High-resolution Manometry Determinants of Refractoriness of Reflux Symptoms to Proton Pump Inhibitor Therapy

( Mentore Ribolsi ),( Edoardo Savarino ),( Benjamin Rogers ),( Arvind Rengarajan ),( Marco Della Coletta ),( Matteo Ghisa ),( Michele Cicala ),( C Prakash Gyawali ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2020 Journal of Neurogastroenterology and Motility (JNM Vol.26 No.4

Background/Aims Impaired esophageal motility and disrupted esophagogastric junction (EGJ) on high-resolution manometry (HRM) have been associated with increased reflux severity in gastroesophageal reflux disease (GERD) patients. However, there are limited data evaluating HRM parameters in proton pump inhibitors (PPI) non-responders. Methods Clinical and endoscopic data, HRM and multichannel intraluminal impedance-pH studies performed of PPI therapy in patients with typical GERD symptoms were reviewed from 3 international centers. Frequency of GERD symptoms was assessed on and off PPI therapy in both non-responders (< 50% symptom improvement on PPI therapy) and responders. Rome IV definitions identified non-erosive reflux disease, reflux hypersensitivity, and functional heartburn. Univariate and multivariate analyses were performed to determine predictors of non-response. Results Of 204 patients, 105 were PPI non-responders and 99 were responders. Non-responders showed higher EGJ contractile integral values, and a lower frequency of type II and III EGJ morphology (P ≤ 0.03 for each comparison). Esophageal body diagnoses on HRM (fragmented peristalsis, ineffective esophageal motility, or absent peristalsis) did not predict non-response. On multivariate analysis, non-pathological acid exposure time (OR, 2.5; 95% CI, 1.2-5.0; P < 0.001), normal mean nocturnal baseline impedance values (OR, 2.7-2.4; 95% CI, 1.0-6.1; P < 0.05), normal EGJ contractile integral values (OR, 3; 95% CI, 1.3-7.4; P = 0.012), and presence of type I EGJ morphology (OR, 1.9; 95% CI, 1.0-3.4; P = 0.044) were associated with an unfavorable response to PPIs. Conclusions Intact EGJ metrics on HRM complement normal reflux burden in predicting non-response to PPI therapy. HRM has value in the evaluation of PPI non-responders. (J Neurogastroenterol Motil 2020;26:447-454)

Patients With Definite and Inconclusive Evidence of Reflux According to Lyon Consensus Display Similar Motility and Esophagogastric Junction Characteristics

( Mentore Ribolsi ),( Edoardo Savarino ),( Benjamin Rogers ),( Arvind Rengarajan ),( Marco Della Coletta ),( Matteo Ghisa ),( Michele Cicala ),( C Prakash Gyawali ) 대한소화기기능성질환·운동학회 2021 Journal of Neurogastroenterology and Motility (JNM Vol.27 No.4

Background/Aims The role of esophageal high-resolution manometry (HRM) within Lyon consensus phenotypes, especially patients with inconclusive gastroesophageal reflux disease (GERD) evidence, has not been fully investigated. In this multicenter, observational study we aim to compare HRM parameters in patients with GERD stratified according to the Lyon consensus. Methods Clinical and endoscopic data, HRM and multichannel intraluminal impedance-pH (MII-pH) studies performed off proton pump inhibitor therapy in patients with esophageal GERD symptoms were reviewed. Lyon consensus criteria identified pathological GERD, reflux hypersensitivity, functional heartburn, and inconclusive GERD. Patients, with inconclusive GERD were further subdivided into 2 groups based on total reflux numbers (≤ 80 or > 80 reflux episodes) during the MII-pH recording time. Results A total of 264 patients formed the study cohort. Pathological GERD and inconclusive GERD patients were associated with higher numbers of reflux episodes, lower mean nocturnal baseline impedance (MNBI) values, and a higher proportion of patients with pathologic MNBI compared to functional heartburn (P < 0.05 for each comparison). On multivariate analysis, pathological GERD and inconclusive GERD patients, both with ≤ 80 or > 80 reflux episodes, were significantly associated with pathologic esophagogastric junction contractile integral values and with presence of hiatus hernia (type 2/3 esophagogastric junction). Patients with inconclusive GERD and > 80 reflux episodes were significantly associated with fragmented peristalsis and ineffective esophageal motility whilst inconclusive GERD with ≤ 80 reflux episodes were significantly associated with fragmented peristalsis. Conclusion Esophageal motor parameters on HRM are similar between pathologic and inconclusive GERD according to the Lyon consensus. (J Neurogastroenterol Motil 2021;27:565-573)

Clinical Factors Associated with the Non-Operative Airway Management of Patients with Robin Sequence

Albino, Frank P.,Wood, Benjamin C.,Han, Kevin D.,Yi, Sojung,Seruya, Mitchel,Rogers, Gary F.,Oh, Albert K. Korean Society of Plastic and Reconstructive Surge 2016 Archives of Plastic Surgery Vol.43 No.6

Background The indications for surgical airway management in patients with Robin sequence (RS) and severe airway obstruction have not been well defined. While certain patients with RS clearly require surgical airway intervention and other patients just as clearly can be managed with conservative measures alone, a significant proportion of patients with RS present with a more confusing and ambiguous clinical course. The purpose of this study was to describe the clinical features and objective findings of patients with RS whose airways were successfully managed without surgical intervention. Methods The authors retrospectively reviewed the medical charts of infants with RS evaluated for potential surgical airway management between 1994 and 2014. Patients who were successfully managed without surgical intervention were included. Patient demographics, nutritional and respiratory status, laboratory values, and polysomnography (PSG) findings were recorded. Results Thirty-two infants met the inclusion criteria. The average hospital stay was 16.8 days (range, 5-70 days). Oxygen desaturation (<70% by pulse oximetry) occurred in the majority of patients and was managed with temporary oxygen supplementation by nasal cannula (59%) or endotracheal intubation (31%). Seventy-five percent of patients required a temporary nasogastric tube for nutritional support, and a gastrostomy tube placed was placed in 9%. All patients continued to gain weight following the implementation of these conservative measures. PSG data (n=26) demonstrated mild to moderate obstruction, a mean apneahypopnea index (AHI) of $19.2{\pm}5.3events/hour$, and an oxygen saturation level <90% during only 4% of the total sleep time. Conclusions Nonsurgical airway management was successful in patients who demonstrated consistent weight gain and mild to moderate obstruction on PSG, with a mean AHI of <20 events/hour.

Clinical Factors Associated with the Non- Operative Airway Management of Patients with Robin Sequence

Frank P. Albino,Benjamin C. Wood,Kevin D. Han,Sojung Yi,Mitchel Seruya,Gary F. Rogers,Albert K. Oh 대한성형외과학회 2016 Archives of Plastic Surgery Vol.43 No.6

Background The indications for surgical airway management in patients with Robin sequence (RS) and severe airway obstruction have not been well defined. While certain patients with RS clearly require surgical airway intervention and other patients just as clearly can be managed with conservative measures alone, a significant proportion of patients with RS present with a more confusing and ambiguous clinical course. The purpose of this study was to describe the clinical features and objective findings of patients with RS whose airways were successfully managed without surgical intervention. Methods The authors retrospectively reviewed the medical charts of infants with RS evaluated for potential surgical airway management between 1994 and 2014. Patients who were successfully managed without surgical intervention were included. Patient demographics, nutritional and respiratory status, laboratory values, and polysomnography (PSG) findings were recorded. Results Thirty-two infants met the inclusion criteria. The average hospital stay was 16.8 days (range, 5–70 days). Oxygen desaturation (<70% by pulse oximetry) occurred in the majority of patients and was managed with temporary oxygen supplementation by nasal cannula (59%) or endotracheal intubation (31%). Seventy-five percent of patients required a temporary nasogastric tube for nutritional support, and a gastrostomy tube placed was placed in 9%. All patients continued to gain weight following the implementation of these conservative measures. PSG data (n=26) demonstrated mild to moderate obstruction, a mean apneahypopnea index (AHI) of 19.2±5.3 events/hour, and an oxygen saturation level <90% during only 4% of the total sleep time. Conclusions Nonsurgical airway management was successful in patients who demonstrated consistent weight gain and mild to moderate obstruction on PSG, with a mean AHI of <20 events/hour.

Incidence and Predictors of HandeArm Musculoskeletal Complaints among Vibration-exposed African Cassava and Corn Millers

Lukuke Hendrick Mbutshu,Kaj Francoise Malonga,Nlandu Roger Ngatu,Sakiko Kanbara,Narufumi Suganuma,Benjamin Longo-Mbenza 한국산업안전보건공단 산업안전보건연구원 2014 Safety and health at work Vol.5 No.3

Background: Cassava and corn milling is a growing small-scale enterprise in Africa. We aimed todetermine the incidence of handearm musculoskeletal complaints among vibration-exposed Congolesecassava and corn millers in the previous 12 months. Methods: A cross-sectional study was conducted, prior to a follow-up study, from March to May2013 among cassava/corn millers in Lubumbashi, Democratic Republic of Congo, in which 365 millersage-matched to 365 civil workers anonymously answered a questionnaire. Results: Overall incidence of handearm musculoskeletal complaints was 25.8% in millers (vs. 5.2% in civilworkers; p < 0.001). The risk of experiencing musculoskeletal symptoms was seven times higher inmillers [vs. civil workers; odds ratio (OR) ¼ 7.10; 95% confidence interval (CI): 4.03e12.50; p < 0.0001];2.4 times higher in smoking millers (vs. smoking civil office workers; OR ¼ 2.36; 95% CI: 1.42e3.88;p < 0.001); 3.6 times higher in millers with longer daily exposure (> 8 hours; vs. those working ? 8hours; OR ¼ 3.56; 95% CI: 1.93e3.61; p ¼ 0.026); and 7.4 times higher in young millers (vs. older millers,OR ¼ 7.39; 95% CI: 1.29e75.52; p < 0.001). Smoking, number of cigarettes, and daily exposure durationwere positively correlated with musculoskeletal complaints. Conclusion: This study revealed a relatively high incidence of musculoskeletal complaints among Africancassava and corn millers. The use of anti-vibration protective equipment and the regulation of thishazardous occupation may reduce the burden of musculoskeletal disorders in millers.

Incidence and Predictors of Hand-Arm Musculoskeletal Complaints among Vibration-exposed African Cassava and Corn Millers

Mbutshu, Lukuke Hendrick,Malonga, Kaj Francoise,Ngatu, Nlandu Roger,Kanbara, Sakiko,Longo-Mbenza, Benjamin,Suganuma, Narufumi Occupational Safety and Health Research Institute 2014 Safety and health at work Vol.5 No.3

Background: Cassava and corn milling is a growing small-scale enterprise in Africa. We aimed to determine the incidence of hand-arm musculoskeletal complaints among vibration-exposed Congolese cassava and corn millers in the previous 12 months. Methods: A cross-sectional study was conducted, prior to a follow-up study, from March to May 2013 among cassava/corn millers in Lubumbashi, Democratic Republic of Congo, in which 365 millers age-matched to 365 civil workers anonymously answered a questionnaire. Results: Overall incidence of hand-arm musculoskeletal complaints was 25.8% in millers (vs. 5.2% in civil workers; p < 0.001). The risk of experiencing musculoskeletal symptoms was seven times higher in millers [vs. civil workers; odds ratio (OR) = 7.10; 95% confidence interval (CI): 4.03-12.50; p < 0.0001]; 2.4 times higher in smoking millers (vs. smoking civil office workers; OR = 2.36; 95% CI: 1.42-3.88; p < 0.001); 3.6 times higher in millers with longer daily exposure (> 8 hours; vs. those working ${\leq}8$ hours; OR = 3.56; 95% CI: 1.93-3.61; p = 0.026); and 7.4 times higher in young millers (vs. older millers, OR = 7.39; 95% CI: 1.29-75.52; p < 0.001). Smoking, number of cigarettes, and daily exposure duration were positively correlated with musculoskeletal complaints. Conclusion: This study revealed a relatively high incidence of musculoskeletal complaints among African cassava and corn millers. The use of anti-vibration protective equipment and the regulation of this hazardous occupation may reduce the burden of musculoskeletal disorders in millers.

Interaction between surface waters and the Quaternary shallow alluvial aquifer of Lake Maga downstream: influence of ponds, streams, irrigation canals, and geological features (Far North, Cameroon)

Edmond M. Iwoudam,Tchouta D. Kemgang,Valentin Y.E. Mvondo,Roger A. Tamonkem,Benjamin N. Ngounou 한국지질과학협의회 2024 Geosciences Journal Vol.28 No.2

The valorization of Lake Maga for agricultural purposes has not only contributed to the socio-economic development of the study area, but has also modified the surface water (SW) and groundwater (GW) flow regimes. Understanding the interaction between the SW and the shallow Quaternary aquifer, under land use change and soil structure modification, is still a challenge, especially in the semi-arid area. In this study, GW level, hydrogeochemical characterization, and geological features are used to understand, locally, the influence of Lake Maga, its associated hydraulic components, and the other SW bodies on the GW behaviour. GW levels were measured in 51 wells in December 2012 and monitored in February 2013, and in 15 wells (beyond the 51) in June 2017 and December 2018. Physicochemical parameters of SWs and GWs were measured in the field, and 15 water samples were collected for major ion characterization. The GW levels were close (mean value ≈5 m) to the land surface, with zero to very low (< 1 m) water levelfluctuations near SW bodies. The GW levels (< 2 m) are influenced more by their proximity to irrigation canals, ponds, and streams than Lake Maga (mean ≈3.5 m). The analysis of electrical conductivity (EC) values and GW levels showed that the weakly mineralized (< 200 μS.cm−1) GW were associated with the shallower GW table level. The moderate GW mineralization (200 < EC < 700 μS.cm−1) were more influenced by the geological texture of the shallow aquifer. The analysis of the geological characteristics of the sub-shallow aquifer structure in the locality of Pouss is mainly sandy, while in the localities of Maga and Guirvidig, clay, clayey-sand and sandyclay materials dominate. There are no trends in GW chemical evolution from Lake Maga waters towards the shallow groundwater table (SGWT). The mixing-ratios values showed that the SW contributed for more than 65% (mean) to the sub-shallow aquifer in the study area, and the highest SWs (80%) contribution occurred in the locality of Pouss, close to Lake Maga, pond, Logone River, irrigation canal, and seasonal stream, associated with the shallowest GW levels (< 1.5 m). The proximity to SW bodies and the texture of the fluvio-lacustrine deposit of the shallow aquifer strongly influenced GW table levels and their hydrogeochemical characteristics. This work could be a prerequisite to understand how the physicochemical and chemical properties of GW in the shallow aquifer evolve and respond under the influence of SW bodies.

Stabilization and improved functionality of three-dimensional perfusable microvascular networks in microfluidic devices under macromolecular crowding

Ho-Ying Wan,Jack Chun Hin Chen,Qinru Xiao,Christy Wingtung Wong,Boguang Yang,Benjamin Cao,Rocky S. Tuan,Susan K. Nilsson,Yi-Ping Ho,Michael Raghunath,Roger D. Kamm,Anna Blocki 한국생체재료학회 2023 생체재료학회지 Vol.27 No.00

Background There is great interest to engineer in vitro models that allow the study of complex biological processes of the microvasculature with high spatiotemporal resolution. Microfluidic systems are currently used to engineer microvasculature in vitro, which consists of perfusable microvascular networks (MVNs). These are formed through spontaneous vasculogenesis and exhibit the closest resemblance to physiological microvasculature. Unfortunately, under standard culture conditions and in the absence of co-culture with auxiliary cells as well as protease inhibitors, pure MVNs suffer from a short-lived stability. Methods Herein, we introduce a strategy for stabilization of MVNs through macromolecular crowding (MMC) based on a previously established mixture of Ficoll macromolecules. The biophysical principle of MMC is based on macromolecules occupying space, thus increasing the effective concentration of other components and thereby accelerating various biological processes, such as extracellular matrix deposition. We thus hypothesized that MMC will promote the accumulation of vascular ECM (basement membrane) components and lead to a stabilization of MVN with improved functionality. Results MMC promoted the enrichment of cellular junctions and basement membrane components, while reducing cellular contractility. The resulting advantageous balance of adhesive forces over cellular tension resulted in a significant stabilization of MVNs over time, as well as improved vascular barrier function, closely resembling that of in vivo microvasculature. Conclusion Application of MMC to MVNs in microfluidic devices provides a reliable, flexible and versatile approach to stabilize engineered microvessels under simulated physiological conditions.