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Background: Dietary modification is an important component of chronic kidney disease (CKD) management. The aim of this study was to explore the perceptions of people with earlier-stage CKD living in rural Australia about the role of dietary intervention in their health and access to dietetic care., Methods: Semi-structured interviews were conducted with 14 people with stage 3-4 CKD living in a rural Australian health district. Interview questions were guided by the principles of the appreciative inquiry study methodology. The thematic analysis involved inductive coding of data, discussions of emerging themes between co-researchers as coding proceeded and thematic memoing to finalise the transformation of data into distinct themes., Results: Three predominant themes were evident from the data. First, people with CKD expressed that 'Dietary change empowers' them in self-management. Second, 'Dietetics is valued' in achieving dietary change. Third, it was clear that nephrologists had a key role in determining service access through 'Awareness and advocacy' of renal dietetic services., Conclusions: People with CKD living in rural Australia desire early, specialised renal dietetic care. The unexpectedly high acceptability of less resource-intensive technology for dietetic intervention suggests that there is an opportunity for service reorientation. Access to dietetic care could be enhanced by building on the key role of nephrologists in dietetic referral, service awareness and perception of value., (© 2024 The British Dietetic Association Ltd.)

Context: Prior research has explored the effect of synbiotics, the combination of probiotics and prebiotics, on the gut microbiota in clinical populations. However, evidence related to the effect of synbiotics on the gut microbiota in healthy adults has not been reviewed to date., Objective: A systematic review and meta-analysis was conducted to comprehensively investigate the effect of synbiotics on the gut microbiota and inflammatory markers in populations of healthy adults., Data Sources: Scopus, PubMed, Web of Science, ScienceDirect, MEDLINE, CINAHL, and The Cochrane Library were systematically searched to retrieve randomized controlled trials examining the primary outcome of gut microbiota or intestinal permeability changes after synbiotic consumption in healthy adults. Secondary outcomes of interest were short-chain fatty acids, inflammatory biomarkers, and gut microbiota diversity., Data Extraction: Weighted (WMD) or standardized mean difference (SMD) outcome data were pooled in restricted maximum likelihood models using random effects. Twenty-seven articles reporting on 26 studies met the eligibility criteria (n = 1319)., Data Analysis: Meta-analyses of 16 studies showed synbiotics resulted in a significant increase in Lactobacillus cell count (SMD, 0.74; 95% confidence interval [CI], 0.15, 1.33; P = 0.01) and propionate concentration (SMD, 0.22; 95% CI, 0.02, 0.43; P = 0.03) compared with controls. A trend for an increase in Bifidobacterium relative abundance (WMD, 0.97; 95% CI, 0.42, 2.52; P = 0.10) and cell count (SMD, 0.82; 95% CI, 0.13, 1.88; P = 0.06) was seen. No significant differences in α-diversity, acetate, butyrate, zonulin, IL-6, CRP, or endotoxins were observed., Conclusion: This review demonstrates that synbiotics modulate the gut microbiota by increasing Lactobacillus and propionate across various healthy adult populations, and may result in increased Bifidobacterium. Significant variations in synbiotic type, dose, and duration should be considered as limitations when applying findings to clinical practice., Systematic Review Registration: PROSPERO no. CRD42021284033., (© The Author(s) 2024. Published by Oxford University Press on behalf of the International Life Sciences Institute.)

Dysregulated differentiation of naïve CD4+ T cells into T helper 17 (Th17) cells is likely a key factor predisposing to many autoimmune diseases. Therefore, better understanding how Th17 differentiation is regulated is essential to identify novel therapeutic targets and strategies to identify individuals at high risk of developing autoimmunity. Here, we extend our prior work using chemical inhibitors to provide mechanistic insight into a novel regulator of Th17 differentiation, the kinase dual-specificity tyrosine phosphorylation-regulated kinase 1A (DYRK1A). We generated a conditional knockout mouse model to validate DYRK1A as a regulator of Th17 differentiation that acts in a dose-dependent fashion at least in part by modulating interleukin (IL)-6 signaling through multiple mechanisms. We identified a new role for DYRK1A in regulating surface expression of IL-6 receptor subunits in naïve CD4+ T cells, consistent with DYRK1A's impact on Th17 differentiation. Physiologic relevance is supported by findings in people with Down syndrome, in which increased expression of DYRK1A, encoded on chromosome 21, is linked to increased IL-6 responsiveness. Our findings highlight DYRK1A as a druggable target of broad therapeutic and prognostic interest in autoimmunity and immune function., (© The Author(s) 2025. Published by Oxford University Press on behalf of The American Association of Immunologists.)

Background: It is well established that antibiotics administered in preterm prelabor rupture of membranes increases latency to delivery. While data is limited for membrane rupture prior to viability, antibiotics may also increase latency in this population., Objective: To assesses the effect of prophylactic antibiotics on the duration of latency in individuals with previable prelabor rupture of membranes., Study Design: Retrospective cohort of pregnancies with previable prelabor rupture of membranes prior to 23 weeks, 0 days in a single health system(2013-2022). Patients opting for termination or with a contraindication to expectant management were excluded. The primary outcome was latency from previable prelabor rupture of membranes diagnosis to delivery. Secondary outcomes included subanalysis by gestational age as well as maternal and neonatal morbidity and mortality. Bivariate statistics compared patients who did and did not received antibiotics. Kaplan-Meier/Cox proportional hazards ratios using significant covariates(p<0.1) in bivariate analysis models examined antibiotic impact on latency., Results: Of 115 patients, 46(40%) met inclusion criteria, of whom 34(74%) received latency antibiotics. Median latency did not differ with antibiotic receipt(1 week, [0.4,2.6] versus 0.6 weeks [0.3,0.9], p=0.27). When adjusted for gestational age at rupture of membranes, antibiotics were not associated with longer latency(hazard ratio1.33 [0.91,1.93]). Antibiotic receipt was associated with lower rates of previable delivery(23.0 weeks, [22.7, 24.0] versus 21.3 weeks [20.5,23.1], p=0.006). Adjusted odds of previable delivery remained lower with receipt of antibiotics(adjusted odds ratio 0.20, [0.04,0.90]). Antibiotics were associated with longer latency in patients with rupture of membranes at less than 22 week's gestation(2.4wks [1.3,4.4] vs 0.6wks [0.1,0.9], p=0.02)., Conclusion: Antibiotic administration at the time of previable prelabor rupture of membranes was associated with longer latency if prior to 22 weeks' gestation. Antibiotic administration increased the odds of delivering after viability. Further study should address optimal antibiotics strategies for this unique population., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Objective: To describe the process of developing and implementing a novel approach to renal diet education by changing from a nutrient-based food list to a pictorial meal compilation approach through the skill steps: plan, select, cook, eat., Design and Methods: The skill-based teaching method accommodates low literacy levels and respects cultural values. This teaching style aligns the complex renal diet guidelines with family living. Each meal plan is based on a balanced diet and includes family preferences. Appropriate cooking methods and food swaps that match renal diet specifications are included. The accompanying Cook for Life cookbook demonstrates how to prepare the new kidney-friendly family meal. Recipes were supplied by a local Māori elder and his whānau and tested by the dietitian. The cookbook is provided to all patients receiving renal dietetic education. The teaching method has undergone several iterations to accommodate feedback from dietitians, nurses, doctors, and patients. This included patient engagement to develop the Storybook, a pictorial representation of typical meals consumed in the community with a corresponding food substitution to illustrate how to compile kidney-friendly meals., Results: Analysis of feedback regarding this approach indicates high levels of acceptance and engagement with this new teaching style., Conclusion: This practical skill-based dietary education teaching style appears to be a feasible, acceptable, culturally sensitive, and appropriate approach to dietary education for people who live with kidney disease. Patient engagement in the design of this approach supports effective learning and behavior change., (Copyright © 2024 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Studies exploring early life-course BMI trajectories and subsequent mental health outcomes are limited but may provide important insights for early intervention. We investigated associations between BMI trajectories from 0 to 18 years and mental health outcomes in emerging adulthood., Methods: Data were obtained from 434 participants in the Melbourne Atopy Cohort Study (MACS). Anthropometric data were collected across 26 timepoints from infancy to age 25 and group-based trajectory modelling was used to develop BMI trajectories from 0.1 to 18 years. Moderate-to-severe psychological distress (MSPD) and likely depression were assessed at age 18 and 25 years. Associations between BMI trajectories and mental health at 25 years and change in mental health between 18 and 25 years were estimated using logistic regression. History of asthma, hay fever or eczema were independently examined as potential effect modifiers., Results: Five BMI trajectories were identified from 1 month to 18 years. When compared to the stable average BMI trajectory, we found an increased risk of MSPD (OR = 2.97; 95%CI: 1.09,8.06) and likely depression (3.56; 1.39,9.12) at age 25 in the average increasing-to-high trajectory. This group also had a greater likelihood of new-onset depression (4.82; 1.54,15.0) from 18 to 25 years of age., Limitations: MACS participants are not representative of the general population and mental health data was not available before 18 years of age., Conclusion: Excessive weight gain across the childhood transition was associated with poorer mental health in emerging adulthood, highlighting the importance of monitoring growth to allow for early identification and stratification of individuals at risk of poor mental health., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Antimicrobial resistance (AMR) has been declared one of the top 10 global public health challenges of our age by the World Health Organization, and the World Bank describes AMR as a crisis affecting the finance, health, and agriculture sectors and a major threat to the attainment of Sustainable Development Goals. But what is AMR? It is a phenotype that evolves in microbes exposed to antimicrobial molecules and causes dangerous infections. This suggests that scientists and healthcare workers should be on the frontline in the search for sustainable solutions to AMR. Yet AMR is also a societal problem to be understood by everyone. This review aims to explore the need to address the problem of AMR through a coherent, international strategy with buy-in from all sectors of society. As reviewed here, the sustainable solutions to AMR will be driven by better understanding of AMR biology but will require more than this alone to succeed. Some advances on the horizon, such as the use of bacteriophage (phage) to treat AMR infections. However, many of the new technologies and new therapeutics to address AMR require access to biodiversity, where the custodians of that biodiversity-and the traditional knowledge required to access it-are needed as key partners in the scientific, clinical, biotechnological, and international ventures that would treat the problem of AMR and ultimately prevent its further evolution. Many of these advances will be built on microbial assessments to understand the extent of AMR in our environments and bioprospecting to identify microbes that may have beneficial uses. Genuine partnerships for access to this biodiversity and sharing of benefits accrued require a consideration of ethical practice and behavior. Behavior change is needed across all sectors of culturally diverse societies so that rapid deployment of solutions can be implemented for maximum effect against the impacts of AMR., (© 2024 The Author(s). IUBMB Life published by Wiley Periodicals LLC on behalf of International Union of Biochemistry and Molecular Biology.)