The Mediterranean diet and health: a comprehensive overview.

The Mediterranean diet (MedDiet), one of the most studied and well-known dietary patterns worldwide, has been associated with a wide range of benefits for health. In the present narrative review, we aimed to provide a comprehensive overview of the current knowledge on the relation of the MedDiet to important health outcomes, considering both observational and intervention studies with both risk factors and clinical diseases as outcomes. In addition, we considered the clinical and public health impacts of the MedDiet on both human and planetary health. Earlier research confirmed by recent studies has provided strong evidence for the benefits of the MedDiet on cardiovascular health, including reduction in the incidence of cardiovascular outcomes as well as risk factors including obesity, hypertension, metabolic syndrome, and dyslipidaemia. There is also evidence that MedDiet is associated with lower rates of incident diabetes, and better glycaemic control in diabetic patients compared to control diets. In prospective studies, adherence to the MedDiet reduced mortality, especially cardiovascular mortality, hence increased longevity. In addition, it has been associated with less age-related cognitive dysfunction and lower incidence of neurodegenerative disorders, particularly Alzheimer's disease. Furthermore, the relatively low environmental impacts (water, nitrogen and carbon footprint) of the MedDiet is an additional positive aspect of the Mediterranean dietary model. It is likely that the combination of a healthy diet with social behaviours and the way of life of Mediterranean regions makes the MedDiet a sustainable lifestyle model that could likely be followed in other regions with country-specific and culturally appropriate variations.

Two-dimensional optical chimera states in an array of coupled waveguide resonators.

Two-dimensional arrays of coupled waveguides or coupled microcavities allow us to confine and manipulate light. Based on a paradigmatic envelope equation, we show that these devices, subject to a coherent optical injection, support coexistence between a coherent and incoherent emission. In this regime, we show that two-dimensional chimera states can be generated. Depending on initial conditions, the system exhibits a family of two-dimensional chimera states and interaction between them. We characterize these two-dimensional structures by computing their Lyapunov spectrum and Yorke-Kaplan dimension. Finally, we show that two-dimensional chimera states are of spatiotemporal chaotic nature.

Chain dynamics of human dermis by Thermostimulated currents: A tool for new markers of aging.

BACKGROUND/PURPOSE: The purpose of this clinical study was to identify dielectric markers to complete a previous thermal and vibrational study on the molecular and organizational changes in human dermis during intrinsic and extrinsic aging. METHODS: Sun-exposed and non-exposed skin biopsies were collected from 28 women devised in two groups (20-30 and ≥60 years old). The dielectric relaxation modes associated with localized and delocalized dynamics in the fresh and dehydrated state were determined by the Thermostimulated currents technique (TSC). RESULTS: Intrinsic and extrinsic aging induced significant evolution of some of the dielectric parameters of localized and delocalized dynamics of human skin. With photo-aging, freezable water forms a segregated phase in dermis and its dynamics is close to free water, what evidences the major role of extrinsic aging on water organization in human skin. Moreover, TSC indicators highlight the restriction of localized mobility with intrinsic aging due to glycation, and the cumulative effect of chronological aging and photo-exposition on the molecular mobility of the main structural proteins of the dermis at the mesoscopic scale. CONCLUSION: TSC is a well-suited technique to scan the molecular mobility of human skin. It can be uses as a relevant complement of vibrational and thermal characterization to follow human skin modifications with intrinsic and extrinsic aging.

Gestational chronodisruption leads to persistent changes in the rat fetal and adult adrenal clock and function.

KEY POINTS: Light at night is essential to a 24/7 society, but it has negative consequences on health. Basically, light at night induces an alteration of our biological clocks, known as chronodisruption, with effects even when this occurs during pregnancy. Here we explored the developmental impact of gestational chronodisruption (chronic photoperiod shift, CPS) on adult and fetal adrenal biorhythms and function. We found that gestational chronodisruption altered fetal and adult adrenal function, at the molecular, morphological and physiological levels. The differences between control and CPS offspring suggest desynchronization of the adrenal circadian clock and steroidogenic pathway, leading to abnormal stress responses and metabolic adaptation, potentially increasing the risk of developing chronic diseases. ABSTRACT: Light at night is essential to a 24/7 society, but it has negative consequences on health. Basically, light at night induces an alteration of our biological clocks, known as chronodisruption, with effects even when this occurs during pregnancy. Indeed, an abnormal photoperiod during gestation alters fetal development, inducing long-term effects on the offspring. Accordingly, we carried out a longitudinal study in rats, exploring the impact of gestational chronodisruption on the adrenal biorhythms and function of the offspring. Adult rats (90 days old) gestated under chronic photoperiod shift (CPS) decrease the time spent in the open arm zone of an elevated plus maze to 62% and increase the rearing time to 170%. CPS adults maintained individual daily changes in corticosterone, but their acrophases were distributed from 12.00 h to 06.00 h. CPS offspring maintained clock gene expression and oscillation, nevertheless no daily rhythm was observed in genes involved in the regulation and synthesis of steroids. Consistent with adult adrenal gland being programmed during fetal life, blunted daily rhythms of corticosterone, core clock gene machinery, and steroidogenic genes were observed in CPS fetal adrenal glands. Comparisons of the global transcriptome of CPS versus control fetal adrenal gland revealed that 1078 genes were differentially expressed (641 down-regulated and 437 up-regulated). In silico analysis revealed significant changes in Lipid Metabolism, Small Molecule Biochemistry, Cellular Development and the Inflammatory Response pathway (z score: 48-20). Altogether, the present results demonstrate that gestational chronodisruption changed fetal and adult adrenal function. This could translate to long-term abnormal stress responses and metabolic adaptation, increasing the risk of developing chronic diseases.

Subretinal fibrosis is associated with fundus pulverulentus in pseudoxanthoma elasticum.

BACKGROUND: Pseudoxanthoma elasticum (PXE) is a rare autosomal recessive disorder caused by mutations in the ABCC6 gene, resulting in various retinal lesions, among other systemic manifestations. Visual loss may occur in PXE, most commonly caused by choroidal neovascularization and macular atrophy, but little is known about the consequences of fundus pulverulentus (FP) in PXE. The aim of this study was to evaluate ophthalmic outcomes in patients with FP associated with PXE in a large series of PXE patients. METHODS: In a retrospective observational study, ophthalmic outcomes were compared between two groups of age-matched patients with genetically and pathologically confirmed PXE: one group with FP versus one without FP. All included patients underwent thorough clinical examination. Further investigation (optical coherence tomography (OCT), Cirrhus, Zeiss Germany, and/or fluorescein/indocyanin green angiography) was performed in cases of suspected choroidal neovascularization (CNV). RESULTS: The study included 13 PXE patients with FP (group 1: 8 men and 5 women, aged 45-65 years) and 47 age-matched PXE patients without FP (group 2: 19 men and 28 women). Mean patient follow-up was 63 months (range 0-132 months). Subretinal fibrosis (SRF) was more frequently associated with FP (9/26 eyes, 34.6%), compared to absence of FP (4/94, 4.2%) (p = 0.0001). Independently of SRF, FP can evolve into deep macular atrophy and/or CNV with dramatic consequences for central vision. CONCLUSIONS: Fundus pulverulentus may occur in PXE and is most commonly associated with subretinal fibrosis in the posterior pole and visual loss by macular atrophy even in the absence of CNV.

Chimera states in a Duffing oscillators chain coupled to nearest neighbors.

Coupled nonlinear oscillators can present complex spatiotemporal behaviors. Here, we report the coexistence of coherent and incoherent domains, called chimera states, in an array of identical Duffing oscillators coupled to their nearest neighbors. The chimera states show a significant variation of amplitude in the desynchronized domain. These intriguing states are observed in the bistability region between a homogeneous state and a spatiotemporal chaotic one. These dynamical behaviors are characterized by their Lyapunov spectra and their global phase coherence order parameter. The local coupling between oscillators prevents one domain from invading the other one. Depending on initial conditions, a family of chimera states appear, organized in a snaking-like diagram.

Chimera-like states in an array of coupled-waveguide resonators.

We consider coupled-waveguide resonators subject to optical injection. The dynamics of this simple device are described by the discrete Lugiato-Lefever equation. We show that chimera-like states can be stabilized, thanks to the discrete nature of the coupled-waveguide resonators. Such chaotic localized structures are unstable in the continuous Lugiato-Lefever model; this is because of dispersive radiation from the tails of localized structures in the form of two counter-propagating fronts between the homogeneous and the complex spatiotemporal state. We characterize the formation of chimera-like states by computing the Lyapunov spectra. We show that localized states have an intermittent spatiotemporal chaotic dynamical nature. These states are generated in a parameter regime characterized by a coexistence between a uniform steady state and a spatiotemporal intermittency state.

The PREDIMED trial, Mediterranean diet and health outcomes: How strong is the evidence?

AIMS: To address potential controversies on the health benefits of the Mediterranean diet (MedDiet) after PREDIMED, a randomized trial of MedDiet for primary cardiovascular prevention. We have focused on: a) the PREDIMED study design, b) analysis of PREDIMED data and c) interpretation of its results. DATA SYNTHESIS: Regarding the design of the trial, its early termination and between-group differences in the intensity of the intervention are potential causes of concern. The planned duration was 6 years but the trial was prematurely stopped when an interim analysis at 4.8-year provided sufficient evidence of benefit for the two MedDiets. In the MedDiet groups supplemented with extra-virgin olive oil or mixed-nuts, the primary composite endpoint (myocardial infarction, stroke, or cardiovascular death) was reduced by 30% and 28% respectively, as compared with the control group. Final results did not change after taking into account the different intensity of educational efforts during the trial. Other potential doubts related to data analysis (e.g., intention to treat versus a per-protocol approach, and consequences of dropouts) should not be causes of concern. Finally, we addressed alternative interpretations of the effect on all-cause mortality. The protocol-defined primary endpoint was a composite cardiovascular endpoint, not all-cause mortality. To analyze total mortality, we would have needed a much larger sample size and longer follow-up. Therefore, the PREDIMED results cannot be used to draw firm conclusions on MedDiets and all-cause mortality. CONCLUSIONS: The PREDIMED study was designed to overcome three major problems of previous nutritional research: a) residual confounding, addressed by using a randomized design; b) single-nutrient approaches, by randomizing an overall dietary pattern; and c) the limitations of assessing only intermediate risk markers, by using hard clinical end-points.

Identification of ageing biomarkers in human dermis biopsies by thermal analysis (DSC) combined with Fourier transform infrared spectroscopy (FTIR/ATR).

BACKGROUND/PURPOSE: The purpose of this clinical study was to identify suitable biomarkers for a better understanding of the molecular and organizational changes in human dermis during intrinsic and extrinsic ageing. METHODS: Sun-exposed and non-exposed skin biopsies were collected from twenty-eight women devised in two groups (20-30 and ≥60 years old). The hydric organization and thermal transitions were determined by Differential Scanning Calorimetry (DSC). Fourier Transform Infrared spectroscopy (FTIR) was used to identify the absorption bands of the dermis and to quantify the different absorbance ratio. RESULTS: The amounts of total, freezable and unfreezable water were determined. A significant increasing amount of freezable water is evidenced in sun-exposed area skin of aged group compared with young group (P=.0126). Another significant effect of extrinsic ageing (P=.0489) is the drastic decrease of fibrillary collagen, the main protein component of dermis. The only significant effect of intrinsic ageing (P=.0184) is an increase of the heat-stable fraction of collagens in dermis. CONCLUSION: DSC and FTIR are well-suited techniques to characterize human skin, giving accurate results with a high reproducibility. The combination of these techniques is useful for a better understanding of human skin modifications with intrinsic and extrinsic ageing.

Conformational and thermal characterization of a synthetic peptidic fragment inspired from human tropoelastin: Signature of the amyloid fibers.

OBJECTIVES: This work deals with the conformational and thermal characterization of a synthetic peptide (S4) released during the proteolysis of human tropoelastin by the matrix metalloproteinase-12 that was shown to form amyloid-like fibres under certain conditions. MATERIALS AND METHODS: S4 peptides were synthesized by solid-phase methodology and aggregated in solution at 80°C. Fourier transform-infrared spectroscopy (FT-IR) was used to access the secondary structure. Thermal characterization was performed by thermogravimetric analysis (TGA) and differential scanning calorimetry (DSC). RESULTS: The DSC study of the soluble linear peptide S4 in solution in TBS reveals the irreversible aggregation into amyloid fibres. FT-IR, DSC and TGA analyses performed on freeze-dried samples evidence differences between the linear peptide and its associated amyloid-like fibres, both on the conformation and the physical structure. When S4 peptides are aggregated, the prominent conformation scanned by FT-IR is the cross ß-structure, corresponding to TGA to an increase of the thermal stability. Moreover, the DSC thermograms of S4 fibres are characteristic of a highly ordered structure, in contrast to the DSC thermograms of S4 linear peptides, characteristic of an amorphous structure. Finally, the DSC analysis of differently hydrated S4 fibres brings to the fore the specific thermal answer of the wet interfaces of the cross ß-fibres. CONCLUSION: FT-IR and thermal techniques are well suited to evidence conformational and structural differences between the soluble peptide and its amyloid form.

Dancing vortices in a driven nematic liquid crystal cell: Theory and experiment.

The interaction of light beams with helical defects in optical materials generates optical vortices. Understanding and manipulating the dynamics of helical defects allows for the creation of versatile sources of optical vortex beams. Using a magnetic ring on a nematic liquid crystal cell, we trapped helical defects identified as matter vortices. We observe oscillatory rotating and beating matter vortices by applying a low-frequency voltage. Experimentally, we determine the region of parameters where these vortices are observed. The amplitude of oscillatory rotating vortices decays with the inverse of the voltage frequency. We propose an adequate amplitude equation, which allows us to describe the vortex dynamics; theoretical findings have a qualitative agreement with the experimental observations.

Best practice in brachytherapy.

The 2020 recommendations for good brachytherapy procedures ("Recorad") are updated based on the 2016 article. This new brachytherapy article took into account recent data published in the literature as well as international recommendations. The different brachytherapy steps are successively described from the treatment preparation (brachytherapy technique prescription; procedure and material, dedicated images for planification, dose distribution analysis and validation) to the end of the procedure as well as post-treatment surveillance.

Guidelines for being a foster care home, report of an experience. / Guía para la práctica de acogimiento familiar, relato de una experiencia.

Receiving a child in foster home care needs the strength to face complex situations, gives care and support, and be aware of the temporary nature of that position. The pediatrician plays a decisive role not only in the health care of children and adolescents with lost rights, but also in the early detection of cases, based on an attentive and committed attitudes facing each child circumstances. We present the experience of 5 siblings with lost rights in which the Promotion and Integral Protection of Children's Rights System intervened through a program of foster families, with the aim of clarifying the current legal situation and raising awareness about this alternative.

Recibir a un niño o a una niña en cuidado transitorio supone la fortaleza para enfrentar situaciones complejas, ofrecer cuidados y contención, y ser consciente del carácter temporario de ese hecho. El pediatra juega un papel determinante no solo en el cuidado de la salud de niños, niñas y adolescentes con derechos vulnerados, sino también como actor clave en la detección temprana de los casos, a partir de una mirada atenta y comprometida con la situación de cada niño. Se presenta un caso de 5 hermanos con derechos vulnerados, en el que intervino el Sistema de Promoción y Protección Integral de Derechos de los Niños a través de un programa de familias de abrigo, con el objetivo de clarificar la situación legal actual y concientizar sobre dicha alternativa.

Prostate cancer brachytherapy: SFRO guidelines 2021.

Prostate brachytherapy techniques are described, concerning both permanent seed implant and high dose rate brachytherapy. The following guidelines are presented: brachytherapy indications, implant procedure for permanent low dose rate implants and high dose rate with source projector, as well as dose and dose-constraints objectives, immediate postoperative management, post-treatment evaluation, and long-term follow-up.

Multicenter study on multidisciplinary committees in advanced prostate cancer.

INTRODUCTION AND OBJECTIVE: Although Multidisciplinary Teams (MDTs) are recommended in the management of Advanced Prostate Cancer (APC), their functioning in real practice has been poorly evaluated. We carried out a multicenter study with the objective of evaluating the functioning of uro-oncology MDTs in 6 hospitals. MATERIALS AND METHODS: A descriptive cross-sectional study was performed. The level of Compliance with the Fundamental Quality Requirements (CFQR) of the MDTs was evaluated by means of a questionnaire filled out by the coordinators of the MDTs in each hospital. The information on the perspective of the members of the MDTs was evaluated through an anonymous survey. RESULTS: A high level of CFQR in MDTs was evidenced (75%), showing deficiencies in terms of protocol update, agendas, audits, and scientific production. The survey was answered by 62.32% of the 69 physicians surveyed (urologists, oncologists, radiation therapists, radiologists, and pathologists). The 88.4% consider the duration of the meetings appropriate. There are disparate opinions concerning the protection of the MDT meeting time as well as protocol update. Of the patients with APC presented at the MDTs meeting, 62,8% require intervention from two specialties. Only 50% of respondents believe that all CRPC cases are discussed and that there is a prior agenda. The decisions made by the MDTs are reflected in the clinical history in 65.1% and are binding only in 60.5% of the cases. Half of the respondents have not been trained in MDTs. Most participants (90.7%) agree on the fact that MDTs. convey benefits. CONCLUSIONS: The evaluations of the MDTs identify rectifiable deficiencies by modifying hospital inertia and care planning.

Melatonin exerts direct inhibitory actions on ACTH responses in the human adrenal gland.

In nonhuman primates and rodents, melatonin acting directly on the adrenal gland, inhibits glucocorticoid response to ACTH. In these species, an intrinsic adrenal circadian clock is involved in ACTH-stimulated glucocorticoid production. We investigated whether these findings apply to the human adrenal gland by determining i) expression of clock genes in vivo and ii) direct effects of melatonin in ACTH-stimulated adrenal explants over a) expression of the clock genes PER1 (Period 1) mRNA and BMAL1 [Brain-Muscle (ARNT)-like] protein, ACTH-induced steroidogenic acute regulatory protein (StAR), and 3ß-hydroxysteroid dehydrogenase (3ß-HSD) and b) over cortisol and progesterone production. Adrenal tissue was obtained from 6 renal cancer patients undergoing unilateral nephrectomy-adrenalectomy. Expression of the clock genes PER1, PER2, CRY2 (Cryptochrome 2), CLOCK (Circadian Locomotor Output Cycles Kaput) and BMAL1, was investigated by RT-PCR in a normal adrenal and in an adenoma. In independent experiments, explants from 4 normal adrenals were preincubated in culture medium (6 h) followed by 12 h in: medium alone; ACTH (100 nM); ACTH plus melatonin (100 nM); and melatonin alone. The explants' content of PER1 mRNA (real-time PCR) and StAR, 3ß-HSD, BMAL1 (immuno slot-blot), and their cortisol and progesterone production (RIA) were measured. The human adrenal gland expresses the clock genes PER1, PER2, CRY2, CLOCK, and BMAL1. ACTH increased PER1 mRNA, BMAL1, StAR, and 3ß-HSD protein levels, and cortisol and progesterone production. Melatonin inhibited these ACTH effects. Our study demonstrates, for the first time, direct inhibitory effects of melatonin upon several ACTH responses in the human adrenal gland.

Oral Health and Undernutrition in the Frail Elderly Persons.

INTRODUCTION: Although many studies associate a poor state of oral health with the risk of undernutrition in both the autonomous and dependent elderly, very few of them consider the frail elderly person. However, the identification of the frail elderly is one of major issues of modern geriatrics. It is at this stage that preventive strategies are the most effective against the risks of dependency. The main objective of our study is to explore the nature of the association between oral health and undernutrition in the frail elderly patient, and to identify the associated factors. MATERIALS AND METHODS: We have used the data of an observational transversal monocentric study, conducted among a population of patients hospitalized for frailty assessment at the Geriatric Frailty Clinic (G.F.C.) for Assessment of Frailty and Prevention of Disability. The enrolment site is the Cité de la Santé, at Toulouse University Hospital. Data were collected from January 25, 2016 February 2, 2018. The data collected sociodemographic characteristics, oral health (Oral Health Assessment Tool), nutritional status (Mini Nutritional Assessment), Body Mass Index, and weight loss according to Fried), frailty (Fried criteria), functional status (Mini Mental State Examination, Activity of Daily Living, Instrumental Activity of Daily Living, Geriatric Depression Scale-15), and behavior (tobacco and alcohol). RESULTS: We included 1,155 subjects with an average age of 81.9 years, including 65% women. Bivariate analysis indicated a statistically significant association (p<0.05) between a pathological state of oral health and undernutrition, particularly with regard to decay of natural teeth, pathologies of the tongue, gums and tissues, dry mouth, lack of oral cleanliness and presence of dental pain. Multivariate analysis adjusted for socio-demographic, behavioral and functional data confirmed some of these associations, notably between the item gum/mucous membrane and the decrease of the score (p<0.01); this same item and weight loss according to Fried (p<0.01), and the item tongue and weight loss (p<0.05). A statistically significant association appeared between the state of oral health and frailty (item tongue (p<0.01)). DISCUSSION: Our study shows a statistically significant association between a pathological state of oral health and nutrition disorders in the frail elderly person. This result confirms the hypothesis postulating that a poor state of oral health would be associated with nutritional disorders among the frail elderly. Our analysis also shows a statistically significant association between a deteriorated state of oral health and frailty. Tongue diseases here increase the risk of frailty for the patient. Our results are, however, limited and do not allow for an analysis of causal effect. It would be useful to complete our study by more refined analyses of risk factors, conducted on a larger sample, and with a follow-up patients over time. CONCLUSION: We show here the importance of targeting the frail population in order to screen for oral disease and refer patients for dental care. Ensuring oral health care of frail patients seems indispensable if they are to maintain not only a healthy nutritional state, but also a satisfactory general state of health, thus allowing for successful aging.

[Hereditary optic atrophies]. / Les atrophies optiques héréditaires.

INTRODUCTION: Hereditary optic neuropathies, resulting from retinal ganglion cell degeneration, are a heterogeneous group of diseases ranging from asymptomatic forms to legal blindness. STATE OF KNOWLEDGE: Two most frequent phenotypes are Kjer's disease, an autosomal dominant optic atrophy caused by OPA1 gene mutations, and Leber's disease due to maternally inherited mitochondrial DNA mutations. PROSPECTS AND CONCLUSION: Both optic neuropathies usually isolated are sometimes associated with extraocular symptoms, especially neurological symptoms, thus justifying a systematic neurological evaluation and brain imaging.

A community outbreak of Legionnaires' disease associated with a cooling tower in Vic and Gurb, Catalonia (Spain) in 2005.

We report the investigation of a community-acquired outbreak of Legionnaires' disease. An epidemiological, environmental, and meteorological investigation was undertaken. Fifty-five cases were reported in October and November 2005. The exposure occurred in a large area, with 12 cases (21.8%) located between 1,800 and 3,400 metres from the source. Water sample cultures showed that Legionella pneumophila serogroup 1 (Lp-1) was present in five cooling towers in two industrial locations in Gurb (plants A and B). Two Lp-1 strains were recovered from plants A and B, but only Lp-1 strains from plant A showed a pulsed-field gel electrophoresis (PFGE) profile identical to those obtained from three of the cases. Inspection of the cooling towers in plant A revealed inadequate maintenance. Weather conditions in October 2005, with mostly high temperatures and high humidity, together with the flat terrain could have been favouring factors. This study showed a community outbreak from a cooling tower as a common source in a large area. Climate and terrain could explain the dissemination of contaminated aerosols.

Front depinning by deterministic and stochastic fluctuations: A comparison.

Driven dissipative many-body systems are described by differential equations for macroscopic variables which include fluctuations that account for ignored microscopic variables. Here, we investigate the effect of deterministic fluctuations, drawn from a system in a state of phase turbulence, on front dynamics. We show that despite these fluctuations a front may remain pinned, in contrast to fronts in systems with Gaussian white noise fluctuations, and explore the pinning-depinning transition. In the deterministic case, this transition is found to be robust but its location in parameter space is complex, generating a fractal-like structure. We describe this transition by deriving an equation for the front position, which takes the form of an overdamped system with a ratchet potential and chaotic forcing; this equation can, in turn, be transformed into a linear parametrically driven oscillator with a chaotically oscillating frequency. The resulting description provides an unambiguous characterization of the pinning-depinning transition in parameter space. A similar calculation for noise-driven front propagation shows that the pinning-depinning transition is washed out.