Efficacy of a 1% malic acid spray for xerostomia treatment: A systematic review and meta-analysis.

OBJECTIVES: To assess the efficacy of topical sialogogue spray containing malic acid 1% for treating xerostomia. METHODS: We searched PubMed, Cochrane Library, Embase, ClinicalTrials.gov and Web of Science databases. Literature search, screening, study selection, data collection, data extraction and assessment of bias risk were independently conducted by two reviewers. The study appraisal was performed by Cochrane Collaboration's tool for assessing bias risk. The systematic review registration number was PROSPERO-CRD42021241322. All statistical analyses were performed using Review Manager version 5.4. RESULTS: Five original articles involving 244 patients with xerostomia who received topical sialogogue spray (malic acid 1%) or placebo for two weeks were included in this review. Based on the questionnaire survey, the topical sialogogue spray (malic acid 1%) improved the symptoms of dry mouth significantly better than the placebo, which was reflected in the Dry Mouth Questionnaire (DMQ), Xerostomia Inventory (XI) and Visual Analogue Scale (VAS) scores. Regarding the increase in unstimulated and stimulated saliva flow rates, the intervention group was also better than the placebo group after a two-week course of treatment. CONCLUSIONS: Although the included studies are limited, our results show that topical sialogogue spray (malic acid 1%) is an effective method for the treatment of xerostomia. Additional randomised controlled trials in the future are needed to provide high-quality evidence of this therapy and to improve clinical practice guidelines.

Effect of citrulline on post-exercise rating of perceived exertion, muscle soreness, and blood lactate levels: A systematic review and meta-analysis.

BACKGROUND: Citrulline is one of the non-essential amino acids that is thought to improve exercise performance and reduce post-exercise muscle soreness. We conducted a systematic review and meta-analysis to determine the effect of citrulline supplements on the post-exercise rating of perceived exertion (RPE), muscle soreness, and blood lactate levels. METHODS: A random effects model was used to calculate the effect sizes due to the high variability in the study design and study populations of the articles included. A systematic search of PubMed, Web of Science, and ClinicalTrials.gov was performed. Eligibility for study inclusion was limited to studies that were randomized controlled trials involving healthy individuals and that investigated the acute effect of citrulline supplements on RPE, muscle soreness, and blood lactate levels. The supplementation time frame was limited to 2 h before exercise. The types and number of participants, types of exercise tests performed, supplementation protocols for L-citrulline or citrulline malate, and primary (RPE and muscle soreness) and secondary (blood lactate level) study outcomes were extracted from the identified studies. RESULTS: The analysis included 13 eligible articles including a total of 206 participants. The most frequent dosage used in the studies was 8 g of citrulline malate. Citrulline supplementation significantly reduced RPE (n = 7, p = 0.03) and muscle soreness 24-h and 48-h after post-exercise (n = 7, p = 0.04; n = 6, p = 0.25, respectively). However, citrulline supplementation did not significantly reduce muscle soreness 72-h post-exercise (n = 4, p = 0.62) or lower blood lactate levels (n = 8, p = 0.17). CONCLUSION: Citrulline supplements significantly reduced post-exercise RPE and muscle soreness without affecting blood lactate levels.

Citrulline Malate Does Not Improve Muscle Recovery after Resistance Exercise in Untrained Young Adult Men.

The effects of citrulline malate (CM) on muscle recovery from resistance exercise remains unknown. We aimed to determine if citrulline malate supplementation improves muscle recovery after a single session of high-intensity resistance exercise (RE) in untrained young adult men. Nine young adult men (24.0 ± 3.3 years) participated in a double-blind crossover study in which they received 6 g of CM and placebo (PL) on two occasions, separated by a seven-day washout period. Each occasion consisted of a single session of high-intensity RE (0 h) and three subsequent fatigue tests sessions (at 24, 48, and 72 h) to assess the time course of muscle recovery. During the tests sessions, we assessed the following variables: number of maximum repetitions, electromyographic signal (i.e., root mean square (RMS) and median frequency (MF)), muscle soreness and perceived exertion, as well as blood levels of creatine kinase (CK), lactate, insulin, and testosterone:cortisol ratio. CK levels increased at 24 h post-exercise and remained elevate at 48 and 72 h, with no difference between CM and PL conditions. Muscle soreness increased at 24 h post-exercise, which progressively returned to baseline at 72 h in both conditions. Lactate levels increased immediately post-exercise and remained elevated at 24, 48, and 72 h in both conditions. No significant treatment × time interaction was found for all dependents variables (maximum repetitions, perceived exertion, CK, lactate, RMS, MF, and testosterone:cortisol ratio) during the recovery period. In conclusion, our data indicate that CM supplementation (single 6 g dose pre-workout) does not improve the muscle recovery process following a high-intensity RE session in untrained young adult men.

Acute citrulline malate supplementation improves upper- and lower-body submaximal weightlifting exercise performance in resistance-trained females.

PURPOSE: Citrulline malate (CM) is a nonessential amino acid that increases exercise performance in males. However, based on physiological differences between genders, these results cannot be extrapolated to females. Therefore, the purpose of this investigation was to evaluate effects of acute CM supplementation on upper- and lower-body weightlifting performance in resistance-trained females. METHODS: Fifteen females (23 ± 3 years) completed two randomized, double-blind trials consuming either CM (8 g dextrose + 8 g CM) or a placebo (8 g dextrose). One hour after supplement consumption, participants performed six sets each of upper- (i.e., bench press) and lower-body (i.e., leg press) exercises to failure at 80 % of previously established one-repetition maximum. Immediately after each set, repetitions completed, heart rate and rating of perceived exertion (RPE) were recorded. RESULTS: Repeated-measures analysis of variance indicated that subjects completed significantly (p = .045) more repetitions throughout upper-body exercise when consuming CM versus placebo (34.1 ± 5.7 vs. 32.9 ± 6.0, respectively). When consuming CM, similar significant (p = .03) improvements in total repetitions completed were observed for lower-body exercise (66.7 ± 30.5 vs. 55.13 ± 20.64, respectively). Overall RPE score was significantly lower (p = .02) in upper-body exercise when subjects consumed CM versus placebo (7.9 ± 0.3 and 8.6 ± 0.2, respectively). The supplement consumed exhibited no significant effects on heart rate at any time point. CONCLUSIONS: Acute CM supplementation in females increased upper- and lower-body resistance exercise performance and decreased RPE during upper-body exercise. These data indicate that athletes competing in sports with muscular endurance-based requirements may potentially improve performance by acutely supplementing CM.

Comparison of Malated Ringer's with Two Other Balanced Crystalloid Solutions in Resuscitation of Both Severe and Moderate Hemorrhagic Shock in Rats.

In preclinical treatment of polytraumatized patients crystalloids are preferentially used. To avoid metabolic acidosis, metabolizable anions like lactate or acetate are used to replace chloride in these solutions. We here studied the effects of malated Ringer's in resuscitation of both shock severities in comparison to lactated and acetated Ringer's. Male Wistar rats underwent severe (mean arterial blood pressure (MAP) of 25-30 mmHg) or moderate (MAP 40-45 mmHg) hemorrhagic shock. Adjacent to the shock period animals were resuscitated with acetated (AR), lactated (LR), or malated Ringer's (MR) and observed for 150 min. MR improved survival compared with LR and AR in severe hemorrhagic shock whereas it was equally effective to LR and superior to AR in moderate hemorrhagic shock. In all other parameters tested, MR was also effective similar to the other solutions under these conditions. We conclude that MR is preferable to AR and LR in resuscitation of hemorrhagic shock independent of shock depth. The positive effects of MR may stem from the absence of any adverse impact on energy metabolism under both conditions.

Role of peroxyacetic acid, octanoic acid, malic acid, and potassium lactate on the microbiological and instrumental color characteristics of ground beef.

UNLABELLED: This study evaluated the effects of peroxyacetic acid (PAA), malic acid (MA), octanoic acid (OA), and potassium lactate (KL) followed by mixing with trisodium phosphate (TSP) and an ultra-chilled CO2 snow shower on microbial counts of Escherichia coli (EC), coliform (CF), aerobic plate count (APC), and Salmonella Typhimurium (ST) on inoculated beef trimmings and the instrumental color attributes of the resultant ground beef. Beef trimmings inoculated with EC and ST were treated with either 0.02% PAA; 2% MA; 0.04% OA; or 2% KL, followed by mixing with 10% TSP and rapid chilling with CO2 snow shower. Treated trimmings were then ground, packaged, displayed under simulated retail conditions, and sampled on days 1, 2, 3, 5, and 7 for microbial counts and instrumental color characteristics. PAA, MA, OA, and KL reduced (P < 0.05) the microbial counts of EC, CF, APC, and ST during display. Among treatments, OA was most effective on EC, CF, ST, and APC during retail display. Chilling beef trimmings with CO2 improved instrumental color characteristics of the produced ground beef but made little difference in reducing microbial counts during display. During retail display, ground beef produced from beef trimmings treated with antimicrobials tended to maintain redness, myoglobin redox form stability (630 nm/580 nm), and overall instrumental color characteristics. PRACTICAL APPLICATION: This research provides a practical and cost-effective decontamination technology for beef processors that can be immediately implemented in the ground beef production chain. Using antimicrobial intervention coupled with rapid chilling could benefit the meat industry by preserving the quality attributes of ground beef during retail display under aerobic packaging environment.

Acids with an equivalent taste lead to different erosion of human dental enamel.

OBJECTIVES: The consumption of acidic soft drinks may lead to demineralization and softening of human dental enamel, known as dental erosion. The aims of this in vitro study were to determine: (i) if different acids with a similar sensorial acidic taste lead to different hardness loss of enamel and (ii) if the fruit acids tartaric, malic, lactic or ascorbic acid lead to less hardness loss of enamel than citric or phosphoric acid when their concentration in solution is based on an equivalent sensorial acidic taste. METHODS: Enamel samples of non-erupted human third molars were treated with acidic solutions of tartaric (TA), malic (MA), lactic (LA), ascorbic (AA), phosphoric (PA) and citric (CA) acids with a concentration that gave an equivalent sensorial acidic taste. The acidic solutions were characterized by pH value and titratable acidity. Atomic force microscopy (AFM) based nanoindentation was used to study the nano mechanical properties and scanning electron microscopy (SEM) was used to study the morphology of the treated enamel samples and the untreated control areas, respectively. RESULTS: The investigated acids fell into two groups. The nano hardnesses of MA, TA and CA treated enamel samples (group I) were statistically significantly greater (p<0.05) than the nano hardnesses of PA, AA and LA treated enamel samples (group II). Within each group the nano hardness was not statistically significantly different (p>0.05). The SEM micrographs showed different etch prism morphologies depending on the acid used. SIGNIFICANCE: In vitro, the acids investigated led to different erosion effects on human dental enamel, despite their equivalent sensorial acidic taste. This has not been reported previously.

Comparación del Efecto de la adición de malato vs monensina sobre parámetros bioquímicos en terneros en crecimiento / Comparison between malate vs monensin adition on biochemicals parameters in growing steers

El objetivo del presente trabajo fue evaluar “ in vivo ” las repercusiones que tiene la adición de malato sódico sobre parámetros del medio interno, comparándolos con los resultados obtenidos al aplicar monensina sódica. Los parámetros sanguíneos estudiados fueron: glucosa, colesterol, triglicéridos, ácidos grasos libres, y las enzimas aspartato amino transferasa (ASAT), amilasa y gamma glutamil transpeptidasa (GGT). El estudio fue realizado con 13 animales, 8 de ellos recibieron malato sódico y 5 animales monensina sódica, extrayendo 6 muestras a cada animal, una toma basal (toma 1), y a los 3 (toma 2), 7 (toma 3), 21 (toma 4), 46 (toma 5) y 57 días (toma 6). Los resultados obtenidos muestran muy pocas diferencias entre ambos grupos y evoluciones parecidas, con variaciones entre grupos en el día 3 (ácidos grasos libres), día 7 (GGT), en el día 21 (amilasa) y en el día 46 (amilasa y GGT). En cuanto a las evoluciones de los parámetros a lo largo del experimento, colesterol, triglicéridos, amilasa y ASAT son los cuatro parámetros que presentan cambios estadísticos, con evoluciones similares en ambos grupos.

Effects of sodium malate addition on selected blood parameters, compared with the monensin addition were evaluated in this study. Serum glucose, triglycerides, cholesterols, free fatty acids (FFA), and the enzymes aspartate amino transferase (ASAT), amylase and gamma glutamyl transpeptidase (GGT) were studied. Thirteen steers, distributed in two different groups were used, one group (n=8) received sodium malate, and another group (n=5) received monensin and considered for us as a control group. Six samplings were obtained for each animal, at day 0 (before addition), and at days 3; 7; 21; 46 and 57 (after addition), respectively. Results obtained showed a similar evolution in both groups with small differences between them, at day 3 (FFA), at day 7 (GGT), at day 21 (amylase) and at day 46 (GGT and amylase). In relation with the evolution, we have seen similar statistical changes in both groups for cholesterol, triglycerides, amylase and ASAT assays.

Homeopathic pathogenetic trials of Acidum malicum and Acidum ascorbicum.

Two homeopathic pathogenetic trials (HPTs, provings), of identical design were conducted: of Acidum malicum 12 cH and Acidum ascorbicum 12 cH. Each trial included 20 healthy volunteers. Both were of double-blind, placebo-controlled, randomised, four period crossover design, with two sequences. 'Healthy' was defined in terms of SF-36 scores, medical judgement and blood tests. All volunteers had regular interviews with the same supervisor. No serious adverse reactions occurred. The causal relationship of each symptom with treatment was judged, blind, by the volunteer, the supervisor and a 9-item pathogenetic index. For Acidum malicum 79 symptoms were identified by the supervisor, 57 were included in the final analysis, 22 occurred in verum treatment periods. For Acidum ascorbicum, of 55 symptoms, 39 were included in the analysis. 16 occurred in verum treatment periods.

Final report on the safety assessment of Malic Acid and Sodium Malate.

Malic Acid functions in cosmetic formulations as a pH adjuster, and Sodium Malate functions as a skin conditioning agent-humectant. Malic Acid is reportedly used in almost 50 cosmetic formulations across a range of product types at low concentrations, whereas Sodium Malate is used in only one. As a pH adjuster, Malic Acid is used at low concentrations. One commercial method of preparing Malic Acid is hydration of fumaric acid or maleic acid, and then purified to limit the amount of the starting material present. Because Malic Acid is a component of the Kreb's cycle, another method is fermentation. Malic Acid was relatively nontoxic in acute toxicity studies using animals. In a chronic oral study, feeding Malic Acid to rats resulted only in weight gain changes and changes in feed consumption. Malic Acid did not cause reproductive toxicity in mice, rats, or rabbits. Malic Acid was a moderate to strong skin irritatant in animal tests, and was a strong ocular irritant. Malic Acid was not mutagenic across a range of genotoxicity tests. Malic Acid was irritating in clinical tests, with less irritation seen as pH of the applied material increased. Patients patch tested with Malic Acid, placed on a diet that avoided foods containing Malic or citric acid, and then challenged with a diet high in Malic and citric acid had both immediate urticarial and delayed contact dermatitis reactions. These data were considered sufficient to determine that Malic Acid and Sodium Malate would be safe at the low concentrations at which these ingredients would be used to adjust pH (even though Sodium Malate is not currently used for that purpose). The data, however, were insufficient to determine the safety of these ingredients when used in cosmetics as other than pH adjusters and specifically, the data are insufficient to determine the safety of Sodium Malate when used as a skin conditioning agent-humectant. The types of data required for the Expert Panel to determine the safety of Sodium Malate as a skin-conditioning agent are: concentration of use data; dermal irritation and sensitization data; and ocular irritation data, if available. The data needed to assess the safety of Malic Acid or Sodium Malate for some function other than as a skin-conditioning agent cannot be specified without knowing the intended function. Were these ingredients to be used as exfoliants, for example, data similar to that included in the Cosmetic Ingredient Review safety assessment of Glycolic Acid would be needed. Until these data are available, it is concluded that the available data are insufficient to support the safety of these ingredients in cosmetic formulations for functions other than use as a pH adjuster.

The acidity (pH) and buffering capacity of Canadian fruit juice and dental implications.

Excessive consumption of acidic fruit juices is associated with dental morbidity. The pH and buffering capacities of fruit juices packaged and consumed in Canada were measured, and the implications on dental pathology of consuming juices of these qualities are discussed. Canadian fruit juices have a pH below the critical dissolving pH of enamel, and have buffering capacities similar to juices produced and consumed elsewhere in the world. Citrus, apple, and grape juice, or blends of these juices, are all potentially hazardous to teeth. Erosion, attrition, decay and dentinal hypersensitivity may all result from abusive juice drinking.

Experimental erosion of dentin.

Experimental erosion in human dentin was investigated with scanning electron microscopy. Erosion was caused by solutions containing either 0.030 mekV/g malic acid (pH 3.4), 0.034 mekV/g phosphoric acid (pH 2.6), or 0.038 mekV/g citric acid (pH 2.8). Test specimens prepared from the coronal parts of erupted third molars were immersed in the solutions from 30 s to 60 min. When compared with controls, exposure of dentin tubules was observed in all the specimens already after 30 s immersion, irrespective of the acid used. Mineral loss was seen to progress at the interface between peritubular and intertubular dentin in specimens immersed for 60 s in the acidic solutions. Longer times of immersion resulted in hollowing of the tubular openings by complete destruction of the peritubular dentin. Surface roughness and porosities were seen also at the intertubular areas. Although based on a simplified study model, our results may explain why so many patients with erosions suffer from painful sensitivity of their teeth: the acids causing erosion can expose inner dentin structures to outer stimuli by significant enlargement of the dentinal tubules.

A study to assess the effects of a new Betadine cream formulation compared to a standard topical treatment regimen for burns.

This study has shown that Betadine cream with or without Aserbine is as easy to apply and remove as Betadine ointment plus Aserbine. With Betadine cream there is as good as and in some instances better healing than with Betadine ointment/Aserbine in the topical treatment of burns. However, the addition of a necrolytic cream to Betadine cream does have favourable effects on wound healing and bacterial counts. More importantly, this study suggests that Betadine cream can penetrate the wound more effectively than the Betadine ointment/Aserbine combination but that the addition of a necrolytic cream is still advantageous.

Effect of saliva stimulants (Hybrin and malic acid) on cervical root surfaces in vitro.

Two saliva stimulating drugs, solutions of Hybrin and malic acid were in an in vitro study found to have a heavy demineralizing effect on the root surface of the dental hard tissue. Consequently the drugs cannot be recommended to patients suffering from dry mouth reaction.