Use of acidified versus non-acidified liquid human milk fortifier in very low birth weight infants: A retrospective comparison of clinical outcomes.

BACKGROUND: Use of human milk is recommended for low birth weight (VLBW) infants, but must be safety fortified with sterile liquid fortifiers to be nutritionally sufficient. Due to clinical concern for a high incidence of metabolic acidosis among VLBW infants fed human milk fortified with acidified liquid human milk fortifier (ALHMF), we aimed to retrospectively compare the outcomes of infants fed ALHMF to those fortified with non-acidified liquid HMF (NLHMF). METHODS: Medical records of VLBW neonates admitted to our institution's neonatal intensive care unit from July 1st, 2013 to June 30th, 2014 were reviewed. 129 patients were included in the study, 61 of which received ALHMF and 68 received NLHMF. Metabolic, nutritional and clinical outcomes, including growth, were compared between the two cohorts. RESULTS: Of the infants who received ALHMF, 70.5% developed metabolic acidosis compared to only 11.8% in the NLHMF group (p < 0.001). In addition, infants who received NLHMF had a 10% greater growth velocity during the period of fortification (p = 0.01). During the full course of hospitalization, no difference in growth velocity was seen between the groups and greater length gains were found in the ALHMF group. CONCLUSIONS: The use of human milk fortified with ALHMF was associated with an increased incidence of metabolic acidosis and poorer growth during the period of fortification when compared to NLHMF-fortified feedings. These growth effects were not apparent when the duration of hospitalization was considered, suggesting a need for further study to better characterize the advantages and disadvantages of each fortifier.

Brain mechanisms of pain relief by transcutaneous electrical nerve stimulation: A functional magnetic resonance imaging study.

BACKGROUND: Although the exact mechanism of TENS pain relief is unknown, it is believed that TENS impulses interrupt nociceptive signals at the dorsal horn of the spinal cord. AIMS: To evaluate the hypotheses that during pain caused by noxious stimuli, brain responses, temporal summation and brain functional connectivity are modulated by TENS, and that mechanisms of pain relief by TENS differ between men and women. METHODS: During fMRI scanning, the same noxious stimuli were delivered to each participant in pain-only and pain+TENS conditions. In the pain-only condition, noxious stimuli were presented without TENS. In the pain+TENS condition, participants received noxious stimuli and TENS concurrently. Participants were initially presented with TENS at an intensity that was just below that causing discomfort. TENS intensity was presented in a step-wise fashion to prevent temporal summation from repetitive noxious stimuli. RESULTS: Pain and unpleasantness ratings were significantly higher in the pain-only than the pain+TENS condition. With non-painful TENS, primary and secondary somatosensory and parietal cortices were activated, and temporal summation from repetitive noxious stimuli was prevented. Periaqueductal gray (PAG) and lateral prefrontal cortex functional connectivity was increased by TENS, and modulated by testosterone and cortisol. Women reported greater pain during TENS than men, and showed greater activation in the temporoparietal junction cortex and increased PAG functional connectivity with the orbitofrontal cortex. CONCLUSION: TENS led to pain reduction, probably due to activation of the descending pain-inhibitory pathway, indicating that this TENS method may be applied in clinical practice.

Alternative bleaching methods for Cheddar cheese whey.

UNLABELLED: Residual annatto colorant (norbixin) in fluid Cheddar cheese whey can be bleached. The 2 approved chemical bleaching agents for whey, hydrogen peroxide (HP) and benzoyl peroxide (BP), negatively impact the flavor of dried whey protein. The objective of this study was to evaluate alternative methods for bleaching liquid whey: ultraviolet radiation (UV), acid-activated bentonite (BT), and ozone (OZ). Colored Cheddar cheese whey was manufactured followed by pasteurization and fat separation. Liquid whey was subjected to one of 5 treatments: control (CT) (no bleaching; 50 °C, 1 h), HP (250 mg/kg; 50 °C, 1 h), UV (1 min exposure; 50 °C), BT (0.5% w/w; 50 °C, 1 h), or OZ (2.2g/h, 50 °C, 1 h). The treated whey was then ultrafiltered, diafiltered, and spray-dried to 80% whey protein concentrate (WPC80). The entire experiment was replicated 3 times. Color (norbixin extraction and measurement), descriptive sensory, and instrumental volatile analyses were conducted on WPC80. Norbixin elimination was 28%, 79%, 39%, and 15% for HP, BT, UV, and OZ treatments, respectively. WPC80 from bleached whey, regardless of bleaching agent, had lower sweet aromatic and cooked/milky flavors compared to unbleached CT (P < 0.05). The HP and BT WPC80 had higher fatty flavor compared to the CT WPC80 (P < 0.05), and the UV and OZ WPC80 had distinct mushroom/burnt and animal flavors. Volatile compound results were consistent with sensory results and confirmed higher relative abundances of volatile aldehydes in UV, HP, and OZ WPC80 compared to CT and BT WPC80. Based on bleaching efficacy and flavor, BT may be an alternative to chemical bleaching of fluid whey. PRACTICAL APPLICATION: The 2 approved chemical bleaching agents for whey, hydrogen peroxide (HP) and benzoyl peroxide (BP), negatively impact flavor of dried whey protein, and restrictions on these agents are increasing. This study evaluated 3 alternatives to chemical bleaching of fluid whey: UV radiation, ozone, and bentonite.

Needlescopy-assisted resection of pulmonary nodule after dual localisation.

The aim of this study was to evaluate the feasibility of dual localisation with hookwire and lipiodol before needlescopy-assisted resection for pulmonary nodule. Computed tomography-guided dual marking was performed on 36 pulmonary nodules of 32 patients and needlescopy-assisted resection was performed monitored by C-arm fluoroscopy. The mean age of the patients was 58 ± 12 (range 12-77) yrs. The mean size of the nodules was 7.5 ± 3.7 (3-17) mm. Their mean distance from the pleural surface was 7.3 ± 7.5 (0-35) mm. There were nine pure ground-glass opacity lesions, five semi-solid lesions and 22 solid lesions. The time of the dual localisation procedure was 13.1 ± 4.8 (7-23) min. Complications of the marking were pneumothorax in nine patients, and intrapulmonary bleeding in three. One hookwire dislodged during the operation. All nodules were successfully resected under needlescopy without conversion to a conventional thoracoscopy (5 mm or 10 mm thoracoscopy) or a minithoracotomy. There was no complication related to needlescopy-assisted resection. Dual marking with hookwire and lipiodol is a safe and none time consuming procedure, and needlescopy-assisted lung resection for small nodules is technically feasible and useful for histological diagnosis and treatment.

Invited review: Annatto usage and bleaching in dairy foods.

Annatto is a yellow/orange colorant that is widely used in the food industry, particularly in the dairy industry. Annatto, consisting of the carotenoids bixin and norbixin, is most commonly added to produce orange cheese, such as Cheddar, to achieve a consistent color over seasonal changes. This colorant is not all retained in the cheese, and thus a percentage remains in the whey, which is highly undesirable. As a result, whey is often bleached. Hydrogen peroxide and benzoyl peroxide are the 2 bleaching agents currently approved for bleaching whey in the United States. Recent studies have highlighted the negative effect of bleaching on whey flavor while concurrently there is a dearth of current studies on bleaching conditions and efficacy. Recent international mandates have placed additional concern on the use of benzoyl peroxide as a bleaching agent. This review discusses the advantages, disadvantages, regulatory concerns, flavor implications, and optimal usage conditions of 2 widely used bleaching agents, hydrogen peroxide and benzoyl peroxide, as well as a few alternative methods including lipoxygenase, peroxidase, and lactoperoxidase systems.

The effect of bleaching agent on the flavor of liquid whey and whey protein concentrate.

The increasing use and demand for whey protein as an ingredient requires a bland-tasting, neutral-colored final product. The bleaching of colored Cheddar whey is necessary to achieve this goal. Currently, hydrogen peroxide (HP) and benzoyl peroxide (BPO) are utilized for bleaching liquid whey before spray drying. There is no current information on the effect of the bleaching process on the flavor of spray-dried whey protein concentrate (WPC). The objective of this study was to characterize the effect of bleaching on the flavor of liquid and spray-dried Cheddar whey. Cheddar cheeses colored with water-soluble annatto were manufactured in duplicate. Four bleaching treatments (HP, 250 and 500 mg/kg and BPO, 10 and 20 mg/kg) were applied to liquid whey for 1.5 h at 60 degrees C followed by cooling to 5 degrees C. A control whey with no bleach was also evaluated. Flavor of the liquid wheys was evaluated by sensory and instrumental volatile analysis. One HP treatment and one BPO treatment were subsequently selected and incorporated into liquid whey along with an unbleached control that was processed into spray-dried WPC. These trials were conducted in triplicate. The WPC were evaluated by sensory and instrumental analyses as well as color and proximate analyses. The HP-bleached liquid whey and WPC contained higher concentrations of oxidation reaction products, including the compounds heptanal, hexanal, octanal, and nonanal, compared with unbleached or BPO-bleached liquid whey or WPC. The HP products were higher in overall oxidation products compared with BPO samples. The HP liquid whey and WPC were higher in fatty and cardboard flavors compared with the control or BPO samples. Hunter CIE Lab color values (L*, a*, b*) of WPC powders were distinct on all 3 color scale parameters, with HP-bleached WPC having the highest L* values. Hydrogen peroxide resulted in a whiter WPC and higher off-flavor intensities; however, there was no difference in norbixin recovery between HP and BPO. These results indicate that the bleaching of liquid whey may affect the flavor of WPC and that the type of bleaching agent used may affect WPC flavor.

Comparison of bioavailability of two ubidecarenone products in healthy Korean volunteers.

OBJECTIVE: This study aimed to evaluate the bioavailability of two pharmaceutical products of ubidecarenone (coenzyme Q10, CoQ10). MATERIALS: Two brands (brand A and brand B) of commercial CoQ10 hard capsules. METHODS: Two brands of CoQ10 capsules were administered at 100 mg dose to two groups of healthy volunteers, respectively, and blood samples were withdrawn at predetermined time intervals and assayed by a validated HPLC method with an electrochemical detector. RESULTS AND CONCLUSIONS: Intra- and inter-day precision and inter-day accuracy were acceptable for all quality control samples including the lower limit of quantitation of 50 ng/ml. Recovery of CoQ10 from human plasma was greater than 98.2%. CoQ10 was stable in human plasma under various storage conditions. This method was applied to a pharmacokinetic study after oral administration of CoQ10 hard capsules to healthy volunteers. The intrinsic CoQ10 concentrations were measured for three consecutive days before drug administration, which were ranged between 0.68 and 0.79 microg/ml, and there was no statistically significant difference between groups. In brand A, the plasma concentration after administration of CoQ10 was not higher than the intrinsic level, indicating that no significant drug absorption occurred, whereas considerably higher concentrations were obtained with brand B. The dissolution rates of brand A and B after 3 h were 0.35 +/- 0.09 and 1.27 +/- 0.16%, respectively. From the adjusted concentration-time curve, the AUC and t1/2 of brand B were calculated to be 11.51 +/- 5.76 microg x h/ml and 21.7 h, respectively. A mean Cmax of 0.32 +/- 0.1 microg/ml was obtained at 7.9 h. In conclusion, it was found that bioavailability of CoQ10 was significantly different depending on the formulations, and dissolution could be one of the important factors affecting CoQ10 absorption.

Glucose metabolism in early onset versus late onset Alzheimer's disease: an SPM analysis of 120 patients.

The aims of this cross-sectional study were (i) to compare the overall glucose metabolism between early onset and late onset Alzheimer's disease in a large sample of patients; and (ii) to investigate the pattern of glucose metabolism as a function of dementia severity in early onset versus late onset Alzheimer's disease, using a statistical parametric mapping (SPM) analysis. Subjects consisted of four groups: 74 patients with early onset Alzheimer's disease, 46 patients with late onset of the disease, and two control groups age matched to each patient group. All the subjects underwent 2-[(18)F]fluoro-2-deoxy-d-glucose (FDG)-PET under the same scanning conditions. Severity of dementia was rated with the Clincial Dementia Rating (CDR). Voxel-based SPM99 was used for statistical analyses. Overall glucose hypometabolism of early onset Alzheimer's disease patients was much greater in magnitude and extent than that of late onset patients, though both groups were similar in dementia severity: the early onset group showed more severe hypometabolism in parietal, frontal and subcortical (basal ganglia and thalamus) areas. When the decline of glucose metabolism was compared as a function of CDR stage, the slope was steeper in early onset than in late onset Alzheimer's disease. The rapid decline occurred at CDR 0.5-1 in the early onset group, whereas similar changes occurred at CDR 2-3 in the late onset group. The greater hypometabolism in early onset than in late onset patients is required to reach the same severity of dementia, probably reflecting greater functional reserve in younger than in older subjects. Alternatively, the metabolic decline curve suggests that the early onset patients may take a more rapid course in the reduction of glucose metabolism than the late onset patients.

The Preliminary Study of Quantitative Morphology of the Corpus Callosum, Thalamus, Cerebellum and Pons in Autistic Disorder and Developmental Language Disorder / 신경정신의학

OBJECTIVES: This study aimed to planimetrically measure the corpus callosum, cerebellum, pons and thalamus in the boys with autistic disorder and developmental language disorder. METHODS: The midsagittal brain MR images of 8 autistic and 8 developmental language disorder subjects who met the DSM-III-R diagnostic criteria and 10 comparison subjects were collected. MR images were redigitalized with flatbed scanner and the data were analyzed with NIH IMAGE 1.61 software. Pixel counting and area measurements were done. The corpus callosum was divided into seven regions and the cerebellar vermis was divided into three regions. RESULTS: In autistic subjects, the rostrum of corpus callosum was found to have significantly smaller area than comparison and developmental language disorder subjects. In developmental language disorder subjects, the thalamus was significantly larger than comparison subjects. The cerebellar vermis and pons did not differ among three groups. CONCLUSION: The rostrum of the corpus callosum in autistic disorder was significantly smaller. This finding supports the theory of abnormal prefrontal lobe development in autistic disorder.

Hippocampal modulation of cingulo-thalamic neuronal activity and discriminative avoidance learning in rabbits.

Two experiments assessed the effects of 1) combined subicular complex and posterior cingulate cortical lesions on training-induced neuronal activity (TIA) in the anterior ventral (AV) and medial dorsal (MD) thalamic nuclei; 2) hippocampal (Ammon's horn and dentate gyrus) lesions on TIA in cingulate cortex and in the AV and MD thalamic nuclei. The rabbits acquired a conditioned avoidance response (CR), stepping in an activity wheel upon hearing a 0.5-s tone (CS+), in order to prevent a foot-shock scheduled 5 s after tone onset. No response was required after a different, safety-predictive tone (CS-). In experiment 1 the combined subicular and cingulate cortical lesions enhanced thalamic TIA during acquisition and increased CR incidence in the first session of acquisition. These results confirmed the hypothesis that subicular and cingulate cortical efferents are not essential for thalamic TIA or for avoidance learning. Hippocampal lesions (experiment 2) also enhanced thalamic TIA. However, unlike subicular lesions, hippocampal lesions enhanced posterior cingulate cortical TIA as well, especially during extinction training. Hippocampal lesions did not affect CR performance. The results suggested that subicular excitatory efferents are responsible for incrementing cingulate cortical TIA, which is viewed as subserving associative attention. Activity from hippocampus downregulates the cue-elicited neuronal activity of the cingulo-thalamic circuits by suppressing the excitatory influence of the subiculum. The hippocampal influence reduces cingulo-thalamic cue-elicited activation in particular circumstances, such as the onset of CR extinction, when an expected reinforcer is omitted.

Stimulus-related and movement-related single-unit activity in rabbit cingulate cortex and limbic thalamus during performance of discriminative avoidance behavior.

Neuronal discharges related to acoustic conditional stimuli and locomotive behavioral responses of 152 anterior and medial dorsal (MD) thalamic and cingulate cortical single-units sorted from multi-unit activity were recorded as rabbits performed in a discriminative avoidance task. The goals were: (1) to document the single-unit constituents of multi-site, multi-unit activity recorded previously in response to the conditional stimuli used for avoidance training; and (2) to document neuronal activity related to the onset of the behavioral avoidance response. Ninety-five units showed discriminative discharges: significantly different firing rates 90-700 ms after a foot shock-predictive conditional stimulus (CS+) than to a safety-predictive conditional stimulus (CS-). In accord with the multi-unit data, a majority of these units discharged at higher rates after the CS+ than after the CS-. The discharge rates of 87 units were greater during the 2-s period preceding the onset of avoidance responses than during comparable trial periods after CS-presentations followed by no response. Fifty-six of the 87 avoidance-related units exhibited a progressive ramp-like firing increase 2 s before the avoidance response, with the maximal discharge rate occurring 200 ms before the response. These dynamic pre-avoidance discharges occurred first in limbic thalamus then in cingulate cortex, suggesting that cortical pre-motor processing may confer temporal specificity upon a more generalized command volley relayed from thalamus. Unlike the multi-unit data, 24 neurons exhibited inverse discrimination, i.e., significantly greater discharges in response to the CS-than to the CS+. Also 27 neurons showed significantly more firing in the 2-s period before the end of CS-trials in which no behavioral response occurred, than in the 2-s pre-avoidance period on CS+ trials with responses. This "inverse' CS-related and pre-avoidance activity occurred at low incidence (< 15%) in all areas except the MD nucleus, wherein it was exhibited by 45% of the recorded units. The inverse activity may reflect the operation of local inhibitory neurons which suppress the discharges of other neurons in response to the CS-. The prevalence of inverse activity in the MD nucleus suggested an involvement of this area in behavioral inhibition.

Effect of aqueous neem (Azadirachta indica) extract on testosterone and other blood constituents in male rats. A pilot study.

Effect of oral administration of crude aqueous neem extract on serum testosterone and other blood constituents was studied in the male Wistar rats for 10 weeks. The neem treatment resulted in significant decreases (p < 0.01) in total testosterone, total bilirubin and K+ in serum. There were also increases (p < 0.05) in packed cell volume, mean corpuscular haemoglobin concentration, red blood cell, white blood cell and lymphocyte counts without showing any cytotoxic effects in the body.

Toxic effects of ackee oil (Blighia sapida L) following subacute administration to rats.

Subacute intraperitoneal administration of the lipid portion of the unripe ackee arillus, referred to as "ackee oil", resulted in marked neutropenia (p less than 0.001) and increase in platelets (p less than 0.01) without anaemia, in rats. Blood urea, sodium and aspartate aminotransferase levels were significantly decreased but glucose and bilirubin levels were similar to those of controls. The lungs showed areas of petechial haemorrhages and a dose-related perivascular and peribronchial mononuclear cell infiltration. The pulmonary toxicity may be interpreted as a hypersensitive reaction to ackee oil. Further research is in progress on the neutropenic effects of ackee oil.

Comprehensive assessment of long-term postoperative continence in pediatric imperforate anus. Clinical, manometric and contrast studies.

109 patients with imperforate anus were followed up postoperatively for 5 to 28 years. Postoperative continence was evaluated by anorectal manometry, barium enema and clinical symptoms. A comprehensive assessment system, combining the clinical and objective systems was designed which can reflect postoperative anal continence function completely and objectively. It is useful for determining the causes of incontinence and its treatment.

Muscarinic receptor binding increases in anterior thalamus and cingulate cortex during discriminative avoidance learning.

Training-induced neuronal activity develops in the mammalian limbic system during discriminative avoidance conditioning. This study explores behaviorally relevant changes in muscarinic ACh receptor binding in 52 rabbits that were trained to one of five stages of conditioned response acquisition. Sixteen naive and 10 animals yoked to criterion performance served as control cases. Upon reaching a particular stage of training, the brains were removed and autoradiographically assayed for 3H-oxotremorine-M binding with 50 nM pirenzepine (OXO-M/PZ) or for 3H-pirenzepine binding in nine limbic thalamic nuclei and cingulate cortex. Specific OXO-M/PZ binding increased in the parvocellular division of the anterodorsal nucleus early in training when the animals were first exposed to pairing of the conditional and unconditional stimuli. Elevated binding in this nucleus was maintained throughout subsequent training. In the parvocellular division of the anteroventral nucleus (AVp), OXO-M/PZ binding progressively increased throughout training, reached a peak at the criterion stage of performance, and returned to control values during extinction sessions. Peak OXO-M/PZ binding in AVp was significantly elevated over that for cases yoked to criterion performance. In the magnocellular division of the anteroventral nucleus (AVm), OXO-M/PZ binding was elevated only during criterion performance of the task, and it was unaltered in any other limbic thalamic nuclei. Specific OXO-M/PZ binding was also elevated in most layers in rostral area 29c when subjects first performed a significant behavioral discrimination. Training-induced alterations in OXO-M/PZ binding in AVp and layer Ia of area 29c were similar and highly correlated.(ABSTRACT TRUNCATED AT 250 WORDS)

Dose effects of adenine on myocardial ATP content in the post-anoxic nonworking rat heart.

1. Tissue ATP levels were measured in Langendorff perfused nonworking rat hearts subjected to 50 min anoxia prior to reperfusion with Krebs-Ringer bicarbonate (KRB) buffer alone or supplemented with 50 microM or 1 mM adenine for 60 min. 2. ATP content was restored to the normoxic range in hearts reperfused with 50 microM adenine in KRB (20.82 +/- SEM 1.90 mumol/g dry weight vs 24.95 +/- 0.83 in normoxic hearts, P = NS). 3. Reperfusion with oxygenated KRB alone or buffer with 1 mM adenine failed to improve ATP levels (17.23 +/- 0.91 mumol/g dry weight for buffer alone, 15.60 +/- 0.46 with 1 mM adenine and 13.45 +/- 0.93 for anoxic hearts not reperfused). 4. These findings indicate that adenine at 50 microM dosage can restore ATP concentrations to the normoxic range after 60 in of anoxia in the nonworking rat heart while raising the adenine dose to 1 mM inhibited the tissue ATP content.