Effect of Preoperative Administration of Oral Arginine and Glutamine in Patients with Enterocutaneous Fistula Submitted to Definitive Surgery: a Prospective Randomized Trial.

BACKGROUND: The use of glutamine and arginine has shown several advantages in postoperative outcomes in patients after gastrointestinal surgery. We determined the effects of its use in patients with enterocutaneous fistula after operative treatment. PATIENTS AND METHODS: Forty patients with enterocutaneous fistula were randomly assigned to one of two groups. The control group received the standard medical care while the patients of the experimental group were supplemented with enteral administration of 4.5 g of arginine and 10 g of glutamine per day for 7 days prior to the surgery. The primary outcome variable was the recurrence of the fistula and the secondary outcomes were preoperative and postoperative serum concentrations of interleukin 6 and C-reactive protein and postoperative infectious complications. RESULTS: Twenty patients were assigned to each group. The fistula recurred in two patients (10%) of the experimental group and in nine patients (45%) of the control group (P < 0.001). We found a total of 13 infectious complications in six patients of the control group (all with fistula recurrence) and none in the experimental group. Mean preoperative serum concentrations of interleukin 6 and C-reactive protein were lower in patients from the experimental group. In addition, these levels were lower in patients who had recurrence if compared to patients that did not recur. CONCLUSION: Preoperative administration of oral arginine and glutamine could be valuable in the postoperative recovery of patients with enterocutaneous fistulas submitted to definitive surgery.

Spirulina maxima Decreases Endothelial Damage and Oxidative Stress Indicators in Patients with Systemic Arterial Hypertension: Results from Exploratory Controlled Clinical Trial.

(1) Background: Spirulina (Arthrospira) maxima has shown beneficial effects such as being anti-dyslipidemic, antiviral, antioxidant and antihypertensive. However, there are few and limited clinical studies. (2) Methods: a prospective, randomized, parallel pilot study of 4.5 g administration of Spirulina maxima or placebo for 12 weeks in 16 patients with systemic arterial hypertension (SAH) undergoing treatment with angiotensin-converting enzyme (ACE) inhibitors was performed to assess the effects on endothelial damage and oxidative stress indicators. The blood levels of sICAM-1, sVCAM-1, endothelin-1, and sE-selectin were quantified; the activities of catalase, superoxide dismutase, glutathione peroxidase, glutathione reductase and concentrations of reduced glutathione, oxidized glutathione, and thiobarbituric acid reactive substances, were also quantified before and after the treatment period. (3) Results: There were statistically significant (p < 0.05) decreases in systolic blood pressure, sVCAM-1, sE-selectin and endothelin-1 levels, and increases in glutathione peroxidase activity and oxidized glutathione levels. (4) Conclusion: The effects found in the present study agree with antihypertensive and antioxidant effects previously reported for Spirulina maxima. However, this is the first report about the effects on indicators of endothelial damage. More research in this field is necessary to gain an insight into the effects of Spirulina on these indicators.

Lipid droplets accumulation and other biochemical changes induced in the fungal pathogen Ustilago maydis under nitrogen-starvation.

In many organisms, the growth under nitrogen-deprivation or a poor nitrogen source impacts on the carbon flow distribution and causes accumulation of neutral lipids, which are stored as lipid droplets (LDs). Efforts are in progress to find the mechanism of LDs synthesis and degradation, and new organisms capable of accumulating large amounts of lipids for biotechnological applications. In this context, when Ustilago maydis was cultured in the absence of a nitrogen source, there was a large accumulation of lipid bodies containing mainly triacylglycerols. The most abundant fatty acids in lipid bodies at the stationary phase were palmitic, linoleic, and oleic acids, and they were synthesized de novo by the fatty-acid synthase. In regard to the production of NADPH for the synthesis of fatty acids, the cytosolic NADP+-dependent isocitrate dehydrogenase and the glucose-6-phosphate and 6-phosphogluconate dehydrogenases couple showed the highest specific activities, with a lower activity of the malic enzyme. The ATP-citrate lyase activity was not detected in any of the culture conditions, which points to a different mechanism for the transfer of acetyl-CoA into the cytosol. Protein and RNA contents decreased when U. maydis was grown without a nitrogen source. Due to the significant accumulation of triacylglycerols and the particular composition of fatty acids, U. maydis can be considered an alternative model for biotechnological applications.

Coenzyme Q10 supplementation improves metabolic parameters, liver function and mitochondrial respiration in rats with high doses of atorvastatin and a cholesterol-rich diet.

BACKGROUND: The aim of this study was to evaluate the actions of coenzyme Q10 (CoQ10) on rats with a cholesterol-rich diet (HD) and high doses of atorvastatin (ATV, 0.2, 0.56 or 1.42 mg/day). METHODS: Two experiments were done, the first one without coenzyme Q10 supplementation. On the second experiment all groups received coenzyme Q10 0.57 mg/day as supplement. After a 6-week treatment animals were sacrificed, blood and liver were analyzed and liver mitochondria were isolated and its oxygen consumption was evaluated in state 3 (phosphorylating state) and state 4 (resting state) in order to calculate the respiratory control (RC). RESULTS: HD increased serum and hepatic cholesterol levels in rats with or without CoQ10. ATV reduced these values but CoQ10 improved even more serum and liver cholesterol. Triacylglycerols (TAG) were also lower in blood and liver of rats with ATV + CoQ10. HDL-C decreased in HD rats. Treatment with ATV maintained HDL-C levels. However, these values were lower in HD + CoQ10 compared to control diet (CD) + CoQ10. RC was lessened in liver mitochondria of HD. The administration of ATV increased RC. All groups supplemented with CoQ10 showed an increment in RC. In conclusion, the combined administration of ATV and CoQ10 improved biochemical parameters, liver function and mitochondrial respiration in hypercholesterolemic rats. CONCLUSIONS: Our results suggest a potential beneficial effect of CoQ10 supplementation in hypercholesterolemic rats that also receive atorvastatin. This beneficial effect of CoQ10 must be combined with statin treatment in patient with high levels of cholesterol.

Factors predictive of recurrence and mortality after surgical repair of enterocutaneous fistula.

Many enterocutaneous fistulas (ECF) require operative treatment. Despite recent advances, rates of recurrence have not changed substantially. This study aims to determine factors associated with recurrence and mortality in patients submitted to surgical repair of ECF. Consecutive patients submitted to surgical repair of ECF during a 5-year period were studied. Several patient, disease, and operative variables were assessed as factors related to recurrence and mortality through univariate and multivariate analysis. There were 35 male and 36 female patients. Median age was 52 years (range, 17-81). ECF recurred in 22 patients (31%), 18 of them (82%) eventually closed with medical and/or surgical treatment. Univariate analyses disclosed noncolonic ECF origin (p = 0.04), high output (p = 0.001), and nonresective surgical options (p = 0.02) as risk factors for recurrence; the latter two remained significant after multivariate analyses. A total of 14 patients died (20%). Univariate analyses revealed risk factors for mortality at diagnosis or referral including malnutrition (p = 0.03), sepsis (p = 0.004), fluid and electrolyte imbalance (p = 0.001), and serum albumin <3 g/dl (p = 0.02). Other significant variables were interval from last abdominal operation to ECF operative treatment ≤20 weeks (p = 0.03), preoperative serum albumin <3 g/dl (p = 0.001), and age ≥55 years (p = 0.03); the latter two remained significant after multivariate analyses. Interestingly, recurrence after surgical treatment was not associated with mortality (p = 0.75). Among several studied variables, recurrence was only independently associated with high output and type of surgical treatment (operations not involving resection of ECF). Interestingly, once ECF recurred its management was as successful as non-recurrent fistulas in our series. Mortality was associated to previously-reported bad prognostic factors at diagnosis or referral.

Effects of acute electromagnetic field exposure and movement restraint on antioxidant system in liver, heart, kidney and plasma of Wistar rats: a preliminary report.

PURPOSE: The aim of the present study was to evaluate the early effects of acute (2 h) exposure to extremely low frequency electromagnetic fields (ELF-EMF), as well as movement restraint (MR) and the combination of both on the antioxidant systems in the plasma, liver, kidney, and heart of rats. MATERIALS AND METHODS: Twenty-four adult male Wistar rats were divided in two groups, restrained and unrestrained. The restrained animals were confined into an acrylic tube for 120 min. Half of the animals of each group were exposed to ELF-EMF (60 Hz, 2.4 mT) during the period of restriction. Immediately after treatment, reduced glutathione (GSH), catalase (CAT), superoxide dismutase (SOD), and thiobarbituric acid reactive substances (TBARS) were measured in tissues. RESULTS: GSH concentration was significantly lower in the heart of all experimental animals when compared to the control group; furthermore, the decrease was higher in the liver of restrained animals. SOD activity was lower in the plasma of restrained and EMF exposed animals compared to unrestrained rats. There were no significant differences in CAT activity and TBARS levels among all the experimental groups vs. the control group. CONCLUSION: Two hours of 60 Hz EMF exposure might immediately alter the metabolism of free radicals, decreasing SOD activity in plasma and GSH content in heart and kidney, but does not induce immediate lipid peroxidation. Oxidative stress induced by movement restraint was stronger than that produced by EMF.

Protective effects of Spirulina maxima on hyperlipidemia and oxidative-stress induced by lead acetate in the liver and kidney.

BACKGROUND: Oxidative damage has been proposed as a possible mechanism involved in lead toxicity, specially affecting the liver and kidney. Previous studies have shown the antioxidant effect of Spirulina maxima in several experimental models of oxidative stress. The current study was carried out to evaluate the antioxidant activity of Spirulina maxima against lead acetate-induced hyperlipidemia and oxidative damage in the liver and kidney of male rats. Control animals were fed on a standard diet and did not receive lead acetate (Control group). Experimental animals were fed on a standard laboratory diet with or without Spirulina maxima 5% in the standard laboratory diet and treated with three doses of lead acetate (25 mg each/weekly, intraperitoneal injection) (lead acetate with Spirulina, and lead acetate without Spirulina groups). RESULTS: The results showed that Spirulina maxima prevented the lead acetate-induced significant changes on plasma and liver lipid levels and on the antioxidant status of the liver and kidney. On the other hand, Spirulina maxima succeeded to improve the biochemical parameters of the liver and kidney towards the normal values of the Control group. CONCLUSIONS: It was concluded that Spirulina maxima has protective effects on lead acetate-induced damage, and that the effects are associated with the antioxidant effect of Spirulina.

Hepatoprotective effects of Spirulina maxima in patients with non-alcoholic fatty liver disease: a case series.

INTRODUCTION: Non-alcoholic fatty liver diseases range from simple steatosis to non-alcoholic steatohepatitis. The "two hits" hypothesis is widely accepted for its pathogenesis: the first hit is an increased fat flux to the liver, which predisposes our patient to a second hit where increasing free fatty acid oxidation into the mitochondria leads to oxidative stress, lipoperoxidation and a chain reaction with increased ROS. Clinical indications include abdominal cramps, meteorism and fatigue. Most patients, however, are asymptomatic, and diagnosis is based on aminotransferase elevation and ultrasonography (or "brilliant liver"). Spirulina maxima has been experimentally proven to possess in vivo and in vitro hepatoprotective properties by maintaining the liver lipid profile. This case report evaluates the hepatoprotective effects of orally supplied Spirulina maxima. CASE PRESENTATION: Three Hispanic Mexican patients (a 43-year-old man, a 77-year-old man and a 44-year-old woman) underwent ultrasonography and were treated with 4.5 g/day of Spirulina maxima for three months. Their blood samples before and after the treatment determined triacylglycerols, total cholesterol, high-density lipoprotein cholesterol, alanine aminotransferase and low-density lipoprotein cholesterol levels. The results were assessed using ultrasound. CONCLUSION: Treatment had therapeutic effects as evidenced by ultrasonography and the aminotransferase data. Hypolipidemic effects were also shown. We conclude that Spirulina maxima may be considered an alternative treatment for patients with non-alcoholic fatty liver diseases and dyslipidemic disorder.

Cardiovascular and metabolic effects of intensive Hatha Yoga training in middle-aged and older women from northern Mexico.

BACKGROUND: Hatha Yoga (HY) can be an alternative to improve physical activity in middle-aged and older women. However, conventional HY (CHY) exercising may not result in enough training stimulus to improve cardiovascular fitness. The purpose of this study was to evaluate the effect of an intensive HY intervention (IHY) on cardiovascular risk factors in middle-aged and older women from Northern Mexico. MATERIALS AND METHODS: In this prospective quasiexperimental design, four middle-aged and nine older CHY practicing females (yoginis) were enrolled into an 11-week IHY program consisting of 5 sessions/week for 90 min (55 sessions). The program adherence, asana performance, and work intensity were assessed along the intervention. Anthropometric [body mass index (BMI), % body fat and Σ skin folds], cardiovascular fitness [maximal expired air volume (VE(max)), maximal O(2) consumption (VO(2max)), maximal heart rate (HR(max)), systolic (BPs) and diastolic blood pressure (BPd)], biochemical [glucose, triacylglycerols (TAG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C)], and dietary parameters were evaluated before and after IHY. RESULTS: Daily caloric intake (~1,916 kcal/day), program adherence (~85%), and exercising skills (asana performance) were similar in both middle-aged and older women. The IHY program did not modify any anthropometric measurements. However, it increased VO(2max) and VE(max) and HDL-C while TAG and LDL-C remained stable in both middle-aged and older groups (P < 0.01). CONCLUSIONS: The proposed IHY program improves different cardiovascular risk factors (namely VO(2max) and HDL-C) in middle-aged and older women.

The Respiratory Exchange Ratio is Associated with Fitness Indicators Both in Trained and Untrained Men: A Possible Application for People with Reduced Exercise Tolerance.

BACKGROUND: The respiratory exchange ratio (RER) indirectly shows the muscle's oxidative capacity to get energy. Sedentarism, exercise and physically active lifestyles modify it. For that reason, this study evaluates the associations between RER during sub-maximum exercise and other well established fitness indicators (body fat, maximum heart rate, maximum O(2) uptake, workload, and lactate threshold), in physically active trained and untrained men. METHODS: The RER, O(2) uptake and blood lactate were measured in eight endurance trained and eight untrained men (age, 22.9 ± 4.5 vs. 21.9 ± 2.8 years; body mass, 67.1 ± 5.4 vs. 72.2 ± 7.7 kg; body fat, 10.6 ± 2.4% vs. 16.6 ± 3.8% and maximum O(2) uptake, 68.9 ± 6.3 vs. 51.6 ± 5.8 ml•kg(-1)•min(-1)), during maximum exercise test and during three different sub-maximum exercises at fixed workload: below, within or above the lactate threshold. RESULTS: Endurance trained men presented higher O(2) uptake, lower blood lactate concentrations and lower RER values than those in untrained men at the three similar relative workloads. Even though with these differences in RER, a strong association (p < 0.05) of RER during sub-maximum exercise with the other well established fitness indicators was observed, and both maximum O(2) uptake and lactate threshold determined more than 57% of its variance (p < 0.05). CONCLUSIONS: These data demonstrate that RER measurement under sub-maximum exercise conditions was well correlated with other established physical fitness indicators, despite training condition. Furthermore, the results suggest that RER could help obtain an easy approach of fitness status under low exercise intensity and could be utilized in subjects with reduced exercise tolerance.

Effects of whole body exposure to extremely low frequency electromagnetic fields (ELF-EMF) on serum and liver lipid levels, in the rat.

BACKGROUND: [corrected] The effects of extremely low-frequency electromagnetic fields (ELF-EMF) on the blood serum and liver lipid concentrations of male Wistar rats were assessed. METHODS: Animals were exposed to a single stimulation (2 h) of ELF-EMF (60 Hz, 2.4 mT) or sham-stimulated and thereafter sacrificed at different times (24, 48 or 96 h after beginning the exposure). RESULTS: Blood lipids showed, at 48 h stimulated animals, a significant increase of cholesterol associated to high density lipoproteins (HDL-C) than those observed at any other studied time. Free fatty acid serum presented at 24 h significant increases in comparison with control group. The other serum lipids, triacylglycerols and total cholesterol did not show differences between groups, at any time evaluated. No statistical differences were shown on total lipids of the liver but total cholesterol was elevated at 24 h with a significant decrease at 96 h (p = 0.026). The ELF-EMF stimulation increased the liver content of lipoperoxides at 24 h. CONCLUSION: Single exposures to ELF-EMF increases the serum values of HDL-C, the liver content of lipoperoxides and decreases total cholesterol of the liver. The mechanisms for the effects of ELF-EMF on lipid metabolism are not well understand yet, but could be associated to the nitric oxide synthase EMF-stimulation.

Antihyperlipemic and antihypertensive effects of Spirulina maxima in an open sample of Mexican population: a preliminary report.

BACKGROUND: Spirulina maxima is a filamentous cyanobacterium used as food supplement because of its high nutrient contents. It has been experimentally proven, in vivo and in vitro that posses several pharmacological properties. The purpose of this study was to evaluate the effects of Spirulina maxima orally supplied (4.5 g/day, for 6 weeks) to a sample of 36 subjects (16 men and 20 women, with ages between 18-65 years) on serum lipids, glucose, aminotransferases and on blood pressure. The volunteers did not modify their dietary habits or lifestyle during the whole experimental period. From each subject, a sample of blood was drawn in fasting state of 12 hours to determi the plasma concentrations of glucose, triacylglycerols (TAG), total cholesterol (TC), cholesterol associated to high density lipoprotein (HDL-C) and aspartate aminotransferase (AST). Anthropometric measurements including systolic (SYST-P) and diastolic (DIAST-P) blood pressure, height, weight and Body Mass Index (BMI) were also recorded. RESULTS: Comparing initial and final data, the results showed that there were no significant changes in the values of glucose and AST, but significant differences in TAG, TC, and HDL-C, were observed: TAG 233.7 +/- 177.8 vs. 167.7 +/- 100.7 mg/dL (p < 0.001), TC 181.7 +/- 37.5 vs. 163.5 +/- 34.4 mg/dL (p < 0.001), C-HDL 43.5 +/- 14.4 vs. 50 +/- 18.8 mg/dL (p < 0.01). The univariated analysis showed that the changes in the HDL-C and TC concentrations were dependent on TAG concentration (p = 0.247 and p = 0.108, respectively); nevertheless the calculated values for cholesterol associated to low density lipoprotein (LDL-C) were significantly reduced by the Spirulina maxima treatment but independently of the TAG changes. In addition, significant differences were found comparing initial and final SYST-P and DIAST-P blood pressure in both male and female: SYST-P male 121 +/- 9 vs. 111 +/- 8 mm Hg (p < 0.01), DIAST-P male 85 +/- 6.5 vs. 77 +/- 9 mm Hg (p < 0.01); SYST-P female 120 +/- 9.5 vs. 109 +/- 11 mm Hg (p < 0.002), DIAST-P female 85 +/- 11 vs. 79 +/- 7.5 mm Hg (p < 0.03). CONCLUSION: The Spirulina maxima showed a hypolipemic effect, especially on the TAG and the LDL-C concentrations but indirectly on TC and HDL-C values. It also reduces systolic and diastolic blood pressure.

Protective effect of Arthrospira maxima on fatty acid composition in fatty liver.

BACKGROUND: Arthrospira maxima has been widely used for nutritional purposes. Additionally, A. maxima has shown immunomodulator, antiviral, antioxidant, vasomotor and hypolipidemic effects in laboratory and animal studies. A. maxima prevents fatty liver induced by either carbon tetrachloride (CCl4) or fructose-rich diet; however, the liver lipid composition in these models is not clearly known yet. The aim of this study was to evaluate the effects of A. maxima on the liver lipid profile in CCl4-induced steatohepatitis. METHODS: A single sublethal, intraperitoneal dose of CCl4 was administered to male Wistar rats fed a diet with or without 5% A. maxima. Liver lipids: total lipids, triacylglycerols, total cholesterol, free fatty acids, and thiobarbituric acid reactive substances were assessed 24 and 48 h after injury with CCl4. Additionally, triacylglycerols, total cholesterol and aspartate aminotransferase were evaluated in blood. RESULTS: Forty eight hours after CCl4 treatment, rats fed a diet without A. maxima had serum aspartate aminotransferase and liver triacylglycerols values that were, respectively, 2.2 and 1.4 times higher than those of animals receiving 5% A. maxima in their diet. The same pattern was observed for liver free fatty acids and thiobarbituric acid reactive substances. The groups fed a diet with A. maxima and treated with CCl4 showed a higher saturated fatty acid liver content than the groups without A. maxima in their diet. The percentage of unsaturated fatty acids increased 48 h after CCl4 treatment, but its value was 0.5 times lower in the group receiving A. maxima than in the group fed without A. maxima. In the liver, all animals receiving A. maxima showed a trend towards a lower percentage of unsaturated fatty acids, despite the mentioned increase 48 h after CCl4 treatment. CONCLUSIONS: The results suggest that, in the fatty liver induced by CCl4, the hepatoprotective effect of A. maxima involves (a) an antioxidant mechanism and (b) a lower unsaturation of the liver fatty acids. The preventive effect of A. maxima on the liver lipid changes induced by CCl4 could be partially explained by its antioxidant action and the ability to increase the synthesis/release of nitric oxide, but not by its soluble dietary fiber.

Ethanolic extract of Spirulina maxima alters the vasomotor reactivity of aortic rings from obese rats.

BACKGROUND: Aortic rings with endothelium excised from fructose-fed obese rats develop more tension in response to phenylephrine and relax less in response to carbachol than corresponding rings from lean rats. This altered vascular reactivity is prevented when Spirulina maxima is added to the fructose-rich diet. In the present study the effects of a raw ethanolic extract of Spirulina maxima on the vasomotor responses of aorta rings from sucrose-fed obese hypertensive rats were analyzed. METHODS: The experiments were performed on aorta rings from sucrose-fed obese male rats. For each experiment, a pair of rings from the same aorta (one with intact endothelium, the other without a functional endothelium) was used. In this study we analyzed, in vitro, the effects of the ethanolic extract of Spirulina maxima on the reactivity of the aortic rings to phenylephrine and to carbachol. RESULTS: On rings with endothelium, the extract produced the following effects: a) a concentration-dependent (0.06-1.0 mg/mL) decrease of the contractile response to phenylephrine; b) a rightward shift and a decrease in maximal developed tension, of the concentration-response curve to phenylephrine; c) a concentration-dependent relaxation of phenylephrine-precontracted rings. These effects persisted in the presence of indomethacin but were prevented by L-NAME. The extract had no effect on the concentration-response curve of phenylephrine-precontracted rings to carbachol. On endothelium-denuded rings the extract caused a significant rightward shift of the concentration response curve to phenylephrine without any effect on maximal tension development. CONCLUSIONS: These results suggest that, in rings from obese rats, the extract, in addition to increasing the synthesis/release of NO, also inhibits the synthesis/release of a cyclooxygenase-dependent vasoconstrictor metabolite of arachidonic acid, which is increased in obesity.

Comparative analysis of erythrocyte fatty acid composition in a sample of Mexico city children and young adults on a free diet

In the present study the influence of age on red blood cell fatty acid (RBCFA) composition was analyzed in a sample of Mexico City children and young people on a free diet, as there is scarce information about RBCFA composition in the Mexican population. Erythrocyte lipids were extracted with isopropyl alcohol and fatty acid methyl esters were prepared to be analyzed by gas liquid chromatography. The 1. to 2-year-old group showed a higher percent level of C18:0 (34.73 ñ 2.5 vs. 29.67 ñ 1.3, p<0.002) and lower of C16:1 (0.58 ñ 0.2 vs. 1.09 ñ 0.2, p<0.005), C20:4 (14.08 ñ 4.1 vs, 18.20 ñ 1.2, p<0.05) and C22:5 (2.79 ñ 1.7 vs. 7.68 ñ 0.8, p<0.001) than the 20- to 25-year-old group. Both groups showed a very low linoleic acid proportion, children 0.48 percent and young adults 0.54 percent. The unsaturated/saturated fatty acid ratio was found to be 0.55 ñ 0.2 in children and 0.91 ñ 0.1 in adults (p<0.001). These findigs indicate the presence of factors related to age that affect the fatty acid composition in the erythrocyte membrane different from diet habits in the sample analyzed. Results are compared with reports in the literature