Stratified and precision nutrition refers to disease management or prevention of disease onset, based on dietary interventions tailored to a person's characteristics, biology, gut microbiome, and environmental exposures. Such treatment models may lead to more effective management of inflammatory bowel disease (IBD) and reduce risk of disease development. This societal position paper aimed to report advances made in stratified and precision nutritional therapy in IBD. Following a structured literature search, limited to human studies, we identified four relevant themes: (a) nutritional epidemiology for risk prediction of IBD development, (b) food-based dietary interventions in IBD, (c) exclusive enteral nutrition (EEN) for Crohn's disease (CD) management, and (d) pre- and probiotics for IBD management. There is scarce literature upon which we can make recommendations for precision or stratified dietary therapy for IBD, both for risk of disease development and disease management. Certain single-nucleotide polymorphisms related to polyunsaturated fatty acid (PUFA) metabolism may modify the effect dietary PUFA have in increasing the risk of IBD development. Non-colonic CD, mild-to-moderate CD, and high microbiota richness may predict success of EEN and may be used both for prediction of treatment continuation, but also for early cessation in nonresponders. There is currently insufficient evidence to make recommendations for precision or stratified dietary therapy for patients with established IBD. Despite the great interest in stratified and precision nutrition, we currently lack data to support conclusive recommendations. Replication of early findings by independent research groups and within structured clinical interventions is required.
Ukončování ventilační podpory představuje u nemocných v terminálním stadiu orgánové dysfunkce možnou součást procesu odnímání postupů orgánové podpory. Cílem ukončení umělé plicní ventilace není v žádném případě urychlení procesu umírání, ale vysazení součásti terapie, která nemá své medicínské odůvodnění, a kdy útrapy, stres, bolest, dyskomfort a strádání spojené s pokračováním ventilační podpory nejsou vyváženy jejím přínosem z hlediska ovlivnění nepříznivé prognózy u nemocného s ireverzibilně narušenou integritou orgánových funkcí. Proces ukončování umělé plicní ventilace probíhá nejčastěji stupňovitým snižováním parametrů ventilace, méně častým způsobem je terminální extubace. Při splnění všech nezbytných podmínek a předpokladů představuje ukončení ventilační podpory postup, který je v souladu s etickými principy medicíny i se současným právním rámcem poskytování zdravotní péče, a nelze jej označit za eutanazii.
Terminal weaning from ventilatory support represents on of the possible techniques of complex withdrawing of therapy in patients with irreversible failure of vital functions. In the period from January 1, 1999 to June 1, 2000 mechanical ventilation was withdrawn in 15 patients with terminal illnesses; all patients from the group died. In ten patients, withdrawing of ventilatory support was done by terminal disconnection from the ventilator, in five patients ventilatory support was gradually decreased without terminal extubation. Analgosedation was used in eight patients, no muscle relaxants were used. The mean period of ventilatory support withdrawal until the pronounciation of death was 243 minutes. The detailed information on ventilatory support withdrawal as a part of the process of organ functions supporting measures withdrawal was given to the family in five cases. Ventilatory support withdrawal is medically accepted management in appropriate cases. This is in accordance with ethical principles of current practice of medicine, as well as with current legislation on health care provision.
Blood group B glycosphingolipids (B-GSLs) are substrates of the lysosomal alpha-galactosidase A (AGAL). Similar to its major substrate-globotriaosylceramide (Gb3Cer)-B-GSLs are not degraded and accumulate in the cells of patients affected by an inherited defect of AGAL activity (Fabry disease-FD).The pancreas is a secretory organ known to have high biosynthesis of blood group GSLs. Herein, we provide a comprehensive overview of the biochemical and structural abnormalities in pancreatic tissue from two male FD patients with blood group B. In both patients, we found major accumulation of a variety of complex B-GSLs carrying predominantly hexa- and hepta-saccharide structures. The subcellular pathology was dominated by deposits containing B-glycoconjugates and autofluorescent ceroid. The contribution of Gb3Cer to the storage was minor. This abnormal storage pattern was specific for the pancreatic acinar epithelial cells. Other pancreatic cell types including those of islets of Langerhans were affected much less or not at all.Altogether, we provide evidence for a key role of B-antigens in the biochemical and morphological pathology of the exocrine pancreas in FD patients with blood group B. We believe that our findings will trigger further studies aimed at assessing the potential pancreatic dysfunction in this disease.
- MeSH
- ABO Blood-Group System metabolism MeSH
- Acinar Cells metabolism ultrastructure MeSH
- Insulin-Secreting Cells metabolism ultrastructure MeSH
- Fabry Disease blood metabolism pathology MeSH
- Galactose analysis metabolism MeSH
- Glycosphingolipids chemistry metabolism MeSH
- Middle Aged MeSH
- Humans MeSH
- Pancreas metabolism ultrastructure MeSH
- Case-Control Studies MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
Synthesis of a novel cyanoethyl-type linker suitable for the solid-phase synthesis of oligodeoxynucleotides possessing terminal 3'-phosphate group is described. Since the linker is a 2-substituted 2-cyanoethanol, the release of the synthesized oligonucleotide from the solid support is accomplished by ß-elimination in the ammonia deprotection step.
BACKGROUND: To support family caregivers of people with dementia in end-of-life decision making, a family booklet on comfort care has been adapted and adopted by several European jurisdictions since the original publication in Canada in 2005. METHODS: We analyzed and compared the adaptations to the family booklets used in Canada, the Czech Republic, Italy, the Netherlands, the UK and Ireland that were made up to 2021. Qualitative content analysis was used to create a typology of changes to the original booklet. Interviews with the teams that adapted the booklets contributed to methodological triangulation. Further, using an established framework, we assessed whether the contents of the booklets addressed all domains relevant to optimal palliative dementia care. RESULTS: The booklets differed in the types of treatment addressed, in particular tube feeding, euthanasia, and spiritual care. There was also variability in the extent to which medical details were provided, an emphasis on previously expressed wishes in medical decision making, addressing of treatment dilemmas at the end of life, the tone of the messages (indirect or explicit) and the discussion of prognosis (as more or less positive), and the involvement of various healthcare professionals and family caregivers in care. All booklets addressed all domains of palliative dementia care. CONCLUSIONS: We identified core elements in providing information on end-of-life care to family caregivers of people with dementia as related to optimal palliative care in dementia. Additionally, local adaptations and updates are required to account for socio-cultural, clinical, and legal differences which may also change over time. These results may inform development of educational and advance care planning materials for different contexts.
- MeSH
- Pamphlets MeSH
- Dementia * therapy MeSH
- Patient Comfort MeSH
- Humans MeSH
- Caregivers MeSH
- Palliative Care methods MeSH
- Terminal Care * MeSH
- Family MeSH
- Death MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
INTRODUCTION: A reliable electrocardiographic predictor of ventricular fibrillation (VF) in patients with ST elevation myocardial infarction (STEMI) is lacking so far. Previous experimental/simulation study suggested a terminal T-wave inversion (TTWI) in ischemia-related ECG leads corresponding to anterior infarct localization as an independent predictor of reperfusion VF (rVF). This T-wave characteristic has never been tested as a rVF predictor in clinical settings. The aim of this study was to test if terminal T-wave inversion (TTWI) at admission ECG (before reperfusion) can serve as a predictor of ventricular fibrillation during reperfusion (rVF) in patients with anterior STEMI undergoing primary PCI. METHODS AND RESULTS: Study population included consecutive patients with anterior infarct localization admitted for primary PCI (n = 181, age 65 [57; 76] years, 66% male). Of those, 14 patients had rVF (rVF group, age 59 [47; 76] years, 64% male) and patients without rVF comprised the No-rVF group (n = 167, age 65 [57; 76] years, 66% male). Association of TTWI with rVF was analyzed using logistic regression analysis adjusted for relevant clinical and electrocardiographic covariates. The prevalence of TTWI in rVF group was 62% comparing to 23% in the No-rVF group, p = 0.005. TTWI was associated with increased risk of rVF (OR 5.51; 95% CI 1.70-17.89; p = 0.004) and remained a significant predictor after adjustment for age, gender, history of MI prior to index admission, VF before reperfusion, Tpeak-Tend, maximal ST elevation, and QRS duration (OR 23.49; 95% CI 3.14-175.91; p = 0.002). CONCLUSIONS: The terminal T-wave inversion in anterior leads before PCI independently predicted rVF in patients with anterior MI thus confirming the previous experimental/simulation findings.
- MeSH
- Electrocardiography methods MeSH
- Ventricular Fibrillation etiology MeSH
- Anterior Wall Myocardial Infarction * MeSH
- ST Elevation Myocardial Infarction * complications diagnosis MeSH
- Percutaneous Coronary Intervention * MeSH
- Middle Aged MeSH
- Humans MeSH
- Reperfusion adverse effects MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Tachycardia MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
