Non-invasive stress estimation in simulative endoscopy setting: literature review

One of the most common stressors is so-called “occupational stress.” It is defined as the sum of physical, mental and physiological responses to work in situations where the workload or stress associated with it intensifies for an extended period of time. It is a gradual process in which individual cognitive assessments of occupational stressors generate adverse health events and may lead to burnout. Since it has become a major problem in the medical field, studying, measuring and limiting it have been set as goals for the future. We present a literature review on the topic of measuring stress using non-invasive means, such as cardiac indices measured through different devices, electrodermal activity, skin temperature, and salivary biomarkers. A virtual reality simulation could be used in conducting such experiments in order to provide a standardized environment with set variables for researchers to discern the most precise indices to be used in a real-life setting

Kinetika difuzije soli i randman nekih tipova kozjih sireva

This paper studies the dynamics of salt diffusion during the ageing of three types of cheese from goat\u27s milk: Mozzarella, White Brined and Pecorino. The salt concentration was consistently analyzed at the 72nd hour and on the 5th, 10th, 20th, 40th, 50th, 60th and 90th day of the cheese ageing period. The distribution of salt in the three layers of cheese – inner (I), middle (II) and outer (III) was also studied. The salt equilibration in the cheese mass of Mozzarella occurred on the 15th day, in the White Brined - on the 60th day, whereas in Pecorino the content of salt even on the 90th day was by 1% lower, in the inner layer than in the two other layers of this cheese. The utilization rate of dry matter was 52.17% in Mozzarella, 50.64% in the White Brined and 48.32% in Pecorino. Accordingly, the yield of Mozzarella is 18.13 ±0.43%, of White Brined - 12.50 ±0.37% and the yield of Pecorino is 9.18 ±0.13%.Istražena je kinetika difuzije soli tijekom zrenja tri vrste kozjeg sira (Mocarela, Bijeli salamureni sir i Pekorino). Analize su učinjene periodično svakih 72 sata, 5-tog, 10-tog, 40-teog, 50-tog, 60-tog i 90-tog dana od zrenja sira. Istovremeno smo ispitivali koncentraciju soli u tri sloja sira: unutrašnjem (1), srednjem (2), vanjskom (3). Izjednačavanje soli u sirnoj masi kod sira Mocarela počinje 15-tog dana; kod Bijelog salamurenog sira 60-tog dana dok kod Pekorino sira sadržaj soli je 90-tog dana za 1% manji u unutrašnjem sloju nego u druga dva sloja. Stupanj iskorištavanja suhe tvari kod Mocarela sira je 52,17 %, kod Bijelog salamurenog sira je 50,64 % i kod Pekorino 48,32 %. Suglasno tome, randman sira Mocarela je 18,13±0,43 %, kod Bijelog salamurenog sira je 12,70±0,37 % i kod Pekorino sira 9,58±0,37 %

Serum NT-ProBNP potential marker of cirrhotic cardiomyopathy

Introduction: Based on many previous studies, liver cirrhosis is traditionally associated with cardiac dysfunction. The main clinical features of cirrhotic cardiomyopathy include attenuated systolic contractility in response to physiologic or pharmacologic strain, diastolic dysfunction, electrical conductance abnormalities, and chronotropic incompetence. Previous studies have found that the levels of brain natriuretic peptide (BNP) and its precursor the N-terminal pro B-type natriuretic peptide (NT-proBNP) are elevated in cirrhosis with systolic as well as diastolic dysfunction. Aim: The aim of this study was to establish the association between early changes in cardiac function in patients with liver cirrhosis and NT- proBNP plasma levels. Materials and methods: Forty-two consecutive hospitalized patients with viral-related cirrhosis were studied. We also evaluated a control group of 20 age and sex-matched patients with arterial hypertension. All underwent abdominal ultrasound, upper GI endoscopy, ECG, and echocardiography, and their plasma levels of NT-proBNP were determined. Results: We observed higher NT-proBNP plasma levels in cirrhotic patients than in controls. We also found that atrial volumes, ejection fraction and partially left ventricular mass and PAPs (systolic pulmonary arterial pressure) were significantly altered in comparison with the hypertensive controls. Supporting previous studies, we also found that the mean QTc interval was prolonged in 65% of women and 96% of men. Conclusions: In conclusion, the present study shows that plasma NT-proBNP levels, LAD (left atrium diameter), the E/A ratio, EDT (end diastolic time) and E/e’ ratio may be reliable indicators of the extent of cardiac abnormalities in cirrhotic patients

Initial experience with peroral endoscopic myotomy in Bulgaria: case series

Achalasia is a rare motility disorder with unknown etiology that results in failure of relaxation of the lower esophageal sphincter (LES). As there is no etiological treatment, different pharmacological agents and invasive techniques have been used for relieving the symptoms. For the past decade, peroral endoscopic myotomy (POEM) has proven to have excellent results.We present a retrospective study of five patients that underwent POEM for primary achalasia. We used anterior approach for the submucosal tunneling. The procedure showed immediate results and no severe short- or long-term adverse events. We have been following the patients up for more than 3 years now.Since its invention more than ten years ago, the POEM procedure and its advantages and disadvantages compared to the pneumatic dilatation and the Heller myotomy have been extensively studied. There is still no universal opinion on which procedure should be the first line treatment

Session 17 Ecophysiology

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Risk Factors and Incidence of Poor Bowel Preparation in Elderly Patients: Prospective Study

This article has been withdrawn due to inaccuracy of the information provided

Dynamics of salt diffusion and yield of three types of goat's milk cheese

This paper studies the dynamics of salt diffusion during the ageing ofthree types of cheese from goat's milk: Mozzarella, White Brined andPecorino. The salt concentration was consistently analyzed at the 72nd hour and on the 5th, 10th, 20th, 40th, 50th, 60th and 90th day of the cheese ageing period. The distribution of salt in the three layers of cheese – inner (I), middle (II) and outer (III) was also studied. The salt equilibration in the cheese mass of Mozzarella occurred on the 15th day, in the White Brined - on the 60th day,whereas in Pecorino the content of salt even on the 90th day was by 1% lower, in the inner layer than in the two other layers of this cheese. The utilization rate of dry matter was 52.17% in Mozzarella, 50.64% in the White Brined and 48.32% in Pecorino. Accordingly, the yield of Mozzarella is 18.13 ±0.43%, of White Brined - 12.50 ±0.37% and the yield of Pecorino is 9.18 ±0.13%

Prevention of Migration of Esophageal Self-Expandable Metallic Stents Using Endoscopic Clips

Background and Objectives: Esophageal stenting with self-expandable metallic stents (SEMS), for both benign and malignant reasons, has been widely practiced for decades, but migration still remains the most common complication of the procedure. In this report we aim to review our experience and results in stent fixation with clips. Materials and Methods: We present 18 patients who underwent esophageal stenting for both benign and malignant reasons. The SEMSs used were partially covered and were fixated with two to four through the scope hemostatic clips in the proximal end of the prothesis. The procedure was performed only on patients with a high risk of migration of the stent. Results: Migration occurred in only one of the above-mentioned patients and was treated with stent repositioning. The other adverse events that occurred were related to tumor growth in patients with malignant diseases. Conclusions: Clip fixation of an esophageal self-expandable metallic stent in cases considered high-risk for migration is a safe procedure. It reduces the migration rate significantly for both benign and malignant indications

Initial experience in target peroral endoscopic submucosal myotomy combined with septotomy for epiphrenic diverticulum

The epiphrenic esophageal diverticulum is a rare non-malignant condition that is commonly associated with motility disorders. It would normally be treated surgically, but with the advancement of endoscopy techniques, peroral endoscopic myotomy with septotomy (D-POEM) has shown its benefits in coping with the symptoms. We present a case of a 71-year-old woman with increasing symptoms of dysphagia, weight loss and imaging data showing a large epiphrenic diverticulum. We treated her using peroral endoscopic myotomy combined with septotomy of the diverticular septum. The procedure showed excellent results with reducing the amount of contrast materials retained in it, improving the quality of life of the patient, and increasing her weight. There were minimal adverse events and no perforations or severe adverse effects occurred. D-POEM is a new and rapidly evolving procedure that is proving to be a safe and effective method of treating epiphrenic esophageal diverticulum