Gum Arabic/Chitosan Coacervates for Encapsulation and Protection of Lacticaseibacillus rhamnosus in Storage and Gastrointestinal Environments.

Probiotics, such as Lacticaseibacillus rhamnosus, are essential to the food industry for their health benefits to the host. The Lcb. rhamnosus strain is susceptible to processing, gastrointestinal, and storage conditions. In this study, Lcb. rhamnosus strains were encapsulated by complex coacervation in a gum arabic/chitosan or gum arabic/trehalose/chitosan and cross-linked with sodium tripolyphosphate. The physicochemical properties (zeta potential, water activity, water content, and hygroscopicity), encapsulation efficiency, and probiotic survival under storage conditions and simulated gastrointestinal fluids were evaluated. The results showed that crosslinking improves the encapsulation efficiency after drying; however, this result was remarkable when trehalose was used as a cryoprotectant. Furthermore, the encapsulation matrix preserved the viability of probiotics during 12 weeks with probiotic counts between 8.7-9.5, 7.5-9.0, and 5.2-7.4 log10 CFU g-1 at -20, 4, and 20 °C, respectively. After 12 days of digestion in an ex vivo simulator, acetic, butyric, propionic, and lactic acid production changed significantly, compared to free probiotic samples. This work shows that encapsulation by complex coacervation can promote the stability of probiotic bacteria in storage conditions and improve the viability of Lcb. rhamnosus HN001 during consumption so that they can exert their beneficial action in the organism.

Physical Properties and Prebiotic Activities (Lactobacillus spp.) of Gelatine-Based Gels Formulated with Agave Fructans and Agave Syrups as Sucrose and Glucose Substitutes.

This research developed model foods of gelatine-based gels, where carbohydrates from Agave tequilana Weber var. Azul (agave syrups or/and agave fructans) were incorporated into gel formulations as healthy sucrose and glucose substitutes. The sugars (sucrose and glucose) were substituted by agave carbohydrates (agave syrups and agave fructans), obtaining the subsequent gel formulations: 100% agave syrup (F2 gel), 100% agave fructan (F3 gel), and 50% agave syrup−50% agave fructan (F4 gel). The unsubstituted gel formulation was used as a control (F1 gel). The prebiotic activities, physical properties, thermal stability (HP-TLC), and texture of gelatine-based gels were evaluated. The gel formulations showed translucent appearances with approximately 36 g/100 g of water and water activities values between 0.823 and 0.929. The HP-TLC analysis validated that agave fructans did not hydrolyse during the thermal process of gels production. Gels produced with agave syrup and agave fructan (F2-F4 gels) provided higher hardness, gumminess, and springiness values (p < 0.05) than those produced with glucose and sucrose (F1 gel). Gelatine-based gel formulations displayed prebiotic activities correlated to the ability of Lactobacillus plantarum, Lactobacillus paracasei, and Lactobacillus rhamnosus to use agave carbohydrates as carbon sources. Based on the prebiotic effect and physical and textural properties, the F2 and F4 gel formulations displayed the best techno-functional properties to produce gel soft candies.

Supercritical CO2-ethanol extraction of oil from green coffee beans: optimization conditions and bioactive compound identification.

In this research, a supercritical CO2-ethanol extraction was optimized to obtain a green coffee oil rich in bioactive compounds. A face-centered central composite design was used to evaluate the effect of temperature (50-70 °C), extraction pressure (15.0-30.0 MPa), and cosolvent content (5-20%) on the extraction yield and total phenolic compound content of green coffee supercritical extract (GCSE). The experimental data were fitted to a second-order polynomial model. According to the statistical analyses, the lack of fit was not significant for either mathematical model. From the response surface plots, the extraction pressure and cosolvent content significantly impacted the extraction yield, while the total phenolic compound content was impacted by temperature and cosolvent content. The optimal conditions were a 20% cosolvent content, a pressure of 30 MPa, and a temperature of 62 °C, which predicted an extraction yield of 7.7% with a total phenol content of 5.4 mg gallic acid equivalent g GCSE-1. The bioactive compounds included 5-caffeoylquinic acid (11.53-17.91 mg g GCSE-1), caffeine (44.76-79.51 mg g GCSE-1), linoleic acid (41.47-41.58%), and palmitic acid (36.07-36.18%). Our results showed that GCSE has the outstanding chemical quality and antioxidant potential, suggesting that GCSE can be used as a functional ingredient.

Abordaje terapéutico paliativo de la obstrucción biliar en el cáncer de vesícula irresecable / Palliative therapeutic approach to bile obstruction in irresecable bladder cancer

El cáncer de vesícula es la neoplasia maligna más frecuente del tracto biliar. Con un mal pronóstico, su enfoque terapéutico muchas veces se centra en el tratamiento paliativo debido a que los pacientes suelen recibir un diagnóstico en estadios avanzados de la neoplasia, en los cuales ya no son candidatos para tratamientos quirúrgicos curativos. Por esta razón se utilizan stents o drenajes vesiculares, a fin de reducir el principal síntoma que se presenta: la ictericia, con sus consecuencias, por obstrucción biliar maligna. Este artículo pretende hacer una revisión de la evidencia recolectada en los últimos 5 años (período 2016 - 2021) acerca de los diferentes abordajes mínimamente invasivos en el tratamiento paliativo del cáncer de vesícula, sus resultados clínicos, y las diferencias entre ellos.

Gallbladder cancer is the most common malignancy neoplasm of the bile ducts. With a poor prognosis, its therapeutic approach is often focused on palliative treatment because patients usually receive a diagnosis in advanced stages of the neoplasm, in which they are no longer candidates for curative surgical treatments. For this reason, stents or gallbladder drains are used in order to reduce the main symptom that occurs: jaundice, with its consequences, due to malignant biliary obstruction. This article aims to review the evidence collected in the last 5 years (period 2016 - 2021) about the different minimally invasive approaches in the palliative treatment of gallbladder cancer, their clinical results, and the differences between them.

Endoscopic Gallbladder Drainage for Acute Cholecystitis.

BACKGROUND/AIMS: Surgery is the mainstay of treatment for cholecystitis. However, gallbladder stenting (GBS) has shown promise in debilitated or high-risk patients. Endoscopic transpapillary GBS and endoscopic ultrasound-guided GBS (EUS-GBS) have been proposed as safe and effective modalities for gallbladder drainage. METHODS: Data from patients with cholecystitis were prospectively collected from August 2004 to May 2013 from two United States academic university hospitals and analyzed retrospectively. The following treatment algorithm was adopted. Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and cystic duct stenting was initially attempted. If deemed feasible by the endoscopist, EUS-GBS was then pursued. RESULTS: During the study period, 139 patients underwent endoscopic gallbladder drainage. Among these, drainage was performed in 94 and 45 cases for benign and malignant indications, respectively. Successful endoscopic gallbladder drainage was defined as decompression of the gallbladder without incidence of cholecystitis, and was achieved with ERCP and cystic duct stenting in 117 of 128 cases (91%). Successful endoscopic gallbladder drainage was also achieved with EUS-guided gallbladder drainage using transmural stent placement in 11 of 11 cases (100%). Complications occurred in 11 cases (8%). CONCLUSIONS: Endoscopic gallbladder drainage techniques are safe and efficacious methods for gallbladder decompression in non-surgical patients with comorbidities.

Neuroprotective activity of (1S,2E,4R,6R,-7E,11E)-2,7,11-cembratriene-4,6-diol (4R) in vitro and in vivo in rodent models of brain ischemia.

(1S,2E,4R,6R,-7E,11E)-2,7,11-cembratriene-4,6-diol (4R) is a precursor to key flavor ingredients in leaves of Nicotiana species. The present study shows 4R decreased brain damage in rodent ischemic stroke models. The 4R-pretreated mice had lower infarct volumes (26.2±9.7 mm3) than those in control groups (untreated: 63.4±4.2 mm3, DMSO: 60.2±14.2 mm3). The 4R-posttreated rats also had less infarct volumes (120±65 mm3) than those in the rats of the DMSO group (291±95 mm3). The results from in vitro experiments indicate that 4R decreased neuro2a cell (neuroblastoma cells) apoptosis induced by oxygen-glucose deprivation (OGD), and improved the population spikes' (PSs) recovery in rat acute hippocampal slices under OGD; a phosphatidylinositol 3-kinase (PI3K) inhibitor, wortmannin, abolished the effect of 4R on PSs recovery. Furthermore, 4R also inhibited monocyte adhesion to murine brain-derived endothelial (bEND5) cells and upregulation of intercellular adhesion molecule-1(ICAM-1) induced by OGD/reoxygenation (OGD/R), and restored the p-Akt level to pre-OGD/R values in bEND5 cells. In conclusion, the present study indicates that 4R has a protective effect in rodent ischemic stroke models. Inhibition of ICAM-1 expression and restoration of Akt phosphorylation are the possible mechanisms involved in cellular protection by 4R.

Endoscopic ultrasonography-guided cholecystogastrostomy in patients with unresectable pancreatic cancer using anti-migratory metal stents: a new approach.

Cholecystectomy is contraindicated in patients with comorbidities or unresectable cancer. Percutaneous transhepatic gallbladder drainage (PTGBD) is typically offered with response rates ranging from 56% to 100%, but has several risks such as bleeding, pneumothorax, pneumoperitoneum, bile leak, and/or catheter migration. Endoscopic transpapillary gallbladder drainage (ETGD) and endoscopic ultrasound-guided transmural gallbladder drainage (EUS-GBD) are alternative endoscopic modalities that have a technical feasibility, efficacy and safety profile comparable with PTGBD. In this report, we present the first case series of transgastric EUS-GBD with placement of a fully covered self-expandable metal stent with anti-migratory fins. In three pancreatic cancer cases with acute cholecystitis when ETGD was unsuccessful, there were no bile leaks or procedurally related complications. There were no acute cholecystitis recurrences. In conclusion, EUS-GBD is a promising, minimally invasive treatment for acute cholecystitis. Additional comparative studies are needed to validate the benefit of this technique.

Management and risk factors for mortality in very elderly patients with acute myocardial infarction.

AIM: Elderly patients often remain underrepresented in clinical trials. The aim of our study was to analyze the treatment, clinical outcome and risk factors for mortality in patients aged ≥85 years with ST-segment elevation myocardial infarction (STEMI). METHODS: From 2005-2011, 102 patients aged ≥85 years with STEMI admitted to a coronary care unit were retrospectively reviewed. Clinical data, treatment and outcome were recorded. Reperfusion strategy and its influence in hospital morbidity and mortality were evaluated. Morbidity was defined as the presence of heart failure (Killip-Kimball >1), arrhythmias, mechanical complications, stroke or major bleeding. Risk factors for mortality were assessed by multivariate analysis. RESULTS: The mean age was 87.5±2.5 years (range 85-96). Therapeutic strategy on admission was: primary-angioplasty (PCI) for 33 patients (32.3%) fibrinolysis for 30 patients (29.4%) and conservative treatment for 35 patients (34.3%). In the four remaining patients, rescue angioplasty was required. A total of 29 patients (28.4%) died, and morbidity was seen in 63 patients (61.7%). The morbidity and mortality rates in the conservative treatment group (77.1% and 48.5%) were higher than that found in the reperfusion strategy group (primary-PCI and fibrinolysis; 53.7% and 17.9%; P=0.02 and P=0.002, respectively). Regarding mortality, the univariate analysis showed that heart failure on admission (P=0.0001) and previous coronary artery disease (P=0.01) were prognostic variables. Only heart failure was an independent risk factor for mortality (odds ratio=3.64, 95% CI 0.78-21.87, P<0.0001). CONCLUSIONS: Mortality and morbidity in very elderly patients with STEMI are very high, especially in those not receiving reperfusion therapies. Heart failure on admission was an independent risk factor for hospital mortality.

Granulocytic sarcoma of the small bowel, greater omentum and peritoneum associated with a CBFß/MYH11 fusion and inv(16) (p13q22): a case report.

INTRODUCTION: Granulocytic sarcoma (GS) is an extramedullary disease which is composed of immature myeloid cells or myeloblasts and usually occurs in association with acute myeloid leukemia (AML), as an initial presentation or a relapse. GS has been associated with various cytogenetic abnormalities, particularly with the t(8;21) translocation and less frequently the inv(16) type. CASE PRESENTATION: We present a rare case of GS of the small bowel, greater omentum and peritoneum, which caused obstruction, in a patient with AML associated with a CBFß/MYH11 fusion gene and an inv(16) (p13q22). In this patient there was only mild myeloid hyperplasia in bone marrow aspiration but molecular analysis identified a CBFß-MYH11 fusion and inv(16) (p13;q22). CONCLUSION: Because of its nonspecific clinical and radiologic findings, this entity can be misdiagnosed and can mimic other solid neoplasms, making it a diagnostic challenge. In a GS with no or minimal morphological changes in bone marrow aspiration it is very important to perform a cytogenetic analysis to benefit from the diagnosis and therapeutic strategy.

Outcome and prognostic factors of morbidity and mortality in perforated sigmoid diverticulitis.

The aim of this study was to assess the outcomes after treatment of patients with this condition and to identify prognostic factors of morbidity and mortality. From 1986 to 2005, the charts of 114 consecutive patients who were treated for perforated sigmoid diverticulitis were retrospectively reviewed. Thirty-three patients (28.9%) were treated conservatively, and 81 (71.1%) underwent surgery. Postoperative major morbidity and mortality rates were 35.8% and 6.2%, respectively. Age > 70 years, female sex, associated diseases, low serum albumin level, high American Society of Anesthesiologists class, and Mannheim Peritonitis Index score of 21 or more were factors linked with a poor outcome. Perforated diverticulitis carries substantial morbidity and occasional mortality. To achieve improvements in outcomes, the surgical procedure should be chosen on the basis of the presence of prognostic factors. Moreover, intensive treatment after surgery in patients with risk factors is recommended.

Presentation, management and outcome of acute sigmoid diverticulitis requiring hospitalization.

AIM: This study was conducted to assess the presentation, management, and outcomes of patients with acute sigmoid diverticulitis requiring hospitalization. METHODS: From 1986 to 2005, the medical records of 265 patients treated for acute sigmoid diverticulitis requiring hospitalization were retrospectively analyzed. Data were collected with regard to patient's demographics, clinical characteristics, presentations of acute diverticulitis, treatment, morbidity, and mortality. RESULTS: Only 47 patients (17.7%) had a previous diverticulitis episode. Of the 265 patients, 166 (62.6%) were managed without operation, and 99 (37.4%) underwent surgery. Overall and major morbidity in the whole series were 30.2 (80/265) and 15.5% (40/265), respectively; whereas among the patients with surgical management, were 72.7 (72/99), and 35.3% (35/99), respectively. Overall and postoperative mortality rates were 2.6 (7/265) and 6.1% (6/99), respectively. Older age, steroid use, perforation, and co-morbidities were significantly associated with unfavorable outcomes. CONCLUSIONS: It was concluded that surgery for acute sigmoid diverticulitis requiring hospitalization carries important morbidity and mortality. To achieve improvements in outcome, a selective therapeutic approach should be considered, choosing the best surgical procedure for each complication of diverticular disease.

Emergency surgery for complicated colorectal carcinoma: a comparison of older and younger patients.

The outcomes after emergency surgery for complicated colorectal cancer of 54 patients >70 years of age (group 1) and 53 patients < or =70 years of age (group 2) treated between 1991 and 2002 were compared. Forty-two patients had obstructions in group 1 and 41 patients had obstructions in group 2. Twelve patients had perforations in each group. Significantly higher ASA grading and APACHE II scores were seen in group 1. The overall and major morbidity and mortality rates in groups 1 and 2 were 81.5% and 58.5% (P = 0.009), 42.6% and 24.6% (P = 0.04), and 27.8% and 1.9% (P = 0.000), respectively. It was concluded that the outcome in older patients who underwent emergency surgery for complicated colorectal carcinoma was poor compared with that of younger patients. Careful preoperative assessment of the patient's general condition and intensive treatment after surgery in those with a poor physical status are recommended.

Obstructing colorectal carcinoma: outcome and risk factors for morbidity and mortality.

BACKGROUND/AIMS: Emergency surgery for colorectal cancer is widely thought to be associated with high morbidity and mortality. The aim of this study was to assess the operative results of patients who had emergency operations for obstructing colorectal cancer. Clinical factors that might influence the outcome were also evaluated. PATIENTS AND METHODS: This is a retrospective study including 83 patients who underwent emergency operations for completely obstructing colorectal cancers from 1991 to 2002. Demographic, clinical, and pathological variables were examined. Their influence on major morbidity and mortality was assessed using univariate and multivariate analyses. RESULTS: The overall and major morbidity rate was 67.5 and 32.5%, respectively. Mortality was 10.8%. Univariate analysis showed that high ASA class and perioperative blood transfusion were significantly associated with major complication, whereas older age and high APACHE II were linked to mortality. Independent risk factors for major morbidity were perioperative blood transfusion and high ASA class. The only independent predictor of postoperative death was high APACHE II score. CONCLUSIONS: Emergency surgery for obstructing colorectal carcinoma carries a negative impact on outcome. Patients with risk factors should undergo safe and least risky procedures. Moreover, their presence might help in selecting patients for intensive treatment after surgery.

Presentation, treatment, and multivariate analysis of risk factors for obstructive and perforative colorectal carcinoma.

BACKGROUND: It is known that emergency surgery for colorectal cancer is associated with high morbidity and mortality. The aim of this study was to assess the presentation, treatment, and outcome of patients with complicated colorectal cancer. Risk factors for morbidity and mortality were also evaluated. METHODS: From 1991 to 2002, the medical records of 107 consecutive patients undergoing emergency surgery for obstructing or perforating colorectal carcinoma were retrospectively reviewed. Information regarding patient and tumor characteristics, treatment, and outcome was recorded. Risk factors were assessed by multivariate analysis. RESULTS: Eighty-three patients (78%) had complete obstruction and 24 (22%) had perforation. Overall and major complications occurred in 70% and 34%, respectively. The mortality rate was 15%. Independent risk factors for major morbidity were perioperative blood transfusion and high American Society of Anesthesiologists (ASA) class, whereas those for mortality were older age and high Acute Physiology and Chronic Health Evaluation II (APACHE II) score. CONCLUSIONS: Emergency surgery for complicated colorectal carcinoma carries high rates of morbidity and mortality. To achieve improvements in outcome, intensive treatment after surgery in patients with risk factors is recommended.

Hernias externas incarceradas en pacientes octogenarios / Incarcerated external hernias in octogenarian patient

Objetivo. Estudiar la presentación y evolución clínica de pacientes octogenarios intervenidos de urgencia por hernia externa y, además, tratar de identificar los factores que pudieran tener algún efecto en su curso evolutivo. Pacientes y método. Se ha revisado retrospectivamente a 60 pacientes de 80 años o más intervenidos de urgencia por hernia externa incarcerada, entre enero de 1992 y diciembre de 2001. Se estudió el tipo de hernia, las características de la presentación clínica, el grado ASA, el tipo de anestesia, los métodos quirúrgicos, las complicaciones y la mortalidad. Se realizó también un análisis univariable para determinar los factores clínicos con una posible influencia en la evolución clínica. Resultados. Hubo 16 varones (26,7 por ciento) y 44 mujeres (73,3 por ciento). Un total de 32 casos fueron hernias crurales, 15 inguinales, 7 umbilicales y 6 eventraciones. Veintiséis enfermos (43,3 por ciento) acudieron al hospital con incarceración herniaria de más de 48 h de evolución. En 47 pacientes (78,3 por ciento) se observaron enfermedades asociadas significativas. Veintiocho casos (46,7 por ciento) fueron ASA II, 29 ASA III (48,3 por ciento) y 3 ASA IV (5 por ciento). En 36 pacientes (60 por ciento) se usó anestesia general y en 24, raquianestesia. Los métodos quirúrgicos más utilizados fueron las técnicas preperitoneal y de McVay. En 33 enfermos (55 por ciento) se objetivó estrangulación y en 17 (28,3 por ciento) fue necesaria una resección intestinal. Las tasas de morbilidad global y mayor y de mortalidad fueron del 58,3, 18,3 y 8,3 por ciento, respectivamente. La hospitalización tardía y un grado ASA alto fueron factores significativamente asociados con morbilidad y mortalidad. Conclusiones. Para disminuir la elevada morbimortalidad en estos pacientes, la cirugía electiva precoz debería ser la estrategia terapéutica adecuada (AU)

Emergency hernia repairs in elderly patients.

The aim of this study was to determine the clinical presentation, morbidity, and mortality and to identify the factors that might affect the outcome of emergency repair in elderly patients. A study of 143 patients (> 65 years old) who underwent emergency surgical repair for incarcerated external hernias during the period 1992-2001 was done. Fifty patients (35%) presented after 48 hours of symptoms onset. Coexisting diseases were found in 104 cases (77.7%). Bowel resection was required in 25 patients (17.5%). Overall morbidity was 46.2%, and major complications were seen in 17 cases (11.9%). Mortality was observed in seven patients (4.9%). Longer duration of symptoms, delayed hospitalization, concomitant illness, and high American Society of Anesthesiologists scores were significant factors linked with unfavorable outcome. To avoid the increased risks of emergency hernia repairs in the elderly, priority admission and early elective surgery should be used.