The effects of fermentation time on sourdough bread: An analysis of texture profile, starch digestion rate, and protein hydrolysis rate.

To ensure the best quality bread, it is important to consider the speed of digestion of starch and proteins, as well as how time fermentation and storage time influence the rate of starch digestion and the texture of the bread. This study compared the effect of fermentation time and days of storage on the texture, physicochemical, protein and starch digestibility of sourdough bread. Texture profile analysis showed that the fermentation time in recently baked sourdough bread affects hardness, chewiness, and springiness. The electrophoretic profile showed a decrease in band thickness with increase in fermentation time, consistent with a higher percentage of protein digestion. While fermentation time did not significantly affect rapidly digestible starch (RDS) and slowly digestible starch (SDS), storage time resulted in a decrease in RDS and an increase in SDS. Sourdough breads had higher levels of resistant starch (RS). The digestibility characteristics of protein and starch, as well as texture properties, are significantly influenced by fermentation and storage time. The evidence suggests that sourdough bread has the potential to improve the digestion of protein and to effectively regulate the glycemic response, which is due to its higher levels of SDS and RS.

Impact of an integrated classifier using biomarkers, clinical and imaging factors on clinical decisions making for lung nodules.

Background: An integrated classifier that utilizes plasma proteomic biomarker along with five clinical and imaging factors was previously shown to be potentially useful in lung nodule evaluation. This study evaluated the impact of the integrated proteomic classifier on management decisions in patients with a pretest probability of cancer (pCA) ≤50% in "real-world" clinical setting. Methods: Retrospective study examining patients with lung nodules who were evaluated using the integrated classifier as compared to standard clinical care during the same period, with at least 1-year follow-up. Results: A total of 995 patients were evaluated for lung nodules over 1 year following the implementation of the integrated classifier with 17.3% prevalence of lung cancer. 231 patients met the study eligibility criteria; 102 (44.2%) were tested with the integrated classifier, while 129 (55.8%) did not. The median number of chest imaging studies was 2 [interquartile range (IQR), 1-2] in the integrated classifier arm and 2 [IQR, 1-3] in the non-integrated classifier arm (P=0.09). The median outpatient clinic visit was 2.00 (IQR, 1.00-3.00) in the integrated classifier arm and 2.00 (IQR, 2.00-3.00) in the non-integrated classifier (P=0.004). Fewer invasive procedures were pursued in the integrated classifier arm as compared to non-integrated classifier respectively (26.5% vs. 79.1%, P<0.001). All patients in the integrated classifier arm with post-pCA (likely benign n=39) had designated benign diagnosis at 1-year follow-up. Conclusions: In patients with lung nodules with a pCA ≤50%, use of the integrated classifier was associated with fewer invasive procedures and clinic visits without misclassifying patients with likely benign lung nodules results at 1-year follow-up.

Pleural Disease in Acute COVID-19 Pneumonia: A Single Center Retrospective Cohort Study.

BACKGROUND: Pleural diseases encompass pleural effusion and pneumothorax (PTX), both of which were uncommon in coronavirus disease of 2019 (COVID-19). We aimed to describe the frequency, characteristics, and main outcomes of these conditions in patients with COVID-19 pneumonia. METHODS: We performed a retrospective cohort analysis of inpatients with COVID-19 pneumonia between January 1, 2020 and January 1, 2022, at Beth Israel Deaconess Medical Center in Boston, Massachusetts. RESULTS: Among 4419 inpatients with COVID-19 pneumonia, 109 (2.5%) had concurrent pleural disease. Ninety-four (2.1%) had pleural effusion (50% seen on admission) and 15 (0.3%) had PTX, both with higher rates of underlying conditions such as heart failure, liver disease, kidney disease, and malignancy. A total of 28 (30%) pleural effusions were drained resulting in 32% being exudative, 43% pseudoexudative, and 25% transudative. Regarding PTX, 5 (33%) were spontaneous and 10 (67%) were due to barotrauma while on mechanical ventilation. We found that the presence of underlying lung disease was not associated with an increased risk of developing PTX. In addition, patients with pleural disease had a higher incidence of severe or critical illness as represented by intensive care unit admission and intubation, longer hospital and intensive care unit stay, and a higher mortality rate as compared with patients without the pleural disease. CONCLUSION: Pleural effusions and pneumothoraces are infrequent findings in patients admitted due to COVID-19 pneumonia, worsened outcomes in these patients likely reflect an interplay between the severity of inflammation and parenchymal injury due to COVID-19 disease and underlying comorbidities.

Placebo response in objective and subjective measures of hypersomnia in randomized clinical trials on obstructive sleep apnea. A systematic review and meta-analysis.

Sleepiness is one of the outcomes most used in randomized clinical trials (RCT) on the effect of treatments for obstructive sleep apnea (OSA). Furthermore, it is known that there is a placebo effect, especially in subjective measures. Therefore, given that sleepiness is a subjective measure, the objective of this systematic review with meta-analysis and three-level meta-regression was to assess the response to different placebos (pills and sham-CPAP) used in RCTs in OSA, both on subjective (Epworth Sleepiness Scale [ESS]) and objective (Multiple Sleep Latency Test [MSLT], Maintenance Wake Test [MWT], the Osler test and the Psychomotor Vigilance Task [PVT]). We observed a statistically significant placebo effect in both subjective and objective measures of hypersomnia, and in both sham-CPAP and pills. This placebo effect was greater, even clinically significant, in subjective measures (ESS: -2.84 points) and in those RCTs that used pills as a placebo. In the meta-regression, only a higher baseline value of the ESS and Osler test was related to the placebo effect.

[How to interpret systematic reviews with multiple comparisons or network meta-analysis]. / Como interpretar una revisión sistemática con comparaciones múltiples o network metaanálisis.

Systematic reviews evaluating multiple interventions can be useful in different clinical situations. However, some concerns arise when more than two interventions are compared and there is a paucity of good quality randomized clinical trials. A novel statistical method based on indirect comparisons, called network meta-analysis (NMA), can be a useful approach to find a clinical answer when multiple interventions are evaluated for the same outcome or comparator. The aim of this review is to describe the main characteristics and provide a user guide for a critical analysis of NMA focusing on its three main domains, namely homogeneity, transitivity and consistency.

Como interpretar una revisión sistemática con comparaciones múltiples o network metaanálisis / How to interpret systematic reviews with multiple comparisons or network meta-analysis

Systematic reviews evaluating multiple interventions can be useful in different clinical situations. However, some concerns arise when more than two interventions are compared and there is a paucity of good quality randomized clinical trials. A novel statistical method based on indirect comparisons, called network meta-analysis (NMA), can be a useful approach to find a clinical answer when multiple interventions are evaluated for the same outcome or comparator. The aim of this review is to describe the main characteristics and provide a user guide for a critical analysis of NMA focusing on its three main domains, namely homogeneity, transitivity and consistency.

Nutritional Characterization of Prosopis laevigata Legume Tree (Mesquite) Seed Flour and the Effect of Extrusion Cooking on its Bioactive Components.

Mesquite (Prosopis laevigata) is a legume tree widely distributed in Aridoamerica. The mature fruit of this legume is a pod, which is currently underutilized and has high nutritional potential. In the present work, mesquite seed flour is described in terms of its nutritional value, as well as the effect of extrusion cooking on its bioactive components. Mesquite seed flour is rich in fiber (7.73 g/100 g) and protein (36.51 g/100 g), with valine as the only limiting amino acid. Total phenolic compound contents in raw and extruded seed flour were 6.68 and 6.46 mg of gallic acid equivalents/g (mg GAE/g), respectively. 2-2-Diphenyl-1-picrylhydrazyl (DPPH) radical scavenging capacity values in raw and extruded seed flour were 9.11 and 9.32 mg of ascorbic acid equivalent/g (mg AAE/g), respectively. The absorbance at 290 nm, as an indicator of generation of Maillard reaction product (MRP), was the same for raw and extruded samples. Apigenin was the only flavonoid found in mesquite seed flour (41.6 mg/kg) and was stable in the extrusion process. The water absorption index (WAI) and water solubility index (WSI) were changed significantly during extrusion. The expansion of mesquite seed flour extrudates was null due to the high protein and fiber content in the sample. Extrusion cooking of mesquite seed flour is a useful form of technology for the industrialization of this underutilized and nutritionally valuable legume.

«Colombia, la más sana¼. La urgente necesidad de una visión para la salud colombiana / «Colombia, the healthiest¼. The urgent need of a vision for the Colombian health

Como las personas, como las empresas, los sectores sociales requieren aspiraciones mayores. Un propósito superior. Una visión de largo plazo por alcanzar, máxime en países en desarrollo, donde la inequidad y la pobreza son retos complejos que requieren de esfuerzos sostenidos en el tiempo para algún día quedar atrás. Es el caso de Colombia. En educación, el Gobierno Nacional ha planteado una aspiración mayor: Colombia, la (nación) más educada de la región en el año 2025. Este gran reto marca el derrotero de las políticas educativas y permite identificar áreas y esfuerzos específicos por trabajar, por ejemplo en materia de regulación, inversión, formación de talento humano y mejoramiento de la calidad. En síntesis: da norte. Los sistemas de salud también se deben construir en torno a un sueño de largo plazo. Son sistemas complejos y dinámicos con múltiples actores que requieren una visión colectiva que plasme lo mejor de las expectativas y los compromisos de la sociedad alrededor de ellos. Una construcción social (de Estado) que defina los elementos constitutivos a desarrollar en 10, 20 o 50 años. Una imagen clara e inequívoca que exprese cómo se consolidarán en su estructura y servicios los principios y criterios orientadores acordados, los objetivos comprometidos en materia de acceso, calidad, equidad y solidaridad, el grado deseado de participación y emprendimiento privados, así como el equilibrio en los derechos y deberes de todos. De hecho, se puede decir que hay dos tipos de sistemas de salud en el mundo: los que tienen una visión de largo plazo, y los que no.

Characterization of films made with chayote tuber and potato starches blending with cellulose nanoparticles.

The aim of this study was to characterize chayotextle starch films reinforced with cellulose (C) and cellulose nanoparticle (CN) (at concentrations of 0.3%, 0.5%, 0.8% and 1.2%), using thermal, mechanical, physicochemical, permeability, and water solubility tests. C was acid-treated to obtain CN. The films were prepared by casting; potato starch and C were used as the control. The solubility of the starch films decreased with the addition of C and CN compared with its respective film without C and CN. No statistical difference (α=0.05) was found in the films added with different concentrations of C and CN. In general, the mechanical properties were improved with the addition of C and CN, and higher values of tensile strength and elastic modulus were determined in the films reinforced with CN. The melting temperature and enthalpy increased with the addition of C and CN, and the values of both thermal parameters were higher in the films with CN than with C; the enthalpy value of the film decreased when the concentration of C or CN increased in the composite. Low concentration of C and CN is better distributed in the matrix film. The addition of C and CN in the starch films improved some mechanical, barrier, and functional properties.

Physicochemical, rheological and structural characteristics of starch in maize tortillas.

Fresh and stored maize (white and blue) tortillas were evaluated for physicochemical, rheological and structural characteristics assessed by calorimetry, x-ray diffraction, Fourier transform infrared (FTIR) spectroscopy, dynamic viscoelastic tests, and high-performance size-exclusion chromatography. Two endotherms were found in studies of fresh and stored tortillas. The low temperature endotherm (50-56 degrees C) was due to reorganized (retrograded) amylopectin, while the high temperature endotherm (105-123 degrees C) was attributed to retrograded amylose. The enthalpy value for the lower temperature transition was minor than that of the high temperature transition. Fresh tortillas showed an amorphous starch arrangement by x-ray diffraction study. Stored samples showed the presence of peaks at 2theta = 17 masculine and 23 masculine, indicating re-crystallization of starch components. FTIR results confirmed the development of higher levels of starch crystals during storage. Differences in the viscoelastic parameters were also observed between fresh and stored samples. At the longest storage times, white tortillas were more rigid than blue tortillas. Molar mass values for starch increased for both white and blue tortillas as storage time progressed, though relatively higher values were obtained for white tortillas. More starch reorganization occurred in white tortillas, in accordance to calorimetric, x-ray diffraction, FTIR and rheological results. These results corroborate that changes occurring in tortillas during storage are related to reorganization of starch components, and the maize variety more than the color plays an important role.