Salinity-independent dissipation of antibiotics from flooded tropical soil: a microcosm study

River deltas are frequently facing salinity intrusion, thus challenging agricultural production in these areas. One adaption strategy to increasing salinity is shrimp production, which however, heavily relies on antibiotic usage. This study was performed to evaluate the effect of increasing salinity on the dissipation rates of antibiotics in tropical flooded soil systems. For this purpose, paddy top soil from a coastal Vietnamese delta was spiked with selected frequently used antibiotics (sulfadiazine, sulfamethazine, sulfamethoxazole, trimethoprim) and incubated with flood water of different salt concentrations (0, 10, 20 g L−1). Antibiotic concentrations were monitored in water and soil phases over a period of 112 days using liquid chromatography and tandem mass spectrometry. We found that sulfamethazine was the most persistent antibiotic in the flooded soil system (DT50 = 77 days), followed by sulfadiazine (DT50 = 53 days), trimethoprim (DT50 = 3 days) and sulfamethoxazole (DT50 = 1 days). With the exception of sulfamethoxazole, the apparent distribution coefficient increased significantly (p < 0.05) for all antibiotics in course of the incubation, which indicates an accumulation of antibiotics in soil. On a whole system basis, including soil and water into the assessment, there was no overall salinity effect on the dissipation rates of antibiotics, suggesting that common e-fate models remain valid under varying salinity

The association between prealbumin, all‐cause mortality and response to nutritional treatment in patients at nutritional risk. Secondary analysis of a randomized‐controlled trial

IntroductionDue to the shorter half-life as compared with albumin, serum prealbumin concentrations have been proposed to be useful nutritional biomarkers for the assessment of patients at nutritional risk. In a post-hoc analysis of patients at nutritional risk from a randomized-controlled nutritional trial, we therefore tested the hypothesis that (a) prealbumin is associated with higher all-cause 180-day mortality rates and that (b) individualized nutritional support compared to usual care nutrition more effectively improves survival at 30 days in patients with low prealbumin levels compared to patients with normal prealbumin levels.MethodsWe performed a pre-specified cohort study in patients included in the pragmatic, Swiss, multicenter, randomized-controlled EFFORT trial comparing the effects of individualized nutritional support with usual care. We studied low prealbumin concentrations (<0.17 g/l) in a subgroup of 517 patients from one participating centre.ResultsA total of 306 (59.2%) patients (mean age 71.9 years, 53.6% men) had low admission prealbumin levels (<0.17 g/L). There was a significant association between low prealbumin levels and mortality at 180-days [115/306 (37.6%) vs. 47/211 (22.3%), fully adjusted hazard ratio (HR) 1.59, 95%CI 1.11 to 2.28, p=0.011]. Prealbumin levels significantly improved the prognostic value of the Nutritional Risk Screening total score regarding mortality prediction at short- and long-term. The difference in mortality between patients receiving individualized nutritional support and usual care nutrition was similar for patients with low prealbumin levels compared with patients with normal prealbumin levels [HR 0.90 (95%CI 0.51 to 1.59) vs. HR 0.88 (95%CI 0.35 to 2.23)] with no evidence for interaction (p=0.823).ConclusionAmong medical inpatients at nutritional risk, low admission prealbumin levels correlated with different nutritional markers and higher mortality risk; but patients with low or high prealbumin levels had a similar benefit from nutritional support. Further studies should identify nutritional markers that help further personalize nutritional interventions.Trial RegistrationClinicalTrials.gov Identifier: NCT0251747

Land use change from permanent rice to alternating rice-shrimp or permanent shrimp in the coastal Mekong Delta, Vietnam: Changes in the nutrient status and binding forms

Saline water intrusion has become a severe threat in the coastal areas of Mekong delta of Vietnam, though offering farmers the option to diversify their land use, and switching, for instance, from permanent rice to alternating rice-shrimp systems or even to permanent shrimp systems. The objective of this study was to evaluate the respective impacts on soil salinity, nutrient status and their binding forms. Hence, we sampled the topsoils (cultivation layer, 0–15 cm) from 10 permanent rice systems and the rice platforms of 10 alternating riceshrimp systems. Furthermore, the sludges and the soils 10 cm underneath of the sludges from the ditches of the alternating rice-shrimp as well as from ponds of the permanent shrimp systems were sampled in Bến Tre and Sóc Trăng provinces, Vietnam, respectively. The samples were analyzed regarding their electric conductivity, total and plant-available nutrient contents. To reveal possible changes in nutrient binding forms, sequential P and S extraction, 31P-nuclear magnetic resonance spectroscopy, and S and P X-ray absorption near edge structure spectroscopy were applied. The results showed that permanent and alternating shrimp cultivation lead to elevated salt concentrations but also improved the overall nutrient status relative to the permanent rice management and especially in the sludges relative to the soils underneath. The continued deposition of shrimp and feed debris promoted the accrual of stable, Ca- and Mg-associated P forms as well as of P-monoesters, whereas the S forms were depleted in thiophene S groups but enriched in sulfides relative to permanent rice fields. As effects by alternating rice-shrimp management were intermediate, this management has more potential to serve as a no-regret strategy for farmers to remain flexible in their response to climate changes and concurrent salinity intrusion relative to permanent shrimp production, which requires strict maintenance of adequate salinity levels also during the rainy season

The association between prealbumin, all-cause mortality and response to nutritional treatment in patients at nutritional risk. Secondary analysis of a randomized-controlled trial.

INTRODUCTION Due to the shorter half-life as compared with albumin, serum prealbumin concentrations have been proposed to be useful nutritional biomarkers for the assessment of patients at nutritional risk. In a post-hoc analysis of patients at nutritional risk from a randomized-controlled nutritional trial, we therefore tested the hypothesis that (a) prealbumin is associated with higher all-cause 180-day mortality rates and that (b) individualized nutritional support compared to usual care nutrition more effectively improves survival at 30 days in patients with low prealbumin levels compared to patients with normal prealbumin levels. METHODS We performed a pre-specified cohort study in patients included in the pragmatic, Swiss, multicenter, randomized-controlled EFFORT trial comparing the effects of individualized nutritional support with usual care. We studied low prealbumin concentrations (<0.17 g/l) in a subgroup of 517 patients from one participating centre. RESULTS A total of 306 (59.2%) patients (mean age 71.9 years, 53.6% men) had low admission prealbumin levels (<0.17 g/L). There was a significant association between low prealbumin levels and mortality at 180-days [115/306 (37.6%) vs. 47/211 (22.3%), fully adjusted hazard ratio (HR) 1.59, 95%CI 1.11 to 2.28, p=0.011]. Prealbumin levels significantly improved the prognostic value of the Nutritional Risk Screening total score regarding mortality prediction at short- and long-term. The difference in mortality between patients receiving individualized nutritional support and usual care nutrition was similar for patients with low prealbumin levels compared with patients with normal prealbumin levels [HR 0.90 (95%CI 0.51 to 1.59) vs. HR 0.88 (95%CI 0.35 to 2.23)] with no evidence for interaction (p=0.823). CONCLUSION Among medical inpatients at nutritional risk, low admission prealbumin levels correlated with different nutritional markers and higher mortality risk; but patients with low or high prealbumin levels had a similar benefit from nutritional support. Further studies should identify nutritional markers that help further personalize nutritional interventions. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02517476 This article is protected by copyright. All rights reserved

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to &lt; 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of &amp; GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P &lt; 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo