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Conflict of interest: No Introduction and Objectives: Cirrhosis is a chronic disease with a variable clinical course ranging from compensated stage to acute-on-chronic liver failure. The management of such patients focuses on multiorgan support in the intensive care unit (ICU). However, the criteria for defining the futility of management or even potential candidates for transplantation in our setting are not clearly established. Objectives: To describe the sociodemographic and clinical characteristics and outcomes of adult patients with liver cirrhosis treated in the ICU between 2018 and 2023 at the Cardioinfantil Foundation. Patients / Materials and Methods: A retrospective observational cohort study was conducted. Quantitative variables were described as mean and standard deviation or median and interquartile range, depending on their distribution. Qualitative variables were expressed as frequencies and percentages. To compare variables between groups, Student's t tests were used for continuous variables and chi-square tests or Fisher's exact test for categorical variables. Logistic regression models were applied to identify risk factors associated with mortality, adjusting for possible confounders. Results and Discussion: Statistically significant differences (p

Conflict of interest: No Introduction and Objectives: Cirrhosis is classically classified as compensated or decompensated in relation to the presence of ascites, variceal bleeding or encephalopathy. 5 stages of the course of the disease have been associated with the combination of these decompensations being the most advanced stages associated with higher mortality (60% per year). Acute-on-chronic liver failure (ACLF) can appear at any time during the course of the disease. Trying to understand the clinical course of cirrhosis, the PREDICT study established the CLIF-C AD score as a scale with greater sensitivity (>50 pts) to discriminate patients at high risk of developing ACLF with new trajectories of the course of cirrhosis: Stable and unstable decompensated cirrhosis; and pre-ACLF. Currently, there are no studies in Latin America that characterize the clinical outcomes in relation to the courses proposed by the PREDICT study. Objectives: Describe the demographic, clinical, paraclinical, management and outcomes in adult patients with cirrhosis, who have received medical care at the Cardioinfantil Foundation for any episode of decompensation in the period between 2015-2021 Patients / Materials and Methods: Historical cohort where exposure was defined as decompensated cirrhotic patients requiring hospital care during the period from 2015 to 2021. Descriptive statistics were used, and flow charts were used to indicate the distribution of patients. Results and Discussion: Information was collected from 259 patients, mainly men (45%). Main etiologies of cirrhosis were MASH (18.9%), alcoholic (17%), cryptogenic (13.9%), and autoimmune hepatitis (12%). Patients mainly corresponded to the stable decompensated group (75%). The most frequent decompensation documented on admission was ascites in 66%, followed by hepatic encephalopathy in 41.3%. In the pre-ACLF group, mortality and renal dysfunction were higher. Conclusions: Patients who present with decompensation of cirrhosis and who during their stay developed an infectious process associated with renal dysfunction and high CLIF C-AD scores are more likely to develop ACLF.

The complexity of a sustainable economy is rooted in its socio-economic and environmental intricacies, particularly in formulating pathways for the harmonious integration of these parameters. This study introduces an extended input-output analysis and a multi-objective optimisation framework designed to discern trajectories for reducing CO2 emissions while simultaneously maximising GDP and employment. The economic alterations are evaluated through metrics facilitating the examination of both direct and indirect consequences stemming from perturbations within the economy. The focus of this research centres on the French economy, concentrating on pivotal sectors where reducing demand could yield the greatest reduction in CO2 emissions with minimal socio-economic ramifications. Additionally, a model is outlined for energy substitution, wherein fossil fuels in the French electricity mix are supplanted with clean energies. The ensuing effects of such a model on emission reduction pathways are scrutinised, followed by a comparison with the baseline case study.

Abstract Background There is strong evidence showing the association between obesity, type 2 diabetes mellitus (T2DM), and knee pain resulting from osteoarthritis. Regular exercise has been reported as a foundational piece of the preventive therapy puzzle for knee osteoarthritis (KOA) patients. Nonetheless, evidence-based exercise protocols for people with comorbidities, such as obesity, T2DM, and KOA are limited. Therefore, the present trial aimed to assess the effectiveness of a 12-week home-based circuit training (HBCT) protocol on various indices related to cardiometabolic health, musculoskeletal fitness, and health-related quality of life (HRQoL) among overweight/obese older adult patients with KOA and T2DM during the COVID-19 lockdown. Methods This is a randomized controlled trial study registered at the National Medical Research Register (ID: RSCH ID-21-01180-KGTNMRR ID-21-02367-FUM) and obtained approval on December 9, 2021. Seventy overweight or obese patients with KOA and T2DM (62.2 ± 6.1 years; 56% female) were randomly assigned to the intervention group (n = 35, HBCT) or the no-exercise control group (n = 35, CON). HBCT performed a 12-week progressive protocol (seven exercises; 15–30 repetitions per exercise, 1 min passive rest between exercises; 2–4 rounds per session; 20–60 min total session duration). Blood samples were collected, and assays were performed to assess the lipid profile, liver function, and fasting blood glucose (FBG). In addition, the 30-s Chair Stand Test (30CST) was used to evaluate lower body muscular strength and endurance while the Timed Up and Go (TUG) test was used to evaluate lower limb function, mobility, and the risk of falls for all the participants. HRQoL was assessed using the Osteoarthritis Knee and Hip Quality of Life (OAKHQoL). All the assessments were conducted at pre-, mid-, and post-training stages during the application or practice of the exercise protocol, rather than during the training sessions themselves. Results HBCT significantly reduced total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), aminotransferase, alanine aminotransferase, FBG and knee pain (p

Este estudio, realizado en 2022, aborda la asignación de valores en la autoevaluación de posgrados, específicamente, en la Maestría en Salud Integral y Movimiento Humano (MSIMH) de la Universidad Nacional, con base en el Manual Oficial de Acreditación de carreras de Posgrado del Sistema Nacional de Acreditación (SINAES). Se destaca la importancia de realizar esta labor de manera sistemática y organizada, con un fundamento claro, para lograr un análisis objetivo de los aspectos que aseguran la calidad de la carrera. Además, se involucran diferentes agentes en el proceso de autoevaluación, incluyendo responsables, personal administrativo, docentes, estudiantes y tutores. Los resultados revelan que las dimensiones "Recursos" y "Proceso Educativo" son centrales, con una atención especial en los componentes "Infraestructura", "Investigación" y "Personal académico". Aunque componentes como el plan de estudio y la metodología de enseñanza y aprendizaje son relevantes, también se resalta la importancia de la gestión académica y financiera para el desarrollo y sostenibilidad de la carrera. En futuras investigaciones, se recomienda contrastar los resultados de la ponderación con los hallazgos de la autoevaluación de la MSIMH para identificar fortalezas y áreas de mejora en relación con los valores ponderados establecidos. En resumen, este estudio destaca la importancia de asignar valores adecuados en la autoevaluación de posgrados y promueve la participación de múltiples actores en este proceso. Por lo tanto, este documento sirve como guía para nuevos procesos de asignación de valores en este tipo de acreditaciones.

Sweat rate magnitude is a desired outcome for any wearable sensing patch dedicated to sweat analysis. Indeed, sweat rate values can be used two-fold: self-diagnosis of dehydration and correction/normalization of other physiological metrics, such as Borg scale, VO2, and different chemical species concentrations. Herein, a reliable sweat rate belt device for sweat rate monitoring was developed. The device measures sweat rates in the range from 1.0 to 5.0 µL min−1 (2 to 10 µL min−1 cm−2), which covers typical values for humans. The working mechanism is based on a new direct current (DC) step protocol activating a series of differential resistance measurements (spatially separated by 800 µm) that is gradually initiated by the action of sweat, which flows along a customized microfluidic track (~600 µm in width, 10 mm in length, and 235 µm in thickness). The device has a volumetric capacity of ~16 µL and an acquisition frequency between 0.010 and 0.043 Hz within the measured sweat rate range. Importantly, instead of using a typical and rather complex AC signal interrogation and acquisition, we put forward the DC approach, offering several benefits, such as simplified circuit design for easier fabrication and lower costs, as well as reduced power consumption and suitability for wearable applications. For the validation, either the commercial sweat collector (colorimetric) or the developed device was performed. In five on-body tests, an acceptable variation of ca. 10% was obtained. Overall, this study demonstrates the potential of the DC-based device for the monitoring of sweat rate and also its potential for implementation in any wearable sweat platform.

Background Structured aerobic or resistance training alone seems to be a beneficial tool for improving glucose homeostasis, chronic systemic inflammation, resting cardiovascular function, and mental health in people with obesity and type 2 diabetes mellitus (T2DM). The aim of the present study was to synthesize the available data on the effectiveness of combined aerobic and resistance training (CART) on glycemic control, blood pressure, inflammation, cardiorespiratory fitness (CRF), and quality of life (QoL) in overweight and obese individuals with T2DM. Methods A database search was carried out in PubMed, Web of Science, Scopus, Science Direct, Cochrane Library, and Google Scholar from inception up to May 2023. The Cochrane risk of bias tool was used to assess eligible studies, and the GRADE method to evaluate the reliability of evidence. A random-effects model was used, and data were analyzed using standardized mean differences and 95% confidence intervals. The study protocol was registered in the International Prospective Register of Systematic Reviews (ID: CRD42022355612). Results A total of 21,612 studies were retrieved; 20 studies were included, and data were extracted from 1,192 participants (mean age: 57 ± 7 years) who met the eligibility criteria. CART demonstrated significant improvements in body mass index, glycated hemoglobin, systolic and diastolic blood pressure, C-reactive protein, tumor necrosis factor-alpha, interleukin-6, CRF, and QoL compared to ST. These findings highlight the significance of exercise interventions such as CART as essential elements within comprehensive diabetes management strategies, ultimately enhancing overall health outcomes in individuals with T2DM and overweight/obesity.No differences were found in resting heart rate between CART and ST. An uncertain risk of bias and poor quality of evidence were found among the eligible studies. Conclusion These outcomes show clear evidence considering the positive role of CART in inducing beneficial changes in various cardiometabolic and mental health-related indicators in patients with T2DM and concurrent overweight/obesity. More studies with robust methodological design are warranted to examine the dose-response relationship, training parameters configuration, and mechanisms behind these positive adaptations.

The study aimed to develop a microencapsulated probiotic (Lactiplantibacillus plantarum) delivery method, cryoprotected by chitosan-inulin complex microcapsules and freeze-dried to obtain maximum cell viability. Probiotic viability was assessed using simulated gastrointestinal conditions and storage at different temperatures. The L. plantarum microcapsules were developed using a Box-Behnken experimental design with varied concentrations of CaCl2, chitosan, and Inulin as an encapsulant agents. In addition, the current study used the response surface approach to explore the influence of various formulations and storage capsulate viabilities to verify an optimized L plantarum formulation. Under optimum conditions, small microbeads with the highest cell encapsulation efficiency were produced and the highest cell viability (68.33 %) was obtained. The results showed that the intelligent microcapsule of L. plantarum with SM significantly increased the viability of cells (p

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El objetivo de la investigación fue identificar los indicadores de carga externa e interna en balonmano juvenil durante un torneo congestionado en Costa Rica, seleccionando variables a través de Análisis de Componentes Principales (ACP) como técnica de reducción de datos, y determinar si existen diferencias entre sexo. Los datos se obtuvieron de 73 jugadores juveniles de balonmano (33 mujeres y 38 hombres) de ocho clubes locales durante un torneo de partidos congestionados de 3 días. Se analizaron doce partidos (seis masculinos y seis femeninos) utilizando ACP y una prueba t-Student independiente para las diferencias relacionadas entre sexos. Se identificaron seis indicadores principales de carga, cinco de carga externa [distancia relativa (DR); cantidad de aceleraciones (AceR), aceleración máxima (AceMáx), velocidad máxima (VMáx), y diferencia entre aceleraciones y deceleraciones (DfAce-Dec)] y uno de carga interna [frecuencia cardíaca media (FCmedia)]. En hombres, los indicadores más representativos fueron la DR, la FCmedia y AceMáx, explicaron el 39,6% de la varianza. En mujeres fueron la VMáx y AceMáx explicando el 44,4% de la varianza. AceR (p< 0,01), AceMáx (p< 0,01), VMáx (p< 0,01) fueron mayores en hombres respecto a las mujeres. Mientras que la FCmedia (p= 0,02) fue mayor en mujeres que hombres. Se concluye que la carga externa e interna mostró diferencias entre jugadores masculinos y femeninos. Hombres caracterizados por variables asociadas con el volumen, mientras que, para las mujeres fueron más comunes indicadores relacionados con la intensidad. Para torneos congestionados, es importante individualizar según sexo las cargas de entrenamiento, así como priorizar las cualidades físicas a entrenar.

The study aimed to calculate training intensity and load using muscle oxygen saturation (SmO2) during two differentiated physical tasks. 29 university athletes participated in a 40-m Maximal Shuttle Run Test (MST, 10 × 40-m with 30 s recovery between sprints) and a 3000-m time trial run. Distance and time were used to calculate external load (EL). Internal load indicators were calculated based on percentage of maximum heart rate (%HRMAX) and SmO2 variables: muscle oxygen extraction (∇%SmO2) and the cardio-muscle oxygen index (CMOI) was also provided by relating ∇%SmO2 ÷ %HRMAX, and the training load were calculated as the product of speed (m/min × IL) and the efficiency index [Effindex (m/min ÷ IL)]. A student t test was applied based on Bayesian factor analysis. As expected, EL differed in the 40-m MST (331 ± 22.8) vs. 3000-m trials (222 ± 56.8) [BF10 = 6.25e+6; p = 10 = 1.70; p = 0.039]. Training load was greater in 40-m MST (85.77 ± 27.40) vs. 3000-m (15.55 ± 6.77) [(m/min × ∇%SmO2): BF10 = 12.5; p = 0.003] and 40-m MST (129.27 ± 49.44) vs. 3000-m (70.63 ± 32.98) [(m/min × CMOI): BF10 = 169.6; p = index was higher in 40-m MST (10.19 ± 4.17) vs. 3000-m (6.06 ± 2.21) [(m/min × ∇%SmO2): BF10 = 137.03; p = 10 = 1.86; p = 0.035]. This study demonstrates calculations of training intensity and load based on SmO2 as an internal load indicator along with speed as an external load indicator during two differentiated exercises.

An increase in the delivery and use of oxygen to the musculature in physically active subjects are determinants of improving health-related aerobic capacity. Additional health benefits, such as an increase in the muscle mass and a decrease in fat mass, principally in the legs, could be achieved with weekly global physical activity levels of more than 300 min. The objective was to compare the muscle vascular and metabolic profiles of physically very active and inactive subjects. Twenty healthy men participated in the study; ten were assigned to the physically very active group (25.5 ± 4.2 years; 72.7 ± 8.1 kg; 173.7 ± 7.6 cm) and ten to the physically inactive group (30.0 ± 7.4 years; 74.9 ± 11.8 kg; 173.0 ± 6.4 cm). The level of physical activity was determined by the Global Physical Activity Questionnaire (GPAQ). A resting vascular occlusion test (5 min of an ischemic phase and 3 min of a reperfusion phase) was used, whereas a near-field infrared spectroscopy (NIRS) device was used to evaluate the muscle oxygenation in the right vastus lateralis of the quadriceps muscle. The area under the curve of the deoxyhemoglobin (HHb) during the ischemic phase and above the curve of the tissue saturation index (TSI) during the reperfusion phase were obtained to determine muscle metabolic and vascular responses, respectively. Physically very active group showed a higher absolute HHb (3331.9 ± 995.7 vs. 6182.7 ± 1632.5 mmol/s) and lower TSI (7615.0 ± 1111.9 vs. 5420.0 ± 781.4 %/s) and relative to body weight (46.3 ± 14.6 vs. 84.4 ± 27.1 mmol/s/kg and 106.0 ± 20.6 vs. 73.6 ± 13.8 %/s/kg, respectively), muscle mass (369.9 ± 122.2 vs. 707.5 ± 225.8 mmol/kg and 829.7 ± 163.4 vs. 611.9 ± 154.2 %/s/kg) and fat mass (1760.8 ± 522.9 vs. 2981.0 ± 1239.9 mmol/s/kg and 4160.0 ± 1257.3 vs. ±2638.4 ± 994.3 %/s/kg, respectively) than physically inactive subjects. A negative correlation was observed between HHb levels and TSI (r = −0.6; p < 0.05). Physically very active men (>300 min/week) present better muscle oxidative metabolism and perfusion and perform significantly more physical activity than physically inactive subjects. Extra benefits for vascular health and muscle oxidative metabolism are achieved when a subject becomes physically very active, as recommended by the World Health Organization. In addition, a higher level of physical activity determined by GPAQ is related to better vascular function and oxidative metabolism of the main locomotor musculature, i.e., the quadriceps.