[Consenso del grupo de trabajo de los trastornos de la conducta alimentaria de SENPE (GTTCA-SENPE). Evaluación y tratamiento médico-nutricional en la anorexia nerviosa. Actualización 2023]. / Consenso del grupo de trabajo de los trastornos de la conducta alimentaria de SENPE (GTTCA-SENPE). Evaluación y tratamiento médico-nutricional en la anorexia nerviosa. Actualización 2023.

Anorexia nervosa (AN) is a multifactorial disorder. A possible role of the social network and the gut microbiota in pathogenesis has been added. Exogenous shocks such as the COVID19 pandemic have had a negative impact on patients with AN. The potential medical and nutritional impact of malnutrition and/or compensatory behaviors gives rise to a complex disease with a wide range of severity, the management of which requires a multidisciplinary team with a high level of subject matter expertise. Coordination between levels of care is necessary as well as understanding how to transition the patient from pediatric to adult care is essential. A proper clinical evaluation can detect possible complications, as well as establish the organic risk of the patient. This allows caregivers to tailor the medical-nutritional treatment for each patient. Reestablishing adequate nutritional behaviors is a fundamental pillar of treatment in AN. The design of a personalized nutritional treatment and education program is necessary for this purpose. Depending on the clinical severity, artificial nutrition may be necessary. Although the decision regarding the level of care necessary at diagnosis or during follow-up depends on a number of factors (awareness of the disease, medical stability, complications, suicidal risk, outpatient treatment failure, psychosocial context, etc.), outpatient treatment is the most frequent and most preferred choice. However, more intensive care (total or partial hospitalization) may be necessary in certain cases. In severely malnourished patients, the appearance of refeeding syndrome should be prevented during renourishment. The presence of AN in certain situations (pregnancy, vegetarianism, type 1 diabetes mellitus) requires specific care. Physical activity in these patients must also be addressed correctly.

[A consensus report by the Working Group on Eating Disorders of Sociedad Española de Nutrición Clínica y Metabolismo (GTTCA-SENPE). Evaluation, medical and nutritional management of anorexia nervosa. Update 2023]. / Consenso del grupo de trabajo de los trastornos de la conducta alimentaria de SENPE (GTTCA-SENPE). Evaluación y tratamiento médico-nutricional en la anorexia nerviosa. Actualización 2023.

Introduction: Anorexia nervosa (AN) is a multifactorial disorder. A possible role of the social network and the gut microbiota in pathogenesis has been added. Exogenous shocks such as the COVID19 pandemic have had a negative impact on patients with AN. The potential medical and nutritional impact of malnutrition and/or compensatory behaviors gives rise to a complex disease with a wide range of severity, the management of which requires a multidisciplinary team with a high level of subject matter expertise. Coordination between levels of care is necessary as well as understanding how to transition the patient from pediatric to adult care is essential. A proper clinical evaluation can detect possible complications, as well as establish the organic risk of the patient. This allows caregivers to tailor the medical-nutritional treatment for each patient. Reestablishing adequate nutritional behaviors is a fundamental pillar of treatment in AN. The design of a personalized nutritional treatment and education program is necessary for this purpose. Depending on the clinical severity, artificial nutrition may be necessary. Although the decision regarding the level of care necessary at diagnosis or during follow-up depends on a number of factors (awareness of the disease, medical stability, complications, suicidal risk, outpatient treatment failure, psychosocial context, etc.), outpatient treatment is the most frequent and most preferred choice. However, more intensive care (total or partial hospitalization) may be necessary in certain cases. In severely malnourished patients, the appearance of refeeding syndrome should be prevented during renourishment. The presence of AN in certain situations (pregnancy, vegetarianism, type 1 diabetes mellitus) requires specific care. Physical activity in these patients must also be addressed correctly.

Introducción: La anorexia nerviosa (AN) es una enfermedad de origen multifactorial. Recientemente se ha sumado el papel de las redes sociales y la microbiota intestinal en la patogenia. La pandemia por COVID-19 ha tenido un impacto negativo en los pacientes con AN. La potencial afectación médica y nutricional derivada de la desnutrición o las conductas compensatorias dan lugar a una compleja enfermedad de gravedad variable, cuyo manejo precisa un equipo multidisciplinar con elevado nivel de conocimientos en la materia. Es fundamental la coordinación entre niveles asistenciales y en la transición de pediatría a adultos. Una adecuada valoración clínica permite detectar eventuales complicaciones, así como establecer el riesgo orgánico del paciente y, por tanto, adecuar el tratamiento médico-nutricional de forma individualizada. El restablecimiento de un apropiado estado nutricional es un pilar fundamental del tratamiento en la AN. Para ello es necesario diseñar una intervención de renutrición individualizada que incluya un programa de educación nutricional. Según el escenario clínico puede ser necesaria la nutrición artificial. Aunque la decisión de qué nivel de atención escoger al diagnóstico o durante el seguimiento depende de numerosas variables (conciencia de enfermedad, estabilidad médica, complicaciones, riesgo autolítico, fracaso del tratamiento ambulatorio o contexto psicosocial, entre otros), el tratamiento ambulatorio es de elección en la mayoría de las ocasiones. No obstante, puede ser necesario un escenario más intensivo (hospitalización total o parcial) en casos seleccionados. En pacientes gravemente desnutridos debe prevenirse la aparición de un síndrome de alimentación cuando se inicia la renutrición. La presencia de una AN en determinadas situaciones (gestación, vegetarianismo, diabetes mellitus de tipo 1, etc.) exige un manejo particular. En estos pacientes también debe abordarse de forma correcta el ejercicio físico.

Consenso del Grupo de Trabajo de los Trastornos de la Conducta Alimentaria de SENPE (GTTCA-SENPE). Evaluación y tratamiento médico-nutricional en la anorexia nerviosa.Actualización 2023 / A consensus report by the Working Group on Eating Disorders of Sociedad Española de Nutrición Clínica y Metabolismo (GTTCA-SENPE). Evaluation, medical and nutritional management of anorexia nervosa. Update 2023

La anorexia nerviosa (AN) es una enfermedad de origen multifactorial. Recientemente se ha sumado el papel de las redes sociales y la microbiota intestinal en la patogenia. La pandemia por COVID-19 ha tenido un impacto negativo en los pacientes con AN. La potencial afectación médica y nutricional derivada de la desnutrición o las conductas compensatorias dan lugar a una compleja enfermedad de gravedad variable, cuyo manejo precisa un equipo multidisciplinar con elevado nivel de conocimientos en la materia. Es fundamental la coordinación entre niveles asistenciales y en la transición de pediatría a adultos. Una adecuada valoración clínica permite detectar eventuales complicaciones, así como establecer el riesgo orgánico del paciente y, por tanto, adecuar el tratamiento médico-nutricional de forma individualizada. El restablecimiento de un apropiado estado nutricional es un pilar fundamental del tratamiento en la AN. Para ello es necesario diseñar una intervención de renutrición individualizada que incluya un programa de educación nutricional. Según el escenario clínico puede ser necesaria la nutrición artificial. Aunque la decisión de qué nivel de atención escoger al diagnóstico o durante el seguimiento depende de numerosas variables (conciencia de enfermedad, estabilidad médica, complicaciones, riesgo autolítico, fracaso del tratamiento ambulatorio o contexto psicosocial, entre otros), el tratamiento ambulatorio es de elección en la mayoría de las ocasiones. No obstante, puede ser necesario un escenario más intensivo (hospitalización total o parcial) en casos seleccionados. En pacientes gravemente desnutridos debe prevenirse la aparición de un síndrome de alimentación cuando se inicia la renutrición. La presencia de una AN en determinadas situaciones (gestación, vegetarianismo, diabetes mellitus de tipo 1, etc.) exige un manejo particular. En estos pacientes también debe abordarse de forma correcta el ejercicio físico.(AU)

Anorexia nervosa (AN) is a multifactorial disorder. A possible role of the social network and the gut microbiota in pathogenesis has been added.Exogenous shocks such as the COVID19 pandemic have had a negative impact on patients with AN.The potential medical and nutritional impact of malnutrition and/or compensatory behaviors gives rise to a complex disease with a wide range ofseverity, the management of which requires a multidisciplinary team with a high level of subject matter expertise. Coordination between levelsof care is necessary as well as understanding how to transition the patient from pediatric to adult care is essential. A proper clinical evaluationcan detect possible complications, as well as establish the organic risk of the patient. This allows caregivers to tailor the medical-nutritionaltreatment for each patient.Reestablishing adequate nutritional behaviors is a fundamental pillar of treatment in AN. The design of a personalized nutritional treatment andeducation program is necessary for this purpose. Depending on the clinical severity, artificial nutrition may be necessary. Although the decisionregarding the level of care necessary at diagnosis or during follow-up depends on a number of factors (awareness of the disease, medical stability,complications, suicidal risk, outpatient treatment failure, psychosocial context, etc.), outpatient treatment is the most frequent and most preferredchoice. However, more intensive care (total or partial hospitalization) may be necessary in certain cases. In severely malnourished patients, theappearance of refeeding syndrome should be prevented during renourishment.The presence of AN in certain situations (pregnancy, vegetarianism, type 1 diabetes mellitus) requires specific care. Physical activity in thesepatients must also be addressed correctly.(AU)

The Prebiotic Effects of an Extract with Antioxidant Properties from Morus alba L. Contribute to Ameliorate High-Fat Diet-Induced Obesity in Mice.

Obesity is a global health issue, in which modifications in gut microbiota composition have a key role. Different therapeutic strategies are being developed in combination with diet and exercise, including the use of plant extracts, such as those obtained from Morus alba L. leaves. Recent studies have revealed their anti-inflammatory and antioxidant properties. The aim of the present work was to evaluate whether the beneficial effects of M. alba L. leaf extract in high-fat diet-induced obesity in mice is correlated with its impact on gut microbiota. The extract reduced body weight gain and attenuated lipid accumulation, as well as increased glucose sensitivity. These effects were associated with an amelioration of the obesity-associated inflammatory status, most probably due to the described antioxidant properties of the extract. Moreover, M. alba L. leaf extract mitigated gut dysbiosis, which was evidenced by the restoration of the Firmicutes/Bacteroidota ratio and the decrease in plasma lipopolysaccharide (LPS) levels. Specifically, the extract administration reduced Alistipes and increased Faecalibaculum abundance, these effects being correlated with the beneficial effects exerted by the extract on the obesity-associated inflammation. In conclusion, anti-obesogenic effects of M. alba L. leaf extract may be mediated through the amelioration of gut dysbiosis.

Resultados de la encuesta sobre unidades asistenciales y atención a trastornos de la conducta alimentaria en España. Grupo de Trabajo sobre Trastornos de la Conducta Alimentaria de SENPE / Results of the survey on care units and caring for eating disorders in Spain. SENPE Working Group on Eating Disorders

Introducción: los trastornos de la conducta alimentaria (TCA) suponen un reto terapéutico. Objetivo: describir la asistencia a los TCA desde la perspectiva de las unidades de nutrición clínica y dietética (UNCyD) en relación con los recursos humanos y asistenciales, las actividades realizadas y la satisfacción con la atención en España; recoger demandas de los profesionales para mejorar la asistencia. Métodos: estudio transversal y observacional a partir de un cuestionario remitido online a socios de la Sociedad Española de Nutrición Clínica y Metabolismo (SENPE) y al Área de Nutrición de la Sociedad Española de Endocrinología y Nutrición (SEEN). Los datos se analizaron según las camas de los hospitales encuestados (< 500/≥ 500). Resultados: 23 respuestas de 8 comunidades autónomas. En el 87 % de las UNCyD se prestaba atención a los TCA; el 65,2 % contaban con un proceso específico; el 91,3 % colaboraban con Psiquiatría; el 34,8 % tenían área propia de hospitalización; el 56,5 % disponían de hospital de día pero participaban en él el 21,7 %; el 39,1 % tenían consulta monográfica; se realizaba educación nutricional en el 87 %, sobre todo por enfermería; se prescribían frecuentemente dietas individualizadas y suplementos orales en el 39,1 y el 56,5 %, respectivamente; solo los hospitales más grandes participaban en investigación sobre TCA (62,5 %); y el 21,7 % colaboraban con asociaciones de pacientes. Los hospitales con ≥ 500 camas disponían de más recursos y estaban más satisfechos. Los profesionales demandaban recursos y procesos consensuados con psiquiatría. Conclusiones: los recursos y las prácticas asistenciales son dispares en las UNCyD encuestadas, así como la colaboración multidisciplinar. La evidencia recogida permite diseñar estrategias de mejora en este ámbito. (AU)

Introduction: eating disorders (EDs) entail a therapeutic challenge. Objective: to describe ED care from the perspective of Nutrition Units (NU) in relation to human and care resources, the activities carried out, and satisfaction with care in Spain; to collect demands from professionals to improve assistance. Methods: a cross-sectional, observational study based on a questionnaire sent online to members of the Spanish Society of Clinical Nutrition and Metabolism (SENPE) and to the Nutrition Area of the Spanish Society of Endocrinology and Nutrition (SEEN). The data were analyzed according to number of beds of the hospitals surveyed (< 500/≥ 500). Results: 23 responses from 8 autonomous communities. In 87 % of NUs care was given to eating disorders; 65.2 % had a specific process; 91.3 % collaborated with Psychiatry; 34.8 % had their own hospitalization area; 56.5 % had a day hospital, but 21.7 % participated in it; 39.1 % had a monographic consultation office; nutritional education was carried out in 87 %, especially by nursing; individualized diets and oral supplements were frequently prescribed in 39.1 % and 56.5 %, respectively; only the largest hospitals participated in research on EDs (62.5 %), and 21.7 % collaborated with patient associations. Hospitals with ≥ 500 beds had more resources and were more satisfied. Professionals demanded resources and processes agreed with Psychiatry. Conclusions: resources and care practices are uneven in the NUs surveyed, as well as multidisciplinary collaboration. The collected evidence allows us to design improvement strategies in this area. (AU)

[Results of the survey on care units and caring for eating disorders in Spain. SENPE Working Group on Eating Disorders]. / Resultados de la encuesta sobre unidades asistenciales y atención a trastornos de la conducta alimentaria en España. Grupo de Trabajo sobre Trastornos de la Conducta Alimentaria de SENPE.

Introduction: Introduction: eating disorders (EDs) entail a therapeutic challenge. Objective: to describe ED care from the perspective of Nutrition Units (NU) in relation to human and care resources, the activities carried out, and satisfaction with care in Spain; to collect demands from professionals to improve assistance. Methods: a cross-sectional, observational study based on a questionnaire sent online to members of the Spanish Society of Clinical Nutrition and Metabolism (SENPE) and to the Nutrition Area of the Spanish Society of Endocrinology and Nutrition (SEEN). The data were analyzed according to number of beds of the hospitals surveyed (< 500/≥ 500). Results: 23 responses from 8 autonomous communities. In 87 % of NUs care was given to eating disorders; 65.2 % had a specific process; 91.3 % collaborated with Psychiatry; 34.8 % had their own hospitalization area; 56.5 % had a day hospital, but 21.7 % participated in it; 39.1 % had a monographic consultation office; nutritional education was carried out in 87 %, especially by nursing; individualized diets and oral supplements were frequently prescribed in 39.1 % and 56.5 %, respectively; only the largest hospitals participated in research on EDs (62.5 %), and 21.7 % collaborated with patient associations. Hospitals with ≥ 500 beds had more resources and were more satisfied. Professionals demanded resources and processes agreed with Psychiatry. Conclusions: resources and care practices are uneven in the NUs surveyed, as well as multidisciplinary collaboration. The collected evidence allows us to design improvement strategies in this area.

Introducción: Introducción: los trastornos de la conducta alimentaria (TCA) suponen un reto terapéutico. Objetivo: describir la asistencia a los TCA desde la perspectiva de las unidades de nutrición clínica y dietética (UNCyD) en relación con los recursos humanos y asistenciales, las actividades realizadas y la satisfacción con la atención en España; recoger demandas de los profesionales para mejorar la asistencia. Métodos: estudio transversal y observacional a partir de un cuestionario remitido online a socios de la Sociedad Española de Nutrición Clínica y Metabolismo (SENPE) y al Área de Nutrición de la Sociedad Española de Endocrinología y Nutrición (SEEN). Los datos se analizaron según las camas de los hospitales encuestados (< 500/≥ 500). Resultados: 23 respuestas de 8 comunidades autónomas. En el 87 % de las UNCyD se prestaba atención a los TCA; el 65,2 % contaban con un proceso específico; el 91,3 % colaboraban con Psiquiatría; el 34,8 % tenían área propia de hospitalización; el 56,5 % disponían de hospital de día pero participaban en él el 21,7 %; el 39,1 % tenían consulta monográfica; se realizaba educación nutricional en el 87 %, sobre todo por enfermería; se prescribían frecuentemente dietas individualizadas y suplementos orales en el 39,1 y el 56,5 %, respectivamente; solo los hospitales más grandes participaban en investigación sobre TCA (62,5 %); y el 21,7 % colaboraban con asociaciones de pacientes. Los hospitales con ≥ 500 camas disponían de más recursos y estaban más satisfechos. Los profesionales demandaban recursos y procesos consensuados con psiquiatría. Conclusiones: los recursos y las prácticas asistenciales son dispares en las UNCyD encuestadas, así como la colaboración multidisciplinar. La evidencia recogida permite diseñar estrategias de mejora en este ámbito.

Novel Horizons in Postbiotics: Lactobacillaceae Extracellular Vesicles and Their Applications in Health and Disease.

Lactobacillus probiotics contained in dietary supplements or functional foods are well-known for their beneficial properties exerted on host health and diverse pathological situations. Their capacity to improve inflammatory bowel disease (IBD) and regulate the immune system is especially remarkable. Although bacteria-host interactions have been thought to occur directly, the key role that extracellular vesicles (EVs) derived from probiotics play on this point is being unveiled. EVs are lipid bilayer-enclosed particles that carry a wide range of cargo compounds and act in different signalling pathways. Notably, these EVs have been recently proposed as a safe alternative to the utilisation of live bacteria since they can avoid the possible risks that probiotics may entail in vulnerable cases such as immunocompromised patients. Therefore, this review aims to give an updated overview of the existing knowledge about EVs from different Lactobacillus strains, their mechanisms and effects in host health and different pathological conditions. All of the information collected suggests that EVs could be considered as potential tools for the development of future novel therapeutic approaches.

Analysis of metabolic dynamics during drought stress in Arabidopsis plants.

Drought is a major cause of agricultural losses worldwide. Climate change will intensify drought episodes threatening agricultural sustainability. Gaining insights into drought response mechanisms is vital for crop adaptation to climate emergency. To date, only few studies report comprehensive analyses of plant metabolic adaptation to drought. Here, we present a multifactorial metabolomic study of early-mid drought stages in the model plant Arabidopsis thaliana. We sampled root and shoot tissues of plants subjected to water withholding over a six-day time course, including brassinosteroids receptor mutants previously reported to show drought tolerance phenotypes. Furthermore, we sequenced the root transcriptome at basal and after 5 days drought, allowing direct correlation between metabolic and transcriptomic changes and the multi-omics integration. Significant abiotic stress signatures were already activated at basal conditions in a vascular-specific receptor overexpression (BRL3ox). These were also rapidly mobilized under drought, revealing a systemic adaptation strategy driven from inner tissues of the plant. Overall, this dataset provides a significant asset to study drought metabolic adaptation and allows its analysis from multiple perspectives.

Beneficial Effects of Limosilactobacillus fermentum in the DCA Experimental Model of Irritable Bowel Syndrome in Rats.

Limosilactobacillus fermentum CECT5716, a probiotic strain isolated from human milk, has reported beneficial effects on different gastrointestinal disorders. Moreover, it has shown its ability to restore altered immune responses, in association with microbiome modulation in different pathological conditions. Therefore, our aim was to assess the effects of a Limosilacbacillus fermentum CECT5716 in a rat experimental model of irritable bowel syndrome (IBS) that resembles human IBS. The experimental IBS was induced by deoxycholic acid (DCA) in rats and then, Limosilactobacillus fermentum CECT5716 (109 CFU/day/rat) was administered. Behavioral studies, hyperalgesia and intestinal hypersensitivity determinations were performed and the impact of the probiotic on the inflammatory and intestinal barrier integrity was evaluated. Additionally, the gut microbiota composition was analyzed. Limosilactobacillus fermentum CECT5716 attenuated the anxiety-like behavior as well as the visceral hypersensitivity and referred pain. Moreover, this probiotic ameliorated the gut inflammatory status, re-establishing the altered intestinal permeability, reducing the mast cell degranulation and re-establishing the gut dysbiosis in experimental IBS. Therefore, our results suggest a potential use of Limosilactobacillus fermentum CECT5716 in clinical practice for the management of IBS patients.

Nutritional management of gastric cancer.

Gastric cancer is the third leading cause of cancer mortality and is frequently associated with nutritional disorders, the detection and proper management of which can contribute to improving quality of life and survival. Being aware of the consequences and of the different treatments for this neoplasm allows us to offer an adequate nutritional approach. In surgical candidates, integration into ERAS-type programs is increasingly frequent, and includes a pre-surgical nutritional approach and the initiation of early oral tolerance. After gastrectomy, the new anatomical and functional state of the digestive tract may lead to the appearance of "post-gastrectomy syndromes", the management of which may require diet modification and medical treatment. Those who receive neoadjuvant or adjuvant antineoplastic therapy benefit from specific dietary recommendations based on intercurrent symptoms and/or artificial nutrition. In palliative patients, the nutritional approach should be carried out while respecting the principle of autonomy and weighing the risks and benefits of the intervention. The objective of this review is to highlight the importance and role of nutrition in patients with gastric cancer and to provide guidelines for nutritional management based on the current evidence.

Attentional processing biases to threat in schizophrenia: Evidence from a free-viewing task with emotional scenes.

Attentional biases to threatening stimuli have been suggested to play a key role in the onset and course of schizophrenia. However, current research has not completely demonstrated this assumption. The aim of this eye-tracking study was to shed light on the underlying psychological mechanisms of schizophrenia by examining the attentional processing of socio-emotional information. Forty-four individuals with schizophrenia and 47 healthy controls were assessed in a 3-s free-viewing task with a social scene (i.e., happy, threatening, or neutral) in competition with a non-social one to determine the effects of emotional information on the different stages of the attentional processing. The location and latency of initial fixations (i.e., initial orienting), the firs-pass fixations and gaze duration (i.e., attentional engagement), and the percentage of total duration and total fixations (i.e., attentional maintenance) were analyzed. It was found that the schizophrenia group showed longer first-pass gaze duration, as well as higher percentage of total fixations and total duration toward threatening scenes in relation to the non-social ones, compared to controls. Therefore, an attentional bias toward threatening scenes in schizophrenia was found in the attentional maintenance and engagement, but not in the initial orienting of attention. Of note, the threat-related attentional bias was not associated with positive symptoms of schizophrenia. These findings offer empirical support to affective-information processing models stating that threatening information may confer psychological vulnerability to develop schizophrenia. Moreover, the results can improve psychological treatments, such as attentional bias modification paradigms or cognitive-behavior interventions managing maladaptive schemas related to threat.

The BES1/BZR1-family transcription factor MpBES1 regulates cell division and differentiation in Marchantia polymorpha.

Brassinosteroids (BRs) play essential roles in growth and development in seed plants;1 disturbances in BR homeostasis lead to altered mitotic activity in meristems2,3 and organ boundaries4,5 and to changes in meristem determinacy.6 An intricate signaling cascade linking the perception of BRs at the plasma membrane to the regulation of master transcriptional regulators belonging to the BEH, for BES1 homologues, family7 has been described in great detail in model angiosperms. Homologs of these transcription factors are present in streptophyte algae and in land plant lineages where BR signaling or function is absent or has not yet been characterized. The genome of the bryophyte Marchantia polymorpha does not encode for BR receptors but includes one close ortholog of Arabidopsis thaliana BRI1-EMS-SUPPRESSOR 1 (AtBES1)8 and Arabidopsis thaliana BRASSINAZOLE-RESISTANT 1 (AtBZR1),9 MpBES1. Altered levels of MpBES1 severely compromised cell division and differentiation, resulting in stunted thalli that failed to differentiate adult tissues and reproductive organs. The transcriptome of Mpbes1 knockout plants revealed a significant overlap with homologous functions controlled by AtBES1 and AtBZR1, suggesting that members of this gene family share a subset of common targets. Indeed, MpBES1 behaved as a gain-of-function substitute of AtBES1/AtBZR1 when expressed in Arabidopsis, probably because it mediates conserved functions but evades the regulatory mechanisms that native counterparts are subject to. Our results show that this family of transcription factors plays an ancestral role in the control of cell division and differentiation in plants and that BR signaling likely co-opted this function and imposed additional regulatory checkpoints upon it.

Early detection of intensive care needs and mortality risk by use of five early warning scores in patients with traumatic injuries: An observational study.

OBJECTIVE: The purpose of this research was to evaluate the predictive capacity of five Early Warning Scores in relation to the clinical evolution of adult patients with different types of trauma. RESEARCH METHODOLOGY: We conducted a longitudinal, prospective, observational study, calculating the Early Warning Scores [Modified Early Warning Score (MEWS), National Early Warning Score 2 (NEWS-2), VitalPAC Early Warning Score (ViEWS), Modified Rapid Emergency Medicine Score (MREMS), and Rapid Acute Physiology Score (RAPS)] upon arrival of patients to the emergency department. SETTING: In total, 445 cases of traumatic injuries were included in the study. MAIN OUTCOME MEASURES: The predictive capacity was verified with the data on admission to intensive care units (ICU) and mortality at two, seven and 30 days. RESULTS: 201 patients were hospitalized and 244 were discharged after being attended in the emergency department. 91 cases (20.4%) required ICU care and 4.7% of patients died (21 patients) within two days, 6.5% (29 patients) within seven days and 9.7% (43 patients) within 30 days. The highest area under the curve for predicting the need for ICU care was obtained by the National Early Warning Score 2 and the VitalPAC Early Warning Score. For predicting mortality, the Modified Rapid Emergency Medicine Score obtained the best scores for two-day mortality, seven-day mortality and 30-day mortality. CONCLUSIONS: Every Early Warning Score analyzed in this study obtained good results in predicting adverse effects in adult patients with traumatic injuries, creating an opportunity for new clinical applications in the emergency department.

Manipulating feedback on schizophrenia: Evidence from a Posner task.

Individuals with schizophrenia show difficulties in achieving vital objectives. Abnormal behavioral and emotional responses to environmental feedback may be some of the psychological mechanisms underlying this lack of goal attainment in schizophrenia. The present study aims to assess how different types of feedback may affect performance in a computerized affective Posner task (non-monetary vs. monetary rewards; contingent vs. non-contingent feedback). The sample was composed of 32 patients with schizophrenia and 35 controls. Reaction times and error rates were the behavioral measurements. The emotional experience was assessed through self-reported affective scales. The results indicated that: ii) the performance with monetary rewards was better than with non-monetary ones in all participants, especially in patients with schizophrenia when higher attentional resources are required (invalid trials). Second, all participants demonstrated faster reaction times, but higher error rates, with non-contingent feedback (frustration condition). Significantly, the schizophrenia group only equaled the controls performance in the non-contingent condition with monetary rewards. Additionally, the higher the negative symptoms were in patients, the worse performance they had under frustration. Third, discrepancies between performance and self-report affect were found in patients. Specifically, after the induction of frustration, the patients reported feeling better and having no arousal changes. Therefore, the findings suggest that, in schizophrenia: i) non-monetary rewards are relatively less important; ii) monetary rewards lessen the negative effects of frustration, iii) discrepancies in self-reported affective scales suggest an unrealistic self-evaluation made under frustration. These findings shed light on the underlying mechanisms of the lack of goal attainment in schizophrenia.

Inmunonutrición del paciente quirúrgico en los procedimientos fast-track: revisión de la evidencia y algoritmo adaptado / Immunonutrition in fast-track surgical patients - Evidence review and adapted algorithm

El estrés quirúrgico predispone a los pacientes a la disfunción inmune y a un mayor riesgo de infección. Los pacientes quirúrgicos desnutridos presentan una mayor morbimortalidad posoperatoria, mayores tasas de reingreso y costes hospitalarios más elevados. En las guías de la ESPEN se asocia el uso de una fórmula inmunomoduladora a una reducción significativa de los problemas de la cicatrización de heridas, de los fallos de la sutura y de las complicaciones infecciosas y globales. Varios autores han sugerido que, dado que la mayoría de los ensayos clínicos que evalúan la eficacia de la inmunonutrición se han realizado en un entorno perioperatorio tradicional, sería interesante investigar su eficacia en un entorno más controlado, como en el protocolo ERAS (Enhanced Recovery after Surgery). El objetivo de este trabajo es: a) definir el papel que debe jugar la inmunonutrición en los protocolos ERAS sobre la base de la mejor evidencia científica; b) analizar las dificultades que siguen existiendo en la práctica clínica real para realizar el cribado del riesgo nutricional del paciente; c) proponer unos algoritmos adaptados a las características de nuestro entorno sobre el cribado, la valoración y el tratamiento nutricional del paciente quirúrgico en modalidad fast-track. (AU)

Surgical stress predisposes patients to have immune dysfunction and an increased risk of infection. Malnourished surgical patients have higher postoperative morbidity and mortality rates, higher readmission rates, and higher hospital costs. The use of an immunomodulatory formula is associated in the ESPEN guidelines with a reduction in wound healing problems, suture failure, and infectious and global complications. Several authors have suggested that, since most clinical trials evaluating the efficacy of immunonutrition have been carried out in a traditional perioperative setting, it would be interesting to investigate its efficacy in a more controlled setting, such as in the ERAS (Enhanced Recovery after Surgery) protocol. The objective of this work was: a) to define the role that immunonutrition should play in ERAS protocols based on the best scientific evidence available; b) to analyze the difficulties that continue to exist in real-life clinical practice to screen the nutritional risk of patients; c) to make a proposal of algorithms adapted to the characteristics of our environment regarding the screening, assessment, and nutritional treatment of surgical patients in fast-track surgery. (AU)

[de la evidencia y algoritmo adaptado Immunonutrition in fast-track surgical patients - Evidence review and adapted algorithm]. / Inmunonutrición del paciente quirúrgico en los procedimientos fast-track: revisión de la evidencia y algoritmo adaptado.

INTRODUCTION: Surgical stress predisposes patients to have immune dysfunction and an increased risk of infection. Malnourished surgical patients have higher postoperative morbidity and mortality rates, higher readmission rates, and higher hospital costs. The use of an immunomodulatory formula is associated in the ESPEN guidelines with a reduction in wound healing problems, suture failure, and infectious and global complications. Several authors have suggested that, since most clinical trials evaluating the efficacy of immunonutrition have been carried out in a traditional perioperative setting, it would be interesting to investigate its efficacy in a more controlled setting, such as in the ERAS (Enhanced Recovery after Surgery) protocol. The objective of this work was: a) to define the role that immunonutrition should play in ERAS protocols based on the best scientific evidence available; b) to analyze the difficulties that continue to exist in real-life clinical practice to screen the nutritional risk of patients; c) to make a proposal of algorithms adapted to the characteristics of our environment regarding the screening, assessment, and nutritional treatment of surgical patients in fast-track surgery.

INTRODUCCIÓN: El estrés quirúrgico predispone a los pacientes a la disfunción inmune y a un mayor riesgo de infección. Los pacientes quirúrgicos desnutridos presentan una mayor morbimortalidad posoperatoria, mayores tasas de reingreso y costes hospitalarios más elevados. En las guías de la ESPEN se asocia el uso de una fórmula inmunomoduladora a una reducción significativa de los problemas de la cicatrización de heridas, de los fallos de la sutura y de las complicaciones infecciosas y globales. Varios autores han sugerido que, dado que la mayoría de los ensayos clínicos que evalúan la eficacia de la inmunonutrición se han realizado en un entorno perioperatorio tradicional, sería interesante investigar su eficacia en un entorno más controlado, como en el protocolo ERAS (Enhanced Recovery after Surgery). El objetivo de este trabajo es: a) definir el papel que debe jugar la inmunonutrición en los protocolos ERAS sobre la base de la mejor evidencia científica; b) analizar las dificultades que siguen existiendo en la práctica clínica real para realizar el cribado del riesgo nutricional del paciente; c) proponer unos algoritmos adaptados a las características de nuestro entorno sobre el cribado, la valoración y el tratamiento nutricional del paciente quirúrgico en modalidad fast-track.

The Value of Prehospital Early Warning Scores to Predict in - Hospital Clinical Deterioration: A Multicenter, Observational Base-Ambulance Study.

OBJECTIVES: Early warning scores are clinical tools capable of identifying prehospital patients with high risk of deterioration. We sought here to contrast the validity of seven early warning scores in the prehospital setting and specifically, to evaluate the predictive value of each score to determine early deterioration-risk during the hospital stay, including mortality at one, two, three and seven- days since the index event. Methods: A prospective multicenter observational based-ambulance study of patients treated by six advanced life support emergency services and transferred to five Spanish hospitals between October 1, 2018 and December 31, 2019. We collected demographic, clinical, and laboratory variables. Seven risk score were constructed based on the analysis of prehospital variables associated with death within one, two, three and seven days since the index event. The area under the receiver operating characteristics was used to determine the discriminant validity of each early warning score. Results: A total of 3,273 participants with acute diseases were accurately linked. The median age was 69 years (IQR, 54-81 years), 1,348 (41.1%) were females. The overall mortality rate for patients in the study cohort ranged from 3.5% for first-day mortality (114 cases), to 7% for seven-day mortality (228 cases). The scores with the best performances for one-day mortality were Vitalpac Early Warning Score with an area under the receiver operating characteristic (AUROC) of 0.873 (95% CI: 0.81-0.9), for two-day mortality, Triage Early Warning Score with an AUROC of 0.868 (95% CI: 0.83-0.9), for three and seven-days mortality the Modified Rapid Emergency Medicine Score with an AUROC of 0.857 (0.82-0.89) and 0.833 (95% CI: 0.8-0.86). In general, there were no significant differences between the scores analyzed. Conclusions: All the analyzed scores have a good predictive capacity for early mortality, and no statistically significant differences between them were found. The National Early Warning Score 2, at the clinical level, has certain advantages. Early warning scores are clinical tools that can help in the complex decision-making processes during critical moments, so their use should be generalized in all emergency medical services.

Circulating microRNAs in Breast Milk and Their Potential Impact on the Infant.

MicroRNAs (MiRNAs) are small RNA molecules that can exert regulatory functions in gene expression. MiRNAs have been identified in diverse tissues and biological fluids, both in the context of health and disease. Breastfeeding has been widely recognized for its superior nutritional benefits; however, a number of bioactive compounds have been found to transcend these well-documented nutritional contributions. Breast milk was identified as a rich source of miRNAs. There has been increasing interest about their potential ability to transfer to the offspring as well as what their specific involvement is within the benefits of breast milk in the infant. In comparison to breast milk, formula milk lacks many of the benefits of breastfeeding, which is thought to be a result of the absence of some of these bioactive compounds. In recent years, the miRNA profile of breast milk has been widely studied, along with the possible transfer mechanisms throughout the infant's digestive tract and the role of miRNA-modulated genes and their potential protective and regulatory functions. Nonetheless, to date, the current evidence is not consistent, as many methodological limitations have been identified; hence, discrepancies exits about the biological functions of miRNAs. Further research is needed to provide thorough knowledge in this field.

Accuracy of prehospital point-of-care lactate in early in-hospital mortality.

BACKGROUND: Emergency medical services (EMS) routinely face complex scenarios where decisions should be taken with limited clinical information. The development of fast, reliable and easy to perform warning biomarkers could help in such decision-making processes. The present study aims at characterizing the validity of point-of-care lactate (pLA) during prehospital tasks for predicting in-hospital mortality within two days after the EMS assistance. MATERIALS AND METHODS: Prospective, multicentric, ambulance-based and controlled observational study without intervention, including six advanced life support and five hospitals. The pLA levels were recorded during EMS assistance of adult patients. The validity of pLA to determine the in-hospital mortality was assessed by the area under the curve (AUC) of the receiver operating curve (ROC). RESULTS: A total of 2997 patients were considered in the study, with a median of 69 years (IQR 54-81) and 41.4% of women. The median pLA value was 2.7 mmol/L (1.9-3.8) in survivors and 5.7 mmol/L (4.4-7.6) in nonsurvivors. The global discrimination level of pLA reached an AUC of 0.867, being 1.9 mmol/L and 4 mmol/L the cut-off point for low and high mortality. The discrimination value of pLA was not affected by sex, age or pathology. CONCLUSIONS: Our results highlight the clinical importance of prehospital pLA to determine the in-hospital risk of mortality. The incorporation of pLA into the EMS protocols could improve the early identification of risky patients, leading to a better care of such patients.

Accuracy of early warning scores for predicting serious adverse events in pre-hospital traumatic injury.

BACKGROUND: Traumatically injured patients are at higher risk of serious adverse events. Numerous physiological scoring systems are employed as diagnostic and/or prognostic tools. The objective of this study was to evaluate the scales most commonly used by emergency medical services for the early detection of prehospital serious adverse events. METHODS: Design. Preliminary longitudinal prospective observational study without intervention study in adults with prehospital traumatic injury. SETTING: The study was carried out in the public health system of Castile and León (Spain), from April 1, 2018 to October 31, 2019, involving seven advanced life support units and five hospitals. PARTICIPANTS: Traumatically injured patients over 18 years of age who were stabilized and transferred in advanced life support units to their referral hospital. MAIN OUTCOME MEASURES: Appearance of serious adverse events at the prehospital level at the scene or during the transfer to the emergency department. RESULTS: A total of 346 patients were included in the study. The median age was 50 years (IQR: 38-65). 32 cases (7.8%) presented serious adverse events at the prehospital level. Areas under the curve for the detection of serious adverse events were obtained with the Prehospital Index (0.979; 95% CI: 0.94-1.00) and National Early Warning Score 2 (0.956; 95% CI: 0.90-1.00); p <0.001 for all scores. The Prehospital Index had a positive probability coefficient of 78.4 (95% CI: 62.8-68.6) and the National Early Warning Score 2 obtained 52.9 (95% CI: 39.7-65.6). A comparison of the curves was not significant for any of the scores studied (p> 0.05). CONCLUSIONS: All scoring systems were able to detect prehospital serious adverse events early in traumatic injury; therefore, any of the scoring systems could be useful and represent an ideal tool for routine use by emergency medical services in cases of traumatic injury.