Effect of soybean grain (Glycine max L.) supplementation on the production and fatty acid profile in milk of grazing cows in the dry tropics of Mexico.

Improving the lipid profile in milk of cows with the use of soybean grain (Glycine max L.) can be favored in the grazing systems in the dry tropics of Mexico. The objective was to evaluate the milk production, the chemical composition, and the fatty acids profile (FAs) of the milk of cows in continuous grazing and supplemented with and without ground roasted soybean in the dry tropics of Mexico. Ten cows randomly distributed in two equal groups were used. Daily during confinement for milking, the cows individually received the treatments on dry basis T0: supplement with 4.6 kg commercial concentrate® without soybean, T1: supplement with 3.7 kg commercial concentrate® with 380 g of soybean. During the 78 days of the experiment, milk production was measured in all cows, and samples were collected to determine the chemical composition and FAs profile. Milk production, protein, milk total fat, lactose, and non-fat solids did not vary with treatment (p >0.05). Linoleic acid content (C18: 2, cis, cis-∆9, ∆12) increased by 22% in milk fat of cows of the T1 (p ˂0.05). The sum of the mono- and polyunsaturated FAs 29.1%, the ratio of saturated-unsaturated FAs (1.65), and the atherogenicity index (1.71) also improved in the milk of cows supplemented with T1 (p ˂0.05). It was concluded that ground roasted soybean supplement in the diet of grazing dairy cows did not affect production and did improve the lipid profile in milk fat with favorable index to promote human health.

The impact of improving the quality of coding in the utilities of Diagnosis Related Groups system in a private healthcare institution. 14-year experience.

BACKGROUND AND PROJECT AIM: The American British Cowdray Medical Center is a private healthcare institution in Mexico City. One of the many tools that we use and help us to achieve a high standard of quality and recognition worldwide is the clinical coding and Diagnosis Related Groups (DRG). To help the readers to improve the process of clinical coding, we will share the challenges, changes and different applications of the generation of DRG in the private healthcare institution. METHODS AND RESULTS: A retrospective, descriptive study to demonstrate the changes on the process of coding and measure the outcome of clinical coding, precision of data and better quality in the generations of DRGs. Initially, less than 2 diagnoses and 1 procedure were coded per discharge, using partial medical records. By the second half of 2007, a different coding procedure was implemented, and the complete medical records started being used; also, comorbid conditions were included in coding. Nowadays, the average number of coded diagnoses is 5.4 and the average number of coded procedures is 4.2, with a coding error rate of 0.68% and a DRG outliers' rate of 0.45%. DISCUSSION AND CONCLUSIONS: While many countries use DRG for reimbursement, we exploit the clinical data registration and the DRGs for the economic and organizational. Through more efficient and accurate coding, DRGs are useful within the institution to generate indicators on resources, cost, length of stay and goals for each service. Having better quality clinical data has allowed for improved service line management, which has translated into patient-oriented services. Prospective studies are necessary to keep evaluating in a objective way the utilities of the DRG in healthcare private institutions.

Modification of HIF-1α, NF-aκB, IGFBP-3, VEGF and adiponectin in diabetic foot ulcers treated with hyperbaric oxygen.

Introduction: Diabetic foot ulcers are a frequent complication of diabetes and the first cause of non-traumatic lower limb amputation. They affect quality of life, restrict social productivity and generate a high economic burden for health care systems. Hyperbaric oxygen (HBO2) therapy is an adjunctive treatment option because it improves wound healing in the short term. However, its ability to modulate the pro- and anti-inflammatory balance and the hypoxic cell response in the clinical setting has not been fully described. Objective: To determine modifications in HIF-1α, NF-κB, IGFBP-3, and VEGF expression in wounds as well as circulating inflammatory cytokines in patients with diabetic foot ulcers subjected to HBO2. Materials and methods: We studied 17 ambulatory patients and one hospitalized patient with diabetic foot ulcers classified as Grade 3 or 4 according to the Wagner scale. All underwent HBO2 therapy. Tissue expression of HIF-1α, NF-κB, IGFBP-3, and VEGF was determined by immunohistochemistry. Plasma levels of adiponectin, IL-6, IFN-γ, IL-10 and IL-4 were measured by ELISA and chemiluminescence. Fibrosis and angiogenesis were determined by Masson's trichrome staining. Results: Ulcers in all patients healed after one month of HBO2, and none presented relapses at the one-year follow-up. At the beginning of treatment, HIF-1α and NF-κB expression was observed mainly in the nucleus, whereas these proteins were localized in the cytoplasm at the end of HBO2. There were significant modifications in VEGF expression after therapy, an increase in the plasma level of proinflammatory IL-6, and a decrease in that of IFN-γ. IGFBP-3 expression and plasma levels of adiponectin were increased at the end of HBO2. Increases in fibrosis and angiogenesis were also observed. Conclusion: These results suggest that adjuvant HBO2 modifies the proinflammatory balance related to the cellular response to hypoxia.

Modulation by bovine lactoferrin of parameters associated with the IgA response in the proximal and distal small intestine of BALB/c mice.

BACKGROUND: Secretory IgA (SIgA) and the polymeric immunoglobulin receptor (pIgR) have a pivotal role in gut homeostasis. Bovine lactoferrin (bLf) has been shown to modulate intestinal immunity and endogenous corticosterone. Considering the regionalization of the intestinal immune response, the aim of this work was to compare the impact of bLf on the IgA response in the proximal versus distal small intestine under physiological conditions. METHODS: Groups of healthy male BALB/c mice were orally treated with one daily dose of bLf (50, 500, or 5000 µg) or untreated (control) for 7 d, and then sacrificed. From plasma samples, corticosterone levels were determined by an enzyme-linked immunosorbent assay (ELISA) kit. From distal and proximal segments of the small intestine, the following material was obtained: intestinal secretions to evaluate IgA levels by ELISA; epithelial cell extracts for protein-analysis of α-chain and pIgR by Western blot; mucosa samples for mRNA analysis of α-/J-chain, pIgR, and interleukin (IL)-2, -4, -5, and -6 by real-time quantitative reverse transcription polymerase chain reaction (RT-PCR). RESULTS: With 5000 µg of bLf, there were greater modulatory effects in the distal (versus proximal) segment, evidenced by an increase in the (i) level of total and specific IgA, (ii) protein expression of α-chain and pIgR, (iii) mRNA transcripts of α-chain, IL-2 and IL-5, and (iv) level of plasma corticosterone. CONCLUSIONS: Endogenous corticosterone elicited by bLf may have allowed for an IL profile that favored the IgA antibody response. The latter has a key role in maintaining intestinal homeostasis.

Effect of Bovine Lactoferrin Treatment Followed by Acute Stress on the IgA-Response in Small Intestine of BALB/c Mice.

Secretory IgA (SIgA) has a pivotal role in gut homeostasis, which can be disturbed by stress. SIgA is formed by IgA-dimers (associated by the J-chain) and the secretory component, a protein derivative of polymeric immunoglobulin receptor (pIgR). Given the gut immuno-modulatory properties of bovine lactoferrin (bLf), the aim of this study was to compare, after bLf treatment followed by acute stress, the IgA response and IgA-associated parameters in proximal versus distal small intestine. Male BALB/c mice (n = 6) were orally treated with bLf (50, 500, and 5000 µg) for 7 days, then stressed by immobilization for 1 h, and sacrificed. In proximal and distal segments, levels were determined of IgA in gut secretions (enzyme-linked immunosorbent assay [ELISA]), the α-/J-chain and pIgR proteins in epithelial cells (Western-blot), and mRNA expression of the α-/J-chain, pIgR, and interleukins (ILs) in mucosa (RT-PCR). Data were compared by two-way analysis of variance (ANOVA) (significance at P < 0.05). Under acute stress, bLf triggered higher levels of IgA, SIgA, and anti-bLf-IgA as well as greater mRNA expression of pIgR, IL-4, and IL-6 (500 µg) in proximal intestine, while inducing higher levels of the total IgA, α-/J-chain, and pIgR proteins as well as greater mRNA expression of the α-chain and IL-4 (5000 µg) in distal intestine. Compared to unstressed/bLf-untreated mice, plasma corticosterone (a stress biomarker, measured by ELISA) increased in stressed/bLf-treated (0, 50 and 500 µg) and unstressed/bLf-treated (5000 µg) mice. The interplay of corticosterone with gut neuroendocrine factors may have elicited signals creating anti-inflammatory conditions for an IgA-response profile in each intestinal region, according to the bLf concentration administered.

Stress modulates intestinal secretory immunoglobulin A.

Stress is a response of the central nervous system to environmental stimuli perceived as a threat to homeostasis. The stress response triggers the generation of neurotransmitters and hormones from the hypothalamus pituitary adrenal axis, sympathetic axis and brain gut axis, and in this way modulates the intestinal immune system. The effects of psychological stress on intestinal immunity have been investigated mostly with the restraint/immobilization rodent model, resulting in an up or down modulation of SIgA levels depending on the intensity and time of exposure to stress. SIgA is a protein complex formed by dimeric (dIgA) or polymeric IgA (pIgA) and the secretory component (SC), a peptide derived from the polymeric immunoglobulin receptor (pIgR). The latter receptor is a transmembrane protein expressed on the basolateral side of gut epithelial cells, where it uptakes dIgA or pIgA released by plasma cells in the lamina propria. As a result, the IgA-pIgR complex is formed and transported by vesicles to the apical side of epithelial cells. pIgR is then cleaved to release SIgA into the luminal secretions of gut. Down modulation of SIgA associated with stress can have negative repercussions on intestinal function and integrity. This can take the form of increased adhesion of pathogenic agents to the intestinal epithelium and/or an altered balance of inflammation leading to greater intestinal permeability. Most studies on the molecular and biochemical mechanisms involved in the stress response have focused on systemic immunity. The present review analyzes the impact of stress (mostly by restraint/immobilization, but also with mention of other models) on the generation of SIgA, pIgR and other humoral and cellular components involved in the intestinal immune response. Insights into these mechanisms could lead to better therapies for protecting against pathogenic agents and avoiding epithelial tissue damage by modulating intestinal inflammation.

Causas que inciden en la automedicación con medicamentos y plantas medicinales en las mujeres del Reparto Primero de Mayo territorio Mántica Berio de la ciudad de León en los meses de agosto - octubre del año 2003 / Causes that affect the self-medication with medicines and medicinal plants in the women of the First May May Mántica Berio territory of the city of León in the months of August - October 2003

El presente estudio de investigación trata de identificar las causas que inciden en la automedicación con medicamentos y plantas medicinales en las mujeres del Reparto Primero de Mayo. Territorio Mántica Berio de la ciudad de León en los meses Agosto a Octubre del 2003. Así como, relacionar el número de mujeres que se automedican según la edad, con el nivel de escolaridad y ocupación de la población; describir las causas que contribuyen a la práctica de automedicación en la población y conocer el grupo de medicamentos, plantas medicinales y la frecuencia de uso en la automedicación en la población de estudio.