Current Understanding of the Effects and Potential Clinical Utility of Kratom: A Review

OBJECTIVE

The increasingly widespread use of kratom in the United States has raised concerns about its safety as well as spurring research into potential applications of its active ingredients in medical treatments.

METHODS

We reviewed the literature published over the past 20 years, including peer-reviewed publications and data released by United States government health agencies to provide an overview of this topic.

RESULTS

A variety of potentially beneficial and adverse effects of kratom use related to its opioid and stimulant properties have been documented, including addiction and withdrawal. Preliminary research in animals and case reports in humans have suggested medical utility for kratom in treating alcohol and opioid use disorders, pain, depression, and anxiety. However, the lack of controlled, standardized studies limits the clinical utility of this agent and is a barrier to safe consumption.

CONCLUSIONS

Historically, kratom has been used for medical purposes and for the treatment of alcohol and substance use disorders. The currently available literature suggests a potential for similar clinical applications. However, without controlled research studies or regulation, kratom poses numerous health risks to consumers.

The effect of COVID-19 on schoolteachers’ emotional reactions and mental health

Background

Schoolteachers play a major role in the society's response to the COVID-19 pandemic. When schools are open teachers are responsible for hindering spread of SARS-CoV-2, while carrying out their core task of teaching. This double role as well as the risk of infection may affect mental health in this occupational group. Therefore, we investigated schoolteachers' emotional reactions to COVID-19 and mental health during three phases of the COVID-19 pandemic in Denmark. We further analyzed if teachers, who belonged to a COVID-19 risk group, had more emotional reactions and poorer mental health than “non-risk” groups.

Methods

We collected questionnaire data in May, June, and November-December 2020 and used data from 2665 teachers employed at public schools (871 individuals participated in all three surveys). Participants reported their fear of infection, fear of transmission of infection to their home or pupils, perceived burnout and stress, and worries about their ability to manage the working conditions. We also had information about COVID-19 risk group status, sex, age, organization of teaching (physical presence or remote teaching), and the pupils' grade. We estimated prevalence ratios and took repeated measures into account.

Results

Fear of infection and transmission of infection as well as burnout, stress, and worries increased statistically significantly with 27-84% from May to November-December 2020 (p < 0.05). We also found that teachers, who were particularly vulnerable to the adverse consequences of COVID-19, had the highest prevalence of fear of infection and poor mental health.

Conclusions

The dual role of teaching and virus control along with concerns regarding the health consequences of an infection may contribute to the observed increase in emotional reactions to COVID-19 and poor mental health from the beginning of the pandemic to the beginning of the second wave.

Key messages

The results raise attention to the working conditions, exposure to infection and mental health of teachers being in the frontline when schools were open during the COVID-19 pandemic.

School teachers play a major role in pandemic control along with teaching obligations, which warrants allocation of resources, clear guidelines, and possibilities for protection from infection.

Sustainable initiatives to limit the spread of corona-virus among Danish school teachers

Background

Schoolteachers play an important role in limiting the spread of corona-virus among pupils while carrying out their core tasks. This double role affects teachers' mental health negatively. Still, open schools are important for pupils' learning and wellbeing. Hence, it is crucial to identify viable strategies for virus control that can be implemented in schools without draining teachers' resources. Thus, our aim was to analyze the sustainability of interventions aimed at hindering spread of virus in public schools.

Methods

The qualitative data consisted of 700 free text responses from a survey among 1332 Danish schoolteachers from Nov 25 to Dec 9, 2020, i.e. when facing the second wave of the COVID-19 pandemic. Using Thematic Network Analysis, we analyzed the participants' answers to the question “What initiatives to prevent the spread of infection would you be able to carry out for a longer period of time?”

Results

Most initiatives consumed resources (financial, staffing, time, mental, and relational) to an extend that was unacceptable for the participants. Improved hygiene and ventilation were sustainable initiatives given that the allocation of responsibility was clear. The sustainability of using visor/facemask was compromised by its negative effects on social interactions and by stigma. Isolation of teachers, when having been in contact with infected pupils, had major consequences for the teachers' private life. Finally, the sustainability of initiatives to keep a physical distance was challenged by implications related to the possibility of comforting younger schoolchildren and teaching activities demanding proximity to pupils.

Conclusions

It should be ensured that schools have the resources needed to hinder spread of virus while delivering high quality teaching. In addition, our findings suggest that school leaders clarify the prioritization between preventive initiatives and core tasks, and inform about responsibilities and academic expectations.

Key messages

Actions to make preventive initiatives sustainable within school environments are highly needed to keep schools open during this and future pandemics.

Policies should ensure that schools have the resources needed in order to hinder spread of virus while delivering high quality teaching.

Performance of near-infrared spectroscopy in pork shoulder as a predictor for pork belly softness

Pork belly quality indicators are economically relevant in the pork industry. Near-infrared (NIR) spectroscopy of the pork shoulder outer subcutaneous fat layer, belly flop angle, and subjective softness scores of the pork belly were measured (N = 144) to determine the accuracy of pork shoulder NIR spectroscopy as a predictor of pork belly softness. The NIR spectra hot carcass estimates explained over 80.0% variability in pork belly softness (80.5%–90.8%), with low prediction error, suggesting that NIR spectroscopy measured in the pork shoulder is an efficient and accurate indicator of pork belly softness to classify pork bellies for specific market demands.

Performance and risk factors associated with first antibiotic treatment in two herds, raising pigs without antibiotics

Background

Antibiotic (AB) consumption in production animals has a high awareness among politicians and consumers due to the risk of selection for AB resistance among potentially zoonotic bacteria. However, AB treatment of animals is at times necessary to treat diseases and ensure the wellbeing of the animals we take into our care. Raised without antibiotics (RWA) is a concept where pigs are individually ear-tagged for tracking, and if pigs are AB treated, they lose their RWA status. At slaughter, the farmer receives an additional price for non-AB treated pigs. The objective of this study was to identify risk factors for AB treatment and to investigate growth performance of pigs in two Danish RWA herds.

Results

A total of 518 pigs in herd A and 436 pigs in herd B, were individually ear-tagged and subjected to weekly investigations of AB treatment status from birth to 12 weeks of age. Bodyweight was recorded at birth, 2, 4 and 12 weeks of age. The results showed, that at 12 weeks of age, 82 of 518 liveborn pigs were AB treated in herd A and 31 of 436 liveborn pigs were AB treated in herd B. Individual pigs that required AB treatment had a reduced average daily gain from day 0 to 28 in both herds (herd A, P <  0.001; herd B, P = 0.062) and from day 0 to 84 in herd A (P <  0.001). Additionally, significant risk factors for AB treatment were identified as a low bodyweight in herd A, whereas barrows and litters with less than 19 piglets were the main risk factors in herd B.

Conclusion

The results suggests that in order to reduce AB treatments particular attention should be addressed to smaller pigs and barrows in RWA herds. In these two Danish RWA herds from this study it was possible for 64 and 68% pigs to reach 12 weeks of life without any AB treatments.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40813-021-00198-y.

Potential of near infrared (NIR) spectroscopy and dual energy X-ray absorptiometry (DXA) in predicting pork belly softness

Pork bellies (n = 198) were scanned with dual energy X-ray absorptiometry (DXA). Visible and near-infrared reflectance (Vis-NIR) spectra were collected from the lean (latissimus dorsi), subcutaneous fat and intermuscular fat layers. Belly-flop angle and subjective belly scores were collected as measures of pork belly softness. Vis-NIR spectra from a single fat layer could explain between 72.7 and 81.1% of the variation in pork belly softness (43.6-72.4% in validation set). The combination of the lean and subcutaneous layers improved the calibration model fit to 79.7-99.9% (66.3-71.5% in validation set). The DXA estimates explained 62.3% of variation in pork belly softness (65.2% in validation set). Results indicated that DXA and NIR technologies could potentially be utilized for pork belly softness sorting in the pork industry.

ABH-Glycan Microarray Characterizes ABO Subtype Antibodies: Fine Specificity of Immune Tolerance After ABO-Incompatible Transplantation

Organ transplantation from ABO blood group-incompatible (ABOi) donors requires accurate detection, effective removal and subsequent surveillance of antidonor antibodies. Because ABH antigen subtypes are expressed differently in various cells and organs, measurement of antibodies specific for the antigen subtypes in the graft is essential. Erythrocyte agglutination, the century-old assay used clinically, does not discriminate subtype-specific ABO antibodies and provides limited information on antibody isotypes. We designed and created an ABO-glycan microarray and demonstrated the precise assessment of both the presence and, importantly, the absence of donor-specific antibodies in an international study of pediatric heart transplant patients. Specific IgM, IgG, and IgA isotype antibodies to nonself ABH subtypes were detected in control participants and recipients of ABO-compatible transplants. Conversely, in children who received ABOi transplants, antibodies specific for A subtype II and/or B subtype II antigens-the only ABH antigen subtypes expressed in heart tissue-were absent, demonstrating the fine specificity of B cell tolerance to donor/graft blood group antigens. In contrast to the hemagglutination assay, the ABO-glycan microarray allows detailed characterization of donor-specific antibodies necessary for effective transplant management, representing a major step forward in precise ABO antibody detection.

Quantitative Trait Locus Based Virulence Determinant Mapping of the HSV-1 Genome in Murine Ocular Infection: Genes Involved in Viral Regulatory and Innate Immune Networks Contribute to Virulence

Herpes simplex virus type 1 causes mucocutaneous lesions, and is the leading cause of infectious blindness in the United States. Animal studies have shown that the severity of HSV-1 ocular disease is influenced by three main factors; innate immunity, host immune response and viral strain. We previously showed that mixed infection with two avirulent HSV-1 strains (OD4 and CJ994) resulted in recombinants that exhibit a range of disease phenotypes from severe to avirulent, suggesting epistatic interactions were involved. The goal of this study was to develop a quantitative trait locus (QTL) analysis of HSV-1 ocular virulence determinants and to identify virulence associated SNPs. Blepharitis and stromal keratitis quantitative scores were characterized for 40 OD4:CJ994 recombinants. Viral titers in the eye were also measured. Virulence quantitative trait locus mapping (vQTLmap) was performed using the Lasso, Random Forest, and Ridge regression methods to identify significant phenotypically meaningful regions for each ocular disease parameter. The most predictive Ridge regression model identified several phenotypically meaningful SNPs for blepharitis and stromal keratitis. Notably, phenotypically meaningful nonsynonymous variations were detected in the UL24, UL29 (ICP8), UL41 (VHS), UL53 (gK), UL54 (ICP27), UL56, ICP4, US1 (ICP22), US3 and gG genes. Network analysis revealed that many of these variations were in HSV-1 regulatory networks and viral genes that affect innate immunity. Several genes previously implicated in virulence were identified, validating this approach, while other genes were novel. Several novel polymorphisms were also identified in these genes. This approach provides a framework that will be useful for identifying virulence genes in other pathogenic viruses, as well as epistatic effects that affect HSV-1 ocular virulence.

In addition to causing recurrent labial lesions, herpes simplex virus type 1 (HSV-1) is also the primary source of infectious blindness in the United States. Animal studies have shown that the severity of infection is influenced by several factors, including viral strain. Conventional studies investigating the genetics of viral virulence have focused on characterizing a naturally occurring strain, and engineering mutations into viruses. The purpose of this study was to develop a quantitative trait locus (QTL) computational analysis of HSV-1 genome to identify ocular virulence determinants and associated viral SNPs. Notably, phenotypically meaningful variations were detected in the UL24, UL29 (ICP8), UL41 (VHS), UL53 (gK), UL54 (ICP27), UL56, ICP4, US1 (ICP22), US3 and gG genes. Several genes previously implicated in virulence were identified, validating this approach, while other genes were novel. This is the first time a QTL based approach has been applied to a herpesvirus and it will also be valuable in future virulence, epistasis, and protein-protein interaction studies.

Discarded Human Thymus Is a Novel Source of Stable and Long-Lived Therapeutic Regulatory T Cells

Regulatory T cell (Treg)-based therapy is a promising approach to treat many immune-mediated disorders such as autoimmune diseases, organ transplant rejection, and graft-versus-host disease (GVHD). Challenges to successful clinical implementation of adoptive Treg therapy include difficulties isolating homogeneous cell populations and developing expansion protocols that result in adequate numbers of cells that remain stable, even under inflammatory conditions. We investigated the potential of discarded human thymuses, routinely removed during pediatric cardiac surgery, to be used as a novel source of therapeutic Tregs. Here, we show that large numbers of FOXP3(+) Tregs can be isolated and expanded from a single thymus. Expanded thymic Tregs had stable FOXP3 expression and long telomeres, and suppressed proliferation and cytokine production of activated allogeneic T cells in vitro. Moreover, expanded thymic Tregs delayed development of xenogeneic GVHD in vivo more effectively than expanded Tregs isolated based on CD25 expression from peripheral blood. Importantly, in contrast to expanded blood Tregs, expanded thymic Tregs remained stable under inflammatory conditions. Our results demonstrate that discarded pediatric thymuses are an excellent source of therapeutic Tregs, having the potential to overcome limitations currently hindering the use of Tregs derived from peripheral or cord blood.

Selective Allosteric Antagonists for the G Protein-Coupled Receptor GPRC6A Based on the 2-Phenylindole Privileged Structure Scaffold

G protein-coupled receptors (GPCRs) represent a biological target class of fundamental importance in drug therapy. The GPRC6A receptor is a newly deorphanized class C GPCR that we recently reported for the first allosteric antagonists based on the 2-arylindole privileged structure scaffold (e.g., 1-3). Herein, we present the first structure-activity relationship study for the 2-arylindole antagonist 3, comprising the design, synthesis, and pharmacological evaluation of a focused library of 3-substituted 2-arylindoles. In a FRET-based inositol monophosphate (IP1) assay we identified compounds 7, 13e, and 34b as antagonists at the GPRC6A receptor in the low micromolar range and show that 7 and 34b display >9-fold selectivity for the GPRC6A receptor over related GPCRs, making 7 and 34b the most potent and selective antagonists for the GPRC6A receptor reported to date.

Chemical Basis for Qualitative and Quantitative Differences Between ABO Blood Groups and Subgroups: Implications for Organ Transplantation

Blood group ABH(O) carbohydrate antigens are carried by precursor structures denoted type I-IV chains, creating unique antigen epitopes that may differ in expression between circulating erythrocytes and vascular endothelial cells. Characterization of such differences is invaluable in many clinical settings including transplantation. Monoclonal antibodies were generated and epitope specificities were characterized against chemically synthesized type I-IV ABH and related glycans. Antigen expression was detected on endomyocardial biopsies (n = 50) and spleen (n = 11) by immunohistochemical staining and on erythrocytes by flow cytometry. On vascular endothelial cells of heart and spleen, only type II-based ABH antigens were expressed; type III/IV structures were not detected. Type II-based ABH were expressed on erythrocytes of all blood groups. Group A1 and A2 erythrocytes additionally expressed type III/IV precursors, whereas group B and O erythrocytes did not. Intensity of A/B antigen expression differed among group A1 , A2 , A1 B, A2 B and B erythrocytes. On group A2 erythrocytes, type III H structures were largely un-glycosylated with the terminal "A" sugar α-GalNAc. Together, these studies define qualitative and quantitative differences in ABH antigen expression between erythrocytes and vascular tissues. These expression profiles have important implications that must be considered in clinical settings of ABO-incompatible transplantation when interpreting anti-ABO antibodies measured by hemagglutination assays with reagent erythrocytes.

Genetic relatedness of commensal Escherichia coli from nursery pigs in intensive pig production in Denmark and molecular characterization of genetically different strains

AIMS

To determine the genetic relatedness and the presence of virulence and antibiotic resistance genes in commensal Escherichia coli from nursery pigs in Danish intensive production.

METHODS AND RESULTS

The genetic diversity of 1000 E. coli strains randomly picked (N = 50 isolates) from cultured faecal samples (N = 4 pigs) from five intensive Danish pigs farms was analysed by repetitive extragenic palindromic-PCR (REP-PCR) and 42 unique REP-profiles were detected (similarity <92%). One profile was dominant (67.2% of strains) but farms differed significantly in the diversity of commensal E. coli: between eight and 21 different profiles per farm were detected. One to three strains representing each REP-profile were characterized by multilocus typing scheme-typing, as well as for presence of antimicrobial and virulence genes and serogrouping through microarray analysis. The 42 REP-profiles were classified into 22 different sequence types (ST) with ST10 being the most common, encompassing 10 REP-profiles. Resistance and virulence genes were detected in most of the isolates. Genes encoding AmpC-β-lactamases and quinolone resistance were found in one and three isolates, respectively. Toxin-producing genes were observed in 20 isolates.

CONCLUSIONS

A low genetic diversity was found in commensal gut E. coli from nursery pigs in Denmark. No correlation was observed between REP-profiles, ST-types and resistance/virulence patterns.

SIGNIFICANCE AND IMPACT OF THE STUDY

This is the first study analysing in depth the genetic variability of commensal E. coli from pigs in Danish intensive pig production. A tendency for higher diversity was observed with in nursery pigs that were treated with zinc oxide only, in absence of other antimicrobials. Strains with potential to disseminate virulence and antibiotic resistance genes to pathogenic subgroups of E. coli were found to be wide-spread.

High- and moderate-intensity aerobic exercise and excess post-exercise oxygen consumption in men with metabolic syndrome

Physical activity is central in prevention and treatment of metabolic syndrome. High-intensity aerobic exercise can induce larger energy expenditure per unit of time compared with moderate-intensity exercise. Furthermore, it may induce larger energy expenditure at post-exercise recovery. The aim of this study is to compare the excess post-exercise oxygen consumption (EPOC) in three different aerobic exercise sessions in men with metabolic syndrome. Seven men (age: 56.7 ± 10.8) with metabolic syndrome participated in this crossover study. The sessions consisted of one aerobic interval (1-AIT), four aerobic intervals (4-AIT), and 47-min continuous moderate exercise (CME) on separate days, with at least 48 h between each test day. Resting metabolic rate (RMR) was measured pre-exercise and used as baseline value. EPOC was measured until baseline metabolic rate was re-established. An increase in O2 uptake lasting for 70.4 ± 24.8 min (4-AIT), 35.9 ± 17.3 min (1-AIT), and 45.6 ± 17.3 min (CME) was observed. EPOC were 2.9 ± 1.7 L O2 (4-AIT), 1.3 ±  .1 L O2 (1-AIT), and 1.4 ± 1.1 L O2 (CME). There were significant differences (P < 0.001) between 4-AIT, CME, and 1-AIT. Total EPOC was highest after 4-AIT. These data suggest that exercise intensity has a significant positive effect on EPOC in men with metabolic syndrome.

Prevention of bleeding after islet transplantation: lessons learned from a multivariate analysis of 132 cases at a single institution

Islet transplantation is being offered increasingly for selected patients with unstable type 1 diabetes. Percutaneous transhepatic portal access avoids a need for surgery, but is associated with potential risk of bleeding. Between 1999 and 2005, we performed 132 percutaneous transhepatic islet transplants in 67 patients. We encountered bleeding in 18/132 cases (13.6%). In univariate analysis, the risk of bleeding in the absence of effective track ablation was associated with an increasing number of procedures (2nd and 3rd procedures with an odds ratio (OR) of 9.5 and 20.9, respectively), platelets count <150,000 (OR 4.4), elevated portal pressure (OR 1.1 per mm Hg rise), heparin dose > or =45 U/kg (OR 9.8) and pre-transplant aspirin (81 mg per day) (OR 2.6, p = 0.05). A multivariate analysis further confirmed the cumulative transplant procedure number (p < 0.001) and heparin dose > or =45 U/kg (p = 0.02) as independent risk factors for bleeding. Effective mechanical sealing of the intrahepatic portal catheter tract with thrombostatic coils and tissue fibrin glue completely prevented bleeding in all subsequent procedures (n = 26, p = 0.02). We conclude that bleeding after percutaneous islet implantation is an avoidable complication provided the intraparenchymal liver tract is sealed effectively.

Clinical outcomes and insulin secretion after islet transplantation with the Edmonton protocol

Islet transplantation offers the prospect of good glycemic control without major surgical risks. After our initial report of successful islet transplantation, we now provide further data on 12 type 1 diabetic patients with brittle diabetes or problems with hypoglycemia previous to 1 November 2000. Details of metabolic control, acute complications associated with islet transplantation, and long-term complications related to immunosuppression therapy and diabetes were noted. Insulin secretion, both acute and over 30 min, was determined after intravenous glucose tolerance tests (IVGTTs). The median follow-up was 10.2 months (CI 6.5-17.4), and the longest was 20 months. Glucose control was stable, with pretransplant fasting and meal tolerance-stimulated glucose levels of 12.5+/-1.9 and 20.0+/-2.7 mmol/l, respectively, but decreased significantly, with posttransplant levels of 6.3+/-0.3 and 7.5+/-0.6 mmol/l, respectively (P < 0.006). All patients have sustained insulin production, as evidenced by the most current baseline C-peptide levels 0.66+/-0.06 nmol/l, increasing to 1.29+/-0.25 nmol/l 90 min after the meal-tolerance test. The mean HbA1c level decreased from 8.3+/-0.5% to the current level of 5.8+/-0.1% (P < 0.001). Presently, four patients have normal glucose tolerance, five have impaired glucose tolerance, and three have post-islet transplant diabetes (two of whom need oral hypoglycemic agents and low-dose insulin (<10 U/day). Three patients had a temporary increase in their liver-function tests. One patient had a thrombosis of a peripheral branch of the right portal vein, and two of the early patients had bleeding from the hepatic needle puncture site; but these technical problems were resolved. Two patients had transient vitreous hemorrhages. The two patients with elevated creatinine levels pretransplant had a significant increase in serum creatinine in the long term, although the mean serum creatinine of the group was unchanged. The cholesterol increased in five patients, and lipid-lowering therapy was required for three patients. No patient has developed cytomegalovirus infection or disease, posttransplant lymphoproliferative disorder, malignancies, or serious infection to date. None of the patients have been sensitized to donor antigen. In 11 of the 12 patients, insulin independence was achieved after 9,000 islet equivalents (IEs) per kilogram were transplanted. The acute insulin response and the insulin area under the curve (AUC) after IVGTT were consistently maintained over time. The insulin AUC from the IVGTT correlated to the number of islets transplanted, but more closely correlated when the cold ischemia time was taken into consideration (r = 0.83, P < 0.001). Islet transplantation has successfully corrected labile type 1 diabetes and problems with hypoglycemia, and our results show persistent insulin secretion. After a minimum of 9,000 IEs per kilogram are provided, insulin independence is usually attained. An elevation of creatinine appears to be a contraindication to this immunosuppressive regimen. For the subjects who had labile type 1 diabetes that was difficult to control, the risk-to-benefit ratio is in favor of islet transplantation.

corkscrew encodes a putative protein tyrosine phosphatase that functions to transduce the terminal signal from the receptor tyrosine kinase torso

We describe the characterization of the Drosophila gene, corkscrew (csw), which is maternally required for normal determination of cell fates at the termini of the embryo. Determination of terminal cell fates is mediated by a signal transduction pathway that involves a receptor tyrosine kinase, torso, a serine/threonine kinase, D-raf, and the transcription factors, tailless and huckebein. Double mutant and cellular analyses between csw, torso, D-raf, and tailless indicate that csw acts downstream of torso and in concert with D-raf to positively transduce the torso signal via tailless, to downstream terminal genes. The csw gene encodes a putative nonreceptor protein tyrosine phosphatase covalently linked to two N-terminal SH2 domains, which is similar to the mammalian PTP1C protein.