Percutaneous Gastrostomy Tube Research Articles

Cone-beam computed tomography-assisted percutaneous gastrostomy tube insertion in children with challenging anatomy.

Percutaneous radiological gastrostomy tube insertion is a common procedure in children. An approach using ultrasound and fluoroscopy may not be feasible in patients with challenging anatomy; therefore, advanced techniques or other imaging modalities may be required. To describe our experience using cone-beam computed tomography (CT)-assisted percutaneous gastrostomy insertion in pediatric patients with challenging anatomy. A retrospective review was performed in children who underwent cone-beam CT-assisted percutaneous radiologic gastrostomy between January 2015 and July 2019. Indications, technique, outcomes, complications, and radiation dose (reference-point air kerma, air kerma area product) were assessed through chart and imaging review. Descriptive statistics only were used. Twenty-seven procedures were attempted in 26 patients. Reasons for utilizing cone-beam CT guidance were high-positioned stomach (n = 10), interposing bowel loops and liver (n = 19), omphalocele (n = 1), severe scoliosis (n = 1), and ventriculoperitoneal shunt (n = 1). Technical success was 85% (23/27). Mean procedure time was 96min (range 50-131min). No safe access route into the stomach was encountered in four patients; three were referred for surgical gastrostomy and one had a successful re-attempt. Radiation dose data was obtained from 19 procedures (17 successful) with a total dose in successful procedures ranging from 8.1 to 63.6mGy (average 26.2mGy, median 24.9mGy). The number of cone-beam CT acquisitions per procedure ranged from 1 to 4. Major complication frequency was 11% (3/27) (bleeding, peritonitis, and aspiration pneumonia); minor complication frequency was 3.7% (1/27). This study shows that cone-beam CT guidance can be useful for assisting percutaneous radiologic gastrostomy in children with challenging anatomy.

Regional Anesthesia as an Alternative to Moderate Sedation for Perioperative Pain Control for Percutaneous Gastrostomy Tube Placement

Percutaneous gastrostomy tube placement is typically performed under moderate sedation. However, some patients are not ideal candidates for moderate sedation because of respiratory compromise, difficult airways, or other factors. The purpose of this study was to evaluate regional anesthesia as an alternative to moderate sedation. A retrospective review of patients who underwent percutaneous gastrostomy tube placement between March 2014 and September 2020 was performed. Data on patient demographics, anesthesia type, pain scores, and opiate usage were collected. A total of 189 patients were included in the study; 35 (18.5%) received regional anesthesia and 154 received moderate sedation. Patients in the regional anesthesia group tolerated the procedure well, with lower mean immediate postprocedural and maximal pain scores of 0.7 vs 2.2 (P = .011) and 4.3 vs 6.5 (P = .003), respectively. Regional anesthesia is effective at controlling perioperative pain and is an alternative with a low complication rate for patients who cannot tolerate moderate sedation.

The Abdominal Wall Factor: Impact of Surgical Technique in Feeding Access in the Obese Population

INTRODUCTION: Surgical feeding access is necessary in long-term care of patients. Although high complication rates have been documented, modification of operative technique to minimize complication has not been described. We sought to document complication rate of surgical feeding access and identify contributing factors. We hypothesized that in obese patients, laparoscopic gastrostomy tubes (LapG) would confer fewer complications than percutaneous gastrostomy tubes (PEG). METHODS: We conducted a retrospective review of all surgical feeding access cases performed by the ACS service from September 1, 2012, to June 30, 2021. Patient demographics, hospitalization metrics, and outcomes were compared. RESULTS: Feeding access accounted for 14% of cases performed by the ACS service and represented 21% of 30-day mortalities. There were 133 complications associated with these procedures, with no difference between trauma and emergency general surgery populations (6.8% vs 5.7%, p = 0.44). Patients with a BMI >30 kg/m2 had a higher incidence of complications including tube migration requiring operation (4.6% vs 2.5%, p = 0.03). This association held true in PEG patients (4.8% vs 2.2%, p = 0.03), but not in LapG patients (2.4% vs 2.6%, p = 0.87). CONCLUSION: Complications from feeding access has been studied, but this is the first to determine thresholds for changes in operative approach. ACS surgeons should consider LapG over PEG to minimize complication risk in patients with BMI >30 kg/m2. We must tailor our operative technique to the patient populations we care for instead of using a “one-size fits all” approach. If surgeons are tasked feeding access procedures to facilitate patient throughput, we must mitigate potential complications instead of accepting their inevitability.

S2601 Gastroepiploic Pseudoaneurysm: A Shocking Complication of PEG Tube Placement

Introduction: Percutaneous gastrostomy (PEG) tubes are commonly used for enteric feeds and medication administration. While considered safe and routine, PEG tube placement is not without its complications. Here we present a rare case of hemorrhagic shock secondary to traumatic pseudoaneurysm formation after PEG tube placement. Case Description/Methods: A 52-year-old male with atrial fibrillation on apixaban and a recent stroke with PEG tube placement 1 month prior to arrival presented to the hospital with multiple episodes of hematemesis. CT angiography of the abdomen was unremarkable and negative for signs of active bleeding. Antiplatelets were held and anticoagulation was reversed with prothrombin complex concentrate. Esophagogastroduodenoscopy showed signs of erosive esophagitis with proper PEG tube placement but without signs of active bleeding. Hematemesis re-occurred less than 24 hours after anticoagulation was resumed, with subsequent development of hemorrhagic shock. Visceral arteriogram revealed a right gastroepiploic artery pseudoaneurysm, which likely developed from trauma during recent PEG placement. The patient stabilized after coil embolization and blood transfusion. He was then safely resumed on anticoagulation without further bleeding. Discussion: GI bleeding associated with PEG placement occurs in 0.6-1.2% of cases, and usually occurs at the gastrostomy tract or from gastric ulceration. Bleeding related to pseudoaneurysm formation is exceedingly rare with only a handful of case reports documenting such occurrence. While contrast enhanced imaging may aid in the diagnosis, small pseudoaneurysms may not be detected with noninvasive angiographic studies (as was the case here). Given this potentially life-threatening complication, clinicians must consider pseudoaneurysm formation as part of their differential for GI bleed after recent PEG placement especially if endoscopic evaluation is unrevealing.

S2530 Utility of Hemostatic Powder Spray for Management of Recently Placed Percutaneous Gastrostomy Tube Tract Bleeding

S2530 Utility of Hemostatic Powder Spray for Management of Recently Placed Percutaneous Gastrostomy Tube Tract Bleeding

S1887 A Case of PEG-Induced Pancreatitis

Introduction: PEG (percutaneous endoscopic gastrostomy) tube placement is a commonly performed procedure for patients in need of long-term enteral nutrition. It is a relatively safe procedure, with some complications including bleeding, infection, buried bumper syndrome, and dislodgement. Even rarer is the tube migration into the duodenum, obstructing the ampulla, causing biliary obstruction and pancreatitis. We present a case of pancreatitis secondary to migrated PEG tube bumper [1, 2]. Case Description/Methods: An 83-year-old male with a history of stroke and dysphagia, who one year prior had a PEG tube placed presenting with vomiting and epigastric pain and tenderness. Initial lipase was 1761 (reference 8-69 U/L), alkaline phosphatase was 145 (reference 36-112 IU/L), transaminases, bilirubin, and triglycerides were normal. Abdominal CT scan showed a migrated PEG tube balloon in second part of the duodenum at level of the ampulla (Figure). As it turned out patient was tolerating oral diet thus PEG was no longer needed. GI team deflated the balloon and removed the PEG without any further complications. With aggressive fluid resuscitation, patient's symptoms resolved after two days. Discussion: Pancreatitis due to migrated PEG tube obstructing the ampulla is a rare entity, with only a few case reports published. Patient's can present with nonspecific symptoms with significantly elevated hepatic and pancreatic enzymes. CT findings can show pancreatic inflammation and biliary/pancreatic duct dilation with PEG bumper at level of ampulla [1, 2]. Physical exam findings would show very little external tubing indicating distal internal migration of PEG bumper. Interestingly this can also cause intermittent gastric outlet obstruction. Treatment is PEG tube removal/replacement, and IV fluids. Marking the tube at the insertion site can help in diagnosis of migration, if it happens. Patients and care givers should be educated about tube care, regular follow-ups to ensure positioning and to ascertain the timing of removal.Figure 1.: Migration of percutaneous gastrostomy tube balloon to second portion of duodenum at level of ampulla.

Adjunctive techniques for percutaneous enteral access in children: a pictorial review.

Primary percutaneous gastrostomy and gastrojejunostomy tube placements are fundamental procedures performed in pediatric interventional radiology, with both antegrade and retrograde techniques described. In pediatric patients, however, challenges may arise due to smaller patient size and anatomical variations. Several adjunctive techniques may facilitate safe percutaneous access in the setting of a limited percutaneous gastric access window. These include the intra-procedural use of cone beam computed tomography (CT), percutaneous needle decompression in the setting of distended air-filled bowel interposed between the stomach and abdominal wall, post-pyloric balloon occlusion to facilitate gastric distension, ultrasound-guided gastric puncture, and intra-gastric contrast-enhanced ultrasound (ceUS) to define the relationship of the gastric wall and the anterior abdominal wall. Adjunctive techniques may increase successful primary percutaneous gastroenteric tube placement and may improve operator confidence in safe placement.

Impact of dosimetric factors on long-term percutaneous enteral gastrostomy (PEG) tube dependence in head and neck cancer patients after (chemo)radiotherapy—results from a prospective randomized trial

Purpose/objectiveTo analyze dose–volume histogram (DVH)-derived data on the exposure of organs at risk with impact on long-term percutaneous enteral gastrostomy (PEG) tube dependence in head and neck cancer patients at 6 and 12 months after definitive or adjuvant (chemo)radiotherapy.Materials and methodsSixty-one patients were prospectively treated with (chemo)radiotherapy. Prophylactic or reactive gastrostomy tube placement was performed in 41 (67.2%) patients. Dose–volume histogram parameters were obtained for the swallowing apparatus.ResultsMedian follow-up time was 25 (2–34) months. Overall survival was shorter in patients with inlying PEG tubes at 6 and 12 months (log rank p = 0.038 and p = 0.017) after therapy completion. The estimated median time of tube dependency was 6 (95% confidence interval: 2–14) months. After 6 months, 46.5% of patients were tube dependent. After 12 months, this estimated proportion fell to 31.5%. For both time points, the volume to the larynx (in %) receiving at least 50 Gy (larynx V50Gy) exceeding 53% was predictive for long-term tube feeding (6 months: p = 0.041 and 12 months: p = 0.042) being an independent predictor during multivariable analysis. There was no clinical feature influencing tube dependence after 12 months.ConclusionLong-term gastrostomy dependence was found to be strongly associated with an exposure of laryngeal structures (specifically, V50Gy ≥ 53%) during radiotherapy. Consequently, the avoidance of supraglottic as well as glottic structures is warranted.

TU1.6 Endoscopic Management of Broncho-Oesophageal Fistula Caused by Impacted Denture

Abstract Background Oesophageal foreign body impaction in adults is fairly common. Although, dentures being often accidentally ingested among the elderly, it is very unusual to develop a broncho-oesophageal fistula (BOF) secondary to a retained denture. The few cases reported in the literature were mostly managed with thoracotomy. We present a clinical case of a BOF successfully treated by endoscopic approach following a combined assessment and planning between intervention radiology, general and cardiothoracic surgery. Case Report A 60-year-old male was transferred from neighbouring DGH to our centre due to worsening of dysphagia. Patient reported that he had swallowed a denture 6 month earlier. The CT scan showed the denture along with a left BOF. Imaging was further reviewed and discussed amongst interventional radiology, cardiothoracic, and upper gastrointestinal surgeons. Endoscopic retrieval of impacted denture plate was successful, followed by the insertion of left bronchial stent, and percutaneous gastrostomy tube. The left bronchial stent was removed after three months with successful closure of the fistula. Conclusion Our clinical case highlights that multidisciplinary team discussion is crucial in the management of complex surgical cases in order to achieve the best outcome possible. Additionally, endoscopic management of BOF is a safe alternative option to thoracotomy when the required resources are available.

Abstract No. 572 Outcomes of balloon percutaneous gastrostomy tube placements

Gastrostomy tube failures contribute to increased patient burden and are associated with hospital readmission and increased utilization of healthcare resources. The purpose of this study is to compare the outcomes of the novel balloon gastrostomy technique with the standard serial dilation.

Predicting Gastrostomy Tube Placement After Intracerebral Hemorrhage: External Validation of the GRAVo Score.

Dysphagia is a common consequence of intracerebral hemorrhages (ICH). It can lead to enduring impairments of dietary intake and the requirement for feeding via percutaneous gastrostomy (PEG) tubes. However, variabilities in the course of swallowing recovery after ICH make it difficult to anticipate the need for PEG placement in an individual patient. A new tool called the GRAVo score was recently developed to predict PEG tube placement after an ICH but has not been externally validated. Our study aims were to externally validate the GRAVo score in a multicenter cohort and reexamine the role of race in predicting PEG placement, given the uncertain biological plausibility for this relationship observed in the derivation cohort. Patients for this analysis were selected from a previously completed multicenter, randomized, double-blind futility design clinical trial, the Intracerebral Hemorrhage Deferoxamine trial, and underwent a retrospective review of prospectively collected data. The GRAVo scores were computed by using previously established methods using the following variables: Glasgow Coma Scale ≤ 12 (2 points), race (1 point for Black), age > 50years (2 points), and ICH volume > 30mL (1 point). Association of GRAVo scores with PEG placement were examined by using logistic regression analysis after adjustment for exposure to deferoxamine. Model performance was estimated by using area under the receiving operating characteristic curve (AUROC). Subsequently, a second model was created by excluding scores for race, and the AUROC of both models were compared. A total of 291 patients with complete data points served as the study cohort; 38 (13%) underwent PEG placement. The median GRAVo score for patients in the PEG and non-PEG groups were 4 (interquartile range 3-4) versus 2 (interquartile range 2-3), respectively (p < 0.0001). External validation of the GRAVo score yielded an AUROC of 0.7008 (95% confidence interval 0.6036-0.78); the model obtained without assignment of scores for the variable race yielded an AUROC of 0.6958 (95% confidence interval 0.6124-0.7891). The receiver operating characteristic curves from both models demonstrated close overlap. The results of our external validation demonstrate the validity of GRAVo scores for predicting PEG tube placement after an ICH. However, its performance was more modest compared with that of the derivation cohort. Inclusion of the race variable had no measurable effect on model performance. Differences in patient characteristics between these cohorts may have influenced our results. These findings should be taken into consideration when using the GRAVo score to assist clinical decision making on PEG placement after an ICH.

Risk Stratification of Dysphagia After Surgical Treatment of Hypopharyngeal Cancer.

ObjectiveHypopharyngeal cancer is managed by either surgical resection or radiation therapy-based treatment. In choosing the treatment modality, the patient’s swallowing function should be considered to achieve optimal treatment outcomes. This study aimed to stratify the risk factors predictive of postoperative dysphagia in hypopharyngeal cancer.Study DesignRetrospective study.SettingTertiary referral center.MethodsWe enrolled 100 patients who were diagnosed with hypopharyngeal cancer and underwent curative surgery between January 2010 and December 2019, and retrospectively reviewed their medical records.ResultsPostoperative dysphagia occurred in 29 patients (29%) who required a tracheostomy tube or percutaneous gastrostomy tube for feeding or preventing aspiration; additionally, the overall survival rate was lower in those patients than in those without dysphagia. The univariate analysis revealed that postoperative dysphagia was associated with clinical T stage (p = 0.016), N stage (p = 0.002), and surgical resection extent of the larynx and pharynx (p < 0.001). Patients who underwent total laryngectomy with total/partial pharyngectomy were more likely to have dysphagia than those in the larynx-preserving pharyngectomy groups (odds ratio [OR] = 3.208, 95% confidence interval [CI] 1.283–8.024, p = 0.011). Concerning the posterior pharyngeal wall (PPW), which has an important role in swallowing, patients who underwent resection of ≥1/2 of the PPW were more likely to have dysphagia (OR = 7.467, 95% CI 1.799–30.994, p = 0.003).ConclusionsSurgical resection extent was proportionally associated with dysphagia in hypopharyngeal cancer patients. Patients with smaller lesions but no laryngeal invasion had better postoperative swallowing function than patients with larger lesions or laryngeal involved lesions. Preserving the larynx and hypopharyngeal mucosa (especially the PPW) as much as possible can help preserve postoperative swallowing function.

Long-term monitoring and predictive factors of critical weight loss among patients with nasopharyngeal carcinoma in a curative treatment setting

PurposeWe aimed to determine weight change over time and identify risk factors of critical weight loss among patients with nasopharyngeal carcinoma (NPC). Materials and methodsIn this retrospective study, we investigated weight change over time in 445 patients with NPC who underwent curative treatment. Logistic regression analysis was used to identify possible predictors of critical weight loss. ResultsThe incidence of critical weight loss was 67.87%. The long-term monitoring demonstrated a rapid weight loss, especially in the first 2 months of treatment, which continued up to 5 months. Patients with critical weight loss did not regain weight until 3 years. Univariate analysis showed that the following factors were significantly associated with critical weight loss: lower pretreatment body mass index (BMI), tumor stage, subjective global assessment score, Eastern Cooperative Oncology Group (ECOG) score, and enteral tube feeding. Multivariate analysis showed four factors that were associated with a lower critical weight loss: pretreatment BMI < 18.5 kg/m2 (p < 0.001, 95% confidence interval [CI] = 0.25 [0.12–0.52]), early tumor stage (p = 0.004, 95% CI = 0.46 [0.27–0.79]), ECOG grade II (p = 0.006, 95% CI = 0.15 [0.04–0.51]), and early prophylactic percutaneous gastrostomy (PEG) tube feeding (p = 0.001, 95% CI = 0.26 [0.12–0.59]). ConclusionPatients having NPC with critical weight loss showed a significantly rapid decline in their weight in the first 2 months; the weight was persistently less than the baseline value during a 36-month follow-up period. Patients with lower BMI, early-stage cancer, and early prophylactic PEG tube feeding had a significantly lower critical weight loss than those without the abovementioned characteristics.

Gastric Aspiration Improves Postprandial Glucose Tolerance Without Causing a Compensatory Increase in Appetite and Food Intake.

AspireAssist® allows aspiration of ~30% of an ingested meal through a percutaneous gastrostomy tube, reducing caloric uptake. We evaluated the acute effects of gastric aspiration on postprandial glucose tolerance, responses of gluco-regulatory and appetite-regulating hormones, appetite sensations, and food intake. Seven AspireAssist®-treated individuals underwent two separate experimental days each involving a mixed meal test (MMT) with double-blinded aspiration and sham aspiration, respectively. Seven age and body mass index (BMI)-matched controls underwent one MMT. MMTs were followed by an ad libitum meal. Postprandial glucose tolerance was improved during aspiration vs. sham visits (median [interquartile range] baseline-subtracted area under the curve (bsAUC) 170 [88.4;356] vs. 388 [239;456] mmol/L × min, p = 0.025). Reduced responses (bsAUCs) of C-peptide (113 [28.4;224] vs. 302 [215;433] nmol/L × min, p = 0.014), cholecystokinin (223 [59.4;402] vs. 467 [416;546] pmol/L × min, p = 0.005), glucose-dependent insulinotropic polypeptide (4.63 [1.49;9.04] vs. 15.4 [9.59;18.9] nmol/L × min, p = 0.025), and glucagon-like peptide 1 (532.8 [274.5;1,278] vs. 1,296 [746.2;1,618] pmol/L × min, p = 0.032) were observed during aspiration vs. sham visits.Responses of glucagon, gastrin, ghrelin and peptide YY, appetite sensations, and ad libitum food intake were unaffected by aspiration. Responses of plasma glucose, gut hormones, appetite sensations, and food intake were similar during sham and control visits. Gastric aspiration improved postprandial glucose tolerance without causing compensatory increases in appetite or food intake, pointing to acute beneficial metabolic effects of aspiration therapy together with previously reported body weight-lowering effects.

Transpharyngeal Approaches for Management of Oropharyngeal Squamous Cell Carcinoma: Mayo Clinic Institution Experience.

Investigate oncologic and functional outcomes associated with transhyoid and lateral pharyngotomy (transpharyngeal) approaches in the treatment of oropharyngeal squamous cell carcinoma (OPSCC). Retrospective review. Single institution (tertiary care center). This is a retrospective case series of patients with OPSCC undergoing transpharyngeal resection from 1990 to 2017 at Mayo Clinic. Oncologic outcomes, postoperative complications, objective swallowing data, and rates of tracheostomy and percutaneous gastrostomy tube dependence were recorded. Of 83 patients meeting inclusion criteria, 56 (68%) were human papillomavirus positive. Overall survival rates at 5 and 10 years following surgery were 85% and 80%, respectively. Cancer-specific survival rates at these same time points were 90% and 88%. Following treatment, 35 of 49 patients (71%) had a Functional Oral Intake Scale score ≥5, indicating total oral intake of multiple consistencies; 79 of 82 (96%) were without tracheostomy or laryngectomy; and 71 of 81 (88%) were on a full oral diet. Transpharyngeal approaches provide adequate functional and oncologic outcomes in the majority of patients with OPSCC. These results may have important implications for patients who are not candidates for, or are unwilling to undergo, nonoperative therapy or for those without access to radiation therapy.

Is percutaneous gastrostomy tube insertion contraindicated in adult peritoneal dialysis patients? A single-centre experience of three successful cases: It is time to revisit.

Percutaneous endoscopic gastrostomy (PEG) tube placement in adults who are already established on peritoneal dialysis (PD) remains challenging due to the limited experience and data in this area which lacks clear guidance. Given the fact that peritoneal dialysis is one of the relative contraindications for PEG tube insertion, and PEG tube on its own is a risk for peritonitis, how to overcome these obstacles and utilize the advantage of PEG tube for feeding malnourished PD patients remains uncertain. Here we report our unique successful experience of treating three adult peritoneal dialysis patients in whom the PEG tube was inserted successfully with no complications. To the best of our knowledge, this is the first successful case series in the literature for treating adult prevalent PD patients by PEG tube placement.

A Rare Finding of Gastric Metastasis From Tonsillar Squamous Cell Carcinoma.

A 61-year-old Caucasian man with tonsillar squamous cell carcinoma (SCC, stage T2N1, diagnosed 1 year ago) underwent an endoscopic percutaneous gastrostomy tube (PEG) placement for oropharyngeal dysphagia at the time of diagnosis. Given pulmonary metastases, he was begun on immunotherapy. Upper endoscopy was scheduled for PEG tube replacement. He denied abdominal pain, melena, and hematochezia. Hemoglobin was 11.6 g/dL. The upper endoscopy found a 3-cm ulcerated mass along the greater curvature of the gastric body (Figure A and Figure B). This was located 2 cm away from the internal PEG bumper. He underwent an uneventful PEG replacement. Biopsies demonstrated SCC (Figure C), with staining positive for p40 (Figure D). This established the diagnosis of gastric metastasis of tonsillar SCC. He was continued on immunotherapy. Head and neck SCC metastasize to the lung, bone, and liver. We demonstrate here one of the few reported cases of tonsillar metastases to the stomach, which is one of the least common primary malignancies that result in gastric metastases. Although our patient did not have metastases at the gastric stoma, PEG tubes have been suggested as a risk factor for distal seeding of metastases. Gastroenterologists should consider direct PEG placement instead of pull-through placement in such patients.View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Percutaneous gastrostomy tube placement in a patient with prior sleeve gastrectomy

Sleeve gastrectomies have quickly become the most common bariatric weight loss surgery performed in the United States (U.S.). Given that hundreds of thousands of gastrostomy tubes (G tubes) are also placed each year, the number of patients with prior sleeve gastrectomies requiring a G tube will surely rise in the coming years. The case presented herein is a patient with prior sleeve gastrectomy who underwent percutaneous G tube placement.

Pharmacokinetics of hydrogen after ingesting a hydrogen-rich solution: A study in pigs

Drinking hydrogen (H2)-rich water is a common way to consume H2. Although many studies have shown efficacy of drinking H2-rich water in neuropsychiatric and endocrine metabolic disorders, their authenticity has been questioned because none examined the associated pharmacokinetics of H2. Therefore, we performed the first study to investigate the pharmacokinetics of H2 in pigs given an H2-rich glucose solution with the aim to extrapolate the findings to humans. We inserted blood collection catheters into the jejunal and portal veins, suprahepatic inferior vena cava, and carotid artery of 4 female pigs aged 8 weeks. Then, within 2 min we infused 500 ml of either H2-rich or H2-free glucose solution into the jejunum via a percutaneous gastrostomy tube and measured changes in H2 concentration in venous and arterial blood over 120 min. After infusion of the H2-rich glucose solution, H2 concentration in the portal vein peaked at 0.05 mg/L and remained at more than 0.016 mg/L (H2 saturation level, 1%) after 1 h; it also increased after infusion of H2-free glucose solution but remained below 0.001 mg/L (H2 saturation level, 0.06%). We assume that H2 was subsequently metabolized in the liver or eliminated via the lungs because it was not detected in the carotid artery. In conclusion, drinking highly concentrated H2-rich solution within a short time is a good way to increase H2 concentration in portal blood and supply H2 to the liver.

Prenatal stress reduces heterotypical sexual behavior and inhibits homotypical sexual behavior in female rats: relationships with kisspeptin

We aimed to determine weight change over time and identify risk factors of critical weight loss among patients with nasopharyngeal carcinoma (NPC).In this retrospective study, we investigated weight change over time in 445 patients with NPC who underwent curative treatment. Logistic regression analysis was used to identify possible predictors of critical weight loss.The incidence of critical weight loss was 67.87%. The long-term monitoring demonstrated a rapid weight loss, especially in the first 2 months of treatment, which continued up to 5 months. Patients with critical weight loss did not regain weight until 3 years. Univariate analysis showed that the following factors were significantly associated with critical weight loss: lower pretreatment body mass index (BMI), tumor stage, subjective global assessment score, Eastern Cooperative Oncology Group (ECOG) score, and enteral tube feeding. Multivariate analysis showed four factors that were associated with a lower critical weight loss: pretreatment BMI < 18.5 kg/m2 (p < 0.001, 95% confidence interval [CI] = 0.25 [0.12–0.52]), early tumor stage (p = 0.004, 95% CI = 0.46 [0.27–0.79]), ECOG grade II (p = 0.006, 95% CI = 0.15 [0.04–0.51]), and early prophylactic percutaneous gastrostomy (PEG) tube feeding (p = 0.001, 95% CI = 0.26 [0.12–0.59]).Patients having NPC with critical weight loss showed a significantly rapid decline in their weight in the first 2 months; the weight was persistently less than the baseline value during a 36-month follow-up period. Patients with lower BMI, early-stage cancer, and early prophylactic PEG tube feeding had a significantly lower critical weight loss than those without the abovementioned characteristics.