Nutritional properties of raw and cooked Azolla caroliniana Willd., an aquatic wild edible plant

Azolla caroliniana Willd. is an understudied wild edible plant native to the Eastern United States. Other species of Azolla have been used across the world for several thousand years as a livestock feed and as "green manure." The use of Azolla for human consumption is thought to be limited by its high total polyphenolic content (TPC). However, the TPC and nutritional content of A. caroliniana has not been thoroughly studied. We measured TPC and other nutrients before and after cooking methods designed to lower TPC. We found that TPC was 4.26 g gallic acid equivalent (GAE) kg-1 DW in raw A. caroliniana. All cooking methods significantly lowered TPC. Protein content was 19% DW, and the apparent protein digestibility was 78.45%. Our yield was 173 g FW m-2 day-1 and 5.53 g DW m-2 day-1. Azolla caroliniana is a high-yielding plant with great potential for cultivation and domestication.

Protocolized nurse-guided intravenous conscious sedation for cryoballoon ablation of paroxysmal and persistent atrial fibrillation

Background

Nursing staff is playing an increasingly important role in arrhythmia units and it entails acquiring more specialized knowledge. Intravenous conscious sedation is being administered more frequently in a wide variety of cardiac procedures including cryoballoon ablation (CBA). Nurses and physicians have distinct yet collaborative roles in the management and care of the patient receiving conscious sedation. It is imperative that the nurse be aware of her/his role in caring for the patient before, during, and after the administration of intravenous conscious sedation.

Purpose

We aimed to evaluate the nurse's role, working in coordination with the medical staff, in intravenous conscious sedation for CBA following a standardized protocol ensuring proper handling and administration of the different drugs, monitorization of vital signs and management of drug infusion in order to avoid pain but also complications inherent to the procedure and sedation.

Method

We included consecutive patients with paroxysmal or persistent AF who underwent a CBA from 2017 to 2021. We evaluated a nurse-guided sedation, under medical surveillance, in CBA procedures using propofol. The dosage was based on the patient's weight, starting sedation with a bolus of 1 ml (1% solution) for every 20 kg of weight, and starting a perfusion at 10 ml/h (2% solution), monitoring constantly patient's vital signs, especially blood pressure and O2saturation. This infusion was adjusted according to the patient's response. During the procedure, on a stable hemodynamic situation, booster bolus of 1 ml (1% solution) could be administered approximately every 15 minutes when needed for sedation. When systolic blood pressure was under 100 mmHg, a solution of midazolam (1mg/ml) and fentanyl (0.05mg/ml) in a mixture of 1cc + 1cc was preferred as booster. Saline and colloid solutions andephedrine (30mg/ml) bolus could be used when severe hypotension to revert propofol's hypotensive effect. Systematic standardized CBA was performed and intraprocedural and periprocedural complications were recorded.

Results

104 patients were included (mean age 58±8 year-old, 85% male). Of these patients, 76 (73%) had recurrent paroxysmal AF, failure of antiarrhythmic drugs was present in 96% and prior radiofrequency ablation in 4%, 61 (59%) showed left atria enlargement (>40 mm or area >20 cm2), and 11 (10%) had structural heart disease. Mean CHA2DS2VASc score was 1. Baseline characteristics in Table 1. Procedural-related complications occurred in 6 patients (5%), transient phrenic nerve palsy in 2 patients and vascular damage in 4. All sedations were performed without complications.

Conclusions

In our experience, protocolized nurse-guided intravenous conscious sedation under medical surveillance in CBA procedures is safe and really useful. It contributes to help medical operators to focus on the procedure sharing the patient's sedation management with trained nurses.

Funding Acknowledgement

Type of funding sources: None.

Maternal bone lead contribution to blood lead during and after pregnancy

We examined bone lead contribution to blood lead in a group of 311 immigrant women, 99% from Latin America, during the third trimester of pregnancy and 1 to 2 months after delivery. We measured in vivo tibia and calcaneus (heel) bone lead concentration in the postdelivery period with K shell X-ray fluorescence. Prenatal and postnatal geometric mean (range) blood lead level was 2.2 microg/dL (0.4 to 38.7) and 2.8 microg/dL (0.4 to 25.4), reflecting low current exposure. Postnatal blood lead level was significantly higher than prenatal (P<0.0001). Mean (range) tibia and calcaneus lead concentration was 6.7 microg/g (-33.7 to 62.2) and 8.4 microg/g (- 30.1 to 66.4), reflecting varying but elevated past lead exposure. Mean calcaneus lead concentration was significantly higher than mean tibia lead concentration (P = 0.055). Variance-weighted multiple regression and structural equation models showed that both calcaneus and tibia lead were directly associated with prenatal blood lead but only calcaneus lead was associated with postnatal blood lead. Increasing natural log years in the United States independently predicted decreasing calcaneus and third-trimester blood lead. The data suggest that while some exogenous lead sources and modulators of blood lead level, such as use of lead-glazed pottery and calcium in the diet, control lead exposure during and after pregnancy, endogenous lead sources from past exposure before immigration continue to influence blood lead levels in this sample.

Maternal blood lead level during pregnancy in South Central Los Angeles

Twenty-five years of public health efforts produced a striking reduction in lead exposure; the blood lead average in the United States has decreased to less than 20% of levels measured in the 1970s. However, poor minority groups that live in large urban centers are still at high risk for elevated lead levels. In this study, our data showed that pregnant immigrants (n = 1,428) who live in South Central Los Angeles--one of the most economically depressed regions of California--have significantly higher (p < .0001) blood lead levels (geometric mean = 2.3 microg/dl [0.11 micromol/l]) than 504 pregnant nonimmigrants (geometric mean = 1.9 microg/dl [0.09 micromol/l]). The most important factors associated with lower blood lead levels in both groups were younger age; more-recent date of blood sampling (i.e., decreasing secular trend); and blood sampling in mid-autumn, instead of mid-spring (i.e., seasonal trend). Blood lead levels of immigrants were strongly dependent on time elapsed since immigration to the United States; each natural log increase in years of residence was associated with an approximately 19% decrease in blood lead levels. Although blood lead means for both groups were almost the same as the estimated national average, 25 of the 30 cases of elevated blood lead (i.e., > or = 10 microg/dl [0.48 micromol/l) occurred in the immigrant group. The odds ratio (95% confidence intervals within parentheses) for having elevated blood lead levels (a) was 9.3 (1.9, 45.8) if the immigrant engaged in pica; (b) was 3.8 (1.4, 10.5) if the immigrant had low dietary calcium intake during pregnancy; and (c) was .65 (.43, .98) for every natural log unit increase of years of residence in the United States. The control of pica and dietary calcium intake may offer a means of reducing lead exposure in immigrants.