Advances on delta 5-unsaturated-polymethylene-interrupted fatty acids: Resources, biosynthesis, and benefits.

Though the knowledge on delta 5-unsaturated-polymethylene-interrupted fatty acids (Δ5-UPIFAs) is being updated, the issue of their integration still exists within the field. Thus, this review systematically summarizes the sources, biosynthesis and metabolism, analytical methods, preparation, and health-promoting roles of Δ5-UPIFAs. In plants, the content of Δ5-UPIFAs is higher, which is an ideal source. In animals, although the content of Δ5-UPIFAs is not high, there are many species, which is the possible source of some special Δ5-UPIFAs. At present, although the extraction of Δ5-UPIFAs is mainly from plants, the fermentation by organisms, especially for genetically modified microorganisms engineering maybe be a substitue of pepration of Δ5-UPIFAs. Δ5-UPIFAs have been proved to possess multi-beneficial effects, such as lipid lowering, anti-inflammation and so on, so it has a certain potential application value. However, related knowledge of the underlying molecular mechanisms regarding Δ5-UPIFAs limited, and how Δ5-UPIFAs work is not clear. Further clinical and human studies about Δ5-UPIFAs are also needed. Studies on tapping new resources, developing structured lipide rich in Δ5-UPIFA and enhancing delivery were quite deficient. This review emphasizes the further directions on Δ5-UPIFAs with scientific suggestions to pay more attention to the applications of Δ5-UPIFAs in food, pharmaceutical and cosmetic industries.

Self-rated health among people living with HIV in Spain in 2019: a cross-sectional study.

BACKGROUND: HIV infection has become a chronic disease and well-being of people living with HIV (PLHIV) is now of particular concern. The objectives of this paper were to describe self-rated health among PLHIV, on ART and on ART virally suppressed and to analyse its determinants. METHODS: Data were obtained from a second-generation surveillance system based on a cross-sectional one-day survey in public hospitals. Epidemiological and clinical data were collected among HIV-infected inpatients and outpatients receiving HIV-related care the day of the survey in 86 hospitals in 2019. Self-rated health was measured using a question included in the National Health Survey: "In the last 12 months, how would you rate your health status?" an ordinal variable with five categories (very good, good, moderate, bad and very bad). For the analysis, these responses were dichotomized into two categories: 1 = very good/good and 0 = moderate, bad or very bad health status. Factors associated with very good/good self-rated health were estimated using logistic regression. RESULTS: Of 800 PLHIV, 67.5% perceived their health as very good/good, 68.4% among PLHIV on ART and 71.7% of those virally suppressed. Having university education (adjusted odds ratio (aOR):2.1), being unemployed (aOR:0.3) or retired (aOR:0.2), ever being diagnosed of AIDS (aOR:0.6), comorbidities (aOR:0.3), less than 2 year since HIV diagnosis (aOR:0.3) and not receiving ART (aOR:0.3) were associated with good self-rated health. Moreover, among PLHIV on ART, viral load less than 200 copies (aOR:3.2) were related to better perceived health. Bad adherence was inversely associated with good self-rated health among PLHIV on ART (aOR:0.5) and of those virally suppressed (aOR:0.4). CONCLUSIONS: Nearly seven in 10 PLHIV in Spain considered their health status as very good/good, being higher among virally suppressed PLHIV. Both demographic and clinical determinants affect quality of life.

Main Applications of Cyclodextrins in the Food Industry as the Compounds of Choice to Form Host-Guest Complexes.

Cyclodextrins (CDs) are cyclic oligomers broadly used in food manufacturing as food additives for different purposes, e.g., to improve sensorial qualities, shelf life, and sequestration of components. In this review, the latest advancements of their applications along with the characteristics of the uses of the different CDs (α, ß, γ and their derivatives) were reviewed. Their beneficial effects can be achieved by mixing small amounts of CDs with the target material to be stabilized. Essentially, they have the capacity to form stable inclusion complexes with sensitive lipophilic nutrients and constituents of flavor and taste. Their toxicity has been also studied, showing that CDs are innocuous in oral administration. A review of the current legislation was also carried out, showing a general trend towards a wider acceptance of CDs as food additives. Suitable and cost-effective procedures for the manufacture of CDs have progressed, and nowadays it is possible to obtain realistic prices and used them in foods. Therefore, CDs have a promising future due to consumer demand for healthy and functional products.

Technological Application of Tannin-Based Extracts.

Tannins are polyphenolic compounds naturally found in vegetables. Their presence in nature has prompted their historical use in many different ways. The revision of their traditional utilization has allowed their further modification aiming for an industrial application. Sometimes these modifications have implied the addition of harmful substances such as formaldehyde, classified as a carcinogen of category B1. In other cases, these natural tannins have been replaced by synthetic compounds that threaten human and animal health and damage the environment. Therefore, currently, both academy and industry are searching for the substitution of these unsafe complexes by the increasing inclusion of tannins, natural molecules that can be obtained from several and diverse renewable resources, modified using harmless additives. To achieve promising results, cost-efficient and eco-friendly extraction methods have been designed. Once these green alternatives have been isolated, they have been successfully applied to many fields with very assorted aims of utilization such as coagulants, adhesives, floatation agents, tannings, dyes, additives, or biomolecules. Therefore, this review offers a global vision of the full process that involves the tannin's technological application including an overview of the most relevant tannin sources, effective extraction methods, and their utilization in very diverse fields.

[Clinical characteristics of patients with atrial fibrillation treated with direct oral anticoagulants attended in primary care setting. The SILVER-AP study]. / Perfil clínico de pacientes con fibrilación auricular tratados con anticoagulantes orales de acción directa atendidos en atención primaria. Estudio SILVER-AP.

OBJECTIVE: To analyse the clinical characteristics and management of patients with non-valvular atrial fibrillation (NVAF) treated with direct oral anticoagulants (DOAC). DESIGN: Observational, cross-sectional and multicentre study. LOCATION: Autonomous Communities in which the general practitioner can prescribe DOAC (n=9). PARTICIPANTS: The study included a total of 790 patients on chronic treatment with anticoagulants, and on whom therapy was changed, as well as being currently on treatment with DOAC for at least for 3 months. MAIN MEASURES: A record was made of the sociodemographic and clinical management date. RESULTS: Mean age was 78.6±8.4 years, and 50.5% of patients were men. Mean CHADS2 score was 2.6±1.2, mean CHA2DS2-VASc score was 4.3±1.6, and the mean HAS-BLED score was 2.3±1.0. Mean duration of treatment with DOAC was 15.8±12.5 months. Rivaroxaban was the DOAC most frequently prescribed (57.8%), followed by dabigatran (23.7%), and apixaban (18.5%). Of the patients receiving rivaroxaban, 70.2% were taking the dose of 20mg/daily. Of the patients receiving dabigatran, 41.7% were taking the dose of 150mg twice daily, and in the case of apixaban, 56.2% were taking the dose of 5mg twice daily. Satisfaction (ACTS Burdens scale 52.0±7.2 and ACTS Benefits scale 12.1±2.2), and therapeutic adherence (97.8% of patients took their medication regularly) with DOAC were high. CONCLUSIONS: Patients treated with DOAC in Spain have a high thromboembolic risk. A significant proportion of patients receive a lower dose of DOAC than that recommended according to their clinical profile. Satisfaction and medication adherence are high.

Perioperative complications and surgical oncology outcomes in an initial study from 84 patients submitted to laparoscopic radical cystectomy.

OBJECTIVES: The Gold Standard treatment for a non-metastatic, invasive bladder cancer is an open radical cystoprostatectomy (ORCP). Laparoscopic radical cystoprostatectomy (LRCP) is still an experimental technique in evaluation. We describe our perioperative results defined as surgical and safety oncology variables. METHODS: Every patient who underwent a LRCP between January 2007 and July 2011 in the urology department of the University Public Hospital was evaluated. We perform a descriptive retrospective analysis. RESULTS: We evaluated 84 patients, 72 males and 12 females, with a mean age of 68 (44-79). A Bricker diversion was performed in 80 patients, a Camey II bladder replacement was performed in 3 patients, and a Studer bladder replacement was performed in 1 patient. Seventeen patients (20.23%) presented with previous abdominal surgery, and 6 patients (7.14%) presented a medical history of urological surgery. The mean surgery time was 257.57 minutes (180-420). The mean hospital stay was 11.875 days (standard deviation (SD): 6.28). The onset of tolerance to surgery occurred after 3.7 days (SD: 2.21).The transfusion rate after surgical intervention was 20.2%. The mean number of nodes removed, by means of ilio-obturator lymphadenectomy, was 17 (13-19). There were no intraoperative complications. Early complications (less than 1 month after the intervention) occurred in 28 patients (33.3% ).There were no post-operative deaths. There were late complications (starting one month after the intervention) in 7 patients (8.3% ). CONCLUSIONS: Our study demonstrated that LRCP is safe and reproducible and represents a minimally invasive option for patients with infiltrative bladder cancer.

Identification of New Key Genes and Their Association with Breast Cancer Occurrence and Poor Survival Using In Silico and In Vitro Methods.

Breast cancer is one of the most prevalent types of cancer diagnosed globally and continues to have a significant impact on the global number of cancer deaths. Despite all efforts of epidemiological and experimental research, therapeutic concepts in cancer are still unsatisfactory. Gene expression datasets are widely used to discover the new biomarkers and molecular therapeutic targets in diseases. In the present study, we analyzed four datasets using R packages with accession number GSE29044, GSE42568, GSE89116, and GSE109169 retrieved from NCBI-GEO and differential expressed genes (DEGs) were identified. Protein-protein interaction (PPI) network was constructed to screen the key genes. Subsequently, the GO function and KEGG pathways were analyzed to determine the biological function of key genes. Expression profile of key genes was validated in MCF-7 and MDA-MB-231 human breast cancer cell lines using qRT-PCR. Overall expression level and stage wise expression pattern of key genes was determined by GEPIA. The bc-GenExMiner was used to compare expression level of genes among groups of patients with respect to age factor. OncoLnc was used to analyze the effect of expression levels of LAMA2, TIMP4, and TMTC1 on the survival of breast cancer patients. We identified nine key genes, of which COL11A1, MMP11, and COL10A1 were found up-regulated and PCOLCE2, LAMA2, TMTC1, ADAMTS5, TIMP4, and RSPO3 were found down-regulated. Similar expression pattern of seven among nine genes (except ADAMTS5 and RSPO3) was observed in MCF-7 and MDA-MB-231 cells. Further, we found that LAMA2, TMTC1, and TIMP4 were significantly expressed among different age groups of patients. LAMA2 and TIMP4 were found significantly associated and TMTC1 was found less correlated with breast cancer occurrence. We found that the expression level of LAMA2, TIMP4, and TMTC1 was abnormal in all TCGA tumors and significantly associated with poor survival.

Testing the role of allelochemicals in different wheat cultivars to sustainably manage weeds.

BACKGROUND: Selecting wheat varieties with allelopathic potential or high competitiveness against weeds is a sustainable solution for organic farming to eliminate the use of synthetic herbicides. Wheat is one of the most economically important crops. This study focuses on screening the allelopathic or competitive potential of four wheat cultivars, Maurizio, NS 40S, Adesso and Element, on two weeds of interest due to acquired herbicide resistance, Portulaca oleracea and Lolium rigidum, through germination and growth bioassays and the identification and quantification of benzoxazinoids (BXZs) and polyphenols (phenolic acids and flavonoids). RESULTS: The different cultivars showed different abilities to manage surrounding weeds and different capacity to exude or accumulate specialized metabolites in the presence of those weeds. Furthermore, each cultivar behaved differently depending on the weed present in the medium. The most efficient cultivar to control the tested monocot and dicot weeds was Maurizio, as it effectively controlled germination and growth of L. rigidum and P. oleracea while exuding large amounts of benzoxazinones through the roots, especially the hydroxamic acids 2,4-dihydroxy-7-methoxy-1,4-benzoxazin-3-one and dihydroxy-2H-1,4-benzoxaxin-3(4H)-one. By contrast, NS 40S, Adesso and Element showed the potential to control the growth of just one of the two weeds through allelopathy or competition. CONCLUSION: This study reveals that Maurizio is the most promising wheat cultivar for sustainable weed control, and that the screening of crop varieties with allelopathic potential, which results in the displacement of synthetic herbicides, is an immediate solution in ecological and sustainable agriculture. © 2023 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Specialized Metabolites Accumulation Pattern in Buckwheat Is Strongly Influenced by Accession Choice and Co-Existing Weeds.

Screening suitable allelopathic crops and crop genotypes that are competitive with weeds can be a sustainable weed control strategy to reduce the massive use of herbicides. In this study, three accessions of common buckwheat Fagopyrum esculentum Moench. (Gema, Kora, and Eva) and one of Tartary buckwheat Fagopyrum tataricum Gaertn. (PI481671) were screened against the germination and growth of the herbicide-resistant weeds Lolium rigidum Gaud. and Portulaca oleracea L. The chemical profile of the four buckwheat accessions was characterised in their shoots, roots, and root exudates in order to know more about their ability to sustainably manage weeds and the relation of this ability with the polyphenol accumulation and exudation from buckwheat plants. Our results show that different buckwheat genotypes may have different capacities to produce and exude several types of specialized metabolites, which lead to a wide range of allelopathic and defence functions in the agroecosystem to sustainably manage the growing weeds in their vicinity. The ability of the different buckwheat accessions to suppress weeds was accession-dependent without differences between species, as the common (Eva, Gema, and Kora) and Tartary (PI481671) accessions did not show any species-dependent pattern in their ability to control the germination and growth of the target weeds. Finally, Gema appeared to be the most promising accession to be evaluated in organic farming due to its capacity to sustainably control target weeds while stimulating the root growth of buckwheat plants.

Stability and antioxidant capacity of epigallocatechin gallate in Dulbecco's modified eagle medium.

Though the instability of polyphenols in cell culture experiment has been investigated previously, the underlying mechanism is not completely clear yet. Therefore, in this study, the stability of epigallocatechin gallate (EGCG) in cell culture medium DMEM was investigated at 4 °C and 37 °C via UPLC-MS-MS analysis followed by determination of the antioxidant capacity of EGCG. EGCG was instable in DMEM and formed various degradation products derived from its dimer with increasing incubation time with many isomers being formed at both temperatures. The dimer products were more stable at 4 °C than at 37 °C. The structure and formation mechanism of five products were analyzed with four unidentified. Ascorbic acid significantly improved the stability of EGCG by protecting EGCG from auto-oxidation in DMEM, particularly at 4 °C. The antioxidative activity of EGCG in DMEM was determined by DPPH, ABTS and FRAP assay. The antioxidative properties of EGCG continuously decreased over 8 h in DMEM, which was consistent with its course of degradation.

Evaluation of toxic effects of several carboxylic acids on bacterial growth by toxicodynamic modelling.

BACKGROUND: Effects of organic acids on microbial fermentation are commonly tested in investigations about metabolic behaviour of bacteria. However, they typically provide only descriptive information without modelling the influence of acid concentrations on bacterial kinetics. RESULTS: We developed and applied a mathematical model (secondary model) to capture the toxicological effects of those chemicals on kinetic parameters that define the growth of bacteria in batch cultures. Thus, dose-response kinetics were performed with different bacteria (Leuconostoc mesenteroides, Carnobacterium pisicola, Escherichia coli, Bacillus subtilis and Listonella anguillarum) exposed at increasing concentrations of individual carboxylic acids (formic, acetic, propionic, butyric and lactic). In all bioassays the acids affected the maximum bacterial load (Xm) and the maximum growth rate (vm) but only in specific cases the lag phase (λ) was modified. Significance of the parameters was always high and in all fermentations the toxicodynamic equation was statistically consistent and had good predictability. The differences between D and L-lactic acid effects were significant for the growth of E. coli, L. mesenteroides and C. piscicola. In addition, a global parameter (EC50,τ) was used to compare toxic effects and provided a realistic characterization of antimicrobial agents using a single value. CONCLUSIONS: The effect of several organic acids on the growth of different bacteria was accurately studied and perfectly characterized by a bivariate equation which combines the basis of dose-response theory with microbial growth kinetics (secondary model). The toxicity of carboxylic acids was lower with the increase of the molecular weight of these chemicals.

Penile metastasis of prostatic adenocarcinoma. Case report.

OBJECTIVE: Penile metastases are late manifestations of a primary tumor, and they are a sign of poor prognosis. We report a case of a rare presentation: penile metastases from prostate cancer. METHODS: 77 year-old male presented hematuria and acute urinary retention; on physical examination multiple hard lesions were detected. The patient underwent a Doppler ultrasound, subsequent penile and prostate biopsy, and staging study. Currently he is being treated with complete androgen blockade. RESULTS: A histological study of the penile biopsy showed penile metastasis from prostate adenocarcinoma. The histological study of prostate biopsy confirmed Gleason 8 (4+4) adenocarcinoma. CONCLUSIONS: Despite of the different therapeutic alternatives for treatment of symptomatic penile metastases, it would be with palliative target; due to the median survival of these patients is less than a year.

Evaluation of Visuospatial Short-term and Working Memory from the First to Second Year of Life: A Novel Task.

The prototypical tasks for assessing visuospatial memory in infancy are based on the search for a hidden object in two locations. Fewer studies include more locations, delayed responses nor changes in the object's position. Our aim was to assess the visuospatial short-term and working memory in 12, 15, 18 and 22-month-old children (N = 65). Assessment included our experimental task, a working memory task and a cognitive developmental scale. Short-term and working memory abilities increased markedly at 22 months compared to younger ages and the performance of the children in our experimental task is related to other tasks previously used.

Evolution of Flavors in Extra Virgin Olive Oil Shelf-Life.

Extra virgin olive oil (EVOO) is one of the most distinctive ingredients of the Mediterranean diet. There are many properties related to this golden ingredient, from supreme organoleptic characteristics to benefits for human health. EVOO contains in its composition molecules capable of exerting bioactivities such as cardio protection, antioxidant, anti-inflammatory, antidiabetic, and anticancer activity, among others, mainly caused by unsaturated fatty acids and certain minor compounds such as tocopherols or phenolic compounds. EVOO is considered the highest quality vegetable oil, which also implies a high sensory quality. The organoleptic properties related to the flavor of this valued product are also due to the presence of a series of compounds in its composition, mainly some carbonyl compounds found in the volatile fraction, although some minor compounds such as phenolic compounds also contribute. However, these properties are greatly affected by the incidence of certain factors, both intrinsic, such as the olive variety, and extrinsic, such as the growing conditions, so that each EVOO has a particular flavor. Furthermore, these flavors are susceptible to change under the influence of other factors throughout the oil's shelf-life, such as oxidation or temperature. This work offers a description of some of the most remarkable compounds responsible for EVOO's unique flavor and aroma, the factors affecting them, the mechanism that lead to the degradation of EVOO, and how flavors can be altered during the shelf-life of the oil, as well as several strategies suggested for the preservation of this flavor, on which the quality of the product also depends.

Status and Challenges of Plant-Anticancer Compounds in Cancer Treatment.

Nowadays, cancer is one of the deadliest diseases in the world, which has been estimated to cause 9.9 million deaths in 2020. Conventional treatments for cancer commonly involve mono-chemotherapy or a combination of radiotherapy and mono-chemotherapy. However, the negative side effects of these approaches have been extensively reported and have prompted the search of new therapeutic drugs. In this context, scientific community started to look for innovative sources of anticancer compounds in natural sources, including traditional plants. Currently, numerous studies have evaluated the anticancer properties of natural compounds derived from plants, both in vitro and in vivo. In pre-clinical stages, some promising compounds could be mentioned, such as the sulforaphane or different phenolic compounds. On the other hand, some phytochemicals obtained positive results in clinical stages and were further approved for cancer treatment, such as vinca alkaloids or the paclitaxel. Nevertheless, these compounds are not exempt of limitations, such as low solubility, restricted effect on their own, negative side-effects, etc. This review aims to compile the information about the current phytochemicals used for cancer treatment and also promising candidates, main action mechanisms and also reported limitations. In this sense, some strategies to face the limitations have been considered, such as nano-based formulations to improve solubility or chemical modification to reduce toxicity. In conclusion, although more research is still necessary to develop more efficient and safe phytochemical drugs, more of these compounds might be used in future cancer therapies.

[Development and validation of a generic questionnaire for evaluating satisfaction in patients with chronic disease: the SAT-Q Questionnaire]. / Desarrollo y validación de un cuestionario genérico para la evaluación de la satisfacción de los pacientes crónicos: Cuestionario SAT-Q.

OBJECTIVES: To develop and validate a brief general questionnaire to assess satisfaction in patients with chronic disease. DESIGN: epidemiological, observational, multicentre cross-sectional study. LOCATION: 4 Primary Health Care Centers from the IV Health Area in the Principality of Asturias. SUBJECTS: A total of 202 patients diagnosed with chronic illness who were following a pharmacological regimen for at least one year. METHODS: An extensive literature review was conducted to create an initial item pool of 61 questions regarding patient satisfaction. Then, a forward-backward translation into Spanish was carried out. Next, both the expert (n=8) and patient (n=30) panels led to a new version of 34 items (concerning satisfaction with medication and satisfaction with health service). Finally, scale item reduction (item-total correlation and exploratory factorial analysis -EFA-) and psychometrical validation (feasibility, reliability and criterion validity) of the SAT-Q- were evaluated. Both the SAT-Q and the SF-12 (to assess patient health related quality of life) were applied. RESULTS: Item reduction analysis resulted in 18 items: general satisfaction with medication (3), adverse-events (3), oversights (2), effectiveness (3), convenience (4) and Health services (3). Internal consistency (Cronbach α) and Intraclass Correlation Coefficients were moderate-high. Moreover, significant positive correlations between SAT-Q scores and SF-12 Physical and Mental Summary Components were found (with the exception of oversights). CONCLUSIONS: A brief questionnaire for measuring satisfaction in chronic patients has been developed and preliminary validated.

Treatment of urachal disorders: The open and laparoscopic surgery approach. / Abordaje laparoscópico de la patología uracal. Nuestra serie.

INTRODUCTION: The present study analyzes cases of urachal abnormalities treated with laparoscopic approach in our hospital. CASE DESCRIPTION: A retrospective descriptive study of urachal disorders with laparoscopic surgery approach performed at our hospital in the period 1999-2015. Patients' clinical data are presented (radiological findings, surgical data, pathology findings, complications and a follow-up of each patient). RESULTS: 7 Adults presented complicated urachal disorders treated laparoscopically. The average age was 43.1 years old (DE ±11). The mean surgical time of laparoscopic management was 154.2 minutes (range 120-240). Mean hospital stay was 4.9 days (DE ±1.1). There were no early or late postoperative complications. CONCLUSION: Laparoscopic removal of urachal remnants is a safe and reproducible technique.

Evaluation of SAMe-TT2R2 score and other clinical factors influencing the quality of anticoagulation therapy in non-valvular atrial fibrillation: a nationwide study in Spain.

OBJECTIVE: To assess the major clinical factors affecting the quality of anticoagulation and evaluate the predictive value of the SAMe-TT2R2 score to identify patients who will achieve a high average time in therapeutic range (T.T.R.) with vitamin K antagonist (V.K.A.) treatment. RESEARCH DESIGN AND METHODS: This observational, cross-sectional, retrospective and nationwide multicenter study included 1524 patients from the primary care setting with non-valvular atrial fibrillation receiving V.K.A. (≥12 months). We performed a bivariate analysis to identify factors individually associated with the T.T.R. and a multiple regression analysis to identify the independent predictive factors. For the validation of the SAMe-TT2R2 score, the receiver operating characteristic (R.O.C.) curve was calculated and the Hosmer-Lemeshow test was used to test calibration. RESULTS: A total of 94.8% of patients received acenocumarol (4.8% warfarin). A progressive decrease in mean T.T.R. was found when the SAMe-TT2R2 score increased from 0 points (72.1 ± 17.1%) to 4 points (64.1 ± 23.2%), p < 0.001. Other risk scores (CHADS2 and CHA2DS2-VASc, HAS-BLED) were also associated with the mean T.T.R. We found a significant association between low T.T.R. and the following clinical factors: female sex, three or more comorbidities, amiodarone treatment, dietary habits, bleeding history and the intake of ≥7 tablets per day besides V.K.A. (p < 0.01). Regarding SAMe-TT2R2 score validation, the R.O.C. curve showed significant capability, although not high, of discriminating good anticoagulation control (T.T.R. ≥65%) with an area under the curve of 0.562 (95% C.I. 0.533-0.592, p < 0.001) which increased, remaining modest, to 0.594 (95% C.I. 0.564-0.624, p < 0.001) when the factors not included in SAMe-TT2R2 score were added. CONCLUSION: In this cohort, the SAMe-TT2R2 score had a significant, although modest, ability to assess the likelihood of good international normalized ration (I.N.R.) control, and its predictive value might slightly improve by adding other simple clinical factors. Further research is needed to refine the predictive scales.