Characterization of esophageal motor activity, gastroesophageal reflux, and evaluation of prokinetic effectiveness in mechanically ventilated critically ill patients: a high-resolution impedance manometry study.

BACKGROUND: Motility disorders of upper gastrointestinal tract are common in critical illness and associated with significant clinical consequences. However, detailed quantitative and qualitative analyses of esophageal motor functions are lacking. Therefore, we aimed to characterize the key features of esophageal motility functions using high-resolution impedance manometry (HRIM) and to evaluate an objective link between esophageal motor patterns, gastric emptying, and gastroesophageal reflux. We also studied the prokinetic effects of metoclopramide. METHODS: We prospectively performed HRIM for 16 critically ill hemodynamically stable patients. Patients were included if they had low gastric volume (LGV; < 100 mL/24 h, n = 8) or high gastric volume (HGV; > 500 mL/24 h, n = 8). The HRIM data were collected for 5 h with intravenous metoclopramide administration (10 mg) after the first 2 h. RESULTS: The findings were grossly abnormal for all critically ill patients. The esophageal contraction vigor was markedly increased, indicating prevailing hypercontractile esophagus. Ineffective propulsive force was observed for 73% of esophageal activities. Panesophageal pressurization was the most common pressurization pattern (64%). Gastroesophageal reflux predominantly occurred with transient lower esophageal sphincter relaxation. The common features of the LGV group were a hyperreactive pattern, esophagogastric outflow obstruction, and frequent reflux. Ineffective motility with reduced lower esophageal sphincter tone, and paradoxically fewer reflux episodes, was common in the HGV group. Metoclopramide administration reduced the number of esophageal activities but did not affect the number of reflux episodes in either group. CONCLUSION: All critically ill patients had major esophageal motility abnormalities, and motility patterns varied according to gastric emptying status. Well-preserved gastric emptying and maintained esophagogastric barrier functions did not eliminate reflux. Metoclopramide failed to reduce the number of reflux episodes regardless of gastric emptying status. Trial registration ISRCTN, ISRCTN14399966. Registered 3.9.2020, retrospectively registered. https://www.isrctn.com/ISRCTN14399966 .

[Percutaneous endoscopic gastrostomy: analysis of practice at the endoscopic center of tertiary medical care]. / Perkutánní endoskopická gastrostomie: analýza praxe v endoskopickém centru terciární lékarské péce.

INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) is a minimally invasive routine procedure used to provide long-term enteral nutrition in selected patients with impaired oral intake. The knowledge of clinical, technical and safety features of PEG is an important issue in clinical practice.The aim of this study was to evaluate the popu-lation of patients selected for PEG insertion, describe certain aspects of the insertion procedure, assess the service life of PEG, as well as account for the number of complications and patient mortality in the six-month period following the procedure. METHODS: We used a retrospective analysis of data from medical database. The data were collected in a single endoscopic tertiary-referral center for a period of seven and a half years. RESULTS: We evaluated 326 PEG insertions performed on 292 patients with a median age of 63 years (IQR 55-70). Mortality in the six-month period following PEG insertion was 26 %. Prevailing indications for PEG insertion were oncological (53 %) and neurological (40 %) diseases, with certain fluctuation of these numbers during the observed period according to changing demands of the two medical specialties. Local anesthesia alone was applied in 56 % of patients, 38 % underwent analgosedation and 6 % required general anesthesia. Median duration of the procedure (from insertion of endoscope to its final extraction) in 68 consecutive procedures was 6 minutes (IQR 5-8). Median interval between PEG introduction and its first replacement in 21 patients was 22 months (IQR 14-31, range 4-76). 61 patients underwent PEG extraction during the observed period, 66 % of whom had oncological disease. Periprocedural complications were seen in 5.8 % of patients, of these one patient (0.3 %) suffered a serious complication. The buried bumper syndrome was observed in four patients (1.2 %), all of whom had neurological disease. CONCLUSIONS: PEG is a relatively safe procedure and can be performed in a short time using local anesthesia or analgosedation in a majority of patients. The population of patients indicated for PEG insertion reflects primarily the current needs of neurological and oncological departments. Most patients within the observed group benefit from PEG insertion for more than six months. KEY WORDS: analgosedation - complications - mortality - percutaneous endoscopic gastrostomy.

Phytoremediation of pharmaceuticals--preliminary study.

Phytoremediation of selected pharmaceuticals (diclofenac, ibuprofen, and acetaminophen) using Armoracia rusticana and Linum usitatissimum cell cultures and by hydroponically cultivated Lupinus albus, Hordeum vulgaris, and Phragmites australis plants in laboratory conditions is described. During in vitro experiments, the best results for acetaminophen were achieved using Armoracia rusticana hairy root cultures, where 100% of the starting amount was removed from the media during eight days. Total removal of ibuprofen and diclofenac was achieved using a Linum usitatissimum suspension culture after one and six days, respectively. In the hydroponic arrangement, the best results were achieved for Lupinus, where acetaminophen was totally removed from media during two or four days in concentrations of 0.1 or 0.2 mM, respectively. The best effectiveness of ibuprofen removal (50% of starting amount) was found in case of Phragmites. Effectiveness of all tested plants for diclofenac removal was low. The best removal was achieved using Phragmites in the case of 0.2 mM concentration-67% of the starting amount and Hordeum for 0.1 mM starting concentration, 56%.

Study of soil-plant transfer of 226Ra under greenhouse conditions.

A soil-plant transfer study was performed using soil from a former uranium ore processing factory in South Bohemia. We present the results from greenhouse experiments which include estimates of the time required for phytoremediation. The accumulation of (226)Ra by different plant species from a mixture of garden soil and contaminated substrate was extremely variable, ranging from 0.03 to 2.20 Bq (226)Ra/g DW. We found differences in accumulation of (226)Ra between plants from the same genus and between cultivars of the same plant species. The results of (226)Ra accumulation showed a linear relation between concentration of (226)Ra in plants and concentration of (226)Ra in soil mixtures. On the basis of these results we estimated the time required for phytoremediation, but this appears to be too long for practical purposes.