Critical care specialists, the missing link in organ procurement for transplantation.

The procurement process for organ donation begins with the identification of potential organ donors in emergency or critical care units (CCU), followed by their clinical evaluation, diagnostic procedures, and therapeutic interventions, mostly conducted in CCUs. It concludes with the request for organ donation and, if accepted, the retrieval of organs. Despite most interventions occurring in detection units, there has been a neglect of the strategic role played by critical care specialists (CCS) in managing and caring for brain-dead or near-brain-death patients. Questions arise: Are they willing to undertake this responsibility? Do they fully comprehend the nature of organ procurement? Are they aware of the specific interventions required to maintain possible organ donors in optimal physiological condition? Our objective is to examine the role of CCS in organ procurement and propose ways to enhance it, ultimately aiming to increase and enhance organ donation rates.

Neutrophils cultured ex vivo from CD34+ stem cells are immature and genetically tractable.

BACKGROUND: Neutrophils are granulocytes with essential antimicrobial effector functions and short lifespans. During infection or sterile inflammation, emergency granulopoiesis leads to release of immature neutrophils from the bone marrow, serving to boost circulating neutrophil counts. Steady state and emergency granulopoiesis are incompletely understood, partly due to a lack of genetically amenable models of neutrophil development. METHODS: We optimised a method for ex vivo production of human neutrophils from CD34+ haematopoietic progenitors. Using flow cytometry, we phenotypically compared cultured neutrophils with native neutrophils from donors experiencing emergency granulopoiesis, and steady state neutrophils from non-challenged donors. We carry out functional and proteomic characterisation of cultured neutrophils and establish genome editing of progenitors. RESULTS: We obtain high yields of ex vivo cultured neutrophils, which phenotypically resemble immature neutrophils released into the circulation during emergency granulopoiesis. Cultured neutrophils have similar rates of ROS production and bacterial killing but altered degranulation, cytokine release and antifungal activity compared to mature neutrophils isolated from peripheral blood. These differences are likely due to incomplete synthesis of granule proteins, as demonstrated by proteomic analysis. CONCLUSION: Ex vivo cultured neutrophils are genetically tractable via genome editing of precursors and provide a powerful model system for investigating the properties and behaviour of immature neutrophils.

Association between gait speed and balance disorders in older adults from 12 high Andean Peruvian communities, 2013-2019.

Background: Gait speed is associated with a higher prevalence of balance disorders in older adults residing at high altitudes. This study investigated this association in older adults from 12 high-altitude Andean Peruvian communities. Methods: We performed a secondary data analysis from an analytical cross-sectional study of adults >60 years of age, residing in 12 high-altitude Andean Peruvian communities, enrolled between 2013 and 2019. The exposure and outcome variables were gait speed (categorized in tertiles), and balance disorders (defined as a functional reach value of ≤20.32 cm), respectively. We built generalized linear models of the Poisson family with a logarithmic link function and robust variances, and estimated crude prevalence ratios (cPR) and adjusted prevalence ratios (aPR) with 95% confidence intervals (CIs). Results: We analyzed 418 older adults; 38.8% (n=162) were male, and the mean age was 73.2 ± 6.9 years. The mean gait speed and functional reach were 0.66 ± 0.24 m/s and 19.9 ± 6.48 cm, respectively. In the adjusted regression model, the intermediate (aPR=1.88; 95% CI: 1.39-2.55; p<0.001) and low (aPR=2.04; 95% CI: 1.51-2.76; p<0.001) tertiles of gait speed were associated with a higher prevalence of balance disorders. Conclusions: The intermediate and low tertiles of gait speed were associated with a higher prevalence of balance disorders among older adult residents of 12 high-altitude Andean communities. We recommend further research on the behavior of this association to propose interventions for these vulnerable groups and reduce the impact of geriatric conditions.

Acute pancreatitis in children and adolescents: diagnostic and therapeutic approach according to management guidelines in a group of pediatricians.

BACKGROUND: Acute pancreatitis is observed more frequently in the pediatric age. Currently, there are recommendation guidelines for its proper diagnosis and treatment. The objective of this study was to evaluate the level of knowledge of the international recommendations on acute pancreatitis in pediatrics of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition in a group of pediatricians. METHODS: Observational, multicenter study, through a survey applied to pediatricians and pediatric residents. RESULTS: 48.8% of physicians had prior knowledge of the guidelines for the treatment of acute pancreatitis in children. 72.4% knew the current criteria for the diagnosis of acute pancreatitis. There were no differences in the majority of responses between pediatricians and pediatric residents. CONCLUSIONS: Although only half of the respondents followed the guidelines for diagnosis and treatment of acute pancreatitis, about three-quarters adequately use the criteria for diagnosis. There is adequate knowledge about the prescription of antibiotics and pancreatitis follow-up. There is lack of knowledge on the recommendation of monitoring vital signs and the precise time to perform cholecystectomy in the pancreatitis of biliary origin.

INTRODUCCIÓN: La pancreatitis aguda se observa con mayor frecuencia en la edad pediátrica. Actualmente existen guías de recomendaciones para su adecuado diagnóstico y tratamiento. El objetivo de este estudio fue evaluar el nivel de conocimiento de las recomendaciones internacionales sobre pancreatitis aguda de la North American Society for Pediatric Gastroenterology, Hepatology and Nutrition en un grupo de pediatras. MÉTODOS: Estudio observacional, multicéntrico, mediante una encuesta aplicada a médicos pediatras y médicos pediatras en formación. RESULTADOS: El 48.8% de los médicos tenían conocimiento de las guías para tratamiento de pancreatitis aguda en niños. El 72.4% conocían los criterios actuales para el diagnóstico de pancreatitis aguda. No hubo diferencias en la mayoría de las respuestas entre médicos pediatras y médicos pediatras en formación. CONCLUSIONES: Aunque solo la mitad de los encuestados conocían la guía para el diagnóstico y el tratamiento de la pancreatitis aguda, cerca de tres cuartas partes utilizan adecuadamente los criterios para el diagnóstico. Existe adecuado conocimiento sobre la prescripción de antibióticos y el seguimiento posterior a la pancreatitis aguda. Hay déficit en el conocimiento sobre las recomendaciones de la monitorización de los signos vitales y el momento adecuado para realizar la colecistectomía ante una pancreatitis de origen biliar.

Preanalytical considerations for clinical assays of circulating human miRNA-451a, miRNA-423-5p and miRNA-199a-3p for diagnostic purposes.

Circulating miRNA has recently emerged as important biomolecules with potential clinical values as diagnostic markers for several diseases. However, to be used as such, it is critical to accurately quantify miRNAs in the clinic. Yet, preanalytical factors that can affect an error-free quantification of these miRNAs have not been explored. This study aimed at investigating several of these preanalytical factors that may affect the accurate quantification of miRNA-451a, miRNA-423-5p and miRNA-199a-3p in human blood samples. We initially evaluated levels of these three miRNAs in red blood cells (RBCs), white blood cells (WBCs), platelets, and plasma by droplet digital PCR (ddPCR). Next, we monitored miRNA levels in whole blood or platelet rich plasma (PRP) stored at different temperatures for different time periods by ddPCR. We also investigated the effects of hemolysis on miRNA concentrations in platelet-free plasma (PFP). Our results demonstrate that more than 97% of miRNA-451a and miRNA-423-5p in the blood are localized in RBCs, with only trace amounts present in WBCs, platelets, and plasma. Highest amount of the miRNA-199a-3p is present in platelets. Hemolysis had a significant impact on both miRNA-451a and miRNA-423-5p concentrations in plasma, however miRNA-199a levels remain unaffected. Importantly, PRP stored at room temperature (RT) or 4°C showed a statistically significant decrease in miRNA-451a levels, while the other two miRNAs were increased, at days 1, 2, 3 and 7. PFP at RT caused statistically significant steady decline in miRNA-451a and miRNA-423-5p, observed at 12, 24, 36, 48 and 72 hours. Levels of the miRNA-199a-3p in PFP was stable during first 72 hours at RT. PFP stored at -20°C for 7 days showed declining stability of miRNA-451a over time. However, at -80°C miRNA-451a levels were stable up to 7 days. Together, our data indicate that hemolysis and blood storage at RT, 4°C and -20°C may have significant negative effects on the accuracy of circulating miRNA-451a and miRNA-423-5p quantification.

Addition of synthetic polymers to a conventional cryoprotectant solution in the vitrification of bovine ovarian tissue.

Some synthetic polymers can be used at low concentrations to reduce the toxicity of conventional cryoprotectant agents. In this study we investigated whether the addition of synthetic polymers to a conventional cryoprotectant solution would improve the cryopreservation of bovine ovarian tissue. Freshly collected ovaries from ten adult crossbred cows were incised using a scalpel in the frontal section. From each cow, ovarian cortical slices of 1 mm thickness were divided into 30 fragments of 3 × 3 mm, of which 10 served as fresh controls, 10 were vitrified with conventional cryoprotectant agents (2.93 M glycerol, 27 % w/v; 4.35 M ethylene glycol, 27 % w/v), and 10 were vitrified using the same cryoprotectant agents in addition to synthetic polymers (0.2 % PVP K-12, 0.2 % SuperCool X-1000 ™ w/v and 0.4 % SuperCool Z-1000 ™ w/v). After warming, histology was used to assess follicular quantity and integrity, while in vitro culture of mechanically isolated follicles encapsulated in an alginate matrix was performed for 15 days to assess their growth and hormonal production. Vitrified ovarian tissues presented abnormal morphology, a higher percentage of atretic follicles, and their isolated follicles had lower survival rates and lower frequency of antrum formation during in vitro culture compared to those from fresh tissue. At the end of culture, the follicles that had been cryopreserved produced less estradiol and progesterone than the fresh ones. The addition of synthetic polymers during tissue vitrification did not modify any of these parameters. We conclude that, under the conditions of this study, the use of this combination of synthetic polymers for tissue vitrification did not enhance the preservation of the morphological or functional integrity of bovine ovarian follicles.

Simultaneous Tricuspid Valve Repair at the Time of Mitral Valve Surgery: Determinants of Postoperative Pacemaker Implantation.

OBJECTIVE: Guidelines recommend tricuspid valve (TV) repair for patients with severe tricuspid valve regurgitation (TR) undergoing surgery for degenerative mitral valve (MV) disease, but management of ≤ moderate TR is controversial. This study examines the incidence and causes of bradyarrhythmias leading to PPM implantation. METHODS: Review of patients undergoing simultaneous TV repair and MV surgery for degenerative MV disease from 2001 to 2022 (N=404). Primary endpoint was the incidence of postoperative PPM implantation. Secondary endpoints included the incidence of high-degree AV block and overall survival. RESULTS: All patients underwent TV repair at the time of MV surgery; 332 (82%) underwent MV repair and 72 (18%) MV replacement. Tricuspid valve repair techniques included flexible band (n=258, 63.8%), DeVega annuloplasty (n=78, 19.3%), complete flexible ring (n=49, 12.1%), and incomplete rigid ring (n=19, 4.7%). The 30-day mortality was 0.5% (n=2). A total of 35 (8.7%) patients had a PPM implanted postoperatively, 26 (6.4%) for high-degree AV block. On multivariable analysis, only older age was associated with PPM implantation. Patients who received a PPM due to high-degree AV block had reduced overall survival (Figure, p=0.01). CONCLUSIONS: Need for permanent pacing following TV repair at the time of MV surgery is not uncommon, but there are few modifiable factors that might reduce this risk. Careful selection of patients with less-than-severe TR and surgical techniques may reduce PPM-related risks and complications.

Abnormal uterine bleeding: The well-known and the hidden face.

Abnormal uterine bleeding (AUB) is a bleeding from the uterine corpus that is abnormal in regularity, volume, frequency or duration. It encompasses heavy menstrual bleeding, irregular menstrual bleeding and intermenstrual bleeding, which are common symptoms among women of reproductive age, impacting their overall well-being. Menstruation involves interactions between endometrial epithelial and stromal cells, immune cell influx, and changes in endometrial vasculature. These events resemble an inflammatory response with increased vessel permeability, tissue breakdown, and the arrival of innate immune cells. However, the mechanisms of menstrual cessation are poorly understood. AUB can be related to structural causes (polyp, adenomyosis, leiomyoma, malignancy/hyperplasia) and nonstructural conditions (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic). While transvaginal ultrasound is the primary method for the screening of intracavitary lesions, saline infusion sonohysterography is more accurate to detect endometrial polyps and submucous leiomyomas, while hysteroscopy with biopsy remains the reference method for a definitive diagnosis. The main goals in managing AUB are addressing and correcting the underlying primary cause, if possible, and establishing a regular bleeding pattern or amenorrhea, which can be done with antifibrinolytic agents, progestins, gonadotropin-releasing hormone agonists and antagonists, or surgical interventions, each one with specific indications and limitations. Further research is necessary to assess the effectiveness and the long-term effects of various medical and surgical treatments. Meanwhile, the availability of diagnostic methods such as transvaginal ultrasound and hysteroscopy and the universal distribution of medical treatments for AUB should be prioritized by policymakers to minimize the diagnostic and treatment delay and thus reduce the risk of AUB-related anemia and the need of hysterectomy.

Long-term Stroke and Mortality Risk in Nonagenarians Following Transcatheter Aortic Valve Insertion.

BACKGROUND: Limited data exist on the long-term outcomes of transcatheter aortic valve insertion (TAVI) in nonagenarian patients. The purpose of this study is to investigate the relationship between patient baseline comorbidity and frailty on the long-term outcome of the nonagenarian population. METHODS: Retrospective analysis of 187 consecutive nonagenarian patients who underwent TAVI from 2009 to 2020. Multivariable models were utilized to analyze the association between basleline patient and frailty variables and mortality, stroke, and repeat hospitalization. Long-term survival was compared to an age- and sex-matched US population. RESULTS: The median STS-predicted risk of mortality (STS-PROM) was 10% (IQR, 7-17%). Frailty was met in 72% of patients based on the five-meter walk test, 13% based on KCCQ-12 score, 12% based on KATZ activities of daily living, and 8% based on serum albumin levels. Procedure-related mortality occured in 3 (2%) patients and stroke in 8 (4%). The median duration of follow-up was 3.4 years. Outcomes included death in 150 (80%) patients, stroke in 15, and repeat hospitalization in 114. Multivariable analysis identified no association between any of the baseline patient variables with mortality, stroke, repeat hospitalization, or the combined outcomes (all P>0.05). One- and five-year survival rates in TAVI-treated nonagenarians were similar to age- and sex-matched controls (P=0.27). CONCLUSIONS: Long-term death or stroke is independent of STS-PROM and frailty risk variables in this nonagenarian patient population who received TAVI. Furthermore, survival is similar to age- and sex-matched controls.

Linking Variability in Phytochemical Composition with Safety Profile of Thymus carnosus Boiss. Extracts: Effect of Major Compounds and Evaluation of Markers of Oxidative Stress and Cell Death.

Natural products are generally considered safe for human consumption, but this classification is often based on ethnobotanical surveys or their use in traditional medicine over a long period of time. However, edaphoclimatic factors are known to produce different chemotypes, which may affect the safety profile and bioactivities, and are not commonly considered for plants exploited as crops worldwide. Thymus carnosus Boiss., a thyme species with various health-promoting effects, has potential pharmaceutical applications, but edaphoclimatic factors were found to significantly impact its phytochemical composition. Thus, we aimed to assess the safety profile of T. carnosus extracts obtained from plants harvested in two locations over three consecutive years and to establish an association with specific components, an essential study in the search for new sources of nutraceuticals. Thus, the antiproliferative effect of an aqueous decoction (AD), hydroethanolic (HE) extracts, and major extracts' components of T. carnosus was evaluated on intestinal (Caco-2) and hepatic (HepG2) cell models, revealing effects dependent on extract type, cell line, and tested compounds. Flavonoids induced different cytotoxic patterns, which could be attributed to molecular structural differences. Flow cytometry analysis showed apoptosis and necrosis induction, mediated by the modulation of intracellular reactive oxygen species and mitochondrial membrane potential, effects that were dependent on the cell line and phytochemical composition and on the synergism between extracts components, rather than on the activity of an isolated compound. While ursolic acid was the component with the strongest impact on the difference between extraction methods, flavonoids assumed a pivotal role in the response of different cell lines to the extracts. We report for the first time, for Thymus spp. extracts, that variations in the phytochemical composition clearly influence the cellular response, thus highlighting the need for extract standardization for medicinal applications.

Sarcopenia and sarcopenic obesity among community-dwelling Peruvian adults: A cross-sectional study.

INTRODUCTION: Sarcopenia and sarcopenic obesity (SO) have emerged as significant contributors to negative health outcomes in the past decade. We aimed to estimate the prevalence of probable sarcopenia, sarcopenia, and SO in a community-dwelling population of 1151 adults aged ≥55 years in Lima, Peru. METHODS: This cross-sectional study was conducted between 2018 and 2020. Sarcopenia was defined as the presence of low muscle strength (LMS) and low muscle mass (LMM) according to European (EWGSOP2), US (FNIH) and Asian (AWGS2) guidelines. We measured muscle strength by maximum handgrip strength and muscle mass using bioelectrical impedance analyzer. SO was defined as a body mass index ≥ 30 kg/m2 and sarcopenia. RESULTS: The study participants had a mean age of 66.2 years (SD 7.1), age range between 60 to 92 years old, of which 621 (53.9%) were men. Among the sample, 41.7% were classified as obese (BMI ≥30.0 kg/m²). The prevalence of probable sarcopenia was estimated to be 22.7% (95%CI: 20.3-25.1) using the EWGSOP2 criteria and 27.8% (95%CI: 25.2-30.4) using the AWGS2 criteria. Sarcopenia prevalence, assessed using skeletal muscle index (SMI), was 5.7% (95%CI: 4.4-7.1) according to EWGSOP2 and 8.3% (95%CI: 6.7-9.9) using AWGS2 criteria. The prevalence of sarcopenia based on the FNIH criteria was 18.1% (95%CI: 15.8-20.3). The prevalence of SO, considering different sarcopenia definitions, ranged from 0.8% (95%CI: 0.3-1.3) to 5.0% (95%CI: 3.8-6.3). CONCLUSION: Our findings reveal substantial variation in the prevalence of sarcopenia and SO, underscoring the necessity for context-specific cut-off values. Although the prevalence of SO was relatively low, this result may be underestimated. Furthermore, the consistently high proportion of probable sarcopenia and sarcopenia point to a substantial public health burden.

Predicting outcomes after kidney transplantation: Can Pareto's rules help us to do so?

Kidney transplantation is the best option for kidney replacement therapy, even considering that most of the times the grafts do not survive as long as their recipients. In the Khalil et al's experience, published in this issue of the Journal, they analyze their second kidney graft survival and describe those significant predictors of early loss. This editorial comments on the results and put in perspec tive that most of the times, long-term graft survival could be inadvertently jeopardized if the immunosuppressive therapy is reduced or withdrawn for any reason, and that it could happen frequently if the transplant physician intends to innovate with the clinical care without proper evidence-based data.

Minimizing neurovascular complications during image-guided percutaneous cryoablation of a cervical spinal aneurysmal bone cyst using protective doxycycline sclerotherapy: a case report.

Background: Aneurysmal bone cysts (ABC) are rare, locally aggressive bone tumors primarily observed in pediatric patients. Surgical curettage is the treatment of choice. Image-guided percutaneous cryoablation (CYOA) is a recently implemented alternative technique in cases not amenable to surgery. CYOA may be limited if the lesion is close to critical neurovascular structures. In this case report, a cervical spinal ABC was successfully treated using CYOA in combination with complementary and protective image-guided percutaneous doxycycline sclerotherapy (DS) to dissect and treat the portion of the lesion in contact with critical structures. Case Description: A 4-year-old male presented with a symptomatic ABC within the C5 vertebral body, which encompassed the right vertebral artery and contacted the right C5-C6 spinal cord and nerve roots. After ruling out surgery due to the proximity of critical neurovascular structures, treatment with CYOA was performed. However, subsequent follow-up showed recurrence in the part of the lesion contacting critical structures. A second approach was then decided, using DS to dissect and treat the most vulnerable portion and CYOA to treat the remaining tumor. Follow-up showed almost complete sclerosis of the lesion and total resolution of symptoms 3 years after treatment. Conclusions: Using DS to dissect and treat the portion of the lesion in contact with critical neurovascular structures during CYOA treatment of a cervical spinal ABC allowed for a safe and effective approach in our case.

Liver impalement with an antique African iron barbed spear. A case report.

Impalement injuries happen when an object penetrates a body cavity or organ and remains in situ. We present a case of a 35-year-old fisherman whose act of violence resulted in the lodging of an antique iron spear in segment V of the liver, which was then referred to our institution on the day after the accident. Despite the challenges posed by patient transfer, diagnosis, resuscitation, and, most importantly, handling in the operating room, the object was successfully removed via hepatotomy, and the patient is now in good health. Impalement by an ancient African iron spear, repurposed as a fishing tool in modern times, remains undocumented in the literature, necessitating reporting and a call for further research by the medical community into managing impalement injuries of varying severity.

Fiber-in-tube SPME-CapLC-MS/MS method to determine Aß peptides in cerebrospinal fluid obtained from Alzheimer's patients.

Mass spectrometry is characterized by its high sensitivity, ability to measure very low analyte concentrations, specificity to distinguish between closely related compounds, availability to generate high-throughput methods for screening, and high multiplexing capacity. This technique has been used as a platform to analyze fluid biomarkers for Alzheimer's disease. However, more effective sample preparation procedures, preferably antibody-independent, and more automated mass spectrometry platforms with improved sensitivity, chromatographic separation, and high throughput are needed for this purpose. This short communication discusses the development of a fiber-in-tube SPME-CapLC-MS/MS method to determine Aß peptides in cerebrospinal fluid obtained from Alzheimer's disease patients. To obtain the fiber-in-tube SPME capillary, we longitudinally packed 22 nitinol fibers coated with a zwitterionic polymeric ionic liquid into the same length of the PEEK tube. In addition, this communication compares this fiber-in-tube SPME method with the conventional HPLC scale (HPLC-MS/MS) and when directly coupled to CapESI-MS/MS without chromatographic separation, and, as a case study, discusses the benefits and challenges inherent in miniaturizing the flow scale of the sample preparation technique (fiber-in-tube SPME) to the CapLC-MS/MS system. Fiber-in-tube SPME-CapLC-MS/MS provided LLOQ ranging from 0.09 to 0.10 ng mL-1, accuracy ranging from 91 to 117 % (recovery), and reproducibility of less than 18 % (RSD). Analysis of the cerebrospinal fluid samples obtained from Alzheimer's disease patients evidenced that the method is robust. At the capillary scale (10 µL min-1), this innovative method presented higher analytical sensitivity than the conventional HPLC-MS/MS scale. Although fiber-in-tube SPME directly coupled to CapESI-MS/MS offers advantages in terms of high throughput, the sample was dispersed and non-quantitatively desorbed from the capillary at low flow rate. These results highlighted that chromatographic separation is important to decrease the matrix effect and to achieve higher detectability, which is indispensable for bioanalysis.

Intraoperative radiofrequency ablation for unresectable abdominal paraganglioma: a case report.

For pheochromocytoma and paraganglioma (PPGL), the efficacy of percutaneous ablative therapies in achieving control of metastatic tumors measuring <3 cm had been demonstrated in only few reports, and intraoperative radiofrequency ablation (RFA) of locally invasive primary PPGLs has not been reported. We presented the case of a 31-year-old man who had a 9-cm functioning unresectable PPGL. He was treated with 13 cycles of cytotoxic chemotherapy without objective tumor response, according to the Response Evaluation Criteria in Solid Tumors (RECIST). Subsequently, magnetic resonance imaging revealed a 9.0 × 8.6 × 6.0-cm retroperitoneal mass that extended to the inferior portion of the inferior vena cava, the inferior mesenteric artery, and the infrarenal aorta. Biochemical evaluation demonstrated high level of plasma normetanephrine (20.2 nmol/L, normal range <0.9 nmol/L). Genetic investigation showed the germline pathogenic variant c.1591delC (p. Ser198Alafs*22) in the SDHB gene. I131-metaiodobenzylguanidine scintigraphy was negative and Ga68-dotatate PET-CT scan showed high tumor uptake without distant metastases. On open laparotomy, tumor debulking was not possible. Therefore, intraoperative RFA was performed by a highly experienced team of interventional radiologists. At 12 months after the RFA, the tumor volume decreased from 208 to 45 mL (78%), plasma normetanephrine decreased from 20.2 to 2.6 nmol/L (87%), and the doxazosin dose was reduced from 16 to 8 mg/day. To our best knowledge, this was the first report on intraoperative RFA that markedly reduced the size of a large primary unresectable PPGL, along with clinical and biochemical responses.

Production and Characterization of Red Fruit Spirits Made from Red Raspberries, Blueberries, and Strawberries.

This study demonstrated the feasibility of fermenting and distilling low-commercial-value red fruits such as red raspberries, blueberries, and strawberries to produce high-value red fruit spirits. The fermentation process was efficient, with all red berry wines achieving a notable ethanol conversion yield (46.33 to 66.31%), without the need for nutrient supplementation or fruit juice solid separation, which showed no significant effect on the quality of the final product. Small-scale copper Charentais alembic distillation of the fermented red fruit juices resulted in fruit spirits equivalent to 1%, 7%, and 2% of the initial volume for red raspberries, blueberries, and strawberries, respectively. Except for the blueberry spirit, which had a lower volatile compound concentration (79.4 g/hL, absolute alcohol), all the produced red fruit spirits complied with legislation, including ethanol (37.9-40.2% v/v) and methanol (22.8-877.9 g/hL, absolute alcohol) concentrations and exhibited favorable aromatic profiles. The findings highlight that fermentation and distillation are straightforward, consistent, and reproducible methods, enabling the production of high-quality red fruit spirits from economically viable red fruit sources. This presents a significant opportunity in the spirits market, offering versatile applications as low-alcohol options, base spirits, or, with re-distillation, high-alcohol spirits.

Overview of the distinctive characteristics of strawberry, raspberry, and blueberry in berries, berry wines, and berry spirits.

Red berries have gained popularity as functional and nutritious food due to their health benefits, leading to increased consumer demand and higher production, totaling over 11,000 ktons for strawberries, raspberries, and blueberries combined in 2021. Nutritionally, strawberries, raspberries, and blueberries present high levels of vitamin C (9.7-58.8 mg/100 g dry weight [dw]), folates (6-24 µg/100 g dw), and minerals (96-228 mg/100 g dw). Due to their perishable nature, producers have utilized alcoholic fermentation to extend their shelf life, not only increasing the lifespan of red berries but also attracting consumers through the production of novel beverages. Strawberry, blueberry, and raspberry wines possess low alcohol (5.5-11.1% v/v), high acidity (3.2-17.6 g/L), and interesting bioactive molecules such as phenolic compounds, carotenoids, polysaccharides, and melatonin. Distillation holds tremendous potential for reducing food waste by creating red berry spirits of exceptional quality. Although research on red berry spirits is still in the early stages, future studies should focus on their production and characterization. By incorporating these factors, the production chain would become more sustainable, profitable, and efficient by reducing food waste, capitalizing on consumer acceptance, and leveraging the natural health-promoting characteristics of these products. Therefore, this review aims to provide a comprehensive overview of the characteristics of strawberry, blueberry, and red raspberry in berries, wines, and spirits, with a focus on their chemical composition and production methods.

Hemodynamic Comparison of the On-X and Top Hat Mechanical Aortic Valve Prostheses.

BACKGROUND: There are limited data comparing hemodynamic valve function in mechanical aortic valve prostheses. This study compared the hemodynamic function of 2 commonly used mechanical aortic valve (AV) prostheses, the On-X (Artivion) and Top Hat (CarboMedics Inc) valves. METHODS: This study was a retrospective analysis of 512 patients who underwent AV replacement with the On-X (n = 252; 49%) or Top Hat (n = 260; 51%) mechanical valves between 2011 and 2019. Patients were matched on the basis of selected variables. Echocardiographic data were collected preoperatively and postoperatively over a median follow-up of 1.39 years. RESULTS: A total of 320 patients were matched, 160 patients in each group. Despite being matched for left ventricular outflow tract diameter, patients in the Top Hat group received a greater prevalence of smaller tissue annulus diameter valves (≤21 mm) (83% vs 38%; P < .001). Patients in the On-X group had longer aortic cross-clamp times (78 minutes vs 64 minutes; P < .001) during isolated aortic valve replacement. Discharge echocardiography showed no difference in the AV area index between both groups (1.00 cm2/m2 vs 1.02 cm2/m2; P = .377). During longer-term echocardiographic follow-up, the AV area index remained stable for both valves within their respective tissue annulus diameter groups (P = .060). CONCLUSIONS: There was no difference between the 2 valves with respect to the AV area index at discharge, and hemodynamic function was stable during longer-term follow-up. The longer aortic cross-clamp time observed in the On-X group may indicate increased complexity of implantation compared with the Top Hat group.

Correlation between Instrumental Activities of Daily Living and muscle mass in older adults: impact of comorbidities.

Background: There is evidence that sarcopenia and functionality are closely related. However, the association between geriatric syndromes, such as dependence, on instrumental activities and sarcopenia could be affected by the presence of certain comorbidities, such as overweight, obesity, diabetes, and chronic obstructive pulmonary disease (COPD). Therefore, the present study aimed to determine the association between instrumental activities of daily living and muscle mass in the elderly and evaluate the impact of certain comorbidities on this association. Methods: This was a retrospective analytical observational study, including 1897 patients. Muscle mass was measured with calf circumference, and instrumental activities were measured with the Lawton index. Results: Among different parameters studies, a statistical correlation was found in a stratified regression analysis between the Lawton index score and muscle mass in patients who were overweight (p value:0.001 ;beta coefficient: 0.08), obese (p value: 0.001 ; beta coefficient: 0.05), had diabetes (p value: 0.012 ;beta coefficient: 0.03), and had COPD (p value:0.001 ;beta coefficient:0.03). Conclusion: The correlation between muscle mass and instrumental activities of daily living should be evaluated individually according to the needs of each participant and according to their comorbidities, promoting patient-centered geriatric medicine.