Extracorporeal shock wave lithotripsy: retrospective study on possible predictors of treatment success and revisiting the role of non-contrast-enhanced computer tomography in kidney and ureteral stone disease

Extracorporeal shock wave lithotripsy (ESWL) is a safe and efficient treatment option for urinary stone disease. The overall stone-free rate (SFR) varies significantly. This study aimed to assess the influence of stone size, location, stone density, and skin-to-stone distance (SSD), on the outcome of ESWL. We assessed whether pre-treatment non-contrast-enhanced CT scan (NCCT) confers significant advantages compared to kidney-ureter-bladder film (KUB) only. We reviewed the medical records of 307 cases (165 men, 142 women) with renal and ureteral stones treated consecutively at our institution with ESWL between 2020 and 2023. 44 of these underwent a NCCT. The outcome of ESWL was defined in two ways: visible stone fragmentation on KUB, and the need for further treatment. Overall success of fragmentation was 85% (261 patients). 61% of patients (n = 184) didn't need any further treatment. Stone size and location correlated significantly with treatment outcomes regarding the need for further treatment (p = 0.004) and stone fragmentation (p = 0.016), respectively. Unlike mean SSD (p = 0.462), the mean attenuation value (MAV) significantly correlated with the need for retreatment (p = 0.016). MAV seems to be a better predictor of treatment success (AUC of the ROC curve: 0.729), compared to stone size (AUC: 0.613). The difference between groups (with and without NCCT) in both treatment outcomes did not reach statistical significance. During decision-making, information regarding SSD and MAV can be useful in more dubious scenarios. However, it appears that their inclusion doesn't provide substantial advantages when compared to relying solely on KUB.

A Survey on Environmental Sustainability Among Anesthesiologists: An Opportunity for Changing Behaviors

Introduction  Environmental sustainability (ES) is a current issue related to natural resource scarcity, pollution and climate change. Although operating rooms (ORs) comprise a small proportion of the entire hospital infrastructure, they significantly impact the environment. Anesthesiologists are ideally positioned to assume leadership, mitigating this negative impact regarding OR waste in the environment. We created a Green Team, comprising multidisciplinary professionals from different areas of a tertiary Portuguese medical center, and conducted a survey that was sent to all the institution's anesthesiologists to assess the current state of ES. Results  From the sample of 133 participants, 101 responses were obtained. Concerning knowledge and training on ES, a significant portion of the respondents (66.7%) seem to attribute "great importance" to the subject. As to the greatest barrier to waste separation in the OR, several respondents highlighted the issues of "inadequate information/education/training" (62.6%) and "lack of support from hospital/OR in-chief/administration" (26.3%). Finally, among seven methods to raise awareness of ES, "training during residency" was the top choice for these professionals, with 52.5% of the votes. Discussion  Most anesthesiologists who responded to the survey recognize the utmost importance of ES and have perceived the environmental impact of their anesthetic practices in the OR. Overall, this tendency is consistent with other international studies. Moreover, most of those surveyed separate waste at home and want to extend this practice -in a more structured approach- to their workplace, with an effective separation of anesthetic and general waste in the OR. Conclusion Professionals perceive barriers to performing green practices, whether the lack of environmental education and awareness, the absence of recycling containers or waste separation bags, or the lack of protocols and guidelines implementing these circuits. With the publication of this work, we aim to encourage other institutions to implement ES projects in their hospitals and ORs.

The effectiveness of concept mapping as a tool for developing critical thinking in undergraduate medical education - a BEME systematic review: BEME Guide No. 81

BACKGROUND

Concept maps (CMs) visually represent hierarchical connections among related ideas. They foster logical organization and clarify idea relationships, potentially aiding medical students in critical thinking (to think clearly and rationally about what to do or what to believe). However, there are inconsistent claims about the use of CMs in undergraduate medical education. Our three research questions are 1) What studies have been published on concept mapping in undergraduate medical education; 2) What was the impact of CMs on students' critical thinking; 3) How and why have these interventions had an educational impact?

METHODS

Eight databases were systematically searched (plus a manual and an additional search were conducted). After eliminating duplicate entries, titles and abstracts and full-texts were independently screened by two authors. Data extraction and quality assessment of the studies were independently performed by two authors. Qualitative and quantitative data were integrated using mixed-methods. The results were reported using the STructured apprOach to the Reporting In healthcare education of Evidence Synthesis statement and BEME guidance.

RESULTS

Thirty-nine studies were included from 26 journals (19 quantitative, 8 qualitative and 12 mixed-methods studies). CMs were considered as a tool to promote critical thinking, both in the perception of students and tutors, as well as in assessing students' knowledge and/or skills. In addition to their role as facilitators of knowledge integration and critical thinking, CMs were considered both a teaching and a learning methods.

CONCLUSIONS

CMs are teaching and learning tools which seem to help medical students develop critical thinking. This is due to the flexibility of the tool as a facilitator of knowledge integration, as a learning and teaching method. The wide range of contexts, purposes, and variations in how CMs and instruments to assess critical thinking are used increases our confidence that the positive effects are consistent.

Outcomes of Urinary Tract Endometriosis-Laparoscopic Treatment: A 10-Year Retrospective Study

INTRODUCTION

Urinary tract endometriosis (UTE), a rare manifestation, encompasses bladder and ureteral involvement. Surgical intervention is commonly recommended for UTE, though the optimal surgical approach remains a subject of debate. This study aims to report our centre's experience with UTE.

METHODS

We conducted a retrospective cohort study of 55 patients who underwent surgical treatment for UTE at a single tertiary centre over a 10-year period (2012-2022). Patient data, including demographics, symptoms, intraoperative findings, and complications, were collected from medical records. Data were statistically analysed, and correlations were explored.

RESULTS

The study population had a mean age of 37.11 years, with dysmenorrhea (89.1%) being the most common symptom. Bladder endometriosis was present in 27 cases, ureteral endometriosis in 25, and mixed-location in 3. Laparoscopy was the primary surgical approach, with multidisciplinary teams involving urologists. There were six patients with postoperative complications, and there were six (10.9%) recurrences of endometriosis. A positive correlation was found between age and recurrence, but no significant predictors of recurrence were identified in our analysis.

CONCLUSIONS

Laparoscopic treatment of urinary endometriosis is safe and effective. Multidisciplinary collaboration plays a pivotal role in addressing this challenging condition.

Extraperitoneal robot-assisted radical prostatectomy with the Hugo™ RAS system: initial experience of a tertiary center with a high background in extraperitoneal laparoscopy surgery

PURPOSE

The Hugo™ RAS system is a novel robotic platform with innovative features. However, there are currently no available data on extraperitoneal robot-assisted radical prostatectomy (RARP) performed using this system. The objective of this study is to describe the surgical setup and assess the safety and feasibility of the extraperitoneal approach in robotic radical prostatectomy with the Hugo™ RAS system.

METHODS

Sixteen consecutive patients diagnosed with localized prostate cancer underwent extraperitoneal RARP ± lymph node dissection at our institution, between March and May 2023. All RARP procedures were performed extraperitoneal with a modular four-arm configuration. The focus was to describe the operative room setup, trocar placement, tilt and docking angles and evaluate the safety and feasibility of this approach with this robotic platform. Secondary outcomes recorded included, total operative time, console time, estimated bleeding, intra- and postoperative complications, and length of stay after surgery. A descriptive analysis was conducted.

RESULTS

We report on the first sixteen cases of extraperitoneal robot-assisted radical prostatectomy performed with the new Hugo™ RAS system. All procedures were completed, without the need for conversion or placement of additional ports. No intraoperative complications or major technical failures that would prevent the completion of surgery were recorded. The median operative time was 211 min (IQR 180-277), and the median console time was 152 min (IQR 119-196). The mean docking time was 4.6 min (IQR 4.1-5.2). The median estimated blood loss and the median time to remove the vesical catheter were 200 mL (IQR 150-400) and 8 days (IQR 7-8), respectively. The median length of stay was 2 days (IQR 2-2). Only one minor complication was registered in the first 30 days.

CONCLUSION

This study provides evidence of the safety and feasibility of the extraperitoneal approach in RARP with the Hugo™ RAS system. The description of the surgical setup in terms of trocar placement, arm-cart disposition, tilt and docking angles offers valuable information for surgeons interested in adopting this surgical approach with the Hugo™ RAS platform.

An in-depth characterisation of European seabass intestinal segments for assessing the impact of an algae-based functional diet on intestinal health

Sustainable farming of fish species depends on emerging new feed ingredients, which can alter the features of the digestive tract and influence animals' overall health. Recent research has shown that functional feeds hold great potential for enhancing fish robustness by evoking appropriate responses at the intestine level. However, there is a lack of extensive and accurate descriptions of the morphology of the gastrointestinal tract of most farmed fish. We have characterised the intestine of European seabass thoroughly, by targeting four segments - anterior, mid, posterior and rectum. Results indicated that the anterior segment is mostly associated with absorption-related features; this segment has the largest absorptive area, the longest villi, and the highest number of neutral goblet cells (GC). The posterior segment and rectum have distinct histomorphometric features, but both seem to be important for immunity, displaying the highest count of acid GC and the highest expression of immune-related genes. The strongest proliferating cell nuclear antigen (PCNA) signal was observed in the anterior intestine and rectum, with PCNA⁺ cells appearing at the base of the villi and the corresponding villi branches. We have also evaluated the impact of a novel feed supplemented with a macro- and microalgae blend and found that there were no differences in terms of growth. However, the alterations observed in the mid intestine of fish fed the blend, such as thickening of the submucosa and lamina propria, an increased number of leucocytes, and higher expression of immune- and oxidative stress-related genes, suggest that algae may have an immunomodulatory effect. In the current article, we have described the morphology and expression patterns of the intestine segments of European seabass in detail and have presented a comprehensive report of the indices and methods used for the semi-quantitative and quantitative histomorphometric assessments, thereby providing useful information for future studies that aim to maintain intestinal health through dietary interventions.

Open-source tool for real-time and automated analysis of droplet-based microfluidic

Droplet-based microfluidic technology is a powerful tool for generating large numbers of monodispersed nanoliter-sized droplets for ultra-high throughput screening of molecules or single cells. Yet further progress in the development of methods for the real-time detection and measurement of passing droplets is needed for achieving fully automated systems and ultimately scalability. Existing droplet monitoring technologies are either difficult to implement by non-experts or require complex experimentation setups. Moreover, commercially available monitoring equipment is expensive and therefore limited to a few laboratories worldwide. In this work, we validated for the first time an easy-to-use, open-source Bonsai visual programming language to accurately measure in real-time droplets generated in a microfluidic device. With this method, droplets are found and characterized from bright-field images with high processing speed. We used off-the-shelf components to achieve an optical system that allows sensitive image-based, label-free, and cost-effective monitoring. As a test of its use we present the results, in terms of droplet radius, circulation speed and production frequency, of our method and compared its performance with that of the widely-used ImageJ software. Moreover, we show that similar results are obtained regardless of the degree of expertise. Finally, our goal is to provide a robust, simple to integrate, and user-friendly tool for monitoring droplets, capable of helping researchers to get started in the laboratory immediately, even without programming experience, enabling analysis and reporting of droplet data in real-time and closed-loop experiments.

Impact of a daily legume-based meal on dietary and nutritional intake in a group of omnivorous adults

Adopting eco-friendly diets will demand the consumption of more plant-based protein food sources such as legumes. However, assessing the impact of such a dietary shift on the dietary and nutritional intake of traditionally omnivorous populations is needed. The objective of this study was to assess the impact of substituting a traditional omnivorous-based lunch for a vegetarian, legume-based meal on the daily dietary and nutritional intake in a group of omnivorous adults in the city of Porto, Portugal. Nineteen, non-vegetarian, healthy young adults consumed a vegetarian, legume-based meal from Monday to Friday, for 8 consecutive weeks. Socio-demographic data, health status, lifestyle-related information and anthropometric parameters were recorded. Three-day food records were used to collect food intake at baseline and week 8. European Food Safety Authority and World Health Organization reference values were used to assess nutritional inadequacies. Variables were described as medians (P₂₅ and P₇₅ ). Wilcoxon signed-rank and Mann-Whitney tests were used for statistical comparisons. A p-value of <0.05 was considered statistically significant. Participants consumed 38.0 (P₂₅  = 35.0; P₇₅  = 40.0) meals, resulting in an intake of 84.5 g (P₂₅  = 74.9; P₇₅  = 98.4) of cooked legumes per meal, meaning 11 subjects (57.9%) met the Portuguese guidelines for legume consumption (≥80 g/day of legumes). The current dietary intervention did not seem to aggravate the prevalence of nutritional inadequacies for the macro- and micronutrients tested, except for the case of vitamin B₁₂ (52.6% [95% CI: 28.9-75.6] vs. 78.9% [95% CI: 54.4-94.0]). This could be linked to the reduction of dietary sources of this vitamin which is an expected consequence of vegetarian meals. Dietary changes towards grain legume-based diets are desirable yet need to be carefully implemented to prevent exacerbating potential nutrient inadequacies, especially of vitamin B₁₂ .

Challenges and opportunities of CAR T cell therapies for CLL

Chimeric antigen receptor (CAR) T-cell therapies have transformed the treatment landscape of blood cancers. These engineered receptors which endow T cells with antibody-like target cell recognition combined with the typical T cell target cell lysis abilities. Introduced into the clinic in the 2010s, CAR T-cells have shown efficacy in chronic B lymphocytic leukemia (CLL), but a majority of patients do not achieve sustained remission. Here we discuss the current treatment landscape in CLL using small molecules and allogeneic stem cell transplantation, the niche CAR T-cells filled in this context, and what we have learned from biomarker and mechanistic studies. Several product parameters and improvements are introduced as examples of how the bedside-to-bench is translated into improved CAR T-cells for CLL. We hope to convey to our readers the crucial role translational medicine plays in transforming the treatment outcomes for patients with CLL and how this line of research is an essential component of modern medicine.

Potential application and beneficial effects of a marine microalgal biomass produced in a high-rate algal pond (HRAP) in diets of European sea bass, Dicentrarchus labrax

Microalgae have been used as live food in aquatic species. In recent years, the interest in microalgae has considerably increased, thanks to the evolution of production techniques that have identified them as an ecologically attractive aquafeed ingredient. The present study provides the first data about the effects of dietary inclusion of a microalgae consortium grown in a high-rate algal pond system on zootechnical performance, morphometric indices, and dietary nutrient digestibility as well as morphology and functionality of the digestive system of European sea bass, Dicentrarchus labrax. A dietary treatment including a commercial mono-cultured microalgae (Nannochloropsis sp.) biomass was used for comparison. Six hundred and thirty-six European sea bass juveniles (18 ± 0.28 g) were randomly allotted into 12 experimental groups and fed 4 different diets for 10 weeks: a control diet based on fish meal, fish oil, and plant protein sources; a diet including 10% of Nannochloropsis spp. biomass (100 g/kg diet); and two diets including two levels (10% and 20%) of the microalgal consortium (100 and 200 g/kg diet). Even at the highest dietary inclusion level, the microalgal consortium (200 g/kg diet) did not affect feed palatability and fish growth performance. A significant decrease in the apparent digestibility of dry matter, protein, and energy was observed in diets including 10 and 20% of the microalgal consortium, but all fish exhibited a well-preserved intestinal histomorphology. Moreover, dietary inclusion with the microalgal consortium significantly increased the enzymatic activity of maltase, sucrase-isomaltase, and ɤ-glutamil transpeptidase in the distal intestine of the treated European sea bass. Algal consortium grown using fish farm effluents represents an attempt to enhance the utilization of natural biomasses in aquafeeds when used at 10 % as substitute of vegetable ingredients in diet for European sea bass.

The Use of Defatted Tenebrio molitor Larvae Meal as a Main Protein Source Is Supported in European Sea Bass (Dicentrarchus labrax) by Data on Growth Performance, Lipid Metabolism, and Flesh Quality

Objective

This study aims to determine the maximal inclusion level of defatted (d-) Tenebrio molitor larvae meal (TM) able to replace dietary fishmeal (FM) without compromising growth performance, general metabolism, and flesh quality traits in European sea bass, and to evaluate the major underlying physiological mechanisms.

Materials and Methods

Fish (55 ± 2 g) were fed with diets containing increasing levels of dTM: 0, 40, 80 and 100% (CTRL, TM40, TM80, and TM100, respectively) to replace FM. After 10 weeks of feeding, the growth performance, nutrient and energy balance, intestinal integrity, plasma metabolites and the expression of genes related to growth and nutrient metabolism, in liver and muscle were determined. The fatty acids (FA) profile, textural properties and color were also evaluated in muscle.

Results

Protein and lipids digestibility remained unaltered up to 80% dTM inclusion. Growth performance parameters were similar among dietary treatments. The dTM inclusion increased the hepatosomatic index in fish fed TM100. Muscle eicosapentaenoic acid, docosahexaenoic acid and n-3 long-chain polyunsaturated FA levels were maintained up to 80% dTM inclusion, but total cholesterol and non-esterified FA increased with dietary dTM inclusion. In liver, the expression of elongation of very long-chain FA protein 6 (elovl6) and FA desaturase 2 (fads2) did not change in fish fed TM40 and TM80, but elovl6 decreased whilst fads2 increased in fish fed TM100 when compared to those fed CTRL. The expression of cholesterol 7 alpha-monooxygenase (cyp7a1) decreased with dietary dTM inclusion. In muscle, the expression of myoblast determination protein-2 (myod2) decreased in fish fed TM80 and TM100.

Conclusion

It is feasible to substitute dietary FM by dTM up to 80% in European sea bass without detrimental effects on nutrient digestibility, growth performance and associated genetic pathways, whilst assuring fillet nutritional value for human consumption.

The role of the pediatrician in accurate recognition of autistic spectrum disorders and symptoms: literature review

INTRODUCTION: Autism spectrum disorder (ASD) is a neurodevelopmental disorder, diagnosed by disruption in the process of socialization, behavior and communication. It is among the most common developmental disorders, affecting 1 in 100 children. Its subtle, symptomatic and chronic profile has the involvement of essential biological mechanisms related to development. OBJECTIVES: Due to the low scope of the theme in the curriculum of the medicine and specialization in pediatrics course, which makes early diagnosis difficult, this review seeks to develop knowledge about: history, clinical characteristics and diagnostic tools associated with ASD. METHODS: A systematic review used the databases: MEDLINE (PubMed), SciELO, LILACS and Google Scholar, using “autism and the pediatrician” and “autism and the pediatrician”, “autism” as a search strategy. RESULT AND DISCUSSION: Through the CHAT (checklist for autism in children), health professionals can make diagnostic suspicion, through parents reports on the child’s behavior, as well as at the time of the consultation. CONCLUSION: The early introduction of therapies to rehabilitate children with ASD, through interdisciplinary intervention, is important for improving the behavior and quality of life of patients with autism spectrum.

Mediterranean diet, sociodemographic factors and ultra-processed food consumption in Portugal

Background

Mediterranean diet has been shown to promote beneficial effects on health, while ultra-processed food (UPF) consumption has been associated with lower diet quality and higher risk for non-communicable diseases. Our aims were to explore the adherence to a Mediterranean dietary pattern (MDP) in Portugal and its association with sociodemographic factors and UPF consumption.

Methods

Participants were from the Portuguese National Food, Nutrition and Physical Activity Survey 2015-2016, aged 18-84y (n = 3,852). CAPI face-to-face interviews were used including 2 dietary 24-h recalls. UPF were identified using NOVA classification. Adherence to MDP was defined by the Mediterranean Diet Score (MDS), which may vary from 0 to 9. MDS≥6 was considered as high adherence. Weighted multivariate logistic regression analysis was used to explore associations of high adherence to MDP with sex, age, region, educational level, family income and dietary share of UPF groups.

Results

High adherence to MDP was observed for 19.6% of participants and was inversely associated with higher consumption of UPF, namely, sugar-sweetened beverages (OR = 0.924; 95%CI 0.883-0.966), confectionery (OR = 0.893; 95%CI 0.816-0.977), sweet snacks (OR = 0.953; 95%CI 0.923-0.985), cakes/desserts (OR = 0.956; 95%CI 0.934-0.978) and meat products (OR = 0.922; 95%CI 0.874-0.972). Being female (OR = 0.629; 95%CI 0.471-0.841) and not from the North or Alentejo regions were inversely associated with high adherence to MDP. There was no relation between income and adherence to MDP. The higher the level of education or age, the higher the odds of high adherence to MDP (OR = 2.573; 95%CI 1.741-3.803 and OR = 1.028; 95%CI 1.020-1.037, respectively).

Conclusions

Actions to improve adherence to MDP in Portugal should consider discouraging UPF consumption and be addressed to specific subgroups.

Funding

POCI-01-0145-FEDER-032090 (FCT/FEDER); FAPESP 2018/07391-9, 2019/05972-7 (MCR), 2016/14302-7 (FR).

Key messages

High adherence to a Mediterranean dietary pattern was observed for near 20% of Potuguese over 18 years old. The higher the level of education or age, the higher the odds of high adherence to MDP. High adherence to a Mediterranean dietary pattern was inversely associated with higher consumption of sugar-sweetened beverages, confectionery, sweet snacks, cakes/desserts and meat products.

Revisiting the role of concept mapping in teaching and learning pathophysiology for medical students

Concept mapping methodology is a way of representing knowledge described as a useful tool in medical education. It was introduced in the pathophysiology curricular unit at NOVA Medical School in 2002, within an ongoing experience of problem-based learning. Our goal is to present a comparison between the students' opinions and performances in two academic years, 2017-18 and 2018-19, to evaluate the effects of pedagogical changes in the concept mapping methodology, applied in the last year, which is also described in detail. Our convenience samples were composed by 224 students in 2017-2018 and by 216 students in 2018-2019. The analysis used the students' responses to the yearly institutional questionnaire on the quality of teaching and to a specific questionnaire applied to evaluate the tutorial sessions of 2018-19. Both were anonymous, and the response rate was above 50%. A comparison was also made between the continuous assessment during the tutorial sessions, expressed as a final cumulative score, and the results of an obligatory multiple-choice final test. The students considered the introduced pedagogical changes useful in their different components, such as identification of core concepts, construction of mini-maps, and their inclusion in final global maps. The better performance of the tutors, signaled by the students in 2018-19, was probably due to the preparatory pedagogical sessions.

Fast Prototyping Microfluidics: Integrating Droplet Digital Lamp for Absolute Quantification of Cancer Biomarkers

Microfluidic (MF) advancements have been leveraged toward the development of state-of-the-art platforms for molecular diagnostics, where isothermal amplification schemes allow for further simplification of DNA detection and quantification protocols. The MF integration with loop-mediated isothermal amplification (LAMP) is today the focus of a new generation of chip-based devices for molecular detection, aiming at fast and automated nucleic acid analysis. Here, we combined MF with droplet digital LAMP (ddLAMP) on an all-in-one device that allows for droplet generation, target amplification, and absolute quantification. This multilayer 3D chip was developed in less than 30 minutes by using a low-cost and extremely adaptable production process that exploits direct laser writing technology in "Shrinky-dinks" polystyrene sheets. ddLAMP and target quantification were performed directly on-chip, showing a high correlation between target concentration and positive droplet score. We validated this integrated chip via the amplification of targets ranging from five to 500,000 copies/reaction. Furthermore, on-chip amplification was performed in a 10 µL volume, attaining a limit of detection of five copies/µL under 60 min. This technology was applied to quantify a cancer biomarker, c-MYC, but it can be further extended to any other disease biomarker.

A concept map template to be used by medical students for displaying pathophysiological mechanisms within clinical cases

This article was migrated. The article was marked as recommended. Background: The use of concept maps (CMs) in health and medical education is increasing, particularly in the last decade. The research developed in this area has not yet clarified the role played by CMs in meaningful learning. Approach: Our group developed a methodology, in a pathophysiology course, based on the classical CMs construction, using short clinical cases. Outcomes: We propose a template that allows the display of the short clinical case embedded in the architecture of the CMs and connecting words targeted to specific pathophysiological mechanisms. Next Steps: We consider that this experience can be extrapolated to the teaching and learning of pathophysiology in other health areas.

Insights into the development of grapefruit nutraceutical powder by spray drying: physical characterization, chemical composition and 3D intestinal permeability

BACKGROUND

The development of functional and nutraceutical foods comes from a greater awareness of the relationship between food and health by consumers. In recent years, the idea of purifying and encapsulating bioactive compounds through techniques such as spray drying has been well received by the food industry. The development and characterization of a grapefruit (Citrus paradisi) nutraceutical powder obtained by spray drying is of great interest owing to the different bioactive compounds and the potential health effects.

RESULTS

The grapefruit powder was characterized by a low water amount (1.5 g water per 100 g powder) and a high porosity (75%). The color parameters were L* = 80.0 ± 1.8, h_ab * = 61.7 ± 0.4 and C_ab * = 11.4 ± 0.6. The IC₅₀ values determined for the freeze-dried oxalic acid extract (FDOA) and the freeze-dried methanol-water extract (FDMW) were 0.48 and 0.72 mg mL^-1 respectively, while the total phenolic content (TPC) ranged between 1274 and 1294 mg gallic acid equivalent (GAE) per 100 g dry basis (d.b.). Regarding total flavonoid content (TFC), FDOA presented the highest amount (6592 mg quercetin equivalent (QE) per 100 g d.b.). For both extracts, the cell viability in Caco-2 and HT29-MTX was above 90% at 100 μg mL^-1 . The bioavailability of the bioactive compounds was analyzed through a 3D intestinal model. Delphenidin-3-glucoside and hesperitin-7-O-glucoside presented a permeation higher than 50%, followed by hesperidin which was close to 30%.

CONCLUSION

This work allows to establish that the formulation of grapefruit powder has great potential as a nutraceutical food, with spray drying being a good alternative technique in the food industry. © 2019 Society of Chemical Industry.

Sexual dimorphism of AMBRA1-related autistic features in human and mouse

Ambra1 is linked to autophagy and neurodevelopment. Heterozygous Ambra1 deficiency induces autism-like behavior in a sexually dimorphic manner. Extraordinarily, autistic features are seen in female mice only, combined with stronger Ambra1 protein reduction in brain compared to males. However, significance of AMBRA1 for autistic phenotypes in humans and, apart from behavior, for other autism-typical features, namely early brain enlargement or increased seizure propensity, has remained unexplored. Here we show in two independent human samples that a single normal AMBRA1 genotype, the intronic SNP rs3802890-AA, is associated with autistic features in women, who also display lower AMBRA1 mRNA expression in peripheral blood mononuclear cells relative to female GG carriers. Located within a non-coding RNA, likely relevant for mRNA and protein interaction, rs3802890 (A versus G allele) may affect its stability through modification of folding, as predicted by in silico analysis. Searching for further autism-relevant characteristics in Ambra1^+/- mice, we observe reduced interest of female but not male mutants regarding pheromone signals of the respective other gender in the social intellicage set-up. Moreover, altered pentylentetrazol-induced seizure propensity, an in vivo readout of neuronal excitation-inhibition dysbalance, becomes obvious exclusively in female mutants. Magnetic resonance imaging reveals mild prepubertal brain enlargement in both genders, uncoupling enhanced brain dimensions from the primarily female expression of all other autistic phenotypes investigated here. These data support a role of AMBRA1/Ambra1 partial loss-of-function genotypes for female autistic traits. Moreover, they suggest Ambra1 heterozygous mice as a novel multifaceted and construct-valid genetic mouse model for female autism.

Effects of soil and space on the woody species composition and vegetation structure of three Cerrado phytophysiognomies in the Cerrado-Amazon transition

Abstract The Cerrado Biome is considered one of the world's biodiversity hotspots because of its rich biodiversity, the high level of endemism and the increasing threat. The Cerrado is composed by a mosaic of different vegetation types, including physiognomies that vary from grasslands (campo limpo) to savannas (typical cerrado or cerrado sensu stricto) and cerrado woodlands (cerradão). However, the factors that determine the composition of the Cerrado’s flora and the structure of the physiognomies that compose this biome are still poorly understood. Here, we investigate the influence of the chemical and granulometric properties of the soil and the effect of geographic distance on the occurrence and abundance of woody species in three Cerrado phytophysiognomies – cerrado woodland (cerradão), dense cerrado savanna and typical cerrado savanna – in the Cerrado-Amazon transition. We tested the hypothesis that the edaphic characteristics and geographic space determine the species composition and the structure of the woody vegetation of these three phytophysiognomies. We demonstrate that the dissimilarities in the structure and composition of the three sites were determined more by space (13% of explanation) than edaphic properties (1%), but primarily by the interaction between these two factors (26%). We conclude that, in situations where the chemical and granulometric properties of the soil are relatively homogeneous, as we found in the present study, geographic distance between sites has a greater influence than variation in the substrate’s properties on modelling the occurrence and abundance of the woody plant species in the Cerrado.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Acute respiratory distress syndrome in burn patients: incidence and risk factor analysis

After a burn lesion, Acute Respiratory Distress Syndrome (ARDS) may occur via direct lung injury due to inhaled smoke and fumes or mediated by the inflammatory response associated with the burn or its infectious complications. The aim of the present study is to assess the epidemiologic profile of ARDS in adult burn patients admitted to intensive care in a burn unit at a university hospital. A prospective cohort study was performed from January to December 2012. Demographic and diagnostic data, prognostic scores, etiology and data on the extent and depth of burns were collected. Data related to risk factors for ARDS and death were also recorded. A total of 85 patients were included in the study. Patients were aged 41.7 (SD = 15.7) years old; 71.8% were male and the mean total body surface area burned was 28.3% (SD = 19.1%); 35.3% presented inhalation injuries. Invasive ventilatory support was required in 44 ICU inpatients (51.8%). ARDS was diagnosed in 38.6% of patients under invasive mechanical ventilation. In multivariate analysis, the presence of inhalation injuries was a risk factor for ARDS (OR = 9.75; CI 95% 2.79 - 33.95; P < 0.001). ARDS is a common complication in burn patients admitted to specialized intensive care units. Inhalation injuries were an independent risk factor for ARDS. Mortality rate observed in the study patients was high and associated with ARDS diagnosis.

Cognitive bio-radar: The natural evolution of bio-signals measurement

In this article we discuss a novel approach to Bio-Radar, contactless measurement of bio-signals, called Cognitive Bio-Radar. This new approach implements the Bio-Radar in a Software Defined Radio (SDR) platform in order to obtain awareness of the environment where it operates. Due to this, the Cognitive Bio-Radar can adapt to its surroundings in order to have an intelligent usage of the radio frequency spectrum to improve its performance. In order to study the feasibility of such implementation, a SDR based Bio-Radar testbench was developed and evaluated. The prototype is shown to be able to acquire the heartbeat activity and the respiratory effort. The acquired data is compared with the acquisitions from a Biopac research data acquisition system, showing coherent results for both heartbeat and breathing rate.

ERP correlates of error processing during performance on the Halstead Category Test

The Halstead Category Test (HCT) is a neuropsychological test that measures a person's ability to formulate and apply abstract principles. Performance must be adjusted based on feedback after each trial and errors are common until the underlying rules are discovered. Event-related potential (ERP) studies associated with the HCT are lacking. This paper demonstrates the use of a methodology inspired on Singular Spectrum Analysis (SSA) applied to EEG signals, to remove high amplitude ocular and movement artifacts during performance on the test. This filtering technique introduces no phase or latency distortions, with minimum loss of relevant EEG information. Importantly, the test was applied in its original clinical format, without introducing adaptations to ERP recordings. After signal treatment, the feedback-related negativity (FRN) wave, which is related to error-processing, was identified. This component peaked around 250ms, after feedback, in fronto-central electrodes. As expected, errors elicited more negative amplitudes than correct responses. Results are discussed in terms of the increased clinical potential that coupling ERP information with behavioral performance data can bring to the specificity of the HCT in diagnosing different types of impairment in frontal brain function.

Nutritional risk of European elderly

BACKGROUND/OBJECTIVES

The elderly constitute a population group with a high prevalence of non-communicable chronic diseases and high risk of malnutrition. The aim of this study was to identify factors associated to nutritional risk in free-living European elderly.

SUBJECTS/METHODS

The sample included 644 European citizens, free living in the community, aged 65 years or more. The sample was quota controlled for age groups (65-74, ≥75 years), gender (male/female) and living circumstances (living alone/with others). Logistic regression was performed to identify factors associated with nutritional risk.

RESULTS

Several variables regarding socio-demographic characteristics, food choice, health status and the satisfaction with food-related life were included in the analysis. According to the recoded score of the 'Determine your nutritional health' (NSI checklist), 53% of the elderly were at nutritional risk. Nutritional risk was more likely to occur in elderly who considered that it was more important to choose foods 'easy to chew'; with lower average number of fruit and vegetables (F&V) intake episodes and lower score for general health. It was also found in non-married participants; those that did not identify changes in their appetite; and those that felt changes in health status. In this sample, the lowest nutritional risk was found for body mass index (BMI) around 18.5 kg/m(2). Country of residence, gender and age were not found to have a significant effect on nutritional risk.

CONCLUSIONS

Attention should be drawn to the living circumstances, changes in appetite or health, the general heath perception, F&V intake, choice of foods easy to chew and having a low or high BMI.

Application of Qual2Kw model as a tool for water quality management: Cértima River as a case study

Modelling can be a useful management tool because models allow the understanding of water body response to different pollution pressure scenarios which may help on the decision-making process and in prosecuting the Water Framework Directive objectives. This study aims to evaluate the usage of simple water quality models (Qual2Kw) applied to small river basins in order to better understand the response of a river to different loads of nitrogen and phosphorus. Qual2Kw model was applied to Cértima River (Portugal), a small river that ends in a shallow lake called Pateira Fermentelos and represents a very important ecosystem to the local community. Along its pathway, Cértima River has a significant enrichment in nutrients due to agriculture, livestock, domestic sewage and industrial effluents discharged into the river. In case of nitrogen, the highest loads are from domestic (44%) and diffuse (35%) sources. The main sources of phosphorous are domestic (46%), livestock (24%) and diffuse sources (20%). Cértima River is strongly enriched with nutrients, and neither nitrogen nor phosphorous is limiting the algal growth. According to the criterion of Dodds et al. (Water Res, 32(5):1455-1462, 1998), the river is classified as eutrophic. By comparing in stream measurements with Qual2Kw simulations, it can be concluded that it would be necessary to decrease the actual pollutants loads of nitrogen and phosphorous 5 and 10 times, respectively, in order to change Cértima River classification from eutrophic to mesotrophic.

Antiradical activity, phenolics profile, and hydroxymethylfurfural in espresso coffee: influence of technological factors

The influence of technological factors (decaffeination, brew volume, coffee species, and roast degree) on antiradical activity and phenolics content of espresso coffee is described. The screenings of phenolics profile and other compounds (caffeine and trigonelline), as well as the quantification of hydroxymethylfurfural, were performed by LC-DAD-ESI-MS. Significantly lower (p < 0.05) scavenging activities and phenolics contents were found in decaffeinated espressos when compared with regular ones (32 vs 38% and 324 vs 410 mg/30 mL cup, respectively). A long espresso (70 mL) offers more than twice the phenolics amount of a short one (20 mL). Robusta brews showed higher (p < 0.05) antiradical activity and phenolic contents than arabica ones, for all roast degrees (light, medium, and dark). No significant differences (p > 0.05) were observed for scavenging activities of differently roasted robusta brews, whereas an increase in medium-dark brews was observed for arabica samples. Total phenolics in robusta espressos decreased (p < 0.05) with the increase of roast degree, but no significant differences (p > 0.05) were found between arabica espressos from different roasts. By LC-DAD-ESI-MS, 23 hydroxycinnamic derivatives were found, including chlorogenic acids, lactones, and cinnamoyl-amino acid conjugates. The amount of each compound was differently affected by species and roast. Robusta brews presented superior levels of caffeine and chlorogenic acids, whereas arabica ones contained more trigonelline. Hydroxymethylfurfural contents in the brew (30 mL) varied from 2.60 to 0.84 mg for light- and dark-roasted arabicas and from 1.29 to 0.68 mg for light- and dark-roasted robustas, respectively.