Lactic Acid Fermentation Improved Textural Behaviour, Phenolic Compounds and Antioxidant Activity of Chia (Salvia hispanica L.) Dough

U radu su izolirane autohtone bakterije mliječno-kiselog vrenja iz tijesta s dodatkom chia (Salvia hispanica L.) sjemenki, te razvrstane prema kinetici zakiseljavanja i proteolitičkoj aktivnosti. Soj C8 identificiran je kao soj bakterije Lactobacillus plantarum C8, te je upotrijebljen kao starter kultura za dobivanje kiselog tijesta s dodatkom chia sjemenki. Mliječno-kiselim vrenjem povećan je maseni udjel organskih kiselina (mliječne na 12,3 g, octene na 1,0 g i fenilacetatne kiseline na 23,8 μg po kilogramu tijesta), te antioksidacijska aktivnost, koja je porasla za 33-40 % u usporedbi s nefermentiranim tijestom s dodatkom chia sjemenki. Osim toga, ukupni se udjel fenolnih spojeva uvećao za 25 %, a njihov se sastav bitno promijenio nakon 24 h fermentacije s pomoću soja bakterije L. plantarum C8. Klorogena je kiselina pronađena jedino u fermentiranom tijestu (2,5 mg/g), dok je ferulinska kiselina detektirana već na početku vrenja, i to u 32 % većoj količini u kiselom tijestu s dodatkom chia sjemenki (5,6 mg/g). Upotrebom fermentiranog kiselog tijesta s dodatkom chia sjemenki poboljšana su ukupna svojstva bijelog kruha, uključujući fizikalna (npr. smanjena tvrdoća i otpor krušnih mrvica pri žvakanju) i antioksidacijska svojstva (u prosjeku za 25 %). Dobiveni rezultati pokazuju da kiselo tijesto s dodatkom chia sjemenki poboljšava tehnološka i antioksidacijska svojstava pšeničnog kruha. Osim toga, u radu je po prvi puta prikazano da bakterije mliječno-kiselog vrenja mogu fermentirati tijesto s dodatkom chia sjemenki, čime poboljšavaju ukupna svojstva kruha.In this work, autochthonous lactic acid bacteria (LAB) were isolated from chia (Salvia hispanica L.) dough and selected on the basis of the kinetics of acidification and proteolytic activity. Strain no. C8, identified as Lactobacillus plantarum C8, was selected and used as starter to obtain chia sourdough. Lactic acid fermentation increased the organic acid mass fractions (lactic, acetic and phenyl lactic acids to 12.3 g, 1.0 g and 23.8 μg per kg of dough respectively), and antioxidant activities, which increased by approx. 33–40 % compared to unfermented chia flour dough. In addition, total phenolic content increased 25 % and its composition was strongly modified after 24 h of fermentation by L. plantarum C8. Chlorogenic acid was only found in the fermented dough (2.5 mg/g), while ferulic acid was detected from the beginning of fermentation, being 32 % higher in chia sourdough (5.6 mg/g). The use of fermented chia sourdough improved the overall characteristics of white bread, including physical (e.g. reduced hardness and chewiness of the crumb) and antioxidant properties (25 % on average), compared to the white bread. These results indicate that the use of chia sourdough could be a promising alternative to improve the technological and antioxidant properties of wheat bread. In addition, this work has shown, for the first time, that lactic acid bacterium is able to ferment chia dough, improving its overall characteristics

Lactic Acid Fermentation Improved Textural Behaviour, Phenolic Compounds and Antioxidant Activity of Chia (Salvia hispanica L.) Dough

U radu su izolirane autohtone bakterije mliječno-kiselog vrenja iz tijesta s dodatkom chia (Salvia hispanica L.) sjemenki, te razvrstane prema kinetici zakiseljavanja i proteolitičkoj aktivnosti. Soj C8 identificiran je kao soj bakterije Lactobacillus plantarum C8, te je upotrijebljen kao starter kultura za dobivanje kiselog tijesta s dodatkom chia sjemenki. Mliječno-kiselim vrenjem povećan je maseni udjel organskih kiselina (mliječne na 12,3 g, octene na 1,0 g i fenilacetatne kiseline na 23,8 μg po kilogramu tijesta), te antioksidacijska aktivnost, koja je porasla za 33-40 % u usporedbi s nefermentiranim tijestom s dodatkom chia sjemenki. Osim toga, ukupni se udjel fenolnih spojeva uvećao za 25 %, a njihov se sastav bitno promijenio nakon 24 h fermentacije s pomoću soja bakterije L. plantarum C8. Klorogena je kiselina pronađena jedino u fermentiranom tijestu (2,5 mg/g), dok je ferulinska kiselina detektirana već na početku vrenja, i to u 32 % većoj količini u kiselom tijestu s dodatkom chia sjemenki (5,6 mg/g). Upotrebom fermentiranog kiselog tijesta s dodatkom chia sjemenki poboljšana su ukupna svojstva bijelog kruha, uključujući fizikalna (npr. smanjena tvrdoća i otpor krušnih mrvica pri žvakanju) i antioksidacijska svojstva (u prosjeku za 25 %). Dobiveni rezultati pokazuju da kiselo tijesto s dodatkom chia sjemenki poboljšava tehnološka i antioksidacijska svojstava pšeničnog kruha. Osim toga, u radu je po prvi puta prikazano da bakterije mliječno-kiselog vrenja mogu fermentirati tijesto s dodatkom chia sjemenki, čime poboljšavaju ukupna svojstva kruha.In this work, autochthonous lactic acid bacteria (LAB) were isolated from chia (Salvia hispanica L.) dough and selected on the basis of the kinetics of acidification and proteolytic activity. Strain no. C8, identified as Lactobacillus plantarum C8, was selected and used as starter to obtain chia sourdough. Lactic acid fermentation increased the organic acid mass fractions (lactic, acetic and phenyl lactic acids to 12.3 g, 1.0 g and 23.8 μg per kg of dough respectively), and antioxidant activities, which increased by approx. 33–40 % compared to unfermented chia flour dough. In addition, total phenolic content increased 25 % and its composition was strongly modified after 24 h of fermentation by L. plantarum C8. Chlorogenic acid was only found in the fermented dough (2.5 mg/g), while ferulic acid was detected from the beginning of fermentation, being 32 % higher in chia sourdough (5.6 mg/g). The use of fermented chia sourdough improved the overall characteristics of white bread, including physical (e.g. reduced hardness and chewiness of the crumb) and antioxidant properties (25 % on average), compared to the white bread. These results indicate that the use of chia sourdough could be a promising alternative to improve the technological and antioxidant properties of wheat bread. In addition, this work has shown, for the first time, that lactic acid bacterium is able to ferment chia dough, improving its overall characteristics

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research