Improve the clinical effective decision of the oral feeding readiness in preterm infants: Revise and validate the TC-POFRAS

BACKGROUND

Currently there is limited information to guide health professionals regarding the optimal time frame to initiate safe and effective oral feedings to preterm infants. The study aims to revise and validate a streamlined version of the Traditional Chinese-Preterm Oral Feeding Readiness Assessment Scale, the TC-POFRAS®, and evaluate its construct validity in the clinical decisions regarding feeding readiness of preterm infants.

METHODS

Eighty-one clinically stable preterm infants were assessed using the TC-POFRAS for oral feeding readiness. Item-total correlation analysis was used to check if any item was inconsistent with the averaged TC-POFRAS scores. Cronbach's α coefficient was used to evaluate the inter-item consistency. Exploratory factor analysis was used to determine the coherence of variables to reorganize assessment domains. The revised version of TC-POFRAS (TC-POFRAS®) was developed and a new cut-off score based on discriminant accuracy was established.

RESULTS

Based on the results from statistical analysis, five items ("lips posture," "tongue posture," "biting reflex," "gag reflex," and "tongue cupping") were deleted from the original TC-POFRAS to form the TC-POFRAS®. The TC-POFRAS®'s global accuracy was 92.1%. The cut-off value of 19 was the one that presented the most optimization of sensitivity based on specificity. The TC-POFRAS® was reconstructed into corrected gestational age and five behavioral domains.

CONCLUSIONS

The TC-POFRAS® is considered a valid, safe, and accurate objective instrument to assist health professionals to initiate oral feeding of preterm infants.

Structural and Biomechanical Adaptations to Free-Fall Landing in Hindlimb Cortical Bone of Growing Female Rats

The purpose of the study was to investigate the adaptation process of hindlimb cortical bone subjected to free-fall landing training. Female Wistar rats (7 weeks old) were randomly assigned to four landing (L) groups and four age-matched control (C) groups (n = 12 per group): L1, L2, L4 L8, C1, C2, C4 and C8. Animals in the L1, L2, L4 and L8 groups were respectively subjected to 1, 2, 4 and 8 weeks of free-fall-landing training (40 cm height, 30 times/day and 5 days/week) while the C1, C2, C4 and C8 groups served as age-matched control groups. The tibiae of the L8 group were higher in cortical bone mineral content (BMC) than those in the C8 group (p < 0.05). Except for the higher bone mineralization over bone surface ratio (MS/BS, %) shown in the tibiae of the L1 group (p < 0.05), dynamic histomorphometry in the tibial and femoral cortical bone showed no difference between landing groups and their age-matched control groups. In the femora, the L1 group was lower than the C1 group in cortical bone area (Ct.Ar) and cortical thickness (Ct.Th) (p < 0.05); however, the L4 group was higher than the C4 group in Ct.Ar and Ct.Th (p <0 .05). In the tibiae, the moment of inertia about the antero-posterior axis (I_ap), Ct.Ar and Ct.Th was significantly higher in the L8 group than in the C8 group (p < 0.05). In biomechanical testing, fracture load (FL) of femora was lower in the L1 group than in the C1 group (p < 0.05). Conversely, yield load (YL), FL and yield load energy (YE) of femora, as well as FL of tibiae were all significantly higher in the L8 group than in the C8 group (p < 0.05). Free-fall landing training may initially compromise bone material. However, over time, the current free-fall landing training induced improvements in biomechanical properties and/or the structure of growing bones.

Role of heel lifting in standing balance recovery: A simulation study

Although lifting the heels has frequently been observed during balance recovery, the function of this movement has generally been overlooked. The present study aimed to investigate the functional role of heel lifting during regaining balance from a perturbed state. Computer simulation was employed to objectively examine the effect of allowing/constraining heel lifting on balance performance. The human model consisted of 3 rigid body segments connected by frictionless joints. Movements were driven by joint torques depending on current joint angle, angular velocity, and activation level. Starting from forward-inclined and static straight-body postures, the optimization goal was to recover balance effectively (so that ground projection of the mass center returned to the inside of the base of support) and efficiently by adjusting ankle and hip joint activation levels. Allowing/constraining heel lifting resulted in virtually identical movements when balance was mildly perturbed at the smallest lean angle (8°). At larger lean angles (8.5° and 9°), heel lifting assisted balance recovery more evidently with larger joint movements. Partial and altered timings of ankle/hip torque activation due to constraining heel lifting reduced linear and angular momentum generation for avoiding forward falling, and resulted in hindered balancing performance.

Short-term free-fall landing causes reduced bone size and bending energy in femora of growing rats

The purpose of this study was to determine the effects of a mechanical loading course (short-term free-fall landing) on femoral geometry and biomechanical properties in growing rats. Thirty-two female Wistar rats (7-week-old) were randomly assigned to three groups: L30 (n = 11), L10 (n = 11) and CON (n = 10) groups. Animals in the L10 and L30 groups were subjected to a 5-day free-fall landing program in which animals were dropped from a height of 40cm 10 and 30 times per day, respectively. Landing ground reaction force (GRF) was measured on the 1(st) and 5(th) days of landing training. All animals were subjected to two fluorescent labeling injections on the days before and after the 5-day landing training. Three days after the last labeling injection, animals were sacrificed under deep anesthesia. Methods of dynamic histomorphometry, tissue geometry and tissue biomechanical measurements were used to investigate the response in femora. A significant decrease in peak GRF in the hind-limb was shown from day 1 to day 5. No significant difference was shown among groups in dynamic histomorphometry. Biomechanical property analyses showed significantly lower maximal energy and post-yield energy in the L10 and L30 groups as compared to the CON group (p < 0.05). Moreover, geometric measurements revealed that cross-sectional cortical areas and thicknesses were significantly lower in landing groups than in the CON group. Short-term (5-day) free-fall landing training resulted in minor compromised long bone tissue, as shown by reduced bending energy and cortical bone area but not in other mechanical properties or tissue measurements (e.g. weights and length) of growing female rats. Further studies would be valuable to investigate whether this compromised bone material represents the existence of a latency period in the adaptation of bone material to external mechanical loading. Key pointsShort-term free-fall landing causes compromised bone material as shown by reduced post-yield energy in long bones of rodents.The results of the current study suggest the existence of unsettled bone material after a short-term mechanical loading regime.The connection of the present animal study to the stress fractures occurring in young athletes needs to be clarified.

The three-dimensional kinematics of a barbell during the snatch of Taiwanese weightlifters

The purpose of this study is to characterize the trajectory of a barbell and clarify whether there is a standard pattern in the barbell trajectory for each lifter. Two high-speed cameras (mega-speed MS1000, sampling rate=120 Hz) were used to film the barbell trajectories of male Taiwanese weightlifters under competitive conditions. Twenty-four successful lifts were filmed and classified into 3 groups (n=8 per group) by relative barbell-mass (RBM): the better-performance group (RBM>1.63), the middle group (1.28<RBM<1.63), and the worse-performance group (RBM<1.28). The results indicate that 3 horizontal (the horizontal position of the barbell at clearing the knee of the lifter, projectile range, and the horizontal velocity of the barbell at its highest position) and 3 vertical variables (the barbell's maximum vertical height, the maximum height normalized by the height of the catch position, and the vertical displacement from the maximum height to the catch position) of the barbell movements in the sagittal plane were significantly different in the 3 groups (p<0.05). A greater vertical travel range of the barbell (19.5+/-1.9 cm) was found for the better-performance group than for the results of male weightlifters (about 10-14 cm) in previous studies. Although the barbell movement patterns in the vertical direction were similar, there seemed to be no standard trajectory for each weightlifter because of the variation in horizontal movements. The results of this study suggest that weightlifters may be instructed to reduce horizontal velocity and increase the vertical travel range of the bar to catch it under the conditions of less strength (as in female lifters) or heavier barbell mass.

Effects of insoles and additional shock absorption foam on the cushioning properties of sport shoes

The purpose of this study was to investigate the effects of insoles and additional shock absorption foam on the cushioning properties of various sport shoes with an impact testing method. Three commercial sport shoes were used in this study, and shock absorption foam (TPE5020; Vers Tech Science Co. Ltd., Taiwan) with 2-mm thickness was placed below the insole in the heel region for each shoe. Eight total impacts with potential energy ranged from 1.82 to 6.08 J were performed onto the heel region of the shoe. The order of testing conditions was first without insole, then with insole, and finally interposing the shock absorption foam for each shoe. Peak deceleration of the striker was measured with an accelerometer attached to the striker during impact. The results of this study seemed to show that the insole or additional shock absorption foam could perform its shock absorption effect well for the shoes with limited midsole cushioning. Further, our findings showed that insoles absorbed more, even up to 24-32% of impact energy under low impact energy. It seemed to indicate that insoles play a more important role in cushioning properties of sport shoes under a low impact energy condition.

Molecular cloning and sequence analysis of the complestatin biosynthetic gene cluster

Streptomyces lavendulae produces complestatin, a cyclic peptide natural product that antagonizes pharmacologically relevant protein-protein interactions including formation of the C4b,2b complex in the complement cascade and gp120-CD4 binding in the HIV life cycle. Complestatin, a member of the vancomycin group of natural products, consists of an alpha-ketoacyl hexapeptide backbone modified by oxidative phenolic couplings and halogenations. The entire complestatin biosynthetic and regulatory gene cluster spanning ca. 50 kb was cloned and sequenced. It consisted of 16 ORFs, encoding proteins homologous to nonribosomal peptide synthetases, cytochrome P450-related oxidases, ferredoxins, nonheme halogenases, four enzymes involved in 4-hydroxyphenylglycine (Hpg) biosynthesis, transcriptional regulators, and ABC transporters. The nonribosomal peptide synthetase consisted of a priming module, six extending modules, and a terminal thioesterase; their arrangement and domain content was entirely consistent with functions required for the biosynthesis of a heptapeptide or alpha-ketoacyl hexapeptide backbone. Two oxidase genes were proposed to be responsible for the construction of the unique aryl-ether-aryl-aryl linkage on the linear heptapeptide intermediate. Hpg, 3,5-dichloro-Hpg, and 3,5-dichloro-hydroxybenzoylformate are unusual building blocks that repesent five of the seven requisite monomers in the complestatin peptide. Heterologous expression and biochemical analysis of 4-hydroxyphenylglycine transaminon confirmed its role as an aminotransferase responsible for formation of all three precursors. The close similarity but functional divergence between complestatin and chloroeremomycin biosynthetic genes also presents a unique opportunity for the construction of hybrid vancomycin-type antibiotics.

G1 phase dependent nuclear localization of relaxed-circular hepatitis B virus DNA and aphidicolin-induced accumulation of covalently closed circular DNA

During chronic hepatitis B virus (HBV) infection, virus persistence relies on the maintenance of a pool of covalently closed circular DNA (cccDNA) in the nuclei of infected hepatocytes. To achieve this, HBV DNA has to be transported from the cytoplasm to the nucleus. By carrying out subcellular fractionation experiment, both of the relaxed-circular (RC) and single-stranded (SS) HBV DNA were found in the cytoplasm whereas only RC form could be detected in the nucleus of a hepatoblastoma cell line (HepG2) stably producing HBV. This fraction of nuclear RC viral DNA was clearly demonstrated in the G1 but not S phase of synchronized HepG2 cells. Conversely, the relative amount of cytoplasmic RC viral DNA in the S phase was larger than that in the G1 phase. Although no cccDNA could be detected in HepG2 cells without synchronization, an increasing amount of cccDNA in the nucleus was demonstrated after prolonged incubation of the cells in aphidicolin. Finally, by undertaking in situ hybridization using a probe specific to plus-strand HBV DNA, nuclear viral DNA was detected predominantly in the G1 phase of HepG2 cells. In summary, the results indicated that only RC but not SS form of HBV DNA was localized to the nuclei of HepG2 cells. The nuclear localization occurred preferentially in the G1 but not S phase and prolonged treatment with aphidicolin resulted in accumulation of nuclear cccDNA.

G1 phase dependent nuclear localization of relaxed-circular hepatitis B virus DNA and aphidicolin-induced accumulation of covalently closed circular DNA

During chronic hepatitis B virus (HBV) infection, virus persistence relies on the maintenance of a pool of covalently closed circular DNA (cccDNA) in the nuclei of infected hepatocytes. To achieve this, HBV DNA has to be transported from the cytoplasm to the nucleus. By carrying out subcellular fractionation experiment, both of the relaxed-circular (RC) and single-stranded (SS) HBV DNA were found in the cytoplasm whereas only RC form could be detected in the nucleus of a hepatoblastoma cell line (HepG2) stably producing HBV. This fraction of nuclear RC viral DNA was clearly demonstrated in the G1 but not S phase of synchronized HepG2 cells. Conversely, the relative amount of cytoplasmic RC viral DNA in the S phase was larger than that in the G1 phase. Although no cccDNA could be detected in HepG2 cells without synchronization, an increasing amount of cccDNA in the nucleus was demonstrated after prolonged incubation of the cells in aphidicolin. Finally, by undertaking in situ hybridization using a probe specific to plus-strand HBV DNA, nuclear viral DNA was detected predominantly in the G1 phase of HepG2 cells. In summary, the results indicated that only RC but not SS form of HBV DNA was localized to the nuclei of HepG2 cells. The nuclear localization occurred preferentially in the G1 but not S phase and prolonged treatment with aphidicolin resulted in accumulation of nuclear cccDNA.

Pre-steady-state kinetic analysis of the trichodiene synthase reaction pathway

The pre-steady-state kinetics of the trichodiene synthase reaction were investigated by rapid chemical quench methods. The single-turnover rate was found to be 3.5-3.8 s-1, a rate 40 times faster than the steady-state catalytic rate (kcat = 0.09 s-1) for trichodiene synthase-catalyzed conversion of farnesyl diphosphate (FPP) to trichodiene at 15 degrees C. In a multiturnover experiment, a burst phase (kb = 4.2 s-1) corresponding to the accumulation of trichodiene on the surface of the enzyme was followed by a slower, steady-state release of products (klin = 0.086 s-1) which corresponds to kcat. These results strongly suggest that the release of trichodiene from the enzyme active site is the rate-limiting step in the overall reaction, while the consumption of FPP is the step which limits chemical catalysis at the active site. Single-turnover experiments with trichodiene synthase mutant D101E, for which the steady-state rate constant kcat is 1/3 of that of wild type, revealed that the mutation actually depresses the rate of FPP consumption by a factor of 100. The deuterium isotope effect on the consumption of [1-2H,1,2-14C]FPP was found to be 1.11 +/- 0.06. Single turnover reactions of [1,2-14C]FPP catalyzed by trichodiene synthase were carried out at 4, 15, or 30 degrees C in an effort to provide direct observation of the proposed intermediate nerolidyl diphosphate (NPP). However, no NPP was detected, indicating that the conversion of NPP must be too fast to be observed within the detection limits of the assay. Taken together, these observations suggest that the isomerization of FPP to NPP is the step which limits the rate of chemical catalysis in the trichodiene synthase reaction pathway.