Probiotics as a novel approach to modulate incretins, insulin secretion and risk factors of type 2 diabetes and complications

Background and Aim: Ingestion of probiotics can modify gut microbiota and alter insulin resistance and diabetes development in rodents. We hypothesized that daily intake of Lactobacillus (L.) reuteri increases insulin sensitivity by changing cytokine release and insulin secretion via modulation of glucagon-like peptide (GLP-1, GLP-2) release.Material and Methods: A prospective, double-blind, randomized trial was performed in 21 glucose tolerant humans (10 obese; age 51±2 years, BMI 36.0±4.8 kg/m2; 11 lean; 49±4 years, BMI 23.6±1.9 kg/m2). Participants ingested 1010 L. reuteri or placebo b.i.d. over 4 weeks. Oral glucose tolerance and isoglycemic glucose infusion tests were used to assess GLP-1, GLP-2 and C-peptide secretion, hyperinsulinemic-euglycemic clamps with [6,6-2H2]glucose to measure peripheral insulin sensitivity (M-value) and endogenous glucose production (EGP). Muscle and hepatic lipid contents were measured by 1H magnetic resonance spectroscopy. Immune status was assessed by measuring systemic cytokines, high-sensitive C-reactive protein (hsCRP) and lipopolysaccharide (LPS) concentrations. Results: Intervention did not affect body mass, ectopic fat content and circulating cytokines. M was 37% lower (pL. reuteri treatment. However, administration of L. reuteri increased glucose-stimulated insulin and C-peptide secretion by 49% (pConclusions: Enrichment of gut microbiota with L. reuteri increased incretin-mediated insulin and C-peptide release, without effects on insulin sensitivity in glucose tolerant human subjects. These results suggest that modifying the microbiome could increase insulin secretion and thereby serve as a novel therapeutic tool for the treatment of type 2 diabetes. However, further studies are needed to address this issue in this emerging research field

Un MOOC et ses partenaires - Remettre l'humain dans le massif

International audienceCes derniers mois, les MOOC ont attiré l'attention des professionnels de l'enseignement et la formation. Alors que la croissance des MOOC est phénoménale, des nombreuses critiques surgissent à propos des modèles économiques, l'ingénierie pédagogique insuffisante ou les taux d'abandon élevés. Du 10 octobre au 12 décembre 2013, la deuxième saison d'ITyPA a réuni quelques 2.600 participants. En collaboration avec une quarantaine de partenaires français et internationaux, des rencontres physiques et virtuelles étaient proposées afin de permettre aux inscrits de mieux appréhender les différents aspects du cours, de rythmer leur participation et de maintenir leur niveau de motivation. Du simple meet-up au programme de formation parallèle, les partenaires ont permis une plus grande personnalisation de l'expérience de l'apprenant dans le MOOC, un renforcement de l'ingénierie pédagogique et l'émergence de nouveaux modèles économiques

Efficiency of arsenic oxidizing bacterial biofilms for arsenic contaminated drinking water treatment

In drinking water supplies, arsenic exists mostly as two inorganic forms, arsenite [As(III)] and arsenate [As(V)] which are toxic to living organisms . According to WHO recommendations, the drinking water standard was reduced from 50 to 10 µg/L and many regulatory agencies have recently accepted this new standard. Most of the existing treatment processes are effective only on arsenic anionic forms [As(V)] and not on neutral and mobile arsenic complexes. To overcome this lack of efficiency, a first oxidation step of As(III) form is necessary and is usually performed using strong oxidant or binding materials that are costly for small drinking water treatment units. An alternative to theses physico-chemical treatments is the biological treatment using As(III)-oxidising bacteria. Numerous autotrophic bacteria are able to oxidise arsenic. Among them, Thiomonas arsenivorans [4-6] is able to oxidise As(III) up to 100 mg As(III)/L and appears to be a good candidate for its known capacity to use As(III) as an energy source and carbon dioxide or carbonates as carbon source. An As(III)-oxidizing biological treatment pilot unit coupled to trapping units for As(V) removal at the outflow of the biological bioreactor was performed on site in order to study the strength of the biological process in real operating conditions. The bioreactor was previously inoculated with the autotrophic As(III)-oxidizing Thiomonas arsenivorans. Then, it has been intermittently fed with contaminated water from the drinking water well, at site temperature (15-17°C) and under downstream mode. As(III)-oxidizing biofilm development has been followed during the pilot functioning using CE-SSCP-16S (targeting the global community) and PCR-DGGE-aoxB (targeting As(III) oxidizers) fingerprinting techniques. Results showed a complete colonization of the mineral support (i.e. pozzolana) by indigenous bacteria of the groundwater to be treated. Moreover, the oxidation yield of the biological step was in the range of 54 to 100 % depending on the residence time (from 30 to 7 minutes) and the residual As concentration at the end of the complete treatment process (biological oxidation and trapping) was below 2 µg As/L. These results are thus very encouraging for an industrial application in regard to the strength and its absence of nutrients supply, except for the low amount of oxygen needed if it is not in sufficient concentration in the site water.

Anxiety following mild traumatic brain injury

Purpose/Objective: The goals of the present study were (1) to document the prevalence of anxiety-related disorders and anxiety symptoms at 4, 8, and 12 months post-injury in individuals with mild traumatic brain injury (mTBI) while considering pre-injury history of anxiety disorders and (2) to verify whether the presence of anxiety in the first months following mTBI was associated with more symptoms present one year after the injury. Research Method/Design: One hundred and twenty participants hospitalized after an accident and having sustained mTBI were assessed at 4, 8, and 12 months post-accident with the Mini-International Neuropsychiatric Interview, the Hospital Anxiety and Depression Scale and questionnaires assessing fatigue, irritability, perceived stress, cognitive difficulties, depression, insomnia, and pain. Results: At 4 months, 23.8% of participants presented with at least one anxiety-related disorder compared to 15.2% at 8 months and 11.2% at 12 months. Overall, 32.5% presented with at least one anxiety disorder over the first 12 months post-mTBI. Participants with a history of anxiety (20.5%) were significantly more anxious following their accident. Individuals who were anxious 4 months after the accident presented with more symptoms in different areas 12 months post-injury compared to non-anxious individuals. Conclusions/Implications: The present results highlight that anxiety should be evaluated and managed carefully as it appears to be a key factor in the persistence of other mTBI-related symptom

Evaluation of intensive versus standard blood pressure reduction and association with cognitive decline and dementia : a systematic review and metaAnalysis

Importance: Optimal blood pressure (BP) targets for the prevention of cognitive impairment remain uncertain. Objective: To explore the association of intensive (i.e. lower than usual) BP reduction compared to guidelines on the incidence of cognitive decline and dementia in adults with hypertension. Data Sources and Study Selection: We conducted a systematic review and meta-analysis of randomized controlled trials that evaluated the association of intensive systolic BP lowering on cognitive outcomes by searching MEDLINE, Embase, CENTRAL, Web of Science, CINAHL, PsycINFO, ICTRP and ClinicalTrials.gov for data up to October 27, 2020. Data Extraction and Synthesis: Data screening and extraction were performed independently by two reviewers based on PRISMA guidelines. The risk of bias was assessed using the Cochrane risk-of-bias 2 tool. We used random-effects models using the inverse variance method for our pooled analyses. We evaluated the presence of potential heterogeneity with the I2 index. Main Outcomes and Measures: Our primary outcome was cognitive decline. Secondary outcomes included the incidence of dementia, mild cognitive impairment (MCI), cerebrovascular events, serious adverse events, and all-cause mortality. Results: From 7,755 citations, we identified sixteen publications from five trials (17,396 participants, mean age 65.7 years, 60.5% males) and two additional ongoing trials. All five trials included in quantitative analyses were considered at unclear to high risk of bias. The mean followup duration was 3.3 years (range 2.0 to 4.7 years). Intensive BP reduction was not significantly associated with global cognitive performance (SMD 0.01, 95% CI -0.04 to 0.06, I2 = 0%, four trials, 5,246 patients), incidence of dementia (RR 1.09, 95% CI 0.32 to 3.67, I2 = 27%, two trials, 9,444 patients) or incidence of MCI (RR 0.91, 95% CI 0.73 to 1.14, I2 = 74%, two trials, 10,774 patients) when compared to standard treatment. However, we found a reduction of cerebrovascular events in the intensive arm (RR 0.79, 95% CI 0.67-0.93, I2 = 0%, five trials, 17,396 patients) without an increased risk of serious adverse events or mortality. Conclusions and Relevance: We did not detect a significant association between BP reduction and lower risk of cognitive decline, dementia or MCI. The certainty of this evidence is low due to the limited sample size, the risk of bias of included trials and the observed statistical heterogeneity. Hence, current available evidence does not justify the use of lower BP targets for the prevention of cognitive decline and dementi

Parc automobile et effet de serre. Agir sur le parc automobile pour réduire l’effet de serre

International audienceCette étude traite des conditions du renouvellement du parc automobile afin de mieux maîtriser l'impact sur l'effet de serre. Quels sont les critères d'achat et les conditions d'utilisation des véhicules ? Quelles politiques publiques peuvent orienter le choix des consommateurs et l'offre des constructeurs vers des véhicules moins polluants ? Divers instruments de politiques publiques sont analysés

Prevalence and causes of prescribing errors: the prescribing outcomes for trainee doctors engaged in clinical training (PROTECT) study

Objectives Study objectives were to investigate the prevalence and causes of prescribing errors amongst foundation doctors (i.e. junior doctors in their first (F1) or second (F2) year of post-graduate training), describe their knowledge and experience of prescribing errors, and explore their self-efficacy (i.e. confidence) in prescribing. Method A three-part mixed-methods design was used, comprising: prospective observational study; semi-structured interviews and cross-sectional survey. All doctors prescribing in eight purposively selected hospitals in Scotland participated. All foundation doctors throughout Scotland participated in the survey. The number of prescribing errors per patient, doctor, ward and hospital, perceived causes of errors and a measure of doctors' self-efficacy were established. Results 4710 patient charts and 44,726 prescribed medicines were reviewed. There were 3364 errors, affecting 1700 (36.1%) charts (overall error rate: 7.5%; F1:7.4%; F2:8.6%; consultants:6.3%). Higher error rates were associated with : teaching hospitals (p&#60;0.001), surgical (p = &#60;0.001) or mixed wards (0.008) rather thanmedical ward, higher patient turnover wards (p&#60;0.001), a greater number of prescribed medicines (p&#60;0.001) and the months December and June (p&#60;0.001). One hundred errors were discussed in 40 interviews. Error causation was multi-factorial; work environment and team factors were particularly noted. Of 548 completed questionnaires (national response rate of 35.4%), 508 (92.7% of respondents) reported errors, most of which (328 (64.6%) did not reach the patient. Pressure from other staff, workload and interruptions were cited as the main causes of errors. Foundation year 2 doctors reported greater confidence than year 1 doctors in deciding the most appropriate medication regimen. Conclusions Prescribing errors are frequent and of complex causation. Foundation doctors made more errors than other doctors, but undertook the majority of prescribing, making them a key target for intervention. Contributing causes included work environment, team, task, individual and patient factors. Further work is needed to develop and assess interventions that address these.</p

Association of metabolic syndrome and change in Unified Parkinson\u27s Disease Rating Scale scores.

OBJECTIVE: To explore the association between metabolic syndrome and the Unified Parkinson\u27s Disease Rating Scale (UPDRS) scores and, secondarily, the Symbol Digit Modalities Test (SDMT). METHODS: This is a secondary analysis of data from 1,022 of 1,741 participants of the National Institute of Neurological Disorders and Stroke Exploratory Clinical Trials in Parkinson Disease Long-Term Study 1, a randomized, placebo-controlled trial of creatine. Participants were categorized as having or not having metabolic syndrome on the basis of modified criteria from the National Cholesterol Education Program Adult Treatment Panel III. Those who had the same metabolic syndrome status at consecutive annual visits were included. The change in UPDRS and SDMT scores from randomization to 3 years was compared in participants with and without metabolic syndrome. RESULTS: Participants with metabolic syndrome (n = 396) compared to those without (n = 626) were older (mean [SD] 63.9 [8.1] vs 59.9 [9.4] years; p \u3c 0.0001), were more likely to be male (75.3% vs 57.0%; p \u3c 0.0001), and had a higher mean uric acid level (men 5.7 [1.3] vs 5.3 [1.1] mg/dL, women 4.9 [1.3] vs 3.9 [0.9] mg/dL, p \u3c 0.0001). Participants with metabolic syndrome experienced an additional 0.6- (0.2) unit annual increase in total UPDRS (p = 0.02) and 0.5- (0.2) unit increase in motor UPDRS (p = 0.01) scores compared with participants without metabolic syndrome. There was no difference in the change in SDMT scores. CONCLUSIONS: Persons with Parkinson disease meeting modified criteria for metabolic syndrome experienced a greater increase in total UPDRS scores over time, mainly as a result of increases in motor scores, compared to those who did not. Further studies are needed to confirm this finding. CLINICALTRIALSGOV IDENTIFIER: NCT00449865

To Protect Fatty Livers from Ischemia Reperfusion Injury: Role of Ischemic Postconditioning

BACKGROUND The benefit of ischemic postconditioning (IPostC) might be the throttled inflow following cold ischemia. The current study investigated advantage and mechanisms of IPostC in healthy and fatty rat livers. METHODS Male SD rats received a high-fat diet to induce fatty livers. Isolated liver perfusion was performed after 24 h ischemia at 4°C as well as in vivo experiments after 90 min warm ischemia. The so-called follow-up perfusions served to investigate the hypothesis that medium from IPostC experiments is less harmful. Lactate dehydrogenase (LDH), transaminases, different cytokines, and gene expressions, respectively, were measured. RESULTS Fatty livers showed histologically mild inflammation and moderate to severe fat storage. IPostC reduced LDH and TXB2 in healthy and fatty livers and increased bile flow. LDH, TNF-\textgreeka, and IL-6 levels in serum decreased after warm ischemia + IPostC. The gene expressions of Tnf, IL-6, Ccl2, and Ripk3 were downregulated in vivo after IPostC. CONCLUSIONS IPostC showed protective effects after ischemia in situ and in vivo in healthy and fatty livers. Restricted cyclic inflow was an important mechanism and further suggested involvement of necroptosis. IPostC represents a promising and easy intervention to improve outcomes after transplantation

Evaluating national guidelines for monitoring early growth using routinely collected data in Bergen, Norway

Aims: The overarching aim of this study was to evaluate the Norwegian guidelines for growth monitoring using routinely collected data from healthy children up to five years of age. We analysed criteria for both status (size for age) and change (centile crossing) in growth. Methods: Longitudinal data were obtained from the electronic health record (EHR) at the well-baby clinic for 2130 children included in the Bergen growth study 1 (BGS1). Measurements of length, weight, weight-for-length, body mass index (BMI) and head circumference were converted to z-scores and compared with the World Health Organization (WHO) growth standards and the national growth reference. Results: Using the WHO growth standard, the proportion of children above +2SD was generally higher than the expected 2.3% for all traits at birth and for length at all ages. Crossing percentile channels was common during the first two years of life, particularly for length/height. By the age of five years, 37.9% of the children had been identified for follow-up regarding length/height, 33% for head circumference and 13.6% for high weight-for-length/BMI. Conclusions: The proportion of children beyond the normal limits of the charts is higher than expected, and a surprisingly large number of children were identified for rules concerning length or growth in head circumference. This suggests the need for a revision of the current guidelines for growth monitoring in Norway.publishedVersio