Degradation kinetics of sugars (glucose and xylose), amino acids (proline and aspartic acid) and their binary mixtures in subcritical water: Effect of Maillard reaction.

A systematic kinetic study was conducted in subcritical water medium in the temperature range from 150 to 200 °C for pure glucose, xylose, proline and aspartic acid as well as binary mixtures of sugars + amino acids to understand the reaction kinetics and interactions among biomass components and to discern the influence of Maillard reaction (MR) on the overall reaction kinetics. The main degradation products identified for glucose and xylose were the respective dehydration products, hydroxymethyl furfural and furfural, yielding an increasing solid residue with temperature (15.9 wt% at 200 °C) with an augmented heating value. The degradation of sugars and amino acids in binary systems was faster compared to pure compounds due to MR and the production of dehydration products was delayed when considering total sugar conversion. Higher relative reactivity in MR was observed for xylose over glucose showing also higher antioxidant activity.

Subcritical water as hydrolytic medium to recover and fractionate the protein fraction and phenolic compounds from craft brewer's spent grain.

The valorization of the brewer's spent grain (BSG) generated in a craft beer industry was studied by subcritical water hydrolysis in a semi-continuous fixed-bed reactor. Temperature was varied from 125 to 185 °C at a constant flow rate of 4 mL/min. Biomass hydrolysis yielded a maximum of 78% of solubilized protein at 185 °C. Free amino acids presented a maximum level at 160 °C with a value of 55 mg free amino acids/gprotein-BSG. Polar amino acid presented a maximum at lower temperatures than non-polar amino acids. The maximum in total phenolic compounds was reached at 185 °C. This maximum is the same for aldehyde phenolic compounds such as vanillin, syringic and protocatechuic aldehyde; however, for hydroxycinnamic acids, such as ferulic acid and p-coumaric, the maximum was obtained at 160 °C. This allows a fractionation of the bioactive compounds. Subcritical water addresses opportunities for small breweries to be incorporated within the biorefinery concept.

Structural changes of a protein extract from apple with polyphenoloxidase activity obtained by cationic reversed micellar extraction induced by high-pressure carbon dioxide and thermosonication.

Polyphenoloxidase from apple was extracted and further concentrated by cationic reversed micellar extraction. Previous to reversed micellar extraction a crude protein extract was obtained using AG2-X8 as adsorbent of phenolic compounds and the detergent Triton X-100. Forward and backward extraction conditions were optimized by using dodecyl trimethyl ammonium bromide as surfactant in the organic phase. Optimization was carried out to obtain the highest value of PPO activity recovery and the purification fold at the different experimental conditions. Under the optimum extraction conditions, PPO activity recovery was 99% and purification fold reached a value of 17, showing that reversed micellar extraction was a good technique as a first step to concentrate on a targeted enzyme. After removing some impurities by centrifuge ultrafiltration, the protein extract with PPO activity was treated by pressurized carbon dioxide and thermosonication achieving residual PPO activity values of 16 ± 3 and 9 ± 1%, respectively. Quenching experiments by iodide performed in the non-treated extract and in the treated extracts revealed conformational changes of this protein fraction reflected in the greater exposure of the fluorophore to the quencher.

Effect of cold plasma on polyphenol oxidase inactivation in cloudy apple juice and on the quality parameters of the juice during storage.

Direct cold plasma treatment has been investigated as an alternative non-thermal technology as a means of maintaining and improving quality of fresh cloudy apple juice. Process variables studied included type of plasma discharge, input voltage and treatment time on polyphenol oxidase (PPO) inactivation. Spark discharge plasma at 10.5 kV for 5 min was the best treatment, with near total inactivation of PPO achieved, although good PPO inactivation was also recorded using shorter treatment times. Residual activity (RA) of PPO was 16 and 27.6% after 5 and 4 min of treatment respectively. This PPO inactivation was maintained throughout the storage trials, but decreased with samples treated for a shorter time. Plasma treatment improved key quality parameters of Golden delicious cloudy apple juice, with retention of critical quality parameters during extended storage trials. Color was the most noticeable change, which was enhanced with retention of a greener color. An increase of 69 and 64% was obtained in the total phenolic content after 4 and 5 min of treatment, respectively. Therefore, cold plasma was demonstrated to be a good alternative to traditional heat treatments for enhanced quality retention of fresh cloudy apple juice and over its storage.

Asthma exacerbations: risk factors for hospital readmissions.

OBJECTIVE: The aim of our study is to analyse hospital readmissions due to asthma, as well as the factors associated with their increase. STUDY DESIGN: We carried out a retrospective study including all admissions of patients over 18 years old due to exacerbation of asthma occurring in our hospital between the years 2000 and 2010. METHODS: The data were gathered by two members of the research team, by reviewing the clinical records. The first hospital admission of each patient was included for this study. An early readmission (ER) was defined as that which occurred in the following 15 days after hospital discharge and late readmission (LR) to that occurring from 16 days after discharge. RESULTS: This study included 2166 hospital admissions and 1316 patients, with a mean age of 62.6 years. Of the 1316 patients analysed, 36 (2.7%) had one ER and 313 (23.8%) one LR. The only factor independently associated with a higher probability of an ER was poor lung function. A higher probability of LR was associated with a greater severity of the asthma (OR: 17.8, for severe asthma versus intermittent asthma), to have had any hospital admission in the previous year (OR: 3.5) and the use of a combination of ICS-LABA as maintenance treatment. CONCLUSIONS: About 25% of the patients in our area admitted to hospital due to asthma exacerbation had repeat episodes of hospitalisation.

Factors associated with the incidence of serious adverse events in patients admitted with COPD acute exacerbation.

BACKGROUND: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common cause of hospitalization. Patient outcome and prognosis following AECOPD are variable. The aim of this study is to identify the factors associated with the incidence of serious adverse events (SAE), defined as need for ICU admission, noninvasive ventilation, death during hospitalization or early readmission, in those patients admitted with AECOPD. METHODS: We conducted a retrospective study by reviewing the medical records of all patients admitted with AECOPD in the University Hospital Complex of Santiago de Compostela in 2007 and 2008. To identify variables independently associated with SAE incidence, we conducted a logistic regression including those variables which proved to be significant in the univariate analysis. RESULTS: 757 patients were assessed (mean age 74.8 years, SD 11.26), 77.2 % male, and 186 (24.6 %) of the patients assessed experienced an SAE. Factors associated with SAE in multivariate analysis were anticholinergic therapy (OR 3.19; CI 95 %: 1.16; 8.82), oxygen therapy at home (OR 3.72; CI 95 %: 1.62; 8.57), oxygen saturation at admission (OR 0.93; CI 95 %: 0.88; 0.99) and serum albumin (OR 0.26; CI 95 %: 0.1; 0.66). CONCLUSION: Oxygen therapy at home, anticholinergic therapy as baseline treatment, lower oxygen saturation at admission and lower serum albumin level seem to be associated with higher incidence of SAE in patients with AECOPD.

Effects of pork vs veal consumption on serum lipids in healthy subjects.

AIMS: To analyse the influence of lean pork (P) and veal (V) consumption on the lipid profile of healthy subjects within the framework of a healthy diet comprising low levels of total fat (TF), saturated fatty acids (SFA) and cholesterol. DESIGN: Double-crossover, randomized and controlled trial SUBJECTS: 44 healthy individuals (22 male and 22 female), recruited voluntarily from the University Complutense of Madrid. The weight and lipid profiles of these volunteers were normal and their dietary patterns were typical for people in our area. INTERVENTIONS: The study comprised 4 phases: stabilisation phase (5 weeks), the participants followed their normal diet; second phase (6 weeks), half of the subjects, were randomised to lean pork or veal consumption, 150 g per day, for their main meal of the day; washout period (5 weeks) and final phase, which was the second phase of intervention (6 weeks). During the intervention stages, only the main meal of the day was taken in the Hospital. The rest of the subjects' diets consisted of different fortnightly menus designed in accordance with the recommendations of the Spanish Society of Arteriosclerosis (SEA). RESULTS: After both stages of intervention had been completed, there was a mean reduction of 5.5% in low-density lipoprotein cholesterol. However, after each intervention there were no significant differences between those who had consumed P, 2.62 (0.55) mmol/L and those who had consumed V, 2.71 (0.47) mmol/L. No differences were observed in any of the other parameters between those who had consumed P and those who had consumed V. CONCLUSIONS: Lean pork and veal produces similar effects on the lipid profiles of healthy subjects. Its consumption, as part of the saturated fat and cholesterol-controlled diet, could therefore be included in food guidelines, both for normal and therapeutic diets.

Prognostic value of the quantified expression of p185 in non-small cell lung cancer.

BACKGROUND: We sought to assess the relationship between tissue concentration of erb -b-2 or neu oncogene-encoded protein (p185(neu)) with overall survival in patients with non-small cell lung cancer. METHODS: Levels of protein p185(neu) were determined in 102 patients with the diagnosis of non-small cell lung cancer. Concentration of p185(neu) protein was determined by using enzyme immunoassay and evaluated by using several variables. The relative prognostic importance of this marker and its influence on other prognostic factors was evaluated by using the Cox regression model. RESULTS: The mean p185(neu) value in these samples was 250 +/- 200 U/mg (95% confidence interval, 210-290). This distinguished two groups within the tumoral population: those with less than 350 U/mg and those with 350 U/mg or greater (80th percentile). Multivariable analysis established an independent prognostic value for protein p185(neu). Patients with p185(neu) values of the 80th percentile or greater had a risk of death that was 2.11-fold (95% confidence interval, 1.10-4.05) that of patients with values of less than 350 U/mg (P =.03), and increases in the neu oncogene of 100 U/mg increased the probability of death by 17% (P =.02; 95% confidence interval, 1.04-1.31). CONCLUSION: This study shows that the p185(neu) expression is an objective and comparable variable for the assessment of phenotypic aggressivity in non-small cell lung cancer, and in the future, it could be included in daily clinical practice.

Critical study of fluorimetric determination of selenium in urine.

Different steps for the fluorimetric determination of Se in urine have been investigated. A HNO(3)HClO(4) (4:1) mixture is useful for urine digestion, and reduction of Se(VI) to Se(IV) is effectively carried out with HCl (6M). Selenium(VI) present after the digestion process constitutes 14.5-36.6% of total Se. An optimum pH of 1.80+/-0.05 and the addition of 1 ml of 2,3-diaminonaphthalene (DAN) (0.1%, w/v) are established in the formation of Se-DAN complex. Heating to 60 degrees C, a time of incubation of 15 min is recommended to assure the complete formation of Se-DAN complex. A volume of 5 ml of cyclohexane and vigorous shaking for 45 sec is necessary for the extraction process. With this optimized method, the detection limit of selenium was 0.82 mug/l., within-day precision for a 50.0 mug/l. standard solution and urine (27.3 mug/l.) were 2.4 and 2.7% and between-day for the urine was 3.9% (33.9 mug/l.). Analytical recovery of 0.5 ml of Se standard (250 mug/l.) added to 1 ml of urine was 99.9+/-2.9% (95.8-104.4, n = 12). Normal levels of selenium excretion in urine obtained from healthy people were 27.9+/-8.7 mug/day (13.2-44.1), not observing significant differences (P < 0.05) between sexes.

[The estimation of prevalence of Parkinson disease in Navarra. An epidemiological study of the consumption of anti-parkinsonian drugs]. / Estimación de la prevalencia de la enfermedad de Parkinson en Navarra. Estudio farmacoepidemiologico del consumo de antiparkinsonianos.

BACKGROUND: Research concerning the prevalence of Parkinson's disease in our community was scarce. In addition, this had been carried out using different methodologies. Therefore it was not possible to determine its true impact on public health in our community. Research into the consumption of specific and compulsory drugs such as L-dopa by people with Parkinson's disease made it possible for us to discover its true prevalence. METHODS: The prevalence of Parkinson's Disease (332.0 and 332.1 of the ICD, 9th Revision) is determined by the consumption of antiparkinsonian drugs (N04A) in Navarra in 1993 and 1994 by calculating the daily defined doses (DDD) per 100,000 inhabitants (10(5)) for each of the prescribed drugs. The data from prescriptions have been obtained from the Pharmaceutical Service of the Health System of Navarre, which covers 93.5% of the population. RESULTS: By determining the daily defined doses (DDD) of L-dopa per 10(5) inhabitants, a prevalence of 161.5 x 10(5) (CI 95% 172.4-150.6) is estimated for the population as a whole, 8 x 10(5) (CI 95% 10.4-5.6) for people under 65 years of age and 1001.1 x 10(5) for those of 65 years of age and over (CI 95% 1069.6-932.4). Consumption figures of L-dopa in Basic Health Areas (Health Districts) allows the determination of the geographical distribution of Parkinson's Disease in Navarra. It varies between a prevalence in people over 65 years of age of 1602.77 x 10(5) in Alsasua (north-west) and 517.61 x 10(5) in Lodosa (south). CONCLUSIONS: The figures obtained for Navarre place it in the middle range of European areas, although methodological differences do not allow definitive conclusions to be drawn in this sense.

[Breast-feeding]. / Lactancia materna.

In order to promote maternal lactation it is necessary to know what problems prevent it. With this in mind, a survey of 202 mothers who had children between the first of October and the end of November in 1992 was conducted. 91.5% of these mothers began normal lactation, yet 30.7% were incapable of giving milk after one month. A high frequency of lactating failure correlated with women from disadvantaged income groups. Factors that influenced the duration and difficulty of breast feeding were: lactating problems with the previous child, family opinions, rigid feeding schedules, excessive maternal preoccupation, working out of the home. Once the problems were recognized, a second objective of this study was to design a plan that would create positive attitudes toward maintaining natural lactation. After putting this plan to work, a three month study showed that 70.2% of the mothers in a experimental group continued to breast feed, whereas only 39.5% of the control group did. After four months 55% of the variable group was still nursing their children, while the control group fell to 30.2%.

[Spinal anesthesia. Repercussions on childbirth]. / Anestesia epidural. Repercusiones sobre el parto.

A study was carried out to discover the action of epidural anesthesia on pain, on the evolution of dilation and expulsion intervals, on the number of surgically assisted births, and on perinatal morbidity. Some of the most significant results indicated that with good techniques, pain disappears in all cases; that the dilating period is significantly shortened with epidural anesthesia, although there is an increase in instrumental-assisted childbirths. Even though epidural anesthesia is, as of this writing, the best method available, the ideal pain reduction method has yet to be discovered. Part of this study was presented before the National Congress of Midwives and received the "Nuk" Prize.

Symptoms, location and prognosis of pulmonary embolism.

BACKGROUND AND OBJECTIVE: Pulmonary embolism (PE) is a common disease with variable symptoms and high overall mortality. The clinical relevance of the extent of PE is still debatable, and the role of anticoagulation in patients with subsegmental involvement has been contested. Our objective is to describe the clinical details of patients with PE in our hospital and to analyze their prognosis based on the extent of the disease. MATERIALS AND METHODS: Retrospective study of 313 patients diagnosed with PE by chest computed tomography (CT) scan at the Hospital Complex of Pontevedra in Spain for six years. Predictors of mortality were determined by multivariate analysis. RESULTS: Women accounted for 56% of patients, and patient median age was 70 years (interquartile range 53-78 years). Subsegmental PE accounted for 7% of all cases; these patients were younger and had lower comorbidity; they reported chest pain more often, performed better in blood gas analysis and none of them had proximal deep vein thrombosis (DVT). Patients with subsegmental PE had a higher survival rate. Factors independently associated with mortality were cancer diagnosis and higher comorbidity. CONCLUSIONS: Patients with subsegmental PE clinically differ from those with more proximal PE. Underlying diseases have more influence on the prognosis than the extent of the disease.

Timeliness of care and prognosis in patients with lung cancer.

BACKGROUND: Timeliness of care is an important dimension of health care quality. The determining factors of less timely care and their influence on the survival of patients with lung cancer (LC) remain uncertain. AIMS: To analyse the delays in the diagnosis and treatment of LC in our health area, the factors associated with the timeliness of care and their possible relationship with the survival of these patients. METHODS: A retrospective study was conducted on all patients with a cytohistologically confirmed diagnosis of LC between 1 June 2005 and 31 May 2008. The time delays for consultation (specialist delay), diagnosis (diagnosis delay), and treatment (treatment delay), were analysed, as well as the factors associated with these delays and the influence of the timeliness of care on survival. RESULTS: A total of 307 cases were included (87 % males). The mean specialist delay was 53.6 days (median 35 days), diagnosis delay 31.5 days (median 18 days), treatment delay 23.5 days (median 14 days). The greater age of the patient and a more advanced stage were associated with a shorter specialist delay. Male sex, a more advanced stage, and poor general status were associated with a shorter treatment delay. The survival is longer in patients with a longer treatment delay. CONCLUSIONS: The delay in the diagnosis in our population seems to be excessively long. The greater the age, a more advanced tumour stage, male sex, and poor general health status are associated with shorter delays. A longer treatment delay is associated with a longer survival.

Influence of pollen level on hospitalizations for asthma.

The effect of pollen level on asthma hospitalizations is still under debate. The aim of this study was to analyze hospital admissions due to asthma and its relation with environmental pollen and meteorological factors. During 13 years, we included every patient admitted with asthma as primary or secondary diagnosis. For this purpose, we used a case-crossover analysis to compare pollen concentrations at the time of admission with values of the same variables 2 to 6 days before admission. We included 6,687 hospital admissions. High maximum temperature and low humidity were associated with lower risk of asthma admissions. High mean pollen levels exerted a moderate effect and high maximum pollen levels led to a dramatic increase of hospital admissions due to asthma, especially among females. In conclusion, environmental pollen level increases the risk of asthma hospital admissions.

[Lung cancer in the Pontevedra health area: incidence, clinical presentation and survival]. / Cancer de pulmon en el area sanitaria de Pontevedra: incidencia, presentación clinica y supervivencia.

BACKGROUND: To describe the clinical and epidemiological characteristics, and survival of patients with lung cancer (LC) in the Pontevedra Health Area. METHODS: A retrospective observational study was conducted on all patients with a diagnosis of LC in the Pontevedra Hospital Complex (CHOP) health area over a three-year period. The data recorded included, age, gender, smoking history, comorbidity, functional status, diagnostic method, histology type, stage, treatment received, and survival. The patients were followed up for 3 years. RESULTS: A total of 358 cases of LC were included in the study, which gave a crude incidence rate adjusted to the standard European population of 37.33/100,000 inhabitants/year in males and 4.88/100,000 inhabitants/year in females. The large majority were males (87%). The mean age was 68.7 years, and 82% were smokers or ex-smokers. The most common histology type was epidermoid, with 35.2% of the cases. The diagnosis was made in stages III-B or IV in 79% of cases. Chemotherapy was the first treatment in 53% of the cases. Survival after the first year was 25%, which decreased to 4% at the third year. CONCLUSIONS: The incidence of LC in our health area continues to be mainly in male smokers, although the incidence in females and in people who never smoked is higher than in other populations in our country. It is diagnosed in the advance stages of the disease, and survival is poor.

[Pulmonary thromboembolism: clinical suspicion required]. / Trombo-embolismo pulmonar: necesitamos sospecha clínica.

Venous thromboembolism (VTE) is a major health problem, with an annual incidence of 1-2 per 1,000 person-years. One in three patients with symptomatic VTE presents pulmonary embolism (PE), which is often underdiagnosed due to variable and nonspecific clinical presentation. Knowing the signs and symptoms of VTE can reduce delays in diagnosis, and thus VTE-related morbidity and mortality as well. Nevertheless, PE can present a wide clinical spectrum, ranging from being asymptomatic to shock or hemodynamic instability, which is why PE suspicion should not be limited to those patients with typical presentation. Therefore, this diagnostic possibility should not only be considered for patients with acute symptoms, but also for those with persistent respiratory symptoms.

Asthma and risk of lung cancer.

Asthma is a very common chronic disease that occurs in all age groups. Its high prevalence has significant health costs, which are even higher in the most severe disease forms. Lung cancer has the highest incidence of all cancers in the developed world and is an important cause of mortality. Patients with lung cancer are a big economic burden on health services, both in direct and indirect costs. Different authors suggest that atopic constitution, including different manifestations of allergy and asthma, are possible risk factors for lung cancer, above all in never-smokers. Given the high asthma prevalence and lung cancer incidence and mortality in developed countries, this association would have important public health implications. Uncertainties about the association and the underlying physiopathological mechanisms, however, seem to require further studies.

[Delayed diagnosis of alpha-1 antitrypsin deficiency]. / Diagnóstico tardío de déficit de α-1-antitripsina.

Alpha-1 antitrypsin deficiency (AAT-D) is a genetic disease, relatively common in populations of European ancestry. AAT-D remains undiagnosed in many patients, and there are often long delays between the onset of respiratory symptoms and diagnosis. AAT-D can be readily diagnosed by measurement of the serum or plasma protein level, which should be confirmed by assessing the genotype or protein phenotype when AAT levels are below the normal range. Close monitoring for the development or progression of lung disease or liver disease is required, and can improve the prognosis. We show the case of a 69 year old woman with recurrent respiratory infections and asthma symptoms. The serum levels of AAT were below the normal range, and ZZ genotype was confirmed. The delayed diagnosis of our patient seems to emphasize the need to remind the doctors about AAT-D, frequently associated with asthma or COPD symptoms.