Population-based Study of Gastric Cancer Survival and Associations in Rural Western Honduras.

BACKGROUND: Two-thirds of global cancer occur in low/middle income countries (LMICs). Northern Central America is the largest LMIC region in the western hemisphere, and lack cancer registries to guide cancer control. We conducted a gastric cancer (GC) survival study in rural western Honduras, characterized as having among the highest GC incidence rates in Latin America. METHODS: The cohort of incident GC diagnosed between 2002-2015 was studied with active follow-up, with household visits. The regional gastric cancer registry was primary for case identification, with completeness examination with hospital data and national death certificates. Cox regression models were used for survival calculations. RESULTS: Survival follow-up was achieved in 741/774 patients (95.7%). Household interviews were conducted in 74.1% (n=549). 65.7% were male, median age at diagnosis was 64 years, 24.5% were <55. 43.9% of tumors had pyloric obstruction. 45.2%, 43.2%, and 7.3% of histology was intestinal, diffuse, and mixed, respectively. 24.7% patients received treatment. 5-year survival rates were 9.9% for both males and females, 7.7% for age <45, and 7.9% for diffuse GC. Median survival time was 4.8 months (95%CI,4.2-5.6). In the final Cox regression model including age, sex, Lauren subtype, and poverty index, only treatment was significantly associated with survival (HR 2.43, 95%CI,1.8-3.2). CONCLUSIONS: Markedly low gastric cancer 5-year survival rates are observed in rural Central America. The majority of patients present with advanced disease, and a minority have access to therapy. IMPACT: The findings have implications for cancer control in the Central America LMICs and for U.S. Latino populations.

High Incidence of Gastric Cancer in El Salvador: A National Multisectorial Study 2000-2014.

BACKGROUND: Gastric adenocarcinoma (GC) is the fourth leading cause of global cancer mortality, and leading infection-associated cancer. GC has significant geographic variability, with a high incidence in East Asia and mountainous regions of Latin America. In the U.S., GC represents a marked disparity with incidence rates that are 2-3 times higher in Hispanics compared to non-Hispanic whites. METHODS: We conducted a national retrospective study of incident GC in El Salvador from to 2000-2014 to estimate the age-standardized incidence rate (ASIR) by using a combination of pathology and endoscopy databases. A unique multisectorial coalition was formed between the Ministry of Health (MINSAL) and ES Gastroenterology Society (AGEDES), representing public hospitals (n=5), governmental employee hospitals (ISSS, n=5), and private facilities (n=6), accounting for >95% of national endoscopy capacity. HER2 and EBV tumor status was ascertained in a representative sample during 2014-2016. RESULTS: 10,039 unique cases of GC were identified, 45.5% female, and mean age of 65. 21% and 9.4% were <55 and <45 years old, respectively. ASIRs (M, F) were 18.9 (95%CI;14.4-20.7) and 12.2 per 100,000 persons (95%CI;10.9-13.5), respectively, in the period 2010-2014 with all centers operational. Intestinal GC was 2.8 times more common than diffuse GC. 23.2% had partial or complete pyloric obstruction. The HER2 2+/3+ status was 16.7% and EBER positivity was 10.2%. CONCLUSIONS: A high incidence of gastric cancer was confirmed in El Salvador, and nearly half of patients were female. IMPACT: The findings have implications for cancer control in the Central America LMICs and for U.S. Latino populations.

High Gastric Cancer Mortality and Years of Life Lost in Nicaragua: A Population-Based Study 1997 - 2012.

BACKGROUND: Gastric adenocarcinoma (GC) is the fourth leading cause of cancer-related mortality, and leading infection-associated cancer. GC has striking geographic variability, with high incidence in East Asia and mountainous Latin America. Reliable cancer data and population-based cancer registries (PBCRs) are lacking for the majority of LMICs, including the Central American Four region (CA-4, Nicaragua, El Salvador, Honduras, and Guatemala). METHODS: Mortality data for Nicaragua were obtained from the highly-rated Ministry of Health death registry. All the patients were diagnosed with gastric cancer between 1997 and 2012 (ICD-10 codes C16.0-C16.9) and death due to any cause were included in the study. Data on variables such as sex, age (stratified by 5-year age groups), municipality, urban/rural, altitude, and year of death were analyzed. RESULTS: A total of 3,886 stomach cancer deaths were reported in Nicaragua between 1997 and 2012, of which 2,214 (56.9%) were male. The ASMR were 13.1 and 8.7 per 100,000 habitants for males and females, respectively, and without significant change during the study period (APC= -0.7, P=0.2). An average of 17.9 years were lost per death (AYLL), accounting for 67,964 years of life lost (YYL). CONCLUSIONS: The burden of gastric cancer mortality is high in Nicaragua with significantly elevated ASMR, YYL, and AYLL. IMPACT: The projected increase in mortality portends the double cancer burden in northern Central America, with persistent infection-associated cancers and growing transition cancers (e.g., breast and colon cancers), which has implications for cancer control in Mesoamerica and U.S. Latino populations.

Vertical heterostructure of graphite-MoS2 for gas sensing.

2D materials, given their form-factor, high surface-to-volume ratio, and chemical functionality have immense use in sensor design. Engineering 2D heterostructures can result in robust combinations of desirable properties but sensor design methodologies require careful considerations about material properties and orientation to maximize sensor response. This study introduces a sensor approach that combines the excellent electrical transport and transduction properties of graphite film with chemical reactivity derived from the edge sites of semiconducting molybdenum disulfide (MoS2) through a two-step chemical vapour deposition method. The resulting vertical heterostructure shows potential for high-performance hybrid chemiresistors for gas sensing. This architecture offers active sensing edge sites across the MoS2 flakes. We detail the growth of vertically oriented MoS2 over a nanoscale graphite film (NGF) cross-section, enhancing the adsorption of analytes such as NO2, NH3, and water vapor. Raman spectroscopy, density functional theory calculations and scanning probe methods elucidate the influence of chemical doping by distinguishing the role of MoS2 edge sites relative to the basal plane. High-resolution imaging techniques confirm the controlled growth of highly crystalline hybrid structures. The MoS2/NGF hybrid structure exhibits exceptional chemiresistive responses at both room and elevated temperatures compared to bare graphitic layers. Quantitative analysis reveals that the sensitivity of this hybrid sensor surpasses other 2D material hybrids, particularly in parts per billion concentrations.

Effects of Glucagon-Like Peptide-1 Receptor Agonists on Gastric Mucosal Visibility and Retained Gastric Contents During Esophagogastroduodenoscopy.

BACKGROUND AND AIMS: Glucagon-like peptide-1 receptor agonists (GLP-1RA) are increasingly utilized in diabetes and obesity management. GLP-1RAs delay gastric emptying; however, their impact on visibility during esophagogastroduodenoscopy (EGD) remains uncertain. METHODS: A 1:1 matched case-control study was conducted. Individuals undergoing EGD on GLP-1RAs were matched to non-users based on demographics and diabetes status. A validated scale (POLPREP) was used to determine gastric mucosal visibility scores. RESULTS: A total of 84 pairs (n=168) were included. GLP-1RA users showed significantly lower visibility scores, with a 2.54 times higher likelihood of lower scores compared to non-users. Additionally, GLP-1RA users had a higher incidence of retained gastric contents (13.1% vs. 4.8%, aOR:4.62, p=0.025) and aborted procedures due to this issue. No anesthesia-related adverse events were observed. CONCLUSIONS: GLP-1RA use at the time of endoscopy exhibited higher odds of lower gastric mucosal visibility scores, retained contents and aborted procedures. Further research is warranted.

Prevalence of celiac disease in systemic lupus erythematosus, sjogren syndrome and systemic sclerosis: A systematic review and meta-analysis.

BACKGROUND: Celiac disease (CeD) is an immune-mediated disorder affecting the small bowel, associated with genetic factors and increasing global prevalence. AIM: This study explores the association between CeD, Systemic Lupus Erythematosus (SLE), primary Sjogren syndrome (pSS), and Systemic Sclerosis (SSc). METHODS: A systematic review and meta-analysis were conducted following PRISMA guidelines. Searches across multiple databases yielded 2728 articles, with 15 studies selected. Data extraction included study characteristics, prevalence of CeD and CeD antibodies in SLE, pSS, and SSc. Quality assessment utilized the Newcastle-Ottawa Scale. RESULTS: The meta-analysis revealed a pooled prevalence of biopsy-proven CeD in SLE, pSS, and SSc of approximately 3%. Seroprevalence of any CeD antibody in SLE, pSS, and SSc ranged from 3% to 10%. Notably, pSS exhibited the highest prevalence at 5.59%. High heterogeneity was observed in seroprevalence across autoimmune conditions. Quality assessment indicated robust methodological quality in the selected studies. CONCLUSION: This study highlights a significantly higher prevalence of CeD, especially pSS, compared to the general population. The findings underscore the importance of recognizing elevated CeD antibodies in patients with SLE, pSS and SSc emphasizing the need for early detection and comprehensive care for gastrointestinal symptoms in these conditions.

Colorectal Cancer Screening Programs in Latin America: A Systematic Review and Meta-Analysis.

Importance: Colorectal cancer (CRC) is a leading cause of cancer-related mortality globally, with increasing incidence and mortality in Latin America. CRC screening programs can reduce disease burden, but information on screening programs in Latin America is limited. Objective: To describe characteristics (eg, type of program, uptake, neoplastic yield) of CRC screening programs in Latin America. Data Sources: PubMed, Ovid MEDLINE, EMBASE, Cochrane, PsycINFO, Web of Science Core Collection, LILACS, and SciELO were searched from inception to February 2023. Relevant references from bibliographies, conference proceedings, and gray literature were considered. The search strategy included English, Spanish, and Portuguese terms. Study Selection: Included were studies of CRC screening programs in Latin America using fecal immunochemical test (FIT) or colonoscopy as the primary screening method. Four reviewers independently assessed study eligibility based on titles, with review of abstracts and full texts as needed. Data Extraction and Synthesis: Guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed for data abstraction and quality assessment. Descriptive information was extracted, and data were pooled using a random-effects model. Main outcomes and Measures: Program performance indicators included rates of participation and FIT positivity, adenoma detection rate (ADR), advanced adenoma detection rate (AADR), CRC detection rate, and colonoscopy quality indicators. Results: There were 17 studies included from upper middle-income and high-income countries in Latin America with a total of 123 929 participants. Thirteen studies used FIT as the initial screening method, whereas 4 used screening colonoscopy. The participation rate in FIT-based programs was 85.8% (95% CI, 78.5%-91.4%). FIT positivity rates were 15.2% (95% CI, 9.6%-21.8%) for the 50-ng/mL threshold and 9.7% (95% CI, 6.8%-13.0%) for the 100-ng/mL threshold. For FIT-based studies, the pooled ADR was 39.0% (95% CI, 29.3%-49.2%) and CRC detection rate was 4.9% (95% CI, 2.6%-7.9%); for screening colonoscopy-based studies, the pooled ADR was 19.9% (95% CI, 15.5%-24.8%) and CRC detection rate was 0.4% (95% CI, 0.1%-0.8%). Conclusions and Relevance: This systematic review and meta-analysis suggests that CRC screening in upper middle-income countries in Latin America is feasible, detecting rates of neoplasia comparable with those of high-income regions. Population-based screening programs should be developed or enhanced in these settings. There is a knowledge gap regarding feasibility and yield of screening programs in lower middle-income countries.

Social determinants of health influencing the adherence to post-endoscopic mucosal resection surveillance.

BACKGROUND AND AIMS: Colorectal cancer (CRC) is a global health challenge, particularly in Alabama, where the incidence rates exceed national averages. This study investigated the factors influencing adherence to post-endoscopic mucosal resection (EMR) colonoscopies, focusing on travel distance and socioeconomic status. This study aimed to provide evidence-based insights to improve patient care in CRC management. METHODS: This retrospective study in a tertiary care referral center analyzed 465 patients who underwent EMR. The data included demographics, clinical details, and travel-related variables. Descriptive statistics, logistic regression, and spatial analysis were used to assess the factors affecting adherence. RESULTS: Of 465 patients, 36.6 % had adequate follow-up, 21.8 % had inadequate follow-up, and 41.6 % were lost to follow-up. Noteworthy demographic variations were observed, with median ages differing across adherence groups. Traveled distances showcased compelling insights, indicating a median distance of 22.2 miles for adequate follow-up, 15.7 miles for inadequate follow-up, and 31.6 miles for the lost-to-follow-up group (p<0.001). Longer travel distances were associated with better adherence. Longer travel distances from the hospital were associated with significantly lower odds of inadequate follow-up: 10-25 miles OR:0.29, 25-85 miles OR:0.35, and >80 miles OR:0.24 compared to the first quartile (<10 miles). Socioeconomic factors, particularly educational attainment, significantly influenced the follow-up rates. CONCLUSIONS: This study revealed suboptimal post-EMR follow-up rates and underscored the impact of travel distance and socioeconomic factors. Targeted interventions addressing distance-related barriers can enhance treatment adherence and ensure timely CRC surveillance after EMR. Further research is needed in diverse healthcare settings.

Safety and efficacy of direct percutaneous endoscopic jejunostomy tube placement compared with surgical jejunostomy: a tertiary care analysis.

BACKGROUND AND AIMS: Jejunostomy tube placements provides enteral access for feeding in eligible patients who cannot meet their nutritional needs by mouth. They can be surgically placed laparoscopically (lap-J) or with the use of a conventional open laparotomy approach (open-J). Recently, direct percutaneous endoscopic jejunostomy (DPEJ) has emerged as an alternative owing to its low cost and shorter recovery times. We sought to retrospectively compare the procedural success rates and adverse events of these methods. METHODS: Patients were identified by querying our health system patient database and the departmental database of patients who underwent DPEJ. The patients were divided into 3 cohorts based on the procedure: DPEJ, lap-J, or open-J. Patient age and body mass index, procedural success rate, and adverse event rate were compared among the 3 groups. RESULTS: A total of 201 patients met inclusion criteria (65 DPEJ, 111 lap-J, and 25 open-J). Procedural success rates were similar among the 3 groups (DPEJ 96.9%, lap-J 99.1%, open-J 100%; P = .702). Rates of infection and bleeding were also similar among the 3 groups. There were no cases of GI perforation. Tube dysfunction for any reason that required complete removal or replacement within 90 days occurred more often in the surgical groups than in the DPEJ group (DPEJ 0%, lap-J 35.1%, open-J 40.0%; P < .001). This was driven largely by increased rates of tube clogging and tube dislodgement in the surgical groups. CONCLUSIONS: DPEJ is a safe and effective alternative to surgical jejunostomy in eligible patients and may be associated with decreased adverse event rates at 90 days.

Wood cookstove use is associated with gastric cancer in Central America and mediated by host genetics.

Biomass cookstove food preparation is linked to aero-digestive cancers, mediated by ingested and inhaled carcinogens (e.g., heterocyclic amines, and polycyclic aromatic hydrocarbons). We investigated the association between gastric adenocarcinoma, wood cookstove use, H. pylori CagA infection and risk modification by variants in genes that metabolize and affect the internal dose of carcinogens. We conducted a population-based, case-control study (814 incident cases, 1049 controls) in rural Honduras, a high-incidence region with a homogeneous diet and endemic H. pylori infection, primarily with the high-risk CagA genotype. We investigated factors including wood cookstove use, H. pylori CagA serostatus, and 15 variants from 7 metabolizing genes, and the interactions between wood stove use and the genetic variants. Male sex (OR 2.0, 1.6-2.6), age (OR 1.04, 1.03-1.05), wood cookstove use (OR 2.3, 1.6-3.3), and CagA serostatus (OR 3.5, 2.4-5.1) and two SNPs in CYP1B1 (rs1800440 and rs1056836) were independently associated with gastric cancer in multivariate analysis. In the final multivariate model, a highly significant interaction (OR 3.1, 1.2-7.8) was noted between wood cookstove use and the rs1800440 metabolizing genotype, highlighting an important gene-environment interaction. Lifetime wood cookstove use associates with gastric cancer risk in the high-incidence regions of Central America, and the association is dependent on the rs1800440 genotype in CYP1B1. H. pylori CagA infection, wood cookstove use and the rs1800440 genotype, all of which are highly prevalent, informs who is at greatest risk from biomass cookstove use.

Path integrals, particular kinds, and strange things.

This paper describes a path integral formulation of the free energy principle. The ensuing account expresses the paths or trajectories that a particle takes as it evolves over time. The main results are a method or principle of least action that can be used to emulate the behaviour of particles in open exchange with their external milieu. Particles are defined by a particular partition, in which internal states are individuated from external states by active and sensory blanket states. The variational principle at hand allows one to interpret internal dynamics-of certain kinds of particles-as inferring external states that are hidden behind blanket states. We consider different kinds of particles, and to what extent they can be imbued with an elementary form of inference or sentience. Specifically, we consider the distinction between dissipative and conservative particles, inert and active particles and, finally, ordinary and strange particles. Strange particles can be described as inferring their own actions, endowing them with apparent autonomy or agency. In short-of the kinds of particles afforded by a particular partition-strange kinds may be apt for describing sentient behaviour.

Genome-wide maps of UVA and UVB mutagenesis in yeast reveal distinct causative lesions and mutational strand asymmetries.

Ultraviolet (UV) light primarily causes C > T substitutions in lesion-forming dipyrimidine sequences. However, many of the key driver mutations in melanoma do not fit this canonical UV signature, but are instead caused by T > A, T > C, or C > A substitutions. To what extent exposure to the UVB or UVA spectrum of sunlight can induce these noncanonical mutation classes, and the molecular mechanism involved is unclear. Here, we repeatedly exposed wild-type or repair-deficient yeast (Saccharomyces cerevisiae) to UVB or UVA light and characterized the resulting mutations by whole genome sequencing. Our data indicate that UVB induces C > T and T > C substitutions in dipyrimidines, and T > A substitutions that are often associated with thymine-adenine (TA) sequences. All of these mutation classes are induced in nucleotide excision repair-deficient cells and show transcriptional strand asymmetry, suggesting they are caused by helix-distorting UV photoproducts. In contrast, UVA exposure induces orders of magnitude fewer mutations with a distinct mutation spectrum. UVA-induced mutations are elevated in Ogg1-deficient cells, and the resulting spectrum consists almost entirely of C > A/G > T mutations, indicating they are likely derived from oxidative guanine lesions. These mutations show replication asymmetry, with elevated G > T mutations on the leading strand, suggesting there is a strand bias in the removal or bypass of guanine lesions during replication. Finally, we develop a mutation reporter to show that UVA induces a G > T reversion mutation in yeast that mimics the oncogenic NRAS Q61K mutation in melanoma. Taken together, these findings indicate that UVA and UVB exposure can induce many of the noncanonical mutation classes that cause driver mutations in melanoma.

On Bayesian mechanics: a physics of and by beliefs.

The aim of this paper is to introduce a field of study that has emerged over the last decade, called Bayesian mechanics. Bayesian mechanics is a probabilistic mechanics, comprising tools that enable us to model systems endowed with a particular partition (i.e. into particles), where the internal states (or the trajectories of internal states) of a particular system encode the parameters of beliefs about external states (or their trajectories). These tools allow us to write down mechanical theories for systems that look as if they are estimating posterior probability distributions over the causes of their sensory states. This provides a formal language for modelling the constraints, forces, potentials and other quantities determining the dynamics of such systems, especially as they entail dynamics on a space of beliefs (i.e. on a statistical manifold). Here, we will review the state of the art in the literature on the free energy principle, distinguishing between three ways in which Bayesian mechanics has been applied to particular systems (i.e. path-tracking, mode-tracking and mode-matching). We go on to examine a duality between the free energy principle and the constrained maximum entropy principle, both of which lie at the heart of Bayesian mechanics, and discuss its implications.

High-Dose vs. Low-Dose Dexamethasone in Patients With COVID-19: A Cohort Study in Rural Central America.

To compare the clinical outcomes of a low dose dexamethasone strategy vs. a high-dose dexamethasone strategy in hypoxemic COVID-19 patients. A retrospective observational study comparing low-dose (8 mg) and high-dose dexamethasone (24 mg) of COVID-19 patients admitted from September 1, 2020 to October 31, 2020 in a hospital in Honduras. We included 81 patients with confirmed COVID-19 who required oxygen therapy. The mean age was similar between groups (57.49 vs. 56.95 years). There were more male patients in the group of 24 mg ( p = 0.01). Besides, patients on the 24 mg dose had more prevalence of hypertension ( p = 0.052). More patients in the 24 mg group had a higher rate of invasive mechanical ventilation (15.00% vs. 2.56%, p = 0.058). When evaluating the association between the high dose group and outcomes, we find no significant association with mortality, nosocomial infections, high flow mask, invasive mechanical ventilation, or the need for vasopressors. We find no significant differences in the Kaplan-Meier analysis regarding the survival (log-rank p -value = 0.315). We did not find significant differences between the use of 24 mg and 8 mg of dexamethasone in hypoxemic COVID-19 patients.

Substrate degradation and postbiotic analysis of alternative fiber ingredients fermented using an in vitro canine fecal inoculum model.

Many fiber ingredients are used by the pet food industry; however, little data are available regarding the fermentation characteristics of alternative fibers currently being used. The objectives of this study were to determine organic matter disappearance (OMD) and postbiotic production from various fruit and vegetable fiber sources using an in vitro dog fecal inoculum model. Apple pomace (AP), blueberry pomace (BP), cranberry pomace (CP), tomato pomace (TP), and pea fiber (PF) were used as experimental treatments. Inoculum was prepared using freshly voided feces under anaerobic conditions. Predigested fibers were inoculated and incubated for 1, 3, 6, and 12 h at 39 °C. Short-chain fatty acids (SCFA), branched-chain fatty acids (BCFA), total volatile fatty acids (VFA), and OMD were determined for each fiber source and time point in triplicate. After 12 h of incubation, OMD was similar (P > 0.05; average of 18.5%) among treatments. Proportionally, acetate was greater for BP and AP (P < 0.05; average of 80.1%) than for the other treatments (68.3% to 71.2%). Molar proportions of propionate was greatest (P < 0.05) for CP (26.8%) compared to the remaining treatments (13.6 to 20.7%). Butyrate was proportionally greater for PF (7.7%; P < 0.05) than for BP and CP (average of 4.8%) and was lowest for AP (3.8%); however, TP was not different from PF (P > 0.05; average of 7.25%). Total VFA concentration was highest for AP (P < 0.05) followed by TP (1.17 and 0.75 mmol*g-1 of substrate, respectively). Both BP and PF were similar (average of 0.48 mmol*g-1 of substrate) and lower than for TP, with CP having the lowest VFA concentration (0.21 mmol*g-1 of substrate) among all treatments. Additionally, when comparing molar concentrations, AP and TP (average of 0.0476 mmol*g-1 of substrate) had greater butyrate concentrations than did PF (0.0344 mmol*g-1 of substrate). The AP, BP, and TP treatments had both linear and quadratic relationships (Table 7; P < 0.05) for acetate, propionate, and butyrate concentrations across time. CP only demonstrated a linear relationship for propionate (P < 0.05), whereas acetate and butyrate had quadratic relationships with time. PF only demonstrated quadratic relationships between acetate, propionate, and butyrate concentrations and time (P < 0.05). Overall, the fiber substrates evaluated were marginally to moderately fermentable when incubated for up to 12 h with canine fecal inoculum.

Fibers fermented in the gut result in the production of short-chain fatty acids (SCFA) acetate, propionate, and butyrate. These postbiotic compounds, particularly butyrate, play an important role in colonic and host health. Fibers not degraded by the microbiota aid in stool formation and promote laxation. Many fiber ingredients are used in pet diets; however, data regarding the fermentation characteristics of alternative fiber ingredients are scarce. In this work, substrate degradation and postbiotic analysis were evaluated for apple pomace (AP), blueberry pomace (BP), cranberry pomace (CP), pea fiber (PF), and tomato pomace (TP) incubated for 1, 3, 6, and 12 h at 39 °C using canine fecal inoculum. After 12 h, substrate degradation was not different among treatments due to high variability. AP had the highest concentration of total SCFA, followed by TP, BP, PF, and CP. The molar proportion of acetate was greatest for AP and BP. CP had the highest molar proportion of propionate. PF had greater molar proportions of butyrate than did AP, BP, and CP, but had similar molar proportions as TP. Additionally, the molar concentrations of butyrate were greatest for AP and TP. Overall, fiber substrates were marginally to moderately fermentable when incubated for up to 12 h with canine fecal inoculum.

Prevalence of Obesity and Metabolic Syndrome in the High Cardiovascular Risk Setting of Rural Western Honduras.

Objective: To determine the prevalence of obesity and metabolic syndrome (MS) in the population older than 45 years in rural Western Honduras and contribute to the limited literature on MS in Central America. Methods: Descriptive cross-sectional study conducted in the District of Copan. The study includes 382 men and women aged 45 to 75 years. With proper consent, anthropometric parameters, blood pressure, blood sugar, and lipid profile were evaluated. MS was diagnosed by using the National Cholesterol Education Program Criteria - Adult Panel Treatment III (NCEP-ATP III). Data were stored in REDCap (Research Electronic Data Capture) and analyzed with STATA14. Results: Data were collected on 382 patients; of these, 38% were male and 62% female. The prevalence of obesity was 24.1% for both sexes. The prevalence of MS was 64.9%. Prevalence in males and females was 54% and 71%, respectively. Notable parameters were elevated triglycerides (71%), low High-density lipoprotein cholesterol (HDL-C) (63.4%), and abdominal obesity (56.8%). In men, the distribution of MS was more homogeneous, with a mean result of 80% amongst all ages. Conclusions: The overall prevalence of obesity and MS is severely underestimated in rural Honduras. The most remarkable parameter for MS was high triglycerides (71%). Sixty-nine percent of the population has above-normal Body Mass Index (BMI). Public health efforts to control comorbidities and tackle risk factors in this population should take utmost priority.

Evaluation of Torula yeast as a protein source in extruded feline diets.

The objective of this work was to evaluate the use of a Torula yeast (TY) on diet processing, palatability, and total tract nutrient digestibility in extruded feline diets. Four dietary treatments were compared, differing by protein source: TY, pea protein concentrate (PP), soybean meal (SM), and chicken meal (CM). Diets were produced using a single-screw extruder under similar processing conditions. Palatability assessment was conducted as a split plate design where both first choice and intake ratio (IR) were determined. Apparent total tract digestibility (ATTD) of nutrients was estimated using Titanium dioxide as an indigestible marker. During diet production, specific mechanical energy of TY and SM (average of 187 kJ/kg) was greater (P < 0.05) than for PP (138 kJ/kg); however, CM was similar to all treatments (167 kJ/kg). Kibble diameter, piece volume, and sectional expansion ratio were greatest for TY (P < 0.05). Additionally, both bulk and piece density were lowest (P < 0.05) for TY. Kibble hardness was lower for TY and SM (P < 0.05; average of 2.10 Newtons) compared to CM and PP (average of 2.90 Newtons). During the palatability trial, TY was chosen first a greater number of times than CM (P < 0.05; 36 vs. 4, respectively), but differences were not found between TY and PP (25 vs. 15, respectively) or TY and SM (24 vs. 16, respectively). Cats had a greater IR (P < 0.05) of TY compared to CM and PP (0.88 and 0.73, respectively). However, there was no difference in preference between TY and SM. ATTD of dry matter (DM) and organic matter (OM) was greater (P < 0.05) for CM (87.43% and 91.34%, respectively) than other treatments. Both DM and OM ATTD of TY were similar (P < 0.05) to PP and SM (average of 86.20% and average of 89.76%, respectively). Ash ATTD was greater (P < 0.05) for cats fed TY and SM (average of 37.42%), intermediate for PP (32.79%), and lowest for CM (23.97%). Crude protein (CP) ATTD of TY was similar to all other treatments (average of 89.97%), but fat ATTD was lower (P < 0.05; 92.52%) than other treatments (93.76% to 94.82%). Gross energy ATTD was greater (P < 0.05) for CM than TY (90.97% vs. 90.18%, respectively); however, TY was similar to PP and SM (average of 90.22%). Total dietary fiber ATTD was similar between TY and CM (average of 66.20%) and greater (P < 0.05) than PP and SM (average of 58.70%). The TY used in this study facilitated diet formation, increased diet preference, and was highly digestible when fed to cats.

In 2021, US$50 billion was spent on pet food and pet treats in the United States alone. Pet diets are largely sourced from animal proteins; however, the sustainability of these diets remains a major concern. Microbial proteins from microorganisms such as yeasts offer a sustainable protein alternative. Torula yeast (TY) is produced specifically for nutritional value and is grown on low-value woody waste materials. In this work, a commercially available TY product was evaluated in extruded feline diets and compared against soybean meal (SM), pea protein (PP), and chicken meal (CM). During diet manufacturing, the TY ingredient facilitated processing and forming of the final product. When comparing preference of dietary treatments, the diet containing the TY was preferred over that of the PP diet and the CM diet but was not different from the SM diet. Nutrient digestibility was similar or greater for TY compared with other protein ingredients, apart from a lower fat digestibility. Cats fed TY produced softer and less formed feces likely attributed to fiber composition. It was concluded here that TY could be safely included into feline diets, but inclusion level may be limited by fecal quality considerations.

Gastric Cancer: Emerging Trends in Prevention, Diagnosis, and Treatment.

Gastric adenocarcinoma (GC) is the fourth leading cause of global cancer mortality, and the leading infection-associated cancer. Helicobacter pylori is the dominant risk factor for GC and classified as an IARC class I carcinogen. Surveillance of gastric premalignant conditions is now indicated in high-risk patients. Upper endoscopy is the gold standard for GC diagnosis, and image-enhanced endoscopy increases the detection of gastric premalignant conditions and early gastric cancer (EGC). Clinical staging is crucial for treatment approach, defining early gastric cancer, operable locoregional disease, and advanced GC. Endoscopic submucosal dissection is the treatment of choice for most EGC. Targeted therapies are rapidly evolving, based on biomarkers including MSI/dMMR, HER2, and PD-L1. These advancements in surveillance, diagnostic and therapeutic strategies are expected to improve GC survival rates in the near term.