Abstract

undefined: The gut microbiota is increasingly recognized as an important modulator of human health. As such, there is a growing need to identify effective means of selectively modifying gut microbial communities. Bacteriophages, which were briefly utilized as clinical antimicrobials in the early 20th century, present an opportunity to selectively reduce populations of undesirable microorganisms. However, whether intentional consumption of specific bacteriophages affects overall gut ecology is not yet known. Using a commercial cocktail of -targeting bacteriophages, we examined their effects on gut microbiota and markers of intestinal and systemic inflammation in a healthy human population. In a double-blinded, placebo-controlled crossover trial, normal to overweight adults consumed bacteriophages for 28 days. Stool and blood samples were collected and used to examine inflammatory markers, lipid metabolism, and gut microbiota. Reductions in fecal loads were observed with phage consumption. However, there were no significant changes to alpha and beta diversity parameters, suggesting that consumed phages did not globally disrupt the microbiota. However, specific populations were altered in response to treatment, including increases in members of the butyrate-producing genera and a decreased proportion of taxa most closely related to . Short-chain fatty acid production, inflammatory markers, and lipid metabolism were largely unaltered, but there was a small but significant decrease in circulating interleukin-4 (Il-4). Together, these data demonstrate the potential of bacteriophages to selectively reduce target organisms without global disruption of the gut community.

Abstract

undefined: Acute otitis media (AOM) is one of the most common bacterial infections in children. Empiric antibiotherapy leads to increasing antimicrobial resistance rates among otopathogens and may impair the correct development of the microbiota in early life. In this context, probiotics seem to be an attractive approach for preventing recurrent AOM (rAOM) through the restoration of the middle ear and nasopharyngeal microbiota. The aim of this study was the selection of a probiotic strain ( PS7), specifically tailored for its antagonism against otopathogens. Since PS7 was safe and displayed a strong antimicrobial activity against otopathogens, its efficacy in preventing rAOM was assessed in a trial involving 61 children suffering from rAOM. Children consumed daily ~1 × 10⁸ CFU of PS7, and the number of AOM episodes were registered and compared with that observed in the previous 6 and 12 months. The microbiota of samples collected from the external auditory canal samples was quantitatively and qualitatively assessed. The number of AOM episodes during the intervention period decreased significantly (84%) when compared to that reported during the 6 months period before the probiotic intervention. In conclusion, PS7 is a promising strain for the prevention of rAOM in infants and children.

Abstract

During pregnancy, vitamin D supplementation may be a feasible strategy to help prevent low birthweight (LBW) and small for gestational age (SGA) births. However, evidence from randomized controlled trials (RCTs) is inconclusive, probably due to heterogeneity in study design and type of intervention. A systematic literature search in the PubMed-Medline, EMBASE, and Cochrane Central Register of Controlled Trials databases was carried out to evaluate the effects of oral vitamin D supplementation during pregnancy on birthweight, birth length, head circumference, LBW, and SGA. The fixed-effects or random-effects models were used to calculate mean difference (MD), risk ratio (RR), and 95% Confidence Interval (CI). On a total of 13 RCTs, maternal vitamin D supplementation had a positive effect on birthweight (12 RCTs; MD = 103.17 g, 95% CI 62.29⁻144.04 g), length (6 RCTs; MD = 0.22 cm, 95% CI 0.11⁻0.33 cm), and head circumference (6 RCTs; MD:0.19 cm, 95% CI 0.13⁻0.24 cm). In line with these findings, we also demonstrated that maternal vitamin D supplementation reduced the risk of LBW (3 RCTs; RR = 0.40, 95% CI 0.22⁻0.74) and SGA (5 RCTS; RR = 0.69, 95% CI 0.51⁻0.92). The present systematic review and meta-analysis confirmed the well-established effect of maternal vitamin D supplementation on birth size. However, further research is required to better define risks and benefits associated with such interventions and the potential implications for public health.

Abstract

Vitamin D deficiency has been implicated in numerous human diseases leading to an increased interest in assessing vitamin D status. Consequentially, the number of requests for vitamin D measurement keeps dramatically increasing year-on-year. Currently, the recognised best marker of vitamin D status is the concentration of the 25-hydroxyvitamin D (25(OH)D₃) in the blood circulation. While providing an accurate estimate of vitamin D status at the point in time of sampling, it cannot account for the high variability of 25(OH)D₃ concentration. In this proof of concept study we set out to provide evidence that 25(OH)D₃ can be extracted from hair samples in a similar fashion to steroid hormones. Two of the authors (L.Z. and M.H.) provided hair samples harvested from the crown area of the scalp and the third author (E.L.) provided beard samples. These samples, cut into 1 cm lengths, were weighed, washed and dried. 25(OH)D was extracted using a previously published steroid hormones extraction procedure. Blood samples were taken from the subjects at the same time all tissue samples were analysed using liquid-chromatography mass spectrometry. Hair samples showed presence of quantifiable 25(OH)D₃ with concentrations ranging from 11.9⁻911 pg/mg. The beard sample had a concentration of 231 pg/mg. Serum levels of 25(OH)D₃ ranged from 72⁻78 nmol/L. The results presented here confirm the feasibility of measuring 25(OH)D₃ in hair samples. The findings warrant further validation and development and have the potential to yield valuable information relating to temporal trends in vitamin D physiology.

Abstract

BACKGROUND Health-related quality of life (HRQL) is increasingly recognized for its importance in health research. As there is increasing recognition of the inter-individual difference in response to therapeutic interventions, it may be helpful to apply individualized measures of HRQL. The MYMOP is a commonly used example of such measures, although several adaptations have been developed. OBJECTIVE This review was conducted to identify adaptations of MYMOP, and evaluate the measurement properties of MYMOP and its adaptations. METHODS Adaptations were identified using MYMOP website and personal communication, supplemented by a SCOPUS search in April 2017. Bibliographies of included studies were hand-searched. COSMIN criteria were used to evaluate the measurement properties. RESULTS Sixteen studies were included in this review. Adaptations were developed to evaluate individualized therapies in cancer, psychiatry, and acupuncture. The included measures were MYMOP, measure yourself concern and wellbeing, psychological outcome profiles (PSYCHLOPS), and MYMOP-pictorial (MYMOP-P). The quality of the measurement properties varied; none of the included measures met all currently recommended quality criteria for measurement properties. CONCLUSION Current literature provides evidence that MYMOP and its adaptations offer individualized assessment of patient-centered outcomes, and thereby provide a means to understand heterogeneity of treatment effects. However, current recommendations for psychometric testing suggest further validation of these measures would be beneficial.

Abstract

BACKGROUND Faecal microbiome transplantation (FMT) appears to be an effective method for treating irritable bowel syndrome (IBS) patients. However, it is not clear if a high transplant dose and/or repeating FMT are/is needed to ensure a response. The present study was undertaken to clarify this matter. METHODS Ten IBS patients who did not respond to a 30-g transplant subsequently received a 60-g transplant into the duodenum via a gastroscope. The patients provided faecal samples before and 1 month after FMT. They completed five questionnaires measuring symptoms, fatigue and quality of life at baseline and then at 2 weeks, 1 month and 3 months after FMT. The dysbiosis index (DI) was measured using the GA-map Dysbiosis Test . RESULTS Seven patients (70%) responded to the 60-g transplant, with significant clinical improvements in the abdominal symptoms, fatigue and quality of life in 57%, 80% and 67% of these patients. The 60-g transplant also reduced the DI. CONCLUSION FMT is an effective treatment for IBS. A high-dose transplant and/or repeated FMT increase the response rate and the intensity of the effects of FMT.

Abstract

undefined: Studies of probiotics, fructan-type prebiotics, and synbiotics in patients with ulcerative colitis (UC) show significant heterogeneity in methodology and results. Here, we study the efficacy of such interventions and the reasons for the heterogeneity of their results. Eligible random controlled trials were collected from the PUBMED and SCOPUS databases. A total of 18 placebo-controlled and active treatment-controlled (i.e., mesalazine) studies were selected with a Jadad score ≥ 3, including 1491 patients with UC. Data for prebiotics and synbiotics were sparse and consequently these studies were excluded from the meta-analysis. The UC remission efficacy of probiotics was measured in terms of relative risk (RR) and odds ratio (OR). Significant effects were observed in patients with active UC whenever probiotics containing bifidobacteria were used, or when adopting the US Food and Drug Administration (FDA)-recommended scales (UC Disease Activity Index and Disease Activity Index). By the FDA recommended scales, the RR was 1.55 (CI95%: 1.13⁻2.15, -value = 0.007, ² = 29%); for bifidobacteria-containing probiotics, the RR was 1.73 (CI95%: 1.23⁻2.43, -value = 0.002, ² = 35%). No significant effects were observed on the maintenance of remission for placebo-controlled or mesalazine-controlled studies. We conclude that a validated scale is necessary to determine the state of patients with UC. However, probiotics containing bifidobacteria are promising for the treatment of active UC.

Abstract

BACKGROUND/AIMS: Measure Yourself Medical Outcome Profile 2 (MYMOP2) is a patient-generated outcome measure allowing patients to select the problems that are the most important to them and that they want to address, and it measures the effects of the problem from a wide range of health care interventions. This study aimed to translate the questionnaire into Turkish language (Turkish MYMOP-TMYMOP) and add this clinically useful measure to Turkish medical practice by assessing its validity and reliability. MATERIALS AND METHODS Fifty volunteers with anorectal disorders were prospectively included into the study. Each patient was enrolled into a pelvic floor training biofeedback program, specific to their anorectal symptomatology. The subjects were administered both the Nottingham Health Profile and the TMYMOP2 questionnaires before the treatment session (initial visit) and at the control follow-up visits (the first and second months, via e-mail or telephone calls). RESULTS The TMYMOP2 questionnaire was shown to be moderately valid (the Pearson correlation coefficient score between the total scores of the subgroups of the two questionnaires were 0.335 and 0.642, respectively, p<0.05) and highly reliable (the Cronbach's alfa coefficient score between the total scores of the subgroups of the two questionnaires were 0.77, 0.82, and 0.88 in the beginning and at the first and second month follow-up visits, respectively). CONCLUSION The TMYMOP2 was shown to be a low-to-moderately valid and a highly reliable scale. Because it is brief and short to complete, it might be an important and free-to-use tool to measure the diseases, and it can enhance the patient-centered care within the Turkish health care context.

Abstract

BACKGROUND Complications related to concurrent chemoradiotherapy (CCRT) such as acute radiation-induced esophagitis (ARIE) may cause significant morbidity and unplanned treatment delays in patients with advanced non-small cell lung cancer (NSCLC). We designed a prospective randomized study to assess the impact of glutamine (GLN) supplementation in preventing CCRT-induced toxicities of advanced NSCLC patients. METHODS From September 2014 to September 2015, 60 patients diagnosed with NSCLC were included to the study. Thirty patients (50%) received prophylactic powdered GLN orally at a dose of 10 g/8 h. The prescribed radiation dose to the planning target volume was 30 Gy in 2-Gy fractions. The endpoints were radiation-induced esophagitis, mucositis, body weight loss, overall survival and progression-free survival. RESULTS The 60 patients with NSCLC included 42 men and 18 women with a mean age ± standard deviation of 60.3 years ± 18.2 (range, 44-78 years).At a median follow-up of 26.4 months (range 10.4-32.2), all patients tolerated GLN well. A administration of GLN was associated with a decrease in the incidence of grade 2 or 3 ARIE (6.7% vs 53.4% for Gln+ vs Gln-; P = .004). GLN supplementation appeared to significantly delay ARIE onset for 5.8 days (18.2 days vs 12.4 days; P = .027) and reduced incidence of weight loss (20% vs 73.3%; P = .01). DISCUSSION Our study suggests a beneficial effect of oral glutamine supplementation for the prevention from radiation-induced injury and body weight loss in advanced NSCLC patients who receiving CCRT.

Abstract

CONTEXT Cannabidiol (CBD) is one of many cannabinoid compounds found in cannabis. It does not appear to alter consciousness or trigger a "high." A recent surge in scientific publications has found preclinical and clinical evidence documenting value for CBD in some neuropsychiatric disorders, including epilepsy, anxiety, and schizophrenia. Evidence points toward a calming effect for CBD in the central nervous system. Interest in CBD as a treatment of a wide range of disorders has exploded, yet few clinical studies of CBD exist in the psychiatric literature. OBJECTIVE To determine whether CBD helps improve sleep and/or anxiety in a clinical population. DESIGN A large retrospective case series at a psychiatric clinic involving clinical application of CBD for anxiety and sleep complaints as an adjunct to usual treatment. The retrospective chart review included monthly documentation of anxiety and sleep quality in 103 adult patients. MAIN OUTCOME MEASURES Sleep and anxiety scores, using validated instruments, at baseline and after CBD treatment. RESULTS The final sample consisted of 72 adults presenting with primary concerns of anxiety (n = 47) or poor sleep (n = 25). Anxiety scores decreased within the first month in 57 patients (79.2%) and remained decreased during the study duration. Sleep scores improved within the first month in 48 patients (66.7%) but fluctuated over time. In this chart review, CBD was well tolerated in all but 3 patients. CONCLUSION Cannabidiol may hold benefit for anxiety-related disorders. Controlled clinical studies are needed.