Polyphenolic Characterization and Anti-Inflammatory Effect of In Vitro Digested Extracts of Echinacea purpurea L. Plant Parts in an Inflammatory Model of Human Colon Cells.

Echinacea purpurea L. (EP) preparations are globally popular herbal supplements known for their medicinal benefits, including anti-inflammatory activities, partly related to their phenolic composition. However, regarding their use for the management of inflammation-related intestinal diseases, the knowledge about the fate of orally ingested constituents throughout the human gastrointestinal tract and the exposition of in vitro digested extracts in relevant inflammatory models are unknown. This study investigated for the first time the impact of in vitro gastrointestinal digestion (INFOGEST) on the phenolic composition and anti-inflammatory properties of EP extracts from flowers (EF), leaves (EL), and roots (ER) on IL-1ß-treated human colon-derived CCD-18Co cells. Among the seven hydroxycinnamic acids identified using HPLC-UV-MS/MS, chicoric and caftaric acids showed the highest concentrations in EL, followed by EF and ER, and all extracts exerted significant reductions in IL-6, IL-8, and PGE2 levels. After digestion, despite reducing the bioaccessibility of their phenolics, the anti-inflammatory effects were preserved for digested EL and, to a lesser extent, for EF, but not for digested ER. The lower phenolic content in digested EF and ER could explain these findings. Overall, this study emphasizes the potential of EP in alleviating intestinal inflammatory conditions and related disorders.

Magnetic resonance imaging as a predictor of therapeutic response to pasireotide in acromegaly.

OBJECTIVE: Hyperintensity signal in T2-weighted magnetic resonance imaging (MRI) has been related to better therapeutic response during pasireotide treatment in acromegaly. The aim of the study was to evaluate T2 MRI signal intensity and its relation with pasireotide therapeutic effectiveness in real-life clinical practice. DESIGN, PATIENTS AND MEASUREMENTS: Retrospective multicentre study including acromegaly patients treated with pasireotide. Adenoma T2-weighted MRI signal at diagnosis was qualitatively classified as iso-hyperintense or hypointense. Insulin-like growth factor (IGF-I), growth hormone (GH) and tumour volume reduction were assessed after 6 and 12 months of treatment and its effectiveness evaluated according to baseline MRI signal. Hormonal response was considered 'complete' when normalization of IGF-I levels was achieved. Significant tumour shrinkage was defined as a volume reduction of ≥25% from baseline. RESULTS: Eighty-one patients were included (48% women, 50 ± 1.5 years); 93% had previously received somatostatin receptor ligands (SRLs) treatment. MRI signal was hypointense in 25 (31%) and hyperintense in 56 (69%) cases. At 12 months of follow-up, 42/73 cases (58%) showed normalization of IGF-I and 37% both GH and IGF-I. MRI signal intensity was not associated with hormonal control. 19/51 cases (37%) presented a significant tumour volume shrinkage, 16 (41%) from the hyperintense group and 3 (25%) from the hypointense. CONCLUSIONS: T2-signal hyperintensity was more frequently observed in pasireotide treated patients. Almost 60% of SRLs resistant patients showed a complete normalization of IGF-I after 1 year of pasireotide treatment, regardless of the MRI signal. There was also no difference in the percentage tumour shrinkage over basal residual volume between the two groups.

Ultraviolet exposure of competitors during a Tokyo Olympic Sailing Regatta Test Event.

BACKGROUND: Overexposure to sunlight is the main cause of skin cancer. Photoprotection practices and sunburn play a crucial role in skin cancer prevention. OBJECTIVES: This study aimed to quantify the risk of sun exposure and to evaluate photoprotection practices in Spanish sailors during Olympic competitions. METHODS: Solar daily ultraviolet (UV) radiation cycle, personal UV dosimetry, photoprotection practices and sunburn checking were followed during three consecutive days of competition among sailors from the Spanish Olympic Sailing Team during a Tokyo Olympic Regatta Test Event. RESULTS: A total of 13 sailors (7 women), with mean age of 27.6 ± 4.7 years and sports experience of 17.7 ± 5.4 years, were studied. The most common phototypes were type III (53.8%) and type II (38.5%). The rate of sunburn checked was high (46.2%). The mean daily personal UV exposure received was 761.0 ± 263.6 J/m2 , 3.0 ± 1.1 minimal erythemal dose and 7.6 ± 2.6 standard erythemal dose, seven times greater than the maximum permissible UV light exposure values for an 8 h working day. The use of a T-shirt was the most common practice (94.2%), followed by the use of shade (50.2%), hat/cap (44.0%), sunglasses (26.1%) and sunscreen (11.8%). CONCLUSIONS: Olympic sailor's studies presented high levels of UV radiation received, high rate of sunburn and insufficient adherence to sun-protective behaviours (especially, to use of sunscreen) to prevent sunburn, the main cause of skin cancer. Sport Federations should develop educational campaigns addressing sun-related exposure habits and photoprotection behaviours to reduce the risk of skin cancer among these athletes.

(Poly)phenols: The Missing Piece in the Puzzle of Inflammation.

Despite researchers' and clinicians' exponential understanding of chronic diseases' complexity, ranging from cancer, diabetes, and neurodegenerative disorders, we still have a lot of unanswered questions on pathobiology mechanisms, wherein inflammation is central [...].

Dietary (Poly)phenols in Traumatic Brain Injury.

Traumatic brain injury (TBI) remains one of the leading causes of death and disability in young adults worldwide. Despite growing evidence and advances in our knowledge regarding the multifaceted pathophysiology of TBI, the underlying mechanisms, though, are still to be fully elucidated. Whereas initial brain insult involves acute and irreversible primary damage to the brain, the processes of subsequent secondary brain injury progress gradually over months to years, providing a window of opportunity for therapeutic interventions. To date, extensive research has been focused on the identification of druggable targets involved in these processes. Despite several decades of successful pre-clinical studies and very promising results, when transferred to clinics, these drugs showed, at best, modest beneficial effects, but more often, an absence of effects or even very harsh side effects in TBI patients. This reality has highlighted the need for novel approaches that will be able to respond to the complexity of the TBI and tackle TBI pathological processes on multiple levels. Recent evidence strongly indicates that nutritional interventions may provide a unique opportunity to enhance the repair processes after TBI. Dietary (poly)phenols, a big class of compounds abundantly found in fruits and vegetables, have emerged in the past few years as promising agents to be used in TBI settings due to their proven pleiotropic effects. Here, we give an overview of the pathophysiology of TBI and the underlying molecular mechanisms, followed by a state-of-the-art summary of the studies that have evaluated the efficacy of (poly)phenols administration to decrease TBI-associated damage in various animal TBI models and in a limited number of clinical trials. The current limitations on our knowledge concerning (poly)phenol effects in TBI in the pre-clinical studies are also discussed.

An extension of the characteristic curve model of plant species behavior in heavy metal soils.

This article proposes a mathematical model to characterize phytoremediation processes in soils contaminated with heavy metals. In particular, the proposed model constructs characteristic curves for the concentrations of several metals (As, Cd, Cu, Fe, Pb, Sb, and Zn) in soils and plants based on the experimental data retrieved from several bibliographical sources comprising 305 vegetal species. The proposed model is an extension of previous models of characteristic curves in phytoremediation processes developed by Lam et al. for root measurements using the bioconcentration factor. However, the proposed model extends this approach to consider roots, as well as aerial parts and shoots of the plant, while at the same time providing a less complex mathematical formula compared to the original. The final model shows an adjusted R2 of 0.712, and all its parameters are considered statistically significant. The model may be used to assess samples from a given plant species to identify its potential as an accumulator in the context of soil phytoremediation processes. Furthermore, a simplified version of the model was constructed using an approximation to provide an easy-to-compute alternative that is valid for concentrations below 37,000 mg/kg. This simplified model shows results similar to the original model for concentrations below this threshold and it uses an adjusted factor defined as [Formula: see text] that must be compared with a threshold depending on the metal, type of measurement, and target (e.g., accumulator or hyperaccumulator). The full model construction shows that 90 out of the 305 species assessed have a potential behavior as accumulators and 10 of them as hyperaccumulators. Finally, out of the 1405 experimental measurements, 1177 were shown to be accumulators or hyperaccumulators. In particular, 85% of the results coincide with the reported values, thus validating the proposed model.

[Teleophthalmology-based diabetic retinopathy screening in a rural health basic area]. / Cribado de la retinopatía diabética mediante teleoftalmología en una zona básica de salud rural.

OBJECTIVE: To investigate the prevalence of diabetic retinopathy in a rural health basic area, and to establish the type, the severity degree and the relationship with sex and with another cardiovascular risk factors. DESIGN: Cross-sectional or prevalence descriptive study. LOCATION: Rural health basic area in Spain. Primary health care level. PARTICIPANTS: 500 patients over 18 years old with diabetes. MAIN MEASUREMENTS: Study of the retina through retinography under mydriasis, according to the Joslin Vision Network protocol, with the incorporation of a diagnostic reading center. Correlation of the existence and severity of the retinopathy with the cardiovascular risk factors -smoking, hypertension and hyperlipidemia- and the characteristics of the diabetes -type, evolution time, treatment, metabolic control and renal function-. RESULTS: The findings showed a 16.4% prevalence, with no significant differences between both sexes. The variables smoking and high blood pressure were related to the existence of retinopathy, and the variable years of diabetes evolution was correlated to both the existence and the severity of the retinopathy. In the study, 9.6% of the affected people were preferentially referred to the ophthalmologists because of sight-threatening retinopathy, and 6.8% of the people studied were referred due to other ophthalmological pathologies. CONCLUSIONS: It is possible to do the ophthalmological follow-up of 82% of the population with diabetes in primary health care, involving its professionals and team-working with the ophthalmologists. It is paramount to consider diabetic retinopathy within the global context of the person with diabetes, relating diabetic retinopathy with the other microvascular complications and cardiovascular diseases.

Recurrent Germline DLST Mutations in Individuals with Multiple Pheochromocytomas and Paragangliomas.

Pheochromocytomas and paragangliomas (PPGLs) provide some of the clearest genetic evidence for the critical role of metabolism in the tumorigenesis process. Approximately 40% of PPGLs are caused by driver germline mutations in 16 known susceptibility genes, and approximately half of these genes encode members of the tricarboxylic acid (TCA) cycle. Taking as a starting point the involvement of the TCA cycle in PPGL development, we aimed to identify unreported mutations that occurred in genes involved in this key metabolic pathway and that could explain the phenotypes of additional individuals who lack mutations in known susceptibility genes. To accomplish this, we applied a targeted sequencing of 37 TCA-cycle-related genes to DNA from 104 PPGL-affected individuals with no mutations in the major known predisposing genes. We also performed omics-based analyses, TCA-related metabolite determination, and 13C5-glutamate labeling assays. We identified five germline variants affecting DLST in eight unrelated individuals (∼7%); all except one were diagnosed with multiple PPGLs. A recurrent variant, c.1121G>A (p.Gly374Glu), found in four of the eight individuals triggered accumulation of 2-hydroxyglutarate, both in tumors and in a heterologous cell-based assay designed to functionally evaluate DLST variants. p.Gly374Glu-DLST tumors exhibited loss of heterozygosity, and their methylation and expression profiles are similar to those of EPAS1-mutated PPGLs; this similarity suggests a link between DLST disruption and pseudohypoxia. Moreover, we found positive DLST immunostaining exclusively in tumors carrying TCA-cycle or EPAS1 mutations. In summary, this study reveals DLST as a PPGL-susceptibility gene and further strengthens the relevance of the TCA cycle in PPGL development.

Sunscreens effectiveness are not altered by concomitant use of moisturizing creams: An ultraviolet reflectance photography study.

BACKGROUND: Sunscreens are widely used to protect the skin against the harmful effects of solar radiation. It is not known whether solar protection factor of a sunscreen is altered by the concomitant use of other cosmetic products. OBJECTIVES: The aim of this study was to analyze changes in the protective effect of different commercial and ISO standards sunscreens with high SPF applied shortly before and after application of non-sunscreens galenic formulas type moisturizing creams. METHODS: ISO 24444:2019 standard sunscreens, which claimed SPF 16 and 63, as well as 4 different claimed SPF 50 and 50+ commercial sunscreens were prepared and applied in different sequential order to the back of 25 volunteers and compared with different commercial moisturizing formulas. Ultraviolet (UV) reflectance photography followed by image analysis was used to compare untreated skin and skin treated with moisturizing creams alone and combined with sunscreens. RESULTS: The UV reflectance analysis showed no significant changes of the skin color reflectance treated with moisturizing cream compared with untreated skin. Application of the sunscreen formulations were associated with a 35% - 70% decrease in color related to the in vivo expected SPF, indicating significant UV absorption for all sunscreen formulas. All standard and commercial sunscreens showed no significant differences in UV reflection color level when combined with the different moisturizing creams applied before or after the sunscreen. CONCLUSIONS: Effectiveness of low- and high-protection sunscreens were not altered by the concomitant use of a moisturizing creams applied shortly before and after the sunscreens.

Reducing non-attendance in outpatient appointments: predictive model development, validation, and clinical assessment.

BACKGROUND: Non-attendance to scheduled hospital outpatient appointments may compromise healthcare resource planning, which ultimately reduces the quality of healthcare provision by delaying assessments and increasing waiting lists. We developed a model for predicting non-attendance and assessed the effectiveness of an intervention for reducing non-attendance based on the model. METHODS: The study was conducted in three stages: (1) model development, (2) prospective validation of the model with new data, and (3) a clinical assessment with a pilot study that included the model as a stratification tool to select the patients in the intervention. Candidate models were built using retrospective data from appointments scheduled between January 1, 2015, and November 30, 2018, in the dermatology and pneumology outpatient services of the Hospital Municipal de Badalona (Spain). The predictive capacity of the selected model was then validated prospectively with appointments scheduled between January 7 and February 8, 2019. The effectiveness of selective phone call reminders to patients at high risk of non-attendance according to the model was assessed on all consecutive patients with at least one appointment scheduled between February 25 and April 19, 2019. We finally conducted a pilot study in which all patients identified by the model as high risk of non-attendance were randomly assigned to either a control (no intervention) or intervention group, the last receiving phone call reminders one week before the appointment. RESULTS: Decision trees were selected for model development. Models were trained and selected using 33,329 appointments in the dermatology service and 21,050 in the pneumology service. Specificity, sensitivity, and accuracy for the prediction of non-attendance were 79.90%, 67.09%, and 73.49% for dermatology, and 71.38%, 57.84%, and 64.61% for pneumology outpatient services. The prospective validation showed a specificity of 78.34% (95%CI 71.07, 84.51) and balanced accuracy of 70.45% for dermatology; and 69.83% (95%CI 60.61, 78.00) for pneumology, respectively. The effectiveness of the intervention was assessed on 1,311 individuals identified as high risk of non-attendance according to the selected model. Overall, the intervention resulted in a significant reduction in the non-attendance rate to both the dermatology and pneumology services, with a decrease of 50.61% (p<0.001) and 39.33% (p=0.048), respectively. CONCLUSIONS: The risk of non-attendance can be adequately estimated using patient information stored in medical records. The patient stratification according to the non-attendance risk allows prioritizing interventions, such as phone call reminders, to effectively reduce non-attendance rates.

Chlorophyll-a Pigment Measurement of Spirulina in Algal Growth Monitoring Using Portable Pulsed LED Fluorescence Lidar System.

Chlorophyll-a measurement is important in algal growth and water quality monitoring in natural waters. A portable pulsed LED fluorescence lidar system based on the preliminary algal organic matter and pigments excitation-emission matrix (EEM) of commercialized AZTEC Spirulina powder at varying concentrations was developed. Fluorescence peaks from EEMs showed increasing intensity as the Spirulina concentration increases. Using this information, an LED fluorescence lidar with a wavelength of 385 nm, pulse width of 10 ns, and repetition frequency of 500 kHz was constructed for chlorophyll detection at 680 nm. Turbidity measurements were also conducted at 700 nm emission wavelength at the same excitation wavelength. Range-resolved fluorescence lidar signals from the portable pulsed LED fluorescence lidar system are highly correlated with the standard methods such as optical density at 680 nm (R2 = 0.87), EEM fluorescence chlorophyll-a pigment at 680 nm (R2 = 0.89), and corrected chlorophyll-a concentration (R2 =0.92). The F680/F700 lidar ratio was measured to provide a linear relationship of chlorophyll-a and turbidity in waters. The F680/F700 measurement showed strong correlations with Spirulina concentration (R2 = 0.94), absorbance at 680 nm (R2 = 0.84), EEM chlorophyll-a pigment at 680 nm (R2 = 0.83), and corrected chlorophyll-a concentration (R2 = 0.86). Results revealed that this new technique of chlorophyll-a measurement can be used as an alternative to other standard methods in algal growth monitoring.

A look beyond dietary (poly)phenols: The low molecular weight phenolic metabolites and their concentrations in human circulation.

A large number of epidemiological studies have shown that consumption of fruits, vegetables, and beverages rich in (poly)phenols promote numerous health benefits from cardiovascular to neurological diseases. Evidence on (poly)phenols has been applied mainly to flavonoids, yet the role of phenolic acids has been largely overlooked. Such phenolics present in food combine with those resulting from gut microbiota catabolism of flavonoids and chlorogenic acids and those produced by endogenous pathways, resulting in large concentrations of low molecular weight phenolic metabolites in human circulation. Independently of the origin, in human intervention studies using diets rich in (poly)phenols, a total of 137 low molecular weight phenolic metabolites have been detected and quantified in human circulation with largely unknown biological function. In this review, we will pinpoint two main aspects of the low molecular weight phenolic metabolites: (i) the microbiota responsible for their generation, and (ii) the analysis (quali- and quantitative) in human circulation and their respective pharmacokinetics. In doing so, we aim to drive scientific advances regarding the ubiquitous roles of low molecular weight phenolic metabolites using physiologically relevant concentrations and under (patho)physiologically relevant conditions in humans.

Use of renin-angiotensin-aldosterone system inhibitors and risk of COVID-19 requiring admission to hospital: a case-population study.

BACKGROUND: Concerns have been raised about the possibility that inhibitors of the renin-angiotensin-aldosterone system (RAAS) could predispose individuals to severe COVID-19; however, epidemiological evidence is lacking. We report the results of a case-population study done in Madrid, Spain, since the outbreak of COVID-19. METHODS: In this case-population study, we consecutively selected patients aged 18 years or older with a PCR-confirmed diagnosis of COVID-19 requiring admission to hospital from seven hospitals in Madrid, who had been admitted between March 1 and March 24, 2020. As a reference group, we randomly sampled ten patients per case, individually matched for age, sex, region (ie, Madrid), and date of admission to hospital (month and day; index date), from Base de datos para la Investigación Farmacoepidemiológica en Atención Primaria (BIFAP), a Spanish primary health-care database, in its last available year (2018). We extracted information on comorbidities and prescriptions up to the month before index date (ie, current use) from electronic clinical records of both cases and controls. The outcome of interest was admission to hospital of patients with COVID-19. To minimise confounding by indication, the main analysis focused on assessing the association between COVID-19 requiring admission to hospital and use of RAAS inhibitors compared with use of other antihypertensive drugs. We calculated odds ratios (ORs) and 95% CIs, adjusted for age, sex, and cardiovascular comorbidities and risk factors, using conditional logistic regression. The protocol of the study was registered in the EU electronic Register of Post-Authorisation Studies, EUPAS34437. FINDINGS: We collected data for 1139 cases and 11 390 population controls. Among cases, 444 (39·0%) were female and the mean age was 69·1 years (SD 15·4), and despite being matched on sex and age, a significantly higher proportion of cases had pre-existing cardiovascular disease (OR 1·98, 95% CI 1·62-2·41) and risk factors (1·46, 1·23-1·73) than did controls. Compared with users of other antihypertensive drugs, users of RAAS inhibitors had an adjusted OR for COVID-19 requiring admission to hospital of 0·94 (95% CI 0·77-1·15). No increased risk was observed with either angiotensin-converting enzyme inhibitors (adjusted OR 0·80, 0·64-1·00) or angiotensin-receptor blockers (1·10, 0·88-1·37). Sex, age, and background cardiovascular risk did not modify the adjusted OR between use of RAAS inhibitors and COVID-19 requiring admission to hospital, whereas a decreased risk of COVID-19 requiring admission to hospital was found among patients with diabetes who were users of RAAS inhibitors (adjusted OR 0·53, 95% CI 0·34-0·80). The adjusted ORs were similar across severity degrees of COVID-19. INTERPRETATION: RAAS inhibitors do not increase the risk of COVID-19 requiring admission to hospital, including fatal cases and those admitted to intensive care units, and should not be discontinued to prevent a severe case of COVID-19. FUNDING: Instituto de Salud Carlos III.

Epigenetic responses of hare barley (Hordeum murinum subsp. leporinum) to climate change: an experimental, trait-based approach.

The impact of reduced rainfall and increased temperatures forecasted by climate change models on plant communities will depend on the capacity of plant species to acclimate and adapt to new environmental conditions. The acclimation process is mainly driven by epigenetic regulation, including structural and chemical modifications on the genome that do not affect the nucleotide sequence. In plants, one of the best-known epigenetic mechanisms is cytosine-methylation. We evaluated the impact of 30% reduced rainfall (hereafter "drought" treatment; D), 3 °C increased air temperature ("warming"; W), and the combination of D and W (WD) on the phenotypic and epigenetic variability of Hordeum murinum subsp. leporinum L., a grass species of high relevance in Mediterranean agroforestry systems. A full factorial experiment was set up in a savannah-like ecosystem located in southwestern Spain. H. murinum exhibited a large phenotypic plasticity in response to climatic conditions. Plants subjected to warmer conditions (i.e., W and WD treatments) flowered earlier, and those subjected to combined stress (WD) showed a higher investment in leaf area per unit of leaf mass (i.e., higher SLA) and produced heavier seeds. Our results also indicated that both the level and patterns of methylation varied substantially with the climatic treatments, with the combination of D and W inducing a clearly different epigenetic response compared to that promoted by D and W separately. The main conclusion achieved in this work suggests a potential role of epigenetic regulation of gene expression for the maintenance of homoeostasis and functional stability under future climate change scenarios.

Ultrasonography for predicting a difficult laryngoscopy. Getting closer.

Our objective was to evaluate the usefulness of five ultrasound measurements to predict a difficult laryngoscopy (DL). Prospective observational study. 50 patients underwent scheduled surgery under general anesthesia with orotracheal intubation with classical laryngoscopy at the University Hospital of Jaén (Spain). Sociodemographic variables, classic preintubation screening tests and ultrasound measurements of the neck soft tissue from skin to hyoid (DSH), epiglottis (DSE) and glottis (DSG) were obtained, as well as two measurements derived from the above: DSH + DSE and DSE - DSG. The relationship between a DL and ultrasound measurements was evaluated using t student test. The ROC Curve was used to establish the diagnostic accuracy of ultrasound measurements to discriminate a DL and logistic regression was used to establish a cut-off point. Multivariate analysis was performed to assess the impact of these measures in clinical practice. Patients with DL showed greater thickness of DSE (2.9 ± 0.46 cm vs 2.32 ± 0.54 cm; p = 0.001), DSH + DSE (4.25 ± 0.45 cm vs 3.62 ± 0.77 cm; p = 0.001) and DSE - DSG (1.83 ± 0.54 cm vs 1.24 ± 0.46 cm; p = 0.001) than those with an easy laryngoscopy. DSE and DSE - DSG had the highest diagnostic accuracy for DL with an area under the ROC curve of 0.79 [95%IC 0.66-0.92] and 0.82 [95%IC 0.68-0.96], respectively. It was established that DSE ≥ 3 cm, could predict a DL with a positive predictive value (PPV) of 69.23% [95%CI 40.3-98.2], and DSE - DSG ≥ 1.9 cm would do so with a PPV of 78.57% [95%CI 53.31-100%]. The multivariate analysis endorsed that DSE and DSE - DSG combined with classic tests (the Modified Mallampati score, the thyromental distance and the upper lip bite test) improved the preoperative detection of a DL. The inclusion of DSE and DSE - DSG in a multivariate model with classic parameters may offer the anesthesiologist better information for detecting a DL preoperatively.

Evaluation of copper tailing amendments through poultry waste and ammonium nitrate.

In this study, two amendments, poultry waste and ammonium nitrate, were evaluated to condition and stabilize a mine tailing and thus help the vegetation cover settle. Individually, ammonium nitrate was tested as a nitrogen source and chicken bone ash as a phosphate source. For this, laboratory tests were made on soil columns from the area to be remediated. The mobility and availability of metals and nutrients were determined by analyzing their leachates chemically. The results showed that the use of chicken bone ash decreases soluble metal concentrations, particularly in Fe and soluble Mn. On the other hand, experimental conditions proved that the acidification produced by ammonium nitrate nitrification does not significantly increase the lechate metal content. Therefore, its use for fertilization does not involve phytotoxicity risks. Regarding the availability of macronutrients as well as trace elements, the results showed that the concentrations lie within the ranges suitable for plant nutrition. So, the treatments are effective both for fertilization and phytoremediation.

[Health professionals' perception about the socio-educational group intervention with women who present somatic symptoms without organic cause]. / Percepción de profesionales de la salud sobre la intervención grupal socioeducativa con mujeres que presentan síntomas somáticos sin causa orgánica.

OBJECTIVE: To know the perception and opinion of primary care health professionals on the impact of non-medicalizing group educational intervention (GRUSE) with women who present somatic symptoms without organic cause. DESIGN: Qualitative phenomenological study. SETTING: Primary care health centers in Andalusia, during 2017 and 2018. PARTICIPANTS AND/OR CONTEXTS: Twenty-four health professionals, selected according to their level of involvement in the GRUSE strategy (socio-educational groups). METHOD: A qualitative methodology is applied, through the phenomenological method. The technique used to collect the information is the discussion group, and a content analysis is carried out on it. The software Atlas.ti 8.0 is used as a support resource for the analysis. RESULTS: Health professionals highlight group work as a means of achieving change, and point to the importance of intervention as a non-medicalizing strategy. They perceive that the participants obtain some benefits: the improvement of their personal well-being, the increase of their self-esteem and self-determination, and the generation of social networks, benefits that also affect their immediate surroundings. CONCLUSIONS: In the opinion of the professionals, the strategy has positive effects on women and does not mean an increase in resources for the health system. In addition, they express the importance of provide women with tools to cope with daily life problems derivates mostly from gender mandates of a patriarchal society.

CHANGES IN TOTAL AND INNER RETINAL THICKNESSES IN TYPE 1 DIABETES WITH NO RETINOPATHY AFTER 8 YEARS OF FOLLOW-UP.

PURPOSE: To evaluate changes in retinal layer thickness in patients with Type 1 diabetes with no diabetic retinopathy after 8 years of follow-up. METHODS: Ninety Type 1 diabetes and 60 control eyes were studied. Changes in the retinal nerve fiber layer, ganglion cell layer, and inner nuclear layer thicknesses in all Early Treatment Diabetic Retinopathy Study areas were evaluated. RESULTS: The mean ages were 42.93 ± 13.62 and 41.52 ± 13.05 years in the diabetic and control group, respectively. In 2009, total retinal thickness was higher in diabetic patients; differences were statistically significant in all except the nasal areas. In both groups, the mean foveal thickness remained the same during the 8 years. Among diabetic patients, there was a significant reduction in total retinal thickness in all areas excluding the outer temporal one; controls only in the inferior areas. The thickness loss was due to the thinning of the inner retinal layers (inner nuclear layer, ganglion cell layer, and retinal nerve fiber layer). The controls showed a significant diminution in the retinal nerve fiber layer and in the ganglion cell layer areas. The inner nuclear layer showed a diminution in the diabetes mellitus group. CONCLUSION: Before the onset of diabetic retinopathy, Type 1 diabetes patients experience a diminution of their inner retinal layer thicknesses over time, supporting the hypothesis of retinal neurodegeneration.

Effective Fundus Image Decomposition for the Detection of Red Lesions and Hard Exudates to Aid in the Diagnosis of Diabetic Retinopathy.

Diabetic retinopathy (DR) is characterized by the presence of red lesions (RLs), such as microaneurysms and hemorrhages, and bright lesions, such as exudates (EXs). Early DR diagnosis is paramount to prevent serious sight damage. Computer-assisted diagnostic systems are based on the detection of those lesions through the analysis of fundus images. In this paper, a novel method is proposed for the automatic detection of RLs and EXs. As the main contribution, the fundus image was decomposed into various layers, including the lesion candidates, the reflective features of the retina, and the choroidal vasculature visible in tigroid retinas. We used a proprietary database containing 564 images, randomly divided into a training set and a test set, and the public database DiaretDB1 to verify the robustness of the algorithm. Lesion detection results were computed per pixel and per image. Using the proprietary database, 88.34% per-image accuracy (ACCi), 91.07% per-pixel positive predictive value (PPVp), and 85.25% per-pixel sensitivity (SEp) were reached for the detection of RLs. Using the public database, 90.16% ACCi, 96.26% PPV_p, and 84.79% SEp were obtained. As for the detection of EXs, 95.41% ACCi, 96.01% PPV_p, and 89.42% SE_p were reached with the proprietary database. Using the public database, 91.80% ACCi, 98.59% PPVp, and 91.65% SEp were obtained. The proposed method could be useful to aid in the diagnosis of DR, reducing the workload of specialists and improving the attention to diabetic patients.

Dietary Phenolics against Breast Cancer. A Critical Evidence-Based Review and Future Perspectives.

Breast cancer (BC) is the most common malignancy and the leading cause of cancer-related death in adult women worldwide. Over 85% of BC cases are non-hereditary, caused by modifiable extrinsic factors related to lifestyle, including dietary habits, which play a crucial role in cancer prevention. Although many epidemiological and observational studies have inversely correlated the fruit and vegetable consumption with the BC incidence, the involvement of their phenolic content in this correlation remains contradictory. During decades, wrong approaches that did not consider the bioavailability, metabolism, and breast tissue distribution of dietary phenolics persist behind the large currently existing gap between preclinical and clinical research. In the present review, we provide comprehensive preclinical and clinical evidence according to physiologically relevant in vitro and in vivo studies. Some dietary phenolics such as resveratrol (RSV), quercetin, isoflavones, epigallocatechin gallate (EGCG), lignans, and curcumin are gaining attention for their chemopreventive properties in preclinical research. However, the clinical evidence of dietary phenolics as BC chemopreventive compounds is still inconclusive. Therefore, the only way to validate promising preclinical results is to conduct clinical trials in BC patients. In this regard, future perspectives on dietary phenolics and BC research are also critically discussed.