Οξειδωτικό Στρες προερχόμενο από το περιβάλλον με επιπτώσεις στην Υγεία: Υπογονιμότητα

Το παρόν πόνημα πραγματεύεται την ανασκόπηση των μηχανισμών δια των οποίων δημιουργείται το οξειδωτικό stress σε συνδυασμό με την επίδραση που ασκεί στον τομέα της υπογονιμότητας των ζευγαριών. Το σώμα της εργασίας αποτελείται από τρία κεφάλαια. Στο πρώτο κεφάλαιο ερευνάται ο ορισμός του οξειδωτικού stress, σε συνδυασμό με τους παράγοντες που το συνιστούν αλλά και τους τρόπους δημιουργίας και συντήρησης τους και παρατίθενται οι διάφοροι τρόποι μέτρησης του οξειδωτικού stress. Επίσης, γίνεται και μία αναφορά στην μελέτη της κλινικής επίδρασης του οξειδωτικού stress. Εν συνεχεία, στο δεύτερο κεφάλαιο, γίνεται αναφορά στη σύνδεση του οξειδωτικού stress με το περιβάλλον αφού ο αριθμός των χημικών ενώσεων που ευθύνονται για τοξικότητα αυξάνεται συνεχώς, καταλήγοντας στις βλαπτικές συνέπειες του οξειδωτικού stress, με κυρίαρχη την δυσκολία στη γοναδική λειτουργία ανδρών και γυναικών. Πιο συγκεκριμένα, οι περιβαλλοντικοί ρύποι μολυσματικού χαρακτήρα οι οποίοι εμφανίζονται στην αναπαραγωγική φάση επηρεάζοντας ιδιαίτερα την υγεία και την σύλληψη συνδυαστικά με την γονιμότητα ανέρχονται σε περίπου 90.000 καθώς είναι αποτέλεσμα της ανθρώπινης έκθεσης στον αέρα, του νερού αλλά και των τροφίμων. Τέλος, στο τρίτο και τελευταίο κεφάλαιο μελετάται αναλυτικά η έννοια της υπογονιμότητας ως προϊόν αποτελέσματος οξειδωτικού stress. Αναλυτικότερα, το 15-20% των ζευγαριών αντιμετωπίζουν προβλήματα τεκνοποίησης, με βασικότερη την αδυναμία σύλληψης κυρίως μετά από δώδεκα μήνες συνεχούς σεξουαλικής επαφής απαλλαγμένη από τη χρήση αντισυλληπτικών μεθόδων ή ευρύτερα γνωστή ως υπογονιμότητα. Μάλιστα, ως προς το περιβάλλον, διαπιστώνεται από ειδικούς οι οποίοι μελέτησαν τη σχέση του οξειδωτικού stress το οποίο συμβαίνει στους όρχεις με την αναπαραγωγική ανικανότητα , ότι αποτελεί ιδιαίτερα μεγάλη ευθύνη για την αύξηση των πρωτεϊνικών μορίων , καθώς έχει αποδειχθεί πως αν κάποιο σπερματοζωάριο τοποθετηθεί σε περιβάλλον οξειδωτικού stress, μπορεί να μην είναι ικανό να ολοκληρώσει – ως οφείλει- τη γονιμοποίηση στους όρχεις. Μετά την θεωρητική ανασκόπηση που προηγήθηκε για την συγγραφή της παρούσας μέσα από τα τρία κεφάλαια, ακολουθούν τα συμπεράσματα στον επίλογο και οι ανάγκες για συνέχιση μελλοντικών ερευνών, καθώς ο τομέας της ανδρικής αλλά και γυναικείας υπογονιμότητας παραμένει ακόμη και σήμερα ένας τομέας ανεξερεύνητος σε ένα ζήτημα που αναπτύσσεται ραγδαία λαμβάνοντας διαστάσεις επιδημίας. Ακόμη, αξίζει να αναφερθεί πως η διερεύνηση παρόμοιων θεμάτων ίσως κάποτε αποτελέσουν τον θεμέλιο λίθο για την ανάπτυξη νέων, αποτελεσματικότερων μεθόδων αντισύλληψης χαρακτηριζόμενες από ασφάλεια. Τέλος, παρέχεται η βιβλιογραφία που χρησιμοποιήθηκε για την συγγραφή της παρούσης εργασίας σε συνδυασμό με τις πηγές δικτυογραφίας που τέθηκαν προς εκμετάλλευση.This paper deals with a review of the mechanisms by which oxidative stress is created in conjunction with its effect on the infertility of couples. The body of the work consists of three chapters. In the first chapter we investigate the definition of oxidative stress, together with the factors that constitute it, but also the ways of their creation and maintenance and the various ways of measuring the oxidative stress. Also, a reference is made to the study of the clinical effect of oxidative stress. Subsequently, in the second chapter, reference is made to the connection of oxidative stress with the environment, since the number of chemical compounds responsible for toxicity is constantly increasing, resulting in the damaging effects of oxidative stress, with the prevalence of difficulty in gonadal functioning of men and women. More specifically, environmental pollutants of infectious nature occurring in the reproductive phase, particularly affecting health and conception combined with fertility, amount to about 90,000 as a result of human exposure to air, water and food. Finally, the third and final chapter analyzes the concept of infertility as a result of oxidative stress. In more detail, 15-20% of couples face childbearing problems, most notably after 12 months of continuous sexual contact, free of contraceptive methods or more commonly known as infertility. Indeed, in terms of the environment, it is seen by experts who have been studying the relationship of oxidative stress that occurs in testicles with reproductive incapacity, that it is particularly responsible for the growth of the protein molecules as it has been shown that if a sperm is placed in an environment oxidative stress, may not be able to complete - as it should - fertilization in the testis. After the theoretical review that preceded this writing through the three chapters, we follow the conclusions on the outlook and the need to continue future research, as the male and female infertility sector still remains an area unexplored in an issue develops rapidly taking epidemic proportions. It is also worth mentioning that investigating such issues may once be the foundation stone for the development of new, more effective methods of contraception characterized by safety. Finally, the bibliography used for the writing of this paper is provided in conjunction with the sources of networking put into exploitation

Development of a circular oriented bioprocess for microbial oil production using diversified mixed confectionery side-streams

Diversified mixed confectionery waste streams were utilized in a two-stage bioprocess to formulate a nutrient-rich fermentation media for microbial oil production. Solid-state fermentation was conducted for the production of crude enzyme consortia to be subsequently applied in hydrolytic reactions to break down starch, disaccharides, and proteins into monosaccharides, amino acids, and peptides. Crude hydrolysates were evaluated in bioconversion processes using the red yeast Rhodosporidium toruloides DSM 4444 both in batch and fed-batch mode. Under nitrogen-limiting conditions, during fed-batch cultures, the concentration of microbial lipids reached 16.6−17 g·L−1 with the intracellular content being more than 40% (w/w) in both hydrolysates applied. R. toruloides was able to metabolize mixed carbon sources without catabolite repression. The fatty acid profile of the produced lipids was altered based on the substrate employed in the bioconversion process. Microbial lipids were rich in polyunsaturated fatty acids, with oleic acid being the major fatty acid (61.7%, w/w). This study showed that mixed food side-streams could be valorized for the production of microbial oil with high unsaturation degree, pointing towards the potential to produce tailor-made lipids for specific food applications. Likewise, the proposed process conforms unequivocally to the principles of the circular economy, as the entire quantity of confectionery by-products are implemented to generate added-value compounds that will find applications in the same original industry, thus closing the loop

Bioprocess development for biolubricant production using microbial oil derived via fermentation from confectionery industry waste

Microbial oil produced from confectionery and wheat milling side streams has been evaluated as novel feedstock for biolubricant production. Nutrient-rich fermentation media were produced by a two-step bioprocess involving crude enzyme production by solid state fermentation followed by enzymatic hydrolysis of confectionery industry waste. Among 5 yeast strains and 2 fungal strains cultivated on the crude hydrolysate, Rhodosporidium toruloides and Cryptococcus curvatus were selected for further evaluation for biolubricant production based on fermentation efficiency and fatty acid composition. The extracted microbial oils were enzymatically hydrolysed and the free fatty acids were esterified by Lipomod 34-MDP in a solvent-free system with trimethylolpropane (TMP) and neopentyl glycol (NPG). The highest conversion yields were 88% and 82.7% for NPG esters of R. toruloides and C. curvatus, respectively. This study also demonstrates that NPG esters produced from microbial oil have promising physicochemical properties for bio-based lubricant formulations that could substitute for conventional lubricants

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat