Comprehensive optimization of composite cryoprotectant for Saccharomyces boulardii during freeze-drying and evaluation of its storage stability.

Saccharomyces boulardii (S. boulardii) is widely adopted in the diarrhea treatment for humans or livestock, so guaranteeing the survival rate of S. boulardii is the critical issue during freeze-drying process. In this study, the survival rate of S. boulardii with composite cryoprotectants during freeze-drying procedure and the subsequent storage were investigated. With the aid of response surface method, the composite cryoprotectants were comprehensively optimized to be lactose of 21.24%, trehalose of 22.00%, and sodium glutamate of 4.00%, contributing to the supreme survival rate of S. boulardii of 64.22 ± 1.35% with the viable cell number of 9.5 ± 0.07 × 109 CFU/g, which was very close to the expected rate of 65.55% with a number of 9.6 × 109 CFU/g. The accelerated storage test demonstrated that the inactivation rate constant of the freeze-dried S. boulardii powder was k-18 = 8.04 × 10-6. In addition, the freeze-dried goat milk powder results exhibited that the inactivation rate constants were k4 = 4.48 × 10-4 and k25 = 9.72 × 10-3 under 4 and 25 °C, respectively. This work provides a composite cryoprotectant formulation that has a good protective effect for the probiotic S. boulardii during freeze-drying process, possessing the potential application prospect in food, medicine, and even feed industry.

The study on the feasibility of using bispectral index value to assess the degree of acute brain injury / 中国神经精神疾病杂志

Objective To explore the feasibility of using bispectral index (BIS)value to assess the degree of acute brain injury (ABI) and study the correlation between Glasgow Coma Scale (GCS)scores and BIS values in ABI patients. Method A prospective and double-blinded study was conducted to assess GCS scores and BIS values in 330 patients with ABI from January 2013 till July 2017. Mean BIS values (BISMEAN) in mild, moderate and severe group of ABI were calculated. Linear regression between BIS values and GCS scores was constructed. Receiver operating characteristic(ROC) curves to predict non-mild ABI (GCS score less than 13) and severe ABI (GCS score less than 9) were plotted respectively. Results BISMEAN were significantly different among mild, moderate and severe ABI group (75.46±12.94、64.30±12.56、50.37±16.90 respectively, P＜0.01). There were a significant positive correlations between GCS scores and BIS values (R2=0.446, F=264.374, P＜0.01). Regression equation was BIS=2.96 GCS+33.77. ROC curve to predict non-mild ABI demonstrated that area under the curve (AUC)was equal to 0.835 and the optimal cut-off point (BIS value) corresponding with the maximum of sensitivity+specificity was 72.7(sensitivity=0.689, specificity=0.840); ROC curve to predict severe ABI demonstrated that AUC was equal to 0.846 and the optimal cut-off point (BIS value) corresponding with the maximum of sensitivity + specificity was 65.8 (sensitivity=0.721, specificity=0.861). Conclusion BIS values significantly correlate with GCS scores in ABI patients, indicating the feasiblity of using BIS value to assess the degree of ABI. Furthermore, continuous and real-time BIS monitoring can assess degree of ABI better than BIS value.

Diagnosis and treatment of 3 patients of intracranial fungai granulomas / 中华神经科杂志

Objective To examine clinical features, neuroimaging presentation and treatment of intracranial fungal granulomas (ICFG) in order to improve the accuracy rates of diagnosis and cure. Methods Three pathologically proven cases with ICFG were retrospectively analyzed. Cases of ICFG reported in literature were also summarized. Results Among the 3 patients with ICFG, 1 patient had a history of head trauma and craniotomy and 1 had a history of type 2 diabetes mellitus and a long history of exposure to doves. In all 3 patients, the symptoms started with headache and vomiting, accompanied by low-grade fever, convulsion, and cranial nerve deficits. Intracranial mass lesion was revealed on brain computed tomography (CT) scan and (or) magnetic resonance imaging (MRI) with or without intravenous contrast. CT scan showed low-density lesions and granulations with ring and homogenous enhancement, indicating fungal abscesses. MRI in all 3 cases showed one or multiple circumscribed intracranial space-occupying lesion, with ring, heterogeneous contrast enhancement and perilesional edema. The treatments were initiated with craniotomy and surgical resection of granulations followed by intravenous injection of amphotericin B (AMB) combined with fluconazole. The daily administration of AMB was increased gradually from 0.25-1.50 mg/kg and the total dosage of 2-4 g should be achieved within 3 months. The combination therapy with fluconazole (400 mg/d ) was also given by intravenous injection. To increase penetration into cerebrospinal fluid, intrathecal injection of AMB had also been given at the maximum dosage of 1 mg every time, twice a week. Two patients were administered fluconazole (200 mg/d ) orally for 3, 6 months consecutively after completing the combination therapy of AMB with fluconazole, while the other patient refused continuous antifungal treatment 1 month postoperatively. All 3 patients were followed up for a period between 3, 24, 48 months. The 2 patients that completed full antifungal treatment were cured without recurrence. The other patient had improved transiently after operation but died after 3 months. Conclusions Because no distinct chnical and neuroimaging features are presented in ICFG, it is difficult to diagnose preoperatively. Indications for surgery include diagnosis, relief mass effect and increase efficiency of drug treatment. Use of appropriate and completed antifungal treatment decreases mortality. The treatment requires continued and long-term administration of antifungal medication to prevent relapses, whether granulomas are totally removed or not.