Protein extracted from Moringa oleifera Lam. Leaves: Bio-evaluation and characterization as suitable plant-based meat-protein alternative.

This study aimed to isolate and characterize moringa leaf protein (MLP) via HPLC and evaluate its consumption's effects through rat model. Four groups of Albino Wistar rats (n = 25 each) along with a control group (n = 25) were acclimatized. The isolated MLP was added to the basal diet (casein; control) in various percentages (25, 50, 75, 100%) for a 21-day experimental period. On three intervals (1st, 11th, 21st days), blood samples were collected and subjected for hematological and biochemical examination (Renal Function Test (RFT), Liver Function Test (LFT)). MLP contained a variety of essential and non-essential amino acids in substantial amounts. The Protein Efficiency Ratio (PER) of 50% MLP-treated group was the highest (1.72) among MLP treatments. Increases in feed intake and weight were observed in treated rats compared to the control. The hematological profile of the rats revealed increases in Hemoglobin (Hb) (7.9-14.0%), White Blood Cell (WBC) (35.9-51.5%), Red Blood Cell (RBC) (17.1-22.2%), Hematocrit (HCT) (13.1-22.9%), and platelets levels (36.5-40.6%) from day 1. Protein isolates decreased liver parameters but resulted in non-significant changes in liver and kidney functions in rats. Further investigation is needed to determine the safe daily intake of MLP.

Community-Based Pediatric Palliative Care: How Services Support Children's and Families' Quality of Life.

Background: The Massachusetts Department of Public Health's Pediatric Palliative Care Network (PPCN) provides Community-Based Pediatric Palliative Care (CBPPC) to children with life-limiting conditions and their families. CBPPC services aim to improve children and families' quality of life (QOL). Objectives: To identify perceived domains of QOL important for children and families and to understand whether and how CBPPC supports QOL. Design: A community-based participatory research framework was used to develop recruitment and data collection materials for eight focus groups and seven interviews. Collected data were transcribed and analyzed with an inductive approach. Setting/Subjects: A convenience sample of 33 PPCN caregivers, 20 providers, and seven key informants, including policymakers, community organizations, and hospital-based clinicians, were interviewed virtually in the United States. Measurements: Perceived QOL domains for children and families, respectively, and perceived impact of CBPPC services on QOL. Results: Reported QOL domains described as important for children were socialization/community integration and accessibility; expression/play; and physical wellness. Control or autonomy, psycho-emotional wellness, and self-care were identified as important for families. Clinical services were described as "integral to mental health" through offered spiritual support; advocacy in the community; and education. PPCN's integrative services were noted as distractions from pain and helped improve communication and bonding. Sibling support and bereavement care were also mentioned as impactful on QOL. Conclusions: Family-centered CBPPC was described as supportive of children's and families' QOL. Future studies should consider using population-based QOL measures, leveraging the QOL domains identified through this analysis and other outcome measures in a cost-effectiveness analysis.

Excellent ultraviolet optical limiting properties of Se nanosheets.

Selenium (Se) is located in the fourth period of the periodic table in group VIA (element 34). In this experiment, three different solvents (isopropyl alcohol, N-methyl-2-pyrrolidone, and ethanol) were used to prepare the two-dimensional Se nanosheets, which were manufactured by the liquid phase exfoliation method with a thickness of 3.35-4.64 nm and a transverse scale of several hundred nanometers. The nonlinear absorption properties at 355, 532, and 1064 nm were studied using the open apertureZ-scan technique. Final results showed that Se nanosheets exhibited optical limiting (OL) effect in all three wavebands and three solvents, and had large two-photon absorption coefficients, especially in ultraviolet (UV) waveband. Which proved that Se nanosheets had great potential application as excellent OL materials in UV waveband. Our research broadens the path for the semiconductor field of Se, inspires the application of Se in nonlinear optics field.

Paediatric palliative care for the generalist.

Palliative care has been defined as 'the active holistic care of individuals across all ages with serious health-related suffering due to severe illness, and especially of those near the end of life'. Unfortunately, palliative care and especially paediatric palliative care remain a neglected area of medicine and are widely misunderstood, with few healthcare providers having any formal training in South Africa. To relieve health-related suffering, healthcare providers must understand that the field is not limited to end-of-life care for the terminally ill, and holistic care (physical, emotional, social and spiritual) should commence at the time of diagnosis of a serious illness. It is imperative that all healthcare providers develop the knowledge and skills to provide this essential care across all levels of care and disciplines. The article aims to raise awareness and show how to practically implement palliative care through case studies.

Use of preventive medication and supplements in general practice in patients in their last year of life: a Retrospective cohort study.

BACKGROUND: Several preventive medications and supplements become inappropriate in the last phase of life due to increased risk of adverse events caused by changed pharmacokinetics, drug-drug interactions, and changed care goals. Information on these preventive medication and supplements use in patients with a life-limiting illness in the home-care setting is limited. The primary aim of this study was to assess the use of four different groups of preventive drugs and supplements, which are inappropriate in adult patients with a life-limiting illness, living at home in the last year of life. The secondary aims were to assess reasons for discontinuing these drugs as documented in the general practitioners' patient file and whether these reasons affected the time between medication discontinuation and death. METHODS: We performed a retrospective cohort study using the routine primary care database of the Julius General Practitioners' Network of the University Medical Centre Utrecht, a database consisting of routine care data from GPs from the city of Utrecht and its vicinity. Patients in the homecare setting with a life-limiting illness, diagnosed at least one year before death, were included. Descriptive analyses were used to describe the study population and the frequency of starting, using, and discontinuing medication and supplements in the last year of life. RESULTS: A total of 458 of 666 included patients (69%) used at least one preventive drug in the last year of life. Vitamins were used by 36% of the patients, followed with 35% using cholesterol-lowering medication, 24% using calcium supplements and 9% using bisphosphonates. Bisphosphonates were discontinued by 70% of the users, calcium supplements by 61%, vitamins by 56% and cholesterol-lowering medication by 48% of the users, with a median interval between day of discontinuation and death of 119, 60, 110 and, 65 days, respectively. The median time between medication or supplement discontinuation and death was longest in patients with side effects and who had medication reviews. CONCLUSION: Many patients in their last phase of life in the home-care setting use inappropriate medication and supplements. Timely medication review may contribute to optimise medication use in the last year of life.

Bean softening during hydrothermal processing is greatly limited by pectin solubilization rather than protein denaturation or starch gelatinization.

The rate liming step of bean softening during cooking was evaluated. Red kidney beans (fresh/non-aged and aged) were cooked at different temperatures (70-95 °C) and their texture evolution established. Softening of beans (loss of hard texture) with cooking and increasing cooking temperature was evident at ≥ 80 °C more so for non-aged than aged beans, evidencing hard-to-cook development during storage. Beans at each cooking time and temperature were subsequently classified into narrow texture ranges and bean cotyledons in the most frequent texture class evaluated for the extent of starch gelatinization, protein denaturation and pectin solubilization. During cooking, starch gelatinization was shown to precede pectin solubilization and protein denaturation, with these reactions progressing faster and to a greater extent with increasing cooking temperature. At 95 °C for instance (practical bean processing temperature), complete starch gelatinization and protein denaturation is attained earlier (∼10 and 60 min cooking, respectively and at comparable time moments for both non-aged and aged beans) than plateau bean texture (∼120 and 270 min for non-aged and aged beans)/plateau pectin solubilization. The extent of pectin solubilization in the cotyledons was consequently most correlated (negatively, r = 0.95) with and plays the most significant role (P < 0.0001) in directing the relative texture of beans during cooking. Ageing was shown to significantly retard bean softening. Protein denaturation plays a less significant role (P = 0.007) while the contribution of starch gelatinization is insignificant (P = 0.181). Thermo-solubilization of pectin in bean cotyledons is therefore the rate limiting step of bean softening towards attaining a palatable texture during cooking.

Life-limiting fetal conditions: Are Australian student midwives prepared? A mixed-methods survey.

AIM: To document current teaching methods, curriculum, and perceived educational preparation related to the teaching of life-limiting fetal conditions, termination, and perinatal palliative care to Australian student midwives. BACKGROUND: Australian women receiving a diagnosis of a life-limiting fetal condition are generally offered a choice between termination of pregnancy and perinatal palliative care. Midwives are often involved with caring for these women. What Australian student midwives are being taught about life-limiting fetal conditions, termination of pregnancy, and perinatal palliative care during their entry-to-practice program is unknown. DESIGN: This study utilised a mixed-methods descriptive approach for data collection and analysis. METHODS: Academic Leads of all Australian entry-to-practice midwifery programs received a questionnaire exploring topics taught, teaching time, teacher role, and perceived effectiveness of student preparation. Data was analysed statistically and thematically. RESULTS: Twelve of 24 Academic Leads responded (50%); only five stated their programs taught all three areas. More respondents taught about termination of pregnancy (10/12) than perinatal palliative care (7/12). On average 5.8 ( ± 2.8) total hours was spent teaching about life-limiting fetal conditions, termination of pregnancy, and perinatal palliative care during the entire midwifery program, with a range of 1 - 10 h. The free-text data identified three central themes: lack of value within the curriculum; disconnect between the university and the placement hospital; and preparation for practice. Most (10/12) Academic Leads did not believe student midwives are prepared to care for affected families. CONCLUSIONS: Entry-to-practice midwifery programs vary considerably in their education surrounding life-limiting fetal conditions, however teaching hours overall were low and most Academic leads did not feel (or know if) their students were adequately prepared. Further research is required to determine if early career midwives find their university education in life-limiting fetal conditions adequate preparation for practice, and to then remediate identified deficiencies.

Atorvastatin attenuates allergic inflammation by blocking prostaglandin biosynthesis in rats with allergic rhinitis.

BACKGROUND: Prostaglandins (PGs) are bioactive lipid mediators derived from the nuclear and plasma membranes via the cyclooxygenase (COX) pathway of arachidonic acid (AA) metabolism. PGs bridge the interactions between various immunomodulatory cells in allergic rhinitis (AR) and are considered key players in regulating pro-inflammatory and anti-inflammatory responses. AA conversion to PGs involves rate-limiting enzymes that may be blocked by statins. The mechanisms by which statins regulate these enzymes in AR remain unclear. We investigated the effects of oral atorvastatin on PGs production in AR. METHODS: An ovalbumin-induced AR rat model was constructed and the changes in nasal symptom score and nasal mucosa histopathological characteristics of AR rats under different atorvastatin doses were assessed. qRT-PCR, western blotting, and immunofluorescence were used to detect the mRNA and protein expression levels of rate-limiting enzymes and downstream molecules of AA metabolism in the nasal mucosa and liver. RESULTS: Oral atorvastatin significantly alleviated symptoms and eosinophil infiltration in the nasal mucosa, inhibited goblet cell hyperplasia and mast cell recruitment, and decreased mucus secretion in AR rats. Increasing atorvastatin dose increased the anti-inflammatory effects. High-dose atorvastatin inhibited upregulation of the inflammatory mediator PGD2 in the nasal mucosa of AR rats. Compared to the control group, the mRNA and protein expression of the rate-limiting enzymes COX-2, PGDS, and PGES in AA metabolism in the AR group were upregulated but downregulated after the oral administration of high-dose atorvastatin. Atorvastatin also showed dose-dependent inhibition of ERK1/2 and downstream NF-κB phosphorylation in the nasal mucosa and liver of AR rats. CONCLUSIONS: Atorvastatin inhibited allergic inflammation and attenuated AR nasal symptoms by downregulating PGD2 and rate-limiting enzyme expression in PGD2 biosynthesis, possibly by blocking the RAS/ERK/NF-κB signaling pathway.

Palliative care services for children with life-limiting conditions.

BACKGROUND: Palliative care (PC) for children with life-limiting conditions (LLC) is a holistic approach to achieve the best quality of life. AIMS: Highlighting collaboration between pediatric and PC services is essential in providing seamless care. METHODS: Retrospective data obtained including patient cohort, disease profile, place of death, and the resource requirements for children with a LLC in the Mid-West region of Ireland over a 7-year period. RESULTS: Seventy-seven patients were identified (n = 77); five still receiving care, four discharged, and 68 have died. The cohort ranged in age from 1 day to 17 years with a mean of approximately 6 years. Thirty-five percent of patients were less than 1 year old. Fifty-one percent were male. Seventy-one percent were referred initially to PC for end-of-life care and 29% for symptom management. Forty-four percent had home support services in place prior to referral to PC. An advanced care plan was created for 65%. Of those that died (n = 68), 70.5% died at home, 25% in hospital, and 4.4% in residential care or a children's hospice. The clinical nurse coordinator for children with life-limiting conditions (CNCCLLC) was involved with 88% of patients. The specialist PC teams were involved with 87%; 65 patients had community support, 31 patients had in-hospital support, and 29 patients were seen by both hospital and community services. CONCLUSIONS: Our study highlights the growing number of LLCs and current pediatric and PC services require further resources and development.

Nitrogen and phosphorus spatio-temporal distribution and fluxes intensifying eutrophication in three tropical rivers of Côte d'Ivoire (West Africa).

Nutrient contamination assessments in the three West African tropical Comoé, Bandama, and Bia Rivers (Côte d'Ivoire) were performed from March 2016 to March 2018. Five stations per river were sampled. Nutrients spatio-temporal distributions were mapped and showed nitrogen concentrations (nitrite 0.001 to 0.025 mg/L NO2--N, and nitrate 0.26 to 3.60 mg/L NO3--N) increased significantly with rainfall contrary to phosphorus (0.01 to 0.12 mg/L P). The Chl-a and TSItsr data revealed the hypereutrophic status of rivers. Moreover, N:P mass ratio suggests nitrogen as the main limiting factor of primary production during the low (March) and high flow periods (October-November), while phosphorus is the limiting factor in June, at the high flow beginning. The land uses around watersheds were the main sources of phosphorus and nitrogen enhancing the rivers' eutrophication. Phosphorus and nitrogen fluxes were related to leaching river catchments and were significant sources of nutrients to the Atlantic Ocean.

Limiting amino acids supplementation in low crude protein diets and their impacts on growth performance and carcass composition in Labeo rohita (rohu) adult fish / Limitação da suplementação de aminoácidos em dietas com baixo teor de proteína bruta e seus impactos no desempenho de crescimento e composição da carcaça em peixes adultos Labeo rohita (rohu)

Abstract Ninety days study was conducted in hapas installed in earthen ponds. Fish of an average initial weight (220g) were evenly distributed in triplicate groups within fifteen hapas. Five experimental diets labeled as T1 (25% CP and NRC recommended amino acid level) as control diet, T2 (with 2% low protein and 5% amino acid supplementation), T3 (with 2% low protein and 10% amino acid supplementation), T4 (with 4% low protein and 10% amino acid supplementation) and T5 (with 4% low protein and 20% amino acid supplementation) were prepared. Fish were fed with @3% of their body weight twice a day at 10.00 & 16:00 hour. Significantly higher percent weight gain (420.18 ± 66.84a) and specific growth rate (13499.33±1273.54a) along with improved feed conversion ratio (1.29 ± 0.09b) and hundred percent survivals were recorded during the trial. Furthermore proximate analysis of meat showed significant improvement in the crude protein level (81.77 ± 0.19a) served with diet containing 20% limiting amino acids mixture. Therefore, limiting amino acids can be a source of cost effective feed and use safely in L. rohita diet.

Resumo O estudo de 90 dias foi realizado em hapas instalados em tanques de terra. Peixes com peso inicial médio (220 g) foram distribuídos uniformemente em grupos triplicados em 15 hapas. Cinco dietas experimentais rotuladas como T1 (25% de CP e NRC recomendado nível de aminoácidos) como dieta controle, T2 (com 2% de proteína baixa e 5% de suplementação de aminoácidos), T3 (com 2% de proteína baixa e 10% de suplementação de aminoácidos), T4 (com 4% de baixa proteína e 10% de suplementação de aminoácidos) e T5 (com 4% de baixa proteína e 20% de suplementação de aminoácidos) foram preparadas. Os peixes foram alimentados com 3% do seu peso corporal duas vezes por dia às 10h00 e 16h00. Ganho de peso significativamente maior (420,18 ± 66,84a) e taxa de crescimento específico (13499,33 ± 1273,54a) juntamente com taxa de conversão alimentar melhorada (1, 29 ± 0,09b) e sobrevivência de cem por cento foram registrados durante o ensaio. Além disso, a análise aproximada da carne mostrou melhora significativa no nível de proteína bruta (81,77 ± 0,19a) servida com dieta contendo 20% de mistura de aminoácidos limitantes. Portanto, a limitação de aminoácidos pode ser uma fonte de alimentação econômica e usada com segurança na dieta de L. rohita.

Limiting amino acids supplementation in low crude protein diets and their impacts on growth performance and carcass composition in Labeo rohita (rohu) adult fish / Limitação da suplementação de aminoácidos em dietas com baixo teor de proteína bruta e seus impactos no desempenho de crescimento e composição da carcaça em peixes adultos Labeo rohita (rohu)

Ninety days study was conducted in hapas installed in earthen ponds. Fish of an average initial weight (220g) were evenly distributed in triplicate groups within fifteen hapas. Five experimental diets labeled as T1 (25% CP and NRC recommended amino acid level) as control diet, T2 (with 2% low protein and 5% amino acid supplementation), T3 (with 2% low protein and 10% amino acid supplementation), T4 (with 4% low protein and 10% amino acid supplementation) and T5 (with 4% low protein and 20% amino acid supplementation) were prepared. Fish were fed with @3% of their body weight twice a day at 10.00 & 16:00 hour. Significantly higher percent weight gain (420.18 ± 66.84a) and specific growth rate (13499.33±1273.54a) along with improved feed conversion ratio (1.29 ± 0.09b) and hundred percent survivals were recorded during the trial. Furthermore proximate analysis of meat showed significant improvement in the crude protein level (81.77 ± 0.19a) served with diet containing 20% limiting amino acids mixture. Therefore, limiting amino acids can be a source of cost effective feed and use safely in L. rohita diet.

O estudo de 90 dias foi realizado em hapas instalados em tanques de terra. Peixes com peso inicial médio (220 g) foram distribuídos uniformemente em grupos triplicados em 15 hapas. Cinco dietas experimentais rotuladas como T1 (25% de CP e NRC recomendado nível de aminoácidos) como dieta controle, T2 (com 2% de proteína baixa e 5% de suplementação de aminoácidos), T3 (com 2% de proteína baixa e 10% de suplementação de aminoácidos), T4 (com 4% de baixa proteína e 10% de suplementação de aminoácidos) e T5 (com 4% de baixa proteína e 20% de suplementação de aminoácidos) foram preparadas. Os peixes foram alimentados com 3% do seu peso corporal duas vezes por dia às 10h00 e 16h00. Ganho de peso significativamente maior (420,18 ± 66,84a) e taxa de crescimento específico (13499,33 ± 1273,54a) juntamente com taxa de conversão alimentar melhorada (1, 29 ± 0,09b) e sobrevivência de cem por cento foram registrados durante o ensaio. Além disso, a análise aproximada da carne mostrou melhora significativa no nível de proteína bruta (81,77 ± 0,19a) servida com dieta contendo 20% de mistura de aminoácidos limitantes. Portanto, a limitação de aminoácidos pode ser uma fonte de alimentação econômica e usada com segurança na dieta de L. rohita.

Limiting amino acids supplementation in low crude protein diets and their impacts on growth performance and carcass composition in Labeo rohita (rohu) adult fish

Abstract Ninety days study was conducted in hapas installed in earthen ponds. Fish of an average initial weight (220g) were evenly distributed in triplicate groups within fifteen hapas. Five experimental diets labeled as T1 (25% CP and NRC recommended amino acid level) as control diet, T2 (with 2% low protein and 5% amino acid supplementation), T3 (with 2% low protein and 10% amino acid supplementation), T4 (with 4% low protein and 10% amino acid supplementation) and T5 (with 4% low protein and 20% amino acid supplementation) were prepared. Fish were fed with @3% of their body weight twice a day at 10.00 & 16:00 hour. Significantly higher percent weight gain (420.18 ± 66.84a) and specific growth rate (13499.33±1273.54a) along with improved feed conversion ratio (1.29 ± 0.09b) and hundred percent survivals were recorded during the trial. Furthermore proximate analysis of meat showed significant improvement in the crude protein level (81.77 ± 0.19a) served with diet containing 20% limiting amino acids mixture. Therefore, limiting amino acids can be a source of cost effective feed and use safely in L. rohita diet.

Resumo O estudo de 90 dias foi realizado em hapas instalados em tanques de terra. Peixes com peso inicial médio (220 g) foram distribuídos uniformemente em grupos triplicados em 15 hapas. Cinco dietas experimentais rotuladas como T1 (25% de CP e NRC recomendado nível de aminoácidos) como dieta controle, T2 (com 2% de proteína baixa e 5% de suplementação de aminoácidos), T3 (com 2% de proteína baixa e 10% de suplementação de aminoácidos), T4 (com 4% de baixa proteína e 10% de suplementação de aminoácidos) e T5 (com 4% de baixa proteína e 20% de suplementação de aminoácidos) foram preparadas. Os peixes foram alimentados com 3% do seu peso corporal duas vezes por dia às 10h00 e 16h00. Ganho de peso significativamente maior (420,18 ± 66,84a) e taxa de crescimento específico (13499,33 ± 1273,54a) juntamente com taxa de conversão alimentar melhorada (1, 29 ± 0,09b) e sobrevivência de cem por cento foram registrados durante o ensaio. Além disso, a análise aproximada da carne mostrou melhora significativa no nível de proteína bruta (81,77 ± 0,19a) servida com dieta contendo 20% de mistura de aminoácidos limitantes. Portanto, a limitação de aminoácidos pode ser uma fonte de alimentação econômica e usada com segurança na dieta de L. rohita.

Nutrition in palliative care: issues, perceptions and opportunities to improve care for patients.

Dietary advice, the provision of timely nutritional support and the alleviation of diet-related issues, should be an essential component of a holistic approach to palliative and end-of-life care, adjusted to account for the stage in the patient's journey, including prognosis. With an ageing population and increasing numbers of people living with not just one life-limiting disease but several, the dietary management of these patients is becoming more complex. This article considers the issues patients and families experience, how nurses can play a key role in identifying and alleviating nutrition- and diet-related issues in palliative care, including the use of tools to screen, assess and guide nutrition conversations and interventions. The content of the article is mostly drawn from the literature relating to palliative cancer care, knowledge derived from stakeholder engagement, clinical observations in a dietetic role in a hospice setting and qualitative research on the role of diet in palliative care as perceived by patients, carers, and health professionals.

Effectiveness of time-limited eye movement desensitization reprocessing therapy for parents of children with a rare life-limiting illness: a randomized clinical trial.

BACKGROUND: Parents of children with a rare progressive life-limiting illness are at risk for parental posttraumatic stress disorder (PTSD). Studies on the treatment of parental PTSD with eye movement and desensitization reprocessing (EMDR) therapy in pediatric practice are lacking. Therefore this study aims to evaluate the feasibility and effectiveness of time-limited EMDR therapy in reducing PTSD symptoms, comorbid psychological symptoms, distress, and parental stress. METHODS: Mono-center randomized clinical trial conducted between February 2020 and April 2021. Fourteen parents (N = 7 mothers, N = 7 fathers) of mucopolysaccharidosis type III patients reporting PTSD symptoms on a (sub)clinical level were assigned to EMDR or a wait-list control condition followed by EMDR. Four sessions of EMDR (each 90 min) divided over two half-days were offered. Measurements were conducted at baseline, post-treatment/post-waitlist, and 3-months post-treatment. The primary outcome was PTSD symptom severity (PTSD Check List for DSM-5). Secondary outcomes included comorbid psychological symptoms (Brief Symptom Inventory), distress (Distress Thermometer for Parents) and parenting stress (Parenting Stress Questionnaire). Between-group comparisons pre-to-post treatment (N = 7 EMDR vs. N = 7 wait-list) and within-group comparisons (EMDR, N = 14) from pre-to-post treatment and from pre-treatment to 3-months follow-up were carried out per intent-to-treat linear mixed model analyses. RESULTS: Compared to wait-list, EMDR resulted in a significant reduction on total PTSD symptom severity (d = 1.78) and on comorbid psychological symptoms, distress and parenting stress (d = .63-1.83). Within-group comparisons showed a significant effect on all outcomes at post-treatment (d = 1.04-2.21) and at 3-months follow-up (d = .96-2.30) compared to baseline. EMDR was well-tolerated, associated with a low drop-out rate, a high therapy adherence and no adverse events. CONCLUSION: Time-limited EMDR reduces PTSD symptoms, psychological comorbidity, distress and parenting stress in parents of children with a rare progressive life-limiting illness. This treatment was feasible for these overburdened parents. Recurrent monitoring of PTSD symptoms, and, if needed, offering this time-limited type of trauma treatment should be introduced in everyday pediatric practice. Trial registration Netherlands Trial Register, NL8496. Registered 01-04-2020, https://trialsearch.who.int/Trial2.aspx?TrialID=NL8496 .

The crucial influence of trophic status on the relative requirement of nitrogen to phosphorus for phytoplankton growth.

Clarifying the pattern of relative nitrogen (N)-to-phosphorus (P) requirements for phytoplankton growth is of great significance for eutrophication mitigation and aquatic system management. The relative N-to-P requirement for phytoplankton growth is considered an essential trait determining species dominance within ecosystems and explaining phytoplankton response to nutrient availability. These requirements vary with environmental trophic status, though this variation remains unclear. Here, we evaluated the relative N-to-P requirements under different absolute nutrient levels using previous and current experimental data on eight phytoplankton species (three studied by us and five extrapolated from previous studies). Results showed that relative N-to-P requirements for phytoplankton growth decreased as absolute nutrient levels increased. Thus, N may be crucial for enhancing phytoplankton growth under low nutrient conditions, whereas P may be the primary limiting factor of phytoplankton growth under sufficient nutrient conditions. This result applies to single species as well as species assemblages, which are independent of species shifts occurring along water N:P gradients. The response observed in our large trophic status gradient may help elucidate the relative importance of N and P reductions in mitigating the impact of eutrophication on ecosystems.

CpG ODN (K3)-toll-like receptor 9 agonist-induces Th1-type immune response and enhances cytotoxic activity in advanced lung cancer patients: a phase I study.

BACKGROUND: Cytosine-phosphate-guanine oligodeoxynucleotide (CpG ODN) (K3)-a novel synthetic single-stranded DNA immune adjuvant for cancer immunotherapy-induces a potential Th1-type immune response against cancer cells. We conducted a phase I study of CpG ODN (K3) in patients with lung cancer to assess its safety and patients' immune responses. METHODS: The primary endpoint was the proportion of dose-limiting toxicities (DLTs) at each dose level. Secondary endpoints included safety profile, an immune response, including dynamic changes in immune cell and cytokine production, and progression-free survival (PFS). In a 3 + 3 dose-escalation design, the dosage levels for CpG ODN (K3) were 5 or 10 mg/body via subcutaneous injection and 0.2 mg/kg via intravenous administration on days 1, 8, 15, and 29. RESULTS: Nine patients (eight non-small-cell lung cancer; one small-cell lung cancer) were enrolled. We found no DLTs at any dose level and observed no serious treatment-related adverse events. The median observation period after registration was 55 days (range: 46-181 days). Serum IFN-α2 levels, but not inflammatory cytokines, increased in six patients after the third administration of CpG ODN (K3) (mean value: from 2.67 pg/mL to 3.61 pg/mL after 24 hours). Serum IFN-γ (mean value, from 9.07 pg/mL to 12.7 pg/m after 24 hours) and CXCL10 levels (mean value, from 351 pg/mL to 676 pg/mL after 24 hours) also increased in eight patients after the third administration. During the treatment course, the percentage of T-bet-expressing CD8+ T cells gradually increased (mean, 49.8% at baseline and 59.1% at day 29, p = 0.0273). Interestingly, both T-bet-expressing effector memory (mean, 52.7% at baseline and 63.7% at day 29, p = 0.0195) and terminally differentiated effector memory (mean, 82.3% at baseline and 90.0% at day 29, p = 0.0039) CD8+ T cells significantly increased. The median PFS was 398 days. CONCLUSIONS: This is the first clinical study showing that CpG ODN (K3) activated innate immunity and elicited Th1-type adaptive immune response and cytotoxic activity in cancer patients. CpG ODN (K3) was well tolerated at the dose settings tested, although the maximum tolerated dose was not determined. TRIAL REGISTRATION: UMIN-CTR number 000023276. Registered 1 September 2016, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000026649.

Iron enrichment from hypoxic hypolimnion supports the blooming of Raphidiopsis raciborskii in a tropical reservoir.

Occurring worldwide, blooms of Raphidiopsis raciborskii threaten the use of water resources especially in tropical and subtropical waterbodies. Its high flexibility in the uses of light and macronutrients (C, N, P) frustrates any bloom prediction and control based on macronutrients regulation. To identify the critical factors promoting periodic blooms of R. raciborskii, the trends of meteorological, hydrodynamic, physical, and chemical variables (including macro- and micronutrients: N, P, Fe) were analyzed in a Chinese tropical large reservoir (Dashahe reservoir) over five years. It was hypothesized that Fe availability, mediated by the mixing pattern of the reservoir, played a crucial role in the periodic blooms of the cyanobacterium. To have a more complete understanding, the effects of Fe on growth of a local R. raciborskii strain were tested in a monoculture experiment. The biomass and relative abundance of R. raciborskii in the reservoir showed a clear seasonal trend, with relative abundance > 50% in summer/autumn (July to October). Three habitat types along a dominance gradient were identified in the reservoir and 17 variables were used to compare them. Statistical analysis and habitat comparison showed that temperature and stratification, dissolved Fe and N concentrations in the epilimnion, and dissolved Fe and oxygen concentrations in the hypolimnion were the critical factors driving the dynamics of R. raciborskii in the study reservoir. The habitat dominated by R. raciborskii was characterized by a relatively low availability of macro resources (Zeu/Zm < 1, SRP < 0.01 mg/L, DIN < 0.3 mg/L) and by a high Fe availability supplemented from hypoxic hypolimnion. The dependence of growth on Fe concentration increase was confirmed in culture where the maximum was reached at 0.689 mg Fe /L. Our results suggest that a high Fe bioavailability, also originating from the hypoxic hypolimnion, influences the dynamics R. raciborskii and favors the blooms of the species. As a consequence, Fe concentrations in the water column as well as oxygen measurements along the water column should be routinely included in the monitoring programs aimed at predicting and controlling R. raciborskii blooms.

Development of Palliative Care Services at a Tertiary Care Teaching Hospital in Pakistan: Retrospective Analysis of Existing Palliative Care Program.

CONTEXT: Palliative care (PC) is an important aspect of providing holistic care to patients and their families who are dealing with a serious or life limiting illness. Medical community and public poorly understand the implications and benefits of these services. Unfortunately, because of this, PC remains a neglected area of healthcare in the most institutions of Pakistan. OBJECTIVES: We sought to review the current structure, barriers in context of growing need for PC, possible means to overcome these challenges and future perspectives at tertiary care hospital. METHODS: Retrospective longitudinal cross-sectional study was done using data from 2017 to 2019 in the section of PC at Aga Khan University Hospital (AKUH). RESULTS: PC program has been self-sustainable and serving 3747 patients in 2017-2019. The results show that palliative care services (PCS) are well integrated for oncology with all three models of PCS delivery. Most of the patients opted for comfort code during hospital stay and preferred end-of-life-care at home. We received less referral from outside the hospital and other specialties but received more self-referrals surprisingly. Home-based-palliative-care was also a key aspect of the program. PCS providing quality of care and nearly reaching target goal of quality indicators. CONCLUSION: The enormous burden of life-threatening illnesses is associated with physical and psychosocial sufferings, which explains the illustrious need for PC in developing countries such as Pakistan. PCS at AKUH initiated in 2017. Nevertheless, there are challenges to service expansion and progress, which are being addressed.

Variabilities in autumn cyanobacterial responses to ecosystem external enrichments based on nutrient addition bioassay in Pengxi River, Three Gorges Reservoir, China.

Nutrient availability, is a crucial anthropogenic stressor promoting freshwater eutrophication and rapid expansion of harmful algal blooms (HABs), deteriorating water quality and threatening public health worldwide. The estimation of the HABs community responses to diel changes in the nutrients while characterizing the ecosystem growth limiting factors, is key to prudent watershed management. The present study investigated the short-term variabilities in autumn cyanobacterial responses to the external nutrient inputs into the Pengxi River using the nutrient addition bioassay approach. Results reveal phytoplankton community structure dominated by the cyanobacteria: Anabaena and Aphanizomenon spp. (relative abundance = 46.20% equilibrium abundance), followed by the diatoms, out of which Lindayia bodaniica, are preponderant. Nutrient enrichment triggered strong variabilities in dominance and successions among the cyanobacterial group, with maximum dominance (76.34%) exhibited by the Aphanizomenon sp. upon NH4 addition. Fe enrichment led to the succession of cyanobacteria, Leptolyngbya tenuis, which was below the detectable limit in the control, indicating the role of Fe in its proliferation. Studies on nutrient limitation demonstrated P/NH4 co-limited ecosystem, with P as the primary and NH4, a secondary limiting factor. The nitrate preference index (NO3-RPI = 0.991) shows a high preference for NH4 while NO3 constitutes the bulk of the ecosystem TN. Considering the elevated NO3 concentration, we posit that a shift in the phytoplankton community structure from cyanobacteria to diatoms dominated ecosystem, is expected following Fe depletion and a further stretch on the current ecosystem NH4 limitation. The study provides useful and first-ever insights for nutrient reduction in the middle Three Gorges Reservoir (TGR) before the onset of the heavy HABs during spring in the Pengxi River.