[High nutritional risk by three variants of NUTRIC score in critically ventilated patients]. / Comparación del riesgo nutricional alto por tres variantes del puntaje NUTRIC en pacientes críticos ventilados.

Introduction: Introduction: variants of the NUTRIC score with or without inflammatory biomarkers, modified without interleukin 6 (IL-6) (NUTRICm), with C-reactive protein (CRP) instead of IL-6, dichotomous (NUTRICpcr1) or in tertiles (NUTRICpcr2), were proposed to assess nutritional risk (NR) in critical patients. However, the assessment of the high NR might not be uniform between these scores. Objectives: to compare the assessment of the high NR by NUTRICm and the two variants of the NUTRICpcr. Material and methods: analysis of a prospective cohort of patients ventilated prior to COVID-19. Agreement was analyzed using the Kappa test and mortality discrimination by logistic regression. The proportion of patients with high NR was compared with the Chi-square test. Results: five hundred and fifty patients were analyzed. Median (IQR) age and APACHE II: 44 (28-58) years and 17 (12-22) points, predominant traumatic pathology (38.2 %) and Intensive Care Unit (ICU) mortality of 32.5 %. The concordance was high between NUTRICm and NUTRICpcr1 (Kappa = 0.81) and lower between NUTRICm and NUTRICpcr2 (Kappa = 0.60). The AUCROC (95 % CI) of NUTRICm, NUTRICpcr1 and NUTRICpcr2 to discriminate mortality was 0.695 (0.495-0.591), 0.693 (0.495-0.591) and 0.685 (0.495-0.591), respectively. The tall NB showed significant differences between NUTRICm and NUTRICpcr1 (19.8 % vs 14.4 %, p 0.0243), being greater between NUTRICm and NUTRICpcr2 (19.8 vs 9.8 %, p < 0.0001). Conclusion: the three NUTRIC variants studied discriminate mortality in a similar way. However, the NUTRICm, without an inflammatory biomarker, classifies more patients as high nutritional risk.

Introducción: Introducción: las variantes del puntaje NUTRIC con o sin biomarcadores inflamatorios, modificada sin interleucina-6 (IL-6) (NUTRICm), con proteína C reactiva (PCR) en lugar de IL-6, dicotómica (NUTRICpcr1) o en terciles (NUTRICpcr2), se propusieron para evaluar el riesgo nutricional (RN) en pacientes críticos. Sin embargo, la valoración del RN alto podría no ser uniforme entre dichos puntajes.. Objetivos: comparar la valoración del RN alto por NUTRICm y las dos variantes del NUTRICpcr. Material y métodos: análisis de una cohorte prospectiva de pacientes ventilados previa al COVID-19. El acuerdo se analizó mediante la prueba de Kappa y la discriminación de la mortalidad por regresión logística. La proporción de pacientes de RN alto se comparó con la prueba Chi-cuadrado. Resultados: se analizaron 550 pacientes. Mediana (RIQ) de edad y APACHE II: 44 (28-58) años y 17 (12-22) puntos, patología traumática predominante (38,2 %) y mortalidad en Unidad de Cuidados Intensivos (UCI) del 32,5 %. La concordancia fue alta entre NUTRICm y NUTRICpcr1 (Kappa = 0,81) y menor entre NUTRICm y NUTRICpcr2 (Kappa = 0,60). El AUCROC (IC 95 %) del NUTRICm, NUTRICpcr1 y NUTRICpcr2 para discriminar mortalidad fue de 0,695 (0,495-0,591), 0,693 (0,495-0,591) y 0,685 (0,495-0,591), respectivamente. El RN alto mostró diferencias significativas entre NUTRICm y NUTRICpcr1 (19,8 % vs. 14,4 %, p 0,0243), y fue mayor entre NUTRICm y NUTRICpcr2 (19,8 vs. 9,8 %, p < 0,0001). Conclusión: las tres variantes del NUTRIC estudiadas discriminan la mortalidad en forma similar. Sin embargo, el NUTRICm, sin biomarcador inflamatorio, clasifica más pacientes como de RN alto.

Toward Optimal Irrigation Management at the Plot Level: Evaluation of Commercial Water Potential Sensors.

Proper irrigation practice consists of applying the optimum amount of water to the soil at the right time. The porous characteristics of the soil determine the capacity of the soil to absorb, infiltrate, and store water. In irrigation, it is not sufficient to only determine the water content of the soil; it is also necessary to determine the availability of water for plants: water potential. In this paper, a comprehensive laboratory evaluation-accuracy and variability-of the world's leading commercial water potential sensors is carried out. No such comprehensive and exhaustive comparative evaluation of these devices has been carried out to date. Ten pairs of representative commercial sensors from four different families were selected according to their principle of operation (tensiometers, capacitive sensors, heat dissipation sensors, and resistance blocks). The accuracy of the readings (0 kPa-200 kPa) was determined in two soils of contrasting textures. The variability in the recordings-repeatability and reproducibility-was carried out in a homogeneous and inert material (sand) in the same suction range. The response in terms of accuracy and value dispersion of the different sensor families was different according to the suction range considered. In the suction range of agronomic interest (0-100 kPa), the heat dissipation sensor and the capacitive sensors were the most accurate. In both families, registrations could be extended up to 150-200 kPa. The scatter in the readings across the different sensors was due to approximately 80% of the repeatability or intrinsic variability in the sensor unit and 20% of the reproducibility. Some sensors would significantly improve their performance with ad hoc calibrations.

EUSEDcollab: a network of data from European catchments to monitor net soil erosion by water.

As a network of researchers we release an open-access database (EUSEDcollab) of water discharge and suspended sediment yield time series records collected in small to medium sized catchments in Europe. EUSEDcollab is compiled to overcome the scarcity of open-access data at relevant spatial scales for studies on runoff, soil loss by water erosion and sediment delivery. Multi-source measurement data from numerous researchers and institutions were harmonised into a common time series and metadata structure. Data reuse is facilitated through accompanying metadata descriptors providing background technical information for each monitoring station setup. Across ten European countries, EUSEDcollab covers over 1600 catchment years of data from 245 catchments at event (11 catchments), daily (22 catchments) and monthly (212 catchments) temporal resolution, and is unique in its focus on small to medium catchment drainage areas (median = 43 km2, min = 0.04 km2, max = 817 km2) with applicability for soil erosion research. We release this database with the aim of uniting people, knowledge and data through the European Union Soil Observatory (EUSO).

Challenges and progresses in the detailed estimation of sediment export in agricultural watersheds in Navarra (Spain) after two decades of experience.

Soil erosion is a very serious environmental problem worldwide, with agriculture considered the main source of sediment in inland waters. In order to determine the extent and importance of soil erosion in the Spanish region of Navarra, in 1995 the Government of Navarra established the Network of Experimental Agricultural Watersheds (NEAWGN), which consists of five small watersheds representative of local conditions. In each watershed, key hydrometeorological variables, including turbidity, were recorded every 10 min, and daily samples were taken to determine suspended sediment concentration. In 2006, the frequency of suspended sediment sampling was increased during hydrologically relevant events. The main objective of this study is to explore the possibility of obtaining long and accurate time series of suspended sediment concentration in the NEAWGN. To this end, simple linear regressions between sediment concentration and turbidity are proposed. In addition, supervised learning models incorporating a larger number of predictive variables are used for the same purpose. A series of indicators are proposed to objectively characterize the intensity and timing of sampling. It was not possible to obtain a satisfactory model for estimating the concentration of suspended sediment. This would be mainly due to the large temporal variability found of the physical and mineralogical characteristics of the sediment, which would be affecting the turbidity value, independently of the sediment concentration, per se. This fact would be particularly important in small river watersheds such as those of this study, and especially if their physical conditions are spatially and temporally radically disturbed by agricultural tillage and by a constant modification of the vegetation cover, as is the case in cereal basins. Our findings suggest that better results could be obtained by including in the analysis variables such as soil texture and exported sediment texture, rainfall erosivity, and the state of vegetation cover and riparian vegetation.

Experimental evidence that rill-bed morphology is governed by emergent nonlinear spatial dynamics.

Past experimental work found that rill erosion occurs mainly during rill formation in response to feedback between rill-flow hydraulics and rill-bed roughness, and that this feedback mechanism shapes rill beds into a succession of step-pool units that self-regulates sediment transport capacity of established rills. The search for clear regularities in the spatial distribution of step-pool units has been stymied by experimental rill-bed profiles exhibiting irregular fluctuating patterns of qualitative behavior. We hypothesized that the succession of step-pool units is governed by nonlinear-deterministic dynamics, which would explain observed irregular fluctuations. We tested this hypothesis with nonlinear time series analysis to reverse-engineer (reconstruct) state-space dynamics from fifteen experimental rill-bed profiles analyzed in previous work. Our results support this hypothesis for rill-bed profiles generated both in a controlled lab (flume) setting and in an in-situ hillside setting. The results provide experimental evidence that rill morphology is shaped endogenously by internal nonlinear hydrologic and soil processes rather than stochastically forced; and set a benchmark guiding specification and testing of new theoretical framings of rill-bed roughness in soil-erosion modeling. Finally, we applied echo state neural network machine learning to simulate reconstructed rill-bed dynamics so that morphological development could be forecasted out-of-sample.

The impact of nutritional status on health-related quality of life in hemodialysis patients.

Malnutrition is frequent in hemodialysis (HD) patients. Nutritional deficiencies may negatively impact quality of life (QOL). This study examines the utility of the Malnutrition-Inflammation Score (MIS) in detecting nutritional risk (NR) and assesses the correlation between nutritional status and QOL in dialysis patients upon starting a nutritional intervention program (NIP). One hundred and twenty patients were included in this cross-sectional study. The MIS was used to detect NR and the Kidney Disease Quality of Life (KDQOL-SF) instrument version 1.2 was used to assess QOL. 62% of patients were found to be at NR (MIS > 5). Nutritional status was significantly correlated with all generic QOL sub-scales. On a multiple linear regression analysis, malnutrition showed the highest level of explanation in the Kidney Disease Summary Component which explained 28.9% of the variance; the Physical Component Summary which explained 33% of the variance; and the Mental Component Summary which explained 21.5% of the variance. Malnutrition was found to be the most significant predictor of impaired scores on the KDQOL-SF. The use of MIS to identify patients at NR and a nutritional assessment to detect malnutrition in its early stages are important given the effects a NIP can have on improving QOL in HD patients.

Spanish scleroderma risk score (RESCLESCORE) to predict 15-year all-cause mortality in scleroderma patients at the time of diagnosis based on the RESCLE cohort: Derivation and internal validation.

A few scores predicting the short-term risk of mortality in Systemic sclerosis (SSc) have been reported to date. Our study aimed to create a predictive 15-year all-cause mortality score at the time of the diagnosis of SSc. The study was based on the Spanish Scleroderma Registry (RESCLE). The cohort was split up in derivation (DC) and validation cohort (VC). A multivariate analysis to detect variables related to all-cause mortality within the first 15 years from SSc diagnosis was performed, assigning points to the rounded beta values to create the score (RESCLESCORE). 1935 SSc patients were included. The variables in the final model were as follows: age at diagnosis (+2 points > 65 years-old), male gender (+1 point), lcSSc subset (-1 point), mode of onset other than Raynaud's (+1 point), cancer (+1 point) and visceral involvement, such as ILD (+1 point), PAH (+1 point), heart (+1 point) and renal involvement (+2 points). Autoantibodies did not achieve statistical significance in the multivariate analysis. The 3 categories of risk to predict 15-year all-cause mortality at the time of diagnosis were as follows: low risk (5% vs. 7%, p = .189), intermediate risk (26.5% vs. 25.5%, p = .911) and high risk (47.8% vs. 59%, p = .316). The AUC was 0.799 (DC) vs. 0.778 (VC) (p = .530). In conclusion, the RESCLESCORE demonstrated an excellent ability to categorize SSc patients at the time of diagnosis in separate 15-year all-cause mortality risk strata at the time of diagnosis.

Serodiscordant patients with systemic sclerosis: when antibody does not correspond to skin involvement.

OBJECTIVES: Diffuse cutaneous systemic sclerosis (dcSSc) is associated with anti-topoisomerase (ATA) whereas limited cutaneous (lcSSc) and sine scleroderma (ssSSc) are mainly associated with anti-centromere antibody (ACA). Serodiscordant patients were defined as lcSSc subjects with ATA, dcSSc with ACA, and ssSSc with ATA. The aim of the present study was to compare the clinical manifestations and prognosis between serodiscordant patients and their counterparts (those with lcSSc with ACA, dcSSc with ATA and ssSSc with ACA, respectively). METHODS: From the Spanish Scleroderma Registry we selected those patients for whom skin involvement (dcSSc, lcSSc or ssSSc) was detailed at baseline and last visit and ACA and ATA had been determined. Demographic, clinical characteristics, and survival data were compared according to the antibody status. RESULTS: The whole cohort comprised 901 patients and six mutually exclusive groups were defined: lcSScACA in 511 (57%) patients, lcSScATA group in 87 (10%), dcSScATA group in 172 (19%), dcSScACA group in 21 (2%), ssSScACA group in 92 (10%), and ssSScATA group in 18 (2%) patients, respectively. Interstitial lung disease (ILD) and severe ILD were more frequent in patients with dcSScATA than in those with dcSScACA. Conversely, the prevalence of isolated pulmonary hypertension (without ILD) was higher in those with dcSScACA (15% vs. 2%; p=0.018). No differences were found regarding survival when comparing serodiscordant patients with the seroconcordants patients. CONCLUSIONS: In our cohort, the prevalence of serodiscordant SSc patients was low. They differed from their counterparts in some clinical manifestations. The management of patients with SSc should be guided by both serology and cutaneous subtype.

Pulmonary hypertension in Spanish patients with systemic sclerosis. Data from the RESCLE registry.

INTRODUCTION: Our objective was to evaluate the pulmonary hypertension (PH) data for Spanish patients with systemic sclerosis (SSc), define the PH types and determine the associated factors. METHOD: Descriptive study of PH-related data from the multicentre RESCLE registry. Estimated systolic pulmonary artery pressure (esPAP), measured via echocardiogram was considered elevated if ≥ 35 mmHg. Left heart disease (LHD) and interstitial lung disease (ILD) were identified. When performed, data from right heart catheterisation (RHC) were collected. RESULTS: esPAP was elevated in 350 of 808 patients (43.3%). One hundred and forty-four patients (17.8%) were considered to have PH (88 via RHC and the rest due to elevated esPAP along with evidence of significant LHD or ILD): PAH 3.7%, secondary to ILD 8.3%, secondary to LHD 2.8% and unclassified 3%. Prevalence of elevated esPAP was greater in diffuse SSc (dSSc) than in limited scleroderma (lSSc) (50.5 vs. 42.2%, p 0.046). In the group with elevated esPAP, a lower prevalence of anti-centromere antibodies (41.9% vs. 52.3%, p 0.006) and a greater prevalence of anti-topoisomerase-1 antibodies (ATA) (25.1% vs. 18.6%, p 0.04) were observed compared to the group with normal esPAP. Patients with elevated esPAP had a lower rate of digital ulcers (50.6% vs. 60.2%, p 0.007) and esophageal involvement (83.6% vs. 88.7%, p 0.07) and higher rate of renal crisis (4.6% vs. 1.8%, p 0.066). CONCLUSIONS: Prevalence of PAH was lower than expected (3.7%). Probability of having elevated esPAP was higher among patients with dSSc and among those with ATA.

[Not Available]. / Doble carga de malnutrición en escolares urbanos y rurales de Guatemala.

Introducción: Guatemala ha estado experimentando una transición en sus estilos de vida. Mientras que la desnutrición crónica sigue siendo prevalente, se ha experimentado un aumento sustancial de los casos de obesidad. Objetivo: proporcionar información actualizada sobre las nuevas tendencias en cuanto al estado nutricional en Guatemala. Métodos: se diseñó un estudio transversal con una muestra de 392 niños y adolescentes (5-18 años) seleccionados de manera aleatoria. El muestreo fue estratificado según su ubicación geográfica (rural y urbana), sexo y edad. Resultados: alrededor del 62% de la muestra urbana presentó problemas de sobrepeso y un 13,8 de obesidad. Entre los participantes urbanos, la prevalencia de sobrepeso/obesidad fue mayor en el grupo de 11-14 años. El grupo urbano presentó una mayor prevalencia de sobrepeso/obesidad que el grupo rural para todos los grupos de edad (excepto en el grupo de 15-18 años que presentó unos índices de obesidad ligeramente más elevados en el grupo rural). Se observó una mayor prevalencia de retraso en el crecimiento en el grupo rural, excepto para el grupo de edad de 15-18 años. La prevalencia de bajo peso fue significativamente mayor en el grupo rural (25% vs. 1,2%) así como la prevalencia del delgadez, excepto para el grupo de edad de 5-10 años. Conclusión: la alta prevalencia de bajo peso y la de sobrepeso/obesidad coexisten en los niños y adolescentes en Guatemala.

Combination of Analytical and Chemometric Methods as a Useful Tool for the Characterization of Extra Virgin Argan Oil and Other Edible Virgin Oils. Role of Polyphenols and Tocopherols.

Analysis of phenolic profile and tocopherol fractions in conjunction with chemometrics techniques were used for the accurate characterization of extra virgin argan oil and eight other edible vegetable virgin oils (olive, soybean, wheat germ, walnut, almond, sesame, avocado, and linseed) and to establish similarities among them. Phenolic profile and tocopherols were determined by HPLC coupled with diode-array and fluorescence detectors, respectively. Multivariate factor analysis (MFA) and linear correlations were applied. Significant negative correlations were found between tocopherols and some of the polyphenols identified, but more intensely (P < 0.001) between the γ-tocopherol and oleuropein, pinoresinol, and luteolin. MFA revealed that tocopherols, especially γ-fraction, most strongly influenced the oil characterization. Among the phenolic compounds, syringic acid, dihydroxybenzoic acid, oleuropein, pinoresinol, and luteolin also contributed to the discrimination of the oils. According to the variables analyzed in the present study, argan oil presented the greatest similarity with walnut oil, followed by sesame and linseed oils. Olive, avocado, and almond oils showed close similarities.

A pilot duplicate diet study on manganese, selenium and chromium intakes in institutionalised children and adolescents from Guatemala.

Hidden hunger occurs in the presence of an otherwise nutritionally or energetically appropriate diet that is deficient in essential vitamins and minerals. Guatemala has the highest rate of child malnutrition in Latin America and the prevalence of hidden hunger is high. The aim of this study was to determine the Mn, Se and Cr dietary intakes in Guatemalan institutionalised children (4-14 years), a population group at high risk of mineral deficiency. For this purpose, the contents of Mn, Se and Cr were analysed in a duplicate diet (for 7 consecutive days) by electrothermal atomisation-atomic absorption spectrophotometry following acid digestion. Mn, Se and Cr intakes from the duplicate diets were in the range of 1·3-2·31 mg/d, 58·7-69·6 µg/d and 6·32-27·57 µg/d, respectively. Mn and Cr values were below current recommended daily intakes. A cereal- and legumes-based diet is habitually consumed by this population. Local vegetables, fruits and nutritional supplements are included daily, but the consumption of fish, meat, eggs and dairy products is very infrequent or negligible. Mean daily energy intake from the 7-d diet was 8418·2 kJ (2012 kcal), with a macronutrient energy distribution of carbohydrates 69·4 %, proteins 12·3 % and fats 18·3 %. Correlations between Mn, Se and Cr intakes and energy and other nutrient intakes were also evaluated. The present findings will help establish new nutritional strategies for this and similar population groups.

Does Lactobacillus plantarum or ultrafiltration process improve Ca, Mg, Zn and P bioavailability from fermented goats' milk?

Ca, Mg, Zn and P bioavailability from two experimental ultrafiltered fermented goats' milks (one of them with the probiotic Lactobacillus plantarum and another one without it), and fermented goats' milk samples available in the market were evaluated. Solubility, dialysability and a model combining simulated gastrointestinal digestion and mineral retention, transport and uptake by Caco-2 cells were used to assess bioavailability. The highest Ca, Mg, Zn and P bioavailability values always corresponded to the fermented milk developed by our research group, which could be explained by the effect of milk ultrafiltration. The fermented milk with L. plantarum showed higher Ca retention than the ones without the microorganism, and major Ca uptake when compared to commercial products. This fact could be attributed to a positive effect exerted by the probiotic strain.

The probiotic bacterial strain Lactobacillus fermentum D3 increases in vitro the bioavailability of Ca, P, and Zn in fermented goat milk.

We determined calcium, magnesium, phosphorus and zinc levels in a total of 27 samples of commercial goat- and cow-milk fermented products and 9 samples of a goat-milk fermented product with addition of a probiotic bacterial strain, Lactobacillus fermentum D3, manufactured experimentally by our research group. Atomic absorption spectroscopy with flame atomization and UV/VIS spectrophotometry were used as analytic techniques. The results of an in vitro digestion process showed that the bioavailability of calcium, phosphorus, and zinc was significantly higher in our fermented milk containing the probiotic bacterial strain than it was in commercial goat-milk fermented products. Furthermore, our product showed a significantly higher bioavailability of calcium and zinc compared to goat- and cow-milk fermented products made with other microorganisms. We conclude that, in in vitro assays, strain D3 seems to increase the bioavailability of these minerals and that this new product may constitute a better source of bioavailable minerals compared to other products already on the market.

Bioactive compounds and nutritional significance of virgin argan oil--an edible oil with potential as a functional food.

This review compiles recently published scientific reports on the bioactive compounds present in virgin argan oil along with their possible beneficial effects on human health, which could justify consideration of this oil as a new functional food. Virgin argan oil is characterized by high levels of linoleic and oleic acids, tocopherols (especially γ-tocopherol), and minor compounds such as sterols, carotenoids, and squalene. The total antioxidant capacity of virgin argan oil is higher than that of other vegetable oils. Recent studies suggest that this edible oil, as a functional food, may play a role in disease prevention. For example, some authors have found it to have hypolipidemic, hypocholesterolemic, hypoglycemic, and antihypertensive effects as well as a possible role in cancer prevention. This review demonstrates the need for further studies in order to fully characterize argan oil from bromatological, nutritional, culinary, and technological perspectives. In particular, the scarcity of clinical data hampers relevant conclusions from being drawn regarding the therapeutic effects of virgin argan oil.

Levels of Se, Zn, Mg and Ca in commercial goat and cow milk fermented products: Relationship with their chemical composition and probiotic starter culture.

We determined Se, Zn, Mg and Ca levels in 42 samples of goat and cow fermented milks which are widely consumed in Spain were determined. Atomic absorption spectrometry (hydride generation for Se and flame atomisation for remaining elements) was used as an analytical technique. Reliability of the procedure was checked. Only Mg levels in goat fermented milks were significantly higher to those found in cow fermented milks (p<0.022). Important similarities in concentrations and behaviours for Mg and Ca have been observed. Mg contents were significantly correlated with Zn (r=0.590; p<0.001) and Ca (r=0.344; p<0.028) concentrations, Zn, Mg and Ca levels with protein content (r=0.554, r=0.479, r=0.388, respectively), Mg levels with fats (r=0.403; p=0.011) and Se levels with carbohydrates (r=-0.379; p=0.031). Mineral and macronutrient levels in yogurts with traditional probiotic starter cultures were not significantly different to those found in fermented milks with additional probiotic microorganisms (p>0.05). It was concluded that goat fermented milks are a better source for Mg than cow samples.