Enhanced delivery of doxorubicin for breast cancer treatment using pH-sensitive starch/PVA/g-C3N4 hydrogel.

This study introduces a starch/PVA/g-C3N4 nanocarrier hydrogel for pH-sensitive DOX delivery in breast cancer. DOX was loaded into the nanocarrier with 44.75 % loading efficiency and 88 % Entrapment Efficiency. The release of DOX from the starch/PVA/g-C3N4 hydrogel was pH-sensitive: DOX was released faster in the acidic environment pertinent to cancer tumors (with a pH level of 5.4) than in the surrounding regular tissue environment carrying a more neutral environment (pH 7.4). The release kinetics analysis, encompassing zero-order, first-order, Higuchi, and Korsmeyer-Peppas models, revealed significant fitting with the Higuchi model at both pH 5.4 (R2 = 0.99, K = 9.89) and pH 7.4 (R2 = 0.99, K = 5.70) levels. Finally, we found that hydrogel was less damaging to healthy cells and more specific to apoptotic cells than the drug's free form. The starch/PVA/g-C3N4 hydrogel had low toxicity for both normal cells and breast cancer cells, whereas DOX loaded into the starch/PVA/g-C3N4 hydrogel had higher toxicity for cancer cells than the DOX-only control samples, and led to specific high apoptosis for cancer cells. The study suggests that DOX can be loaded into a starch/PVA/g-C3N4 hydrogel to improve the specificity of the drug's release in cancer tumors or in vitro breast cancer cells.

Salivary Amylase-Responsive Buccal Tablets Wipe Out Chemotherapy-Rooted Refractory Oral Mucositis.

Oral mucositis (OM) is the most common and refractory complication of cancer chemotherapy and radiotherapy, severely affecting patients' life quality, lowering treatment tolerance, and discouraging patient compliance. Current OM delivery systems mostly affect the comfort of patient use and lead to poor compliance and unsatisfactory effects. Herein, salivary amylases (SAs)-responsive buccal tablets consisting of porous manganese-substituted Prussian blue (PMPB) nanocubes (NCs), anti-inflammatory apremilast (Apr) and starch controller have been engineered. PMPB NCs with large surface area can serve as carriers to load Apr, and their multienzyme-mimicking activity enables them to scavenge reactive oxygen species (ROS), which thus synergize with Apr to mitigate inflammation. More significantly, the starch controller can respond to abundant SAs in the oral cavity and realize the cascade, continuous, and complete drug release after enzymatic decomposition, which not only aids with high tissue affinity to prolong the resistance time but also improves the comfort of use. The preclinical study reveals that contributed by the above actions, such buccal tablets mitigate inflammation, promote endothelium proliferation and migration, and accelerate wound healing for repressing chemotherapy-originated intractable OM with positive oral microenvironment and shorter recovery time, thus holding high potentials in clinical translation.

The application of microwaves in axillary hyperhidrosis: Curative effect observation of a pathological examination over 1 year.

BACKGROUND: In Asia, axillary hyperhidrosis is a frequent problem for many people, and the consequent excessive sweating can seriously affect many aspects of daily life and even lead to mental disorders. Microwave therapy is a new, non-invasive treatment method for axillary hyperhidrosis, whose energy and long-term effectiveness still needs to be clinically validated. OBJECTIVE: The aim of this study was to evaluate the clinical efficacy, safety, histological changes, and psychological status of microwave devices in the treatment of axillary hyperhidrosis and osmidrosis. METHOD: We conducted a prospective self-controlled study in a top-tier Chinese hospital. After a 5/5 energy treatment session, a skin biopsy was taken to observe histological changes both before and after treatment. An iodine starch test was used to determine the sweating range. We evaluated symptoms of improved efficacy using the Hyperhidrosis Disease Severity Scale (HDSS) and assessed changes in life status with the DLQI. In the case of concurrent underarm odor, odor-5, VAS, and Young-Jin Park grading were used to assess odor relief. The effect of odor on psychology was assessed by using a psychological status symptom checklist (scl-90). The study period was 1 year. RESULTS: We observed 20 patients in this study. Of those, 90% met the primary treatment endpoint of a decrease in axillary hyperhidrosis symptomatology to below grade 2 on the HDSS score (p < 0.001). Furthermore, 75% of patients achieved a treatment endpoint of at least 50% reduction in VAS (p < 0.001). 70% of patients achieved a treatment endpoint of at least 50% reduction in odor-5 (p < 0.001). The iodine starch test showed that the region decreased 99% from the baseline to 12 months after follow-up had ended (p < 0.001). Eight patients volunteered to undergo histological examination; their average light density of immunohistochemistry decreased from 1.04 (0.4-2.11) to 0.07 (0.04-0.46; p < 0.05). The immunohistochemical positive number for sweat glands was initially 104 (59.75-132.5) but was 41.5 (29.75-62) after the procedure. None of the patients experienced any serious adverse reactions. CONCLUSION: The treatment demonstrated high effectiveness, safety, and short-lived adverse reactions.

Almidón de maíz modificado para pacientes con alteraciones de la deglución / Modified corn starch for patients with swallowing disorders

ÁREA DESCRIPTIVA DEL PROBLEMA DE SALUD: La deglución es el proceso de transporte por el que los alimentos y los líquidos pasan desde la boca hasta el estómago. Es un proceso fundamental, que requiere la integridad física y funcional de las estructuras anatómicas implicadas. A la vez es un acto complejo, porque supone la realización de una serie de secuencias motoras tanto voluntarias como involuntarias, que en última instancia están bajo el control del sistema nervioso central. Para que la deglución se realice de modo seguro (protección del árbol respiratorio) y eficaz (que cumpla su objetivo de alimentar e hidratar), es necesario la coordinación de múltiples mecanismos neuromotores, en los que participan 40 grupos musculares de 3 regiones anatómicas, inervados por las ramas motoras y sensitivas de 5 pares craneales. La disfagia consiste en una dificultad para la deglución de alimentos líquidos, sólidos o ambos. Existe dificultad para transferir el alimento desde la boca hasta el estómago, pasando por la faringe y el esófago. Implica que hay alguna anomalía en uno o más mecanismos de la deglución. METODOLOGÍA: Se realizó una búsqueda en las principales bases de datos bibliográficas. Se filtra la búsqueda a Estudios Clínicos fase 111, controlados randomizados, Revisiones Sistemáticas, Meta-análisis, Guías de Práctica Clínica, además se limitó la búsqueda estudios en humanos. También se realiza búsqueda manual en otras bases de datos bibliográficas (Cochrane, NIH, TRIP DATABASE), en buscadores genéricos de internet, agencias de evaluación de tecnologías sanitarias y financiadores de salud. Se priorizó la inclusión de revisiones sistemáticas, meta-análisis, estudios clínicos aleatorizados y controlados, guías de práctica clínica, evaluaciones de tecnología sanitaria, evaluaciones económicas y políticas de cobertura de otros sistemas de salud. CONCLUSIONES: Eficacia: El aumento de la viscosidad del bolo con espesantes mejora probablemente la seguridad de la deglución en la disfagia orofaríngea crónica posterior al accidente cerebrovascular mediante un mecanismo compensatorio; por el contrario. al revisar la evidencia los espesantes a base de almidón aumentan el residuo orofaríngeo. Seguridad: No se cuentan con efectos adversos graves en los estudios realizados hasta la comercialización. los efectos adversos más frecuentes de los agentes espesantes son estreñimiento. flatulencia o heces blandas (heces blandas o diarrea). Costo: El impacto presupuestario máximo que la institución debería de invertir para los pacientes planificados actualmente es de gasto que aumentaría cada año en base a los pacientes proyectados desde hasta por 50 - 100 pacientes nuevos cada año. Conveniencia: El aumento de la viscosidad de los líquidos es una estrategia de manejo bien establecida para la disfagia orofaríngea. Sin embargo. los efectos de los agentes espesantes sobre la fisiología de la deglución no se entienden completamente. y no hay acuerdo sobre el grado de viscosidad del bolo.

Resistant starch improves cardiometabolic disease outcomes: A narrative review of randomized trials.

Healthy dietary patterns with adequate fiber improve cardiometabolic (CM) outcomes and attenuate disease progression. Resistant starch (RS) is a fermentable fiber that affects CM outcomes; however, studies are heterogeneous and inconsistent. Thus, the purpose of this narrative review is to assess the impact of RS intake by type and amount on CM outcomes while considering subject characteristics and trial duration. Randomized crossover or parallel studies (n = 31) were selected and compared according to acute (1 day; n = 12), medium (>1-30 days; n = 8), or long (>30 days; n = 11) duration. Most acute trials in healthy adults showed improvements in postprandial glycemic outcomes irrespective of RS type or amount. However, a more pronounced reduction occurred when test meals did not match for available carbohydrate. Daily RS intake had a minimal effect on CM outcomes in medium duration trials, but insulin resistant adults had better glycemic control at 4 weeks. Several longer duration trials (8-12 weeks) showed favorable CM outcomes with daily RS intake in adults with type 2 diabetes (T2D), but not in those at risk for T2D. Furthermore, some studies reported improved lipids, inflammatory biomarkers, and heart rate. Future studies should consider matching for available carbohydrates between the RS and control groups to understand the gut microbiome's role. Furthermore, energy and fiber should be considered. Overall, the acute intake of RS improves glycemic outcomes, and consuming RS at for least 4 and up to 8 to 12 weeks in adults with prediabetes and T2D, respectively, appears to improve CM outcomes.

Resistant Starch as a Dietary Intervention to Limit the Progression of Diabetic Kidney Disease.

Diabetes is the leading cause of kidney disease, and as the number of individuals with diabetes increases there is a concomitant increase in the prevalence of diabetic kidney disease (DKD). Diabetes contributes to the development of DKD through a number of pathways, including inflammation, oxidative stress, and the gut-kidney axis, which may be amenable to dietary therapy. Resistant starch (RS) is a dietary fibre that alters the gut microbial consortium, leading to an increase in the microbial production of short chain fatty acids. Evidence from animal and human studies indicate that short chain fatty acids are able to attenuate inflammatory and oxidative stress pathways, which may mitigate the progression of DKD. In this review, we evaluate and summarise the evidence from both preclinical models of DKD and clinical trials that have utilised RS as a dietary therapy to limit the progression of DKD.

Glycemic and Insulinemic Responses of Healthy Humans to a Nutrition Bar with or without Added Fibersym® RW, a Cross-Linked Phosphorylated RS4-Type Resistant Wheat Starch.

The current study compared postprandial glycemic and insulinemic responses to four nutrition bars containing two different doses of resistant starch type-4. Normoglycemic adults (n = 17) completed six treatments, consuming either 50 g or 30 g digestible carbohydrate as: dextrose beverages (DEX), control puffed wheat bars (PWB), or RS4 test bars (RS4). Glucose (mg/dL) and insulin (µIU/mL) were measured at baseline and 10, 20, 30, 60, 90, and 120 min. There was a main effect of dose and treatment on glucose incremental area under the curve (iAUC, ps < 0.001), such that RS4 (50 g: 941, 95% confidence interval (CI): 501, 1519; 30 g: 481, 95% CI: 186, 914) was lower than PWB (50 g: 1746, 95% CI: 1109, 2528; 30 g: 693, 95% CI: 331, 1188) and DEX (50 g: 1940, 95% CI: 1249, 2783; 30 g:1432, 95% CI: 883, 2114). There was a main effect of dose and treatment on insulin iAUC (ps < 0.001), such that RS4 (50 g: 1993, 95% CI: 1347, 2764; 30 g: 943, 95% CI: 519, 1493) was lower than PWB (50 g: 3501, 95% CI: 2625, 4502; 30 g: 1789, 95% CI: 1193, 256) and DEX (50 g: 3143, 95% CI: 2317, 4095; 30 g: 2184, 95% CI: 1519, 2970). Results demonstrate significantly lower glycemic and insulinemic responses following consumption of nutrition bars containing RS4, regardless of dose, when compared with puffed wheat bars and dextrose.

Non-Antimicrobial Methods to Control Liver Abscesses.

Beef feedlots have few non-microbial approaches available to decrease the incidence of liver abscesses. Decreasing the degree of grain processing might be useful, but methods that decrease dietary starch (eg, feeding digestible fiber sources such as distillers grains) have limited effects. Managing feed intake to decrease daily variation has little effect on abscesses, as do feed additives such as essential oils and tannins. Live yeast and yeast fermentation products provide some benefits, but further research is needed. Lack of reproducible in vitro and in vivo models for rapid screening of potential non-antimicrobial methods has limited progress.

Use of the SGLT2 inhibitor canagliflozin for control of refractory equine hyperinsulinemia and laminitis.

Background: Hyperinsulinemia associated with pituitary pars intermedia dysfunction (PPID) and/or equine metabolic syndrome is well documented to put horses at high risk of laminitis. While dietary control of simple sugars and starch is the most effective therapy to control hyperinsulinemia, some horses fail to respond. Case Descriptions: Ten horses with hyperinsulinemia refractory to diet control, metformin, levothyroxine, and pergolide (if diagnosed with PPID) were treated with sodium-glucose cotransporter-2 inhibitor canagliflozin (Invokana®). Nine horses were hyperglycemic (>5.5 mmol/l) or had a history of hyperglycemia. Before instituting therapy, renal function was assessed by determining serum creatinine and blood urea nitrogen concentrations. Canagliflozin was administered orally once a day, with food. Dipstick urinalysis was performed every 2 weeks to confirm glucosuria and screen for proteinuria. Owners were also instructed regarding clinical signs consistent with urinary tract infection. All horses responded with a substantial decrease in serum insulin concentrations to normal or near normal values. Laminitis pain resolved in all cases, with regression of fat deposits. Owner satisfaction with outcomes was 100%. Conclusion: Once daily administration of the SGLT2 inhibitor canagliflozin corrected hyperglycemia, reduced insulin to normal or near normal levels, and was 100% effective in reversing or reducing abnormal fat pads and eliminating laminitis pain in horses with refractory hyperinsulinemia and laminitis. The core aspects of therapy-diet control, exercise when possible, and adequate treatment of PPID-must also be maintained if using canagliflozin. Canagliflozin should be reserved for refractory cases. Further controlled trials to investigate canagliflozin pharmacokinetics, pharmacodynamics, efficacy, and safety are needed.

Lavender improves fatigue symptoms in multiple sclerosis patients: A double-blind, randomized controlled trial.

BACKGROUND: Fatigue is one of the most common complications of Multiple Sclerosis (MS) patients. Several pharmacological and non-pharmacological interventions have been recommended to control this complication. Lavender is one of the plants considered by Persian Medicine (PM) and recommended by scholars of past centuries in the treatment of neurological diseases. This study aimed to investigate the efficacy of lavender capsule on improving fatigue symptoms in MS patients. MATERIAL AND METHODS: In a double-blind, controlled trial, using a computer block randomization approach, 48 confirmed MS patients with eligibility criteria of being 18 years or older, Modified Fatigue Impact Scale (MFIS) ≥25, relapsing-remitting MS patients, EDSS ≤6, not pregnant, not breastfeeding, and not suffering from other diseases that cause fatigue, were randomized to receive capsules containing 600mg of lavender flowers as the intervention group or capsules containing 600mg cornstarch as the control group. Patients were randomized after completing the MFIS and were asked to take one capsule three times daily for 60 days. The MFIS again checked to assess the impact of two interventions. Analysis of Covariance (ANCOVA) was used to assess the impact of two interventions. RESULTS: 24 patients included in each group. The mean (standard deviation) of MFIS was 40.56 (7.63) in the intervention and 41.43 (7.89) in the control groups (p=0.706) before the intervention. However, there was a significant reduction (p0.001˂) in the intervention group, 7.04 (4.91) compared to the control group, 38.17 (9.78) after the intervention. CONCLUSION: In comparison to cornstarch capsules, consuming the capsules of lavender flowers decreased the MFIS in MS patients.

Uncooked cornstarch for the prevention of hypoglycemic events.

Hypoglycemia is a pathological condition characterized by a low plasma glucose concentration associated with typical autonomic and/or neuroglycopenic symptoms, and resolution of these symptoms with carbohydrate consumption. Hypoglycemia is quite common in clinical practice, particularly in insulin-treated patients with diabetes and in other inherited or acquired conditions involving the regulation of glucose metabolism. Beyond symptoms that might strongly affect the quality of life, hypoglycemia can lead to short- and long-term detrimental consequences for health. Hypoglycemia can be prevented by appropriate changes in dietary habits or by relevant modifications of the drug treatment. Several dietary approaches based on the intake of various carbohydrate foods have been tested for hypoglycemia prevention; among them uncooked cornstarch (UCS) has demonstrated a great efficacy. In this narrative review, we have summarized the current evidence on the UCS usefulness in some conditions characterized by high hypoglycemic risk, focusing on some inherited diseases -i.e. glycogen storage diseases and other rare disorders - and acquired conditions such as type 1 diabetes, postprandial hypoglycemia consequent to esophageal-gastric or bariatric surgery, and insulin autoimmune syndrome. We also considered the possible role of UCS during endurance exercise performance. Lastly, we have discussed the dose requirement, the side effects, the limitations of UCS use, and the plausible mechanisms by which UCS could prevent hypoglycemia.

Feruloyl Sucrose Esters: Potent and Selective Inhibitors of α-glucosidase and α-amylase.

INTRODUCTION: Feruloyl Sucrose Esters (FSEs) are a class of Phenylpropanoid Sucrose Esters (PSEs) widely distributed in plants. They were investigated as potential selective Alpha Glucosidase Inhibitors (AGIs) to eliminate the side effects associated with the current commercial AGIs. The latter effectively lowers blood glucose levels in diabetic patients but causes severe gastrointestinal side effects. METHODS: Systematic structure-activity relationship (SAR) studies using in silico, in vitro and in vivo experiments were used to accomplish this aim. FSEs were evaluated for their in vitro inhibition of starch and oligosaccharide digesting enzymes α-glucosidase and α- amylase followed by in silico docking studies to identify the binding modes. A lead candidate, FSE 12 was investigated in an STZ mouse model. RESULTS: All active FSEs showed desired higher % inhibition of α-glucosidase and desired lower inhibition of α -amylase in comparison to AGI gold standard acarbose. This suggests a greater selectivity of the FSEs towards α -glucosidase than α -amylase, which is proposed to eliminate the gastrointestinal side effects. From the in vitro studies, the position and number of the feruloyl substituents on the sucrose core, the aromatic 'OH' group, and the diisopropylidene bridges were key determinants of the % inhibition of α - glucosidase and α -amylase. In particular, the diisopropylidene bridges are critical for achieving inhibition selectivity. Molecular docking studies of the FSEs corroborates the in vitro results. The molecular docking studies further reveal that the presence of free aromatic 'OH' groups and the substitution at position 3 on the sucrose core are critical for the inhibition of both the enzymes. From the in vitro and molecular docking studies, FSE 12 was selected as a lead candidate for validation in vivo. The oral co-administration of FSE 12 with starch abrogated the increase in post-prandial glucose and significantly reduced blood glucose excursion in STZ-treated mice compared to control (starch only) mice. CONCLUSION: Our studies reveal the potential of FSEs as selective AGIs for the treatment of diabetes, with a hypothetical reduction of side effects associated with commercial AGIs.

Hemostatic Efficacy and Biocompatibility Evaluation of a Novel Absorbable Porous Starch Hemostat.

BACKGROUND: A novel absorbable porous starch hemostat (APSH) based on calcium ion-exchange crosslinked porous starch microparticles (Ca2+CPSM) was developed to improve hemostasis during surgeries for irregular cuts. The aim of this study was to compare its hemostatic efficacy and biocompatibility in a standard rat liver injury model relatively to Arista AH, Quickclean, and crosslinked porous starch microparticles (CPSM, without calcium ion). METHODS: 72 Wistar rats (220g-240 g) were randomly assigned to six groups (Arista, Quickclean, CPSM, Ca2+CPSM, native potato starch, and untreated control group, n =12 per group). 30 mg of each hemostatic agent was applied to a standard circular liver excision (8 mm in diameter and 3 mm deep) in rats. Following their hemostatic efficacy, in vivo biocompatiblity evaluation was examined. The native potato starch (NPS) group was used as the negative group. RESULTS: Ca2+CPSM had almost the same hemostatic efficacy compared with Arista; meanwhile, all the 4 hemostatic agents had good blood compatibility. In terms of in vivo tissue compatibility, Ca2+CPSM had relatively fast degradation and absorption rate with good histocompatibility. As the morphological, anatomic observation and H&E staining of liver defects after implantation, Ca2+CPSM was almost completely absorbed by liver tissue after 14 days. CONCLUSION: According to our study, Ca2+CPSM could effectively achieve hemostasis in the standard rat liver injury model and exhibited good blood compatibility and in vivo tissue compatibility. These finding suggested that Ca2+CPSM as a new kind of APSH had its extensive clinical application value.

Acceptance of different types of thickeners, with and without flavoring, in hospitalized patients with dysphagia - a pilot study / Aceptación de diferentes tipos de espesante, con y sin saborizante, en pacientes con disfagia hospitalizados: un estudio piloto

Introduction: the goal of this work was to evaluate the acceptance of various types of thickeners, specifically modified starch thickener and gum thickener, both with and without flavoring. Patients and methods: a randomized sample of 40 hospitalized patients with oropharyngeal dysphagia was recruited. The taste, smell, and appearance of each type of thickener were evaluated, as well as the volume of liquid ingested by the patients taking each type of thickener (modified starch thickener vs. gum thickener, both with and without flavoring).Results: the overall acceptance of gum thickener was significantly higher than that of modified starch thickener (7.45 (1.57) vs. 5.10 (2.43), respectively; p = 0.001). When a food flavor was added to the thickened water, the overall rating of the product was higher than when no flavor was added (7.70 (1.53) vs. 4.85 (2.16); p < 0.001). The difference between the daily volume of water consumed by the patients who received gum thickeners (928.33 (331.27) mL) and those who received starch thickeners (670.00 (288.35) mL) was statistically significant (p = 0.012). Patient consumption was also higher when flavoring was added as compared to when it was not (943.33 (302.45) mL) vs. (655.00 (304.60) mL; p = 0.005). Conclusion: the acceptances of the thickener and of water intake by patients with dysphagia were both significantly higher when using gum thickeners compared to starch thickeners, and when adding flavoring. (AU)

Introducción: el objetivo de este trabajo fue evaluar la aceptación de varios tipos de espesantes (almidón modificado frente a gomas) con y sin saborizante. Pacientes y métodos: se reclutaron 40 pacientes hospitalizados con disfagia orofaríngea. Se evaluaron el sabor, el olor y la apariencia de cada tipo de espesante, así como el volumen de líquido ingerido por los pacientes que tomaban cada tipo de espesante (espesante de almidón modificado vs. espesante de goma, ambos con o sin saborizante). Resultados: la aceptación general del espesante de goma fue significativamente mayor que la del almidón modificado (7,45 (1,57) vs. 5,10 (2,43); p = 0,001). Cuando se añadió un saborizante al agua espesada, la calificación general fue mejor (7,70 (1,53) frente a 4,85 (2,16); p < 0,001). La diferencia entre el volumen diario de agua consumida por los pacientes que recibieron espesantes de goma (928,33 (331,27) ml) y los que recibieron espesantes de almidón (670,00 (288,35) ml) fue estadísticamente significativa (p = 0,012). El consumo de líquido también fue mayor cuando se agregó el saborizante (943,33 (302,45) ml frente a 655,00 (304,60) ml; p = 0,005). Conclusión: la aceptación del espesante y la ingesta de agua por parte de los pacientes con disfagia fueron significativamente mayores cuando se utilizaron espesantes de goma, en comparación con los espesantes de almidón, y al agregar saborizantes. (AU)

A triple-blinded crossover study to evaluate the short-term safety of sweet manioc starch for the treatment of glycogen storage disease type Ia.

BACKGROUND: Glycogen storage disease type 1a (GSD Ia) is characterized by severe fasting hypoglycemia. The clinical management includes the administration of uncooked cornstarch (UCCS). Although such a diet approach is effective in achieving euglycemia, its impact on the quality of life of patients should be considered. In vitro analyses suggest a longer release of glucose when using sweet manioc starch (SMS). METHODS: We compared the efficacy and safety of the administration of SMS and UCCS during a short-fasting challenge in patients with GSD Ia in a randomized, triple-blind, phase I/II, cross-over study. GSD Ia patients aged ≥ 16 years and treated with UCCS were enrolled. Participants were hospitalized for two consecutive nights, receiving UCCS or SMS in each night. After the administration of the starches, glucose, lactate and insulin levels were measured in 1-h interval throughout the hospitalization period. The procedures were interrupted after 10 h of fasting or in a hypoglycemic episode (< 3.88 mmol/L). RESULTS: Eleven individuals (mean age: 21.6 ± 4.3 years; all presenting body mass index > 25 kg/m2) participated in the study. The average fasting period was 8.2 ± 2.0 h for SMS and 7.7 ± 2.3 h for UCCS (p = 0.04). SMS maintained euglycemia for a greater period over UCCS. Increased lactate concentrations were detected even in absence of hypoglycemia, not being influenced by the different starches investigated (p = 0.17). No significant difference was found in total cholesterol, HDL, triglycerides and uric acid levels in both arms. None of the patients showed severe adverse events. CONCLUSIONS: SMS appears to be non-inferior to UCCS in the maintenance of euglycemia, thus emerging as a promising alternative to the treatment of GSD Ia.

Acceptance of different types of thickeners, with and without flavoring, in hospitalized patients with dysphagia - A pilot study.

INTRODUCTION: Introduction: the goal of this work was to evaluate the acceptance of various types of thickeners, specifically modified starch thickener and gum thickener, both with and without flavoring. Patients and methods: a randomized sample of 40 hospitalized patients with oropharyngeal dysphagia was recruited. The taste, smell, and appearance of each type of thickener were evaluated, as well as the volume of liquid ingested by the patients taking each type of thickener (modified starch thickener vs. gum thickener, both with and without flavoring). Results: the overall acceptance of gum thickener was significantly higher than that of modified starch thickener (7.45 (1.57) vs. 5.10 (2.43), respectively; p = 0.001). When a food flavor was added to the thickened water, the overall rating of the product was higher than when no flavor was added (7.70 (1.53) vs. 4.85 (2.16); p < 0.001). The difference between the daily volume of water consumed by the patients who received gum thickeners (928.33 (331.27) mL) and those who received starch thickeners (670.00 (288.35) mL) was statistically significant (p = 0.012). Patient consumption was also higher when flavoring was added as compared to when it was not (943.33 (302.45) mL) vs. (655.00 (304.60) mL; p = 0.005). Conclusion: the acceptances of the thickener and of water intake by patients with dysphagia were both significantly higher when using gum thickeners compared to starch thickeners, and when adding flavoring.

INTRODUCCIÓN: Introducción: el objetivo de este trabajo fue evaluar la aceptación de varios tipos de espesantes (almidón modificado frente a gomas) con y sin saborizante. Pacientes y métodos: se reclutaron 40 pacientes hospitalizados con disfagia orofaríngea. Se evaluaron el sabor, el olor y la apariencia de cada tipo de espesante, así como el volumen de líquido ingerido por los pacientes que tomaban cada tipo de espesante (espesante de almidón modificado vs. espesante de goma, ambos con o sin saborizante). Resultados: la aceptación general del espesante de goma fue significativamente mayor que la del almidón modificado (7,45 (1,57) vs. 5,10 (2,43); p = 0,001). Cuando se añadió un saborizante al agua espesada, la calificación general fue mejor (7,70 (1,53) frente a 4,85 (2,16); p < 0,001). La diferencia entre el volumen diario de agua consumida por los pacientes que recibieron espesantes de goma (928,33 (331,27) ml) y los que recibieron espesantes de almidón (670,00 (288,35) ml) fue estadísticamente significativa (p = 0,012). El consumo de líquido también fue mayor cuando se agregó el saborizante (943,33 (302,45) ml frente a 655,00 (304,60) ml; p = 0,005). Conclusión: la aceptación del espesante y la ingesta de agua por parte de los pacientes con disfagia fueron significativamente mayores cuando se utilizaron espesantes de goma, en comparación con los espesantes de almidón, y al agregar saborizantes.

Using iron-based phosphate binders in phosphate reduction and anemia improvement in patients receiving dialysis: a meta-analysis of randomized controlled trials.

PURPOSE: A study was conducted to determine whether iron-based phosphate binders (IBPBs) need to be preferred for hyperphosphatemia and anemia management in patients on dialysis. METHODS: For this meta-analysis, we searched PubMed, Embase, and Cochrane Central Register of Controlled Trials for randomized controlled trials that evaluated the efficacy and safety of IBPBs in decreasing phosphate and correcting anemia in dialysis patients. RESULTS: Nineteen trials comprising 4719 participants were included. Compared with placebo, serum phosphate decreased significantly after treatment with ferric citrate (FC), fermagate (one study), and SBR759 (one study). Hemoglobin increased significantly after treatment with FC and sucroferric oxyhydroxide (PA21). In addition, FC and PA21 reduced serum intact parathyroid hormone (iPTH) and increased ferritin and transferrin saturation, but SBR759 did not. Compared with active treatment, the non-inferiority of IBPBs in reducing serum phosphate and iPTH was demonstrated. FC significantly improved serum hemoglobin and iron-related parameters and decreased the use of intravenous iron and erythropoiesis-stimulating agent, whereas PA21 did not increase serum hemoglobin level. The incidences of infection and hospitalization were similar between the two groups, with FC having a higher risk of diarrhea than the placebo and active treatments. CONCLUSION: FC was associated with the control of hyperphosphatemia and the improvement of anemia. However, PA21 did not show superiority for alleviating anemia compared with the active treatment. Other IBPBs, such as fermagate and SBR759, remained poorly understood due to the limited number of studies. Further trials are required to assess the effect of IBPBs on the risk of cardiovascular events and all-cause mortality.

A review on orally disintegrating films (ODFs) made from natural polymers such as pullulan, maltodextrin, starch, and others.

In recent years, orally disintegrating films (ODFs) have been studied as alternative ways for drug administration. They can easily be applied into the mouth and quickly disintegrate, releasing the drug with no need of water ingestion and enabling absorption through the oral mucosa. The ODFs matrices are typically composed of hydrophilic polymers, in which the natural polymers are highlighted since they are polymers extracted from natural sources, non-toxic, biocompatible, biodegradable, and have favorable properties for this application. Besides that, natural polymers such as polysaccharides and proteins can be applied either alone or blended with other synthetic, semi-synthetic, or natural polymers to achieve better mechanical and mucoadhesive properties and fast disintegration. In this review, we analyzed ODFs developed using natural polymers or blends involving natural polymers, such as maltodextrin, pullulan, starch, gelatin, collagen, alginate, chitosan, pectin, and others, to overview the recent publications and discuss how natural polymers can influence ODFs properties.

Hydroxyethyl starch is an alternative washing solution for peripheral bloodstem cells products.

Cryopreservation of hematopoietic stem cells (HSC) involves slow rate cooling in the presence of a cryoprotectant (DMSO) to avoid the damaging effects of intracellular ice formation. The infusion of DMSO with the thawed product has been related to adverse events. Reduction of DMSO content by washing the HSCs after thawing has been suggested as a method to avoid infusion-related side-effects. Albumin-dextran washing methods have proved useful in thawing HSC products. Dextran40 shortages prompted us to search for suitable alternatives. We report the results of a comparative study of the use of hydroxyethyl starch (HES) as an alternative to dextran40 for washing thawed HSCs products. A total of 10 HSC bags cryopreserved with 10 % DMSO were used. We conducted a paired study; one of the bags was thawed and washed with our standard washing solution (Dextran 40) and the paired bag with HES solution with a final HES and Human Serum Albumin (HSA) concentration of 2.4 % and 4.2 % respectively. Each final product was tested immediately after washing (sample 0') and after 90 min (sample 90') for total nucleated cells (TNC) recovery, acridine orange viability, viable CD34+ enumeration, and clonogenicity. No significant difference was found for any of the cell counts, viability tests, cell recovery, or potency. We can state that the washing solution based on 2.4 % HES and 4.2 % HSA is equivalent to that used in our routine practice. Therefore, we could use the solution with HES, paying special attention to the renal function of the recipient.