Handgrip strength predicts length of hospital stay in an abdominal surgical setting: the role of frailty beyond age.

BACKGROUND: Chronological age per se cannot be considered a prognostic risk factor for outcomes after elective surgery, whereas frailty could be. A simple and easy-to-get marker for frailty, such as handgrip strength (HGS), may support the surgeon in decision for an adequate healthcare plan. AIMS: The aims of this study were to: (1) determine the prevalence of frailty in an abdominal surgery setting independent of age; (2) evaluate the predictive validity of HGS for the length of hospital stay (LOS). METHODS: This is a retrospective study conducted in subjects who underwent abdominal surgical procedures. Only subjects with complete cognitive, functional, nutritional assessments and available measurement of HGS at admission were included. A final cohort of 108 patients were enrolled in the study. RESULTS: Subjects had a mean age of 67.8 ± 15.8 years (age range 19-93 years old) and were mostly men. According to Fried's criteria, 17 (15.7%, 4F/13 M) were fit, 58 (23.7%; 24F/34 M) were pre-frail and 33 (30.6%; 20F/13 M) were frail. As expected, HGS significantly differed between groups having frail lower values as compared with pre-frail and fit persons (fit: 32.99 ± 10.34 kg; pre-frail: 27.49 ± 10.35 kg; frail: 15.96 ± 9.52 kg, p < 0.0001). A final regression analysis showed that HGS was significantly and inversely associated with LOS (p = 0.020) independent of multiple covariates, including age. DISCUSSION: Most of the population undergoing abdominal surgery is pre-frail or frail. The measurement of handgrip strength is simple and inexpensive, and provides prognostic information for surgical outcomes. Muscle strength, as measured by handgrip dynamometry, is a strong predictor of LOS in a surgical setting.

Effect of αS1-casein genotype on phenolic compounds and antioxidant activity in goat milk yogurt fortified with Rhus coriaria leaf powder.

The aim of this work was to evaluate the phenolic compounds and antioxidant activity of goat milk yogurt characterized by different αS1-casein genotypes and fortified with Rhus coriaria leaf powder. The αS1-casein genotype was determined by isoelectric focusing, total phenol content was determined by the Folin-Ciocalteu method, phenolic compounds were identified and quantified by HPLC-UV analysis, and antioxidant activity was measured using 2,2'-azino-bis-3-ethylbenzothiazoline-6-sulfonic acid and ferric-reducing antioxidant power. The statistical analysis showed a significant effect of the studied factors. Comparing different genotypes it emerged that yogurt from goats with weak alleles at CSN1S1 loci (FF) showed the lowest phenolic compounds and therefore a lower antioxidant activity compared with yogurt from goats with strong alleles at CSN1S1 loci (AA, BB, AB). Rhus coriaria-fortified yogurt showed a significant increase in total phenolic compounds and antioxidant activity in comparison with plain yogurt. The FF-fortified yogurt presented the lowest total phenol content and antioxidant activity. This could be due to a greater capacity of proteins and peptides in this yogurt to form stable complexes with phenols. The different total phenol content detected in R. coriaria-fortified yogurt indicates that the αS1-casein genotype influenced the amount of added phenols that are bound to the caseins and, therefore, the part that remains free and that affects the biological capacity of the final product.

Quality and sensorial evaluation of beef burgers added with Sicilian sumac (Rhus coriaria L).

The Sicilian sumac (Rhus coriaria L.) is considered an excellent source of natural polyphenols whose antioxidant activity is able to affect specific technological functions. The effect of the Rhus coriaria addition on the quality of beef burgers before and after cooking was evaluated, by pH, colour, protein (-SH) and lipid oxidation, total phenol content and antioxidant activity (ABTS assay). The sumac in burgers (THs) resulted in a significant increase in all dry matter components (P < 0.05), while water content and pH value decreased. Furthermore, THs, compared with control burgers (CHs), were characterised by lower L* and peroxidation values and higher a* and b* values (p < 0.05). The Rhus added in the burgers positively influenced the total phenolic content and antioxidant activity values. Cooking reduced content of phenols, -SH groups and antioxidant activity. However, in THs the reduction of -SH, phenols and antioxidant activity was more limited than in CHs (p < 0.05). Sensory analysis showed a higher appreciation for THs by consumers for all the considered attributes. The ground meat incorporated with sumac could be a valid strategy to improve its quality and sensorial evaluation.

Comparison of Fatty Acid Profile in Egg Yolk from Late-Age Hens Housed in Enriched Cages and in a Free Range System.

In recent years, the free-range system for laying hens has increased, driven by societal sensitivity to animal welfare. This study aimed to comparatively analyze the total lipid, cholesterol, and fatty acid composition of egg yolks of late-age laying hens reared in enriched cages (C) and the free-range system (FR). Eggs were collected from Lohmann Brown Classic hens at the 68th, 70th, 72nd, and 74th week of age. The concentrations of total lipids and cholesterol were not affected (p > 0.05) by either factor. Egg yolk from the FR group showed lower (p < 0.01) monounsaturated fatty acids and higher (p < 0.01) polyunsaturated fatty acid (PUFA) compared with that of the C group. From a nutritional point of view, the PUFA n-6/n-3 and the PUFA/SFA ratios of egg yolk from the FR group were favorably lower and higher (p < 0.01) compared with the C one. Conversely, hen age did not affect (p > 0.05) the fatty acid composition of yolks. Interactions between factors were found for total n-3 and n-6 PUFA and the n-6/n-3 ratio (p < 0.01), as well as the thrombogenic index (p < 0.05). In conclusion, the results confirmed that the free-range system may improve the nutritional yolk fatty acid profile and its positive impact on human health.

Chemical and Functional Characterization of Propolis Collected from Different Areas of South Italy.

This study investigated the chemical and functional characterization of propolis collected in southern Italy, in particular in Basilicata, a region rich in ecological and vegetative biodiversity. Sixteen samples of propolis, collected within a radius of 40 km from each other in the Basilicata region, showed significant differences between the chemical and functional parameters investigated: color index (L*, a*, b*; p < 0.05) and variation in chemical composition and antioxidant activities by ABTS and FRAP assays. In general, Lucanian propolis had a low content of waxes (p < 0.05) and a high content of resin (p < 0.05) and balsams (p < 0.05). The content of the total phenolic compounds and flavonoids was highly variable, as was the biological capacity. In conclusion, Lucanian propolis showed remarkable variability, highlighting significant diversification according to the geographical position and the diversity of the flora surrounding the apiary that the bees use as a source of resin. This study, therefore, contributes to the enhancement of the quality of propolis, laying the foundations for the production and marketing of propolis not only in the food industry but also in the pharmaceutical and cosmetic industries.

Antioxidant Activity of Beef, Pork and Chicken Burgers before and after Cooking and after In Vitro Intestinal Digestion.

The aim of the present work was to evaluate and compare in vitro the antioxidant activity of raw, cooked and cooked-digested pork, beef and chicken burgers. The cooking process influenced the antioxidant capacity of the meat by decreasing the values of ABTS, FRAP and the content of free thiols. Conversely, a positive effect was observed after in vitro gastrointestinal digestion which increased the biological activity of the meat, characterised by greater antioxidant activity. The type of meat influenced the chemical composition and biological capacity of the burgers. In fact, both before and after the cooking process, beef burgers showed higher thiol content and, consequently, a higher oxidative stability of proteins than chicken and pork burgers. In vitro gastrointestinal digestion also improved the nutraceutical quality of beef burgers, which showed higher ABTS values and thiol content than pork burgers, which showed higher FRAP values. This work aims to support the potential of meat constituents as a natural antioxidant component that is essential to counteract the oxidative stress responsible for imbalances in the human organism and several cardiovascular diseases.

Effects of Extracts of Two Selected Strains of Haematococcus pluvialis on Adipocyte Function.

Recently, microalgae are arousing considerable interest as a source of countless molecules with potential impacts in the nutraceutical and pharmaceutical fields. Haematococcus pluvialis, also named Haematococcus lacustris, is the largest producer of astaxanthin, a carotenoid exhibiting powerful health effects, including anti-lipogenic and anti-diabetic activities. This study was carried out to investigate the properties of two selected strains of H. pluvialis (FBR1 and FBR2) on lipid metabolism, lipolysis and adipogenesis using an in vitro obesity model. FBR1 and FBR2 showed no antiproliferative effect at the lowest concentration in 3T3-L1 adipocytes. Treatment with FBR2 extract reduced lipid deposition, detected via Oil Red O staining and the immunocontent of the adipogenic proteins PPARγ, ACLY and AMPK was revealed using Western blot analysis. Extracts from both strains induced lipolysis in vitro and reduced the secretion of interleukin-6 and tumor necrosis factor-α. Moreover, the FBR1 and FBR2 extracts improved mitochondrial function, reducing the levels of mitochondrial superoxide anion radical and increasing mitochondrial mass compared to untreated adipocytes. These findings suggest that FBR2 extract, more so than FBR1, may represent a promising strategy in overweight and obesity prevention and treatment.

Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: An Italian single-institution 5-year experience analysis and updated literature review.

Background: Hemorrhoidal disease is a highly prevalent, chronic disorder that usually compromise patients' quality of life. Despite recent advances in pharmacologic and surgical therapeutic options, a clear treatment "gold standard" is lacking. Our aim is to analyze the outcomes following Transanal Hemorrhoidal Dearterialization (THD) procedure. Methods: Patients who failed conservative treatment and underwent THD Doppler between 2017 and 2021 were enrolled. Follow-up interviews (consisting of clinical examination, Visual Analog Scale for pain-VAS, Vaizey incontinence score, Hemorrhoid Severity Score) were administered 1 week, 2 weeks, 1 month and 6 months after surgery. Results: Forty-seven out of 75 patients were male, and the mean age was 50 (± 17.9) years. Hemorrhoids were classified as Goligher's degree II in 25 cases, III in 40 and IV, simple irreducible without ischemic changes, in 10. The mean operative time was 35 (28-60) minutes, and most procedures were performed with epidural anesthesia (80%). No intraoperative complications occurred, and 73 patients (97.3%) were discharged within post-operative day 1. Early post-operative pain and bleeding occurred in 37.3% and 8% of patients, respectively. No patients experienced anal incontinence and severe symptoms at 6 months after surgery. The overall success rate was 97.3%. Conclusions: THD is safe and effective in hemorrhoidal disease at degree II if bleeding, III, and IV without ischemic changes, both as a first intervention and on recurrence. Physician and patient need to understand each other's expectations, weight the risks and benefits, and customize the treatment.

In vitro phenols bioaccessibility and antioxidant activity of goat milk yogurt fortified with Rhus coriaria leaf powder.

Goat yogurt samples fortified with 20% (w/v) Rhus coriaria leaf powder were in vitro digested in order to evaluate the total phenolic content (TPC), antioxidant activity (AA), and bioaccessibility of phenolic compounds in the digestate. After digestion, TPC and AA values of the R. coriaria-fortified yogurts increased compared to the undigested yogurts (P < 0.001). In particular, TPC has increased about twice; whereas, AA values have increased about 10 and 6 times, for ABTS and FRAP assays, respectively. The bioaccessibility index was well above the 100% for all identified phenols; except for (-)-epicatechin (82.04%), rutin (51.51%), and gallic acid (5.42%). This different behavior highlighted that the bioaccessibility was modulated by both the yogurt-polyphenol complexes and phenol stability under digestion system. These findings can contribute to elucidate the influence of in vitro digestion on antioxidant capacity and polyphenols recovery infortified yogurts, and may help in the design of dairy products with better functional quality PRACTICAL APPLICATION: Rhus coriaria L. (Sumac) is a polyphenol-rich Mediterranean plant that may be used as functional ingredient to enrich fermented food such as yogurt. However, in fortified yogurts the evaluation of bioaccessibility, that is, the compounds released from the yogurt and stable in the digestive environment, thus able to exert their biological effects on the gastrointestinal system, is more important than the content of these compounds in the corresponding food. This study highlighted the phenolic content, antioxidant activity, and bioaccessibility of phenolic compounds in goat milk yogurt fortified with R. coriaria leaf powder after simulated gastro-pancreatic digestion.

Effect of a cauliflower (Brassica oleraceae var. Botrytis) leaf powder-enriched diet on performance, carcass and meat characteristics of growing rabbit.

The aim of this study was to investigate the effect of a cauliflower leaf powder (CLP)-enriched diet on the performance, quality and antioxidative potential of rabbit meat. No significant differences were found for live performance parameters between rabbits fed with standard (SD) and CLP diet. Dietary supplementation influenced the meat traits of rabbits: CLP meat showed significantly lower drip loss after 48 h, cooking loss, and a significantly higher lightness (L*) and redness (a*) values, vitamin A and vitamin E content, and oxidative stability, compared to SD meat. Moreover, the CLP supplementation caused a significant decrease in SFA and increase in PUFA percentage of rabbit intramuscular fat. The statistical analysis also showed a significant effect of dietary fortification on phenolic content and antioxidant activity of rabbit meat which resulted higher in meat of CLP group. This study highlighted that dietary fortification with CLP is a valid strategy to produce rabbit meat with better technological and functional quality.

Noninvasive evaluation of muscle mass by ultrasonography of quadriceps femoris muscle in End-Stage Renal Disease patients on hemodialysis.

BACKGROUND & AIMS: Protein-Energy Wasting (PEW) is a pathological condition of renal patients with advanced Chronic Kidney Disease characterized by a progressive reduction of energy and protein assets. Nutritional status assessment, especially for what concerns muscle mass, is essential for both the identification of patients at risk for the development of PEW, as well as monitoring the effects of nutritional interventions. Ultrasound methods are easily applicable at the bedside for quantitative assessment of skeletal muscle. The present study was aimed at evaluating quadriceps rectus femoris thickness (QRFT) and quadriceps vastus intermedius thickness (QVIT) in patients on chronic hemodialysis. METHODS: This was a prospective observational study. Three groups of adult patients were studied: young healthy subjects, well-nourished hospitalized patients with normal renal function, and End-Stage Renal Disease patients on hemodialysis (ESRD-HD). QRFT and QVIT were measured at two sites bilaterally (8 measures/patient) and were compared between groups, and also between subgroups of ESRD-HD patients stratified on the basis of conventional nutritional status parameters. RESULTS: We enrolled 35 healthy subjects, 30 hospitalized patients, and 121 ESRD-HD patients on hemodialysis. QRFT and QVIT of ESRD patients on hemodialysis were lower than those of both control groups (P < 0.001). After stratifying ESRD patients into subgroups based on nutritional variable cut-offs commonly used to define PEW in this clinical setting (BMI [≥ 23 vs <23 kg/m2], albumin [≥3.8 vs <3.8 g/dL]) and malnutrition inflammation score (MIS) status (<6 vs ≥6), QRFT and QVIT of patients with worse nutritional status were significantly lower than those of well-nourished ESRD-HD patients (P value range: <0.001 to <0.05). CONCLUSION: Skeletal muscle ultrasound is a simple and easily applicable bedside technique in the dialysis units, and could represent an adequate tool for the identification of patients with reduced muscle mass.

A phase II study of cetuximab/irinotecan in patients with heavily pretreated metastatic colorectal cancer: predictive value of early specific toxicities.

BACKGROUND: This study was designed to evaluate the predictive value of early specific toxicities on efficacy of weekly irinotecan/cetuximab administered as salvage therapy in patients with metastatic colorectal cancer (CRC) refractory to oxaliplatin and irinotecan. PATIENTS AND METHODS: Seventy patients received a regimen composed of weekly irinotecan 125 mg/m2 as a 1-hour intravenous infusion and cetuximab 400 mg/m2 infused over 2 hours as the initial dose and 250 mg/m2 infused over 1 hour for subsequent administrations. A single treatment cycle was composed of 4 weekly irinotecan infusions followed by 2 weeks of rest. The predictive value of adverse events (AEs) attributable to cetuximab (rash) and major toxicities attributable to irinotecan (gastrointestinal [GI] and hematologic) were observed after the first cycle of treatment and, therefore, correlated to activity and efficacy of cetuximab and weekly irinotecan. RESULTS: Sixty-six of 70 patients received >or= 1 cycle of chemotherapy and were therefore evaluable for response. Overall, toxicity observed was generally mild and manageable. According to an intent-to-treat analysis, a partial response was exhibited in 15.7% of patients, with a median progression-free survival (PFS) and median overall survival time of 4 months and 9 months, respectively. As expected, PFS (P = .01) and median survival (P = .04) correlated strongly with the presence and severity of the rash. Surprisingly, the presence of at least moderate hematologic and GI toxicity was associated with improved PFS (P = .03). CONCLUSION: Our data suggest that irinotecan-induced AEs might predict a better outcome in advanced CRC. This finding would identify a different subset of patients-those likely to benefit from a renewed sensitivity to irinotecan induced by cetuximab.

Estimate of body water compartments and of body composition in maintenance hemodialysis patients: comparison of single and multifrequency bioimpedance analysis.

OBJECTIVE: The goal of this study was to compare the adequacy of single and multifrequency bioimpedance analysis (BIA) to evaluate body water compartments, body composition, and nutritional status in maintenance hemodialysis patients. DESIGN: Cross-sectional study. SETTING: University-based hemodialysis unit. PATIENTS: Nineteen patients (12 male, 7 female), ages 28 to 82 years (mean, 58.9), treated with maintenance hemodialysis (MHD) for 0.5 to 15 years (mean, 7.3). INTERVENTION: This was a noninterventional study. Patients gave their informed consent to the diagnostic procedures performed. MAIN OUTCOME MEASURES: Total body water (TBW), extracellular water (ECW), fat-free mass (FFM), and body cell mass (BCM) volumes were estimated with single-frequency (sf BIA) and multifrequency (mf BIA) plethysmographs before and after a midweek dialytic session. Predialysis TBW also was estimated from anthropometric data (e TBW). Serum albumin, prealbumin and myoglobin, and creatinine index were determined as indicators of nutritional status and muscle mass. RESULTS: Sf BIA and mf BIA gave very similar results for TBW volumes. A high linear correlation was also found between e TBW values and both sf TBW and mf TBW; however, a statistically significant difference was found between e TBW and sf and mf TBW. Sf BIA and mf BIA gave quite different results for ECW, particularly when measured predialysis. The results obtained for FFM indicate a poor agreement between sf and mf BIA. The agreement was better when FFM was measured postdialysis. The values of BCM, either measured predialysis or postdialysis, indicate a significant difference between sf and mf BIA. FFM and BCM estimated with mf BIA had a closer correlation with creatinine index than sf BIA. mf BCM had also a higher correlation with serum myoglobin, which is produced by muscle cells. CONCLUSIONS: TBW can be estimated with enough confidence from either sf or mf BIA at any time. On the contrary, the results of ECW are significantly different with sf and mf BIA when measured predialysis. Thus, it seems more convenient to perform BIA after dialysis, in particular when assessing the "ideal" body weight. The measurements of FFM and BCM, obtained with either sf or mf BIA, are correlated with different indicators of nutritional status. In particular, mf BCM seems more appropriate than sf BCM for estimating muscle mass.

Prediction of glomerular filtration rate from body cell mass and plasma creatinine.

The gold standards for the measurement of glomerular filtration rate (GFR) are inulin clearance and radioisotopic methods. However, creatinine clearance is the most used test to evaluate GFR in clinical practice. Its adequacy is questionable, since its repeatability is quite poor, mainly due to errors in the collection of urine. The aim of this study was to evaluate a new method to predict GFR from the body cell mass (BCM) and plasma creatinine (Pcr), avoiding urine collection. The values of BCM were obtained in 275 adult renal patients with different renal function, ranging from normality to advanced renal failure. The relationship of GFR (clearance of (99m)Tc-DTPA) with BCM and Pcr was calculated in the first 85 patients. A highly significant linear correlation was found between GFR and the ratio BCM/Pcr. Thereafter, GFR was predicted from BCM and Pcr (BCM GFR) with formulas derived from the relationships found between GFR and the ratio BCM/Pcr. For comparison, GFR was predicted also according to other prediction formulas: Cockcroft and Gault (CG GFR), and the simplified MDRD formula (MDRD GFR). BCM GFR gave a more precise estimate of GFR than CG GFR and MDRD GFR. In fact, BCM GFR had the best correlation and agreement with true GFR ((99m)Tc-DTPA). Furthermore, CG GFR and MDRD GFR markedly overestimated true GFR. Finally, the error of prediction of BCM GFR was definitely lower than that of the two other estimates of GFR. GFR can be predicted from BCM and plasma creatinine. This method, which is very simple and accurate, seems suitable to establish the adequate dosage of drugs cleared by the kidneys.

O trabalho do psicólogo com grupo de adolescente em privação de liberdade / The psychologist's work with a group of adolescentes in deprivation of liberty / El trabajo del psicologo con el grupo de adolescentes en privación de libertad

The policies for the adolescent offenders' care presume the presence of psychologists in the multidisciplinary teams of socio-educational assistance, being up to these professionals different ways of acting and the reflection on their role in this system. Therefore, this paper discusses the coordination psychological intervention of groups with adolescents in detention units based on an experience report. One can notice the need among these adolescents to report their experiences with drugs, violence and drug trafficking, which constitute what they call the "world of crime". Thus, it is fundamental for the group coordination with adolescents in deprivation of liberty to recognize their histories and experiences, taking into account the ethical stance that the psychologist must assume when conducting the group session, which main goal is to provide an acceptance space for collective discussion and reflection.

En las políticas de atención a los adolescentes en conflicto con la ley, se evidencia la presencia obligatoria del psicólogo en los equipos multidisciplinares de atención socioeducativa, teniendo en cuenta las diferentes formas de actuar de estos profesionales y, especialmente, la reflexión sobre su papel en ese sistema. Así, este manuscrito discute la intervención psicológica con grupos de adolescentes en las unidades de privación de libertad a partir de un relato de experiencia. Se notó la necesidad entre los adolescentes de relatar sus experiencias con drogas, violencia y tráfico, puntos que constituyen lo que llaman de "mundo del crimen". Así, se considera fundamental para la coordinación de grupo con adolescentes en privación de libertad el reconocimiento de sus historias y experiencias, considerando la postura ética que el profesional psicólogo debe asumir al realizar el trabajo grupal, cuyo objetivo central es proporcionar un espacio de acogida, discusión y reflexión.

Nas políticas de atendimento aos adolescentes em conflito com a lei, evidencia-se a presença obrigatória do psicólogo nas equipes multidisciplinares de atendimento socioeducativo, cabendo a esses profissionais diferentes formas de atuar e, sobretudo a reflexão sobre o seu papel nesse sistema. Assim, este artigo discute a intervenção psicológica com grupos de adolescentes nas unidades de privação de liberdade a partir de um relato de experiência. Notou-se a necessidade entre os adolescentes de compartilharem as suas experiências com drogas, violência e tráfico, aspectos que constituem o que chamam de "mundo do crime". Assim, entende-se fundamental para a coordenação de grupo com adolescentes em privação de liberdade o reconhecimento de suas histórias e experiências, considerando a postura ética que o profissional psicólogo deve assumir ao conduzir o trabalho grupal, cujo objetivo central é proporcionar um espaço de acolhida para discussão e reflexão coletivas.