Effects of the use of raw or cooked chickpeas and the sausage cooking time on the quality of a lamb-meat, olive-oil emulsion-type sausage.

Reformulation of cooked sausages using high-protein plant-based food such as chickpea as meat extenders and vegetable oils to replace animal fat can be a suitable approach to promote the consumption of smaller portions of meat. The pre-processing of chickpea and the sausage cooking intensity can potentially affect the quality of reformulated sausages. In this study, an emulsion-type sausage made with lamb meat, chickpea and olive oil was prepared in triplicate following three different formulations containing the same targeted levels of protein (8.9%), lipids (21.5%), and starch (2.9%): control sausage (CON; control, without chickpea), and raw (RCP) and cooked chickpea (CCP) sausages (both with 7% chickpea). Sausages were cooked at 85 °C for two heating times (40 min or 80 min) and were analysed for weight loss, emulsion stability, colour, texture, lipid oxidation and volatile composition. Compared to CON sausages, the use of raw chickpea reduced the elasticity and significantly increased lipid oxidation during the sausage-making process resulting in major changes in the volatile composition. The use of previously cooked chickpea, however, resulted in the sausages having greater cooking loss, hardness and chewiness than CON sausages, while there was no difference in lipid oxidation, and differences in volatile compounds were scarce. The reformulation with cooked chickpea could provide a sausage with more similarity to the CON sausage. The extended heating time of 80 min at 85 °C did not significantly affect the quality traits in either CON or reformulated sausages except for a higher cooking loss.

Safety and efficacy of cobimetinib plus atezolizumab in patients with solid tumors: a phase II, open-label, multicenter, multicohort study.

BACKGROUND: Although introduction of immune checkpoint inhibitors has revolutionized the treatment of cancer, their response rates are generally low. Preclinical and early phase clinical data suggest that MEK inhibition may sensitize tumors to immune checkpoint inhibitors by upregulating tumor antigen expression, programmed death-ligand 1 (PD-L1) expression, and tumor T-cell infiltration. We evaluated the efficacy and safety of cobimetinib plus atezolizumab in patients with advanced solid tumors in the open-label, multicohort phase II COTEST study. PATIENTS AND METHODS: This analysis of the COTEST trial included patients from cohorts 1-4 [1-3: anti-programmed cell death protein 1 (PD-1)/PD-L1 treatment-naive patients; 4: patients with disease progression on anti-PD-1/anti-PD-L1 treatment] who received cobimetinib 60 mg once daily for the first 21 days and intravenous infusions of atezolizumab 840 mg on days 1 and 15 of each 28-day cycle. Efficacy endpoints included objective response rate, overall survival, progression-free survival (PFS), and disease control rate. RESULTS: Overall, 77 patients were enrolled in cohorts 1-4 (78% male; median age 62.8 years). Objective response rate was 20% in cohort 1 [squamous cell carcinoma of the head and neck (SCCHN)], 30% in cohort 2 (urothelial carcinoma), and 18% in cohort 3 (renal cell carcinoma); there were no responders among 20 patients in cohort 4 (SCCHN). The disease control rates in cohorts 1-4 were 50%, 40%, 24%, and 25%, respectively. The median PFS was 5.5, 3.4, 3.4, and 3.6 months in cohorts 1-4, respectively, and the median overall survival was 16.8, 18.7, 21.7, and 7.7 months, respectively. Most adverse events were of grade 1/2 and were manageable. CONCLUSIONS: Cobimetinib plus atezolizumab had moderate activity in patients with anti-PD-1/PD-L1 treatment-naive SCCHN and urothelial carcinoma, and weak activity in anti-PD-1/PD-L1 treatment-naive renal cell carcinoma, and no activity in checkpoint inhibitor-treated patients.

Biomarkers of treatment benefit with atezolizumab plus vemurafenib plus cobimetinib in BRAFV600 mutation-positive melanoma.

BACKGROUND: The phase III IMspire150 study (NCT02908672) demonstrated significantly improved progression-free survival (PFS) with atezolizumab, vemurafenib, and cobimetinib (atezolizumab group) versus placebo, vemurafenib, and cobimetinib (control group) in patients with BRAFV600-mutated advanced melanoma. We report exploratory biomarker analyses to optimize targeting of patients who are more likely to benefit from triplet combination therapy. PATIENTS AND METHODS: Five hundred fourteen patients were randomized to atezolizumab (n = 256) or control (n = 258). Outcomes were evaluated in subgroups defined by key biomarkers, including programmed death-ligand 1 (PD-L1) expression, lactate dehydrogenase (LDH) level, tumor mutational burden (TMB), and interferon-γ (IFN-γ) gene signature. Exploratory recursive partitioning analysis was then used to model associations between PFS and baseline covariates, including key biomarkers. RESULTS: PFS benefit for atezolizumab versus control was greater in patients with high TMB [≥10 mutations/Mb; hazard ratio (HR) 0.73; 95% confidence interval (CI) 0.52-1.02; P = 0.067] versus low TMB (<10 mutations/Mb; HR 0.92; 95% CI 0.65-1.30; P = 0.64) and similar between patients with strong IFN-γ (≥median; HR 0.76; 95% CI 0.54-1.06) versus weak IFN-γ (

Assessment of the antioxidant effect of astaxanthin in fresh, frozen and cooked lamb patties.

Astaxanthin is a natural red carotene exerting a strong antioxidant action. The effect of this carotene on the oxidative stability of raw and cooked lamb patties was evaluated. Seven experimental treatments were included in this study depending on the antioxidants added, which are: no antioxidant added (control), 450 mg/kg of sodium metabisulphite, 500 mg/kg of sodium ascorbate, and 20 mg/kg, 40 mg/kg, 60 mg/kg and 80 mg/kg of astaxanthin. The raw patties were either refrigerated for up to 11 days or frozen for 3 months under aerobic conditions. Changes in thiobarbituric reactive substances (TBARS), instrumental colour, pH and Eh were determined in the refrigerated patties and TBARS in the frozen patties. Volatile compounds were determined in cooked patties and cholesterol oxides in both cooked and after cooking microwave reheated patties. The changes in TBARS of cooked patties during a four-day refrigerated storage were also studied. Compared to the control patties, the use of astaxanthin reduced the TBARS generation in a manner depending on the dose for both raw and cooked patties during storage (P < 0.05). Astaxanthin added at levels of 60 and/or 80 mg/kg showed a greater antioxidant effect than ascorbate and metabisulphite. The presence of astaxanthin, like that of ascorbate, decreased the oxysterols levels of cooked patties with regard to controls. The amount of volatiles released from the cooked patties was also reduced by astaxanthin. This effect was not observed for ascorbate or metabisulphite. Astaxanthin in lamb patties at levels of 60-80 mg/kg could improve raw and cooked lamb patty oxidative stability during refrigerated aerobic storage, protect their lipids against thermal degradation more than ascorbate and metabisulphite, and reduce oxysterols formation during cooking in a similar way to ascorbate.

Vemurafenib in patients with BRAFV600 mutation-positive metastatic melanoma: final overall survival results of the randomized BRIM-3 study.

BACKGROUND: The BRIM-3 trial showed improved progression-free survival (PFS) and overall survival (OS) for vemurafenib compared with dacarbazine in treatment-naive patients with BRAFV600 mutation-positive metastatic melanoma. We present final OS data from BRIM-3. PATIENTS AND METHODS: Patients were randomly assigned in a 1 : 1 ratio to receive vemurafenib (960 mg twice daily) or dacarbazine (1000 mg/m2 every 3 weeks). OS and PFS were co-primary end points. OS was assessed in the intention-to-treat population, with and without censoring of data for dacarbazine patients who crossed over to vemurafenib. RESULTS: Between 4 January 2010 and 16 December 2010, a total of 675 patients were randomized to vemurafenib (n = 337) or dacarbazine (n = 338, of whom 84 crossed over to vemurafenib). At the time of database lock (14 August 2015), median OS, censored at crossover, was significantly longer for vemurafenib than for dacarbazine {13.6 months [95% confidence interval (CI) 12.0-15.4] versus 9.7 months [95% CI 7.9-12.8; hazard ratio (HR) 0.81 [95% CI 0.67-0.98]; P = 0.03}, as was median OS without censoring at crossover [13.6 months (95% CI 12.0-15.4) versus 10.3 months (95% CI 9.1-12.8); HR 0.81 (95% CI 0.68-0.96); P = 0.01]. Kaplan-Meier estimates of OS rates for vemurafenib versus dacarbazine were 56% versus 46%, 30% versus 24%, 21% versus 19% and 17% versus 16% at 1, 2, 3 and 4 years, respectively. Overall, 173 of the 338 patients (51%) in the dacarbazine arm and 175 of the 337 (52%) of those in the vemurafenib arm received subsequent anticancer therapies, most commonly ipilimumab. Safety data were consistent with the primary analysis. CONCLUSIONS: Vemurafenib continues to be associated with improved median OS in the BRIM-3 trial after extended follow-up. OS curves converged after ≈3 years, likely as a result of crossover from dacarbazine to vemurafenib and receipt of subsequent anticancer therapies. CLINICALTRIALS.GOV: NCT01006980.

[The pediatrician and child death: integration of palliative care in the pediatric intensive care unit]. / El pediatra ante la muerte del niño: integración de los cuidados paliativos en la unidad de cuidados intensivos pediátricos.

Palliative care is essential in the pediatric intensive care unit (PICU). Because of the mortality rates and the presence of life-threatening conditions in children admitted to the PICU, pediatricians must be prepared to provide palliative care independently of cure-directed therapies. The present article reviews certain issues, including the decision-making process in the PICU, psychosocial needs and susceptibility to burnout among PICU staff, and the emotions and attitudes of the staff when a child dies. We provide some guidelines on how to act when a child dies, how to meet with parents after the child's death and how to follow-up parental bereavement. Strategies that can help PICU pediatricians to cope with the numerous loses they experience are suggested.

[Pediatric palliative care: a comprehensive model of care for children with life-threatening conditions and their families]. / Los cuidados paliativos: un modelo de atención integral al niño gravemente enfermo y a su familia.

The present article reviews aspects unique to pediatric palliative care: the attitudes of medical staff toward pediatric death and life-threatening conditions, distinct patterns of pediatric deaths, the causes of suffering in children with life-threatening conditions and their families, and the features that make palliative care a challenge for children, families, medical staff and society. Concepts of pediatric palliative care and various approaches are described. In addition, Universal Principles of Pediatric Palliative Care are presented. Special attention is paid to approaches that start palliative care at diagnosis of a life-threatening conditions, do not require a short-term life prognosis and do not exclude curative or life-prolonging therapies since these approaches can benefit both children who survive life-threatening conditions and those who die, as well as their families. The need for certain changes through education and research is proposed to improve the quality of life of children and families who currently suffer, satisfaction and cohesion among medical staff, and healthcare quality.

[Effective psychological interventions for coping with painful medical procedures in pediatric oncology: a theoretical review]. / Intervenciones psicológicas eficaces para el afrontamiento de procedimientos médicos dolorosos en oncología pediátrica: revisión teórica.

Children with chronic diseases have to undergo numerous and repeated painful medical procedures. Psychological interventions have produced good results in the treatment of this kind of pediatric pain and, although they have not been routinely incorporated into pediatric practice, they provide an effective complement to physical and pharmacological therapies. The present article reviews research into cognitive-behavioral treatment of the distress, pain and anxiety associated with medical procedures in pediatric oncology. We present the possible benefits of these interventions and suggest uses for cognitive-behavioral techniques when performing painful medical procedures.

[Psychological intervention for coping with painful medical procedures in pediatric oncology]. / Intervención psicológica para el afrontamiento de procedimientos médicos dolorosos en oncología pediátrica.

BACKGROUND: Psychological treatments for procedural distress have shown good results in pediatric oncology and several institutions recommend their implementation to reduce the procedural distress, anxiety and pain associated with painful medical procedures. OBJECTIVES: To assess the results of a psychological intervention in the first child participating in the study "Prospective Analysis of a Psychological Program for Coping with Medical Procedures in Pediatric Oncology". METHODS: We performed a single-case study, using pain and anxiety self-reports by the child and an observational scale in a psychological intervention with the following components: Breathing exercises, imagery, reinforcement, and behavioral rehearsal. RESULTS: The psychological intervention decreased procedural distress, anticipatory anxiety and pain. The 3-year-old child was able to give pain and anxiety self-reports using appropiate tools. CONCLUSIONS: The potential benefits of this kind of intervention are discussed, and some recommendations for future research are proposed.

[Assessment of pain and anxiety related to painful medical procedures in pediatric oncology]. / Evaluación de la ansiedad y el dolor asociados a procedimientos médicos dolorosos en oncología pediátrica.

In this article we review the instruments most commonly used in clinical practice and research to assess the pain and anxiety experienced by children with cancer undergoing painful medical procedures. Issues such as the prevalence of pain in childhood cancer, the psychologic impact of medical procedures in children, and the efforts some institutions are making to implement pediatric pain assessment programs are also reviewed, bearing in mind that pain is a subjective and multidimensional experience. Behavioral measures, self-reports, multidimensional assessment tools and physiological measures are included, emphasizing the importance of self-reports, which are considered the gold standard in pediatric pain assessment. This literature review indicates the need for research and for the education of health care professionals in pediatric pain assessment. Finally, recommendations for pediatric pain assessment are suggested.

Dermatomyositis.

Dermatomyositis is a disease that has a characteristic skin eruption that may occur with or without a proximal myopathy. The disease with cutaneous features only is classified as amyopathic dermatomyositis. The origin is unknown, but autoimmune factors are believed to play an important role. Autoantibodies are found in most patients and some have myositis-specific antibodies. Systemic changes may occur and there appears to be a relationship to internal malignancy, particularly in older patients. Juvenile disease has an associated vasculopathy. Treatment includes systemic corticosteroids and other immunosuppressive agents. The cutaneous changes may be difficult to treat.

The aging face. Why changes occur, how to correct them.

Most changes that occur in the aging face are related to gravity working on skin that is becoming progressively thinner, drier, and less elastic. Exposure to sunlight hastens these changes, and protection from the sun is the only proved way to delay them. Dermabrasion, chemabrasion, and collagen implant (Zyderm) injection are safe and effective nonsurgical procedures that can improve the appearance of the aging face. Plastic surgical procedures to remove excess skin at the upper eyelids, raise the eyebrows, tighten the lower lids, and elevate the nasal tip can provide functional as well as cosmetic improvement.

Scar sarcoidosis.

A patient with erythema nodosum, bilateral hilar adenopathy, and induration of a scar is presented. Scar sarcoidosis is one of the specific but more unusual manifestations of sarcoidosis.

Lipoid proteinosis. Report of 2 cases with histology of the vocal folds.

Two cases of lipoid proteinosis, in which biopsies of the vocal cords were done, are presented. The condition is briefly discussed.