Full Diet Research Articles

Diet quality and nutrition impact symptoms in head and neck cancer survivors treated with chemoradiotherapy

Rationale: After chemoradiotherapy (CRT), survivors of head and neck cancer (HNC) often report presence of local (e.g., swallowing or chewing problems) and/or systemic (e.g., fatigue) nutrition impact symptoms (NIS) that hinder food intake. It is unclear to what extent these NIS affect diet quality in this population. Therefore, the aim of this study was to gain insight into the relationship between NIS and diet quality in survivors of HNC treated with CRT on a full oral diet.

S0544 Endoscopic Management of Post-Pancreaticoduodenectomy Delayed Gastric Emptying

INTRODUCTION: Delayed gastric emptying (DGE) is a common cause of post-operative morbidity after pancreaticoduodenectomy (PD). The etiology of DGE is multifactorial and can include disturbances in muscular, hormonal, and neurologic function affecting overall motility. Endoscopic management has been used in patients with refractory DGE at our institution. We aimed to identify those post-PD patients with DGE who underwent endoscopy, characterize their demographics and risk factors, as well as summarize their outcomes. METHODS: This was a single-center retrospective cohort study evaluating patients who underwent PD between 2017 and 2020. Primary endpoints included modified International Study Group on Pancreas Surgery (ISGPS) DGE severity, endoscopic intervention for DGE, and resolution of DGE symptoms following endoscopy as assessed by time to nasogastric tube removal and toleration of full liquid diet. Secondary endpoints included gender, age, presence of diabetes mellitus (DM) (I or II), type of PD (pylorus-preserving versus classic), type of anastomosis, and post-operative day (POD) of initial DGE symptoms. RESULTS: Of the 281 patients reviewed, DGE developed in 55 (19.6%) patients. Of those with DGE, 34 (61.8%), 13 (23.6%), and 8 (14.5%) were categorized as Grade A, B, and C, respectively, with 9 (16.3%) patients requiring endoscopic evaluation (Table 1). Of the 9 patients who underwent endoscopy, the median age was 67.3 (±12.8) years, 5 (55.6%) were men, none had DM, 4 (44.4%) were classified as Grade B, and 5 (55.6%) were classified as Grade C. The median time to onset of DGE symptoms was 4 days, and the median time to endoscopic intervention was 15 days. Only 1/3 of patients required balloon dilation of stricture or angulation during endoscopy, and 7 (77.8%) patients had immediate improvement in DGE symptoms post-endoscopy. CONCLUSION: Endoscopic intervention may play a role in the treatment of patients that are post-PD with Grade B or higher DGE who are refractory to medical therapies. Our data suggests that regardless of the type of PD or whether balloon dilation is performed endoscopically, patients with grade B or higher DGE may benefit from endoscopy and overall have resolution in their symptoms within one day of the procedure.Table 1

S1454 Severe Acute Pancreatitis Initial Presentation of COVID-19 Infection

INTRODUCTION: SARS-CoV-2, also known as the COVID-19 has affected more than 7 million people worldwide. While the most scommon initial symptoms are cough and fever, it is known that approximately 50% of patients present with GI related symptoms. We discuss below a case of a COVID-19 patient who initially presented with unexplained severe acute pancreatitis (AP). CASE DESCRIPTION/METHODS: A 71-year-old male presented to the hospital with significant abdominal pain for one day. In the ER, a contrast enhanced CT scan showed peripancreatic inflammation and peripancreatic fluid along the body and tail. The initial lipase was 8400 u/L (73–393 u/L). The patient had no alcohol history or evidence of biliary obstruction. He denied acetaminophen, steroids, or any new medications. The lipid panel was normal along with the LFTs. The BISAP score on admission was 3 for: age >60, BUN >25, and SIRS criteria of fever and leukocytosis. He was treated for severe acute pancreatitis with aggressive IV fluid hydration. On day 4, he had resolution of his abdominal pain and was tolerating a full liquid diet. Despite improvement in his severe acute pancreatitis, the patient developed persistent fevers and increasing oxygenation requirements. A chest X-Ray was then performed with showed infiltrates concerning for pneumonia. He tested positive for COVID-19 and then developed progressive deterioration toward acute hypoxemic respiratory failure. He was transferred to the ICU and intubated on day 19 of his stay and expired a short time after. DISCUSSION: An extensive literature has revealed few cases involving COVID-19 induced AP. While many theories behind this disease process have been discussed, there is no definitive explanation for the pathogenesis. There has been evidence showing ACE2 receptor expression on the pancreas is responsible for damage during a COVID-19 infection. One such study out of China showed 1-2% of non-severe COVID patients and 17% of severe COVID patients exhibited some degree of pancreatic damage. Endothelial damage from the patient's inflammatory response can cause activation of the cytokine cascade. Too much IL-6 activation, as seen with COVID-19, can cause a cytokine storm leading to pancreatitis. While certain viral illnesses have a well-established link to AP, more research needs to be undertaken to determine whether a true relationship exists with the coronavirus. This case highlights that during this global pandemic, unexplained acute pancreatitis may be a presenting symptom of COVID-19 infection.

SPONTANEOUS PNEUMOMEDIASTINUM IN AN ADULT ASTHMATIC MALE

SESSION TITLE: Medical Student/Resident Disorders of the Mediastinum Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Pneumomediastinum is a condition usually caused by trauma where air escapes from the lung, airway, or bowel into the chest cavity. CASE PRESENTATION: A 29-year-old male with a history of asthma, active marijuana use, and prior incarceration presented with 4 days of productive cough, wheezing, and pleuritic chest pain. Prior to arrival, he had several consecutive episodes of clear emesis. He was febrile to 101°F and was breathing at 22 breaths/minute with mild accessory muscle usage. Bilateral diffuse rhonchi were noted on auscultation and palpation of his supraclavicular neck revealed crepitus. He had no preceding trauma. CXR displayed subcutaneous gas in the right supraclavicular region. Contrast CT imaging revealed extensive pneumomediastinum in the anterior neck (right>left) without any extravasation of oral contrast or esophageal perforation. There were findings of aspiration in the bilateral lower lobes. He was treated for aspiration pneumonia, asthma exacerbation, and spontaneous pneumomediastinum. An oral challenge was recommended by Thoracic Surgery. His respiratory status improved after antibiotics and nebulizer treatments. Though his crepitus persisted on exam, he tolerated a full diet well. He was discharged home with amoxicillin-clavulanic acid and nebulizers. A repeat CXR 5 days later revealed complete resolution of the pneumomediastinum and subcutaneous gas seen on the previous study. DISCUSSION: Spontaneous pneumomediastinum (SPM) is defined by the presence of air or gas in the mediastinum occurring without a traumatic cause. It is usually seen in young adolescent males, and is rarely seen in adults or children. Air from ruptured alveoli moves towards the mediastinum via the bronchovascular sheath. The most common causes are asthma exacerbation and lower respiratory tract infections, followed by Valsalva maneuvers and vomiting. A clinical triad of chest pain, dyspnea, and subcutaneous emphysema (present in this case) may be seen. Diagnosis is confirmed by chest radiography, and contrast esophagography is indicated when suspicion for esophageal rupture is present; it was necessary here given the patient’s clinical status and vomiting prior to arrival. The disease process is usually self-limited, and treatment aims at addressing underlying causes. The most likely triggers for this patient were asthma exacerbation, vomiting, and pneumonia; his marijuana use (found to be an underappreciated risk factor for developing SPM) may have also played a role. Rare, severe complications include tension pneumothorax/pneumomediastinum or pneumopericardium. CONCLUSIONS: SPM is a rare occurrence of air or gas in the mediastinum without a traumatic cause. The most common triggers are asthma exacerbation and pneumonia; marijuana use is an underappreciated risk factor. Treatment aims at addressing underlying causes. Reference #1: Johnson JN, Jones R, Wills BK. Spontaneous pneumomediastinum. West J Emerg Med 2008;9:217–8 Reference #2: Cicak B, Verona E, Mihatov-Stefanovic I, Vrsalovic R. Spontaneous pneumomediastinum in a healthy adolescent. Acta Clin Croat 2009;48:461–467 Reference #3: Weiss ZF, Gore S, Foderaro A. Pneumomediastinum in marijuana users: a retrospective review of 14 cases. BMJ Open Respir Res 2019 DISCLOSURES: No relevant relationships by Christopher Chu, source=Web Response no disclosure on file for MARUTI KUMARAN; No relevant relationships by Ali Noory, source=Web Response

S1592 Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis (EUS-Guided CPN)—An Unexpected Complication,

INTRODUCTION: Pancreatic cancer patients experience debilitating pain which makes pain management an integral part of the treatment plan. Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-guided CPN) is an alternative palliative therapy for patients with pain due to pancreatic cancer. We report a patient who developed paralytic ileus as a complication of EUS-guided CPN. CASE DESCRIPTION/METHODS: A 77- year-old male patient presented with nausea, vomiting, and abdominal pain of one day duration. He denied chest pain, shortness of breath, cough, dysphagia, diarrhea, or constipation. He was diagnosed with stage IV pancreatic adenocarcinoma 3 weeks prior to presentation for which he underwent EUS-guided CPN. Otherwise, past medical and surgical histories were noncontributory. He was a former smoker who quit 31 years ago. He reported moderate alcohol use and denied illicit drug use. In the emergency department, the patient appeared in mild discomfort. Vital signs demonstrated normal blood pressure, heart rate, respiratory rate, and temperature. Abdominal exam was significant for minimal epigastric tenderness without guarding or rebound. His labs showed a normal white blood cell (WBC) count and acute kidney injury with a creatinine of 1.34 mg/dL. Patient was placed on intravenous fluids with a bowel rest regimen and admitted to the hospital for further evaluation. Computed tomography (CT) scan of the abdomen showed significant gastric distension with a component concerning for obstruction at the level of the duodenum. Gastroparesis could not be ruled out with CT imaging. EGD, upper gastrointestinal tract series with barium swallow, and push enteroscopy were unremarkable. With obstruction ruled out, patient's diet was slowly advanced over the next few days. He was given anti-emetics and laxatives as needed. His abdominal pain and nausea gradually improved, and emesis subsided. Patient experienced a return of normal bowel activity. After 1 week, he was able to tolerate a full diet and was discharged home in a stable condition. DISCUSSION: Although EUS-guided CPN is a safe procedure, the procedure resulted in unexpected ileus which has rarely been reported in the literature. Future studies with large sample sizes are recommended to capture the occurrence of the rare side effects of EUS-guided CPN.

S2813 Mimicking Superior Mesenteric Artery Syndrome: A Case of Duodenal Malrotation

INTRODUCTION: Intestinal malrotation is a rare cause of mechanical bowel obstruction in adults. We describe a case of duodenal malrotation mimicking superior mesenteric artery syndrome. CASE DESCRIPTION/METHODS: A 22-year-old male with history of schizophrenia presented with abdominal pain and distension. He fasted for the past two months with 40 lbs weight loss, limiting himself to water in order “challenge himself.” The day prior to arrival, he ended his fast with a “large meal.” He immediately had abdominal pain and distension. Vital signs were normal. Labs were only remarkable for hypokalemia 3.4 mmol/g and trace levels of urinary ketones. CT revealed gastric distension filled with large air-fluid levels. An NG tube was placed for decompression with significant improvement. EGD revealed LA grade A esophagitis, mild diffuse gastric erythema, and a single 8 mm gastric ulcer with clean base. The endoscopist reported difficulty traversing from the second to third portion of duodenum and was concerned about extrinsic compression. MRE and upper GI series showed no obstruction. Both studies revealed that the duodenum did not cross midline and loops of jejunum in the right upper quadrant, indicative of malrotation. The patient improved gradually over several days and resumed a full diet. He was discharged to inpatient psychiatry with follow-up to assess for further surgical intervention. DISCUSSION: Bowel obstruction results from a mechanical or functional impedance of the intestines. Duodenal malrotation is a rare cause of mechanical obstruction. In adults, it occurs between 2%–5% of patients and most remain asymptomatic throughout life. Symptomatic patients typically present postprandially such as in ours, with also emesis, pain, failure to thrive, weight loss, and malabsorption. In our patient, the weight loss may likely have been due to poor intake due to the malrotation rather than the patient wishing to “challenge himself.” In a rare subset of malrotation patients, they present with a potentially life-threatening condition called acute midgut volvulus. Abdominal CT is the first line of screening and oral contrast studies are needed to confirm diagnosis. Treatment includes enteric tube for decompression, bowel rest, and possible surgical intervention. Patients presenting as adults with intestinal malrotation may be misdiagnosed, which can delay management. However, duodenal malrotation should be in the differential for patients presenting with obstruction without significant surgical history.Image 1.: The duodenum does not cross midline to the left with loops of jejunum seen in the right upper quadrant, indicative of malrotation.Image 2.: EGD image revealing narrowed second and third portion of the duodenum concerning for external compression.Image 3.: Descending duodenum is normal, however the 2nd portion of the duodenum does not cross the midline, but rather extends to the right. There is no distention of the duodenum to suggest SMA syndrome.

Proton-NMR Metabolomics of Rainbow Trout Fed a Plant-Based Diet Supplemented with Graded Levels of a Protein-Rich Yeast Fraction Reveal Several Metabolic Processes Involved in Growth

Plant raw materials are commonly used in aquafeeds, as marine resources are unsustainable. However, full plant-based diets lead to poorer fish growth performance. We aimed to understand the metabolic effects of a yeast fraction as a protein supplement in a plant-based diet and to integrate such effects with phenotypic traits as a new approach to assess the interest of this raw material. Juvenile (49g) rainbow trout (Oncorhynchus mykiss) were fed graded levels of a yeast protein-rich fraction (5% YST05, 10% YST10, 15% YST15) in a plant-based diet (PB) for 84 d. Final body weight, feed conversion ratio, and hepatosomatic and viscerosomatic indexes were measured. Plasma, liver, and muscle 1H-NMR fingerprints were analyzed with principal component analyses, and their metabolite patterns were clustered according to the yeast level to identify concomitant metabolic effects. A regression modeling approach was used to predict tissue metabolite changes from plasma fingerprints. In tissues, the patterns of metabolite changes followed either linear trends with the gradual inclusion of a yeast fraction (2 patterns out of 6 in muscle, 1 in liver) or quadratic trends (4 patterns in muscle, 5 in liver). Muscle aspartate and glucose (395 and 138% maximum increase in relative content compared with PB, respectively) revealing modification in energy metabolism, as well as modification of liver betaine (163% maximum increase) and muscle histidine (57% maximum decrease) related functions, indicates that the yeast fraction could improve growth in several ways. The highest correlation between measured and predicted metabolite intensities in a tissue based on plasma fingerprints was observed for betaine in liver (r=0.80). These findings herald a new approach to assess the plurality of metabolic effects induced by diets and establish the optimal level of raw materials. They open the way for using plasma as a noninvasive matrix in trout nutrition studies.

Performances of Broiler Chickens Fed the Commercial Diets Partially Substituted with Feeds Containing Fermented and Non Fermented Leubim Fish Meal (Canthidermis maculata)

The purpose of present study was to evaluate the performance of broilers fed the commercial diet partially substituted with leubim fish (Canthidermis maculata) waste meal (LFWM) treated by fermentation and without fermentation. As many as 100 broiler chicks, MB 202 strain, unsex, were reared up to 5 weeks in this study. The research was set up into randomized block design (RBD) consisting of 5 treatments and 4 blocks with 5 birds each. Blocks were as replicate based on the body weights of the birds at the beginning of feeding experimental diets. The experimental diets were commercial diets partially replaced with LFWM administered by either fermentation or not with the level of 6 and 12% each, 6.5% and 13% yellow corn, and 0.5% topmix. The data was analyzed using an Analysis of Variance (AOV) and continued by Duncan’s Multiple Range Test (DMRT) only if significant effects were detected among the treatments. The result of recent study indicated that the inclusion of feeds containing LFWM treated by either or not fermented combined with yellow corn and topmix as partially substitution of commercial diets significantly increased (P<0.05) FBW, BWG, feed intake, and protein intake compared to those fed full commercial diet. However, FCR and PER were not significantly affected. DMRT indicated there were no significant diferences in broiler performances fed the feeds containing LFWM treated by fermentation vs without fermentation.

Continent Cutaneous Catheterizable Channels in Pediatric Patients: A Decade of Experience with Open and Robotic Approaches in a Single Center

BackgroundTo allow patients with bladder and bowel dysfunctions to achieve social continence, continent catheterizable channels (CCCs) are effective alternatives to intermittent self-catheterization and enema. ObjectiveWe aimed to describe our progressive advancement from open to robotic construction of CCCs, reporting outcomes and comparing the two approaches. Design, setting, and participantsWe retrospectively reviewed electronic medical records of pediatric patients who underwent construction of CCCs between 2008 and 2019. The inclusion criteria were age ≤18 yr, and CCCs with or without bladder augmentation or bladder neck surgery. We compared open versus robotic approaches for demographics, and intra- and postoperative outcomes; operative time was calculated as incision-to-closure time. Surgical procedureChannels performed were appendicovesicostomy (APV), Monti with tapered ileum, and antegrade colonic enema (ACE). A Monti channel with tapered ileum was preferred to a spiral Monti or double Monti, as it has more robust blood supply and it was performed only with an open approach. MeasurementsThe primary outcome was success rate, defined as postoperative stomal continence. Stomal incontinence was defined as the presence of urine leakage noted by caregivers or patients and confirmed by the surgeon. Secondary outcomes were stomal stenosis (supra- and subfascial), incontinence, need for surgical revision, and surgical site infection. Results and limitationsA total of 69 patients were included in the study, with 35 open and 34 robotic procedures. The robotic approach showed a significant decrease in length of hospital stay (LOS) compared with the open approach. Six primary subfascial revisions were performed in five patients––three Monti, two ACE, and one APV. Continence rates were 91.4% and 91.2% for open and robotic approaches, respectively. ConclusionsRobotic surgery for CCCs showed acceptable postoperative functional outcomes and complication rates, which are comparable with those of the traditional open approach. Additionally, due to its minimally invasive nature, it offers advantages such as decreased postoperative pain, LOS, and time to full diet, and better cosmesis. Patient summaryRobotic surgery for continent catheterizable channels showed acceptable postoperative functional outcomes and complication rates, which are comparable with those of the traditional open approach.

Isolated Intestine Transplantation for Autoimmune Enteropathy: A Case Report

Autoimmune enteropathy is a rare disease characterized by chronic watery diarrhea, weight loss, and immune-mediated injury of the enterocolic mucosa. The clinicopathologic findings of this disease are variable, and timely diagnosis is challenging. It is usually managed medically. If medical management fails, surgical intervention is considered. This is a case report of a patient with autoimmune enteropathy mimicking collagenous enterocolitis. A 55-year-old man developed intestinal failure that manifested as profuse watery diarrhea, electrolyte disturbances, and weight loss. Initially, he was diagnosed with collagenous enterocolitis based on pathologic findings. Medical interventions were started, but the patient failed to show improvement. At 13 months after the onset of the disease, he was listed for isolated intestine transplantation (IITX) for intestinal failure. A healthy donor graft became available. IITX with chimney colostomy was performed. Based on the pathologic findings of the excised native small intestine, the patient was diagnosed with severe autoimmune enteropathy. The postoperative course was uneventful. By the third postoperative week, a full diet was tolerated and parenteral nutrition (PN) was weaned to end. He was discharged on postoperative day 34. Since discharge, he has been off PN, remaining on an enteral diet. This case is the first reported IITX performed on a patient with severe autoimmune enteropathy that was both curative and lifesaving. The present case confirms that IITX promptly restores gastrointestinal absorption in medically refractory autoimmune enteropathy. This observation provides clinicians with an effective treatment option in this challenging group of patients.

Synchronous reconstruction of esophageal defect and voice with J-flap after laryngopharyngectomy: Indications and outcomes.

The primary reconstruction goal for patients with laryngopharyngectomy is the restoration of esophagus, whereas voice reconstruction is less readily reconstructed. J-flap is a novel surgical technique designed to reconstruct voice and esophagus synchronously, permitting functional rehabilitation of aerodigestive tract after laryngopharyngectomy. This study aims to present indications, surgical steps, and outcomes of an innovative technique for synchronous reconstruction of the esophagus and voice tube with a free thigh flap (J-flaps). Single-center study from 2011 to 2017 recruiting patients with hypopharyngeal cancer needing laryngopharyngectomy and J-flaps reconstruction. Patient details were analyzed, and surgical outcomes were examined. 20 patients were recruited with an average age of 61. Tumor staging was IIB or above. The average follow-up period was 15months. 65% of these patients resumed a full diet. The row phonation rate was 75%. The average maximum phonation time was 8.9s, and the average number of counting in a breath was 14. Most patients achieved a conversational level of speech capacity with a humanoid voice. J-flap can be utilized safely, supporting the social re-integration of these patients with their new voice.

Preservation of Internal Branch of Superior Laryngeal Nerve during Surgery for Hypopharyngeal Cancer

This study was performed to evaluate the significance of intraoperative preservation of the internal branch of the superior laryngeal nerve (ibSLN) during surgery for hypopharyngeal squamous cell carcinoma (HSCC). Twelve patients with HSCC underwent surgery between January 2017 and December 2018. Sensation in the hypopharyngeal mucosa was tested using a flexible laryngeal endoscope on postoperative day 5. Surgeries were successfully performed in 10 patients with HSCC arising from the internal wall of the pyriform fossa and in 2 patients with HSCC arising from the posterior wall of the hypopharynx. The main trunk of the ibSLN was preserved in all patients. Testing of sensation in the hypopharyngeal mucosa revealed the presence of the cough reflex in all patients. All patients achieved a full normal oral diet at a median of 8.5 days (range, 6-11 days) and removal of the tracheal tube at a median of 10 days (range, 7-12 days). Our results showed that preservation of the ibSLN during surgery for HSCC is feasible and important in the recovery of sensation in the hypopharyngeal mucosa.

Pre-, Peri-, and Postoperative Intravenous Ropivacaine versus that of Lidocaine for Analgesia after Hand-Assisted Laparoscopic Surgery of Left Colon Cancer: A Retrospective Analysis

Purposes Pre-, peri-, and postoperative intravenous lidocaine are reported effective in the management of postoperative pain in laparoscopic colorectal surgery but until the time, that of ropivacaine is not tested for the same. The objectives of the study were to evaluate the effectiveness of pre-, peri-, and postoperative intravenous ropivacaine against that of lidocaine on the postoperative pain, bowel function recoveries, and hospital stays in patients who underwent surgery of left colon cancer. Materials and methods Data regarding total doses of fentanyl required, bowel function recoveries, surgical-related complications, and hospital stays of 367 patients who underwent hand-assisted laparoscopic surgery of left colon cancer were retrospectively collected and analyzed. Patients received pre-, peri-, and postoperative intravenous normal saline (NS cohort, n = 104), or that of lidocaine (LC cohort, n = 145), or that of ropivacaine (RC cohort, n = 118). Results Fewer dose of fentanyl was required in patients of RC cohort than those of NS (9 doses/patient vs. 11 doses/patient, p < .0001, q = 27.445) and LC (9 doses/patient vs. 10 doses/patient, p < .0001, q = 9.911) cohorts. Patients of the RC cohort had less time to first drink, first bowel movement, full diet, and hospital stay than those of NS and LC cohorts (p < .05 and q > 3.329 for all). Conclusions Pre-, peri-, and postoperative intravenous ropivacaine are safe and effective than that of normal saline or lidocaine in hand-assisted laparoscopic surgery of left colon cancer.

Methionine Restriction Regulates Cognitive Function in High-Fat Diet-Fed Mice: Roles of Diurnal Rhythms of SCFAs Producing- and Inflammation-Related Microbes.

Methionine restriction (MR) is known to potently alleviate inflammation and improve gut microbiome in obese mice. The gut microbiome exhibits diurnal rhythmicity in composition and function, and this, in turn, drives oscillations in host metabolism. High-fat diet (HFD) strongly altered microbiome diurnal rhythmicity, however, the role of microbiome diurnal rhythmicity in mediating the improvement effects of MR on obesity-related metabolic disorders remains unclear. 10-week-old male C57BL/6J mice are fed a low-fat diet or HFD for 4 weeks, followed with a full diet (0.86% methionine, w/w) or a methionine-restricted diet (0.17% methionine, w/w) for 8 weeks. Analyzing microbiome diurnal rhythmicity at six time points, the results show that HFD disrupts the cyclical fluctuations of the gut microbiome in mice. MR partially restores these cyclical fluctuations, which lead to time-specifically enhance the abundance of short-chain fatty acids producing bacteria, increases the acetate and butyric, and dampens the oscillation of inflammation-related Desulfovibrionales and Staphylococcaceae over the course of 1 day. Notably, MR, which protects against systemic inflammation, influences brain function and synaptic plasticity. MR could serve as a potential nutritional intervention for attenuating obesity-induced cognitive impairments by balancing the circadian rhythm in microbiome-gut-brain homeostasis.

Methionine restriction alleviates high-fat diet-induced obesity: Involvement of diurnal metabolism of lipids and bile acids

Circadian misalignment induced by a high-fat diet (HFD) increases the risk of metabolic diseases. Methionine restriction (MR) is known to have the potential of alleviating obesity by improving insulin sensitivity. However, the role of the circadian clock in mediating the effects of MR on obesity-related metabolic disorders remains unclear. Ten-week-old male C57BL/6 J mice were fed with a low-fat diet (LFD) or a HFD for 4 wk., followed with a full diet (0.86% methionine, w/w) or a methionine-restricted diet (0.17% methionine, w/w) for 8 wk. Our results showed that MR attenuated insulin resistance triggered by HFD, especially at ZT12. Moreover, MR led to a time-specific enhancement of the expression of FGF21 and activated the AMPK/PGC-1α signaling. Notably, MR upregulated the cyclical levels of cholic acid (CA) and chenodeoxycholic acid (CDCA), and downregulated the cyclical level of deoxycholic acid (DCA) in the dark phase. MR restored the HFD-disrupted cyclical fluctuations of lipidolysis genes and BAs synthetic genes and improved the circulating lipid profile. Also, MR improved the expressions of clock-controlled genes (CCGs) in the liver and the brown adipose tissue throughout one day. In conclusion, MR exhibited the lipid-lowering effects on HFD-induced obesity and restored the diurnal metabolism of lipids and BAs, which could be partly explained by improving the expression of CCGs. These findings suggested that MR could be a potential nutritional intervention for attenuating obesity-induced metabolic misalignment.

Per oral pyloromyotomy utilizing a lesser curvature approach: how we do it.

The treatment of gastroparesis refractory to medical therapy has evolved to include purely endoscopic techniques. Per oral pyloromyotomy (POP) has evolved from traditional laparoscopic or open pyloroplasty to become a safe and effective minimally invasive option for patients with gastroparesis. As compared to laparoscopic pyloroplasty (LP), POP produces similar improvements in gastric emptying and symptom mitigation, while having shorter lengths of stay. There are slight variations in technique that vary by institution. Described here is a technique utilizing a lesser curve approach, with a mucosotomy closure using clips in an effort to maximize efficiency of the procedure. Preoperative workup includes a scintigraphic gastric emptying study or a wireless motility capsule study, and the Gastroparesis Cardinal Symptom Index (GCSI). After an upper endoscopy, the procedure begins with injection into the submucosal space with methylene blue in saline on the lesser curve, 3-5cm proximal to the pylorus. A 1.5cm incision is then made with the ERBE hybrid knife. A submucosal tunnel is created past the distal end of the pylorus, and the muscle is hooked, and divided with the hybrid knife. The mucosotomy is closed with clips (Boston Scientific Resolution 360, Boston, MA) after the completion of the myotomy. Post-operatively, patients are discharged home after an overnight stay with a proton pump inhibitor, sucralfate, and a full liquid diet for 2 weeks. A lesser curve approach with mucosotomy closure using clips is a safe, effective, and efficient modality for performing POP. As more centers adopt POP as a tool for gastroparesis management, the lesser curve method limits the length of the submucosal tunnel needed, and allows for wide adoption of the technique.

Metabonomic analysis of hypophosphatemic laying fatigue syndrome in laying hens

Laying fatigue syndrome (LFS) is a common disease in poultry, which is characterized by low egg laying rate, increased broken and soft shell egg rate and osteoporosis, and even death of poultry. Insufficient phosphorus content in feed is one of the major causes of LFS. In this study, a total of 22-week-old Roman white shell hens were randomly divided into two groups, including control (group C) and low dietary phosphorus (group P) groups. The hens of groups C and P were fed with a full mixed diet and a mixed diet containing 0.18% available phosphorus content, respectively. At 25, 29 and 34 weeks, the production performance of hens was detected and the serum samples of hens were collected to detect the changes of serum phosphorus, calcium, osteopelectin (OPG), parathyroid hormone (PTH), estradiol (E2), tartaric acid-resistant phosphatase (TRACP) and alkaline phosphatase (ALP). The keels were removed and x-rayed. In addition, all serum samples were tested by LC-MS metabolomics. Our results showed that low dietary phosphorus decreased the production performance, phosphorus content, and E2 and OPG levels, while increased calcium and PTH levels, and ALP and TRACP activities in laying hens. The hens of group P had bent keels. Besides, small molecular metabolites in serum were enriched in 10 pathways and 17 metabolites were significantly different according to the area under the receiver operating characteristic curve (AUC) analysis. Our results showed that low phosphorus diet could induce LFS. Also, 17 metabolites detected by metabonomics can be used as biomarkers for clinical diagnosis and early warning of hypophosphatemic laying fatigue syndrome (HLFS). This study provides a scientific basis for the early prevention and treatment of HLFS.

Retropharyngeal Internal Carotid Artery Management in TORS Using Microvascular Reconstruction.

Guidelines for transoral robotic surgery (TORS) have generally regarded patients with retropharyngeal carotid arteries as contraindicated for surgery due to a theoretical risk of intraoperative vascular injury and/or perioperative cerebrovascular accident. We aimed to demonstrate that careful TORS-assisted resection and free flap coverage could not only avoid intraoperative injury and provide a physical barrier for vessel coverage but also achieve adequate margin control. Retrospective cohort analysis. Retrospective review of patients with oropharyngeal malignancies and radiologically confirmed retropharyngeal carotid arteries who underwent TORS, concurrent neck dissection, and free flap reconstruction between 2015 and 2019. Twenty patients were included, 19 (95.0%) with tonsillar tumors and one (5.0%) with a tongue base tumor with significant tonsillar extension. Eighteen patients (90.0%) received a radial artery forearm flap, one (5.0%) an ulnar artery forearm flap, and one (5.0%) an anteromedial thigh flap. All 20 (100%) flaps were inset through combined transcervical and transoral approaches without mandibulotomy. There were no perioperative mortalities, carotid injuries, oropharyngeal bleeds, cervical hematomas, or cerebrovascular accidents. One patient (5.0%) had a free flap failure requiring explant. All patients underwent decannulation and resumed a full oral diet. The mean length of hospitalization was 6.8 (standard deviation 1.2) days. One (5.0%) patient had a positive margin. In this analysis, 20 patients with oropharyngeal malignancy and retropharyngeal carotid arteries underwent TORS, neck dissection, and microvascular reconstruction without serious complication (perioperative mortality, vascular injury, or neurologic sequalae) with an acceptable negative margin rate. These results may lead to a reconsideration of a commonly held contraindication to TORS. 3 Laryngoscope, 131:E821-E827, 2021.

Phenolic profile and antioxidant activity of bee pollen extracts from different regions of Algeria

Abstract Due to its complex biochemical properties, the bee pollen is considered one of the functional foods. Bee pollen collected from pollen grains from different botanical sources offers almost a full diet such as carbohydrates, proteins, amino acids, vitamins, minerals. In this study, methanol extracts of 13 honeybee pollen samples were evaluated for flavonoids, phenolic compounds, and antioxidant capacity. Caffeic acid, chlorogenic acid, vanillic acid, p-coumaric acid, gallic acid, quercetin, rutin, vanillin, and naringin were identified as main phenolic compounds in pollen extracts by High-Performance Liquid Chromatography (HPLC) analysis. The obtained results are: total phenolic content - 379.8 to 915.6 mg GAE/100 g, total flavonoid content - 207.1 to 550 mg QE/100 g, and antioxidant activity - 808.2 to 3311 mg GAE/100 g in bee pollen extracts.

3D Morphometric Analysis Reveals Similar Ecomorphs for Early Kangaroos (Macropodidae) and Fanged Kangaroos (Balbaridae) from the Riversleigh World Heritage Area, Australia

Understanding feeding ecology of extinct kangaroos is fundamental to understanding the evolution of kangaroos and the Australia paleoenvironment during the Oligo-Miocene. Comparisons with extant species have suggested that the macropodiforms of the Oligo/Miocene (kangaroos and allies) from the Riversleigh World Heritage Area, northern Australia, were predominantly folivorous browsers or fungivores, unlike the majority of extant species. To further test this hypothesis, we investigate the relationship between variation in cranial and mandibular shape of extant and extinct macropodiforms and ecological factors such as diet, locomotion, and body mass using 3D geometric morphometric analysis of 42 living species and eight extinct species from two radiations (the extinct clade of Balbaridae and some early representatives of the extant Macropodidae. Dietary class (fungivore, browser, grazer, and mixed feeder) correlated strongly with variation in cranial shape (20–25% of variance explained). There was also significant association between cranial shape, and both locomotor mode and body mass. In a principal component analysis of shape variation for crania (including the shape of the molar row), Riversleigh macropodiforms cluster with extant folivorous browsers on principal components (PC) 1 and 3, providing support for previous interpretations of these species as browsing kangaroos. However, as a group and regardless of phylogenetic association, the shape centroid of extinct species differs significantly from that of extant species. Riversleigh macropodiforms cluster with regular hoppers or arboreal tree kangaroos, but this may be a result of the correlation between diet and locomotor mode in kangaroos. Their similarity to extant browsers supports previous interpretations of rainforest and woodland environments at Riversleigh during the early and middle Miocene, respectively. Procrustes ANOVA Analysis of the full shape dataset and diet also shows that diet accounts for a significant portion of variation; however, when phylogeny is taken into account these results become nonsignificant. In analyses of dentary shape, some balbarid species cluster with extant mixed feeders, although this may reflect phylogenetic differences rather than ecological signal.