Period Of Intake Research Articles

Up-regulation of the kidney renin angiotensin system contributes to long-term renal dysfunction in severe food restricted-refed female rats

Background: Severe food restriction (sFR) due to various psychological, environmental, and economical reasons can have adverse consequences to cardiovascular functioning and health. Less understood are the long-term risks for developing cardiovascular disease after the sFR period has ended. The renin-angiotensin system (RAS) is responsible for regulating blood pressure and we have found that the RAS is chronically upregulated months after the sFR is over and body weight (BW) recovered due to refeeding (sFR-Refed). AIM: Determine the role of the kidney in the chronic up-regulation of the RAS in sFR-Refed rats. Methods: We investigated the long-term consequences of sFR after refeeding on kidney structure and function in sFR-Refed rats. Female Fischer rats (3-months-old) were maintained on normal chow (Ctrl) ad libitum or a 60% caloric restricted diet for 2 weeks. Thereafter, all rats received regular chow ad libitum for 3 months. Kidney function was analyzed by precision ultrasound. ACE expression (qPCR) and activity (fluorescent assay) were measured and renal pathology was assessed by H&E staining. Results: After 2 weeks of sFR, rats lost 15% of their initial BW [DFinal/Initial): Ctrl, 1.50±0.80 vs sFR, -15.4±1.1; p<0.001; n=8]. After 3 months of refeeding, there was no detectable difference in BW, blood pressure and heart rate between Ctrl and sFR-Refed groups. However, the renal artery blood flow was reduced by 13% [(mm/s): Ctrl, 255 ± 12 vs sFR-Refed, 199 ± 7.8; p<0.02; n=4-8 Glomeruli size was reduced [(mm): Ctrl, 399 ± 6.2 vs sFR-Refed, 383 ± 3.8; p<0.05; n=9] and renal AT1R mRNA expression was increased by 1.3-fold [(fold of Ctrl): Ctrl, 1.00 ± 0.060 vs sFR-Refed, 1.29 ± 0.040; p<0.005; n=8]. Conclusion: In summary, AT1Rs in the renal cortex are up-regulated under conditions in which kidney structure and function are impaired months after the sFR period has ended and BW is restored to normal levels. These findings suggest increased renal AT1R activity contributes to the long-term renal dysfunction observed in sFR-Refed rats. Further research is needed to understand how women who are subjected either voluntarily (e.g., crash diets) or involuntarily (e.g., very low food security) to periods of inadequate caloric intake could be at increased risk for developing renal disease later in life. AHA: 940246 (AS); IH 1R01HL119380 (KS) This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Sex dimorphism of glucosensing parameters and appetite-regulating peptides in the hypothalamus of rainbow trout broodstocks

Rainbow trout (Oncorhynchus mykiss) is traditionally considered as a poor user of digestible carbohydrates harbouring persistent postprandial hyperglycaemia and decreased growth performances when fed a diet containing more than 20% of digestible carbohydrates. While this glucose-intolerant phenotype is well-described in juveniles, evidence points to a particular regulation of glucose metabolism in rainbow trout broodstrocks. By detecting changes in glucose levels and triggering a specific metabolic response, the hypothalamus plays a key role in the regulation of peripheral glucose metabolism. Therefore, our objective was to assess, for the first time in fish, the short-term consequences in hypothalamus, the glucose sensing and feed intake regulation of feeding mature female and male, and neomale rainbow trout with a diet containing either no or a 33% carbohydrate. The hypothalamic glucosensing capacity was assessed through mRNA levels of glucosensing related-genes and feed intake regulation through appetite-regulating peptides. Our data indicate that a brief period of carbohydrate intake (5 meals at 8 °C) did not induce specific changes in glucosensing capacity and appetite-regulating peptides in the hypothalamus of rainbow trout broodstock. Our results did however demonstrate, for the first time in fish, the existence of sex dimorphism of glucosensing-related genes and appetite-regulating peptides.

The effectivity of hypnobreastfeeding on the success of exclusive breastfeeding by mothers giving birth at Dian Dwi Anggraini Independent Midwifery Practice in Bogor Regency

<p><strong><em>Background:</em></strong><em>Stunting is an indicator of chronic malnutrition due to a long period of insufficient food intake. The prevalence rate of stunting in Indonesia reached 24.4% in 2021. Generally, problems related to linear growth in toddlers are frequently disregarded because it is still considered as normal as long as the child’s weight has met the standard. Several studies stated that stunting is associated with an increased risk of morbidity and mortality, as well as inhibited development of motoric and mental abilities. To decrease the prevalence of stunting, specific intervention in the form of exclusive breastfeeding needs to be carried out. The coverage of exclusive breastfeeding in Indonesia was 52.5%. Feeding the baby exclusively with breast milk up to the age of 6 months has been recommended by the World Health Organization (WHO). However, various obstacles occurred in the breastfeeding process cause the mothers unable to provide the babies with exclusive breast milk. One of the inhibiting factors of breast milk production is the psychological factor, which is the occurrence of stressors in breastfeeding mothers. One of the efforts which can be done to relieve stress in breastfeeding mothers is by applying hypnobreastfeeding. It is a natural effort carried out by providing positive affirmations for the breastfeeding process when mothers are in a very relaxed or very concentrated state.</em></p><p><em> <strong>Objectives : </strong> This study aims to figure out the effect of hypnobreastfeeding on the success of giving exclusive breastfeeding.<strong></strong></em></p><p><strong><em>Methods: </em></strong><em>This research employed quantitative descriptive analysis with a quasi-experimental and control group post-test-only design.</em></p><p><strong><em>Results :</em></strong><em> The results of this study obtained the effectiveness of hypnobreastfeeding on the success of exclusive breastfeeding. It is indicated by statistical values with a p-value of < 0.05., and the effect is 5.5 times greater than that of the group without hynobreastfeeding. <strong>Conclusions : </strong>Referring to the high effectiveness of hypnobreastfeeding on the success of exclusive breastfeeding shown in this study, the researchers confirmed that hypnobreastfeeding is an action that must be given by health workers when accompanying mothers in labor.</em></p>

Chronic circadian desynchronization of feeding-fasting rhythm generates alterations in daily glycemia, LDL cholesterolemia and microbiota composition in mice.

The circadian system synchronizes behavior and physiology to the 24-h light- dark (LD) cycle. Timing of food intake and fasting periods provide strong signals for peripheral circadian clocks regulating nutrient assimilation, glucose, and lipid metabolism. Mice under 12 h light:12 h dark (LD) cycles exhibit behavioral activity and feeding during the dark period, while fasting occurs at rest during light. Disruption of energy metabolism, leading to an increase in body mass, was reported in experimental models of circadian desynchronization. In this work, the effects of chronic advances of the LD cycles (chronic jet-lag protocol, CJL) were studied on the daily homeostasis of energy metabolism and weight gain. Male C57 mice were subjected to a CJL or LD schedule, measuring IPGTT, insulinemia, microbiome composition and lipidemia. Mice under CJL show behavioral desynchronization and feeding activity distributed similarly at the light and dark hours and, although feeding a similar daily amount of food as compared to controls, show an increase in weight gain. In addition, ad libitum glycemia rhythm was abolished in CJL-subjected mice, showing similar blood glucose values at light and dark. CJL also generated glucose intolerance at dark in an intraperitoneal glucose tolerance test (IPGTT), with increased insulin release at both light and dark periods. Low-density lipoprotein (LDL) cholesterolemia was increased under this condition, but no changes in HDL cholesterolemia were observed. Firmicutes/Bacteroidetes ratio was analyzed as a marker of circadian disruption of microbiota composition, showing opposite phases at the light and dark when comparing LD vs. CJL. Chronic misalignment of feeding/fasting rhythm leads to metabolic disturbances generating nocturnal hyperglycemia, glucose intolerance and hyperinsulinemia in a IPGTT, increased LDL cholesterolemia, and increased weight gain, underscoring the importance of the timing of food consumption with respect to the circadian system for metabolic health.

Emotional Intelligence and Professional Identity of Student Teachers During Practicum

Every profession has its own professional identity, and the teaching profession is not excluded. A teacher’s professional identity potentially affects their commitment, attitude, and belief in fulfilling the teaching tasks. In this study, the student teachers’ professional identities are investigated along with their emotional intelligence. A quantitative study was conducted to identify the level of emotional intelligence and professional identity as well as the relationship between the two variables. A total of 301 student teachers, under the same intake period (June 2020) from the campuses of Teacher Education Institutions in the Central Zone, Malaysia answered the questionnaire of this study. The analysis revealed that the student teachers had high emotional intelligence and possessed a high level of professional identity. The Spearman correlation coefficient results showed that there was a strong and significant relationship between emotional intelligence and professional identity among student teachers, r(301)=0.614, p=0.000 (p<0.01). This finding provided evidence that emotional intelligence plays an important role in the development of professional identity among student teachers. The findings of this study can also serve as a guide to help the Teacher Education Institutions in this country plan and design relevant curricula and programmes that incorporate emotional intelligence so that the professional identity of student teachers can be more effectively cultivated and promoted.

Alterations in Oxidative Stress Markers and Na,K-ATPase Enzyme Properties in Kidney after Fructose Intake and Quercetin Intervention in Rats.

The study aimed to characterize the consequences of a 15-week intake of 10% fructose on the kidney, with the focus on oxidative stress markers and properties of the Na,K-ATPase enzyme. Various antioxidants naturally occurring in common food were demonstrated to be protective against fructose-induced deterioration of kidneys. Therefore, we also aimed to observe the effect of 6-week quercetin administration (20 mg/kg/day) that was initiated following the 9-week period of higher fructose intake, by determining the concentration of sodium, potassium, creatinine, urea, and glucose in blood plasma and oxidative status directly in the renal tissue. Kinetic studies of renal Na,K-ATPase were utilized for a deeper insight into the molecular principles of expected changes in this enzyme activity under conditions of presumed fructose-induced renal injury. Fructose intake led to increase in body weight gain, plasma glucose and sodium levels, and deterioration of kidney properties, although some compensatory mechanisms were observable. Quercetin administration improved glycemic control in rats exposed to fructose overload. However, an increase in plasma creatinine, a decrease in GSH/GSSG ratio in renal tissue homogenate, and a controversial effect on renal Na,K-ATPase enzyme suggest that quercetin treatment may not be beneficial in the condition of pre-existing renal pathology.

The effects of yogurt consumption on immune function in university male track and field athletes -A randomized, double-blind, placebo-controlled, parallel-group study-

This study aimed to evaluate the effects of ingesting yogurt fermented with Lactobacillus delbrueckii subsp. bulgaricus (OLL1073R-1) on the immune function of healthy university men track and field athletes. Study design Randomized, double-blind, placebo-controlled, parallel-group study. A total of 37 track and field athletes aged ≥18 years were randomly assigned into two groups. For 2 weeks, two bottles of yogurt fermented with OLL1073R-1 and Streptococcus thermophilus OLS3059 or placebo sour milk were ingested daily to the participants. During the intake period, a 1-week training camp was held and participants were subjected to strenuous exercise. Natural killer (NK) cell activity, which is the primary endpoint, was significantly lower in the placebo group after ingestion than that at baseline; however, it remained unchanged during the pre-exercise level of the yogurt group. The two-way repeated measures analysis of variance showed an interaction effect in the NK cell activity change (P=0.018) and a significant difference between the groups after the 2-week ingestion (P=0.015). Among the secondary endpoints, cytokines and chemokines levels involved in activating innate immunity maintained or enhanced only in the yogurt group. ALT, LDH, and CK significantly elevated only in the placebo group. Furthermore, amino acid levels were significantly lower in the placebo group after ingestion than that at baseline; however, it remained unchanged during the pre-exercise level in the yogurt group. Consuming yogurt fermented with OLL1073R-1 prevents the decline in immune function associated with strenuous exercise. Additionally, the yogurt may contribute to stable physical condition.

Transient high salt intake causes epigenetic changes and leads to persistent inflammatory activation to produce “salt memory”

Transient high salt intake causes a sustained increase in blood pressure (BP) even after returning to a normal-salt diet, a phenomenon known as “salt memory.” However, the molecular mechanisms of this phenomenon remain to be elucidated. Dahl salt-sensitive (SS) rats were fed a high-salt (8% NaCl) or high-salt diet and treated with drugs for 8 to 16 weeks and then returned to a normal-salt diet for 3 months. This study investigated the molecular mechanisms of salt memory and its mediation of SS hypertension and renal damage. We show that transient high salt intake caused persistent elevation of BP and exacerbation of kidney damage in Dahl SS rats even after returning to a normal-salt diet. Both epigenetic changes and inflammatory activation also persisted after resumption of a normal diet. Arterial BP, renal injury and the inflammatory response returned to normal levels in rats administered mycophenolate mofetil (MMF) during the 8-week period of high salt intake, resulting in the disappearance of salt memory. However, the vasodilator hydralazine did not ameliorate kidney damage or inflammatory activation, although it decreased BP to control levels. Transient high salt intake increased histone 3 lysine 4 monomethylation (H3K4me1) levels at the nuclear factor κB (NF-κB) subunit p65 promoter in SS rats, promoting p65 gene transcription and NF-κB activation and further leading to a series of inflammatory responses. Our findings demonstrate that transient high salt-induced epigenetic changes and persistent inflammatory activation play important roles in salt memory and its mediation of SS hypertension and renal damage.

An overview of micro- and macronutrient intake in stunted and normal infants in Indonesia

Stunting is a symptom of chronic malnutrition in a person. The aim is to find differences in treatment, consumption patterns, and intake of macro- and micronutrients in stunted and normal toddlers. A literature review study is used in this research method to find, combine, and analyse facts from sources that meet scientific criteria that are valid and accurate. The results found from this literature search were 681 libraries from Google Scholar, which were then selected for 10 articles. Energy consumption itself comes from daily food during the intake period. macronutrients, namely protein, fat, and carbohydrates.&#x0D;

The impact of providing flexible meals on patients' nutritional intake, fasting times and cost when admitted to a trauma unit.

Malnutrition is associated with increased morbidity, mortality, decreased quality of life, increased length of hospital stay and higher treatment costs. Prevalence rates in Australian hospitals is reported between 30% and 50%. Trauma patients experience significant periods of restricted oral intake resulting from pre-operative fasting for complex and frequent surgical procedures. In addition, they have elevated nutritional requirements for recovery resulting in significant accrued nutritional deficits. The present study hypothesised that not having hot meals available outside of the hospital food service system was contributing to increased nutritional deficits. The study aimed to investigate the impact of providing flexible frozen meals and snacks in a trauma ward, on nutritional intake, cost and duration of perioperative fasting. This was a pre- and post-interventional study examining 40 fasting experiences of hospitalised patients in a trauma ward. Frozen meals and snack bags were readily accessible to nursing staff to provide to patients out of kitchen service hours. Nutritional intake and fasting times were measured from patient records and interviews. Implementing flexible food items increased patient nutritional intake by 28% (15%-43%) on the day of fasting. Fasting duration was not significantly reduced (1.73 h); however, when patient fasting was ceased, food was provided more responsively. Nursing staff showed improved satisfaction with project implementation. The present study has demonstrated that provision of food items outside of regular meal service hours is a low cost intervention that improves nutritional intake, provides nutrition more responsively and is well received by nursing staff.

DOP25 Contraceptive method use according to Inflammatory Bowel Disease status among young women in the United States

Abstract Background Inflammatory bowel disease (IBD) and estrogen-based contraceptives both increase thromboembolism risk, leading gastroenterologists to recommend long-acting reversible contraceptives (LARCs) over estrogen-based methods for women with IBD. No study has evaluated whether young women with IBD follow this guidance, especially as many patients lack awareness of estrogen-related risks, and young women generally prefer estrogen-based methods. We evaluated contraceptive use patterns for young women with versus without IBD, including odds of estrogen-based contraceptive use. Methods Using the IQVIA Pharmetrics Plus Database, a United States (US) health insurance claims database, we identified US women ages 15-25 with ≥1 prescription contraceptive and ≥6 months continuous enrollment from enrollment start to first contraceptive code (intake period). We excluded patients with ≥1 hysterectomy/sterilization claim during intake. The independent variable was IBD diagnosis, defined as ≥3 codes for Crohn’s disease (CD) or ulcerative colitis (UC), 2 CD and/or UC codes and 1 IBD medication code, or 1 CD or UC code and 2 IBD medication codes during intake. The dependent variable was estrogen-based contraceptive use (estrogen-based contraceptive pill, patch, and ring) versus non-estrogen-based (progestin-only pill, injectable, implant, and intrauterine device [IUD]), based on the first contraceptive claim. We generated descriptive statistics for contraceptive sub-type and covariates stratified by IBD status and performed bivariate comparisons. Using multivariable logistic regression, we determined adjusted odds ratios (aOR) with 95% confidence intervals (CI) for estrogen-based contraceptive use, adjusting for age, region, year, and insurance. Results We identified 802,932 young women on contraceptives, of whom 1,083 had IBD. Demographics were similar across IBD status except more women with IBD had commercial insurance (Table). Use of the estrogen-based pill, patch, and ring was similar or marginally lower for women with IBD versus without IBD (67.6% vs 68.8%, 2.7 vs 3.1%, and 1.5 vs 1.4%). Women with IBD had a slightly higher proportion of implant use and similar IUD use versus those without IBD (16.1% vs 14.2%; 1.8% vs 1.7%,) (Table, Figure). After adjustment, young women with IBD were 0.82 times as likely to use estrogen-based contraceptives compared to those without IBD (aOR 0.82; 95% CI 0.71-0.94). Conclusion Young women with IBD on contraceptives are only slightly less likely to use estrogen-based methods as those without IBD, despite the recommendation for LARC over estrogen-based contraceptives in IBD. This finding suggests a need for reproductive health education efforts and contraceptive safety studies specific to young women with IBD.

Probiotic responder identification in cross-over trials for constipation using a Bayesian statistical model considering lags between intake and effect periods

Recent advances in microbiome research have led to the further development of microbial interventions, such as probiotics and prebiotics, which are potential treatments for constipation. However, the effects of probiotics vary from person to person; therefore, the effectiveness of probiotics needs to be verified for each individual. Individuals showing significant effects of the target probiotic are called responders. A statistical model for the evaluation of responders was proposed in a previous study. However, the previous model does not consider the lag between intake and effect periods of the probiotic. It is expected that the lag exists when probiotics are administered and when they are effective. In this study, we propose a Bayesian statistical model to estimate the probability that a subject is a responder, by considering the lag between intake and effect periods. In synthetic dataset experiments, the proposed model was found to outperform the base model, which did not factor in the lag. Further, we found that the proposed model could distinguish responders showing large uncertainty in terms of the lag between intake and effect periods.

Acid-tolerant Lactiplantibacillus plantarum ZDY2013 shows a colonization niche preference and interacts with enterotoxigenic Bacillus cereus in specific-pathogen-free mice.

Probiotics have long been utilized as functional food and modulate gut microbial homeostasis, but their colonization niche is mostly unclear and transient, which restrains the development of microbiome-targeted strategies. Lactiplantibacillus (L.) plantarum ZDY2013 is an allochthonous species of the human gastrointestinal tract with acid-tolerant properties. It serves as an antagonistic agent against the food-borne pathogen Bacillus (B.) cereus and a potent regulator of the gut microbiota. However, there is a knowledge gap regarding the colonization dynamics of L. plantarum ZDY2013 in the host intestine and the colonization niche of its interaction with pathogens. Here, we designed a pair of specific primers targeting L. plantarum ZDY2013 based on its whole genome sequence. We evaluated their accuracy and sensitivity with other host-derived strains and confirmed their availability with artificially spiked fecal samples from different mouse models. Additionally, the content of L. plantarum ZDY2013 was quantified by qPCR in fecal samples from BALB/c mice, followed by the analysis of its colonization niche preference. Moreover, the interactions between L. plantarum ZDY2013 and enterotoxigenic B. cereus HN001 were also elucidated. The results revealed that the newly designed primers could identify L. plantarum ZDY2013 with high specificity and were resistant to the influence of the complex fecal matrix and gut microbes from different hosts. Interestingly, the content of mixed L. plantarum ZDY2013 and B. cereus HN001 when orally administered remained higher when compared with the single strain group in BALB/c mice upon discontinuation of intragastric administration. In addition, L. plantarum ZDY2013 was mainly enriched in the large intestine during the ingestion period and maintained the highest content in the stomach after discontinuing supplementation on day 7. Moreover, L. plantarum ZDY2013 colonization neither damaged the intestine nor ameliorated the damage triggered by B. cereus in BALB/c mice. Overall, our study constructed two efficient specific primers targeting L. plantarum ZDY2013 and provided the potential to explore the underlying mechanism of competition between L. plantarum ZDY2013 and pathogens in host species.

Parenteral nutrition only in patients with delayed gastric emptying after whipple - Is it safe?

Background: Delayed gastric emptying (DGE) after pancreatoduodenectomy (PD) presents both an economic and functional burden on affected patients. Patients with DGE often require nutritional supplementation as they experience prolonged periods of inadequate oral intake. Some patients are not able to tolerate enteral nutrition and receive parenteral nutrition only. In this study we aim to evaluate if supplementation by parenteral nutrition only adversely affects outcomes in patients with DGE.

Effects of breed on preferential intake of hydroxychloride and sulfate sources of trace minerals in growing beef heifers

Abstract This study evaluated the effects of breed on voluntary preferential intake of two sources of Cu, Mn, and Zn when added to white salt-based trace mineral supplement (days 0 to 55; experiment 1) and protein supplement (days 56 to 112; experiment 2). On day 0, Nelore and ½ Angus × ½ Nelore heifers (n = 20/breed) were stratified by breed, body weight (BW = 347 ± 82 kg), and age (12 to 30 mo), and randomly allocated into 1 of the 40 drylot pens (1 heifer/pen). Both experiments were divided into washout (days 0 to 27 in experiment 1 and days 56 to 83 in experiment 2) and preferential intake periods (days 28 to 55 in experiment 1 and days 84 to 112 in experiment 2). During the respective preferential intake period, heifers were provided simultaneous free-choice access to sulfate (SUL) and hydroxychloride (HYD) sources of Cu, Mn, and Zn mixed into salt-based trace mineral supplements from days 28 to 55 (experiment 1) and then protein supplements from days 84 to 112 (experiment 2). Heifers were provided free-choice access to Tifton 85 (Cynodon sp.) hay from days 0 to 112. Effects of breed × source × day of the study were detected (P ≤ 0.05) for daily trace mineral intake from days 28 to 56 and days 84 to 112. Angus × Nelore heifers consumed a greater amount of SUL vs. HYD supplements on days 31 to 33 (P = 0.02) and HYD vs. SUL supplements on days 37 to 42 (P ≤ 0.02), whereas Nelore heifers consumed more HYD vs. SUL supplements on days 31 to 33 and 43 to 51 (P ≤ 0.05). Both breeds consumed (P ≤ 0.05) a greater amount of protein supplement containing HYD vs. SUL from days 84 to 112, but the differences in protein supplement intake increased (P ≤ 0.04) in greater magnitude for Nelore vs. Angus × Nelore heifers. Supplement intake coefficient of variation (CV) from days 28 to 41 and days 84 to 97 tended (P = 0.06) to be greater for Nelore vs. Angus × Nelore heifers. Effects of breed × source were detected (P = 0.02) for supplement intake CV from days 84 to 112. Intake CV of supplements added with HYD did not differ (P ≥ 0.40) between Nelore vs. Angus × Nelore heifers but was greater (P &amp;lt; 0.01) for Nelore vs. Angus × Nelore heifers fed SUL supplements. Overall, Nelore heifers had greater preferential intake for mineral and protein supplements containing hydroxychloride vs. sulfate sources compared to Angus × Nelore heifers. Hydroxychloride sources encouraged voluntary intake and reduced variation in supplement consumption compared to SUL sources of the same metals.

Alcohol Withdrawal at Different Points in Time Distinctly Affects Wistar Rats’ Spatial Reference Memory

Objectives: The consumption of alcohol by adults may lead to severe neurodegeneration and significant behavioral problems. An increase in the harmful effects of alcohol becomes aggravated after the development of alcohol dependence. Furthermore, the serious damage from chronic alcohol intake on the hippocampus has gained attention due to its role on learning and memory. Therefore, the study aimed to examine the retention of spatial reference memory during different points in time regarding alcohol withdrawal in Wistar rats. Materials and Methods: The study has therefore administered alcohol to rats at gradually increasing doses from 4.5 to 12 g/kg/day in a binge-like manner using the intragastric intubation technique for six days followed by 24, 48, or 96 hours of alcohol withdrawal. To evaluate the effects of alcohol withdrawal, the alcohol-exposed rats have been tested regarding their spatial reference memory. Results: An adverse effect from alcohol withdrawal on memory retention was observed in the 24-hour alcohol withdrawal group. This effect decreased at 48 hours of withdrawal, but reappeared at 96 hours. Conclusion: The study’s results suggest that alcohol withdrawal itself, even after a relatively short period of alcohol intake, may also adversely affect memory. Therefore, withdrawal therapy from alcohol should be performed in a controlled manner to protect the brain from extended alcohol withdrawal-induced spatial memory impairments.

S3312 Acute Decompensation of Late-Onset Glutaric Acidemia Type II in the Setting of Multifactorial Cirrhosis

Introduction: Glutaric acidemia type 2 (GA2), or multiple acyl CoA dehydrogenase deficiency (MADD), is a disorder of fatty acid oxidation, amino acid and choline metabolism. GA2 is inherited in an autosomal recessive manner by changes in the ETFA, ETFB, or ETFDH genes. The classic and most severe form of GA2 is neonatal onset. Our patient has symptoms of late onset disease, including fatigue, vomiting, episodic hyperammonemia, fatty infiltration of the liver, and an absence of congenital malformations. In acute decompensations, triggered by catabolism and/or intercurrent illness, individuals with GA2 may develop metabolic acidosis, rhabdomyolysis, elevation of transaminases, and hyperammonemia. Case Description/Methods: This case describes a 36-year-old gentleman with late onset glutaric acidemia type II, multifactorial cirrhosis from non-alcoholic steatohepatitis in the setting of a metabolic disorder, class III obesity, alcoholic associated liver disease, portal hypertension, splenic embolization, CHF, presented to the ED for confusion following progressive nausea and vomiting over five days, and was found to have elevated ammonia level at 165 mcmol/L. His vital signs were tachycardia of 133 bpm, hypertension of 221/133, he was afebrile in no respiratory distress. Physical exam was notable for a drowsy obese male oriented to self and place, diaphoretic, tachycardic, no JVD, no crackles, non-tender abdomen with normoactive bowel sounds, and asterixis. Initial lab studies were significant for platelets of 131k, potassium of 2.4 mmol/L, total bilirubin 3.7 mg/dL, AST 355 ALT 130 ALP 143 IU/L, and no detectable ethanol, acetaminophen or salicylates. Multiple factors can influence his ammonia level, including underlying cirrhosis and glutaric acidemia. His metabolic crisis was suspected due to a catabolic state from intake of high-protein diet, and was managed with 10% Dextrose IV fluids, levocarnitine, riboflavin, lactulose, low-protein low-fat diet with improvement in encephalopathy. Hypokalemia from decreased absorption and lactulose use resolved with potassium supplements and addition of spironolactone. Discussion: Metabolic disorders are rare but important to consider in patients that present with metabolic crisis. They can decompensate after periods of dehydration, exercise, alcohol ingestion or illnesses and develop hyperammonemia, transaminitis, metabolic acidosis. These individuals have a lifelong risk of intermittent episodes of metabolic crisis and prompt management is imperative to recovery.

Influence of esomeprazole on the bioavailability of afatinib: A pharmacokinetic cross-over study in patients with non-small cell lung cancer

Afatinib is an oral small-molecule kinase inhibitor (SMKI) approved for treatment of metastatic non-small cell lung cancer (NSCLC) with an epidermal growth factor receptor (EGFR) driver mutation. Although oral administration is convenient, most SMKIs experience pH-dependent solubility. A drug-drug interaction between afatinib and proton-pump inhibitors (PPIs) has, however, never been studied in humans. Hence, we performed a randomized, three-period cross-over study. Afatinib (30 mg or 40 mg) was administered without PPI (period A), concomitantly with esomeprazole (period B) and three hours after esomeprazole intake (period C). Primary objective was the area under the curve (AUC0–24 h) comparing period A to period B and period A to period C. Secondary objectives were other pharmacokinetic parameters and toxicity. Linear mixed effect modelling was performed for differences in AUC0–24 h and Cmax between periods A and B and periods A and C. In 18 evaluable NSCLC patients, concomitant use of 40 mg esomeprazole decreased the steady-state afatinib AUC0–24 h with 10.2% (95% CI −29.2 to +14.0%; p = 0.564) compared to afatinib administration without PPI. Esomeprazole intake three hours prior to afatinib did not significantly influence afatinib AUC0–24 h (−0.6%; 95% CI −14.9 to +16.1%; p = 1.0). No differences in toxicity were observed. To conclude, esomeprazole did not change the exposure to afatinib in patients with NSCLC. Since there is no clinically relevant drug-drug interaction, esomeprazole can safely be co-administered with afatinib. This is important for clinical practice, because other EGFR-SMKIs (e.g. erlotinib and gefitinib) do experience clinically relevant drug-drug interactions with acid-suppressive agents.

Military field training exercise with prolonged physical activity and sleep restriction causes hormonal imbalance in firefighter cadets.

To evaluate the impact of the "Search and rescue" field military training exercise (SR_FTX) on hormonal modulation and identify their possible correlation with physical and cognitive performance. An observational (before and after) study was carried out, with male firefighters cadets (n = 42; age = 23[22;27] years) undergoing a nine-day military exercise (SR_FTX). The Countermovement jump (physical performance), the Stroop test (cognitive alertness), and blood tests for testosterone, cortisol, GH, and IGF-1 were applied. Wilcoxon for paired samples and Spearman's correlation tests were used. Testosterone (751.10 [559.10;882.8]vs.108.40 [80.12;156.40] ng/dL) and IGF-1 (217.5 [180;239.30]vs.105 [93;129] ng/mL) significantly decreased while GH (0.10 [0.06;0.18]vs.1.10 [0.58;2.28] ng/mL) and cortisol (9.60 [8.20;11.55]vs.15.55 [12.28;18.98] ug/dL) significantly increased. Physical performance (31.2 [30.04;35.4]vs.21.49 [19,02;23,59] cm) and cognitive alertness were significantly worse after SR_FTX (Congruent task: 1,78 (0183)vs.1,56 (0185) response/s and incongruous task: 1,23 (0191)vs.1,02 (0207) response/s). The physical performance showed a strong correlation with testosterone (rho = 0.694) and regular correlations with both IGF-1 (rho = 0.598) and cortisol (rho = -0.580). The Stroop test presented weak correlations with GH (rho = -0.350) and cortisol (rho = -0.361). SR_FTX negatively impacted hormonal modulation, physical and cognitive performance. These findings could help commanders decide to replace the employed firefighters in a real mission more frequently. Also, if the real scenario allows, they could think about providing better work conditions, such as improving caloric intake and rest periods, to preserve the military performance and health.

Oral Supplementation with Low-molecular-weight Collagen Peptide Improves Hydration, Facial Lifting, Dermal Density, Skin Desquamation and Nails: A Randomized, Double-blind, Placebo-controlled, and Maintenance of Effect Study

Background: Oral low-molecular-weight collagen peptide (LMWCP) hydrolyzed enzymatically is a fish-derived type I collagen hydrolysate with more than 15% of its content made up of tripeptides in the form of Gly-X-Y (X and Y are placed arbitrarily, but are often occupied by proline, hydroxyproline, and alanine) including 3% Gly-Pro-Hyp. LMWCP helps with skin hydration, wrinkles and elasticity via previous findings, has been recognized individually by the Ministry of Food and Drug Safety (MFDS notice No. 2013-30) as a functional food ingredient. In this study, to expand the scope of diversity in the efficacy of LMWCP, we evaluated hydration according to depth of the stratum corneum, facial lifting, dermal density, skin thickness, skin desquamation, and roughness of the nail plate surface. Moreover, the measurement timelines were considered including the early time intake and off-intake periods. Methods and materials: This study was designed as a double-blind, randomized, placebo-controlled for 14 weeks including oral intake for 12 weeks followed by 2 weeks of the off-intake period. Water content (depths of 0.1 mm, 0.5 mm), facial lifting, dermal density, skin thickness and skin desquamation were assessed at baseline, 2 weeks, 4 weeks, 8 weeks, 12 weeks after intake of the oral supplementation and after 2 weeks of off-intake (+2W). The roughness of the fingernail plate was measured at 0W, 8W and 12W. Results: The test group saw significant improvements compared to the placebo group. According to each measurement result, the skin moisture (depth of 0.1 mm) and skin desquamation were improved after 2 weeks of ingestion, and the skin moisture (depth of 0.5 mm), facial lifting, dermal density and skin thickness were improved after 4 weeks. For all measurement items, even after 2 weeks of off-intake, the test group showed a statistically significant improvement compared to the placebo group. In the roughness of the fingernail plate, it was found that the roughness was improved in the test group after 12 weeks compared to before ingestion. Discussion: These results demonstrated that the effects of LMWCP appear in early-intake and are maintained even after off-intake. This study suggests LMWCP as a safe and effective ingredient for anti-skin aging in the nutricosmetic market targeting both internal and external beauty and health.