Nondigestible carbohydrates in the diets of infants and young children: a commentary by the ESPGHAN Committee on Nutrition

The consumption of nondigestible carbohydrates is perceived as beneficial by health professionals and the general public, but the translation of this information into dietary practice, public health recommendations, and regulatory policy has proved difficult. Nondigestible carbohydrates are a heterogeneous entity, and their definition is problematic. Without a means to characterize the dietary components associated with particular health benefits, specific attributions of these cannot be made. Food labeling for "fiber" constituents can be given only in a general context, and the development of health policy, dietary advice, and education, and informed public understanding of nondigestible carbohydrates are limited. There have, however, been several important developments in our thinking about nondigestible carbohydrates during the past few years. The concept of fiber has expanded to include a range of nondigestible carbohydrates. Their fermentation, fate, and effects in the colon have become a defining characteristic; human milk, hitherto regarded as devoid of nondigestible carbohydrates, is now recognized as a source for infants, and the inclusion of nondigestible carbohydrates in the diet has been promoted for their "prebiotic" effects. Therefore, a review of the importance of nondigestible carbohydrates in the diets of infants and young children is timely. The aims of this commentary are to clarify the current definitions of nondigestible carbohydrates, to review published evidence for their biochemical, physiologic, nutritional, and clinical effects, and to discuss issues involved in defining dietary guidelines for infants and young children.     

Elevation of biochemical markers for myocardial damage prior to hospital admission in patients with acute chest pain or other symptoms raising suspicion of acute coronary syndrome

Abstract. Svensson L, Axelsson C, Nordlander R, Herlitz J (South Hospital, Stockholm; and Sahlgrenska University Hospital, Göteborg; Sweden). Elevation of biochemical markers for myocardial damage prior to hospital admission in patients with acute chest pain or other symptoms raising suspicion of acute coronary syndrome. J Intern Med 2003; 253: 311–319. Objectives. To evaluate the occurrence of elevation of serum biochemical markers for myocardial damage in the prehospital setting amongst patients who called for an ambulance due to a suspected acute coronary syndrome (ACS). Design. Prospective observational study. Subjects. All the patients who called for an ambulance due to suspected ACS. Setting. South Hospital's catchment area in Stockholm and in the Municipality of Göteborg, Sweden between January and November in the year 2000, were included. Interventions. On arrival of the ambulance crew, a blood sample was drawn for bedside analysis of serum myoglobin, creatine kinase MB and troponin I. A 12‐lead electrocardiogram (ECG) was simultaneously recorded. Main outcome measures. Elevation of biochemical markers prior to hospital admission. Results. In all, 511 patients participated on 538 occasions. Elevation of any biochemical marker was observed in 11% of all patients. The corresponding figure for patients developing myocardial infarction was 21%; for patients with myocardial ischaemia 8%; for patients with a possible myocardial ischaemia 4% and for patients with other diagnoses 5%. Amongst those who had a final diagnosis of acute myocardial infarction (AMI), 47% had ST‐elevation on initial ECG and 57% had either ST‐elevation or elevation of any biochemical marker. Conclusion. Bedside analysis of biochemical markers in serum is already feasible prior to hospital admission amongst patients with a suspected ACS. About 20% of patients with AMI have elevated biochemical markers at that stage. When found this data might increase the possibility of diagnosing an AMI very early in the course. However, false positives were found and whether this strategy will improve the triage of these patients in the prehospital setting remains to be proven.     

Patient-controlled regional analgesia (PCRA) with ropivacaine after arthroscopic subacromial decompression

BACKGROUND: The aim of the study was to evaluate postoperative analgesia and safety of wound instillation of ropivacaine either by a single dose or a patient-controlled regional anaesthesia (PCRA) technique. METHODS: In 40 patients undergoing arthroscopic subacromial decompression the surgeon placed a catheter into the subacromial space at the end of the operation. In Phase I (10 patients), ropivacaine 250 mg was injected twice within 1 h. In Phase II, 30 patients were randomised into three groups: group prilocaine-ropivacaine (PR) = 20 ml of 1% prilocaine-epinephrine injected preoperatively into the subacromial bursa + 20 ml of 0.5% ropivacaine infused in the catheter postoperatively; group saline-ropivacaine (SR) = saline-epinephrine (20 ml) preoperatively + 0.5% ropivacaine as in group PR; group saline-saline (SS) = saline-epinephrine (20 ml) preoperatively + saline postoperatively. The PCRA pump was filled with local anaesthetic or saline to allow boluses of 10-ml each, maximum one bolus/h, via the catheter. Pain relief, side-effects and venous plasma concentration of ropivacaine were evaluated during a 24-h-test period. RESULTS: The free plasma concentration of ropivacaine was 0.12 + 0.041 mg l-1 in Phase I. No adverse effects were seen. In Phase II pain at rest and on movement was lower in group PR than in group SS during the first 30 min postoperatively (P < 0.05). Group PR had the lowest morphine consumption (P < 0.05). Five to seven boluses were administered via the PCRA-pump, and 20 min after administration of the study solution, pain was lower in groups PR and SR compared with group SS (P < 0.001). CONCLUSIONS: Preoperative intrabursal prilocaine with epinephrine + postoperative subacromial administration of ropivacaine by PCRA-technique provided the most effective analgesia with no major side-effects. The free plasma concentrations of ropivacaine were far below toxic concentrations.     

Large veins in the Atlantic cod (Gadus morhua) and the rainbow trout (Oncorhynchus mykiss) are innervated by neuropeptide-containing nerves

Previous studies have shown that fish veins are reactive to several hormones known to exist in the fish circulation. Besides this humoral control, another possible means of active regulation of venous return is by autonomic nervous control of venous tone. This study therefore investigated the presence of a perivascular innervation of major veins in the Atlantic cod (Gadus morhua) and the rainbow trout (Oncorhynchus mykiss) using immunohistochemical methods. Histological staining was employed to investigate the smooth muscle distribution in the vessel walls. Vasoactive intestinal polypeptide-immunoreactive nerve fibers were found to be widespread in the venous system of G. morhua and O. mykiss, while pituitary adenylate cyclase-activating polypeptide-immunoreactive fibers were demonstrated in the duct of Cuvier of both species. Fibers containing neurokinin A and/or substance P were found in the duct of Cuvier and the posterior cardinal vein of both species and in the hepatic portal vein of O. mykiss. Calcitonin-gene related peptide-immunoreactive fibers were present in the duct of Cuvier of both species and in the hepatic portal vein of O. mykiss. Galanin-immunoreactive fibers were found in the duct of Cuvier in O. mykiss and in the hepatic portal vein of both species. Co-existence of neuropeptides in the perivascular nerve fibers was investigated by double labelling. Vasoactive intestinal polypeptide/pituitary adenylate cyclase-activating polypeptide-immunoreactive fibers were found in both species. Vasoactive intestinal polypeptide/galanin-immunoreactive fibers and vasoactive intestinal polypeptide/calcitoningene related peptide-immunoreactive fibers were found in G. morhua but not in O. mykiss. This study gives further evidence for an active venoregulation by autonomic nerves in teleost fish.     

Exposure assessment to alpha- and beta-pinene,delta(3)-carene and wood dust in industrial production of wood pellets

The main aim of the study was to measure the exposure to monoterpenes (alpha- and beta-pinene and Delta(3)-carene) and wood dust during industrial production of wood pellets and briquettes. Additional aims were to compare the results from wood dust sampled on a filter with real time measurements using a direct reading instrument and to identify peak exposures to dust. Twenty-four men working at six companies involved in industrial production of wood pellets and briquettes participated in the study. Monoterpenes were measured by diffusive sampling and wood dust was measured as total dust. A data logger (DataRAM) was used for continuous monitoring of dust concentration for 18 of the participants. The sampling time was approximately 8 h. The personal exposure to monoterpenes ranged from 0.64 to 28 mg/m(3) and a statistically significant (Kruskal-Wallis test, P = 0.0002) difference in levels of monoterpenes for workers at different companies was seen. In the companies the personal exposure to wood dust varied between 0.16 and 19 mg/m(3) and for 10 participants the levels exceeded the present Swedish occupational exposure limit (OEL) of 2 mg/m(3). The levels of wood dust during the morning shift were significantly (Mann-Whitney test, P = 0.04) higher compared with the afternoon shift. Continuous registration of dust concentration showed peak values for several working operations, especially cleaning of truck engines with compressed air. For 24 workers in six companies involved in industrial production of wood pellets the personal exposure to monoterpenes was low and to wood dust high compared with the present Swedish OEL and previous studies in Swedish wood industries. Since the DataRAM can identify critical working tasks with high wood dust exposure a reduction in exposure levels could probably be achieved by changes in working routines and by the use of protective equipment.     

Humoral immunity targeting site I of antigenic domain 2 of glycoprotein B upon immunization with different cytomegalovirus candidate vaccines

Glycoprotein B (gB) is a major component in several vaccines that are under development for prevention of disease by cytomegalovirus. It contains multiple determinants that are targets for neutralizing antibodies. One of them is site I of antigenic domain 2 (AD-2). The epitope, defined by short peptides, is quite conserved between different isolates. However, it is poorly immunogenic in natural infection. In this study we investigated the extent to which different vaccines, attenuated live Towne vaccine with or without priming with a canarypox virus coding for gB, or a recombinant gB vaccine adjuvanted with MF59, induced antibodies to this epitope. As in natural infection only a fraction of all subjects developed antibody responses against site I of AD-2 following vaccination. We suggest that strategies that enhance immunogenicity of this epitope will improve vaccine efficacy.     

在瑞典宠爱养鸟与肺癌危险性的探讨

目的：调查瑞典养鸟与肺癌危险性的联系。研究设计：肺癌病例与社区对照组的病例对照研究，由两位经过特殊训练的护士进行调查。调查地区：瑞典西南地区三所医院。病例：全部为新近诊断的肺癌病例，年龄最大７５岁，居住于Ｇｏｔｈｅｎｂｕｒｇ，Ｂｏｈｕｓ及Ａｌｖｓｂｏｒｇ三个城市的２６个社区。对照组配对条件：从人口登记资料中选出同性别、年龄相近和同一居住地点的居民。养鸟情况：肺癌病例３８０人（男２５２，女１２８），对照组６９６人（男４３３，女２６３）。探讨的主要问题：探讨养鸟与否和养鸟年限与肺癌的ＯＲ值。结果：家中曾养鸟和未养鸟的调整ＯＲ值男性为０．９４（９５％ＣＩ＝０．６４～１．３９），女性为１．１０（９５％ＣＩ＝０．６４～１．９０）。未见到养鸟年限增加有肺癌危险性增加的倾向。结论：瑞典家中养鸟对男、女肺癌危险性并无影响     

Role of fat mass and adipokines in chronic kidney disease

PURPOSE OF REVIEW: As traditional risk factors cannot alone explain the high prevalence and incidence of cardiovascular disease in chronic kidney disease, the complex of insulin resistance, oxidative stress, and endothelial dysfunction has increasingly been studied as an important non-traditional risk factor. Recent studies show that the adipose tissue is a complex organ with pleiotropic functions far beyond the mere storage of energy. Fat tissue secretes a number of adipokines including leptin and adiponectin, as well as cytokines, such as resistin, visfatin, tumor-necrosis factor-alpha and interleukin-6. RECENT FINDINGS: Adipokine serum levels are markedly elevated in chronic kidney disease, likely due to a decreased renal excretion. Evidence suggests that these pluripotent signaling molecules may have multiple effects modulating insulin signaling, endothelial health and vascular outcome. SUMMARY: Fat tissue is a storage depot for energy and a source of circulating signaling molecules. It plays an important role in the catabolic uremic milieu, and has been linked to systemic inflammation and uremic anorexia. Further research is needed to investigate the complex interactions between adipokine signaling networks and its effects on vascular health and outcome in chronic kidney disease.