Grape Polyphenols Prevent Fructose-Induced Oxidative Stress and Insulin Resistance in First-Degree Relatives of Type 2 Diabetic Patients

OBJECTIVE

To assess the clinical efficacy of nutritional amounts of grape polyphenols (PPs) in counteracting the metabolic alterations of high-fructose diet, including oxidative stress and insulin resistance (IR), in healthy volunteers with high metabolic risk.

RESEARCH DESIGN AND METHODS

Thirty-eight healthy overweight/obese first-degree relatives of type 2 diabetic patients (18 men and 20 women) were randomized in a double-blind controlled trial between a grape PP (2 g/day) and a placebo (PCB) group. Subjects were investigated at baseline and after 8 and 9 weeks of supplementation, the last 6 days of which they all received 3 g/kg fat-free mass/day of fructose. The primary end point was the protective effect of grape PPs on fructose-induced IR.

RESULTS

In the PCB group, fructose induced 1) a 20% decrease in hepatic insulin sensitivity index (P < 0.05) and an 11% decrease in glucose infusion rate (P < 0.05) as evaluated during a two-step hyperinsulinemic-euglycemic clamp, 2) an increase in systemic (urinary F2-isoprostanes) and muscle (thiobarbituric acid–reactive substances and protein carbonylation) oxidative stress (P < 0.05), and 3) a downregulation of mitochondrial genes and decreased mitochondrial respiration (P < 0.05). All the deleterious effects of fructose were fully blunted by grape PP supplementation. Antioxidative defenses, inflammatory markers, and main adipokines were affected neither by fructose nor by grape PPs.

CONCLUSIONS

A natural mixture of grape PPs at nutritional doses efficiently prevents fructose-induced oxidative stress and IR. The current interest in grape PP ingredients and products by the global food and nutrition industries could well make them a stepping-stone of preventive nutrition.The Western diet, dominated by ultra-processed products rich in saturated fats and sugar, including high-fructose corn syrup, and poor in micronutrients (1), is a major contributor to the worldwide “diabesity” epidemic. In addition to contributing to calorie overconsumption, the unique metabolism of fructose (2) and its marked effect on systemic oxidative stress (3) could give it a pivotal role in the pathophysiology of insulin resistance (IR) and the metabolic syndrome (4).The “French Paradox,” defined as a low incidence of coronary heart disease despite consumption of a diet rich in saturated fat (5), has stimulated interest in investigating whether grape polyphenols (PPs) may offer antioxidant-consequential health benefits (6–8) including improved insulin sensitivity (9), although this effect remains debated (10). If this outcome were to be confirmed in humans, then supplementation of highly processed foods with grape PPs may prove to be a promising strategy to stem the tide of chronic metabolic diseases, which, furthermore, would be quite easy to implement, since PPs are currently marketed in the form of dyes and tannins that can be used safely in relatively large amounts in sugary foods (11).We thus designed a randomized double-blinded controlled study to assess the clinical efficacy of nutritional amounts of grape PPs in counteracting the metabolic effects of high-fructose diet (HFrD) to substantiate the hypothesis that by neutralizing oxidative stress, grape PPs can prevent fructose-induced IR.     

Communication and Human Patient Simulation in Psychiatric Nursing

Communication is an integral component of nursing education and has been shown to improve health outcomes, patient compliance, and patient satisfaction. Psychiatric nursing emphasizes knowledge and utilization of communication skills. Nursing students often express anxiety and lack of confidence regarding communicating with patients diagnosed with psychiatric illnesses. Human patient simulation is one method that may be used for students to practice and become proficient with communication skills in a simulated environment. The authors of this article provide an overview of communication and psychiatric nursing as well as review of the current research related to the use of human patient simulation in nursing education.     

In vivo induction of the nitric oxide pathway in hepatocytes after injection with irradiated malaria sporozoites,malaria blood parasites or adjuvants

The mechanisms responsible for malarial immunity induced by repetitive injections of X-irradiated sporozoites have not been fully established. We demonstrate here that a single injection of irradiated sporozoites induced, as soon as 24 h after, a non-permissive state to hepatocyte reinfection with sporozoites in vitro. The same effect was observed when malarial blood forms, irradiated promastigotes of Leishmania infantum, adjuvants (muramyl dipeptide, poly acidylic uridylic) or interferon-γ was injected. Activation of the nitric oxide (NO) pathway in the hepatocyte by these factors was found to be responsible for hepatocyte refractory status. Additionally, this metabolic pathway is involved in protection given by repeated injections of irradiated sporozoites since protection could be reversed by treating mice at the time of sporozoite challenge with a competitive inhibitor (N^G-monomethyl-L-arginine) of the NO pathway. These results suggest that, in view of an antisporozoite vaccine, further studies are needed to find out how to activate specifically a long-lasting nonspecific immune response.     

Written patient information: a review of the literature*

In the United States during the 1940s Flesch and Gunning pioneered the movement to improve the comprehensibility of government documents Since that time the provision of comprehensible information to the general public has become increasingly important Indeed, most computer programs have the facility to assess what percentage of the population will understand certain forms of written information Vast quantities of written patient information have been produced over the decades and more are being produced daily This literature review sets out to provide an insight into the studies which have looked at the value and purpose of such literature Considering the amount of written patient information in existence the amount of research into this interesting subject is small Many concepts have to be considered Is this information of any use to patients? Can they understand and recall it and does it increase compliance? Are patients satisfied with the amount, quality and detail of written information? If health professionals are to inform their patients fully, written information is an area which should be more fully researched for ethical, quality and economic reasons     

Family Factors Associated with Aggressive Symptomatology in Boys with Attention Deficit Hyper activity Disorder: A Research Note

This study tested whether parent and child affective attitudes and interactional behavior co-varied with the presence or absence of associated aggressive symptomatology in families with an attention deficit hyperactivity disorder (ADHD) child. Affective attitudes of both parents and their ADHD sons were studied using a modified measure of expressed emotion, the five minute speech sample (FMSS-EE), in 29 families. A direct interaction task was also used to measure verbal and non-verbal communication. FMSS-EE status predicted parental interactional behavior, but the degree of child aggressiveness did not. The child's behavior towards parents, however, was highly correlated with their aggressiveness but not their EE status regarding their parents, despite the fact that child and parent EE were highly correlated. The study supports the notion that aggressiveness and a negative family climate may be independent factors in determining the long-term course of ADHD children.     

Accuracy and quality of immunization information systems in forty-one low income countries

Objectives  To measure the accuracy and quality of immunization information systems in a range of low-income countries eligible to receive GAVI support.
Methods  The Data Quality Audit (DQA) uses a WHO validated, standard methodology to compare data collected from health unit (HU) records of immunizations administered with reports of immunizations at central level and to collect quality indicators of the reporting system. The verification factor (VF), as a measure of accuracy, expresses the proportion of immunizations reported at national level that can be tracked down to the HU. A VF of 80% or above entitles countries to receive additional GAVI financial support. Quality indicators are assigned points which were summed to obtain quality scores (QS) at national, district and HU levels. DQAs included here were conducted between 2002 and 2005 in 41 countries, encompassing 1082 primary healthcare units in 188 randomly selected districts.
Results  Almost half of countries obtained a VF below 80% and only nine showed consistently high VF and QS scores. The most frequent weaknesses in the information systems were inconsistency of denominators used to estimate coverage, poor availability of guidelines (e.g. for late reporting), incorrect estimations of vaccine wastage and lack of feedback on immunization performance. In all six countries that failed a first DQA and undertook a second DQA, the VF and all QSs improved, not all of them statistically significantly.
Conclusions  The DQA is a diagnostic tool to reveal a number of crucial problems that affect the quality of immunization data in all tiers of the health system. It identifies good performance at HU and district levels which can be used as examples of best practices. The DQA methodology brings data quality issues to the top of the agenda to improve the monitoring of immunization coverage.     

Reciprocal interactions between β1-integrin and epidermal growth factor receptor in three-dimensional basement membrane breast cultures: A different perspective in epithelial biology

Anchorage and growth factor independence are cardinal features of the transformed phenotype. Although it is logical that the two pathways must be coregulated in normal tissues to maintain homeostasis, this has not been demonstrated directly. We showed previously that down-modulation of β1-integrin signaling reverted the malignant behavior of a human breast tumor cell line (T4–2) derived from phenotypically normal cells (HMT-3522) and led to growth arrest in a three-dimensional (3D) basement membrane assay in which the cells formed tissue-like acini (14). Here, we show that there is a bidirectional cross-modulation of β1-integrin and epidermal growth factor receptor (EGFR) signaling via the mitogen-activated protein kinase (MAPK) pathway. The reciprocal modulation does not occur in monolayer (2D) cultures. Antibody-mediated inhibition of either of these receptors in the tumor cells, or inhibition of MAPK kinase, induced a concomitant down-regulation of both receptors, followed by growth-arrest and restoration of normal breast tissue morphogenesis. Cross-modulation and tissue morphogenesis were associated with attenuation of EGF-induced transient MAPK activation. To specifically test EGFR and β1-integrin interdependency, EGFR was overexpressed in nonmalignant cells, leading to disruption of morphogenesis and a compensatory up-regulation of β1-integrin expression, again only in 3D. Our results indicate that when breast cells are spatially organized as a result of contact with basement membrane, the signaling pathways become coupled and bidirectional. They further explain why breast cells fail to differentiate in monolayer cultures in which these events are mostly uncoupled. Moreover, in a subset of tumor cells in which these pathways are misregulated but functional, the cells could be “normalized” by manipulating either pathway.