SPECIFIC FEATURES OF THE ORAL MICROBIOME IN YOUNG CHILDREN WITH ARYNGOPHARYNGEAL REFLUX AND ITS ROLE THE DEVELOPMENT OF RECURRENT RESPIRATORY DISEASES.

OBJECTIVE: The aim: To examine the composition of the oral microbiome in young children with laryngopharyngeal reflux (LPR) and its role the development of recurrent respiratory diseases. PATIENTS AND METHODS: Materials and methods: There were examined 38 children with physiological gastroesophageal reflux (GER), 18 children with LPR who had a medical history of recurrent bronchitis and 17 healthy children (control group). The study included the collection of anamnesis, objective examination. The qualitative and quantitative microbial composition of the upper respiratory tract was performed obtained by oropharyngeal deep swab. Salivary pepsin level and IL-8 were determined by enzyme-linked immunosorbent assay. RESULTS: Results: This research showed significant alterations in the oral microbiome of patients with GER and LPR as compared to healthy control. We found that gram-negative microbiota such as Klebsiella pneumoniae, Escherichia coli, Proteus vulgaris, Proteus spp. and Candida albicans were identified in children with GER and LPR compared to the healthy control. At the same time, the amount of such a representative of the normal microbiome as Streptococcus viridans in children with LPR was sharply reduced. There were established a much higher mean salivary pepsin level of the patients with LPR than in the GER and control group. We found the association between high pepsin levels, saliva IL-8 levels and frequency of respiratory pathology in children with LPR. CONCLUSION: Conclusions: Our study confirms that increased levels of pepsin in saliva are a risk factor for recurrent respiratory diseases in children with LPR.

Antioxidants Rich Herbal Formula Ger-Gen-Chyn-Lian-Tang Protects Lipotoxicity and Ameliorates Inflammation Signaling through Regulation of Mitochondrial Biogenesis and Mitophagy in Nonalcoholic Fatty Liver Disease Mice.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) has become a prevalent issue and a consequence of metabolic syndrome impact on human health. Both of anti-atherosclerosis and anti-hepatic fibrosis capabilities of herbal medicine Ger-Gen-Chyn-Lian-Tang (GGCLT) has attracted attention, but their molecular regulatory mechanisms in a NAFLD model have not been elucidated. The aim of the present study was to explore the bioactivity of db/db mice following treatment with GGCLT. METHODS: NAFLD phenotype of db/db mice were treated with GGCLT and lipogenesis, mitochondria dysfunction, mitophagy, macrophage polarization and adipose tissue browning were then evaluated using qRT-PCR and/or Western blot analysis, immunofluorescence, and immunohistochemistry assays, respectively. RESULTS: GGCLT not only decreased serum levels of TG and free fatty acids, but glucose and insulin tolerance test in db/db mice. In parallel, GGCLT reduced lipogenesis and hypoxia-inflammation cascades in NAFLD progression. GGCLT reduced lipid accumulation and was accompanied by the enhanced mitochondria biogenesis, M2 macrophage, and decreased M1 macrophage. The latter two events contributing to the anti-inflammation are resulting from mitochondria dynamics, and the lipotoxicity lowering effect of GGCLT of NAFLD mice is mediated by promoting mitophagy in Parkin-dependent and -independent pathways, by mitochondrial fusion over fission manner. GGCLT also inactivated lipogenesis and decreased lipid accumulation in epididymal white adipose tissue with a higher M2/M1 macrophage ratio. CONCLUSIONS: Besides in the liver, modulating of mitochondrial biogenesis and adipose tissue browning were characterized by increased Tmem26, Tfam, and Prdm16 expression by GGCLT in EWAT also contributes to the beneficial action in NAFLD.

Long-Term Evaluation of Gastroesophageal Reflux in Neonates with and without Preventive Anti-reflux Surgery at the Time of Congenital Diaphragmatic Hernia Repair.

One potential comorbidity after congenital diaphragmatic hernia (CDH) is gastroesophageal reflux (GER), which can have a substantial effect on patients' quality of life, thriving, and complications later in life. Efforts have been made to reduce gastroesophageal reflux with a preventive anti-reflux procedure at the time of CDH repair. In this follow-up study of neonates participating in a primary RCT study on preventive anti-reflux surgery, symptoms of GER were assessed longitudinally. Long-term data with a median follow-up time of ten years was available in 66 patients. Thirty-one neonates received an initial fundoplication. Secondary anti-reflux surgery was necessary in 18% and only in patients with large defects. It was required significantly more often in patients with intrathoracic herniation of liver (p = 0.015) and stomach (p = 0.019) and patch repair (p = 0.03). Liver herniation was the only independent risk factor identified in multivariate regression analysis. Primary fundopexy and hemifundoplication did not reveal a protective effect regarding the occurrence of GER symptoms, the need for secondary antireflux surgery or the gain of body weight regardless of defect size neither in the short nor in the long term. Symptoms of GER must be assessed carefully especially in children with large defects, as these are prone to require secondary anti-reflux surgery in the long-term. Routine evaluation of GER including endoscopy and impedance measurement should be recommended especially for high-risk patients.

Non-Cardiac Conditions that Mimic Cardiac Symptoms in Athletes.

When considering the variety of complaints an athlete can present with, chest pain is arguably the most concerning given the potential for catastrophic outcomes. Luckily, these do not comprise the majority of cases, and indeed, are quite rare. The bulk of presentations of athletes with chest pain are due to musculoskeletal, gastrointestinal, and pulmonary causes. Each and every healthcare provider who works closely with athletes must have a thorough understanding of contributing conditions that present as chest pain. Here, we explore some of the more prevalent causes of non-cardiac chest pain, classic presentations, and management considerations.

Deployment of a remote monitoring solution for the elderly: experiment with an elderly patient / Déploiement d'une solution de télésurveillance du sujet âgé : expérimentation auprès d'un patient âgé

Introduction: Telemedicine can help manage patients suffering from chronic pathologies, particularly elderly patients with numerous comorbidities. We experimented with the e-platform, MyPredi, dedicated to the automated, intelligent detection of situations where patients are at risk of decompensation from geriatric syndromes. We focused our experiment on one particular patient included in the GER-e-TEC study. Methods: The MyPredi platform uses on medical sensors that communicate and relay real-time feedback to an intelligent system of physiological information that analyzes medical ontology, ultimately leading to the generation of alerts. These alerts are linked to a deterioration in the patient's state of health due to a decompensation of chronic pathologies. We reported the results of this experiment for the patient who was participating. Results: The telemedicine solution made 6,073 measurements for the patient throughout his hospitalization, averaging 253 measurements per day. The telemedicine solution issued 110 alerts for the patient during his stay, with an average of 5 alerts per day. The patient had 15 mild alerts, 31 moderate alerts, and 64 severe alerts. In terms of sensitivity, the results are 100% for all geriatric risks and very satisfactory in terms of positive and negative predictive value. Conclusion: MyPredi telemedicine platform enables the generation of alerts in an automatic and non-intrusive way relating to the deterioration of a patient's state of health with regard to geriatric risks.

Introduction: La télémédecine est susceptible d'apporter une aide à la prise en charge des patients souffrant de pathologies chroniques, en particulier les sujets âgés porteurs de nombreuses comorbidités. Dans ce cadre, nous avons expérimenté la e-plateforme MyPredi dédiée à la détection automatisée et intelligente des situations à risque de décompensation des syndromes gériatriques, auprès d'un patient inclus pour l'étude GER-e-TEC (pour geriatrics and e-technology). Méthodes: La plateforme MyPredi repose sur des capteurs médicaux communicants permettant de remonter, en temps réel, à un système intelligent des informations physiologiques, et sur une analyse de l'ontologie médicale, ce qui aboutit in fine à la génération d'alertes. Ces dernières sont liées à une dégradation de l'état de santé des patients en rapport avec une décompensation des pathologies chroniques. Nous indiquons les résultats de cette expérimentation pour le patient inclus. Résultats: La solution de télémédecine a réalisé 6 073 mesures pour le patient durant tout le long de son hospitalisation, avec en moyenne 253 mesures par jour. La solution de télémédecine a émis 110 alertes pour le patient durant son séjour, avec en moyenne cinq alertes par jour. Le patient a eu 15 alertes légères, 31 modérées et 64 sévères. On note une sensibilité de 100 % pour l'ensemble des risques gériatriques, avec des résultats très satisfaisants en termes de valeurs prédictives positives et négatives. Conclusion: En pratique, le système de télémédecine MyPredi permet, de façon automatique et non intrusive, de générer des alertes en rapport avec la dégradation de l'état de santé du patient en ce qui concerne les risques gériatriques.

Beclomethasone dipropionate and sodium cromoglycate protect against airway hyperresponsiveness in a human ex vivo model of cow's milk aspiration.

BACKGROUND: Recurrent cow's milk (CM) aspiration is often associated with gastroesophageal reflux in infants and toddlers and it seems to be implicated in the etiology of different inflammatory lung disorders. This study aimed to investigate ex vivo the impact of CM aspiration on human airways and whether treatment with beclomethasone dipropionate (BDP) or sodium cromoglycate (SCG) may prevent the potential CM-induced airway hyperresponsiveness (AHR). METHODS: Human isolated bronchi were contracted by electrical field stimulation (EFS10Hz) to mimic the contractile tone induced by the parasympathetic activity and challenged with CM, fat/lactose-free CM, or human breast milk (HM). The effect of pre-treatment with beclomethasone dipropionate (BDP) and sodium cromoglycate (SCG) was also investigated on the AHR induced by CM. RESULTS: After a 60 min-challenge with CM 1:10 v/v and fat/lactose-free CM 1:10 v/v, ASM significantly (P â€‹< â€‹0.05) increased compared to control (+67.04 â€‹± â€‹17.08% and +77.91 â€‹± â€‹1.34%, respectively), a condition that remained stable for 150 â€‹min post-treatment, whereas HM did not alter ASM contractility. BDP 1 â€‹µM and 10 â€‹µM significantly (P â€‹< â€‹0.05) reduced the AHR elicited by CM (-52.49 â€‹± â€‹10.97% and -66.98 â€‹± â€‹7.90%, respectively vs. control). At the same manner, SCG 1 â€‹µM and 10 â€‹µM significantly (P â€‹< â€‹0.05) inhibited the CM-induced AHR (-59.03 â€‹± â€‹9.24% and -73.52 â€‹± â€‹7.41%, respectively vs. control). CONCLUSION: CM induces AHR in human ASM by eliciting an increased parasympathetic contractile response. Preventive treatment with nebulized SCG may be indicated in infants or toddlers fed with CM, rather than with BDP due to a superior safety profile.

Preferences and Experiences of People with Chronic Illness in Using Different Sources of Health Information: Results of a Mixed-Methods Study.

BACKGROUND: People with chronic illness are particularly dependent on adequate health literacy (HL), but often report difficulties in accessing, understanding, appraising, and applying health information. To strengthen the HL of people with chronic illness, in-depth knowledge about how they deal with health information is crucial. METHODS: To this end, quantitative data from the Second Health Literacy Survey Germany (HLS-GER 2) and qualitative data from seven focus group discussions were used to examine the interest in health information, preferred sources of information as well as experiences and challenges with information management among people with chronic illness. RESULTS: The results show that people with chronic illness have a great interest in health information and use very different sources of health information, preferring personal information from physicians most. The results also point to several challenges in health information management that seem to be influenced by the illness duration as well as by the experiences made with the respective sources. CONCLUSIONS: Overall, the study provides important starting points for intervention development for the provision and communication of health-related information, but also to research on health information behavior and HL.

Programmed Cell Death Recruits Macrophages Into the Developing Mouse Cochlea.

Programmed cell death (PCD) plays a critical role in the development and maturation of the cochlea. Significant remodeling occurs among cells of the greater epithelial ridge (GER) of Kölliker's organ, leading to tissue regression and formation of the inner sulcus. In mice, this event normally occurs between postnatal days 5-15 (P5-15) and is regulated by thyroid hormone (T3). During this developmental time period, the cochlea also contains a large population of macrophages. Macrophages are frequently involved in the phagocytic clearance of dead cells, both during development and after injury, but the role of macrophages in the developing cochlea is unknown. This study examined the link between developmental cell death in the GER and the recruitment of macrophages into this region. Cell death in the basal GER begins at P5 and enhanced numbers of macrophages were observed at P7. This pattern of macrophage recruitment was unchanged in mice that were genetically deficient for CX3CR1, the receptor for fractalkine (a known macrophage chemoattractant). We found that injection of T3 at P0 and P1 caused GER cell death to begin at P3, and this premature PCD was accompanied by earlier recruitment of macrophages. We further found that depletion of macrophages from the developing cochlea (using CX3CR1DTR/+ mice and treatment with the CSF1R antagonist BLZ945) had no effect on the pattern of GER regression. Together, these findings suggest that macrophages are recruited into the GER region after initiation of developmental PCD, but that they are not essential for GER regression during cochlear remodeling.

Glycemic Disorder Risk Remote Monitoring Program in the COVID-19 Very Elderly Patients: Preliminary Results.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has necessitated the use of new technologies and new processes to care for hospitalized patients, including diabetes patients. This was the basis for the "GER-e-TEC COVID study," an experiment involving the use of the smart MyPredi TM e-platform to automatically detect the exacerbation of glycemic disorder risk in COVID-19 older diabetic patients. Methods: The MyPredi TM platform is connected to a medical analysis system that receives physiological data from medical sensors in real time and analyzes this data to generate (when necessary) alerts. An experiment was conducted between December 14th, 2020 and February 25th, 2021 to test this alert system. During this time, the platform was used on COVID-19 patients being monitored in an internal medicine COVID-19 unit at the University Hospital of Strasbourg. The alerts were compiled and analyzed in terms of sensitivity, specificity, positive and negative predictive values with respect to clinical data. Results: 10 older diabetic COVID-19 patients in total were monitored remotely, six of whom were male. The mean age of the patients was 84.1 years. The patients used the telemedicine solution for an average of 14.5 days. 142 alerts were emitted for the glycemic disorder risk indicating hyperglycemia, with an average of 20.3 alerts per patient and a standard deviation of 26.6. In our study, we did not note any hypoglycemia, so the system emitted any alerts. For the sensitivity of alerts emitted, the results were extremely satisfactory, and also in terms of positive and negative predictive values. In terms of survival analysis, the number of alerts and gender played no role in the length of the hospital stay, regardless of the reason for the hospitalization (COVID-19 management). Conclusion: This work is a pilot study with preliminary results. To date, relatively few projects and trials in diabetic patients have been run within the "telemedicine 2.0" setting, particularly using AI, ICT and the Web 2.0 in the era of COVID-19 disease.

A narrative review of gastroesophageal reflux in the pediatric patient.

Gastroesophageal reflux (GER) is the retrograde passage of gastric contents into the esophagus. It is a physiologic condition that is common in neonates, typically resolves spontaneously, and does not result in clinically significant complications. When pathologic, gastroesophageal reflux disease (GERD) can cause numerous complications including persistent emesis, failure to thrive, aspiration, and respiratory symptoms. While a diagnosis can often be made from a thorough history and physical, some patients may require further testing. In general, many clinicians will reserve extensive investigation such as multiple intraluminal impedance and pH monitoring for patients with a confounding clinical picture or relative contraindications to medical or surgical management. Whereas most pediatric GER resolves spontaneously, medical management including lifestyle changes, changes to feeds, and the use of H2-antagonists and/or proton pump inhibitors (PPIs) can be utilized to alleviate symptoms. Surgical treatment is reserved for patients who are refractory to medical management or have suffered significant complications as a consequence of GER. In this article we seek to provide a concise but detailed review of recent updates in the understanding, work up and management of GER in the pediatric patient. A summary of new technologies used in the diagnostic and therapeutic arms of this disease are included.

Cow's Milk Allergy or Gastroesophageal Reflux Disease-Can We Solve the Dilemma in Infants?

Cow's milk allergy (CMA) and gastro-esophageal reflux disease (GERD) may manifest with similar symptoms in infants making the diagnosis challenging. While immediate reaction to cow's milk protein indicate CMA, regurgitation, vomiting, crying, fussiness, poor appetite, sleep disturbances have been reported in both CMA and GERD and in other conditions such as functional gastrointestinal disorders, eosinophilic esophagitis, anatomic abnormalities, metabolic and neurological diseases. Gastrointestinal manifestations of CMA are often non-IgE mediated and clinical response to cow's milk free diet is not a proof of immune system involvement. Neither for non-IgE CMA nor for GERD there is a specific symptom or diagnostic test. Oral food challenge, esophageal pH impedance and endoscopy are recommended investigations for a correct clinical classification but they are not always feasible in all infants. As a consequence of the diagnostic difficulty, both over- and under- diagnosis of CMA or GERD may occur. Quite frequently acid inhibitors are empirically started. The aim of this review is to critically update the current knowledge of both conditions during infancy. A practical stepwise approach is proposed to help health care providers to manage infants presenting with persistent regurgitation, vomiting, crying or distress and to solve the clinical dilemma between GERD or CMA.

Results of the "GER-e-TEC" Experiment Involving the Use of an Automated Platform to Detect the Exacerbation of Geriatric Syndromes.

INTRODUCTION: Telemedicine is believed to be helpful in managing patients suffering from chronic diseases, in particular elderly patients with numerous accompanying conditions. This was the basis for the "GERIATRICS and e-Technology (GER-e-TEC) study", which was an experiment involving the use of the smart MyPredi™ e-platform to automatically detect the exacerbation of geriatric syndromes. METHODS: The MyPredi™ platform is connected to a medical analysis system that receives physiological data from medical sensors in real time and analyzes this data to generate (when necessary) alerts. These alerts are issued in the event that the health of a patient deteriorates due to an exacerbation of their chronic diseases. An experiment was conducted between 24 September 2019 and 24 November 2019 to test this alert system. During this time, the platform was used on patients being monitored in an internal medicine unit at the University Hospital of Strasbourg. The alerts were compiled and analyzed in terms of sensitivity, specificity, and positive and negative predictive values with respect to clinical data. The results of the experiment are provided below. RESULTS: A total of 36 patients were monitored remotely, 21 of whom were male. The mean age of the patients was 81.4 years. The patients used the telemedicine solution for an average of 22.1 days. The telemedicine solution took a total of 147,703 measurements while monitoring the geriatric risks of the entire patient group. An average of 226 measurements were taken per patient per day. The telemedicine solution generated a total of 1611 alerts while assessing the geriatric risks of the entire patient group. For each geriatric risk, an average of 45 alerts were emitted per patient, with 16 of these alerts classified as "low", 12 classified as "medium", and 20 classified as "critical". In terms of sensitivity, the results were 100% for all geriatric risks and extremely satisfactory in terms of positive and negative predictive values. In terms of survival analysis, the number of alerts had an impact on the duration of hospitalization due to decompensated heart failure, a deterioration in the general condition, and other reasons. CONCLUSION: The MyPredi™ telemedicine system allows the generation of automatic, non-intrusive alerts when the health of a patient deteriorates due to risks associated with geriatric syndromes.

e-Health: A Future Solution for Optimized Management of Elderly Patients. GER-e-TEC™ Project.

Background: Elderly residents in nursing homes have multiple comorbidities (including cognitive and psycho-behavioral pathologies, malnutrition, heart failure, diabetes, chronic obstructive pulmonary disease, and renal failure) and use multiple medications. Methods: The GER-e-TEC project aims to provide these fragile and complex patients with telemedicine tools, more specifically telemonitoring, backed by a well-defined and personalized protocol. Results: Medically, this implies the need for regular monitoring and a high level of medical and multidisciplinary expertise for the healthcare team. The tools use non-invasive communicating sensors and artificial intelligence techniques, allowing daily monitoring with the ability to detect any abnormal changes in the patient's condition early. Conclusions: The GER-e-TEC project specifically considers the challenges of aging residents and significant challenges in nursing homes, with the main geriatric syndromes (falls, malnutrition, cognitive-behavioral disorders, and iatrogenic conditions).

Ecological and Human Health Risk Assessment of Heavy Metal Pollution in the Soil of the Ger District in Ulaanbaatar, Mongolia.

The aim of the present study was to evaluate human health and potential ecological risk assessment in the ger district of Ulaanbaatar city, Mongolia. To perform these risk assessments, soil samples were collected based on reference studies that investigated heavy element distribution in soil samples near the ger area in Ulaanbaatar city. In total, 42 soil samples were collected and 26 heavy metals were identified by inductively coupled plasma optical emission spectrometry (ICP-OES) and inductively coupled plasma mass spectrometry (ICP-MS) methods. The measurement results were compared with the reference data in order to validate the soil contamination level. Although there was a large difference between the measurement results of the present and reference data, the general tendency was similar. Soil contamination was assessed by pollution indexes such as geoaccumulation index and enrichment factor. Mo and As were the most enriched elements compared with the other elements. The carcinogenic and noncarcinogenic risks to children exceeded the permissible limits, and for adults, only 12 out of 42 sampling points exceeded the permissible limit of noncarcinogenic effects. According to the results of the ecological risk assessment, Zn and Pb showed from moderate to considerable contamination indexes and high toxicity values for ecological risk of a single element. The Cr and As ranged as very high ecological risk than that of the other measured heavy metals.

Cross-Cultural Adaptation and Validation of the Arabic Version of the Intermittent and Constant Osteoarthritis Pain Questionnaire.

This study aimed to translate and adapt the Intermittent and Constant Osteoarthritis Pain questionnaire into the Arabic language and evaluate the validity and reliability of this scale for participants with knee or hip osteoarthritis. This questionnaire was translated based on the Manufacturers Alliance for Productivity and Innovation protocol. The test-retest reliability was calculated using the Intraclass Correlation Coefficient. Then, Cronbach's alpha was used to assess the internal consistency of Intermittent and Constant Osteoarthritis Pain questionnaire. After that, the criterion validity was evaluated against the Knee injury and Osteoarthritis Outcome Score. A total of 90 participants were included in this study, of which 29 participants were re-evaluated for reliability testing. The Intraclass Correlation Coefficient of the Knee Intermittent and Constant Osteoarthritis Pain questionnaire were 0.841, 0.923 and 0.911 for the total, constant, and intermittent knee pain, respectively. Cronbach's alpha was 0.88, 0.93 and 0.94 for the total score, the intermittent knee pain and the constant knee pain, respectively. Eventually, criterion validity was r=0.24(P<0.05). Intermittent and Constant Osteoarthritis Pain in Arabic is a valid and reliable instrument to be used in Arabic-speaking patients with knee/hip osteoarthritis.

Impact of gastroesophageal reflux in the pathogenesis of tracheal stenosis.

Benign airway stenosis is a multifactorial and heterogeneous disease often occurring after tracheal intubation. Despite the frequent finding of pathological gastroesophageal reflux (GER) in benign tracheal stenosis, the cause-and-effect relationship between these two entities and its impact on the outcome of the stenosis itself have not been established. The altered ventilatory dynamics caused by an increased thoracoabdominal pressure gradient in such patients has been proposed as a central cause. The presence of GER in a setting of microaspiration can also induce changes in the local collagen proliferation response, as well as in the local microbiome of the tracheal stenosis site, which may potentially cause and enhance the harm imposed to the already diseased tracheal wall. Diagnosis of GER remains underestimated in the general population, thus making its accurate detection and treatment in central airway stenosis a matter of investigation. The high prevalence of GER in tracheal stenosis patients often occurs in the absence of typical upper digestive signs and symptoms, therefore requiring an objective assessment using a 24-hour ambulatory esophageal pH/impedance study that has shown abnormal results in more than half the patients. The impact of the treatment of GER in patients with benign tracheal has been scarcely reported. Our group showed recently that the surgical control of GER through laparoscopic fundoplication in selected patients with tracheal stenosis can improve substantially the chance of resolution of the tracheal stenosis as opposed to the medical management with high dose proton pump inhibitors. This chapter describes the impact of GER in the pathogenesis of tracheal stenosis with a focus on its mechanisms, diagnosis and treatment strategy.

First Test of an Automated Detection Platform to Identify Risk of Decompensation in Elderly Patients.

INTRODUCTION: We tested the MyPredi™ e-platform which is dedicated to the automated, intelligent detection of situations posing a risk of decompensation in geriatric patients. OBJECTIVE: The goal was to validate the technological choices, to consolidate the system and to test the robustness of the MyPredi™ e-platform through daily use. RESULTS: The telemedicine solution took 3,552 measurements for a hospitalized patient during her stay, with an average of 237 measurements per day, and issued 32 alerts, with an average of 2 alerts per day. The main risk was heart failure which generated the most alerts (n=13). The platform had 100% sensitivity for all geriatric risks, and had very satisfactory positive and negative predictive values. CONCLUSION: The present experiment validates the technological choices, the tools and the solutions developed. LEARNING POINTS: Patients with chronic conditions can be monitored with telemedicine systems to optimise their management, particularly during the COVID-19 pandemic.The goal was to validate the technological choices, to consolidate the system and to test the robustness of the MyPredi™ e-platform, through daily use in an elderly patient.The present experiment demonstrates the relevance of the technological choices, the tools and the solutions developed.

Influence of gastrointestinal activity on the absorption of nilotinib.

Nilotinib has bioavailability (BA) of only about 25% or less. The purpose of this study was to evaluate the influence of gastrointestinal activity on the absorption of nilotinib. In order to change gastrointestinal activity, mosapride was used for enhancement and butylscopolamine was used for suppression. Experiments on oral administration of nilotinib using rats whose gastrointestinal activity was altered by mosapride or butylscopolamine were carried out. The results of oral administration of acetaminophen to rats with peristalsis movement changed showed that the effects of peristalsis and gastric emptying rate (GER) on drug absorption could be evaluated in this experimental system. Similarly, even with nilotinib, no change in Tmax was observed, but Cmax increased and decreased significantly. Due to the change in gastrointestinal activity, Cmax of nilotinib changed greatly. This showed that gastrointestinal activity affected the emulsifying action of bile and that the absorbability changed. As a result of examining the contribution to the emulsifying action, it was found that when the bile does not exist in the gastrointestinal tract, absorption of nilotinib did not change even when gastrointestinal motility was enhanced. Therefore, the results suggested that gastrointestinal activity influenced the emulsifying action of bile and the absorption of nilotinib was changed.

Laparoscopic fundoplication for a case of esophageal hiatal hernia after gastroschisis repair.

BACKGROUND: Esophageal hiatal hernia and gastroesophageal reflux have been recognized as inevitable complications after the definitive gastroschisis operation. Patients with refractory gastroesophageal reflux require anti-reflux surgery; however, the surgical adhesions may complicate subsequent surgical therapy, especially in the cases treated by staged repair. CASE PRESENTATION: A male infant who showed a severe gastroesophageal reflux due to hiatal hernia after staged abdominal fascial closure of gastroschisis. In spite of continuous conservative management, frequent vomiting and hematemesis had become progressively worse at the age of 8 months. Laparoscopic Nissen fundoplication was attempted and completed with no adverse events. CONCLUSIONS: Laparoscopic fundoplication may be applied, as a first-line approach, for the treatment of gastroesophageal reflux in this difficult group of patients, after the repair of congenital abdominal wall defect.