Development of Healthy Snacks Incorporating Meal from Tenebrio molitor and Alphitobius diaperinus Using 3D Printing Technology.

This study analyzes the nutritional properties of edible insects, specifically Tenebrio molitor and Alphitobius diaperinus, and explores the potential of 3D printing technology to introduce a nutritious and tasty alternative to essential nutrients for Western consumers. An original formulation for the printing of snacks with microalgae was adapted to incorporate edible insects. Concentrations of 10% of edible insects, both isolated and mixed, were incorporated into the developed ink-doughs. Stress and frequency sweeps were performed on the doughs to understand the rheology and the impact on the internal structure to better adapt these materials to the 3D printing process. The nutritional profile of the developed snacks was assessed, revealing a significant amount of protein, enough to claim the snacks as a "source of protein", as well as an increased mineral profile, when compared to the control snack. The antioxidant profile and total phenolic content were equally assessed. Finally, a sensory analysis test was performed, comparing the control snack to three other samples containing 10% T. molitor, 10% A. diaperinus and 5% + 5% of T. molitor and A. diaperinus, respectively, resulting in a preference for the A. diaperinus and for the combination of the two insects. Considered as a "novel food", foods incorporating edible insects represent, in fact, the reintroduction of foods used in the West before the Middle Ages, when the Judeo-Christian tradition began to consider insects as not kosher. Educating consumers about the transition to novel foods can be helped by 3D printing food, as an innovative process that can be used to design creative rich animal protein snacks that make final products more appealing and acceptable to consumers.

The Experimental Development of Emulsions Enriched and Stabilized by Recovering Matter from Spirulina Biomass: Valorization of Residue into a Sustainable Protein Source.

Spirulina consists of a cluster of green-colored cyanobacteria; it is commonly consumed as a food or food supplement rich in bioactive compounds with antioxidant activity, predominantly C-phycocyanin (C-PC), which is related to anti-inflammatory action and anticancer potential when consumed frequently. After C-PC extraction, the Spirulina residual biomass (RB) is rich in proteins and fatty acids with the potential for developing food products, which is interesting from the circular economy perspective. The present work aimed to develop a vegan oil-in-water emulsion containing different contents of Spirulina RB, obtaining a product aligned with current food trends. Emulsions with 3.0% (w/w) of proteins were prepared with different chickpea and Spirulina RB ratios. Emulsifying properties were evaluated regarding texture and rheological properties, color, antioxidant activity, and droplet size distribution. The results showed that it was possible to formulate stable protein-rich emulsions using recovering matter rich in protein from Spirulina as an innovative food ingredient. All the concentrations used of the RB promoted the formulation of emulsions presenting interesting rheological parameters compared with a more traditional protein source such as chickpea. The emulsions were also a source of antioxidant compounds and maintained the color for at least 30 days after production.

Nutritional Improvement of Fresh Cheese with Microalga Chlorella vulgaris: Impact on Composition, Structure and Sensory Acceptance.

Research background: The production of foods fortified with bioactive ingredients has been recognized by food companies as a way to position their products in health food markets. The fortification of cheese represents a major challenge, due to the chemical and structural complexity of the cheese matrix, as well as the complexity of the biochemical reactions occurring during the fermentation and maturation processes. Microalgae are nutritious and sustainable food sources with important bioactive compounds such as proteins, polyunsaturated fatty acids, polysaccharides, chlorophylls, carotenoids, vitamins and minerals. Experimental approach: This work aims to study the impact of the 2 and 4 % microalga Chlorella vulgaris addition on the nutritional composition, bioactivity, structure and sensory profile of quark and cream cheese, both probiotic fermented products. Texture profile analysis and fundamental rheology measurements (oscillatory and stationary) were performed to evaluate the impact of C. vulgaris on the mechanical properties of the fresh cheese. The nutritional composition was evaluated using standard methods and bioactivity through the determination of total phenolic compounds and antioxidant capacity.1. Results and conclusions: C. vulgaris had an impact on the firmness of both cheeses. In general, the cheese with added C. vulgaris had a better nutritional profile, with an increase in protein content, content of Mg, P, S, Cu, Zn, Fe and Mn, and better bioactivity with an increase in the antioxidant activity. Sensory testing results were promising, especially for cream cheese. Novelty and scientific contribution: The enrichment of traditional foods such as fresh cheese with microalgae represents an interesting strategy to develop hybrid products (with protein from animal and vegetable sources), obtain innovative and more sustainable products, and improve their nutritional profile in terms of protein and mineral content and bioactivity.

Acorn flour from holm oak (Quercus rotundifolia): Assessment of nutritional, phenolic, and technological profile.

Acorn is the fruit of holm oak (Quercus rotundifolia), being mainly used nowadays to feed animals, however a substantial part remains in the fields without any valorization. Underexploited crops are gaining new interest, driven by food security concerns and health benefits potential as well. In the present work, it was studied the physicochemical characteristics and functional perspective of acorn flour, as an ingredient for human diet. The study included nutritional composition analysis, phenolic compounds profile through HPLC, starch content and its microstructure, fibre, and pasting properties assessment. Acorn flour presented a high content in fat, particularly monounsaturated and polyunsaturated (oleic and linoleic acids), and high minerals content in particular K. Concerning phenolic profile, rutin, catechin, ellagic acid, gallic acid, and syringic acid were identified. In regards to technological profile, fibre was mainly insoluble, with around 11%, and starch content was 50%. Its pasting behaviour revealed a high gelatinization temperature (85 °C), with low breakdown, and higher retrogradation consistency. These results show acorn flour potential as a valuable and sustainable multipurpose food ingredient.

New Alternatives to Milk From Pulses: Chickpea and Lupin Beverages With Improved Digestibility and Potential Bioactivities for Human Health.

There is a strong demand for plant-based milk substitutes, often low in protein content (<1.5% w/v). Protein-rich pulse seeds and the right processing technologies make it possible to make relevant choices. The major objective of this study was to assess the impact of processing on the nutritional characteristics of beverages with a high impact on health, in particular on digestibility and specific bioactivities. The results suggest that pulse beverages are as high in protein content (3.24% w/v for chickpea and 4.05% w/v for lupin) as cow's milk. The anti-nutrient level characteristics of pulses have been considerably reduced by strategic processing. However, when present in small quantities, some of these anti-nutritional factors may have health benefits. Controlling processing conditions play a crucial role in this fine balance as a tool to take advantage of their health benefits. There is evidence of protein hydrolysis by in vitro digestion and limited bioaccessibility of minerals. In addition to being highly digestible, lupin and chickpea beverages have anti-inflammatory and anti-carcinogenic potential evaluated through the inhibition of metalloproteinase MMP-9.

Innovative and Healthier Dairy Products through the Addition of Microalgae: A Review.

In recent years, the development of healthier foods, richer in nutraceutical or functional compounds, has been in great demand. Microalgae are attracting increasing attention, as their incorporation in foods and beverages can be a promising strategy to develop sustainable foods with improved nutritional profiles and a strong positive impacts on health. Despite the increasing market demand in plant-based foods, the popularity of fermented dairy foods has increased in the recent years since they are a source of microorganisms with health-promoting effects. In this context, the incorporation of microalgae in cheeses, fermented milks and other dairy products represents an interesting approach towards the development of innovative and added-value hybrid products based on animal proteins and enriched with vegetable origin ingredients recognized as extremely valuable sources of bioactive compounds. The effect of the addition of microalgal biomass (Chlorella vulgaris, Arthrospira platensis, Pavlova lutheri, and Diacronema vlkianum, among others) and its derivates on the physicochemical composition, colorimetric and antioxidant properties, texture and rheology behavior, sensory profile, and viability of starter cultures and probiotics in yogurt, cheese and ice cream is discussed in the current work. This review of the literature on the incorporation of microalgae in dairy products aims to contribute to a better understanding of the potential use of these unique food ingredients in the development of new sustainable products and of their beneficial effects on health. Considering the importance of commercialization, regulatory issues about the use of microalgae in dairy products are also discussed.

Improving the Nutritional, Structural, and Sensory Properties of Gluten-Free Bread with Different Species of Microalgae.

Microalgae are an enormous source of nutrients that can be utilized to enrich common food of inherently low nutritional value, such as gluten-free (GF) bread. Addition of the algae species: Tetraselmis chuii (Tc), Chlorella vulgaris (Cv), and Nannochloropsis gaditana (Ng) biomass led to a significant increase in proteins, lipids, minerals (Ca, Mg, K, P, S, Fe, Cu, Zn, Mn), and antioxidant activity. Although, a compromise on dough rheology and consequential sensory properties was observed. To address this, ethanol treatment of the biomass was necessary to eliminate pigments and odor compounds, which resulted in the bread receiving a similar score as the control during sensory trials. Ethanol treatment also resulted in increased dough strength depicted by creep/recovery tests. Due to the stronger dough structure, more air bubbles were trapped in the dough resulting in softer breads (23-65%) of high volume (12-27%) vs. the native algae biomass bread. Breads baked with Ng and Cv resulted in higher protein-enrichment than the Tc, while Tc enrichment led to an elevated mineral content, especially the Ca, which was six times higher than the other algae species. Overall, Ng, in combination with ethanol treatment, yielded a highly nutritious bread of improved technological and sensory properties, indicating that this species might be a candidate for functional GF bread development.

Apple Flour in a Sweet Gluten-Free Bread Formulation: Impact on Nutritional Value, Glycemic Index, Structure and Sensory Profile.

Baking bread without gluten presents many challenges generally related with poor sensorial and nutritional characteristics, and strategies to overcome this issue are needed. Despite many gluten-free (GF) bread studies, to the best of our knowledge, few are dedicated to sweet GF bread. Sweet breads have traditionally been an important type of food and are still frequently consumed worldwide. Apple flour is naturally GF, and is obtained from apples which do not accomplish market quality requirements and are being wasted. Apple flour was, therefore, characterized in terms of nutritional profile, bioactive compounds, and antioxidant capacity. The aim of this work was to develop a GF bread with incorporation of apple flour, in order to study its effect on nutritional, technological, and sensory characteristics of sweet GF bread. Additionally, in vitro starch hydrolysis and glycemic index (GI) were also analyzed. Results demonstrated the influence of apple flour in dough's viscoelastic behavior, increasing G' and G''. Regarding bread characteristics, apple flour led to better acceptance by the consumer, with firmness increasing (21.01; 26.34; 23.88 N), and consequently specific volume decreasing (1.38; 1.18; 1.13 cm3/g). In addition, an increase of bioactive compounds content and antioxidant capacity of the breads were revealed. As expected, the starch hydrolysis index increased, as well as GI. Nevertheless the values were really close to low eGI (56), which is a relevant result for a sweet bread. Apple flour showed good technological and sensory properties as a sustainable and healthy food ingredient for GF bread.

Technological Feasibility of Couscous-Algae-Supplemented Formulae: Process Description, Nutritional Properties and In Vitro Digestibility.

The aim of this work was to develop functional couscous in a traditional Tunisian manner (hand rolling), enriched in algae biomass (6% w/w). Four Chlorella vulgaris (C. vulgaris) biomasses and one mixture of C. vulgaris and two macroalgae biomasses (Ulva rigida and Fucus vesiculosus) were used. The C. vulgaris strain was subjected to random mutagenesis and different culture conditions (Allmicroalgae), resulting in different pigmentations and biochemical compositions. Couscous samples were characterized in terms of nutritional properties, oscillatory rheology properties and digestibility. All biomasses provided a significant supplementation of nutrients and excellent acceptance. The enrichment resulted in lower firmness, higher viscoelastic functions (G' and G″) and a significant improvement in the cooking quality. Major differences between couscous samples with different microalgae were observed in protein and mineral contents, fully meeting Regulation (EC) No. 1924/2006 requirements for health claims made on foodstuffs. The amount of digested proteins was also higher in algae-containing samples. The fatty acid profile of the enriched couscous varied in a biomass-specific way, with a marked increase in linolenic acid (18:3 ω3) and a decrease in the ω6/ω3 ratio. Sensory analysis revealed that microalgae-containing products could compete with conventional goods with an added advantage, that is, having an ameliorated nutritional value using algae as a "trendy" and sustainable ingredient.

Potential role of serum mesothelin in predicting survival of patients with malignant pleural mesothelioma.

Malignant pleural mesothelioma (MPM) is an aggressive tumor with poor survival rates. Therefore, it is essential to have effective biological markers predicting the course of the disease and prognosis. The aim of the present study was to highlight the prognostic significance of serum soluble mesothelin-related protein (Se-SMRP) in patients with MPM at diagnosis. Se-SMRP was determined in 60 patients using an ELISA commercial kit. Se-SMRP levels were subdivided into three tertile-based categories and in each category overall survival (OS) indexes were determined using the Kaplan-Meier and Cox regression analyses. The association between Se-SMRP levels and OS was also assessed by restricted cubic spline (RCS) analysis. No notable differences in the Kaplan-Meier probabilities were identified across the Se-SMRP categories (<0.66 nM, 0.66-1.46 nM, >1.46 nM) although an upward trend in death rate ratios (RR) was pointed out by comparing the higher (RR=1.95) and intermediate (RR=1.86) categories with the lower category (RR=1.00). In addition, such an increasing tendency, particularly when the biomarker exceeded 1.0 nM, was confirmed by an RCS function of Se-SMPR levels fitted to survival data using the Cox regression equation. The present study provided evidence in favor of a prognostic value of Se-SMRP in patients with MPM.

Italian Version of Cancer Dyspnea Scale: Cultural-Linguistic and Clinical Validation in Patients With Advanced Cancer Disease in Palliative Care Settings.

CONTEXT: The Cancer Dyspnea Scale (CDS) is a self-reported multidimensional tool used for the assessment of dyspnea, a subjective experience of breathing discomfort, in patients with cancer. The scale describes dyspnea using three distinct factors: physical, psychological, and discomfort at rest. OBJECTIVES: To crossculturally validate the Italian version of CDS (CDS-IT) and examine its content validity, feasibility, internal consistency, and construct validity in patients with advanced cancer. METHODS: A cross-sectional study was conducted. CDS-IT was forward-backward translated, and its content was validated among a group of experts. Cronbach's α coefficients were used to assess the internal consistency. Construct validity was examined in terms of structural validity through confirmatory factor analysis, and convergent validity was examined with Visual Analogue Scale Dyspnea through the Pearson's correlation coefficient (r). Cancer Quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care) and Italian Palliative Outcome Scale were also tested. RESULTS: The CDS-IT was crossculturally validated and showed satisfactory content validity. A total of 101 patients (mean age = 76 [SD = 12]; 53% females) were recruited in palliative care settings. CDS-IT reported a good internal consistency in the total score and its factors (α = 0.74-0.83). The factor analysis corresponded acceptably but not completely with the original study. CDS-IT strongly correlated with Visual Analogue Scale Dyspnea (r = 0.68) and moderately with Italian Palliative Outcome Scale and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (r = 0.33-0.36, respectively). CONCLUSION: The study findings supported the crosscultural validity of the CDS-IT. Its feasibility, internal consistency, and construct validity are satisfactory for clinical practice. The CDS-IT is available to health care professionals as a useful tool to assess dyspnea in patients with cancer.

Heterogeneous Strain Distribution in the Subchondral Bone of Human Osteoarthritic Femoral Heads, Measured with Digital Volume Correlation.

Osteoarthritis (OA) is a chronic disease, affecting approximately one third of people over the age of 45. Whilst the etiology and pathogenesis of the disease are still not well understood, mechanics play an important role in both the initiation and progression of osteoarthritis. In this study, we demonstrate the application of stepwise compression, combined with microCT imaging and digital volume correlation (DVC) to measure and evaluate full-field strain distributions within osteoarthritic femoral heads under uniaxial compression. A comprehensive analysis showed that the microstructural features inherent in OA bone did not affect the level of uncertainties associated with the applied methods. The results illustrate the localization of strains at the loading surface as well as in areas of low bone volume fraction and subchondral cysts. Trabecular thickness and connectivity density were identified as the only microstructural parameters with any association to the magnitude of local strain measured at apparent yield strain or the volume of bone exceeding yield strain. This work demonstrates a novel approach to evaluating the mechanical properties of the whole human femoral head in case of severe OA.

Treating Schizophrenia: Open Conversations and Stronger Relationships Through Psychoeducation and Shared Decision-Making.

Integrated pharmacological and psychosocial treatments, such as psychoeducation (PE) and shared decision-making (SDM), have been shown to significantly improve outcomes for people living with schizophrenia (PLWS). Underpinning the success of these interventions is a strong therapeutic relationship between PLWS, their carers, and their healthcare team. While many recognize the value of this relationship, implementation of the interventions necessary to facilitate its construction remain low. In this article, we identify the barriers to developing productive therapeutic relationships and explain how PE and SDM, taking into account cultural difference, can improve adherence to treatment, strengthen therapeutic relationships, and ultimately equip patients to achieve better functional outcomes.

Acorn Flour as a Source of Bioactive Compounds in Gluten-Free Bread.

Polyphenols are important bioactive compounds whose regular ingestion has shown different positive impacts in health. Celiac patients have nutritional deficiencies, bringing many problems to their health. Thus, it is important to develop gluten-free (GF) products, such as bread, with nutritional benefits. The acorn is the fruit of holm oak and cork oak, being an underexploited resource nowadays. Its nutritional and functional characteristics are remarkable: rich in unsaturated fatty acids and fiber, vitamin E, chlorophylls, carotenoids, phenolic compounds, and antioxidant properties. The purpose of this study was to assess the use of acorn flour as a bioactive compounds source and natural GF ingredient for baking GF bread. Bread loaves were prepared with buckwheat, rice, acorn flour, and potato starch. Two levels of acorn flour (23% and 35% of the flour mixture) were tested. The physical, nutritional, and sensory characteristics of the bread were analysed, as well as the composition of phenolic compounds: total phenols, ortho-diphenols, and flavonoids. The phenolic profile was assessed by Reverse Phase-High-Performance Liquid Chromatography-Diode Array Detector (RP-HPLC-DAD). The antioxidant activity of the bread extracts was determined by 2,2-azino-bis (3-ethylbenzothiazoline-6-sulphonic acid) diammonium salt (ABTS), diphenyl-1-picrylhidrazyl radical (DPPH), and ferric reducing antioxidant power (FRAP) methodologies. Acorn flour can be considered a good source of bioactive compounds and antioxidants in GF bread. Acorn flour showed good technological properties in GF baking, improving bread nutritional and sensory characteristics.

Tetraselmis chuii as a Sustainable and Healthy Ingredient to Produce Gluten-Free Bread: Impact on Structure, Colour and Bioactivity.

The objective of this work is to increase the nutritional quality of gluten-free (GF) bread by addition of Tetraselmis chuii microalgal biomass, a sustainable source of protein and bioactive compounds. The impact of different levels of T. chuii (0%-Control, 1%, 2% and 4% w/w) on the GF doughs and breads' structure was studied. Microdough-Lab mixing tests and oscillatory rheology were conducted to evaluate the dough´s structure. Physical properties of the loaves, total phenolic content (Folin-Ciocalteu) and antioxidant capacity (DPPH and FRAP) of the bread extracts were assessed. For the low additions of T. chuii (1% and 2%), a destabilising effect is noticed, expressed by lower dough viscoelastic functions (G' and G'') and poor baking results. At the higher level (4%) of microalgal addition, there was a structure recovery with bread volume increase and a decrease in crumb firmness. Moreover, 4% T. chuii bread presented higher total phenolic content and antioxidant capacity when compared to control. Bread with 4% T. chuii seems particularly interesting since a significant increase in the bioactivity and an innovative green appearance was achieved, with a low impact on technological performance, but with lower sensory scores.

Potentially Inappropriate Prescriptions in Ambulatory Elderly Patients Living in Rural Areas of Romania Using STOPP/START (Version 2) Criteria.

BACKGROUND: Rational use of medications and monitoring of prescriptions in elderly patients is important to decrease the number and duration of hospitalizations, emergency medical consultations, mortality, as well as medical costs. PURPOSE: To identify potentially inappropriate medications (PIMs) and potential prescription omissions (PPOs), and determine their prevalence based on the Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) v2 criteria and Screening Tool to Alert doctors to Right Treatment (START) v2 criteria for patients aged >65 years. METHODS: This cross-sectional study was conducted in two rural counties in Romania based on electronic prescriptions for chronic conditions (EPCCs) issued from 30 days to 90 days by a specialist or general practitioner. Collected EPCCs were evaluated by an interdisciplinary team of specialists based on 26 STOPP v2 criteria and 10 START v2 criteria. RESULTS: PIM prevalence was 25.80% and PPO prevalence was 41.72% for 646 EPCCs. The mean age of patients was 75 years and the mean number of drugs per EPCC was four. The most frequently identified PIMs were treatment duration (6.65%), theophylline administration (5.72%), drug indication (4.64%), cyclo-oxygenase-2 non-steroidal anti-inflammatory drugs (1.39%), and zopiclone prescription (0.77%). Statins (24.76%), beta-blockers (8.04%), and beta-2 agonist/antimuscarinic bronchodilators (5.88%) were the most frequently identified PPOs. CONCLUSION: PPOs were more prevalent than PIMs for elderly populations living in the two rural counties in Romania we studied. Health practitioners (family physicians, specialists, and pharmacists) should focus on prophylactic and curative considerations when prescribing agents to decrease the morbidity and mortality of elderly rural Romanian patients.

Determination of Mesothelin Levels in Pleural Effusion Does Not Help Predict Survival of Patients With Malignant Pleural Mesothelioma.

AIM: This study evaluated the prognostic value of soluble mesothelin-related protein (SMRP) levels in pleural effusions (PE) from patients with pleural mesothelioma (MPM). PATIENTS AND METHODS: SMRP level in PE was tested using an enzyme-linked immunosorbent assay (ELISA) in 109 patients with MPM at diagnosis before any treatment. The Kaplan-Meier method and the Cox regression were applied to compare overall survival probabilities across tertile categories of SMRP level. RESULTS: No significant differences in Kaplan-Meier overall survival probabilities among the SMRP categories were found. A statistically non-significant trend for increased death rate ratio (RR) was computed (p=0.327) when the higher (>46.5 nM, RR=1.38) and intermediate (8.5-46.5 nM, RR=1.18) SMRP categories were compared to the lower category (<8.5 nM, RR=1.00). Cox regression modelling including a restricted cubic spline showed a moderately rising non-linear trend in death rate. CONCLUSION: The SMRP level in PE does not appear to have prognostic significance and its detection is not recommended in routine clinical management of patients with MPM.

Micro Finite Element models of the vertebral body: Validation of local displacement predictions.

The estimation of local and structural mechanical properties of bones with micro Finite Element (microFE) models based on Micro Computed Tomography images depends on the quality bone geometry is captured, reconstructed and modelled. The aim of this study was to validate microFE models predictions of local displacements for vertebral bodies and to evaluate the effect of the elastic tissue modulus on model's predictions of axial forces. Four porcine thoracic vertebrae were axially compressed in situ, in a step-wise fashion and scanned at approximately 39µm resolution in preloaded and loaded conditions. A global digital volume correlation (DVC) approach was used to compute the full-field displacements. Homogeneous, isotropic and linear elastic microFE models were generated with boundary conditions assigned from the interpolated displacement field measured from the DVC. Measured and predicted local displacements were compared for the cortical and trabecular compartments in the middle of the specimens. Models were run with two different tissue moduli defined from microindentation data (12.0GPa) and a back-calculation procedure (4.6GPa). The predicted sum of axial reaction forces was compared to the experimental values for each specimen. MicroFE models predicted more than 87% of the variation in the displacement measurements (R2 = 0.87-0.99). However, model predictions of axial forces were largely overestimated (80-369%) for a tissue modulus of 12.0GPa, whereas differences in the range 10-80% were found for a back-calculated tissue modulus. The specimen with the lowest density showed a large number of elements strained beyond yield and the highest predictive errors. This study shows that the simplest microFE models can accurately predict quantitatively the local displacements and qualitatively the strain distribution within the vertebral body, independently from the considered bone types.