ResumenLos inhibidores de la bomba de protones (IBP) son el estándar de referencia para el tratamiento de las enfermedades relacionadas con el ácido. En la enfermedad por reflujo gastroesofágico ...(ERGE) la supresión ácida se asocia con una alta tasa de cicatrización de la mucosa; sin embargo, la respuesta sintomática difiere entre los fenotipos endoscópicos. Las manifestaciones extraesofágicas tienen buena respuesta clínica en quienes presentan una exposición anormal al ácido (prueba diagnóstica) en el esófago.Los IBP han demostrado su efectividad para disminuir la intensidad sintomática en el reflujo nocturno y en los trastornos del sueño, mejorando la calidad de vida y la productividad laboral. Esto se logra, en ocasiones, mediante las modificaciones al fraccionar o aumentar la dosis, así como la galénica.Estos fármacos no están exentos de aspectos controversiales en relación con los eventos adversos asociados. El desarrollo tecnológico está encaminado a mejorar el rendimiento del IBP mediante el incremento de la vida media, la concentración máxima y el área bajo la curva de las concentraciones plasmáticas mediante la galénica, y por otra parte a crear fármacos más seguros y tolerables.En esta revisión nos enfocamos a los mecanismos de acción, las propiedades farmacocinéticas y los avances tecnológicos para incrementar el rendimiento farmacológico de un IBP.
Resumen En la actualidad la funduplicatura laparoscópica tipo Nissen se considera el tratamiento quirúrgico de elección para la enfermedad por reflujo gastroesofágico (ERGE) y su efectividad a largo ...plazo es mayor del 90%. Dentro de los factores predictores de buena respuesta clínica están la adecuada selección del paciente y la experiencia del cirujano. Sin embargo, la prevalencia de síntomas nuevos, persistentes y recurrentes posteriores al procedimiento antirreflujo puede ser de hasta un 30%. Las causas son múltiples pero en general se deben a una o más alteraciones en la anatomía y en la función esofagogástrica. Ante la persistencia de los síntomas posterior al procedimiento quirúrgico se debería de utilizar el término «falla». En el caso de que un paciente inicialmente manifieste control de sus síntomas y posteriormente estos reaparezcan, se pudiera emplear el término «disfunción». Por otra parte, ante el empeoramiento de los síntomas o la aparición de síntomas o situaciones clínicas que no existían antes de la cirugía, debe de considerarse una «complicación». La disfagia postoperatoria y los síntomas dispépticos son muy frecuentes y requieren un abordaje integral para poder determinar el mejor tratamiento posible. En esta revisión se detallan los aspectos fisiopatológicos, de diagnóstico y tratamiento de los síntomas y las complicaciones posteriores a la funduplicatura para el manejo de la ERGE.
The world ocean occupies 70 % on the earth and the average sea depth is about 4,000 m. More than 80 percent of it has not been investigated precisely and the bottom shape of the sea has not been ...mapped. When doing resource-searching in the future, the precise maps must be required. So, the authors have developed a drone movable around 4,000 m deep sea to measure the bottom of the ocean. It is based on spheres, which includes cameras, batteries, some sensors and controllers. It can rotate a spherical rotor sensing widely to obtain the information about the bottom of the sea. At the first step of the research, the authors have made basic experiments of the motor’s performance in water. The authors have obtained the excellent results in maneuverability, temperature durability, and shock resistance of the motor.
Aims : Tumour budding is an adverse prognostic factor in colorectal cancer (CRC). We have investigated the significance of cytoplasmic fragments occurring in the immediate vicinity of tumour budding ...foci.
Methods and results : Seventy‐three CRCs with high‐grade budding (> 10 budding foci in a × 20 objective field) were classified according to extent of budding (10–19 versus 20+ foci) and by the presence or absence of cytoplasmic fragments identified by immunostaining for cytokeratin. In serial sections, cytoplasmic fragments were shown to be dendritic cell processes in continuity with budding tumour cells and were renamed pseudo‐fragments. Cytoplasmic pseudo‐fragments, but not extent of budding, were associated with aberrant expression of β‐catenin (P = 0.045) and laminin‐5 γ2 (P < 0.0001), and with absent peritumoral lymphocytic infiltration (P = 0.0077). Cytoplasmic pseudo‐fragments had a stronger association with infiltrating growth pattern (P = 0.0014) than extent of tumour budding (P = 0.014). There was no association between extent of budding and cytoplasmic pseudo‐fragments (P = 0.12).
Conclusions : Cytoplasmic pseudo‐fragments may be a marker for an activated budding phenotype that is associated with cell motility and increased invasiveness in CRC and is independent of the extent of budding.
Laparoscopic Nissen fundoplication is currently considered the surgical treatment of choice for gastroesophageal reflux disease (GERD) and its long-term effectiveness is above 90%. Adequate patient ...selection and the experience of the surgeon are among the predictive factors of good clinical response. However, there can be new, persistent, and recurrent symptoms after the antireflux procedure in up to 30% of the cases. There are numerous causes, but in general, they are due to one or more anatomic abnormalities and esophageal and gastric function alterations. When there are persistent symptoms after the surgical procedure, the surgery should be described as "failed". In the case of a patient that initially manifests symptom control, but the symptoms then reappear, the term "dysfunction" could be used. When symptoms worsen, or when symptoms or clinical situations appear that did not exist before the surgery, this should be considered a "complication". Postoperative dysphagia and dyspeptic symptoms are very frequent and require an integrated approach to determine the best possible treatment. This review details the pathophysiologic aspects, diagnostic approach, and treatment of the symptoms and complications after fundoplication for the management of GERD.
In search of the grail: A race for acid suppression Sobrino-Cossío, S; Teramoto-Matsubara, O; Mateos-Pérez, G ...
Revista de gastroenterología de México,
2019 Jul - Sep, Volume:
84, Issue:
3
Journal Article
Peer reviewed
Open access
Proton pump inhibitors are the reference standards for the treatment of acid-related diseases. Acid suppression in gastroesophageal reflux disease is associated with a high rate of mucosal ...cicatrization, but symptom response differs among endoscopic phenotypes. Extraesophageal manifestations have a good clinical response in patients that present with abnormal acid exposure (diagnostic test) in the esophagus. Proton pump inhibitors have shown their effectiveness for reducing symptom intensity in nighttime reflux and sleep disorders, improving quality of life and work productivity. That can sometimes be achieved through dose modifications by splitting or increasing the dose, or through galenic formulation. Proton pump inhibitors are not exempt from controversial aspects related to associated adverse events. Technological development is directed at improving proton pump inhibitor performance through increasing the half-life, maximum concentration, and area under the curve of the plasma concentrations through galenic formulation, as well as creating safer and more tolerable drugs. The present review is focused on the mechanisms of action, pharmacokinetic properties, and technological advances for increasing the pharmacologic performance of a proton pump inhibitor.
Tissue factor (TF) is an initiator of the extrinsic cascade of blood coagulation. Although recent studies have revealed a relationship between metastatic properties and TF expression in some ...neoplastic cells, the significance of TF in lung cancer, especially in non-small-cell lung cancer (NSCLC), is still unclear. In this study, TF was detected in NSCLC cell lines by functional study, Western blot analysis and immunocytochemical staining. TF levels in eight NSCLC cell lines were also quantitated by enzyme-linked immunosorbent assay (ELISA), and TF expression was evaluated in 55 specimens of surgically resected NSCLCs. NSCLC cell lines derived from metastatic lesions produced high levels of TF (48.3+/-23.5 ng 10(-6) cells, mean +/- s.e.m.), whereas those derived from primary lesions produced low levels of TF (0.2+/-0.1 ng 10(-6) cells). Immunohistochemical studies disclosed significantly stronger staining for TF in cells from NSCLC patients with metastasis than in those without metastasis. Among the 28 patients with metastasis, ten were strongly positive, 16 were moderately positive and two were negative for TF. In contrast, among the 27 patients without metastasis, only two were strongly positive, 18 were moderately positive and seven were negative for TF. Therefore, malignant cells from patients with lung cancer produce various levels of TF, and TF may play an important role in the metastatic process.
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