Does Enzymatic Debridement Allow Us To Perform Conservative Treatment On Clinically Deep Hand Burns? A Retrospective Review.

The hands are one of the main locations of burns. In deep second-degree and third-degree burns, the gold standard of treatment is surgical debridement and subsequent coverage, which can result in suboptimal aesthetic and functional results. The aim of our study is to assess whether treatment by initial enzymatic debridement (NexoBrid®) of deep second-degree and third-degree burns prevents the need for surgery. We carried out a retrospective study of 53 hands with deep burns treated in our centre from May 2015 to December 2016. Two experts evaluated the initial photographs of the burns and classified them as surgical or nonsurgical (interobserver kappa index = 0.83). These assessments were compared with the actual need for surgery on each hand. Sixteen of the 32 (50%) hands that the experts considered surgical spontaneously epithelialized. Four of the 17 hands (23.5%) that were not considered surgical required a split-thickness skin graft for healing. Enzymatic debridement helps to preserve viable tissue, which reduces the number and extension of surgical interventions, thus favouring better results.

Les mains sont une des principales localisations de brûlures. Dans les brûlures du 2e degré profond et du 3e degré, le traitement de référence est l'excision chirurgicale suivie d'un geste de couverture, et donne des résultats fonctionnels ou esthétiques pas toujours parfaits. Le but de notre étude est d'évaluer si le débridement enzymatique (NexoBrid®) des brûlures du 2e degré profond et du 3e degré permet d'éviter les gestes chirurgicaux. Nous avons mené une étude rétrospective sur 53 mains présentant des brûlures profondes traitées dans notre centre entre mai 2004 et décembre 2016. Deux experts ont évalué les photographies initiales et classé les brûlures en « chirurgicales ¼ ou « non chirurgicales ¼ (coefficient Kappa inter-opérateur = 0,83). Ces évaluations ont été comparées à la nécessité réelle de prise en charge chirurgicale pour chacune des mains. 16 des 32 mains (50%) que les experts avaient jugées « chirurgicales ¼ ont cicatrisé spontanément. 4 des 17 mains (23,5%) qui ont été considérée comme « non chirurgicales ¼ ont nécessité une greffe de peau mince pour obtenir la cicatrisation. Le débridement enzymatique permet de conserver les tissus viables, ce qui diminue le nombre et l'importance des gestes chirurgicaux, et donc favorise l'obtention de meilleurs résultats.

Biorefineries based on coffee cut-stems and sugarcane bagasse: furan-based compounds and alkanes as interesting products.

This work presents a techno-economic and environmental assessment for a biorefinery based on sugarcane bagasse (SCB), and coffee cut-stems (CCS). Five scenarios were evaluated at different levels, conversion pathways, feedstock distribution, and technologies to produce ethanol, octane, nonane, furfural, and hydroxymethylfurfural (HMF). These scenarios were compared between each other according to raw material, economic, and environmental characteristics. A single objective function combining the Net Present Value and the Potential Environmental Impact was used through the Analytic Hierarchy Process approach to understand and select the best configurations for SCB and CCS cases. The results showed that the configuration with the best economic and environmental performance for SCB and CCS is the one that considers ethanol, furfural, and octane production (scenario 1). The global economic margin was 62.3% and 61.6% for SCB and CCS respectively. The results have shown the potential of these types of biomass to produce fuels and platform products.

Relevance of dietary glycerophospholipids and sphingolipids to human health.

Glycerophospholipids and sphingolipids participate in a variety of indispensable metabolic, neurological, and intracellular signaling processes. In this didactic paper we review the biological roles of phospholipids and try to unravel the precise nature of their putative healthful activities. We conclude that the biological actions of phospholipids activities potentially be nutraceutically exploited in the adjunct therapy of widely diffused pathologies such as neurodegeneration or the metabolic syndrome. As phospholipids can be recovered from inexpensive sources such as food processing by-products, ad-hoc investigation is warranted.

Effect of aracnotoxin from Latrodectus mactans on bovine sperm function: modulatory action of bovine oviduct cells and their secretions.

Latrodectus mactans' aracnotoxin (Atx) induces changes in sperm function that could be used as a co-adjuvant in male contraceptive barrier methods. This effect includes the suppression of intracellular reactive oxygen species (ROS), an event necessary for capacitation, chemotaxis and acrosome reaction (AR). The sperm that are not trapped by the barrier method can reach the oviduct before fertilisation and be exposed to the secretions of the oviducts. This study evaluated the effect of bovine tubal explants (TU) and conditioned media (CM) from the ampullar and isthmal regions on spermatozoa exposed to Atx. Thawed bovine sperm were incubated with Atx, TU and CM from the ampullar and isthmal regions for 4 h and then DNA integrity, intracellular ROS and lysophosphatidylcholine-induced AR were determined. Spermatozoa exposed to Atx and co-incubated with TU and CM for 4 h produced an increase in sperm DNA damage, a decrease in ROS production and a decrease in %AR, compared with the control. A similar result was obtained from the co-incubation of spermatozoa with Atx. In conclusion, the effect of Atx is not modified by tubal cells or their secretions and this opens the door to future studies to evaluate the application of synthetic peptides obtained from Atx as a co-adjuvant of contraceptive barrier methods.

Estudio transversal sobre la prevalencia de la Enfermedad Metabólica Ósea(EMO) y Nutrición Parenteral Domiciliaria (NPD) en España: datos del Grupo NADYA / Transversal study on the Prevalence of Metabolic Bone Disease (mbd) and Home Parenteral Nutrition (hpn) in Spain: Data from NADYA Group

Los pacientes con insuficiencia intestinal que reciben NPD presentan un elevado riesgo de presentar EMO. El origen de esta afectación ósea es multifactorial y depende en gran parte de la enfermedad de base que origina la necesidaddel soporte. En nuestro medio no disponemos de datos acerca de la prevalencia de esta enfermedad, por lo que elgrupo NADYA-SENPE ha patrocinado este estudio transversal para intentar conocer la prevalencia de la EMO. Material y métodos: Se han recogido datos retrospectivos de 51 pacientes pertenecientes a 13 hospitales. La encuesta realizada incluía datos demográficos y los datos clínicos más relevantes que pudieran influir en la apariciónde EMO. También se han registrados los datos analíticosmás significativos para este proceso (calciuria, PTH,25 OH vitamina D) y los resultados de la primera y la última densitometría realizadas. Resultados: Solamente 21 pacientes tenían realizada una densitometría en el momento de iniciar la NPD. La calidad del hueso está alterada al inicio de la NPD en un porcentaje significativo de casos (52%) Tras un seguimiento medio de 6 años ese porcentaje se eleva hasta el 81%. Dado el carácter retrospectivo del estudio y el escaso número de sujetos no esposible determinar el papel que juega la NPD en la etiología de la EMO. Sólo un 35% de los pacientes presentan niveles de vitamina D por encima de los niveles recomendados y la mayoría de ellos no recibe suplementación específica. Conclusiones: La NPD se asocia a un riesgo muy elevado de presentar EMO, por tanto es necesario disponer de protocolos de actuación que permitan detectar precozmente este problema y orientar el seguimiento y tratamiento de estos pacientes (AU)

Patients with intestinal failure who receive HPN are at high risk of developing MBD. The origin of this bonealteration is multifactorial and depends greatly on theunderlying disease for which the nutritional support is required. Data on the prevalence of this disease in our environment is lacking, so NADYA-SEMPE group has sponsored this transversal study with the aim of knowing the actual MBD prevalence.Material and methods: Retrospective data from 51 patients from 13 hospitals were collected. The questionnaire included demographic data as well as the most clinically relevant for MBD data. Laboratory data (calciuria,PTH, 25 -OH -vitamin D) and the results from the first and last bone densitometry were also registered. Results: Bone mineral density had only been assessed by densitometry in 21 patients at the moment HPN was started. Bone quality is already altered before HPN in a significant percentage of cases (52%). After a mean follow up of 6 years, this percentage increases up to 81%. Due toretrospective nature of the study and the low number of subjects included it has not been possible to determine the role that HPN plays in MBD etiology. Only 35% of patients have vitamin D levels above the recommended limits and the majority of them is not on specific supplementation. Conclusions: HPN is associated with very high risk ofMBD, therefore, management protocols that can lead toearly detection of the problem as well as guiding for followup and treatment of these patients are needed (AU)

Chemical composition and antiradical activity of the essential oil from Satureja intricata, S. obovata and their hybrid Satureja x delpozoi.

Satureja x delpozoi is a hybrid found in south-eastern Spain, in a population in which both parents S. intrincata and S. obovata are found together. This work presents for the first time the volatile profile and antioxidant activity of the essential oils of this hybrid. The volatile profile of the essential oils from S. x delpozoi underlines the hybrid character of these plants since the p-cymene, gamma-terpinene, camphor and thymol concentrations in hybrid 1, and the same components, along with alpha-terpineol concentrations in hybrid 2, showed intermediate values with respect to the values observed in the parents. As regards the antioxidant capacity, the phenolic content of S. intrincata resulted in its essential oil having the greatest activity against the DPPH* and ABTS*+ radicals. Both hybrids showed low activity against these radicals, although S. obovata showed none. On the bases of their essential oil composition and antioxidant capacity, these results corroborate the hybrid character of these two S. x delpozoi plants.

[Transversal study on the prevalence of Metabolic Bone Disease (MBD) and Home Parenteral Nutrition (HPN) in Spain: data from NADYA group]. / Estudio transversal sobre la prevalencia de la Enfermedad Metabólica Ósea (EMO) y Nutrición Parenteral Domiciliaria (NPD) en España: datos del Grupo NADYA.

UNLABELLED: Patients with intestinal failure who receive HPN are at high risk of developing MBD. The origin of this bone alteration is multifactorial and depends greatly on the underlying disease for which the nutritional support is required. Data on the prevalence of this disease in our environment is lacking, so NADYA-SEMPE group has sponsored this transversal study with the aim of knowing the actual MBD prevalence. MATERIAL AND METHODS: Retrospective data from 51 patients from 13 hospitals were collected. The questionnaire included demographic data as well as the most clinically relevant for MBD data. Laboratory data (calciuria, PTH, 25 -OH -vitamin D) and the results from the first and last bone densitometry were also registered. RESULTS: Bone mineral density had only been assessed by densitometry in 21 patients at the moment HPN was started. Bone quality is already altered before HPN in a significant percentage of cases (52%). After a mean follow up of 6 years, this percentage increases up to 81%. Due to retrospective nature of the study and the low number of subjects included it has not been possible to determine the role that HPN plays in MBD etiology. Only 35% of patients have vitamin D levels above the recommended limits and the majority of them is not on specific supplementation. CONCLUSIONS: HPN is associated with very high risk of MBD, therefore, management protocols that can lead to early detection of the problem as well as guiding for follow up and treatment of these patients are needed.

The phylogeographical history of the Iberian steppe plant Ferula loscosii (Apiaceae): a test of the abundant-centre hypothesis.

The geology and climate of the western Mediterranean area were strongly modified during the Late Tertiary and the Quaternary. These geological and climatic events are thought to have induced changes in the population histories of plants in the Iberian Peninsula. However, fine-scale genetic spatial architecture across western Mediterranean steppe plant refugia has rarely been investigated. A population genetic analysis of amplified fragment length polymorphism variation was conducted on present-day, relict populations of Ferula loscosii (Apiaceae). This species exhibits high individual/population numbers in the middle Ebro river valley and, according to the hypothesis of an abundant-centre distribution, these northern populations might represent a long-standing/ancestral distribution centre. However, our results suggest that the decimated southern and central Iberian populations are more variable and structured than the northeastern ones, representing the likely vestiges of an ancestral distribution centre of the species. Phylogeographical analysis suggests that F. loscosii likely originated in southern Spain and then migrated towards the central and northeastern ranges, further supporting a Late Miocene southern-bound Mediterranean migratory way for its oriental steppe ancestors. In addition, different glacial-induced conditions affected the southern and northern steppe Iberian refugia during the Quaternary. The contrasting genetic homogeneity of the Ebro valley range populations compared to the southern Iberian ones possibly reflects more severe bottlenecks and subsequent genetic drift experienced by populations of the northern Iberia refugium during the Pleistocene, followed by successful postglacial expansion from only a few founder plants.

Chronic effects of a high-fat diet enriched with virgin olive oil and a low-fat diet enriched with alpha-linolenic acid on postprandial endothelial function in healthy men.

Traditional cardiovascular risk factors are associated with endothelial dysfunction. The vascular endothelium plays a key role in local vascular tone regulation and can be modulated by dietary fat. We propose to determine the chronic effect of three diets with different fat compositions on postprandial endothelial function and inflammatory biomarkers. Twenty healthy men followed three 4-week diets in a randomised cross-over design: a Western diet, rich in saturated fat (22% SFA, 12% MUFA and 0.4% alpha-linolenic acid (ALA), all fractions are % of energy); a Mediterranean diet, rich in MUFA ( < 10 % SFA, 24 % MUFA and 0.4% ALA); a low-fat diet enriched in ALA ( < 10% SFA, 12% MUFA and 2% ALA). At the end of each dietary period all subjects underwent a postprandial study. Plasma concentrations of lipid parameters, soluble intercellular cell-adhesion molecule-1, soluble vascular cell-adhesion molecule-1 (sVCAM-1), nitrates and nitrites (NOx) and endothelial function studied by laser Doppler were examined at 0, 2, 4, 6 and 8 h. The endothelium-dependent vasodilatory response was greater 4 h after the ingestion of the MUFA-rich diet than after the SFA or ALA low-fat diets (P = 0.031). The 4 h postprandial plasma sVCAM-1 levels were lower after the MUFA meals than after the ALA low-fat diet (P = 0.043). The bioavailability of NOx was higher following the MUFA diet than after the SFA and ALA low-fat diets (P = 0.027). We found no differences in the other parameters measured. Chronic ingestion of a Mediterranean diet avoids the postprandial deterioration of endothelial function associated with Westernised diets in healthy individuals.

Fluorouracil-based chemotherapy in patients with gastrointestinal malignancies: influence of nutritional folate status on toxicity.

This study aimed to prospectively evaluate the potential influence of folate status on the toxicity induced by 5-fluorouracil (5-FU)-based chemotherapy in patients with gastrointestinal tumors. 105 patients with colorectal, pancreatic or gastric cancer were entered into the study. Treatment regimens consisted of bolus 5-FU/leucovorin or infusional 5-FU combined with cisplatin. Baseline homocysteine, vitamin B(12) and folic acid serum levels were determined in all patients. Univariate and multivariate logistic regression models were used to identify predictive factors for toxicity. Univariate analysis showed a significant association between older age, low BSA, gastric/pancreatic cancer and treatment with 5-FU/cisplatin and the incidence of grade 3-4 hematological toxicity, and between female sex, low BSA and gastric/pancreatic cancer and the incidence of severe non-hematological toxicity. Variables that retained independent prognostic value in the multivariate model were tumor type, chemotherapy schedule and BSA for both hematological and non-hematological toxicities. Baseline homocysteine, vitamin B(12) or folate status were not significant predictors of any kind of toxicity either according to univariate or multivariate analysis. This study failed to demonstrate a significant association between a patient s nutritional folate status and the toxicity induced by fluoropyrimidine-based chemotherapy in a cohort of patients with various gastrointestinal malignancies.

La determinación peroperatoria de PTHi como factor predictivo de curación en el hiperparatiroidismo / Intraoperative intact parathyroid hormone determination as a predictive factor of hyperparathyroidism resolution

Introducción. Nuestros objetivos son valorar la eficacia de la determinación peroperatoria de la hormona paratiroidea intacta (PTHi) como marcador de curación del hiperparatiroidismo (HPT), establecer el número mínimo de muestras sanguíneas necesarias y comprobar si la manipulación cervical eleva la PTHi basal. Pacientes y método. Estudio prospectivo realizado con 45 pacientes. Peroperatoriamente se hicieron 3 determinaciones sanguíneas de PTHi: basal y a los 10 y 25 min de extirpar la lesión. Para analizar los efectos de la manipulación cervical, en 19 pacientes, se hicieron otras 2 determinaciones tras 2 min de masaje en ambos lados del cuello. Se aceptó como criterio diagnóstico y terapéutico el descenso > 50% del valor de PTHi entre las muestras postexeréticas y la basal (gradiente > 50) y como criterio de curación la normalización de la calcemia. Resultados. Siempre que se extirpó la causa del HPT hubo descensos de PTHi a los 10 y 25 min de la exéresis. Este descenso tuvo valor predictivo de curación cuando el gradiente fue > 50. La manipulación cervical (masaje) no produjo elevación de la cifra de PTHi. En los casos curados, también se normalizaron las cifras de la calcemia. Conclusiones. La determinación intraoperatoria de PTHi, con gradiente > 50, es un excelente indicador de curación. Sólo se precisan 2 muestras de PTHi: la basal y la extraída a los 10 min de la exéresis. La manipulación cervical preoperatoria no produjo elevación de los valores de PTHi (AU)

Introduction. The objectives of this study were: a) to evaluate the effectiveness of intraoperative intact parathyroid hormone (PTHi) determination as a marker of hyperparathyroidism resolution; b) to establish the minimum number of blood samples required; and c) to determine whether cervical manipulation increases baseline PTHi levels. Patients and method. We performed a prospective study in 45 patients. Three intraoperative blood PTHi determinations were performed: at baseline and at 10 and 25 minutes after excising the lesion. To analyze the effects of cervical manipulation, in 19 patients, 2 further determinations were made after 2 minutes of massage on both sides of the neck. A decrease of > 50% in PTHi values between postexeresis samples and the baseline sample (gradient > 50%) was used as diagnostic and therapeutic criteria and normalization of calcemia was used as a criteria for complete resolution. Results. Whenever the lesion causing hyperparathyroidism was extirpated, PTHi levels decreased at 10 and 25 minutes after exeresis. This decrease was predictive of complete resolution when the gradient was > 50. Cervical manipulation (massage) did not increase PTHi values. In patients with complete resolution, blood calcium levels also returned to normal. Conclusions. 1. Intraoperative PTHi determination with a gradient > 50 is an excellent prognostic marker of resolution. 2. Only 2 PTHi samples are required: one at baseline and another at 10 minutes after exeresis. 3. Preoperative cervical manipulation does not increase PTHi values (AU)

Pólenes alergénicos y polinosis en la ciudad de Burgos / Allergenic pollens and pollinosis in the city of Burgos

El objetivo de este estudio ha sido conocer cuáles son los pólenes que con más probabilidad producen polinosis en el área de la ciudad de Burgos. Método: Para ello se realizaron recuentos de pólenes con un colector Burkard, situado en la terraza del hospital General Yagüe. Se analizaron los taxones cuya media fuera superior al 1% del total de los años 1997, 1998 y del 2001 al 2004. Dentro de un estudio multicéntrico del Comité de Aerobiología de la SEAIC para el estudio de la polinosis, se seleccionaron 147 pacientes de ambos sexos, con clínica de rinitis, asma o ambas estacionales, residentes en nuestra área y con pruebas positivas frente a pólenes. Según el método de estudio se realizaron pruebas cutáneas por la técnica del prick con una batería de 25 pólenes. Resultados: Los pólenes alergénicos más frecuentemente encontrados en la atmósfera de Burgos fueron: cupresáceas (38,87%), especies de Quercus (14,51%), gramíneas (13,58%), especies de Pinus (10%), especies de Urtica (4,74%), especies de Platanus (3,49%), especies de Plantago (3,32%), Populus (2,26%), Olea (2,20%) y chenopoidaceas-amarantaceas (1,26%). Comparado con los pólenes anteriores, los resultados de las pruebas del prick en orden de prevalencia fue: gramíneas (91%), Plantago lanceolata (42,86%), Olea europaea (36,05%), Chenopodium album (26,53%), Urtica dioica (24,49%), Platanus hispanica (21,77%), Cupressus arizonica (19,05%) y Quercus ilex (18,37%). Como se observa en nuestros resultados, la sensibilización frente al polen de las gramíneas es la causa principal de polinosis en nuestro medio

The aim of the study was to know the main pollens with a higher probability of inducing pollinosis in the city of Burgos. Methods: For this purpose, pollen levels were measured by a Burkard collector situated in the terrace of the General Yagüe’s Hospital. Taxons with a mean above 1% of total during 1997, 1998 and 2001-2004 were analyzed. As part of a multicentric study from the SEAIC’s Aerobiology Committee for the study of pollinosis, 147 patients of both sexes with symptoms of seasonal rhinitis and/or asthma, resident in our area and with positive tests to pollens were selected. According to the study’s methodology, prick tests were performed with a panel of 25 pollens. Results: The allergenic pollens more prevalent in the atmosphere of Burgos were: cuppressus (38.87%), Quercus spp (14.51%), grasses (13.58%), Pinus spp (10%), Urtica spp (4.74%), Platanus spp (3.49%), Plantago spp (3.32%), Populus (2.26%), Olea (2.20%) y Chenopoidaceae- Amarantaceae (1.26%). Comparing with previous pollens, the results of prick tests were in order of prevalence: grass (91%), Plantago lanceolata (42.86%), Olea europaea (36.05%), Chenopodium album (26.53%), Urtica dioica (24.49%), Platanus hispanica (21.77%), Cupressus arizonica (19.05%) and Quercus ilex (18.37%). As we can infer from our results, sensitization to grass pollens constitutes the major cause of pollinosis en our area

Long-term results of high-dose chemotherapy and autologous stem cell rescue for high-risk neuroblastoma patients: a report of the Spanish working party for BMT in children (Getmon).

The authors retrospectively analyzed the long-term outcome of 67 patients over 1 year of age at diagnosis with high-risk neuroblastoma (stage 4 or stage 3 with N-myc amplification) who were treated with megatherapy and stem cell rescue from 1984 to 1998. Median age at transplant was 4 years (range 1.6-15 years). The source of cells was peripheral stem cells in 29 and bone marrow in 38 patients. In 12 patients, an in vitro purging of bone marrow harvest was performed. Most patients were conditioned with melphalan, BCNU, and VM-26. After transplant 19 patients received complementary treatment with IL-2 (16) or 13-cis-retinoic acid (3). Six patients (8%) died from transplant-related toxicity and 39 from disease progression. Three patients were alive with active disease at the time of analysis. Nineteen patients are alive and disease-free at a median follow-up of 104 months. Five-year event-free survival is 0.30. Survival of patients who received a purged graft was not significantly better than the rest. Post-transplant complementary treatment significantly improved overall and event-free survival (p = .01 and p = .04, respectively).

Effects of taurine on polymorphonuclear phagocytosis activity in burned patients.

This study determines the effects of taurine (Tau) on phagocytosis of polymorphonuclear neutrophils (PMN) isolated from normal subjects (n = 41) and severely burned patients (n = 20). Phagocytosis was measured by nitroblue of tetrazolium (NBT) reduction in samples with and without latex bead stimulation. Taurine was added at doses of 0.2, 0.4, 0.8 and 1.6 mM to stimulated samples. In control cells there were statistically significant increases in phagocytosis after addition of Tau 0.8 mM and 1.6 mM to as compared to samples without Tau addition (295 +/- 23% and 330 +/- 35% vs. 248 +/- 18%; mean +/- S.E.; p < 0.05). A statistically significant increase in phagocytosis was observed in cells from the burned population after addition of Tau 1.6 mM (288 +/- 38% vs. 198 +/- 13%; mean +/- S.E.; p < 0.05). No changes in phagocytosis were found in cells from a subgroup of burn patients (n = 13) followed over 7, 15 and 21 days. These results indicate that taurine supplementation in vitro at doses of 0.8 to 1.6 mM improves the phagocytic capacity of neutrophils in healthy subjects and in patients with severe burn injury, mainly when neutrophil function is unaltered.

Comparison of an oleic acid enriched-diet vs NCEP-I diet on LDL susceptibility to oxidative modifications.

OBJECTIVE: The objective of this trial was to compare the effect on the susceptibility of plasma Low Density Lipoprotein (LDL) to oxidative modifications of consumption of two oleic rich diets, prepared with two different plant oils, virgin olive oil (OL)1 and refined high monounsaturated fatty acids (MUFA sunflower oil (SU)), with the susceptibility of plasma LDL to oxidation after an National Cholesterol Education Program step 1 (NCEP-I) phase diet. DESIGN: A randomized crossover design. SUBJECTS AND INTERVENTIONS: Twenty-two healthy normolipidemic young males consumed an NCEP-I diet for a 4-week period. Subjects were then assigned to two diets each of 4-weeks duration. Group one was placed on an olive oil enriched diet (40% fat, 22% MUFA) followed by a 4-week period of a MUFA diet enriched in sunflower oil (40% fat, 22% MUFA). In group two, the order of the diets was reversed. RESULTS: Both MUFA diets induced a decrease in saturated (14:0, 16:0, and 18:0) and an increase in monounsaturated and polyunsaturated n-6 (18:2, 20:3, and 20:5) plasma LDL-phospholipid fatty acids, compared to the NCEP-I diet (P<0.01). No significant differences in lag times were observed between the olive oil and the NCEP-I diet periods. However there was a greater inhibition time (P<0.001) when subjects consumed the MUFA rich sunflower oil diet compared to the NCEP-I diet. These differences were probably related to the relative enrichment of plasma LDL particles in alpha-tocopherol due to the high vitamin E content of the MUFA-rich sunflower oil. Indeed, the alpha-tocopherol content was positively correlated with lag time (r=0.338; P<0.008). CONCLUSION: Our findings suggest that changes in plasma LDL alpha-tocopherol content with practical solid-food diets can decrease its susceptibility to oxidation. SPONSORSHIP: This work has been supported by grants from the Investigaciones de la Seguridad Social (FIS 92/0182, to Francisco Pérez Jiménez); and from Koype Co, Andújar, Jaén, Spain. European Journal of Clinical Nutrition (2000) 54, 61-67

[Mediterranean diet improves low density lipoprotein susceptibility to oxidative modifications]. / La dieta mediterránea mejora la resistencia a la oxidación de las lipoproteínas de baja densidad.

UNLABELLED: Most experts, specially from Anglo-Saxon countries, recommend a low fat diet in order to prevent cardiovascular diseases. However, mortality rate by ischemic cardiopathy is low in Mediterranean countries, probably because of the consumption of a Mediterranean diet, with a high level of monounsaturated fats provided by the olive oil. We have conducted this study in order to investigate the possible influence of this kind of diet on the oxidation of LDL in vitro, the key element for the development of atherosclerosis. PATIENTS AND METHODS: 41 healthy male subjects were submitted to three consecutive 4-week diets. The first was a saturated fat-rich diet (SAT diet, 38% fat, 20% saturated). This was followed by a low fat diet (NCEP-I, 28% fat, 10% saturated) and after that a Mediterranean diet (38% fat, 22% monounsaturated fat). Plasma levels of total cholesterol, LDL-c, HDL-c, triglycerides, apolipoproteins A-I and B, -tocopherol, and the in vitro susceptibility to oxidation of LDL particles. Both hypolipidemic diets produced a significant decrease in total cholesterol, LDL-c, and apo-B plasma levels. However, it was only the NCEP-I diet that revealed a decrease in the HDL-c. The shift from a saturated fat-rich diet, or a diet rich in carbohydrates, to a Mediterranean diet increased the resistance of LDL particles to oxidation increasing the lag time period (p < 0.038), and decreasing (p < 0.001) the progression rate of the curve of oxidation of LDL. Our results point out two positive consequences of the consumption of a Mediterranean diet by healthy young males, compared with the low fat diet recommended by most Anglo-Saxon experts. On the one hand, the Mediterranean diet increases HDL-c plasma levels, and on the other hand, it decreases the susceptibility of LDL to oxidation. This is why the Mediterranean diet must be recommended in order to prevent cardiovascular diseases.

Prevention of nosocomial pneumonia using topical and parenteral antimicrobial agents.

The efficacy of antimicrobial agents applied topically in the oropharynx and trachea with and without intravenous antibiotics in preventing bacterial pneumonias during prolonged (7 to 10 days) mechanical ventilation was studied in 35 baboons, 30 of which had acute lung injury induced by either oleic acid or hyperoxia. In 12 animals receiving no antibiotics, only topical application of polymyxin B (PB), or only intravenous penicillin and gentamicin (IV PCN/GM), moderate or severe pneumonia was found in 81% of lobes examined at necropsy; no lobes were sterile. Pneumonias were polymicrobial in the absence of antibiotics, due to PCN-sensitive organisms in the topical PB group, and due to gram-negative bacilli in the IV PCN/GM group. Combinations of topical PB or GM or both plus IV PCN were highly efficacious in preventing pneumonia in 23 animals as only 15% of the lobes contained moderate to severe pneumonia and 52% of lobes were sterile. In these groups, histologically evident pneumonias were associated with low concentrations of bacteria in lung tissue, principally gram-negative bacilli resistant to the topical agent being used. Resistance to PB appeared to be solely due to selection of intrinsically resistant species, whereas resistance to GM may have developed through additional mechanisms as well. Although this approach to pneumonia prevention is clearly efficacious in this animal model, clinical studies are needed to define the frequency and significance of microbial resistance in human subjects.