Transient Vomiting Research Articles

Psychedelic Therapy: A Primer for Primary Care Clinicians-N,N-Dimethyltryptamine and Ayahuasca.

N,N-dimethyltryptamine (DMT) is a naturally occurring serotonergic psychedelic found in natural plants around the globe. As the main psychoactive component in ayahuasca, which also contains monoamine oxidase inhibitors, DMT has been consumed as plant-based brew by indigenous peoples for centuries. Further research is required to delineate the therapeutic utility of DMT. Although previous research has shown that DMT is synthesized endogenously, it may not be produced at physiologically relevant concentrations. Additionally, the phenomenological similarities between the DMT-induced state and near-death experiences led to the popular hypothesis that endogenous DMT is released during the dying process. However, this hypothesis continues to be debated. Generally, DMT and ayahuasca seem to be physiologically and psychiatrically safe, although ayahuasca is known to cause transient vomiting. A double-blind, randomized controlled trial showed that, within 1 week, ayahuasca causes remission in 36% of patients with treatment-resistant depression. According to top-line results from a recent phase IIa trial, 57% of patients with major depressive disorder experienced remission 12 weeks after receiving a single intravenous dose of DMT. There has only been a single published double-blind randomized controlled trial on ayahuasca and 2 on DMT. All clinical trials have had small sample sizes (≤34 participants). DMT requires further research to understand its therapeutic and clinical potential as a psychedelic. Preliminary evidence indicates that ayahuasca and DMT may be more effective than existing antidepressants for treating major depressive disorder and treatment-resistant depression.

Feasibility and safety of integrating mass drug administration for helminth control with seasonal malaria chemoprevention among Senegalese children: a randomized controlled, observer-blind trial

BackgroundThe overlap in the epidemiology of malaria and helminths has been identified as a potential area to exploit for the development of an integrated control strategy that may help to achieve elimination of malaria and helminths. A randomized, controlled, observer-blind trial was conducted to assess the feasibility and safety of combining mass drug administration (MDA) for schistosomiasis and soil transmitted helminths (STH) with seasonal malaria chemoprevention (SMC) among children living in Senegal.MethodsFemale and male children aged 1–14 years were randomized 1:1:1, to receive Vitamin A and Zinc on Day 0, followed by SMC drugs (sulfadoxine-pyrimethamine and amodiaquine) on Days 1–3 (control group); or praziquantel and Vitamin A on Day 0, followed by SMC drugs on Days 1–3 (treatment group 1); or albendazole and praziquantel on Day 0, followed by SMC drugs on Days 1–3 (treatment group 2). Safety assessment was performed by collecting adverse events from all children for six subsequent days following administration of the study drugs. Pre- and post-intervention, blood samples were collected for determination of haemoglobin concentration, malaria microscopy, and PCR assays. Stool samples were analyzed using Kato-Katz, Merthiolate-iodine-formalin and PCR methods. Urine filtration, PCR and circulating cathodic antigen tests were also performed.ResultsFrom 9 to 22 June 2022, 627 children aged 1–14 years were randomized into the three groups described above. Mild, transient vomiting was observed in 12.6% (26/206) of children in treatment group 2, in 10.6% (22/207) in group 1, and in 4.2% (9/214) in the control group (p = 0.005). Pre-intervention, the geometric mean value of Plasmodium falciparum parasite density was highest among children who received albendazole, praziquantel with SMC drugs. Post-intervention, the parasite density was highest among children who received SMC drugs only. Children who received praziquantel and SMC drugs had a lower risk of developing severe anaemia than their counterparts who received SMC drugs alone (OR = 0.81, 95% CI 0.13–5.00, p = 0.63).ConclusionsIntegration of MDA for helminths with SMC drugs was safe and feasible among Senegalese children. These findings support further evaluation of the integrated control model.Trial registration: The study is registered at Clinical Trial.gov NCT05354258.

クドア食中毒

A myxozoan parasite Kudoa septempunctata causing the food poisoning of humans which consume raw olive flounder Paralichthys olivaceus has become a new threat to public health. ​This review focuses the recent occurrence of K. septempunctata-induced food poisoning in Japan for 10 years, the typical symptoms of the foodborne disease in humans, parasitology, diagnoses, countermeasures and the remaining issues. ​The numbers of K. septempunctata-induced cases and patients have peaked in 2014, followed by a gradual decrease in recent years. ​The symptoms of humans are characterized by transient vomiting and diarrhea. ​Also, onset of the disease is dose-dependent of fresh spores (> 1 × 107). ​The host fish for K. septempunctata is mainly limited to P. olivaceus. ​The geographical distribution is Japan and Korea. ​The two locality isolates are easily differentiated by a ratio of spores possessing 7 polar capsules. ​The light-microscopy, conventional or real-time PCRs, LAMP, immunochromatography have been developed for the diagnostic tools. ​To prevent the infection with K. septempunctata in juvenile stage of cultured flounder, a sand-filtration combined with ultraviolet irradiation (> 46 mJ/cm2) is effective. ​At the time of shipment of adult flounder, light-microscopic examination for spores is recommended to remove the infected fish group. ​The remaining problems include the disease mechanisms in humans, the host range, and the harmful Kudoa species other than K. septempunctata.

Phase 1/2 study of elraglusib (9-ING-41), a small molecule selective glycogen synthase kinase-3 beta (GSK-3β) inhibitor, alone or with irinotecan, temozolomide/irinotecan or cyclophosphamide/topotecan in pediatric patients with refractory malignancies: Interim results.

e22015 Background: GSK-3β overexpression is associated with aggressive malignancies, treatment resistance and poor prognosis. The GSK-3β inhibitor Elraglusib induces apoptosis via NFΚB and p53 pathways and has potent anti-fibrotic and immunomodulatory activity. Adult studies of elraglusib demonstrate clinical activity in pancreatic cancer, melanoma, lymphoma and sarcoma as a single agent or in combination with cytotoxic chemotherapy. Elraglusib is active in in vivo models of neuroblastoma (NBL) and malignant glioma. This first-in-pediatrics study (NCT04239092) is evaluating the safety, pharmacokinetics (PK), and efficacy of elraglusib monotherapy and in combination with chemotherapy in patients with refractory malignancies. Methods: Elraglusib is given intravenously (IV) twice-weekly at 3 dose levels (DL) (9.3, 12.4 and 15 mg/kg) as a single agent or in combination with irinotecan, cyclophosphamide/topotecan or temozolomide/irinotecan in 21-day cycles. A cohort of pts with refractory NBL will be treated at the recommended phase 2 dose (RP2D) of elraglusib with temozolomide/irinotecan. Results: As of January 2022, 23 pts (n = 7 female, median age 14.2 years) have received at least one dose of elraglusib. Tumor types: 5 NBL, 3 diffuse midline glioma (DMG), 3 osteosarcoma (OS), 3 ependymoma (EP), 2 alveolar rhabdomyosarcoma (aRMS), 1 angiosarcoma (AS), 1 Ewing sarcoma (ES), 1 glioblastoma (GBM), 1 hepatoblastoma (HB), 1 embryonal CNS tumor NOS, 1 NUT midline carcinoma, 1 pineoblastoma (PB). Median time from diagnosis is 26 months (range: 6.7 – 156.3) and median number of lines of prior systemic therapy is 2 (range 0-14). Two DLs of single agent (6 pts) have been completed (9.3 and 12.4 mg/kg) without elraglusib-attributable severe adverse events (SAEs). Of the 15 patients on the combination arm with irinotecan or cyclophosphamide/topotecan, a single adverse event (Grade 4 hypotension/infusion reaction) was reported. Grade 1/2 elraglusib attributable-AEs include: transient visual change (n = 10), nausea (n = 7), vomiting (n = 6), fatigue (n = 2), hypotension (n = 2) and infusion reaction (n = 1). One pt with recurrent ES had a radiographic and pathologic CR after 3 cycles of elraglusib/cyclophosphamide/topotecan. 6 pts (26.1%) had SD (2 NBL, 1 aRMS, 1 EP, 1 OS, 1 GBM). 8 pts (35%) remained on study treatment ≥ 3 months (2 NBL, 2 EP, 1 OS, 1 aRMS, 1 ES, 1 PB). Median treatment duration was 40 days (range 1 - 126). 4 pts remain on therapy. Conclusions: Elraglusib is well tolerated as a single agent and with several chemotherapy regimens in this heavily pretreated pediatric population with refractory cancers. It has encouraging antitumor activity, with 1 CR in a patient with recurrent ES. Enrollment is ongoing; a RPD2 has not been reached. Clinical trial information: NCT04239092.

A retrospective evaluation of the steroid sparing effects of oral mycophenolate mofetil (MMF) as an adjunct immunosuppressant for the treatment of canine pemphigus foliaceus.

Oral mycophenolate mofetil (MMF) currently is considered a low-risk steroid-sparing therapeutic option for the management of canine pemphigus foliaceus (PF). This retrospective study evaluates the therapeutic outcomes of dogs with PF treated with the combination of oral MMF and glucocorticoid (GC). Clinical outcomes and adverse side effects are reported. Eleven dogs diagnosed with PF. Retrospective review of medical records from dogs presented with PF to the dermatology service of a veterinary teaching hospital between 2015 and 2020. Eleven dogs were identified which had received concurrent GCs and MMF. The MMF dose range was 19.8-45 mg/kg/day. Only two dogs (two of 11) treated with a mean MMF dosage of 39 mg/kg/day along with oral prednisone or dexamethasone achieved complete remission (CR). Partial remission (PR) was achieved in four of 11 dogs who received either prednisone, prednisolone or dexamethasone along with MMF (mean dosage 26 mg/kg/day). Four dogs (four of 11) showed poor response to MMF given at 28.5 mg/kg/day along with prednisone or dexamethasone. In one dog (one of 11) MMF was discontinued due to severe GI upset; transient vomiting and diarrhea was observed in four of 11 dogs. The median duration of MMF therapy in conjunction with GC for all groups was 70.5 days. Tapering of oral GCs while continuing MMF administration at the same dosage and frequency led to recurrence of lesions in all PF patients. Oral MMF combined with GC achieved CR in two of 11 PF dogs included in this study. Further research of MMF efficacy in PF may need to be performed.

Prophylactic transdermal scopolamine for the reduction of postoperative length of stay after uterine aspiration at Kaiser Permanente Northern California from 2017−2018

ObjectiveTo determine if transdermal scopolamine is associated with decreased postoperative nausea and vomiting and shorter length of stay in the postoperative care unit among patients undergoing uterine aspiration for abortion or early pregnancy loss. Study DesignWe conducted a retrospective cohort study at an integrated medical center that initiated a protocol to prescribe transdermal scopolamine to patients undergoing uterine aspiration under moderate sedation. We compared outcomes among patients who underwent uterine aspiration in 2017, before the institution enacted the protocol, with their counterparts in 2018, immediately after the institution instated the protocol. We reviewed patient charts for data on the postoperative length of stay, use of additional antiemetics, and a standardized clinician designated postoperative nausea and vomiting score. We analyzed outcomes by relevant demographic and clinical characteristics using chi-square or Fisher's exact tests for categorical variables and t tests for continuous variables. ResultsThe final sample included 386 patients; 228 who did not receive scopolamine and 158 who did. The cohorts were comparable in terms of demographic and clinical characteristics. The cohort that received transdermal scopolamine had a similar mean postoperative length of stay (75.4 ± 54.1 vs 71.1 ± 50.8 minutes; p = 0.43). There were no differences in the proportions of patients who were provided additional antiemetics (26 ± 11.4 vs 17 ± 10.8; p = 0.84) or had transient vomiting and retching (3 ± 1.9 vs 3 ± 1.3; p = 0.69) between the cohorts. ConclusionWe found no evidence that prophylactic transdermal scopolamine reduces postoperative nausea, vomiting, or length of stay among patients undergoing uterine aspiration. ImplicationsAmong patients who underwent uterine aspiration under moderate sedation, use of prophylactic transdermal scopolamine was not associated with shorter postoperative length of stay or lesser use of antiemetics. Prophylactic transdermal scopolamine is not likely to be useful for patients undergoing uterine aspiration and could be an unnecessary cost.

A prospective evaluation of oral Yunnan Baiyao therapy on thromboelastographic parameters in apparently healthy cats

To determine the effect of Yunnan Baiyao (YB) on hemostatic parameters measured by thromboelastography (TEG) in apparently healthy cats administered 1 capsule of YB orally twice daily for 1 week. Prospective study of client-owned cats at a small animal specialty hospital. One private referral center. Twenty client-owned adult cats were prospectively enrolled. All cats underwent echocardiographic examination by the same board-certified cardiologist to rule out occult cardiomyopathy. Blood samples were collected for analysis of baseline CBC, fibrinogen, and kaolin-activated TEG values. Cats were administered 1 capsule (250 mg/capsule) of YB twice daily orally for 1 week and the physical examination, CBC, fibrinogen, and TEG were re-evaluated. Any side effects attributed to YB were noted at this time. Three cats were excluded as 2 cats were identified with underlying cardiomyopathy and another cat had a cystic mass in the cranial mediastinum identified via echocardiography. Seventeen cats were treated with YB; however, 1 cat could not complete the study due to severe vomiting associated with YB administration. The remaining 16 cats completed the study, although 2 additional cats experienced transient vomiting. Yunnan Baiyao administration was associated with a significant decrease in HCT and red blood cell count, although no cat became anemic. None of the TEG parameters significantly changed compared to baseline after 1 week of YB therapy. The results of this study suggest YB at a dose of 1 capsule orally twice daily in cats fails to produce any significant change in hemostatic parameters as measured by TEG, although it did significantly reduce HCT and red blood cell count. Yunnan Baiyao was tolerated for most of the cats, although 3 of 17 (17.6%) cats experienced vomiting. Clinicians should be aware of these effects before considering the use of YB in cats.

The Role of Intra-Arterial Chemotherapy in the Manegment of Advanced Retinoblastoma; Group D & E

AbstractBackground: The treatment modalities for managing retinoblastoma have evolved in the past decade. While globe-salvage still relies heavily on intravenous chemotherapy, tumors in advanced stages D and E that failed chemotherapy are now referred for intra-arterial chemotherapy (IAC) to avoid enucleation.Aim of the Study: To evaluate the effectiveness and com-plications of intra-arterial chemotherapy (IAC) for treating advanced refractory group D and E retinoblastoma (RB).Material and Methods: 30 intro-ocular advanced refractory retinoblastoma of 26 consecutive patients who received IAC were included in the study during the period between Novem-ber 2013 and January 2017. These patients failed to respond adequately to a standard systemic chemotherapy (i.e., carbo-platin, vincristine, and etoposide) with or without local therapy. Clinical outcomes and complications of these patients were reviewed.Results: All our patients received IAC with injection of melphalan. The mean follow-up period was 14.2 months after final IAC (ranged from 6 to 20 months). The rate of overall globe salvage was 95% in Group D and 30% in Group E of this study. Short-term ocular adverse events included eyelid edema (n=15, 50%), bulbar conjunctiva congestion (n=7, 23.3%), mild ptosis (n=5, 16.7%) and long-term complications included ophthalmic artery spasm with reperfusion (n=2, 6.7%) retinal atrophy (n=1, 3.3%). Fever was observed after IAC in 10 patients and transient vomiting was observed in 16 patients.Conclusion: IAC can be an evolving optional treatment to save Group D RB that failed in systemic chemotherapy and were destined for enucleation. However, it should be cautioned for Group E. Both the ocular and systemic toxicities of IAC were within tolerance.

A historical cohort study of anesthetic methods for percutaneous left atrial appendage closure

Objective To explore the appropriate anesthetic method of percutaneous left atrial appendage closure by comparing the safety and feasibility of the different anesthetic methods. Methods Ninety nine patients with percutaneous left atrial appendage closure were divided into three groups according to anesthetic scheme by using a method of Historical Cohort Research: laryngeal mask general anesthesia without muscle relaxant (L group, n=19), endotracheal intubation general anesthesia with muscle relaxation antagonist (S group, n=40), and endotracheal intubation general anesthesia without muscle relaxation antagonist (G group, n=40). Target controlled infusion(TCI) of propofol and remifentanil for anesthesia induction and maintenance were used in L group and S group. The laryngeal mask was used in L group without muscle relaxants. Rocuronium was used for endotracheal intubation in S group, but the muscle relaxation was antagonized by sugammadex at the end of operation. Endotracheal intubation was performed after TCI propofol, intravenous sufentanil and cisatracurium in G group, but the muscle relaxation was not antagonized at the end of the operation. The outcome indexes were as follows: the time of spontaneous respiration, the time of consciousness recovery, the time of extubation, the time of staying at the postanesthesia care unit (PACU), the successful rate of esophageal ultrasonic probe placement, the incidence of displacement and air leakage of laryngeal mask, the incidence of replacement of a laryngeal mask with tracheal intubation during operation, and the adverse events after awakening. Results The recovery time of autonomic respiration in S group and L group were significantly shorter than that in G group[(2.5±0.5), (1.9±0.6) min vs (22.2±7.1) min, P<0.05]. The recovery time of consciousness was (3.4±0.6), (2.7±0.6) min in L group and S group respectively, both which were significantly shorter than that in G group[(28.8±12.9) min, P<0.05]. The time of extubation in L and S group was (4.5±1.0), (3.6±1.0) min respectively, both which were significantly shorter than that in G group [(34.6±16.0) min, P<0.05]. The time of staying at PACU in L group and S group was (28±4), (26±5) min respectively, which were significantly shorter than that in G group[(65±20) min, P<0.05]. The successful rate of one-time placement of TEE was 42.1% in L group, but that in S group and G group was more than 95% respectively(P<0.05). The intraoperative displacement rate in L group was 36.8%. The incidence of replacement of a laryngeal mask with tracheal intubation during operation was 21.1% in L group(P<0.05). The incidence of transient hypoxemia, agitation, nausea and vomiting and urinary retention were lower in S group and L group than in G group after awakening(P<0.05). Conclusions Endotracheal intubation general anesthesia was performed by combined intravenous injection of rocuronium with TCI propofol and remifentanil and reversal of rocuronium by sugammadex, which have the advantages of safe airway controllability, recovery rapidly after operation, extubation earlier, the lower incidence of hypoxemia and the lower incidence of agitation. Therefore, this anesthetic pattern is an ideal anesthetic method for percutaneous left atrial appendage closure. Key words: Left atrial appendage closure; General anesthesia; Sugammadex

Intra-arterial chemotherapy as primary or secondary treatment for infants diagnosed with advanced retinoblastoma before 3\u2009months of age

BackgroundTo evaluate the safety and efficacy of intra-arterial chemotherapy (IAC) for the primary or secondary treatment of infants diagnosed with advanced retinoblastoma before 3 months of age.MethodsThis single-center retrospective study included 39 infants (42 eyes) aged ≤3 months who were diagnosed with unilateral or bilateral advanced intraocular retinoblastoma (group D and E eyes) and received IAC as primary or secondary treatment between June 2012 and February 2017. Based on each patient’s therapeutic history and response to chemotherapeutic drugs, melphalan, topotecan, and/or carboplatin were used for IAC. The main outcomes included the technical success rate for IAC, survival rates, and adverse events.ResultsIn total, 29 and 13 eyes received IAC as primary and secondary treatments, respectively. Catheterization was successful in 136 of 137 procedures. All eyes in the secondary IAC group had previously received intravenous chemotherapy. The mean number of IAC sessions for each eye was 3 (range, 2–6). The 2-year ocular survival rates were 80.7% (95% confidence interval [CI], 58.9–91.7) in the primary IAC group and 91.7% (95% CI, 53.9–98.8) in the secondary IAC group. During the follow-up period, 1 patient with unilateral disease (group E) developed extraocular disease and died. The 2-year recurrence-free survival rates in the primary and secondary IAC groups were 71.9% (95% CI, 49.4–85.7) and 75.0% (95% CI, 40.8–91.2), respectively. During each catheterization procedure, the main complications included eyelid erythema (2.4%), fundus hemorrhage (11.9%), myelosuppression (7.7%), transient vomiting and hair loss (2.6%), and transient pancytopenia (2.6%). Prolonged complications included phthisis bulbi (19.0%), vision loss (19.0%), poor vision (9.5%), and cataract (2.4%). There was no case of stroke, neurological impairment, secondary malignant tumor, or metastasis.ConclusionsOur findings suggest that IAC, whether primary or secondary, is effective and fairly safe for the management of advanced retinoblastoma in infants aged < 3 months. However, adverse events related to intra-arterial injection and the visual outcomes cannot be neglected and require further investigation.

Cannabis Use in Patients Presenting to a Gastroenterology Clinic: Associations with Symptoms, Endoscopy Findings, and Esophageal Manometry

Recreational cannabis use is increasing with its legalization in many states. Animal studies suggest cannabis can reduce transient lower esophageal sphincter relaxations (TLESRS), reflux and vomiting, while human studies report conflicting findings. There are currently no large studies investigating gastrointestinal symptoms in patients with chronic cannabis use. This was a retrospective case-control study including patients who presented to an outpatient Gastroenterology office, with documented cannabis use. Their main presenting complaint, demographics, frequency and duration of cannabis use, endoscopic and high-resolution esophageal manometry (HREM) with impedance findings were recorded. Cannabis users were more likely to complain of abdominal pain (25% vs. 8%, p &lt; 0.0001), heartburn (15% vs. 9%, p &lt; 0.0001), and nausea &amp; vomiting (7% vs. 1%, p &lt; 0.0001). They were also more likely to have findings of esophagitis (8% vs. 3%, p = 0.0002), non-erosive gastritis (30% vs. 15%, p = 0.0001) and erosive gastritis (14% vs. 3%, p &lt; 0.0001) on upper endoscopy. Cannabis users were more likely to have impaired esophageal bolus clearance (43% vs. 17%, p = 0.04) and a hypertensive lower esophageal sphincter (LES) (29% vs. 7%, p = 0.04). This study is the largest to date evaluating GI complaints of patients with chronic recreational cannabis use. Our results suggest that cannabis use may potentiate or fail to alleviate a variety of GI symptoms which goes against current knowledge.

Intra-arterial chemotherapy as second-line treatment for advanced retinoblastoma

To evaluate the effectiveness and complications of intra-arterial chemotherapy (IAC) for treating advanced refractory retinoblastoma (RB) in a large single-center cohort. Eighty-four eyes of 62 consecutive patients with advanced refractory RB who received IAC were included in the study during January 2013 and April 2015. These patients failed to respond adequately to a standard systemic chemotherapy (i.e., carboplatin, vincristine, and etoposide) with or without local therapy. Clinical outcomes and complications of these patients were reviewed. All of these patients received IAC of melphalan combined with topotecan. The mean follow-up period was 14.2 months after final IAC (ranged from 3 to 28 months). The rate of eye preservation was 41.67% in Group D and 20.83% in Group E of this study. Short-term ocular adverse events included eyelid edema (n = 12, 14.29%), bulbar conjunctiva congestion (n = 25, 29.76%), and excessive tearing (n = 10, 11.90%). Long-term complications included vitreous hemorrhage (n = 7, 8%), subretinal hemorrhage (n = 9, 11%), retinal vasculopathy (n = 6, 7%), and ophthalmic artery spasm with reperfusion (n = 11, 13%). Fever was observed after IAC in 14 patients; transient vomiting was observed in 17 patients; there were 8 cases of transient myelosuppression. IAC can be an optional treatment to save eyes of Group D RB that failed in systemic chemotherapy and were destined for enucleation. However, it should be cautioned for Group E. Both the ocular and systemic toxicities of IAC were within tolerance.

Safety and efficacy of chloral hydrate for procedural sedation in paediatric ophthalmology: a systematic review and meta-analysis

PurposeAlthough chloral hydrate (CH) has been used as a sedative for decades, it is not widely accepted as a valid choice for ophthalmic examinations in uncooperative children. This study aimed...

Intragastric balloon as a novel modality for weight loss in patients with cirrhosis and morbid obesity awaiting liver transplantation.

In extreme obesity, bariatric surgery or weight loss by lifestyle modification is often not possible because of presence of decompensated cirrhosis. Endoscopic intragastric balloon placement may be used as minimal invasive technique to promote weight loss and make them better candidates for liver transplantation surgery; however, there is no literature in this regard. Patients with body mass index (BMI) >40kg/m(2) or BMI between 35 and 40 (with a low graft to recipient weight ratio) were considered for weight reduction modalities including dietary counseling and intragastric balloon placement when feasible. Intragastric balloon placement was done in six males and two females, age 46 ± 5years, BMI 43.5 ± 6.9kg/m(2). All patients (except one with hepatocellular carcinoma) had decompensated liver disease, mean Child score was 8.5 ± 1.6. Five of them had successful liver transplantation (three deceased and two living donor liver transplantation) after weight loss, while three are waiting. All these five patients had uneventful post-transplant course. All patients had transient vomiting except one, in whom volume of balloon was decreased due to persistent vomiting. All patients except one had weight loss. None of patients had any serious complications. Three of five patients maintained weight loss post-transplant also. Intragastric balloon placement is a useful modality for promoting short-term weight loss and thereby making morbidly obese recipients fit for liver transplantation surgery.

Medium-Term Results of Combined Laparoscopic Sleeve Gastrectomy and Modified Jejuno-Ileal Bypass in Bariatric Surgery.

The ideal bariatric operation achieves 70-100% maintained excess weight loss, is simple with low operative risks, and maintains absorption of trace elements. Our aim was to find a bariatric procedure that achieves the above while avoiding drawbacks of current options. A standard sleeve gastrectomy was combined with a modified jejuno-ileal bypass dividing the small bowel 75cm distal to the duodeno-jejunal flexure, anastomosing it to the ileum 75cm proximal to the ileocaecal valve. Operative and follow-up data were collected prospectively between December 2004 and January 2013. One hundred sixty-eight procedures were analysed (110 female, 58 male). Mean patient age was 43years (IQR 37-47), and median preoperative body mass index (kg/m(2)) was 52 (IQR 49-59). All operations were completed laparoscopically. Excess weight loss was 78% (IQR 70-83%, 12months, n = 168), 79% (IQR 70-85%, 24months), maintained at most recent follow-up with 77% (IQR 68-84%, n = 168), and for 8year follow-up alone 75% (IQR 66-84%, n = 18). There was no operative mortality and 5.4% morbidity. A 6.5% of patients experienced transient vomiting. No symptoms of dumping or bacterial overgrowth were observed. All had normal liver enzymes. Hypocalcaemia (20.8%) and zinc deficiency (25.6%) resolved with oral supplementation. Type 2 diabetes mellitus resolved in 80.3% and improved in the remainder of patients, hypertension resolved in 92.3% and improved in the rest. Whilst currently an investigative procedure, and within the studies limitations combined sleeve gastrectomy with modified jejuno-ileal bypass is safe and effective, and evades many problems associated with current bariatric operations whilst offering maintained excess weight loss.

A 90-day subchronic toxicity study with sodium formononetin-3′-sulphonate (Sul-F) delivered to dogs via intravenous administration

Sodium formononetin-3′-sulphonate (Sul-F) is a water-soluble derivate of formononetin, and an increasing number of studies have shown that Sul-F not only possesses favorable water solubility but also exhibits good lipid-lowering and bioactivities. In the current study, the toxicity of Sul-F was evaluated in dogs after 90-day intravenous infusion. Dogs were treated with Sul-F at dose of 0, 33.3, 100, and 300 mg/kg, and observed for 90-day followed by 28-day recovery period. Weekly measurement of body weight, temperature and food consumption were conducted. Ophthalmoscopy, ECG examination, urinalysis, serum biochemistry and hematology examination were performed at pre-test, on days 45 and 90, and following by 28-day recovery period. Histological examination was performed on day 90 and 28-day recovery period. No mortality, ophthalmic abnormalities or treatment-related findings in body weight, clinical chemistry, hematology, and histopathological examination were detected. However, a white crystal (non-metabolic Sul-F), transient vomiting and recoverable vascular stimulation were observed in 300 mg/kg/day Sul-F treated dogs. Under the conditions, the no-observed-adverse-effect-level (NOAEL) for Sul-F was 100 mg/kg in dogs.

Acute toxicity of sodium formononetin-3′-sulphonate (Sul-F) in Sprague-Dawley rats and Beagle dogs

Sodium formononetin-3′-sulphonate (Sul-F, C16H12O7SNa), a water-soluble derivate of formononetin, provided significant neuroprotective and cardioprotective effects in vitro and in vivo. The aim of this study was to evaluate acute toxicity of Sul-F after intravenous administration in rats and dogs. Animals were intravenously administered Sul-F at the maximum dosage of 2000 mg/kg and 1000 mg/kg in rats and dogs, respectively. After treatment, rats and dogs were monitored for 14 days. Body weight, clinical signs, the hematological and biochemical findings, and pathological examination were performed. The results showed that no Sul-F related clinical signs of toxicity or mortality were observed in rats. Of note, the transient vomiting was found in dogs after Sul-F administration 15–20 min. In addition, a white crystal, non-metabolic Sul-F, was found after urine volatilization in Sul-F treated animals (rats and dogs). However, neither biochemical findings nor histopathological changes due to Sul-F treatment were found in tests. In summary, the present study results provided practical guidance for selecting a safe dosage for Sul-F further studies and clinical trials in the future.

A comparison of toxicity profile of gemcitabine monotherapy versus etoposide/cisplatin in the treatment of locally advanced or metastatic non-small cell lung cancer

Background: Lung cancer is the leading cause of cancer deaths globally in which about 40% patients reporting in advanced stage disease. Both platinum and non platinumcombinations have been shown to be equally efficacious as initial first-line treatment of advanced non-small cell lung cancer (NSCLC), however because of the toxicity of cisplatin, combination treatment can only be administered to a minority of patients in good general health. Gemcitabine could be combined with one of the other new agents to create novel non-platinum-doublet combinations with efficacy and/or toxicity profile superior to that of standard platinum based combinations. Hence, this study was conducted to compare the toxicity profiles of gemcitabine monotherapy and the cisplatin/etoposide combination therapy. Methods: This was a randomized prospective study, which included 96 patients selected on the basis of histologically or cytologically confirmed Stage III B or IV of NSCLC. Study was divided into two arms-Arm A received gemcitabine monotherapy in a dose of 1000 mg/m 2 on day 1 and 5 of the cycle andrepeated after every 3 weeks while Arm B received cisplatin (25 mg/m 2 on day 1, 2 and 3) + etoposide (100 mg/m 2 ). Patient were evaluated for adverse events by following World Health Organization grading of toxicity. Results: Out of the 96 patients enrolled in the study, 74 (77.0%) patients were eligible and were analyzed. Of these, 36 (37.5%) patients belonged to Arm A and 38 (39.5%) to Arm B. Transient vomiting (45.8% vs. 37.5%), leukopenia (33.3% vs. 8.3%) were seen more in Arm A, while thrombocytopenia (33.3% vs. 12.5%), patchy hair loss (68.4% vs. 16.6%) was seen more in Arm B. Nephrotoxicity was seen almost similarly in both the groups. Conclusions: Single-agent gemcitabine appears to have a safer toxicity profile than the combination cisplatin-etoposide in the first-line chemotherapy of advanced NSCLC. With less toxic anticancer drugs like gemcitabine, the physician now has greater choice in choosing treatment, which can have better effect on the patients concerned.

Esophagojejunostomy feeding tube placement in 5 dogs with pancreatitis and anorexia.

Enteral feeding tube placement has been described in veterinary medicine for several years. Indications include oral, esophageal, gastrointestinal, pancreatic, hepatic, and neurologic diseases. In this paper, endoscopically assisted placement of an esophagojejunostomy (EJ) feeding tube in dogs with pancreatitis and prolonged anorexia is described. To the author's knowledge there are no published reports of this procedure. Esophagojejunostomy feeding tubes provide an alternative to other forms of postgastric feeding tube placement (e.g., nasojejunal, gastrojejunostomy, and jejunostomy tubes) without the associated complications of patient discomfort, sneezing, epistaxis, and peritonitis. Tube occlusion, transient vomiting and loose stool were the most commonly reported complications.

Glucagon-like peptide-1 based therapies: Effects beyond blood glucose control

Therapies based on the gut-derived glucagon-like peptide-1 (GLP-1) are a recent addition to the treatment of Type 2 diabetes. They are either inhibitors of the enzyme DPP-4, which inactivates GLP-1, or analogues of GLP-1 that are resistant to enzymatic degradation. Clinical trials show that long-term treatment with these classes of drugs have a favourable impact on the patient’s lipid profile, reduce systolic blood pressure and reduce abdominal obesity, suggesting a significant cardiovascular benefit in addition to glycaemic control. Transient nausea and vomiting are common adverse effects with this class of drugs and may occur due to reduction in gastric motility. GLP-1 based drugs might be associated with a slight increase in the risk of acute pancreatitis, but there is no evidence that these drugs cause pancreatic cancer in humans. GLP-1 based therapy induces medullary thyroid cancer in rat models, but there is no evidence of it increasing the risk in humans. In animal models, GLP-1 and its analogues improve markers of diabetic nephropathy and diabetic neuropathy by modulating inflammatory pathways. In a rat model of diabetes, GLP-1 analogues preserve pancreatic beta cell function and beta cell mass. On-going studies are investigating whether these benefits are replicated in humans. GLP-1 based drugs have a favourable effect on cardiovascular risk factors. They should be used with caution in patients at risk of pancreatitis. Animal studies suggest improvement in microvascular complications of diabetes.