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Tea (Camellia sinensis) has grown for over 300 years and is recognized worldwide as among other well-renowned crops. The quality of black tea depends on plucking (method, standard, season, and intervals), withering and rolling (time and temperature), fermentation (time, temperature, and RH), drying (temperature and method), and storage conditions, which have a high influence on the final quality of black tea. At the rolling stage, the oxidation process is initiated and ends at the early drying stage until the enzymes that transform tea polyphenols into thearubigins (TRs) and theaflavins (TFs) are denatured by heat. By increasing fermentation time, TRs increased, and TF decreased. Each is liable for black tea’s brightness, taste, and color. The amino acids and essential oils also grant a distinctive taste and aroma to black tea. Throughout withering, rolling, and fermentation, increases were found in essential oil content, but during drying, a decrease was observed. However, the Maillard reaction, which occurs when amino acids react with sugar during drying, reimburses for this decrease and enhances the flavor and color of black tea. As compared to normal conditions, accelerated storage showed a slight decrease in the total color, TF, and TRs. It is concluded that including plucking, each processing step (adopted technique) and storage system has a remarkable impact on black tea’s final quality. To maintain the quality, an advanced mechanism is needed to optimize such factors to produce high-quality black tea, and an objective setting technique should be devised to attain the desirable quality characteristics.

Peaches are among the most well-known fruits in the world due to their appealing taste and high nutritional value. Peach fruit, on the other hand, has a variety of postharvest quality issues like chilling injury symptoms, internal breakdown, weight loss, decay, shriveling, and over-ripeness, which makes a challenging environment for industries and researchers to develop sophisticated strategies for fruit quality preservation and extending shelf life. All over the world, consumers prefer excellent-quality, high-nutritional-value, and long-lasting fresh fruits that are free of chemicals. An eco-friendly solution to this issue is the coating and filming of fresh produce with natural edible materials. The edible coating utilization eliminates the adulteration risk, presents fruit hygienically, and improves aesthetics. Coatings are used in a way that combines food chemistry and preservation technology. This review, therefore, examines a variety of natural coatings (proteins, lipids, polysaccharides, and composite) and their effects on the quality aspects of fresh peach fruit, as well as their advantages and mode of action. From this useful information, the processors could benefit in choosing the suitable edible coating material for a variety of fresh peach fruits and their application on a commercial scale. In addition, prospects of the application of natural coatings on peach fruit and gaps observed in the literature are identified.

Olmesartan, an angiotensin II receptor blocker (ARB), is associated with gastrointestinal symptoms resembling sprue-like enteropathy. Some have proposed that enteropathy may be a class effect rather than olmesartan-specific. We performed a systematic review to identify literature of sprue-like enteropathy for all ARBs. Case reports, case series and comparative studies of ARBs were searched on PubMed and Embase databases through 21 November 2018 and then assessed. A total of 82 case reports and case series as well as 5 comparative studies, including 248 cases, were selected and analysed. The ARBs listed in the case reports were olmesartan (233 users; 94.0%), telmisartan (5 users; 2.0%), irbesartan (4 users; 1.6%), valsartan (3 users; 1.2%), losartan (2 users; 0.8%) and eprosartan (1 user; 0.4%). The periods between ARB initiation and onset of symptoms ranged from 2 weeks to 13 years. Histologic results were reported in 218 cases, in which 201 cases (92.2%) were villous atrophy and 131 cases (60.1%) were intraepithelial lymphocytosis. Human leucocyte antigen (HLA) testing was performed in 147 patients, among whom 105 (71.4%) had HLA-DQ2 or HLA-DQ8 haplotypes. Celiac-associated antibodies were tested in 169 patients, among whom 167 (98.8%) showed negative results. Gluten exclusion from the diet failed to relieve symptoms of enteropathy in 127 (97.7%) of 130 patients with information. Complete remission of symptoms after discontinuation of ARB was reported in 233 (97.4%) of the 239 patients with information. Seven cases (2.8%) reported recurrence of symptoms after restarting olmesartan; rechallenge was not reported for the non-olmesartan ARBs. The retrospective studies conducted worldwide had inconsistent study designs (e.g. differences in periods of study and case definition) and findings. Although enteropathy is rare, clinicians should remain vigilant of this potential adverse event even years after medication initiation.

High-pressure processing (HPP) is used as a non-thermal approach for controlling microbial viability. The purposes of this study were to (i) establish the decimal reduction times (D-values) for pathogenic bacteria during 350 MPa HPP treatment,; (ii) evaluate the impact of 350 MPa HPP on total plate count (TPC), yeasts and molds (YM), and lactic acid bacteria (LAB) in camel milk; (iii) investigate the behavior of several spoilage-causing bacteria during storage at 4 °C and 10 °C for up to 10 d post-HPP treatment; and (iv) assess the effect of HPP on the protein degradation of camel milk. The D-values for L. monocytogenes, E. coli O157:H7, and Salmonella spp. were 3.77 ± 0.36 min, 1.48 ± 0.08 min, and 2.10 ± 0.13 min, respectively. The HPP treatment decreased pathogenic microorganisms by up to 2 to 3 log cfu/mL (depending on treatment conditions). However, HPP reduced TPC, YM, and LAB by <1 log cfu/mL, regardless of the length of pressure exposure. HPP treatment, even at extended holding times, did not significantly alter either the proteolytic activity or casein micelle structure in camel milk. This study highlights HPP as a promising non-thermal technique for enhancing the microbiological safety of camel milk.

The combination of rectally administered indomethacin and placement of a prophylactic pancreatic stent is recommended to prevent pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) in high-risk patients. Preliminary evidence suggests that the use of indomethacin might eliminate or substantially reduce the need for stent placement, a technically complex, costly, and potentially harmful intervention. In this randomised, non-inferiority trial conducted at 20 referral centres in the USA and Canada, patients (aged ≥18 years) at high risk for post-ERCP pancreatitis were randomly assigned (1:1) to receive rectal indomethacin alone or the combination of indomethacin plus a prophylactic pancreatic stent. Patients, treating clinicians, and outcomes assessors were masked to study group assignment. The primary outcome was post-ERCP pancreatitis. To declare non-inferiority, the upper bound of the two-sided 95% CI for the difference in post-ERCP pancreatitis (indomethacin alone minus indomethacin plus stent) would have to be less than 5% (non-inferiority margin) in both the intention-to-treat and per-protocol populations. This trial is registered with ClinicalTrials.gov (NCT02476279), and is complete. Between Sept 17, 2015, and Jan 25, 2023, a total of 1950 patients were randomly assigned. Post-ERCP pancreatitis occurred in 145 (14·9%) of 975 patients in the indomethacin alone group and in 110 (11·3%) of 975 in the indomethacin plus stent group (risk difference 3·6%; 95% CI 0·6–6·6; p=0·18 for non-inferiority). A post-hoc intention-to-treat analysis of the risk difference between groups showed that indomethacin alone was inferior to the combination of indomethacin plus prophylactic stent (p=0·011). The relative benefit of stent placement was generally consistent across study subgroups but appeared more prominent among patients at highest risk for pancreatitis. Safety outcomes (serious adverse events, intensive care unit admission, and hospital length of stay) did not differ between groups. For preventing post-ERCP pancreatitis in high-risk patients, a strategy of indomethacin alone was not as effective as a strategy of indomethacin plus prophylactic pancreatic stent placement. These results support prophylactic pancreatic stent placement in addition to rectal indomethacin administration in high-risk patients, in accordance with clinical practice guidelines. US National Institutes of Health.

We evaluated factors associated with pathogenic genetic variants in patients with idiopathic pancreatitis. Genetic testing (PRSS1, CFTR, SPINK1, and CTRC) was performed in all eligible patients with idiopathic pancreatitis between 2010 to 2015. Patients were classified into the following groups based on a review of medical records: (1) acute recurrent idiopathic pancreatitis (ARIP) with or without underlying chronic pancreatitis; (2) idiopathic chronic pancreatitis (ICP) without a history of ARP; (3) an unexplained first episode of acute pancreatitis (AP)<35 years of age; and (4) family history of pancreatitis. Logistic regression analysis was used to determine the factors associated with pathogenic genetic variants. Among 197 ARIP and/or ICP patients evaluated from 2010 to 2015, 134 underwent genetic testing. A total of 88 pathogenic genetic variants were found in 64 (47.8%) patients. Pathogenic genetic variants were identified in 58, 63, and 27% of patients with ARIP, an unexplained first episode of AP <35 years of age, and ICP without ARP, respectively. ARIP (OR: 18.12; 95% CI: 2.16-151.87; P=0.008) and an unexplained first episode of AP<35 years of age (OR: 2.46; 95% CI: 1.18-5.15; P=0.017), but not ICP, were independently associated with pathogenic genetic variants in the adjusted analysis. Pathogenic genetic variants are most likely to be identified in patients with ARIP and an unexplained first episode of AP<35 years of age. Genetic testing in these patient populations may delineate an etiology and prevent unnecessary diagnostic testing and procedures.

Cholecystectomy during or within 4 weeks of hospitalization for acute biliary pancreatitis is recommended by guidelines. We examined adherence to the guidelines for incident mild-to-moderate acute biliary pancreatitis and the effectiveness of cholecystectomy to prevent recurrent episodes of pancreatitis. Individuals in the 2010-2013 MarketScan Commercial Claims & Encounters database with a hospitalization associated with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes of 577.0 for acute pancreatitis and 574.x for gallstone disease were eligible. Guideline adherence was considered cholecystectomy within 30 days of the first/index hospitalization for biliary pancreatitis. Individuals with and without guideline-adherent cholecystectomy were compared for subsequent hospitalization for acute or chronic pancreatitis using a Cox proportional hazards model adjusted for age, sex, comorbidities, and length of index hospital stay. Of the 17,010 patients who met the inclusion criteria, 78% were adherent with the guidelines, including 10,918 who underwent cholecystectomy during the index hospitalization and 2,387 who underwent cholecystectomy within 30 days. Among 3,705 patients non-adherent with the guidelines, 1,213 had a cholecystectomy 1-6 months after the index hospitalization. Guideline-adherent cholecystectomy resulted in fewer subsequent hospitalizations for acute and chronic pancreatitis as compared with non-adherence to the guidelines (acute pancreatitis: 3% vs. 13%, P<0.001; chronic pancreatitis: 1% vs. 4%, P<0.001). Nearly four out of five patients underwent cholecystectomy for acute biliary pancreatitis in a timeframe, consistent with guidelines. Adherence resulted in a decrease in subsequent hospitalizations for both acute and chronic pancreatitis. However, the majority of non-adherent patients did not undergo a subsequent cholecystectomy. There may be factors that predict the need for immediate vs. delayed cholecystectomy.

ObjectiveThis study aimed to develop and validate a patient-reported outcome measure (PROM) in acute pancreatitis (AP) as an endpoint centred on the patient.DesignA PROM instrument (PAtieNt-rePoRted OutcoMe scale in acute pancreatItis, an international proSpEctive cohort study, PAN-PROMISE scale) was designed based on the opinion of patients, professionals and an expert panel. The scale was validated in an international multicentre prospective cohort study, describing the severity of AP and quality of life at 15 days after discharge as the main variables for validation. The COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) methodology was applied. Both the design and validation stages considered the content and face validity of this new instrument; the metric properties of the different items, reliability (reproducibility and internal consistence), the construct, structural and criterion validity, responsiveness and interpretability of this scale.ResultsPAN-PROMISE consists of a seven-item scale based on the symptoms that cause the most discomfort and concern to patients with AP. The validation cohort involved 15 countries, 524 patients. The intensity of symptoms changed from higher values during the first 24 hours to lower values at discharge and 15 days thereafter. Items converged into a unidimensional ordinal scale with good fit indices. Internal consistency and split-half reliability at discharge were adequate. Reproducibility was confirmed using test–retest reliability and comparing the PAN-PROMISE score at discharge and 15 days after discharge. Evidence is also provided for the convergent-discriminant and empirical validity of the scale.ConclusionThe PAN-PROMISE scale is a useful tool to be used as an endpoint in clinical trials, and to quantify patient well-being during the hospital admission and follow-up.Trial registration number NCT03650062

INTRODUCTION:Recent pilot trials in acute pancreatitis (AP) found that lactated ringers (LR) usage may result in decreased risk of moderately severe/severe AP compared with normal saline, but their small sample sizes limit statistical power. We investigated whether LR usage is associated with improved outcomes in AP in an international multicenter prospective study.METHODS:Patients directly admitted with the diagnosis of AP were prospectively enrolled at 22 international sites between 2015 and 2018. Demographics, fluid administration, and AP severity data were collected in a standardized prospective manner to examine the association between LR and AP severity outcomes. Mixed-effects logistic regression analysis was performed to determine the direction and magnitude of the relationship between the type of fluid administered during the first 24 hours and the development of moderately severe/severe AP.RESULTS:Data from 999 patients were analyzed (mean age 51 years, female 52%, moderately severe/severe AP 24%). Usage of LR during the first 24 hours was associated with reduced odds of moderately severe/severe AP (adjusted odds ratio 0.52; P = 0.014) compared with normal saline after adjusting for region of enrollment, etiology, body mass index, and fluid volume and accounting for the variation across centers. Similar results were observed in sensitivity analyses eliminating the effects of admission organ failure, etiology, and excessive total fluid volume.DISCUSSION:LR administration in the first 24 hours of hospitalization was associated with improved AP severity. A large-scale randomized clinical trial is needed to confirm these findings.

INTRODUCTION:We aimed to evaluate the frequency and factors associated with failed ERCP in the Medicare population.METHODS:We identified patients who underwent ERCP using CPT codes from Medicare fee-for-service carrier claims from 1/10/15-6/20/18. Medicare beneficiaries comprise 15% of the total US population. Each patient’s index ERCP was defined as their first ERCP during the study period and was defined as failed if a second ERCP was performed within a week of the index ERCP. We evaluated factors associated with failed ERCP using a multivariable logistic regression model with cluster-robust standard errors calculated at the facility-level using demographics, ERCP indications, endoscopist and facility characteristics as covariates with results reported as [OR(95% CI)]. A cutoff of 50 and 200 ERCPs over the study period was used to dichotomize endoscopists and facilities into low and high volume, respectively.RESULTS:A total of 170,500 patients (54.3% female) underwent index ERCPs performed by 6,686 endoscopists at 2,847 facilities. The mean volume of ERCPs performed by endoscopists and at facilities was 25 ± 35 and 60 ± 103, respectively, during the study period. Indications for ERCP were gallstone disease (42%), biliary obstruction (25%), cholangitis (2.4%), abnormal imaging/laboratory findings (6.7%), bile duct (BD) injury (1.3%), pancreatitis (6.3%), malignancy (5.8%), sphincter of Oddi dysfunction (SOD) (3.2%) and others (7.3%). Approximately 95% of the index ERCPs were performed by male endoscopists; 92% performed by endoscopists with >10 years in practice; 51% performed by low-volume endoscopists; and 57% performed in low-volume facilities. A total of 9186 patients (5.4%) underwent a second ERCP within 7 days. Older age [1.05(1.01-1.11)] and male patients [1.12(1.12-1.27)] were more likely to have failed ERCP. Compared to gallstone disease, abnormal imaging /laboratory findings [1.28(1.17-1.40)], BD injury [1.54(1.29-1.83)], biliary obstruction [1.44(1.33-1.55)], cholangitis [1.74(1.52-2.00)], malignancy [2.01(1.84-2.20)], pancreatitis [1.31(1.07-1.61)] and SOD [1.29(1.14-1.46)] were more likely to result in failed ERCP. Female endoscopists [1.23(1.09-1.38)], low volume endoscopists [1.59(1.45-1.74)] and low volume facilities [1.90(1.03-1.35)] were more likely to experience failed ERCP.CONCLUSION:Younger age, female patients, gallstone disease, male as well as high volume endoscopists and high volume facilities are associated with lower rates of ERCP failure among Medicare beneficiaries.