GRAvity- versus Wall suction-drIven large volume Thoracentesis: a rAndomized controlled Study (GRAWITAS study).

BACKGROUND: Prior studies found no differences in procedural chest discomfort for patients undergoing manual syringe aspiration or drainage with gravity after thoracentesis. However, whether gravity drainage could protect against chest pain due to the larger negative pressure gradient generated by wall suction has not been investigated. RESEARCH QUESTION: Does wall suction drainage result in more chest discomfort compared to gravity drainage in patients undergoing large volume thoracentesis? STUDY DESIGN AND METHODS: In this multicenter, single-blinded, randomized controlled trial, patients with large free-flowing effusions of ≥500 mL were assigned to wall suction or gravity drainage in a 1:1 ratio. Wall suction was performed with suction system attached to the suction tubing and with vacuum pressure adjusted to full vacuum. Gravity drainage was performed with a drainage bag placed 100 cm below the catheter insertion site and connected via straight tubing. Patients rated chest discomfort on a 100-mm visual analog scale before, during, and after drainage. The primary outcome was postprocedural chest discomfort at 5 minutes. Secondary outcomes included measures of post procedure chest discomfort, breathlessness, procedure time, volume of fluid drained and complication rates. RESULTS: Of the 228 patients initially randomized, 221 were included in the final analysis. The primary outcome of procedural chest discomfort did not differ significantly between the groups (p = 0.08), nor did the secondary outcomes of postprocedural discomfort and dyspnea. Similar volumes were drained in both groups, but the procedure duration was longer in the gravity arm by approximately 3 minutes. No differences in rate of pneumothorax or re-expansion pulmonary edema were noted between the two groups. INTERPRETATION: Thoracentesis via wall suction and gravity drainage results in similar levels of procedural discomfort and dyspnea improvement.

Early full-day leg movement kinematics and swaddling patterns in infants in rural Guatemala: A pilot study.

BACKGROUND: Tools to accurately assess infants' neurodevelopmental status very early in their lives are limited. Wearable sensors may provide a novel approach for very early assessment of infant neurodevelopmental status. This may be especially relevant in rural and low-resource global settings. METHODS: We conducted a longitudinal observational study and used wearable sensors to repeatedly measure the kinematic leg movement characteristics of 41 infants in rural Guatemala three times across full days between birth and 6 months of age. In addition, we collected sociodemographic data, growth data, and caregiver estimates of swaddling behaviors. We used visual analysis and multivariable linear mixed models to evaluate the associations between two leg movement kinematic variables (awake movement rate, peak acceleration per movement) and infant age, swaddling behaviors, growth, and other covariates. RESULTS: Multivariable mixed models of sensor data showed age-dependent increases in leg movement rates (2.16 [95% CI 0.80,3.52] movements/awake hour/day of life) and movement acceleration (5.04e-3 m/s2 [95% CI 3.79e-3, 6.27e-3]/day of life). Swaddling time as well as growth status, poverty status and multiple other clinical and sociodemographic variables had no impact on either movement variable. CONCLUSIONS: Collecting wearable sensor data on young infants in a rural low-resource setting is feasible and can be used to monitor age-dependent changes in movement kinematics. Future work will evaluate associations between these kinematic variables from sensors and formal developmental measures, such as the Bayley Scales of Infant and Toddler Development.

Cardiovascular risk assessment in the resource limited setting of Western Honduras: An epidemiological perspective.

Cardiovascular Disease (CVD) epidemiology varies significantly among Low and Middle-Income Countries. Honduras is the Central American country with the highest Ischemic Heart Disease and CVD mortality rates. The aim of this study was to assess the individual CVD risk factors and calculate Cardiovascular Risk Assessment Scores (CVRAS) from the population. Methods: A cross-sectional study in western Honduras. Estimation of CV risk was performed using Framingham, MESA, ACC/AHA-PCEs and ESC SCORE calculators. Results: 38% were male. For men and women respectively; 49% and 48% had self-reported hypertension (HTN), on measured blood pressure only 18% and 30% had normal readings. Diabetes Mellitus was reported in 19% and 22%. Tobacco use was 14% and 3%. Self-reported regular exercise was 39.9% and 25%. Obesity was diagnosed in 24% and 24%. Lipid profile; total cholesterol was ≥200 mg/dl in 63% of subjects. LDL-C was elevated (>100 mg/dl) in 74% of participants, 9% had LDL-C levels higher than 190 mg/dl. Triglycerides were high (>160 mg/dl) in 60%, of these subjects 22% were taking lipid-lowering medications. 52% reported family-history of CVD. The risk calculation for men and women respectively for each CVRAS were; AHA/ACC-PCEs high risk (score ≥ 7.5%) in 62% and 30%, FRS high risk (score ≥ 20%) 46% and 15%, MESA high risk (Score ≥ 7.5%) in 70.6% and 17.7%, ESC SCORE high risk (score ≥ 5% in 32.4% and 11.8%). Conclusions: CV risk calculations revealed higher than rates than expected with consequently reflected on higher than estimated CVRAS. This represents the first report of its kind in Honduras.

Effect of the red seaweed Mastocarpus stellatus intake on lipid metabolism and antioxidant status in healthy Wistar rats.

Health-promoting effect of dietary supplementation with the red seaweed Mastocarpus stellatus was studied. Its major component is dietary fibre (31.7/100 g dry weight), 72% as soluble fibre, mainly formed by carrageenans, sulphated-galactans of red seaweeds. Thus, rats were fed either a basal- or an algal-supplemented diet (10%). Then, lipid metabolism was assessed in serum, and reducing power measured in serum and caecum by FRAP method. Also, caecal pH was monitored and short chain fatty acids analysed by gas-liquid chromatography. Seaweed intake reduced significantly triglycerides and total cholesterol in healthy rats, but not atherogenic index. Also, a significant increase in caecal moisture and proportion of acetic and propionic acids was obtained but no clear prebiotic effect was shown. Sulphated-galactans seemed to be related to the antioxidant status improvement in caecum and also to the 1.7-fold increase in anticoagulant capacity of plasma. Therefore, Mastocarpus could be regarded as a source of functional ingredients but its health benefits need to be further explored depending on specific use.

Molecular weight distribution of polysaccharides from edible seaweeds by high-performance size-exclusion chromatography (HPSEC).

Biological properties of polysaccharides from seaweeds are related to their composition and structure. Many factors such as the kind of sugar, type of linkage or sulfate content of algal biopolymers exert an influence in the relationship between structure and function. Besides, the molecular weight (MW) also plays an important role. Thus, a simple, reliable and fast HPSEC method with refractive index detection was developed and optimized for the MW estimation of soluble algal polysaccharides. Chromatogram shape and repeatability of retention time was considerably improved when sodium nitrate was used instead of ultrapure water as mobile phase. Pullulan and dextran standards of different MW were used for method calibration and validation. Also, main polysaccharide standards from brown (alginate, fucoidan, laminaran) and red seaweeds (kappa- and iota-carrageenan) were used for quantification and method precision and accuracy. Relative standard deviation (RSD) of repeatability for retention time, peak areas and inter-day precision was below 0.7%, 2.5% and 2.6%, respectively, which indicated good repeatability and precision. Recoveries (96.3-109.8%) also showed its fairly good accuracy. Regarding linearity, main polysaccharide standards from brown or red seaweeds showed a highly satisfactory correlation coefficient (r>0.999). Moreover, a good sensitivity was shown, with corresponding limits of detection and quantitation in mg/mL of 0.05-0.21 and 0.16-0.31, respectively. The method was applied to the MW estimation of standard algal polysaccharides, as well as to the soluble polysaccharide fractions from the brown seaweed Saccharina latissima and the red Mastocarpus stellatus, respectively. Although distribution of molecular weight was broad, the good repeatability for retention time provided a good precision in MW estimation of polysaccharides. Water- and alkali-soluble fractions from S. latissima ranged from very high (>2400 kDa) to low MW compounds (<6 kDa); this high heterogeneity could be attributable to the complex polysaccharide composition of brown algae. Regarding M. stellatus, sulfated galactans followed a descending order of MW (>1400 kDa to <10 kDa), related to the different solubility of carrageenans in red seaweeds. In summary, the method developed allows for the molecular weight analysis of seaweed polysaccharides with very good precision, accuracy, linearity and sensitivity within a short time.

A simple ion chromatography method for inorganic anion analysis in edible seaweeds.

A new, simple, fast and sensitive ion chromatography (IC) method, for the simultaneous analysis of fluoride, chloride, nitrite, bromide, nitrate, phosphate and sulphate in edible seaweeds was developed and reported for the first time. The validation of the analytical method was studied in terms of linearity, sensitivity, precision and accuracy. All standard calibration curves showed very good correlation between anion peak area and concentration (r>0.999). Limits of detection and quantitation ranged between 0.002-0.05 mg/L and 0.01-0.1mg/L, respectively and indicated the high sensitivity of the method. Relative standard deviation values of repeatability and inter-day precision for standard anions with the same sample were less than 2%. Anion recoveries ranged from 97 to 113% for chloride and from 87 to 105% for sulphate, respectively and showed the fairly good accuracy of the method. The method was applied to the analysis of inorganic anions in brown and red edible seaweeds. Brown seaweeds were characterized by higher chloride content up to 33.7-36.9%, while red seaweeds were characterized by higher sulphate content (45-57%). Sulphate content in seaweeds is related to the presence of sulphated polysaccharides of biological importance. The method developed was well applicable to mineral anion analysis in edible seaweeds and shows suitability and reliability of use in other food samples of nutritional importance.