Effects of different thickening agents on infant gut microbiota.

Infant microbiota has to progress from an almost sterile to a complex and varied community, so the main objective of this work was to evaluate the effect of three thickening ingredients on infant microbiota, as well as their in vitro gut fermentability. Experiments were performed using fresh faecal samples from healthy donors of 2-3 months of age. Stabilised stool samples were injected into Wheaton serum bottles containing pre-reduced MBM and 1% (w/v) fermentation substrates (locust bean gum, LBG; maize hydroxypropylated distarch phosphate, Mhdp; and pre-gelatinized rice starch, gRS). Samples were taken during fermentation, and pH, gas pressure, SCFA and bacterial population were analysed. The addition of thickeners resulted in a significant negative correlation (p < 0.05) between time and pH, showing significantly lower (p < 0.01) pH values for Mhdp and gRS than for LBG. Modified starches showed significantly higher values (p < 0.05) of total gas production than did LBG. Total SCFA molar concentrations for LBG, as well as propionate production, were significantly higher (p < 0.05) than for Mhdp and gRS. Regarding bacterial population, LBG promoted a more varied microbiota enhancing the growth of Atopobium and Bacteroidetes, whereas Mhdp and gRS induced higher Lactobacillus and Bifidobacteria at the beginning of fermentation. LBG induced moderate gas production and a slow drop of pH, and caused a decreasing acetate : propionate ratio, enhancing the development of a varied faecal microbiota. In contrast, Mhdp and gRS induced high gas production, a sudden drop of pH and a greater production of acetate, which promoted a less varied faecal microbiota.

Short-term Use of Ventricular Assist Device in a Patient With Restrictive Cardiomyopathy: A Case Report.

The CentriMag (Levitronix LLC, Waltham, MA, USA) ventricular assist device is a centrifugal pump designed for short-term support in patients with cardiogenic shock. In patients with restrictive physiology, there is some concern about the use of these devices due a very small ventricular cavity. We review the evolution of a 32-year-old woman with restrictive cardiomyopathy, moderate pulmonary hypertension, and severe biventricular systo-diastolic dysfunction in whom a biventricular Centrimag device was implanted due to a progressive clinical worsening.

In vitro modulation of gut microbiota by whey protein to preserve intestinal health.

The effect of several types of whey milk - cow, sheep, goat and a mixture of them (60 : 20 : 20, respectively) - was assessed in the human gut microbiota. The prebiotic potential of these substrates was evaluated through in vitro gastrointestinal digestion following faecal batch culture fermentations (mimicking colonic fermentation) for 48 hours, using faeces from normal-weight (NW) and obese (OB) donors. Throughout the fermentation process, pH, gas production, short chain and branched fatty acids (SCFA-BCFA) were measured, as well as the changes of microbiota using qPCR. The pH decreased in all whey samples during the fermentation process. Gas production was higher in all whey samples than in controls, especially at 12 hours (p < 0.05). The diversity of SCFA and BCFA production was significantly different between the donors, in particular cow and mixed whey. Whey milk had a strong prebiotic effect on the gut microbiota of NW and OB donors, showing a significant increase of Bifidobacterium (p < 0.05) with cow, sheep and mixed whey and increase in the Lactobacillus group, particularly in OB donors. Bacteria associated with obesity did not show an increase in any of the groups of donors. Therefore, supplementing a diet with these types of whey can selectively stimulate the growth of probiotic bacteria, enhancing SCFA production, which could improve intestinal disorders. In addition, it may be an interesting approach to the prevention of overweight and obesity and related diseases. Whey milk has a potent prebiotic effect. It can selectively stimulate desirable bacteria and SCFA profile, in both OB and NW donors, contributing to improved intestinal health and reducing obesity.

A Randomized Controlled Trial of a Mobile Health Intervention to Promote Self-Management After Lung Transplantation.

Lung transplant recipients are encouraged to perform self-management behaviors, including (i) monitoring health indicators, (ii) adhering to their regimen, and (iii) reporting abnormal health indicators to the transplant coordinator, yet performance is suboptimal. When hospital discharge was imminent, this two-group trial randomized 201 recipients to use either the mobile health (mHealth) intervention (n = 99) or usual care (n = 102), to compare efficacy for promoting self-management behaviors (primary outcomes) and self-care agency, rehospitalization, and mortality (secondary outcomes) at home during the first year after transplantation. The mHealth intervention group performed self-monitoring (odds ratio [OR] 5.11, 95% confidence interval [CI] 2.95-8.87, p < 0.001), adhered to medical regimen (OR 1.64, 95% CI 1.01-2.66, p = 0.046), and reported abnormal health indicators (OR 8.9, 95% CI 3.60-21.99, p < 0.001) more frequently than the usual care group. However, the two groups did not differ in rehospitalization (OR 0.78, 95% CI 0.36-1.66, p = 0.51) or mortality (hazard ratio 1.71, 0.68-4.28, p = 0.25). The positive impact of the mHealth intervention on self-management behaviors suggests that the intervention holds promise and warrants further testing.

A novel dual ex vivo lung perfusion technique improves immediate outcomes in an experimental model of lung transplantation.

The lungs are dually perfused by the pulmonary artery and the bronchial arteries. This study aimed to test the feasibility of dual-perfusion techniques with the bronchial artery circulation and pulmonary artery circulation synchronously perfused using ex vivo lung perfusion (EVLP) and evaluate the effects of dual-perfusion on posttransplant lung graft function. Using rat heart-lung blocks, we developed a dual-perfusion EVLP circuit (dual-EVLP), and compared cellular metabolism, expression of inflammatory mediators, and posttransplant graft function in lung allografts maintained with dual-EVLP, standard-EVLP, or cold static preservation. The microvasculature in lung grafts after transplant was objectively evaluated using microcomputed tomography angiography. Lung grafts subjected to dual-EVLP exhibited significantly better lung graft function with reduced proinflammatory profiles and more mitochondrial biogenesis, leading to better posttransplant function and compliance, as compared with standard-EVLP or static cold preservation. Interestingly, lung grafts maintained on dual-EVLP exhibited remarkably increased microvasculature and perfusion as compared with lungs maintained on standard-EVLP. Our results suggest that lung grafts can be perfused and preserved using dual-perfusion EVLP techniques that contribute to better graft function by reducing proinflammatory profiles and activating mitochondrial respiration. Dual-EVLP also yields better posttransplant graft function through increased microvasculature and better perfusion of the lung grafts after transplantation.

Cancer-free survival following alemtuzumab induction in heart transplantation.

BACKGROUND: The malignancy rate after alemtuzumab (C-1H) induction in cardiac transplantation is unknown. METHODS: A retrospective analysis from a single center for all patients that underwent cardiac transplantation from January 2000 to January 2011 and that had no history of malignancy before transplantation was performed. Patients induced with alemtuzumab were compared with a group of patients receiving thymoglobulin or no induction and assessed for 4-year cancer-free post-heart transplantation survival. RESULTS: Of 402 patients included, 185 (46.0%) received alemtuzumab, 56 (13.9%) thymoglobulin, and 161 (40.0%) no induction. Baseline characteristics did not differ between groups: mean age 54.0 years, male 77.1%, white 88.6%, ischemic cardiomyopathy 49.0%. The calcineurin inhibitor was tacrolimus in 98.9% of alemtuzumab patients, 98.2% of thymoglobulin patients, and 87.0% of the noninduced (P < .001). The secondary agent was mycophenolate mofetil in all but 16 noninduced patients (9.9%), who received azathioprine. The 4-year cancer-free survival did not differ between groups: 88.1% alemtuzumab, 87.5% thymoglobulin, 88.2% noninduction; P = .088. The 4-year nonskin cancer-free survival was 96.8% for the alemtuzumab group, 96.4% for the thymoglobulin group, and 95.7% for the noninduced; P = .899. CONCLUSIONS: Neither the 4-year cancer-free survival nor the 4-year nonskin cancer-free survival differed between the alemtuzumab, thymoglobulin, and noninduced groups.

Epidemiology and outcomes of deep surgical site infections following lung transplantation.

We conducted a retrospective study of deep surgical site infections (SSIs) among consecutive patients who underwent lung transplantation (LTx) at a single center from 2006 through 2010. Thirty-one patients (5%) developed SSIs at median 25 days after LTx. Empyema was most common (42%), followed by surgical wound infections (29%), mediastinitis (16%), sternal osteomyelitis (6%), and pericarditis (6%). Pathogens included Gram-positive bacteria (41%), Gram-negative bacteria (41%), fungi (10%) and Mycobacterium abscessus, Mycoplasma hominis and Lactobacillus sp. (one each). Twenty-three percent of SSIs were due to pathogens colonizing recipients' native lungs at time of LTx, suggesting surgical seeding as a source. Patient-related independent risk factors for SSIs were diabetes and prior cardiothoracic surgery; procedure-related independent risk factors were LTx from a female donor, prolonged ischemic time and number of perioperative red blood cell transfusions. Mediastinitis and sternal infections were not observed among patients undergoing minimally invasive LTx. SSIs were associated with 35% mortality at 1 year post-LTx. Lengths of stay and mortality in-hospital and at 6 months and 1 year were significantly greater for patients with SSIs other than empyema. In conclusion, deep SSIs were uncommon, but important complications in LTx recipients because of their diverse microbiology and association with increased mortality.

α-Lactoalbúmina como ingrediente de fórmulas infantiles

La α-lactoalbúmina es la principal proteína del lactosuero en la leche materna, alcanzando una concentración de 2,44 g/L en la leche madura. Su principal función es la síntesis de lactosa a partir de glucosa y galactosa en la glándula mamaria, aunque posee además otros efectos beneficiosos sobre la salud del lactante debido a su elevada proporción de aminoácidos esenciales (triptófano y cisteína). Según diversos estudios parece influir positivamente en la absorción de hierro en el intestino del niño, y en experimentos in vitro, unida al ácido oleico (complejo HAMLET), es efectiva frente a tumores celulares como el papiloma humano. El complejo HAMLET también presenta un claro efecto antimicrobiano frente a Streptococcus pneumoniae, Haemophilus influenzae, cepas enteropatógenas de Escherichia coli y Salmonella thypimurium, sin embargo no se ha demostrado que durante la digestión de la leche materna se forme dicho complejo en el tracto digestivo del lactante. El desarrollo de fórmulas infantiles destinadas a la alimentación del niño durante el primer año de vida ha mejorado considerablemente en las últimas décadas intentando no sólo adecuar la concentración de nutrientes a los requerimientos del lactante, sino también adicionando compuestos bioactivos de diferente naturaleza, como la α-lactoalbúmina, con el objetivo de alcanzar los efectos funcionales que se producen en los niños alimentados con leche materna.

α-Lactalbumin as an ingredient of infant formula. α-lactalbumin is the main whey protein in human milk rising 2,44 g/L in mature milk. It has a key function in the synthesis of lactose from glucose and galactose in the mammary gland although this compound has also other beneficial effects on the infant health due to the high proportion of essential aminoacids (tryptophan and cysteine). It seems also to increase iron absorption in the digestive track, and in in vitro experiments, linked to oleic acid (HAMLET complex), has shown anticarcinogenic effects against cellular tumor such as human papilloma. In addition, this complex has been reported to exhibit antimicrobial properties against Streptococcus pneumoniae,Haemophilus influenzae, enteropathogenic strains of Escherichia coli and Salmonella thypimurium. However, the in vivo synthesis of HAMLET complex during milk digestion has not been proved yet. Infant formula have been improved considerably during the last decades not only adapting nutrient concentrations to infants requirements but also by the addition of new bioactive ingredients such as α-lactalbumin, to have the same functional effect as in breast fed babies.

[Alpha-Lactalbumin as an ingredient of infant formula]. / Alpha-Lactoalbúmina como ingrediente de fórmulas infantiles.

Alpha-Lactalbumin is the main whey protein in human milk rising 2,44 g/L in mature milk. It has a key function in the synthesis of lactose from glucose and galactose in the mammary gland although this compound has also other beneficial effects on the infant health due to the high proportion of essential aminoacids (tryptophan and cysteine). It seems also to increase iron absorption in the digestive track, and in in vitro experiments, linked to oleic acid (HAMLET complex), has shown anticarcinogenic effects against cellular tumor such as human papilloma. In addition, this complex has been reported to exhibit antimicrobial properties against Streptococcus pneumoniae, Haemophilus influenzae, enteropathogenic strains of Escherichia coli and Salmonella thypimurium. However, the in vivo synthesis of HAMLET complex during milk digestion has not been proved yet. Infant formula have been improved considerably during the last decades not only adapting nutrient concentrations to infants requirements but also by the addition of new bioactive ingredients such as alpha-lactalbumin, to have the same functional effect as in breast fed babies.

Efecto de distintos antimicrobianos sobre el crecimiento de Listeria monocytogenes / Effect of different antimicrobial agents on the growth of Listeria monocytogenes

En este estudio se ha evaluado la eficacia de dos ácidos orgánicos contemplados en la lista positiva de aditivos alimentarios, el lactato sódico (E-325) y el diacetato sódico (E-262), sobre el crecimiento de Listeria monocytogenes. Estos aditivos se adicionaron en diferentes concentraciones a un medio de cultivo líquido, determinando el incremento de densidad óptica del medio a 600 nm durante 24 horas a 37 ºC, con respecto al medio sin inocular que se tomó como blanco, realizando la medida cada hora. El incremento de absorbancia se midió con respecto al tiempo, evaluando el crecimiento de la bacteria a través de la interpretación de la tasa máxima de incremento de absorbancia (micro) y el tiempo mínimo requerido para detectar un incremento en la densidad óptica del medio (epsilon). Este último parámetro se puede equiparar al tiempo de latencia o tiempo de adaptación al medio. Así, para el lactato sódico, se observó que ejerce un efecto negativo dosis dependiente sobre el crecimiento de L. monocytogenes, prolongando el tiempo que necesitó la bacteria para adaptarse al medio de cultivo (epsilon), sin afectar a la tasa de crecimiento (micro) una vez que esta comenzó a crecer. El diacetato sódico mostró ser más efectivo que el lactato sódico frente al crecimiento de la bacteria, incrementando el tiempo de adaptación al medio, así como disminuyendo la tasa de crecimiento. Además, el diacetato sódico consiguió inhibir de forma completa el crecimiento de la bacteria a concentraciones iguales o superiores a 0.2%(AU)

The effectiveness of two organic acids included in the positive list for additives, sodium lactate (E-325) and sodium diacetate (E-262), was evaluated against Listeria monocytogenes growth. Different concentrations of these additives were added to the liquid culture medium. The optical density increments at 600 nm was measured for a 24 hours period under 37 0C, using non-inoculated medium as blank. The measurements were taken every hour in sterile 96 wells plates each. After this analysis, a graphical representation of absorbance increment against time was done, extrapolating the maximum absorbance increment rate (micro) and the minimum time required to detect an absorbance increment (epsilon) from the graphic. These two parameters made possible to evaluate the bacterial growth. After the analysis of epsilon and micro for lactate concentrations, a negative effect in bacterial growth was observed, extending epsilon value. Nevertheless, once the bacterial growth started, any effect on micro value was detected. A higher inhibitory effect was observed after the analysis of these parameters for diacetate concentrations, an extension on epsilon value as well as a micro value descent was found. In this way, a total inhibition of growth occurred when diacetate concentration was 0,2% or higher(AU)