Gastric Stimulation Research Articles

Load shift keying communication techniques in implantable devices.

Inductive links represent a highly promising avenue for both powering and communicating medical implants. Yet they encounter challenges such as constrained communication distance and limited data rate. In Load Shift Keying (LSK), a switch in the secondary side of the inductive link can be placed in parallel with the load (Short-Circuit Technique - SCT), in series with the load (Open-Circuit Technique - OCT), or both (Dual Technique - DLT), to vary the impedance of the secondary. Hence, the impedance reflected to the primary side changes and is used to transmit information externally from the implant. Among these, DLT is a novel LSK technique proposed in this work, which becomes independent from the load on the implant side. This study compares these three methods, confronting measurements to simulations. The evaluation focused on variations in coil distance and load. The proposal is illustrated in the case of an implantable gastric stimulator, with specific constraints in secondary coil size and power requirements. The newly developed DLT consistently outshone SCT and OCT in extending the operational range of communication, registering a maximum modulation index of 0.797 and a bit error rate below 10- 7 at an operating distance of 95mm through the air. Its load-independent characteristic allowed DLT to surpass the performance of SCT and OCT, which were each advantageous under high and low loads, respectively. All these results are confirmed by a LTSpice simulation. Consequently, the communication techniques put forward in this work mark a significant progression in medical implant communications, enhancing coil-to-coil operational distance while adhering to a low carrier frequency.

Addition of pyloroplasty may improve glycemic control and refractory early satiety in gastroparesis at rates similar to gastric neurostimulation alone: a retrospective analysis

Objectives Gastroparesis that is refractory to standard dietary and medical management may benefit from surgical treatment with gastric electrical neurostimulation, which has shown promise in reducing symptoms of the disease. Pyloroplasty may serve an adjunctive role to a gastric stimulator, but the precise benefit remains unclear. The present study compares reported rates of symptom improvement following gastric neurostimulator implantation with and without pyloroplasty. Materials and methods A single center retrospective analysis of consecutive patients who received operative management for symptom refractory gastroparesis from 1 January 2020 to 31 December 2021 was performed. Subjects were assigned to cohorts based on treatment with gastric electrical stimulation alone (GES-only) or combined with pyloroplasty (GES + PP). A survey-based assessment was administered post-operatively that evaluated cardinal symptoms of gastroparesis (nausea, vomiting, early satiety) before and after treatment. Results In total, 42 patients (15 GES-only, 27 GES + PP) were included in the study. Both groups reported a high degree of improvement in global symptom control following surgery (93% vs 81%) with no differences between treatment cohorts (p = 0.09). Early satiety demonstrated better improvement in patients who received gastric stimulation alone (p = 0.012). Subgroup analysis of diabetic gastroparesis patients showed a 2.2% decrease in hemoglobin A1c levels in the GES + PP group (p-0.034). Conclusions Symptom reduction in refractory gastroparesis appears to improve after placement of a gastric neurostimulator with or without the addition of a pyloroplasty procedure.

Efficacy of gastric stimulator as an adjunct to pyloroplasty for gastroparesis: characterizing patients suitable for single procedure vs dual procedure approach

BackgroundPyloroplasty is an effective surgery for gastroparesis. However, some patients fail to improve after pyloric drainage and may require subsequent gastric electric stimulation. There is a paucity of data on the efficacy of gastric stimulator as an adjunct to failed pyloroplasty. This study aimed to describe our experience with pyloroplasty, determine the efficacy of gastric stimulator for failed pyloroplasty, and compare the final outcomes of those who required pyloroplasty with and without gastric stimulator for gastroparesis. MethodsRecords of patients who underwent primary pyloroplasty for gastroparesis at our institution were reviewed. Patients with poor symptomatic improvement after pyloroplasty underwent subsequent gastric stimulator. Symptoms were assessed using the gastroparesis cardinal symptom index (GCSI) preoperatively and after each surgery. Severe gastroparesis was defined as GCSI total score ≥3. Outcomes were assessed after pyloroplasty in all patients and after stimulator in patients who failed pyloroplasty. Final outcomes were then compared between those who did and did not require adjunct gastric stimulator. ResultsThe study population consisted of 104 patients (89.4% females) with a mean (SD) age of 42.2 years (11) and body mass index of 26.9 kg/m2 (7). Gastroparesis etiologies were 71.2% idiopathic, 17.3% diabetic, and 11.5% postsurgical. At 18.7 months (12) after pyloroplasty, there was a decrease in the GCSI total score (3.5 [1] to 2.7 [1.2]; P = .0012) and the rate of severe gastroparesis (71.9%−29.3%; P < .0001). Gastric emptying scintigraphy (GES) 4-hour retention decreased (36.5 [24] to 15.3 [18]; P = .0003).Adjunct gastric stimulator was required by 30 patients (28.8%) owing to suboptimal outcomes with no improvement in GCSI (P = .201) or GES (P = .320). These patients were younger (40.5 [10.6] vs 49.6 [15.2] years; P = .0016), with higher baseline GCSI total scores (4.3 [0.7] vs 3.7 [1.1]; P < .001) and more severe gastroparesis (100% vs 55.6%; P < .001). All other preoperative characteristics were similar. At 21.7 months (15) after gastric stimulator, there was improvement in GCSI (4.1 [0.7] to 2.6 [1.1]; P < .0001), severe gastroparesis (100%−33.3%; P < .0001), and GES 4-hour retention (21.2 [22] to 7.6 [10]; P = .054). Before gastric stimulator, those who failed pyloroplasty had significantly worse GCSI (P = .0009) and GES (P = .048). However, after gastric stimulator, GCSI and GES improved and were comparable with those who only required pyloroplasty (P > .05). ConclusionPyloroplasty improved gastroparesis symptoms and gastric emptying, yet 28% failed, requiring gastric stimulator. Younger patients and those with preoperative GCSI scores ≥3 were more likely to fail. Gastric stimulator improved outcomes after failed pyloroplasty, with comparable final GCSI and GES with those who did not fail.

Electrical stimulation in special clinical situations

Introduction: Neuromodulation is an approach used to treat diseases that are refractory to clinical treatments by employing electrical and chemical stimulation techniques, especially in cardiac, neurological, and psychiatric disorders. Objective: This study aims to provide an overview of the latest developments in neuromodulation therapies that use electrical stimulation. Methods and results: The present study describes the most common neuromodulation techniques. Neuroplasticity is used to adjust the ions and neural excitability in response to central and peripheral nervous system stimulation. The spinal cord, dorsal root, and gastric stimulations are effective treatments for neuropathies, chronic pain, muscle spasticity, epilepsy, depression, cluster headaches, heart failure, and gastroparesis symptoms. Deep brain stimulation and invasive cortical stimulation are medical procedures used selectively to treat Parkinson’s disease, dystonia, obsessive-compulsive disorder, and chronic pain. Barostimulation therapy is beneficial in controlling refractory hypertension, reducing the risk of cardiovascular events, and improving overall quality of life. Repetitive Transcranial Magnetic Stimulation is a recommended treatment option for fibromyalgia, neuropathic pain, chronic headaches, treatment-resistant depression, generalized anxiety disorders, schizophrenia, and attention deficit disorder. While controlling obesity shows promise in regulating appetite and promoting satiety, more research is needed to understand the safety and efficacy of these therapies in various groups. Conclusion: Neuromodulation devices hold promise for treating diseases that do not respond to clinical treatments. Additional clinical trials and studies are required to understand it fully.

Difference in Cyclic Versus Non-cyclic Symptom Patterns in Patients with the Symptoms of Gastroparesis Undergoing Bioelectric Therapy.

Patients with gastroparesis (Gp) have symptoms with or without a cyclic pattern. This retrospective study evaluates differences in cyclic vs. non-cyclic symptoms of Gp by analyzing mucosal electrogastrogram (mEG), familial dysautonomias, and response to gastric stimulation. 37 patients with drug refractory Gp, 7 male and 30 female, with a mean age of 41.4years, were studied. 18 had diabetes mellitus, 25 had cyclic (Cyc), and 12 had a non-cyclic (NoCyc) pattern of symptoms. Patients underwent temporary mucosal gastric stimulator (tGES) placement, which was done as a trial before permanent stimulator (GES) placement. Electrogastrogram (EGG) by mucosal (mEG) measures, including frequency, amplitude, and frequency-amplitude ratio (FAR), were pre- and post-tGES. Patients' history of personal and familial dysautonomias, quality of life, and symptom scores were recorded. Baseline vs. follow-ups were compared by paired t tests and McNemar's tests. T tests contrasted symptom scores, gastric emptying tests (GET), and mEG measures, while chi-squared tests deciphered comorbidity differences between two groups and univariate and multivariate analyses. There were significantly more patients with diabetes in the Cyc group vs. the NoCyc group. Using a 1 point in symptom outcome, 18 patients did not improve and 19 did improve with tGES. Using univariable analysis, with the cyclic pattern as a predictor, patients exhibiting a cyclic pattern had an odds ratio of 0.22 (95% CI 0.05-0.81, p = 0.054) for achieving an improvement of at least one unit in vomiting at follow-up from baseline. The mucosal electrogastrogram frequency to amplitude ratio (FAR) for the "not Improved" group was 19.6 [3.5, 33.6], whereas, for the "Improved" group, it was 54.3 [25.6, 72.5] with a p-value of 0.049. For multivariate logistic regression, accounting for sex and age squared, patients exhibiting a cyclic pattern had an adjusted odds ratio (OR) of 0.16 (95% CI 0.03-0.81, p = 0.027) for achieving an improvement of at least one unit in vomiting at follow-up from baseline. The two groups had no significant differences in the personal or inherited history of investigated familial patterns. This study shows differences in Gp patients with Cyc vs. NoCyc symptoms in several areas. Larger studies are needed to elicit further differences between the two groups about cycles of symptoms, EGG, findings, familial patterns, and response to mucosal GES.

A systematic review of effectiveness and safety of some herbal compounds as treatment for primary insomnia

Introduction Sleep related disorders affect around 30% of people all over the world, and evidence shows that 10% require therapeutic intervention. Insomnia represents the most common disturbance of sleep, defined as the experience of poor sleep for at least 1 month. Most of primary insomnia can be prevented by a proper lifestyle and sleep hygiene rules. Regardless, hypnotic drugs and widely prescribed, and most times, long-term used, which is not recommended because of its negative side effects.ObjectivesReview the scientific evidence about effectiveness of plant extracts for insomnia, natural products with practically no side-effects, and thus be possible to reduce or even avoid the use of hypnotic drugs.MethodsThe Medline database through the Pubmed search engine was used with the following keywords: “insomnia” and “herbal compounds”.ResultsValerian activity on sleep disturbances has been attributed to the presence of isovaleric acids and valepotriates with reported calming action and GABA reuptake inhibition with sedative effects. Considering the data presented in the literature, despite controversial and conflicting, several studies showed that valerian (160-600mg/day) improved sleep quality and reduced sleep latency and duration; also valerian seems more effective for chronic insomnia than acute episodes.Hop has different properties: calming, sleep inducing, gastric secretion stimulating and spasmolytic.Increasing GABAergic activity seems to be the main mechanism of action, thus inhibiting the central nervous system and also has demonstrated binding affinities to some of the melatonin and serotonin receptor. It’s sedative characteristics have been confirmed in a clinical trial in association with valerian, where sleep latency and quality were improved. However, monotherapy studies showed no relevant effectiveness in sleep.Kava Kava plant showed promising results, in rats and humans, with decrease sleep latency, better sleep quality and recuperation after sleep. However, raised concern about its potential of hepatotoxicity.There is also promising evidence of the lavender efficacy for sleep disorders in a wide variety of populations and diseases, it was actually mentioned to be as effective as lorazepam in adults with anxiety and sleeping problems. With studies with dose of 80mg it was observed a reduction in sleep awakenings, sleep duration and overall sleep quality and anxiety.Conclusions There is a clear preference from the patient to natural compounds, and with almost nonexistent side effects, some herbal derivates are showed to have positive effectiveness in mild insomnia, but nonetheless much more studies on this field are needed.Disclosure of InterestNone Declared

Diabetic gastroparesis: a disease for which long-term therapeutic benefits are difficult to obtain.

The pathophysiology of diabetic gastroparesis (DGP), a common complication in diabetic patients, is not fully known. Its development has been linked to several causes, including hyperglycaemia, vagal nerve dysfunction, aberrant Cajal's interstitial cell network (ICC), lack of nerve nitric oxide synthase (nNOS) expression in the intermuscular plexus, and hormonal alterations in the gastrointestinal tract. Glucose management, diet control, gastric stimulants, anti-emetic medications, Helicobacter pylori eradication, stomach electrical stimulation, and surgery are the main current treatments. These methods, however, could have unfavourable consequences. By examining recent studies and literature reviews, we outline the state of the study on diabetic gastroparesis in this paper.

Histamine Receptors: Ex Vivo Functional Studies Enabling the Discovery of Hits and Pathways.

Histamine receptors (HRs) are G-protein-coupled receptors involved in diverse responses triggered by histamine release during inflammation or by encounters with venomous creatures. Four histamine receptors (H1R-H4R) have been cloned and extensively characterized. These receptors are distributed throughout the body and their activation is associated with clinical manifestations such as urticaria (H1R), gastric acid stimulation (H2R), regulation of neurotransmitters in neuronal diseases (H3R), and immune responses (H4R). Despite significant homologous overlap between H3R and H4R, much remains unknown about their precise roles. Even though some drugs have been developed for H1R, H2R, and H3R, not a single H4R antagonist has been approved for clinical use. To enhance our understanding and advance innovative therapeutic targeting of H1R, H2R, H3R, and H4R, we established a robust ex vivo functional platform. This platform features the successful heterologous expression of H1R-H4R in Xenopus laevis oocytes, utilizing an electrophysiological readout. Our findings contribute to a deeper understanding of the function and pharmacological properties of the histamine receptors. Researchers can benefit from the utility of this platform when investigating the effects of histamine receptors and exploring potential therapeutic targets. In doing so, it broadens the horizon of drug discovery, offering new perspectives for therapeutic interventions.

Surgical Treatment of Gastroparesis.

Gastroparesis and intestinal dysmotility are life-altering diagnoses with no cure. Lifestyle changes, pharmacological, and surgical interventions are combined in a multidisciplinary fashion to improve the quality of life in this patient population. Starting with lifestyle changes, adjustments are made to the types and amounts of food consumed, medical conditions are optimized, and the use of narcotic pain medications as well as smoking is discontinued. For many, these changes are not enough, and antiemetics and promotility agents are used to control symptoms. Finally, when these measures fail, patients turn to surgery, which can include surgical alterations to the stomach, implantation of a gastric stimulator, placement of drainage tubes, and possibly even the complete removal of different organs, including the stomach or gallbladder. In our clinic, patients not only see a surgeon but also a gastroenterologist, dietitian, and psychologist. We strongly believe in a multidisciplinary approach to this condition. The goal is to provide patients with hope and help them live fuller and happier lives. The study primarily addresses technical considerations and the surgical approach for patients diagnosed with gastroparesis. It outlines the entire process, starting from preparations before the surgery, encompassing the preoperative work-up, and detailing the steps involved in the surgical procedure. One of the key diagnostic challenges faced in treating gastroparesis patients is determining the underlying cause of the condition, as this information is critical for selecting the appropriate surgical intervention. Once the patient's condition has been categorized based on the cause, the medical team engages in a discussion with the patient regarding potential treatment options, which may include endoscopic procedures, minimally invasive techniques, or open surgery.

FRI064 The Role Of GLP-1 Receptor Agonists In The Treatment Of Pituitary And Hypothalamic Tumor Induced Obesity

Abstract Disclosure: C.S. Botero Suarez: None. D. Broutin: None. H. Yau: None. Introduction: Glucagon-like peptide-1 receptor agonists (GLP1-RA) act by stimulating the GLP-1 receptor resulting in a reduction in food intake, increased energy expenditure, and improved glycemic control. The role of GLP1-RA in pituitary/suprasellar tumors causing hyperphagia and hypothalamic obesity is yet unknown. We present a case of a patient with a large non-functional pituitary mass resulting in severe hyperphagia and hypothalamic obesity. A trial of GLP-1RA showed significant improvement of hyperphagia. Case Description: A 30-year-old African American male is seen in the Endocrinology clinic. He was recently diagnosed with a non-functional pituitary mass 2 months prior, after a presentation of hyperphagia, significant weight gain, and altered personality changes causing significant social distress. He underwent transsphenoidal pituitary resection which resulted in postoperative hypopituitarism. His physical exam showed normal vital signs, a weight of 185 lbs, and a BMI of 25. His medications included hydrocortisone total of 15 mg daily, desmopressin 0.1mg daily, levothyroxine 137mcg daily, and risperidone 1mg daily. A brain MRI showed postoperative changes depicted by a T1 hyperintensity within the sella as well as T2 hyperintensity of the chiasm and hypothalamus indicating edema and a mass effect. Based on his presentation of marked hyperphagia and rapid weight gain with suggestive imaging, the clinical diagnosis of hypothalamic obesity was made. Further follow-up revealed a rapid weight gain of 45 lbs in 2 months, a worsening glycemic control, and a HbA1C of 7.2% compared to a HbA1C of 5.4% in his prior visit. Lab work showed a TSH of 0.017 mlU/mL, fT4 of 1.4ng/dL, prolactin 3.94 ng/mL, alpha subunit of 0.1 ng/mL (reference 0.1-0.5 ng/mL), ACTH of 15 pg/mL, morning cortisol of &amp;lt; 3 ug/dL. Given the significant metabolic consequences of his marked hyperphagia, related weight gain, and new onset of diabetes, the patient was started on semaglutide 0.5mg weekly and later up-titrated to 1mg weekly. There was marked improvement of hyperphagia, and his weight remained neutral at the 3-month follow-up. Discussion: Hyperphagia is a rare presentation of sellar and suprasellar tumors and can lead to hypothalamic obesity. Tumors can affect the arcuate nucleus of the hypothalamus, which is a key regulator of energy homeostasis and is regulated by orexigenic (AgRP/NPY) and anorexigenic neurons (POMC/CART). GLP-1R agonists, have shown to cause significant weight loss due to decreased gastric emptying and stimulating POMC/CART neurons, but they also inhibit neuropeptide Y (NPY) and agouti-related peptide (AgRP), leading to reduced hunger, energy intake, and food cravings. Although the clinical role of GLP1-RA in pituitary tumors with significant hyperphagia is unknown, we believe early initiation can help avoid a rapid progression of obesity and glycemic deterioration. Presentation: Friday, June 16, 2023

Optimal Frequency and Wireless Power Budget for Miniature Receivers in Obese People.

This study investigates wireless power transfer for deep in-body receivers, determining the optimal frequency, power budget, and design for the transmitter and receiver. In particular, the focus is on small, in-body receivers at large depths up to 20 cm for obese patients. This enables long-term monitoring of the gastrointestinal tract for all body types. Numerical simulations are used to investigate power transfer and losses as a function of frequency and to find the optimal design at the selected frequency for an obese body model. From all ISM-frequencies in the investigated range (1 kHz-10 GHz), the value of 13.56 MHz yields the best performance. This optimum corresponds to the transition from dominant copper losses in conductors to dominant losses in conductive tissue. At this frequency, a transmitting and receiving coil are designed consisting of 12 and 23 windings, respectively. With a power transfer efficiency of 2.70×10-5, 18 µW can be received for an input power of 0.68 W while still satisfying exposure guidelines. The power transfer is validated by measurements. For the first time, efficiency values and the power budget are reported for WPT through 20 cm of tissue to mm sized receivers. Compared to WPT at higher frequencies, as commonly used for small receivers, the proposed system is more suitable for WPT to large depths in-body and comes with the advantage that no focusing is required, which can accommodate multiple receivers and uncertainty about receiver location more easily. The received power allows long-term sensing in the gastrointestinal tract by, e.g., temperature, pressure, and pH sensors, motility sensing, or even gastric stimulation.

Computational Evaluation of the Potential of Salicylate Compound from Syzygium aromaticum on Carbonic Anhydrase I as a Gastric Acid Stimulant

Computational Evaluation of the Potential of Salicylate Compound from Syzygium aromaticum on Carbonic Anhydrase I as a Gastric Acid Stimulant

A Systematic Review of the Long-Term Clinical Success of Gastric Peroral Endoscopic Myotomy for Refractory Gastroparesis.

Gastroparesis is a chronic and debilitating gastrointestinal disorder with few medical treatment options. Traditional surgical management has involved laparoscopic pyloromyotomy or gastric stimulation. In recent years, gastric peroral endoscopic myotomy (GPOEM) has become an attractive, less invasive option for patients with refractory gastroparesis. There is little information on the long-term clinical success of GPOEM in patients with refractory gastroparesis. This systematic review aims to evaluate the data on this procedure's long-term clinical efficacy and safety. A comprehensive literature review was done in PubMed, EMBASE, Ovid, and Google Scholar databases from the date of earliest entry in May 2017 up to August 15, 2022. The Gastroparesis Cardinal Symptom Index (GCSI) score, adverse reaction, and length of stay were analyzed. Eleven studies were eligible for inclusion (900 patients), seven of the studies were retrospective, while four were prospective. The GCSIis a 6-point Likert scale questionnaire that assesses improvement in gastroparesis. An average decrease of GCSI by 1 point compared to baseline GCSI for all patients (described as clinical success) was found in 662 patients out of 713 (92.8%) at one-year follow-up, 421 out of 460 (91.5%) at two-year follow-up, 270 out of 270 (100%) at three-year follow-up, and 102 out of 102 (100%) at four-year follow-up. Adverse events occurred in 62 out of 835 patients (in nine studies), with two of the most frequent being bleeding and mucosal tears. GPOEM is an effective and safe treatment option for patients with refractory gastroparesis, with symptom improvement noted up to four years postoperatively.

Sustained Release Microneedles: Materials and Applications in Facial Rejuvenation.

Wrinkled and loose skin resulting from collagen degradation along with fibers decreasing reflects the youth diminishing. Microneedles (MNs) have opened up new avenues for the development of painless and noninvasive transdermal drug delivery systems for facial rejuvenation. Encapsulated drugs or molecules are transmitted to targeted tissues via percutaneous microchannels, which eliminate potential gastric stimulation or first-pass metabolic effects, as well as boost patient compliance. Although MNs are considered effective and feasible therapeutic alternatives to metals, silicon, and polymers, traditional procedures with reduction processes continue to encounter methodological limitations. In recent years, promising additive manufacturing processes such as three-dimensional printing and two-photon polymerization manufacturing have been developed with the aim of overcoming the limitations by traditional processes to facilitate an efficient and economic production mode. This review summarizes the design, material selection, and manufacturing method for recently advanced MN systems. Furthermore, we also highlight specific polymeric or natural microneedle products, like hyaluronan, plant derivates, and vitamins, for esthetic applications in this review. Impact Statement In this review, the materials and manufactural routes of microneedles (MNs) are detailed. Moreover, similar to the diagnostic or therapeutic MNs, the feature of dispensation with training and ready-to-use is perfect for beautification and anti-aging, which necessitate repeated and long-term usage. Furthermore, the specific polymeric or natural products for esthetic applications of MNs are highlighted in this review.

The Roth Net at 40 years: celebrating the spirit of innovation

The Roth Net at 40 years: celebrating the spirit of innovation

S3586 Elucidating with Endoscopy: Investigating Surprising Symptoms in a Patient With a Gastric Electrical Stimulator

Introduction: Gastric electrical stimulators (GES) are long-term options for patients with gastroparesis refractory to pharmacotherapy and lifestyle changes. As GES use rises, recognizing device complications is crucial for managing patients with complex disease. This scenario highlights a case in which the etiology of the patient’s complications was discovered during endoscopy. Case Description/Methods: A 30-year-old female with gastroparesis related to type 1 diabetes mellitus, and GES placement one year prior, was admitted for electrical shock sensations near her stimulator site, with radiation to her left arm and neck. It occurred about twelve times a day, and was associated with nausea and vomiting. She reported mild abdominal distension and feeling as if her pacer moved. There were no complications during device placement, and follow-up interrogations revealed no abnormalities. The patient denied other gastrointestinal symptoms or trauma to the pacer site area. Her abdomen was soft with mild generalized tenderness, and the surgical scars from GES placement were well-healed. Device interrogation revealed settings at 2.5 volts, and impedance at 503 ohms. AP and lateral abdominal X-ray revealed proper lead placement. The decision was made to shut off the device, which ceased the shock sensations. Upper endoscopy revealed linear, subepithelial protrusions along the greater curvature of the antrum, located approximately 10.0 cm from the pylorus, consistent with typical gastric stimulator leads (Figure). After surgical consultation, stimulator leads were replaced, and the patient was discharged without continued symptoms. Discussion: Adverse effects related to GES use include disruption of lead placement, erosion in the submucosa or mucosa, and obstruction, with generator site infection as the most common issue. Studies have shown that lead penetration into the gastric lumen occurs in 3% of patients, with 16% of patients requiring a corrective surgical procedure. This patient’s presentation demonstrates a rare event after GES placement. Typically, leads are placed in the muscularis propria of the greater gastric curvature. Lead displacement can be detected either on imaging or if impedance values are outside the normal range; however, neither of those occurred in this patient. Abnormal presentations demonstrated by patients with GES should be evaluated thoroughly, with suspicion for hardware malposition. Diagnostic work-up with endoscopy can guide further management.Figure 1.: A: Upper endoscopy revealing linear, subepithelial protrusions at the greater curvature of the antrum, located approximately 10 cm from the pylorus, consistent with typical gastric stimulator leads Figure B: Abdominal x-ray showing an anterior view of gastric pacer generator and lead placement.

Fenugreek Seed

Abstract: Fenugreek (Trigonella foenum graecum), native to southern Europe and Asia, is anannual herb with white flowers and hard, yellowish brown and angular seeds,known from ancient times, for nutritional value beside of it medicinal effects. Fenugreek seeds are rich source of gum, fiber, alkaloid, flavonoids, saponin and volatile content. Due to it's high content of fiber, fenugreek could be used as food stabilizer, adhesive and emulsifying agent to change food texture for some special purposes. Some evidences suggest that fenugreek may also be regarded as antidiabetic, anticarcinogenic, remedy for hypocholesterolemia and hypoglycemia, antioxidant, antibacterial agent, gastric stimulant, and anti-anorexia agent. The present article is aimed to review the potential applications of fenugreek as a functional food and nutraceutical. Keywords: Chemical composition, Fenugreek gum, Fenugreek, Health benefits

Impact of adaptive gastric electrical stimulation on weight, food intake, and food intake rate in dogs.

Gastric electrical stimulation (GES) has been studied for decades as a promising treatment for obesity. Stimulation pulses with fixed amplitude and pulse width are usually applied, but these have limitations with regard to overcoming habituation to GES and inter-subject variation. This study aims to analyze the efficacy of an adaptive GES protocol for reducing food intake and maintaining lean weight in dogs. Six beagle dogs were implanted with a remotely programmable gastric stimulator. An adaptive protocol was designed to increase the stimulation energy proportionally to the excess of food consumption, with respect to the dogs' maintenance energy requirements. After surgery and habituation to experimental conditions, the dogs went through both a control and a stimulation period of 4weeks each, in a randomized order. The stimulation parameters were adapted daily. Body weight, food intake, food intake rate, and postprandial cutaneous electrogastrograms (EGG) were recorded to assess the effect of adaptive GES. Adaptive GES decreased food intake and food intake rate (p<0.05) resulting in weight maintenance. In the absence of GES, the dogs gained weight (p<0.05). Postprandial EGG dominant frequency was accelerated by GES (p<0.05). The strategy of adapting the stimulation energy was effective in causing significant mid-term changes. Adaptive GES is effective for reducing food intake and maintaining lean weight. The proposed adaptive strategy may offer benefits to counter habituation and adapt to inter-subject variation in clinical use of GES for obesity.

Advances in the quality control of fenugreek seeds using chromatographic, spectroscopic and DNA-based techniques: A comprehensive review.

Fenugreek has been used in traditional remedies since ancient times. It has a long history of use against medical ailments as an antidiabetic, anticarcinogenic, hypocholesterolemic, antioxidant, antibacterial, hypoglycemic, gastric stimulant, and anti-anorexia agent. The major active constituents include alkaloids, fibres, saponins, proteins, and amino acids. To provide a comprehensive overview of the application of chromatographic and spectroscopic methods, in addition to DNA-profiling methods to assess the quality of fenugreek. Also, to highlight the recent application of chemometrics combined with quality control methods during the last two decades. A literature search conducted from January 2000 up to December 2020 using various scientific databases (e.g., Scopus, Medline, PubMed, EBSCO, JSTOR, ScienceDirect, Google Scholar, Web of Science and Egyptian Knowledge Bank, Academic Journals, and Springer Link); general web searches were also undertaken using Google applying some related search terms. Studies involving the application of quality control analyses were classified into three categories according to the conducted analysis method including chromatographic [high-performance liquid chromatography (HPLC), high-performance thin-layer chromatography (HPTLC), and gas chromatography (GC)], spectroscopic [ultraviolet (UV), infrared (IR), and nuclear magnetic resonance (NMR)], and DNA-based markers. This review shed the light on relevant studies covering the past two decades, presenting the application of spectroscopic and chromatographic methods and DNA profiling in the quality control of fenugreek. The reviewed chromatographic and spectroscopic methods combined with chemometrics provide a powerful tool that could be applied widely for the quality control of fenugreek.

AYURVEDIC CLINICAL APPROACH FOR THE MANAGEMENT OF AMAVATA (RHEUMATOID ARTHRITIS)

In Ayurveda, Acharya Madhava Kar mentioned first the Amavata as a special disease entity. According to the clinical features and pathogenesis Amavata very closely resembles Rheumatoid arthritis. In Amavata, Ama (bio- toxin) and Vata (biophysical force or kinetics) are playing the most important role in the samprapti (pathogenesis) of this disease. The Chikitsa (management) of Amavata (Rheumatoid arthritis) is more clearly and precisely de- scribed in Chakradutta. Acharya Chakradatta was the pioneer in describing the principles of treatment for this disease, which are Langhana (body lightness procedure), Swedana (warm compress), drugs having Tikta-Katu Rasa (bitter-pungent taste) and Deepana (gastric stimulant) action, Virechana (purgation therapy), Snehapana (intake of grita or oil) and Anuvasana (enema with Ayurvedic oil) as well as Ksharabasti (enema with Ayurvedic alkali preparation). Keywords: Amavata, Rheumatoid arthritis, Chikitsa, management, Chakradutta