A novel personalized systems nutrition program improves dietary patterns, lifestyle behaviors and health-related outcomes: results from the habit study

Personalized nutrition may be more effective in changing lifestyle behaviors compared to population-based guidelines. This single-arm exploratory study evaluated the impact of a 10-week personalized systems nutrition (PSN) program on lifestyle behavior and health outcomes. Healthy men and women (n = 82) completed the trial. Individuals were grouped into seven diet types, for which phenotypic, genotypic and behavioral data were used to generate personalized recommendations. Behavior change guidance was also provided. The intervention reduced the intake of calories (−256.2 kcal; p < 0.0001), carbohydrates (−22.1 g; p < 0.0039), sugar (−13.0 g; p < 0.0001), total fat (−17.3 g; p < 0.0001), saturated fat (−5.9 g; p = 0.0003) and PUFA (−2.5 g; p = 0.0065). Additionally, BMI (−0.6 kg/m2; p < 0.0001), body fat (−1.2%; p = 0.0192) and hip circumference (−5.8 cm; p < 0.0001) were decreased after the intervention. In the subgroup with the lowest phenotypic flexibility, a measure of the body’s ability to adapt to environmental stressors, LDL (−0.44 mmol/L; p = 0.002) and total cholesterol (−0.49 mmol/L; p < 0.0001) were reduced after the intervention. This study shows that a PSN program in a workforce improves lifestyle habits and reduces body weight, BMI and other health-related outcomes. Health improvement was most pronounced in the compromised phenotypic flexibility subgroup, which indicates that a PSN program may be effective in targeting behavior change in health-compromised target groups

Plasma exchange in the intensive care unit: a narrative review

In this narrative review, we discuss the relevant issues of therapeutic plasma exchange (TPE) in critically ill patients. For many conditions, the optimal indication, device type, frequency, duration, type of replacement fluid and criteria for stopping TPE are uncertain. TPE is a potentially lifesaving but also invasive procedure with risk of adverse events and complications and requires close monitoring by experienced teams. In the intensive care unit (ICU), the indications for TPE can be divided into (1) absolute, well-established, and evidence-based, for which TPE is recognized as first-line therapy, (2) relative, for which TPE is a recognized second-line treatment (alone or combined) and (3) rescue therapy, where TPE is used with a limited or theoretical evidence base. New indications are emerging and ongoing knowledge gaps, notably regarding the use of TPE during critical illness, support the establishment of a TPE registry dedicated to intensive care medicine

Adaptive variation in coral geometry and the optimization of internal colony light climates

1. The ability of photosynthetic organisms to adjust their light climate has high adaptive significance because irradiance can vary spatially by orders of magnitude. Using a plating (foliaceous) coral species (Turbinaria mesenterina), we tested the hypothesis that plasticity of colony geometry optimizes internal irradiance distributions. 2. We developed a two-dimensional model to predict the internal irradiance distribution of a foliaceous colony as a function of its geometry. Field tests showed that the model explained 85% of the variation in irradiance within colonies of T. mesenterina with minimal bias. 3. Colony plate angle, plate spacing and range of tissue distributions into the colony were exponential functions of water depth. In shallow water plates tended to be nearly vertical, narrowly spaced, and had living tissue only near the growing edge of the plate. In deep water plates grew more horizontally, were more widely spaced, and had living tissue extending well into the colony interior. This pattern of phenotypic plasticity effectively evens out differences in within-colony irradiances. 4. We compared within-colony irradiance distributions across light habitats (depth), based on the observed variation in colony geometry with water depth. Despite fourfold differences in environmental irradiance, within-colony irradiances had a common mode of 100-200 mu mol m(-2) s(-1). This is near the hypothesized photosynthetic optimum defined by the upper limit of the subsaturation parameter (E-k) of the photosynthesis-irradiance curve. 5. Our study demonstrates that phenotypic plasticity of colony geometry is an important mechanism for regulating light capture during growth in T. mesenterina, and facilitates near-optimal internal irradiances across a wide range of environmental light regimes

Esofagite por refluxo e laringite por refluxo: Estágios clínicos diferentes da mesma doença? Reflux esophagitys and reflux laryngitis: Different stages of the same disease?

Introdução: O refluxo gastro-esofágico (RGE) é uma entidade decorrente de falha anatômica e/ou funcional dos mecanismos de contenção do conteúdo gástrico. As manifestações otorrinolaringológicas do RGE são globus em orofaringe, regurgitação, disfonia, pirose orofaríngea, disfagia e tosse crônica. Objetivo: Pretende-se avaliar os sintomas otorrinolaringológicos do refluxo em pacientes com indicação cirúrgica de hérnia hiatal e comparar com pacientes apenas com queixas laríngeas do RGE. Forma de Estudo: prospectivo clínico randomizado. Material e método: Foram avaliados dois grupos. O grupo A, com 18 pacientes admitidos nos Serviços de Cirurgia do Aparelho Digestivo e Cirurgia Geral que necessitavam de tratamento cirúrgico de esofagite graus III e IV, quanto aos sintomas otorrinolaringológicos do RGE. O grupo B, com 44 pacientes do Serviço de Otorrinolaringologia com queixas laríngeas de RGE. Os pacientes foram submetidos a um protocolo, videolaringoscopia e endoscopia digestiva alta (EDA). Os dados obtidos foram tabulados e comparados com a literatura. Resultados: Os sintomas referidos pelos pacientes do grupo B foram os mesmos do grupo A, porém, disfonia, tosse, regurgitação e pirose em orofaringe foram mais prevalentes no grupo B. As alterações laringoscópicas dos pacientes do grupo B foram mais significativas. As alterações de EDA foram mais prevalentes nos pacientes do grupo A. A partir destes dados nota-se que não existe correlação entre a doença esofageana e os sintomas laríngeos. Conclusão: O trabalho demonstrou a correlação entre sintomas otorrinolaringológicos e o refluxo gastro-esofágico, porém a comparação entre os dois grupos permitiu concluir que, apesar dos quadros apresentarem fisiopatologia semelhante, não se tratam de estágios evolutivos da mesma doença.<br>Introduction: Gastroesophageal reflux disease (GRD) is an entity due to anatomical or functional failure of contention mechanisms of gastric content. Otolaryngology manifestations of GRD are oropharynx globus, dysphonia, oropharyngeal pirosis, dysfagia, chronic cough. The research intends to evaluate the otolaryngology symptoms of reflux in patients with surgical indication of hiatal hernia and compare the patients’ complaints. Study design: prospective clinical randomized. Material and method: The patients were divided in two groups. Group A, with 18 patients admitted in the General Surgery Service with surgical treatment indication for esophagitys, degrees III and IV and group B, with 40 patients of the Otolaryngology Service with reflux laryngitis complaints. Patients were submitted to a protocol, videolaryngoscopy and upper endoscopy (UE). Obtained data were tabulated and compared to the literature. Results: Symptoms referred by the patients of group B were the same of the group A, but dysphonia, cough, oropharynx pirosis were more prevalent in group B. The laryngoscopic evaluation of group B has shown more altered findings than group A. Altered UE were more prevalent in patients of the group A. Considering the results it is possible to verify that the degree of esophageal disease has no correlation with laryngeal disease. Conclusion: The comparison among the two groups allowed concluding that, despite the similarity of the clinical picture and fisiopatology, the gastroesophageal reflux and the laryngeal reflux must not be considered different stages of the same disease