Determination of Factors Associated with Upstage in Atypical Ductal Hyperplasia to Identify Low-Risk Patients Where Active Surveillance May be an Alternative.

BACKGROUND: Excision is routinely recommended for atypical ductal hyperplasia (ADH) found on core biopsy given cancer upstage rates of near 20%. Identifying a cohort at low-risk for upstage may avoid low-value surgery. Objectives were to elucidate factors predictive of upstage in ADH, specifically near-complete core sampling, to potentially define a group at low upstage risk. PATIENTS AND METHODS: This retrospective, cross-sectional, multi-institutional study from 2015 to 2019 of 221 ADH lesions in 216 patients who underwent excision or active observation (≥ 12 months imaging surveillance, mean follow-up 32.6 months) evaluated clinical, radiologic, pathologic, and procedural factors for association with upstage. Radiologists prospectively examined imaging for lesional size and sampling proportion. RESULTS: Upstage occurred in 37 (16.7%) lesions, 25 (67.6%) to ductal carcinoma in situ (DCIS) and 12 (32.4%) to invasive cancer. Factors independently predictive of upstage were lesion size ≥ 10 mm (OR 5.47, 95% CI 2.03-14.77, p < 0.001), pathologic suspicion for DCIS (OR 12.29, 95% CI 3.24-46.56, p < 0.001), and calcification distribution pattern (OR 8.08, 95% CI 2.04-32.00, p = 0.003, "regional"; OR 19.28, 95% CI 3.47-106.97, p < 0.001, "linear"). Near-complete sampling was not correlated with upstage (p = 0.64). All three significant predictors were absent in 65 (29.4%) cases, with a 1.5% upstage rate. CONCLUSIONS: The upstage rate among 221 ADH lesions was 16.7%, highest in lesions ≥ 10 mm, with pathologic suspicion of DCIS, and linear/regional calcifications on mammography. Conversely, 30% of the cohort exhibited all low-risk factors, with an upstage rate < 2%, suggesting that active surveillance may be permissible in lieu of surgery.

Investigating the impact of London's ultra low emission zone on children's health: children's health in London and Luton (CHILL) protocol for a prospective parallel cohort study.

BACKGROUND: Air pollution harms health across the life course. Children are at particular risk of adverse effects during development, which may impact on health in later life. Interventions that improve air quality are urgently needed both to improve public health now, and prevent longer-term increased vulnerability to chronic disease. Low Emission Zones are a public health policy intervention aimed at reducing traffic-derived contributions to urban air pollution, but evidence that they deliver health benefits is lacking. We describe a natural experiment study (CHILL: Children's Health in London and Luton) to evaluate the impacts of the introduction of London's Ultra Low Emission Zone (ULEZ) on children's health. METHODS: CHILL is a prospective two-arm parallel longitudinal cohort study recruiting children at age 6-9 years from primary schools in Central London (the focus of the first phase of the ULEZ) and Luton (a comparator site), with the primary outcome being the impact of changes in annual air pollutant exposures (nitrogen oxides [NOx], nitrogen dioxide [NO2], particulate matter with a diameter of less than 2.5micrograms [PM2.5], and less than 10 micrograms [PM10]) across the two sites on lung function growth, measured as post-bronchodilator forced expiratory volume in one second (FEV1) over five years. Secondary outcomes include physical activity, cognitive development, mental health, quality of life, health inequalities, and a range of respiratory and health economic data. DISCUSSION: CHILL's prospective parallel cohort design will enable robust conclusions to be drawn on the effectiveness of the ULEZ at improving air quality and delivering improvements in children's respiratory health. With increasing proportions of the world's population now living in large urban areas exceeding World Health Organisation air pollution limit guidelines, our study findings will have important implications for the design and implementation of Low Emission and Clean Air Zones in the UK, and worldwide. CLINICALTRIALS: GOV: NCT04695093 (05/01/2021).

Effects of an external pneumatic compression device vs static compression garment on peripheral circulation and markers of sports performance and recovery.

PURPOSE: To identify the effects of a single 30 min partial lower leg external pneumatic compression (EPC) treatment compared to a static compression (SC) garment or a no treatment control (CTL) on markers of recovery and performance following a muscle damaging protocol. METHODS: Thirty healthy, active males (23 ± 3 years; 180.2 ± 9.0 cm; 81.6 ± 11.3 kg) performed 100 drop jumps from a 0.6 m box followed by a randomized, single 30 min treatment of either a partial lower leg EPC device worn below the knee and above the ankle (110 mmHg), SC garment (20-30 mmHg) covering the foot and calf just below the knee, or no treatment CTL, and then returned 24 and 48 h later. Participants were assessed for measures of muscle soreness, fatigue, hemodynamics, blood lactate, muscle thickness, circumferences, and performance assessments. RESULTS: The drop jump protocol significantly increased muscle soreness (p < 0.001), fatigue (p < 0.001), blood flow (p < 0.001), hemoglobin (p < 0.001), and muscle oxygen saturation (SMO2; p < 0.001). Countermovement jump and squat jump testing completed after treatment with either EPC, SC, or CTL revealed no differences for jump height between any condition. However, EPC treatment maintained consistent braking force and propulsive power measures across all timepoints for countermovement jump testing. EPC and SC treatment also led to better maintenance of squat jump performance for average relative propulsive force and power variables at 24 and 48 h compared to CTL. CONCLUSIONS: A single 30 min partial leg EPC treatment may lead to more consistent jump performance following a damaging bout of exercise.

Position-Specific Body Composition Values in Female Collegiate Rugby Union Athletes.

ABSTRACT: Harty, PS, Zabriskie, HA, Stecker, RA, Currier, BS, Moon, JM, Richmond, SR, Jagim, AR, and Kerksick, CM. Position-specific body composition values in female collegiate rugby union athletes. J Strength Cond Res 35(11): 3158-3163, 2021-Rugby union is a full-contact, intermittent team sport. Anthropometric characteristics of rugby union athletes have been shown to influence suitability for a given position and affect performance. However, little anthropometric data exist in female rugby union athletes. Thus, the purpose of this study was to report position-specific anthropometric, body composition, and bone density values in female collegiate rugby union athletes and to identify between-position differences in these variables. This investigation was a cross-sectional study involving 101 female collegiate rugby union athletes, categorized as forwards and backs as well as by position (props, hookers, locks, flankers, number 8 forwards, halfback, fly-half, centers, wings, and fullbacks). Anthropometric characteristics of all athletes were measured, and body composition was assessed via dual-energy x-ray absorptiometry. Outcome variables included age, height, body mass, BMI, body fat percentage, fat mass (FM), FM index, fat-free mass (FFM), FFM index, lean soft tissue, bone mineral content, bone mineral area, and bone mineral density. Anthropometric and body composition differences between forwards and backs were identified via independent t-tests and Mann-Whitney U tests, depending on normality of the variable. Between-position differences were assessed using one-way analysis of variances (ANOVAs) with Tukey post-hoc comparisons or Welch's ANOVA with Dunnett's T3 post-hoc test. Significant differences (p < 0.014) were identified between forwards and backs for every anthropometric variable, with forwards displaying greater height (167.7 ± 7.2 cm), body mass (81.5 ± 15.1 kg), and body fat percentage (28.2 ± 6.1%) relative to backs (164.5 ± 5.1 cm; 64.5 ± 7.7 kg; 21.9 ± 3.7%). Likewise, significant differences were identified for every anthropometric variable between several positions (p < 0.01). Significant (p < 0.05) interposition differences were identified within the subgroup of forwards, but not within the subgroup of backs. The present investigation is the first to report position-specific anthropometric and body composition data in female collegiate rugby union athletes. The results of this study can be used by rugby union coaches for recruiting and personnel decisions, to determine a player's suitability for a given position, and to further inform training and nutritional interventions in this population.

Fine-scale spatial homogenization of microbial habitats: a multivariate index of headwater wetland complex condition.

With growing public awareness that wetlands are important to society, there are intensifying efforts to understand the ecological condition of those wetlands that remain, and to develop indicators of wetland condition. Indicators based on soils are not well developed and are absent in some current assessment protocols; these could be advantageous, particularly for soils, which are complex habitats for plants, invertebrates, and microbial communities. In this study, we examine whether multivariate soil indicators, correlated with microbial biomass and community composition, can be used to distinguish reference standard (i.e., high condition) headwater wetland complexes from impacted headwater wetland complexes in central Pennsylvania, USA. Our reference standard sites existed in forested landscapes, while our impacted sites were situated in multi-use landscapes and were affected by a range of land-use legacies in the 1900s. We found that current assessment protocols are likely underrepresenting sampling needs to accurately represent site mean soil properties. On average, more samples were required to represent soil property means in reference standard sites compared to impacted sites. Reference standard and impacted sites also had noticeably different types of microbial habitats for the two multivariate soil indices assessed, and impacted sites were more homogenized in terms of the fine-scale (i.e., 1 and 5 m) spatial variability of these indices. Our study shows promise for the use of multivariate soil indices as indicators of wetland condition and provides insights into the sample sizes and scales at which soil sampling should occur during assessments. Future work is needed to test the generalizability of these findings across wetland types and ecoregions and establish definitive links between structural changes in microbial habitats and changes in wetland soil functioning.

Upper and lower thresholds of fat-free mass index in a large cohort of female collegiate athletes.

Fat-free mass index (FFMI) is a height-adjusted metric of fat-free mass which has been suggested as a useful method of body composition assessment in athletic populations. The purpose of this study was to determine sport-specific FFMI values and the natural upper threshold of FFMI in female athletes. 372 female collegiate athletes (Mean±SD; 20.03±1.55 years, 167.55±7.50 cm, 69.46±13.04 kg, 24.18±5.48% bodyfat) underwent body composition assessment via dual-energy x-ray absorptiometry. FFMI was adjusted to height via linear regression and sport-specific reference values were determined. Between-sport differences were identified using one-way ANOVA with Tukey post-hoc tests. Average FFMI was 18.82±2.08 kg/m2; height-adjusted values were not significantly different (p<0.05) than unadjusted values. FFMI in rugby athletes (20.09±2.23 kg/m2) was found to be significantly higher (p<0.05) than in gymnastics (18.62±1.12 kg/m2), ice hockey (17.96±1.04 kg/m2), lacrosse (18.58±1.84 kg/m2), swim & dive (18.16±1.67 kg/m2), and volleyball (18.04±1.13 kg/m2). FFMI in cross country (16.56±1.14 kg/m2) and synchronized swimming (17.27±1.47 kg/m2) was significantly lower (p<0.05) than in Olympic weightlifting (19.69±1.98 kg/m2), wrestling (19.15±2.47 kg/m2), and rugby. The upper threshold for FFMI in female athletes (97.5th percentile) was 23.90 kg/m2. These results can be used to guide personnel decisions and assist with long-term body composition, training, and nutritional goals.

Fat-Free Mass Index in a Diverse Sample of Male Collegiate Athletes.

Currier, BS, Harty, PS, Zabriskie, HA, Stecker, RA, Moon, JM, Jagim, AR, and Kerksick, CM. Fat-free mass index in a diverse sample of male collegiate athletes. J Strength Cond Res 33(6): 1474-1479, 2019-Fat-free mass index (FFMI) is a body composition metric that has been used to assess relative muscularity in athletes. Fat-free mass index is calculated by dividing FFM by height squared, although further height corrections through linear regression may be needed in taller individuals. This study reported height-adjusted FFMI (FFMIAdj) data in 209 male collegiate athletes from 10 sports (baseball, cross country, football, golf, ice hockey, weightlifting, rugby, swimming, track and field, and water polo) and the FFMIAdj natural upper limit for sports with sufficient sample size. The body composition of all subjects (mean ± SD; age: 20.7 ± 1.9 years, height: 182.9 ± 6.7 cm, body mass: 90.8 ± 16.8 kg, and percent body fat: 15.6 ± 5.3) was measured using dual-energy x-ray absorptiometry. Linear regression was used to adjust for height, and the FFMIAdj natural upper limit was determined by calculating the 97.5th percentile of all values. One-way analyses of variance with Games-Howell post hoc comparisons were used to determine between-sport differences. A paired-samples t-test revealed a significant difference (p < 0.001) between unadjusted and adjusted mean FFMI values. The overall mean FFMIAdj was 22.8 ± 2.8 kg·m. Significant between-sport differences (p < 0.001) in FFMIAdj were identified. Average FFMIAdj was highest in football athletes (24.28 ± 2.39 kg·m) and lowest in water polo athletes (20.68 ± 3.56 kg·m). The FFMIAdj upper limit was calculated for all athletes (28.32 kg·m), rugby (29.1 kg·m), and baseball (25.5 kg·m). This study reported FFMIAdj values in a diverse cohort of male collegiate athletes, providing data for the first time in several sports. These values can be used to guide nutritional and exercise interventions, predict athletic performance, and provide coaches with standardized information regarding the potential for further FFM accretion in male athletes.

Community pharmacy transition of care services and rural hospital readmissions: A case study.

OBJECTIVES: To explore community pharmacist involvement in the transition of care (TOC) process for patients discharged with acute myocardial infarction (AMI), heart failure (HF), pneumonia, chronic obstructive pulmonary disease (COPD), or elective total hip or knee arthroplasty (THA/TKA). SETTING: Patients discharged from a 60-bed acute care hospital located in rural Missouri were seen by a community pharmacist in 2 independent community pharmacy locations. PRACTICE INNOVATION: Patients admitted with 1 of the 5 qualifying conditions and identifying the participating pharmacy as their primary pharmacy spoke with a community pharmacist within 72 hours of discharge to complete a comprehensive medication review. A follow-up telephone call occurred 7 days after the encounter to evaluate for drug-related problems, adherence, and key information recalled from the previous visit. A final telephone call occurred on the 30th day after discharge to assess for hospital readmissions and emergency department (ED) visits. EVALUATION: Number of patients readmitted or visiting the ED within 30 days after discharge. RESULTS: Of the 9 patients completing the study, none were readmitted or visited the ED within 30 days after discharge. All of the participants were satisfied with the care and education provided by pharmacists. The majority of patients recalled points related to specific medication education topics. Based on the adherence tool, 8 of the 9 study participants had at least 1 barrier to medication access or adherence that could lead to post-discharge medication-related problems. CONCLUSION: Community pharmacist involvement in the TOC process may help to prevent readmissions for patients with AMI, HF, pneumonia, COPD, and elective THA/TKA. Patients are overall satisfied with community pharmacist involvement as they move from inpatient care to home. In addition, there are multiple barriers affecting access and adherence to medication therapy while at home, providing opportunities for pharmacist intervention and assistance.

It's Dead! Can Postbiotics Really Help Performance and Recovery? A Systematic Review.

In recent years, postbiotics have increased in popularity, but the potential relevancy of postbiotics for augmenting exercise performance, recovery, and health is underexplored. A systematic literature search of Google Scholar and PubMed databases was performed with the main objective being to identify and summarize the current body of scientific literature on postbiotic supplementation and outcomes related to exercise performance and recovery. Inclusion criteria for this systematic review consisted of peer-reviewed, randomized, double-blind, and placebo-controlled trials, with a population including healthy men or women >18 years of age. Studies required the incorporation of a postbiotic supplementation regimen and an outcome linked to exercise. Search terms included paraprobiotics, Tyndallized probiotics, ghost biotics, heat-killed probiotics, inactivated probiotics, nonviable probiotics, exercise, exercise performance, and recovery. Only investigations written in English were considered. Nine peer-reviewed manuscripts and two published abstracts from conference proceedings were included and reviewed. Supplementation periods ranged from 13 days to 12 weeks. A total of 477 subjects participated in the studies (n = 16-105/study) with reported results spanning a variety of exercise outcomes including exercise performance, recovery of lost strength, body composition, perceptual fatigue and soreness, daily logs of physical conditions, changes in mood states, and biomarkers associated with muscle damage, inflammation, immune modulation, and oxidative stress. Early evidence has provided some indication that postbiotic supplementation may help to support mood, reduce fatigue, and increase the readiness of athletes across several weeks of exercise training. However, more research is needed to further understand how postbiotics may augment health, resiliency, performance, and recovery. Future investigations should include longer supplementation periods spanning a wider variety of competitive athletes and exercising populations.

Evaluating the effects of PeakATP® supplementation on visuomotor reaction time and cognitive function following high-intensity sprint exercise.

The purpose of this study was to examine the effects of 14-days adenosine 5'-triphosphate (ATP) supplementation (PeakATP®) on reaction time (RT), multiple object tracking speed (MOT), mood and cognition. Twenty adults (22.3 ± 4.4 yrs., 169.9 ± 9.5 cm, 78.7 ± 14.6 kg) completed two experimental trials in a double-blind, counter-balanced, crossover design. Subjects were randomized to either PeakATP® (400 mg) or placebo (PLA) and supplemented for 14-days prior to each trial. During each trial, subjects completed a three-minute all-out test on a cycle ergometer (3MT), with measures of visuomotor RT [Dynavision D2 Proactive (Mode A) and Reactive (Mode B) tasks], MOT (Neurotracker), mood (Profile of Mood States Questionnaire; POMS) and cognition (Automated Neuropsychological Assessment Metrics; ANAM) occurring before (PRE), immediately post (IP) and 60 min post-3MT (60P). Subjects ingested an acute dose of the assigned supplement 30 min prior to completing PRE assessments for each trial. Trials were separated by a 14-day washout period. PeakATP® significantly attenuated declines in hits (p = 0.006, ηp2 = 0.235) and average RT (AvgRT, p = 0.006, ηp2 = 0.236) in Mode A, significantly improved AvgRT (p = 0.039, ηp2 = 0.174) in Mode B, and significantly reduced the total number of misses (p = 0.005, ηp2 = 0.343) in Mode B. No differences between treatments were noted for MOT, POMS or ANAM variables. In conclusion, these results indicate that PeakATP® maintains proactive RT and improves reactive RT following high-intensity sprint exercise suggesting that supplemental ATP may mitigate exercise induced cognitive dysfunction.

The Effects of Two Weeks of Oral PeakATP® Supplementation on Performance during a Three-Minute All out Test.

Exogenous ATP has been shown to increase total weight lifted during resistance training interventions and attenuate fatigue during repeated Wingate assessments. However, the influence of exogenous ATP on single bout maximal effort performance has yet to be examined. The purpose of this study was to investigate the effects of PeakATP® supplementation on performance during a 3-min all-out test (3MT). Twenty adults (22.3 ± 4.4 years, 169.9 ± 9.5 cm, 78.7 ± 14.6 kg) completed two identical 3MT protocols in a double-blind, counter-balanced, crossover design. Participants were randomized to either PeakATP® (400 mg·day-1) or placebo (PLA) treatments and consumed their assigned supplement for 14 days and ingested an acute dose 30 min before each 3MT. A 14-day wash-out period was completed between each supplementation period and subsequent 3MT. Peak power, time to peak power, work above end power, end power, and fatigue index were assessed during each 3MT. Dependent t-tests and Hedge's g effect sizes were used to assess differences between treatments. No significant differences were observed between treatments for 3MT performance (p > 0.05). These findings indicate that 3MT performance was not significantly impacted by PeakATP® supplementation. This may be due in part to the continuous nature of the 3MT as disodium ATP has been shown to be beneficial for repeated bout activities.

Gilchrist's Hollow Lung.

Blastomycosis is an endemic mycosis in certain parts of North America. The dimorphic fungus can manifest with both pulmonary and extrapulmonary features. We present the case of a 24-year-old African American male with a history of vaping and daily marijuana who presented with hemoptysis and a cough of one-week duration. He was initially treated as community-acquired pneumonia (CAP). The patient had a bronchoscopy with bronchoalveolar lavage (BAL) done in the posterior segment of the right upper lobe. Cultures grew methicillin-resistant Staphylococcus aureus (MRSA), followed by Blastomyces dermatitidis in the histopathologic examination. Chronic pulmonary blastomycosis may present with hemoptysis, weight loss, chronic cough, and night sweats, along with upper lobe predominant cavitation. We have to exclude tuberculosis (TB), lung cancer, and chronic pulmonary histoplasmosis. This case epitomizes many classic perils in the identification of pulmonary blastomycosis. The patient was being treated with itraconazole 200 mg BID for 12 months as per infectious disease suggestion. The patient is nine months into treatment. At six months, his chest computed tomography (CT) revealed a reduction in size from 5.0 × 5.3 cm to 4.2 × 4.0 cm. Although there are no articles supporting increased secondary bacterial infections with underlying fungal infections, more research needs to be done to find any associated features.

COVID-19-Related Left-Sided Ptosis.

The coronavirus disease 2019 (COVID-19) infection commonly presents with symptoms of fever, cough, and anosmia. However, there have been case reports of unusual symptoms associated with COVID-19. We encountered one such case where a 55-year-old male who tested positive for COVID-19 was noted to have, along with cough and vomiting, a new onset of left eyelid ptosis. COVID-19 infection and ptosis association is seldom seen and very few similar studies are reported.

Naturally Bicarbonated Water Supplementation Does Not Improve Anaerobic Cycling Performance or Blood Gas Parameters in Active Men and Women.

The completion of high-intensity exercise results in robust perturbations to physiologic homeostasis, challenging the body's natural buffering systems to mitigate the accumulation of metabolic by-products. Supplementation with bicarbonate has previously been used to offset metabolic acidosis, leading to improvements in anaerobic exercise performance. PURPOSE: The purpose of this study was to investigate the presence of ergogenic properties in naturally occurring low-dose bicarbonated water and their effects on anaerobic cycling performance and blood gas kinetics in recreationally active men and women. METHODS: Thirty-nine healthy, recreationally active men and women (28.1 ± 8.0 years, 169.8 ± 11.7 cm, 68.9 ± 10.8 kg, 20.1 ± 7.9% fat, V˙O2peak: 42.8 ± 7.6 mL/kg/min) completed two separate testing sessions consisting of 15 cycling sprints (10 s sprint, 20 s active rest) against 7.5% of their body mass. Using a randomized, double-blind, placebo-controlled, parallel group study design, study participants consumed a 10 mL/kg dose of either spring water (SW) or bicarbonated mineral water (BMW) (delivering ~3 g/day of bicarbonate) for 7 days. Venous blood was collected before, immediately after, and 5 and 10 min after the sprint protocol and was analyzed for lactate and a series of blood gas components. After the completion of 15 cycling sprints, averages of peak and mean power for bouts 1-5, 6-10, and 11-15, along with total work for the entire cycling protocol, were calculated. All performance and blood gas parameters were analyzed using a mixed-factorial ANOVA. RESULTS: pH was found to be significantly higher in the BMW group immediately after (7.17 ± 0.09 vs. 7.20 ± 0.11; p = 0.05) and 10 min post exercise (7.21 ± 0.11 vs. 7.24 ± 0.09; p = 0.04). A similar pattern of change was observed 5 min post exercise wherein pH levels in the SW group were lower than those observed in the BMW group; however, this difference did not achieve statistical significance (p = 0.09). A statistical trend (p = 0.06) was observed wherein lactate in the BMW group tended to be lower than in the SW group 5 min post exercise. No significant main effect for time (p > 0.05) or group × time interactions (p > 0.05) for the total work, average values of peak power, or average values of mean power were observed, indicating performance was unchanged. CONCLUSION: One week of consuming water with increased bicarbonate (10 mL/kg; ~3 g/day bicarbonate) showed no effect on anaerobic cycling performance. BMW decreased blood lactate concentrations 5 min after exercise and increased blood pH immediately and 10 min after exercise.

Focused ultrasound neuromodulation of the spleen activates an anti-inflammatory response in humans.

Focused ultrasound stimulation (FUS) activates mechanosensitive ion channels and is emerging as a method of noninvasive neuromodulation. In preclinical studies, FUS of the spleen (sFUS) activates an anti-inflammatory neural pathway which suppresses acute and chronic inflammation. However, the relevance of sFUS for regulating inflammatory responses in humans is unknown. Here, we used a modified diagnostic ultrasound imaging system to target the spleen of healthy human subjects with 3 min of continuously swept or stationary focused pulsed ultrasound, delivered at three different energy levels within allowable safety exposure limits. Potential anti-inflammatory effects of sFUS were assessed by measuring sFUS-elicited changes in endotoxin-induced tumor necrosis factor (TNF) production in whole blood samples from insonified subjects. We found that stimulation with either continuously swept or focused pulsed ultrasound has an anti-inflammatory effect: sFUS lowers TNF production for >2 h, with TNF returning to baseline by 24 h following sFUS. This response is independent of anatomical target (i.e., spleen hilum or parenchyma) or ultrasound energy level. No clinical, biochemical, or hematological parameters are adversely impacted. This is the first demonstration that sFUS suppresses the normal inflammatory response in humans, with potential implications for noninvasive bioelectronic therapy of inflammatory disorders.

Corrigendum: A randomized controlled trial to examine the impact of a multi-strain probiotic on self-reported indicators of depression, anxiety, mood, and associated biomarkers.

[This corrects the article DOI: 10.3389/fnut.2023.1219313.].

A randomized controlled trial to examine the impact of a multi-strain probiotic on self-reported indicators of depression, anxiety, mood, and associated biomarkers.

Objective: To examine the efficacy of supplementing with a multi-strain probiotic (MSP) on changes associated with mood, anxiety, and neurotransmitter levels. Method: In a randomized, double-blind, placebo-controlled fashion, 70 healthy men and women (31.0 ± 9.5 years, 173.0 ± 10.4 cm, 73.9 ± 13.8 kg, 24.6 ± 3.5 kg/m2) supplemented with a single capsule of MSP (a total daily dose of 4 × 109 colony forming units [CFU] comprised of a 1 × 109 CFU dose from each of the following strains: Limosilactobacillus fermentum LF16, Lacticaseibacillus rhamnosus LR06, Lactiplantibacillus plantarum LP01, and Bifidobacterium longum 04, Probiotical S.p.A., Novara, Italy) or a maltodextrin placebo (PLA). After 0, 2, 4, and 6 weeks of supplementation and 3 weeks after ceasing supplementation, study participants completed the Beck Depression Inventory (BDI-II), State-Trait Anxiety Inventory (STAI), and Leiden Index of Depression Sensitivity (LEIDS-R) questionnaires and had plasma concentrations of cortisol, dopamine, serotonin, and C-reactive protein determined. Results: BDI, STAI, and total LEIDS-R scores were reduced from baseline (p < 0.05) with MSP supplementation after 4 and 6 weeks of supplementation and 3 weeks after supplementation while no changes (p > 0.05) were reported in PLA. When compared to PLA, MSP scores for state anxiety, trait anxiety, and LEIDS-R (hopeless, aggression, rumination, and total score) were significantly lower (p < 0.05) after supplementation. Plasma serotonin concentrations in MSP were increased from baseline after 6 weeks of supplementation and 3 weeks after ceasing supplementation. No changes (p > 0.05) in plasma dopamine, C-reactive protein, or cortisol concentrations were observed between groups. Conclusion: MSP supplementation resulted in widespread improvements in several questionnaires evaluating mood, anxiety, and depression in young, healthy men and women. MSP supplementation increased serotonin increased after 6 weeks of MSP supplementation with no change in dopamine, C-reactive protein, or cortisol. Clinical trial registration: https://classic.clinicaltrials.gov/ct2/show/NCT05343533, NCT05343533.

Metabolic impact of feeding prior to a 60-min bout of moderate-intensity exercise in females in a fasted state.

Background: The metabolic impact of pre-exercise feeding of protein or carbohydrate on fat oxidation and energy expenditure rates, especially, in females, is poorly understood. Methods: Recreationally active females (n = 15, 32 ± 10 years, 164.8 ± 5.6 cm, 63.5 ± 9.3 kg, 23.4 ± 3.2 kg/m2) completed four testing sessions in a randomized, double-blind, crossover fashion after fasting overnight. Participants ingested isovolumetric and isoenergetic solutions containing either 25 g of whey protein, casein protein, carbohydrate (CHO), or a non-caloric placebo (PLA). Participants then completed 60 min of treadmill exercise at 15% below ventilatory threshold 30 min after ingestion. Respiratory exchange ratio (RER) was evaluated throughout exercise and resting energy expenditure (REE) was assessed pre-exercise, and 0-, 60-, and 120-min post-exercise. Results: A significant condition x time interaction was observed for RER (p = 0.008) during exercise, with CHO exhibiting higher RER values (vs. PLA) at four time points. A significant main effect for condition was observed for carbohydrate (p = 0.001) and fat (p = 0.02) oxidation rates during exercise, with fat oxidation rates being higher in PLA vs. CHO (p = 0.01). When total fat oxidized was calculated across the entire exercise bout, a significant main effect for condition was observed (p = 0.01), with PLA being greater than CHO (p = 0.04). A significant condition x time interaction (p = 0.02) was found for both absolute and normalized REE, with casein and whey protein having significantly higher values than CHO (p < 0.05) immediately post-exercise. Conclusion: When compared to a fasted control (PLA), consuming CHO, but not protein, decreased total fat oxidation prior to a 60-min bout of moderate-intensity exercise in females.

Absorption Kinetics of Berberine and Dihydroberberine and Their Impact on Glycemia: A Randomized, Controlled, Crossover Pilot Trial.

Berberine is a natural alkaloid used to improve glycemia but displays poor bioavailability and increased rates of gastrointestinal distress at higher doses. Recently, dihydroberberine has been developed to combat these challenges. This study was designed to determine the rate and extent to which berberine appeared in human plasma after oral ingestion of a 500 mg dose of berberine (B500) or 100 mg and 200 mg doses of dihydroberberine (D100 and D200). In a randomized, double-blind, crossover fashion, five males (26 ± 2.6 years; 184.2 ± 11.6 cm; 91.8 ± 10.1 kg; 17.1 ± 3.5% fat) completed a four-dose supplementation protocol of placebo (PLA), B500, D100, and D200. The day prior to their scheduled visit, participants ingested three separate doses with breakfast, lunch, and dinner. Participants fasted overnight (8-10 h) and consumed their fourth dose with a standardized test meal (30 g glucose solution, 3 slices white bread) after arrival. Venous blood samples were collected 0, 20, 40, 60, 90, and 120 minutes (min) after ingestion and analyzed for BBR, glucose, and insulin. Peak concentration (CMax) and area under the curve (AUC) were calculated for all variables. Baseline berberine levels were different between groups (p = 0.006), with pairwise comparisons indicating that baseline levels of PLA and B500 were different than D100. Berberine CMax tended to be different (p = 0.06) between all conditions. Specifically, the observed CMax for D100 (3.76 ± 1.4 ng/mL) was different than PLA (0.22 ± 0.18 ng/mL, p = 0.005) and B500 (0.4 ± 0.17 ng/mL, p = 0.005). CMax for D200 (12.0 ± 10.1 ng/mL) tended (p = 0.06) to be different than B500. No difference in CMax was found between D100 and D200 (p = 0.11). Significant differences in berberine AUC were found between D100 (284.4 ± 115.9 ng/mL × 120 min) and PLA (20.2 ± 16.2 ng/mL × 120 min, p = 0.007) and between D100 and B500 (42.3 ± 17.6 ng/mL × 120 min, p = 0.04). Significant differences in D100 BBR AUC (284.4 ± 115.9 ng/mL×120 min) were found between PLA (20.2 ± 16.2 ng/mL × 120 min, p = 0.042) and B500 (42.3 ± 17.6 ng/mL × 120 min, p = 0.045). Berberine AUC values between D100 and D200 tended (p = 0.073) to be different. No significant differences in the levels of glucose (p = 0.97) and insulin (p = 0.24) were observed across the study protocol. These results provide preliminary evidence that four doses of a 100 mg dose of dihydroberberine and 200 mg dose of dihydroberberine produce significantly greater concentrations of plasma berberine across of two-hour measurement window when compared to a 500 mg dose of berberine or a placebo. The lack of observed changes in glucose and insulin were likely due to the short duration of supplementation and insulin responsive nature of study participants. Follow-up efficacy studies on glucose and insulin changes should be completed to assess the impact of berberine and dihydroberberine supplementation in overweight, glucose intolerant populations.