Multi-omics signatures in new-onset diabetes predict metabolic response to dietary inulin: findings from an observational study followed by an interventional trial

AIM

The metabolic performance of the gut microbiota contributes to the onset of type 2 diabetes. However, targeted dietary interventions are limited by the highly variable inter-individual response. We hypothesized (1) that the composition of the complex gut microbiome and metabolome (MIME) differ across metabolic spectra (lean-obese-diabetes); (2) that specific MIME patterns could explain the differential responses to dietary inulin; and (3) that the response can be predicted based on baseline MIME signature and clinical characteristics.

METHOD

Forty-nine patients with newly diagnosed pre/diabetes (DM), 66 metabolically healthy overweight/obese (OB), and 32 healthy lean (LH) volunteers were compared in a cross-sectional case-control study integrating clinical variables, dietary intake, gut microbiome, and fecal/serum metabolomes (16 S rRNA sequencing, metabolomics profiling). Subsequently, 27 DM were recruited for a predictive study: 3 months of dietary inulin (10 g/day) intervention.

RESULTS

MIME composition was different between groups. While the DM and LH groups represented opposite poles of the abundance spectrum, OB was closer to DM. Inulin supplementation was associated with an overall improvement in glycemic indices, though the response was very variable, with a shift in microbiome composition toward a more favorable profile and increased serum butyric and propionic acid concentrations. The improved glycemic outcomes of inulin treatment were dependent on better baseline glycemic status and variables related to the gut microbiota, including the abundance of certain bacterial taxa (i.e., Blautia, Eubacterium halii group, Lachnoclostridium, Ruminiclostridium, Dialister, or Phascolarctobacterium), serum concentrations of branched-chain amino acid derivatives and asparagine, and fecal concentrations of indole and several other volatile organic compounds.

CONCLUSION

We demonstrated that obesity is a stronger determinant of different MIME patterns than impaired glucose metabolism. The large inter-individual variability in the metabolic effects of dietary inulin was explained by differences in baseline glycemic status and MIME signatures. These could be further validated to personalize nutritional interventions in patients with newly diagnosed diabetes.

[Evaluation of the effectiveness of the BACTEC MGIT automatic system for culture of mycobacteria in comparison with classical methods of culture. Experience after one year of use]

The fully automatic non-radiometric cultivation system BACTEC MGIT 960 of Becton Dickinson is one of the systems using the so-called rapid metabolic method of mycobacteria cultivation. For detection of mycobacterial growth it uses the fluorescent technology. The objective of the present work is to compare the effectiveness of this system with classical cultivation on solid (egg) and liquid media. During the period from April 27, 1999 till April 28, 2000 in our department concurrently by both methods a total of 2144 samples were examined from which a total of 149 mycobacterial strains were isolated. It was revealed that the BACTEC MGIT 960 system is much more sensitive than classical cultivation (it detected 136 isolates as compared with 103 detected by the classical method): in isolation of Mycobacterium the difference in sensitivity is even more marked (from the total number of isolated strains of Mycobacterium tuberculosis the BACTEC MGIT 960 detected 105, classical cultivation only 76). The mean Time to Detection (TTD) of positive samples in the BACTEC MGIT 960 system was 13.2 days while for classical cultivation it was 33.6 days. It was thus confirmed that the BACTEC MGIT 960 achieves, as compared with classical cultivation, better results which applies to the sensitivity of the two methods as well as to the detection rate of positive samples.

[Cysts and pseudocysts of the spleen in children]

A cyst in the upper pole of the spleen was diagnosed in three children. In all the pole of the spleen was resected -in two instances it contained a cyst, in one a pseudocyst. The postoperative course was without complications. All patients had scintigraphic check-up examinations, in all three instances functional lienal tissue was found which did not differ much as to its size from that of a normal spleen. In cysts situated in the splenic pole the authors consider partial resection of the affected portion of the spleen as the optimal surgical method. In cysts of other portions of the spleen it would be better to select a different surgical procedure, e.g. enucleation of the cysts, partial decapsulation of the cyst or percutaneous puncture of the cyst combined, if necessary, with sclerotization.

[Postoperative pain in children]

The authors present their experience with the follow up and influencing of postoperative pain in 65 children aged 6-18 years operated and hospitalised at the department of paediatric surgery of the Faculty Hospital in Hradec Králové. The authors investigated in operated children with different diagnoses the topology, quality, intensity, development and treatment of postoperative pain. As to selected ways of monitoring of different dimensions of pain they selected those which take into account age and possible communication with the child. For the treatment of postoperative pain they used in 96% analgesics and in 4% anaesthetics.

[Laparoscopy-assisted appendectomy in children]

During a 13-month period (March 1, 1995 March 31, 1996) the authors performed in 70 children a laparoscopically assisted appendectomy. 68 children were operated on account of chronic appendicitis, two on account of acute appendicitis. During the postoperative period early, not very serious, postoperative complications were recorded in 7 children. One girl had on the second day after operation fever and severe abdominal pain, four children developed on the 5th-7th day after surgery abdominal pain, associated in three instances with fever and in two instances with the pathological finding of pericoecal fluid. The complaints receded within 1-2 days in all five patients after conservative treatment. In another two children the wound healed per secundam intentionem. No late complications were recorded.

[Disorders of intestinal rotation and fixation in older children]

The authors discuss five older children where malrotation of the gut was diagnosed. The youngest child was three years old, the oldest 16 years. In three children the malrotation was diagnosed from clinical symptoms and examination by imaging methods, in two it was detected by chance during operation. In the two children where the impaired rotation of the gut was detected on operation, non-rotation was involved. In the remaining three children twice a left side paraduodenal hernia was diagnosed and once an external stenosis of the duodenum by Ladd's bands.

[Comparison of the results of conservative and surgical therapy of dislocated supracondylar fractures of the humerus in children]

The authors evaluate retrospectively in a group of 121 children with a dislocated supracondylar fracture in 1984-1993 the results of different therapeutic methods. The highest percentage of excellent and satisfactory results was recorded in children treated by closed reposition with percutaneous pinning with Kirschner wires (88%). In open reposition with Kirschner wires 60% of the results were excellent of satisfactory. The lowest percentage of excellent and satisfactory results was recorded when fixation with a plaster bandage was used (48%). The highest percentage of poor results was observed in surgical reposition with internal fixation (37%). The cause of failure in the majority of patients is according to the authors inadequate reposition of fragments. The authors discuss different types of treatment. They recommend non-surgical reposition with percutaneous pinning, even for less dislocated extension supracondylar fractures of the humerus as well as for fractures complicated by vascular injuries.

[A solitary congenital hepatic cyst]

The author discusses a congenital, solitary, multilocular liver cyst in a two-year-old boy. The cyst originated in the margo ventralis of the right liver lobe. Clinically it was manifested by marked enlargement of the abdomen. The diagnosis was established by ultrasonography. The whole cyst was removed surgically.

[Adnexal torsion in childhood]

During the 7-year period (1987-1993) the authors treated nine girls on account of torsion of the adnexa. In six girls torsion of primarily unaltered adnexa occurred, in one girl torsion of an ovary enlarged by a cyst and in two torsion of the ovary affected with a benign tumour, a coetaneous teratoma. In seven instances the organ affected with ischaemic necrosis had to be resected. In two girls detorsion of the ovary was performed, according to a sonographic control examination, however, in one the affected ovary atrophied. In the discussion the authors deal with the diagnosis of torsion of the adnexa and the method of treatment. The authors consider ultrasonic examination of organs of the abdominal cavity and retroperitoneum a very suitable method in all cases of abdominal pain in childhood, as this method can greatly contribute to the diagnosis of acute abdominal and gynaecological attacks. During surgery they recommend to preserve adnexa with a doubtful vitality because there is certain hope that they will be saved. During the postoperative period they recommend the long-term follow up of girls clinically and by ultrasonographic checks. If pathological changes are detected on the preserved adnexa, they recommend early re-operation and elimination of the risk factor (cysts etc.). The operation should be supplemented by prophylactic fixation of the preserved adnexa if this fixation was not done already during the primary operation.

[Diagnosis and therapy of post-traumatic hemobilia]

The submitted case-history deals with a successfully diagnosed and treated case of post-traumatic hemobilia in a 13-year-old girl. Hemobilia was manifested clinically by the typical Sandblom triad of symptoms. It was due to a pseudoaneurysm of the peripheral arteriole of the hepatic artery diagnosed by selective liver angiography. In treatment selective intraarterial embolization of the supplying artery proved useful.

[Immunologic parameters in women with threatened premature labor]

The authors examined some immunological indicators in a group of female patients with imminent premature delivery and compared them, using statistical methods, with findings in a control group. The objective was to find a possible predictive value of the investigated parameters for the diagnosis of subclinical intraamnial infection as the possible cause of so-called idiopathic premature delivery. In the immunoglobulin classes they did not find significant differences between the two groups. In the group of patients with an imminent premature delivery they found, however, statistically significantly higher levels of the C3 component of complement, of orosomucoid, alpha-2 and gamma-globulins. They compared the results with data in the literature and assume that some immunological indicators can, after confirmation of the results by other authors, serve as the prediction of subclinical intraamnial infection with imminent prematurity.

[Conservative therapy of liver injuries in children]

During the 14-year period between 1979 and 1992 the authors treated by conservative methods nine children with liver injuries. They operated on four children. The liver injury did not bleed during operation or haemorrhage was only minimal and probably the patients would have also recovered after conservative treatment. In the discussion the authors mention diagnostic approaches in liver injuries and criteria and methods of conservative treatment. The authors consider conservative treatment of liver injuries in children to be a very suitable method which is associated only with a very small number of complications, and which proves successful in the majority of patients. The prerequisite for its application are high standard of diagnostic visualization methods, monitoring of the child's condition and the possibility of immediate surgery, if conservative treatment fails.

[A vesico-sigmoid fistula in a 15-year-old girl]

The authors diagnosed in a fifteen-year-old girl. other wise healthy, a double vesicosigmoidal fistula. It developed probably at the age of two after an acute abdominal attack of inflammatory character which was treated conservatively. The fistulae caused repeated inflammations of the urinary pathways. In the late diagnosis participated among others evaluation of miction cystography which was imperfect from the technical aspect. When repeated, this examination contributed to the diagnosis. After surgery the girl recovered.

Giant Meckel's diverticulum

A case of incomplete intestinal obstruction caused by a giant Meckel's diverticulum in a 13-year-old girl is reported. Short resection of the ileum with the diverticulum and end-to-end anastomosis was carried out. The possibilities of diagnosis and treatment as well as the controversial classification of this rare congenital anomaly are discussed.

[Adverse effects of antidepressive agents in hospitalized geriatric patients]

The frequency, intensity and profile of adverse effects of antidepressants was studied in elderly patients. The series consisted of 102 patients with depression admitted to hospitals in Bratislava and Moscow. The adverse effects of amitriptyline (Amitriptylin Spofa) and maprotiline (Ludiomil Ciba-Geigy) were compared. The assessment done on days 0, 7, and 28 of treatment showed that xerostomia had the highest occurrence rate with both preparations studied. In patients treated with amitriptyline adverse effects were more severe and were recorded more frequently, requiring treatment withdrawal in 3 patients. The overall intensity of adverse effects was significantly higher with amitriptyline (p < 0.05). In the group of patients treated with amitriptyline the adverse effects were more marked in those with severe somatic pathology. The risk of amitriptyline treatment in elderly patients is being emphasized along with the need for monitoring and correcting adverse effects of the treatment. Although maprotiline exhibited a lower occurrence rate of adverse effects, cardiac functions should be regularly checked in patients with preexisting cardiac pathology. (Tab. 2, Fig. 3, Ref. 6.).

Endoscopic retrograde cholangiopancreatography in childhood

ERCP was performed in 19 children and adolescents aged 4 to 16 years. In 13 children the examination was done under general anesthesia, in 6 cases with the usual premedication using dolsin and atropine. Indications for examination were unclear abdominal pain with occasional amylase elevation, in 3 patients status after an abdominal injury. In 16 patients the examination clarified the complaints by detecting organic disease of the gallbladder or the pancreas. ERCP is an important procedure in the event of uncertain diagnosis in children and adolescents and, if the indication is correct, and the technique good, is well tolerated by the patients.

[Evaluation of the analgesic effect of dolsin during labor]

The authors evaluate the analgetic action of 50 mg dolsin in parturient women during childbirth using a Slovak version of McGill's questionnaire on pain. The intensity of pain in women is evaluated before administration of dolsin and after its administration. The obtained data on the analgetic effect are compared with the total score of pain and individual components of pain by the paired t-test. Although the mean values of the total score of pain and the sensory components of pain declined after administration of dolsin, the change was not statistically significant. In the affective component of pain the mean value of PRI(A) increased after dolsin administration.

[The significance of endoscopic retrograde cholangiopancreatography in the diagnosis of pancreatic injuries in children]

The condition of the main pancreatic duct determines very probably in a decisive way the fate of posttraumatic pancreatic pseudocysts and acute pancreatic injuries. Endoscopic retrograde cholangiopancreatography is the only diagnostic method which makes possible to evaluate the condition of this duct. The authors performed ERCP in three children, in two of them an internal drainage of the pseudocyst was carried out on account of verified ductal rupture. In the third girl, after evidence of an intact main pancreatic duct, conservative therapy was successfully applied. In the discussion the authors summarize data from the literature regarding the use of ERCP in the preoperative diagnosis of posttraumatic pancreatic pseudocysts and acute pancreatic injuries. The authors consider ERCP a method which renders the diagnosis of posttraumatic pancreatic pseudocysts and acute pancreatic injuries more accurate.

[Results of keratoplasty performed at the Eye Clinic of the ILF in Ustí nad Labem]

The authors give an account of their experience and results with transplantations of the cornea in 79 eyes during a period of 44 months. They investigated the condition of the optic disk and visual acuity with optimal postoperative correction in patients after keratoplasty. In 61% of the eyes vision improved as compared with the condition prior to operation, in 61% of the eyes the disk of the donor remained clear throughout the observation period. The observation period was at least one month, the maximum being 44 months.

Influence of fluctuating temperature on soil microflora

The effect of different constant and "square-wave" fluctuating temperatures on the soil microflora was studied in laboratory experiments. The growth of soil microorganisms was higher at lower temperatures, indicating the higher degree of substrate immobilization and the better energy economy of the soil bionta. Microbial counts were slightly higher after five days of incubation at fluctuating temperatures than those obtained at a constant mean temperature. It was important whether the fluctuation started at lower or at higher temperatures. At a fluctuating temperature the amount of nitrates decreased compared to the amount at a constant temperature. The development dynamics of soil microorganisms was accelerated by the fluctuation of temperature as judged by nitrogen transformation and simultaneous changes in microbial counts.

[Interactions of drugs, used in the treatment of rheumatism in the elderly (author's transl)]

This paper reviews the possibilities of interactions of drugs, used in the treatment of rheumatism in the elderly. Exspecially glycosides, antikoagulants, diuretics, uricosurics, salicylates, barbiturates and corticosteroides are discussed.