Current status of the gastrointestinal digestion effects on honey: A comprehensive review

In the past five years, more than 8000 scientific reports have been published on honey composition and its potential bioactivity as a source of pro-health components. However, the potential effectiveness of nutrients and other compounds in the human body is greatly influenced by the individual digestion conditions. Consequently, changes in the structure of honey components and their interactions with other constituents are expected and they may affect the bioaccessibility, the bioavailability, and further physiological functions of honey nutrients and bioactives. In this context, in addition to present key physiological characteristics for each step of the human digestion and their simulation aspects, this review also summarizes and discusses available data regarding the effect of the digestion (in vitro and in vivo) on honey compounds. Additionally, we consider the influence of the digestion on biological activities described for the compounds in the honey.

Quality, composition and health-protective properties of citrus honey: A review

Citrus honey is one of the most important monofloral honeys produced and consumed worldwide. This honey has pleasant sensorial characteristics, which include light color and typical aroma and flavor. Besides that, several constituents such as minerals, phenolic and volatile compounds, amino acids, sugars, enzymes, vitamins, methylglyoxal and organic acids are found in citrus honey. Moreover, potential biological properties have been associated with citrus honey. All these factors make it highly desired by consumers, increasing its market value, which can stimulates the practice of fraud. Also, citrus honey is susceptible to contamination and to inadequate processing. All these factors can compromise the quality, safety and authenticity of citrus honey. In this sense, this review aims to update and to discuss, for the first time, the data available in the literature about the physicochemical and the sensorial characteristics, composition, health properties, contamination, authenticity and adulteration of citrus honey. With this background, we aim to provide data that can guide future researches related to this honey.

Biparietal meander expansion technique for sagittal suture synostosis in patients older than 1 year of age-technical note

OBJECTIVE

Sagittal suture synostosis (SSS) is the most common form of craniosynostosis. For older patients, the strategy for surgical correction needs to consider diminished growth dynamics of the skull and an active reconstruction cranioplasty aims to sustain stability for the active child. We describe our technique of biparietal meander expansion (BME) technique for SSS for patients older than 1 year and retrospectively reviewed the perioperative course as well as the subjective experience of patients and caregivers during follow-up.

METHODS

The BME technique incorporates bilateral serpentine craniotomies and fixation of the consecutively expanded bone tongues with crossing sutures for patients with SSS older than 12 months of age at surgery. We reviewed patients undergoing this surgical technique for correction of SSS and collected data about the clinical course and performed a patients reported outcome measure (PROM) for patients or caregivers to evaluate subjective experience and outcome after surgical treatment.

RESULTS

BME was performed in 31 patients (8 females; median age: 43 months; range 13-388). The mean length of operation was 172.7±43 minutes (range 115-294). Patients experienced no immediate complications or neurological morbidity after surgery. Considering a total of 21 completed PROM questionnaires, the head shape after surgery was evaluated as either "better" (57%) or "much better" (43%) compared to preoperatively. Eighty-one percent of patients or caregivers answered that the patient experiences no limitation in daily activities. Although 42.8% perceived the hospital as strenuous, 90.5% would choose to undergo this treatment again.

CONCLUSION

BME is a feasible technique for older SSS patients resulting in immediate stability of the remodelled calvarium with a more normal head shape. The survey among caregivers or patients revealed a favourable subjectively experienced outcome after this type of surgical treatment of SSS in the more complex context of an older patient cohort.

Impact of a global leader on pharmaceutical practice and policy around the world

This commentary describes the contributions of a Dutch pharmacist who contributed in a unique manner to the development of community pharmacy practice in Europe, to the evolution of practice-based research and to its publication. With an interest in pharmaceutical care and in clinical pharmacy, Dr. van Mil changed practice and policy in Europe over the last decades in a very visible way, here documented through a summary of some of his main written contributions. We write this to honour his memory and contribute to the preservation of his legacy.

[Regional distribution of the cochlear implant (CI) centers in Germany]

The treatment of patients with severe hearing loss or deafness with a cochlear implant (CI) represents a standard in Germany today. However, there is hardly any data on the current number of clinical CI centers (CI clinics) and their geographical distribution. The patient self-help organization, German Cochlear Implant Society (DCIG), and the German Society for Otorhinolaryngology, Head and Neck Surgery (DGHNO-KHC) have therefore initiated a survey to determine the regional distribution, the range of services, the consideration of existing quality standards and cooperation with patient self-help organizations of the individual clinical CI centers.For this purpose, a total number of 170 ENT departments or their directors (37 professors and 133 chief physicians), respectively, were contacted by e-mail and provided with a questionnaire. The survey took place from October 2019 to February 2020.Of the 170 departments contacted, 71 (41.8 %) took part in the survey. Of these, 70 departments (98.6 %) confirmed to perform CI surgeries. Thus, 41.8 % of all clinics contacted reported to perform CI surgeries (70 of 170 clinics), while this information was not available from 99 clinics. All 70 clinical CI centers (100 %) reported to conduct CI surgeries on adults, 60 centers (85.7 %) also on children (< 18 years). 36 departments (51.4 %) reported that the total number of CI surgeries at their facility in 2018 was more than 50. In 64 departments (91.4 %), the recommendations of the DGHNO-KHC on CI care (according to the White Paper CI care 2018) were followed. A collaboration between the department and patient self-help organization was confirmed by 67 institutions (95.7 %). The geographical distribution of the clinical CI centers showed a heterogeneous distribution pattern between the individual federal states and also within the respective federal state.The work presented here is a first assessment of the situation with regard to the regional distribution of clinical CI centers in Germany. A clustering of CI centers was noticeable in metropolitan areas, sometimes with several facilities in one city. The predominant attention to quality-related aspects, such as the consideration of the DGHNO-KHC white paper and the cooperation with patient self-help, is gratifying. The limitations of the study result from limited participation in the survey (41.8 % of the contacted clinics).

Prevalence, specialized ambulatory care and guideline-recommended therapy of peripheral vascular diseases in Germany

Background

Cardiovascular diseases are the leading causes of death in the industrialized world. In addition to coronary heart disease, PAD defines morbidity and is associated with increased mortality. Guideline-recommended therapy and specialized ambulatory care is essential for optimal treatment. Knowledge of the treatment structures, contact with dedicated specialists and pharmacotherapy in the outpatient area are essential for improving treatment, reducing symptoms and finally improve mortality in this high-risk population.

Methods

The study is based on the ambulatory claims data of the panel doctors services according to § 295 SGB V and drug prescription data according to § 300 SGB V. The prevalence of PAD in Germany (medical diagnoses of PAD ICD I70.2–9) was analyzed by age and gender-specific characteristics with a timeframe of 10 years (2009–2018). In addition, the current ambulatory care structure was examined subdivided by vascular specialist (vascular surgeons or angiologists) and primary care physicians (internal medicine or general practitioners). Additionally, the prescription of guideline-recommended pharmacotherapy like statins and antiplatelet inhibitors was analyzed for the years 2009–2016.

Results

An increase of PAD diagnosis was observed with a maximum in 2018 with 2.280.000 patients in Germany. The rise of PAD patients strongly correlates with increased age (age group 50–59: 243.000, age group 60–69: 533.000, age group 70–79: 735.000, age group 75–79: 438.000, age group 80–89: 710.000) and more commonly affects males (55%) than females (45%). Access to vascular specialist was low for all age groups with only 11% of patients receiving care from vascular surgeons and only 9% from angiologists. However, 99% received care by a primary care physician.

The prescription of lipid-lowering drugs and platelet aggregation inhibitors in the current analysis period from 2009–2016 is insufficient, with only 46% receiving statins and 29% receiving antiplatelets and 15% oral anticoagulation,

Conclusion

There are relevant differences in age and gender-specific prevalence of PAD in Germany. In addition to the regular care provided by primary care physicians, PAD patients are in need for specialized vascular care. Guideline recommended prescriptions are alarmingly low in PAD patients. There is a clear need to improve the treatment algorithms in the high-risk PAD population.

Funding Acknowledgement

Type of funding source: None

Pyrrolizidine alkaloids and beehive products: A review

Pyrrolizidine alkaloids (PA) are secondary metabolites of plants, which are mostly found in the genus Senecio, Echium, Crotalaria, and Eupatorium. The presence of 1,2-unsaturated PA in foods is a concern to food regulators around the world because these compounds have been associated to acute and chronic toxicity, mainly in the liver. The intake foods with PA/PANO usually occur through accidental ingestion of plants and their derivatives, besides to products of vegetal-animal origin, such as honey. PA/PANO are transferred to honey by their presence in nectar, honeydew, and pollen, which are collected from the flora by bees. In addition to honey, other beekeeping products, such as pollen, royal jelly, propolis, and beeswax, are also vulnerable to PA contamination. In this context, this review provides information about chemical characteristics, regulation, and toxicity, as well as summarizes and critically discusses scientific publications that evaluated PA in honeys, pollens, royal jelly, and propolis.

Açaí (Euterpe oleracea Mart.) and juçara (Euterpe edulis Mart.) juices improved HDL-c levels and antioxidant defense of healthy adults in a 4-week randomized cross-over study

OBJECTIVE

To evaluate the effects of moderate-term açaí and juçara juice intake on fasting glucose, lipid profile, and oxidative stress biomarkers in healthy subjects.

METHODS

A randomized cross-over study was performed with 30 healthy adults. The subjects were assigned to drink 200 mL/day of açaí or juçara juice for four weeks with a 4-week washout period. Before and after each nutritional intervention, blood samples were obtained to evaluate the outcomes: fasting glucose, total cholesterol, triglycerides, high-density lipoprotein-cholesterol (HDL-c), low-density lipoprotein-cholesterol (LDL-c), small, dense LDL-c (sd-LDL-c), total antioxidant capacity (TAC), total oxidant status (TOS), oxidative stress index (OSI), uric acid, and activity of the enzymes superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx).

RESULTS

After four weeks, açaí and juçara juices increased the concentrations of HDL-c by 7.7% and 11.4%, respectively (P < 0.05). In addition, açaí juice intake promoted significant increases in TAC (66.7%), CAT (275.1%), GPx (15.3%), and a decrease in OSI (55.7%) compared to baseline (P < 0.05 for all). Juçara juice intake significantly increased CAT activity (~15.0%) in relation to baseline. No significant intergroup differences were observed for any outcomes (P > 0.05).

CONCLUSION

The results indicated a positive impact of regular consumption of açaí and juçara juices on the HDL-c levels, as well as on the antioxidant enzyme activities, which may contribute to cardiovascular health.

Determination of Phenolic Compounds in Three Edible Ripening Stages of Yellow Guava (Psidium cattleianum Sabine) after Acidic Hydrolysis by LC-MS/MS

Yellow guava (Psidium cattleianum Sabine) has received considerable attention in the last years because of their high content in bioactive compounds with potential application in food and pharmaceutical industries. In this regard, this study aimed to investigate the phenolic compounds of three edible ripening stages of yellow guava fruits after acidic hydrolysis by liquid chromatography-tandem mass spectrometry (LC-MS/MS) and their antioxidant capacity. Among the 23 phenolics quantified, catechin, isoquercitrin, quercetin, gallic acid, and syringic acid showed significant concentrations in all the evaluated stages, with values ranging from 479.59 ± 12.52 to 12,795.50 ± 320.95 μg 100 g^-1 of dry matter. In general, higher concentrations of phenolic acids were found in the latter ripening stages, while flavonoids were in the earlier ripening stages. These findings suggest that the ripening process promotes changes in the phenolic composition of yellow guava. However, considering the sum of phenolic compounds and the antioxidant capacity, all ripening stages investigated can be suggested as a supply of bioactive compounds for consumers.

Bounding Global Aerosol Radiative Forcing of Climate Change

Aerosols interact with radiation and clouds. Substantial progress made over the past 40 years in observing, understanding, and modeling these processes helped quantify the imbalance in the Earth's radiation budget caused by anthropogenic aerosols, called aerosol radiative forcing, but uncertainties remain large. This review provides a new range of aerosol radiative forcing over the industrial era based on multiple, traceable, and arguable lines of evidence, including modeling approaches, theoretical considerations, and observations. Improved understanding of aerosol absorption and the causes of trends in surface radiative fluxes constrain the forcing from aerosol-radiation interactions. A robust theoretical foundation and convincing evidence constrain the forcing caused by aerosol-driven increases in liquid cloud droplet number concentration. However, the influence of anthropogenic aerosols on cloud liquid water content and cloud fraction is less clear, and the influence on mixed-phase and ice clouds remains poorly constrained. Observed changes in surface temperature and radiative fluxes provide additional constraints. These multiple lines of evidence lead to a 68% confidence interval for the total aerosol effective radiative forcing of -1.6 to -0.6 W m-2, or -2.0 to -0.4 W m-2 with a 90% likelihood. Those intervals are of similar width to the last Intergovernmental Panel on Climate Change assessment but shifted toward more negative values. The uncertainty will narrow in the future by continuing to critically combine multiple lines of evidence, especially those addressing industrial-era changes in aerosol sources and aerosol effects on liquid cloud amount and on ice clouds.

The Quest to solve the HL-LHC data access puzzle

HL-LHC will confront the WLCG community with enormous data storage, management and access challenges. These are as much technical as economical. In the WLCG-DOMA Access working group, members of the experiments and site managers have explored different models for data access and storage strategies to reduce cost and complexity, taking into account the boundary conditions given by our community.Several of these scenarios have been evaluated quantitatively, such as the Data Lake model and incremental improvements of the current computing model with respect to resource needs, costs and operational complexity.To better understand these models in depth, analysis of traces of current data accesses and simulations of the impact of new concepts have been carried out. In parallel, evaluations of the required technologies took place. These were done in testbed and production environments at small and large scale.We will give an overview of the activities and results of the working group, describe the models and summarise the results of the technology evaluation focusing on the impact of storage consolidation in the form of Data Lakes, where the use of streaming caches has emerged as a successful approach to reduce the impact of latency and bandwidth limitation.We will describe the experience and evaluation of these approaches in different environments and usage scenarios. In addition we will present the results of the analysis and modelling efforts based on data access traces of the experiments.

Endoscopic third ventriculostomy in children with third ventricular pressure gradient and open ventricular outlets on MRI

OBJECTIVE

Patients with non-communicating hydrocephalus due to aqueductal stenosis are often successfully treated with endoscopic third ventriculocisternostomy (ETV). In hydrocephalus, due to other locations of obstruction of the major CSF pathways, endoscopic treatment may also be a good option. We investigated our cohort of patients treated by ETV with patent ventricular outflow but pressure gradient signs at the third ventricle in a single-center retrospective study.

METHODS

We retrospectively reviewed records and imaging studies of 137 patients who underwent an ETV in our department in the time period of June 2010 to March 2018. We included patients who showed the following findings in MRI: 1st: open Sylvian aqueduct, 2nd: open outlets of the 4th ventricle, 3rd: open spinal canal, 4th: intra-/extraventricular pressure gradient seen at the 3rd ventricle and excluded patients with history of CSF infection or hemorrhage. Perioperative clinical state and possible complications or reoperations were recorded. Shunt dependency and changes in ventricular dilatation were measured as frontal and occipital horn ratio (FOHR) before surgery and during follow-up.

RESULTS

A total of 21 patients met the defined criteria. During the mean follow-up time of 40.7 ± 30 months (range; 5-102 months), two children had to undergo a re-ETV, and six children (all < 1 year of age) received a VP shunt. ETV shunt-free survival was 100% for children > 1 year of age. The ventricular width measured as FOHR was significantly reduced after ETV 0.5 ± 0.08 (range 0.42-0.69; p < 0.05). FOHR was significantly reduced at last follow-up shunt independent patients (0.47 ± 0.05; range 0.41-0.55; p < 0.001) CONCLUSION: We conclude that ETV seems to be a successful treatment option for patients with MRI signs of intra-/extraventricular pressure gradient at the 3rd ventricle and patent aqueduct and fourth ventricular outlets in children older than 1 year of age. This condition is observed only rarely and warrants further research on a multicenter basis in order to get more solid data of its pathophysiology.

Determination of Sucralose in Soft Drinks by High-Performance Thin-Layer Chromatography: Interlaboratory Study

An interlaboratory comparison was carried out to evaluate the effectiveness of a method based on HPTLC in which reagent-free derivatization is followed by UV/fluorescence detection. The method was tested for the determination of sucralose (C12H19Cl3O8; (2R,3R,4R,5S,6R)-2- [(2R,3S,4S,5S)-2,5-bis(chloromethyl)-3,4-dihydroxyoxolan- 2-yl]oxy-5-chloro-6-hydroxymethyl)oxane-3, 4-diol; CAS Registry No. 56038-13-2) in carbonated and still beverages at the proposed European regulatory limits. For still beverages, a portion of the sample was diluted with methanolwater. For carbonated beverages, a portion of the sample was degassed in an ultrasonic bath before dilution. Turbid beverages were filtered after dilution through an HPLC syringe filter. The separation of sucralose was performed by direct application on amino-bonded (NH2) silica gel HPTLC plates (no cleanup needed) with the mobile phase acetonitrilewater. Sucralose was determined after reagent-free derivatization at 190C; it was quantified by measurements of both UV absorption and fluorescence. The samples, both spiked and containing sucralose, were sent to 14 laboratories in five different countries. Test portions of a sample found to contain no sucralose were spiked at levels of 30.5, 100.7, and 299 mg/L. Recoveries ranged from 104.3 to 124.6 and averaged 112 for determination by UV detection; recoveries ranged from 98.4 to 101.3 and averaged 99.9 for determination by fluorescence detection. On the basis of the results for spiked samples (blind duplicates at three levels), as well as sucralosecontaining samples (blind duplicates at three levels and one split level), the values for the RSDr ranged from 10.3 to 31.4 for determinations by UV detection and from 8.9 to 15.9 for determinations by fluorescence detection. The values for the RSDR values ranged from 13.5 to 31.4 for determinations by UV detection and from 8.9 to 20.7 for determinations by fluorescence detection.