Teigen, Levi

Background Lewy body disease (LBD) is a progressive neurodegenerative a-synucleinopathy, whereas isolated REM sleep behavior disorder (iRBD) is recognized as a prodromal stage of LBD. Although growing evidence implicates the gut–brain axis in neurodegeneration, the taxonomic and functional roles of the gut microbiome across the prodromal-to-symptomatic LBD continuum remain poorly defined. Methods Here, we performed shotgun metagenomic sequencing on stool samples from 25 patients with LBD (10 mild cognitive impairment due to LBD [MCI-LB] and 15 dementia with Lewy bodies [DLB]), 10 individuals with iRBD, and their household matched cohabitant controls to characterize disease-associated microbial alterations while minimizing environmental confounding. Results Despite no significant differences in global microbial diversity, we identified convergent shifts in microbial taxa, metabolic pathways, and gene families across disease stages. Both LBD and iRBD showed increased abundance of microbial taxa potentially associated with gut barrier disruption, as well as higher abundance of functional pathways related to lipopolysaccharide biosynthesis. LBD showed lower abundance of pathways related to complex carbohydrate fermentation, and both groups showed lower abundance of pathways associated with neurotransmitter-related metabolism. In particular, pathways and gene families associated with starch degradation were reduced in LBD, and those associated with histidine-to-glutamate/ GABA metabolism were reduced in both groups. Discussion These exploratory findings represent the first high-resolution, shotgun metagenomic characterization of gut microbiome alterations across the LBD continuum, highlighting functional patterns that may serve as candidate markers of disease progression in future longitudinal and mechanistic studies.

Abstract Ileostomy creation is common among patients with colorectal cancer, diverticulitis, and inflammatory bowel disease. Surgical removal or diversion of the colon can result in nutrition complications, most notably dehydration—a leading cause of hospital readmission—and increased risk of kidney injury. Existing studies on fluid and electrolyte management after ileostomy largely focus on short bowel syndrome or high‐output stomas, overlooking the physiological implications of ileostomy creation, even in patients with normal output. Given the absence of standardized oral rehydration protocols and limited interventional data, a scoping review was conducted to map the current evidence on oral rehydration solutions for postoperative fluid and electrolyte management in adults without short bowel syndrome or high‐output stoma. Comprehensive searches across five databases identified 5738 articles, of which 6 met inclusion criteria. Eligible studies examined adults with ileostomy for any standard indication in which oral rehydration solution use was a study objective. The included studies were methodologically heterogeneous, encompassing randomized controlled, crossover, double‐blinded comparator, retrospective cohort, and qualitative designs. Collectively, available evidence supports a pivotal role for oral rehydration solutions in both short‐term and long‐term management after ileostomy, improving hydration and reducing complications. This review highlights the need for standardized, evidence‐based oral rehydration regimens and underscores opportunities to reduce postoperative morbidity, kidney injury, and hospital readmissions while optimizing long‐term outcomes in this growing patient population.

AbstractBackgroundDespite malnutrition being associated with increased mortality and morbidity, there continues to be great difficulty in defining criteria and implementing widespread screening. Tools used to diagnose decreased fat‐free mass (FFM [sarcopenia]) should be easy to use, relatively inexpensive, and safe. Bioelectrical impedance analysis (BIA) has the potential to meet these criteria, but reliability across body mass index (BMI) classes is a concern.MethodsA total of 176 healthy ambulatory participants (aged 18–65 years) were recruited equally (n = 44) in 4 BMI categories: (1) 18.5–24.9, (2) 25.0–29.9, (3) 30–34.9, and (4) ≥35.0. Participants were fasting overnight and had S‐MFBIA (InBody 770) measurements the next morning, with DXA being performed subsequently within 30 minutes.ResultsThe measurement (mean ± SD) for FFM with DXA was 52.8 ± 11.0, and BIA was 53.6 ± 11.0. Delta (S‐MFBIA vs DXA) was 0.8 ± 2.2 (5% limits of agreement −3.5 to +5.2), and concordance correlation coefficient (CCC) was 0.98 (95% CI, 0.97–0.98). The measurements (mean ± SD) for PBF with DXA was 37.5 ± 10.6% and S‐MFBIA was 36.6 ± 11.3%. Delta (S‐MFBIA vs DXA) was −0.9 ± 2.6 (5% limits of agreement 6.0 to +4.2), and CCC was 0.97 (95% CI, 0.96–0.98). The CCC according to the 4 BMI groups for FFM and PBF was between 0.96–0.98 and 0.90–0.94, respectively.ConclusionsFFM and PBF measured by S‐MFBIA had good agreement with DXA across all BMI categories measured in the current study of ambulatory participants.

Abstract Introduction Post-traumatic stress disorder (PTSD) is characterized by persistent mental and emotional stress following one or more significant physical or psychological traumatic incidents earlier in life. Vivid recall of the events, including traumatic nightmares, and prominent sleep disturbance are usual in PTSD. Previous studies have suggested that PTSD may share some clinical features with idiopathic REM sleep behavior disorder (iRBD) including altered REM sleep without atonia (RSWA) levels. Our group has previously found evidence for altered RSWA control in patients with psychiatric disease, including a pilot sample of PTSD patients with iRBD. We aimed to comparatively analyze RSWA levels between patients with PTSD, PTSD and RBD (PTSD+RBD), iRBD, and controls. Methods We selected 18 PTSD, 18 PTSD+RBD, 15 iRBD, and 51 healthy control patients matched for age and sex from the Mayo Clinic Center for Sleep Medicine’s polysomnography database for RSWA quantification. RSWA amounts in the submentalis (SM) and anterior tibialis (AT) were quantitatively analyzed as a percentage of REM sleep duration, in accordance with previously published methods. Non-parametric analyses were performed to compare RSWA, patient demographics, and PSG data across groups. Significance was set at p < 0.016. Results Patients with PTSD had significantly higher RSWA than controls in all RSWA density measures (p < 0.016 for all). All measures of RSWA, excluding average SM duration, were significantly greater in PTSD+RBD patients compared with controls (p < 0.016 for all). Within the PTSD group, patients on antidepressants did not have significantly higher RSWA in any of the measures. PTSD+RBD patients had significantly higher SM Phasic, AT Any, SM+AT Any, and Tonic RSWA measures than PTSD patients (p < 0.016 for all). Conclusion PTSD patients have significantly higher RSWA than controls, with PTSD+RBD patients having higher RSWA levels than PTSD patients. These data provide the first evidence for abnormal RSWA control in patients with chronic PTSD. This provides evidence of a unique biology in PTSD that could imply a future risk for neurodegenerative disease in PTSD similar to RBD patients. Further prospective studying will need to be performed on patients with PTSD to understand the unique biology. Support

Background Migraine is an incompletely understood, debilitating disorder that lacks a universally effective treatment. Magnesium participates in a variety of biochemical processes related to migraine pathophysiology, and a deficiency could contribute to migraine development. Methods A review of the literature from 1990 to the present on magnesium and migraine was conducted. Review The authors identified 16 studies aimed at magnesium status assessment in migraine, and four intervention trials assessing the efficacy of oral magnesium supplementation, independent of other therapies, in the prevention of migraine. Conclusion The strength of evidence supporting oral magnesium supplementation is limited at this time. With such limited evidence, a more advantageous alternative to magnesium supplementation, in patients willing to make lifestyle changes, may be to focus on increasing dietary magnesium intake.