CLINIMEX Aerobic Fitness Questionnaire: Proposal and Validation

Cardiorespiratory (aerobic) fitness is strongly and directly related to major health outcomes, including all-cause mortality. Maximum oxygen uptake (VO2max), directly measured by maximal cardiopulmonary exercise test (CPET), represents the subject's aerobic fitness. However, as CPET is not always available, aerobic fitness estimation tools are necessary. Objectives: a) to propose the CLINIMEX Aerobic Fitness Questionnaire (C-AFQ); b) to validate C-AFQ against measured VO2max; and c) to analyze the influence of some potentially relevant variables on the error of estimate. Methods: We prospectively studied 1,000 healthy and unhealthy subjects (68.6% men) aged from 14 to 96 years that underwent a CPET. The two-step C-AFQ describes physical activities with corresponding values in metabolic equivalents (METs) - ranging from 0.9 to 21 METs. Results: Application of C-AFQ took less than two minutes. Linear regression analysis indicated a very strong association between estimated (C-AFQ) and measured (CPET) maximal METs - r2 = 0.83 (Sy.x = 1.63; p < .001) - with median difference of only 0.2 METs between both values and interquartile range (percentiles 25 and 75) of 2 METs. The difference between estimated and measured METs was not influenced by age, sex, body mass index, clinical condition, ß-blocker use or sitting-rising test scores. Conclusion: C-AFQ is a simple and valid tool for estimating aerobic fitness when CPET is unavailable and it is also useful in planning individual ramp protocols. However, individual error of estimate is quite high, so C-AFQ should not be considered a perfect substitute for CPET's measured VO2max

Recovery from sauna bathing favorably modulates cardiac autonomic nervous system.

OBJECTIVE: Sauna bathing is becoming a common activity in many countries and it has been linked to favorable health outcomes. However, there is limited data on the heart rate (HR) and heart rate variability (HRV) responses to an acute sauna exposure. DESIGN: We conducted a single-group, longitudinal study utilizing a pre-post design to examine acute effects of sauna bathing on the autonomic nervous system as reflected by HRV. A total of 93 participants (mean [SD] age: 52.0 [8.8] years, 53.8% males) with cardiovascular risk factors were exposed to a single sauna session (duration: 30 min; temperature: 73 °C; humidity: 10-20%) and data on HRV variables were collected before, during and after sauna. RESULTS: Time and frequency-domain HRV variables were significantly modified (p < 0.001) by the single sauna session, with most of HRV variables tending to return near to baseline values after 30 min recovery. Resting HR was lower at the end of recovery (68/min) compared to pre-sauna (77/min). A sauna session transiently diminished the vagal component, whereas the cooling down period after sauna decreased low frequency power (p < 0.001) and increased high frequency power in HRV (p < 0.001), favorably modulating the autonomic nervous system balance. CONCLUSIONS: This study demonstrates that a session of sauna bathing induces an increase in HR. During the cooling down period from sauna bathing, HRV increased which indicates the dominant role of parasympathetic activity and decreased sympathetic activity of cardiac autonomic nervous system. Future randomized controlled studies are needed to show if HR and HRV changes underpins the long-term cardiovascular effects induced by regular sauna bathing.

Dolor en la articulación sacroilíaca: estudio prospectivo, aleatorizado, experimental y comparativo de la radiofrecuencia térmica con el bloqueo de la articulación sacroilíaca / Sacroiliac joint pain: Prospective, randomised, experimental and comparative study of thermal radiofrequency with sacroiliac joint block

Objetivo. Comparar el bloqueo con la radiofrecuencia térmica bipolar para el dolor de la articulación sacroilíaca. Método. Estudio prospectivo, aleatorizado y experimental en 60 pacientes, seleccionados en 9 meses en 2 centros, con dolor intenso (escala visual analógica [EVA] > 6) de > 3 meses de duración. Fueron divididos en 3 grupos (n = 20). Grupo A: pacientes a los que se les realizaron 2 bloqueos intraarticulares, con control ecográfico en 7 días. Grupo B: radiofrecuencia bipolar «palisade» utilizando 6 agujas perpendiculares a la zona dorsal del sacro, a una distancia de 1 cm, para producir lesiones contiguas entre los forámenes S1-S2-S3 y la línea articular. Grupo C: radiofrecuencia bipolar «palisade» modificada (distancia entre agujas > 1 cm). Los pacientes fueron evaluados al mes, a los 3 y a los 12 meses del tratamiento. Se valoraron los datos demográficos (en la visita basal), la eficacia analgésica y los efectos secundarios (en el resto). Resultados. Al mes, la reducción del dolor en los 3 grupos fue > 50% (p ≤ 0,001). A los 3 y 12 meses el grupo A no refirió disminución significativa del dolor. El grupo B, a los 3 meses, alivio cercano al 50% (p = 0,03), y < 25% (23,8) a los 12 meses (p = 0,01). En el grupo C, alivio próximo al 50% a los 3 y 12 meses (p < 0,001) respecto al basal. Todos los pacientes finalizaron el estudio. Conclusiones. La radiofrecuencia bipolar «palisade», especialmente aumentando la distancia entre las agujas, ha sido eficaz, a más largo plazo, que el bloqueo con anestésicos y corticoides en el alivio del dolor de la articulación sacroilíaca (AU)

Objective. To compare the analgesic effects between the blockade and bipolar thermal radiofrequency in the treatment of sacroiliac joint pain. Method. Prospective, randomised and experimental study conducted on 60 patients selected in the two hospitals over a period of nine months, who had intense sacroiliac joint pain (Visual Analogue Scale [VAS] > 6) that lasted more than 3 months. Patients were randomised into three groups (n = 20): Group A (two intra-articular sacroiliac injections of local anaesthetic/corticosteroid guided by ultrasound in 7 days). Group B: conventional bipolar radiofrequency «palisade». Target points were the lateral branch nerves of S1, S2, and S3, distance needles 1 cm. Group C: modified bipolar radiofrequency «palisade» (needle distance > 1 cm). Patients were evaluated at one month, three months, and one year. Demographic data, VAS reduction, and side effects of the techniques were assessed. Results. One month after the treatment, pain reduction was > 50% in the three groups P < .001. Three and 12 months after the technique, the patients of the group A did not have a significant reduction in pain. At 3 months, almost 50% patients of the group B referred to improvement of the pain (P = .03), and < 25% at 12 months, and those results were statistically significant (P = .01) compared to the baseline. Group C showed an improvement of 50% at 3 and 12 months (P < .001). All patients completed the study. Conclusions. Bipolar radiofrequency «palisade», especially when the distance between the needles was increased, was more effective and lasted longer, compared to join block and steroids, in relieving pain sacroiliac joint (AU)

Spatiotemporal variability of hypoxia and eutrophication in Manila Bay, Philippines during the northeast and southwest monsoons.

Hypoxia in Manila Bay, Philippines was previously reported during the northeast monsoon (dry season) in February 2010. In this study, four more field surveys of the same 31 stations were conducted in July 2010, August 2011 and 2012 (wet season, southwest monsoon), and February 2011 (dry season, northeast monsoon). During the wet season, bottom hypoxia spread northward towards the coast with dissolved oxygen (DO) ranging from 0.12 to 9.22 mg/L and the bay-wide average reaching 2.10 mg/L. Nutrient levels were elevated, especially near the bottom where dissolved inorganic nitrogen reached 22.3 µM (July 2010) and phosphorus reached 5.61 µM (August 2011). High nutrient concentrations often coincided with low near-bottom DO content. Our work builds on the preliminary assessment of hypoxia in Manila Bay, the importance of repeated temporal studies, and shows hypoxia to prevail significantly during the southwest monsoon (wet season) when increased freshwater discharge caused strong water column stratification.

Nutrient inputs from submarine groundwater discharge on the Santiago reef flat, Bolinao, Northwestern Philippines.

Submarine groundwater discharge (SGD) on the reef flat of Bolinao, Pangasinan (Philippines) was mapped using electrical resistivity, 222Rn, and nutrient concentration measurements. Nitrate levels as high as 126 µM, or 1-2 orders of magnitude higher than ambient concentrations, were measured in some areas of the reef flat. Nutrient fluxes were higher during the wet season (May-October) than the dry season (November-April). Dissolved inorganic nitrogen (DIN=NO3+NO2+NH4) and soluble reactive phosphorus (SRP) fluxes during the wet season were 4.4 and 0.2 mmoles m(-2) d(-1), respectively. With the increase population size and anthropogenic activities in Bolinao, an enhancement of SGD-derived nitrogen levels is likely. This could lead to eutrophic conditions in the otherwise oligotrophic waters surrounding the Santiago reef flat.

Development and characterisation of a new model of rat trophoblasts.

The placenta plays a key role during pregnancy. In vitro models have proven to assess the role of placental transporters in the exchange of nutrients, waste products and the distribution of drugs between the maternal and fetal compartments. Therefore, a primoculture of Wistar rat trophoblasts from the labyrinth zone was developed and characterised. Expression of placental transporters including P-glycoprotein (P-gp) and bcrp was evaluated by western blot and their activity using different inhibitors. A time-dependent increase in P-gp expression was noted from primocultures Day 2 to Day 4 followed by a plateau thereafter, whereas bcrp expression was stable throughout the culture period. P-gp and bcrp expression was maintained after seven passages in primocultures and in cryopreserved trophoblasts (up to 3 freezings and 10 passages). Activity of efflux transporters was confirmed in both placental primocultures and cryopreserved trophoblasts by an approximately 60% inhibition with cyclosporin A and valspodar for P-gp and 55% with elacridar for bcrp. In sum, this new in vitro model seems promising for a better understanding of the role of P-gp and bcrp in the toxicity of drugs during pregnancy and could be considered as an additional step towards the minimization of animal testing during drug development.

Overexpression of dopamine receptor genes and their products in the postnatal rat brain following maternal n-3 fatty acid dietary deficiency.

A combination of PCR-Select cDNA subtraction and gene array hybridization was used to identify differentially expressed genomic markers in brains of rats fed for 3 weeks in utero and 2 weeks after birth on an n-3 polyunsaturated fatty acid (PUFA)-deficient diet supplied to dams. Total RNA was isolated, switch mechanism at 5'-end of the RNA transcripts (SMART) applied and used for PCR-Select subtraction of PUFA-deficient and adequately-fed control preparations. Subtracted and amplified ds-cDNA end-products were fragmented, terminally labeled with biotin-ddUTP and hybridized with a RN-U34A gene array. A 10-fold increase in potential genes with log2(Tester/Driver) = 1.4 was found compared with traditional gene array technology when the same chip was tested using non-subtracted targets. Reverse transcription-real-time relative PCR confirmed 30% of the transcripts. Among the validated transcripts, D1 and D2 receptors for dopamine (DA), were most prominent among a number of over-expressed neurotransmitter receptors and retinoic acid receptor (RXR alpha-2 and alpha-1). Immunohistochemical staining of brain sections from 2-week-old pups revealed a substantial enrichment of the D2 receptor in discrete regions of the mesolimbic and mesocortical pathways as well as in a large number of brain areas from the n-3 PUFA-deficient pups. Punches of the same areas run on western blots showed similar results. The overwhelming expression of D1 and D2 receptors may be attributed to a behavioral hypersensitivity caused by the possible impairment of DA production during brain development, which may have implications in certain disorders of the nervous system.

Selenium in bovine plasma, soil and forage measured by neutron activation analysis

A deficiência de selênio já foi identificada pela medição da atividade da enzima glutationa de peroxidase no sangue de animais (vacas) criados em certas regiões do Pampa Umido, mais especificamente na cidade de Nueve de Julio (Buenos Aires - Argentina). Em trabalho anterior, a análise de ativação neutrônica confirmou esses baixos níveis de selênio em uma determinada fazenda de cria para gado de corte. Neste trabalho, foram analisados os níveis de selênio no solo, na forragem e no plasma dos animais do mesmo estabelecimento. A população analisada (n=60) apresentou níveis de selênio abaixo do normal (30,1 ± 4,6æg/ml). De maneira semelhante, a concentração de selênio da forragem consumida - matéria seca igual a 30 por cento - proveniente de uma área de baixada do piquete, assim como o feno de palha de trigo (MS=91 por cento) utilizado como suplemento, foi muito baixa (<0,05æg/gMS). A concentração de selênio no solo foi maior (entre 3,4 e 3,9æg/g MS) do que o intervalo normal (entre 0,02 e 2,50 æg/g MS) em todas as frações analisadas. Desse modo, confirma-se que a deficiência de selênio nos animais analisados é atribuída por uma determinação direta do mineral, ou seja, os resultados indicam que pode existir relação entre a baixa concentração de selênio na forragem e no suplemento, e sua deficiência nos animais.

Utilizing Solanum glaucophyllum alone or with phytase to improve phosphorus utilization in broilers.

Experiments were conducted to determine if Solanum glaucophyllum (SG), a plant containing a glycoside of 1,25-dihydroxyvitamin D, could be used as a feed additive to improve P utilization of broilers. SG leaves (1, 2.5, or 5 g/kg), 1,25-dihydroxyvitamin D (15 microg/kg), or Ca and P (to achieve a 0.92% Ca:0.65% P:0.41% nonphytate P control diet) were added to a 0.56% Ca/0.45% P/0.28% nonphytate P basal diet and fed to broilers from 7 to 28 d of age. Birds fed basal ration alone exhibited reduced weight gain, bone density, and bone mineral content when compared with birds fed the 0.92% Ca:0.65% P diet. Adding 5 g SG leaves or 15 microg of 1,25-dihydroxyvitamin D/kg to the basal diet increased body weight gain, plasma Ca and P, bone ash, and bone density above basal diet levels. Plasma P and weight gain of birds fed 5 g SG or 15 microg of 1,25-dihydroxyvitamin D/kg basal diet were equivalent to those observed in birds fed the 0.92% Ca:0.65% P diet. In experiment 2, the effect of higher doses of SG, as well as the additive effect of SG with 1,200 phytase units/kg diet, were examined in chicks fed a 0.59% Ca and 0.42% P basal diet. Two levels of SG leaves (7.5 g and 10 g), phytase, or both SG (7.5 g) and phytase were added per kilogram of basal diet. Adding SG or phytase to the basal diet increased weight gain, plasma Ca, plasma P, and bone mineral content over that observed in birds fed basal diet alone. Combining SG with phytase provided no significant gains in growth or bone parameters over treatment with phytase alone.

1,25(OH)2 vitamin D concentration in the plasma of Solanum glaucophyllum intoxicated rabbits.

OBJECTIVE: To test Solanum glaucophyllum calcinotic effects in adult New Zealand White rabbits in relation to cumulative dose and active principle concentration in plasma. DESIGN: An intoxication assay with controls. PROCEDURE: Rabbits were orally dosed with aqueous extracts of dry leaves of S glaucophyllum for 5, 7 or 9 days. During the experiment, body weight, calcaemia and phosphataemia were measured; retinal blood vessel calibre was observed by ophthalmoscopic examination of the ocular fundus. 1,25(OH)2 vitamin D plasma concentration was determined at the end of the experimental periods. Soft tissue calcium concentration and the presence of calcinotic lesions were studied after euthanasia. RESULTS: Toxic effects were evident in S glaucophyllum treated groups (loss of body weight, elevation of soft tissue calcium concentration, and presence of calcinotic lesions). Plasma 1,25(OH)2 vitamin D concentrations were negatively correlated with final body weight (r = -0.97; P < or = 0.001), and positively correlated with renal calcium concentration (r = 0.74; P = 0.02). There was also a significant regression of plasma 1,25 (OH)2 vitamin D concentration on the cumulative dose of S glaucophyllum (R2 = 0.87; P < or = 0.001). CONCLUSIONS: The procedure described here offers a sensitive and practical experimental model for the study of the pathogenesis of enteque seco.

Lipid constituents in oligodendroglial cells alter susceptibility to H2O2-induced apoptotic cell death via ERK activation.

The present work examines the effect of membrane lipid composition on activation of extracellular signal-regulated protein kinases (ERK) and cell death following oxidative stress. When subjected to 50 microM docosahexaenoic acid (DHA, 22 : 6 n-3), cellular phospholipids of OLN 93 cells, a clonal line of oligodendroglia origin low in DHA, were enriched with this polyunsaturated fatty acid. In the presence of 1 mM N,N-dimethylethanolamine (dEa) a new phospholipid species analog was formed in lieu of phosphatidylcholine. Exposure of DHA-enriched cells to 0.5 mM H2O2, caused sustained activation of ERK up to 24 h. At this time massive apoptotic cell death was demonstrated by ladder and TUNEL techniques. H2O2-induced stress applied to dEa or DHA/dEa co-supplemented cells showed only a transient ERK activation and no cell death after 24 h. Moreover, while ERK was rapidly translocated into the nucleus in DHA-enriched cells, dEa supplements completely blocked ERK nuclear translocation. This study suggests that H2O2-induced apoptotic cell death is associated with prolonged ERK activation and nuclear translocation in DHA-enriched OLN 93 cells, while both phenomena are prevented by dEa supplements. Thus, the membrane lipid composition ultimately modulates ERK activation and translocation and therefore can promote or prevent apoptotic cell death.

N-methyl bases of ethanolamine prevent apoptotic cell death induced by oxidative stress in cells of oligodendroglia origin.

A major reason for brain tissue vulnerability to oxidative damage is the high content of polyunsaturated fatty acids (PUFAs). Oligodendroglia-like OLN 93 cells lack PUFAs and are relatively insensitive to oxidative stress. When grown in serum-free defined medium in the presence of 0.1 mM docosahexaenoic acid (DHA; 22:6 n-3) for 3 days, OLN 93 cells release in the medium 2.6-fold more thiobarbituric acid-reactive substances (TBARS) after a 30-min exposure to 0.1 mM H2O2 and 50 microM Fe2+. Release of TBARS was substantially decreased by approximately 20 and 30% on coincubation with either 1 mM N-monomethylethanolamine or N,N'-dimethylethanolamine (dEa), respectively. The protective effect of dEa was concentration- and time-dependent and was still visible after dEa removal, suggesting a long-lasting mechanism of protection. After 24 h following H2O2-induced stress, cell death monitored by cell sorting showed 16% of the cells in the sub-G1 area, indicative of apoptotic cell death. DHA-supplemented cultures showed 35% cell death, whereas cosupplements with dEa reduced cell death to 12%, indicating cell rescue. Although the exact mechanism for this protection is not known, the nature of the polar head group and the degree of unsaturation may determine the ultimate resistance of nerve cells to oxidative stress.

Lipoprotein profiles and serum peroxide levels of aged women consuming palmolein or oleic acid-rich sunflower oil diets.

OBJECTIVE: To investigate the hypercholesterolemic effects of a dietary exchange between 16:0 and 18:1 while 18:2 was at relatively lower level (approximately 4%) in aged women with initially high total serum cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) values and with high intakes of dietary cholesterol. DESIGN: Subjects were assigned to two consecutive 28 d periods. In the first period all subjects followed an oleic acid-rich diet in the form of oleic acid-rich sunflower oil. This was followed by a second period rich in palmitic acid in the form of palmolein. Nutrient intakes, serum lipids, lipoproteins, antioxidant vitamins, peroxides and LDL-peroxides were measured at two dietary periods. SETTING: Instituto de Nutrición y Bromatología (CSIC), Departamento de Nutrición y Bromatología I (Nutrición) and Sección Departamental de Quimica Analítica, Universidad Complutense, Madrid, Spain. RESULTS: The palmolein period led to an increase in TC (P < 0.001; 17.7%) and serum apolipoprotein (Apo) B levels (P < 0.001; 18.0%). LDL-C and LDL-Apo B concentrations were higher (P < 0.001, 4.33+/-0.94 mmol/L and P < 0.01, 1.08+/-0.20 g/L, respectively) following this period than following the oleic acid-rich sunflower oil diet (3.56+/-0.85 mmol/L, 0.93+/-0.16g/L, respectively). No significant differences were observed in the TC/high density lipoprotein cholesterol (TC/HDL-C) ratio between the two dietary periods. Serum and LDL-peroxides were lower (P < 0.01, 49.5%, and P < 0.001, 69.0%, respectively) after the palmolein diet than after the oleic acid-rich sunflower oil diet. The palmolein diet significantly increased TC, LDL-C, Apo B, VLDL-ApoB, LDL-ApoB in women with TC > or = 6.21 mmol/L or with TC < 6.21 mmol/L, but the increase in Apo B, LDL-C and LDL-Apo B was greater among the women with high TC. The palmolein diet increased HDL-C in women with high or with low TC but this rise was on the borderline of statistical significance (P = 0.06) only in normocholesterolemics. Serum and LDL-peroxides tended to be higher in women with TC > 6.21 mmol/L than in women with TC < 6.21 mmol/L, but palmolein decreased serum and LDL-peroxide in hypercholesterolemics more than in the normocholesterolemics, resulting in serum and LDL-peroxide levels which theoretically are more adequate. CONCLUSIONS: Though palmolein increased LDL-C concentrations, it better protected LDL particles, mainly in women with high TC, against peroxidation than did oleic acid-rich sunflower oil.

Heterogeneous responsiveness of normolipemic women to n-3 long chain fatty acid supplementation. Changes in serum lipids and apoproteins.

The effect of 10 day-low dosage of n-3 long chain fatty acids (390 mg/day of EPA and 252 mg/day of DHA) on lipid and apolipoprotein (Apo) concentrations has been studied in nine normolipidaemic women aged 28.9 +/- 4.2 years. n-3 fatty acid supplementation did not significantly decrease total cholesterol and triglyceride levels but markedly decreased the Apo A1 and Apo B concentrations (12.7%, p < 0.01 and 23.1%, p < 0.001, respectively), while the Apo A1/Apo B ratio significantly increased (14.8%, p < 0.02). In contrast to the individual variations found for triglycerides and cholesterol, Apo changes indicate a fairly homogeneous response to the fish oil supplement. In seven women Apo A1 decreased (> 10%), whereas Apo B decreased (> 10%) in all of them. The Apo A1/Apo B ratio increased (> 10%) in five of these nine women. Changes in Apo A-1 and Apo B did not significantly correlate with changes in serum lipids. These findings suggest that short-term supplementation with low amount of n-3 long chain fatty acids, EPA and DHA, influences the serum Apo content more than the lipid levels in normolipidaemic women.

[Electrolyte solution with polyethylene glycol to cleanse the colon for colonoscopy or enema]. / Solución electrolítica con polietilenglicol en la limpieza colónica para colonoscopia o colon por enema.

The efficacy and safety of an electrolyte-polyethylene glycol solution (SE-PEG) for colonic lavage, was compared with standard bowel preparation (SBP) in a randomized blinded study of volunteers and patients undergoing colonoscopy and barium enema examination. Side effects, biochemical and hematologic changes and quality of examinations were monitored. Colonoscopy and barium enema was scored by colonic segment for type of residual stool and percentage of bowel wall visualized. For colonoscopy and barium enema, preparation with SE-PEG allowed better visualization and produced more optimal exams (8 vs 3; p less than 0.03) and (6 vs 4; p = NS) respectively. We conclude that colonic lavage with SE-PEG is an alternative bowel preparation method and is cheaper, more safe and effective than SBP procedure.

[Rationale for the use of sodium benzoate in clinical hepatology]. / Benzoato de sodio. Fundamentos para su uso clínico en hepatología.

Sodium benzoate is widely used in the Alimentary Industry at low doses for its antimicrobial action. It has also been used as a liver function test. The principle is to evaluate the liver capacity for conjugation of glycine to benzoic acid and to form hippuric acid which is excreted in the urine. In hyperammonemic syndromes, secondary to enzymatic deficiency of the urea cicle, sodium benzoate has the property to act as an alternative way of nitrogen excretion to urinary hippurate instead of urea. Recently, it has been proposed as a therapeutic alternative in cirrhotic patients with portal systemic encephalopathy. Historical, biochemical and clinical data which constitute the principles to validate its clinical application in Hepatology are reviewed in this manuscript.

Acidifying enemas (lactitol and lactose) vs. nonacidifying enemas (tap water) to treat acute portal-systemic encephalopathy: a double-blind, randomized clinical trial.

A double-blind, controlled trial to study the efficacy of acidifying enemas of lactitol, a new galactoside-sorbitol disaccharide, and lactose vs. nonacidifying tap-water enemas was performed in 45 episodes of acute portal-systemic encephalopathy. At the time of randomization, all patients had encephalopathy of at least Grade 2+ severity, delay in the performance of number connection tests and hyperammonemia. A sequential analysis was performed which revealed after the inclusion of the first 20 patients, a significant failure of the nonacidifying enemas as compared to the lactitol enemas (p less than 0.004). The tap-water enema group was, therefore, suspended but the rest of the study continued after rerandomization for lactose and lactitol groups. A favorable response to treatment was obtained in 19 (86%) of the patients receiving lactitol enemas and in 14 (78%) of those receiving lactose enemas. A similar significant improvement in portal-systemic encephalopathy parameters and index was observed after both treatments. Both types of acidifying enemas induced a significant pH decrease in stool (p less than 0.05). These data suggest that acidifying agents like lactose and lactitol are effective and superior to tap-water enemas for the treatment of acute nitrogenous portal-systemic encephalopathy.