Primary Care Considerations for the Pediatric Endurance Athlete.

PURPOSE OF REVIEW: This study aimed to provide an overview of some of the medical concerns surrounding the care of the pediatric endurance athletes and add to the limited literature specific to the pediatric endurance athlete. RECENT FINDINGS: Endurance athletes are at risk for overtraining, relative energy deficiency in sport (RED-S), overuse injuries, nutritional deficiencies, and sleep dysfunction. Youth runners and female endurance athletes are particularly high-risk populations for RED-S; nutritional deficiencies and their care should involve thoughtful mitigation of modifiable risk factors. The growing endurance athlete may experience slightly different cardiac adaptations than the adult endurance athlete with the long-term implications of these changes still unclear. Endurance sports are common among youth athletes. Multidisciplinary care that includes screening and early intervention for high-risk areas is critical to optimize their care and promote, safe lifelong sport participation.

Intrafamilial phenotypic variability in autosomal recessive DOCK6-related Adams-Oliver syndrome.

Adams-Oliver syndrome (AOS) is diagnosed in presence of aplasia cutis congenita (ACC) of the scalp and terminal transverse limb defects (TTLD). The autosomal recessive (AR) DOCK6-related form of AOS is most often associated with a severe phenotype including also central nervous system and ocular abnormalities. We report a sister and brother with different expression of the phenotype. Both were compound heterozygous pathogenic variants in the DOCK6 gene, including a heterozygous c.5939+2T > C intronic variant that was maternally inherited, and a heterozygous deletion of exons 10 to 21 that was paternally inherited. The sister had microcephaly, periventricular calcifications, minor retinal vasculopathy, and mild impaired neurodevelopment, but only very subtle limb abnormalities and no ACC. Her brother showed a classical DOCK6-related AOS phenotype, including a severe bilateral peripheral ischemic retinopathy. From a review of 22 molecularly confirmed cases with DOCK6-related AOS with ophthalmic examination, we found that 16 of them had retinal vascular pathology (72.7%), confirming as the major ocular anomaly. Documented intrafamilial variability in our family and the evidence revised from previous reports, confirm that AR DOCK6-related AOS expressivity can produce a "milder" phenotype without ACC or TTLD, which could be underdiagnosed in simplex cases because it is difficult to recognize out of a familial context. Therefore, in order to know its real magnitude is required the future inclusion of DOCK6 gene in NGS panels directed to the study of simplex cases of patients with microcephaly, periventricular calcifications, retinal vasculopathy, and/or cardiovascular defects.

Development of a screening test for cognitive impairment in alcoholic population: TEDCA.

INTRODUCTION: Several studies have found cognitive impairment in patients with a history of alcohol use disorder, affecting their psychosocial functioning and the achievement of therapeutic goals. In order to identify these effects, several cognitive screening tests have been used, though they were not specific for alcoholic population, possibly leading to an increase in the risk of error. OBJECTIVE: The aim of this study is to assess the main cognitive deficits in patients with history of alcohol use disorders, through the development of a specific screening test for alcohol-related cognitive impairment. METHODOLOGY: The TEDCA (Test of detection of cognitive impairment in alcoholism) was designed based on three dimensions: Visuospatial Cognition, Memory / Learning and Executive Function. The study was divided in two phases: During phase 1, test items with greater capacity for discrimination between patients with different levels of cognitive impairment were selected, and during phase 2, the analysis for validity and reliability indexes took place. The sample consisted of 248 participants, 88 controls (phase 2) and 160 patients (phase 1: n=70 and phase 2: n=90). RESULTS: TEDCA test obtained a high reliability (Cronbach’s alpha 0.754) value and the factor analysis confirmed the presence of the three dimensions previously defined. The present screening tool also discriminated between patients and control group, together with a good diagnostic validity of cognitive impairment. CONCLUSIONS: TEDCA is a new screening test, which identifies the possible presence of cognitive impairment in patients with a history of alcohol use disorders, which can be used in the fields of psychiatry, primary care and research.

Desarrollo de un test de detección de deterioro cognitivo en población alcohólica: TEDCA / Development of a screening test for cognitive impairment in alcoholic population: TEDCA

Introducción. Numerosos estudios han encontrado alteraciones cognitivas en pacientes con historia de trastorno por consumo de alcohol, afectando su funcionamiento psicosocial y consecución de objetivos terapéuticos. Para identificar estas afectaciones se han utilizado pruebas de cribado cognitivo a pesar de que no han sido diseñadas para esta población, aumentando el riesgo de error. Objetivo. Valorar los principales déficits cognitivos en pacientes con historia de trastorno por consumo de alcohol, para desarrollar una prueba de cribado de alteraciones cognitivas específica para estos pacientes. Metodología. El TEDCA (Test de detección de deterioro cognitivo en alcoholismo) se diseñó en base a tres dimensiones: Cognición Viso-espacial, Memoria/Aprendizaje y Función Ejecutiva. El estudio se dividió en dos fases: En la fase 1 se seleccionaron las pruebas con mayor capacidad de discriminación entre pacientes con diferentes niveles de afectación cognitiva, y en la fase 2 se realizaron los análisis de validez y fiabilidad. La muestra estuvo formada por 248 participantes, 88 controles (fase 2) y 160 pacientes (fase 1: n=70 y fase 2: n=90). Resultados. El TEDCA obtuvo una fiabilidad elevada (alfa de Cronbach 0.754), el análisis factorial confirmó la presencia de las 3 dimensiones definidas previamente, discriminó entre pacientes y controles, y presenta una buena validez diagnóstica de afectación cognitiva. Conclusiones. El TEDCA es una nueva prueba de cribado, que permite identificar la posible presencia de afectación cognitiva en pacientes con historia de trastorno por (AU)

Introduction. Several studies have found cognitive impairment in patients with a history of alcohol use disorder, affecting their psychosocial functioning and the achievement of therapeutic goals. In order to identify these effects, several cognitive screening tests have been used, though they were not specific for alcoholic population, possibly leading to an increase in the risk of error. Objective.The aim of this study is to assess the main cognitive deficits in patients with history of alcohol use disorders, through the development of a specific screening test for alcohol-related cognitive impairment. Methodology. The TEDCA (Test of detection of cognitive impairment in alcoholism) was designed based on three dimensions: Visuospatial Cognition, Memory / Learning and Executive Function. The study was divided in two phases: During phase 1, test items with greater capacity for discrimination between patients with different levels of cognitive impairment were selected, and during phase 2, the analysis for validity and reliability indexes took place. The sample consisted of 248 participants, 88 controls (phase 2) and 160 patients (phase 1: n=70 and phase 2: n=90). Results.TEDCA test obtained a high reliability (Cronbach's alpha 0.754) value and the factor analysis confirmed the presence of the three dimensions previously defined. The present screening tool also discriminated between patients and control group, together with a good diagnostic validity of cognitive impairment. Conclusions. TEDCA is a new screening test, which identifies the possible presence of cognitive impairment in patients with a history of alcohol use disorders, which can be used in the fields of psychiatry, primary care and research (AU)

Associated congenital anomalies in infants with isolated gastroschisis: A single-institutional experience.

The aim of our study was to determine the frequency and type of associated congenital anomalies in patients with isolated gastroschisis born at the Dr. Juan I. Menchaca Civil Hospital of Guadalajara (Guadalajara, México), and to explore its possible association with the included outcome variables. One hundred-eight cases with isolated gastroschisis were reviewed from 2009 to 2014. The occurrence of intestinal and extraintestinal associated anomalies (either secondary or primary) was prospectively assessed. The type of gastroschisis, length of hospital stay (LOS), and in-hospital mortality were outcome variables for statistical analysis. Of infants with gastroschisis, 52 (48.1%) had one or more associated anomalies (AA), with increased odds in males (OR = 2.3, 95%CI: 1.1-5.0). AA classified, as secondary and primary were present in 34.3 and 5.6% of patients, respectively. Of secondary AA, 25.9% were intestinal anomalies, and 17.6% were extraintestinal. Primary AA were congenital heart disease (n = 3), meningomyelocele, and hydrocephaly and amniotic band sequence in one instance, respectively. Multivariate logistic regression showed that secondary AA (both intestinal and extraintestinal) were associated with complex gastroschisis, prolonged LOS, and in-hospital death, whereas primary AA were not related to a worse outcome. Our results highlight the pathogenic importance of properly investigating and categorizing the presence of others secondary or primary AA when diagnosis of gastroschisis is made.

Validación de la versión española del Test Stroop de Alcohol / Validation of the Spanish Version of the Alcohol Stroop Test

El sesgo atencional para el alcohol se ha mostrado útil para identificar a personas con consumo patológico así como a personas dependientes con altas probabilidades de recaída. El objetivo de este trabajo fue validar la versión española del Test Stroop de Alcohol diseñado para evaluar el sesgo atencional en pacientes dependientes del alcohol. La muestra estuvo compuesta por 173 participantes divididos en dos grupos: Un grupo de pacientes (n = 88) cumpliendo criterios de dependencia alcohólica y un grupo control (n = 85) con riesgo bajo de consumo de alcohol, que realizaron el Test de palabras y colores de Stroop (Stroop clásico), el Test de Stroop neutro y el Test de Stroop de Alcohol. Se observaron diferencias estadísticamente significativas en las interferencias para el Stroop Clásico y el Stroop de Alcohol. Los pacientes con dependencia, en comparación a los participantes control, mostraron mayores interferencias para estímulos de contenido alcohólico que para estímulos de contenido neutro. Este efecto fue explicado por un sesgo atencional para información relacionada con el alcohol en pacientes con dependencia. Se calcularon curvas COR, observándose áreas bajo la curva estadísticamente significativas para las interferencias del Stroop clásico y del Stroop de alcohol. Este trabajo sirvió para validar la versión española del Test Stroop de Alcohol para evaluar sesgos atencionales hacia el alcohol en personas con problemas de consumo y dependencia alcohólica

Attention bias for alcohol has proved useful to distinguish people with a pathological consumption of people who do not, and dependents who are more likely to fall in consumption. The aim of this study was to validate the Spanish version of the Alcohol Stroop test, designed to evaluate attention biases for alcohol in alcohol-dependent patients. The sample was composed by 173 participants divided into 2 groups: 1) “Patients” (n = 88) meeting criteria for alcohol dependence; and 2) “Control” (n = 85) having a low risk for alcohol consumption, that completed the Stroop color naming Task (Classic Stroop), the Neutral Stroop test and the alcohol Stroop test. Statistically significant differences were found in the interference effects calculated for the Classic and Alcohol Stroop tests. Patients compared to control participants showed a higher interference effect for alcohol-related stimuli than for neutral stimuli. These effects were accounted by an attention bias for alcohol-related information in patients. ROC curves were calculated for the three interference effects, showing an area under the curve statistically significant in the Classic Stroop interference and the Alcohol Stroop interference. This study provides the validation of the Spanish version of the Alcohol Stroop test that allows to evaluate attention biases for alcohol stimuli in individuals with both pathologic alcohol consumption and alcohol dependence

The flavonol isorhamnetin exhibits cytotoxic effects on human colon cancer cells.

The aim of this study was to determine whether isorhamnetin, an immediate 3'-O-methylated metabolite of quercetin, affects proliferation, cell death, and the cell cycle of human colon carcinoma (HCT-116) cells. Isorhamnetin was found to be a potent antiproliferative agent in a dose- and time-dependent manner, with an IC50 of 72 µM after 48 h of incubation as estimated by MTT assay. Flow cytometry and fluorescence microscopy analysis showed that isorhamnetin exerted a stimulatory effect on apoptosis and necrosis. Isorhamnetin also increased the number of cells in G2/M phase. Serum deprivation appeared to potentiate the effects of isorhamnetin on cell death and facilitated cell cycle progression to G0/G1 phase. These results suggest that isorhamnetin might mediate inhibition of HCT-116 cell growth through the perturbation of cell cycle progression and are consistent with the notion that G2/M checkpoints could be a conserved target for flavonoids in human colon cancer cells, leading to apoptotic and necrotic death. These antiproliferative, apoptotic, necrotic, and cell cycle effects suggest that isorhamnetin may have clinically significant therapeutic and chemopreventive capabilities. To our knowledge, this is the first report of the effect of isorhamnetin on human colon cancer cells.

3,4-Dihydroxyphenylglycol (DHPG): an important phenolic compound present in natural table olives.

The presence of 3,4-dihydroxyphenylglycol (DHPG) was studied in 32 samples and 10 different cultivars of natural table olives, using an accurate method to avoid wrong quantification. Hydroxytyrosol (HT), tyrosol, and verbascoside were also quantified, as these four compounds comprise the majority of the chromatographic profile. Analyses were carried out by HPLC-DAD-UV after extraction of all phenolics, and hydroxytyrosol was the major component in nearly all samples. High levels of DHPG (up to 368 mg/kg of dry weight) were found in the pulp of natural black olives independent of cultivar and processing method, similar to its concentration in the brine in almost all of the samples. The presented data for this antioxidant indicate that natural table olives are a rich source of DHPG and hydroxytyrosol, compounds with interesting nutritional and antioxidant properties.

Olive stone an attractive source of bioactive and valuable compounds.

The olive stone and seed are an important byproduct generated in the olive oil extraction and pitted table olive industries. As a lignocellulosic material, the hemicellulose, cellulose and lignin are the main components of olive stone as wells as protein, fat, phenols, free sugars and poliols composition. The main use of this biomass is as combustion to produce electric energy or heat. Other uses such as activated carbon, furfural production, plastic filled, abrasive and cosmetic or other potential uses such as biosorbent, animal feed or resin formation have been cited. In this article, an overview of the characterization and main uses of olive stone and seed are described for the first time. Also, this review discusses the potential use of this material based on each component. In this way, a new approach to the olive stone and seed by pretreating with a steam explosion followed by chemical fractionation is described.

Identification of flavonoid diglycosides in several genotypes of asparagus from the Huétor-Tájar population variety.

The qualitative and quantitative composition of flavonoids from the Huétor-Tájar population variety of asparagus (commonly known as " triguero") was investigated. Flavonoids were analyzed by reversed-phase high-performance liquid chromatography-diode array detection (HPLC-DAD). Liquid chromatography-mass spectrometry (LC-MS) under identical HPLC conditions was used to verify the identities of the flavonoid glycosides from triguero asparagus. The quantities of asparagus flavonoids were calculated according to concentration curves constructed with authentic standards. Total flavonoid contents, calculated as the sum of individual compounds, were determined and ranged from 400 to 700 mg/kg fresh weight. The most abundant was rutin, which represented 55-98% of the total flavonoid complement. Triguero asparagus were revealed to be an important source of not only quercetin derivatives but also kaempferol and isorhamnetin glycosides. Significant differences (p < 0.05) in the content and relative composition of flavonoids were found among the spears of the distinct asparagus genotypes from the Huétor-Tájar population variety.

Effect of steam treatment of alperujo on the composition, enzymatic saccharification, and in vitro digestibility of alperujo.

The solid waste from two-phase olive oil extraction or "alperujo" was submitted to steam treatment at high pressure or temperature, 200 degrees C for 5 min, in the presence and absence of mild acid catalyst. This treatment made easier the separation of the solid and liquid fractions. Besides the recovery of certain valuable components from the liquid fraction (the antioxidant hydroxytyrosol, low molecular weight oligosaccharides, glucose, mannitol, etc.), the major components of the solid residue could be also exploited. In this study, changes in composition of alperujo due to steam treatment were determined. The process reduced appreciably the hemicellulose concentrations (75-88%), removed a substantial portion of Klason lignin and protein (50%), and led to an extensive solubilization of alperujo (55-67%). Cellulose was very resistant to autohydrolysis and acid-catalyzed hydrolysis, so the solid residue was enriched in fat (13-18 g/100 g of dry steam-treated alperujo) and cellulose (15-25 g/100 g of dry and defatted steam-treated alperujo). The steam-treated material can be efficiently saccharified with commercial cellulase. The best hydrolysis yields were attained, up to 80%, when the treated material was post-treated with NaOH. The possibility of using this steam-treated alperujo in animal feeding was evaluated by an in vitro digestibility test, using the pepsin-cellulase method. The treatment affected positively the nutritional characteristics of alperujo with an increase in its in vitro (dry and organic matter) digestibility (8-10% higher than untreated material). In vitro digestibility and cellulose accessibility to enzymatic hydrolysis were improved by the alkali post-treatment.

Culture conditions determine the balance between two different exopolysaccharides produced by Lactobacillus pentosus LPS26.

Lactobacillus pentosus LPS26, isolated from a natural fermentation of green olives, produces a capsular polymer constituted of two exopolysaccharides (EPS): EPS A, a high-molecular-weight (high-Mw) polysaccharide (1.9x10(6) Da) composed of glucose and rhamnose (3:1), and EPS B, a low-Mw polysaccharide (3.3x10(4) Da) composed of glucose and mannose (3:1). Fermentation experiments in a chemically semidefined medium with different carbon sources (glucose, fructose, mannitol, and lactose) showed that all of them except fructose supported EPS A production rather than EPS B production. The influence of temperature and pH was further analyzed. As the temperature dropped, increased synthesis of both EPS was detected. The control of pH especially enhanced EPS B production. With regard to this, the maximum total EPS production (514 mg liter-1) was achieved at a suboptimal growth temperature (20 degrees C) and pH 6.0. Continuous cultures showed that EPS A, synthesized mainly at low dilution rates, is clearly dependent on the growth rate, whereas EPS B synthesis was hardly affected. EPS production was also detected in supplemented skimmed milk, but no increase on the viscosity of the fermented milk was recorded. This could be linked to the high proportion of the low-Mw polysaccharide produced in these conditions in contrast to that observed in culture media. Overall, the present study shows that culture conditions have a clear impact on the type and concentration of EPS produced by strain LPS26, and consequently, these conditions should be carefully selected for optimization and application studies. Finally, it should be noted that this is, to our knowledge, the first report on EPS production by L. pentosus.

Antioxidant activity of ethanolic extracts from several asparagus cultivars.

Three different methods (antiradical activity, inhibition of primary oxidation, and ferric reducing power) have been used to evaluate the antioxidant activity of eight different asparagus cultivars and byproducts: white and green asparagus from Alcalá del Río (Guadalquivir Valley, Seville) and American hybrids, native spears, and their byproducts from Huétor-Tájar (Vega de Granada). The correlation between antioxidant activity and total phenol content was studied. Six standards were also tested to validate the modified methods for antioxidant activity determination. Results obtained for antiradical capacity and reducing power were very similar, and a high correlation with phenols was found (R > or = 0.9 for both tests). Sample origin was an important factor, spears from Huétor-Tájar having higher values (ARC between 7 and 10 and P(R) of 0.25-0.33) than those from Alcalá del Río (ARC 0.6-2 and P(R) of 0.05-0.07). Significant differences were found between spears with the same origin, suggesting that genetics are another factor to take into account. Asparagus inhibits lipid primary oxidation, but no correlation between the inhibition percentage and phenols was observed. Asparagus origin was the only factor that led to significant differences: samples from Huétor-Tájar had higher values (POIC between 18 and 32) than those from Alcalá del Río (POIC of 5-9). Byproducts from the canning industry at Huétor-Tájar were also assayed for antioxidant activity; the results obtained suggested that byproducts could be considered as an excellent source of natural antioxidants.

Total recovery of the waste of two-phase olive oil processing: isolation of added-value compounds.

A process for the value addition of solid waste from two-phase olive oil extraction or "alperujo" that includes a hydrothermal treatment has been suggested. In this treatment an autohydrolysis process occurs and the solid olive byproduct is partially solubilized. From this water-soluble fraction can be obtained besides the antioxidant hydroxytyrosol several other compounds of high added value. In this paper three different samples of alperujo were characterized and subjected to a hydrothermal treatment with and without acid catalyst. The main soluble compounds after the hydrolysis were represented by monosaccharides xylose, arabinose, and glucose; oligosaccharides, mannitol and products of sugar destruction. Oligosaccharides were separated by size exclusion chromatography. It was possible to get highly purified mannitol by applying a simple purification method.

Production in large quantities of highly purified hydroxytyrosol from liquid-solid waste of two-phase olive oil processing or "Alperujo".

The effect of hydrothermal treatment of two-phase olive waste (alperujo) on the solubilization of hydroxytyrosol was studied. Different conditions of saturated steam were assayed. A high amount of hydroxytyrosol was solubilized and increased with increasing steaming temperature and time, reaching 1.4-1.7 g/100 g of dry alperujo. The effect of acidic (H(2)SO(4)) and basic (NaOH) catalysts was also evaluated. Acid-catalyzed treatment was more effective at milder conditions, whereas the alkali-catalyzed conditions were not very suitable. In the present study, the extracted hydroxytyrosol was purified by means of a new, simple, and inexpensive chromatographic system, under international patent application (PCT/ES02/00058). From 1000 kg of alperujo, with 70% humidity, can be obtained approximately 4.5-5 kg of hydroxytyrosol. After a purification process, at least 3 kg of hydroxytyrosol, at 90-95% purity, would be obtained. The purified compound was identified by HPLC/UV and (1)H and (13)C NMR analyses, and its antioxidant activity was tested on refined olive oil without antioxidants by Rancimat method. The oxidative stability of refined olive oil was increased by a factor of 1.71 in the presence of 100 ppm of hydroxytyrosol.

Planificación económica en la evaluación y programación de proyectos de salud / Economic planning in the evaluation and programming of health projects

Contiene las presetaciones de la exposición. Hace un análisis de la problemática, sugiere soluciones inmediatas y a largo plazo