Incidencia de lesiones cutáneas asociadas a la humedad en una unidad de cuidados intensivos / Incidence of moisture-associated skin damage in an intensive care unit

Objetivos: Determinar la incidencia de las lesiones cutáneas asociadas a la humedad (LESCAH) en el área del pañal, identificar los factores predisponentes y conocer las medidas preventivas y registros realizados. Metodología: Estudio descriptivo longitudinal (junio de 2014-abril de 2015) en una UCI polivalente. Se incluyeron pacientes con estancia > 48 h y sin lesiones cutáneas. Se valoró diariamente la piel hasta la aparición de LESCAH, alta o un máximo de 14 días. Se registraron datos demográficos, estancia, tipo de LESCAH, incontinencia, consistencia y número de deposiciones, obesidad, escala Braden y prevención. Resultados: Se estudiaron 145 pacientes (66,2% hombres), la mediana de edad fue 69 (P25 = 56,5-P75 = 76) años y la estancia de 5(P25 = 3-P75 = 11,25) días, el 29,9% presentó obesidad. Se detectó un 26,2% de dermatitis asociada a la incontinencia (DAI) y un 15,9% dermatitis intertriginosa (DI). Se registró el 23,8% de las LESCAH. Las variables relacionadas con la DAI fueron la incontinencia fecal, número de deposiciones, heces líquidas y estancia. Para la DI fueron la obesidad y la puntuación en la escala Braden. El análisis multivariable seleccionó la incontinencia fecal (OR = 5,4; IC 95%:1,1-26) y el número de deposiciones (OR = 1,1; IC:1,0-1,2) como variables independientes para desarrollar DAI y la obesidad (OR=2,8; IC95%:1,0-8,2) y escala Braden (OR =0,8; IC95%:0,7-1,0) para desarrollar DI. Se realizó prevención al 23,8% de los obesos y al 42,9% de los incontinentes. Conclusiones: Existe una elevada incidencia en LESCAH. Tener incontinencia fecal y mayor número de deposiciones son factores de riesgo para desarrollar DAI. La obesidad y una puntuación menor en la escala Braden predisponen a sufrir DI. El registro de las LESCAH y la prevención en pacientes de riesgo es insuficiente

Objectives: To determine the incidence of moisture-associated skin damage (MASD) in the nappy area, identify predisposing factors and know the preventive measures and nursing records. Method: Descriptive longitudinal study (June 2014-April 2015) in a general ICU. Patients whose stay >48 hours and without skin lesions were included. The skin was assessed daily until the appearance of MASD, discharge or a maximum of 14 days. Demographics, stay, MASD type, incontinence, number and consistency of stools, obesity, Braden scale and prevention were recorded. Results: 145 patients (66.2% male) were studied, median age was 69 (P25 = 56.5, P75 = 76) and median length of stay was five days (P25 = 3, P75 = 11.25), 29.9% were obese. Incontinence-associated dermatitis (IAD) was detected in 26.2% and intertriginous dermatitis (ITD) in 15.9%. MASD was recorded in 23.8%. The variables causing IAD to develop were faecal incontinence, number of stools, liquid stools, and stay. Those for ITD were obesity and score on the Braden scale. Multivariate analysis selected faecal incontinence (OR = 5.4, CI95%: 1.1-26) and the number of stools (OR = 1.1, CI 95%:1.0-1.2) as independent variables for developing IAD and obesity (OR = 2.8, CI 95%:1.0-8.2) and Braden (OR = 0.8, CI 95%:0.7-1.0) for developing ITD. Prevention to 23.8% of obese and 42.9% of incontinent was performed. Conclusions: There is a high incidence in MASD. Faecal incontinence and higher number of stools are the risk factors for developing IAD. Obesity and a lower score on the Braden scale may affect susceptibility to ITD. Recording of MASD and its prevention in patients at risk is insufficient

Incidence of moisture-associated skin damage in an intensive care unit. / Incidencia de lesiones cutáneas asociadas a la humedad en una unidad de cuidados intensivos.

OBJECTIVES: To determine the incidence of moisture-associated skin damage (MASD) in the nappy area, identify predisposing factors and know the preventive measures and nursing records. METHOD: Descriptive longitudinal study (June 2014-April 2015) in a general ICU. Patients whose stay >48hours and without skin lesions were included. The skin was assessed daily until the appearance of MASD, discharge or a maximum of 14 days. Demographics, stay, MASD type, incontinence, number and consistency of stools, obesity, Braden scale and prevention were recorded. RESULTS: 145 patients (66.2% male) were studied, median age was 69 (P25=56.5, P75=76) and median length of stay was five days (P25=3, P75=11.25), 29.9% were obese. Incontinence-associated dermatitis (IAD) was detected in 26.2% and intertriginous dermatitis (ITD) in 15.9%. MASD was recorded in 23.8%. The variables causing IAD to develop were faecal incontinence, number of stools, liquid stools, and stay. Those for ITD were obesity and score on the Braden scale. Multivariate analysis selected faecal incontinence (OR=5.4, CI95%: 1.1-26) and the number of stools (OR=1.1, CI95%:1.0-1.2) as independent variables for developing IAD and obesity (OR=2.8, CI95%:1.0-8.2) and Braden (OR=0.8, CI95%:0.7-1.0) for developing ITD. Prevention to 23.8% of obese and 42.9% of incontinent was performed. CONCLUSIONS: There is a high incidence in MASD. Faecal incontinence and higher number of stools are the risk factors for developing IAD. Obesity and a lower score on the Braden scale may affect susceptibility to ITD. Recording of MASD and its prevention in patients at risk is insufficient.

CT angiography for surgical planning in face transplantation candidates.

SUMMARY: Facial allotransplantation replaces missing facial structures with anatomically identical tissues, providing desired functional, esthetic, and psychosocial benefits far superior to those of conventional methods. On the basis of very encouraging initial results, it is likely that more procedures will be performed in the near future. Typical candidates have extremely complex vascular anatomy due to severe injury and/or multiple prior reconstructive attempts; thus, each procedure is uniquely determined by the defects and vascular anatomy of the candidate. We detail CT angiography vascular mapping, noting the clinical relevance of the imaging, the angiosome concept and noninvasive delineation of the key vessels, and current controversies related to the vascular anastomoses.

Procyanidin content of grape seed and pomace, and total anthocyanin content of grape pomace as affected by extrusion processing.

UNLABELLED: Grape juice processing by-products, grape seed and pomace are a rich source of procyanidins, compounds that may afford protection against chronic disease. This study was undertaken to identify optimal extrusion conditions to enhance the contents of monomers and dimers at the expense of large molecular weight procyanidin oligomers and polymers in grape seed and pomace. Extrusion variables, temperature (160, 170, and 180 degrees C in grape seed, and 160, 170, 180, and 190 degrees C in pomace) and screw speed (100, 150, and 200 rpm in both) were tested using mixtures of grape seed as well as pomace with decorticated white sorghum flour at a ratio of 30 : 70 and moisture content of 45%. Samples of grape seed and pomace were analyzed for procyanidin composition before and after extrusion, and total anthocyanins were determined in pomace. Additionally, chromatograms from diol and normal phase high-performance liquid chromatography were compared for the separation of procyanidins. Extrusion of both grape by-products increased the biologically important monomer and dimers considerably across all temperature and screw speeds. Highest monomer content resulted when extruded at a temperature of 170 degrees C and screw speed of 200 rpm, which were 120% and 80% higher than the unextruded grape seed and pomace, respectively. Increases in monomer and dimer contents were apparently the result of reduced polymer contents, which declined by 27% to 54%, or enhanced extraction facilitated by disruption of the food matrix during extrusion. Extrusion processing reduced total anthocyanins in pomace by 18% to 53%. PRACTICAL APPLICATIONS: Extrusion processing can be used to increase procyanidin monomer and dimer contents in grape seed and pomace. Procyanidins in grape by-products have many health benefits, but most are present as large molecular weight compounds, which are poorly absorbed. Extrusion processing appears to be a promising technology to increase levels of the bioactive low molecular weight procyanidins.

Influence of extrusion processing on procyanidin composition and total anthocyanin contents of blueberry pomace.

Blueberry juice processing by-products are a rich source of procyanidins, which comprise a group of compounds shown to possess numerous health benefits, including protection against coronary heart disease, type II diabetes, and obesity. Most of the procyanidins present in blueberry pomace, however, are large molecular weight compounds that are poorly absorbed and show weak bioactivity compared to the smaller molecular weight monomers and dimers. The objective of our study was to identify optimal extrusion variables to enhance the contents of monomers and dimers at the expense of large molecular weight procyanidin oligomers and polymers. Extrusion variables temperature (160 and 180 degrees C) and screw speed (150 and 200 rpm) were tested using mixtures of blueberry pomace with decorticated white sorghum flour at a ratio of 30 : 70 and 45% moisture content. Extrudates were analyzed for procyanidin composition and total anthocyanin content. Extrusion of blueberry pomace increased the monomer, dimer, and trimer contents considerably at both temperature and screw speeds. The highest monomer content, obtained at 180 degrees C and 150 rpm screw speed, was 84% higher than the nonextruded control. Significantly higher levels of dimer and trimer contents were also obtained under these conditions. Increases in monomer, dimer, and trimer contents apparently were the result of reduced polymer contents, which was approximately 40% lower for samples extruded at 180 degrees C temperature and 150 rpm screw speed. Extrusion processing reduced total anthocyanin contents by 33% to 42% indicating that additional treatments are needed to retain the pigments. These results demonstrate that extrusion processing can be used to increase procyanidin monomer and dimers in blueberry pomace.

Processing and storage effects on monomeric anthocyanins, percent polymeric color, and antioxidant capacity of processed blueberry products.

This study evaluated the effects of processing and 6 mo of storage on total monomeric anthocyanins, percent polymeric color, and antioxidant capacity of blueberries that were canned in syrup (CS), canned in water (CW), pureed, and juiced (clarified and nonclarified). Total monomeric anthocyanins, percent polymeric color, and oxygen radical absorbing capacity (ORAC) assay using fluorescein (ORAC(FL)) were determined postprocessing after 1 d, and 1, 3, and 6 mo of storage. Thermal processing resulted in marked losses in total anthocyanins (28% to 59%) and ORAC(FL) values (43% to 71%) in all products, with the greatest losses occurring in clarified juices and the least in nonclarified juices. Storage at 25 degrees C for 6 mo resulted in dramatic losses in total anthocyanins, ranging from 62% in berries CW to 85% in clarified juices. This coincided with marked increases in percent polymeric color values of these products over the 6-mo storage. The ORAC(FL) values showed little change during storage, indicating that the formation of polymers compensated for the loss of antioxidant capacity due to anthocyanin degradation. Methods are needed to retain anthocyanins in thermally processed blueberries.

Processing and storage effects on monomeric anthocyanins, percent polymeric color, and antioxidant capacity of processed black raspberry products.

This study evaluated the effects of processing and 6 mo of storage on total monomeric anthocyanins, percent polymeric color, and antioxidant capacity of black raspberries that were individually quick-frozen (IQF), canned-in-syrup, canned-in-water, pureed, and juiced (clarified and nonclarified). Total monomeric anthocyanins, percent polymeric color, and ORAC(FL) were determined 1 d postprocessing and after 1, 3, and 6 mo of storage. Thermal processing resulted in marked losses in total anthocyanins ranging from 37% in puree to 69% to 73% in nonclarified and clarified juices, respectively, but only the juices showed substantial losses (38% to 41%) in ORAC(FL). Storage at 25 degrees C of all thermally processed products resulted in dramatic losses in total anthocyanins ranging from 49% in canned-in-syrup to 75% in clarified juices. This coincided with marked increases in percent polymeric color values of these products over the 6-mo storage. ORAC(FL) values showed little change during storage, indicating that the formation of polymers compensated for the loss of antioxidant capacity due to anthocyanin degradation. Total anthocyanins and ORACFL of IQF berries were well retained during long-term storage at -20 degrees C.

Antioxidant status of young children: response to an antioxidant supplement.

OBJECTIVE: To study oxidative stress indicators in healthy young children and their response to a commercially available fruit- and vegetable-based antioxidant supplement. DESIGN: Healthy children were randomly assigned to a placebo and a supplement (commercial antioxidant supplement produced from dried fruit and vegetable extracts and fortified with antioxidants, resembling a gummy-type candy). The placebo and the supplement were taken in 2 doses per day for 21 days. SUBJECTS: Participants were 39 children (26 boys and 13 girls) aged 5 to 10 years. Research was conducted at Primary Children's Medical Center and the University of Utah, Salt Lake City. MAIN OUTCOME MEASURES: Breath and urine samples were collected on days 1 and 21 and assayed for breath pentane and urine 8-hydroxydeoxyguanosine, malondialdehyde, nitrites, and 8-isoprostane as noninvasive indicators of oxidative stress. Urine oxygen radical absorbance capacity was measured at days 1 and 21 as an indirect indicator of the antioxidant capacity of the body. Three-day food records were collected at the beginning and end of the study to measure intake of dietary fruit; vegetable; and antioxidant vitamins A, C, and E. STATISTICAL ANALYSIS: Descriptive statistics, repeated measures analysis of variance, paired t tests, and Pearson r correlations. RESULTS: Markers of oxidative stress were not significantly different between the placebo and supplement groups at day 1 or day 21. The oxidative stress indicators of the healthy children in this study appear to be similar to those of healthy adults and were not changed by antioxidant supplementation. The diet record analyses indicated that mean fruit and vegetable intakes (2.75 servings/day) were similar to the national average intake for children in the United States. APPLICATIONS/CONCLUSIONS: This research presents original information on the subject of oxidative stress in healthy children. The results of this study may be useful as reference baseline markers to use in conjunction with clinical dietary evaluations and for future research with healthy children and with children in disease states who are subject to elevated levels of oxidative stress.

A mutant of Burkholderia pseudomallei, auxotrophic in the branched chain amino acid biosynthetic pathway, is attenuated and protective in a murine model of melioidosis.

Using a transposon mutagenesis approach, we have identified a mutant of Burkholderia pseudomallei that is auxotrophic for branched chain amino acids. The transposon was shown to have interrupted the ilvI gene encoding the large subunit of the acetolactate synthase enzyme. Compared to the wild type, this mutant was significantly attenuated in a murine model of disease. Mice inoculated intraperitoneally with the auxotrophic mutant, 35 days prior to challenge, were protected against a challenge dose of 6,000 median lethal doses of wild-type B. pseudomallei.

Parity measurements of nuclear levels using a free-electron-laser generated gamma-ray beam.

The quality and intensity of gamma rays at the High Intensity gamma-ray Source are shown to make nuclear resonance fluorescence studies possible at a new level of precision and efficiency. First experiments have been carried out using an intense (10(7) gamma/s) beam of 100% linearly polarized, nearly monoenergetic, gamma rays on the semimagic nucleus (138)Ba. Negative parity quantum numbers have been assigned to 18 dipole excitations of (138)Ba between 5.5 MeV and 6.5 MeV from azimuthal gamma-intensity asymmetries.

Development and validation of an improved oxygen radical absorbance capacity assay using fluorescein as the fluorescent probe.

An improved method of oxygen radical absorbance capacity (ORAC) assay has been developed and validated using fluorescein (3',6'-dihydroxyspiro[isobenzofuran-1[3H],9'[9H]-xanthen]-3-one) as the fluorescent probe. Our results demonstrate that fluorescein (FL) is superior to B-phycoerythrin. The oxidized FL products induced by peroxyl radical were identified by LC/MS, and the reaction mechanism was determined to follow a classic hydrogen atom transfer mechanism. In addition, methodological and mechanistic comparison of ORAC(FL) with other widely used methods was discussed. It is concluded that, unlike other popular methods, the improved ORAC(FL) assay provides a direct measure of hydrophilic chain-breaking antioxidant capacity against peroxyl radical.

Interspecific variation in anthocyanins, phenolics, and antioxidant capacity among genotypes of highbush and lowbush blueberries (Vaccinium section cyanococcus spp.).

Recent interest in the possible protective effects of dietary antioxidant compounds against human degenerative disease has prompted investigation of foods such as blueberries (Vaccinium sp.), which have a high antioxidant capacity. Fruit obtained from genotypes of highbush blueberries (Vaccinium corymbosum L.) and lowbush blueberries (Vaccinium angustifolium Aiton) were analyzed for their antioxidant capacity, their content of anthocyanins, and total phenolic compounds, to evaluate the intraspecific and interspecific variation in these parameters. The method of extraction influenced the composition of fruit extracts; the highest anthocyanin and total phenolic contents and antioxidant capacity were found in extracts obtained using a solvent of acidified aqueous methanol. Regardless of the method, lowbush blueberries were consistently higher in anthocyanins, total phenolics, and antioxidant capacity, compared with highbush blueberries. There was no relationship between fruit size and anthocyanin content in either species.

Antioxidant and pro-oxidant capacity of catecholamines and related compounds. Effects of hydrogen peroxide on glutathione and sphingomyelinase activity in pheochromocytoma PC12 cells: potential relevance to age-related diseases.

The antioxidant and pro-oxidant capacity of catecholamines (CA) and related compounds were analyzed using the oxygen radical absorbance capacity (ORAC) assay. In the assay 2,2'-azobis (2-amidino-propane) dihydrochloride (AAPH), a peroxyl radical generator, ROO*; H2O2-Cu2+, mainly a hydroxyl radical generator, *OH; and Cu2+ a transition metal were used. The antioxidant effect of CA and its related compounds were in the order: neurotransmitters: dopamine (DA), norepinephrine (NE) > metabolites > amino acid precursors as measured by using AAPH. The antioxidant effect of CA and related compounds as measured by using AAPH were linearly correlated with concentration, while the antioxidant effect of CA in scavenging *OH produced by H2O2-Cu2+ increased proportionally to concentration at low concentration, but after reaching a maximum declined with increasing concentration. In the presence of Cu2+, CA acted as pro-oxidant. Glutathione (GSH) acted as a pro-oxidant when H2O2-Cu2+ or when Cu2+ alone was used as an oxidant and showed much higher pro-oxidant effect than DA, which could have relevance in the vulnerability of dopaminergic neurons to oxidative stress in the aging and aging related diseases. The antioxidant capacity of CA and many related compounds seems to be correlated with the numbers of hydroxyl groups and their position on the benzoic ring. The O-methylation and sulfate conjugation of the hydroxyl substitution inactivates both the antioxidant and pro-oxidant activities of CA. Our results show that oxidative stress induced by low (5 microM) or high (300 microM) doses H2O2 in pheochromocytoma PC12 cells significantly up-regulate the activity of Mg-dependent neutral sphingomyelinase (Sase), and significantly decreased GSH.

Recombinant bactericidal/permeability-increasing protein (rBPI21) for treatment of parvovirus enteritis: a randomized, double-blinded, placebo-controlled trial.

We evaluated the ability of an antimicrobial and endotoxin-neutralizing agent, the recombinant amino terminal fragment of bactericidal permeability-increasing protein (rBPI21), to decrease plasma endotoxin concentration and severity of clinical signs of canine parvovirus and to improve survival. This randomized, double-blinded, placebo-controlled clinical trial included 40 client-owned dogs and 9 normal puppies from a closed research colony. Dogs weighing >5 kg (11 lb) with fecal antigen-confirmed parvovirus and clinical signs of vomiting and diarrhea were randomly assigned to receive placebo or rBPI21 infusion over 6 hours. Plasma endotoxin concentration was measured at 0, 3, and 6 hours of infusion. Owners chose continued medical care with either the Veterinary Hospital of the University of Pennsylvania Internal Medicine Service or a local veterinarian. Telephone follow-up was conducted at 14 days. Surviving dogs were reevaluated at >30 days (recovered group), at which time plasma samples for measurement of endotoxin concentration were obtained. Plasma endotoxin concentrations were significantly higher in dogs with parvovirus than in normal or recovered dogs. Despite 90% survival, the rBPI21 treatment did not have a significant effect on outcome, duration of hospitalization, or plasma endotoxin concentrations. Treatment in a tertiary care hospital, however, significantly improved survival but resulted in a significantly increased duration of hospitalization. Endotoxemia occurs in dogs with parvovirus enteritis, but rBPI21 is not associated with improved survival.

Anthocyanins are absorbed in glycated forms in elderly women: a pharmacokinetic study.

BACKGROUND: Anthocyanins are potent antioxidants that are widely distributed in fruit, vegetables, and red wines. Anthocyanin products are also prescribed as medicines in many countries for treating various diseases. However, the pharmacokinetics of dietary anthocyanins are not known in humans because these glycosides were long considered nonabsorbable. OBJECTIVE: The objective of this study was to determine whether anthocyanins can be absorbed as glycosides and to evaluate their pharmacokinetics in humans. DESIGN: Four healthy elderly women consumed 720 mg anthocyanins. A series of blood and urine samples were collected before and after consumption of the anthocyanins. Anthocyanins were measured in plasma and urine by combining an octadecylsilane solid-phase extraction for sample preparation and an HPLC system with diode array for anthocyanin separation and detection. The structures of anthocyanins as glycosides in plasma and urine were further confirmed by using liquid chromatography-mass spectrometry. RESULTS: Anthocyanins were detected as glycosides in plasma and urine. The maximum plasma concentration of total anthocyanins varied from 55.3 to 168.3 nmol/L, with an average of 97.4 nmol/L, and was reached within 71.3 min. The elimination of plasma anthocyanins appeared to follow first-order kinetics. The elimination half-life of plasma total anthocyanins was calculated to be 132.6 min. Most anthocyanin compounds were excreted in urine during the first 4 h. The excretion rate of total anthocyanins was 77 microg/h during the first 4 h and 13 microg/h during the second 4 h. CONCLUSION: Anthocyanins are absorbed in their unchanged glycated forms in elderly women.

Oxygen radical absorbance capacity (ORAC) and phenolic and anthocyanin concentrations in fruit and leaf tissues of highbush blueberry.

Antioxidant capacity, as measured by oxygen radical absorbance capacity (ORAC), and total phenolic and total anthocyanin contents were evaluated in fruit tissues of 87 highbush blueberry (Vacciniumcorymbosum L.) and species-introgressed highbush blueberry cultivars. ORAC and phenolic levels were evaluated in leaf tissues of the same materials. Average values for ORAC, phenolics, and anthocyanins in fruit were 15.9 ORAC units, 1.79 mg/g (gallic acid equivalents), and 0.95 mg/g (cyanidin-3-glucoside equivalents), respectively. Cv. Rubel had the highest ORAC per gram of fresh weight values, at 31.1 units, and cv. Elliott had the highest values on the basis of ORAC per square centimeter of surface area. In leaf tissue, values for both ORAC and phenolics were significantly higher than in fruit tissue, with mean values of 490 ORAC units and 44.80 mg/g (gallic acid equivalents), respectively. Leaf ORAC had a low, but significant, correlation with fruit phenolics and anthocyanins, but not with fruit ORAC. An analysis of ORAC values versus calculated midparent values in 11 plants from the 87-cultivar group in which all parents were tested suggested that, across cultivars, ORAC inheritance is additive. An investigation of ORAC values in a family of 44 cv. Rubel x Duke seedlings showed negative epistasis for ORAC values, suggesting Rubel may have gene combinations contributing to ORAC that are broken up during hybridization.

Identification of procyanidins and anthocyanins in blueberries and cranberries (Vaccinium spp.) using high-performance liquid chromatography/mass spectrometry.

Blueberries and cranberries were analyzed for procyanidins using normal-phase HPLC/MS. Monomers, identified as (+)-catechin and (-)-epicatechin, and a series of oligomers were detected in blueberries, and MS data confirmed that the oligomers consisted of (epi)catechin units that were exclusively singly linked (B-type). The procyanidin "fingerprints" were similar for Tifblue and Rubel but higher than that for lowbush blueberries. In whole cranberries, (-)-epicatechin was present, along with a complex series of oligomers. Both A-type (contained only one double linkage per oligomer) and B-type oligomers were present. Two commercial cranberry juices exhibited similar procyanidin profiles, except that one contained increased quantities. There were processing effects on the procyanidin content of cranberry extract and juices when compared to those of the unprocessed fruits. Monomer, dimers, and A-type trimers were the primary procyanidins, with only trace levels of the B-type trimers and A-type tetramers and with an absence of the higher oligomers in cranberry extract and juices.