Static in vitro digestion model adapted to the general older adult population: an INFOGEST international consensus

Understanding the mechanisms of food digestion is of paramount importance to determine the effect foods have on human health. Significant knowledge on the fate of food during digestion has been generated in healthy adults due to the development of physiologically-relevant in vitro digestion models. However, it appears that the performance of the oro-gastrointestinal tract is affected by ageing and that a model simulating the digestive conditions found in a younger adult (<65 years) is not relevant for an older adult (>65 years). The objectives of the present paper were: (1) to conduct an exhaustive literature search to find data on the physiological parameters of the older adult oro-gastrointestinal tract, (2) to define the parameters of an in vitro digestion model adapted to the older adult. International experts have discussed all the parameters during a dedicated workshop organized within the INFOGEST network. Data on food bolus properties collected in the older adult were gathered, including food particle size found in older adult boluses. In the stomach and small intestine, data suggest that significant physiological changes are observed between younger and older adults. In the latter, the rate of gastric emptying is slowed down, the pH of the stomach content is higher, the amount of secretions and thus the hydrolytic activities of gastric and intestinal digestive enzymes are reduced and the concentration of bile salts lower. The consensus in vitro digestion model of the older adult proposed here will allow significant progress to be made in understanding the fate of food in this specific population, facilitating the development of foods adapted to their nutritional needs. Nevertheless, better foundational data when available and further refinement of the parameters will be needed to implement the proposed model in the future.

Assessment of the environmental acceptability of potential artificial reef materials using two ecotoxicity tests: Luminescent bacteria and sea urchin embryogenesis

Ecotoxicological analysis of construction products is a relatively unexplored area at international level. Aquatic toxicity tests on construction products has been recommended recently for freshwater environment. However, the biological effects of alternative materials on marine ecosystem are still not considered. In this study, the main aim was to assess the environmental impact of alternative mortars proposed as artificial reefs (ARs) materials. The ARs specimens were developed by 3D printing, based on cement and geopolymer mortars using recycled sands of glass and seashells. For this purpose, a leaching test and two different toxicity bioassays, luminosity reduction of marine bacteria Vibrio fischeri (Microtox®) and the success of embryo-larval development of sea-urchin Paracentrotus lividus, were conducted. From the leaching results it should be noted that the mobility of all trace elements considered in both, raw materials and mortars, meet the inert landfill limits, except As, Mo, Se or Sb in the leachates geopolymer mortars. However, the results obtained from the both bioassays show low environmental acceptability for those mortars containing shell sand, probably due to the degradation of the organic matter adhered to the shells. On the other hand, cement mortars obtain better results than geopolymer mortars, regardless of the aggregate used, showing certain consistency with the leaching behaviour, since they present the lowest mobility of trace chemical elements. Therefore, the results supporting the environmental acceptability of its potential use as alternative materials in the production of ARs.

Maternal Obesity during Pregnancy is Associated with Lower Cortical Thickness in the Neonate Brain

BACKGROUND AND PURPOSE

Recent studies have suggested that maternal obesity during pregnancy is associated with differences in neurodevelopmental outcomes in children. In this study, we aimed to investigate the relationships between maternal obesity during pregnancy and neonatal brain cortical development.

MATERIALS AND METHODS

Forty-four healthy women (28 normal-weight, 16 obese) were prospectively recruited at <10 weeks' gestation, and their healthy full-term neonates (23 boys, 21 girls) underwent brain MR imaging. All pregnant women had their body composition (fat mass percentage) measured at ∼12 weeks of pregnancy. All neonates were scanned at ∼2 weeks of age during natural sleep without sedation, and their 3D T1-weighted images were postprocessed by the new iBEAT2.0 software. Brain MR imaging segmentation and cortical surface reconstruction and parcellation were completed using age-appropriate templates. Mean cortical thickness for 34 regions in each brain hemisphere defined by the UNC Neonatal Cortical Surface Atlas was measured, compared between groups, and correlated with maternal body fat mass percentage, controlled for neonate sex and race, postmenstrual age at MR imaging, maternal age at pregnancy, and the maternal intelligence quotient and education.

RESULTS

Neonates born to obese mothers showed significantly lower (P ≤ .05, false discovery rate-corrected) cortical thickness in the left pars opercularis gyrus, left pars triangularis gyrus, and left rostral middle frontal gyrus. Mean cortical thickness in these frontal lobe regions negatively correlated (R = -0.34, P = .04; R = -0.50, P = .001; and R = -0.42, P = .01; respectively) with the maternal body fat mass percentage measured at early pregnancy.

CONCLUSIONS

Maternal obesity during pregnancy is associated with lower neonate brain cortical thickness in several frontal lobe regions important for language and executive functions.

How surgical training in Switzerland affects outcomes and new predictors for teaching

Objective

Teaching in the operating room represents the cornerstone of surgical education. Residents need to perform a sufficient number of basic procedures in order to gain independence. However, it is still debated what impact surgical teaching has on outcomes. With this study, we provide recent data of a large national cohort and identify new factors that are associated with increased teaching.

Methods

We studied common procedures that are essential for surgical training: Laparoscopic Appendectomy (LA), Laparoscopic Cholecystectomy (LC), ostomy closure (OC), laparoscopic (LH) and Open Inguinal Hernia Repair (OH). The national database of the Swiss association for quality management in surgery was screened, and 72072 patients were identified from 2009 to 2019. Teaching was defined as a procedure mainly performed by a surgeon in training under supervision.

Results

A minority of basic surgical procedures were used for teaching (LA 28.1%, LC 22.3%, OC 21.5%, OH 31.8%, LH 6.3%), even in teaching hospitals of &gt; 200 beds (LA 33.0%, LC 32.9%, OC 27%, OH 51.5%, LH 6.5%). During the study period, there was also generally a trend towards less teaching, exemplified by the two most frequent procedures: LA 35.6 to 26.7% (-25.0%, p = &lt;0.001), LC 27.6 to 18.9% (-31.5%, p = &lt;0.001). Operating time was significantly longer for procedures that were used for teaching with a more pronounced effect for inguinal hernia repairs: LA 63.4 vs 57.5min (+10.3%, p = &lt;0.001), LC 84.0 vs 74.9min (+12.1%, p = &lt;0.001), OC 88.6 vs 81.6min (+8.6%, p = &lt;0.001), OH 81.5 vs 68.3min (+19.3%, p = &lt;0.001), LH 97.9 vs 73.8min (+32.7%, p = &lt;0.001). The overall complication rate for LA (2.6 vs 1.8%, p = &lt;0.001) and LC (3.6 vs 2.8%, p = &lt;0.001) were slightly higher in the no-teaching group and without a significant difference between the groups for OC, LH and OH. We identified the following parameters associated with increased teaching: A hospital size above 200 beds (OR = 2.48, p = &lt;0.001), an operation during office hours (OR = 1.27, p = &lt;0.001), the summer months (OR = 1.11, p = &lt;0.001) and weekdays (OR = 1.10, p = 0.003).

Conclusion

The teaching of basic surgical procedures appears safe. Even if associated with longer operating times, it should be promoted as teaching is currently only performed in a minority of procedures (10-33%).

Autonomic Activity in Overweight-Obese Children During the Morning Transition in Cardiac Circadian Regulation (P21-065-19)

Objectives

Regulation of the autonomic nervous system is disturbed in obese children and adults. This dysregulation—which includes sympathetic nervous system (SNS) over activity and disruption of cardiac circadian rhythms—is of interest because of the negative impact of these effects on cognition, regulation of energy homeostasis, cardiovascular health, and metabolic functions. The present study evaluated heart rate (HR) measures during the first hours following awakening from sleep when circadian cardiac control transitions from an emphasis on parasympathetic nervous system activity (PNS) during sleep to an emphasis on SNS activity during wakefulness.

Methods

Resting HR recordings (5 min) were obtained from healthy normal weight (NW: BMI < 85th %ile; n = 47; 25 boys) and overweight-obese (OB: BMI > 95th %ile; n = 48; 24 boys) 10 yr olds enrolled in the ACNC's Brain Food study. The first of two recording sessions (T1) took place 2 hrs after awakening (1 hr after a standardized breakfast), and the second (T2) 1 hr later. Recordings were processed for measures of sympathetic [low frequency (LF)] and parasympathetic [high frequency (HF); vagal tone (VT); root mean square of intervals between adjacent heart beats (RMSSD)] activities.

Results

Separate ANOVAs (recording session by group by sex) were conducted for each measure. Previous reports of higher HR in girls than boys and in OB than NW groups were confirmed (both P ≤ 0.001) HR slowed significantly from T1 to T2 for OB (P = 0.021), but not NW. These effects were associated with T1 to T2 increases in SNS LF activity for both groups (both P ≤ 0.003), but significant increases in PNS measures (HF, RMSSD, VT; all P < 0.05) for only OB children. Increases in PNS activity across recording sessions for OB children attenuated group HR differences during T2 (T1: OB > NW, P = 0.008; T2: OB > NW, P = .051). Gender differences were consistent with faster HR in girls which was maintained across groups and recording sessions.

Conclusions

The results are the first to show that autonomic dysregulation in obese children modulates the shift in SNS-PNS balance characteristic of the transition from sleep to waking. These findings may inform the development of new early intervention strategies to attenuate obesity that consider the role played by circadian rhythms.

Funding Sources

Funded by USDA-ARS Project 6026-51000-010-05S.

Early Postnatal Diet Differentially Affects the Fecal Microbiome and Metabolome (FS04-02-19)

Objectives

Infants who receive breastmilk have better immune response compared to formula fed children in part due to differences in their gut microbiome and metabolome. The aim of the study is to describe microbiota and metabolome differences and associations between these factors’ in 3 and 12 month old infants who exclusively received breast milk (BM) or either soy (SF) or dairy (DF) formula until 4 months of age.

Methods

Samples from 3 month old infants (BM = 10, DF = 8, SF = 9) and 12 month old infants (BM = 22, DF = 12, SF = 10) were obtained from infants fed formula or BM exclusively for 4 months. Fecal metabolomics and microbiota were assessed by LC-MS and 16s rRNA sequencing, respectively. Data analyses were conducted using standardized pipelines (QIIME 1.9, R, and Metabo-Analyst).

Results

At 3 months of age, both the fecal microbiome and metabolites were affected by diet. The BM group had the lowest microbial diversity (Shannon index) and the SF had the highest diversity (P < 0.01) at genera taxonomic level while DF fell in the middle. There were 41 metabolites affected by diet at 3 months of age (P < 0.05, FDR < 0.05). Hippuric, succinic, lactic and uric acids were higher in the BM group and butyric and propionic acids were higher in the formula groups (P < 0.01). Correlation analyses revealed extensive associations within each diet type. For instance, we observed positive associations between succinic acid and Lactobacillus in BM group and lactic acid with Salmonella and Clostridium in SF group. Streptococcus and butyric acid in the DF, and Bifidobacterium and indole-2-carboxylic acid in the SF were negatively associated. At 12 months of age, there were no differences in microbial diversity and only fecal inosine remained significantly (P < 0.05) different among the diet groups. This metabolite was found to be negatively associated with Bifidobacterium in the breastfed group (P < 0.01).

Conclusions

There is a strong effect of diet on the fecal metabolome and microbiota at 3 months of age. Additionally, multiple associations between the two across various diets are apparent, suggesting that differences in specific gut bacteria influence the metabolite milieu. Future mechanistic studies will examine the roles of microbiota and metabolites in immune function.

Funding Sources

USDA-ARS Project 6251-51000-010-05S and NIH P20GM121293.

Antenatal and Postnatal Factors Associated with Offspring Adiposity During the First Two Years of Life (FS18-08-19)

Objectives

Maternal obesity is a risk factor for the development of obesity in offspring. Yet, it is unclear what other antenatal and postnatal characteristics can also influence offspring's obesity risk. The objective of this study was to determine which factors are the strongest predictors of offspring adiposity during the first 2 years of life to better inform future intervention strategies.

Methods

Two hundred and twenty-four (224) mother (BMI 18.5–35 kg/m2) and child pairs (male: N = 128, female: N = 96) were included in this analysis. Percent fat mass (%FM) was obtained using quantitative nuclear magnetic resonance in children at 11 time points between age 0.5 to 24 months. Maternal race, age, gestational weight gain, first trimester %FM, delivery mode as well as averaged gestational measures of resting energy expenditure, respiratory exchange ratio, physical activity (PA), FM (BodPod®), serum cytokines, serum lipids, and dietary intake were considered as the maternal independent variables. Child's sex, birth weight and length, length of breastfeeding, and PA at 2 years of age were considered as the child's independent variables. Linear mixed models were used to construct the best-fitted models for the entire cohort and for each sex.

Results

Maternal %FM, serum low density lipoprotein (LDL), high density lipoprotein (HDL), child's sex, birth weight and length of breastfeeding were independent predictors of offspring %FM in the entire cohort. When stratified by child sex, maternal %FM was the strongest predictor of girls adiposity (β = 0.14, P = 0.002) followed by maternal serum HDL levels (β = 0.07, P < 0.001). For male offspring, birth weight (β = 1.80, P = 0.01) was the strongest predictor of adiposity during the first 2 years of life followed by maternal serum HDL (β = 0.04, P = 0.013) and length of breastfeeding (β = 0.004, P = 0.005).

Conclusions

Maternal obesity has a sexually dimorphic effect on offspring %FM from birth to age 2 years. In both boys and girls, maternal serum HDL levels in early pregnancy were a significant predictor of offspring FM accrual during the first 2 years of life. Further investigations on the precise mechanisms of how maternal %FM and lipid profiles can influence female compared to male offspring fat accretion are needed.

Funding Sources

USDA-ARS # Project #6026-51000-010-05S.

Parental Obesity Differentially Associates with Newborn Adiposity. Is Programming of the GH-IGF Axis Involved? (OR09-05-19)

Objectives

Maternal obesity is strongly associated with offspring obesity risk. However, studies show that paternal obesity also affects offspring phenotype, especially in males. Programming of the growth hormone (GH) insulin-like growth factor (IGF) axis seems to be an important mechanism in this finding, but evidence regarding this relationship in humans is scarce. The primary purpose of this study was to evaluate associations between maternal and paternal adiposity with that of their offspring. A secondary aim was to investigate associations between paternal adiposity with GH levels in male offspring.

Methods

Parent-offspring trios (n = 209) from the Glowing study were studied. Percent body fat mass (%FM) was measured using air displacement plethysmography early in pregnancy in parents, and at age 2 weeks in the offspring. Plasma GH levels were measured at birth from umbilical cord blood (n = 31) and at age 2 years (n = 39) in male offspring. Multiple linear regression was used to model infant's %FM (dependent variable) at 2 weeks of age using parental %FM, race, age, IQ, income, delivery method, gestational weight gain, feeding mode, and gestational age (GA) as independent variables. The best fitted models were constructed for girls and boys. Spearman correlations (ρ) between paternal %FM and offspring GH levels were adjusted for maternal %FM.

Results

Girls (n = 94): Paternal %FM did not associate with female newborn %FM. Instead, maternal %FM (β = 0.12, P = 0.010) and C-section delivery mode (β = 2.56, P = 0.011) had the strongest associations with female newborn %FM. Boys (n = 115): Maternal %FM (β = 0.12, P = 0.006) and GA (β = 1.06, P = 0.003) were positively associated with male newborn %FM, whereas paternal %FM was negatively associated (β = −0.09, P = 0.014) with male offspring adiposity. There was no significant correlation between paternal %FM and GH measured at birth (ρ = 0.19, P = NS) in boys. However, at age 2 years, GH levels in boys decreased with increasing paternal %FM (ρ = −0.40, P = 0.015). Maternal %FM did not correlate with offspring GH level at any age.

Conclusions

Parental obesity differentially associates with newborn girls’ and boys’ adiposity at age 2 weeks. In line with prior findings in animal models, this preliminary analysis points to programming of the GH/IGF axis in male offspring born to obese fathers.

Funding Sources

USDA ARS # 6026-51000-010-05S, NIH 1UL1RR029884.

In vitro starch digestibility and fate of crocins in pasta enriched with saffron extract

This work aims to study the effect of the addition of saffron extract on fresh pasta in-vitro digestibility. Fresh pasta was formulated with different concentrations of saffron extracts (0.2 and 0.4 %w/w), cooked at two different times (1.5 and 3 min), and in vitro digested (oral, gastric and intestinal stages). Oil was added to pasta before digestion to evaluate the presence of lipids on starch and crocin bioaccessibility. Saffron enrichment and oil addition slowed down the digestion of starch, thus, decreasing the glycemic index of pasta. Concentration of saffron and oil addition contributed to crocin release in the digestion fluids, with the opposite effect of cooking time. Isomerization from trans to cis was enhanced by both, cooking and oil addition. Bioaccessibility of total crocins varied from 2.9 ± 1.1, to 97 ± 3%. Finally, the trans:cis isomers distribution was only close to 50:50 in enriched-pasta cooked during 3 min or with oil addition.

Gestational Age at Birth and Brain White Matter Development in Term-Born Infants and Children

BACKGROUND AND PURPOSE

Studies on infants and children born preterm have shown that adequate gestational length is critical for brain white matter development. Less is known regarding how variations in gestational age at birth in term infants and children affect white matter development, which was evaluated in this study.

MATERIALS AND METHODS

Using DTI tract-based spatial statistics methods, we evaluated white matter microstructures in 2 groups of term-born (≥37 weeks of gestation) healthy subjects: 2-week-old infants (n = 44) and 8-year-old children (n = 63). DTI parameters including fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity were calculated by voxelwise and ROI methods and were correlated with gestational age at birth, with potential confounding factors such as postnatal age and sex controlled.

RESULTS

Fractional anisotropy values, which are markers for white matter microstructural integrity, positively correlated (P < .05, corrected) with gestational age at birth in most major white matter tracts/regions for the term infants. Mean diffusivity values, which are measures of water diffusivities in the brain, and axial and radial diffusivity values, which are markers for axonal growth and myelination, respectively, negatively correlated (P < .05, corrected) with gestational age at birth in all major white matter tracts/regions excluding the body and splenium of the corpus callosum for the term infants. No significant correlations with gestational age were observed for any tracts/regions for the term-born 8-year-old children.

CONCLUSIONS

Our results indicate that longer gestation during the normal term period is associated with significantly greater infant white matter development (as reflected by higher fractional anisotropy and lower mean diffusivity, axial diffusivity, and radial diffusivity values); however, similar associations were not observable in later childhood.

Conventional and right-sided screening for subcutaneous ICD in a population with congenital heart disease at high risk of sudden cardiac death

BACKGROUND

Information regarding suitability for subcutaneous defibrillator (sICD) implantation in tetralogy of Fallot (ToF) and systemic right ventricle is scarce and needs to be further explored. The main objective of our study was to determine the proportion of patients with ToF and systemic right ventricle eligible for sICD with both, standard and right-sided screening methods. Secondary objectives were: (i) to study sICD eligibility specifically in patients at high risk of sudden cardiac death, (ii) to identify independent predictors for sICD eligibility, and (iii) to compare the proportion of eligible patients in a nonselected ICD population.

METHODS

We recruited 102 patients with ToF, 33 with systemic right ventricle, and 40 consecutive nonselected patients. Conventional electrocardiographic screening was performed as usual. Right-sided alternative screening was studied by positioning the left-arm and right-arm electrodes 1 cm right lateral of the xiphoid midline. The Boston Scientific ECG screening tool was utilized.

RESULTS

In high-risk patients with ToF, eligibility was higher with right-sided screening in comparison with standard screening (61% vs. 44%; p = .018). Eligibility in high-risk right ventricle population was identical with both screening methods (77%, p = ns). The only independent predictor for sICD eligibility was QRS duration.

CONCLUSION

In high-risk patients with ToF, right-sided implantation of the sICD could be an alternative to a conventional ICD. In patients with a systemic right ventricle, implantation of a sICD is an alternative to a conventional sICD.

Preliminary Single-Center Canadian Experience of Human Normothermic Ex Vivo Liver Perfusion: Results of a Clinical Trial

After extensive experimentation, outcomes of a first clinical normothermic machine perfusion (NMP) liver trial in the United Kingdom demonstrated feasibility and clear safety, with improved liver function compared with standard static cold storage (SCS). We present a preliminary single-center North American experience using identical NMP technology. Ten donor liver grafts were procured, four (40%) from donation after circulatory death (DCD), of which nine were transplanted. One liver did not proceed because of a technical failure with portal cannulation and was discarded. Transplanted NMP grafts were matched 1:3 with transplanted SCS livers. Median NMP was 11.5 h (range 3.3-22.5 h) with one DCD liver perfused for 22.5 h. All transplanted livers functioned, and serum transaminases, bilirubin, international normalized ratio, and lactate levels corrected in NMP recipients similarly to controls. Graft survival at 30 days (primary outcome) was not statistically different between groups on an intent-to-treat basis (p = 0.25). Intensive care and hospital stays were significantly more prolonged in the NMP group. This preliminary experience demonstrates feasibility as well as potential technical risks of NMP in a North American setting and highlights a need for larger, randomized studies.

Voxel-Based Morphometry and fMRI Revealed Differences in Brain Gray Matter in Breastfed and Milk Formula-Fed Children

BACKGROUND AND PURPOSE

Infant diets may have significant impact on brain development in children. The aim of this study was to evaluate brain gray matter structure and function in 8-year-old children who were predominantly breastfed or fed cow's milk formula as infants.

MATERIALS AND METHODS

Forty-two healthy children (breastfed: n = 22, 10 boys and 12 girls; cow's milk formula: n = 20, 10 boys and 10 girls) were studied by using structural MR imaging (3D T1-weighted imaging) and blood oxygen level-dependent fMRI (while performing tasks involving visual perception and language functions). They were also administered standardized tests evaluating intelligence (Reynolds Intellectual Assessment Scales) and language skills (Clinical Evaluation of Language Fundamentals).

RESULTS

Total brain gray matter volume did not differ between the breastfed and cow's milk formula groups. However, breastfed children had significantly higher (P < .05, corrected) regional gray matter volume measured by voxel-based morphometry in the left inferior temporal lobe and left superior parietal lobe compared with cow's milk formula-fed children. Breastfed children showed significantly more brain activation in the right frontal and left/right temporal lobes on fMRI when processing the perception task and in the left temporal/occipital lobe when processing the visual language task than cow's milk formula-fed children. The imaging findings were associated with significantly better performance for breastfed than cow's milk formula-fed children on both tasks.

CONCLUSIONS

Our findings indicated greater regional gray matter development and better regional gray matter function in breastfed than cow's milk formula-fed children at 8 years of age and suggested that infant diets may have long-term influences on brain development in children.

Effect of long-term prophylaxis in the development of cytomegalovirus-specific T-cell immunity in D+/R- solid organ transplant recipients

BACKGROUND

This study aimed to characterize the dynamics of acquisition of cytomegalovirus (CMV)-specific cell-mediated immunity (CMI) in CMV donor positive/recipient negative solid organ transplant (SOT) patients receiving long-term antiviral prophylaxis, and to determine whether development of CMI confers protection against CMV disease.

METHODS

A prospective multicenter study was conducted in Spain from September 2009 to September 2012. Whole blood specimens were prospectively collected at 30, 90, 120, 200, and 365 days after SOT, and CMI was determined by enumeration of CMV pp65 and IE-1-specific CD69(+) /interferon-γ-producing CD8(+) and CD4(+) T cells by flow cytometry for intracellular cytokine staining. As part of a simultaneous clinical trial, patients received either early prophylaxis (in the first 3 days after transplantation) in the first period of the study or delayed prophylaxis (initiated at day 14) during the second period of the study. The impact of the dynamics of acquisition of CMV-specific CMI on the incidence of CMV disease was evaluated by Kaplan-Meier survival analysis.

RESULTS

A total of 95 SOT recipients were recruited. CMV infection and disease occurred in 38 (40%) and 26 (27.4%) patients, respectively. The proportion of patients achieving any detectable CMV-specific CMI response at each of the different monitoring points was higher in liver transplant recipients, as compared to kidney or heart transplant recipients. The presence of any detectable response at day 120 or 200 was protective against the development of CMV disease (positive predictive values 92% and 93%, respectively).

CONCLUSIONS

The rate of acquisition of CMV-specific CMI in SOT recipients undergoing antiviral prophylaxis differed significantly between different SOT populations. Patients developing any detectable CMI response were protected against the occurrence of CMV disease.

Effect of delaying prophylaxis against CMV in D+/R- solid organ transplant recipients in the development of CMV-specific cellular immunity and occurrence of late CMV disease

OBJECTIVES

Evaluate the protective effect against late CMV disease of delaying antiviral prophylaxis initiation in D+/R- patients receiving solid organ transplant (SOT).

METHODS

Prospective multicenter study in D+/R- SOT recipients in Spain (Sept/09-Sept/12). Whole blood specimens were prospectively collected after Tx for CMV-specific cell-mediated immunity (CMI) determination. Two prophylaxis strategies were compared: early prophylaxis (EP; starting within the first 3 days after Tx) and delayed prophylaxis (DP; starting 14 days after Tx). Risk factors for the occurrence of CMV disease were determined by survival analysis and proportional risk Cox regression models.

RESULTS

We included 95 patients (50 EP V 45 DP). Twenty six patients (27.4%) developed CMV disease: 32.7% EP vs. 20% DP; (p = 0.2). No cases of CMV disease were reported previously to beginning delayed prophylaxis. The percentage of individuals with detectable CMI response was higher in patients with DP although differences did not reach statistic significance (42% vs 29.6% at day 200 after Tx; p = 0.4). There was a clear trend towards less end-organ CMV disease in patients receiving DP (18.2% EP vs 5% DP; p = 0.09) and DP was the only protective factor in the multivariate analysis (HR: 0.26; CI: 0.05-1.2; p = 0.09).

CONCLUSIONS

A 14-day delay in CMV prophylaxis in D+/R- SOT recipients is safe and may reduce the incidence of late CMV end-organ disease although correlation of this effect with CMI responses was not complete.

Surgical management of patients with colorectal cancer and simultaneous liver and lung metastases

Background

The management of patients with colorectal cancer and simultaneously diagnosed liver and lung metastases (SLLM) remains controversial.

Methods

The LiverMetSurvey registry was interrogated for patients treated between 2000 and 2012 to assess outcomes after resection of SLLM, and the factors associated with survival. SLLM was defined as liver and lung metastases diagnosed 3 months or less apart. Survival was compared between patients with resected isolated liver metastases (group 1, control), those with resected liver and lung metastases (group 2), and patients with resected liver metastases and unresected (or unresectable) lung metastases (group 3). An Akaike test was used to select variables for assessment of survival adjusted for confounding variables.

Results

Group 1 (isolated liver metastases, hepatic resection alone) included 9185 patients, group 2 (resection of liver and lung metastases) 149 patients, and group 3 (resection of liver metastases, no resection of lung metastases) 285 patients. Ten variables differed significantly between groups and seven were included in the model for adjusted survival (age, number of liver metastases, synchronicity of liver metastases with primary tumour, carcinoembryonic antigen level, node status of the primary tumour, initial resectability of liver metastases and inclusion in group 3). Adjusted overall 5-year survival was similar for groups 1 and 2 (51·5 and 44·5 per cent respectively), but worse for group 3 (14·3 per cent) (P = 0·001).

Conclusion

Patients who had resection of liver and lung metastases had similar overall survival to those who had undergone removal of isolated liver metastases.

RNA-seq analysis of the rat placentation site reveals maternal obesity-associated changes in placental and offspring thyroid hormone signaling

INTRODUCTION

In animal models, maternal obesity (OB) leads to augmented risk of offspring OB. While placental function is influenced by maternal habitus, the effect of maternal obesity on the interacting zones of the placenta [the labyrinth (LZ), junctional (JZ) and metrial gland (MG)] remains unknown.

METHODS

Using a rat maternal obesity model, we conducted transcriptomic profiling of the utero-placental compartments and fetal liver (FL) at dpc 18.5, in conjunction with analyses of mRNA expression of key thyroid hormone (TH) signaling genes in the placenta, fetus and weanling offspring.

RESULTS AND DISCUSSION

Gene expression analysis of placenta and offspring revealed that each utero-placental compartment responds distinctly to maternal OB with changes in inflammatory signaling, lipid metabolism and hormone stimulus being the predominant effects. OB-induced alterations in 17 genes were confirmed by qPCR, including reductions in thyrotropin-releasing hormone (Trh) in JZ. We further characterized mRNA and protein expression of TH signaling regulators including deiodinases (Dio), TH receptors (Tr), and downstream targets (uncoupling proteins (Ucp)). A concerted down-regulation of multiple facets of thyroid hormone signaling in the JZ and FL was observed. JZ expression of thyroid hormone signaling components Trh, Dio2, Trα, and Ucp2 were negatively associated with maternal leptin. mRNA expression of TRH, TRβ and UCP1 were also decreased in term placenta from OB women. Finally, our studies identified persistent impairments in expression of TH related genes in tissues from offspring of obese dams.

CONCLUSIONS

The role of lower placental thyroid expression is worthy of further study as a possible pathway that leads to low energy metabolism and obesity in animals born to obese mothers.

Impaired white matter development in extremely low-birth-weight infants with previous brain hemorrhage

BACKGROUND AND PURPOSE

Brain hemorrhage is common in premature infants. The purpose of the study is to evaluate white matter development in extremely low-birth-weight infants with or without previous brain hemorrhage.

MATERIALS AND METHODS

Thirty-three extremely low-birth-weight infants were prospectively enrolled and included in this institutional review board-approved study. Another 10 healthy term infants were included as controls. The medical records of the extremely low-birth-weight infants were reviewed for sonography diagnosis of intraventricular hemorrhage. All infants had an MR imaging examination at term-equivalent age for detection of previous hemorrhage, and their white matter was scored and compared among different groups. DTI measured fractional anisotropy values were also compared voxelwise by tract-based spatial statistics.

RESULTS

Compared with controls, the white matter score was not significantly different in extremely low-birth-weight infants without blood deposition on MR imaging (P = .17), but was significantly worse in extremely low-birth-weight infants with blood deposition on MR imaging but no intraventricular hemorrhage diagnosis by sonography (P = .02), in extremely low-birth-weight infants with grade 1 or 2 intraventricular hemorrhage on sonography (P = .003), and in extremely low-birth-weight infants with grade 3 or 4 intraventricular hemorrhage on sonography (P = .0001). Extremely low-birth-weight infants without blood deposition on MR imaging did not show any white matter regions with significantly lower fractional anisotropy values than controls. Extremely low-birth-weight infants with blood deposition on MR imaging, but no intraventricular hemorrhage diagnosis, did show white matter regions with significantly lower fractional anisotropy values, and extremely low-birth-weight infants with intraventricular hemorrhage diagnosis had widespread white matter regions with lower fractional anisotropy values.

CONCLUSIONS

Previous brain hemorrhage is associated with abnormal white matter in extremely low-birth-weight infants at term-equivalent age, and sonography is not sensitive to minor hemorrhages that are sufficient to cause white matter injury.

Use of a "CNI holidays" strategy in acute renal dysfunction late after heart transplant. Report of two cases

BACKGROUND

Acute renal dysfunction (ARD) may appear in heart transplant (HTx) patients both in the early postoperative period and during follow-up, even after several years. CD25 is a subunit of the interleukin-2 receptor which is found exclusively on activated CD4 T lymphocytes. CD25 is crucial for clonal expansion of anti-allograft host lymphocytes that mediate in acute rejection. There are experiences supporting the use of Anti-CD25 monoclonal antibodies (MAb) immediately after HTx in patients with ARD as a bridge to renal function recovery, allowing the temporary suspension of treatment with CNI.

METHODS

In this study we report two cases of successful use of weekly MAb (basiliximab) in HTx patients who developed late ARD after HTx.

CONCLUSIONS

In coclusion, we think that in cases of ARD where CNI therapy plays a key role, the use of weekly doses of basiliximab allows CNI discontinuation until the restoration of renal function is achieved.

Maternal obesity is associated with a lipotoxic placental environment

Maternal obesity is associated with placental lipotoxicity, oxidative stress, and inflammation, where MAPK activity may play a central role. Accordingly, we have previously shown that placenta from obese women have increased activation of MAPK-JNK. Here, we performed RNA-sequencing on term placenta from twenty-two subjects who were dichotomized based on pre-pregnancy BMI into lean (BMI 19-24 kg/m(2); n = 12) and obese groups (BMI, 32-43 kg/m(2); n = 12). RNA-seq revealed 288 genes to be significantly different in placenta from obese women by ≥ 1.4-fold. GO analysis identified genes related to lipid metabolism, angiogenesis, hormone activity, and cytokine activity to be altered in placenta from obese women. Indicative of a lipotoxic environment, increased placental lipid and CIDEA protein were associated with decreased AMPK and increased activation of NF-κB (p65) in placenta from obese women. Furthermore, we observed a 25% decrease in total antioxidant capacity and increased nuclear FOXO4 localization in placenta from obese women that was significantly associated with JNK activation, suggesting that maternal obesity may also be associated with increased oxidative stress in placenta. Maternal obesity was also associated with decreased HIF-1α protein expression, suggesting a potential link between increased inflammation/oxidative stress and decreased angiogenic factors. Together, these findings indicate that maternal obesity leads to a lipotoxic placental environment that is associated with decreased regulators of angiogenesis and increased markers of inflammation and oxidative stress.

A comprehensive analysis of the human placenta transcriptome

As the conduit for nutrients and growth signals, the placenta is critical to establishing an environment sufficient for fetal growth and development. To better understand the mechanisms regulating placental development and gene expression, we characterized the transcriptome of term placenta from 20 healthy women with uncomplicated pregnancies using RNA-seq. To identify genes that were highly expressed and unique to the placenta we compared placental RNA-seq data to data from 7 other tissues (adipose, breast, hear, kidney, liver, lung, and smooth muscle) and identified several genes novel to placental biology (QSOX1, DLG5, and SEMA7A). Semi-quantitative RT-PCR confirmed the RNA-seq results and immunohistochemistry indicated these proteins were highly expressed in the placental syncytium. Additionally, we mined our RNA-seq data to map the relative expression of key developmental gene families (Fox, Sox, Gata, Tead, and Wnt) within the placenta. We identified FOXO4, GATA3, and WNT7A to be amongst the highest expressed members of these families. Overall, these findings provide a new reference for understanding of placental transcriptome and can aid in the identification of novel pathways regulating placenta physiology that may be dysregulated in placental disease.

Development of liver fibrosis during aging: effects of caloric restriction

Liver is the central metabolic organ of the body and diet is considered one of the main environmental factors that can impact on aging liver. In the elderly stage liver function is relatively well conserved although there are a variety of not well defined morphological changes related to liver fibrosis which is commonly associated with an inflammatory state. The aim of this paper is to study these alterations during the physiological process of aging in Wistar rats and also test if caloric restriction (CR) could ameliorate them. As fibrosis is associated to hepatic stellate cell (HSC) function we also analyzed these cells during aging. Livers from five groups of male Wistar rats (3-, 8-, 24-months old ad libitum and 8- and 24-months caloric restricted rats) were used in this study. Histological analysis, expression of genes implicated in liver fibrosis and the status of inflammatory step-pathways as p38 mitogen-activated protein kinase (p38-MAPK), c-Jun N-terminal kinase (JNK) and the nuclear factor kappa B (NFkB) isoforms, p50 and p65, in cytosolic and nuclear fractions were performed. During elderly, associated with morphological change of HSC, there is a progressive increase in collagen deposition due to an inhibition in collagen degradation. Higher expression of cytokines and the activation of inflammatory pathways are associated with aging. CR ameliorates these circumstances being more effective when it started in middle age. In conclusion elderly stage is associated to a mild fibrotic and inflammatory state in the liver which could be ameliorated after CR.