A quality improvement strategy to reduce unintended extubation in the very low birth weight infant: A case report.

BACKGROUND: Unintended extubations remain a common complication across neonatal intensive care units, with very low birthweight infants being the most vulnerable of them all. Ongoing efforts across different institutions exist with the goal of reducing the rate of unintended extubations to keep a median rate of <2 events per 100 ventilator days as defined by the Vermont Oxford Network. Our objective was to reduce unintended extubations in the very low birthweight infant in a large delivery hospital to ≤2/100 ventilator days. METHODS: A collaborative group was formed between two academic health institutions targeting training and implementation of the Children's National unintended extubation system, focusing on endotracheal tube securement methods and surveillance protocols. RESULTS: The unintended extubation rate decreased from 3.23 to 0.64 per 100 ventilator days. Changes were implemented from 2018-2020 with a sustained reduction in the unintended extubation rate of 1.54 per 100 ventilator days. Most events occurred between 12 : 00 pm -4 : 00 pm and the commonest cause was spontaneous (25%) followed by dislodgment during repositioning (19%). CONCLUSION: Very low birth weight infants present a challenge to endotracheal tube maintenance due to their developmental and anatomical changes during their neonatal intensive care unit stay. Successful reduction of unintended extubations in the very low birthweight infant can be achieved by adaptation of successful protocols for older infants.

The immune response of the scallop Argopecten purpuratus is associated with changes in the host microbiota structure and diversity.

All organisms live in close association with a variety of microorganisms called microbiota. Furthermore, several studies support a fundamental role of the microbiota on the host health and homeostasis. In this context, the aim of this work was to determine the structure and diversity of the microbiota associated with the scallop Argopecten purpuratus, and to assess changes in community composition and diversity during the host immune response. To do this, adult scallops were immune challenged and sampled after 24 and 48 h. Activation of the immune response was established by transcript overexpression of several scallop immune response genes in hemocytes and gills, and confirmed by protein detection of the antimicrobial peptide big defensin in gills of Vibrio-injected scallops at 24 h post-challenge. Then, the major bacterial community profile present in individual scallops was assessed by denaturing gradient gel electrophoresis (DGGE) of 16S rDNA genes and dendrogram analyses, which indicated a clear clade differentiation of the bacterial communities noticeable at 48 h post-challenge. Finally, the microbiota structure and diversity from pools of scallops were characterized using 16S deep amplicon sequencing. The results revealed an overall modulation of the microbiota abundance and diversity according to scallop immune status, allowing for prediction of some changes in the functional potential of the microbial community. Overall, the present study showed that changes in the structure and diversity of bacterial communities associated with the scallop A. purpuratus are detected after the activation of the host immune response. Now, the relevance of microbial balance disruption in the immune capacity of the scallop remains to be elucidated.

Daily uptake of mycotoxins - TDI might not be protective for nursed infants.

Exclusive breast feeding is recommended by international bodies for the first six months of life. Because of the presence of contaminants, breast feeding might lead to toxicologically relevant exposure of the nursed child. Exposure towards mycotoxins is of specific interest because of their widespread occurrence in food and of their toxicological profile. We calculated the relationship between maternal intake at the level of the existing TDIs and the exposure in the nursed infants of several mycotoxins to evaluate whether maternal exposure at the TDI is also safe for the nursed infant. If published information was not available we used in silico methods for estimating toxicokinetic parameters and the lactational transfer. A single dose and a continuous daily intake scenario were considered. Maternal intake at the TDI exceeds the age-adjusted TDI (TDI/3) values for infants in case of deoxynivalenol and patulin in the single dose scenario. Exceedance is particularly pronounced for ochratoxin A in the continuous daily intake scenario (29.2 fold above the child adjusted TDI). According to published data in infants impaired kidney function may result from this exceedance. When setting a TDI, the safety of the exclusively nursed infant should be considered in the continuous daily intake scenario.

Improving risk assessment for post-surgical low cardiac output syndrome in patients without severely reduced ejection fraction undergoing open aortic valve replacement. The role of global longitudinal strain and right ventricular free wall strain.

Low cardiac output syndrome (LCOS) after surgical aortic valve replacement (SAVR) is related to increased mortality and treatment related costs. We aimed to evaluate whether echocardiography-derived left ventricular global longitudinal strain (LV-GLS) relates to the occurrence of postoperative LCOS in patients undergoing SAVR. We prospectively enrolled 75 patients with symptomatic severe aortic stenosis, left ventricular ejection fraction (LVEF) >40%, NYHA Class

Chemically induced hypoxia promotes differential outcomes over preadipocyte- or adipocyte-macrophage communication.

Expansion of white adipose tissue induce insufficient vascularization, driving hypoxia and low-grade inflammation. Resident preadipocytes are thought to be involved. We evaluated the effects of hypoxia over preadipocytes and adipocytes, to determine which cellular type impacts the most over macrophages activation. 3T3-L1 cells were either differentiated, or maintained undifferentiated. Each group was subjected to the presence or absence of chemical hypoxia (200 µM CoCl2) for 24 h. Conditioned media were used as treatment for murine RAW264.7 macrophages for 24 h. Gene expression of HIF-1α and TNF-α, and the release of several markers were assessed. It was observed that culture media from hypoxic preadipocytes induced greater expression of inflammatory markers and NO release than culture media from hypoxic adipocytes, by macrophages. Gene expression correlated closer with inflammatory markers release specially on macrophages treated with conditioned media from preadipocytes. Hence, the present work highlights the importance of preadipocytes on inflammatory conditions in vitro.

Evidence of ochratoxin A conjugates in urine samples from infants and adults.

Ochratoxin A (OTA), a mycotoxin with nephrotoxic and carcinogenic properties, is an important contaminant of food and feed. Analysis of OTA in human biological fluids (blood, urine, or breast milk) has documented frequent exposure to this mycotoxin, yet at quite variable levels in different population groups across the world. Urine is the preferred matrix in biomonitoring since sample collection is non-invasive and better accepted by study participants. As only a small fraction of the ingested OTA is excreted in urine, determination of urinary OTA requires sensitive analytical techniques, and phase-II-metabolites should be also considered as biomarkers of exposure. Yet, data published so far on the presence of OTA-glucuronide/sulfate in human urine have been contradictory. In this study, urines (n = 38) from two groups of breastfed infants (German and Turkish) and from German adults were now analysed for the presence of OTA glucuronides or sulfates by an indirect method, i.e. by comparing the levels of OTA (aglycone) in urines without and after enzymatic hydrolysis with ß-glucuronidase/arylsulfatase. Additionally, ochratoxin A-8-ß-glucuronide and open lactone ochratoxin A-8-ß-glucuronide were synthesized to serve as reference materials for metabolite analysis. Attempts for definitive confirmation of glucuronides of OTA via direct identification in LC-MS/MS analysis were hampered by the lower ionizability of the conjugates compared to the parent compound. Considerable increases in OTA levels were found after enzymatic hydrolysis in several (not all) urine samples and provide clear evidence for the excretion of OTA-conjugates. The latter observation is of importance, since OTA phase-II-metabolites may escape detection when direct methods are applied for urinary biomarker analysis. In conclusion, enzymatic hydrolysis of urine samples is highly advisable in order to avoid an underestimation of the OTA-exposure.

Evidences of Polymorphism Associated with Circadian System and Risk of Pathologies: A Review of the Literature.

The circadian system is a supraphysiological system that modulates different biological functions such as metabolism, sleep-wake, cellular proliferation, and body temperature. Different chronodisruptors have been identified, such as shift work, feeding time, long days, and stress. The environmental changes and our modern lifestyle can alter the circadian system and increase the risk of developing pathologies such as cancer, preeclampsia, diabetes, and mood disorder. This system is organized by transcriptional/tranductional feedback loops of clock genes Clock, Bmal1, Per1-3, and Cry1-2. How molecular components of the clock are able to influence the development of diseases and their risk relation with genetic components of polymorphism of clock genes is unknown. This research describes different genetic variations in the population and how these are associated with risk of cancer, metabolic diseases such as diabetes, obesity, and dyslipidemias, and also mood disorders such as depression, bipolar disease, excessive alcohol intake, and infertility. Finally, these findings will need to be implemented and evaluated at the level of genetic interaction and how the environment factors trigger the expression of these pathologies will be examined.

Effect of plastic mulching on mycotoxin occurrence and mycobiome abundance in soil samples from asparagus crops.

Plastic mulching (PM) is widely used in modern agriculture because of its advantageous effects on soil temperature and water conservation, factors which strongly influence the microbiology of the soil. The aim of this study was to assess the effect of PM on mycotoxin occurrence in relation with mycobiome abundance/diversity and soil physicochemical properties. Soil samples were collected from green (GA) and white asparagus (WA) crops, the last under PM. Both crops were cultivated in a ridge-furrow-ridge system without irrigation. Samples were analyzed for mycotoxin occurrence via liquid chromatography coupled to high-resolution mass spectrometry (LC-HRMS). Total colony-forming unit was indicative of mycobiome abundance, and analysis of mycobiome diversity was performed by internal transcribed spacer (ITS) sequencing. PM avoided the drop of soil temperature in winter and allowed higher soil temperature in early spring compared to non-covered soil. Moreover, the use of PM provided controlled conditions for water content in soil. This was enough to generate a dissimilar mycotoxin occurrence and mycobiome diversity/abundance in covered and non-covered soil. Mycotoxin soil contamination was confirmed for deoxynivalenol (DON), range LOD to 32.1 ng/g (LOD = 1.1 ng/g). The DON values were higher under PM (average 16.9 ± 10.1 ng/g) than in non-covered soil (9.1 ± 7.9 ng/g); however, this difference was not statically significant (p = 0.09). Mycobiome analysis showed a fungal compartment up to fivefold higher in soil under PM compared to GA. The diversity of the mycobiome varied between crops and also along the soil column, with an important dominance of Fusarium species at the root zone in covered soils.

Exposure of infants to ochratoxin A with breast milk.

The nephrotoxic and carcinogenic mycotoxin ochratoxin A (OTA) is a worldwide contaminant in food commodities and also found frequently in human biological fluids. Dietary contaminants ingested by nursing mothers can appear in breast milk. But the rate of lactational transfer of OTA has not been investigated so far at various stages of breastfeeding. Therefore, and to investigate OTA exposure of Chilean infants, we conducted a longitudinally designed study in mother-child pairs (n = 21) with parallel collection of maternal blood, milk and of infant urine samples over a period of up to 6 months. Validated analytical methods were applied to determine OTA concentrations in all biological samples (n = 134). OTA was detected in almost all maternal blood plasma, at concentrations ranging between 72 and 639 ng/L. The OTA concentrations in breast milk were on average one quarter of those measured in plasma (M/P ratio 0.25). Interestingly, a higher fraction of circulating OTA was excreted in colostrum (M/P 0.4) than with mature milk (M/P ≤ 0.2). Infants exposure was calculated as daily intake from our new data for OTA levels in breast milk, and taking into account milk consumption and body weight as additional variables: Chilean infants have an average intake of 12.7 ± 9.1 ng/kg bw during the first 6 days after delivery while intake with mature milk results in average values close to 5.0 ng/kg bw/day. Their OTA exposure is discussed in the context of tolerable intake values suggested by different scientific bodies. Moreover, the study design enabled a comparison of OTA intake and infant urine concentrations over the breastfeeding period. The statistical analysis of n = 27 paired values showed a good correlation (r = 0.57) for this type of studies and thereby confirms that urinary OTA analysis in infants is a valid biomarker of exposure.

[Occurrence of the mycotoxin ochratoxin a in breast milk samples from Germany]. / Zum Vorkommen des Mykotoxins Ochratoxin A in Muttermilchproben aus Deutschland.

INTRODUCTION: Breast milk is the best form of nutrition early in life, yet it may contain contaminants which were ingested by mothers. Ochratoxin A (OTA) is a well-known nephrotoxin with carcinogenic properties and a frequent food contaminant. Ingested OTA is partly excreted with human milk and studies conducted in different countries have shown a wide range of OTA concentrations. The aim of this study was to assess the exposure of infants to OTA by analysing breast milk samples from 2 German areas. METHODS: Breast milk samples were obtained from 90 mothers who had signed an informed consent sheet. The previously validated analytical method (LOD=10 ng/L, LOQ=30 ng/L) involves liquid-liquid extraction and analysis by HPLC with tandem mass spectrometric detection. A preliminary risk assessment was done using the TDI approach. CONCLUSION: More than 50% of the collected 90 milk samples contained detectable OTA levels. Overall, the average concentration in milk from -Dortmund (24.4 ± 21.1 ng/L (n=30), range:<10-100 ng/L) were significant higher than those measured in the Hannover cohort (14.4 ±1 5.1 ng/L (n=60), range: <10-78 ng/L). The OTA levels of 13 samples were measured with concentrations≥ LOQ. The burden of breast milk in different lactation stages, differentiated by colostrum, transitional milk and mature milk, did not differ in the 2 samples collectives Dortmund and Hannover. The infants' exposure was assessed by calculating their OTA intake via human milk. These results were then compared to the recently re-evaluated Tolerable Daily Intake (TDI) of 3 ng/kg body weight/day. In 29% of the cases (with 26 milk samples), the TDI of 3 ng/kg body weight/day was exceeded.In summary, infant exposure to OTA with human milk in Germany is usually low compared to several other countries. Given that in some cases the TDI is exceeded, further efforts to regulate OTA levels in food with the aim of reducing the contamination should be made to minimize the exposure of lactating women to OTA.

FKBP5 and emotional neglect interact to predict individual differences in amygdala reactivity.

Individual variation in physiological responsiveness to stress mediates risk for mental illness and is influenced by both experiential and genetic factors. Common polymorphisms in the human gene for FK506 binding protein 5 (FKBP5), which is involved in transcriptional regulation of the hypothalamic-pituitary-adrenal (HPA) axis, have been shown to interact with childhood abuse and trauma to predict stress-related psychopathology. In the current study, we examined if such gene-environment interaction effects may be related to variability in the threat-related reactivity of the amygdala, which plays a critical role in mediating physiological and behavioral adaptations to stress including modulation of the HPA axis. To this end, 139 healthy Caucasian youth completed a blood oxygen level-dependent functional magnetic resonance imaging probe of amygdala reactivity and self-report assessments of emotional neglect (EN) and other forms of maltreatment. These individuals were genotyped for 6 FKBP5 polymorphisms (rs7748266, rs1360780, rs9296158, rs3800373, rs9470080 and rs9394309) previously associated with psychopathology and/or HPA axis function. Interactions between each SNP and EN emerged such that risk alleles predicted relatively increased dorsal amygdala reactivity in the context of higher EN, even after correcting for multiple testing. Two different haplotype analyses confirmed this relationship as haplotypes with risk alleles also exhibited increased amygdala reactivity in the context of higher EN. Our results suggest that increased threat-related amygdala reactivity may represent a mechanism linking psychopathology to interactions between common genetic variants affecting HPA axis function and childhood trauma.

Human papillomavirus infection and its association with cervical dysplasia in Ecuadorian women attending a private cancer screening clinic.

Women living in Latin American countries bear a disproportionate burden of cervical cancer, a condition caused by infection with the human papillomavirus (HPV). We performed a study in Santa Elena, Guayas (currently Santa Elena Province), Ecuador, to determine how often HPV could be detected in women attending a private cancer screening clinic. Participants underwent a Pap test, and vaginal and cervical swabs were performed for HPV testing by the polymerase chain reaction (PCR). Each participant completed a verbally administered survey. The mean age of 302 participants was 37.7 years (range 18 to 78 years). The majority of cervical and vaginal specimens contained sufficient DNA to perform PCR. Overall, 24.2% of the participants had either a cervical or vaginal swab that tested positive for HPV. In general, there was a good correlation between the HPV types detected in the cervical and vaginal swabs from the participants, but vaginal swabs were more likely to contain HPV DNA than were cervical swabs. The high-risk HPV types 16, 52, 58, and 59 and the low-risk HPV types 62, 71, 72, and 83 were the most frequently detected HPV types. The number of lifetime sexual partners was positively associated with detection of any HPV type, detection of oncogenic HPV, and abnormal Pap smears. Further studies are needed to determine if these results are representative of all Ecuadorian women and to determine if cervical cancers in Ecuadorian women are caused by the same HPV types found in the swab specimens obtained in this study.

Human papillomavirus infection and its association with cervical dysplasia in Ecuadorian women attending a private cancer screening clinic

Women living in Latin American countries bear a disproportionate burden of cervical cancer, a condition caused by infection with the human papillomavirus (HPV). We performed a study in Santa Elena, Guayas (currently Santa Elena Province), Ecuador, to determine how often HPV could be detected in women attending a private cancer screening clinic. Participants underwent a Pap test, and vaginal and cervical swabs were performed for HPV testing by the polymerase chain reaction (PCR). Each participant completed a verbally administered survey. The mean age of 302 participants was 37.7 years (range 18 to 78 years). The majorityof cervical and vaginal specimens contained sufficient DNA to perform PCR. Overall, 24.2% of the participants had either a cervical or vaginal swab that tested positive for HPV. In general, there was a good correlation between the HPV types detected in the cervical and vaginal swabs from the participants, but vaginal swabs were more likely to contain HPV DNA than were cervical swabs. The high-risk HPV types 16, 52, 58, and 59 and the low-risk HPV types 62, 71, 72, and 83 were the most frequently detected HPV types. The number of lifetime sexual partners was positively associated with detection of any HPV type, detection of oncogenic HPV, and abnormal Pap smears. Further studies are needed to determine if these results are representative of all Ecuadorian women and to determine if cervical cancers in Ecuadorian women are caused by the same HPV types found in the swab specimens obtained in this study.

Conocimiento sobre el ácido fólico en la prevención de defectos de cierre del tubo neural: una encuesta a mujeres que viven en Santiago de Chile / Awareness of post partum women on the effects of folie acid in the prevention of congenital anomalies

Background: Wheat flour in Chile is fortified with folie acid and pregnant women are also supplemented with the vitamin, but the population level of knowledge or awareness about this vitamin and its use by pregnant women is unknown. Aim: To assess the level of knowledge that postpartum women from Santiago de Chile have about folie acid. Material and methods: A questionnaire about folie acid and its efects on the prevention of neural tube defects was developed adapting questionnaires designed abroad. It was applied by medical students to puerperal women, hospitalized in public hospitals. Results: The questionnaire was applied to 342 women aged 26 ± 7 years. Sixty one percent were housewives and 55 percent completed high school education. Forty seven percent of these women had heard about folie acid, 9.6 percent knew that it was able to prevent congenital defects and only one received an adequate supplementation during pregnancy. Women aged 25 to 34 years and those with an adequate medical care during pregnancy had a significantly better knowledge about folie acid and its role in the prevention of congenital anormalies. The more commom means to receive information about folie acid were midwifes (34 percent), mass media (28 percent) and doctors (20 percent). Two hundred eleven women (62 percent) agreed to take folie acid in a future gestation and 58 percent preferred to do so using fortified foods. Conclusions: Post partum women from Santiago have a poor knowledge about the relevance of folie acid supplementation.

Rationale for the administration of acellular pertussis vaccine to parents of infants in the neonatal intensive care unit.

Pertussis infections in the United States are increasing as a consequence of waning immunity and increased surveillance. Those most at-risk of mortality include infants less than 6 months of age and premature infants. The 2006 immunization schedule emphasizes an adolescent pertussis booster at 12 years of age. However, of concern is the current generation of parents and grandparents who will still be un-immunized and therefore, available vectors of pertussis to vulnerable neonates. Given the proximity of parents to medical care in the Neonatal Intensive Care Unit (NICU), and the potential for severe disease in their children, NICU personnel should consider administration of acellular pertussis vaccine to parents of hospitalized infants.

[Awareness and knowledge of the use of folic acid in the prevention of neural tube defects: a survey of women living in Santiago, Chile]. / Conocimiento sobre el ácido fólico en la prevención de defectos de cierre del tubo neural: una encuesta a mujeres que viven en Santiago de Chile.

BACKGROUND: Wheat flour in Chile is fortified with folie acid and pregnant women are also supplemented with the vitamin, but the population level of knowledge or awareness about this vitamin and its use by pregnant women is unknown. AIM: To assess the level of knowledge that postpartum women from Santiago de Chile have about folic acid. MATERIAL AND METHODS: A questionnaire about folic acid and its effects on the prevention of neural tube defects was developed adapting questionnaires designed abroad. It was applied by medical students to puerperal women, hospitalized in public hospitals. RESULTS: The questionnaire was applied to 342 women aged 26 +/- 7 years. Sixty one percent were housewives and 55% completed high school education. Forty seven percent of these women had heard about folic acid, 9.6% knew that it was able to prevent congenital defects and only one received an adequate supplementation during pregnancy. Women aged 25 to 34 years and those with an adequate medical care during pregnancy had a significantly better knowledge about folic acid and its role in the prevention of congenital anomalies. The more common means to receive information about folic acid were midwives (34%), mass media (28%) and doctors (20%). Two hundred eleven women (62%) agreed to take folic acid in a future gestation and 58% preferred to do so using fortified foods. CONCLUSIONS: Post partum women from Santiago have a poor knowledge about the relevance of folic acid supplementation.

Conocimiento y uso de ácido fólico periconcepcional: estudio comparativo entre puérperas adolescentes y adultas en Santiago de Chile / Knowledge and use of periconceptional folic acid

Introduction: intake of Folic Acid (FA) before conception and during early pregnancy reduces the incidence of neural tube defects (NTD). In Chile the management of the pregnant adolescent women is a relevant public health problem. So, the aim of this study was to determine the level of knowledge and intake of FA in a sample of adolescent and older parturient. Methods: a survey was conducted in one group of teenagers (group A) and another group of older puerperal (group B) corresponding to four public maternities of Santiago. Results: finally, 79 teenagers and 263 older women were surveyed. Both groups showed a poor knowledge about the benefit of intake of FA during this period. Regarding the control before pregnancy, we found an attendance of 10.1 percent in the group A and 24.7 percent in the group B, whereas only 5.1 percent of the group A and 1.9 percent of the group B had an intake of FA according to the medical recommendation. Conclusion: our patients have scanty information about the benefits of the periconceptional intake of FA. It seems necessary to design new methods and tools in order to increase the use of the FA in women of childbearing age, especially in the groups at risk for NTD.

Trypanosoma evansi isolated from capybara (Hidrochaeris hidrochaeris).

A study was conducted to determine the morphological and biometric characteristics of Trypanosoma isolated from 50 capybaras animals, raised in captivity in the Peruvian Amazon. Trypanosoma was found in 14 blood samples using the microhaematocrit, wide drop, and Giemsa-stain methods and T. evansi was identified through morphological details in all 14 positive samples (the subterminal kinetoplast, the developed undulating membrane, and a long free flagellum were used for the identification of the agent).

Loss of HNF-1alpha function in mice leads to abnormal expression of genes involved in pancreatic islet development and metabolism.

Mutations in hepatocyte nuclear factor 1alpha (HNF-1alpha) lead to maturity-onset diabetes of the young type 3 as a result of impaired insulin secretory response in pancreatic beta-cells. The expression of 50 genes essential for normal beta-cell function was studied to better define the molecular mechanism underlying the insulin secretion defect in Hnf-1alpha(-/-) mice. We found decreased steady-state mRNA levels of genes encoding glucose transporter 2 (Glut2), neutral and basic amino acid transporter, liver pyruvate kinase (L-Pk), and insulin in Hnf-1alpha(-/-) mice. In addition, we determined that the expression of several islet-enriched transcription factors, including Pdx-1, Hnf-4alpha, and Neuro-D1/Beta-2, was reduced in Hnf-1alpha(-/-) mice. These changes in pancreatic islet mRNA levels were already apparent in newborn animals, suggesting that loss of Hnf-1alpha function rather than chronic hyperglycemia is the primary cause of the altered gene expression. This expression profile was pancreatic islet-specific and distinct from hepatocytes, where we found normal expression of Glut2, L-Pk, and Hnf-4alpha in the liver of Hnf-1alpha(-/-) mice. The expression of small heterodimer partner (Shp-1), an orphan receptor that can heterodimerize with Hnf-4alpha and inhibit its transcriptional activity, was also reduced in Hnf-1alpha(-/-) islets. We characterized a 0.58-kb Shp-1 promoter and determined that the decreased expression of Shp-1 may be indirectly mediated by a downregulation of Hnf-4alpha. We further showed that Shp-1 can repress its own transcriptional activation by inhibiting Hnf-4alpha function, thereby establishing a feedback autoregulatory loop. Our results indicate that loss of Hnf-1alpha function leads to altered expression of genes involved in glucose-stimulated insulin secretion, insulin synthesis, and beta-cell differentiation.