Selenium bioaccesibility after in vitro digestion/fermentation of foods differs in adults and children

Selenium (Se) as essential element regulates the immune, endocrine, reproductive and neurological systems through selenoproteins. More important than its content, is the fraction available to be absorbed (bioaccesibility) to exert its important metabolic functions. The objective of this study was to determine the bioaccessibility of Se (Se-BA) in multiple foods by an in vitro digestion/fermentation method. Samples were subjected to homemade culinary techniques and fermented with feces from healthy adults (HE-AD), and healthy (HE-CH) and unhealthy children (with gluten related disorders, GRD-CH; obesity, OB-CH; or allergy/intolerance to cow’s milk proteins, AICM-CH). Se-BA varied largely among samples depending on their vegetal/animal origin, category and type of food. Animal-vs. plant-based foods have higher mean Se concentration and total Se-BA (82.5(±97.5) and 93.6 (±8.58) vs. 44.3(±55.6) μg/kg and 77.7(±20.4)%, respectively). In plant-based foods, higher Se-BA values were found in the large intestine (41.0(±25.7) vs. 30.1(±26.7%) in animal-base foods). In comparison to raw foods, the cooking techniques of vegetal- and animal-based foods grouped by heating in liquid media (frying-boiling) or hot air (roasting-grilling) decrease Se-BA in the small intestine (42.5(±27.0) vs. 34.8(±25.1) and 34.0(±24.3), and 75.9(±38.0) vs. 52.4(±28.9) and 71.3(±24.8)%, respectively), while it is increased in the large intestine (36.6(±28.5) vs. 41.3(±24.9) and 44.2(±23.6), and 19.9(±30.4) vs. 39.9(±26.0) and 23.4(±22.7)%, respec tively). The higher Se-BA levels in the large intestine found in HE-CH (42.1 (±26.5) vs. HE-AD (35.2(±27.1) and unhealthy children (GRD-CH and OB-CH; 38.0(±24.6) and 35.8(±28.1)%, respectively) could be related to greater demands on growth and specific fermentative microbiota.AGR-295 Alimentación y microbiota intestinal: relación con los alimentos y su procesado (Foodmicrogut

Quality standards for managing children and adolescents with bronchiectasis: an international consensus

The global burden of bronchiectasis in children and adolescents is being recognised increasingly. However, marked inequity exists between, and within, settings and countries for resources and standards of care afforded to children and adolescents with bronchiectasis compared with those with other chronic lung diseases. The European Respiratory Society (ERS) clinical practice guideline for the management of bronchiectasis in children and adolescents was published recently. Here we present an international consensus of quality standards of care for children and adolescents with bronchiectasis based upon this guideline. The panel used a standardised approach that included a Delphi process with 201 respondents from the parents and patients’ survey, and 299 physicians (across 54 countries) who care for children and adolescents with bronchiectasis. The seven quality standards of care statements developed by the panel address the current absence of quality standards for clinical care related to paediatric bronchiectasis. These internationally derived, clinician-, parent-and patient-informed, consensus-based quality standards statements can be used by parents and patients to access and advocate for quality care for their children and themselves, respectively. They can also be used by healthcare professionals to advocate for their patients, and by health services as a monitoring tool, to help optimise health outcomes.</p

Molecular and biochemical study in heterozygotes of vitamin - D - resistant rickets

Background/Aims: HVDRR carriers is a rare monogenic autosomal recessive disorder associated with mutations in the gene of the vitamin D receptor (VDR), the mediator of 1,25(OH)₂D₃ action. Although many investigations have discussed the clinical manifestations and molecular etiology of this disease, only a few have investigated the biochemical and hormonal status of heterozygous HVDRR. The aim of the current work was to investigate the profile of selected molecular, biochemical and hormonal parameters related to the vitamin D endocrine system in a large number of HVDRR heterozygotes. Methods: 67 relatives of 2 HVDRR patients, all members of an extended Greek kindred of five generations with a common ancestor, were included in the study. Direct sequencing was used to identify VDR gene mutations. Serum Ca, Ρ, 25(OH)D, PTH, and 1,25(OH)₂D levels were determined in all members of the kindred. Furthermore, VDR allelic polymorphisms were assessed by restriction fragment length polymorphisms after specific polymerase chain reaction amplification. Results: DNA analysis of the participants led to the design of two study groups: the HVDRR carriers (24) and the control subjects (43). Our results showed elevated circulating serum levels of 1,25(OH)₂D₃ and lower levels of PTH than their age- and sex-matched controls. No hypocalcemia or hypophosphatemia were detected in HVDRR carriers. The distribution of genotypic and allelic frequencies differed between HVDRR carriers and their respective controls regarding Bsm I and Taq I polymorphisms. The bb genotype and the Τ allele (presence of Bsm land absence of Taq I polymorphisms) were less frequent in the HVDRR carrier group than in the control group in a statistically significant manner (p = 0.029 and p = 0.025, respectively). Conclusions: Our findings suggest that HVDRR carriers may have compensatory elevated serum levels of 1,25(OH)₂D₃ through which they restrain PTH secretion. HVDRR carriers represent a different distribution of Bsm I and Taq I VDR polymorphisms than their controls. The study of HVDRR carriers could be a useful tool for the investigation of the vitamin D endocrine system.Εισαγωγή-Σκοπός: Η εξαρτημένη ραχίτιδα τύπου 2 (ή υπασβεστιαιμική ανθεκτική στη βιταμίνη D ραχίτιδα - Hypocalcemic Vitamin D-Resistant Rickets - HVDRR) είναι μια σπάνια αυτοσωματική υπολειπόμενη νόσος που οφείλεται σε μεταλλάξεις στον υποδοχέα της βιταμίνης D (vitamin D receptor - VDR). Παρόλο που πολλοί ερευνητές έχουν μελετήσει τις κλινικές εκδηλώσεις και τη μοριακή βλάβη της νόσου, ελάχιστοι μόνο έχουν αναφερθεί ακροθιγώς στον βιοχημικό, ορμονολογικό και μοριακό φαινότυπο των ετεροζυγωτών. Ο σκοπός της παρούσας μελέτης ήταν η διερεύνηση των παραπάνω παραμέτρων σε ένα μεγάλο αριθμό HVDRR ετεροζυγωτών. Μέθοδοι: Στη μελέτη μετείχαν συγγενείς 2 ασθενών με HVDRR. Η ανάλυση των μεταλλάξεων και των πολυμορφισμών έγινε με PCR και τη βοήθεια κατάλληλων εκκινητών και περιοριστικών ενζύμων. Στον ορό αίματος έγινε προσδιορισμός των Ca, Ρ, ALP, 25(OH)D, 1,25(OH)₂D, ΡΤΗ και οστεοκαλσίνης. Αποτελέσματα: Η ανάλυση του DNA οδήγησε σε διαχωρισμό του πληθυσμού μελέτης σε 2 ομάδες: τους ετεροζυγώτες (24) και τους μη ετεροζυγώτες (43) της HVDRR. Οι τελευταίοι αποτέλεσαν την ομάδα μαρτύρων. Τα αποτελέσματα του βιοχημικού - ορμονολογικού ελέγχου έδειξαν αυξημένα επίπεδα 1,25(OH)₂D₃ και ελαττωμένα επίπεδα ΡΤΗ στους ετεροζυγώτες. Η κατανομή των γονότυπων καθώς και η συχνότητα των αλληλίων διέφεραν μεταξύ των δύο ομάδων σε σχέση με τους πολυμορφισμούς Bsm Ι και Taq Ι. Οι bb γονότυποι και τα Τ αλλήλια ήταν λιγότερο συχνά στην ομάδα των ετεροζυγωτών σε σχέση με την ομάδα των μαρτύρων (p = 0.029 and p = 0.025, αντίστοιχα). Συμπέρασμα: Τα ευρήματα της παρούσας μελέτης υποδηλώνουν πως οι ετεροζυγώτες της HVDRR εκδηλώνουν ενδεχομένως αντιρροπιστικά, αυξημένα επίπεδα 1,25(OH)₂D₃ μέσω των οποίων περιορίζουν την έκκριση της ΡΤΗ. Οι ετεροζυγώτες φαίνεται πως αποτελούν μια ομάδα με διαφορετική κατανομή των Bsm Ι και Taq Ι πολυμορφισμών του VDR. Η περαιτέρω μελέτη τους ίσως θα μπορούσε να αποτελέσει ένα ιδιαίτερα χρήσιμο εργαλείο στην διερεύνηση του ενδοκρινικού συστήματος της βιταμίνης D

Time to Say Goodbye to Bronchiolitis, Viral Wheeze, Reactive Airways Disease, Wheeze Bronchitis and All That

The diagnosis and management of infants and children with a significant viral lower respiratory tract illness remains the subject of much debate and little progress. Over the decades various terms for such illnesses have been in and fallen out of fashion or have evolved to mean different things to different clinicians. Terms such as “bronchiolitis,” “reactive airways disease,” “viral wheeze,” and many more are used to describe the same condition and the same term is frequently used to describe illnesses caused by completely different dominant pathologies. This lack of clarity is due, in large part, to a failure to understand the basic underlying inflammatory and associated processes and, in part, due to the lack of a simple test to identify a condition such as asthma. Moreover, there is a lack of insight into the fact that the same pathology can produce different clinical signs at different ages. The consequence is that terminology and fashions in treatment have tended to go around in circles. As was noted almost 60 years ago, amongst pre-school children with a viral LRTI and airways obstruction there are those with a “viral bronchitis” and those with asthma. In the former group, a neutrophil dominated inflammation response is responsible for the airways’ obstruction whilst amongst asthmatics much of the obstruction is attributable to bronchoconstriction. The airways obstruction in the former group is predominantly caused by airways secretions and to some extent mucosal oedema (a “snotty lung”). These patients benefit from good supportive care including supplemental oxygen if required (though those with a pre-existing bacterial bronchitis will also benefit from antibiotics). For those with a viral exacerbation of asthma, characterized by bronchoconstriction combined with impaired b-agonist responsiveness, standard management of an exacerbation of asthma (including the use of steroids to re-establish bronchodilator responsiveness) represents optimal treatment. The difficulty is identifying which group a particular patient falls into. A proposed simplified approach to the nomenclature used to categorize virus associated LRTIs is presented based on an understanding of the underlying pathological processes and how these contribute to the physical signs

Can Getting Enough Vitamin D during Pregnancy Reduce the Risk of Getting Asthma in Childhood?

The worldwide increase in asthma prevalence during the last decades and the re-emergence of vitamin D deficiency in many populations hinted toward an underlying association between these two conditions. Since asthma is presented with high incidence in childhood and neonatal vitamin D stores depend on maternal vitamin levels, a possible programming effect of maternal vitamin D status during gestation was suggested. Observational and longitudinal studies on this subject led to inconclusive results with glimmer of positivity. In the randomized controlled clinical trials (RCTs) that followed, increased doses of vitamin D were tested in pregnant women being at high risk of having an asthmatic child. Although, the results of RCTs showed a potential association with asthma-related phenotypes rather than asthma per se, the low toxicity of vitamin D supplements make it tempting to speculate that pregnant women at a high risk of obtaining a child with asthma may be benefited, especially if they are vitamin D deficient

The Current Practice of Noninvasive Ventilation in Patients With Cystic Fibrosis

In patients with cystic fibrosis (CF), despite the availability of many different pharmacologic agents, lung function deteriorates and lung disease progresses and leads to hypercapnic respiratory failure in some patients. In such cases, noninvasive ventilation (NIV) seems to be a promising technique that can be used on demand. This review summarizes the current applications of NIV in clinical settings as well as findings of the clinical trials that involved the delivery of NIV on variable occasions, such as an adjunct to physiotherapy, in nocturnal hypoventilation, and acute and chronic respiratory failure. NIV has been used in patients with CF and with advanced lung disease who are not considered candidates for lung transplantation. It can stabilize lung function, although its effect on hypercapnia is not always evident. Nocturnal NIV has been used in patients with CF and with hypoventilation during sleep but without clear benefits on daytime P-CO2. NIV as an adjunct to chest physiotherapy may be helpful when desaturation is observed during physiotherapy and when there are signs of respiratory muscle fatigue. NIV use in CF has been increasing, mainly in adult CF centers, and offers patients an opportunity to reach lung transplantation or to overcome acute hypercapnic respiratory failure

Can Getting enough vitamin D during Pregnancy Reduce the Risk of Getting Asthma in Childhood?

The worldwide increase in asthma prevalence during the last decades and the re-emergence of vitamin D deficiency in many populations hinted toward an underlying association between these two conditions. Since asthma is presented with high incidence in childhood and neonatal vitamin D stores depend on maternal vitamin levels, a possible programming effect of maternal vitamin D status during gestation was suggested. Observational and longitudinal studies on this subject led to inconclusive results with glimmer of positivity. In the randomized controlled clinical trials (RCTs) that followed, increased doses of vitamin D were tested in pregnant women being at high risk of having an asthmatic child. Although, the results of RCTs showed a potential association with asthma-related phenotypes rather than asthma per se, the low toxicity of vitamin D supplements make it tempting to speculate that pregnant women at a high risk of obtaining a child with asthma may be benefited, especially if they are vitamin D deficient

The Role of Sensitization to Allergen in Asthma Prediction and Prevention

The burden of asthma in childhood is considerable worldwide, although some populations are much more affected than others. Many attempts have been made by different investigators to identify the factors that could predict asthma development or persistence in childhood. In this review, the relation between atopic sensitization as an indicator of allergy and asthma in childhood will be discussed. Cross sectional studies, carried out in different countries, failed to show any firm correlation between asthma and atopic sensitization. Birth cohort mainly of infants at high risk for asthma and case–control studies showed that atopic sensitization was a risk factor for current asthma in children older than 6 years. In general, clear relations are observed mostly in affluent Western countries, whereas in less affluent countries, the picture is more heterogeneous. For the prediction of asthma development or persistence in school age children, other prerequisites should also be fulfilled such as family history of asthma and wheezing episodes at preschool age. Despite the conductance of different studies regarding the potential role of allergen avoidance for the primary prevention of childhood asthma, it does not seem that this approach is of benefit for primary prevention purposes. However, the identification of children at risk for asthma is of benefit as these subjects could be provided with the best management practices and with the appropriate secondary prevention measures