The Effect of Using Premedication of Simethicone/Pronase With or Without Postural Change on Visualization of the Mucosa Before Endoscopy: A Prospective, Double Blinded, Randomized Controlled Trial.

INTRODUCTION: To investigate the efficacy and safety of preprocedural simethicone (S) and pronase (P) for optimal mucosal visualization during esophagogastroduodenoscopy with sedation. The effect of postural change combined with premedication on mucosal visibility was also examined. METHODS: The study randomized 496 patients into 8 groups based on the type of premedication provided and whether a postural change occurred. The premedication in the control group was 100 mL of normal saline solution (NS). The remaining 3 intervention groups were administered 100 mL of simethicone alone (S), pronase solution alone (P), and simethicone plus pronase solution (S + P). Each group was classified into subgroups according to whether there was a postural change (PC). The mucosal visibility score (MVS), total mucosal visibility score (TVS), procedure time, water consumption for mucosal cleansing, and proportion of patients with diminutive lesions <5 mm were recorded. RESULTS: The P and S groups had a significantly better TVS than the NS group (11.86 ± 3.36 in group P vs 14.52 ± 2.57 in group NS, P < 0.001; 12.36 ± 2.93 in group S vs 14.52 ± 2.57 in group NS, P = 0.006). The TVS was better in the P group than in the S group (11.86 ± 3.36 vs 12.36 ± 2.93, P = 0.037). The MVS was significantly better in the esophagus and duodenum and worse in the upper and lower gastric body in the S group than in the P group. The P + S group had a significantly better TVS than the P and S groups (9.81 ± 2.90 in group P + S vs 11.86 ± 3.36 in group P and 12.36 ± 2.93 in group S, respectively, P < 0.001),\ and had a reduced amount of flushing water during the procedure (0 [interquartile range [IQR]: 0-33] mL in group P + S vs 40 [IQR: 0-70] mL in group P, P < 0.01; 0 [IQR: 0-33] mL in group P + S vs 50 [IQR: 20-98] mL in group S, P < 0.001). The TVS was significantly better in the P + S + PC group than in the P + S group (8.44 ± 2.10 vs 9.81 ± 2.90, P = 0.003). The MVS was significantly better in the gastric antrum, fundus, and upper and lower gastric body in the P + S + PC group than in the P + S group. There was no significant difference in the detection rate of diminutive lesions among the different groups during an endoscopic examination ( P > 0.05). DISCUSSION: The combination of preprocedural administration with simethicone and pronase achieved superior mucosal visualization compared with saline, simethicone, or pronase alone in patients receiving upper endoscopy. Postural change maneuvers performed before endoscopy further improved the mucosal visibility in most parts of the stomach when used with preprocedural simethicone and pronase.

Human-influenced changes in pollution status and potential risk of sediment heavy metals in Xincun Bay, a typical lagoon of Hainan, China.

Pollution status and ecological risks associated with sediment heavy metals (Cu, Pb, Zn, Cd, and Cr) were investigated around Xincun Bay, assessing their spatial variations and relationship with sediment physiochemical factors. Higher concentrations and associated risks were observed in the central region, where mariculture activities were concentrated, compared to non-maricultured areas. Despite with overall low concentrations, Cd had a higher ecological risk. Correlation and principal component analyses revealed similar sources for all metals in Xincun Bay. Heavy metal concentrations varied with expansion of mariculture operations in terms of quantity and scale, confirming the influence of mariculture activities. Sediments around mariculture had higher contents of clay, silt, and total organic carbon (TOC), and finer particle sizes. Quantitative analyses through correlation and linear regression indicated that TOC significantly regulated heavy metal concentration and distribution (p < 0.05). Considering its significant association with TOC, the influence of mean grain size should not be overlooked.

Environmental effects on trace elements in the fingernails of centenarians and their offspring.

Bio-monitoring is commonly used to investigate trace elements, and the human nail provides an ideal medium for such testing. Toxic and essential trace metals (Cd, Pb, Fe, and Se) in the fingernails of participants from the Hainan Province were investigated. Samples included 136 centenarians and 197 offspring (101 older adult children and 96 middle-aged grandchildren) who were also sampled for comparison. As a hotspot for longevity, participants in the Hainan Province were found to have high essential nutrients of Fe and Se, and lacked the toxic element Pb. A similar trend was found for trace elements in soil and rice in the Hainan Province. The trace elements preserved in nails revealed dietary and environmental influences that varied among different generations. For the grandchildren's generation, the environment played an important role in elements in their nails, and a significant correlation and linear relationships were found, especially for Fe and Se. As the participants increased in age (from the grandchildren to the centenarians), the correlation between various elements decreased. For centenarians, the influence of beneficial or harmful properties of the elements became more important than their environment. The results also pointed to the important role of trace elements in human health, especially Fe and Se as essential elements. This study can provide information on the factors that influence the existence of trace elements in the human body and demonstrate the advantage of using the human fingernail in bio-monitoring.

Normalized Mitochondrial DNA Copy Number Can Optimize Pregnancy Outcome Prediction in IVF.

The aim of this study is to explore the relationship between mitochondrial DNA (mtDNA) copy number and embryo implantation potential in in vitro fertilization (IVF). A retrospective study of 319 blastocysts from patients undergoing preimplantation genetic testing (PGT) at Reproductive Medicine Center in Tongji Hospital from January 2016 to February 2018 was conducted. We used multiple annealing- and looping-based amplification cycles (MALBAC) technology to amplify the genetic materials from the trophectoderm cells of blastocysts, and next-generation sequencing (NGS) technology to test mitochondrial DNA copy number. Box-Cox transformation was introduced to eliminate the skewness distribution of mtDNA copy number, and the transformed data were defined as adjusted mtDNA. Subsequently, associations between adjusted mtDNA and the clinical characteristics of patients were assessed by univariate analysis and multiple linear regression. In addition, Gaussian Naive Bayes classifier was also used to predict pregnancy outcomes. We observed that only antral follicle count (AFC) was significantly associated with adjusted mtDNA without the influence of multicollinearity. What's more, the distribution of the adjusted mtDNA of blastocysts resulting in live birth was more concentrated than that of others. The area under the curve (AUC) of the prediction model that combined adjusted mtDNA with other clinical characteristics of patients was up to 0.81, higher than that excluded adjusted mtDNA. Among patient clinical characteristics, AFC was significantly associated with adjusted mtDNA. Mitochondrial DNA copy number may help to optimize the pregnancy outcome prediction in IVF.

Trace metal concentrations in commercial fish, crabs, and bivalves from three lagoons in the South China Sea and implications for human health.

Seafood is increasingly used worldwide due to its nutritional value. It is rich in essential minerals, liposoluble vitamins, and high-quality proteins. However, many seafood species tend to accumulate metals, making them a threat to human health. We chose Xincun Lagoon and Li-an Lagoon, which have been seriously polluted by local activities, and the relatively clean Tufu Bay as the research areas to investigate whether trace metals in economic seafood species in these areas threaten the food safety of consumers. The results show that the mean concentrations (mg kg-1 ww) of trace metals were Cu 0.22 ± 0.18, Pb 0.040 ± 0.028, Zn 5.25 ± 1.60, Cd 0.009 ± 0.004, Hg 0.0072 ± 0.0031, As 0.21 ± 0.12, and Cr 0.084 ± 0.048 in fish samples (Trachinotus ovatus); Cu 4.00 ± 0.96, Pb 0.075 ± 0.030, Zn 19.10 ± 2.64, Cd 0.050 ± 0.024, Hg 0.0131 ± 0.0035, As 0.91 ± 0.27, and Cr 0.216 ± 0.095 in crab samples (Charybdis natator); and Cu 5.37 ± 1.39, Pb 0.095 ± 0.023, Zn 21.38 ± 3.59, Cd 0.096 ± 0.026, Hg 0.0208 ± 0.0052, As 1.65 ± 0.59, and Cr 0.406 ± 0.117 in bivalve samples (Ruditapes philippinarum), respectively, with species specific (fish < crab < bivalve) and significant seasonal and spatial variation (p < 0.05). However, health risk assessment (EDI, THQ, TTHQ, CR) indicated that the consumption of the analyzed seafood from the study areas is safe for local consumers. But there is a potential risk for fishermen and those who prefer seafood.

Heavy metal distribution and bioaccumulation ability in marine organisms from coastal regions of Hainan and Zhoushan, China.

We analyzed the distribution and bioaccumulation of six heavy metals (Cu, Pb, Zn, Cr, Cd and Hg) in marine organisms, water, and sediments from China's Hainan and Zhoushan coastal regions. In all marine organism, seawater, and sediment samples, Zn and Hg had the highest and lowest concentrations, respectively. Heavy metals in marine organisms varied by region and species, with concentrations being higher in Zhoushan than in Hainan (except for Zn) and in crab than in fish. Marine organisms' ability to digest and eliminate heavy metals (bioaccumulation ability), based on bioaccumulation factors, was significantly higher for heavy metals in seawater than in sediment. Higher sediment background values may explain the higher heavy metal concentrations in crab. Generally, marine organisms' bioaccumulation ability was higher for Cu and Zn and lower for Pb. Findings specific to the coastal environments may be generalizable to other coastal areas in China or worldwide.