Search

This paper summarizes the nursing experience of a patient with gastric distention of spleen deficiency and dampness obstruction syndrome treated by Traditional Chinese Medicine ointment and Bian-stone ironing and rubbing therapy. According to the clinical manifestations and syndrome differentiation of the patient, the Traditional Chinese Medicine ointment and Bian-stone ironing and rubbing therapy were used to improve the digestive function of the patient. In addition, routine interventions such as daily living guidance and dietary nursing were carried out to improve the early recovery of the patient. (本文总结中药膏摩砭石熨摩治疗1例脾虚湿阻型胃痞患者的护理体会。基于护理评估和中医辨证, 在生活指导、饮食护理等常规护理基础上, 根据患者的临床表现, 采用中药膏摩砭石熨摩、手指点穴等中医护理干预, 能够有效改善患者的消化功能, 促进早期康复。)

Electroacupuncture (EA) point specific (ST36-37) stimulation decreases cardiovascular reflex responses through supraspinal regions such as the hypothalamic paraventricular nucleus (PVN) while mechanical stimulation of acupoints decreases pressor responses through peripheral thermal transient receptor potential vanilloid type-1 (TRPV1). Moxibustion generating heat applied at acupoint in combination with antihypertensive drugs decreases elevated blood pressure. We hypothesized that moxibustion modulates sympathoexcitatory cardiovascular responses through the hypothalamic PVN and peripheral heat sensitive TRPV1 in the absence of antihypertensive drugs. Rats were anesthetized, ventilated, and heart rate and mean blood pressure were monitored. Gastric distention induced consistent pressor reflex responses every 10-min. Thirty-minutes of bilateral moxibustion at the acupoint ST36, overlying the deep peroneal nerves, reduced the gastric distention evoked elevation in blood pressure. Blood pressure reflex responses were not reduced by both EA and moxibustion at G39. The moxibustion inhibition but not EA inhibition of the cardiovascular responses was reversed with blockade of local heat sensitive TRPV1 at ST36. Accordingly, activation of thermal TRPV1 by moxibustion at an average of 44.2°C in contrast to 40°C reduced the pressor responses. Naloxone, an opioid receptor antagonist, microinjected into PVN inhibited transiently the effect of moxibustion. Thus, activation of peripheral heat sensitive TRPV1 mediated the moxibustion-inhibition, but not EA-inhibition, of sympathoexcitatory cardiovascular reflex responses through hypothalamic PVN opioid system.

Electroacupuncture (EA) point specific (ST36-37) stimulation decreases cardiovascular reflex responses through supraspinal regions such as the hypothalamic paraventricular nucleus (PVN) while mechanical stimulation of acupoints decreases pressor responses through peripheral thermal transient receptor potential vanilloid type-1 (TRPV1). Moxibustion generating heat applied at acupoint in combination with antihypertensive drugs decreases elevated blood pressure. We hypothesized that moxibustion modulates sympathoexcitatory cardiovascular responses through the hypothalamic PVN and peripheral heat sensitive TRPV1 in the absence of antihypertensive drugs. Rats were anesthetized, ventilated, and heart rate and mean blood pressure were monitored. Gastric distention induced consistent pressor reflex responses every 10-min. Thirty-minutes of bilateral moxibustion at the acupoint ST36, overlying the deep peroneal nerves, reduced the gastric distention evoked elevation in blood pressure. Blood pressure reflex responses were not reduced by both EA and moxibustion at G39. The moxibustion inhibition but not EA inhibition of the cardiovascular responses was reversed with blockade of local heat sensitive TRPV1 at ST36. Accordingly, activation of thermal TRPV1 by moxibustion at an average of 44.2°C in contrast to 40°C reduced the pressor responses. Naloxone, an opioid receptor antagonist, microinjected into PVN inhibited transiently the effect of moxibustion. Thus, activation of peripheral heat sensitive TRPV1 mediated the moxibustion-inhibition, but not EA-inhibition, of sympathoexcitatory cardiovascular reflex responses through hypothalamic PVN opioid system.

ST-segment elevation myocardial infarction (STEMI) is the most serious manifestation of acute coronary syndrome. A variety of noncardiac conditions can mimic STEMI on electrocardiography (ECG). We describe a case of gastrointestinal distention and ileus masquerading as STEMI on ECG and posits a mechanism for this effect. (Level of Difficulty: Intermediate.)

Abstract Introduction Although the important roles of bidirectional interactions between the brain and gut in stress and emotional responses have long been recognized, the underlying neuronal mechanisms remain unclear. The bed nucleus of the stria terminalis (BNST) is a limbic structure involved in stress responses and negative affective states, such as anxiety and depression. We have previously demonstrated that noradrenergic transmission within the ventral part of the BNST (vBNST) plays a crucial role in anxiety‐like behaviors and pain‐induced aversion. Objectives This study aimed to examine the involvement of noradrenergic transmission via β‐adrenoceptors within the vBNST in bidirectional brain‐gut interactions. Methods We measured the gastric distention (GD)‐induced noradrenaline release within the vBNST of freely moving rats using an in vivo microdialysis technique. Gastric emptying and intestinal transit were examined following intra‐vBNST injections of isoproterenol, a β‐adrenoceptor agonist, in the absence or presence of the coadministration of timolol, a β‐adrenoceptor antagonist. Results Gastric distention at a higher pressure (45 mm Hg) but not at a lower pressure (25 mm Hg) resulted in a significant increase in extracellular noradrenaline levels within the vBNST. Intra‐vBNST injections of isoproterenol (30 nmol/side) induced significant reductions in gastric emptying and small intestinal transit, both of which were reversed by the coadministration of timolol (30 nmol/side). Conclusion Noradrenergic transmission via β‐adrenoceptors within the vBNST was involved in bidirectional brain‐gut interactions. These findings suggest that gastric dysfunction may induce negative affective states via the enhanced release of noradrenaline within the vBNST which, in turn, may cause gastrointestinal impairments.

• The control of feeding behavior in the hypothalamus of neonatal rats. • Nutritional sensors mTOR and AMPK respond to fasting at an early age. • Control by the peptides in the food intake even at an early age. In the neonate, the main mediator for satiety or hunger is the information of distention or gastric contraction. Food intake controls has two types of a short-term one, based on the level of hydration, and another long-term one, dependent on the gastric stretch. The aim of this study is to evaluate the gene expression of peptides and nutrient sensors in the hypothalamus at 10 and 18 days of postnatal life. Male rats divided into groups: Fasting, Water, Milk, and Gavage.Two age groups had analyzed into 10 and 18 days. Gene expression of hypothalamic peptides, Neuropeptide Y(NPY), Agouti-related peptide(AgRP), proopiomelanocortin(POMC), cocaine-and amphetamine-regulated transcript(CART), and energy sensors mechanistic target of rapamycin(mTOR) and AMP-activated protein kinase(AMPK) in the hypothalamus was seen. During the fasting period, there was an increase in expression of AMPK seen in 10 and 18 days, also mTOR reduction. Expression of NPY, AgRP, and POMC suffered the fasting effect only at 18 days. The effect of gastric distention and energy loads, there was increased expression of AMPK at 10 and 18 days, but expression of mTOR showed only at 18 days. There was increased NPY expression at 18 days, but not at 10 days, while AgRP increased its expression at both ages. At 10 days gene expression of CART increased and POMC as well as 10–18 days. Data demonstrated a simultaneous responsiveness to hypothalamic nutrient sensing also, controlling peptide food consumption even at an early age. The mature standard of control only observed at 18 days of life. [ABSTRACT FROM AUTHOR]

An approximately four-year-old male castrated guinea pig (Cavia porcellus) was presented for painful defecation with a 24-hour history of hyporexia and intermittent episodes of rolling behavior. Upon presentation the patient was quiet, alert, and responsive, and mildly hypothermic. Abdominal palpation revealed an approximately 2-cm long oblong mass within the caudal abdomen. Abdominal radiographs revealed gastric dilation without volvulus and a peritoneal mass effect. The patient was euthanized following gastric reflux of brown malodorous fluid from his nares and oral cavity. A necropsy was performed and revealed a jejuno-jejunal intussusception causing mechanical gastrointestinal ileus, and gastric dilatation without volvulus. While non-obstructive gastrointestinal stasis is common and obstructive ileus is uncommon in guinea pigs, this report shows that intestinal intussusception is a differential in guinea pigs with ileus and gastric dilatation.

Electroacupuncture (EA) point specific (ST36-37) stimulation decreases cardiovascular reflex responses through supraspinal regions such as the hypothalamic paraventricular nucleus (PVN) while mechanical stimulation of acupoints decreases pressor responses through peripheral thermal transient receptor potential vanilloid type-1 (TRPV1). Moxibustion generating heat applied at acupoint in combination with antihypertensive drugs decreases elevated blood pressure. We hypothesized that moxibustion modulates sympathoexcitatory cardiovascular responses through the hypothalamic PVN and peripheral heat sensitive TRPV1 in the absence of antihypertensive drugs. Rats were anesthetized, ventilated, and heart rate and mean blood pressure were monitored. Gastric distention induced consistent pressor reflex responses every 10-min. Thirty-minutes of bilateral moxibustion at the acupoint ST36, overlying the deep peroneal nerves, reduced the gastric distention evoked elevation in blood pressure. Blood pressure reflex responses were not reduced by both EA and moxibustion at G39. The moxibustion inhibition but not EA inhibition of the cardiovascular responses was reversed with blockade of local heat sensitive TRPV1 at ST36. Accordingly, activation of thermal TRPV1 by moxibustion at an average of 44.2°C in contrast to 40°C reduced the pressor responses. Naloxone, an opioid receptor antagonist, microinjected into PVN inhibited transiently the effect of moxibustion. Thus, activation of peripheral heat sensitive TRPV1 mediated the moxibustion-inhibition, but not EA-inhibition, of sympathoexcitatory cardiovascular reflex responses through hypothalamic PVN opioid system.

Background: Gastric distention contributes to meal termination. There is little research on the neural correlates of gastric distention by food. To date, neural measures have not been obtained concurrently with measurements of gastric distention.Objectives: 1) To study how offering a small versus a large water load following a standardized nutrient load affects gastric distention over time. 2) To assess associations between satiety experiences and brain activity and the degree of gastric distention.Method: 19 healthy males (age 22.2 ± 2.5 y, BMI 21.8 ± 1.5 kg/m2) participated in a randomized crossover study with two treatments: ingestion of a 500-kcal 150-mL liquid meal shake followed by a low (LV, 50 mL) or a high volume (HV, 350 mL) water load. At baseline and three times after ingestion satiety was scored, MRI scans were made to determine total gastric content volume (TGV) and functional MRI scans were made to measure cerebral blood flow (CBF).Results: TGV was significantly higher for HV compared to LV at all time points (p < 0.001) with relative differences between HV and LV of 292 ± 37 mL after ingestion, 182 ± 83 mL at t = 15 min and 62 ± 57 mL at t = 35 min. Hunger decreased (p = 0.023) and fullness increased (p = 0.030) significantly more for HV compared to LV. Ingestion increased CBF in the inferior frontal gyrus and the anterior insula, but there were no differences between treatments. There were no significant correlations between appetite ratings and CBF values.Conclusion: Performing concurrent gastric MRI and CBF measurements can be used to investigate neural correlates of gastric distention. Increased distention did not induce significantly greater brain activation. Future research should further examine the role of the inferior frontal gyrus in satiety. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Although the important roles of bidirectional interactions between the brain and gut in stress and emotional responses have long been recognized, the underlying neuronal mechanisms remain unclear. The bed nucleus of the stria terminalis (BNST) is a limbic structure involved in stress responses and negative affective states, such as anxiety and depression. We have previously demonstrated that noradrenergic transmission within the ventral part of the BNST (vBNST) plays a crucial role in anxiety‐like behaviors and pain‐induced aversion. Objectives: This study aimed to examine the involvement of noradrenergic transmission via β‐adrenoceptors within the vBNST in bidirectional brain‐gut interactions. Methods: We measured the gastric distention (GD)‐induced noradrenaline release within the vBNST of freely moving rats using an in vivo microdialysis technique. Gastric emptying and intestinal transit were examined following intra‐vBNST injections of isoproterenol, a β‐adrenoceptor agonist, in the absence or presence of the coadministration of timolol, a β‐adrenoceptor antagonist. Results: Gastric distention at a higher pressure (45 mm Hg) but not at a lower pressure (25 mm Hg) resulted in a significant increase in extracellular noradrenaline levels within the vBNST. Intra‐vBNST injections of isoproterenol (30 nmol/side) induced significant reductions in gastric emptying and small intestinal transit, both of which were reversed by the coadministration of timolol (30 nmol/side). Conclusion: Noradrenergic transmission via β‐adrenoceptors within the vBNST was involved in bidirectional brain‐gut interactions. These findings suggest that gastric dysfunction may induce negative affective states via the enhanced release of noradrenaline within the vBNST which, in turn, may cause gastrointestinal impairments. [ABSTRACT FROM AUTHOR]

The objective of our study was to examine the neurobiological support for an interoceptive sensory processing model of bulimia nervosa (BN). To do so, we conducted a systematic review of interoceptive sensory processing in BN, using the PRISMA guidelines. We searched PsychInfo, Pubmed, and Web of Knowledge databases to identify biological and behavioral studies that examine interoceptive detection in BN. After screening 390 articles for inclusion and conducting a quality assessment of articles that met inclusion criteria, we reviewed 41 articles. We found that global interoceptive sensory processing deficits may be present in BN. Specifically there is evidence of abnormal brain function, structure and connectivity in the interoceptive neural network, in addition to gastric and pain processing disturbances. These results suggest that there may be a neurobiological basis for global interoceptive sensory processing deficits in BN that remain after recovery. Data from taste and heart beat detection studies were inconclusive; some studies suggest interoceptive disturbances in these sensory domains. Discrepancies in findings appear to be due to methodological differences. In conclusion, interoceptive sensory processing deficits may directly contribute to and explain a variety of symptoms present in those with BN. Further examination of interoceptive sensory processing deficits could inform the development of treatments for those with BN. [ABSTRACT FROM AUTHOR]

An approximately four-year-old male castrated guinea pig (Cavia porcellus) was presented for painful defecation with a 24-hour history of hyporexia and intermittent episodes of rolling behavior. Upon presentation the patient was quiet, alert, and responsive, and mildly hypothermic. Abdominal palpation revealed an approximately 2-cm long oblong mass within the caudal abdomen. Abdominal radiographs revealed gastric dilation without volvulus and a peritoneal mass effect. The patient was euthanized following gastric reflux of brown malodorous fluid from his nares and oral cavity. A necropsy was performed and revealed a jejuno-jejunal intussusception causing mechanical gastrointestinal ileus, and gastric dilatation without volvulus. While non-obstructive gastrointestinal stasis is common and obstructive ileus is uncommon in guinea pigs, this report shows that intestinal intussusception is a differential in guinea pigs with ileus and gastric dilatation. [ABSTRACT FROM AUTHOR]

Summary: We describe a nonsurgical technique for managing gastric distention in infants with type C esophageal atresia, involving intubating the trachea with an umbilical catheter and entering the stomach through the fistula as soon as a flexible bronchoscope found its wide‐open orifice. This technique might have a special role when gastric distention precedes other commonly used preventive measures. [ABSTRACT FROM AUTHOR]

A 57-year-old woman was admitted to the intensive care unit in a state of severe hypotensive shock following a session of hyperbaric oxygen (HBO2) therapy. Shock was attributed to gastric barotrauma, which resulted in a massive venous gas embolism. Gastric barotrauma was attributed to the presence of a filled gastric band/cuff during the HBO2 therapy that prevented expanding gas from escaping on decompression. After deflation of the gastric band, two additional HBO2 sessions were performed and resulted in complete symptom resolution. Vasoactive drugs could be weaned, and the patient was discharged from hospital on Day Three with complete symptom resolution. Given the risk of gastric barotrauma and venous gas embolism, physicians should be aware of gastric band history before HBO2 therapy. [ABSTRACT FROM AUTHOR]

Background Gastro-esophageal reflux ( GER), the retrograde flow of gastric contents into the esophagus is a physiologic phenomenon, which can evoke symptoms and/or lesions in the esophagus (=gastro-esophageal reflux disease or GERD). Proton pump inhibitors ( PPIs) reduce gastric acidity; however, as they are unable to control transient lower esophageal sphincter relaxations ( TLESRs), the main mechanism for reflux in GERD, they do not abolish reflux. TLESRs occur predominantly in the postprandial period, and they are believed to be triggered by gastric distention. Gastric accommodation ( GA) is the physiologic response to gastric distention and serves to prevent a rise in gastric wall tension during food intake. We aimed to study the relationship between GA and TLESRs, as they both are triggered by gastric distention. Methods We studied 12 GERD patients (average age 37 years [range 18-62], 7m/5f) and nine healthy volunteers (average age 27 years [range 22-36], 2m/7f) using high resolution manometry-impedance measurement before and after a mixed meal challenge. We determined the number of TLESRs (with or without reflux) and measured pre- and postprandial IGP. The change in IGP between the pre- and postprandial period (Δ IGP) is used as surrogate for GA. We also measured LES pressure before and after the meal and calculated the change (Δ LESp). Key Results There were no statistical differences between pre- and postprandial IGP in GERD and healthy volunteers and similarly, there was no significant difference between pre- and postprandial LES pressures in GERD patients and healthy volunteers. The number of TLESRs (with or without reflux) was similar in GERD and healthy volunteers. More importantly, we did observe a negative correlation between Δ IGP and the number of TLESRs, irrespective of whether they were associated with reflux or not, in the GERD patients (without reflux r = −0.67, p = 0.017; with reflux r = −0.81, p = 0.0014). The same observations were found in healthy volunteers, where Δ IGP and the number of TLESRs are significantly inversely correlated (without reflux r = −0.87, p = 0.0045; with reflux r = −0.75, p = 0.021). We could not establish a correlation between Δ LESp and the number of TLESRs, neither in GERD patients nor in healthy volunteers. Conclusions & Inferences This is the first study showing a clear negative correlation between Δ IGP and the number of TLESRs, irrespective of whether they were associated with reflux or not, both in GERD patients and in healthy subjects. These results suggest that TLESRs and GA are closely linked, probably through activation of mechanoreceptors involved in triggering of TLESRs. [ABSTRACT FROM AUTHOR]

Abstract: An adolescent male trauma patient developed new asymptomatic ST segment elevations that mimicked a myocardial infarction on infero-lateral telemetry leads on hospital day #8, following burn excision and skin grafting. This was confirmed on 12 lead electrocardiogram. Laboratory test results indicated normal potassium. Troponins ×3 were negative. X-rays indicated marked gaseous gastric distention. A nasogastric tube was placed with evacuation of 400mL of fluid and resolution of gastric distention. After gastric decompression, the ST segment elevations resolved. This case illustrates the need to consider acute gastric distention in the differential of acute ST segment elevation. [Copyright &y& Elsevier]

We describe the use of an endoscopy face mask with a perforated membrane, which allows a nasogastric tube for continuous noninvasive ventilation in acute hypercapnic respiratory failure, in 2 patients who developed gastric distention. This interface was able to avoid most nonintentional leaks through the mask, as compared with a conventional approach, improving ventilation efficiency. To our knowledge, this is the first case report of an endoscopy face mask used in noninvasive ventilation for this specific side effect. [ABSTRACT FROM AUTHOR]

Abstract: Investigating the localization of gastric sensation within the brain is important for understanding the neural correlates of satiety. Previous rodent studies have identified the brain-stem and hypothalamus as key mediators of gastric distention-induced satiation. Although, recent blood oxygen level-dependent functional magnetic resonance imaging (BOLD fMRI) studies in humans have identified a role for higher cortico-limbic structures in mediating the satiation effects of gastric distention, the role of these regions in rodents remains to be characterized. We determined the effects of gastric distention on global spatio-temporal BOLD fMRI signal changes in the rodent brain. Brain images were acquired with a high resolution 9.4 T magnet during gastric distention with continuous monitoring of blood pressure in adult male Sprague Dawley rats (n=8–10). Distention of the stomach with an intragastric balloon, at rates which mimicked the rate of consumption and emptying of a mixed nutrient liquid meal, resulted in robust reduction in food intake and increase in blood pressure. Gastric distention increased BOLD fMRI activity within homeostatic regions such as the hypothalamus and nucleus tractus solitarius, as well as non homeostatic regions including the hippocampus, amygdala, thalamus, cerebellum and the cortex (cingulate, insular, motor and sensory cortices). Further, the increase in BOLD fMRI activity following distention was strongly correlated to an increase in blood pressure. These results indicate that gastric distention, mimicking the rate of intake and emptying of a liquid meal, increases BOLD fMRI activity in both homeostatic and non homeostatic brain circuits which regulate food intake, and that these BOLD fMRI signal changes may in part be attributable to transient increases in blood pressure. [Copyright &y& Elsevier]

We report for the first time a case of acute kidney injury associated with severe gastric distention after a laparoscopic Nissen-Rossetti fundoplication of the stomach for hiatal hernia. An abdominal compartment syndrome secondary to intra-abdominal hypertension was suspected. Naso-gastric tube decompression resulted in immediate restauration of the diuresis and progressive recovery of renal function. [ABSTRACT FROM AUTHOR]

Afferent fibers innervating the gastrointestinal tract have major roles in consciously evoked sensations including pain. However, little is known about the molecules involved in mechanonociception from the upper gastrointestinal tract. We recently reported that activation of extracellular signal-regulated kinase 1/2 (ERK1/2), a member of the mitogen-activated protein kinase cascade in primary afferent neurons, was induced by noxious gastric distention in the rat, and that the activation of ERK1/2 in dorsal root ganglion (DRG) neurons can be implicated in acute visceral pain. Transient receptor potential (TRP) A1, a member of the TRP family of cation channels, was expressed in both DRG and nodose ganglion (NG) neurons innervating the stomach and in nerve fibers in the gastric wall. TRPA1 was coexpressed with ERK1/2 in gastric primary afferent neurons, and attenuation of TRPA1 activation using antisense peptides and a specific blocker led to suppression of both ERK1/2 activation and visceromotor responses. TRPA1 also significantly colocalized with substance P (SP) and calcitonin gene-related peptide (CGRP) in the thoracolumbar DRG, NG and stomach. These data indicate that SP and CGRP may also be released by TRPA1 activation in primary afferent neurons to elicit neurogenic inflammation and promote visceral hyperalgesia. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

A long- loop pathway, involving the hypothalamic arcuate nucleus (ARC), ventrolateral periaqueductal gray (vlPAG), and the rostral ventrolateral medulla (rVLM), is essential in electroacupuncture (EA) attenuation of sympathoexcitatory cardiovascular reflex responses. The ARC provides excitatory input to the vlPAG, which, in turn, inhibits neuronal activity in the rVLM. Although previous studies have shown that endocannabinoid CB1 receptor activation modulates -γ-aminobutyric acid (GABA)-ergic and glutamatergic neurotransmission in the dorsolateral PAG in stress-induced analgesia, an important role for endocannabinoids in the vlPAG has not yet been observed. We recently have shown (Fu LW, Longhurst JC. J Appi Physiol; doi: 10.1 152/japplphysiol.91648.2008) that EA reduces the local vlPAG concentration of GABA, but not glutamate, as measured with high- performance liquid chromatography from extracellular samples collected by microdialysis. We, therefore, hypothesized that, during EA, endocannabinoids, acting through CB1 receptors, presynaptically inhibit GABA release to disinhibit the vIPAG and ultimately modulate excitatory reflex blood pressure responses. Rats were anesthetized, ventilated, and instrumented to measure heart rate and blood pressure. Gastric distention-induced blood pressure responses of 18 ± S mmHg were reduced to 6 ± 1 mmHg by 30 mm of low-current, low- frequency EA applied bilaterally at pericardial p 5-6 acupoints overlying the median nerves. Like EA, microinjection of the fatty acid amide hydrolase inhibitor URB597 (0.1 nmol, 50 nl) into the vlPAG to increase endocannabinoids locally reduced the gastric distention cardiovascular reflex response from 21 ± 5 to 3 ± 4 mmHg. This inhibition was reversed by pretreatment with the GABAA antagonist gabazine (27 mM, 50 nl), suggesting that endocannabinoids exert their action through a GABAergic receptor mechanism in the vlPAG. The EA-related inhibition from 18 ± 3 to 8 ± 2 mmHg was reversed to 14 ± 2 mmHg by microinjection of the CB1 receptor antagonist AM251 (2 nmol, 50 nl) into the vlPAG. Pretreatment with gabazine eliminated reversal following CB1-receptor blockade. Thus EA releases endocannabinoids and activates presynaptic CB1 receptors to inhibit GABA release in the vlPAG. Reduction of GABA release disinhibits vlPAG cells, which, in turn, modulate the activity of rVLM neurons to attenuate the sympathoexcitatory reflex responses. [ABSTRACT FROM AUTHOR]

Abstract: Gastric distention during meal ingestion activates vagal afferents, which send signals from the stomach to the brain and result in the perception of fullness and satiety. Distention is one of the mechanisms that modulates food intake. We measured regional brain activation during dynamic gastric balloon distention in 18 health subjects using functional magnetic resonance imaging and the blood oxygenation level-dependent (BOLD) responses. The BOLD signal was significantly changed by both inflow and outflow changes in the balloon''s volume. For lower balloon volumes, water inflow was associated with activation of sensorimotor cortices and right insula. The larger volume condition additionally activated left posterior amygdala, left posterior insula and the left precuneus. The response in the left amygdala and insula was negatively associated with changes in self-reports of fullness and positively with changes in plasma ghrelin concentration, whereas those in the right amygdala and insula were negatively associated with the subject''s body mass index. The widespread activation induced by gastric distention corroborates the influence of vagal afferents on cortical and subcortical brain activity. These findings provide evidence that the left amygdala and insula process interoceptive signals of fullness produced by gastric distention involved in the controls of food intake. [Copyright &y& Elsevier]

The nucleus of the solitary tract (NTS) is a primary center, not only for receiving visceral afferents, but also for somatic afferents. Previous experiments demonstrated that NTS might be a primary afferent center for connecting the Stomach Meridian (ST Medirian) and the Stomach. In this study, an extracellular recording method was used to analyze the firing neurons. The variety of NTS' neurons' responses to gastric distention (GD) and different body surface points were compared. In 52 rats, 104 firing neurons of NTS were recorded, in which there were 47 GD related neurons. For the 47 GD related neurons, there were 33 neurons responsive to acupuncture at Sibai (ST 2, belonging to ST Meridian). Therefore, in the 47 GD related neurons, the response neuron occurring rate (RNOR) for acupuncture at ST 2 was 70.21%. Meanwhile in the 47 GD related neurons, when acupuncture was performed at Quanliao (SI 18, belonging to Small Intestine Meridian) and non-acupoint respectively, there were 18 and 17 firing neurons, and the RNOR were 38.30% and 36.17% respectively. The experiment demonstrated that there were some varieties in the response of NTS neurons to GD stimuli and acupuncture at different body surface points, which suggested that the ST Meridian was more intimately linked to the Stomach and that the different acupoints do have some specificity. [ABSTRACT FROM AUTHOR]

Background: Gastric electrical stimulation (GES) has been shown to be effective in inducing satiety in patients with obesity, as well as in treating nausea and vomiting in patients with gastroparesis. It is conceivable that these effects are mediated via the central nervous system, although there is a lack of studies or evidences. The aims of this study were to investigate the effects of GES with different parameters on neurons in the paraventricular nucleus (PVN) of the hypothalamus and to study whether the neuronal response was related to stimulation parameters. Methods: Extracellular potentials of single neurons in the PVN were recorded in anesthetized rats at baseline, during gastric distention (GD) and during GES with various sets of parameters. Results: Of 115 PVN neurons tested by GD, 104 were GD-responsive neurons. Most of these GD-responsive neurons were responsive to GES of various parameters. 1) GES with parameters used in treating obesity, activated neurons both excited (GD-E) and inhibited (GD-I) by gastric distention; it excited 48.4% (16/33) of the GD-E neurons and 60.4% (29/48) of GD-I neurons. 2) GES with increased pulse width was of the highest efficacy in exciting the GD-responsive neurons, whereas a reduction in stimulation frequency resulted in a lower activation. 3) GES with parameters used in treating gastroparesis solicited neuronal responses opposite to those with parameters used for treating obesity. Conclusion: GES activates gastric-related neurons in the PVN, and the excitatory effect of GES seems related to stimulation strength. The GES used for treating gastroparesis and the GES used for treating obesity seem to solicit different neuronal responses in the PVN. [ABSTRACT FROM AUTHOR]

Abstract: Bulimia nervosa (BN) is a psychiatric illness characterized by eating binges followed by inappropriate behavioral attempts to compensate for the binges, usually vomiting or laxative abuse. Patients with BN have disturbances in the development of satiety during a meal as well as disturbances in functions of the upper gastrointestinal tract such as slowed gastric emptying, impaired gastric accommodation reflex and blunted cholecystokinin release. The present study examined gastric compliance and sensory responses to gastric distention in women with BN and controls. Sixteen women with BN and 13 healthy control subjects swallowed an inflatable bag that was placed in the proximal stomach. The bag was inflated to produce increasing steps of pressure against the stomach wall, before and after consumption of a 200 ml (200 Kcal) liquid meal. Pressure and volume were recorded for 2-min periods, beginning at 0 mm Hg pressure and increasing in steps of 2 mm Hg until subjects reported discomfort, gastric volume reached 600 ml, or pressure reached 20 mm Hg. At each pressure step subjects made sensory ratings. Gastric compliance was calculated as the slope of the best-fit straight line of each subject''s gastric volume vs. gastric pressure. There was a significant postmeal increase in gastric compliance in both groups of subjects but there was no difference in compliance between patients with BN and controls. Patients with BN appeared to have diminished sensitivity to gastric distention. In conclusion, although other studies have described gastrointestinal abnormalities associated with BN, the current study found gastric compliance of patients with BN to be normal. [Copyright &y& Elsevier]

Systemic or hindbrain administration of MK-801, a noncompetitive N-methyl-D-aspartate receptor antagonist, increases meal size. To examine whether MK-801 enhances intake by increasing gastric emptying, we administered MK-801 (2.0 µg/3.0 µl) into the fourth ventricle [intracerebroventricular (ICV)] and measured feeding and gastric emptying of 5-ml NaCl or 15% sucrose loads. In a parallel experiment, we examined food intake and gastric emptying following intraperitoneal (IP) injection of MK-801 (100 pg/kg). MK-801, either IP or 1CV, increased 30-mm sucrose intake compared with control (12.3 ± 0.7 vs. 9.8 ± 0.5 and 16.6 ± 2.0 vs. 10.7 ± 0.7 ml, for IP and ICV administration, respectively). Also, IP MK-801 increased 5-mm gastric emptying of NaCl (4.13 ± 0.1 ml emptied) and sucrose (3.11 ± 0.1 ml emptied) compared with control (3.75 ± 0.2 and 2.28 ± 0.1 ml emptied for NaCI and sucrose loads, respectively). In contrast, ICV MK-801 did not alter NaCl emptying (3.82 ± 0.1 ml emptied) compared with control (3.82 ± 0.3 ml emptied) and actually reduced gastric emptying of sucrose (2.1 ± 0.2 and 2.94 ± 0.1 ml emptied, for MK and vehicle, respectively). These data confirm previous results that systemic as well as hindbrain injection of MK- 801 increases food intake. However, because ICV MK-801 failed to increase gastric emptying, these results indicate that MK-801 increases food intake through mechanisms independent of altered gastric emptying. [ABSTRACT FROM AUTHOR]

This study aimed to measure brain activation during gastric distention as a way to investigate short-term satiety. We estimated regional cerebral blood flow with positron emission tomography (15O-water) during gastric balloon inflation and deflation in 18 healthy young women. The contrast between inflated minus deflated conditions showed activation in the following four key regions that were identified a priori: dorsal brain stem; left inferior frontal gyrus; bilateral insula; and right subgenual, anterior cingulate cortex. Extant neuroimaging literature provides context for these areas as follows: the brain stem represents vagal projection zones for visceral afferent processing; the inferior frontal gyrus serves as a convergence zone for processing food-related stimuli; and both the insula and subgenual anterior cingulate cortex respond to emotional stimulation. The identification of neural correlates of gastric distention is a key step in the discovery of new treatments for obesity. New therapies could intervene by modifying the perception of gastric distention, an important contributor to meal termination and short-term satiety. This first study of brain activation during nonpainful, proximal gastric distention provides the groundwork for future research to discover novel treatments for obesity. [Copyright &y& Elsevier]

Objective: To study the effects of noninvasive positive pressure ventilation (NIPPV) on intra-abdominal pressure.Design and Setting: Single case report from a tertiary teaching hospital.Patients and Methods: A 65-year-old man who experienced a sudden respiratory and cardiovascular collapse during NIPPV. This was caused by gastric overdistension due to aerophagia followed by raised intra-abdominal pressure leading to intra-abdominal hypertension and abdominal compartment syndrome.Results: The respiratory and cardiovascular problems resolved immediately after the introduction of a nasogastric tube. This resulted in normalization of IAP.Conclusions: This is the first case reported of an abdominal compartment syndrome related to NIPPV. Clinicians should be aware of this possible complication while using NIPPV. [ABSTRACT FROM AUTHOR]

We sought to determine whether gastric distention from air insufflation affects the accuracy of the Toomey™ syringe in detecting esophageal intubation. We conducted a randomized, single-blinded, crossover trial using human cadavers in which cuffed endotracheal (ET) tubes were placed into the esophagus and trachea. Operators used the Toomey™ syringe to determine the location of the ET tube before and after gastric insufflation via Ambu-bag ventilation. Greater amounts of air were aspirated (35.4 cc vs. 13.7 cc, respectively, p < 0.001) and less resistance was noted on a five-point scale (3.2 vs. 4.8, respectively, p < 0.001) from esophageally placed ET tubes after gastric insufflation. Sensitivity in detecting esophageally placed ET tubes decreased from 100% in noninsufflated cadavers to only 58% after gastric insufflation (p < 0.001). In the thawed fresh frozen cadaveric model, the Toomey™ syringe was unreliable in detecting an esophageal intubation after gastric distention insufflation. [Copyright &y& Elsevier]