Statistical Evaluation of Metaproteomics and 16S rRNA Amplicon Sequencing Techniques for Study of Gut Microbiota Establishment in Infants with Cystic Fibrosis

Newborn screening for cystic fibrosis (CF) can identify affected but asymptomatic infants. The selection of omic technique for gut microbiota study is crucial due to both the small amount of feces available and the low microorganism load. Our aims were to compare the agreement between 16S rRNA amplicon sequencing and metaproteomics by a robust statistical analysis, including both presence and abundance of taxa, to describe the sequential establishment of the gut microbiota during the first year of life in a small size sample (8 infants and 28 fecal samples). The taxonomic assignations by the two techniques were similar, whereas certain discrepancies were observed in the abundance detection, mostly the lower predicted relative abundance of Bifidobacterium and the higher predicted relative abundance of certain Firmicutes and Proteobacteria by amplicon sequencing. During the first months of life, the CF gut microbiota is characterized by a significant enrichment of Ruminococcus gnavus, the expression of certain virulent bacterial traits, and the detection of human inflammation-related proteins. Metaproteomics provides information on composition and functionality, as well as data on host-microbiome interactions. Its strength is the identification and quantification of Actinobacteria and certain classes of Firmicutes, but alpha diversity indices are not comparable to those of amplicon sequencing. Both techniques detected an aberrant microbiota in our small cohort of infants with CF during their first year of life, dominated by the enrichment of R. gnavus within a human inflammatory environment. IMPORTANCE In recent years, some techniques have been incorporated for the study of microbial ecosystems, being 16S rRNA gene sequencing being the most widely used. Metaproteomics provides the advantage of identifying the interaction between microorganisms and human cells, but the available databases are less extensive as well as imprecise. Few studies compare the statistical differences between the two techniques to define the composition of an ecosystem. Our work shows that the two methods are comparable in terms of microorganism identification but provide different results in alpha diversity analysis. On the other hand, we have studied newborns with cystic fibrosis, for whom we have described the establishment of an intestinal ecosystem marked by the inflammatory response of the host and the enrichment of Ruminococcus gnavus.

Long-term docosahexaenoic acid (DHA) supplementation in cystic fibrosis patients: a randomized, multi-center, double-blind, placebo-controlled trial

BACKGROUND

Cystic fibrosis (CF) patients have an alteration in fatty acid (FA) metabolism, associated with increased omega-6 and low omega-3 FA. Previous studies on supplementation with omega-3 FA in CF had contradictory results, and to date there is no evidence to recommend routine use of omega-3 supplements in CF patients. We hypothesized that long-term supplementation with docosahexaenoic acid (DHA) will have beneficial effects in these patients, by reducing pulmonary, systemic and intestinal inflammation.

METHODS

This was a randomized, double-blind, parallel, placebo-controlled trial. CF patients (age >2 months) were randomized to receive a seaweed DHA oil solution (50 mg/Kg/day) or matching placebo for 48 weeks. Primary outcomes were pulmonary (interleukin [IL]-8), systemic (IL-8) and intestinal (calprotectin) inflammatory biomarkers. Secondary outcomes included other pulmonary (IL-1β, IL-6, neutrophil elastase, lactate and calprotectin) and systemic (serum-IL-1β, IL-6) inflammatory biomarkers, as well as clinical outcomes (FEV₁, pulmonary exacerbations, antibiotic use, nutritional status and quality of life).

RESULTS

Ninety six CF patients, 44 female, age 14.6±11.9 years (48 DHA and 48 placebo) were included. At trial completion, there were no differences in all primary outcomes [serum-IL-8 (p=0.909), respiratory-IL-8 (p=0.384) or fecal calprotectin (p=0.948)], all secondary inflammatory biomarkers, or in any of the clinical outcomes evaluated. There were few adverse events, with similar incidence in both study groups.

CONCLUSION

In this study, long-term DHA supplementation in CF patients was safe, but did not offer any benefit on inflammatory biomarkers, or in clinical outcomes compared with placebo. (NCT01783613).

Assessment of food safety using a new real-time PCR assay for detection and quantification of virulence factors of enterococci in food samples

AIMS

Development of Taqman MGB real-time PCR (q-PCR) assays for the quantitative detection of virulence factor genes in pure culture and food samples with regard to food safety assessment.

METHODS AND RESULTS

New Taqman primers and probes were designed for the ace, esp and gelE genes based on the determinants of virulence profiles of enterococcal strains from GenBank. The high specificity and accuracy of the Taqman probe assay was confirmed. The limit of detection for the different virulence genes was 10²  CFU ml^-1 or CFU g^-1 for pure culture and meat samples, and 10³  CFU g^-1 for cheese samples.

CONCLUSION

This method provides the specific and rapid detection and quantification of ace, esp and gelE genes compared to conventional PCR assays, thus allowing the rapid and direct safety assessment of Enterococcus genus in food samples.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study presents efficient methods that can be used directly on food products for the rapid quantification and tracing of virulence genes, regarding food safety assessment. Moreover, this is the first study to quantify these virulence factors using a specific Taqman q-PCR assay in food samples.

Effects of inhaled high-molecular weight hyaluronan in inflammatory airway disease

Cystic fibrosis (CF) is a chronic inflammatory disease that is affecting thousands of patients worldwide. Adjuvant anti-inflammatory treatment is an important component of cystic fibrosis treatment, and has shown promise in preserving lung function and prolonging life expectancy. Inhaled high molecular weight hyaluronan (HMW-HA) is reported to improve tolerability of hypertonic saline and thus increase compliance, and has been approved in some European countries for use as an adjunct to hypertonic saline treatment in cystic fibrosis. However, there are theoretical concerns that HMW-HA breakdown products may be pro-inflammatory. In this clinical pilot study we show that sputum cytokines in CF patients receiving HMW-HA are not increased, and therefore HMW-HA does not appear to adversely affect inflammatory status in CF airways.

Biofilm formation, phenotypic production of cellulose and gene expression in Salmonella enterica decrease under anaerobic conditions

Salmonella enterica subsp. enterica is one of the main food-borne pathogens. This microorganism combines an aerobic life outside the host with an anaerobic life within the host. One of the main concerns related to S. enterica is biofilm formation and cellulose production. In this study, biofilm formation, morphotype, cellulose production and transcription of biofilm and quorum sensing-related genes of 11 S. enterica strains were tested under three different conditions: aerobiosis, microaerobiosis, and anaerobiosis. The results showed an influence of oxygen levels on biofilm production. Biofilm formation was significantly higher (P<0.05) in aerobiosis than in microaerobiosis and anaerobiosis. Cellulose production and RDAR (red, dry, and rough) were expressed only in aerobiosis. In microaerobiosis, the strains expressed the SAW (smooth and white) morphotype, while in anaerobiosis the colonies appeared small and red. The expression of genes involved in cellulose synthesis (csgD and adrA) and quorum sensing (sdiA and luxS) was reduced in microaerobiosis and anaerobiosis in all S. enterica strains tested. This gene expression levels were less reduced in S. Typhimurium and S. Enteritidis compared to the tested serotypes. There was a relationship between the expression of biofilm and quorum sensing-related genes. Thus, the results from this study indicate that biofilm formation and cellulose production are highly influenced by atmospheric conditions. This must be taken into account as contamination with these bacteria can occur during food processing under vacuum or modified atmospheres.

Biofilm Formation and Morphotypes of Salmonella enterica subsp.arizonae Differs from Those of Other Salmonella enterica Subspecies in Isolates from Poultry Houses

Salmonella serovars are responsible for foodborne diseases around the world. The ability to form biofilms allows microorganisms to survive in the environment. In this study, 73 Salmonella strains, belonging to four different subspecies, were isolated from poultry houses and foodstuffs and tested. Biofilm formation was measured at four different temperatures and two nutrient concentrations. Morphotypes and cellulose production were evaluated at three different temperatures. The presence of several genes related to biofilm production was also examined. All strains and subspecies of Salmonella had the ability to form biofilms, and 46.57% of strains produced biofilms under all conditions tested. Biofilm formation was strain dependent and varied according to the conditions. This is the first study to analyze biofilm formation in a wide number of Salmonella enterica subsp. arizonae strains, and no direct relationship between the high prevalence of Salmonella enterica subsp. arizonae strains and their ability to form biofilm was established. Morphotypes and cellulose production varied as the temperature changed, with 20°C being the optimum temperature for expression of the red, dry, and rough morphotype and cellulose. Salmonella enterica subsp. arizonae, whose morphotype is poorly studied, only showed a smooth and white morphotype and lacked the csgD and gcpA genes that are implicated in biofilm production. Thus, Salmonella biofilm formation under different environmental conditions is a public health problem because it can survive and advance through the food chain to reach the consumer.

Prevalence, molecular characterization and antimicrobial resistance of Salmonella serovars isolated from northwestern Spanish broiler flocks (2011-2015)

The present study investigated the prevalence, antimicrobial resistance to twenty antibiotics, and class 1 integron and virulence genes of Salmonella isolated from poultry houses of broilers in northwestern Spain between 2011 and 2015. Strains were classified to the serotype level using the Kauffman-White typing scheme and subtyping with enterobacterial repetitive intergenic consensus PCR. The prevalence of Salmonella spp. was 1.02%. Sixteen different serotypes were found, with S. typhimurium and S. arizonae 48:z4, z23:- being the most prevalent. A total of 59.70% of strains were resistant to at least one, and 19.70% were resistant to multiple drugs. All Salmonella spp. were susceptible to cefotaxime, ciprofloxacin, gentamicin, kanamycin, levofloxacin, neomycin, and trimethoprim. The highest level of resistance was to sulfamethoxazole (40.29%), doxycycline (17.91%), and nalidixic acid (17.91%). None of the isolates carried class 1 integron and only isolates of S. enterica subspecies enterica were positive for all virulence factors tested, whereas S. arizonae lacked genes related to replication and invasion in nonphagocytic cells. This study demonstrates that the prevalence and antimicrobial resistance of Salmonella spp. in poultry houses of broilers of northwestern Spain is low compared with those found in other studies and in other steps of the food chain.

Pulmonary function in children with type 1 diabetes mellitus

AIM

To assess lung function in children and adolescents with type 1 diabetes mellitus (T1DM).

PATIENTS AND METHODS

We conducted a case-control study of 100 patients with T1DM [median age 13 (10.6-14.7), 44% men, 23% prepubertal, and all nonsmokers] and 77 controls. None had evidence of lung disease or any other comorbidity. We performed pulmonary function tests, including spirometry [forced vital capacity (FVC), forced expiratory volume in 1 s (FEV₁), and FEV₁/FVC ratio], plethysmography [total lung capacity (TLC), residual volume (RV), RV/TLC ratio, and airway resistance (Raw)], and diffusing capacity of carbon monoxide in the lung (TLCO), alveolar volume (AV), and TLCO/AV ratio. The duration of diabetes, degree of metabolic control, insulin dose, and presence of diabetic complications were registered. The χ²-test and analysis of variance were used to compare categorical and quantitative variables, respectively.

RESULTS

The duration of diabetes was 6.2±3.8 years with a median HbA₁c of 7.08±0.4%. FEV₁/FVC ratio was found to be significantly higher in patients with TIDM than in controls. Patients with diabetes also had a nonsignificant trend towards lower FVC, FEV₁, Raw, and TLCO, and higher RV, TLC, and RV/TLC than controls. There were no differences in pulmonary function based on duration of disease or metabolic control. We found differences in pulmonary evaluation when pubertal stage was analyzed.

CONCLUSIONS

The lung is functionally involved in children with T1DM. Pubertal development stage influences the evaluation of lung function.

Improvement of digestive health and reduction in proteobacterial populations in the gut microbiota of cystic fibrosis patients using a Lactobacillus reuteri probiotic preparation: a double blind prospective study

BACKGROUND

Although scientific knowledge about the benefits of probiotic use in cystis fibrosis (CF) is scarce, their expectative is promising. The aim of this work was to analyze the effect of a Lactobacillus reuteri probiotic preparation versus placebo in CF patients.

METHODS

A prospective, double blind, crossover and with placebo study was carried out in 30 CF patients from two Spanish hospitals. Patients were randomized in Group A (6 months of probiotic followed by 6 months of placebo) and Group B (6 months of placebo followed by 6 months of probiotic). GIQLI (gastrointestinal) and SF-12 (general) health tests were performed after probiotic and placebo intakes. Fat absorption coefficient, calprotectin, and inflammatory interleukin quantification were determined in fecal samples. Total fecal DNA was obtained and metagenomic 454-pyrosequencing was applied to analyze the microbiome composition. STATA v12 MP software was used for statistical analyses.

RESULTS

Statistically significant improvement in the gastrointestinal health and decrease of the calprotectin levels were demonstrated in patients after probiotic exposure, in comparison with placebo. All CF subjects reported good tolerance to L. reuteri without secondary effects. Metagenomic analysis showed an important dysbiosis in CF gut microbiota associated with a high concentration of Proteobacteria. Probiotic intake was followed by a reduction in the total bacterial density, mostly due to a considerable reduction in the γ-Proteobacteria phylum; and an important increase of the microbial diversity with a higher representation of Firmicutes.

CONCLUSIONS

Probiotics might ameliorate the dysbiosis of CF gut microbiota, characterized by a high density of Proteobacterial organisms. L. reuteri significantly decrease intestinal inflammation and increase digestive comfort.

Cough in children

Cough during childhood is very common, and is one of the most frequent reasons for consultation in daily pediatric practice. The causes differ from those in adults, and specific pediatric guidelines should be followed for correct diagnosis and treatment. The most common cause of cough in children is viral infection producing "normal cough", but all children with persistent cough, i.e. a cough lasting more than 4-8weeks or "chronic cough", must be carefully evaluated in other to rule out specific causes that may include the entire pediatric pulmonology spectrum. The treatment of cough should be based on the etiology. Around 80% of cases can be diagnosed using an optimal approach, and treatment will be effective in 90% of them. In some cases of "nonspecific chronic cough", in which no underlying condition can be found, empirical treatment based on the cough characteristics may be useful. There is no scientific evidence to justify the use of over-the-counter cough remedies (anti-tussives, mucolytics and/or antihistamines), as they could have potentially serious side effects, and thus should not be prescribed in children.

Inhaled antibiotics for the treatment of chronic bronchopulmonary Pseudomonas aeruginosa infection in cystic fibrosis: systematic review of randomised controlled trials

INTRODUCTION

Inhaled antibiotics are probably the safest and most effective therapy for Pseudomonas aeruginosa chronic lung infection in cystic fibrosis (CF) patients.

AREAS COVERED

To summarise the available evidence, a systematic review of the three currently available inhaled antibiotics (aztreonam lysine (AZLI), colistin (COL) and tobramycin (TOB)) was performed. The three AZLI placebo-controlled studies showed that the improvements in FEV1 and mean sputum P. aeruginosa density were statistically significant better than with placebo. The two COL placebo-controlled studies involved few patients but showed that COL was better than placebo in terms of maintenance of some pulmonary function parameters. The tobramycin inhalation solution (TIS) and tobramycin inhalation powder studies showed that the efficacy of both formulations was similar but significantly better than placebo. In the comparative studies, TIS showed more efficacy than COL solution, colistin inhalation powder showed non-inferiority to TIS and AZLI was superior to TIS.

EXPERT OPINION

Placebo-controlled and comparative clinical trials have shown that clinical evidence of inhaled antibiotics is very different. The choice of treatment for each individual CF patient must be based on the features of the drug (clinical evidence on efficacy and safety), the inhalation system and the patient characteristics. Development of new inhaled antibiotics will allow new end points of efficacy and therapy regimens to be assessed.

In vitro prevention of Pseudomonas aeruginosa early biofilm formation with antibiotics used in cystic fibrosis patients

The ability of antibiotics used in bronchopulmonary infections in cystic fibrosis (CF) patients to prevent Pseudomonas aeruginosa early biofilm formation was studied using a biofilm microtitre assay with 57 non-mucoid P. aeruginosa isolates (44 first colonisers and 13 recovered during the initial intermittent colonisation stage) obtained from 35 CF patients. Minimum biofilm inhibitory concentrations (BICs) of levofloxacin, ciprofloxacin, imipenem, ceftazidime, tobramycin, colistin and azithromycin were determined by placing a peg lid with a formed biofilm onto microplates containing antibiotics. A modification of this protocol consisting of antibiotic challenge during biofilm formation was implemented in order to determine the biofilm prevention concentration (BPC), i.e. the minimum concentration able to prevent biofilm formation. The lowest BPCs were for fluoroquinolones, tobramycin and colistin and the highest for ceftazidime and imipenem. The former antibiotics had BPCs identical to or only slightly higher than their minimum inhibitory concentrations (MICs) determined by standard Clinical and Laboratory Standards Institute (CLSI) microdilution and were also active on formed biofilms as reflected by their low BIC values. In contrast, ceftazidime and imipenem were less effective for prevention of biofilm formation and on formed biofilms. In conclusion, the new BPC parameter determined in non-mucoid P. aeruginosa isolates recovered during early colonisation stages in CF patients supports early aggressive antimicrobial treatment guidelines in first P. aeruginosa-colonised CF patients.

MALDI-TOF MS improves routine identification of non-fermenting Gram negative isolates from cystic fibrosis patients

Identification of non-fermenting Gram-negative bacteria (NFGNB) from cystic fibrosis (CF) patients is often limited. A collection of stored NFGNB isolates (n=182) recovered from CF patients over a 15 year period was examined. The routinely reported identification during this period was compared with that obtained by MALDI-TOF MS. Isolates giving discrepant identification at the genus level were further analyzed by 16S rDNA sequencing. The MALDI-TOF MS system identified 94% of the isolates, including Burkholderia cepacia and Pandoraea spp. isolates, the latter previously misidentified as other NFGNB by conventional microbiological methods. Lack of identification by MALDI-TOF MS was associated with the absence of entries in the database.

Analysis of pharmacodynamic interaction of sevoflurane and propofol on Bispectral Index during general anaesthesia using a response surface model

BACKGROUND

Propofol and sevoflurane act on the GABA(A) receptor, modulating the function of this receptor in an additive manner. The pharmacodynamic interaction of both drugs considering their effect on EEG activity analysed by the bispectral index (BIS) was identified as additive, but this has not been studied in a clinical setting. The objective of this study was to analyse the pharmacodynamic interaction of propofol and sevoflurane on BIS using a surface response model in patients undergoing general anaesthesia with i.v. induction and inhalation maintenance.

METHODS

We performed a prospective study in 24 patients undergoing general anaesthesia with propofol induction and sevoflurane maintenance. Anaesthetic depth was measured with a BIS VISTA Bilateral monitor. Propofol biophase concentration was determined using a three-compartment pharmacokinetic model, and sevoflurane end-tidal concentration was measured continuously. The response surface model described by Minto and colleagues was used to analyse the interaction. Statistical analysis was performed with Excel 2002 and SPSS v11.0.

RESULTS

The mean value of U(50)(theta) was 0.956 (sd 0.029) in the overall estimated data, and remained within the predefined range for all ratios of the drugs, fulfilling the criterion of additivity. The median of the weighted residuals between the actual BIS value and the BIS value predicted by the model was -5.926%.

CONCLUSIONS

Under the study conditions, it was confirmed that sevoflurane and propofol have an additive effect on BIS, with no evidence suggesting the existence of a synergistic effect for the concentrations of both drugs typically used in clinical practice.

Monitoring sedation in the critically ill child

Sedation is an essential part of the management of the critically ill child, and its monitoring must be individualised and continuous in order to adjust drug doses according to the clinical state. There is no ideal method for evaluating sedation in the critically ill child. Haemodynamic variables have not been found to be useful. Clinical scales are useful when sedation is moderate, but are limited by their subjective nature, the use of stimuli, and the impossibility of evaluating profoundly sedated patients or those receiving neuromuscular blocking drugs; in addition, many of these scales have not been evaluated in children. The COMFORT scale is the most appropriate, as it was designed and validated for critically ill children requiring mechanical ventilation. Electroencephalography-derived methods permit continuous monitoring, provide an early indication of changes in the level of sedation, and facilitate a rapid adjustment of medication. However, these methods were designed and validated for patients under anaesthesia and their results cannot be fully extrapolated to the critically ill patient; in addition, some of them have not been validated in small children and there is still little experience in critically ill children. The main indications for the use of these methods are in patients with deep sedation and/or neuromuscular blockade. The bispectral index is the most widely used method at the present time. Analysis and comparison of the efficacy of the different methods for evaluating sedation in the critically ill child is required.

The functional neuroanatomy of blood-injection-injury phobia: a comparison with spider phobics and healthy controls

BACKGROUND

Most neuroimaging studies of specific phobia have investigated the animal subtype. The blood-injection-injury (BII) subtype is characterized by a unique biphasic psychophysiological response, which could suggest a distinct neural substrate, but direct comparisons between phobia types are lacking.

METHOD

This study compared the neural responses during the presentation of phobia-specific stimuli in 12 BII phobics, 14 spider (SP) phobics and 14 healthy controls using functional magnetic resonance imaging (fMRI).

RESULTS

Subjective ratings showed that the experimental paradigm produced the desired symptom-specific effects. As in many previous studies, when viewing spider-related stimuli, SP phobics showed increased activation in dorsal anterior cingulate and anterior insula, compared to BII phobics and healthy controls. However, when viewing images of blood-injection-injuries, participants with BII phobia mainly showed increased activation in the thalamus and visual/attention areas (occipito-temporo-parietal cortex), compared with the other two groups. The degree of provoked anxiety and disgust by phobia-relevant images was strongly associated with activation in several common regions across the two phobia groups (thalamus, cerebellum, occipito-temporal regions) but only correlated with activation in the dorsal anterior cingulate gyrus and the anterior insula in the SP phobics.

CONCLUSIONS

These results suggest partially distinct neurobiological substrates of animal and BII phobias and support their current classification as two distinct subtypes in the DSM-IV-TR. Further research is needed to better understand the precise neurobiological mechanisms in BII phobia and particularly the fainting response.

Assessment of the level of sedation in children after cardiac surgery

BACKGROUND

There is no reference method for the evaluation of the level of sedation in children after cardiac surgery. The utility of the bispectral index and middle latency auditory evoked potentials has not been evaluated.

METHODS

The bispectral index, middle latency auditory evoked potentials, Ramsay scale, and COMFORT scale were used for assessment of the level of sedation in critically ill children after cardiac surgery and other surgical procedures. The measurements with these four methods were recorded simultaneously once a day for five days. The level of sedation was categorized in two levels, moderate or deep, according to the values obtained from each method. Correlations and agreements among the methods and the best bispectral index and middle latency auditory evoked potential values that discriminated between the two levels of sedation were calculated.

RESULTS

Thirty-two children after cardiac surgery were included in the study, together with eighteen children after other surgical procedures who formed the control group. In each group, the correlation and agreement between the four methods varied between moderate and good. In the cardiac surgery patients, when the level of sedation was determined by the Ramsay scale, the best values of bispectral index and middle latency auditory evoked potentials that discriminated between the two levels of sedation were 63.5 and 37.5, respectively, and these values predicted the level of sedation correctly in 84.4% of the patients with each method.

CONCLUSIONS

Bispectral index and middle latency auditory evoked potentials could be useful to assess the level of sedation in children after cardiac surgery.

Unorthodox long-term aerosolized ampicillin use for methicillin-susceptible Staphylococcus aureus lung infection in a cystic fibrosis patient

Staphylococcus aureus is a significant cause of pulmonary colonization in cystic fibrosis (CF) patients. The optimal strategy of therapy in chronically infected patients with this pathogen is not yet established. We report a successful long-term aerosolized ampicillin treatment of a 14-year-old girl with chronic symptomatic S. aureus lung infection.

Responsiveness to stimuli of bispectral index, middle latency auditory evoked potentials and clinical scales in critically ill children

SUMMARY

We performed simultaneous recordings of Bispectral Index (BIS) and middle latency auditory evoked potentials. We also recorded two clinical scales, the Modified Ramsay scale and the COMFORT scale. Heart rate and blood pressure were measured once a day, for a maximum of 5 days, in 81 critically ill children. Changes with tactile, auditory, and painful stimuli were analysed. All the stimuli significantly increased the BIS value, the painful stimulus having the greatest effect. The painful stimulus was the only one that altered the middle latency auditory evoked potentials. Although the responses of the clinical scales to stimuli were statistically significant, they were of little clinical relevance. None of the stimuli used significantly altered the heart rate or blood pressure. We conclude that tactile, auditory and painful stimuli produced changes of little relevance in the clinical scales, BIS or middle latency auditory evoked potentials. We found the BIS was the most sensitive method and the painful stimulus had the greatest effect.

[Aspergillus fumigatus and Candida albicans in cystic fibrosis: clinical significance and specific immune response involving serum immunoglobulins G, A, and M]

OBJECTIVE

The aim of this study was to analyze the clinical significance of Aspergillus fumigatus and Candida albicans in respiratory secretions from patients with cystic fibrosis and to assess the immune response to these fungi in serum.

PATIENTS AND METHODS

The study included 66 patients with cystic fibrosis (34 men; mean age, 16.2 years). Sera from 15 healthy individuals were used as controls.

RESULTS

The serum concentrations of immunoglobulin (Ig) G, IgA, and IgM against A fumigatus and C albicans were higher in patients than in the control group. There was no correlation between the presence of A fumigatus in respiratory secretions and the immune response to the fungus measured in serum. In contrast, the presence of C albicans in respiratory secretions was correlated with the immune response to that fungus. The likelihood of obtaining A fumigatus cultures from respiratory secretions increased with age. The presence of these fungi in respiratory samples was not a risk factor for greater respiratory impairment.

CONCLUSIONS

In response to increased colonization of the lower respiratory tract by A fumigatus and C albicans, patients with cystic fibrosis have elevated serum levels of IgG, IgA, and IgM against those fungi. In patients with cystic fibrosis, culture of sputum and oropharyngeal secretions is adequate for the assessment of lower respiratory tract colonization by C albicans but not A fumigatus. Fungal colonization of the lower respiratory tract is not a risk factor for greater respiratory impairment in patients with cystic fibrosis.

Assessing sedation in critically ill children by bispectral index, auditory-evoked potentials and clinical scales

OBJECTIVE

To evaluate the correlation and agreement between the bispectral index (BIS), middle latency auditory-evoked potential index (AEP index), Ramsay scale (RS) and COMFORT scale (CS) for evaluation of the level of sedation in critically ill children.

DESIGN

Prospective observational study.

SETTING

Pediatric critical care unit.

PATIENTS

Seventy-seven critically ill children receiving sedation and mechanical ventilation.

MEASUREMENTS AND RESULTS

Simultaneous recording of BIS, AEP index, RS and CS were performed once a day, for a maximum of 5 days. Two levels of sedation were categorized: light-moderate versus deep-very deep. Correlations between methods were determined using Spearman rank correlation test and the agreement using Cohen's Kappa test. The correlation and agreement between the four methods was moderate-to-good. Correlation was not found in paralyzed children. There was no correlation between the four methods and the heart rate or blood pressure, or with the type or dose of sedative medication. Receiver-operating characteristic (ROC) analysis revealed best discrimination between light-moderate and deep-very deep sedation at BIS and AEP index values of 63.5 and 33.5 when the level of sedation was classified by the RS, and at BIS and AEP index values of 67 and 37.5, respectively, when the level of sedation was classified by the CS.

CONCLUSION

There is a moderate-to-good correlation and agreement of BIS and AEP index with the clinical scales in critically ill children without neuromuscular blockade. BIS and AEP index could be useful to evaluate the level of sedation in critically ill children with and without neuromuscular blockade.

Prognosis of child recipients of hematopoietic stem cell transplantation requiring intensive care

OBJECTIVE

To determine prognostic factors in child recipients of hematopoietic stem cell transplantation from blood or bone marrow (BMT) requiring critical care.

DESIGN

Retrospective study of a cohort of patients.

SETTING

Pediatric Intensive Care Unit (PICU) in a university tertiary care center.

PATIENTS AND PARTICIPANTS

Child recipients of BMT requiring PICU admission.

MEASUREMENTS AND RESULTS

Of the 151 children receiving transplants in our institution, 44 (29.1%) had 49 admissions to the PICU. Mechanical ventilation (MV) was required in 34 patients (69.4% of all admissions). Overall mortality was 31/44 (70.4%). Mortality in patients requiring MV and not requiring MV was 26/34 (76.5%) and 5/10 (50%), respectively. The following variables were significantly associated with mortality in the univariate analysis: male gender (P=0.02), older age (P=0.03), acute graft versus host disease (aGVHD) grades III or IV (P=0.01), severe hemorrhagic cystitis (P=0.01), the diagnosis of lung injury (P=0.04), the need for MV (P=0.03) or for renal replacement therapy (P=0.02), the presence of respiratory (P=0.003), cardiovascular (P=0.009) or gastrointestinal (P=0.01) failures, and the failure of > or =3 organs (P=0.01). In the multivariate analysis, the presence of aGVHD grades III or IV, male gender, severe hemorrhagic cystitis, and the failure of > or =3 organs were found to be independent predictors of mortality.

CONCLUSIONS

The need for intensive care is common among child recipients of a BMT. These patients have a high mortality rate but some complications are reversible with critical care support. Certain clinical parameters are useful to establish a realistic prognosis and to optimize the use of the available resources.

Bronchiolitis obliterans organizing pneumonia associated with Evans syndrome

The association of bronchiolitis obliterans organizing pneumonia (BOOP) with insulin-dependent diabetes mellitus (IDDM) and Evans syndrome (autoimmune pancytopenia) has not been reported previously. We describe the case of a 4-year-old child diagnosed with IDDM and Evans syndrome who presented malaise, fever and nonproductive cough for several months. The chest radiograph revealed several patchy alveolar opacities with peripheral and bilateral distribution and multiple hilar and mediastinal adenopathies. An open lung biopsy established the diagnosis of BOOP. During the follow-up over the next 7 years, the patient had chronic relapses in spite of corticosteroid treatment and developed restrictive lung disease.

Nutritional value of the marine invertebrates Anemonia viridis and Haliothis tuberculata and effects on serum cholesterol concentration in ratsopen star

The purpose of this study was to determine the nutritional value of diets with protein from two marine species (Haliotis tuberculata and Anemonia viridis) as compared to a high-quality protein reference based on casein or casein supplemented with olive oil. We also investigated the effects of these diets on serum lipid levels. Male rats were fed these diets for 23 days. Protein quality indicators (true digestibility, net protein utilization, biological value) were similar to those obtained for casein-based feeds except for lower true digestibility and net protein utilization values for the Anemonia viridis feed. HDL-cholesterol level was significantly higher (p < 0.05) in the groups fed marine species or casein supplemented with olive oil than in the casein group. Total-cholesterol level was higher in the group fed Haliotis tuberculata fed than in the other groups. These results suggest that these marine species are a good protein source, and that they may have positive effects on serum cholesterol level.

Nutritive value of protein from sea urchin, and its effects on intestinal leucine aminopeptidase and intestinal and hepatic gamma-glutamyltranspeptidase

Seafoods are a rich source of easily digestible protein that also provides polyunsaturated fatty acids, vitamins and minerals for human nutrition. The purpose of this study was to determine the nutritive value of diets high in protein from two species of sea urchin (Paracentrotus lividus and Echinus esculentus) as compared to a high-quality reference protein such as casein, as well as the effects of these diets on leucine aminopeptidase and gamma-glutamyltranspeptidase, intestinal and hepatic enzymes. The test was carried out on three groups of male rats fed these diets for 23 days. The result of the nutritive parameters indicated that sea urchin, Echinus esculentus, were significantly lower than the casein protein except for food intake, and the nutritive parameters of sea urchin, Paracentrotus lividus, were similar to the values obtained for casein protein except for digestibility and net protein utilization. Intestinal leucine aminopeptidase activity was significantly lower (P < 0.05) in the group fed Paracentrotus lividus as compared to the group fed casein. Intestinal gamma-glutamyltranspeptidase showed a significantly higher activity in the group fed E. esculentus than in the two other groups and the hepatic gamma-glutamyltranspeptidase activity in the groups fed the two species of sea urchin were lower. Nutritive values suggested that these marine species are a good protein source and similar to casein. The activity of the enzymes under study must have been affected by the amino acid composition of the protein.