Combining fracture mechanics and rheology to investigate the impact of micro-aeration on chocolate oral processing.

This study presents a rigorous mechanical characterisation investigation on milk chocolate with varying porosities, at different temperatures and strain rate levels. Uniaxial compression tests at temperatures varying from 20 °C to 30 °C were performed to measure the bulk properties of chocolate as a function of porosity and temperature. Fracture experiments were also conducted to compute the fracture energy at temperature levels between 20 °C and 30 °C for all tested samples. Additionally, rheological experiments are conducted to compute the viscosity of the different chocolates at 37 °C. This combined experimental analysis of solid mechanics, fracture mechanics, and rheology aims to define the impact of temperature and chocolate's phase change from solid to liquid on its mechanical properties. Moreover, the impact of micro-aeration on the relationship between material properties and temperature is discussed. The results demonstrate a significant impact of both temperature and micro-aeration on the chocolate's material properties; fracture stresses decrease with micro-aeration due to the presence of micro-pores creating weak links in the chocolate matrix, the critical strain energy release rate decreases with micro-aeration at temperatures up to 25 °C and increases at temperatures above 30 °C. Finally, the viscosity at 37 °C increases with increasing porosity due to the obstruction of the flow by micro-pores acting as "solid" particles. The results highlight how the impact of micro-aeration on the material properties of chocolate alters as the testing temperature rises and the material changes phase. The relationships between the micro-aeration and material properties and the dependence of temperature on the different mechanical properties are used to explain the difference in textural attributes as obtained from temporal dominance sensation tests. This study seeks to contribute valuable insights into the field of chocolate technology, emphasizing the need for a combined engineering approach to understand the structural breakdown of chocolate during oral processing as mechanisms such as chewing, melting, mixing and shearing occur.

Operative blood loss adversely affects short and long-term outcomes after colorectal cancer surgery: results of a systematic review and meta-analysis.

BACKGROUND: The aim of this meta-analysis was to assess the impact of operative blood loss on short and long-term outcomes following colorectal cancer surgery. METHODS: A systematic literature review and meta-analysis were performed, from inception to the 10th of August 2020. A comprehensive literature search was performed on the 10th of August 2020 of PubMed MEDLINE, Embase, Science Citation Index Expanded, and Cochrane Central Register of Controlled Trials. Only studies reporting on operative blood loss and postoperative short term or long-term outcomes in colorectal cancer surgery were considered for inclusion. RESULTS: Forty-three studies were included, reporting on 59,813 patients. Increased operative blood loss was associated with higher morbidity, for blood loss greater than 150-350 ml (odds ratio [OR] 2.09, p < 0.001) and > 500 ml (OR 2.29, p = 0.007). Anastomotic leak occurred more frequently for blood loss above a range of 50-100 ml (OR 1.14, p = 0.007), 250-300 ml (OR 2.06, p < 0.001), and 400-500 ml (OR 3.15, p < 0.001). Postoperative ileus rate was higher for blood loss > 100-200 ml (OR 1.90, p = 0.02). Surgical site infections were more frequent above 200-500 ml (OR 1.96, p = 0.04). Hospital stay was increased for blood loss > 150-200 ml (OR 1.63, p = 0.04). Operative blood loss was significantly higher in patients that suffered morbidity (mean difference [MD] 133.16 ml, p < 0.001) or anastomotic leak (MD 69.56 ml, p = 0.02). In the long term, increased operative blood loss was associated with worse overall survival above a range of 200-500 ml (hazard ratio [HR] 1.15, p < 0.001), and worse recurrence-free survival above 200-400 ml (HR 1.33, p = 0.01). Increased blood loss was associated with small bowel obstruction caused by colorectal cancer recurrence for blood loss higher than 400 ml (HR 1.97, p = 0.03) and 800 ml (HR 3.78, p = 0.02). CONCLUSIONS: Increased operative blood loss may adversely impact short term and long-term postoperative outcomes. Measures should be taken to minimize operative blood loss during colorectal cancer surgery. Due to the uncertainty of evidence identified, further research, with standardised methodology, is required on this important subject.

Experimental and numerical evaluation of the effect of micro-aeration on the thermal properties of chocolate.

Thermal properties, such as thermal conductivity, specific heat capacity and latent heat, influence the melting and solidification of chocolate. The accurate prediction of these properties for micro-aerated chocolate products with varying levels of porosity ranging from 0% to 15% is beneficial for understanding and control of heat transfer mechanisms during chocolate manufacturing and food oral processing. The former process is important for the final quality of chocolate and the latter is associated with sensorial attributes, such as grittiness, melting time and flavour. This study proposes a novel multiscale finite element model to accurately predict the temporal and spatial evolution of temperature across chocolate samples. The model is evaluated via heat transfer experiments at temperatures varying from 16 °C to 45 °C. Both experimental and numerical results suggest that the rate of heat transfer within the micro-aerated chocolate is reduced by 7% when the 15% micro-aerated chocolate is compared to its solid counterpart. More specifically, on average, the thermal conductivity decreased by 20% and specific heat capacity increased by 10% for 15% micro-aeration, suggesting that micro-pores act as thermal barriers to heat flow. The latter trend is unexpected for porous materials and thus the presence of a third phase at the pore's interface is proposed which might store thermal energy leading to a delayed release to the chocolate system. The developed multiscale numerical model provides a design tool to create pore structures in chocolate with optimum melting or solidifying response.

A systematic review and network meta-analysis comparing energy devices used in colorectal surgery.

BACKGROUND: The aim of this study was to compare energy devices used for intraoperative hemostasis during colorectal surgery. METHODS: A systematic literature review and Bayesian network meta-analysis performed. MEDLINE, EMBASE, Science Citation Index Expanded, and Cochrane were searched from inception to August 11th 2021. Intraoperative outcomes were operative blood loss, operative time, conversion to open, conversion to another energy source. Postoperative outcomes were mortality, overall complications, minor complications and major complications, wound complications, postoperative ileus, anastomotic leak, time to first defecation, day 1 and 3 drainage volume, duration of hospital stay. RESULTS: Seven randomized controlled trials (RCTs) were included, reporting on 680 participants, comparing conventional hemostasis, LigaSure™, Thunderbeat® and Harmonic®. Harmonic® had fewer overall complications compared to conventional hemostasis. Operative blood loss was less with LigaSure™ (mean difference [MD] = 24.1 ml; 95% confidence interval [CI] - 46.54 to - 1.58 ml) or Harmonic® (MD = 24.6 ml; 95% CI - 42.4 to - 6.7 ml) compared to conventional techniques. Conventional hemostasis ranked worst for operative blood loss with high probability (p = 0.98). LigaSure™, Harmonic® or Thunderbeat® resulted in a significantly shorter mean operative time by 42.8 min (95% CI - 53.9 to - 31.5 min), 28.3 min (95% CI - 33.6 to - 22.6 min) and 26.1 min (95% CI - 46 to - 6 min), respectively compared to conventional electrosurgery. LigaSure™ resulted in a significantly shorter mean operative time than Harmonic® by 14.5 min (95% CI 1.9-27 min) and ranked first for operative time with high probability (p = 0.97). LigaSure™ and Harmonic® resulted in a significantly shorter mean duration of hospital stay compared to conventional electrosurgery of 1.3 days (95% CI - 2.2 to - 0.4) and 0.5 days (95% CI - 1 to - 0.1), respectively. LigaSure™ ranked as best for hospital stay with high probability (p = 0.97). Conventional hemostasis was associated with more wound complications than Harmonic® (odds ratio [OR] = 0.27; CI 0.08-0.92). Harmonic® ranked best with highest probability (p = 0.99) for wound complications. No significant differences between energy devices were identified for the remaining outcomes. CONCLUSIONS: LigaSure™, Thunderbeat® and Harmonic® may be advantageous for reducing operative blood loss, operative time, overall complications, wound complications, and duration of hospital stay compared to conventional techniques. The energy devices result in comparable perioperative outcomes and no device is superior overall. However, included RCTs were limited in number and size, and data were not available to compare all energy devices for all outcomes of interest.

Effect of micro-aeration on the mechanical behaviour of chocolates and implications for oral processing.

Aeration in foods has been widely utilised in the food industry to develop novel foods with enhanced sensorial characteristics. Specifically, aeration at the micron-sized scale has a significant impact on the microstructure where micro-bubbles interact with the other microstructural features in chocolates. This study aims to determine the effect of micro-aeration on the mechanical properties of chocolate products, which are directly correlated with textural attributes such as hardness and crumbliness. Uniaxial compression tests were performed to determine the mechanical properties such as Poisson's ratio, Young's modulus and macroscopic yield strength together with fracture tests to estimate the fracture toughness. In vivo mastication tests were also conducted to investigate the link between the fracture properties and fragmentation during the first two chewing cycles. The uniaxial stress-strain data were used to calibrate a viscoplastic constitutive law. The results showed that micro-aeration significantly affects mechanical properties such as Young's modulus, yield and fracture stresses, as well as fracture toughness. In addition, it enhances the brittle nature of the chocolate, as evidenced by lower fracture stress but also lower fracture toughness leading to higher fragmentation, in agreement with observations in the in vivo mastication tests. As evidenced by the XRT images and the stress-strain measurements micro-aeration hinders the re-arrangement of the microscopic features inside the chocolate during the material's deformation. The work provides a new insight of the role of bubbles on the bulk behaviour of complex multiphase materials, such as chocolates, and defines the mechanical properties which are important input parameters for the development of oral processing simulations.

Computer simulations of food oral processing to engineer teeth cleaning.

Oral biofilm accumulation in pets is a growing concern. It is desirable to address this problem via non-invasive teeth cleaning techniques, such as through friction between teeth and food during chewing. Therefore, pet food design tools are needed towards optimising cleaning efficacy. Developing such tools is challenging, as several parameters affecting teeth cleaning should be considered: the food's complex mechanical response, the contacting surfaces topology as well as the wide range of masticatory and anatomical characteristics amongst breeds. We show that Finite Element (FE) models can efficiently account for all these parameters, through the simulation of food deformation and fracture during the first bite. This reduces the need for time consuming and costly in-vivo or in-vitro trials. Our in-silico model is validated through in-vitro tests, demonstrating that the initial oral processing stage can be engineered through computers with high fidelity.

A systematic approach to the formulation of anti-onychomycotic nail patches.

Nail patches have a potential role as drug carriers for the topical treatment of nail diseases such as onychomycosis, a common condition. Our aim was therefore to develop a systematic and novel approach to the formulation of a simple drug-in-adhesive ungual patch. Twelve pressure-sensitive adhesives (PSAs), four backing membranes, two release liners and three drugs were screened for pharmaceutical and mechanical properties. From this initial screening, two PSAs, two drugs, one backing membrane and one release liner were selected for further investigation. Patches were prepared by solvent-casting and characterised. The patches had good uniformity of thickness and of drug content, and showed minimal drug crystallisation during six months of storage. Meanwhile, the drug stability in the patch upon storage and patch adhesion to the nail was influenced by the nature of the drug, the PSA and the backing membrane. The reported methodology paves the way for a systematic formulation of ungual nail patches to add to the armamentarium of nail medicines. Further, from this work, the best patch formulation has been identified.

Antipsychotic treatment resistance in first-episode psychosis: prevalence, subtypes and predictors.

BACKGROUND: We examined longitudinally the course and predictors of treatment resistance in a large cohort of first-episode psychosis (FEP) patients from initiation of antipsychotic treatment. We hypothesized that antipsychotic treatment resistance is: (a) present at illness onset; and (b) differentially associated with clinical and demographic factors. METHOD: The study sample comprised 323 FEP patients who were studied at first contact and at 10-year follow-up. We collated clinical information on severity of symptoms, antipsychotic medication and treatment adherence during the follow-up period to determine the presence, course and predictors of treatment resistance. RESULTS: From the 23% of the patients, who were treatment resistant, 84% were treatment resistant from illness onset. Multivariable regression analysis revealed that diagnosis of schizophrenia, negative symptoms, younger age at onset, and longer duration of untreated psychosis predicted treatment resistance from illness onset. CONCLUSIONS: The striking majority of treatment-resistant patients do not respond to first-line antipsychotic treatment even at time of FEP. Clinicians must be alert to this subgroup of patients and consider clozapine treatment as early as possible during the first presentation of psychosis.

Fracture investigation in starch-based foods.

The study of oral processing and specifically cutting of the food piece during mastication can lead towards optimization of products for humans or animals. Food materials are complex biocomposites with a highly nonlinear constitutive response. Their fracture properties have not been largely investigated, while the need for models capable of predicting food breakdown increases. In this study, the blade cutting and the essential work of fracture (EWF) methodologies assessed the fracture behaviour of starch-based pet food. Tensile tests revealed rate-dependent stiffness and stress softening effects, attributed to viscoplasticity and micro-cracking, respectively. Cutting data were collected for 5, 10 and 30 mm s(-1) sample feed rates, whereas the EWF tests were conducted at 1.7, 3.3 and 8.3 mm s(-1) crosshead speeds corresponding to average crack speeds of 4, 7 and 15 mm s(-1), respectively. A reasonable agreement was achieved between cutting and EWF, reporting 1.26, 1.78, 1.76 kJ m(-2) and 1.52, 1.37, 1.45 kJ m(-2) values, respectively, for the corresponding crack speeds. These toughness data were used in a novel numerical model simulating the 'first' bite mastication process. A viscoplastic material model is adopted for the food piece, combined with a damage law that enabled predicting fracture patterns in the product.