Addition of acacia gum to a FOS/inulin blend improves its fermentation profile in the Simulator of the Human Intestinal Microbial Ecosystem (SHIME®)

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Addition of acacia gum to a FOS/inulin blend improves its fermentation profile in the Simulator of the Human Intestinal Microbial Ecosystem (SHIME (R))

The Simulator of the Human Intestinal Microbial Ecosystem (SHIME (R)) was used to assess the impact of the partial substitution of fructooligosaccharides (FOS) and inulin by acacia gum in a fibre blend. Both blends were well fermented and the presence of acacia gum modified the intestinal fermentation of the blend from a boosted fermentation into a gradual one in the complete colon. Confirmation of the gradual fermentation was obtained by analysis of the pH profile, measurement of the residual acacia gum fractions in the colon and by the increased expression of specific catabolic enzymes. Both blends increased the total amount of short chain fatty acids (SCFAs; +42 mmol/L), propionate (+26 mmol/L) and butyrate (+9 mmol/L) and showed bifidogenic properties. Metagenomic Illumina sequencing confirmed that the blends exerted a diverse modulating activity in the different areas of the colon. Long-term repeated administration of the prebiotic blends is needed to reach gradual changes in the gut microbial community structure and activity. The partial substitution of FOS and inulin by acacia gum slowed the speed of the fermentation of the blend. In humans, this may translate into benefits for gut health, allowing for incorporation of higher amounts of fibre into the diet. (C) 2015 Elsevier Ltd. All rights reserved.publisher: Elsevier articletitle: Addition of acacia gum to a FOS/inulin blend improves its fermentation profile in the Simulator of the Human Intestinal Microbial Ecosystem (SHIME®) journaltitle: Journal of Functional Foods articlelink: http://dx.doi.org/10.1016/j.jff.2015.04.039 content_type: article copyright: Copyright © 2015 Elsevier Ltd. All rights reserved.status: publishe

Tertiary assessment of trauma patients in a hospital in the city of São Paulo: a question of necessity

OBJECTIVE: To minimize the occurrence of missed injuries, the tertiary evaluation was introduced consisting of reassessment of the patient, 24 hours after admission, with: complete history, physical examination, review of exams and diagnostic testing if necessary. METHODS: Observational study evaluating trauma patients admitted to a teaching hospital in São Paulo, according to a protocol for tertiary evaluation. RESULTS: Between February and May 2012, for 12 weeks, 182 patients were submitted to tertiary evaluation, 100 (55%) polytraumatized and 82 (45%) were victims of low-energy trauma. Neglected lesions were observed in 21 (11.5%) patients, who had 28 missed injuries. Of these 28 lesions, seven (25%) required surgical treatment. CONCLUSION: Strategies including formal tertiary evaluation, the protocol applied for assessing trauma victims, seem to be beneficial in these patients, regardless of the mechanism of trauma. The method is easily applied, effective and has low cost in identifying missed injuries in the victims of trauma

Effect of an enteral amino acid blend on muscle and gut functionality in critically ill patients: a proof-of-concept randomized controlled trial

International audienceBackground: A defining feature of prolonged critical illness is muscle wasting, leading to impaired recovery. Supplementation with a tailored blend of amino acids may bolster the innate gut defence, promote intestinal mucosa repair and limit muscle loss. Methods: This was a monocentric, randomized, double-blind, placebo-controlled study that included patients with sepsis or acute respiratory distress syndrome. Patients received a specific combination of five amino acids or placebo mixed with enteral feeding for 21 days. Markers of renal function, gut barrier structure and functionality were collected at baseline and 1, 2, 3 and 8 weeks after randomization. Muscle structure and function were assessed through MRI measurements of the anterior quadriceps volume and by twitch airway pressure. Data were compared between groups relative to the baseline. Results: Thirty-five critically ill patients were randomized. The amino acid blend did not impair urine output, blood creatinine levels or creatinine clearance. Plasma citrulline levels increased significantly along the treatment period in the amino acid group (difference in means [95% CI] 5.86 [1.72; 10.00] nmol/mL P = 0.007). Alanine aminotransferase and alkaline phosphatase concentrations were lower in the amino acid group than in the placebo group at one week (ratio of means 0.5 [0.29; 0.86] (P = 0.015) and 0.73 [0.57; 0.94] (P = 0.015), respectively). Twitch airway pressure and volume of the anterior quadriceps were greater in the amino acid group than in the placebo group 3 weeks after randomization (difference in means 10.6 [0.99; 20.20] cmH20 (P = 0.035) and 3.12 [0.5; 5.73] cm3/kg (P = 0.022), respectively). Conclusions: Amino acid supplementation increased plasma citrulline levels, reduced alanine aminotransferase and alkaline phosphatase levels, and improved twitch airway pressure and anterior quadriceps volume. Trial registration ClinicalTrials.gov, NCT02968836. Registered November 21, 2016