Phase Angle but Not Psoas Muscle Predicts Nutritional Risk and Prognosis in Males with Hepatocellular Carcinoma.

Despite those with hepatocellular carcinoma (HCC) being at increased risk of malnutrition, there is a notable absence of practical approaches for nutritional assessment in clinical practice. We investigated the usefulness of phase angle (PhA) and Total Psoas Area Index (TPAI) for indicating nutritional risk and HCC prognosis. Weight, height, body mass index (BMI), adductor pollicis muscle thickness (APMT), and handgrip strength (HGS) were assessed. The Nutritional Risk Index (NRI) was calculated. Body composition was assessed using bioimpedance spectroscopy and magnetic resonance imaging. The Child-Turcotte-Pugh (CTP) score and Barcelona-Clinic Liver Cancer (BCLC) classification determined the prognosis. Fifty-one males with HCC were enrolled (CTP C = 11.8%). PhA showed a moderate positive correlation with APMT (r = 0.450; p < 0.001) and HGS (r = 0.418; p = 0.002) and a weak positive correlation with TPAI (r = 0.332; p = 0.021). PhA had a strong positive correlation with NRI (r = 0.614; p < 0.001). Mean PhA values were significantly different according to disease severity (CTP C p = 0.001, and BCLC D p = 0.053). TPAI had no significant correlation with HGS, CTP, or BCLC. PhA was a superior approach for predicting nutritional risk and prognosis in HCC than TPAI. Lower PhA is associated with disease progression, lower muscle mass and function, greater severity of nutritional risk, and increased mortality in HCC.

Estimating Muscle Mass Using D3-Creatine Dilution: A Narrative Review of Clinical Implications and Comparison With Other Methods.

BACKGROUND: The D3-creatine (D3-Cr) dilution method is of emerging interest for estimating total-body skeletal muscle mass. This review explores the association of muscle mass estimated via D3-Cr with various clinical outcomes and provides a summary of the literature comparing D3-Cr with other body composition techniques. METHODS: A literature search was conducted on PubMed/MEDLINE and Web of Science for studies using D3-Cr to measure muscle in adult populations (ie, ≥18 years old) from inception until September 2023. RESULTS: Out of the 23 included studies, 15 investigated the correlation between D3-Cr and clinical outcomes. More consistent associations were reported for mortality (100%, n = 2), mobility disability (100%; n = 5), falls and fractures (100%; n = 3), physical performance (63.3%; n = 11), muscle strength (44.4%; n = 9), and muscle composition (33.3%; n = 3). However, conflicting findings were also reported for such correlations. Among the 23 studies, 14 compared D3-Cr-estimated muscle with other body composition techniques, including magnetic resonance imaging (MRI) as a reference method. Strong and positive correlations were found between D3-Cr and MRI. Nonetheless, variations in muscle measurements were noted, with differences in D3-Cr values ranging from 0.62 kg lower to 13.47 kg higher compared to MRI. CONCLUSIONS: D3-Cr-estimated muscle mass may be a valuable predictor of clinical outcomes showing consistent associations with falls and fractures, mobility disability, and mortality. However, less consistent associations were found with muscle strength and composition, and physical performance. Although a strong correlation exists between D3-Cr-estimated muscle mass and MRI measurements, under- or overestimation may occur.

Association Between Diabetes and Risk of Prostate Cancer: A Systematic Review and Meta-Analysis of Observational Studies.

PURPOSE: Metabolic diseases such as diabetes mellitus may play a role in the development and progression of prostate cancer (PC); however, this association remains to be explored in the context of specific PC stages. The objective of this study was to systematically review the evidence for an association between diabetes and overall, early, or advanced PC risk. MATERIALS AND METHODS: A systematic review with meta-analysis was performed (MEDLINE, EMBASE, and CINAHL) from inception until September 2023. Cohort and case-control studies that assessed PC risk in adult males (≥18 years) associated with type 2 diabetes mellitus or diabetes (if there was no distinction between diabetes type) were included. The Newcastle-Ottawa Scale (NOS) was used to assess study bias; those with NOS<7 were excluded. Evidence certainty was assessed with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method. RESULTS: Thirty-four studies (n=26 cohorts and n=8 case-controls) were included. Of these, 32 assessed diabetes and all PC stages combined, 12 included early PC stages, and 15 included advanced PC stages. Our meta-analysis showed diabetes had a protective effect against early PC development (n=11, risk ratio [RR]=0.71; 95% confidence interval [CI]=0.61-0.83, I²=84%) but no association was found for combined (n=21, RR=0.95; 95% CI=0.79-1.13, I²=99%) or advanced PC stages (n=15, RR=0.96; 95% CI=0.77-1.18, I²=98%) at diagnosis. According to GRADE, the evidence certainty was very low. CONCLUSIONS: Diabetes may be protective against early PC stages, yet evidence linking diabetes to risk across all stages, and advanced PC specifically, is less conclusive. High heterogeneity may partially explain discrepancy in findings and was mostly associated with study design, method used for PC diagnosis, and risk measures. Our results may aid risk stratification of males with diabetes and inform new approaches for PC screening in this group, especially considering the reduced sensitivity of prostate-specific antigen values for those with diabetes.

Evaluating predictive equations for energy requirements throughout breast cancer trajectory: A comparative study.

BACKGROUND & AIMS: Accurately estimating resting energy requirements is crucial for optimizing energy intake, particularly in the context of patients with varying energy needs, such as individuals with cancer. We sought to evaluate the agreement between resting energy expenditure (REE) predicted by 40 equations and that measured by reference methods in women undergoing active breast cancer treatment stage (I-IV) and post-completion (i.e., survivors). METHODS: Data from 4 studies were combined. REE values estimated from 40 predictive equations identified by a systematic search were compared with REE assessed by indirect calorimetry (IC) using a metabolic cart (MC-REE N = 46) or a whole-room indirect calorimeter (WRIC-REE N = 44). Agreement between methods was evaluated using Bland-Altman and Lin's concordance coefficient correlation (Lin's CCC). RESULTS: Ninety participants (24 % survivors, 61.1% had early-stage breast cancer I or II, mean age: 56.8 ± 11 years; body mass index: 28.7 ± 6.4 kg/m2) were included in this analysis. Mean MC-REE and WRIC-REE values were 1389 ± 199 kcal/day and 1506 ± 247 kcal/day, respectively. Limits of agreement were wide for all equations compared to both MC and WRIC (∼300 kcal for both methods), including the most commonly used ones, such as Harris-Benedict and Mifflin ST. Jeor equations; none had a bias within ±10% of measured REE, and all had low agreement per Lin's CCC analysis (<0.90). The Korth equation exhibited the best performance against WRIC and the Lvingston-Kohlstadt equation against MC. Similar patterns of bias were observed between survivors and patients and between patients with stages I-III versus IV cancer. CONCLUSION: Most equations failed to accurately predict REE at the group level, and none were effective at the individual level. This inaccuracy has significant implications for women with or surviving breast cancer, who may experience weight gain, maintenance, or loss due to inaccurate energy needs estimations. Therefore, our research underscores the need for further efforts to improve REE estimation.

Energy Metabolism in Gynecological Cancers: A Scoping Review.

Determining energy requirements is vital for optimizing nutrition interventions in pro-catabolic conditions such as cancer. Gynecological cancer encompasses the most common malignancies in women, yet there is a paucity of research on its metabolic implications. The aim of this review was to explore the literature related to energy metabolism in gynecological cancers. We were particularly interested in exploring the prevalence of energy metabolism abnormalities, methodological approaches used to assess energy metabolism, and clinical implications of inaccurately estimating energy needs. A search strategy was conducted from inception to 27 July 2021. Studies investigating energy metabolism using accurate techniques in adults with any stage of gynecological cancer and the type of treatment were considered. Of the 874 articles screened for eligibility, five studies were included. The definition of energy metabolism abnormalities varied among studies. Considering this limitation, four of the five studies reported hypermetabolism. One of these studies found that hypermetabolism was more prevalent in ovarian compared to cervical cancer. Of the included studies, one reported normometabolism at the group level; individual-level values were not reported. One of the studies reported hypermetabolism pre- and post-treatment, but normometabolism when re-assessed two years post-treatment. No studies explored clinical implications of inaccurately estimating energy needs. Overall, commonly used equations may not accurately predict energy expenditure in gynecological cancers, which can profoundly impact nutritional assessment and intervention.

Mechanistic Study of the Peroxyoxalate System in Completely Aqueous Carbonate Buffer.

The peroxyoxalate reaction is one of the most efficient chemiluminescence transformations, with emission quantum yields of up to 50%; additionally, it is widely utilized in analytical and bioanalytical assays. Although the real reason for its extremely high efficiency is still not yet understood, the mechanism of this transformation has been well elucidated in anhydrous medium. Contrarily, only few mechanistic studies have been performed in aqueous media, which would be of great importance for its application in biological systems. We report here our experimental results of the peroxyoxalate reaction in completely aqueous carbonate buffer, using fluorescein as chemiluminescence activator. The kinetics are very fast in the used basic conditions (pH > 9); despite this, reproducible kinetic results were obtained. The reaction proceeds by specific base catalysis, with rate-limiting attack of hydrogen peroxide anion to the oxalic ester, in competition with ester hydrolysis by hydroxide ion. Emission quantum yields increase with the hydrogen peroxide concentration up to an optimal concentration of 10 mmol L-1 . The infinite singlet quantum yield of (5.8 ± 0.2) × 10-7 is much lower than in anhydrous medium; however, it is similar to quantum yields measured before in partially aqueous media.

Phase angle as a severity indicator for liver diseases.

OBJECTIVE: The aim of this study was to evaluate the applicability of phase angle (PhA) as a severity indicator of chronic liver diseases. METHODS: We examined the medical records of 54 patients-27 with hepatocellular carcinoma (HCC) and 27 with non-alcoholic fatty liver disease (NAFLD). The patients were ≥18 y of age. Clinical data, such as Child-Pugh and Barcelona Clinic Liver Cancer (HCC), aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis (FIB)-4 (NAFLD), nutritional parameters (body mass index [BMI], handgrip strength [HGS], and bioelectrical impedance [BIA] data) were collected. Nutritional Risk Index (NRI) was calculated. Analysis was performed using Mann-Whitney test and analysis of variance. Simple multiple linear regression for predictions (Child-Pugh in HCC, APRI and FIB-4 in NAFLD). Receiver operating characteristic curve was estimated to search a cutoff for PhA. For survival, we used the Kaplan-Meier estimator. To verify whether PhA affected patients' survival, we used the Mantel-Haenszel. RESULTS: The prevalence of cirrhosis was high in HCC (n = 25) and low in the NAFLD (n = 4). No patient was classified as undernourished based on BMI; however, NRI showed that 74.1% of patients with HCC had nutritional risk. Child-Pugh was positively correlated with the edema index (extracellular water/total body water [ECW/TBW]) and negatively correlated with PhA and HGS. Higher Child-Pugh and BCLC scores were associated with worse NRI. APRI and FIB-4 were positively correlated with weight and BMI. A significant difference between groups was found for the median values of R, ECW/TBW, PhA, HGS, and albumin. There was a trend toward lower survival in patients with HCC, according to the cutoff point of 5.1 degrees for PhA. CONCLUSION: PhA was shown to be an independent prognostic indicator for cirrhosis and may be related to survival in these patients.

Microencapsulation of betanin in monodisperse W/O/W emulsions.

Betanin is the main pigment of the food color beetroot red (E162). Due to the fair heat and light stability of E162, this pigment is mainly used in minimally processed packaged food products. Encapsulation increases the stability of betanin, but detailing on the effect of different sources of betanin on the properties and stability of multiple emulsions are scarce. Here we describe the encapsulation of E162, spray-dried beetroot juice and betanin in a monodisperse food-grade water-in-oil-in-water (W/O/W) emulsions by using microchannel emulsification. We compare the tinctorial strength of the encapsulated pigments and investigate the effect of temperature, storage period and pigment concentration on emulsion stability and color. Betanin increases the overall stability of the W/O/W emulsion, reduce the oil droplet size and improve size distribution when compared to the negative control without pigment and to emulsions containing betanin from other sources.

[PRUNAPE: screening for psychomotor development problems at primary care level]. / PRUNAPE: pesquisa de trastornos del desarrollo psicomotor en el primer nivel de atención.

Information on prevalence, type of problems on psychomotor development (PPD) and conceptions of the professionals and parents that take part of a screening project was obtained by implementing a national screening test for PPD in 839 apparently healthy children aged 0-5 years attending three health centers in San Isidro. Parents and professionals conceptions about the test and programme were studied with qualitative research approach. The test was administered by three previously trained pediatricians. General failure rate was 20.0%. Out of a total number of 170 children failing the test and referred to hospital for diagnosis and treatment, only 96 complied and went through a series of studies carried out by a multidisciplinary team for diagnosis, classified according to DSM-IV: global developmental delay: 60 children, pervasive disorders: 11, communication disorders: 10, motor disorders: 6 (2 children with cerebral palsy), attention deficit disorders: 5, attachment disorders: 2, normal children: 3. Co-morbidity was present in 22 affected children. Forty-three per cent of children failing the test did not comply with the indication of hospital referral or did not complete the studies. Qualitative investigation helped to understand the key role played by parents and professionals participating in the screening process. The fact that there are now 96 children with developmental disorders under treatment, supports the validity of the screening procedure implemented.

Chicos y chicas en situación de calle y procesos de democratización educativa / Meninos e meninas en situaçao de rua e processos da democratizaçao educativa / Boys and girls in “street situation” and process of educational democratization

En este artículo presentamos reflexiones sobre una propuesta pedagógica orientada a promover la escolarización de chicos y chicas en situación de calle y sus líneas de acción: la vinculación escolar y los talleres escolares. La vinculación escolar supone elaboración de intervenciones que favorezcan el posicionamiento de chicos y chicas como sujetos de la educación en las escuelas. Los talleres escolares son espacios educativos desarrollados en instituciones destinadas a esta población. Allí se promueven experiencias centradas en la construcción y apropiación de conocimientos. En el trabajo destacamos el papel del contexto y las particularidades que presenta esta población para prácticas educativas destinadas a ella, y reflexionamos sobre el problema de la democratización educativa en escenarios signados por la desigualdad social y educativa.

Este artigo apresenta reflexões sobre uma proposta pedagógica orientada a promover a escolarizaçāo de meninos e meninas en situaçāo de rua e suas linhas de açāo: a vinculaçāo escolar e as oficinas escolares. A vinculaçāo escolar supõe a elaboraçāo de intervenções que favoreçam o posicionamento de meninos e meninas como sujeitos da educaçāo nas escolas. As oficinas escolares sao espaços educativos desenvolvidos em instituições destinadas a esta populaçāo. Ali se promovem experiências centralizadas na construçāo e apropiaçāo de conhecimentos. O trabalho destaca o papel do contexto e as particularidades desta populaçāo em relaçāo às práticas educativas destinadas a ela e reflexiona sobre o problema da democratizaçāo educativa em cenários signados pela desigualdade social e educativa.

This article presents some reflections on a pedagogical project oriented to promote schooling among boys and girls in “street situation”. We will also present its courses of action: the ‘link with school’ and ‘school workshops’. The ‘link with school’ implies the elaboration of interventions to encourage the positioning of children as subjects of education in schools. The ‘school workshops’ are educational spaces developed in institutions aimed at this population. Some experiences centered in the construction and appropriation of knowledge are promoted in these spaces. This paper enlightens the role of the context and the particularities that this population poses regarding educational practices addressed to it. We also reflect on the issue of educational democratization in scenarios marked by social and educational inequality.

PRUNAPE: Pesquisa de trastornos del Desarrollo Psicomotor en el Primer Nivel de Atención / PRUNAPE: Screening for psychomotor development problems at primary care level

La implementación de programas de pesquisa de trastornos inaparentes del desarrollo psicomotor enel primer nivel de atención requiere el conocimiento previo sobre la prevalencia de los problemas a encontrar,su naturaleza y las concepciones de los actores participantes (familiares del niño y profesionales del equipo evaluador) acerca del proceso de pesquisa. Con estos objetivos, tres pediatras previamente capacitados implementaron la Prueba Nacional de Pesquisa PRUNAPE con 839 niñospresuntamente sanos que concurrían a tres centros de salud. Los niños que no pasaban la prueba eran derivados al Hospital Materno Infantil San Isidro en donde un equipo multidisciplinario (EM) llevaba a cabo una serie de estudios con fines diagnósticos,hecho en base al DSM-IV. La prevalencia general de fracaso de la PRUNAPE fue del 20,0 por ciento. De los 170 niños derivados al hospital, completaron los estudios 96; los diagnósticos finales fueron los siguientes:normal (3), retardo global del desarrollo(60, de los cuales 17 tenían comorbilidad), trastorno generalizado del desarrollo (11), trastornos del lenguajeo comunicación (10), trastornos de la coordinación(5) (dos niños con parálisis cerebral), trastornosde déficit de atención (5), trastornos del vínculo(2). Los 74 niños sin diagnóstico final no concurrieron al hospital o no completaron los estudios. La investigación cualitativa permitió obtener de lospadres y los profesionales muy valiosa información sobre el proceso de pesquisa. La detección de 96 niños con problemas que eran inaparentes y que ahora están bajo tratamiento demuestra la validez del programa de pesquisa implementado.