Chlorhexidine oral rinses for symptomatic COPD: a randomised, blind, placebo-controlled preliminary study

ObjectivesDetermine the effect of twice-daily chlorhexidine oral rinses on oral and lung microbiota biomass and respiratory symptoms.SettingSingle centre.ParticipantsParticipants were aged 40–85 with chronic obstructive pulmonary disease (COPD) and chronic productive cough or COPD exacerbation within the last year. Exclusions included antibiotics in the previous 2 months and/or those with less than four teeth. Forty-four participants were recruited and 40 completed the study.InterventionParticipants were randomised 1:1 to twice-daily 0.12% chlorhexidine oral rinses versus placebo for 2 months along with daily diaries. St. George’s Respiratory Questionnaire (SGRQ), blood tests, oral rinse and induced sputum were collected at randomisation and the final visit.Primary and secondary outcomesPrimary outcome was a change in oral and sputum microbiota biomass. Secondary outcomes included: sputum and oral microbiota Shannon and Simpson diversity and taxonomy; inflammatory markers; Breathlessness, Cough and Sputum Scale and SGRQ scores.ResultsNeither the oral microbiota nor the sputum microbiota biomass decreased significantly in those using chlorhexidine compared with placebo (oral microbiota mean log10 difference (SE)=−0.103 (0.23), 95% CI −0.59 to 0.38, p=0.665; sputum microbiota 0.80 (0.46), 95% CI −0.15 to 1.75, p=0.096). Chlorhexidine decreased both oral and sputum microbiota alpha (Shannon) diversity (linear regression estimate (SE) oral: −0.349 (0.091), p=0.001; sputum −0.622 (0.169), p=0.001). Chlorhexidine use did not decrease systemic inflammatory markers compared with placebo (C reactive protein (chlorhexidine 1.8±7.5 vs placebo 0.4±6.8, p=0.467), fibrinogen (22.5±77.8 vs 10.0±77.0, p=0.406) or leucocytes (0.2±1.8 vs 0.5±1.8, p=0.560)). Chlorhexidine use decreased SGRQ scores compared with placebo (chlorhexidine −4.7±8.0 vs placebo 1.7±8.9, p=0.032).ConclusionsWe did not detect a significant difference in microbiota biomass due to chlorhexidine use. Chlorhexidine decreased oral and sputum microbiota alpha diversity and improved respiratory health-related quality of life compared with placebo.Trial registrationNCT02252588.

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634. Chlorhexidine Oral Rinses to Alter the Oral and Sputum Microbiota in COPD (CLIMB): a Randomized, Double-blinded, Placebo-controlled, Parallel-group Pilot Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.828 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S377-S377

Author(s):

Alexa Pragman ◽

Ann Fieberg ◽

Cavan Reilly ◽

Chris Wendt

Keyword(s):

Systemic Inflammation ◽

Diversity Index ◽

Alpha Diversity ◽

Lower Airway ◽

Chronic Obstructive ◽

Oral Microbiota ◽

Primary Analysis ◽

Double Blind ◽

Treatment Groups ◽

Wbc Count

Abstract Background Chronic obstructive pulmonary disease (COPD) is a progressive, inflammatory lung disease with few available disease-modifying therapies. Acute exacerbations of COPD (AECOPD) increase morbidity and mortality, and their occurrence coincides with sputum and oral microbiota dysbiosis. The oral microbiota also serves as the source of the lower airway microbiota. Chlorhexidine oral rinses are known to alter the oral microbiota. We hypothesized that subjects randomized to 8 weeks of chlorhexidine oral rinses (vs. placebo) will demonstrate decreased microbiota biomass compared to baseline and those on placebo. Methods We performed a randomized, double-blind, placebo-controlled, 8-week study of the effects of twice-daily chlorhexidine oral rinses on 44 subjects with COPD. Baseline and post-treatment data were obtained evaluating oral and sputum microbiota biomass and composition, systemic inflammation (CRP, fibrinogen, and WBC count), and respiratory symptoms (Breathlessness, Cough, and Sputum Scale [BCSS], St. George’s Respiratory Questionnaire [SGRQ], and AECOPD assessment). All analyses were prespecified. Results Forty of 44 participants completed the study. The primary analysis of the mean differences in oral and sputum microbiota biomass between treatment groups was not significant. Chlorhexidine use was associated with a decrease in oral and sputum microbiota alpha diversity compared with placebo (Shannon diversity index change [standard error]: -0.349 [0.091] and -0.622 [0.169] respectively; padj=0.001 for both). There was no significant change in CRP, fibrinogen, WBC count, or BCSS score between treatment groups over the study period. Chlorhexidine use was associated with a significant improvement in SGRQ score when compared to the placebo (mean change ± standard deviation: chlorhexidine -4.7 ± 8.0 vs. placebo 1.7 ± 8.9, p=0.011; minimal clinically important difference in SGRQ score -4). Few adverse events were reported. Conclusion Among those with COPD, use of twice-daily chlorhexidine oral rinses resulted in decreased oral and sputum microbiota alpha diversity and clinically significant improvement in COPD symptoms. Chlorhexidine use did not result in decreased oral or sputum microbiota biomass or decreased systemic inflammation. Disclosures All Authors: No reported disclosures

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Dynamics of Inflammatory Markers in Patients with Pulmonary Hypertension on the Background of COPD combined with Hypertension under the Influence of Treatment

Ukraïnsʹkij žurnal medicini bìologìï ta sportu ◽

10.26693/jmbs05.06.150 ◽

2020 ◽

Vol 5 (6) ◽

pp. 150-157

Author(s):

K. L. Nikolaieva ◽

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Hypertension ◽

Pulmonary Disease ◽

Inflammatory Markers ◽

Modern Society ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Significant Difference ◽

Comprehensive Survey ◽

Hs Crp

Chronic obstructive pulmonary disease significantly affects the quality of life, considerably limiting the physical capabilities of patients and is one of the main causes of morbidity and mortality in modern society. Currently, the problem of the comorbidity for the patients with chronic obstructive pulmonary disease is very relevant. The most common in patients of this category is hypertension. Today, it has been established that disorders in the immune system are detected in a very large group of diseases, including both chronic obstructive pulmonary disease and hypertension. The purpose of the study was to evaluate the dynamics of inflammatory markers in the patients with pulmonary hypertension on the background of chronic obstructive pulmonary disease in combination with hypertension under the influence of treatment. Material and methods. The results of the study are based on data from a comprehensive survey of 170 patients aged 40 to 65 years with chronic obstructive pulmonary disease, of which 123 had pulmonary hypertension (of which 87 had stage II hypertension and 36 were without hypertension) and 47 people were without pulmonary hypertension. The patients were chosen in the period from 2015 to 2018 on the basis of the municipal institution "Zaporizhzhia regional clinical hospital" of the Zaporizhzhia regional council. Results and discussion. The results of this study indicate the role of inflammation, or rather the levels of hs-CRP and IL-6, in the pathogenesis of pulmonary hypertension in patients with chronic obstructive pulmonary disease. The level of hs-CRP among the patients with pulmonary hypertension on a background of chronic obstructive pulmonary disease made up 10.46 [6,24 ; 15,30] mg/l and was significantly higher as against the values in the group of patients with chronic obstructive pulmonary disease without pulmonary hypertension and compared with group of healthy persons. The increase in the level of IL-6 in the group of patients having pulmonary hypertension with chronic obstructive pulmonary disease is significantly higher by 57 % compared to the value in the group of chronic obstructive pulmonary disease without pulmonary hypertension and by 7.4 times the value in the group of healthy individuals (p <0.05). Comparing the subgroups of patients, and depending on the variant of exacerbation of chronic obstructive pulmonary disease, the level of hs-CRP and IL-6 was considerably higher in the subgroup with the infectious type of exacerbation compared with the subgroup of the non-infectious type of exacerbation of chronic obstructive pulmonary disease. Conclusion. After 12 months of treatment, when roflumilast was added to the basic therapy, we revealed a statistically significant difference in the levels of IL-6, hs-CRP and IL-10 in the plasma of patients with pulmonary hypertension on the background of chronic obstructive pulmonary disease combined with hypertension

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CRISPR/Cas9 Genome Editing Tool: A Promising Tool for Therapeutic Applications on Respiratory Diseases

Current Gene Therapy ◽

10.2174/1566523220666201012145731 ◽

2020 ◽

Vol 20 (5) ◽

pp. 333-346

Author(s):

Sadiya Bi Shaikh ◽

Yashodhar Prabhakar Bhandary

Keyword(s):

Respiratory Diseases ◽

Gene Editing ◽

Epithelial Mesenchymal Transition ◽

Respiratory Health ◽

Chronic Obstructive ◽

Therapeutic Tool ◽

Obstructive Pulmonary Disease ◽

Mesenchymal Transition ◽

Chronic Respiratory Diseases ◽

Promising Tool

Respiratory diseases are one of the prime topics of concern in the current era due to improper diagnostics tools. Gene-editing therapy, like Clustered regularly interspaced palindromic repeats- associated nuclease 9 (CRISPR/Cas9), is gaining popularity in pulmonary research, opening up doors to invaluable insights on underlying mechanisms. CRISPR/Cas9 can be considered as a potential gene-editing tool with a scientific community that is helping in the advancement of knowledge in respiratory health and therapy. As an appealing therapeutic tool, we hereby explore the advanced research on the application of CRISPR/Cas9 tools in chronic respiratory diseases such as lung cancer, Acute respiratory distress syndrome (ARDS) and cystic fibrosis (CF). We also address the urgent need to establish this gene-editing tool in various other lung diseases such as asthma, Chronic obstructive pulmonary disease (COPD) and Idiopathic pulmonary fibrosis (IPF). The present review introduces CRISPR/Cas9 as a worthy application in targeting epithelial-mesenchymal transition and fibrinolytic system via editing specific genes. Thereby, based on the efficiency of CRISPR/Cas9, it can be considered as a promising therapeutic tool in respiratory health research.

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COPD-Lower Respiratory Tract Infection Visual Analogue Score (c-LRTI-VAS) validation in stable and exacerbated patients with COPD

BMJ Open Respiratory Research ◽

10.1136/bmjresp-2020-000761 ◽

2021 ◽

Vol 8 (1) ◽

pp. e000761

Author(s):

Hendrik Johannes Prins ◽

Ruud Duijkers ◽

Johannes M A Daniels ◽

Thys van der Molen ◽

Tjip S van der Werf ◽

...

Keyword(s):

Tract Infection ◽

Respiratory Tract ◽

Respiratory Tract Infection ◽

Lower Respiratory Tract Infection ◽

Lower Respiratory Tract ◽

Visual Analogue Score ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Significant Difference ◽

Related Quality

BackgroundWe developed the chronic obstructive pulmonary disease (COPD)-Lower Respiratory Tract Infection-Visual Analogue Score (c-LRTI-VAS) in order to easily quantify symptoms during exacerbations in patients with COPD. This study aimed to validate this score.MethodsIn our study, patients with stable COPD as well as those with an acute exacerbations of COPD (AECOPD) were included. The results of c-LRTI-VAS were compared with other markers of disease activity (lung function parameters, oxygen saturation and two health related quality of life questionnaires (St Georges Respiratory Questionnaire (SGRQ) and Clinical COPD Questionnaire (CCQ)) and validity, reliability and responsiveness were assessed.ResultsEighty-eight patients with clinically stable COPD and 102 patients who had an AECOPD completed the c-LRTI-VAS questionnaire. When testing on two separate occasions for repeatability, no statistically significant difference between total scores was found 0.143 (SD 5.42) (p=0.826). Internal consistency was high across items (Cronbach’s apha 0.755). Correlation with SGRQ and CCQ total scores was moderate to high. After treatment for hospitalised AECOPD, the mean c-LRTI-VAS total score improved 8.14 points (SD 9.13; p≤0.001).Conclusionsc-LRTI-VAS showed proper validity, responsiveness to change and moderate to high correlation with other questionnaires. It, therefore, appears a reliable tool for symptom measurement during AECOPD.Trial registration numberNCT01232140.

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Effects of a Rehabilitation Programme Using a Nasal Inspiratory Restriction Device in COPD

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18084207 ◽

2021 ◽

Vol 18 (8) ◽

pp. 4207

Author(s):

Jose L. Gonzalez-Montesinos ◽

Jorge R. Fernandez-Santos ◽

Carmen Vaz-Pardal ◽

Jesus G. Ponce-Gonzalez ◽

Alberto Marin-Galindo ◽

...

Keyword(s):

Pulmonary Rehabilitation ◽

Rehabilitation Programme ◽

Group Differences ◽

Control Group ◽

Chronic Obstructive ◽

Maximum Value ◽

Copd Patients ◽

Significant Difference ◽

Pulmonary Rehabilitation Programme ◽

Positive Increment

Chronic obstructive pulmonary disease (COPD) patients are characterised for presenting dyspnea, which reduces their physical capacity and tolerance to physical exercise. The aim of this study was to analyse the effects of adding a Feel-Breathe (FB) device for inspiratory muscle training (IMT) to an 8-week pulmonary rehabilitation programme. Twenty patients were randomised into three groups: breathing with FB (FBG), oronasal breathing without FB (ONBG) and control group (CG). FBG and ONBG carried out the same training programme with resistance, strength and respiratory exercises for 8 weeks. CG did not perform any pulmonary rehabilitation programme. Regarding intra group differences in the value obtained in the post-training test at the time when the maximum value in the pre-training test was obtained (PostPRE), FBG obtained lower values in oxygen consumption (VO2, mean = −435.6 mL/min, Bayes Factor (BF10) > 100), minute ventilation (VE, −8.5 L/min, BF10 = 25), respiratory rate (RR, −3.3 breaths/min, BF10 = 2), heart rate (HR, −13.7 beats/min, BF10 > 100) and carbon dioxide production (VCO2, −183.0 L/min, BF10 = 50), and a greater value in expiratory time (Tex, 0.22 s, BF10 = 12.5). At the maximum value recorded in the post-training test (PostFINAL), FBG showed higher values in the total time of the test (Tt, 4.3 min, BF10 = 50) and respiratory exchange rate (RER, 0.05, BF10 = 1.3). Regarding inter group differences at PrePOST, FBG obtained a greater negative increment than ONBG in the ventilatory equivalent of CO2 (EqCO2, −3.8 L/min, BF10 = 1.1) and compared to CG in VE (−8.3 L/min, BF10 = 3.6), VCO2 (−215.9 L/min, BF10 = 3.0), EqCO2 (−3.7 L/min, BF10 = 1.1) and HR (−12.9 beats/min, BF10 = 3.4). FBG also showed a greater PrePOST positive increment in Tex (0.21 s, BF10 = 1.4) with respect to CG. At PreFINAL, FBG presented a greater positive increment compared to CG in Tt (4.4 min, BF10 = 3.2) and negative in VE/VCO2 intercept (−4.7, BF10 = 1.1). The use of FB added to a pulmonary rehabilitation programme in COPD patients could improve tolerance in the incremental exercise test and energy efficiency. However, there is only a statically significant difference between FBG and ONBG in EqCO2. Therefore, more studies are necessary to reach a definitive conclusion about including FB in a pulmonary rehabilitation programme.

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Influence of Femoral Version on the Outcomes of Hip Arthroscopic Surgery for Femoroacetabular Impingement or Labral Tears: A Systematic Review and Meta-analysis

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211009192 ◽

2021 ◽

Vol 9 (6) ◽

pp. 232596712110091

Author(s):

Chenghui Wang ◽

Yaying Sun ◽

Zheci Ding ◽

Jinrong Lin ◽

Zhiwen Luo ◽

...

Keyword(s):

Systematic Review ◽

Patient Satisfaction ◽

Femoroacetabular Impingement ◽

Arthroscopic Surgery ◽

Harris Hip Score ◽

Cochrane Library ◽

Femoral Version ◽

Labral Tears ◽

Significant Difference ◽

Secondary Outcomes

Background: It remains controversial whether abnormal femoral version (FV) affects the outcomes of hip arthroscopic surgery for femoroacetabular impingement (FAI) or labral tears. Purpose: To review the outcomes of hip arthroscopic surgery for FAI or labral tears in patients with normal versus abnormal FV. Study Design: Systematic review; Level of evidence, 4. Methods: Embase, PubMed, and the Cochrane Library were searched in July 2020 for studies reporting the outcomes after primary hip arthroscopic surgery for FAI or labral tears in patients with femoral retroversion (<5°), femoral anteversion (>20°), or normal FV (5°-20°). The primary outcome was the modified Harris Hip Score (mHHS), and secondary outcomes were the visual analog scale (VAS) for pain, Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), Non-Arthritic Hip Score (NAHS), failure rate, and patient satisfaction. The difference in preoperative and postoperative scores (Δ) was also calculated when applicable. Results: Included in this review were 5 studies with 822 patients who underwent hip arthroscopic surgery for FAI or labral tears; there were 166 patients with retroversion, 512 patients with normal version, and 144 patients with anteversion. Patients with retroversion and normal version had similar postoperative mHHS scores (mean difference [MD], 2.42 [95% confidence interval (CI), –3.42 to 8.26]; P = .42) and ΔmHHS scores (MD, –0.70 [96% CI, –8.56 to 7.15]; P = .86). Likewise, the patients with anteversion and normal version had similar postoperative mHHS scores (MD, –3.09 [95% CI, –7.66 to 1.48]; P = .18) and ΔmHHS scores (MD, –1.92 [95% CI, –6.18 to 2.34]; P = .38). Regarding secondary outcomes, patients with retroversion and anteversion had similar ΔNAHS scores, ΔHOS-SSS scores, ΔVAS scores, patient satisfaction, and failure rates to those with normal version, although a significant difference was found between the patients with retroversion and normal version regarding postoperative NAHS scores (MD, 5.96 [95% CI, 1.66-10.26]; P = .007) and postoperative HOS-SSS scores (MD, 7.32 [95% CI, 0.19-14.44]; P = .04). Conclusion: The results of this review indicated that abnormal FV did not significantly influence outcomes after hip arthroscopic surgery for FAI or labral tears.

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Current measures of distress may not account for what's most important in existential care interventions: Results of the outlook trial

Palliative & Supportive Care ◽

10.1017/s1478951520001170 ◽

2020 ◽

Vol 18 (6) ◽

pp. 648-657

Author(s):

Karen E. Steinhauser ◽

Karen M. Stechuchak ◽

Katherine Ramos ◽

Joseph Winger ◽

James A. Tulsky ◽

...

Keyword(s):

Quality Of Life ◽

Early Stage ◽

Well Being ◽

Primary Analysis ◽

Significant Difference ◽

Spiritual Well Being ◽

Screening For Distress ◽

Secondary Outcomes ◽

Stage Renal Disease

AbstractObjectiveCompare the efficacy of two interventions addressing emotional and existential well-being in early life-limiting illness.MethodPrimary trial analysis (n = 135) included patients with advanced cancer, congestive heart failure, or end-stage renal disease; Arm 1 received the Outlook intervention, addressing issues of life completion and preparation, and Arm 2 received relaxation meditation (RM). Primary outcomes at five weeks (primary endpoint) and seven weeks (secondary): completion and preparation (QUAL-E); secondary outcomes: anxiety (POMS) quality of life (FACT-G) and spiritual well-being (FACIT-Sp) subscales of faith, meaning, and peace.ResultsAverage age was 62; 56% were post-high school-educated, 54% were married, 52% white, 44% female, and 70% had a cancer diagnosis. At baseline, participants demonstrated low levels of anxiety (<5 on POMS subscale) and depression (<10 on CESD) relative to population norms. Results of the primary analysis revealed no significant differences in mean Preparation by treatment arm at five weeks (14.4 Outlook vs. 14.8 RM; between-group difference −0.4 [95% CI, −1.6, 0.8], p = 0.49) or seven weeks (15.2 vs.15.4; between-group difference −0.2 [95% CI, −1.5, 1.0], p = 0.73). There were also no significant differences in mean Life Completion by treatment arm between five weeks (26.6 Outlook vs. 26.3 RM; between-group difference 0.2 [95% CI, −1.2, 1.7], p = 0.76) or seven weeks (26.5 vs. 27.5; between-group difference −1.0 [95% CI, −2.7, 0.7], p = 0.23). Compared to RM, Outlook participants did not have significant differences over time in the secondary outcomes of overall quality of life, anxiety, depression, FACT-G subscales, and FACIT-Sp subscales.DiscussionIn early-stage life-limiting illness, Outlook did not demonstrate a significant difference in primary or secondary outcomes relative to RM. Results underscore the importance of pre-screening for distress. Qualitatively, Outlook participants were able to express suppressed emotions, place illness context, reflect on adaptations, and strengthen identity. Screening for distress and identifying specified measures of distress, beyond anxiety and depression, is essential in our ability to adequately assess the multi-dimensional mechanisms that decrease existential suffering.

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Serum bilirubin and chronic obstructive pulmonary disease (COPD): a systematic review

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01395-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

David M. MacDonald ◽

Ken M. Kunisaki ◽

Timothy J. Wilt ◽

Arianne K. Baldomero

Keyword(s):

Systematic Review ◽

Health Status ◽

Lung Function ◽

Serum Bilirubin ◽

Respiratory Health ◽

Airflow Obstruction ◽

Risk Of Bias ◽

Chronic Obstructive ◽

Strength Of Evidence ◽

Acute Exacerbations

Abstract Background Bilirubin is a potent antioxidant and higher serum bilirubin levels have been associated with improved COPD outcomes. We performed a systematic review to evaluate the association between serum bilirubin levels and lung function (FEV1), prevalence/incidence of COPD, acute exacerbations of COPD, respiratory health status, and mortality. Methods MEDLINE® and Embase were searched using Ovid® (search updated October 1st, 2019). We included studies that measured serum bilirubin levels and outcomes of interest in adults with or without underlying lung disease. We excluded studies of those with liver disease or drug-induced elevations in bilirubin. We used the Newcastle–Ottawa scale to assess individual study risk of bias (ROB) and the US Agency for Healthcare Research and Quality—Evidence Based Practice tool to assess overall strength of evidence (SOE). Two authors independently determined eligibility, performed data abstraction, assessed ROB, and determined SOE. Results Thirteen studies (5 low risk of bias, 3 moderate and 5 high risk) were included. We found low strength of evidence for the association between higher bilirubin levels and lower risk of acute exacerbations of COPD (2 studies), mortality (3 studies), COPD diagnosis (4 studies), and lung function (FEV1) (8 studies). We found insufficient evidence on the relationship between serum bilirubin and respiratory health status/exercise capacity (1 study) and airflow obstruction (FEV1/FVC ratio) (4 studies). Conclusion Higher bilirubin levels may be associated with lower mortality and improved COPD outcomes. Randomized trials are needed to evaluate the effect of medications that raise serum bilirubin on COPD outcomes. PROSPERO registration: CRD42019145747.

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Quality of life assessments in clinical practice using either the EORTC-QLQ-C30 or the SEIOQL-DW: a randomized study

Journal of Patient-Reported Outcomes ◽

10.1186/s41687-021-00315-z ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Åsa Kettis ◽

Hanna Fagerlind ◽

Jan-Erik Frödin ◽

Bengt Glimelius ◽

Lena Ring

Keyword(s):

Quality Of Life ◽

Clinical Practice ◽

Significant Difference ◽

Patient Reported ◽

Health Related Qol ◽

Health Related ◽

Secondary Outcomes ◽

The Impact ◽

Over Time

Abstract Background Effective patient-physician communication can improve patient understanding, agreement on treatment and adherence. This may, in turn, impact on clinical outcomes and patient quality of life (QoL). One way to improve communication is by using patient-reported outcome measures (PROMs). Heretofore, studies of the impact of using PROMs in clinical practice have mostly evaluated the use of standardized PROMs. However, there is reason to believe that individualized instruments may be more appropriate for this purpose. The aim of this study is to compare the effectiveness of the standardized QoL-instrument, the European Organization for Research and Treatment of Cancer Quality of Life C-30 (EORTC-QOL-C30) and the individualized QoL instrument, the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW), in clinical practice. Methods In a prospective, open-label, controlled intervention study at two hospital out-patient clinics, 390 patients with gastrointestinal cancer were randomly assigned either to complete the EORTC-QOL-C30 or the SEIQoL-DW immediately before the consultation, with their responses being shared with their physician. This was repeated in 3–5 consultations over a period of 4–6 months. The primary outcome measure was patients’ health-related QoL, as measured by FACIT-G. Patients’ satisfaction with the consultation and survival were secondary outcomes. Results There was no significant difference between the groups with regard to study outcomes. Neither intervention instrument resulted in any significant changes in health-related QoL, or in any of the secondary outcomes, over time. This may reflect either a genuine lack of effect or sub-optimization of the intervention. Since there was no comparison to standard care an effect in terms of lack of deterioration over time cannot be excluded. Conclusions Future studies should focus on the implementation process, including the training of physicians to use the instruments and their motivation for doing so. The effects of situational use of standardized or individualized instruments should also be explored. The effectiveness of the different approaches may depend on contextual factors including physician and patient preferences.

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The plant secondary compound swainsonine reshapes gut microbiota in plateau pikas (Ochotona curzoniae)

Applied Microbiology and Biotechnology ◽

10.1007/s00253-021-11478-6 ◽

2021 ◽

Author(s):

Shien Ren ◽

Chao Fan ◽

Liangzhi Zhang ◽

Xianjiang Tang ◽

Haibo Fu ◽

...

Keyword(s):

Gut Microbiota ◽

Artificial Diet ◽

Alpha Diversity ◽

Term Treatment ◽

Short Term Treatment ◽

Ochotona Curzoniae ◽

Rdna Sequencing ◽

Long Term Treatment ◽

Significant Difference ◽

Herbivorous Mammals

Abstract Plants produce various plant secondary compounds (PSCs) to deter the foraging of herbivorous mammals. However, little is known about whether PSCs can reshape gut microbiota and promote gut homeostasis of hosts. Using 16S rDNA sequencing to investigate the effects of PSCs on the gut microbiota of small herbivorous mammals, we studied plateau pikas (Ochotona curzoniae) fed diets containing swainsonine (SW) extracted from Oxytropis ochrocephala. Our results showed that both long- and short-term treatment of a single artificial diet in the laboratory significantly reduced alpha diversity and significantly affected beta diversity, core bacteria abundance, and bacterial functions in pikas. After SW was added to the artificial diet, the alpha diversity significantly increased in the long-term treatment, and core bacteria (e.g., Akkermansiaceae) with altered relative abundances in the two treatments showed no significant difference compared with pikas in the wild. The complexity of the co-occurrence network structure was reduced in the artificial diet, but it increased after SW was added in both treatments. Further, the abundances of bacteria related to altered alanine, aspartate, and glutamate metabolism in the artificial diet were restored in response to SW. SW further decreased the concentration of short-chain fatty acids (SCFAs) in both treatments. Our results suggest that PSCs play a key role in regulating gut microbiota community and intestinal homeostasis, thereby maintaining host health. Key points • Swainsonine improves the intestinal bacterial diversity of plateau pikas. • Swainsonine promotes the recovery of core bacterial abundances in the gut of plateau pikas. • Swainsonine promotes the restoration of intestinal bacterial functions of plateau pikas.

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