Tannat grape pomace as an ingredient for potential functional biscuits: bioactive compound identification, in vitro bioactivity, food safety, and sensory evaluation.

Grape pomace, the main by-product of wine process, shows high potential for the development of functional foods, being a natural source of bioactive compounds and dietary fiber. Thus, the present study proposes the development of five potential functional biscuits. The five formulations were achieved by varying the Tannat grape pomace powder (TGP, 10-20% w/w total wet dough) and sweetener sucralose (2-4% w/w total wet dough) content through a factorial design with central points. TGP microbiological and pesticides analysis were performed as a food safety requirement. Identification of bioactive compounds by HPLC-DAD-MS, in vitro bioactivity (total phenol content, antioxidant by ABTS and ORAC-FL, antidiabetic and antiobesity by inhibition of α-glucosidase and pancreatic lipase, respectively) and sensory properties of the biscuits were evaluated. TGP microbiological and pesticides showed values within food safety criteria. Sensory profiles of TGP biscuits were obtained, showing biscuits with 20% TGP good sensory quality (7.3, scale 1-9) in a cluster of 37 out of 101 consumers. TGP addition in biscuits had a significant (p < 0.05) effect on total phenolic content (0.893-1.858 mg GAE/g biscuit) and bioactive properties when compared to controls: 11.467-50.491 and 4.342-50.912 µmol TE/g biscuit for ABTS and ORAC-FL, respectively; inhibition of α-glucosidase and pancreatic lipase, IC50 35.572-64.268 and 7.197-47.135 mg/mL, respectively. HPLC-DAD-MS results showed all the identified phenolic compounds in 20/4% biscuit (TGP/sucralose%) were degraded during baking. Malvidin-3-O-(6'-p-coumaroyl) glucoside, (+)-catechin, malvidin-3-O-glucoside, and (-)-epicatechin were the main phenolic compounds (in descendent order of content) found. The bioactive properties could be attributed to the remaining phenolic compounds in the biscuits. In conclusion, TGP biscuits seemed to be a promising functional food with potential for ameliorating oxidative stress, glucose and fatty acids levels with good sensory quality.

Bougie-Facilitated Tamponade Balloon Placement for Massive Esophagogastric Variceal Hemorrhage: A Case Series and Novel Procedural Technique Description.

BACKGROUND: Balloon tamponade of esophagogastric variceal hemorrhage is a lifesaving but challenging procedure. One difficulty that often arises is coiling of the tube in the oropharynx. We describe a novel use of the bougie as an external stylet to help guide placement of the balloon to help overcome this challenge. DISCUSSION: We describe four cases in which the bougie was successfully utilized as an external stylet to place a tamponade balloon (3 Minnesota tubes, 1 Sengstaken-Blakemore tube) without any apparent complication. The straight end of the bougie is inserted approximately 0.5 cm into the most proximal of the gastric aspiration ports. The tube is then inserted into the esophagus under direct or video laryngoscopic visualization using the bougie to help "push" the tube into place as an external stylet. Once the gastric balloon is fully inflated and withdrawn to the gastroesophageal junction, the bougie is gently removed. CONCLUSION: The bougie may be considered as an adjunct for placement of tamponade balloons for massive esophagogastric variceal hemorrhage when placement proves refractory to traditional techniques. We think this can be a valuable tool in the emergency physician's procedural repertoire.

Identification and characterization of antioxidant peptides obtained from the bioaccessible fraction of α-lactalbumin hydrolysate.

Whey is an abundantand sustainable source of bioactive peptides obtained from cheese making process. Whey proteins such as α-lactalbumin can be biologically active when the bioactive peptides encrypted in the amino acid sequence of the native protein are released by enzymatic hydrolysis. In the present work, the identification, sequence analysis, and antioxidant activity of bioaccessible peptides from α-lactalbumin alcalase-hydrolysate was assessed. Antioxidant activity (ABTS, ORAC, and HORAC) of α-lactalbumin showed a significant increase (p < 0.05) after the enzymatic treatment with alcalase and this capacity increased even more after the simulation of the gastrointestinal digestion process. Peptides contained in the gastrointestinal digest of α-lactalbumin hydrolysate were separated by preparative RP-HPLC (55 fractions), and three peptides were identified by LC-MS/MS analysis from selected fractions: IWCKDDQNPH (MW: 1254.54 Da) f(59-68), KFLDDDLTDDIM (MW: 1439.64 Da) f(79-90), DKFLDDDLTDDIM (MW: 1554.67 Da) f(78-90). Among the chemically synthesized peptides, IWCKDDQNPH showed the highest antioxidant capacity determined by ORAC, ABTS, and HORAC assays (IC50 0.015 ± 0.002, 0.45 ± 0.02, and 1.30 ± 0.05 mg/ml, respectively) and this activity may be related to the amino acid sequence. This is the first report where these bioaccessible peptides from α-lactalbumin hydrolysate were identified. The α-lactalbumin hydrolysate could be employed as a functional antioxidant ingredient. PRACTICAL APPLICATION: The present work studied the bioaccessibility of antioxidant peptides from an α-lactalbumin alcalase-hydrolysate by identifying three novel bioaccessible peptides responsible for the antioxidant capacity, providing evidence of the hydrolysate potential as an antioxidant ingredient in the formulations of functional foods and/or food supplements.

Sgc8-c Aptamer as a Potential Theranostic Agent for Hemato-Oncological Malignancies.

Background: Aptamers represent an emerging class of oligonucleotides that have the ability to bind ligands with high affinity. Sgc8-c aptamer recognizes PTK7, a member of the catalytically defective receptor protein tyrosine kinase family that is upregulated in various cancers, including hemato-oncological malignancies. Herein, an Sgc8-c-NOTA-radiolabeled probe was prepared for theranostic purpose. Materials and Methods: In this work, an Sgc8-c-radiolabeled probe against PTK7 was prepared, and biological evaluations-pharmacokinetic studies, biodistribution analysis, and in vivo molecular imaging-were performed. To obtain the radiolabeled probe, a modified 5'-amino-derivative of the Sgc8-c aptamer was bound to the metal chelator NOTA, and subsequently labeled with 67Ga with high yield and radiochemical purity. The precursor, Sgc8-c-NOTA, the radio probe Sgc8-c-NOTA-67Ga, and its nonradioactive complex, Sgc8-c-NOTA-69/71Ga, were purified by reverse-phase high-performance liquid chromatography and characterized by electrospray ionization mass spectrometry. The binding ability of Sgc8-c-NOTA-67Ga was studied in vitro against purified PTK7 receptor. In addition, the binding was also evidenced against the hemato-oncological A20 cell line, derived from B lymphocytes, and the corresponding A20-green fluorescent protein (GFP)-transfected cells. The proof of concept was performed on A20-GFP tumor-bearing mice, in which the biodistribution of the radiolabeled probe was evaluated through imaging, using X-ray, fluorescence, and γ modalities. The specific uptake of the probe was confirmed by blocking with the Sgc8-c aptamer in an in vivo competition assay. Results: The biodistribution results showed considerable uptake in tumor since 2 h, with highest at 48 h postinjection. However, the blood and muscle ID/g (injected dose per gram of tissue) activities were decreasing with time and tumor/no-target ratios increasing to 20 at 24 h postinjection. These results are consistent with the in vivo images. Conclusions: This study supports the utility of Sgc8-c-NOTA radiolabeled as a theranostic agent.

Cardioinhibitory syncope: from pathophysiology to treatment-should we think on cardioneuroablation?

Vasovagal syncope (VVS) is the most common type of syncope; the lone cardioinhibitory syncope represents only a small group of patients; however, the "cardioinhibitory component" is highly prevalent in reflex syncope and can be severe enough to produce asystole, lasting for a few seconds followed by a recovery to sinus beats. The environment in which syncope occurs can compromise life, and in-depth knowledge of the disease can prevent deaths and guide the appropriate management. The therapeutic cornerstone is general measures (increase water and salt) followed by pharmacologic therapy; for cardioinhibitory syncope, both treatments fail most of the time, and the next therapeutic option is pacemaker implantation. However, although the pacemaker causes a reduction in syncope, recurrence is high, and a one-time, effective, and safe intervention would be ideal. Cardioneuroablation (CNA) therapy has been proposed as a pacemaker alternative with these characteristics. CNA has shown a high reduction or even complete syncope elimination during 3 years of follow-up in some studies. Patients also reported prolonged prodromal periods, which allowed them enough time to abort the syncope. Invasive therapies like CNA require further extensive cohort studies, randomized clinical trials, and more substantial follow-up to evaluate adverse side effects. This review highlights syncope pathophysiology, dividing it into a central theory and a peripheral theory, the diagnosis explaining the head-up tilt test protocols, and treatments like CAN, representing it with figures for a simplified understanding.

Derivation of a procedural performance checklist for ultrasound-guided femoral arterial line placement using the modified Delphi method.

BACKGROUND: Many specialties utilize procedural performance checklists as an aid to teach residents and other learners. Procedural checklists ensure that the critical steps of the desired procedure are performed in a specified manner every time. Valid measures of competency are needed to evaluate learners and ensure a standard quality of care. The objective of this study was to employ the modified Delphi method to derive a procedural checklist for use during placement of ultrasound-guided femoral arterial access. METHODS: A 27-item procedural checklist was provided to 14 experts from three acute care specialties. Using the modified Delphi method, the checklist was serially modified based on expert feedback. RESULTS: Three rounds of the study were performed resulting in a final 23-item checklist. Each item on the checklist received at least 70% expert agreement on its inclusion in the final checklist. CONCLUSION: A procedural performance checklist was created for ultrasound-guided femoral arterial access using the modified Delphi method. This is an objective tool to assist procedural training and competency assessment in a variety of clinical and educational settings.

Control glucémico de pacientes diabéticos en dos Unidades de Salud Familiar, Paraguay, 2018. Estudio piloto

RESUMEN Introducción: la diabetes mellitus (DM) es una enfermedad prevalente en el Paraguay y el tratamiento adecuado exige un control glucémico estricto. Objetivos: determinar la frecuencia de control glucémico adecuado en diabéticos de tres Unidades de Salud Familiar de Areguá, Paraguay. Metodología: diseño observacional, prospectivo que incluyó a varones y mujeres adultos, portadores de DM en tres Unidades de Salud Familiar de Areguá y Asunción, Paraguay, en 2018. Se midieron variables antropométricas, clínicas y laboratoriales. La glucemia en ayunas fue obtenida por glucómetro. Resultados: se incluyó a 111 diabéticos, 97% de tipo 2. La edad media fue 62±9 años y predominó el sexo femenino (70%). La frecuencia de diabéticos con hemoglobina glicada <7% fue 56%. La preobesidad y obesidad juntas se observaron en 71%. La comorbilidad más frecuente fue la hipertensión arterial (87%). El mal control glucémico se asoció significativamente al sedentarismo y bajo ingreso económico. Conclusiones: el control glucémico adecuado determinado por la hemoglobina glicada fue 56%. Se requieren estudios en mayores muestras para determinar las causas de falta de control glucémico en los diabéticos de las Unidades de Salud Familiar.

ABSTRACT Introduction: Diabetes mellitus (DM) is a prevalent disease in Paraguay and proper treatment requires strict glycemic control. Objectives: To determine the frequency of adequate glycemic control in diabetics of three Family Health Units in Areguá, Paraguay. Methodology: Observational, prospective design that included adult men and women, carriers of DM in three Family Health Units of Areguá and Asunción, Paraguay in 2018. Anthropometric, clinical and laboratorial variables were measured. Fasting blood glucose was obtained by a glucometer. Results: One hundred eleven diabetics were included, 97% of type 2. The average age was 62±9 years and the female sex predominated (70%). The frequency of diabetics with glycated hemoglobin <7% was 56%. The pre-obesity and obesity together were observed in 71%. The most frequent comorbidity was arterial hypertension (87%). Poor glycemic control was significantly associated with sedentary lifestyle and low income. Conclusions: The adequate glycemic control determined by the glycated hemoglobin was 56%. Studies in larger samples are required to determine the causes of lack of glycemic control in diabetics of Family Health Units.

Derivatizations of Sgc8-c aptamer to prepare metallic radiopharmaceuticals as imaging diagnostic agents: Syntheses, isolations, and physicochemical characterizations.

Aptamers, oligonucleotides with the capability to bind to a target through non-covalent bonds with high affinity and specificity, have a great number of advantages as scaffold to prepare molecular imaging agents. In this sense, we have performed post-SELEX modifications of a truncated aptamer, Sgc8-c, which bind to protein tyrosine kinase 7 to obtain a specific molecular targeting probe for in vivo diagnosis and in vivo therapy. Herein, we describe the synthetic efforts to prepare conjugates between Sgc8-c and different metallic ions chelator moieties in short times, high purities, and adequate yields. The selected chelator moieties, derived from 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid, 2-benzyl-1,4,7-triazacyclononane-1,4,7-triacetic acid, and 6-hydrazinonicotinic acid, were covalently attached at the 5'-aptamer position yielding the expected products which were stable in aqueous solution up to 75°C and in typical aptamer storage conditions at least for 30 days.

Prevalencia de malos hábitos orales y respiración bucal en niños de 5 a 17 años del área de Santiago Centro / Prevalence of bad oral habits and mouth breathing in children of 5 to 17 years old from the center area of Santiago

Se realizó un estudio epidemiológico descriptivo para determinar la prevalencia de malos hábitos orales y respiración bucal en niños de 5 a 17 años del área Centro de Santiago que son atendidos en el servicio de Ortodoncia del Consultorio de Especialidades del Hospital San Borja Arriarán. Para esto se seleccionaron al azar a 217 niños por edad y sexo. Se utilizó la clasificación de malos hábitos orales que establece el Departamento Odontológico del Ministerio de Salud. El método estadístico utilizado fue una prueba de hipótesis sobre proporciones usando distribución normal. Se utilizó un nivel de bondad de un 95 por ciento. Los resultados encontrados determinaron que la prevalencia de malos hábitos orales encontrada fue de un 50,2 por ciento, dentro de éstos el mayor porcentaje correspondió a la respiración bucal con un 34,5 por ciento, seguido por la interposición de objetos y onicofagia con un 16,6 por ciento y por la interposición lingual con un 12 por ciento