How to Approach Long-term Enteral and Parenteral Nutrition

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Endoscopic Duodenal Mucosal Resurfacing: A Potential Therapeutic Treatment for Metabolic Disease

Type 2 diabetes mellitus (T2DM) and nonalcoholic fatty liver disease (NAFLD) are pandemic metabolic disorders. In fact, NAFLD is now the leading cause of liver disease in developed countries. Despite several therapies, including medications and weight loss, most patients do not achieve treatment goals. Bariatric surgery is currently considered to be the only approach that can lead to partial or complete remission of T2DM and has highlighted the metabolic role of the duodenum in glucose metabolism. Based on this finding, a novel, minimally invasive endoscopic approach, duodenal mucosal resurfacing, has been developed to ablate the duodenal mucosa in order to induce its regeneration. This review focuses on the role of the duodenum in the regulation of glucose and lipid homeostasis and the current clinical data available regarding duodenal mucosal resurfacing in T2DM and NAFLD. This new therapeutic procedure promises to become part of the therapeutic armamentarium for diabetic and obese patients and, more widely, for metabolic disorders.SCOPUS: ch.binfo:eu-repo/semantics/publishe

Metabolic endoscopy: Today’s science—tomorrow’s treatment

Obesity, type 2 diabetes mellitus (T2DM) and nonalcoholic steatohepatitis are increasing pandemic metabolic disorders. Lifestyle intervention (LSI) is the cornerstone treatment for these but is successful as standard care alone in only a few patients, given the modest weight loss at mid and long term. Conversely, bariatric surgery is the only proven effective treatment for these metabolic disorders, albeit offered only in a small percentage of cases because of its invasiveness and cost. The so-called endoscopic bariatric and metabolic therapies (EBMTs) include new, less-invasive technologies such as intragastric balloons, aspiration therapy, endoscopic sleeve gastroplasty, diversion devices, and duodenal mucosal resurfacing, currently at various stages of development. EBMTs, as an add-on to LSI, might represent an effective treatment filling the gap between medical and surgical management, taking into account, however, that obesity and its associated comorbidities constitute a chronic disease that needs lifelong therapy. In this review we describe the current scientific evidence surrounding EBMTs as well as future opportunities for such treatments in managing obesity and metabolic disorders.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Left Ventricular Adaptation to Acute Hypoxia: A Speckle-Tracking Echocardiography Study.

BACKGROUND: Hypoxia depresses myocardial contractility in vitro but does not affect or may even improve indices of myocardial performance in vivo, possibly through associated changes in autonomic nervous system tone. The aim of this study was to explore the effects of hypoxic breathing on speckle-tracking echocardiographic indices of left ventricular function, with and without β1-adrenergic inhibition. METHODS: Speckle-tracking echocardiography was performed in 21 healthy volunteers in normoxia and after 30 min of hypoxic breathing (fraction of inspired oxygen, 0.12). Measurements were also obtained after the administration of atropine in normoxia (n = 21) and after bisoprolol intake in normoxia (n = 6) and in hypoxia (n = 10). RESULTS: Hypoxia increased heart rate (from 68 ± 11 to 74 ± 9 beats/min, P = .001), without changing mean blood pressure (P = NS), and decreased total peripheral resistance (P = .003). Myocardial deformation magnitude increased (circumferential strain, -19.6 ± 1.9% vs -21.2 ± 2.5%; radial strain, 19.2 ± 3.7% vs 22.6 ± 4.1%, P < .05; longitudinal and circumferential strain rate, -0.88 ± 0.11 vs -0.99 ± 0.15 sec(-1) and -1.03 ± 0.16 vs -1.18 ± 0.18 sec(-1), respectively, P < .05 for both; peak twist, 8.98 ± 3.2° vs 11.1 ± 2.9°, P < .05). Except for peak twist, these deformation parameters were correlated with total peripheral resistance (P < .05). Atropine increased only longitudinal strain rate magnitude (-0.88 ± 0.11 vs -0.97 ± 0.14 sec(-1), P < .05). The increased magnitude of myocardial deformation persisted in hypoxia under bisoprolol (P < .05). In normoxia, bisoprolol decreased heart rate (73 ± 10 vs 54 ± 7 beats/min, P = .0005), mean blood pressure (88 ± 7 vs 81 ± 4 mm Hg, P = .0027), without altering deformation. CONCLUSIONS: Hypoxic breathing increases left ventricular deformation magnitude in normal subjects, and this effect may not be attributed to hypoxia-induced tachycardia or β1-adrenergic pathway changes but to hypoxia-induced systemic vasodilation.JOURNAL ARTICLESCOPUS: ar.jinfo:eu-repo/semantics/publishe

Noninvasive diagnosis in alcohol-related liver disease

Background: Alcohol-related liver disease (ALD) represents a major cause of death worldwide, and unfortunately, most patients are diagnosed at an advanced stage of the disease, which is related to poorer outcomes. Liver biopsy has historically been the gold standard for identifying advanced hepatic fibrosis, but this approach has several limitations, including invasiveness, low applicability, sampling variability, and cost. Main Text: In order to detect earlier features of advanced liver fibrosis, surrogate biomarkers and techniques have been developed. While these were initially developed for chronic liver diseases such as viral hepatitis and nonalcoholic fatty liver disease (NAFLD), their performance in ALD has also been recently studied. Among the noninvasive surrogate markers and techniques used to detect liver fibrosis, the Enhanced Liver Fibrosis test, FibroTest, and Transient Elastography are the most accurate and validated techniques. In this review, we summarize the current status of the noninvasive assessment of liver disease in ALD and provide a synthesis of how these noninvasive tools can be used in clinical practice. Finally, we briefly outline novel biomarkers that are currently being investigated and discuss future directions and new opportunities in the noninvasive diagnosis of ALD.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Left ventricular adaptation to high altitude: speckle tracking echocardiography in lowlanders, healthy highlanders and highlanders with chronic mountain sickness

Hypoxic exposure depresses myocardial contractility in vitro, but has been associated with indices of increased cardiac performance in intact animals and in humans, possibly related to sympathetic nervous system activation. We explored left ventricular (LV) function using speckle tracking echocardiography and sympathetic tone by spectral analysis of heart rate variability (HRV) in recently acclimatized lowlanders versus adapted or maladapted highlanders at high altitude. Twenty-six recently acclimatized lowlanders, 14 healthy highlanders and 12 highlanders with chronic mountain sickness (CMS) were studied. Control measurements at sea level were also obtained in the lowlanders. Altitude exposure in the lowlanders was associated with slightly increased blood pressure, decreased LV volumes and decreased longitudinal strain with a trend to increased prevalence of post-systolic shortening (p = 0.06), whereas the low frequency/high frequency (LF/HF) ratio increased (1.62 ± 0.81 vs. 5.08 ± 4.13, p < 0.05) indicating sympathetic activation. Highlanders had a similarly raised LF/HF ratio, but no alteration in LV deformation. Highlanders with CMS had no change in LV deformation, no significant increase in LF/HF, but decreased global HRV still suggestive of increased sympathetic tone, and lower mitral E/A ratio compared to healthy highlanders. Short-term altitude exposure in lowlanders alters indices of LV systolic function and increases sympathetic nervous system tone. Life-long altitude exposure in highlanders is associated with similar sympathetic hyperactivity, but preserved parameters of LV function, whereas diastolic function may be altered in those with CMS. Altered LV systolic function in recently acclimatized lowlanders may be explained by combined effects of hypoxia and changes in loading conditions.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Endoscopic Duodenal Mucosal Resurfacing for the Treatment of Type 2 Diabetes

Type 2 diabetes is a pandemic disease with an incidence that has risen steadily over recent decades. Experimental evidence in animals has demonstrated that intestinal bypass surgery of the upper small intestine, particularly the duodenum, has an important role in glucose homoeostasis. Furthermore, Roux-en-Y bypass performed as bariatric surgery has shown to correct hyperglycaemia from the first postoperative days in obese diabetic patients. Therefore, on the basis of these considerations, duodenal mucosal resurfacing was studied in type 2 diabetes patients as a minimally invasive procedure that could offer an alternative treatment for these patients. Further studies, and particularly large controlled trials, are needed to determine the place of this procedure in the treatment of type 2 diabetes as well as other metabolic diseases such as non-alcoholic fatty liver disease/non-alcoholic steatohepatitis.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Optical and Electrical Characteristics of an Endoscopic DBD Plasma Jet

In this work, a new cold plasma source design capable of generating and transporting a plasma jet over long distances (2 m) is presented with the purpose of being used in flexible endoscopy for treatment within the gastrointestinal tract. This dielectric barrier discharge helium plasma jet consists of a polytetrafluoroethylene capillary connected to a quartz chamber around which a copper electrode is wrapped. A copper wire is freely inserted inside the capillary. The applied voltage is a conventional AC 18-kHz signal to drive the discharge. In order to develop a safe and predictable treatment, a robust and reliable electrical model is necessary and we hypothesized that plasma transport can be modeled as a transmission line. We therefore assessed the electrical behavior of our new cold plasma source. As it is known that the target to which the plasma jet is applied drastically changes the behavior of the plasma itself, an electrical substitute simulating the impedance of a human body is introduced into the circuit, and the plasma behavior is then compared to the free-jet configuration. The effects of the input power (from 10 W to 80 W), and the length of the jet (from 60 cm to 220 cm) were investigated, as well as the electrical changes induced by the presence of an endoscope. The results obtained show trend curves similar to our hypothetical model, although the latter is still only qualitative. This long plasma jet model represents a promising approach that can be used, after further refinement, for controllability of plasma jets for endoscopy applications.info:eu-repo/semantics/publishe