Factors of poor prognosis in newborns with a prenatal diagnosis of gastroschisis in Bogota, Colombia.

OBJECTIVES: To identify factors associated with poor prognoses in newborns with a prenatal diagnosis of gastroschisis in eight hospitals in Bogota, Colombia, from 2011 to 2022. METHODS: A multi-center retrospective case-control study was conducted on newborns with gastroschisis in eight hospitals in Bogota, Colombia. Poor prognosis was defined as the presence of sepsis, intestinal complications, or death. RESULTS: The study included 101 patients. Preterm newborns under 32 weeks had a poor neonatal prognosis (OR 6.78 95 % CI 0.75-319). Oligohydramnios (OR 4.95 95 % CI 1.15-21.32) and staged closure with silo (OR 3.48; 95 % CI 1.10-10.96) were risk factors for neonatal death, and intra-abdominal bowel dilation of 20-25 mm was a factor for the development of intestinal complications (OR 3.22 95 % CI 1.26-8.23). CONCLUSIONS: Intra-abdominal bowel dilation between 20 and 25 mm was associated with intestinal complications, while oligohydramnios was associated with the risk of perinatal death, requiring increased antenatal surveillance of fetal wellbeing. Management with primary reduction when technically feasible is recommended in these infants, considering that the use of silos was associated with higher mortality.

Long-Term Clinical and Echocardiographic Outcomes Following the Ross Procedure: A Post Hoc Analysis of a Randomized Clinical Trial.

Importance: The Ross procedure as treatment for adults with aortic valve disease (AVD) has been the subject of renewed interest. Objective: To evaluate the long-term clinical and echocardiographic outcomes following the Ross procedure for the treatment of adults with AVD. Design, Setting, and Participants: This post hoc analysis of a randomized clinical trial included adult patients (age <69 years) who underwent a Ross procedure for the treatment of AVD, including those with active endocarditis, rheumatic AVD, decreased ejection fraction, and previous cardiac surgery. The trial, conducted from September 1, 1994, to May 31, 2001, compared homograft root replacement with the Ross procedure at a single center. Data after 2010 were collected retrospectively in November and December 2022. Exposure: Ross procedure. Main Outcomes and Measures: The primary end point was long-term survival among patients who underwent the Ross procedure compared with that in the age-, country of origin- and sex-matched general population. Secondary end points were freedom from any reintervention, autograft reintervention, or homograft reintervention and time-related valve function, autograft diameter, and functional status. Results: This study included 108 adults (92 [85%] male) with a median age of 38 years (range, 19-66 years). Median duration of clinical follow-up was 24.1 years (IQR, 22.6-26.1 years; 2488 patient-years), with 98% follow-up completeness. Of these patients, 9 (8%) had active endocarditis and 45 (42%) underwent reoperations. The main hemodynamic lesion was stenosis in 30 (28%) and regurgitation in 49 (45%). There was 1 perioperative death (0.9%). Twenty-five year survival was 83.0% (95% CI, 75.5%-91.2%), representing a relative survival of 99.1% (95% CI, 91.8%-100%) compared with the general population (83.7%). At 25 years, freedom from any reintervention was 71.1% (95% CI, 61.6%-82.0%); from autograft reintervention, 80.3% (95% CI, 71.9%-89.6%); and from homograft reintervention, 86.3% (95% CI, 79.0%-94.3%). Thirty-day mortality after the first Ross-related reintervention was 0% and after all Ross-related reinterventions was 3.8% (n = 1); 10-year survival after reoperation was 96.2% (95% CI, 89.0%-100%). Conclusions and Relevance: This study found that the Ross procedure provided excellent survival into the third decade postoperatively that was comparable to that in the general population. Long-term freedom from reintervention demonstrated that the Ross procedure may be a durable substitute into late adulthood, showing a delayed but progressive functional decline. Trial Registration: isrctn.org Identifier: ISRCTN03530985.

Sustainable Particleboards Based on Brewer's Spent Grains.

Brewer's spent grain (BSG) is the main solid waste generated in beer production and primarily consists of barley malt husks. Based on the active promotion of circular economy practices aimed at recycling food industry by-products, this study assessed for the first time the production of particleboards based on BSG as the sole source of lignocellulosic material and natural adhesive without the use of additives or other substrates. In order to achieve particleboards from entirely sustainable sources, BSG particles have to self-bind by thermo-compression with water. In this context, the aim of this study is to assess the effects of pressing temperatures and particle size on properties such as modulus of elasticity, modulus of rupture, internal bond, thickness swelling, and water absorption. The performance of binderless boards was compared with that of a control panel (control) using BSG combined with phenolic resin. Processing conditions were selected to produce boards with a target density of 1000 kg/m³ and a thickness of 5 mm. To confirm the efficiency of the self-adhesion process, scanning electron microscopy was used to examine the boards. The processes of self-adhesion and particle-to-particle contact were facilitated at a pressing temperature of 170 °C and a particle size range of 200-2380 µm (ground BSG), resulting in improved flexural properties and enhanced water resistance. The properties of BSG-based binderless boards were comparable to those reported for other biomass residues, suggesting that they might be used in non-structural applications, such as interior decoration.

Identifying crustal contributions in the Patagonian Chon Aike Silicic Large Igneous Province.

The volcanic rocks of the Chon Aike Silicic Large Igneous Province (CASP) are recognized as magmas dominantly produced by crustal anatexis. Investigating the zircon of the CASP provides an opportunity to gain further insight into geochemical and isotopic differences of the potential magmatic sources (i.e., crust versus mantle), to identify crustal reservoirs that contributed to the felsic magmas during anatexis, and to quantify the contributions of the respective sources. We present a combined zircon oxygen and hafnium isotope and trace element dataset for 16 volcanic units of the two youngest volcanic phases in Patagonia, dated here with LA-ICP-MS U-Pb geochronology at ca. 148-153 Ma (El Quemado Complex, EQC) and ca. 159 Ma (western Chon Aike Formation, WCA). The EQC zircon have 18O-enriched values (δ18O from 7 to 9.5‰) with correspondingly negative initial εHf values (- 2.0 to - 8.0). The WCA zircon have δ18O values between 6 and 7‰ and εHf values ranging between - 4.0 and + 1.5. Binary δ18O-εHf mixing models require an average of 70 and 60% melt derived from partial melting of isotopically distinct metasedimentary basements for the EQC and WCA, respectively. Zircon trace element compositions are consistent with anatexis of sedimentary protoliths derived from LIL-depleted upper continental crustal sources. The overlap between a high heat flux environment (i.e., widespread extension and lithospheric thinning) during supercontinental breakup and a fertile metasedimentary crust was key in producing voluminous felsic volcanism via anatexis following the injection and emplacement of basaltic magmas into the lower crust. Supplementary Information: The online version contains supplementary material available at 10.1007/s00410-023-02065-1.

Antifungal Soybean Protein Concentrate Adhesive as Binder of Rice Husk Particleboards.

The aim of this research was to prepare an antifungal soybean protein concentrate (SPC) adhesive containing carvacrol (CRV) as a bioactive agent able to delay the attack of molds and yeast during storage of SPC adhesive at 4 °C as water-based systems. CRV was incorporated in SPC slurry at 0.5% v/v (~10 times its minimum inhibitory concentration against Aspergillus terreus, used as model fungus), to ensure its long-term action. CRV scarcely altered the thermal properties, structure and apparent viscosity of SPC adhesive. Active SPC aqueous dispersion was microbiologically stable for at least 30 days at 4 °C where the colonization begins, while control SPC was visually colonized from the second day. Rice husk (RH) particleboards of density ~900 kg/m3 were manufactured using the active SPC stored for 0, 10, 20, and 30 days as a binder. Modulus of elasticity, modulus of rupture and internal bond of RH-control SPC (without CRV) panels were 12.3 MPa, 2.65 GPa and 0.27 MPa, respectively, and were statistically unaltered compared with those obtained with fresh SPC, regardless of the presence of CRV or the storage time. This last implies that active SPC should not necessarily have to be prepared daily and/or be used immediately after its preparation. Since it is microbiologically stabilized, it can be store at least for 30 days, ensuring the stability of the protein. The quality of the adhesive was evidenced by the consistent properties of the adhesive, expanding its potential use and commercialization.

Gauging classical and quantum integrability through out-of-time-ordered correlators.

Out-of-time-ordered correlators (OTOCs) have been proposed as a probe of chaos in quantum mechanics, on the basis of their short-time exponential growth found in some particular setups. However, it has been seen that this behavior is not universal. Therefore, we query other quantum chaos manifestations arising from the OTOCs, and we thus study their long-time behavior in systems of completely different nature: quantum maps, which are the simplest chaotic one-body system, and spin chains, which are many-body systems without a classical limit. It is shown that studying the long-time regime of the OTOCs it is possible to detect and gauge the transition between integrability and chaos, and we benchmark the transition with other indicators of quantum chaos based on the spectra and the eigenstates of the systems considered. For systems with a classical analog, we show that the proposed OTOC indicators have a very high accuracy that allow us to detect subtle features along the integrability-to-chaos transition.

Ultrastructural, Molecular and Functional Mapping of GABAergic Synapses on Dendritic Spines and Shafts of Neocortical Pyramidal Neurons.

The location of GABAergic synapses on dendrites is likely key for neuronal integration. In particular, inhibitory inputs on dendritic spines could serve to selectively veto or modulate individual excitatory inputs, greatly expanding the computational power of individual neurons. To investigate this, we have undertaken a combined functional, molecular, and ultrastructural mapping of the location of GABAergic inputs onto dendrites of pyramidal neurons from upper layers of juvenile mouse somatosensory cortex. Using two-photon uncaging of GABA, intracellular labeling with gerphyrin intrabodies, and focused ion beam milling with scanning electron microscopy, we find that most (96-98%) spines lack GABAergic synapses, although they still display GABAergic responses, potentially due to extrasynaptic GABA receptors. We conclude that GABAergic inputs, in practice, contact dendritic shafts and likely control clusters of excitatory inputs, defining functional zones on dendrites.

Long-term stability of compression-molded soybean protein concentrate films stored under specific conditions.

Post-processing evolution of the functional properties of soybean protein concentrate (SPC) films, plasticized with varying levels of glycerol and processed by compression molding, was examined over a period of 90days. Films stored in the glassy state (25±2°C and 65±2% relative humidity) lost glycerol and water over time, as determined by gas chromatography and the decline in moisture content. SPC films plasticized with 40-50% glycerol showed a time-dependent increment of the elastic modulus and the tensile strength. In turn, the elongation, barrier properties, soluble mass and opacity of these films varied marginally with time. By contrast, films with 30% glycerol lost the most moisture and their elongation was reduced significantly, while water vapor permeability slightly increased with aging. The performance of aged films resulted from the balance between plasticizer and water loss, and the progressive replacement of unordered structures by intermolecular hydrogen bonded ß-sheets and aggregates.

Medium-density particleboards from modified rice husks and soybean protein concentrate-based adhesives.

The main goal of this work was to evaluate the technical feasibility of using rice husk (RH) as wood substitute in the production of environmentally sound medium-density particleboards using adhesives from soybean protein concentrate (SPC). Chemical modification of rice husk with sodium hydroxide and sodium hydroxide followed by hydrogen peroxide (bleaching) were undertaken to evaluate the effect of such treatments on the composition and topology of rice husk and the performance of produced panels. Both treatments were efficient in partially eliminating hemicelluloses, lignin and silica from RH, as evidenced by thermo-gravimetric analysis (TGA). Scanning electron microscopy observations suggested that alkaline treatment resulted in a more damaged RH substrate than bleaching. The dependence of mechanical properties (modulus of rupture, modulus of elasticity, and internal bond) and the physical properties (water absorption and thickness swelling) on chemical treatments performed on both, rice husk and SPC was studied. Bleached-rice husk particleboards bonded with alkaline-treated soybean protein concentrate displayed the best set of final properties. Particleboards with this formulation met the minimum requirements of internal bond, modulus of elasticity and modulus of rupture recommended by the US Standard ANSI/A208.1 specifications for M1, MS and M2-grade medium-density particleboards, but failed to achieve the thickness swelling value recommended for general use panels. This limitation of soybean protein concentrate-bonded rice husk particleboards was counterbalanced by the advantage of being formaldehyde-free which makes them a suitable alternative for indoor applications.

Photorelease of GABA with Visible Light Using an Inorganic Caging Group.

We describe the selective photorelease of gamma-amino butyric acid (GABA) with a novel caged-GABA compound that uses a ruthenium complex as photosensor. This compound ("RuBi-GABA") can be excited with visible wavelengths, providing greater tissue penetration, less photo-toxicity, and faster photorelease kinetics than currently used UV light-sensitive caged compounds. Using pyramidal neurons from neocortical brain slices, we show that RuBi-GABA uncaging induces GABA-A receptor-mediated responses, has no detectable side effects on endogenous GABAergic and glutamatergic receptors and generates responses with kinetics and spatial resolution comparable to the best caged GABA compounds presently available. Finally, we illustrate two potential applications of RuBi-GABA uncaging: GABA receptor mapping, and optical silencing of neuronal firing.

Clinical outcomes of mitral valve repair with the Colvin-Galloway Future Band: a single-center experience.

OBJECTIVES: In 2001, a semirigid band (Colvin-Galloway Future Band, Medtronic, Inc., Minneapolis, Minnesota, USA) for mitral valve repair came onto the market. We report our experience of the correction of all types of mitral regurgitation using this device. METHODS: From August 2003 to December 2006, 140 patients (71% men, mean age 64 +/- 11 years) underwent valvuloplasty with this device for all types of mitral regurgitation: 94 (67%) degenerative, 34 (24%) postischemic, 11 (8%) dilative cardiomyopathy, and one (1%) postendocarditic. The patients underwent clinical and echocardiographic evaluation preoperatively, postoperatively before discharge, and after a median follow-up of 7 months (25th-75th percentile, 4-24 months). RESULTS: Total mortality was 6.4% (nine out of 140 patients): four patients (2.8%) died within 30 days (early death) and five died subsequently (the cause was cardiac in one case). Predischarge echocardiographic examination revealed a reduction in mitral regurgitation of at least 2 degrees in 99.2% of patients and the absence of systolic anterior movement. At the last follow-up, we recorded an improvement in New York Heart Association functional class (2.4 +/- 0.9 vs. 1.1 +/- 0.4, P < 0.0001), a significant reduction in the degree of mitral regurgitation (3.5 +/- 0.9 vs. 0.9 +/- 0.5, P < 0.0001), an increase in ejection fraction (54 +/- 11 vs. 55 +/- 9, P = 0.09), and a significant reduction in end-diastolic diameter (59 +/- 6 vs. 55 +/- 6, P < 0.0001). Two patients were reoperated on for mitral valve replacement, and no postoperative thromboembolic events occurred. CONCLUSION: Our experience shows that the Colvin-Galloway Future Band yields good results in mitral valvuloplasty for all types of mitral regurgitation. We are encouraged to continue using this device.

Increased expression of the immediate-early gene arc/arg3.1 reduces AMPA receptor-mediated synaptic transmission.

Arc/Arg3.1 is an immediate-early gene whose expression levels are increased by strong synaptic activation, including synapse-strengthening activity patterns. Arc/Arg3.1 mRNA is transported to activated dendritic regions, conferring the distribution of Arc/Arg3.1 protein both temporal correlation with the inducing stimulus and spatial specificity. Here, we investigate the effect of increased Arc/Arg3.1 levels on synaptic transmission. Surprisingly, Arc/Arg3.1 reduces the amplitude of synaptic currents mediated by AMPA-type glutamate receptors (AMPARs). This effect is prevented by RNAi knockdown of Arc/Arg3.1, by deleting a region of Arc/Arg3.1 known to interact with endophilin 3 or by blocking clathrin-coated endocytosis of AMPARs. In the hippocampal slice, Arc/Arg3.1 results in removal of AMPARs composed of GluR2 and GluR3 subunits (GluR2/3). Finally, Arc/Arg3.1 expression occludes NMDAR-dependent long-term depression. Our results demonstrate that Arc/Arg3.1 reduces the number of GluR2/3 receptors leading to a decrease in AMPAR-mediated synaptic currents, consistent with a role in the homeostatic regulation of synaptic strength.

Hughes technique, amniotic membrane allograft, and topical chemotherapy in conjunctival melanoma with eyelid involvement.

A 59-year-old woman presented with a pigmented mass in the inferior tarsal conjunctiva of the left eye with an associated diffuse, multifocal pigmentation involving largely the inferior half of the bulbar conjunctiva, fornix, and eyelid skin. Histopathologic examination of map biopsies disclosed conjunctival melanoma from primary acquired melanosis. Surgical excision of the inferior bulbar conjunctiva, fornix, and lower eyelid with histopathologic free margins was performed. Adjuvant cryotherapy was applied. The bulbar conjunctiva and lower fornix were reconstructed with an amniotic membrane allograft. Lower eyelid reconstruction was accomplished by use of the Hughes technique. Topical mitomycin C (0.04%) was applied after surgery. After 2 years of follow-up, no tumor recurrence has been detected and the eyelid and conjunctival defect have been satisfactorily corrected. This combined surgical procedure using amniotic membrane allograft and a composite tarsoconjunctival flap is shown to be useful in the treatment of an advanced conjunctival neoplasia with extensive eyelid involvement.

Cavitary choroidal melanoma.

CASE REPORT: We report an unusual case of cavitary choroidal melanoma. The results of ultrasonography, magnetic resonance imaging, computed tomography, and immunohistochemical studies are presented for a 38-year-old woman who developed an amelanotic tumor in the posterior choroid. B-scan ultrasonography disclosed intratumoral cavitations. Systemic and extraocular extension studies were negative. Enucleation was performed and histopathologic examination showed a choroidal melanoma of spindle cell type, with intratumoral cavitations lined by flattened tumor cells. COMMENTS: The majority of previous reports of intraocular cavitary tumors describe cavitary ciliary body tumors. Uveal melanoma should be included in the differential diagnosis of choroidal cavitary lesions. As far as we know, this is the second documented clinicopathologic correlation of a cavitary choroidal melanoma.

A double blind randomized controlled trial using topical application of travoprost 0.004% (40 µg/ml) vs placebo to induce hair growth among healthy male volunteers with androgenetic alopecia

BACKGROUND: Androgenetic alopecia (AGA) is the most common type of hair loss affecting men. Prostaglandin analogues are a new class of antiglaucoma agents documented to have localized and possibly permanent hair growth OBJECTIVE:To obtain quantitative evidence of the hair-inducing properties of travoprost (0.004%) vs a placebo METHODS: Included are twenty healthy male subjects with male pattern baldness types III to VII based on the Hamilton Norwood Scale for pattern of hair loss. Participants applied the substances onto the test sites of the scalp twice daily. Baseline photos and bimonthly photographs were taken. Hair growth was evaluated during each follow-up in terms of hair density and hair type and manual hair count was done. Repeated measure analysis was performed with a level of significance set at 0.05RESULTS: After 8 weeks of treatment, there was no significant difference in total hair density between the travoprost and the placebo groups (p=0.49). No significant difference was demonstrated in the number of vellus, intermediate and terminal hair at different follow-up periods using travoprost and placebo(p=0.66, p=0.86, p=0.89)CONCLUSION: The use of topical travoprost 40 mg/ml did not induce statistically significant hair growth in the bald scalps of human subjects.

Asymptomatic cardiac lymphoma in a hepatitis C virus-positive thalassemic patient.

Primary cardiac non-Hodgkin lymphomas are fast-growing intracavitary and/or intramyocardial nodular masses, while secondary lymphomas most commonly infiltrate the cardiac tissue. By any definition, cardiac non-Hodgkin lymphomas usually manifest through arrhythmias, refractory heart failure, pericardial effusion, and embolic stroke. We here describe a case of a cardiac non-Hodgkin lymphoma in which the following, previously undescribed features manifest simultaneously. It occurred in a polytransfused hepatitis C virus-positive splenectomized thalassemic patient; it rapidly grew, giving rise to an enormous right atrial mass and, this notwithstanding, it was completely asymptomatic. This cardiac lymphoma was discovered during staging for a CD20+ large B-cell lymphoma of the tonsils. In particular, transesophageal echocardiography, showing that this prolapsing mass had a wide base on the atrial wall, led us to strongly suspect the lymphomatous origin of the mass itself. Notwithstanding anti-CD20 antibody therapy, urgent surgery was unavoidable and histology revealed that the mass consisted of lymphoma proliferation infiltrating even the right atrial wall and the pericardium. During the postoperative course the patient presented with a massive, fatal hemopericardium consequent to intravascular disseminated coagulation. This very unusual case, occurring in a hepatitis C virus-positive thalassemic patient, suggests that a case control study on the incidence of non-Hodgkin lymphoma in such patients may be interesting.

Use of a new thickened formula for treatment of symptomatic gastrooesophageal reflux in infants.

BACKGROUND: Paediatricians are familiar with infants complaining of regurgitation and emesis from gastrooesophageal reflux. These subjects, usually growing satisfactorily and healthy, are affected by "functional" or "symptomatic" gastrooesophagel reflux and are treated with posture changes and thickened feedings. AIM: To evaluate in infants with symptomatic gastrooesophageal reflux the effect of a new formula (Nutrilon AR), containing carob flour/locus bean gum as a thickening agent; both clinical features and oesophageal acid exposure were evaluated. PATIENTS: Twenty-four infants (age range: 5-11 months; median age: 8 months; 8 females) presented at our Unit with a history of chronic postprandial regurgitation. METHODS: During a 24-hour intraoesophageal pH test a traditional formula thickened with rice flour at a concentration of 5% was alternated with the formula Nutrilon AR; thereafter infants were randomly allocated to receive, for two weeks, either a traditional thickened formula or the new formula, in addition to posture changes. RESULTS: Intraoesophageal acid exposure was significantly lower in the periods following the new formula than after traditional formula; at the end of the treatment period patients receiving the new formula had a more significant decrease of both symptomatic score and number of episodes of emesis than patients on traditional formula. CONCLUSIONS: The new available formula, with the characteristics of a thickened meal, is better than a formula, traditionally thickened with added rice flour, in the conservative treatment of infants with symptomatic gastrooesophageal reflux.

Antroduodenal motor effects of intravenous erythromycin in children with abnormalities of gastrointestinal motility.

BACKGROUND: The macrolide antibiotic erythromycin (EM) affects gastrointestinal motor activity by acting as agonist of motilin receptors located on the smooth muscle cells of the gastroduodenal tract. We studied the effect of intravenous EM on fasting antroduodenal motility in controls and children with gastrointestinal dysmotility. METHODS: EM lactobionate (rate, 3.0 mg/kg/h) was infused intravenously while antroduodenal manometry was recorded in 10 controls, in 7 patients with functional dyspepsia and in 6 patients with gut pseudo-obstruction. The mean (SD) age (years) was 5.7 (1.4), 6.5 (2.4), and 6.7 (3.2), respectively. Manometry was performed by means of a four- or six-lumen catheter introduced through the nose and perfused with a low compliance pneumohydraulic system. Five controls received EM and five received saline. RESULTS: EM, infused 5 minutes after passage of an activity front (AF), induced in controls a premature antroduodenal AF occurring 15.4 +/- 3.2 minutes after starting infusion; no motor changes were seen after saline; duration and propagation velocity of EM-induced AFs did not differ from spontaneous AFs. In patients with functional dyspepsia EM induced various patterns such as premature antroduodenal AFs, antral phase III-like pattern with short duodenal bursts or prolonged phasic antral waves and no duodenal activity. In patients with neurogenic pseudo-obstruction rare or absent antral activity with incoordinated or absent duodenal activity was induced; no contractions were elicited in two patients with myogenic pseudo-obstruction. CONCLUSIONS: It is confirmed that EM, given at subtherapeutic doses, is a powerful prokinetic agent that can have clinical applications in patients with gastrointestinal dysmotility; however, the effect of the drug seems to be influenced by the nature of the underlying disorder.

Effects of omeprazole on mechanisms of gastroesophageal reflux in childhood.

Prolonged recordings of esophageal motility have shown that dynamic changes of lower esophageal sphincter (LES) pressure such as transient LES relaxation and LES pressure drifts are the most common mechanisms underlying gastroesophageal reflux (GER). The coexistence of a delayed gastric emptying has also been reported in a high proportion of patients with reflux disease. However, not much information is available on the effects of antireflux therapy on the pathogenetic mechanisms of GER. The purpose of this study was to determine in a group of children with severe reflux disease the effect of omeprazole therapy on motor changes of LES underlying GER as well as on gastric emptying time. Twenty-two children (median age: 6.6 years) with GER disease, refractory to combined ranitidine and cisapride administration, entered into an eight-week omeprazole course. Ten subjects with moderate GER disease served as controls (median age: 6.0 years). Before and after omeprazole administration, the following variables were assessed: esophagitis grading, fasting and fed simultaneous prolonged recording of distal esophageal sphincter pressure (with a sleeve catheter) and intraesophageal pH, LES and esophageal peristalsis amplitude, and gastric emptying time of a mixed solid-liquid meal (measured with gastric ultrasound). As compared to controls, patients showed a higher rate of transient LES relaxation and LES pressure drift (P < 0.01), a reduced amplitude of basal sphincter pressure (P < 0.01) and peristalsis (P < 0.05), and a more prolonged gastric emptying time (P < 0.05). After ending omeprazole, there was no significant change in any of the motor abnormalities of the esophagus and in gastric emptying time despite a marked improvement of symptoms and esophagitis in all patients. Sixteen patients were symptomatic when reevaluated on a clinical basis two months after ending therapy. We conclude that in children with severe GER disease, an abnormally high rate of both transient LES relaxation and LES pressure drift and slow gastric emptying are not affected by omperazole treatment, even though esophageal mucosal damage is markedly improved or cured. These abnormalities represent a primary motor disorder and can be implicated in the refractoriness of reflux disease.