Primary gastrointestinal lymphoma is the most common type of extra-nodal lymphoma, representing about 30%-50% of all extra-nodal involvement. The stomach is the most common site, with the colon and rectum accounting for a minority of occurrences. Primary colorectal lymphoma is uncommon, representing only 0.3% of all large intestinal malignancies and approximately 3% of gastrointestinal (GI) lymphomas, with the majority of these being B-cell non-Hodgkin lymphoma and diffuse large B-cell lymphoma (DLBCL) being the most common subtype. We present a case of an 85-year-old male who presented with symptoms suggestive of bowel obstruction, who, after further evaluation, was diagnosed with primary non-Hodgkin lymphoma of the colon, DLBCL subtype.

Phenobarbital (PB) is one of the most important antiseizure drugs (ASDs) to treat canine idiopathic epilepsy (IE). The effect of PB on the taxonomic changes in gastrointestinal microbiota (GIM) and their functions is less known, which may explain parts of its pharmacokinetic and pharmacodynamic properties, especially its antiseizure effect and drug responsiveness or drug resistance as well as its effect on behavioral comorbidities. Fecal samples of 12 dogs with IE were collected prior to the initiation of PB treatment and 90 days after oral PB treatment. The fecal samples were analyzed using shallow DNA shotgun sequencing, real-time polymerase chain reaction (qPCR)-based dysbiosis index (DI), and quantification of short-chain fatty acids (SCFAs). Behavioral comorbidities were evaluated using standardized online questionnaires, namely, a canine behavioral assessment and research questionnaire (cBARQ), canine cognitive dysfunction rating scale (CCDR), and an attention deficit hyperactivity disorder (ADHD) questionnaire. The results revealed no significant changes in alpha and beta diversity or in the DI, whereas only the abundance of Clostridiales was significantly decreased after PB treatment. Fecal SCFA measurement showed a significant increase in total fecal SCFA concentration and the concentrations of propionate and butyrate, while acetate concentrations revealed an upward trend after 90 days of treatment. In addition, the PB-Responder (PB-R) group had significantly higher butyrate levels compared to the PB-Non-Responder (PB-NR) group. Metagenomics of functional pathway genes demonstrated a significant increase in genes in trehalose biosynthesis, ribosomal synthesis, and gluconeogenesis, but a decrease in V-ATPase-related oxidative phosphorylation. For behavioral assessment, cBARQ analysis showed improvement in stranger-directed fear, non-social fear, and trainability, while there were no differences in ADHD-like behavior and canine cognitive dysfunction (CCD) scores after 90 days of PB treatment. While only very minor shifts in bacterial taxonomy were detected, the higher SCFA concentrations after PB treatment could be one of the key differences between PB-R and PB-NR. These results suggest functional changes in GIM in canine IE treatment.

The herbal preparation coffee charcoal is produced by over-roasting and milling green dried Coffea arabica L. seeds, and has a long-standing tradition in the treatment of inflammatory and gastrointestinal disorders. Its therapeutic properties are commonly attributed to adsorptive and astringent effects. This insufficiently explains its mode of action, especially when used in the treatment of inflammatory diseases in lower dosages. Our investigations aimed to identify bioactive secondary plant metabolites affecting cytokine-signaling. Thus, a phytochemical analysis of coffee charcoal extract was conducted using HPLC and LC/MS. Trigonelline, neochlorogenic acid, chlorogenic acid, caffeine, cryptochlorogenic acid, feruloylquinic acid isomers, and a caffeoylquinolacton were identified in the extract. Subsequently, the effects of coffee charcoal extract, chlorogenic acid isomers, their metabolite caffeic acid, caffeine, and trigonelline on cytokine (TNF, IL-6, MCP-1) release from LPS-challenged human THP-1 macrophages were examined to evaluate anti-inflammatory activity. Coffee charcoal showed concentration-dependent mild-to-medium inhibitory effects. The chlorogenic acid isomers and caffeic acid inhibited the TNF release, with cryptochlorogenic acid exerting the most distinct effects, as well as decreasing the release of IL-6 and MCP-1. In addition, scanning electron microscopic images provided an impression of the particle constitution, indicating a larger particle size and less structured surface of coffee charcoal in comparison to activated charcoal. In conclusion, our findings underline that beyond adsorptive effects, coffee charcoal exhibits pharmacological properties, which derive from a spectrum of secondary plant metabolites and support the therapeutic use in inflammatory diseases. Chlorogenic acids, particularly cryptochlorogenic acid, appear as pivotal bioactive compounds.

<p>Stress is known to play an important role in the natural history of gastrointestinal diseases, and functional disorders in particular. In health, activation of the stress response serves to maintain homeostasis in response to harmful stimuli. However, prolonged activation of the stress response can become maladaptive and contribute to the initiation and maintenance of symptoms in disorders such as irritable bowel syndrome (IBS). The mechanisms underlying this detrimental effect are unclear. This thesis investigates this relationship by examining the influence of 10 days of water avoidance stress on a murine model of acute bacterial gastroenteritis; a known trigger in a subset of IBS patients. Results indicate that stress can increase the level of the stress hormone norepinephrine in the gut. However, the overall influence of host stress during infection proves to be beneficial in this model, with decreased colonic inflammation and earlier clearance of the pathogen. Next, we utilized the olfactory bulbectomy (OBx) model of depression comorbid anxiety, which shows a heightened stress response, to examine mechanism underlying stress-mediated susceptibility in a more chronic setting. OBx resulted in increased neural activity and motility in the gut, and a change in composition of gut microbiota. These responses were not accompanied by changes in gut permeability or immune activation. Thus stress alters the habitat of commensal bacteria via a neurally mediated change in colonic motility. These results have bearing on the ability of stress to alter the microbiota: a feature of functional GI disorders.</p> / Doctor of Philosophy (Medical Science)

<p>Emerging evidence indicates that the commensal microbiota communicates with the brain and influences behavior. In animal models, perturbation of the microbiota is accompanied by changes in brain-derived neurotrophic factor (BDNF) levels in the brain. However, underlying mechanisms are unknown. We investigated whether vagal-parasympathetic and sympathetic branches of the autonomic nervous system are involved in the microbiota-gut-brain signalling and attempt to identify specific brain regions that are responsive to alterations in the intestinal microbiota. Specific pathogen-free Balb/c mice, with or without surgical vagotomy or chemical sympathectomy, received oral non-absorbable antimicrobials (ATM) <em>ad libitum</em> for 7 days. Behavior was tested on day 7 in the light/dark preference and step-down latency tests. Specific brain regions were sectioned and stained for the neuronal activation marker, <em>c-fos</em>. Perturbation of the microbiota significantly enhanced the exploratory behavior of mice in both tests and increased the expression of <em>c-fos</em> and phosphorylated <em>c-fos</em> in the hippocampus and dentate gyrus. <em>c-fos</em> expression in the nucleus of the solitary tract was unaffected and neither vagal-parasympathetic nor sympathetic neurotransmission were required for induction of the behavioral change following perturbation of the microbiota. Instability of the commensal microbiota enhances the activation of the hippocampal formation and influences host behavior in a manner that is independent of vagal-parasympathetic and sympathetic autonomic neurotransmission.</p> / Master of Health Sciences (MSc)

The combinatorial code of cPcdh isoforms creates a diversified cell-surface molecular signature for cell-cell recognition in neural networks. This genetic architecture, combined with a regulated expression pattern and trans-homophilic binding properties, provides insights into cell specialization and signaling. Anomalies in cPcdhs, which include genetic mutations, epigenetic modifications, structural variations, and altered gene expression profiles, are associated with several neurological, neuropsychiatric, and systemic conditions, highlighting the importance of cPcdh investigations. This study focuses on the transcriptional regulation of the Pcdhα gene cluster. Each neuron displays a specific Pcdhα alternate exon repertoire, necessitating an understanding of the transcriptional dynamics. Using the SK-N-SH human neuroblastoma cell line and methodologies such as cRNA-seq and Start-Seq, these dynamics are examined. The application of CRISPR-Cas9 gene editing and a dCas9-VPR gain-of-function assay in the HEK293T cell line reveals the role of as-lncRNA and its interaction with DNA methylation within the Pcdhα gene cluster. This study identifies the role of noncoding as-lncRNA in RNA transcription and provides information on CTCF binding and Pcdhα promoter activation. The research also examines the gastrointestinal domain, as cPcdhs are linked to various diseases. Shifting focus from the canonical realm of the CNS, the research embarks on a preliminary yet pivotal exploration of the gastrointestinal domain. As cPcdhs intersect with a plethora of diseases, an incisive understanding of their expression could yield revelations into tissue susceptibilities with potential disease ramifications. Employing a novel single-domain antibody technique coupled with immunohistochemistry, the endeavor casts a precise lens into the gastrointestinal expression dynamics of Pcdhα and Pcdhγ. These insights not only fortify the understanding of cPcdh within neural structures but also beckon a deeper inquiry into their multifaceted biological roles.

Chronic conditions such as obesity, inflammatory bowel disease (IBD), and colitis are associated with gastrointestinal (GI) inflammation and compromised GI barrier integrity. Cocoa may be a potential dietary strategy to mitigate gut-related conditions and been shown to elicit anti-inflammatory, antioxidant, and prebiotic effects. Alkali treatment of cocoa was once thought to reduce its bioactivity, but new evidence suggests it may enhance cocoa's health properties, through the formation of new, potentially bioactive high molecular weight compounds. Inulin, a fructose-containing plant polymer, exerts prebiotic effects and has also been investigated in the mitigation of IBD. This study aims to 1) investigate effects of alkali processing on gut health related bioactivity and phytochemical composition of cocoa and 2) evaluate potential additive benefits of combining cocoa and inulin. Polyphenolic and flavanol compounds in natural cocoa, alkalized cocoa, and inulin powders were characterized using Folin-Ciocalteu (total polyphenols) and 4-dimethylaminocinnamaldehyde (total flavanols) assays, thiolysis , and HILIC UPLC-MS/MS. Treatments of cocoa and inulin were made in 1:2 cocoa:inulin and 1:4 cocoa:inulin mixtures for both natural and alkalized cocoas. Cocoa mixtures, in addition to both cocoa powders and inulin alone, were subjected to an in-vitro digestion to generate material for an in-vitro fecal fermentation. Samples collected from the fermentation at 0, 6, 12, and 24 hours were analyzed via HPLC-MS for microbial metabolites, applied to HT-29 colon cancer cells to assess anti-inflammatory activity, and applied to a florescence assay measuring PLA2 inhibitory activity. The alkalized cocoa powder was found to have a significantly lower concentration of total polyphenols and total flavanols, as well as a lower mDP, suggesting that alkalization may affect larger procyanidins more than smaller flavanol compounds. Inulin enhanced the inhibition of the PLA2 enzyme and enhanced the IL-8 anti-inflammatory properties of cocoa, although the trends were weak. Overall, we did not see any clear, significant effects of alkalization or the addition of inulin to cocoa's colonic metabolite formation or its gut bioactivity in vitro. However, we have demonstrated that colonic fermentation of cocoa may have a negative effect on its bioactivity in vitro. Future research should further explore flavanol DP and bioactivity, fiber's interaction with polyphenols, colonic metabolism of cocoa, and cocoa's gut health effects in vivo. / Master of Science in Life Sciences / Gut conditions like obesity-associated inflammation and inflammatory bowel disease are highly prevalent, debilitating, and currently have no cure. Cocoa has been investigated as a possible dietary strategy for the mitigation and prevention of chronic inflammatory gut conditions due to its anti-inflammatory and enzyme inhibiting properties. Most attribute these effects of cocoa to its abundance of compounds called polyphenols. It is widely thought that the ability of cocoa to promote health is lost when cocoa beans are processed, because of the loss of polyphenols. Alkalization, or "Dutching", is an optional step in cocoa processing that some manufacturers perform to enhance flavor and color formation. Dutching cocoa can promote the polymerization of many smaller, flavanol, protein, and other compounds into larger, indigestible compounds. These indigestible compounds will not be absorbed in the small intestine and may be broken down in the large intestine by colonic bacteria, forming new metabolites. We obtained cocoa powders, one natural (not alkalized) and one alkalized and compared them in terms of content of polyphenols, bioactivities, and anti-inflammatory abilities. Additionally, we added a known prebiotic, inulin, to our cocoa formulations to determine if there are additive benefits of cocoa and inulin together. Ultimately, we found that alkalized cocoa contained lower concentrations of all polyphenolic compounds, even the larger compounds. Inulin enhanced the inhibition of digestive enzymes and the anti-inflammatory properties of cocoa, though not significantly. Inulin also reduced the pH (i.e. increased the acidity) of a simulated gut environment, which may be beneficial. Alkalization did not significantly affect cocoa's enzyme inhibitory activity or anti-inflammatory activity. Overall, the addition of inulin to cocoa does not seem to be effective in increasing cocoa's ability to treat and prevent gut diseases, but more information is needed.

Tesis por compendio / [ES] En el sistema actual de producción intensiva de alimentos surge la necesidad de considerar la sostenibilidad de las industrias agroalimentarias. En esta tesis se estudia la forma en que algunas tecnologías contribuyen a la mejora de la funcionalidad de alimentos con alto contenido en antioxidantes y probióticos. El tema se aborda desde dos enfoques: por un lado, la aplicación de las tecnologías existentes para la mejora de la funcionalidad de los alimentos, ya sea mediante la incorporación de ingredientes o bien a partir de la formación de estructuras; y, por otro lado, el aprovechamiento de fuentes alternativas de ingredientes alimentarios con elevado contenido en compuestos bioactivos. Las tecnologías estudiadas en esta tesis han sido el tratamiento con altas presiones de homogeneización (HPH), la encapsulación mediante HPH, la impregnación a vacío (IV) y el secado por aire caliente. Se estudió el efecto combinado de la aplicación de HPH (20, 50, 100 y 150 MPa) y la adición de trehalosa (10, 20 y 30 g/ 100 g) en zumo de mandarina con y sin Lactobacillus salivarius spp. salivarius sobre las principales propiedades fisicoquímicas y funcionales del zumo. Los resultados obtenidos mostraron que el tratamiento por HPH redujo el tamaño medio de la distribución de las partículas suspendidas en el zumo, mejoró la estabilidad de la nube y aumentó el contenido en fenoles totales y flavonoides. La incorporación de trehalosa en una cantidad de 20 g/100 g mejoró la actividad antioxidante determinada por el método ABTS. Los resultados en el zumo de mandarina con L. salivarius constataron que, tanto la aplicación de presiones de homogeneización como la adición de trehalosa mejoraron la hidrofobicidad del probiótico y su supervivencia tras el almacenamiento. De forma adicional, la encapsulación de las células microbianas mediante presiones de homogenización permite mejorar la viabilidad de L salivarius en zumo de mandarina. En los discos de manzana impregnados con el zumo de mandarina con el probiótico encapsulado no se observó una mejora en la supervivencia del probiótico durante las operaciones de IV y de secado con aire a 40 ºC, aunque la encapsulación sí que mejoró su resistencia al proceso de digestión in vitro. Se estudió el almacenamiento del zumo y de los discos de manzana, determinándose en ambos casos el efecto de la encapsulación sobre la supervivencia de L. salivarius y sobre su resistencia al proceso de digestión in vitro. Los resultados muestran que el probiótico encapsulado presentó mayor supervivencia durante el almacenamiento y el proceso de digestión in vitro que el probiótico sin encapsular. En relación al aprovechamiento de otras fuentes para la obtención de nuevos ingredientes alimentarios con elevado contenido en compuestos bioactivos, se seleccionaron 11 azúcares de caña no refinados como alternativa al azúcar blanco y se analizaron sus propiedades fisicoquímicas y antioxidantes. Se confirmó que los azúcares de caña no refinados presentaron compuestos con actividad antioxidante y que su contenido guardaba relación con el grado de refinado del producto. Por último se aborda el aprovechamiento de subproductos para la obtención de polvos a partir de bagazo de arándano mediante secado por aire caliente y posterior triturado. Se ha analizado el efecto de la temperatura de secado (60 y 70 ºC) y de la intensidad del triturado sobre las propiedades fisicoquímicas y funcionales de los mismos. El secado disminuyó la capacidad antioxidante del bagazo de arándano pero no hubo un efecto significativo de la temperatura. La acción mecánica del triturado, redujo de manera significativa el contenido en fibra del polvo. Además, se demostró que el tamaño de partícula y el contenido en fibra de los polvos influyeron de forma decisiva en las propiedades de interacción con el agua y con el aceite, lo que condiciona en gran medida su estabilidad y su aplicación como ingr / [EN] In the current system of intensive food production, there is the need to consider sustainability in agri-food industries. In this thesis, the way in which some technologies can improve the functionality of food with a high content of antioxidants and probiotics are studied. This is addressed from two approaches: on the one hand, the application of existing technologies for the improvement of food functionality, either through the incorporation of ingredients or from the formation of structures; and, on the other hand, the use of alternative food ingredients sources with high content in bioactive compounds. The technologies studied in this thesis have been the treatment with high homogenization pressures (HPH), encapsulation by HPH, vacuum impregnation (VI) and hot air drying. Combined effect of HPH treatment (20, 50, 100 and 150 MPa) and the addition of trehalose (10, 20 and 30 g / 100 g) in mandarin juice with and without Lactobacillus salivarius spp. salivarius on the main physicochemical and functional properties were studied. It was obtained that HPH treatment reduced the particle size distribution of suspended particles in juice, improved cloud stability and increased total phenols content and flavonoids. Trehalose addition in the amount of 20 g / 100 g increased the antioxidant activity determined by the ABTS method. Results of the mandarin juice with L. salivarius evidenced that both the application of homogenization pressures and the addition of trehalose improved the hydrophobicity of the probiotic and its survival after storage. Additionally, microbial cells encapsulation by means of homogenization pressures improved the L. salivarius survival in mandarin juice. In apple discs impregnated with mandarin juice including microbiane cells encapsulated, it was not observed an improvement in probiotic survival after vacuum impregnation and air drying at 40 ºC, although encapsulation does improve the resistance to in vitro digestion. Mandarin juice and apple discs storage was studied, determining in both the effect of the encapsulation on L. salivarius survival and on its resistance to in vitro digestion. Results obtained in the mandarin juice show that the encapsulated probiotic had a greater survival than non- encapsulated one. In apple discs, the encapsulation had no effect on probiotic survival after IV and air drying at 40 °C, although it improved its resistance to the in vitro digestion process. In relation to the use of other sources to obtain new food ingredients with high content of bioactive compounds, 11 non-refined sugar cane were selected as alternatives to white sugar and their physicochemical and antioxidant properties were analyzed. It was confirmed that the no refined sugar cane presented compounds with antioxidant activity and that their content was related to the degree of refining of the product. Finally, the use of by-products to obtain powders from blueberry pomace by using hot air drying and subsequent grinding is considered. The effect of the drying temperature (60 and 70 °C) and grinding intensity on the physicochemical and functional properties was analyzed. Drying decreased the antioxidant capacity of the blueberry pomace regardless the temperature. The mechanical action of the grinding significantly reduced the fibre content of the powder. In addition, it was demonstrated that particle size and fibre content of powders had a decisive influence on interaction with water and oil properties, which largely conditioned its stability and its application as an ingredient for food formulations. / [CA] En el sistema actual de producció intensiva d'aliments sorgeix la necessitat de considerar la sostenibilitat en les indústries agroalimentàries. En aquesta tesi s'estudia la forma en què algunes tecnologies contribueixen a la millora de la funcionalitat d'aliments amb alt contingut en antioxidants i probiótics. El tema s'aborda des de dos enfocaments: d'una banda, l'aplicació de les tecnologies existents per a la millora de la funcionalitat dels aliments, ja siga per mitjà de l'incorporació d'ingredients o bé a partir de la formació d'estructures; i d'altra banda, l'aprofitament de fonts alternatives d'ingredients alimentaris amb elevat contingut en compostos bioactius. Les tecnologies estudiades en aquesta tesi han sigut el tractament amb altes pressions d'homogeneïtzació (HPH), l'encapsulació per mitjà de HPH, la impregnació a buit (IV) i l'assecat per aire calent. Es va estudiar l'efecte combinat de l'aplicació de HPH (20, 50, 100 i 150 MPa) i l'addició de trehalosa (10, 20 i 30 g/ 100 g) en suc de mandarina amb i sense Lactobacillus salivarius spp. salivarius sobre les principals propietats fisicoquímiques i funcionals del mateix. Es va obtindre que el tractament per HPH va reduir la distribució de la grandària de partícula de la polpa, va millorar l'estabilitat del núvol i va augmentar el contingut en fenols totals i flavonoids i a més, que la trehalosa va millorar l'activitat antioxidant determinada pel mètode ABTS quan es va afegir 20 g/100 g. Els resultats en el suc de mandarina amb L. salivarius van constatar que, tant l'aplicació de pressions d'homogeneïtzació com l'addició de trehalosa van millorar l'hidrofobicitat del probiòtic i la seua supervivència després de l'emmagatzenament. De forma addicional, l'encapsulació de les cèl¿lules microbianes mitjançant pressions d'homogenización permet millorar la viabilitat de L. salivarius en suc de mandarina. En els discos de poma impregnats amb el suc de mandarina incloent les cèl¿lules microbianes encapsulades no es va observar una millora en la supervivència del probiótic durant les operacions d'IV i d'assecat amb aire a 40 °C, encara que l'encapsulació si que va millorar la seua resistència al procés de digestió in vitro. Es va estudiar l'emmagatzematge del suc i dels discs de poma, determinant-se en tots dos casos l'efecte de l'encapsulació sobre la supervivència de L. salivarius i sobre la seua resistència al procés digestiu in vitro. Els resultats obtinguts mostren que el probiótic encapsulat va presentar major supervivència durant l'emmagatzematge i el procés de digestió in vitro que el probiótic sense encapsular. En relació a l'aprofitament d'altres fonts per a l'obtenció de nous ingredients alimentaris amb elevat contingut en compostos bioactius, es van seleccionar 11 sucres de canya no refinats com a alternativa al sucre blanc i es van analitzar les seues propietats fisicoquímiques i antioxidants. Es va confirmar que els sucres de canya no refinats presentaren compostos amb activitat antioxidant i que el seu contingut guardava relació amb el grau de refinat del producte. Finalment s'aborda l'aprofitament de subproductes per a l'obtenció de pols a partir de bagàs de nabiu per mitjà d'assecat per aire calent i posterior triturat. S'ha analitzat l'efecte de la temperatura d'assecat (60 i 70 ºC) i de la intensitat del triturat sobre les propietats fisicoquímiques i funcionals dels mateixos. L'assecat va disminuir la capacitat antioxidant del bagàs de nabiu però no va haver-hi un efecte significatiu de la temperatura. L'acció mecànica del triturat, va reduir de manera significativa el contingut en fibra de la pols. A més, la grandària de partícula i el contingut en fibra de les pols van influir de forma decisiva en les propietats d'interacció amb l'aigua i amb l'oli, que condicionen en gran manera la seua estabilitat i la seua aplicació com a ingredient en la formulació d'aliments. / Calabuig Jiménez, L. (2018). Mejoras tecnológicas para el aumento de la funcionalidad de antioxidantes y probióticos. Contribución a la sostenibilidad de la industria agroalimentaria [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/111829 / Compendio

Bakgrund: Kolorektal cancer är en av de vanligaste och dödligaste cancerformerna ivärlden. Det är viktigt att sjukdomen upptäckas och behandlas i god tid för attundvika metastasering i andra delar av kroppen och minska dödligheten. För attupptäcka kolorektal cancer finns olika diagnostiska metoder, inklusive DT-kolografi,koloskopi, dubbelkontrast bariumlavemang och sigmoidoskopi. Syftet: Syftet var att undersöka patienters upplevelser vid DT-kolografi jämfört medandra tarmundersökningsmetoder. Metod: Pubmed och Cinahl användes för att söka artiklar. Åtta kvantitativa artiklaruppfyllde kriterierna för inkludering och granskades med hjälp av Olsson ochSörensens mall. Data analyserades med Popenoes metod för dataanalys i allmännalitteraturöversikt. Resultat: Resultatet delades in i fyra huvudområden bestående av obehag, smärta,oro/ångest och patientpreferens. Dessa områden jämfördes mellan DT-kolografi ochandra undersökningsmetoder. Resultaten visade variation angående obehag och oro,men färre patienter rapporterade smärta under DT-kolografi och patienternaföredrog DT-kolografi jämfört med andra tarmundersökningsmetoder. Konklusion: Sammanställning av resultaten visar att alla tarmundersökningar,oavsett undersökningsform, var fysisk krävande till någon grad, vilket betonarbehovet att minska negativa upplevelser genom förmedling av information, ha godkommunikation, och att arbeta personcentrerat. / Background: Colorectal cancer is one of the most common and deadly cancers inthe world. It is crucial that the disease is detected and treated early to preventmetastasis to other parts of the body and reduce mortality. Various diagnosticmethods are available to detect colorectal cancer, including CT colonography,colonoscopy, double-contrast barium enema, and sigmoidoscopy. Aim: The aim of the study was to investigate patients' experiences with CTcolonography compared to other methods of lower gastrointestinal examination. Methods: The Pubmed and Cinahl databases were searched for articles. Eightquantitative articles met the criteria for inclusion and were critically appraised usingOlsson and Sörensen’s template. Data were analyzed using Popenoe's method fordata analysis in general literature reviews. Results: The results were divided into four main areas consisting of discomfort,pain, anxiety, and patient preference. Patient experience was compared between CTcolonography and other examination methods. The results revealed variation indiscomfort and anxiety, but fewer patients reported pain during CT colonography,and patients preferred CT colonography compared with other lower gastrointestinalexamination methods. Conclusion: A summary of the results indicates that all gastrointestinalexaminations are physically demanding to varying degrees, emphasizing the need toalleviate negative experiences through information provision, effectivecommunication and adopting a person-centered approach.

Introdução: Ainda que o uso de Sondas Nasoentéricas (SNE) pareça ser frequente em hospitais, são raros os estudos dimensionando a prevalência do procedimento e o tempo despendido entre indicação e seu uso, especialmente em Emergências. Nestes espaços assistenciais, os atrasos podem contribuir para a manutenção da superlotação e, também, configurarem-se como incidentes no processo assistencial. Objetivo: Conhecer o tempo entre a indicação da SNE e seu efetivo uso e entre as etapas intermediárias desse processo, além de dos fatores associados a atrasos. Método: Entre abril e junho de 2015, foram incluídos adultos admitidos em uma Emergência de um hospital universitário brasileiro em uma coorte prospectiva. Os pacientes foram acompanhados do momento da indicação ao efetivo uso da SNE, mesurando-se os tempos demandados em cada etapa e os possíveis fatores associados ao tempo despendido até a utilização da sonda (variáveis relacionadas à clínica do paciente ou ao processo de trabalho). Para avaliar os fatores associados a ao tempo despendido, adotou-se o modelo de Equações de Estimações Generalizadas (Generalized Estimating Equations – GEE), respeitando-se a distribuição Gamma da variável diferença de tempo. Para a comparação intrafatores foi adotado o teste de Bonferroni como teste Post Hoc. Resultados: Houve 150 inserções de SNE em 115 pacientes. A mediana de tempo entre a indicação e o uso da sonda foi 573 (IQR: 360 - 1093; mínimo: 63 – máximo: 3120) minutos. Analisando-se as diferentes subetapas do processo, foram identificados como fatores independentes de risco para maior tempo entre a indicação e o uso da SNE: inserção de SNE em paciente que não a utilizava antes do atendimento na Emergência, médico não entregar a prescrição de inserção de sonda ao enfermeiro, inserção de SNE na jornada de trabalho noturna, alocação do paciente na sala de cuidados intensivos, retardos na rotina médica, da nutrição e de enfermagem, uso de ventilação mecânica, noradrenalina e necessidade de jejum. Conclusão: O tempo entre a indicação e o uso de sonda nasoentérica foi elevado, excedendo 10 horas em metade dos casos. Fatores relacionados às condições clínicas dos pacientes e à gestão da assistência contribuiriam para o aumento neste tempo. / Background: Although the use of Nasoenteric tubes (NET) appears to be common in hospitals, few studies measure the prevalence of the procedure and the time between the indication and its use, especially in Emergencie Departement. In the Emergency Departament, delays may contribute to the maintenance of overcrowding and also being configured as incidents in the care process. Objective: Knowing the time spent between the indication of the NET and its effective use, as well as the times and factors associated to delays in sub-steps of process. Method: Between April and June 2015, patients adults admitted to an Emergency Departament of a Brazilian university hospital were included in a prospective Cohort. Patients were followed-up from the NET indication until its effective use. The spent time in each sub-step and the possible associated factors with the time taken to use the NET (variables related to the patient's clinical or work process) were analised. To evaluate the associated factors with time spent, the Generalized Estimating Equations model was adopted, respecting the Gamma distribution of variable "time difference". For intrafatores comparison was adopted Bonferroni test as a post hoc test. Results: There were 150 insertions NET in 115 patients. The median time between the NET indication and its use was 573 (IQR: 360-1093; minimum: 63 - maximum: 3120) minutes. Analyzing the different sub-steps of the process, were identified as independent risk factors for increased time between the NET indication and its use: NET insertion in patients who do not used before the Emergency Departement, doctor does not deliver the NET insert prescription to the nurse, NET insertion in the night working hours, patient allocation in intensive care room, delays in medical, nutrition and nursing routine, patients undergoing mechanical ventilation, norepinephrine and need fasting. Conclusion: The time between the NET indication and its use was high, exceeding 10 hours in half the cases. Factors related to the patients' clinical conditions and the management of the assistance would contribute to the increase at this time lapse. / Introducción: Aunque el usio de Sondas Nasoentericas (SNE) parezca frequenteen Hospitales, son raros los estudios dimensionando el predominio el procedimiento y el tiempo dispensado entre indicación y el uso, especialmente em Emergencias. En estos espacios asistenciales, los atrasos pueden contribuir para el mantenimiento de la super población, tambien se configura como incidentes em el proceso asistencial. Objetivo: Conocer el tiempo entre la indicación de la SNE e su efectivo uso y entrelas etapas intermediarias de este proceso, además de los factores asociados a atrasos. Método: Entre abril y junio de 2015, fueron incluídos adultos admitidos em uma emergência de um hospital universitário brasileño em uma Cohorte prospectiva. Los pacientes fueron acompanados del momento de la indicacional efectivo uso de la SNE, mesurando los tiempo demandados em cada etapa y los posibles factores asociados al tiempo dispoensado hasta la utilización de sonda (variables relacionadas a la paraclinica del paciente al proceso del trabajo). Para evaluar los factores asociados al tiempo dispensado, se adopto el modelo de Ecuaciones de Estimativos Generalizadas (Genneralized Estimating Equations – GEE), respetando la distribución Gamma de la variable diferencia del tiempo. Para la comparación intra factores fue adoptado la tesis de Bonferroni como test Post Hoc. Resultados: hubo 150 inserciones de SNE em 115 pacientes. A mediano tiempo entre la indicación y el uso de la sonda fueron 573 (IQR:360 – 1093; mínimo:63 – máximo: 3120) minutos. Se analizan lãs diferentes sub etapas del proceso, fueron identificados como factores independientes de riesgo para mayor tiempo entre la indicacion y el uso de la SNE: ionserción de SNE em paciente que no la utilizaba antes de la atencion em la Emergencia, médico no entregar la prescripción de inserción de sonda al enfermero, inserción de SNE em la jornada de trabajo nocturno, transferência del paciente em la sala de cuidados intensivos, retardos em la rutina medica, del la nutricion y de Enfermería, uso de ventilación mecânica, noradrenalina y la necesidad de la ayuna. Conclusión: El tiempo ente la indicación y el uso de la sonda nasoenterica fue elevado, exediendose 10 horas em la mitad de los casos. Factores relacionados a lãs condiciones clinicas de los pacientes y de la gestion de la Asistencia contribuyeron para el aumento en este tiempo.