Diabetic gastroparesis: Therapeutic options

Gastroparesis is a condition characterized by delayed gastric emptying and the most common known underlying cause is diabetes mellitus. Symptoms include nausea, vomiting, abdominal fullness, and early satiety, which impact to varying degrees on the patient’s quality of life. Symptoms and deficits do not necessarily relate to each other, hence despite significant abnormalities in gastric emptying, some individuals have only minimal symptoms and, conversely, severe symptoms do not always relate to measures of gastric emptying. Prokinetic agents such as metoclopramide, domperidone, and erythromycin enhance gastric motility and have remained the mainstay of treatment for several decades, despite unwanted side effects and numerous drug interactions. Mechanical therapies such as endoscopic pyloric botulinum toxin injection, gastric electrical stimulation, and gastrostomy or jejunostomy are used in intractable diabetic gastroparesis (DG), refractory to prokinetic therapies. Mitemcinal and TZP-101 are novel investigational motilin receptor and ghrelin agonists, respectively, and show promise in the treatment of DG. The aim of this review is to provide an update on prokinetic and mechanical therapies in the treatment of DG

The state of the Martian climate

60°N was +2.0°C, relative to the 1981–2010 average value (Fig. 5.1). This marks a new high for the record. The average annual surface air temperature (SAT) anomaly for 2016 for land stations north of starting in 1900, and is a significant increase over the previous highest value of +1.2°C, which was observed in 2007, 2011, and 2015. Average global annual temperatures also showed record values in 2015 and 2016. Currently, the Arctic is warming at more than twice the rate of lower latitudes

Stability of inorganic arsenic species in simulated raw waters with the presence of NOM

Effect of natural organic matter (NOM) on the stability of inorganic arsenic species in simulated raw water was examined at circumneutral pH. An ion chromatography- inductively coupled plasma mass spectrometry system was used for simultaneous determination of As(III) and As(V). A reduction of arsenate (As(V)) to arsenite (As(III)) was observed in the unfiltered simulated raw waters (USW). The As(V) reduction to As(III) did not occur in the simulated waters that passed through a 0.2 μm membrane (FSW). Microorganism activities is probably the major reason causing As(V) reduction in the USW. In the FSW without NOM, As(III) tended to be oxidized into As(V). The addition of 0.036 mM of Fe(II) significantly facilitated the oxidation. The presence of 10 mg/L Suwannee River NOM as C inhibited As(III) oxidation no matter whether Fe(II) existed or not. The experimental results suggest that NOM can mediate distribution of inorganic arsenic species in water, thus it is an important factor controlling the mobility and toxicity of arsenic in drinking water. © IWA Publishing 2006