Poly-gamma-glutamate (gamma-PGA) has applications in food, medical, cosmetic, animal feed, and wastewater industries. Bacillus subtilis DB430, which possesses the gamma-PGA synthesis ywsC-ywtAB genes in its chromosome, cannot produce gamma-PGA. An efficient synthetic expression control sequence (SECS) was introduced into the upstream region of the ywtABC genes, and this resulted in gamma-PGA-producing B. subtilis mutant strains. Mutant B. subtilis PGA6-2 stably produces high levels of gamma-PGA in medium A without supplementation of extra glutamic acid or ammonium chloride. The mutant B. subtilis PGA 6-2 is not only a gamma-PGA producer, but it is also a candidate for the genetic and metabolic engineering of gamma-PGA production.

Successful weaning from ventilators not only improves the quality of life of patients, but also reduces medical expenses. The aim of this study was to explore the association between nutritional provision and successful ventilator weaning. In this retrospective study data from the Respiratory Care Center of Chung Shan Medical University Hospital between October, 2017 and July, 2019 on patient characteristics, amount of nutrition delivered, and clinical outcomes were retrieved. A total of 280 ventilated patients were enrolled and divided into successful extubation and failed weaning groups. There were 178 males (63.6%) and 102 females (36.4%) with a mean age of 67.3 ± 16.9 years. The successful extubation group consisted of patients who tended towards ideal body weight during the weaning process (BMI 23.9 ± 5.0 versus 22.7 ± 4.8 kg/m2, p < 0.001). Patients from both groups initially received the same nutritional intervention, while patients of successful extubation received significantly more calories and protein after weaning (23.8 ± 7.8 kcal versus 27.8 ± 9.1 kcal, p < 0.001 and 0.97 ± 0.36 g versus 1.14 ± 0.42 g, p < 0.001). Successful weaning was associated with higher survival rate (p = 0.016), shortened hospital stay (p = 0.001), and reduced medical costs (p < 0.001). Overall, nutritional support with high calories and protein was associated with the probability of successful ventilator weaning in patients undergoing prolonged mechanical ventilation. Adequate nutrition is a determinant of successful ventilator weaning.

Objectives Aggressive nutritional intervention may improve the outcomes of critically ill patients. Therefore, the National Health Insurance Administration (NHIA) in Taiwan revised its relevant fee schedule. On October 1, 2019, nutritional care items for intensive care unit (ICU) patients, covered by the NHIA under the category of nutritional care fees, were introduced to reflect real clinical needs. Methods This retrospective cohort study was conducted in a medical center ICU. The study period was January 1, 2019 to May 31, 2020, before and after the start of national health insurance (NHI) coverage of new nutritional care items for ICU patients. A total of 5292 patients were recruited and divided into two groups based on timing of NHI coverage. There were 1591 patients included in the analysis (751 in the non-NHI group and 840 in the NHI group). In the NHI group, the following nutritional protocol was implemented: First visit was at 48hr following admission to the ICU with 2 follow up visits over the next 5 days, then 3 visits the following week. Patient demographics, daily nutritional data, and outcomes were collected to investigate the impact of this protocol. Results Both groups were given the same nutritional intervention initially. However, there were significant differences in nutritional intervention following the incorporation of this treatment protocol in the ICU. Closely monitored nutritional intervention met critical requirements without overfeeding and led to shorter ICU stays (non-NHI 8.11 ± 6.69 days vs NHI 7.12 ± 7.43 days, p &lt; 0.01). Conclusions Nutritional care plan based on frequent assessments and interventions by dietitians is associated with reduced ICU stays for critically ill patients. Funding Sources None.

Dear Editor, I have reviewed the article by Lima et al. 1 entitled "Impact of intermittent fasting on body weight in overweight and obese individuals". In recent decades, intermittent fasting (IF) is currently a popular strategy for weight loss. Therefore, it is of great evidence-based practice to verify the relationship of IF in the body weight of overweight and obese individuals. The study of Lima et al. 1 makes some valuable contributions. However, I'd like to confirm the details of this article. The authors indicate that table 1 shows 4 papers related to the impact of vitamin D in the glucose profile of pre-diabetic individuals in the headline. In fact, four studies were considered enrolled all assessed the effect of IF in overweight or obese individuals comparing IF groups with calorie-restrictive diet (CRD) groups but not mentioned the impact of vitamin D in the glucose profile.In addition, a review of the published literature reported improvements in cardiovascular and metabolic parameters (triglycerides, LDL-cholesterol particle size, blood pressure, fat mass, and C-reactive protein), mood/depression status, and quality of life, even longevity genes expression or DNA damage 2 . Observational studies expanded on the fasting benefited with CAD and diabetes. IF with a high-protein diet is effective for weight loss were reported in few studies but not included vitamin D 3 . The description of the impact of vitamin D in the glucose profile of pre-diabetic individuals should be addressed in detail or revised.