Dietary-based gut flora modulation against Clostridium difficile onset

Clostridium difficile infection is a frequent complication of antibiotic therapy in hospitalised patients, which today is attracting more attention than ever and has led to its classification as a 'superbug'. Disruption of the composition of the intestinal microflora following antibiotic treatment is an important prerequisite for overgrowth of C. difficile and the subsequent development of an infection. Treatment options for antibiotic-associated diarrhoea and C. difficile-induced colitis include administration of specific antibiotics (e.g. vancomycin), which often leads to high relapse rates. More importantly, both the rate and severity of C. difficile-associated diseases are increasing, with new epidemic strains of C. difficile often implicated. For the prevention and treatment of antibiotic-associated diarrhoea and C. difficile infection, several probiotic bacteria such as selected strains of lactobacilli (especially Lactobacillus rhamnosus GG), Bifidobacterium longum, and Enterococcus faecium and the non-pathogenic yeast Saccharomyces boulardii have been used. Controlled trials indicate a benefit of S. boulardii and L. rhamnosus GG as therapeutic agents when used as adjuncts to antibiotics. However, the need for more well designed controlled trials with probiotics is explicit

Changes in the intestinal microbiota after a short period of dietary over-indulgence, representative of a holiday or festival season

The effects on the intestinal microbiota of a short period of marginal over-eating, characteristic of holiday or festival periods, were investigated in a pilot study. Fourteen healthy male subjects consumed a diet rich in animal protein and fat for seven days. During this period, the subjects significantly increased their dietary energy, protein, carbohydrate and fat intakes by 56, 59, 53 and 58%, respectively (all P < 0.05). The mean weight gain of 0.27 kg was less than the expected 1 kg, but this was consistent with a degree of under-reporting on the baseline diet. Fluorescence in situ hybridisation analysis confirmed the relative stability of each individual’s faecal microbiota but showed considerable variations between them. The diet was associated with a significant increase in numbers of total faecal bacteria and the bacteroides group, as detected by the universal bacterial probe (DAPI) and Bacteroides probe (Bac 303), respectively. Overall, there was a decrease in numbers of the Lactobacillus/Enterococcus group (Lab 158 probe; 2.8 ± 3.0% to 1.8 ± 1.8%) and the Bifidobacterium group (Bif 164 probe; 3.0 ± 3.7% to 1.7 ± 1.2%), although there was considerable inter-individual variation. Analysis of the relative proportions of each bacterial group as a percentage of the subject’s total bacteria showed a trend for a change in the intestinal microbiota that might be considered potentially unhealthy

Novel models for chronic intestinal inflammation in chickens : intestinal inflammation pattern and biomarkers

For poultry producers, chronic low-grade intestinal inflammation has a negative impact on productivity by impairing nutrient absorption and allocation of nutrients for growth. Understanding the triggers of chronic intestinal inflammation and developing a non-invasive measurement is crucial to managing gut health in poultry. In this study, we developed two novel models of low-grade chronic intestinal inflammation in broiler chickens: a chemical model using dextran sodium sulfate (DSS) and a dietary model using a high non-starch polysaccharide diet (NSP). Further, we evaluated the potential of several proteins as biomarkers of gut inflammation. For these experiments, the chemical induction of inflammation consisted of two 5-day cycles of oral gavage of either 0.25mg DSS/ml or 0.35mg DSS/ml; whereas the NSP diet (30% rice bran) was fed throughout the experiment. At four times (14, 22, 28 and 36-d post-hatch), necropsies were performed to collect intestinal samples for histology, and feces and serum for biomarkers quantification. Neither DSS nor NSP treatments affected feed intake or livability. NSP-fed birds exhibited intestinal inflammation through 14-d, which stabilized by 36-d. On the other hand, the cyclic DSS-treatment produced inflammation throughout the entire experimental period. Histological examination of the intestine revealed that the inflammation induced by both models exhibited similar spatial and temporal patterns with the duodenum and jejunum affected early (at 14-d) whereas the ileum was compromised by 28-d. Calprotectin (CALP) was the only serum protein found to be increased due to inflammation. However, fecal CALP and Lipocalin-2 (LCN-2) concentrations were significantly greater in the induced inflammation groups at 28-d. This experiment demonstrated for the first time, two in vivo models of chronic gut inflammation in chickens, a DSS and a nutritional NSP protocols. Based on these models we observed that intestinal inflammation begins in the upper segments of small intestine and moved to the lower region over time. In the searching for a fecal biomarker for intestinal inflammation, LCN-2 showed promising results. More importantly, calprotectin has a great potential as a novel biomarker for poultry measured both in serum and feces.</jats:p

Evaluation of Vomitoxin Control Strategies on Nursery Pig Growth Performance and Blood Measures

A total of 4,318 pigs (337 × 1050, PIC; initially 14.3 ± 0.18 lb) were used in a 35-d growth trial to evaluate mycotoxin control strategies on nursery pig performance and blood measures. Pigs were weaned at approximately 21 d of age and randomly allotted to 1 of 5 dietary treatments. The randomized complete block design was blocking structure including sow farm origin, date of entry into the facility, and average pen BW. A total of 160 pens were used with 80 double-sided 5-hole stainless steel fence line feeders, with feeder serving as the experimental unit. For each feeder, 1 pen contained 27 gilts and 1 pen contained 27 barrows. There were 16 replications per dietary treatment. A common phase 1 diet was fed in pelleted form to all pigs for 7 d prior to treatment diets. Experimental treatments were fed in a single phase and included a 1) low deoxynivalenol (DON) diet; 2) high DON diet; 3) high DON + sodium metabisulfite (SMB); 4) high DON + Technology1; or 5) high DON + Technology1+. Overall (d 0 to 35), pigs fed the high DON diet had reduced (P \u3c 0.001) ADG, ADFI, and final BW compared to the pigs fed the low DON diet. Furthermore, pigs fed the high DON+SMB diet had greater (P \u3c 0.05) ADG, ADFI, and final BW compared to the pigs fed the high DON, high DON+Technology1, or high DON+Technology1+ diets. An improvement (P \u3c 0.05) in feed efficiency was observed in pigs fed high DON+SMB or high DON+Technology1+ diets compared to the low DON or high DON+Technology1 diets with high DON diets intermediate. Pigs fed high DON+SMB or high DON+Technology1 diets had reduced (P \u3c 0.05) total removals and mortality compared to pigs fed low DON diets with high DON and high DON+Technology1+ intermediate. For economic analysis (d 0 to 35), pigs fed high DON+SMB diets had the greatest (P \u3c 0.05) feed cost, revenue, and IOFC compared to all other treatments. The LC-MS/MS analysis of dried blood spots at the end of the trial revealed that pigs fed high DON or high DON+Technology1 had increased (P \u3c 0.05) DON concentrations in the blood compared to low DON, with high DON+SMB and high DON+Technology1+ intermediate. Interestingly, while not statistically significant in this study, the reductions in presence and concentration of other important mycotoxins like fumonisin B1, B2, beta-zearalenol, and the emerging beauvericin—as well as the trends in circulating neutrophil-to-lymphocyte ratio and GGT in blood—when pigs were fed high DON+Technology1+ suggest that other important metabolic processes may be influenced. In summary, pigs fed high DON diets had reduced performance compared to pigs fed low DON diets. In our trial, SMB supplementation to high DON diets led to the greatest improvement in growth performance, but other metabolic changes associated with Technology1+ warrant further investigation

The sinus tarsi approach in displaced intra-articular calcaneal fractures: a systematic review

Purpose: Although open reduction and internal fixation is currently considered the gold standard in surgical treatment of displaced intra-articular calcaneal fractures, various different approaches exist including the limited lateral approach. The aim of this systematic review was to combine the results of studies using the sinus tarsi approach, which is the most frequently applied limited lateral approach. Method: A literature search in the electronic databases of the Cochrane Library and Pubmed Medline, between January 1st 2000 to December 1st 2010, was conducted to identify studies in which the sinus tarsi approach or a modified sinus tarsi approach was utilized for the treatment of displaced intra-articular calcaneal fractures. The methodological quality of the included studies was assessed using the Coleman methodology score. Results: A total of eight case series reporting on 256 patients with 271 calcaneal fractures was identified. Overall good to excellent outcome was reached in three-quarters of all patients. An average complication rate of minor wound complications of 4.1% was reported and major wound complications in 0.7%. The need for a secondary subtalar arthrodesis occurred at an average rate of 4.3%. The average Coleman methodology score was 56.8 (range 39-72) points. Conclusion: The results, i.e. functional outcome and complication rates, of the sinus tarsi approach compare similarly or favourably to the extended lateral approach. Therefore, in the process of tailoring the best treatment modality to the right patient and the right fracture type, the sinus tarsi approach might be a valuable asset

Determinants of outcome in operatively and non-operatively treated Weber-B ankle fractures

Introduction: Treatment of ankle fractures is often based on fracture type and surgeon's individual judgment. Literature concerning the treatment options and outcome are dated and frequently contradicting. The aim of this study was to determine the clinical and functional outcome after AO-Weber B-type ankle fractures in operatively and conservatively treated patients and to determine which factors influenced outcome. Patients and methods: A retrospective cohort study in patients with a AO-Weber B-type ankle fracture. Patient, fracture and treatment characteristics were recorded. Clinical and functional outcome was measured using the Olerud-Molander Ankle Score (OMAS), the American Orthopaedic Foot and Ankle Society ankle-hindfoot score (AOFAS) and a Visual Analog Score (VAS) for overall satisfaction (range 0-10). Results: Eighty-two patients were treated conservatively and 103 underwent operative treatment. The majority was female. Most conservatively treated fractures were AO-Weber B1.1 type fractures. Fractures with fibular displacement (mainly AO type B1.2 and Lauge-Hansen type SER-4) were predominantly treated operatively. The outcome scores in the non-operative group were OMAS 93, AOFAS 98, and VAS 8. Outcome in this group was independently negatively affected by age, affected side, BMI, fibular displacement, and duration of plaster immobilization. In the surgically treated group, the OMAS, AOFAS, and VAS scores were 90, 97, and 8, respectively, with outcome negatively influenced by duration of plaster immobilization. Conclusion: Treatment selection based upon stability and surgeon's judgment led to overall good clinical outcome in both treatment groups. Reducing the cast immobilization period may further improve outcome

Reliability, validity and psychometric properties of the Greek translation of the Major Depression Inventory

BACKGROUND: The Major Depression Inventory (MDI) is a brief self-rating scale for the assessment of depression. It is reported to be valid because it is based on the universe of symptoms of DSM-IV and ICD-10 depression. The aim of the current preliminary study was to assess the reliability, validity and psychometric properties of the Greek translation of the MDI. METHODS: 30 depressed patients of mean age 23.41 (± 5.77) years, and 68 controls patients of mean age 25.08 (± 11.42) years, entered the study. In 18 of them, the instrument was re-applied 1–2 days later and the Translation and Back Translation made. Clinical diagnosis was reached with the use of the SCAN v.2.0 and the International Personality Disorders Examination (IPDE). The Center for Epidemiological Studies-Depression (CES-D) and the Zung Depression Rating Scale (ZDRS) were applied for cross-validation purposes. Statistical analysis included ANOVA, the Spearman Product Moment Correlation Coefficient, Principal Components Analysis and the calculation of Cronbach's α. RESULTS: Sensitivity and specificity were 0.86 and 0.94, respectively, at 26/27. Cronbach's α for the total scale was equal to 0.89. The Spearman's rho between MDI and CES-D was 0.86 and between MDI and ZDRS was 0.76. The factor analysis revealed two factors but the first accounted for 54% of variance while the second only for 9%. The test-retest reliability was excellent (Spearman's rho between 0.53 and 0.96 for individual items and 0.89 for total score). CONCLUSION: The current study provided preliminary evidence concerning the reliability and validity of the Greek translation of the MDI. Its properties are similar to those reported in the international literature, but further research is necessary

Probiotic modulation of dendritic cell function is influenced by ageing

Dendritic cells (DCs) are critical for the generation of T-cell responses. DC function may be modulated by probiotics, which confer health benefits in immunocompromised individuals, such as the elderly. This study investigated the effects of four probiotics, Bifidobacterium longum bv. infantis CCUG 52486, B. longum SP 07/3, L. rhamnosus GG (L.GG) and L. casei Shirota (LcS) on DC function in an allogeneic mixed leucocyte reaction (MLR) model, using DCs and T-cells from young and older donors in different combinations. All four probiotics enhanced expression of CD40, CD80 and CCR7 on both young and older DCs, but enhanced cytokine production (TGF-β, TNF-α) by old DCs only. LcS induced IL-12 and IFNγ production by DC to a greater degree than other strains, while Bifidobacterium longum bv. infantis CCUG 52486 favoured IL-10 production. Stimulation of young T cells in an allogeneic MLR with DC was enhanced by probiotic pretreatment of old DCs, which demonstrated greater activation (CD25) than untreated controls. However, pretreatment of young or old DCs with LPS or probiotics failed to enhance the proliferation of T-cells derived from older donors. In conclusion, this study demonstrates that ageing increases the responsiveness of DCs to probiotics, but this is not sufficient to overcome the impact of immunosenescence in the MLR