Huisarts en Wetenschap

Pyridine-2,6-dicarboxylic acid (DPA) is a valuable dicarboxylic acid that has the potential to serve as a precursor for bio-sustainable and bio-degradable materials and self-healing polymers. It also plays a crucial role in the heat resistance of Bacillus subtilis spores. However, extracting DPA from spores is resource-intensive and technically complex, limiting its industrial application. To overcome these challenges, this study aims to engineer B. subtilis as a microbial cell factory for the direct production of free and soluble DPA. This study first demonstrated that blocking sporulation reduced DPA production due to the repression of dipicolinate synthase expression. To enhance extracellular DPA production, dipicolinate synthase expression was fine-tuned, increasing the extracellular DPA titer to 330 ± 10mg/l in strain BSDYvyDVF. Transcriptomic analysis revealed that spore coat assembly genes modulate DPA production. By disrupting a spore coat assembly activator in strain BSDYvyDVF-gerE, sporulation was successfully inhibited, significantly boosting the DPA yield to 944 ± 3mg/l. Further optimization of fermentation conditions was performed using an orthogonal design. The highest DPA titer of 1250mg/l was achieved and validated through fed-batch fermentation in a 1.5-l bioreactor. This study demonstrates the potential of engineered B. subtilis BSDYvyDVF-gerE as an efficient cell factory for sustainable DPA biosynthesis. In addition, it identifies key challenges in DPA production, including synthesis efficiency (regulation of key enzyme expression) and transport (intracellular-to-extracellular export), and proposes corresponding solutions.

Inleiding: De JGZ nodigt op specifieke leeftijden alle ouders uit voor fysieke consulten om de ontwikkeling van het kind te volgen. Na validering van de Structured Problem Analysis of Raising Kids (SPARK) ontstond de mogelijkheid om de zorg te differentiëren op basis van de verschillende behoeften van gezinnen. Methode: Dit onderzoek startte met de ontwikkeling van een zorgpad met e-consulten voor peuters met laag risico. Na implementatie werden gezondheid en ontwikkeling van het kind gevolgd via door ouders ingevulde vragenlijsten. Ter evaluatie werd een consult op de leeftijd van 30 maanden uitgevoerd en werden gebruikerservaringen van ouders en jeugdverpleegkundigen uitgevraagd. Resultaten: Het bleek in de dagelijkse praktijk haalbaar om ouders en kinderen met een laag risico op opvoedings- en ontwikkelingsproblemen e-consulten aan te bieden, die hen ondersteunen. Binnen de projectduur zijn 106 e-consulten op 24 maanden, 81 op 30 maanden en 59 op 36 maanden uitgevoerd. Ouders waren zeer tevreden over de e-consulten, in tegenstelling tot jeugdverpleegkundigen. Beschouwing: Dit onderzoek liet veelbelovende mogelijkheden zien voor digitale zorg in de JGZ. Het perspectief van ouders motiveerde jeugdverpleegkundigen om door te gaan met e-consulten. Door te beginnen met een digitaal aanbod voor ouders en kinderen met laag risico, kan tijd vrijkomen om in te zetten voor ouders en kinderen met meer zorgbehoeften en hoger risico. Vervolgonderzoek naar de effectiviteit van e-consulten ten opzichte van fysieke consulten volgt.

Abstract: Background: Bipolar affective disorder is a chronic condition with high relapse rate, morbidity, and psychosocial impairment that often persist despite pharmacotherapy highlighting the need for psychosocial treatments. Non pharmacological intervention like family focused therapy (FFT) can improve the disease outcome i.e. depression and mania symptoms and reduces relapse rate. Objective: To assess the effect of family Focused therapy on disease outcome of bipolar affective disorder patients. Materials and Method: In this review Pub med, Medline, Google scholar, Cochrane database between 1999 to 2024 were searched by using RCT, reviews fulfilling inclusion criteria were included. Randomized controlled trials comparing family focused therapy with pharmacotherapy as usual, enhanced care, added in the study. Adolescents without any psychotic feature, any neurological disorders, and substance use disorders were included in this review. Two independent reviewers extracted data and assessed the quality of the trials. The results were presented in form of forest Plots. Results: A total of 13 studies, including 1208 bipolar patients, were included in the review for qualitative analysis. Amongst them eight studies involving.584 bipolar patients receiving Family focused therapy included in meta analysis in depression and mania outcome .Overall, there was a reduction in depressive and manic symptoms among the bipolar patients receiving family focused therapy compared to treatment as usual and enhanced care. For depression{SMD:-0.38(-0.67,-0.08,95%CI)}.For Mania SMD:-0.45(-0.77,-0.12,95%CI)}.Significant reduction of relapse rate were found .No significant changes of medication adherence and quality of life were found. Conclusion: Family focused therapy adjunct to pharmacotherapy in bipolar affective disorder is effective in reducing depressive and manic symptoms. Reducing number of mood episodes, and hospitalization and increased time between episodes.