Metabolomics approach for predicting stomach and colon contents in dead Arctocephalus pusillus pusillus, Arctocephalus tropicalis, Lobodon carcinophaga and Ommatophoca rossii from sub-Antarctic region.

The dietary habits of seals play a pivotal role in shaping management and administration policies, especially in regions with potential interactions with fisheries. Previous studies have utilized various methods, including traditional approaches, to predict seal diets by retrieving indigestible prey parts, such as calcified structures, from intestines, feces, and stomach contents. Additionally, methods evaluating nitrogen and stable isotopes of carbon have been employed. The metabolomics approach, capable of quantifying small-scale molecules in biofluids, holds promise for specifying dietary exposures and estimating disease risk. This study aimed to assess the diet composition of five seal species-Arctocephalus pusillus pusillus, Lobodon carcinophaga, Ommatophoca rossii, and Arctocephalus tropicalis 1 and 2-by analyzing stomach and colon contents collected from stranded dead seals at various locations. Metabolite concentrations in the seal stomach and colon contents were determined using Nuclear Magnetic Resonance Spectroscopy. Among the colon and stomach contents, 29 known and 8 unknown metabolites were identified. Four metabolites (alanine, fumarate, lactate, and proline) from stomach contents and one metabolite (alanine) from colon contents showed no significant differences between seal species (p>0.05). This suggests that traces of these metabolites in the stomach and colon contents may be produced by the seals' gut microbiome or derived from other animals, possibly indicating reliance on fish caught at sea. Despite this insight, the cause of death for stranded seals remains unclear. The study highlights the need for specific and reliable biomarkers to precisely indicate dietary exposures across seal populations. Additionally, there is a call for the development of relevant metabolite and disease interaction networks to explore disease-related metabolites in seals. Ultimately, the metabolomic method employed in this study reveals potential metabolites in the stomach and colon contents of these seal species.

The impact of chronic and acute problems on sea turtles: The consequences of the oil spill and ingestion of anthropogenic debris on the tropical semi-arid coast of Ceará, Brazil.

Sea turtle mortality is often related to materials that reach the coast from different anthropic activities worldwide. This study aimed to investigate whether sea turtle mortality was related to older marine problems, such as solid waste, or one of the largest oil spill accidents on the Brazilian coast, that occurred in 2019. We posed three questions: 1) Are there solid residues in the digestive tract samples, and which typology is the most abundant? 2) Can meso­ and macro-waste marine pollutants cause mortality? 3) Is the dark material found really oil? A total of 25 gastrointestinal content (GC) samples were obtained, of which 22 ingested waste of anthropogenic origin and 18 were necropsied. These 22 samples were obtained during or after the 2019 oil spill, of which 17 specimens were affected, making it possible to suggest oil ingestion with the cause of death in the animals that could be necropsied. Macroscopic data showed that the most abundant solid waste was plastic (76.05 %), followed by fabrics (12.18 %) and oil-like materials. However, chemical data confirmed only three specimens with oil levels ranging from remnants to high. It was possible to infer possible causes of death in 16 of the total 18 necropsied cases: Most deaths were due to respiratory arrest (62.5 %), followed by pulmonary edema (12.5 %), cachexia syndrome (12.5 %), circulatory shock (6.25 %), and head trauma (6.25 %), which may have been caused by contact with solid waste, oil, or both. The study showed that not all dark material found in the GCs of turtles killed in oiled areas is truly oil, and in this sense, a chemical analysis step to prove the evidence of oil must be added to international protocols.

Shigella sonnei utilises colicins during inter-bacterial competition.

The mammalian colon is one of the most densely populated habitats currently recognised, with 1011-1013 commensal bacteria per gram of colonic contents. Enteric pathogens must compete with the resident intestinal microbiota to cause infection. Among these enteric pathogens are Shigella species which cause approximately 125 million infections annually, of which over 90 % are caused by Shigella flexneri and Shigella sonnei. Shigella sonnei was previously reported to use a Type VI Secretion System (T6SS) to outcompete E. coli and S. flexneri in in vitro and in vivo experiments. S. sonnei strains have also been reported to harbour colicinogenic plasmids, which are an alternative anti-bacterial mechanism that could provide a competitive advantage against the intestinal microbiota. We sought to determine the contribution of both T6SS and colicins to the anti-bacterial killing activity of S. sonnei. We reveal that whilst the T6SS operon is present in S. sonnei, there is evidence of functional degradation of the system through SNPs, indels and IS within key components of the system. We created strains with synthetically inducible T6SS operons but were still unable to demonstrate anti-bacterial activity of the T6SS. We demonstrate that the anti-bacterial activity observed in our in vitro assays was due to colicin activity. We show that S. sonnei no longer displayed anti-bacterial activity against bacteria that were resistant to colicins, and removal of the colicin plasmid from S. sonnei abrogated anti-bacterial activity of S. sonnei. We propose that the anti-bacterial activity demonstrated by colicins may be sufficient for niche competition by S. sonnei within the gastrointestinal environment.

Quantitative description of six fish species' gut contents and prey abundances in the Baltic Sea (1968-1978).

The dataset presents a compilation of stomach contents from six demersal fish species from two functional groups inhabiting the Baltic Sea. It includes detailed information on prey identities, body masses, and biomasses recovered from both the fish's digestive systems and their surrounding environment. Environmental parameters, such as salinity and temperature levels, have been integrated to enrich this dataset. The juxtaposition of information on prey found in stomachs and in the environment provides an opportunity to quantify trophic interactions across different environmental contexts and investigate how fish foraging behaviour adapts to changes in their environment, such as an increase in temperature. The compilation of body mass and taxonomic information for all species allows approaching these new questions using either a taxonomic (based on species identity) or functional trait (based on body mass) approach.

Increased Attenuation of Intestinal Contents at CT Indicates Bowel Necrosis in Closed-Loop Small Bowel Obstruction.

Background Preoperative recognition of irreversible bowel necrosis is important, as it provides valuable guidance for surgical strategy selection but also may inform perioperative risk assessment and communication. Few studies have focused on the association between CT signs and bowel necrosis. Purpose To assess the diagnostic accuracy of CT signs to predict bowel necrosis in patients with closed-loop small bowel obstruction (CL-SBO). Materials and Methods This retrospective single-center study included patients who were surgically confirmed to have CL-SBO caused by adhesion or internal hernia between January 2016 and May 2022. Necrosis was determined based on surgical exploration and postoperative pathologic examination. Two radiologists independently reviewed CT signs by both subjective visual assessment and objective measurement. Disagreements were resolved in consensus with a third gastrointestinal radiologist. Univariable and multivariable analyses were used to assess the association between CT signs and bowel necrosis, and Cohen κ was used to assess interobserver agreement. Sensitivity and specificity were calculated for each CT sign. Results This study included 145 patients: 61 (42.1%) in the necrotic group (median age, 62 years [IQR, 51-71.5 years]; 37 [60.7%] women) and 84 (57.9%) in the nonnecrotic group (median age, 61.5 years [IQR, 51-68.8 years]; 51 [60.7%] women). Univariable analysis and multivariable analysis showed that increased attenuation of intestinal contents and increased attenuation of intestinal wall were independent predictors for bowel necrosis (odds ratio = 45.3 and 15.1; P = .001 and P < .001, respectively). Increased attenuation of intestinal contents and increased attenuation of intestinal wall had similar sensitivity (64% and 67%, respectively) and specificity (99% and 92%, respectively) for predicting bowel necrosis. However, interobserver agreement was better for assessing the contents than the wall (κ = 0.84 and 0.59, respectively). Conclusion Increased attenuation of intestinal contents was a highly specific CT sign with good reproducibility to predict bowel necrosis in CL-SBO. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Taourel and Zins in this issue.

Marine turtles as bio-indicators of plastic pollution in the eastern Mediterranean.

The loggerhead turtle (Caretta caretta) has been suggested as a bio-indicator species for plastic pollution. However, detailed investigations in the eastern Mediterranean are limited. Here, we present data from loggerhead turtles (2012-2022; n = 131) of which 42.7 % (n = 57) had ingested macroplastic (pieces ≥ 5 mm). Frequency of occurrence (%) was not found to have changed over time, with body size (CCL cm), between stranded or bycaught turtles, or with levels of digesta present. The characteristics of ingested plastic (n = 492) were largely sheetlike (62 %), clear (41 %) or white (25 %) and the most common polymers identified were Polypropylene (37 %) and Polyethylene (35 %). Strong selectivity was displayed towards certain types, colours and shapes. Data are also presented for posthatchling turtles (n = 4), an understudied life stage. Much larger sample sizes will be needed for this species to be an effective bio-indicator, with the consideration of monitoring green turtles (Chelonia mydas) for the eastern Mediterranean recommended allowing a more holistic picture to be gathered.

Microplastics in the stomach content of the commercial fish species Scomber colias in the Gulf of Cadiz, SW Europe.

Concerning microplastics (MPs) contamination is increasing due their negative impacts on marine food webs and their potential toxicity to wildlife and humans. In this study, we analyze the presence of MPs in the stomachs of the commercial fish species Scomber colias (Atlantic chub mackerel) in the Gulf of Cadiz (GoC). Out of the 104 analyzed stomachs, 90.4 % contained some type of MPs, with an average of 5.4 MPs per individual. Of the 1152 MPs analyzed, 91.1 % were fibers, and 8.9 % fragments type. Fourier Transformation Infrared Spectrometry analysis was performed on 152 items, revealing that 73.6 % were MPs. The most common synthetic polymers found were polyamide (64 %), polypropylene (15 %), polystyrene (12 %), polyvinyl chloride (5 %), and polyethylene (4 %). The consistent ingestion of synthetic polymers by the individuals of Atlantic chub mackerel across different zones might suggest an even distribution of MP contamination throughout the GoC.

Synthesis and quantification of short-chain fatty acid esters of hydroxy fatty acids in rat intestinal contents and fecal samples by LC-MS/MS.

Short-chain fatty acid esters of hydroxy fatty acids (SFAHFAs) are a new class of endogenous lipids belonging to the fatty acid esters of the hydroxy fatty acid family. We previously uncovered their chemical structure and discussed their potential biological significance. We anticipate an increased need for SFAHFA measurements as markers of metabolic and inflammatory health. In this study, we synthesized sixty isomeric SFAHFAs by combining 12 hydroxy fatty acids (C16-C24) and five short-chain fatty acids (C2-C6) including a labelled internal standard. SFAHFA enrichment was achieved by solid-phase extraction and established a sensitive method for their quantitation by targeted LC-MS/MS. The method was applied to profile SFAHFAs in intestinal contents and fecal samples collected from rats fed a high-fat diet (HFD). The results demonstrated a significant decrease in SFAHFAs in the intestinal contents of the HFD group compared with the control group. The fecal time course (0-8 weeks) profile of SFAHFAs showed significant downregulation of acetic and propanoic acid esters in just 2 weeks after HFD administration. This study offers the first synthesis and quantitation method for SFAHFAs, demonstrating their potential use in elucidating SFAHFA sources, their role in various diseases, and potential biochemical signalling pathways.

Effects of fermented rapeseed meal on performance, intestinal morphology, the viscosity of intestinal content, phosphorus availability, and egg quality of laying hens.

Fermented rapeseed meal has the potential to partial replace soybean meal in feed mixtures for poultry without a negative impact on the health condition and performance of birds. This is due to the fact that the fermentation process can reduce the amount of antinutritional factors, improve the use of nutrients and impart probiotic properties to rapeseed meal. Therefore, this study was undertaken to investigate the effect of fermented rapeseed meal on the performance, egg quality, intestinal morphometry, the viscosity of intestinal content and total phosphorus availability. A total of 108 Lohmann Brown laying hens at 26 wk of age were used in the 90-day study. All hens were randomly divided into 3 treatment groups, with 12 replicates (cages) each, as follows: control group received no rapeseed meal, the URSM group received 3% unfermented rapeseed meal and the FRSM group received 3% fermented rapeseed meal. In the case of performance, egg traits, sensory evaluation of eggs, the viscosity of intestinal content and the availability of total phosphorus, if the distribution was normal, a 1-way analysis of variance was performed. If the distribution was not normal, the Kruskal-Wallis test was performed. In the case of histomorphometric evaluation of the intestine, if the distribution was normal, the Student t test for independent samples was performed. If not, a Mann-Whitney U test was performed. The performed analyses showed that the supplementation of fermented rapeseed meal had no negative effect on the performance of birds and the quality of eggs. Fermented rapeseed meal was also associated with improved histomorphometric parameters of the small intestine compared to the group receiving unfermented rapeseed meal in the feed. Laying hens from FRSM group were characterized by significantly lower viscosity of intestinal content (P < 0.05) compared to URSM group. Phosphorus in FRSM group was significantly more available to the birds (P < 0.05) compared to URSM group. These results suggest that supplementation with fermented rapeseed meal may be beneficial, especially in times of unstable prices of soybean meal and problems with its availability.

Evaluation of the 'Sip Til Send' regimen before elective caesarean delivery using bedside gastric ultrasound: A paired cohort pragmatic study.

BACKGROUND: Pre-operative fasting is routinely advocated to avoid pulmonary aspiration. The European Society of Anaesthesiology and Intensive Care (ESAIC) recommends a fasting period of 2 h for liquids before surgery. Liberal drinking policies such as the 'Sip Til Send' are a suggested alternative to maintain hydration before surgery. OBJECTIVES: To compare residual gastric volumes in fully fasted nonlabouring parturients before elective caesarean delivery with the 'Sip Til Send' with water liberal drinking protocol. Our hypothesis was the 'Sip Til Send' would be noninferior to standard fasting at minimising the residual gastric volume immediately before surgery. DESIGN: A paired cohort prospective observational pragmatic study using gastric ultrasound, analysed by an operator blinded to the fasting status of each scan. SETTING: A tertiary maternity hospital in Dublin, Ireland. The study was conducted between January and June 2023. PARTICIPANTS: Pregnant women about to undergo elective caesarean delivery who had followed ESAIC fasting guidelines before admission. INTERVENTIONS: Each participant underwent two pairs (semi-recumbent and the semi-recumbent right lateral positions) of standardised ultrasound examinations of the gastric antrum: the order of these scans was randomised. The first pair of scans occurred on admission before the 'Sip Til Send' protocol commenced, the other pair just before spinal anaesthesia for caesarean delivery, after a variable time following the 'Sip Til Send' protocol. MAIN OUTCOME MEASURE: The primary outcome was the difference in antral cross-sectional area (CSA) between the fully fasted women on admission and the same women after following the 'Sip Til Send' protocol until just before spinal anaesthesia. RESULTS: Fifty-eight women were randomised for the study: 55 and 54 scans in the semi-recumbent position on admission, and 55 and 54 scans in the right lateral position just before spinal anaesthesia. The mean differences (95% CI) in CSA in the semi-recumbent and RL positions were 0.07 (-0.39 to 0.53) cm 2 and 0.04 (-0.60 to 0.68) cm 2 , respectively. Since the of 95% CIs did not cross the predefined noninferiority margin of 0.88 cm 2 , 'Sip Til Send' was noninferior to fully fasting in in terms of the antral CSA. CONCLUSION: The 'Sip Til Send' protocol of liberal hydration with water was noninferior to standard fasting prior to elective caesarean delivery. TRIAL REGISTRY NUMBER: NCT05783427 ClinicalTrials.gov.

Detection of chromosome-mediated blaNDM-1-carrying Aeromonas spp. in the intestinal contents of fresh water river fish in Ho Chi Minh City, Vietnam.

The spread of antibiotic-resistant bacteria is a global problem that should be addressed through the perspective of the "one health" concept. The purpose of this study was to determine the contamination rate of antibiotic-resistant Aeromonas spp. in fresh water river fish purchased from a fish market in Vietnam. We then defined the pattern of antibiotic resistance to assess antibiotic-resistant contamination. Antibiotic-resistant Aeromonas spp. were detected in the intestinal contents of 32 of 80 fish. blaNDM-1 was detected in seven strains. Extended-spectrum ß-lactamase and AmpC ß-lactamase-related genes were detected in 28 strains, including blaCTX-M-55, blaCTX-M-15, blaCTX-M-1, and blaDHA,blaFOX, and blaMOX. The blaNDM-1 detected in the seven Aeromonas spp. strains were found chromosomally. This finding suggests that the blaNDM gene is stable in the natural environment and may spread widely into animals and humans via Aeromonas spp. with a transposon. Our results suggest the importance of continuing to monitor carbapenemase genes in Aeromonas spp. to evaluate the possibility that they may spread in other Enterobacterales, and to elucidate the mechanism of spread.

Trophic ecology of Acestrorhynchus falcirostris Cuvier, 1819 in island lakes on the lower stretch of the Solimões River, Amazon Basin / Ecologia trófica de Acestrorhynchus falcirostris Cuvier, 1819 em lagos de ilha no trecho inferior do Rio Solimões, Bacia Amazônica

Abstract The aim objective of this study was to determine the trophic ecology of juvenile and adult Acestrorhynchus falcirostris during the rising and flood (high-water) period in six island lakes adjacent to the Solimões River. As such, we investigated: i) the trophic position, through the fractional trophic niche; ii) the niche breadth; iii) niche overlap and iv) the food strategy of the species. The specimens were collected during the years 2014 to 2017, using gillnets with mesh sizes ranging from 30 to 120mm between opposite knots. Through the analysis of stomach contents, the preference in the consumption of items of animal origin was observed. Juveniles consumed insects in greater proportions (IAi% = 50%), while adults consumed fish (IAi%=99,98%). Despite the large supply of food items available in the high-water period, juveniles were the only ones to consume items of allochthonous origin, such as insects. Juveniles presented a different dietary strategy and dietary composition to adults. Juveniles were omnivores with a generalist strategy, while adults were piscivores with a specialist strategy. Thus, the food composition, niche breadth, trophic position and feeding strategy of Acestrorhynchus falcirostris change due to the stage of development.

Resumo O objetivo deste estudo foi determinar a ecologia trófica de juvenis e adultos de Acestrorhynchus falcirostris durante o período de enchente e cheia em seis lagos de ilha adjacentes ao rio Solimões. Assim, investigamos: i) a posição trófica, através do nicho trófico fracional; ii) a largura de nicho; iii) sobreposição de nicho; iv) a estratégia alimentar. Os espécimes foram coletados durante os anos de 2014 a 2017, utilizando redes de emalhar com malha variando de 30 a 120mm entre nós opostos. Por meio da análise do conteúdo estomacal, observamos a preferência no consumo de itens de origem animal. Os juvenis consumiram insetos em maiores proporções (IAi% = 50%), enquanto os adultos consumiram preferencialmente peixes (IAi% = 99,98%). Apesar da grande oferta de alimentos disponíveis no período da cheia, os juvenis eram os únicos a consumir itens de origem alóctone, como por exemplo, os insetos. Os juvenis apresentaram uma estratégia alimentar e composição alimentar diferente para os adultos. Os juvenis foram considerados onívoros com uma estratégia generalista, enquanto os adultos foram considerados piscívoros com uma estratégia alimentar mais especialista. Assim, a composição alimentar, amplitude do nicho, posição trófica e a estratégia alimentar de Acestrorhynchus falcirostris muda em função do estágio de desenvolvimento.

Exceptionally preserved stomach contents of a young tyrannosaurid reveal an ontogenetic dietary shift in an iconic extinct predator.

Tyrannosaurids were large carnivorous dinosaurs that underwent major changes in skull robusticity and body proportions as they grew, suggesting that they occupied different ecological niches during their life span. Although adults commonly fed on dinosaurian megaherbivores, the diet of juvenile tyrannosaurids is largely unknown. Here, we describe a remarkable specimen of a juvenile Gorgosaurus libratus that preserves the articulated hindlimbs of two yearling caenagnathid dinosaurs inside its abdominal cavity. The prey were selectively dismembered and consumed in two separate feeding events. This predator-prey association provides direct evidence of an ontogenetic dietary shift in tyrannosaurids. Juvenile individuals may have hunted small and young dinosaurs until they reached a size when, to satisfy energy requirements, they transitioned to feeding on dinosaurian megaherbivores. Tyrannosaurids occupied both mesopredator and apex predator roles during their life span, a factor that may have been key to their evolutionary success.

Notes on stomach contents of pygmy and dwarf sperm whales (Kogia spp.) from around Japan.

The diets of pygmy (Kogia breviceps) and dwarf (K. sima) sperm whales in Japanese waters are poorly known. We report new information on the diets of these two species from these waters based on identifiable hard-part remains recovered from the stomach contents of 29 whales (11 pygmy and 18 dwarf sperm whales) that stranded between 1991 and 2021; those of a further two dwarf sperm whales were empty. The cephalopod (and secondarily fish and crustacean) component of the diets of these 29 whales, based on analysis of identifiable stomach-content remains, is described. The main prey includes cephalopods, represented by 1556 identifiable lower beaks (and 1483 upper beaks), crustaceans (represented by heavily digested, unidentifiable remains), and fishes (as represented by 92 otoliths). Identified prey comprises 30 species from 16 cephalopod families and 5 families from 5 fish orders. Oceanic cephalopods are the main prey of both whale species, particularly Enoploteuthis (Paraenoploteuthis) chunii and Chiroteuthis (Chirothauma) picteti. Prey diversity index values (Shannon-Weaver's diversity index H') are 2.41 for the pygmy sperm whale and 2.66 for the dwarf sperm whale. Although the main cephalopod component in the diets of these two whale species is similar, Pianka's index (0.40), a measure of niche overlap, is not that high, and may be influenced by differences in prey dominance in different feeding areas.

Evaluation of meso- and microplastic ingestion by the northern fulmar through a non-lethal sampling method.

An increasing number of organisms from the polar regions are reported contaminated by plastic. Rarely a non-killing sampling method is used. In this study we wanted to assess plastic levels using stomach flushing and evaluate the method suitability for further research and monitoring. The stomach of 22 fulmars from Bjørnøya, Svalbard, were flushed with water in the field. On return to the laboratory, the regurgitated content was digested using potassium hydroxide. The extracted plastics were visually characterised and analysed with spectroscopy. Only three birds had plastics in their stomach, totaling 36 particles, most of them microplastics (< 5 mm). The plastic burdens are much lower than previously reported in Svalbard. The stomach flushing is assumed not to allow the collection of the gizzard content. This is a major limitation as most of the plastics accumulate in the fulmar's gizzard. However, the method is still useful for studies investigating plastic ingestion dynamics, allowing to sample the same individuals over time.

Particulate Gastric Contents in Patients Prescribed Glucagon-Like Peptide 1 Receptor Agonists After Appropriate Perioperative Fasting: A Report of 2 Cases.

Glucagon-like peptide 1 (GLP-1) receptor agonists have surged in popularity for the treatment of both diabetes mellitus and obesity. While GLP-1 reduces proximal gastrointestinal motility and delays gastric emptying, the impact of these medications on adequate fasting before surgery is not clear. We present 2 cases of particulate gastric contents after following appropriate presurgical fasting in diabetic patients taking GLP-1 receptor agonists and review current literature regarding perioperative implications of these drugs.

Development of a Core Outcome Set for the research and assessment of inoperable malignant bowel obstruction.

BACKGROUND: Malignant bowel obstruction is experienced by 15% of people with advanced cancer, preventing them from eating and drinking and causing pain, nausea and vomiting. Surgery is not always appropriate. Management options include tube or stent drainage of intestinal contents and symptom control using medication. Published literature describing palliative interventions uses a broad range of outcome measures, few of which are patient-relevant. This hinders evidence synthesis, and fails to consider the perspectives of people undergoing treatment. AIMS: To develop a Core Outcome Set for the assessment of inoperable malignant bowel obstruction with clinician, patient and caregiver involvement, using COMET methodology (Core Outcome Measures in Effectiveness Trials). METHODS: A systematic review of clinical trials and observational studies, a rapid review of the qualitative literature and in-depth patient and clinician interviews were conducted to identify a comprehensive list of outcomes. Outcomes were compared and consolidated by the study Steering Group and Patient and Public Involvement contributors, and presented to an international clinical Expert Panel for review. Outcomes from the finalised list were rated for importance in a three-round international Delphi process: results of two survey rounds were circulated to respondents, and two separate consensus meetings were conducted with clinicians and with patients and caregivers via virtual conferencing, using live polling to reach agreement on a Core Outcome Set. RESULTS: 130 unique outcomes were identified. Following the independent Expert Panel review, 82 outcomes were taken into round 1 of the Delphi survey; 24 outcomes reached criteria for critical importance across all stakeholder groups and none reached criteria for dropping. All outcomes rated critically important were taken forward for re-rating in round 2 and all other outcomes dropped. In round 2, all outcomes were voted critically important by at least one stakeholder group. Round 2 outcomes were presented again at online consensus meetings, categorised as high ranking (n = 9), middle ranking (n = 7) or low ranking (n = 8). Stakeholders reached agreement on 16 core outcomes across four key domains: Symptom control, Life impact, Treatment outcomes, and Communication and patient preferences. CONCLUSION: Use of this Core Outcome Set can help to address current challenges in making sense of the evidence around treatment for inoperable malignant bowel obstruction to date, and underpin a more robust future approach. Clearer communication and an honest understanding between all stakeholders will help to provide a basis for responsible decision-making in this distressing situation in clinical practice.

A review of pediatric fasting guidelines and strategies to help children manage preoperative fasting.

Fasting for surgery is a routine step in the preoperative preparation for surgery. There have however been increasing concerns with regard to the high incidence of prolonged fasting in children, and the subsequent psycho-social distress and physiological consequences that this poses. Additionally, the past few years have yielded new research that has shown significant inter-individual variation in gastric emptying regardless of the length of the fast, with some patients still having residual gastric contents even after prolonged fasts. Additionally, multiple large-scale studies have shown no long-term sequalae from clear fluid aspiration, although two deaths from aspiration have been reported within the large Wake Up Safe cohort. This has led to a change in the recommended clear fluid fasting times in multiple international pediatric societies; similarly, many societies continue to recommend traditional fasting times. Multiple fasting strategies exist in the literature, though these have mostly been studied and implemented in the adult population. This review hopes to summarize the recent updates in fasting guidelines, discuss the issues surrounding prolonged fasting, and explore potential tolerance strategies for children.

Stable isotopic and stomach content analyses reveal changes in the trophic level and feeding habit of large-head hairtail (Trichiurus lepturus) in the northern South China Sea.

The feeding habit of large-head hairtail (Trichiurus lepturus) in the northern South China Sea was investigated through isotopic and stomach content analyses. The isotopic features of the hairtail at the same body size differed among regions, with the fish in coastal waters presenting higher δ15N and δ13C values compared to those in the open sea, indicating different trophic levels (TL), food habits, and isotopic baselines. According to the partial correlation of water depth with δ15N values, the sampling stations were divided into three regions based on the depth of water: coastal (20-40 m), near coastal (60-80 m), and open sea (100-200 m) regions. In the coastal region, the hairtail from stations affected by the Pearl River plume exhibited lower δ15N and δ13C values. The stomach content analysis indicated different feeding habits of the hairtail from different regions. The hairtail in the coastal and near coastal waters fed more on fish and less on crustaceans compared to the hairtail in the open sea. The relationship between δ15N and fish size exhibited two contrary patterns. First, the δ15N values increased with increasing preanal length in the hairtail sampled from the water depth of 30-40 m in section F (in fish with preanal length < 200 mm) and those samples from the water depth of 100-200 m. This finding reflected an ontogenetic shift in diet and TL. However, the δ15N values tended to decrease with the increasing preanal length of the hairtail samples collected from the water depth of 30-40 m in section F (fish with a preanal length of ~200-300 mm). These findings suggested that under the conditions of insufficient availability of high-quality prey, the larger hairtail fed more on low-TL prey to compensate for the increase energy demand, arising due to growth, which led to the observed decrease in δ15N values.