Pepsin A in Tracheal Secretions From Patients Receiving Mechanical Ventilation

Background In patients in the intensive care unit (ICU) receiving mechanical ventilation, aspiration of gastric contents may lead to ventilator-associated events and other adverse outcomes. Pepsin in pulmonary secretions is a biomarker of microaspiration of gastric contents. Objectives To evaluate the association between tracheal pepsin A and clinical outcomes related to ventilator use. Methods A subset of 297 patients from a larger clinical trial on aspiration of oral secretions in adults receiving mechanical ventilation consented to have pepsin A measured in their tracheal aspirate samples. A concentration ≥6.25 ng/mL indicated a positive result. Abundant microaspiration was defined as pepsin A in ≥30% of samples. Statistical analyses included analysis of variance, analysis of covariance, and χ2 tests. Results Most patients were White men, mean age 59.7 (SD, 18.8) years. Microaspiration was found in 43.8% of patients (n = 130), with abundant microaspiration detected in 17.5% (n = 52). After acuity was controlled for, patients with tracheal pepsin A had a longer mechanical ventilation duration (155 vs 104 hours, P < .001) and ICU stay (9.9 vs 8.2 days, P = .04), but not a longer hospital stay. Conclusions Microaspiration of gastric contents occurred in nearly half of patients and was associated with a longer duration of mechanical ventilation and a longer stay in the ICU. Additional preventative interventions beyond backrest elevation, oropharyngeal suctioning, and management of endotracheal tube cuff pressure may be needed. Also, the timing of pepsin measurements to capture all microaspiration events requires additional exploration.

Distribuição de óbitos por causas externas entre crianças menores de um ano, 2004-2019 / Distribution of deaths from external causes among children under one year during the period of 2004-2019

Resumo: O objetivo foi analisar a distribuição de óbitos por acidentes e violências em crianças menores de 1 ano. Métodos: o número de óbitos foi obtido no site do Departamento de Informática do Sistema Único de Saúde considerando o período de 2004-2019. Resultados: No período ocorreram 16.274 mortes de bebês devido aos acidentes (n=12.984) e violências (n=3.290), configurando a quinta causa de morte no primeiro ano de vida. A maior parte dos óbitos por acidentes foi devida a “outras causas de traumatismos acidentais” (n=11.300), e mais de 75% deles foi devido à aspiração de objeto, alimento, conteúdo gástrico. As agressões (n=1450) apresentaram tendência de aumento no período de estudo. Conclusão: Os acidentes e violências ocupam a quinta causa de morte de crianças menores de 1 ano. Tendo em vista a evitabilidade desses óbitos é crucial a proposição de intervenções que antecedam o nascimento da criança, preferencialmente envolvendo a atenção pré-natal. Abstract:The objective was to analyze the distribution of deaths due to accidents and violence in children under 1 year of age. Methods: the number of deaths was obtained from the website of the Informatics Department of the Unified Health System considering the period 2004-2019. Results: In the period there were 16,274 deaths of babies due to accidents (n=12,984) and violence (n=3,290), making up the fifth cause of death in the first year of life. Most of the deaths from accidents were due to “other causes of accidental trauma” (n=11,300), and more than 75% of them were due to aspiration of objects, food, gastric contents. Aggression (n=1450) tended to increase during the study period. Conclusion: Accidents and violence are the fifth leading cause of death for children under 1 year of age. In view of the preventability of these deaths, it is crucial to propose interventions that precede the child's birth, preferably involving prenatal care.Keywords: Children. External Causes. Accidents. Violence. Mortality. Child mortality.

"Conveyor machine" for collecting gastric juice

The study of gastric digestion has a long history. Since the time of the first researchers who had to kill animals (Tiedemann and Gmelin) in order to get 7-10 kb. see gastric contents, the development of the method of obtaining gastric juice goes through a number of stages.

DNA metabarcoding Uncover the Diet of Subterranean Rodents in China

ObjectiveIn the past, the zokor, which lived in northern China, caused great harm to agriculture and forestry production due to its large and sophisticated diet. Since the rat lives underground for most of its life, researchers know little about its dietary habits. Further understanding of its diet in the field is of important meaning for developing green and sustainable control strategies for the rat.MethodsLongde County in Liupan Mountain area of Ningxia Hui Autonomous Region was selected as the interest area to capture zokor and investigate the species of habitat plants.We selected chloroplast trnL gene and eukaryotic internal transcription spacer 1 (ITS 1) primers to amplify DNA from the gastric contents of zokor,and then sequenced on Illumina Miseq PE300 platform.ResultsThe gastric contents of Eospalax smithii (n=16) and E.cansus(n=9) were analyzed by operational taxonomic units (OTU) clustering and amplicon sequence variants(ASVs).The OTU clustering method obtained 2,995 OTUs, and the ASV method obtained 4,657 ASVs. The ASV method was better than the OTU clustering method, and the ASV method was adopted in the subsequent analysis. The food list of 32 families, 80 genera and 154 species was obtained by ASV method after the error was removed. The food composition of zokor was evaluated by relative abundance(%RA) method and frequency of occurrence(%ROO) method. At the Family level, it was found that zokor mainly fed on Asteraceae, Poaceae, Rosaceae, Pinaceae, Brassicaceae, Apiaceae, etc. At the Genus level, they are mainlyEchinops, Littledalea,Artemisia,Picea, Cirsium, Elymus and so on. The diet alpha diversity of E.cansus was slightly higher than that of E.smithii (P > 0.05). The correlation coefficient between Sobs index of alpha diversity and body weight of zokor was −0.382 (P = 0.059). The diet beta diversity proved that most zokors (22/25) clustered together, with low heterogeneity. They fed positively on Calamagrostis, Cirsium, Echinops, Medicago, Sanguisorba and Taraxacum. We found that zokor mainly fed on the roots of perennial herbs(PH), which were rich in water, carbohydrate, fat and protein, which provided an important energy source for its survival.ConclusionHigh-throughput sequencing(HTS) based DNA metabarcoding technology has well revealed the diet of zokor, which are generalist.

Clinical Efficacy of Unani Drug in the Management of Tabkheer-I-Meda (Gastroesophageal Reflux Disease)

Tabkheer-i-meda has been described as reflux of acid from stomach in the Unani classical literatures. This disease is characterized by various symptoms like indigestion, pain in abdomen, suppression of thrust, burning sensation in the epigastrium, anorexia, nausea and acid reflux etc. In modern medicine, Gastro-esophageal Reflux Disease (GERD) is defined as symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus or beyond, into the oral cavity (including larynx) or lungs. The objective of the present study was to evaluate the efficacy of Safoof-i-Tabkheer on the patients suffering with associated symptoms of Tabkheer-i-Meda (Gastro-esophageal Reflux Disease). Patients were advised orally 5grams of Safoof-i-Tabkheer with water twice daily after the meal. It was observed that after the treatment, all associated symptoms of Tabkheer-i-Meda/ GRED including retrosternal burning, epigastric pain acidic brash and anorexia were significantly (p<0.05) reduced. The percentage reduction in retrosternal burning, acidicbrash, epigastric pain and anorexia were 53.89%, 51.56%, 48.53% and 40.65% respectively as compared to base line. No adverse effect of drug was found. Highly significant improvements (p<0.001, paired t test) in all associated symptom of the disease suggest that the results are really due to the therapy. On the ground of above observation, it can be concluded that the Unani pharamacopieal formulation ‘Safoof-i-Tabkheer’ is very effective and safe in the treatment of Tabkheer-i-Meda.