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1.
Med Sci Monit ; 26: e919815, 2020 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-32248203

RESUMO

BACKGROUND Fructus aurantii is a flavonoid derived from Citrus aurantium (bitter orange) that is used in traditional Chinese medicine (TCM) to treat gastric motility disorders. This study aimed to investigate the effects of low-dose and high-dose decoctions of Fructus aurantii in a rat model of functional dyspepsia (FD). MATERIAL AND METHODS Sprague-Dawley rats (n=90) were divided into nine study groups: the control group, the FD model group, the domperidone-treated (Domp) group, the low-dose raw Fructus aurantii (FA-L) group, the high-dose raw Fructus aurantii (FA-H) group, the low-dose Fructus aurantii with stir-fried wheat bran (Bran-L) group, the high-dose Fructus aurantii with stir-fried wheat bran (Bran-H) group, the low-dose Fructus aurantii with stir-fried wheat bran and honey (Honey-L) group, and the high-dose Fructus aurantii with stir-fried wheat bran and honey (Honey-H) group. The FD rat model was established by semi-starvation, followed by tail damping, stimulation, and forced exercise with fatigue. Change in weight, rate of gastric emptying and intestinal propulsion, and serum levels of leptin, motilin, vasoactive intestinal peptide (VIP), gastrin, calcitonin gene-related peptide (CGRP), ghrelin, and cholecystokinin were compared between the groups. RESULTS In the FD model group, weight, rate of gastric emptying and intestinal propulsion significantly decreased, the expression of leptin, VIP and CGRP increased, and expression of motilin, gastrin, ghrelin, and cholecystokinin significantly decreased. Treatment with low-dose Fructus aurantii with stir-fried wheat bran significantly reversed these effects. CONCLUSIONS In the rat model of FD, low-dose Fructus aurantii with stir-fried wheat bran increased gastrointestinal motility and gastrointestinal hormone levels.


Assuntos
Citrus/química , Dispepsia/tratamento farmacológico , Animais , Relação Dose-Resposta a Droga , Medicamentos de Ervas Chinesas/farmacologia , Esvaziamento Gástrico/efeitos dos fármacos , Esvaziamento Gástrico/fisiologia , Motilidade Gastrointestinal/efeitos dos fármacos , Motilidade Gastrointestinal/fisiologia , Medicina Tradicional Chinesa , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley
2.
Anaesthesia ; 75(3): 323-330, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31802485

RESUMO

We aimed to compare the reliability of aspiration via a nasogastric tube with ultrasound for assessment of residual gastric volume. Sixty-one adult patients who were mechanically ventilated and received continuous enteral feeding through a nasogastric tube for > 48 h were included. A first qualitative and quantitative ultrasound examination of the gastric antrum was followed by gastric suctioning, performed by an operator blinded to the result of the ultrasound examination. A second ultrasound examination was performed thereafter, followed by re-injection of the aspirated gastric contents (≤ 250 ml) into the stomach. A third ultrasound assessment was then immediately performed. If the suctioned volume was ≥ 250 ml, 250 mg erythromycin was infused over 30 min. A fourth ultrasound was performed 90 min after the third. Sixty (98%) patients had a qualitatively assessed full stomach at first ultrasound examination vs. 52 (85%) after gastric suctioning (p = 0.016). The calculated gastric volume significantly decreased after gastric suctioning, without a significant decrease in the number of patients with volume ≥ 250 ml. Four of the nine patients with calculated gastric volume ≥ 250 ml had vomiting within the last 24 h (p = 0.013). The antral cross-sectional area significantly decreased between the third and the fourth ultrasound examination (p = 0.015). Erythromycin infusion did not make a significant difference to gastric volume (n = 10). Our results demonstrate that gastric suctioning is not a reliable tool for monitoring residual gastric volume. Gastric ultrasound is a feasible and promising tool for gastric volume monitoring in clinical practice.


Assuntos
Aspiração Respiratória de Conteúdos Gástricos/diagnóstico por imagem , Estômago/diagnóstico por imagem , Sucção/métodos , Adulto , Idoso , Antibacterianos/efeitos adversos , Estudos de Coortes , Eritromicina/efeitos adversos , Feminino , Esvaziamento Gástrico , Conteúdo Gastrointestinal , Humanos , Intubação Gastrointestinal , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Estudos Prospectivos , Reprodutibilidade dos Testes , Estômago/anatomia & histologia , Estômago/efeitos dos fármacos , Ultrassonografia , Vômito/etiologia
4.
Diabetes Res Clin Pract ; 158: 107892, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31669625

RESUMO

AIMS: Glucagon has an important role in glucose homeostasis. Recently, a new plasma glucagon assay based on liquid chromatography-high resolution mass spectrometry was developed. We evaluated the influence of a dipeptidyl peptidase-4 inhibitor (anagliptin) on plasma glucagon levels in Japanese patients with type 2 diabetes by using this new assay. METHODS: Twenty-four patients with type 2 diabetes were enrolled in a prospective, single-center, randomized, open-label study and were randomly allocated to 4 weeks of treatment with metformin (1000 mg/day) or anagliptin (200 mg/day). A liquid test meal labeled with sodium [13C] acetate was ingested before and after the treatment period. Samples of blood and expired air were collected over 3 h. Plasma levels of glucose, glucagon, C-peptide, glucagon-like peptide-1 (GLP-1), and glucose-dependent insulinotropic polypeptide (GIP) were measured, and gastric emptying was also evaluated. RESULTS: Twenty-two patients completed the study (metformin group: n = 10; anagliptin group: n = 12). Glycemic control showed similar improvement in both groups. In the anagliptin group, there was a slight decrease of the incremental area under the plasma concentration versus time curve for glucagon after the test meal (P = 0.048). In addition, the plasma level of active GLP-1 and GIP was increased, and plasma C-peptide was also increased versus baseline. Neither anagliptin nor metformin delayed gastric emptying. CONCLUSIONS: In patients with type 2 diabetes maintained endogenous insulin secretion, anagliptin increased the plasma level of active GLP-1 and GIP in association with a slight stimulation of insulin secretion and slight inhibition of glucagon secretion, but did not delay gastric emptying. Clinical Trial Registry: University hospital Medical Information Network UMIN000028293.


Assuntos
Esvaziamento Gástrico/efeitos dos fármacos , Glucagon/efeitos dos fármacos , Hipoglicemiantes/uso terapêutico , Espectrometria de Massas/métodos , Metformina/uso terapêutico , Pirimidinas/uso terapêutico , Adulto , Idoso , Diabetes Mellitus Tipo 2/sangue , Feminino , Humanos , Hipoglicemiantes/farmacologia , Masculino , Metformina/farmacologia , Pessoa de Meia-Idade , Estudos Prospectivos , Pirimidinas/farmacologia , Adulto Jovem
5.
Pak J Pharm Sci ; 32(4): 1723-1747, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31608897

RESUMO

Curcumin, a natural polyphenolic compound derived from turmeric (Curcuma longa L), has proven to exhibit biological activity towards different kinds of diseases. But the low oral bioavailability results in a limited application in clinic treatment. Recently, numerous curcumin derivatives were synthesized by the modification of three important functional groups: The aromatic o-methoxy phenolic group, a seven conjugated carbon linker and the ß-diket one moiety. However, many people know curcumin only as an anticancer agent and overlook the diverse biological activities of curcumin and curcumin-based derivatives. In this article, we summarized the novel synthetic curcuminoids by different therapeutic activities including antioxidant activity, anti-HIV activity, stimulating activity of gastric emptying, anti-inflammatory activity, ACE inhibition activity, prevention of Parkinson's disease, anti-parasitism, anti-obesity, prevention of Alzheimer's disease, and antibacterial activity. The relation between structural features and activities were also investigated.


Assuntos
Fármacos Anti-HIV/farmacologia , Antioxidantes/farmacologia , Antiparkinsonianos/farmacologia , Diarileptanoides/farmacologia , Doença de Alzheimer/tratamento farmacológico , Inibidores da Enzima Conversora de Angiotensina/química , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Animais , Antibacterianos/química , Antibacterianos/farmacologia , Fármacos Anti-HIV/química , Fármacos Antiobesidade/química , Fármacos Antiobesidade/farmacologia , Antioxidantes/química , Antiparkinsonianos/química , Antiprotozoários/química , Antiprotozoários/farmacologia , Diarileptanoides/síntese química , Diarileptanoides/química , Esvaziamento Gástrico/efeitos dos fármacos , Humanos , Estrutura Molecular
6.
Medicine (Baltimore) ; 98(41): e17205, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593078

RESUMO

Bariatric surgery (BAS) may result in adverse outcomes that include appearance of gastrointestinal (GI) symptoms and/or failure to reach the weight reduction goal. This retrospective study tested the hypothesis that pre-operative gastric emptying (GE) abnormality is responsible for adverse post-surgical outcomes.Pre-operative GE was performed using the standard solid-meal GE scintigraphy (GES) in 111 consecutive patients (105 females and 6 males, mean age 46.2 years, range 20-70 years) who were evaluated for BAS. All underwent BAS - 93 had laparoscopic sleeve gastrectomy (LSG) and 18 had Roux-en-Y (ReY) gastric bypass. All had short-term (3-6 months) and long-term (up to 54 months) follow-up with review of symptoms, physical, and laboratory examinations. Chi-square analysis was performed. P-value < .05 was considered significant.Of the 111 patients, 83 had normal and 28 had abnormal pre-op GES. Sixty-eight were asymptomatic and 43 were symptomatic prior to surgery. Following surgery, 81 patients were asymptomatic and 30 were symptomatic at long-term follow-up. There was no significant difference between pre-op GE results and post-surgical adverse clinical outcome (p = ns). However, GES results seem to have guided the selection of surgical procedure significantly (P = .008).Pre-operative GE study was not a strong predictor of clinical outcome in BAS. Although, it influenced the type of surgery, as when the GES was abnormal, the patient was more likely to undergo ReY and when GES was normal, they favored LSG. Interestingly, many of our symptomatic patients at 6 months post-op were asymptomatic after long-term follow-up.


Assuntos
Cirurgia Bariátrica/estatística & dados numéricos , Esvaziamento Gástrico/fisiologia , Obesidade Mórbida/fisiopatologia , Seleção de Pacientes , Cintilografia/estatística & dados numéricos , Adulto , Idoso , Cirurgia Bariátrica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Período Pré-Operatório , Estudos Retrospectivos , Adulto Jovem
7.
J Pharm Pharmacol ; 71(11): 1663-1676, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31566757

RESUMO

OBJECTIVES: The main objective of the present work was to combine in-vitro and in-silico tools to better understand the in-vivo behavior of the immediate release (IR) formulation of zolpidem in the fasted and fed states. METHODS: The dissolution of zolpidem was evaluated using biorelevant media simulating the gastric and intestinal environment in the fasted and fed states. Additionally, the influence of high viscosity and high fat content on the release of zolpidem under fed state conditions was investigated. The in-vitro results were combined with a physiologically based pharmacokinetic (PBPK) model constructed with Simcyp® to simulate the zolpidem pharmacokinetic profile in both prandial states. KEY FINDINGS: In vitro biorelevant dissolution experiments representing the fasted and fed states, combinedwith PBPKmodelling, were able to simulate the plasma profiles from the clinical food effect studies well. Experiments reflecting the pH and fat content of themeal led to a good prediction of the zolpidem plasma profile in the fed state, whereas increasing the viscosity of the gastricmedia led to an under-prediction. CONCLUSIONS: This work demonstrates that the combination of biorelevant dissolution testing and PBPK modelling is very useful for understanding the in-vivo behavior of zolpidem in the fasted and fed states. This approach could be implemented in the development of other drugs exhibiting negative food effects, saving resources and bringing new drug products to the market faster.


Assuntos
Interações Alimento-Droga/fisiologia , Comprimidos/farmacocinética , Zolpidem/farmacocinética , Administração Oral , Adolescente , Adulto , Simulação por Computador , Jejum/fisiologia , Esvaziamento Gástrico/fisiologia , Humanos , Absorção Intestinal/fisiologia , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Solubilidade/efeitos dos fármacos , Adulto Jovem
8.
Thorac Surg Clin ; 29(4): 415-419, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31564398

RESUMO

Giant paraesophageal hernias can present as an asymptomatic incidentally detected paraesophageal hernia to an emergent gastric volvulus with concern for ischemia. In the acute setting, the preoperative evaluation aims to determine the extent of complications from gastric volvulus. In the elective setting, preoperative testing defines the gastroesophageal anatomy and function to select the optimal operation. Through thoughtful preoperative evaluation, the best operative approach can be tailored to each patient.


Assuntos
Tomada de Decisão Clínica , Hérnia Hiatal/cirurgia , Herniorrafia , Seleção de Pacientes , Algoritmos , Doenças Assintomáticas , Endoscopia do Sistema Digestório , Esvaziamento Gástrico , Humanos , Laparoscopia , Cuidados Pré-Operatórios , Medição de Risco , Volvo Gástrico/etiologia , Volvo Gástrico/cirurgia , Conduta Expectante
10.
Am Surg ; 85(10): 1162-1165, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657316

RESUMO

The risk factors and associated conditions of median arcuate ligament syndrome (MALS) have not been well characterized in the literature. In this study, we aim to investigate the presentation and outcomes of MALS patients with an emphasis on the prevalence of other uncommon disorders. To this end, data of patients with MALS who underwent surgery between 2013 and 2018 were collected and compiled into a retrospective database and analyzed. Eleven patients were identified. Seven of these eleven patients underwent diagnostics to evaluate gastric emptying. Five of these seven patients (71.4%) had radiographic evidence of delayed gastric emptying. Four of the eleven patients (36.4%) were found to have anatomic abnormalities of their visceral vasculature. Two of the eleven patients (18.2%) were found to have connective tissue disorders, both with Ehlers-Danlos syndrome. Three of the eleven (27.3%) had a diagnosis of postural orthostatic tachycardia syndrome. This is the first case series reporting on an association between MALS and delayed gastric emptying. We also explored the relationship between MALS and visceral vascular abnormalities, Ehlers-Danlos syndrome, and postural orthostatic tachycardia syndrome. It is notable that these conditions are more prevalent in the MALS population than in the general population, suggesting a possible pathophysiologic relationship.


Assuntos
Síndrome de Ehlers-Danlos/complicações , Esvaziamento Gástrico , Gastroparesia/complicações , Síndrome do Ligamento Arqueado Mediano/complicações , Síndrome do Ligamento Arqueado Mediano/fisiopatologia , Síndrome da Taquicardia Postural Ortostática/complicações , Adulto , Índice de Massa Corporal , Diagnóstico Diferencial , Síndrome de Ehlers-Danlos/diagnóstico , Feminino , Gastroparesia/diagnóstico , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Síndrome do Ligamento Arqueado Mediano/diagnóstico , Síndrome do Ligamento Arqueado Mediano/cirurgia , Cuidados Pré-Operatórios , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Vísceras/irrigação sanguínea
11.
Gut ; 68(12): 2238-2250, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31563877

RESUMO

Gastroparesis is defined by delayed gastric emptying (GE) and symptoms of nausea, vomiting, bloating, postprandial fullness, early satiety and abdominal pain. Most common aetiologies include diabetes, postsurgical and postinfectious, but in many cases it is idiopathic. Clinical presentation and natural history vary by the aetiology. There is significant morbidity and healthcare utilisation associated with gastroparesis. Mechanistic studies from diabetic animal models of delayed GE as well as human full-thickness biopsies have significantly advanced our understanding of this disorder. An innate immune dysregulation and injury to the interstitial cells of Cajal and other components of the enteric nervous system through paracrine and oxidative stress mediators is likely central to the pathogenesis of gastroparesis. Scintigraphy and 13C breath testing provide the most validated assessment of GE. The stagnant gastroparesis therapeutic landscape is likely to soon see significant changes. Relatively newer treatment strategies include antiemetics (aprepitant), prokinetics (prucalopride, relamorelin) and fundic relaxants (acotiamide, buspirone). Endoscopic pyloromyotomy appears promising over the short term, especially for symptoms of nausea and vomiting. Further controlled trials and identification of the appropriate subgroup with pyloric dysfunction and assessment of long-term outcomes are essential. This review highlights the clinical presentation, diagnosis, mechanisms and treatment advancements for gastroparesis.


Assuntos
Endoscopia Gastrointestinal/métodos , Esvaziamento Gástrico/fisiologia , Fármacos Gastrointestinais/uso terapêutico , Gastroparesia , Gastroparesia/diagnóstico , Gastroparesia/fisiopatologia , Gastroparesia/terapia , Humanos
13.
Med Hypotheses ; 130: 109282, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31383330

RESUMO

This novel, iso-osmo-resistive theory offers electro-resistivity of food components as a new dimension for digestion. Firstly, fats, carbohydrates and proteins differ markedly in their resistivity, which offers a way to monitor them, especially when digestive enzymes cause consistent and distinctive changes. Secondly the state of iso-resistivity is in theory most likely to pass through the membranes of absorbing cells and be compatible with plasma in portal blood vessels. Hence, the theory proposes that the aim of the digestive process in the upper gut is to present digesta to absorption sites in a state at, or close to, iso-osmo-resistivity. It requires a method of monitoring resistivity which could be achieved by neuronal endings based in the upper gut mucosa. They could be simple nerve endings or, probably less likely, part of the structure of duodenal Brunner's Glands. They would monitor the overall effect of the various digestive processes initiated by the G-protein-coupled receptors (GPCRs). The combination of sensitive electroreceptor and osmoreceptor output would provide a system that would accurately monitor the overall progress of digestion to conserve enzyme production.


Assuntos
Carboidratos/química , Proteínas na Dieta/química , Digestão/fisiologia , Mucosa Intestinal/metabolismo , Osmorregulação , Animais , Glândulas Duodenais/fisiopatologia , Duodeno/fisiopatologia , Impedância Elétrica , Fenômenos Eletrofisiológicos , Esvaziamento Gástrico , Humanos , Modelos Biológicos , Permeabilidade , Ornitorrinco , Receptores Acoplados a Proteínas-G/metabolismo
14.
Eur J Pharm Sci ; 138: 105019, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31374253

RESUMO

Enteric coating is a common procedure in the development of oral pharmaceutical dosage forms. The main advantage of enteric coating is that it protects the drug from acidic pH and enzymatic degradation in the stomach while protecting it from the undesirable effects of some drugs. There is certain controversy regarding the real influence of enteric coating on the bioavailability of many drugs. Various scientific articles have demonstrated an improvement in the extent of bioavailability of some drugs when enteric coating is used. In recent years, there have been many studies examining different formulation strategies for monolithic and multiparticulate systems, including different pharmaceutical oral dosage forms and delivery systems based on the combined use of enteric coating and other methods that improve the bioavailability of drugs administered orally. However, the real bioavailability, serum levels and therapeutic effect of these drugs may be influenced by gastrointestinal pH values, gastrointestinal environment, inter-individual or intra-individual variability in gastric emptying and gastrointestinal transit time, interpatient variability associated with the type of polymer used for enteric coating or other formulation variables. It deserves special attention to know the real influence of enteric coating on the bioavailability of new oral dosage forms.


Assuntos
Preparações Farmacêuticas/química , Preparações Farmacêuticas/metabolismo , Administração Oral , Disponibilidade Biológica , Química Farmacêutica/métodos , Formas de Dosagem , Sistemas de Liberação de Medicamentos/métodos , Esvaziamento Gástrico/efeitos dos fármacos , Trânsito Gastrointestinal/efeitos dos fármacos , Humanos
15.
AAPS PharmSciTech ; 20(7): 290, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31428895

RESUMO

Dosage forms with increased gastric residence time are promising tools to increase bioavailability of drugs with narrow absorption window. Low-density floating formulations could avoid gastric emptying; therefore, sustained drug release can be achieved. Our aim was to develop a new technology to produce low-density floating formulations by melt foaming. Excipients were selected carefully, with the criteria of low gastric irritation, melting range below 70°C and well-known use in oral drug formulations. PEG 4000, Labrasol and stearic acid type 50 were used to create metronidazole dispersion which was foamed by air on atmospheric pressure using in-house developed apparatus at 53°C. Stearic acid was necessary to improve the foamability of the molten dispersion. Additionally, it reduced matrix erosion, thus prolonging drug dissolution and preserving hardness of the moulded foam. Labrasol as a liquid solubiliser can be used to increase drug release rate and drug solubility. Based on the SEM images, metronidazole in the molten foam remained in crystalline form. MicroCT scans with the electron microscopic images revealed that the foam has a closed-cell structure, where spherical voids have smooth inner wall, they are randomly dispersed, while adjacent voids often interconnected with each other. Drug release from all compositions followed Korsmeyer-Peppas kinetic model. Erosion of the matrix was the main mechanism of the release of metronidazole. Texture analysis confirmed that stearic acid plays a key role in preserving the integrity of the matrix during dissolution in acidic buffer. The technology creates low density and solid matrix system with micronsized air-filled voids.


Assuntos
Formas de Dosagem , Temperatura Alta , Metronidazol/química , Estômago , Disponibilidade Biológica , Preparações de Ação Retardada , Composição de Medicamentos , Liberação Controlada de Fármacos , Excipientes/química , Esvaziamento Gástrico , Metronidazol/farmacocinética , Solubilidade , Ácidos Esteáricos/química
16.
Life Sci ; 233: 116749, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31412264

RESUMO

AIMS: Functional dyspepsia (FD) is very common worldwide with a high prevalence of 10%-30%, and it becomes a heavy burden to patients because of its hard to be cured. In our previous study, phenylethanoid glycosides were found to exist in Houpo, a traditional Chinese medicine commonly used for the treatment of abdominal distention, pain and dyspepsia. In the present study, the effect of magnoloside A (MA), a main phenylethanoid glycoside in Houpo, on FD was firstly evaluated and its potential mechanism was concluded. MATERIALS AND METHODS: MA was orally administered consequently for 3 weeks, and its effect on a FD rat model established through transient neonatal gastric irritation and mature alternate-day fasting was tested. Levels of brain-gut peptides and inflammatory factors in blood or tissues were determined by ELISA methods. Meanwhile, the gut microbiota was analyzed by 16S rRNA gene sequencing and short chain fat acids were determined by GC/MS. KEY FINDINGS: MA exhibited anti-FD activities by fastening the delayed gut emptying rate of FD rat and increasing the levels of gastrin, motilin, and calcitonin gene related protein; and decreasing the levels of 5-hydroxytryptamine, nitric oxide synthase, and vasoactive intestinal peptide. On the other hand, MA can modulate the composition of gut microbiota, resulting in the variation of the short chain fat acids. SIGNIFICANCE: MA ameliorated FD rats by modulating of the secretion of related brain-gut peptides and altering the composition of intestinal microbiota.


Assuntos
Encéfalo/metabolismo , Dispepsia/tratamento farmacológico , Microbioma Gastrointestinal , Trato Gastrointestinal/metabolismo , Glicosídeos/administração & dosagem , Fragmentos de Peptídeos/metabolismo , Administração Oral , Animais , Animais Recém-Nascidos , Dispepsia/metabolismo , Dispepsia/microbiologia , Esvaziamento Gástrico/efeitos dos fármacos , Glicosídeos/química , Magnolia/química , Masculino , Álcool Feniletílico/química , Ratos , Ratos Sprague-Dawley
17.
EBioMedicine ; 46: 452-462, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31401193

RESUMO

BACKGROUND: Gastric bypass surgery is a very effective treatment of obesity and type 2 diabetes. However, very few eligible patients are offered surgery. Some patients also prefer less invasive approaches. We aimed to study the effects of the Sleeveballoon - a new device combining an intragastric balloon with a connecting sleeve, which covers the duodenal and proximal jejunal mucosa - on insulin sensitivity, glycemic control, body weight and body fat distribution. METHODS: We compared the effects of Sleeveballoon, Roux-en-Y Gastric-Bypass (RYGB) and sham-operation in 30 high-fat diet (HFD) fed Wistar rats. Whole body and hepatic insulin sensitivity and insulin signaling were studied. Transthoracic echocardiography was performed using a Vevo 2100 system (FUJIFILM VisualSonics Inc., Canada). Gastric emptying was measured using gastrografin. FINDINGS: Hepatic (P = .023) and whole-body (P = .011) insulin sensitivity improved in the Sleeveballoon and RYGB groups compared with sham-operated rats. Body weight reduced in both Sleeveballoon and RYGB groups in comparison to the sham-operated group (503.1 ±â€¯8.9 vs. 614.4 ±â€¯20.6 g, P = .006 and 490.0 ±â€¯17.7 vs. 614.4 ±â€¯20.6 g, P = .006, respectively). Ectopic fat deposition was drastically reduced while glycogen content was increased in both liver and skeletal muscle. Gastric emptying (T1/2) was longer (157.7 ±â€¯29.2 min, P = .007) in the Sleeveballoon than in sham-operated rats (97.1 ±â€¯26.3 min), but shorter in RYGB (3.5 ±â€¯1.1 min, P < .0001). Cardiac function was better in Sleeveballoon and RYGB versus sham-operated rats. INTERPRETATION: The Sleeveballoon reduces peripheral and hepatic insulin resistance, glycaemia, body weight and ectopic fat deposition to a similar level as RYGB, although the contribution of gastric emptying to blood glucose reduction is different.


Assuntos
Glicemia , Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Glucose/metabolismo , Hepatopatia Gordurosa não Alcoólica/metabolismo , Adiposidade , Animais , Biomarcadores , Peso Corporal , Modelos Animais de Doenças , Ecocardiografia , Derivação Gástrica/instrumentação , Esvaziamento Gástrico , Teste de Tolerância a Glucose , Insulina/metabolismo , Resistência à Insulina , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/etiologia , Hepatopatia Gordurosa não Alcoólica/terapia , Cuidados Pós-Operatórios , Ratos , Transdução de Sinais
18.
Medicine (Baltimore) ; 98(34): e16663, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441841

RESUMO

BACKGROUND: The aim of present study is to investigate the relationship between the antecolic (AC) route of gastrojejunostomy (GJ) after pancreaticoduodenectomy (PD) or duodenojejunostomy (DJ) reconstruction after pylorus-preserving pancreaticoduodenectomy (PPPD), and the incidence of delayed gastric emptying (DGE). METHODS: An electronic search of 4 databases to identify all articles comparing AC and retrocolic (RC) reconstruction after PD or PPPD was performed. RESULTS: Fifteen studies involving 2270 patients were included for final pooled analysis. The overall incidence of DGE was 27.2%. Meta-analysis results showed AC group had lower incidence of DGE (odds ratio, 0.29; 95% confidence interval [CI], 0.16-0.52, P < .0001) and shorter hospital length of stay (weight mean difference, -3.29; 95% CI, -5.2 to -1.39, P = .0007). Days until to liquid and solid diet in the AC group were also significantly earlier than that in the RC group (P = .0006 and P < .0001). There was no difference in operative time, incidence of pancreatic fistula and bile leakage, and mortality, respectively. CONCLUSIONS: AC route of GJ after PD or DJ after PPPD is associated with a lower incidence of DGE. However, the preferred route for GJ or DJ reconstruction remains to be investigated in well-powered, randomized, controlled trial.


Assuntos
Derivação Gástrica/métodos , Esvaziamento Gástrico , Pancreaticoduodenectomia/métodos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Perda Sanguínea Cirúrgica , Humanos , Intubação Gastrointestinal , Duração da Cirurgia
19.
Food Funct ; 10(8): 4577-4583, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31328214

RESUMO

White rice is considered a high glycemic index (GI) food and extruded reformed rice offers the opportunity to design a lower GI product. This study tested the effect of added soy protein isolate (SPI) or dietary fibers [corn bran (CB), resistant maltodextrin (RMD)] to delay in vitro digestion, and on human gastric emptying rate and satiety scoring. Starch digestion using a human simulated system showed a single-phase kinetic pattern for regular reformed rice and two-phase kinetic patterns for 20% supplemented extruded rice, which lowered the estimated glycemic index (eGI). For 20% SPI extruded rice (20SPI-ER), the first-phase rate constant (k1) of cooked extruded rice was higher than its second-phase (k2). Conversely, for 20% corn bran extruded rice (20CB-ER), a low value of k1 and high for k2 and C∞2 were found. The 20% RMD extruded rice (20RMD-ER) and the control exhibited a single-phase kinetic digestion with similar k values. The end-point of the second-phase digestion (C∞2) and the eGI of cooked 20SPI-ER were lower than for fiber addition. These differences were speculated to be due to the heterogeneous matrices of the SPI and CB incorporated kernels, opposed to the homogeneous matrices of the RMD and control. Thus, extruded rice compositions were found that resulted in different starch digestion kinetics [single phase and two-phase (k1/k2) high/low, low/high] and were medium eGI with added protein or fiber. Compared to the control, only 20RMD-ER had lower gastric half-emptying time and 20CB-ER had higher subject satisfaction.


Assuntos
Fibras na Dieta/metabolismo , Aditivos Alimentares/metabolismo , Trato Gastrointestinal/metabolismo , Oryza/metabolismo , Proteínas de Soja/metabolismo , Amido/metabolismo , Fibras na Dieta/análise , Digestão , Aditivos Alimentares/química , Esvaziamento Gástrico , Trato Gastrointestinal/química , Índice Glicêmico , Humanos , Cinética , Oryza/química , Proteínas de Soja/química , Amido/química , Zea mays/química , Zea mays/metabolismo
20.
Nutrients ; 11(7)2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31295897

RESUMO

The achievement of optimal post-prandial (PP) glucose control in patients with type 1 diabetes (T1DM) remains a great challenge. This review summarizes the main factors contributing to PP glucose response and discusses the likely reasons why PP glucose control is rarely achieved in T1DM patients. The macronutrient composition of the meal, the rate of gastric emptying and premeal insulin administration are key factors affecting the PP glucose response in T1DM. Although the use of continuous insulin infusion systems has improved PP glucose control compared to conventional insulin therapy, there is still need for further ameliorations. T1DM patients frequently present a delayed gastric emptying (GE) that produces a lower but more prolonged PP hyperglycemia. In addition, delayed GE is associated with a longer time to reach the glycemic peak, with a consequent mismatch between PP glucose elevation and the timing of premeal insulin action. On this basis, including GE time and meal composition in the algorithms for insulin bolus calculation of the insulin delivery systems could be an important step forward for optimization of PP glucose control in T1DM.


Assuntos
Glicemia/fisiologia , Diabetes Mellitus Tipo 1 , Esvaziamento Gástrico/fisiologia , Período Pós-Prandial/fisiologia , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/metabolismo , Diabetes Mellitus Tipo 1/fisiopatologia , Humanos , Insulina/fisiologia , Refeições/fisiologia
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