Gastrointestinal Tolerance and Protein Absorption Markers with a New Peptide Enteral Formula Compared to a Standard Intact Protein Enteral Formula in Critically Ill Patients

The aim of this exploratory study was to investigate gastrointestinal tolerance and protein absorption markers with a new enteral peptide formula (PF) compared to an isocaloric enteral intact protein standard formula (SF) containing the same amount of protein in ICU patients. Patients admitted to a cardio-thoracic intensive care unit expected to receive tube feeding for ≥5 days were randomized to receive either PF (1.5 kcal/mL) or SF in a double-blind manner for ≤14 days. Twenty-six patients were randomized (13 SF and 13 PF) and 23 (12 SF and 11 PF) completed at least 5 days of product administration. There were no statistically significant differences between the feeds during the first 5 days of intervention for diarrhea (SF:3 (23%); PF:5 (39%), p = 0.388), vomiting (SF:1 (8%); PF:2 (15%), p = 0.549), constipation (SF:7 (54%), PF:3 (23%), p = 0.115), and high gastric residual volume (>500 mL: SF:1 (8%); PF: 2 (15%), p = 0.535). There were no differences in plasma amino acids or urinary markers of protein absorption and metabolism. In conclusion, no major differences were found in tolerability and protein absorption markers between the standard intact protein formula and the peptide formula.

Impact of Sodium Bicarbonate on Blood Lactate and Psychometric Dimensions of Fatigue

Background The purpose of this study was to assess the impact of sodium bicarbonate (NaHCO3) on blood lactate (BLa) and psychometric dimensions of fatigue in response to exercise. Methods Twelve recreationally active subjects (age 22.25 ± 2.70 years) performed three (one control and two supplemented) sessions of a 20-minute progressive exercise routine. Subjects completed the control condition during session one, and in the two subsequent sessions, subjects were randomly provided a beverage with either a 0.15g•kg− 1 body weight NaHCO3 or a placebo of 0.30g•kg− 1 body weight calcium carbonate (CaCO3) in a double-blind manner. Measurements of BLa, heart rate (HR), state anxiety (SAI), rating of perceived exertion (RPE), and perceived mood states (POMS) were measured prior to and during the exercise protocol, and then immediately post-exercise. Results BLa levels were significantly different [F(8,88) = 2.04, p < .05] between the three conditions. Further, BLa [F(4,44) = 41.25, p < .05], HR [F(4,32) = 182.16, p < .05], and RPE [F(4,44) = 140.13, p < .05] increased significantly as exercise progressed, with BLa [F(2,22) = 5.55, p < .05 ] and RPE [F(2,22) = 4.09, p < .05] changing differently between conditions. SAI responses showed no change from to pre-to post-measures, but a significant difference was seen between the conditions [F(2, 22) = 3.84, p = .05], with differences between the placebo and NaHCO3, but not the control. Only the POMS subscale of vigor was different between conditions [F(2, 22) = 7.69, p = .003], while the subscales of tension [F(1, 11) = 6.59, p = .03], anger [F(1, 11) = 9.81, p = .01], and confusion [F(1, 11) = 7.21, p = .02] changed across time. Conclusions Both BLa and RPE were greatest in the control condition compared to the placebo and NaHCO3 conditions, with no differences being seen between the control and NaHCO3 conditions for RPE, and between the placebo and NaHCO3 conditions for BLa. Using either NaHCO3 or CaCO3 appears to provide benefits by blunting BLa production during progressively intensive exercise, but differences in psychometric values suggest that other psychophysiological factors may impact perceptions of effort.

SEPT9 Gene Methylation as a Noninvasive Marker for Hepatocellular Carcinoma

Background. Early detection appears to be the most effective approach to improve the overall survival of patients with hepatocellular carcinoma (HCC). We evaluated the potential performance of plasma SEPT9 methylation (mSEPT9) as a noninvasive biomarker for the diagnosis of patients with HCC. Methods. A total of 373 subjects were included, and the group consisted of 104 HCC patients, 95 with an at-risk disease, and 174 healthy controls (HC). The methylation of mSEPT9 was determined using methylation-specific fluorescence quantitative PCR. The diagnostic performance of plasma mSEPT9 for HCC was assessed in a single-blind manner. Results. The receiver operating characteristic (ROC) curve showed that plasma mSEPT9 can be used to detect and discriminate HCC with an area under the ROC curve (AUROC) of 0.961, a sensitivity of 82.7%, and specificity of 96.0% from HC. These results showed that plasma mSEPT9 had better diagnostic performance than serum alpha fetoprotein (AFP) (AUROC 0.881, sensitivity 57.7%, and specificity 98.3%). Similar results were noted in the detection of early-stage HCC. When combined with serum AFP, the sensitivity increased to 91.3% and 87.7% for the detection of HCC and early-stage HCC,respectively. Notably, the levels of plasma mSEPT9 dramatically decreased after surgery ( P = 0.001 ). Conclusions. Plasma SEPT9 methylation might serve as a useful and noninvasive biomarker for the diagnosis of HCC and can be used to evaluate the therapeutic efficacy of HCC treatment.

Can Creatine Supplementation Interfere with Muscle Strength and Fatigue in Brazilian National Level Paralympic Powerlifting?

The aim of the present study was to analyze the effect of creatine (Cr) supplementation on peak torque (PT) and fatigue rate in Paralympic weightlifting athletes. Eight Paralympic powerlifting athletes participated in the study, with 25.40 ± 3.30 years and 70.30 ± 12.15 kg. The measurements of muscle strength, fatigue index (FI), peak torque (PT), force (kgf), force (N), rate of force development (RFD), and time to maximum isometric force (time) were determined by a Musclelab load cell. The study was performed in a single-blind manner, with subjects conducting the experiments first with placebo supplementation and then, following a 7-day washout period, beginning the same protocol with creatine supplementation for 7 days. This sequence was chosen because of the lengthy washout of creatine. Regarding the comparison between conditions, Cr supplementation did not show effects on the variables of muscle force, peak torque, RFD, and time to maximum isometric force (p > 0.05). However, when comparing the results of the moments with the use of Cr and placebo, a difference was observed for the FI after seven days (U3: 1.12; 95% CI: (0.03, 2.27); p = 0.02); therefore, the FI was higher for placebo. Creatine supplementation has a positive effect on the performance of Paralympic powerlifting athletes, reducing fatigue index, and keeping the force levels as well as PT.

MIFAL: fully automated Multiple-Image Finder ALgorithm for strong-lens modelling – proof of concept

ABSTRACT We outline a simple procedure designed for automatically finding sets of multiple images in strong lensing (SL) clusters. We show that by combining (a) an arc-finding (or source extracting) program, (b) photometric redshift measurements, and (c) a preliminary light-traces-mass lens model, multiple-image systems can be identified in a fully automated (‘blind’) manner. The presented procedure yields an assessment of the likelihood of each arc to belong to one of the multiple-image systems, as well as the preferred redshift for the different systems. These could be then used to automatically constrain and refine the initial lens model for an accurate mass distribution. We apply this procedure to Cluster Lensing And Supernova with Hubble observations of three galaxy clusters, MACS J0329.6-0211, MACS J1720.2 + 3536, and MACS J1931.8-2635, comparing the results to published SL analyses where multiple images were verified by eye on a particular basis. In the first cluster all originally identified systems are recovered by the automated procedure, and in the second and third clusters about half are recovered. Other known systems are not picked up, in part due to a crude choice of parameters, ambiguous photometric redshifts, or inaccuracy of the initial lens model. On top of real systems recovered, some false images are also mistakenly identified by the procedure, depending on the thresholds used. While further improvements to the procedure and a more thorough scrutinization of its performance are warranted, the work constitutes another important step toward fully automatizing SL analyses for studying mass distributions of large cluster samples.

A Formula to Predict the Magnitude of Achilles Tendon Lengthening Required to Correct Equinus Deformity

Objectives: Achilles tendon lengthening (ATL) is one of the most commonly performed procedures in paediatric orthopaedic surgery. An appropriate adjustment of the amount of ATL is crucial to avoid insufficient or excessive lengthening. However, there is currently no effective method to preoperatively calculate the tendon length needed for equinus deformity correction. Thus, in this study we evaluated the accuracy of a calculation using a mathematical model based on the law of cosines. Methods: A total of 16 feet of 14 patients who were scheduled for ATL surgery due to equinus deformity were included in the study. ATL surgery was performed using a standard Z-plasty technique. Calculation of the amount of ATL using the law of cosines, and assessments of intraoperative lengthening of the tendon, were performed in a double-blind manner. The extent of lengthening resulting from the two methods was then compared. Results: The mean ATL determined intraoperatively was 23.67 ± 8.7 mm, and that obtained using the cosine-based method was 22.49 ± 8.6 mm. Thus, the new method showed excellent statistical agreement with the actual lengthening performed during surgery. Conclusions: The required dimension of ATL can be calculated preoperatively using the mathematical formula presented here. The advantages of this approach are that it allows accurate tendon lengthening and reduces the size of the surgical incision.

Color changes of esthetic orthodontic ligatures evaluated by orthodontists and patients: a clinical study

ABSTRACT Objective: To evaluate in vivo changes in the color of esthetic elastomeric ligatures from different manufacturers. Methods: Four widely used commercial brands of elastomeric ligatures were selected and used in 20 adult patients in a split-mouth design. The ligatures were evaluated by orthodontists and patients in a double-blind manner on the day the ligatures were placed (T0) and 30 days after intraoral exposure (T1) by means of a system of staining scores. Groups were compared by Friedman test with p < 0.05. Results: Orthodontists and patients reported similar staining scores (p > 0.05). Results showed that all brands underwent significant staining when exposed to the intraoral environment. Modular-crystal MorelliTM (Sorocaba, SP, Brazil) showed the highest degree of staining with the median reaching the maximum value (3); while the other brands (3M UnitekTM, American OrthodonticsTM and GAC DentsplyTM) showed the median equal to 1 (p < 0.001). A large individual variability in the degree of staining was also found for all brands. Conclusions: All four brands of esthetic ligatures showed significant staining, which appeared to be more pronounced for the MorelliTM brand. Changes in color of the elastomeric ligatures were perceived similarly by patients and orthodontists. The industry needs to improve the color stability of esthetic ligatures.

Actigraph Evaluation of Acupuncture for Treating Restless Legs Syndrome

We evaluated the effects of acupuncture in patients with restless legs syndrome (RLS) by actigraph recordings. Among the 38 patients with RLS enrolled, 31 (M=12,F=19; mean age,47.2±9.7years old) completed the study. Patients were treated with either standard acupuncturen=15or randomized acupuncturen=16in a single-blind manner for 6 weeks. Changes in nocturnal activity (NA) and early sleep activity (ESA) between week 0 (baseline), week 2, week 4, and week 6 were assessed using leg actigraph recordings, the International Restless Legs Syndrome Rating Scale (IRLSRS), and Epworth Sleepiness Scale (ESS). Standard but not randomized acupuncture reduced the abnormal leg activity of NA and ESA significantly in week 2, week 4, and week 6 based on the changes in the clinical scores for IRLSRS and ESS in week 4 and week 6 compared with the baseline. No side effects were observed. The results indicate that standard acupuncture might improve the abnormal leg activity in RLS patients and thus is a potentially suitable integrative treatment for long-term use.

The Comparison of Pain Caused by Suprapubic Aspiration and Transurethral Catheterization Methods for Sterile Urine Collection in Neonates: A Randomized Controlled Study

This study was performed to compare the levels of pain experienced by young infants undergoing either suprapubic aspiration (SPA) or transurethral catheterization (TUC) for the collection of sterile urine samples. This prospective randomized clinical trial was conducted in hospitalized neonates in a university-affiliated hospital. Patients who required urine cultures were randomly assigned into one of two groups, the SPA or TUC group. The infants’ faces were videotaped, and the changes in the facial expression and physiological parameters during the procedure were scored using the Premature Infant Pain Profile (PIPP) in a blind manner. The primary outcome was the severity of the pain experienced during each procedure, and the secondary outcomes were the success rate, the duration, and the complications of each procedure. Ninety-four percent of male infants in the TUC group and 77.3% in the SPA group were uncircumcised (P=0.1). The mean (SD) of the PIPP pain scores did not differ between groups (9.95 ± 3.7 in SPA and 9.64 ± 3.2 in TUC,P=0.6). The duration of TUC was longer. Both methods can be used to collect urine from neonates, but the difficulty of performing TUC on females and uncircumcised males should be considered.

An Interdisciplinary Study of Orthodontic, Orthopedic, and Otorhinolaryngological Findings in 12–14-Year-Old Preorthodontic Children

Background and Objective. Malocclusion, the body posture, and the breathing pat- tern may correlate, but this issue is still controversial. The aim of the study was to examine the relationship between the type of malocclusion, the body posture, and the nasopharyngeal obstruction in 12-14-year-old children. Material and Methods. The study group consisted of 76 orthodontic patients (35 boys, 41 girls) aged 12-14 years (mean age, 12.79 years {SD, 0.98J). All the patients were examined by the same orthodontist (study model and cephalometric radiograph analysis), the same orthopedic surgeon (body posture examined from the front, the side, and the back), and the same otorhinolaryngologist (anterior and posterior rhinoscopy and pharyngoscopy) in a blind manner. Results. The prevalence of a poor body posture and a nasopharyngeal pathology was high in the present study. In total, 48.7% of the orthodontic patients had a kyphotic posture and 55.3% a rib hump in the thoracic region. The nasopharyngeal pathology was diagnosed in 78.9% of the patients. The patients with the kyphotic posture had a higher mandibular plane angle (MP-SN) and a lower sagittal position of the mandible SNB angle. A deeper overbite correlated with shoulder and scapular asymmetry. The kyphotic posture was diagnosed in 55.0% of the patients with the naso- pharyngeal pathology. Conclusions. The sagittal body posture was related to the vertical craniofacial parameters and hypertrophy of the tonsils and/or the adenoids. The study showed no relationship between the degree of crowding, the presence of a posterior cross bite, orthopedic parameters, and a breathing pattern.