Using the Biomechanical Examination to Guide Therapy.

In trying to explain the myriad of foot deformities and symptoms that have slow onset and/or are considered to be overuse syndromes, clinicians have been trying to develop quantitative examinations to describe the cause of the patient's problems and to better individualize treatment modalities. This type of examination is called a biomechanical examination. This article discusses some of the more common portions of a biomechanical examination of the foot and lower extremity. It will also point out some ways that the information from a biomechanical examination can be applied in clinically treating patients.

Survival of Probiotics in Hypromellose Capsules with Rice or Potato Maltodextrin Excipient.

There is currently no authorized or established therapeutic level/dose of probiotics for proposed health benefits; however, a daily probiotic consumption of 108 to 1010 CFU has been recommended. This study determined the survival of 5 individual probiotic strains, Lactobacillus rhamnosus, Lactobacillus paracasei, Lactobacillus plantarum, Lactobacillus acidophilus, and Bifidobacterium lactis, along with a mixture of the 5 strains in hypromellose capsules with rice or potato maltodextrin at 4, 25, and 37 °C for 12 mo. Samples were collected monthly and plated on deMan-Rogosa Sharpe agar with 0.05% l-cysteine hydrochloride. Results showed that samples stored at 4 °C had an average count of 108 to 1011 CFU/g of probiotic cells during the 12 mo period, whereas at 25 °C, L. rhamnosus and L. paracasei had an average counts below 108 CFU/g during the storage period. L. rhamnosus was the most vulnerable strain used in this study, having the least viable counts at all 3 storage temperatures. Probiotics stored in rice maltodextrin, on average, had higher probiotic counts compared to those stored in potato maltodextrin. Study suggests that to provide consumers with 108 to 1010 CFU/d of probiotic cells, robust bacterial strains, suitable carriers, and a storage temperature of 4 °C are required.

Development of a Drinkable, Peanut-Based Dietary Supplement and Comparison of Its Nutritional and Microbiological Qualities with Commercial Products.

This study was undertaken to formulate, using peanuts as a major ingredient, a beverage which will benefit older adults who are at a high risk of protein-energy malnutrition and other health complications, and to compare its nutritional and microbiological qualities to commercial products. Peanuts, rice flour, and flaxseed meal in a ratio of 48.0:49.8:2.2 were mixed with water (20% solids) and cooked into gruel which was sequentially treated with BAN(®) , (480 KNU-B/g, 75 °C 1 h), Alcalase(®) (2.4 AU-A/g, 60 °C 1 h), and Flavourzyme(®) (1000 LAPU/g, 55 °C 1 h) to predigest starch and protein, respectively. The degree of hydrolysis and product viscosity during hydrolysis was measured. The nutritional and microbiological qualities of the product were compared to 10 commercial products. Results indicate that 60% of starch was hydrolyzed while a total of 1.62% protein hydrolysis was observed. Product viscosity reduced from 228.55 to 3.60 cP at the end of hydrolysis. The formulation had no cholesterol and low sodium which was a functional property that was absent in the commercial products. Results of this study suggest that the formulation can be further optimized into a unique product that could cater for the protein needs and other nutritional requirements of older adults.

The use of nutrient-optimizing/cost-minimizing software to develop ready-to-use therapeutic foods for malnourished pregnant women in Mali.

Malnutrition affects people of all ages in many countries in the developing world. One treatment for malnutrition is the intervention involving ready-to-use therapeutic foods (RUTFs). This study developed RUTFs for pregnant women in Mali using formulation computer software and largely local, plant-based ingredients. Mali has the world's second highest birth rate and infant mortality rate. Nutrient profiles of possible ingredients and their prices from 2004 to 2009 were entered into the software. Computer-selected ingredients included peanuts, cowpeas, and millet as well as rice or barley koji (sources of α-amylase and ingredients). Components of the six selected formulations were milled, hydrolyzed with koji α-amylase, and heated at 121°C for 15 min. The contents of protein, fat, ash, fiber, carbohydrates, amino acid, and energy of dehydrated products were determined and compared with software-predicted values. Actual and predicted values were comparable: the protein content was 1.45-2.04% higher, and ash content was 0.60-0.89% higher than the predicted values, while the fat content was 0.18-0.88% lower, the lysine content was 0.17-0.25% lower, and fiber content was 0.16% lower to 2.06% higher than the predicted values. The difference in actual and predicted energy levels were 14.8-22.2%. The amount of RUTF needed to meet the requirement of most limiting nutrients, lysine and energy, ranged from 2620 to 3002 g. The costs for producing the RUTFs were substantially lower than importing commercial RUTFs even with increased ingredient prices in Mali from 2004 to 2009.

Survival of four commercial probiotic mixtures in full fat and reduced fat peanut butter.

A well-documented health benefit of probiotics is their ability to reduce the incidence of diarrhea in young, malnourished children in the developing countries. This study was undertaken to determine whether peanut butter, a nutritious, low-moisture food could be a carrier for probiotics by observing the survivability of selected probiotic mixtures in peanut butter under different storage conditions. Commercial probiotic mixtures (B, U, N and S) comprising of multiple strains of Lactobacillus, Bifidobacterium, Streptococcus and Lactococcus were inoculated into full fat or reduced fat peanut butter at 10(7) CFU/g. Resulting products were stored at 4, 25 or 37 °C for 12 months. Populations of Lactobacillus, Bifidobacterium and Streptococcus/Lactococcus were determined periodically. The average viable cell counts of N and S were significantly lower than those of B and U (p < 0.05). In all probiotic products stored at different temperatures, Bifidobacterium had the greatest survivability, followed by Lactobacillus and Streptococcus/Lactococcus. The probiotics used in the study had different surviving patterns, and their survival was influenced by storage conditions. Fat content of peanut butter had no significant impacts on probiotic viability. Results suggest that peanut butter can be a vehicle to deliver probiotics for preventing diarrhea among malnourished children.

Survival of Lactobacillus rhamnosus GG as influenced by storage conditions and product matrixes.

Mortality resulting from diarrhea especially that occurs in children younger than 5 y of age ranks 3rd among all deaths caused by infectious diseases worldwide. Probiotics such as Lactobacillus rhamnosus GG are clinically shown to effectively reduce the incidence of diarrhea in children. A food substrate is one of the major factors regulating the colonization of microorganisms in human gastrointestinal tracts. Peanut butter is a nutritious, low-moisture food that could be a carrier for probiotics. In this study, we observed the influence of storage conditions and product matrixes on the survival of L. rhamnosus GG. Cells of L. rhamnosus GG were inoculated into full fat or reduced fat peanut butter at 10(7) CFU/g. Inoculated peanut butter was stored at 4, 25, or 37 °C for 48 wk. Samples were drawn periodically to determine the populations of L. rhamnosus GG. Results showed that there was no significant decrease in the viable counts of L. rhamnosus GG in products stored 4 °C. The survivability of L. rhamnosus GG decreased with increasing storage temperature and time. Product matrixes did not significantly affect the survival of L. rhamnosus GG except at 37 °C. Populations of L. rhamnosus GG were preserved at >6 logs in products stored at 4 °C for 48 wk and at 25 °C for 23 to 27 wk. At 37 °C, the 6-log level could not be maintained for even 6 wk. The results suggest that peanut butter stored at 4 and 25 °C could serve as vehicles to deliver probiotics.

Inhibition of renin and the (pro)renin receptor system.

Renin is the rate-limiting step of the renin-angiotensin system (RAS) and can induce hypertension and cardiovascular diseases (CVDs) through the over-activated renin-angiotensin-converting enzyme (ACE)-angiotensin (Ang) II-Ang II type 1 receptor (AT(1)R) axis. Prorenin and renin bound to the (pro)renin receptor [(P)RR] not only increase the catalytic conversion of angiotensinogen (AGT) to Ang I, but also upregulate the expression of profibrotic genes. This review will discuss the inhibition of renin and the (P)RR system pharmacologically and nutritionally.

Three key proteases--angiotensin-I-converting enzyme (ACE), ACE2 and renin--within and beyond the renin-angiotensin system.

The discovery of angiotensin-I-converting enzyme 2 (ACE2) and a (pro)renin receptor has renewed interest in the physiology of the renin-angiotensin system (RAS). Through the ACE2/angiotensin-(1-7)/Mas counter-regulatory axis, ACE2 balances the vasoconstrictive, proliferative, fibrotic and proinflammatory effects of the ACE/angiotensin II/AT1 axis. The (pro)renin receptor system shows an angiotensin-dependent function related to increased generation of angiotensin I, and an angiotensin-independent aspect related to intracellular signalling. Activation of ACE2 and inhibition of ACE and renin have been at the core of the RAS regulation. The aim of this review is to discuss the biochemistry and biological functions of ACE, ACE2 and renin within and beyond the RAS, and thus provide a perspective for future bioactives from natural plant and/or food resources related to the three proteases.

Changes in selected physical property and enzyme activity of rice and barley koji during fermentation and storage.

UNLABELLED: Koji are solid-state fermentation products made by inoculating steamed grains with the spores of fungi, particularly Aspergillus spp. This research was undertaken to identify the fermentation and storage conditions optimal for the production and maintenance of selected hydrolytic enzymes, such as α-amlyase and protease, in koji. Steamed rice and barley were inoculated with 2 × 10 ¹¹ Aspergillus oryzae spores per kilogram of grains and fermented for 118 h in a growth chamber at 28 to 32 °C with controlled relative humidities. Samples were drawn periodically during fermentation and storage at -20, 4, or 32 °C, and α-amylase and protease activity, mold counts, a(w), moisture contents, and pH of collected samples were determined. It was observed that the a(w), moisture contents, and pH of the koji were influenced by the duration of fermentation and temperature of storage. The α-amylase activity of both koji increased as the populations of A. oryzae increased during the exponential growth phase. The enzyme activity of barley koji was significantly higher than that of rice koji, reaching a peak activity of 211.87 or 116.57 U at 46 and 58 h, respectively, into the fermentation process. The enzyme activity in both products started to decrease once the mold culture entered the stationary growth phase. The protease activities of both koji were low and remained relatively stable during fermentation and storage. These results suggest that rice and barley koji can be used as sources of α-amylase and desired enzyme activity can be achieved by controlling the fermentation and storage conditions. PRACTICAL APPLICATION: Amylases and proteases are 2 important hydrolytic enzymes. In the food industry, these enzymes are used to break down starches and proteins while reducing the viscosity of foods. Although amylases and proteases are found in plants and animals, commercial enzymes are often produced using bacteria or molds through solid state fermentation, which is designed to use natural microbial process to produce enzymes in a controlled environment. A properly produced and maintained koji with a high hydrolytic enzyme activity can serve as an important source of the enzymes for the food industry.

Purification, activity and sequence of angiotensin I converting enzyme inhibitory peptide from alcalase hydrolysate of peanut flour.

Peanut hydrolysate obtained after 6 h of digestion by Alcalase was used to isolate angiotensin I converting enzyme (ACE) inhibitory peptides. After centrifugation and ultrafiltration through a 0.2 microm nylon filter, the hydrolysate was filtered through the polyethersulfone membrane with a molecular weight cutoff (MWCO) of 10 kDa. The resulting permeate was then separated by primary reverse-phase high performance liquid chromatography (RP-HPLC). Eluate was divided into six major fractions according to eluation time. The fraction with eluting time 50-60 min showed the most potent ACE inhibition and was subjected to further purification by the secondary RP-HPLC. Four peaks were found to have strong ACE inhibitory activities, and their IC(50) values were determined. Peptide mass for the most potent peak was obtained by matrix-assisted laser desorption and ionization (MALDI), and sequence was determined by MALDI tandem TOF-TOF (time-of-flight) mass spectrometer (MS/MS) to be Lys-Ala-Phe-Arg.

Plant food-derived Angiotensin I converting enzyme inhibitory peptides.

Hypertension is one of the most common worldwide diseases that afflict humans. Angiotensin I converting enzyme (ACE) catalyzes the formation of vasoconstrictor, angiotensin II, and the inactivation of vasodilator, bradykinin. The influences of ACE on blood pressure make it an ideal target clinically and nutritionally in the treatment of hypertension. A number of animal food-derived peptides have been reviewed about their in vitro and in vivo ACE inhibitory activities. The aim of this review is to discuss the plant food-derived angiotensin I converting enzyme (ACE) inhibitory peptides from sources, production, purification, and structure to in vitro and in vivo activities.

2003 William J. Stickel Gold Award. In vivo forces in the plantar fascia during the stance phase of gait: sequential release of the plantar fascia.

Plantar fasciotomies have become commonplace in podiatric and orthopedic medicine for the treatment of plantar fasciitis. However, several complications have been associated with plantar fascial release. It has been speculated that the cause of these complications is excessive release of the plantar fascia. The aim of this project was to determine whether the amount of fascia released, from medial to lateral, causes a significant increase in force in the remaining fascia. A dynamic loading system was developed that allowed a cadaveric specimen to replicate the stance phase of gait. The system was capable of applying appropriate muscle forces to the extrinsic tendons on the foot and replicating the in vivo timing of the muscle activity while applying force to the tibia and fibula from heel strike to toe-off. As the plantar fascia was sequentially released from medial to lateral, from intact to 33% released to 66% released, the real-time force and the duration of force in the remaining fascia increased significantly, and the force was shifted later in propulsion. In addition, the subtalar joint was unable to resupinate as the amount of fascia release increased, indicating a direct relationship between the medial band of the plantar fascia and resupination of the subtalar joint during late midstance and propulsion.

Reliability and accuracy of biomechanical measurements of the lower extremities.

The reliability of biomechanical measurements of the lower extremities, as they are commonly used in podiatric practice, was quantified by means of intraclass correlation coefficients (ICCs). This was done not only to evaluate interrater and intrarater reliability but also to provide an estimate for the accuracy of the measurements. The measurement protocol involved 30 asymptomatic subjects and five raters of varying experience. Each subject was measured twice by the same rater, with the retest immediately following the test. The study demonstrated that the interrater ICCs were quite low (< or =0.51), except for the measurements of relaxed calcaneal stance position and forefoot varus (both 0.61 and 0.62 for left and right, respectively). However, the intrarater ICCs were relatively high (>0.8) for most raters and measurement variables. Measurement accuracy was moderate between raters.