Encapsulation of Lacticaseibacillus rhamnosus GG: Probiotic Survival, In Vitro Digestion and Viability in Apple Juice and Yogurt

This study was aimed to prepare and characterize capsules loaded with Lacticaseibacillus rhamnosus GG (LGG), evaluating cell viability under gastrointestinal in vitro conditions and during storage in yogurt and apple juice, an alternative to traditional probiotic foods for people who are lactose intolerant. The capsules were prepared by ionic gelation, with an emulsification process as pretreatment. Cell viability of encapsulated LGG was evaluated after two different homogenization processes: magnetic stirring (AM) and Ultraturrax® homogenizer (UT). The system with the best relationship between viability and morphology was UT, which produced a viability of 85.80%. During in vitro evaluation, the capsules provided higher protection than free cells, up to 100% of cell viability. The morphology of capsules of both systems displayed a continuous and homogeneous surface. The cell viability of the encapsulated probiotics added in apple juice stored for 22 days at 4 °C was 86.16% for AM and 100% for UT, while the viability of free cells was 80.50%. In natural yogurt, the cell viability of the probiotics encapsulated stored 30 days at 4 °C was 100% for AM, 100% for UT, and 92.68% for free cells. This study suggests an alternative to preserve probiotic bacteria in a potential functional food

Encapsulation of Lactobacillus gasseri: Characterization, Probiotic Survival, In Vitro Evaluation and Viability in Apple Juice

The development of functional foods containing probiotic bacteria has become increasingly relevant to improve and maintain health. However, this is often limited to dairy food matrices given the complexity involved in maintaining a stable system together with high microbial viability in matrices such as juices. The objective of this study was to develop and characterize sodium alginate capsules loaded with Lactobacillus gasseri ATCC® 19992 ™ (LG). Cell viability under in vitro gastrointestinal conditions and during storage in apple juice were evaluated. The capsules were prepared by ionic gelation and an emulsification process was performed as pretreatment using two homogenization methods: magnetic stirring (AM) and Ultraturrax® rotor-stator homogenizer (UT). Cell viability after encapsulation was similar in the two processes: 65%. At the end of the in vitro gastrointestinal evaluation, the non-encapsulated probiotic cells did not show any viability, while the AM system was able to retain 100% of its viability and the UT retained 79.14%. The morphology of the capsules consisted of a continuous and homogeneous surface. Cell viability of LG encapsulated in apple juice stored at 4 °C for 21 days was 77% for AM, 55.43% for UT, and 63.10% for free LG

Encapsulation of <i>Lacticaseibacillus rhamnosus</i> GG: Probiotic Survival, In Vitro Digestion and Viability in Apple Juice and Yogurt

This study was aimed to prepare and characterize capsules loaded with Lacticaseibacillus rhamnosus GG (LGG), evaluating cell viability under gastrointestinal in vitro conditions and during storage in yogurt and apple juice, an alternative to traditional probiotic foods for people who are lactose intolerant. The capsules were prepared by ionic gelation, with an emulsification process as pretreatment. Cell viability of encapsulated LGG was evaluated after two different homogenization processes: magnetic stirring (AM) and Ultraturrax® homogenizer (UT). The system with the best relationship between viability and morphology was UT, which produced a viability of 85.80%. During in vitro evaluation, the capsules provided higher protection than free cells, up to 100% of cell viability. The morphology of capsules of both systems displayed a continuous and homogeneous surface. The cell viability of the encapsulated probiotics added in apple juice stored for 22 days at 4 °C was 86.16% for AM and 100% for UT, while the viability of free cells was 80.50%. In natural yogurt, the cell viability of the probiotics encapsulated stored 30 days at 4 °C was 100% for AM, 100% for UT, and 92.68% for free cells. This study suggests an alternative to preserve probiotic bacteria in a potential functional food

Métodos y mediciones

Actitud y conducta hacia la salud oral en estudiantes de la comuna de AraucoAn&aacute;lisis de instrumentos de registro odontol&oacute;gicos en la red de APS de la Regi&oacute;n MetropolitanaAn&aacute;lisis de la eficiencia relativa del Hospital de Cabildo mediante la aplicaci&oacute;n del an&aacute;lisis de fronteraAn&aacute;lisis de letalidad intrahospitalaria y acumulada a 30 d&iacute;as de eventos IAM, 2003-2007An&aacute;lisis del programa de c&aacute;ncer cervicouterino en Chile con metodolog&iacute;a de marco l&oacute;gicoA&ntilde;os de vida perdidos por muerte prematura: efecto de diferentes criterios de correcci&oacute;n de subregistrosCalidad global de la alimentaci&oacute;n de mujeres asistidas por el sistema de salud p&uacute;blico chilenoCarga de mortalidad para el estado de R&iacute;o de Janeiro, BrasilCausas de extracciones permanentes en adultos atendidos en la Posta Central, ChileComparaci&oacute;n del consumo de drogas en escolares hombres utilizando metodolog&iacute;a de pares y cuestionario autoregistradoCuidado hospitalario de pacientes con accidente cerebrovascular isqu&eacute;mico atendidos bajo r&eacute;gimen GESDescripci&oacute;n de dimensiones del constructo de calidad de vida en ni&ntilde;os de 2-5 a&ntilde;osDistribuci&oacute;n de benzodiacepinas en establecimientos del SNSS, per&iacute;odo 2006-2008Evaluaci&oacute;n de calidad, implementaci&oacute;n del control odontol&oacute;gico del ni&ntilde;o sano en CAP'S, Regi&oacute;n del MauleEvaluaci&oacute;n de la satisfacci&oacute;n del usuario interno de la Unidad de Cuidados B&aacute;sicos del Hospital MetropolitanoEvaluaci&oacute;n del protocolo de referencia de cefalea tensional y migra&ntilde;a en consultorio Llay-LlayEvaluaci&oacute;n econ&oacute;mica del Programa de Fluoraci&oacute;n del Agua en ChileFactores de riesgo de enfermedad hipertensiva del embarazo en la UCI del H.G EcatepecImpacto de reforma sanitaria en autorizaciones sanitarias y de desempe&ntilde;o en instalaciones de radiodiagn&oacute;stico dentalInstitucionalidad de la investigaci&oacute;n en salud p&uacute;blica en ChileLetalidad intrahospitalaria y a 30 d&iacute;as de los eventos de accidente cerebrovascular isqu&eacute;mico en ChileLimitaciones y desaf&iacute;os de la investigaci&oacute;n en salud p&uacute;blica en ChileMejora de agudeza visual y utilizaci&oacute;n cirug&iacute;a de segundo ojo en pacientes con cataratas GESMortalidad infantil en la Regi&oacute;n Metropolitana II del Estado de R&iacute;o de Janeiro, 1981-2008Mortalidad por c&aacute;ncer de tiroides en Chile en el per&iacute;odo 1985-2007Mortalidad por tumores cerebrales en poblaci&oacute;n infantil y adolescente, ciudad R&iacute;o de Janeiro, 1980-2007Mortalidad por tumores del sistema nervioso central en adultos, R&iacute;o de Janeiro, 1980 a 2007Prevalencia de anemia ferropriva en una muestra representativa de beneficiarios del PNACPrevalencia de caries y fluorosis previo a la fluoruraci&oacute;n del agua potable en TemucoPrevalencia de traumatismos dentoalveolares en ni&ntilde;os del Hospital Dr. S&oacute;tero del R&iacute;o, enero-junio 2010Propuesta de un indicador de la calidad para los centros de salud familiarSalud p&uacute;blica y la emergencia del dispositivo cl&iacute;nico en la modernidad nacionalSatisfacci&oacute;n de funcionalidad familiar en adolescentes entre 12 y 18 a&ntilde;os consumidores de drogasValidaci&oacute;n cualitativa del cuestionario ASAQ para la determinaci&oacute;n de la conducta sedentaria en escolare

Métodos y mediciones

Actitud y conducta hacia la salud oral en estudiantes de la comuna de AraucoAn&aacute;lisis de instrumentos de registro odontol&oacute;gicos en la red de APS de la Regi&oacute;n MetropolitanaAn&aacute;lisis de la eficiencia relativa del Hospital de Cabildo mediante la aplicaci&oacute;n del an&aacute;lisis de fronteraAn&aacute;lisis de letalidad intrahospitalaria y acumulada a 30 d&iacute;as de eventos IAM, 2003-2007An&aacute;lisis del programa de c&aacute;ncer cervicouterino en Chile con metodolog&iacute;a de marco l&oacute;gicoA&ntilde;os de vida perdidos por muerte prematura: efecto de diferentes criterios de correcci&oacute;n de subregistrosCalidad global de la alimentaci&oacute;n de mujeres asistidas por el sistema de salud p&uacute;blico chilenoCarga de mortalidad para el estado de R&iacute;o de Janeiro, BrasilCausas de extracciones permanentes en adultos atendidos en la Posta Central, ChileComparaci&oacute;n del consumo de drogas en escolares hombres utilizando metodolog&iacute;a de pares y cuestionario autoregistradoCuidado hospitalario de pacientes con accidente cerebrovascular isqu&eacute;mico atendidos bajo r&eacute;gimen GESDescripci&oacute;n de dimensiones del constructo de calidad de vida en ni&ntilde;os de 2-5 a&ntilde;osDistribuci&oacute;n de benzodiacepinas en establecimientos del SNSS, per&iacute;odo 2006-2008Evaluaci&oacute;n de calidad, implementaci&oacute;n del control odontol&oacute;gico del ni&ntilde;o sano en CAP'S, Regi&oacute;n del MauleEvaluaci&oacute;n de la satisfacci&oacute;n del usuario interno de la Unidad de Cuidados B&aacute;sicos del Hospital MetropolitanoEvaluaci&oacute;n del protocolo de referencia de cefalea tensional y migra&ntilde;a en consultorio Llay-LlayEvaluaci&oacute;n econ&oacute;mica del Programa de Fluoraci&oacute;n del Agua en ChileFactores de riesgo de enfermedad hipertensiva del embarazo en la UCI del H.G EcatepecImpacto de reforma sanitaria en autorizaciones sanitarias y de desempe&ntilde;o en instalaciones de radiodiagn&oacute;stico dentalInstitucionalidad de la investigaci&oacute;n en salud p&uacute;blica en ChileLetalidad intrahospitalaria y a 30 d&iacute;as de los eventos de accidente cerebrovascular isqu&eacute;mico en ChileLimitaciones y desaf&iacute;os de la investigaci&oacute;n en salud p&uacute;blica en ChileMejora de agudeza visual y utilizaci&oacute;n cirug&iacute;a de segundo ojo en pacientes con cataratas GESMortalidad infantil en la Regi&oacute;n Metropolitana II del Estado de R&iacute;o de Janeiro, 1981-2008Mortalidad por c&aacute;ncer de tiroides en Chile en el per&iacute;odo 1985-2007Mortalidad por tumores cerebrales en poblaci&oacute;n infantil y adolescente, ciudad R&iacute;o de Janeiro, 1980-2007Mortalidad por tumores del sistema nervioso central en adultos, R&iacute;o de Janeiro, 1980 a 2007Prevalencia de anemia ferropriva en una muestra representativa de beneficiarios del PNACPrevalencia de caries y fluorosis previo a la fluoruraci&oacute;n del agua potable en TemucoPrevalencia de traumatismos dentoalveolares en ni&ntilde;os del Hospital Dr. S&oacute;tero del R&iacute;o, enero-junio 2010Propuesta de un indicador de la calidad para los centros de salud familiarSalud p&uacute;blica y la emergencia del dispositivo cl&iacute;nico en la modernidad nacionalSatisfacci&oacute;n de funcionalidad familiar en adolescentes entre 12 y 18 a&ntilde;os consumidores de drogasValidaci&oacute;n cualitativa del cuestionario ASAQ para la determinaci&oacute;n de la conducta sedentaria en escolare

Efficacy and safety of the CVnCoV SARS-CoV-2 mRNA vaccine candidate in ten countries in Europe and Latin America (HERALD): a randomised, observer-blinded, placebo-controlled, phase 2b/3 trial

Background: Additional safe and efficacious vaccines are needed to control the COVID-19 pandemic. We aimed to analyse the efficacy and safety of the CVnCoV SARS-CoV-2 mRNA vaccine candidate. Methods: HERALD is a randomised, observer-blinded, placebo-controlled, phase 2b/3 clinical trial conducted in 47 centres in ten countries in Europe and Latin America. By use of an interactive web response system and stratification by country and age group (18–60 years and ≥61 years), adults with no history of virologically confirmed COVID-19 were randomly assigned (1:1) to receive intramuscularly either two 0·6 mL doses of CVnCoV containing 12 μg of mRNA or two 0·6 mL doses of 0·9% NaCl (placebo) on days 1 and 29. The primary efficacy endpoint was the occurrence of a first episode of virologically confirmed symptomatic COVID-19 of any severity and caused by any strain from 15 days after the second dose. For the primary endpoint, the trial was considered successful if the lower limit of the CI was greater than 30%. Key secondary endpoints were the occurrence of a first episode of virologically confirmed moderate-to-severe COVID-19, severe COVID-19, and COVID-19 of any severity by age group. Primary safety outcomes were solicited local and systemic adverse events within 7 days after each dose and unsolicited adverse events within 28 days after each dose in phase 2b participants, and serious adverse events and adverse events of special interest up to 1 year after the second dose in phase 2b and phase 3 participants. Here, we report data up to June 18, 2021. The study is registered at ClinicalTrials.gov, NCT04652102, and EudraCT, 2020–003998–22, and is ongoing. Findings: Between Dec 11, 2020, and April 12, 2021, 39 680 participants were enrolled and randomly assigned to receive either CVnCoV (n=19 846) or placebo (n=19 834), of whom 19 783 received at least one dose of CVnCoV and 19 746 received at least one dose of placebo. After a mean observation period of 48·2 days (SE 0·2), 83 cases of COVID-19 occurred in the CVnCoV group (n=12 851) in 1735·29 person-years and 145 cases occurred in the placebo group (n=12 211) in 1569·87 person-years, resulting in an overall vaccine efficacy against symptomatic COVID-19 of 48·2% (95·826% CI 31·0–61·4; p=0·016). Vaccine efficacy against moderate-to-severe COVID-19 was 70·7% (95% CI 42·5–86·1; CVnCoV 12 cases in 1735·29 person-years, placebo 37 cases in 1569·87 person-years). In participants aged 18–60 years, vaccine efficacy against symptomatic disease was 52·5% (95% CI 36·2–64·8; CVnCoV 71 cases in 1591·47 person-years, placebo, 136 cases in 1449·23 person-years). Too few cases occurred in participants aged 61 years or older (CVnCoV 12, placebo nine) to allow meaningful assessment of vaccine efficacy. Solicited adverse events, which were mostly systemic, were more common in CVnCoV recipients (1933 [96·5%] of 2003) than in placebo recipients (1344 [67·9%] of 1978), with 542 (27·1%) CVnCoV recipients and 61 (3·1%) placebo recipients reporting grade 3 solicited adverse events. The most frequently reported local reaction after any dose in the CVnCoV group was injection-site pain (1678 [83·6%] of 2007), with 22 grade 3 reactions, and the most frequently reported systematic reactions were fatigue (1603 [80·0%] of 2003) and headache (1541 [76·9%] of 2003). 82 (0·4%) of 19 783 CVnCoV recipients reported 100 serious adverse events and 66 (0·3%) of 19 746 placebo recipients reported 76 serious adverse events. Eight serious adverse events in five CVnCoV recipients and two serious adverse events in two placebo recipients were considered vaccination-related. None of the fatal serious adverse events reported (eight in the CVnCoV group and six in the placebo group) were considered to be related to study vaccination. Adverse events of special interest were reported for 38 (0·2%) participants in the CVnCoV group and 31 (0·2%) participants in the placebo group. These events were considered to be related to the trial vaccine for 14 (<0·1%) participants in the CVnCoV group and for five (<0·1%) participants in the placebo group. Interpretation: CVnCoV was efficacious in the prevention of COVID-19 of any severity and had an acceptable safety profile. Taking into account the changing environment, including the emergence of SARS-CoV-2 variants, and timelines for further development, the decision has been made to cease activities on the CVnCoV candidate and to focus efforts on the development of next-generation vaccine candidates. Funding: German Federal Ministry of Education and Research and CureVac

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

International audienceBackground: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society

Predictors of embolism and death in left-sided infective endocarditis: the European Society of Cardiology EURObservational Research Programme European Infective Endocarditis registry

International audienceBackground and Aims Even though vegetation size in infective endocarditis (IE) has been associated with embolic events (EEs) and mortality risk, it is unclear whether vegetation size associated with these potential outcomes is different in left-sided IE (LSIE). This study aimed to seek assessing the vegetation cut-off size as predictor of EE or 30-day mortality for LSIE and to determine risk predictors of these outcomes. Methods The European Society of Cardiology EURObservational Research Programme European Infective Endocarditis is a prospective, multicentre registry including patients with definite or possible IE throughout 2016–18. Cox multivariable logistic regression analysis was performed to assess variables associated with EE or 30-day mortality. Results There were 2171 patients with LSIE (women 31.5%). Among these affected patients, 459 (21.1%) had a new EE or died in 30 days. The cut-off value of vegetation size for predicting EEs or 30-day mortality was &gt;10 mm [hazard ratio (HR) 1.38, 95% confidence interval (CI) 1.13–1.69, P = .0015]. Other adjusted predictors of risk of EE or death were as follows: EE on admission (HR 1.89, 95% CI 1.54–2.33, P &lt; .0001), history of heart failure (HR 1.53, 95% CI 1.21–1.93, P = .0004), creatinine &gt;2 mg/dL (HR 1.59, 95% CI 1.25–2.03, P = .0002), Staphylococcus aureus (HR 1.36, 95% CI 1.08–1.70, P = .008), congestive heart failure (HR 1.40, 95% CI 1.12–1.75, P = .003), presence of haemorrhagic stroke (HR 4.57, 95% CI 3.08–6.79, P &lt; .0001), alcohol abuse (HR 1.45, 95% CI 1.04–2.03, P = .03), presence of cardiogenic shock (HR 2.07, 95% CI 1.29–3.34, P = .003), and not performing left surgery (HR 1.30 95% CI 1.05–1.61, P = .016) (C-statistic = .68). Conclusions Prognosis after LSIE is determined by multiple factors, including vegetation size

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates