Manometry Data Research Articles

Frequency of detection of dyssynergic defecation in patients with overlap syndrome of functional disorders of the digestive organs associated with constipation

Introduction. The presence of dyssynergic defecation in a cohort of patients with overlap syndrome of functional disorders is poorly studied.Aim. To assess the motor function and sensitivity parameters of the anorectal zone, to identify dyssynergic defecation and to analyze the frequency of correlation in patients with overlap syndrome of functional gastrointestinal disorders associated with constipation.Materials and methods. A one-stage examination was conducted in four parallel groups. The study included 100 patients aged 30 to 40 years with the following diagnoses: constipation-p redominance irritable bowel syndrome (IBS-C) (group 1), IBS-C combined with functional dyspepsia (group 2), IBS-C combined with functional biliary disorder (group 3) and healthy volunteers (group 0). All patients underwent a balloon expulsion test and high-resolution anorectal manometry to determine the presence of dyssynergic defecation.Results. Based on the analysis of parameters according to anorectal manometry data, dyssynergic defecation was not detected in group 0, in group 1 dyssynergic defecation was detected in 8 people – 32.0% (95% CI 12.3–51.6), in group 2 – in 14 people – 56.0% (95% CI 35.0–76.9), in group 3 – in 16 people – 64.0% (95% CI 43.7–84.2). A negative evacuation test was detected in 8 (32%) patients in group 1, in 14 (56%) patients in group 2, and in 17 (68%) patients in group 3, which confirmed the presence of dyssynergic defecation.Conclusions. This study demonstrated the presence of dyssynergic defecation in three groups of subjects, more often with a combination of irritable bowel syndrome with predominant constipation with functional dyspepsia, and most often with a functional disorder of the gallbladder.

Jugular venous narrowing and spontaneous spinal cerebrospinal fluid leaks: A case-control study exploring association and proposed mechanism.

Spontaneous skull base cerebrospinal fluid leaks (CSFLs) are associated with increased intracranial pressure in idiopathic intracranial hypertension (IIH) and hypothesized to relate to skull base erosions due to increased CSF pressure. Given the increasing recognition of internal jugular venous stenosis (IJVS) as a cause of intracranial hypertension (IH), we evaluated the relationship between spinal CSFL and venous causes of IH. The spinal CSFL database at a single institution was assessed to identify 12 consecutive spontaneous, non-traumatic spinal CSFL patients with CTV data. Exclusion criteria included documented IIH and iatrogenic CSFL. Demographics, clinical parameters, imaging characteristics, and IJV manometry results were recorded. Internal jugular venous stenosis was graded as: none (0-10%), mild (10-50%), moderate (50-80%), severe (>80-99%), and occluded (100%). Twelve consecutive patients who presented with cerebrovascular accidents without CSFL, matched by age and sex, were similarly analyzed as a control group. STROBE guidelines were used in reporting results. All CSFL patients had IJVS (83.3% bilateral, 33.3% severe) compared to 41.7% of the control group (33.3% bilateral, 16.7% severe-occluded); p = 0.04. All CSFL patients with available venogram manometry data had at least unilateral IJV gradients. Most patients presented with modified Rankin score (mRS) of 1 (66.7%), but in those with higher mRS, medical and/or surgical interventions were associated with decreased morbidity. Spontaneous spinal CSFL was associated with IJVS in patients not meeting IIH criteria. Persistently high CSF pressure resulting in CSFL may cause opening pressure to be falsely normal or low. Internal jugular venous stenosis may be a viable target in recurrent CSFL management and improve morbidity.

586. VALUE OF PEPSIN IN SALIVA TO ASSESS THE POSTOPERATIVE OUTCOME OF PATIENTS WITH GERD

Abstract Background The aim of this study was to evaluate the value of salivary pepsin to assess the outcome of surgical treatment of patients with gastroesophageal reflux (GERD). Methods Forty-five consecutive patients with GERD despite proton pump inhibitor treatment received laparoscopic anti-reflux surgery (LARS). 24-hour esophageal pH-monitoring (MII-pH) and esophageal manometry (HRM) data were documented preoperatively and at 3-month follow-up. Clinical symptoms were rated with the Gastrointestinal Quality of Life Index (GIQLI) and gastrointestinal symptoms were evaluated by a standardized symptom checklist (SCL), assessing the severity and intensitiy of 14 different symptoms. Simultaneous to MII-pH the collection of 3 saliva samples per patient was performed. Treatment failure was defined as improvement of GIQLI and SCL of < 10 points, despite showing a normal DeMeester score. Results At baseline, all patients showed a pathological MII-pH measurement. Furthermore, all patients showed postoperatively a normal DeMeester score (mean 7.10 ± 4.56). Ten patients were defined as treatment failures with a change of pepsin concentration from a mean value of 198.73 ng/mL to 186.00 ng/mL (p>0.05). In patients defined as treatment success, mean pepsin value decreased from 205.83 ng/mL to 85.24 ng/mL (p<0.001). Conclusion Salivary pepsin could be a marker for treatment success after LARS. However, larger studies are required to reach firm conclusions.

Does preoperative symptom duration affect outcomes following per oral endoscopic myotomy (POEM)?

Per oral endoscopic myotomy (POEM) is a safe therapy for the treatment of achalasia. Long-term effects of untreated achalasia include worsening dysmotility and disruptions in esophageal anatomy, i.e., tortuosity and dilation. We hypothesize that long-standing achalasia prior to intervention will have worse outcomes following POEM than in patients with symptoms for shorter duration. We retrospectively analyzed achalasia patients who underwent POEM at our institution from 2011 to 2023, categorizing them into symptom duration cohorts (< 1year, 1-3years, 4-10years, > 10years). Inclusion criteria comprised patients with documented achalasia diagnosis who received POEM treatment at our facility. Exclusion criteria encompassed individuals lacking data pertaining to achalasia diagnosis, the time frame before intervention, or those missing pre and postoperative Eckardt scores. POEM failure was defined as symptom recurrence, necessity for repeat intervention, or high postoperative Eckardt score. We compared demographic, preoperative, and postoperative outcomes across these cohorts, and employed multivariable logistic regression to explore the link between symptom duration and POEM response. During the study period, in our increased cohort 234 patients met inclusion criteria. 75 patients had symptoms for < 1year, 78 patients had symptoms from 1 to 3years, 47 patients had symptoms from 4 to 10years, and 34 patients had symptoms > 10years. Patient demographics such as age, sex, BMI, Charleson-Deyo-Comorbidity-Index, and diabetes did not differ amongst cohorts. High-resolution manometry data, including achalasia type, Median IRP, LES residual pressure, and Basal LES pressure did not differ between groups. Preoperative Eckardt scores ranged from 4 to 5 across groups (p 0.24). Patients endorsed an average of three total preoperative symptoms across groups (p 0.13). Patients with symptoms greater than 4years had significantly more endoscopic interventions prior to POEM (37% vs, 68% p .001). There was no significant difference in post-procedure mean Eckardt scores between cohorts. All cohorts experienced the same number of post-POEM symptoms. Post-POEM manometric measurements remained consistent across cohorts. Similarly, there were no significant differences in terms of symptom recurrence, requirement for repeat interventions, or repeat POEM among the cohorts. Multivariable logistic regression analysis determined achalasia symptoms greater than a decade did not result in increased odds of having a higher postoperative Eckardt score, worse dysphagia, regurgitation, or weight loss. In this increased cohort, this data once again suggests that longer symptom duration is not associated with increased rates of POEM failure.

Hemorrhoidectomy with lateral ultrasonic dissection in cutting mode in patients with stages 3–4 hemorrhoids

AIM: to assess original method of hemorrhoidectomy with lateral ultrasonic dissection in cutting mode in patients with stages 3–4 hemorrhoids.PATIENTS AND METHODS: a retrospective study included 140 patients with hemorrhoids 2–4 stages. In the main group (n = 80), an original technique of lateral ultrasound dissection in cutting mode was used (patent for invention No. 2722997). Patients in the control group (n = 60) underwent Milligan-Morgan hemorrhoidectomy using electrosurgical scalpel.RESULTS: significant differences were achieved in intensity of pain syndrome, morbidity rate, which were significantly in the main group. Histology showed that the depth of coagulative necrosis when in the original technique was 145 ± 25 µm vs 1730 ± 180 µm in the controls (р &lt; 0,001). Anorectal manometry data, significantly less dysfunction anal sphincter was noted in the postoperative period in the main group.CONCLUSION: hemorrhoidectomy with lateral ultrasonic dissection in cutting mode reduces tissue trauma, morbidity rate and intensity of pain, and also promotes rapid restoration of anal continence.

Integrative effects of transcutaneous auricular vagus nerve stimulation on esophageal motility and pharyngeal symptoms via vagal mechanisms in patients with laryngopharyngeal reflux disease.

Laryngopharyngeal reflux disease (LPRD) is primarily characterized by discomfort in the pharynx and has limited treatment options. This research aimed to assess the efficacy of transcutaneous auricular vagus nerve stimulation (tVNS) in patients with LPRD and delve into the potential underlying mechanisms. A total of 44 participants, diagnosed with LPRD were divided into two groups randomly. Twice-daily stimulation was delivered for 2 weeks for patients in experimental group, with stimulation ranging from 1.0 mA to 1.5 mA (n = 22), while the control group underwent sham tVNS (n = 22) with the same stimulation parameters and different anatomical location. The severity of symptoms and levels of anxiety and depression were monitored using questionnaires. High-resolution esophageal manometry data were collected, and the patients' autonomic function was assessed through heart rate variability analysis. There was a positive correlation between reflux symptom index (RSI) scores and low frequency/high frequency (LF/HF) ratio (r = 0.619; p < 0.001), Hamilton anxiety scale (HAMA) scores (r = 0.623; p < 0.001), and Hamilton depression scale (HAMD) scores (r = 0.593; p < 0.001). Compared to the pre-tVNS phase, RSI (p < 0.001), HAMA (p < 0.001), and HAMD (p < 0.001) scores were significantly reduced after 2 weeks of treatment. Additionally, the resting pressure of the upper esophageal sphincter (UESP; p < 0.05) and lower esophageal sphincter (LESP; p < 0.05) showed significant enhancement. Notably, tVNS led to an increase in root mean square of successive differences (RMSSD; p < 0.05) and high frequency (HF; p < 0.05) within heart rate variability compared to the pre-treatment baseline. Compared to the control group, RSI (p < 0.001), HAMA (p < 0.001), and HAMD (p < 0.001) scores in tVNS group were significantly lower at the end of treatment. Similarly, the resting pressure of UESP (p < 0.05) and LESP (p < 0.05) in tVNS group were significantly higher than that of control group. Notably, RMSSD (p < 0.05) and HF (p < 0.05) in tVNS group were significantly higher than that of control group. This study demonstrated that tVNS as a therapeutic approach is effective in alleviating LPRD symptoms. Furthermore, it suggests that improvements in esophageal motility could be associated with vagus nerve-dependent mechanisms.

Interpretation of Impedance Data on High-resolution Impedance Manometry Studies-A Worldwide Survey.

Esophageal manometry is the gold standard for esophageal motility evaluation. High-resolution esophageal manometry with impedance (HRIM) allows concurrent assessment of bolus transit and manometry. Inconsistencies between concomitant impedance and manometry data pose a clinical dilemma and has not yet been addressed. We aim to assess interpretation trends of HRIM data among gastroenterologists worldwide. A cross-sectional study using an anonymous survey was conducted among gastroenterologists worldwide. Statistical analysis was performed to compare responses between providers. We received responses from 107 gastroenterologists (26 countries). Most were adult providers (69, 64.5%), and most (77, 72.0%) had > 5 years of experience. Impedance was found to be helpful by 83 (77.6%) participants, but over 30% reported inconsistencies between impedance and manometry data. With incomplete bolus clearance and normal manometry 41 (38.7%) recommended observation, 41 (38.7%) recommended 24-hours pH-impedance, and 16 (15.1%) recommended prokinetics. With abnormal manometry and complete bolus clearance, 60 (57.1%) recommended observation while 18 (17.1%) recommended 24-hours pH impedance and 15 (14.3%) recommended prokinetics. A significant difference was found between providers from different continents in treating cases with discrepancy between impedance and manometry findings (P < 0.001). No significant differences were seen in responses between adult versus pediatric providers and between providers with different years of experience. There is no consensus on interpreting HRIM data. Providers' approaches to studies with inconsistencies between manometry and impedance data vary. There is an unmet need for guidelines on interpreting impedance data in HRIM studies.

The reservoir characteristics and their controlling factors of the sublacustrine fan in the Paleogene Dongying Formation, Bohai Sea, China

Sublacustrine fan is an important element in continental lacustrine basins and is significant for reservoir exploration. Oil and gas resources have been found in the sublacustrine fan sandstone reservoirs of the Paleogene Dongying Formation in the Bohai Sea. In this study, the characteristics of the sublacustrine fan reservoirs and the controlling factors are studied using information from logging, cores, physical properties, casting thin sections, X-ray diffraction of clay minerals, vitrinite reflectance, rock pyrolysis, manometry data, and 3D seismic data. The sublacustrine fans of the Dongying Formation in the LD10, QHD34, and BZ21 structures show high-quality reservoirs with porosity >15 % and permeability >5 mD. The main controlling factors of the high-quality reservoirs are attributed to the favorable sedimentary facies type and negligible compaction, and cementation, substantial dissolution of K-feldspar, overpressure, and the development of faults and fractures. A high-quality sublacustrine fan reservoir model has been established to explain how these factors affected the physical properties. The favorable targets for oil and gas exploration in the Dongying Formation of Bohai Sea include undercompacted sandy debris flow reservoirs showing the dissolution of K-feldspar, and the reservoirs which are connected to the source rocks by faults. This study provides insights to establish the relationship between sedimentology, diagenesis and reservoir quality. The results of this study are significant for the exploration and development of the sublacustrine fan sandstone reservoirs in the Bohai Sea and analogous sandstone reservoirs elsewhere.

S477 Esophageal Symptoms in Postural Orthostatic Tachycardia Syndrome: A Retrospective Analysis of Esophageal Manometry Data From an Academic Medical Center

S477 Esophageal Symptoms in Postural Orthostatic Tachycardia Syndrome: A Retrospective Analysis of Esophageal Manometry Data From an Academic Medical Center

Nasal Breathing Computed Diagnosis System

Rhino manometry is widely used for measuring nasal aerodynamic resistance, but its clinical use is still limited and needs further standardization. The main aim of the study is to determine the total nasal resistance and to locate the place and the reasons for nasal cavity obstruction. A scheme of modern hybrid computed Rhino manometry for functional diagnosis of upper respiratory disease is proposed. The role of the main parameters in nasal aerodynamics is described (the airflow, the pressure, different types of local resistances, and nasal respiratory energy efficiency). The hybrid approach is based on a CT study and the Rhino manometry data. The study discovers four new features in the nasal breathing graph, which help in discrimination between different types of breathing modes, and this increases the accuracy of calculating the pressure losses by 12%. Also, the method used for calculating the mucosal roughness, which used as a criterion for evaluating the airflow mode. The accuracy of the hybrid functional method in calculating the total nasal aerodynamic resistance is 30% higher than with previous methods.

Long-term results of treatment of achalasia cardia by combined balloon dilation. The role of high-resolution manometry in the diagnosis of achalasia. Endoscopic and manometric parallels

The aim. To analyze the results of treatment of achalasia cardia by balloon dilatation with an accent on hydrodilatation, to compare the types of achalasia cardia according to high-resolution manometry with endoscopic semiotics and to evaluate the effectiveness of endoscopic balloon dilatation depending on the type of achalasia. Materials and methods. The article details an additional method of endoscopic balloon dilatation of the cardia - hydrodilatation (42 patients). The results of endoscopic balloon dilatation were analyzed according to high-resolution manometry data (37 patients). High-resolution manometry data were also evaluated in correlation with endoscopic efficacy criteria (11 patients). Results. Hydrodilatation is used as an additional method after pneumodilatation to increase efficiency of treatment (39 patients) or as an independent method (3 patients) with a combination of achalasia cardia and cicatricial changes of the esophageal-gastric junction, as well as after surgery on the cardia. The combined balloon dilatation technique gives good immediate results in 89.7% (35/39), as an independent method - 100%. Of the total number of patients, 90.5% (38/42) completed the course of endoscopic dilatation with good results, despite the fact that this is a more complex group of patients resistant to standard intervention - balloon pneumodilatation. It is not known which high-resolution manometry data should be used to assess the effectiveness of balloon dilatation: the dilatation efficiency is 75% according to the resting pressure of the lower esophageal sphincter, 83.3% according to the total relaxation pressure, 66.7% according to the cumulative analysis, strictly adhering to the reference values, and 100% according to the tendency to lower pressure. Conclusion. Endoscopic balloon dilatation is a highly effective minimally invasive method of treating achalasia cardia. Hydrodilatation is used to improve the results of endoscopic treatment. For an objective assessment of the effectiveness of balloon dilatation, high-resolution manometry should be performed before and after treatment.

Characterization of a chronic cough in cerebellar ataxia, neuropathy, vestibular areflexia syndrome.

Cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS) is a common cause of late-onset ataxia that often presents with chronic cough. This study is the first to characterize the CANVAS cough both objectively and subjectively. A cross-sectional study of 13 patients was conducted. Medical records and available esophagram, modified barium swallow study, esophageal manometry, and video laryngostroboscopy data were reviewed. Leicester cough questionnaire (LCQ) and Eating Assessment Tool-10 were administered to evaluate quality of life (QoL) impairments and dysphagia symptoms, respectively. CANVAS history questionnaire was developed to characterize the clinical course. 92% of patients endorsed chronic cough that preceded gait instability by a median of 16 years. Cough was dry (67%), disturbed sleep (75%), triggered by various factors, including talking, eating, and dry/spicy foods, did not respond to standard reflux therapy, and inconsistently responded to neuromodulators and superior laryngeal nerve injections. Despite perceived cough severity worsening or remaining constant in most patients, no correlation was found between cough duration and total LCQ scores. Patients reported significantly more negative social QoL impacts compared to physical QoL impacts. Ataxia duration and years of cough before ataxia symptoms were directly and inversely correlated with total LCQ scores, respectively. Imaging data revealed esophageal dysmotility (71%), vestibular penetration (57%), vestibular aspiration (14%), supraglottic compression (63%), vocal fold lesions/atrophy (50%), and arytenoid erythema (38%). Chronic cough is a hallmark presenting symptom in CANVAS with predominantly psychosocial QoL effects and unrecognized laryngeal alterations. In cases of idiopathic, refractory chronic cough, genetic testing for CANVAS should be considered, especially in association with sensory, cerebellar, and/or vestibular involvement. VI.

Morphofunctional substantiation of hemorrhoidectomy with lateral ultrasound dissection in the cutting mode

The immediate and long-term results of the surgical treatment of hemorrhoids in two patient groups were compared. In the main group, the original technique of lateral ultrasound dissection in the cutting mode was used, whereas in the control group, hemorrhoidectomy using monopolar electrocautery was performed. The dynamics of the intensity of postoperative pain syndrome was analyzed using a specialized questionnaire. Pathomorphological changes in the removed hemorrhoids were studied as part of a comparative assessment of the damaging effects of ultrasound and electrosurgical scalpel on the tissues. To assess the extent of the influence of the surgical intervention on the function of the rectal locking apparatus, impairments in the contractile activity of the anal sphincter were analyzed by balloon manometry. The intensity of the pain syndrome and the frequency of postoperative complications were significantly lower in the main group than in the control group. The depth of coagulation necrosis and severity of necrobiotic and reactive changes when using lateral ultrasound dissection in the cutting mode were significantly less than that after electrosurgical hemorrhoidectomy. In the comparative analysis of transanal manometry data, significantly less pronounced impairment of the tonic activity of the sphincter in the postoperative period was noted in patients who underwent lateral ultrasound dissection in the cutting mode. Thus, the original technique of lateral ultrasound dissection in the cutting mode is characterized by less tissue injury, reduces the frequency of complications and intensity of postoperative pain syndrome, and contributes to faster restoration of the function of the rectal locking apparatus..

Association of delivery mode and number of pregnancies with anorectal manometry data in patients with postpartum constipation

ObjectiveTo explore the association of delivery mode and the number of pregnancies with anorectal manometry data in patients with postpartum constipation.MethodsThis retrospective study included women with postpartum constipation treated at the pelvic floor rehabilitation department of Huzhou Maternity & Child Health Care Hospital between January 2018 and December 2019.ResultsAmong 127 patients included, 55 (43.3%) had one pregnancy, 72 (56.7%) had two pregnancies, 96 (75.6%) delivered spontaneously, 25 (16.7%) underwent Cesarean section, and six (4.7%) needed a Cesarean section despite spontaneous labor. The median duration of constipation was 12 months (range, 6–12). There were no differences between the two groups for any manometry parameters (all P > 0.05). The patients with a spontaneous delivery had a lower change in maximal contracting sphincter pressure compared with those with Cesarean section (14.3 (4.5–25.0) vs. 19.6 (13.4–40.0), P = 0.023). Only the delivery mode (Cesarean vs. spontaneous) independently affected the changes in contracting sphincter pressure (B = 10.32, 95%CI: 2.95–17.69, P = 0.006); age (P = 0.201), number of pregnancies (P = 0.190), and constipation duration (P = 0.161) were not associated.ConclusionThe patients with a spontaneous delivery had a lower change in maximal contracting sphincter pressure compared with those with a Cesarean section, suggesting that patients with Cesarean may retain a better “push” function during defecation.

Real-world evidence with magnetic sphincter augmentation for gastroesophageal reflux disease: a scoping review

Summary Background The burden of gastroesophageal reflux disease (GERD) is high, with up to 30% of the Western population reporting reflux-related symptoms with or without hiatal hernia. Magnetic sphincter augmentation (MSA) is a standardized laparoscopic procedure for patients who are dissatisfied with medical therapy and for those with early-stage disease who would not usually be considered ideal candidates for fundoplication. The MSA device is manufactured in different sizes and is designed to augment the physiologic barrier to reflux by magnetic force. Methods An extensive scoping review was performed to provide a map of current evidence with respect to MSA, to identify gaps in knowledge, and to make recommendations for future research. All the authors contributed to the literature search in PubMed and Web of Science and contributed to summarizing the evidence. Results Magnetic sphincter augmentation, especially in combination with crural repair, is effective in reducing GERD symptoms, proton pump inhibitor use, and esophageal acid exposure, and in improving patients’ quality of life. Safety issues such as device erosion or migration have been rare and not associated with mortality. The MSA device can be removed laparoscopically if necessary, thereby preserving the option of fundoplication or other therapies in the future. Contraindication to scanning in high-power Tesla magnetic resonance systems remains a potential limitation of the MSA procedure. High-resolution manometry and functional lumen imaging probes appear to be promising tools to predict procedural outcomes by improving reflux control and reducing the incidence of dysphagia. Conclusion A consensus on acquisition and interpretation of high-resolution manometry and impedance planimetry data is needed to gain better understanding of physiology, to improve patient selection, and to pave the way for a personalized surgical approach in antireflux surgery.

Intra- and inter-observer agreement in the classification of dyssynergic defecation on high-resolution anorectal manometry using water-perfusion system

Dyssynergic defecation (DD) classified on anorectal manometry is based on variations in anal sphincter pressures and rectal pressure generated during bearing down. There is a paucity of data on intra- and inter-observer agreement in the classification of DD on high-resolution anorectal manometry (HRAM) using a water-perfusion system. This cross-sectional observational study was conducted between June 2014 and May 2016 on 70 adult patients with DD. Observer 1 did the baseline analysis and reanalyzed the readings at least 6 months later, blinded to the initial analysis results (intra-observer variability). Four other blinded observers (5-25 years in anorectal manometry and minimum 5 years of experience in HRAM) then individually analyzed the manometry data (inter-observer variability). Intra-observer agreement was excellent (kappa 0.862) for classifying DD. Agreement between the six observations (i.e. two from observer 1 and four from independent observers) was also good (kappa 0.632). The highest agreement was for type 4 DD (kappa 0.738), followed by type 1 (0.680), type 2 (0.664), and type 3 (0.537). Cronbach's alpha value was 0.93, suggesting excellent internal consistency. The diagnosis of the types of DD on anorectal manometry using a water-perfusion system has excellent intra-observer and good inter-observer agreement.

Phenotypes of gastroesophageal reflux disease: classification, pathogenesis and diagnostic criteria: A review

The literature review focuses on the current understanding of visceral hypersensitivity mechanisms in the esophagus. Mechanisms of peripheral and central sensitization and their relation to heartburn symptoms are covered in detail. Diagnostic criteria and algorithms for non-erosive reflux disease, functional heartburn, and esophagus hypersensitivity based on pH-impedance testing and high-resolution esophageal manometry data are presented.

Malignant obstruction of the inferior vena cava: clinical experience with the self-expanding Sinus-XL stent system

PurposeTo evaluate the technical and clinical outcome of Sinus-XL stent placement in patients with malignant obstruction syndrome of the inferior vena cava.MethodsBetween October 2010 and January 2021, 21 patients with different malignant primary disease causing inferior vena cava obstruction were treated with Sinus-XL stent implantation. Procedural data, technical and clinical outcome parameters were retrospectively analyzed.ResultsTechnical success was 100%. Analysis of available manometry data revealed a significant reduction of the mean translesional pressure gradient following the procedure (p = 0.008). Reintervention rate was 4.8% (1/21). The available follow-up imaging studies showed primary and primary-assisted stent patency rates of 93% (13/14) and 100% (14/14), respectively. Major complications did not occur. The clinical success regarding lower extremity edema was 82.4% (14/17) for the first and 85.7% (18/21) for the last follow-up. Longer lengths of IVC obstruction were associated with reduced clinical improvement after the procedure (p = 0.025). Improvement of intraprocedural manometry results and lower extremity edema revealed only minor correlation. Ascites and anasarca were not significantly positively affected by the procedure.ConclusionSinus-XL stent placement in patients with malignant inferior vena cava obstruction showed high technical success and low complication rates. Regarding the clinical outcome, significant symptom improvement could be achieved in lower extremity edema, whereas ascites and anasarca lacked satisfying symptom relief. Based on our results, this procedure should be considered as a suitable therapy in a palliative care setting for patients with advanced malignant disease.

Measuring H2O concentrations in olivine by secondary ion mass spectrometry: Challenges and paths forward

Abstract Trace concentrations of H2O in olivine strongly affect diverse mantle and magmatic processes. H2O in olivine has been difficult to accurately quantify due to challenges in sample preparation and measurement, as well as significant uncertainties in standard calibrations. Here we directly compare secondary-ion mass spectrometry (SIMS) measurements of the olivine standards of Bell et al. (2003, hereafter Bell03) and Withers et al. (2012, hereafter Withers12) upon which most SIMS and Fourier transform infrared (FTIR) spectroscopy analyses are based. In the same SIMS session, we find that the olivine standards from the two studies are offset by ~50%, forming lines of different slope when comparing SIMS measurements to the independent nuclear reaction analysis (NRA) in Bell03 and elastic recoil detection analysis (ERDA) in Withers12. This offset is similar to the ~40% offset that exists in the FTIR absorption coefficients determined by those two studies, and points to the NRAERDA data as the cause for the offset more than different IR absorption characteristics of the different olivines. We find that the Withers12 olivine standards form the most precise calibration line, and that the measured Bell03 olivine standards have issues of reproducibility and accuracy due to the presence of hydrous inclusions (as documented previously by Mosenfelder et al. 2011). Owing to the limited availability of the Withers12 olivine standards, however, we recommend using orthopyroxene standards (Kumamoto et al. 2017) to calibrate H2O in olivine by SIMS due to similar calibration slopes. We revise the reference values of current orthopyroxene standards to account for uncertainties in the Bell et al. (1995) manometry data. With these revised values, the orthopyroxene calibration line is within 12% of the Withers12 olivine line, which is within the long-term uncertainty of the SIMS olivine measurements. We apply our SIMS calibration protocol to revise estimates of the partition coefficients for H2O between olivine and melt, resulting in a value of 0.0009 ± 0.0003 at pressures ~0.2–2 GPa. This brings into closer agreement between the partition coefficients determined from experimental studies and those based on natural studies of olivine-hosted melt inclusions.

Nasal Breathing Pre-Surgery Planning System

Rhino manometry is widely used for measuring nasal aerodynamic resistance, but its clinical use is still limited and needs further standardization. The main aim of the study is to determine the total nasal resistance and to locate the place and the reasons for nasal cavity obstruction. A scheme of modern hybrid computed Rhino manometry for functional diagnosis of upper respiratory disease is proposed. The role of the main parameters in nasal aerodynamics is described (the airflow, the pressure, different types of local resistances, and nasal respiratory energy efficiency). The hybrid approach is based on a CT study and the Rhino manometry data. The study discovers four new features in the nasal breathing graph, which help in discrimination between different types of breathing modes, and this increases the accuracy of calculating the pressure losses by 12%. Also, the method used for calculating the mucosal roughness, which used as a criterion for evaluating the airflow mode. The accuracy of the hybrid functional method in calculating the total nasal aerodynamic resistance is 30% higher than with previous methods.