Egg Beater Research Articles

Design and Application of Portable Centrifuge Inspired by a Hand-Powered Spinning Top.

Traditional centrifuges, extensively employed in biology, chemistry, medicine, and other domains for tasks such as blood separation and pathogen extraction, have certain limitations. Their high cost, substantial size, and reliance on electricity restrict their range of application. Contemporary centrifuges, inspired by everyday items like paper trays and egg beaters, boast characteristics such as ease of operation, independence from electricity, and portability. These features offer unique advantages in specific situations, such as electricity shortages, inadequate infrastructure, and challenging medical conditions. Consequently, we designed a hand-powered portable centrifuge driven by pulling a rope. Our experiments revealed significant performance factors, including load capacity, rope length, and frequency of rope pulling. The results demonstrated that the revolutions per minute (RPM) of a hand-powered portable centrifuge were directly proportional to the length of the rope and the frequency of pulling, up to a certain limit, while inversely proportional to the load. When used for separating and washing polystyrene microspheres, the portable centrifuge's performance equaled that of traditional centrifuges. According to relevant calculations, this centrifuge could be capable of meeting the application of blood separation. Therefore, we believe this portable centrifuge will find meaningful applications in similar areas, particularly in resource-poor settings.

Fall 1994, and: Then again, all things ((being equal))

Fall 1994, and: Then again, all things ((being equal)) Saleem Hue Penny (bio) Keywords poetry, Saleem Hue, Penny, disability poetry, erasure poem, dialect, car accident, Lowcountry poet, Deaf, erasure Fall 1994 To Whom It May Concern, I am grateful that my three children are thriving and flourishing at Heath-wood Hall Episcopal SchooI. The opportunity to attend your School has changed our lives. However, with the new dress code requirements it is difficult to buy polo shirts, khaki pants, a pair of brown shoes, and a pair of black shoes. for three children, since we are not wealthy. I am resourceful and do most of our clothing shopping at thrift stores. My pastor's wife distributed black and white flyers for discount purchases from the Children's Exchange clothing swap last Sunday. Unfortunately, I was unable to get enough clothes for my children to last them the full year it seems the word has caught on about the sale . Especially in this recession, everyone loves a bargain, even if they don't need it. I am writing to humbly ask for clothing assistance. Especially since they are each one of a handful of Black students in their respective grades, I am worried they will stick out. I want them to feel confident and secure. After recently stealing the gym uniform of my son, who is not the fastest, but is a kind, fair team player, a classmate then urinated on it. I appreciate Assistant Coach Williams swiftly replacing the shirt and shorts. However, it is disheartening that so many bystanders remained silent and only after two days of the class losing recess privileges did a student finally come forward. Head Coach Taylor allowed the student to remain anonymous. Avoiding additional embarrassment was a priority, so gym staff declined to inform the student's parents. Please consider my request for clothing assistance so my children (who take pride in their appearance) will be in compliance with the dress code. Your support will allow me to meet the basic needs of my family. I hope this letter finds you well. Sincerely, Ms. Olethea Penny [End Page 647] Then again, all things ((being equal)) after Jasper "Ninn" Washington (1937–2005)& Stacy "Tire Man" Washington (1975–2021 a quarter mile behind/ they see the popeye of the Cressida wagon's dusty tail light/ barrelingdown the road/ track rods shot, power steering grunts/ now, maybe one quarter of a mile, then she'll cutthe wheel hard/ clear the eroding culvert pipe, pull onto the side yard grass—that one perennially scorcheddiagonal patch/ let's move cuzzo, they back early from the store/ c'mon, push it, y'all—turbo boost time!/big league chew spit out/ like mike, rookie tongues out/ making whooshing sounds to go fast/ & faster/ still, like momma'n'them gone whup us/—make us hold still like—/ i don't wanna pick my own switch/dire reminders signal muscle reserves fire/ we spin our pedals/ like egg beater/ like cotton gin/ like don't say nothing, better keep on stirring/ you little boys weren't too tired to stealoff to Mr Joe's for candy?—no— so you better buck up, quit looking at me with them puppy dog eyes/ these beans ain't magic & caint shuck theyselves, & you ain't Jack … so they yes ma'am'ed/ stayed on task for/ almost a minute and a half/hours await/ summer sadness blossoms from the bottomlessness of their buckets/competing with cicadas screeching across the creek/ their gaze keeps drifting/ something summoning them to go/ back [End Page 648] down the road/ see if auntie's mailbox really did get baseball-batted-in last night/the family used to all be here … / but again & again, kinkeep going down the road/ (pulled, tugged, yanked, who knows?)/ the unspoken we cannot hold: how last week, those crackerschased Uncle Jasper straight into that hairpin/ bald wheels too old togrip/ too broke for anti-lock brakes, so he just went into the ditch/—(this the script the adults voted to tell the kids)/— the string bean boys slide their buckets close, lean in like, you thinkthe grownups...

Femoral acetabular impingement labral pathology on MRI is correlated with greater hip flexion and decreased abduction in collegiate water polo players: A pilot study

ObjectivesFemoroacetabular impingement (FAI) morphology is associated with hip pain and disability. Water polo players utilise the egg beater motion (method of treading water with legs rotating like an “egg beater”), and it is currently unclear what the relationship is between an egg beater and FAI morphology. Our objective was to associate hip range of motion during egg beater motion to MRI findings. MethodsEight National Collegiate Athletic Association (NCAA) Division 1 varsity water polo athletes (5 females and 3 males) were filmed at orthogonal views performing the egg beater motion using two waterproof cameras in synchrony. A model-based image-matching technique was used to determine hip joint angles which were recorded from the software. These athletes also underwent noncontrast MRI scans of both hips using a 3T MRI scanner and completed an 33-item International Hip Outcome Tool (iHOT-33) hip pain outcomes questionnaire. Descriptive statistics are reported as counts and percentages for categorical variables and as means, standard deviations, and a five-number summary for continuous variables. Relationships between the range of motion measures with MRI measures and with iHOT33 scores were analysed using linear regression models. All statistical analyses were completes using a two-sided level of significance of 0.05. ResultsThe average alpha angles for the right and left hips were 71.80 ±7.50 and 74.10 ±8.40, respectively. There was no statistically significant correlation between hip range of motion in any plane and alpha angle or lateral centre edge angle (CEA) on MRI. The average iHOT33 was 85.9 ± 18.9. Participants who had a labral tear had significantly smaller hip abduction ranges than participants who did not have a labral tear (29° ± 4.1 vs. 35.3° ± 0.6, p = 0.02), and those who had a labral tear had significantly increased hip flexion during egg beater kicking as compared with participants who did not have a labral tear (28.2° ± 6.1 vs. 16.3° ± 4, p = 0.02). There were no differences between right and left alpha angles or between right and left CEA. ConclusionThere were no significant correlations between hip range of motion and alpha angle or CEA, but hips with labral pathology had greater hip flexion and more limited hip abduction ranges.

1248 Late Onset Rapid Gastric Emptying: A New Entity to Explain Post-Prandial Symptoms

INTRODUCTION: Symptomatic patients with a suspected upper GI dysmotility disorder may have a normal 4 hour gastric emptying (GE) using the standardized radioisotope labeled egg beater meal methodology and do not meet criteria for the diagnosis of either delayed or rapid gastric emptying. We propose conservative thresholds to identify abnormal gastric emptying patterns among such symptomatic patients determined to have normal gastric emptying (NGE) in order to classify a subset as meeting criteria for a new entity, late-onset rapid gastric emptying (LRGE). METHODS: We recruited and conducted IRB approved standardized 4-h GE studies on 19 healthy normal subjects (Mean age 49, 68% females, 68% Hispanics) and in 425 patients (Mean age 51, 80% females, 69% Hispanics, and 33% with diabetes) who had symptoms suggesting an upper GI dysmotility disorder and referred for a standardized 4-h GES from 2009 to 2015. Patients had postprandial symptoms ranging from nausea, early satiety, fullness, epigastric pain, stool urgency, and bloating. Their GES was reported as normal based on no rapid gastric emptying at 1 h or delayed GE at 2 or 4 hrs. The 95% upper reference limits for the decrement percentages in gastric retention values from 1-2 h, 2-3 h and 3-4 h were determined using normal distribution in the 19 healthy normal subjects. These thresholds were applied to from the 425 NGE patients referred from 2009-2015. A 95% confidence interval (CI) of LRGE prevalence was determined. RESULTS: Approximately 5% of patients who had normal standardized 4-h GES results had an abnormal GE pattern based on the proposed criteria for late-onset rapid gastric emptying. Our data raises awareness to apply the gastric emptying decrement cut offs we have established to identify the diagnosis of LRGE in patients who otherwise would be interpreted as having normal GE and this will enable an explanation and management for their postprandial symptom profile. CONCLUSION: Approximately 5% of patients who had normal standardized 4-h GES results had an abnormal GE pattern based on the proposed criteria for late-onset rapid gastric emptying. Our data raises awareness to apply the gastric emptying decrement cut offs we have established to identify the diagnosis of LRGE in patients who otherwise would be interpreted as having normal GE and this will enable an explanation and management for their postprandial symptom profile.

Medical Care of the Aquatics Athlete.

Competitive swimmers are affected by several musculoskeletal and medical complaints that are unique to the sport. 'Swimmer's shoulder,' the most common overuse injury, is usually caused by some combination of impingement, rotator cuff tendinopathy, scapular dyskinesis, and instability. The condition may be treated with training modifications, stroke error correction, and strengthening exercises targeting the rotator cuff, scapular stabilizers, and core. Implementation of prevention programs to reduce the prevalence of shoulder pathology is crucial. Knee pain usually results from the breaststroke kick in swimmers, and the 'egg beater' kick in water polo players and synchronized swimmers. Lumbar back pain also is common in aquatics athletes. Among the medical conditions of particular importance in swimmers are exercise-induced bronchoconstriction, respiratory illnesses, and ear problems. Participants in other aquatics sports (water polo, diving, synchronized swimming, and open water swimming) may experience medical ailments specific to the sport.

On-site sampling and sample-preparation approach with a portable sampler based on hollow-fiber/graphene bars for the microextraction of nitrobenzene compounds in lake water.

A novel on-site sampling and sample-preparation approach was developed and evaluated in the present work. In this procedure, hollow-fiber/graphene bars (HF/GBs) were used for sampling and sample preparation. A handheld battery-operated electric egg beater was utilized to support the HF/GBs and stir the sample solution to facilitate extraction at the sampling site. Four nitrobenzene compounds (nitrobenzene, o-nitrophenol, m-nitrophenol, and p-nitrophenol) were used as model compounds. Several factors affecting performance, including types and amount of graphene used and extraction and desorption times, were investigated and optimized in the laboratory. Under optimized conditions, the enrichment factors of the four nitrobenzene compounds ranged from 46 to 69. Good linearities of 0.01-10 μg/mL with regression coefficients between 0.9917 and 0.9973 were obtained for all analytes. The LOD of the method was 0.3 ng/mL. Satisfactory recoveries (98-102%) and precision (1.0-5.8%) were also achieved. The ultrastructures and extraction mechanism of the HF/GBs were characterized and analyzed. The proposed approach coupled with high-performance liquid chromatography was successfully applied in the extraction and determination of trace nitrobenzene compounds in lake water. Experimental results showed that the approach is simple, convenient, rapid, and practical for routine environmental monitoring.

Effects of egg ingestion on endothelial function in adults with coronary artery disease: A randomized, controlled, crossover trial

Prevailing recommendations call for restricting intake of dietary cholesterol and eggs for those at risk of heart disease, despite accumulating evidence challenging this association. Our prior studies showed no short-term adverse effects of daily egg intake on cardiac risk factors in at-risk adults. We conducted this study to determine effects of daily egg consumption in adults with established coronary artery disease (CAD). Randomized, controlled, single-blind, crossover trial of 32 adults (mean age, 67 years; 6 women, 26 men) with CAD assigned to 1 of 6 possible sequence permutations of 3 different treatments (breakfast with 2 eggs, breakfast with ½ cup Egg Beaters, ConAgra Foods, St. Louis, MO, or a high-carbohydrate breakfast part of an ad libitum diet) for 6 weeks, with 4-week washout periods. The primary outcome measure was endothelial function measured as flow-mediated dilatation. Compared with the control breakfast (ie, high-carbohydrate breakfast), daily consumption of eggs showed no adverse effects on flow-mediated dilatation (7.2% ± 2.9% vs 7.5% ± 2.9%, P = .33), lipids (total cholesterol: 158.3 ± 28.6 mg/dL vs 156.2 ± 27.4 mg/dL, P = .49), blood pressure (systolic blood pressure: 132.8 ± 14.1 mm Hg or vs 135.5 ± 14.9 mm Hg, P = .52; diastolic blood pressure: 77.2 ± 6.1 mm Hg vs 76.7 ± 6.9 mm Hg, P = .86), or body weight (90.8 ± 17.5 kg vs 91.8 ± 17.1 kg, P = .92). No outcomes differed (P > .05) between eggs and Egg Beaters. We found no evidence of adverse effects of daily egg ingestion on any cardiac risk factors in adults with CAD over a span of 6 weeks.

A Lower Calorie Egg Whites Breakfast is as Satiating as a Higher Calorie Whole Eggs Breakfast

Eggs are a highly satiating food. Egg whites (EW), due to greater protein and volume per kcal, may offer similar satiety with fewer calories than eggs (E). Fifty three men and women (ages 39 ± 10, BMI 22 ± 2) consumed each of two breakfasts: 2 slices toast, 10 g margarine, 284 mL non‐caloric beverage and either 141 mL EW (Egg Beaters® Original, ConAgra Foods), cooked (70 kcal, 15 g protein, 0.5 g fat) or 97 mL E, cooked (2 large eggs equivalent, 140 kcal, 13 g protein, 9.5 g fat). E breakfast provided 330 kcal, and EW breakfast provided 70 kcal less, 260 kcal. Ad libitum lunch was consumed 3 hours after the test meal. Equal satiety of the EW and E breakfast meals was observed as indicated by no difference (p >; 0.05) in 10 cm visual analog scale ratings before lunch for hunger (4.8 vs. 4.9), fullness (3.8 vs. 3.8), and lunch energy consumption (582 ± 305 vs. 575 ± 315 kcal), respectively. These data indicate that an EW serving providing half the calories, similar protein, and 45% greater volume is as satiating as E, resulting in reduced short‐term energy intake from breakfast and lunch combined.

Effects of Egg Ingestion on Endothelial Function in Adults with Coronary Artery Disease: A Randomized, Controlled, Crossover Trial

ObjectiveTo determine effects of daily egg consumption on endothelial function, biomarkers, and anthropometric measures in individuals with coronary disease (CHD).MethodsThis was a randomized, controlled, single‐blind, crossover trial. Thirty‐two participants (mean age 67 years; 6 women and 26 men) with CHD were randomly assigned to one of 6 possible sequence permutations of 3 different treatments (breakfast with 2 eggs, ½ cup Egg Beaters, or a high‐carbohydrate breakfast as part of an ad libitum diet) for 6 weeks. The primary outcome measure was endothelial function measured as flow mediated dilatation (FMD).ResultsAs compared to the control breakfast, daily consumption of eggs showed no adverse effects on FMD (7.2 ± 2.9% vs. 7.5 ± 2.9%; p=0.33), lipids (total cholesterol: 158.3 ± 28.6 mg/dL vs. 156.2 ± 27.4mg/dL; p=0.49), blood pressure (systolic BP: 132.8 ± 14.1 mmHg or vs. 135.5 ± 14.9mmHg; p=0.52, diastolic BP: 77.2 ± 6.1 mmHg vs. 76.7 ± 6.9 mmHg; p=0.86) or body weight (90.8 ± 17.5 kg vs. 91.8 ± 17.1 kg; p= 0.92). Outcomes did not differ between eggs and Egg Beaters.ConclusionsOur findings, and the overall weight of evidence, argue against the exclusion of eggs from heart‐healthy diets, even among those with actual coronary disease.The source of research support:the Egg Nutrition Center/America Egg Board and Centers for Disease Control and Prevention.

Characterization of lipids and antioxidant capacity of novel nutraceutical egg products developed with omega‐3‐rich oils

Cardiovascular disease has had an unquestioned status of the number one cause of death in the US since 1921. Omega-3 polyunsaturated fatty acids (ω-3 PUFAs) have cardio-protective benefits. However, egg is typically a poor source of ω-3 PUFAs and, in general, the American diet is low in these cardio-protective fatty acids. Novel, nutritionally enhanced egg products were developed by substituting yolk with ω-3 PUFA-rich flaxseed, menhaden, algae, or krill oil. Experimental egg products matched composition of hen egg (whole egg). The experimental egg products, mixed whole egg, and a liquid egg product (Egg Beaters) were microwave-cooked and compared. Although fat, protein, and moisture contents of experimental egg products matched (P > 0.05) mixed whole egg, experimental egg products had more (P < 0.05) ω-3 PUFAs, lower (P < 0.05) ω-6/ω-3 ratio, and depending on oil added, a higher (P < 0.05) unsaturated/saturated fatty acids ratio compared to mixed whole egg. Triglycerides were the main lipid class in all experimental egg products except those developed with krill oil, which had even more phospholipids than mixed whole egg. Analysis of thiobarbituric acid reactive substances showed that lipid oxidation of experimental egg products was lower (P < 0.05) or similar (P > 0.05) to mixed whole egg, except for experimental egg products with krill oil. However, peroxide value showed that all egg samples had minimal oxidation. Experimental egg products developed with menhaden or flaxseed oil had the highest (P < 0.05) concentration of the antioxidant, ethyoxquin compared to all other egg samples. However, experimental egg products with krill oil likely contained a natural antioxidant, astaxanthin. This study demonstrated an alternative approach to developing novel, nutraceutical egg products. Instead of dietary modification of chicken feed, yolk substitution with ω-3 PUFAs oils resulted in enhancement of ω-3 PUFAs beyond levels possible to achieve by modifying chicken feed.

Can Gastrointestinal Clinical Presentation Predict Gastroparesis: Results From a Tertiary Referral Center

Background: Gastroparesis can have varied clinical presentation. There are no well defined clinical parameters for predicting gastroparesis in patients presentingwith different gastrointestinal symptoms. Aims: To assess clinical predictors of gastroparesis in a large cohort of patients undergoing gastric emptying test Methods: A retrospective chart review of patients referred to our tertiary care center with presumed diagnosis of gastroparesis and various combinations of abdominal symptoms (nausea, vomiting, abdominal pain, bloating, post parandial fullness and early satiety) were included. All patients underwent a standardized 4-hrs scintigraphic gastric emptying test (GET) consisting of low-fat (2%) isotope labeled egg beaters meal of 250 kcal at our center. Patient demographics, medical/surgical history, drug use (affecting gastric/GI motility), proton pump inhibitor (PPI) use, endoscopic findings and results of hydrogen breath test were noted. Patients with previous history of gastric or small bowel resection, IBD, significant co-morbidities (end stage liver, kidney disease) were excluded. A univariate analysis was performed using Fisher's exact to evaluate predictors of gastroparesis, variables with a significance (p<0.05) were further evaluated using a multivariate logistic regressions model to identify independent predictors for gastroparesis. Results: 217 patients (mean age 46 yrs, 77% females, 83% Caucasians, average BMI 29 kg/m2, 18% smoker and 32% alcohol use history) were included. The frequency of gastrointestinal symptoms were: nausea 70%, abdominal pain 54%, vomiting 45%, bloating 34%, early satiety 14%, constipation 35%, and associated heart burn or acid reflux 40% and weight loss 30%. Diabetes mellitus (DM type 1 and 2) were present in 25% patients, 30 % had cholecystectomy history and 37% carried a diagnosis of depression. A total of 42% (92) patients had DGE (mild = 53%, moderate = 31%, severe = 16%) and of these 33% had diabetic gastroparesis and rest had idiopathic gastroparesis. In univariate analysis presence of nausea, DM, chronic use of PPIs were significant predictors for delayed gastric emptying (DGE), however, in multivariate analysis there was no independent clinical variable that predicted DGE, Table 1. Similarly, in patients with DM no clinical predictors for presence of DGE were identified. The number of patients with moderate and severe delay in gastric emptying was comparable between diabetic gastroparesis and idiopathic gastroparesis patients: moderate 30% vs. 31% and severe 16% vs. 18 %, respectively. Conclusion: In a large cohort of patients presenting with varied gastrointestinal symptoms, there was no independent clinical factor that predicted gastroparesis. Future RCTs are needed to confirm these findings. Clinical parameters in patients with delayed and normal gastric emptying

Autonomic nerve function in adult patients with cyclic vomiting syndrome

Cyclic vomiting syndrome (CVS) in adults is a disorder characterized by recurrent and stereotypic episodes of severe nausea and vomiting separated by symptom-free periods. Autonomic dysfunction has been a postulated mechanism for the pathogenesis of this disorder in children but has not been explored in adults. Our goals were to investigate autonomic nerve function in adult patients with CVS. The sympathetic nervous system was evaluated through postural changes in heart rate and blood pressure and sympathetic skin response in the hand and foot. The parasympathetic nervous system was tested through heart rate response to deep breathing [expiration/inspiration (E/I)], Valsalva and postural indices (30 : 15 ratio). All patients had a 4-h standard isotope labeled egg beater meal gastric emptying test (GET). Twenty-two adult (18 female), mean age 35 ± 11 (range 19-61 years), who met Rome III criteria for CVS were included. History of migraine headache was reported in three patients. Five (23%) had pediatric onset. Of 21 patients who completed the test, nine patients had 21 abnormalities detected in their autonomic nerve testing profile and the remaining 12 had normal autonomic function results. Orthostatic tachycardia was observed in two (mean heart rate increase 39 beats min(-1)) and a decline in blood pressure (BP) in three patients (mean BP drop 30/14 mmHg). Parasympathetic abnormalities were elicited in six patients with an abnormal response to deep breathing and E/I index <1.25. Sympathetic nerve dysfunction was reported in seven patients with absent sympathetic skin response in the foot and/or hand. Twelve (57%) of CVS group had rapid GET (<50% retention at 1 h). The frequency of abnormal autonomic nerve function was not significantly higher in rapid GET subgroup. (i) Autonomic nerve dysfunction is common in adult CVS patients, being observed in 43% of our cohort; (ii) Sympathetic abnormalities dominate; and (iii) Rapid gastric emptying, present in 57% of patients, did not correlate with autonomic testing results. These new data provide more insight into the pathophysiology of CVS in adults and help explain the spectrum of clinical manifestations observed in this entity.

Does Grading the Severity of Gastroparesis Based on Scintigraphic Gastric Emptying Predict the Treatment Outcome of Patients with Gastroparesis?

The objectives of this study were as follows: (1) Whether gastric emptying is different between gastroparesis (GP) patients responding or not responding to standard medical therapy; (2) Identifying if mild, moderate, and severe degrees of gastroparesis based on the scintigraphic gastric emptying test (GET) can predict treatment responses for GP of diabetic (DM) and idiopathic (ID) origin. A total of 165 patients (119 F) diagnosed with GP [126 (76%) DM, 39 (24%) ID etiology] failed medical treatment and required the gastric electrical stimulation (GES) device (GES group). In addition, 112 patients (89 F) [37 (33%) DM, 75 (67%) ID] with GP who symptomatically responded to medical therapies are the comparison group (MED GP). All patients underwent a standardized scintigraphic GET consisting of low-fat (2%) isotope labeled egg beaters meal of 250 kcal. We also analyzed the GET data to find cut-off points for different degrees of GP and identified mild (11-20% retention), moderate (21-35%), and severe gastroparesis (>35%) based on percent retention of isotope at 4 h. Overall gastric retention at 4 h was significantly greater in the GES group (45±1.9%) than MED GP (30±2%) (p<0.001). The distribution severity of the GET was different in GES-treated patients than MED treated (p<0.001). In the diabetics, 57% of GES patients retained >35% after 4 h (severe) similar to 43% in the DM MED group. However, 50% of the ID GES patients had retention>35% at 4 h significantly more than only 17% of ID MED GP. Significantly more ID patients who responded to medical therapy had mild gastroparesis and significantly more requiring GES had severe GET (p<0.05). (1) GET in patients whose GP symptoms were refractory to standard medical therapy and required GES was significantly slower than in GP patients whose symptoms responded to medical therapy. (2) Stratifying GET into mild, moderate, and severe degrees of gastric retention does not predict whether a medical or surgical approach will be better to control the symptoms of diabetic GP but does correlate with treatment for the idiopathic GP subgroup.

Gastric Emptying

Gastric Emptying

W2081 Neuropathic Pseudoobstruction a Frequent Cause of Nausea, Vomiting and Abdominal Pain

Background: Antroduodenal manometry (ADM) allows assessment of neural control and smooth muscle response throughout the stomach and small intestine. Patients with altered neural control of motility consistent with neuropathic pseudoobstruction present a therapeutic challenge. The Aim of this study was to determine 1) if the symptoms of gastroparesis, nausea (N), vomiting (V) or abdominal pain (AP), were associated with abnormal small intestinal motility and 2) the effect of altered small bowel function on gastric emptying and small bowel bacterial overgrowth (SBBO). Methods 174 ADM studies performed for the evaluation of moderate to severe upper GI symptoms, including N, V or AP, were analyzed for a presence of neuropathic pseudo-obstruction. ADM was performed during 3 hours of fasting and followed by sequential stimulation with erythromycin (ERY) and octreotide (OCT). Neuropathic pseudo-obstruction was defined as abnormal duodenal contractions during fasting (cluster, retrograde, or disorganized contractions with normal or increased amplitude). Gastric emptying (standardized egg beater meal) (47/50 patients) and lactulose breath testing (Quintron)(34/50 patients) were recorded. Results are expressed as mean + SEM. Results: Neuropathic pseudo-obstruction was seen on 28.7% of ADM studies. 70% of patients were female with a mean age 45.9 + 2.2 and BMI 25.6 + 0.8. Six patients (12%) had diabetes mellitus. 17 patients (34%) had previous abdominal surgery. Symptoms at the time of clinical evaluation were N/V (72%), AP (56%), and bloating/fullness (28%). Change in bowel habits was observed in 15 patients diarrhea in 6 patients (12%) and constipation in 9 patients (18%). During fasting none of the 50 patients had duodenal MMC activity. ERY stimulated antral contractions in 40 patients (80%). OCT stimulated duodenal contractions in 45/50 patients (90%). Mean 2 and 4 hour gastric retention were 48.6% + 4.2% and 22.0% + 3.3%, respectively. Eleven patients (22%) had rapid gastric empting (gastric retention at 2 hours less or equal 15%). 27 patients (57.4%) had delayed gastric emptying (gastric retention at 4 hours > 10%). A lactulose breath test showed small bowel bacterial overgrowth (SBBO) in 21/34 patients (61.7%). Conclusions: N, V with AP are frequently associated with an altered ADM consistent with neuropathic pseudoobstruction. Gastric emptying is variable in patients with these symptoms. SBBO is present in a large number of patients with disturbed intestinal motility. Thus, a disturbed intestinal motility pattern can be a major cause of severe N,V, and abdominal pain, even in patients with normal or rapid gastric emptying.

Egg beater as centrifuge: isolating human blood plasma from whole blood in resource-poor settings

This paper demonstrates that a hand-powered egg beater can be modified to serve as a centrifuge for separating plasma from human whole blood. Immunoassays used to diagnose infectious diseases often require plasma from whole blood, and obtaining plasma typically requires electrically-powered centrifuges, which are not widely available in resource-limited settings. Human whole blood was loaded into polyethylene (PE) tubing, and the tubing was attached to the paddle of an egg beater. Spinning the paddle pelleted the blood cells to the distal end of the PE tubing; the plasma remained as the supernatant. A cholesterol assay (run on patterned paper) demonstrated the suitability of this plasma for use in diagnostic assays. The physics of the system was also analyzed as a guide for the selection of other rotating systems for use in centrifugation. Egg beaters, polyethylene tubing, and paper are readily available devices and supplies that can facilitate the use of point-of-care diagnostics at sites far from centralized laboratory facilities.

Prevalence of Gall Bladder Dyskinesia in Gastroparesis

Purpose: The aim of this study is to assess the gall bladder ejection fraction (GBEF) by cholescintigraphy in a cohort of gastroparetic patients with prominent postprandial abdominal pain. Methods: 17 patients with gastroparesis (14 females) underwent the hydroxyl iminodiacetic acid (HIDA) scan to measure their GBEF over the last 2 years. A GBEF between 35%–50% on the HIDA scan was considered as a borderline positive test for gall bladder dysmotility and a GBEF < 35% was considered as definite evidence of gall bladder dyskinesia. Gastroparesis for this study was defined as retention of >10% of a standardized low fat isotope labeled egg beater meal at the end of 4 hours by scintigraphy. Demographic data, the etiology of gastroparesis, duration of gastroparetic symptoms, and bowel movement pattern were also recorded. Results: 11/17 (65%) of patients had a GBEF of < 50%, 8 of these patients had definite evidence of gall bladder dyskinesia, while the other 3 had a borderline positive test. 7/8 patients with a definitely positive test underwent cholecystectomy, of which 5 had chronic cholecystitis on pathology. 6/7 patients reported improvement in pain after the cholecystectomy. None of the patients with borderline evidence of gall bladder dysmotilily underwent cholecystectomy. Clinical characteristics of patients are summarized in table. There was no significant difference (p > 0.05) in age, or duration of gastroparetic symptoms in patients with normal and abnormal gall bladder ejection fraction. Gall bladder dysmotility was numerically more likely in females (OR 5; 95% CI: 0.35–72%), idiopathic gastroparesis (OR 5; 95% CI: 0.6–46), and in patients with constipation (OR 2; 95% CI: 0.2–13) Conclusion: 1) This pilot study shows that gall bladder dysmotility is present in a majority of patients with gastroparesis; particularly of idiopathic etiology 2) Underlying neuromuscular dysfunction in gastroparesis may also extend to the gall bladder, consistent with a neuropathic etiology to explain the gall bladder dyskinesia. 3) Appreciating the need to diagnose and treat biliary dyskinesia in gastroparesis could be an important strategy to address the pain component in this challenging clinical setting.Table: Clinical Characteristics of gastroparetic patients who underwent HIDA scan

ENDOSCOPIC PYLORIC INJECTION OF BOTULINUM TOXIN FOR THE TREATMENT OF POSTVAGOTOMY GASTROPARESIS.

Background Gastroparesis is a common clinical condition characterized by nausea, vomiting, abdominal pain, postprandial fullness, loss of appetite, and, in severe cases, malnutrition. It is more prevalent in women, and common etiologies include diabetes, postsurgical usually secondary to a vagotomy and/or gastric resections, and idiopathic. Therapy includes prokinetic agents such as metoclopramide, domperidone, erythromycin, and nutritional support. Recently, botulinum toxin injected into the pylorus is being used to treat refractory gastroparesis, which is idiopathic or secondary to diabetes. Little is known about its efficacy in postsurgical gastroparesis due to vagal nerve and where in the past a surgical pyloroplasty would have been considered. Aims of the Study To evaluate the efficacy of endoscopic injection of botulinum toxin injection into the pylorus of the stomach in patients with postsurgical gastroparesis. Methods This open-labeled trial identified and recruited 11 patients who developed symptomatic gastroparesis after a surgical procedure (10 fundoplication, 1 exploratory laparoscopy). Gastroparesis was defined as an abnormal solid-phase gastric emptying test using the standardized 4-hour radionuclide egg beater meal method. Eight patients had vagal nerve injury documented by sham meal testing. Subjects were being followed in the gastrointestinal motility clinic and completed at least the sixth month follow-up visit after their pylorus was injected with botulinum toxin injection in a four-quadrant manner. Patients either received 100 (n = 2) or 200 (n = 9) units of botulinum toxin. Questionnaires recorded symptom severity beginning at baseline prior to the injection and at monthly intervals for the next 6 months. Nausea, vomiting, abdominal pain, early satiety, loss of appetite, and weight loss were scored on a scale of 0 to 5 for severity. All but one patient completed the questionnaire. Results Seven females and three males (age range 31-84 years) finished the sixth month follow-up visit. The mean symptom score prior to therapy was 18 ± 5.8 (1 SD) and showed a consistent and significant (p Conclusions Endoscopic injection of botulinum toxin in the pylorus appears to be a safe and effective addition to the therapeutic armamentarium for refractory postvagotomy gastroparesis. Randomized trials with botulinum toxin injections seem warranted in this subset of gastroparesis.

Egg Beaters

Egg Beaters

Delayed Gastric Emptying in Gastroesophageal Reflux Disease: Reassessment with New Methods and Symptomatic Correlations

Previous studies have shown that patients with gastroesophageal reflux disease (GERD) have slower rates of gastric emptying than control subjects, but the prevalence has differed because of variations in methodology. The recent establishment of international control values for scintigraphic gastric emptying assessment makes standardization of this technique possible. It would also be useful to determine whether specific gastrointestinal symptoms predicted delayed gastric emptying in GERD. Forty-nine patients (mean age, 42.9 years; range, 24-65 years; 35 women, 14 men) who were diagnosed with GERD in the previous 12 months were given a standardized 280-kcal 99Tc-labeled low fat meal (egg beater). Percentage of intragastric residual content was recorded at baseline and at hourly intervals for 240 minutes by scintigraphy. Patients were also asked about the presence of dyspepsia (bloating, postprandial discomfort or belching, or early satiety), dysphagia, or regurgitation. Sixteen patients (33%) had intragastric residual contents greater than the 95th percentile (>40%) at 120 minutes, and 13 (26%) had abnormal results at 240 minutes (>6%). Dyspepsia was present in all patients. Regurgitation and dysphagia were common (present in approximately 80% and 40% of patients, respectively) and the prevalence of these symptoms did not differ between patients with normal versus delayed gastric emptying. Using standardized techniques: 1) delayed gastric emptying is common in patients presenting with GERD at both 120 and 240 minutes after ingestion of a solid meal and 2) symptoms alone are not a useful predictor of this pathophysiology. Awareness of this subgroup of patients can be important in treatment strategies and long-term therapy.