Modern Achalasia: Diagnosis, Classification, and Treatment

Marcella Pesce,Marta Pagliaro,Giovanni Sarnelli,Rami Sweis 대한소화기 기능성질환∙운동학회 2023 Journal of Neurogastroenterology and Motility (JNM Vol.29 No.4

Achalasia is a major esophageal motor disorder featured by the altered relaxation of the esophagogastric junction in the absence of effective peristaltic activity. As a consequence of the esophageal outflow obstruction, achalasia patients present with clinical symptoms of dysphagia, chest pain, weight loss, and regurgitation of indigested food. Other less specific symptoms can also present including heartburn, chronic cough, and aspiration pneumonia. The delay in diagnosis, particularly when the presenting symptoms mimic those of gastroesophageal reflux disease, may be as long as several years. The widespread use of high-resolution manometry has permitted earlier detection and uncovered achalasia phenotypes which can have prognostic and therapeutic implications. Other tools have also emerged to help define achalasia severity and which can be used as objective measures of response to therapy including the timed barium esophagogram and the functional lumen imaging probe. Such diagnostic innovations, along with the increased awareness by clinicians and patients due to the availability of alternative therapeutic approaches (laparoscopic and robotic Heller myotomy, and peroral endoscopic myotomy) have radically changed the natural history of the disorder. Herein, we report the most recent advances in the diagnosis, classification, and management of esophageal achalasia and underline the still-grey areas that needs to be addressed by future research to reach the goal of personalizing treatment.

Angled implant brush for hygienic maintenance of full-arch fixed-implant rehabilitations: a pilot study

Setti, Paolo,Pesce, Paolo,Dellepiane, Elena,Bagnasco, Francesco,Zunino, Paola,Menini, Maria Korean Academy of Periodontology 2020 Journal of Periodontal & Implant Science Vol.50 No.5

Purpose: This pilot study was conducted to evaluate the cleaning efficacy of an angled implant brush for home oral hygiene of full-arch fixed-implant prostheses. Methods: Forty-one patients treated with a full-arch implant rehabilitation in the maxilla or mandible (164 implants) for at least 4 months were enrolled. The screw-retained fixed prostheses were removed and baseline (T0) parameters were recorded, including plaque index (PI), probing depth (PD), and bleeding on probing (BOP). All patients completed a 5-item questionnaire on hygiene maintenance and received an implant brush for home hygiene. After 1 month (T1) PI, PD, and BOP were recorded again and patients completed a 7-item questionnaire to evaluate their satisfaction with the implant brush. One-way repeated-measures analysis of variance was conducted to evaluate the significance of changes in PI, PD, and BOP. A P value <0.05 was considered to indicate statistical significance. Results: A statistically significant reduction of BOP (0.62±0.6 at T0 vs. 0.5±0.5 at T1; P=0.032) was found, while no statistically significant changes in PD (1.74±0.5 mm at T0 vs. 1.77±0.5 mm at T1; P=0.050) or PI (1.9±0.7 at T0 vs. 1.7±0.7 at T1; P=0.280) occurred. According to the 7-item questionnaire, patients reported no difficulty in using the angled brush (63.4%) and deemed it highly (46.3%) or very highly (4.8%) effective in improving their home oral hygiene. Conclusions: Within the limits of the present pilot study, the patients experienced a reduction of BOP 1 month after being instructed to use the angled implant brush. The angled implant brush appeared to be a well-accepted device for home-care hygiene of full-arch fixed-implant rehabilitations.

The Bitter Taste Receptor Agonist Quinine Reduces Calorie Intake and Increases the Postprandial Release of Cholecystokinin in Healthy Subjects

( Paolo Andreozzi ),( Giovanni Sarnelli ),( Marcella Pesce ),( Francesco P Zito ),( Alessandra D`alessandro ),( Viviana Verlezza ),( Ilaria Palumbo ),( Fabio Turco ),( Katherine Esposito ),( Rosario C 대한소화기기능성질환·운동학회 2015 Journal of Neurogastroenterology and Motility (JNM Vol.21 No.4

Background/Aims Bitter taste receptors are expressed throughout the digestive tract. Data on animals have suggested these receptors are involved in the gut hormone release, but no data are available in humans. Our aim is to assess whether bitter agonists influence food intake and gut hormone release in healthy subjects. Methods Twenty healthy volunteers were enrolled in a double-blind cross-over study. On 2 different days, each subject randomly received an acid-resistant capsule containing either placebo or 18 mg of hydrochloride (HCl) quinine. After 60 minutes, all subjects were allowed to eat an ad libitum meal until satiated. Plasma samples were obtained during the experiment in order to evaluate cholecystokinin (CCK) and ghrelin levels. Each subject was screened to determine phenylthiocarbamide (PTC) tasting status. Results Calorie intake was significantly lower when subjects received HCl quinine than placebo (514 ± 248 vs 596 ± 286 kcal; P = 0.007). Significantly higher CCK ΔT90 vs T0 and ΔT90 vs T60 were found when subjects received HCl quinine than placebo (0.70 ± 0.69 vs 0.10 ± 0.86 ng/mL, P = 0.026; 0.92 ± 0.75 vs 0.50 ± 0.55 ng/mL, P = 0.033, respectively). PTC tasters ingested a significantly lower amount of calories when they received HCl quinine compared to placebo (526 ± 275 vs 659 ± 320 kcal; P = 0.005), whereas no significant differences were found for PTC non-tasters (499 ± 227 vs 519 ± 231 kcal; P = 0.525). Conclusions This study showed that intra-duodenal release of a bitter compound is able to significantly affect calorie intake and CCK release after a standardized meal. Our results suggest that bitter taste receptor signaling may have a crucial role in the control of food intake. (J Neurogastroenterol Motil 2015;21:511-519)

Chymotrypsin - Eudragit Complex Formation

Valeria Boeris,Laura Verónica Cappella,Gisele Peres,Inés Burgos,Nádya Pesce da Silveira,Gerardo Fidelio,Guillermo Picó 한국생물공학회 2013 Biotechnology and Bioprocess Engineering Vol.18 No.3

Eudragit® L100 (EuL) and Eudragit® S100(EuS) are synthetic polyanions differing on their electric charge density. They interact with chymotrypsin (ChTRP),a basic protein forming soluble and non-soluble complexes. The complex formation was studied by dynamic light scattering, isothermal titration calorimetry, native fluorescence emission, circular dichroism and thermodynamical thermal stability of the enzyme. EuS was able to bind 33 ChTRP molecules while EuL, 60. The binding of ChTRP to both Eu was slightly endothermic and the entropic factor was responsible for the soluble complexes formation. The ChTRP-Eu size increases with pH and the binding of ChTRP to Eu modifies the Eu hydrodynamic radium. The interaction of ChTRP with Eu did not modify its secondary or tertiary structure. The thermal stability of ChTRP was increased when it interacted with both Eu.

Health Related Quality of Life in Common Variable Immunodeficiency

Isabella Quinti,Stefano Tabolli,Cristina Di Pietro,Helene Martini,Anna Maria Pesce,Francesca Lombardi,Maddalena Baumghartner,Stefania Colantuono,Cinzia Milito 연세대학교의과대학 2012 Yonsei medical journal Vol.53 No.3

Purpose: To quantify the health related quality of life in primary immunodeficiency patients. Materials and Methods: We used generic health status and general psychological health questionnaires to determine the range of issues that needed to be considered in examining the burden of common variable immunodeficiency (CVID). Results: The health status of patients with CVID was lower than that observed in normal subjects. Overall, Role-Physical and General Health scales correlated with a poorer clinical status. Surprisingly, the duration of disease did not influence health status. Being female, older, General Health Questionnaire-positive and alexithymic proved to be major risk factors associated with a poor health status. Patients with chronic lung disease and chronic diarrhea had the lowest values on the Medical Outcome Study, Short Form SF-36 (SF-36) scales. Disease severity perception was associated with the General Health Questionnaire and alexithymia status. Limitations in daily activities as a result of lower physical health were the major problems facing common variable immunodeficiency patients. Conclusion: Our data underlined the importance of conducting a periodical health related quality of life assessment on patients with primary antibody deficiencies and, moreover, stressed the necessity of providing psychological support to at risk patients.

Breast US Computer-aided Diagnosis System: Robustness across Urban Populations in South Korea and the United States

Gruszauskas, N.P.,Drukker, K.,Giger, M.L.,Chang, R.-F.,Sennett, C.A.,Moon, W.K.,Pesce, L.L. RADIOLOGICAL SOCIETY OF NORTH AMERICA 2009 Radiology Vol.253 No.3

Enhancing the H₂O Megamaser Detection Rate Using Optical and Mid-infrared Photometry

Kuo, C. Y.,Constantin, A.,Braatz, J. A.,Chung, H. H.,Witherspoon, C. A.,Pesce, D.,Impellizzeri, C. M. V.,Gao, F.,Hao, Lei,Woo, J.-H.,Zaw, Ingyin American Astronomical Society 2018 The Astrophysical journal Vol.860 No.2

<P>Water megamasers from circumnuclear disks in galaxy centers provide the most accurate measurements of supermassive black hole masses and uniquely probe the subparsec accretion processes. At the same time, these systems offer independent crucial constraints of the Hubble constant in the nearby universe, and thus, the arguably best single constraint on the nature of dark energy. The chances of finding these golden standards are, however, abysmally low, at less than or similar to 3% overall for any level of water maser emission detected at 22 GHz and less than or similar to 1% for those exhibiting disk-like configuration. We provide here a thorough summary of the current state of detection of water megamaser disks along with a novel investigation of the likelihood of increasing their detection rates based on a multivariate parameter analysis of the optical and mid-infrared (mid-IR) photometric properties of the largest database of galaxies surveyed for 22 GHz emission. We find that galaxies with water megamaser emission tend to be associated with strong emission in all Wide-field Infrared Survey Explorer mid-IR wavelengths, with the strongest enhancement in the W4 band, at 22 mu m, as well as with previously proposed and newly found indicators of active galactic nucleus strength in the mid-IR, such as red W1 - W2 and W1 - W4 colors, and the integrated mid-IR luminosity of the host galaxy. These trends offer a potential boost of the megamaser detection rates to 6%-15%, or a factor of 2-8 relative to the current rates, depending on the chosen sample selection criteria, while fostering real chances for discovering. 20 new megamaser disks.</P>

THE MEGAMASER COSMOLOGY PROJECT. IX. BLACK HOLE MASSES FOR THREE MASER GALAXIES

Gao, F.,Braatz, J. A.,Reid, M. J.,Condon, J. J.,Greene, J. E.,Henkel, C.,Impellizzeri, C. M. V.,Lo, K. Y.,Kuo, C. Y.,Pesce, D. W.,Wagner, J.,Zhao, W. American Astronomical Society 2017 The Astrophysical journal Vol.834 No.1

<P>As part of the Megamaser Cosmology Project, we present VLBI maps of nuclear water masers toward five galaxies. The masers originate in sub-parsec circumnuclear disks. For three of the galaxies, we fit Keplerian rotation curves to estimate their supermassive black hole (SMBH) masses, and determine (2.9 +/- 0.3) x 10(6)M(Theta) for J0437+2456, (1.7 +/- 0.1) x 10(7)M(Theta) for ESO 558-G009, and (1.1 +/- 0.2) x 10(7)M(Theta) for NGC 5495. In the other two galaxies, Mrk 1029 and NGC 1320, the geometry and dynamics are more complicated and preclude robust black hole mass estimates. Including our new results, we compiled a list of 15 VLBI-confirmed disk maser galaxies with robust SMBH mass measurements. With this sample, we confirm the empirical relation of R-out proportional to 0.3M(SMBH) reported in Wardle & Yusef-Zadeh. We also find a tentative correlation between maser disk outer radii and Wide-Field Infrared Survey Explorer luminosity. We find no correlations of maser disk size with X-ray 2-10 keV luminosity or [O III] luminosity.</P>