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Bone marrow aspiration (BMA) or biopsy is a necessary and frequent procedure for diagnosis and monitoring of hematological diseases. Pharmacological pain management approaches exist; however, previous experience and psychological preparation for BMA may impact pain perception. This study aimed to explore current practices in procedural pain management for BMA or biopsy. A cross-sectional internet-based survey was performed by the Nurses Group of the Italian Transplant Group (GITMO). Participants were nurses working in bone marrow transplant centers regularly performing BMA/biopsies. Sixty out of 94 centers receiving the survey responded (63.8%), 47 adult and 13 pediatric centers. The majority of them (75%) provided only verbal information for patient preparation before BMA.. Injected local anesthetics were used in 55.4% of centers, and combined with topical anesthetics in 33.9% of centers. Use of oral anesthetics was rare; however, anxiolytics and benzodiazepines were occasionally used (18.3%, 18.3% respectively). All pediatric centers used deep sedation for the procedure (p <.001), but drug choice depended on anesthetist preference. Ice packs (35.0%) and oral analgesia as required (40.0%) were used for postprocedural pain. Nurses perceived their patients' pain scores as relatively low (3.5 on scale 0–10), but recognized that it was a painful procedure provoking anxiety, and that pain management could be improved. Results revealed the lack of a standardized approach to procedural pain management for BMA in this study sample. Assessing a patient's pain experience is a key component to identifying effective pain management for BMA. [ABSTRACT FROM AUTHOR]

To identify the core competencies of the pediatric hematology-oncology nurse. A Delphi study was conducted. After identifying the competencies of the pediatric hematology-oncology nurse through a literature review, a questionnaire was created to be administered to a panel of experts to obtain consensus. The panel of experts consisted of 19 nurses. For each competence identified, it was necessary to evaluate the competence in terms of "understanding" and "relevance", assigning a score from 0 (not at all) to 4 (completely), according to a Likert scale. Then, the experts identified what could be the necessary "level of work experience" within which a nurse should become autonomous in every competency choosing among the levels: beginner, intermediate, expert. Consensus among the experts was reached in two rounds. After submitting the document to two rounds, a final document was obtained with a total of 126 competencies, divided into nine areas. Fifty-eight competencies fall into the "beginner" level, 46 competencies into the "intermediate" level and 22 competencies into the "expert" level. The document produced by this study could be a starting point for organizing specific training courses for nurses in the pediatric hematology-oncology department. A clear description of specific competencies for pediatric hematology-oncology nurses would help ensure the best care for the child. • Specialized nurses can ensure better care. • The identification of specific competencies makes it possible to organize the placement of newly hired nurses. • The definition of specialist competencies makes it possible to homogenize education throughout the national territory. [ABSTRACT FROM AUTHOR]

Phenolic acids are phytochemical compounds widely known for their pharmacological potential in promoting human health. This bibliometric analysis explored the research trends, gaps, and application of phenolic acids over the last five years. The results obtained demonstrate a remarkable increase in the number of published documents over the last five years, amounting to 6134 articles and 833 reviews. Through keyword network analysis, the research field concerning phenolic acids featured an important cluster of antioxidant activity and polyphenols. Furthermore, the major theme, "phenolic acids" has been advanced by the study of metabolomics, mass spectrometry, chromatography, bioavailability, and bioaccessibility, which are important topics to identify these phytochemicals compounds and their impact on human health. The future trends in phenolic acids are focused on the biological properties (antioxidant capacity, anti-inflammatory, antimicrobial, and anticancer activity) for the industrial and pharmaceutical applications in the development of innovative nutraceutical products based on phenolic acids extracted from natural sources. [Display omitted] • There is a constant increase in the study of phenolic acids from natural sources. • The central themes are associated with the biological properties and application of phenolic acids. • Central themes include metabolomics, analytical techniques, bioavailability, and bioaccessibility. • There is a research trend in the industrial and pharmaceutical application for the development of nutraceutical products. [ABSTRACT FROM AUTHOR]

The primary aim of this study was to maximize the value of black grape pomace by harnessing innovative and environmentally friendly extraction and hydrolysis technology on the biorefinery concept. This automated system seamlessly integrates pressurized hot water extraction (PHWE) and sequential subcritical water hydrolysis (SubCWH), complemented by inline purification through solid phase extraction (SPE) and online analysis via high-performance liquid chromatography (HPLC) equipped with photodiode array (PDA) and refractive index (RI) detectors. The results of this investigation revealed the presence of twelve anthocyanins, each exceeding a concentration of 3 mgEC3G gDBGP-1. By summing the concentration of these individual anthocyanins, a total yield of 47.6 mgEC3G gDBGP-1 was achieved, attributed to the utilization of acidified water as the solvent and adherence to optimal process conditions. The newly developed system demonstrated its efficacy in both PHWE and SubCWH of black grape pomace, coupled with inline SPE purification and real-time HPLC analysis of various natural compounds. The real-time monitoring capability facilitated swift and efficient responses, reducing processing time, minimizing solvent consumption, decreasing labor requirements, conserving energy, and mitigating environmental impact. • Automated system integrating pressurized hot water extraction and sequential subcritical water hydrolysis. • Online analysis via HPLC equipped with photodiode array and refractive index detectors. • Identification of 12 anthocyanins, each exceeding a concentration of 3 mgEC3G gDBGP-1. • Inline SPE purification and real-time HPLC analysis of various natural compounds. • Real-time monitoring capability for swift and efficient responses. [ABSTRACT FROM AUTHOR]

This study aimed to develop a nutritious vegan brownie with fiber and bioactive compounds, sensorially accepted by consumers using phenolic compounds extracted from defatted chia flour (a coproduct of the production of chia oil) and chia mucilage. The brownies were developed by evaluating the replacement of 2, 4, and 6% of the flour with the freeze-dried extract obtained from defatted chia flour. The extract obtained from the coproduct presented ferulic acid (1.91 ± 0.006 mg g−1) and rosmarinic acid (3.79 ± 0.03 mg g−1). The brownies prepared with 2, 4, and 6% extract showed 70%, 89%, and 92% of ferulic acid and 60%, 75%, and 91% rosmarinic acid added to the formulation, respectively. Proximate composition analyses demonstrated that replacing egg with chia seed mucilage decreased fat and protein and increased fiber in vegan brownies. However, the addition of phenolic extract obtained from defatted chia flour increased the fat content of vegan brownies. A residual lipid fraction present in the chia flour was probably extracted during the extraction of phenolic compounds. The technological analyzes (firmness, specific volume, symmetry, and uniformity) showed that the physical characteristics of the brownies were not affected by the different formulations used. However, the color of the products was affected by the addition of the mucilage, which appears grayish, and by the extract containing the phenolic compounds, which presents a yellowish color. The 4% replacement brownie was chosen for sensory analysis with the vegan control brownie. The results of the sensorial analysis indicated an excellent acceptance (76%) of the brownie with 4% of the extract, not differing from the vegan control. In this way, we demonstrated the possibility of producing a sensorially acceptable vegan brownie using a phenolic extract obtained from a coproduct of the food industry. [Display omitted] • Freeze-dried phenolic extract compounds from defatted chia flour remained in brownies even after baking. • Chia seed mucilage reduces fat and increases fiber content of vegan brownies compared to traditional brownies with eggs. • The addition of the extract derived from defatted chia flour increased the fat content of vegan brownies. • Sensory analysis showed good acceptability of the brownie, which did not differ from the vegan control. [ABSTRACT FROM AUTHOR]

This systematic review and bibliometric analysis investigated the research gaps, trends, and updates in the recovery and applications of betanin and vitexin, focusing on describing the sustainable extraction methods and biological properties. The bibliometric analysis revealed considerable growth in publications in the last two years. The keywords network analysis demonstrated that antioxidant activity, betalain, betanin, and betacyanin are the main research clusters, highlighting that the recovery of vitexin from by-products is a potential theme for investigation. The demand for betanin and vitexin has been increasing in the last years, mainly due to the beneficial biological properties (anti-inflammatory, antioxidant, antimicrobial, and anticancer activity) and pharmaceutical applications for replacing synthetic drugs in the development of nutraceutical food products. Hence, the application of ultrasound-assisted extraction, pulsed electric field extraction, pressurized liquid extraction, and subcritical water extraction are the sustainable extraction methods most suitable for the recovery of betanin and vitexin, which support the application in the food, pharmaceutical, and health industries. • The work investigated the research gaps, trends, and updates in the recovery and applications of betanin and vitexin. • The antioxidant activity, betalain, betanin, and betacyanins are the main research clusters. • Betanin and vitexin show anti-inflammatory, antioxidant, antimicrobial, and anticancer activity and pharmaceutical applications. • Ultrasound-assisted and pressurized liquid extractions are the sustainable methods for the recovery of betanin and vitexin. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the effects of sonication on the biogas production dynamics of sugarcane straw and vinasse in an anaerobic digestion. Two different ultrasound pretreatments were evaluated namely 180 W of ultrasonic power irradiated at 37 kHz for 30 min (PBU) and 800 W of ultrasonic power irradiated at 19 kHz for 15 min (PSU). Significant differences were observed in the biogas compositions of the PBU and PSU pretreatments and their respective controls. A continuous increase in methane concentration of the biohythane (biohydrogen and methane combined) was recorded in the PBU reactors (60–80% by volume). The main effect of ultrasound pretreatment was on the composition biohydrogen, methane and carbon dioxide (biohythane) produced. [ABSTRACT FROM AUTHOR]

Highlights: [•] The focus was lignocellulosic agricultural residues and animal wastes to energy. [•] The availability of residues and generation potential index generated in Brazil was calculated. [•] The sugarcane has the highest agronomic availability, reaching 157 million tons of fresh material. [•] The estimated reuse potential of sugarcane was 19.6 million tons (dry basis). [•] The values of agronomic availability followed were at residues of soybeans, rice, maize, orange. [Copyright &y& Elsevier]

Background: Limited information exists about the real impact of the etiology of shock on early and late outcome after emergency surgery in acute native mitral valve endocarditis (ANMVE). This multicenter study analyzed the impact of the etiology of shock on early and late outcome in patients with ANMVE. Methods: Data were collected in eight institutions. Three hundred-seventy-nine ANMVE patients undergoing surgery on an emergency basis between May 1991 and December 2009 were eligible for the study. According to current criteria used for the differential diagnosis of shock, patients were retrospectively assigned to one of three groups: group 1, no shock (n = 154), group 2, cardiogenic shock (CS [n = 118]), and group 3, septic shock (SS [n = 107]). Median follow-up was 69.8 months. Results: Early mortality was significantly higher in patients with SS (p < 0.001). At multivariable logistic regression analysis, compared with patients with CS, patients with SS had more than 3.8 times higher risk of death. That rose to more than 4 times versus patients without shock. In addition, patients with SS had 4.2 times and 4.3 times higher risk of complications compared with patients with CS and without shock, respectively. Sepsis was also an independent predictor of prolonged artificial ventilation (p = 0.04) and stroke (p = 0.003) whereas CS was associated with a higher postoperative occurrence of low output syndrome and myocardial infarction (p < 0.001). No difference was detected between groups in 18-year survival, freedom from endocarditis, and freedom from reoperation. Conclusions: Our study suggests that emergency surgery for ANMVE in patients with CS achieved satisfactory early and late results. In contrast, the presence of SS was linked to dismal early prognosis. Our findings need to be confirmed by further larger studies. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the incidence of postoperative atrial fibrillation (POAF), the predisposing factors, the results of treatment before discharge, and the impact on duration and costs of hospitalization. Design: A prospective observational study. Methods: Patients who underwent cardiac surgery from January 1, 2007 to December 31, 2007. Interventions: Electrocardiography was continuously monitored after surgery. Patients with symptomatic new-onset atrial fibrillation or lasting >15 minutes were treated with amiodarone and with DC shock in prolonged cases. Results: POAF occurred in 29.7%, with the higher incidence between the 1st and 4th postoperative day. Age (p < 0.001), atrial size >40 mm (p < 0.001), previous episodes of AF (p < 0.001), female sex (p = 0.010), and combined valve and bypass surgery (p = 0.012) were multivariate predictors of POAF at logistic regression. Sinus rhythm was restored by early treatment in 205 of 215 patients. This was associated with a low incidence of cerebrovascular events (<0.5%) and with a limited increase of average length of hospitalization (24 hours) in patients with POAF. Conclusions: The overall incidence of POAF in the authors'' center is close to 30%; 95.3% of patients were discharged in sinus rhythm. The increase in length and costs of hospitalization (on average, 1.0 day with a burden of about €1,800/patient) were significantly lower than in previous investigations. [Copyright &y& Elsevier]

Background: We investigated leaflet and subvalvular configurations to identify mechanisms leading to recurrent mitral regurgitation after combined undersized mitral annuloplasty and coronary artery bypass and to preoperatively recognize patients who are unlikely to benefit from this approach. Methods: Among 261 subjects with chronic ischemic mitral regurgitation undergoing undersized annuloplasty and coronary bypass surgery at one institution between September 2001 and September 2007, 31 were excluded: 4 had intraoperative annuloplasty failure, 12 showed residual regurgitation, and 15 had incomplete echocardiograms available. The study population consisted of 230 patients who were divided into 2 groups: patients without (group 1, n = 176) or with (group 2, n = 54) late recurrent mitral regurgitation. Fifty healthy subjects were used as control subjects. Serial echocardiographic analysis was performed preoperatively, at discharge, and at follow-up appointments (early: median, 6 months [interquartile range, 5–6 months; late: median, 33 months [interquartile range, 17–51 months]). Results: Subjects with late regurgitation had preoperatively more symmetric tethering (P < .001), more accentuated anterior mitral leaflet tethering (P < .001), and more restricted anterior leaflet excursion (P = .003) than patients in group 1. Postoperatively, tethering of the posterior leaflet increased (P < .001) and was predominant in both groups, whereas tethering of the anterior leaflet was reduced at discharge (P = .01 and P = .03, respectively), remaining constant afterward. Multivariable analysis showed an anterior tethering angle of 39.5° or greater (P < .001), an anterior/posterior tethering angle ratio of 0.76 or greater (P < .001), an anterior leaflet excursion angle of 35° or less (P = .001), and a coaptation height of 11 mm or greater (P = .04) to be predictors of recurrent mitral regurgitation. Conclusions: Preoperative symmetric tethering with anterior mitral leaflet predominance was strongly associated with recurrence of mitral regurgitation. Measures of leaflet tethering resulted in fundamental findings to identify ischemic patients who can really benefit from restrictive annuloplasty. Further larger studies are necessary to confirm our results. [Copyright &y& Elsevier]

Background: Long-term durability of combined coronary artery bypass grafting and of undersized mitral ring annuloplasty (UMRA) is uncertain. A considerable number of patients show recurrent regurgitation. This study examines the difference in the benefit of UMRA on clinical end points and recurrence of mitral regurgitation between responders and nonresponders of left ventricular reverse remodeling. Methods: Study eligibility criteria were fulfilled by 204 patients with chronic ischemic mitral regurgitation (CIMR) who survived combined coronary artery bypass grafting and reductive annuloplasty between September 2001 and September 2006. Patients underwent echocardiography preoperatively, at discharge, and at follow-up appointments (100% complete). Median early follow-up was 6 months (interquartile range [IRQ], 3 to 8 months; late follow-up, 35 months (IRQ, 21 to 50 months). Reverse remodeling was considered a reduction in left ventricular end systolic volume index exceeding 15%. Results: There were 84 responders (41.2%) of reverse remodeling (age, 68 ± 7.4 years; 51 men) and 120 nonresponders (58.8%; age, 67 ± 7.6 years; 78 men). Nonresponders had a higher recurrence of mitral regurgitation (p < 0.001), higher reoperation rate for failed repair (p < 0.001), and significantly larger left ventricular volumes and dimension at any study point (p < 0.001), with significant late increase of sphericity indexes exceeding preoperative values (p < 0.001). At multivariable analysis, a baseline myocardial performance index of less than 0.90 (p < 0.001), a systolic sphericity index of less than 0.72 (p < 0.001), and wall motion score index of less than 1.59 (p = 0.003) were independent predictors of reverse remodeling. Conclusions: Our experience suggests that more information on possible echo predictors of an inadequate result may improve preoperative decision making of CIMR patients for UMRA. [Copyright &y& Elsevier]

Purpose: Endovascular treatment of aortoiliac aneurysms near or involving the hypogastric artery (HGA) requires HGA occlusion before endografting to avoid retrograde filling of the aneurysm. The purpose of this study is to evaluate clinical outcomes of bilateral HGA occlusion and determine if benefits gained by endovascular aneurysm repair (EVAR) outweigh the morbidity associated with the procedure. Materials and Methods: Between 1999 and 2004, 128 patients with abdominal aortic aneurysm (AAA) were treated with bifurcated endograft placement. Bilateral coverage or embolization of HGAs was performed in 14 patients (10.9%). Embolization was achieved by deployment of coils and coverage was accomplished by extending the endoprosthesis into the external iliac artery. Clinical follow-up and computed tomographic angiography were performed at 1, 3, 6, 9, and 12 months and annually thereafter to detect potential aneurysm growth and endoleaks. Results: During follow-up (range, 1–72 months), buttock claudication was noted in four patients (28.6%), including unilateral claudication in two and bilateral claudication in two. One patient experienced claudication longer than 12 months, which resolved within 18 months. De novo erectile dysfunction was seen in one patient, and pelvic ischemia was not found in any patient. There was no evidence of endoleak, aneurysm enlargement, or death associated with HGA occlusion. Conclusions: In our series, complications of bilateral HGA occlusion before EVAR were moderate and resolved over time. The benefits gained from EVAR outweigh the clinical problems caused by bilateral HGA occlusion, as there are no technical complications added to the EVAR procedure. [Copyright &y& Elsevier]

To investigate the degree of concordance on fatigue assessment between children and adolescents with cancer and their parents, and its changes over time. Multicentre longitudinal study. Data from 134 dyads were analysed. The mean age of patients was 11.7 years; caregivers had a mean age of 44.1 years. Almost 90% of patients already reported mild or moderate fatigue at the time of diagnosis, decreasing to 69.7% after one year. Concordance on the total fatigue improved over time for the total sample, moving from moderate at the time of diagnosis to good concordance after one year. This was the first study with a longitudinal design investigating concordance between paediatric self-reports and parent proxy reports on fatigue. It showed how concordance between proxies and patients changed over time reaching a good level after one year from the cancer diagnosis. • Fatigue is a prevalent problem for children and adolescents diagnosed with cancer. • The prevalence and intensity of fatigue decrease over time. • Concordance between proxy and patient on fatigue level is higher one year after diagnosis. [ABSTRACT FROM AUTHOR]

Aβ deposition is a pathological hallmark of Alzheimer's disease (AD). Besides the full-length amyloid forming peptides (Aβ 1–40 and Aβ 1–42), biochemical analyses of brain deposits have identified a variety of N- and C-terminally truncated Aβ variants in sporadic and familial AD patients. However, their relevance for AD pathogenesis remains largely understudied. We demonstrate that Aβ 4–42 exhibits a high tendency to form β-sheet structures leading to fast self-aggregation and formation of oligomeric assemblies. Atomic force microscopy and electrophysiological studies reveal that Aβ 4–42 forms highly stable ion channels in lipid membranes. These channels that are blocked by monoclonal antibodies specifically recognizing the N-terminus of Aβ 4–42. An Aβ variant with a double truncation at phenylalanine-4 and leucine 34, (Aβ 4–34), exhibits unstable channel formation capability. Taken together the results presented herein highlight the potential benefit of C-terminal proteolytic cleavage and further support an important pathogenic role for N-truncated Aβ species in AD pathophysiology. N- and C-terminal truncated Aβ species play an important role in the pathophysiology of Alzheimer's disease (AD). In this study, structural, morphological and electrical activity of one of the main N-truncated species Aβ 4–42 was analyzed. Through EM and AFM analysis we report that Aβ 4–42 forms oligomeric structures and in the membrane environment these structures have a pore-like morphology. These pores are electrically active as evident from the transmembrane current recorded through electrophysiological studies. These results have broad implications in understanding the pathophysiology of AD and help advance the design of therapeutic agents. Unlabelled Image [ABSTRACT FROM AUTHOR]