue 3 2002M. Horowitz Abstract The outcome of recent studies has led to redefinition of concepts relating to the prevalence, pathogenesis and clinical significance of disordered gastric emptying in patients with diabetes mellitus. The use of scintigraphic techniques has established that gastric emptying is abnormally slow in approx. 30,50% of outpatients with long-standing Type 1 or Type 2 diabetes, although the magnitude of this delay is modest in many cases. Upper gastrointestinal symptoms occur frequently and affect quality of life adversely in patients with diabetes, although the relationship between symptoms and the rate of gastric emptying is weak. Acute changes in blood glucose concentration affect both gastric motor function and upper gastrointestinal symptoms. Gastric emptying is slower during hyperglycaemia when compared with euglycaemia and accelerated during hypoglycaemia. The blood glucose concentration may influence the response to prokinetic drugs. Conversely, the rate of gastric emptying is a major determinant of post-prandial glycaemic excursions in healthy subjects, as well as in Type 1 and Type 2 patients. A number of therapies currently in development are designed to improve post-prandial glycaemic control by modulating the rate of delivery of nutrients to the small intestine. [source] Comparison of the effect of a cornstarch thickened formula and strengthened regular formula on regurgitation, gastric emptying and weight gain in infantile regurgitationDISEASES OF THE ESOPHAGUS, Issue 2 2007H.-C. Chao SUMMARY., The purpose of this study was to evaluate the efficacy of a specially selected cornstarch-supplemented formula on clinical symptoms, gastric emptying and weight gain in infants with regurgitation. We performed a prospective randomised trial evaluating the therapeutic efficacy of two different formula feedings (cornstarch-thickened formula, group A; 25% strengthened formula, group B) in 81 young infants with regurgitation/vomiting , 3 times/day. A Tc-99 m milk scintigraphy was performed at inclusion and after 2 months to quantify gastric emptying time; all studied infants underwent a 2-month period of clinical follow-up evaluating regurgitation and body weight gain. At inclusion, group A and B had a similar age and weight. After the 2-month period of intervention, regurgitation and vomiting had both greater decrease (both P < 0.001 at 1 and 2 months) in group A (from a score of 4.19 ± 1.71 to 0.93 ± 0.42) than in group B (from a score of 4.15 ± 1.68 to 2.89 ± 1.16). Non-regurgitation symptoms (irritability, cough, choking, night-waking) decreased (P = 0.045 at 1 month and 0.017 at 2 months) in group A (from a score of 18 at baseline to 3 after 8 weeks) as compared to group B (from a score of 18 at baseline to 11 after 8 weeks). Weight increased more in group A (29.1 ± 3.9 g/day over 8 weeks) versus group B (23.6 ± 3.5 g/day over 8 weeks) (P < 0.01 at 1 and 2 months) Gastric emptying improved significantly in group A as compared with group B (all P < 0.001 for T1/2, and residual volume at 60 and 90 min). Ingested feeding volume was significantly larger in the group receiving cornstarch-thickened formula, both at 4 weeks (109.4 ± 24.5 vs. 98.5 ± 23.6 mL/meal) (P: 0.042) and at 8 weeks (137.6 ± 27.9 vs. 115.7 ± 26.5 mL/meal) (P < 0.001). Cornstarch-thickened formula feeding decreases the frequency of regurgitation/vomiting, provides better body weight gain and has an accelerated gastric emptying in comparison to a 25% strengthened regular formula in infants with regurgitation. [source] Long-term follow-up of achalasic patients treated with botulinum toxinDISEASES OF THE ESOPHAGUS, Issue 2 2000D'Onofrio Botulinum toxin A (BoTx), a potent inhibitor of acetylcholine release from nerve endings both within the myenteric plexus and at the nerve,muscle junction, has been shown to decrease the lower esophageal sphincter (LES) pressure in patients with achalasia. Because of this property, the esophageal injection of BoTx has been suggested as an alternative treatment in achalasia. The objective of this study was to determine the long-term efficacy and safety of intrasphincteric injection of BoTx in a group of achalasic patients. Nineteen patients (mean age 56.1 ± 19.2 years) were enrolled in the study. All of them were injected endoscopically with 100 U of BoTx by sclerotherapy needle at different sites of the LES. Symptom score (dysphagia, regurgitation and chest pain, each on a 0,3 scale), esophageal manometer and esophageal radionuclide emptying were assessed before the treatment and at 4 weeks, 3 months and 1 year after BoTx injection. In case of failure or relapse (symptom score >2), the treatment was repeated. All but five patients (74%) were in clinical remission at 1 month. Mean symptom score after 1 month of BoTx decreased from 7.1 ± 0.9 to 2.2 ± 2.5 (p < 0.05). LES pressure decreased from 38.4 ± 13.7 to 27.4 ± 13.5 mmHg (p < 0.05) and 10-min radionuclide retention decreased from 70.9 ± 20.7% to 33.8 ± 27.0% (p < 0.05). Side-effects (transient chest pain) were mild and infrequent. At 12 months, the clinical score was 0.9 ± 0.5 (p < 0.05 vs. basal); mean LES pressure was 22.0 ± 7.1 (p < 0.05 vs. basal) and 10-min radionuclide retention was 15.8 ± 6.0% (p < 0.05 vs. basal). The efficacy of the first injection of BoTx lasted for a mean period of 9 months (range 2,14 months). At the time of writing (follow-up period mean 17.6 months, range 2,31), 14 patients (10 with one injection) were still in remission (74%). Our results showed that one or two intrasphincteric injections of BoTx resulted in clinical and objective improvement in about 74% of achalasic patients and are not associated with serious adverse effects; the efficacy of BoTx treatment was long lasting; this procedure could be considered an attractive treatment, especially in elderly patients who are poor candidates for more invasive procedures. [source] Exenatide effects on glucose metabolism and metabolic disorders common to overweight and obese patients with type 2 diabetesDRUG DEVELOPMENT RESEARCH, Issue 8 2006David M. Webb Abstract The risks of cardiovascular disease (CVD) and type 2 diabetes increase as body mass index increases in overweight (25,30,kg/m2) and obese (>30,kg/m2) individuals. However, these risks can be reduced with even modest weight loss. In patients with established type 2 diabetes, control of both glycemia and body weight are important to minimize the risk of future diabetic complications. Exenatide is a 39-amino-acid peptide incretin mimetic currently approved in the United States for the treatment of type 2 diabetes as an adjunct to sulfonylurea and/or metformin. Phase-3 clinical studies showed exenatide therapy for 30 weeks significantly reduced glycosylated hemoglobin (HbA1c), and fasting and postprandial plasma glucose, while significantly reducing body weight. Open-label extensions from these pivotal trials demonstrated patients treated with exenatide for 2 years had sustained reductions in glycemic control at 30 weeks and a progressive reduction in body weight. Patients treated with exenatide also had improvement in blood pressure, inflammatory markers, and lipid profiles. The glucoregulatory and weight-reducing effects of exenatide are the result of multiple modes of action that mimic several of the glucoregulatory actions of the naturally occurring peptide, glucagon-like peptide-1 (GLP-1). These include restoration of first phase insulin response, enhancement of glucose-dependent insulin secretion, suppression of inappropriate glucagon secretion, slowing of gastric emptying, and affects on satiety leading to reduced food intake. Further research is required to fully understand the role for exenatide to potentially alleviate metabolic disorders associated with type 2 diabetes, including CVD and obesity. Drug Dev. Res. 67:666,676, 2006. © 2006 Wiley-Liss, Inc. [source] Impact of Effective Valvotomy in Mitral Stenosis on Pulmonary Venous Flow PatternECHOCARDIOGRAPHY, Issue 7 2006Solange Bernardes Tatani M.D. Aims: Transesophageal Doppler echocardiography (TEE) is a useful tool to investigate pulmonary venous flow (PVF) velocity, which is altered in patients with mitral stenosis (MS). This study used TEE to analyze the variations in the PVF pattern after successful valvar dilatation in MS patients. Methods/Results: A total of 15 MS patients, mean age 27.2 years, underwent effective percutaneous balloon valvotomy (PBV). All were submitted to TEE before and after PBV. TEE assessed systolic (SPFV) and diastolic (DPFV) peak flow velocities and their ratio (SPFV/DPFV), time-velocity integrals (STVI and DTVI) and their ratio, and diastolic flow deceleration (DFD). Valvotomy yielded statistically significant increases (P , 0.05) in the SPFV: increase on average by 67% and STVI by 120%, as well as in the diastolic component: increased on average by 35%, DTVI by 33%, and DFD by 75%. Conclusion: TEE demonstrated that PBV induced a global increase in velocities of PVF, probably related to improvement of left atrial emptying. [source] The Use of Anatomic M-Mode Echocardiography to Determine the Left Atrial Appendage Functions in Patients with Sinus RhythmECHOCARDIOGRAPHY, Issue 2 2005Yekta Gurlertop M.D. Left atrial appendage (LAA) contractile dysfunction is associated with thrombus formation and systemic embolism. LAA function is determined by its flow velocities and fractional area change. This study was performed in order to determine the LAA functions with the anatomic M-mode echocardiography (AMME). Our study comprised 74 patients who had sinus rhythm and underwent transesophageal echocardiography (TEE) for various reasons. LAA fractional change (LAAFAC) was measured by manual planimetry in a transverse basal short-axis approach and LAA emptying and filling velocities also were measured. The AMME values were determined by an M-mode cross section from a cursor placed beneath the orifice of the LAA in transverse basal short-axis imaging. From these values LAA fractional shortening (LAAFS) and ejection fraction (LAAEF) were calculated. LAAEF was calculated by the Teicholz method. The comparisons were conducted, and no correlations between the LAA late filling and the anatomic M-mode values were found (for LAAFS r = 0.18; P > 0.05 and for LAAEF r = 0.19; P > 0.05). There were significant but poor correlations among the LAA late emptying with the anatomic M-mode measurements (for LAAFS r = 0.26; P < 0.05 and for LAAEF r = 0.30; P < 0.01), whereas, there were significant and good correlations between the LAAFAC and the anatomic M-mode values (for LAAFS r = 0.75; P < 0.01 and for LAAEF r = 0.78; P < 0.01). There were significant differences between the valvular heart disease group and the normal group, and between the valvular heart disease group and the ASD group (for LAAFAC P < 0.01, for LAAEF P < 0.01, for LAAFS P < 0.01). There was no difference between the normal group and the ASD group. Our study showed that the LAAEF and LAAFS in patients with sinus rhythm obtained via anatomical M-mode echocardiography is a new method, which can be used instead of left atrial appendage area change. [source] Changes of gallbladder and gastric dynamics in patients with acute hepatitis AEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 7 2001P. Portincasa Transient alterations of gallbladder morphology and dynamics have been reported in patients with during acute hepatitis A. The presence of dyspepsia also suggests involvement of gastric motility. During a 60-day follow-up, we investigated gallbladder and gastric motility in relation to dyspepsia in acute viral hepatitis A patients. Twenty patients were assessed at referral (day 0) and at days 7, 21, 42 and 60 and compared with 20 healthy volunteers. Gallbladder morphology and motility and gastric motility were assessed in the fasting and postprandial period by functional ultrasonography using a liquid test meal. Dyspeptic symptoms were scored. At day 0, fasting gallbladder volume was 5·9 ± 1·3 mL, 32·6 ± 4·6 mL, and 21·5 ± 1·9 mL (mean ±,SE) in patients with gallbladder sludge (n = 7), without sludge (n = 13) and controls, respectively (P < 0·05 in sludge vs. no sludge and controls; P < 0·05 in no sludge vs. controls, anova). Small fasting gallbladder volume in patients with sludge increased and sludge disappeared within 7 days. At day 0, patients with sludge also had increased thickness of fasting gallbladder wall and increased serum transaminase levels compared with patients without sludge and controls. Gallbladder contraction was similar in patients and controls. However, patients had delayed gastric emptying, which positively correlated with dyspepsia score. Gallbladder morphological changes observed in the acute phase of hepatitis A are transient and are associated with hepatocellular damage. Gastric emptying is delayed during the first week of disease and is associated with dyspeptic symptoms. [source] Autonomic symptoms in patients and pre-manifest mutation carriers of Huntington's diseaseEUROPEAN JOURNAL OF NEUROLOGY, Issue 8 2010N. A. Aziz Background and purpose:, Although autonomic function tests have revealed abnormalities of the autonomic nervous system in Huntington's disease (HD), autonomic symptoms and their association with other symptoms and signs of HD have not yet been assessed in large groups of patients or pre-manifest mutation carriers. Therefore, we aimed at delineating the characteristics and correlates of autonomic symptoms in HD. Methods:, Using the scales for outcomes in Parkinson's disease-autonomic symptoms (SCOPA-AUT) and Beck Depression Inventory questionnaires, autonomic symptoms and depressed mood were assessed in 63 patients with HD, 21 pre-manifest mutation carriers, and 85 controls. The Unified Huntington's Disease Rating Scale was used to assess other HD symptoms and signs. Results:, Relative to controls, patients with HD experienced significantly more gastrointestinal, urinary, cardiovascular and, in men, sexual problems. The most prevalent symptoms were swallowing difficulties, erection and ejaculation problems, dysphagia, sialorrhea, early abdominal fullness, straining for defecation, fecal and urinary incontinence, urgency, incomplete bladder emptying, and light-headedness whilst standing. Pre-manifest mutation carriers experienced significantly more swallowing difficulties and light-headedness on standing up compared with controls. In patients with HD, autonomic symptoms were associated with a greater degree of functional disability, more severe depression, and antidepressant drugs use. However, depression was the only independent predictor of autonomic dysfunction. Conclusions:, Autonomic symptoms are highly prevalent in patients with HD and may even precede the onset of motor signs. Moreover, autonomic dysfunction is related to functional disability and depression in HD. [source] Assessing autonomic symptoms of Parkinson's disease with the SCOPA-AUT: a new perspective from Rasch analysisEUROPEAN JOURNAL OF NEUROLOGY, Issue 2 2010M. J. Forjaz Background:, The Scale for Outcomes in Parkinson's disease (PD) for Autonomic Symptoms (SCOPA-AUT) is a specific scale to assess autonomic dysfunction in PD patients. It was developed and validated under the classic test theory approach. This study sought to test whether the SCOPA-AUT meets item response theory standards for reliability, internal construct validity, response category ordering, and differential item functioning by gender and age group. Method:, The Rasch measurement model was applied to a sample of 385 PD patients. Results:, Model fit was obtained after the response categories were rescored and item 10-Incomplete emptying deleted because of redundancy. Person separation index, a reliability measure, was 0.82. All but two items (2-Sialorrhea and 13-Nocturia) were free of gender- and age-related bias. The strict tests of unidimensionality were met, indicating the validity of the total sumscore. Scale targeting suggested the need for items representing milder autonomic symptoms. Conclusions:, Suggestions for improving the SCOPA-AUT include a shorter scale with a simpler response scheme and a combination of sexual items for men and women. The resulting SCOPA-AUT is a reliable scale, with good internal construct validity, providing Rasch transformed results on a linear metric scale. [source] Ginger accelerates gastric emptying in healthy peopleFOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 4 2008Article first published online: 3 JUN 2010 [source] Anti-diarrhoeal and ulcer-protective effects of violacein isolated from Chromobacterium violaceum in Wistar ratsFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 4 2009Paulrayer Antonisamy Abstract Violacein was isolated from Chromobacterium violaceum, a soil Gram-negative bacterium collected from the forest water body soil sample from Kolli Hills of Tamil Nadu, India. In the present study the anti-diarrhoeal and ulcer-protective properties of violacein were investigated in Wistar rats using castor oil, magnesium sulphate and ethanol. The intestinal transit in rats was significantly (P < 0.001) reduced and gastric emptying was delayed; 40 mg/kg of violacein elicited a greater anti-motility activity than 0.1 mg/kg of atropine. Violacein exhibited ulcer-protective properties against ethanol-induced ulceration in rats with maximal anti-ulcer activity at 40 mg/kg. Violacein also exerted significant anti-enteropooling effects, causing a dose-related inhibitory effect on castor oil-induced enteropooling in rats. A profound anti-diarrhoeal activity was observed when violacein was tested in diarrhoeic rats. The frequencies of defaecation as well as the wetness of the faecal droppings were significantly reduced. Furthermore, violacein (40 mg/kg) produced 87.84% inhibition of castor oil-induced diarrhoea in rats. The results suggested that violacein can be used for the treatment of diarrhoeal and ulcer-related diseases. [source] Gastric Stasis Occurs in Spontaneous, Visually Induced, and Interictal MigraineHEADACHE, Issue 10 2007Sheena Aurora MD Objective., To evaluate and compare gastric motility and emptying during spontaneous migraine to previous observations from induced migraine. Blackground., We have previously demonstrated a delay in gastric emptying both during the interictal period and during an induced migraine. A limitation noted in these studies was whether there are differences gastrointestinally during a visually induced migraine compared to spontaneous migraines. To address this, 9 additional studies have been performed to ascertain if there is a similar delay during spontaneous migraine Methods., Gastric scintigraphy using a standard meal was performed in 3 subjects during 3 periods: spontaneous migraine, induced migraine, and interictal period. Results., On average, the time to half emptying was delayed during spontaneous migraine (124 minutes), during induced migraine (182 minutes), and during the interictal period migraine (243 minutes) compared to normative values established at our center (112 minutes). On average, similar gastric slowing was seen in all 3 groups when the percentage of nuclear material remaining in the stomach at 2 hours was measured. Conclusions., This study provides additional evidence of gastric stasis in migraineurs interictally during induced and spontaneous migraine. [source] Gastric Stasis in Migraine: More Than Just a Paroxysmal Abnormality During a Migraine AttackHEADACHE, Issue 1 2006Objective.,The aim of this article is to evaluate gastric motility and emptying in the ictal and interictal period in migraine. Background.,Nausea is a predominant symptom of migraine and the basis of it is thought to be gastric stasis. Objective methods to establish this are however lacking. We utilized gastric scintigraphy studies to determine gastric motility in the ictal and interictal period of migraine. Methods.,Ten migraine subjects were compared to equal number of age and sex matched controls. Gastric scintigraphy using a standard meal was performed in all control subjects once and in all 10 migraine subjects in the interictal period and nine studies were performed in the ictal period migraine. Results.,The time to half emptying was delayed in migraine ictally (78%) and interictal period (80%) using normative data at this institution. Gastric stasis was less pronounced ictally (149.9 minutes) compared to interictal period (188.8 minutes). There was a significant delay compared to nonmigrainous controls (migraine 188.8 minutes vs normal controls 111.8 minutes; P < .05). These data were replicated in percentage of radioactive material remaining in the stomach at 2 hours. Conclusions.,Contrary to previous belief, this study has demonstrated that migraineurs suffer from gastric stasis both during and outside an acute migraine attack. This may suggest that migraineurs may have an abnormal autonomic function compared to nonmigrainous controls. The potential role of this in pathophysiology of migraine is discussed and avenues for further investigations are explored. [source] ,Cross-section gastroenterostomy' in patients with irresectable periampullary carcinomaHPB, Issue 2 2001O Horstmann Background The most frequent complication following gastroenterostomy (GE) for gastric outlet obstruction is delayed gastric emptying (DGE), which occurs in roughly 20% of patients. There is evidence that DGE may be linked to the longitudinal incision of the jejunum and that a transverse incision (cross-section GE) may decrease the incidence of DGE following GE. Patients and methods In contrast to the orthodox GE, the jejunum is severed transversely up to a margin of 1.5 cm at the mesenteric border and the anastomosis is created with a single running suture. A Braun anastomosis is added 20,30 cm distally to the GE. Patients were followed prospectively with special regard to the occurrence of DGE. Results Between 1 August 1994 and 1 August 1998, 25 patients underwent cross-section GE, mostly because of an irresectable periampullary carcinoma. Eight patients exhibited clinical signs of gastric outlet obstruction preoperatively, while in 17 the GE was performed on a prophylactic basis. A biliary bypass was added in 15 patients. There was no disruption of the GE, but one patient died in hospital (4%). The nasogastric tube was withdrawn on the first postoperative day (range 0,6 days), a liquid diet was started on the fifth day (range 2,7 days) and a full regular diet was tolerated at a median of 9 days (6,14 days). The incidence of DGE was 4%: only the single patient who died fulfilled the formal criteria for DGE. Discussion In contrast to orthodox GE, DGE seems to be of minor clinical importance following cross-section GE. As the technique is easy to perform, is free of specific complications and leads to a low incidence of DGE, it should be considered as an alternative to conventional GE. [source] A finite volume solver for 1D shallow-water equations applied to an actual riverINTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN FLUIDS, Issue 1 2002N. Gouta Abstract This paper describes the numerical solution of the 1D shallow-water equations by a finite volume scheme based on the Roe solver. In the first part, the 1D shallow-water equations are presented. These equations model the free-surface flows in a river. This set of equations is widely used for applications: dam-break waves, reservoir emptying, flooding, etc. The main feature of these equations is the presence of a non-conservative term in the momentum equation in the case of an actual river. In order to apply schemes well adapted to conservative equations, this term is split in two terms: a conservative one which is kept on the left-hand side of the equation of momentum and the non-conservative part is introduced as a source term on the right-hand side. In the second section, we describe the scheme based on a Roe Solver for the homogeneous problem. Next, the numerical treatment of the source term which is the essential point of the numerical modelisation is described. The source term is split in two components: one is upwinded and the other is treated according to a centred discretization. By using this method for the discretization of the source term, one gets the right behaviour for steady flow. Finally, in the last part, the problem of validation is tackled. Most of the numerical tests have been defined for a working group about dam-break wave simulation. A real dam-break wave simulation will be shown. Copyright © 2002 John Wiley & Sons, Ltd. [source] Scandinavian clinical practice guidelines on general anaesthesia for emergency situationsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2010A. G. JENSEN Emergency patients need special considerations and the number and severity of complications from general anaesthesia can be higher than during scheduled procedures. Guidelines are therefore needed. The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine appointed a working group to develop guidelines based on literature searches to assess evidence, and a consensus meeting was held. Consensus opinion was used in the many topics where high-grade evidence was unavailable. The recommendations include the following: anaesthesia for emergency patients should be given by, or under very close supervision by, experienced anaesthesiologists. Problems with the airway and the circulation must be anticipated. The risk of aspiration must be judged for each patient. Pre-operative gastric emptying is rarely indicated. For pre-oxygenation, either tidal volume breathing for 3 min or eight deep breaths over 60 s and oxygen flow 10 l/min should be used. Pre-oxygenation in the obese patients should be performed in the head-up position. The use of cricoid pressure is not considered mandatory, but can be used on individual judgement. The hypnotic drug has a minor influence on intubation conditions, and should be chosen on other grounds. Ketamine should be considered in haemodynamically compromised patients. Opioids may be used to reduce the stress response following intubation. For optimal intubation conditions, succinylcholine 1,1.5 mg/kg is preferred. Outside the operation room, rapid sequence intubation is also considered the safest method. For all patients, precautions to avoid aspiration and other complications must also be considered at the end of anaesthesia. [source] Treatment of type 2 diabetes with glucagon-like peptide-1 receptor agonistsINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 8 2009K. B. Hansen Summary The incretin system is an area of great interest for the development of new therapies for the management of type 2 diabetes. Existing antidiabetic drugs are often insufficient at getting patients to glycaemic goals. Furthermore, current treatment modalities are not able to prevent the continued ongoing decline in pancreatic beta-cell function and, lastly, they have a number of side effects including hypoglycaemia and weight gain. Glucagon-like peptide-1 (GLP-1) receptor agonists are a new class of pharmacological agents, which improve glucose homeostasis in a multifaceted way. Their effects include potentiation of glucose-stimulated insulin secretion, glucose-dependent inhibition of glucagon secretion and reduction in gastric emptying, appetite, food intake and body weight. Additionally, preclinical data suggest that they may preserve beta-cell mass and function. The incidence of hypoglycaemia with GLP-1 receptor agonists is low, the compounds have clinically relevant effects on body weight, and data are suggesting beneficial effects on cardiovascular risk factors. Exenatide was released in 2005 for the treatment of type 2 diabetes and liraglutide is expected to be approved by the Food and Drug Administration in US and the European Medical Agency in Europe for use in 2009. In this review, the available data on the two drugs are presented and discussed. [source] Prevalence of storage and voiding symptoms among men aged 40 years and older in a US population-based study: results from the Male Attitudes Regarding Sexual Health studyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 8 2007D. B. Glasser Summary Aims:, Lower urinary tract symptoms (LUTS) are categorised as storage (urgency, frequency, nocturia and incontinence), voiding (sensation of incomplete emptying, hesitancy, weak stream and straining) or mixed symptoms. Methods:, In this US population-based study, we investigated the prevalence of male LUTS and the relative frequency of the LUTS subtypes, and we evaluated associations between LUTS and age, race/ethnicity and erectile dysfunction (ED). The Male Attitudes Regarding Sexual Health study included a nationally representative sample of non-Hispanic black, non-Hispanic white and Hispanic men aged , 40 years. Participants completed a questionnaire including items on ED and the International Prostate Symptom Score (IPSS). The prevalence and subtypes of LUTS were investigated post hoc by age, race/ethnicity and the presence of ED. Results:, The overall prevalence rates of storage (13%) and mixed (9%) symptoms were higher than that of voiding symptoms (6%). The prevalence of storage symptoms was similar across age groups, whereas voiding and mixed symptoms increased with age. Among men with IPSS , 8, the rates of storage (29%) and mixed (38%) symptoms were also higher than voiding symptoms (23%). Distributions of the LUTS subtypes were comparable among black, white and Hispanic respondents with IPSS , 8. The overall prevalence rate of ED (40%) increased with age among those with IPSS , 8. Isolated storage symptoms were more than twice as common as isolated voiding symptoms among US men , 40 years of age. Conclusion:, Careful attention to individual symptoms may help distinguish storage LUTS from voiding LUTS, a distinction that has important implications for treatment. [source] Urodynamic findings in children with cerebral palsyINTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2005M IHSAN KARAMAN Abstract Aim: More than one-third of children with cerebral palsy are expected to present with dysfunctional voiding symptoms. The voiding dysfunction symptoms of the cerebral palsy patients in the present study were documented. Methods: Of the study group, 16 were girls and 20 were boys (mean age: 8.2 years). Children with cerebral palsy were evaluated with urodynamics consisting of flow rate, filling and voiding cystometry, and electromyography findings of the external urethral sphincter to determine lower urinary tract functions. Treatment protocols were based on the urodynamic findings. Anticholinergic agents to reduce uninhibited contractions and to increase bladder capacity were used as a treatment. Clean intermittent catheterization and behavioral modification were used for incomplete emptying. Results: Of the children, 24 (66.6%) were found to have dysfunctional voiding symptoms. Daytime urinary incontinence (47.2%) and difficulty urinating (44.4%) were the most common symptoms. Urodynamic findings showed that neurogenic detrusor overactivity (involuntary contractions during bladder filling) with a low bladder capacity was present in 17 (47.2%) children, whereas detrusor,sphincter dyssynergia was present in four patients (11%). The mean bladder capacity of patients with a neurogenic bladder was 52.2% of the expected capacity. Conclusions: The present study concluded that voiding dysfunction was seen in more than half of the children with cerebral palsy, which is a similar result to other published studies. We propose that a rational plan of management of these patients depends on the evaluation of the lower urinary tract dysfunction with urodynamic studies. These children benefit from earlier referral for assessment and treatment. [source] Effects of fermentable or non-fermentable fibre on gastric emptying, serum chemistries following an oral glucose bolus, and satiety in catsJOURNAL OF ANIMAL PHYSIOLOGY AND NUTRITION, Issue 3-4 2007L. A. Foster [source] In-situ small-angle neutron scattering study of pore filling and pore emptying in ordered mesoporous silicaJOURNAL OF APPLIED CRYSTALLOGRAPHY, Issue 1 2010M. Erko The capillary condensation and capillary emptying of water and perfluoropentane in ordered mesoporous SBA-15 silica is studied by in-situ small-angle neutron scattering (SANS). The SANS data can be perfectly described by a simple analytical model for spatially random pore filling (Laue scattering) for the entire range of pore-filling fractions. From this it is concluded that recently proposed pore correlations due to elastic interactions between neighbouring pores upon capillary condensation do not play a role in this system. The pores fill randomly according to their size distribution, in perfect agreement with the classical Kelvin equation. The relation between the overall pore-filling fraction as determined from the volumetric sorption isotherm, and the fraction of completely filled pores as obtained from the fit of the SANS data, allows conclusions to be drawn about the thermodynamic metastability of the adsorption process. [source] Eucalyptus pollen grain emptying by two Australian nectarivorous psittacinesJOURNAL OF AVIAN BIOLOGY, Issue 3 2001B. D. Gartrell The relative importance of pollen as a source of protein to vertebrates is controversial. In nectarivorous psittacine birds, field studies support its importance, but an experimental study in a nectarivorous parrot showed that less than 7% of pollen grains were emptied. We investigated pollen grain emptying by two nectarivorous Australian parrots, the Swift Parrot Lathamus discolor and the Musk Lorikeet Glossopsitta concinna. We used a controlled experiment, and examined pollen located at different levels through the alimentary tract of wild L. discolor. There was significant emptying of pollen grains (x=45.4%±1.91 s.e.) by all birds in the experimental trials. There was also a progressive increase in the percentage of pollen grains emptied at different sites along the alimentary tract in wild birds (crop x=24.2%±4.44 s.e., proventriculus x=34.0%±7.29 s.e., duodenum x=54.3%±5.42 s.e. and distal intestine x=64.2%±4.68 s.e.). The percentage of pollen grains emptied by captive L. discolor in the experimental trial (x=44.1%±2.77 s.e.) was not significantly different from that found in wild L. discolor (x=40.3%±4.25 s.e.). Both species of nectarivorous parrot were able to rapidly ingest large quantities of Eucalyptus pollen and appeared to empty the pollen grains efficiently. Eucalyptus pollen appears to be an important source of protein for these birds. [source] | |||||||||||||||||||||||||||||||||||||||||||