Same-day discharge after atrial fibrillation ablation under a nurse-coordinated standardized protocol.

AIMS: Same-day discharge (SDD) after atrial fibrillation (AF) ablation is an effective means to spare healthcare resources. However, safety remains a concern, and besides structural adaptations, SDD requires more efficient logistics and coordination. Therefore, in this study, we implement a streamlined, nurse-coordinated SDD programme following a standardized protocol. METHODS AND RESULTS: As a dedicated SDD coordinator, a nurse specialized in ambulatory cardiac interventions was in charge of the full SDD protocol, including eligibility, patient flow, in-hospital logistics, patient education, and discharge as well as early post-discharge follow-up by smartphone-based virtual visits. Patients planned for AF ablation were considered eligible if they had a left ventricular ejection fraction (LVEF) ≥35%, with basic support at home and accessibility of the hospital within 60 min also forming a part of the eligibility criteria. A total of 420 consecutive patients were screened by the SDD coordinator, of whom 331 were eligible for SDD. The reasons for exclusion were living remotely (29, 6.9%), lack of support at home (19, 4.5%), or LVEF <35% (17, 4.0%). Of the eligible patients, 300 (91%) were successfully discharged the same day. There were no major post-SDD complications. Rates of unplanned medical attention (19, 6.3%) and 30-day readmission (5, 1.6%) were extremely low and driven by femoral access-site complications. These were significantly reduced upon the introduction of compulsory ultrasound-guided punctures after the initial 150 SDD patients (P = 0.0145). Standardized SDD coordination resulted in efficient workflows and reduced the total workload of the medical staff. CONCLUSION: Same-day discharge after AF ablation following a nurse-coordinated standardized protocol is safe and efficient. The concept of ambulatory cardiac intervention nurses functioning as dedicated coordinators may be key in the future transition of hospitals to SDD. Ultrasound-guided femoral puncture virtually eliminated relevant femoral access-site complications in our cohort and should therefore be a prerequisite for SDD.

Accumulation of endogenous free radicals is required to induce titan-like cell formation in Cryptococcus neoformans.

IMPORTANCE: Cryptococcus neoformans is an excellent model to investigate fungal pathogenesis. This yeast can produce "titan cells," which are cells of an abnormally larger size that contribute to the persistence of the yeast in the host. In this work, we have used a new approach to characterize them by identifying drugs that inhibit this process. We have used a repurposing off-patent drug library, combined with an automatic method to image and analyze fungal cell size. In this way, we have identified many compounds that inhibit this transition. Interestingly, several compounds were antioxidants, allowing us to confirm that endogenous ROS and mitochondrial changes are important for titan cell formation. This work provides new evidence of the mechanisms required for titanization. Furthermore, the future characterization of the inhibitory mechanisms of the identified compounds by the scientific community will contribute to better understand the role of titan cells in virulence.

Global Emergence of Resistance to Fluconazole and Voriconazole in Candida parapsilosis in Tertiary Hospitals in Spain During the COVID-19 Pandemic.

Background: Candida parapsilosis is a frequent cause of candidemia worldwide. Its incidence is associated with the use of medical implants, such as central venous catheters or parenteral nutrition. This species has reduced susceptibility to echinocandins, and it is susceptible to polyenes and azoles. Multiple outbreaks caused by fluconazole-nonsusceptible strains have been reported recently. A similar trend has been observed among the C. parapsilosis isolates received in the last 2 years at the Spanish Mycology Reference Laboratory. Methods: Yeast were identified by molecular biology, and antifungal susceptibility testing was performed using the European Committee on Antimicrobial Susceptibility Testing protocol. The ERG11 gene was sequenced to identify resistance mechanisms, and strain typing was carried out by microsatellite analysis. Results: We examined the susceptibility profile of 1315 C. parapsilosis isolates available at our reference laboratory between 2000 and 2021, noticing an increase in the number of isolates with acquired resistance to fluconazole, and voriconazole has increased in at least 8 different Spanish hospitals in 2020-2021. From 121 recorded clones, 3 were identified as the most prevalent in Spain (clone 10 in Catalonia and clone 96 in Castilla-Leon and Madrid, whereas clone 67 was found in 2 geographically unrelated regions, Cantabria and the Balearic Islands). Conclusions: Our data suggest that concurrently with the coronavirus disease 2019 pandemic, a selection of fluconazole-resistant C. parapsilosis isolates has occurred in Spain, and the expansion of specific clones has been noted across centers. Further research is needed to determine the factors that underlie the successful expansion of these clones and their potential genetic relatedness.

The moderating role of physical fitness in the relationship between sugar-sweetened beverage consumption and adiposity in schoolchildren.

The mediating and moderating associations of cardiorespiratory fitness (CRF) and handgrip strength on the association between dietary patterns and several health outcomes have been previously studied. For instance, handgrip strength has been found as a moderator of the relationship between excess weight and cardiometabolic risk factors in young adults. Similarly, CRF has been shown as a mediator of the association between diet and obesity in children. However, to our knowledge, the role of CRF and handgrip strength on the association between sugar-sweetened beverage (SSB) consumption and adiposity is still unclear. The aim of this study was to determine whether CRF and handgrip strength moderate the association between SSB consumption and adiposity in a population-based sample of Spanish schoolchildren. This cross-sectional study involved 475 schoolchildren (52.0% girls), aged 8-12, from ten schools in Cuenca (Spain). Adiposity was determined as body fat (in kg), which was measured using a bioimpedance analysis system. Data on SSB consumption were gathered by using the Children's Eating Habits Questionnaire, which was completed by parents. The CRF level was determined by the 20-m Shuttle Run test and Nevill's curvilinear allometric model. Handgrip strength was determined using a digital dynamometer with adjustable grip. For each unit (in ml/kg/min) of CRF increased, the association between SSB consumption and adiposity was moderated (B = - 0.09, CI 95% - 0.14 to - 0.04). This significant moderation was also found for each 0.01 unit of increased normalized handgrip strength (B = - 0.07; CI 95% - 0.11 to - 0.02). Similarly, the Johnson-Neymann technique established three different regions. The first region shows that the association of SSB consumption on adiposity in participants who had levels of CRF < 43.4 ml/kg/min or handgrip strength < 0.34 was greater and statistically significant. The second region (43.4-57.4 ml/kg/min for CRF; 0.34-0.58 for normalized handgrip strength) depicted that the association between SSB consumption and adiposity was not statistically significant in those with a CRF level or normalized handgrip strength between the lower and upper thresholds. The third region was found at > 57.4 ml/kg/min (for CRF level) and > 0.58 (for normalized handgrip strength), indicating that the association between SSB consumption and adiposity was lower and statistically significant in children above these moderator values. Our results showed that certain levels of CRF and normalized handgrip strength moderate the association between SSB consumption and adiposity in a sample of Spanish schoolchildren. It might be possible that higher physical fitness level in childhood may contribute to reducing the association between SSB consumption and adiposity.

Inhibition of Candida glabrata Biofilm by Combined Effect of Dendritic Compounds and Amphotericin.

In the last decade, Candida glabrata has become an important emerging opportunistic pathogen not only because of the increase in nosocomial infections frequency but also because of its ability to form biofilms and its innate resistance to commercial antifungals. These characteristics make this pathogen a major problem in hospital settings, including problems regarding equipment, and in immunosuppressed patients, who are at high risk for candidemia. Therefore, there is an urgent need for the development of and search for new antifungal drugs. In this study, the efficacy of two dendritic wedges with 4-phenyl butyric acid (PBA) at the focal point and cationic charges on the surface ArCO2G2(SNMe3I)4 (1) and ArCO2G3(SNMe3I)8 (2) was studied against C. glabrata strain to inhibit the formation of biofilms and eliminate established biofilm. For this, MBIC (minimum biofilm inhibitory concentration), MBDC (minimum biofilm damaging concentrations), as well as MFCB (minimum fungicidal concentration in biofilm) and MBEC (minimum biofilm eradicating concentration) were determined. In addition, different combinations of dendrons and amphotericin B were tested to study possible synergistic effects. On the other hand, cytotoxicity studies were performed. C. glabrata cells and biofilm structure were visualized by confocal microscopy. ArCO2G2(SNMe3I)4 (1) and ArCO2G3(SNMe3I)8 (2) dendrons showed both an MBIC of 8 mg/L and a MBDC of 32 mg/L and 64 mg/L, respectively. These dendrons managed to eradicate the entirety of an established biofilm. In combination with the antifungal amphotericin, it was possible to prevent the generation of biofilms and eradicate established biofilms at lower concentrations than those required individually for each compound at these conditions.

The effectiveness of a high-intensity interval games intervention in schoolchildren: A cluster-randomized trial.

The aim of this study was to assess the effectiveness of a high-intensity interval training (HIIT) intervention based on playground games (MOVI-daFit!) on improvements in adiposity, physical fitness, and cardiometabolic risk factors in schoolchildren. A cluster-randomized controlled trial (RCT) was performed that included 562 schoolchildren (9-11 years) from 10 schools in Cuenca, Spain. The intervention consisted of four 60-min sessions per week in the school setting. Analyses were conducted on the intention-to-treat basis. Changes in physical fitness parameters (cardiorespiratory fitness: main outcome), body composition, blood pressure, and biochemical cardiometabolic risk parameters were analyzed using both mixed linear and logistic regression models, controlling for baseline covariates, Tanner stages, health dietary score index, body mass index, and cluster factor school. In boys, no significant differences in any outcome measure were noted except for the standing long jump test (10.13 cm; 95% CI 2.94 to 17.32; p = 0.006) between the intervention group (IG) and the control group (CG). Improvements in mean arterial pressure (-1.68 mmHg; 95% CI -3.28 to -0.08; p = 0.039), the triglyceride/HDL-c ratio (-0.36 mg/dl; 95% CI -0.59 to -0.13; p = 0.002), C-reactive protein (-0.23 mg/L; 95% CI -0.43 to -0.03), VO2 max (1.44 ml/kg/min; 95% CI 0.52 to 2.36, p = 0.002), 20-m shuttle run test (3.64 laps; 95% CI 0.51 to 6.78), and standing long jump test (7.04 cm; 95% CI 1.21 to 12.87; p = 0.018) were observed in girls in the IG compared with those in the CG. Body composition parameters did not change significantly in either boys or girls. Additionally, children with lower fitness levels obtained greater improvements than children with higher fitness levels. In conclusion, MOVI-daFit! may represent a good strategy for incorporating HIIT into playground games, although its implementation may need to be improved to extend the benefits to children and enhance its adherence.

A Cluster Mediation Analysis Confirms the Validity of the "Fat but Fit" Paradigm in Children's Cognitive Function and Academic Achievement.

OBJECTIVE: To evaluate the fat but fit conceptual model, testing whether this paradigm for body mass index (BMI) and maximum rate of oxygen consumption (VO2max) exists in schoolchildren and whether executive functions mediate the relationship between fat but fit categories and academic achievement. STUDY DESIGN: Cluster cross-sectional analyses of data from 554 children aged 9-11 from Cuenca, Spain. BMI, VO2max, core executive functions (inhibition, working memory, and cognitive flexibility) and academic achievement (language and mathematics). RESULTS: Cluster analysis of BMI and VO2max z-scores resulted in a 4-cluster solution that could be interpreted according to fat unfit, unfat unfit, fat fit, and unfat fit categories. ANCOVA models confirmed an increasing trend by cluster category in terms of VO2max levels and, conversely, a decreasing trend in terms of adiposity variables. These models also confirmed that children in the fat fit and unfat fit categories scored higher than their peers in the fat unfit and unfat unfit categories. Mediation analyses using fat but fit clusters as multicategory independent variable, executive functions as mediators, and academic achievement as outcome variable showed that the positive association between the BMI-VO2max clusters and academic achievement was mediated by inhibition levels in fat fit and unfat fit individuals, by working memory levels only in those classified as fat fit, and by cognitive flexibility only in unfat fit individuals. CONCLUSIONS: This study confirms the validity of the 4-cluster conceptual model regarding BMI and VO2max and reinforces the predictive validity, proving that fitness levels are able to counteract the detrimental effect of obesity on academic achievement.

Monitoring gestational weight gain and prepregnancy BMI using the 2009 IOM guidelines in the global population: a systematic review and meta-analysis.

BACKGROUND: Previous studies have reported a high prevalence of excessive gestational weight gain (GWG) in women with prepregnancy BMI classified as overweight and obese. However, the joint evidence regarding GWG and prepregnancy BMI in the worldwide population has not been synthesized. Thus, this systematic review and meta-analysis aimed to estimate global and regional mean GWG and the prevalence of GWG above, within and below 2009 Institute of Medicine (IOM) guidelines. Second, we aimed to estimate global and regional prepregnancy BMI and the prevalence of BMI categories according to World Health Organization (WHO) classification. METHODS: We searched Medline, Embase, the Cochrane Library and Web of Science to identify observational studies until 9 May 2018. We included studies published from 2009 that used 2009 IOM guidelines, reporting data from women in general population with singleton pregnancies. The 2009 IOM categories for GWG and the WHO categories for prepregnancy BMI were used. DerSimonian and Laird random effects methods were used to estimate the pooled and their respective 95% confidence intervals (95% CIs) of the mean and by category rates of GWG and prepregnancy BMI, calculated by global and regions. RESULTS: Sixty-three published studies from 29 countries with a total sample size of 1,416,915 women were included. The global prevalence of GWG above and below the 2009 IOM guidelines, was 27.8% (95% CI; 26.5, 29.1) and 39.4% (95% CI; 37.1, 41.7), respectively. Furthermore, meta-regression analyses showed that the mean GWG and the prevalence of GWG above guidelines have increased. The global prevalence of overweight and obesity, was 23.0% (95% CI; 22.3, 23.7) and 16.3% (95% CI; 15.4, 17.4), respectively. The highest mean GWG and prepregnancy BMI were in North America and the lowest were in Asia. CONCLUSIONS: Considering the high prevalence of GWG above the 2009 IOM guidelines and women with overweight/obesity and their continuously increasing trend in most regions, clinicians should recommend lifestyle interventions to improve women's weight during reproductive age. Due to regional variability, these interventions should be adapted to each cultural context. TRIAL REGISTRATION: Prospectively registered with PROSPERO ( CRD42018093562 ).

Obesity and thinness prevalence trends in Spanish schoolchildren: are they two convergent epidemics?

BACKGROUND: The objective of this study was to analyse the secular trends in body composition variables and weight status among Spanish schoolchildren from 1992 to 2017, and to examine the persistence in the same weight status category from 2013 to 2017 of the birth cohort in 2007-08. METHODS: The data for the prevalence/trend analysis were taken from cross-sectional analyses conducted in 1992 (n = 308), 1996 (n = 307), 1998 (n = 275), 2004 (n = 1119), 2010 (n = 912), 2013 (n = 352) and 2017 (n = 275) using similar procedure methods among schoolchildren (aged 4-6 y and 8-11 years) from 22 public schools in the province of Cuenca, Spain. The data for the longitudinal analysis were obtained from cross-sectional analyses of measurements gathered in 2013 and 2017 in the same cohort of children (n = 275) born in 2007 and 2008. Weight, height, body fat percentage (by electronic bioimpedance) and waist circumference were measured by trained personnel. Weight status was defined according to the BMI cut-offs proposed by the International obesity task force (IOTF) criteria. RESULTS: In schoolchildren, the overall prevalence of thinness increased from 5.9% in 1992 to 14.5% in 2017, P < 0.001. Whereas, the overall prevalence of obesity/overweight remained relatively steady between the same time period (from 25.2% to 26.9%), P = 0.599. In relation to the longitudinal analyses, we observed that 70.9% of schoolchildren in 2017 remained in the same weight status category as in 2013. CONCLUSIONS: The child obesity epidemic in Spain has remained relatively stable over the last two decades. However, the prevalence of thinness shows a worrying upward trend.

Adherence to the Mediterranean Diet and Its Association with Body Composition and Physical Fitness in Spanish University Students.

The aims of this study were to assess the association of adherence to the Mediterranean diet (MD) with physical fitness and body composition in Spanish university students and to determine the ability to predict the MD adherence of each Mediterranean Diet Adherence Screener (MEDAS) item. A cross-sectional study was performed involving 310 first-year university students. Adherence to the MD was evaluated with MEDAS-14 items. Anthropometric variables, body composition, and physical fitness were assessed. Muscle strength was determined based on handgrip strength and the standing long jump test. Cardiorespiratory fitness (CRF) was measured using the Course-Navette test. Only 24% of the university students had good adherence to the MD. The ANCOVA models showed a significant difference between participants with high adherence to the MD and those with medium and low adherence in CRF (p = 0.017) and dynamometry (p = 0.005). Logistic binary regression showed that consuming >2 vegetables/day (OR = 20.1; CI: 10.1-30.1; p < 0.001), using olive oil (OR = 10.6; CI: 1.4-19.8; p = 0.021), consuming <3 commercial sweets/week (OR = 10.1; IC: 5.1-19.7; p < 0.001), and consuming ≥3 fruits/day (OR = 8.8; CI: 4.9-15.7; p < 0.001) were the items most associated with high adherence to the MD. In conclusion, a high level of adherence to the MD is associated with high-level muscular fitness and CRF in Spanish university students.

Embolia pulmonar en los pacientes muy ancianos. Un reto diagnóstico / Pulmonary embolism in very elderly patients. A diagnostic challenge

Introducción: El diagnóstico de embolia pulmonar supone un reto. Su presentación comparte manifestaciones clínicas con otras entidades. En los pacientes muy ancianos (MA≥80 años) el reto aumenta por la comorbilidad asociada comparando con controles más jóvenes (CO<80 años). Objetivo: Describir la incidencia de embolia pulmonar en pacientes muy ancianos en nuestro medio, identificar diferencias en manifestaciones clínicas, comorbilidad y parámetros analíticos entre subgrupos (MA/CO). Método: Estudio casos-controles de base hospitalaria. Revisión de las embolias pulmonares diagnosticadas, en nuestro centro, mediante angiografía pulmonar por tomografía computarizada entre 2013 y 2016. Resultados: Incluimos 413 pacientes (124 MA). La edad mediana fue 72 años [RIQ 58-81]. La tríada típica de presentación fue poco frecuente y no mostró diferencias entre subgrupos. Los principales síntomas de presentación fueron: disnea (73,4% MA vs. 63,7% CO; p=0,055), dolor torácico (26,6% vs. 39,5%; p=0,013) y tos/hemoptisis (31,1% vs. 18,9%; p=0,021). Presentaron mayor comorbilidad los MA (4,88+/-2,55 vs. 2,89+/-2,85; p=0,0001). Conclusión: Un 30% de las embolias pulmonares fueron en MA. La forma de presentación típica fue infrecuente. Se detectaron diferencias significativas en síntomas individuales, comorbilidad y parámetros de laboratorio en comparación con pacientes más jóvenes

Background: Diagnosing pulmonary embolisms can be challenging, given that its presentation shares clinical manifestations with other conditions. For patients 80 years of age or older, the healthcare challenge increases due to associated comorbidity when compared with younger patients (<80 years). Objective: The aim of our study was to report the incidence of pulmonary embolism in elderly patients in our setting and identify differences in the clinical manifestations, comorbidity and laboratory parameters between these 2 groups of patients. Method: We conducted a hospital-based, case-control study to review the pulmonary embolisms diagnosed in our centre using computed tomography pulmonary angiography between 2013 and 2016. Results: The study included 413 patients, 124 of whom were 80 years of age or older, with a median age of 72 years (IQR, 58-81). The typical presentation triad was uncommon and showed no differences between subgroups. The main symptoms presented by these groups were dyspnoea (73.4% vs. 63.7% for the elderly and younger groups, respectively; P=.055), chest pain (26.6% vs. 39.5%; P=.013) and cough/haemoptysis (31.1% vs. 18.9%; P=.021). The elderly group had more comorbidity (4.88+/-2.55 vs. 2.89+/-2.85; P=.0001). Conclusion: Thirty percent of the pulmonary embolisms occurred in the elderly group. The typical presentation form was uncommon. We detected significant differences in individual symptoms, comorbidity and laboratory parameters compared with the younger patients

Prevalence of Overweight and Obesity among European Preschool Children: A Systematic Review and Meta-Regression by Food Group Consumption.

The aim of this review was to estimate the prevalence of overweight and obesity among European children aged 2-7 years from 2006 to 2016 and to analyze these estimations by gender, country, and food group consumption. We searched CINAHL, EMBASE, MEDLINE, and Web of Science databases from their inception until 27 February 2019 including cross-sectional studies and baseline measurements of cohort studies with overweight and obesity defined according to the International Obesity Task Force criteria. Both the inverse-variance fixed-effects method and the DerSimonian and Laird random effects method were used to determinate pooled prevalence estimates and their respective 95% confidence intervals (CIs). A total of 32 studies (n = 197,755 children) with data from 27 European countries were included. Overall, the pooled prevalence estimates of overweight/obesity in European children (aged 2-7 years) during the period 2006-2016 was 17.9% (95% CI: 15.8-20.0), and the pooled prevalence estimate of obesity was 5.3% (95% CI: 4.5-6.1). Southern European countries showed the highest prevalence of excess weight. Additional measures to address the obesity epidemic in early life should be established, especially in European countries where the prevalence of excess weight is very high.

Rationale and methods of the MOVI-da10! Study -a cluster-randomized controlled trial of the impact of classroom-based physical activity programs on children's adiposity, cognition and motor competence.

BACKGROUND: Although physical activity (PA) integrated in schools' classrooms have shown a positive effect on children's behaviors, its effectiveness on cognitive functions, PA levels and other health variables remains unclear. This article outlines the rationale and methods of two classroom-based PA interventions (MOVI-da10!) on improving adiposity, executive function and motor competence in preschool children. METHODS: A three-arm cluster-randomized controlled trial (RCT) was carried out including eight schools (rural and urban areas) from Cuenca province, Spain. The schools were allocated to one of three groups: MOVI-da10-Enriched! intervention (n = 3), MOVI-da10-Standard! intervention, (n = 2), and the control group (n = 3). Around 900 children aged 4 to 6 years old were assesed at baseline (September 2017) and at the end (June 2018) of the intervention. The primary outcomes were changes in body fat by bioimpedance, executive function and motor competence. During a school year (from October 2017 to May 2018), children belonging to the MOVI-da10-Enriched! group performed enriched PA integrated into the academic curriculum including two active breaks lasting 10 min, 5 days/week. The children belonging to the MOVI-da10-Standard! group performed PA breaks (with low cognitive demand, where curricular contents were not reinforced) including two active breaks lasting 10 min, 5 days/week. In the control group, regular PA continued. DISCUSSION: To our knowledge, MOVI-da10! is the first RCT to examine the effectiveness of two programs (enriched PA integrated into the academic curriculum and PA breaks only) versus a control group on improving adiposity, executive function and motor competence in preschool children. TRIAL REGISTRATION: NCT03236363 (clinicaltrials.gov), 31st July 2017.

Pulmonary embolism in very elderly patients. A diagnostic challenge. / Embolia pulmonar en los pacientes muy ancianos. Un reto diagnóstico.

BACKGROUND: Diagnosing pulmonary embolisms can be challenging, given that its presentation shares clinical manifestations with other conditions. For patients 80 years of age or older, the healthcare challenge increases due to associated comorbidity when compared with younger patients (<80 years). OBJECTIVE: The aim of our study was to report the incidence of pulmonary embolism in elderly patients in our setting and identify differences in the clinical manifestations, comorbidity and laboratory parameters between these 2 groups of patients. METHOD: We conducted a hospital-based, case-control study to review the pulmonary embolisms diagnosed in our centre using computed tomography pulmonary angiography between 2013 and 2016. RESULTS: The study included 413 patients, 124 of whom were 80 years of age or older, with a median age of 72 years (IQR, 58-81). The typical presentation triad was uncommon and showed no differences between subgroups. The main symptoms presented by these groups were dyspnoea (73.4% vs. 63.7% for the elderly and younger groups, respectively; P=.055), chest pain (26.6% vs. 39.5%; P=.013) and cough/haemoptysis (31.1% vs. 18.9%; P=.021). The elderly group had more comorbidity (4.88±2.55 vs. 2.89±2.85; P=.0001). CONCLUSION: Thirty percent of the pulmonary embolisms occurred in the elderly group. The typical presentation form was uncommon. We detected significant differences in individual symptoms, comorbidity and laboratory parameters compared with the younger patients.

Skin Autofluorescence-Indicated Advanced Glycation End Products as Predictors of Cardiovascular and All-Cause Mortality in High-Risk Subjects: A Systematic Review and Meta-analysis.

Background Chronic deposits of advanced glycation end products produced by enzymatic glycation have been suggested as predictors of atherosclerotic-related disorders. This study aimed to estimate the relationship between advanced glycation end products indicated by skin autofluorescence levels and the risk of cardiovascular and all-cause mortality based on data from observational studies. Methods and Results We systematically searched Medline, Embase, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and the Web of Science databases from their inceptions until November 2017 for observational studies addressing the association of advanced glycation end products by skin autofluorescence levels with cardiovascular and all-cause mortality. The DerSimonian and Laird random-effects method was used to compute pooled estimates of hazard ratios and their respective 95% confidence intervals for the risk of cardiovascular and all-cause mortality associated with levels of advanced glycation end products by skin autofluorescence. Ten published studies were included in the systematic review and meta-analysis. Higher skin autofluorescence levels were significantly associated with a higher pooled risk estimate for cardiovascular mortality (hazard ratio: 2.06; 95% confidence interval, 1.58-2.67), which might not be important to moderate heterogeneity (I2=34.7%; P=0.163), and for all-cause mortality (hazard ratio: 1.91; 95% confidence interval, 1.42-2.56) with substantial heterogeneity (I2=60.8%; P=0.0.18). Conclusions Our data suggest that skin autofluorescence levels could be considered predictors of all-cause mortality and cardiovascular mortality in patients at high and very high risk.

Cardiorespiratory Fitness as a Mediator of the Influence of Diet on Obesity in Children.

The association between diet and obesity has been widely studied and it continues to be controversial; however, the extent to which cardiorespiratory fitness (CRF) acts as a confounder or mediator in this relation has not been analyzed. The aim of this study is to examine if the relation between diet and obesity is mediated by CRF. In this cross-sectional study, fat mass (by electronic bioimpedance) was measured in 320 schoolchildren, aged 9-11 years. Diet was measured through two computerised 24-h dietary recalls and CRF was assessed by the 20-m shuttle run test. Simple mediation analyses were fitted. CRF acts as a partial mediator in the negative relationship between dietary factors (energy intake/weight, carbohydrate intake/weight, protein intake/weight, and fat intake/weight) and fat mass. The percentage of mediation ranged from 24.3 to 33.2%. Thus, Spanish schoolchildren with higher levels of energy and macronutrients intake had lower adiposity levels, especially when they had good levels of CRF.

Simultaneous inter-arm and inter-leg systolic blood pressure differences to diagnose peripheral artery disease: a diagnostic accuracy study.

PURPOSE: Inter-arm systolic blood pressure differences (IASBPD) and inter-leg systolic blood pressure differences (ILSBPD) have arisen as potential tools to detect peripheral artery disease (PAD) and individuals at high cardiovascular risk. This study aims to evaluate the diagnostic accuracy of IASBPD and ILSBPD to detect PAD, and whether IASBPD or ILSBPD improves diagnostic accuracy of the oscillometric ankle-brachial index (ABI). MATERIALS AND METHODS: In this prospective study, eligible for inclusion were consecutive adults, with at least one of the following cardiovascular risk factors: diabetes, dyslipidemia, hypertension, smoking habit or age ≥65. IASBPD, ILSBPD and ankle-brachial index (ABI) were measured in all participants through four-limb simultaneous oscillometric measurements and compared with Doppler ABI (reference test, positive cut-off: ≤ 0.9). RESULTS: Of 171 subjects included, PAD was confirmed in 23 and excluded in 148. Thirteen and 38 subjects had IASBPD and ILSBPD ≥10 mmHg, respectively. Pearson correlation with Doppler ABI of IASBPD and ILSBPD was 0.073 (P = .343) and -0.628 (P < .001), respectively. Diagnostic accuracy of an ILSBPD ≥10 mmHg to detect PAD was: sensitivity = 69.6% (95%CI = 48.6-90.5), specificity = 85.1% (79.1-91.2), diagnostic odds ratio (dOR) = 13.1 (4.8-35.5) and area under ROC curve (AUC) = 0.765 (0.616-0.915). IASBPD had an AUC = 0.532 (0.394-0.669), and oscillometric ABI had an AUC = 0.977 (0.950-1.000). The addition of ILSBPD to oscillometric ABI reduced dOR from 174.0 (38.3-789.9) to 34.4 (9.5-125.1). Similarly, the addition of IASBPD reduced dOR to 49.3 (14.6-167.0). CONCLUSIONS: In a Primary Care population with ≥1 cardiovascular risk factors, ILSBPD showed acceptable diagnostic accuracy for PAD, whilst IASBPD accuracy was negligible. However, the combination of ILSBPD (or IASBPD) with oscillometric ABI did not improve the ability to detect PAD. Thus, oscillometer ABI seems to be preferable to detect PAD and individuals at high cardiovascular risk. ILSBPD could be uniquely recommended for the diagnosis of PAD when blood pressure measurements in upper limbs are not possible.