Combined Reflux Research Articles

High-performance solid-state asymmetric Supercapacitor based on α-Fe2O3/r-GO/GCN composite electrode material for energy storage application

Herein, a 3D/2D/2D of α-Fe2O3/r-GO/GCN composites were synthesized by combined reflux condensation and sonochemical-assisted wet-impregnation techniques. The physicochemical properties of the prepared materials were inspected by various analytical techniques. Morphology analysis techniques of different electron microscopes were employed to confirm the rhombohedral (3D) and two-dimensional (2D) sheets' morphology. The electrochemical behaviour of the as-synthesised electrode materials was assessed for use in a redox electrolyte-based energy storage system. Electrochemical measurements in a 6M KOH solution revealed that the electrode exhibited good supercapacitive behaviour. The 3D/2D/2D -α-Fe2O3/r-GO/GCN composite had a higher capacitance rate of roughly 810 F g−1 than α-Fe2O3 nanoparticles at 1Ag−1. From cyclic stability, ternary composite has good cyclic retention (98.9%) after 10,000 cycles at 10 Ag−1. The surface characteristics of metal oxide nanostructures and the efficient conductive networks of r-GO and GCN sheets are primarily responsible for the ternary α-Fe2O3/r-GO/GCN composite's superior electrochemical performance. Asymmetric supercapacitor (ASC) devices were constructed using 3D/2D/2D anodic material and activated carbon as a cathode material with a power density of 929 Wkg−1, energy density of 40 WhKg−1, and 92 % of capacity retention.

ОСОБЕННОСТИ НАРУШЕНИЙ МОТОРНОЙ ФУНКЦИИ ЖЕЛУДКА ПРИ ДИСРЕГЕНЕРАТОРНЫХ ИЗМЕНЕНИЯХ ЕГО СЛИЗИСТОЙ ОБОЛОЧКИ

The study was conducted at the Department and Clinic of Hospital Therapy of the Military Medical Academy. CM. Kirov. The work studied the relationship of motor disorders of the stomach with morphological changes in the gastric mucosa in 90 patients with chronic atrophic gastritis and 93 patients with chronic non-atrophic gastritis aged 20 to 73 years (the average age of patients was 52.7+1.7 years and 48.5+ 3.6 respectively). Motor disorders were characteristic of 87% of patients with chronic atrophic gastritis and 79.6% of patients with chronic non-atrophic gastritis. It was found that in patients with chronic atrophic gastritis significantly more often (p<0.01) than in patients with chronic non-atrophic gastritis, there was an insufficiency of the lower esophageal sphincter. At the same time, insufficiency of the pylorus in comparison with its spasm was significantly more often (p<0.01) detected in chronic atrophic gastritis. Duodenogastric reflux in combination with insufficiency of the lower esophageal sphincter in patients with chronic atrophic gastritis significantly more often (p<0.01) atrophy was observed in the body and antrum of the stomach. When atrophy was localized only in the antrum, pyloric insufficiency was observed significantly more often than spasm (p<0.01). Duodenogastric reflux in combination with insufficiency of lower esophageal sphincter in patients with chronic atrophic gastritis significantly more often (p<0,01) atrophy in the body and antral part of the stomach was observed. Thus, the relationship between insufficiency of the lower esophageal and pyloric sphincters with a diffuse atrophic process has been established.

O018 Determining the relationships between venous reflux patterns, clinical severity, and health-related quality of life

Abstract Introduction Various classification systems have been created to describe the anatomical distribution of venous reflux, including the VEIN-TERM and Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification. It is still unclear whether different reflux patterns correlate with health-related quality of life (HRQoL) and clinical severity. Methods Some 507 chronic venous disease patients and 105 asymptomatic controls underwent duplex ultrasound assessment. Patients were stratified according to VEIN-TERM and the CEAP classification systems. The Aberdeen Varicose Vein Questionnaire (AVVQ) score was used to compare HRQoL and the Venous Clinical Severity Score (VCSS) was used to compare clinical severity between groups. Results Patients were significantly older than controls (p<0.00001). All VEIN-TERM reflux patterns had significantly greater VCSS than no reflux (p<0.001). Superficial axial and combined axial reflux were associated with significantly greater VCSS than superficial segmental reflux (p<0.001, p=0.042 respectively). All VEIN-TERM reflux types had significantly worse AVVQ scores than no reflux (p<0.03). However, there were no significant differences in AVVQ scores across all VEIN-TERM reflux patterns. Most CEAP reflux patterns had increased VCSS and worse AVVQ scores when compared to no reflux (all p<0.05), except for deep reflux, and deep and perforator reflux only. The deep, superficial and perforator reflux group had significantly higher VCSS (p=0.013) and AVVQ (p<0.001) versus the superficial reflux only group. Conclusion When compared to no reflux, both classification systems show associations of any reflux pattern with worse VCSS and AVVQ scores. Combined reflux patterns were associated with the greatest clinical severity and worst HRQoL scores.

Hemodynamic and neurobiological factors for the development of chronic pelvic pain in patients with pelvic venous disorder

ObjectiveThe study was aimed at the identification of hemodynamic and neurobiological factors for the development of chronic pelvic pain (CPP) in patients with pelvic venous disorder (PeVD) using ultrasound, radionuclide, and enzyme immunoassay methods. MethodsThis cohort study included 110 consecutive patients with PeVD and 20 healthy controls. Seventy patients with PeVD had symptoms (CPP in 100% of cases, discomfort in hypogastrium, dyspareunia, vulvar varices, and dysuria), and 40 were asymptomatic. Patients underwent clinical examination, duplex ultrasound study of the pelvic veins and lower extremities, and single-photon emission computed tomography of the pelvic veins with in vivo labeled red blood cells. The prevalence, duration, severity, and pattern of reflux in the pelvic veins, as well as the severity of pelvic venous congestion, were evaluated. Healthy controls underwent only clinical and duplex ultrasound examination. All 130 patients were assessed using enzyme immunoassays to determine plasma levels of calcitonin gene-related peptide (CGRP) and substance P (SP). ResultsSymptomatic patients with PeVD had a higher prevalence of reflux in the ovarian veins (OVs) than asymptomatic ones (45.7% vs 10%, respectively; P = .001) and a greater reflux duration (4.1 ± 1.7 seconds vs 1.4 ± 0.3 seconds; P = .002), although no differences in the OV diameter were found. Similar results were obtained when comparing the diameters of the parametrial veins (PVs) and the duration of reflux in them. Type II/III reflux (greater than 2 seconds) was identified in 41.4% of symptomatic and in only 5% of asymptomatic patients (P = .001). Among patients with CPP, 24.2% had a combined reflux in the OVs, PVs, and uterine veins, and 45.7% had a combined reflux in the OVs and PVs, whereas 90% of patients without CPP had only an isolated reflux in the PVs. The pelvic venous congestion was moderate or severe in 95.7% of patients with CPP and in only 15% patients without CPP (P = .001). In patients with PeVD, the presence of CPP was associated with higher levels of CGRP and SP compared with asymptomatic patients (CGRP: 0.48 ± 0.06 vs 0.19 ± 0.02 ng/mL, respectively, P = .001; SP: 0.38 ± 0.08 vs 0.13 ± 0.03 ng/mL, P = .001). ConclusionsIn patients with PeVD, significant hemodynamic and neurobiological factors for the CPP development were found to be reflux in the pelvic veins greater than 2 seconds, involvement of several venous collectors, and increased plasma levels of CGRP and SP.

Consistency analysis of pepsin immunohistochemistry and pepsin test box in the diagnosis of laryngopharyngeal reflux

Objective:To analyze the consistency of pepsin assay kit, pepsin IHC, reflux symptom index（RSI） and reflux finding score（RFS） in the diagnosis of laryngopharyngeal reflux disease（LPRD）. Methods:The clinical data of 61 inpatients with laryngeal diseases who were admitted to the Department of Otolaryngology, the First Affiliated Hospital of Kunming Medical University from May 2020 to December 2021 were retrospectively analyzed. The RSI and RFS scores, the Formwitz score of pepsin immunohistochemistry, and the results of pepsin detection kit were recorded. ICC group correlation coefficient and Kappa consistency analysis was used for three detection methods. Results:Among 61 patients, 30 cases were positive and 31 cases were negative for the pepsin test kit, with a positive rate of 49.18%. The positive rate of pepsin immunohistochemistry was 45.90%（28/61）, and the diagnostic agreement rate between the two was 70.49%. The consistency between them was high（κ=0.409）. The positive rate of RSI and RFS in diagnosing LPRD was 62.30%（38/61）, and the consistency rate was 73.77% with pepsin detection kit. The consistency between them was high（κ=0.486）. Taking pepsin IHC as the reference standard, the sensitivity, specificity, positive predictive value and negative predictive value of pepsin detection kit were 71.43%（20/28）, 69.70%（23/33）, 66.67%（20/30） and 74.19%（23/31）, respectively. Using RSI and RFS scales as reference criteria, the sensitivity, specificity, positive predictive value and negative predictive value of pepsin detection kit were 89.29%（25/28）, 60.61%（20/33）, 65.79%（25/38） and 86.96%（20/23）, respectively. Analysis of correlation coefficient within ICC group: ICC value was 0.628, 95% confidence interval（0.497-0.741）, the three methods have good consistency. Conclusion:The RSI and RFS scale scores were in good agreement with the pepsin test kit, and the pepsin test kit was also in good agreement with pepsin immunohistochemistry. As a non-invasive diagnostic technique, the pepsin test kit can be widely used in the diagnosis of pharyngeal reflux in combination with pepsin immunohistochemistry and RSI and RFS scale.

Obscure Presentation of Postthrombotic Syndrome

Postthrombotic syndrome (PTS) will develop in 20% to 50% of patients within 1 to 2 years of symptomatic deep venous thrombosis (DVT). Limbs afflicted with PTS have more than three times the odds of having combined reflux and obstruction compared with limbs without PTS. Here, we present a case of an involvement of the right lower limb with classical features of PTS. Due to its low prevalence and similar presentations as those of chronic venous insufficiency lead to a missed diagnosis and prolonged follow up and complications of PTS. This can be prevented by employing CT venography as an early investigation modality. Here we treated the patient with open method as endovascular procedure was not successful.

Predictor properties of indicators of undifferentiated connective tissue dysplasia in children with gastroesophageal reflux for prediction of the development of heart rhythm and conduction disorders

The aim: to improve the early diagnosis of cardiac arrhythmia and conduction disorders in children with gastroesophageal reflux by studying the predictor properties of indicators of undifferentiated connective tissue dysplasia in this category of patients.
 Materials and methods. We examined 56 children aged 8 to 18 years, with an average age of 14.93±2.62 years, of which 28 children with gastroesophageal reflux in combination with cardiac arrhythmias and conduction disorders were divided into group I, and 28 children with only gastroesophageal reflux without heart rhythm and conduction disturbances – into group II (control). All examined patients underwent clinical and instrumental studies (electrocardiography, 24-hour ECG Holter monitoring, esophagogastroduodenoscopy and PH-metry) and an assessment of the phenotypic signs of undifferentiated connective tissue dysplasia according to the criteria of T. Milkovskaya-Dimitrova and A. Karkashov.
 Results. When analyzing the predictor properties of indicators of undifferentiated connective tissue dysplasia for predicting the development of cardiac arrhythmias and conduction disorders in children with gastroesophageal reflux, it was found that scoliotic posture had very high predictor properties (I=5.99), а high growth (I=1.94) and a short upper lip (I=1.17) – high, dysplastic tooth growth (I=0 .6) – moderate, and an abnormal shape of the auricles – low ones (I=0.27).
 Other indicators of undifferentiated connective tissue dysplasia did not have predictive properties at all: joint hypermobility (I=0.22), total number of signs of undifferentiated connective tissue dysplasia (I=0.11), asthenic type of constitution (I=0.11), flat feet (I=0.08), refractive errors (I=0.05), deviated septum of nose (I=0.03), dilated bridge of the nose (I=0.01), short neck (I=0.01).
 The mean value of the prognostic significance of indicators of undifferentiated connective tissue dysplasia was high (І̅=1,99).
 Conclusions. It was found that the mean value of the prognostic significance of indicators of undifferentiated connective tissue dysplasia was high (І̅=1,99).
 It was determined that arrhythmias and cardiac conduction disturbances in children with gastroesophageal reflux are associated with the presence of a scoliotic posture (І=5,99), high growth (І=1,94), dysplastic growth of teeth (І=0,6); in the absence of a short upper lip (І=1,17) and an abnormal shape of the auricles (І=0,27)

Predictive significance of the life history of children with gastroesophageal reflux for predicting the development of arrhythmias and conduction disorders

The aim: to improve the early diagnosis of cardiac arrhythmias and conduction disorders in children with gastroesophageal reflux, by studying the prognostic significance of the life history in this group of patients.
 Materials and methods. 56 children aged 8 to 18 years, mean age 14,93±2,62 years were examined. All examined children were divided into two alternative groups: Group I (main) was represented by 28 children with gastroesophageal reflux in combination with cardiac arrhythmias and conduction disorders, and Group II (control) - 28 children with only gastroesophageal reflux without cardiac arrhythmias and conduction disorders. Patients underwent clinical, anamnestic (with a detailed study of life history) and instrumental studies (electrocardiography, Holter daily ECG monitoring, esophagogastroduodenoscopy).
 Results. When analyzing the prognostic significance of the patient's life history, it was found that its very high level was observed for the number of foci of chronic infection (I=6.0) and the frequent incidence of a child up to year old of life (I=3.05).
 High prognostic value was registered relative to the number of diseases suffered by the child per year on average (I=2.35), and moderate predictor properties are characteristic of chickenpox (I=0.89) and the number of chronic diseases at present (I=0.71).
 The duration of breastfeeding showed low (I=0.30) prognostic significance.
 Suffered previously bacterial infections did not have predictor properties (I=0.12). In general, the prognostic significance of the patient's life history was high (I̅=2.20).
 Conclusions. It was found that in general the prognostic significance of the patient's life history was high (I̅=2.20)
 It is determined that in favour of the development of cardiac arrhythmias and conduction disorders evidence: the number of foci of chronic infection ≥1-2; lack of frequent morbidity in a child up to a year of life; the number of diseases suffered per year ≤5; the presence in past medical history of chickenpox; the number of chronic diseases in a child at present ≤2 and short-term (≤9 months) breastfeeding.
 It has been established what denies probability of development of the researched pathology: absence of the centers of a chronic infection; the presence frequent incidence of a child up to year old of life; the number of diseases suffered per year≥6, and chronic diseases at present ≥3; longer (≥9 months) breastfeeding and no history of chickenpox

PERINATAL AND HEREDITARY RISK FACTORS OF HEART RATE AND CONDUCTION DISORDERS IN CHILDREN WITH GASTROESOPHAGEAL REFLUX

Objective: to improve the early diagnosis of cardiac arrhythmias and conduction disorders in children with gastroesophageal reflux by evaluating hereditary and perinatal risk factors for this pathology. Materials and Methods. The study involved 56 children aged 8 to 18 years, with an average age of 13.67 ± 2.67 years; 28 children with gastroesophageal reflux in combination with arrhythmias and cardiac conduction disorder comprised Group I (the main group), and 28 children with only gastroesophageal reflux without disorders of heart rhythm and conduction comprised Group II (the control group). Patients underwent clinical, anamnestic (with special attention paid to hereditary and perinatal history) and instrumental studies (electrocardiography, 24-hour Holter ECG monitoring, esophagogastroduodenoscopy). Results. Genetic burden of cardiovascular disease was found in 57.1% of mothers and 42.9% of fathers of patients in the main group, which was significantly higher than that in the control group: by 3.2 times (17.9%; p ≤ 0.001) and 2 times (in 21.4%; p ≤ 0.05), respectively. Apart from that, stratification of the parameter by the number of chronic diseases, namely ≤ 1 and ≥ 2, in both parents, showed that fewer (≤ 1) chronic diseases were characteristic of mothers and fathers of the control group children and were registered in 53.5% and 58,9% of them, respectively, while in the main group, the proportion of such parents was lower: by 5 times (10.7%; p ≤ 0.001) and 1.8 times (32.1%; p ≤ 0.05), respectively. It was found that gravida 1 para 1 and gravida 2 para 2 mothers were significantly more common among those of patients in the control group (85.8% and 62.5%, respectively; p ≤ 0.05), while gravida 3 para 3 and more was typical for mothers of patients in the main group and were observed in 37.5% of them, while in the control group, this value was 2.6 times lower (14.2%; p ≤ 0.05). As for the parity, the first childbirth was reported in 64.3% of mothers in the main group and in 28.6% of mothers (2.2 times less often) in the control group (p ≤ 0.05); while multipara mothers were characteristic of the control group children (71.4%), which was 2 times more often than in the main group (35.7%; p ≤ 0.05). The risk factors of arrhythmias and cardiac conduction disorder were threatened miscarriage and toxemia in the first half of pregnancy. Thus, threatened miscarriage was reported in 46.4% of mothers of the main group children and was observed 2.2 times less often (21.4%; p ≤ 0.05) in the control group; toxemia in the first half of pregnancy was diagnosed in 50% of mothers of children in the main group and 2 times less often (in 25%; p ≤ 0.05) – in the control group. Another predictor of the studied pathology was the physiological course of childbirth. Complicated childbirth was observed in 60.7% of mothers in the main group and 1.9 times less often (32.9%; p ≤ 0.05) – in the control group. Relatively low (up to 3000 g) birthweight and fetal macrosomia (≥ 4000 g) also acted as risk factors. The proportion of patients with a bodyweight of up to 3000 g was 32.1% in the main group, and 3 times less (10.7%; p ≤ 0.05) – in the control group. The bodyweight of ≥ 4000 g (large fetus) was a specific feature of patients in the main group, as it was reported exclusively among them (17.9%) and was not observed in the control group (0%, p ≤ 0.001). Conclusions. It was revealed that the maternal and paternal genetic burden of cardiovascular diseases and the number of chronic diseases in parents were statistically significant hereditary risk factors for the development of arrhythmias and conduction disorders in children. It was found that statistically significant perinatal predictors of arrhythmias and conduction disorders in children with GER included threatened miscarriage; toxemia; multigravida and multipara status; complicated delivery; relatively low (up to 3000 g) birthweight and fetal macrosomia (≥ 4000 g).

Сapabilitу of 24-hour esophageal pH-impedance monitoring in the diagnosis of GERD-associated laryngeal diseases

Extraesophageal manifestations of gastroesophageal reflux disease (GERD), despite the improvement of methods of diagnosis and treatment of patients with this pathology, still remain an urgent problem of medicine and cause increased attention of clinicians and researchers. In some cases, patients with GERD do not present typical complaints of heartburn, regurgitation; the disease may manifest extraesophageal manifestations, such as chronic cough, hoarseness, reflux laryngitis, and others caused by the presence of laryngopharyngeal reflux (LFR) – inflammation of the mucous membrane of the upper digestive and respiratory tracts with possible morphological changes associated with direct and indirect (reflex) exposure to gastroduodenal reflux. The occurrence of LFR is possible due to a violation of the motor function of the esophagus and insufficiency of the upper esophageal sphincter, as well as a decrease in the tone of the pharyngeal muscles. The most accessible methods of diagnosis of LFR are registration of complaints according to the questionnaire “index of reflux symptoms”, assessment of the clinical and functional state of the larynx using a visually analog “scale of reflux signs”. A positive response to the empirical use of proton pump inhibitors in combination with procinetics and determination of pepsin content in saliva can also be alternative diagnostic methods. To date, 24-hour pH-impedance monitoring is a method that allows the most accurate diagnosis of all types of reflux, regardless of the pH value, to verify high reflux in combination with its physical properties, as well as to estimate the time of chemical and volumetric esophageal clearance. In addition to performing esophagogastroduodenoscopy, the use of this method is indicated in patients with suspected extraesophageal manifestations of GERD. The article presents clinical examples of patients with extraesophageal manifestations of GERD, describes the possibilities of 24-hour pH-impedance monitoring of the esophagus in the diagnosis of LFR and reflux-associated diseases of the larynx.

BLOOD ZINC LEVEL IN CHILDREN WITH COMBINED GASTROESOPHAGEAL REFLUX DISEASE AND CHRONIC GASTRODUODENAL PATHOLOGY

Pathology of the upper digestive tract is the most common among gastroenterological diseases in children of different ages and is 48-50 %. Recently, there has been an increase in combined lesions of the esophagus and organs of the gastroduodenal zone. Currently, microelements are considered to play a role in the etiopathogenesis of the diseases of the gastrointestinal tract. The aim of the work was to study zinc level in the blood of children with combined gastroesophageal reflux disease (GERD) and chronic gastroduodenal pathology. Materials and methods. 110 children with combined GERD and lesions of the gastroduodenal zone at the age of 10–18 years were under observation. In order to verify the diagnosis, esophagogastroduodenoscopy was performed. The level of zinc in the blood of children was studied using photometric method. Results. 52.5 % of children with concomitant GERD and chronic gastroduodenal pathologies had a reduced zinc level in the blood. According to the results of the study, the risk factors of zinc deficiency in children with combined pathology of the upper digestive tract include male sex, age older than 14 years, the duration of the disease longer than 3 years. The level of zinc in the blood of children was significantly reduced in destructive lesions of the esophagus, as well as with more pronounced inflammation of the gastric mucosa, in duodenitis and erosions in the duodenal bulb. Conclusions. Thus, the results of the study showed the importance of studying the level of zinc in the blood of patients with combined GERD and chronic gastroduodenal pathology to achieve positive changes by its correction. Zinc deficiency more often develops in boys over 14 year old, who has inflammatory changes of digestive tract.

Эхосонографическое исследование желудка у детей с сочетанными гастроэзофагеальной рефлюксной болезнью и хронической гастродуоденальной патологией

Эхосонографическое исследование желудка у детей с сочетанными гастроэзофагеальной рефлюксной болезнью и хронической гастродуоденальной патологией

PS01.065: MAGNETIC SPHINCTER AUGMENTATION AS AN EFFECTIVE ALTERNATIVE TO ROUX-EN-Y CONVERSION AFTER BILLROTH II GASTRECTOMY

Abstract Background Background and hypothesis Conversion into a 60 cm Roux-en-Y jejunal loop is the most common remedial procedure in patients with gastroesophageal reflux after Billroth II gastrectomy. While this allows diversion of bilio-pancreatic secretions, symptomatic acid reflux may persist in the presence of a mechanically incompetent lower esophageal sphincter. We hypothesized that magnetic sphincter augmentation (MSA) may relieve symptoms and control esophagitis by reducing both acid and biliary reflux. Methods Methods A 70 year-old male patient presented with intractable reflux symptoms and grade B esophagitis 46 years after partial gastrectomy and Billroth II reconstruction for perforated gastric ulcer. The patient underwent extensive diagnostic evaluation. There was a 3 cm hiatus hernia, grade B esophagitis, and hyperemia of the gastrojejunal anastomosis. Biopsies were negative for malignancy and Helicobacter Pylori. pH-impedance testing showed combined acid and non-acid reflux; esophageal peristalsis was normal on high-resolution manometry. After informed consent, the patient preferred the option of laparoscopic MSA versus open laparotomy and Roux-en-Y conversion. Pneumoperitoneum was established with a Hasson trocar. After adhesiolysis, a hiatus hernia with retroesophageal lipoma was identified. The gastroesophageal junction was completely reduced in the abdominal cavity and a posterior crural repair was performed. A tunnel was made between the esophageal wall and the posterior vagus nerve and a no. 16 MSA (Linx®) device was applied. Results Results The postoperative course was uneventful and the patient was discharged home on postoperative day one. At 1- and 6-month follow-up visit the patient was off-medication, tolerated a free diet, and did not complain of any reflux symptom. The mean GERD-HRQL score decreased from 26 to 2 compared to baseline. A barium swallow confirmed the complete reduction of the hiatal hernia and the absence of reflux in the Trendelenburg position. Esophagitis was completely healed. Conclusion Conclusions To the best of our knowledge, this is the first case of MSA implant for refractory gastroesophageal reflux disease after Billroth II gastrectomy. This simple laparoscopic procedure allowed correction of both acid and biliary reflux. Disclosure All authors have declared no conflicts of interest.

The role of сompression stockings in the complex treatment of reticular varicose veins and telangiectasias

Objective — compare the results of treatment reticular varicose veins and telangiectasias depending on the use of compression stockings or elastic bandage, determine the optimal duration of compression.Materials and methods. The study involved 67 patients aged 18 to 60 years with reticular varicose veins and telangiectasias who were treated with sclerotherapy and Müller mini­flebectomy with elastic bandaging or compressionstockings. The results of treatment evaluated in a month, 6 months, 1 year and 3 years.Results and discussion. In the group of patients who used elastic bandage during 1 month the relapse of reticular varicose was observed in 5 (17.9 %) cases, and in the group where compression stockings was used in 1 (2.56 %) case (p = 0.032). Patients who used elastic limb bandage for two weeks experienced the relapse in 2 (7.14 %) cases, patients who used compression for three weeks it occurred in 2 (7.14 %) cases and 1 (3.62 %) patients, who used it for 4 weeks, there was no statistically significant difference between subgroups. Relapse in the group with medical compression stocking occurred in the subgroup where medical compression was used for two weeks. The difference between the groups did not change in the 6­month, 1 year and three­year terms.Conclusions. The most stable result in treatment of reticular varicose veins and telangiectasia is provides minimally invasive surgical correction of venous reflux in combination with sclerotherapy and compression stockings. The use of compression stocking in comparison with the elastic bandage of the limbs gives long lasting result. Compression stocking is much easier and more accessible when used in outpatient surgery. It is advisable to continue the studies with a large number of patients to determine the optimal timing for the use of compression therapy.

Microwave assisted synthesis of zeolitic material from agricultural waste bagasse fly ash for the sorption of monocrotophos

The sorption of monocrotophos (MCP) from aqueous solution by native bagasse fly ash (BFA) and zeolitic material (MZBFA) synthesised by combined conventional and microwave reflux method was studied. These sorbents were characterised by XRF, PXRD, FTIR and SEM and were establish to have improved morphology with new crystalline phases. Batch sorption experiments for the removal of MCP by BFA and MZBFA were carried out to evaluate isotherm capacity and kinetics of sorption processes. The isotherm data proved to fit the Langmuir isotherm than that of Freundlich, Temkin and Dubinin-Radushkevich isotherms. The highest sorption capacity, calculated through the values of the isotherm constant Kf, was obtained for MZBFA. The kinetics data proved a closer fit to the pseudo-second order model. The kinetics data of intra particle diffusion confirmed that the sorption rate was controlled by film diffusion followed by pore diffusion.

PWE-085 Characterising Nocturnal and Daytime Gord Using Oesophageal High Resolution Manometry; A Retrospective Study

Introduction Patients suffering from gastro-oesophageal reflux disease (GORD) can be categorised into those suffering from a purely daytime (DAY), purely nocturnal (NOCT) or combined reflux pattern. Despite identifying a dominant pattern of reflux the treatment strategies are not specifically targeting a specific type reflux pattern. This may expose patients to treatments which may not necessarily be beneficial to that particular pattern of reflux. Possible factors affecting different patterns of reflux may include abnormal oesophageal motility, lower oesophageal sphincter (LOS) length, presence of a hiatus hernia or too short of a time gap between meal and sleep. We aimed to determine the mechanisms behind patients suffering from purely nocturnal reflux compared to purely daytime reflux. Methods Patients who underwent High Resolution Manometry (HRM) in an outpatients clinic from December 2014 to November 2015 were retrospectively grouped into those with purely nocturnal reflux and those with purely daytime reflux as measured by 24 hour ambulatory pH-impendance monitoring. Comparisons were made between the two groups using Fisher’s exact tests and receiver operating characteristic (ROC) curves for LOS baseline pressure, LOS length, meal-sleep time gap, presence of a hiatus hernia, oesophageal motility disorders, age and gender. A P value Results 62 patients with purely nocturnal reflux (median age 46.5, 27 male) and 32 patients with purely daytime reflux (median age 60, 15 male) were included. HRM diagnosis were not significantly different between these two groups (53% ineffective oesophageal motility (IOM) in NOCT and 50% IOM in DAY patients, P = 0.8). There was also no significant difference between the two groups in terms of prevalence of a hiatus hernia (P = 0.4), LOS length (P = 0.1), LOS mean or min baseline pressure (P = 0.6 for both). However, the meal-sleep time gap appeared to be significantly different between the DAY and NOCT group (148 ± 18 min in DAY vs 107 ± 9 min in NOCT, P = 0.03). Also, younger patients showed a significantly higher rate of nocturnal reflux ( Conclusion In this study we did not find any manometric parameter to be significantly predictive of being a NOCT or DAY patient. Nevertheless, further study is required to explore in more detail the effect of age on pattern of GORD. Previous literature have demonstrated the effect of the meal-sleep time gap which is also confirmed in this study. Disclosure of Interest None Declared

Clinical characteristics and psychosocial impact of different reflux time in gastroesophageal reflux disease patients.

Gastroesophageal reflux disease (GERD) is an emerging disease, and can impair quality of life and sleep. This study aimed to investigate whether GERD patients with different timings of reflux symptoms have different clinical characteristics. This study prospectively enrolled individuals who underwent upper gastrointestinal endoscopy during a health checkup. Each participant completed all questionnaires including Reflux Disease Questionnaire, Nighttime GERD questionnaire, Pittsburg Sleep Quality Index, Taiwanese Depression Questionnaire, and State-Trait Anxiety Inventory. Combined reflux was defined as the timing of reflux symptoms occurring at both daytime and nighttime. A total of 2604 participants were enrolled. Of them, 651 symptomatic GERD patients, according to the Reflux Disease Questionnaire score, were recruited for final analysis. Of them, 224 (34.4%) had erosive esophagitis on endoscopy. According to the timing of reflux symptoms, 184 (28.3%) were assigned to the daytime reflux group, 71 (10.9%) to the nighttime reflux group, and 396 (60.8%) to the combined reflux group. In post hoc analysis, the combined reflux group had a significantly higher Reflux Disease Questionnaire score than the daytime reflux group (p<0.0001). Combined and nighttime reflux groups had higher body mass index and longer duration (> 12years) of education than the daytime reflux group (p<0.05). There was no difference in Pittsburg Sleep Quality Index, Taiwanese Depression Questionnaire, and State-Trait Anxiety Inventory scores among three groups. GERD patients with combined daytime and nighttime reflux of have more troublesome symptoms than those with daytime reflux. GERD patients with different timings of reflux symptoms have different clinical characteristics in terms of body mass index and duration of education, but not in terms of esophageal inflammation, quality of sleep, and psychosocial status.

Survey of findings in patients having persistent heartburn on proton pump inhibitor therapy.

In patients with refractory heartburn while on proton pump inhibitor (PPI) therapy, changing drugs or increasing treatment to a twice a day (b.i.d.) dose has become a common practice. This study aims to study patients with persistent heartburn while on PPI therapy and to determine if persistent symptom indicates the need for more aggressive or different therapy. A retrospective review of impedance-pH tracings on PPI therapy (q.d. or b.i.d.) for patients with persistent heartburn was performed. DeMeester score, impedance, and symptom sensitive index (SSI) were used as indices. Statistical analyses were performed using chi-squared test with Yates correction and paired t-test. One hundred consecutive patients, (female 50%, male 50%, mean age 54 [range 16-83] years) were studied on q.d. (n = 45) or b.i.d. PPI (n = 55). Only 20% of the patients had abnormal DeMeester score; 41% had an abnormal impedance score and 56% had abnormal SSI; 29% had all indices normal. There was no difference between patients taking q.d. versus b.i.d. PPI for abnormal DeMeester score (22 vs. 18%), impedance (38 vs. 44%) and SSI (53 vs. 58%); P = 0.80, 0.69, and 0.77, respectively. In 56 patients with positive SSI, symptoms were due to acid reflux in 8 (14%) patients, nonacid reflux in 31 (55%) patients, and combined acid and nonacid reflux in 17 (30%) patients. Patients with persistent heartburn on PPI therapy show a variety of disorders: (i) acid reflux (20%); (ii) nonacid reflux (26%); (iii) positive SSI (56%); (iv) all normal indices (29%). These studies indicate that persistent heartburn on PPI therapy is a complex problem that may not respond to simply increasing acid inhibition.

Patient Symptoms Correlate Poorly with Objective Measures among Patients with Gastroesophageal Reflux Disease

Presentation of gastroesophageal reflux disease (GERD) varies among patients. To attempt to understand the patient's perception of the severity of their reflux symptoms, we developed a questionnaire on which patients rated symptom severity at each office visit. After receiving Institutional Review Board approval, we retrospectively reviewed patient charts of all patients seen by one surgeon for GERD symptoms and/or presence of hiatal hernia (HH) from September 2012 to April 2013. Data from patient questionnaires combined with objective findings from subsequent or prior workup and eventual operative information were recorded. A total of 144 questionnaires were reviewed from 108 patients. Frequencies were calculated for categorical variables. Patients were divided into four categories based on size of the HH on the endoscopic report; 10 patients had no HH, 15 had small HH, 20 had medium HH, and 31 patients had large HH. Size of HH was not available for three patients. Pre- and postoperative questionnaire responses were obtained for 15 patients. A combined reflux score was calculated using the median for each symptom. Patient perception of severity of symptoms does not necessarily predict presence of pathological reflux or HH nor is there a perfect combination of symptoms to predict the presence of pathological reflux or HH based on our sample. The workup of this pathology must be comprehensive, and the confirmation of reflux is imperative when the diagnosis is unclear.

Sorption of phosphamidon onto microwave synthesized zeolitic material

Bagasse fly ash (BFA) a sugar industry waste had been collected and converted to zeolitic material (MZBFA) by combined conventional and microwave reflux method. The synthesized sorbent has been characterized using various techniques such as FTIR, XRD, and SEM. BFA and MZBFA were used for the removal of phosphamidon (PSM), an organophosphorus pesticide from aqueous solution. The PSM sorption capacities of MZBFA and BFA were determined by batch sorption technique. Langmuir, Freundlich, Dubinin Redushkwich, and Temkin isotherms were estimated for the sorption nature and efficiency of sorbents. The sorption kinetics is better reflected by pseudo second order model and thermodynamics parameters exhibited specified endothermic nature of sorption. The overall sorption was approximated well by film diffusion at lower concentrations and pore diffusion at higher concentrations simultaneously. From the results, it was observed that MZBFA exhibited higher removal capacity than BFA. © 2013 American Institute of Chemical Engineers Environ Prog, 33: 114–122, 2014