A municipal health center's co-constructed therapeutic patient education program for patients with single or multiple morbidities / Co-construction d'un dispositif d'ETP mono et polypathologique dans un centre municipal de santé

Introduction: The accessibility of Therapeutic Patient Education (TPE) is essential to reduce social inequalities and to meet the challenges posed by the increase in chronic diseases. In France, the distribution of TPE throughout the territory is heterogeneous and patients still lack sufficient access. With these perspectives in mind, a municipal health center has developed an innovative TPE device by involving concerned patients from the outset. Objectives: The objectives of this article are to present the methodology implemented to co-construct a TPE program for patients with one or more prevalent diseases in the territory, as well as the results of the co-construction. Methods: Creation of a project team with various actors: patients, health professionals, administrators, researchers. Organization of synchronous and asynchronous times. Results: Four meetings and numerous exchanges made it possible to: define the common values and operating rules of the project team, reflect on the coordination of the care pathway, identify the specific and shared needs of patients affected by type 2 diabetes, arterial hypertension and/or obesity, agree on the principles of the device. Conclusion: The advantages of this device were discussed: flexible organization with numerous links with local actors, development of partnerships, expansion of the population concerned. Questions and difficulties were encountered, such as the coordination of actors and the representation of partner patients for the targeted diseases. This device will be tested and evaluated, mainly with an objective of improving it.

Introduction: L'accessibilité de l'Éducation Thérapeutique du Patient (ETP) est essentielle pour contribuer à une réduction des inégalités sociales et répondre aux défis posés par l'accroissement des maladies chroniques. En France, la répartition de l'offre d'ETP sur le territoire est inhomogène et les patients y occupent une place encore trop modeste. Dans ces perspectives, un centre municipal de santé a élaboré un dispositif innovant d'ETP en impliquant, dès le début, des patients concernés. Objectifs: Les objectifs de cet article sont de présenter la méthodologie mise en œuvre pour co-construire un dispositif d'ETP pour des patients porteurs d'une ou de plusieurs maladies prévalentes sur le territoire, ainsi que les résultats de la co-construction. Méthodes: Constitution d'une équipe projet avec divers acteurs : patients, professionnels de santé, administratifs, chercheurs. Organisation de temps synchrones et asynchrones. Résultats: Quatre réunions et de nombreux échanges ont permis de : définir les valeurs communes et les règles de fonctionnement de l'équipe projet, réfléchir sur la coordination du parcours de soins, identifier des besoins propres et partagés des patients touchés par le diabète de type 2, l'hypertension artérielle et/ou l'obésité, se mettre d'accord sur les principes du dispositif. Conclusion: Ce dispositif présente des avantages certains : organisation souple avec de nombreux liens avec les acteurs locaux, développement du partenariat, élargissement de la population concernée. Néanmoins, des questionnements et des difficultés ont été rencontrés comme la coordination des acteurs et la représentation des patients partenaires pour les maladies ciblées. Ce dispositif sera expérimenté et évalué principalement en vue de son amélioration.

Physiological and Proteomic Studies of the Cyanobacterium Anabaena sp. Acclimated to Desiccation Stress.

Agricultural productivity is threatened by increasing incidence of drought and the drought tolerant cyanobacteria offer a better solution in the restoration of soil fertility and productivity. The present study describes the comparative physiological response of the cyanobacterium Anabaena sp. acclimated and un-acclimated to desiccation stress induced by polyethylene glycol (10% PEG). While, the acclimated cyanobacterial cells grew luxuriantly with optimal chlorophyll content, photosynthetic activities and nitrogen fixation, the un-acclimated cells exhibited reduced growth rate, chlorophyll content, photosynthetic activities and nitrogen fixation. Distinct differences in the accumulation of lipid peroxidation products, proline and activity of superoxide dismutase were observed under identical growth conditions in the acclimated and un-acclimated cells. Desiccation-acclimated and un-acclimated cyanobacteria showed significant alterations in the abundance of important proteins in the proteome. Two-dimensional gel electrophoresis followed by MALDI-TOF-MS/MS analysis identified twelve proteins. The acclimated cells showed the up regulation of proteins such as Rubisco, fructose-bis-phosphate aldolase, fructose 1-6 bisphosphatase, phosphoglycerate dehydrogenase and elongation factors Tu and Ts as compared to un-acclimated cells. Therefore, the ability to maintain photosynthesis, antioxidants and increased accumulation of proteins related to energy metabolism helped the acclimated cyanobacterium Anabaena sp. to grow optimally under desiccation stress conditions.

Isolation and characterization of high temperature tolerant mutant from the cyanobacterium Anabaena doliolum.

The mutant strain of the diazotrophic cyanobacterium Anabaena doliolum able to tolerate high temperature was isolated by induced mutation techniques using ethyl methane sulphonate. This mutant strain exhibited higher temperature tolerance than the wild type. The wild type was able tolerate temperature up to 40 °C whereas the mutant was able to grow at an elevated temperature of 48 °C. This mutant exhibited higher growth rate, heterocyst frequency, and nitrogen fixation. Mutant strains exhibited comparable levels of chlorophyll, phycocyanin, PS II activity, and O2 evolution as compared to unexposed control. Results also showed that the mutant accumulated low levels of peroxides and lipid peroxidation products with enhanced activity of antioxidant enzymes. The FAME analysis revealed quantitative and qualitative changes in the profile of fatty acids in the mutant strain. Maximum number of saturated fatty acids was observed in the mutant strain followed by control whereas the wild type exposed to elevated temperature showed least diversity of fatty acids. Enhanced level of antioxidant enzymes coupled with efficient modulation of fatty acid profile could therefore enhance the mutant to resist the high temperature stress. The results could be exploited further to decipher molecular mechanisms underlying the temperature tolerance and enhancing the utility of A. doliolum as efficient biofertilizer for rice paddy keeping in view of the future climatic change scenario.

Physico-chemical factors influencing spore germination in cyanobacterium Fischerella muscicola.

Spore (akinete) formation in the heterocystous and branched filamentous cyanobacterium Fischerella muscicola involves a significant increase in cell size and formation of several endospores in each of the cells. In present study, the physico-chemical factors (pH, light sources, nutrient deficiency, nitrogen sources, carbon sources, and growth hormones) affecting the germination of spores of F. muscicola were examined. Increase in spore germination frequency was detected above pH 8 with maximum germination (46.04%) recorded at pH 9, whereas a significant decrease in germination was observed at pH 6 when compared to control (pH 7.6). Spore germination was not observed at pH 5. Among light sources germination frequency followed the following order, that is, red light (39.9%) > white light (33.8%) > yellow light (3.4%) > green light (1.3%) whereas germination did not take place in dark and blue light. Ammonium chloride (NH4 Cl) supported maximum (99.5%) germination frequency followed by calcium nitrate (Ca(NO3 )2 ), potassium nitrate (KNO3 ), and minimum germination was observed in urea. Nutrient (phosphorus, calcium, and magnesium) deficiency significantly enhanced the germination frequency with maximum increase in magnesium (Mg) deficient condition. Further, supplementation of carbon sources (glucose, fructose, and sodium acetate) and growth hormones (IAA and GA) also enhanced the germination frequency in this cyanobacterium. Therefore, it may be concluded that, those factors supporting higher germination frequency could be considered for successful production and use of this cyanobacterium in biofertilizer and other algal production technologies.

Isolation and characterization of high protein and phycocyanin producing mutants of Arthrospira platensis.

Cyanobacteria are known to exhibit their efficiency in producing high concentrations of compounds of commercial value. Arthrospira is one such cyanobacterium which is considered as important source of protein (65%) and other nutrients. In present study, chemical mutagenesis using N-methyl-N-Nitro-nitrosoguanidine (NTG), a proven potent mutagen for cyanobacteria was used to bring stable and desirable alteration in Arthrospira platensis ARM 730. Three morphological mutants (G-1, G-2, and SF) were selected and characterized. The G-1 and G-2 were helical, more bluish in pigmentation than the wild type strain where G-1 also showed enlarged cell size. The SF mutant was an altered straight-filament having maximum biomass. Among three mutants, higher protein and phycocyanin contents were observed in G-1 and G-2 mutants whereas chlorophyll was less in these mutants as compared to wild type strain indicating change in the pigment ratio. Carotenoid content was higher in SF mutant as compared to wild type and other mutants. Variation in total sugar content was not observed in comparison to wild type strain. The analysis of amino acid spectrum of all the mutants and wild type showed significant increase in proline content. Overall, it is revealed from the results that G-1 and G-2 mutants showed higher biomass, phycocyanin, and protein contents in comparison to wild type which indicated their great potential to be used in food and pharmaceutical industries.

Comparative Analysis of Soybean Root Proteome Reveals Molecular Basis of Differential Carboxylate Efflux under Low Phosphorus Stress.

Carboxylate efflux from roots is a crucial and differential response of soybean genotypes to low phosphorus (P) stress. Exudation of carboxylic acids including oxalate, citrate, succinate and fumarate was induced under low P stress, particularly in P-efficient soybean genotypes. Enhancement of root length, surface area and volume further improved P acquisition under low P stress. To understand the molecular basis of carboxylate efflux under low P stress, the root proteome of contrasting genotypes (P-efficient: EC-232019 and P-inefficient: EC-113396) was compared. Among a total of 325 spots, 105 (32%) were differentially abundant proteins (DAPs) between sufficient (250 µM) and low P (4 µM) levels. Abundance of 44 (14%) proteins decreased by more than two-fold under low P stress, while 61 (19%) proteins increased by more than two-fold. Protein identification and annotation revealed that the DAPs were involved in a myriad of functions including carboxylic acid synthesis, carbohydrate, protein and lipid metabolism. Proteins with significant abundance included malate dehydrogenase, isocitrate dehydrogenase, phosphoglucomutase, phosphoglycerate mutase, fructokinase, enolase, phosphoglycerate kinase, triosephosphate isomerase, alcohol dehydrogenase, glucan water dikinase, glutamine synthetase and argininosuccinate lyase. Inferences from proteomic analysis suggests the crosstalk between various metabolic pathways implicated in conferring superior P acquisition efficiency under stress.

Salinity-induced inhibition of growth in the aquatic pteridophyte Azolla microphylla primarily involves inhibition of photosynthetic components and signaling molecules as revealed by proteome analysis.

Salinity stress causes adverse physiological and biochemical changes in the growth and productivity of a plant. Azolla, a symbiotic pteridophyte and potent candidate for biofertilizer due to its nitrogen fixation ability, shows reduced growth and nitrogen fixation during saline stress. To better understand regulatory components involved in salinity-induced physiological changes, in the present study, Azolla microphylla plants were exposed to NaCl (6.74 and 8.61 ds/m) and growth, photochemical reactions of photosynthesis, ion accumulation, and changes in cellular proteome were studied. Maximum dry weight was accumulated in control and untreated plant while a substantial decrease in dry weight was observed in the plants exposed to salinity. Exposure of the organism to different concentrations of salt in hydroponic conditions resulted in differential level of Na+ and K+ ion accumulation. Comparative analysis of salinity-induced proteome changes in A. microphylla revealed 58 salt responsive proteins which were differentially expressed during the salt exposure. Moreover, 42 % spots among differentially expressed proteins were involved in different signaling events. The identified proteins are involved in photosynthesis, energy metabolism, amino acid biosynthesis, protein synthesis, and defense. Downregulation of these key metabolic proteins appears to inhibit the growth of A. microphylla in response to salinity. Altogether, the study revealed that in Azolla, increased salinity primarily affected signaling and photosynthesis that in turn leads to reduced biomass.

Salinity induced physiological and biochemical changes in the freshly separated cyanobionts of Azolla microphylla and Azolla caroliniana.

Freshly separated cyanobionts of Azolla microphylla and Azolla caroliniana plants exposed to salinity showed decline in the cellular constituents such as chlorophyll (23.1 and 38.9%) and protein (12.9 and 19.3%). However, an increase in the carotenoid and sugar content was observed. Exposure to salinity stress reduced the heterocyst frequency (35.4 and 57.2%) and nitrogenase activity (37.7 and 46.3%) of the cyanobionts. Increase in the activity of antioxidant enzymes such as super oxide dismutase (50.6 and 11.5%), ascorbate peroxidase (63.7 and 57.9%), catalase (94.2 and 22.5%) as well as non-enzymatic antioxidant proline (18.8 and 13.3%) was also observed in response to salinity. The cyanobionts exhibited significant increase in the intracellular Na(+) level and reduced intracellular K(+)/Na(+) and Ca(2+)/Na(+) ratio in response to salinity. The results demonstrate the adverse impact of salinity on the freshly separated cyanobionts as similar to free living cyanobacteria. These results may be helpful in the critical evaluation of salinity tolerance mechanism of the cyanobiont and its interaction with the host.

Nitrogen-Deficiency Stress Induces Protein Expression Differentially in Low-N Tolerant and Low-N Sensitive Maize Genotypes.

Nitrogen (N) is essential for proper plant growth and its application has proven to be critical for agricultural produce. However, for unavoidable economic and environmental problems associated with excessive use of N-fertilizers, it is an urgent demand to manage application of fertilizers. Improving the N-use efficiency (NUE) of crop plants to sustain productivity even at low N levels is the possible solution. In the present investigation, contrasting low-N sensitive (HM-4) and low-N tolerant (PEHM-2) genotypes were identified and used for comparative proteome-profiling of leaves under optimum and low N as well as restoration of low N on 3rd (NR3) and 5th (NR5) days after re-supplying N. The analysis of differential expression pattern of proteins was performed by 2-D gel electrophoresis. Significant variations in the expression of proteins were observed under low N, which were genotype specific. In the leaf proteome, 25 spots were influenced by N treatment and four spots were different between the two genotypes. Most of the proteins that were differentially accumulated in response to N level and were involved in photosynthesis and metabolism, affirming the relationship between N and carbon metabolism. In addition to this, greater intensity of some defense proteins in the low N tolerant genotype was found that may have a possible role in imparting it tolerance under N starvation conditions. The new insights generated on maize proteome in response to N-starvation and restoration would be useful toward improvement of NUE in maize.

Heterologous expression of Aspen PTM3, a MADS box gene in cotton.

The PTM3 gene of Aspen was ectopically expressed in cotton to explore the opportunity to introduce desirable agronomic traits with the potential to improve yield and modify the duration of the parent cotton variety. Sixty-seven transgenic cotton lines expressing Aspen PTM3 (MADS box) gene were developed. The transgenic cotton lines expressing PTM3 gene showed earliness of 4-15 days variations in flowering and maturity. The transgenic lines were confirmed by kanamycin leaf paint assay, GUS assay and PCR. Among 67 transgenic lines, the event-10 showed profuse branching, event-24 showed abnormal growth and the remaining events exhibited single erect phenotype. In addition, the event-24 produced no flower and this might be due to the positional effect of PTM3 gene integration. Southern blot analysis performed for event-10, 24 and 48 showed distinct single copy integrations of PTM3 gene cassette. GUS assay performed using various plant parts of event-10 showed constitutive expression of the transgene. In view of cotton breeding, among all the events, the event-10 was found to be phenotypically significant with earliness of 12 days in flowering and 15 days in maturity and yield enhancement of 27%. In addition, the event-10 showed no square dropping and allowed the plants to bear more number of bolls. Based on these results, event-10 was chosen to carry out the inheritance study of expressed characters in the progeny.

Induction of salt tolerance in Azolla microphylla Kaulf through modulation of antioxidant enzymes and ion transport.

Azolla microphylla plants exposed directly to NaCl (13 dsm(-1)) did not survive the salinity treatment beyond a period of one day, whereas plants exposed directly to 4 and 9 dsm(-1) NaCl were able to grow and produce biomass. However, plants pre-exposed to NaCl (2 dsm(-1)) for 7 days on subsequent exposure to 13 dsm(-1) NaCl were able to grow and produce biomass although at a slow rate and are hereinafter designated as pre-exposed plants. The pre-exposed and directly exposed plants distinctly differed in their response to salt in terms of lipid peroxidation, proline accumulation, activity of antioxidant enzymes, such as SOD, APX, and CAT, and Na(+)/K(+) ratio. Efficient modulation of antioxidant enzymes coupled with regulation of ion transport play an important role in the induction of salt tolerance. Results show that it is possible to induce salt adaptation in A. microphylla by pre-exposing them to low concentrations of NaCl.