Nutritional Intervention Through Ketogenic Diet in GLUT1 Deficiency Syndrome.

Glucose transporter type 1 (GLUT1) deficiency syndrome (DS) is a metabolic brain disorder caused by a deficiency resulting from SLC2A1 gene mutation and is characterized by abnormal brain metabolism and associated metabolic encephalopathy. Reduced glucose supply to the brain leads to brain damage, resulting in delayed neurodevelopment in infancy and symptoms such as eye abnormalities, microcephaly, ataxia, and rigidity. Treatment options for GLUT1 DS include ketogenic diet (KD), pharmacotherapy, and rehabilitation therapy. Of these, KD is an essential and the most important treatment method as it promotes brain neurodevelopment by generating ketone bodies to produce energy. This case is a focused study on intensive KD nutritional intervention for an infant diagnosed with GLUT1 DS at Gangnam Severance Hospital from May 2022 to January 2023. During the initial hospitalization, nutritional intervention was performed to address poor intake via the use of concentrated formula and an attempt was made to introduce complementary feeding. After the second hospitalization and diagnosis of GLUT1 DS, positive effects on the infant's growth and development, nutritional status, and seizure control were achieved with minimal side effects by implementing KD nutritional intervention and adjusting the type and dosage of anticonvulsant medications. In conclusion, for patients with GLUT1 DS, it is important to implement a KD with an appropriate ratio of ketogenic to nonketogenic components to supply adequate energy. Furthermore, individualized and intensive nutritional management is necessary to improve growth, development, and nutritional status.

Clinical Practice Guidelines for Oropharyngeal Dysphagia.

OBJECTIVE: Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one's physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. METHODS: Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. RESULTS: Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. CONCLUSION: This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

On surface composition and stability of ß-carotene microcapsules comprising pea/whey protein complexes by synchrotron-FTIR microspectroscopy.

This study aims to elucidate the stability of spray dried ß-carotene microcapsules by identifying their surface composition using synchrotron-Fourier transform infrared (FTIR) microspectroscopy. To investigate the impact of enzymatic cross-linking and polysaccharide addition on heteroprotein, three wall materials were prepared: pea/whey protein blends (Con), cross-linked pea/whey protein blends (TG), and cross-linked pea/whey protein blends-maltodextrin complex (TG-MD). The TG-MD exhibited the highest encapsulation efficiency (>90 %) after 8 weeks of storage followed by TG and Con. Chemical images obtained using synchrotron-FTIR microspectroscopy confirmed that the TG-MD displayed the least amount of surface oil, followed by TG and Con, due to increasing amphiphilic ß-sheet structure of the proteins led by cross-linking and maltodextrin addition. Both enzymatic cross-linking and polysaccharide addition improved the stability of ß-carotene microcapsules, demonstrating that pea/whey protein blends with maltodextrin can be utilised as a hybrid wall material for enhancing the encapsulation efficiency of lipophilic bioactive compounds in foods.

Food Emulsion Gels from Plant-Based Ingredients: Formulation, Processing, and Potential Applications.

Recent advances in the understanding of formulations and processing techniques have allowed for greater freedom in plant-based emulsion gel design to better recreate conventional animal-based foods. The roles of plant-based proteins, polysaccharides, and lipids in the formulation of emulsion gels and relevant processing techniques such as high-pressure homogenization (HPH), ultrasound (UH), and microfluidization (MF), were discussed in correlation with the effects of varying HPH, UH, and MF processing parameters on emulsion gel properties. The characterization methods for plant-based emulsion gels to quantify their rheological, thermal, and textural properties, as well as gel microstructure, were presented with a focus on how they can be applied for food purposes. Finally, the potential applications of plant-based emulsion gels, such as dairy and meat alternatives, condiments, baked goods, and functional foods, were discussed with a focus on sensory properties and consumer acceptance. This study found that the implementation of plant-based emulsion gel in food is promising to date despite persisting challenges. This review will provide valuable insights for researchers and industry professionals looking to understand and utilize plant-based food emulsion gels.

Nutritional Intervention for a Critically Ill Trauma Patient: A Case Report.

Critically ill trauma patients generally show good nutritional status upon initial hospitalization. However, they have a high risk of malnutrition due to hyper-metabolism during the acute phase. Hence, suitable nutritional support is essential for the optimal recovery of these patients; therefore, outcomes such as preservation of fat-free mass, maintenance of immune functions, reduction in infectious complications, and prevention of malnutrition can be expected. In this report, we present the experience of a patient subjected to 40 days of nutritional interventions during postoperative intensive care unit (ICU) care. Although the patient was no malnutrition at ICU admission, enteral nutrition (EN) was delayed for > 2 weeks because of several postoperative complications. Subsequently, while receiving parenteral nutrition (PN), the patient displayed persistent hypertriglyceridemia. As a result, his prescription of PN were converted to lipid-free PN. On postoperative day (POD) #19, the patient underwent jejunostomy and started standard EN. A week later, the patient was switched to a high-protein, immune-modulating formula for postoperative wound recovery. Thereafter, PN was stopped, while EN was increased. In addition, because of defecation issues, a fiber-containing formula was administered with previous formula alternately. Despite continuous nutritional intervention, the patient experienced a significant weight loss and muscle mass depletion and was diagnosed with severe malnutrition upon discharge from the ICU. To conclude, this case report highlights the importance of nutrition interventions in critically ill trauma patients with an increased risk of malnutrition, indicating the need to promptly secure an appropriate route of feeding access for active nutritional support of patients in the ICU.

Current techniques used to perform surgery for anterior and posterior vaginal wall prolapse in South Korea.

OBJECTIVE: This study aimed to evaluate the current surgical techniques for anterior and posterior vaginal wall prolapse repair in South Korea. METHODS: A web-based questionnaire survey was sent to 780 members of the Korean Society of Obstetrics and Gynecology. The items assessed in the questionnaire were the demographic characteristics and current surgical techniques used for the correction of anterior and posterior vaginal wall prolapse. RESULTS: The response rate was 16%. There were variations in the suture materials and methods used for anterior and posterior colporrhaphy. Most respondents used only rapid absorbable suture materials to plicate the fibromuscular layer and close the mucosal layer of the anterior and posterior vaginal wall. Simple interrupted sutures are the most popular suture method for both the fibromuscular and mucosal layers. Thirty-one and eleven percent of the respondents used mesh for surgical correction of anterior and posterior vaginal wall prolapse, respectively. Concomitant perineorrhaphy was routinely performed with posterior vaginal wall repair by 42% of the respondents, whereas 58% performed perineorrhaphy only in cases with perineal defects. CONCLUSION: There is considerable diversity in the current surgical techniques for anterior and posterior vaginal wall prolapse repair in Korea. Further research is required to standardize the surgical techniques.

Investigation of a Gas Hydrate Dissociation-Energy-Based Quick-Freezing Treatment for Sludge Cell Lysis and Dewatering.

A gas Hydrate dissociation-energy-based Quick-Freezing treatment (HbQF) was applied for sewage sludge cell rupture and dewatering. Carbon dioxide (CO2) and water (H2O) molecules in sewage create CO2 gas hydrates, and subsequently the sludge rapidly freezes by releasing the applied pressure. Cell rupture was observed through a viability evaluation and leachate analysis. The decreased ratios of live cell to dead cells, increased osmotic pressure, and increased conductivity showed cell lysis and release of electrolytes via HbQF. The change in physicochemical properties of the samples resulting from HbQF was investigated via zeta potential measurement, rheological analysis, and particle size measurement. The HbQF treatment could not reduce the sludge water content when combined with membrane-based filtration post-treatment because of the pore blocking of fractured and lysed cells; however, it could achieve sludge microbial cell rupture, disinfection, and floc disintegration, causing enhanced reduction of water content and enhanced dewatering capability via a sedimentation post process. Furthermore, the organic-rich materials released by the cell rupture, investigated via the analysis of protein, polysaccharide, total organic carbon, and total nitrogen, may be returned to a biological treatment system or (an) aerobic digester to increase treatment efficiency.

Induced hypothermia attenuates the acute lung injury in hemorrhagic shock.

BACKGROUND: In previous animal studies, induction of therapeutic hypothermia (HT) in hemorrhagic shock (HS) had beneficial effects on the hemodynamic and metabolic parameters and on the survival. However, the effect of induced HT on acute lung injury (ALI) in HS has not been investigated. We sought to determine the effects of HT on ALI in HS. METHODS: Male Sprague-Dawley rats (350-390 g; n = 8 per group) were randomized to the normothermia (NT; 36-37 degrees C) group or the moderate HT (27-30 degrees C) group and were subjected to volume-controlled (2 mL/100 g weight) HS (90 minutes) followed by 90 minutes of resuscitation. ALI score, lung malondialdehyde content, and myeloperoxidase activity were measured. The expression of glycogen synthase kinase 3beta (GSK-3beta), phosphorylated GSK-3beta, inducible nitric oxide synthase (iNOS), heat shock protein (HSP) 72, and nuclear factor-kappaB (NF-kappaB) in the lung were compared. RESULTS: ALI score, lung malondialdehyde content, and myeloperoxidase were lower in the HT group. GSK-3beta and iNOS gene expressions in lung tissue were significantly decreased in the HT group (p < 0.05). On the contrary, the expression of phosphorylated GSK-3beta was increased in the HT group (p < 0.001). HSP 72 was expressed in the HT group but not in the NT group. The activated p65 NF-kappaB levels in lung nuclear extract were significantly lower in the NT group (p = 0.03). CONCLUSIONS: HT attenuates HS-induced ALI in rats by the modulation of GSK, HSP 72, iNOS, and NF-kappaB.

The impact of helical computed tomography on the negative appendectomy rate: a multi-center comparison.

Emergency departments have different strategies concerning the use of computed tomography (CT) for diagnosing appendicitis. We explored the association between CT utilization rates and the negative appendectomy rates in patients with suspected appendicitis at three medical centers. A retrospective multi-center comparative study was conducted to determine the association between CT use and negative appendectomy rates at three different medical centers. Standardized extraction of data from medical records and operative reports was performed by trained investigators. Of the 339 patients included, 242 (71.4%) were imaged with abdominal CT before appendectomy (CT group), whereas the remaining patients were not (non-CT group). Thirty-six of the 339 patients (10.6%) were found to have negative appendectomies. The CT group had a significantly lower negative appendectomy rate than the non-CT group (6.6% vs. 20.6%, respectively, p < 0.05). The three centers had significantly different rates of CT utilization for diagnosing acute appendicitis (86.9%, 66.4%, and 13.3%, p < 0.05). These three centers also had significantly different negative appendectomy rates (2.5%, 16.8%, and 23.3%, p < 0.05). There was a significant inverse correlation (rho = -1, p < 0.05) between CT utilization rates and negative appendectomy rates. The rate of negative appendectomies in this retrospective study was inversely related to the rates of CT imaging before exploration in Emergency Department patients with suspected appendicitis.