A new strategy for enteral nutrition using a deflection flexible visual gastric tube: A randomized crossover manikin trial.

BACKGROUND: Enteral nutrition via gastric tube insertion is a routine clinical practice for critically ill patients, although complications due to blind manipulation are occasionally reported. METHODS: An 8.4Fr deflection flexible ureteroscope was delivered into a 15Fr conventional gastric tube to create a gastric visual guidance system. Twenty inexperienced physicians were randomly assigned to perform 5 repeated orogastric tube placements in a manikin using both the conventional method and the deflection visual gastric tube, for a total of 10 procedures per physician. Placement time, procedure-related complications, and participants' experience with both methods were recorded. RESULTS: Under real-time guidance, the visual gastric tube successfully reached the stomach. The procedure provided additional information on the anatomy of the esophagus and stomach. Placement time was significantly less in the visual group than in the conventional group (39.39 ±â€Š2.11 seconds vs 49.82 ±â€Š3.11 seconds; P < .001). Procedure-related complications were not observed in the visual group; however, the gastric tube was misplaced into the airway in 19 out of 100 cases (19%) in the conventional group. Furthermore, 17 out of 20 participants (85%) preferred the visual gastric tube guide over the standard method. CONCLUSIONS: Results of this manikin model demonstrate that it is feasible to use the deflection flexible visual gastric tube to create a route for enteral nutrition and that such a procedure decreases placement time and procedure-related complications compared to the conventional procedure. These findings may point to a new strategy for gastric tube insertion in the future.

[Recurrent miscarriage and the quality of semen and sperm: a case-control study].

OBJECTIVE: To analyze the relation between recurrent miscarriage and routine semen parameters. METHODS: We compared the semen parameters of normal healthy men with those of the spouses of recurrent miscarriage women through 1: 1 age-matched case-control study. RESULTS: Compared with the healthy controls, the men of the case group showed a significantly lower mean semen volume ([1.95 +/- 1.11] ml vs [2.74 +/- 1.43] ml), sperm concentration ([48.68 +/- 20.07] x 10(6)/ml vs [59.26 +/- 25.35] x 10(6)/ml), percentage of grade b sperm ([12.07 +/- 3.34] % vs [16.18 +/- 6.74] %), fruit-sugar content ([1.73 +/- 0.64] g/L vs [2.21 +/- 0.75] g/L), acrosomal enzyme activity ([84.34 +/- 26.69] U/mg prot vs [94.20 +/- 26.35] U/mg prot), alpha-glucuronidase (alpha-GLU) content ([36.28 +/- 15.98] U/ml vs [44.45 +/- 12. 54] U/ml), and acid phosphatase (ACP) content ([68.55 +/- 35.45] U/ml vs [84.78 +/- 51. 10] U/ml) (P < 0.05), but remarkably higher percentages of head teratospermia ([47.36 +/- 4.59] % vs [46.50 +/- 6.32] %) and tail teratospermia ([7.56 +/- 2.27] % vs [7.28 +/- 3.10] %), and elastase content ([885.64 +/- 1 272.30] ng/ml vs [661.08 +/- 764.64] ng/ml) (P < 0.05). Based on the results of discriminant analysis, the semen volume, percentages of grade b sperm and combined teratospermia, and contents of fruit-sugar, alpha-GLU and ACP could be used to evaluate the semen and sperm quality of the spouses of recurrent miscarriage women. CONCLUSION: Routine semen and sperm tests might help evaluate the seminal factors of recurrent miscarriage, but they lack specificity and need comprehensive analysis. Poorer semen quality is associated with higher incidence of recurrent miscarriage.

Behavior of meiotic chromosomes in Pinus wallichiana, P. strobus and their hybrid and nrDNA localization in pollen mother cells of the hybrid by using FISH.

The complete process of meiosis was investigated in Pinus wallichiana, P. strobus and their artificial hybrid (F1) using microsporocytes. It is revealed that there were slightly lower chiasma frequency, lower ring bivalent frequency, lower meiotic index and distinctly higher frequency of aberrance (chromosomal bridges, fragments or micronuclei) in pollen mother cells (PMCs) of the hybrid (F1) than those of the parental species, which showed a certain degree of differentiation between homologous chromosomes of the two parents. However, relatively higher frequency of ring bivalents and higher meiotic index in all the three entities indicate the great stability of genomes of parental species, and the differentiation of genomes between the two parents must have been slight. Total nineteen signal loci of 18S rDNA were observed in nine bivalents of the hybrid (F1), among which one bivalent bears two loci, while the others have only one. It is suggested that distinct differentiation at genetic level existed in homologous chromosomes of the two parental species, whereas only slight differentiation at karyotypic and genomic levels take place between the parent species.