[New solutions for an old problem : Current developments in oral contrast agents]. / Neue Lösung für ein altes Problem : Aktuelle Entwicklungen bei oralen Kontrastmitteln.

BACKGROUND: Several radiological societies in Europe have so far spoken out in favor of MRI of the small intestine over CT, since MRI is said to provide more detailed image information. Due to the limited availability of MRI machines, long waiting times arise for many patients who clinically require small bowel imaging. OBJECTIVES: These circumstances guided our search for an improved CT technique that would provide scans that mimic the image impression of T1 sequence in MRI, i.e. with IV contrast-enhanced intestinal wall versus low/no signal lumen. MATERIAL AND METHODS: The oral use of fat or oil is poorly tolerated by patients, as is the placement of a naso-duodenal tube for air insufflation. We have now succeeded in creating a foamy drink with 44% air content, which is kept stable by protein together with buffers, and can be easily administered orally. CT with the Lumentin® beverage as bowel filling agent has been tested on healthy adult volunteers; oncology patients; and Crohn's disease patients who, for comparison, also underwent MRI of the small bowel with conventional oral contrast. RESULTS: The results so far with Lumentin® show a very good distribution throughout the entire small intestine with good lumen distension, images with strongly enhanced contrast of the intestinal mucosa, and lesions that are detected at the same or increased frequency as compared with MRI. Side effects were few and mild, and overall fewer than with commonly used oral agents. Lumentin's foamy consistency was unfamiliar to a few patients, but it wasn't difficult to drink. CONCLUSIONS: The new and innovative luminal HU-negative contrast agent Lumentin® improves the diagnostic CT image quality. In addition, Lumentin® experimental MRI tests have provided promising results, which are currently leading to further clinical MRI studies.

A novel food-based negative oral contrast agent compared with two conventional oral contrast agents in abdominal CT: a three-arm parallel blinded randomised controlled single-centre trial.

BACKGROUND: A negative oral contrast agent (OCA) has been long sought for, to better delineate the bowel and visualise surrounding structures. Lumentin® 44 (L44) is a new OCA formulated to fill the entire small bowel. The aim of this study was to compare L44 with positive and neutral conventional OCA in abdominal computed tomography (CT). METHODS: Forty-five oncologic patients were randomised to receive either L44 or one of the two comparators (MoviPrep® or diluted Omnipaque®). Abdominal CT examinations with intravenous contrast agent were acquired according to standard protocols. The studies were read independently by two senior radiologists. RESULTS: The mean intraluminal Hounsfield units (HU)-values of regions-of-interest (ROIs) for each subsegment of small bowel and treatment group were -404.0 HU for L44, 166.1 HU for Omnipaque®, and 16.7 HU for MoviPrep® (L44 versus Omnipaque, p < 0.001: L44 versus MoviPrep p < 0.001; Omnipaque versus MoviPrep, p = 0.003). Adverse events, only mild, using L44 were numerically fewer than for using conventional oral contrast agents. Visualisation of abdominal structures beyond the small bowel was similar to the comparators. CONCLUSIONS: L44 is a negative OCA with luminal radiodensity at approximately -400 HU creating a unique small bowel appearance on CT scans. The high bowel wall-to-lumen contrast may enable improved visualisation in a range of pathologic conditions. L44 showed a good safety profile and was well accepted by patients studied. TRIAL REGISTRATION: EudraCT (2017-002368-42) and in ClinicalTrials.gov (NCT03326518).

Cultivation of the gut bacterium Prevotella copri DSM 18205T using glucose and xylose as carbon sources.

Prevotella copri DSM18205T is a human gut bacterium, suggested as a next-generation probiotic. To utilize it as such, it is, however, necessary to grow the species in a reproducible manner. Prevotella copri has previously been reported to be highly sensitive to oxygen, and hence difficult to isolate and cultivate. This study presents successful batch cultivation strategies for viable strain inoculations and growth in both serum bottles and a stirred tank bioreactor (STR), without the use of an anaerobic chamber, as long as the cells were kept in the exponential growth phase. A low headspace volume in the STR was important to reach high cell density. P. copri utilized xylose cultivated in Peptone Yeast Xylose medium (PYX medium), resulting in a comparable growth rate and metabolite production as in Peptone Yeast Glucose medium (PYG medium) in batch cultivations at pH 7.2.Up to 5 g/L of the carbon source was consumed, leading to the production of succinic acid, acetic acid, and formic acid, and cell densities (OD620 nm ) in the range 6-7.5. The highest yield of produced succinic acid was 0.63 ± 0.05 g/g glucose in PYG medium cultivations and 0.88 ± 0.06 g/g xylose in PYX medium cultivations.

Liking, preference and practical implications of protein and energy enriched in-between-meals designed for elderly people.

BACKGROUND: An adequate dietary intake, especially of protein and energy, is important for maintaining health among elderly people, especially those in care homes. One strategy to ensure nutritional intake is to customise attractive products through enrichment to match the needs of elderly people in care homes. OBJECTIVE: To evaluate liking and practical aspects of protein and energy enriched in-between meals designed for elderly people in care homes through the use of quantitative and qualitative assessments. DESIGN: A broad range of energy and protein enriched in-between meals, including both savoury and sweet products, were included. The products were evaluated by a consumer test and a focus group discussion with elderly respondents. The products were also evaluated by a second focus group discussion with care staff. RESULTS: The most liked products were ice cream and cheesecake. All products achieved high scores for appearance, taste/flavour and texture. No product included in the study was extremely disliked. However, the least liked product was tomato soup, which scored above the middle of the scale except for texture. It was clear from the focus group discussions that a colourful appearance, small portion size and texture were of primary importance. The temperature had an impact on liking and swallowability. DISCUSSION: Most products were perceived by the elderly participants as appealing and tasting good, and possible to include in a daily diet. It was clear that the colours of the foods were of primary importance. In line with other studies, it was found that highly liked in-between meals were frozen, cold and sweet. These products were also easy to swallow. CONCLUSIONS: It is possible to produce highly liked energy and protein enriched in-between meal products designed for elderly people. The temperature had a great impact on the liking of texture, taste and flavour. In-between meals should preferably be colourful and have a small portion size.

A novel food-based foam as oral contrast agent with negative Hounsfield units for demarcation of small bowel loops on abdominal CT: tolerability and bowel distension in 25 volunteers.

BACKGROUND: Diseases of the bowel are not always displayed on conventional abdominal computed tomography (CT). The studied oral contrast agent aims to improve this. PURPOSE: To investigate whether the use of a novel oral contrast for abdominal CT enables the same diagnostic advantages as seen in magnetic resonance imaging (MRI). MATERIAL AND METHODS: Twenty-five consented volunteers drank up to 1400 mL of a stable, drinkable foam. Comments on acceptance and side effects were noted immediately and 24 h later. Foam palatability was documented through interviews, and distribution in the small bowel by Hounsfield units from the CT software. The CT results were compared with age- and sex-matched controls, pretreated according to routine. A non-enhanced abdominal CT protocol of lowest possible radiation dose was used. External referees evaluated all data obtained. RESULTS: Foam was considered odd to swallow, and fullness was reported by all volunteers after 950 mL. Five had difficulties in drinking the last 320 mL and two abstained from it. All adverse symptoms were mild. The distribution in the small bowel was on par with standard agents. Foam density revealed stability with intraluminal values of around -550 HU from stomach to terminal ileum, satisfying the requirement of a great bowel lumen-to-wall contrast. External reviewers re-evaluated all our data, and one predicted the foam to offer a potential for improved diagnostics. CONCLUSION: A CT true-negative bowel filling agent was formulated, with high acceptance, few side effects, and a potential to mimic T1-weighted MRI images.