Hôpital Nestlé

Nicotinamide adenine dinucleotide (NAD(H)) and its phosphorylated form NADP(H) are vitamin B3-derived redox cofactors essential for numerous metabolic reactions and protein modifications. Various health conditions are associated with disturbances in NAD+ homeostasis. To restore NAD+ levels, the main biosynthetic pathways have been targeted, with nicotinamide (Nam), nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN) being the most prominent boosters. However, while many preclinical studies have examined the effects of these precursors, a direct comparison in humans is lacking, and recent rodent research suggests that the NAD+-boosting effects of NR and NMN may depend on their microbial conversion to nicotinic acid (NA), a mechanism not yet confirmed in humans. Here we show in a randomized, open-label, placebo-controlled study in 65 healthy participants that 14 days of supplementation with NR and NMN, but not Nam, comparably increases circulatory NAD+ concentrations in healthy adults. Unlike the chronic effect, only Nam acutely and transiently affects the whole-blood NAD+ metabolome. Using ex vivo fermentation with human microbiota, we identify that NR and NMN give rise to NA and specifically enhance microbial growth and metabolism. We further demonstrate ex vivo in whole blood that NA is a potent NAD+ booster, while NMN, NR and Nam are not. Ultimately, we propose a gut-dependent model for the modes of action of the three NAD+ precursors with NR and NMN elevating circulatory NAD+ via the Preiss-Handler pathway, while rapidly absorbed Nam acutely affects NAD+ levels via the salvage pathway. Overall, these results indicate a dual effect of NR and NMN and their microbially produced metabolite NA: a sustained increase in systemic NAD+ levels and a potent modulator of gut health. ClinicalTrials.gov identifier: NCT05517122 .

BackgroundPremeal whey protein (WP) consumption may reduce postprandial glucose (PPG) levels and appetite. We assessed the effects of twice daily consumption of a low-dose non-gelling novel WP formulation (WP microgel [WPM]) on PPG, self-reported appetite, and ad-libitum food consumption.MethodsThis was a randomized, prospective, open-label, controlled, single-center crossover study, and adults with BMI 27–35 kg/m2 were randomized to consume either 125 mL of 10 g WPM or control (water) 15 min before breakfast and lunch for four consecutive days. Three days were under free-living conditions, and the 4th day was at the clinic where breakfast (09:00 a.m.) was standardized (323 kcal, 7.0 g proteins), and lunch (12:00 p.m.) ad-libitum (pizza, 228.8 kcal/9.9 g proteins per 100 g). Following a 3-day wash-out, participants were switched to the opposite regimen. The primary confirmatory endpoint was breakfast 2 h-PPG (assessed using CGM) analyzed as iAUC-15-120min using a linear mixed effects model. Appetite was captured by frequent self-reporting (hunger, desire, amount, fullness, satisfaction) using a visual analogue scale (0–100 mm). Ad-libitum food consumption (lunch) was assessed by weighing the amount consumed.Result18 individuals (8 females, median age 57 years, BMI 29.8 kg/m2, HbA1c 5.5 %) were randomized and consumed products. The breakfast 2 h-PPG iAUC was 39.3 % lower with WPM compared with control (LSM iAUC Ratio WPM/control (95 % CI): 0.607 [0.4 43, 0.831], p = 0.0047), and during lunch numerically reduced (p = 0.0649). Appetite scores during breakfast and lunch supported a modest suppressing effect of the WPM. Food consumption during the ad-libitum lunch was significantly reduced by 9.4 % (WPM vs Control −66.8 kcal [-133.1, −0.6], p = 0.0482).ConclusionsA 125 mL pre-meal dose of WPM consumed twice daily before breakfast and lunch for 4 days in adults with obesity significantly reduced breakfast PPG and had a moderate appetite-suppressing effect, which led to a significantly lower energy consumption during ad-libitum lunch (NCT06593769).

Chest pain, a frequent reason for medical consultation, can have benign causes or be a sign of serious conditions requiring thorough assessment. Identifying "red flags" (hypotension, tachycardia) and conducting a comprehensive evaluation, including medical history, vital signs, electrocardiogram (ECG), biomarkers, and imaging, is essential to distinguish between benign and critical causes. Acute coronary syndromes, such as ST-elevation/non-ST-elevation myocardial infarction, are guided by European recommendations based on troponins and 24-hour ECG monitoring. Chronic coronary syndromes require early screening for risk factors, lifestyle optimisation, and personalised treatment, improving diagnosis, management, and outcomes.

This article reports on new findings on integrative and complementary medicine published in 2024. The implementation of guidelines for the management of pain in cancer patients is discussed. Then, a literature review is presented, that aims to clarify the role of complementary approaches in the management of chemotherapy-induced nausea and vomiting and provides a concrete example of how recommendations are established. Finally, a meta-analysis focusing on the efficacy of Echinacea in the treatment of upper respiratory tract infections is summarized. These articles illustrate the complexity of the path from science to practice and underscore the importance of identifiable centers of reference to support the dissemination of knowledge to health care professionals and promote broad patient access to well-coordinated therapies.

Ankle fractures account for 10 % of all fractures in adults. The incidence of ankle fractures is rising, particularly as the population ages. Two thirds are isolated malleolar fractures. The most used classifications are anatomical, Weber's and Lauge-Hansen's classifications. The treatment of lateral malleolar fractures may be conservative or surgical, depending on the ankle stability. To test this, a weight-bearing X-ray is required. If this is not possible on the day of trauma, it can be done 7 days later. Conservative treatment consists of a six-week immobilization in a splint or plaster cast, with weight-bearing as tolerated. Surgical treatment is mandatory for unstable fractures.

La fin de la pandémie de coronavirus se dessine en Suisse.Ainsi, la politique de la santé pourra s'appuyer à nouveau sur ses structures ordinaires et se recentrer sur des objectifs plus larges que la seule capacité des unités de soins intensifs.Les stratégies cantonales et supracantonales en matière de coronavirus revêtiront une importance particulière.Avec le variant de SARS-CoV-2 Omicron, une fois la vague d'infection actuelle surmontée, le risque d'une défaillance du système de santé devrait nettement diminuer.Malgré le nombre très élevé d'infections, les hospitalisations de personnes dont l'infection a été confirmée en laboratoire n'ont pas augmenté dans la mesure redoutée, l'occupation des unités de soins intensifs par les patients Covid-19 est toujours élevée, mais la tendance est à la baisse (fig.1).A moins d'une propagation d'un nouveau variant plus virulent et plus contagieux, la Suisse se trouve sur la voie d'un retour à une politique de santé normale grâce à une