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OBJECTIVES: Reticulocyte hemoglobin (Ret-Hb) content and soluble transferrin receptor (sTfR) are described as promising biomarkers in the analysis of iron status. However, the value of Ret-Hb and sTfR in the early detection of iron depletion, as frequently observed in children in high-income countries, is unclear. We hypothesized that young children to iron depletion, using the WHO cutoff of ferritin < 12 µg/l, would have lower Ret-Hb and higher sTfR concentrations compared to children with a ferritin ≥ level 12 µg/l. SUBJECTS/METHODS: In this cross-sectional study, we analyzed mean concentrations of Ret-Hb and sTfR in 351 healthy children aged 0.5-3 years in a high-income country. The Student's t-test was used to compare Ret-Hb and sTfR concentrations between groups. RESULTS: We showed that concentrations of Ret-Hb and sTfR are similar in children with and without iron depletion. A decrease in Ret-Hb concentration was present only when ferritin concentrations were < 8 µg/l. sTfR concentrations were similar in children with ferritin concentrations < 6 pg/l and ≥ 12 µg/l. CONCLUSIONS: Our results showed that the discriminative value of Ret-Hb and sTfR for the detection of iron depletion is limited. Our findings suggest that ferritin is the most useful biomarker in the screening of iron depletion in healthy children in high-income countries. However, ideally, reference ranges of iron status biomarkers should be based on studies showing that children with concentrations outside reference ranges have poor neurodevelopmental outcomes. European Journal of Clinical Nutrition (2014) 68, 882-886; doi: 10.1038/ejcn.2014.70; published online 30 April 2014, INTRODUCTION Young children are at risk of iron deficiency (ID) because of rapid growth with expanding erythroid mass and subsequent high iron requirements. ID occurs in progressive stages, beginning with [...]

Intermittent enteral nutrition (EN) may have physiologic benefits over continuous feeding in critical illness. We aimed to compare nutrition and infection outcomes in critically ill children receiving intermittent or continuous EN. International, multi-center prospective observational study of mechanically ventilated children, 1 month to 18 years of age, receiving EN. Percent energy or protein adequacy (energy or protein delivered/prescribed × 100) and acquired infection rates were compared between intermittent and continuous EN groups using adjusted-multivariable and 4:1 propensity-score matched (PSM) analyses. Sensitivity analyses were performed after excluding patients who crossed over between intermittent and continuous EN. 1375 eligible patients from 66 PICUs were included. Patients receiving continuous EN (N = 1093) had a higher prevalence of respiratory illness and obesity, and lower prevalence of neurologic illness and underweight status on admission, compared to those on intermittent EN (N = 282). Percent energy or protein adequacy, proportion of patients who achieved 60% of energy or protein adequacy in the first 7 days of admission, and rates of acquired infection were not different between the 2 groups in adjusted-multivariable and propensity score matching analyses (P > 0.05). Intermittent versus continuous EN strategy is not associated with differences in energy or protein adequacy, or acquired infections, in mechanically ventilated, critically ill children. Until further evidence is available, an individualized feeding strategy rather than a universal approach may be appropriate. [ABSTRACT FROM AUTHOR]

The aim of the research was to develop a galenical formulation for the combination of the three probiotic strains Lactobacillus gasseri PA 16/8, Bifidobacterium longum SP 07/3 and Bifidobacterium bifidum MF 20/5 that would lead to the presence of a high amount of viable cells in the small intestine, the presumed site of action of these strains. This was tested in a validated, dynamic in vitro model of the stomach and small intestine (TIM‐1), simulating human adults after intake of a meal. Experiments were performed both in the gastric compartment of the model, as well as in the complete system (stomach + small intestine). Survival of the strains in an unformulated probiotic powder after transit through the gastric compartment was 5·3% for the bifidobacteria and 1% for L. gasseri. After transit through the complete gastrointestinal tract, this dropped to 2% for bifidobacteria and 0·1% for Lactobacillus. After several rounds of optimization, an enteric‐coated tablet was developed that increased the delivery of viable cells reaching the small intestine to 72% (gastric survival) for bifidobacteria, and 53% (gastric) for L. gasseri. Also survival in the small intestine increased by about an order of magnitude. The final galenical formulation was tested in two applications: adults and elderly, both of which have their own physiological parameters. These experiments corroborated the results obtained in the development phase of the project. In conclusion, the developed enteric coating led to a 20‐ to 40‐fold increase in the delivery of viable cells to the small intestine. Significance and Impact of the Study: Predictive GI in vitro models are very helpful and reliable tools for the development of new galenical formula containing probiotics, and in the current example helped to deliver >10‐fold higher numbers of viable cells to the small intestine, presumably leading to improved functionality of the strains. [ABSTRACT FROM AUTHOR]

Background: Enteral feeding is challenging in critically ill infants. Target intakes are often not achieved as a result of fluid restriction, procedural interruptions and perceived enteral feeding intolerance. In those infants perceived to have poor feeding tolerance, the use of a peptide nutrient‐energy dense enteral feed (PEF) may improve nutritional intake and minimise feeding interruptions as a result of gastrointestinal symptoms. The aim of this observational study was to characterise the use of a PEF amongst critically ill infants in two paediatric intensive care units (PICUs). Methods: Records from critically ill infants aged <12 months admitted to two PICUs were retrospectively reviewed with a PICU length of stay (LOS) ≥ 7 days. Achievement of nutritional targets for the duration of PEF was reviewed. Gastrointestinal symptoms, including gastric residual volume, constipation and vomiting, were evaluated as tolerance parameters. Results: In total, 53 infants were included, with a median age on admission of 2.6 months. Median admission weight was 3.9 kg in PICU‐1 and 4.7 kg in PICU‐2. Median (interquatile range) energy intake in PICU‐1 and PICU‐2 was 68 (47–92) and 90 (63–124) kcal kg−1, respectively, and median (interquatile range) protein intake 1.7 (1.1–2.4) g kg−1 and 2.5 (1.6–3.2) g kg−1, respectively. Feeding was withheld because of feeding intolerance in one infant (4%) on two occasions in PICU‐1 for 2.5 h and in two infants (7%) on two occasions in PICU‐2 for 19.5 h. Gastric residual mean (SD) volumes were 3.5 (5.4) mL kg−1 in PICU‐1 and 16.9 (15.6) mL kg−1 in PICU‐2. Conclusions: Peptide nutrient‐energy dense feeding in infants admitted to the PICU is feasible, well tolerated and nutritional targets are met. However, with this study design, it is not possible to draw any conclusions regarding the benefit of PEF over standard PE feed in critically ill children and future work is required to clarify this further. [ABSTRACT FROM AUTHOR]

Background: Reaching an optimal nutritional intake is challenging in critically ill infants. One possible way to minimise nutritional deficits is the use of protein and energy‐enriched (PE)‐formulas. We aimed to describe weight achievement and gastrointestinal symptoms in infants admitted to the paediatric intensive care unit (PICU) while receiving PE‐formula for a prolonged period. Methods: Records from infants admitted to a multidisciplinary PICU and using PE‐formula were analysed retrospectively. Infants were eligible if they received PE‐formula daily for at least 2 weeks. Weight achievement was determined as the difference between weight‐for‐age (WFA) Z‐scores at the start and end of PE‐formula use. Gastrointestinal symptoms, including gastric residual volume, constipation and vomiting, were evaluated as tolerance parameters. Results: Seventy infants with a median [interquartile range (IQR)] age of 76 (30–182) days were eligible. The PICU duration was 50 (35–83) days during which they received PE‐formula for 30 (21–54) days. Predominant admission diagnoses were post‐cardiac surgery, respiratory and cardiac diagnosis. A significant mean (SD) WFA Z‐score increase of 0.48 (1.10) (P < 0.001) and a median (IQR) weight gain of 5.80 (3.28–9.04) g kg−1 day−1 was observed. Multivariate regression showed that a lower WFA Z‐score at start was associated with a higher WFA Z‐score increase during PE‐formula use (β −0.35 (95% confidence interval =  −0.50 to −0.19); P < 0.001). The maximum 24‐h gastric residual volume was 8.1 mL (IQR = 2.2–14.3) for each 1 kg in bodyweight. Three (4%) infants were treated for diarrhoea and three infants were treated for vomiting. Conclusions: The majority of infants with a prolonged PICU stay showed weight improvement when using PE‐formula. PE‐formula was well tolerated because gastrointestinal symptoms only occurred in few infants. [ABSTRACT FROM AUTHOR]

Objective The objective of this research is to study effects of a 4-week high-protein (HP) diet on energy intake, resting energy expenditure (REE), protein turnover and body composition in children with obesity. Methods In this randomized placebo-controlled single-blind crossover study, children with obesity (n = 14; mean age: 10.1 years ± 1.2 standard deviation; body mass index-standard deviation score [BMI-SDS]: 2.8 ± 0.5) received an ad libitum HP (+50 g protein per day) or normal-protein (NP) diet for 4 weeks with a washout period of =2 weeks. Energy intake, REE, protein turnover, weight, BMI-SDS and body composition were measured. Results No differences were found in energy intake or REE between HP and NP. There was an increased urea production and phenylalanine hydroxylation after HP compared with NP (p < 0.05). There was an increased rise in fat-free mass after HP compared with NP (?HP: 0.8 ± 0.8 kg vs. ?NP: 0.1 ± 0.6 kg, p < 0.05). BMI and BMI-SDS increased during the study (BMI-SDS start: 2.8 ± 0.5, end: 2.9 ± 0.5, p < 0.05) without a difference between groups. Conclusions A 4-week HP diet with ad libitum food intake did not affect energy intake and energy expenditure in children with obesity. BMI increased, although that could be partly explained by an increase in fat-free mass. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To test the effect of microencapsulation on the survival of two probiotic strains isolated from Dadih, Indonesian fermented buffalo milk, in a dynamic, computer‐controlled in vitro model of the upper gastrointestinal (GI) tract (TIM‐1), simulating human adults. Methods and Results: Free or microencapsulated probiotics, Lactobacillus plantarum IS‐10506 or Enterococcus faecium IS‐27526, resuspended in milk were studied for survival in the complete TIM‐1 system (stomach + small intestine) or in the gastric compartment of TIM‐1 only. Hourly samples collected after the ileal‐caecal valve or after the pylorus were plated on MRS agar (for Lactobacillus) or S&B agar (for Enterococcus). Survival of the free cells after transit through the complete TIM‐1 system was on average for the E. faecium and L. plantarum 15·0 and 18·5% respectively. Survival of the microencapsulated E. faecium and L. plantarum was 15·7 and 84·5% respectively. The free cells were further assessed in only the gastric compartment of TIM‐1. E. faecium and L. plantarum showed an average survival of 39 and 32%, respectively, after gastric passage. Conclusion: There is similar sensitivity to gastric acid as well as survival after complete upper GI tract transit of free cells, but microencapsulation only protected L. plantarum. Significance and Impact of Study: Survival of microencapsulated L. plantarum IS‐10506 is increased compared to free cells in a validated in vitro model of the upper GI tract. It increases its use as an ingredient of functional foods. [ABSTRACT FROM AUTHOR]

Hybrid composite-concrete elements are increasingly developed because of their lightweight and durable properties. This paper investigates the structural behaviour of a new hybrid composite concrete floor – based on the beam-and-block concept – analytically and experimentally. Experiments on two identical hybrid floors of 3 m span demonstrate the structural feasibility of this floor concept as the loadbearing and stiffness requirements are largely met, both in casting and permanent stage. These floors exhibit sufficient stiffness in the transverse direction and thus allow an analytical prediction based on beam calculations. These simulations predict the casting deflection as well as the overall load-deflection behaviour accurately. [ABSTRACT FROM AUTHOR]

Early detection of iron deficiency (ID) and iron deficiency anemia (IDA) in young children is important to prevent impaired neurodevelopment. Unfortunately, many biomarkers of ID are influenced by infection, thus limiting their usefulness. The aim of this study was to investigate the value of red blood cell distribution width (RDW) and the platelet count for detecting ID(A) among otherwise healthy children. A multicenter prospective observational study was conducted in the Netherlands to investigate the prevalence of ID(A) in 400 healthy children aged 0.5–3 years. ID was defined as serum ferritin (SF) <12 μg/L in the absence of infection (C-reactive protein [CRP] <5 mg/L) and IDA as hemoglobin <110 g/L combined with ID. RDW (%) and the platelet count were determined in the complete blood cell count. RDW was inversely correlated with SF and not associated with CRP. Calculated cutoff values for RDW to detect ID and IDA gave a relatively low sensitivity (53.1% and 57.1%, respectively) and specificity (64.7% and 69.9%, respectively). Anemic children with a RDW >14.3% had a 2.7 higher odds (95% confidence interval [CI]: 1.2–6.3) to be iron deficient, compared with anemic children with a RDW <14.3%. The platelet count showed a large range in both ID and non-ID children. In conclusion, RDW can be helpful for identifying ID as the cause of anemia in 0.5- to 3-year-old children, but not as primary biomarker of ID(A). RDW values are not influenced by the presence of infection. There appears to be no role for the platelet count in diagnosing ID(A) in this group of children. [ABSTRACT FROM PUBLISHER]

Highlights: [•] Simultaneous application AE and DIC NDT techniques. [•] Verification of the sources of AE trends by the transient DIC strain fields. [•] Acoustic parameters are used to characterize the crucial moments of load drops and the related processes. [Copyright &y& Elsevier]

In order to reduce on-site building time, the construction industry shows an increasing interest in stay-in-place formwork with a reinforcement function after concrete hardening, such as CFRP formwork confinement for columns. The current combined systems however do not answer the demand of the building industry for a material system that is both lightweight and fire safe. High performance textile reinforced cement (TRC) composites can address this need. They can be particularly interesting for the shear reinforcement of concrete beams. This paper describes a preliminary analysis and feasibility study on structural stay-in-place formwork made of TRC. Comparative bending experiments demonstrate that a fully steel reinforced beamand an equivalent beam with shear reinforcement in TRC formwork show similar yielding behaviour, indicating that the TRC shear reinforcement system actually works. Moreover, the cracking moment of the concrete was more or less doubled, resulting in a much lower deflection in serviceability limit state than calculated. Digital image correlation measurements show that the latter is due to the crack bridging capacity of the external TRC shear reinforcement. [ABSTRACT FROM AUTHOR]

Megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS) is a rare congenital disorder characterized by a dilated, non-obstructive urinary bladder and hypoperistalsis of the gastrointestinal tract, which is considered lethal. About 90 patients have been reported, predominantly female. We present the case of a female newborn with MMIHS in whom antenatal ultrasound was suggestive for the diagnosis, which was confirmed after delivery. Diagnostic features by antenatal ultrasound are described. [ABSTRACT FROM AUTHOR]

Abstract Textile Reinforced Cements (TRCs) offer an adequate alternative to more conventional building systems in construction due to their tunable and lightweight geometries. TRCs are currently either modelled by means of a discrete approach, where the textiles and the matrix are modelled separately, or by means of a smeared approach that averages the material's mechanical response over the cross-section. The research presented in this paper proposes a new, layered-wise approach of modelling where the through-thickness response of the composite is subdivided in different layers with individual mechanical properties. A tensile experimental campaign on different combinations of TRC layups, combining both glass and carbon fibre textiles, is performed and used as an input for the layered-wise numerical model. The model is then validated by comparison with flexural experiments performed on four different TRC layup combinations. The good agreement witnessed between the numerical predictions and the experimental results validates the layered-wise modelling approach proposed in this paper. [ABSTRACT FROM AUTHOR]

Textile Reinforced Cement composites (TRCs) have become a key research topic when it comes to lightweight alternative construction materials for traditional concrete industry. While most of the research performed on TRCs combines a cementitious matrix material with 2D textile fabrics, this paper investigates the mechanical behaviour of TRCs reinforced with 3D textile fabrics. The main goal is to investigate the influence of the transversal fibre that is connecting the fibre layers and is typical for 3D textiles, on the tensile and flexural properties of the TRC. Therefore two textile fabric architectures were compared, firstly an unaltered 3D textile fabric and secondly a tensile-equivalent 2D textile fabrics with equal in-plane textile reinforcement. An experimental campaign in tension and bending was performed on four different TRC layups. When comparing the bending behaviour of the unaltered 3D-TRCs with the 2D alternatives, an increase in stiffness in the post-cracking stage was observed, while no influence was observed in tension. The experimental results were also compared with numerical predictions of the 2D-TRCs to put in evidence the influence of the 3D architecture. [ABSTRACT FROM AUTHOR]