Mechanical upper bowel obstruction caused by a large trichobezoar in a young woman: A very unusual case report

BACKGROUND Bezoars usually compile human fibers and debris.A special form of bezoar in case of psychologically altered individuals is the trichobezoar.It consists of voluntarily swallowed hair bulks and is normally removed via gastroscopy.Trichobezoars leading to ileus have rarely been reported.CASE SUMMARY A 24-year-old female patient presented to the emergency room with abdominal pain,nausea,and vomiting for 3 d.Her previous medical and psychiatric history was unremarkable.Laboratory analysis showed iron deficiency anemia,leukocytosis,and elevated liver enzymes.An abdominal CT scan revealed a dense structure in the patients’stomach which turned out to be a huge trichobezoar completely obstructing the pylorus.The trichobezoar had to be removed surgi-cally.During her postoperative course,a subcutaneous seroma formed.After a single puncture,the rest of the recovery process was unremarkable,and the patient recovered fully.CONCLUSION A mechanical bowel obstruction is a potentially life-threatening event for every patient.In our case a young female was suffering from severe symptoms of an obstruction which might have resulted in serious harm without successful surgical management.

Death from caustic ingestion:A case report

Rationale:Acute caustic ingestion from suicidal intent is not usual in emergency departments in developed countries.One of the substances commonly ingested by suicidal patients,phosphoric acid,tends to cause multi-system derangements.Patient’s Concern:A 41-year-old male patient presented with complaints of throat discomfort,severe generalized abdominal pain,and multiple episodes of hematemesis after ingesting a restroom cleaning solution.Diagnosis:Poisoning by acute caustic ingestion(containing<30%phosphoric acid and<4%ethylene glycol).Interventions:The patient was administered 50 mL of 8.4%sodium bicarbonate solution followed by an isotonic sodium bicarbonate solution running at 500 mL/h,a hyperkalemia kit,ceftriaxone,metronidazole,omeprazole,and atropine.The patient then underwent urgent hemodialysis.Outcomes:The patient suffered gastrointestinal bleeding as a result of local caustic injury.In addition,his course of illness was complicated by severe acidemia from high anion gap metabolic acidosis and deranged electrolytes(hyperphosphatemia,hyperkalemia,and hypocalcemia).He developed multi-organ failure and eventually demised.Lessons:The clinician needs to be mindful of the multi-system complications arising from such a caustic ingestion.These patients need to be monitored closely for deterioration,and have prompt management of the various arising complications,to reduce the high morbidity and mortality associated with this condition.

Oral Sodium Hyaluronate Moisturizes Skin in Healthy Adults: An 8-Week, Randomized, Double-Blinded, Placebo-Controlled Study

Objective: Few studies have evaluated the effect of oral sodium hyaluronate (SH) ingestion on the moisture content of the superficial stratum corneum. This study aimed to assess whether oral SH ingestion improves the moisture content of the upper layer of the stratum corneum, which is susceptible to changes in environmental humidity, using the Skicon 200EX. Design: Randomized, double-blind, placebo-controlled, parallel-group study. Participants: One hundred healthy Japanese men and women aged 20 - 64 years. Interventions: Oral ingestion of one 119-mg SH or dextrin (placebo) capsule once daily for 8 weeks. Evaluations: Measurement of water content in the superficial stratum corneum of the face and upper extremities using the Skicon 200EX. Results: Overall facial stratum corneum water content changes were significantly higher at 8 weeks in the SH group compared to the placebo group. Conclusions: In healthy Japanese adults, oral SH ingestion improved skin moisture by increasing the stratum corneum water content. Clinical Trial Registration: The study protocol was preregistered with the Clinical Trials Registry System (registration no. UMIN000053322, January 11, 2024).

Gluconacetobacter hansenii GK-1 Ingestion for 8 Weeks Improves Skin Discomfort in Healthy Adults: A Randomized, Double-Blind, Placebo-Controlled Study

Gluconacetobacter hansenii GK-1 is an acid-resistant gram-negative bacterium used in vinegar brewing. Oral ingestion of GK-1 was previously reported to help maintain immunity and reduce nasal discomfort. Considering the suggested mechanism of action of activation of regulatory T cells via TLR4 to control Th1/Th2 balancing, GK-1 is also assumed to reduce skin discomfort secondary to immune reactions;however, this has not been validated in humans. Thus, we conducted a randomized, double-blind, placebo-controlled, parallel-group study on 100 healthy Japanese men and women (mean age, 47.6 ± 1.01 years) aged 20–64 years who consumed GK-1 (9 × 109 cells) daily for 8 weeks. Visual analog scale for overall, facial, arm, and leg skin discomfort was assessed before and after ingestion. The cumulative days of skin discomfort during the ingestion period were assessed. Compared with the placebo group, the G. hansenii GK-1 group had a significantly lower visual analog scale for overall and facial skin discomfort after 8 weeks and cumulative days of skin discomfort. Moreover, there were no adverse events attributable to G. hansenii GK-1. This study confirmed that oral ingestion of G. hansenii GK-1 contributed to skin integrity. The study protocol was preregistered at the Clinical Trials Registry System (registration no. UMIN000053005, December 7, 2023).

Impact of Social Media Challenges on Pediatric Single-Use Detergent Sacs and Diphenhydramine Ingestions Reported to United States Poison Control Centers

Background: Social media platforms are popular among children and often feature challenges that become viral. Notably, the Tide Pod® and Benadryl® challenges encouraged viewers to ingest these substances for their visual appeal and hallucinogenic effects, respectively. This study aimed to assess the clinical impact and outcomes of single-use detergent sacs (SUDS) and diphenhydramine challenges on pediatric ingestions reported to United States (U.S.) Poison Control Centers (PCCs). Methods: We conducted a retrospective review of pediatric exposures reported to U.S. PCCs using data from the National Poison Data System (NPDS). The study included intentional single-substance ingestions of both brand-name and generic forms of SUDS and diphenhydramine among children ≤ 19 years. We compared the number of calls, clinical effects, disposition, and management strategies for SUDS (pre: 01/01/17 to 12/31/17 vs. post: 01/01/18 to 12/31/18) and diphenhydramine (pre: 08/01/19 to 07/31/20 vs. post: 08/01/20 to 07/31/21) ingestions 12 months before and after the introduction of the respective social media challenges. Differences in proportions were compared using the Chi-square test. Results: During the study period, 469 ingestions of SUDS and 5,702 ingestions of diphenhydramine were reported. Post-challenge periods saw an increase in both SUDS (pre: 82 vs. post: 387;372% increase) and diphenhydramine ingestions (pre: 2,672 vs. post: 3,030;13% increase). While there were no significant changes in moderate or major clinical outcomes, hospitalizations increased post-challenge for both SUDS [pre: 4 (4.9%) vs. post: 33 (8.5%);p = 0.25] and diphenhydramine [pre: n = 904 (33.8%) vs. post: 1,190 (39.3%);p Conclusion: Pediatric ingestions reported to U.S. PCCs and hospitalizations increased coinciding with the introduction of Tide Pod® and Benadryl® challenges. While causality cannot be definitively established, it is essential for pediatricians and parents to be aware of these challenges and educate vulnerable children about the harmful effects of participation in such challenges.

Caustic injury of the upper gastrointestinal tract: A comprehensive review

Prevention has a paramount role in reducing the incidence of corrosive ingestion especially in children, yet this goal is far from being reached in developing countries, where such injuries are largely unreported and their true prevalence simply cannot be extrapolated from random articles or personal experience. The specific pathophysiologic mechanisms are becoming better understood and may have a role in the future management and prevention of long-term consequences, such as esophageal strictures. Whereas the mainstay of diagnosis is considered upper gastrointestinal endoscopy, computed tomography and ultrasound are gaining a more significant role, especially in addressing the need for emergency surgery, whose morbidity and mortality remains high even in the best hands. The need to perform emergency surgery has a persistent long-term negative impact both on survival and functional outcome. Medical or endoscopic prevention of stricture is debatable, yet esophageal stents, absorbable or not, show promising data. Dilatation is the first therapeutic option for strictures and bougies should be considered especially for long, multiple and tortuous narrowing. It is crucial to avoid malnutrition, especially in developingcountries where management strategies are influenced by malnutrition and poor clinical conditions. Late reconstructive surgery, mainly using colon transposition, offers the best results in referral centers, either in children or adults, but such a difficult surgical procedure is often unavailable in developing countries. Possible late development of esophageal cancer, though probably overemphasized, entails careful and long-term endoscopic screening.

Emergency admissions due to swallowed foreign bodies in adults

AIM:To study a retrospective analysis of patients who presented to the emergency departments(ED)with complaints related to foreign body ingestions.METHODS:Patients older than 16 years of age who presented to the ED between January 1stand December 31stof 2010 with complaints related to swallowed foreign bodies were identified from electronic health records and patient charts.RESULTS:A total of 100 patients presented with a complaint of foreign body ingestion during the study period.Overall,an X-ray was performed on 75 patients,and a fiberoptic evaluation was performed on45 patients.A foreign body was detected in 46(46%)patients.The diagnostic yield of the X-ray was 27(36%)out of 75 patients,while the diagnostic yield of the fiberoptic evaluations was 21(47%)out of 45 patients.The detected foreign bodies were mostly located in the esophagus(17 out of 46 foreign bodies detected).When the types of ingested foreign bodies were evaluated,52(52%)patients reported ingesting food,and19(19%)patients reported swallowing pins.An X-ray was performed on 33 patients with accidental food ingestions but yielded a positive result in only two cases.In 12 out of 21 patients with accidental food ingestion who underwent fiberoptic evaluation,the foreign material was detected and removed.CONCLUSION:Plain radiography is helpful in the localization of radiopaque swollen foreign bodies,while fiberoptic methods are useful as both diagnostic and therapeutic tools,regardless of radiopacity.

Intentional ingestions of foreign objects among prisoners: A review

The intentional ingestion of foreign objects(IIFO) is described more commonly in prison populations than in the general population, with an estimated annual incidence of 1 in 1900 inmates in our state correctional facilities. Incidents often involve ingestion of small metal objects(e.g., paperclips, razor blades) or other commonly available items like pens or eating utensils. Despite ingestion of relatively sharp objects, most episodes can be clinically managed with either observation or endoscopy. Surgery should be reserved for those with signs or symptoms of gastrointestinal perforation or obstruction. For those with a history of IIFO, efforts should focus on prevention of recurrenceas subsequent episodes are associated with higher morbidity, significant healthcare and security costs. The pattern of IIFO is often repetitive, with escalation both in frequency of ingestions and in number of items ingested. Little is known about successful prevention strategies, but efforts to monitor patients and provide psychiatric care are potential best-practice strategies. This article aims to provide state-of-the art review on the topic, followed by a set of basic recommendations.

Z-line examination by the PillCam^(TM) SB:Prospective comparison of three ingestion protocols

AIM:To evaluate the Z-line visualization by the PillCamTM SB2 using three different ingestion protocols. METHODS:Ninety consecutive patients undergoing small bowel capsule endoscopy(SBCE)between January and May 2008 were included in the study. They swallowed the capsule in the standing(Group A= 30),supine(Group B=30)and right supine positions (Group C=30).Baseline patient characteristics, difficulties in capsule ingestion,esophageal transit times(ETT)and Z-line visualization were noted. RESULTS:No significant differences were found between the groups with regard to baseline patient characteristics,ingestion difficulties and complete SB examinations(P>0.05).At least 1 frame of the Z-line was detected in 15.8%,46.7%and 90%of patients in groups A,B and C,respectively(P<0.001).The average number of Z-line images was 0.21±0.53,3.23 ±6.59 and 5.53±7.55 and the mean%of the Z-linedetected was 71.3,25.1 and 8.3,in groups A,B and C, respectively(both P<0.001).ETT times were longer in the supine group followed by the right supine and the standing groups(median of 237 s vs 64 s and 39 s, respectively;P<0.001). CONCLUSION:Z-line visualization in patients undergoing SBCE can be accurately achieved in most cases when the capsule is swallowed in the right supine position.

Prevention and treatment of gastrointestinal dysfunction following severe burns: A summary of recent 30-year clinical experience

AIM： To sum up the recent 30-year experience in the prevention and treatment of gastrointestinal dysfunction in severe burn patients, and propose practicable guidelines for the prevention and treatment of gastrointestinal （GI） dysfunction. METHODS： From 1980 to 2007, a total of 219 patients with large area and extraordinarily large area burns （LAB） were admitted, who were classified into three stages according the therapeutic protocols used at the time： Stage 1 from 1980 to 1989, stage 2 from 1990 to 1995, and stage 3 from 1996 to 2007. The occurrence and mortality of GI dysfunction in patients of the three stages were calculated and the main causes were analyzed. RESULTS： The occurrence of stress ulcer in patients with LAB was 8.6% in stage 1, which was significantly Dower than that in stage 1 （P 〈 0.05）. No massive hemorrhage from severe stress ulcer and enterogenic infections occurred in stages 2 and 3. The occurrence of abdominal distension and stress ulcer and the mortality in stage 3 patients with extraordinarily LAB was 7.1%, 21.4% and 28.5%, respectively, which were significantly lower than those in stage 1 patients （P 〈 0.05 or P 〈 0.01）, and the occurrence of stress ulcer was also significantly lower than that in stage 2 patients （P 〈 0.05）. CONCLUSION： Comprehensive fluid resuscitation, early excision of necrotic tissue, staged food ingestion, and administration of specific nutrients are essential strategies for preventing gastrointestinal complications and lowering mortality in severely burned patients.

Effect of UV-B Radiation on Ingesting and Nutritional Selecting Behavior of Rotifer Brachionus urceus

Effect of UV-B radiation on ingesting and nutritional selecting behavior of the roifer Brachionus urceus on 5 species of microlgae were studied under controlled laboratory conditions. Restdts showed that enhanced UV-B radiation significantly inhibited ingesting of the rotifer B. urceus when it was fed with 5 species of micro-algae （p〈0.05）. The ingesting selectivity rate varied with the UV-B radiation enhancement when it was fed with 5 species micro-algal mixture. Results indicated that the enhanced UV-B radiation could affect ingesting and nutritional selectivity of B. urceus.

Knowledge of aflatoxin contamination in groundnut and the risk of its ingestion among health workers in Ibadan,Nigeria

Objective:To assess the awareness and knowledge of aflatoxin contamination in groundnut and the risk of its ingestion among health workers in Ibadan.Methods:The study was a descriptive cross-sectional study.Study instrument was a semi-structured self administered questionnaire. The respondents were health workers from a public health facility.Results:A total of 417 health workers participated out of which males were 60.2%.The mean age of respondents was(28.0±4.9) years old.Doctors made up 83.0%while others were nurses.95%of the respondents had previous awareness of aflatoxin and class room lectures was the most common source of information(56%).Occupation and religion both showed a significant association with previous awareness of aflatoxin(P<0.05).Knowledge regarding aflatoxin contamination in groundnut and the risk of its ingestion was obtained showing knowledge score range of 0 to 14.In all,80.6%had good scores of 11 to 14.None of the respondents had ever told their patients about the risk of aflatoxin ingestion. Conclusions:There is a need to explore the possibility of incorporating aflatoxin awareness into routine health talk to increase the level of awareness of patients and their relatives.

Role of endoscopy in caustic injury of the esophagus

Caustic injury of the esophagus is a problematic condition challenging endoscopists worldwide. Althoughthe caustic agents and motives are different among countries and age groups, endoscopy still plays an invaluable role in diagnosis and treatment. Endoscopy can determine the severity of caustic ingestion which is of great importance in choosing appropriate treatment. However, some aspects of endoscopy in diagnosis of caustic injury remain controversial. Whether or not all patients need endoscopy, when to perform endoscopy and how to assess the severity are just some examples of these controversies. Due to lack of randomized controlled trials, many findings and suggestions are inconclusive. Computerized tomography scan of the chest and abdomen gains popularity in assessing the severity of caustic injury and avoiding unnecessary surgery. If esophageal stricture eventually develops, endoscopic dilatation is a mainstay. Maneuvers such as steroid injection and esophageal stent may be used in a refractory stricture. Nevertheless, some patients have to undergo surgery in spite of vigorous attempts with esophageal dilatation. To date, caustic injury remains a difficult situation. This article reviews all aspects of caustic injury of the esophagus focusing on endoscopic role. Pre-endoscopic management, endoscopy and its technique in acute and late phase of caustic injury including the endoscopic management of refractory stricture, and the treatment outcomes following each endoscopic intervention are thoroughly discussed. Finally, the role of endoscopy in the long term follow-up of patients with esophageal caustic injury is addressed.

Management of esophageal caustic injury

Ingestion of caustic substances and its long-term effect on the gastrointestinal system maintain its place as an important public health issue in spite of the multiple efforts to educate the public and contain its growing number. This is due to the ready availability of caustic agents and the loose regulatory control on its production. Substances with extremes of pH are very corrosive and can create severe injury in the upper gastrointestinal tract. The severity of injury depends on several aspects: Concentration of the substance, amount ingested, length of time of tissue contact, and p H of the agent. Solid materials easily adhere to the mouth and pharynx, causing greatest damage to these regions while liquids pass through the mouth and pharynx more quickly consequently producing its maximum damage in the esophagus and stomach. Esophagogastroduodenoscopy is therefore a highly recommended diagnostic tool in the evaluation of caustic injury. It is considered the cornerstone not only in the diagnosis but also in the prognostication and guide to management of caustic ingestions. The degree of esophageal injury at endoscopy is a predictor of systemic complication and death with a 9-fold increase in morbidity and mortality for every increased injury grade. Because of this high rate of complication, prompt evaluation cannot be overemphasized in order to halt development and prevent progression of complications.

Enhanced electrogastrography: A realistic way to salvage a promise that was never kept?

To enhance the clinical utility of electrogastrography (EGG), which has been recorded since 1922, but is clinically unutilized. METHODSAn innovative method to salvage the promise of EGG is proposed by introducing a preliminary procedure, while maintaining the electrodes, standardized equipment, and signal processing utilized in the well-established EGG testing of today. The proposed enhanced EGG (EEGG) protocol involves swallowing an ingestible capsule containing miniature electronic oscillator embedded in an expandable, self-disintegratable, biocompatible pseudobesoar residing in the stomach for the duration of the test. The benefits of the proposed approach are outlined, tested and discussed in details. RESULTSExperiments were performed on eight mongrel dogs (6F, 4M, 23.8 ± 3.3 kg). Four were administered an active EEGG capsule, while the rest were given a deactivated (battery removed) capsule. Pharmacologically facilitated gastric motility revealed a significant (P < 0.01) Pearson correlation between gastric motility indices obtained by force transducers implanted directly on the stomach, and the motility indices obtained by EEGG. A particular emphasis was made on preserving standard EGG-related hardware and software in order to facilitate the introduction of the proposed EEGG in environments which already utilize standard EGG testing. The expanded intragastric pseudobezoar containing the miniature electronic oscillator was retained during the tests, and could be disintegrated on demand. CONCLUSIONEnhancing standard EGG by an ingestible, self-expanding and self-disintegrating pseudobesoar containing a miniature electronic oscillator can be an important avenue for clinical applicability of this test.

Emerging wearable technology applications in gastroenterology:A review of the literature

The field of gastroenterology has recently seen a surge in wearable technology to monitor physical activity,sleep quality,pain,and even gut activity.The past decade has seen the emergence of wearable devices including Fitbit,Apple Watch,AbStats,and ingestible sensors.In this review,we discuss current and future devices designed to measure sweat biomarkers,steps taken,sleep efficiency,gastric electrical activity,stomach pH,and intestinal contents.We also summarize several clinical studies to better understand wearable devices so that we may assess their potential benefit in improving healthcare while also weighing the challenges that must be addressed.

Comparison of the effects of cold water and ice ingestion on endurance cycling capacity in the heat

Purpose: The purpose of this study was to examine the effects of pre-cooling and fluid replacement with either crushed ice or cold water.Methods: On 2 separate occasions, in a counterbalanced order, 9 recreationally-trained males ingested 1.25 g/kg(80–100 g) of either crushed ice(0.5℃)or cold water(4℃) every 5 min for 30 min before exercise. They also ingested 2.0 g/kg(130–160 g) of the same treatment drink at 15 min, 30 min, and45 min after the commencement of cycling to exhaustion at 60%VO_(2max) until voluntary exhaustion in a hot environment(35℃ and 30% relative humidity).Results: The cycling time to exhaustion in the crushed ice trial(50.0 ± 12.2 min) was longer than the cold water trial(42.2 ± 10.1 min; p = 0.02).Although the rectal temperature fell by 0.37℃± 0.03℃(p = 0.01) at the end of the resting period after the crushed ice ingestion, the rates of rise in rectal temperature during the exercise period were not significantly different between these 2 conditions(crushed ice: 0.23℃± 0.07℃, 5 min;cold water: 0.22℃± 0.07℃, 5 min; p = 0.94).Conclusion: Crushed ice ingestion before and during exercise in a hot environment may be a preferred and effective approach for minimizing thermal strain, and for improving endurance performance as compared with cold water ingestion.

Endoscopic retrieval of a duodenal perforating teaspoon

Foreign objects ingestion occur commonly in pediatric patients. The majority of ingested foreign bodies pass spontaneously the gastrointestinal tract and surgery is rarely required for extraction. Endoscopic removal of foreign bodies larger than 10 cm has not yet been described. We present the case of a 16 years old bulimic girl that swallowed a 12 cm long teaspoon in order to provoke vomiting. The teaspoon perforated the duodenum. However, it was removed during gastroscopy and the site of perforation was closed endoscopically. This particular case shows the importance of endoscopy for retrieval of large foreign bodies, and the possibility to endoscopically close a perforated duodenal wall.

燃气轮机发动机内流及二次流系统（英文）

The challenging conditions at which gas turbine engines operate mean that careful management of component temperatures is necessary, in order to ensure component integrity and reasonable service life. Pressurised flows extracted from the compressor can be used for cooling, sealing and balancing of components throughout the engine. Cooling is typically necessary for some combustor and turbine components, and sealing flows may be needed to exclude high temperature gases. In addition to cooling and sealing requirements, there is also a need to balance thrust loads in an engine, to limit loads on bearings, arising from the pressure differentials across compressor and turbine disc assemblies. The diverse tasks of cooling, sealing and balancing are generally assigned to a system known as the internal air system or secondary flow system. This paper describes the technologies associated with this system for both industrial gas turbine engines and aero-engines, and the current state of the art and challenges in component and subsystem design.

An uncommon cause of corrosive esophageal injury

We present an unusual case of corrosive esophageal injury following liquid glue ingestion. The endoscopic f indings were tissue sloughing and blackened appearance of the esophagogastric junction,due to caustic esophageal injuries following ingestion of glue containing toluene.