Mediterranean Diet and Lung Function in Adults Current Smokers: A Cross-Sectional Analysis in the MEDISTAR Project

Mediterranean diet; Lung function; SmokingDieta mediterrània; Funció pulmonar; FumarDieta mediterránea; Función pulmonar; FumarBackground: Previous studies have shown that adherence to the Mediterranean Diet (MeDi) has a positive impact on lung function in subjects with lung disease. In subjects free of respiratory diseases, but at risk, this association is not yet well established. Methods: Based on the reference data from the MEDISTAR clinical trial (Mediterranean Diet and Smoking in Tarragona and Reus; ISRCTN 03.362.372), an observational study was conducted with 403 middle-aged smokers without lung disease, treated at 20 centres of primary care in Tarragona (Catalonia, Spain). The degree of MeDi adherence was evaluated according to a 14-item questionnaire, and adherence was defined in three groups (low, medium, and high). Lung function were assessed by forced spirometry. Logistic regression and linear regression models were used to analyse the association between adherence to the MeDi and the presence of ventilatory defects. Results: Globally, the pulmonary alteration prevalence (impaired FEV1 and/or FVC) was 28.8%, although it was lower in participants with medium and high adherence to the MeDi, compared to those with a low score (24.2% and 27.4% vs. 38.5%, p = 0.004). Logistic regression models showed a significant and independent association between medium and high adherence to the MeDi and the presence of altered lung patterns (OR 0.467 [95%CI 0.266, 0.820] and 0.552 [95%CI 0.313, 0.973], respectively). Conclusions: MeDi adherence is inversely associated with the risk impaired lung function. These results indicate that healthy diet behaviours can be modifiable risk factors to protect lung function and reinforce the possibility of a nutritional intervention to increase adherence to MeDi, in addition to promoting smoking cessation

A clinical trial to evaluate the effect of the Mediterranean diet on smokers lung function

Mediterranian diet; Smoke; Lung functionDieta mediterránea; Fumar; Función pulmonarDieta mediterrània; Fumar; Funció pulmonarData on the association between lung function and some dietary patterns have been published. However, it is not yet well known if whether the Mediterranean Diet (MD) pattern can preserve or improve lung function. Our purpose is to evaluate the effect of increased MD adherence on lung function in smokers. A multicenter, parallel, cluster-randomized, controlled clinical trial is proposed. A total of 566 active smokers (>10 packs-year), aged 25-75 years will be included, without previous respiratory disease and who sign an informed consent to participate. Twenty Primary Care Centres in Tarragona (Spain) will be randomly assigned to a control or an intervention group (1:1). All participants will receive advice to quit smoking, and the intervention group, a nutritional intervention (2 years) designed to increase MD adherence by: (1) annual visit to deliver personalized nutritional education, (2) annual telephone contact to reinforce the intervention, and (3) access to an online dietary blog. We will evaluate (annually for 2 years): pulmonary function by forced spirometry and MD adherence by a 14-item questionnaire and medical tests (oxidation, inflammation and consumption biomarkers). In a statistical analysis by intention-to-treat basis, with the individual smoker as unit of analysis, pulmonary function and MD adherence in both groups will be compared; logistic regression models will be applied to analyze their associations. We hope to observe an increased MD adherence that may prevent the deterioration of lung function in smokers without previous respiratory disease. This population may benefit from a dietary intervention, together with the recommendation of smoking cessation

Implications of oral dysbiosis and HPV infection in head and neck cancer: from molecular and cellular mechanisms to early diagnosis and therapy

Head and neck cancer (HNC) is the sixth most common type of cancer, with more than half a million new cases annually. This review focuses on the role of oral dysbiosis and HPV infection in HNCs, presenting the involved taxons, molecular effectors and pathways, as well as the HPV-associated particularities of genetic and epigenetic changes and of the tumor microenvironment occurred in different stages of tumor development. Oral dysbiosis is associated with the evolution of HNCs, through multiple mechanisms such as inflammation, genotoxins release, modulation of the innate and acquired immune response, carcinogens and anticarcinogens production, generation of oxidative stress, induction of mutations. Thus, novel microbiome-derived biomarkers and interventions could significantly contribute to achieving the desideratum of personalized management of oncologic patients, regarding both early diagnosis and treatment. The results reported by different studies are not always congruent regarding the variations in the abundance of different taxons in HNCs. However, there is a consistent reporting of a higher abundance of Gram-negative species such as Fusobacterium, Leptotrichia, Treponema, Porphyromonas gingivalis, Prevotella, Bacteroidetes, Haemophilus, Veillonella, Pseudomonas, Enterobacterales, which are probably responsible of chronic inflammation and modulation of tumor microenvironment. Candida albicans is the dominant fungi found in oral carcinoma being also associated with shorter survival rate. Specific microbial signatures (e.g., F. nucleatum, Bacteroidetes and Peptostreptococcus) have been associated with later stages and larger tumor, suggesting their potential to be used as biomarkers for tumor stratification and prognosis. On the other hand, increased abundance of Corynebacterium, Kingella, Abiotrophia is associated with a reduced risk of HNC. Microbiome could also provide biomarkers for differentiating between oropharyngeal and hypopharyngeal cancers as well as between HPV-positive and HPV-negative tumors. Ongoing clinical trials aim to validate non-invasive tests for microbiome-derived biomarkers detection in oral and throat cancers, especially within high-risk populations. Oro-pharyngeal dysbiosis could also impact the HNCs therapy and associated side-effects of radiotherapy, chemotherapy, and immunotherapy. HPV-positive tumors harbor fewer mutations, as well as different DNA methylation pattern and tumor microenvironment. Therefore, elucidation of the molecular mechanisms by which oral microbiota and HPV infection influence the HNC initiation and progression, screening for HPV infection and vaccination against HPV, adopting a good oral hygiene, and preventing oral dysbiosis are important tools for advancing in the battle with this public health global challenge

Effectiveness of a motivational intervention based on spirometry results to achieve smoking cessation in primary healthcare patients: randomised, parallel, controlled multicentre study

Dejar de fumar; Espirometría; Ateción primariaDeixar de fumar; Espirometria; Atenció primàriaSmoking cessation; Spirometry; Primary healthcareObjective: This 12-month study in a primary healthcare network aimed to assess the effectiveness of usual smoking cessation advice compared with personalised information about the spirometry results. Design: Randomised, parallel, controlled, multicentre clinical trial. Setting: This study involved 12 primary healthcare centres (Tarragona, Spain). Participants: Active smokers aged 35–70 years, without known respiratory disease. Each participant received brief smoking cessation advice along with a spirometry assessment. Participants with normal results were randomised to the intervention group (IG), including detailed spirometry information at baseline and 6-month follow-up or control group (CG), which was simply informed that their spirometry values were within normal parameters. Main outcome: Prolonged abstinence (12 months) validated by expired-CO testing. Results: Spirometry was normal in 571 patients in 571 patients (45.9% male), 286 allocated to IG and 285 to CG. Baseline characteristics were comparable between the groups. Mean age was 49.8 (SD ±7.78) years and mean cumulative smoking exposure was 29.2 (±18.7) pack-years. Prolonged abstinence was 5.6% (16/286) in the IG, compared with 2.1% (6/285) in the CG (p=0.03); the cumulative abstinence curve was favourable in the IG (HR 1.98; 95% CI 1.29 to 3.04). Conclusions: In active smokers without known respiratory disease, brief advice plus detailed spirometry information doubled prolonged abstinence rates, compared with brief advice alone, in 12-month follow-up, suggesting a more effective intervention to achieve smoking cessation in primary healthcare

Management of biliary lithiasis in pregnancy – an updated overview

It is estimated that 2% of pregnant women develop gallstones during pregnancy. Symptoms of biliary lithiasis may vary during pregnancy, from a slight added digestive discomfort to biliary colic of varying intensity, acute cholecystitis, or acute pancreatitis. Ultrasonography is the gold standard for diagnosis of sludge and gallstones, being both highly sensitive and specific. Initial management overlaps with the out-of-pregnancy management, initiating conservative, supportive care, as well as an adequate diet. Laparoscopic cholecystectomy is considered a safe intervention in pregnancy, being the second most common surgery after appendicectomy. If open laparoscopy is preferred, the major risk - perforation of the uterus - is avoided. Important complications of gallstones in pregnancy, jaundice and acute pancreatitis can be resolved safely and quickly by cholangiopancreatography (ERCP) techniques, with stone removal, sphincterotomy or stent mounting. After remission of pancreatic symptoms, laparoscopic cholecystectomy can be performed. Recent scientific data and current practice suggest an increase of biliopancreatic emergencies during pregnancy (probably due to rising incidence of obesity, age of gravida, prolonged use of oral combined contraceptives, dyslipidemia, etc.). Surgeons, as well as obstetricians, should be aware of the prompt modern management of these cases

Alkaline Phosphatase Immobilization on New Chitosan Membranes with Mg2+ for Biomedical Applications

In this paper, we present the fabrication and characterization of new chitosan-based membranes while using a new biotechnology for immobilizing alkaline phosphatase (ALP). This technology involved metal ions incorporation to develop new biopolymeric supports. The chemical structure and morphological characteristics of proposed membranes were evaluated by infrared spectroscopy (FT-IR) and the scanning electron microscopy technique (SEM). The inductively coupled plasma mass spectrometry (ICP-MS) evidenced the metal ion release in time. Moreover, the effect of Mg2+ on the enzymatic activity and the antibacterial investigations while using Gram-negative Escherichia coli and Gram-positive Staphylococcus aureus bacteria, hemolysis, and biocompatibility behavior were studied. Immobilizing ALP into the chitosan membranes composition followed by the incorporation of Mg2+ led to polymeric supports with enhanced cellular viability when comparing to chitosan-based membranes without Mg2+. The results obtained evidenced promising performance in biomedical applications for the new biopolymeric supports that are based on chitosan, ALP, and metal ions

Raman Spectroscopy as Spectral Tool for Assessing the Degree of Conversion after Curing of Two Resin-Based Materials Used in Restorative Dentistry

(1) Background: The treatment of dental cavities and restoration of tooth shape requires specialized materials with specific clinical properties, including being easy to model, light-cured, having a natural color, reduced shrinkage, a hardness similar to hydroxyapatite, and no leakage. The dimensional stability of resin composite materials is affected by polymerization shrinkage, degree of conversion (number of π carbon bonds converted into σ ones), thermal contraction and expansion, and interactions with an aqueous environment. (2) Methods: The materials used in our investigation were two composite resins with similar polymer matrices, but different filler (micro/nano filler). To evaluate the properties of samples, we employed the pycnometer technique (pycnometer from Paul Marienfeld Gmbh, Lauda-Königshofen, Germany), RAMAN spectroscopy technique (MiniRam Equipment from B&W Tek Inc., Plainsboro Township, NJ, USA; 785 nm laser source), SEM and EDX (FEI Inspect S.). (3) Results: The size of the filler plays an important role in the polymerization: for the pycnometric results, the larger particle filler (Sample 1) seems to undergo a rapid polymerization during the 45 s curing, while the nanoparticle filer (Sample 2) needs additional curing time to fully polymerize. This is related to a much larger porosity, as proved by SEM images. The lower degree of conversion, as obtained by Raman spectroscopy, in the same geometry means that the same volume is probed for both samples, but Sample 1 is more porous, which means less amount of polymer is probed for Sample 1. (4) Conclusions: For the two composites, we obtained a degree of conversion of 59% for Sample 1 and 93% for Sample 2, after 45 s of curing

Morphological Analysis of Laser Surface Texturing Effect on AISI 430 Stainless Steel

Laser surface texturing (LST) is a method to obtain micro-structures on the material’s surface for improving tribological performances, wetting tuning, surface treatment, and increasing adhesion. The material selected for LST is AISI 430 ferritic stainless steel, distinguished by the low cost in manufacturing, corrosion resistance, and high strength at elevated temperature. The present study addresses the morphology of new pattern designs (crater array, ellipse, and octagonal shapes). The patterns are applied on the stainless-steel surface by a non-contact method with high quality and precision nanosecond pulsed laser equipment. The investigation of laser parameter influence on thermal affected area and micro-structures is accomplished by morphological and elemental analysis (SEM + EDX). The parameters of the laser micro-patterning have a marked influence on the morphology, creating groove-type sections with different depths and recast material features. From the SEM characterization, the highest level of recast material is observed for concentric octagon LST design. Its application is more recommended for the preparation of the metal surface before hybrid welding. Additionally, the lack of the oxygen element in the case of this design suggests the possible use of the pattern in hybrid joining

DIFFERENTIAL DIAGNOSIS BETWEEN STATIN MYOTOXICITY AND INFLAMMATORY MYOSITIS – CASE PRESENTATION

Inflammatory myopathies, include polymyositis, dermatomyositis, inclusion body myositis and necrotising myopathy, but their diagnosis requires a comprehensive differential, in order to optimise treatment and to have the best outcome. One of the most controversial diagnosis in this situation is drug related myotoxicity, since the symptoms may vary significantly, but usually include muscle weakness and myalgia accompanied by elevated creatine kinase serum levels Patient background. We report a case of a 70 year-old patient, treated with statins, with onset of symptoms since one year with tolerable myalgia, accompanied by mild muscle weakness shortly after and progressive worsening in the last couple of months. Interruption of statins was recommended based on current symptoms and elevated muscle enzymes: creatine kinase (CK) x3 fold and aspartate aminotransferase (AST) x2 fold normal range. Investigations. Autoimmunity panel including anti-nuclear and 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) antibodies was negative. The needle EMG was abnormal, with diffuse fibrillation potentials in almost all investigated sites, both in the proximal and distal muscles. Complex repetitive discharges were also observed in most muscles tested. Existence of clear myogenic signs on needle EMG revealed the probable cause for the clinical presentation as being myogenic in nature. Discussion. Statin-induced myopathy (SIM) is typically self-limited showing remission in the following weeks or months after statin cessation. Although EMG studies support the presence of typical myopathy features in SIM, it cannot point-out specific changes attributed to a statin-related dysfunction. Patient outcome was favorable on hospital discharge. On a two week check-up, she reported improvement in muscle strength, range of motion and remitted myalgia. Repeated blood work showed a descending trend in both CK and AST, with values in normal range. Conclusions. The clinical case, the whole algorithm of clinical evaluation and paraclinical tests that lead to final diagnosis and the literature review, highlight the importance of an exhaustive approach. Electrophysiology tests offer important aid to the physician in the approach of patients with an underlying toxic myopathy in initial diagnosis, follow-up and biopsy yield if necessary

Current Challenges in Deciphering Sutton Nevi—Literature Review and Personal Experience

Halo nevi, known as leukoderma acquisitum centrifugum, Sutton nevus, leukopigmentary nevus, perinevoid vitiligo, or perinevoid leukoderma, together with vitiligo and melanoma-associated hypopigmentation, belong to the group of dermatoses designated as immunological leukodermas. The etiology and pathogenesis of halo nevi has not been fully elucidated. There are several mechanisms through which a lymphocytic infiltrate can induce tumoral regression. In this review, we aimed to update the knowledge about Sutton nevi starting with the clinical appearance and dermoscopic features, continuing with information regarding conventional microscopy, immunohistochemistry, and the immunological mechanisms responsible for the occurrence of halo nevi. We also included in the article original unpublished results when discussing dermoscopic, pathologic and immunohistochemical results in halo nevi. Sutton nevi are valuable models for studying antitumor reactions that the human body can generate. The slow and effective mechanism against a melanocytic skin tumor can teach us important lessons about both autoimmune diseases and anticancer defenses