Effect of high hydrostatic pressure processing on the rennet coagulation kinetics and physicochemical properties of sheep milk rennet-induced gels.

The effects of high hydrostatic pressure on the constituents and coagulation ability and their effect on cheese production of sheep milk have not been studied in detail. The objective of this work was to evaluate the effect of high hydrostatic pressure processing on the coagulation kinetics and physicochemical properties of sheep milk and to explore how such treatment could improve the cheesemaking process. Five batches of milk were tested: 1 untreated control batch and 4 batches each subjected to a different pressure (150, 300, 450, or 600 MPa) for 5 min at 10°C. As treatment pressure increased, values of electrical conductivity and oxidation-reduction potential were found to decrease. However, no significant reduction in pH was recorded. Treatment pressures >300 MPa produced milk with lower lightness (luminosity) and a more yellow and green hue. Pressures >150 MPa resulted in micellar fragmentation, as well as significant increases in particle size, viscosity, and water-holding capacity as a consequence of the denaturing of soluble proteins. High-pressure treatments increased the solubility of colloidal calcium phosphate, leading to a considerable increase in the concentration of minerals in the serum phase. The highest concentrations of calcium and phosphorus in the rennet whey of milk were reached at 300 MPa. Curd coagulation time was reduced by 28% at pressures >300 MPa, and an increase in the curd firming rate was observed. As treatment pressure increased to 450 MPa, the firmness, elasticity, and the percentage creep recovery of gels increased, whereas values of compliance and fracture strain were reduced. Thus, we can conclude that 300 MPa is the optimum treatment pressure for milk intended for cheesemaking by enzymatic coagulation. This pressure produced milk with optimal coagulation kinetics and water-holding properties with the least loss of fat and protein to the whey.

Targeted Electromyographic Biofeedback With Endoanal Electrostimulation for Anal Incontinence.

Purpose. Anal incontinence (AI) is a disabling condition with a variable response to conservative physical therapies. We assess the utility of combining electromyographic biofeedback with endoanal electrostimulation targeted to the weakest areas of the pelvic floor using the MAPLe® probe (Multiple Array Probe Leiden Novuqare). Methods. Patients with AI unresponsive to conservative measures were assessed before and after treatment with anorectal manometry (ARM), electromyography (EMG), Wexner Continence Scoring, Visual Analog Scoring (VAS), FIQL and SF-12 quality of life determination. Results. Of 29 patients in the final analysis, there was an improvement in the mean Wexner continence score from 13.59 to 8.03 and a concomitant improvement in the reported VAS from 3.45 to 6.72. Both Wexner continence and VAS scores were maintained during follow-up. Maximum voluntary manometric contraction significantly improved from 91.76 mmHg to 110.33 mmHg with no changes in resting pressure. The EMG values ​​(µV) that significantly improved included the average and peak resistance, the average general voluntary contraction, and the average and peak voluntary contraction for both the external anal sphincter and the puborectalis. In the FIQL, behavior, depression and shame domains improved after treatment and during follow-up with lifestyle improvements detected at 6 and 12 months. Physical and mental components of the SF-12 improved at 6 and 12 months. Conclusions. Targeted electromyographic biofeedback and endoanal electrostimulation using MAPLe® probe in AI patients sustainably improves objective ARM and EMG parameters along with subjective reporting of continence severity, VAS, and quality of life.

A simple algorithm for differential diagnosis in hemodynamic shock based on left ventricle outflow tract velocity-time integral measurement: a case series.

Echocardiography has gained wide acceptance among intensive care physicians during the last 15 years. The lack of accredited formation, the long learning curve required and the excessive structural orientation of the present algorithms to evaluate hemodynamically unstable patients hampers its daily use in the intensive care unit. The aim of this article is to show 4 cases where the use of our simple algorithm based on VTI, was crucial. Subsequently, to explain the benefit of using the proposed algorithm with a more functional perspective, as a means for clinical decision-making. A simple algorithm based on left ventricle outflow tract velocity-time integral measurement for a functional hemodynamic monitoring on patients suffering hemodynamic shock or instability is proposed by Spanish Critical Care Ultrasound Network Group. This algorithm considers perfusion and congestion variables. Its simplicity might be useful for guiding physicians in their daily decision-making managing critically ill patients in hemodynamic shock.

Short-term outcomes of patients with a long stay in an internal medicine service.

OBJECTIVE: To describe the characteristics and short-term prognostic factors of patients with prolonged stay in internal medicine. MATERIAL AND METHODS: Retrospective case series study including patients admitted to an Internal Medicine service of a university hospital with lengths of stay greater than 30 days during 5 years. Information was obtained from the Minimum Basic Data Set. Outcome variables were a very long length of stay, in-hospital mortality, and adverse outcomes in the first 30 days after discharge. RESULTS: Out of 11,948 patients, 335 (2.8%) cases had a prolonged stay. The total length of stay was 15,271 days (15% of the total length of stay of the service). The mean age was 74.5 (±13.9) years, 180 (53.7%) were male. The median length of stay was 39 (RIC 34-49) days. Intensive Care Unit admission (OR = 2.5; 95%CI 1.4-4.7; p = 0.003) and receiving a geriatric assessment (OR = 0.3; 95%CI 0.8-0.9; p = 0.042) were independent factors with an effect on very long length of stay. Having an admission in the previous year was an independent factor for an adverse outcome 30 days after discharge (OR = 2.2; 95%CI 1.0-4.8). CONCLUSIONS: The percentage of patients with prolonged length of stay is less than 3%, but they have a high impact on the activity of an internal medicine service. There are factors associated with a very long length of stay and with the presence of an early adverse outcome after discharge.

Quantifying Recruitment Source and Participant Communication Preferences for Alzheimer's Disease Prevention Research.

BACKGROUND: Evidence on effective engagement of diverse participants in AD prevention research is lacking. OBJECTIVES: To quantify recruitment source in relation to race, ethnicity, and retention. DESIGN: Prospective cohort study. SETTING: University lab. PARTICIPANTS: Participants included older adults (N=1170) who identified as White (86%), Black (8%), and Hispanic/Latino ethnicity (6%). MEASUREMENTS: The Cognitive Aging Lab Marketing Questionnaire assessed recruitment source, social media use, and research opportunity communication preferences. RESULTS: Effective recruitment methods and communication preferences vary by race and ethnicity. The most common referral sources were postcards for racial minorities, friend/family referrals for Hispanic/Latinos, and the newspaper for Whites. Whereas Whites preferred email communications, Hispanic/Latinos preferred texts. CONCLUSIONS: Recruiting diverse samples in AD prevention research is clinically relevant given high AD-risk of minorities and that health disparities are propagated by their under-representation in research. Our questionnaire and these results may be applied to facilitate effective research engagement.

[Analysis of the predictive value of preventive isolation criteria in the intensive care unit]. / Análisis del valor predictivo de los criterios de aislamiento preventivo en una unidad de cuidados intensivos.

OBJECTIVE: To assess the diagnostic accuracy of the criteria used to detect patients carrying multiresistant microorganisms (MRMs). DESIGN: A prospective observational study was carried out from May 2014 to May 2015. SETTING: Polyvalent Intensive Care Unit. PATIENTS: A cohort of consecutively admitted patients meeting the following criteria for preventive isolation according to the "Zero Resistance" project: hospital length of stay>4 days in the last three months ("hospital"); antibiotherapy during one week in the last month ("antibiotic"); institutionalized patients or recurrent contact with healthcare ("institution or care"); MRM carrier in the last 6 months ("previous MRM"). VARIABLES: Demographic data, culture results and isolation time. A multivariate analysis was performed using multiple logistic regression between each of the risk factors and patient MRM carrier status. RESULTS: During the study period, 575 patients were admitted, of which 28% met the isolation criteria (162). Fifty-one (31%) were MRM carriers. Of the patients who did not meet the criteria, 29 (7%) were carriers. In the multivariate analysis, the only variable independently associated to carrier status was "previous MRM", with OR=12.14 (95%CI 4.24-34.77). CONCLUSIONS: The only criterion independently associated with the ability to detect patients with MRMs upon admission to the ICU was the existence of "previous MRM".

Health Care Professionals as Relatives in Organ Donation Interviews: Analysis of the Important Role of Health Care Professionals as Family Members.

INTRODUCTION: The organ and tissue donation interview is a vital step in obtaining the donation. Therefore, it is important to obtain as much information as possible regarding the relatives of the potential donor prior to this interview and know if there is a health care professional among the relatives who may act as an interlocutor. OBJECTIVE: The objective of this study is to assess the influence that relatives who are health care professionals may have if present at the interview for the organ and tissue donation request. METHODS: This is a descriptive study of all the organ donations from 1996 to 2019. Variables of the interview record form were completed by the Regional Transplant Coordination Office. Quantitative variables are expressed as mean (standard deviation) or median (interquartile range), and qualitative variables are expressed in percentage. The χ2 test was used for inferential statistics. RESULTS: Health care professionals were present as interlocutors in 8.4% of the total interviews conducted (9279). Organ donation was accepted in 86% of these interviews, while the relative who was a health care professional gave a 93.8% (729) positive response to the donation. Having a health care professional as an interlocutor favors the acceptance of the donation (odds ratio 9.325, 95% confidence interval: 5.054-17.205; P < .001). CONCLUSION: Health care professionals have a very positive attitude toward donation. This attitude positively impacts other relatives' acceptance of the donation.

Analysis of adherence to HIV-positive quality of care indicators and their impact on service quality perceptions in patients: a Spanish cross-sectional study.

BACKGROUND: Since the identification of human immunodeficiency virus (HIV) infection, there have been significant advances in its diagnosis and treatment, but there have been few contributions to the area of care quality. In 2010, the Spanish AIDS Study Group (GeSIDA) published the document "Health quality indicators of GeSIDA for the care of people infected with HIV/AIDS" in which standards are proposed for the purpose of improving and standardizing the assistance provided to people infected with HIV. The purpose of this study was to evaluate the degree of compliance with these indicators and to analyse whether adherence to the standards improves patient perception of care quality in terms of their satisfaction with the health care they have received. METHODS: Compliance with GeSIDA indicators was analysed within a cohort of people living with HIV (PLHIV) in a hospital in the Madrid region. To evaluate patient perception, the External Consultation User Satisfaction Questionnaire (SUCE) was used, which is a tool that was previously validated in the Spanish population. RESULTS: A total of 334 patients were included. The level of adherence to the indicators was 74.46%. The score on the SUCE questionnaire was 9.04 out of 10 (CI 95%: 8.90-9.19). Of the 47 indicators assessed, only 4 were related to satisfaction with health care. CONCLUSIONS: The levels of compliance with the indicators and patient satisfaction with health care were high. Adherence to quality indicators showed little relation to patient-reported satisfaction.

Capnometry levels as an indicator of renal graft evolution in uncontrolled non-heart beating donors. / Niveles de capnometría como indicador de evolución de injerto renal de donantes en asistolia no controlada.

OBJECTIVE: The capnometry values during resuscitation are an evolutive predictor of kidneys obtained from uncontrolled non-heart beating donors. DESIGN: The study comprised a retrospective onset cohort of 37 non-heart beating donors and a validation cohort of 55 trasplanted kidneys in the period 2013-2017. SCOPE: The population served by the emergency service and referred to Hospital Universitario Doce de Octubre (Madrid, Spain) as potential uncontrolled non-heart beating donors. PATIENTS: A total of 55 renal transplant patients subjected to hemodialysis and with grafts from uncontrolled non-heart beating donors. INTERVENTIONS: Capnometry and capnography measurements in potential uncontrolled non-heart beating donors. VARIABLES: Capnometry values recorded initially and at transfer in hospital for comparison with the viability of the extracted kidneys; renal failure and delayed renal function. RESULTS: A total of 55 out of 74 extracted kidneys were trasplanted (74.3%). The rest were ruled out due to poor perfusion or signs of ischemia. An association was observed (P=.016) between the capnometry values during resuscitation in the grafted kidneys (µ=22.8 mmHg) and in the kidneys discarded for transplantation (µ=17.35 mmHg). CONCLUSIONS: Capnometry during resuscitation serves as a marker to be taken into account in relation to the viability of the trasplanted organs in uncontrolled non-heart beating donors.

Niveles de cobre y zinc en diferentes etapas de la leche materna y la influencia del estado nutricional de madres lactantes / Levels of copper and zinc in different stages of breast milk and the influence of the nutritional state of nursing mothers

RESUMEN La leche humana materna tiene una composición única para proporcionar a los recién nacidos todos los nutrientes esenciales como proteínas, grasas, hidratos de carbono, minerales, vitaminas y otras substancias fisiológicamente activas, con el fin de suplir en cantidad y calidad las necesidades calóricas y nutricionales del lactante. El objetivo fue establecer las concentraciones totales de cobre y zinc en la leche materna en sus distintas etapas: calostro, de transición y madura, determinadas espectrométricamente y la influencia del estado nutricional de madres lactantes; estudio descriptivo transversal en madres entre 18 y 35 años, sanas y no fumadoras; los resultados evidencian una disminución en las concentraciones de cobre y zinc a medida que la lactancia va evolucionando, además, el promedio de índice de masa corporal de las madres en período de lactancia reflejaron sobrepeso. Concluimos que el contenido calórico de los oligoelementos de la leche materna es esencial para el crecimiento de los niños por los beneficios nutricionales e inmunológicos que proporciona, por lo que es importante que la madre se encuentre en un estado nutricional adecuado que permita suministrar los requerimientos adecuados al niño para su crecimiento y desarrollo.

ABSTRACT Human milk has a unique composition and provides newborns with all essential nutrients such as proteins, fats, carbohydrates, minerals, vitamins and other physiologically active substances, in order to supply in quantity and quality the caloric and nutritional needs of the infant. The objective of this study was to establish the total concentration of copper and zinc in breast milk in its different stages: colostrum, transitional and mature milk, determined spectrometrically and the influence of the nutritional status of nursing mothers. We conducted a descriptive cross-sectional study in healthy non-smoking mothers between 18 and 35 years of age. Lower concentrations of copper and zinc as lactation progressed were observed. The average of body mass index of nursing mothers reflected overweight. We concludes that the caloric content of the trace elements of breast milk is essential for the growth of children because of the nutritional and immunological benefits that it provides, so it is important that the mother has an adequate nutritional state that allows to supply the adequate requirements for the child to grow and develop.

[Reliability and concurrent validity of the app Goniometer Pro vs Universal Goniometer in the determination of passive knee flexion]. / Fiabilidad y validez concurrente de la app Goniometer Pro vs goniómetro universal en la determinación de la flexión pasiva de rodilla.

BACKGROUND: Smartphones have become a fundamental part of our society, not only everyday, but also professional, since many applications have emerged for the health field. The objective of the study was to analyze the reliability and concurrent validity of an app for iPhone in relation to traditional measurement. MATERIAL AND METHODS: A non-experimental, double-blind validation and descriptive study. On a sample of 21 subjects, four measurements of knee mobility were performed. Two using universal goniometer (GU) and two through the application Goniometer-Pro (G-Pro) for IPhone. The X-ray was used as a reference measure of the knee flexion angle and was analyzed by a single evaluator who compared this result with that of the other evaluators. RESULTS: The difference between the average intra-group values was 3.148o (± 2.669o) for GU and 2.476o (± 2.638o) for G-Pro. The inter-group mean difference reached 5.45o. The Inter-observer reliability was 0.990 for GU and 0.993 for G-Pro; as for validity, the values obtained were 0.976 for GU and 0.992 for G-Pro. CONCLUSIONS: The G-Pro app is a reliable tool with a high accuracy to measure the knee flexion angle. Its results are slightly superior and more accurate to those of traditional instruments.

ANTECEDENTES: Los teléfonos inteligentes se han convertido en una parte fundamental de nuestra sociedad, no sólo cotidiana, sino también profesional, pues han surgido numerosas aplicaciones para el ámbito sanitario. El objetivo del estudio fue analizar la fiabilidad y validez concurrente de una app para iPhone en relación con la goniometría tradicional. MATERIAL Y MÉTODOS: Estudio comparativo y descriptivo de validación no experimental a doble ciego. En una muestra de 21 sujetos se realizaron cuatro mediciones de movilidad de rodilla: dos mediante goniometría universal (GU) y dos mediante la aplicación Goniometer-Pro (G-Pro) para iPhone. La radiografía se empleó como medida de referencia del ángulo de flexión de rodilla y fue analizada por un único evaluador que comparó este resultado con el de los otros evaluadores. RESULTADOS: La diferencia entre los valores medios intragrupos fue de 3.148o (± 2.669o) para GU y 2.476o (± 2.638o) para G-Pro. La diferencia de medias intergrupos alcanzó 5.45o. La fiabilidad interobservador fue de 0.990 para GU y 0.993 para G-Pro; en cuanto a la validez, los valores obtenidos fueron 0.976 para GU y 0.992 para G-Pro. CONCLUSIONES: La app G-Pro es una herramienta fiable y con una elevada exactitud para medir el ángulo de flexión de la rodilla. Sus resultados son ligeramente superiores y más precisos a los de la goniometría tradicional.

Control over the transverse structure and long-distance fiber propagation of light at the single-photon level.

Quantum entanglement is arguably the cornerstone which differentiates the quantum realm from its classical counterpart. While entanglement can reside in any photonic degree of freedom, polarization permits perhaps the most straightforward manipulation due to the widespread availability of standard optical elements such as waveplates and polarizers. As a step towards a fuller exploitation of entanglement in other degrees of freedom, in this work we demonstrate control over the transverse spatial structure of light at the single-photon level. In particular we integrate in our setup all the technologies required for: (i) fibre-based photon pair generation, (ii) deterministic and broadband single-photon spatial conversion relying on a passive optical device, and (iii) single-photon transmission, while retaining transverse structure, over 400 m of few-mode fibre. In our experiment, we employ a mode selective photonic lantern multiplexer with the help of which we can convert the transverse profile of a single photon from the fundamental mode into any of the supported higher-order modes. We also achieve conversion to an incoherent or coherent addition of two user-selected higher order modes by addressing different combinations of inputs in the photonic lantern multiplexer. The coherent nature of the addition, and extraction of usable orbital angular momentum at the single-photon level, is further demonstrated by far-field diffraction through a triangular aperture. Our work could enable studies of photonic entanglement in the transverse modes of a fibre and could constitute a key resource quantum for key distribution with an alphabet of scalable dimension.

Fiabilidad y validez concurrente de la app Goniometer Pro vs goniómetro universal en la determinación de la flexión pasiva de rodilla / Reliability and concurrent validity of the app Goniometer Pro vs Universal Goniometer in the determination of passive knee flexion

Resumen: Antecedentes: Los teléfonos inteligentes se han convertido en una parte fundamental de nuestra sociedad, no sólo cotidiana, sino también profesional, pues han surgido numerosas aplicaciones para el ámbito sanitario. El objetivo del estudio fue analizar la fiabilidad y validez concurrente de una app para iPhone en relación con la goniometría tradicional. Material y métodos: Estudio comparativo y descriptivo de validación no experimental a doble ciego. En una muestra de 21 sujetos se realizaron cuatro mediciones de movilidad de rodilla: dos mediante goniometría universal (GU) y dos mediante la aplicación Goniometer-Pro (G-Pro) para iPhone. La radiografía se empleó como medida de referencia del ángulo de flexión de rodilla y fue analizada por un único evaluador que comparó este resultado con el de los otros evaluadores. Resultados: La diferencia entre los valores medios intragrupos fue de 3.148o (± 2.669o) para GU y 2.476o (± 2.638o) para G-Pro. La diferencia de medias intergrupos alcanzó 5.45o. La fiabilidad interobservador fue de 0.990 para GU y 0.993 para G-Pro; en cuanto a la validez, los valores obtenidos fueron 0.976 para GU y 0.992 para G-Pro. Conclusiones: La app G-Pro es una herramienta fiable y con una elevada exactitud para medir el ángulo de flexión de la rodilla. Sus resultados son ligeramente superiores y más precisos a los de la goniometría tradicional.

Abstract: Background: Smartphones have become a fundamental part of our society, not only everyday, but also professional, since many applications have emerged for the health field. The objective of the study was to analyze the reliability and concurrent validity of an app for iPhone in relation to traditional measurement. Material and methods: A non-experimental, double-blind validation and descriptive study. On a sample of 21 subjects, four measurements of knee mobility were performed. Two using universal goniometer (GU) and two through the application Goniometer-Pro (G-Pro) for IPhone. The X-ray was used as a reference measure of the knee flexion angle and was analyzed by a single evaluator who compared this result with that of the other evaluators. Results: The difference between the average intra-group values was 3.148o (± 2.669o) for GU and 2.476o (± 2.638o) for G-Pro. The inter-group mean difference reached 5.45o. The Inter-observer reliability was 0.990 for GU and 0.993 for G-Pro; as for validity, the values obtained were 0.976 for GU and 0.992 for G-Pro. Conclusions: The G-Pro app is a reliable tool with a high accuracy to measure the knee flexion angle. Its results are slightly superior and more accurate to those of traditional instruments.

Cardiovascular disease and survival in non-small cell lung cancer: a multicenter prospective assessment.

PURPOSE: Chronic inflammation contributes to cancer development via multiple mechanisms. We hypothesized that cardiovascular diseases (CVD) are also an independent risk factor for survival in non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Prospective multicenter data from 345 consecutive NSCLC patients treated from January 2013 to January 2017 were assessed. Median follow-up for all patients was 13 months (range 3-60 months). There were 109 patients with baseline heart disease (HD 32%), 149 with arterial hypertension (43%), 85 with diabetes mellitus (25%), 129 with hyperlipidemia (37%) and 45 with venous thromboembolism events (VTE 13%). A total of 289 patients (84%) were treated with platinum-based chemotherapy (CT), 300 patients (87%) received thoracic radiation therapy (RT; median radiation dose: 60 Gy [range 12-70]); and 50 (15%) patients underwent surgery. RESULTS: Our cohort consisted of 305 men (88%) and 40 (12%) women, with a median age of 67 years (range 31-88 years). Seventy percent had a Karnofsky performance status (KPS) ≥ 80. Multivariate analyses showed a lower OS and higher risk of distant metastasis in patients with advanced stages (p = 0.05 and p < 0.001, respectively) and HD (HR 1.43, p = 0.019; and HR 1.49, p = 0.025, respectively). Additionally, patients with VTE had lower local control (HR 1.84, p = 0.025), disease-free survival (HR 1.64, p = 0.020) and distant metastasis-free survival (HR 1.73, p = 0.025). CONCLUSIONS: HD and VTE are associated with a higher risk of mortality and distant metastasis in NSCLC patients. Chronic inflammation associated with CVDs could be an additional pathophysiologic factor in the development of distant metastasis.