Prediction of neonatal survival according to lung-to-head ratio in fetuses with right congenital diaphragmatic hernia (CDH): A multicentre study from the Latin American CDH Study Group registry.

OBJECTIVE: To evaluate survival outcomes of fetuses with right sided congenital diaphragmatic hernia (CDH) treated in Latin American centres and to assess the utility of left lung area to predict neonatal survival. METHODS: A retrospective cohort including isolated right sided CDH cases managed expectantly during pregnancy in six tertiary centers from five Latin American countries. The utility of the observed/expected lung-to-head ratio (O/E-LHR) in predicting neonatal survival was assessed, and the best cut-off to predict prognosis was automatically selected by decision tree analysis. RESULTS: A total of 99 right sided CDH cases were recruited, 58 isolated fetuses were selected at a median gestational age of 26.2 weeks, showing an overall survival rate of 26.2%. A linear trend was observed between survival and the O/E-LHR, showing that at higher O/E-LHR, the greater probability of survival (r = 0.56, p < 0.001). O/E-LHR discriminates two groups with different survival outcomes: fetuses with an O/E-LHR ≥65% showed a significantly higher survival rate than those with an O/E-LHR <65% (81.8% vs. 15.6%, p < 0.01). CONCLUSIONS: Overall survival rate in right sided CDH is lower in Latin American countries. The severity category of pulmonary hypoplasia should be classified according to lung area and the survival rate in such population.

Optimization of 5-CQA Extraction Conditions from Green Coffee By-Product (Coffea arabica) Using a Response-Surface Design and the Study of Its Extraction Kinetics.

To take advantage of the residues generated in the production of products from green coffee and due to the special interest in the compounds contained in the bean, a by-product obtained after the extraction of the oil was studied. The physical characterization of the green-coffee-bean by-product was carried out. Subsequently, the extraction of compound 5-CQA was carried out via leaching using central composition design 24 and evaluating factors such as temperature, time, solid/solvent ratio, and ethanol percentage, and its yield was quantified using HPLC. In addition, the response-surface methodology was used to maximize the efficiency of 5-CQA extraction and to perform the kinetic study. Yields of 59 ± 2 mg of 5-CQA/g from the by-product were obtained, and by selecting the best leaching conditions, the kinetic study was performed at 45, 60, and 75 °C, increasing the yield to a total of 61.8 ± 3 mg of 5-CQA/g. By applying the kinetic model of mass transfer, a fit of R2 > 0.97 was obtained, with KLa values between 0.266 and 0.320 min−1. This study showed an approach to optimize the 5-CQA extraction conditions, resulting in a simple, fast, reproducible, accurate, and low-cost method.

Validation of an Analytical Method for the Simultaneous Determination of Hyaluronic Acid Concentration and Molecular Weight by Size-Exclusion Chromatography.

The hyaluronic acid (HA) global market growth can be attributed to its use in medical, cosmetic, and pharmaceutical applications; thus, it is important to have validated, analytical methods to ensure confidence and security of its use (and to save time and resources). In this work, a size-exclusion chromatography method (HPLC-SEC) was validated to determine the concentration and molecular distribution of HA simultaneously. Analytical curves were developed for concentration and molecular weight in the ranges of 100-1000 mg/L and 0.011-2.200 MDa, respectively. The HPLC-SEC method showed repeatability and reproducibility greater than 98% and limits of detection and quantification of 12 and 42 mg/L, respectively, and was successfully applied to the analysis of HA from a bacterial culture, as well as cosmetic, and pharmaceutical products.

Innovation in a Continuous System of Distillation by Steam to Obtain Essential Oil from Persian Lime Juice (Citrus latifolia Tanaka).

The citrus industry is one of the most important economic areas within the global agricultural sector. Persian lime is commonly used to produce lime juice and essential oil, which are usually obtained by batch distillation. The aim of this work was to validate a patented continuous steam distillation process and to both physically and chemically characterize the volatile fractions of essential Persian lime oil. Prior to distillation, lime juice was obtained by pressing the lime fruit. Afterwards, the juice was subjected to a continuous steam distillation process by varying the ratio of distillate flow to feed flow (0.2, 0.4, and 0.6). The distillate oil fractions were characterized by measuring their density, optical rotation, and refractive index. Gas chromatography GC-FID was used to analyze the chemical compositions of the oil fractions. The process of continuous steam distillation presented high oil recovery efficiencies (up to 90%) and lower steam consumption compared to traditional batch process distillation since steam consumption ranged from 32 to 60% for different steam levels. Moreover, a reduction in process time was observed (from 8 to 4 h). The oil fractions obtained via continuous steam distillation differed significantly in their composition from the parent compounds and the fractions.

Supercritical CO2-ethanol extraction of oil from green coffee beans: optimization conditions and bioactive compound identification.

In this research, a supercritical CO2-ethanol extraction was optimized to obtain a green coffee oil rich in bioactive compounds. A face-centered central composite design was used to evaluate the effect of temperature (50-70 °C), extraction pressure (15.0-30.0 MPa), and cosolvent content (5-20%) on the extraction yield and total phenolic compound content of green coffee supercritical extract (GCSE). The experimental data were fitted to a second-order polynomial model. According to the statistical analyses, the lack of fit was not significant for either mathematical model. From the response surface plots, the extraction pressure and cosolvent content significantly impacted the extraction yield, while the total phenolic compound content was impacted by temperature and cosolvent content. The optimal conditions were a 20% cosolvent content, a pressure of 30 MPa, and a temperature of 62 °C, which predicted an extraction yield of 7.7% with a total phenol content of 5.4 mg gallic acid equivalent g GCSE-1. The bioactive compounds included 5-caffeoylquinic acid (11.53-17.91 mg g GCSE-1), caffeine (44.76-79.51 mg g GCSE-1), linoleic acid (41.47-41.58%), and palmitic acid (36.07-36.18%). Our results showed that GCSE has the outstanding chemical quality and antioxidant potential, suggesting that GCSE can be used as a functional ingredient.

A multicentre study to predict neonatal survival according to lung-to-head ratio and liver herniation in fetuses with left congenital diaphragmatic hernia (CDH): Hidden mortality from the Latin American CDH Study Group Registry.

OBJECTIVE: To evaluate natural history of fetuses congenital diaphragmatic hernia (CDH) prenatally diagnosed in countries where termination of pregnancy is not legally allowed and to predict neonatal survival according to lung area and liver herniation. METHODS: Prospective study including antenatally diagnosed CDH cases managed expectantly during pregnancy in six tertiary Latin American centres. The contribution of the observed/expected lung-to-head ratio (O/E-LHR) and liver herniation in predicting neonatal survival was assessed. RESULTS: From the total population of 380 CDH cases, 144 isolated fetuses were selected showing an overall survival rate of 31.9% (46/144). Survivors showed significantly higher O/E-LHR (56.5% vs 34.9%; P < .001), lower proportion of liver herniation (34.8% vs 80.6%, P < .001), and higher gestational age at birth (37.8 vs 36.2 weeks, P < 0.01) than nonsurvivors. Fetuses with an O/E-LHR less than 35% showed a 3.4% of survival; those with an O/E-LHR between 35% and 45% showed 28% of survival with liver up and 50% with liver down; those with an O/E-LHR greater than 45% showed 50% of survival rate with liver up and 76.9% with liver down. CONCLUSIONS: Neonatal mortality in CDH is higher in Latin American countries. The category of lung hypoplasia should be classified according to the survival rates in our Latin American CDH registry.

Endoscopic Placental Laser Coagulation in Dichorionic and Monochorionic Triplet Pregnancies.

OBJECTIVE: To report the outcome of monochorionic (MC) and dichorionic (DC) triamniotic (TA) triplet pregnancies treated with endoscopic laser coagulation of the communicating placental vessels for severe feto-fetal transfusion syndrome (FFTS) and selective fetal growth restriction (sFGR). METHODS: Laser surgery was performed at 18 (15-24) weeks' gestation in 11 MCTA and 33 DCTA pregnancies complicated by FFTS and 14 DCTA pregnancies complicated by sFGR. Data from our study and previous reports were pooled using meta-analytic techniques. RESULTS: Survival of at least one baby and survival among all fetuses was 97.0 and 72.7% in DCTA pregnancies with FFTS, 78.6 and 52.4% in DCTA pregnancies with sFGR and 81.8 and 39.4% in MCTA pregnancies with FFTS. In the combined data from our study and previous reports, the pooled survival rates in 132 DCTA pregnancies with FFTS were 94.4 and 76.1%, and in 29 MCTA pregnancies with FFTS, they were 80.6 and 57.5%. CONCLUSIONS: Survival after laser surgery is higher in DC triplets with FFTS than in those with sFGR and in DC than in MC triplets with FFTS.

Evaluation of mango residues to produce hyaluronic acid by Streptococcus zooepidemicus.

Mango processing generates significant amounts of residues (35-65%) that may represent environmental problems owed to improper disposal. The use of mango byproducts as substrates to produce hyaluronic acid (HA) is an attractive alternative to reduce the cost of substrate. In this study, we evaluated the potential of hydrolyzates from mango peels and seeds to produce HA by Streptococcus equi. subsp. zooepidemicus. The physicochemical characterization of mango residues showed that the seeds contain a higher amount of holocellulose (cellulose and hemicellulose), which amounts 54.2% (w/w) whereas it only represents 15.5% (w/w) in the peels. Mango peels, however, are composed mainly of hot water-extractives (62% w/w, that include sucrose, fructose, glucose and organic acids). A higher concentration of monosaccharides (39.8 g/L) was obtained from the enzymatic hydrolysis (with Macerex) of peels as compared to seeds (24.8 g/L with Celuzyme). From mango peels, hydrolyzates were obtained 0.6 g/L HA, while 0.9 g/L HA were obtained with hydrolyzates from mango seeds. These results demonstrate that mango byproducts have the potential to be used for production of HA.

Support Systems and Limitations in Therapeutic Abortion Care by the Gynecologist-Obstetrician of Public Hospitals in Peru.

OBJECTIVE: To identify the barriers to provide to women and adequately train physicians on therapeutic abortions in public hospitals in Peru. METHODS: Descriptive cross-sectional survey-based study. We invited 400 obstetrics and gynecology specialists from 7 academic public hospitals in Lima and 8 from other regions of Peru. Expert judges validated the survey. RESULTS: We collected survey results from 160 participants that met the inclusion criteria. Of those, 63.7% stated that the hospital where they work does not offer abortion training. Most of the participants consider that the position of the Peruvian government regarding therapeutic abortion is indifferent or deficient. The major limitations to provide therapeutic abortions included Peruvian law (53.8%), hospital policies (18.8%), and lack of experts (10.6%). CONCLUSION: Most surveyed physicians supported therapeutic abortions and showed interest in improving their skills. However, not all hospitals offer training and education. The limited knowledge of the physicians regarding the law and institutional policies, as well as fear of ethical, legal, and religious repercussions, were the main barriers for providing abortions.

OBJETIVO: Identificar as barreiras para oferecer às mulheres e capacitar adequadamente os médicos sobre abortos terapêuticos nos hospitais públicos do Peru. MéTODOS: Estudo descritivo transversal baseado em inquérito. Convidamos 400 especialistas em obstetrícia e ginecologia de 7 hospitais públicos acadêmicos de Lima e 8 de outras regiões do Peru. Juízes especialistas validaram a pesquisa. RESULTADOS: Coletamos os resultados da pesquisa de 160 participantes que atenderam aos critérios de inclusão. Destes, 63,7% afirmaram que o hospital onde trabalham não oferece treinamento sobre aborto. A maioria dos participantes considera que a posição do governo peruano em relação ao aborto terapêutico é indiferente ou deficiente. As principais limitações para fornecer abortos terapêuticos incluem a lei peruana (53,8%), políticas hospitalares (18,8%) e falta de especialistas (10,6%). CONCLUSãO: A maioria dos médicos pesquisados apoiava o aborto terapêutico e demonstrava interesse em aprimorar suas habilidades. No entanto, nem todos os hospitais oferecem treinamento e educação. O conhecimento limitado dos médicos sobre a lei e as políticas institucionais, além do medo de repercussões éticas, legais e religiosas, foram as principais barreiras para a realização do aborto.

Effect of Operating Conditions and Fructans Size Distribution on Tight Ultrafiltration Process for Agave Fructans Fractionation: Optimization and Modeling.

The objective of this work was to evaluate the effect of operating conditions and fructans size distribution on the tight Ultrafiltration process for agave fructans fractionation. A mathematical model of limiting mass flux transfer was used to represent the profile of concentrations over time at the outlet of a pilot scale ultrafiltration system. First, a Box-Behnken experimental design was performed for the optimization of the parameters that determine the operating conditions in their respective ranges: temperature, 30−60 °C; transmembrane pressure (TMP), 1−5 bar and feed concentration, 50−150 kg∙m−3, on the separation factor (SF) and permeate flux. Then, the validation of the model for different fructans size distribution was carried out. The results showed that for SF, the quadratic terms of temperature, TMP and feed concentration were the most significant factors. Statistical analysis revealed that the temperature-concentration interaction has a significant effect (p < 0.005) and that the optimal conditions were: 46.81 °C, 3.27 bar and 85.70 kg∙m−3. The optimized parameters were used to validate the hydrodynamic model; the adjustments conclude that the model, although simplified, is capable of correctly reproducing the experimental data of agave fructans fractionation by a tight ultrafiltration pilot unit. The fractionation process is favored at higher proportions of FOS:Fc in native agave fructans.

Management practices for placenta accreta spectrum patients: a Latin American hospital survey.

INTRODUCTION: Placenta accreta spectrum (PAS) causes severe morbidity and can result in maternal death. It must be managed in specialized centers with interdisciplinary groups, but few publications have described the usual management within a specific geographic region. We intend to describe the usual approach for PAS in reference centers in Latin America. METHODOLOGY: This was an observational, multicenter, cross-sectional study conducted in Latin American PAS reference centers. A standardized survey was implemented and applied to obstetric service coordinators and leaders of interdisciplinary groups with experience in PAS between September and November 2020. RESULTS: One hundred fifty-four hospitals were included. Most of them (64.3%) handle approximately one case of PAS every two months, and almost all centers (89.6%) believe that their performance could be improved. CONCLUSIONS: Most of the reference centers for PAS in Latin America attend to a small number of cases each year, and almost all of these hospitals identify opportunities to improve the management or approach for PAS in women.

Influence of supplemented nutrients in tequila vinasses for hydrogen and polyhydroxybutyrate production by photofermentation with Rhodopseudomonas pseudopalustris.

There is a great interest for replacing petroleum-derived chemical processes with biological processes to obtain fuels and plastics from industrial waste. Accordingly, Rhodopseudomonas species are capable of producing hydrogen and polyhydroxybutyrate. Culture conditions for production of both hydrogen and polyhydroxybutyrate with Rhodopseudomonas pseudopalustris (DSM 123) from tequila vinasses were analyzed. The production of hydrogen using tequila vinasses was higher with respect to two synthetic media. Replacing the headspace with N2 increased the production of hydrogen with respect to Argon, while a higher concentration of polyhydroxybutyrate was achieved using Argon as compared to N2. A higher concentration of phosphates increased the production of hydrogen (250 mL), while the highest concentration of polyhydroxybutyrate (305 mg/L) was accomplished when the bacteria were cultivated only with phosphates contained in tequila vinasses. This study revealed that the culture conditions for Rhodopseudomonas pseudopalustris (DSM 123) for production of hydrogen are the opposite of those for production of polyhydroxybutyrate.

Genetic markers for preeclampsia in Peruvian women.

BACKGROUND: Preeclampsia is a multiorgan disorder associated with maternal and perinatal morbi-mortality. In Peru, incidence is 10% and accounts for 22% of maternal deaths. Genome and genetic epidemiological studies have found an association between preeclampsia and genetic polymorphisms. OBJECTIVE: To determine the association of the vascular endothelial growth factor (VEGF) +936 C/T and +405 G/C, interleukine-6 (IL-6) -174 G/C, IL-1ß-511 C/T, Apo A-1-75 G/A, Apo B-100 2488 C/T (Xbal) polymorphisms with preeclampsia in pregnant Peruvian women. METHODS: Were included preeclamptic and healthy (control) pregnant women. Maternal blood samples were subjected to DNA extraction, and molecular genetic analysis was conducted using the PCR-RFLP technique and following a specific protocol for each gene. Allele and genotypic frequencies in the cases and controls were compared. RESULTS: No association was found between the VEGF+936C/T and VEGF+405 polymorphisms and preeclampsia. The frequencies of the GG genotypes and the G allele of the -174 G/C polymorphism in the IL6 gene in preeclamptic and controls showed significant differences, with higher frequencies in cases. For the -511 C/T polymorphism of the IL-1ß gene, no significant differences were found in the frequencies of TT genotypes compared with CT+CC. The genotypes and alleles of the Apo-A1-75 G/A and Apo-B100 Xbal variants showed no significant differences between cases and controls. CONCLUSION: No association was found between the studied genetic markers and preeclampsia. However, in the -174G/C polymorphism of the IL-6 gene, significant differences were found mainly in the GG genotype and G allele.

Evaluation criteria for internet cancer support groups.

Despite positive reports about Internet cancer support groups, studies have rarely addressed how to choose an appropriate Internet cancer support group to conduct research. The purpose of this article was to propose evaluation criteria for selecting Internet cancer support groups from which to recruit research participants. The authors developed proposed criteria while conducting an Internet-based study of cancer pain experience among cancer patients recruited through Internet cancer support groups. During recruitment and data collection, the researchers conducted biweekly discussions about recruitment progress and kept detailed records about issues that arose in the process of identifying, contacting, and announcing the study in Internet cancer support groups. Then, the written records were analyzed using content analysis to develop the evaluation criteria. The evaluation criteria developed were (1) private or public domains, (2) mission and purpose of the Internet cancer support group, (3)target users of the Internet cancer support group, (4) scope of the Internet cancer support group, (5) contents of the Internet cancer support group, (6) logistics for study announcements in the Internet cancer support group, (7) dynamics within the Internet cancer support group, and (8) credibility and authenticity of the owner/administrator of the Internet cancer support group. Because these criteria were developed from experiences gained during only one study, further development and refinement of the evaluation criteria are essential.

A Technical Look at Fetoscopic Laser Ablation for Fetal Laryngeal Surgical Recanalization in Congenital High Airway Obstruction Syndrome.

Background: Congenital high airway obstruction syndrome (CHAOS) is a rare condition characterized by complete obstruction of the upper fetal airways. Left untreated, it is uniformly fatal. Ex utero intrapartum treatment (EXIT) has been used to establish a surgical airway in affected fetuses during delivery. While this procedure benefits those fetuses that survive to delivery, high mortality in the prenatal period necessitates earlier innovative strategies. Herein, we report a novel technique for in utero intervention. Methods: A fetoscopic intervention was performed at 28 weeks on a 35-year-old G1P0 woman with fetal CHAOS from a laryngeal obstruction measuring 11 mm in length on prenatal imaging. Under ultrasound guidance, a 3.3-mm curved fetoscope was used to access the uterine cavity through a single subcentimeter maternal skin incision. The scope was driven through the fetal oral cavity and manipulated to attain a view of the vocal cords. A subglottic obstruction was observed. A 600-micron laser fiber was passed through the working channel of the scope and used to ablate the obstructed airway. Using the laser fiber and a guidewire, the ablated opening was traversed with the fetoscope to the level of the carina. Results: Postoperatively, the lungs became less hyperinflated. There was improvement in ascites and diaphragmatic eversion. At 31 1/7 weeks' gestation, the mother experienced preterm premature rupture of membranes with active labor and the fetus was delivered through EXIT to tracheostomy. The infant was managed on mechanical ventilation and is currently thriving at home with a tracheostomy at 2 years of age. Conclusion: Fetoscopy with laser ablation of the airway obstruction is an effective prenatal management strategy that offers the potential to alter the devastating natural course of CHAOS.

Performance Evaluation of Tight Ultrafiltration Membrane Systems at Pilot Scale for Agave Fructans Fractionation and Purification.

Ceramic and polymeric membrane systems were compared at the pilot scale for separating agave fructans into different molecular weight fractions that help to diversify them into more specific industrial applications. The effect of the transmembrane pressure of ultrafiltration performance was evaluated through hydraulic permeability, permeate flux and rejection coefficients, using the same operating conditions such as temperature, feed concentration and the molecular weight cut-off (MWCO) of membranes. The fouling phenomenon and the global yield of the process were evaluated in concentration mode. A size distribution analysis of agave fructans is presented and grouped by molecular weight in different fractions. Great differences were found between both systems, since rejection coefficients of 68.6% and 100% for fructans with degrees of polymerization (DP) > 10, 36.3% and 99.3% for fructooligosaccharides (FOS) and 21.4% and 34.2% for mono-disaccharides were obtained for ceramic and polymeric membrane systems, respectively. Thus, ceramic membranes are better for use in the fractionation process since they reached a purity of 42.2% of FOS with a yield of 40.1% in the permeate and 78.23% for fructans with DP > 10 and a yield of 70% in the retentate. Polymeric membranes make for an efficient fructan purification process, eliminating only mono-disaccharides, and reaching a 97.7% purity (considering both fructan fractions) with a yield of 64.3% in the retentate.

Evaluation of the Use of a Coffee Industry By-Product in a Cereal-Based Extruded Food Product.

The evaluation of by-products to be added to food products is complex, as the residues must be analyzed to demonstrate their potential use as safe foods, as well as to propose the appropriate process and product for recycling. Since coffee is a very popular beverage worldwide, the coffee industry is responsible for generating large amounts of by-products, which include the coffee silverskin (CS), the only by-product of the roasting process. In this work, its characterization and food safety were evaluated by chemical composition assays, microbiological determinations, aflatoxin measurements and acute toxicity tests. The results showed that CS is safe for use in food, in addition to providing dietary fiber, protein and bioactive compounds. An extruded cereal-based ready-to-eat food product was developed through an extreme vertices mixture design, producing an extruded food product being a source of protein and with a high fiber content. Up to 15% of CS was incorporated in the extruded product. This work contributes to the establishment of routes for the valorization of CS; nevertheless, further research is necessary to demonstrate the sustainability of this food industry by-product.

A national online forum on ethnic differences in cancer pain experience.

BACKGROUND: Cultural values and beliefs related to cancer and pain have been used to explain ethnic differences in cancer pain experience. Yet, very little is known about similarities and differences in cancer pain experience among different ethnic groups. OBJECTIVE: The objective of this study was to explore similarities and differences in cancer pain experience among four major ethnic groups in the United States. METHODS: A feminist approach by Hall and Stevens was used. This was a cross-sectional qualitative study among 22 White, 15 Hispanic, 11 African American, and 27 Asian patients with cancer recruited through both Internet and community settings. Four ethnic-specific online forums were conducted for 6 months. Nine topics related to cancer pain experience were used to guide the online forums. The collected data were analyzed using thematic analysis involving line-by-line coding, categorization, and thematic extraction. RESULTS: All participants across ethnic groups reported "communication breakdowns" with their healthcare providers and experienced "changes in perspectives." All of them reported that their cancer pain experience was "gendered experience." White patients focused on how to control their pain and treatment selection process, whereas ethnic minority patients tried to control pain by minimizing and normalizing it. White patients sought out diverse strategies of pain management; ethnic minority patients tried to maintain normal lives and use natural modalities for pain management. Finally, the cancer pain experience of White patients was highly individualistic and independent, whereas that of ethnic minority patients was family oriented. DISCUSSION: These findings suggest that nurses need to use culturally competent approaches to cancer pain management for different ethnic groups. Also, the findings suggest further in-depth cultural studies on the pain experience of multiethnic groups of patients with cancer.