Effects of a mediterranean diet on the gut microbiota and microbial metabolites: A systematic review of randomized controlled trials and observational studies.

Consumption of the Mediterranean dietary pattern (MedDiet) is associated with reduced risk of numerous non-communicable diseases. Modulation of the composition and metabolism of the gut microbiota represents a potential mechanism through which the MedDiet elicits these effects. We conducted a systematic literature search (Prospero registration: CRD42020168977) using PubMed, The Cochrane Library, MEDLINE, SPORTDiscuss, Scopus and CINAHL databases for randomized controlled trials (RCTs) and observational studies exploring the impact of a MedDiet on gut microbiota composition (i.e., relative abundance of bacteria or diversity metrics) and metabolites (e.g., short chain fatty acids). Seventeen RCTs and 17 observational studies were eligible for inclusion in this review. Risk of bias across the studies was mixed but mainly identified as low and unclear. Overall, RCTs and observational studies provided no clear evidence of a consistent effect of a MedDiet on composition or metabolism of the gut microbiota. These findings may be related to the diverse methods across studies (e.g., MedDiet classification and analytical techniques), cohort characteristics, and variable quality of studies. Further, well-designed studies are warranted to advance understanding of the potential effects of the MedDiet using more detailed examination of microbiota and microbial metabolites with reference to emerging characteristics of a healthy gut microbiome.

Histological prognosticators in neoadjuvant naive oesophageal cancer patients.

PURPOSE: Prognosis of oesophageal cancer is primarily based upon the TNM stage of the disease. However, even in those with similar TNM staging, survival can be varied. Additional histopathological factors including venous invasion (VI), lymphatic invasion (LI) and perineural invasion (PNI) have been identified as prognostic markers yet are not part of TNM classification. The aim of this study is to determine the prognostic importance of these factors and overall survival in patients with oesophageal or junctional cancer who underwent transthoracic oesophagectomy as the unimodality treatment. METHODS: Data from patients who underwent transthoracic oesophagectomy for adenocarcinoma without neoadjuvant treatment were reviewed. Patients were treated with radical resection, with a curative intent using a transthoracic Ivor Lewis or three staged McKeown approach. RESULTS: A total of 172 patients were included. Survival was poorer when VI, LI and PNI were present (p<0.001), with the estimated survival being significantly worse (p<0.001) when patients were stratified according to the number of factors present. Univariable analysis of factors revealed VI, LI and PNI were all associated with survival. Presence of LI was independently predictive of incorrect staging/upstaging in multivariable logistic regression analysis (OR 12.9 95% CI 3.6-46.6, p<0.001). CONCLUSION: Histological factors of VI, LI and PNI are markers of aggressive disease and may have a role in prognostication and decision-making prior to treatment. The presence of LI as an independent marker of upstaging could be a potential indication for the use of neoadjuvant treatment in patients with early clinical disease.

Evaluation of an established colorectal robotic programme at an NHS district general hospital: audit of outcomes and systematic review of published data.

INTRODUCTION: Robotic-assisted surgery (RAS) offers potential advantages over traditional surgical approaches. This study aimed to assess outcomes from a district general hospital (DGH) robotic colorectal programme against published data. MATERIALS AND METHODS: The robotic programme was established following simulator, dry/wet lab training, and proctoring. We performed a case series analysing technical, patient, and oncological outcomes extracted from a prospective database of colorectal RAS cases (2015-2022). A registered systematic review (PROSPERO CRD42022300773; PubMed, Web of Science, EMBASE) of single-centre colorectal series from established robotic centres (n>200 cases) was completed and compared to local data using descriptive summary statistics. Risk of bias assessment was performed using an adapted version of the Cochrane ROBINS-I tool. RESULTS: Two hundred thirty-two RAS cases were performed including 122 anterior resections, 56 APERs, 19 rectopexies, and 15 Hartmann's procedures. The median duration was 325 (IQR 265-400) min. Blood loss was < 100 ml in 97% of cases with 2 (0.9%) cases converted to open. Complications (Clavien-Dindo 3-5) occurred in 19 (8%) patients, with 3 (1.3%) deaths in < 30 days. Length of stay was 7 (IQR 5-11) days. In 169 rectal cancer cases, there were 9 (5.3%) cases with a positive circumferential or distal margin and lymph node yield of 17 (IQR 13-24). A systematic review of 1648 abstracts identified 13 studies from established robotic centres, totaling 4930 cases, with technical, patient, and oncological outcomes comparable to our own case series. CONCLUSIONS: Outcomes from our robotic colorectal programme at a UK DGH are comparable with the largest published case series from world-renowned centres. Training and proctoring together with rolling audit must accompany the expansion of robotic surgery to safeguard outcomes.

Biochar filters as an on-farm treatment to reduce pathogens when irrigating with wastewater-polluted sources.

Microbial contamination of vegetables due to irrigation with wastewater-polluted streams is a common problem around most cities in developing countries because wastewater is an available source of water and nutrients but wastewater treatment is often inadequate. On-farm treatment of polluted water is a feasible option to manage microbial risks in a multi-barrier approach. Current evidence indicates good suitability of biochar filters for microbe removal from wastewater using the hydraulic loading rate (HLR) designed for sand filters, but their suitability has not been tested under on-farm conditions. This study evaluated the combined effect of several variables on removal of microbial indicators from diluted wastewater by biochar filtration on-farm and the correlations between removal efficiency and HLR. Columns of biochar with three different effective particle diameters (d10) were fed with diluted wastewater at 1x, 6x, and 12x the design HLR and two levels of water salinity (electrical conductivity, EC). Influent and effluent samples were collected from the columns and analyzed for bacteriophages (ɸX174 and MS2), Escherichia coli, Enterococcus spp., and Saccharomyces cerevisiae. Microbe removal decreased with increasing HLR, from 2 to 4 to 1 log10 for bacteria and from 2 to 0.8 log10 for viruses, while S. cerevisiae removal was unaffected. Effective particle diameter (d10) was the main variable explaining microbe removal at 6x and 12x, while EC had no effect. Correlation analysis showed removal of 2 log10 bacteria and 1 log10 virus at 3x HLR. Thus biochar filters on-farm would not remove significant amounts of bacteria and viruses. However, the design HLR was found to be conservative. These results, and some technical and management considerations identified, can assist in the development of a scientific method for designing biochar filters for on-farm and conventional wastewater treatment.

Pathogens in crop production systems irrigated with low-quality water in Bolivia.

In dry areas, the need for irrigation to ensure agricultural production determines the use of all available water sources. However, the water sources used for irrigation are often contaminated by untreated or minimally treated wastewater. Microbial risks from reusing wastewater for vegetable irrigation can be addressed by installing environmental barriers that pathogens must cross to reach humans in the reuse system. Knowledge of pathogen flows inside the system and pathogen removal potential is the first step towards devising a risk management strategy. This study assessed microbe prevalence in farming systems in the Bolivian highlands that use wastewater-polluted sources for irrigation of lettuce. Samples of soil, lettuce and different water sources used in the farming systems were taken during one crop season and concentrations of coliphages, Escherichia coli and helminth eggs were measured. The results showed high spread of these microorganisms throughout the whole system. There was a significant correlation between microbial quality of water and of the harvested produce for several microorganisms. The microbial prevalence in protected shallow wells was found to be significantly lower than in other water sources. These findings can help formulate feasible risk management strategies in contexts where conventional technologies for microbial removal are not possible.

Endoscopic radiofrequency Stretta therapy reduces proton pump inhibitor dependency and the need for anti-reflux surgery for refractory gastroesophageal reflux disease.

BACKGROUND/AIMS: Radiofrequency treatment of the gastroesophageal junction using the Stretta procedure for treating gastroesophageal reflux disease (GERD) is observed to improve the symptoms and proton pump inhibitor (PPI) dependence and reduce the need for anti-reflux operations. As one of the largest studies in Europe, we evaluated the clinical outcomes of Stretta in patients with medically refractory GERD. METHODS: A tertiary UK center evaluated all patients with refractory GERD who underwent Stretta between 2014 and 2022. Patients and primary care professionals were contacted to obtain information regarding the initiation of PPI and reintervention after Stretta. RESULTS: Of the 195 patients (median age, 55 years; 116 women [59.5%]) who underwent Stretta, PPI-free period (PFP) data were available for 144 (73.8%) patients. Overall, 66 patients (45.8%) did not receive PPI after a median follow-up of 55 months. Six patients (3.1%) underwent further interventions. The median PFP after Stretta was 41 months. There was a significant negative correlation between PFP and age (p=0.007), with no differences between sexes (p=0.96). Patients younger than 55 years of age had a longer PFP than their older counterparts (p=0.005). Younger males had a significantly longer PFP than older males (p=0.021). However, this was not observed in the female cohort (p=0.09) or between the younger men and women (p=0.66). CONCLUSION: Our findings suggest that Stretta is a safe and feasible option for treating refractory GERD, especially in younger patients. It prevents further anti-reflux interventions in most patients and increases the lead-time to surgery in patients with refractory GERD.

Subcutaneous entomophthoromycosis masquerading as soft tissue neoplasm in breastfeeding mother.

Subcutaneous entomophthoromycosis is an infection caused by saprophytic, ubiquitous and highly opportunistic fungal pathogens. Individuals with immune disorders are frequently susceptible to these infections. Entomophthoromycosis is a rare fungal infection that primarily affects children andmen, and is known to cause infection in healthy individuals. Diagnosis of the disease is by demonstration of fungal elements using special stains, and the disease responds well to oral antifungal agents. Long-term antifungal agents reduce the need for surgical intervention when the disease presents as a mass. We report a case of an immunocompetent nursing mother in her 20s who presented with a soft tissue mass in her right arm. It was diagnosed as subcutaneous entomophthoromycosis and treated with long-term fluconazole. The lesion showed a significant reduction in size following treatment for 2 months. Subcutaneous fungal infection presenting as a mass-forming lesion in extremities may mimic a neoplasm. Fungal infection should be ruled out in inflammatory cell-rich lesions seen on histopathological examination.

Mechanical energy on anaerobic capacity during a supramaximal treadmill running in men: Is there influence between runners and active individuals?

This study verified whether mechanical variables influence the anaerobic capacity outcome on treadmill running and whether these likely influences were dependent of running experience. Seventeen physical active and 18 amateur runners, males, performed a graded exercise test and constant load exhaustive running efforts at 115% of intensity associated to maximal oxygen consumption. During the constant load were determined the metabolic responses (i.e., gas exchange and blood lactate) to estimate the energetic contribution and anaerobic capacity as well as kinematic responses. The runners showed higher anaerobic capacity (16.6%; p = 0.005), but lesser time to exercise failure (-18.8%; p = 0.03) than active subjects. In addition, the stride length (21.4%; p = 0.00001), contact phase duration (-11.3%; p = 0.005), and vertical work (-29.9%; p = 0.015). For actives, the anaerobic capacity did not correlate significantly with any physiologic, kinematic, and mechanical variables and no regression model was fitted using the stepwise multiple regression, while to runners the anaerobic capacity was significantly correlated with phosphagen energetic contribution (r = 0.47; p = 0.047), external power (r = -0.51; p = 0.031), total work (r = -0.54; p = 0.020), external work (r = -0.62; p = 0.006), vertical work (r = -0.63; p = 0.008), and horizontal work (r = -0.61; p = 0.008), and the vertical work and phosphagen energetic contribution presented a coefficient of determination of 62% (p = 0.001). Based on findings, it is possible to assume that for active subjects, the mechanical variables have no influence over the anaerobic capacity, however, for experienced runners, the vertical work and phosphagen energetic contribution have relevant effect over anaerobic capacity output.

It's No Has Bean: A Review of the Effects of White Kidney Bean Extract on Body Composition and Metabolic Health.

The rising prevalence of overweight and obesity is a global concern, increasing the risk of numerous non-communicable diseases and reducing quality of life. A healthy diet and exercise remain the cornerstone treatments for obesity. However, adherence rates can be low and the effectiveness of these interventions is often less than anticipated, due to compensatory changes in other aspects of the energy balance equation. Whilst some alternative weight-loss therapies are available, these strategies are often associated with side effects and are expensive. An alternative or adjunct to traditional weight-loss approaches may be the use of bioactive compounds extracted from food sources, which can be incorporated into habitual diet with a low cost and minimal burden. One product which has attracted attention in this regard is white kidney bean extract (WKBE), which has been suggested to inhibit the enzyme α-amylase, limiting carbohydrate digestion and absorption with small but potentially meaningful attendant beneficial effects on body weight and metabolic health. In this review, drawing evidence from both human and animal studies, we discuss the current evidence around the effects of WKBE on body composition and metabolic health. In addition, we discuss evidence on the safety of this supplement and explore potential directions for future research.

3-min all-out effort on cycle ergometer is valid to estimate the anaerobic capacity by measurement of blood lactate and excess post-exercise oxygen consumption.

The purpose of this study was to investigate the use of a single 3-min all-out maximal effort to estimate anaerobic capacity (AC) through the lactate and excess post-exercise oxygen consumption (EPOC) response methods (AC[La-]+EPOCfast) on a cycle ergometer. Eleven physically active men (age = 28.1 ± 4.0 yrs, height = 175.1 ± 4.2 cm, body mass = 74.8 ± 11.9 kg and ⩒O2max = 40.7 ± 7.3 mL kg-1 min-1), participated in the study and performed: i) five submaximal efforts, ii) a supramaximal effort at 115% of intensity of ⩒O2max, and iii) a 3-min all-out maximal effort. Anaerobic capacity was estimated using the supramaximal effort through conventional maximal accumulated oxygen deficit (MAOD) and also through the sum of oxygen equivalents from the glycolytic (fast component of excess post-exercise oxygen consumption) and phosphagen pathways (blood lactate accumulation) (AC[La-]+EPOCfast), while during the 3-min all-out maximal effort the anaerobic capacity was estimated using the AC[La-]+EPOCfast procedure. There were no significant differences between the three methods (p > 0.05). Additionally, the anaerobic capacity estimated during the 3-min all-out effort was significantly correlated with the MAOD (r = 0.74; p = 0.009) and AC[La-]+EPOCfast methods (r = 0.65; p = 0.029). Therefore, it is possible to conclude that the 3-min all-out effort is valid to estimate anaerobic capacity in physically active men during a single cycle ergometer effort.

Obturator hernia - MRI image.

Obturator hernia although considered a rare entity is the most frequently encountered pelvic floor hernia. Since the first published report in the 18th century, their unusual and unfamiliar clinical presentation still represents a diagnostic dilemma for the modern day clinician. A detailed history and clinical examination in our thin, elderly female patient who presented with intermittent small bowel obstruction and symptoms of right obturator nerve compression with a positive Howship-Romberg sign was crucial in establishing a diagnosis. Sophisticated radiologic modalities such as MRI as shown below in the case of our patient can reliably confirm the diagnosis of obturator hernia.