Abnormal Motility Research Articles

The value of conventional manometry in the identification of normal esophageal manometry.

In the last decade, high-resolution esophageal manometry (HREM) is the main device for the management of dysphagia replacing conventional manometry (CM). Conventional manometry still seems to have some space to diagnose major motility disorders and differentiate normal from abnormal esophageal motility. The long term outcomes of patients with normal CM were analyzed in our study.Participants (patients with dysphagia and normal CM) took a questionnaire via a phone call in February 2021. Impact Dysphagia Questionnaire (IDQ) was used as an assessment tool.Only 55% (83/151) the individuals with previous normal manometric findings were reached via telephone. The group who have completed the survey was representative of the cohort. 66.2% of the participants were female (P = .40). The mean age was 57.21, mean weight was 70.69 kg, mean height was 163.74 cm and mean body mass index was 26.41. More than 40% of patients were completely asymptomatic at follow up, reflected by an IDQ score of 0. Only 28 out of 83 (33.7%) patients reported significant symptoms as reflected by an IDQ score greater than or equal to 7. The rest of responders admitted as having moderate to mild symptoms.HREM is a valid technique with comparable precision to CM. HREM measurements differ considerably to CM. The identification of normal motor function in CM is not likely a positive prognostic indicator and must be interpreted precautiously.

Multiple Sclerosis Manifested by Paralysis of Cranial VI Pair with Diplopia

Aims: To describe a Multiple Sclerosis Manifested by Paralysis of Cranial VI Pair with Diplopia.
 Presentation of Case: A.P.R. female patient, 31 years old, has presented diplopia for 04 days. She denied too many symptoms and comorbidities. No eye trauma and previous eye surgery.
 Discussion: Multiple Sclerosis (MS) is a chronic, immune-mediated and demyelinating disease of the central nervous system that mainly affects young female adults. About 85% of individuals with MS start the clinical picture in the form of a relapse, and less can open the picture with progressive neurological deficits, although occasional relapses occur during the course of the disease. Eye changes are frequent in MS and are often the first clinical manifestation.
 Results: MS is a rare comorbidity and there are no exact and concrete epidemiological studies so far. Studies about eye alterations are also scarce in Latin American countries.
 Ocular involvement may be the first sign of MS. Although MS is an uncommon cause of cranial nerve palsies, its frequency increases in young individuals, with a predominance of abducens nerve palsy, as occurred with the patient in the present report, emphasizing the importance of knowing the profile of this disease.
 Conclusion: Ocular findings in MS include optic neuritis, retinitis, peripheral vasculitis, ocular motility abnormalities that can manifest as diplopia or nystagmus, and these manifestations should be recognized by ophthalmologists.

Small intestinal intussusception in horses: Multicentre retrospective report on 26 cases (2009‐2020)

SummaryBackgroundIntussusception is an infrequent cause of equine colic, most commonly encountered in young horses. This condition occurs due to abnormalities of motility and frequently includes the caecum.ObjectivesThe purpose of this study was to review the cases of equine small intestinal (SI) intussusception excluding those with caecal involvement.Study designCase series, analytical retrospective study.MethodsMedical records of all horses that had SI intussusception, not involving the caecum, from three equine clinics between 2009 and 2020 were reviewed. Information obtained included: clinical parameters, surgical or necropsy findings, complications and outcome. The Mann‐Whitney U test was used to compare the outcome and complications with various parameters. Fisher’s exact test was used to compare short‐term survival with categorical variables. Significance was set at p ≤ 0.05.ResultsTwenty‐six horses met the inclusion criteria. Median age of horses was 9 months (interquartile range 2.8 months–6.5 years). Relevant history included diarrhoea and general anaesthesia. Twenty‐two out of 26 horses were diagnosed during surgery and 4 at necropsy. During surgery, 5 horses were subjected to euthanasia, 9 underwent manual reduction and 8 underwent resection and anastomosis. The postoperative complication rate was high at 47% and included ileus, diarrhoea and colic. The prognosis decreased when the involved segment was longer (p = 0.032), lactate levels were higher (p = 0.024) and reflux was present before admission (p = 0.024). Of all horses, 53% survived to discharge and 92% of these survived for >1 year post‐operatively (one case was lost to follow‐up).Main limitationThe retrospective nature of the study and the low number of cases included.ConclusionsSmall intestinal intussusception was diagnosed in horses of a variety of breeds and ages. Alterations of motility can predispose to intussusception, not only due to hypermotility (diarrhoea), but also due to hypomotility (anaesthesia). Prognosis for hospital discharge was fair; however, following hospital discharge, the long‐term survival rate is high and complications are rare.

Motility and Abnormality of Sheep Spermatozoa That is Being Frozen Using Soybean Lecithin (Soybean Lecithin)

The specific purpose of this study was to determine the effect of optimal levels of soybean lecithin in sperm extenders on motility and abnormalities of sheep spermatozoa after undergoing the freezing process. This research was conducted experimentally in a laboratory with a completely randomized design (CRD) with five treatments and three replications. The five treatments tested were soybean lecithin levels in Tris (L) diluent, consisting of: L0 = 0% soybean lecithin + 95% Tris diluent + 5% glycerol; L1 = 1% soy lecithin + 94% Tris diluent + 5% glycerol; L2 = 2% soy lecithin + 93% Tris diluent + 5% glycerol; L3 = 3% soy lecithin + 92% Tris diluent + 5% glycerol; L4 = 4% soy lecithin + 91% Tris diluent + 5% glycerol. The independent variable in this study was the level of soy lecithin in the Tris diluent. The dependent variable is the progressive motility and abnormalities of post-clotting spermatozoa. Soybean lecithin levels had a significantly different effect (P?0.05) on the percentage of progressive motility and spermatozoa abnormalities of post-freezing sheep. The level of 3% soya bean lecithin is the best level in maintaining the quality of post-freezing sheep spermatozoa.

Motility and Abnormality of Sheep Spermatozoa That is Being Frozen Using Soybean Lecithin (Soybean Lecithin)

The specific purpose of this study was to determine the effect of optimal levels of soybean lecithin in sperm extenders on motility and abnormalities of sheep spermatozoa after undergoing the freezing process. This research was conducted experimentally in a laboratory with a completely randomized design (CRD) with five treatments and three replications. The five treatments tested were soybean lecithin levels in Tris (L) diluent, consisting of: L0 = 0% soybean lecithin + 95% Tris diluent + 5% glycerol; L1 = 1% soy lecithin + 94% Tris diluent + 5% glycerol; L2 = 2% soy lecithin + 93% Tris diluent + 5% glycerol; L3 = 3% soy lecithin + 92% Tris diluent + 5% glycerol; L4 = 4% soy lecithin + 91% Tris diluent + 5% glycerol. The independent variable in this study was the level of soy lecithin in the Tris diluent. The dependent variable is the progressive motility and abnormalities of post-clotting spermatozoa. Soybean lecithin levels had a significantly different effect (P?0.05) on the percentage of progressive motility and spermatozoa abnormalities of post-freezing sheep. The level of 3% soya bean lecithin is the best level in maintaining the quality of post-freezing sheep spermatozoa.

Association between the presence of Mycoplasma spp. and male infertility

While male infertility has been associated with Mycoplasma infections, few studies have investigated the association between Mycoplasma infection and male infertility. Therefore, this study aimed at addressing this issue. Semen samples were collected from 136 patients (68 infertile men and 68 fertile men) in the Central Laboratory of Yazd, Iran. Of semen samples collected from 68 infertile and 68 fertile men, 13 (19.12%) and 2 (2.94%) cases were positive for Mycoplasma spp. using PCR, respectively. Among Mycoplasma-infected infertile men, 10 and 6 men showed abnormal sperm morphology and motility, respectively. None of the positive samples for Mycoplasma spp. was positive for M. hominis and one of the positive samples for Mycoplasma spp. belonged to Mycoplasma hyorhinis (strain NBRC 14858). The presence of Mycoplasma spp. was significantly higher in infertile men (p = .003). Mycoplasma infection was relatively high in infertile men. The surprising issue was the absence of M. hominis and the presence of M. hyorhinis strain NBRC 14858 in the semen of infertile men. Therefore, investigating reproductive tract infections caused by other Mycoplasma spp. should be taken into consideration in male infertility. Impact statement What is already known on this subject? Mycoplasma hyorhinis has been mostly reported as a cause of animal respiratory tract infections and the development of various cancers. Information on the association of M. hyorhinis with male infertility is not yet available. What do the results of this study add? This study shows that the presence of M. hyorhinis in the semen of infertile men may be associated with infertility. This study shows that the investigation of unpredictable species of genus Mycoplasma such as M. hyorhinis in the semen of infertile men is essential. What are the implications of these findings for clinical practice and/or further research? The results of the present study indicate that in addition to M. genitalium and M. hominis, studies on the role of M. hyorhinis in reproductive tract infections and infertility should be expanded.

A mechanism of abnormal motility of the esophagus and stomach and associated sound phenomenon

The aim of the article is to update the pathophysiological mechanisms that cause the appearance and activation of pathological peristalsis of the esophagus and stomach and associated esophageal-gastrointestinal-diaphragmatic noise, described earlier, designed to expand the diagnostic capabilities of physical methods for diagnosing hiatal hernia and to facilitate the differential diagnosis of this disease with other diseases of the chest. The result of the study is to describe 5 the pathophysiological mechanisms of developing hernia hiatal and lead to the emergence of pathological motility of the esophagus and stomach in the form of the strengthening or emergence of antiperistaltic waves. The resulting acoustic phenomenon is the essence of a new physical symptom in this disease - esophageal-gastrointestinal-diaphragmatic noise. The first mechanism that determines the pathological motor activity of the smooth muscle cells of the esophageal wall is the so-called esophageal “cleansing” peristalsis, which prevents the regurgitation of the acidic contents of the stomach into the esophagus, where the environment is normally neutral. The second mechanism that causes the appearance and strengthening of pathological peristalsis of the stomach is the deformation during the passage of its part through the esophageal opening of the diaphragm into the chest cavity. The third mechanism that determines the occurrence of pathological peristalsis of the esophagus and stomach is a violation of the secretion and metabolism of nitric oxide in diaphragmatic hernias. The fourth mechanism that leads to the appearance of esophageal-diaphragmatic noise is the pathological peristalsis of the esophagus and stomach in patients with hiatal hernia, which causes the appearance of antiperistaltic waves accompanied by gastro-esophageal reflux and manifests itself in clinically pathological belching. The fifth mechanism that causes pathological peristalsis of the esophagus is the phenomenon of hydrodynamic cavitation, which occurs as a result of regurgitation of the contents of the stomach into the esophagus. Understanding the pathophysiological mechanisms that cause the appearance of pathological peristalsis and antiperistalsis of the esophagus and stomach in patients with diaphragmatic hernia allows us to understand the causes of the sound phenomenon and the associated physical symptom in this disease.

Analytical Study of the Royal-Jelly Effect on Sperms Morphological Characteristics and some Liver Function Parameters and their Correlation with some Antioxidants in Male Albino Rats Treated with Pregabalin Drug

In recent years, the consideration of natural products as anti-inflammatory and antioxidative treatments has more interested worldwide. Moreover, natural products are easily obtained and are relatively safe the Royal jelly (RJ) is one of them. The current study was carried to evaluate the effects of pregabalin (PGB) on physiological activity of sperms, reproductive hormones assay and some biochemical analysis. Forty (40) male albino rats (10-weeks-old) were divided into four groups (10 rats each): G1 (treated with PGB drug, 150 mg/kg B.wt (Lyrica-Pfizer-Pharmaceutical Industries), G2 (treated with RJ 1g/kg), G3 (treated with PGB drug and RJ together), and G4 control treated with normal saline only. all groups were treated orally via stomach tube for 60 consecutive days.. PGB caused a significant reduction in sperm count, sperm viability, motility and sperm abnormality percent, serum FSH, LH and testosterone levels, the co-administration of RJ caused normal level of the previous tests near the control group level. Results of the lipid profile and some the present results of the liver function parameters showed increased concentrations in PGB-treated group, but after treated with RJ the levels were recovered to normal level. In the studied antioxidants markers, the results appeared high level in malondialdehyde (MDA) and low level in the antioxidants enzymes; superoxide dismutase (SOD) and catalase (CAT) the RJ was appeared direct effect on MDA and showed decreased concentration of MDA and increased levels in the studied antioxidants enzymes of the PGB group which treated with RJ.

Novel understanding on genetic mechanisms of enteric neuropathies leading to severe gut dysmotility.

The enteric nervous system (ENS) is the third division of the autonomic nervous system and the largest collection of neurons outside the central nervous system (CNS). The ENS has been referred to as “the brain-in-thegut” or “the second brain of the human body” because of its highly integrated neural circuits controlling a vast repertoire of gut functions, including absorption/secretion, splanchnic blood vessels, some immunological aspects, intestinal epithelial barrier, and gastrointestinal (GI) motility. The latter function is the result of the ENS fine-tuning over smooth musculature, along with the contribution of other key cells, such as enteric glia (astrocyte-like cells supporting and contributing to neuronal activity), interstitial cells of Cajal (the pacemaker cells of the GI tract involved in neuromuscular transmission), and enteroendocrine cells (releasing bioactive substances, which affect gut physiology). Any noxa insult perturbing the ENS complexity may determine a neuropathy with variable degree of neuro-muscular dysfunction. In this review we aim to cover the most recent update on genetic mechanisms leading to enteric neuropathies ranging from Hirschsprung’s disease (characterized by lack of any enteric neurons in the gut wall) up to more generalized form of dysmotility such as chronic intestinal pseudo-obstruction (CIPO) with a significant reduction of enteric neurons. In this line, we will discuss the role of the RAD21 mutation, which we have demonstrated in a family whose affected members exhibited severe GI dysmotility. Other genes contributing to gut motility abnormalities will also be presented. In conclusion, the knowledge on the molecular mechanisms involved in enteric neuropathy may unveil strategies to better manage patients with neurogenic gut dysmotility and pave the way to targeted therapies.

Ozone Induces Distress Behaviors in Fig Wasps with a Reduced Chance of Recovery.

Simple SummaryEcological interactions among organisms underpin the stability of ecological networks, which are responsible for species biodiversity in ecosystems. These interactions are currently threatened by environmental risks, mainly due to human activities, such as air pollution. Among air pollutants, tropospheric ozone (O3) is known to disrupt chemical communication between plants and their pollinators. Alarmingly, its concentration is likely to increase by two–four-fold in the next two decades. However, the direct effects of O3 on the behavior of pollinators themselves have not been investigated so far, even though insect behavior is key to their ecological interactions. In this study, we evaluated the potential effects of O3 at different field-realistic concentrations on the behavior of the fig wasp Blastophaga psenes, the exclusive pollinator of the Mediterranean fig species Ficus carica. We found that O3, even at low concentrations, induced abnormal motility in fig wasps, and that exposed individuals might only have a reduced chance of recovery. Overall, our findings indicate that O3 can affect pollinator behavior, which may have detrimental implications for pollination systems.Among anthropogenic environmental risks, air pollution has the potential to impact animal and plant physiology, as well as their interactions and the long-term survival of populations, which could threaten the functioning of ecosystems. What is especially alarming is that the concentration of tropospheric ozone (O3) has dramatically increased since pre-industrial times. However, the direct effects of O3 on the behavior of pollinators themselves have not been investigated so far even though insect behavior is key to their ecological interactions, which underpin the stability of ecological networks responsible for species biodiversity in ecosystems. In this study, we aim to determine the potential effects of O3 episodes at different field-realistic concentrations (0, 40, 80, 120, and 200 ppb for 60 min) on the behavior of the fig wasp Blastophaga psenes by monitoring exposed individuals hourly for 5 h after exposure. We found that ozone episodes induced major changes in insect behavior, which were already significant at 80 ppb with individuals displaying abnormal motility. The tracking over time clearly showed that exposed individuals might only have a reduced chance of recovery, with a decreasing proportion of active fig wasps despite the cessation of an O3 episode. These findings illustrate that O3 episodes can affect pollinator behavior, which may have detrimental implications for pollination systems. It is, therefore, of importance to assess the effects of O3 on insect behavior in order to predict how it could modify ecological interactions and species biodiversity in ecosystems.

Diagnostic Yield of High-resolution Esophageal Manometry With Chicago Classification Version 3.0 in Thai Patients

Background/AimsHigh-resolution manometry with the Chicago classification scheme has been introduced in clinical practice as a gold standard for esophageal motility test. This study aims to evaluate the diagnostic yield of high-resolution manometry in Thai patients.MethodsAll available high-resolution esophageal manometry (HREM) studies performed during the study period were retrospectively reviewed and interpreted according to the Chicago classification version 3.0. The main esophageal symptoms and coexisting factors were correlated with the HREM findings.ResultsOf the 201 patients, nearly half (49.8%) were documented to have dysphagia. The second most common condition was refractory reflux symptoms (17.4%). More than 70.0% of dysphagia patients showed abnormal esophageal motility, contrary to globus patients who mostly had normal test findings (65.4%). Dysphagia still was the most often correlated condition with major esophageal motility disorders (88.7%), particularly the elderly patients who have coexisting weight loss. Endoscopic and/or surgical procedures were revealed for the highest rate among patients with dysphagia but no one in the globus group needed this intervention. The sensitivity and specificity of dysphagia for major esophageal motility disorders were 70.0% and 67.0%. A much lower sensitivity and higher specificity were found in other non-dysphagia symptoms, especially nausea/vomiting or belching (3.0% or 89.0%). The highest positive likelihood ratio (2.10) to detect major abnormalities was also observed in dysphagia.ConclusionEsophageal manometry provided the highest yield in dysphagia; it was not a strongly beneficial test in patients presenting with non-dysphagia to identify clinically relevant esophageal motor disorders.

De novo identification of mammalian ciliary motility proteins using cryo-EM

SUMMARYDynein-decorated doublet microtubules (DMTs) are critical components of the oscillatory molecular machine of cilia, the axoneme, and have luminal surfaces patterned periodically by microtubule inner proteins (MIPs). Here we present an atomic model of the 48-nm repeat of a mammalian DMT, derived from a cryoelectron microscopy (cryo-EM) map of the complex isolated from bovine respiratory cilia. The structure uncovers principles of doublet microtubule organization and features specific to vertebrate cilia, including previously unknown MIPs, a luminal bundle of tektin filaments, and a pentameric dynein-docking complex. We identify a mechanism for bridging 48- to 24-nm periodicity across the microtubule wall and show that loss of the proteins involved causes defective ciliary motility and laterality abnormalities in zebrafish and mice. Our structure identifies candidate genes for diagnosis of ciliopathies and provides a framework to understand their functions in driving ciliary motility.

MOTILITY OF THE UNPREPARED INTESTINAL TRACT IN HEALTHY HUMANS AND PATIENTS WITH SLOW TRANSIT CONSTIPATION REVEALED BY USING MICRO-ELECTRONIC CAPSULE

Slow transit constipation (STC) is usually accompanied by intestinal motility abnormalities. Although conventional anorectal manometry could record the pressure in the colon, most patients need preparation of intestinal tract. The intervention of catheter for monitoring the intestinal pressure also affects the clinical measurement. The pressure data collected by the conventional anorectal manometry cannot fully characterize the dynamic characteristics of the intestine. Thus, we aimed to obtain colonic pressure data under normal physiological conditions. Utilizing these data, we analyze the difference of colonic motility parameters between healthy control and patients with STC. A micro-electronic capsule made by ourselves was used to gather the subjects’ intestinal pressure in their daily life. Several intestinal motility parameters were calculated from the pressure profile. The average energy of colonic pressure data in the STC group is higher than the healthy control group (HC: 259.95 vs. STC: 821.28). But the STC group has a lower average complexity of colonic motility (HC: 0.80 vs. STC: 0.64). About 81.25% of the colonic data from patients with STC could be identified by using slow transit constipation (SVM) classifier. Compared with health control, most colonic parameters of patients with STC are higher under the normal physiological conditions, but the complexity of colonic motility is lower in the STC group. The correct rate of colonic pressure recognition in the STC group is more than 80% by using SVM classifier.

Fetal akinesia deformation sequence and massive perivillous fibrin deposition resulting in fetal death in six fetuses from one consanguineous couple, including literature review.

BackgroundMassive perivillous fibrin deposition (MPFD) is associated with adverse pregnancy outcomes and is mainly caused by maternal factors with limited involvement of fetal or genetic causes. We present one consanguineous couple with six fetuses developing Fetal Akinesia Deformation Sequence (FADS) and MPFD, with a possible underlying genetic cause. This prompted a literature review on prevalence of FADS and MPFD.MethodsFetal ultrasound examination, motor assessment, genetic testing, postmortem examination, and placenta histology are presented (2009–2019). Literature was reviewed for the association between congenital anomalies and MPFD.ResultsAll six fetuses developed normally during the first trimester. Thereafter, growth restriction, persistent flexed position, abnormal motility, and contractures in 4/6, consistent with FADS occurred. All placentas showed histologically confirmed MPFD. Genetic analyses in the five available cases showed homozygosity for two variants of unknown significance in two genes, VARS1 (OMIM*192150) and ABCF1 (OMIM*603429). Both parents are heterozygous for these variants. From 63/1999 manuscripts, 403 fetal outcomes were mobilized. In 14/403 fetuses, congenital abnormalities in association with MPFD were seen of which two fetuses with contractures/FADS facial anomalies.ConclusionThe low prevalence of fetal contractures/FADS facial anomalies in association with MPFD in the literature review supports the possible fetal or genetic contribution causing FADS and MPFD in our family. This study with literature review supports the finding that fetal, fetoplacental, and/or genetic components may play a role in causing a part of MPFDs.

A 2020 Update on 20/20 X 2 Diplopia after Ocular Surgery: Strabismus Following Retinal Detachment Surgery

ABSTRACT Persistent ocular motility and sensorial abnormalities following retinal detachment surgery are not common. Scleral buckling increases the risk of deviation in secondary gaze positions most commonly horizontal deviations. Suspect superior oblique incarceration in patients with limited downgaze. For patients with persistent strabismus, surgery is an option. Removing the exoplant may be necessary to access the extraocular muscles but the effect on alignment is minimal except in cases were the scleral buckle migrates anteriorly causing restriction. Removing the scleral buckle may increase the risk of retinal re-detachment. Hangback recessions and adjustable sutures can be safely used.

NOT ALL THE ASPIRATIONS ARE COMING FROM THE OROPHARYNX

TOPIC: Imaging TYPE: Medical Student/Resident Case Reports INTRODUCTION: Aspiration is the entry of oral or gastric materials into the lungs leading to chemical pneumonitis, bacterial infection, or airway obstruction. Frequent conditions that predispose aspiration result from reduced level of consciousness without airway protection, neurologic disorders, or dysphagia from gastrointestinal tract disorders. While the most common route of aspiration is oropharyngeal, tracheoesophageal fistula (TEF) may initially present in the same manner. We present a middle-aged male with repeated aspiration pneumonia and pneumonitis secondary to TEF. CASE PRESENTATION: A 58-year-old male with history of squamous cell lung carcinoma stage IIIa in remission after chemoradiation and recurrent aspiration pneumonia with gastrostomy tube. Presented to the hospital in hypoxic respiratory failure due to sudden onset of dyspnea after attempting tube feeds. Initial evaluation was significant for leukocytosis and normal procalcitonin level. A CT of the chest showed ground glass opacities with consolidation in bilateral upper and lower lobes and tree-in-bud pattern. A bronchoscopy revealed tracheobronchial erythema with multilobar exudate and large tracheal fistula. An Upper GI series identified aspiration coating the trachea and left main bronchus. The patient was diagnosed with chemical pneumonitis and aspiration pneumonia secondary to tracheoesophageal fistula most likely from recurrent infections and radiation. He was transferred to a tertiary care center for esophageal and tracheal stent placement. DISCUSSION: TEF is an abnormal connection between the trachea and the esophagus that is mostly congenital, and in rare occasions can be acquired most commonly through esophageal malignancy, trauma, and chemoradiation. TEF is often associated with abnormal esophageal motility causing recurrent pneumonia and acute lung injury from chemical pneumonitis. Diagnosis of TEF as a result of these conditions can be challenging, but the preferred diagnosis method is direct visualization with esophagoscopy or bronchoscopy. Treatment consists of interventional procedures including airway and/or esophageal stent placement. It is the most common approach to prevent liquid leakage and help with the healing. Biological glue or thermal ablation can also be performed, as well as surgical intervention or conservative management. CONCLUSIONS: The patient presented with respiratory failure secondary to recurrent aspiration pneumonia and chemical pneumonitis who failed therapy with gastrostomy tube placement, due to tracheoesophageal fistula. TEF is a rare complication of chemoradiation that increases morbidity and mortality. It can be treated with airway/esophageal stent placement or more invasive surgical intervention. It is important to expand work up and differential diagnosis in patients with aspiration who continue failing therapy to include endoscopy for direct visualization of anatomical abnormalities. REFERENCE #1: Ke M, Wu X, Zeng J. The treatment strategy for tracheoesophageal fistula. J Thorac Dis. 2015;7(Suppl 4):S389-S397. doi:10.3978/j.issn.2072-1439.2015.12.11 REFERENCE #2: Abugroun A, Ahmed F, Singh N, Nadiri M. Late Onset Chemo/Radiation Induced Tracheoesophageal Fistula in Squamous Cell Cancer of the Lung. World J Oncol. 2017;8(5):171-173. REFERENCE #3: Lo WL, Leu HB, Yang MC, et al. Dysphagia and risk of aspiration pneumonia: A nonrandomized, pair-matched cohort study. J Dent Sci 2019; 14:241. DISCLOSURES: No relevant relationships by Nehal Bhatt, source=Web Response No relevant relationships by Joshuam Ruiz Vega, source=Web Response

Cross-Sectional Study of Swallowing Phases in Cases of Megaesophagus Caused by Chagas Disease.

BackgroundChagas disease, caused by the flagellate protozoan Trypanosoma cruzi, is an infectious cause of secondary achalasia and megaesophagus. Moreover, the oral and pharyngeal phases of swallowing may also be affected, which may contribute to dysphagia and increase the possibility of airway aspiration during and/or after swallowing. This cross-sectional study evaluated, with videofluoroscopy, the oral, pharyngeal, and esophageal phases of swallowing in patients with megaesophagus caused by Chagas disease. The hypothesis is that there is impairment of the pharyngeal phase of swallowing that may increase the risk of airway aspiration.MethodsA total of 29 patients, aged 48 - 73 years (mean: 63.8 ± 5.1 years), with dysphagia, radiological changes in the esophagus, and positive serologic test for Chagas disease, participated in the study. They were submitted to the videofluoroscopic evaluation of oral, pharyngeal, and esophageal phases, swallowing twice 10 mL of liquid and 10 mL of thickened barium boluses.ResultsThe most frequent findings were: oral residues and ineffective ejection in the oral phase; residues in vallecula, pharynx, and pyriform sinuses in the pharyngeal phase; abnormal esophageal motility, longer clearance, and longer transit in the esophageal phase. Laryngeal penetration was seen in 28% of the patients. Patients with increased esophageal diameter had more pharyngeal residues than patients without increased esophageal diameter. None of the patients had airway aspiration.ConclusionMegaesophagus caused by Chagas disease may affect all phases of swallowing, with an increase in oral and pharyngeal residues which suggest the impairment of oral and pharyngeal efficiency. None of the patients had airway aspiration.

Identification of proAKAP4 concentration variations in dromedary sperm and their correlation with monthly semen parameters.

ProAKAP4 is synthetized as a precursor polypeptide that must be converted into mature AKAP4 in living spermatozoa and is considered as a functional marker of spermatozoa. The gene is well-conserved in mammals although uncharacterized in Camelidae. In the present study, we investigate the expression metabolism of proAKAP4 and AKAP4 proteins and evaluate their seasonal dynamics relative to semen quality in dromedary camels. Semen parameters including volume and viscosity and characteristics of sperm including concentration, total production, total and progressive motility, vitality, acrosome integrity and morphological abnormalities were assessed in semen samples collected weekly from six camels during the rutting season, from November to April. Only total sperm production varied, peaking in January. Both the precursor proAKAP4 and AKAP4 proteins were investigated and shown to express biochemical properties similar to those described in other mammals. ProAKAP4 concentrations expressed in ng/10 million spermatozoa as assayed using a specific ELISA showed a strong positive correlation with ejaculate volume (P = 0.045), viscosity (P < 0.001) and sperm total motility (P = 0.049). Furthermore, their concentrations exhibited clear seasonal variations in camel semen. In conclusion, the assessment of proAKAP4 concentrations in camel sperm provides a novel parameter to assess sperm quality. Further studies should be performed to investigate proAKAP4 concentrations relative to fertility in Camelidae that may help to define the right time for mating and semen collection and increase the success of breeding programs.Lay summaryBreeding related to the seasons/time of year in the camel has been reported in several studies. A better knowledge of semen quality during the breeding season would assist in determining the best period for mating in camels. However, conventional sperm parameters are held to be unsatisfactory because they cannot predict breeding potential. ProAKAP4 a sperm-specific protein has been described as a functional marker of sperm and a key fertility marker in several species but has not been described in camels. Motility or membrane integrity parameters of semen collected throughout the breeding season and also the presence of proAKAP4 protein were investigated. ProAKAP4 was identified for the first time in camels and their concentrations exhibited clear seasonal variations in camel semen showing strong correlations with ejaculate volume and total motility and viscosity. Further studies should be performed to investigate proAKAP4 concentrations relative to fertility in camels to define the right time for mating and increase the success of breeding programs.

Effect of body condition score on the testicular biometrical measures, semen characteristics and testosterone level in jackass.

This study was undertaken to evaluate the effect of body condition score (BCS) on testicle and epididymis biometrics, semen characteristics and testosterone level in Egyptian Jack. This study was conducted on 50 mature Jacks divided according to their body condition score into four groups: Poor (G1), moderate (G2), good (G3) and fat (G4). The complete testis was collected immediately after execution in the Giza Zoo abattoir; then, the epididymis was carefully dissected at the testicular junction. Biometrical measures including length, weight and volume were determined for the right and left testis and epididymis. Also, epididymal sperm was collected from all examined animas and evaluated for sperm concentration, progressive motility, viability and sperm abnormalities. Serum samples were collected for determination of total testosterone level. Results showed that the body condition score of the examined animal affects their biometrical measure of testicles and epididymis. There is a significant decrease (p<.05) in biometrical measures for the testicles and epididymis, sperm concentration, motility, viability and testosterone level in poor BCS animals (G1). The highest values were recorded in Good BCS (G3) Jacks. Conclusion: Jacks with good BCS (G3) should be selected for breeding activity in donkey.

Chronic Diarrhea and Weight Loss in an 18-month-old Boy.

Chronic Diarrhea and Weight Loss in an 18-month-old Boy.