Diagnostic utility of salivary pepsin in laryngopharyngeal reflux: a systematic review and meta-analysis

Abstract Objective: Salivary pepsin has emerged as a biomarker for Laryngopharyngeal Reflux (LPR), which, however, has been questioned for its efficacy due to a lack of supporting medical data. Therefore, this study analyzed the diagnostic value of salivary pepsin for LPR and assessed a better cutoff value. Methods: Studies were searched in PubMed, Embase, and Cochrane Library from their receptions to October 1, 2021. Then, RevMan 5.3 and Stata 14.0 were utilized to summarize the diagnostic indexes for further meta-analysis. Data were separately extracted by two reviewers according to the trial data extraction form of the Cochrane Handbook. The risk of bias in Randomized Control Trials (RCTs) was evaluated with the Cochrane Risk of Bias Tool. Results: A total of 16 studies matched the criteria and were subjected to meta-analysis. The results revealed a pooled sensitivity of 61% (95% CI 50%-71%), a pooled specificity of 67% (95% CI 48%-81%), a positive likelihood ratio of 2 (95% CI 1.2-2.8), a negative likelihood ratio of 0.58 (95% CI 0.47-0.72), and the area under the receiver operating characteristic curve of 0.67 (95% CI 0.63-0.71). Subgroup analyses indicated that the cutoff value of pepsin at 50 ng/mL had a higher degree of diagnostic accuracy than that of pepsin at 16 ng/mL in cohort studies. Conclusion: The review demonstrated low diagnostic performance of salivary pepsin for LPR and that the cutoff value of 50 ng/mL pepsin had superior diagnostic accuracy. Nevertheless, the diagnostic value may vary dependent on the utilized diagnostic criteria. Therefore, additional research is needed on the improved way of identifying salivary pepsin in the diagnosis of LPR, and also longer-term and more rigorous RCTs are warranted to further assess the effectiveness of salivary pepsin.

Clinical implementation of comprehending dentin on a microscopic level

SUMMARY: The aim of the present in vitro study is to visualize dentin to get an in-depth knowledge of the nature of dentin that could provide useful information regarding conditioning dentinal substrate when treating dentinal lesions. Forty-nine extracted human third molars were obtained and prepared to produce artificial dentinal lesions through demineralizing with acetic acid for 7 and 14 days, or lactic acid for 7 days. The teeth were divided into groups and treated with either NaOCl, pepsin, trypsin, or phosphoric acid. To obtain information on the morphology of the treated dentinal surfaces, all samples were visualized under high resolution field emission scanning electron microscope. With high magnification reaching x50000 dentin was clearly visualized together with its constitutes. The effect of various demineralization approaches and various treatment protocols were demonstrated clearly. The relationship between the conditioning procedure steps and the subsequent bond strength was discussed. To our best knowledge, there is no previous clear highly magnified scanning electron microscope images for dentin, and dentinal components and constitutes with and without various treatments. The current in vitro study suggests the complexity nature of dentin as a substrate that should be treated carefully especially with technique sensitive procedures such as adhesive restorations.

El objetivo del presente estudio in vitro fue visualizar la dentina para obtener un conocimiento completo de la naturaleza de ella lo que podría proporcionar información útil sobre el acondicionamiento del sustrato dentinario en el tratamiento de lesiones dentinarias. Se obtuvieron 49 terceros molares humanos extraídos y se prepararon para producir lesiones dentinales artificiales mediante desmineralización con ácido acético por 7 y 14 días, o ácido láctico por 7 días. Los dientes se dividieron en grupos y se trataron con NaOCl, pepsina, tripsina o ácido fosfórico. Para obtener información sobre la morfología de las superficies dentinarias tratadas, todas las muestras se visualizaron bajo un microscopio electrónico de barrido de emisión de campo de alta resolución. Con un gran aumento que alcanzó x50000, la dentina se visualizó claramente junto con sus componentes. Se demostró el efecto de varios enfoques de desmineralización y varios protocolos de tratamiento. Se discutió la relación entre los pasos del procedimiento de acondicionamiento y la subsiguiente fuerza de unión. Hasta donde sabemos, no hay imágenes claras previas de microscopio electrónico de barrido altamente ampliadas para la dentina y los componentes y constituyentes de la dentina con y sin diferentes tratamientos. El estudio in vitro actual sugiere la naturaleza compleja de la dentina como sustrato que debe tratarse con cuidado, especialmente en los procedimientos sensibles a la técnica, tal como las restauraciones adhesivas.

Carangoides bartholomaei (Cuvier, 1833) stomach: a source of aspartic proteases for industrial and biotechnological applications / Estômago de Carangoides bartholomaei (Cuvier, 1833): uma fonte de proteases aspárticas para aplicações industriais e biotecnológicas

The viscera and other residues from fish processing are commonly discarded by the fishing industry. These byproducts can be a source of digestive enzymes with industrial and biotechnological potential. In this study, we aimed at the extraction, characterization, and application of acidic proteases from the stomach of Carangoides bartholomaei (Cuvier, 1833). A crude extract from the stomachs was obtained and submitted to a partial purification process by salting-out, which obtained a Purified Extract (PE) with a specific proteolytic activity of 54.0 U·mg-1. A purification of 1.9 fold and a yield of 41% were obtained. The PE presents two isoforms of acidic proteases and a maximum proteolytic activity at 45 °C and pH 2.0. The PE acidic proteolytic activity was stable in the pH range of 1.5 to 7.0 and temperature from 25 °C to 50 °C. Purified Extract kept 35% of its proteolytic activity at the presence of NaCl 15% (m/v) but was totally inhibited by pepstatin A. Purified Extract aspartic proteases presented high activity in the presence of heavy metals such as Cd2+, Hg2+, Pb2+, Al3+, and Cu2+. The utilization of PE as an enzymatic addictive in the collagen extraction from Nile tilapia scales has doubled the process yield. The results indicate the potential of these aspartic proteases for industrial and biotechnological applications.

As vísceras e outros resíduos do processamento de peixes são geralmente descartados pela indústria pesqueira. Esses resíduos podem ser uma fonte de enzimas digestivas com potencial industrial e biotecnológico. Neste estudo, objetivamos a extração, caracterização e aplicação de proteases aspárticas do estômago de Carangoides bartholomaei (Cuvier, 1833). Um extrato bruto do estômago foi obtido e submetido a um processo de purificação parcial, que obteve um Extrato Purificado (EP) com uma atividade proteolítica específica de 54,0 U·mg-1. Foi obtida uma purificação de 1,9 vezes e um rendimento de 41%. O EP apresenta duas isoformas de proteases ácidas e atividade proteolítica máxima a 45 °C e pH 2,0. A atividade proteolítica do EP foi estável na faixa de pH de 1,5 a 7,0 e temperatura de 25 °C a 50 °C. O EP manteve 35% de sua atividade proteolítica na presença de NaCl a 15% (m/v), mas foi totalmente inibida pela pepstatina A. As proteases ácidas do EP apresentaram alta atividade na presença de metais pesados como o Cd2+, Hg2+, Pb2+, Al3+ e Cu2+. A utilização de EP como aditivo enzimático na extração de colágeno a partir de escamas de tilápia do Nilo dobrou o rendimento do processo. Os resultados indicam um potencial dessas proteases para aplicações industriais e biotecnológicas.

Efficacy evaluation of pepsin enzyme-based gel in chemo-mechanical caries removal on primary anterior teeth: a randomized controlled clinical study / Avaliação da eficácia do gel à base de enzima pepsina na remoção químico-mecânica da cárie em dentes anteriores decíduos: um estudo clínico controlado randomizado

Objective: To evaluate the efficacy of a new pepsin enzyme-based gel compared with Carisolv as a CMCR agent. Clinical and radiographical evaluations of recurrent caries were made 3 and 6 months after treatment. Material and Methods: A split-mouth designed randomized controlled clinical study was carried out on 40 primary anterior teeth of children aged between 4-7 years. Pepsin enzyme-based gel and Carisolv solution were applied to carious lesions until complete removal of caries. The efficacy of both agents was evaluated by the number of application times to remove all caries. Recurrent caries were evaluated clinically and radiographically after 3 and 6 months of treatment. Results: Results showed no statistically significant differences in the efficacy of caries removal by the number of application times (P = 0.919). Concerning recurrent caries, clinical and radiographical evaluation after three and six months showed no statistically significant differences between the two groups (P = 0.574, P = 0.547, respectively). Conclusion: Pepsin enzyme-based gel can be considered similar to Carisolv gel regarding its efficacy as a CMCR agent for small carious lesions on primary anterior teeth in children aged 4-7 years old. (AU)

Objetivo: avaliar a eficácia de um novo gel a base de enzima pepsina comparada com o Carisolv como um agente na remoção químico-mecânica da cárie. Avaliações clínicas e radiográficas de cárie recorrente foram feitas em 3 e 6 meses apos o tratamento. Material e Métodos: um estudo clínico controlado randomizado de boca-dividida foi realizado em 40 dentes deciduos anteriores de crianças com idade entre 4-7 anos. Gel à base de enzima pepsina e a soluçao de Carisolv foram aplicados sobre a lesão cariosa até a completa remoção da carie. A eficácia de ambos agentes foi avaliada pelo número de tempo de aplicações para a remoção de todo tecido cariado. Cárie recorrente foi avaliada clinicamente e radiograficamente após 3 e 6 meses de tratamento. Resultados: Não houve diferença significativa na eficácia de remoção de cárie pelo número de tempo de aplicação (P = 0.919). Em relação à cárie recorrente, avaliação clínica e radiográfica apos 3 e 6 meses mostraram que não houve diferença estatisticamente significante entre os 2 grupos (P = 0.574, P = 0.547, respectivamente). Conclusão: o gel à base de enzima pepsina pode ser considerado similar ao gel Carisolv em relação a sua eficácia como um agente químico-mecânico na remoção da cárie para lesões cariosas pequenas em dentes anteriores decíduos em crianças entre 4-7 anos de idade.(AU)

Carangoides bartholomaei (Cuvier, 1833) stomach: a source of aspartic proteases for industrial and biotechnological applications / Estômago de Carangoides bartholomaei (Cuvier, 1833): uma fonte de proteases aspárticas para aplicações industriais e biotecnológicas

The viscera and other residues from fish processing are commonly discarded by the fishing industry. These by products can be a source of digestive enzymes with industrial and biotechnological potential. In this study, we aimed at the extraction, characterization, and application of acidic proteases from the stomach of Carangoides bartholomaei (Cuvier, 1833). A crude extract from the stomachs was obtained and submitted to a partial purification process by salting-out, which obtained a Purified Extract (PE) with a specific proteolytic activity of 54.0 U·mg-¹. A purification of 1.9 fold and a yield of 41% were obtained. The PE presents two isoforms of acidic proteases and a maximum proteolytic activity at 45 °C and pH 2.0. The PE acidic proteolytic activity was stable in the pH range of 1.5 to 7.0 and temperature from 25 °C to 50 °C. Purified Extract kept 35% of its proteolytic activity at the presence of NaCl 15% (m/v) but was totally inhibited by pepstatin A. Purified Extract aspartic proteases presented high activity in the presence of heavy metals such as Cd2+, Hg2+, Pb2+, Al3+, and Cu2+. The utilization of PE as an enzymatic addictive in the collagen extraction from Nile tilapia scales has doubled the process yield. The results indicate the potential of these aspartic proteases for industrial and biotechnological applications.

As vísceras e outros resíduos do processamento de peixes são geralmente descartados pela indústria pesqueira. Esses resíduos podem ser uma fonte de enzimas digestivas com potencial industrial e biotecnológico. Neste estudo, objetivamos a extração, caracterização e aplicação de proteases aspárticas do estômago de Carangoides bartholomaei (Cuvier, 1833). Um extrato bruto do estômago foi obtido e submetido a um processo de purificação parcial, que obteve um Extrato Purificado (EP) com uma atividade proteolítica específica de 54,0 U·mg-¹. Foi obtida uma purificação de 1,9 vezes e um rendimento de 41%. O EP apresenta duas isoformas de proteases ácidas e atividade proteolítica máxima a 45 °C e pH 2,0. A atividade proteolítica do EP foi estável na faixa de pH de 1,5 a 7,0 e temperatura de 25 °C a 50 °C. O EP manteve 35% de sua atividade proteolítica na presença de NaCl a 15% (m/v), mas foi totalmente inibida pela pepstatina A. As proteases ácidas do EP apresentaram alta atividade na presença de metais pesados como o Cd2+, Hg2+, Pb2+, Al3+ e Cu2+. A utilização de EP como aditivo enzimático na extração de colágeno a partir de escamas de tilápia do Nilo dobrou o rendimento do processo. Os resultados indicam um potencial dessas proteases para aplicações industriais e biotecnológicas.

Carangoides bartholomaei (Cuvier, 1833) stomach: a source of aspartic proteases for industrial and biotechnological applications

Abstract The viscera and other residues from fish processing are commonly discarded by the fishing industry. These by-products can be a source of digestive enzymes with industrial and biotechnological potential. In this study, we aimed at the extraction, characterization, and application of acidic proteases from the stomach of Carangoides bartholomaei (Cuvier, 1833). A crude extract from the stomachs was obtained and submitted to a partial purification process by salting-out, which obtained a Purified Extract (PE) with a specific proteolytic activity of 54.0 Umg-1. A purification of 1.9 fold and a yield of 41% were obtained. The PE presents two isoforms of acidic proteases and a maximum proteolytic activity at 45 °C and pH 2.0. The PE acidic proteolytic activity was stable in the pH range of 1.5 to 7.0 and temperature from 25 °C to 50 °C. Purified Extract kept 35% of its proteolytic activity at the presence of NaCl 15% (m/v) but was totally inhibited by pepstatin A. Purified Extract aspartic proteases presented high activity in the presence of heavy metals such as Cd2+, Hg2+, Pb2+, Al3+, and Cu2+. The utilization of PE as an enzymatic addictive in the collagen extraction from Nile tilapia scales has doubled the process yield. The results indicate the potential of these aspartic proteases for industrial and biotechnological applications.

Resumo As vísceras e outros resíduos do processamento de peixes são geralmente descartados pela indústria pesqueira. Esses resíduos podem ser uma fonte de enzimas digestivas com potencial industrial e biotecnológico. Neste estudo, objetivamos a extração, caracterização e aplicação de proteases aspárticas do estômago de Carangoides bartholomaei (Cuvier, 1833). Um extrato bruto do estômago foi obtido e submetido a um processo de purificação parcial, que obteve um Extrato Purificado (EP) com uma atividade proteolítica específica de 54,0 Umg-1. Foi obtida uma purificação de 1,9 vezes e um rendimento de 41%. O EP apresenta duas isoformas de proteases ácidas e atividade proteolítica máxima a 45 °C e pH 2,0. A atividade proteolítica do EP foi estável na faixa de pH de 1,5 a 7,0 e temperatura de 25 °C a 50 °C. O EP manteve 35% de sua atividade proteolítica na presença de NaCl a 15% (m/v), mas foi totalmente inibida pela pepstatina A. As proteases ácidas do EP apresentaram alta atividade na presença de metais pesados como o Cd2+, Hg2+, Pb2+, Al3+ e Cu2+. A utilização de EP como aditivo enzimático na extração de colágeno a partir de escamas de tilápia do Nilo dobrou o rendimento do processo. Os resultados indicam um potencial dessas proteases para aplicações industriais e biotecnológicas

Advances in identification of biomarkers for aspiration: from laboratory research to clinical practice / 中华老年医学杂志

Aspiration is the entry of oropharyngeal or gastric contents into the lower respiratory tract through the glottis, a common and important cause of death in elderly patients due to lung infections.However, a lack of accurate and rapid clinical methods for the diagnosis of aspiration leads to misdiagnosis, missed diagnosis or delayed diagnosis of aspiration, especially aspiration pneumonia.In recent years, with further research into the mechanisms of aspiration syndromes, multiple aspiration biomarkers with potential and clinical translational value have been found, and may help early detection of aspiration and have important and practical significance for elderly health.Therefore, this article reviews aspiration biomarkers such as pepsin, α-amylase, bile acid and other potential biomarkers as well as current relevant research, detection methods, their clinical value and prospects concerning challenges and directions of innovation in future research.

Laryngopharyngeal Reflux: Symptoms, Signs, and Presence of Pepsin in Saliva - A Reliable Diagnostic Triad

Abstract Introduction Twenty-four-hour multichannel intraluminal impedance with double probe pH monitoring (MII-pH), though considered the most sensitive tool for the diagnosis of gastroesophageal reflux disease (GERD), is invasive, time consuming, not widely available, and unable to detect non-acid reflux. In contrast, the presence of pepsin in the saliva would act as a marker for reflux, considering that pepsin is only produced in the stomach. Objective To evaluate the predictive value of salivary pepsin in diagnosing laryngopharyngeal reflux (LPR) as suggested by the results of reflux symptom index (RSI > 13), reflux finding score (RFS > 7), and positive response to treatment with a 4-week course of proton-pump inhibitors. Methods This prospective study was done at a tertiary care hospital on 120 adult patients attending ENT OPD with clinical diagnosis of LPR. The presence of pepsin in their pharyngeal secretions and saliva using a lateral flow device, the Peptest, was compared with RSI, RFS, and with the response to medical treatment using the Chi-squared test. Results Salivary pepsin was found to be positive in 68% of the patients, with 87.5% of them showing positive response to treatment. Chi-squared analysis showed a significant association between positive salivary pepsin and RFS > 7, RSI >13, a combination of RFS > 7 and RSI > 13 as well as with response to treatment (p < 0.0001). Conclusion When considered along with the clinical indicators of RFS and RSI of more than 7 and 13, respectively, and/or with a response to treatment, a positive salivary pepsin test indicates statistically significant chance of presence of LPR.

Effect of high hydrostatic pressure on the antioxidant capacity and peptic hydrolysis of whey proteins / Efeito da alta pressão hidrostática na hidrólise péptica das proteínas do soro de leite e na capacidade antioxidante

ABSTRACT: The effect of high hydrostatic pressure (HHP) application on whey protein concentrate was evaluated both before (pre-treatment - PT) and during (hydrolysis assisted - HA) hydrolysis processes. A factorial design 22 with 3 central points was used with pressure (100, 250, 400 MPa) and time (5, 20 and 35 minutes) as independent variables. The hydrolysis was evaluated and monitored by soluble protein, aromatic amino acid contents and RP-HPLC. ABTS and ORAC tests were used to evaluate the in vitro antioxidant capacity. The reduction of soluble protein content was approximately 20% for conventional hydrolysis and for all PT treatments up to 4 h of reaction, while HHP assisted hydrolysis at 100 MPa showed a 35% protein reduction after 35 minutes of reaction. In addition, pressurization favored peptic hydrolysis of β-lactoglobulin by up to 98% and also improved the in vitro antioxidant capacity of the hydrolysates, which increased from 34.25 to 60.89 μmoles TE g-1 of protein in the best treatment. The results suggest that the use of HHP assisted hydrolysis favored the peptic hydrolysis, with a reduction in hydrolysis time and increased antioxidant activity.

RESUMO: Neste estudo, o efeito da aplicação de alta pressão hidrostática (HHP) sobre o concentrado proteico de soro de leite foi avaliado antes (pré-tratamento - PT) e durante os processos de hidrólise (assistida por hidrólise - HA). Utilizou-se o delineamento fatorial 22 com três pontos centrais, onde as variáveis independentes foram pressão (100, 250, 400 MPa) e tempo (5, 20 e 35 minutos). A hidrólise foi avaliada pelo conteúdo de proteínas solúveis e aminoácidos aromáticos, além do perfil peptídico por RP-HPLC. As análises de ABTS e ORAC foram utilizadas para avaliar a capacidade antioxidante in vitro. A redução do teor de proteína solúvel foi de aproximadamente 20% para a hidrólise convencional e para todos os pontos de PT até 4h de reação, enquanto a hidrólise assistida por HHP a 100 MPa mostrou uma redução de 35% de proteína em 35 minutos de reação. Além disso, a pressurização favoreceu a hidrólise péptica da β-lactoglobulina em até 98% e também melhorou a capacidade antioxidante in vitro dos hidrolisados, que aumentaram de 34,25 para 60,89 μmoles de TE g-1 de proteína no melhor tratamento. Os resultados sugerem que o uso da hidrólise assistida por HHP favoreceu a hidrólise péptica, com redução no tempo de hidrólise e aumento da atividade antioxidante.

Development of a novel and practical bioassay for the quality evaluation and control of Galli Gigerii Endothelium Corneum based on the detection of digestive enzyme activity / 药学学报

Galli Gigerii Endothelium Corneum (GGEC) represents digestion-promoting medicines with measurable effects and extensive clinical application. However, its effective components are not clear. The quality control index in the current edition of Chinese Pharmacopoeia is rather elementary and does not reflect its clinical efficacy. In this study, a bioassay method based on pepsin activity was proposed as a novel quality control method. With pepsin activity as the evaluation index, the extraction of GGEC was optimized and a method for the determination of biological potency was established by using the qualitative reaction parallel line method. The biological potency and consistency of 20 batches of GGEC were investigated. To provide scientific evidence in support of this bioassay method, two validation experiments were designed. One was to study the viscosity-reducing activity of a nutritional semi-solid paste after adding GGEC samples with differing potency. The other was to correlate the gastric residual rate in mice and pepsin activity with the alcohol soluble extract content. The results showed that the optimal preparation method was to dilute crude powder of GGEC with 50 volumes of water and subject to ultrasonic extraction at 300 W and 40 kHz for 0.5 h. The shape of the dose-response curve was similar to that of the positive control drug multienzyme tablets and the precision, intermediate precision and repeatability met the methodology requirements. The results showed that the potency of 20 batches of samples ranged from 13.49 to 34.69 U·mg-1, with an average value of 22.21 U·mg-1. The validation experiment demonstrated that the effect of reducing the viscosity of the nutrient paste became more significant as GGEC sample potency increased. The correlation coefficient R of gastric residual rate with pepsin potency and alcohol soluble extract content was 0.867 and 0.518, respectively, which indicated that the pepsin potency was highly correlated with in vivo activity. This study shows that a bioassay method based on pepsin activity is reliable and reproducible for GGEC and could provide reference method for the quality evaluation of other digestant herbs.

Citral as food additive for common snook - zootechnical parameters and digestive enzymes / Citral como aditivo na ração para robalo flecha - parâmetros zootécnicos e enzimas digestivas

ABSTRACT: Essential oils of plants whose main compound is citral showed beneficial effects when added to fish feed. The objective of the present study was to evaluate the dietary effect of the addition of citral on zootechnical parameters and digestive enzyme activities of Centropomus undecimalis. Juveniles were fed for 45 days with diets containing different amounts of citral (0.0 - control, 0.5, 1.0, and 2.0 mL per kg of diet). The water quality parameters were kept stable during the experiment and no mortality was observed. At the end of the experimental period, the treatment 0.5 mL citral per kg of diet had the lowest weight gain and specific growth rate, and the highest feed conversion, while the same parameters did not differ between the other treatments. Pepsin activity was higher in the stomach of fish fed with 0.5 mL citral per kg of diet and amylase activity was higher in the intestine of fish fed with 0.5 and 2.0 mL citral per kg of diet compared to the control group. Intestinal lipase activity was higher in all groups that were fed with citral compared to the control group. Chymotrypsin and trypsin activities showed no difference between groups. Consequently, dietary addition of citral at any of the levels tested is not recommended for common snook.

RESUMO: Óleos essenciais de plantas, cujo composto majoritário é o citral, mostraram efeitos benéficos quando adicionados à ração para peixes. O objetivo do presente estudo foi avaliar o efeito da adição de citral sobre os parâmetros zootécnicos e atividades das enzimas digestivas de Centropomus undecimalis. Os juvenis foram alimentados por 45 dias com dietas contendo diferentes quantidades de citral (0,0 - controle, 0,5, 1,0 e 2,0 mL por kg de ração). Os parâmetros de qualidade da água foram mantidos estáveis ​​durante o experimento e nenhuma mortalidade foi observada. Ao final do período experimental, o tratamento 0,5 mL citral por kg de ração teve o menor ganho de peso e taxa de crescimento específico e a maior conversão alimentar, enquanto os mesmos parâmetros não diferiram entre os demais tratamentos. A atividade da pepsina foi maior no estômago de peixes alimentados com 0,5 mL de citral por kg de ração e a atividade de amilase foi maior no intestino de peixes alimentados com 0,5 e 2,0 mL citral por kg de ração comparado ao grupo controle. A atividade da lipase intestinal foi maior em todos os grupos que foram alimentados com citral, em comparação ao grupo controle. As atividades de quimotripsina e tripsina não mostraram diferença entre os grupos. Consequentemente, a adição de citral na ração em qualquer um dos níveis testados não é recomendada para robalo flecha.

Intraoperative Aspiration / 中国肺癌杂志

Intraoperative aspiration is a common pulmonary complication in the surgery, anesthesia and position were main factors leading to the operative aspiration. In recent years, perioperative lung protection has attracted wide attention of thoracic surgeons and anesthetist; how to accelerate the process of postoperative rehabilitation, reduce the incidence of related complications and significantly improve the prognosis of patients, these have become a chief goal of surgical treatment. This article will center on operative aspiration and summarize it from anatomy, pathophysiology, manifestation, diagnosis, treatment and prevention.

Comparison of in vitro erosion protocols in bovine teeth to simulate natural erosion lesion: analysis of mechanical properties and surface gloss

Abstract Objective The aim of this study was to compare two in vitro erosion protocols, in which one simulates in vivo conditions experienced by patients with gastroesophageal disorders or bulimia (HCl-pepsin protocol), and the other simulates the diet of an individual who consumes a high volume of erosive beverages (citric acid protocol). In addition, the mechanical properties and surface gloss of eroded human dentin were compared with those of sound human dentin. Materials and Methods Blocks of cervical dentin were used: sound human dentin (n=10), human dentin with erosive lesions (n=10), and bovine dentin (n=30). Twenty bovine blocks were subjected to either of two erosion protocols (n=10/protocol). In the first protocol, samples were demineralized using HCl-pepsin solution, then treated with trypsin solution. In the second protocol, samples were demineralized with 2% citric acid. Toothbrushing was performed in both protocols using a toothbrushing machine (15 s with a 150 g load). Ten bovine dentin blocks were not subjected to any erosive treatment. All samples of bovine and human dentin were analyzed to obtain Martens hardness values (MH), elastic modulus (Eit*) and surface gloss. One-way ANOVA and Tukey's test were performed to analyze the data (α=0.05). Results Sound human and eroded human dentin groups showed similar MH and Eit* values (p>0.05); however, sound human dentin showed a higher surface gloss value when compared to eroded human dentin (p<0.05). Sound bovine dentin and HCl-pepsin-treated bovine dentin treatments resulted in similar values for both MH and Eit* (p>0.05), but HCl-pepsin-treated bovine dentin and citric acid-treated bovine dentin resulted in lower surface gloss than sound bovine dentin (p<0.05). Conclusions The HCl-pepsin protocol modified bovine dentin properties that could be similar to those that occur on human dentin surfaces with erosive lesions.

Establishment and research of a New Zealand rabbit model of laryngopharyngeal reflux / 中华耳鼻咽喉头颈外科杂志

Objective@#To establish a New Zealand rabbit animal model of laryngopharyngeal reflux disease (LPRD) using esophageal balloon together with metal internal stent dilation and to investigate the changes of mucosa.@*Methods@#20 New Zealand rabbits were randomly divided into experimental group and control group, with 10 in each group. Balloon dilatation and metal internal stent dilation were carried out in experimental group to reproduce the animal model of LPRD.The middle of balloon was placed at the lower esophageal sphincter (LES) while the stent was placed at the upper esophageal sphincter (UES). The guide wire was placed in the control group, but the balloon was not expanded and the stent was not placed. The general condition, pH value of hypopharynx, laryngeal histopathology and changes of pepsin content of New Zealand rabbits were observed regularly. The difference between experimental group and control group was compared.@*Results@#The 24-hour Dx-pH monitoring results showed that the number of reflux episodes(20.0[9.5, 35.0], 13.0[6.5, 22.0]), and the percent time below pH 5.5 (1.36%[0.60%, 4.57%], 1.36%[0.43%, 2.77%]) in the experimental group at the 2nd and 4th week were significantly different from those in the control group (0[0,3.0], 1.0[0.5, 3.8]; 0[0, 0.01%], 0[0, 0], respectively, all P<0.01), suggesting that the experimental group New Zealand rabbits developed LPRD. Compared with the control group under microscope, lymphocytes infiltration and submucosal gland hyperplasia increased in the mucosa of the throat of the experimental group. The results of pepsin immunohistochemical staining between the two groups were statistically significant (P=0.014).@*Conclusion@#The use of balloon dilatation of the LES combined with metal stent dilatation of the UES can successfully establish a laryngopharyngeal reflux model, and lesions in the throat tissue can be observed.

Study on Prevention Effect and Mechanism of Miao Medicine Liangjiang Weiyang Capsule on Gastric Ulcer Model Rats / 中国药房

OBJECTIVE： To study the protective effect and mechanism of Miao medicine Liangjiang weiyang capsule on gastric ulcer model rats. METHODS： Rats were randomly divided into normal group （normal saline）， model group （normal saline）， positive control group （omeprazole， 0.02 g/kg） and Liangjiang weiyang capsule low-dose， medium-dose and high-dose groups （0.3， 0.6， 1.2 g/kg）， with 12 rats in each group. All rats were intragastrically administered once a day for consecutive one week. 1 h after last administration， all rats except those in normal group were given the absolute ethanol to induce gastric ulcer model. 1 h after modeling， gastric juice volume， gastric juice pH， pepsin activity， gastric ulcer area and inhibitory rate of gastric ulcer were recorded in each group. Histopathological changes of gastric mucosa in rats of each group were observed by HE staining. The serum levels of TNF-α and IL-6 were determined by ELISA. The expression of nuclear factor-κB pathway related protein （p-NF-κB p65， p-IκBα） in gastric tissue of rats were determined by Western blot. RESULTS： Compared with normal group， gastric juice volume， pepsin activity， gastric ulcer area， TNF-α and IL-6 levels in serum， p-NF-κB p65 and p-IκBα levels in the gastric tissue were significantly increased/rised （P＜0.05）， while gastric juice pH was significantly decreased （P＜0.01）； there were gastric mucosal hyperemia and redness， obvious defect of mucosal epithelial cells， destruction of gland structure and incomplete cell structure. Compared with model group， gastric juice volume， pepsin activity， gastric ulcer area and the levels of TNF-α and IL-6 were reduced/decreased significantly in positive control group， Liangjiang weiyang capsule medium-dose and high-dose groups （P＜0.05 or P＜0.01）， while pH value of gastric juice was increased significantly （P＜0.05）； gastric mucosa was normal， gland destruction was alleviated and cell structure was intact. The levels of p-NF-κB p65 and p-IκBα in gastric tissue were significantly decreased in Liangjiang weiyang capsule high-dose groups （P＜0.05）. CONCLUSIONS： Liangjiang weiyang capsule play a role to protect gastric ulcer by increasing gastric juice pH， inhibiting pepsin activity， reducing the release of inflammatory factors as TNF-α， IL-6 and inhibiting the expression of NF-κB pathway related protein.

Partial characterization of digestive proteases in sheepshead, Archosargus probatocephalus (Spariformes: Sparidae)

Digestive proteases were partially characterized in sheepshead juveniles, using biochemical and electrophoretic techniques. Results showed higher activity level of the stomach proteases (2.39 ± 0.02 U mg protein-1) compared to the intestinal proteases (1.6 ± 0.1 U mg protein-1). The activity of trypsin, chymotrypsin, leucine aminopeptidase and carboxypeptidase A was also recorded. The optimum temperature of the stomach proteases was recorded at 45 °C, while for intestinal proteases was recorded at 55 °C. Stomach proteases showed less stability to temperature changes than intestinal proteases. An optimum pH of 2 was recorded for stomach proteases with high stability under acidic conditions, while an optimum pH of 9 was recorded for intestinal proteases showing high stability under alkaline conditions. Stomach proteases were inhibited around 78% with Pepstatin A, indicating the presence of pepsin as the main protease. The stomach proteases zymogam revealed one active band with Rf of 0.49, this enzyme was completely inhibited by Pepstatin A. The intestinal proteases zymogram revealed four active proteases (51.3, 34.9, 27.8 and 21.2 kDa) that were inhibited by TLCK, which mainly represent a trypsin-like serine proteases. It can be conclude that digestion in sheepshead can be considered as a carnivorous species with an omnivorous tendency.(AU)

Se caracterizaron parcialmente las proteasas digestivas de juveniles del sargo, utilizando técnicas bioquímicas y electroforéticas. Los resultados muestran mayores niveles de actividad en las proteasas estomacales (2.39 ± 0.02 U mg proteina-1) comparados con los de las proteasas intestinales (1.6 ± 0.1 U mg protein-1), también se registró la actividad de tripsina, quimotripsina, leucina aminopeptidasa y carboxipeptidasa A. La temperatura óptima de las proteasas estomacales fue de 45 °C, mientras que la de las proteasas intestinales fue de 55 °C. El pH óptimo fue de 2 para las proteasas estomacales con alta estabilidad a condiciones ácidas, mientras que el pH óptimo para las proteasas intestinales fue de 9, mostrando una alta estabilidad en condiciones alcalinas. Las actividades de las proteasas estomacales fue inhibida en un 78% con Pepstatina A, lo que indica la presencia de pepsina, como principal proteasa. El zimograma de proteasas estomacales reveló una sola banda con actividad proteasa, con Rf de 0.49, completamente inhibida por Pepstatina A. El zimograma de proteasas intestinales reveló cuatro bandas (51.3, 34.9, 27.8 y 21.2 kDa). Todas las bandas se inhibieron con TLCK, lo que muestra la presencia principalmente de serina proteasas tipo tripsina. Se concluye que la digestión del sargo puede ser considerada como la de una especie carnívora con tendencia al omnivorismo.(AU)

Enzymatic hydrolysis (pepsin) assisted by ultrasound in the functional Properties of hydrolyzates from different collagens / Hidrólise enzimática (pepsina) assistida por ultrassom nas propriedades Funcionais de hidrolisados de diferentes colágenos

ABSTRACT: Enzymatic hydrolysis (pepsin) assisted with or without ultrasound in the functional properties of hydrolyzates from different collagens were analyzed. Degree of hydrolysis, antioxidant activity (DPPH) and antimicrobial activity (MIC) were assessed. The treatment that resulted in greater antioxidant activity for the fiber sample was with the use of 4% of enzyme and concomitant ultrasound (40.7%), leading to a degree of hydrolysis of 21.7%. For the powdered fiber sample the hydrolysis treatment with use of 4% of enzyme resulted in lower protein content (6.97mg/mL), higher degree of hydrolysis (19.9%) and greater antioxidant activity (38.6%). The hydrolyzates showed inhibitory capacity against gram-negative bacteria Salmonella choleraesuis and gram-positive bacteria Staphylococcus aureus. It can be concluded that enzymatic hydrolysis concomitant or not with the use of ultrasound increased the functionality of the fiber and powdered fiber samples, for the other samples its use as supplementary treatment was not productive, due to the worse results of antioxidant activity (DPPH) reported. However, it provided greater hydrolysis degree.

RESUMO: Foram avaliados os efeitos da hidrólise enzimática (pepsina) assistida com ou sem ultrassom nas propriedades funcionais de hidrolisados de diferentes colágenos. Foi analisado o grau de hidrólise, a atividade antioxidante (DPPH) e a atividade antimicrobiana (MIC). O tratamento que possibilitou maior atividade antioxidante para a amostra fibra foi com a utilização de 4% de enzima e ultrassom concomitante (40,7%), levando a um grau de hidrólise de 21,7%. Para a amostra fibra pó o tratamento de hidrólise com uso de 4% de enzima resultou em menor teor de proteína (6,97mg/mL), maior grau de hidrólise (19,9%) e maior atividade antioxidante (38,6%). Os hidrolisados mostraram capacidade inibitória contra a bactéria gram-negativa Salmonella choleraesuis e gram-positiva Staphylococcus aureus. Pode-se concluir que a hidrólise enzimática concomitante, ou não, ao uso do ultrassom apresentou aumento da funcionalidade das amostras fibra e fibra pó. Para as demais amostras, sua utilização como tratamento complementar, a hidrólise não foi interessante, devido aos piores resultados de atividade antioxidante (DPPH) encontrados. Porém, proporcionou maior grau de hidrólise.

Progress in diagnosis and treatment of children with laryngopharyngeal reflux / 中华实用儿科临床杂志

Laryngopharyngeal reflux is an independent disease that affects the quality of life in children,but its pathogenesis is not clear and its diagnostic criteria is not unified.With the reports of laryngopharyngeal reflux continuing to emerge in recent years,this study aims to review the progress in pathogenesis,diagnosis and treatment of laryngopharyngeal reflux in children.

Clinical Study of Futongning Granules in Treating Functional Abdominal Pain in Children / 广州中医药大学学报

Objective To observe the clinical effect of Futongning Granules for the treatment of functional abdominal pain in children. Methods A total of 187 children with functional abdominal pain were randomized into treatment group(N = 122)and control group(N = 65). The treatment group was treated with Futongning Granules and the control group was treated with Compound Pepsin Powder. The gastrointestinal syndrome scores of the two groups were observed, and the short-term and long-term clinical efficacy of the two groups was evaluated after treatment. Results (1)The total effective rate and the effective rate for syndromes of abdominal internal cold, spleen-stomach deficiency cold, indigestion induced by milk and food stagnation, liver-Qi stagnation, blood collateral obstruction, gastrointestinal heat stagnation in the treatment group were 92.3％, 92.9％, 95.0％, 95.2％, 90.3％, 85.7％, 90.0％, and those in the control group were 71.0％, 69.2％, 69.2％, 86.7％, 66.7％, 50.0％, 60.0％, respectively. The total effective rate and the effective rate for various syndromes in the treatment group were superior to those of the control group (P < 0.05). (2) After treatment, gastrointestinal syndrome scores of various syndromes and overall scores in the two groups were obviously decreased(P<0.05 or P<0.01 compared with those before treatment), and the decrease in the treatment group was superior to that in the control group (P < 0.05). (3) The results of 6-month follow-up showed that the clinical efficacy during the follow-up in the treatment group was better than that in the control group(P < 0.05), and the difference was statistically significant(P<0.05). Conclusion Futongning Granules exert certain effect for the treatment of functional abdominal pain in children, and are effective for significantly relieving clinical symptoms and reducing the recurrence of disease.

Measuring serum pepsinogen level for screening early stage of gastric cancer / Монголын Анагаах Ухаан

@#Gastric cancer is the second leading cause of death worldwide. About half of the incidence of stomach cancer has been reported in East Asian countries. In Mongolia, gastric cancer is the second most common cancer in males and the third most common in females. The age-standardized mortality rate for gastric cancer was 29.3 per 100,000 in 2016, ranking second after liver cancer. Pepsinogen (PG) is a proenzyme of pepsin, by chief and mucous neck cells in the gastric mucosa. On the basis of the source of secretion, PGs are subdivided into 2 types: PG I and II. PG I is only secreted from the fundic glands in the corpus of the stomach, whereas PG II is secreted from the corpus, as well as the pyloric glands in the antrum and proximal duodenum. PG is excreted mainly into the stomach lumen, but approximately 1% diffuses into the blood stream. Atrophic gastritis and intestinal metaplasia are well-known risk factors for gastric neoplasms including dysplasia. To identify these premalignant gastric conditions, histological biopsy or image-enhanced endoscopy is performed. Gastric cancer is usually preceded by a decades-long precancerous process driven by Helicobacter pylori infection and environmental conditions with well-defined successive lesions. In the advanced stages, they are characterized by glandular atrophy and intestinal metaplasia. These changes involve loss of the original glands and result in decrease of the mass of chief cells of the gastric corpus, where PGI is produced. Loss of chief cells leads to lower PGI levels and PGI/PGII ratio in the peripheral blood. Serum PG levels are therefore a key tool to be used in screening programs. Serum PG measurements could provide a simple and noninvasive method for screening gastric neoplasms.