bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of Hyperglycemic Women's Perinatal Health Status
Authors: Yu Ching‐Yun , Hung Chich‐Hsiu , Huang Mei‐Chuan , Chan Te‐Fu
Published: August 2016

Background

Hyperglycemic women face dramatic physiological and psychosocial changes during the perinatal period; however, studies examining hyperglycemic women's health are few, and limited to cross‐sectional designs.

Purpose

This study aimed to examine changes in hyperglycemic women's stress, social support, depression, and health status from pregnancy to 1 year postpartum, and to identify factors predicting hyperglycemic women's perinatal health.

Methods

Ninety‐nine participants with positive results in a 50‐g glucose challenge test were recruited in a medical center in southern Taiwan. A repeated measures study was conducted; measurements were made at 28 weeks of pregnancy, and 1 week, 6 weeks, 6 months, and 1 year after childbirth. The Social Support Scale, the Perceived Stress Scale, the Taiwanese Depression Questionnaire, and the Chinese Health Questionnaire were used.

Results

Compared with hyperglycemic women's depression at 28 weeks of pregnancy, significant decreases in mean depression scores were found at 1 week and 1 year postpartum. Hyperglycemic women's health status improved at 6 months and 1 year postpartum. Depression significantly predicted hyperglycemic women's perinatal health status.

Linking Evidence to Action

Stress and depression are associated with perinatal health status in hyperglycemic women. Healthcare providers should more closely assess stress and depression levels in hyperglycemic women from pregnancy to 1 year postpartum. Interventions promoting the psychological well‐being of hyperglycemic women are required.
Material-driven fibronectin assembly for high-efficiency presentation of growth factors
Authors: Llopis-Hernández Virginia , Cantini Marco , González-García Cristina , Cheng Zhe A. , Yang Jingli , Tsimbouri Penelope M , García Andrés J. , Dalby Matthew J. , Salmerón-Sánchez Manuel
Published: August 2016

Researchers develop a simple technique to enhance the activity of growth factors during tissue healing.
Ambient-condition growth of high-pressure phase centrosymmetric crystalline KDP microstructures for optical second harmonic generation
Authors: Ren Yan , Zhao Xian , Hagley Edward W. , Deng Lu
Published: August 2016

Exotic nonlinear optical single-crystal microstructures have unique guided-wave and efficient frequency-doubling properties.
Ice-like water supports hydration forces and eases sliding friction
Authors: Dhopatkar Nishad , Defante Adrian P. , Dhinojwala Ali
Published: August 2016

Surface-sensitive spectroscopy and contact mechanics reveal ice-like confined water between surfactant-covered charged surfaces.
A Survival Strategy for Pseudomonas aeruginosa That Uses Exopolysaccharides To Sequester and Store Iron To Stimulate Psl-Dependent Biofilm Formation
Authors: Yu Shan , Wei Qing , Zhao Tianhu , Guo Yuan , Ma Luyan Z.
Published: August 2016

Exopolysaccharide Psl is a critical biofilm matrix component inPseudomonas aeruginosa, which forms a fiber-like matrix to enmesh bacterial communities. Iron is important forP. aeruginosabiofilm development, yet it is not clearly understood how iron contributes to biofilm development. Here, we showed that iron promoted biofilm formation via elevating Psl production inP. aeruginosa. The high level of iron stimulated the synthesis of Psl by reducing rhamnolipid biosynthesis and inhibiting the expression of AmrZ, a repressor ofpslgenes. Iron-stimulated Psl biosynthesis and biofilm formation held true in mucoidP. aeruginosastrains. Subsequent experiments indicated that iron bound with Pslin vitroand in biofilms, which suggested that Psl fibers functioned as an iron storage channel inP. aeruginosabiofilms. Moreover, among three matrix exopolysaccharides ofP. aeruginosa, Psl is the only exopolysaccharide that can bind with both ferrous and ferric ion, yet with higher affinity for ferrous iron. Our data suggest a survival strategy ofP. aeruginosathat uses exopolysaccharide to sequester and store iron to stimulate Psl-dependent biofilm formation.

IMPORTANCEPseudomonas aeruginosais an environmental microorganism which is also an opportunistic pathogen that can cause severe infections in immunocompromised individuals. It is the predominant airway pathogen causing morbidity and mortality in individuals affected by the genetic disease cystic fibrosis (CF). Increased airway iron and biofilm formation have been proposed to be the potential factors involved in the persistence ofP. aeruginosain CF patients. Here, we showed that a high level of iron enhanced the production of the key biofilm matrix exopolysaccharide Psl to stimulate Psl-dependent biofilm formation. Our results not only make the link between biofilm formation and iron concentration in CF, but also could guide the administration or use of iron chelators to interfere with biofilm formation inP. aeruginosain CF patients. Furthermore, our data also imply a survival strategy ofP. aeruginosaunder high-iron environmental conditions.
Immobilization of LccC Laccase from Aspergillus nidulans on Hard Surfaces via Fungal Hydrophobins
Authors: Fokina Oleksandra , Fenchel Alex , Winandy Lex , Fischer Reinhard
Published: August 2016

Fungal hydrophobins are small amphiphilic proteins that can be used for coatings on hydrophilic and hydrophobic surfaces. Through the formation of monolayers, they change the hydrophobicity of a given surface. Especially, the class I hydrophobins are interesting for biotechnology, because their layers are stable at high temperatures and can only be removed with strong solvents. These proteins self-assemble into monolayers under physiological conditions and undergo conformational changes that stabilize the layer structure. Several studies have demonstrated how the fusion of hydrophobins with short peptides allows the specific modification of the properties of a given surface or have increased the protein production levels through controlled localization of hydrophobin molecules inside the cell. Here, we fused the
Aspergillus nidulans
laccase LccC to the class I hydrophobins DewA and DewB and used the fusion proteins to functionalize surfaces with immobilized enzymes. In contrast to previous studies with enzymes fused to class II hydrophobins, the DewA-LccC fusion protein is secreted into the culture medium. The crude culture supernatant was directly used for coatings of glass and polystyrene without additional purification steps. The highest laccase surface activity was achieved after protein immobilization on modified hydrophilic polystyrene at pH 7. This study presents an easy-to-use alternative to classical enzyme immobilization techniques and can be applied not only for laccases but also for other biotechnologically relevant enzymes.

IMPORTANCE
Although fusion with small peptides to modify hydrophobin properties has already been performed in several studies, fusion with an enzyme presents a more challenging task. Both protein partners need to remain in active form so that the hydrophobins can interact with one another and form layers, and so the enzyme (e.g., laccase) will remain active at the same time. Also, because of the amphiphilic nature of hydrophobins, their production and purification remain challenging so far and often include steps that would irreversibly disrupt most enzymes. In our study, we present the first functional fusion proteins of class I hydrophobins from
A. nidulans
with a laccase. The resulting fusion enzyme is directly secreted into the culture medium by the fungus and can be used for the functionalization of hard surfaces.
Nectrisine Biosynthesis Genes in Thelonectria discophora SANK 18292: Identification and Functional Analysis
Authors: Miyauchi Ryuki , Ono Chiho , Ohnuki Takashi , Shiba Yoichiro
Published: August 2016

The fungus
Thelonectria discophora
SANK 18292 produces the iminosugar nectrisine, which has a nitrogen-containing heterocyclic 5-membered ring and acts as a glycosidase inhibitor. In our previous study, an oxidase (designated NecC) that converts 4-amino-4-deoxyarabinitol to nectrisine was purified from
T. discophora
cultures. However, the genes required for nectrisine biosynthesis remained unclear. In this study, the nectrisine biosynthetic gene cluster in
T. discophora
was identified from the contiguous genome sequence around the
necC
gene. Gene disruption and complementation studies and heterologous expression of the gene showed that
necA
,
necB
, and
necC
could be involved in nectrisine biosynthesis, during which amination, dephosphorylation, and oxidation occur. It was also demonstrated that nectrisine could be produced by recombinant
Escherichia coli
coexpressing the
necA
,
necB
, and
necC
genes. These findings provide the foundation to develop a bacterial production system for nectrisine or its intermediates through genetic engineering.

IMPORTANCE
Iminosugars might have great therapeutic potential for treatment of many diseases. However, information on the genes for their biosynthesis is limited. In this study, we report the identification of genes required for biosynthesis of the iminosugar nectrisine in
Thelonectria discophora
SANK 18292, which was verified by disruption, complementation, and heterologous expression of the genes involved. We also demonstrate heterologous production of nectrisine by recombinant
E. coli
, toward developing an efficient production system for nectrisine or its intermediates through genetic engineering.
Antimicrobial Peptide Resistance Genes in the Plant Pathogen Dickeya dadantii
Authors: Pandin Caroline , Caroff Martine , Condemine Guy
Published: August 2016

Modification of teichoic acid through the incorporation of
d
-alanine confers resistance in Gram-positive bacteria to antimicrobial peptides (AMPs). This process involves the products of the
dltXABCD
genes. These genes are widespread in Gram-positive bacteria, and they are also found in a few Gram-negative bacteria. Notably, these genes are present in all soft-rot enterobacteria (
Pectobacterium
and
Dickeya
) whose
dltDXBAC
operons have been sequenced. We studied the function and regulation of these genes in
Dickeya dadantii
.
dltB
expression was induced in the presence of the AMP polymyxin. It was not regulated by PhoP, which controls the expression of some genes involved in AMP resistance, but was regulated by ArcA, which has been identified as an activator of genes involved in AMP resistance. However,
arcA
was not the regulator responsible for polymyxin induction of these genes in this bacterium, which underlines the complexity of the mechanisms controlling AMP resistance in
D. dadantii
. Two other genes involved in resistance to AMPs have also been characterized,
phoS
and
phoH
.
dltB
,
phoS
,
phoH
, and
arcA
but not
dltD
mutants were more sensitive to polymyxin than the wild-type strain. Decreased fitness of the
dltB
,
phoS
, and
phoH
mutants in chicory leaves indicates that their products are important for resistance to plant AMPs.

IMPORTANCE
Gram-negative bacteria can modify their lipopolysaccharides (LPSs) to resist antimicrobial peptides (AMPs). Soft-rot enterobacteria (
Dickeya
and
Pectobacterium
spp.) possess homologues of the
dlt
genes in their genomes which, in Gram-positive bacteria, are involved in resistance to AMPs. In this study, we show that these genes confer resistance to AMPs, probably by modifying LPSs, and that they are required for the fitness of the bacteria during plant infection. Two other new genes involved in resistance were also analyzed. These results show that bacterial resistance to AMPs can occur in bacteria through many different mechanisms that need to be characterized.
Bacterial Quorum Sensing Stabilizes Cooperation by Optimizing Growth Strategies
Authors: Bruger Eric L. , Waters Christopher M.
Published: August 2016

Communication has been suggested as a mechanism to stabilize cooperation. In bacteria, chemical communication, termed quorum sensing (QS), has been hypothesized to fill this role, and extracellular public goods are often induced by QS at high cell densities. Here we show, with the bacterium
Vibrio harveyi
, that QS provides strong resistance against invasion of a QS defector strain by maximizing the cellular growth rate at low cell densities while achieving maximum productivity through protease upregulation at high cell densities. In contrast, QS mutants that act as defectors or unconditional cooperators maximize either the growth rate or the growth yield, respectively, and thus are less fit than the wild-type QS strain. Our findings provide experimental evidence that regulation mediated by microbial communication can optimize growth strategies and stabilize cooperative phenotypes by preventing defector invasion, even under well-mixed conditions. This effect is due to a combination of responsiveness to environmental conditions provided by QS, lowering of competitive costs when QS is not induced, and pleiotropic constraints imposed on defectors that do not perform QS.

IMPORTANCE
Cooperation is a fundamental problem for evolutionary biology to explain. Conditional participation through phenotypic plasticity driven by communication is a potential solution to this dilemma. Thus, among bacteria, QS has been proposed to be a proximate stabilizing mechanism for cooperative behaviors. Here, we empirically demonstrate that QS in
V. harveyi
prevents cheating and subsequent invasion by nonproducing defectors by maximizing the growth rate at low cell densities and the growth yield at high cell densities, whereas an unconditional cooperator is rapidly driven to extinction by defectors. Our findings provide experimental evidence that QS regulation prevents the invasion of cooperative populations by QS defectors even under unstructured conditions, and they strongly support the role of communication in bacteria as a mechanism that stabilizes cooperative traits.
Intracellular pH Response to Weak Acid Stress in Individual Vegetative Bacillus subtilis Cells
Authors: Pandey Rachna , Vischer Norbert O. E. , Smelt Jan P. P. M. , van Beilen Johan W. A. , Ter Beek Alexander , De Vos Winnok H. , Brul Stanley , Manders Erik M. M.
Published: August 2016

Intracellular pH (pH
i
) critically affects bacterial cell physiology. Hence, a variety of food preservation strategies are aimed at perturbing pH
i
homeostasis. Unfortunately, accurate pH
i
quantification with existing methods is suboptimal, since measurements are averages across populations of cells, not taking into account interindividual heterogeneity. Yet, physiological heterogeneity in isogenic populations is well known to be responsible for differences in growth and division kinetics of cells in response to external stressors. To assess in this context the behavior of intracellular acidity, we have developed a robust method to quantify pH
i
at single-cell levels in
Bacillus subtilis
. Bacilli spoil food, cause disease, and are well known for their ability to form highly stress-resistant spores. Using an improved version of the genetically encoded ratiometric pHluorin (IpHluorin), we have quantified pH
i
in individual
B. subtilis
cells, cultured at an external pH of 6.4, in the absence or presence of weak acid stresses. In the presence of 3 mM potassium sorbate, a decrease in pH
i
and an increase in the generation time of growing cells were observed. Similar effects were observed when cells were stressed with 25 mM potassium acetate. Time-resolved analysis of individual bacteria in growing colonies shows that after a transient pH decrease, long-term pH evolution is highly cell dependent. The heterogeneity at the single-cell level shows the existence of subpopulations that might be more resistant and contribute to population survival. Our approach contributes to an understanding of pH
i
regulation in individual bacteria and may help scrutinizing effects of existing and novel food preservation strategies.

IMPORTANCE
This study shows how the physiological response to commonly used weak organic acid food preservatives, such as sorbic and acetic acids, can be measured at the single-cell level. These data are key to coupling often-observed single-cell heterogeneous growth behavior upon the addition of weak organic acid food preservatives. Generally, these data are gathered in the form of plate counting of samples incubated with the acids. Here, we visualize the underlying heterogeneity in cellular pH homeostasis, opening up avenues for mechanistic analyses of the heterogeneity in the weak acid stress response. Thus, microbial risk assessment can become more robust, widening the scope of use of these well-known weak organic acid food preservatives.
Chlorobaculum tepidum Modulates Amino Acid Composition in Response to Energy Availability, as Revealed by a Systematic Exploration of the Energy Landscape of Phototrophic Sulfur Oxidation
Authors: Levy Amalie T. , Lee Kelvin H. , Hanson Thomas E.
Published: August 2016

Microbial sulfur metabolism, particularly the formation and consumption of insoluble elemental sulfur (S0), is an important biogeochemical engine that has been harnessed for applications ranging from bioleaching and biomining to remediation of waste streams.Chlorobaculum tepidum, a low-light-adapted photoautolithotrophic sulfur-oxidizing bacterium, oxidizes multiple sulfur species and displays a preference for more reduced electron donors: sulfide > S0> thiosulfate. To understand this preference in the context of light energy availability, an “energy landscape” of phototrophic sulfur oxidation was constructed by varying electron donor identity, light flux, and culture duration. Biomass and cellular parameters ofC. tepidumcultures grown across this landscape were analyzed. From these data, a correction factor for colorimetric protein assays was developed, enabling more accurate biomass measurements forC. tepidum, as well as other organisms.C. tepidum's bulk amino acid composition correlated with energy landscape parameters, including a tendency toward less energetically expensive amino acids under reduced light flux. This correlation, paired with an observation of increased cell size and storage carbon production under electron-rich growth conditions, suggests thatC. tepidumhas evolved to cope with changing energy availability by tuning its proteome for energetic efficiency and storing compounds for leaner times.

IMPORTANCEHow microbes cope with and adapt to varying energy availability is an important factor in understanding microbial ecology and in designing efficient biotechnological processes. We explored the response of a model phototrophic organism,Chlorobaculum tepidum, across a factorial experimental design that enabled simultaneous variation and analysis of multiple growth conditions, what we term the “energy landscape.”C. tepidumbiomass composition shifted toward less energetically expensive amino acids at low light levels. This observation provides experimental evidence for evolved efficiencies in microbial proteomes and emphasizes the role that energy flux may play in the adaptive responses of organisms. From a practical standpoint, our data suggest that bulk biomass amino acid composition could provide a simple proxy to monitor and identify energy stress in microbial systems.
Sedimentary DNA Reveals Cyanobacterial Community Diversity over 200 Years in Two Perialpine Lakes
Authors: Monchamp Marie-Eve , Walser Jean-Claude , Pomati Francesco , Spaak Piet
Published: August 2016

We reconstructed cyanobacterial community structure and phylogeny using DNA that was isolated from layers of stratified sediments spanning 200 years of lake history in the perialpine lakes Greifensee and Lake Zurich (Switzerland). Community analysis based on amplification and sequencing of a 400-nucleotide (nt)-long 16S rRNA fragment specific to
Cyanobacteria
revealed operational taxonomic units (OTUs) capturing the whole phylum, including representatives of a newly characterized clade termed
Melainabacteria
, which shares common ancestry with
Cyanobacteria
and has not been previously described in lakes. The reconstruction of cyanobacterial richness and phylogenetic structure was validated using a data set consisting of 40 years of pelagic microscopic counts from each lake. We identified the OTUs assigned to common taxa known to be present in Greifensee and Lake Zurich and found a strong and significant relationship (adjusted
R
2
= 0.89;
P
< 0.001) between pelagic species richness in water and OTU richness in the sediments. The water-sediment richness relationship varied between cyanobacterial orders, indicating that the richness of
Chroococcales
and
Synechococcales
may be underestimated by microscopy. PCR detection of the microcystin synthetase gene
mcyA
confirmed the presence of potentially toxic cyanobacterial taxa over recent years in Greifensee and throughout the last century in Lake Zurich. The approach presented in this study demonstrates that it is possible to reconstruct past pelagic cyanobacterial communities in lakes where the integrity of the sedimentary archive is well preserved and to explore changes in phylogenetic and functional diversity over decade-to-century timescales.

IMPORTANCE
Cyanobacterial blooms can produce toxins that affect water quality, especially under eutrophic conditions, which are a consequence of human-induced climate warming and increased nutrient availability. Lakes worldwide have suffered from regular cyanobacterial blooms over the last century. The lack of long-term data limits our understanding of how these blooms form. We successfully reconstructed the past diversity of whole cyanobacterial communities over two hundred years by sequencing genes preserved in the sediments of two perialpine lakes in Switzerland. We identified changes in diversity over time and validated our results using existing data collected in the same two lakes over the past 40 years. This work shows the potential of our approach for addressing important ecological questions about the effects of a changing environment on lake ecology.
Orenia metallireducens sp. nov. Strain Z6, a Novel Metal-Reducing Member of the Phylum Firmicutes from the Deep Subsurface
Authors: Dong Yiran , Sanford Robert A. , Boyanov Maxim I. , Kemner Kenneth M. , Flynn Theodore M. , O'Loughlin Edward J. , Chang Yun-juan , Locke Randall A. , Weber Joseph R. , Egan Sheila M. , Mackie Roderick I. , Cann Isaac , Fouke Bruce W.
Published: August 2016

A novel halophilic and metal-reducing bacterium,Orenia metallireducensstrain Z6, was isolated from briny groundwater extracted from a 2.02 km-deep borehole in the Illinois Basin, IL. This organism shared 96% 16S rRNA gene similarity withOrenia marismortuibut demonstrated physiological properties previously unknown for this genus. In addition to exhibiting a fermentative metabolism typical of the genusOrenia, strain Z6 reduces various metal oxides [Fe(III), Mn(IV), Co(III), and Cr(VI)], using H2as the electron donor. Strain Z6 actively reduced ferrihydrite over broad ranges of pH (6 to 9.6), salinity (0.4 to 3.5 M NaCl), and temperature (20 to 60°C). At pH 6.5, strain Z6 also reduced more crystalline iron oxides, such as lepidocrocite (γ-FeOOH), goethite (α-FeOOH), and hematite (α-Fe2O3). Analysis of X-ray absorption fine structure (XAFS) following Fe(III) reduction by strain Z6 revealed spectra from ferrous secondary mineral phases consistent with the precipitation of vivianite [Fe3(PO4)2] and siderite (FeCO3). The draft genome assembled for strain Z6 is 3.47 Mb in size and contains 3,269 protein-coding genes. Unlike the well-understood iron-reducingShewanellaandGeobacterspecies, this organism lacks thec-type cytochromes for typical Fe(III) reduction. Strain Z6 represents the first bacterial species in the genusOrenia(orderHalanaerobiales) reported to reduce ferric iron minerals and other metal oxides. This microbe expands both the phylogenetic and physiological scopes of iron-reducing microorganisms known to inhabit the deep subsurface and suggests new mechanisms for microbial iron reduction. These distinctions from otherOreniaspp. support the designation of strain Z6 as a new species,Orenia metallireducenssp. nov.

IMPORTANCEA novel iron-reducing species,Orenia metallireducenssp. nov., strain Z6, was isolated from groundwater collected from a geological formation located 2.02 km below land surface in the Illinois Basin, USA. Phylogenetic, physiologic, and genomic analyses of strain Z6 found it to have unique properties for iron reducers, including (i) active microbial iron-reducing capacity under broad ranges of temperatures (20 to 60°C), pHs (6 to 9.6), and salinities (0.4 to 3.5 M NaCl), (ii) lack ofc-type cytochromes typically affiliated with iron reduction inGeobacterandShewanellaspecies, and (iii) being the only member of theHalanaerobialescapable of reducing crystalline goethite and hematite. This study expands the scope of phylogenetic affiliations, metabolic capacities, and catalytic mechanisms for iron-reducing microbes.
Invasive meningococcal disease in children in Ireland, 2001–2011
Authors: Ó Maoldomhnaigh Cilian , Drew Richard J , Gavin Patrick , Cafferkey Mary , Butler Karina M
Published: August 2016

Background

In 1999, invasive meningococcal disease was hyperendemic in Ireland at 14.75/100 000 population, with 60% group B and 30% group C diseases. National sepsis guidelines and meningococcal C vaccines were introduced in 2000. Despite a spontaneous decline in group B infection, invasive meningococcal disease remains a leading cause of sepsis. This study characterises the epidemiology of invasive meningococcal disease in children in Ireland since the introduction of meningococcal C vaccine and reviews its clinical presentation, hospital course and outcome in anticipation of meningococcal B vaccine introduction.

Methods

National surveillance data were obtained from the Health Protection Surveillance Centre. A retrospective study of all meningococcal cases at two tertiary paediatric hospitals was conducted from 2001 to 2011. Records were reviewed using a standardised assessment tool. A study of 407 meningococcal cases published in 2002 provided comparative data.

Results

Of 1820 cases <19 years of age notified nationally, 382 (21%) cases attended a study hospital; 94% group B, 3% group C, 225 (59%) male, median age 5 years (range 0.1–18). Fever was absent at presentation in 18%. Fifteen patients (3.6%) died. 221 (61%) were admitted to paediatric intensive care units (PICU). Permanent sequelae occurred in 9.4%. Compared with the historical cohort, there were differences in presentation, an increase in PICU interventions, but no significant decline in morbidity or mortality.

Conclusions

Despite the meningococcal C vaccination campaign, invasive meningococcal disease continues to cause serious morbidity and claim lives. Group B infections remain dominant. As children who die often present with fulminant disease, preventive strategies including use of meningococcal B vaccine are needed to avert death and sequelae.
Impact of symptomatic upper respiratory tract infections on insulin absorption and action of Technosphere inhaled insulin
Authors: Levin Philip A , Heinemann Lutz , Boss Anders , Rosenblit Paul D
Published: August 2016

Objective

Uncomplicated, acute upper respiratory tract infections (URTIs) occur in patients with diabetes at a similar frequency to the general population. This study (NCT00642681) investigated the effect of URTIs on the pharmacokinetic (PK) and pharmacodynamic (PD) properties of Technosphere inhaled insulin (TI) in patients with type 1 or type 2 diabetes.

Research design and methods

This was a phase 2 study conducted in patients who developed a URTI while being treated with TI in a phase 3 study (N=20, mean age 50 years, 60% men). Patients underwent two 4-hour meal challenges, during which blood samples were drawn to measure serum fumaryl diketopiperazine (FDKP; the excipient representing an essential part of TI), serum insulin, serum C-peptide, and plasma glucose. The primary outcome was the ratio of serum FDKP area under the concentration–time curve from 0 to 240 min (AUC0–240 min) during URTI and after clinical resolution of URTI symptoms (≥15 to ≤45 days).

Results

No significant differences in PK parameters were seen during URTI versus post-URTI for FDKP. The ratio of serum FDKP AUC0–240 minduring URTI and post-URTI was 1.1 (SD 0.6), p=0.4462. Plasma glucose concentrations during each 4-hour meal challenge were similar, showing small non-significant differences. No adverse events, including hypoglycemia, occurred during meal challenge visits.

Conclusions

Development of an active, symptomatic URTI during treatment with TI had no significant impact on the PK/PD properties of TI, suggesting that no adjustment in prandial insulin dosing is needed. However, if patients are unable to conduct proper inhalation, they should administer their prandial insulin subcutaneously.

Trial registration number

NCT00642681; Results.
Parity and type 2 diabetes mellitus: a study of insulin resistance and β-cell function in women with multiple pregnancies
Authors: Iversen Ditte Smed , Støy Julie , Kampmann Ulla , Voss Thomas Schmidt , Madsen Lene Ring , Møller Niels , Ovesen Per Glud
Published: August 2016

Objective

Increasing parity may be a risk factor for the development of type 2 diabetes mellitus and the metabolic alterations during a normal pregnancy induces a prediabetic state; thus, multiple pregnancies may act as a risk factor for development of type 2 diabetes if these physiological alterations in glucose homeostasis are not reversed postpartum. We hypothesize that multiple pregnancies may lead to β-cell exhaustion and that the insulin resistance that occurs during pregnancy may persist after multiple births.

Research design and measures

A total of 28 healthy premenopausal women were recruited: 15 high parity women (≥4 children) and 13 body mass index (BMI)-matched and age-matched low parity women (1 and 2 children). The study consisted of an intravenous glucose tolerance test for assessment of β-cell function followed by a hyperinsulinemic euglycemic clamp for assessment of insulin sensitivity. Dual-energy X-ray absorptiometry was performed to assess body composition.

Results

All anthropometric measures, measures of body composition and baseline blood samples were comparable between the 2 groups. Neither first phase insulin release (0–10 min, p=0.92) nor second phase insulin release (10–60 min, p=0.62), both measured as area under the curve, differed between the 2 groups. The M-value, calculated as the mean glucose infusion rate during the last 30 min of the clamp period, was 8.66 (7.70 to 9.63) mg/kg/min in the high parity group compared with 8.41 (7.43 to 9.39) mg/kg/min in the low parity group (p=0.69).

Conclusions

We did not detect any effects of increasing parity on insulin sensitivity or β-cell function.
Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation
Authors: van Gaalen Johanna L , van Bodegom-Vos Leti , Bakker Moira J , Snoeck-Stroband Jiska B , Sont Jacob K
Published: August 2016

Objectives

The aim of this study was to explore barriers among patients, general practitioners (GPs) and practice nurses to implement internet-based self-management support as provided by PatientCoach for asthma in primary care.

Setting

Primary care within South Holland, the Netherlands.

Participants

Twenty-two patients (12 women, mean age 38 years), 21 GPs (6 women, mean age 52 years) and 13 practice nurses (all women, mean age 41 years).

Design

A qualitative study using focus groups and interviews.

Outcomes

Barriers as perceived by patients, GPs and practice nurses to implementation of PatientCoach.

Methods

10 focus groups and 12 interviews were held to collect data: 4 patient focus groups, 4 GP focus groups, 2 practice nurse focus group, 2 patient interviews, 5 GP interviews and 5 practice nurse interviews. A prototype of PatientCoach that included modules for coaching, personalised information, asthma self-monitoring, medication treatment plan, feedback, e-consultations and a forum was demonstrated. A semistructured topic guide was used. Directed content analysis was used to analyse data. Reported barriers were classified according to a framework by Grol and Wensing.

Results

A variety of barriers emerged among all participant groups. Barriers identified among patients include a lack of a patient–professional partnership in using PatientCoach and a lack of perceived benefit in improving asthma symptoms. Barriers identified among GPs include a low sense of urgency towards asthma care and current work routines. Practice nurses identified a low level of structured asthma care and a lack of support by colleagues as barriers. Among all participant groups, insufficient ease of use of PatientCoach, lack of financial arrangements and patient characteristics such as a lack of asthma symptoms were reported as barriers.

Conclusions

We identified a variety of barriers to implementation of PatientCoach. An effective implementation strategy for internet-based self-management support in asthma care should focus on these barriers.
Inclusion of persons with disabilities in systems of social protection: a population-based survey and case–control study in Peru
Authors: Bernabe-Ortiz Antonio , Diez-Canseco Francisco , Vasquez Alberto , Kuper Hannah , Walsham Matthew , Blanchet Karl
Published: August 2016

Objective

This study aims to assess the needs of people with disabilities and their level of inclusion in social protection programmes.

Design

Population based-survey with a nested case–control study.

Setting

Morropon, a semiurban district located in Piura, northern Peru.

Participants

For the population survey, a two-stage sampling method was undertaken using data from the most updated census available and information of each household member aged ≥5 years was collected. In the nested case–control study, only one participant, case or control, per household was included in the study.

Primary and secondary outcome measures

Disability was screened using the Washington Group short questionnaire. A case, defined as an individual aged ≥5 years with disabilities, was matched with one control without disabilities by sex and age (±5 years). Information was collected on socioeconomic status, education, health and rehabilitation and social protection participation.

Results

The survey included 3684 participants, 1848 (50.1%) females, mean age: 36.4 (SD: 21.7). A total of 290 participants (7.9%; 95% CI 7.0% to 8.7%) were classified as having disability. Adults with disabilities were more likely to be single (OR=3.40; 95% CI 1.54 to 7.51) and not to be working (OR=4.36; 95% CI 2.26 to 8.40), while those who did work were less likely to receive the national minimum wage (ie, 750 PEN or about US$265; p=0.007). People with disabilities were more likely to experience health problems. There was no difference between those enrolled in any social protection programme among participants with and without disabilities.

Conclusions

People with disabilities were found to have higher needs for social protection, but were not more likely to be enrolled in social protection programmes. The Peruvian social protection system should consider adding disability status to selection criteria in their cash transfer programmes as well as implementing disability-specific interventions.
Sexual and testing behaviour associated withChlamydia trachomatisinfection: a cohort study in an STI clinic in Sweden
Authors: Veličko Inga , Ploner Alexander , Sparén Pär , Marions Lena , Herrmann Björn , Kühlmann-Berenzon Sharon
Published: August 2016

Background

Genital chlamydia infection (chlamydia) is the most commonly reported sexually transmitted infection (STI) in Sweden. To guide prevention needs, we aimed to investigate factors associated with chlamydia.

Methods

A cohort of visitors aged 20–40 years at an urban STI clinic in Sweden was recruited. Behavioural data were collected using a self-administered questionnaire. Self-sampled specimens were tested for chlamydia by a DNA amplification assay. Statistically significant (p<0.05) and epidemiologically relevant covariates were entered in a multivariate Poisson model adjusted for potential confounders (age and gender). Backward stepwise elimination produced a final model. Multiple imputation was used to account for missing values.

Results

Out of 2814 respondents, 1436 were men with a chlamydia positivity rate of 12.6% vs 8.9% in women. Lifetime testing for chlamydia and HIV was high (82% and 60%, respectively). Factors significantly associated with chlamydia were: 20–24 years old (adjusted risk ratio (ARR)=2.10, 95% CI 1.21 to 3.65); testing reason: contact with a chlamydia case (ARR=6.55, 95% CI 4.77 to 8.98) and having symptoms (ARR=2.19, 95% CI 1.48 to 3.24); 6–10 sexual partners (ARR=1.53, 95% CI 1.06 to 2.21); last sexual activity ‘vaginal sex and oral sex and anal sex and petting’ (ARR=1.84, 95% CI 1.09 to 3.10); alcohol use before sex (ARR=1.98, 95% CI 1.10 to 3.57); men with symptoms (ARR=2.09, 95% CI 1.38 to 3.18); tested for chlamydia (ARR=0.72, 95% CI 0.55 to 0.94).

Conclusions

Risk factors associated with chlamydia were consistent with previous reports in similar settings and suggest no major changes over time. Increased risk for chlamydia infection associated with high-risk behaviour (eg, alcohol use, increased number of sexual partners) supports the need for behavioural interventions in this population such as promotion of safer sex behaviour (condom use) and testing.
Comparative study analysing women's childbirth satisfaction and obstetric outcomes across two different models of maternity care
Authors: Conesa Ferrer Ma Belén , Canteras Jordana Manuel , Ballesteros Meseguer Carmen , Carrillo García César , Martínez Roche M Emilia
Published: August 2016

Objectives

To describe the differences in obstetrical results and women's childbirth satisfaction across 2 different models of maternity care (biomedical model and humanised birth).

Setting

2 university hospitals in south-eastern Spain from April to October 2013.

Design

A correlational descriptive study.

Participants

A convenience sample of 406 women participated in the study, 204 of the biomedical model and 202 of the humanised model.

Results

The differences in obstetrical results were (biomedical model/humanised model): onset of labour (spontaneous 66/137, augmentation 70/1, p=0.0005), pain relief (epidural 172/132, no pain relief 9/40, p=0.0005), mode of delivery (normal vaginal 140/165, instrumental 48/23, p=0.004), length of labour (0–4 hours 69/93, >4 hours 133/108, p=0.011), condition of perineum (intact perineum or tear 94/178, episiotomy 100/24, p=0.0005). The total questionnaire score (100) gave a mean (M) of 78.33 and SD of 8.46 in the biomedical model of care and an M of 82.01 and SD of 7.97 in the humanised model of care (p=0.0005). In the analysis of the results per items, statistical differences were found in 8 of the 9 subscales. The highest scores were reached in the humanised model of maternity care.

Conclusions

The humanised model of maternity care offers better obstetrical outcomes and women's satisfaction scores during the labour, birth and immediate postnatal period than does the biomedical model.
Consumption of fruits and vegetables and associations with risk factors for non-communicable diseases in the Yangon region of Myanmar: a cross-sectional study
Authors: Kjøllesdal Marte , Htet Aung Soe , Stigum Hein , Hla Ne Yi , Hlaing Hlaing Hlaing , Khaine Ei Kay , Khaing Win , Khant Aung Kyaw , Khin Naw Ohn Khin , Mauk Kay Khine Aye , Moe Ei Ei , Moe Hla , Mon Kyawt Kyawt , Mya Kyaw Swa , Myint Chomar Kaung , Myint Cho Yi , Myint Maung Maung , Myint Ohnmar , New Aye Aye , Oo Ei Sanda , Oo Khin Sandar , Pyone Zin Zin , Soe Yin Yin , Wai Myint Myint , Win Nilar , Bjertness Espen
Published: August 2016

Objectives

To explore the intake of fruits and vegetables in the Yangon region, Myanmar, and to describe associations between intake of fruits and vegetables (FV) and established risk factors for non-communicable diseases.

Design

2 cross-sectional studies, using the STEPs methodology.

Setting

Urban and rural areas of the Yangon region of Myanmar.

Participants

1486, men and women, 25–74 years, were recruited through a multistage cluster sampling method. Institutionalised people, military personnel, Buddhist monks and nuns were not invited. Physically and mentally ill people were excluded.

Results

Mean intake of fruit was 0.8 (SE 0.1) and 0.6 (0.0) servings/day and of vegetables 2.2 (0.1) and 1.2 (0.1) servings/day, in urban and rural areas, respectively. Adjusted for included confounders (age, sex, location, income, education, smoking and low physical activity), men and women eating ≥2 servings of fruits and vegetables/day had lower odds than others of hypertriglyceridaemia (OR 0.72 (95% CI 0.56 to 0.94)). On average, women eating at least 2 servings of fruits and vegetables per day had cholesterol levels 0.28 mmol/L lower than the levels of other women. When only adjusted for sex and age, men eating at least 2 servings of fruits and vegetables per day had cholesterol levels 0.27 mmol/L higher than other men.

Conclusions

A high intake of FV was associated with lower odds of hypertriglyceridaemia among men and women. It was also associated with cholesterol levels, negatively among women and positively among men.
Near-infrared fluorescence cholangiography assisted laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy (FALCON trial): study protocol for a multicentre randomised controlled trial
Authors: van den Bos Jacqueline , Schols Rutger M , Luyer Misha D , van Dam Ronald M , Vahrmeijer Alexander L , Meijerink Wilhelmus J , Gobardhan Paul D , van Dam Gooitzen M , Bouvy Nicole D , Stassen Laurents P S
Published: August 2016

Introduction

Misidentification of the extrahepatic bile duct anatomy during laparoscopic cholecystectomy (LC) is the main cause of bile duct injury. Easier intraoperative recognition of the biliary anatomy may be accomplished by using near-infrared fluorescence (NIRF) imaging after an intravenous injection of indocyanine green (ICG). Promising results were reported for successful intraoperative identification of the extrahepatic bile ducts compared to conventional laparoscopic imaging. However, routine use of ICG fluorescence laparoscopy has not gained wide clinical acceptance yet due to a lack of high-quality clinical data. Therefore, this multicentre randomised clinical study was designed to assess the potential added value of the NIRF imaging technique during LC.

Methods and analysis

A multicentre, randomised controlled clinical trial will be carried out to assess the use of NIRF imaging in LC. In total, 308 patients scheduled for an elective LC will be included. These patients will be randomised into a NIRF imaging laparoscopic cholecystectomy (NIRF-LC) group and a conventional laparoscopic cholecystectomy (CLC) group. The primary end point is time to ‘critical view of safety’ (CVS). Secondary end points are ‘time to identification of the cystic duct (CD), of the common bile duct, the transition of CD in the gallbladder and the transition of the cystic artery in the gallbladder, these all during dissection of CVS’; ‘total surgical time’; ‘intraoperative bile leakage from the gallbladder or cystic duct’; ‘bile duct injury’; ‘postoperative length of stay’, ‘complications due to the injected ICG’; ‘conversion to open cholecystectomy’; ‘postoperative complications (until 90 days postoperatively)’ and ‘cost-minimisation’.

Ethics and dissemination

The protocol has been approved by the Medical Ethical Committee of Maastricht University Medical Center/Maastricht University; the trial has been registered at ClinicalTrials.gov. The findings of this study will be disseminated widely through peer-reviewed publications and conference presentations.

Trial registration number

NCT02558556.
Systematic review and meta-analysis of randomised controlled trials on the effects of potassium supplements on serum potassium and creatinine
Authors: Cappuccio Francesco P , Buchanan Laura A , Ji Chen , Siani Alfonso , Miller Michelle A
Published: August 2016

Objectives

High potassium intake could prevent stroke, but supplementation is considered hazardous. We assessed the effect of oral potassium supplementation on serum or plasma potassium levels and renal function.

Setting

We updated a systematic review of the effects of potassium supplementation in randomised clinical trials carried out worldwide, published in 2013, extending it to July 2015. We followed the PRISMA guidelines.

Participants

Any individual taking part in a potassium supplementation randomised clinical trial. Studies included met the following criteria: randomised clinical trials, potassium supplement given and circulating potassium levels reported.

Intervention

Oral potassium supplementation.

Primary outcome measures

Serum or plasma potassium and serum or plasma creatinine.

Results

A total of 20 trials (21 independent groups) were included (1216 participants from 12 different countries). All but 2 were controlled (placebo n=16, control n=2). Of these trials, 15 were crossover, 4 had a parallel group and 1 was sequential. The duration of supplementation varied from 2 to 24 weeks and the amount of potassium given from 22 to 140 mmol/day. In the pooled analysis, potassium supplementation caused a small but significant increase in circulating potassium levels (weighted mean difference (WMD) 0.14 mmol/L, 95% CI 0.09 to 0.19, p<1×10−5), not associated with dose or duration of treatment. The average increase in urinary potassium excretion was 45.75 mmol/24 hours, 95% CI 38.81 to 53.69, p<1×10−5. Potassium supplementation did not cause any change in circulating creatinine levels (WMD 0.30 µmol/L, 95% CI −1.19 to 1.78, p=0.70).

Conclusions

In short-term studies of relatively healthy persons, a moderate oral potassium supplement resulted in a small increase in circulating potassium levels and no change in renal function.