NSAIDs for Pain Control During the Peri-Operative Period of Hip Fracture Surgery: A Systematic Review

BACKGROUND

Hip fracture (HF) mostly affects older adults and is responsible for increased morbidity and mortality. Non-steroidal anti-inflammatory drugs (NSAIDs) are part of the peri-operative multimodal analgesic management, but their use could be associated with adverse events in older adults. This systematic review aimed to assess outcomes associated with NSAIDs use in the peri-operative period of HF surgery.

METHODS

This systematic review was conducted according to the PRISMA guidelines. Three databases (PubMed/EMBASE/Cochrane Central) were used to search for clinical trials and observational studies assessing efficacy, safety and impact of NSAIDs use on non-specific post-operative outcomes, such as functional status and post-operative complications.

RESULTS

Among the 1320 references initially identified, four provided data on efficacy, four on safety and six on non-specific post-operative outcomes (three randomized controlled clinical trials, three observational studies). Mean study population ages ranged from 68 to 87 years. Two studies found that NSAIDs were effective on pain control, but two studies found conflicting results on opioid sparing. No increased risk of acute kidney injury was observed, while results concerning bleeding risk and delirium were conflicting. No study has found any effect of NSAIDs use on walk recovery. Quality of evidence was high for pain control, but low to very low for all the other studied outcomes.

CONCLUSIONS

The use of NSAIDs may be effective for pain control in the peri-operative period of HF surgery. However, safety data were conflicting with low levels of certainty. Further studies are needed to assess their benefit-risk balance in this context. The research protocol was previously registered on PROSPERO (registration number: CRD42021237649).

The acute inflammatory response to copper(II)-doped biphasic calcium phosphates

Infection and inflammation are two key features to consider to avoid septic or aseptic loosening of bone-implanted biomaterials. In this context, various approaches to fine-tune the biomaterial's properties have been studied in order to modulate the crosstalk between immune and skeletal cells. Cation-doping strategies for tuning of calcium phosphates properties has been evidenced as a promising way to control the biomaterial-induced inflammatory process, and thus improving their osteoimmunomodulatory properties. Copper(II) ions are recognized for their antibacterial potential, but the literature on their impact on particulate material-induced acute inflammation is scarce. We synthesized copper(II) ions-doped biphasic calcium phosphate (BCP), intended to exhibit osteoimmunomodulatory properties. We addressed in vitro, for the first time, the inflammatory response of human primary polymorphonuclear neutrophils (PMNs) to copper(II) ions-doped or undoped (BCP) powders, synthesized by an original and robust wet method, in the presence or absence of LPS as a costimulant to mimic an infectious environment. ELISA and zymography allowed us to evidence, in vitro, a specific increase in IL-8 and GRO-α secretion but not MIP-1β, TNF-α, or MMP-9, by PMNs. To assess in vivo relevance of these findings, we used a mouse air pouch model. Thanks to flow cytometry analysis, we highlighted an increased PMN recruitment with the copper(II) ions-doped samples compared to undoped samples. The immunomodulatory effect of copper(II) ions-doped BCP powders and the consequent induced moderate level of inflammation may promote bacterial clearance by PMNs in addition to the antimicrobial potential of the material. Copper(II) doping provides new insights into calcium phosphate (CaP)-based biomaterials for prosthesis coating or bone reconstruction by effectively modulating the inflammatory environment.

High performance of a novel antigen detection test on nasopharyngeal specimens for diagnosing SARS-CoV-2 infection

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has become a major public health issue worldwide. Developing and evaluating rapid and easy-to-perform diagnostic tests is a high priority. The current study was designed to assess the diagnostic performance of an antigen-based rapid detection test (COVID-VIRO®) in a real-life setting. Two nasopharyngeal specimens of symptomatic or asymptomatic adult patients hospitalized in the Infectious Diseases Department or voluntarily accessing the COVID-19 Screening Department of the Regional Hospital of Orléans, France, were concurrently collected. The diagnostic specificity and sensitivity of COVID VIRO® results were compared to those of real-time reverse-transcriptase quantitative polymerase chain reaction (RT-qPCR) results. A subset of patients underwent an additional oropharyngeal and/or saliva swab for rapid testing. A total of 121 patients confirmed to be infected and 127 patients having no evidence of recent or ongoing infection were enrolled for a total of 248 nasopharyngeal swab specimens. Overall, the COVID-VIRO® sensitivity was 96.7% (CI, 93.5%-99.9%). In asymptomatic patients, symptomatic patients having symptoms for more than 4 days and those with an RT-qPCR cycle threshold value ≥ 32, the sensitivities were 100%, 95.8%, and 91.9%, respectively. The concordance between RT-qPCR and COVID VIRO® rapid test results was 100% for the 127 patients with no SARS-CoV-2 infection. The COVID-VIRO® test had 100% specificity and sensitivity greater than 95%, which are better than the recommendations set forth by the WHO (specificity ≥ 97%-100%, sensitivity ≥ 80%). These rapid tests may be particularly useful for large-scale screening in emergency departments, low-resource settings, and airports.

Toward RGB LEDs based on rare earth-doped ZnO

By using ZnO thin films doped with Ce, Tb or Eu, deposited via radiofrequency magnetron sputtering, we have developed monochromatic (blue, green and red, respectively) light emitting devices (LEDs). The rare earth ions introduced with doping rates lower than 2% exhibit narrow and intense emission peaks due to electronic transitions in relaxation processes induced after electrical excitation. This study proves zinc oxide to be a good host for these elements, its high conductivity and optical transparency in the visible range being as well exploited as top transparent electrode. After structural characterization of the different doped layers, a device structure with intense electroluminescence is presented, modeled, and electrically and optically characterized. The different emission spectra obtained are compared in a chromatic diagram, providing a reference for future works with similar devices. The results hereby presented demonstrate three operating monochromatic LEDs, as well as a combination of the three species into another one, with a simply-designed structure compatible with current Si technology and demonstrating an integrated red-green-blue emission.

Teen drivers' awareness of vehicle instrumentation in naturalistic research

INTRODUCTION

Naturalistic driving methods require the installation of instruments and cameras in vehicles to record driving behavior. A critical, yet unexamined issue in naturalistic driving research is the extent to which the vehicle instruments and cameras used for naturalistic methods change human behavior. We sought to describe the degree to which teenage participants' self-reported awareness of vehicle instrumentation changes over time, and whether that awareness was associated with driving behaviors.

METHOD

Forty-two newly-licensed teenage drivers participated in an 18-month naturalistic driving study. Data on driving behaviors including crash/near-crashes and elevated gravitational force (g-force) events rates were collected over the study period. At the end of the study, participants were asked to rate the extent to which they were aware of instruments in the vehicle at four time points. They were also asked to describe their own and their passengers' perceptions of the instrumentation in the vehicle during an in-depth interview. The number of critical event button presses was used as a secondary measure of camera awareness. The association between self-reported awareness of the instrumentation and objectively measured driving behaviors was tested using correlations and linear mixed models.

RESULTS

Most participants' reported that their awareness of vehicle instrumentation declined across the duration of the 18-month study. Their awareness increased in response to their passengers' concerns about the cameras or if they were involved in a crash. The number of the critical event button presses was initially high and declined rapidly. There was no correlation between driver's awareness of instrumentation and their crash and near-crash rate or elevated g-force events rate.

CONCLUSION

Awareness was not associated with crash and near-crash rates or elevated g-force event rates, consistent with having no effect on this measure of driving performance.

PRACTICAL APPLICATIONS

Naturalistic driving studies are likely to yield valid measurements of driving behavior.

Efficacy and safety of methadone in the treatment of pain in palliative care patients with cancer: The EQUIMETH2 national, randomized, open, phase III study

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Background: Methadone is used more and more as a second-line treatment for refractory cancer pain in palliative care patients. Methods: The study aimed to compare the effect of two methadone titration methods (Stop and Go vs progressive titration) in 146 palliative care cancer patients with pain inadequately relieved or intolerant to level 3 opioids. The primary endpoint was the rate of success/failure at Day 4 defined by pain relief (reduction of at least two points of the numerical scale (0 - 10) AND a pain score < 5 for 2 consecutive days) AND no overdose (Rudkin scale ≥ 3 AND respiratory rate < 8/min). Results: Pain was nociceptive in 16% and mixed in 84%. 85% of the patients had breakthrough pain. Half received oxycodone, 1/5 fentanyl, 1/5 morphine and < 10% hydromorphone. Reasons for switching were lack of efficacy isolated (56%), or with intolerance to previous opioid (38%). More than 2/3 of the patients reached a pain score < 5 for two days at D4, adequate pain relief was obtained in 80% of the patients (median of 3 days in both groups (p = 0.12)) and lasted until D56. The rate of success/failure was about 40% at D4 with no difference between the two methods. Overdoses defined as respiratory rate < 8/min were observed in 13.2% patients throughout the study with no difference between groups. 9 required naloxone. The two methods were equally considered easy by about 60% of the clinicians. Conclusions: Methadone is an effective and sustainable second-line alternative opioid in the treatment of cancer pain in palliative care patients inadequately relieved or intolerant to level 3 opioids. The two methods of titration of methadone are comparable in terms of efficacy, safety and ease of use.

Mechanistic model coupling gas exchange dynamics and Listeria monocytogenes growth in modified atmosphere packaging of non respiring food

A mechanistic model coupling O2 and CO2 mass transfer (namely diffusion and solubilisation in the food itself and permeation through the packaging material) to microbial growth models was developed aiming at predicting the shelf life of modified atmosphere packaging (MAP) systems. It was experimentally validated on a non-respiring food by investigating concomitantly the O2/CO2 partial pressure in packaging headspace and the growth of Listeria monocytogenes (average microbial count) within the food sample. A sensitivity analysis has revealed that the reliability of the prediction by this "super-parametrized" model (no less than 47 parameters were required for running one simulation) was strongly dependent on the accuracy of the microbial input parameters. Once validated, this model was used to decipher the role of O2/CO2 mass transfer on microbial growth and as a MAP design tool: an example of MAP dimensioning was provided in this paper as a proof of concept.

Chitosan/hydroxyapatite hybrid scaffold for bone tissue engineering

BACKGROUND

To favor regeneration following critical bone defect, a combination of autologous bone graft and biomaterials is currently used. Major drawbacks of such techniques remain the availability of the autologous material and the second surgical site, inducing pain and morbidity.

OBJECTIVE

Our aim was to investigate the biocompatibility in vitro of three dimensions hybrid biodegradable scaffolds combining osteoconductive properties of hydroxyapatite and anti-inflammatory properties of chitosan.

METHODS

Hybrid scaffolds were characterized by microscopic observations, equilibrium swelling ratio and overtime weight loss measurements. In vitro studies were performed using primary human bone cells cultured for 7, 14 and 21 days. Cell viability, proliferation, morphology and differentiation through alkaline phosphatase (ALP) activity measurement were assessed.

RESULTS

Characterization of our scaffolds demonstrated porous, hydrophilic and biodegradable characteristics. In vitro studies showed that these scaffolds have induced slight decrease in cell death and proliferation comparing to the culture plastic substrate control condition, as well as increased short term osteoinductive properties.

CONCLUSIONS

In this study, we have provided evidence that our hybrid hydroxyapatite/chitosan scaffolds could be suitable for bone filling.

Infusion of docosahexaenoic acid protects against myocardial infarction

Most of the cardioprotective effects of long-chain omega 3 fatty acids, namely docosahexaenoic (DHA; 22:6n-3) and eicosapentaenoic (EPA; 20:5n-3), are due to their hypotriglyceridemic and anti-inflammatory effects, which lower the risk for cardiovascular disease and myocardial infarction. Little is known on the direct preventive activities of DHA and EPA on heart function. In isolated hearts, we studied (1) whether infused DHA is able to protect the heart from ischemia/reperfusion damage and (2) the role played by Notch-mediated signal transduction pathways in myocardial infarction. Perfusion with DHA before and before/after induction of ischemia reperfusion significantly diminished cardiac damage and afforded antioxidant protection. Mechanistically, infusion of DHA before and before/after the induction of ischemia differentially modulated the expression of Notch2 and 3 target genes. In particular, DHA increased the expression of Hey1 when infused pre- and pre/post-ischemia; Jagged 1 and the Notch2 receptors increased with DHA pre-ischemia, but not pre/post; Notch2 and 3 receptors as well as Delta increased following DHA administration pre- and (especially) pre/post-ischemia. In conclusion, while the precise nature of the Notch-mediated protection from ischemia/reperfusion afforded by DHA is as yet to be fully elucidated, our data add to the growing body of literature that indicates how systemic administration of DHA provides cardiovascular protection.

Association between adiponectin and cartilage degradation in human osteoarthritis

OBJECTIVE

Conflicting findings raise questions about the role of adiponectin in osteoarthritis (OA). The current study aimed to investigate in OA patients the association between the production of adiponectin and the grade of cartilage destruction, and to provide functional evidence for a potential role of adiponectin in OA.

DESIGN

The expression of adiponectin was examined by immunohistochemistry in cartilage obtained from healthy individuals (n = 2; ages 56 and 41 years; 1 male and 1 female) and OA patients (n = 11; ages 64-79 years; 2 male and 9 female). The association between its production in chondrocytes and the grade of cartilage destruction was established on full-depth cartilage biopsies. The functional activity of adiponectin in OA cartilage was determined from the relation between the expression of adiponectin, its receptor, cartilage-specific components and factors involved in matrix degradation, and from the chondrocyte response to the full-length or the globular form of adiponectin.

RESULTS

Adiponectin was not detected in healthy cartilage. Conversely, the adipokine was up-regulated in damaged tissue, but no strong association with the grade of cartilage destruction was found. We showed a positive correlation between adiponectin and mPGES or MMP-13 while AdipoR1 was related to the expression of type 2 collagen, aggrecan and Sox9. The full-length form of adiponectin but not the globular isoform, stimulated the production of PGE2 and MMP-13 activity in cultured human chondrocytes.

CONCLUSIONS

The elevated level of adiponectin found in chondrocytes from OA patients might contribute to matrix remodelling during OA, the full-length isoform being the single active form.

Effect of strontium-substituted biphasic calcium phosphate on inflammatory mediators production by human monocytes

Calcium phosphate materials are widely used as bone substitutes because of their properties close to those of the mineral phase of bones. Nevertheless, after several months, calcium phosphate-based materials release particles that may be phagocytosed by monocytes, leading to an inflammatory reaction. Strontium is well known to counteract the osteoporosis process, but little is known about its effect on inflammatory processes. The purpose of this work was to study the effect of biphasic calcium phosphate (BCP) particles substituted with strontium on the inflammatory reaction. Human primary monocytes stimulated or not by lipopolysaccharide (LPS) were exposed to BCP particles containing strontium for 6 and 24 h. Inflammatory mediators (cytokines and matrix metalloproteinases (MMPs)) production was then quantified by ELISA and zymography. We observed that the presence of strontium had few effects on unstimulated cells, but it decreased the production of pro-inflammatory cytokines and the chemokine interleukin 8 in LPS-stimulated cell-conditioned medium. This work suggests for the first time that strontium may be involved in the control of inflammatory processes following BCP phagocytosis by human monocytes.

Behavior of human osteoblast-like cells in contact with electrodeposited calcium phosphate coatings

Calcium-deficient hydroxyapatite (Ca-def-HAP) thin films were elaborated on Ti6Al4V substrates by electrodeposition. The coatings exhibit two different morphologies and crystallinities. Human osteoblast-like cells (MG-63) were cultured on the surfaces of these materials; the cell content and viability were evaluated up to 28 days. The scanning electron microscopy and biological investigations showed cells with a normal morphology, good proliferation, and viability from 7 to 21 days. But after 28 days, the number of live cells decreases in both cases; however, this decrease is less important in the case of calcium phosphate (CaP) coating surface when compared with the control (cell culture plastic). The cells cultured on Ca-def-HAP coating exhibit more cellular extensions and extracellular matrix. RT-PCR for type I collagen, alkaline phosphatase, and osteocalcin studies were also carried out, and was found that the CaP enhances gene expression of ALP and OC and thus the differentiation of osteoblast-like cells. Moreover, this study shows that the difference in the morphology of CaP coatings has no effect on the biocompatibility.

Synthesis of hexagonal Ni(3)N using high pressures and temperatures

The only known bulk ambient pressure nickel nitride phase is hexagonal Ni(3)N (space group P6(3)22). Multianvil synthesis experiments at 20 GPa and 2000 K using nickel (Ni) and sodium azide (NaN(3)) starting materials, and ex situ analysis using transmission electron microscopy and scanning electron microscopy measurements show that this phase can be recovered at ambient pressure (space group P6(3)22, a = 4.62 Å, c = 4.30 Å, Z = 2). Formation of this phase is correlated with the repulsive interactions between closely spaced nitrogen ions and with the extent of thermal stability of nickel nitride at ambient and at high densities. These two factors are also important in relating the high temperature and pressure behaviour of nickel nitride to those of several other interstitial nitrides recovered from similar pressures after heating. Further, we report formation of a sodium rhenium nitride phase by reaction of the azide with the rhenium capsule in which the reactants were contained.

Differential distribution of adipokines between serum and synovial fluid in patients with osteoarthritis. Contribution of joint tissues to their articular production

OBJECTIVE

To analyze the distribution of leptin, adiponectin and resistin between paired serum and synovial fluid (SF) samples of patients with osteoarthritis (OA) and to determine the potential sources of these adipokines in the joint. The active free form of leptin was also examined by evaluating the level of the soluble leptin receptor (sOb-R).

METHODS

Levels of adipokines and sOb-R were measured by a sandwich enzyme-linked immunosorbent assay in serum and SF collected from OA patients. The levels of adipokines were also determined in conditioned media from cultured joint tissues (synovium, infrapatellar fat pad, meniscus, osteophyte, cartilage and bone).

RESULTS

The adipokines exhibited different patterns of distribution between the joint and the circulating compartment. Serum levels of resistin and adiponectin exceeded those in the paired SF. Conversely, leptin SF concentrations were similar or higher than those measured in serum counterparts. Leptin and adiponectin in SF may derive from each joint tissue examined, whereas resistin was not detected in conditioned media of cultured explants. Synovium and infrapatellar fat pad were the major sources of adipokines, but osteophytes released also large amounts of leptin. The sOb-R deficiency found in SF further increased the difference in the bioactive leptin levels between serum and SF. A gender-specific difference was observed with women exhibiting the highest level of free leptin in the joint.

CONCLUSION

These data demonstrated that adipokines serum levels are not predictive values for SF determination. The joint cavity is a special space where each adipokine undergoes specific regulatory pathways, strengthening the hypothesis that adipokines may have local effects in the joint and may account for the high prevalence of OA in women.

Pasteurellose bactériémique : à propos d'un cas

Bacteremic pasteurellosis is an uncommon form of Pasteurella multocida infection, usually involved in local infections. This systemic infection often occurs in immuno-compromised patient such as cirrhotic or alcoholic patients, with a high mortality rate (up to 60%). Septic shock may occur and neurological disorders or coma are frequent. We report such a case. Treatment associated local care, antibiotics (beta-lactam antibiotics plus fluoroquinolone) during 14 days and resuscitation of septic shock. Owing these therapies, septic shock was successfully treated without complications.

Rennet-Induced Gelation of Calcium and Phosphate Supplemented Skim Milk Subjected to CO2 Treatment

A Doehlert design was performed to study the effect of calcium and phosphate supplementation at 0 to 25 mmol/kg and 0 to 16 mmol/kg, respectively, on the rennet gelation of reconstituted skim milk subjected to pH-reversible CO(2) acidification. Supplemented reconstituted skim milk samples were acidified to pH 5.80 by the addition of CO(2) under pressure and depressurized under vacuum to restore the initial pH value. The second-order polynomial models satisfactorily predicted the effect of salt addition on the micellar molar Ca:P ratio and the average diameter of the casein micelles, whereas only trends were used in the analysis of the rennet-clotting behavior of salt-supplemented, CO(2)-treated milk. Whether added Ca was the most determinant factor on the micellar molar Ca:P ratio, added Pi (a mixture of Na(2)HPO(4) and NaH(2)PO(4)) was the most determinant factor on the other responses studied, and its effect was most pronounced when Ca was simultaneously added. By comparison with control samples, changes observed in this study were essentially due to salt supplementation and not to the CO(2) treatment. Therefore, this CO(2) treatment could be considered as an entirely reversible treatment rather than only pH-reversible, and predictions might be applied to untreated milk. In the case of Ca-supplemented milk, the micellar molar Ca:P ratio increased, the average micellar diameter decreased, and the rennet-clotting properties were improved, whereas opposite effects were observed upon Pi supplementation. Since modification of the micellar molar ratio is the result of change in the chemical composition of micellar calcium phosphate, the effect of calcium and phosphate supplementation on the rennet clotting of milk was found to be also dependent on the nature of the interaction between caseins and colloidal calcium phosphate.

[Medico-economic evaluation of a care management program for asthmatic patients]

This study aimed at measuring the medico-economic interest of a care management programme established for asthmatic patients in the Amiens region ("Action Asthma Amieris") by using and comparing different evaluation tools. Three tools were used in parallel: 1) a questionnaire for collecting information on healthcare received was completed monthly by 305 patients recruited by 73 physicians between November 1998 and January 1999; 2) data issued by the national insurance fund for the years 1998 and 1999, for those patients included after January 1999; and 3) data on all hospitalisations for 1998 and 1999 in the University Hospital Centre obtained from the French hospital information database (PMSI). Data from the national insurance fund and from the PMSI are essential to evaluate costs, since the patients' statements proved to under-estimate the amount of healthcare administered and received. Following the implementation of this asthma care management programme, an increase of pharmaceutical expenses and a decrease in the number of hospitalisations for asthmatic patients were observed.

Biodistribution study of phosphonolipids: a class of non-viral vectors efficient in mice lung-directed gene transfer

BACKGROUND

A multitude of cationic lipids have been synthesized since they were first proposed for use in gene therapy. Cationic lipids are able to efficiently transfect cells both in vitro and in vivo. Whereas most research groups have focused their investigations on the toxicity of these molecules, and on the location of expression of the DNA transferred by these vectors, little has been done to determine their biodistribution and elimination pathways. Our group has developed a family of cationic lipids termed phosphonolipids. Following a large in vitro screening experiment, we have selected several molecules for in vivo testing, with some of these phosphonolipids forming lipoplexes efficient in transfecting mouse lungs. It was thus of interest to study their fate after intravenous injection.

METHODS

The respective biodistributions of both the GLB43 phosphonolipid and plasmid DNA were investigated and compared with DNA expression sites. Using the optimal conditions determined for phosphonolipids, we followed the gene transfer agent and plasmid DNA distributions versus time by radiolabeling them with (14)C and (32)P, respectively. Otherwise, we performed imaging by radiolabeling plasmid DNA with (99m)Tc.

RESULTS

The lipoplexes appear to be directly located in the lung after administration. Secondly, the plasmid is released mainly into the lungs and the phosphonolipid vector is rapidly degraded. The hydrophilic moiety of the phosphonolipid is eliminated in the urine, as is the free plasmid.

CONCLUSIONS

This study reveals that there are slight differences in the observed results depending on the technique used to label the DNA; secondly, results show that the residence time of phosphonolipids in the mouse body is related to the DNA binding time.

Effect of controlled kappa-casein hydrolysis on rheological properties of acid milk gels

An experimental method based on the controlled chymosin-induced kappa-casein hydrolysis of milk was proposed to modify micellar reactivity. Milk samples with a degree of kappa-casein hydrolysis of 19, 35, and 51% were obtained. The physicochemical properties of partially converted casein micelles were determined. The net negative charge of casein micelles was reduced with increasing degree of kappa-casein hydrolysis and a small but significant decrease in hydrodynamic diameter and micellar hydration were noted. Dynamic low amplitude oscillatory rheology was used to monitor the rheological properties of acid milk gels (GDL) made with partially chymosin-hydrolyzed milks in comparison with those of strictly acid and rennet gels. An increase in the gelation pH value was observed with increasing the degree of kappa-casein hydrolysis. The moduli values (G' and G'') reached 2 h after the point of gel were, for all degrees of hydrolysis tested, significantly higher than those of strictly rennet and acid gels. Comparison of changes in delta G'/delta t with time indicated differences in gel formation that could be related to the increased values of G' obtained for acid gel made with chymosin-treated milk. At a given time after gelation (2 h), increasing the degree of kappa-casein hydrolysis in milk led also to an increase in the loss tangent and the serum holding capacity of acid milk gels suggesting a correlation between these two parameters.

Effect of salt addition on the micellar composition of milk subjected to pH reversible CO2 acidification

Response surface methodology was used to investigate the effect of salt supplementation on the micellar composition of reconstituted skim milk subjected to acidification by CO2 pressure to pH 5.8, followed by depressurization under vacuum. Using a Doehlert design, calcium and phosphate were added to skim milk in the range of 0 to 25 mmol/kg and 0 to 16 mmol/kg of milk, respectively, and the pH was adjusted to 6.65 +/- 0.02. After carbonation, the milk sample was depressurized, and the pH returned to its initial value without modification of the ionic strength. Micellar composition was assessed by the concentration of micellar Ca, P, Mg, and protein, and the buffering properties of milk. The second order polynomial models satisfactorily predicted the effect of salt supplementation on the micellar composition (R2adj > 0.75). Added calcium was the most determinant factor, and favored the removal of Ca, P, Mg, and proteins from the soluble phase to the micellar phase when this addition was less than 17.5 mmol/kg of milk. Above this concentration, only the concentration of micellar Ca increased. The buffering response surface showed that the amount of micellar calcium phosphate increased to a maximum upon addition of 17.5 mmol of Ca/kg. By comparison with a control sample (supplemented but untreated skim milk), changes were essentially due to salt supplementation and not to the CO2 treatment. We suggest that Ca formed micellar calcium phosphate when added at a concentration less than 17.5 mmol/kg; whereas above this concentration, Ca bound directly to micellar proteins.