Mycobacterium tuberculosis (Mtb) killed more people in 2017 than any other single infectious agent. This dangerous pathogen is able to withstand stresses imposed by the immune system and tolerate ...exposure to antibiotics, resulting in persistent infection. The global tuberculosis (TB) epidemic has been exacerbated by the emergence of mutant strains of Mtb that are resistant to frontline antibiotics. Thus, both phenotypic drug tolerance and genetic drug resistance are major obstacles to successful TB therapy. Using a chemical approach to identify compounds that block stress and drug tolerance, as opposed to traditional screens for compounds that kill Mtb, we identified a small molecule, C10, that blocks tolerance to oxidative stress, acid stress, and the frontline antibiotic isoniazid (INH). In addition, we found that C10 prevents the selection for INH-resistant mutants and restores INH sensitivity in otherwise INH-resistant Mtb strains harboring mutations in the katG gene, which encodes the enzyme that converts the prodrug INH to its active form. Through mechanistic studies, we discovered that C10 inhibits Mtb respiration, revealing a link between respiration homeostasis and INH sensitivity. Therefore, by using C10 to dissect Mtb persistence, we discovered that INH resistance is not absolute and can be reversed.
Summary
Background
Faecal microbiota transplantation (FMT) is effective for recurrent Clostridioides difficile infection (rCDI), but its effect varies inexplicably.
Aims
To optimise the effectiveness ...of FMT for rCDI and validate determinants for effect
Methods
We conducted a cohort study, including all patients treated with FMT for rCDI between October 2018 and June 2020. Statistical process control was used to evaluate the impact of prospective quality improvement on the effect of single FMT treatments per 10–11 patients. Targeting an 80% effect, optimisations included changes to processing procedures, preparation and clinical application of FMT. The primary outcome was the resolution of Clostridioides difficile‐associated diarrhoea at week 8. If CDI recurred, FMT was repeated. All patients were followed for 8 weeks after their latest FMT.
Results
183 patients with rCDI received 290 FMT treatments. A single FMT achieved resolution at week 8 in 127 (69%, 95% CI: 62%–76%), while repeated FMT cumulatively achieved resolution in 167/183 (91%, 95% CI: 86%–95%). The single FMT effect varied between 36% and 100% over time. In a mixed‐effect model, patient age above 65 years, non‐rCDI antibiotics at week 1 post‐FMT, and donor were associated with effect. Neither increasing the dosages of faecal microbes nor standardising the processing improved outcomes.
Conclusion
FMT has a high cumulative effectiveness in patients with rCDI following multiple administrations, but the single FMT effect is variable and may be optimised using statistical process control. Optimising FMT by considering patient age, post‐FMT antibiotics, donor and multiple administrations may improve the treatment outcomes.
ClinicalTrials.gov (Study identifier: NCT03712722).
Donor, patient age and exposure to antibiotics are associated with the outcome of faecal microbiota transplantation for recurrent Clostridioides difficile infection: A prospective cohort study.
ABSTRACT
Background
Because of changes in sedation strategies, more patients in the intensive care unit (ICU) are conscious. Therefore, new and challenging tasks in nursing practice have emerged, ...which require a focus on the problems that patients experience. Thirst is one such major problem, arising because the mechanical ventilator prevents the patients from drinking when they have the urge to do so. To gain a deeper understanding of the patients' experiences and to contribute new knowledge in nursing care, this study focuses on the patients' experiences of thirst during mechanical ventilation (MV) while being conscious.
Aims
To explore patients' experience of thirst while being conscious and mechanically ventilated.
Design
This hermeneutic study used qualitative interviews of 12 patients.
Method
Data were analyzed based on content analysis. Interviews were conducted between September and October 2014 in two large ICUs in Denmark.
Result
Four themes relating to the patients' experiences of thirst during MV were identified: a paramount thirst, a different sense in the mouth, deprivation of the opportunity to quench thirst and difficulties associated with thirst.
Conclusion
Patients associate feelings of desperation, anxiety and powerlessness with the experience of thirst. These feelings have a negative impact on their psychological well‐being. A strategy in the ICU that includes no sedation for critically ill patients in need of MV introduces new demands on the nurses who must care for patients who are struggling with thirst.
Relevance to clinical practice
This study shows that despite several practical attempts to relieve thirst, it remains a paramount problem for the patients. ICU nurses need to increase their focus on issues of thirst and dry mouth, which are two closely related issues for the patients. Communication may be a way to involve the patients, recognize and draw attention to their problem.
Featured Cover Baunwall, Simon M. D.; Hansen, Mette M.; Andreasen, Sara E. ...
Alimentary pharmacology & therapeutics,
September 2023, 2023-09-00, 20230901, Letnik:
58, Številka:
5
Journal Article
Recenzirano
Odprti dostop
The cover image is based on the Original Article Donor, patient age and exposure to antibiotics are associated with the outcome of faecal microbiota transplantation for recurrent Clostridioides ...difficile infection: A prospective cohort study by Simon M. D. Baunwall et al., https://doi.org/10.1111/apt.17642 Image Credit: Nina Rågård
Objective The aim of this cohort study was to investigate associations between parity, pre-pregnancy body mass index (BMI), assisted reproductive therapy (ART), time to pregnancy (TTP), and ...engagement in physical exercise and the risk of sickness absence in pregnancy from 10–29 completed pregnancy weeks. Methods Data from 51 874 pregnancies in the Danish National Birth Cohort collected from 1996 until 2002 were linked to the Danish Register for Evaluation of Marginalization. Exposure information was based on questionnaires. Hazard ratios (HR) with 95% confidence intervals (95% CI) were calculated by Cox regression, using time of first episode of sickness absence as the primary outcome. Results Multiparity 1.26 (95% CI 1.10–1.45), overweight 1.13 (95% CI 1.08–1.18), obesity 1.23 (95% CI 1.15–1.31), ART 1.10 (95% CI 1.01–1.20), and TTP>12 months 1.06 (95% CI 0.99–1.13) were associated with higher HR of sickness absence. Physical exercise of >120 minutes per week was associated with lower HR 0.84 (95% CI 0.75–0.95). Conclusion Risk for sickness absence was higher among women who were multiparous, overweight, obese, received ART, and had prolonged TTP, and lower among women engaged in leisure-time physical exercise. Few studies have investigated these associations, and the results should be confirmed in other studies of pregnant women.
Ecological intensification of cropping systems aims at restoring multi-functionality while supporting current productivity levels. Intercropping is a form of ecological intensification involving ...ecological processes beneficial to farmers that do not take place in monocultures. Thus, it represents a practical approach to decrease the use of synthetic inputs such as insecticides in cultivated systems. Whereas insecticide reduction via intercropping-facilitated suppression of aphids is reported in literature, the majority of published studies focussed on herbaceous crops. Thus, the effect of intercropping on aphid populations of cultivated trees remains largely unaddressed. In this study we hypothesized that intercropping a specific companion plant within perennial crops would divert ant attendance from an aphid attacking the crop to another aphid feeding on the newly introduced plant, reducing aphid damage on the crop. We tested our hypothesis in the system of apple (Malus domestica Borkhausen), the rosy apple aphid (Dysaphis plantaginea Passerini) and the black garden ant (Lasius niger L.). Bean plants (Vicia faba) with the black bean aphid (Aphis fabae Scopoli) were intercropped within apple trees inoculated with D. plantaginea. We measured ant attendance, aphid development and survival as well as honeydew composition on both plant species through semi-field and field experiments. The majority of ants chose to attend A. fabae over D. plantaginea in the semi-field experiment with potted plants. In the orchard, a larger majority of scouts were scored on A. fabae over D. plantaginea. A higher number of D. plantaginea colonies remained active in the apple control, whilst they were almost eradicated by intercropping. Although chemical analyses of honeydew disclosed differences in the carbohydrate and amino acid profiles between aphid species, the difference in honeydew composition did not explain the preference for A. fabae. Ants did not discriminate between the two honeydew mimics both in laboratory and field bioassays. Our results showed the potential of intercropping apple trees with beans as a method to reduce ant attendance and thus colony survival. We propose that intercropping represents a bottom-up approach towards ecological intensification of perennial crops. Together with other ecosystem-based measures such as habitat management, intercropping should be considered when planning ecosystem redesign to increase biological control of pests.
Collagen is characterized by its high content of glycine, proline and hydroxyproline, and is found to exert beneficial effects on joint pain related to activity and osteoarthritis. However, to exert ...any beneficial effects it is essential that collagen is optimally absorbed. This study aimed to investigate the postprandial absorption of collagen and elucidate the impact of an exogenous enzymatic hydrolysis on absorption rate and bioavailability. A randomized, blinded, cross-over study was conducted where ten healthy male subjects received either 35 g enzymatically hydrolyzed collagen protein (EHC), 35 g non-enzymatically hydrolyzed collagen protein (NC) or placebo (250 mL water) on three nonconsecutive days. Blood samples were drawn before, and up to 240 min following, ingestion and the blood metabolome was characterized by nuclear magnetic resonance (NMR)-based metabolomics. A significant increase in the plasma concentration of nearly all amino acids (AAs) was observed over a 240 min period for both EHC and NC. In addition, the absorption rate and bioavailability of glycine, proline and hydroxyproline were significantly higher for EHC (
< 0.05). In conclusion, ingestion of collagen hydrolysates increases postprandial plasma concentrations of AAs over a period of 240 min, and an enzymatic hydrolysis increases the absorption rate and bioavailability of the collagen-rich AAs glycine, proline and hydroxyproline.
Purpose
Intake of vegetables has been associated with a lower risk of ischemic stroke in observational studies controlling for total energy intake. However, adjustment for energy intake introduces a ...substitution aspect, which affects the interpretation of the results. We investigated replacement of potatoes with other vegetables, substitutions between vegetable subgroups, and risk of ischemic stroke and ischemic stroke subtypes.
Methods
The Danish Diet, Cancer and Health cohort included 57,053 participants aged 50–64 years at recruitment in 1993–1997. Diet was assessed from a validated 192-item semi-quantitative food frequency questionnaire. We calculated hazard ratios (HR) with 95% confidence intervals (CI) for the incidence of ischemic stroke using Cox proportional hazard regression.
Results
During 13.5 years of follow-up, 1879 cases of ischemic stroke were identified including 319 cases of large-artery atherosclerosis and 844 cases of small-vessel occlusion. The adjusted HR for total ischemic stroke associated with food substitutions of equal amounts (500 g/week) was 0.86 (95% CI 0.76, 0.97) for replacement of potatoes with fruiting vegetables and 0.92 (95% CI 0.84, 1.02) for replacement of potatoes with other root vegetables. The HR for replacing potatoes with the sum of other vegetables was 0.95 (95% CI 0.90, 1.00). Substitution of cabbage for either potatoes, fruiting vegetables or other root vegetables was associated with a statistically non-significant higher risk of ischemic stroke. The patterns of associations were similar for ischemic stroke subtypes and for equivalent substitutions using isocaloric amounts.
Conclusion
Replacing potatoes with fruiting vegetables was associated with a lower risk of ischemic stroke.
Background: adequate protein intake is essential to humans and, since the global demand for protein-containing foods is increasing, identifying new high-quality protein sources is needed. In this ...study, we investigated the acute postprandial bioavailability of amino acids (AAs) from a krill protein hydrolysate compared to a soy and a whey protein isolate. Methods: the study was a randomized, placebo-controlled crossover trial including ten healthy young males. On four non-consecutive days, volunteers consumed water or one of three protein-matched supplements: whey protein isolate, soy protein isolate or krill protein hydrolysate. Blood samples were collected prior to and until 180 min after consumption. Serum postprandial AA concentrations were determined using 1H NMR spectroscopy. Hunger and satiety were assessed using visual analogue scales (VAS). Results: whey and krill resulted in significantly higher AA concentrations compared to soy between 20–60 min and 20–40 min after consumption, respectively. Area under the curve (AUC) analyses revealed that whey resulted in the highest postprandial serum concentrations of essential AAs (EAAs) and branched chain AAs (BCAAs), followed by krill and soy, respectively. Conclusions: krill protein hydrolysate increases postprandial serum EAA and BCAA concentrations in a superior manner to soy protein isolate and thus might represent a promising future protein source in human nutrition.
•Women with different chronic medical conditions shared similar experiences of maternity care.•Maternity carewas described as fragmentated, confusing and focusing primarily on health risks.•Women ...with chronic medical conditions described feelings of abandonment after giving birth.•Women with chronic medical conditions expressed a need for continuity in specialised maternity care.
To explore maternity care experiences and needs of women with various types of chronic medical conditions receiving specialised maternity care. Design A qualitative descriptive study.
A highly specialised hospital providing maternity care to women with high-risk pregnancies in Copenhagen, Denmark. Participants Fourteen purposefully selected women referred to specialist maternity care at a large tertiary hospital due to one or more chronic medical conditions.
Individual in-depth interviews (n = 14) were performed between January 2018 and June 2019. Analysed using thematic analysis.
One overarching theme was identified: Monitored but not sufficiently guided. Three main themes unfolding this overarching theme were: Chronic condition as determining pregnancy care, Childbearing woman as messenger and interpreter, and Feelings of abandonment after giving birth.
Across various types of chronic medical conditions, women expressed a need for increased continuity in specialised maternity care. Healthcare professionals should help women with chronic medical conditions navigate the healthcare system and interpret complex information.
Pregnancy should be recognised as a significant life event, even though the childbearing woman is living with a chronic medical condition, and professionals should emphasise the aspects of pregnancy that develop uncomplicated. Information about the anticipated development of chronic medical conditions postpartum and concerns regarding breastfeeding could preferably be addressed during pregnancy. Continuity of care was particularly important to the women and could relieve some of the worrying women experienced during pregnancy.
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