Very-low-carbohydrate diets or ketogenic diets have been in use since the 1920s as a therapy for epilepsy and can, in some cases, completely remove the need for medication. From the 1960s onwards ...they have become widely known as one of the most common methods for obesity treatment. Recent work over the last decade or so has provided evidence of the therapeutic potential of ketogenic diets in many pathological conditions, such as diabetes, polycystic ovary syndrome, acne, neurological diseases, cancer and the amelioration of respiratory and cardiovascular disease risk factors. The possibility that modifying food intake can be useful for reducing or eliminating pharmaceutical methods of treatment, which are often lifelong with significant side effects, calls for serious investigation. This review revisits the meaning of physiological ketosis in the light of this evidence and considers possible mechanisms for the therapeutic actions of the ketogenic diet on different diseases. The present review also questions whether there are still some preconceived ideas about ketogenic diets, which may be presenting unnecessary barriers to their use as therapeutic tools in the physician's hand.
Background A ketogenic diet (KD) is a nutritional approach, usually adopted for weight loss, that restricts daily carbohydrates under 30 g/day. KD showed contradictory results on sport performance, ...whilst no data are available on team sports. We sought to investigate the influence of a KD on different parameters in semi-professional soccer players. Methods Subjects were randomly assigned to a iso-protein (1.8 g/Kg body weight/day) ketogenic diet (KD) or western diet (WD) for 30 days. Body weight and body composition, resting energy expenditure (REE), respiratory exchange ratio (RER), cross sectional area (CSA) and isometric muscle strength of quadriceps, counter movement jump (CMJ) and yoyo intermittent recovery test time were measured. Results There was a significantly higher decrease of body fat (p = 0.0359), visceral adipose tissue (VAT) (p = 0.0018), waist circumference (p = 0.0185) and extra-cellular water (p = 0.0060) in KD compared to WD group. Lean soft tissue, quadriceps muscle area, maximal strength and REE showed no changes in both groups. RER decreased significantly in KD (p = 0.0008). Yo-yo intermittent test improved significantly (p < 0.0001) in both groups without significant differences between groups. CMJ significantly improved (p = 0.0021) only in KD. Conclusions This is the first study investigating the effects of a KD on semi-professional soccer players. In our study KD athletes lost fat mass without any detrimental effects on strength, power and muscle mass. When the goal is a rapid weight reduction in such athletes, the use of a KD should be taken into account. Trial registration registered retrospectively on Clinical Trial registration number NCT04078971. Keywords: Ketogenic diet, Soccer, Body composition, Yo-yo intermittent test, Muscle cross sectional area, Metabolism
Catalysts are required for the oxygen evolution reaction, which are abundant, active, and stable in acid. MnO2 is a promising candidate material for this purpose. However, it dissolves at high ...overpotentials. Using first‐principles calculations, a strategy to mitigate this problem by decorating undercoordinated surface sites of MnO2 with a stable oxide is developed here. TiO2 stands out as the most promising of the different oxides in the simulations. This prediction is experimentally verified by testing sputter‐deposited thin films of MnO2 and Ti–MnO2. A combination of electrochemical measurements, quartz crystal microbalance, inductively coupled plasma mass spectrometry measurements, and X‐ray photoelectron spectroscopy is performed. Small amounts of TiO2 incorporated into MnO2 lead to a moderate improvement in stability, with only a small decrease in activity. This study opens up the possibility of engineering surface properties of catalysts so that active and abundant nonprecious metal oxides can be used in acid electrolytes.
A strategy for designing a nonprecious metal catalyst with improved stability for oxygen evolution in acidic electrolytes is presented. Density functional theory calculations suggest that surface titanium on manganese oxide should increase the catalyst stability without affecting the activity. This notion is confirmed experimentally with thin films of Ti–MnO2.
Future generations require more efficient and localized processes for energy conversion and chemical synthesis. The continuous on-site production of hydrogen peroxide would provide an attractive ...alternative to the present state-of-the-art, which is based on the complex anthraquinone process. The electrochemical reduction of oxygen to hydrogen peroxide is a particularly promising means of achieving this aim. However, it would require active, selective and stable materials to catalyse the reaction. Although progress has been made in this respect, further improvements through the development of new electrocatalysts are needed. Using density functional theory calculations, we identify Pt-Hg as a promising candidate. Electrochemical measurements on Pt-Hg nanoparticles show more than an order of magnitude improvement in mass activity, that is, A g(-1) precious metal, for H2O2 production, over the best performing catalysts in the literature.
The potential of additive manufacturing to produce optimised and customized polymeric parts is often impaired by poor surface finish, low mechanical properties, and insufficient dimensional accuracy. ...Post-processing treatments are usually adopted to address these issues. Scientific community and industrial actors are engaged in the development and use of post-processing to enhance the performance and widen the range of application of polymeric components manufactured by additive technologies.
The present work aims to provide an exhaustive classification and discussion of the post-processing treatments, as well as an extensive literature review of the approaches proposed within the scientific community. A holistic view of post-processing is provided, including a discussion of the benefits associated with each technique as well as its side effects. This work is intended to support the selection of the most appropriate post-processing by considering multiple aspects such as the material, part geometry, processing time, costs, and treatment specificity.
Because of the rising need for energy storage, potentially facilitated by electrolyzers, improvements to the catalysis of the oxygen evolution reaction (OER) become increasingly relevant. ...Standardized protocols have been developed for determining critical figures of merit, such as the electrochemical surface area, mass activity and specific activity. Even so, when new and more active catalysts are reported, the catalyst stability tends to play a minor role. In this work, we monitor corrosion on RuO2 and MnOx by combining the electrochemical quartz crystal microbalance (EQCM) with inductively coupled plasma mass spectrometry (ICP–MS). We show that a meaningful estimation of the stability cannot be achieved based on purely electrochemical tests. On the catalysts tested, the anodic dissolution current was four orders of magnitude lower than the total current. We propose that even if long‐term testing cannot be replaced, a useful evaluation of the stability can be achieved with short‐term tests by using EQCM or ICP–MS.
Quantifying stability: It is shown that short‐term electrochemical measurements are inadequate to establish oxygen evolution catalyst stability. Independent measurements of mass losses are essential.
Background
Nasal continuous positive airway pressure (NCPAP) is used to support preterm infants recently extubated, those experiencing significant apnoea of prematurity and those with respiratory ...distress soon after birth as an alternative to intubation and ventilation. This review focuses exclusively on identifying the most effective pressure source and interface for NCPAP delivery in preterm infants.
Objectives
To determine which technique of pressure generation and which type of nasal interface for NCPAP delivery most effectively reduces the need for additional respiratory support in preterm infants extubated to NCPAP following intermittent positive pressure ventilation (IPPV) for respiratory distress syndrome (RDS) or in those treated with NCPAP soon after birth.
Search methods
The strategy included searches of MEDLINE (1966 ‐ 2006), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2006) CINAHL, s from conference proceedings, cross‐referencing of previous reviews and the use of expert informants.
Selection criteria
Randomised or quasi‐randomised trials comparing different techniques of NCPAP pressure generation and/or nasal interfaces in preterm infants extubated to NCPAP following IPPV for RDS or treated with NCPAP soon after birth.
Data collection and analysis
Data was extracted and analysed by the first three authors. Dichotomous results were analysed using the relative risk (RR), risk difference (RD) and number needed to treat (NNT).
Main results
1. Preterm infants being extubated to NCPAP following a period of IPPV for RDS:
Meta‐analysis of the results from Davis 2001 and Roukema 1999a demonstrated that short binasal prongs are more effective at preventing re‐intubation than single nasal or nasopharyngeal prongs typical RR 0.59 (CI: 0.41, 0.85), typical RD ‐0.21 (CI: ‐0.35, ‐0.07), NNT 5 (CI: 3, 14). In one study comparing short binasal prong devices (Sun 1999), the re‐intubation rate was significantly lower with the Infant Flow Driver than with the Medicorp prong RR 0.33 (CI: 0.17, 0.67), RD ‐0.32 (CI: ‐0.49, ‐0.15), NNT 3 (CI: 2, 7). The other study comparing short binasal prong devices (Infant Flow Driver versus INCA prongs, Stefanescu 2003) demonstrated no significant difference in the re‐intubation rate but did show a significant reduction in the total days in hospital in the Infant Flow Driver group MD ‐12.60 (95% CI: ‐22.81, ‐2.39) days. 2. Preterm infants primarily treated with NCPAP soon after birth:
In the one trial identified, Mazzella 2001 found a significantly lower oxygen requirement and respiratory rate in those randomised to short binasal prongs when compared with CPAP delivered via nasopharyngeal prong. The requirement for intubation beyond 48 hours from randomisation was not assessed.
3. Studies randomising preterm infants to different NCPAP systems using broad inclusion criteria
The studies of Rego 2002 and Buettiker 2004 did not examine the primary outcomes of this review. Of the secondary outcomes, Rego 2002 demonstrated a significantly higher incidence of nasal hyperaemia with the use of the Argyle prong compared with Hudson prongs RR 2.39 (95% CI: 1.27, 4.50), RD 0.28 (95% CI: 0.10, 0.46).
One study comparing different techniques of pressure generation is awaiting further assessment as it is currently available in form only.
Authors' conclusions
Short binasal prong devices are more effective than single prongs in reducing the rate of re‐intubation. Although the Infant Flow Driver appears more effective than Medicorp prongs the most effective short binasal prong device remains to be determined. The improvement in respiratory parameters with short binasal prongs suggests they are more effective than nasopharyngeal CPAP in the treatment of early RDS. Further studies incorporating longer‐term outcomes are required. Studies are also needed to determine the optimal pressure source for the delivery of NCPAP.
In this paper, we present a new methodology for clustering hyperspectral images. It aims at simultaneously solving the following three different issues: 1) estimation of the class statistical ...parameters; 2) detection of the best discriminative bands without requiring the a priori setting of their number by the user; and 3) estimation of the number of data classes characterizing the considered image. It is formulated within a multiobjective particle swarm optimization (MOPSO) framework and is guided by three different optimization criteria, which are the log-likelihood function, the Bhattacharyya statistical distance between classes, and the minimum description length (MDL). A detailed experimental analysis was conducted on both simulated and real hyperspectral images. In general, the obtained results show that interesting classification performances can be achieved by the proposed methodology despite its completely unsupervised nature.
The paper report the results of the first European prospective nonrandomized trial dedicated to pediatric synovial sarcoma. The study included 138 patients treated from 2005 to 2012 with a multimodal ...therapeutic approach. The overall treatment results were higher than those previously published by pediatric groups.
To report the results of the first European prospective nonrandomized trial dedicated to pediatric synovial sarcoma.
From August 2005 to August 2012, 138 patients <21 years old with nonmetastatic synovial sarcoma were registered in 9 different countries (and 60 centers). Patients were treated with a multimodal therapy including ifosfamide–doxorubicin chemotherapy and radiotherapy, according to a risk stratification based on surgical stage, tumor size and site, and nodal involvement.
With a median follow-up of 52.1 months (range 13.8–104.4 months), event-free survival (EFS) was 81.9% and 80.7%, and overall survival (OS) was 97.2% and 90.7%, at 3 and 5 years, respectively. The only significant prognostic variable at univariate analysis was the risk group: 3-year EFS was 91.7% for low-risk, 91.2% for intermediate-risk, and 74.4% for high-risk cases. In 24 low-risk patients (completely resected tumor ≤5 cm in size) treated with surgery alone, there were two local relapses and no metastatic recurrences. Among 67 high-risk patients (unresected, or axial tumor or nodal involvement), 66 underwent surgery after neoadjuvant chemotherapy. Response to chemotherapy was 55.2%, including 22.4% cases with complete or major partial remissions, and 32.8% with minor partial remissions.
This study demonstrates that collaborative prospective studies on rare pediatric sarcomas are feasible even on a European scale, with excellent treatment compliance. The overall results of treatment were satisfactory, with higher survival rates than those previously published by pediatric groups. Nonetheless, larger, international projects are needed, based on a cooperative effort of pediatric and adult oncologists.
European Union Drug Regulating Authorities Clinical Trials No. 2005-001139-31.
The equivalence of a short full-dose regimen of neoadjuvant CT with anthracycline-ifosfamide compared with standard dosing in localized high-risk soft tissue sarcoma is confirmed at a long FU. ...Likewise the association of response with better OS and the importance of the concurrent neoadjuvant administration of CT and RT when preservation of function is goal are confirmed.
To report on long-term results of a phase 3 trial comparing three versus five cycles of adjuvant chemotherapy (CT) with full-dose epirubicin+ifosfamide in high-risk soft tissue sarcomas (STS).
Patients (pts) were randomized to receive three preoperative cycles of epirubicin 120 mg/m2 and ifosfamide 9 g/m2 (Arm A) or to receive the same three preoperative cycles plus two postoperative cycles (Arm B). Radiotherapy could be either delivered in the preoperative or in the postoperative setting. Non-inferiority of the primary end point, OS, was assessed by the confidence interval of the hazard ratio (HR; Arm A/Arm B) derived from Cox model.
Between January 2002 and April 2007, 164 pts were assigned to arm A and 164 to arm B. At a median follow-up (FU) of 117 months (IQ range 103–135 months), 123 deaths were recorded: 58 in Arm A and 65 in Arm B. Ten-year OS was 61% for the entire group of patients: 64% in Arm A and 59% in Arm B. The intention-to-treat analysis confirmed that three cycles were not inferior to five cycles (one-sided 95% upper confidence limit was 1.24). A per protocol analysis was consistent with these results. Pts with leiomyosarcoma and undifferentiated pleomorphic sarcoma (UPS) had the lowest, and the highest response rates, respectively. Consistently, Leiomyosarcoma and UPS had the worse and the best prognosis, respectively.
At a longer FU, the non-inferiority of three cycles of a full-dose conventional CT in comparison to five is confirmed. Response to therapy is also confirmed to be associated with better survival. This regimen is currently tested within an ongoing international trial against three cycles of a neoadjuvant histology-tailored CT (ClinicalTrials.gov Identifier: NCT01710176).
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