A simple and reliable method for the simultaneous determination of nine phenolic compounds in barley and malted barley was established, using liquid chromatography-diode array detection-electrospray ionization tandem mass spectrometry (HPLC-DAD-ESI-MS/MS). The phenolic compounds can be easily detected with both systems, despite significant differences in sensitivity. Concentrations approximately 180-fold lower could be achieved by mass spectrometry analysis compared to diode array detection, especially for the flavan-3-ols (+)-catechin and (−)-epicatechin, which have poor absorptivity in the UV region. Malt samples were characterized by higher phenolic content comparing to corresponding barley varieties, revealing a significant increase of the levels of (+)-catechin and (−)-epicatechin during the malting process. Moreover, the industrial malting is responsible for modification on the phenolic profile from barley to malt, namely on the synthesis or release of sinapinic acid and epicatechin. Accordingly, the selection of the malting parameters, as well as the barley variety plays an important role when considering the quality and antioxidant stability of beer.

Malt is known to have an impact on beer flavor stability mainly due to the presence of antioxidants. In this study, five barley varieties were malted at industrial and micro scale, and quality parameters of the resulting malts were measured (diastatic power, friability, beta-glucan content, antiradical power, reducing power, lipoxygenase activity, and nonenal potential) and correlated with the sensory data obtained for the corresponding fresh and forced aged beers. A statistical strategy using multiple linear regressions was applied to explore relationships between the malt chemical parameters and beer sensory data, showing antiradical power as the major contribution of malt to beer flavor stability. Additionally, the measured antiradical power, which is well correlated with the polyphenolic content, was found to be very similar for malt and barley, emphasizing the key role of barley endogenous polyphenols.

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Background and Aims Patients with type 2 diabetes mellitus (T2DM), may have various underlying causes contributing to kidney disease beyond diabetic nephropathy (DN). In such cases, a kidney biopsy (KB) can provide a definite diagnosis and allow for tailored treatment options. The aim of this study is to evaluate non diabetic kidney disease (NDKD) in T2DM patients and identify data to support KB indications. Method This is a retrospective observational study that included patients with T2DM who were submitted to a native KB between 2011 and 2022. We collected demographic, clinical and laboratory data at the date of biopsy. KB indication was considered in order to include the patients in the first encountered criteria defined sequentially as the presence of (1) nephrotic syndrome, (2) low or rapidly declining estimated glomerular filtration rate (eGFR), (3) nephrotic proteinuria and (4) hematuria. Results We analysed 72 patients with T2DM that were submitted to KB (Table 1). All except one patient had hypertension and 38 patients were screened for diabetic retinopathy (DR), which was present in 23 patients (60%). The criteria for KB was in most of the patients (59.7%) a low or rapidly declining eGFR, followed by nephrotic proteinuria (19.4%), nephrotic syndrome (16.7%) and hematuria (4.2%). KB showed 50% (n = 36) of patients with NDKD, 12.5% (n = 9) with NDKD and DKD and 37.5% (n = 27) with isolated NDKD. Among these patients, hypertensive nephrosclerosis (19.4%), focal segmental glomerulosclerosis (13.8%), acute interstitial nephritis (13.8%), membranous nephropathy (11.2%) and IgA nephropathy (5.6%), were the most prevalent diagnosis. Patients with DR had a higher prevalence of DKD with a positive predictive value (PPV) of 87%. On the other hand, in the absence of DR, DKD was only absent in 66.7%. Patients submitted to KB for the criteria of low or rapid declining eGFR had significantly more NDKD (p = 0.016). DKD with or without NDKD was found in patients with higher levels of albumin to creatinine ratio (p = 0.001) and HbA1c (p = 0.05). Conclusion Our data showed that NDKD is prevalent in T2DM patients, and given its potentially treatable nature, KB should be considered in T2DM patients, especially in those with low or rapid declining eGFR. DR supports the diagnosis of DKD (PPV of 87%), but alone is insufficient to exclude other causes. Patients with DKD had higher levels of albuminuria and HbA1c. Overall, more than half of the patients had hematuria, without any correlation with any group.

Background and Aims Chronic volume overload is a major contributor to cardiovascular mortality in patients receiving maintenance hemodialysis (HD). Hence, accurately assessing volume status in this population is crucial. Bioelectrical impedance analysis (BIA) is a validated, non-invasive, and straightforward bedside technique that estimates total body water (TBW), extracellular water (ECW), intracellular water (ICW), and over hydration (OH). However, it is not suitable for use in patients with limb amputation or metallic medical devices. On the other hand, lung ultrasound (LUS) is used to evaluate extravascular lung water (EVLW) and has been shown to predict all-cause mortality and cardiac events in HD patients. Although a 28-zone LUS is the reference standard for LUS studies, recent studies have shown that an 8-zone LUS protocol can be as accurate. The aim of this study was to compare the performance of an 8-zone LUS protocol with bioelectrical impedance analysis to evaluate hydration status in an outpatient haemodialysis unit. Method Adult patients under thrice-weekly 4h HD sessions using high-flux membrane dialyzers for at least 1 month were prospectively enrolled between June and August 2022. We excluded patients with systemic infections, advanced neoplasia, metallic medical devices, decompensated cirrhosis, and limb amputations. The dry weight (DW) was established by the attending nephrologist, blind to the results. All measurements were performed in the first session of the week. BIA was assessed before HD using a portable whole body BIA device (BCM—Fresenius Medical Care D GmbH) and the OH was normalized to ECW. LUS using 8-zone protocol was performed before and after HD, with patients in the near-to-supine or supine position using a 2–5 MHz convex probe (Acuson X150®, Siemens, Germany), and the total number of B lines was recorded. Results A total of 37 patients with median age of 60 (IQR 15) years, 75% males, 65% with residual diuresis >300 mL/24 h were included. The median HD vintage was 9 (IQR 10) months, and median body mass index (BMI) of 22.7 (IQR 9) Kg/m2. At the beginning of HD, the median systolic blood pressure (BP) was 140 (IQR 24) mmHg and the median diastolic BP was 79 (IQR 16) mmHg. The median interdialytic weight gain was 4.2% (IQR 2.8) and median ultrafiltration (UF) was 2600 (IQR 1300) mL. The BIA showed median TBW of 38.2 (IQR 11) L, ECW 18.2 (IQR 7.73) L, ICW 20.8 (IQR 6.55) L, and normalized OH 0.138 (IQR 0.147). There was a positive correlation between BMI, TBW (r = 0.375, p = 0.045), and ECW (r = 0.486, p = 0.006), but not with ICW (r = 0.061, p = 0.755), nor normalized OH (r = 0.14, p = 0.468). Systolic BP, but not diastolic, was correlated with the water volume measured in both compartments (ECW: r = 0.498, p = 0.005; ICW: r = 0.421, p = 0.023, TBW: r = 0.423, p = 0.022). The 8-zone LUS showed a statistically significative (p<0.001) reduction in the number of B lines between pre and post HD evaluation (16.5 (IQR 17.25) lines to 8.5 (IQR 10.25) lines). Total evaluation time was under 8 minutes. When comparing LUS before HD with BIA assessment we found that the number of B lines correlated with the normalized OH (r = 0.454, p = 0.018), ECW (r = 0.501, p = 0.007), TBW (r = 0.418, p = 0.030), but not ICW (r = 0.239, p = 0.23). The total number of B lines post HD was also correlated with the ECW (r = 0.568, p = 0.002), TBW (r = 0.465, p = 0.017), and normalized OH (r = 0.408, p = 0.039). Conclusion The 8-zone LUS protocol provides a quick and efficient way to evaluate patients prior to HD sessions. Our study reveals a strong correlation between the total number of B lines determined by the 8-zone protocol and BIA parameters such as TBW, ECW, and normalized OH. This demonstrates that the 8-zone protocol can effectively be used in routine evaluations of HD patients. Although these techniques reflect different over-fluid compartments, they have a complementary role for fluid overload determination and dry weight guidance.

A 48-year-old woman with a medical history of hypertension, chronic obstructive pulmonary disease, and active smoking presented to the emergency room with acute onset of right flank pain and acute kidney injury (serum creatinine [sCr] of 1.7 mg/dl) and increased serum inflammatory markers and pyuria. Upper urinary tract infection was considered, antibiotic treatment was started, and the patient was discharged the same day. One week later, the patient returned with acute left flank pain, without urinary symptoms. Vital signs were normal, except for high blood pressure. Physical examination was unremarkable, with no signs of peripheral hypoperfusion. Blood tests revealed deterioration of kidney function (sCr 6.9 mg/dl and BUN 66 mg/ dl) and inflammatory markers persistently increased (leukocytes 28.100/mm 3 , C-reactive protein 12.9 mg/ dl) with normal lactate dehydrogenase levels. Urine dipstick presented significant proteinuria, hemoglobin, and leukocytes. Upper urinary tract infection was diagnosed, and intravenous antibiotics were started. However, while performing the initial work-up, sudden anuria developed. A kidney Doppler ultrasound showed normal echogenicity and kidney size along with the signs of aortic occlusion juxta-superior mesenteric artery emergence, which was confirmed by contrastenhanced computed tomography (CT) scan (Figure 1A). The CT scan also showed collateral circulation in the abdominal wall allowing sufficient blood supply to the lower limbs. Only the left kidney showed residual contrast uptake (Figure 1B) suggesting lack of perfusion of the right kidney. Emergent aortobifemoral bypass and end-to-side anastomosis of left renal artery and bypass graft were performed assuming that the left kidney was still viable. The patient started hemodialysis after surgery. Urinary output gradually increased along with kidney function recovery two weeks after surgery. These findings were supported by Doppler ultrasound showing normal flow in the left kidney (data not shown). Hemodialysis was withheld 27 days after surgery, and 3 months later, sCr was 1.7 mg/dl. DiscussionAcute aortic occlusion (AAO) is a life-threatening condition. The reported incidence of AAO is 3.8 per one million person-years, with no sex preponderance, and 30-day mortality rates between 21% and 52%. 1 The clinical presentation of AAO may vary from limb ischemia, paraplegia, visceral ischemia, acute kidney injury, and refractory hypertension. The main cause of AAO is superimposed thrombosis of an atherosclerotic abdominal aorta. Other causes were excluded in this patient during follow-up. The most common location of AAO is infrarenal. 2 A well-developed collateral circulation in preexisting infrarenal occlusive disease may prevent lower extremity ischemia and limit symptoms to acute kidney injury. Collateral circulation in our patient suggested a chronic aortoiliac atherosclerotic obstructive disease, with sudden progression of thrombus to the suprarenal level leading to acute renal failure and anuria. Active smoking is a well-estab...

Hypertriglyceridemia-induced pancreatitis is a relatively common form of acute pancreatitis that may represent up to 10% of all etiologies of this condition. Due to its specific pathogenic mechanisms related to high serum triglyceride levels, different treatment options have been proposed, including insulin perfusion, heparin perfusion, and plasmapheresis. Although the superiority of plasmapheresis in this clinical setting has not been demonstrated in randomized clinical trials, many centers have reported its effectiveness and considered this as a possible alternative according to the current guidelines. We report a case of a young patient diagnosed with hypertriglyceridemia-induced pancreatitis that was successfully treated with plasmapheresis. Since complications associated with plasmapheresis are rare and other therapeutic options may not be so effective or safe, we believe that this should be a valid alternative treatment that may be offered to these patients. More studies are still needed to further evaluate its effectiveness and to elucidate if there is a subset of patients in whom treatment with plasmapheresis may be more beneficial.

Os autores descrevem o caso clínico de uma doente com 41 anos com um episódio psicótico inaugural caracterizado por alucinações auditivo-verbais e visuais e delírios de caráter persecutório e místico-messiânico com discurso altissonante e catastrófico. Pela exuberância do quadro clínico, a doente foi internada, tendo sido excluída a causa orgânica para a sintomatologia. Foi medicada com risperidona, que manteve após alta, tendo atingido uma remissão total do quadro clínico e de funcionamento, retomando a sua atividade social e profissional. O diagnóstico foi de psicose cicloide. O relato deste caso justifica-se pela sua apresentação particular e importância de um correto diagnóstico, com adequada avaliação do ponto de vista orgânico e psiquiátrico, dado o bom prognóstico atribuído a esta patologia.