Effect of Resveratrol on Markers of Oxidative Stress and Sirtuin 1 in Elderly Adults with Type 2 Diabetes.

Type 2 diabetes (T2D) affects a large part of the adult population and impairs its quality of life. Because of this, natural compounds with antioxidant, anti-inflammatory and hypoglycemic properties have been used as adjuvants. Among these compounds, resveratrol (RV) stands out, a polyphenol that has been studied in several clinical trials, the results of which are controversial. We conducted a randomized clinical trial on 97 older adults with T2D to evaluate the effect of RV on oxidative stress markers and sirtuin 1, using doses of 1000 mg/day (EG1000, n = 37) and 500 mg/day (EG500, n = 32) compared with a placebo (PG, n = 28). Biochemical markers, oxidative stress and sirtuin 1 levels were measured at baseline and after six months. We observed a statistically significant increase (p < 0.05) in total antioxidant capacity, antioxidant gap, the percentage of subjects without oxidant stress and sirtuin 1 levels in EG1000. In the PG, we observed a significant increase (p < 0.05) in lipoperoxides, isoprostanes and C-reactive protein levels. An increase in the oxidative stress score and in the percentage of subjects with mild and moderate oxidative stress was observed too. Our findings suggest that 1000 mg/day of RV exerts a more efficient antioxidant effect than 500 mg/day.

Arterial Fistulas in Urinary Diverted Patients: A Report of 5 Cases.

OBJECTIVE: Arterio-urinary fistulae are a rare but potentially lethal complication that may arise after pelvic surgery, such as radical cystectomy. Historically, open surgery was the gold standard treatment, but currently endovascular treatment has gained prominence. METHODS: We report our centre experience in endovascular treatment of cystectomy-related arterial fistulae and review the reported literature on the topic. During the postoperative period of radical cystoprostatectomy five patients presented different ranges of haematuria, and one presented rectal bleeding, four of them with haemodynamic instability. An urgent three-phase computed tomography was performed, showing active bleeding in 2 patients, while the rest of the patients presented indirect signs of fistulae. An angiography was performed, showing contrast extravasation in 60% of the cases and vessel wall irregularity in 40%. Five arteriourinary fistulae and one arterioenteric fistula were urgently treated with a covered stent placement, sealing the site of the fistula in the artery. RESULTS: Immediate results were satisfactory in all cases; however, one patient died secondary to fistula-related causes 15 days post-treatment. No stent thrombosis or rebleeding have been registered during follow-up. In this review, reported results and complications after covered stent placement are shown, and controversial topics such as antibiotic coverage and antithrombotic treatment after endovascular treatment are also reviewed.

Influence of Age and Dose on the Effect of Resveratrol for Glycemic Control in Type 2 Diabetes Mellitus: Systematic Review and Meta-Analysis.

Background: Several clinical trials have suggested that resveratrol has hypoglycemic properties; however, there are other studies in which such an effect has not been observed. Methods: We carried out a systematic search in several databases; seventeen studies were selected for the systematic review and fifteen were included in the meta-analysis. Results: Resveratrol decreases glucose levels in subjects aged 45−59 years at doses <250 mg/day (−8.64 mg/dL, p < 0.00001), 250−500 mg/day (−22.24 mg/dL, p = 0.0003), and 500−1000 mg/day (−28.40 mg/dL, p = 0.0008), while in subjects older than 60 years, it only decreases with doses of 250−500 mg/day. Likewise, HbA1c improved in subjects aged 45−59 years with doses of 250−500 mg (−0.60%, p < 0.00001), but not in subjects older than 60 years. Insulin levels improved in subjects aged 45−59 years with doses < 250 mg/day (−0.80 mIU/L, p = 0.0003) and doses of 250−500 mg/day (−5.0 mIU/L, p = 0.0003), although in subjects older than 60 years, they only improved with doses of 250−500 mg/day (−1.79 mIU/L, p = 0.01). On the other hand, HOMA-IR only improved in subjects older than 60 years with doses of 250−500 mg/day (−0.40, p = 0.01). Conclusions: Resveratrol has a statistically significant dose−response effect on glucose concentrations, HbA1c, and insulin levels; however, there is not enough scientific evidence to propose a therapeutic dose.

Emotion Classification from EEG with a Low-Cost BCI Versus a High-End Equipment.

The assessment of physiological signals such as the electroencephalography (EEG) has become a key point in the research area of emotion detection. This study compares the performance of two EEG devices, a low-cost brain-computer interface (BCI) (Emotiv EPOC+) and a high-end EEG (BrainVision), for the detection of four emotional conditions over 20 participants. For that purpose, signals were acquired with both devices under the same experimental procedure, and a comparison was made under three different scenarios, according to the number of channels selected and the sampling frequency of the signals analyzed. A total of 16 statistical, spectral and entropy features were extracted from the EEG recordings. A statistical analysis revealed a major number of statistically significant features for the high-end EEG than the BCI device under the three comparative scenarios. In addition, different machine learning algorithms were used for evaluating the classification performance of the features extracted from high-end EEG and low-cost BCI in each scenario. Artificial neural networks reported the best performance for both devices with an F[Formula: see text]-score of 75.08% for BCI and 98.78% for EEG. Although the professional EEG outcomes were higher than the low-cost BCI ones, both devices demonstrated a notable performance for the classification of the four emotional conditions.

Evaluation of Brain Functional Connectivity from Electroencephalographic Signals Under Different Emotional States.

The identification of the emotional states corresponding to the four quadrants of the valence/arousal space has been widely analyzed in the scientific literature by means of multiple techniques. Nevertheless, most of these methods were based on the assessment of each brain region separately, without considering the possible interactions among different areas. In order to study these interconnections, this study computes for the first time the functional connectivity metric called cross-sample entropy for the analysis of the brain synchronization in four groups of emotions from electroencephalographic signals. Outcomes reported a strong synchronization in the interconnections among central, parietal and occipital areas, while the interactions between left frontal and temporal structures with the rest of brain regions presented the lowest coordination. These differences were statistically significant for the four groups of emotions. All emotions were simultaneously classified with a 95.43% of accuracy, overcoming the results reported in previous studies. Moreover, the differences between high and low levels of valence and arousal, taking into account the state of the counterpart dimension, also provided notable findings about the degree of synchronization in the brain within different emotional conditions and the possible implications of these outcomes from a psychophysiological point of view.

Detection of Negative Stress through Spectral Features of Electroencephalographic Recordings and a Convolutional Neural Network.

In recent years, electroencephalographic (EEG) signals have been intensively used in the area of emotion recognition, partcularly in distress identification due to its negative impact on physical and mental health. Traditionally, brain activity has been studied from a frequency perspective by computing the power spectral density of the EEG recordings and extracting features from different frequency sub-bands. However, these features are often individually extracted from single EEG channels, such that each brain region is separately evaluated, even when it has been corroborated that mental processes are based on the coordination of different brain areas working simultaneously. To take advantage of the brain's behaviour as a synchronized network, in the present work, 2-D and 3-D spectral images constructed from common 32 channel EEG signals are evaluated for the first time to discern between emotional states of calm and distress using a well-known deep-learning algorithm, such as AlexNet. The obtained results revealed a significant improvement in the classification performance regarding previous works, reaching an accuracy about 84%. Moreover, no significant differences between the results provided by the diverse approaches considered to reconstruct 2-D and 3-D spectral maps from the original location of the EEG channels over the scalp were noticed, thus suggesting that these kinds of images preserve original spatial brain information.

Hypoglycemic Effect of Resveratrol: A Systematic Review and Meta-Analysis.

Resveratrol (RV) is a polyphenolic compound with antioxidant, anti-inflammatory, and hypoglycemic properties. Several in vitro and animal model studies have demonstrated the beneficial effects of RV; however, the results in humans are not conclusive. After a search of different databases, 32 studies were selected for this systematic review and 30 were included in the meta-analysis. Studies that evaluated the effect of RV on glucose, insulin, HbA1c, and insulin resistance (HOMA-IR) levels were included. A significant decrease of glucose (-5.24 mg/dL, p = 0.002) and insulin levels (-1.23 mIU/L, p = 0.0003) was observed. HbA1c and HOMA-IR did not show significant changes. Due to heterogeneity, sub-analyzes were performed. Sub-analysis by dose revealed that glucose levels improve significantly after the administration of 500-1000 mg/day of RV (-7.54 mg/dL, p = 0.002), while insulin improves with doses lower than 500 mg/day (-1.43 mIU/L, p = 0.01) and greater than 1000 mg/day (-2.12 mIU/L, p = 0.03). HbA1c and HOMA-IR remained unchanged after sub-analysis by dose. Our findings suggest that RV improves glucose and insulin levels in subjects with type 2 diabetes mellitus (T2DM) and aged 45-59 years, regardless of the duration of the intervention. HbA1c improves with interventions ≥3 months. HOMA-IR does not exhibit significant changes after RV administration.

The Effect of 600 mg Alpha-lipoic Acid Supplementation on Oxidative Stress, Inflammation, and RAGE in Older Adults with Type 2 Diabetes Mellitus.

Alpha-lipoic acid (ALA) has been used as a dietary supplement at different doses in patients with diabetes mellitus type 2 (T2DM) due to its antioxidant, anti-inflammatory, and hypoglycemic effects. However, the reports on the effects of ALA are controversial. For this reason, the purpose of the present study was to determine the effect of 600 mg/day of ALA on the markers of oxidative stress (OxS) and inflammation and RAGE in older adults with T2DM. A quasiexperimental study was carried out with a sample of 135 sedentary subjects (98 women and 37 men) with a mean age of 64 ± 1 years, who all had T2DM. The sample was divided into three groups: (i) experimental group (EG) with 50 subjects, (ii) placebo group (PG) with 50 subjects, and control group (CG) with 35 subjects. We obtained the following measurements in all subjects (pre- and posttreatment): glycosylated hemoglobin (HbA1c), receptor for advanced glycation end products (RAGE), 8-isoprostane, superoxide dismutase (SOD), glutathione peroxidase (GPx), total antioxidant status (TAS), and inflammatory (CRP, TNF-α, IL-6, IL-8, and IL-10) markers. Regarding the effect of ALA on HbA1c, a decrease was observed in the EG (baseline 8.9 ± 0.2 vs. posttreatment 8.6 ± 0.3) and the PG (baseline 8.8 ± 0.2 vs. posttreatment 8.4 ± 0.3) compared to the CG (baseline 8.8 ± 0.3 vs. six months 9.1 ± 0.3) although the difference was not statistically significant (p < 0.05). There was a statistically significant decrease (p < 0.05) in the blood concentration of 8-isoprostane in the EG and PG with respect to the CG (EG: baseline 100 ± 3 vs. posttreatment 57 ± 3, PG: baseline 106 ± 7 vs. posttreatment 77 ± 5, and CG: baseline 94 ± 10 vs. six months 107 ± 11 pg/mL). Likewise, a statistically significant decrease (p < 0.05) in the concentration of the RAGE was found in the EG (baseline 1636 ± 88 vs. posttreatment 1144 ± 68) and the PG (baseline 1506 ± 97 vs. posttreatment 1016 ± 82) compared to CG (baseline 1407 ± 112 vs. six months 1506 ± 128). A statistically significant decrease was also observed in all markers of inflammation and in the activity of SOD and GPx in the CG with respect to the EG and PG. Our findings suggest that the administration of ALA at a dose of 600 mg/day for six months has a similar effect to that of placebo on oxidative stress, inflammation, and RAGE in older adults with T2DM. Therefore, higher doses of ALA should be tried to have this effect. This trial is registered with trial registration number ISRCTN13159380.

Multi-Lag Analysis of Symbolic Entropies on EEG Recordings for Distress Recognition.

Distress is a critical problem in developed societies given its long-term negative effects on physical and mental health. The interest in studying this emotion has notably increased during last years, being electroencephalography (EEG) signals preferred over other physiological variables in this research field. In addition, the non-stationary nature of brain dynamics has impulsed the use of non-linear metrics, such as symbolic entropies in brain signal analysis. Thus, the influence of time-lag on brain patterns assessment has not been tested. Hence, in the present study two permutation entropies denominated Delayed Permutation Entropy and Permutation Min-Entropy have been computed for the first time at different time-lags to discern between emotional states of calmness and distress from EEG signals. Moreover, a number of curve-related features were also calculated to assess brain dynamics across different temporal intervals. Complementary information among these variables was studied through sequential forward selection and 10-fold cross-validation approaches. According to the results obtained, the multi-lag entropy analysis has been able to reveal new significant insights so far undiscovered, thus notably improving the process of distress recognition from EEG recordings.

The influence of an educational internet-based intervention in the beliefs and attitudes of primary care professionals on non-specific chronic low back pain: study protocol of a mixed methods approach.

BACKGROUND: Personal convictions in referral to pain cause misbeliefs in health professionals, which can influence patients who suffer from non-specific chronic low back pain. Likewise, health professionals' beliefs affect their advice and attitudes towards patients' treatment, becoming a possible cause of greater disability. The development of educational interventions based on the best scientific evidence in neurophysiology of pain could be a way to provide information and advice to primary care health professionals to change their cognition towards chronic non-specific low back pain. The use of Information and Communication Technologies allows the development of web sites, which might be one of the effective resources to modify misbeliefs and attitudes, in relation to the origin and meaning of non-specific chronic low back pain, of primary care professionals and that may modify their attitudes in patients' treatment. METHODS: The aim of this project is to identify misbeliefs and attitudes of primary care physicians and nurses about chronic non-specific low back pain to develop a web-based educational tool using different educational formats and gamification techniques. This study has a mixed-method sequential exploratory design. The participants are medical and nursing staff working in primary care centers in the city of Lleida, Spain. For the qualitative phase of this study, the authors will use personal semi-structured interviews. For the quantitative phase the authors will use an experimental study design. Subjects will be randomly allocated using a simple random sample technique. The intervention group will have access to the web site where they will find information related to non-specific chronic low back pain, based on the information obtained in the qualitative phase. The control group will have access to a video explaining the clinical practice guidelines on low back pain. DISCUSSION: This study has been designed to explore and modify the beliefs and attitudes about chronic low back pain of physicians and nurses working in primary care settings, using a web-based educational tool with different educational formats and gamification techniques. The aim of the educational intervention is to change their knowledge about the origin and meaning of pain, with the result of reducing their misbeliefs and attitudes of fear avoidance. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02962817 . Date of registration: 11/09/2016.

Multiscale Entropy Analysis for Recognition of Visually Elicited Negative Stress From EEG Recordings.

Automatic identification of negative stress is an unresolved challenge that has received great attention in the last few years. Many studies have analyzed electroencephalographic (EEG) recordings to gain new insights about how the brain reacts to both short- and long-term stressful stimuli. Although most of them have only considered linear methods, the heterogeneity and complexity of the brain has recently motivated an increasing use of nonlinear metrics. Nonetheless, brain dynamics reflected in EEG recordings often exhibit a multiscale nature and no study dealing with this aspect has been developed yet. Hence, in this work two nonlinear indices for quantifying regularity and predictability of time series from several time scales are studied for the first time to discern between visually elicited emotional states of calmness and negative stress. The obtained results have revealed the maximum discriminant ability of 86.35% for the second time scale, thus suggesting that brain dynamics triggered by negative stress can be more clearly assessed after removal of some fast temporal oscillations. Moreover, both metrics have also been able to report complementary information for some brain areas.

Ancianos con prescripción inapropiada; ¿deprescribimos? / Elderly people with inappropriate prescriptions; should we de-prescribe?

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