Observational cohort study of the effect of a single lubricant exposure during transvaginal ultrasound on cell-shedding from the vaginal epithelium.

The outer layers of the vaginal epithelium (VE) are important because they accumulate glycogen which, under optimal conditions, Lactobacillus spp. consume to grow and acidify the vaginal microenvironment with lactic acid. We hypothesized that exposure to lubricant, for example in the conduct of a transvaginal ultrasound (TVUS), may contribute to the shedding of mature epithelial cells, exposing immature cells. Cervicovaginal fluid (CVF) was sampled at four time points by menstrual cup (Softdisc™) from 50 women referred for TVUS, during which a controlled volume of lubricant was applied to the TVUS wand. Samples were collected (1) immediately before TVUS and (2) 6-12 hours, (3) within one week, and (4) two weeks after TVUS. Clinical vaginal lubricants are similar to commercial lubricants, and often have a high osmolality or pH, and contain bactericides such as methylparaben and propylparaben. The number and maturity of epithelial cells in each CVF sample were measured by quantitative and differential fluorimetry (maturity index, MI). Comparisons of cell-counts and maturity were made by paired Wilcoxon signed-rank tests. Among women with a high pre-TVUS MI (> 3), there was a decrease in median cell-count and mean MI in the sample collected 6-12 hours after TVUS (p<0.001, n = 26 and p < 0.001, n = 26, respectively). For these women, cell-count and MI remained lower in the sample collected within the subsequent week (p<0.001, n = 29 and p<0.01, n = 29, respectively), and MI remained lower in the sample collected within two weeks of TVUS (p<0.01, n = 25), compared to the pre-TVUS sample. Among participants with a low pre-TVUS MI (< 3), cell-count was higher in the sample collected within two weeks of TVUS compared to the pre-TVUS sample (p = 0.03, n = 15), but no significant changes in MI were observed. Results were similar when restricted to reproductive-age women. This preliminary data indicates hypertonic vaginal lubricants may increase vaginal epithelial cell shedding.

Effective reduction in inadequate Pap smears by using a saline-lubricated speculum and two glass slides.

OBJECTIVE: The aim of the study was to propose a method using saline lubrication and two glass slides to reduce the proportion of inadequate Pap smears. MATERIALS AND METHODS: This was a retrospective study of patients at a medical center in eastern Taiwan that performs 5000-6000 Pap smears annually. The extracted data only detailed the number and percentage of inadequate Pap smears. We applied two modifications to the conventional Pap smear technique. The first modification was lubricating the speculum with normal saline instead of jelly. The second modification was performing the smear on two glass slides instead of just one. We used the modified technique beginning in January 2017. Therefore, we collected data from 2016 (before the modified technique was employed) and 2018 (after the modified technique was employed). The categorical data are presented as numbers (percentages). The differences in the number and percentage of inadequate smears resulting from both techniques were assessed using the Chi-square test. RESULTS: During 2016 and 2018, 28 and 2 women received inadequate Pap smears among the total of 594 and 613 women who received Pap smears, respectively. The proportion of inadequate Pap smears was 4.71% and 0.33% in 2016 and 2018, respectively (P < 0.001). CONCLUSIONS: The use of this modified technique effectively reduced the percentage of inadequate Pap smears.

Lubrication and Vaginal Sex: Lubricant Use and Preferences in General Population Women and Women at Risk of HIV.

Personal or additional lubricants are used by individuals to enhance sexual experience. Lubrication norms during sex are linked to factors including sociocultural norms, gender dynamics, age, and education. This article provides an overview of literature, exploring thematic areas of interest and relevance to the topic. In some regions/countries, lubricated sex is preferable, and in others, a dry/tight vagina is preferred. Women may use a variety of products to achieve these states. There is little research on lubrication preferences during sex; however, microbicide gel acceptability and adherence studies have provided some insight into these preferences. There is a need for more information on lubrication preferences, including volumes, frequency of use, and site of application. In addition, condom use with lubricants needs further exploration. Context, gender, and individual preferences have implications for acceptability and use of personal additional lubricants and should be taken into account during marketing and dissemination of these products.

Understanding the impact of magnesium stearate variability on tableting performance using a multivariate modeling approach.

The objective of this research is to understand how the properties of magnesium stearate (MgSt) affect product performance in a quantitative manner using a multivariate modeling approach. In addition, we explored the feasibility of using NIR and Raman spectra as a surrogate measurement of physiochemical properties in prediction of performance in tablet direct compression. Partial least square models to predict performance attributes (PAs) from MgSt properties or spectra were developed and validated. The model input variables are MgSt physiochemical properties, spectra, key formulation and process parameters. Material physiochemical properties include fatty acid composition, loss on drying, densities, particle size distribution, specific surface area, and solid state properties. The key formulation and process parameters include MgSt concentration, filler type and compression force. The output variables are PAs including tablet ejection force, breaking force and disintegration time. It was found that the prediction of MgSt performance from its properties greatly depends on filler type and PAs of interest. NIR spectra successfully predicted lubricant performance in lactose tablet; however, predictions from Raman spectra were not acceptable. In the cases that the contributing physiochemical properties in performance prediction are sufficiently captured in the spectra, the spectra can be used as an alternative tool to predict excipient performance.

Evaluating the effect of micro-lubrication in orthopedic drilling.

Achievement of low temperature, thrust force, and clean operating zone under with/without irrigation-assisted drilling is still a challenge in orthopedic surgery owing to substantial bone-tissue damage that extends the healing time. In order to mitigate the above challenges, a new micro-lubrication technique-a low-pressure cold mist impinged on the tool-bone joint interface and penetrating well into the bone surface to improve the cooling/lubrication efficiency-has been proposed in bone drilling. In this study, the aims are to characterize the effect of micro-cooling/lubrication on temperature and thrust force at different levels of cutting speed, feed rate, drill diameter, and coolant flow rate. For that purpose, a fresh calf bone was drilled through commercially available drill tool on three-axis mini-machine. The response surface methodology was applied to get the design of experiments, and the analysis of variance at p-values < 0.5 was used. Moreover, the empirical models were developed to examine the simultaneous effect of all the parameters on performance measures. The employed cooling-lubrication technology has shown a percentage reduction in temperature ranging from 34.3% to 48.3%, and 26.8%-35.9% under irrigation with respect to without-irrigation mode. For cutting force, these reductions are 13%-47.6% and 14.5%-44.2%, respectively. Furthermore, analysis of variance has highlighted the cutting speed and feed rate as the two most prominent parameters for temperature and thrust force under all the drilling modes. Relatively high-pressure cold mist in micro-lubrication has offered a lower temperature, thrust force, and clean operating zone under micro-lubrication mode than with/without-irrigation modes. Henceforth, the micro-lubrication technique has been found as a suitable cooling technique for drilling of bone in the viewpoint of temperature and thrust force.

Vaginal lubricants in the couple trying-to-conceive: Assessing healthcare professional recommendations and effect on in vitro sperm function.

Vaginal lubricants are commonly used by couples trying-to-conceive. However, most vaginal lubricants are sperm toxic and therefore should not be used by couples trying-to-conceive. Despite this, lubricant sperm toxicity is insufficiently reported and guidance for healthcare professionals (HCPs) is absent. In this study, lubricant-related practices of fertility-based HCPs in Scotland were sampled via an online survey. Lubricants identified as being utilised in the fertility setting were subsequently incubated with prepared sperm samples to establish effects on sperm motility. HCP recommendations (n = 32) on lubricant use were varied although knowledge related to sperm toxicity was generally poor. HCPs infrequently asked about lubricant use and were unaware of guidance in this area. Aquagel, the only prescribed lubricant identified in this study, reduced sperm progressive motility to 49% of control after 10 minutes, even at concentrations as low as 5%. Vitality testing suggested the deterioration in progressive motility with Aquagel was not as a result of cell death. Conversely, Pré Vaginal Lubricant, a 'sperm-safe' lubricant, did not significantly affect any markers of sperm function assessed. Development of clinical guidance in this area is recommended to ensure HCPs deliver informed advice as lubricant use in couples trying-to-conceive may inadvertently contribute to delay in conception.

Investigation of the lubrication properties and synergistic interaction of biocompatible liposome-polymer complexes applicable to artificial joints.

Achievement of efficient biolubrication is essential for the design of artificial joints with long lifetimes. This study examines the frictional behaviors and adsorption structures of liposomes and liposome complexes with biocompatible polymers to reveal the underlying lubrication mechanisms between biomimetic bearing surfaces of polyetheretherketone (PEEK) and silicon nitride (Si3N4). The liposomes with increasing carbon chain lengths exhibit the remarkable lubrication capabilities that correlate strongly with the structural integrity of small unilamellar vesicles adsorbed on the Si3N4 surfaces, while the bilayer structures weaken the stability of vesicles against rupture and cause the increase of friction. The synergistic interaction of liposomes and biocompatible negative-charged polymer leads to the formation of a boundary-lubricating layer with high-density liposome-polymer complex structures that can efficiently improve the lubrication properties of liposomes. Our findings might have implications for future biolubrication investigations on biocompatible liposome-polymer complexes applicable to artificial joints at the specified macroscale conditions.

Probing the Molecular Interactions and Lubrication Mechanisms of Purified Full-Length Recombinant Human Proteoglycan 4 (rhPRG4) and Hyaluronic Acid (HA).

Probing the adsorption and lubrication behavior of lubricin, also known as proteoglycan 4 (PRG4), is important for understanding the ultralow friction of cartilage lubrication. Most previous research has focused on native lubricin either purified from synovial fluid or articular cartilage explant culture media. In this work, the adsorption behavior and lubrication mechanism of full-length recombinant human PRG4 (rhPRG4) on mica as well as the effect of adding hyaluronic acid (HA, a polysaccharide) were systematically investigated using a surface forces apparatus (SFA) technique. A low friction coefficient (µ ∼ 0.04) was measured when multilayer rhPRG4 (∼31 nm) was confined in between mica surfaces, even when the load increased to ∼1.2 MPa. Intriguingly, a previously unreported ultralow friction coefficient (µ < 0.005) was observed at a low sliding velocity ( v = 0.14 µm/s) with the applied load P reaching ∼3.6 MPa when a diluted rhPRG4 solution (∼90 µg/mL) was used. The distinct friction behavior is likely due to the smooth and more close-packed lubricin coating, as made evident by the atomic force microscope imaging. Adding HA onto multilayer rhPRG4-coated mica increased the friction coefficient µ to ∼0.1; however, the load bearing property increased, indicating potential synergistic effect between rhPRG4 and HA, which was further demonstrated by the weak adhesion observed when separating rhPRG4-coated mica and HA-coated aminopropyltriethoxysilane-mica (APTES-mica). Alternatively, adding premixed rhPRG4-HA on mica had a friction coefficient (µ ∼ 0.1) close to that of injecting concentrated rhPRG4 (∼450 µg/mL) with lower load sustainability. Our results provide fundamental insights into the adsorption and lubrication behavior of lubricin and its interaction with HA, with useful implications for the underlying mechanism of ultralow friction provided by synovial fluid.

Roller compaction: Ribbon splitting and sticking.

Roller compaction is the main technique employed in dry granulation. Ribbon sticking and splitting are among the major factors that can hinder the use of this process for some formulations. Ribbon splitting can occur either transversally (through the ribbon thickness) or longitudinally (through the ribbon width). It was observed that transverse splitting is commonly associated with sticking of the split ribbons to the rollers and results in an inferior performance of the process. Longitudinal splitting is associated with an across-width distribution of the ribbon density so that there may an adverse effect on the mechanical strength and dissolution properties of the tablets formed from the milled granules. The aim of the current work was to elucidate the mechanisms of splitting by an experimental study involving single component powders with a range of yield strengths, including those that are commonly used as excipients. Both smooth and knurled rollers were employed without and with lubrication by applying magnesium stearate to the rollers. The minimum gap was fixed and the maximum roll stress was varied. The observed trends for the smooth rollers were rationalised in terms of a splitting index, which is a measure of the residual stresses driving crack growth relative to the tensile strength of the ribbons. There was a lower limit at which splitting was observed but the occurrence of transverse splitting decreased and that for longitudinal splitting increased with increasing values of the index, which was accompanied by an increase in mixed transverse-longitudinal splitting. Transverse splitting was always associated with sticking to the rollers and was prevented by external lubrication. The main difference with the knurled rollers was that in some cases transverse splitting occurred without sticking to the rollers. A detailed discussion of the mechanisms involved is presented.

The effects of unintentional and intentional process disturbances on tablet quality during long continuous manufacturing runs.

Several kinds of process disturbances can occur during (continuous) tablet manufacturing, i.e. unintentional or intentional disturbances. Long run-time continuous manufacturing studies are used to investigate the effects of intentional and unintentional deviations. In this study, the horizontal continuous manufacturing line included a double mixing - direct compression set up. The study consisted of two long duration test runs. In the first run, the API (paracetamol) was fed in during the first feeding and blending stage with lubricant (Mg.Stear.) added during the second feeding and blending stage. In the second run, the API and lubricant feeding stages were reversed. The run protocol included a long run with several feeder re-fills and an overnight hold-time, continuing with the same API concentration followed by a change to a higher API concentration on the fly (without cleaning). The objectives of this pilot study were to determine the intentional (e.g. overnight hold time, product concentration change) and unintentional (e.g. equipment or software failures) deviations, which could affect the critical quality attributes (CQA's) of the final product and to create a deviation document which would reveal the changes that had occurred in the product concentration during the runs. Another goal was to study the effect of feeding location of lubricant and API feeding. The CQA's were the assayed values of API, tablet strength, friability, tablet weight and its dissolution profile. The vacuum conveyors, which were needed to transfer materials in the horizontal set-up, were observed to introduce variation into the mass flow rates and feeding. Thus, there were significant challenges to ensuring a constant mass flow rate during the runs. One expected effect was that over-lubrication was evident when the lubricant was fed during the first feeding and mixing stage, resulting in a significantly reduced tablet strength and a slower dissolution of API. There were no observable trends over time in the process parameters or CQAs i.e. evidence of a stable process. The overnight hold-time did not affect the CQAs of tablets. Moreover, the variation in all CQAs was smaller after the overnight hold-time which was particularly unexpected. In conclusion, the results reveal that the process itself was able to produce a quality end product, but the set-up needs to be better designed and controlled to ensure a constant mass flow and prevent over-lubrication.

Articular cartilage. Strong adsorption and cohesion of phospholipids with the quaternary ammonium cations providing satisfactory lubrication of natural joints.

Much evidence supports the hypothesis that surface-active phospholipid (SAPL) molecules on articular cartilage (AC) adsorbed to negatively-charged proteoglycan matrix form phospholipid (membrane), are negatively charged surface (-PO4-) and hydrophilic. In Hills cartilage model (1984) phospholipids adsorbed to cartilage surface act as boundary lubricants making the surface extremely hydrophobic. Hydrophobic surface of AC has gained no support in all experimental facts presented in this paper and the current literature showing that AC is amphoteric and hydrophilic with the negatively charged surface (-PO4-). The interfacial energy of the model membrane of spherical lipid bilayers evident from phosphatidylcholine "bell-shaped curve" has amphoteric character and lowest energy in lubrication at a pH 7.4 ± 1 of the natural joint.

Compression-Induced Polymorphic Transformation in Tablets: Role of Shear Stress and Development of Mitigation Strategies.

Our goals were to evaluate the effects of (i) hydrostatic pressure alone and (ii) its combined effect with shear stress during compaction, on the polymorphic transformation (form C → A) of a model drug, chlorpropamide. The powder was either subjected to hydrostatic pressure in a pressure vessel or compressed in a tablet press, at pressures ranging from 25 to 150 MPa. The overall extent of phase transformation was determined by powder X-ray diffractometry, whereas 2D-X-ray diffractometry enabled quantification of the spatial distribution of phase composition in tablets. Irrespective of the pressure, the extent of transformation following compaction was higher than that because of hydrostatic pressure alone, the difference attributed to the contribution of shear stress experienced during compaction. At a compression pressure of 25 MPa, there was a pronounced gradient in the extent of phase transformation when monitored from radial tablet surface to core. This gradient decreased with increase in compression pressure. Four approaches were attempted to minimize the effect of compression-induced phase transformation: (a) site-specific lubrication, (b) use of a viscoelastic excipient, (c) ceramic-lined die, and (d) use of cavity tablet. The ceramic-lined die coupled with site-specific lubrication was most effective in minimizing the extent of compression-induced phase transformation.

Active agents, biomaterials, and technologies to improve biolubrication and strengthen soft tissues.

Normal functioning of articulating tissues is required for many physiological processes occurring across length scales from the molecular to whole organism. Lubricating biopolymers are present natively on tissue surfaces at various sites of biological articulation, including eyelid, mouth, and synovial joints. The range of operating conditions at these disparate interfaces yields a variety of tribological mechanisms through which compressive and shear forces are dissipated to protect tissues from material wear and fatigue. This review focuses on recent advances in active agents and biomaterials for therapeutic augmentation of friction, lubrication, and wear in disease and injured states. Various small-molecule, biological, and gene delivery therapies are described, as are tribosupplementation with naturally-occurring and synthetic biolubricants and polymer reinforcements. While reintroduction of a diseased tissue's native lubricant received significant attention in the past, recent discoveries and pre-clinical research are capitalizing on concurrent advances in the molecular sciences and bioengineering fields, with an understanding of the underlying tissue structure and physiology, to afford a desired, and potentially patient-specific, tissue mechanical response for restoration of normal function. Small and large molecule drugs targeting recently elucidated pathways as well as synthetic and hybrid natural/synthetic biomaterials for restoring a desired tissue mechanical response are being investigated for treatment of, for example, keratoconjunctivitis sicca, xeroderma, and osteoarthritis.

Clinical study of hyaluronic acid gel in dyspareunia caused by vaginal dryness / Estudio clínico con un gel de ácido hialurónico en la dispareunia por sequedad vaginal

Objective: Hyaluronic acid plays a key role in the hydration, elasticity, and lubrication of the vagina. We evaluated the efficacy of a hyaluronic acid gel (Hyaluron mucus(R)) in the treatment of dyspareunia due to vaginal dryness. Material and methods: A total of 150 women applied the gel using their fingers before intercourse. The gel could also be applied simultaneously by the partner. We assessed the intensity of pain, discomfort during intercourse, and degree of vaginal dryness; we also recorded overall opinion (physician and/or patient) on the efficacy and tolerability of the gel and on its cosmetic and medical properties. Adverse effects and their causality were also recorded. Results: An improvement in pain, discomfort during intercourse, and vaginal dryness was reported by 91%, 84%, and 92% of patients, respectively. Medical opinion was favorable in 81% of cases and moderate in the remaining 19%. Patient opinion was favorable in 82%, moderate in 15%, and poor in 3%. Tolerability was good (2 cases of pruritus, 3 of stinging, and 1 of burning sensation). Compared with the previous treatment, the new gel was considered better by 64% of the women, equal or similar by 33%, and worse by 4%. Conclusions: The hyaluronic acid gel studied (Hyaluron mucus(R)) significantly improved vaginal dryness and dyspareunia with good tolerability and favorable cosmetic-medical properties in around 90% of cases

Objetivo: el ácido hialurónico es clave en la hidratación, elasticidad y lubricación vaginal. Hemos valorado la eficacia de un gel de ácido hialurónico (Hyaluron mucus(R)) en el tratamiento de la dispareunia asociada a sequedad vaginal. Material y métodos: 150 mujeres se aplicaron el gel en la vagina digitalmente antes de cada relación sexual, y se dejó abierta la posibilidad de que se aplicara simultáneamente por la pareja. Se valoraron la intensidad del dolor, la dificultad en la relación y el grado de sequedad vaginal; se registró la opinión global (del médico y/o del paciente) sobre la eficacia, la tolerabilidad y las características cosmético-galénicas del gel. También se recogieron los efectos adversos y su imputabilidad. Resultados: el dolor, la dificultad en la relación y la sequedad vaginal mejoraron en el 91%, el 84% y el 92%, respectivamente. El juicio médico global fue bueno para el 81% de los casos y moderado en el 19% restante, para las pacientes fue bueno en el 82%, moderado en el 15% y malo en un 3%. La tolerabilidad ha sido buena (2 casos de prurito, 3 de escozor y 1 de quemazón). El gel en estudio fue considerado mejor por el 64% de las mujeres, igual o semejante por el 33% y peor por el 4%, respecto al tratamiento previo. Conclusiones: el gel de ácido hialurónico estudiado mejora de forma relevante en torno al 90% de los casos la sequedad vaginal y la dispareunia con una buena tolerabilidad y aceptabilidad cosmeto-galénica

Lubricant based determination of design space for continuously manufactured high dose paracetamol tablets.

The objective of this study was to devise robust and stable continuous manufacturing process settings, by exploring the design space after an investigation of the lubrication-based parameters influencing the continuous direct compression tableting of high dose paracetamol tablets. Experimental design was used to generate a structured study plan which involved 19 runs. The formulation variables studied were the type of lubricant (magnesium stearate or stearic acid) and its concentration (0.5, 1.0 and 1.5%). Process variables were total production feed rate (5, 10.5 and 16kg/h), mixer speed rpm (500, 850 and 1200rpm), and mixer inlet port for lubricant (A or B). The continuous direct compression tableting line consisted of loss-in-weight feeders, a continuous mixer and a tablet press. The Quality Target Product Profile (QTPP) was defined for the final product, as the flowability of powder blends (2.5s), tablet strength (147N), dissolution in 2.5min (90%) and ejection force (425N). A design space was identified which fulfilled all the requirements of QTPP. The type and concentration of lubricant exerted the greatest influence on the design space. For example, stearic acid increased the tablet strength. Interestingly, the studied process parameters had only a very minor effect on the quality of the final product and the design space. It is concluded that the continuous direct compression tableting process itself is insensitive and can cope with changes in lubrication, whereas formulation parameters exert a major influence on the end product quality.

Review of the Mechanism of Action for Supartz FX in Knee Osteoarthritis.

Objective Summarize the biologic effects of Supartz FX for knee osteoarthritis (OA), the first worldwide clinically approved intra-articular (IA) hyaluronic acid (HA) product. Design To determine the mechanism of action from preclinical and clinical studies, a literature search was conducted of Supartz FX using academic databases from 1987 to 2016. Articles on Supartz FX that deal with its mechanisms of action were extracted, categorized, and reviewed. Results Supartz FX has 2 potential mechanisms of action: (1) biomechanical: IA Supartz FX directly improves the viscoelasticity and lubrication of synovial fluid; (2) physiologic: IA Supartz FX penetrates synovium and cartilage tissues to reach HA receptors on the surface of synoviocytes and chondrocytes. In synovium, suppression of gene expression in inflammatory mediators results in improved endogenous HA production, improved properties of synovial fluid, and reduction in pain. In cartilage, suppression of gene expression of collagenases and aggrecanases suppresses cartilage degeneration. Conclusion The net results of basic and clinical studies is that IA Supartz FX provides a more favorable biomechanical and functional environment in the knee joint. Hence, it is not only a lubricant but is also physiologically active. These actions may help explain both short- and long-term improvement in pain and function often achieved from IA Supartz FX in knee OA.

Women's willingness to experiment with condoms and lubricants: A study of women residing in a high HIV seroprevalence area.

The objective of this study was to investigate women's willingness to experiment with new condoms and lubricants, in order to inform condom promotion in a city with high rates of poverty and HIV. One hundred and seventy-three women (85.9% Black) sexually transmitted infection clinic attendees in Jackson, Mississippi, United States completed a questionnaire assessing willingness to experiment with condoms and lubricants and sexual pleasure and lubrication in relation to last condom use. Most women were willing to: (1) experiment with new types of condoms and lubricants to increase their sexual pleasure, (2) touch/handle these products in the absence of a partner, and (3) suggest experimenting with new condoms and lubricants to a sex partner. Previous positive sexual experiences with lubricant during condom use predicted willingness. The role women may play in male condom use should not be underestimated. Clinicians may benefit women by encouraging them to try new types of condoms and lubricants to find products consistent with sexual pleasure.

Texture and lubrication properties of functional cream cheese: Effect of ß-glucan and phytosterol.

The effect of ß-glucan (BG) and phytosterols (PS) as fat replacers on textural, microstructural, and lubrication properties of reduced-fat cream cheese was investigated. Five formulations (BG-PS ester, PS ester, BG-PS emulsions, PS emulsions, and BG) of cream cheese with added ß-glucan and phytosterols (in emulsified and esterified form) were investigated and compared with commercial cheese. Among the five formulations used in this experiment, the effect of ß-glucan appeared to be more pronounced imparting increased viscosity and firmness to reduced-fat cream cheese, similar to commercial high-fat cream cheese sample. Conversely, in lubrication study both the phytosterols (esterified and emulsified) were effective in reducing the coefficient of friction resulting in a more spreadable cream cheese. The microstructure of cream cheese with added ß-glucan and phytosterols, used solo or in combination, exhibited more open structure of casein matrix, although differences in fat globule size were observed. Cream cheese made from PS emulsion (emulsified from phytosterols powder) resulted in a larger fat globule size than PS ester and ß-glucan as shown by confocal laser scanning microscopy. In addition, the particle size distribution of cream cheese formulation containing ß-glucan only showed a monomodal curves with small globule size, while a bimodal distribution with larger particle size was observed from cream cheese with phytosterols alone. PRACTICAL APPLICATIONS: Reducing the fat content, impacts the quality characteristics of low-fat cream cheese. This research showed a novel way to incorporate ß-glucan and phytosterols as fat replacers and functional ingredients in cream cheese formulation that improves its textural and lubrication properties. In addition, this article discusses the effect of ß-glucan and phytosterols used both individually and in combination on the particle size, microstructural and rheological characteristics of functional cream cheese and compares them against commercial product. The potential use of ß-glucan and phytosterols as fat replacers in low-fat cream cheese will be useful for the industries to develop functional cream cheese that meets consumers demand.

Effects of lubrication on air-sealing performance of a pediatric cuffed tracheal tube.

BACKGROUND: Lubrication of cuffed tracheal tubes (CTTs) reduces liquid leakage. However, it is not clear how cuff lubrication influences air leakage. We aimed to test the hypothesis that pretreatment with K-Y jelly, a water-soluble lubricant, would improve the air-sealing performance of pediatric CTTs in a model study. METHODS: We placed Parker Flex-Tip™ CTT with 4.0- and 5.0-mm internal diameter (ID) into a tracheal model with 9- and 12-mm ID. The tracheal model was connected to a test lung ventilated in pressure control mode. We compared three cuff lubrication conditions: none (N), water (W), and K-Y jelly (KY). We measured the leak airway pressure (LAWP), defined as the lowest peak airway pressure (PAWP) at which leakage was detected, with the fixed cuff pressure (CP) at 20 cmH2O and varied PAWP. We also measured the leak CP (LCP), defined as the highest CP at which leakage was detected, with fixed PAWP at 25 cmH2O and varied CP. We confirmed air leakage when an apparent elevation of oxygen concentration was detected above the cuff after changing the inspiratory gas from air to oxygen. RESULTS: For both 4.0-mm ID and 5.0-mm ID endotracheal tubes, the KY group showed significantly higher LAWP and lower LCP than the other two groups. For the 4.0-mm ID, median values and ranges of LAWP and LCP were K-Y group: 25 (25) and 15 (15); N group: 5 (5) and 35 (35): and W group: 5 (5) and 35 (15-35) cmH2O. For the 5.0-mm ID, median values and ranges of LAWP and LCP were K-Y group: 25 (15-25) and 15 (15-35); N group: 5 (5) and 35 (35); and W group: 5 (5) and 35 (15-35) cmH2O. Water application did not change these outcomes compared with the N group. CONCLUSION: Pre-treatment of the cuff with K-Y jelly significantly improved the air-sealing performance of a pediatric CTT in our model study.