Increase of lower esophageal sphincter pressure after osteopathic intervention on the diaphragm in patients with gastroesophageal reflux.

The treatment of gastroesophageal reflux disease may be clinical or surgical. The clinical consists basically of the use of drugs; however, there are new techniques to complement this treatment, osteopathic intervention in the diaphragmatic muscle is one these. The objective of the study is to compare pressure values in the examination of esophageal manometry of the lower esophageal sphincter (LES) before and immediately after osteopathic intervention in the diaphragm muscle. Thirty-eight patients with gastroesophageal reflux disease - 16 submitted to sham technique and 22 submitted osteopathic technique - were randomly selected. The average respiratory pressure (ARP) and the maximum expiratory pressure (MEP) of the LES were measured by manometry before and after osteopathic technique at the point of highest pressure. Statistical analysis was performed using the Student's t-test and Mann-Whitney, and magnitude of the technique proposed was measured using the Cohen's index. Statistically significant difference in the osteopathic technique was found in three out of four in relation to the group of patients who performed the sham technique for the following measures of LES pressure: ARP with P= 0.027. The MEP had no statistical difference (P= 0.146). The values of Cohen d for the same measures were: ARP with d= 0.80 and MEP d= 0.52. Osteopathic manipulative technique produces a positive increment in the LES region soon after its performance.

Malnutrition during lactation as a metabolic imprinting factor inducing the feeding pattern of offspring rats when adults. The role of insulin and leptin.

The aim of the present study was to determine the impact of malnutrition during early postnatal life and the feeding pattern of rat offspring when adults (2 months and 1 year old). In comparison with rats normally fed during lactation, we observed that adult offspring displayed a faster process of feeding reduction when a protein-free diet was offered. In addition, we studied the concentration of insulin and leptin in the lactating pups (10 days) and when these offspring became adult after the onset of a new feeding pattern induced by the protein-free diet. When the diet was changed at 60 days, the offspring malnourished during lactation displayed, after 3 days, a food intake reduction around 41.4 vs 14.2% of the control group. At 10 days of life, plasma leptin and insulin were higher in the malnourished pups when compared with normally fed rats (leptin: 4.6 +/- 0.8 vs 2.25 ng/ml; insulin: 0.73 +/- 0.12 vs 0.22 +/- 0.03 ng/ml) while at 60 days they showed reduction of both hormones when compared with the control group (leptin: 1.03 +/- 0.25 vs 1.43 +/- 0.5 ng/ml; insulin: 0.54 +/- 0.3 vs 0.61 +/- 0.4 ng/ml). Despite the different food intake reductions, the malnourished and control rats displayed a similar reduction of insulin and leptin after 3 days of protein-free diet (from 60 to 63 days). The data suggest that the high concentration of insulin and leptin found at 10 days in the malnourished pups may elicit a sustained long-term and unique feeding pattern.

Malnutrition during lactation as a metabolic imprinting factor inducing the feeding pattern of offspring rats when adults. The role of insulin and leptin

The aim of the present study was to determine the impact of malnutrition during early postnatal life and the feeding pattern of rat offspring when adults (2 months and 1 year old). In comparison with rats normally fed during lactation, we observed that adult offspring displayed a faster process of feeding reduction when a protein-free diet was offered. In addition, we studied the concentration of insulin and leptin in the lactating pups (10 days) and when these offspring became adult after the onset of a new feeding pattern induced by the protein-free diet. When the diet was changed at 60 days, the offspring malnourished during lactation displayed, after 3 days, a food intake reduction around 41.4 vs 14.2 percent of the control group. At 10 days of life, plasma leptin and insulin were higher in the malnourished pups when compared with normally fed rats (leptin: 4.6 0.8 vs 2.25 ng/ml; insulin: 0.73 0.12 vs 0.22 0.03 ng/ml) while at 60 days they showed reduction of both hormones when compared with the control group (leptin: 1.03 0.25 vs 1.43 0.5 ng/ml; insulin: 0.54 0.3 vs 0.61 0.4 ng/ml). Despite the different food intake reductions, the malnourished and control rats displayed a similar reduction of insulin and leptin after 3 days of protein-free diet (from 60 to 63 days). The data suggest that the high concentration of insulin and leptin found at 10 days in the malnourished pups may elicit a sustained long-term and unique feeding pattern

Insulin secretion impairment and insulin sensitivity improvement in adult rats undernourished during early lactation.

In order to study the effect of undernutrition on the onset of disturbances in insulin secretion and insulin resistance, we compared the effects of a low protein diet containing 4% of protein (LPD) and a normal diet containing 25% of protein (NPD) supplied to the dams during the first 10 days of lactation when the pups turn into adults (90 days). We studies, in these rats, the insulin secretion, the glucose tolerance test (GTT) and, using the glucose clamp technique, the insulin resistance. The GTT showed a delay of the response of LPD group to the glucose challenge (1 mg/kg body weight) at 10 minutes (NPD = 450 +/- 27 mg/dl; LPD = 650 +/- 32 mg/dl, p < 0.01). The insulin secretion, four minutes after stimulation was found reduced in the LPD group (LPD = 1.1 +/- 0.08 microU/islet/min; NPD = 1.85 +/- 0.02 microU/islet/min, p < 0.01). Using the glucose clamp technique the plasma glucose concentration was raised during the first 20 minutes after the glucose stimulation with 10 mg/Kg-1.min-1 (NPD = 200 +/- 32 mg/dl and; LPD = 160 +/- 14 mg/dl., p < 0.01). Afterwards, the hyperglycemia was subsequently maintained (NPD = 154 +/- 9 mg/dl; LPD = 149 +/- 12 mg/dl) and the insulinemia was unchanged by infusion of glucose in the LPD group. In a similar experiment, the administration of glucose (10 mg/Kg-1. min-1) plus insulin (1.67 mU/Kg-1. min-1), the LPD group when compared with the NPD group, displayed an accentuated decreasing of glucose concentration level (LPD = 90 +/- 7 mg/dl; NPD = 130 +/- mg/dl., p < 0.01), 30 minutes after the infusion. The data suggest that undernutrition induces an adaptive process of insulin sensitivity which occurs together with an insulin secretion first phase blockage.