Assessing whether early attention of very preterm infants can be improved by an omega-3 long-chain polyunsaturated fatty acid intervention: a follow-up of a randomised controlled tria

Introduction Docosahexaenoic acid (DHA) accumulates in the frontal lobes (responsible for higher-order cognitive skills) of the fetal brain during the last trimester of pregnancy. Infants born preterm miss some of this in utero provision of DHA, and have an increased risk of suboptimal neurodevelopment. It is thought that supplementing infants born preterm with DHA may improve developmental outcomes. The aim of this follow-up is to determine whether DHA supplementation in infants born preterm can improve areas of the brain associated with frontal lobe function, namely attention and distractibility. Methods and analysis We will assess a subset of children from the N-3 (omega-3) Fatty Acids for Improvement in Respiratory Outcomes (N3RO) multicentre double-blind randomised controlled trial of DHA supplementation. Infants born <29 weeks’ completed gestation were randomised to receive an enteral emulsion containing 60 mg/kg/day of DHA or a control emulsion from within the first 3 days of enteral feeding until 36 weeks’ postmenstrual age. Children will undergo multiple measures of attention at 18 months’ corrected age. The primary outcome is the average time to be distracted when attention is focused on a toy. Secondary outcomes are other aspects of attention, and (where possible) an assessment of cognition, language and motor development with the Bayley Scales of Infant and Toddler Development, Third Edition. A minimum of 72 children will be assessed to ensure 85% power to detect an effect on the primary outcome. Families, and research personnel are blinded to group assignment. All analyses will be conducted according to the intentionto-treat principal. Ethics and dissemination All procedures were approved by the relevant institutional ethics committees prior to commencement of the study. Results will be disseminated in peer-reviewed journal publications and academic presentations. Trial registration number ACTRN12612000503820; Preresults

In vitro inhibitory activities of selected Australian medicinal plant extracts against protein glycation, angiotensin converting enzyme (ACE) and digestive enzymes linked to type II diabetes

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background There is a need to develop potential new therapies for the management of diabetes and hypertension. Australian medicinal plants collected from the Kuuku I’yu (Northern Kaanju) homelands, Cape York Peninsula, Queensland, Australia were investigated to determine their therapeutic potential. Extracts were tested for inhibition of protein glycation and key enzymes relevant to the management of hyperglycaemia and hypertension. The inhibitory activities were further correlated with the antioxidant activities. Methods Extracts of five selected plant species were investigated: Petalostigma pubescens, Petalostigma banksii, Memecylon pauciflorum, Millettia pinnata and Grewia mesomischa. Enzyme inhibitory activity of the plant extracts was assessed against α-amylase, α-glucosidase and angiotensin converting enzyme (ACE). Antiglycation activity was determined using glucose-induced protein glycation models and formation of protein-bound fluorescent advanced glycation endproducts (AGEs). Antioxidant activity was determined by measuring the scavenging effect of plant extracts against 1, 1-diphenyl-2-picryl hydrazyl (DPPH) and using the ferric reducing anti-oxidant potential assay (FRAP). Total phenolic and flavonoid contents were also determined. Results Extracts of the leaves of Petalostigma banksii and P. pubescens showed the strongest inhibition of α-amylase with IC50 values of 166.50 ± 5.50 μg/mL and 160.20 ± 27.92 μg/mL, respectively. The P. pubescens leaf extract was also the strongest inhibitor of α-glucosidase with an IC50 of 167.83 ± 23.82 μg/mL. Testing for the antiglycation potential of the extracts, measured as inhibition of formation of protein-bound fluorescent AGEs, showed that P. banksii root and fruit extracts had IC50 values of 34.49 ± 4.31 μg/mL and 47.72 ± 1.65 μg/mL, respectively, which were significantly lower (p < 0.05) than other extracts. The inhibitory effect on α-amylase, α-glucosidase and the antiglycation potential of the extracts did not correlate with the total phenolic, total flavonoid, FRAP or DPPH. For ACE inhibition, IC50 values ranged between 266.27 ± 6.91 to 695.17 ± 15.38 μg/mL. Conclusions The tested Australian medicinal plant extracts inhibit glucose-induced fluorescent AGEs, α-amylase, α-glucosidase and ACE with extracts of Petalostigma species showing the most promising activity. These medicinal plants could potentially be further developed as therapeutic agents in the treatment of hyperglycaemia and hypertension

The short and long-term effects of DHA in preterm infants: free fatty acids, lipid mediators and neurodevelopmental outcomes

Infants born preterm (< 37 weeks’ completed gestation) are at an increased risk of short and long-term health complications. This may be in part because they miss out on the in utero accretion of nutrients, including lipids. Lipids, in particular the omega-3 and omega-6 long chain polyunsaturated fatty acids (LCPUFA) are thought to play an important role in neurodevelopment and immune function. These LCPUFA exhibit their biological action when released from the cell membrane into the free fatty acid (FFA) pool, where they are oxidised to downstream lipid mediators, collectively known as oxylipins. Measuring these compounds may therefore give us an insight to the functional lipid status in these infants. Although there are a number of existing methods for measuring FFA and oxylipins in human blood samples, these all have some limitations, most notably the need for relatively large sample volumes and laborious, multi-step extraction processes or potential loss of compounds due to oxidation/degradation. Therefore, a new method is required to measure these compounds. Very few studies have assessed the endogenous concentration of FFA and oxylipins in infants born preterm at birth. It is important to measure the level of FFA and oxylipins in infants born preterm to determine the status at birth, whether levels change after birth or following nutrient supplementation, and to understand whether the endogenous level of these compounds are related to adverse clinical outcomes in this infant population. Infants born preterm miss out on the peak period of in utero docosahexaenoic acid (DHA), an omega-3 LCPUFA, accretion into the brain at a time of rapid brain development, during the last trimester of pregnancy. This may contribute to the higher incidence of neurodevelopmental deficits observed in this population. It is unclear whether supplementing infants born preterm with DHA in the early postnatal period may promote brain development and improve neurodevelopmental outcomes in early childhood. The aims of this PhD project were 1) To develop and validate a method for measuring FFA and oxylipins from dried blood spot (DBS), 2) To estimate the volume of blood in a small disc (3 mm or 6 mm) obtained from a DBS, 3) To measure the levels of FFA and oxylipins in infants born preterm and assess the effect of DHA supplementation on these levels and 4) To determine whether DHA supplementation in infants born preterm during early postnatal period improves attention at 18 months’ corrected age. A method for quantitation of 6 individual omega-3 and omega-6 FFA and 21 oxylipins from DBS were developed and validated by liquid chromatography tandem mass spectrometry (LC–MS/MS) using stable isotope dilution analysis. The volume of blood in 3 mm and 6 mm discs obtained from DBS was estimated using four different methods. Concentrations of FFA and oxylipins were measured in ~ 70 infants born preterm (< 29 weeks’ gestation) who received either a high-dose of DHA (60 mg/kg/day) or no DHA (soy oil) from within a few days of birth until 36 week’s postmenstrual age (PMA). DHA supplementation in infants born preterm resulted in an increased concentration of free DHA and the DHA oxylipin, 4-hydroxydocosahexaenoic acid (4-HDHA) in the DHA group compared to the control group at 36 weeks’ PMA. Attention was assessed at 18 months’ corrected age in the same population of preterm infants using a specialised attention assessment. There was no evidence of a difference in any measures of attention between the DHA and control groups. In conclusion, we successfully developed methods for assessment of FFA and oxylipins in DBS using LC-MS/MS technology. DHA supplementation in infants born preterm resulted in changes in the FFA and oxylipin profile. However, there was no effect of supplemental DHA on attention outcomes in these children at 18 months’ corrected age. These results need confirmation in larger studies.Thesis (Ph.D.) -- University of Adelaide, School of Agriculture, Food and Wine, 201

Assessing whether meditation improves quality of life for adolescent girls with polycystic ovary syndrome : Protocol for a randomized controlled trial

Background: Polycystic Ovary Syndrome (PCOS) is a common endocrine condition characterized by irregular periods and hyperandrogenism. Adolescents with PCOS have impaired quality of life (QOL) and increased psychological distress. Transcendental Meditation (TM) is a well-established self-management strategy that has been used to improve stress and well-being. A meta-analysis of TM trials has shown beneficial effects on stress and blood pressure in adults. Recent data are suggesting that another self-management strategy called a mindfulness stress management program has a role in improving QOL in women with PCOS, but there are no studies in adolescents. Objective: This study aims to evaluate the effect of TM on QOL and psychological distress in adolescent girls with PCOS. Methods: This study is a randomized controlled trial that will be conducted over eight weeks at the Women’s and Children’s Hospital in Adelaide, South Australia, to determine the effect of TM on QOL and psychological distress in adolescent girls (aged 12-20 years) with PCOS. A total of 40 girls will be randomized into either the TM (n=20) or control group (n=20). The TM group will be asked to practice TM in a comfortable sitting position with the eyes closed, for 15 minutes twice daily over eight weeks. The control group will be asked to sit quietly for 15 minutes twice daily for eight weeks. The primary outcomes are any effects on improving QOL and psychological distress, and the secondary outcomes are any effects on lowering blood pressure and salivary cortisol levels. Results: The recruitment of study participants began in May 2019 and is expected to be completed by June 2020. It is expected that the adolescent girls with PCOS practicing TM over eight weeks will have a significant improvement in QOL and psychological distress compared to adolescents in the control group. Also, it is expected that adolescent girls in the TM group will have lower salivary cortisol levels and lower blood pressure. Conclusions: This study will be the first to evaluate the effect of TM on QOL in adolescent girls with PCOS. The study will provide valuable information on a potential self-management strategy to improve QOL and well-being in adolescent girls with PCOS. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN1261900019010; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376657&amp;amp;isReview=true International Registered Report Identifier (IRRID): PRR1-10.2196/1454

Patient and partner perspectives of pregnancy-related counseling and information needs in women with kidney disease : an Australian national survey

Introduction: The experiences and information needs for reproductive health counseling in women with chronic kidney disease (CKD) are poorly defined, despite the known importance of pregnancy planning in this higher-risk cohort. Methods: Australian adult women with CKD and their partners or family members completed a consumer codesigned survey about experiences of and preferences for pregnancy-related counseling, support, and education. Data were analyzed descriptively and with qualitative content analysis of free-text responses. Results: Responses were received from 102 women (CKD, n = 60; dialysis, n = 11; transplant, n = 26; unsure, n = 5 ) and 17 partners/family members. Pregnancy-related discussions were initiated mostly by women themselves (60.0%) compared to nephrologists (26.7%), and only after conception in 14.7%. Women found pregnancy-related discussions satisfactory (68.0%) and useful (50.7%) but also stressful (66.7%), with only 54.7% feeling in control of decision-making. Information deficits and quality, preformed decisions, clinician-patient disconnect, and burden of decision-making contributed to usefulness and outcomes of pregnancy-related counseling. Women received insufficient information about contraception (not provided in 35.2% of cases), medication safety (40.9%), fetal complications (33.8%) and emotional and psychological impact of pregnancy (73.2%). Women preferred counseling from nephrologists (86.4%), face-to-face settings (79.6%), websites (72.7%), handouts (61.4%), and online support groups (46.6%). High-quality, multiformat information by content experts, peer support, and psychological support were also strongly desired. Conclusion: This study highlights that preconception counseling and information needs of women with CKD are currently not being met. Frameworks and tools to assist patients and clinicians, particularly nephrologists, to initiate and conduct sensitive, useful, and informed shared decision-making (SDM) about pregnancy are urgently needed. © 202

Additional file 1: of In vitro inhibitory activities of selected Australian medicinal plant extracts against protein glycation, angiotensin converting enzyme (ACE) and digestive enzymes linked to type II diabetes

Excel spreadsheet. Sheet 1. Sample codes. Sheet 2. IC50 calculations for anti-glycation, α-amylase, α-glucosidase and ACE inhibition. Sheet 3. Data for total phenolics, flavonoid content, FRAP and DPPH. (XLSX 19 kb

Comparison of catheters or new arteriovenous fistulas for commencement of haemodialysis in pregnant women with chronic kidney disease: an international observational study.

BACKGROUND Evidence surrounding vascular access options for commencing dialysis in pregnancy complicated by chronic kidney disease (CKD) is limited. Creation of new arteriovenous fistulas (AVFs) in pregnant women is rare. METHODS Retrospective cohort study of approaches to vascular access in pregnancy in centres in Australia, the United Kingdom (UK) and Canada (2002-2018). RESULTS Twenty-three women with advanced CKD commenced dialysis in pregnancy (n = 20) or planned to commence (n = 3). Access at dialysis start was a tunnelled catheter (n = 13), temporary catheter (n = 1), AVF created pre-conception but used in pregnancy (n = 3) and AVF created during pregnancy (n = 3). No women commencing dialysis with an AVF required a catheter. No differences in perinatal outcomes were observed comparing AVFs and catheters at dialysis commencement. No AVFs were created in pregnancy in Canadian women. From Australia and the UK, 10 women had a new AVF created in pregnancy, at median gestation 14.5 weeks (IQR 12.5, 20.75). Four women still needed a catheter for dialysis initiation and 3 eventually used the new AVF. Six AVFs were successfully used in pregnancy at median gestation 24 weeks (IQR 22.5, 28.5), 2 were successfully created but not used and 2 had primary failure. No catheter-associated complications were identified except one episode of catheter-related sepsis. CONCLUSIONS Catheter-related complications were minimal. In selected women, with sufficient pre-planning, an AVF can be created and successfully used during pregnancy to minimise catheter use if preferred. Pre-conception counselling in advanced CKD should include discussing vascular access options reflecting local expertise and patient preferences

Impact of COVID-19 pandemic on research and careers of early career researchers: A DOHaD perspective

The COVID-19 pandemic has exposed several inequalities worldwide, including the populations´ access to healthcare systems and economic differences that impact the access to vaccination, medical resources, and health care services. Scientific research activities were not an exception, such that scientific research was profoundly impacted globally. Research trainees and early career researchers (ECRs) are the life force of scientific discovery around the world, and their work and progress in research was dramatically affected by the COVID-19 pandemic. ECRs are a particularly vulnerable group as they are in a formative stage of their scientific careers, any disruptions during which is going to likely impact their lifelong career trajectory. To understand how COVID-19 impacted lives, career development plans, and research of Developmental Origins of Health and Disease (DOHaD) ECRs, the International DOHaD ECR committee formed a special interest group comprising of ECR representatives of International DOHaD affiliated Societies/Chapters from around the world (Australia and New Zealand, Canada, French Speaking DOHaD, Japan, Latin America, Pakistan and USA). The anecdotal evidence summarized in this brief report, provide an overview of the findings of this special interest group, specifically on the impact of the evolving COVID-19 pandemic on daily research activities and its effects on career development plans of ECRs. We also discuss how our learnings from these shared experiences can strengthen collaborative work for the current and future generation of scientists.Fil: Bansal, Amita. Australian National University; AustraliaFil: Abruzzese, Giselle Adriana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Centro de Estudios Farmacológicos y Botánicos. Universidad de Buenos Aires. Facultad de Medicina. Centro de Estudios Farmacológicos y Botánicos; ArgentinaFil: Hewawasam, Erandi. South Australian Health & Medical Research Institute; Australia. University of Adelaide; AustraliaFil: Hasebe, Kyoko. University of New South Wales; AustraliaFil: Hamada, Hirotaka. Tohoku University Graduate School of Medicine; JapónFil: Hoodbhoy, Zahra. Aga Khan University; PakistánFil: Diounou, Hanna. Université de Paris; Francia. Inserm; Francia. Centre National de la Recherche Scientifique; FranciaFil: Ibáñez, Carlos A.. Instituto Nacional de Ciencias Médicas y Nutrici´on Salvador Zubirán; MéxicoFil: Miranda, Rosiane A.. Universidade Federal Do Rio de Janeiro. Instituto de Biología; BrasilFil: Golden, Thea N.. University of Pennsylvania; Estados UnidosFil: Miliku, Kozeta. Mc Master University; CanadáFil: Isasi, Carmen R.. Albert Einstein College of Medicine; Estados Unido