Measuring Pain-related Behavioral Inhibition and Behavioral Activation System Responses: Further Validity Evidence for the Pain Responses Scale.

OBJECTIVES: The Pain Responses Scale and its Short Form (PRS-SF) were recently developed to assess the affective, behavioral, and cognitive responses to pain based on the behavioral inhibition system (BIS) and behavioral activation system (BAS) model of chronic pain. The purpose of this study was to provide additional tests of the psychometric properties of the PRS-SF in a new sample of individuals with chronic pain. METHODS: A sample of Spanish adults (N = 190) with chronic non-cancer pain completed a translated version of the PRS-SF and a battery of questionnaires measuring validity criteria hypothesized the be associated with BIS and BAS activation, including measures of sensitivity to punishment, sensitivity to reward, pain intensity, pain interference, catastrophizing, and pain acceptance. RESULTS: Confirmatory factor analysis supported a 4-factor structure for the PRS-SF assessing despondent, escape, approach, and relaxation responses (S-B χ 2 [5] = 1.49, Comparative Fit Index = 0.99, Non-Normed Fit Index = 0.99, root-mean-square error of approximation = 0.051, Akaike Information Criterion = 4113.66), with marginal internal consistency for 1 scale (relaxation) and adequate to good internal consistency for the others. The pattern of associations found between the PRS-SF Scale scores and the validity criterion supports the validity of the instrument. CONCLUSION: The results provide additional support for the validity of the 4 PRS-SF Scale scores, and the reliability of 3 of the scales. If these findings are replicated in future research, investigators may wish to administer more items from the original Relaxation Scale when assessing this domain to ensure adequate reliability for this scale. The other items from the PRS-SF assessing despondent, escape, and approach responses appear to provide at least adequate reliability. When used in this way, the PRS-SF may be used to measure BIS and BAS responses to pain to: (1) provide further tests of the BIS-BAS model of chronic pain and/or (2) understand the potential mediating effects of BIS and BAS responses on the effects of psychological pain treatments to help determine which specific responses are most responsible for the benefits of treatment, and, therefore, which responses should be specifically targeted to enhance treatment response.

Neuropsychological and biopsychosocial evolution, therapeutic adherence and unmet care needs during paediatric transplantation: study protocol of a mixed-methods design (observational cohort study and focus groups) - the TransplantKIDS mental health project.

The present article describes the protocol of a mixed-methods study (an observational cohort design and focus groups), aimed to examine neuropsychological functioning and other biopsychosocial outcomes, therapeutic adherence and unmet care needs in paediatric population undergoing solid organ or allogeneic hematopoietic transplant during the pre- and post-transplant phases. Following a multi-method/multi-source approach, neuropsychological domains will be comprehensively measured with objective tests (SDMT, K-CPT 2/CPT 3, TAVECI/TAVEC, WISC-V/WAIS-IV Vocabulary and Digit Span subtests, Verbal Fluency tests, Stroop, ROCF, and TONI-4); ecological executive functioning, affective and behavioral domains, pain intensity/interference, sleep quality and therapeutic adherence will be assessed through questionnaires (parent/legal guardians-reported: BRIEF-2 and BASC-3; and self-reported: BASC-3, BPI, PROMIS, AIQ and SMAQ); and blood levels of prescribed drugs will be taken from each patient's medical history. These outcomes will be measured at pre-transplant and at 4-weeks and 6-months post-transplant phases. The estimated sample size was 60 patients (any type of transplant, solid organ, or hematopoietic) from La Paz University Hospital (Madrid, Spain). Finally, three focus group sessions will be organized with patients, parents/guardians, and transplant clinicians (n = 15, with 5 participants per group), in order to qualitatively identify unmet care needs during the pre-, and post-transplant stages of the process. The study protocol was registered at ClinicalTrials.gov (NCT05441436).

Physicians' perception about predictors of opioid abuse in patients with chronic non-cancer pain: a Delphi study.

Background: Opioids are being prescribed widely, and increasingly, for the treatment of chronic non-cancer pain (CNCP). However, several side effects are associated with mid- and long-term opioid use and, for certain patients, with the risk of problematic opioid use. The aim of this study is to know the perception of the physicians about which variables could be associated with increased risk of patients with CNCP developing a problem of abuse or misuse of the prescribed opioid medication. Methods: Twenty-nine physicians with experience in CNCP pain management and opioids prescription participated in a two-round Delphi study focused on the risk factors for opioid misuse and abuse. Results: The variables that reached consensus regarding their relationship with the increased risk of suffering a problem of opioid abuse or misuse were: (1) Experiencing pain on a daily basis, (2) previous use of high-dose opioids, (3) generalized anxiety, (4) hopelessness, (5) benzodiazepine intake, (6) use of opioids for reasons other than pain, (7) family problems, family instability or family breakdown, and (8) having access to several opioid prescribers. The only variable that reached consensus regarding it not being associated to a possible risk of abuse or misuse was having mild pain intensity (0-4 on a NRS-11). Conclusions: This study provides useful information that could help make decisions about the use of opioids for CNCP treatment and prevent future difficulties. Prospective studies testing the relationship of the variables that reached consensus with the risk of opioid misuse and abuse are warranted. Significance: This study shows the variables of CNCP that the professional must take into account in order to avoid possible problems when prescribing opioids.

Spent coffee grounds and its antioxidant dietary fiber promote different colonic microbiome signatures: Benefits for subjects with chronodisruption.

Chronodisruption, commonly displayed by people living with obesity (PLO), is linked to colonic microbiota dysbiosis, and may increase the risk of many chronic non-communicable diseases, whereas dietary interventions-called chrononutrition may mitigate it. We evaluated the in vitro effects of spent coffee grounds (SCG), and their antioxidant dietary fiber (SCG-DF) on the colonic microbiota of an obese donor displaying dysbiosis and chronodisruption. Basal microbiota pattern was associated with an increased risk of non-communicable chronic diseases. Both samples decrease species richness and increase microbiota diversity (p < 0.05; Chao and Shannon index, respectively), positively enhancing Firmicutes/Bacteroidetes index (SCG, p < 0.04; SCG-DF, p < 0.02). SCG and SCG-DF modulated the microbiota, but SCG-DF induced greater changes, significantly increasing. p_Actonobacterias (SCG p < 0.04; SCG-DF, p < 0.02), and reducing g_Alistipes; s_putredinis, g_Prevotella;s_copri. The highest increase was displayed by p_Proteobacteria (f_Desulfovibrionaceae and f_Alcanigenaceae, p < 0.05), while g_Haemophilus; s_parainfluenzae decreased (p < 0.05). However, neither SCG nor SCG-DF modulated g_Alistipes (evening-type colonic microbial marker) beneficially. SCG and SCG-DF reduced (p < 0.05) g_Lachnospira, a microbial evening-type marker, among other microbial populations, of an obese donor displaying chronodisruption and dysbiosis. SCG and SCG-DF displayed a prebiotic effect with the potential to mitigate diseases linked to chronodisruption.

Unique Immune Blood Markers Between Severe Dengue and Sepsis in Children.

BACKGROUND: Pediatric dengue and sepsis share clinical and pathophysiologic aspects. Multiple inflammatory and regulatory cytokines, decoy receptors and vascular permeability factors have been implicated in the pathogenesis of both diseases. The differential pattern and dynamic of these soluble factors, and the relationship with clinical severity between pediatric dengue and sepsis could offer new diagnosis and therapeutic strategies. METHODS: We evaluated the concentration levels of 11 soluble factors with proinflammatory, regulatory and vascular permeability involvement, in plasma from children with dengue or sepsis, both clinically ranging from mild to severe, in the early, late and convalescence phases of the disease. RESULTS: During early acute infection, children with sepsis exhibited specific higher concentration levels of IL-6, vascular endothelial growth factor (VEGF), and its soluble decoy receptor II (sVEGFR2) and lower concentration levels of IL-10 and the soluble tumor necrosis factor receptor 2 (sTNFR2), in comparison with children with severe dengue. In addition, the circulating amounts of soluble ST2, and VEGF/sVEGFR2 were widely associated with clinical and laboratory indicators of dengue severity, whereas secondary dengue virus infections were characterized by an enhanced cytokine response, relative to primary infections. In severe forms of dengue, or sepsis, the kinetics and the cytokines response during the late and convalescence phases of the disease also differentiate. CONCLUSIONS: Dengue virus infection and septic processes in children are characterized by cytokine responses of a specific magnitude, pattern and kinetics, which are implicated in the pathophysiology and clinical outcome of these diseases.

Quercetin and Its Fermented Extract as a Potential Inhibitor of Bisphenol A-Exposed HT-29 Colon Cancer Cells' Viability.

Bisphenol A (BPA) promotes colon cancer by altering the physiological functions of hormones. Quercetin (Q) can regulate signaling pathways through hormone receptors, inhibiting cancer cells. The antiproliferative effects of Q and its fermented extract (FEQ, obtained by Q gastrointestinal digestion and in vitro colonic fermentation) were analyzed in HT-29 cells exposed to BPA. Polyphenols were quantified in FEQ by HPLC and their antioxidant capacity by DPPH and ORAC. Q and 3,4-dihydroxyphenylacetic acid (DOPAC) were quantified in FEQ. Q and FEQ exhibited antioxidant capacity. Cell viability with Q+BPA and FEQ+BPA was 60% and 50%, respectively; less than 20% of dead cells were associated with the necrosis process (LDH). Treatments with Q and Q+BPA induced cell cycle arrest in the G0/G1 phase, and FEQ and FEQ+BPA in the S phase. Compared with other treatments, Q positively modulated ESR2 and GPR30 genes. Using a gene microarray of the p53 pathway, Q, Q+BPA, FEQ and FEQ+BPA positively modulated genes involved in apoptosis and cell cycle arrest; bisphenol inhibited the expression of pro-apoptotic and cell cycle repressor genes. In silico analyses demonstrated the binding affinity of Q > BPA > DOPAC molecules for ERα and ERß. Further studies are needed to understand the role of disruptors in colon cancer.

A Mobile Application to Help Self-Manage Pain Severity, Anxiety, and Depressive Symptoms in Patients with Fibromyalgia Syndrome: A Pilot Study.

Treatment for individuals with fibromyalgia syndrome (FMS) is complex and is not always accessible to those who could benefit. The aim of this study was to conduct a preliminary evaluation of a mobile-app-delivered, cognitive behavioral treatment (CBT)-based intervention in helping adults self-manage fibromyalgia symptoms. A total of 100 adults with FMS (M [SD] age = 49.81, [9.99] years; 94% women) were given access to the digital treatment program and downloaded the app. Pain severity, anxiety symptoms, depression symptoms, fatigue, and sleep quality were assessed at pre-treatment, post-treatment, and 3-month follow-up. Fifty-three of the potential participants completed the 47-day treatment. Data showed significant improvements in pain severity (p = 0.007, d = 0.43), anxiety (p = 0.011, d = 0.40) and depressive symptoms (p = 0.001, d = 0.50) from pre-treatment to post-treatment. The effect sizes associated with app use are consistent with improvements seen in previously published clinical trials of CBT for FMS. Improvements were generally maintained, although there was some decrease in the outcomes from post-treatment to the 3-month follow-up. Most participants reported that they were very satisfied with the app. The use of the app was associated with similar levels of improvements found with in-person CBT treatment for FMS. Research to evaluate the effectiveness of the app in a controlled trial is warranted.

Fermentation Extract of Naringenin Increases the Expression of Estrogenic Receptor ß and Modulates Genes Related to the p53 Signalling Pathway, miR-200c and miR-141 in Human Colon Cancer Cells Exposed to BPA.

The estrogenic receptor beta (ERß) protects against carcinogenesis by stimulating apoptosis. Bisphenol A (BPA) is related to promoting cancer, and naringenin has chemoprotective activities both can bind to ERß. Naringenin in the colon is metabolized by the microbiota. Cancer involves genetic and epigenetic mechanisms, including miRNAs. The objective of the present study was to evaluate the co-exposure effect of colonic in vitro fermented extract of naringenin (FEN) and BPA, to elucidate molecular effects in HT-29 colon cancer cell line. For this, we quantified genes related to the p53 signaling pathway as well as ERß, miR-200c, and miR-141. As an important result, naringenin (IC50 250 µM) and FEN (IC50 37%) promoted intrinsic pathways of apoptosis through phosphatase and tensin homolog (PTEN) (+2.70, +1.72-fold, respectively) and CASP9 (+3.99, +2.03-fold, respectively) expression. BPA decreased the expression of PTEN (-3.46-fold) gene regulated by miR-200. We suggest that once co-exposed, cells undergo a greater stress forcing them to mediate other extrinsic apoptosis mechanisms associated with death domain FASL. In turn, these findings are related to the increase of ERß (5.3-fold with naringenin and 13.67-fold with FEN) gene expression, important in the inhibition of carcinogenic development.

Effect of drying method on the production of in vitro short-chain fatty acids and histone deacetylase mediation of cocoa pod husk.

We evaluated the effect of cocoa pod husk (CPH) processing (microwave [MW], forced-air drying [FAD], and FAD plus extrusion [FAD-E]), and in vitro gastrointestinal digestion on the in vitro human colonic fermentation metabolism, in vitro bioactivity on human HT-29 colon cancer cell, and the in silico mechanism of selected compounds. CPH as a substrate for human colonic microbiota significantly decrease local pH (MW -0.7, FAD -0.2, and FAD-E -0.3, 24 h) and modifies their metabolic activity (short-chain fatty acids [SCFAs] production). FAD-E generated the highest butyric (7.6 mM/L, 4 h) and FAD the highest acetic and propionic acid levels (71.4 and 36.7 mM/L, 24 h). The in vitro colonic fermented FAD-E sample (FE/FAD-E) caused HT-29 colorectal cancer cells death by inducing damage on membrane integrity and inhibiting (up to 92%) histone-deacetylase (HDAC) activity. In silico results showed that chlorogenic acid, (-)-epicatechin, and (+)-catechin, followed by butyric and propionic acids, are highly involved in the HDAC6 inhibitory activity. The results highlight the potential human health postbiotic benefits of CPH consumption, mediated by colonic microbiota-derived metabolites. PRACTICAL APPLICATION: The enormous amount of CPH (10 tons/1 ton of dry beans) generated by the cocoa industry can be used as a removable source of bioactive compounds with physicochemical functionality and health bioactivity. However, their potential applications and health benefits are insufficiently explored. CPH represents a serious disposal problem; practical and innovative ideas to use this highly available and affordable material are urgent. Research exploring their potential applications can increase the sustainability of the cocoa agro-industry. This paper highlights the value addition that can be achieved with this valuable industrial co-product, generating new functional products and ingredients.

Garambullo (Myrtillocactus geometrizans): effect of in vitro gastrointestinal digestion on the bioaccessibility and antioxidant capacity of phytochemicals.

Garambullo (Myrtillocactus geometrizans), endemic fruit from Mexico, contains several bioactive compounds (phenolic compounds, betalains, antioxidant fiber), highlighting it as a good functional food. In this research, the impact of the in vitro gastrointestinal digestion on phytochemical bioaccessibility from garambullo and its antioxidant capacity are studied. The fruit contained previously unidentified phytochemicals in the polar and non-polar extracts (acetone and hexane). The bioaccessibility decreased in the mouth and stomach for flavanones (up to 11.9 and 8.9%, respectively), isoflavones (up to 20.0 and 9.2%, respectively), flavonols (up to 15.2 and 15.7%, respectively), hydroxycinnamic acids (up to 21.7 and 13.1%, respectively), and betalains (up to 10.5 and 4.2%, respectively); hydroxybenzoic acids were increased (up to 752.8 and 552.6%, respectively), while tocopherols increased in the mouth (127.7%) and decreased in the stomach (up to 90.3%). In the intestinal phase, the digestible fraction showed low phytochemicals bioaccessibility, and some compounds were recovered in the non-digestible fraction. The antioxidant capacity decreased in different compartments of the gastrointestinal tract, being higher in the mouth (872.9, 883.6, 385.2, and 631.2 µmol TE per g dw by ABTS, DPPH, ORAC, and FRAP, respectively) and stomach (836.2, 942.1, 289.0, and 494.9 µmol TE per g dw ABTS, DPPH, ORAC, and FRAP, respectively). The results indicate that digestion positively or negatively affects compounds' bioaccessibility depending on their structural family, and the antioxidant capacity decreases but remains higher than other functional foods.

Adaptación transcultural y validación de un contenido del cuestionario Texas Textbook Evaluation Tool (T-TET) de evaluación de libros de texto para ciencias de la salud / Cross-Cultural Adaptation and Content Validation of Texas Textbook Evaluation Tool (T-TET) a Book Evaluation Questionnaire for Health Sciences / Adaptação transcultural e validação de um questionário para as ciências da saúde

Introducción: La actualización y evaluación de libros de texto es esencial en el proceso educativo; sin embargo, en idioma español no se encuentran instrumentos para evaluarlos en el área de ciencias de la salud. Objetivo: Llevar a cabo la adaptación transcultural y validación de contenido del instrumento Texas Textbook Eva-luation Tool. Método: Estudio descriptivo de corte transversal con componente psicométrico. Se realizó la adaptación transcul-tural con traducción directa, síntesis de traducciones, traducción inversa, consolidación de traducciones en juicio de expertos y aplicación de una prueba piloto. Todo ello seguido del análisis de fiabilidad interobservador y la consistencia interna a través del alfa ordinal y el análisis factorial confirmatorio.Resultados: Se modificó un ítem que obtuvo un 36,66% de discrepancia. Se obtuvo un alfa de Cronbach de 0,98 y una kappa de Cohen de 0,91. Las pruebas de esfericidad de Barlett y Kaiser-Meyer-Olkin dieron como resulta-do 0,00 y 0,93, respectivamente. Así, se obtuvo en el análisis factorial confirmatorio que todas las variables se agrupan en las seis dimensiones propuestas. Conclusiones: Se realizó una apropiada implementación de los métodos. Los resultados obtenidos destacan la confianza e idoneidad del instrumento. El instrumento presenta una excelente consistencia interna, y se comprobó que mide las dimensiones para las que fue diseñado.

Introduction: The updating and evaluation of textbooks is essential in the educational process, however, in the Spanish language there are no instruments to evaluate them in Health Sciences. Objective: To make a cross-cultural adaptation and content validation of the Texas Textbook Evaluation Tool. Method: Cross-sectional descriptive study with a psychometric component, cross-cultural adaptation is carried out with direct translation, translation synthesis, reverse translation, consolidation of trans-lations in expert judgment and pilot test application. Followed by inter-observer reliability analysis and internal consistency through ordinal alpha and confirmatory factor analysis. Results: One item was modified that obtained a 36% discrepancy. An ordinal alpha of 0.98 and Cohen's Kappa index of 0.91 were obtained. The Bartlett and Kaiser-Meyer-Olkin sphericity tests resul-ted in 0.00 and 0.93 respectively, obtaining in the confirmatory factorial analysis that all the variables are grouped in the 6 proposed dimensions. Conclusions: An appropriate implementation of the methods, the results obtained highlight the con-fidence and suitability of the instrument. The instrument has excellent internal consistency, and it was verified that it measures the dimensions for which it was designed.

Introdução: A atualização dos livros de texto é essencial no processo educacional em Ciências da Saúde, mas no idioma espanhol não há instrumentos para sua avaliação. Objetivo: Adaptação transcultural e validação do instrumento Texas Textbook Evaluation Tool. Método: A tradução, retrotradução, teste piloto, confiabilidade, consistência interna e análise de fatores exploratórios foram abrangidos. Resultados: Um item foi modificado com uma discrepância de 36,66%. Foi obtido um coeficiente alfa de Cronbach de 0,98 e o índice Kappa de Cohen de 0,91. Os testes de esfericidade de Barlett e Kaiser-Meyer-Olkin resultaram em 0,00 e 0,93 respetivamente. Conclusões: Os métodos foram implementados adequadamente, e os resultados obtidos destacam a confiança e adequação do instrumento

Face validity of a simulated low back pain clinical case in physical therapy training / Validez aparente de un caso clínico simulado de dolor lumbar en formación en fisioterapia

Abstract Introduction: The use of clinical cases in simulated environments allows for a more realistic approach to the simulated health condition, which results in a more effective training experience for students, as they are immersed in situations they may encounter in their professional practice. Objective: To determine the face validity of a low back pain clinical case as a clinical simulation tool in the training of physical therapy students. Materials and methods: Study conducted to determine the face validity of a low back pain clinical case presented to physical therapy students. The case has 9 items, which were evaluated by 5 expert raters. Agreement between raters regarding the pertinence, relevance, coherence, clarity, and sufficiency of the case was established using the Fleiss' Kappa coefficient. Results: Fleiss ' Kappa for the simulated case was 0.67 (substantial agreement), and for items 1, 2, 4, and 9 was 0.97, 1.0, 0.89, and 1.0, respectively (almost perfect agreement). Furthermore, the percentage of case comprehensibility (9 items) was 95.2. Conclusion: The face validity of the low back pain clinical case was confirmed, so its use in clinical simulation practices in the physical therapy programs offered by the Universidad de La Sabana and Universidad de Boyacá in Colombia is valid.

Resumen Introducción. El uso de casos clínicos en ambientes simulados brinda un mejor acercamiento a la condición de salud que se intenta simular, lo que permite una mejor formación de los estudiantes al verse inmersos en situaciones a las que podrían enfrentarse en su práctica profesional. Objetivo. Determinar la validez aparente de un caso clínico de dolor lumbar como herramienta de simulación clínica en la formación de estudiantes de fisioterapia. Materiales y métodos. Estudio realizado para determinar la validez de apariencia de un caso clínico de dolor lumbar para ser abordado por estudiantes de fisioterapia, el cual presenta nue -ve elementos evaluados por cinco jueces expertos. La concordancia entre los jueces respecto a la pertinencia, relevancia, coherencia, claridad y suficiencia del caso se estableció mediante el coeficiente Kappa de Fleiss. Resultados. El Kappa de Fleiss para el caso simulado fue 0.67 (acuerdo sustancial), y para los elementos 1, 2, 4 y 9 fue 0.97, 1.0, 0.89 y 1.0, respectivamente (acuerdo casi perfecto). Además, el porcentaje de comprensibilidad del caso (9 ítems) fue 95.2. Conclusión. La validez aparente del caso clínico fue confirmada, por lo que su uso en prácticas de simulación clínica en los programas de fisioterapia de la Universidad de La Sabana y la Universidad de Boyacá en Colombia es válido.

Influence of extrusion process on the release of phenolic compounds from mango (Mangifera indica L.) bagasse-added confections and evaluation of their bioaccessibility, intestinal permeability, and antioxidant capacity.

Extruded polyphenol-rich by-products like mango bagasse (MB) could be used to manufacture functional confections. However, few reports have assessed the extrusion impact on MB polyphenols within a food matrix. This research aimed to evaluate the impact of extrusion on the bioaccessibility, intestinal permeability, and antioxidant capacity of phenolic compounds (PC) from non-extruded and extruded MB-added confections (EMBC and MBC, respectively). The inhibition of 2,2-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) and 2,2-diphenyl-1-picrylhydrazyl radicals and in silico approaches were used to evaluate the antioxidant capacity. MBC displayed the highest gastric bioaccessibility (%) of xanthones and flavonoids, whereas selective release of gallic acid, mangiferin, and quercetin glucoside was shown for EMBC. Lower PC' apparent permeability coefficients were found in EMBC compared to MB (0.11 to 0.44-fold change, p < 0.05). EMBC displayed the highest antioxidant capacity by the DPPH method for the non-digestible fraction, being mangiferin the highest in silico contributor (-4 kcal/mol). Our results showed that the extrusion process helps release selective phenolics from MBC, which increases their bioaccessibility and intestinal permeability.

Anticancer potential of (-)-epicatechin in a triple-negative mammary gland model.

OBJECTIVES: The main aim of this work was to analyse the potential tumour growth inhibition effects of (-)-epicatechin (EC). Triple-negative breast cancer (TNBC) is an invasive form of cancer characterized by the absence of progesterone receptor, estrogen receptor and human epidermal growth factor receptor 2. Doxorubicin (DOX) is widely used for its anti-tumour activity. EC belongs to the flavanol subfamily and is a candidate molecule for the adjuvant treatment of cancer due to its antiproliferative activities. METHODS: Evaluation of EC effects and pathways involved in a model of TNBC. KEY FINDINGS: EC inhibited tumour growth as efficiently as DOX (inhibition rates of 74% and 79% for EC and DOX, respectively). The evaluation of adenosine monophosphate-activated protein kinase (AMPK) and Akt phosphorylation and mTOR expression indicates that EC modulates these pathways, resulting in the inhibition of cell proliferation. Additionally, we found an increase in the survival of EC-treated animals compared with control-treated animals. This effect was similar to the effects induced by DOX (survival rates of 44% and 30% for EC and DOX, respectively). CONCLUSION: EC has antiproliferative properties and increases survival in a model of TNBC. These effects may occur through the modulation of deregulated AMPK and Akt/mTOR signalling pathways.

A digital health peri-operative cognitive-behavioral intervention to prevent transition from acute to chronic postsurgical pain in adolescents undergoing spinal fusion (SurgeryPalTM): study protocol for a multisite randomized controlled trial.

BACKGROUND: Spinal fusion surgery is associated with severe acute postsurgical pain and high rates of chronic postsurgical pain in adolescents. Psychological distress, sleep disturbance, and low pain self-efficacy predict higher acute pain and likelihood of developing chronic postsurgical pain. Interventions targeting baseline psychosocial risk factors have potential to interrupt a negative trajectory of continued pain and poor health-related quality of life (HRQL) over time but have not yet been developed and evaluated. This randomized controlled trial will test effectiveness of a digital peri-operative cognitive-behavioral intervention (SurgeryPalTM) vs. education-control delivered to adolescents and their parents to improve acute and chronic pain and health outcomes in adolescents undergoing spine surgery. METHODS: Adolescents 12-18 years of age undergoing spinal fusion for idiopathic conditions, and their parent, will be recruited from pediatric centers across the USA, for a target complete sample of 400 dyads. Adolescents will be randomized into 4 study arms using a factorial design to SurgeryPalTM or education control during 2 phases of treatment: (1) pre-operative phase (one-month before surgery) and (2) post-operative phase (1 month after surgery). Acute pain severity and interference (primary acute outcomes) and opioid use will be assessed daily for 14 days following hospital discharge. Chronic pain severity and interference (primary acute outcomes), as well as HRQL, parent and adolescent distress, sleep quality, and opioid use/misuse (secondary outcomes), will be assessed at 3 months and 6 months post-surgery. DISCUSSION: Demonstration of effectiveness and understanding optimal timing of perioperative intervention will enable implementation of this scalable psychosocial intervention into perioperative care. Ultimately, the goal is to improve pain outcomes and reduce reliance on opioids in adolescents after spine surgery. TRIAL REGISTRATION: NCT04637802 ClinicalTrials.gov. Registered on November 20, 2020.

In vitro gastrointestinal digestion and simulated colonic fermentation of pistachio nuts determine the bioaccessibility and biosynthesis of chronobiotics.

Chronodisruption leads to obesity and other metabolic disorders that can be alleviated by food-derived potential chronobiotics, such as phytomelatonin (PMT), phenolic compounds (PCs) and dietary fiber rich pistachios. Pistachios with (PN + SC) or without (PN) the seed coat were investigated for their in vitro chronobiotic potential since they are one of the main reported PMT sources. Consequently we evaluated the bioaccessibility, permeability, and biosynthesis of pistachio chronobiotics, particularly PMT, during gastrointestinal and colonic fermentation. The maximum in vitro bioaccessibility and apparent permeability (efflux-prone) of PCs, flavonoids and PMT were sample-specific [∼1.3% (both), 27 and 3.4% (PN + SC)], but additional amounts (flavonoids > PCs > PMT) were released under simulated colonic conditions. Short-chain fatty acids (SCFAs; 38 mM; >50% butyrate, PN + SC > PN) and some metabolites (e.g., indole, benzaldehyde, phenolic acids, and aliphatic/aromatic hydrocarbons) were detected depending on the sample. The predominant pistachio butyrate production during in vitro colonic fermentation can improve chronodisruption and benefit obese individuals. Pistachio's digestion increases the bioaccessibility and intestinal permeability of potential chronobiotics (PMT and PCs) and the biosynthesis of colonic metabolites (SCFAs, among others) also with chronobiotic potential.

Experiencia en la implementación de sistemas de gestión de calidad para la atención odontológica en un centro docente asistencial universitario / Experience in the implementation of quality management systems for dental care in a university teaching center

RESUMEN: Objetivo: Describir el desarrollo e implementación para el establecimiento, cumplimiento y acreditación como centro de atención abierta, para la atención odontológica de un centro docente asistencial. Metodología: Para alcanzar mayores niveles de calidad sanitaria y lograr satisfacción de pacientes, profesionales, estudiantes, personal auxiliar y administrativo, definimos 8 niveles de acción: orientar trabajo a resultados; realizar actividades centradas en el paciente; desarrollar el liderazgo y coherencia en los objetivos; gestionar por medio de procesos; involucrar a toda la comunidad; incorporar a la gestión el aprendizaje, la innovación y la mejora constante; potenciar alianzas internas y externas y garantizar la responsabilidad social. Resultados: El comité de calidad rediseñó protocolos, realizó mejoras computacionales y administrativas, realizó diálogos con la comunidad, incrementando de 80% a 100% el cumplimiento de los estándares obligatorios (n= 11) y de 70 % a 96 % los globales. Conclusiones: Alcanzar las competencias de planificación, gestión sanitaria y elevar los niveles de calidad en la atención de pacientes de un centro de salud que incluye una Facultad de Odontología, es un desafío continuo en el tiempo que involucra toda la comunidad, requiere especialistas del área, incrementa los costos de operación y conduce a su acreditación como centro de atención abierta.

ABSTRACT: Objective: To describe the development and implementation for the establishment, fulfillment and accreditation as an open-care center, for dental care in a University Teaching Center. Methodology: In order to reach higher levels of health care quality and additionally achieve the satisfaction of patients, professionals, students, auxiliary and administrative staff, the quality committee developed 8 levels of action: 1, orienting the work to results; 2, performing patient-centered activities; 3, developing leadership and coherence in the objectives; 4, managing through processes; 5, involving the entire community; 6, incorporating learning, innovation and constant improvement into management; 7, strengthening internal and external alliances and 8, ensuring social responsibility. Results: After 4 years of work by the quality and review committees, with the redesign of protocols, computer and administrative improvements, evaluation of progress and dialogue with the community, compliance with mandatory quality standards (n=11) was increased from 80% to 100% and compliance with the global standard was increased from 70% to 96% (mandatory + non-mandatory standards). Conclusions: The strategy to achieve planning and management competences in the health system and to raise quality levels of patient care in a health center that includes a dental school is a continuous challenge over time that involves the entire community, requires specialists in the area, increases operating costs and leads to accreditation as an Open.Care Center.

Bioactive compounds from Octopus vulgaris ink extracts exerted anti-proliferative and anti-inflammatory effects in vitro.

Underutilized marine food products such as cephalopods' ink could be sources of bioactive compounds providing health benefits. This study aimed to assess the anti-proliferative and anti-inflammatory effects from Octopus vulgaris ink extracts (hexane-, ethyl acetate-, dichloromethane- (DM), and water extracts) using human colorectal (HT-29/HCT116) and breast (MDA-MB-231) cancer cells, and LPS-challenged murine RAW 264.7 cells. Except by ethyl-acetate, all of the extracts exhibited anti-proliferative effects without being cytotoxic to ARPE-19 and RAW 264.7 cells. Among DM fractions (F1/F2/F3), DM-F2 showed the highest anti-proliferative effect (LC50 = 52.64 µg/mL), inducing pro-apoptotic morphological disruptions in HCT116 cells. On RAW 264.7 cells, DM-F2 displayed the lowest nitrites reduction and up-regulation of key-cytokines from the JAK-STAT, PI3K-Akt, and IL-17 pathways. Compared to control, DM-F2 increased IL-4 and decreased NF-κB fluorometric expression in peripheral blood mononuclear cells (PBMCs). Metabolomic analysis of DM-F2 highlighted hexadecanoic acid and 1-(15-methyl-1-oxohexadecyl)-pyrrolidine as the most important metabolites. These compounds also exhibited high in silico binding affinity (-4.6 to -5.8 kcal/mol) to IL-1α, IL-1ß, and IL-2. Results suggested the joint immuno-modulatory and anti-proliferative effect derived from selected compounds of underutilized marine food products such as ink. This is the first report of such biological activities in extracts from O. vulgaris ink.

Octopus vulgaris ink extracts exhibit antioxidant, antimutagenic, cytoprotective, antiproliferative, and proapoptotic effects in selected human cancer cell lines.

Cancer is a noncommunicable disease of rising worldwide concern. Marine food products such as Octopus vulgaris ink (OI) could be sources of compounds addressing these concerns. This study aimed to evaluate the antimutagenic, cytoprotective, antiproliferative, proapoptotic, and antioxidant capacity of OI extracts on human cancer cell lines (22Rv1, HeLa, A549). The ARPE-19 cell line was used as a reference human cell line to evaluate the ink's cytotoxicity. The water extract exhibited the highest antimutagenic and cytoprotective effect, but the dichloromethane extract (DM) showed the lowest half lethal concentration against 22Rv1 cells. Structural elucidation of purified DM fractions (F1, F2, F3) identified an unreported compound, N-(2-ozoazepan-3-yl)-pyrrolidine-2-carboxamide (OPC). DM-F2 showed high antiproliferative effect (LC50 = 27.6 µg/mL), reactive species modulation, early-apoptosis induction (42.9%), and nuclei disruption in 22Rv1 cells. In silico analysis predicted high OPC affinity with Cyclin D1 (-6.70 kcal/mol), suggesting its potential impact on cell cycle arrest. These results highlight the antimutagenic, cytoprotective, and antiproliferative potential health benefits derived from underutilized marine food products such as OI. Further investigations at in vitro or in vivo levels are required to elucidate mechanisms and health benefits from OI. PRACTICAL APPLICATION: O. vulgaris ink is an underutilized marine natural product that could be a source of biological compounds with potential health benefits such as antioxidant activity and cancer prevention.

Colonic metabolites from digested Moringa oleifera leaves induced HT-29 cell death via apoptosis, necrosis, and autophagy.

Colorectal cancer is an important concern in modern society. Risk factors such as the diet indicate the need to find healthy food products displaying additional health benefits. This study aimed to characterise and evaluate the impact of the colonic metabolites from the fermented non-digestible fraction of Moringa oleifera (MO) leaves (FNFM) on cell death mechanisms from HT-29 cells. MO leaves were digested in vitro, and the 12 h-colonic extract was obtained. FNFM mainly contained morin and chlorogenic acids (41.97 and 25.33 µg/g sample). Butyric acid was ranked as the most important metabolite of FNFM. The FNFM exerted antiproliferative effect against HT-29 colorectal cancer cells (half lethal concentration, LC50: 5.9 mL/100 mL). Compared to untreated control, LC50 increased H2O2 production (149.43%); induced apoptosis (119.02%), autophagy (75.60%), and necrosis (87.72%). These results suggested that digested MO colonic metabolites exert antiproliferative effect against HT-29 cells, providing additional health benefits associated with MO consumption.