Application of a Platform for Gluten-Free Diet Evaluation and Dietary Advice: From Theory to Practice.

The present work aimed to analyze, through the GlutenFreeDiet digital platform, the evolution over one year of the nutritional status, dietary profile and symptoms present among celiac people on a gluten-free diet (GFD) while receiving individualized dietary advice. Twenty-seven adults and thirty-one celiac children/adolescents participated in the study. This was then followed up by three visits, at diagnosis, and after 3 and 12 months (vt0, vt3 and vt12). Participants filled out dietary and gastrointestinal symptoms questionnaires. All patients received written personalized dietary advice from dietitians who interpreted data from the platform. Results obtained indicated that participants consumed proteins and lipids in excess and carbohydrates in defect. Low intakes of cereals, fruit and vegetables and high meat intakes were observed. However, gluten-free product (GFP) consumption and that of ultra-processed foods was reduced after 1 year in adults. Symptoms decreased after vt3 but recurred in vt12. Changes in ultra-processed foods and GFP intake, but lack of changes in the rest of the parameters suggested that the platform support was not effective enough. Even though the platform represents a useful tool for monitoring celiac patients and giving dietary advice, modules that require more continuous attention and nutritional education of patients should be provided for interventions to be more effective.

Non-celiac gluten sensitivity and chronic refractory low back pain with spondyloarthritis features.

OBJECTIVE: To propose the hypothesis that non-celiac gluten sensitivity is associated with chronic low-back pain related to spondyloarthritis, and a gluten free diet has a therapeutic benefit in a subgroup of patients. Gut involvement is a well-known association of spondyloarthritis but limited to a few disorders such as inflammatory bowel disease. Currently the therapeutic implication of this association is pharmacologic treatment for inflammation with immunosupresive drugs for both diseases. Here is a case series of patients with chronic low-back pain, spondyloarthritis related features, and response to gluten free diet despite celiac disease being ruled out. METHODS: Retrospective case report of 110 patients from a tertiary hospital rheumatology clinic specialized in chronic pain and gluten sensitivity. These are patients with refractory low-back pain and spondyloarthritis features who followed a gluten free diet despite celiac disease being ruled out. Demanding improvement was defined based on the achievement of at least one of the following objectives: asymptomatic status, remission of chronic low-back pain, returning to normal life, returning to work, changing from confinement to bed/wheelchair to being able to walk, returning to self-sufficiency for hygiene and personal care, discontinuation of opioids. RESULTS: Average age at low-back onset pain was 30. Average disease duration was 15 years. 87 (79%) of the patients experienced improvement. 69 (62%) of the patients achieved demanding improvement. Average duration of gluten-free diet in patients with demanding improvement was 60 months. 56 out of 69 patients with demanding improvement ingested gluten. Of these 56 patients, 54 experienced clinical worsening and were considered as having non-celiac gluten sensitivity. Oral aphthae and having a relative with celiac disease were associated with demanding improvement. Out of 28 patients retrospectively classified as having axial spondyloarthritis, 23 had demanding improvement. Out of 16 patients with uveitis, 13 had demanding improvement. Out of 83 patients with fibromyalgia, 48 had demanding improvement. CONCLUSION: These observational data support the proposed hypothesis and offer information regarding possible clinical predictors of response to diet.

Metodología para el análisis de la sostenibilidad de las organizaciones sanitarias / Methodology for the analysis of the sustainability of health organizations

El sistema sanitario afronta retos financieros, de incremento de la demanda y de escasez de recursos, en un marco donde la calidad asistencial se hace imprescindible. El sistema actual necesita reformas que aseguren su sostenibilidad. Se proponen diferentes reformas para el sistema sanitario, pero cada organización tiene sus propias necesidades y es a este nivel donde debemos plantearnos cómo conocer cada situación particular para afrontar el futuro. Para ello se ha realizado una revisión bibliográfica sobre sostenibilidad organizacional y sobre metodologías utilizadas en su estudio. Tras analizar la bibliografía y la opinión de expertos se identificó como la mejor opción utilizar una metodología mixta cuantitativo-cualitativa combinando herramientas que identifiquen en las organizaciones la cultura de la adaptabilidad y la respuesta a las necesidades y expectativas de las partes interesadas. Esta metodología aporta una visión holística de la organización en consonancia con el propio enfoque de la profesión enfermera

The health system has financial challenges, increasing demand and scarcity of resources, in a framework where quality of care is essential. The current system needs reforms that ensure its sustainability. Different reforms are proposed that the system needs, but each organization has its own needs and it is at this level where we should consider how to know each particular situation to face the future. A bibliographical review on sustainability and on methodologies used in its study has been carried out with this aim. After analyzing the bibliography and the opinion of experts, it was identified as the best option to use a mixed quantitative-qualitative methodology combining tools that identify in the organizations the culture of adaptability and the response to the needs and expectations of the interested parties. This methodology provides a holistic view of the organization in line with the approach of the nursing profession

Sueño saludable: evidencias y guías de actuación. Documento oficial de la Sociedad Española de Sueño / Healthy sleep: evidence and guidelines for action. Official document of the Spanish Sleep Society

La Sociedad Española de Sueño tiene como uno de sus principales objetivos la promoción de un sueño saludable en la población general y profesionales de la salud. El presente documento pretende realizar una revisión de la literatura científica actual sobre hábitos de sueño que sirva de fundamento para establecer unas recomendaciones generales y útiles para la población general española, en el contexto de un sueño saludable, e identificar aquellos principales retos en la investigación sobre hábitos de sueño. El desarrollo del documento se ha realizado por un equipo multidisciplinar de miembros de la Sociedad Española de Sueño integrado por expertos en medicina pediátrica del sueño, neurofisiología clínica, neumología, neurología, cronobiología, fisiología y psicología. Se ha procedido a una revisión de la bibliografía científica existente sobre hábitos de sueño en población general, y se han abordado los siguientes aspectos: estado actual de los hábitos de sueño en la población española; revisión genérica de la cantidad óptima de horas de sueño; impacto del entorno ambiental (ruido, temperatura, iluminación...), horarios de sueño, alimentación y deporte; y apartados específicos para niños y adolescentes, trabajadores a turnos y conducción de vehículos. De todos los aspectos abordados a lo largo de este documento, se concluyen unas recomendaciones generales finales que servirán de guía a la población general y profesionales de la salud, así como se discuten los principales retos ambientales y futuras direcciones de investigación (AU)

One of the main objectives of the Spanish Sleep Society is to promote healthy sleep in both the general population and in health professionals. This document aims to conduct a review of the current scientific literature on sleep habits that can serve as the basis on which to establish a set of general recommendations, regarding healthy sleep, for use by the general population in Spain as well as to identify the main challenges faced by research into sleep habits. The document has been developed by a multidisciplinary team made up of members of the Spanish Sleep Society who are experts in paediatric sleep medicine, clinical neurophysiology, pulmonology, neurology, chronobiology, physiology and psychology. The existing scientific literature dealing with sleep habits in the general population was reviewed, and the following aspects were addressed: the current state of sleep habits in the Spanish population; a generic review of the optimum number of hours of sleep; the impact of the environmental setting (noise, temperature, illumination, etc.), hours of sleep, diet and sport, together with several specific sections for children and teenagers, shift-workers and drivers of different vehicles. The conclusions from all the aspects addressed in this document have resulted in a set of final general recommendations that will serve as a guide for the general population and health professionals. Likewise, the principal environmental challenges and future lines of research are also discussed (AU)

Predicción en tiempo real de la malignidad de ganglios linfáticos mediastínicos mediante ecografía endobronquial / Real-Time Prediction of Mediastinal Lymph Node Malignancy by Endobronchial Ultrasound

Objetivo: Evaluar la utilidad de diferentes características ecográficas para diferenciar los ganglios linfáticos (GL) benignos y malignos mediante ecografía endobronquial (EBUS) y validar una puntuación para una aplicación clínica en tiempo real. Métodos: Se analizaron 208 GL mediastínicos procedentes de 141 pacientes. Dos observadores evaluaron de manera independiente 6 criterios ecográficos diferentes (eje menor ≥ 10 mm, forma, margen, ecogenicidad y estructura hiliar central [EHC] y presencia de densidad hiperecogénica). Se generó una puntuación simplificada en la que a la presencia de márgenes bien definidos, la forma redondeada y el eje menor ≥ 10 mm se les asignaba una puntuación de 1 y a la ecogenicidad heterogénea y la ausencia de EHC se les asignaba una puntuación de 1,5. La puntuación se evaluó prospectivamente para la aplicación clínica en tiempo real en 65 GL durante la EBUS llevada a cabo por 2 operadores experimentados en 39 pacientes. Estos criterios se correlacionaron con los resultados histopatológicos, y se calcularon la sensibilidad, la especificidad y los valores predictivos positivo (VPP) y negativo (VPN). Resultados: La heterogeneidad y la ausencia de EHC fueron los parámetros que mostraron la máxima sensibilidad y VPN (≥ 90%) en la predicción de la malignidad de los GL, con una coincidencia interobservadores aceptable (92 y 87%, respectivamente). En la aplicación en tiempo real, la sensibilidad y la especificidad de la puntuación > 5 fueron del 78 y del 86%, respectivamente; tan solo la ausencia de EHC, la forma redondeada y el tamaño de los GL mostraron una asociación significativa con la malignidad de estos. Conclusiones: La combinación de diferentes criterios ecográficos puede ser útil en la predicción de la malignidad de los GL mediastínicos y válida para una aplicación clínica en tiempo real

Objective: To evaluate the utility of different ultrasonographic (US) features in differentiating benign and malignant lymph node (LN) by endobronchial ultrasound (EBUS) and validate a score for real-time clinical application. Methods: A total of 208 mediastinal LNs acquired from 141 patients were analyzed. Six different US criteria were evaluated (short axis ≥ 10 mm, shape, margin, echogenicity, central hilar structure [CHS], and presence of hyperechoic density) by two observers independently. A simplified score was generated where the presence of margin distinction, round shape and short axis ≥ 10 mm were scored as 1, and heterogeneous echogenicity and absence of CHS were scored as 1.5. The score was evaluated prospectively for real-time clinical application in 65 LNs during EBUS procedure in 39 patients undertaken by two experienced operators. These criteria were correlated with the histopathological results and the sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated. Results: Both heterogenicity and absence of CHS had the highest sensitivity and NPV (≥ 90%) for predicting LN malignancy with acceptable inter-observer agreement (92% and 87% respectively). On real-time application, the sensitivity and specificity of the score > 5 were 78% and 86% respectively; only the absence of CHS, round shape and size of LN were significantly associated with malignant LN. Conclusions: A combination of different US criteria can be useful for the prediction of mediastinal LN malignancy and valid for real-time clinical application

Real-time prediction of mediastinal lymph node malignancy by endobronchial ultrasound.

OBJECTIVE: To evaluate the utility of different ultrasonographic (US) features in differentiating benign and malignant lymph node (LN) by endobronchial ultrasound (EBUS) and validate a score for real-time clinical application. METHODS: 208 mediastinal LN acquired from 141 patients were analyzed. Six different US criteria were evaluated (short axis ≥10 mm, shape, margin, echogenicity, and central hilar structure [CHS], and presence of hyperechoic density) by two observers independently. A simplified score was generated where the presence of margin distinction, round shape and short axis ≥10 mm were scored as 1 and heterogeneous echogenicity and absence of CHS were scored as 1.5. The score was evaluated prospectively for real-time clinical application in 65 LN during EBUS procedure in 39 patients undertaken by two experienced operators. These criteria were correlated with the histopathological results and the sensitivity, specificity, positive and negative predictive values (PPV and NPV) were calculated. RESULTS: Both heterogenicity and absence of CHS had the highest sensitivity and NPV (≥90%) for predicting LN malignancy with acceptable inter-observer agreement (92% and 87% respectively). On real-time application, the sensitivity and specificity of the score >5 were 78% and 86% respectively; only the absence of CHS, round shape and size of LN were significantly associated with malignant LN. CONCLUSIONS: Combination of different US criteria can be useful for prediction of mediastinal LN malignancy and valid for real-time clinical application.

SO(2) protects the amino nitrogen metabolism of Saccharomyces cerevisiae under thermal stress.

Thermal stress conditions during alcoholic fermentation modify yeasts' plasma membrane since they become more hyperfluid, which results in a loss of bilayer integrity. In this study, the influence of elevated temperatures on nitrogen metabolism of a Saccharomyces cerevisiae strain was studied, as well as the effect of different concentrations of SO(2) on nitrogen metabolism under thermal stress conditions. The results obtained revealed that amino nitrogen consumption was lower in the fermentation sample subjected to thermal stress than in the control, and differences in amino acid consumption preferences were also detected, especially at the beginning of the fermentation. Under thermal stress conditions, among the three doses of SO(2) studied (0, 35, 70 mg l(-1) SO(2) ), the highest dose was observed to favour amino acid utilization during the fermentative process, whereas sugar consumption presented higher rates at medium doses.

The Rover Environmental Monitoring Station Ground Temperature Sensor: a pyrometer for measuring ground temperature on Mars.

We describe the parameters that drive the design and modeling of the Rover Environmental Monitoring Station (REMS) Ground Temperature Sensor (GTS), an instrument aboard NASA's Mars Science Laboratory, and report preliminary test results. REMS GTS is a lightweight, low-power, and low cost pyrometer for measuring the Martian surface kinematic temperature. The sensor's main feature is its innovative design, based on a simple mechanical structure with no moving parts. It includes an in-flight calibration system that permits sensor recalibration when sensor sensitivity has been degraded by deposition of dust over the optics. This paper provides the first results of a GTS engineering model working in a Martian-like, extreme environment.

The pharmacology of the acute hyperthermic response that follows administration of 3,4-methylenedioxymethamphetamine (MDMA, 'ecstasy') to rats.

1. The pharmacology of the acute hyperthermia that follows 3,4-methylenedioxymethamphetamine (MDMA, 'ecstasy') administration to rats has been investigated. 2. MDMA (12.5 mg kg(-1) i.p.) produced acute hyperthermia (measured rectally). The tail skin temperature did not increase, suggesting that MDMA may impair heat dissipation. 3. Pretreatment with the 5-HT(1/2) antagonist methysergide (10 mg kg(-1)), the 5-HT(2A) antagonist MDL 100,907 (0.1 mg kg(-1)) or the 5-HT(2C) antagonist SB 242084 (3 mg kg(-1)) failed to alter the hyperthermia. The 5-HT(2) antagonist ritanserin (1 mg kg(-1)) was without effect, but MDL 11,939 (5 mg kg(-1)) blocked the hyperthermia, possibly because of activity at non-serotonergic receptors. 4. The 5-HT uptake inhibitor zimeldine (10 mg kg(-1)) had no effect on MDMA-induced hyperthermia. The uptake inhibitor fluoxetine (10 mg kg(-1)) markedly attenuated the MDMA-induced increase in hippocampal extracellular 5-HT, also without altering hyperthermia. 5. The dopamine D(2) antagonist remoxipride (10 mg kg(-1)) did not alter MDMA-induced hyperthermia, but the D(1) antagonist SCH 23390 (0.3 - 2.0 mg kg(-1)) dose-dependently antagonized it. 6. The dopamine uptake inhibitor GBR 12909 (10 mg kg(-1)) did not alter the hyperthermic response and microdialysis demonstrated that it did not inhibit MDMA-induced striatal dopamine release. 7. These results demonstrate that in vivo MDMA-induced 5-HT release is inhibited by 5-HT uptake inhibitors, but MDMA-induced dopamine release may not be altered by a dopamine uptake inhibitor. 8. It is suggested that MDMA-induced hyperthermia results not from MDMA-induced 5-HT release, but rather from the increased release of dopamine that acts at D(1) receptors. This has implications for the clinical treatment of MDMA-induced hyperthermia.