Refractory myasthenia gravis, dysphagia and malnutrition : a case report to suggest disease-specific nutritional issues

Objective: We describe a case of refractory myasthenia gravis with bulbar involvement and the nutritional treatment solutions proposed to treat the associated dysphagia and malnutrition. Methods: A 39-y-old woman with refractory myasthenia gravis was referred to our clinical nutrition unit for deteriorating dysphagia and progressive malnutrition. Results: The first-line nutritional approach consisted of dietary counseling and thickened meals. Unfortunately, no adequate oral intake was achieved and an enteral nutrition treatment was proposed. A nasogastric tube was removed after a few days due to local pain and poor quality of life. Despite consistent weight loss and overt malnutrition, the patient refused percutaneous endoscopic gastrostomy placement. Neurologic symptoms did not show any improvement but unexpectedly the patient's weight started to increase to previous values. Anamnestic recall revealed that the patient learned by herself how to position the nasogastric tube that is now temporarily used for formula infusion coinciding with neurologic pouss\ue9s. Conclusions: Current guidelines consider chronic neurologic diseases with associated dysphagia, where refractory myesthania gravis has also been considered, a unique category. Chronic neurogenic dysphagia with high risk of aspiration, long-term inability to obtain adequate oral intakes, and malnutrition are established indications for percutaneous endoscopic gastrostomy placement. However, patients may need different forms of nutritional intervention during the course of their illness and choices and indications should contemplate ethical reasons, clinical benefits, minimal risks, and acceptable quality of life. Minimally invasive intermittent enteral nutrition might be considered a possible clue for nutritional management of exacerbating dysphagia

Kinetic energy of solid neon by Monte Carlo with improved Trotter- and finite-size extrapolation

The kinetic energy of solid neon is calculated by a path-integral Monte Carlo approach with a refined Trotter- and finite-size extrapolation. These accurate data present significant quantum effects up to temperature T=20 K. They confirm previous simulations and are consistent with recent experiments.Comment: Text and figures revised for minor corrections (4 pages, 3 figures included by psfig

Impact of wheat aleurone on biomarkers of cardiovascular disease, gut microbiota and metabolites in adults with high body mass index: a double‑blind, placebo‑controlled, randomized clinical trial

Purpose Aleurone is a cereal bran fraction containing a variety of beneficial nutrients including polyphenols, fibers, minerals and vitamins. Animal and human studies support the beneficial role of aleurone consumption in reducing cardiovascular disease (CVD) risk. Gut microbiota fiber fermentation, polyphenol metabolism and betaine/choline metabolism may in part contribute to the physiological effects of aleurone. As primary objective, this study evaluated whether wheat aleurone supplemented foods could modify plasma homocysteine. Secondary objectives included changes in CVD biomarkers, fecal microbiota composition and plasma/urine metabolite profiles. Methods A parallel double-blind, placebo-controlled and randomized trial was carried out in two groups of obese/overweight subjects, matched for age, BMI and gender, consuming foods supplemented with either aleurone (27 g/day) (AL, n = 34) or cellulose (placebo treatment, PL, n = 33) for 4 weeks. Results No significant changes in plasma homocysteine or other clinical markers were observed with either treatment. Dietary fiber intake increased after AL and PL, animal protein intake increased after PL treatment. We observed a significant increase in fecal Bifidobacterium spp with AL and Lactobacillus spp with both AL and PL, but overall fecal microbiota community structure changed little according to 16S rRNA metataxonomics. Metabolomics implicated microbial metabolism of aleurone polyphenols and revealed distinctive biomarkers of AL treatment, including alkylresorcinol, cinnamic, benzoic and ferulic acids, folic acid, fatty acids, benzoxazinoid and roasted aroma related metabolites. Correlation analysis highlighted bacterial genera potentially linked to urinary compounds derived from aleurone metabolism and clinical parameters. Conclusions Aleurone has potential to modulate the gut microbial metabolic output and increase fecal bifidobacterial abundance. However, in this study, aleurone did not impact on plasma homocysteine or other CVD biomarkers. Trial Registration The study was registered at ClinicalTrials.gov (NCT02067026) on the 17th February 2014

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Enzyme production from food wastes using a biorefinery concept

According to Food and Agricultural Organization (FAO), one-third of food produced globally for human consumption (nearly 1.3 billion tonnes) is lost along the food supply chain. In many countries food waste is currently landfilled or incinerated together with other combustible municipal wastes for possible recovery of energy. However, these two options are facing more and more economic and environmental stresses. Due to its organic- and nutrient-rich nature, theoretically food waste can be converted to valuable products (e.g. bio-products such as methane, hydrogen, ethanol, enzymes, organic acids, chemicals and fuels) through various fermentation processes. Such conversion of food waste is potentially more profitable than its conversion to animal feed or transportation fuel. Food waste valorisation has therefore gained interest, with value added bio-products such as methane, hydrogen, ethanol, enzymes, organic acids, chemicals, and fuels. Therefore, the aim of this review is to provide information on the food waste situation with emphasis on Asia–Pacific countries and the state of the art food waste processing technologies to produce enzymes

Targeting riboswitches with synthetic small RNAs for metabolic engineering

Raw data supporting the work "Targeting riboswitches with synthetic small RNAs for metabolic engineering". The data demonstrate the design and implementation of a new small RNA tool to target bacterial riboswitches. The synthetic sRNA activates gene expression at the transcription level by counteracting the riboswitch's control. The riboswitch-targeting sRNA is suitable for use in cell-free and cellular systems and can be combined into arrays for multiplex riboswitch-targeting

Targeting riboswitches with synthetic small RNAs for metabolic engineering

Raw data supporting the work "Targeting riboswitches with synthetic small RNAs for metabolic engineering". The data demonstrate the design and implementation of a new small RNA tool to target bacterial riboswitches. The synthetic sRNA activates gene expression at the transcription level by counteracting the riboswitch's control. The riboswitch-targeting sRNA is suitable for use in cell-free and cellular systems and can be combined into arrays for multiplex riboswitch-targeting