Clinical and Microbiological Impact of Implementing a Decision Support Algorithm through Microbiologic Rapid Diagnosis in Critically Ill Patients: An Epidemiological Retrospective Pre-/Post-Intervention Study.

BACKGROUND: Data on the benefits of rapid microbiological testing on antimicrobial consumption (AC) and antimicrobial resistance patterns (ARPs) are scarce. We evaluated the impact of a protocol based on rapid techniques on AC and ARP in intensive care (ICU) patients. METHODS: A retrospective pre- (2018) and post-intervention (2019-2021) study was conducted in ICU patients. A rapid diagnostic algorithm was applied starting in 2019 in patients with a lower respiratory tract infection. The incidence of nosocomial infections, ARPs, and AC as DDDs (defined daily doses) were monitored. RESULTS: A total of 3635 patients were included: 987 in the pre-intervention group and 2648 in the post-intervention group. The median age was 60 years, the sample was 64% male, and the average APACHE II and SOFA scores were 19 points and 3 points. The overall ICU mortality was 17.2% without any differences between the groups. An increase in the number of infections was observed in the post-intervention group (44.5% vs. 17.9%, p < 0.01), especially due to an increase in the incidence of ventilator-associated pneumonia (44.6% vs. 25%, p < 0.001). AC decreased from 128.7 DDD in 2018 to 66.0 DDD in 2021 (rate ratio = 0.51). An increase in Pseudomonas aeruginosa susceptibility of 23% for Piperacillin/tazobactam and 31% for Meropenem was observed. CONCLUSION: The implementation of an algorithm based on rapid microbiological diagnostic techniques allowed for a significant reduction in AC and ARPs without affecting the prognosis of critically ill patients.

Efecto del extracto de cresta de gallo, rico en ácido hialurónico, sobre los parámetros isocinéticos en personas con gonalgia leve / Effect of rooster comb extract, rich in hyaluronic acid, on isokinetic parameters in adults with mild knee pain

Introducción: La artrosis de rodilla se manifiesta en una primera fase como una gonalgia leve y produce una disminución de la fuerza muscular, que puede ser valorada objetivamente con la prueba isocinética. Dentro de su tratamiento se debe considerar el ácido hialurónico por vía oral. Objetivo: Valorar la evolución de los parámetros isocinéticos de fuerza muscular en la articulación de la rodilla con gonalgia leve antes y después del consumo de un extracto de cresta de gallo (ECG), rico en ácido hialurónico, por vía oral. Metodología: Ensayo de intervención nutricional, doble ciego, aleatorizado, controlado con placebo y en paralelo con dos grupos de tratamiento: grupo activo con ingesta de un yogur bajo en grasa con 80 mg de ECG rico en ácido hialurónico y grupo control con ingesta de un yogur bajo en grasa sin ECG. Se valoraron los parámetros isocinéticos de pico torque (PT), trabajo total (TT) y potencia media (PM) a las velocidades de 180º/seg y 240º/seg para los movimientos de flexión y extensión de la rodilla. Resultados: Después de 12 semanas del consumo del yogur, los hombres del grupo activo, en comparación con los del grupo control, obtuvieron diferencias estadísticamente significativas (p<0,05) y mejora clínica (>10%) a la velocidad de 180º/seg en el movimiento de extensión en la variable PT (p=0,048) (19,33%), TT (p=0,020) (37,97%) y PM (p=0,029) (47,25%), y en el movimiento de flexión en la variable PT (p=0,007) (25,41%), TT (p=0,014) (42,98%) y PM (p=0,022) (48,90%). Conclusión: La ingesta de un yogur bajo en graso con extracto de cresta de gallo rico en ácido hialurónico mejora la fuerza muscular de la rodilla en hombres con gonalgia leve

Background: Knee osteoarthritis manifests itself in a first phase as a mild gonalgia and produces a decrease in muscle strength, which can be objectively assessed with isokinetic testing. In the treatment of knee osteoarthritis, should be considered the hyaluronic acid orally. Objective: Assess the evolution of isokinetic parameters of muscle strength in the knee joint with mild gonalgia before and after the consumption of RCE, rich in hyaluronic acid, orally. Methodology: Nutritional intervention trial, double-blind, randomized, controlled with placebo and in parallel with two treatment groups: the active group with a low-fat yogurt with 80 mg of roster comb extract (RCE) and the control group with a low-fat yogurt without RCE. The main variables of the study were the peak torque, total work and mean power of the isokinetic valuation at the speed of 180 º/seg and 240 º/seg by the movements of flexion and extension of the knee joint. Results: After 12 weeks of consumption of yogurt, men of the active group, compared with those in the control group, obtained statistically significant differences (p <0.05) and clinical improvement (>10%) at the speed of 180º/seg in the movement extension in the PT variable (p=0.048) (19.33%), TT (p=0.020) (37.97%) and PM (p=0.029) (47.25%), and in the flexion movement in the variable PT (p=0.007) (25.41%), TT (p=0.014) (42.98%) and PM (p=0.022) (48.90%). Conclusions: The intake of a low-fat yogurt with RCE rich in hyaluronic acid improves the muscle strength of the knee in men with mild gonalgia

Protective effects of fish oil on pre-diabetes: a lipidomic analysis of liver ceramides in rats.

A high intake of fat and sucrose can dramatically increase bioactive lipids such as ceramides in tissues. Ceramides regulate several steps in the insulin signal pathway. The effects of n-3 PUFA on insulin resistance are inconsistent, especially in liver. We investigated the effect of n-3 PUFA (EPA/DHA 1 : 1) from fish oil on hepatic ceramides in a pre-diabetic animal model. Three groups of rats were fed standard feed, high fat high sucrose feed (HFHS) or HFHS enriched with n-3 PUFA. We investigated by lipidomic analysis how supplementation of a HFHS diet with n-3 PUFA modifies the hepatic ceramide profile triggered by a HFHS diet. Our results show that n-3 PUFA modified the ceramide profile of the liver and reduced their total content in pre-diabetic rats. Significant linear correlations were observed between ceramides and biochemical insulin parameters. Long chain ceramide 18:1/18:0 showed a positive correlation with the HOMA index. Very long chain ceramide 18:1/24:0 showed a negative correlation with insulin and the HOMA index. Finally, very long chain ceramide 18:1/20:0 correlated negatively with glucose levels, plasmatic insulin levels and the HOMA index. In conclusion, the modulation of the ceramide profile in pre-diabetic rats may explain the protective action of n-3 PUFA against liver insulin resistance (IR) caused by an HFHS diet. We confirm the protective role of very long chain ceramide 18:1/24:0 and the harmful role of long chain ceramide 18:1/18:0 in the pre-diabetic state and propose ceramide 18:1/20:0 as a biomarker of early liver IR in rats.

Lipidomics to analyze the influence of diets with different EPA:DHA ratios in the progression of Metabolic Syndrome using SHROB rats as a model.

The role of specific proportions of ω-3 EPA and DHA, in the modulation of inflammation and oxidative stress markers associated to the progression of Metabolic Syndrome was investigated. Potential inflammatory eicosanoids and docosanoids were discussed together to biomarkers of CVD, obesity, inflammation and oxidative stress in an animal model of metabolic disorders. Results evidenced a noteworthy health effect of 1:1 and 2:1 EPA:DHA proportions over 1:2 EPA:DHA based diets through a down-regulation in the production of strong pro-inflammatory ω-6 eicosanoids, a decrement of biomarkers of oxidative stress, and a modulation of fatty acid desaturase activities and plasma and membrane PUFAs towards greater anti-inflammatory profiles. Outcomes contribute to the general knowledge on the health benefits of marine lipids and their role on the progress of MetS, inflammation and oxidative stress. Results shed light on controversial protective mechanisms of EPA and DHA to better design dietary interventions aimed at reducing MetS.

Virgin Olive Oil Enriched with Its Own Phenols or Complemented with Thyme Phenols Improves DNA Protection against Oxidation and Antioxidant Enzyme Activity in Hyperlipidemic Subjects.

The effects of virgin olive oil (VOO) enriched with its own phenolic compounds (PC) and/or thyme PC on the protection against oxidative DNA damage and antioxidant endogenous enzymatic system (AEES) were estimated in 33 hyperlipidemic subjects after the consumption of VOO, VOO enriched with its own PC (FVOO), or VOO complemented with thyme PC (FVOOT). Compared to pre-intervention, 8-hydroxy-2'-deoxyguanosine (a marker for DNA damage) decreased in the FVOO intervention and to a greater extent in the FVOOT with a parallel significant increase in olive and thyme phenolic metabolites. Superoxide dismutase (AEES enzyme) significantly increased in the FVOO intervention and to a greater extent in the FVOOT with a parallel significant increase in thyme phenolic metabolites. When all three oils were compared, FVOOT appeared to have the greatest effect in protecting against oxidative DNA damage and improving AEES. The sustained intake of a FVOOT improves DNA protection against oxidation and AEES probably due to a greater bioavailability of thyme PC in hyperlipidemic subjects.

A low-fat yoghurt supplemented with a rooster comb extract on muscle joint function in adults with mild knee pain: a randomized, double blind, parallel, placebo-controlled, clinical trial of efficacy.

Preliminary results suggested that oral-administration of rooster comb extract (RCE) rich in hyaluronic acid (HA) was associated with improved muscle strength. Following these promising results, the objective of the present study was to evaluate the effect of low-fat yoghurt supplemented with RCE rich in HA on muscle function in adults with mild knee pain; a symptom of early osteoarthritis. Participants (n = 40) received low-fat yoghurt (125 mL d(-1)) supplemented with 80 mg d(-1) of RCE and the placebo group (n = 40) consumed the same yoghurt without the RCE, in a randomized, controlled, double-blind, parallel trial over 12 weeks. Using an isokinetic dynamometer (Biodex System 4), RCE consumption, compared to control, increased the affected knee peak torque, total work and mean power at 180° s(-1), at least 11% in men (p < 0.05) with no differences in women. No dietary differences were noted. These results suggest that long-term consumption of low-fat yoghurt supplemented with RCE could be a dietary tool to improve muscle strength in men, associated with possible clinical significance. However, further studies are needed to elucidate reasons for these sex difference responses observed, and may provide further insight into muscle function.

Effect of n-3 PUFA supplementation at different EPA:DHA ratios on the spontaneously hypertensive obese rat model of the metabolic syndrome.

The increasing incidence of the metabolic syndrome (MetS), a combination of risk factors before the onset of CVD and type 2 diabetes, encourages studies on the role of functional food components such as long-chain n-3 PUFA as preventive agents. In the present study, we explore the effect of EPA and DHA supplementation in different proportions on spontaneously hypertensive obese (SHROB) rats, a model for the MetS in a prediabetic state with mild oxidative stress. SHROB rats were randomised into four groups (n 7), each supplemented with EPA/DHA at ratios of 1:1, 2:1 and 1:2, or soyabean oil as the control for 13 weeks. The results showed that in all the proportions tested, EPA/DHA supplementation significantly lowered total and LDL-cholesterol concentrations, compared with those of the control group. EPA/DHA supplementation at the ratios of 1:1 and 2:1 significantly decreased inflammation (C-reactive protein levels) and lowered oxidative stress (decreased excretion of urinary isoprostanes), mainly at the ratio of 1:2. The activity of antioxidant enzymes increased in erythrocytes, abdominal fat and kidneys, with magnitudes depending on the EPA:DHA ratio. PUFA mixtures from fish affected different MetS markers of CVD risk factors in SHROB rats, depending on the ratios of EPA/DHA supplementation. The activation of endogenous defence systems may be related to the reduction of inflammation and oxidative stress.

Effects of functional olive oil enriched with its own phenolic compounds on endothelial function in hypertensive patients. A randomised controlled trial.

UNLABELLED: The additional health-promoting properties of functional virgin olive oil (FVOO) enriched with its own phenolic compounds (OOPC) versus the parental virgin olive oil (VOO) must be tested in appropriate human clinical trials. Our aim was to assess the effects of FVOO on endothelial function in hypertensive patients. Thirteen pre- and stage-1 hypertensive patients received a single dose of 30 mL of FVOO (OOPC=961 mg/kg) or VOO (OOPC=289 mg/kg) in a postprandial randomised, double blind, crossover trial. Endothelial function, measured as ischemic reactive hyperemia (IRH) and related biomarkers, were followed for 5h after consumption. Compared with VOO, FVOO increased IRH (P<0.05) and plasma Cmax of hydroxytyrosol sulphate, a metabolite of OOPC 2h postprandial (P=0.05). After FVOO ingestion, oxidised LDL decreased (P=0.010) in an inverse relationship with IRH AUC values (P=0.01). FVOO provided more benefits on endothelial function than a standard natural virgin olive oil in pre- and hypertensive patients. TRIAL REGISTRATION: isrctn.org. Identifier ISRCTN03450153.

Follow-up of a healthy lifestyle education program (the Educació en Alimentació Study): 2 years after cessation of intervention.

PURPOSE: The Educació en Alimentació (EdAl) program conducted over 28 months in primary school children reduced obesity (OB) prevalence in boys and increased voluntary physical activity (PA). The continued benefit after cessation of EdAl is unknown. We assessed the changes in OB prevalence and healthy lifestyle in 11- to 13-year-old adolescents, the age group that had complete inclusion data available 2 years after the EdAl program's conclusion. METHODS: Adolescents (n = 421 intervention; n = 198 control) with data at baseline and 2-year follow-up were recruited. Analyses included body mass index (BMI), BMI z-score, and lifestyle data (from questionnaires). RESULTS: Between baseline and 2-year follow-up, OB prevalence was reduced (-5.5%; p < .01) and BMI z-score (-.29; p < .001) in intervention compared with control group. BMI z-score was effectively reduced in intervention in both genders: -.26 units in boys and -.32 units in girls, compared with control group. The ≥4 hours/week after-school PA was increased significantly by 13.1% in adolescents of intervention group compared with control group (p = .023); a tendency toward increased PA in intervention girls was observed (p = .062). At 2-year follow-up, participating in ≥4 hours/week after-school PA (odds ratio, .240; p = .002) and daily fruit consumption (odds ratio, .447; p = .025) were protective factors against OB, whereas ≤2 hours/week after-school PA was a risk factor for OB. CONCLUSIONS: At 2-year follow-up, the EdAl program induced a lowering of BMI z-score and OB prevalence, compared with control group. After-school PA practice can be stimulated in primary school as part of a healthy lifestyle and maintained subsequently despite cessation of the intervention program.

[Surgical patients hospital home care program: two years evaluation]. / Programa de hospitalización domiciliara de pacientes quirúrgicos: evaluación de los dos años de funcionamiento.

OBJECTIVE: To evaluate the results after two years of the implementation of surgical patients' hospital home care program in Consort. Hospitalari de Vic. METHOD: Longitudinal study conducted between January 2011 and December 2012 on patients enrolled in hospital home care program patients. Sociodemographic, clinical, financial, management and patients experience variables were analysed. Data were obtained from hospital home care program records and Hospital Information Systems in addition to telephone surveys. We performed a univariate descriptive analysis using the statistical package SPSS Statistics 19. RESULTS. 691 patients were assessed, and 80.75% were included in hospital home care program. The average hospital length of stay was 5.01 days, with a 3.05% of readmission rate. A higher number of male patients were treated; patients under general surgery, orthopaedics and urology specialties were the more prevalence in the program. 82% of patients were assigned to the care plan "surgical patient", and the most recorded potential complications were pain (539) and infection (436). The mean overall satisfaction score with care was 8.67 +/- 1.37 out of 10. CONCLUSIONS: The results objectively reflect the impact of hospital home care program in our context. Moreover, it highlights the importance of the advanced nursing role.

Programa de hospitalización domiciliaria de pacientes quirúrgicos. Evaluación de los dos años de funcionamiento / Surgical patients hospital home care program: two years evaluation

Objetivo. Evaluar los resultados obtenidos con la implantación del programa de Hospitalización Domiciliaria Quirúrgica (HDQ) en el Consorci Hospitalari de Vic durante un periodo de dos años. Método. Estudio longitudinal realizado entre enero de 2011 y diciembre de 2012, sobre los pacientes incluidos en el programa de HDQ. Se estudiaron variables sociodemográficas, clínicas, económicas, de gestión y de percepción del usuario. Los datos se obtuvieron de los registros del programa HDQ, de la Unidad de Planificación y de los sistemas de información, y mediante encuestas telefónicas. Se realizó un análisis descriptivo univariado con el paquete estadístico IBM SPSS Statistics 19. Resultados. Se valoraron 691 pacientes. El 80.75 % se incluyó en el programa HDQ, su estancia media global fue de 5.01 días y la tasa de reingreso del 3.05 %. Destacó un mayor número de pacientes tratados de sexo masculino; las especialidades que aportaron más pacientes al programa fueron cirugía general, traumatología y urología. Se asignó el plan de cuidados del «paciente quirúrgico intervenido» al 82 % de los pacientes, y las complicaciones potenciales enfermeras más registradas fueron el dolor (539) y la infección (436). La puntuación media de satisfacción global sobre la atención recibida y el funcionamiento de HDQ fue de 8.67 ± 1.37 sobre 10. Conclusiones. Los resultados objetivan el impacto de la HDQ en nuestro ámbito y ponen de manifiesto la relevancia del rol de la atención enfermera especializada en el domicilio (AU)

Objective. To evaluate the results after two years of the implementation of surgical patients’ hospital home care program in Consorci Hospitalari de Vic. Method. Longitudinal study conducted between January 2011 and December 2012 on patients enrolled in hospital home care program patients. Sociodemographic, clinical, financial, management and patients experience variables were analysed. Data were obtained from hospital home care program records and Hospital Information Systems in addition to telephone surveys. We performed a univariate descriptive analysis using the statistical package SPSS Statistics 19. Results. 691 patients were assessed, and 80.75 % were included in hospital home care program. The average hospital length of stay was 5.01 days, with a 3.05 % of readmission rate. A higher number of male patients were treated; patients under general surgery, orthopaedics and urology specialties were the more prevalence in the program. 82 % of patients were assigned to the care plan «surgical patient», and the most recorded potential complications were pain (539) and infection (436). The mean overall satisfaction score with care was 8.67 ± 1.37 out of 10. Conclusions. The results objectively reflect the impact of hospital home care program in our context. Moreover, it highlights the importance of the advanced nursing role (AU)

Targets of protein carbonylation in spontaneously hypertensive obese Koletsky rats and healthy Wistar counterparts: a potential role on metabolic disorders.

The study innovatively pinpoints target proteins of carbonylation, a key PTM induced by oxidative stress, in the SHROB (genetically obese spontaneously hypertensive) rat model of metabolic syndrome (MetS). Protein carbonylation was assessed by a fluorescence-labeling proteomics approach, and complemented with biometric and biochemical markers of MetS. SHROB and healthy Wistar rats were fed two diets, soybean and linseed oil supplementations, in order to distinguish intrinsic carbonylation of SHROB animals from diet-modulated carbonylation unrelated to MetS. First exploratory data showed similar carbonylation patterns and metabolic conditions in SHROB rats fed soybean and linseed, but different from Wistar animals. A total of 18 carbonylated spots in liver, and 12 in skeletal tissue, related to pathways of lipid (29.6%), carbohydrate (25.9%) and amino acid (18.5%) metabolisms, were identified. In particular, SHROB animals present higher carbonylation in four liver proteins belonging to lipid metabolism, redox regulation and chaperone activity (ALDH2, PDI, PDIA3, PECR), and in the skeletal muscle ALDOA that is involved in muscle dysfunction. Conversely, SHROB rats display lower carbonylation in liver albumin, AKR1C9, ADH1 and catalase. This investigation provides a novel perspective of carbonylation in the context of metabolic disorders, and may be a starting point to characterize new redox pathways exacerbating MetS. BIOLOGICAL SIGNIFICANCE: Oxidative stress is a concomitant factor in the pathogenesis of MetS that induces oxidative PTM as carbonylation. Through the use of a redox proteomics approach, we have thoroughly mapped the occurrence of protein targets of carbonylation in the genetically-induced MetS model SHROB rat. The present research brings a new insight of MetS pathogenesis and it may provide valuable information to understand the biological impact of oxidative stress in patients with MetS.

Oxidative stress markers in predicting response to treatment with ferric carboxymaltose in nondialysis chronic kidney disease patients.

BACKGROUND: Nearly half of all non-dialysis chronic kidney disease (CKD) patients respond to iron therapy. Factors affecting anemia response to iron therapy are not well characterized. Oxidative stress (OS) is a recognized factor for anemia in CKD and promotes erythropoiesis stimulating agent (ESA) resistance; however, the influence in predicting response to intravenous (IV) iron has not been evaluated. METHODS: Patients (n = 47) with non-dialysis CKD stages 3 - 5 (mean eGFR: 26 ± 10.4 mL/min/1.73 m2) and iron-deficiency anemia (hemoglobin < 11 g/dL, transferrin saturation (TSAT) index < 20%, and/or ferritin < 100 ng/mL) received a single injection of 1,000 mg of ferric carboxymaltose (FCM) and were observed for 12 weeks. Based on erythropoietic response (defined as ≥ 1 g/dL increase in hemoglobin level), patients were classified as responders or non-responders. Baseline conventional markers of iron status (TSAT and ferritin), inflammatory markers (C-reactive protein and IL-6), OS markers (oxidized LDL, protein carbonyl groups, erythrocyte superoxide dismutase, and glutathione peroxidase (GPx)), and catalase activity were measured. RESULTS: FCM resulted in a significant increase in hemoglobin, TSAT, and ferritin (10 ± 0.7 vs. 11.4 ± 1.3 g/dL, p < 0.0001; 14.6 ± 6.4% vs. 28.9 ± 10%, p < 0.0001; 67.8 ± 61.7 vs. 502.5 ± 263.3 ng/dL, p < 0.0001, respectively). Responders and non-responders were 34 (72%) and 13 (28%), respectively. Age, baseline hemoglobin, estimated glomerular filtration rate, parathyroid hormone, and use of ESA or angiotensin-modulating agents were similar in both groups. Responders showed a tendency towards lower TSAT than non-responders (13.6 ± 6.5% vs. 17.2 ± 5.6%, p = 0.06) but similar ferritin levels. Inflammatory markers were similar in both groups. eGPx activity was lower in non-responders compared to responders (103.1 ± 50.9 vs. 144.9 ± 63.1 U/g Hb, p = 0.01, respectively), although the other proteins, lipid oxidation markers, and enzymatic antioxidants did not differ between the two groups. In the multivariate adjusted model, odds (95% CI) for achieving erythropoietic response to FCM were 10.53 (1.25 - 88.16) in the third tertile of eGPX activity and 3.20 (0.56 - 18.0) in the second tertile compared to those in the lowest tertiles (p = 0.02). CONCLUSIONS: Decreased eGPx activity has adverse influences on response to FCM, suggesting that impaired erythrocyte antioxidant defense may be involved in the response to iron therapy in CKD patients.

Diet, iron biomarkers and oxidative stress in a representative sample of Mediterranean population.

BACKGROUND: The consumption pattern characterized by high consumption of vegetables, fruit, fish, olive oil and red wine has been associated with improvements in the total antioxidant capacity of individuals and reduced incidence of diseases related to oxidation. Also, high body iron levels may contribute to increase the oxidative stress by the generation of reactive oxygen species. The objective of this study is to analyze the relationship between antioxidant and pro-oxidant factors obtained from the diet and iron biomarkers on lipoprotein oxidation and total antioxidant capacity in a representative sample of the Mediterranean population. METHODS: Cross-sectional prospective study, carried out with 815 randomly selected subjects (425 women and 390 men). Dietary assessment (3-day food records), iron biomarkers (serum ferritin, serum iron and transferrin saturation), biochemical markers of lipoperoxidation (TBARS), antioxidant capacity (ORAC) and CRP (C-Reactive Protein) were determined. Multiple Linear Regression (MLR) models were applied to analyze the association between diet factors and iron biomarkers on TBARS and ORAC levels. RESULTS: We observed that lipoperoxidation measured by TBARS increased by age but no differences were observed by sex. Antioxidant capacity measured by ORAC is independent of age and sex. In general, increasing age, tobacco, heme iron intake from meat and fish and transferrin saturation were independently and positively associated with TBARS, while non-heme iron was negatively associated. Vegetables, vitamin C intake and serum ferritin were positively associated with ORAC, whereas saturated fatty acids and meat intake were negatively associated. CONCLUSIONS: In our general population, we observed that oxidative stress is related to aging, but antioxidant capacity is not. The highest intake of dietary non-heme iron, vegetables and vitamin C intake exerts a protective effect against oxidation while the highest intake of dietary heme iron from meat and fish and saturated fatty acids are associated with increased oxidative stress. High levels of circulating iron measured by transferrin saturation are associated with increased oxidative stress in women however its association with the higher levels of serum ferritin is controversial.

Oxidative stress and other risk factors for white matter lesions in chronic hemodialysis patients.

BACKGROUND: Chronic kidney disease (CKD) is a risk factor for cardiovascular disease and promotes oxidative tress (OS), which has been implicated in the pathogenesis of white matter lesions (WML), a form of small-vessel cerebrovascular disease. The relationship between OS and WML in chronic hemodialysis (HD) patients has not yet been studied. METHODS: We studied 67 chronic HD patients, aged 40 - 65 years (average 54 years) without known cerebrovascular disease. All patients underwent brain magnetic resonance imaging and subcortical and periventricular WML were evaluated using semiquantitative measures. Patients were classified into two groups depending on the presence or absence of WML (Fazekas classification), and the WML were scored. Carotid ultrasonography was also performed to evaluate the presence of carotid artery plaques and/or stenosis. Markers of protein and lipid oxidation (protein carbonyl and oxLDL antibodies), the glutathione system, enzymatic antioxidants (superoxide dismutase, glutathione peroxidase, glutathione reductase and catalase) and total antioxidant capacity (ORAC) were measured. OS markers were compared to those of a group of 36 healthy subjects. RESULTS: WML were present in 54% of the total population. Patients who had WML were older and had lower predialysis diastolic blood pressure than patients without WML. Other potential cardiovascular risk factors for WML, including obesity, hyperlipidemia, diabetes mellitus, presence of carotid artery plaques or stenosis, and duration and adequacy of HD were not related to the presence of WML. Compared to controls, HD patients had increased OS and decreased antioxidant capacity. However, OS did not differ between patients with WML and those without, and we found no association between OS markers and mean WML scores. After adjusting for several factors, only age and low predialysis diastolic blood pressure independently predicted an increased risk of WML. CONCLUSIONS: Our results confirm that chronic HD patients have increased OS, but this is not related to the presence or severity of WML.

Olive oil polyphenols enhance the expression of cholesterol efflux related genes in vivo in humans. A randomized controlled trial.

Both oleic acid and polyphenols have been shown to increase high-density lipoprotein (HDL) cholesterol and to protect HDL from oxidation, a phenomenon associated with a low cholesterol efflux from cells. Our goal was to determine whether polyphenols from olive oil could exert an in vivo nutrigenomic effect on genes related to cholesterol efflux in humans. In a randomized, controlled, cross-over trial, 13 pre/hypertensive patients were assigned 30 ml of two similar olive oils with high (961 mg/kg) and moderate (289 mg/kg) polyphenol content. We found an increase in ATP binding cassette transporter-A1, scavenger receptor class B type 1, peroxisome proliferator-activated receptor (PPAR)BP, PPARα, PPARγ, PPARδ and CD36 gene expression in white blood cells at postprandial after high polyphenol olive oil when compared with moderate polyphenol olive oil intervention (P<.017), with COX-1 reaching borderline significance (P=.024). Linear regression analyses showed that changes in gene expression were related to a decrease in oxidized low-density lipoproteins and with an increase in oxygen radical absorbance capacity and olive oil polyphenols (P<.05). Our results indicate a significant role of olive oil polyphenols in the up-regulation of genes involved in the cholesterol efflux from cells to HDL in vivo in humans. These results are in agreement with previous ones concerning the fact that benefits associated with polyphenol-rich olive oil consumption on cardiovascular risk could be mediated through an in vivo nutrigenomic effect in humans.

Effect of different doses of iron supplementation during pregnancy on maternal and infant health.

Currently, there is no consensus regarding the optimum iron supplementation during pregnancy. The aim of this study is to evaluate the effect of different iron supplementation doses (including no supplementation) during pregnancy on the iron status of the mother and on the health of the neonate. A longitudinal study was conducted involving 358 pregnant women and their newborns. Mothers were classified as non-supplemented, low iron supplemented (<60 mg/day), moderate iron supplemented (between 60 and 100 mg/day) or high iron supplemented (>100 mg/day). General clinical and obstetric histories, haemoglobin (Hb), serum ferritin (SF) and transferrin saturation were evaluated in the first, second, third trimesters, and at partum. SF and Hb decreased less sharply in the iron-supplemented groups compared to the non-supplemented group. The higher the doses of iron supplementation, the lower the percentages of iron depletion at partum (p < 0.001), iron deficiency anaemia (p < 0.001) and preterm deliveries (p = 0.009) as well as a higher birth weight of the newborn. However, the group with high supplementation had a greater percentage (27.6 %) of women at risk of haemoconcentration at partum. Our Mediterranean women began gestation with iron stores close to deficit (SF, 28.1 µg/L; 95 % CI 27.9-28.4). With these iron stores, supplementation with iron at daily doses of between 60 and 100 mg appears to be the most beneficial for the health of mother and child. These findings need to be confirmed in further randomised clinical trials.

Polyphenol-rich foods exhibit DNA antioxidative properties and protect the glutathione system in healthy subjects.

SCOPE: Polyphenols (ingested via food items) can decrease DNA, and oxidative damage of proteins and lipids. However, polyphenol effects in healthy populations have not been well defined. The aim of this study was to assess the relationship between urinary total polyphenol excretion (TPE), a biomarker of total polyphenol intake (TPI), polyphenol-rich foods, and oxidative stress biomarkers in healthy adults of different ages participating in the cross-sectional PAScual MEDicina study. METHODS AND RESULTS: Urinary TPE was determined by Folin-Ciocalteau method in spot urine samples of 81 participants (46 women), classified into three age groups: 18 to 39, 40 to 54, and 55 to 72 years of age. TPI was quantified from 3-day dietary records using the Phenol-Explorer database. Urinary TPE increased with age (p < 0.001). Urinary TPE was inversely associated with urinary 8-hydroxydeoxyguanosine (8-OHdG; p<0.001) and erythrocyte-oxidized glutathione concentrations (p < 0.05). A negative association between urinary 8-OHdG and daily intake of polyphenols from vegetables and fermented beverages such as red wine was observed. CONCLUSION: Urinary TPE increased with age and may reflect attenuation of oxidative damage. These results could explain the beneficial effects in healthy individuals of a diet rich in vegetables and moderate red wine; food items typical of the Mediterranean diet.

Role of oxidative stress in cardiovascular effects of anemia treatment with erythropoietin in predialysis patients with chronic kidney disease.

BACKGROUND/AIM: Oxidative stress (OS) is involved in left ventricular hypertrophy (LVH). Short-term treatment with erythropoietin (EPO) in chronic kidney disease (CKD) complicated by anemia and LVH is associated with a reduction in left ventricular mass (LVM). We proposed to assess whether the pro-oxidant status of CKD influences these outcomes. METHODS: Predialysis patients (n = 76) with CKD and hemoglobin (Hb) levels < 11 g/dl received EPO for 6 months. The effects of this anemia correction on LVH regression were evaluated using echocardiography. Patients with LVM decrease > 10% were considered "responders" (n = 25) to treatment and those with LVM change < 10% were considered "non-responders" (n = 24). Measurement of OS included plasma and erythrocyte oxidized (GSSG) and reduced (GSH) glutathione, GSH redox ratio (GSSG/GSH), erythrocyte glutathione peroxidase (GPx) and oxidized LDL (Ox- LDL). RESULTS: 49 patients completed the study. With EPO therapy, mean Hb levels increased from 9.9 ± 0.6 to 12.8 ± 1.5 g/ dl (p < 0.0001) and LVM index decreased from 69.2 ± 17.7 to 64.1 ± 19.6 g/m2.7 (p = 0.01). At 6 months, "non-responders" had higher systolic blood pressure, pulse pressure, GSSG and GSH redox ratio and lower GSH than "responders". In multivariate analysis, and following adjustment for confounding variables, systolic blood pressure and GSH redox ratio independently predicted LVH regression. CONCLUSION: Blood pressure and plasma GSH redox ratio (a marker of OS) are important predictors of LVH regression in anemic predialysis patients treated with EPO.