Explore the vast range of titles available.

IntroductionGastric Alimetry is a novel diagnostic tool which involves simultaneous body surface gastric electrical mapping and symptom profiling. A range of pathophysiological profiles has been described in patients with chronic gastroduodenal symptoms but less is known in patients with known gastric neuromuscular dysfunction. We sought to characterise Alimetry findings in patients with scleroderma, autoimmune autonomic ganglionopathy (AAG) and mitochondrial diseases, to determine whether there are spectral phenotypic differences between them.MethodsRetrospective observational study in consecutive patients with scleroderma, autoimmune autonomic ganglionopathy (AAG) and mitochondrial diseases. PAGI SYM questionnaires assessed foregut symptoms. Alimetry parameters e.g. principle gastric frequency (PGF), gastric rhythm index (RI), BMI adjusted amplitude (BMI-A) fed:fasted ratio (FFR), and meal-related symptoms were described in each cohort and compared across the 3 groups.Results17 patients were included, 6 scleroderma, 6 AAG, 5 mitochondrial disease; 13 (76.5%) were female, mean age 46.2, median PAGI SYM: 36 (range:4-82). Abnormal spectral phenotypes were present in 5 (83%) scleroderma patients, 3 (50%) mitochondrial and 2(33%) autonomic patients. Scleroderma patients had low amplitude phenotypes with disorganised electrical activity and significantly lower RI (p=0.007);mitochondrial and AAG patients had high frequency phenotypes with significantly higher FFR in mitochondrial patients (p<0.001) – table 1. A low BMI (p=0.02) but not abnormal gastric emptying (p=0.19), nor PAGI SYM scores (p=0.49) predicted abnormal spectral analysis.Excessive fullness (58.8%) and nausea (29.4%) were the most common meal responsive symptoms.Abstract P113 Table 1Demographics and alimetry parameters in patients with scleroderma, AAG and mitochondrial disorders. PGF: Principal gastric frequency; BMI-A: BMI adjusted gastric amplitude; RI: Gastric rhythm index; F:F ratio: fed to fasted ratioConclusionAnormal spectral phenotypes are present in patients with gastric neuromuscular dysfunction and seem to differ in scleroderma, mitochondrial disorders and AAG. Gastric alimetry may be a useful tool to differentiate the cause of gastric dysfunction in systemic conditions.

Purpose & Methods Neuroendocrine neoplasms are a heterogenous group of tumours, for which nuclear medicine plays an important role in the diagnostic work-up as well as in the targeted therapeutic options. This guideline is aimed to assist nuclear medicine physicians in recommending, performing, reporting and interpreting the results of somatostatin receptor (SSTR) PET/CT imaging using Ga-68-DOTA-conjugated peptides, as well as F-18-DOPA imaging for various neuroendocrine neoplasms. Results & Conclusion The previous procedural guideline by EANM regarding the use PET/CT tumour imaging with Ga-68-conjugated peptides has been revised and updated with the relevant and recent literature in the field with contribution of distinguished experts.

Background Many patients with foregut cancer do not receive guideline-concordant treatment (GCT). Although social determinants of health (SDOH) have been associated with differences in receipt of GCT, the underlying mechanisms that perpetuate these disparities remain unknown. This mixed-methods study explored barriers to receipt of care among patients with foregut cancer. Methods Patients with foregut cancers treated at a safety-net hospital in the Deep South were purposively selected. The patients completed semi-structured interviews, which were recorded, transcribed, and analyzed. Grounded theory methodology was used to generate themes through open coding, develop a thematic coding structure, and create a codebook. Intercoder agreement was above 90%. Patient sociodemographic and treatment-related variables were abstracted from the patients’ medical records to produce simple descriptive statistics. Results The majority of the 30 participating patients were male ( n = 23, 77%), black ( n = 18, 60%), and with a median age of 63 years (interquartile range, 55–67 years). Using the socioecologic model, barriers were categorized into individual, interpersonal, organizational, and policy levels. Within the individual level, the barriers were access to primary care providers, personal barriers, competing responsibilities, multifaceted financial barriers, and transportation barriers. The interpersonal barriers involved communication challenges, physician mistrust, and absence of social support. The organizational level barriers were health system mistrust, inadequate health care infrastructure, and lack of insurance coverage consequences. The policy level barriers were health care access policies and insurance policies. Conclusions The patients reported multiple barriers related to accessing and adhering to their treatments. Understanding these barriers is critical to forming the basis for developing and implementing programs to increase the delivery of GCT.

Organoid models of early tissue development have been produced for the intestine, brain, kidney and other organs, but similar approaches for the heart have been lacking. Here we generate complex, highly structured, three-dimensional heart-forming organoids (HFOs) by embedding human pluripotent stem cell aggregates in Matrigel followed by directed cardiac differentiation via biphasic WNT pathway modulation with small molecules. HFOs are composed of a myocardial layer lined by endocardial-like cells and surrounded by septum-transversum-like anlagen; they further contain spatially and molecularly distinct anterior versus posterior foregut endoderm tissues and a vascular network. The architecture of HFOs closely resembles aspects of early native heart anlagen before heart tube formation, which is known to require an interplay with foregut endoderm development. We apply HFOs to study genetic defects in vitro by demonstrating that NKX2.5 -knockout HFOs show a phenotype reminiscent of cardiac malformations previously observed in transgenic mice. Heart-forming organoids model early cardiac development.

A recent study shows that the commensal bacterium Lactiplantibacillus plantarum recognizes the foregut of the fruit fly as its physical niche via sugar-binding adhesins.

BackgroundAntroduodenal manometry (ADM) is one of the tests for the evaluation of gastric as well as duodenal motility. It is considered one of the most difficult diagnostic tests in neurogastroenterology, given the difficulty in placement of the catheter and the duration of the test involved.Currently, available commercial ADM catheters are limited. With this initial study, we describe our initial experience using a novel wire-guided water-perfused catheter (KARE Catheter) with radio-opaque markers for performing antroduodenal manometry.MethodsInclusion Criteria—Patients aged 18 years and above referred for evaluation of antro-duodenal dysmotility in suspected cases of gastroparesis or chronic idiopathic pseudo-obstruction underwent ADM using the novel KARE catheter. Patients had symptoms of diffuse or upper gastro-intestinal dysmotility, including postprandial bloating, recurrent vomiting, upper abdominal discomfort, and weight loss.Exclusion Criteria- Mechanical Obstruction, inability to pass the catheter, negative consent for the procedure, age less than 1811 patients underwent ADM at our referral Neuro-gastroenterology & GI motility lab using the novel KARE catheter.Data collected was symptoms of the patient (taking the predominant symptom of the patient), age, sex, prior history of diabetes or foregut interventions (surgery or endoscopic), time taken for catheter insertion, successful completion of study defined as completion of all phases of test or demonstration of phase 3 antral MMCs during the study.ResultsCatheter placement using the KARE catheter was successful in all the patients (IDDF2024-ABS-0347 Figure 1. Placement of KARE catheter). The mean time to insert a catheter was 8.8 minutes, with a median of 9 minutes (IQR 4). Spontaneous Phase 3 MMCs (IDDF2024-ABS-0347 Figure 2. Image acquired showing antral 3cpms and duodenal contractions using KARE) were identified in 9 out of 11 patients. Conversion to fed pattern was also seen in 9 out of 11 patients. Antral hypomotility, as well as duodenal hypomotility, was seen in 1 patient with small bowel pseudo-obstruction; the dominant frequency in the antrum was 1.7 cpm, and the antral amplitude was 35mmhg. 2 patients with gastroparesis also showed dominant frequencies below 3 cpm in the antrum.Abstract IDDF2024-ABS-0347 Figure 1Placement of KARE catheter.Abstract IDDF2024-ABS-0347 Figure 2Image acquired showing antral 3cpms and duodenal contractions using KARE.ConclusionsThis novel wire-guided, radio-opaque, water-perfused high-resolution antro-duodenal catheter makes antro-duodenal manometry easier, with less time required for insertion and subsequent analysis.

Visceral organs, such as the lungs, stomach and liver, are derived from the fetal foregut through a series of inductive interactions between the definitive endoderm (DE) and the surrounding splanchnic mesoderm (SM). While DE patterning is fairly well studied, the paracrine signaling controlling SM regionalization and how this is coordinated with epithelial identity is obscure. Here, we use single cell transcriptomics to generate a high-resolution cell state map of the embryonic mouse foregut. This identifies a diversity of SM cell types that develop in close register with the organ-specific epithelium. We infer a spatiotemporal signaling network of endoderm-mesoderm interactions that orchestrate foregut organogenesis. We validate key predictions with mouse genetics, showing the importance of endoderm-derived signals in mesoderm patterning. Finally, leveraging these signaling interactions, we generate different SM subtypes from human pluripotent stem cells (hPSCs), which previously have been elusive. The single cell data can be explored at: https://research.cchmc.org/ZornLab-singlecell . The fetal murine foregut develops into visceral organs via interactions between the mesoderm and endoderm, but how is unclear. Here, the authors use single cell RNAseq to show a diversity in organ specific splanchnic mesoderm cell-types, infer a signalling network governing organogenesis and use this to differentiate human pluripotent stem cells.

COVID-19 has overwhelmed many health care systems which has affected the landscape of elective surgery. A pandemic driven protocol was developed to perform foregut surgeries as a Same Day Surgery (SDS) discharge for all comers to reduce resource utilization. Retrospective review of all patients who underwent elective laparoscopic foregut surgery (hiatal hernia, paraesophageal hernia, heller myotomy, and fundoplication) from 8/1/2020–1/31/2022 by a single surgeon after the implementation of a SDS protocol. Patients were compared to a pre-pandemic cohort, from 8/1/2019–4/30/2020, when overnight admission was standard practice. There were 36 pre-pandemic patients, and 41 pandemic patients successfully discharged the same day of surgery. We failed to detect a statistically significant difference between the two groups regarding 30-day ED visit rate (p-value of 0.4557) and 30-day readmission rate (p-value of 0.6790). The creation of a SDS protocol for foregut surgery is a safe way to deliver much needed care to the community while decreasing resource utilization. •Enhanced recovery foregut surgery protocol was developed with COVID-19 restrictions.•Similar post-operative outcomes for same day discharge foregut surgery.•Foregut surgery can safely be performed as a same day discharge for all comers.

Somatostatin analogues (SSAs) are widely used to treat gastroenteropancreatic neuroendocrine tumors (GEP-NETs). Somatostatin receptor 2 (SSTR2) immunoreactivity serves as a predictive marker of the therapeutic efficacy of SSAs in pancreatic NETs. However, SSTR2 expression profiles in tumor cells and their association with the therapeutic efficacy of SSAs remains virtually unknown in gastrointestinal NETs (GI-NETs). Therefore, we evaluated the association between SSTR2 immunoreactivity and embryological origin and proliferative activity in 132 resected surgical tissues of GI-NETs. The correlation between SSAs’ therapeutic efficacy and SSTR2 immunoreactivity was evaluated in 14 GI-NETs treated with SSAs. SSTR2 immunoreactivity was evaluated using Volante scores, immunoreactive scores, and digital image analysis (DIA). SSTR2 immunoreactivity was significantly negatively and positively correlated with the Ki-67 labeling index in foregut and hindgut NETs, respectively. In the normal mucosa, neuroendocrine cells in the rectum had significantly lower positive rates of SSTR2 than those in the stomach and duodenum. SSTR2 expression profiles in GI-NETs could differ by primary sites, while the difference of those between foregut and hindgut NETs might be derived from the SSTR2 status of normal neuroendocrine cell counterparts. In addition, DIA could provide a good alternative for predicting response to SSAs in evaluating SSTR2 immunoreactivity of GI-NETs.