Noninvasive Neuromonitoring Modalities in Children Part I: Pupillometry, Near-Infrared Spectroscopy, and Transcranial Doppler Ultrasonography.

BACKGROUND: Noninvasive neuromonitoring in critically ill children includes multiple modalities that all intend to improve our understanding of acute and ongoing brain injury. METHODS: In this article, we review basic methods and devices, applications in clinical care and research, and explore potential future directions for three noninvasive neuromonitoring modalities in the pediatric intensive care unit: automated pupillometry, near-infrared spectroscopy, and transcranial Doppler ultrasonography. RESULTS: All three technologies are noninvasive, portable, and easily repeatable to allow for serial measurements and trending of data over time. However, a paucity of high-quality data supporting the clinical utility of any of these technologies in critically ill children is currently a major limitation to their widespread application in the pediatric intensive care unit. CONCLUSIONS: Future prospective multicenter work addressing major knowledge gaps is necessary to advance the field of pediatric noninvasive neuromonitoring.

Newborns with a Congenital Heart Defect and Diastolic Steal Have an Altered Cerebral Arterial Doppler Profile.

OBJECTIVES: To compare trends in the anterior cerebral artery (ACA) Doppler markers of vascular flow for neonates with a congenital heart defect (CHD) with and without diastolic systemic steal during the first 7 days of life. METHODS: Prospective study recruiting newborns (≥35 weeks of gestation) with a CHD. Doppler ultrasound and echocardiography were performed daily from day 1 to 7. The cohort was divided into the presence/absence of holo-diastolic retrograde flow in the postductal aorta ("retrograde") on the last-available echocardiogram. Data extractors were masked to retrograde status. Mixed effect models (random slope/intercept) were constructed using RStudio. RESULTS: We enrolled 38 neonates with CHD. Retrograde aortic flow was present on the last echocardiogram in 23 (61%). Peak systolic velocity and mean velocity increased significantly over time, independent of retrograde status. However, having a "retrograde" flow status conferred a significant decrease over time of their ACA-end-diastolic velocity (ß = -5.75 cm/s, 95% CI -8.38 to -3.12, P < .001, when compared with the nonretrograde group), and a significant increase in the ACA resistive (ß = 0.16, 95% CI 0.10-0.22, P < .001) and pulsatility (ß = 0.49, 95% CI 0.28-0.69, P < .001) indexes. No subject presented retrograde diastolic flow in the ACA. CONCLUSIONS: In neonates with CHD in the first week of life, infants with echocardiographic signs of systemic diastolic steal within the pulmonary circulation have Doppler signs of cerebrovascular steal in the ACA.

Melatonin Improves Levels of Zn and Cu in the Muscle of Diabetic Obese Rats.

Melatonin improves metabolic alterations associated with obesity and its diabetes (diabesity). We intend to determine whether this improvement is exerted by changing Zn and/or Cu tissue levels in liver, muscle, pancreas, and brain, and in internal (perirenal, perigonadal, and omentum) and subcutaneous lumbar white adipose tissues (IWAT and SWAT, respectively). Male Zücker diabetic fatty (ZDF) rats and lean littermates (ZL) were orally supplemented either with melatonin (10 mg/kg body weight/day) or vehicle for 6 weeks. Zn and Cu concentrations were not significantly influenced by diabesity in the analyzed tissues (p > 0.05), with the exception of Zn in liver. In skeletal muscle Zn and Cu, and in perirenal WAT, only Zn levels increased significantly with melatonin supplementation in ZDF rats (p < 0.05). This cytoplasmic Zn enhancement would be probably associated with the upregulation of several Zn influx membrane transporters (Zips) and could explain the amelioration in the glycaemia and insulinaemia by upregulating the Akt and downregulating the inhibitor PTP1B, in obese and diabetic conditions. Enhanced Zn and Cu levels in muscle cells could be related to the reported antioxidant melatonin activity exerted by increasing the Zn, Cu-SOD, and extracellular Cu-SOD activity. In conclusion, melatonin, by increasing the muscle levels of Zn and Cu, joined with our previously reported findings improves glycaemia, insulinaemia, and oxidative stress in this diabesity animal model.

Ca and Mg Concentrations in Spices and Growth of Commonly Sporulated and Non-Sporulated Food-Borne Microorganisms According to Marketing Systems.

Ca and Mg levels were determined in five spices according to marketing system (in bulk or commercialized in glass or polyethylene terephthalate (PET) containers) and correlated with microbial growth of commonly sporulated (Clostridium perfringens and Bacillus cereus) and non-sporulated (Listeria monocytogenes, psychrophilic and mesophilic bacteria, and yeasts and molds) food-borne pathogens present in them, when they were previously added to the microbial culture media. The basil had the highest mean Ca and Mg level and showed the highest microbial growth in the food-borne pathogenic microorganisms studied (p < 0.001). For Ca, the lowest levels were measured in cloves (p < 0.001), which had the lowest capacity for microbial contamination. Ca and Mg contents in spices correlated linear and positively (p < 0.05). Ca concentrations weakly and positively correlated (p < 0.05) with microbial counts for almost all studied microorganisms, and Mg levels for B. cereus, C. perfringens, and mesophilic bacteria (p < 0.05), possibly acting as a growing factor for some sporulated and non-sporulated foodborne pathogens. These relationships are especially significant when PET vs. glass was used as a packaging material for spices.

Zn, Cu, and Fe Concentrations in Dehydrated Herbs (Thyme, Rosemary, Cloves, Oregano, and Basil) and the Correlation with the Microbial Counts of Listeria monocytogenes and Other Foodborne Pathogens.

Zn, Cu, and Fe concentrations were measured in dehydrated herbs (thyme, rosemary, cloves, oregano, and basil) marketed in bulk or packaged in glass or polyethylene terephthalate (PET). Microbial counts of Listeria monocytogenes and other five foodborne pathogens were also checked when herbs were previously added to the growing media. The highest mean concentrations were found in basil for Zn and Cu, and in thyme and basil for Fe; the lowest ones for these minerals were in cloves (p < 0.05). Basil had significantly higher microbial counts in five of the six foodborne pathogens studied (p < 0.05). Cloves have the best hygienic quality as there is no microbial growth of L. monocytogenes, Clostridium perfringens, and Bacillus cereus; they therefore could be used as a natural preservative in food. Aromatic herbs marketed in bulk showed a significantly higher microbial count (p < 0.05). Zn, Cu, and Fe concentrations were positively correlated with microbial growth for L. monocytogenes, C. perfringens, B. cereus, and psychrophilic microorganisms (p < 0.05), so they could act as a growing factor for the foodborne pathogens.

Changes in the Antioxidant Properties of Extra Virgin Olive Oil after Cooking Typical Mediterranean Vegetables.

Extra virgin olive oil (EVOO), water, and a water/oil mixture (W/O) were used for frying, boiling and sautéeing Mediterranean vegetables (potato, pumpkin, tomato and eggplant). Differences in antioxidant capacity (AC) (2,2-diphenyl-1-picrylhydrazyl (DPPH), ferric iron (FRAP), 2,2-azinobis-(3-ethylbensothiazoline)-6-sulphonic acid (ABTS)), total phenolic content (TPC) and individual phenols (high-performance liquid chromatography (HPLC)) in unused and used EVOO and water were determined. The water used to boil tomatoes showed the highest TPC value, whilst the lowest was found in the EVOO from the W/O used for boiling potatoes. After processing, the concentrations of phenols exclusive to EVOO diminished to different extents. There was a greater transfer of phenols from the vegetable to the oil when eggplant, tomato and pumpkin were cooked. W/O boiling enriched the water for most of the phenols analysed, such as chlorogenic acid and phenols exclusive to EVOO. The values of AC decreased or were maintained when fresh oil was used to cook the vegetables (raw > frying > sautéing > boiling). The water fraction was enriched in 6-hydroxy-2,5,7,8-tetramethyl-chroman-2-carboxylic acid (Trolox) equivalents following boiling, though to a greater extent when EVOO was added. Phenolic content and AC of EVOO decreased after cooking Mediterranean diet vegetables. Further, water was enriched after the boiling processes, particularly when oil was included.

Serum zinc and copper concentrations and ratios in cirrhotic patients: correlation with severity index.

INTRODUCTION: zinc (Zn) and copper (Cu) are essential elements that play an important role in the whole-body metabolism and seems to have a role in the pathogenesis of the liver cirrhosis (LC). OBJECTIVE: the aim of this study is to evaluate the influence on serum Zn and Cu concentrations and Cu/Zn ratios of different factors like cirrhosis, severity index, age, sex, death, and disease complications. METHODS: ninety-three patients with LC were included. The severity index was measured by the Child-Pugh index (CPI). RESULTS: mean serum Cu concentration and Cu/Zn ratio were significantly higher in patients than in healthy controls (p ≤ 0.001). Serum Zn concentrations were reduced with higher cirrhosis severity (specifically low vsmedium severity CPI, p < 0.05). Mean serum Cu concentration was significantly higher in the oldest (> 50 years) versusyoungest (< 30 years) age group. Serum Zn concentrations were lower and Cu/Zn ratios were higher (p < 0.05) in patients that died. Among complications, significantly higher serum Zn concentrations were found in cirrhotic patients with ascites than in those with bacteremia-sepsis. CONCLUSIONS: levels of Zn, Cu and Cu/Zn ratio are affected by the presence of hepatic cirrhosis. Serum Zn concentrations are lower with higher severity of cirrhosis, while those for Cu are increased in cirrhotic patients. We can observe that the presence of elevated Cu/Zn ratios in these patients might be useful in the evaluation of suspected liver cirrhosis.

Serum zinc and copper concentrations and ratios in cirrhotic patients: correlation with severity index / Concentraciones séricas de zinc, cobre y sus cocientes correspondientes en pacientes cirróticos: correlación con el índice de severidad

Introduction: zinc (Zn) and copper (Cu) are essential elements that play an important role in the whole-body metabolism and seems to have a role in the pathogenesis of the liver cirrhosis (LC).Objective: the aim of this study is to evaluate the influence on serum Zn and Cu concentrations and Cu/Zn ratios of different factors like cirrhosis, severity index, age, sex, death, and disease complications. Methods: ninety-three patients with LC were included. The severity index was measured by the Child-Pugh index (CPI).Results: mean serum Cu concentration and Cu/Zn ratio were significantly higher in patients than in healthy controls (p ≤ 0.001). Serum Zn concentrations were reduced with higher cirrhosis severity (specifically low vsmedium severity CPI, p < 0.05). Mean serum Cu concentration was significantly higher in the oldest (> 50 years) versusyoungest (< 30 years) age group. Serum Zn concentrations were lower and Cu/Zn ratios were higher (p < 0.05) in patients that died. Among complications, significantly higher serum Zn concentrations were found in cirrhotic patients with ascites than in those with bacteremia-sepsis. Conclusions: levels of Zn, Cu and Cu/Zn ratio are affected by the presence of hepatic cirrhosis. Serum Zn concentrations are lower with higher severity of cirrhosis, while those for Cu are increased in cirrhotic patients. We can observe that the presence of elevated Cu/Zn ratios in these patients might be useful in the evaluation of suspected liver cirrhosis

Introducción: el zinc (Zn) y el cobre (Cu) son elementos esenciales ya que juegan un papel fundamental en el metabolismo en general y parecen tener implicación en la patogénesis de la cirrosis hepática (CH). Objetivos: el objetivo del presente estudio es evaluar la influencia sobre los niveles séricos de Zn y Cu, y sobre los cocientes entre los niveles de Cu y Zn de diferentes factores como la cirrosis, el índice de severidad, la edad, el sexo, la mortalidad y las complicaciones de la enfermedad. Metodología: noventa y tres pacientes con CH fueron incluidos en el estudio y el grado de severidad se midió utilizando el índice Child-Pugh (ICP). Resultados: las concentraciones séricas de Cu y los cocientes entre los niveles de Cu y Zn se encontraron significativamente aumentados en los pacientes con respecto a los controles sanos (p ≤ 0.001). A mayor grado de severidad cirrótica, se obtuvieron valores medios de Zn significativamente disminuidos (concretamente en los enfermos con ICP bajo frente a los que tenían un ICP medio, p < 0.05). La media de las concentraciones séricas de Cu fue significativamente superior en el grupo de sujetos de mayor edad (> 50 años) con respecto al grupo más joven (< 30 años). En aquellos pacientes que habían sufrido un deceso, las concentraciones séricas de Zn estaban significativamente disminuidas, mientras que los cocientes entre los niveles de Cu y Zn se encontraron elevadas (p < 0.05). En cuanto a las complicaciones de la enfermedad, obtuvimos valores séricos significativamente elevados de Zn en aquellos pacientes cirróticos que padecían ascitis respecto a los que presentaban bacteriemia-sepsis. Conclusiones: los valores de Zn, Cu y los cocientes entre los niveles de Cu y Zn se encuentran afectados en la enfermedad cirrótica. Las concentraciones séricas de Zn son bajas cuando existe un mayor grado de severidad de la cirrosis hepática, mientras que los valores de Cu apararen incrementados en los pacientes con esta enfermedad. Podemos observar que la presencia de valores elevados de los cocientes entre los niveles de Cu y Zn podría ser de utilidad en la evaluación de la posible presencia de la enfermedad

Evaluación de Nutrire(R): una herramienta on-line para realizar estudios de evaluación del estado nutricional / Evaluation of Nutrire(R): An On-Line Tool for Carrying Out Evaluation Studies to Assess Nutritional Status

Introducción: Nutrire(R) es un programa informático, fruto de tres proyectos de innovación docente de la Universidad de Granada (España), que permite la valoración del estado nutricional mediante a partir de parámetros antropométricos, dietéticos y bioquímicos. Objetivo: El objetivo de este trabajo es presentar los resultados obtenidos de la evaluación global del programa por alumnos y egresados para poder analizar sus puntos fuertes y débiles que sirvan con posterioridad para realizar las modificaciones oportunas. Material y Métodos: Se ha realizado una encuesta anónima a 128 alumnos de 3 titulaciones de grado y 1 de postgrado de la Universidad de Granada. Se incluye 6 preguntas sobre navegabilidad y diseño y 5 sobre contenidos académicos del programa. Asimismo, se han entrevistado a 20 egresados que lo han utilizado en su actividad profesional. Resultados: La puntuación media obtenida en los alumnos fue de 4,1 sobre 5. Como aspectos positivos destacan: facilidad de uso, incorporación de fotografías de alimentos para elegir el tamaño de ración/ porción. Como aspectos de mejora señalan: incorporar más fotos de alimentos, el poder instalar el programa para su uso en un ordenador. Según los egresados, el principal punto fuerte es tener reunido en un solo programa los tres aspectos de la evaluación del estado nutricional. Como puntos débiles señalan la falta de algún nutriente, como los azucares, en la base de datos nutricional. Conclusión: Nutrire(R) es un programa de fácil utilización, muy bien valorada por los alumnos y por los egresados para realizar estudios de evaluación del estado nutricional

Introduction: Nutrire(R) is a computer programme, a product of three innovation teaching projects of the University of Granada (Spain), designed to carry out the assessment of the nutritional status by anthropometric, dietetic and biochemical parameters. Objectives: The main aim of this study is to present its overall results and to analyze its strengths and weaknesses and to carry out the modifications to improve the programme. Material and Method: An anonymous survey was carried out on 128 students from three different degrees and one the Master’s degree. The survey included 6 questions on navigability and design and 5 about the academic content of the programme. Twenty post-graduates who had used the programme in their professional life were also interviewed. Results and Discussion: The average marking of the students was 4.1 out of 5. The main positive aspects which stood out were the ease of use of the computer programme, and the inclusion of photographs of foodstuffs which facilitated the choice of size of portion when evaluating a diet. Negative aspects that were commented on were the necessity to include more photos of foodstuffs, and the impossibility of using the programme without the internet. According to the post-graduates the main benefit of the programme is to have the three principal aspects of the assessment of the nutritional status. The weak points commented on are that the table showing the composition of the foodstuffs does not give information on simple sugars. Conclusion: Nutrire(R) is an easy tool to use and highly valued by both under-graduates and graduates to evaluate nutritional status

Phenols and the antioxidant capacity of Mediterranean vegetables prepared with extra virgin olive oil using different domestic cooking techniques.

Potato, tomato, eggplant and pumpkin were deep fried, sautéed and boiled in Mediterranean extra virgin olive oil (EVOO), water, and a water/oil mixture (W/O). We determined the contents of fat, moisture, total phenols (TPC) and eighteen phenolic compounds, as well as antioxidant capacity in the raw vegetables and compared these with contents measured after cooking. Deep frying and sautéing led to increased fat contents and TPC, whereas both types of boiling (in water and W/O) reduced the same. The presence of EVOO in cooking increased the phenolics identified in the raw foods as oleuropein, pinoresinol, hydroxytyrosol and tyrosol, and the contents of vegetable phenolics such as chlorogenic acid and rutin. All the cooking methods conserved or increased the antioxidant capacity measured by DPPH, FRAP and ABTS. Multivariate analyses showed that each cooked vegetable developed specific phenolic and antioxidant activity profiles resulting from the characteristics of the raw vegetables and the cooking techniques.

Extra virgin olive oil (EVOO) consumption and antioxidant status in healthy institutionalized elderly humans.

Recent studies show that the elderly have increased oxidative stress and impaired antioxidant defense systems. Our study aims to evaluate the effects of daily consumption of EVOO in the healthy institutionalized elderly. We studied anthropometric, biochemical and antioxidant parameters in 62 subjects aged 65-96 years after a 6-week daily intake of polyphenol-rich EVOO with high oleuropein derivative contents. Subjects were divided into a control group (CG) who maintained their dietary habits (n=39) and an olive group (OG) who consumed EVOO as the only added fat, plus a daily dose of 50ml (n=23). We found a significant reduction of total cholesterol (TC), HDL, LDL and TGs in OG subjects and a significant increase of HDL levels. There was no significant variation in the CG parameters. In OG the total antioxidant capacity (TAC) in plasma increased with significant differences over CG. Plasma hydroxytyrosol (OH-Tyr) concentration showed a significant increase after EVOO intervention. Daily consumption of EVOO was found to have positive effects on lipid profiles, OH-Tyr levels and TAC. The results also show a significant increase of catalase (CAT) in erythrocytes and a decrease (p<0.05) in superoxide dismutase (SOD) and glutathione peroxidase (GH-PX) activity after EVOO intake. To our knowledge, no other study has examined the effects of EVOO consumption on biochemical parameters, antioxidant capacity and antioxidant enzyme activity in healthy elderly subjects. In conclusion, our results show that nutritional intervention with EVOO improves antioxidant status in healthy elderly people.