Cecilia Martínez-Costa

Carotid Artery Stiffness as an Early Marker of Vascular Lesions in Children and Adolescents With Cardiovascular Risk Factors

INTRODUCTION AND OBJECTIVES The availability of a noninvasive marker of vascular lesions that enables their detection in the preclinical phase would be of great benefit for cardiovascular disease prevention. The aim of this study was to investigate the usefulness of a range of indices of arterial wall stiffness in the common carotid artery, as derived using high-resolution Doppler ultrasonography, for identifying vascular damage in children with risk factors. METHODS The study involved 99 children (age, 8-16 years) divided into two groups: 65 had cardiovascular risk factors (45 obesity, 20 dyslipidemia) and 34 were controls. Family histories of cardiovascular risk factors and anthropometric and biochemical measurements were recorded. Functional parameters of arterial stiffness (i.e., arterial compliance, elastic modulus, beta stiffness index, pulse wave velocity, and augmentation index) and the intima-media thickness were also measured. RESULTS Some functional vascular parameters were higher in obese children than controls: there were significant differences in beta stiffness index (P< .02), elastic modulus (P< .001) and pulse wave velocity (P< .01). There was a significant difference in arterial compliance between dyslipidemics and controls (P< .05). No significant difference in intima-media thickness was found between the groups. In obese children, there were positive correlations between body mass index, systolic pressure and triglyceride levels and vascular parameters (i.e., elastic modulus and pulse wave velocity); in dyslipidemic children, triglyceride levels and the same parameters were correlated. CONCLUSIONS Ultrasonographic measurement of arterial stiffness is a sensitive technique that can detect vascular damage in children with cardiovascular risk factors earlier than intima-media thickness measurement.

Anti-rotavirus antibodies in human milk: quantification and neutralizing activity.

Objective: To analyze anti-rotavirus antibodies in human milk in order to determine their isotypes and neutralizing activity on rotavirus strains representing different viral serotypes. Methods: One hundred seventy-three milk samples (65 colostrum, 55 transitional milk and 53 mature milk) obtained from 65 mothers were analyzed along with 49 serum samples collected just before delivery. Total immunoglobulin A (IgA) and rotavirus-specific IgA and immunoglobulins G (IgG) antibodies were determined in milk and serum by enzyme-linked immunosorbent assay. Neutralizing activity was evaluated by an immunoperoxidase focus reduction assay. Milk IgA was purified by binding to the lectin jacalin, elution and ultrafiltration. Results: Total IgA antibodies were detected in all serum and milk samples analyzed. IgA levels decreased sharply during the replacement of colostrum by transitional milk, and more gradually from transitional to mature milk. These differences in IgA concentration during the 3 periods were statistically significant. Anti-rotavirus antibodies detected in human milk were exclusively of the IgA type, whereas both IgA and IgG anti-rotavirus antibodies were present in serum samples. Both milk and serum samples showed in vitro neutralization of the infectivity of rotavirus strains SA11, Wa and VA70, this activity being stronger toward the human rotavirus strain Wa. No correlation was however found between the inhibitory effect on rotavirus and the concentrations of IgA in human milk and serum samples. Conclusion: Anti-rotavirus antibodies are only partly responsible for the neutralizing activity detected in milk and serum. This result suggests that other components possessing suppressive activity against rotavirus must also be present.

Copper, iron and zinc determinations in human milk using FAAS with microwave digestion.

Abstract A method for determining copper, iron and zinc in human milk was optimized and validated. It includes microwave mineralization of the sample and measuring the elements by flame atomic absorption spectroscopy (FAAS). Only 2 ml of milk is needed, and the method is free of matrix interferences. The values obtained for the detection limits (0.07; 0.07; 0.11 μg/ml milk, for copper, iron and zinc) precision of the method, intra-assay (2.9; 5.2; 6.1%RSD for copper, iron and zinc) and accuracy, evaluated using recovery assays (98.8; 100.4; 95.9% for copper, iron and zinc) show that the method is useful for the purpose mentioned. Moreover, the method is rapid and simple, and the determinations are carried out by FAAS.

Association between WHO cut-offs for childhood overweight and obesity and cardiometabolic risk.

OBJECTIVE To examine the association between cardiovascular risk and childhood overweight and obesity using the BMI cut-offs recommended by the WHO. DESIGN Children were classified as normal weight, overweight and obese according to the WHO BMI-for-age reference. Blood pressure, lipids, glucose, insulin, homeostasis model assessment-insulin resistance (HOMA-IR) and uric acid levels were compared across BMI groups. ANOVA and tests of linearity were used to assess overall mean differences across groups. Crude and adjusted odds ratios were calculated for adverse plasma levels of biochemical variables. SETTING Paediatric care centres. SUBJECTS Children (n 149) aged 8-18 years. RESULTS About 37 %, 22 % and 41 % of children were classified respectively as normal weight, overweight and obese. There were significant linear mean differences between BMI groups in systolic blood pressure, HDL-cholesterol, TAG, insulin, HOMA-IR and uric acid. Obese children were 10·6 times more likely than normal-weight children to have hypertension; OR for other associations were 60·2 (high insulin), 39·5 (HOMA-IR), 27·9 (TAG), 16·0 (HDL-cholesterol), 4·3 (LDL-cholesterol) and 3·6 (uric acid). Overweight children were more likely than normal-weight children to have hypertension (OR = 3·5), high insulin (OR = 28·2), high HOMA-IR (OR = 23·3) and high TAG (OR = 16·1). Nearly 92 % and 57 % of the obese and overweight children, respectively, had one or more risk factor. CONCLUSIONS Obesity and overweight defined using the WHO BMI-for-age cut-offs identified children with higher metabolic and vascular risk. These results emphasize the importance of prevention of overweight and obesity in childhood to reduce cardiovascular risk.

Medida de la rigidez de la arteria carótida como marcador precoz de lesión vascular en niños y adolescentes con factores de riesgo cardiovascular

Introduccion y objetivos Para la prevencion de la enfermedad cardiovascular resulta de gran interes disponer de un marcador incruento de lesion vascular que permita su deteccion en fase preclinica. Nuestro objetivo fue analizar diversos indices de rigidez arterial de la carotida comun mediante ultrasonografia Doppler de alta resolucion para definir su utilidad como detector de dano vascular en ninos con factores de riesgo. Metodos Se estudio a 99 ninos (edades, 8-16 anos) divididos en dos grupos: 65 ninos con factores de riesgo cardiovascular (45 obesos, 20 dislipemicos) y 34 controles. Se recogieron antecedentes familiares de riesgo cardiovascular y variables antropometricas y bioquimicas. Se midieron parametros funcionales de rigidez arterial (compliance arterial, modulo elastico, indice beta de rigidez, velocidad de la onda de pulso e indice de aumento) y el grosor intima-media. Resultados Los ninos obesos presentaron parametros vasculares funcionales elevados respecto a los controles, que fueron significativos para el indice beta (p Conclusiones La medida ultrasonografica de la rigidez arterial es un procedimiento sensible que puede resultar mas precoz que el grosor intima-media para detectar dano vascular en ninos con factores de riesgo cardiovascular.

Copper, iron, and zinc contents in human milk during the first three months of lactation: a longitudinal study.

The aim of the study has been to analyze the evolution of copper, iron, and zinc contents in human milk, from colostrum to the third postpartum month, following a longitudinal design, under specific conditions of sample collection and to apply an analytical procedure previously optimized to reduce any variation outside physiological lactation.The copper, iron, and zinc concentrations in 144 milk samples from 39 healthy puerpera women, were analyzed in five stages by flame atomic absorption spectrometry, following a standardized protocol.Copper presented a gradual decrease from 0.38 mg/L to 0.19 mg/L by the 90th day; the particular analysis from colostrum to transitional milk manifested the following two tendencies. Whereas an increase from 0.19 to 0.42 mg/L was observed in some women, a decrease from 0.53 to 0.45 mg/L was detected in others; therefore, copper presented two significant behaviors in the evolution from colostrum to transitional milk. In both cases, the evaluated changes were significant. The iron content varied from 0.56 to 0.40 mg/L by the 30th day, remaining constant until the first trimester concluded. The average zinc concentration decreased sharply from 7.99 to 3.3 mg/L on d 15; the rate of decrease slowed down gradually until 1.05 mg/L.

A study of factors that may influence the determination of copper, iron, and zinc in human milk during sampling and in sample individuals.

The aim of this study was to establish the possible effects of the sampling protocol (between-breast, within-feed, and diurnal differences) and the mother’s personal factors (age, parity, iron supple-mentation, smoking habits, and lactation period) on the copper, iron, and zinc contents in human milk.One hundred thirty-six human milk samples identified by their origin and sampling conditions were analyzed. The samples were obtained from the 2nd to 15th d postpartum from 62 women. The data on the individuals required for the study were available. Mineral determinations were analyzed by flame atomic absorption spectrometry following a standarized protocol.The results showed that iron contents were higher in hind-milk samples and at the nighttime feeding and depended on the breast from which the sample was taken. The copper and zinc concentrations showed no significant variations. There was no significant relationship among the mothers’ age, parity, smoking habits, iron supplementation, and copper content. Milk from older women had lower zinc contents than that of younger women. Increased amounts of iron were found in multiparous women. Between colostrum and transitional milk, a sharp decrease in zinc content was observed, whereas copper and iron contents remained constant.All of these results make it clear that standardized sampling protocols are needed in order to obtain comparable values.

Influence of Gestational Age, Secretor and Lewis Blood Group Status on the Oligosaccharide Content of Human Milk.

Objectives: Human milk oligosaccharides (HMOs) are considered to play an important role for the infant. As the biotechnical production of some HMOs is feasible today and clinical studies are being designed, the individual variation of the total amount of HMOs and of single components is of particular importance. Our objectives were to investigate whether differences exist between term and preterm milk, milk from mothers with secretor or nonsecretor status, and a Lewis blood group (a+b−), (a−b+), or (a−b−) pattern. Methods: Within a longitudinal study 96 milk samples (colostrum, transitional, and mature milk) from 32 mothers with preterm (n = 18) and term (n = 14) infants were collected. Delipidated and deproteinized milk was subjected to porous graphitized carbon cartridges followed by high pH anion exchange chromatography with pulsed amperometric detection. Results: Quantitation of 16 single HMOs revealed changes during the first weeks of lactation without discrepancies between term and preterm milk. Significant differences occurred between “secretor” and “nonsecretor” milk (median approximately 10 vs 5 g/L total HMOs). Lacto-N-tetraose (LNT) and lacto-N-fucopentaose (LNFP) II comprised > 55% of the total HMO content in Lewis blood group (a+b−), “nonsecretor” milk and LNT together with 2’fucosyllactose, LNFP I, and difucosyllactose approximately 60% in Lewis (a−b+), “secretor” milk. In Lewis (a−b−), “secretor” milk 80% of oligosaccharides are due to LNT, 2’fucosyllactose, and LNFP I. Conclusions: There are marked differences in total HMOs and single HMOs in milk depending on Lewis blood group and secretor status, which need to be taken into account in clinical studies.

Longitudinal Study of Cytokine Expression, Lipid Profile and Neuronal Growth Factors in Human Breast Milk from Term and Preterm Deliveries

Breast milk (BM) is considered as a reference for infant nutrition. The role of bioactive components, such as cytokines, hormones, growth factors (GFs) and fatty acids (FAs) is poorly known, but they might be implicated in immune response development. The aim of this study was to identify the lipid profile and the spectrum of cytokines and neuronal GF in BM samples and analyse the influence of gestational age and lactation time on these components. This study used a longitudinal prospective method for the characterization of cytokines, FAs and GFs global profiles in 120 BM samples from 40 healthy mothers (20 preterm and 20 term) collected as colostrum, transitional and mature milk. The cytokines were analysed by protein array (Ray Bio® Human Cytokine Array G6. Ray Biotech, Inc. Norcross, GA, USA) and the FAs were analysed by gas chromatography. The FA profile was similar between the term and the preterm BM samples. Omega-3-α-linoleic and docosahexaenoic acid (DHA) and omega-6-linoleic acid were the most abundant in the term and preterm samples during lactation. Omega-3 ETA and omega-3 EPA we observed exclusively in the preterm samples. The cytokine profile showed a different trend based on gestational age. A significantly higher expression of neurotrophic factors was found in the mature preterm milk samples as compared to the mature term samples. Our study is the first to identify the influence and interactions of perinatal factors on cytokine, GFs and FAs in human milk.

Intervención nutricional en niños y adolescentes con fibrosis quística. Relación con la función pulmonar

Objective: To investigate the prevalence of trematode Aspidogastrea in the freshwater mussels in the Yangtze River basin within Anhui province, China. Methods: We initially harvested the freshwater mussels living in the Yangtze River running through Anhui area, and labeled them with corresponding number. Then the samples were dissected for isolating the flukes, which were identified by conventional staining. Results: Infection rate of trematode Aspidogastrea in freshwater mussels in the Yangtze River basin within the territory of Anhui province was 30.38℅(103/339)in general, and a total of 912 flukes of Aspidogastrea were detected in the 103 mussels, with average infection rate of 8.85 for each mussel. Conclusion: Trematode Aspdogastrea is prevalent in the freshwater bivalves living in the Yangtze River basin running through Anhui area, and the treamatode was identified as Aspidogaster sp. belong to Aspidogaste under Aspidogastridae of Aspidogastrea.Objective: to assess the use of oral nutritional supplements analyzing the reason for prescription and its implication in caloric-protein intake. Setting: study performed at a university hospital of 350 beds with medical and surgical specialties. Subjects, patients: Patients inclusion was done by selecting all starting oral nutritional supplement prescription. Exclusion criteria were being younger than 18 years, being admitted to the Intensive Care Unit, having cognition or communication impairments, being on concomitant parenteral nutrition or requiring complete enteral diet, and/or using nasogastric tube for feeding. We also excluded special enteral diets, specifically designed for certain conditions. Interventions: One-year long prospective study on prescription of oral nutritional supplements. Through clinical chart review and personal interview, we recorded demographic data, nutritional parameters, characteristics of the diet and supplement, and caloricprotein intake prescribed and ingested. The data were introduced in an Access97 database and processed by means of SPSS software for Windows®. We performed a descriptive study of quantitative and qualitative variables, a χ2 analysis between qualitative variables, and a comparative analysis between means of all paired data by means of the student’s t test, and variance analysis between quantitative variables. The significance level was set at p < 0.05. Results: we were only able to analyze 77 out of 130 prescriptions for nutritional supplements since we could not adequately interview the remaining patients, mainly due to neurological impairments. Mean age was 74.8 years (SD = 12) and 50.6% were women. The departments prescribing the highest number of supplements were hematology (22.1%) and internal medicine (20.8%). GI neoplasm was the most frequent diagnosis at admission (27.3%). The most frequent indication was kwashiorkor (45.5%), with 15.6% of patients being well nourished. Mean therapy duration was 11 days (SD = 11.1), and the main reason for termination was hospital discharge (70.1%). The supplement was concomitantly prescribed with the meals in 70.6% of the cases, and more than halfMaterial y metodos: Estudio retrospectivo de 55 pacientes de 65,4 ± 14,7 anos, 35,7% mujeres y 64,3% varones con un IMC 27,87 ± 5,56 kg/m (0% con IMC 30 kg/m ) en tratamiento con NPT con una duracion de 28 ± 5 dias (mas de 20 dias en el 75% de los casos). El 16,1% presentaba Diabetes Mellitus previa al inicio de NPT. En el 64,3% de los pacientes, la fistula ocurria tras cirugia reciente: en un 38.8% tras reseccion de colon, 16,6% de intestino delgado y 13,9% de estomago. La NPT se planificaba para aportar diariamente 1,5 × Gasto Energetico Basal, 1,5 g/kg/dia de proteinas, 6 mg de vitamina B 12 y 414 μg de acido folico. Ninguna solucion contenia hierro.Objective. To assess the impact of weight loss in clinical progression of the comorbidities in a group of morbid obese patients submitted to surgical treatment with the duodenal switch technique. Study setting. Between 2001-2006, we have operated by the duodenal crossing technique a total of 118 morbid obese patients (97 women and 21 men), mean age 42.6 years. Average pre-surgical BMI was 49.7, with average overweight of 69.1 kg. After surgical intervention, we have prospectively assessed the progression of the main comorbidities (arterial hypertension, diabetes, OSAS, osteoarticular pathology, dyslipidemia), according to the subscale of the BAROS scoring system. Postsurgical controls are done at months 3, 6, 12, 18, and 24 and annually thereafter. We have followed-up 110 patients, of whom 90 presented comorbidities, being the ones studied. Results. At 3 months post-surgery, we observed a decrease in the mean value of %WL to 31%, and a mean BMI value of 41.3, the percentage of lost BMI being 40.3%. Most of the weight loss occurred within 2 years, with %WL of 74.8% and a percentage of lost BMI of 97.7%. In 68 patients (75.5%) there was resolution of their comorbidities, 14.4% having improvement, and 10% with no improvement in spite of the surgery. Of patients achieving complete resolution, almost all of them achieved it within two years after surgery. Cure rates correlate with weight loss, so that at 3 months, with a mean weight loss of 25 kg (BMI decrease of 8.4 points) the comorbidity resolution rate is 45.5%. At 12 months, with a mean decrease in BMI of 16.4 points, %WL of 61.6% and % of lost BMI of 70.4%, the comorbidity resolution rate is 89.7%. At two years, by the time most of the main comorbidities resolved (68 patients), the BMI decreased by 22.4 points, the %WL 74.8% and the % of lost BMI 97.9%. Conclusion. The aim of bariatric surgery is weight loss and overweight-associated comorbidities improvement. In our study, most of the comorbidities improvement started at the third month, with the highest improvement rate occurring within two years, verifying that there is a direct relationship between post-surgical weight loss comorbidities improvement and resolution in most of the cases.Objective: To investigate the breeding rate and breeding density of Carpoglyphus lactis in stored Fructus Jujubae in Anhui, China in order to provide a scientific basis for prevention of Carpoglyphus lactis(C. lactis) from spoiling the dried fruit of such category. Methods： By the breeding nature of C. lactis, we collected samples of Fructus Jujubae, which were kept over 6 months in general, from the dried fruit shop and (or) Chinese herbal medicine warehouse, and isolated C. lactis from those samples. The mite specimens were prepared, and microscopically and morphologically identified. Species classification was done in accordance with Hughes (1976). Result:C. lactis was identified in 19 of the 300 samples, with breeding density and breeding rate of 6.52 heads/g and 6.33%. Constitute ratio at distinct developmental phase was associated with adult (including nymph, 85.71%), larva(12.27%), hypopus (0.56%) and egg(1.45%), respectively. The richness index, diversity index and evenness index was1.644, 1.644 and 0.923, respectively. Conclusion： Carpoglyphus lactis appears infesting in large quantity in the Fructus Jujubae stored in the above places in Anhui province, and the density is higher. Therefore, it is urgent to take effective measures to prevent C. lactis from spreading over other dried products stored in the same room and potential human intestinal acariasis as a result of the biological contamination.Objective: To determine possible associations between the risk of breast cancer in Brazilian women and demographic, social and economical variables, and past dietary intake. Methods: A case-control study was conducted in Joinville, Santa Catarina, Brazil, between june and november 2003 involving a group of 33 women recently diagnosed with breast cancer and a control group of 33 healthy women volunteers. Personal details, health history and past dietary intake were obtained via questionnaires and interviews. Data between groups were compared using χ2, Fisher, and Student’s t test, whilst associations were evaluated using a non-conditional logistic regression method and odds ratio (OR). Results: Statistically significant differences between the two groups were revealed with respect to age distribution (P = 0.007), family income level (P = 0.02), educational level (P 45 years), low family income (<