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Lower esophageal sphincter relaxation is impaired in older patients with dysphagia

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World Journal of Gastroenterology 2011年第10期17卷 1326-1331页

作者： Laura K Besanko carly m burgstad Reme mountifi eld Jane m Andrews Richard Heddle Helen Checklin Robert JL Fraser Investigation and Procedures Unit Repatriation General Hospital Department of Gastroenterology and Hepatology Royal Adelaide Hospital Discipline of medicine University of Adelaide Adelaide 5000 South Australia Australia Department of medicine Flinders University of South Australia Bedford Park 5042 South Australia Australia

AIm: To characterize the effects of age on the mechanisms underlying the common condition of esophageal dysphagia in older patients, using detailed manometric analysis. mETHODS: A retrospective case-control audit was performed on 19 patients aged ≥ 80 years (mean age 85 ± 0.7 year) who underwent a manometric study for dysphagia (2004-2009). Data were compared with 19 younger dysphagic patients (32 ± 1.7 years). Detailed manometric analysis performed prospectively included basal lower esophageal sphincter pressure (BLESP), pre-swallow and nadir LESP, esophageal body pressures and peristaltic duration, during water swallows (5 mL) in right lateral (RL) and upright (UR) postures and with solids. Data are mean ± SE; a P-value mmHg; P mmHg vs 0.7 ± 0.6 mmHg, P mmHg vs 1.6 ± 0.5 mmHg, P = 0.01) with shorter relaxation after solids (7.9 ± 1.5 s vs 9.7 ± 0.4 s, P = 0.05). No age-related differences were seen in esophageal body pressures or peristalsis duration. CONCLUSION: Basal LES pressure is elevated and swallow-induced relaxation impaired in elderly dysphagic patients. Its contribution to dysphagia and the effects of healthy ageing require further investigation.

关键词：中老年人食管癌括约肌患者吞咽松弛毫米汞柱压力升高

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World Journal of Gastroenterology 2017年第15期23卷 2785-2794页

作者： Charles Cock Laura K Besanko carly m burgstad Alison Thompson Stamatiki Kritas Richard Heddle Robert JL Fraser Taher I Omari Investigation and Procedures Unit Repatriation General Hospital Department of Gastroenterology and Hepatology Flinders University of South Australia Gastroenterology Unit Women's and Children's Health Network Human Physiology School of MedicineFlinders University of South Australia

AIm To investigate the functional effects of abnormal esophagogastric(EGJ) measurements in asymptomatic healthy volunteers over eighty years of age. mETHODS Data from 30 young controls(11 m, mean age 37 ± 11 years) and 15 aged subjects(9 m, 85 ± 4 years) were compared for novel metrics of EGJ-function: EGJcontractile integral(EGJ-CI), "total" EGJ-CI and bolus flow time(BFT). Data were acquired using a 3.2 mm, 25 pressure(1 cm spacing) and 12 impedance segment(2 cm) solid-state catheter(Unisensor and mmS SolarGI system) across the EGJ. Five swallows each of 5 m L liquid(L) and viscous(V) bolus were analyzed. mean values were compared using Student's t test for normally distributed data or mann Whitney U-test when non-normally distributed. A P value milar for older subjects compared to controls. "Total" EGJ-CI, measured during liquid swallowing, was increased in older individuals when compared to young controls(O 39 ± 7 mm *** vs C 18 ± 3 mm ***; P = 0.006). For both liquid and viscous bolus consistencies, IRP4 was increased(L: 11.9 ± 2.3 mm Hg vs 5.9 ± 1.0 mm Hg, P = 0.019 and V: 14.3 ± 2.4 mm Hg vs 7.3 ± 0.8 mm Hg; P = 0.02) and BFT was reduced(L: 1.7 ± 0.3 s vs 3.8 ± 0.2 s and V: 1.9 ± 0.3 s vs 3.8 ± 0.2 s; P mpared to young. A matrix of bolus flow and presence above the EGJ indicated reductions in bolus flow at the EGJ occurred due to both impaired bolus transport through the esophageal body(i.e., the bolus never reached the EGJ) and increased flow resistance at the EGJ(i.e., the bolus retained just above the EGJ).CONCLUSION Bolus flow through the EGJ is reduced in asymptomatic older individuals. Both ineffective esophageal bolus transport and increased EGJ resistance contribute to impaired bolus flow.

关键词：老化食管阻抗 manometry 压力 Esophagogastric 连接

modulation of individual components of gastric motor response to duodenal glucose

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World Journal of Gastroenterology 2013年第35期19卷 5863-5869页

作者： Adam m Deane Laura K Besanko carly m burgstad marianne J Chapman michael Horowitz Robert JL Fraser Discipline of Acute Care medicine University of Adelaide Intensive Care Unit Royal Adelaide Hospital National Health and medical Research Council of Australia Centre for Clinical Research Excellence in Nutritional Physiology and Outcomes Investigation and Procedures Unit Repatriation General Hospital Department of Gastroenterology and Hepatology Royal Adelaide Hospital Discipline of medicine University of Adelaide Royal Adelaide Hospital

AIm:To evaluate individual components of the antro-pyloro-duodenal(APD)motor response to graded small intestinal glucose infusions in healthy ***:APD manometry was performed in 15healthy subjects(12 male;40±5 years,body mass index 26.5±1.6 kg/m2)during four 20-min intraduodenal infusions of glucose at 0,0.5,1.0 and 1.5 kcal/min,in a randomised double-blinded *** solutions were infused at a rate of 1 mL/min and separated by 40-min"wash-out"*** are mean±*** analyses are repeated measure analysis of variance with Bonferroni post-hoc ***:At 0 kcal/min frequency of pressure waves were:antrum(7.5±1.8 waves/20 min)and isolated pyloric pressure waves(IPPWs)(8.0±2.3 waves/20min)with pyloric tone(0.0±0.9 mmHg).Intraduodenal glucose infusion acutely increased IPPW frequency(Pmulation was observed at 1.0 kcal/min for pyloric phasic pressure waves(P=0.002)and 1.5 kcal/min for pyloric tone and antral ***:There is hierarchy for the activation of gastrointestinal motor responses to duodenal glucose *** increase in IPPWs is the first response observed.

关键词： Glucose Gastrointestinal motility Pyloric Antral Duodenum manometry motor activity Blood glucose

Outcomes of Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding

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World Journal of Gastroenterology 2013年第36期19卷 6035-6043页

作者： Nam Q Nguyen Philip Game Justin Bessell Tamara L Debreceni melissa Neo carly m burgstad Pennie Taylor Gary A Wittert Department of Gastroenterology and Hepatology Royal Adelaide Hospital Discipline of medicine University of Adelaide Department of Surgery Royal Adelaide Hospital Adelaide Obesity Surgery Calvary Wakefield Hospital Department of Surgery Flinders University

AIm:To evaluate weight loss and surgical outcomes of Roux-en-Y gastric bypass(RYGB)and laparoscopic adjustable gastric band(LAGB).mETHODS:Data relating to changes in body mass index(BmI)and procedural complications after RYGB(1995-2009;n=609;116m:493F;42.4±0.4 years)or LAGB(2004-2009;n=686;131m:555F;37.2±0.4years)were extracted from prospective ***:Pre-operative BmI was higher in RYGB than LAGB patients(46.8±7.1 kg/m2vs 40.4±4.2 kg/m2,Pmore patients with BmIm2underwent LAGB than RYGB(17.1%vs 4.1%,PmI decrease was greater after *** were direct relationships between weight loss and pre-operative BmI(Pmale LAGB patients had greater BmI reduction than females(-8.2±4.3 kg/m2vs-3.9±1.9kg/m2,P=0.02).Peri-operative complications occurred more frequently following RYGB than LAGB(8.0%vs0.5%,Pmajority related to wound *** had more long-term complications requiring corrective procedures than RYGB(8.9%vs 2.1%,PmI reduction(-9.5±3.8 kg/m2)compared to removal and replacement of the band(-6.0±3.0 kg/m2).Twelve months post-surgery,fasting glucose,total cholesterol and low density lipoprotein levels were significantly lower with the magnitude of reduction greater in RYGB ***:RYGB produces substantially greater weight loss than *** peri-operative complications are greater after RYGB,long-term complication rate is higher following LAGB.

关键词： Bariatric surgery Gastric bypass Gastric banding Weight loss Complications Co-morbidity Outcomes

mechanisms underlying feed intolerance in the critically ill: Implications for treatment

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World Journal of Gastroenterology 2007年第29期13卷 3909-3917页

作者： Adam Deane marianne J Chapman Robert J Fraser Laura K Bryant carly burgstad Nam Q Nguyen Intensive Care Unit Royal Adelaide Hospital Adelaide South Australia Discipline of medicine University of Adelaide and Investigation and Procedures Unit Repatriation General Hospital Adelaide South Australia Investigation and Procedures Unit Repatriation General Hospital Adelaide South Australia Department of Gastroenterology and Hepatology Royal Adelaide Hospital Adelaide South Australia

malnutrition is associated with poor outcomes in critically ill patients. Although nutritional support is yet to be proven to improve mortality in non-malnourished critically ill patients, early enteral feeding is considered best practice. However, enteral feeding is often limited by delayed gastric emptying. The best method to clinically identify delayed gastric emptying and feed intolerance is unclear. Gastric residual volume (GRV) measured at the bedside is widely used as a surrogate marker for gastric emptying, but the value of GRV measurement has recently been disputed. While the mechanisms underlying delayed gastric emptying require further investigation, recent research has given a better appreciation of the pathophysiology. A number of pharmacological strategies are available to improve the success of feeding. Recent data suggest a combination of intravenous metoclopramide and erythromycin to be the most successful treatment, but novel drug therapies should be explored. Simpler methods to access the duodenum and more distal small bowel for feed delivery are also under investigation. This review summarises current understanding of the factors responsible for, and mechanisms underlying feed intolerance in critical illness, together with the evidence for current practices. Areas requiring further research are also highlighted.

关键词：急诊肠道营养胃排空胃动力胃肠道激素胃复安红霉素

Impact of a Pilot, Pharmacy-Led Tobacco Cessation medication Protocol at Discharge in a Community Hospital

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Journal of Pharmacy and Pharmacology 2017年第9期5卷 642-647页

作者： carly m. mcKenzie Rachana Patel Kaitlyn R. Eder University Hospitals St. John medical Center Westlake Ohio 44145 USA

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Liver iron transport

World Journal of Gastroenterology 2007年第35期13卷 4725-4736页

作者： Ross m Graham Anita CG Chua carly E Herbison John K Olynyk Debbie Trinder School of medicine and Pharmacology Fremantle HospitalUniversity of Western AustraliaFremantleWestern AustraliaAustralia School of medicine and Pharmacology Fremantle HospitalUniversity of Western AustraliaFremantleWestern AustraliaAustralia Western Australian Institute for Medical ResearchNedlandsWestern AustraliaAustralia

肝在铁新陈代谢起一个中央作用。它是为铁的主要存储地点并且也表示涉及铁运输和铁动态平衡的规定的分子的一个复杂范围。与肝的铁运输或规定联系的越来越多的基因被识别了。这些包括转铁蛋白受体(TFR1 并且 2 ) ， ferrireductase (STE... 详细信息

肝在铁新陈代谢起一个中央作用。它是为铁的主要存储地点并且也表示涉及铁运输和铁动态平衡的规定的分子的一个复杂范围。与肝的铁运输或规定联系的越来越多的基因被识别了。这些包括转铁蛋白受体(TFR1 并且 2 ) ， ferrireductase (STEAP3 ) ，运输 ers 二价的金属 transporter-1 (DmT1 ) 和象 haemochromatosis 蛋白质， HFE 和 haemojuvelin (HJV ) 一样的 ferroportin (FPN ) ，它正在表明分子。许多也这些基因参予铁集中于肝的肽 hepcidin 的规章的小径。然而，我们开始仍然仅仅正在理解在肝之间的复杂相互作用熨运输和铁动态平衡。这评论在铁运输和铁动态平衡的规定构画出我们铁新陈代谢和他们的角色的分子的当前的知识。

关键词：肝脏铁传递铁平衡铁吸收铁释放遗传性血色素沉着

Subgroups of chronic fatigue syndrome based on psychiatric disorder onset and current psychiatric status

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Health 2010年第2期2卷 90-96页

作者： molly m. Brown carly Kaplan Leonard A. Jason Christopher B. Keys 不详

Few studies have examined the effects of psy-chiatric disorders occurring over a long dura-tion among patients with chronic fatigue syn-drome (CFS). The role of premorbid and current psychiatric disorders in impairment was ex-plored with a sample of 113 participants with CFS. Subgroups were created based on past and current psychiatric status including those whose psychiatric history was premorbid and current, postmorbid and current, past but not current, and those with no lifetime diagnosis. Results from a one-way mANOVA revealed that patients with a premorbid and current psychiat-ric disorder reported significantly higher pain severity, more somatic symptoms, poorer sleep quality, and poorer quality of life than those with no psychiatric history. Levels of fatigue and physical functioning among patients with CFS were unrelated to the four subgroups in this study. Although those with a premorbid and current psychiatric disorder were differentiated from those with no psychiatric history on some markers of impairment, the sample as a whole had severe fatigue-related impairment, which is the cardinal symptom of CFS. Implications for research are discussed.

关键词： Chronic Fatigue Syndrome Psychiatric Comorbidity Subgroups Impairment

Past Century Fossil Fuel Burning Recorded by Tree-Ring δ13C and δ34S from Chaling,South China

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吉林大学学报(地球科学版) 2015年第S1期 371-372页

作者： Luhua Xie Peter m.Wynn carly J.Stevens Baruch.Spiro Gangjian Wei Gan Zhang State Key Laboratory of Isotope Geochemistry Guangzhou Institute of Geochemistry Chinese Academy of Sciences Key Laboratory of marginal Sea Geology Guangzhou Institute of Geochemistry Chinese Academy of Sciences Lancaster Environment Centre University of Lancaster Natural History museum London UK State Key Laboratory of Organic Geochemistry Guangzhou Institute of Geochemistry Chinese Academy of Sciences

工业革命以来由人类活动带来的大量化石燃料燃烧导致严重的环境污染,并引起气候变化。我国自1970年代开始大量排放人类活动产生的CO2和SO2,而且现在我国已经成为世界最大的CO2和SO2排放国。树轮碳-硫同位素及硫含量能很好地记录长时间... 详细信息

工业革命以来由人类活动带来的大量化石燃料燃烧导致严重的环境污染,并引起气候变化。我国自1970年代开始大量排放人类活动产生的CO2和SO2,而且现在我国已经成为世界最大的CO2和SO2排放国。树轮碳-硫同位素及硫含量能很好地记录长时间尺度的气候变化,水利用效率,及化石燃料燃烧。本摘要报道了来自南方森林115年全树树轮碳-硫同位素及硫含量,目的在于记录人类活动产生的CO2和SO2历排放历史,及试图探讨人类活动产生的CO2和SO2对树碳同位素及水利用效率的影响。结果显示树轮碳同位素自1940年代后期至2000年代后期持续下降,是由持续增加的化石燃料产生的CO2导致的;大气CO2校正后的树轮碳同位素反映了全年降雨量。此外,树轮细胞内CO2浓度及水利用效率自1940年代后期持续升高,其原因是大气CO2浓度增加。另一方面,树轮硫含量没有明显的变化,表明硫是树的基本元素,而硫同位素自1890年代后期以来持续下降,记录了化石燃料(北方煤)使用历史。与之前发表的数据,显示最近几年或几十年来树轮碳同位素的增加(1.2‰~2.5‰),但不能证明是由大气污染(SO2增加)引起的,因其被气候变化所掩盖。

关键词：树轮碳同位素硫同位素气候变化燃料燃烧 C and 人类活动时间尺度利用效率年降雨量