Aliment Pharmacol Ther 2011; 34: 509–518
Summary
Background Antibiotic prophylaxis seems to decrease the incidence of bacterial infections in patients with cirrhosis and upper gastrointestinal ...bleeding and is considered standard of care. However, there is no updated information regarding the effects of this intervention.
Aim To assess the benefits and harms of antibiotic prophylaxis in cirrhotic patients with gastrointestinal bleeding by performing a systematic review of randomised trials.
Methods We searched The Cochrane Hepato‐Biliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE and Science Citation Index EXPANDED until June 2010. We statistically combined data calculating relative risk (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes.
Results Twelve trials (1241 patients) evaluating antibiotic prophylaxis against placebo or no antibiotic prophylaxis were included. Antibiotic prophylaxis was associated with reduced mortality (RR 0.79, 95% CI 0.63–0.98), mortality from bacterial infections (RR 0.43, 95% CI 0.19–0.97), bacterial infections (RR 0.35, 95% CI 0.26–0.47), rebleeding (RR 0.53, 95% CI 0.38–0.74) and days of hospitalisation (MD −1.91, 95% CI −3.80–0.02). Trials analysing rebleeding rate and hospitalisation length are still scarce, thus, caution should be exerted when interpreting the results.
Conclusions Antibiotic prophylaxis in patients with cirrhosis and upper gastrointestinal bleeding significantly reduced bacterial infections, and reduce all‐cause mortality, bacterial infection mortality, rebleeding events and hospitalisation length. Novel clinically significant outcomes were included in this meta‐analysis. Some benefits are biased and the risks are not yet properly assessed, this encourages future research in this field.
Nontraumatic lower-extremity amputation is a devastating complication of peripheral artery disease (PAD) with a high mortality and medical expenditure. There are ≈150 000 nontraumatic leg amputations ...every year in the United States, and most cases occur in patients with diabetes. Among patients with diabetes, after an ≈40% decline between 2000 and 2009, the amputation rate increased by 50% from 2009 to 2015. A number of evidence-based diagnostic and therapeutic approaches for PAD can reduce amputation risk. However, their implementation and adherence are suboptimal. Some racial/ethnic groups have an elevated risk of PAD but less access to high-quality vascular care, leading to increased rates of amputation. To stop, and indeed reverse, the increasing trends of amputation, actionable policies that will reduce the incidence of critical limb ischemia and enhance delivery of optimal care are needed. This statement describes the impact of amputation on patients and society, summarizes medical approaches to identify PAD and prevent its progression, and proposes policy solutions to prevent limb amputation. Among the actions recommended are improving public awareness of PAD and greater use of effective PAD management strategies (eg, smoking cessation, use of statins, and foot monitoring/care in patients with diabetes). To facilitate the implementation of these recommendations, we propose several regulatory/legislative and organizational/institutional policies such as adoption of quality measures for PAD care; affordable prevention, diagnosis, and management; regulation of tobacco products; clinical decision support for PAD care; professional education; and dedicated funding opportunities to support PAD research. If these recommendations and proposed policies are implemented, we should be able to achieve the goal of reducing the rate of nontraumatic lower-extremity amputations by 20% by 2030.
A series of recent acute blindness cases following non-complicated retinal detachment surgery caused the release of several health alerts in Spain. The blindness was attributed to certain lots of ...perfluoro-octane (PFO; a volatile and transient medical device). Similar cases have been reported in other countries. This has raised questions regarding the validity of cytotoxicity test methods currently used to certify the safety of PFO lots. The tests were performed according to the International Organization for Standardization (ISO) norms, using the extract dilution method or the indirect contact method as applied to L929 cells, a line derived from mouse fibroblasts. The limitations of those methods have been resolved in this study by proposing a new cytotoxicity test method for volatile substances. The new method requires direct contact of the tested substance with cells that are similar to those exposed to the substance in the clinical setting. This approach includes a few new technical steps that are crucial for detecting cytotoxicity. Our new method detected toxic PFO lots that corresponded to the lots producing clinical blindness, which previous methods failed to detect. The study suggests applying this new method to avoid occurrence of such cases of blindness.
This paper presents a novel multi-stage optimization model for farm management during a certain planning time horizon. The salient features of this optimization model are the proper incorporation of ...crop rotation schemes and the consideration of crop impacts on the environment via linear environmental constraints. This decision support tool produces an optimal crop rotation plan (i.e. which crop to cultivate each year and their area) which maximizes farmer' profit while satisfying specified environmental constraints and crop rotation schemes requirements. The optimization model is formulated as a mixed-integer linear programming (MILP) problem for which sound and powerful solvers exist. The paper thoroughly investigates the impact of various types of environmental constraints, which aim at maintaining the environmental impacts of farm activities below specified levels either overall, i.e. over the entire planning horizon, or tight, i.e. after each crop rotation. The environmental constraints are derived by adopting a Life Cycle Assessment (LCA) approach. The proposed approach is illustrated, without loss of generality, using agriculture system data specific to Luxembourg. The impact of a variety of environmental constraints, including greenhouse gas emissions and European Union (EU) common agricultural policy (CAP), is discussed.
•We propose a novel multi-stage MILP optimization model for optimal farm management.•The optimization model incorporates properly constraints imposed by crop rotation schemes.•Crop impacts on the environment are derived via linear environmental constraints.•The formulation of environmental constraints relies on a life cycle assessment approach.•The proposed approach is illustrated using agriculture data of Luxembourg.
Comprising more than 1,400 species, bats possess adaptations unique among mammals including powered flight, unexpected longevity, and extraordinary immunity. Some of the molecular mechanisms ...underlying these unique adaptations includes DNA repair, metabolism and immunity. However, analyses have been limited to a few divergent lineages, reducing the scope of inferences on gene family evolution across the Order Chiroptera. We conducted an exhaustive comparative genomic study of 37 bat species, one generated in this study, encompassing a large number of lineages, with a particular emphasis on multi‐gene family evolution across immune and metabolic genes. In agreement with previous analyses, we found lineage‐specific expansions of the APOBEC3 and MHC‐I gene families, and loss of the proinflammatory PYHIN gene family. We inferred more than 1,000 gene losses unique to bats, including genes involved in the regulation of inflammasome pathways such as epithelial defence receptors, the natural killer gene complex and the interferon‐gamma induced pathway. Gene set enrichment analyses revealed genes lost in bats are involved in defence response against pathogen‐associated molecular patterns and damage‐associated molecular patterns. Gene family evolution and selection analyses indicate bats have evolved fundamental functional differences compared to other mammals in both innate and adaptive immune system, with the potential to enhance antiviral immune response while dampening inflammatory signalling. In addition, metabolic genes have experienced repeated expansions related to convergent shifts to plant‐based diets. Our analyses support the hypothesis that, in tandem with flight, ancestral bats had evolved a unique set of immune adaptations whose functional implications remain to be explored.
This study aimed to identify and characterise biosurfactant compounds produced by bacteria associated with a marine eukaryotic phytoplankton bloom. One strain, designated MCTG214(3b1), was isolated ...by enrichment with polycyclic aromatic hydrocarbons and based on 16S rDNA, and
gyrB
sequencing was found to belong to the genus
Pseudomonas
, however not related to
P. aeruginosa
. Cell-free supernatant samples of strain MCTG214(3b1) at stationary phase showed significant reductions in surface tension. HPLC-MS and NMR analysis of these samples indicated the presence of five different rhamnolipid (RL) congeners. Di-rhamnolipids accounted for 87% relative abundance and all congeners possessed fatty acid moieties consisting of 8–12 carbons. PCR screening of strain MCTG214(3b1) DNA revealed homologues to the
P. aeruginosa
RL synthesis genes
rhlA
and
rhlB
; however, no
rhlC
homologue was identified. Using the
Galleria mellonella
larvae model, strain MCTG214(3b1) was demonstrated to be far less pathogenic than
P. aeruginosa
. This study identifies for the first time a significantly high level of synthesis of short chain di-rhamnolipids by a non-pathogenic marine
Pseudomonas
species. We postulate that RL synthesis in
Pseudomonas
sp. MCTG214(3b1) is carried out by enzymes expressed from
rhlA
/
B
homologues similar to those of
P. aeruginosa
; however, a lack of
rhlC
potentially indicates the presence of a second novel rhamnosyltransferase responsible for the di-rhamnolipid congeners identified by HPLC-MS.
IntroductionThe Autonomous Sensory Meridian (ASMR) is a static or tingling sensation on the skin that usually starts on the scalp and runs through the back of the neck and upper spine. It has been ...compared to tactile auditory synesthesia and may overlap with shivering. It is a subjective experience of “low-grade euphoria”, characterized by “a combination of positive feelings and a static tingling sensation on the skin”. It is most commonly triggered by auditory or visual stimuli, and less commonly by intentional attentional control.ObjectivesTo determine the effects produced by the perception of ASMR in the population with mental disorders.MethodsA literature review was carried out in Pubmed using the descriptors: “ASMR” AND “mental”. 7 results are obtained. The results of a time limit of 10 years were filtered, obtaining 6 results and selecting all of them for their relevance to the PICO question. Subsequently, the search was repeated using the same descriptors and time limit in the Cochrane Library and NICE, in which no results were found.ResultsThe first result, an RCT of 475 people between the ages of 18 and 54, showed that 80% of the participants answered positively when asked if ASMR has an effect on their mood, while 14% were not sure and 6 % felt ASMR did not alter their mood. When subjected to a mixed ANOVA with factors for time (before, during, immediately after, and 3 h after ASMR) and for depression status (high, medium, or low as defined by the BDI), we found a significant main effect. of time in mood. p<0.0005In one of these studies, the default neural network (the one that works when the brain is relaxed) was analyzed in 11 volunteers in whom ASMR caused them to relax, in contrast to 11 individuals in the control group. At the end of the study, the ASMR volunteers generally showed less functional connectivity than the other volunteers. It also showed “increased connectivity between regions of the occipital, frontal, and temporal cortices,” suggesting that ASMR favors the association of those networks that are activated in the resting state.ConclusionsWith the available evidence it is concluded that ASMR could improve of the affective clinic reflected in the parameters of the Beck depression scale as well as a sense of calm and relaxation and it reduces the heart rate or increases the conductivity of the skin, something that happens when certain emotional states are altered.Disclosure of InterestNone Declared
IntroductionOmega-3 polyunsaturated fatty acids (PUFAs) have been studied in relation to mental illness. Among the most important omega 3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic ...acid (DHA) stand out, both derived from alpha-linolenic acid. Both EPA and DHA are essential fatty acids. Consequently, mammals are not capable of synthesizing them and must incorporate them through the consumption of products such as fish oil. The interest about the role of omega 3 fatty acids for the treatment of patients with impulsiveness, hostility and aggressiveness is growing and originated from the finding of a low level of EPA and DHA in the central nervous system of these individuals.ObjectivesTo determine the evidence on the effectiveness of omega-3 acids in reducing severe symptoms in patients diagnosed with Borderline Personality Disorder.MethodsA literature review was carried out in Epistemonikos, using the descriptors: “borderline personality disorder” AND “Omega-3”. 7 results are obtained. The results of a time limit of 10 years with meta-analyses and systematic reviews were filtered, obtaining 7 results and selecting 3 of them for their relevance to the PICO question. Subsequently, the search was repeated using the same descriptors and time limit in the Cochrane Library, NICE, and Pubmed; no selection was made by coincidence of those previously selected.ResultsThe first systematic review studied the effectiveness of omega-3 fatty acids in symptomatology associated with BPD, with differentiation of the domains of affective, impulsive and cognitive-perceptual symptoms. Within the meta-analysis, 5 randomized controlled trials (RCTs) were included that compared omega-3 fatty acids with placebo or any active comparator, four of these RCTs verified the effect of omega-3 acids in 137 patients with BPD or behavior related to the BPD.The second systematic review, conducted in the Cochrane Collaboration, performed a meta-analysis of randomized comparisons of drug versus placebo. Twenty-seven trials testing first- and second-generation antipsychotics, mood stabilizers, antidepressants, and omega-3 fatty acids were included. For supplemental omega-3 fatty acids, significant effects were found in one study (n = 49 ) for reduction in suicidality (RR = 0.52, 95% CI 0.28 to 0.95) and depressive symptoms (RR = 0.48, 95% CI 0.28 to 0, 81).ConclusionsAvailable data indicate that marine omega-3 fatty acids improve BPD symptoms, particularly impulsive behavioral dyscontrol and affective dysregulation, reducing depressive symptoms and suicidal tendencies. Marine omega-3 fatty acids could be considered as a complementary therapy for the improvement of severe symptoms associated with patients with BPD.Disclosure of InterestNone Declared
Abstract
The continued increase of the demand for seed of the Pacific oyster (
Crassostrea gigas
) has driven the aquaculture industry to produce land-based hatcheries using broodstock conditioning. ...This has led to the need to create closed systems to control the main factors involved in reproduction (temperature and food). Additionally, reproductive synchronization of broodstocks may be considered to ensure homogeneous maturation and spawning among the organisms. In this work, we synchronized the broodstock reproductive stage of Pacific oysters in a recirculating aquaculture system (RAS) using a “preconditioning” process and evaluated the effect of the water quality and the CO
2
-carbonate system on preconditioned broodstock. The oysters were kept at 12 °C for 45 days in a RAS containing a calcium reactor (C2) or without a calcium reactor (C1, control). Water quality parameters were measured daily, and the oyster’s condition and reproductive development were monitored using condition index, biometrics, and histology, on Days 0, 20, and 45. C1 and C2 systems kept the water quality within the ranges reported as favorable for bivalves. The calcium reactor kept the pH (8.03–8.10), alkalinity (200 mg/L as CaCO
3
), CO
3
2−
(≤ 80 µmol/kg), and Ω aragonite (≤ 1) closer to the ranges reported as optimal for bivalves. However, no significant differences were detected in the total weight and the condition index in C1 and C2. The preconditioning allowed to maintain the organisms in early reproductive development, allowing gametogenesis synchronization to start maturation.
A novel series of linear, high-molecular-weight polymers and copolymers was synthesized by one-pot, metal-free superacid-catalyzed reaction of trifluoromethylalkyl (1 a–1c) and trifluoromethylaryl (1 ...d–1h) ketones with the linear, nonactivated, multiring aromatic hydrocarbons biphenyl (A), p-terphenyl (B), and p-quaterphenyl (C). The polymerizations were performed at room temperature in the Brønsted superacid trifluoromethanesulfonic acid (CF3SO3H, TFSA) and in a mixture of TFSA with methylene chloride. Polymerizations of trifluoromethyl ketones (1c, 1 f–1h) bearing functional groups gave polymers with reactive lateral groups such as bromomethyl, 4-(N,N-dimethylamino)phenyl-, 3-sulfophenyl-, and 2,3,4,5,6-pentafluorophenyl. The polymers obtained were soluble in most common organic solvents and flexible transparent films could be cast from the solutions. 1H and 13C NMR analyses of the polymers synthesized revealed their linear structure with para-substitution in the phenylene fragments of the main chain. The molecular weights (M w) of the polymers based on trifluoromethylalkyl ketones and aromatic are very high and reach 1 000 000, while the molecular weights of the polymers based on trifluoromethylaryl ketones and aromatic ranged from 30 000 to 300 000 g/mol. The polydispersity of the polymers is generally less than 2. The polymers also possess high thermostability. Mechanistic aspects of polymerization mechanism have been discussed, and a new approach for monomer design has been proposed.
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