Prueba de caminata de 6 minutos: del sujeto normal a la obesidad mórbida / Six minute walk test: from normal to morbid obesity subject

Resumen Introducción: La obesidad mórbida se asocia a alteraciones de la capacidad de caminar, sin embargo se desconoce cómo es el comportamiento de la prueba de caminata de 6 minutos en sujetos con incrementos del índice de masa corporal (IMC). Objetivo: Describir el comportamiento de la prueba de caminata de 6 minutos en sujetos con IMC normal hasta la obesidad mórbida. Métodos: Mediante un diseño transversal analítico se estudiaron sujetos de ambos sexos de 18 a 60 años con IMC: normal (18.5-24.9 kg/m2), sobrepeso (25-29.9 kg/m2), obesidad (30-39.9 kg/m2), obesidad mórbida (> 40 kg/m2). Se les realizó prueba de caminata de 6 minutos, se acotaron variables demográficas y antecedentes personales patológicos. Se analizaron las categorías de IMC con ANOVA de una vía y ajuste de Bonferroni y los sexos con prueba t, ambos para grupos independientes y correlaciones de Pearson para las diversas variables. Una p < 0.05 fue considerada estadísticamente significativa. Resultados: Se estudiaron 480 sujetos de ambos sexos en cuatro grupos. Edad: hombres 43 ± 11 y mujeres 45 ± 10 años. Porcentaje diabetes mellitus (6.7%), hipertensión arterial (18.3%). Metros caminados hombres vs. mujeres por IMC (normal: 483 ± 56 vs. 449 ± 61; sobrepeso: 471 ± 55 vs. 441 ± 44; obesidad: 455 ± 70 vs. 421 ± 47; obesidad mórbida: 443 ± 49 vs. 403 ± 54; p < 0.05). Correlación IMC-metros caminados r: -0.446 (p < 0.0001). Conclusiones: Los metros caminados en la prueba de caminata de 6 minutos disminuyeron conforme incrementó el IMC. El sexo masculino caminó más metros en todas las categorías.

Abstract Introduction: Morbid obesity is associated with alterations in the ability to walk, however, the behavior of the 6-minute walk test in subjects with increases in body mass index is unknown. Objective: To describe the behavior of the 6-minute walk test in subjects with normal body mass index to morbid obesity. Methods: Through an analytical cross-sectional design, subjects of both genders from 18 to 60 years old with body mass index were studied: Normal (BMI: 18.5-24.9); overweight (BMI: 25-29.9); obesity (BMI: 30-39.9); morbid obesity (BMI: > 40) kg/m2. A 6-minute walk test was performed, demographic variables and pathological personal history were delimited. BMI categories were analyzed with one-way ANOVA and Bonferroni adjustment, and gender with t-test, both for independent groups, and Pearson's correlations for the various variables. Results: 480 subjects of both genders were studied in four groups. Age: men 43 ± 11 and women 45 ± 10 years old. Percentage diabetes mellitus (6.7%), arterial hypertension (18.3%). Meters walked men vs. women by body mass index (normal: 483 ± 56 vs. 449 ± 61; overweight: 471 ± 55 vs. 441 ± 44; obesity: 455 ± 70 vs. 421 ± 47; morbid obesity: 443 ± 49 vs. 403 ± 54, p < 0.05). Correlation body mass index-meters walked: r: -0.446 (p < 0.0001). Conclusions: Meters walked in the 6-minute walk test decreased as body mass index increased. The male gender walked more meters in all categories.

Evaluation of Nutritional Interventions in the Care Plan for Cancer Patients: The NOA Project.

The NOA (Oncological Nutrition in Andalusia) project analyses the degree of integration and areas of improvement in implementing nutritional support in the care plans of cancer patients in Andalusia. The aim was to analyse nutritional interventions for better care of cancer patients and for the improvement of the management of malnutrition in cancer. A prospective evaluation of the implementation of two areas of improvement in nutrition was conducted in three hospitals. Data were collected from each hospital over a six-month period using an online platform. A standardised care plan was designed for hospitals in Andalusia, in which proposed improvements were devised and prioritised, selecting nutritional screening in oncology services and the participation of the Nutrition Support Team (NST) on the tumour boards, as well as the assessment of the patients presented at these sessions. Our results indicated an increase in the number of medical records with nutritional evaluation results six months later, regardless of the type of tumour or hospitalisation; and there was greater participation of the NST on the tumour boards, mainly for head and neck and oesophagogastric cases. Solutions for improvement have been pinpointed and implemented that have positively impacted the nutritional care plan in the course of oncological disease.

Association of Antisecretory Drugs with Upper Gastrointestinal Bleeding in Patients Using Oral Anticoagulants: A Systematic Review and Meta-Analysis.

BACKGROUND: The role of antisecretory drugs for the prevention of upper gastrointestinal bleeding in patients using anticoagulants is unclear. We investigated this question in a systematic review and meta-analysis. METHODS: We searched Embase, PubMed, Web of Science, Scopus, the Cochrane Library, and clinicaltrials.gov thru April 2021 for controlled randomized trials and observational studies evaluating the association of proton pump inhibitors (PPIs) or H2-receptor antagonists with overt upper gastrointestinal bleeding in patients using anticoagulants. Independent duplicate review, data extraction, and risk of bias assessment were performed. Observational studies were included only if they provided results controlled for at least 2 variables. Meta-analyses were performed using random effects models. RESULTS: Six observational studies and 1 randomized trial were included. All but 1 study had low risk of bias. None of the studies excluded patients with concomitant aspirin or nonsteroidal anti-inflammatory drug use. For PPIs, the pooled relative risk of upper gastrointestinal bleeding was 0.67 (95% confidence interval 0.61, 0.74) with low statistical heterogeneity (I2 = 15%). Individual studies showed greater treatment effect in patients with higher risk for upper gastrointestinal bleeding (eg, nonsteroidal anti-inflammatory drug or aspirin use, elevated bleeding risk score). A single observational study evaluating the association of H2-receptor antagonists with upper gastrointestinal bleeding found a relative risk of 0.69 (95% confidence interval 0.24-2.02). CONCLUSIONS: Evidence drawn mostly from observational studies with low risk of bias demonstrate that PPIs reduce upper gastrointestinal bleeding in patients prescribed oral anticoagulants. The benefit appears to be most clearcut and substantial in patients with elevated risk of upper gastrointestinal bleeding.

Alfalfa (Medicago sativa L.) pho2 mutant plants hyperaccumulate phosphate.

In this article, we describe a set of novel alfalfa (Medicago sativa L.) plants that hyper-accumulate Phosphate ion (Pi) at levels 3- to 6-fold higher than wild-type. This alfalfa germplasm will have practical applications reclaiming Pi from contaminated or enriched soil or be used in conservation buffer strips to protect waterways from Pi run-off. Hyper-accumulating alfalfa plants were generated by targeted mutagenesis of PHOSPHATE2 (PHO2) using newly created CRISPR/Cas9 reagents and an improved mutant screening strategy. PHO2 encodes a ubiquitin conjugating E2 enzyme (UBC24) previously characterized in Arabidopsis thaliana, Medicago truncatula, and Oryza sativa. Mutations of PHO2 disrupt Pi homeostasis resulting in Pi hyper-accumulation. Successful CRISPR/Cas9 editing of PHO2 demonstrates that this is an efficient mutagenesis tool in alfalfa despite its complex autotetraploid genome structure. Arabidopsis and M. truncatula ortholog genes were used to identify PHO2 haplotypes in outcrossing tetraploid M. sativa with the aim of generating heritable mutations in both PHO2-like genes (PHO2-B and PHO2-C). After delivery of the reagent and regeneration from transformed leaf explants, plants with mutations in all haplotypes of PHO2-B and PHO2-C were identified. These plants were evaluated for morphology, Pi accumulation, heritable transmission of targeted mutations, segregation of mutant haplotypes and removal of T-DNA(s). The Agrobacterium-mediated transformation assay and gene editing reagents reported here were also evaluated for further optimization for future alfalfa functional genomic studies.

Systematic review: development of a consensus code set to identify cirrhosis in electronic health records.

BACKGROUND: Electronic health records (EHRs) collate longitudinal data that can be used to facilitate large-scale research in patients with cirrhosis. However, there is no consensus code set to define the presence of cirrhosis in EHR. This systematic review aims to evaluate the validity of diagnostic coding in cirrhosis and to synthesise a comprehensive set of ICD-10 codes for future EHR research. METHOD: MEDLINE and EMBASE databases were searched for studies that used EHR to identify cirrhosis and cirrhosis-related complications. Validated code sets were summarised, and the performance characteristics were extracted. Citation analysis was done to inform development of a consensus code set. This was then validated in a cohort of patients. RESULTS: One thousand six hundred twenty-six records were screened, and 18 studies were identified. The positive predictive value (PPV) was the most frequently reported statistical estimate and was ≥80% in 17/18 studies. Citation analyses showed continued variation in those used in contemporary research practice. Nine codes were identified as those most frequently used in the literature and these formed the consensus code set. This was validated in diverse patient populations from Europe and North America and showed high PPV (83%-89%) and greater sensitivity for the identification of cirrhosis than the most often used code set in the recent literature. CONCLUSION: There is variation in code sets used to identify cirrhosis in contemporary research practice. A consensus set has been developed and validated, showing improved performance, and is proposed to align EHR study designs in cirrhosis to facilitate international collaboration and comparisons.

Identifying Ascites in Patients with Cirrhosis Using Administrative Codes and Diuretic Use: A Multicenter Study.

BACKGROUND: Ascites is associated with significantly increased morbidity, mortality, and health care costs. Large population studies are necessary to determine the burden and impact of ascites; however, ascites ICD-10 codes perform poorly in the identification of patients. METHODS: We utilized three independent retrospective cohorts at the University of Michigan (cohorts 1 and 2) and Duke University (cohort 3). Cohort 1: Child A5-6 patients followed up to 10 years (n = 150); cohort 2: Child A5-B7 patients with portal hypertension followed for up to 1 year (n = 65); cohort 3: cross-sectional cohort of patients evaluated for liver transplant (n = 100). We computed performance characteristics for ascites-related ICD-10 codes (K70.31, K70.11, K71.51, R18.8), as well as loop and/or potassium-sparing diuretics. RESULTS: A total of 315 patients were included across three cohorts. Algorithms including any ascites code provided better sensitivity and equivalent specificity to R18.8 alone for all cohorts. In cohort 2, we found that loop diuretics, potassium-sparing diuretics, and a combination of both with a cirrhosis code were highly sensitive (82.3% for each) and specific (89.1-93.5%). In contrast, ascites codes were insensitive. In patients with moderate-severe ascites, a combination of recorded diuretics showed high sensitivity and specificity (95.2% and 86.8%). In Cohort 3's transplant evaluation patients, we found that loop diuretics, potassium-sparing diuretics, and a combination of both with a cirrhosis code were highly sensitive (90.4%, 78.8% and 75.0%, respectively) and specific (85.0%, 90.0% and 95.0%, respectively). For moderate-severe cirrhosis, loop diuretics and R18.8 showed higher sensitivity (77.8%) and specificity (88.9%), respectively. CONCLUSION: Diuretic records with a cirrhosis code improve the identification of ascites. This method for identifying ascites should be used in future large dataset studies.

A Prospective, Blinded Assessment of Ammonia Testing Demonstrates Low Utility Among Front-Line Clinicians.

Although ammonia is essential to the pathophysiology of hepatic encephalopathy (HE), its levels cannot diagnose HE, do not correlate with the grade of HE, and are plagued by technical challenges.1 Nevertheless, ammonia levels are routinely obtained in the evaluation of hospitalized patients.2 We have advocated for quality improvement to limit testing.3 However, data are lacking regarding the reasons for, context, and perceived value of ammonia testing among ordering clinicians. Additional data are needed to optimize a quality improvement intervention aiming to curb overuse.

Impact of Inpatient Attending Specialty and Gastroenterology Consultation on Quality of Care of Patients Hospitalized with Decompensated Cirrhosis.

BACKGROUND: Data suggest hospitalists are less adherent to quality indicators for decompensated cirrhosis, and gastroenterology consultation may improve adherence. We sought to evaluate the impact of inpatient attending specialty and gastroenterology consultation on quality of care for decompensated cirrhosis. METHODS: This was a retrospective cohort study of patients with decompensated cirrhosis admitted to gastroenterology or hospitalist service at the University of Michigan between 2016-2020. The primary outcome was adherence to nationally recommended inpatient quality indicators for ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, and gastrointestinal bleeding. Performance was calculated per patient admission as the proportion of quality indicators met vs quality indicators for which the patient was eligible. Quality indicator scores were compared between services using t-tests. We also evaluated the effect of gastroenterology consultation on quality indicator scores for patients admitted to hospitalist service. Clinical outcomes were compared using multivariable models adjusted for patient characteristics. RESULTS: Two hundred eighty-eight admissions were included (155 to gastroenterology service; 133 to hospitalist service). Quality indicator score for all admissions was 69.9% (standard deviation [SD] ± 24.2%). Quality indicator scores were similar between gastroenterology (69.9%, SD ± 23.6%) and hospitalist (69.8%, SD ± 25.1%) services (P = .913). There was no difference in quality indicator subscores for each complication between services. Hospitalists placed a gastroenterology consultation in 53.4% of admissions, and it was associated with higher albumin administration for patients with spontaneous bacterial peritonitis (57.1% vs 25%, P = .044). Patients admitted to gastroenterology service had higher readmissions within 30 days (adjusted odds ratio = 1.95) and shorter length of hospitalization (adjusted rate ratio = 0.85). CONCLUSIONS: Hospitalists provided comparable quality of care to gastroenterologists for inpatients with decompensated cirrhosis.

Health Care Workers' Reasons for Choosing Between Two Different COVID-19 Prophylaxis Trials in an Acute Pandemic Context: Single-Center Questionnaire Study.

BACKGROUND: In April 2020, two independent clinical trials to assess SARS-CoV-2 prophylaxis strategies among health care workers were initiated at our hospital: MeCOVID (melatonin vs placebo) and EPICOS (tenofovir disoproxil/emtricitabine vs hydroxychloroquine vs combination therapy vs placebo). OBJECTIVE: This study aimed to evaluate the reasons why health care workers chose to participate in the MeCOVID and EPICOS trials, as well as why they chose one over the other. METHODS: Both trials were offered to health care workers through an internal news bulletin. After an initial screening visit, all subjects were asked to respond to a web-based survey. RESULTS: In the first month, 206 health care workers were screened and 160 were randomized. The survey participation was high at 73.3%. Health care workers cited "to contribute to scientific knowledge" (n=80, 53.0%), followed by "to avoid SARS-CoV-2 infection" (n=33, 21.9%) and "the interest to be tested for SARS-CoV-2" (n=28, 18.5%), as their primary reasons to participate in the trials. We observed significant differences in the expected personal benefits across physicians and nurses (P=.01). The vast majority of volunteers (n=202, 98.0%) selected the MeCOVID trial, their primary reason being their concern regarding adverse reactions to treatments in the EPICOS trial (n=102, 69.4%). CONCLUSIONS: Health care workers' reasons to participate in prophylaxis trials in an acute pandemic context appear to be driven largely by their desire to contribute to science and to gain health benefits. Safety outweighed efficacy when choosing between the two clinical trials.

Potato improvement through genetic engineering.

Potato (Solanum tuberosum L.) is the third most important crop worldwide and a staple food for many people worldwide. Genetically, it poses many challenges for traditional breeding due to its autotetraploid nature and its tendency toward inbreeding depression. Breeding programs have focused on productivity, nutritional quality, and disease resistance. Some of these traits exist in wild potato relatives but their introgression into elite cultivars can take many years and, for traits such as pest resistance, their effect is often short-lasting. These problems can be addressed by genetic modification (GM) or gene editing (GE) and open a wide horizon for potato crop improvement. Current genetically modified and gene edited varieties include those with Colorado potato beetle and late blight resistance, reduction in acrylamide, and modified starch content. RNAi hairpin technology can be used to silence the haplo-alleles of multiple genes simultaneously, whereas optimization of newer gene editing technologies such as base and prime editing will facilitate the routine generation of advanced edits across the genome. These technologies will likely gain further relevance as increased target specificity and decreased off-target effects are demonstrated. In this Review, we discuss recent work related to these technologies in potato improvement.

Validation of the body image dimensional assessment in adolescents from Spanish high school.

INTRODUCTION: There are not many valid instruments to quickly and easily identify body dissatisfaction in adolescents. Most studies have used the Stunkard Rating Scale to assess body image. Nevertheless, this scale has been described as too abrupt and crude for adolescents. AIM: Was to validate the body image dimensional assessment (BIDA) questionnaire in a sample of adolescents from Secondary schools of Spain. METHOD: The BIDA consists of four items to answer with reference to a series of four silhouettes using a numeric scale that allows the quantification of the degree of body dissatisfaction (BD), sexual body dissatisfaction (SxBD), comparative body dissatisfaction (CBD) and the calculation of the final body dissatisfaction index (BDIndex). The sample included 2059 adolescents, 1132 males and 929 females aged 13.10 ± 0.89. Participants answered the BIDA and then their anthropometrics measurements were taken. RESULTS: Reliability test, a convergent test and confirmatory factorial analysis were conducted to validate BIDA instrument. A single factor structure emerged from confirmatory factorial analysis; the BIDA demonstrated adequate internal consistency in adolescents: (CFI > 0.90, TLI > 0.90, α > 0.80). Significant correlations (p < 0.001) emerged between the BIDA indices and all the anthropometric measures. CONCLUSIONS: The BIDA questionnaire is a valid and reliable instrument to evaluate body dissatisfaction in Spanish adolescents. LEVEL OF EVIDENCE: Level V, descriptive study.

Growth Plate Pathology in the Mucopolysaccharidosis Type VI Rat Model-An Experimental and Computational Approach.

BACKGROUND: Mucopolysaccharidoses (MPS) are a group of inherited metabolic diseases caused by impaired function or absence of lysosomal enzymes involved in degradation of glycosaminoglycans. Clinically, MPS are skeletal dysplasias, characterized by cartilage abnormalities and disturbances in the process of endochondral ossification. Histologic abnormalities of growth cartilage have been reported at advanced stages of the disease, but information regarding growth plate pathology progression either in humans or in animal models, as well as its pathophysiology, is limited. METHODS: Histological analyses of distal femur growth plates of wild type (WT) and mucopolysaccharidosis type VI (MPS VI) rats at different stages of development were performed, including quantitative data. Experimental findings were then analyzed in a theoretical scenario. RESULTS: Histological evaluation showed a progressive loss of histological architecture within the growth plate. Furthermore, in silico simulation suggest the abnormal cell distribution in the tissue may lead to alterations in biochemical gradients, which may be one of the factors contributing to the growth plate abnormalities observed, highlighting aspects that must be the focus of future experimental works. CONCLUSION: The results presented shed some light on the progression of growth plate alterations observed in MPS VI and evidence the potentiality of combined theoretical and experimental approaches to better understand pathological scenarios, which is a necessary step to improve the search for novel therapeutic approaches.

Upper Gastrointestinal Bleeding Due to a Duodenal Metastasis from Primary Testicular Squamous Cell Carcinoma.

BACKGROUND Primary squamous cell carcinoma of the testis (tSCC) is exceptionally rare. To date, only 5 cases have been described in the literature. We report the first case of upper gastrointestinal bleeding due to a duodenal metastasis from tSCC. CASE REPORT We report a male patient who presented with marked swelling of his left scrotum. Inguinal orchiectomy demonstrated keratinizing squamous cell carcinoma (SCC). All surgical margins were negative, and germ cell neoplasia in situ was not identified. PET/CT showed retroperitoneal metastasis. He underwent surgical resection. Three months later, surveillance imaging revealed progression of metastatic disease, including a mass between the transverse duodenum and inferior vena cava invading the duodenal wall without obstruction. Two days later, he presented to the hospital due to gastrointestinal bleeding. CT of the abdomen was negative for a retroperitoneal bleed or intraluminal bleed with stable metastatic retroperitoneal lymph nodes. Esophagogastroduodenoscopy (EGD) showed a fungating and oozing mass in the second portion of the duodenum. Biopsies confirmed metastatic SCC. Palliative radiation and adjuvant chemotherapy were initiated. CONCLUSIONS tSCC, though rare, is an aggressive malignancy and requires prompt and aggressive combined oncological treatment. Most of the cases have been reported to develop from an epidermal cyst, chronic hydrocele, or epididymis. This malignancy can lead to unexpected phenomena such as gastrointestinal bleeding or intestinal obstruction due to its unique metastatic pattern.

Wildfire effects on diversity and composition in soil bacterial communities.

In recent years, the Mediterranean area has witnessed an increase of both the frequency and severity of large fires, which appears to be intimately associated with climate and land use changes. To measure the impact of wildfires on living organisms, diverse indicators have been proposed. These indicators of fire severity traditionally rely on quantifying the damage caused to the vegetal component of ecosystems. However, the use of bacterial communities as severity indicators has received less attention. Here, we studied the differences between bacterial communities of three different Mediterranean ecosystems, two shrubby and one arboreal, two months after a large wildfire. Two levels of severity were compared to a control unburnt soil. The results showed that greater fire severity triggers a reduction in the diversity of soil bacterial communities. In high-severity fires, this reduction reached 40.6 and 58.6% of the control values for richness and Shannon's diversity, respectively. We also found that the greatest differences between communities could be attributed first to the severity of the fire, and second to the ecosystem from which they originated. Importantly, species of just five families of bacteria: Oxalobacteraceae, Micrococcaceae, Paenibacillaceae, Bacillaceae and Planococcaceae, became dominant in all three ecosystems. The average frequency increase for particular species was 100 times. However, due to random uncontrolled factors, the species that became dominant in each community were not always the same.

Understanding Physical Activity Intentions in Physical Education Context: A multi-level Analysis from the Self-Determination Theory.

Using self-determination theory as a framework, we aimed to study the relationships between perceived need support and need satisfaction with self-determined motivation and extracurricular physical activity intentions in the physical education (PE) classroom, including sex and out-of-school sport participation as moderators. Additionally, we aimed to test whether a need-supportive classroom environment in PE moderates these associations. Participants were 1259 students (556 males) aged between 12 to 16 years (Mage = 13.46 years; SD = 0.74) from 77 PE classes. At the student level we found (a) need satisfaction to predict positively autonomous motivation and negatively amotivation, and (b) autonomous motivation to predict positively and amotivation to predict negatively intentions to undertake extracurricular physical activities. At the classroom level, in need-supportive classes males benefit more than females in terms of increased autonomous motivation while females benefit more than males in terms of decreased amotivation. Finally, class-level perceived need support moderated (i.e., attenuated) the negative association between need satisfaction and amotivation and between amotivation and intentions. These results suggest a buffering role that a need-supportive classroom environment may have on students' motivation and behavior.

Heritable temporal gene expression patterns correlate with metabolomic seed content in developing hexaploid oat seed.

Oat ranks sixth in world cereal production and has a higher content of health-promoting compounds compared with other cereals. However, there is neither a robust oat reference genome nor transcriptome. Using deeply sequenced full-length mRNA libraries of oat cultivar Ogle-C, a de novo high-quality and comprehensive oat seed transcriptome was assembled. With this reference transcriptome and QuantSeq 3' mRNA sequencing, gene expression was quantified during seed development from 22 diverse lines across six time points. Transcript expression showed higher correlations between adjacent time points. Based on differentially expressed genes, we identified 22 major temporal co-expression (TCoE) patterns of gene expression and revealed enriched gene ontology biological processes. Within each TCoE set, highly correlated transcripts, putatively commonly affected by genetic background, were clustered and termed genetic co-expression (GCoE) sets. Seventeen of the 22 TCoE sets had GCoE sets with median heritabilities higher than 0.50, and these heritability estimates were much higher than that estimated from permutation analysis, with no divergence observed in cluster sizes between permutation and non-permutation analyses. Linear regression between 634 metabolites from mature seeds and the PC1 score of each of the GCoE sets showed significantly lower p-values than permutation analysis. Temporal expression patterns of oat avenanthramides and lipid biosynthetic genes were concordant with previous studies of avenanthramide biosynthetic enzyme activity and lipid accumulation. This study expands our understanding of physiological processes that occur during oat seed maturation and provides plant breeders the means to change oat seed composition through targeted manipulation of key pathways.

A Mechanism-Based Sphingosine-1-phosphate Lyase Inhibitor.

The synthesis of a series of vinylated analogues of sphingosine-1-phosphate together with their unambiguous configurational assignment by VCD methods is reported. Among them, compound RBM10-8 can irreversibly inhibit human sphingosine-1-phosphate lyase (hS1PL) while behaving also as an enzyme substrate. These findings, together with the postulated mechanism for S1PL activity, reinforce the role of RBM10-8 as a new mechanism-based hS1PL inhibitor.