Effects of polyphenol supplementation on hepatic steatosis, intima-media thickness and non-invasive vascular elastography in obese adolescents: a pilot study protocol.

INTRODUCTION: Non-alcoholic fatty liver disease (NAFLD) is increasingly prevalent in obese adolescents. Increased systemic inflammation and decreased gut microbial diversity linked to obesity affect the liver and are also associated with cardiovascular diseases in adulthood. However, NAFLD and vascular alterations are reversible. METHODS AND ANALYSIS: This pilot study evaluated the feasibility of a prospective open-label randomised controlled trial evaluating the effects of polyphenols on NAFLD and vascular parameters in obese adolescents. Children aged 12-18 years with hepatic steatosis (n=60) will be recruited. The participants will be randomised with a 1:1 allocation ratio to receive polyphenol supplementation one time per day for 8 weeks along with the clinician-prescribed treatment (group B, n=30) or to continue the prescribed treatment without taking any polyphenols (group A, n=30). The outcome measures will be collected from both the groups at day 1 before starting polyphenol supplementation, at day 60 after 8 weeks of supplementation and at day 120, that is, 60 days after supplementation. The changes in hepatic steatosis and vascular parameters will be measured using liver and vascular imaging. Furthermore, anthropometric measures, blood tests and stool samples for gut microbiome analysis will be collected. After evaluating the study's feasibility, we hypothesise that, as a secondary outcome, compared with group A, the adolescents in group B will have improved NAFLD, vascular parameters, systemic inflammation and gut microbiome. ETHICS AND DISSEMINATION: This study is approved by Health Canada and the hospital ethics. Participants and their parents/tutors will both provide consent. Trial results will be communicated to the collaborating gastroenterologists who follow the enrolled participants. Abstracts and scientific articles will be submitted to high-impact radiological societies and journals. CLINICALTRIALS: gov ID: NCT03994029. Health Canada authorisation referral number: 250 811. Protocole version 13, 2 June 2023. TRIAL REGISTRATION NUMBER: NCT03994029.

Design and implementation of a device based on an off-axis parabolic mirror to perform luminescence experiments in a scanning tunneling microscope.

We present the design, implementation, and illustrative results of a light collection/injection strategy based on an off-axis parabolic mirror collector for a low-temperature Scanning Tunneling Microscope (STM). This device allows us to perform STM induced Light Emission (STM-LE) and Cathodoluminescence (STM-CL) experiments and in situ Photoluminescence (PL) and Raman spectroscopy as complementary techniques. Considering the Étendue conservation and using an off-axis parabolic mirror, it is possible to design a light collection and injection system that displays 72% of collection efficiency (considering the hemisphere above the sample surface) while maintaining high spectral resolution and minimizing signal loss. The performance of the STM is tested by atomically resolved images and scanning tunneling spectroscopy results on standard sample surfaces. The capabilities of our system are demonstrated by performing STM-LE on metallic surfaces and two-dimensional semiconducting samples, observing both plasmonic and excitonic emissions. In addition, we carried out in situ PL measurements on semiconducting monolayers and quantum dots and in situ Raman on graphite and hexagonal boron nitride (h-BN) samples. Additionally, STM-CL and PL were obtained on monolayer h-BN gathering luminescence spectra that are typically associated with intragap states related to carbon defects. The results show that the flexible and efficient light injection and collection device based on an off-axis parabolic mirror is a powerful tool to study several types of nanostructures with multiple spectroscopic techniques in correlation with their morphology at the atomic scale and electronic structure.

Peer review of the pesticide risk assessment of the active substance carbon dioxide.

The conclusions of the European Food Safety Authority (EFSA) following the peer review of the initial risk assessments carried out by the competent authorities of the rapporteur Member State, France, and co-rapporteur Member State, Austria, for the pesticide active substance carbon dioxide and the considerations as regards the inclusion of the substance in Annex IV of Regulation (EC) No 396/2005 are reported. The context of the peer review was that required by Commission Implementing Regulation (EU) No 844/2012, as amended by Commission Implementing Regulation (EU) No 2018/1659. The conclusions were reached on the basis of the evaluation of the representative uses of carbon dioxide as an insecticide and acaricide on stored cereal grains, oilseeds, medicinal plants, cereal products, spices, tobacco, tea, dried fruits and other stored plant products (except semolina and oilseed meal) (all indoor uses). The reliable end points, appropriate for use in regulatory risk assessment, are presented.

Non-alcoholic fatty liver disease severity and metabolic complications in obese children: impact of omega-3 fatty acids.

Although n-3 polyunsaturated fatty acids (PUFA) revealed promising therapeutic results in non-alcoholic fatty liver disease (NAFLD), which is considered as the most prevalent cause of chronic hepatic disease, inconsistencies are calling for further confirmatory trials to demonstrate therapeutic efficacy and safety. The study, registered as NCT02201160 on www.clinicaltrials.gov, was designed to compare two groups of NAFLD with a different severity, and to evaluate the efficacy of n-3 PUFA supplementation. Twenty young male participants of French Canadian origin with NAFLD were enrolled and classified into moderate (mNAFLD) and severe (sNAFLD) fatty liver groups, according to transaminase levels, ultrasonography, NAFLD Activity Score and Fatty Liver Index (FLI). The sNAFLD patients were assigned to consume 2 g of n-3 PUFA for 6 months. sNAFLD patients displayed higher insulinemia, insulin resistance (IR), oxidative stress (OxS), systolic blood pressure and the risk lipid indicators of cardiovascular diseases. Supplementation of n-3 PUFA for 6 months resulted in a significant increase in concentrations of eicosapentaenoic and docosahexaenoic acids in red blood cells along with an attenuation of hepatic steatosis as reflected by the reduction of the FLI, ALT and ALT/AST ratio. Moreover, the n-3 PUFA improved the lipid profile and carotid intima-media thickness, while reducing metabolic and OxS markers as well as raising adiponectin. In conclusion, NAFLD severity was essentially related to IR. Treatment with n-3 PUFA has an evidently beneficial effect on liver steatosis and related metabolic abnormalities. Furthermore, the cross association of omega-3 index with cardiometabolic markers may serve as a predictor for cardiovascular risk disorders in NAFLD.

Management of cirrhotic ascites in children. Review and recommendations. Part 1: Pathophysiology, diagnostic evaluation, hospitalization criteria, treatment, nutritional management. / Manejo de la ascitis secundaria a cirrosis en el paciente pediátrico. Revisión y recomendaciones. Parte 1: Fisiopatología, evaluación diagnóstica, criterios de hospitalización, tratamiento, manejo nutricional.

Ascites is a major complication of cirrhosis. There are several evidence-based articles and guidelines for the management of adults, but few data have been published in relation to children. In the case of pediatric patients with cirrhotic ascites (PPCA), the following questions are raised: How are the clinical assessment and ancillary tests performed? When is ascites considered refractory? How is it treated? Should fresh plasma and platelets be infused before abdominal paracentesis to prevent bleeding? What are the hospitalization criteria? What are the indicated treatments? What complications can patients develop? When and how should hyponatremia be treated? What are the diagnostic criteria for spontaneous bacterial peritonitis? How is it treated? What is hepatorenal syndrome? How is it treated? When should albumin be infused? When should fluid intake be restricted? The recommendations made here are based on pathophysiology and suggest the preferred approach to its diagnostic and therapeutic aspects, and preventive care.

La ascitis es una complicación grave de la cirrosis. Existen numerosos artículos y guías basadas en la evidencia para adultos, pero poco se ha publicado para niños. Ante un paciente pediátrico con ascitis secundaria a cirrosis (PPAC), se plantean las siguientes preguntas: ¿Cómo se realiza la evaluación clínica y los exámenes complementarios? ¿Cuándo se considera que la ascitis es refractaria; cómo se trata? ¿Debe infundirse plasma fresco y plaquetas antes de la paracentesis abdominal para evitar el sangrado? ¿Cuáles son los criterios de hospitalización? ¿Cuáles son los tratamientos indicados? ¿Qué complicaciones puede presentar? ¿Cuándo y cómo debe tratarse la hiponatremia? ¿Qué criterios diagnósticos tiene la peritonitis bacteriana espontánea; cómo se trata? ¿Qué es el síndrome hepatorrenal; cómo se trata? ¿Cuándo debe infundirse albúmina? ¿Cuándo debe restringirse el aporte líquido? Las recomendaciones que efectuamos, basadas en la fisiopatología, sugieren el enfoque preferido para encarar sus aspectos diagnósticos, terapéuticos y los cuidados preventivos.

Evaluación de los resultados antes y después de la implantación del Código Sepsis en Aragón / Before-after study of the effect of implementing a sepsis code for emergency departments in the community of Aragon

Objetivo. Estudiar el grado de cumplimiento del grupo de medidas de la Campaña Sobrevivir a la Sepsis (CSS) y su efecto en la mortalidad a corto plazo y tras la implantación de un código sepsis (CS) en Aragón. Método. Estudio cuasiexperimental que comparó dos cohortes antes (grupo pre-CS) y después (grupo pos-CS) de la implantación de un CS. Se seleccionaron retrospectivamente, a través de un registro administrativo, los episodios correspondientes a procesos infecciosos o con disfunción orgánica entre diciembre de 2012 y enero de 2013 (pre-CS) y entre diciembre de 2014 y enero de 2015 (pos-CS). El CS consistió en la activación electrónica desde triaje a partir de parámetros clínicos alterados, la definición de rutas de atención específica y la formación basada desde el triaje en la CSS. Las variables de resultado fueron porcentaje de cumplimiento del grupo de medidas de las CSS en las tres primeras horas desde la llegada a urgencias, mortalidad intrahospitalaria y a los 30 días. Resultados. Se incluyeron 222 pacientes en cada grupo. El porcentaje de cumplimiento fue mayor tras la implantación del CS respecto la aplicación del antibiótico en la primera hora (p = 0,100), la extracción de hemocultivos (p < 0,001), la determinación del ácido láctico (p < 0,001) y la aplicación de volumen aplicado/indicado (p < 0,001). La mortalidad intrahospitalaria fue de 31,1% en el grupo pre-CS y de 20,7% en el grupo pos-CS (p = 0,016) y la mortalidad a los 30 días fue de 30,1% en el grupo pre-CS y de 19,8% en el grupo pos-CS (p = 0,016). Conclusiones. La implantación de un CS ha mostrado una mejora en la aplicación de las medidas recomendadas y en la supervivencia a corto plazo (AU)

Objectives. To study the effect of an emergency department sepsis code on the degree of compliance with measures recommended by the Surviving Sepsis Campaign and short-term mortality in the Spanish Autonomous Community of Aragon. Material and methods. Quasi-experimental study of 2 case cohorts, one including of cases before implementation of the sepsis code and one included cases managed afterwards. We extracted retrospectively data from hospital records for infectious processes and organ failures between December 2012 and January 2013 for the pre-code group and between December 2014 and January 2015 for the post-code group. Staff training sessions on the campaign recommendations were provided and the code, which specified clinical pathways, was activated electronically on inputting clinical variables at the moment of triage. Outcome measures were the percentage of compliance with the campaign’s recommendations in the first 3 hours after a patient’s arrival at the emergency department in-hospital mortality, and 30-day mortality. Results. A total of 222 cases were included in each group. Compliance with the following campaign recommendations improved after implementation of the sepsis code: antibiotic therapy in the first hour (P=.100), extractions for blood cultures (P<.001), lactic acid measurement (P<.001), and recommended fluid loading (P<.001). In-hospital mortality was 31.1% in the pre-code cohort and 20.7% post-code; 30-day mortality rates were 30.1% and 19.8%, respectively (P=.016, all comparisons). Conclusion. Use of a sepsis code led to short-term improvement in how often the measures recommended by a sepsis survival campaign were put into practice (AU)

[Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice]. / Adaptación española de las guías europeas de 2016 sobre prevención de la enfermedad cardiovascular en la práctica clínica.

The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.

[Spanish Adaptation of the 2016 European Guidelines on Cardiovascular Disease Prevention in Clinical Practice]. / Adaptación española de las guías europeas de 2016 sobre prevención de la enfermedad cardiovascular en la práctica clínica.

The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than 10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.

Usefulness of percutaneous elastography by acoustic radiation force impulse for the non-invasive diagnosis of chronic pancreatitis.

OBJECTIVE: To determine the accuracy of the acoustic radiation force impulse (ARFI) technique for the diagnosis of chronic pancreatitis. MATERIALS AND METHODS: We present an observational, single-center study that included patients with suspected chronic pancreatitis in the period between October 2012 and September 2015 who underwent endoscopic ultrasound (EUS) and were classified according to the standard and Rosemont criteria. The same group of patients was assessed by the ARFI technology using ACUSON S2000™ equipment with Virtual Touch™ Quantification software for the assessment of pancreatic stiffness by obtaining the shear wave velocity (SWV) in the head, body and tail of the pancreas. Data were analyzed using ANOVA and nonparametric correlation methods. Diagnostic accuracy was obtained by analyzing receiver operating characteristic (ROC) curve. RESULTS: A total of thirty-three patients were studied (45.5% women); mean age was 58.3 ± 11.8 years. Seventeen with a diagnosis of chronic pancreatitis and sixteen classified as normal according to standard criteria. A significant difference was detected between the means of SWV in pancreatic body of patients without (SWV: 1.27 m/s) and with chronic pancreatitis (SWV 1.57 m/s), p = 0.037. The area under the ROC curve was 71.3% (95% CI 0.532-0.895) and the accuracy of ARFI for diagnosing chronic pancreatitis was 69.7% for a SWV of 1.4 m/s in the pancreatic body. The SWV means in head (r = 0.421, p < 0.05) and body (r = 0.455, p < 0.05) of the pancreas showed a significant correlation with the number of EUS criteria for chronic pancreatitis. CONCLUSION: Quantification of pancreatic stiffness with ARFI elastography technique has proven to be useful for the non-invasive diagnosis of chronic pancreatitis.

Photooxidation of parenteral multivitamins induces hepatic steatosis in a neonatal guinea pig model of intravenous nutrition.

Photooxidation of multivitamin solutions results in the generation of peroxides. Because peroxides are associated with hepatic steatosis and fibrosis as well as cholestasis, we questioned whether multivitamins are implicated in hepatic complications of parenteral nutrition. Guinea pig pups were assigned to groups receiving intravenously either total parenteral nutrition, photo-protected or not, or a control solution (5% dextrose + 0.45% NaCl) supplemented with either a) multivitamins; b) photo-protected multivitamins; c) multivitamins without riboflavin; or d) peroxides (H(2)O(2), tert-butylhydroperoxide). After 4 d, liver was sampled for histology and isoprostane-F(2alpha) levels, a marker of radical attack. Multivitamins as well as total parenteral nutrition were associated with steatosis (scored 0-4), the severity of which was reduced (p < 0.05) by photo protection. Although H(2)O(2) is the major peroxide contaminating multivitamins, it did not induce steatosis scores different than the controls. Compared with controls, hepatic isoprostane-F(2alpha) content increased in animals infused with H(2)O(2) (p < 0.05), but not in those infused with Multi-12 pediatric multivitamins or total parenteral nutrition. Results suggest that peroxides and/or free radicals are not mediators of the induction of steatosis observed with infusion of photo-exposed multivitamins, as there was no correspondence between histologic findings and hepatic levels of isoprostanes. It is suspected that a component of the multivitamin solution becomes hepato-toxic after photo-exposure, as indicated by the protective effect observed when withdrawing riboflavin. Photo-oxidation of multivitamins might be the common link between reports involving amino acids, lipids, and light exposure in the ethiology of hepatic complications of parenteral nutrition.

Experiencia latinoaméricana con nimodipina en el tratamiento de la demencia degenerativa primaria y demencia multinfarto / Experience in latin american with nimodipine in the treatment of patients with primary degenerative dementia and vascular demencia due to multi-infort

El objetivo de este estudio fue evaluar la eficacia y seguridad de la nimodipina en pacientes con demencia degenerativa primaria tipo Alzheimer (PDD-AD) y demencia vascular debido a infartos múltiples (MID). Este fue el primer estudio abierto latinoamericano, multinacional multicéntrico, con un período de duración de 12 semanas. El seguimiento incluyó una evaluación basal y luego cada cuatro semanas, con una serie de pruebas tanto cognitivas (Mini Mental State Examination (MMSE) y Trail Marking Test (TMT-A), como escalas de comportamiento y funcionalidad (Sandoz Clinical Assesment Geriatric Scale (SSCAG) y Assessment of Geriatric Symtoms (RAGS-E)

Síndrome colestático neonatal: perspectiva y manejo médico-quirúrgico / Neonatal cholestasis. A review of the surgical treatment

El síndrome colestático neonatal obedece a múltiples causas, muchas de las cuales son aún desconocidas; el diagnóstico diferencial suele realizarse en mucho tiempo, lo cual repercute negativamente en la evolución y el pronóstico del lactante con ictericia obstructiva susceptible de corrección quirúrgica. La responsabilidad de agilizar su envío a los servicios quirúrgicos y/o continuar su estudio en el menor tiempo posible, reside en el pediatra clínico. En esta revisión se señalan las causas más frecuentes de colestasis neonatal que requieren tratamiento quirúrgico temprano, se sugiere una estrategia de toma de decisiones rápida para mejorar los resultados a corto y mediano plazo, con las técnicas actuales de tratamiento

Common airborne allergens and their clinical relevancein the Caracas valley / Aeroalergenos mas comunes del valle de Caracas y su relevancia clínica

In orden to determine the sequential prevalence of pollen grains and fungi spores in the city of Caracas by the volumetric method of collection and its on the population at risk. The first multidisciplinary team of aerobiological research was structured through a protocol designed for five experimental stages namely: a) Determination of the climatological parameters, relative humidity, speed and wind direction, precipitation and atmospheric stability, through simultaneous records of meteorological status located in the metropolitan area of Caracas: b) Collection, identification, classification and determination of the local distribution of the important pollen grains existing in the zone under study: c) Collection, identification and classification of the most important fungi spores in the area; d) Preparation of the first pollinic calendar of Caracas and e) Evaluation of possible implication of the environment and the response through the IgE antibody in the selected patients in the area under study. Our results show: 1) The climatic conditions existing during the sampling period coincide with the analysis of the last 20 years in the Valley of Caracas. 2) The Venezuelan Central University (UCV) station was elected as the most representative point for permanent sampling. 3) An ideal statistical method is obtained in order to determine the spatial arrangement in the sampler rod of a dense type of spores typical of the area under study. 4) The firdt pollinic calendar of Caracas was structured and 5) A seasonal tendency of the IgE response is shown. These results suggested concept of poliseasonality and antigenic polysensitization, and between individual seasonality with a specific reactivity and, finally, between tropical mixed seasonality with the expression of combined respiratory pathologies in our environment