Submerged fermentation of lentil protein isolate and its impact on protein functionality, nutrition, and volatile profiles.

Fermentation of pulses as a clean processing technique has been reported to have a favorable impact on the functional and nutritional quality of the starting materials. Compared to commonly fermented pulses such as peas and chickpeas, limited information is available on the effect of fermentation on lentils, especially when using a high protein isolate (>80% protein) as compared to seeds or flours. Therefore, in the present work, lentil protein isolate was used as a feedstock for submerged fermentation with Aspergillus niger, Aspergillus oryzae, or Lactobacillus plantarum. After 48 h, the samples showed increased protein content with enhanced solubility and oil-holding capacity. Controlled fermentation, as opposed to spontaneous fermentation, maintained the high foaming capacity; however, all fermented samples had lower foam and emulsion stabilizing properties and reduced water-holding capacity compared to the control. The fermented proteins were also less digestible, possibly due to an increase in phenolics and saponins. New volatile compounds were identified in fermented samples that show promise for improved sensory attributes. Significant differences were observed in specific quality attributes depending on the microbial strain used. Further research is required to better understand the fermentative metabolism of microbial communities when provided high-protein lentil ingredients as growth substrates. PRACTICAL APPLICATION: Fermented lentil protein isolate has promising flavor profiles that may improve its sensory properties for food application.

Facilitating exit from encampments: combining low-barrier transitional housing with stabilizing treatment for substance related problems.

BACKGROUND: Tent encampments in the neighborhood surrounding Boston Medical Center (BMC) grew to include 336 individuals at points between 2019 and 21, prompting public health concerns. BMC, the City of Boston, and Commonwealth of Massachusetts partnered in 2/2022 to offer low-barrier transitional housing to encampment residents and provide co-located clinical stabilization services for community members with substance use disorders (SUDs) experiencing homelessness. METHODS: To meet the needs of some of the people who had been living in encampments, BMC established in a former hotel: 60 beds of transitional housing, not contingent upon sobriety; and a low-barrier SUD-focused clinic for both housing residents and community members, offering walk-in urgent care, SUD medications, and infection screening/prevention; and a 24/7 short-stay stabilization unit to manage over-intoxication, withdrawal, and complications of substance use (e.g., abscesses, HIV risk, psychosis). A secure medication-dispensing cabinet allows methadone administration for withdrawal management. Housing program key metrics include retention in housing, transition to permanent housing, and engagement in SUD treatment and case management. Clinical program key metrics include patient volume, and rates of initiation of medication for opioid use disorder. RESULTS: Housing: Between 2/1/22-1/31/2023, 100 people entered the low-barrier transitional housing (new residents admitted as people transitioned out); 50 former encampment residents and 50 unhoused people referred by Boston Public Health Commission. Twenty-five residents transferred to permanent housing, eight administratively discharged, four incarcerated, and four died (two overdoses, two other substance-related). The remaining 59 residents remain housed; none voluntarily returned to homelessness. One hundred residents (100%) engaged with case management, and 49 engaged with SUD treatment. CLINICAL: In the first 12 months, 1722 patients (drawn from both the housing program and community) had 7468 clinical visits. The most common SUDs were opioid (84%), cocaine (54%) and alcohol (47%) and 61% of patients had a co-occurring mental health diagnosis in the preceding 24-months. 566 (33%) patients were started on methadone and accepted at an Opioid Treatment Program (OTP). CONCLUSIONS: During the 1st year of operation, low-barrier transitional housing plus clinical stabilization care was a feasible and acceptable model for former encampment residents, 49% of whom engaged with SUD treatment, and 25% of whom transitioned to permanent housing.

Food cue reactivity in successful laparoscopic gastric banding: A sham-deflation-controlled pilot study.

Laparoscopic adjustable gastric banding (LAGB) offers a unique opportunity to examine the underlying neuronal mechanisms of surgically assisted weight loss due to its instant, non-invasive, adjustable nature. Six participants with stable excess weight loss (%EWL ≥ 45) completed 2 days of fMRI scanning 1.5-5 years after LAGB surgery. In a within-subject randomized sham-controlled design, participants underwent (sham) removal of ∼ 50% of the band's fluid. Compared to sham-deflation (i.e., normal band constriction) of the band, in the deflation condition (i.e., decreasing restriction) participants showed significantly lower activation in the anterior (para)cingulate, angular gyrus, lateral occipital cortex, and frontal cortex in response to food images (p < 0.05, whole brain TFCE-based FWE corrected). Higher activation in the deflation condition was seen in the fusiform gyrus, inferior temporal gyrus, lingual gyrus, lateral occipital cortex. The findings of this within-subject randomized controlled pilot study suggest that constriction of the stomach through LAGB may indirectly alter brain activation in response to food cues. These neuronal changes may underlie changes in food craving and food preference that support sustained post-surgical weight-loss. Despite the small sample size, this is in agreement with and adds to the growing literature of post-bariatric surgery changes in behavior and control regions.

Effect of roasting pulse seeds at different tempering moisture on the flour functional properties and nutritional quality.

Knowledge on the functional and nutritional properties of wet roasted pulses can increase the utilization of processed pulses as ingredients in food products. This study investigated the effects of tempering different pulse [chickpea (CP), green lentil (GL), navy bean (NB) and yellow pea (YP)] seeds to 20 or 30% moisture prior to roasting (160℃ for 30 min) on the functional properties and nutritional quality of their resulting flours. The surface charge of each pulse remained the same (p > 0.05) after wet roasting and there were no significant (p > 0.05) differences between the different raw pulse flours. The oil holding capacity (OHC) of GL (~2 g/g) was not improved by wet roasting (p > 0.05) whereas the other pulses generally had better OHC for one or both of the tempering moistures used prior to roasting. Foaming properties of all pulses decreased after heat treatment with the exception of both foaming capacity (107%) and stability (~71%) for GL tempered to 20% moisture prior to roasting (p > 0.05). Raw GL had inferior foaming properties compared to the other raw pulse flours (p < 0.001). Emulsion properties of the wet roasted pulses were similar to those of the control (raw flour) for each pulse. Solubility decreased with roasting regardless of the tempering moisture (p < 0.05) whereas in general the in vitro protein digestibility increased. Small improvements (2.4-6.9% increase) in the in vitro protein digestibility-corrected amino acid score were found for GL and NB tempered to 20% moisture before roasting and roasted YP at either moisture content (p < 0.05). Wet roasting increased (p < 0.05) the rapidly digestible starch content, more so with a tempering moisture of 30%. Overall the results from this study will allow for the utilization of wet roasted pulses as ingredients based on their functional properties and protein quality.

Shame and Self-compassion as Risk and Protective Mechanisms of the Internalized Weight Bias and Emotional Eating Link in Individuals Seeking Bariatric Surgery.

BACKGROUND: Emotional eating in bariatric surgery patients is inconsistently linked with poor post-operative weight loss and eating behaviors, and much research to date is atheoretical. To examine theory-informed correlates of pre-operative emotional eating, the present cross-sectional analysis examined paths through which experienced weight bias and internalized weight bias (IWB) may associate with emotional eating among individuals seeking bariatric surgery. METHODS: We examined associations of experienced weight bias, IWB, shame, self-compassion, and emotional eating in patients from a surgical weight loss clinic (N = 229, 82.1% female, M. BMI: 48 ± 9). Participants completed a survey of validated self-report measures that were linked to BMI from the patient medical record. Multiple regression models tested associations between study constructs while PROCESS bootstrapping estimates tested the following hypothesized mediation model: IWB ➔ internalized shame ➔ self-compassion ➔ emotional eating. Primary analyses controlled for adverse childhood experiences (ACE), a common confound in weight bias research. Secondary analyses controlled for depressive/anxiety symptoms from the patient medical record (n = 196). RESULTS: After covariates and ACE, each construct accounted for significant unique variance in emotional eating. However, experienced weight bias was no longer significant and internalized shame marginal, after controlling for depressive/anxiety symptoms. In a mediation model, IWB was linked to greater emotional eating through heightened internalized shame and low self-compassion, including after controlling for depressive/anxiety symptoms. CONCLUSIONS: Pre-bariatric surgery, IWB may signal risk of emotional eating, with potential implications for post-operative trajectories. Self-compassion may be a useful treatment target to reduce IWB, internalized shame, and related emotional eating in bariatric surgery patients. Further longitudinal research is needed.

Effect of different levels of esterification and blockiness of pectin on the functional behaviour of pea protein isolate-pectin complexes.

This research examines changes to the functional (solubility, emulsifying and foaming) properties of pea protein isolate when complexed with commercial citrus pectin of different structural attributes. Specifically, a high methoxy (P90; degree of esterification: 90.0%; degree of blockiness: 64.5%; galacturonic acid content 11.4%) and low methoxy (P29; degree of esterification: 28.6%; degree of blockiness: 31.1%; galacturonic acid: 70%) pectin at their optimum mixing ratios with pea protein isolate (4:1 pea protein isolate to P90; 10:1 pea protein isolate to P29) were assessed at the pHs associated with critical structure forming events during the complexation process (soluble complexation (pHc), pH 6.7 and 6.1; insoluble complex formation (pHϕ1), pH 4.0 and 5.0; maximum complexation (pHopt), pH 3.5 and 3.8; dissolution of complexes, pH 2.4 and 2.1; for admixtures of pea protein isolate-P90 and pea protein isolate-P29, respectively). Pea protein isolate solubility was improved from 41 to 73% by the presence of P90 at pH 6.0 and was also moderately increased at pH 4.0 and pH 5.0 by P90 and P29, respectively. The emulsion stability of both pea protein isolate-pectin complexes was higher than the homogeneous pea protein isolate at all critical pHs except pHopt as well as pHc for pea protein isolate-P29 only. P90, with the higher level blockiness and esterification, displayed better foaming properties at the maximal complexation pH when complexed with pea protein isolate than pea protein isolate-P29 or pea protein isolate alone. However at pHϕ2, pea protein isolate-P29 admixtures produced foams with 100% stability, increasing pea protein isolate foam stability by 85%. The enhanced functionality of pea protein isolate-pectin complexes based on the type of pectin used at critical pHs indicates they may be useful biopolymer ingredients in plant protein applications.

Reasons for Revision: Primary Total Hip Arthroplasty Mechanisms of Failure.

BACKGROUND: This study aimed to examine the major reasons for total hip arthroplasty (THA) failure and temporal patterns in THA revisions. METHODS: A retrospective chart review was conducted on 535 revisions performed on 444 THAs from January 2010 to May 2019 at our institution. RESULTS: The average time to revision THA was 8.51 ± 8.38 years, with 136 cases (30.9%) occurring within 2 years after primary THA. The major mechanisms of failure that resulted in revision surgery were mechanical failure (162, 36.5%), metallosis (95, 21.4%), dislocation or instability (65, 14.6%), periprosthetic fracture (46, 10.4%), infection (44, 9.9%), hematoma or poor wound healing (15, 3.4%), and pain or other (17, 3.8%). CONCLUSION: Based on our institutional experience over the past decade, mechanical failure without dislocation, metallosis, dislocation, periprosthetic fracture, and infection are typical reasons patients present for primary THA revision. Revisions within 2 years after primary THA are more likely to be the result of infection and periprosthetic fracture. Mechanical failure is the most common reason for revision THA overall, and mechanical failure and metallosis are more likely to be the reason revision is necessary 2 or more years after primary THA.

Weight Bias, Shame, and Self-Compassion: Risk/Protective Mechanisms of Depression and Anxiety in Prebariatic Surgery Patients.

OBJECTIVE: Psychopathology in bariatric surgery patients may contribute to adverse postoperative sequelae, including weight regain, substance use, and self-harm. This cross-sectional study aimed to advance the understanding of the risk and protective paths through which weight bias associates with depressive and anxiety symptoms in bariatric surgery candidates (BSC). METHODS: BSC recruited from a surgical clinic (N = 213, 82.2% women, 43 [SD 12] years, mean BMI: 49 [SD 9] kg/m2 ) completed measures of experienced weight bias (EWB), internalized weight bias (IWB), body and internalized shame, and self-compassion; anxiety and depression screeners were accessed from medical charts. Multiple regression and PROCESS bootstrapping estimates tested our hypothesized mediation model as follows: EWB→IWB→body shame→shame→self-compassion→symptoms. RESULTS: After accounting for EWB and IWB, internalized shame accounted for greater variance in both end points than body shame. EWB was associated with greater anxiety through risk paths implicating IWB, body shame, and/or internalized shame. Protective paths associated EWB with fewer depressive and anxiety symptoms among those with higher self-compassion. CONCLUSIONS: The findings suggest a potentially important role for weight bias and shame in psychological health among BSC and implicate self-compassion, a trainable affect-regulation strategy, as a protective factor that may confer some resiliency. Future research using longitudinal and causal designs is warranted.

Workplace Racial Discrimination, Negative Emotions Based on Treatment Due to Race, and Substance Use.

BACKGROUND: Experiencing racial discrimination may be associated with poor health outcomes including negative emotional states and substance use. The workplace is a setting where people may experience discriminatory treatment. Objectives: This study examined associations, between negative emotions due to treatment based on race (NE), workplace racial discrimination (WRD), and substance use outcomes (drinking and smoking), stratified by race. Methods: Data from the cross-sectional 2014 Behavioral Risk Factor Surveillance System (BRFSS), Minnesota and New Mexico sub-samples, were analyzed. This study excluded non-Hispanic white participants, resulting in a sample of n = 3098 adult, U.S. residents. Multivariable logistic regression models were utilized to examine the associations, and possible interactions, between WRD, NE, and substance use (alcohol and tobacco). Results: Prior to stratification, WRD was not associated with drinking or smoking after controlling for NE and other sociodemographic variables, however, NE was associated with heavy drinking. NE appeared to account for some of the observed bivariate associations between WRD and heavy drinking and daily smoking. Post-stratification, WRD was associated with heavy drinking for non-Hispanic other respondents, even after controlling for NE. For non-Hispanic black participants, NE was associated with smoking after controlling for WRD. A stratified interaction analysis of WRD*NE revealed that there was only an association between NE and heavy drinking for Hispanic participants who did not experience WRD. Conclusions: The relationship between WRD and substance use may be in part accounted for by NE. Further exploration is needed to more fully understand why associations exist for some race/ethnicity groups but not others.

Adolescent Cannabis Use and Perceived Social Norm Trends Pre- and Post-Implementation of Washington State's Liberalized Recreational Cannabis Policy: Healthy Youth Survey, 2008-2018.

This study examined trends in adolescent perceptions of social norms pertaining to adolescent cannabis use, in relation to past 30-day adolescent cannabis use, and was interpreted in light of Washington State's liberalized recreational cannabis policy (LRCP: 2012). Data come from Washington's Healthy Youth Survey (HYS), collected during even-numbered years between 2008 and 2018, with methods-stabilized surveys of school-attending youths in grades 8, 10, and 12. This study used an aggregate state census sample of n = 325,723. Year-specific social norms and cannabis use proportions were estimated, stratified by grade. Regression analyses assessed associations between social norms and recent cannabis use. The proportion of recent adolescent cannabis use during the initial years post-LRCP in Washington State remained relatively stable or trended downward slightly; however, 2018 data may indicate a slight upward trend for 10th and 8th graders. Cannabis use by a close friend consistently paralleled adolescent cannabis use trends. The proportion of youth reporting parental acceptance of, and overall community acceptance of, adolescent cannabis use trended slightly upward in 2014 (post-LRCP implementation) but, since, has remained stable or declined slightly. Adolescent self-acceptance of youth cannabis use increased steadily for high school students between 2008 and 2014, edged downward in 2016, and then trended back upward for 8th and 10th graders in 2018. Perceived parental acceptance remained statistically associated with adolescent cannabis use across grades and years, with the strength of associations edging up. Ongoing monitoring of substance use and related risk factor trends will be needed to understand the impacts of LRCPs.

Oral health professionals: An exploration of the physical and psychosocial working environment.

BACKGROUND: Musculoskeletal disorders (MSD) are a significant problem in the oral health profession. This study explores oral health professionals' physical and psychosocial working environments in Australian workplaces. METHOD: Twelve oral health professionals from the public and private dental sectors participated in semi-structured interviews. Interviews were recorded and transcribed. Themes were identified and a coding framework developed which was refined and clarified during analysis. RESULTS: Participants reported a range of physical and psychosocial experiences in their work environment. Three major categories of themes were identified: Job Characteristics - particularly equipment unsuited for task and time constraints; Job Satisfaction - support from management and colleagues was valued, as was the significance of providing oral health care, particularly to children and minority groups; and Individual Factors - MSD and fatigue were reported by most participants. CONCLUSION: Oral health professionals are exposed to a range of workplace physical and psychosocial hazards associated with the development of MSDs. Risk management programs for the prevention of MSDs should take into account the range of physical and psychosocial hazards that oral health professionals are exposed to.

Opioid Use Patterns After Total Joint Arthroplasty.

The incidence of new persistent opioid use following elective total joint arthroplasty (TJA) hasnt been well documented; with this study we aim to further characterize opioid use following TJA, specifically focusing on those patients still requiring opioid prescriptions 6 months postoperatively. Retrospective review of a consecutive series of 977 primary TJA performed from June 2016May 2017. Opioid prescriptions verified in Surescripts database; 3.7% (29) opioid nave patients and 18.0% (35) opioid nonnave patients received fills at 6 months. Opioid nave patients requiring fills at 6 months had more fills from 12 months onward. Opioid nonnave patients requiring fills at 6 months had more preoperative fills than those that werent filling opioid prescriptions (5.49 vs. 2.52 fills). Most patients in this study ceased opioid use by 3 months postoperatively. More preoperative fills in the opioid nonnave population and continuing to fill prescriptions after 23 months were associated with continued opioid use. (Journal of Surgical Orthopaedic Advances 29(1):1317, 2020).

Outpatient, Home-Based Physical Therapy Promotes Decreased Length of Stay and Post-Acute Resource Utilization After Total Joint Arthroplasty.

BACKGROUND: Patients and healthcare systems are increasingly focused on evaluating interventions that increase the value of care delivered. Our objective of this study is to evaluate early post-operative outcomes among those patients who underwent total joint arthroplasty with and without the participation in our piloted Outpatient Physical Therapy Home Visits (OPTHV) program. METHODS: A retrospective analysis of patients undergoing total hip arthroplasty and total knee arthroplasty at a single institution from July 2016 to September 2017 was performed. Matched cohorts were compared according to OPTHV enrollment status. RESULTS: In total, 1729 patients were included in this study. Two hundred ninety-three patients were enrolled in OPTHV, while 1436 patients received institutional standard care. Patients were matched by gender (56.7% vs 57.7% female, P = .751), age (67.75 vs 66.95 years, P = .167), body mass index (30.18 vs 30.12 kg/m2, P = .859), and average American Society of Anesthesiologists score (2.31 vs 2.36, P = .131). OPTHV patients had a shorter length of stay (1.39 vs 1.64 days, P < .001) and were more likely to discharge to home (89.8% vs 74.7%, P < .001). Ninety-day re-admissions (2.7% vs 2.6%, P = .880) and emergency room visits (4.1% vs 4.3%, P = .864) were equivalent. CONCLUSION: OPTHV is a novel program that facilitates discharge home and decreased length of stay after total joint arthroplasty without increasing re-admissions or emergency room visits. Utilization of OPTHV may contribute toward reducing the episode of care costs by reducing utilization of skilled nursing facility and home health services. Further prospective studies are needed to evaluate the effect of OPTHV on the total cost of care and functional outcomes.

Enzymatic cross-linking to improve the handling properties of dough prepared within a normal and reduced NaCl environment.

This research examines the use of three enzymes [glucose oxidase (GOX), hexose oxidase (HOX), and xylanase (XYL)] and their combinations [GOX-XYL and HOX-XYL] on the dough handling properties of CDC Plentiful and Stettler wheat cultivars prepared at reduced (1.0% wt. by flour) and normal (2.0% wt. by flour) NaCl levels. Properties investigated include dough rheology, stickiness, and ratio of resistance to extension and extensibility. The inclusion of XYL and its combinations with GOX and HOX increased the stickiness, yielded lower dough strength indicated by rheology, and reduced the ratio of resistance to extension and extensibility. The inclusion of oxidative enzymes yielded a stronger dough, where HOX addition to dough had the lowest stickiness values and highest |G*| values, whereas GOX addition led to the highest ratio of resistance to extension-extensibility. NaCl only had minor effects overall on dough strength and stickiness for the cultivars studied. Overall, superior dough handling properties were observed with oxidative enzyme addition (GOX and HOX) suggesting that the increased crosslinking that occurs could aid in improving low sodium bread dough properties.

The functional attributes of Peruvian (Kankolla and Blanca juli blend) and Northern quinoa (NQ94PT) flours and protein isolates, and their protein quality.

The overall goal of this research was to examine differences in the composition, functionality and protein quality between Peruvian (PQ) and Northern (NQ) quinoa flours, and their isolates prepared by alkaline extraction/isoelectric precipitation. In the case of the flours, PQ and NQ were comprised of 13.6% and 12.8% protein, respectively. Water hydration (mean value = 1.65 g/g) and oil holding capacities (mean value = 1.75 g/g) of both flours were similar, whereas solubility increased from pH 3 to 7 for both flours, but was higher for PQ. Flours were non-foaming at pH 3, but showed increased foam capacity as the pH increased from 5 to 7, but was higher for PQ. Similar foam stability was found for both flours. Emulsion stability (ES) was similar for both flours, and increased from pH 3 to pH 5/7. In the case of the isolates, water hydration capacity was greater for PQ (4.75 g/g) than NQ (2.85 g/g), whereas oil holding capacity was similar (mean value = 8.6 g/g). For both isolates, solubility was minimum at pH 5.0 and maximum at pH 3/7, with NQ being higher. Isolates showed 2-3 times the foam capacity as flours, the magnitude of which was cultivar and pH dependent. Foam stability was lower at pH 5 than at pH 3/7, whereas ES followed a similar pH effect. Tyrosine and phenylalanine were limiting in both flours, whereas threonine was limiting in both isolates. In vitro protein digestibility corrected amino acid scores for the flours was higher for PQ (56.8%) than NQ (47.7%); however, the reverse was observed for the isolates (NQ, 62.1%; PQ, 58.9%).

The Effect of Neuraxial Anesthesia on Postoperative Outcomes in Total Joint Arthroplasty With Rapid Recovery Protocols.

BACKGROUND: Compared to general anesthesia (GA), neuraxial anesthesia (NA) has been associated with improved outcomes after total joint arthroplasty (TJA). We examined the impact of NA on patient outcomes in an institution with an established rapid recovery protocol. METHODS: This is a single-institution retrospective analysis of 5914 consecutive primary TJA performed from July 2015 to June 2018. Univariate tests and multivariate regression compared length of stay (LOS), transfusion rates, hematocrit levels, discharge disposition, and emergency room returns between patients receiving GA and NA. RESULTS: Patients receiving NA had a significantly shorter LOS (total hip arthroplasty [THA]: GA 1.74 vs NA 1.36 days, P < .001; total knee arthroplasty [TKA]: GA 1.77 vs NA 1.64 days, P < .001). Both THA and TKA patients receiving NA were less likely to require transfusion (THA: GA 5.8% vs NA 1.6%, P < .001; TKA: GA 2.5% vs NA 0.5%, P < .001) and had a higher postoperative hematocrit (THA: GA 32.50% vs NA 33.22%, P < .001; TKA GA 33.57 vs NA 34.50%, P < .001). Patients receiving NA were more likely to discharge home (THA: GA 83.4% vs NA 92.3%, P < .001; TKA: GA 83.3% vs NA 86.3%, P = .010) (THA: NA adjusted OR [aOR] 2.04, P < .001; TKA: NA aOR 1.23, P = .048) and had significantly lower rates of 90-day emergency room visits (THA: NA aOR 0.61, P = .005; TKA: NA aOR 0.74, P = .034). CONCLUSION: NA appears to contribute to decreased LOS, short-term complications, and transfusions while facilitating home discharge following TKA and THA. These trends are consistent when controlling for patient-specific risk factors, suggesting NA may enhance outcomes for patients with increased age, body mass index, and comorbidities. LEVEL OF EVIDENCE: Level III Retrospective Cohort Study.

Effect of extrusion conditions on the physical properties of desi chickpea-barley extrudates and quality attributes of their resulting flours.

In this study, response surface methodology (RSM) was used to evaluate the effect of extrusion conditions on physical properties of chickpea:barley extrudates (60:40), and the resulting protein quality of their flours. Barrel temperature (150-170°C) and moisture content (16-20%) were chosen as independent variables to generate a central composite design. Hardness, expansion index, bulk density, and protein quality were analyzed as responses parameters. Expansion was found to be higher at lower temperatures and higher moisture for the 60:40 chickpea:barley blend; bulk density became reduced with increased moisture; and hardness was found to increase at higher temperatures and lower moistures. The protein quality of their resulting flours was found to be greater at moisture contents higher than 16%. The composition, protein quality, and functional attributes were also examined for raw and precooked flours of chickpea, barley, and their blend at the center point of the RSM design (18% moisture, 160°C). Extrusion also leads to improved water hydration capacities and reduced viscosities for precooked individual and blended flours relative to the raw. Moreover, extrusion also led to improved protein quality in the chickpea and chickpea-barley blend, but not the individual barley flour.

Simultaneous combined retroperitoneal and posterior hip approach for the treatment of iliopsoas abscess with extension to a metal-on-metal prosthetic hip joint.

Iliopsoas abscess is an uncommon entity that has only rarely been associated with periprosthetic hip infection; to our knowledge, these are the first reported cases in patients with metal-on-metal (MoM) hip arthroplasty. We report 2 cases of iliopsoas abscess and concomitant periprosthetic hip infection in patients with a history of MoM hip arthroplasty. Case 1 presented with an acute infection 18 months after revision total hip arthroplasty (THA) for instability and adverse local tissue reaction after MoM THA. Case 2 presented with an acute infection in a previously well-functioning MoM THA. Both cases were treated with combined hip and retroperitoneal approaches and required more aggressive and longer treatment than is typical for periprosthetic infection, but ultimately resulted in successful revision THAs. We outline the treatment of these 2 patients and review the previously reported literature.

Robot-assisted sleeve gastrectomy and Roux-en-y gastric bypass: results from the metabolic and bariatric surgery accreditation and quality improvement program data registry.

BACKGROUND: A stronger evidence base is needed to more fully understand the precise role that robot-assisted (RA) approaches may play in bariatrics. OBJECTIVE: To investigate the utilization and safety of RA-sleeve gastrectomy (RA-SG) and RA-Roux-en-Y gastric bypass (RA-RYGB) using data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) registry. SETTING: National Database. METHODS: We queried the MBSAQIP 2015 through 2016 registry for patients who underwent primary conventional laparoscopic or RA-SG and RA-RYGB. We compared pre- and perioperative characteristics and 30-day outcomes using logistic regression where number of events met statistical guidelines. RESULTS: We included 126,987 cases: conventional laparoscopic SG (n = 83,940), RA-SG (n = 6,780), conventional laparoscopic RYGB (n = 33,525), and RA-RYGB (n = 2,742). The RA significantly lengthened operation time by 24 and 23 minutes for SG and RYGB, respectively. Mortality and serious adverse events were similar for the 2 techniques. RA-SG was associated with higher rates of 30-day intervention (1.3% versus .8%, OR: 1.38, P < .05) and hospital stay >2 days (12.1% versus 9.3%, OR: 1.30, P < .001). RA-RYGB was associated with higher 30-day rates of reoperation (2.6% versus 2.0%, OR: 1.37, P < .05) and readmission (7.0% versus 5.8%, OR:1.21, P < .05) and lower rates of transfusion (0.62% versus 1.12%, OR: .54, P < .05) and hospital stay >2 days (15.7% versus 17%, OR: .89, P < .05). CONCLUSION: RA is as safe as the conventional laparoscopic approach in terms of mortality and serious adverse events.

Protein quality and physicochemical properties of commercial cricket and mealworm powders.

The pressing need for protein supply growth gives rise to alternative protein sources, such as insect proteins. Commercial cricket and mealworm powders were examined for their protein quality, surface charge and functional attributes. Both insect powders had similar proximate compositions with protein and ash contents of ~ 66% db (dry weight basis) and 5% db, respectively, however cricket powder contained more lipid (16.1%, db) than mealworm powder (13.7%, db). Mealworm protein had an amino acid score of 0.71 and was first limiting in lysine, whereas cricket protein was first limiting in tryptophan with an amino acid score of 0.85. In vitro protein digestibility values of 75.7% and 76.2%, and in vitro protein digestibility corrected amino acid scores of 0.54 and 0.65, were obtained for mealworm and cricket powders, respectively. Zeta potential measurements gave isoelectric points near pH 3.9 for both insect powders. Mealworm and cricket powders had water hydration capacities of 1.62 g/g and 1.76 g/g, respectively, and oil holding capacities of 1.58 g/g and 1.42 g/g, respectively. Both insect proteins had low solubility (22-30%) at all pHs (3.0, 5.0, and 7.0) measured. Cricket powder had a foaming capacity of 82% and foam stability of 86%, whereas mealworm powder was non-foaming. Values for commercial pea and faba bean protein concentrates were reported for comparative purposes. The insect proteins had similar protein quality as the pulse proteins and had higher solubility at pH 5.0 but were much less soluble at pH 7.0.