Lactic Fermentation of Cereal Flour: Feasibility Tests on Rice, Oat and Wheat

Background and objective: Consumers show increasing interests in probiotic foods and lactic acid fermentations. Cereal flour, can be a good fermentable substrate due to its prebiotic nature; from which, synbiotic products can be prepared. The aim of the current study was to investigate if three various cereal flours rice, oat and wheat would be good potentially functional foods.Material and methods: Fermentation tests were carried out on rice, oat and wheat flours, using Lactobacillus paracasei CBA L74 and 1.5-L fermenter with 1-L working volume. After 24 h, microbial growth, pH value, lactic acid production and starch consumption were assessed.Results and conclusion: In all three flours, pH reduction was seen; particularly in rice flour. The highest Lactobacillus growth and lactic acid production were achieved at the end of rice fermentation. The greatest starch consumption was reported at the end of rice fermentation. In conclusion, lactic fermentation of cereals as potentially functional foods was possible for the three flours. However, the best result belonged to rice flour.Conflict of interest: The authors declare no conflict of interest.

Effects of the Glucose Addition during Lactic Fermentation of Rice, Oat and Wheat Flours

 Background and objective: Consumer interests in probiotic foods have increased in recent decades. Food industries respond to these growing interests by developing innovative products and guaranteeing high production efficiency. Cereals, due to their prebiotic nature, are good fermentable substrates; from which, potentially functional foods could be achieved. The aim of this study was to verify effects of D-glucose addition on fermentation of rice, oat and wheat flours.Material and methods: Suspensions of 15% of cereals flours (rice, oat and wheat) in distilled water added with increasing glucose concentrations (2, 5, 7 and 10% w v-1) were fermented by Lactobacillus paracasei CBA L74 for 24 h. Then, pH, microbial growth and lactic acid production were assessed.Results and conclusion: Rice fermentation was not affected by glucose addition. For oat and wheat, addition of D-glucose increased bacterial concentration, as well as lactic acid production. In particular, the best growth was achieved by the addition of 2 and 5% of glucose. Furthermore, lactic acid concentration increased with increased glucose concentration. In conclusion, D-glucose addition seems to be unnecessary for the improvement of rice fermentation. On the contrary, oat and wheat fermentations need further available carbon sources for a better Lactobacillus growth and a higher lactic acid production.Conflict of interest: The authors declare no conflict of interest

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Development of processes for the production of postbiotic functional foods

This project - in collaboration with Kraft Heinz - aims to develop processes for the production of postbiotic functional components. The project is divided into several activities. The first part of the project regarded the development of a laboratory scale fermentation process. The strain used in the fermentation tests is Lactobacillus paracasei CBA L74 patented by Kraft Heinz. Fermentation tests are carried out on two different substrates: skimmed milk, and water / rice flour suspension. Fermentation is carried out in a 1.5 L batch reactor. The system is sterilized, loaded with the substrate, inoculated with the microorganism and left to ferment for the established production times. Then, the product is removed from the reactor and the reactor prepared for a new cycle. The process is controlled in terms of: • Mixing; • pH; • temperature. Once the process was optimized on a laboratory scale, the characterization of the obtained fermented broth was performed. The sequence of the functional component and its size were characterized by means of MALDI-TOF analysis. In addition, a RP-HPLC method was developed for its routine quantification. A study on Caco-2 cells, conducted in collaboration with other research groups, has demonstrated the positive effect of metabolites present in the supernatant of the fermented substrate, capable of interfering with the entry of the gliadin peptide P31-43 into the cells. These metabolites belong to a small active fraction (<10 kDa). Then, it was important to obtain a dry postbiotic. Studies have been carried out to choose the best method to shock/ kill the microorganism in the fermented broth, so as to obtain a stable product with a microbial load <102 CFU/mL. Subsequently, the dried product was obtained by freeze-drying. The second part of the project regarded the 'scale up' of the pilot process. The pilot plant where the tests were carried out is located in the Kraft Heinz research and development centre 57 in Nijmegen, the Netherlands. These tests were carried out in a 300 L batch reactor and were monitored in terms of bacterial growth and production of lactic acid and active metabolite. The results obtained on both laboratory and pilot scale have shown good results in terms of bacterial growth, lactic acid production and active metabolite. In order to verify the stability of the obtained postbiotic functional component, 'shelf life' studies are being done at three different storage temperatures and on the different fermented matrices

Early predictors of remission in children and adolescents with new-onset epilepsy: A prospective study

International audiencePurpose: This study aims to identify predictive factors of a two-year remission (2YR) in a cohort of children and adolescents with new-onset seizures based on baseline clinical characteristics, initial EEG and brain MRI findings.Methods: A prospective cohort of 688 patients with new onset seizures, initiated on treatment with antiseizure medication was evaluated. 2YR was defined as achieving at least two years of seizure freedom during the follow-up period. Multivariable analysis was performed and recursive partition analysis was utilized to develop a decision tree.Results: The median age at seizure onset was 6.7 years, and the median follow-up was 7.4 years. 548 (79.7%) patients achieved a 2YR during the follow up period. Multivariable analysis found that presence and degree of intellectual and developmental delay (IDD), epileptogenic lesion on brain MRI and a higher number of pretreatment seizures were significantly associated with a lower probability of achieving a 2YR. Recursive partition analysis showed that the absence of IDD was the most important predictor of remission. An epileptogenic lesion was a significant predictor of non-remission only in patients without evidence of IDD, and a high number of pretreatment seizures was a predictive factor in children without IDD and in the absence of an epileptogenic lesion.Conclusion: Our results indicate that it is possible to identify patients at risk of not achieving a 2YR based on variables obtained at the initial evaluation. This could allow for a timely selection of patients who require close follow-up, consideration for neurosurgical intervention, or investigational treatments trials

Effectiveness of the pre-Omicron COVID-19 vaccines against Omicron in reducing infection, hospitalization, severity, and mortality compared to Delta and other variants: A systematic review

Despite widespread mass rollout programs, the rapid spread of the SARS-CoV-2 Omicron variant called into question the effectiveness of the existing vaccines against infection, hospitalization, severity, and mortality compared to previous variants. This systematic review summarizes and compares the effectiveness of the COVID-19 vaccines, with respect to the above outcomes in adults, children, and adolescents. A comprehensive literature search was undertaken on several databases. Only 51 studies met our inclusion criteria, revealing that the protection from primary vaccination against Omicron infection is inferior to protection against Delta and Alpha infections and wanes faster over time. However, mRNA vaccine boosters were reported to reestablish effectiveness, although to a lower extent against Omicron. Nonetheless, primary vaccination was shown to preserve strong protection against Omicron-associated hospitalization, severity, and death, even months after last dose. However, boosters provide more robust and longer-lasting protection against hospitalizations due to Omicron as compared to only primary series

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit