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- Barazzoni, R, et al.
(författare)
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Carbohydrates and insulin resistance in clinical nutrition : Recommendations from the ESPEN expert group.
- 2017
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Ingår i: Clinical Nutrition. - : Elsevier BV. - 0261-5614 .- 1532-1983. ; 36:2, s. 355-363
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Tidskriftsartikel (refereegranskat)abstract
- Growing evidence underscores the important role of glycemic control in health and recovery from illness. Carbohydrate ingestion in the diet or administration in nutritional support is mandatory, but carbohydrate intake can adversely affect major body organs and tissues if resulting plasma glucose becomes too high, too low, or highly variable. Plasma glucose control is especially important for patients with conditions such as diabetes or metabolic stress resulting from critical illness or surgery. These patients are particularly in need of glycemic management to help lessen glycemic variability and its negative health consequences when nutritional support is administered. Here we report on recent findings and emerging trends in the field based on an ESPEN workshop held in Venice, Italy, 8-9 November 2015. Evidence was discussed on pathophysiology, clinical impact, and nutritional recommendations for carbohydrate utilization and management in nutritional support. The main conclusions were: a) excess glucose and fructose availability may exacerbate metabolic complications in skeletal muscle, adipose tissue, and liver and can result in negative clinical impact; b) low-glycemic index and high-fiber diets, including specialty products for nutritional support, may provide metabolic and clinical benefits in individuals with obesity, insulin resistance, and diabetes; c) in acute conditions such as surgery and critical illness, insulin resistance and elevated circulating glucose levels have a negative impact on patient outcomes and should be prevented through nutritional and/or pharmacological intervention. In such acute settings, efforts should be implemented towards defining optimal plasma glucose targets, avoiding excessive plasma glucose variability, and optimizing glucose control relative to nutritional support.
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| 5. |
- Hamann, M., et al.
(författare)
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Scenarios of Good Anthropocenes in southern Africa
- 2020
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Ingår i: Futures. - : Elsevier BV. - 0016-3287 .- 1873-6378. ; 118
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Tidskriftsartikel (refereegranskat)abstract
- In the rapidly changing and uncertain world of the Anthropocene, positive visions of the future could play a crucial role in catalysing deep social-ecological transformations to help guide humanity towards more sustainable and equitable futures. This paper presents the outcomes from a novel visioning process designed to elicit creative and inspirational future scenarios for southern Africa. The approach based scenario development on seeds of good Anthropocenes, i.e. existing initiatives or technologies that represent current, local-scale innovations for sustainability. A selection of seeds was used to create four distinct, positive visions in a participatory workshop process. Common themes that independently emerged in all four visions were i) decentralized governance and decision-making; ii) a strong emphasis on equity and empathy; iii) high levels of connectedness between people; and iv) a reinforced, respectful relationship with nature. The visions mainly differ in the extent of fusion between people and technology in everyday life, and how much nature plays a role in defining the human experience. The narratives presented here describe worlds that have undergone a more significant paradigm shift towards shared human values and stewardship of resources than is explored in most other ambient narratives for the region. These Good Anthropocene scenarios therefore demonstrate more radical, previously unimagined ways of thinking about sustainability futures on the African continent and beyond.
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| 7. |
- Martins, RM, et al.
(författare)
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An ApiAP2 member regulates expression of clonally variant genes of the human malaria parasite Plasmodium falciparum
- 2017
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Ingår i: Scientific reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 7:1, s. 14042-
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Tidskriftsartikel (refereegranskat)abstract
- Variegated surface antigen expression is key to chronic infection and pathogenesis of the human malaria parasite Plasmodium falciparum. This protozoan parasite expresses distinct surface molecules that are encoded by clonally variant gene families such as var, rif and stevor. The molecular mechanisms governing activation of individual members remain ill-defined. To investigate the molecular events of the initial transcriptional activation process we focused on a member of the apicomplexan ApiAP2 transcription factor family predicted to bind to the 5′ upstream regions of the var gene family, AP2-exp (PF3D7_1466400). Viable AP2-exp mutant parasites rely on expressing no less than a short truncated protein including the N-terminal AP2 DNA-binding domain. RNA-seq analysis in mutant parasites revealed transcriptional changes in a subset of exported proteins encoded by clonally variant gene families. Upregulation of RIFINs and STEVORs was validated at the protein levels. In addition, morphological alterations were observed on the surface of the host cells infected by the mutants. This work points to a complex regulatory network of clonally variant gene families in which transcription of a subset of members is regulated by the same transcription factor. In addition, we highlight the importance of the non-DNA binding AP2 domain in functional gene regulation.
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| 8. |
- Preiser, JC, et al.
(författare)
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A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice
- 2021
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Ingår i: Critical care (London, England). - : Springer Science and Business Media LLC. - 1466-609X .- 1364-8535. ; 25:1, s. 424-
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Tidskriftsartikel (refereegranskat)abstract
- The preferential use of the oral/enteral route in critically ill patients over gut rest is uniformly recommended and applied. This article provides practical guidance on enteral nutrition in compliance with recent American and European guidelines. Low-dose enteral nutrition can be safely started within 48 h after admission, even during treatment with small or moderate doses of vasopressor agents. A percutaneous access should be used when enteral nutrition is anticipated for ≥ 4 weeks. Energy delivery should not be calculated to match energy expenditure before day 4–7, and the use of energy-dense formulas can be restricted to cases of inability to tolerate full-volume isocaloric enteral nutrition or to patients who require fluid restriction. Low-dose protein (max 0.8 g/kg/day) can be provided during the early phase of critical illness, while a protein target of > 1.2 g/kg/day could be considered during the rehabilitation phase. The occurrence of refeeding syndrome should be assessed by daily measurement of plasma phosphate, and a phosphate drop of 30% should be managed by reduction of enteral feeding rate and high-dose thiamine. Vomiting and increased gastric residual volume may indicate gastric intolerance, while sudden abdominal pain, distension, gastrointestinal paralysis, or rising abdominal pressure may indicate lower gastrointestinal intolerance.
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| 9. |
- Preiser, JC, et al.
(författare)
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Glucose Control in the ICU: A Continuing Story
- 2016
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Ingår i: Journal of diabetes science and technology. - : SAGE Publications. - 1932-2968. ; 10:6, s. 1372-1381
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Tidskriftsartikel (refereegranskat)abstract
- In the present era of near-continuous glucose monitoring (CGM) and automated therapeutic closed-loop systems, measures of accuracy and of quality of glucose control need to be standardized for licensing authorities and to enable comparisons across studies and devices. Adequately powered, good quality, randomized, controlled studies are needed to assess the impact of different CGM devices on the quality of glucose control, workload, and costs. The additional effects of continuing glucose control on the general floor after the ICU stay also need to be investigated. Current algorithms need to be adapted and validated for CGM, including effects on glucose variability and workload. Improved collaboration within the industry needs to be encouraged because no single company produces all the necessary components for an automated closed-loop system. Combining glucose measurement with measurement of other variables in 1 sensor may help make this approach more financially viable.
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