Lower Score Values Research Articles

Gaps in Heat-Related Knowledge, Practices and Adaptation Strategies Among Coaches in German Outdoor Sports

ObjectivesClimate change is increasing the risk of heat-related illness in outdoor sports. Coaches have a responsibility to protect the athletes in their care. In this study, the knowledge and practice of German coaches in heat prevention were evaluated nationwide.MethodsCoaches (n = 1,200) from the ten largest outdoor sports in Germany were asked about their knowledge using the knowledge of heat-related illness symptoms index (KOSI, range [0–14]). Prevention measures currently implemented by coaches were analyzed in terms of relative compliance with specified recommendations (heat prevention score (HPS), range [0–100]).ResultsThe KOSI averaged 10.31 ± 1.81 and pointed to clear knowledge deficits: the lowest score values were shown by coaches in skiing (9.85 ± 1.80), soccer (10.07 ± 2.33) and golf (10.09 ± 1.75; pANOVA = 0.015). Heat protection in training was also deficient: The HPS showed a mean value of 62.41 ± 14.89. The greatest deficits existed in tennis (57.71 ± 14.29), mountain sports (58.17 ± 13.08) and soccer (58.70 ± 13.86; pANOVA < 0.001). No correlation between theoretical knowledge and practical prevention was found.ConclusionIn Germany, coaches are insufficiently prepared for the health hazards of heat. Promoting onsite educational programs seems essential to ensure safer sports environments.

Innovative process for improving functional and sensory quality of black garlic

Black garlic (BG) is an aged product high in brown melanoidin pigment and functional quality, however, the long aging process limits its commercial production. The present investigation was undertaken to develop an innovative process for improving the functional quality of BG as well as shortening the aging duration. Peeled garlic was subjected to two pre-treatment steps viz. Freeze-thaw (FT) and blanching (BL) followed by ascorbic acid (AA) infusion and effects were monitored during aging. Non-enzymatic browning, the main visible indicator of MR was significantly (p < 0.05) high in FT garlic due to high infused AA content. The pre-treated garlic showed significantly (p< 0.05) high fructose content (6-7-fold) over the control on the 6th day of aging. The treatment also enhanced the total phenolic content (2.5–3.0-fold) and antioxidant activity (14-fold) while reducing the processing time from 18 to 12 days. The soluble solid content (58.7 °B) and Fast index (fluorescent of advanced Maillard reaction products and soluble tryptophan) was maximum (305.2) in FT garlic on the 12th day. FTIR confirmed a strong peak at 1515 cm−1 depicting the dark nature of the BG subjected to FT. The innovative short process saved 50% of energy in production and was 43% more economical compared to its control counterpart. Overall sensory quality of FT garlic in terms of color, flavour and texture was on par with control except BL sample which showed high stickiness and low score values. Overall results suggest that FT treatment followed by infusion of ascorbic acid accelerated the Maillard reaction (MR), and improved the functional quality of BG.

What is the potential of ChatGPT for qualified patient information? : Attempt of a structured analysis on the basis of a survey regarding complementary and alternative medicine (CAM) in rheumatology

The chatbot ChatGPT represents amilestone in the interaction between humans and large databases that are accessible via the internet. It facilitates the answering of complex questions by enabling acommunication in everyday language. Therefore, it is apotential source of information for those who are affected by rheumatic diseases. The aim of our investigation was to find out whether ChatGPT (version3.5) is capable of giving qualified answers regarding the application of specific methods of complementary and alternative medicine (CAM) in three rheumatic diseases: rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and granulomatosis with polyangiitis (GPA). In addition, it was investigated how the answers of the chatbot were influenced by the wording of the question. The questioning of ChatGPT was performed in three parts. PartA consisted of an open question regarding the best way of treatment of the respective disease. In partB, the questions were directed towards possible indications for the application of CAM in general in one of the three disorders. In partC, the chatbot was asked for specific recommendations regarding one of three CAM methods: homeopathy, ayurvedic medicine and herbal medicine. Questions in partsB andC were expressed in two modifications: firstly, it was asked whether the specific CAM was applicable at all in certain rheumatic diseases. The second question asked which procedure of the respective CAM method worked best in the specific disease. The validity of the answers was checked by using the ChatGPT reliability score, aLikert scale ranging from1 (lowest validity) to7 (highest validity). The answers to the open questions of partA had the highest validity. In partsB andC, ChatGPT suggested avariety of CAM applications that lacked scientific evidence. The validity of the answers depended on the wording of the questions. If the question suggested the inclination to apply acertain CAM, the answers often lacked the information of missing evidence and were graded with lower score values. The answers of ChatGPT (version3.5) regarding the applicability of CAM in selected rheumatic diseases are not convincingly based on scientific evidence. In addition, the wording of the questions affects the validity of the information. Currently, an uncritical application of ChatGPT as an instrument for patient information cannot be recommended.

Construction of Composite Correlation Index Matrix and Analysis of Cultural Properties of Representatives of Mycobacterium abscessus Complex Isolated from Patients with Cystic Fibrosis.

Microbiological diagnosis of mycobacteriosis is often difficult, as it is necessary to differentiate between transient colonization and active infection. We studied the cultural properties of Mycobacterium abscessus complex (MABSc) strains obtained from cystic fibrosis patients, and also analyzed composite correlation index (CCI) values in patients with repeated MABSc inoculation and their correlation with the presence of clinical and radiological manifestations of mycobacteriosis. As a result, MABSc more often grew in S-form colonies in patients without clinical manifestations of chronic infection, while R-form colonies were characteristic of patients with chronic infection and clinical symptoms. At the same time, in patients examined once, no growth of colonies in the R-form was recorded, and all strains produced growth in the form of either S-colonies or in the S- and R-forms simultaneously. Statistically significant results were obtained for the relationship of the CCI with the clinical and radiological picture. In addition, a heterogeneous MABSc population with low CCI score values correlated with the development of mycobacteriosis in patients. In patients with high CCI score values (homogeneity of isolated strains), on the contrary, there were no radiological or clinical signs of the disease. These data make it possible to build a strategy for monitoring patients depending on changes in CCI score values. The use of CCI matrix to evaluate microorganisms' identification results is a potentially new method that expands the use of matrix-assisted laser desorption ionization time-of-flight mass spectrometry.

Development and validation of predictive models for myopia onset and progression using extensive 15-year refractive data in children and adolescents

BackgroundGlobal myopia prevalence poses a substantial public health burden with vision-threatening complications, necessitating effective prevention and control strategies. Precise prediction of spherical equivalent (SE), myopia, and high myopia onset is vital for proactive clinical interventions.MethodsWe reviewed electronic medical records of pediatric and adolescent patients who underwent cycloplegic refraction measurements at the Eye & Ear, Nose, and Throat Hospital of Fudan University between January 2005 and December 2019. Patients aged 3–18 years who met the inclusion criteria were enrolled in this study. To predict the SE and onset of myopia and high myopia in a specific year, two distinct models, random forest (RF) and the gradient boosted tree algorithm (XGBoost), were trained and validated based on variables such as age at baseline, and SE at various intervals. Outputs included SE, the onset of myopia, and high myopia up to 15 years post-initial examination. Age-stratified analyses and feature importance assessments were conducted to augment the clinical significance of the models.ResultsThe study enrolled 88,250 individuals with 408,255 refraction records. The XGBoost-based SE prediction model consistently demonstrated robust and better performance than RF over 15 years, maintaining an R2 exceeding 0.729, and a Mean Absolute Error ranging from 0.078 to 1.802 in the test set. Myopia onset prediction exhibited strong area under the curve (AUC) values between 0.845 and 0.953 over 15 years, and high myopia onset prediction showed robust AUC values (0.807–0.997 over 13 years, with the 14th year at 0.765), emphasizing the models' effectiveness across age groups and temporal dimensions on the test set. Additionally, our classification models exhibited excellent calibration, as evidenced by consistently low brier score values, all falling below 0.25. Moreover, our findings underscore the importance of commencing regular examinations at an early age to predict high myopia.ConclusionsThe XGBoost predictive models exhibited high accuracy in predicting SE, onset of myopia, and high myopia among children and adolescents aged 3–18 years. Our findings emphasize the importance of early and regular examinations at a young age for predicting high myopia, thereby providing valuable insights for clinical practice.

Evaluation of the HFA-PEFF Score: results from the prospective DIAST-CHF cohort.

Although the number of patients suffering from heart failure with preserved ejection fraction (HFpEF) increases, the routine diagnosis remains a challenge. In the absence of a pathognomonic sign for HFpEF or specific treatment strategies, a prognosis-based characterization of suspected patients remains promising for both the risk stratification of the patients and a disease definition. The Heart Failure Association (HFA) of the European Society of Cardiology has introduced an algorithm with different levels of likelihood regarding the diagnosis of HFpEF, the HFA-PEFF score. We aimed to evaluate the predictive value of this algorithm in a large cohort regarding mortality, symptom burden, and the functional status. DIAST-CHF is a multicentre, population-based, prospective, observational study in subjects with at least one risk factor for HFpEF between the age of 50 and 85. We calculated the HFA-PEFF score (n=1668) and analysed the risk groups for overall mortality, cardiovascular hospitalization, and submaximal functional capacity (6-min walk distance) at baseline and after a follow-up period of 10years. Patients with high HFA-PEFF score values 5&6 showed a higher mortality than those with an intermediate score (score values 2-4) and low score values (high 21.3% vs. intermediate 10.1% vs. low 4.3%, P<0.001). Also, the burden of MACE (death, cardiovascular hospitalization, new myocardial infarction, first diagnosis of HF) was increased in the high score values group (high 40.7% vs. intermediate 25.9% vs. low 13.9%, P<0.001). Similarly, patients with higher scores had higher cumulative incidences of cardiovascular hospitalizations (P=0.011). Subjects with higher scores also had lower 6-min walk distance both at baseline and during follow-up. The HFA-PEFF score provides a reliable instrument to stratify suspected HFpEF patients by their risk for mortality, symptom burden, and functional status in cohort at risk with a follow-up period of 10years. As high HFA-PEFF scores are associated with worse outcome, the HFA-PEFF algorithm describes a defining approach towards HFpEF.

Chromohalobacter moromii sp. nov., a moderately halophilic bacterium isolated from lupine-based moromi fermentation

Three moderately halophilic strains, TMW 2.2308T, TMW 2.2299 and TMW 2.2304, were isolated from a lupine-based moromi fermentation. Initial identification based on their low molecular sub-proteome using mass spectrometry showed relation to the genus Halomonas, however, low score values indicated novelty. The comparison of 16S rRNA gene sequences placed these strains within the genus Chromohalobacter with C. japonicus CECT 7219T (99.67% 16S rRNA sequence similarity to strain TMW2.2308T), C. canadensis DSM 6769T (99.54%) and C. beijerinckii LMG 2148T (99.32%) being their closest relatives. However, average nucleotide highest identity values of TMW 2.2308T to C. beijerinckii LMG 2148T of 93.12% and 92.88% to C. japonicus CECT 7219T demonstrate that it represents a novel species within the genus Chromohalobacter with additional strains TMW 2.2299 (96.91%) and TMW 2.2304 (96.98%). The isolated strains were non-spore-forming, motile and able to grow at temperatures from 5 to 45 °C with an optimum at 37 °C. Growth of TMW 2.2308T occurs at 5 to 25% (w/v) NaCl with optimum growth between 10and 12.5%. The genome of TMW 2.2308T has a size of 3.47 Mb and a G + C content of 61.0 mol%. The polyphasic evidence lead to the classification of TMW 2.2308T, TMW 2.2299 and TMW 2.2304 as members of a novel species of the genus Chromohalobacter. We propose a novel species as Chromohalobacter moromii sp. nov., with TMW 2.2308T (=DSM113153T =CECT30422T) as the type strain.

Participatory variety selection of groundnut (Arachis hypogaea L.) in Taricha Zuriya district of Dawuro Zone, southern Ethiopia

Groundnut is a leguminous seed that contains a lot of oil and protein with high energy content. However, improved varieties were hardly evaluated based on farmers' preference criteria and their participation. Therefore, a participatory variety selection was carried out in Taricha Zuriya district in Dawuro Zone on the mother-baby approach on farmers' fields in the 2019 and 2020 main cropping seasons, aiming at evaluating the performance of groundnut varieties through farmers' participation and assessing their preference criteria. Six released groundnut varieties were tested using a randomized complete block design with four replicates at farmers' fields. The mother trial was done at one model farmer field (all four replications on one field), whereas the baby trials were done at four farmers' fields by considering farmers as replication per village. Combined analysis of variance for two years showed a highly significant (P < 0.001) to significant (P < 0.01) differences among groundnut varieties for grain yield, days to 50 % flowering, days to maturity, seeds per pod, pods per plant, 100 seed weight, except for both stand count at emergence and harvest. Among the tested varieties, BaHajidu (1805.84 kg ha−1) was identified as the best yielding groundnut variety, followed by Bulki-01 (1805.50 kg ha−1) and Werer-963 (1780.0 kg ha−1), respectively, while Werer-962 variety has a lower yield (1536.30 kg ha−1). Bulki-01 (96), BaHajidu (90), and Werer- 963 (76) obtained higher score values as preferred by farmers, whereas lower score values were observed for Manipinter variety (45). The aforementioned varieties Bulki-01, BaHajidu and Werer-963 were also preferred using selection criteria set by farmers as 1st, 2nd, and 3rd in rank order respectively. Hence, based on farmers’ preference values and biological data, these three groundnut varieties were recommended for pre-extension demonstration and large-scale production in Dawuro Zone and areas with similar agro-ecologies.

Impact of foot health behavior among ethnic minority populations: A cross-sectional population-based study.

To analyze the impact of the foot health and health behavior and the characteristics of outdoor footwear among minority ethnic groups. A cross-sectional study design using the Foot Health Status Questionnaire: foot pain, foot function, shoe, general foot health, general health, physical activity, social capacity, and vigor. Outcomes included the self-reported type of outdoor footwear and clinical characteristics by sex were collected in 2019-2020. A total of 78 Roma participants self-identified as members of this ethnic minority and 72 participants non-Roma were assessed (n=150). The lower score values was recorded in the footwear and general foot health domains in Roma population. General population obtained higher scores in general health domains. The most common outdoor footwear types were running shoes and walking shoes in non-Roma population, versus flip flops and slippers in Roma population. Clinical characteristics did not show any statistically significant differences (p<.05). Roma people wear flip flops and slippers and non-Roma people running shoes and walking shoes. These findings reveal cultural differences that make it easier for the Roma population to experience a greater burden of foot health problems. General foot health and foot pain dimensions show statistically significant differences among ethnicity.

Seizure Prediction in Genetic Rat Models of Absence Epilepsy: Improved Performance through Multiple-Site Cortico-Thalamic Recordings Combined with Machine Learning.

Seizure prediction is the grand challenge of epileptology. However, effort was devoted to prediction of focal seizures, while generalized seizures were regarded as stochastic events. Long-lasting local field potential (LFP) recordings containing several hundred generalized spike and wave discharges (SWDs), acquired at eight locations in the cortico-thalamic system of absence epileptic rats, were iteratively analyzed in all possible combinations of either two or three recording sites, by a wavelet-based algorithm, calculating the product of the wavelet-energy signaling increases in synchronicity. Sensitivity and false alarm rate of prediction were compared between various combinations, and wavelet spectra of true and false positive predictions were fed to a random forest machine learning algorithm to further differentiate between them. Wavelet analysis of intracortical and cortico-thalamic LFP traces showed a significantly smaller number of false alarms compared with intrathalamic combinations, while predictions based on recordings in Layers IV, V, and VI of the somatosensory-cortex significantly outreached all other combinations in terms of prediction sensitivity. In 24-h out-of-sample recordings of nine Genetic Absence Epilepsy Rats from Strasbourg (GAERS), containing diurnal fluctuations of SWD occurrence, classification of true and false positives by the trained random forest further reduced the false alarm rate by 71%, although at some trade-off between false alarms and sensitivity of prediction, as reflected in relatively low F1 score values. Results provide support for the cortical-focus theory of absence epilepsy and allow the conclusion that SWDs are predictable to some degree. The latter paves the way for the development of closed-loop SWD prediction-prevention systems. Suggestions for a possible translation to human data are outlined.

Computer-Guided Trypanocidal Activity of Natural Lactones Produced by Endophytic Fungus of Euphorbia umbellata.

Hundreds of millions of people worldwide are affected by Chagas' disease caused by Trypanosoma cruzi. Since the current treatment lack efficacy, specificity, and suffers from several side-effects, novel therapeutics are mandatory. Natural products from endophytic fungi have been useful sources of lead compounds. In this study, three lactones isolated from an endophytic strain culture were in silico evaluated for rational guidance of their bioassay screening. All lactones displayed in vitro activity against T. cruzi epimastigote and trypomastigote forms. Notably, the IC50 values of (+)-phomolactone were lower than benznidazole (0.86 vs. 30.78 μM against epimastigotes and 0.41 vs. 4.88 μM against trypomastigotes). Target-based studies suggested that lactones displayed their trypanocidal activities due to T. cruzi glyceraldehyde-3-phosphate dehydrogenase (TcGAPDH) inhibition, and the binding free energy for all three TcGAPDH-lactone complexes suggested that (+)-phomolactone has a lower score value (-3.38), corroborating with IC50 assays. These results highlight the potential of these lactones for further anti-T. cruzi drug development.

Evaluation of Dietary Supplements Containing Viable Bacteria by Cultivation/MALDI-TOF Mass Spectrometry and PCR Identification.

The insufficient quality of products containing beneficial live bacteria in terms of content and viability of labelled microorganisms is an often-reported problem. The aim of this work was to evaluate the quality of dietary supplements containing viable bacteria available in Slovenian pharmacies using plate counting, matrix-assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOF MS) and species- or subspecies-specific PCR with DNA isolated from consortia of viable bacteria, from individual isolates, or directly from the products. Twelve percent of the products (3 of 26) contained insufficient numbers of viable bacteria. Eighty-three of the labelled species (111 in total) were confirmed by PCR with DNA from the product; 74% of these were confirmed by PCR with DNA from viable consortium, and 65% of these were confirmed by MALDI-TOF MS analysis of colonies. Certain species in multi-strain products were confirmed by PCR with DNA from viable consortia but not by MALDI-TOF MS, suggesting that the number of isolates examined (three per labelled strain) was too low. With the exception of Lacticaseibacillus casei and closely related species (Lacticaseibacillus rhamnosus and Lacticaseibacillus zeae), PCR and MALDI-TOF identification results agreed for 99% of the isolates examined, although several MALDI-TOF results had lower score values (1.700–1.999), indicating that the species identification was not reliable. The species L. zeae, which appeared in 20 matches of the Biotyper analysis, was identified as L. rhamnosus by PCR. The MALDI-TOF MS analysis was also unsuccessful in detecting Lactobacillus acidophilus La-5 and Bacillus coagulans due to missing peaks and unreliable identification, respectively. Mislabelling was detected by both methods for two putative L. casei strains that turned out to belong to the species Lacticaseibacillus paracasei. PCR remains more successful in subspecies-level identification as long as the database of MALDI-TOF MS spectra is not expanded by building in-house databases. The lack of positive PCR results with viable consortia or colonies, but positive PCR results with DNA isolated directly from the products observed in 10% (11/112) of the labelled strains, suggests the presence of non-culturable bacteria in the products. MALDI-TOF MS is a faster and simpler alternative to PCR identification, provided that a sufficient number of colonies are examined. Generation of in-house library may further improve the identification accuracy at the species and sub-species level.

Long term pronostic value of suPAR in chronic heart failure: reclassification of patients with low MAGGIC score.

Inflammation is a hallmark of heart failure (HF) and among inflammatory biomarkers, the most studied remains the C-reactive protein (CRP). In recent years several biomarkers have emerged, such as sST2 and soluble urokinase-type plasminogen activator receptor (suPAR). This study set out to examine the relative importance of long-time prognostic strength of suPAR and the potential additive information on patient risk with chronic HF in comparison with pronostic value of CRP and sST2. Demographics, clinical and biological variables were assessed in a total of 182 patients with chronic HF over median follow-up period of 80months. Inflammatory biomarkers (i.e.,CRP, sST2, and suPAR) were performed. In univariate Cox regression analysis age, NYHA class, MAGGIC score and the five biomarkers (N-terminal pro brain natriuretic peptide [NT-proBNP], high-sensitive cardiac troponin T [hs-cTnT], CRP, sST2, and suPAR) were associated with both all-cause and cardiovascular mortality. In the multivariate model, only NT-proBNP, suPAR, and MAGGIC score remained independent predictors of all-cause mortality as well as of cardiovascular mortality. Risk classification analysis was significantly improved with the addition of suPAR particularly for all-cause short- and long-term mortality. Using a classification tree approach, the same three variables could be considered as significant classifier variables to predict all-cause or cardiovascular mortality and an algorithm were reported. We demonstrated the favorable outcome associated with patients with a low MAGGIC score and a low suPAR level by comparison to patients with low MAGGIC score but high suPAR values. The main findings of our study are (1) that among the three inflammatory biomarkers, only suPAR levels were independently associated with 96-month mortality for patients with chronic HF and (2) that an algorithm based on clinical score, a cardiomyocyte stress biomarker and an inflammatory biomarker could help to a more reliable long term risk stratification in heart failure.

Non-specific, agar medium-related peaks can result in false positive Mycoplasma alkalescens and Mycoplasma arginini identification by MALDI-TOF MS

MALDI-TOF MS is a fast and accurate tool to identify Mycoplasma species in liquid media. However, when trying to identify presumptive Mycoplasma bovis (M. bovis) colonies from solid medium (the “direct transfer method”) a surprisingly high occurrence of M. arginini and M. alkalescens identification was observed. It was hypothesized that agar medium components are associated with false positive identification with Mycoplasma spp., as M. bovis colonies are very small and grow into the agar. The objective of this study was to determine whether complete modified pleuropneumonia-like organism (PPLO) agar (supplemented with horse serum, sodium pyruvate, technical yeast extract, ampicillin sodium salt and colistin) and the separate components, result in false identification as Mycoplasma spp. by MALDI-TOF MS. A total of 100 samples were examined, of which 33% of the modified PPLO agar spots were identified as M. alkalescens (16%) and M. arginini (17%)), albeit with relatively low score values (< 1.85). No false identification of M. bovis was obtained. Several medium components (unsupplemented PPLO agar, horse serum and colistin) resulted in spectra with peaks showing close matches with peaks present in the M. alkalescens and M. arginini database spectra. This study shows that the direct transfer method should be interpreted with caution, and one should strive to pick as little as possible agar when sampling Mycoplasma-like colonies from solid medium containing PPLO agar, horse serum and/or colistin.

Content validation of flood disaster preparedness action (FDPA) items among small and medium enterprises (SME) business

PurposeThis paper aims to present the process of construction and content validity of flood disaster preparedness action (FDPA) items to measure flood preparedness characteristics and activities among the small and medium enterprises (SME).Design/methodology/approachThe content validity process involved the act of conceptualization, development and validation. In short, it was implemented to develop the FDPA items that were used to measure flood preparedness at the SME level. The steps began with literature review (adopt and adapt) and judgment of expert panel on the item development process. The list of 54 items was developed. A panel of eight experts rated its content validation during a focus group discussion.FindingsIn total, 52 items were acceptable to be passed on to the next stage of data collection. The items content validity (I-CVI) measurement of the items was within an acceptable range of more than 0.75, except for two items: Q38 and Q39. The scale content validity (S-CVI) value gave an excellent score of 0.95. Several items with low I-CVI score values for relevancy and clarity were subject to modification.Practical implicationsContent validity ensured accurate interpretations of results. To support the construct validity of an instrument, documenting findings from content validity was essential.Originality/valueThis paper demonstrated the initial phase of scale development on FDPA items. This newly developed item allows the integration of several flood disaster preparedness activities construct by review and judgment process by the panel of experts in the field.

Peripartum effect of meconium-stained amniotic fluid (MSAF) and relation to perinatal outcomes

Aim: To determine any possible relationship between fetal distress signs on electronic fetal monitoring and birth outcomes, in case of meconium stained amniotic fluid. Material and Method: This retrospective cohort study included 107 pregnant women at the gestational age of 35-42 weeks, who were admitted to the labor room with signs of active labor process and meconium stained amniotic fluid leakage, between June and September 2016. Results: There were no statistically significant difference between the groups in terms of gestational week at birth, gender of baby, birth length and weight, mode of delivery, and low 5th minute APGAR score (≤5). However, low 1st minute APGAR score (≤5) values, emergency cesarean delivery and neonatal intensive care unit admission were significantly higher in the fetal distress group (p=0.037, p<0.0001, p = 0.002, respectively). Conclusion: Active labor management and induction of labor can be implemented with closely electronic fetal monitoring in the presence of meconium. However, the presence of stress findings should be taken into account. Cases with fetal distress findings are associated with increased poor perinatal outcomes in relation to chronic stress. Moreover, to choose cesarean section as the mode of delivery did not seem to improve perinatal outcomes.

Bitterness in sodium caseinate hydrolysates: role of enzyme preparation and degree of hydrolysis.

Enzymatic hydrolysis of sodium caseinate (NaCas) may lead to the development of bitterness. Careful selection of hydrolysis conditions (i.e. enzyme preparation and duration) yielding different degrees of hydrolysis (DH) may aid in the development of low bitterness. Eighteen NaCas hydrolysates were generated with four enzyme preparations (Alcalase 2.4L, Prolyve 1000, FlavorPro Whey and pepsin) to different DH values. Hydrolysate bitterness score, assessed using a trained panel (ten assessors), generally increased at higher DH values for Alcalase, Prolyve and pepsin hydrolysates. However, all FlavorPro Whey hydrolysates (DH 0.38-10.62%) displayed low bitterness score values (<26.0%) comparable to that of intact NaCas (13.8 ± 2.0%, P > 0.05). Enzyme preparation and DH affect the bitterness of NaCas hydrolysates. The results are relevant for the generation of NaCas hydrolysates with reduced bitterness. © 2017 Society of Chemical Industry.

Radiographic involvement of metacarpophalangeal and radiocarpal joints in hand osteoarthritis.

To evaluate, by means of a longitudinal study, radiographic involvement of metacarpophalangeal and radio-carpal joints in hand osteoarthritis, its relationship with erosive disease and its progression, 368 patients with hand osteoarthritis were enrolled. All patients underwent hand X-rays. On the basis of the presence of central erosions in interphalangeal joints, patients were divided into three groups: 0-no central erosions, 1-one joint with central erosion, and 2-two or more joints with central erosions. A longitudinal study on 44 patients and nine normal controls, whose X-rays were available after 3.9years, was performed. The radiological involvement of metacarpophalangeal and radio-carpal joints was evaluated using Kellgren-Lawrence and OARSI scores. Low number of joints showed Kellgren-Lawrence values ≥2 group 0, 42/1290 (3.3%); group 1, 10/410 (2.4%); and group 2, 36/1980 (1.8%). Low score values were obtained for all radiographic items. Only metacarpophalangeal joint space narrowing score showed significant increase from groups 0 to 2. Subsequent adjustment for age, gender, and BMI did not confirm the statistical significance. Marginal erosions were rarely found (6.7% of joints). Metacarpophalangeal and radio-carpal radiographic per patient scores significantly worsened at follow-up, but no significant increase in joints with Kellgren-Lawrence score ≥2 was found. In normal controls, no significant radiographic worsening was found. Only a minority of metacarpophalangeal joints shows a Kellgren-Lawrence value ≥2. Metacarpophalangeal and to lesser extent radiocarpal joints had significant worsening at follow-up. Metacarpophalangeal joint involvement in hand osteoarthritis is mild but progressive. Radiocarpal involvement is negligible.

Contemporary techniques for coronary CTO revascularization.

Despite permanent improvement in success rate and technical developments, chronic total occlusion (CTO) remains undertreated by percutaneous coronary intervention (PCI). Dedicated CTO operators from Japan, Europe and USA perform these procedures with success rate beyond 90%, but there is still huge gap between this group of specialists and broader population of PCI operators. Recently proposed CTO scores can be used for patients' selection according to the CTO operators' experience. Patients with low CTO Score values may be suitable for less experienced operators at the beginning of the CTO PCI learning curve, while more complex CTOs (higher CTO Score values) should be differed to CTO experts. As most of CTO scores better predict antegrade procedural success, at the hands of expert CTO operators, lower or intermediate CTO Score values suggest cases which could be started by anterograde techniques. In this paper we review: 1) an impact of CTO on completeness of revascularization; 2) appropriate CTO equipment setting; 3) procedure planning aspects, including the use of computed tomography angiography and CTO scores; 4) current CTO techniques classifying them into A) antegrade, B) retrograde and C) hybrid approach. Further advancements in CTO PCI should not only provide higher rate of complete revascularization, with improved clinical outcome, but also simplify procedure and make it suitable for broader spectrum of interventionalists.

Episiotomy and women's sexual function 2–5 years after childbirth: A study from the Czech Republic

Background: Episiotomy is one of the most common interventions during the second stage of labour. Some studies have identified episiotomy as a risk factor for pain during sexual intercourse. Aims: The aim of this cross-sectional study was to establish the effect of episiotomy on the sexual function of women 2–5 years after a vaginal birth. Methods: Women with episiotomy were compared with four control groups: women with intact perineum, women with first-degree perineal tear, women with second-degree perineal tear and women with third- and fourth-degree perineal tear. Data were collected from 13 private gynaecological clinics in three regions in the Czech Republic during August–September 2013. The Female Sexual Function Index (FSFI) was used. Response rate was 41% (246/600 questionnaires); 35 questionnaires were excluded, so the final sample was 211 women. The Kruskal–Wallis test was performed on all women in the study (n = 211) and then again for only the primiparous women (n = 112). Findings: In all samples in women with second-degree perineal tears, lower score values were found in the domains of arousal and orgasm, and these women had a lower total FSFI score compared to those with first-degree perineal tears and women who received an episiotomy. However, in primiparous women only, there was no difference between these groups. Conclusions: Further research is required to establish the effect of episiotomy on women's sexual function.