Indications and hemoglobin thresholds for red blood cell transfusion and iron replacement in adults with gastrointestinal bleeding: An algorithm proposed by gastroenterologists and patient blood management experts.

Gastrointestinal (GI) bleeding is associated with considerable morbidity and mortality. Red blood cell (RBC) transfusion has long been the cornerstone of treatment for anemia due to GI bleeding. However, blood is not devoid of potential adverse effects, and it is also a precious resource, with limited supplies in blood banks. Nowadays, all patients should benefit from a patient blood management (PBM) program that aims to minimize blood loss, optimize hematopoiesis (mainly by using iron replacement therapy), maximize tolerance of anemia, and avoid unnecessary transfusions. Integration of PBM into healthcare management reduces patient mortality and morbidity and supports a restrictive RBC transfusion approach by reducing transfusion rates. The European Commission has outlined strategies to support hospitals with the implementation of PBM, but it is vital that these initiatives are translated into clinical practice. To help optimize management of anemia and iron deficiency in adults with acute or chronic GI bleeding, we developed a protocol under the auspices of the Spanish Association of Gastroenterology, in collaboration with healthcare professionals from 16 hospitals across Spain, including expert advice from different specialties involved in PBM strategies, such as internal medicine physicians, intensive care specialists, and hematologists. Recommendations include how to identify patients who have anemia (or iron deficiency) requiring oral/intravenous iron replacement therapy and/or RBC transfusion (using a restrictive approach to transfusion), and transfusing RBC units 1 unit at a time, with assessment of patients after each given unit (i.e., "don't give two without review"). The advantages and limitations of oral versus intravenous iron and guidance on the safe and effective use of intravenous iron are also described. Implementation of a PBM strategy and clinical decision-making support, including early treatment of anemia with iron supplementation in patients with GI bleeding, may improve patient outcomes and lower hospital costs.

Sustainable Food Support during an Ultra-Endurance and Mindfulness Event: A Case Study in Spain.

The present industrial food-production system is not suitably ecological for the environment. Mindful nutrition in sport is a relevant emergent sub-discipline that could help reduce environmental degradation. This case study describes a sustainable support diet during an ultra-endurance running (UR) event called the "Indoor Everest Challenge". This UR challenge involved attaining the altitude of Mount Everest (8849 m) in a simulated way, in less than 24 h, without using ultra-processed food and without wasting plastics. During this challenge, a male athlete (34 years, weight: 78 kg, and height: 173 cm) wore a SenseWear Armband® (BodyMedia Inc., Pittsburg, PA, USA) accelerometer on his right arm to estimate energy expenditure. To supply his nutritional requirements, the athlete consumed only specially prepared homemade and organic food. All consumption was weighed and recorded in real-time; we determined nutrients using two databases: a food composition software, Dial Alce Ingenieria® (Madrid, Spain), to measure energy and macro- and micro-nutrients, and Phenol Explorer Database® (INRA Institut National de Recherche pour l'Alimentation, Paris, France) precisely to determine polyphenolic content. Most energy intake (up to 96%) came from plant foods. We found that subject consumed 15.8 g/kg-1/d-1 or 1242 g of carbohydrates (CHO), (2.4 g/kg-1/d-1) or 190 g of proteins (P), and 10,692 mL of fluid. The total energy intake (7580 kcal) showed a distribution of 65% CHO, 10% P, and 25% lipids (L). Furthermore, this sustainable diet lead to a high antioxidant intake, specifically vitamin C (1079 mg), vitamin E (57 mg), and total polyphenols (1910 mg). This sustainable approach was suitable for meeting energy, CHO, and P recommendations for UR. Physical and mental training (mindfulness) were integrated from the specific preliminary phase to the day of the challenge. The athlete completed this challenge in 18 h with a low environmental impact. This sports event had an educational component, as it awakened curiosity towards food sustainability.

Physically active men with high brown adipose tissue activity showed increased energy expenditure after caffeine supplementation.

This study measured the effect of caffeine on brown adipose tissue (BAT) activity and the energy expenditure (EE) of subjects with high (HBAT) or low (LBAT) activation. We performed a quasi-experimental double-blind protocol in which 24 physically active healthy men were measured (age: 24.1 ± 6.0 yrs; BM: 75.3 ± 14.4 kg; HT: 171.8 ± 5.9 cm; BMI: 25.5 ± 4.9 kg/m2). Infrared thermography (IRT) protocol was used to separate the participants into the groups according to the BAT activation: high (HBAT; n = 11) and low (LBAT; n = 13). All participants ingested a single supplement caffeine capsule (CAF) of 375 mg (~5 mg/kg BM) or placebo (PLA). Our experimental protocol measured two groups (HBAT and LBAT) under two conditions (CAF and PLA), with intake 30-min before the data collection. BAT activity lasted 60-min (0, 10, 20, 30, 40, 50, 60 min) and was estimated by IRT in subclavicular (Δ SCV) and external (Δ EXT) regions of interest (ROI) and EE by indirect calorimetry. The main results indicated that HBAT at 40-min showed an increased EE versus the other groups and conditions (p = 0.009). There was a significant difference for BAT activation at the 30 (p = 0.019), 40 (p = 0.009), 50 (p = 0.007) and 60 min (p = 0.012) between HBAT-CAF vs. LBAT-CAF. There was also a significant difference at the 20 (p = 0.024), 30 (p = 0.036), 50 (p = 0.05) and 60 min (p = 0.011) between HBAT-CAF vs. HBAT-PLA. In conclusion CAF intake (≈5 mg) increases the thermogenic activity of BAT in healthy young men and increases EE in HBAT subjects.

Analysis of Effectiveness of a Supplement Combining Harpagophytum procumbens, Zingiber officinale and Bixa orellana in Healthy Recreational Runners with Self-Reported Knee Pain: A Pilot, Randomized, Triple-Blind, Placebo-Controlled Trial.

Recreational running (RR) is becoming a popular way to increase physical activity for improving health, together with a higher incidence of knee injuries. The aim was to analyze the effect of a four-week supplementation with a mixture of Harpagophytum procumbens, Zingiber officinale and Bixa orellana on males, middle-aged, RR with an undiagnosed knee discomfort. A randomized triple-blind placebo-control trial was conducted among male RR aged 40-60 years suffering from self-declared knee discomfort after training. Participants were assigned to supplementation (2 g/day in 6 doses; n = 13; intervention group (IG)) or matched placebo (n = 15; control group (CG)) for 4 weeks. At pre- and post-intervention, assessment of routine blood biomarkers, body composition, running biomechanics and body temperature was performed using standardized procedures. Machine learning (ML) techniques were used to classify whether subjects belonged to IG or CG. ML model was able to correctly classify individuals as IG or CG with a median accuracy of 0.857. Leg fat mass decreased significantly (p = 0.037) and a deeper reduction in knee thermograms was observed in IG (p < 0.05). Safety evaluation revealed no significant differences in the rest of parameters studied. Subjects belonging to IG or CG are clearly differentiated, pointing into an effect of the supplement of ameliorating inflammation.

Lactate Concentration Is Related to Skin Temperature Variation After a Specific Incremental Judo Test.

ABSTRACT: Gomes Moreira, D, José Brito, C, de Almeida Ferreira, JJ, Bouzas Marins, JC, López Díaz de Durana, A, Couceiro Canalejo, J, Butragueño Revenga, J, and Sillero-Quintana, M. Lactate concentration is related to skin temperature variation after a specific incremental judo test. J Strength Cond Res 35(8): 2213-2221, 2021-This study aimed to analyze the skin temperature (tsk) response in judokas after a specific incremental test and to determine whether anthropometric and physiological measures can be explained by the variation in mean tsk. A total of 23 male judo athletes (age: 20.1 ± 4.7 years; height: 173.1 ± 8.1 cm; and body mass: 71.7 ± 8.1 kg) performed a specific incremental judo test. Skin temperature evaluations were collected in 26 regions of interest (ROIs), and the mean tsk was calculated using an equation including 10 of them. The time points before the test (pre-test), immediately after (0 minutes), and after 5, 10, and 15 minutes of the test were established to measure the tsk, mean tsk, auricular temperature (tau), and blood lactate (LAC). The athletes completed a mean of 7.0 ± 1.0 stages of the test, 95% confidence interval (CI; 6.2-7.1). The V̇o2peak achieved was 48.7 ± 5.3 ml·kg-1·min-1, 95% CI (46.4-51.0). Compared with pre-test values, only the forehead significantly decreased 5 minutes after the test (p < 0.05). The posterior right arm and posterior left arm remained increased 10 minutes after the test (p < 0.05). After 15 minutes, 19 of the 26 ROIs analyzed were significantly decreased (p < 0.05). Among all tested models of linear regression, only 2 were significant, the difference of tsk 5 minutes compared with pre-test (F1, 21 = 16.49, p = 0.001) and the difference of tsk 10 minutes compared with pre-test, to predict LAC concentration at the end of the test (F1, 21 = 9.30, p = 0.006). We concluded that 5 minutes after the test, the judokas present a higher tau and a higher tsk in 7 ROIs, and the tsk decreases 15 minutes after the test in 19 of the considered ROIs. The variation of mean tsk 5 and 10 minutes after the test compared with pre-test values is associated with blood LAC at the end of the test.

Effect of a Blend of Zingiber officinale Roscoe and Bixa orellana L. Herbal Supplement on the Recovery of Delayed-Onset Muscle Soreness Induced by Unaccustomed Eccentric Resistance Training: A Randomized, Triple-Blind, Placebo-Controlled Trial.

BACKGROUND: There is an increasing interest in the use of eccentric muscle exercise to improve physical condition, especially with regards to its health-related benefits. However, it is known that unaccustomed eccentric exercise causes muscle damage and delayed pain, commonly defined as "delayed onset muscle soreness" (DOMS). The efficacy of herbal preparations in subjects suffering from DOMS has been reported in a few previous studies with small or moderate outcome measures related to muscle recovery. The present study aimed to evaluate the effects of a polyherbal mixture containing whole Zingiber officinale Roscoe and Bixa orellana L., powders called ReWin(d), in young male athletes suffering from DOMS induced by a 1 h session of plyometric exercises. METHODS: Thirty-three young male athletes participated in this randomized, Triple-blind, placebo-controlled trial: 17 of them assigned to the ReWin(d) group and 16 of them to the placebo group. Creatine kinase (CK) was measured as a muscle damage marker, pain was assessed using the Visual Analog Scale (VAS), muscle performance was measured through half-squat exercise (HS) monitored with an accelerometer (Encoder), and heart rate variability (HRV) was monitored for 5 min with the subjects in the supine position. All determinations were performed before and after the eccentric session and 24, 48, and 72 h after the session. RESULTS: The eccentric exercise session caused an increase in CK at 24 and 48 h after exercise intervention in both groups (p < 0.001). There was no interaction between groups regarding muscle damage. The pain increased after the training session in both groups (p < 0.001), and a significant interaction was observed between groups at 48 h after exercise (p = 0.004). Lower limb muscular power showed a significant interaction between groups 24 h after exercise (p = 0.049); the placebo group showed a reduction in muscle power compared to the ReWin(d) group. The LF/HF ratio decreased significantly at 72 h after exercise in the herbal group but not in the placebo group. CONCLUSION: The herbal supplement maintained the maximum power of the lower limbs and attenuated muscle pain. CLINICAL TRIAL REGISTRATION: www.ClinicalTrials.gov, identifier NCT03961022.

Immune Response Related With Skin Thermal Pattern in Judokas: A New Application for Infrared Thermography?

Brito, CJ, Moreira, DG, Ferreira, JJ, Díaz-de-Durana, AL, Miarka, B, Bouzas Marins, JC, and Sillero-Quintana, M. Immune response related with skin thermal pattern in judokas: A new application for infrared thermography? J Strength Cond Res 34(10): 2886-2894, 2020-This study investigated the association between body skin temperature (BST) and immune response after judo training, and compared the immune responses considering 2 post-training skin thermal pattern ("spots"-SPT and "localized"-LOC). For this, we evaluated 32 (25-male) black-belt judokas from the Spanish Junior National Team (18.0 ± 3.5 years, 72.4 ± 18.4 kg, and 17.1 ± 7.5% body fat). White blood cell and BST measurements were performed at pre-training, immediately, 1, and 24-hour post-training. Body skin temperature (° C) was estimated by skin temperature from 4 regions of interest (chest, upper arm, thigh, and calf). The main results indicated that 13 judokas were classified as SPT and 19 as LOC. In comparison with LOC, SPT had a significantly lower BST post-training (SPT = 33.0 ± 0.4 vs. LOC = 33.6 ± 0.8° C; p = 0.016), lower blood concentration of leukocytes (SPT = 7.9 ± 1.9 vs. LOC = 8.9 ± 1.9 cells × 10 per mm; p ≤ 0.001), and neutrophils (SPT = 5.5 ± 1.7 vs. LOC = 6.1 ± 2.2 cells × 10 per mm; p ≤ 0.001). In conclusion, the BST and immune response after judo training seem to be not associated. However, when the skin thermal pattern is considered, the SPT skin thermal pattern presented a lower post-training BST, blood leukocytes, and neutrophils in comparison with the LOC group. These results show a possible relationship between skin thermal pattern and immune responses for the first time; however, further studies are needed to confirm the evidence presented here.

Artificial Intelligence Applied to Flavonoid Data in Food Matrices.

Increasing interest in constituents and dietary supplements has created the need for more efficient use of this information in nutrition-related fields. The present work aims to obtain optimal models to predict the total antioxidant properties of food matrices, using available information on the amount and class of flavonoids present in vegetables. A new dataset using databases that collect the flavonoid content of selected foods has been created. Structural information was obtained using a structural-topological approach called TOPological Sub-Structural Molecular (TOPSMODE). Different artificial intelligence algorithms were applied, including Machine Learning (ML) methods. The study allowed us to demonstrate the effectiveness of the models using structural-topological characteristics of dietary flavonoids. The proposed models can be considered, without overfitting, effective in predicting new values of Oxygen Radical Absorption capacity (ORAC), except in the Multi-Layer Perceptron (MLP) algorithm. The best optimal model was obtained by the Random Forest (RF) algorithm. The in silico methodology we developed allows us to confirm the effectiveness of the obtained models, by introducing the new structural-topological attributes, as well as selecting those that most influence the class variable.

¿Tienen las bebidas energéticas efectos ergogénicos en el ejercicio físico? / Have energy drinks ergogenic effects in physical exercise?

Objetivo: Determinar los posibles efectos ergogénicos de las bebidas energéticas (BE) en el rendimiento físico aeróbico y anaeróbico, y describir sus mecanismos de acción. Metodología: Se realizó una revisión sistemática de la literatura en las bases de datos PubMed/Medline y en SportDiscus, teniendo como criterios de inclusión estudios con humanos que trataban sobre cambios sobre el rendimiento físico aeróbico y/o ejercicios de alta intensidad y de corta duración tras el consumo de BE, publicados en inglés, entre el 1 de enero de 2000 y el 31 de diciembre de 2014. Resultados: Tras un proceso de filtrado fueron seleccionados 20 estudios, siendo 10 sobre modificaciones en el rendimiento físico aeróbico y 10 sobre el rendimiento físico anaeróbico. En cuanto al rendimiento aeróbico, fueron evaluados los siguientes parámetros: tiempo total del ejercicio, consumo máximo de oxígeno (VO2max), y el índice de percepción del esfuerzo (IPE). Durante las actividades anaeróbicas fueron evaluados: la resistencia muscular y potencia anaeróbica, los test físicos anaeró- bicos y el lactato sanguíneo. Fueron encontrados algunos efectos ergogénicos tras el consumo de BE. En actividad aeróbica hubo un aumento en la capacidad temporal para realizar ejercicio y una disminución en la percepción subjetiva de fatiga. Respecto al componente anaeróbico, existió una mejor respuesta muscular, contribuyendo a un aumento de la resistencia muscular y la reducción del tiempo en sprints. Sin embargo, algunos estudios no concluyen ningún efecto positivo tras el consumo de BE, tanto en ejercicios de perfil aeróbico como anaeróbico. Conclusiones: Existen evidencias científicas de que el consumo de BE puede mejorar algunos parámetros importantes de rendimiento físico aeróbico y anaeróbico (AU)

Objective: To determine the potential ergogenic effects of energy drinks (ED) on aerobic and anaerobic exercise performance and describe their mechanisms of action. Methods: It was carried out a systematic review of literature PubMed/Medline and SportDiscus databases, having as inclusion criteria human studies reporting changes on aerobic physical performance and/or high-intensity exercise and short duration after consumption BE, published in English between January 1, 2000 and December 31, 2014. Results: After a filtering process, they were selected 20 studies, dealing 10 with changes in aerobic physical performance and 10 with anaerobic exercise performance. For the aerobic performance, they were assessed the following parameters: total exercise time, maximum oxygen consumption (VO2max), and the rate of perceived exertion (RPE). During anaerobic activities they were evaluated: muscular endurance and anaerobic power, anaerobic physical test and blood lactate. They were found some ergogenic effects after consumption of BE. In aerobic activity there was an increase in temporary capacity for exercise and a decrease in the subjective perception of fatigue. Regarding the anaerobic component, there was a better muscular response, contributing to an increase in muscle strength and a reduced time in sprints. However, some studies do not report any positive effect after consumption of BE, both in aerobic and anaerobic profile exercises. Conclusions: There is scientific evidence that the consumption of BE can improve some important parameters of aerobic and anaerobic exercise performance (AU)

[The "Seville" Consensus Document on Alternatives to Allogenic Blood Transfusion. Sociedades españolas de Anestesiología (SEDAR), Medicina Intensiva (SEMICYUC), Hematología y Hemoterapia (AEHH), Transfusión sanguínea (SETS) Trombosis y Hemostasia (SETH)]. / Documento «Sevilla¼ de Consenso sobre Alternativas a la Transfusión de Sangre Alogénica.

The Consensus Document on Alternatives to Allogenic Blood Transfusion (AABT) has been drawn up by a panel of experts from 5 scientific societies. The Spanish Societies of Anesthesiology (SEDAR), Critical Care Medicine and Coronary Units (SEMICYUC), Hematology and Hemotherapy (AEHH), Blood Transfusion (SETS) and Thrombosis and Hemostasis (SETH) have sponsored and participated in this Consensus Document. Alternatives to blood transfusion have been divided into pharmacological and non-pharmacological, with 4 modules and 12 topics. The main objective variable was the reduction of allogenic blood transfusions and/or the number of transfused patients. The extent to which this objective was achieved by each AABT was evaluated using the Delphi method, which classifies the grade of recommendation from A (supported by controlled studies) to E (non-controlled studies and expert opinion). The experts concluded that most of the indications for AABT were based on middle or low grades of recommendation, "C", "D", or "E", thus indicating the need for further controlled studies.

Documento «Sevilla» de Consenso sobre Alternativas a la Transfusión de Sangre Alogénica / The «Seville» Consensus Document on Alternatives to Allogenic Blood Transfusion

El Documento de Consenso sobre Alternativas a la Transfusión de Sangre Alogénica (ATSA) ha sido elaborado por un panel de expertos pertenecientes a 5 sociedades científicas. Han participado y patrocinado las sociedades españolas de Anestesiología (SEDAR), Medicina Intensiva (SEMICYUC), Hematología y Hemoterapia (AEHH), Transfusión sanguínea (SETS) y Trombosis y Hemostasia (SETH). Las alternativas a la transfusión se han clasificado en farmacológicas y no farmacológicas, con un total de 4 módulos y 12 tópicos. La disminución de las transfusiones de sangre alogénica y/o el número de pacientes transfundidos fue la principal variable objetivo. El grado de cumplimiento de este objetivo, para cada ATSA, se llevó a cabo siguiendo la metodología Delphi, que clasifica el grado de recomendación desde «A» (apoyado por estudios controlados) hasta «E» (estudios no controlados y opinión de expertos). Los expertos concluyeron que la mayor parte de las indicaciones de las ATSA se sustentan en grados de recomendación medios y bajos, «C», «D» o «E», precisándose nuevos estudios controlados (AU)

The Consensus Document on Alternatives to Allogenic Blood Transfusion (AABT) has been drawn up by a panel of experts from 5 scientific societies. The Spanish Societies of Anesthesiology (SEDAR), Critical Care Medicine and Coronary Units (SEMICYUC), Hematology and Hemotherapy (AEHH), Blood Transfusion (SETS) and Thrombosis and Hemostasis (SETH) have sponsored and participated in this Consensus Document. Alternatives to blood transfusion have been divided into pharmacological and non-pharmacological, with 4 modules and 12 topics. The main objective variable was the reduction of allogenic blood transfusions and/or the number of transfused patients. The extent to which this objective was achieved by each AABT was evaluated using the Delphi method, which classifies the grade of recommendation from A (supported by controlled studies) to E (non-controlled studies and expert opinion). The experts concluded that most of the indications for AABT were based on middle or low grades of recommendation, «C», «D», or «E», thus indicating the need for further controlled studies (AU)

Impacto de la activación del código Ictus en la eficacia del tratamiento trombolítico / Stroke code impact on the efficacy of thrombolytic treatment

FUNDAMENTO Y OBJETIVOS: La mayoría de los pacientes con ictus llega a los servicios de urgencias fuera de la ventana terapéutica para el inicio del tratamiento trombolítico. El Código Ictus (CI) ha demostrado su eficacia para reducir los tiempos de latencia en ensayos clínicos, pero se desconoce su eficacia en la práctica clínica diaria. El objetivo fue determinar la aplicabilidad del CI en la práctica clínica diaria y su impacto en la eficacia del tratamiento trombolítico con rt-PA.PACIENTES Y MÉTODO: Pacientes con ictus isquémico de la arteria cerebral media (ACM) tratados con rt-PA desde junio de 2000 a diciembre de 2001, divididos en 3 períodos de 6 meses. Se valoró la influencia de la activación del CI en los tiempos de latencia, recanalización arterial y evolución neurológica precoz. RESULTADOS: Se estudió a 48 pacientes. Se observó un incremento significativo en el número de pacientes tratados con rt-PA en los 3 períodos (4,8; 5,3; 8,0 per cent). Se produjo un acortamiento progresivo y significativo (p = 0,036) del retraso global en el tiempo de inicio de la fibrinólisis (de 161,4 a 130,0 min), fundamentalmente por reducción en el tiempo de llegada a urgencias (72,2 a 52,0 min; p = 0,05). La proporción de pacientes tratados con fibrinolíticos en los que se activó el CI aumentó con el tiempo (p = 0,032). La activación del CI redujo el tiempo de llegada a urgencias (p = 0,013) y el del inicio del tratamiento (p = 0,049), e incrementó el porcentaje de recanalización precoz (p = 0,027) y la probabilidad de una mejor evolución neurológica a las 48 h (p = 0,036). CONCLUSIONES: La activación del CI es muy útil en el tratamiento de la fase aguda del ictus: permite tratar con rt-PA i.v. a un mayor porcentaje de pacientes y de forma más precoz, lo que se traduce en una mejor evolución clínica de estos pacientes (AU)