A patient self-made point-of-care fecal test improves diagnostic accuracy compared with fecal calprotectin alone in inflammatory bowel disease patients

Background: Monitoring inflammatory bowel disease patients may be challenging. Fecal calprotectin is one of the most performed tests. Other fecal biomarkers are less used in clinical practice. Rapid fecal tests that could be performed by patients may be a useful strategy to closely monitor disease activity. Methods: We performed a prospective observational study including consecutive inflammatory bowel disease patients referred for colonoscopy in a single center. Certest FOB + Transferrin + Calprotectin + Lactoferrin® (Certest Biotec S.L, Zaragoza, Spain), a one-step point-of-care test which simultaneously detects these four biomarkers was performed. Endoscopic inflammatory activity was defined using the Mayo score (=1) in ulcerative colitis, SES-CD (>3) and Rutgeerts scores (=1) for Crohn’s disease. Results: Out of a total of 106 patients (56.5% female, mean age 51 years), 54 (50.9%) were diagnosed with ulcerative colitis and 52 (49.1%) with Crohn’s disease. Endoscopic activity was detected in 42 patients (39.0%). Fecal calprotectin provided the best sensitivity (97.6%), with limited specificity (34.4%). Compared to calprotectin, the other 3 fecal biomarkers showed better specificity (87.5–92.1%) and lower sensitivity (45.2–59.5%). Patients with a negative result in all biomarkers (19/106—17.9%) had 100% (CI 95% 97.4–100) negative predictive value, while patients with the 4 biomarkers positive (13/106—12.3%) had 100% (CI 95% 96.1–100) positive predictive value of endoscopic inflammatory activity. AUROC of this 4 biomarker point-of-care test was 0.845 (95% CI 0.771–0.920), significantly higher than the AUROCs of any of the 4 biomarkers. Conclusions: This test may be a useful strategy to monitor inflammatory activity in clinical practice by excluding or prioritizing patients in need of a colonoscopy. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Experimental evaluation of the thermal polarization in direct contact membrane distillation using electrospun nanofiber membranes doped with molecular probes

Membrane distillation (MD) has recently gained considerable attention as a valid process for the production of fresh-water due to its ability to exploit low grade waste heat for operation and to ensure a nearly feed concentration-independent production of high-purity distillate. Limitations have been related to polarization phenomena negatively affecting the thermal efficiency of the process and, as a consequence, its productivity. Several theoretical models have been developed to predict the impact of the operating conditions of the process on the thermal polarization, but there is a lack of experimental validation. In this study, electrospun nanofiber membranes (ENMs) made of Poly(vinylidene fluoride) (PVDF) and doped with (1, 10-phenanthroline) ruthenium (II) Ru(phen) 3 were tested at different operating conditions (i.e., temperature and velocity of the feed) in direct contact membrane distillation (DCMD). The temperature sensitive luminophore, Ru(phen) 3 , allowed the on-line and non-invasive mapping of the temperature at the membrane surface during the process and the experimental evaluation of the effect of the temperature and velocity of the feed on the thermal polarization

A non-invasive optical method for mapping temperature polarization in direct contact membrane distillation

Membrane Distillation (MD) is a thermal membrane process allowing for a theoretical 100% rejection of non-volatile compounds (i.e. ions, macromolecules, colloids, cells), whereas vapour molecules permeate through a micro-porous hydrophobic membrane due to a difference of vapour pressure established across the membrane-self. The effective driving force and, then, the vapour trans-membrane flux is affected by temperature polarization phenomena occurring in the boundary layers adjacent to the membrane. The temperature values at the membrane surface are usually difficult to measure and only recently some invasive techniques were adopted for this scope. The aim of this work was to introduce luminescent molecular probing as an innovative technology for non-invasive and in-situ monitoring of thermal polarization in MD. Tris(phenantroline)ruthenium(II) chloride (Ru(phen)3) was selected as temperature sensitive luminescent probe and immobilized in a flat poly(vinylidene fluoride) electrospun nanofibrous membrane (PVDF ENM). Experiments showed the key role of the Ru(phen)3 and Lithium Chloride (LiCl) in the preparation of homogeneous PVDF ENM due to their ionic nature that improved the electrical conductivity of the polymeric solution favouring the electrospinning. Furthermore, PVDF ENM showed a good performance in Direct Contact Membrane Distillation (DCMD) process. The immobilization of the molecular probe allowed to optically monitoring the membrane surface temperature during DCMD experiments. On the other hand, the employment of an IR-camera permitted the evaluation of the temperature of the bulk of liquid streams. Therefore, the combination of these two optical techniques enabled to evaluate, in a direct and non-invasive way, the thermal polarization along the membrane module during DCMD experiments

Enteritis secundaria a nivolumab, una causa creciente de diarrea

La inmunoterapia es una herramienta cada vez más utilizada en el campo de la oncología. Conviene conocerla debido a sus crecientes usos, entre los que se incluye el tratamiento de tumores del aparato digestivo (hepatocarcinoma1, adenocarcinoma colorrectal con alta inestabilidad en microsatelites2) así como por las reacciones adversas que con elevada frecuencia afectan al tubo digestivo. Presentamos el caso de un varón de 74 años, con antecedentes personales de enfermedad pulmonar obstructiva crónica (EPOC) y melanoma con metástasis pulmonares. Debido a estas patologías tomaba de manera habitual inhaladores de salbutamol y había estado en tratamiento con nivolumab, suspendido hacía cuatro meses tras conseguir una respuesta radiológica completa de las metástasis pulmonares. El paciente refería cuadro diarreico de un mes de evolución, consistente en tres a cuadro deposiciones (Bristol 5-6) sin productos patológicos, que afectaban el descanso nocturno, asociaban molestias centroabdominales intermitentes y pérdida de peso de unos 3-4 kg. No había ingerido alimentos crudos, antibióticos o nuevas medicaciones. Tampoco había convivientes con la misma sintomatología ni había realizado viajes al extranjero. Negaba cualquier otra sintomatología y antecedentes familiares de interés. La exploración física era anodina a excepción de unas ligeras molestias a la palpación profunda en mesogastrio..

Aproximación al manejo de la disección del tronco celíaco

El dolor abdominal constituye uno de los motivos de consulta más frecuentes en los servicios de Urgencias y de Aparato Digestivo. Además, el diagnóstico diferencial supone un importante reto, dado el amplio abanico de entidades clínicas que pueden provocarlo, algunas de ellas con un pronóstico desfavorable. En este sentido, en algunas cohortes no se ha llegado a un diagnóstico específico en más de un 30% de los casos1, 2. Se presenta el caso de un varón de 40 años, fumador activo desde hace más de 20 años, sin otros antecedentes personales ni familiares de interés, excepto traumatismo cerrado abdominal hace cuatro años, que no seguía tratamiento farmacológico habitual. Presentaba dolor abdominal epigástrico continuo e irradiado hacia ambos hipocondrios, de ocho horas de evolución. No asociaba ictericia mucocutánea ni coluria o acolia, tampoco náuseas ni vómitos ni alteraciones en el ritmo y características de las deposiciones. No presentaba fiebre, síndrome constitucional ni otra sintomatología asociada. A la exploración física destacaba dolor a la palpación de epigastrio, sin signos de irritación peritoneal, con peristaltismo y pulsos distales conservados. Asimismo, no presentaba signos de colagenopatía. Para una primera aproximación diagnóstica se realizó analítica de sangre, destacando como únicos hallazgos ligera alteración del perfil hepático (AST 66 U/L, ALT 58 U/L, GGT 106 U/L, FA 76 U/L) con amilasemia, ..

Catch-up growth follows an abnormal pattern in experimental renal insufficiency and growth hormone treatment normalizes it

The primary goal of this study was to determine if the ability to undergo catch-up growth following a transient injury is preserved in an experimental model of moderate chronic renal failure (CRF) and the effect of growth hormone (GH) administration on such phenomenon. Young rats were subtotally nephrectomized (days 0 and 4) (Nx). From days 11 to 13, food intake was restricted in subgroups of Nx and control (C) rats (NxR and CR). After refeeding, subgroups of NxR and CR rats received GH from days 14 to 20 (NxRGH and CRGH). Rats were killed on days 14 (C, CR, Nx, NxR), 17 and 21 (C, CR, CRGH, Nx, NxR, NxRGH), and 36 (C, CR, Nx, NxR). Longitudinal growth rate was measured by osseous front advance in the proximal tibiae. With refeeding, growth rate of CR, NxR, and NXrGH rats became significantly greater than that of C, indicating catch-up growth. This occurred later and with lower growth rate in NxR than in CR rats, whereas the characteristics of catch-up growth in CR and NxRGH animals were similar. Changes in growth rate were associated with modifications in the morphology and proliferative activity of growth cartilage. We conclude that catch-up growth occurs in renal insufficiency but follows a different pattern from that observed with normal renal function. GH treatment normalizes the pattern of catch-up growth in CRF. Changes in growth velocity are associated to modifications in the structure and dynamics of growth cartilage