Executive Functions Rehabilitation in Premature Children Using an Adaptive Motion-Interaction Videogame Platform: A Randomized Controlled Trial.

Background: Premature children are at increased risk of executive functions (EF) deficits and these difficulties persist into adolescence and adulthood, potentially undermining their development and academic achievements. The aim of the present randomized controlled trial (RCT) is to evaluate the efficacy of the Intendu trainer, an adaptive virtual reality platform, at ameliorating EF in preterm children. Methods: A single-center, RCT was conducted. The intervention group was exposed to game session with the Intendu software in addition to the standard of care in use in our center. The main outcome was the proportion of children with a 10-point increase in the processing speed quotient as measured by WPPSI-III after 4 weeks from the baseline assessment. Results: Forty-seven children born before 36 + 5 weeks were randomized to the experimental (n = 24) or control arm (n = 23). Five children were lost to follow-up. Thirteen of 23 children (56%) reached the main outcome in the experimental group and 5 of 19 (26%) in the control group (P = 0.049, per-protocol analysis) with an absolute benefit increase (ABI) of 30% reconfirmed by the intention-to-treat analysis (P = 0.022, ABI of 32%). Conclusion: Intendu brain-trainer showed promising short-term results on EF in pre-term children, however, larger studies with longer periods of follow-up are warranted to better investigate the role of this or similar technology in promoting better EF in preterm children.

Salivary, lacrimal and nasal (SALANS) measure to assess side effects following radioactive iodine treatment: development, psychometric properties, and factor structure.

PURPOSE: This study aimed to develop and psychometrically evaluate a patient-reported outcome measure (PROM), SAlivary, LAcrimal, NaSal (SALANS), to document patients' symptoms after radioactive iodine (RAI) treatment for differentiated thyroid cancer (DTC). METHODS: We generated and iteratively revised SALANS items based on expert input, focus group discussions and feedback from cognitive testing (n = 17). We administered an initial SALANS measure with 39 items to patients diagnosed with DTC in the past two years (n = 105). Exploratory factor analysis (EFA) examined the factor structure of the SALANS items. We assessed the consistency reliability and related the total and subscale scores of the final SALANS to existing PROMs to assess validity. RESULTS: The final SALANS consisted of 33 items and six subscales (sialadenitis, taste, xerostomia, dry eyes, epiphora, and nasal) with six factors extracted by EFA. The six subscales demonstrated good internal reliability (α range = 0.87-0.92). The SALANS total score showed good convergent validity with the Xerostomia Inventory (r = 0.86) and good discriminant validity with a measure of spirituality (r = - 0.05). The mean SALANS total score was significantly higher (d = 0.5, p < 0.04) among patients who had RAI compared to those who did not have RAI. CONCLUSION: Preliminary evidence suggests that SALANS is a novel and reliable PROM to assess the type and frequency all symptoms experienced after RAI treatment for DTC. Future work is needed to further validate and develop the scale.

Effect of Combined High-Pressure Homogenization and Biotechnological Processes on Chitin, Protein, and Antioxidant Activity of Cricket Powder-Based Ingredients.

The main objective of this work was to evaluate the combined effect of a biotechnology process, based on selected yeast strains, and a high-pressure homogenization (HPH) treatment on the microbiological quality, structural organization of proteins, chitin content, and antioxidant activity of a mixture of cricket powder (Acheta domesticus) and water. Compared to untreated samples, the cricket matrix treated with HPH four times at 180 MPa promoted the growth of the inoculated Yarrowia lipolytica and Debaryomyces hansenii strains. HPH did not affect the concentration of chitin; however, the combination with microorganisms tended to reduce the content. Although the antioxidant activity increased from 0.52 to 0.68 TAC mM/TE after a 48 h incubation in the control, it was further improved by the combination of HPH and D. hansenii metabolism, reaching a value of 0.77 TAC mM/TE. The combination of the two approaches also promoted a reduction in the intensity of bands with molecular weights between 31 and 21.5 kDa in favor of bands with a lower molecular weight. In addition, HPH treatment reduced the number of accessible thiols, suggesting protein structure changes that may further impact the technological properties of cricket powder.

Quality evaluation of house cricket flour processed by electrohydrodynamic drying and pulsed electric fields treatment.

House crickets are expected to play a significant role in the future food sector. Electrohydrodynamic (EHD) drying offers an environmentally friendly alternative to conventional drying methods. Pulsed electric fields (PEF) is a non-thermal process that facilitates conventional processes. EHD was applied to house crickets with and without PEF pretreatment, and the effect of PEF and EHD on the quality of the insects was evaluated. PEF pretreatment positively affected the oven drying at 60 °C by reducing its duration and thus decreasing the energy consumption by 14.22%. Moisture removal of EHD was not sufficient to replace oven drying, but when combined with oven drying, the overall energy consumption was reduced by >50%. PEF processing also increased the protein solubility (53.07% higher than the respective control) and antioxidant activity (24.05% higher than the respective control) of the oven-dried samples and reduced the histamine content of the EHD-dried samples (25.87% lower than the respective control).

Essential Oils and Their Combination with Lactic Acid Bacteria and Bacteriocins to Improve the Safety and Shelf Life of Foods: A Review.

The use of plant extracts (e.g., essential oils and their active compounds) represents an interesting alternative to chemical additives and preservatives applied to delay the alteration and oxidation of foods during their storage. Essential oils (EO) are nowadays considered valuable sources of food preservatives as they provide a healthier alternative to synthetic chemicals while serving the same purpose without affecting food quality parameters. The natural antimicrobial molecules found in medicinal plants represent a possible solution against drug-resistant bacteria, which represent a global health problem, especially for foodborne infections. Several solutions related to their application on food have been described, such as incorporation in active packaging or edible film and direct encapsulation. However, the use of bioactive concentrations of plant derivatives may negatively impact the sensorial characteristics of the final product, and to solve this problem, their application has been proposed in combination with other hurdles, including biocontrol agents. Biocontrol agents are microbial cultures capable of producing natural antimicrobials, including bacteriocins, organic acids, volatile organic compounds, and hydrolytic enzymes. The major effect of bacteriocins or bacteriocin-producing LAB (lactic acid bacteria) on food is obtained when their use is combined with other preservation methods. The combined use of EOs and biocontrol agents in fruit and vegetables, meat, and dairy products is becoming more and more important due to growing concerns about potentially dangerous and toxic synthetic additives. The combination of these two hurdles can improve the safety and shelf life (inactivation of spoilage or pathogenic microorganisms) of the final products while maintaining or stabilizing their sensory and nutritional quality. This review critically describes and collects the most updated works regarding the application of EOs in different food sectors and their combination with biocontrol agents and bacteriocins.

Evaluating the Effectiveness of the SPIKES Model to Break Bad News - A Systematic Review.

Introduction: Breaking bad news to patients and families can be challenging for healthcare providers. The present study conducted a systematic review of the literature to determine if formal communication training using the SPIKES protocol improves learner satisfaction, knowledge, performance, or system outcomes. Method: MEDLINE, Embase, CINAHL Plus (Nursing & Allied Health Sciences), and PsycINFO Databases were searched with keywords BAD NEWS and SPIKES. Studies were required to have an intervention using the SPIKES model and an outcome that addressed at least one of the four domains of the Kirkpatrick model for evaluating training effectiveness. The Cochrane Risk of Bias Tool was used to conduct a risk of bias assessment. Due to heterogeneity in the interventions and outcomes, meta-analysis was not undertaken and instead, a narrative synthesis was used with the information provided in the tables to summarise the main findings of the included studies. Results: Of 622 studies screened, 37 publications met the inclusion criteria. Interventions ranged from the use of didactic lecture, role play with standardised patients (SPs), video use, debriefing sessions, and computer simulations. Evaluation tools ranged from pre and post intervention questionnaires, OSCE performance with rating by independent raters and SPs, and reflective essay writing. Conclusions: Our systematic review demonstrated that the SPIKES protocol is associated with improved learner satisfaction, knowledge and performance. None of the studies in our review examined system outcomes. As such, further educational development and research is needed to evaluate the impact of patient outcomes, including the optimal components and length of intervention.

Sublethal HPH treatment is a sustainable tool that induces autolytic-like processes in the early gene expression of Saccharomyces cerevisiae.

Sublethal HPH treatments have been demonstrated to impact the technological properties and functions of treated microorganisms by inducing specific enzymes/genes or modulating membrane structures and inducing autolysis. In this work, the early effects of a 100 MPa HPH treatment on the winery starter Saccharomyces cerevisiae ALEAFERM AROM grown in synthetic must were assessed. While there were no differences in cell cultivability during the first 48 h between treated and untreated cells, a reduction in volatile metabolites released by HPH-treated cells during the first 2 h was observed. This reduction was only temporary since after 48 h, volatile molecules reached similar or even higher concentrations compared with the control. Moreover, the gene expression response of HPH-treated cells was evaluated after 1 h of incubation and compared with that of untreated cells. A massive rearrangement of gene expression was observed with the identification of 1220 differentially expressed genes (DEGs). Most of the genes related to energetic metabolic pathways and ribosome structure were downregulated, while genes involved in ribosome maturation, transcription, DNA repair, response to stimuli and stress were upregulated. These findings suggest that HPH induces or promotes an autolytic-like behaviour that can be exploited in winemaking.

High-Pressure Homogenization and Biocontrol Agent as Innovative Approaches Increase Shelf Life and Functionality of Carrot Juice.

Recently, application of high-pressure homogenization (HPH) treatments has been widely studied to improve shelf life and rheological and functional properties of vegetable and fruit juices. Another approach that has drawn the attention of researchers is the use of biocontrol cultures. Nevertheless, no data on their possible combined effect on fruit juices shelf life and functionality have been published yet. In this work, the microbial, organoleptic, and technological stability of extremely perishable carrot juice and its functionality were monitored for 12 and 7 days (stored at 4 and 10 °C, respectively) upon HPH treatment alone or in combination with a fermentation step using the biocontrol agent L. lactis LBG2. HPH treatment at 150 MPa for three passes followed by fermentation with L. lactis LBG2 extended the microbiological shelf life of the products of at least three and seven days when stored at 10 °C and 4 °C, respectively, compared to untreated or only HPH-treated samples. Moreover, the combined treatments determined a higher stability of pH and color values, and a better retention of ß-carotene and lutein throughout the shelf-life period when compared to unfermented samples. Eventually, use of combined HPH and LBG2 resulted in the production of compounds having positive sensory impact on carrot juice.

Looking under the hood of "the Cadillac of cancers:" radioactive iodine-related craniofacial side effects among patients with thyroid cancer.

PURPOSE: Despite having a generally favorable prognosis, differentiated thyroid cancer is known to have a significant, long-term impact on the quality of life of survivors. We wished to investigate short- and long-term effects among thyroid cancer survivors following radioactive iodine therapy. METHODS: We conducted eight focus groups (N = 47) to understand patients' experiences of short- and long-term effects after radioactive iodine treatment and the impact these treatment-related side effects had on patients' quality of life. We elicited responses regarding experiences with side effects following radioactive iodine treatment, particularly salivary, lacrimal, and nasal symptoms. We transcribed audiotapes and conducted qualitative analyses to identify codes and themes. RESULTS: We identified eight broad themes from the qualitative analyses. Themes reflecting physical symptoms included dry mouth, salivary gland dysfunction, altered taste, eye symptoms such as tearing or dryness, and epistaxis. Psychosocial themes included lack of knowledge and preparation for treatment, regret of treatment, and distress that thyroid cancer is labeled as a "good cancer." CONCLUSIONS: Thyroid cancer survivors reported a wide range of radioactive iodine treatment-related effects and psychosocial concerns that appear to reduce quality of life. The psychosocial concerns reported by participants underscore the significant unmet information and support needs prior to and following RAI treatment among individuals diagnosed with thyroid cancer. IMPLICATIONS FOR CANCER SURVIVORS: Future research is needed to help both patients and physicians understand the effect of radioactive iodine on quality of life, and to better assess the benefits versus the risks of radioactive iodine therapy.

Lactobacillus paracasei A13 and High-Pressure Homogenization Stress Response.

Sub-lethal high-pressure homogenization treatments applied to Lactobacillus paracasei A13 demonstrated to be a useful strategy to enhance technological and functional properties without detrimental effects on the viability of this strain. Modification of membrane fatty acid composition is reported to be the main regulatory mechanisms adopted by probiotic lactobacilli to counteract high-pressure stress. This work is aimed to clarify and understand the relationship between the modification of membrane fatty acid composition and the expression of genes involved in fatty acid biosynthesis in Lactobacillus paracasei A13, before and after the application of different sub-lethal hyperbaric treatments. Our results showed that Lactobacillus paracasei A13 activated a series of reactions aimed to control and stabilize membrane fluidity in response to high-pressure homogenization treatments. In fact, the production of cyclic fatty acids was counterbalanced by the unsaturation and elongation of fatty acids. The gene expression data indicate an up-regulation of the genes accA, accC, fabD, fabH and fabZ after high-pressure homogenization treatment at 150 and 200 MPa, and of fabK and fabZ after a treatment at 200 MPa suggesting this regulation of the genes involved in fatty acids biosynthesis as an immediate response mechanism adopted by Lactobacillus paracasei A13 to high-pressure homogenization treatments to balance the membrane fluidity. Although further studies should be performed to clarify the modulation of phospholipids and glycoproteins biosynthesis since they play a crucial role in the functional properties of the probiotic strains, this study represents an important step towards understanding the response mechanisms of Lactobacillus paracasei A13 to sub-lethal high-pressure homogenization treatments.

Efficacy of sublingual misoprostol for induction of labor at term and post term according to parity and membrane integrity: a prospective observational study.

OBJECTIVE: To evaluate the effectiveness and safety of 25 mcg sublingual misoprostol for induction of Labor at term according to parity and membrane integrity. METHODS: We conducted a prospective observational study on singleton pregnancies undergoing induction of Labor at term. Twenty-five mcg of misoprostol were administered sublingually every 4 h. Main outcomes were vaginal deliveries within 24 h, time-to-vaginal-delivery, hyper-stimulation syndrome, cesarean section rate, arterial pH< 7.0 and NICU admission rate. RESULTS: We studied 508 patients, 375 nulliparous and 133 multiparous women. Sixty-five percent and 78%, respectively, delivered vaginally within 24 h from first administration. Median time-to-vaginal-delivery was significantly shorter in PROM than in women with intact membranes (p < 0.001). Epidural analgesia prolonged time-to-vaginal-delivery among nulliparous women (p < 0.0005). A positive correlation between BMI and time to delivery was observed in both nulliparous and multiparous women (p < 0.05). Cesarean section rate was 22% in nulliparous and 6% in multiparous group. Induction failure was 1.4% and uterine hyper-stimulation 1%. No pH≤ 7.00 was recorded; overall 7 (1.4%) newborns were admitted to NICU. CONCLUSIONS: Sublingually administered misoprostol is an effective and safe method for induction of Labor at term. Parity, status of membranes and BMI significantly affect time to delivery.

Nasal continuous positive airway pressure (CPAP) versus bi-level nasal CPAP in preterm babies with respiratory distress syndrome: a randomised control trial.

OBJECTIVE: To evaluate the clinical course, respiratory outcomes and markers of inflammation in preterm infants with moderate respiratory distress syndrome (RDS) assigned from birth to nasal continuous positive airway pressure (NCPAP) or bi-level NCPAP. METHODS: A total of 40 infants with a gestational age (GA) of 28-34 weeks (<35 weeks' GA), affected by moderate RDS, were considered eligible and were randomised to NCPAP (group A; n=20, CPAP level=6 cm H(2)O) or to bi-level NCPAP (group B; n=20, lower CPAP level=4.5 cm H(2)O, higher CPAP level=8 cm H(2)O), provided with variable flow devices. Inflammatory response was the primary outcome; serum cytokines were measured on days 1 and 7 of life. Length of ventilation, oxygen dependency, need for intubation and occurrence of air leaks were considered as secondary outcomes. RESULTS: Infants showed similar characteristics at birth (group A vs group B: GA 30.3+/-2 vs 30.2+/-2 weeks, birth weight 1429+/-545 vs 1411+/-560 g) and showed similar serum cytokine levels at all times. Group A underwent longer respiratory support (6.2+/-2 days vs 3.8+/-1 days, p=0.025), longer O(2) dependency (13.8+/-8 days vs 6.5+/-4 days, p=0.027) and was discharged later (GA at discharge 36.7+/-2.5 weeks vs 35.6+/-1.2 weeks, p=0.02). All infants survived. No bronchopulmonary dysplasia (BPD) or neurological disorders occurred. CONCLUSIONS: Bi-level NCPAP was associated with better respiratory outcomes versus NCPAP, and allowed earlier discharge, inducing the same changes in the cytokine levels. It was found to be well tolerated and safe in the study population.

Early myoclonic encephalopathy and nonketotic hyperglycinemia.

Early myoclonic encephalopathy is an epileptic syndrome with different etiologies. Nonketotic hyperglycinemia is one cause. We describe two cases of early myoclonic encephalopathy, secondary to nonketotic hyperglycinemia, with fatal evolution in the neonatal period. These two cases may better clarify clinical findings that can be associated with impairment of glycine metabolism. Distinguishing features include agenesis of the corpus callosum in patient 1, and weight loss exceeding 10%, associated with metabolic acidosis, in patient 2. The burst-suppression electroencephalography pattern is relatively common in neonatal encephalopathies, and is frequently associated with seizures. Nonketotic hyperglycinemia is an inborn error of metabolism caused by mutations in genes encoding protein in the mitochondrial glycine cleavage system. The neonatal form is a severe, frequently lethal neurologic disease. When associated with electro-clinical features, progressive lethargy and hypotonia occur in the first days of life, progressing to apnea and often death. Prospective treatment with oral sodium benzoate, the N-methyl-d-aspartate receptor antagonist ketamine, and dextromethorphan can favorably modify the early neonatal course of severe nonketotic hyperglycinemia, but does not prevent poor long-term outcomes.