New treatment strategies for non-metastatic rectal cancer.

The most widely practiced (standard) treatment of non-metastatic rectal cancer is based on proctectomy with mesorectal excision (partial or total according to the location of the tumor and commonly called TME). Surgery is preceded by CAP50-type chemoradiotherapy (capecitabineand 50 Grays radiation) and performed 6-8 weeks after the end of chemoradiotherapy. The development of new endoscopic, surgical, radiation-based and chemotherapeutic modalities leads surgeons to envisage customized treatment to find the best compromise between functional and oncologic results according to the locoregional extension of the tumor. Superficial lesions are amenable to transanal excision. T2-3 tumors<4cm are amenable to rectal preservation when neoadjuvant treatment obtains a complete response, allowing local excision or close surveillance. Intensification endocavitary radiotherapy and induction and consolidation chemotherapy regimens to avoid recourse to salvage abdomino-perineal resection (APR) are under investigation. For locally advanced rectal cancers (T3-4 and all N+ irrespective of T), the following scenarios can be envisaged: for initially resectable tumors (T3N0, T1-T3N+, circumferential resection margin>2mm), neoadjuvant chemotherapy alone aims to minimize the risk of local recurrence while avoiding the sequelae of radiotherapy. In case of initially non-resectable tumors (T4, circumferential resection margin<1mm), induction chemotherapy before chemoradiotherapy and consolidation chemotherapy after short course radiotherapy provide better results than standard treatment in terms of complete response and recurrence-free survival, and should be routinely proposed in this indication.

Social deprivation aggravates post-operative morbidity in carcinologic colorectal surgery: Results of the COINCIDE multicenter study.

AIM OF THE STUDY: Evaluate the impact of social deprivation on morbidity and mortality in surgery for colorectal cancer. METHODS: The COINCIDE prospective cohort included nearly 2,000 consecutive patients operated on for colorectal cancer at the Assistance Publique-Hospitals of Paris (AP-HP) from 2008 to 2010. The data on these patients were crossed with the PMSI administrative database. The European Social Deprivation Index (EDI) was calculated for each patient and classified into five quintiles (quintiles 4 and 5 being the most disadvantaged patients). Thirty-day post-operative morbidity was determined according to the Dindo-Clavien classification, with a Had®Hoc re-analysis of each file. Statistical analysis was performed using the proprietary Q-finder® algorithm. RESULTS: One thousand two hundred and fifty nine curative colorectal resections were analyzed. Mortality was 2.7% and severe morbidity (Dindo-Clavien≥3) occurred in 16.4%. Mortality was not statistically significantly increased among the most disadvantaged who made up almost two thirds of the population (64.2%). Patients in quintiles 4 and 5 had a statistically significant increase in severe morbidity. The relative risk remained 1.5 even after adjustment for the known risk factors found in the analysis: age>70 years, ASA score, urgency, and laparotomy. CONCLUSIONS: The EDI represents an independent risk factor for severe morbidity after carcinologic colorectal resection. This study suggests that the determinants of health are multidimensional and do not depend solely on the quality and performance of the care system. The inclusion of this index in our surgical databases is therefore necessary, as is its use in health policy for the distribution of resources.

Índice de CMP em leite pasteurizado comercializado em Minas Gerais, Brasil, durante os anos de 2011 a 2017 / Caseinomacropeptide index in pasteurized milk retailed in Minas Gerais, Brazil from 2011 to 2017

Cheese whey is a nutritious byproduct in the dairy industry, however, due to low commercial value, its use as a milk adulterant is a common practice not easily detected by routine analysis. In Brazil, quantification of caseinomacropeptide (CMP) index, using High Performance Liquid Chromatography (HPLC), is officially used to investigate illegal cheese whey addition to milk. Milk with CMP index above 30mg/L is considered not suitable for human consumption. The objective of this research was to report the CMP index in 185 samples of pasteurized milk, representing 73 commercial brands produced in 51 counties and ten mesoregions of the state of Minas Gerais, from 2011 to 2013 (58 samples) and 2015 to 2017 (127 samples). CMP index was considered normal (up to 30mg/L) in 75.1% of the samples. However, 21.1% presented CMP index above 75mg/L and 3.8% from 31 to 75mg/L. CMP index above 75mg/L was found in 17.4% of the samples produced during the dry season (April to September) and in 24.7% during the rainy season (October to March). These data point to the need of more efficient monitoring and inspection processes to hinder adulteration with cheese whey addition to milk.(AU)

Elective surgery for tumours of the splenic flexure: a French inter-group (AFC, SFCD, FRENCH, GRECCAR) survey.

BACKGROUND: In an elective setting, there is no consensus regarding the type of colectomy that is best for patients with tumors of the splenic flexure: segmental left colectomy (or splenic flexure colectomy), left hemicolectomy or subtotal colectomy (or extended right hemicolectomy). In the United Kingdom, extended right hemicolectomy is preferred by surgeons. The aim of the present survey was to report on the practices in France for this particular tumor location. METHODS: Between 15/07/17 and 15/10/17, members of two French surgical societies [the French Association of Surgery (AFC) and the French Society of Digestive Surgery (SFCD)] and two French surgical cooperative groups [the French Federation of Surgical Research (FRENCH) and the French Research Group of Rectal Cancer Surgery (GRECCAR)] were solicited by email to answer an online anonymous questionnaire. RESULTS: A total of 190 out of 420 surgeons participated in this study (response rate 45%). The preferred procedure was splenic flexure colectomy (70%), followed by left hemicolectomy (17%) and subtotal colectomy (13%). The most used surgical approach was laparoscopy (63%), followed by laparotomy (31%) and hand-assisted laparoscopy (6%). Lymph node dissection was extended to the middle colic artery in 29% of splenic flexure colectomies and in 33% of left hemicolectomies. Twenty-nine percent of responders thought that tumors of the splenic flexure had a worse prognosis in comparison with other colonic sites, because of insufficient lymph node dissection (73%) or a more advanced stage (50%) at diagnosis. However, this opinion did not change the type of colectomy performed. CONCLUSIONS: There is a strong consensus in France to operate tumors of the splenic flexure with a splenic flexure colectomy and lymph node dissection limited to the left colic artery.

What is the impact of neoadjuvant chemoradiation on outcomes in gastro-intestinal cancer?

Multimodal therapeutic strategies combining chemotherapy, radiation therapy and surgery have been shown to be feasible and to have a positive impact on outcomes by decreasing the risk of locoregional recurrence and often by increasing overall survival. The advantages of neoadjuvant chemo(radio)therapy include optimal tumor control combined with better tolerance and compliance to treatment while also increasing the number of candidates for surgery. Whereas indications for neoadjuvant therapy are increasing, its impact on surgical treatment and postoperative outcomes are not well-known. Surgeons frequently believe that chemo(radio)therapy may amplify intraoperative difficulties, thereby increasing postoperative morbidity and mortality. The aim of this review was to report the state of the art regarding: (i) the role of chemo(radio)therapy; (ii) its impact on surgical indications and modalities; and (iii) its impact on postoperative outcomes for the most frequently encountered gastro-intestinal cancers, i.e. esophageal, rectal, pancreatic, and anal canal cancer.

Trocar-guided trans-vaginal mesh surgery for pelvic organ prolapse: effects on urinary continence and anatomical and functional outcomes. A prospective observational study.

OBJECTIVE: Primary objective of this study was to assess the effects of trocar-guided transvaginal mesh surgery (TVM) on cure and prevention rates for incontinence, without concomitant surgery for Stress Urinary Incontinence (SUI). Our secondary objectives were anatomical outcomes, relief of symptoms and effect on quality of life (QoL). STUDY DESIGN: This prospective observational study evaluated women who underwent TVM for symptomatic stage >2 Pelvic Organ Prolapse (POP). SUI was evaluated objectively using the cough stress test with prolapse reduced. SUI and urge urinary incontinence (UUI) were subjectively evaluated using ICIQ-SF. Anatomical cure was defined as stage <2 at POP-Q. STATISTICAL ANALYSIS: McNemar chi-square test; paired t-test; Mann-Whitney test. RESULTS: Seventy-two patients reached final evaluation (mean follow-up 72 months). In the 40 pre-op continent patients, 34 (85%) remained continent postoperatively and 6 (15%) showed de novo SUI. Only 1 patient chose to undergo subsequent TVT. The number needed to treat was 6 to prevent 1 women developing de novo objective SUI and 39 to prevent 1 woman having to undergo SUI surgery. In the 32 pre-op incontinent patients, 18 (56.3%) became continent postoperatively. Only 1 patient chose to undergo subsequent TVT. UUI was present in 44 patients pre-operatively and 15 (20.8%) post-operatively (1 de novo). Forty-four patients (61.1%) were continent post-operatively for SUI and UUI. We observed a significant improvement in storage, voiding, post-micturition and prolapse-related symptoms. The anatomical cure rate was 87.5% for the anterior compartment and 90.3%.for the apical segment. The apical recurrence was 8.3% in the patients previously hysterectomised, 18.8% in the patients with uterus preservation and 0% in the patients with concomitant hysterectomy. QoL scores improved in all domains except sleep and personal relationships. We observed mesh exposure in 10 patients (13.9%), in 5 of whom it was associated with a concomitant hysterectomy CONCLUSIONS: TVM showed excellent results in terms of continence and can be performed without contemporary anti-incontinence surgery, for both continent and incontinent women. Patients should have pre-operative counselling before POP surgery. For severe uterine prolapse the Perigee™ System should be employed with concomitant hysterectomy because uterus preservation is associated with significantly higher apical recurrence rates.

The accuracy of preoperative imaging in measuring the length of the ileocolic segment affected by Crohn's disease: a prospective cohort study.

AIM: The study aimed to evaluate the accuracy of imaging for measurement of the length of the ileocolic segment affected by Crohn's disease. METHOD: Fifty-four consecutive patients who underwent resection between 2011 and 2014 for ileocolic Crohn's disease were prospectively studied. All had preoperative MR or CT enterography. Two independent radiologists measured the length of the diseased intestinal segment. The measurements were compared with the length of disease assessed on pathology of the non-fixed surgical specimen. RESULTS: The median preoperative length of the Crohn's disease segment on imaging was 20.5 (2-73) cm and 20 (3-90) cm, as measured by the two radiologists. Interobserver agreement was substantial (κ = 0.69) with a correlation coefficient (r) of 0.82 (P < 0.001). The median length of the Crohn's disease segment on pathological examination was 16.5 (2-75) cm and was closely correlated with the radiological measurement (r = 0.76, P < 0.001). The length of the Crohn's disease segment on imaging was correct to within 5 cm of the value on pathology. It was correct in 30 (55%) patients and was underestimated and overestimated in 6 (11.1%) and 18 (33.3%). A length of disease of less than 20 cm found on imaging in 26 patients was confirmed in 25 (96%) on pathology, whereas a length of more than 20 cm found on imaging in 28 patients was confirmed in 18 (64%) on pathology. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of imaging for predicting a length of less than 20 cm were 71%, 95%, 96%, 64% and 79%. CONCLUSION: Imaging accurately identifies the length of the ileocolic segment of Crohn's disease when it is 20 cm or less on pathological examination. In patients with more extensive disease, imaging tends to overestimate the length and should be interpreted with caution.

Nanoprecipitated catestatin released from pharmacologically active microcarriers (PAMs) exerts pro-survival effects on MSC.

Catestatin (CST), a fragment of Chromogranin-A, exerts angiogenic, arteriogenic, vasculogenic and cardioprotective effects. CST is a very promising agent for revascularization purposes, in "NOOPTION" patients. However, peptides have a very short half-life after administration and must be conveniently protected. Fibronectin-coated pharmacologically active microcarriers (FN-PAM), are biodegradable and biocompatible polymeric microspheres that can convey mesenchymal stem cell (MSCs) and therapeutic proteins delivered in a prolonged manner. In this study, we first evaluated whether a small peptide such as CST could be nanoprecipitated and incorporated within FN-PAMs. Subsequently, whether CST may be released in a prolonged manner by functionalized FN-PAMs (FN-PAM-CST). Finally, we assessed the effect of CST released by FN-PAM-CST on the survival of MSCs under stress conditions of hypoxia-reoxygenation. An experimental design, modifying three key parameters (ionic strength, mixing and centrifugation time) of protein nanoprecipitation, was used to define the optimum condition for CST. An optimal nanoprecipitation yield of 76% was obtained allowing encapsulation of solid CST within FN-PAM-CST, which released CST in a prolonged manner. In vitro, MSCs adhered to FN-PAMs, and the controlled release of CST from FN-PAM-CST greatly limited hypoxic MSC-death and enhanced MSC-survival in post-hypoxic environment. These results suggest that FN-PAM-CST are promising tools for cell-therapy.

Outcome of emergency surgery for severe neuroleptic-induced colitis: results of a prospective cohort.

AIM: The study evaluated the outcome of severe acute antipsychotic (neuroleptic) drug related colitis requiring emergency surgery. METHOD: From 2009 to 2014, 20 patients underwent emergency surgery for acute and severe neuroleptic-related ischaemic colitis. Neuroleptic-induced colitis was defined as another cause besides inflammatory, infectious or ischaemic colitis with a relationship to treatment by antipsychotic drugs. RESULTS: The main drugs involved were cyamemazine (n = 9, 45%), loxapine (n = 5, 25%), haloperidol (n = 4, 20%) and alimemazine (n = 4, 20%). Most (n = 14, 70%) patients presented with haemodynamic instability requiring massive resuscitation and vasopressive drugs. CT signs of digestive impairment were found in 13 (65%) patients having emergency surgery. The lesions were pancolonic in 40%; transparietal necrosis was found in 45% and 15% had colonic perforation. Twelve (60%) patients had total or subtotal colectomy and eight (40%) a segmental colectomy with colostomy or ileostomy in all cases. The postoperative mortality was 15% and morbidity was 70%, necessitating surgical reintervention in two (10%) patients. Of the 17 surviving patients, 11 (64.7%) had restoration of intestinal continuity after a median delay of 103 days, with a postoperative morbidity rate of 36.3%. In the intent-to-treat population, the permanent stoma rate was 30%. CONCLUSION: The morbidity and mortality of surgery for neuroleptic-drug-induced colitis is higher than for colitis due to other causes. A better knowledge of this condition should lead to early diagnosis.

The innovative "Bio-Oil Spread" prevents metabolic disorders and mediates preconditioning-like cardioprotection in rats.

BACKGROUND AND AIMS: Obesity is often associated with an increased cardiovascular risk. The food industry and the associated research activities focus on formulating products that are a perfect mix between an adequate fat content and health. We evaluated whether a diet enriched with Bio-Oil Spread (SD), an olive oil-based innovative food, is cardioprotective in the presence of high-fat diet (HFD)-dependent obesity. METHODS AND RESULTS: Rats were fed for 16 weeks with normolipidic diet (ND; fat: 6.2%), HFD (fat: 42%), and ND enriched with SD (6.2% of fat + 35.8% of SD). Metabolic and anthropometric parameters were measured. Heart and liver structures were analyzed by histochemical examination. Ischemic susceptibility was evaluated on isolated and Langendorff-perfused cardiac preparations. Signaling was assessed by Western blotting. Compared to ND rats, HFD rats showed increased body weight and abdominal obesity, dyslipidemia, and impaired glucose tolerance. Morphological analyses showed that HFD is associated with heart and liver modifications (hypertrophy and steatosis, respectively), lesser evident in the SD group, together with metabolic and anthropometric alterations. In particular, IGF-1R immunodetection revealed a reduction of hypertrophy in SD heart sections. Notably, SD diet significantly reduced myocardial susceptibility against ischemia/reperfusion (I/R) with respect to HFD through the activation of survival signals (Akt, ERK1/2, and Bcl2). Systolic and diastolic performance was preserved in the SD group. CONCLUSIONS: We suggest that SD may contribute to the prevention of metabolic disorders and cardiovascular alterations typical of severe obesity induced by an HFD, including the increased ischemic susceptibility of the myocardium. Our results pave the way to evaluate the introduction of SD in human alimentary guidelines as a strategy to reduce saturated fat intake.

Cardiophrenic angle lymph node is an indicator of metastatic spread but not specifically peritoneal carcinomatosis in colorectal cancer patients: Results of a prospective validation study in 91 patients.

BACKGROUND: The presence of cardiophrenic angle lymph node (CPALN) has been associated with the risk of peritoneal carcinomatosis (PC) in high risk colon cancer patients. Its accuracy to predict PC and its prognostic value in non-selected CRC patients has not been validated prospectively. METHODS: From 2011 to 2013, all patients undergoing colectomy for colon cancer were included prospectively. Presence of CPALN was assessed on preoperative computed tomography scan by two radiologists. Surgical exploration was used as reference for the diagnosis of PC. Factors associated with presence of CPALN and progression-free survival were analyzed. RESULTS: Ninety one patients fulfilled inclusion criteria. CPALN was detected in 36 patients (39.5%) on CT scan. At surgical exploration, PC was found in 6 patients (6.5%). Sensitivity, specificity, negative predictive value, positive predictive value and overall accuracy of CPALN on CT scan for predicting PC were 67%, 62%, 96%, 11% and 63% respectively. In multivariate analysis, the presence of distant metastases whatever the site was associated with the presence of CPALN (p = 0.03; hazard ratio HR = 3.8; confidence interval CI 95% = 1.1-13.3). In the multivariate analysis, only vascular involvement (p = 0.034, HR = 3.574, CI 95% = 1.10-11.60) was associated with progression-free survival whereas CPALN was not found to predict outcome (p = 0.893). CONCLUSION: CPALN is a common finding in non-selected colon cancer patients. Although in the absence of CPALN, PC can almost be excluded, its value for the diagnosis of PC is limited. Our findings support that CPALN is mainly an indicator of metastatic spread of the tumor.

Microbiological and physical-chemical characteristics of fermented milk beverages / Características microbiológicas e físico-químicas de bebidas lácteas fermentadas

This study aimed to evaluate some microbiological and physical-chemical characteristics of fermented milk beverages collected at the main supermarkets in Belo Horizonte (MG). 40 samples of the products corresponding to five distinct brands were collected. They were submitted to the following analyses: Most Probable Number (MPN) of total (30ºC) and thermal tolerant coliforms (45ºC), Salmonella spp., coagulase positive Staphylococcus, molds and yeasts, lactic acid bacteria, pH, titratable acidity and contents of moisture, total solids, protein and fat. The analyses were carried out during the last week of shelf life. The microbiological quality of the samples was good and the counts of lactic bacteria were above the minimum established by the official legislation. Streptococcus and Lactobacillus were isolated and identified from the products and Lactobacillus delbrueckii was molecularly identified in three samples. The mean values for the contents of fat and protein, titratable acidity, pH, moisture and total solids ranged from 1.24 to 1.98%; 1.88 to 2.22%; 0.54 to 0.66%; 3.91 to 4.16; 81.18 to 83.25% and 16.75 to 18.82%, respectively. All samples had protein content in agreement with the official legislation.

O objetivo do presente trabalho foi avaliar as características microbiológicas e físico-químicas de bebidas lácteas fermentadas. Foram coletadas 40 amostras de bebidas lácteas fermentadas pertencentes a cinco marcas distintas, em grandes redes de supermercados de Belo Horizonte. Em cada amostra, foram avaliados os seguintes parâmetros: número mais provável de coliformes totais (30ºC), número mais provável de coliformes termotolerantes (45ºC), pesquisa de Salmonella spp., contagem de Staphylococcus coagulase positiva, contagem de bolores e leveduras, contagem total de bactérias lácticas viáveis, umidade, sólidos totais, teor de proteína, teor de gordura, pH e acidez titulável. As análises foram realizadas na última semana do período de validade. As amostras apresentaram qualidade microbiológica satisfatória, bem como contagens totais de bactérias lácticas viáveis superiores ao mínimo estabelecido pela legislação. Streptococcus e Lactobacillus foram identificados em todas as marcas de bebidas lácteas fermentadas analisadas, e em três delas foi possível identificar a espécie Lactobacillus delbrueckii. Os valores médios encontrados para os teores de gordura, proteína, acidez titulável, pH, umidade e sólidos totais variaram de 1,24 a 1,98%, 1,88 a 2,22%, 0,54 a 0,66%, 3,91 a 4,16, 81,18 a 83,25% e 16,75 a 18,82%, respectivamente. Todas as marcas de bebidas lácteas fermentadas apresentaram teor médio de proteína superior ao mínimo preconizado pela legislação.

Pathological response of locally advanced rectal cancer to preoperative chemotherapy without pelvic irradiation.

AIM: Pathological response to chemotherapy without pelvic irradiation is not well defined in rectal cancer. This study aimed to evaluate the objective pathological response to preoperative chemotherapy without pelvic irradiation in middle or low locally advanced rectal cancer (LARC). METHODS: Between 2008 and 2013, 22 patients with middle or low LARC (T3/4 and/or N+ and circumferential resection margin < 2 mm) and synchronous metastatic disease or a contraindication to pelvic irradiation underwent rectal resection after preoperative chemotherapy. The pathological response of rectal tumour was analysed according to the Rödel tumour regression grading (TRG) system. Predictive factors of objective pathological response (TRG 2-4) were analysed. RESULTS: All patients underwent rectal surgery after a median of six cycles of preoperative chemotherapy. Of these, 20 (91%) had sphincter saving surgery and an R0 resection. Twelve (55%) patients had an objective pathological response (TRG 2-4), including one complete response. Poor response (TRG 0-1) to chemotherapy was noted in 10 (45%) patients. In univariate analyses, none of the factors examined was found to be predictive of an objective pathological response to chemotherapy. At a median follow-up of 37.2 months, none of the 22 patients experienced local recurrence. Of the 19 patients with Stage IV rectal cancer, 15 (79%) had liver surgery with curative intent. CONCLUSION: Preoperative chemotherapy without pelvic irradiation is associated with objective pathological response and adequate local control in selected patients with LARC. Further prospective controlled studies will address the question of whether it can be used as a valuable alternative to radiochemotherapy in LARC.

Redox signalling and cardioprotection: translatability and mechanism.

The morbidity and mortality from coronary artery disease (CAD) remain significant worldwide. The treatment for acute myocardial infarction has improved over the past decades, including early reperfusion of culprit coronary arteries. Although it is mandatory to reperfuse the ischaemic territory as soon as possible, paradoxically this leads to additional myocardial injury, namely ischaemia/reperfusion (I/R) injury, in which redox stress plays a pivotal role and for which no effective therapy is currently available. In this review, we report evidence that the redox environment plays a pivotal role not only in I/R injury but also in cardioprotection. In fact, cardioprotective strategies, such as pre- and post-conditioning, result in a robust reduction in infarct size in animals and the role of redox signalling is of paramount importance in these conditioning strategies. Nitrosative signalling and cysteine redox modifications, such as S-nitrosation/S-nitrosylation, are also emerging as very important mechanisms in conditioning cardioprotection. The reasons for the switch from protective oxidative/nitrosative signalling to deleterious oxidative/nitrosative/nitrative stress are not fully understood. The complex regulation of this switch is, at least in part, responsible for the diminished or lack of cardioprotection induced by conditioning protocols observed in ageing animals and with co-morbidities as well as in humans. Therefore, it is important to understand at a mechanistic level the reasons for these differences before proposing a safe and useful transition of ischaemic or pharmacological conditioning. Indeed, more mechanistic novel therapeutic strategies are required to protect the heart from I/R injury and to improve clinical outcomes in patients with CAD.

Propriedades probióticas in vitro de Lactobacillus spp. isolados de queijos minas artesanais da Serra da Canastra - MG / In vitro probiotic properties of Lactobacillus spp. isolated from Minas artisanal cheese from Serra da Canastra - MG

O objetivo deste estudo foi determinar o potencial probiótico in vitro de Lactobacillus spp. isolados de queijos minas artesanais da Serra da Canastra, considerando-se o antagonismo entre amostras isoladas frente a microrganismos indicadores, a susceptibilidade a antimicrobianos, a sensibilidade ao ácido gástrico e a sensibilidade a sais biliares. Todas as bactérias ácido-lácticas testadas apresentaram resistência ao ácido gástrico (pH 2,0) e aos sais biliares (0,3%), bem como atividade antagonista contra Escherichia coli, Staphylococcus aureus, Listeria monocytogenes, Salmonella enterica var. Typhimurium, Enterococcus faecalis e bactérias ácido-lácticas isoladas dos próprios queijos - Lactobacillus plantarum (D27) e Lactobacillus rhamnosus (B25). Todas as amostras foram sensíveis à eritromicina e tetraciclina e resistentes à ciprofloxacina, gentamicina, oxacilina, estreptomicina e vancomicina. L. plantarum (B17) apresentou melhor potencial probiótico, pois obteve resultados satisfatórios em todas as propriedades avaliadas. Mais estudos são necessários para verificar a presença e a capacidade de transmissão de genes de resistência antimicrobiana a outros microrganismos e para avaliar o potencial dos microrganismos in vivo. As bactérias selecionadas poderão ser utilizadas na elaboração de queijos em que sejam mantidos o sabor e a tradição do queijo minas artesanal do estado de Minas Gerais...

The aim of this study was to determine some in vitro probiotic features of Lactobacillus spp. isolated from Minas artisanal cheese from Serra da Canastra in order to select some bacteria for future production of safer cheeses keeping their natural flavor and tradition. The evaluated properties were antagonism against indicator microorganisms, antimicrobial susceptibility and also sensitivity to gastric acid and to bile salts. All lactic acid bacteria tested were resistant to gastric acid (pH 2.0) and bile salts (0.3%). Antagonistic activities were detected against Escherichia coli, Staphylococcus aureus, Listeria monocytogenes, Salmonella entericavar. Typhimurium, Enterococcus faecalis and other lactic bacteria isolated from the same cheese - Lactobacillus plantarum (D27) and Lactobacillus rhamnosus (B25). All samples were sensitive to the antimicrobials erythromycin, tetracycline and resistant to ciprofloxacin, gentamycin, oxacillin, streptomycin and vancomycin. L.plantarum (B17) presented the best probiotic potential. Further studies are needed to verify the presence and the capacity of transmission of antimicrobial resistance genes to other microorganisms and evaluate the in vivo probiotic potential of the selected microorganisms...

Quality of fermented milks produced with Lactobacillus rhamnosus and Lactobacillus fermentum isolated from artisanal cheeses / Qualidade de leites fermentados produzidos com Lactobacillus rhamnosus e Lactobacillus fermentum isolados de queijos artesanais

Leites fermentados por Lactobacillus rhamnosus e Lactobacillus fermentum, isolados de queijos artesanais, foram produzidos e avaliados quanto às características físico-químicas e microbiológicas durante 45 dias de estocagem a 8-10ºC. Análises sensoriais foram realizadas aos 15 e 60 dias. Ambos os leites fermentados apresentaram contagens adequadas das bactérias láticas, superiores a 108 UFC/g, durante toda a estocagem. As médias das análises físico-químicas e microbiológicas dos produtos durante a estocagem foram iguais e todos atenderam às especificações da legislação brasileira. Melhores resultados de avaliações sensoriais (P<0.05) foram aos 15 dias de estocagem. Leites fermentados por L. fermentum obtiveram melhor aceitação sensorial aos 60 dias de estocagem, quando apresentavam acidez titulável inferior à encontrada no leite fermentado por L. rhamnosus. Portanto, a utilização dessas culturas pode ser viável para a elaboração de novos leites fermentados, que apresentariam prazo de validade de 45 dias de estocagem sob refrigeração.(AU)

Detection of cheese whey and caseinomacropeptide in fermented milk beverages using high performance liquid chromatography / Detecção de soro lácteo e caseinomacropeptídeo por cromatografia líquida de alta eficiência em bebidas lácteas fermentadas

Cheese whey level and caseinomacropeptide (CMP) index of fermented milk beverages added with four levels of cheese whey (0, 10, 20, and 40percent) and stored at 8-10oC for 0, 7, 14 and 21 days were determined by high performance liquid chromatography-gel filtration (HPLC-GF). Additionally, the interference of the starter culture and the storage time on the detection of cheese whey and CMP were investigated. Refrigerated storage up to 21 days did not affect (P>0.05) cheese whey and CMP amounts in milk (0 percent of cheese whey) and in fermented milk beverages added with 10 and 20percent of cheese whey (P>0.05). However, cheese whey and CMP amounts were higher than expected (P<0.05) in fermented milk beverages added with 40 percent of cheese whey and stored for 21 days...

O presente trabalho teve como objetivos quantificar o teor de soro e o índice de caseinomacropeptídeo (CMP) de bebidas lácteas fermentadas preparadas em laboratório, adicionadas de diferentes concentrações de soro (0, 10, 20 e 40 por cento), fermentadas e armazenadas em refrigeração (8-10oC) por tempos distintos (zero, sete, 14 e 21 dias), por cromatografia líquida de alta eficiência-filtração em gel (CLAE-FG), bem como verificar a interferência da cultura utilizada no preparo das bebidas lácteas fermentadas e do tempo de armazenamento na detecção de soro lácteo e CMP. Quando os teores de soro lácteo e os índices de CMP obtidos por CLAE-FG de bebidas lácteas fermentadas foram analisados ao longo do tempo de armazenamento, verificou-se que não houve diferença (p>0,05) para o leite (0 por cento de soro) e as bebidas lácteas com 10 e 20 por cento de soro nos tempos de zero, sete, 14 e 21 dias de armazenamento. No entanto, para a bebida láctea fermentada adicionada de 40 por cento de soro, foi observada diferença para o tempo de armazenamento de 21 dias (p<0,05), em que o teor de soro e o índice de CMP obtidos foram maiores que os demais, que se mostraram equivalentes entre si (p>0,05) para os tempos de zero, sete e 14 dias...

Detection of antimicrobial and anthelmintic residues in bulk tank milk from four different mesoregions of Minas Gerais State - Brazil / Detecção de resíduos antimicrobianos e anti-helmínticos no leite de tanque de quatro mesorregiões do estado de Minas Gerais - Brasil

Avaliou-se a presença de resíduos antimicrobianos (ceftiofur, estreptomicinas, quinolonas, tetraciclinas, tianfenicol e tilosina) e anti-helmínticos (benzimidazóis, aminobenzimidazóis, levamisol, avermectinas, tiabendazóis, moxidectina e triclabendazóis) em, respectivamente, 70 e 83 amostras de leite cru provenientes de quatro mesorregiões (Triângulo Mineiro/Alto Paranaíba, Central Mineira, Oeste de Minas e Metropolitana de Belo Horizonte) do estado de Minas Gerais. Este estudo demonstrou a presença de quinolonas (2,86por cento), estreptomicinas (2,86por cento) e tetraciclinas (11,43por cento) nas amostras de leite cru analisadas. Ademais, observou-se expressiva porcentagem de amostras de leite cru positivas para os anti-helmínticos amino- benzimidazóis (55,42por cento), levamisol (53,57por cento), avermectinas (60,24por cento), tiabendazóis (67.47por cento), moxidectina (73,49por cento) e triclabendazóis (45,78por cento), e em menor porcentagem os benzimidazóis (6,02por cento). Desta forma, os resultados do presente estudo indicam que os resíduos de antimicrobianos e anti-helmínticos no leite em Minas Gerais devem ser constantemente monitorados pelas autoridades competentes com intuito de oferecer aos consumidores um alimento sem riscos à saúde humana...

Spontaneous regression of low-grade cervical intraepithelial lesions is positively improved by topical bovine colostrum preparations (GINEDIE®). A multicentre, observational, italian pilot study.

OBJECTIVES: Human papillomavirus (HPV) is the causal agent of cervical cancer. The great majority of abnormal Pap test results - almost 90% - is referrable to either atypical squamous intraepithelial lesion or CIN1. For these lesions, worldwide agreement exists concerning the high rate - ranging from 40% to 70% - of spontaneous regression over a period of 1-5 years. Host's immune response is a key point influencing the natural history of these conditions. Bovine colostrum is a natural agent positively promoting several immune activities against bacterial and viral agents. The aim of this report was to evaluate the potential positive effect of bovine colostrum-containing vaginal tablets administered to CIN1 diagnosed patients in a prospective trial in regards to spontaneous regression rate. PATIENTS AND METHODS: A series of 256 consecutive patients with histologically proven CIN1 recruited in a multicentre, observational, Italian study. Patients have been enrolled in a 24-weeks protocol of treatment and re-tested at the end of the study. Rates of regression have been recorded. RESULTS: Overall regression rate to a negative histology at the end of the 6 month follow up was 75.5%. CONCLUSIONS: Regression to normal histology was observed in a very high rate of cases in a very short period compared to the natural history of these lesions. CIN1 patients could benefit from bovine colostrum topical administration in terms of significantly shortening the regression time.

Caseinomacropeptide index in UHT whole milk stored under different conditions of temperature and time / Efeito das condições de armazenamento no índice de caseinomacropeptídeo de amostras de leite integral ultra alta temperatura (UAT)

Caseinomacropeptide (CMP) index is a method used to detect adulteration of milk by addition of cheese whey, since CMP is a glycopeptide characteristic produced during cheesemaking, and soluble in the whey phase. The objective of this work was to evaluate the caseinomacropeptide index of UHT milk stored under different temperatures. Six batches of recently processed UHT milk were collected and stored under three temperatures (21ºC, 6ºC, and -12ºC) and analyzed by HPLC in the day of the milk collection (day 0) and at 30, 60, 90, and 120 days of storage. The experiment was run as a randomized block design with a 3x5 factorial arrangement, and the Student-Newman-Keuls (SNK) method was used as the post-hoc test (p = 0.05). There was a progressive increase of the CMP index during the storage period of 120 days, and this indicates the possibility of false positive results if the CMP index is used as an adulteration test for long term stored UHT milk. The validity of the CMP index as an adulteration indicator is only possible soon after packaging, and sample freezing is the only alternative when immediate analysis is not possible. The method was found to be precise, with robust CV of 1.9% even with high CMP levels.

O objetivo deste trabalho foi avaliar a influência da temperatura e do tempo de armazenamento de amostras de leite UAT, em relação ao índice de caseinomacropeptídeo, por cromatografia líquida de alta eficiência, e a precisão do método de detecção. Seis lotes foram coletados e armazenados em três temperaturas (21ºC, 6ºC e -12ºC ± 1ºC) e analisadas durante o armazenamento nos dias 0, 30, 60, 90 e 120 dias. Utilizou-se o delineamento em blocos casualizados com os tratamentos em arranjo fatorial 3x5 e os resultados foram comparados por meio do teste Student-Newman-Keuls (SNK) a 5% de significância. Houve aumento progressivo do índice de CMP por CLAE durante os 120 dias; portanto, um produto conforme pode se tornar não conforme sem que ocorra adulteração. A detecção de fraude por adição de soro lácteo em leite UAT pode ser detectada somente após o envase. Caso não seja possível a análise imediata, recomenda-se que as amostras sejam congeladas. O método é muito preciso (CV=1,9%) e indiferente aos níveis de CMP encontrados nas amostras.