Increasing Muscle Mass in Elders through Diet and Exercise: A Literature Review of Recent RCTs.

This study aimed to review the current evidence on the independent and combined effects of diet and exercise and their impact on skeletal muscle mass in the elderly population. Skeletal muscle makes up approximately 40% of total body weight and is essential for performing daily activities. The combination of exercise and diet is known to be a potent anabolic stimulus through stimulation of muscle protein synthesis from amino acids. Aging is strongly associated with a generalized deterioration of physiological function, including a progressive reduction in skeletal muscle mass and strength, which in turn leads to a gradual functional impairment and an increased rate of disability resulting in falls, frailty, or even death. The term sarcopenia, which is an age-related syndrome, is primarily used to describe the gradual and generalized loss of skeletal muscle mass (mainly in type II muscle fibers) and function. Multimodal training is emerging as a popular training method that combines a wide range of physical dimensions. On the other hand, nutrition and especially protein intake provide amino acids, which are essential for muscle protein synthesis. According to ESPEN, protein intake in older people should be at least 1 g/kgbw/day. Essential amino acids, such as leucine, arginine, cysteine, and glutamine, are of particular importance for the regulation of muscle protein synthesis. For instance, a leucine intake of 3 g administered alongside each main meal has been suggested to prevent muscle loss in the elderly. In addition, studies have shown that vitamin D and other micronutrients can have a protective role and may modulate muscle growth; nevertheless, further research is needed to validate these claims. Resistance-based exercise combined with a higher intake of dietary protein, amino acids, and/or vitamin D are currently recognized as the most effective interventions to promote skeletal muscle growth. However, the results are quite controversial and contradictory, which could be explained by the high heterogeneity among studies. It is therefore necessary to further assess the impact of each individual exercise and nutritional approach, particularly protein and amino acids, on human muscle turnover so that more efficient strategies can be implemented for the augmentation of muscle mass in the elderly.

Ceramides in Autoimmune Rheumatic Diseases: Existing Evidence and Therapeutic Considerations for Diet as an Anticeramide Treatment.

Autoimmune rheumatic diseases (AIRDs) constitute a set of connective tissue disorders and dysfunctions with akin clinical manifestations and autoantibody responses. AIRD treatment is based on a comprehensive approach, with the primary aim being achieving and attaining disease remission, through the control of inflammation. AIRD therapies have a low target specificity, and this usually propels metabolic disturbances, dyslipidemias and increased cardiovascular risk. Ceramides are implicated in inflammation through several different pathways, many of which sometimes intersect. They serve as signaling molecules for apoptosis, altering immune response and driving endothelial dysfunction and as regulators in the production of other molecules, including sphingosine 1-phosphate (S1P) and ceramide 1-phosphate (C1P). With lipid metabolism being severely altered in AIRD pathology, several studies show that the concentration and variety of ceramides in human tissues is altered in patients with rheumatic diseases compared to controls. As a result, many in vitro and some in vivo (animal) studies research the potential use of ceramides as therapeutic targets in rheumatoid arthritis (RA), ankylosing spondylitis, systemic lupus erythematosus, fibromyalgia syndrome, primary Sjögren's syndrome, systemic sclerosis, myositis, systemic vasculitis and psoriatic arthritis. Furthermore, the majority of ceramide synthesis is diet-centric and, as a result, dietary interventions may alter ceramide concentrations in the blood and affect health. Subsequently, more recently several clinical trials evaluated the possibility of distinct dietary patterns and nutrients to act as anti-ceramide regimes in humans. With nutrition being an important component of AIRD-related complications, the present review details the evidence regarding ceramide levels in patients with AIRDs, the results of anti-ceramide treatments and discusses the possibility of using medical nutritional therapy as a complementary anti-ceramide treatment in rheumatic disease.

Basics of Sustainable Diets and Tools for Assessing Dietary Sustainability: A Primer for Researchers and Policy Actors.

Climate change can have economic consequences, affecting the nutritional intake of populations and increasing food insecurity, as it negatively affects diet quality parameters. One way to mitigate these consequences is to change the way we produce and consume our food. A healthy and sustainable diet aims to promote and achieve the physical, mental, and social well-being of the populations at all life stages, while protecting and safeguarding the resources of the planet and preserving biodiversity. Over the past few years, several indexes have been developed to evaluate dietary sustainability, most of them based on the EAT-Lancet reference diet. The present review explains the problems that arise in human nutrition as a result of climate change and presents currently available diet sustainability indexes and their applications and limitations, in an effort to aid researchers and policy actors in identifying aspects that need improvement in the development of relevant indexes. Overall, great heterogeneity exists among the indicators included in the available indexes and their methodology. Furthermore, many indexes do not adequately account for the diets' environmental impact, whereas others fall short in the economic impact domain, or the ethical aspects of sustainability. The present review reveals that the design of one environmentally friendly diet that is appropriate for all cultures, populations, patients, and geographic locations is a difficult task. For this, the development of sustainable and healthy diet recommendations that are region-specific and culturally specific, and simultaneously encompass all aspects of sustainability, is required.

The Key Role of Nutritional Elements on Sport Rehabilitation and the Effects of Nutrients Intake.

Adequate nutrition is of utmost importance for athletes, especially during rehabilitation after injury in order to achieve fast healing and return to sports. The aim of this narrative review is to define the proper nutritional elements for athletes to meet their needs and facilitate their fast return to sports after surgery or injury, as well as determine the effects of specific nutrients intake. Studies on antioxidants, which are substances that protect against free radicals, for the injured athlete are few and unclear, yet poly-phenols and especially flavonoids might improve healing and inflammation following an injury. Benefits of vitamin C or E on muscle damage are disputable in relevant studies, while optimal levels of vitamin D and calcium contribute to bone healing. Minerals are also essential for athletes. Other supplements suggested for muscle damage treatment and protein synthesis include leucine, creatine, and hydroxymethylbutyrate. Diets that include high-quality products, rich in micronutrients (like vitamins, minerals, etc.) bio-active compounds and other nutritional elements (like creatine) are suggested, while an individualized nutrition program prescribed by a trained dietitian is important. Further studies are needed to clarify the underlying mechanisms of these nutritional elements, especially regarding injury treatment.

Bioprocess performance, transformation pathway, and bacterial community dynamics in an immobilized cell bioreactor treating fludioxonil-contaminated wastewater under microaerophilic conditions.

Fludioxonil is a post-harvest fungicide contained in effluents produced by fruit packaging plants, which should be treated prior to environmental dispersal. We developed and evaluated an immobilized cell bioreactor, operating under microaerophilic conditions and gradually reduced hydraulic retention times (HRTs) from 10 to 3.9 days, for the biotreatment of fludioxonil-rich wastewater. Fludioxonil removal efficiency was consistently above 96%, even at the shortest HRT applied. A total of 12 transformation products were tentatively identified during fludioxonil degradation by using liquid chromatography coupled to quadrupole time-of-flight Mass spectrometry (LC-QTOF-MS). Fludioxonil degradation pathway was initiated by successive hydroxylation and carbonylation of the pyrrole moiety and disruption of the oxidized cyanopyrrole ring at the NH-C bond. The detection of 2,2-difluoro-2H-1,3-benzodioxole-4-carboxylic acid verified the decyanation and deamination of the molecule, whereas its conversion to the tentatively identified compound 2,3-dihydroxybenzoic acid indicated its defluorination. High-throughput amplicon sequencing revealed that HRT shortening led to reduced α-diversity, significant changes in the ß-diversity, and a shift in the bacterial community composition from an initial activated sludge system typical community to a community composed of bacterial taxa like Clostridium, Oligotropha, Pseudomonas, and Terrimonas capable of performing advanced degradation and/or aerobic denitrification. Overall, the immobilized cell bioreactor operation under microaerophilic conditions, which minimizes the cost for aeration, can provide a sustainable solution for the depuration of fludioxonil-contaminated agro-industrial effluents.

Biotreatment and bacterial succession in an upflow immobilized cell bioreactor fed with fludioxonil wastewater.

The large quantities and the persistent nature of fungicide wastewaters have increased the efforts towards a sustainable technological solution. In this context, fludioxonil-contaminated wastewater was treated in an upflow immobilized cell bioreactor, resulting in chemical oxygen demand (COD) removal efficiency even higher than 80%, whereas the electrical conductivity (EC) of the effluent was gradually increased. Organic-F was mineralized by 94.0 ± 5.2%, which was in accordance with the high fludioxonil removal efficiency (95.4 ± 4.0%). In addition, effluent total Kjeldahl nitrogen (TKN) concentration reduced significantly during bioprocessing. A strong relationship among COD removal, TKN/total nitrogen removal, and effluent EC increase (p < 0.01) was identified. Despite the adequate aeration provided, effluent nitrite and nitrate concentrations were negligible. Illumina sequencing revealed a reduction in the relative abundances of Betaproteobacteria, Chloroflexi, Planctomycetes, and Firmicutes and an increase in the proportion of Alphaproteobacteria and Actinobacteria. A shift in bacterial communities occurred during fludioxonil treatment, resulting in the significant increase of the relative abundances of Empedobacter, Sphingopyxis, and Rhodopseudomonas (from 0.67 ± 0.13% at the start-up to 34.34 ± 1.60% at the end of biotreatment). In conclusion, the immobilized cell bioreactor permitted the proliferation of specialized activated sludge microbiota with an active role in the depuration of postharvest fungicides.

A Proactive Environmental Approach for Preventing Legionellosis in Infants: Water Sampling and Antibiotic Resistance Monitoring, a 3-Years Survey Program.

A proactive environmental monitoring program was conducted to determine the risk and prevent nosocomial waterborne infections of Legionella spp. in infants. Sink taps in a neonatal intensive care unit (NICU) and two obstetric clinics were monitored for Legionella spp. A total of 59 water samples were collected during a 3-year period and 20 of them were found colonized with Legionella pneumophila. Standard culture, molecular, and latex agglutination methods were used for the detection and identification of Legionella bacteria. Hospital personnel also proceeded with remedial actions (hyperchlorination and thermal shock treatment) in the event of colonization. The minimal inhibitory concentration (MIC) values of erythromycin, ciprofloxacin was determined for Legionella isolates using the e-test method. Our data indicate that the majority of neonatal sink-taps were colonized at least once during the study with Legionella spp. Among 20 isolates, 5 were considered as low-level resistant, 3 in erythromycin and 2 in ciprofloxacin, while no resistant strains were detected. Environmental surveillance in neonatal and obstetric units is suggested to prevent waterborne infections, and thus to reduce the risk of neonatal nosocomial infections.

Environmental surveillance and molecular epidemiology of waterborne pathogen Legionella pneumophila in health-care facilities of Northeastern Greece: a 4-year survey.

A 4-year proactive environmental surveillance of Legionella spp. in the water distribution and cooling systems of five health-care facilities was carried out as part of the strategy for the prevention of hospital-acquired Legionnaires' disease in Northeastern Greece. Legionella spp. were detected in 71 out of 458 collected samples. The majority of strains belonged to Legionella pneumophila serogroups 2-15 (75.0%), while all L. pneumophila serogroup 1 strains (23.6%) were isolated from a single hospital. The highest percentage of positive samples was found in distal sites (19.4%), while no Legionella strains were detected in cooling systems. Each hospital was colonized at least once with L. pneumophila, while remedial actions resulted in significant reduction of Legionella concentration. The molecular epidemiology of environmental L. pneumophila strains was also investigated using random amplified polymorphic DNA (RAPD) and multi-gene sequence-based analysis. Based on RAPD patterns, L. pneumophila serogroups 2-15 and serogroup 1 strains were classified into 24 and 9 operational taxonomic units (OTUs), respectively. Sequencing of housekeeping and diversifying pressure-related genes recommended by European Working Group for Legionella Infections (EWGLI) revealed not only a high intraspecies variability but also the circulation and persistence of one specific genotyping profile in the majority of hospitals. This study highlights the necessity for diachronic surveillance of Legionella in health-care facilities by adopting both cultural and molecular methods.

Can Procalcitonin in Cerebrospinal Fluid be a Diagnostic Tool for Meningitis?

BACKGROUND: To study the levels of procalcitonin (PCT) in patients with meningitis and control group and compare them with established markers of infection--such as C-reactive protein (CRP), high-sensitivity CRP, and WBC--in cerebrospinal fluid (CSF) and assess the possible discriminative role of PCT in the differential diagnosis of meningitis from other noninfectious diseases. METHODS: We studied CSF samples of patients from Intensive Care Unit, Internal Medicine, Neurology, Hematology, and Pediatric departments. The total number of patients included in the study was 58. The samples were divided into three groups: group 1 with bacterial meningitis (BM) central nervous system (n = 19); group 2 with viral meningitis (VM, n = 11); and group 3, control group, with noninfectious diseases (n = 28). RESULTS: Values of PCT levels >0.5 ng/ml were considered as abnormal. In group 1, mean PCT levels were 4.714 ± 1.59 ng/ml. In group 2, all patients had PCT <0.5 ng/ml (0.1327 ± 0.03 ng/ml). In group 3, the mean PCT levels were <0.1 ng/ml. CONCLUSION: PCT values in CSF can be very helpful in distinguishing BM from VM and other noninfectious diseases.

First report of Legionella pneumophila in car cabin air filters. Are these a potential exposure pathway for professional drivers?

Recent findings have identified professional drivers as being at an increased risk of Legionnaires' disease. Our hypothesis was that used car cabin air filters represent a reservoir of Legionella bacteria, and thus a potential pathway for contamination. We analysed used cabin air filters from various types of car. The filters were analysed by culture and by molecular methods. Our findings indicated that almost a third of air filters were colonized with Legionella pneumophila. Here, we present the first finding of Legionella spp. in used car cabin air filters. Further investigations are needed in order to confirm this exposure pathway. The presence of Legionella bacteria in used cabin air filters may have been an unknown source of infection until now.

Community-acquired pneumonia due to Legionella pneumophila, the utility of PCR, and a review of the antibiotics used.

INTRODUCTION: There are at least 40 types of Legionella bacteria, half of which are capable of producing disease in humans. The Legionella pneumophila bacterium, the root cause of Legionnaires' disease, causes 90% of legionellosis cases. CASE PRESENTATION: We describe the case of a 60-year-old woman with a history of diabetes mellitus and arterial hypertension who was admitted to our hospital with fever and symptoms of respiratory infection, diarrhea, and acute renal failure. We used real-time polymerase chain reaction (PCR) to detect L. pneumophila DNA in peripheral blood and serum samples and urine antigen from a patient with pneumonia. Legionella DNA was detected in all two sample species when first collected. CONCLUSION: Since Legionella is a cause of 2% to 15% of all community-acquired pneumonias that require hospitalization, legionellosis should be taken into account in an atypical pulmonary infection and not be forgotten. Moreover, real-time PCR should be considered a useful diagnostic method.