Substituting meat for mycoprotein reduces genotoxicity and increases the abundance of beneficial microbes in the gut: Mycomeat, a randomised crossover control trial.

PURPOSE: The high-meat, low-fibre Western diet is strongly associated with colorectal cancer risk. Mycoprotein, produced from Fusarium venanatum, has been sold as a high-fibre alternative to meat for decades. Hitherto, the effects of mycoprotein in the human bowel have not been well considered. Here, we explored the effects of replacing a high red and processed meat intake with mycoprotein on markers of intestinal genotoxicity and gut health. METHODS: Mycomeat (clinicaltrials.gov NCT03944421) was an investigator-blind, randomised, crossover dietary intervention trial. Twenty healthy male adults were randomised to consume 240 g day-1 red and processed meat for 2 weeks, with crossover to 2 weeks 240 g day-1 mycoprotein, separated by a 4-week washout period. Primary end points were faecal genotoxicity and genotoxins, while secondary end points comprised changes in gut microbiome composition and activity. RESULTS: The meat diet increased faecal genotoxicity and nitroso compound excretion, whereas the weight-matched consumption of mycoprotein decreased faecal genotoxicity and nitroso compounds. In addition, meat intake increased the abundance of Oscillobacter and Alistipes, whereas mycoprotein consumption increased Lactobacilli, Roseburia and Akkermansia, as well as the excretion of short chain fatty acids. CONCLUSION: Replacing red and processed meat with the Fusarium-based meat alternative, mycoprotein, significantly reduces faecal genotoxicity and genotoxin excretion and increases the abundance of microbial genera with putative health benefits in the gut. This work demonstrates that mycoprotein may be a beneficial alternative to meat within the context of gut health and colorectal cancer prevention.

Human gut Bacteroidetes can utilize yeast mannan through a selfish mechanism.

Yeasts, which have been a component of the human diet for at least 7,000 years, possess an elaborate cell wall α-mannan. The influence of yeast mannan on the ecology of the human microbiota is unknown. Here we show that yeast α-mannan is a viable food source for the Gram-negative bacterium Bacteroides thetaiotaomicron, a dominant member of the microbiota. Detailed biochemical analysis and targeted gene disruption studies support a model whereby limited cleavage of α-mannan on the surface generates large oligosaccharides that are subsequently depolymerized to mannose by the action of periplasmic enzymes. Co-culturing studies showed that metabolism of yeast mannan by B. thetaiotaomicron presents a 'selfish' model for the catabolism of this difficult to breakdown polysaccharide. Genomic comparison with B. thetaiotaomicron in conjunction with cell culture studies show that a cohort of highly successful members of the microbiota has evolved to consume sterically-restricted yeast glycans, an adaptation that may reflect the incorporation of eukaryotic microorganisms into the human diet.

Study of tyrosine and dopa enantiomers as tyrosinase substrates initiating l- and d-melanogenesis pathways.

Tyrosinase starts melanogenesis and determines its course, catalyzing the oxidation by molecular oxygen of tyrosine to dopa, and that of dopa to dopaquinone. Then, nonenzymatic coupling reactions lead to dopachrome, which evolves toward melanin. Recently, it has been reported that d-tyrosine acts as tyrosinase inhibitor and depigmenting agent. The action of tyrosinase on the enantiomers of tyrosine (l-tyrosine and d-tyrosine) and dopa (l-dopa and d-dopa) was studied for the first time focusing on quantitative transient phase kinetics. Post-steady-state transient phase studies revealed that l-dopachrome is formed more rapidly than d-dopachrome. This is due to the lower values of Michaelis constants for l-enantiomers than for d-enantiomers, although the maximum rates are equal for both enantiomers. A deeper analysis of the inter-steady-state transient phase of monophenols demonstrated that the enantiomer d-tyrosine causes a longer lag period and a lower steady-state rate, than l-tyrosine at the same concentration. Therefore, d-melanogenesis from d-tyrosine occurs more slowly than does l-melanogenesis from l-tyrosine, which suggests the apparent inhibition of melanin biosynthesis by d-tyrosine. As conclusion, d-tyrosine acts as a real substrate of tyrosinase, with low catalytic efficiency and, therefore, delays the formation of d-melanin.

Reliability and Validity of the Polar V800 Sports Watch for Estimating Vertical Jump Height.

This study aimed to assess the reliability and validity of the Polar V800 to measure vertical jump height. Twenty-two physically active healthy men (age: 22.89 ± 4.23 years; body mass: 70.74 ± 8.04 kg; height: 1.74 ± 0.76 m) were recruited for the study. The reliability was evaluated by comparing measurements acquired by the Polar V800 in two identical testing sessions one week apart. Validity was assessed by comparing measurements simultaneously obtained using a force platform (gold standard), high-speed camera and the Polar V800 during squat jump (SJ) and countermovement jump (CMJ) tests. In the test-retest reliability, high intraclass correlation coefficients (ICCs) were observed (mean: 0.90, SJ and CMJ) in the Polar V800. There was no significant systematic bias ± random errors (p > 0.05) between test-retest. Low coefficients of variation (<5%) were detected in both jumps in the Polar V800. In the validity assessment, similar jump height was detected among devices (p > 0.05). There was almost perfect agreement between the Polar V800 compared to a force platform for the SJ and CMJ tests (Mean ICCs = 0.95; no systematic bias ± random errors in SJ mean: -0.38 ± 2.10 cm, p > 0.05). Mean ICC between the Polar V800 versus high-speed camera was 0.91 for the SJ and CMJ tests, however, a significant systematic bias ± random error (0.97 ± 2.60 cm; p = 0.01) was detected in CMJ test. The Polar V800 offers valid, compared to force platform, and reliable information about vertical jump height performance in physically active healthy young men.

Cardiometabolic and Muscular Fatigue Responses to Different CrossFit® Workouts.

CrossFit® consists of workouts of the day (WODs) in which different exercises are conducted at high intensity with minimal or no rest periods. This study sought to quantify exercise intensity and muscular fatigue in the three CrossFit® session modalities: gymnastics (G), metabolic conditioning (M) and weightlifting (W). Thirty two, young, strength-trained, healthy men completed the three WODs: G ("Cindy"), M (double skip rope jumps) and W (power cleans). The variables measured in the sessions were: mean heart rate (HR), rate of perceived exertion (RPE), blood lactate [lactate], and jump height (H), average power (AP) and maximum take-off velocity (Vmax) in a counter movement jump test. In all three WODs, elevated HR values (≥90% of the theoretical HRmax) were recorded at the time points mid-session and end-session. Mean RPEs were 17.6 ± 1.6 (G WOD), 16.0 ± 2.3 (M WOD), and 15.7 ± 2.0 (W WOD). Postexercise [lactate] was higher than 10 mmol·L-1 for the three WODs. Following the G ("Cindy") and W (power cleans) WODs, respectively, significant muscular power losses were observed in H (7.3% and 8.1%), Vmax (13.8% and 3.3%), AP relative (4.6% and 8.3%) and AP total (4.2% and 8.2%) while losses in the M WOD were not significant (p > 0.05). A vigorous intensity of exercise was noted in all three WODs, with greater mean HRs detected in the "Cindy" and skip rope WODs than power clean WOD. Muscular fatigue was produced in response to the "Cindy" and power clean WODs but not the skip rope WOD.

Circadian rhythm effect on physical tennis performance in trained male players.

To determine the effect of circadian rhythm on neuromuscular responses and kinematics related to physical tennis performance, after a standardised warm-up, 13 highly competitive male tennis players were tested twice for serve velocity/accuracy (SVA), countermovement vertical jump (CMJ), isometric handgrip strength (IS), agility T-test (AGIL) and a 10-m sprint (10-m RUN). In a randomised, counter-balance order, tennis players underwent the test battery twice, either in the morning (i.e., AM; 9:00 h) and in the afternoon (i.e., PM; 16:30 h). Paired t-tests were used to analyse differences due to time-of-day in performance variables. Comparison of morning versus afternoon testing revealed that SVA (168.5 ± 6.5 vs. 175.2 ± 6.1 km · h-1; P = 0.003; effect size [ES] = 1.07), CMJ (32.2 ± 0.9 vs. 33.7 ± 1.1 cm; P = 0.018; ES = 1.46), AGIL (10.14 ± 0.1 vs. 9.91 ± 0.2 s; P = 0.007; ES = 1.23) and 10-m RUN time (1.74 ± 0.1 vs. 1.69 ± 0.1 s; P = 0.021; ES = 0.67) were significantly blunted during the morning testing. However, IS was not affected by time-of-day (P = 0.891). Thus, tennis performance may be reduced when competing in the morning in comparison to early evening. Therefore, coaches and tennis players should focus on schedule the SVA, power, speed and agility training sessions in the afternoon.

Acute Physiological and Mechanical Responses During Resistance Exercise at the Lactate Threshold Intensity.

The purpose of this study was to examine acute metabolic, mechanical, and cardiac responses to half-squat (HS) resistance exercise performed at a workload corresponding to the lactate threshold (LT). Thirteen healthy subjects completed 3 HS exercise tests separated by 48-hour rest periods: a maximal strength or 1 repetition maximum (1RM) test, an incremental load test to establish the % 1RM at which the LT was reached, and a constant load test at the LT intensity. During the last test, metabolic, mechanical, and cardiac responses were monitored respectively through blood lactate concentrations, height (H), average power (AP) and peak power (PP) recorded in a countermovement jump test, and heart rate (HR). During the constant load test, lactate concentrations and HR remained stable whereas significant reductions were detected in H, AP, and PP (p ≤ 0.05). Only low correlation was observed between lactate concentrations and the H (r = 0.028), AP (r = 0.072), and PP (r = 0.359) losses produced. Half-squat exercise at the LT elicits stable HR and blood lactate responses within a predominantly aerobic metabolism, although this exercise modality induces significant mechanical fatigue.

Reliability and validity assessment of a linear position transducer.

The objectives of the study were to determine the validity and reliability of peak velocity (PV), average velocity (AV), peak power (PP) and average power (AP) measurements were made using a linear position transducer. Validity was assessed by comparing measurements simultaneously obtained using the Tendo Weightlifting Analyzer Systemi and T-Force Dynamic Measurement Systemr (Ergotech, Murcia, Spain) during two resistance exercises, bench press (BP) and full back squat (BS), performed by 71 trained male subjects. For the reliability study, a further 32 men completed both lifts using the Tendo Weightlifting Analyzer Systemz in two identical testing sessions one week apart (session 1 vs. session 2). Intraclass correlation coefficients (ICCs) indicating the validity of the Tendo Weightlifting Analyzer Systemi were high, with values ranging from 0.853 to 0.989. Systematic biases and random errors were low to moderate for almost all variables, being higher in the case of PP (bias ±157.56 W; error ±131.84 W). Proportional biases were identified for almost all variables. Test-retest reliability was strong with ICCs ranging from 0.922 to 0.988. Reliability results also showed minimal systematic biases and random errors, which were only significant for PP (bias -19.19 W; error ±67.57 W). Only PV recorded in the BS showed no significant proportional bias. The Tendo Weightlifting Analyzer Systemi emerged as a reliable system for measuring movement velocity and estimating power in resistance exercises. The low biases and random errors observed here (mainly AV, AP) make this device a useful tool for monitoring resistance training. Key pointsThis study determined the validity and reliability of peak velocity, average velocity, peak power and average power measurements made using a linear position transducerThe Tendo Weight-lifting Analyzer Systemi emerged as a reliable system for measuring movement velocity and power.

A PCR Test Using the Mini-PCR Platform and Simplified Product Detection Methods Is Highly Sensitive and Specific to Detect Fasciola hepatica DNA Mixed in Human Stool, Snail Tissue, and Water DNA Specimens.

Fasciola hepatica has a complex lifecycle with multiple intermediate and definitive hosts and influenced by environmental factors. The disease causes significant morbidity in children and its prevalent worldwide. There is lack of data about distribution and burden of the disease in endemic regions, owing to poor efficacy of the different diagnostic methods used. A novel PCR-based test was developed by using a portable mini-PCR® platform to detect Fasciola sp. DNA and interpret the results via a fluorescence viewer and smartphone image analyzer application. Human stool, snail tissue, and water samples were used to extract DNA. Primers targeting the ITS-1 of the 18S rDNA gene of Fasciola sp. were used. The limit of detection of the mini-PCR test was 1 fg/µL for DNA samples diluted in water, 10 fg/µL for Fasciola/snail DNA scramble, and 100 fg/µL for Fasciola/stool DNA scramble. The product detection by agarose gel, direct visualization, and image analyses showed the same sensitivity. The Fh mini-PCR had a sensitivity and specificity equivalent to real-time PCR using the same specimens. Testing was also done on infected human stool and snail tissue successfully. These experiments demonstrated that Fh mini-PCR is as sensitive and specific as real time PCR but without the use of expensive equipment and laboratory facilities. Further testing of multiple specimens with natural infection will provide evidence for feasibility of deployment to resource constrained laboratories.

Melatonin in octopus (Octopus vulgaris): tissue distribution, daily changes and relation with serotonin and its acid metabolite.

Information regarding melatonin production in molluscs is very limited. In this study the presence and daily fluctuations of melatonin levels were investigated in hemolymph, retina and nervous system-related structures in the cephalopod Octopus vulgaris. Adult animals were maintained in captivity under natural photoperiod and killed at different times in a regular daily cycle. Levels of melatonin, serotonin (5-HT) and its acid metabolite (5-hydroxyindole acetic acid, 5-HIAA) in the hemolymph, retina, optic lobe, and cerebral ganglion were assayed by HPLC. Melatonin content fluctuated rhythmically in the retina and hemolymph, peaking at night. In the retina, but not in the other neural tissues, the rhythm was opposite to that of 5-HT, which displayed basal levels at night. Also, 5-HIAA levels in the retina were higher during the night, supporting that rhythmic melatonin production could be linked to diurnal changes in 5-HT degradation. The high levels of melatonin found in the retina point to it as the major source of melatonin in octopus; in addition, a large variation of melatonin content was found in the optic lobe with maximal values at night. All these data suggest that melatonin might play a role in the transduction of the light-dark cycle information for adjustment of rhythmic physiological events in cephalopods.

Phenolic substrates and suicide inactivation of tyrosinase: kinetics and mechanism.

The suicide inactivation mechanism of tyrosinase acting on its substrates has been studied. The kinetic analysis of the proposed mechanism during the transition phase provides explicit analytical expressions for the concentrations of o-quinone against time. The electronic, steric and hydrophobic effects of the substrates influence the enzymatic reaction, increasing the catalytic speed by three orders of magnitude and the inactivation by one order of magnitude. To explain the suicide inactivation, we propose a mechanism in which the enzymatic form E(ox) (oxy-tyrosinase) is responsible for such inactivation. A key step might be the transfer of the C-1 hydroxyl group proton to the peroxide, which would act as a general base. Another essential step might be the axial attack of the o-diphenol on the copper atom. The rate constant of this reaction would be directly related to the strength of the nucleophilic attack of the C-1 hydroxyl group, which depends on the chemical shift of the carbon C-1 (delta(1)) obtained by (13)C-NMR. Protonation of the peroxide would bring the copper atoms together and encourage the diaxial nucleophilic attack of the C-2 hydroxyl group, facilitating the co-planarity with the ring of the copper atoms and the concerted oxidation/reduction reaction, and giving rise to an o-quinone. The suicide inactivation would occur if the C-2 hydroxyl group transferred the proton to the protonated peroxide, which would again act as a general base. In this case, the co-planarity between the copper atom, the oxygen of the C-1 and the ring would only permit the oxidation/reduction reaction on one copper atom, giving rise to copper(0), hydrogen peroxide and an o-quinone, which would be released, thus inactivating the enzyme.

How frequently the clinical practice recommendations for nephropathy are achieved in patients with type 2 diabetes mellitus in a primary health-care setting?

OBJECTIVE: To determine the proportion of DM2 patients in primary health-care setting who meet clinical practice recommendations for nephropathy. MATERIAL AND METHODS: 735 patients were included in this cross-sectional study. Nephropathy was defined as glomerular filtration rate < 60 mL/min/1.73 m2 or albuminuria > or = 30 mg/day. To estimate the proportion of patients meeting clinical practice recommendations, the achieved level was classified according to NKF -K/DOQI, ADA, IDF, JNC 7 report, and NCEP-ATPIII. RESULTS: A high frequency of kidney disease and cardiovascular risk factors (smoking, alcoholism, obesity) was observed. Adequate levels were attained in 13% for fasting glucose, 45% for blood pressure, 71% for albuminuria, and 30% for lipids. Nephropathy was diagnosed in 41%. Adequate systolic blood pressure was observed in 40% of patients with nephropathy vs. 49% without nephropathy (p = 0.03). In both groups, body mass index was acceptable in one fifth of patients, and waist circumference in two thirds of men and one third of women (p = NS). Patients with nephropathy used more antihypertensives, particularly angiotensin converting enzyme inhibitors (nephropathy 49% vs. no nephropathy 38%, p = 0.004). Subjects with nephropathy received more frequently (p = 0.05) insulin (11%) than those without nephropathy (7%). In both groups, there was low use of statins (nephropathy 14% vs. no nephropathy 17%, p = 0.23), and aspirin (nephropathy 7% vs. no nephropathy 5%, p = 0.39). CONCLUSIONS: Recommended goals for adequate control of DM2 patients attending primary health-care units are rarely achieved, and this was independent of the presence of nephropathy. These findings are disturbing, as poor clinical and metabolic control may eventually cause that patients without nephropathy develop renal damage, and those subjects already with renal disease progress to renal insufficiency.

Psychological Safety and Support: Assessing Resident Perceptions of the Clinical Learning Environment.

BACKGROUND: Assessments of the clinical learning environment could allow early interventions to improve graduate medical education. To date, measurement tools for this have not been identified. OBJECTIVE: We established the concurrent validity of 2 instruments that assess cultural facets of the clinical learning environment by correlating them with external program evaluation data. METHODS: In 2017 we surveyed residents across 19 training programs on their perceptions of organizational support by using the Short Survey of Perceived Organizational Support (SPOS), and psychological safety by using the Psychological Safety Scale (PSS). Data were aggregated to the program level and correlated with results from the Accreditation Council for Graduate Medical Education (ACGME) Resident Survey. RESULTS: Of 511 residents, 322 (63%) completed the survey, and 496 of 516 residents (96%) completed the ACGME Resident Survey. Perceived organizational support correlated positively with overall program evaluation score (r = 0.75, P < .001); faculty (r = 0.72, P < .001); evaluation (r = 0.73, P < .001); educational content (r = 0.52, P = .022); and resources domains (r = 0.55, P = .014). Psychological safety had a positive correlation with overall program evaluation (r = 0.57, P = .011); faculty (r = 0.50, P = .028); and evaluation (r = 0.62, P < .005). CONCLUSIONS: The SPOS and PSS correlated with key ACGME Resident Survey domains. Programs showing greater support of residents were likely to show more positive ratings on program evaluation metrics. Teaching institutions may benefit from actively monitoring and improving aspects of their learning environment through internal assessments.

The 577X allele of the ACTN3 gene is associated with improved exercise capacity in women with McArdle's disease.

We assessed the possible association existing between alpha-actinin-3 (ACTN3) R577X genotypes and the capacity for performing aerobic exercise in McArdle's patients. Forty adult McArdle's disease patients and forty healthy, age and gender-matched sedentary controls (21 men, 19 women in both groups) performed a graded test until exhaustion and a constant-load test on a cycle-ergometer to determine clinically relevant indices of exercise capacity as peak oxygen uptake (VO(2peak)) and the ventilatory threshold (VT). In the group of diseased women, carriers of the X allele had a higher (P<0.01) VO(2peak) (15.0+/-1.2 ml/kg/min) and a higher (P<0.05) oxygen uptake (VO(2)) at the VT (11.2+/-1 ml/kg/min) than R/R homozygotes (VO(2peak): 9.6+/-0.5 ml/kg/min; VO(2) at the VT: 8.2+/-0.7 ml/kg/min). No differences were found in male patients. In women with McArdle's disease, ACTN3 genotypes might partly explain the large individual variability that exists in the phenotypic manifestation of this disorder.

Exercise capacity in a child with McArdle disease.

We report the exercise capacity of an 8-year-old boy with clinical, histological, biochemical, and genetic evidence of McArdle disease. The patient presented with severe myalgia, proteinuria, hematuria, pyrexia, and elevated creatine kinase after swimming. After pre-exercise ingestion of sucrose, he performed treadmill exercise to symptom limitation. His peak oxygen uptake (18.8 mL/kg/min) and ventilatory threshold (16.0 mL/kg/min) were reduced by 40% and 20% compared with healthy age-matched and gender-matched controls. The results suggest that exercise capacity is reduced early in life in patients with McArdle disease and suggest the need for prophylactic exercise training (following pre-exercise feeding to prevent rhabdomyolysis) to minimize deconditioning.

Intraspecific variability in the Basal metabolic rate: testing the food habits hypothesis.

Several competing hypotheses attempt to explain how environmental conditions affect mass-independent basal metabolic rate (BMR) in mammals. One of the most inclusive and yet debatable hypotheses is the one that associates BMR with food habits, including habitat productivity. These effects have been widely investigated at the interspecific level under the assumption that for any given species all traits are fixed. Consequently, the variation among individuals is largely ignored. Intraspecific analysis of physiological traits has the potential to compensate for many of the pitfalls associated with interspecific analyses and, thus, to be a useful approach for evaluating hypotheses regarding metabolic adaptation. In this study, we investigated the effects of food quality, availability, and predictability on the BMR of the leaf-eared mouse Phyllotis darwini. BMR was measured on freshly caught animals from the field, since they experience natural seasonal variations in environmental factors (and, hence, variations in habitat productivity) and diet quality. BMR was significantly correlated with the proportion of dietary plants and seeds. In addition, BMR was significantly correlated with monthly habitat productivity. Path analysis indicated that, in our study, habitat productivity was responsible for the observed changes in BMR, while diet per se had no effect on this variable.

Utility of the Dipstick Micraltest II in the screening of microalbuminuria of diabetes mellitus type 2 and essential hypertension.

BACKGROUND: In Mexico, diabetes mellitus type 2 and hypertension are leading causes of end-stage renal disease. Diagnosis of early renal damage with detection of microalbuminuria (microAlbU) is fundamental for treatment and prevention, and so avoiding the catastrophes of renal failure. For screening purposes, several simplified tests, including dipstick methods, fulfill the accuracy requirements for microAlbU detection compared with gold standards; however, no study has established the reliability of such tests in our setting. AIM: To evaluate the utility of micraltest II as a screening test for microAlbU compared with nephelometry in patients with diabetes mellitus type 2 and non-diabetic patients with essential hypertension. PATIENTS AND METHODS: Patients with diabetes mellitus type 2 as well as patients with essential hypertension of any age, sex and time of evolution, attending to three primary health-care units (UMF No. 3, 92 and 93, Guadalajara, Jalisco) were included. Patients with transitory albuminuria, secondary hypertension and serum creatinine > or = 2 mg/dL were excluded. Micraltest II was performed in the first morning urine sample, and nephelometry was performed in a 24-h urine collection. Diagnostic accuracy of the dipstick test was then determined. RESULTS: 245 patients were studied: 71 (29%) were diabetics without hypertension, 95 (39%) were diabetics with hypertension, and 79 (32%) had only essential hypertension. In diabetic patients, micraltest II sensitivity was 83%, specificity 96%, and positive and negative predictive values were 95% and 88%, respectively. Correlation between nephelometry and micraltest II results was 0.81 (p < 0.001). The best cut-off point for microAlbU was 30.5 mg/L, and area under the curve (+/- SEM) was 0.91 +/- 0.03 (confidence interval 95%: 0.85-0.96). In non-diabetic patients with essential hypertension, micraltest II sensitivity was 75%, specificity 95%, and positive and negative predictive values were 43% and 99%, respectively. Correlation between nephelometry and micraltest II results was 0.43 (p < 0.001). The best cut-off point for microAlbU was 28.2 mg/L, and area under the curve was 0.85 +/- 0.13 (0.60-1.10). CONCLUSION: Micraltest II dispstick is a rapid, valid and reliable method for albuminuria screening in patients with diabetes mellitus type 2 and in those non-diabetic patients with essential hypertension in our setting.

Implementation of the Spanish National Enhanced Recovery Program (ERAS) in Bariatric Surgery: A Pilot Study.

INTRODUCTION: The essence of Enhanced Recovery After Surgery (ERAS) programs is the multimodal approach, and many authors have demonstrated safety and feasibility in fast track bariatric surgery. According to this concept, a multidisciplinary ERAS program for bariatric surgery has been developed by the Spanish fast track group (ERAS Spain). The aim of this study was to analyze the initial implementation of this Spanish National ERAS protocol in bariatric surgery. PATIENTS AND METHODS: A multicentric prospective pilot study was performed, including 125 consecutive patients undergoing bariatric surgery at 3 Spanish hospitals between January and June 2015, after the Spanish National ERAS protocol in bariatric surgery. Compliance with the protocol, morbidity, mortality, hospital stay, and readmission were evaluated. RESULTS: Bariatric techniques performed included 68 Roux-en-Y gastric bypass (54.4%) and 57 laparoscopic sleeve gastrectomy (45.6%) cases. All surgeries were laparoscopically performed with conversion in only 1 case (0.8%). Median postoperative pain evaluated by visual analogic scale 24 hours after surgery was 2 (range, 0 to 5). Postoperative nausea or vomiting appeared in 7 patients (5.6%). Complications appeared in 6 patients (4.8%). The reoperation rate was 4%. The mortality rate was 0.8%. The median hospital stay was 2 days (range, 2 to 10 d) and readmission rate was 2.4%. The compliance of all the items of the protocol was achieved in 78.4% of the patients. CONCLUSIONS: The Spanish National ERAS protocol is a safe issue with a high implementation rate. It can be recommended to establish this protocol to other institutions.

Detection of early nephropathy in Mexican patients with type 2 diabetes mellitus.

BACKGROUND: The aims of this study were to determine the prevalence of early nephropathy in patients with type 2 diabetes mellitus (DM2) attending primary care medical units and to identify risk factors for nephropathy in this population. METHOD: Seven hundred fifty-six patients with DM2 attending 3 primary care medical units were randomly selected. In a first interview, an albuminuria dipstick and a detailed clinical examination were performed, and a blood sample was obtained. If the albuminuria dipstick was positive, then a 24-hour urine collection was obtained within the next 2 weeks to quantify the albuminuria. In the blood sample, glucose, creatinine, and lipids were determined. Glomerular filtration rate was calculated using the Modification of Diet in Renal Disease Study equation. Demographics and medical history were recorded from clinical examination and medical charts. RESULTS: Prevalence of early nephropathy (EN) was 40%, normal function (NF) was found in 31%, and overt nephropathy (ON) in 29%. Patients with more severe kidney damage were older (NF: 54 +/- 10; EN: 60 +/- 11; ON: 63 +/- 10 years, P < 0.05) and had a higher proportion of illiteracy (NF: 11%, EN: 17%; ON: 25%, P < 0.05). The more severe the nephropathy, the longer the median duration of DM2 (NF: 6.0; EN: 7.0; ON: 11.0 years; P < 0.05); the higher the frequency of hypertension (NF: 38%; EN: 52%; ON: 68%; P < 0.05); and the higher the systolic blood pressure (NF: 126 +/- 21; EN: 130 +/- 19; ON: 135 +/- 23 mm Hg; P < 0.05). Both nephropathy groups had a significantly higher proportion of family history of nephropathy (NF: 4%; EN: 9%; ON: 13%) and a higher frequency of cardiovascular disease (NF: 5%; EN: 12%; ON: 25%), whereas only patients with ON had peripheral neuropathy (NF: 21%; EN: 22%; ON: 43%) and retinopathy (NF: 12%; EN: 18%; ON: 42%) more frequently than others. Fasting glucose was poorly controlled in all groups (NF: 186 +/- 70; EN: 173 +/- 62; ON: 183 +/- 73 mg/dL). Large body mass index (NF: 29.3 +/- 5.3; EN: 29.7 +/- 5.6; ON: 29.6 +/- 5.5 kg/m(2)), smoking (NF: 45%; EN: 43%; ON: 44%), and alcoholism (NF: 29%, EN: 29%; ON: 26%) were frequently found in this population, although there were no significant differences. In the multivariate analysis, only age, duration of DM2, and presence of retinopathy, hypertension, and cardiovascular disease were significantly associated with nephropathy. CONCLUSIONS: Two thirds of Mexican patients with DM2 attending primary health care medical units had nephropathy, 40% of whom were at an early stage of the disease. Many modifiable and nonmodifiable risk factors were present in these patients, but the most significant predictors for nephropathy are older age, longer duration of diabetes, and the presence of retinopathy, hypertension, and cardiovascular disease.