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1
Liu, Xun, Shihao Tu, Dingyi Hao, Yida Lu, Kaijun Miao, and Wenlong Li. "Deformation Law and Control Measures of Gob-Side Entry Filled with Gangue in Deep Gobs: A Case Study." Advances in Materials Science and Engineering 2021 (May 18, 2021): 1–13. http://dx.doi.org/10.1155/2021/9967870.
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Aiming at the large deformation problem of gob-side entry in solid filling mining, the roof subsidence of gob-side entry retaining (GER) was studied under the influence of gangue filling, by taking a deep filling working face in Shandong Province as the engineering background and using theoretical derivation as well as FLAC3D numerical simulation. Research shows that the stiffness of the gangue filling body in the gob and the stiffness and width of the entry protection coal and rock mass (EPCARM) are positively correlated with the GER roof subsidence, which is much less affected by the EPCARM parameters than by the GER stiffness. The GER failure to meet the application requirements is mainly attributed to the insufficient stiffness of the gangue filling body and excessive advance subsidence, which inhibit the roof stress transfer. The GER replacement by the gob-side entry driving (GED) scheme, which implies replacing the entry protection gangue bag wall with the coal pillar with a width of 5 m, will reduce the roof subsidence to 0.114 m, according to the proposed equation. The results obtained are considered quite instrumental in deformation control of the gob-side entry filled with gangue, as well as substantiation of GED and GER applicability options.
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Takahiro, Hosokawa, Mayuki Uchiyama, Yutaka Tanami, Yumiko Sato, Yasuharu Wakabayashi, and Eiji Oguma. "A single-center experience of using milk scintigraphy in 251 pediatric patients: A retrospective study." Medicine 102, no. 45 (November 10, 2023): e35746. http://dx.doi.org/10.1097/md.0000000000035746.
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To report our experience with milk gastroesophageal scintigraphy and the management of gastroesophageal reflux (GER) in children. In 251 pediatric patients we recorded age, underlying disease, central nervous system (CNS) disorders, and GER management. GER management was classified based on treatment plans: grade 0, non-pharmacological treatment; grade 1, non-pharmacological but using a nasogastric tube; grade 2, pharmacological treatment; grade 3, transpyloric feeding; and grade 4, Nissen fundoplication surgery. Patients were included in classified groups with (grades 2, 3, and 4) and without (grades 0 and 1) GER treatment. We evaluated the GER height (classified based on the height of GER, grade 0; no GER, 1; GER in the lower esophagus, 2; GER in the upper esophagus), GER duration in the lower and upper esophagus, presence or absence of massive GER amounts in the lower and upper esophagus, and gastric emptying time. We compared milk scintigraphy results and patient characteristics between groups with (grades 2, 3, and 4) and without (grades 0 and 1) GER treatment. We treated 121 patients for GER. CNS disorders (presence/absence: 46/74 with vs 21/110 without treatment, P < .001). The GER height grade (1.7 ± 0.5 [range, 0–2] with vs 1.5 ± 0.7 [range, 0–2] without treatment, P = .002), massive GER amount (present/absent: 21/99 with vs 9/122 without treatment, P = .011), and duration of GER (seconds) (324.5 ± 508.3 [range, 0–1800] vs 125.0 ± 291.9 [range, 0–1750], P < .001) in the upper esophageal half differed significantly. Similarly massive GER amount (present/absent: 54/66 with vs 34/97 without treatment, P = .002) and GER duration (621.3 ± 601.0 [range, 0–1800] vs 349.8 ± 452.4 [range, 0–1800], P < .001) in the lower esophageal half differed significantly. Additionally, CNS disorders, age, and massive GER in the upper esophageal half differed significantly among grades 2 and 4 in treated patients (P < .05, P < .001, P < .05, respectively). Milk scintigraphy is useful for deciding whether GER treatment is indicated. However, the treatment plan needs to be decided based on each patient’s condition.
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Pappa, Angeliki, Moritz Muschaweck, and Tobias G. Wenzl. "Change of Sleep Stage during Gastroesophageal Reflux in Infants." Children 10, no. 5 (May 4, 2023): 836. http://dx.doi.org/10.3390/children10050836.
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Introduction: This study intended to explore the existence of a temporal association of changes of sleep stage and gastroesophageal reflux (GER) in infants. Materials and Methods: Documentation of sleep stage and GER was conducted via the use of synchronized polygraphic recording combined with impedance-pH-metry in 15 infants. The total recording-time (Rt) was divided into GER-“window-time” (five seconds before and after the onset of a GER episode), “remaining GER time”, and “GER-free time”, and analyzed for changes of sleep stage. Results: a total of 462 GER episodes were identified during Rt (151.1 h) in all infants. During 1.3 h of window-time; 61 changes of sleep stage (47/h); during 5.9 h of Remaining GER-time, 139 changes of sleep stage (24/h); and during 143.9 h of GER-free time, 4087 changes of sleep stage (28/h) were documented. Change of sleep stage was strongly associated with the onset of GER (p < 0.02 and p < 0.05, respectively). Conclusions: There is a strong temporal association between sleep irregularities, i.e., changes of sleep and episodes of GER in infants. When dealing with disturbed sleep in infants, GER should be considered by caregivers.
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Fett, Carlos A., Waléria C. R. Fett, and Julio S. Marchini. "Gasto energético de repouso medido vs. estimado e relação com a composição corporal de mulheres." Arquivos Brasileiros de Endocrinologia & Metabologia 50, no. 6 (December 2006): 1050–58. http://dx.doi.org/10.1590/s0004-27302006000600011.
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OBJETIVOS: Medir o gasto energético de repouso (GER, kcal/d), comparar as equações de predição disponíveis na literatura e associar a composição corporal. MÉTODOS: Vinte e oito sedentárias foram voluntárias [peso: 79 ± 12 kg; estatura: 164 ± 5 cm; idade: 36 ± 11 anos; índice de massa corporal (IMC): 29 ± 4 kg/m²]. A composição corporal foi estimada por antropometria, o GER foi medido por calorimetria indireta e estimado pelas principais equações da literatura. Foram desenvolvidas equações para estimativa do GER sendo a melhor a GER-Nosso. RESULTADOS: Diferentes tempos de coleta produziram resultados similares para o GER medido. O GER estimado pelas fórmulas de Harris & Benedict, FAO/WHO/UNO somente peso e peso mais altura, Schofield e GER-Nosso foram estatisticamente iguais ao GER medido. As equações do Siervo & Falconi, Schofield e Henry & Rees não foram correlacionadas ao GER medido. O melhor preditor isolado do GER foi a massa corporal e a melhor associação quando ajustado por unidade (kg) foi a massa magra. A equação desenvolvida no presente trabalho foi: GER(kcal/d)= 21837 - 14,448 * Peso(kg) + 54,963 * Massa Magra(kg) - 9,341 * Estatura(cm) - 4,349 * Idade(anos) - 19753 * Densidade Corporal(g/ml). CONCLUSÃO: As equações de predição do GER podem induzir a erros de predição e parecem ser população-específicas. O melhor resultado de predição foi para fórmula desenvolvida com os dados antropométricos das voluntárias (medido= 1617 ± 237 kcal/d; GER-Nosso= 1616 ± 167 kcal/d).
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Bapaye, Amol, Ashish Gandhi, and Jay Bapaye. "Gastroesophageal Reflux after Peroral Endoscopic Myotomy: Myth or Reality?" Journal of Digestive Endoscopy 12, no. 04 (December 2021): 202–13. http://dx.doi.org/10.1055/s-0041-1740489.
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AbstractPeroral endoscopic myotomy (POEM) is an accepted treatment for achalasia cardia (AC), and results are comparable to those of laparoscopic Heller myotomy (LHM). In recent years, several reports have confirmed higher incidence of gastroesophageal reflux (GER) following POEM. This review evaluates the current evidence regarding post-POEM GER, critically examines the potential contributing factors responsible for GER, limitations of the current available functional testing, and precautions and preventive measures, and provides future directions for research. Factors conclusively contributing to increased post-POEM GER include injury to the sling fibers of the lower esophageal sphincter, length of gastric myotomy > 2 cm, and others. Historically, these same factors have been implicated for development of GER after surgical (laparoscopic) myotomy. Although less invasive, optimal technique of POEM may be important to control post-POEM GER. Most post-POEM GER occurs during the immediate post-POEM period, is mild, and is easily treatable using proton-pump inhibitors. GER incidence plateaus at 2 years and is comparable to that after LHM. Patients should therefore be prescribed proton-pump inhibitors for at least 2 years. Antireflux procedures (ARPs) are infrequently required in these patients as the incidence of refractory GER is low. Novel ARPs have been recently described and are currently under evaluation. Conclusive diagnosis of GER is a clinical challenge. Most patients are asymptomatic, and GER is diagnosed only on abnormal esophageal acid exposure (EAE). Studies have demonstrated that current measures to diagnose GER are inadequate, inaccurate, and cannot differentiate between true GER and abnormal EAE due to food fermentation in the distal esophagus. The Lyon Consensus criteria should be implemented for confirmation of diagnosis of GER. Finally, the review recommends an evidence-based clinical algorithm for evaluation and management of post-POEM GER and provides guidelines for future research in this field.
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Said, Mardjanis, Rianita Syamsu, Taralan Tambunan, and Badriul Hegar. "Gastroesophageal reflux in children with chronic recurrent cough." Paediatrica Indonesiana 44, no. 5 (October 10, 2016): 201. http://dx.doi.org/10.14238/pi44.5.2004.201-5.
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Background Gastroesophageal reflux (GER) is reported to beone of the most common causes of chronic recurrent cough (CRC).In Indonesia, so far there is no published data concerning GER inchildren with CRC.Objectives To determine the prevalence of GER in children withCRC in general, and asthma in particular; and to describe the clini-cal profile associated with GER in these children.Methods This was a cross sectional study on children with CRCwho were investigated for GER using 24-hour esophageal pHmonitoring. GER was graded based on reflux index (RI) stated inpHmetry results i.e., mild (RI=5-10%), moderate (RI>10-20%), andsevere (RI>20%).Results Among 48 children with CRC, GER was detected in 22(46%) of them (mild GER in 14, moderate in 3, and severe in 5children). In 35 children with asthma, which is the most frequentcause of CRC in our hospital, GER was detected in 15. The preva-lence of GER increased parallel with the frequency of cough epi-sodes i.e., 10/27 in children with infrequent episodes of cough, 4/10 in children with frequent episodes of cough, and 8/11 in chil-dren with persistent cough. Clinical profiles associated with GERin these children were persistent/ frequent episodes of CRC andundernutrition.Conclusions The prevalence of GER in children with CRC was46%, and in those with asthma was 15/35. The clinical profilesassociated with GER are persistent/frequent episodes of CRCand undernutrition
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Field, Stephen K. "Gastroesophageal Reflux and Asthma: Can the Paradox Be Explained?" Canadian Respiratory Journal 7, no. 2 (2000): 167–76. http://dx.doi.org/10.1155/2000/640501.
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BACKGROUND AND OBJECTIVE:The reported effects of asthma on gastroesophageal reflux (GER), effects of GER on asthma and the effects of antireflux therapy on asthma are conflicting. The purpose of this paper is to review the evidence for a relationship between the two conditions.DESIGN:A search of the MEDLINE 1966 to 1999 database, combining the terms GER and asthma, was used to identify studies of the effects of acid perfusion of the esophagus, the physiological equivalent of GER and the effects of both medical and surgical antireflux therapy on asthma. Bibliographies of the identified papers were also reviewed.MAIN RESULTS:The collected evidence suggests that GER causes asthma symptoms but has minimal effects on pulmonary function. Both medical and surgical antireflux therapy can improve asthma symptoms and asthma medication requirements without improving pulmonary function. The paradox of GER causing symptoms without affecting pulmonary function may be because of the retrosternal discomfort that accompanies GER increases minute ventilation and respiratory sensation.CONCLUSIONS:Despite an extensive body of literature, many questions remain about the relationship between GER and asthma. A review of the data suggests a strong association between the two conditions, and that GER worsens asthma symptoms without affecting pulmonary function. Asymptomatic GER does not worsen asthma. Antireflux therapy may have a role in asthma patients with symptomatic GER, possibly being most beneficial for those with reflux-associated respiratory symptoms. Unfortunately, many studies contain flaws such as a lack of controls and small sample sizes. Further properly designed controlled trials, including ones that measure the effects of GER and antireflux therapy on quality of life, are needed to understand better the role of GER in asthma.
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Wenzl, Tobias G., Olaf Stoltenburg, Jiri Silny, and Heino Skopnik. "Gastroesophageal Reflux and Body Movement in Infants: Investigations with Combined Impedance-pH and Synchronized Video Recording." Gastroenterology Research and Practice 2011 (2011): 1–3. http://dx.doi.org/10.1155/2011/271404.
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The aim of this paper was to investigate the temporal association of gastroesophageal reflux (GER) and body movement in infants. GER were registered by combined impedance-pH, documentation of body movement was done by video. Videorecording time (Vt) was divided into “resting time” and “movement time” and analyzed for occurrence of GER. Association was defined as movement 1 minute before/after the beginning of a GER. Statistical evaluation was by Fisher's exact test. In 15 infants, 341 GER were documented during Vt (86 hours). 336 GER (99%) were associated with movement, only 5 episodes (1%) occured during resting time. Movement was significantly associated with the occurrence of GER (). There is a strong temporal association between GER and body movement in infants. However, a clear distinction between cause and effect could not be made with the chosen study design. Combined impedance-pH has proven to be the ideal technique for this approach.
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Sakae, Thiago Mamoru, Marcia Margaret Menezes Pizzichini, Paulo Jose Zimermann Teixeira, Rosemeri Maurici da Silva, Daisson Jose Trevisol, and Emilio Pizzichini. "Exacerbations of COPD and symptoms of gastroesophageal reflux: a systematic review and meta-analysis." Jornal Brasileiro de Pneumologia 39, no. 3 (June 2013): 259–71. http://dx.doi.org/10.1590/s1806-37132013000300002.
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OBJECTIVE: To examine the relationship between gastroesophageal reflux (GER) and COPD exacerbations. METHODS: We conducted a systematic search of various electronic databases for articles published up through December of 2012. Studies considered eligible for inclusion were those dealing with COPD, COPD exacerbations, and GER; comparing at least two groups (COPD vs. controls or GER vs. controls); and describing relative risks (RRs) and prevalence ratios-or ORs and their respective 95% CIs (or presenting enough data to allow further calculations) for the association between GER and COPD-as well as exacerbation rates. Using a standardized form, we extracted data related to the study design; criteria for GER diagnosis; age, gender, and number of participants; randomization method; severity scores; methods of evaluating GER symptoms; criteria for defining exacerbations; exacerbation rates (hospitalizations, ER visits, unscheduled clinic visits, prednisone use, and antibiotic use); GER symptoms in COPD group vs. controls; mean number of COPD exacerbations (with symptoms vs. without symptoms); annual frequency of exacerbations; GER treatment; and severity of airflow obstruction. RESULTS: Overall, GER was clearly identified as a risk factor for COPD exacerbations (RR = 7.57; 95% CI: 3.84-14.94), with an increased mean number of exacerbations per year (mean difference: 0.79; 95% CI: 0.22-1.36). The prevalence of GER was significantly higher in patients with COPD than in those without (RR = 13.06; 95% CI: 3.64-46.87; p < 0.001). CONCLUSIONS: GER is a risk factor for COPD exacerbations. The role of GER in COPD management should be studied in greater detail.
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Matzdorff, Axel C., Gabriele Arnold, Simone S. Hummler, Kelly M. Grotzinger, and Ruslan V. Horblyuk. "Therapy for Chronic ITP - the Patients' Perspective: US and Germany." Blood 114, no. 22 (November 20, 2009): 4451. http://dx.doi.org/10.1182/blood.v114.22.4451.4451.
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Abstract Abstract 4451 Background Chronic ITP is a rare disorder. Steroids are the usual 1st line therapy. Despite published guidelines there is considerable variation in 2nd and 3rd line therapies. Objective of this study was to compare therapies and patient-perceived treatment effects between the US and a European country (Germany). Methods Members of a US and a German patient support group >18 y with self-reported history of chronic ITP (>6 mo) were surveyed. A questionnaire was developed from literature review with clinician and patient input, and administered on-line. Demographics, patient histories, ITP therapy-related effects and side effects were recorded. Results 712 subjects participated in both surveys (US 589, GER 123). Most were female (US 78%, GER 63%), and diagnosed with ITP for ≥5 years (US 59%, GER 70%). Many subjects had a minimum platelet count under 50.000/μl during the last year (US 68%, GER 66%), dry (US 79%, GER 72%) and wet purpura (US 46%, GER 64%). Corticosteroids were the most frequently reported therapy (USA 92%, GER 86%) followed by IVIg (USA 55%, GER 55%), splenectomy (USA 39%, GER 28%), rituximab (USA 36%, GER 22%, note: GER public health insurance does not reimburse rituximab). Patients experienced steroid treatment as particularly bothersome (both US and GER 90% report weight gain, moon face). For rituximab US patients reported most commonly fatigue, tiredness, weakness (47%), GER patients infusion reactions (55%). For splenectomy US patients reported most commonly scarring (67%), GER patients antibiotic use (38%). 56% of splenectomized GER pts. would not recommend this procedure to other patients. Conclusions Responding patients in the US and GER survey are both heavily pre-treated and report comparable side effects of those treatments. 1st line (steroid) and emergency treatment (IVIg) does not differ while 2nd/3rd line therapies vary. US patients are more likely to receive invasive (splenectomy) or even “off-label” therapies (rituximab) to have a chance of cure, presumably to reduce the financial burden of their disease. GER public health insurance covers all costs (except rituximab) and this might explain why GER patients are more willing to delay or even forego splenectomy. This implies that GER patients might be more inclined to try thrombopoietin receptor agonists before splenectomy. Future studies need to consider the effect of different health care systems on treatment decisions. Disclosures: Matzdorff: GlaxoSmithKline: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; AMGEN: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Roche: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Baxter: Consultancy, Honoraria. Off Label Use: Rituximab for chronic ITP. Hummler:GlaxoSmithKline: Employment. Grotzinger:GlaxoSmithKline: Employment. Horblyuk:GlaxoSmithKline: Employment.
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Newman, Leonard J., J. Russe, Mark S. Glassman, Stuart Berezin, Michael S. Halata, Marvin S. Medow, Allen J. Dozor, and Steven M. Schwarz. "Patterns of Gastroesophageal Reflux (GER) in Patients with Apparent Life‐Threatening Events." Journal of Pediatric Gastroenterology and Nutrition 8, no. 2 (February 1989): 157–60. http://dx.doi.org/10.1002/j.1536-4801.1989.tb09726.x.
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The incidence and temporal patterns of gastroesophageal reflux (GER) in infants presenting with an apparent life‐threatening event (ALTE) was compared with GER characteristics of infants evaluated for persistent emesis, utilizing continuous 24 h intraesophageal pH monitoring. These data indicate that the incidence of significant GER was similar in both groups, despite the absence of a clinical vomiting history in 46% of ALTE patients. Furthermore, infants with ALTE demonstrate a significantly higher incidence of steep reflux when compared with control infants presenting with vomiting alone (27 vs. 0%, p < 0.001). Awake GER beyond the first two postprandial hours was not observed in either study group. Monitoring results, therefore, indicate that significant GER is common in infants with ALTE; and these infants manifest an apparently unique pattern of GER distinct from that observed in age‐matched controls with GER alone. Possible relationships between GER in ALTE patients and the development/onset of apneic episodes are discussed.
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Burton, Deborah Mitchell, Seth M. Pransky, Donald B. Kearns, Richard M. Katz, and Allan B. Seid. "Pediatric Airway Manifestations of Gastroesophageal Reflux." Annals of Otology, Rhinology & Laryngology 101, no. 9 (September 1992): 742–49. http://dx.doi.org/10.1177/000348949210100905.
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Gastroesophageal reflux (GER) in children may be classified as physiologic or pathologic, depending on its degree and consequences. There are many head and neck complications of GER in pediatric patients, but most numerous are the airway manifestations, including stridor, recurrent croup, exacerbation of subglottic stenosis, laryngeal irritation with or without laryngospasm, chronic cough, and obstructive apnea. Diagnosis may be difficult unless there is a high index of suspicion for GER and awareness of the concept of “silent” GER. We present the common pediatric airway manifestations of GER, illustrated by case reports, and provide a paradigm to assist in the diagnosis and management of children with airway compromise associated with GER.
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Mukhaiyar, Utriweni, Ferdy Rontos, Kurnia Handoko, and Salma Kardiyanti. "Analisis Faktor-Faktor yang Memengaruhi Angka Partisipasi Kasar SMA/Sederajat di Indonesia Menggunakan Regresi Ridge." Euler : Jurnal Ilmiah Matematika, Sains dan Teknologi 10, no. 2 (November 13, 2022): 222–34. http://dx.doi.org/10.34312/euler.v10i2.15903.
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One indicator of education in Indonesia is the gross enrollment ratio (GER). Based on data from Statistics Indonesia, the GER at the senior high school level in Indonesia is still low compared to the GER at primary and junior high schools. Summarizing the findings of prior studies, the factors affecting GER include the number of schools, percentage of poor population, education budget, and student-teacher ratio. Therefore, this study aims to examine the variables that affect GER in Indonesian senior high schools. Since multicollinearity between the predictor variables was identified, ridge regression was employed. This study found that the number of senior high schools, the percentage of the poor population, and the education budget simultaneously had a significant effect and contributed 71.39% to the GER at the senior high school level in Indonesia. It is remarkable to observe that, partially, the number of senior high schools, the percentage of poor people, and the education budget had no direct effect on the GER. Additionally, there was a positive correlation between the variables and GER. The number of senior high schools and the education budget have a favorable impact. In contrast, the percentage of poor people has a negative effect on GER. Meanwhile, the student-teacher ratio does not have a linear relationship with the GER at the senior high school level in Indonesia.
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Gallardo-Rodríguez, Adán Germán, Irma Olarte Carrillo, Adolfo Martínez Tovar, Rafael Cerón Maldonado, Humberto Baldemar Castellanos Sinco, and Christian Omar Ramos Peñafiel. "Effect of a Crossover and Resistance Exercise Routine on IL-15 in Adults with Type B Acute Lymphoblastic Leukemia during the Induction Phase. Randomized Pilot Study." Blood 142, Supplement 1 (November 28, 2023): 7377. http://dx.doi.org/10.1182/blood-2023-173054.
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Background: IL-15 is a proinflammatory myokine essential for activating NK cells and CD8+ T lymphocytes, and its overexpression has been associated with decreased survival in patients with Acute Lymphoblastic Leukemia (ALL). Physical exercise has been shown to be safe, feasible, and beneficial in hematological cancers. This requires the activation of muscles that secrete cytokines such as IL-15, causing immune mobilization and accumulating CD8 T cells. The objective was to compare the effect of two exercise strategies on IL-15 and survival prognosis in adult patients diagnosed with de novo ALL. Material and Methods: A blind randomized clinical study was carried out where twenty-three peripheral blood samples were obtained pre- and post-exercise from patients classified into three types of intervention: resistance exercise (GER), crossover exercise (GEC), and control group (GC). Ethical disclosure: All patients gave written informed consent for the study and data collection. This three-arm, prospective, randomized, blinded, open-label pilot study (ratio 1:1:1) was conducted in accordance with the Declaration of Helsinki. Results: The results showed that the changes in IL-15 levels during the intervention were not significant in any of the groups (GC p= 0.237, GER p= 0.866, and GEC p= 0.678). However, 78.26% of patients achieved remission at the end of induction, while only 21.73% experienced a relapse. There were no deaths during the study. Conclusions: Although IL-15 compliance levels in GER and GC were similar, GER patients had a better prognosis. It is suggested that resistance exercises may help improve survival prognosis and reduce early relapses in patients with ALL. Keywords Interleukin-15; exercise; Acute lymphoblastic leukemia; chemotherapy; body composition
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Skopnik, Heino, Jiri Silny, Oliver Heiber, Jürgen Schulz, Günter Rau, and Gerhard Heimann. "Gastroesophageal Reflux in Infants: Evaluation of a New Intraluminal Impedance Technique." Journal of Pediatric Gastroenterology and Nutrition 23, no. 5 (December 1996): 591–98. http://dx.doi.org/10.1002/j.1536-4801.1996.tb00348.x.
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SummaryIn this study, pH metry was simultaneously applied with a new technique, the intraluminal multiple electrical impedance (IMP) procedure, for measuring gastrointestinal motility for gastroesophageal reflux (GER) detection. Seventeen infants with clinical symptoms of GER disease such as recurrent apnea, aspiration pneumonia, wheezing, and failure to thrive were investigated during two feeding periods. A single catheter combining a pH electrode with seven electrodes for impedance measurements over a distance of 8.5 cm was used for the investigation. In all patients, 185 acid episodes were detected by pH metry. In 106 of these 185 acid episodes, a unique pattern in the IMP readings was noted, indicated by a retrograde esophageal volume flow. These episodes were regarded as acid GER episodes. Seventy‐one of the 185 acid episodes occurred during the clearance process of a preceding acid GER characterized by typical IMP readings of an anterograde bolus transport. Eight of 185 acid episodes were missed in the IMP readings for technical reasons. The IMP pattern described as characteristic for a GER was observed in 490 other episodes not detected by pH metry. More than 75% of all GER detected by IMP reached the pharyngeal space; 73% of all GER occurred during feeding and the first 2 postprandial hours and 27% occurred during the remaining time until the next feeding. Even during the latter period, 34% of GER were detected by IMP only; they were missed by pH metry. Volume clearance indicated by IMP was always completed earlier than acidity clearance. The results show that IMP technique facilitates the detection of all GER, whereas pH metry is confined to the measurement of acid GER. Therefore, this technique might improve the evaluation of GER disease and detection of GER in conditions with gastric hypoacidity.
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Ha, Jane, Raaj S. Mehta, Yin Cao, Tianyi Huang, Kyle Staller, and Andrew T. Chan. "Assessment of Gastroesophageal Reflux Symptoms and Sleep Quality Among Women in the Nurses’ Health Study II." JAMA Network Open 6, no. 7 (July 19, 2023): e2324240. http://dx.doi.org/10.1001/jamanetworkopen.2023.24240.
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ImportanceLimited data exist on the association of gastroesophageal reflux (GER) symptoms with sleep quality.ObjectiveTo prospectively investigate the association between GER symptoms and sleep quality.Design, Setting, and ParticipantsThis prospective cohort study included data from the Nurses’ Health Study II of female nurses in the US. Participants self-reported the frequency and duration of GER symptoms beginning June 2005, with updates every 4 years through June 2015. Follow-up was completed June 2019, and data were analyzed from November 15, 2022, to June 4, 2023.ExposuresFrequency and duration of GER symptoms.Main Outcomes and MeasuresPoor sleep quality was assessed in 2017 through a modified Pittsburgh Sleep Quality Index, which included difficulty in falling asleep, restlessness of sleep, daytime sleepiness, sleep disturbance, and sleep duration. Relative risk (RR) for poor sleep quality and individual components of poor sleep quality was estimated according to the frequency and duration of GER symptoms.ResultsAmong 48 536 women (median age, 59 years [range, 48-69 years]), 7929 (16.3%) developed poor sleep quality during 4 years of follow-up. Compared with those with GER symptoms less than once a month, the multivariable RR for poor sleep quality among women with GER symptoms more than once a week was 1.53 (95% CI, 1.45-1.62). Women who had GER symptoms once or more a week for more than 7 years had an RR of 1.36 (95% CI, 1.30-1.43) compared with women who had not had GER symptoms once or more a week. The frequency and duration of GER symptoms were significantly associated with each individual component of poor sleep quality; for example, the multivariable RRs for GER symptoms 2 or more times per week compared with no GER symptoms were 1.49 (95% CI, 1.39-1.58) for difficulty in falling asleep, 1.47 (95% CI, 1.39-1.56) for excessive daytime sleepiness, and 1.44 (95% CI, 1.36-1.53) for restlessness of sleep.Conclusions and RelevanceIn this prospective cohort study of female nurses in the Nurses’ Health Study II, the frequency and duration of GER symptoms were associated with subsequent risk of poor sleep quality. The findings suggest that effective treatment of GER disease may be important not only for improvement of symptoms but also for the reduction of comorbidities associated with poor sleep quality.
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Ramadhan, Reka, Asep Solih Awalluddin, and Rini Cahyandari. "Multivariable Panel Data Cluster Analysis using Ward Method Gross Enrollment Ratio (GER) Data in West Java in the Year 2015-2018." Proceeding International Conference on Science and Engineering 3 (April 30, 2020): 291–96. http://dx.doi.org/10.14421/icse.v3.515.
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The aim of this study is to determine cluster analysis for panel data with multivariable data structures. Choosing a Ward method Choosing a method in a cluster analysis hierarchical technique. Ward method is a method based on Sum Square Error (SSE) with a measure of homogeneity between two objects based on the minimum number of error squares. The measure of similarity used is the Euclidean distance squared. The Ward method is used to add variation between objects in one cluster and maximize variation with objects in another cluster. The steps of the analysis are described in the discussion of this study. The method of implementation uses education gross enrollment rate (GER) data in West Java Province in 2015-2018. The results of the study indicate that the grouping of education GER data in West Java in 2015-2018 using the Ward method produces four clusters. The first cluster consists of five regions, GER for Elementary school, junior and senior high school in the cluster are below the average APK in West Java. The second cluster consists of two regions, in contrast to the first cluster GER for elementary schools in this cluster according to the average GER in West Java but for junior and senior high school GER below the average GER in West Java. The third cluster consists of seven regions, the GER for elementary, junior and senior high schools in this cluster is above the average GER in West Java while the fourth cluster consists of five regions, the GER for elementary and junior high schools in this area is above the average GER in West Java.
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Bashirov, R. A., L. E. Samoilenko, S. A. Ryzhkin, K. F. Vartanyan, D. A. Gimaletdinova, A. F. Yusupova, D. I. Abdulganieva, et al. "Radionuclide Diagnosis of Esophageal Dysmotility and Gastroesophageal Reflux in Patients with Systemic Sclerosis." Journal of radiology and nuclear medicine 104, no. 2 (August 7, 2023): 124–37. http://dx.doi.org/10.20862/0042-4676-2023-104-2-124-137.
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Objective: to evaluate the possibilities of dynamic scintigraphy for the diagnosis of esophageal dysmotility (ED) and gastroesophageal reflux (GER) in patients with systemic sclerosis (SS).Material and methods. The study group included 77 patients with established SS of different disease duration (from several months to 30 years) who underwent Technephyt 99mTc dynamic esophageal scintigraphy using two-stage protocol. During the first stage, the esophageal transport function was evaluated; during the second stage, the presence and severity of GER were assessed. Scans were analyzed using visual assessment, quantitative estimation of time/activity curves, and a proposed three-point scale for evaluating ED and GER severity. The control group consisted of 19 practically healthy individuals who underwent a routine examination to exclude digestive system and gastrointestinal tract diseases, the algorithm of which included dynamic scintigraphy.Results. ED was found in 74 of 77 patients (96%). According to three-point scale, severe ED (3 points) was registrated in 41 (55%) patients, moderate ED (2 points) in 15 (21%), and mild ED in 18 (24%). GER was diagnosed in 35 of 77 cases (45%): mild GER in 13 (37%), moderate GER (2 points) in 22 (63%), and none of the patients was found to have severe GER (3 points). A significant relationship between the presence of GER and the severity of ED was not obtained, but a direct correlation was established between ED and GER severity.Conclusion. Most SS patients demonstrated ED of varying severity associated with mild and moderate GER in nearly 45% of the cases. The study results confirm the practical significance of dynamic scintigraphy for assessing the esophageal transport function and GER in SS patients.
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International Labour Law Reports, Editors. "Ger. 1 GERMANY." International Labour Law Reports Online 23, no. 1 (2002): 111–20. http://dx.doi.org/10.1163/221160203x00120.
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International Labour Law Reports, Editors. "Ger. 2 GERMANY." International Labour Law Reports Online 24, no. 1 (2003): 251–61. http://dx.doi.org/10.1163/221160204x00273.
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International Labour Law Reports, Editors. "Ger. 1 GERMANY." International Labour Law Reports Online 24, no. 1 (2003): 325–32. http://dx.doi.org/10.1163/221160204x00354.
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International Labour Law Reports, Editors. "Ger. 1 GERMANY." International Labour Law Reports Online 25, no. 1 (2004): 49–64. http://dx.doi.org/10.1163/221160205x00056.
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Nikfarjam, Jeremy S., Frank Lalezarzadeh, and Joseph S. Shin. "Ralph Ger, MD." Annals of Plastic Surgery 74, no. 1 (January 2015): 3–5. http://dx.doi.org/10.1097/sap.0000000000000207.
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Launay, V., F. Gottrand, D. Turck, L. Michaud, S. Ategbo, and J. P. Farriaux. "Percutaneous Endoscopic Gastrostomy in Children: Influence on Gastroesophageal Reflux." Pediatrics 97, no. 5 (May 1, 1996): 726–28. http://dx.doi.org/10.1542/peds.97.5.726.
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Objective. Few data exist in the literature about the relationship between percutaneous endoscopic gastrostomy (PEG) and gastroesophageal reflux (GER) in children, and the data that do exist are contradictory. The aim of the present study was to evaluate the effect of PEG on GER. Methods. Twenty children underwent PEG for enteral nutrition. They were 55 ± 55 months old and weighed 13 ± 10 kg. A pH study was performed before and after PEG without treatment when GER status was unknown (n = 10) or under treatment (n = 10) if previous GER was demonstrated. In these cases, the pH study was performed under the same treatment before and after PEG. Results. Six pH studies had abnormal results before PEG. After PEG, the GER of these 6 children significantly improved after the treatment was intensified (n = 5) or spontaneously normalized (n = 1). Results of 13 pH studies that were previously normal remained normal. Only one child with a normal reflux index before PEG had GER after it. For the 20 children, the mean reflux index did not change significantly after PEG (5.5% vs 5.6%). Conclusion. Contrary to surgical gastrostomy, PEG does not worsen GER. Therefore, GER is not a contraindication to PEG.
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Emilsson, Össur Ingi, Þórarinn Gíslason, Anna-Carin Olin, Christer Janson, and Ísleifur Ólafsson. "Biomarkers for Gastroesophageal Reflux in Respiratory Diseases." Gastroenterology Research and Practice 2013 (2013): 1–9. http://dx.doi.org/10.1155/2013/148086.
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Gastroesophageal reflux (GER) is commonly associated with respiratory symptoms, either through a vagal bronchoconstrictive reflex or through microaspiration of gastric contents. No diagnostic test is available, however, to diagnose when respiratory illnesses are caused by GER and when not, but research in this field has been moving forward. Various biomarkers in different types of biosamples have been studied in this context. The aim of this review is to summarize the present knowledge in this field. GER patients with respiratory diseases seem to have a different biochemical profile from similar patients without GER. Inflammatory biomarkers differ in asthmatics based on GER status, tachykinins are elevated in patients with GER-related cough, and bile acids are elevated in lung transplant patients with GER. However, studies on these biomarkers are often limited by their small size, methods of analysis, and case selections. The two pathogenesis mechanisms are associated with different respiratory illnesses and biochemical profiles. A reliable test to identify GER-induced respiratory disorders needs to be developed. Bronchoalveolar lavage is too invasive to be of use in most patients. Exhaled breath condensate samples need further evaluation and standardization. The newly developed particles in exhaled air measurements remain to be studied further.
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Waring, J. Patrick, Michael J. Feiler, John G. Hunter, C. Daniel Smith, and Benjamin D. Gold. "Childhood Gastroesophageal Reflux Symptoms in Adult Patients." Journal of Pediatric Gastroenterology and Nutrition 35, no. 3 (September 2002): 334–38. http://dx.doi.org/10.1002/j.1536-4801.2002.tb07830.x.
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ABSTRACTObjectivesGastroesophageal reflux (GER) and its esophageal (esophagitis, Barrett's esophagus) and extraesophageal (asthma, laryngeal disease) disease manifestations (GERD) are increasing common problems in children and adults. There are virtually no published longitudinal outcome studies that describe the natural history of childhood‐onset GER throughout a person's lifetime. The aim of this study was to compare the frequency of recalled childhood reflux symptoms in adult patients currently with and without GER symptoms.MethodsFour hundred adult patients were classified as refluxers (225 patients; 57%), nonrefluxers (154 patients; 38%), and those who claimed to not know if they had reflux (21 patients; 5%; excluded from analysis). Subjects were given a questionnaire asking them to recall childhood symptoms attributed to GER. Of the 225 refluxers, 141 (63%) recalled at least one childhood symptom, compared with 54 of the 154 nonrefluxers (35%) (P < 0.001).ConclusionsAdult refluxers were more likely to recall having developed GER symptoms at an earlier age, beginning at infancy and developing statistically significant GER compared with nonrefluxers after age 11. Adults suffering from GER were far more likely than nonrefluxers to recall having experienced GER symptoms during childhood. Well‐designed, population‐based epidemiologic studies are needed to more accurately assess the extent of GER in the overall population and the extent of its impact on health care in the United States.
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Sacré, Liliane, and Yvan Vandenplas. "Gastroesophageal Reflux Associated with Respiratory Abnormalities During Sleep." Journal of Pediatric Gastroenterology and Nutrition 9, no. 1 (July 1989): 28–33. http://dx.doi.org/10.1002/j.1536-4801.1989.tb09816.x.
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Summary:To determine whether gastroesophageal reflux (GER) might be a factor in the pathogenesis of apnea in certain infants, we analyzed the frequency of prolonged central apnea (>15 s) and of numerous irregularly repeated short apneas (5‐15 s) (“respiratory dysfunction”) in infants with an apparent life‐threatening event (ALTE) (group 1, n = 62), in control infants (group 2, n = 387), and in infants with GER pathologic findings (group 3, n = 60). Finally, the incidence of GER was analyzed in 76 infants with a respiratory dysfunction during sleep (group 4). Gastroesophageal reflux was investigated using 24‐h esophageal pH monitoring; respiration during sleep was investigated by polysomnography. The pH monitoring data and results of sleep investigation were analyzed in a double‐blind study. A great number of infants who had an ALTE appeared to suffer from GER (42%, 26 of 62 infants), especially if the ALTE occurred while the infant was awake (52%, 14 of 27 infants). In the control infants, pH monitoring data were abnormal in 8.5%; respiratory dysfunction was observed in 5%. In those with a respiratory dysfunction, GER was detected in 75% (15 of 20 infants). In those with GER, respiratory dysfunction was observed in 45% (15 of 33 infants). In groups 3 and 4, respiratory dysfunction was associated with abnormal pH data in 40‐43%. If, in the infants with a respiratory dysfunction, the GER pathologic symptoms were treated efficiently (normalization of pH data), respiratory dysfunction disappeared in 92%. If GER was resistant to therapy, respiratory dysfunction persisted in 81% (13 of 16 infants). Results failed to show any causal relationship between prolonged apnea and GER. We conclude that GER in infancy is often associated with a typical breathing pattern during sleep characterized by multiple irregularly repeated short apneas. The recognition of this breathing pattern in (control) infants screened for risk of sudden infant death syndrome should result in GER investigations. We recommend studying GER in all infants with an ALTE.
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Schurr, Patti, and Carla K. Findlater. "Neonatal Mythbusters: Evaluating the Evidence For and Against Pharmacologic and Nonpharmacologic Management of Gastroesophageal Reflux." Neonatal Network 31, no. 4 (2012): 229–41. http://dx.doi.org/10.1891/0730-0832.31.4.229.
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Gastroesophageal reflux (GER) is a challenging clinical entity that has often been associated with a number of negative clinical outcomes. The treatment of this condition lacks evidence and is often based on anecdotal beliefs and myths. This article will define GER and review the recommendations for the diagnosis of GER as well as review the evidence for both pharmacologic and nonpharmacologic treatment of GER.
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Akohoue, Félicien, David Sewordor Gaikpa, Bettina Kessel, Thomas Presterl, and Thomas Miedaner. "Variance Components and Correlations between Doubled Haploid Lines from Two European Flint Landraces and Their Corresponding Testcrosses for Gibberella Ear Rot Resistance, Silking Time, and Plant Height in Maize." Agronomy 11, no. 6 (May 22, 2021): 1039. http://dx.doi.org/10.3390/agronomy11061039.
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Predicting the resistance of hybrids from lines is a relevant approach for accelerating the improvement of disease resistance in hybrid breeding. In this study, genetic variation and covariation among 76 DH lines from two flint landraces, Kemater (KE) and Petkuser (PE), and their corresponding testcrosses (TC) were estimated for the first time for this material for Gibberella ear rot (GER), days to silking (DS), and plant height (PHT). Lines and TC were evaluated in four and two environments, respectively, under artificial infection with GER. TC were, on average, 42% less GER infected than their lines. TC matured 3–4 days earlier and were about 110 cm taller than the lines. GER resistance was 10% higher in KE lines and TC than PE lines and TC. Significant (p < 0.001) genotypic and genotype-by-environment interaction variances were found for all traits. Genotypic variances were generally smaller among TC than lines. Broad-sense heritability estimates were moderate to high for GER severity (0.56–0.82) and high for DS (0.78–0.88) and PHT (0.86–0.94) with higher values always observed in lines. Significant, moderate correlations between TC and line per se performance were found for GER resistance in both KE and PE (r = 0.37 and 0.55, respectively). For the two agronomic traits, correlations were higher (r = 0.59–0.76) than for GER resistance. Genomic prediction accuracies were moderate to high for GER resistance (r = 0.49–0.63) and generally higher for DS and PHT. In conclusion, a pre-selection of DH lines for GER resistance should be feasible; however, TC should be additionally tested on a later selection stage to aim for GER-resistant hybrid cultivars.
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Kumbhari, Vivek, Pietro Familiari, Niels Bjerregaard, Mathieu Pioche, Edward Jones, Weon Ko, Bu Hayee, et al. "Gastroesophageal reflux after peroral endoscopic myotomy: a multicenter case–control study." Endoscopy 49, no. 07 (May 4, 2017): 634–42. http://dx.doi.org/10.1055/s-0043-105485.
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Abstract Background and study aims The variables associated with gastroesophageal reflux (GER) after peroral endoscopic myotomy (POEM) are largely unknown. This study aimed to: 1) identify the prevalence of reflux esophagitis and asymptomatic GER in patients who underwent POEM, and 2) evaluate patient and intraprocedural variables associated with post-POEM GER. Patients and methods All patients who underwent POEM and subsequent objective testing for GER (pH study with or without upper gastrointestinal [GI] endoscopy) at seven tertiary academic centers (one Asian, two US, four European) were included. Patients were divided into two groups: 1) DeMeester score ≥ 14.72 (cases) and 2) DeMeester score of < 14.72 (controls). Asymptomatic GER was defined as a patient with a DeMeester score ≥ 14.72 who was not consuming proton pump inhibitor (PPI). Results A total of 282 patients (female 48.2 %, Caucasian 84.8 %; mean body mass index 24.1 kg/m2) were included. Clinical success was achieved in 94.3 % of patients. GER evaluation was completed after a median follow-up of 12 months (interquartile range 10 – 24 months). A DeMeester score of ≥ 14.72 was seen in 57.8 % of patients. Multivariable analysis revealed female sex to be the only independent association (odds ratio 1.69, 95 % confidence interval 1.04 – 2.74) with post-POEM GER. No intraprocedural variables were associated with GER. Upper GI endoscopy was available in 233 patients, 54 (23.2 %) of whom were noted to have reflux esophagitis (majority Los Angeles Grade A or B). GER was asymptomatic in 60.1 %. Conclusion Post-POEM GER was seen in the majority of patients. No intraprocedural variables were identified to allow for potential alteration in procedural technique.
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Mitra, Debjani, and Tushar K. Ghara. "Gross Enrolment Ratio in Higher Education: A District Level Analysis of the State of West Bengal." Asian Review of Social Sciences 8, no. 3 (November 5, 2019): 37–41. http://dx.doi.org/10.51983/arss-2019.8.3.1600.
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Gross Enrolment Ratio (GER) is the number of students enrolled in a given level of education, expressed as a percentage of the official age group of the population corresponding to the same level of education. In the state of West Bengal, GER in higher education for the age group 18 -23 years is 18.7%, which is far below the national average of 25.8% for 2017-2018. There is a large variation in GER across different districts and among male and female. An effort has been made through this paper to study the spatio temporal variation in GER among the districts of West Bengal. To study the gender disparity in GER in the districts of West Bengal Gender Parity Index (GPI) is calculated. Among the districts of West Bengal, Kolkata has recorded highest GER in higher education in all the years and Uttar Dinajpur has recorded the lowest GER throughout the years (2012 to 2018). GPI in gross enrolment in greater than unity in 14 out of 19 districts of the state.
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Khalaf, M. Nabeel, Rachel Porat, Nancy L. Brodsky, and Vineet Bhandari. "Clinical Correlations in Infants in the Neonatal Intensive Care Unit With Varying Severity of Gastroesophageal Reflux." Journal of Pediatric Gastroenterology and Nutrition 32, no. 1 (January 2001): 45–49. http://dx.doi.org/10.1002/j.1536-4801.2001.tb07205.x.
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ABSTRACTBackgroundGastroesophageal reflux (GER) is frequently a benign condition in infancy with spontaneous resolution. In the neonatal intensive care unit (NICU), however, it can add to neonatal morbidity if not adequately diagnosed and treated. The objective of the current study was to analyze factors associated with GER in infants in the NICU and correlate them with the severity of the disease.MethodsAll infants in the NICU (n = 150; born November 1994 through April 1999) who were evaluated by a five‐channel pH study to rule out GER were included in the study. Infants were grouped as normal, with a reflux index (RI) of less than 6 (n = 66); mild, with RI of 6 to 14 (n = 42); and severe, with RI of more than 14 (n = 42). Maternal and neonatal data were obtained. Clinical GER was defined as the presence of feeding problems (significant gastric residue or emesis) and medical improvement with antireflux measures and medications.ResultsThere was no difference in birth weight, gestational age; incidence of patent ductus arteriosus, intraventricular hemorrhage, necrotizing enterocolitis, or chronic lung disease; and treatment with aminophylline or caffeine among the groups. Infants with mild and severe GER (RI 6–14 and >14) had significantly more clinical GER than the normal group (P = 0.0001). Additionally, infants with RI more than 14 had significantly more respiratory distress syndrome, lower hematocrits at the time of study and longer length of stay than those with no or mild GER (P = 0.02).ConclusionInfants with severe GER had lower hematocrits despite receiving more blood transfusions and iron therapy. Infants with severe GER also had prolonged hospital stays. Early diagnosis and aggressive management of GER may decrease neonatal morbidity and result in earlier discharge from the NICU.
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Parameswaran, Krishnan, Christopher J. Allen, Dennis Kamada, Ann Efthimiadis, Mehran Anvari, and Frederick E. Hargreave. "Sputum Cell Counts and Exhaled Nitric Oxide in Patients with Gastroesophageal Reflux, and Cough or Asthma." Canadian Respiratory Journal 8, no. 4 (2001): 239–44. http://dx.doi.org/10.1155/2001/418490.
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BACKGROUND: Gastroesophageal reflux (GER) is commonly associated with chronic cough and asthma, but there is little or no information on the nature of any associated airway inflammation.OBJECTIVE: To observe whether the association with GER worsens airway inflammation in patients with chronic cough or asthma.PATIENTS AND METHODS: The airway inflammatory indexes in induced sputum and exhaled air were examined in a cross-sectional study of 11 patients with cough and GER, nine patients with mildly symptomatic asthma and GER, nine patients with mildly symptomatic asthma without GER and nine normal, healthy control subjects. GER was shown objectively by 24 h ambulatory pH recording.RESULTS: The sputum total cell count, the proportion of neutrophils and macrophages, and the fibrinogen level were normal in all four groups, with no significant differences among the groups. The sputum eosinophil and metachromatic cell percentages, and eosinophil cationic protein levels were normal in patients with cough and GER. They were significantly increased in patients with asthma compared with healthy subjects (P<0.01) and patients with cough (P<0.01), but were not different between groups with and without GER. Exhaled nitric oxide levels showed similar results (P<0.01). The correlations between the number of episodes of reflux and the proportion of sputum eosinophils, neutrophils or exhaled nitric oxide were modest but not significant.CONCLUSIONS: GER, when associated with cough or mildly symptomatic asthma, does not cause or aggravate existing airway inflammation as measured by induced sputum cell counts and fibrinogen level, or by exhaled nitric oxide.
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Givens Bell,, Susan. "Gastroesophageal Reflux and Histamine2 Antagonists." Neonatal Network 22, no. 2 (January 2003): 53–57. http://dx.doi.org/10.1891/0730-0832.22.2.53.
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GASTROESOPHAGEAL REFLUX (GER) IS THE RETROGRADE movement of the stomach contents into the esophagus, frequently caused by relaxation of the lower esophageal sphincter (LES). The pathophysiology of GER in neonates is not clear. However, many risk factors have been defined (Table 1).1Several developmental factors may influence the incidence of GER in neonates. Jadcherla suggests abdominal wall muscle tone, diaphragmatic activity, esophageal dysmotility, and LES tone as possible reasons for the prevelance of GER in the neonatal population.
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Lerin, Lindomar Alberto, Giada Botti, Alessandro Dalpiaz, Anna Bianchi, Luca Ferraro, Chaimae Chaibi, Federico Zappaterra, Domenico Meola, Pier Paolo Giovannini, and Barbara Pavan. "Characterization and Hydrolysis Studies of a Prodrug Obtained as Ester Conjugate of Geraniol and Ferulic Acid by Enzymatic Way." International Journal of Molecular Sciences 25, no. 11 (June 6, 2024): 6263. http://dx.doi.org/10.3390/ijms25116263.
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Ferulic acid (Fer) and geraniol (Ger) are natural compounds whose antioxidant and anti-inflammatory activity confer beneficial properties, such as antibacterial, anticancer, and neuroprotective effects. However, the short half-lives of these compounds impair their therapeutic activities after conventional administration. We propose, therefore, a new prodrug (Fer-Ger) obtained by a bio-catalyzed ester conjugation of Fer and Ger to enhance the loading of solid lipid microparticles (SLMs) designed as Fer-Ger delivery and targeting systems. SLMs were obtained by hot emulsion techniques without organic solvents. HPLC-UV analysis evidenced that Fer-Ger is hydrolyzed in human or rat whole blood and rat liver homogenates, with half-lives of 193.64 ± 20.93, 20.15 ± 0.75, and 3.94 ± 0.33 min, respectively, but not in rat brain homogenates. Studies on neuronal-differentiated mouse neuroblastoma N2a cells incubated with the reactive oxygen species (ROS) inductor H2O2 evidenced the Fer-Ger ability to prevent oxidative injury, despite the fact that it appears ROS-promoting. The amounts of Fer-Ger encapsulated in tristearin SLMs, obtained in the absence or presence of glucose, were 1.5 ± 0.1%, allowing the control of the prodrug release (glucose absence) or to sensibly enhance its water dissolution rate (glucose presence). These new “green” carriers can potentially prolong the beneficial effects of Fer and Ger or induce neuroprotection as nasal formulations.
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Shaver, Stephanie L., Laura A. Barbur, David A. Jimenez, Benjamin M. Brainard, Karen K. Cornell, MaryAnn G. Radlinsky, and Chad W. Schmiedt. "Evaluation of Gastroesophageal Reflux in Anesthetized Dogs with Brachycephalic Syndrome." Journal of the American Animal Hospital Association 53, no. 1 (January 1, 2017): 24–31. http://dx.doi.org/10.5326/jaaha-ms-6281.
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ABSTRACT Brachycephalic airway syndrome may predispose to gastroesophageal reflux (GER) because of the high negative intrathoracic pressures required to overcome conformational partial upper airway obstruction. To investigate this, 20 dogs presenting for elective correction of brachycephalic airway syndrome (cases) and 20 non-brachycephalic dogs (controls) undergoing other elective surgeries were prospectively enrolled. Dogs underwent a standardized anesthetic protocol, and esophageal pH was monitored. Signalment, body weight, historical gastrointestinal and respiratory disease, complete blood count, serum biochemical values, radiographic findings, and anesthetic and surgical time were compared between cases and controls, and dogs that did and did not have basic (pH > 7.5), acidic (pH < 4), or any GER. Controls had higher mean esophageal pH (6.3) compared to cases (5.6, P = .019), but there was no difference in % with GER (cases 60%, controls 40%, P = .34). When all dogs were evaluated, dogs with GER had increased creatinine (P = .01), % positive for esophageal fluid on radiographs (P = .05), and body weight (P = .04) compared to those without GER. GER was common in both cases and controls, and cases had lower esophageal pH; however, greater numbers are required to determine if a true difference exists in % GER.
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Bashashati, Mohammad, Reza A. Hejazi, Christopher N. Andrews, and Martin A. Storr. "Gastroesophageal Reflux Symptoms not Responding to Proton Pump Inhibitor: GERD, NERD, NARD, Esophageal Hypersensitivity or Dyspepsia?" Canadian Journal of Gastroenterology and Hepatology 28, no. 6 (2014): 335–41. http://dx.doi.org/10.1155/2014/904707.
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Gastroesophageal reflux (GER) is a common gastrointestinal process that can generate symptoms of heartburn and chest pain. Proton pump inhibitors (PPIs) are the gold standard for the treatment of GER; however, a substantial group of GER patients fail to respond to PPIs. In the past, it was believed that acid reflux into the esophagus causes all, or at least the majority, of symptoms attributed to GER, with both erosive esophagitis and nonerosive outcomes. However, with modern testing techniques it has been shown that, in addition to acid reflux, the reflux of nonacid gastric and duodenal contents into the esophagus may also induce GER symptoms. It remains unknown how weakly acidic or alkaline refluxate with a pH similar to a normal diet induces GER symptoms. Esophageal hypersensitivity or functional dyspepsia with superimposed heartburn may be other mechanisms of symptom generation, often completely unrelated to GER. Detailed studies investigating the pathophysiology of esophageal hypersensitivity are not conclusive, and definitions of the various disease states may overlap and are often confusing. The authors aim to clarify the pathophysiology, definition, diagnostic techniques and medical treatment of patients with heartburn symptoms who fail PPI therapy.
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Murray, Robert, William P. Bartoli, Dennis E. Eddy, and Mary K. Horn. "Gastric Emptying and Plasma Deuterium Accumulation Following Ingestion of Water and Two Carbohydrate-Electrolyte Beverages." International Journal of Sport Nutrition 7, no. 2 (June 1997): 144–53. http://dx.doi.org/10.1123/ijsn.7.2.144.
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The purpose of this study was to compare the gastric emptying rates (GER) of water, a 6% carbohydrate (CHO) beverage, and a 20% CHO beverage and to contrast those rates against the rate at which deuterium oxide in the drinks accumulated in plasma (DAR) following beverage ingestion. Ten subjects (8 males, 2 females) cycled at 60% for 70 min; at 13 min, the subjects ingested 400 ml of one of the beverages. The GER and DAR of water and 6% CHO were similar, while GER and DAR were both significantly slowed by ingestion of 20% CHO. Although there was a significant correlation (r = .63, p < .05) between GER and DAR, only 40% of the variation in DAR could be accounted for by variation in GER. These data support the contention that DAR is partially determined by GER, with differences in the rate of fluid absorption across the intestine and other factors accounting for the remaining variation in DAR.
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Koivusalo, Antti I., Mikko P. Pakarinen, Anne Wikström, and Risto J. Rintala. "Assessment and Treatment of Gastroesophageal Reflux in Healthy Infants With Apneic Episodes." Clinical Pediatrics 50, no. 12 (October 12, 2011): 1096–102. http://dx.doi.org/10.1177/0009922811410872.
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This retrospective study sought to assess whether gastroesophageal reflux (GER) is associated with recurrent infant apneic episodes (AEs) and whether its treatment prevents AEs. Symptoms, diagnostic measures, and treatment of GER in 87 infants admitted for AEs were recorded. The effect of GER on recurrent AEs and survival were assessed. Esophageal pH monitoring was done to 58/87 (67%) patients, of whom 53/58 (91%) had a pathological finding; 48 patients had treatment for GER (medical 43%/49%; surgical 5%/6%) with continuing AEs during hospitalization (25%/29% patients) as the main indication. Follow-up (65 patients) disclosed recurrent AEs in 12 (18%) patients (no treatment 4/21, medical 8/39, surgical 0/5, P = NS). All 87 patients survived. Recurrent AEs after discharge was predicted by AEs during hospitalization but not by pathological GER. AEs observed during hospitalization predicted postdischarge AE recurrence. Of GER treatment modalities, only surgery prevented recurrent AEs.
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Tipnis, Neelesh A., Poong-Lyul Rhee, and Ravinder K. Mittal. "Distension during gastroesophageal reflux: effects of acid inhibition and correlation with symptoms." American Journal of Physiology-Gastrointestinal and Liver Physiology 293, no. 2 (August 2007): G469—G474. http://dx.doi.org/10.1152/ajpgi.00019.2007.
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We studied spontaneous gastroesophageal reflux (GER)-induced esophageal distension using ultrasound imaging and its role in the genesis of esophageal symptoms before and during esomeprazole therapy. Ten controls and 10 GER disease (GERD) patients were studied by combined impedance, esophageal pH, manometry, and ultrasonography before and during esomeprazole therapy. Physiological data and symptoms were recorded for 2 h following a standardized meal. From ultrasound images, the esophageal cross-sectional area (CSA) at the peak of GER-induced distension was determined and compared between controls vs. patients, symptomatic vs. asymptomatic GER episodes, and before vs. during esomeprazole in GERD patients. The mean lumen CSA is greater in the patients than controls (271 ± 71 mm2 vs. 163 ± 56 mm2, P = 0.001) but not different among asymptomatic reflux episodes, and those associated with regurgitation (290 ± 110 mm2) or heartburn (271 ± 67 mm2). Eight chest pain episodes associated with reflux revealed a tendency toward larger mean esophageal distension (459 ± 40 mm2) compared with asymptomatic reflux (268 ± 70 mm2, P = 0.058). Following esomeprazole treatment, most GER episodes were nonacidic and asymptomatic except in two patients in whom cyclical reflux was associated with large esophageal distensions. Esomeprazole did not alter the lumen CSA during GER. Esophageal distension is greater in the GERD subjects compared with controls; however, it is unlikely that the GER-induced distension of the esophagus plays a significant role in the genesis of heartburn sensation. Esomeprazole therapy does not alter the GER-induced distension of the esophagus.
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Feiler, Mark J., Benjamin D. Gold, John G. Hunter, C. Daniel Smith, and J. Patrick Waring. "Childhood gastroesophageal reflux(GER) symptoms in adult patients with ger symptoms." Gastroenterology 118, no. 4 (April 2000): A480. http://dx.doi.org/10.1016/s0016-5085(00)84039-1.
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Goseva, Zlatica, Angelko Gjorcev, Elena Jovanovska-Janeva, and Suzana Arbutina. "Gastroesophageal Reflux Symptoms in Patients with Chronic Obstructive Pulmonary Disease." Open Access Macedonian Journal of Medical Sciences 2, no. 3 (September 15, 2014): 461–63. http://dx.doi.org/10.3889/oamjms.2014.080.
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BACKGROUND: It is known that there is some relation between airways obstruction and gastroesophageal reflux symptoms (GER) symptoms in patients with chronic obstructive pulmonary disease (COPD).AIM: The aim was to determine frequency of GER symptoms and correlation with pulmonary function tests in patients with COPD.MATERIAL AND METHODS: The study included 58 patients. First group had 20 patients with mild COPD, second group had 18 patients with moderate COPD and third group had 20 patients with severe COPD. We had also a control group with 12 healthy subjects. All subjects completed their self-reported questionnaire about symptoms like: acid-regurgitation, heartburn, dysphagia, dyspnea and chronic cough.RESULTS: COPD patients with airways obstruction and significant GER symptoms had their respiratory symptoms associated with reflux events. More of COPD patients had significant GER symptoms defined as regurgitation and dysphagia once or more per week. Patients with FEV1 less than 50% showed more prevalent GER symptoms compared to those with values of FEV1 grater then 50%.CONCLUSION: GER symptoms are more prevalent in patients with severe airways obstruction when compared to less airways obstructed group and controls. We could suggest an association between the degree of airways obstruction in patients with COPD and the increased rate of GER symptoms.
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Xu, Hanqi, Jinbo Wu, Yaying Hong, and Weijia Wen. "Impact of molecular chain structure of suspension phase on giant electrorheological performance." Smart Materials and Structures 31, no. 2 (January 20, 2022): 025030. http://dx.doi.org/10.1088/1361-665x/ac4875.
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Abstract We demonstrate the impact of diester structure, in particular the alkyl chain length and branching structure, on the giant electrorheological (GER) effect and suspension stability. The existence of oil–particles interaction is of critical importance to induce the GER effect. To quantify GER performance and colloidal stability, we examine the yield stress, current density, field-off viscosity and sedimentation ratio with respect to the variation of chain length and branching structure. The oil–particles interaction is quantitatively analyzed by investigating the cluster size of particles in different diesters by a multiple light scattering analyzer, along with the wettability of different chain lengths of diesters and solid particles by the Washburn method. Our results indicate that long chain lengths favor the formation of particle agglomerates, thereby enhancing the GER effect (such as high yield stress). The attachment of branches on diester causes the formation of electronic correlation between branches and main chain, depending on the position of branches located, and hence results in superior GER performance and favorable suspension stability. An optimal GER fluid constituted by bis(2-ethylhexyl) sebacate is acquired with the achieved yield stress of 113 kPa at electric field strength of 4 kV mm−1 and the prominent integrated GER properties.
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Hussain, Jamal, David Rosangliana, and Vanlalruata. "Student Gross Enrolment Ratio Forecasting: A Comparative Study Using Statistical Method and Machine Learning." International Journal of Information and Education Technology 13, no. 3 (2023): 439–47. http://dx.doi.org/10.18178/ijiet.2023.13.3.1824.
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Educational data mining has advanced substantially within the past decade. These mining strategies lay out a plan for increasing overall academic enrollment. An increase in student enrolment, in general, would enhance academic performance. Therefore, the student enrollment pattern demands great attention, as it is a vital performance indicator of academic sustainability. In this paper, student enrolment data is pre-processed to obtain the gross enrolment ratio (GER). GER analysis and forecasting were performed using the state of art models Autoregressive Integrated Moving Average (ARIMA) and Long Short-Term Memory (LSTM). The purpose of this study is to analyze and compare student GER (time series data) using ARIMA (statistical methods) and LSTM (machine learning approach), forecast GER using a better method, and propose corrective measures for increasing student enrolment. The comparison results confirmed that LSTM out-performs ARIMA by an average of 0.1322% and 5.6% in both Root Mean Square Error (RMSE) and Accuracy. The predicted GER using LSTM for the academic year 2035 is 34.23% which is far lower than 50% which is targeted by Govt. of India. An in-depth analysis of student enrolment and GER in higher education in Mizoram was done, and corrective measures were proposed for enhancing GER.
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Langer, Jacob C., David E. Wesson, Sigmund H. Ein, Robert M. Filler, Barry Shandling, Riccardo A. Superina, and Moshe Papa. "Feeding Gastrostomy in Neurologically Impaired Children." Journal of Pediatric Gastroenterology and Nutrition 7, no. 6 (November 1988): 837–41. http://dx.doi.org/10.1002/j.1536-4801.1988.tb09651.x.
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SummarySome authors recommend a routine “protective” antireflux procedure (ARP) in neurologically impaired children undergoing feeding gastrostomy (FG). Over 4 years, we performed FG in 107 neurologically impaired children aged 1 month to 16 years. Ninety‐eight had preoperative radiological assessment for gastroesophageal reflux (GER), which was documented in 44, of whom 33 had FG plus ARP and II had FG alone. Seven of the 11 subsequently developed symptomatic GER and 5 of them had a secondary ARP. Of the 54 children with no demonstrable GER preoperatively. 3 children underwent FG plus ARP. The remaining 51 had FG alone. There was one postoperative death. Of the 50 surviving patients. 22 developed symptomatic GER and 17 of these had a subsequent ARP. Mean follow‐up of 20.0 months showed that the risk of developing GER after FG alone was not influenced by age, sex, indication for FG, underlying diagnosis, or method of gastrostomy. There was no significant difference in mortality and early morbidity between patients undergoing FG alone and those having FG with simultaneous or subsequent ARP. Only 44% of our patients in whom GER was not demonstrated initially developed symptomatic GER followed FG alone. This incidence does not justify a routine “protective” ARP.
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Kuriloff, Daniel B., Richard Goldfarb, Paul Chodosh, and Fukiat Ongseng. "Detection of Gastroesophageal Reflux in the Head and Neck: The Role of Scintigraphy." Annals of Otology, Rhinology & Laryngology 98, no. 1 (January 1989): 74–80. http://dx.doi.org/10.1177/000348948909800116.
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Patients with gastroesophageal reflux (GER) present to the head and neck specialist with a myriad of nonspecific complaints that may be manifestations of pharyngoesophageal or upper airway involvement. Numerous diagnostic tests for GER have been used in the past with varying success. In the present study, gastroesophageal scintigraphy using 99 mtechnetium-sulfur colloid was used to evaluate 28 patients with head and neck manifestations of GER. The role of gastroesophageal scintigraphy as an accurate and noninvasive method of detecting GER is discussed in the context of other current diagnostic modalities.
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Daruru, Rangnath, Shanker Mahadevan, and Prashant R. Kokiwar. "Association of gastro esophageal reflex with chronic asthma and its significance: a prospective study." International Journal of Contemporary Pediatrics 4, no. 5 (August 23, 2017): 1833. http://dx.doi.org/10.18203/2349-3291.ijcp20173795.
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Background: Many studies have reported that gastro esophageal reflux is significantly more common in asthmatics than in control populations and this appears to apply particularly in childhood. To study the incidence of gastro esophageal refluxes in children which chronic asthma. To identity the clinical characteristic in children with chronic asthma and GER, which would predict reflux, related asthma?Methods: It is a prospective study of association of GER and chronic asthma using Radio nuclide scintigraphy carried at General pediatric in-patient wards of Niloufer hospital, Hyderabad. A Total of 50 patients with chronic asthma and 15 healthy children were evaluated.Results: Our study showed an incidence of Gastro Esophageal Reflux (GER) in 42% of chronic asthmatic children. High incidence of reflux (47.6%) under 4 years of age. No significance difference in the incidence of GER in children with seasonal verus Non-Seasonal asthma. About 50% of children with GER had no symptoms i.e. they had silent reflux. Nocturnal symptoms were significantly higher in asthmatic children with Ger (54.8%) than asthmatic children without GER (21%). Children with reflux related asthma suffered more morbidity in terms of recurrence of attacks, severity of chronic asthma (moderate persistent) and sleep disturbance as compared to children with no reflux. Presence of atopic signs was significantly higher in patients with asthma without GER.Conclusions: GER should be considered as a potentially important contributing factor in any patient with poorly controlled asthma. The asthmatic patient most likely to experience measurable benefit from anti-reflux therapy is the patients with significant nocturnal asthma and who have symptoms of both asthma and of reflux.
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O'Brien, Cara, Evan Henricks, Angela Beckert, Kathryn Denson, and Edmund Duthie. "An 18-year Experience with an Innovative Geriatrics Training Model: Implications for the Workforce." Innovation in Aging 5, Supplement_1 (December 1, 2021): 757–58. http://dx.doi.org/10.1093/geroni/igab046.2808.
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Abstract Despite the growing population of older adults, the geriatrics workforce has not similarly expanded. The number of geriatrics fellows has declined by 14.3% from 2012-2017. Implementation of innovative training programs may improve this reality. In 2002, the Medical College of Wisconsin (MCW) created the first four-year combined medicine residency and geriatrics fellowship (Med-Ger). Similar programs are currently being developed. The aim of this study is to describe the outcomes of the MCW Med-Ger program. Primary endpoints: American Board of Internal Medicine (ABIM) pass rates, ABIM Geriatric Medicine Certification pass rates, fellowship completion rates, and geriatric-focused practice. Results: There was a Med-Ger program fill rate of 73.7% (n=38). There was equivalent ABIM pass rate of 100% between Med-Ger graduates (n=18) and traditional graduates (n=25). Med-Ger trainees were more likely to complete their geriatrics fellowship (94.4% vs. 88%) and practice in geriatric-focused careers (82.4% vs. 68.2%). These outcomes suggest the benefit of a combined program for training future geriatricians. The MCW Med-Ger fill rate exceeds the national geriatrics fellowship fill rate of under 50%. Additionally, graduates may be more likely to practice geriatric medicine. This may help address population needs for an increased geriatrics workforce. In 2020, the ACGME approved an Advancing Innovation in Residency Education (AIRE) Medicine-Geriatrics Integrated Residency and Fellowship national pilot program. Further investigation of why trainees choose Med-Ger training and are more likely to continue with careers in geriatrics is needed in order to replicate the success of the MCW Med-Ger program.
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Lieu, Judith E. C., P. Ganesh Muthappan, and Ravindra Uppaluri. "Association of Reflux With Otitis Media in Children." Otolaryngology–Head and Neck Surgery 133, no. 3 (September 2005): 357–61. http://dx.doi.org/10.1016/j.otohns.2005.05.654.
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OBJECTIVES: To confirm the finding of pepsin/pepsinogen in middle ear fluid of children with chronic or recurrent otitis media (OME or ROM), and to ask parents about symptoms associated with gastroesophageal reflux (GER). METHODS: Middle ear fluid was collected from children undergoing tympanostomy tube placement. We tested this fluid for pepsin/pepsinogen using a proteolytic enzyme assay and an ELISA. Parents completed questionnaires about symptoms of GER in their children. RESULTS: We collected 36 samples from 22 children; 16 of 22 children (73%) were positive with the proteolytic assay; 17 (77%) were positive with ELISA. Questionnaires did not show increased GER symptoms. CONCLUSIONS: We replicated the finding of pepsin/pepsinogen in middle ear fluid of children with OME or ROM, but did not find any increase in GER symptoms. Further research is needed to establish a causative link between GER and OM.
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Praveen P N, Kushvanth K N, and Ashish Mallige. "A Cross-Sectional Study to Determine the Prevalence of Gastroesophageal Reflux in Children with Persistent Cough and Wheezing." Asian Journal of Clinical Pediatrics and Neonatology 8, no. 4 (December 28, 2020): 36–40. http://dx.doi.org/10.47009/ajcpn.2020.8.4.8.
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Background: Gastroesophageal reflux (GER) occurs in more than two-thirds of otherwise healthy infants and is the topic of discussion with pediatricians at one-quarter of all routine 6-month infant visits. GER is considered a normal physiologic process that occurs several times a day in healthy infants, children, and adults. GER is generally associated with transient relaxations of the lower esophageal sphincter independent of swallowing, which permits gastric contents to enter the esophagus. The Objective to find out the prevalence of GER in children with cough and wheezing and its associated factors. Subjects and Methods: A cross-sectional study was done at A tertiary care hospital at the Institute of Naval Medicine, INHS, Mumbai from August 2016 to December 2017. A total of 30 study subjects Aged between the age of one to twelve years with persistent cough and wheezing lasting for more than three months despite treatment were included for the study. Results: The prevalence of gastroesophageal reflux (GER) in our study was 63.3%.The logistic regression analysis showed that Age, Height, Weight, BMI, duration of cough, Duration of asthma were not significantly associated with Gastroesophageal reflux (GER) (p>0.05). Conclusion: GER seems to have a high prevalence in children with chronic cough. However, no definite recommendations can be made regarding the management of such cases from our study.