Long-term benefit of transoral incisionless fundoplication using the esophyx device for the management of gastroesophageal reflux disease responsive to medical therapy.
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Long-term benefit of transoral incisionless fundoplication using the esophyx device for the management of gastroesophageal reflux disease responsive to medical therapy.
Incisionless transoral fundoplication (TIF) using EsophyX device has been proven effective and safe in patients with Gastroesophageal reflux disease (GERD); However, a subset of patients who will mostly benefit from this technique is still unknown. The purpose of this study was to evaluate the long-term efficacy and safety of TIF procedure in patients with a history of chronic esophagitis or proven GERD symptoms who have achieved control with the administration of proton pump inhibitors (PPI) but do not want to continue receiving medication for life.
Forty-five patients with typical GERD symptoms (heartburn, regurgitation, chest pain) and a history of esophagitis grade A and B or proven GERD with esophageal pH monitoring underwent TIF using Esophyx. Patients with eosphagitis C and D or those with large hiatal hernia (> 2 cm) were excluded. Clinical primary efficacy measure was the elimination of GERD symptoms at follow-up based on the normalization of GERD health-related quality of life (GERD-HRQL) questionnaire.
After a median follow-up period of 59 months (36-75) GERD-HRQL score improved significantly from a median of 27 (2-45) at baseline to 4 (0-26) (P <0.001) in the 44 patients completed the study. Heartburn eliminated in 12 of 21 patients included (57.1%), regurgitation were eliminated in 15 of the 17 patients included (88.2%) and chest pain eventually eliminated in five of six patients including patients (83.3%). Overall, 32 patients out of 44 patients (72.7%) who completed the follow-up study reported elimination of their main symptoms, without the need for administration of PPI (no use of PPIs).
Furthermore, six patients (13.6%), five with heartburn, regurgitation and one with a reported half-dose PPI is taken to <50% from the previous follow-up period (PPI use occasionally), while six patients (four with heartburn, one with regurgitation, and one with chest pain) reported full or half-dose PPI is taken for more than 50% from the previous follow-up period (PPI use every day). The creation of an esophagogastric fundoplication using EsophyX device abolished reflux symptoms in 72.7% of patients with GERD is PPI-responsive at a median of 59 months follow-up.
Long-term benefit of transoral incisionless fundoplication using the esophyx device for the management of gastroesophageal reflux disease responsive to medical therapy.
Responsive to the diversity of medical education: taking intersectionality based approach to curriculum evaluation.
Recent years have seen an increase in efforts to implement a variety of topics to medical education, using either the ‘narrowing down’ or the definition of ‘widespread’ culture. This development is encouraging that the results of such efforts are systematically evaluated by mapping the curriculum for diversity-responsive content.
This study aims to use intersectionality based approach to determine the learning objectives related to diversity-and to evaluate how the biomedical and social aspects of cultural diversity are integrated into the medical curriculum in the Netherlands. We took a three-phase mixed methods approach.
In phase one and two, we define essential learning objectives based on qualitative interviews with school stakeholders and literary diversity. In phase three, we screened for content written curriculum diversity (culture, sex / gender and class) and associated outcomes with the objectives set in the two-phase study. We identified three learning objectives in the field of education (medical knowledge and skills, patient-physician communication, and reflexivity).
Description: CRK, also known as p38, is a protein that in humans is encoded by the CRK gene. This gene is a member of an adapter protein family that binds to several tyrosine-phosphorylated proteins. It is mapped to 17p13.3. The protein participates in the Reelin signaling cascade downstream of DAB1. The product of this gene has several SH2 and SH3 domains (src-homology domains) and is involved in several signaling pathways, recruiting cytoplasmic proteins in the vicinity of tyrosine kinase through SH2-phosphotyrosine interaction. The N-terminal SH2 domain of Crk functions as a positive regulator of transformation whereas the C-terminal SH3 domain functions as a negative regulator of transformation. Two alternative transcripts encoding different isoforms with distinct biological activity have been described.
Most content classified diversity of biomedical knowledge and skills. the limited attention given to social and cultural issues as determinants of health and health care use.
