A comprehensive review of machine learning and its application to dairy products.

Machine learning (ML) technology is a powerful tool in food science and engineering offering numerous advantages, from recognizing patterns and predicting outcomes to customizing and adjusting to individual needs. Its further development can enable researchers and industries to significantly enhance the efficiency of dairy processing while providing valuable insights into the field. This paper presents an overview of the role of machine learning in the dairy industry and its potential to improve the efficiency of dairy processing. We performed a systematic search for articles published between January 2003 and January 2023 related to machine learning in dairy products and highlighted the algorithms used. 48 studies are discussed to assist researchers in identifying the best methods that could be applied in their field and providing relevant ideas for future research directions. Moreover, a step-by-step guide to the machine learning process, including a classification of different machine learning algorithms, is provided. This review focuses on state-of-the-art machine learning applications in milk products and their transformation into other dairy products, but it also presents future perspectives and conclusions. The study serves as a valuable guide for individuals in the dairy industry interested in learning about or getting involved with ML.

Cirrosis en una lactante como manifestación de un defecto congénito de la glicosilación

Se presenta el caso de una recién nacida a término valorada en el servicio de urgencias por ictericia sin criterios de fototerapia. En los controles analíticos posteriores se detecta hipertransaminasemia y dislipemia con aumento de LDL-colesterol. Tras no objetivar alteraciones en los diferentes parámetros estudiados se realiza biopsia hepática que muestra hallazgos compatibles con cirrosis. Se amplía el estudio metabólico y presenta un perfil alterado de sialotransferrinas lo que lleva a realizar un diagnóstico de defecto congénito de la glicosilación. Bajo este nombre se incluye un grupo amplio de enfermedades relacionadas con alteraciones en el proceso de unión de glicanos a las cadenas proteicas. Este defecto, de origen genético, implica cambios en la estructura y funcionalidad de las glicoproteínas. Las manifestaciones clínicas son heterogéneas, en función del gen afecto y del tipo de glicoproteínas alteradas, siendo lo más común la afectación hepática, neurológica y hematológica. (provisto por Infomedic International)

We present the case of a full-term newborn girl evaluated in the emergency department for jaundice without phototherapy criteria. Subsequent laboratory tests showed hypertransaminasemia and dyslipidemia with increased LDL-cholesterol. After finding no alterations in the different parameters studied, a liver biopsy was performed showing findings compatible with cirrhosis. The metabolic study was extended and the patient presented an altered sialotransferrin profile, which led to a diagnosis of congenital defect of glycosylation. This name includes a broad group of diseases related to alterations in the process of glycan binding to protein chains. This defect, of genetic origin, involves changes in the structure and functionality of glycoproteins. The clinical manifestations are heterogeneous, depending on the gene affected and the type of glycoproteins altered, the most common being hepatic, neurological and hematological involvement. (provided by Infomedic International)

Rabdomiólisis aguda en edad pediátrica

La rabdomiólisis es un síndrome caracterizado por la destrucción del músculo esquelético y liberación de elementos intracelulares a la circulación. La triada clásica de dolor muscular, debilidad y orina oscura no es muy común en la edad pediátrica, prevaleciendo una sintomatología más atípica cuanto menor sea la edad del afectado. La etiología puede ser adquirida o hereditaria, siendo las causas más frecuentes las infecciones, miopatías y el ejercicio físico. La severidad de la enfermedad es muy variable, desde una elevación aislada de las enzimas musculares hasta una patología más grave con alteraciones hidroelectrolíticas e insuficiencia renal. A continuación, se describen tres casos clínicos en los que tener un alto índice de sospecha resultó esencial para poder iniciar un tratamiento precoz con hidratación intravenosa y así garantizar una evolución favorable hasta la recuperación. (provisto por Infomedic International)

Rhabdomyolysis is a syndrome characterized by the destruction of skeletal muscle and release of intracellular elements into the circulation. The classic triad of muscle pain, weakness and dark urine is not very common in pediatric age, with more atypical symptomatology prevailing the younger the age of the affected person. The etiology can be acquired or hereditary, the most frequent causes being infections, myopathies and physical exercise. The severity of the disease is very variable, from an isolated elevation of muscle enzymes to a more severe pathology with hydroelectrolytic alterations and renal failure. Three clinical cases are described below in which a high index of suspicion was essential to initiate early treatment with intravenous hydration and thus guarantee a favorable evolution until recovery. (provided by Infomedic International)

Remodelado eléctrico reverso en pacientes tratados con terapia de resincronización cardíaca / Reverse electrical remodeling in patients under cardiac resynchronization therapy

RESUMEN Introducción : La terapia de resincronización cardíaca (TRC) se indica en pacientes que habitualmente presentan remodelado cardíaco generado por dilatación y disincronía contráctil. La TRC contribuye al remodelado reverso, relacionado con menor mortalidad y hospitalizaciones por insuficiencia cardíaca (IC). Se han observado además mejoras en la conducción intraventricular, con reducción del tiempo de activación. La cuantificación del remodelado eléctrico reverso se ha subutilizado como parámetro de respuesta, con escasos reportes sobre su asociación con la respuesta clínica-estructural. Objetivo : Analizar el remodelado eléctrico reverso intraventricular como parámetro de respuesta a la TRC. Métodos: Se incluyeron pacientes con más de 6 meses de implante. Se obtuvo un ECG con estimulación desactivada (QRS intrínseco, QRSi, post TRC), y por ecocardiograma transtorácico se definió la fracción de eyección ventricular izquierda (FEVI), el diámetro de fin de diástole del ventrículo izquierdo (DFDVI) y la presencia de insuficiencia mitral. Se clasificó a los pacientes según la respuesta clínica-estructural. El remodelado eléctrico se caracterizó con la comparación de la duración del QRS pre y post TRC y la valoración de los cambios del QRS (ΔQRSi) entre grupos. Resultados : Se incluyeron 23 pacientes. Un 39% presentó disminución >10 mseg del QRSi. Observamos un QRSi de -9,3 ± 20,7 mseg en respondedores, y 11,25 ± 18,9 mseg en no respondedores (p = 0,027), más acentuada en los hiper respondedores (ΔQRSi: -14,44 ± 17,40 mseg, p = 0,026). Las mujeres con QRS ≥150 mseg pre TRC exhibieron disminución significativa del QRSi (p = 0,0195). Conclusiones : El remodelado eléctrico reverso se comprobó en 39% de los pacientes que recibieron TRC. Observamos una relación significativa del QRSi con la respuesta clínica-estructural, mayor en hiper respondedores. Mujeres con QRS ancho pre-TRC exhiben remodelado eléctrico reverso más acentuado. Este es un parámetro de fácil acceso e interpretación durante los controles ambulatorios.

ABSTRACT Introduction : Cardiac resynchronization therapy (CRT) is indicated in patients who often present cardiac remodeling due to dilatation and contractile dyssynchrony. CRT contributes to reverse remodeling which is associated with reduced mortality and heart failure (HF) hospitalizations. Improvements in intraventricular conduction with decreased ventricular activation time have also been observed. The quantification of reverse electrical remodeling has been underused as a parameter of response, and there are few reports on its association with the clinical-structural response. Objective : To analyze intraventricular reverse electrical remodeling as a parameter of response to CRT in living individuals. Methods : We included patients implanted at least 6 months ago. A deactivated stimulation ECG (post-CRT intrinsic QRS) was obtained, and by means of transthoracic echocardiography (TTE), the left ventricular ejection fraction (LVEF), the left ventricular end-diastolic diameter (LVEDD) and the presence of mitral regurgitation were defined. Patients were classified according to their clinical-structural response. Electrical remodeling was characterized by comparing pre- and post-CRT QRS duration and assessing QRS changes (ΔiQRS) between groups. Results : A total of 23 patients were included, 39% of which showed a >10 ms decrease in iQRS. We observed a iQRS of -9.3±20.7 ms in responders, and of 11.25±18.9 ms in non-responders (p=0.027), more marked in hyper-responders (ΔiQRS: -14.44±17.40 ms, p=0.026). Women with pre-CRT QRS ≥150 ms showed a significant decrease in iQRS (p=0.0195). Conclusion : Reverse electrical remodeling was found in 39% of the patients under CRT. We noted a significant relationship between iQRS and clinical-structural response, higher in hyper-responders. Women with wider pre-CRT QRS showed more marked reverse electrical remodeling. This parameter is accessible and easy to read in outpatient visits.

Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery Associated with Right Coronary Giant Aneurysm.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital malformation, usually diagnosed in the infant period due to myocardial ischemia and heart failure, with the need for emergency surgery. Less commonly, it can be asymptomatic until adulthood. Coronary artery aneurysms are also rare anatomical anomalies with symptoms of acute or chronic angina or even remain completely asymptomatic. We present an unusual case of ALCAPA, associated with a giant aneurysm of the right coronary artery. Meeting presentation: American Association for Thoracic Surgery 102nd annual meeting, Boston MA, USA, May 16, 2022.

Hepatitis autoinmune y enfermedad celiaca en una paciente con hipertransaminasemia crónica

La hepatitis autoinmune es una patología poco frecuente en pediatría cuya incidencia ha aumentado en los últimos años. Aunque su espectro clínico es muy variado, debe sospecharse ante el aumento de transaminasas séricas tras haber descartado otras etiologías. A continuación, se presenta el caso de una paciente de 9 años con hipertransaminasemia crónica que fue diagnosticada de hepatitis autoinmune y enfermedad celiaca. (provisto por Infomedic International)

Autoimmune hepatitis is a rare pathology in pediatrics whose incidence has increased in recent years. Although its clinical spectrum is very varied, it should be suspected due to the increase in serum transaminases after having ruled out other etiologies. The case of a 9-year-old patient with chronic hypertransaminasemia who was diagnosed with autoimmune hepatitis and celiac disease is presented below. (provided by Infomedic International)

Anemia ferropénica como inicio de gastritis atrófica en un paciente con diabetes mellitus tipo 1 / Iron deficiency anaemia as a first manifestation of atrophic gastritis in a patient with type 1 diabetes mellitus

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Erupción purpúrica petequial, ni en guantes, ni en calcetines / Petechial erythema neither gloves, not socks syndrome

El parvovirus B19 generalmente infecta a niños y adultos jóvenes, presentando cuadros exantemáticos característicos, como el eritema infeccioso. Dentro de las manifestaciones hemorrágicas con erupción purpúrica-petequial, está el síndrome papular-purpúrico en guantes y calcetines. En ocasiones, distribuciones atípicas con erupciones petequiales asimétricas podrían complicar el diagnóstico, llevando a plantear diagnósticos diferenciales y a realizar pruebas de laboratorio. Se describe un caso inusual de parvovirus B19 con erupción petequial atípica, y se hace una revisión de la literatura médica reciente

Parvovirus B19 generally infects children and young adults, presenting characteristic rashes such as erythema infectiosum. Among the hemorrhagic manifestations with purpuric-petechial eruption is the papular purpuric socks and gloves syndrome. Occasionally, atypical distributions with asymmetric petechial rashes could complicate the diagnosis leading to differential diagnoses and laboratory tests. We describe an unusual case of parvovirus B19 with atypical petechial rash, and a recent literature review is reported

Acute effects of the intensity in the agonistantagonist paired-set on the neuromuscular performance / Efeito agudo da intensidade no sistema agonista-antagonista pareado por série sobre o desempenho neuromuscular

The intensity employed in the agonist-antagonist paired-set (AAPS) system may influence neuromuscular performance due to increased fatigue and decreased antagonist coactivation. However, it is not yet known whether performing submaximal repetitions at different intensities (i.e., wit h out m uscle failure) negatively affects agonist muscle performance. The aim of this study was to verify the acute effect of the AAPSsystem performed at different intensities with submaximal repetitions. 20 trained m ales in resistance training (RT) (21.8 [3.1] years; 76.9 [9.7] kg; 1.7 [0.0] m; 24.3 [2.6] kg/m2 ) participated of this investigation. All the participants were allocated in a randomized order in one of the two AAPS configurations: high-load (HL) or low-load (LL). In the HL condition, the individuals were submit t ed to one set of eight repetitions at 75% of one-repetition maximum (1RM) in the knee flexion (i.e., antagonist), followed by 75% 1RM knee extension (i.e., agonist) exercise until momentary concentric failure. In t he LL condition, they performed one set of 12 repetitions at 50% 1RMin the knee flexion, followed by knee extension at 75%1RM also until momentary concentric failure. Both experimental conditions p resented similar values for the number of repetitions, without significant difference (p= 0.66, ES= 0.15). Thus, our data suggest that the adoption of AAPS system without an increase of the antagonist fatigue and consequently no reduction of coactivation, acutely, may not lead to increased p erfo rm an ce o f target musculature during a resistance exercise session...(AU)

A intensidade empregada no sistema agonista-antagonista pareado por série ( AAPS) pode influenciar o desempenho neuromuscular devido ao aumento da fadiga e diminuição da co ativação do antagonista. No entanto, ainda não se sabe se realizar repetições submáximas em diferentes intensidades (i.e., sem falha muscular) afeta negativamente o desempenho muscular. O objetivo deste estudo foi verificar o efeito agudo do sistema AAPS realizado em diferentes intensidades com repetições submáximas. 20 homens treinados em treinamento resistido (TR) (21.8 ± 3.1 anos; 76.9 ± 9.7 kg; 1.7 ± 0.0 m; 24.3 ± 2.6 kg/m2 ) participaram desta investigação. Todos os participantes foram alocados, de forma aleatória, em uma das duas configurações do sistema AAPS: alta-carga (AC) ou baixa- carga (BC). Na condição AC, os indivíduos foram submetidos a uma série de oito repetições a 75% 1RMno exercício de flexão do joelho (i.e., antagonista), seguido por uma série a 75% 1RM de extensão do joelho até a falha oncêntrica momentânea. Ambas as condições experimentais apresentaram v alores sim ilares para o número de repetições, sem diferença significante (p = 0.66, TE = 0.15). Assim, nossos dados sugerem que a adoção do sistema AAPSsem aumento da fadiga do antagonista e consequentemente sem redução da coativação, agudamente, pode não levar ao aumento do desempenho da musculatura alvo durante uma sessão de exercício resistido...(AU)

Hypovitaminosis D and Cardiometabolic Risk Factors in Adolescents with Severe Obesity.

BACKGROUND/OBJECTIVES: Obesity is associated with cardiometabolic risk factors and with Vitamin D deficiency. The aim of this study was to examine the relationship between 25(OH)D concentrations and cardiometabolic risk factors in adolescents with severe obesity. SUBJECTS/METHODS: A cross-sectional clinical assessment (body mass index, fat mass index, fat-free mass index, waist-to-height ratio, and blood pressure) and metabolic study (triglycerides, total cholesterol, HDL-C, LDL-C, glucose, insulin, HOMA-IR, leptin, calcium, phosphorous, calcidiol, and PTH) were carried out in 236 adolescents diagnosed with severe obesity (BMI z-score > 3.0, 99th percentile), aged 10.2-15.8 years. The criteria of the US Endocrine Society were used for the definition of Vitamin D status. RESULTS: Subjects with Vitamin D deficiency had significantly elevated values (p < 0.05) for BMI z-score, waist circumference, waist z-score, body fat percentage, fat mass index, systolic and diastolic blood pressure, total cholesterol, triglycerides, LDL-C, insulin, HOMA-IR, leptin, and PTH than subjects with normal Vitamin D status. There was a significant negative correlation (p < 0.05) of serum 25(OH)D levels with body fat percentage, FMI, systolic BP, total cholesterol, triglyceride, LDL-C, glucose, insulin, HOMA-IR, leptin, and PTH. CONCLUSIONS: Low Vitamin D levels in adolescents with severe obesity were significantly associated with some cardiometabolic risk factors, including body mass index, waist circumference, fat mass index, high blood pressure, impaired lipid profile, and insulin resistance.

Ectopia renal intratorácica / Intrathoracic ectopic kidney

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Remodelado reverso de la aurícula izquierda posablación de venas pulmonares en la fibrilación auricular: una serie de casos / Reverse remodeling of left atrium post pulmonary veins ablation in atrial fibrillation: case series / Remodelação reversa do átrio esquerdo pós-ablação de veias pulmonares na fibrilação atrial: uma série de casos

Resumen: El aislamiento de las venas pulmonares usando sistemas de navegación en tercera dimensión (3D) es una técnica de uso universal que ha demostrado tasas de éxito significativas en la ablación de la fibrilación auricular (FA). Sin embargo, el remodelado que sufre la aurícula izquierda (AI) posterior a la ablación ha sido escasamente evaluado. Ocho pacientes fueron sometidos a ablación de las venas pulmonares con sistema de mapeo electroanatómico entre marzo de 2016 y marzo de 2017. Se evaluó la AI con ecocardiograma preprocedimiento, y uno y tres meses luego de este, utilizando las siguientes variables: volumen auricular izquierdo en biplano, fracción de eyección de AI (FEAI) y strain reservorio de AI en pared lateral. Para determinar la existencia de recurrencia se realizó Holter de 24 horas e interrogatorio telefónico a los tres y seis meses posablación. Se evidenció remodelado reverso estructural y funcional de la AI en seis pacientes. Aquellos con recurrencia de FA no presentaron remodelado reverso y mostraron mayor deterioro de la función auricular previo a la ablación. Estos hallazgos permiten plantearnos algunas hipótesis a investigar sobre los predictores de recurrencia.

Summary: Electrical isolation of the pulmonary veins using third dimension navigation systems is a universal technique that has showed a significant success in atrial fibrillation ablation. Nevertheless, the reverse remodeling suffered by the left atrium after ablation has been scarcely evaluated. Eight patients underwent the ablation of the pulmonary veins with electroanatomic map system, between March 2016 to March 2017. The left atrium was evaluated by echocardiogram pre procedure, and one and three months after ablation, using the following variables: left atrial volume in biplane, ejection fraction of the left atrium and reservoir strain of the left atrium in the lateral wall. To determine the existence of recurrence, Holter of 24 hours was applied and phone calls three and six months after were made. There was evidence of a reverse remodeling structural and functional of the left atrium in six patients. Those with recurrence of atrial fibrillation did not show reverse remodel and showed higher deterioration of the auricular function prior to the ablation. These findings let us make some hypotheses and investigate about recurrence predictors.

Resumo: O isolamento das veias pulmonares, utilizando sistemas de navegação em terceira dimensão, é uma técnica de uso universal que tem sucesso significativo na ablação de fibrilação atrial. No entanto, o remodelamento do átrio esquerdo após a ablação tem sido pouco avaliado. Oito pacientes foram submetidos a ablação de veias pulmonares utilizando mapeamento eletro-anatômico entre março de 2016 e março de 2017. O átrio esquerdo foi avaliado com ecocardiograma no pré-procedimento, e um e três meses após o mesmo, usando as seguintes variáveis: volume do átrio esquerdo em biplano, fração de ejeção do átrio esquerdo e tensão do reservatório do átrio esquerdo na parede lateral. Para determinar a existência de recorrência, Holter de 24 horas e interrogatório por telefone foram realizados três e seis meses após a ablação. A remodelação reversa estrutural e funcional do átrio esquerdo foi observado em seis pacientes. Aqueles com recidiva de fibrilação atrial não apresentaram remodelamento reverso e mostraram maior deterioração da função atrial antes da ablação. Estas descobertas permitem propor algumas hipóteses para investigar sobre os preditores de recorrência.

Dispositivos implantables en la insuficiencia cardíaca con fracción de eyección reducida. Más de 30 años de demostrada eficacia terapéutica / Implantable devices in reduced ejection fraction heart failure. More than 30 years of proven therapeutic efficacy

En el presente artículo se analiza el rol de los dispositivos implantables en la mejoría de síntomas y en prevención primaria de muerte súbita en pacientes con insuficiencia cardíaca con fracción de eyección reducida. No se considera la prevención secundaria, es decir, la de aquellos pacientes que ya han presentado un evento arrítmico mayor, que puede ser motivo de otro artículo. Se destaca el análisis de las recomendaciones de las Guías Europeas 2016, tanto para la resincronización cardíaca como para el implante de cardiodesfibrilador, complementado con una descripción pormenorizada de los diferentes ensayos clínicos que pretende contribuir a una correcta toma de decisiones en la práctica clínica. Al final del capítulo el lector encontrará un resumen conceptual con mensajes clave para la puesta al día del conocimiento de estas terapias complementarias del tratamiento médico óptimo.

In this article, the role of implantable devices in improvement of symptoms and primary prevention of sudden death in patients with reduced ejection fraction heart failure, is analyzed. Secondary prevention is not considered, that is, of those patients who have already presented a major arrhythmic event, which may be the reason for another article. The analysis of the recommendations of the 2016 European Guidelines is highlighted, both for cardiac resynchronization and for the implantation of cardio-defibrillators, complemented with a detailed description of the different clinical trials, which aim to correct decision-making in clinical practice. At the end of the chapter, the reader will find a conceptual summary in which key messages are considered for updating the knowledge of these complementary therapies of optimal medical treatment.