Alfalfa biomass as a green source for the synthesis of N,S-CDs via microwave treatment. Application as a nano sensor for nifuroxazide in formulations and gastric juice.

BACKGROUND: Researchers have investigated different techniques for synthesis of carbon dots. These techniques include Arc discharge, laser ablation, oxidation, water/solvothermal, and chemical vapor deposition. However, these techniques suffer from some limitations like the utilization of gaseous charged particles, high current, high temperature, potent oxidizing agents, non-environmentally friendly carbon sources, and the generation of uneven particle size. Therefore, there was a significant demand for the adoption of a new technology that combines the environmentally friendly aspects of both bio-based carbon sourcing and synthesis technique. RESULTS: Medicago sativa L (alfalfa)-derived N, S-CDs have been successfully synthesized via microwave irradiation. The N,S-CDs exhibit strong fluorescence (λex/em of 320/420 nm) with fluorescence quantum yield of 2.2 % and high-water solubility. The produced N,S-CDs were characterized using TEM, EDX, Zeta potential analysis, IR, UV-Visible, and fluorescence spectroscopy. The average diameter of the produced N, S-CDs was 4.01 ± 1.2 nm, and the Zeta potential was -24.5 ± 6.63 mv. The stability of the produced nano sensors was also confirmed over wide pH range, long time, and in presence of different ions. The synthesized N, S-CDs were employed to quantify the antibacterial drug, nifuroxazide (NFZ), by fluorescence quenching via inner filter effect mechanism. The method was linear with NFZ concentration ranging from 1.0 to 30.0 µM. LOD and LOQ were 0.16 and 0.49 µM, respectively. The method was applied to quantify NFZ in simulated gastric juice (SGJ) with % recovery 99.59 ± 1.4 in addition to pharmaceutical dosage forms with % recovery 98.75 ± 0.61 for Antinal Capsules® and 100.63 ± 1.54 for Antinal suspension®. The Method validation was performed in compliance with the criteria outlined by ICH. SIGNIFICANCE AND NOVELTY: The suggested approach primarily centers on the first-time use of alfalfa, an ecologically sustainable source of dopped-CDs, and a cost-effective synthesis technique via microwave irradiation, which is characterized by low energy consumption, minimized reaction time, and the ability to control the size of the produced CDs. This is in line with the growing global recognition of the implementation of green analytical chemistry principles.

Elucidation of Degradation Behavior of Barbiturates in Artificial Gastric Juice: Study on Degradability of Drugs in Stomach (V).

The gastric stability of eight barbiturates (BARs) (barbital, primidone, allobarbital, phenobarbital, cyclobarbital, pentobarbital, secobarbital, and thiobutabarbital (TBB)) was examined in artificial gastric juice using LC/UV detection. Among the eight BARs, only TBB was degraded at higher temperatures. Furthermore, the degradation product of TBB was isolated, structurally analyzed, and finally identified as 5-butan-2-yl-5-ethyl-1,3-diazinane-2,4,6-trione, also known as butabarbital. The study elucidated that butabarbital was formed by substituting the sulfur atom of the carbonyl group at the 2-position of TBB with an oxygen atom under acidic condition.

Impact of saliva incorporation on the rheological properties of in vitro gastric contents formulated from sour cream.

Rheological properties of gastric contents depend on the food ingested, and on the volume and composition of secretions from the host, which may vary. This study investigates the impact of saliva regular incorporation in the stomach after a meal on the rheological properties of gastric contents, considering two levels of salivary flow (low = 0.5 and high = 1.5 mL/min). In vitro chymes were obtained by mixing sour cream, simulated gastric fluid, two different volumes of oral fluid (at-rest human saliva, SSF for Simulated Salivary Fluid or water) and adjusting pH at 3. Chymes samples were characterized at 37°C for their particle size and rheological properties. Overall, particle size distribution was not different between samples: incorporating a larger volume of saliva resulted in more heterogeneity, but the surface area moment D[3,2] and volume moment D[4,3] did not differ significantly with the oral fluid type. Shear viscosity of chyme samples was higher when saliva was incorporated, in comparison with water or SSF. In addition, as shown from data extracted at γ ̇ $$ \dot{\gamma} $$ = 20 s-1 the higher the fluid volume the lower the shear viscosity, which is attributed to a dilution effect. However, this dilution effect was attenuated in the case of saliva, most likely due to its composition in organic compounds (e.g., mucins) contributing to the rheological properties of this biological fluid. In these in vitro conditions, both saliva and the salivation rate had a significant but slight impact on the rheological properties of gastric contents (of the order of 1-5 mPa s at γ ̇ $$ \dot{\gamma} $$ = 20 s-1).

Increasing correlation between oral and gastric microbiota during gastric carcinogenesis.

BACKGROUND/AIMS: Recent research has increasingly focused on the role of the gastric microbiome in the development of gastric cancer. We aimed to investigate the changes in the microbiome during gastric carcinogenesis in structural and functional aspects, with a specific focus on the association between oral and gastric microbiomes. METHODS: We collected saliva, gastric juice, and gastric tissue samples from 141 patients at different stages of gastric carcinogenesis and processed them for microbiome analysis using 16S rRNA gene profiling. The alpha and beta diversities were analyzed, and the differences in microbiome composition and function profiles were analyzed among the groups, as well as the correlation between changes in the oral and gastric microbiomes during carcinogenesis. RESULTS: We observed significant differences in microbial diversity and composition between the disease and control groups, primarily in the gastric juice. Specific bacterial strains, including Schaalia odontolytica, Streptococcus cristatus, and Peptostreptococcus stomatis, showed a significant increase in abundance in the gastric juice in the low-grade dysplasia and gastric cancer groups. Notably, the correlation between the oral and gastric microbiota compositions, increased as the disease progressed. Predictive analysis of the metagenomic functional profiles revealed changes in functional pathways that may be associated with carcinogenesis (ABC transport and two-component systems). CONCLUSION: During gastric carcinogenesis, the abundance of oral commensals associated with cancer increased in the stomach. The similarity in microbial composition between the stomach and oral cavity also increased, implying a potential role of oral-gastric bacterial interactions in gastric cancer development.

Metformin drugs under simulated gastric conditions can generate high nitrite-dependent levels of N-nitrosodimethylamine.

N-nitrosodimethylamine (NDMA) and N-nitrosodiethylamine (NDEA), group 2A carcinogens, were detected in finished drug products, including metformin, ranitidine, sartans and other drugs which caused multiple recalls in the USA and Europe. Important studies also reported the formation of NDMA when ranitidine and nitrite were added to simulated gastric fluid. Our objective was to screen finished drug products from Europe and USA for nitrosamine impurities and investigate the formation of NDMA in metformin finished drug products when added to simulated gastric fluid. One dosage unit of 30 different commercially available drugs, including metformin, sartans, and ranitidine were tested for NDMA, NDEA, and dimethylformamide (DMF) impurities, using a liquid chromatography-mass spectrometry (LC-MS) method. Then, 6 metformin finished drug products were tested in stomach conditions for 2 h at 37 °C in a 100 mL solution with a pH of 2.5 and different nitrite concentrations (40, 10, 1, 0.1 mM) and tested for NDMA, and DMF using LC-MS. We measured NDMA, NDEA, and DMF in 30 finished drug products. NDMA and DMF were quantified for metformin drug products in simulated gastric fluid with different nitrite concentrations. None of the 30 drugs showed concerning levels of NDMA, NDEA, or DMF when tested as single tablets. However, when metformin tablets are added to simulated gastric fluid solutions with high nitrite concentrations (40 mM and 10 mM), NDMA can reach amounts of thousands of nanograms per tablet. At the closest concentration to physiologic conditions we used, 1 mM, NDMA is still present in the hundreds of nanograms in some metformin products. In this in vitro study, nitrite concentration had a very important effect on NDMA quantification in metformin tablets added to simulated gastric fluid. 1 mM nitrite caused an increase above the acceptable daily intake set by the U.S. Food and Drug Administration (FDA) for some of the metformin drugs. 10 mM, 40 mM nitrite solutions generated NDMA amounts exceeding by more than a hundred times the acceptable daily intake set by the FDA of 96 nanograms. These findings suggest that metformin can react with nitrite in gastric-like conditions and generate NDMA. Thus, patients taking metformin could be exposed to NDMA when high nitrite levels are present in their stomach, and we recommend including a statement within the Patient Package Inserts/Instructions for use.

Identification of chronic non-atrophic gastritis and intestinal metaplasia stages in the Correa's cascade through machine learning analyses of SERS spectral signature of non-invasively-collected human gastric fluid samples.

The progression of gastric cancer involves a complex multi-stage process, with gastroscopy and biopsy being the standard procedures for diagnosing gastric diseases. This study introduces an innovative non-invasive approach to differentiate gastric disease stage using gastric fluid samples through machine-learning-assisted surface-enhanced Raman spectroscopy (SERS). This method effectively identifies different stages of gastric lesions. The XGBoost algorithm demonstrates the highest accuracy of 96.88% and 91.67%, respectively, in distinguishing chronic non-atrophic gastritis from intestinal metaplasia and different subtypes of gastritis (mild, moderate, and severe). Through blinded testing validation, the model can achieve more than 80% accuracy. These findings offer new possibilities for rapid, cost-effective, and minimally invasive diagnosis of gastric diseases.

Clinical utility of gastric fluid cytokine levels in preterm infants for predicting histological chorioamnionitis.

BACKGROUND: The risk of various complications, such as neonatal death, early onset sepsis, and chronic lung disease, is increased in infants born to mothers with chorioamnionitis (CAM). However, predicting the diagnosis of histological CAM (hCAM) in the early postnatal period is challenging for clinicians due to pathological considerations. Therefore, an early diagnostic tool for hCAM is needed. Gastric fluid at birth is considered a suitable biomarker for predicting the intrauterine environment because most of its components are from amniotic fluid, and the sampling technique is less invasive. This study aimed to evaluate the clinical utility of cytokines in the gastric fluid of preterm infants at birth as predictors of hCAM. METHODS: We retrieved gastric fluid and serum from 21 preterm infants with a gestational age of ≤ 32 weeks within 1 h after birth and used cytometric bead array to measure the concentrations of interleukin (IL)-2, IL-4, IL-6, IL-10, tumor necrosis factor-alpha, and interferon-gamma. We compared the cytokine concentrations in the gastric fluid and serum of the preterm infants born to mothers with or without hCAM. RESULTS: The gastric fluid, serum IL-6, and serum IL-10 concentrations were significantly higher in the hCAM group than that in the non-hCAM group. The best cutoff values for predicting hCAM was > 2,855 pg/mL and > 315 pg/mL for IL-6 in the gastric fluid and serum, respectively. Receiver operating characteristic curves showed that gastric fluid IL-6 concentrations correlated more strongly with the presence of hCAM than serum IL-6 concentrations. CONCLUSION: IL-6 in the gastric fluid at birth may be a more promising biomarker for predicting the presence of hCAM than that in serum. IL-6 concentration analysis in the gastric fluid at birth might help to diagnose hCAM immediately after birth and improve the prognosis of preterm infants.

The real-time analysis of gastric juice (Endofaster) for detection of Helicobacter Pylori: a reliable tool in substitution of histology.

BACKGROUND: EndoFaster perform gastric juice analysis providing real-time Helicobacter pylori (HP) diagnosis during esophagogastroduodenoscopy (EGD), based on ammonium level. We aimed to assess its accuracy in detecting HP infection compared to the paired histology and to establish the optimum ammonium concentration cut-off point (COP). METHODS: Consecutive adult outpatients referred for EGD were prospectively enrolled between December 2021 and March 2022. In-patients, those with surgically altered anatomy, suspected neoplasia, and bleeding were excluded. EndoFaster and histology were performed in all patients, with additional stool antigen test (SAT) reserved for discordant cases. EndoFaster diagnostic measures were calculated, and ammonium level COP established using AUROC curve analysis. RESULTS: 101 patients (64 female, mean age 56.7±16.1 years) were included. HP infection was diagnosed in 35 (34.6%) and 15 (14.8%) patients by EndoFaster and histology, respectively. Diagnostic accuracy in comparison with histology was 77.8% (95%CI 68.3% - 85.5%). After implementing SAT for gold standard assessment, EndoFaster accuracy increased to 81.6% (95%CI 72.5%-88.7%). AUROC curve (0.93±0.03, 95%CI 0.86-0.99) identified an ammonium COP of ≥67.5ppm. Using the new COP, EndoFaster accuracy further increased to 88.8% (95%CI 80.8%-94.2%). CONCLUSIONS: Endofaster showed high accuracy for HP detection, with moderate agreement to histology. An ammonium COP of 67.5 ppm seems to be the threshold with the highest accuracy for HP detection.

The Impact of Gastric Juice on the Surface Roughness of Surface Sealant-Treated Provisional Restorations.

BACKGROUND AND AIM: Gastroesophageal reflux disease causes gastric acid to enter the oral cavity, leading to mucosal changes and deterioration of dental hard tissues and materials. The purpose of this in vitro study was to evaluate the impact of gastric juice on the surface roughness of two types of acrylics used in provisional restorations. MATERIALS AND METHODS: Acrytemp ® and Temdent acrylic resin discs (10 × 2 mm) totaling 80 were manufactured and divided into eight groups (n = 10). Groups were prepared as follows: Group 1 (Temdent + Universal Polish) (control), Group 2 (Temdent + Universal Polish + Biscover LV), Group 3 (Temdent + Universal Polish + Resin Glaze), Group 4 (Temdent + Universal Polish + Fortify Plus), Group 5 (Acrytemp + Universal Polish) (control), Group 6 (Acrytemp + Universal Polish + Biscover LV), Group 7 (Acrytemp + Universal Polish + Resin Glaze), and Group 8 (Acrytemp + Universal Polish + Fortify Plus). The resin discs were immersed in distilled water for 24 h and in gastric juice (pH = 2) for additional 24 h. The initial and final roughness values of samples were measured and analyzed with non-parametric statistics including Mann-Whitney U-test for pairwise comparison, Kruskall Wallis test for comparing more than two groups, and Wilcoxon signed rank test for within-group comparison (P < 0.05). RESULTS: Surface roughness did not differ significantly between control groups. It notably increased for all samples with surface sealants, both initially and after gastric juice immersion (P < 0.05). CONCLUSION: Surface sealants noticeably increased the roughness of two types of acrylic resins. After immersing in gastric juice, Group 4 (Temdent + Universal Polish + Fortify Plus) showed the highest roughness, while the untreated control groups remained the smoothest.

Volatilomic profiles of gastric juice in gastric cancer patients.

Volatilomics is a powerful tool capable of providing novel biomarkers for the diagnosis of gastric cancer. The main objective of this study was to characterize the volatilomic signatures of gastric juice in order to identify potential alterations induced by gastric cancer. Gas chromatography with mass spectrometric detection, coupled with headspace solid phase microextraction as the pre-concentration technique, was used to identify volatile organic compounds (VOCs) released by gastric juice samples collected from 78 gastric cancer patients and two cohorts of controls (80 and 96 subjects) from four different locations (Latvia, Ukraine, Brazil, and Colombia). 1440 distinct compounds were identified in samples obtained from patients and 1422 in samples provided by controls. However, only 6% of the VOCs exhibited an incidence higher than 20%. Amongst the volatiles emitted, 18 showed differences in their headspace concentrations above gastric juice of cancer patients and controls. Ten of these (1-propanol, 2,3-butanedione, 2-pentanone, benzeneacetaldehyde, 3-methylbutanal, butylated hydroxytoluene, 2-pentyl-furan, 2-ethylhexanal, 2-methylpropanal and phenol) appeared at significantly higher levels in the headspace of the gastric juice samples obtained from patients; whereas, eight species showed lower abundance in patients than found in controls. Given that the difference in the volatilomic signatures can be explained by cancer-related changes in the activity of certain enzymes or pathways, the former set can be considered potential biomarkers for gastric cancer, which may assist in developing non-invasive breath tests for the diagnosis of this disease. Further studies are required to elucidate further the mechanisms that underlie the changes in the volatilomic profile as a result of gastric cancer.

Extraction and Fractionation of Human Gastric Mucins from Gastric Juice.

Mucin, a major component of the mucus, is considered to be one of the principal factors in the physiological defense mechanism of the gastrointestinal mucosa. Measuring the mucin content of human gastric mucus is a useful tool for the assessment of Helicobacter pylori (H. pylori) eradication or the involvement of mucus secretion in various gastroduodenal diseases. Here, we describe a methodology for the isolation of the mucin fraction from human gastric juice and the quantification of mucin.

Gastric juice analysis in clinical practice: why, how, and when. The experience with EndoFaster.

Gastric juice analysis may be useful for clinical purposes, including the detection of H. pylori infection and diffuse atrophic gastritis on gastric mucosa. EndoFaster is a novel device which performs real-time analysis of gastric juice revealing the infection and hypochlorhydria by measuring ammonium concentrations and pH levels. This review aimed to evaluate the clinical applications of such a tool. By considering data from overall 11 studies, the values of sensitivity, specificity, positive predictive value, negative predictive value, accuracy, positive likelihood ratio, and negative likelihood ratio were 90%, 86%, 67%, 96%, 87%, 8.5, and 0.13, respectively, for H. pylori diagnosis, and 83%, 92%, 58%, 97%, 91%, 9.9 and 0.2, respectively, for suspecting diffuse atrophic gastritis. The very high value of negative predictive values for both H. pylori and mucosal atrophy would allow avoiding to perform useless negative gastric biopsies when the results of the test are negative. Some promising data suggest that gastric juice analysis may be useful also to diagnose H. pylori infection in patients with chronic active gastritis without evidence of bacteria at histology, as well as in predicting persistent acid reflux in patients on proton pump inhibitor therapy for reflux disease.

Formulation of a probiotic product using Almond gum.

BACKGROUND: The application of probiotics in food has expanded significantly, yet its viability remains a challenge. In response to this issue, this study explores a unique approach. Almond gum, a natural extract from Prunus dulcis, is utilized as the primary carrier matrix for a novel probiotic product featuring Saccharomyces boulardii, a probiotic yeast. METHODS: This study involves the entrapment of S. boulardii in almond gum through centrifugation (5 min at 1300 × g) and subsequent 24 h drying at 50 °C. Sensory evaluation and other investigations were conducted at different pH levels to assess viability and performance. RESULTS: Post-drying entrapment efficiency was 83.85%, underscoring the benefits of choosing almond gum as a carrier matrix. Promising results were observed from viability testing conducted in gastric juice (pH 1.2) and in simulated intestinal fluid (pH 6.8). Matrix stability was assessed by measuring cfu ml-1 following 7 days' storage at different temperatures, complemented by sensory analysis. CONCLUSION: Almond gum is a promising carrier matrix for probiotic products. Its high entrapment efficiency and its viability under challenging pH conditions demonstrate its efficacy. It is rich in carbohydrates and serves a dual purpose by acting as a prebiotic source, as confirmed through ultraviolet-visible (UV-visible) analysis. The study underscores the potential of this novel approach, providing insights into responses to viability challenges in probiotic food products. © 2024 Society of Chemical Industry.

Graded diagnosis of Helicobacter pylori infection using hyperspectral images of gastric juice.

Helicobacter pylori is a potential underlying cause of many diseases. Although the Carbon 13 breath test is considered the gold standard for detection, it is high cost and low public accessibility in certain areas limit its widespread use. In this study, we sought to use machine learning and deep learning algorithm models to classify and diagnose H. pylori infection status. We used hyperspectral imaging system to gather gastric juice images and then retrieved spectral feature information between 400 and 1000 nm. Two different data processing methods were employed, resulting in the establishment of one-dimensional (1D) and two-dimensional (2D) datasets. In the binary classification task, the random forest model achieved a prediction accuracy of 83.27% when learning features from 1D data, with a specificity of 84.56% and a sensitivity of 92.31%. In the ternary classification task, the ResNet model learned from 2D data and achieved a classification accuracy of 91.48%.

Interplay of egg white gel pH and intragastric pH: Impact on breakdown kinetics and mass transport processes.

Egg white gels have been utilized as a model system to study protein breakdown kinetics based on physical and biochemical breakdown processes during in vitro gastric digestion. Additionally, the impact of regulating intragastric pH on the breakdown kinetic processes was investigated. The present study evaluated the impact of gel pH (based on the pH of protein dispersion prepared at pH 3, 5 and 7.5) and intragastric pH regulation (with or without adjustment to pH 2 during in vitro gastric digestion) on the effective diffusion of gastric juice components (water and HCl), gel softening kinetics during gastric digestion, microstructural analysis using micro- computed tomography and protein hydrolysis in the liquid and solid fraction of egg white gel digesta. Egg white gels were subjected to 30 s oral digestion and 15, 30, 60, 120, 180 or 240 min gastric digestion in a static in vitro gastric digestion model, with or without gastric pH adjustment to pH 2. The gel pH affected all the properties measured during gastric digestion and each gel pH represented a specific driving mechanism for protein breakdown. A lower gel pH (pH 3) demonstrated a higher diffusion of moisture and acid, resulting in faster softening (p < 0.05). An intermediate pH (pH 5) showed greater protein-protein interactions due to the proximity to the isoelectric point of egg white proteins, resulting in very slow softening during digestion (p < 0.05), and a higher pH (pH 7) resulted in higher acid diffusion, intermediate gel hardness and very slow softening kinetics (p < 0.05). The gastric pH adjustment during digestion of egg protein gels affected (p < 0.05) the equilibrium moisture and acid contents as well as protein hydrolysis. The study confirmed that there is an interplay between initial gel pH and the intragastric pH which affected the breakdown kinetics of egg white gels during the gastric digestion process.

Comparison of four digestion protocols on the physical characteristics of gastric digesta from cooked couscous using the Human Gastric Simulator.

In vitro digestion is widely employed in food, nutraceutical and pharmaceutical research, and numerous in vitro gastric digestion protocols have been proposed, with a wide range of experimental conditions. Differences in the simulated gastric fluids (pH, mineral content, enzyme type and enzyme activity) of different digestion protocols may alter the results for the digestion of the same meal. This study aimed to investigate how variations in the gastric secretion rate and composition in four in vitro digestion protocols (Infogest Riddet, Infogest Semi-dynamic, UC Davis and United States Pharmacopeia) impacted the physical properties of the emptied gastric digesta. Cooked couscous was used as a model meal and subjected to simulated gastric digestion using a dynamic gastric model, the Human Gastric Simulator (HGS). The digesta were collected from the outlet of the HGS after 15, 30, 60, 90, 120, 150, or 180 min. The gastric emptying of dry matter, pH, rheological properties, and particle size were evaluated. The digestion protocol significantly influenced the solid content and moisture content of the digesta (p < 0.001), particles per gram of dry matter (p < 0.0001), gastric emptying of dry matter (p < 0.003), shear stress at 0.45 s-1 and consistency coefficient (p < 0.0001). The presence of NaHCO3 in the Infogest Riddet and Infogest Semi-dynamic gastric secretions provided an additional buffering effect and increased the digesta pH during gastric digestion. Similarly, the inclusion of mucin in the UC Davis protocol resulted in a higher flow and viscoelastic properties of the emptied digesta. The highest dilution of gastric content in the United States Pharmacopeia (USP) protocol resulted in larger particles emptied from the HGS and the longest gastric emptying half-time of all digestion protocols. These findings provide new insights into the impact of digestion protocols on the digesta properties, which can be beneficial for the design and standardization of in vitro digestion models.

Colonization of the gastric juice by Candida spp. promotes surgical site infection after hepatectomy.

PURPOSE: Candida spp. cause opportunistic infections in conditions of immunodeficiency. Here, we investigated the relationship between colonization of the gastric juice by Candida spp. and surgical site infection (SSI) in hepatectomy. METHODS: Consecutive hepatectomy cases between November 2019 and April 2021 were enrolled. Gastric juice samples (collected intraoperatively through a nasogastric tube) were cultured. We compared factors related to patient background, blood test findings, surgical findings, and postoperative complications between the Candida + group (positive for colonization of the gastric juice by Candida spp.) and the Candida - group (negative). In addition, we identified the factors that contribute to SSI. RESULTS: There were 29 and 71 patients in the Candida + and Candida - groups, respectively. The Candida + group was significantly older (average age: Candida + 74 years vs. Candida - 69 years; p = 0.02) and contained more patients negative for the hepatitis B and C virus (Candida + 93% vs. Candida - 69%; p = 0.02). SSI was significantly more common in the Candida + group (Candida + 31% vs. Candida - 9%; p = 0.01). Postoperative bile leakage and colonization of the gastric juice by Candida spp. were independent predictors of SSI. CONCLUSION: Colonization of the gastric juice by Candida spp. is a risk factor for SSI after hepatectomy.

Evaluation of probiotic properties of Levilactobacillus brevis isolated from hawthorn vinegar.

Probiotic microorganisms are increasing their interest today due to the benefits they provide to humans. Vinegar is the process of processing foods containing carbohydrates that can be fermented by acetic acid bacteria and yeasts. Hawthorn vinegar is also important in terms of amino acids, aromatic compounds, organic acids, vitamins and minerals it contains. Depending on the variety of microorganisms in it, the content of hawthorn vinegar changes, especially its biological activity. Bacteria were isolated from handmade hawthorn vinegar obtained in this study. After performing its genotypic characterization, it has been tested that it can grow in low pH environment, survive in artificial gastric and small intestinal fluid, survive against bile acids, surface adhesion characteristics, antibiotic susceptibility, adhesion, and degrade various cholesterol precursors. According to the results obtained, the studied isolate is Levilactobacillus brevis, it can reproduce best at pH 6.3, survives 72.22% in simulated gastric juice, 69.59% in small intestinal fluid, and 97% adhesion to HTC-116. Partially reproduces even in the presence of 2% ox-bile, surface hydrophobicity is 46.29% for n-hexadecane. It has been determined that it can degrade 4 different cholesterol precursors except for Sodium thioglycolate and is generally resistant to antibiotics except for CN30 and N30. Considering the experimental findings of Levilactobacillus brevis isolated from hawthorn vinegar for the first time, it can be said that Levilactobacillus brevis has probiotic properties.

Magnetic sphincter augmentation: paradigm change or just another device in the surgeon's toolbox?

The common denominator for virtually all episodes of gastroesophageal reflux in health and disease is the loss of the barrier that confines the distal esophagus to the stomach. Factors important in maintaining the function of the barrier are its pressure, length and position. In early reflux disease, overeating, gastric distention and delayed gastric emptying led to a transient loss of the barrier. A permanent loss of the barrier occurs from inflammatory injury to the muscle allowing free flow of gastric juice into the esophageal body. Corrective therapy requires augmentation or restoration of the barrier referred to more commonly as the lower esophageal sphincter.