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Aims Thermal injury to the oesophagus is an important cause of life-threatening complication after ablation for atrial fibrillation (AF). Thermal protection of the oesophageal lumen by infusing cold liquid reduces thermal injury to a limited extent. We tested the ability of a more powerful method of oesophageal temperature control to reduce the incidence of thermal injury. Methods and results A single-centre, prospective, double-blinded randomized trial was used to investigate the ability of the ensoETM device to protect the oesophagus from thermal injury. This device was compared in a 1:1 randomization with a control group of standard practice utilizing a single-point temperature probe. In the protected group, the device maintained the luminal temperature at 4°C during radiofrequency (RF) ablation for AF under general anaesthesia. Endoscopic examination was performed at 7 days post-ablation and oesophageal injury was scored. The patient and the endoscopist were blinded to the randomization. We recruited 188 patients, of whom 120 underwent endoscopy. Thermal injury to the mucosa was significantly more common in the control group than in those receiving oesophageal protection (12/60 vs. 2/60; P = 0.008), with a trend toward reduction in gastroparesis (6/60 vs. 2/60, P = 0.27). There was no difference between groups in the duration of RF or in the force applied (P value range= 0.2–0.9). Procedure duration and fluoroscopy duration were similar (P = 0.97, P = 0.91, respectively). Conclusion Thermal protection of the oesophagus significantly reduces ablation-related thermal injury compared with standard care. This method of oesophageal protection is safe and does not compromise the efficacy or efficiency of the ablation procedure.

In flexible gastrointestinal (GI) endoscopy, endoscopic insufflation is crucial and directly affects visualization. Optimal visualization enables endoscopists to conduct better examinations and administer optimal treatments. However, endoscopic insufflation is typically performed manually and is subjective. We aimed to measure the GI endoluminal pressure during flexible GI endoscopy. Participants underwent esophagogastroduodenoscopy (EGD) at our endoscopy center. Pressure measurement was conducted after completing diagnostic or follow-up EGD. The endoluminal pressure in the esophagus and stomach was measured at 1-s intervals for 1 min while performing EGD for observational and diagnostic purposes. During the measurements, the endoscopists maintained what they subjectively considered to be adequate exposure for screening for lesions by dilating the lumen. Eighty patients were enrolled in this study. The upper GI endoluminal pressure was assessed during EGD without adverse events. The esophageal endoluminal pressure averaged 8.9 (− 3.0 to 20.7) mmHg, and the gastric endoluminal pressure averaged 10.0 (3.0–17.9) mmHg; the upper GI endoluminal pressures were not affected by patient-related factors or the number of endoscopists’ postgraduate years. We have successfully obtained the GI endoluminal pressures during EGD. Further accumulation of these data may lead to more stable and reproducible flexible endoscopic diagnosis and intervention.

In this paper, we analytically investigate axi-symmetric flow of a micro-polar fluid induced by peristaltic waves with progressively dilating amplitude. By means of mathematical formulation we examine its impact on swallowing of single food bolus through oesophagus. Liquid crystals, blood, some edible solutions resemble micro-polar property. Engineering applications using polymer solutions, colloidal solutions, drilling fluids in oil industries etc. may be better understood by this investigation. Long wavelength and low Reynolds number approximations are employed to get rid of non-linear convective terms and minimise curvature effects of the wall. It is inferred that increasing coupling number and amplitude dilation parameter enhance the pressure inside the tube, while micro-polar parameter is responsible for reducing the pressure along the axis of the tube. Local wall shear stress too increases with amplitude dilation parameter. The study suggests that achalasia patients should avoid the consuption of micro-polar fluids. It is also concluded that reflux action weakens with dilation of wave amplitude for micro-polar flows.

Introduction: Achalasia is a primary motor disorder of the oesophagus characterised by absence of peristalsis and insufficient lower oesophageal sphincter relaxation. With new advances and developments in achalasia management, there is an increasing demand for comprehensive evidence-based guidelines to assist clinicians in achalasia patient care. Methods: Guidelines were established by a working group of representatives from United European Gastroenterology, European Society of Neurogastroenterology and Motility, European Society of Gastrointestinal and Abdominal Radiology, and the European Association of Endoscopic Surgery in accordance with the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. A systematic review of the literature was performed and the certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Recommendations were voted upon using a nominal group technique. Results: These guidelines focus on the definition of achalasia, treatment aims, diagnostic tests, medical, endoscopic and surgical therapy, management of treatment failure, follow-up and oesophageal cancer risk. Conclusion: These multidisciplinary guidelines provide a comprehensive evidence-based framework with recommendations on the diagnosis, treatment and follow-up of adult achalasia patients.

INTRODUCTION: Achalasia is a primary motor disorder of the oesophagus characterised by absence of peristalsis and insufficient lower oesophageal sphincter relaxation. With new advances and developments in achalasia management, there is an increasing demand for comprehensive evidence-based guidelines to assist clinicians in achalasia patient care. METHODS: Guidelines were established by a working group of representatives from United European Gastroenterology, European Society of Neurogastroenterology and Motility, European Society of Gastrointestinal and Abdominal Radiology and the European Association of Endoscopic Surgery in accordance with the Appraisal of Guidelines for Research and Evaluation II instrument. A systematic review of the literature was performed, and the certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation methodology. Recommendations were voted upon using a nominal group technique. RESULTS: These guidelines focus on the definition of achalasia, treatment aims, diagnostic tests, medical, endoscopic and surgical therapy, management of treatment failure, follow-up and oesophageal cancer risk. CONCLUSION: These multidisciplinary guidelines provide a comprehensive evidence-based framework with recommendations on the diagnosis, treatment and follow-up of adult achalasia patients. ispartof: UNITED EUROPEAN GASTROENTEROLOGY JOURNAL vol:8 issue:1 pages:13-34 ispartof: location:England status: published

Dysphagia has a broad aetiology and so it is essential to identify the precise cause. Cervical cancer metastasis is distinctive in that it usually involves local lymph node invasion; however, approximately 1% of cases have mediastinal involvement, which can cause severe compressive symptoms in rare situations. To highlight an uncommon severe manifestation of cervical cancer relapse, we describe a case of dysphagia in a woman with a history of cervical cancer. After a thorough investigation that included endoscopy, endoscopy with ultrasound, an oesophagogram and fine needle aspiration, we eventually reached the diagnosis of mediastinal metastatic cervical cancer. Following interventions, the patient's condition gradually improved, both clinically and radiographically.Mediastinal lymph node enlargement causing dysphagia can be a presenting sign of a metastatic lesion from treated cervical cancer.A PEG tube is helpful in relieving dysphagia caused by metastatic mediastinal lymph node enlargement and as bridge for nutrition during chemotherapy.The VEGF inhibitor bevacizumab can be used in advanced metastatic cervical cancer.Check-point inhibitors like pembrolizumab can be used in metastatic cervical cancer.

The dynamics of topographo-anatomic transformations of the oesophagus has been traced on 12 human prefetuses, measuring 32,0-46,0 mm PCL by means of the methods of preparation, microscopy, morphometry, graphic and plastic reconstruction. The forming of oesophageal embryotopography within the bounds of the superior mediastinum proceeds in close correlations withthe trachea and aorta., На 12 передплодах человека 32,0-46,0 мм ТКД методами препарирования, микроскопии, морфометрии, графической и пластичной реконструкции прослежена динамика топографо-анатомических превраще-ний пищевода. Становление эмбриотопографии пищевода в пределах верхнего средостения происходит в тесных коррелятивных взаимоотно-шениях с трахеей и аортой., На 12 передплодах людини 32,0-46,0 мм ТКД методами препарування, мікроскопії, морфометрії, графічної та пластичної реконструкції простежено динаміку топографо-анатомічних перетворень стравоходу. Становлення ембріотопографії стравоходу в межах верхнього середостіння відбувається в тісних корелятивних взаємовідношеннях із трахеєю та аортою.

Highlights • Barium and Gastrografin improve oesophageal localisation on CBCT. • Barium allows more precise visualization of the oesophagus than Gastrografin. • Barium induced more image artefact than Gastrografin., Introduction SABR may facilitate treatment in a greater proportion of locally-advanced NSCLC patients, just as it has for early-stage disease. The oesophagus is one of the key dose-limiting organs and visualization during IGRT would better ensure toxicity is avoided. As the oesophagus is poorly seen on CBCT, we assessed the extent to which this is improved using two oral contrast agents. Materials & methods Six patients receiving radiotherapy for Stage I-III NSCLC were assigned to receive 50 mL Gastrografin or 50 mL barium sulphate prior to simulation and pre-treatment CBCTs. Three additional patients who did not receive contrast were included as a control group. Oesophageal visibility was determined by assessing concordance between six experienced observers in contouring the organ. 36 datasets and 216 contours were analysed. A STAPLE contour was created and compared to each individual contour. Descriptive statistics were used and a Kappa statistic, Dice Coefficient and Hausdorff distance were calculated and compared using a t-test. Contrast-induced artefact was assessed by observer scoring. Results Both contrast agents significantly improved the consistency of oesophagus localisation on CBCT across all comparison metrics compared to CBCTs without contrast. Barium performed significantly better than Gastrografin with improved kappa statistics (p = 0.007), dice coefficients (p

Background To determine the optimal volume of barium for oesophageal localisation on cone-beam CT (CBCT) for locally-advanced non-small cell lung cancers (NSCLC) and quantify the interfraction oesophageal movement relative to tumour. Methods Twenty NSCLC patients with mediastinal and/or hilar disease receiving radical radiotherapy were recruited. The first five patients received 25 ml of barium prior to their planning CT and alternate CBCTs during treatment. Subsequent five patient cohorts, received 15 ml, 10 ml and 5 ml. Six observers contoured the oesophagus on each of the 107 datasets and consensus contours were created. Overall 642 observer contours were generated and interobserver contouring reproducibility was assessed. The kappa statistic, dice coefficient and Hausdorff Distance (HD) were used to compare barium-enhanced CBCTs and non-enhanced CBCTs. Oesophageal displacement was assessed using the HD between consensus contours of barium-enhanced CBCTs and planning CTs. Results Interobserver contouring reproducibility was significantly improved in barium-enhanced CBCTs compared to non-contrast CBCTs with minimal difference between barium dose levels. Only 10 mL produced a significantly higher kappa (0.814, p = 0.008) and dice (0.895, p = 0.001). The poorer the reproducibility without barium, the greater the improvement barium provided. The median interfraction HD between consensus contours was 4 mm, with 95% of the oesophageal displacement within 15 mm. Conclusions 10 mL of barium significantly improves oesophageal localisation on CBCT with minimal image artifact. The oesophagus moves substantially and unpredictably over a course of treatment, requiring close daily monitoring in the context of hypofractionation.

The proposed methodological program for conservative treatment of oncological diseases does not contradict the good medical practices for chemotherapy. In order to improve the general condition of patients, chemoprevention and/or homeopathy could be applied, but not at the expense of a varied diet, incl. table salt, water, culinary acidifiers and fats. Alternative medicine should only be used to treat individual symptoms, not syndromes., This book is a long-term study and analysis presented in a more scientifically popular form. The matter is presented in a freer way in order to explain the matter. GOALS AND OBJECTIVES OF THE STUDY First goal: A study of what exactly is the reason for the long-term use of toxic amygdalin in the social group Annotation to the realization of the objective: By making a precise socio-anthropological analysis of the life of the ancient people of Botra (Hunza people, Burusho / Brusho people), we come to the hypothesis, which is confirmed by two proofs, through a number of modern quantum-mechanical, molecular-topological and bio-analytical checks. A convenient, harmless, form of amygdalin derivative is available that has the same biological and chemical activity and could be used in conservative clinical oncology. The article also presents a theoretical comparative analysis of biochemical reactivity in in vivo and in vitro media, by which we also determine the recommended dosage for patient administration. Based on a comparative analysis of the data, obtained in published clinical studies of amygdalin, is presented and summarized a scheme of the anti-tumor activity Presentation and scientific popularization of the results: some of the conducted researches are published in the format of an article - Theoretical Analysis for the Safe Form and Dosage of Amygdalin Product https://doi.org/10.2174/1871520620666200313163801. Second goal: Analysis of molecules forming activity in the environment around the cancer cell and their ability to cross the cell membrane Annotation to the realization of the objective: This scientific analysis is a continuation of the first goal (§I.1.). The hypothesis that hydrolyzed to amine/carboxylic acid cyano/nitrile glycosides are a potential anticancer drug has been proposed and theoretically confirmed there. Their biological activity remains unchanged directly from the natural compounds of this group, but their toxicity is many times lower than unmodified native molecules. After defining the chemical formula and determining the pharmaceutical form and dosage, most active groups are also identified, which directly determines their biological activity. Presentation and scientific popularization of the results some of the conducted researches are published in the format of an article - Theoretical Study of the Process of Passage of Glycoside Amides through the Cell Membrane of Cancer Cell https://doi.org/10.2174/1871520620999201103201008 . Third goal: Analysis of models for evaluation of the offered pharmaceutical forms Annotation to the realization of the objective: The pharmaceutical form allows deviation from the chemically pure substance. This is a convenient and at the same time affordable (from a financial and / or technological point of view) form of admission by patients. It is not necessary to use an "ideal" pure active substance (including a specific isomeric form). Due to the wide variety of natural glucosamide nitriles (starting material for the production of amide / carboxylic acid), modern pharmacology allows their combined use by chemical nature and concentration of the active form passing through the cell membrane. Methodology: A comparative analysis is performed based on stoichiometric calculations for the concentration of the active form and the prediction of bioactivity. For this purpose, the following methodology is used: Analysis of data on the active molecular form of anticancer cells and determination of the drug dose. Presentation and scientific popularization of the results: some of the conducted researches are published in the format of an article - Theoretical analysis of anticancer cellular effects of glycoside amides https://doi.org/10.2174/1871520621666210903122831 . AUTHOR'S NOTES With the present scientific work we have tried to present in a more generalized form our long-term theoretical research. We tried to draw every value, every dependence and every conclusion precisely, in a form that is not subject to any personal view and/or to be enslaved to a generally "accepted" opinion. Natural nitrile glycosides would not cross the tumor cell membrane. They decompose to HCN-acid, phenyl methanol and carbohydrate. They do NOT have antitumor activity due to their inability to reach the target unchanged. These compounds, in their natural form, are extremely toxic to the human body. Applying them is not a cure, even at higher concentrations they do more harm than good. Theoretically, we have derived dozens of their modified forms, but their amides and carboxylic acids are the most promising for their introduction in conservative oncology. The fact is that the tumor cell itself is trying to counteract in a way that is quite safe for it. 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Simple Summary The optimal treatment strategy for locally advanced distal oesophageal and gastrooesophageal junction (GOJ) adenocarcinoma is currently not clear. Surgery as a main curative modality is usually combined with either preoperative chemoradiotherapy or perioperative chemotherapy. The aim of the review is to provide an overview of current treatment options in locally advanced oesophageal and GOJ adenocarcinomas based on the latest evidence, including the possible potential of predictive biomarkers in optimizing treatment. Abstract The following main treatment approaches are currently used in locally advanced adenocarcinomas of the oesophagus and gastrooesophageal junction (GOJ): preoperative chemoradiotherapy and surgery, and perioperative chemotherapy and surgery. While preoperative chemoradiotherapy is used primarily in oesophageal tumours, perioperative chemotherapy is the treatment of choice in Western countries for gastric cancer. The optimal treatment strategy for GOJ adenocarcinoma is still not clear. In comparison to other malignancies, biomarkers are used as predictive factors in distal oesophageal and GOJ adenocarcinomas in a very limited way, and moreover, only in metastatic stages (e.g., HER2 status, or microsatellite instability status). The aim of the article is to provide an overview of current treatment options in locally advanced adenocarcinomas of oesophagus and GOJ based on the latest evidence, including the possible potential of predictive biomarkers in optimizing treatment.