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Author: Grafiati

Published: 9 March 2023

Last updated: 10 March 2023

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1

Harrison, S. J. "A Note on Apuleius, Metamorphoses 4.31." Classical Quarterly 41, no. 2 (December 1991): 562–63. http://dx.doi.org/10.1017/s000983880000481x.

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Sic effata et osculis hiantibus filium diu ac pressule saviata proximas oras reflui litoris petit, plantisque roseis vibrantium fluctuum summo rore calcato ecce iam profundi mans sudo resedit vertice, et ipsum quod incipit velle, set statim, quasi pridem praeceperit, non moratur marinum obsequium: adsunt Nerei filiae chorum canentes et Portunus caerulis barbis hispidus et gravis piscoso sinu Salacia et auriga parvulus delphini Palaemon… (Met. 4.31.4ff.)

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2

Bottasso, Anna, and Maurizio Conti. "Economie di integrazione verticale ed economie di scopo nel settore idrico e fognario: alcune considerazioni alla luce dell'evidenza empirica internazionale." ECONOMIA PUBBLICA, no. 3 (November 2021): 89–128. http://dx.doi.org/10.3280/ep2021-003005.

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In questo lavoro vengono affrontati due temi molto rilevanti nel dibattito eco-nomico relativo alla configurazione ottimale dei settori idrico e fognario. In par-ticolare, viene discussa la letteratura empirica internazionale che ha analizzato l'esistenza di possibili economie di scopo derivanti dalla gestione congiunta del servizio idrico al dettaglio e all'ingrosso. A questo proposito, la maggioranza degli studi esaminati tende a identificare l'esistenza di non trascurabili economie di integrazione verticale, soprattutto nel caso di operatori di medie e piccole dimen-sioni. Inoltre, viene passata in rassegna l'evidenza empirica relativa alla presenza di economie di scopo tra il servizio di depurazione e smaltimento delle acque reflue e le parti rimanenti della filiera del Servizio Idrico Integrato. Da questi lavori sembra di poter concludere che esistano di economie di scopo tra (alcune delle) componenti della filiera idrica e fognaria per imprese di dimensioni medio-piccole. In particolare, tali economie sarebbero presenti nei segmenti dove è più semplice condividere taluni fattori produttivi, oltre alla competenza tecnico-manageriale, quali il segmento relativo alla potabilizzazione dell'acqua e quello del trattamento e smaltimento dei reflui. Il lavoro discute infine l'applicabilità di tali risultati al caso italiano

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3

Paula, Luiz Fernando de, and João Adelino de Faria Jr. "Mercado de títulos de dívida corporativa privada no Brasil: aspectos estruturais e evolução recente." Revista de Economia Contemporânea 16, no. 1 (April 2012): 107–37. http://dx.doi.org/10.1590/s1415-98482012000100006.

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Este artigo analisa fatores estruturais e conjunturais que impedem ou estimulam o crescimento do mercado de títulos corporativo de dívida privada (MTD) no Brasil, assim como avalia a evolução recente desse mercado a partir da estabilização de preços pós-1994 até o ano de 2008. Dois aspectos são privilegiados na análise realizada: a relação entre o MTD e a evolução do contexto macroeconômico, já que o comportamento da atividade econômica e da política econômica define o ambiente no qual o MTD cresce e reflui; e a relação entre o mercado de dívida pública e dívida privada corporativa no Brasil, que não tem sido na direção de complementaridade e sim de concorrência.

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4

Mughini, G., and S. Masi. "Clonal eucalyptus plantations fertirrigated with purified urban wastewater (simplified SI-UNIBAS system): a viable opportunity." Forest@ - Rivista di Selvicoltura ed Ecologia Forestale 18, no. 5 (October 31, 2021): 85–92. http://dx.doi.org/10.3832/efor3802-018.

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5

Paiva, Beatriz Augusto de, and Elaine Jussara Tavares. "O confronto de projetos societários na América Latina no Século XXI: uma nova guinada do mundo?" Revista Katálysis 23, no. 3 (December 2020): 601–14. http://dx.doi.org/10.1590/1982-02592020v23n3p601.

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Resumo A intenção primordial deste artigo é apresentar elementos explicativos da conjuntura social na América Latina, desde uma mirada que se alonga e reflui ao Século XX, buscando as reminiscências do imperialismo e fascismo frente ao atual contexto socioeconômico de destrutiva ofensiva do capital. Tal ofensiva, erguida sobre os escombros dos direitos sociais das classes trabalhadoras, ganha elementos explicativos na remissão aos projetos de luta democrática, esboçados em meio a sonhos e ilusões nos primeiros anos dos anos 2000. Em nossa hipótese, vivemos, nas duas décadas do Século XXI, a reedição de processos históricos, que, todavia, ganham novas manifestações e formas particulares ao serem confrontados à dialética da luta de classes, que reatualiza a disjuntiva entre capitalismo e democracia, na submissão aos interesses imperialistas.

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6

Moroni, Flavio. "Principi di funzionamento e aspetti progettuali di un sistema con macrofite radicate a flusso sub-superficiale per il trattamento di reflui civili." Le Journal de botanique 1, no. 1 (1997): 57–59. http://dx.doi.org/10.3406/jobot.1997.1651.

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7

Mandell, Brian F. "Fighting the reflux reflex." Cleveland Clinic Journal of Medicine 84, no. 6 (January 1, 2017): 419. http://dx.doi.org/10.3949/ccjm.84b.06017.

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8

Giacomini, Carlos Homero. "Chega de assunto velho, é hora de assumir responsabilidades...outra vez." Espaço para a Saúde - Revista de Saúde Pública do Paraná 17, no. 1 (December 8, 2016): 14. http://dx.doi.org/10.22421/1517-7130.2016v17n1p14.

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sta reflexão parte de algumas evidências sobre o Brasil: uma das maiores economias do mundo (não obstante as recentes perdas de posições), amplo mercado interno (o oitavo maior do mundo), país de renda média (destaque à baixa produtividade, baixo nível de inovação e à baixa competitividade), PIB em queda(configurando recessão profunda), uma das maiores desigualdades do mundo (que atualmente reflui aos níveis históricos e tende a crescer), renda média do trabalhador em queda, uma das maiores cargas tributárias do mundo, concomitante a um déficit expressivo das contas públicas -¾ do PIB - por descontrole de despesa e queda de arrecadação, que aumenta aceleradamente e projeta crescente voracidade estatal por recursos, juros entre os mais altos do mundo (principalmente para financiar a dívida e o déficit públicos), com pressão Inflacionária, educação de qualidade muito ruim e metas muito tímidas em todos os níveis (destaque negativo para a pré-escola), com uma das piores infraestruturas dos países em desenvolvimento (destaque para a internet banda larga), com um dos piores ambientes de negócios do mundo (regulamentação ineficaz e iníqua), instituições que funcionam precariamente (destaque às organizações políticas), com péssima gestão no setor público (destaque à desgovernança, aos privilégios e à irresponsabilidade estatais), país corrupto (destaque ao maior escândalo de corrupção da história da república), amplamente engajado a um modelo opulento de expectativas (destaque à ausência de qualquer juízo sobre sustentabilidade e futuro). Informações, rankings e pesquisas que atestam isso aí, podem ser encontrados diariamente em revistas, jornais, textos acadêmicos. Há quem a tudo conteste, muitas vezes com o argumento de que o que é publicado é, meramente, a versão das elites. E há quem, como eu, enxergue exatamente isso aí, mesmo admitindo que muito do que circula é política e metodologicamente discutível, e que é possível sempre aprofundar a compreensão da realidade diminuindo conflitos cognitivos e dominando tolices puramente ideológicas.

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9

Bajwa, S., J. A. D. Stewart, S. Treadwell, and D. R. Lakhani. "Swallow syncope: reflex or reflux?" Postgraduate Medical Journal 84, no. 989 (March 1, 2008): 160–62. http://dx.doi.org/10.1136/pgmj.2007.062869.

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10

Roszt??czy, A., L. Makk, R. R??ka, F. Izb??ki, A. Somfay, J. Lonovics, and T. Wittmann. "Reflex and reflux mechanisms of gastroesophageal reflux induced bronchial asthma." Journal of Clinical Gastroenterology 40, Supplement 4 (September 2006): S203—S204. http://dx.doi.org/10.1097/00004836-200609001-00120.

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11

Dale, O. T., O. Alhamarneh, K. Young, and S. Mohan. "Laryngeal sensory testing in the assessment of patients with laryngopharyngeal reflux." Journal of Laryngology & Otology 124, no. 3 (October 26, 2009): 330–32. http://dx.doi.org/10.1017/s0022215109991587.

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AbstractLaryngopharyngeal reflux is commonly encountered in the ENT out-patient setting. It leads to impaired sensory capacity of the laryngeal mucosa. The sensory integrity of the laryngopharynx can be evaluated through endoscopic administration of pulsed air, which stimulates the laryngeal adductor reflex. The pressure of air needed to elicit this reflex indicates the degree of sensory impairment. Such laryngeal sensory testing gives a quantifiable means of assessment in patients with laryngopharyngeal reflux, and can be used to measure the response to treatment. Laryngeal sensory testing is safe and well tolerated by patients.

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12

Adesina, Kehinde Adewale, and C. Abiodun Popoola. "Exergy Rate Profile of Multicomponent Distillation System." International Journal of Recent Contributions from Engineering, Science & IT (iJES) 4, no. 2 (July 5, 2016): 29. http://dx.doi.org/10.3991/ijes.v4i2.5710.

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Exergy rate profiles, exergetic efficiency and irreversibility were used to examine the driving forces in multicomponent distillation system with the view to identifying feasible and efficient operating parameters. The mixture used comprised of 5% propane, 15% iso-butane, 25% nbutane, 20% iso-pentane and 35% n-pentane. Operating variables were feed temperature (-30 oC and -80 oC), pressure (800 kPa and 1200 kPa), and reflux-ratio (2 and 6). Stage-by-stage system exergy analysis was estimated. Column profiles of base case -30 oC, -80 oC, -30 oC-reflus ratio 6, -80 oC reflux ratio 6 and base case reflux ratio 6 did not crossed thus are thermodynamically feasible. Base case -30 oC-reflux ratio 2, -80 oC-reflux ratio 2, and base case-reflux ratio 2 were crossed and constricted and are infeasible. Base case results gave efficiency of 81.7% at depropanizer and 65.2% at debutanizer. Base cases sensitivity results with -30 oC, -80 oC and reflux ratio 6, efficiency range 57.40 – 70% and 65.20% - 54.90% for depropanizer and debutanizer respectively. Spitted cases gave 81.7% and 62.20% with more scatter profiles. Splitted feed base case -30 oC design gave the lowest overall system exergy loss rate of 1.12E+6 and efficiency of 95.70%. Design feasible parameters, system efficiency and irreversibility which form basis

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13

Darabi, Mohsen, Hamid Mohammadiun, and Mohammad Mohammadiun. "Advanced exergy analysis of distillation tower and simulation and optimization by hysys." International Journal of Scientific World 3, no. 1 (May 3, 2015): 163. http://dx.doi.org/10.14419/ijsw.v3i1.4582.

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<p>Exergy rate profiles, exergetic efficiency and irreversibility were used to examine the driving forces in multicomponent distillation system with the view to identifying feasible and efficient operating parameters. The mixture comprised of 5% propane, 15% iso butane, 25% n-butane, 20% iso pentane and 35% n-pentane. Operating variables were feed temperature (-30oC and -80oC), pressure (800KPa and 1200KPa), and reflux-ratio (2 and 6). Sensitivity analysis was carried out to examine the effect of varying operating parameters on the systems. Stage-by-stage system exergy analysis was estimated. Column profiles of a base case -30oC, -80oC, -30oC-reflus ratio 6,80oC -80oC reflux ratio 6 and base case reflux ratio 6 did not cross thus are thermodynamically feasible. Base case -30oC-reflux ratio 2, -80oC-reflux ratio 2, and base case-reflux ratio 2 were crossed and constricted and are infeasible. Base case results gave efficiency of 81.7% at depropanizer and 65.2% at debutanizer. Base cases sensitivity results with -30oC, -80oC and reflux ratio 6, efficiency range 57.40 – 70% and 65.20% - 54.90% for depropanizer and debutanizer respectively. Spitted cases gave 81.7% and 62.20% with more scatter profiles. Splitted feed base case -30oC design gave the lowest overall system exergy loss rate of 1.12E+6 and efficiency of 95.70%.</p>

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14

Balistreri, William F. "The reflex to treat reflux - let’s be conservative regarding gastroesophageal reflux (GER)!" Journal of Pediatrics 152, no. 3 (March 2008): A1. http://dx.doi.org/10.1016/j.jpeds.2008.01.009.

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15

Han, Baek Hwa, and Ki Hwan Hong. "Neurophysiology of Laryngopharyngeal Reflux and Brainstem Reflex." Journal of The Korean Society of Laryngology, Phoniatrics and Logopedics 27, no. 2 (December 30, 2016): 73–77. http://dx.doi.org/10.22469/jkslp.2016.27.2.73.

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16

Hongo, Michio. "Reflux or reflex in GERD-related asthma." Journal of Gastroenterology 40, no. 1 (January 2005): 109–10. http://dx.doi.org/10.1007/s00535-005-1528-9.

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17

Rosztóczy, András, László Makk, Ferenc Izbéki, Richárd Róka, Attila Somfay, and Tibor Wittmann. "Asthma and Gastroesophageal Reflux: Clinical Evaluation of Esophago-Bronchial Reflex and Proximal Reflux." Digestion 77, no. 3-4 (2008): 218–24. http://dx.doi.org/10.1159/000146083.

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18

Canning, Brendan J., and Stuart B. Mazzone. "Reflex mechanisms in gastroesophageal reflux disease and asthma." American Journal of Medicine 115, no. 3 (August 2003): 45–48. http://dx.doi.org/10.1016/s0002-9343(03)00192-x.

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19

Morrison, Murray D. "Is Chronic Gastroesophageal Reflux a Causative Factor in Glottic Carcinoma?" Otolaryngology–Head and Neck Surgery 99, no. 4 (October 1988): 370–73. http://dx.doi.org/10.1177/019459988809900403.

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Several forms of laryngeal dysfunction and pathology can be attributed to the effects of chronic gastric reflux through direct acid irritation, from a reflex alteration in voluntary muscle tone or referred sensation. It is widely accepted that contact ulcers and granulomata over the arytenoid are associated with gastric reflux, but there have not been well-documented cases of glottic carcinoma that are reflux-related. This article presents six cases of glottic carcinoma, all with T1 lesions of the anterior two-thirds of the vocal cord. All of these patients are lifetime nonsmokers, and all had no other ailments other than moderately severe chronic gastroesophageal reflux. Clinical details from the study of these patients gives strong indication that the reflux may have been a factor in the development of the disease. In addition, review of 21 lifetime nonsmokers with glottic carcinoma presenting over a 10-year period at the Cancer Control Agency of British Columbia revealed that 48% had probably experienced reflux, compared to 16% in a group that had stopped smoking 10 or more years earlier. While this small number of cases cannot be said to prove the etiologic relationship between reflux and glottic carcinoma, it is important for the otolaryngologic community to be aware of the possible clinical relationship.

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Barness, Lewis A. "Nutrition Update." Pediatrics In Review 15, no. 8 (August 1, 1994): 321–26. http://dx.doi.org/10.1542/pir.15.8.321.

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Recommendations for improved nutrition have been somewhat modified in the past decade, as evidence clarifies the physiology of digestion, the relation of activity to nutritional requirements, the possible relation of early nutrition to later diseases, the re-evaluation by the American Academy of Pediatrics (AAP) Committee on Nutrition of the use of whole milk in early life, and the recommendations of the USDA of a healthy diet. Breastfeeding continues to be the recommended feeding for infants. Digestive Processes Swallow, digestive, and metabolic processes are well developed in the term infant at birth. Fetal swallowing of amniotic fluid occurs at 16 to 17 gestational weeks; at 30 to 34 gestational weeks, infants develop the ability to suck. At birth, development of the lower esophageal sphincter is incomplete and gastroesophageal reflux is demonstrable; reflux is common up to about 4 months. At birth, the rooting reflex propels the infant to the food source, that is, the mother's or an artificial nipple. The swallowing reflex enables material from the posterior reaches of the mouth to progress to the esophagus, and peristalsis moves the food through the digestive tract. The extrusion reflux, present for up to 2 to 3 months, pushes material out from the anterior part of the mouth, perhaps as a protective mechanism.

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Dua, K., E. Bardan, J. Ren, Z. Sui, and R. Shaker. "Effect of chronic and acute cigarette smoking on the pharyngo-upper oesophageal sphincter contractile reflex and reflexive pharyngeal swallow." Gut 43, no. 4 (October 1, 1998): 537–41. http://dx.doi.org/10.1136/gut.43.4.537.

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Background—Cigarette smoking is known to affect adversely the defence mechanisms against gastro-oesophageal reflux. The effect of smoking on the supraoesophageal reflexes that prevent aspiration of gastric contents has not been previously studied.Aims—To elucidate the effect of cigarette smoking on two of the supraoesophageal reflexes: the pharyngo-upper oesophageal sphincter (UOS) contractile reflex; and the reflexive pharyngeal swallow.Methods—Ten chronic smokers and 10 non-smokers were studied, before and 10 minutes after real or simulated smoking, respectively. UOS pressure and threshold volume for the reflexes were determined using a UOS sleeve assembly. Two modes of fluid delivery into the pharynx were tested: rapid injection and slow injection.Results—For both rapid and slow injections, the threshold volume for triggering the pharyngo-UOS contractile reflex was significantly higher in smokers than in non-smokers (rapid: smokers 0.42 (SE 0.07) ml, non-smokers 0.16 (0.04) ml; slow: smokers 0.86 (0.06) ml, non-smokers 0.38 (0.1) ml; p<0.05). During rapid injection, the threshold volume for reflexive pharyngeal swallow was higher in smokers (smokers 0.94 (0.09) ml, non-smokers 0.46 (0.05) ml; p<0.05). Acute smoking further increased the threshold volume for the pharyngo-UOS contractile reflex and reflexive pharyngeal swallow during rapid injection.Conclusions—Smoking adversely affects stimulation of the pharyngo-UOS contractile reflex and pharyngeal reflexive swallow. These findings may have implications in the development of reflux related respiratory complications among smokers.

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22

Irwin, Richard S., J. Mark Madison, and Armando E. Fraire. "The cough reflex and its relation to gastroesophageal reflux." American Journal of Medicine 108, no. 4 (March 2000): 73–78. http://dx.doi.org/10.1016/s0002-9343(99)00341-1.

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23

Harmeet, S. D., and N. S. Serova. "VESICO-VAGINAL REFLUX." Russian Electronic Journal of Radiology 7, no. 2 (2017): 158–67. http://dx.doi.org/10.21569/2222-7415-2017-7-2-158-167.

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24

Lee, Annemarie L., Brenda M. Button, Linda Denehy, and John W. Wilson. "Gastro-Oesophageal Reflux in Noncystic Fibrosis Bronchiectasis." Pulmonary Medicine 2011 (2011): 1–6. http://dx.doi.org/10.1155/2011/395020.

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The clinical presentation of noncystic fibrosis bronchiectasis may be complicated by concomitant conditions, including gastro-oesophageal reflux (GOR). Increased acidic GOR is principally caused by gastro-oesophageal junction incompetence and may arise from lower oesophageal sphincter hypotension, including transient relaxations, hiatus hernia, and oesophageal dysmotility. Specific pathophysiological features which are characteristic of respiratory diseases including coughing may further increase the risk of GOR in bronchiectasis. Reflux may impact on lung disease severity by two mechanisms, reflex bronchoconstriction and pulmonary microaspiration. Symptomatic and clinically silent reflux has been detected in bronchiectasis, with the prevalence of 26 to 75%. The cause and effect relationship has not been established, but preliminary reports suggest that GOR may influence the severity of bronchiectasis. Further studies examining the implications of GOR in this condition, including its effect across the disease spectrum using a combination of diagnostic tools, will clarify the clinical significance of this comorbidity.

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Starostina, S. V., V. M. Makhov, O. A. Storonova, A. V. Bolshakov, I. V. Kuprina, A. S. Trukhmanov, and V. T. Ivashkin. "Сapabilitу of 24-hour esophageal pH-impedance monitoring in the diagnosis of GERD-associated laryngeal diseases." Meditsinskiy sovet = Medical Council, no. 16 (November 14, 2020): 62–72. http://dx.doi.org/10.21518/2079-701x-2020-16-62-72.

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Extraesophageal manifestations of gastroesophageal reflux disease (GERD), despite the improvement of methods of diagnosis and treatment of patients with this pathology, still remain an urgent problem of medicine and cause increased attention of clinicians and researchers. In some cases, patients with GERD do not present typical complaints of heartburn, regurgitation; the disease may manifest extraesophageal manifestations, such as chronic cough, hoarseness, reflux laryngitis, and others caused by the presence of laryngopharyngeal reflux (LFR) – inflammation of the mucous membrane of the upper digestive and respiratory tracts with possible morphological changes associated with direct and indirect (reflex) exposure to gastroduodenal reflux. The occurrence of LFR is possible due to a violation of the motor function of the esophagus and insufficiency of the upper esophageal sphincter, as well as a decrease in the tone of the pharyngeal muscles. The most accessible methods of diagnosis of LFR are registration of complaints according to the questionnaire “index of reflux symptoms”, assessment of the clinical and functional state of the larynx using a visually analog “scale of reflux signs”. A positive response to the empirical use of proton pump inhibitors in combination with procinetics and determination of pepsin content in saliva can also be alternative diagnostic methods. To date, 24-hour pH-impedance monitoring is a method that allows the most accurate diagnosis of all types of reflux, regardless of the pH value, to verify high reflux in combination with its physical properties, as well as to estimate the time of chemical and volumetric esophageal clearance. In addition to performing esophagogastroduodenoscopy, the use of this method is indicated in patients with suspected extraesophageal manifestations of GERD. The article presents clinical examples of patients with extraesophageal manifestations of GERD, describes the possibilities of 24-hour pH-impedance monitoring of the esophagus in the diagnosis of LFR and reflux-associated diseases of the larynx.

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Andriani, Yunida, Muhammad Amsyar Akil, Masyita Gaffar, and Abdul Qadar Punagi. "Deteksi pepsin pada penderita refluks laringofaring yang didiagnosis berdasarkan reflux symptom index dan reflux finding score." Oto Rhino Laryngologica Indonesiana 41, no. 2 (December 1, 2011): 121. http://dx.doi.org/10.32637/orli.v41i2.48.

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Background: It is estimated that more than 50% of patients with voice disorders who come fortreatment are caused by laryngopharyngeal reflux (LPR). LPR has been implicated in the etiology ofmany laryngeal disorders including subglottic stenosis, laryngeal carcinoma, laryngeal contact ulcer,laryngospasm and vocal nodule on the vocal cords. Ambulatory 24 hour double-probe (pharyngeal andesophageal) pH monitoring is the gold standard examination for diagnosing LPR, but it is still far fromideal criteria.The assessment of pepsin in airway secretions could be used as a sensitive diagnosticmarker of LPR because pepsin is not synthesized by any type of airway cells. Purpose: The aim ofthis study was to detect the presence of pepsin on laryingopharyngeal reflux patients which diagnosedbased on reflux symptom index (RSI) dan reflux finding score (RFS) at Wahidin Sudirohusodo Hospital,Makassar. Methods: This is a comparative quantitative study. We performed RSI and RFS examinationson 51 samples, followed by saliva pepsin detection using ELISA method on 48 samples, then analyzed withSpearman’s Rho test. Result: RSI score >13 was found in 48 samples (94,12%) and RFS score >7 wasin 51 samples (100%). Pepsin was detected on all sputum samples, however there was no significant relationship betwen RSI and RFS scoring with the level of pepsin in saliva (p>0.01). Conclusion: Pepsin was detected on saliva of patients with laringopharyngeal reflux who was diagnosed based on RSI andRFS. We concluded that RSI and RFS can be used as diagnostic tools for LPR. Keywords: laringopharyngeal reflux, reflux symptom index, reflux finding score, pepsin Abstrak : Latar belakang: Diperkirakan lebih dari 50% pasien dengan gangguan suara yang datang berobatke dokter THT diakibatkan oleh refluks laringofaring (RLF). Diduga RLF berperan pada patogenesissejumlah kelainan pada laring, termasuk stenosis subglotik, karsinoma laring, laryngeal contact ulcers,laringospasme dan vokal nodul pada pita suara. Pemeriksaan ambulatory 24 hour double-probe pHmonitoring merupakan gold standard untuk mendiagnosis RLF, namun pemeriksaan ini masih jauh darikriteria ideal. Menentukan adanya pepsin pada sekret saluran napas merupakan petanda diagnostik yangsensitif untuk RLF karena pepsin tidak dihasilkan oleh sel apapun dalam saluran napas. Tujuan: Penelitianini bertujuan mendeteksi keberadaan pepsin pada penderita refluks laringofaring yang didiagnosisberdasarkan refluks symptom index (RSI) dan reflux finding score (RFS). Metode: Jenis penelitian iniadalah komparatif kuantitatif. Dilakukan pemeriksaan RSI dan RFS pada 51 percontoh dan dilanjutkandengan pemeriksaan pepsin saliva menggunakan metode ELISA pada 48 percontoh lalu dilakukan ujiSpearman’s Rho. Hasil: Skor RSI >13 sebanyak 48 percontoh (94,12%) dan skor RFS >7 sebanyak 51percontoh (100%). Pepsin terdeteksi pada saliva semua percontoh. Tidak ada hubungan yang bermaknaantara skoring RSI dan RFS dengan kadar pepsin pada saliva (p>0,01). Kesimpulan: RSI dan RFS dapatdigunakan dalam menegakkan diagnosis RLF. Kata kunci: refluks laringofaring, reflux symptom index, reflux finding score, pepsin

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Felipe, Gabriella Vasconcelos, and Karina Gonzalez Camara Fernandes. "Erosão dentária e refluxo gastroesofásico / Dental erosion and gastroesophageal reflux." Brazilian Journal of Health Review 5, no. 3 (June 1, 2022): 10712–26. http://dx.doi.org/10.34119/bjhrv5n3-229.

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Pecova, R., T. Michnova, J. Fabry, M. Miskovska, P. Klco, and M. Tatar. "Cough Reflex Sensitivity in Gastro-Oesophageal Reflux and Asthma Children." Pulmonary Pharmacology & Therapeutics 24, no. 3 (June 2011): e4. http://dx.doi.org/10.1016/j.pupt.2011.04.010.

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Francis, David O., and Michael F. Vaezi. "Should the Reflex Be Reflux? Throat Symptoms and Alternative Explanations." Clinical Gastroenterology and Hepatology 13, no. 9 (September 2015): 1560–66. http://dx.doi.org/10.1016/j.cgh.2014.08.044.

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Miroslava, Lucanska, Hajtman Andrej, and Pecova Renata. "Changes of the Airway Reactivity in Patients with Rhinosinusitis." Acta Medica Martiniana 22, no. 2 (August 1, 2022): 54–61. http://dx.doi.org/10.2478/acm-2022-0007.

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Abstract Rhinosinusitis is one of the most common conditions in primary and secondary care all over the world. Rhinosinusitis together with asthma and gastroesophageal reflux disease represent the most common causes of chronic cough. The relationship between rhinosinusitis and cough is still not completely understood, however, direct stimulation of nasal mucosa, upper airway cough syndrome, inflammation of the airways, and cough reflex sensitisation play the crucial role in the pathogenesis of chronic cough.

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Shepherd, Kelly L., Richard H. Holloway, David R. Hillman, and Peter R. Eastwood. "The impact of continuous positive airway pressure on the lower esophageal sphincter." American Journal of Physiology-Gastrointestinal and Liver Physiology 292, no. 5 (May 2007): G1200—G1205. http://dx.doi.org/10.1152/ajpgi.00476.2006.

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The lower esophageal sphincter (LES) is the primary barrier to gastroesophageal reflux. Reflux is associated with periods of LES relaxation, as occurs during swallowing. Continuous positive airway pressure (CPAP) has been shown to reduce reflux in individuals with and without sleep apnea, by an unknown mechanism. The aim of this study was to determine the effect of CPAP on swallow-induced LES relaxation. Measurements were made in 10 healthy, awake, supine individuals. Esophageal (Pes), LES (Ples), gastric (Pg), and barrier pressure to reflux (Pb = Ples − Pg) were recorded using a sleeve catheter during five swallows of 5 ml of water. This was repeated at four levels of CPAP (0, 5, 10, and 15 cmH2O). Pressures were measured during quiet breathing and during the LES relaxation associated with a swallow. Duration of LES relaxation was also recorded. During quiet breathing, CPAP significantly increased end-expiratory Pes, Ples, Pg, and Pb ( P < 0.05). The increase in Pb was due to a disproportionate increase in Ples compared with Pg ( P < 0.05). During a swallow, CPAP increased nadir Ples, Pg, and Pb and decreased the duration of LES relaxation (4.1 s with 0-cmH2O CPAP to 1.6 s on 15-cmH2O CPAP, P < 0.001). Pb increased with CPAP by virtue of a disproportionate increase in Ples compared with Pg. This may be due to either reflex activation of LES smooth muscle, or nonspecific transmission of pressure to the LES. The findings suggest CPAP may make the LES less susceptible to reflux by increasing Pb and decreasing the duration of LES relaxation.

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Lang, Ivan M., Bidyut K. Medda, and Reza Shaker. "Mechanisms of reflexes induced by esophageal distension." American Journal of Physiology-Gastrointestinal and Liver Physiology 281, no. 5 (November 1, 2001): G1246—G1263. http://dx.doi.org/10.1152/ajpgi.2001.281.5.g1246.

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We investigated the mechanisms of esophageal distension-induced reflexes in decerebrate cats. Slow air esophageal distension activated esophago-upper esophageal sphincter (UES) contractile reflex (EUCR) and secondary peristalsis (2P). Rapid air distension activated esophago-UES relaxation reflex (EURR), esophago-glottal closure reflex (EGCR), esophago-hyoid distraction reflex (EHDR), and esophago-esophagus contraction reflex (EECR). Longitudinal esophageal stretch did not activate these reflexes. Magnitude and timing of EUCR were related to 2P but not injected air volume. Cervical esophagus transection did not affect the threshold of any reflex. Bolus diversion prevented swallow-related esophageal peristalsis. Lidocaine or capsaicin esophageal perfusion, esophageal mucosal layer removal, or intravenous baclofen blocked or inhibited EURR, EGCR, EHDR, and EECR but not EUCR or 2P. Thoracic vagotomy blocked all reflexes. These six reflexes can be activated by esophageal distension, and they occur in two sets depending on inflation rate rather than volume. EUCR was independent of 2P, but 2P activated EUCR; therefore, EUCR may help prevent reflux during peristalsis. All esophageal peristalsis may be secondary to esophageal stimulation in the cat. EURR, EHDR, EGCR, and EECR may contribute to belching and are probably mediated by capsaicin-sensitive, rapidly adapting mucosal mechanoreceptors. GABA-B receptors also inhibit these reflexes. EUCR and 2P are probably mediated by slowly adapting muscular mechanoreceptors. All six reflexes are mediated by vagal afferent fibers.

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Belhocine, K., and S. Bruley des Varannes. "Gastro-œsophageal reflux disease and surgery." Revue Medicale de Bruxelles 43, no. 5 (2022): 505–5014. http://dx.doi.org/10.30637/2022.22-001.

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Scott, Katie. "Chronic cough in children." InnovAiT: Education and inspiration for general practice 14, no. 6 (April 14, 2021): 356–63. http://dx.doi.org/10.1177/17557380211003312.

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A chronic cough in children is defined in the British Thoracic Society guidelines as a cough of 8 weeks or more. The aetiology of a chronic cough in children differs from adult populations, due to decreased cough reflex control in children, differences in airway anatomy and physiology, and immunological and neurological maturation changes. The three most common causes of chronic cough in adults (asthma, gastro-oesophageal reflux, and upper airway cough syndrome) account for less than 10% of the causes in children. Thus, it is important to assess and manage chronic cough in children differently.

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Fantini, Luiz Henrique Souza, Marília Pereira Gomes, Bianca Azevedo Berger Amaral, Ludmila Corbelli Pereira, Marcelo Machado Alécio, Ana Luíza Paes da Silveira, Pérola Semil de Sousa Martins, and Nestor Augusto Avelino Leite. "Refluxo laringofaringeo: associação com manifestações extraesofagicas / Laryngopharyngeal reflux: association with extraesophageal manifestations." Brazilian Journal of Health Review 5, no. 2 (April 4, 2022): 5899–909. http://dx.doi.org/10.34119/bjhrv5n2-166.

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Unal, Y., G. Kutlu, and L. E. Inan. "FP53-FR-05 Buccopalpebral reflex in Parkinson disease and blink reflux study." Journal of the Neurological Sciences 285 (October 2009): S142. http://dx.doi.org/10.1016/s0022-510x(09)70552-0.

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Bhavani Balakrishnan, Sunantha Selvaraj, Dorairaj Jayachandran, and M. Subash Lenin. "Herbal therapeutics in the management of gag reflex: A literature review." World Journal of Advanced Research and Reviews 16, no. 2 (November 30, 2022): 1072–76. http://dx.doi.org/10.30574/wjarr.2022.16.2.1274.

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Background: Gag reflex is one of the most common conditions faced in the field of dentistry. It is the involuntary defence mechanism against the tactile stimulation of the pharynx and throat. Gag reflex is caused by the stimulation of tonsils and pharynx inhibits the swallowing of foreign object that leads to contraction of the chest, abdominal, muscles of oral and pharynx .There were cases were gag reflex causes severe limitation to a patient's ability to undergo dental treatment which in turn challenges the dentist for providing a better treatment. There are various techniques available for the management of gag reflex like pharmaceutical intervention like anti-emetic drugs, sedatives, local and general anesthetics, herbal remedies and non-pharmaceutical intervention like behavioral therapies, acupressure, laser, acupuncture, and prosthetic appliances. Objectives: To assess the role of natural ingredients in the interventions for the management of gag reflex Search methods: The literature search was done in electronic databases in PubMed, Scopus, Science Direct, MEDLINE and Google search engine to extract clinical studies on natural ingredients used to control the gag reflex among the population with no time limitation. The included search words were “ natural ingredients”, “gag reflux” “Clinical trial,” “Clinical study,” “Blind,” or “review”. Selection criteria: The reviews and randomised controlled trials (RCTs) involving animals or human using natural ingredients in the intervention to manage gagging that interfered with dental treatment. Data collection and analysis: Two authors independently collected the datas. The review authors independently assessed and overall quality of the evidence. Conclusions: The evidence obtained from data the quality of the evidence of the outcome were neither satisfactory nor adequate evidence for interventions for managing the gag reflex during dental treatment. This review thrives to do research to improve the therapeutics in the management of gag reflex.

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Hafeez, Nadeem, Qudrat Ullah, Asif Hanif, Zaheer Akhtar, Muhammad Umar, and Rukhma Rafaqat. "Frequency of Clinical symptoms of Gastroesophageal Reflux Disease in Asthmatic Patients." International Journal of Frontier Sciences 3, no. 1 (January 1, 2019): 3–9. http://dx.doi.org/10.37978/tijfs.v3i1.43.

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Abstract: Background: Gastroesophageal reflex is known as an acid reflex, is long term condition where stomach contents back into the oesophagus resulting in either symptoms or complications. GERD disease is caused by weakness or failure of the lower oesophageal sphincter. Symptoms include the acidic taste behind the mouth, heart burn, chest pain, difficult breathing and vomiting. Complication includes esophagitis, oesophageal strictures and barrettes oesophagus. Objective: The aim of this research was to introduce the symptoms of GERD disease in asthmatic patients and how these symptoms worsen the symptoms of asthma disease and what clinical pictures present with the asthmatic disease. Methodology: A designed performa was used to collect the data and after filling the performa, results were drawn and conclusion through the facts and the information given by patients. Results: In the present study among all 164 asthmatic patients, 70 (42.7%) patients showed dyspepsia, 58 (35.4%) were with chest burning, 23 (14%) were asking about chest pain, with acidic mouth taste were 39 (23.8%), 22 (13.4%) were feeling sore throat and 44 (26.8%) showed regurgitation reflex. Among these 164 patients 16 (9.8%) were smokers and 148 (90.2 %) were non-smokers. 47 (28.7%) were males and 117 (71.3%) were females. Conclusion: It is concluded that gastroesophageal reflux disease in asthmatic patients present symptoms of acidic mouth taste, chest burning, chest pain, dyspepsia, regurgitation reflex and sore throat.

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Trukhan, Dmitry I., Natalia A. Chusova, and Olga V. Drokina. "Extraoesophageal symptoms of gastroesophageal reflux disease: laryngopharyngeal reflux in focus." Consilium Medicum 22, no. 12 (2020): 44–51. http://dx.doi.org/10.26442/20751753.2020.12.200559.

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Gastroesophageal reflux disease (GERD) ranks first among gastroenterological diseases in terms of prevalence. GERD can also manifest with extraesophageal (atypical) symptoms, which include: cardiac, pulmonary, otorhinolaryngological and dental symptoms. In some cases, extraesophageal manifestations can come to the fore in the clinical picture. Moreover, in 25% of cases, GERD clinically occurs only with extraesophageal symptoms, which fits into one of the main features of modern real clinical practice – various diseases are increasingly losing their mononosological character, acquiring the status of comorbidity and multimorbidity. The presence of extraesophageal symptoms in patients with GERD is due to extraesophageal (or, more precisely, gastroesophagolaryngopharyngeal) reflux, which is referred to in the international medical literature as laryngopharyngeal reflux (LFR). Currently, LFR is considered as a condition of inflammation of the mucous membrane of the upper digestive and respiratory tracts associated with direct and indirect (reflex) effects of gastroduodenal refluctate, which can cause morphological changes in the mucous membrane. Over the past decade, two approaches to the treatment of LFR have emerged. The first approach involves the use of proton pump inhibitors (PPIs) as monotherapy along with dietary and lifestyle modification. The second comprehensive approach to LFR therapy in-volves dual therapy (PPI + alginate/antacid or PPI + prokinetic) or triple therapy (PPI + alginate/antacid + prokinetic). In this review, both approaches to the tre-atment of LFR are considered, and the possibilities of alginates in the treatment of LFR are considered.

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Wong, Ian W. Y., Guy Rees, Lennart Greiff, Jennifer C. Myers, Glyn G. Jamieson, and Peter-John Wormald. "Gastroesophageal Reflux Disease and Chronic Sinusitis: In Search of an Esophageal–nasal Reflex." American Journal of Rhinology & Allergy 24, no. 4 (July 2010): 255–59. http://dx.doi.org/10.2500/ajra.2010.24.3490.

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DUA, K., J. BAJAJ, Z. SUI, C. HOFMANN, C. SIMUNCEAK, and R. SHAKER. "Altered pharyngo-upper esophageal sphincter contractile reflex in patients with gastroesophageal reflux disease." Gastroenterology 120, no. 5 (April 2001): A58. http://dx.doi.org/10.1016/s0016-5085(01)80287-0.

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Dua, Kulwinder S., Jasmohan S. Bajaj, Zhumei Sui, Candy L. Hofmann, Chelsey Simunceak, and Reza Shaker. "Altered pharyngo-upper esophageal sphincter contractile reflex in patients with gastroesophageal reflux disease." Gastroenterology 120, no. 5 (April 2001): A58. http://dx.doi.org/10.1016/s0016-5085(08)80287-9.

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Rychlíčková, Jitka. "Gastroesophageal reflux disease - risk drugs and treatment options." Praktické lékárenství 13, no. 4 (December 1, 2017): 169–72. http://dx.doi.org/10.36290/lek.2017.065.

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Khairuddinova, Z. R., and G. S. Khaidarova. "THE USE OF PROBIOTICS IN LARYNGOPHARYNGEAL REFLUX." Oriental Journal of Medicine and Pharmacology 02, no. 01 (January 1, 2022): 96–103. http://dx.doi.org/10.37547/supsci-ojmp-02-01-06.

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The laryngopharyngeal reflex (LPR) is associated with many diseases of the ear, nose, and throat. LPR is characterized by a retrograde flow of gastric contents into the larynx and pharynx, which leads to a recurrent course of otolaryngological symptoms. Proton pump inhibitors (PPIs) are currently the gold standard for LPR. However, there is increasing evidence that not all patients respond satisfactorily to PPIs. 30-35% of patients with LPR require additional intervention to control the symptoms of the disease. Oral probiotics show promise in the treatment of LPR, but evidence is still lacking. Further research is needed to evaluate the impact of oral probiotics on oral, pharyngeal, and laryngeal health.

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Sultana, Zakia, Kathryn A. Hasenstab, and Sudarshan R. Jadcherla. "Pharyngoesophageal motility reflex mechanisms in the human neonate: importance of integrative cross-systems physiology." American Journal of Physiology-Gastrointestinal and Liver Physiology 321, no. 2 (August 1, 2021): G139—G148. http://dx.doi.org/10.1152/ajpgi.00480.2020.

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Swallowing is a critical function for survival and development in human neonates and requires cross-system coordination between neurological, airway, and digestive motility systems. Development of pharyngoesophageal motility is influenced by intra- and extrauterine development, pregnancy complications, and neonatal comorbidities. The primary role of these motility reflex mechanisms is to maintain aerodigestive homeostasis under basal and adaptive biological conditions including oral feeding, gastroesophageal reflux, and sleep. Failure may result in feeding difficulties, airway compromise, dysphagia, aspiration syndromes, and chronic eating difficulties requiring prolonged tube feeding. We review the integration of cross-systems physiology to describe the basis for physiological and pathophysiological neonatal aerodigestive functions.

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Atmaja, Kadek Surya, A. A. Gede Oka Suta Wicaksana, I. Gede Dilajaya Robin, I. Putu Hartawan Mataram, and Putri Esti Andryani. "Asthma related to gastroesophageal reflux disease: a case report and review." International Journal of Advances in Medicine 8, no. 4 (March 23, 2021): 603. http://dx.doi.org/10.18203/2349-3933.ijam20211063.

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Asthma is a common respiratory disorder that characterized by airway hyper-reactivity and chronic inflammation. Asthma and gastroesophageal reflux disease can occur together, both can affect each other. We represent 41 years old male patient with chief complaint of asthma that preceded burning sensation on his throat and also heartburn over the last three months. Patient had visited his family doctor but his symptom still occurred. He had been experienced six episodes of these symptoms since three month ago. On physical examination there were wheezing both of his lung and prolong expiration phase. There was no abnormality on the electrocardiogram, chest X-ray and complete blood count. After administration of short acting bronchodilator and proton pump inhibitor agent, patient clinical status improved dramatically. Patient than given salmoterol fluticasone inhaler, antacid, ANT proton pump inhibitor as take-home medication. On his follow up visit to policlinic on first, fourth- and eight-week patient denied any shortness of breath and heartburn anymore. Various pathological processes play a role in the pathogenesis of GERD and Asthma. There were two theories that suggested in the mechanism that caused GERD induced Asthma, including reflux and reflex theory.

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Badri, Huda, Carmen Gibbard, Dimitra Denton, Imran Satia, Bashar Al-Sheklly, Rachel J. Dockry, Kimberley Holt, et al. "A double-blind randomised placebo-controlled trial investigating the effects of lesogaberan on the objective cough frequency and capsaicin-evoked coughs in patients with refractory chronic cough." ERJ Open Research 8, no. 1 (January 2022): 00546–2021. http://dx.doi.org/10.1183/23120541.00546-2021.

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ObjectiveBaclofen is a centrally acting γ-aminobutyric acid type B (GABAB) receptor agonist which reduces gastro-oesophageal reflux and suppresses the cough reflex; however, central nervous system side-effects limit its use. Lesogaberan is a novel peripherally acting GABAB agonist, but its effects on refractory chronic cough are unknown.DesignWe performed a single-centre, placebo-controlled, double-blind randomised crossover study in patients with chronic cough, refractory to the treatment of underlying conditions. Patients were randomised to treatment with lesogaberan 120 mg modified release twice daily or matched placebo for 2 weeks and then crossed over to the alternative therapy after a 2-week washout. The primary end-point was 24-h cough frequency measured with an acoustic monitoring system. In addition, cough responses to capsaicin were measured, and gastro-oesophageal reflux assessed by 24-h pH/impedance at screening.Results22 patients were randomised to receive lesogaberan/placebo or placebo/lesogaberan (female (73%); mean±sd age 63.7±7.2 years; median (interquartile range) cough duration 10.5 (5.8–17.0) years; mean (95% CI) 45 (29–67) reflux events in 24 h; two patients had abnormal oesophageal acid exposure times). Although lesogaberan reduced cough counts by 26% over placebo, this did not reach statistical significance (p=0.12). However, lesogaberan did significantly improve cough responses to capsaicin (p=0.04) and the number of cough bouts (p=0.04) compared with placebo. Lesogaberan was well tolerated in this study.ConclusionsLesogaberan improved cough hypersensitivity and the number of bouts of coughing, but not coughs per hour. This implies a possible role for peripheral GABAB receptors in refractory chronic cough.

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Khorobrykh, T. V., A. A. Voevodina, D. A. Efremov, V. I. Korotkiy, N. R. Khusainova, Кh U. Elifkhanova, A. Ya Malyugina, and I. A. Martynov. "Correction of gastrocardial syndrome in patients with hernias of the esophageal orifice of the diaphragm during antireflux operations." Meditsinskiy sovet = Medical Council, no. 21-2 (January 8, 2022): 62–71. http://dx.doi.org/10.21518/2079-701x-2021-21-2-62-71.

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Introduction. Hernia of the esophageal opening of the diaphragm in 90% of cases is the main cause of the development of reflux esophagitis. The doctrine highlighted a large group of extraesophageal manifestations of reflux esophagitis, including gastrocardiac syndrome.Аim. The purpose of this publication is to evaluate the effectiveness of antireflux surgery in patients with hiatal hernia through the prism of its effectiveness in the dynamics of gastrocardial syndrome regression.Material and мethods. The paper presents the results of diagnostics and surgical treatment of 101 patients with hiatal hernia.Results. According to the data of instrumental research methods, cardiac hernias of the esophageal opening of the diaphragm were detected in 45 (44.5%) patients, cardiofundal in 40 (39.6%), subtotal in 15 (14.8%), total in 1 (0.9%). The main place in the clinical picture of gastrocardial syndrome was occupied by the pain syndrome behind the breastbone (83.1%). Thus, arrhythmias were found in 16 (40.0%) patients with cardiofundal, in 10 (66.6%) subtotal and in 1 (100.0%) total hiatal hernia, and angina pectoris is characteristic of cardiac hernias and was observed in 20 (44.4%) patients. The clinical manifestation of reflex angina pectoris and arrhythmias depended on the degree of shortening of the esophagus. Thus, arrhythmias were more common in patients with cardiofundal (50.0%), subtotal (71.4%), total (100.0%) hiatal hernia with II degree of shortening of the esophagus, and angina pectoris characteristic of cardiac (75.0%) hiatal hernia. with II degree of shortening of the esophagus. Reflex angina is typical for patients of the older age group, and manifestations of arrhythmia are recorded at a younger age. Heart rate variability was considered, according to electrocardiogram and Holter ECG monitoring before and after surgical treatment, where the parameters significantly (p> 0.05) decreased.Conclusions. The phenomena of gastrocardial syndrome regressed after antireflux surgery in 44 (43.5%) patients. Surgical treatment from the endovideosurgical approach did not worsen the results of surgical treatment.

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Herawati, Vitri Dyah, Indriyati, Sutrisno, and Fajar Alam Putra. "Pelatihan stimulasi ASI dengan media video pemijatan punggung untuk melancarkan produksi ASI." Bhakti Sabha Nusantara 1, no. 2 (December 31, 2022): 45–48. http://dx.doi.org/10.58439/bsn.v1i2.38.

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Produksi ASI sangat ditentukan oleh ibu dan bayinya, dimana banyak ibu post partum yang mengeluhkan susahnya meningkatkan produksi ASI, dan akhirnya ibu post partum langsung memberikan bayinya susu formula. Pijat punggung ini dilakukan untuk merangsang reflek oksitosin atau let down reflex. Selain untuk merangsang let down reflex manfaat pijat oksitosin adalah memberikan kenyamanan pada ibu, mengurangi bengkak (engorgement), mengurangi sumbatan ASI, merangsang pelepasan hormon oksitosin, mempertahankan produksi ASI ketika ibu dan bayi sakit. Di masa covid 19 ini, ibu post partum juga membutuhkan pelayanan keperawatan seperti pijat punggung untuk memperlancar produksi ASI, namun karena ketakutan para ibu untuk mendatangi fasilitas kesehatan, sehingga kami ingin membuat video pijat punggung untuk memperlancar produksi ASI ibu post partum.

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Khoma, Oleksandr, Michael Falk, Hans Van Der Wall, Leticia Burton, and Gregory Falk. "PS01.011: PATHOPHYSIOLOGY OF LARYNGOPHARYNGEAL REFLUX DISEASE: ASSOCIATION WITH PULMONARY ASPIRATION ON SCINTIGRAPHY AND INEFFECTIVE OESOPHAGEAL MOTILITY." Diseases of the Esophagus 31, Supplement_1 (September 1, 2018): 52–53. http://dx.doi.org/10.1093/dote/doy089.ps01.011.

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Abstract Background Gastro-oesophageal reflux disease (GORD) can present with typical symptoms or atypical or laryngopharyngeal reflux (LPR) symptoms. The role of impaired oesophageal motility in these two clinically distinct groups has not been previously examined. Methods This study is a retrospective analysis of 361 consecutive patient records that was extracted from a prospectively populated research database. Patients were categorised by symptom profile as predominantly LPR or GORD (98 GOR and 263 LPR). Presenting symptom profile, pH studies, oesophageal manometry and scintigraphy and the relationship between the above were analysed. Results Severe oesophageal dysmotility was more prevalent in LPR group (P = 0.037). Severe oesophageal dysmotility was strongly associated with isotope aspiration in both groups (P = 0.001). 24 per cent of patients showed evidence of pulmonary aspiration on scintigraphy. Significant correlation was established between total proximal acid on 24-hour pH monitoring and isotope aspiration in both groups (P = 0.00). Rising pharyngeal curves on scintigraphy were the strongest predictors of isotope aspiration (P = 0.00). Conclusion Early research on oesophageal dysmotility has suggested reduced oesophageal clearance in individuals with IOM. This selected group of patients showed a high degree of impaired oesophageal motility, which was associated with rising time-activity curves in both the upper oesophagus and pharynx. The presence of refluxate in the upper oesophagus can stimulate cough via ‘reflex’ afferent pathways and the presence of gastric contents in the pharynx can cause direct irritation to upper airways, both resulting in cough. Reduced pressures in the lower oesophageal sphincter were equally prevalent in LPR and GORD groups and therefore were not discriminatory between the clinical groups. The impairment of oesophageal clearance secondary to diminished oesophageal motility, may offer a plausible explanation for the development of symptoms via combined ‘reflux’ and ‘reflex’ pathways, allowing continued oesophageal exposure or proximal exposure to refluxate. The ROC and cluster analysis demonstrated strong predictive values and linkages between ineffective oesophageal motility and rising pharyngeal time-activity curves for the prediction of lung aspiration. This may form the basis of a new approach to the definitive diagnosis of LPR and lung aspiration. Oesophageal dysmotility is a key factor in pathophysiology of LPR. Severe impaired oesophageal motility is strongly associated with pulmonary aspiration in both LPR and GORD. Disclosure All authors have declared no conflicts of interest.

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