Métodos no térmicos para la pasteurización de leche de cabra y materna

[ES] La demanda de los consumidores evoluciona constantemente, por lo que actualmente está aumentando la búsqueda de procedimientos de conservación de alimentos que ofrezcan productos, como es el caso de la leche comercial, con el mínimo impacto sobre sus propiedades organolépticas y nutricionales, sin renunciar al aumento de vida útil y seguridad que las tecnologías convencionales garantizan. Por lo que se refiere a la leche materna es almacenada en bancos de leche y sometida a pasteurización (método Holder) antes de ser suministrada al neonato. En este caso, es interesante el uso de nuevos métodos que conserven tanto los nutrientes (lactosa, aminoácidos...) como los componentes del sistema inmunitario (citoquinas, inmunoglobulinas¿) que contiene, manteniendo además su seguridad. Las opciones que más se están estudiando actualmente son métodos no térmicos, ya que los tratamientos térmicos intensos se relacionan con una disminución importante de la calidad de los alimentos tratados. Algunas de las más interesantes son las basadas en Ultrasonidos de Potencia (HPU), Pulsos Eléctricos de Alta Intensidad (PEF) y Fluidos Supercríticos (SF). El objetivo de este trabajo ha sido analizar la efectividad del uso de HPU, PEF y CO2 supercrítico asistido por ultrasonidos de potencia (SC-CO2 + HPU), como tratamientos de inactivación de la microbiota de leche de cabra y materna. En cuanto al tratamiento con HPU, no se ha observado una efectividad significativa (reducciones menores a 0.7 ciclos-log), mientras que en el caso de PEF se han conseguido inactivaciones de entre 1.4 y 5.1 ciclos-log de mesófilos aerobios y una inactivación notable (casi total) de enterobacterias. Sin embargo, es necesaria más investigación sobre estos dos métodos. Por otra parte, la combinación de SC-CO2 + HPU ha demostrado poseer un efecto sinérgico y se han logrado inactivaciones totales tanto de mesófilos aerobios como de enterobacterias en tan sólo dos minutos. Así pues, los tratamientos no térmicos y la combinación de estos, principalmente SC-CO2 + HPU, pueden ofrecer alimentos tanto para la población en general, como para neonatos, seguros y con mejores propiedades nutricionales y sensoriales que los obtenidos tras el procesamiento térmico convencional. Sin embargo, es necesaria más investigación al respecto, ya que es fundamental su optimización y puesta a punto para asegurar alimentos con características y estabilidad óptimas.[EN] Consumer demand is constantly evolving, so nowadays is increasing the research about food preservation procedures that offer products, in the case of commercial milk, with the minimum impact on its organoleptic and nutritional properties, without quitting the increased shelf life and safety that conventional technologies guarantee. With regard to human milk, it is stored in milk banks and subjected to pasteurization (Holder method) before being provided to the newborn. In this case, it is interesting the use of new methods that preserve the nutrients (lactose, amino acids ...) and the components of the immune system (cytokines, immunoglobulins¿) that it contains, while also assuring its safety. The options that are currently being studied the most are nonthermal methods, since intense thermal treatments are related to a significant decrease in the quality of the treated food. Some of the most interesting are those based on High Power Ultrasound (HPU), High Intensity Electric Pulses (PEF) and Supercritical Fluids (SF). The objective of this research work was analyzing the effectiveness of the use of HPU, PEF and supercritical CO2 assisted by power ultrasound (SC-CO2 + HPU), as inactivation treatments for goat and human milk microbiota. Regarding HPU treatment, no significant effectiveness has been observed (reductions of less than 0.7 log-cycles), whereas in the case of PEF, inactivations between 1.4 and 5.1 log-cycles of aerobic mesophiles and a notable inactivation (almost total) of enterobacteria have been achieved. However, more research is needed on these two methods. On the other hand, the combination of SC-CO2 + HPU has had a synergistic effect and total inactivations of both aerobic mesophiles and enterobacteria have been achieved in just two minutes. Therefore, nonthermal treatments and the combination of them, mainly SC-CO2 + HPU, can offer food for both the general population and neonates, safe and with better nutritional and sensory properties than those obtained after conventional thermal processing. However, more research is necessary in this regard, since its optimization and fine-tuning are essential to ensure foods with optimal characteristics and stability.Pérez Piqueras, CI. (2020). Métodos no térmicos para la pasteurización de leche de cabra y materna. http://hdl.handle.net/10251/151232TFG

Time to Switch to Second-line Antiretroviral Therapy in Children With Human Immunodeficiency Virus in Europe and Thailand.

Background: Data on durability of first-line antiretroviral therapy (ART) in children with human immunodeficiency virus (HIV) are limited. We assessed time to switch to second-line therapy in 16 European countries and Thailand. Methods: Children aged <18 years initiating combination ART (≥2 nucleoside reverse transcriptase inhibitors [NRTIs] plus nonnucleoside reverse transcriptase inhibitor [NNRTI] or boosted protease inhibitor [PI]) were included. Switch to second-line was defined as (i) change across drug class (PI to NNRTI or vice versa) or within PI class plus change of ≥1 NRTI; (ii) change from single to dual PI; or (iii) addition of a new drug class. Cumulative incidence of switch was calculated with death and loss to follow-up as competing risks. Results: Of 3668 children included, median age at ART initiation was 6.1 (interquartile range (IQR), 1.7-10.5) years. Initial regimens were 32% PI based, 34% nevirapine (NVP) based, and 33% efavirenz based. Median duration of follow-up was 5.4 (IQR, 2.9-8.3) years. Cumulative incidence of switch at 5 years was 21% (95% confidence interval, 20%-23%), with significant regional variations. Median time to switch was 30 (IQR, 16-58) months; two-thirds of switches were related to treatment failure. In multivariable analysis, older age, severe immunosuppression and higher viral load (VL) at ART start, and NVP-based initial regimens were associated with increased risk of switch. Conclusions: One in 5 children switched to a second-line regimen by 5 years of ART, with two-thirds failure related. Advanced HIV, older age, and NVP-based regimens were associated with increased risk of switch

Disseny de consorcis de llevats per a millorar l'estabilitat i la bioactivitat dels vins: interaccions microbianes, metabòliques i moleculars

[ES] La fermentación del vino es un proceso bioquímico complejo en el que la principal reacción es la transformación de azúcares, presentes en el mosto, en etanol y dióxido de carbono por acción de las levaduras. Sin embargo, los principales determinantes de la calidad y estabilidad del vino son compuestos derivados del metabolismo secundario como el glicerol, ácidos, compuestos aromáticos como alcoholes superiores, ésteres y acetatos, etc., a pesar de su menor concentración. En el caso del metabolismo del nitrógeno, este está relacionado con la síntesis de compuestos aromáticos y otros metabolitos con un gran potencial de bioactividad. Resulta de gran interés para la calidad, estabilidad y potencial bioactivo del producto final, ya que es el origen de los aromas fermentativos más importantes (alcoholes y ésteres superiores), antioxidantes (glutatión e hidroxitirosol) y moléculas bioactivas como la melatonina. La melatonina presenta un gran potencial bioactivo que puede contribuir a la calidad y estabilidad de los vinos, además de que aporta múltiples beneficios para la salud. Esto supone una potencial mejora de la imagen del vino como producto con compuestos de interés para la salud de los consumidores, a pesar de que la presencia de etanol exige una recomendación de moderación en su consumo. Por tanto, el objetivo principal de este trabajo es aumentar la presencia de los compuestos indólicos derivados del triptófano, en concreto de la melatonina, en los vinos finales. Se ha visto que estos compuestos se sintetizan de forma diferencial por distintas cepas y especies de levaduras durante la fermentación del vino. En los últimos años se ha observado que es posible aumentar la concentración de múltiples compuestos de interés y mejorar las características organolépticas de los vinos finales empleando levaduras no convencionales e inoculando diferentes especies de levadura en la fermentación, que cooperan formando consorcios. Las levaduras no convencionales han mostrado poseer características que pueden resultar de interés en las fermentaciones a nivel industrial. Además, se ha visto que las cepas de levadura no convencionales aisladas ambientalmente tienen características únicas debido a la adaptación a esos ambientes, que supone el desarrollo de sistemas enzimáticos que las levaduras aisladas de ambientes enológicos no poseen, y por tanto nos pueden aportar características diferentes y muy interesantes en los vinos finales. Es por esto que, para conseguir el objetivo principal del trabajo, se han seleccionado y estudiado dos consorcios de levaduras aisladas de ambientes y las fermentaciones que estos desarrollan, y se ha determinado que el consorcio formado por cepas de S. cerevisiae y S. eubayanus es capaz de producir una cantidad de melatonina superior, de 24,87 ± 2,19 ng/mL, a la que producen cada una de las cepas por separado y a la que produce el otro consorcio, formado por S. cerevisiae y S. uvarum. Además, se han estudiado las interacciones microbianas, metabólicas y moleculares de los consorcios durante la fermentación alcohólica y se han visto diferencias significativas entre ellos, principalmente en los perfiles aromáticos que presentan, caracterizados por aromas florales, frutales y un cierto carácter alcohólico, pero que sería conveniente seguir estudiando.[EN] Wine fermentation is a complex biochemical process in which the main reaction is the transformation of sugars present in the must into ethanol and carbon dioxide by the action of yeasts. However, the main determinants of wine quality and stability are compounds derived from secondary metabolism such as glycerol, acids, aromatic compounds such as higher alcohols, esters and acetates, etc., despite their lower concentration. In the case of nitrogen metabolism, it is related to the synthesis of aromatic compounds and other metabolites with a great potential for bioactivity. It is of great interest for the quality, stability and bioactive potential of the final product, since it is the source of the most important fermentative aromas (higher alcohols and esters), antioxidants (glutathione and hydroxytyrosol) and bioactive molecules such as melatonin. Melatonin has a great bioactive potential that can contribute to the quality and stability of wines, in addition to providing multiple health benefits. This represents a potential improvement in the image of wine as a product with compounds of interest to consumers' health, even though the presence of ethanol requires a recommendation of moderation in its consumption. Therefore, the main objective of this work is to increase the presence of indolic compounds derived from tryptophan, specifically melatonin, in the final wines. It has been seen that these compounds are differentially synthesized by different strains and species of yeast during wine fermentation. In the last times, it has been observed that it is possible to increase the concentration of multiple compounds of interest and improve the organoleptic characteristics of the final wines using unconventional yeasts and inoculating different species of yeast in the fermentation, which cooperate by forming consortia. Unconventional yeasts have shown to have characteristics that are of interest in fermentations at an industrial level. In addition, it has been seen that environmentally isolated non-conventional yeast strains have unique characteristics due to adaptation to these environments, which involves the development of enzyme systems that yeasts isolated from oenological environments do not possess, and therefore they can provide us with different characteristics. and very interesting in the final wines. This is why, in order to achieve the main objective of the work, two consortia of yeasts isolated from environments and the fermentations they develop have been selected and studied, and it has been determined that the consortium formed by strains of S. cerevisiae and S. eubayanus is capable of producing a higher amount of melatonin, 24.87 ± 2.19 ng/mL, than that produced by each of the strains separately and that produced by the other consortium, formed by S. cerevisiae and S. uvarum . In addition, the microbial, metabolic and molecular interactions of the consortia during alcoholic fermentation have been studied and significant differences have been seen between them, mainly in the aromatic profiles they present, characterized by floral, fruity aromas and a certain alcoholic character, but it would be good to continue studying it.Pérez Piqueras, CI. (2022). Diseño de consorcios de levaduras para mejorar la estabilidad y la bioactividad de los vinos: interacciones microbianas, metabólicas y moleculares. Universitat Politècnica de València. http://hdl.handle.net/10251/18548

Switching TNF antagonists in patients with chronic arthritis: An observational study of 488 patients over a four-year period

The objective of this work is to analyze the survival of infliximab, etanercept and adalimumab in patients who have switched among tumor necrosis factor (TNF) antagonists for the treatment of chronic arthritis. BIOBADASER is a national registry of patients with different forms of chronic arthritis who are treated with biologics. Using this registry, we have analyzed patient switching of TNF antagonists. The cumulative discontinuation rate was calculated using the actuarial method. The log-rank test was used to compare survival curves, and Cox regression models were used to assess independent factors associated with discontinuing medication. Between February 2000 and September 2004, 4,706 patients were registered in BIOBADASER, of whom 68% had rheumatoid arthritis, 11% ankylosing spondylitis, 10% psoriatic arthritis, and 11% other forms of chronic arthritis. One- and two-year drug survival rates of the TNF antagonist were 0.83 and 0.75, respectively. There were 488 patients treated with more than one TNF antagonist. In this situation, survival of the second TNF antagonist decreased to 0.68 and 0.60 at 1 and 2 years, respectively. Survival was better in patients replacing the first TNF antagonist because of adverse events (hazard ratio (HR) for discontinuation 0.55 (95% confidence interval (CI), 0.34-0.84)), and worse in patients older than 60 years (HR 1.10 (95% CI 0.97-2.49)) or who were treated with infliximab (HR 3.22 (95% CI 2.13-4.87)). In summary, in patients who require continuous therapy and have failed to respond to a TNF antagonist, replacement with a different TNF antagonist may be of use under certain situations. This issue will deserve continuous reassessment with the arrival of new medications. © 2006 Gomez-Reino and Loreto Carmona; licensee BioMed Central Ltd

High PEEP with recruitment maneuvers versus Low PEEP During General Anesthesia for Surgery -a Bayesian individual patient data meta-analysis of three randomized clinical trials

Background: The influence of high positive end-expiratory pressure (PEEP) with recruitment maneuvers on the occurrence of postoperative pulmonary complications after surgery is still not definitively established. Bayesian analysis can help to gain further insights from the available data and provide a probabilistic framework that is easier to interpret. Our objective was to estimate the posterior probability that the use of high PEEP with recruitment maneuvers is associated with reduced postoperative pulmonary complications in patients with intermediate-to-high risk under neutral, pessimistic, and optimistic expectations regarding the treatment effect. Methods: Multilevel Bayesian logistic regression analysis on individual patient data from three randomized clinical trials carried out on surgical patients at Intermediate-to-High Risk for postoperative pulmonary complications. The main outcome was the occurrence of postoperative pulmonary complications in the early postoperative period. We studied the effect of high PEEP with recruitment maneuvers versus Low PEEP Ventilation. Priors were chosen to reflect neutral, pessimistic, and optimistic expectations of the treatment effect. Results: Using a neutral, pessimistic, or optimistic prior, the posterior mean odds ratio (OR) for High PEEP with recruitment maneuvers compared to Low PEEP was 0.85 (95% Credible Interval [CrI] 0.71 to 1.02), 0.87 (0.72 to 1.04), and 0.86 (0.71 to 1.02), respectively. Regardless of prior beliefs, the posterior probability of experiencing a beneficial effect exceeded 90%. Subgroup analysis indicated a more pronounced effect in patients who underwent laparoscopy (OR: 0.67 [0.50 to 0.87]) and those at high risk for PPCs (OR: 0.80 [0.53 to 1.13]). Sensitivity analysis, considering severe postoperative pulmonary complications only or applying a different heterogeneity prior, yielded consistent results. Conclusion: High PEEP with recruitment maneuvers demonstrated a moderate reduction in the probability of PPC occurrence, with a high posterior probability of benefit observed consistently across various prior beliefs, particularly among patients who underwent laparoscopy

Prevalence and Clinical Outcomes of Poor Immune Response Despite Virologically Suppressive Antiretroviral Therapy Among Children and Adolescents With Human Immunodeficiency Virus in Europe and Thailand: Cohort Study

International audienceIn human immunodeficiency virus (HIV)-positive adults, low CD4 cell counts despite fully suppressed HIV-1 RNA on antiretroviral therapy (ART) have been associated with increased risk of morbidity and mortality. We assessed the prevalence and outcomes of poor immune response (PIR) in children receiving suppressive ART

Prevalence and Clinical Outcomes of Poor Immune Response Despite Virologically Suppressive Antiretroviral Therapy Among Children and Adolescents With Human Immunodeficiency Virus in Europe and Thailand: Cohort Study

BACKGROUND: In human immunodeficiency virus (HIV)-positive adults, low CD4 cell counts despite fully suppressed HIV-1 RNA on antiretroviral therapy (ART) have been associated with increased risk of morbidity and mortality. We assessed the prevalence and outcomes of poor immune response (PIR) in children receiving suppressive ART. METHODS: Sixteen cohorts from the European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) contributed data. Children &lt;18 years at ART initiation, with sustained viral suppression (VS) (≤400 copies/mL) for ≥1 year were included. The prevalence of PIR (defined as World Health Organization advanced/severe immunosuppression for age) at 1 year of VS was described. Factors associated with PIR were assessed using logistic regression. Rates of acquired immunodeficiency syndrome (AIDS) or death on suppressive ART were calculated by PIR status. RESULTS: Of 2318 children included, median age was 6.4 years and 68% had advanced/severe immunosuppression at ART initiation. At 1 year of VS, 12% had PIR. In multivariable analysis, PIR was associated with older age and worse immunological stage at ART start, hepatitis B coinfection, and residing in Thailand (all P ≤ .03). Rates of AIDS/death (95% confidence interval) per 100 000 person-years were 1052 (547, 2022) among PIR versus 261 (166, 409) among immune responders; rate ratio of 4.04 (1.83, 8.92; P &lt; .001). CONCLUSIONS: One in eight children in our cohort experienced PIR despite sustained VS. While the overall rate of AIDS/death was low, children with PIR had a 4-fold increase in risk of event as compared with immune responders