The effects and potential mechanisms of essential metals on the associations of polycyclic aromatic hydrocarbons with blood cell-based inflammation markers.

BACKGROUND: Polycyclic aromatic hydrocarbons (PAHs) are well-acknowledged pro-inflammatory chemicals, but their associations with blood cell-based inflammatory biomarkers need further investigation. Moreover, the effects and mechanisms of essential metals on PAH-related inflammation remain poorly understood. OBJECTS: To elucidate the associations of PAHs on inflammatory biomarkers, as well as the effects and mechanisms of essential metals on these associations. METHODS: A cross-sectional study was conducted on 1388 coke oven workers. We analyzed the modification effects of key essential metal(s) on PAHs-inflammatory biomarkers associations. To explore the possible mechanisms from an inflammation perspective, we performed a bioinformatic analysis on the genes of PAHs and essential metals obtained from the Comparative Toxicogenomics Database (CTD) and performed a mediation analysis. RESULTS: We observed associations of PAHs and essential metals with lymphocyte-to-monocyte ratio (LMR) (P < 0.05). PAH mixtures were inversely associated with LMR (ßQGC-index = -0.18, P < 0.001), with 1-hydroxypyrene (1-OH-Pyr) being the most prominent contributor (weight = 63.37%), whereas a positive association between essential metal mixtures and LMR was observed (ßQGC-index = 0.14, P < 0.001), with tin being the most significant contributor (weight = 51.61%). An inverse association of 1-OH-Pyr with LMR was weakened by increased tin exposure (P < 0.05). The CTD database showed that PAHs and tin compounds co-regulated 22 inflammation-associated genes, but they regulated most genes in opposite directions. Further identified the involvement of oxidative stress and mediation analysis showed that the mediation effect of 8-hydroxydeoxyguanosine (8-OHdG) on 1-OH-Pyr-LMR association presented heterogeneity between low and high tin tertile groups (I2 = 37.84%). CONCLUSION: 1-OH-Pyr and tin were significantly associated with LMR. Modification effects indicated that the inverse association of 1-OH-Pyr with LMR was mitigated with an increase in tin. The mediation effect of 8-OHdG on the inverse association of 1-OH-Pyr with LMR may be partially dependent on tin.

Pyroptosis-Related Gene Signature Predicts Prognosis and Response to Immunotherapy and Medication in Pediatric and Young Adult Osteosarcoma Patients.

Purpose: Pyroptosis, a new form of inflammatory programmed cell death, has recently gained attention. However, the impact of the expression levels of pyroptosis-related genes (PRGs) on the overall survival (OS) of osteosarcoma patients remains unclear. This study aims to investigate the impact of the expression levels of PRGs on the OS of pediatric and young adult patients with osteosarcoma. Patients and Methods: Transcriptome matrix datasets of normal muscle or skeletal tissues from the Genotype-Tissue Expression (GTEx) project and osteosarcoma specimen the National Cancer Institute's (NCI) Therapeutically Applicable Research to Generate Effective Treatments (TARGET) database were used to identify pyroptosis-related genes (PRGs) associated with prognosis. The National Center for Biotechnology Information's (NCBI) GSE21257 dataset was employed to validate the predictive value of the pyroptosis-related signature (PRS). Additionally, reverse transcription polymerase chain reaction (RT-qPCR) experiment was performed in normal and osteosarcoma cell lines. Results: The study identified 18 differentially expressed PRGs (DEPRGs) between normal muscle or skeletal tissues and tumor samples. Multiple machine learning techniques were used to select PRGs, resulting in the identification of four hub PRGs. A PRS-score was calculated for each sample based on the expression of these four hub PRGs, and samples were categorized into low and high PRS-score level groups. It was confirmed that metastatic status and PRS-score level are independent prognostic predictors. A nomogram model for predicting OS of osteosarcoma patients was constructed. Single-cell RNA-sequencing data display the expression patterns of the hub PRGs. RT-qPCR data results were found to be consistent with the differential expression analysis performed on TARGET and GTEx samples. Conclusion: The study developed a novel pyroptosis-related gene signature that can stratify pediatric and young adult osteosarcoma patients into different risk groups, thus predicting their response to immunotherapy and chemotherapy.

The synergistic effect of κ-carrageenan and l-lysine on the 3D printability of yellow flesh peach gels: The importance of material elasticity in the printing process.

This study investigated the effect of κ-carrageenan and l-lysine on the physical, chemical and textural properties of yellow flesh peaches and their suitability for 3D printing. The addition of κ-carrageenan and l-lysine was found to improve the apparent viscosity, elasticity, gel strength, and Young's modulus of the yellow flesh peach with κ-carrageenan and l-lysine gels (PCLG) and increase the minimum piston pressure required for 3D printing, thereby improving the printing performance. Optimum levels of κ-carrageenan and l-lysine (0.1 mmol/mL and 3.42 × 10-2 mmol/mL, respectively) were found to enhance mechanical strength, viscoelasticity and print fidelity. On the other hand, when the addition of κ-carrageenan is 0.1 mmol/mL, the addition of l-lysine causes an increase in the G0 value and a decrease in the η0 value of the PCLG according to Burger's model, indicating a transition from viscosity to elasticity and an increase in maximum extrusion force, while the apparent viscosity does not change significantly. The results of 3D printing showed that when the addition of κ-carrageenan and l-lysine reached 0.1 mmol/mL and 6.84 × 10-2 mmol/mL, respectively, the PCLG could not be smoothly extruded, indicating that elasticity also plays an important role during the extrusion process of the mixed gel.

Association of breakfast, total diet quality, and mental health in adolescents: a cross-sectional study of HBSC in Greece.

The emerging field of nutritional psychiatry offers proof that diet quality can be changed to reduce one's risk of developing mental illness. What you eat has a big impact on teenage mental health, and the quality and frequency of breakfast, as well as the different food groups, can affect adolescent mental health. In this study, regression models were employed to analyze four indicators (self-rated health, body satisfaction, life satisfaction, and eight symptoms) of mental health problems as well as demographic factors (gender, age, body mass index, affluence class, physical activity), with forest plots displaying the regression connections. This study, a descriptive cross-sectional survey of 3480 adolescents aged 11 to 15 years, chosen data from the 2018 Greek Health Behaviour in School-aged Children (HBSC) International Study for secondary analysis. The data revealed that high levels of four indicators of mental health (self-rated health, body satisfaction, life satisfaction, and eight symptoms) were significantly related to breakfast quality, total dietary patterns. Students reporting poor total food quality, for example, were more predictive of self-assessment when unhealthy (2.286 95% CI 1.851-2.824), and the largest connections with eating a "bad" breakfast were discovered when the eight symptoms of mental status were the worst (- 0.869 95% CI: - 1.300, - 0.439); physical activity may enhance the positive relationship of diet quality on mental health, while obesity weakens this positive relationship; and age patterns varied by gender, with girls and older individuals showing a higher risk of diet quality and mental health.   Conclusions: The findings revealed that each of the four indices of general mental health was correlated with teenage breakfast and overall diet quality. Physical activity and weight were shown to be moderating factors, and obesity had the biggest impact on psychological risk. Gender, age, and family economic inequality were potential explanations for the rise in psychological symptoms. Researchers are urged to focus more on nutritional psychiatry research and look into psychological perception disparities in the future. What is Known: • There is a potential correlation between adolescent dietary patterns or quality and mental health. • Factors such as age, gender, socio-economic status, body weight and physical activity all have an impact on diet and mental health outcomes. What is New: • There have been no studies of the ability to simultaneously predict breakfast quality and overall diet quality for broadly defined mental health complaints [positive (life satisfaction), neutral (body satisfaction, self-rated health) and negative (eight symptoms: depressed mood, irritability, nervousness, difficulty sleeping, dizziness, headache, stomachache and backache)]. • Differences in overall diet quality trends between demographic subgroups remain unclear.

Fabrication of anthocyanin-rich W1/O/W2 emulsion gels based on pectin-GDL complexes: 3D printing performance.

The stability of anthocyanin-rich W1/O/W2 double emulsions prepared with Nicandra physalodes (Linn.) Gaertn. Seeds pectin was investigated, including droplet sizes, ζ-potential, viscosity, color, microstructures and encapsulation efficiency. Furthermore, the gelation behavior, rheological behavior, texture behavior and three-dimensional (3D) printing effects of the W1/O/W2 emulsion gels induced with Glucono-delta-lactone (GDL) were studied. The L*, b*, ΔE, droplet sizes and ζ-potential of the emulsions were gradually increased, while other indicators were gradually decreased during 28 days of storage under 4 ℃. The storage stability of sample under storage at 4 ℃ was higher than 25 ℃. The G' of W1/O/W2 emulsion gels gradually boosted with increased GDL addition, and reached the highest after the addition of 1.6 % GDL. In creep-recovery sweep, the minimum strain of 1.68 % and the highest recovery rate of 86 % were also found for the emulsion gels with 1.6 % GDL. Accordingly, the models "KUST", hearts, flowers printed by emulsion gels after 60 min addition of 1.6 % GDL had the best printing effects. The W1/O/W2 emulsion gels based on pectin-GDL complexes exhibited good performance in protecting anthocyanins and suggested as a potential ink for food 3D printing.

Associations of co-exposure to polycyclic aromatic hydrocarbons and metals with hyperuricemia risk in Chinese coke oven workers: Mediating roles of oxidative damage.

Ubiquitous polycyclic aromatic hydrocarbons (PAHs) and metals could induce hyperuricemia and oxidative damage individually, while their co-exposure effects on hyperuricemia risk and the potential roles of oxidative damage in these health outcomes remain poorly understood. We conducted a cross-sectional study in 1379 coke oven workers. We evaluated the levels of PAH-metal exposure and oxidative damage by urinary monohydroxy-PAHs, plasma benzo [a]pyrene-7,8-diol-9,10-epoxide-albumin (BPDE-Alb) adducts, urinary metals, urinary 8-iso-prostaglandin-F2α, and urinary 8-hydroxydeoxyguanosine (8-OH-dG). The subjects were classified into cases of hyperuricemia and controls by the levels of blood uric acid. We found that the sum of multiple hydroxyphenanthrene (ΣOH-Phe) was robustly associated with the increase in hyperuricemia risk, while rubidium and strontium had robust protective associations with hyperuricemia risk (Ptrend<0.05). The risk association of ΣOH-Phe was weaker in workers with high levels of rubidium and strontium [P for modifying effect (PME) < 0.030]. The protective association of strontium was more pronounced in workers with higher ΣOH-Phe (PME = 0.014). We also found that 8-OH-dG was a risk factor for hyperuricemia (Ptrend = 0.006) and mediated 10.13% of the elevated hyperuricemia risk associated with ΣOH-Phe. Our findings suggested that individual PAHs and metals, as well as their co-exposure, may influence hyperuricemia risk among coke oven workers, with oxidative DNA damage playing a potential mediating role in their associations.

Hematological Effects and Benchmark Doses of Long-Term Co-Exposure to Benzene, Toluene, and Xylenes in a Follow-Up Study on Petrochemical Workers.

Benzene, toluene, and xylenes (BTX) commonly co-exist. Exposure to individual components and BTX-rich mixtures can induce hematological effects. However, the hematological effects of long-term exposure to BTX are still unclear, and respective reference levels based on empirical evidence should be developed. We conducted a follow-up study in BTX-exposed petrochemical workers. Long-term exposure levels were quantified by measuring cumulative exposure (CE). Generalized weighted quantile sum (WQS) regression models and Benchmark Dose (BMD) Software were used to evaluate their combined effects and calculate their BMDs, respectively. Many hematologic parameters were significantly decreased at the four-year follow-up (p < 0.05). We found positive associations of CE levels of benzene, toluene, and xylene with the decline in monocyte counts, lymphocyte counts, and hematocrit, respectively (ß > 0.010, Ptrend < 0.05). These associations were stronger in subjects with higher baseline parameters, males, drinkers, or overweight subjects (Pinteraction < 0.05). BTX had positive combined effects on the decline in monocyte counts, red-blood-cell counts, and hemoglobin concentrations (Ptrend for WQS indices < 0.05). The estimated BMDs for CE levels of benzene, toluene, and xylene were 2.138, 1.449, and 2.937 mg/m3 × year, respectively. Our study demonstrated the hematological effects of long-term BTX co-exposure and developed 8h-RELs of about 0.01 ppm based on their hematological effects.

Role of pectin characteristics in orange juice stabilization: Effect of high-pressure processing in combination with centrifugation pretreatments.

"High-pressure processing (HPP) plus" combined technologies are applied to overcome the limitation of single HPP and to produce juices with more stable quality during storage. This research explored the potential of HPP in combination with centrifugation to produce cloud stable orange juice during refrigerated storage. The results indicated that HPP combined processing technology significantly improved the cloud stability of orange juice, which was related to removed large particles, reduced viscosity, decreased protein contents, and inactivated pectin methylesterase activity induced by centrifugation (P < 0.05). Besides, chelator solubilized pectin (CSP) decreased but water solubilized pectin (WSP) maintained in the juice after centrifugation. During storage, the conversion of pectin fraction from WSP to CSP, resulting in sedimentation appeared in centrifugation treated orange juice when stored for 28 days. In general, pectin characteristics changes and pectin fractions conversion were the main driving forces affecting cloud stability of orange juice pasteurized by HPP in combination with centrifugation and during chilled storage.

Investigation on simultaneous change of deformation, color and aroma of 4D printed starch-based pastes from fruit and vegetable as induced by microwave.

Conventional 3D printing exhibits serious limitation for it requires a support layer upon which more layers can be formed. A designed structure that lacks such a layer is therefore very difficult, if not impossible, to be printed. A novel means to allow 4D deformation of simple 3D-printed object into complex suspended structure is therefore proposed; microwave irradiation was used to induce the desired directed deformation. In this study, yellow flesh peach-buckwheat paste was used to study the effects of model structure and microwave power on directed 4D deformation behavior. Then, finite-element based simulation was conducted to investigate interactions between the printed object and microwave irradiation. Experiments and simulations showed that local high temperature generated by microwave (200 W) caused directional micro puffing at resulting hot spots, forming a driving force to allow 3D-printed objects to rapidly undergo 4D deformation (within 90 s). The verification test also proved that puffing was the main factor driving 4D deformation. This strategy could combine with color and flavor changing microcapsules to realize the synchronous 4D printing process of deformation, color changing, and aroma changing within 15 s, induced by a household microwave oven (700 W). The purpose of this study is to provide a new 4D printing method interacting with consumers in a short time, which could be applied to children's food.

3D Printing of Shiitake Mushroom Incorporated with Gums as Dysphagia Diet.

With the speeding tendency of aging society, the population experienced dysphagia is increasing quickly. Desirable dysphagic diets should be safe, visually appealing and nutritious. 3D printing allows for creation of personalized nutritious foods with regular-like appearance. Shiitake mushroom, rich in protein and bioactive compounds, is suitable for elderly, but its hard texture was not friendly to the elderly with dysphagia. This study investigated the feasibility of production of dysphagic product using shiitake mushroom by 3D printing with various gums addition, including arabic gum (AG), xanthan gum (XG) and k-carrageenan gum (KG) at concentrations of 0.3%, 0.6% and 0.9% (w/w). Data suggested that XG and KG incorporation significantly increased inks' mechanical strength by decreasing water mobility and promoting the formation of hydrogen bond, enabling 3D printed objects with great self-supporting capacity. The XG containing and KG-0.3% samples were categorized into level 5-minced and moist dysphagia diet within international dysphagia diet standardization initiative (IDDSI) framework. AG addition decreased mechanical strength and viscosity, hardness and self-supporting capacity of 3D printed constructions. AG-0.3% and AG-0.6% samples could not be classified as dysphagia diets based on IDDSI tests. This study provides useful information for dysphagia diet development with appealing appearance by 3D printing.

Spatial and temporal analysis of water quality from 1991 to 2011 in Miyun Reservoir.

Cluster analysis, discriminant analysis-DA, and principal component analysis/factor analysis were used to analyze temporal-spatial variations and sources of water quality from 1991 to 2011 in the Miyun Reservoir. Water quality analysis was conducted in three interannual (IA) groups: IA I (1991-1993, 1995), IA II (1994, 1996-2000, 2002-2006), and IA III (2001, 2007-2011); two seasonal clusters: non-flood season (NF, November-December and January-April) and flood season (FL, May-October); and two spatial clusters (MP-main part of Kuxi and Kudong and NH-Neihu), based on spatial I (I-Kudong, I-Kuxi, and I-Neihu), spatial II (II-Kudong, II-Kuxi, and II-Neihu), spatial III (III-Kudong, III-Kuxi, and III-Neihu), spatial NF (NF-Kudong, NF-Kuxi, and NF-Neihu), and spatial FL (FL-Kudong, FL-Kuxi, and FL-Neihu). Spatial variations between MP and NH were lower than those between seasonal and IA variations. IA DA showed that electrical conductivity (EC), Ca2+, Mg2+, T-Hard, and T-Alk were due to carbonate dissolution accelerated by SO42- both from fertilizer use and industrial activities. Effective control measures decreased BOD5 and NO3--N. Spatial variations at spatial IA and seasonal scales showed that high levels of significant parameters in MP were mostly attributed to non-point pollution from watershed, whereas cage culture and sediment release in NH. The main pollution was comprised of nitrogen, phosphorus, organic, and other ion pollutants (Ca2+, SO42-, Mg2+, T-Alk, EC, and T-Hard). Future studies must focus on water circulation enhancement, timely sediment dredging, and decreasing non-point pollution in FL (water and soil loss, fertilizer use, and cage culture) and anthropogenic discharge in NF.

Synergistic effect of glycated chitosan and photofrin photodynamic therapy on different breast tumor model.

Metastases and recurrence of cancer are the main causes of failure and death. Induction of a long-term tumor specific immunity seems to be a great strategy to deal with this challenge. Laser immunotherapy (LIT), using immunomodulatory techniques in combination with photodynamic therapy (PDT), so as to enhance an already robust immune response, has been proposed and investigated by numerous researchers. In our study, mice bearing EMT6 breast tumors and 4T1 metastatic breast tumors were addressed in various permutations of the different components in LIT. The survival rates and the tumor growth curve of EMT6 breast tumors bearing mice were analyzed. We compared the level of inflammatory reaction, cell apoptosis and activated immune cells infiltration of local tumors. We validated the systemic effect of LIT through the 4T1 metastatic breast tumors bearing mice. The results not only proved that concomitant with Glycated chitosan (GC) can improve the effect of inhibiting the tumor growth, improving survival, enhancing local inflammatory reaction and attracting acted immune cells to tumor by photodynamic therapy with Photofrin, but also intuitively proved the systemic effect and long-term effect of LIT.

Investigation on characteristics of 3D printing using Nostoc sphaeroides biomass.

BACKGROUND: Gel-like constructs can be produced using an extrusion-based 3D food printing (3D-FP) technique. Nostoc sphaeroides biomass is a natural gel material. Considering its good nutrition and rheological properties, these algae were chosen in this study as supply material (ink) for 3D-FP. With this gel material, the extrusion-based 3D printing system was set as a model, and the printing behavior was investigated. Furthermore, the 3D-FP mechanisms were explained through low-field nuclear magnetic resonance and rheological measurements. RESULTS: Results indicated that although fresh biomass gel was printable, non-uniformity and instability occurred during printing. Blanched inks showed non-smooth printing behavior, which was associated with a decrease in elasticity and viscosity. Printability was improved by increasing the rehydration time to 24 h when rehydrated powder was used. Increasing the rehydration time increased the water-binding degree. Pre-gelatinized potato starch was added to the mixture at ratios ranging from 1 to 100 g kg-1 . The best printing outcome was observed at 40 g kg-1 potato starch. CONCLUSION: We emphasize that elasticity and viscosity balance is an essential parameter to achieve printability. The strategies adopted in this work provide new insights into the development of personalized food regarding texture and nutritional additive content. © 2018 Society of Chemical Industry.

Model Building and Slicing in Food 3D Printing Processes: A Review.

Three-dimensional (3D) printing has been successfully applied to food processing, and widely appreciated by food science researchers. Recently, a lot of researches and review works have been done focusing on the ink's properties, printer design, and printing parameters. However, few articles specifically describe 3D models and slicing methods used in food printing. This work introduced the requirements for 3D printing models in some specific areas, discussed the critical parameter settings in the model slicing processes, and discussed the possible use of numerical techniques in the model building and printing of food 3D printing. The objective of this review is to increase researchers' focus on 3D printing models and slices in order to optimize the printing process and to provide some useful information for future research.

Development and characterization of agar-based edible films reinforced with nano-bacterial cellulose.

Nano-bacterial cellulose (BC), as a reinforcing agent, was used to prepare the agar-based edible films. Effects of BC content (0, 3, 5, 8 and 10%, wt% based on the agar) on the rheological properties of film-forming solution (FFS), and on structure, morphology, crystallinity, and thermal properties of films were investigated. Results of rheological and FTIR analyses revealed that interactions between BC and agar were formed through hydrogen bonds. The crystallinity and the thermal stability of films were improved by addition of BC analyzed by XRD and TGA, respectively. Compared with high BC concentrations (8-10%), a good dispersion of BC at low concentrations (3-5%) in the films was observed by SEM. Moreover, BC addition (10%) significantly decreased moisture content (MC), water solubility (WS) and water vapor permeability (WVP) by 60.4%, 13.3% and 25.7%, respectively. The tensile strength (TS) of films increased from 22.10 to 44.51 MPa after addition of BC (0-10%), whereas the elongation at break (EAB) initially increased with increasing BC concentrations (0-5%), and then decreased with further addition of BC (8-10%). Consequently, agar-based edible films reinforced by moderate nano-BC have the potential as a packaging film for food products.

Pilot-scale radiofrequency blanching of potato cuboids: heating uniformity.

BACKGROUND: Traditional hot water blanching has a slow heat transfer rate, whereas radiofrequency (RF) heating has the advantages of a much faster heating rate and a higher penetration depth. In the present study, RF heating was applied to improve heating uniformity for subsequent blanching experiments involving potato cuboids. Potato cuboids were treated in a pilot-scale, RF heating system (27.12 MHz, 6 kW) under different operating conditions. RESULTS: The dielectric constant increased first and then decreased with temperature, whereas the loss factor increased as the temperature increased. The results of the present study reveal that the electrode gap, sample height and NaCl solution had significant effects (P < 0.05) on the temperature distribution and heating uniformity of the sample after RF heating. The optimum RF heating uniformity was obtained at an electrode gap of 120 mm, a sample height of 60 mm and when immersed in NaCl solution of 0.5 s m-1 . The central heating pattern was presented in a sample. Cold spots were located at the edge of the top surface of the sample. CONCLUSION: The present study shows the great potential of RF heating for the blanching of vegetables. Future studies should aim to determine changes in the texture and nutrient contents of vegetables during RF heating. © 2017 Society of Chemical Industry.

Multivariate statistical analysis of temporal-spatial variations in water quality of a constructed wetland purification system in a typical park in Beijing, China.

Using discriminant analysis (DA) and principal component analysis/factor analysis (PCA/FA), we described the variations in the water quality of a constructed wetland (CW) purification system in Olympic Park supplied with reclaimed water (RW). The analyses were conducted across three seasons (spring, summer, and autumn) and four functional zones (composite vertical flow constructed wetland [CVW], plant oxidation pond [POP], mixed oxidation pond [MOP], and main lake [ML]). The results demonstrated the relatively high water quality of the CW, which was suitable for landscape reuse. The most severe contamination occurred in autumn and in the ML/MOP. Chemical oxygen demand (CODMn), NO3(-)-N, oxidation-reduction potential (ORP), and total nitrogen (TN) caused 91.8% of the temporal variations while DO, cyanobacteria (PCY), and pH caused 70.8% of the spatial variations. The low accuracy of the DA indicated that the four functional areas exhibited similar pollution characteristics. Internal pollution was the major pollutant source in all selected seasons/functional zones. In spring, the CW was largely affected by organic matters. In summer, the CW was contaminated chiefly by nutrient pollutants (N and P), particularly in the CVW and POP. In autumn, the major threat became eutrophication. Enhancing water circulation and shortening hydraulic retention time can effectively weaken the effect of nutrient salts and organic pollutants.

[A clinical trial of ketogenic diet in patients with acute spinal cord injury: safety and feasibility].

OBJECTIVE: To conduct a clinical trial of ketogenic diet (KD) in patients with acute spinal cord injury (SCI) and evaluate its safety and feasibility by measuring blood ketone bodies and blood glucose levels. METHOD: Ten patients with acute SCI were recruited in the trial during the period from May, 2012 to October, 2013. The patients received a standard KD after fasting for 48 h. The levels of blood ketone, blood glucose and uric ketone were tested daily, and routine blood examination, electrolytes, liver and kidney function, body mass index (BMI), sensory and motor function, and adverse reactions were monitored weekly to assess the safety and feasibility of KD. RESULTS: KD treatment lasted for a mean of 12.9 days (4 to 29 days) in these patients. In all the patients, blood ketone level increased during the fasting and maintained a level above 2.0 mmol/L after taking KD, while the uric ketone level ranged from +++ to ++++. The blood glucose level was in the normal range during KD. Except for blood chloride level and BMI, routine blood test results, electrolytes, liver and kidney function showed no significant changes after KD. No significant changes were observed in the sensation of light touch and pinprick. The average motor ASIA score increased from 33.3 to 35.1 after KD. Gastrointestinal dysfunction (diarrhea, nausea, poor appetite, gastric pain, and abdominal distension) was recorded in 5 patients, hypoglycemia occurred in one patient early after KD, and one patient experienced urticaria during KD. All the adverse reactions were relieved after symptomatic treatments. CONCLUSION: This preliminary clinical trial demonstrated that KD could increase ketone bodies level and maintain a normal blood glucose level, suggesting its safety and feasibility in patients with acute SCI.