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Purpose Diagnosis and monitoring of laryngopharyngeal reflux (LPR) is a constant challenge in otolaryngological practice, chiefly because there are no specific symptoms characteristic of the disease. In this paper, we present the validation of a simple, 6-level qualitative scale to gauge the clinical findings of LPR. It has been previously published in Polish as the Warsaw Scale. Methods In the study, we enrolled 100 patients with voice problems who had registered in our clinic, and we performed an extended battery of diagnostic tests for LPR, together with 24-h pH monitoring. Results The Warsaw Scale significantly outperformed other instruments in both predicting LPR status and correlating with pH measurements. Moreover, the rating provided by the scale showed a strong association with patient-reported symptoms. Conclusion The data indicate that the Warsaw Scale could be used as an affordable, consistent, and effective diagnostic and monitoring tool for LPR.

Background Helicobacter pylori (HP) infection has been implicated in several malignant and nonmalignant conditions. The confirmatory diagnosis of HP requires an endoscopic biopsy, followed by a rapid urease test, culture, and/or histopathologic examination using hemotoxylin and eosin, histochemical stains, or immunohistochemistry against HP. EndoFaster is a novel device that can perform real-time ammonium and pH measurements in gastric juice, allowing a diagnosis of HP during gastroduodenal endoscopy. Goal This study aimed to validate the accuracy of EndoFaster and to compare different histochemical and immunohistochemical techniques for the diagnosis of HP infection. Study Consecutive patients who underwent upper endoscopy at our center were prospectively enrolled. During the endoscopy procedure, gastric juice was aspirated to perform an automatic analysis by EndoFaster and gastric biopsies were taken. Histologic sections were reviewed to assess the histopathologic features. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for the EndoFaster test, Diff-Quick (DQ), and immunohistochemistry against HP (anti-HP) using Warthin-Starry as the gold standard for HP detection. Results Overall, 80 patients were enrolled. In 19 cases (23,75%), histology was normal. In the remaining cases, varying degrees of inflammation were found. The sensitivity, specificity, positive predictive value, and negative predictive value were 73.33%, 86.00%, 75.86%, and 84.31% for the EndoFaster test using 67 ppm/mL as the positive threshold; 73.33%, 100%, 100%, and 86.21% for DQ; and 79.31%, 88.00%, 79.31%, and 88.00% for anti-HP, respectively. Conclusions The EndoFaster test has good sensitivity and specificity for the diagnosis of HP during the gastroscopy procedure. DQ and anti-HP are excellent alternatives to Warthin-Starry for the detection of HP.

Evaluate the efficiency of an autologous whole blood clot (WBC) matrix on diabetic foot ulcers (DFU), and analyse its immune response with near-infrared spectroscopy (NIRS) and pH measurement.Three patients were treated with a WBC. The matrix was produced at the point of care, using a WBC system. A WBC gel was formed and applied onto the wounds. The gel remained in place with primary and secondary dressings.Wound-size reduction was 70% after two applications, 97.6% after three applications, and 90.9% after four applications. The NIRS skeletal muscle oxygen saturation (StO2) increased in all cases.The autologous matrix was efficient in treating DFU. The wound area surface reduced after each application and wound healing was achieved in all cases. More studies are needed to understand the benefits of using a WBC matrix on DFU.Evaluar la eficacia de una matriz autóloga en el tratamiento de úlceras de pie diabético (UPD) de difícil cicatrización, y analizar la respuesta inmune a la aplicación de la matriz con un escáner de infrarrojo cercano (NIRS, por sus siglas en inglés) y un medidor de pH dérmico.Tres pacientes fueron tratados con una matriz de coágulo de sangre completa (WBC, por sus siglas en inglés) autóloga. La matriz se realizó en el punto de atención, mezclando la sangre del paciente con una suspensión coloidal de gluconato de calcio/caolín, e inyectándola en una bandeja de coagulación. Se formó un gel de WBC y se aplicó a las heridas. El gel de WBC se mantuvo en su lugar con apósitos primarios y secundarios.Hubo una reducción del tamaño de las UPD de 70% tras dos aplicaciones, 97,6% después de tres aplicaciones, y 90,9% tras cuatro aplicaciones. El NIRS midió un aumento en la saturación de oxígeno tisular. No hubo reacciones adversas.La matriz autóloga fue eficaz en el tratamiento de las UPD. La superficie de las UPD se redujo después de cada aplicación y se logró el cierre completo de las heridas. Se necesitan más ensayos clínicos para comprender mejor los beneficios de la matriz de WBC en UPD.RedDress Ltd. (Pardes-Hanna, Israel) proporcionó los suministros y materiales del estudio. Bennett Health Inc. ayudó con el desarrollo del protocolo y capacitó al personal sobre la aplicación del producto para coágulos sanguíneos. JA es accionista de Bennett Health Inc. No hubo interés financiero para ninguno de los investigadores o participantes.

Pleural effusion is very common, but an etiologic diagnosis is often difficult. We used three unconventional diagnostic techniques (voltammetric analysis, protein electrophoresis and pH measurement) performed on pleural effusion to do a preliminary distinction between a neoplastic and a non-neoplastic origin. Pleural fluid samples were collected through thoracentesis, thoracoscopy, or post-surgery pleural drainage of 116 patients admitted to acute care wards. Samples were analyzed with the three unconventional techniques: voltammetric analysis using the BIONOTE system, capillary electrophoresis and pH measurement using a potentiometric method. The BIONOTE system is an innovative system that performs a cyclic voltammetric analysis of a biological liquid sample. The final output of the electrochemical analysis is an electrical pattern that represents a fingerprint of the analyzed sample and each sample has a different fingerprint. Data from the three unconventional diagnostic techniques were analyzed using partial least squares discriminant analysis to discriminate neoplastic from non-neoplastic effusions; we also evaluated sensitivity, specificity and percentage of correct classification. The mean age was 68 years (SD: 12); 78 (67.24%) participants were men. Results obtained from all the unconventional techniques employed showed that neoplastic and non-neoplastic pleural effusions were correctly classified in 80.2% of cases, with a sensitivity of 77% and specificity of 83%. The combined use of voltammetric analysis, protein electrophoresis and pH measurement of pleural fluid can easily and quickly distinguish a neoplastic from a non-neoplastic pleural effusion with reliable accuracy and represents an innovative diagnostic approach. In fact, this protocol can be executed in just few minutes directly in the patient's bed and it holds great promise to improve the prognosis and therapeutic chances.

Introduction/aim: Levo-pantoprazole, the S-enantiomer of pantoprazole, is a proton pump inhibitor that has been shown in animal studies to be faster and stronger than its racemic formulation. There are no studies on humans and therefore our aim was to evaluate the effects of levo-pantoprazole versus racemic pantoprazole on intragastric pH. Materials and methods: A randomized controlled study was conducted on patients with erosive gastroesophageal reflux disease that were given 20 mg of levo-pantoprazole (n = 15) versus 40 mg of racemic pantoprazole (n = 15) for 7 days. Baseline and end-of-treatment symptom evaluation and intragastric pH measurement were carried out. Results: There were no differences between the groups in the baseline evaluations. From 40 to 115 min after the first dose of levo-pantoprazole, the mean intragastric pH was higher, compared with that of racemic pantoprazole (p < 0.05). After one week, levo-pantoprazole and racemic pantoprazole significantly reduced intragastric acid production and its esophageal exposure (p < 0.05). Even though there was no statistically significant difference, a larger number of patients that received levo-pantoprazole stated that their heartburn improved within the first 3 days. Conclusions: The S-enantiomer of pantoprazole (levo-pantoprazole) had a faster and stronger effect with respect to acid suppression, compared with its racemic formulation. Although the effect on symptoms was faster with levo-pantoprazole, occurring within the first days of treatment, it was equivalent to that of the racemate at one week of treatment. Resumen: Introducción/objetivo: El S-enantiómero del pantoprazol, el levopantoprazol, es un inhibidor de la bomba de protones que en estudios animales ha mostrado ser más rápido y potente que su formulación racémica. Sin embargo, no existen estudios en humanos por lo que nuestro objetivo fue evaluar los efectos sobre el pH intragástrico de levopantoprazol versus de pantoprazol racémico. Material y métodos: Estudio aleatorizado controlado en pacientes con enfermedad por reflujo gastroesofágico erosivo a quienes se les administró 20 mg de levopantoprazol (n=15) versus 40 mg de pantoprazol racémico (n=15) durante 7 días. De forma basal y al final del tratamiento se realizó evaluación sintomática y medición del pH intragástrico. Resultados: No hubo diferencias entre los grupos en las evaluaciones realizadas de forma basal. A partir de los 40 minutos y hasta los 115 minutos posterior a la primera dosis de levopantoprazol el pH intragástrico promedio fue mayor en comparación que el pantoprazol racémico (p

Background: The appropriateness of the wound bed for autograft transplantation is routinely evaluated based on the surgeon's judgment, which might not be reliable in some situations. Therefore, this study was designed to evaluate the association between wound pH, wound temperature, and wound culture results with autograft taking. Materials and Methods: In this prospective, cross-sectional study, the body core temperature, wound pH, and local wound temperature at the beginning of operation and after burn wound excision were measured in 50 patients with burn wounds. Swab culture specimen was obtained from the burn wound after dressing removal and after the completion of wound excision. Autograft taking was evaluated on days 3 and 7 postoperative. Results: There was a statistically significant reverse association between autograft taking on day 3 and wound pH at the beginning of operation (P = 0.016). Besides, there was a statistically significant association between core body temperature and autograft taking on days 3 (P = 0.035) and 7 (P = 0.002). However, there was no significant association between local wound temperature and autograft taking. A positive result for wound culture after excision, even when the colony count was

Nasogastric tube is widely used in intensive care units. The complications of misplacement are rare but very dangerous for critically ill patients. Accurate localization of the position of the tip of nasogastric tube can effectively decrease complications and ensure the safety of critically ill patients. There are various methods that can be used to verify the location of the nasogastric tube such as radiography, PH measurement, electromagnetic navigator and ultrasound. However, there is a lack of general consensus regarding a standard method. In this review, we found that the accuracy of nasogastric tube placement can be greatly improved by visual technology such as X-ray, sonography and electromagnetic navigator. However, visual technology has not been widely used to locate the tip of nasogastric tube in critically ill patients. Best practice guidelines based on the available knowledge and evidence of current methods are necessary to increase the accuracy placement of nasogastric tube. It is envisioned that development of visual technologies will determine a new standard of care for verification of placement of nasogastric tube.

Aim of the study: evaluation of the effectiveness of the integrated use of the Vagilac line of intimate hygiene products in young women with bacterial vaginosis (BV). Design of the study: prospective randomized intervention open study. Materials and methods: 45 menstruating young women diagnosed with «BW» at the age of 11-17 years, divided into 3 equal groups, were examined. In the 1st group adolescents received oral probiotic with Lactobacillus rhamnosus GR-1® and Lactobacillus reuteri RC-14® within 15 days, in the 2nd group within 30 days. Group 3 girls, along with probiotic, used liquid soap and Vagilac moisturising gel with lactic acid for intimate hygiene for 30 days. Diagnosis and control of the results were assessed taking into account complaints, vulvovaginoscopy, pH-metry, microscopy and molecular-genetic examination of vaginal microbiocenosis. Results: 1 month after the end of oral probiotic use, the share of Lactobacillus spp. in vaginal TBM in girls who received the probiotic within 15 days was 21.3%, 30 days 53.4%. The parallel use of liquid soap and Vagilac gel for intimate hygiene was manifested by the steady normalization of lactobacillus representation in the vagina. Conclusion: In the case of bacterial vaginosis in young girls, the most appropriate way to restore vaginal normocenosis was to use an oral probiotic with Lactobacillus rhamnosus GR-1® and Lactobacillus reuteri RC-14® for 30 days with the addition of liquid soap and Vagilac moisturising gel for intimate hygiene.

Multichannel intraluminal impedance-pH measurements (MII-pH) are useful for evaluating acid and non-acid gastroesophageal reflux (GER). However, the use of MIH-pH is not yet established in Japan. The Japanese Pediatric Impedance Working Group (Japanese-PIG) convened to devise a standard protocol for MII-pH in Japanese children. The expert members of the Japanese-PIG collected data on pediatric MII-pH from the relevant literature in English, including the standard protocol of MII-pH presented by the European PIG, and the insights of international experts. The resultant consensus was included in the contents of the standard protocol of MII-pH. The standard protocol included standardization of the indication, methodology, and interpretation of MII-pH in Japanese children. The criteria for abnormal GER by MII-pH were defined using the Reflux Index and number of total reflux episodes independently in children aged

In addition to typical reflux symptoms, many patients with gastroesophageal reflux disease (GERD) present with extraesophageal symptoms such as cough, hoarseness or asthma, which can be caused by laryngopharyngeal reflux (LPR). Due to their multifactorial origin, those symptoms can be a great diagnostic and therapeutic challenge. Esophageal pH-monitoring is commonly used to determine abnormal esophageal acid exposure and confirm the diagnosis of GERD. However, for better evaluation of acid exposure above the upper esophageal sphincter, a new laryngopharyngeal pH measurement system is now available and may lead to more reliable results in patients with predominantly extraesophageal symptoms. This article aims to present a standardized protocol for simultaneous pH measurement using esophageal and laryngopharyngeal pH probes in order to obtain acid exposure scores from both measurements.

Background/Aims The aim of this study is to investigate the degree of delayed gastric emptying (DGE) and evaluate how the severity of DGE affects gastroesophageal reflux disease (GERD) in neurologically impaired (NI) patients utilizing 24-hour multichannel intraluminal impedance pH measurements (pH/MII) and 13C-acetate breath test (13C-ABT) analyses. Methods 13C-ABT and pH/MII were conducted in 26 NI patients who were referred to our institution due to suspected GERD. At first, correlation analyses were performed to investigate the correlation between the 13C-ABT parameters and the clinical or pH/MII parameters. Thereafter, all patients were divided into 2 groups (DGE and severe DGE [SDGE] group) according to each cut off half emptying time (t1/2, 90-170 minutes). Each pH/MII parameter was compared between the 2 groups in each set-up cutoff t1/2. Results The mean t1/2 of all patients was 215.5 ± 237.2 minutes and the t1/2 of 24 (92.3%) patients were > 100 minutes. Significant moderate positive correlations were observed between both t1/2 and lag phase time and the non-acid reflux related parameters. Furthermore, the patients in the SDGE group demonstrated higher non-acid reflux related parameters than those of the DGE groups when the cutoff was t1/2 ≥ 140 minutes. Conclusion The present study demonstrated that GE with t1/2 ≥ 140 minutes was related to an increase of non-acid exposure reaching up to the proximal esophagus in NI patients, and indicating that NI patients with SDGE might have a high risk of non-acid GERD. (J Neurogastroenterol Motil 2017;23:533-540)

Objective: The aim of the present investigation was to develop, optimize and evaluate nanoemulsion system of carvedilol to improve its solubility, and oral bioavailability. Carvedilol is a non-selective beta blocker used in the treatment of mild to moderate congestive heart failure and mild to moderate essential hypertension. It has both poor water solubility (0.583 mg/L) and oral bioavailability (23%) because of significant first-pass hepatic metabolism. Methods: Based on solubility testing, clove oil was used as oil, tween 20 was used as surfactants and PEG 400 was used as cosurfactants in construction of phase diagrams. Carvedilol nanoemulsions were prepared by aqueous phase titration method. Out of twelve formulations, eight thermodynamically stable formulations were selected for preparation of carvedilol loaded nanoemulsions and these nanoemulsions were subjected for characterization i.e. particle size, viscosity, polydispersity, zeta potential. A 12 hrs in-vitro release release study was performed on selected nanoemulsion formulations of carvedilol. Results: The results of viscosity of carvedilol nanoemulsions were found to be in range (60.42 –134.63 m Pa.sec.). The results of pH measurement for formulations explain that the pH values of drug free nanoemulsions were slightly acidic. All formulations have PDI value less than (1.0). Conclusion: Study concludes, nanoemulsion formulation of batch NEC4 (Smix ratio 1:3) was found to be optimum formulation. Peer Review History: Received 9 February 2017; Revised 25 February; Accepted 28 February, Available online 15 March 2017 Academic Editor: Ahmad Najib, Universitas Muslim Indonesia, Indonesia, ahmad.najib@umi.ac.id UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 3.5/10 Average Peer review marks at publication stage: 7.0/10 Reviewer(s) detail: Dr. Sally A. El-Zahaby, Pharos University in Alexandria, Egypt, sally.elzahaby@yahoo.com Dr. Maha Khalifa Ahmed Khalifa, Al-Azhar Universit - Cairo, Egypt, mahakhalifa.ahmed@hotmail.com Similar Articles: FORMULATION AND CHARACTERIZATION OF TOPICAL NANO EMULGEL OF TERBINAFINE This article has been cited by: Fernandes, G.J., Kumar, L., Sharma, K. et al. A Review on Solubility Enhancement of Carvedilol—a BCS Class II Drug. J Pharm Innov 13, 197–212 (2018). Pubmed

Gastrointestinal reflux disease (GERD) is one of the most common benign disorders of the upper gastrointestinal tract, and esophageal pH-metry is the current gold standard in its diagnosis. The DeMeester score, a composite score calculated using different parameters measured by pH-metry, helps to identify an abnormal acid exposure. For patients with atypical, or extraesophageal, symptoms, a new oropharyngeal pH-metry using the Restech device is now available. The composite score of the Restech measurement, the RYAN score, is calculated using different thresholds for an abnormal acid exposure of the oropharynx and helps to identify patients with laryngopharyngeal reflux disease. The DeMeester score and the RYAN score represent the same parameters for esophageal and oropharyngeal acid exposure but are using different thresholds for the calculation of the actual score. Our study of 101 patients with suspected GERD showed that esophageal and oropharyngeal pH measurement does not need to correlate but may supplement each other in the diagnostic pathway.

Prevention of preterm birth as a cause of serious risks for the infant as well as the mother is one of the still unsolved problems in modern medicine. The list of factors for miscarriage, prematurity and stillbirth is lengthy. The Thuringia preventional campaign 2017 offers an effective simple screening approach based on intravaginal pH measurement.

The aim of the study was to evaluate and compare multichannel intraluminal impedance-pH (MII-pH) monitoring with standard investigations including pH testing for detecting gastroesophageal reflux disease (GERD) in children.A retrospective review of all MII-pH studies performed between July 2007 and March 2013 at Sydney Children's Hospital. Results from MII-pH testing, esophagogastroduodenoscopy (EGD), barium meal and pepsin assay, symptoms, underlying comorbidities, age, and medication usage were evaluated.An additional 47.18% of children had GERD detected by MII-pH testing, which would have been missed by pH testing alone. Based on symptomatology, 50.49% of children with respiratory symptoms as a result of GERD and 47.54% of those with gastrointestinal symptoms would have been missed by pH testing alone. GERD was detected in an additional 39.47% of children with neurological impairment, 44.44% for those with cystic fibrosis, and 52.17% for those with esophageal atresia-tracheoesophageal fistula by MII-pH. In patients with persistent symptoms on anti-reflux medication, GERD would have been missed by pH testing alone in 50.40%. GERD was detected in an additional 62.79% of infants and 42.76% of older children by MII-pH compared with pH testing alone. With reference to MII-pH, the sensitivity of other standard investigations, pH testing (32.35%), barium meal (25.00%), EGD (45.26%), and pepsin assay (48.89%) was significantly lower in the detection of GERD in children. Of all abnormal MII-pH results, 51.1% were abnormal because of symptom association alone.Combined MII-pH testing is superior to standard investigations such as 24-hour pH testing, barium meal, EGD, and pepsin assay in detecting GERD in children, particular because of its ability to associate symptoms with acid and non-acid reflux events.

Collection of exhaled breath condensate (EBC) is a non-invasive method to sample the airway lining fluid. The composition of EBC may reflect physiological and pathophysiological processes within the lower airways, which could otherwise be investigated only with more invasive techniques. Hence, analysis of the condensate fluid seems feasible in chronic obstructive pulmonary disease (COPD) to monitor disease processes and facilitate personalized therapy. In the past two decades, a multitude of molecules has been assessed in EBC samples from patients with COPD, characterizing inflammation, oxidative and nitrative stress in this disorder. Recently, multimarker profiling with sensitive metabolomic or proteomic approaches, optimized for the EBC matrix, has also been applied, which could overcome the pitfalls of single marker detection using commercial assay systems. In this review, we describe the theoretical background of EBC formation, systematically discuss technical and methodological difficulties of sample collection and analysis and summarize data on EBC biomarkers in COPD. Finally, based on previous findings and our experience, we propose potential future directions for the EBC research community, which could pave the way for introducing EBC analysis in clinical practice.

Summary Inhibition of gastric acid and increased stomach pH>4.0 is currently accepted as the mainstay of treatment for gastric ulcers in horses. Measurement of gastric pH is complicated and requires placement of a cannula and collection of gastric juice or placement of pH electrodes in the stomach. Since the distance from the nares to the stomach is approximately 200 cm, finding a system with a pH electrode with this length is difficult, not to mention difficult to maintain. There has been a fascination with the measurement of gastric juice pH in horses that has covered three-quarters of a century starting with a fistula model in 1933 and culminating in a recent technique described in this issue. Placement of gastric cannulas and various pH electrodes have been used to measure gastric juice pH in horses in the past and present, but the future may require more sophisticated methods as we look at the efficacy of different formulations of acid suppressive drugs for treatment of equine gastric ulcer syndrome.

The objective of this research was to evaluate postmortem changes concerning electric charge of human erythrocytes and thrombocytes in fatal accidental hypothermia. The surface charge density values were determined on the basis of the electrophoretic mobility measurements of the cells conducted at various pH values of electrolyte solution. The surface charge of erythrocyte membranes after fatal accidental hypothermia increased compared to the control group within whole range of experimental pH values. Moreover, a slight shift of the isoelectric point of erythrocyte membranes towards high pH values was observed. The surface charge of thrombocyte membranes in fatal accidental hypothermia decreased at low pH compared to the control group. However, at pH range 4–9, the values increased compared to the control group. The isoelectric point of thrombocyte membranes after fatal accidental hypothermia was slightly shifted towards low pH values compared to the control group. The observed changes are probably connected with the partial destruction and functional changes of the blood cell structure.

This study aimed to evaluate esophageal function before and after antireflux surgery (ARS) in neurologically impaired (NI) patients using 24 h multichannel intraluminal impedance (MII)-pH measurement. Seven NI patients (age, 0–33 years; median, 13 years) were assessed before and after ARS using 24 h MII-pH. We described reflux parameters such as pH reflux index, bolus exposure index, number of acidic and nonacidic reflux episodes, mean acid clearance time and median bolus clearance time, and esophageal motility parameters in dry swallows such as bolus presence time (BPT), total bolus transit time (TBTT), and total propagation velocity (TPV). The postoperative reflux parameters such as pH reflux index, acid clearance time, bolus exposure index, and the number of acidic reflux episodes significantly decreased (P

Objective Glutamate-aspartate cardioplegia additive solution (GACAS) is used to enhance myocardial preservation and left ventricular function during some cardiac surgeries. This study was designed to evaluate the stability of compounded GACAS stored in sterile polyolefin intravenous (IV) bags. The goal is to extend the default USP beyond-use date (BUD) and reduce unnecessary inventory waste. Methods GACAS was compounded and packaged in sterile polyolefin 250 mL IV bags. The concentration was 232 mM for each amino acid. The samples were stored under refrigeration (2°C-8°C) and analyzed at 0, 1, and 2 months. At each time point, the samples were evaluated by pH measurement and visual inspection for color, clarity, and particulates. The samples were also analyzed by high-performance liquid chromatography (HPLC) for potency and degradation products. Due to the lack of ultraviolet (UV) chromophores of glutamate and aspartate, the samples were derivatized by ortho-phthalaldehyde prior to HPLC analysis. Results The time zero samples of GACAS passed the physical, chemical, and microbiological tests. Over 2 months of storage, there was no significant change in pH or visual appearance for any of the stability samples. The HPLC results also indicated that the samples retained 101% to 103% of the label claim strengths for both amino acids. Conclusion The physical and chemical stability of extemporaneously prepared GACAS has been confirmed for up to 2 months in polyolefin IV bags stored under refrigeration. With proper sterile compounding practice and microbiology testing, the BUD of this product can be extended to 2 months.

Objective Premature newborns and infants suffering from digestive and extradigestive pathologies often need parenteral nutrition to cover their nutritional needs. Our objective is to assess the galenic stability of four all-in-one parenteral nutrition admixtures (PNAs) intended for neonates. Methods A retrospective analysis of 238 prescriptions a given day per week over 6 months was conducted. Four formulae were then elaborated, testing different conditions. Galenic stability was assessed during 7 days through visual inspection, calcium concentration measurement, pH measurement, Zeta potential and particle size measurement. Results No signs of creaming or coalescence or phase separation were observed. Calcium concentrations remained stable for the four formulae. pH ranged from 5.4 to 6 and remained stable. Zeta potential ranged from −32 to −38 mV and remained stable during the whole study for the four formulae. Droplet size distribution curves followed a Gauss curve and were strictly identical to the control (Medialipide) distribution curve. The De Brouckere mean diameter of globules was 0.38 µm and the maximum diameter was 0.78 µm. Conclusions Although further physicochemical analyses should be performed to complete our results, the four all-in-one PNAs we studied can be considered as stable from a galenic point of view and meet French recommendations based on current European Pharmacopoeia and US Pharmacopoeia chapter criteria. For clinical practice, we set the lower limit of lipid percentage at 4% and the use-by date at 3 days between 2°C and 8°C and 24 h between 25°C and 30°C.

BACKGROUND: Jackhammer esophagus is an hypercontractile esophageal disorder recently brought to light with the advent of high resolution manometry (HRM). As Jackhammer esophagus is purely a manometric diagnosis, little is known about its clinical expression. AIMS: We hypothesized that the extreme esophageal contractions encountered in this disease cause upper digestive symptoms such as dysphagia and chest pain. Thus, the aim of our study was to identify the clinical characteristics associated with this new motility disorder. METHODS: A retrospective observational study was conducted from January 2015 to September 2017 at the CHUM gastro-intestinal motility center. Among all the HRM performed, patients with a diagnosis of jackhammer esophagus were included. This diagnosis is made when at least 20% of the swallows being studied are hypercontractile, with a distal contractile integral (DCI) of >8000 mmHg.s.cm (Chicago classification). Each patient’s chart was reviewed to collect clinical data: age, sex, comorbidities, proton pump inhibitor use, along with manometry, upper digestive endoscopy, biopsies, pH-monitoring and barium swallow results. RESULTS: Among the 1046 HRM done during the study period, 34 patients with jackhammer esophagus were included (mean age 62 ± 13 years, 88% females). Their main symptoms were dysphagia (71%), pyrosis (44%), retrosternal chest pain (38%) and epigastralgia (32%). In half of the patients, at least 50% of swallows were hypercontractile. The mean DCI of the hypercontractile esophageal contractions was 11 600 ± 3600 mmHg.s.cm. Other HRM findings were hypertonia (26%) and/or inadequate relaxation (29%) of the lower esophageal sphincter. Upper digestive endoscopy results were available for 26 patients: 18 normal, 3 hiatal hernias, 2 esophageal dilatations, 2 lower esophageal sphincter hypertonia impressions and one with longitudinal striae. Among the 12 available biopsy results, 2 were abnormal: one lymphocytic exostosis and one esophagitis without eosinophilia. Pathological gastro-esophageal reflux was found in 3 of the 9 patients investigated with pH-monitoring. Among the 8 patients who had a barium swallow, 4 had a normal study, 3 had spastic contractions of the esophagus and one had an incomplete relaxation of the cricopharyngeal muscle. CONCLUSIONS: Jackhammer esophagus was diagnosed in 3% of the patients referred for a HRM to our gastro-intestinal motility center. A strong female predominance is found in this study. In more than two thirds of cases, the clinical presentation of jackhammer esophagus is dysphagia. Malfunctioning of the lower esophageal sphincter can be demonstrated during manometry. Upper digestive endoscopy and biopsies seem unhelpful in suspecting the diagnosis before HRM is performed. FUNDING AGENCIES: None

Monitoring of urinary pH is an important part of the assessment of patients with urinary tract stones. It provides valuable information about the future stone risk of certain patients and further allows the effective tailoring of medical intervention. Accurate measurement is therefore essential in these patients.The purpose of this study was to determine the most accurate method of measuring urinary pH in an outpatient setting. Materials, Methods, and Participants: Urine samples were collected from 200 patients attending stone clinics at The University Hospital of South Manchester. pH was measured by three commonly used methods: Siemens Clinitek Status pH meter, a hand-held pH meter, and litmus paper read visually. Results were compared with readings simultaneously obtained from a bench-top laboratory pH machine, which is the reference method for pH measurement.The pH readings obtained were analyzed using the Bland-Altman plot.When compared with the reference method, the hand-held pH meter differed the least with a mean bias of 0.0073 and a maximum under-read of -0.2 pH units and maximum over-read of +0.2 pH units. The Siemens Clinitek pH meter differed most with a mean bias of -0.108, with a maximum over-read of +0.99 pH units and a maximum under-read of 0.78 pH units. The pH values obtained with the litmus paper gave similar results to that of the Clinitek pH meter with a mean bias of -0.069, with a maximum over-read of 0.96 and maximum under-read of 0.82 pH units.The hand-held pH device gave urinary pH readings that most closely and consistently matched those of the reference bench-top laboratory machine. This method of pH measurement should be considered in stone clinics in patients with pH-dependent stone risk.

Barrett’s oesophagus is a condition caused by acid reflux from the stomach to the oesophagus for a prolonged period of time. Patients with Barrett’s oesophagus are at significant risk of developing oesophageal adenocarcinoma. This risk decreases with antireflux surgery. Treatment of gastroesophageal reflux disease (GERD) by Nissen fundoplication surgery has a success rate of 85–90%. The aim of this study is to highlight the significance of oesophageal pH measurement as part of the postoperative follow-up of patients diagnosed with Barrett’s oesophagus who undergo the Nissen fundoplication procedure. Between 2010 and 2012, eleven patients with Barrett’s oesophagus underwent Nissen fundoplication in our clinic, followed by 48h wireless oesophageal pH-metry monitoring. All patients reported relief of GERD typical symptoms. Mean DeMeester score of 1.5 was measured at the fifth postoperative month. Prevention of oesophageal adenocarcinoma in patients with Barrett’s oesophagus is crucial. These patients are exposed to a great risk of adenocarcinoma development, not only owing to the potential progression of Barrett’s oesophagus to adenocarcinoma, but also because of the decreased capacity to experience typical GERD symptoms. Given the possibility of antireflux surgery failure and the fact that symptoms may be an unreliable indicator of GERD presence, postoperative oesophageal pHmetry is mandatory.

BACKGROUND AND OBJECTIVES Blood operators routinely monitor the pH of apheresis platelets as a marker of the so-called storage lesion, which can result from manufacturing problems. It is also suspected that some donor characteristics can increase the risk of poor platelet storage. To explore this hypothesis, we analysed a large, multinational data set of quality control (QC) pH test results on apheresis platelets. MATERIALS AND METHODS For the period between September 2011 and August 2014, seven blood operators in Canada, the USA, the Netherlands, the United Kingdom, France and Australia provided pH QC test results and donor characteristics on a total of 21,671 apheresis platelets. RESULTS Some variations in pH distribution between blood operators were in part explained by differences in collection, processing and testing methods. Younger age and female gender were significantly associated with a pH value below the 10th percentile. Among donors who had two or more pH measurements (n = 3672), there was a strong correlation between pH results (r = 0·726; P < 0·0001). CONCLUSION The strong intradonor correlation of pH measurements and the association between donor characteristics and pH results suggest that donor factors play a role in the quality of platelets.

Pleural fluid pH is a crucial determinant of complicated parapneumonic effusion diagnosis and the need for drainage. It is best measured by blood gas analyzer. We examined whether physicians were aware of this, and whether their laboratories measured pleural pH according to their expectations. Only 53% of physicians understood the need for blood gas analyzer measurements, only 50% of laboratories used blood gas analyzers, and only 35% of physicians correctly identified the method performed in their laboratory. Diagnosis of complicated parapneumonic effusion is jeopardized by inadequate physician knowledge and guideline-discordant laboratory practice. We recommend cooperation between thoracic and biochemistry specialty societies to rectify this issue.

Background: The pH data of multichannel intraluminal impedance-pH testing (MII-pH) may be analyzed by using all pH drops (simulating traditional pH-monitoring) or only analyzing pH drops associated with impedance changes. It is unknown whether the acid exposure measurements would differ between these methods in a group of symptomatic patients. Methods: We evaluated MII-pH studies of patients from 2008 to 2013. Acid analysis was performed in two methods: 1. Creating non-mealtime pH measurements related to retrograde bolus movements (“pH-MII method”) 2. Creating non-mealtime pH measurements anytime the pH fell below 4 (“all-pH method”). Statistical analysis was performed using t-test, Fischer’s test, and logistic regression. Results: 121 patients were eligible. The mean percent total acid exposure time (4.05) was significantly higher in the all-pH method (vs. 1.63 p=0.001). The proportion of patients with abnormal acid exposure time (24.7%) and DeMeester score (24.8%) was higher in the all-pH method (vs. 8.3%, p=0.001; vs. 9.1%, p=0.002). Compared to those without a hiatal hernia (HH), more patients with a HH >2cm had significant differences between analysis methods in upright (19.4% vs. 5.56%, p=0.03), recumbent (29% vs. 6.67%; p=0.002), total time (45.2% vs. 6.67%, p=0.001), and DeMeester score (35.5% vs. 8.89%; p=0.001). Adjusting for age, sex, and PPI usage, HH remained a significant predictor of whether results would differ (OR 12; CI 3.34-42.8 total exposure, OR 8.75; CI 2.36-32.5 DeMeester). Conclusion: Analysis of esophageal acid exposure using all pH data detected more acid reflux than when incorporating impedance measures, particularly in those with a HH. This finding may relate to small volume reflux. Therefore analysis of all-pH reflux rather than just MII-pH should be considered in those patients with a HH.

To further characterize the time course of gastric pH with respect to meals and gastric residence times (GRTs) in dogs, continuous pH measurements were recorded with Bravo capsules, which were attached to the dogs' stomach mucosa or administered as free capsules, respectively. Experiments took place in home or study cages, and meals were administered at designated times. Up until 2 h prior to mealtime, the fasted gastric pH remained constantly acidic (∼2.0) regardless whether the dogs were in the study or home cages. However, as feeding time became imminent, the pH was typically elevated for dogs in home cages, whereas the pH remained acidic for dogs in study cages. For both monitoring locations, the gastric pH remained acidic during meal consumption and for at least 10 h after meals. The GRT between fasted (25 ± 32 min) and fed (686 ± 352 min) conditions was significantly different with considerable inter- and intrasubject variability. Fasted gastric pH was similar to that of literature monkey and human values but differed after meals as the dog gastric pH remained acidic unlike monkey and human. In dogs, the fasted GRT was remarkably rapid and under fed conditions, longer than that observed in humans.

Exhaled breath condensate (EBC) pH has been proposed as a useful, non-invasive marker of airway inflammation in pulmonary diseases. In this study we tested whether cystic fibrosis (CF) is associated with acidification of EBC, when pH is assessed by the CO2 gas standardization method. EBC was collected using two different devices (EcoScreen and R-Tube) in 46 stable CF patients during routine clinical visits and in 28 healthy controls. Mean EBC pH in CF patients and in healthy controls was similar (EcoScreen: CF patients: 6.38 ± 0.03 versus controls: 6.39 ± 0.03, p = 0.699; R-tube: CF patients: 5.94 ± 0.04 versus controls: 6.02 ± 0.03, p = 0.159). Inflammatory cell counts in spontaneously expectorated sputum obtained in a subset of patients (n = 20) showed no correlation with pH values. EBC samples collected with the R-tube were more acidic than those collected with the EcoScreen device (p

Background: Pleural fluid pH measured by a blood gas analyzer is the only recommended method of pH measurement to guide management for patients with parapneumonic pleural effusions. Not all hospitals use blood gas analyzers for pleural fluid pH determination and it is unknown if physicians are aware of this problem. Objective: To determine if a discrepancy exists between the modality used for measuring pleural fluid pH and how physicians believe it is measured. Methods: We surveyed pulmonologists randomly across the USA by e-mail inquiring how they thought pleural fluid pH was measured at their laboratory. We then independently contacted the laboratory and asked how pleural fluid pH was actually measured. Results: Two hundred and sixty-seven pulmonologists completed the survey. Eighty-six percent of the pulmonologists use pleural fluid pH to manage complicated parapneumonic effusions. Forty-three percent did not recognize blood gas analyzer solely as the most accurate and validated method. Thirty-nine percent of the physicians who use pleural pH to manage effusions and believe that blood gas analyzers are the most accurate were wrong in their assumption that their laboratory was using this tool for pleural pH measurement. Conclusions: Whether it is due to inaccurate knowledge or a perception of how pleural fluid pH is tested, a significant number of pulmonologists, when treating complicated parapneumonic effusions, may be making management decisions based on erroneous information.

BACKGROUND: Noninvasive pH measurement of platelet concentrates (PCs) was evaluated as a tool for the quality control of PC storage by simulating worstcase conditions. STUDY DESIGN AND METHODS: PCs from pooling four buffy coats in 70% PAS-3M were both stored in bags wrapped to impair gas permeability and agitated or not until Day 9 of storage. pH values measured both in samples (electrode, blood gas analyzer) and noninvasively by fluorimetry (BCSI pH1000, Blood Cell Storage, Inc.) were compared groupwise and to changes in platelet (PLT) size and biochemical variables. RESULTS: The noninvasive pH measurements agreed well with the results from each of the two reference methods (R 2 > 0.9) in a wide range of pH values

BACKGROUND AND OBJECTIVE Analysis of exhaled breath condensate (EBC) pH is a non-invasive method to study airway inflammation. Low pH is correlated with inflammatory diseases like asthma and COPD. The aim of this study was to assess the influence of measurement temperature on pH values of EBC. METHODS EBC was collected using the RTube in 10 healthy non-smoking controls, 10 smokers before and after cigarette smoking, 10 stable COPD patients and 10 patients with exacerbated COPD. pH was determined directly after degassing at temperatures of 23 degrees C and 37 degrees C. RESULTS When comparing all groups pH was significantly (P = 0.0002) higher (mean +/- SD 7.88 +/- 0.92) at 37 degrees C as compared with 23 degrees C (7.44 +/- 0.90). Specifically, at 23 degrees C pH was significantly lower in the group of exacerbated COPD (6.78 +/- 1.27) and healthy non-smoking controls (8.04 +/- 0.39). In contrast, subgroup analysis of values assessed at 37 degrees C did not display significant differences. CONCLUSIONS Our data indicate a considerable influence of temperature on pH values in EBC. Thus the temperature at which pH measurements in EBC studies are performed should be declared.

The understanding of digestive physiology, gastric acid production, and gastroesophageal reflux disease has been evolving since the 16th century. During this time, several methods to detect gastric refluxate were ingeniously developed. Ambulatory esophageal pH monitoring is still the current gold standard test for the diagnosis of gastroesophageal reflux disease. State-of-the-art technologies use catheter-free wireless pH sensors, an idea first conceived in the 1950s. The authors reviewed the history of esophageal pH monitoring.

Background Pleural fluid pH anaerobically handled and measured by a blood gas analyzer (BGA) is used to define a pleural space infection as complicated and predict the life expectancy of patients with malignant pleural effusions. Pleural fluid pH can also be measured by other less accurate methods. It is unknown whether physicians who use pleural fluid pH measurements are aware of the method used by their laboratories. Methods We surveyed 90 pulmonary physicians in North Carolina about their use of pleural fluid pH and their hospital laboratory's approach (pH indicator stick, pH meter, or BGA). We then contacted their hospital laboratories to determine the actual method of pH measurement. Results Twenty-eight (31%) pulmonologists in 11 North Carolina hospitals responded on their use of pleural fluid pH. Of the 20 pulmonologists who order pleural fluid pH, 90% reported that their hospital measures pleural fluid pH via BGA, but the majority (72%) were inaccurate. Only two of 11 hospitals reported that they measure pleural fluid pH with a BGA. Conclusion Almost two-thirds of the chest physicians that order pleural fluid pH to help manage pleural effusions were using information that is not substantiated by the literature and, despite previous reports, hospitals still use suboptimal methods to measure pleural fluid pH. Further information is needed concerning the barriers to physicians and laboratory practices concerning the use of BGA for the measurement of pleural fluid pH.

Summary Background & aims Clinicians must ensure that enteral feeding tubes are in the correct position prior to use. Malposition of enteral feeding tubes into the trachea resulting in respiratory distress or death has been described in the literature. pH strips can be used to determine tube position; however, commercially available pH strips are industrial in nature and not intended for clinical use. Therefore, institutions have a requirement for clinically validated pH strips. The aim of this study is to compare the accuracy of commercially available pH strips ranges 0–6 and 2–9 (Merck Serono, UK) to a calibrated pH meter (pH 211 Microprocessor, Hanna Instruments) for the assessment of enteral aspirate. Methods Forty-eight patients were included in the study; some patients had an aspirate taken on more than one occasion. A total of 60 measurements were attempted. In 6 cases the investigators failed to obtain an aspirate, therefore 54 aspirates were analysed in total. Each aspirate obtained was analysed by both pH strips and a calibrated pH meter. Results These data show a high correlation between the pH strips (both 0–6 and 2–9) and the pH meter, with r-values (Pearson's correlation) approaching 1 in all cases. Conclusions We conclude that Merck Serono pH strips accurately reflect the actual pH of enteral aspirate when compared to a calibrated pH meter. They may therefore be useful in the placement of feeding tubes and in the determination of feeding tube position in the stomach and small bowel.

To validate a point of care lactate device to replace fetal pH measurement.Cord blood samples drawn immediately following delivery were tested on the Nova Lactate Plus and ARKRAY Lactate Pro, the Corometrics 220 pH System, and the Vitros chemistry analyzer (used as lactate reference).Nova demonstrated a constant positive bias relative to the lactate reference method; while the Lactate Pro correlated well with the reference method up to 6 mmol/L. Receiver operating characteristic (ROC) curve analysis showed optimal sensitivity and specificity for predicting pH7.20 at lactate values of 6.8 mmol/L for the Nova and 4.8 mmol/L for the Lactate Pro.Using Lactate Pro the best cut-off for predicting pHor =7.20 was 4.8 mM; which coincides with current clinical cut-offs. Thus any lactate device that correlates well with the laboratory reference method can be used with a clinical cut-off of 4.8 mmol/L.

In 77 patients suspected of having gastric reflux, long-term pH measurements obtained by an intraluminal pH probe were compared with manometric or endoscopic findings. There was a definite correlation between gastro-oesophageal reflux and both mild and severe stages of reflux disease. Diagnostically the significance and role of endoscopy in the course of routine diagnosis was confirmed. Analysis of the reflux pattern by long-term pH measurement made it possible to provide appropriate drug or surgical treatment of reflux disease.

WOS: 000406781400010 PubMed: 28621094 Gastroesophageal reflux (GER) is a very common condition in children with neurological impairment and this can influence nutritional and respiratory outcomes. The aim of this study was to investigate the presence of GER in children with cerebral palsy (CP) using multiple intraluminal impedance (MII)-pH monitoring. The use of combined MII-pH allows for the detection of both acid and non-acid reflux episodes. A total of 29 CP patients with symptoms suggesting GER, aged 2 to 10 years old, underwent 24-hour combined MII-pH monitoring. There were a total of 3899 reflux episodes, of which 29% were acid, 60% were weakly acid and 11% were alkaline. The number of non-acid reflux episodes was statistically significantly greater (p < 0.01). These findings confirm that GER disease is seen frequently in children with cerebral palsy and most of the reflux episodes are not acidic. Non-acid reflux can also influence the morbidity in patients with cerebral palsy. It can be concluded that 70% of the reflux episodes would not have been recognized by pH measurement alone.

Prolonged, 4-day (96 h) measurement by the wireless Bravo system provides an opportunity to assess the variance, diagnostic reproducibility, and yield of 24- and 48-h pH and symptom association studies.Retrospective analysis of 83 patients with suspected reflux symptoms undergoing wireless pH monitoring with the intention of 96-h measurement. Study periods were classified based on esophageal acid exposure, the DeMeester score (DMS), and the association of reflux events and symptoms (symptom index). The technical success of prolonged pH recording and diagnostic accuracy of 24-, 48-, and 72-h pH studies compared to the 96-h "gold standard" were assessed.Prolonged Bravo pH studies were possible and well tolerated in routine clinical practice. Complete 96-h recordings were available for 34/83 (41%) patients. Variation in pH measurements reduced with increasing study duration (24-h 45%vs 48-h 27%, P0.01), but no change in reflux severity over time was observed (ANOVA, P=ns). Abnormal acid exposure was found in 7 (19%) on every test day and 21 (58%) on at least one of four test days. A diagnosis consistent with the 96-h "gold standard" was present in 22 (63%), 29 (83%), and 32 (91%) patients for 24-, 48-, and 72-h test periods, respectively, with a significant improvement of diagnostic sensitivity with study duration (P0.01). Similar findings were present for symptom association.Increasing the duration of pH studies progressively improves measurement variance and the diagnostic reproducibility of reflux studies. Future studies must address the impact of prolonged pH studies on clinical management.

Background: Measurement of pH in exhaled breath condensate (EBC) may represent a novel method for investigating airway pathology. Objectives: The aim of this longitudinal study was to assess the variability of EBC pH in stable lung transplant recipients (LTR). Methods: During routine clinical visits 74 EBC pH measurements were performed in 17 LTR. EBC pH was also measured in 19 healthy volunteers on four separate occasions. EBC pH was determined at standard CO2 partial pressure by a blood gas analyzer. Results: Mean EBC pH in clinically stable LTR and in controls was similar (6.38 ± 0.09 vs. 6.44 ± 0.16; p =nonsignificant). Coefficient of variation for pH in LTR and controls was 2.1 and 2.3%, respectively. The limits of agreement for between-visit variability determined by the Bland-Altman test in LTR and healthy volunteers were also comparable (–0.29 and 0.46 vs. –0.53 and 0.44). Conclusions: Our data suggest that the variability of EBC pH in stable LTR is relatively small, and it is similar to that in healthy nontransplant subjects.

Background: Pleural fluid (PF) pH measurement is important for establishing a diagnosis and for guiding clinical management. The current standard practice is to collect PF samples for pH measurement in heparinized syringes at room temperature and to instantaneously process these samples. Objective: The purpose of this study is to investigate the effect of collecting PF in heparinized versus non-heparinized syringes at room temperature on PF pH measurements when processed at various time intervals. Methods: From 50 consecutive thoracenteses, 1 ml of PF was collected anaerobically in each of six 3-ml syringes. Only three syringes were coated with heparin. The samples were processed for PF pH measurements at time 0 (T₀) and 1 h (T1) and 2 h (T2) after collection. All specimens were preserved at room temperature, until the measurements were carried out in duplicates by a calibrated blood gas analyzer. Results: PF pH values were significantly lower with heparinized versus non-heparinized syringes at all time intervals (T₀: pH heparinized = 7.378 ± 0.107 vs. pH non-heparinized = 7.390 ± 0.108; T1: pH heparinized = 7.378 ± 0.115 vs. pH non-heparinized = 7.389 ± 0.111; T2: pH heparinized = 7.367 ± 0.105 vs. pH non-heparinized = 7.389 ± 0.121). In the heparinized syringes, there was a significant decrease in PF pH values at T2 versus T₀ and T1. There were no significant changes in PF pH values over time in the non-heparinized syringes. Conclusions: For serial PF pH measurements, the same type of syringes (either heparinized or non-heparinized) should be consistently used. With heparinized syringes, processing of PF pH measurements should be performed within 1 h after collection.

The present study was carried out with the purpose of identifying the critical points of inspection control for hot-dogs before being sold on the streets. Data were collected from 20 vending sites using interviews, questionnaires, the observation of food handling and storage, the temperature of the meat and the pH measurements of sauce. In 30% of the studied sites, hygiene conditions were rated as regular to extremely poor. Mashed potatoes, chicken and beef preparations were high risk. These findings showed unsuitable hygienic practices for food preparation and a lack of basic knowledge regarding food handling—a public health problem. Given the scarcity of literature and official data about street food in Brazil, further studies are recommended.

Objective: To determine the gastrointestinal (GI) tolerance of NUTRIOSE®FB in men. Design: A randomized, placebo-contro lled, parallel, double-blind study. Setting: The metabolic ward of TNO Quality of Life. Subjects: Forty-eight subjects started the study: 16 men participated in one of the three treatments. Subjects consumed either 22.5 g of pure maltodextrin (Glucidex®6), or 30 or 45 g of the dextrin NUTRIOSE®FB daily for 4-5 weeks. Forty-three subjects completed the study (age: 34.7±8.2 years; BMI 24.9±3.3 kg m2). Measurements: Tolerance of NUTRIOSE®FB was examined with a GI complaints questionnaire; effectiveness on colonic flora was examined by faecal analysis; fermentation by breath hydrogen excretion measurement. Furthermore, the effect on body weight (BW), energy intake and blood parameters were examined in the study. Results: Both doses of NUTRIOSE®FB were very well tolerated and GI complaints hardly differed from the placebo treatment. No diarrhoea was reported due to NUTRIOSE®FB supplementation. In the course of the study, some habituation and adaptation of GI symptoms were found. Fermentation and faecal characteristics (pH and enzyme activity) were significantly positively affected with NUTRIOSE®FB treatment. Body weight in both NUTRIOSE®FB groups remained stable over time, although the placebo-treated group showed a small increase in BW (Δday35-1 0.8±1.0 kg) (P=0.07). However, total food intake and macronutrient composition of the diet remained the same throughout the study. No significant differences were found between the three treatment groups in hunger and satiety scores and food preferences. Conclusions: Long-term supplementation of 30 or 45 g of the dextrin NUTRIOSE®FB per day was well tolerated, and may act as a pre-biotic supplement. © 2006 Nature Publishing Group. All rights reserved.

Objectives: Oesophageal pH monitoring is a useful test for the diagnosis of gastro-oesophageal reflux disease (GORD) but has some limitations related to the nasopharyngeal electrode. Recently, a telemetric catheter free system (CFS) (Bravo; Medtronic) was developed. The aim of this study was to determine the concordance of data between the conventional pH measurement system (CPHMS) and the CFS Bravo. Methods: Forty patients with symptoms suggestive of GORD underwent 24 hour oesophageal pH monitoring using the CPHMS with a nasopharyngeal electrode and the Bravo CFS simultaneously. The sensitive tips of both electrodes were positioned at the same level under fluoroscopy. In addition to automatic analysis, each reflux episode was checked visually and characterised. Results: There was a significant correlation ( r = 0.87, p v 3.6 (0.7–8.6); p Conclusions: Despite strong correlations between oesophageal acid exposure recorded with the two devices, the Bravo CFS significantly under recorded acid exposure compared with the CPHMS. Provided some correcting factors are used, the Bravo CFS can improve the sensitivity of pHmetry for the diagnosis of GORD by allowing more prolonged recordings.

Objective: This study analysed the relative accuracy of the Bravo wireless and the Slimline catheter-Mark III Digitrapper pH systems in the detection of acid reflux events. Methods: Twenty five asymptomatic subjects were studied. A Bravo capsule was placed 6 cm above the squamocolumnar junction (SCJ), marked by an endoclip, and a Slimline pH catheter was placed 5 cm above the manometrically localised lower oesophageal sphincter. The distance between the SCJ and each pH electrode was measured fluoroscopically. An in vivo pH reference was established using swallows of orange juice (pH 3.88). Concurrent pH data from the two systems were analysed in Excel spreadsheets. Results: Significantly more acid reflux events were reported by the Digitrapper system than the Bravo system (117.0 v 41.8). This was not explained by electrode position as there was no difference in median distance between the SCJ and either pH electrode (7.25 cm v 7.08 cm). The dominant source of discrepancy between systems was inaccuracy in electrode calibration and, after adjustment using the in vivo orange juice pH measurement, the discrepancy improved by 40%. However, discrepancy still existed and was most pronounced with short reflux events (1–15 s for the catheter, 1–17 s for the Bravo) associated with minimal intraoesophageal acidity and poor concordance between systems. Conclusion: Substantially more reflux events were reported by the Digitrapper system compared with the Bravo system; 40% of excess events were attributable to a flawed software scheme for electrode thermal calibration while most of the remainder were brief events with poor reproducibility between systems.

BACKGROUND: Standards and regulations require measurement of pH as an apheresis platelet (PLT) component quality monitor. The usefulness of this quality control (QC) measure was investigated. STUDY DESIGN AND METHODS: QC data were retrospectively reviewed for apheresis PLTs collected over 4.5 years. Three collection devices were used, the Amicus (Baxter), the CS-3000 Plus (Baxter), and the MCS+ LN9000 (Haemonetics). Each month, four components from each instrument were sampled. PLT counts and component volume were measured immediately after collection, and pH, after 5 days of storage. RESULTS: A total of 668 products were studied. pH decreased as PLT concentration increased (r2 = 0.129, p

The purpose of this study was to evaluate a series of pH values of aspirates from feeding tubes to differentiate between gastric and intestinal tube placement.One hundred ventilator-supported subjects, with an order for nasoduodenal feeding tube placement were randomly selected. The feeding tube was placed into the stomach, verified by auscultation, and 2 pH measurements were obtained. After the pH measurements were taken, tube location was then verified by fluoroscopy. When the tube was advanced into the small intestine, location was verified by fluoroscopy, and 2 additional pH measurements were obtained.From the selected subjects, both a gastric and intestinal aspirate were obtained from 82 subjects. For the 82 subjects, the mean gastric and intestinal pH values were 4.8 +/- 2.3 and 7.1 +/- 1.0, respectively. For patients receiving acid-suppressing agents, these values were 5.0 +/- 2.3 and 7.2 +/- 1.0, respectively. For subjects not receiving acid-suppressing agents, these pH values were 4.0 +/- 2.5 and 6.7 +/- 1.1, respectively. For all patients, using a pH value of 6.5 as a predictor of feeding tube location, the sensitivity and specificity were 0.66 and 0.90. In addition, when an increase in pHor = 1.0 was used as a predictor of location change for all patients, the sensitivity was 0.58.The pH value was a reliable predictor of nasoduodenal tube placement. However, radiographic confirmation of location could not be excluded because of the low sensitivity using pH measurements alone. An increase ofor = 1.0 in gastric vs intestinal pH specimens could be useful to determine use of radiography confirmation of tube placement.

Detection of vulnerable plaques as the underlying cause of myocardial infarction is at the center of attention in cardiology. We have previously shown that infiltration of inflammatory cells in atherosclerotic plaques renders these plaques relatively hot and acidic, with substantial plaque temperature and pH variation. The objective of this investigation was to determine whether near-infrared diffuse reflectance spectroscopy (NIRS) could be used to non-destructively measure the tissue pH in atherosclerotic plaques. NIRS and tissue pH electrode measurements were taken on freshly excised carotid plaques maintained under physiological conditions. The coefficient of determination between NIRS and the pH microelectrode measurement was 0.75 using 17 different areas. The estimated accuracy of the NIRS measurement was 0.09 pH units. These results demonstrate the feasibility of using NIRS tissue pH in freshly excised atherosclerotic plaques in light of marked pH heterogeneity and warrants future in-vivo investigations on pH measurement of atherosclerotic plaques.

This study compared the safety and efficacy of enterally administered pantoprazole, omeprazole and ranitidine at raising gastric pH above 4 in children with gastroesophageal reflux disease. Children with gastrostomy tubes that were being treated with one of the three drugs were included. Caregivers were taught to measure gastric pH. Dose, time of last meal, time of last dose, and time of gastric pH were collected. Four weekly pH measurements were compared among the groups. Seventeen patients were enrolled. Six received ranitidine, 6 received omeprazole, and 5 received pantoprazole. Mean doses were: ranitidine 6.8 mg/kg/day, omeprazole 1.4 mg/kg/day and pantoprazole 1.3 mg/kg/day. Mean gastric pH was 3, 4.3, and 4 for the ranitidine, omeprazole and pantoprazole groups, respectively. Twenty-nine percent of pH readings in the ranitidine, 66% in the omeprazole, and 60% in the pantoprazole group were above 4. Comparing pH to time since last dose, ranitidine failed to routinely achieve pH > 4. Pantoprazole and omeprazole achieved this, but by 12 hours after the dose both failed to maintain pH > 4. Pantoprazole and omeprazole appear more effective at controlling gastric pH than ranitidine. Pantoprazole appears safe, however doses of 1–1.5 mg/kg/day once daily may not be effective in maintaining gastric pH > 4 in children with GERD.