Effect of inulin on breath hydrogen, postprandial glycemia, gut hormone release, and appetite perception in RYGB patients: a prospective, randomized, cross-over pilot study.

BACKGROUND AND OBJECTIVE: Large intestinal fermentation of dietary fiber may control meal-related glycemia and appetite via the production of short-chain fatty acids (SCFA) and the secretion of glucagon-like peptide-1 (GLP-1) and peptide YY (PYY). We investigated whether this mechanism contributes to the efficacy of the Roux-en-Y gastric bypass (RYGB) by assessing the effect of oligofructose-enriched inulin (inulin) vs. maltodextrin (MDX) on breath hydrogen (a marker of intestinal fermentation), plasma SCFAs, gut hormones, insulin and blood glucose concentrations as well as appetite in RYGB patients. METHOD: Eight RYGB patients were studied on two occasions before and ~8 months after surgery using a cross-over design. Each patient received 300 ml orange juice containing 25 g inulin or an equicaloric load of 15.5 g MDX after an overnight fast followed by a fixed portion snack served 3 h postprandially. Blood samples were collected over 5 h and breath hydrogen measured as well as appetite assessed using visual analog scales. RESULTS: Surgery increased postprandial secretion of GLP-1 and PYY (P ≤ 0.05); lowered blood glucose and plasma insulin increments (P ≤ 0.05) and reduced appetite ratings in response to both inulin and MDX. The effect of inulin on breath hydrogen was accelerated after surgery with an increase that was earlier in onset (2.5 h vs. 3 h, P ≤ 0.05), but less pronounced in magnitude. There was, however, no effect of inulin on plasma SCFAs or plasma GLP-1 and PYY after the snack at 3 h, neither before nor after surgery. Interestingly, inulin appeared to further potentiate the early-phase glucose-lowering and second-meal (3-5 h) appetite-suppressive effect of surgery with the latter showing a strong correlation with early-phase breath hydrogen concentrations. CONCLUSION: RYGB surgery accelerates large intestinal fermentation of inulin, however, without measurable effects on plasma SCFAs or plasma GLP-1 and PYY. The glucose-lowering and appetite-suppressive effects of surgery appear to be potentiated with inulin.

Click nanosponge - A novel amine-rich ß-cyclodextrin-based crosslinked polymer for heterogeneous catalysis.

Cyclodextrin-based nanosponges are promising materials for heterogeneous catalysis due to their inherent synthetic versatility, tunable porosity and nontoxicity. In this work, a primary amine-rich ß-cyclodextrin nanosponge was synthesized via click imine condensation reaction between 1,6-hexamethylamine-functionalized ß-cyclodextrin (CDAM) and glutaraldehyde (GLT) to afford CDGLAM, in mild conditions. The crosslinked polymer exhibited a BET surface area of 36.39 m2 g-1, an average pore diameter of 3.09 nm (as assessed by the BJH method), and thermal stability up to 253 °C. CDGLAM was tested as heterogeneous catalyst for the metal-free Henry and Knoevenagel reactions, between aromatic aldehydes and nitromethane or ethyl cyanoacetate, respectively, affording the products in moderate to very high yields. These results show the ease of preparation of ß-CD-based nanosponges from a green chemistry perspective, as well as their potential for future use in catalytic systems.

MamoRef: an optical mammography device using whole-field CW diffuse reflectance. Presentation, validation and preliminary clinical results.

Objective.MamoRef is an mammography device that uses near-infrared light, designed to provide clinically relevant information for the screening of diseases of the breast. Using low power continuous wave lasers and a high sensitivity CCD (Charge-coupled device) that captures a diffusely reflected image of the tissue, MamoRef results in a versatile diagnostic tool that aims to fulfill a complementary role in the diagnosis of breast cancer providing information about the relative hemoglobin concentrations as well as oxygen saturation.Approach.We present the design and development of an initial prototype of MamoRef. To ensure its effectiveness, we conducted validation tests on both the theoretical basis of the reconstruction algorithm and the hardware design. Furthermore, we initiated a clinical feasibility study involving patients diagnosed with breast disease, thus evaluating the practical application and potential benefits of MamoRef in a real-world setting.Main results.Our study demonstrates the effectiveness of the reconstruction algorithm in recovering relative concentration differences among various chromophores, as confirmed by Monte Carlo simulations. These simulations show that the recovered data correlates well with the ground truth, with SSIMs of 0.8 or more. Additionally, the phantom experiments validate the hardware implementation. The initial clinical findings exhibit highly promising outcomes regarding MamoRef's ability to differentiate between lesions.Significance.MamoRef aims to be an advancement in the field of breast pathology screening and diagnostics, providing complementary information to standard diagnostic techniques. One of its main advantages is the ability of determining oxy/deoxyhemoglobin concentrations and oxygen saturation; this constitutes valuable complementary information to standard diagnostic techniques. Besides, MamoRef is a portable and relatively inexpensive device, intended to be not only used in specific medical imaging facilities. Finally, its use does not require external compression of the breast. The findings of this study underscore the potential of MamoRef in fulfilling this crucial role.

Mapping healthy planning frameworks.

AIMS: The aim of this research was to map available healthy planning frameworks to discover the range, composition, design, and implementation of healthy planning frameworks. METHODS: A systematic scoping review with date, location, and usability limitations was augmented by a grey literature search. Data were extracted on key details, design, outcomes considered, and implementation features of the final 61 frameworks. RESULTS: Data extracted indicated that most frameworks tend to focus on one element of the built environment, with active mobility, active environments, and transport being the most prevalent ones (34%). Most frameworks (40) stated their intended outcomes on health in general terms, rather than targeting specific health outcomes. Very few frameworks (12%) were aimed at the public, and only 11% of frameworks included an evaluation. CONCLUSIONS: While there are a wide variety and number of frameworks available in the field of healthy urban planning, they are generally siloed, focusing on highly specific individual urban determinants, and rarely consider health outcomes in detail. There is significantly less provision available for citizen and community use. Frameworks tend to offer limited updating mechanisms and very rarely include ongoing evaluation processes, making their success difficult to assess.

Reconstruction of light absorption changes in the human head using analytically computed photon partial pathlengths in layered media.

Functional near infrared spectroscopy has been used in recent decades to sense and quantify changes in hemoglobin concentrations in the human brain. This noninvasive technique can deliver useful information concerning brain cortex activation associated with different motor/cognitive tasks or external stimuli. This is usually accomplished by considering the human head as a homogeneous medium; however, this approach does not explicitly take into account the detailed layered structure of the head, and thus, extracerebral signals can mask those arising at the cortex level. This work improves this situation by considering layered models of the human head during reconstruction of the absorption changes in layered media. To this end, analytically calculated mean partial pathlengths of photons are used, which guarantees fast and simple implementation in real-time applications. Results obtained from synthetic data generated by Monte Carlo simulations in two- and four-layered turbid media suggest that a layered description of the human head greatly outperforms typical homogeneous reconstructions, with errors, in the first case, bounded up to ∼20% maximum, while in the second case, the error is usually larger than 75%. Experimental measurements on dynamic phantoms support this conclusion.

Therapeutic yoga reduces pro-tumorigenic cytokines in cancer survivors.

INTRODUCTION: Chronic inflammation can remain many years after the completion of cancer treatment and is associated with cancer recurrence. The purpose of this study was to examine how a 16-week therapeutic yoga program (TYP) modulates the cytokine profile in heterogeneous cancer survivors. METHODS: Eligible participants were 18 years of age or older and clinically diagnosed with cancer. Consenting participants were asked to attend three, 75-min sessions weekly of TYP with meditation. Seventeen patients provided blood samples at baseline and end of study. Eight cytokines (interferon (IFN)-γ; interleukin (IL)-1b, IL-1ra, IL-4, IL-6, IL-8, IL-10; and tumor necrosis factor (TNF)-α), three receptors (sIL-6R, sTNFRI, sTNFRII), and C-reactive protein (CRP) were quantified. RESULTS: Patients were 59.6 ± 7.3 years old; over half (56%) were overweight or obese BMI ≥ 25 kg/m2); majority were female (71%) and breast cancer survivors (65%), of which 44% were Hispanic. Marked reductions were observed in all cytokines except IL-4, with significant reductions (p < 0.05) found in IL-1b (- 13%) and IL-1ra (- 13%). No significant changes were observed in soluble cytokine receptors or CRP. CONCLUSIONS: TYP led to significant reduction in circulating cytokines associated with chronic inflammation in a heterogeneous sample of cancer survivors.

ß-Ketoenamine Covalent Organic Frameworks-Effects of Functionalization on Pollutant Adsorption.

Water pollution due to global economic activity is one of the greatest environmental concerns, and many efforts are currently being made toward developing materials capable of selectively and efficiently removing pollutants and contaminants. A series of ß-ketoenamine covalent organic frameworks (COFs) have been synthesized, by reacting 1,3,5-triformylphloroglucinol (TFP) with different C2-functionalized and nonfunctionalized diamines, in order to evaluate the influence of wall functionalization and pore size on the adsorption capacity toward dye and heavy metal pollutants. The obtained COFs were characterized by different techniques. The adsorption of methylene blue (MB), which was used as a model for the adsorption of pharmaceuticals and dyes, was initially evaluated. Adsorption studies showed that -NO2 and -SO3H functional groups were favorable for MB adsorption, with TpBd(SO3H)2-COF [100%], prepared between TFP and 4,4'-diamine- [1,1'-biphenyl]-2,2'-disulfonic acid, achieving the highest adsorption capacity (166 ± 13 mg g-1). The adsorption of anionic pollutants was less effective and decreased, in general, with the increase in -SO3H and -NO2 group content. The effect of ionic interactions on the COF performance was further assessed by carrying out adsorption experiments involving metal ions. Isotherms showed that nonfunctionalized and functionalized COFs were better described by the Langmuir and Freundlich sorption models, respectively, confirming the influence of functionalization on surface heterogeneity. Sorption kinetics experiments were better adjusted according to a second-order rate equation, confirming the existence of surface chemical interactions in the adsorption process. These results confirm the influence of selective COF functionalization on adsorption processes and the role of functional groups on the adsorption selectivity, thus clearly demonstrating the potential of this new class of materials in the efficient and selective capture and removal of pollutants in aqueous solutions.

Anthropomorphic Polydimethylsiloxane silicone-based phantom for Diffuse Optical Imaging.

This work presents a method for constructing phantoms suitable for diffuse optical mammography. They are based on Polydimethylsiloxane silicones, with the characteristic of being anthropomorphic, and having similar mechanical and optical properties as a real breast. These phantoms are useful for testing the performance of diffuse optical imaging devices in the near infrared, both in transmittance and reflectance geometries, since they can be constructed containing inclusions, to simulate breast tumors. An alternative component to be used as scattering agent, that is easier to handle than traditional scattering agents, is also studied. The optical properties of the phantoms were tested varying the concentration of scattering and absorbing agents, while their mechanical properties were modified by adding a silicone fluid to the basic mixture. Finally, the phantoms were tested by Diffuse Optical Imaging experiments, and these images were compared to the ones obtained by conventional ultrasound techniques. Results show that the constructed anthropomorphic phantoms properly reproduce the optical and mechanical characteristics of human breasts, and are suitable to be used in Diffuse Optical Imaging.

Optimal policies for mitigating pandemic costs: a tutorial model.

There have been a number of pharmaceutical and non-pharmaceutical interventions associated with COVID-19 over the past two years. Various non-pharmaceutical interventions were proposed and implemented to control the spread of the COVID-19 pandemic. Most common of these were partial and complete lockdowns that were used in an attempt to minimize the costs associated with mortality, economic losses and social factors, while being subject to constraints such as finite hospital capacity. Here, we use a minimal model posed in terms of optimal control theory to understand the costs and benefits of such strategies. This allows us to determine top-down policies for how to restrict social contact rates given an age-structured model for the dynamics of the disease. Depending on the relative weights allocated to mortality and socioeconomic losses, we see that the optimal strategies range from long-term social-distancing only for the most vulnerable, partial lockdown to ensure not over-running hospitals, and alternating-shifts, all of which lead to significant reduction in mortality and/or socioeconomic losses. Crucially, commonly used strategies that involve long periods of broad lockdown are almost never optimal, as they are highly unstable to reopening and entail high socioeconomic costs. Using parameter estimates from data available for Germany and the USA early in the pandemic, we quantify these policies and use sensitivity analysis in the relevant model parameters and initial conditions to determine the range of robustness of our policies. Finally we also discuss how bottom-up behavioral changes affect the dynamics of the pandemic and show how they can work in tandem with top-down control policies to mitigate pandemic costs even more effectively.

Prevalence of Intracranial Aneurysms in Hereditary Hemorrhagic Telangiectasia: Report from a Single Reference Center.

BACKGROUND AND PURPOSE: Neurologic manifestations in hereditary hemorrhagic telangiectasia include an increased incidence of brain abscesses and ischemic strokes due to paradoxic embolization in addition to a wide spectrum of symptoms and complications due to typical brain vascular malformations. Intracranial aneurysms are not part of this brain vascular malformation spectrum. The aim of this study was to determine their prevalence in patients with hereditary hemorrhagic telangiectasia. MATERIALS AND METHODS: This was a single-center, retrospective study. Adult patients from the institutional Hereditary Hemorrhagic Telangiectasia registry with a definitive diagnosis of hereditary hemorrhagic telangiectasia and an available report or angiographic imaging study were included and reviewed to determine the intracranial aneurysm prevalence. In addition, the morphologic characteristics of intracranial aneurysms and possible associated risk factors were collected. RESULTS: Two hundred twenty-eight patients were analyzed. Thirty-seven aneurysms in 33 patients (14.5%; 95% CI, 9.9%-19%) were found. The median diameter of intracranial aneurysms was 3.2 mm (interquartile range, 2.6-4.4 mm). No association between intracranial aneurysm and sex, age, or genetic background was noted. There were no subarachnoid hemorrhagic events due to intracranial aneurysm rupture. CONCLUSIONS: Due to the high prevalence of intracranial aneurysms in adult patients with hereditary hemorrhagic telangiectasia, further studies regarding bleeding risks and monitoring should be addressed.

Formación de referentes de salud en centros de cuidado infantil. Experiencia en Argentina / Training of health referents at child care centers. Experience in Argentina

El cuidado infantil de buena calidad atenúa los efectos de la adversidad social. La prevención en salud es parte de él. Se presenta un programa innovador de formación de referentes de salud en centros de cuidado infantil que atienden a poblaciones vulnerables en Buenos Aires, Argentina. Este consistió en una capacitación para personal de centros de cuidado infantil, seguido de la implementación, durante 4 meses, de un plan de mejoras elaborado por cada participante para su centro, con apoyo de consultoría permanente. Veintiséis participantes de 19centroscompletaron el programa. Se alcanzaron 35 de 49 objetivos planteados en los planes, incluida la certificación en reanimación cardiopulmonar, la capacitación del personal y las familias, el desarrollo de políticas del centro y la mejora de la gestión de recursos. Es posible mejorar los cuidados preventivos en los centros de cuidado infantil mediante una intervención sencilla y de bajo costo, incluso en condiciones desfavorables.

An adequate child care helps to mitigate the effects of social adversity. Health prevention is a part of it. This is an innovative training program for health referents in child care centers that cater to vulnerable populations in Buenos Aires, Argentina. It consisted in training child care center staff, followed by the implementation, over 4 months, of an improvement plan developed by each participant in their center, with ongoing advisory support. In total, 26 participants from 19 centers completed the program. In total, 35 out of 49 goals proposed in the plans were achieved, including the certification in cardiopulmonary resuscitation, staff and family training, development of center policies, and improved resource management. Preventive care offered in child care centers may be improved via a simple and inexpensive intervention, including in unfavorable conditions

Training of health referents at child care centers. Experience in Argentina. / Formación de referentes de salud en centros de cuidado infantil. Experiencia en Argentina.

An adequate child care helps to mitigate the effects of social adversity. Health prevention is a part of it. This is an innovative training program for health referents in child care centers that cater to vulnerable populations in Buenos Aires, Argentina. It consisted in training child care center staff, followed by the implementation, over 4 months, of an improvement plan developed by each participant in their center, with ongoing advisory support. In total, 26 participants from 19 centers completed the program. In total, 35 out of 49 goals proposed in the plans were achieved, including the certification in cardiopulmonary resuscitation, staff and family training, development of center policies, and improved resource management. Preventive care offered in child care centers may be improved via a simple and inexpensive intervention, including in unfavorable conditions.

El cuidado infantil de buena calidad atenúa los efectos de la adversidad social. La prevención en salud es parte de él. Se presenta un programa innovador de formación de referentes de salud en centros de cuidado infantil que atienden a poblaciones vulnerables en Buenos Aires, Argentina. Este consistió en una capacitación para personal de centros de cuidado infantil, seguido de la implementación, durante 4meses, de un plan de mejoras elaborado por cada participante para su centro, con apoyo de consultoría permanente. Veintiséis participantes de 19centros completaron el programa. Se alcanzaron 35 de 49 objetivos planteados en los planes, incluida la certificación en reanimación cardiopulmonar, la capacitación del personal y las familias, el desarrollo de políticas del centro y la mejora de la gestión de recursos. Es posible mejorar los cuidados preventivos en los centros de cuidado infantil mediante una intervención sencilla y de bajo costo, incluso en condiciones desfavorables.

A Behavioral Lifestyle Intervention to Improve Frailty in Overweight or Obese Older Adults with Type 2 Diabetes: A Feasibility Study.

BACKGROUND: Older adults with Type 2 diabetes (T2D) are more likely to be frail, which increases the risk for disability and mortality. OBJECTIVES: To determine the feasibility of a behavioral lifestyle intervention, enhanced with mobile health technology for self-monitoring of diet and activity, to improve frailty in overweight/obese older adults (≥65 years) diagnosed with T2D. DESIGN, SETTING, AND PARTICIPANTS: Single arm, 6-month study of a behavioral lifestyle intervention in 20 overweight/obese (BMI>25) older adults (≥ 65 years) with self-reported T2D diagnosis who owned a smartphone. A Fitbit tracker was provided to all participants for self-monitoring of diet and physical activity. Our primary outcome of feasibility was measured by session attendance, adherence to Fitbit usage to self-monitor diet and physical activity, and study retention. Secondary outcomes included the preliminary efficacy of the intervention on frailty, physical function, quality of life, and T2D-related outcomes. RESULTS: Eighteen participants completed the study. The mean age was 71.5 (SD ± 5.3) years, 56% were female, and half were Hispanic. At baseline, 13 (72%) were pre-frail, 4 (22%) were frail, and 1 (6%) were non-frail. At follow-up, frailty scores improved significantly from 1.61 ± 1.15 to 0.94 ± 0.94 (p=0.01) and bodyweight improved from 205.66 ± 45.52 lbs. to 198.33 ± 43.6 lbs. (p=<0.001). CONCLUSION: This study provides evidence for the feasibility of a behavioral lifestyle intervention in overweight/obese older adults with T2D and preliminary results support its potential efficacy in improving frailty score.

Caracterización y resultados de pacientes tratados con apremilast en la práctica clínica habitual española: resultados del estudio APPRECIATE / Characterization and Outcomes in Patients Treated With Apremilast in Routine Clinical Practice in Spain: Results From the APPRECIATE Study

Antecedentes y objetivos Es conveniente ampliar el conocimiento del manejo de apremilast en práctica clínica. El estudio APPRECIATE (NCT02740218) pretende describir las características de pacientes con psoriasis tratados con apremilast, evaluar sus perspectivas y las de sus dermatólogos, y los resultados obtenidos en la práctica clínica española. Métodos Estudio observacional, retrospectivo, transversal y multicéntrico en pacientes con psoriasis crónica en placas, a los que se visitó seis (± 1) meses después de iniciar apremilast. Los datos se obtuvieron de las historias clínicas y cuestionarios realizados por pacientes y dermatólogos. Resultados Se evaluaron 80 pacientes, al iniciar apremilast presentaban Psoriasis Area and Severity Index (PASI) medio (desviación estándar, DE) = 8,3 (5,3) y Dermatology Life Quality Index (DLQI) medio (DE) = 8,9 (6,6). A los seis meses, el 58,8% (n = 47) continuaba con apremilast (discontinuaciones: falta de eficacia [16,3%], seguridad/tolerabilidad [20,0%]). En pacientes que continuaban en tratamiento, el PASI75 fue alcanzado por el 36,7%; la puntuación DLQI media (IC 95%) fue 2,2 (0,7-3,6) y Patient Benefit Index medio (DE) 2,8 (0,8). El cumplimiento de las expectativas de los dermatólogos se correlacionó con los beneficios descritos por los pacientes (r = 0,636). El 56,3% reportó acontecimientos adversos (diarrea y náuseas los más frecuentes). Conclusiones Los pacientes que recibieron apremilast durante seis meses en la práctica clínica en España reportaron una mejoría en su calidad de vida (DLQI medio se redujo más de seis puntos) y en la gravedad de la enfermedad (PASI75 alcanzado por más de un tercio de los pacientes), a pesar de presentar una afectación cutánea menor que aquellos pacientes incluidos en ensayos clínicos (AU)

Background and objectives It is necessary to expand the knowledge in the use of apremilast in clinical practice. The APPRECIATE study (NCT02740218) aims to describe the characteristics of patients with psoriasis treated with apremilast, to evaluate their perspectives and those of dermatologists, as well as the outcomes obtained in clinical practice in Spain. Methods Observational, retrospective, cross-sectional, multicenter study of patients with chronic plaque psoriasis who could be contacted 6 (±1) months after apremilast initiation. The data were obtained from medical records and questionnaires from patients and physicians. Results A total of 80 patients were evaluated; at apremilast onset, they showed mean (standard deviation, SD) Psoriasis Area and Severity Index (PASI) = 8.3 (5.3), mean (SD) Dermatology Life Quality Index (DLQI) = 8.9 (6.6). At six months, 58.8% (n=47) of patients continued apremilast treatment (discontinuations due to lack of efficacy [16.3%], safety/tolerability [20.0%]). In patients continuing treatment, PASI75 was achieved by 36.7% of patients; mean (95% CI) DLQI score was 2.2 (0.7-3.6) and mean (SD) Patient Benefit Index score was 2.8 (0.8). Compliance with physicians’ expectations was correlated with benefits reported by patients (r=0.636). Adverse events were reported by 56.3% of patients (the most common were diarrhoea and nausea). Conclusions Patients receiving apremilast for 6 months in Spanish clinical practice, reported substantial improvements in their quality of life (mean DLQI reduced by more than 6 points) and disease severity (PASI75 achieved by over one-third of patients), despite less skin involvement than patients who enrolled in clinical trials (AU)