37 research outputs found

    Improving the diagnostic yield of high-resolution esophageal manometry for GERD: The straight leg-raise international study

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    BACKGROUND & AIMS: The straight leg raise (SLR) maneuver during high-resolution manometry (HRM) can assess esophagogastric junction (EGJ) barrier function by measuring changes in intraesophageal pressure (IEP) when intra-abdominal pressure is increased. We aimed to determine whether increased esophageal pressure during SLR predicts pathologic esophageal acid exposure time (AET). METHODS: Adult patients with persistent gastroesophageal reflux disease (GERD) symptoms undergoing HRM and pH-impedance or wireless pH study off proton pump inhibitor were prospectively studied between July 2021 and March 2022. After the HRM Chicago 4.0 protocol, patients were requested to elevate 1 leg at 45º for 5 seconds while supine. The SLR maneuver was considered effective when intra-abdominal pressure increased by 50%. IEPs were recorded 5 cm above the lower esophageal sphincter at baseline and during SLR. GERD was defined as AET greater than 6%. RESULTS: The SLR was effective in 295 patients (81%), 115 (39%) of whom had an AET greater than 6%. Hiatal hernia (EGJ type 2 or 3) was seen in 135 (46%) patients. Compared with patients with an AET less than 6%, peak IEP during SLR was significantly higher in the GERD group (29.7 vs 13.9 mm Hg; P \u3c .001). Using receiver operating characteristic analysis, an increase of 11 mm Hg of peak IEP from baseline during SLR was the optimal cut-off value to predict an AET greater than 6% (area under the receiver operating characteristic curve, 0.84; sensitivity, 79%; and specificity, 85%), regardless of the presence of hiatal hernia. On multivariable analysis, an IEP pressure increase during the SLR maneuver, EGJ contractile integral, EGJ subtype 2, and EGJ subtype 3, were found to be significant predictors of AET greater than 6% CONCLUSIONS: The SLR maneuver can predict abnormal an AET, thereby increasing the diagnostic value of HRM when GERD is suspected. CLINICALTRIALS: gov ID: NCT04813029

    Stirring by small-scale vortices caused by patchy mixing

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    Author Posting. © American Meteorological Society, 2005. This article is posted here by permission of American Meteorological Society for personal use, not for redistribution. The definitive version was published in Journal of Physical Oceanography 35 (2005): 1245-1262, doi:10.1175/JPO2713.1.Evidence is presented that lateral dispersion on scales of 1–10 km in the stratified waters of the continental shelf may be significantly enhanced by stirring by small-scale geostrophic motions caused by patches of mixed fluid adjusting in the aftermath of diapycnal mixing events. Dye-release experiments conducted during the recent Coastal Mixing and Optics (CMO) experiment provide estimates of diapycnal and lateral dispersion. Microstructure observations made during these experiments showed patchy turbulence on vertical scales of 1–10 m and horizontal scales of a few hundred meters to a few kilometers. Momentum scaling and a simple random walk formulation were used to estimate the effective lateral dispersion caused by motions resulting from lateral adjustment following episodic mixing events. It is predicted that lateral dispersion is largest when the scale of mixed patches is on the order of the internal Rossby radius of deformation, which seems to have been the case for CMO. For parameter values relevant to CMO, lower-bound estimates of the effective lateral diffusivity by this mechanism ranged from 0.1 to 1 m2s−1. Revised estimates after accounting for the possibility of long-lived motions were an order of magnitude larger and ranged from 1 to 10 m2s−1. The predicted dispersion is large enough to explain the observed lateral dispersion in all four CMO dye-release experiments examined.The Coastal Mixing and Optics dye studies were funded by the Office of Naval Research under Grants N00014-95-1-0633 (tracer experiments) and N00014-95-1-1063 (AASERT fellowship). Additional analysis was also performed under ONR Grant N00014-01-1-0984

    The Role of γ-Tubulin in Centrosomal Microtubule Organization

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    As part of a multi-subunit ring complex, γ-tubulin has been shown to promote microtubule nucleation both in vitro and in vivo, and the structural properties of the complex suggest that it also seals the minus ends of the polymers with a conical cap. Cells depleted of γ-tubulin, however, still display many microtubules that participate in mitotic spindle assembly, suggesting that γ-tubulin is not absolutely required for microtubule nucleation in vivo, and raising questions about the function of the minus end cap. Here, we assessed the role of γ-tubulin in centrosomal microtubule organisation using three-dimensional reconstructions of γ-tubulin-depleted C. elegans embryos. We found that microtubule minus-end capping and the PCM component SPD-5 are both essential for the proper placement of microtubules in the centrosome. Our results further suggest that γ-tubulin and SPD-5 limit microtubule polymerization within the centrosome core, and we propose a model for how abnormal microtubule organization at the centrosome could indirectly affect centriole structure and daughter centriole replication

    The elegans of spindle assembly

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    The Caenorhabditis elegans one-cell embryo is a powerful system in which to study microtubule organization because this large cell assembles both meiotic and mitotic spindles within the same cytoplasm over the course of 1 h in a stereotypical manner. The fertilized oocyte assembles two consecutive acentrosomal meiotic spindles that function to reduce the replicated maternal diploid set of chromosomes to a single-copy haploid set. The resulting maternal DNA then unites with the paternal DNA to form a zygotic diploid complement, around which a centrosome-based mitotic spindle forms. The early C. elegans embryo is amenable to live-cell imaging and electron tomography, permitting a detailed structural comparison of the meiotic and mitotic modes of spindle assembly
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