The impact of maternal obesity on iron status, placental transferrin receptor expression and hepcidin expression in human pregnancy.

BACKGROUND: Obesity is associated with decreased iron status, possibly due to a rise in hepcidin, an inflammatory protein known to reduce iron absorption. In animals, we have shown that maternal iron deficiency is minimised in the foetus by increased expression of placental transferrin receptor (pTFR1), resulting in increased iron transfer at the expense of maternal iron stores. OBJECTIVE: This study examines the effect of obesity during pregnancy on maternal and neonatal iron status in human cohorts and whether the placenta can compensate for decreased maternal iron stores by increasing pTFR1 expression. SUBJECTS/METHODS: A total of 240 women were included in this study. One hundred and fifty-eight placentas (Normal: 90; Overweight: 37; Obese: 31) were collected at delivery. Maternal iron status was measured by determining serum transferrin receptor (sTFR) and ferritin levels at 24 and 34 weeks and at delivery. Hepcidin in maternal and cord blood was measured by ELISA and pTFR1 in placentas by western blotting and real-time RT-PCR. RESULTS: Low iron stores were more common in obese women. Hepcidin levels (ng ml(-1)) at the end of the pregnancy were higher in obese than normal women (26.03±12.95 vs 18.00±10.77, P<0.05). Maternal hepcidin levels were correlated with maternal iron status (sTFR r=0.2 P=0.025), but not with neonatal values. mRNA and protein levels of pTFR1 were both inversely related to maternal iron status. For mRNA and all women, sTFR r=0.2 P=0.044. Ferritin mRNA levels correlated only in overweight women r=-0.5 P=0.039 with hepcidin (r=0.1 P=0.349), irrespective of maternal body mass index (BMI). CONCLUSIONS: The data support the hypothesis that obese pregnant women have a greater risk of iron deficiency and that hepcidin may be a regulatory factor. Further, we show that the placenta responds to decreased maternal iron status by increasing pTFR1 expression.

Satisfaction Level of New Mothers with Prenatal Care and the Healthcare Professionals Who Provide It.

INTRODUCTION: Prenatal care is a key strategy to reduce maternal mortality. The aims of this work were to ascertain the level of satisfaction of new mothers with their pregnancy monitoring and with the medical professionals who provided prenatal care. SUBJECTS AND METHODS: A descriptive study was conducted on 265 new mothers, 18-43 years of age, who had given birth at the Virgen de las Nieves University Hospital and the San Cecilio University Hospital in Granada (Spain) in April and May 2012. The data were collected with a questionnaire consisting of 28 items that elicited information from the subjects about their pregnancy, prenatal care activities, the healthcare professionals that provided the care, and those that they would like to monitor future pregnancies. There were also two open questions. The first was about the perceived needs of the participants and the second asked them to suggest ways that prenatal care could be improved. RESULTS: The majority of the subjects (59.6%) had given birth for the first time. The midwife was the healthcare professional who performed most of the monitoring activities and resolved their doubts and problems (32.74%), gave the subjects tranquility and security (37.86%) and listened to their worries (34.53%). The subjects' satisfaction with the healthcare professionals was generally high. This was particularly true of the midwife (90.75%). Half of the subjects surveyed said that they wanted the midwife, obstetrician and general practitioner to monitor their pregnancy. They also underlined the need for longer and more visits with the midwife as well as more consultations with the obstetrician and higher number of ultrasounds. CONCLUSIONS: The subjects were very satisfied with the work of the healthcare professionals that monitored their pregnancy, particularly with the midwife. However, they also highlighted expectations and needs that, if met, would increase their satisfaction.

Quantification of cervical elastography: a reproducibility study.

OBJECTIVES: To assess a new method for numerical quantification of cervical elastography during pregnancy and to evaluate the repeatability of the measurements. METHODS: Cervical elastography was carried out twice by a single operator in 112 singleton pregnancies at a median of 21 (range, 12-40) weeks' gestation. In 50 of the cases a second operator performed another elastography measurement. The intraobserver and interobserver repeatability of measurements in different parts of the cervix were assessed using intraclass correlation coefficients with 95% CI and by Bland-Altman analysis. RESULTS: There were no statistically significant differences in the elastography measurements made by the same and by two different observers in each area measured, except in the area that receives the force of the transducer directly. The distribution of elastographic measurements obtained in different regions of the cervix demonstrated that the external and superior parts were significantly softer than the internal and inferior parts. CONCLUSION: It is possible to provide an objective quantification of elastographic colors in the cervix. The measurements obtained by elastography may be a mere reflection of the force being applied by the transducer to different parts of the cervix. It is too premature to suggest that the measurements of rate-of-change in tissue displacement reflect histological changes that could provide a measure of cervical ripening.

Improvement of beauvericin production by Fusarium oxysporum AB2 under solid-state fermentation using an optimised liquid medium and co-cultures.

The production of beauvericin (BEA) by Fusarium oxysporum AB2 in liquid medium (SmF) was compared to that on solid medium (SSF) on inert support (polyurethane foam or PUF), using a previously optimised medium. The analysis included two different concentrations of the medium (1 × and 3 ×). Under SSF, the production of BEA (22.8 mg·L-1) was higher relative to SmF (0.8 mg·L-1). The production increased proportionally in the concentrated medium (3 ×) (65.3 mg·L-1); using the concentrated medium in SmF, the production of BEA was completely inhibited, although more biomass was produced. The peak of BEA production was reached on day 7 and remained stable until day 11; sustained production after several days has not been achieved in similar reports. The presence of BEA was corroborated by high-performance liquid chromatography (HPLC) and mass spectrometry. The BEA production profile is shown performing mixed cultures of Fusarium oxysporum AB2 and Epicoccum nigrum TORT using the same system, increasing the production of BEA up to 84.6 mg·L-1. We propose SSF using polyurethane foam (PUF) as a solid support as a new culture system for obtaining secondary metabolites such as BEA.

Normalization of the sleep-wake pattern and melatonin and 6-sulphatoxy-melatonin levels after a therapeutic trial with melatonin in children with severe epilepsy.

This study evaluated the sleep-wake pattern, plasma melatonin levels and the urinary excretion of its metabolite, 6-sulphatoxy-melatonin among children with severe epileptic disorders, before and after a therapeutic trial with melatonin. Ten paediatric patients, suffering from severe epileptic disorders, were selected and given a nightly dose of 3 mg of a placebo, for 1 wk; for the next 3 months, the placebo was replaced with a nightly dose of 3 mg of melatonin. At the end of each treatment period, the urinary excretion of 6-sulphatoxy-melatonin (for the intervals 09.00 - 21:00 hr or 21:00-09:00 hr) and plasma levels of melatonin (recorded at 01:00, 05:00, 09:00, 13:00, 17:00 and 21:00 hr) were recorded, over a period of 24 hr; an actigraph record was also kept. Sleep efficiency among patients who received melatonin was significantly higher than among those given the placebo, with fewer night-time awakenings. Periodic plasma melatonin levels were regained and a better control gained of convulsive episodes, in that the number of seizures decreased. We conclude that melatonin is a good regulator of the sleep-wake cycle for paediatric patients suffering from severe epilepsy, moreover, it to a better control of convulsive episodes.

Differences among pollen-allergic patients with and without plant food allergy.

BACKGROUND: A considerable number of pollen-allergic patients develops allergy to plant foods, which has been attributed to cross-reactivity between food and pollen allergens. The aim of this study was to analyze the differences among pollen-allergic patients with and without plant food allergy. METHODS: Eight hundred and six patients were recruited from 8 different hospitals. Each clinical research group included 100 patients (50 plant food-allergic patients and 50 pollen-allergic patients). Diagnosis of pollen allergy was based on typical case history of pollen allergy and positive skin prick tests. Diagnosis of plant-food allergy was based on clear history of plant-food allergy, skin prick tests and/or plant-food challenge tests. A panel of 28 purified allergens from pollens and/or plant foods was used to quantify specific IgE (ADVIA-Centaur® platform). RESULTS: Six hundred and sixty eight patients (83%) of the 806 evaluated had pollen allergy: 396 patients with pollen allergy alone and 272 patients with associated food and pollen allergies. A comparison of both groups showed a statistically significant increase in the food and pollen allergy subgroup in frequency of: (1) asthma (47 vs. 59%; p < 0.001); (2) positive skin test results to several pollens: Plantago, Platanus, Artemisia, Betula, Parietaria and Salsola (p < 0.001); (3) sensitization to purified allergens: Pru p 3, profilin, Pla a 1 - Pla a 2, Sal k 1, PR-10 proteins and Len c 1. CONCLUSION: Results showed relevant and significant differences between both groups of pollen-allergic patients depending on whether or not they suffered from plant-derived food allergy.

Gut microbiota composition is associated with body weight, weight gain and biochemical parameters in pregnant women.

Obesity is associated with complications during pregnancy and increased health risks in the newborn. The objective of the present study was to establish possible relationships between gut microbiota, body weight, weight gain and biochemical parameters in pregnant women. Fifty pregnant women were classified according to their BMI in normal-weight (n 34) and overweight (n 16) groups. Gut microbiota composition was analysed by quantitative real-time PCR in faeces and biochemical parameters in plasma at 24 weeks of pregnancy. Reduced numbers of Bifidobacterium and Bacteroides and increased numbers of Staphylococcus, Enterobacteriaceae and Escherichia coli were detected in overweight compared with normal-weight pregnant women. E. coli numbers were higher in women with excessive weight gain than in women with normal weight gain during pregnancy, while Bifidobacterium and Akkermansia muciniphila showed an opposite trend. In the whole population, increased total bacteria and Staphylococcus numbers were related to increased plasma cholesterol levels. Increased Bacteroides numbers were related to increased HDL-cholesterol and folic acid levels, and reduced TAG levels. Increased Bifidobacterium numbers were related to increased folic acid levels. Increased Enterobacteriaceae and E. coli numbers were related to increased ferritin and reduced transferrin, while Bifidobacterium levels showed the opposite trend. Therefore, gut microbiota composition is related to body weight, weight gain and metabolic biomarkers during pregnancy, which might be of relevance to the management of the health of women and infants.

Photogrammetry of fetal breathing movements during the third trimester of pregnancy: observations in normal and abnormal pregnancies.

OBJECTIVE: To evaluate parameters of fetal breathing movements-displacement of the fetal abdominal wall during inspiration and expiration, time of inspiration and expiration and speed of inspiration and expiration-between 30 and 36 weeks' gestation in normal pregnancies, and in those complicated by gestational diabetes or maternal hypertension. METHODS: Three categories of pregnancy were investigated: 49 were normal, 16 had pregnancy-induced diabetes and 10 were hypertensive. According to their gestational age, the patients were divided into two groups: Group A between 30 and 32 weeks' gestation and Group B between 33 and 36 weeks. Using photogrammetry and a computer-operated algorithm, six parameters of fetal breathing movements were investigated. RESULTS: There were significant differences in the various fetal parameters measured among the three categories of pregnant women. Up until 32 weeks of gestation, the displacements during inspiration and expiration were larger, the speeds of inspiration and expiration were higher, and the times for inspiration and expiration were shorter in the diabetic and hypertensive groups than in the normal group. In the later period, between 33 and 36 weeks, fetuses of pregnancy-induced diabetic patients showed the lowest inspiration and expiration times and the highest speeds of inspiration and expiration. CONCLUSIONS: Photogrammetry in conjunction with a computer-operated algorithm can be used to assess fetal breathing movements. There are significant differences in fetal breathing movements between normal pregnancies and those that are complicated by gestational diabetes or hypertension.

[Study of maternal nutrition and genetic on the foetal adiposity programming (The PREOBE study)]. / Estudio de la influencia de la nutrición y genética maternas sobre la programación del desarrollo del tejido adiposo fetal (Estudio PREOBE).

BACKGROUND: Maternal genetics and feeding before and during pregnancy, different maternal metabolic pathologies, as well as nutrient intakes of newborns in their first months of life may be involved in the obesity aetiology and its long-term consequences. The possible role of these and others factors, the mechanisms and the effects on the metabolism, and the development of this disease need further research. OBJECTIVE: To acquire more knowledge about foetal adipose tissue development and the influence of genetic, dietetic and environmental factors on the risk to suffer from obesity. METHODOLOGY: Four study groups have been established with 30 pregnant women in each one: 1) control group; 2) mothers with glucose intolerance/gestational diabetes; 3) women with low weight gain during pregnancy, and 4) women with overweight/obesity at the beginning of the pregnancy. The magnitudes to be studied are: 1) dietary intake; 2) life-style habits; 3) physical activity; 4) anthropometry and body composition; 5) haematological study; 6) biochemical study (lipid and metabolic biomarkers); 7) immune function profile related to nutritional status; 8) psychological profile; 9) genetic biomarkers, and 10) microbiological markers; all of them in relation to the development of the foetal adipose tissue in the first stages of life and the risk of suffering from obesity in the future. CONCLUSION: This project, coordinated by the Department of Paediatrics of the School of Medicine in the University of Granada, and with the collaboration of well-known and expert research groups, tries to contribute to the knowledge about the obesity aetiology in infancy and its subsequent development in later periods of life.

Evolution of the Quorum network and the mobilome (plasmids and bacteriophages) in clinical strains of Acinetobacter baumannii during a decade.

In this study, we compared eighteen clinical strains of A. baumannii belonging to the ST-2 clone and isolated from patients in the same intensive care unit (ICU) in 2000 (9 strains referred to collectively as Ab_GEIH-2000) and 2010 (9 strains referred to collectively as Ab_GEIH-2010), during the GEIH-REIPI project (Umbrella BioProject PRJNA422585). We observed two main molecular differences between the Ab_GEIH-2010 and the Ab_GEIH-2000 collections, acquired over the course of the decade long sampling interval and involving the mobilome: i) a plasmid harbouring genes for blaOXA 24/40 ß-lactamase and abKA/abkB proteins of a toxin-antitoxin system; and ii) two temperate bacteriophages, Ab105-1ϕ (63 proteins) and Ab105-2ϕ (93 proteins), containing important viral defence proteins. Moreover, all Ab_GEIH-2010 strains contained a Quorum functional network of Quorum Sensing (QS) and Quorum Quenching (QQ) mechanisms, including a new QQ enzyme, AidA, which acts as a bacterial defence mechanism against the exogenous 3-oxo-C12-HSL. Interestingly, the infective capacity of the bacteriophages isolated in this study (Ab105-1ϕ and Ab105-2ϕ) was higher in the Ab_GEIH-2010 strains (carrying a functional Quorum network) than in the Ab_GEIH-2000 strains (carrying a deficient Quorum network), in which the bacteriophages showed little or no infectivity. This is the first study about the evolution of the Quorum network and the mobilome in clinical strains of Acinetobacter baumannii during a decade.

Development and validation of a new Spanish instrument to measure health-related quality of life in patients with allergic rhinitis: the ESPRINT questionnaire.

OBJECTIVES: To develop and validate an instrument to measure health-related quality of life (HRQOL) specific to patients with allergic rhinitis (AR) and primarily for use in Spanish and Spanish-speaking populations. METHODS: An initial item pool was generated from literature review, focus groups with AR patients, and consultations with clinical experts. Item reduction was performed using clinimetric and psychometric approaches after administration of the item pool to 400 AR patients. The resulting instrument's internal consistency, test-retest (2-4 weeks) reliability, known groups and convergent validity, and sensitivity to change were tested in a longitudinal, observational, multicenter study in 210 AR patients who also completed the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). RESULTS: The new questionnaire took a mean (SD) of 7.1 (5.4) minutes to answer. Floor and ceiling effects were less than 15% on all dimensions. Cronbach's alpha values and intraclass correlation coefficient values for six of the sevendimensions and the overall score exceeded 0.70. Statistically significant differences (P < 0.01) were observed on all ESPRINT-28 dimensions and the overall score between patients with mild (mean overall score 1.97, SD 0.99), moderate (mean overall score 2.78, SD 0.88), and severe AR (mean overall score 3.89, SD 0.87). Patients with persistent AR had worse scores (P < 0.05) on all dimensions than patients with intermittent AR. Correlations between the ESPRINT-28 and the RQLQ were generally as expected. Effect sizes for score changes between the two study visits ranged from 0.96 to 1.76 for individual dimensions and the overall score. CONCLUSIONS: This new, Spanish-developed instrument to measure HRQOL in AR patients has shown good reliability, validity, and sensitivity to change. It has also proved easy to use and administer.

Modelling diseases: the allergens of Olea europaea pollen.

This study analyzes the influence of the IgE response to certain olive pollen allergens in the modulation of the different clinical phenotypes of allergic disease and their relationship with the level of exposure to pollen and genetic factors. Patients from high-exposure areas had a complex IgE antibody response to allergens of Olea euroapea, which included 3 or more allergens in 75% of cases. The majority allergens were Ole e 1, Ole e 2 (profilin), Ole e 7 (lipid transporting protein), Ole e 9 (glucanase), and Ole e 10. The existence of the antigen HLA-DR2 (15) led to a higher risk of sensitization to Ole e 10 and a greater trend towards the development of severe asthma, which increased in the presence of an anti-profilin IgE. Thirty percent of patients suffering from pollinosis simultaneously presented allergy to vegetable foods. Anti-Ole e 7 IgE was significantly associated with fruit anaphylaxis and anti-profilin IgE was detected in 90% of patients with oral syndrome. Finally, we analyzed the role of glucanase and Ole e 10 as causes of the pollen-latex-fruit syndrome.

[Latex allergy]. / Alergia al látex.

OBJECTIVE: To review the etiology, diagnosis, prevention and treatment of latex allergy in the hospital setting, and to establish a list of potentially hazardous drugs. METHOD: A literature search was performed. A guide about latex-containing drugs (any component) was developed by contacting manufacturers. RESULTS: The most relevant factor for latex sensitization is exposure extent. Regarding diagnosis the medical history and skin testing are crucial; regarding secondary prevention, identifying the various at-risk groups. Immunotherapy is currently considered a valid option for the management of this condition. CONCLUSIONS: The development of a guide listing latex-containing drugs is essential for the primary prevention of allergic reactions to this substance in hospital.

Maternal Body Weight and Gestational Diabetes Differentially Influence Placental and Pregnancy Outcomes.

CONTEXT: Maternal obesity and gestational diabetes mellitus (GDM) can both contribute to adverse neonatal outcomes. The extent to which this may be mediated by differences in placental metabolism and nutrient transport remains to be determined. OBJECTIVE: Our objective was to examine whether raised maternal body mass index (BMI) and/or GDM contributed to a resetting of the expression of genes within the placenta that are involved in energy sensing, oxidative stress, inflammation, and metabolic pathways. METHODS: Pregnant women from Spain were recruited as part of the "Study of Maternal Nutrition and Genetics on the Foetal Adiposity Programming" survey at the first antenatal visit (12-20 weeks of gestation) and stratified according to prepregnancy BMI and the incidence of GDM. At delivery, placenta and cord blood were sampled and newborn anthropometry measured. RESULTS: Obese women with GDM had higher estimated fetal weight at 34 gestational weeks and a greater risk of preterm deliveries and cesarean section. Birth weight was unaffected by BMI or GDM; however, women who were obese with normal glucose tolerance had increased placental weight and higher plasma glucose and leptin at term. Gene expression for markers of placental energy sensing and oxidative stress, were primarily affected by maternal obesity as mTOR was reduced, whereas SIRT-1 and UCP2 were both upregulated. In placenta from obese women with GDM, gene expression for AMPK was also reduced, whereas the downstream regulator of mTOR, p70S6KB1 was raised. CONCLUSIONS: Placental gene expression is sensitive to both maternal obesity and GDM which both impact on energy sensing and could modulate the effect of either raised maternal BMI or GDM on birth weight.

Genomic Evolution of Two Acinetobacter baumannii Clinical Strains from ST-2 Clones Isolated in 2000 and 2010 (ST-2_clon_2000 and ST-2_clon_2010).

Acinetobacter baumannii is a successful nosocomial pathogen due to its ability to persist in hospital environments by acquiring mobile elements such as transposons, plasmids, and phages. In this study, we compared two genomes of A. baumannii clinical strains isolated in 2000 (ST-2_clon_2000) and 2010 (ST-2_clon_2010) from GenBank project PRJNA308422.

Nephrotic syndrome and respiratory allergy in childhood.

The etiology and pathogenesis of idiopathic nephrotic syndrome remain obscure. Several investigations have reported a role for allergy in the development and maintenance of this disease, especially in childhood. We have studied 20 pediatric patients with relapses of nephrotic syndrome related in time to respiratory symptoms. Sensitization was demonstrated to one or more allergens in 7 patients with episodes of proteinuria of seasonal tendency. Preventive management with disodium cromoglycate was successful in preventing new relapses in 3 patients; specific immunotherapy was assayed in another 2 without beneficial outcome. There appears to be a pathogenic relationship between respiratory allergy and proteinuria in some cases of nephrotic syndrome.

Plasma concentrations of beta-endorphin and adrenocorticotropic hormone in women with and without childbirth preparation.

We studied plasma concentrations of beta-endorphin (beta-EP) and adrenocorticotropic hormone (ACTH) during dilation, expulsion and immediate puerperium in 47 primiparous women with an uneventful pregnancy and spontaneous vaginal delivery. Twenty-five women had received childbirth preparation with the Lamaze method, and 22 had received no preparation. Mean concentrations of beta-EP from the beginning of labor until puerperium were higher in women who had received preparation, but there was no significant difference between the two groups. When behavior during labor was evaluated regardless of which group the patient was assigned to, women whose behavior was unsatisfactory has significantly higher concentrations of ACTH at all times during childbirth. We discuss the role of childbirth preparation as a way to enhance beta-EP secretion. Levels of ACTH, on the other hand, appear to be more closely related with behavior during labor, regardless of whether the mother received preparation.

Plasma levels of beta-endorphin and ACTH during labor and immediate puerperium.

We measured concentrations of beta-endorphin (beta-EP) and adrenocorticotropic hormone (ACTH) in maternal peripheral plasma during dilation, the expulsive period and immediate puerperium, and in the umbilical vein. Plasma levels of both peptides increased markedly and were directly correlated during labor, and decreased 24 h after birth; they were no longer correlated during immediate puerperium. In the umbilical vein, beta-EP and ACTH were also directly correlated. Moreover, the concentration of each of the two peptides in maternal plasma during the expulsive period was correlated with the corresponding concentration in umbilical vein. We discuss the importance of placental corticotropin-releasing factor in the regulation of maternal and fetal stress.

[Neonatal herpetic encephalitis. Current concepts concerning a case]. / Encefalitis herpética neonatal. Conceptos actuales a propósito de un caso.

We describe a newborn patient with herpes simplex infection localized to the central nervous system. The diagnosis was suspected on clinical grounds and it was corroborated by tissue culture isolation of the virus and by herpes simplex glycoprotein B DNA detection by PCR in cerebrospinal fluid. We describe the clinical manifestations of this patient and we present some considerations regarding pathogenesis, diagnosis, prognosis and treatment of this viral infection in the newborn period.

Using machine learning techniques and genomic/proteomic information from known databases for defining relevant features for PPI classification.

In modern proteomics, prediction of protein-protein interactions (PPIs) is a key research line, as these interactions take part in most essential biological processes. In this paper, a new approach is proposed to PPI data classification based on the extraction of genomic and proteomic information from well-known databases and the incorporation of semantic measures. This approach is carried out through the application of data mining techniques and provides very accurate models with high levels of sensitivity and specificity in the classification of PPIs. The well-known support vector machine paradigm is used to learn the models, which will also return a new confidence score which may help expert researchers to filter out and validate new external PPIs. One of the most-widely analyzed organisms, yeast, will be studied. We processed a very high-confidence dataset by extracting up to 26 specific features obtained from the chosen databases, half of them calculated using two new similarity measures proposed in this paper. Then, by applying a filter-wrapper algorithm for feature selection, we obtained a final set composed of the eight most relevant features for predicting PPIs, which was validated by a ROC analysis. The prediction capability of the support vector machine model using these eight features was tested through the evaluation of the predictions obtained in a set of external experimental, computational, and literature-collected datasets.