Evaluation of transjugular intrahepatic portosystemic shunt (TIPS) as a previous step to liver transplantation in pediatric patients. / Evaluación del shunt portosistémico intrahepático transyugular (TIPS) como puente terapéutico al trasplante hepático en pacientes pediátricos.

INTRODUCTION: Transjugular intrahepatic portosystemic shunt (TIPS) was designed to treat complications of portal hypertension (PH). The objective of this study was to analyze the results of the TIPS performed in pediatric patients in our institution as a previous step to liver transplantation (LT). MATERIAL AND METHODS: A retrospective, descriptive study of pediatric patients with liver cirrhosis undergoing TIPS prior to LT from 2015 to 2020 was carried out. RESULTS: TIPS was performed in 10 patients. The reason for TIPS was hard-to-control ascites in 7 patients (70%), upper gastrointestinal bleeding due to esophageal varices in 1 patient (10%), and portal hypoplasia in 2 cases (20%). No intraoperative complications were recorded. Stent patency was achieved in all cases. TIPS patency until LT was observed in 6 patients (60%). Indirect signs of patency were noted in 1 patient (10%). 2 patients (20%) required re-intervention, with patency being achieved in the second attempt. And finally, no patency was observed after 3 attempts in 1 patient (10%). A decrease in portocaval gradient (p = 0.001) and an increase in portal velocity (p = 0.006) were observed. No platelet count changes were found. A slight, non-significant increase in ammonia was noted. CONCLUSION: TIPS is a safe and effective procedure to reduce complications of hard-to-control PH in pediatric patients. It allows general condition to be optimized, deterioration to be avoided, and portal vein narrowing to be alleviated in cirrhosis patients as a previous step to LT.

INTRODUCCION: El shunt portosistémico intrahepático transyugular (TIPS) es un procedimiento para tratar las complicaciones de la hipertensión portal. El objetivo del estudio es analizar los resultados de los TIPS realizados en nuestro centro, a pacientes pediátricos como puente al trasplante hepático (TH). MATERIAL Y METODOS: Estudio retrospectivo y descriptivo de pacientes pediátricos con cirrosis hepática a los cuales se les ha realizado un TIPS previo al trasplante hepático entre los años 2015 y 2020. RESULTADOS: Se realizó el TIPS a 10 pacientes. El motivo fue en 7 por ascitis de difícil control (70%), un caso por hemorragia digestiva alta por varices esofágicas (10%) y en 2 por hipoplasia portal (20%). No hubo complicaciones intraoperatorias y en todos los casos se logró permeabilidad de la endoprótesis. En 6 pacientes (60%) se observó permeabilidad del TIPS hasta el TH, en un paciente se observaron signos indirectos de permeabilidad (10%), 2 casos requirieron reintervención, lográndose permeabilidad en el segundo intento (20%) y en otra paciente (10%) no se observó permeabilidad tras 3 intentos. Se apreció una disminución del gradiente portocava (p = 0,001) y un aumento en la velocidad portal (p = 0,006). No se evidenció cambios en la cifras de plaquetas y se produjo un ligero aumento del amonio, sin ser significativos. CONCLUSION: El TIPS es un procedimiento seguro y eficaz para paliar las complicaciones de la hipertensión portal de difícil control en pacientes pediátricos. Nos permite optimizar el estado general, evitar el deterioro y paliar el estrechamiento de la vena porta de los pacientes cirróticos como puente al TH.

Pediatric living donor liver transplantation: results of laparoscopic vs. open graft removal. / Trasplante hepático pediátrico de donante vivo, resultados en función de extracción del injerto por laparotomía vs. laparoscopia.

INTRODUCTION: Laparoscopic graft removal for pediatric living donor liver transplantation (PLDLT) reduces morbidity and surgical aggressiveness for the donor. It is important to assess whether the approach used for removal purposes compromises implantation. The objective of this study was to analyze PLDLT progression in children according to whether the graft had been removed laparoscopically or through open surgery. MATERIAL AND METHODS: A retrospective, analytical cohort study of PLDLTs carried out in our institution from 2009 to 2020 was carried out. RESULTS: Transplantation was performed in 14 patients, with a median age of 34.5 (R: 6-187) months. In 6 donors (42%), graft removal was conducted laparoscopically. In 1 donor (7%), removal was initiated laparoscopically, but conversion was required. This patient was included within the open surgery group, which consisted of 8 (58%) donors. No differences were found in terms of operating times, ICU stay, hospital stay, complications during admission, or complications post-admission in the recipient. The surgical approach did not compromise the length of the vessels to be anastomosed in any graft, and it added no extra difficulty to implantation. No differences were found in terms of removal times or hospital stay for the donor. Only 1 donor from the laparoscopy group required re-intervention due to bleeding following port insertion. CONCLUSION: PLDLT patients had similar results regardless of the removal approach used, which did not compromise the structures of the graft to be anastomosed, or add any extra difficulty to implantation.

INTRODUCCION: La extracción laparoscópica del injerto para el trasplante hepático pediátrico de donante vivo (THPDV) es una herramienta que reduce la morbilidad y agresividad quirúrgica en el donante. Es importante estudiar si la vía de extracción compromete el implante. El objetivo del estudio es analizar la evolución del THPDV en el niño en función de si el injerto fue extraído por vía abierta o laparoscopia. MATERIAL Y METODOS: Estudio de cohortes retrospectivo y analítico de los THPDV realizados entre 2009 y 2020 en nuestro centro. RESULTADOS: Se trasplantaron 14 pacientes, con edad mediana de 34,5 (R: 6-187) meses. En 6 donantes (42%) se realizó la extracción del injerto vía laparoscópica. En un donante se inició la extracción por laparoscopia, pero fue necesaria la conversión (7%), esté se clasificó en el grupo de laparotomía, compuesta por 8 (58%) donantes. No se encontraron diferencias en el tiempo quirúrgico, en los días en la unidad de cuidados intensivos, en la estancia hospitalaria, en las complicaciones durante el ingreso ni en las complicaciones postingreso en el receptor. El abordaje quirúrgico no comprometió en ningún injerto la longitud de los vasos a anastomosar, sin suponer una dificultad en el implante. No se evidenciaron diferencias en el tiempo de extracción ni en los días de hospitalización del donante. Solo un donante del grupo de laparoscopia precisó reintervención por sangrado de la incisión de un trocar. CONCLUSION: Los pacientes con THPDV presentan resultados similares, independientemente de la vía de extracción del injerto. La vía de abordaje no comprometió las estructuras del injerto a anastomosar, ni dificultó el momento del implante.

Viscosity decay of hydrocolloids under oral conditions.

The aim of this study was to understand the contribution of hydrocolloids to oral structure breakdown of starch-based systems in relation to mouthfeel sensations. For this, carrot purees were prepared using corn starch and a different second thickener (λ-carrageenan, carboxymethylcellulose (CMC), xanthan gum, or an extra amount of starch). The viscosity decay of purees under in vitro oral conditions was measured (starch pasting cell adapted to a rheometer) when shearing at a constant shear rate in the presence of artificial saliva. Sensory properties of purees were described using the Flash Profile technique by a group of 13 panellists. Oral viscosity decay of systems was modelled using a second order structural kinetic equation that included three parameters: initial viscosity, rate of breakdown, and viscosity at equilibrium. Although they had the same initial viscosity, the structural breakdown of the purees in oral conditions varied, depending on the second thickener used. The structure of purees containing xanthan and λ-carrageenan were more resistant under oral conditions exhibiting a slow and smaller breakdown. In contrast, purees containing only starch showed a rapid and large decay because of the complete structure breakdown by amylase. For puree containing CMC, there was also a rapid decrease, but smaller than starch, indicating that part of the structure remained after digestion. Texture sensations freely described by assessors varied according to two main sensory dimensions, that were clearly related to the structural breakdown parameters. As expected, the dimension of thickness (from watery and liquid to thick and viscous) separated base purees from thickened purees and was related to the initial viscosity. The smoothness dimension (from rough and lumpy to the smooth and creamy) was related to the viscosity at equilibrium indicating that after the oral digestion, the characteristics of the remaining structure can explain differences in complex attributes of semisolid systems such as smoothness and creaminess.

The impact of COVID-19 lockdown on food priorities. Results from a preliminary study using social media and an online survey with Spanish consumers.

This preliminary study describes the impact of the COVID-19 health crisis on people's interests, opinions, and behaviour towards food. Here, the evolution of people's internet searches, the characteristics of the most watched YouTube videos, and Tweeted messages in relation to COVID-19 and food was studied. Additionally, an online questionnaire (Spanish population, n = 362) studied changes in food shopping habits during the lockdown, motivations behind the changes, and perceived reliability of the information received from media. Results showed initial trending searches and most watched YouTube videos were about understanding what COVID-19 is and how the illness can progress and spread. When the official statement of a pandemic was released, trending searches in relation to food and shopping increased. Data retrieved from Twitter also showed an evolution from shopping concerns to the feeling of uncertainty for the oncoming crisis. The answers to the online questionnaire showed reduction of shopping frequency but no changes in shopping location. Products purchased with higher frequency were pasta and vegetables (health motivations), others were purchased to improve their mood (nuts, cheese, and chocolates). Reduced purchasing was attributed to products with a short shelf-life (fish, seafood) or because they were unhealthy and contributed to gained body weight (sugary bakery goods) or mood (desserts). Statements made by experts or scientists were considered by consumers to be the most reliable.

Oral processing and dynamics of texture perception in commercial gluten-free breads.

There is an increasing demand for gluten-free products, with the texture being a critical aspect. The aim of this work was to study the food bolus properties of gluten-free breads in relation to the dynamics of sensations perceived during its consumption. In this study, five-commercial gluten-free breads and two regular breads were analysed for their texture, crumb structure, and moisture content. Bread bolus particle size after three chews, bolus characteristics at the swallowing point, and oral activity were determined. The dynamics of textural sensations during bread consumption was evaluated using the temporal dominance of sensations (TDS) technique. Texture and structure properties vary among gluten-free breads being some of them close to regular breads (crumb with more and smaller cells that shows low hardness and high springiness) that lead to different in-mouth breakdown and TDS patterns. At the beginning, harder breads with low springiness values resulted in hard dominant sensations, in contrast, breads with low hardness and high springiness values were perceived soft and spongy. Breads that fragmented into a greater number of small size particles created crumbly and sandy sensations, characteristic of gluten-free breads with large air cell sizes. Compact sensation appeared in breads with low saliva uptake during bolus formation, while pasty and sticky sensations were related to a cohesive and adhesive bolus, respectively. Not only structure and mechanical properties, but also its oral behaviour in terms of fragmentation and bolus formation can fully explain the dynamics of texture perception of gluten-free breads.

Consumer perception and acceptability of microalgae based breadstick.

The demand for sustainable and healthy food is increasing. Therefore, it is necessary to find new sources of functional ingredients for design of novel food products. Microalgae are reliable sources of functional ingredients, ready for exploitation with purpose of production of human food. This work explores consumers' acceptance of novel foods based on microalgae. To achieve natural and realistic eating location, sensory analysis was conducted in a real restaurant in Universitat Politècnica de València. A check-all-that-apply questionnaire and hedonic scale registered the consumers' expectations (N = 85), perceptions and acceptance, before and after taste of typical Valencian breadsticks. Food neophobia can affect acceptability of novel foods, thus, participants completed a test designed to measure their attitudes towards new food. Microalgae breadsticks have distinctive characteristics compared to control breadsticks, such as colour, flavour and odour, because of microalgae presence. Still, those breadsticks were as acceptable as the control breadsticks according to the consumer preferences. Consumers expected more differences amongst both breadsticks before tasting, but they lowered the differences in perception after trying them. Consumers consider that the product is healthier, and they would understand if it had greater expense. We believe this information can be useful for selling / marketing this novel product.

Impact of ethylene degreening treatment on sensory properties and consumer response to citrus fruits.

Degreening treatment is normally applied to early-season citrus varieties grown in the Mediterranean area in order to enhance the external colour when fruits have already reached internal maturity. Despite profound knowledge about the effect of ethylene on the physico-chemical quality of citrus fruit, less is known about its effect on consumers' expectations in the supermarket or consumer quality perceptions when they eat such fruit. In this study, three mandarin cultivars ('Owari', 'Clemenules' and 'Oronules') with two initial colours at harvest, and one orange cultivar, 'Navelina', were submitted to the degreening treatment under commercial conditions. The effect of treatment on both external and internal qualities perceived by consumers was evaluated. The main physico-chemical parameters were also determined. The degreening treatment slightly affected firmness, total soluble solids or acidity level in 'Owari' and 'Navelina'. However, sensory triangle tests, in which 100-122 consumers compared the internal quality of degreened fruit and control fruit, did not show significant differences between treatments for any of the studied cultivars. A survey based on images of citrus fruit was responded by 340 consumers; it showed that the degreening treatment strongly affected consumers' maturity expectations, which resulted in improved fruit liking expectations and increased the number of consumers willing to buy. The extent of this effect depended on the initial colour of the fruit submitted to degreening. In order to improve liking expectations, fruit should arrive on the market with an external colour index (CI = 1000a/Lb) between +10 and +20. We conclude that the ethylene degreening treatment, which did not have any effect on the internal quality that consumers perceive, is a potent postharvest tool to increase citrus fruit sales at the beginning of the season.

Relating texture perception of cooked ham to the bolus evolution in the mouth.

The aim of the present study was to characterize the dynamics of the bolus formation that take place during mastication of commercial cooked ham samples. In addition, the relationships between these properties and texture perception were studied. Five commercial samples which presented different mechanical properties and moisture contents were studied. Ten participants were asked to chew the cooked ham samples normally and to expectorate the bolus after different chewing periods. Oral activity measurements (chewing time and number of chewing strokes), moisture content, saliva uptake and particle size distribution in the boluses were obtained. Seventeen participants evaluated the sensory perceptions generated over the sample consumption time, using the Temporal Check-All-That-Apply (TCATA) method. The results revealed that the duration of mastication and number of chewing cycles through to swallowing varied significantly among the cooked ham samples and were mainly related to instrumental texture parameters. The pattern of fragmentation under mastication also varied greatly between samples. Sensations of softness and hardness during ham consumption were again linked to instrumental texture parameters (TPA hardness, TPA chewiness and shear force). The perception of fibrousness was related to the degree of fragmentation of the ham in the mouth, and juiciness seemed to be related to the amount of saliva taken up by the product.

High hydrostatic pressure treatment provides persimmon good characteristics to formulate milk-based beverages with enhanced functionality.

High hydrostatic pressure (HHP) applied during food processing can improve the retention of food quality attributes and nutritional values in comparison with pasteurization. Persimmon is a good source of bioactive compounds but it is a seasonal fruit that cannot be consumed throughout the year. The aim of this work was to compare the HHP and pasteurization treatments to formulate milk-based beverages containing this carotenoid rich ingredient and to evaluate their performance in these beverages. The carotenoid and tannin contents of persimmon were determined and the microstructure and rheology of the new milk-based persimmon beverages were examined. The results showed that HHP treatment favoured the release of carotenoids from the fruit matrix and precipitation of the tannins. The milk-based beverages prepared with the high-pressure persimmon presented the best rheological properties because unlike the untreated and pasteurized persimmon milk-based beverages, they did not form a gel-like structure or separate out.

[Is the awareness of the risk of nuts aspiration related to the occupation of parents?]. / ¿Influye la profesión de los padres en la concienciación del riesgo de aspiración de frutos secos?

OBJECTIVES: To evaluate the social awareness of the risk of nuts aspiration and the relationship with the occupation of parents. MATERIAL AND METHODS: From January 2013 to January 2014, a self-designed survey was distributed to 247 parents of patients under 14 years admitted to our centre, regardless of the reason for admission. The statistical significance was calculated using confidence intervals (CI). The Pearson Chi-square test was used to analyse the ignorance of this problem depending on the educational level extrapolated from the occupation of respondents. RESULTS: 247 parents responded to the survey. 60.3% (95% CI 54.1-66.2%) confirmed that nuts were included in birthday parties. 30.4% (95% CI 25-36.4%) confirmed that celebrations with nuts at their children's nursery were made. 42.1% (95% CI 36.1-48.3%) believed that nuts were harmless for their young children. The age of administration of nuts was independent on the educational level extrapolated of parents (χ2 = 10.721, p = 0.295), although it did influence on the ignorance of the danger of nuts (41.2% (95% CI 30.3-53%) of respondents with occupations that required higher educational level compared to 55.4% (95% CI 42.4-67.6%) of those with occupation that required less educational level (χ2 = 14.678, p = 0.002)). CONCLUSIONS: Regardless of the occupation, there is widespread ignorance concerning the age of introduction of nuts in children's diet. Given the incidence and severity of the risk of aspiration, more prevention programs are necessary, and Health Authorities should take side in public awareness of this problem.

Fat and salt contents affect the in-mouth temporal sodium release and saltiness perception of chicken sausages.

In cooked meats, sodium chloride is involved in taste, texture and flavour release. So a reduction in the salt content may have an impact on overall perception and acceptability. The aim of this study was to evaluate the influence of composition on sodium release and saltiness intensity in chicken sausages. The rheological properties of the sausages differed according to composition. Temporal sodium release and temporal saltiness intensity were evaluated by four selected subjects when eating sausages. At each time point, the effect of the salt level in sausages on sodium release was positive and highly significant. The effect of lipids on sodium release was negative. Concerning perception, the amount of salt used had a positive effect on saltiness intensity, and lipids seemed to exert a masking effect. Generally, clear relationships between salt levels, sodium release and saltiness intensity were found but the masking effect of lipids on saltiness intensity probably also involved texture or fat perception mechanisms.

[Use of lipofilling in pediatric patients]. / Aplicaciones de autoinjerto graso en pacientes pediátricos.

OBJECTIVE: To Present the benefits of free autologous fat grafts in different pathologies of children. MATERIAL AND METHODS: Retrospective study was performed on 18 patients who received a treatment with an autologous fat graft during the 2009-2012 period. The surgical technique consisted in removing fat from a donor region, processing the fat in order to purify it by centrifugation and grafting injection. The following variables were analysed: age, sex, pathology, complications of the technique, visual aspects results, subjective results (by rating satisfaction from 1-4 in examination room, and by telephone), donor sites and number of sessions. RESULTS: Eighteen patients were studied. Eleven patients had scars (2 were burn sequelae, 8 were side effects of a previous surgery and 1 was postraumatic), 2 patients had breast asymmetry, 1 patient had bilateral breast agenesis and 4 patients had facial asymmetries (Parry-Romberg syndrome in 2 cases, Treacher-Collins and monorhinia). There were no complications with the surgical technique except for fat resorption in 11 patients that needed a new reinjection. All patients with scar sequelae showed considerable improvement. The patients with breast pathology, experienced objective improvement, with practically full symmetry and natural aesthetics. Three to four patients affected by facial asymmetry, achieved good results in contour and symmetry. In order to obtain optimal results, 7 of the patients required just one session and the rest of patients, needed more sessions. The donor area was the abdominal region in 12 patients and the calf region in 6. Similar results were achieved regardless of the donor area. The assessment of patient satisfaction showed these results: very satisfied in 12 patients, satisfied 4 patients, scarcely satisfied 2 patienst and no one was not satisfied. CONCLUSIONS: This study suggests that the use of autologous fat grafts is feasible in the pathologies mentioned previously due to the technical simplicity, the good cosmetic results and the absence of complications in our series.

Active compounds and distinctive sensory features provided by American ginseng (Panax quinquefolius L.) extract in a new functional milk beverage.

American ginseng (Panax quinquefolius L.) has recognized neurocognitive effects, and a ginsenoside-rich extract of the root of the plant has been shown to improve cognitive functions in young adults. This study aimed at assessing the chemical and sensory profiles of a UHT-treated, low-lactose functional milk containing American ginseng. Individual ginsenosides in the milk were analyzed by HPLC. Descriptive sensory analysis was performed by a trained panel to quantitatively document sensory changes resulting from the addition of ginseng and the UHT process on flavored and unflavored milks. Consumer acceptance of the product was also investigated. Total ginsenoside content in the UHT-treated milk enriched with the ginseng extract after UHT process treatment was 7.52 mg/100 g of milk, corresponding to a recovery of 67.6% compared with the content in the unprocessed extract. The intake of 150 to 300 mL of this ginseng-enriched milk provides the amount of total ginsenosides (11.5 to 23 mg) necessary to improve cognitive function after its consumption. Both the presence of ginsenosides and their thermal treatment affected some sensory properties of the milk, most notably an increase in bitterness and metallic taste, the appearance of a brownish color, and a decrease in milky flavor. Levels of brown color, bitterness, and metallic taste were highest in the industrially processed ginseng-enriched milk. The bitterness attributable to ginseng extract was reduced by addition of vanilla flavor and sucralose. A consumer exploratory study revealed that a niche of consumers exists who are willing to consume this type of product.

[Using Kehr's tube in complex anastomoses]. / Utilización de tubo de Kehr en anastomosis intestinales complejas.

OBJECTIVE: To present a new technique using the Kehr's T tube (KT) in complex intestinal anastomoses. MATERIALS AND METHODS: Restrospective descriptive analysis of 8 patients intervened from 2007 to 2011. We performed intestinal anastomoses guided by a KT in 7 patients with intestinal atresia (yeyunal n = 5, ileal n = 1, duodenal n = 1), and in 1 patient with yeyunal stenosis associated with gastroschisis. 4 cases (50%) were reoperations because of complications after the first surgery. SURGICAL TECHNIQUE: the KT is introduced through the dilated proximal bowel. The proximal end of the "T" is tied and the distal one acts as a transanastomotic guide and feeding tube. The long end of the T is externalized through the skin and used for the administration of the enteral nutrition formula. Studied variables were: beginning of enteral feeding, feeding time through the KT, time of intestinal motility recovery, time to complete oral feeding and complications. RESULTS: There were no complications derived from the technique. Feeding was started through the KT between day 2 and 10 (median: 4.5), with a period of 4 to 33 days (median: 7). Patients started intestinal transit between days 2 and 7 (median: 3.5). Reoperated patients showed cholestasis and/or sepsis signs, which were solved with surgery. The KT was left in place between 11-51 days (median: 22), with no complications during or after the removal. CONCLUSIONS: The results of this preliminary study suggests that the use of the KT in complex anastomoses as a transanastomotic guide and feeding tube presents advantages, such as early enteral feeding and prevention of leakage and kinking of the intestinal suture. There were no complications derived from the procedure. As far as we know, this technique has not been previously reported in the literature.

Influence of label information on dark chocolate acceptability.

The aim of the present work was to study how the information on product labels influences consumer expectations and their acceptance and purchase intention of dark chocolate. Six samples of dark chocolate, varying in brand (premium and store brand) and in type of product (regular dark chocolate, single cocoa origin dark chocolate and high percentage of cocoa dark chocolate), were evaluated by 109 consumers who scored their liking and purchase intention under three conditions: blind (only tasting the products), expected (observing product label information) and informed (tasting the products together with provision of the label information). In the expected condition, consumer liking was mainly affected by the brand. In the blind condition, differences in liking were due to the type of product; the samples with a high percentage of cocoa were those less preferred by consumers. Under the informed condition, liking of dark chocolates varied depending on both brand and type of product. Premium brand chocolates generated high consumer expectations of chocolate acceptability, which were fulfilled by the sensory characteristics of the products. Store brand chocolates created lower expectations, but when they were tasted they were as acceptable as premium chocolates. Claims of a high percentage of cocoa and single cocoa origin on labels did not generate higher expectations than regular dark chocolates.

Inulin blend as prebiotic and fat replacer in dairy desserts: optimization by response surface methodology.

The purpose of this work was to optimize the formulation of a prebiotic dairy dessert with low fat content (<0.1g/100g) using a mixture of short- and long-chain inulin. Response surface methodology was applied to obtain the experimental design and data analysis. Nineteen formulations of dairy dessert were prepared, varying inulin concentration (3 to 9 g/100g), sucrose concentration (4 to 16 g/100g), and lemon flavor concentration (25 to 225 mg/kg). Sample acceptability evaluated by 100 consumers varied mainly in terms of inulin and sucrose concentrations and, to a lesser extent, of lemon flavor content. An interaction effect among inulin and sucrose concentration was also found. According to the model obtained, the formulation with 5.5 g/100g inulin, 10 g/100g sucrose and 60 mg/kg of lemon flavor was selected. Finally, this sample was compared sensorially with the regular fat content (2.8 g/100g) sample previously optimized in terms of lemon flavor (146 mg/kg) and sucrose (11.4 g/100g). No significant difference in acceptability was found between them but the low-fat sample with inulin possessed stronger lemon flavor and greater thickness and creaminess.