Increasing stringiness of low-fat mozzarella string cheese using polysaccharides.

When fat content of pasta filata cheese is lowered, a loss of fibrous texture occurs and low-fat (LF) mozzarella cheese loses stringiness, making it unsuitable for the manufacture of string cheese. We investigated the use of various polysaccharides that could act as fat mimetics during the stretching and extruding process to aid in protein strand formation and increase stringiness. Low-fat mozzarella cheese curd was made, salted, and then 3.6-kg batches were heated in hot (80°) 5% brine, stretched, and formed into a homogeneous mass. Hot (80°C) slurries of various polysaccharides were then mixed with the hot cheese and formed into LF string cheese using a small piston-driven extruder. Polysaccharides used included waxy corn starch, waxy rice starch, instant tapioca starch, polydextrose, xanthan gum, and guar gum. Adding starch slurries increased cheese moisture content by up to 1.6% but was not effective at increasing stringiness. Xanthan gum functioned best as a fat mimetic and produced LF string cheese that most closely visually resembled commercial string cheese made using low-moisture part skim (LMPS) mozzarella cheese without any increase in moisture content. Extent of stringiness was determined by pulling apart the cheese longitudinally and observing size, length, and appearance of individual cheese strings. Hardness was determined using a modified Warner-Bratzler shear test. When LF string cheese was made using a 10% xanthan gum slurry added at ~1%, increased consumer flavor liking was observed, with scores after 2wk of storage of 6.44 and 6.24 compared with 5.89 for the LF control cheese; although this was lower than an LMPS string cheese that scored 7.27. The 2-wk-old LF string cheeses containing xanthan gum were considered still slightly too firm using a just-about-right (JAR) test, whereas the LMPS string cheese was considered as JAR for texture. With further storage up to 8wk, all of the LF string cheeses softened (JAR score was closer to 3.0); however, much of the stringiness of the LF string cheeses was also lost during storage. We have demonstrated the potential feasibility of increasing stringiness in LF string cheese using polysaccharides with xanthan gum, although further research is needed to develop quantitative methodology for measuring stringiness and to maintain stringiness through the extended refrigerated shelf life needed for string cheese.

Guideline for stress ulcer prophylaxis in the intensive care unit

Stress ulcer prophylaxis (SUP) is commonly used in the intensive care unit (ICU), and is recommended in the Surviving Sepsis Campaign guidelines 2012. The present guideline from the Danish Society of Intensive Care Medicine and the Danish Society of Anesthesiology and Intensive Care Medicine sums up current evidence and gives clinical recommendations for SUP in the ICU. The GRADE approach was used for grading the evidence (www.gradeworkinggroup.org). In conclusion, existing meta-analyses have been underpowered to reach firm conclusions. We recommend not using SUP routinely for adult critically ill patients in the ICU outside the context of randomized controlled trials (GRADE 1C). No robust evidence supports recommendations for subpopulations in the ICU such as septic, burn, trauma, cardiothoracic or enterally fed patients. However, if SUP is considered clinically indicated in individual patients, we suggest using proton pump inhibitors over histamine-2-receptor antagonists (GRADE 2C)

The development of a hybrid analog/digital retinal surgical laser system.

In the last few years the progress made in producing an integrated automated retinal surgical laser system has grown tremendously. Two different techniques have been developed in parallel: an analog and a digital system. Both the analog and digital systems are capable of tracking the retina while precisely placing lesions in desired locations. However, each system has its unique advantages and disadvantages to an automated surgical system. Current work has been conducted to integrate these two techniques to take full advantage of their unique capabilities. The goal of this research is to successfully integrate the systems to provide a better retinal surgical treatment for those individuals affected by diabetes, retinal tears, and other eye disorders.

Integration of analog and digital retinal tracking and coagulation subsystems.

Laser photocoagulation is used by ophthalmologists to treat retinal disorders such as diabetic retinopathy and retinal breaks and tears. Currently, the procedure is performed manually and suffers from several drawbacks: it often requires many clinical visits, it is very tedious for both patient and physician, the laser pointing accuracy and safety margin are limited by a combination of the physician's manual dexterity and the patient's ability to hold their eye still, and there is a wide variability in retinal tissue absorption parameters. This paper describes progress in developing a computer-assisted robotic laser system that will rapidly and safely place multiple therapeutic lesions at desired locations on the retina in a few seconds.

Development of an integrated automated retinal surgical laser system.

Diabetes is a serious disease that affects millions of people world wide. One of the many complications that may result from this disease is an eye disorder called diabetic retinopathy. This side effect is characterized by the leaching of fluid, mainly blood, into the retinal tissue ultimately killing the rods and cones in the area. Scientists have discovered that by occulating and destroying some of the capillaries near the infected area, further damage may be limited and further vision loss prevented. This procedure is performed on the retina by using a Continuous Wave argon laser to place a pattern of lesions that kill the rods, cones, and underlying capillaries. The "Computer Aided Laser Optics System for Ophthalmic Surgery" or CALOSOS is a system that fully integrates the placement of therapeutic retinal lesions through computer control. To date, two different sub-systems have been used to achieve the desired accuracy needed including lesion placement and depth; an all-digital system and a hybrid analog/digital system. The current tracking system that precisely controls the laser uses a wide-angle lens camera to view the whole retina. The difficulty lies in the fact that the only way to control the depth of the lesion is to measure the central reflectance. The goal of this research is to establish that there is a linear relationship between the reflectance of the lesion and the depth of the lesion when this wide-angle lens is used.

Digital integrated retinal surgical laser system.

The year is 2001--ophthalmic retinal surgery is now fully computer assisted. Patients arriving for scheduled treatments of diabetic retinopathy, retinal tears, or macular degeneration have their retina digitally mapped by a technician. From the retinal map, the ophthalmologist plots therapeutic lesion sites with a light pen on the computer screen that will automatically be placed by a computer controlled argon laser. The treatment only requires 100 ms per lesion placement thus reducing office calls to approximately 45 minutes freeing the ophthalmologist for other pressing cases. This paper reports on the development of a clinically significant prototype system that will help bring this scenario to fruition.

Hybrid retinal photocoagulation system using analog tracking.

We describe initial in vivo experimental results of a new hybrid digital and analog design for retinal tracking and laser beam control. An overview of the design is given. The results show in vivo tracking rates which exceed the equivalent of 38 degrees per second in the eye, with automated lesion pattern creation. Robotically-assisted laser surgery to treat conditions such as diabetic retinopathy and retinal breaks may soon be realized under clinical conditions with requisite safety using standard video hardware and inexpensive optical components based on this design.

Development of an integrated automated retinal surgical laser system.

Researchers at the University of Texas and the USAF Academy have worked toward the development of a retinal robotic laser system. The overall goal of this ongoing project is to precisely place and control the depth of laser lesions for the treatment of various retinal diseases such as diabetic retinopathy and retinal tears. Separate low speed prototype subsystems have been developed to control lesion depth using lesion reflectance feedback parameters and lesion placement using retinal vessels as tracking landmarks. Both subsystems have been successfully demonstrated in vivo on pigmented rabbits using an argon continuous wave laser. Preliminary testing on rhesus primate subjects have been accomplished with the CW argon laser and also the ultrashort pulse laser. Recent efforts have concentrated on combining the two subsystems into a single prototype capable of simultaneously controlling both lesion depth and placement. We have designated this combined system CALOSOS for Computer Aided Laser Optics System for Ophthalmic Surgery. Several interesting areas of study have developed in integrating the two subsystems: 1) "doughnut" shaped lesions that occur under certain combinations of laser power, spot size, and irradiation time complicating measurements of central lesion reflectance, 2) the optimal retinal field of view (FOV) to achieve both tracking and lesion parameter control, and 3) development of a hybrid analog/digital tracker using confocal reflectometry to achieve retinal tracking speeds of up to 100 dgs. This presentation will discuss these design issues of this clinically significant prototype system. Details of the hybrid prototype system are provided in "Hybrid Eye Tracking for Computer-Aided Retinal Surgery" at this conference. The paper will close with remaining technical hurdles to clear prior to testing the full-up clinical prototype system.