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Author version made available in accordance with the publisher's policy., Background: To evaluate dysphagia in relation to bolus movement in patients undergoing laparoscopic fundoplication. Methods: Liquid and viscous swallows were evaluated with impedance/manometry in 19 patients with reflux disease before and after surgery. A new method of automated impedance manometry (AIM) analysis correlated esophageal pressure with impedance data and automatically calculated a range of pressure & bolus movement variables. An iterative analysis determined if any variables were altered in relation to dysphagia. Standard measures of esophago-gastric junction (EGJ) pressure, bolus presence time (BPT) and total bolus transit time (TBTT) were also evaluated. Key Results: At 5 months post-op, 15 patients had some dysphagia, including 7 with new-onset dysphagia. For viscous boluses, three AIM-derived pressure-flow variables recorded pre-operatively varied significantly in relation to post-operative dysphagia. These were: time from nadir esophageal impedance to peak esophageal pressure (TNadImp-PeakP), median intra-bolus pressure (IBP, mmHg) and the rate of bolus pressure rise (IBP slope, mmHg s-1). These variables were combined to form a dysphagia risk index (DRI) of esophageal dysfunction (DRI = IBP*IBP_slope/TNadImp-PeakP). DRI values derived from pre-operative measurements were significantly elevated in those with post-operative dysphagia (DRI 58, IQR 21-408 vs no dysphagia DRI 9, IQR -2-19, p 14 was optimally predictive of dysphagia (sensitivity 75% and specificity 93%). Conclusions & Inferences: Before surgery, a greater and faster compression of a swallowed viscous bolus with less bolus flow time relates to post-operative dysphagia. Thus susceptibility to post-fundoplication dysphagia is related to a pre-existing sub-clinical variation of esophageal function.

Holloway R. Ross. TORRE DI SATRIANO. In: Bibliografia topografica della colonizzazione greca in Italia e nelle Isole Tirreniche, n°21, 2012. Siti : Torre Castelluccia - Zambrone. pp. 21-23.

International audience; ATLAS is one of the largest collaborations ever undertaken in the physical sciences. This paper explains how the software infrastructure is organized to manage collaborative code development by around 300 developers with varying degrees of expertise, situated in 30 different countries. We will describe how the succeeding releases of the software are built, validated and subsequently deployed to remote sites. Several software management tools have been used, the majority of which are not ATLAS specific; we will show how they have been integrated. ATLAS offline software currently consists of about 2 MSLOC contained in 6800 C++ classes, organized in almost 1000 packages.

Background—The abnormally high postprandial rate of transient lower oesophageal sphincter relaxations seen in patients with reflux disease may be related to altered proximal gastric motor function. Heightened visceral sensitivity may also contribute to reporting of symptoms in these patients.Aims—To assess motor function of the proximal stomach and visceral perception in reflux disease with a barostat.Methods—Fasting and postprandial proximal gastric motility, sensation, and symptoms were measured in nine patients with reflux disease and nine healthy subjects. Gastric emptying of solids and liquids was assessed in six of the patients on a different day (and compared to historical controls).Results—Minimal distending pressure and gastric compliance were similar in the two groups, whereas the patients experienced fullness at lower pressures (pConclusions—Reflux disease is associated with delayed recovery of proximal gastric tone after a meal and increased visceral sensitivity. The former may contribute to the increased prevalence of reflux during transient lower oesophageal sphincter relaxations and the delay in emptying from the proximal stomach, whereas both may contribute to symptom reporting.

OBJECTIVE: Transient lower esophageal sphincter relaxations (TLESRs) are the main mechanism underlying gastroesophageal reflux. In the present study we evaluated the effect of loxiglumide, a specific cholecystokininA (CCKA)-receptor antagonist, on the occurrence of TLESRs evoked by gastric distension. METHODS: Eight healthy subjects underwent esophageal manometry using a 10-lumen sleeve assembly during placebo or loxiglumide (10 mg/kg/h) in a randomized double-blind order. Gastric distension was induced by inflation of 400 ml of air. RESULTS: Basal lower esophageal pressure (LESP) and swallow-induced relaxation were not affected by loxiglumide. Loxiglumide significantly reduced the number of TLESRs, from 11.5 (5.8-18.3) to 6.0 (3.3-14.3) during the total recording period of 1 h, and from 5.5 (4.25-7.5) to 2.0 (0.5-6.8) during the first 15 min. The number of common cavities was significantly decreased by loxiglumide, from 8.0 (4.0-20.0) to 5.0 (2.0-7.8). TLESRs represented the main mechanism (60% during placebo, 74% during loxiglumide) underlying common cavities, followed by swallow-induced relaxation. CONCLUSIONS: Loxiglumide significantly reduces the number of TLESRs triggered by gastric distension without interfering with swallow-related relaxation of the lower esophageal sphincter, suggesting the involvement of CCKA receptors in the reflex pathway mediating TLESRs

Information on the mechanism of gastro-oesophageal reflux in patients with reflux disease is limited largely to studies in resting recumbent subjects. Evidence exists that both posture and physical activity may influence reflux. The aim of this study was to investigate reflux mechanisms in ambulant patients with reflux oesophagitis. Concurrent ambulatory oesophageal manometry and pH monitoring were performed in 11 ambulant patients with erosive oesophagitis. Lower oesophageal sphincter (LOS) pressure was monitored with a perfused sleeve sensor. Recordings were made for 90 min before and 180 min after a meal. At set times patients sat in a chair or walked. LOS pressure was ≤2 mmHg at the time of reflux for 98% of reflux episodes. Transient LOS relaxation was the most common pattern overall and the predominant pattern in seven patients, whilst persistently absent basal LOS pressure was the most common pattern in four patients. The pattern of LOS pressure was not altered by the presence of hiatus hernia or by walking. Straining occurred at the onset of 31% of acid reflux episodes but often followed the development of an oesophageal common cavity. The occurrence of straining was not influenced by walking. In ambulant patients with reflux oesophagitis: (1) LOS pressure is almost always absent at the time of reflux, usually because of transient LOS relaxation, (2) persistently absent basal LOS pressure is an important mechanism of reflux in a few patients, (3) straining may help to induce acid reflux in a variable proportion of occasions and may in some instances be a response to gas reflux, and (4) walking does not influence the occurrence of reflux or its mechanisms.