Search

Abstract Background Although some evidence suggests an association between obstructive sleep apnea (OSA) and gestational diabetes mellitus (GDM), its consequences still remain largely unknown. We sought to determine whether OSA is associated with higher inflammation and sympathetic levels in GDM, and to relate them with insulin resistance and perinatal outcomes. Methods OSA was identified by polysomnography and defined as an apnea–hypopnea index of ≥ 5 h−1. Plasma cytokines (TNF-α, IL-1β, IL-6, IL-8, IL-10), metanephrine, and normetanephrine were determined by immunoassays. Results We included 17 patients with GDM and OSA and 34 without OSA. Women with GDM and OSA had higher normetanephrine concentrations [81 IQR (59–134) vs. 68 (51–81) pg/mL]. No differences in the inflammatory profile were found, while IL-1β was higher in patients with mean nocturnal oxyhemoglobin saturation ≤ 94%. We found positive correlations between increased sympathetic activation and IL-1β, with obstructive apneas, while time in REM showed an inverse relationship with IL-1β and metanephrine. Furthermore, IL-10 was inversely related with time in sleep stages 1–2, and with the arousal index, and it was positively related with time in slow-wave sleep. Significant correlations were also found between IL-1β and insulin resistance. There were no significant differences in neonatal characteristics; however, we found inverse relationships between IL-10 and birth weight (BW), and percentile of BW. Conclusions OSA increased sympathetic activity, and IL-1β concentration was higher in patients with GDM with lower nocturnal oxygenation, all of which were related with obstructive events, and time in REM. Moreover, IL-1β was related with insulin resistance, and IL-10 inversely correlated with neonatal BW.

[fr] En 1478 on suscite un débat entre les Jurés, d'une part, et l'Évêque et son Chapitre, d'autre part. Pendant que les précédents interdisaient de faire sortir le blé hors de l'île au moments de disette, pour assurer l'approvisionnement du peuple, les hommes d'église prétendaient placer le céréale, perçue au moyen de cens, dîmes et d'autres droits, aux marchés extérieurs, avec bénéfice en prope.

Parmi les constructions civiles d'intérêt public au Moyen-Age, il faur remar­quer d'une manière toute particulière les ponts. Ils jouent un rôle prédominant en tant qu'endroit clé dans le contexte des voies de communication. Une des principales voies de communication dans la Majorque du XVeme siècle était le chemin d'Inca qui reliait la ville à cette localité, la seconde de l'Ile en importance. Le fameux Pont d’Inca, sur le torrent Gros, était démoli depuis un certain temps ce qui provoquait des difficultés pour franchir la rivière. Après plusieurs tentatives, en 1465, on tente de trouver une solution au problème en adjudicant les travaux de réparation a l'un des maçons les plus prestigieux du moment: Guillem Vilasclar. Cette solution permettrait de surmonter les obstacles que provoquaient l'était du pone, tour a fait en ruine, problèmes qui se faisaient plus manifestes par temps de pluie, quand le torrent particulièrement forci, les passants ne pouvaient le franchir qu'au péril de leur vie et de celle de leurs bêtes. Grâce aux charges accordées entre Guillem Vilasclar et le Grand Conseil Général, nous connaissons les détails de la construction du nouveau pont, de même que ses dimensions, sa structure, sa forme, les matériaux utilisés, la durée des travaux et son prix, qui s'éleva a 51O livres.

Sin resumen

ABSTRACT Clostridioides difficile infection (CDI) causes alterations in the intestinal microbiota, frequently associated with changes in the gut metabolism of bile acids and cholesterol. In addition to the impact on microbiome composition and given the metabolic changes occurring during CDI, our work focuses on the importance to know the effects at the local and systemic levels, both during the infection and its treatment, by paying particular attention to plasma lipid metabolism due to its relationship with CDI pathogenesis. Specific changes, characterized by a loss of microbial richness and diversity and related to a reduction in short-chain acid-producing bacteria and an increase in bile salt hydrolase-producing bacteria, were observed in the gut microbiota of CDI patients, especially in those suffering from recurrent CDI (RCDI). However, gut microbiota showed its ability to restore itself after treatment, resembling healthy individuals, in those patients treated by fecal microbiome transfer (FMT), in contrast with those treated with antibiotics, and displaying increased levels of Eubacterium coprostanoligenes, a cholesterol-reducing anaerobe. Interestingly, changes in plasma lipidome revealed a global depletion in circulating lipids in CDI, with the largest impact on cholesteryl esters. CDI patients also showed a specific and consistent decrease in the levels of lipid species containing linoleic acid—an essential fatty acid—which were only partially recovered after antibiotic treatment. Analysis of the plasma lipidome reflects CDI impact on the gut microbiota and its metabolism, evidencing changes in sterol and fatty acid metabolism that are possibly related to specific alterations observed in gut microbial communities of CDI patients.IMPORTANCEThere is increasing evidence about the influence the changes in microbiota and its metabolism has on numerous diseases and infections such as Clostridioides difficile infection (CDI). The knowledge of these changes at local and systemic levels can help us manage this infection to avoid recurrences and apply the best therapies, such as fecal microbiota transfer (FMT). This study shows a better restoration of the gut in FMT-treated patients than in antibiotic-treated patients, resembling healthy controls and showing increased levels of cholesterol-reducing bacteria. Furthermore, it evidences the CDI impact on plasma lipidome. We observed in CDI patients a global depletion in circulating lipids, particularly cholesteryl esters, and a specific decrease in linoleic acid-containing lipids, an essential fatty acid. Our observations could impact CDI management because the lipid content was only partially recovered after treatment, suggesting that continued nutritional support, aiming to restore healthy lipid levels, could be essential for a full recovery.

Background: Obstructive sleep apnea (OSA) is prevalent in pregnancy and it is associated with adverse pregnancy-related outcomes such as gestational diabetes, pre-eclampsia, and low birth weight. Maternal systemic inflammation is proposed to be one of the main intermediate mechanisms. However, the effects of OSA on systemic inflammation are unknown in normal pregnancy.Methods: Women in the 3rd trimester underwent hospital polysomnography to evaluate whether OSA increases systemic inflammation in normal pregnancy and its potential association with adverse fetal outcomes. OSA was defined as an apnea–hypopnea index (AHI) of ≥ 5 h−1. Plasma cytokines levels (TNF-α, IL-1β, IL-6, IL-8, and IL-10) were determined by multiple immunoassays.Results: We included 11 patients with OSA and 22 women with AHI < 5 h−1, who were homogeneous in age, and body mass index (BMI). Women with OSA had significant higher levels of TNF-α, IL-1β, IL-8, and IL-10. We found significant correlations between AHI during REM and TNF-α (r = 0.40), IL-1β (r = 0.36), IL-6 (r = 0.52), IL-8 (r = 0.43), between obstructive apnea index and TNF-α (r = 0.46) and between AHI and IL-1β (r = 0.43). We also found that CT90% was related to IL-8 (r = 0.37). There were no significant differences in neonatal characteristics; however, we found inverse correlations between TNF-α and IL-8 with birth weight (both r = −0.48), while IL-8 showed a significant inverse relationship with neonatal gestational age (r = −0.48).Conclusions: OSA in our normal pregnancy population was associated with higher systemic inflammation, which was related to obstructive events, especially during REM sleep. Moreover, systemic inflammation was inversely correlated with neonatal birth weight and age.

Objetivo deste estudo foi verificar os registros de enfermagem de pacientes doadores de órgãos quanto aos aspectos éticos e legais. Foram analisados os registros de enfermagem de 12 prontuários de pacientes doadores de órgãos internados em um Hospital Universitário do interior do estado de São Paulo, no período de Janeiro de 1992 a agosto de 1996. Foi identificada a informação quanto ao consentimento para doação de órgãos nos registros de enfermagem em 16,7% dos prontuários. Observamos, em 91,7% dos prontuários, falta de data, de assinaturas, ou presença de rasuras nos registros de enfermagem.The objective of this study was to verify the ethical and legal aspects concerning the documentation of nursing practice in the organ donor's records. The records of the 12 organ donors admitted in a Brazilian University Hospital, from January/1992 to august/1996 were analysed. The donor consent was reported by nurses in 16,7% of the records. Defects that preclude legal value for the charling such as missing date or signature, erasure were found in 91,7% of the records.

L’île de Majorque, au milieu du bassin de la Méditerranée occidentale, a été témoin du passage des navigateurs, spécialement des marchands, lesquels depuis l'Antiquité ont traversé la Mare Nostrum. Cette situation de port important a exercé une influence extraordinaire sur la vie de la cité de Majorque et dans l’île. Quant à l'époque du Bas Moyen Age le commerce constituera une des activités économiques fondamentales. Il ne faut pas s'étonner, alors, que il y ait des marchands de maintes et différentes provenances, surtout des régions méditerranéennes, qui fassent escale à Majorque et parmi eux les Niçois. Quoique les consulats italiens, specialement ceux de Gênes ou de Venise, fussent plus nombreux ou remarquables, Nice néanmoins disposait d'un consulat dans la cité de Majorque, ce qui reflète l'importance des relations commerciales qu'il y avait entre les deux ports. La plupart des Niçois s'appliquaient aux tâches mercantiles; quelques uns même établirent leur résidence définitivement dans la cité de Majorque.

ABSTRACTThe use of immune compounds as antimicrobial adjuvants is a classic idea recovering timeliness in the current antibiotic resistance scenario. However, the activity of certain antimicrobial peptides against ESKAPE Gram-negatives has not been sufficiently investigated. The objective of this study was to determine the activities of human defensins HNP-1 and hBD-3 alone or combined with permeabilizing/peptidoglycan-targeting agents against clinical ESKAPE Gram-negatives [Acinetobacter baumannii (AB), Enterobacter cloacae (EC), Klebsiella pneumoniae (KP), and acute/chronic Pseudomonas aeruginosa (PA)]. Lethal concentrations (LCs) of HNP-1 and hBD-3 were determined in four collections of multidrug resistant EC, AB, KP, and PA clinical strains (10–36 isolates depending on the collection). These defensins act through membrane permeabilization plus peptidoglycan building blockade, enabling that alterations in peptidoglycan recycling may increase their activity, which is why different recycling-defective mutants were also included. Combinations with physiological lysozyme and subinhibitory colistin for bactericidal activities determination, and with meropenem for minimum inhibitory concentrations (MICs), were also assessed. HNP-1 showed undetectable activity (LC > 32 mg/L for all strains). hBD-3 showed appreciable activities: LC ranges 2–16, 8–8, 8->32, and 8->32 mg/L for AB, EC, KP, and PA, being PA strains from cystic fibrosis significantly more resistant than acute origin ones. None of the peptidoglycan recycling-defective mutants showed greater susceptibility to HNP-1/hBD-3. Combination with colistin or lysozyme did not change their bactericidal power, and virtually neither did meropenem + hBD-3 compared to meropenem MICs. This is the first study comparatively analyzing the HNP-1/hBD-3 activities against the ESKAPE Gram-negatives, and demonstrates interesting bactericidal capacities of hBD-3 mostly against AB and EC.IMPORTANCEIn the current scenario of critical need for new antimicrobials against multidrug-resistant bacteria, all options must be considered, including classic ideas such as the use of purified immune compounds. However, information regarding the activity of certain human defensins against ESKAPE Gram-negatives was incomplete. This is the first study comparatively assessing the in vitro activity of two membrane-permeabilizing/peptidoglycan construction-blocking defensins (HNP-1 and hBD-3) against relevant clinical collections of ESKAPE Gram-negatives, alone or in combination with permeabilizers, additional peptidoglycan-targeting attacks, or the blockade of its recycling. Our data suggest that hBD-3 has a notable bactericidal activity against multidrug-resistant Acinetobacter baumannii and Enterobacter cloacae strains that should be considered as potential adjuvant option. Our results suggest for the first time an increased resistance of Pseudomonas aeruginosa strains from chronic infection compared to acute origin ones, and provide new clues about the predominant mode of action of hBD-3 against Gram-negatives (permeabilization rather than peptidoglycan-targeting).