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Representation I will ask the question
would be very often ask my
presentation. I don't want to do you
think remember twenty four hours for
what them so please raise your hands if
you think you remember ninety process
Okay twenty five percent of okay Chris
and process five three seven it is also
the switch and very often a grammatical
students and then I'm showing them
baseline what is the average we call
twenty four hours and you're just
listening it's five percent if we are
discussing it's about fifty percent and
the only person who really benefit is
the presenters so thank you very much
on behalf of the of the present I
thought it said patient for a repeat
again and again what we hope we should
now. I have another question for your
ace after this is the second day of
this symposium do you think about if
you're if you're so that's how most so
yeah that's currently no was used to
call us do you think like that. I think
that some of Mexicans at some some oh
perhaps we are home a bacteria. And the
reason is that one of our colleagues
that we are not human we are working
bacterial colonies and to have her
again and again during this meeting and
we heard that the microbes are not just
passengers and we have heard about this
video is a drug microbe I've got the
alterations which are associated with
this CD I usually show also the next
slide but that I should not display
question but for many of us can still
remains to be determined if the
alterations are the costs or the
consequences but anyway it's clear that
there is some link between the
microbiology and the disease and
there's a number of that they just the
manipulates about micro fibre and in my
presentation I would only focused on
for biotic because this is the main
area of my research interest stars the
initial not provided or six and what is
new in two thousand fourteen this is
the paper developed by international
scientific association for probably a
Peabody or take part in these here and
interest and when it comes to the
definition definition is oh the
definition and the difference is that
tuition. However as you can see on the
side for a duration and say a person so
high but emission is more or less the
same as it used to be a lawyer takes a
porno to your laptop busted out if in
the bacteria spectrum ices what are and
also in the paper Jane mentioned or on
the the provider products are listed
and it's clearly saying is they were a
provider and what are not for
bioethics. And I think it's not
important not not needed to to to
mention it here. What we don't know and
this is how I live stock for years that
not all providers are created equal.
And however recently this point has
been challenged and this has been
challenged by I saw international
scientific also shooting for probably
not exactly but you're with which pose
the question of whether there are
benefits that can be actually beauty
was a general category of provider
optics and that would kind of these in
my presentation I wanna explain or I
would diffuse a summary what I and the
ice some things like that. They slide
summarises the distribution of
mechanisms I'm probably already. And it
you can see on the east side some of
the small make an is how widespread and
mom started for biologics and this
includes colonisation resistance sit
and short right change that has a
production regulation of interests not
the normalisation of virtual
macrobiotic increased turnover of and
just start and competitive exclusion of
a subject which can be come along to
all gender of my organise some of them
are species level effects are there we
went to make and it and some of them
are very specific effect so they're
real effect sizes and wanted to cut
effect immunological effects and open a
logical effect and production of
specific by actives I would come again
to this mechanism later on during my
talk. And I like you a menu of you I am
I am a clinician I'm doing maybe
clinical research I am not doing any
basic research. So people I mean very
often what are the effectiveness of any
intervention and they're also like very
much evidence based medicine and the
strong evidence always comes from
randomised control trials and
systematically use an analysis of
randomised control trials when it comes
to buy a CD yeah there is a number of
studies. And what is important to know
we still know what is the evidence and
I would like to discuss should
indications for the use of probably a
Texan advertising and look alike
prevention of antibiotic associated
diarrhoea and prevention I think you
and treatment of acute just rent
findings and I would like in my answer
the question for benefits that an
attribute it to the general category of
provider optics. So let me start with
neckties and shook a like this if you
are not the annotation and if you are
not the physician you recognise
immediately this it's not healthy child
as a matter of fact in advertising and
for collide is aligned strengthening
these the opinion yeah legit can look
for in one to five percent of all
neonatal intensive care admissions five
to ten percent of all very low birth
weight infants which means inversely
below two hundred rounds can suffer
from I connect at I think and local
ideas we can we will not discuss the
costs of genesis but anyways it
disturbances of the micro by your and
they they use a role in the process of
genesis of these disorders said fifty
percent of those infants requires
surgery approximately thirty percent
right side and survivors have increased
risk of adverse drug development see
what so this is really a life
threatening disease. And the question
is can we prevent this disease and
there is and number of media analysis
that look at the facts about politics
for the prevention of neckties and
trickle out. And you can see this is
not how the number of strong or
increase of the number of entrance
included in this trial increased and he
falls on the most recent media analysis
popping preview and on the slide if
you're not familiar this is a force all
this is that typical way that there is
a lot of making I'm not as are being
present what you see here is the line
of not if that everything that is left
of this time show the effect that
favour of probably a week if something
what would you it would be in favour of
that C or no intervention what did you
have some sorry you can see here and
you see there's a seven percent
reduction in the race of nectar at I
think and look alike this is very
seaview strengthening disease. And it's
not only that provide optics can
prevent an advertising and shook like
this. And they look like two randomised
control trials more than five hundred
five five thousand five hundred
participants already included in those
trials. That's right for mortality more
than five thousand participants there
is no significant difference for
another colour sets it like many other
corpora injury you they have and that
when it comes to the conclusion the
conclusion of the authors is very
strong that a I guess strongly supports
a change in practise and I have a
question to you fifty seven percent no
it doesn't matter whether you are a
dietitian or not was a gynaecologist or
not. It's even better if you're just
not not not not clinician seven percent
reduction in the risk of nick I think
and talk about would you recommend
probably or it's to prevent an
advertising and draw a line in your
patient yeah I know I presume that most
of you would say yes this is my
experience when I show you know I don't
need to tweak thirty three cities in
France would need to be treated with
propriety in order to prevent one case
of an advertising and record that is
what you feel I would just use probably
on my experience is that people are not
that convinced when the here even if
this is exactly the same data just
present it in a different way. But if
you have to say that I would like to
show you some intervention next
utterance from I had gotten function
are being used or not probably many of
us are using studies for my car yeah
I'm not needed to treat is from one
hundred to four hundred depending on
the start ins and get in for
cardiovascular protection forty
properly or it's it's thirty so the
first sentence absolutely here is that
we should use it. But if you don't have
the current recommendations you wanna
see recommendations are consistent no
no no first is that is I need it for
the most studies are needed for
research are needed. And then in that
and then recommendations it means that
if I have the same view some
researchers consider that the current
evidence justifies a routine use of
propriety. And this is one of the
documents that the the documents or a
guideline that were published. And
there is a no practical how this can
use and also I would like to show you
that's all sports are changing their
minds they start that you twelve euros
which are published in the same issue
of PD out in two thousand and ten and
the all stars differ in their opinions
in two thousand and ten but for use
later wrote john addict or the or the
type of which speaks for itself
provided supplementation in preterm
infants. It's time to change practise.
And I discussing in them discussing it
here and I showed you these these data
because I said I said once that may be
substantiated that it might be that
certain has a net effect may be
attributed to many if not all four by
or six people if you know that these a
forest floor you will see of course all
of them are not statistically
significant we can discuss like they're
not statistic but there are most of
them are on the positive side. And and
this makes me think I still think that
each chain has to be evaluated
separately but it is so that's one of
the health benefits can be actually
good or provider that does not want to
make and it's that that that well that
contribute to the prevention in this
case of neckties and struck a light is
you may ask me are the examples of such
media analysis in which no one else
show a positive effect of rubber your
six and it has a good example is
prevention of antibiotic astra shaded
diarrhoea this isn't systematic review
and make an honest is probably already
two years ago jam in their sixties
treatment demise controlled trials
almost twelve thousand participants and
show that it reduces the use of
probably a mix of the group as a
general reduces the risk of antibiotic
associated area by forty two percent
either one or two children sixteen
randomised control trial reduction by
forty five percent. And the impression
you this for as long as there are some
differences but there and systematic
differences in resolve also when you
include it when you look at twelve
biotic so okay select in house if
that's like for example convention of
antibiotic associated very diarrhoea
perhaps maybe active duty too many if
not all four by the optics. Now I'd
like to move to another indication in
another example which I will show which
is your best friend tried by the
wayside at the start address with you
change your in the first row just
reminded me that that oh a research
started with his paper which was not in
the not exactly twenty years ago
fourteenth October nineteen ninety four
but they will not we will talking about
the prevention of that your youngest
will talk about the management of a
diary are diseases and of course one
should start with the hydration and if
you don't this is one of the prince
tree view on that you're what region
acute infections that and you will see
the resistors that again this is a line
of no effect line of no effect that all
of those that you showed in one
direction that there is reduction in
that race of in the increase a
reduction in that in this case
production the duration of diarrhoea.
And like I said in health effects may
actually beauty too many if not all
probably optics and what is the effect
is there a I don't know how many more
than four thousand five hundred
participants mean reduction by
approximately one day this is what you
can expect with the use of provider
ticks. But no it's not without the
ensure because had the religion to for
example why I had that originate it's
it's the start some zero percent one
hundred percent zero means no bigger
than a one hundred percent means doctor
that originate one in even question
whether it's substantiated although
they to get there that but that's
another discussion. So at least
approach is not without as I said
without danger and differences between
individual provider extreme maybe he's
a them all important. And this it was
exactly the pro all that god has begun
stands for european society for
paediatric that central to help out a
lot and notation working for providing
updates and we all of us together if
you're might be a together we in
evidence based position paper on the
use of provider in that and in the
management affected extra try this and
our approach at before before this I
said I was published were that each
other natural biotech straight to be
evaluated separately. So we issues we
we we we finalised the state street
types of statements probably are still
we we identified provided with the
positive recommendation with a negative
recommendation and also provided with
insufficient evidence to make a
recommendation that we start with the
fruit was probably a text with a
positive recommendation wind up with
luck about student GG the use of these
provide you actually uses the duration
of diarrhoea and it uses the risk of
diarrhoea Alaskan towards your seven or
more days that's a that's why some for
some other mice is largely again
reductions the duration of diarrhoea
reduction in the risk of diarrhoea last
four or more days and also and this is
a new comers I would say that the
buttons right right much and much
weaker added ends and much less a
number of studies but this is what they
sure reduction in the duration of
diarrhoea and increased chance of you
on day three so we summarise the ways
that street with this war is is
statements with a problem with the
positive recommendation twelve and a
button GG and secular marxism largely
we gave a it's a lot quality of maybe
that's I can explain make sure why but
recommendation is there's strong and
what about the buttons right right DSM
one seven nine three eight quality of
evidence is very low recommendation
easily simply because the data are not
I mean it's not not just enough data at
the moment and strong enough to to to
to have it is the same it I mean they
should as for AGGS a compromise is what
are in a document to be identified for
biology one by topics with a negative
recommendation this was under a corpus
VSF sixty eight which should not be
used which should not be considered in
the management of children with acute
desperate right is because of safety
issue. And the provider tickets this
micro organism is of course the
recipient of the button mice and
resistant genes and this is the why
this is this recommendation and so yeah
I like probably or text with sufficient
evidence to make a recommendation and
this shows you why some yeah we cannot
say if something works of something
doesn't work much time for example that
one reason the methodological he sure
wasn't my my my problems are to study
but there was so many methodological
issues in for it with all of that we
are not able to formulate a
recommendation not specifically should
have status publish a lot of that is
officially this but it's simply we
didn't know what is the strain that was
that all ones are city was of a we made
when we were developing are we going
next we may to rule if there's only one
drawing on a of a randomised control
trial was a positive or negative it's
not sufficient directly to make
recommendations. And also there was
only one our city of a with no strings
and if you geisha and the least believe
me is a very very long to the many too
many strains. So there's a lot of work
behind it but eventually we cannot say
whether or not something is effective
or not. So it's not it's part of my
presentation a benefit that an
attribute it to the general category of
provider. And brightest austin based on
the example of naked I think and talk
like this and prevention of antibiotic
that's what shady diarrhoea and the
management of the contestants I I would
say that the number of make an analysis
have demonstrated that certain tells
effect may be absolutely too many if
not all pro by our kids and this is
mainly based at pearl mechanism which
are beyond this those widespread make
an is which are common among start it
probably it probably out. And they
system or something that can be
discussed there is quite likely when
you look at the effects of maternal is
that there is something behind behind
it however this approach is not without
danger I should do that they're
heterogeneity very often. So perhaps
for many there might be more trials
with individual trial which I let
status are probably still need what I
like to do now is to discuss some real
strange specific effect and that would
be that like to discuss in the context
of infant a call so now yeah moving
from for life threatening disease. So
something which is definitely not the
life threatening but very distressing
for power and if I'm going to affect
that will result in under three months.
So what are you going to physician but
yeah position or not it might be that
you have that's a child or you have
friends child. So this may try to you
as well. And the client because it
starts in the first week stuff. And and
by age of four to five months and the
one six families but once a
professional like only one in six
because the rest of the internet and
define the answer to that question is
the only one of the problems that one
six times thought comes to us when it
comes to that you are legion risk
factors that we don't really know what
is that word error passage anything
about how everyone all the one of the
anything which is being considered as
an alteration of that might provide
your if you know that you can look at
the literature on that we can go only
in in founder as far as intervention
which had been steady. However very few
of them are effective for I should say
probably effective and the question is
are for biotic effective and one
appropriate which means that it and
perhaps it might be that there's this
strange specificity it's at the bottom
of the right GSM one seven nine three
eight again I'm not the basic signs up
or have someone who is working with
this particular microorganisms and
contribute to the discussion but they
establish a flat buttons right right
approximately you all got an extended
censoring there on the column contract
activity on the perception and that may
be strange specific. And what
constitutes again I'm a munitions so
I'd like to know what is likely to miss
any interventions that you're using
because the mother in front of me
that's and ask me how much bacteria my
child has in the store from whether
it's more between the bacteria let's
let the but what about what she wants
to know whether or not intervention
works or doesn't work and you want to
know it as well. So this is one of
what's going on in amazement but not in
a press that in advance with scalding
defined according to the western
straight you're yeah crime for C R.s
we're day for more than three days a
week. And I was sure that mothers of
those sure number following a colour
smell a thousand feet diet and the
children were randomly received it to
randomly allocated to deceive I I still
like to pursue structure or placebo.
And what this study show that there was
reduction in the crime time use these
reductions and also on a noted increase
in the responders rate responders means
you present production trying I'm from
baseline and you can see the responders
rate was higher on day seven fourteen
and twenty one so the conclusion words
that are about to strike three can
improve symptoms of infant they called
and was also well over eighty and say
the American academy of your days of
the results of these one steady it
concluded there are many benefits for
treating in something called with
providers. But for their starters are
necessary if American academy of
pediatrics ace first studies are
necessary in our department we start to
work entry goes that well I don't know
it's but we would we would like was
talk to see whether or not it's it's
true if it's effective. So we have
divided we have designed the very
similar study to determine with
administration of like about two
structure is beneficial interested in
and we did but we designed to
randomised double blind placebo
controlled trial was intention that we
are not because it was so hard to try
and keep participants full term in a
exactly according to modify with those
criteria the all the way exclusively or
predominantly breastfed. However the
mothers were not ordering that account
somewhere free diet and the primary out
what treatment success and duration of
lying to you can see it duration of
intervention was twenty one days and
you on the slide you can see that there
was increased because it means like
that suicide intervention but also one
week after we finished the intervention
with the contrary you know number
eighty two three Wheelers to show there
is reduction in or by either the
buttons like the rebel in the duration
of crime and also in the parent or
section of or severe. And increased
family quality of life. So this word
result of our trial work since you're
you're in British medical journal paper
from Australia was but every so is the
is the first poster of this paper will
not fly or one hundred sixty seven in
France breastfed infants and formula
but in fan. So it's a different
population and again with with the
sprite urea for crime of fussing and
where again randomised recently about
the structure that's evil and the
article was the duration of one and
there was no significant there there
was no yeah sorry that was increased
risk of and of a good in a in a
increase try finding time in the prior
to draw but when you waited separately
found time and find time it was amazing
you to five times the crime and there
was no significant difference and of
course for those existing to understand
reminders difference of course there
are some differences in the population
but also if you look at the baseline
characteristics you see that a lot of
those should receive turtle on
inhibitors as you can see here some of
them receive high whatever journey from
your some of them receive providing
complaining formula. So and so and
there was already some kind of
intervention and this may explain why
this was not affected you get confused
well many of us got confused with this
idea and then again I ask myself and
then met analytical approach have and
this is what we have we have bizarre of
street under my second forty five and
one of those times reported that flying
on a straight you with twenty one and
if you look at the results to resolve
those trying as you will see that
they're split direction by forty
minutes. So a forty hour which was
accompanying the the energy taper off
the question should we be in in one
point at all. Well I would say I would
ask again should we but my answer would
be researchers and departments may
differ in their opinions demanding so
that's why he makes every significant
difference for for parents. So I think
that the answer is quite clear for for
for for this question. So inside very
what I like to bring to these are yes
is that the current standpoint is that
the health effects of probably all seem
to be strange specific and I believe
that form of many of the indication.
It's true. However this point that's
been shot and and some generalisations
email you on strange specific effect
and I myself perhaps it's for foreign
exercising control collide is for
prevention of antibiotic associated by
your diarrhoea fatigue and if it you
can't fight this and they showed you
mean you making a analysis all of them
are showing that probably are are
effective and all of that on that on
the left side but there are a strange
specific effect and perhaps it down
would be that the bus goes right right
yes and one seven nine straight a a for
infant I called and what works what
doesn't work that well there is some
disagreement and mainly disagreement
everything that they should and this
and you resolve it collecting more data
or to be replaced by more sophisticated
or entirely new hypothesis and many of
that we have heard here at this
symposium and finish with the final
format and the final comments from from
the discussion between one student at
lunchtime once it is that why should I
think questions of this year's exam are
the same as last year and I start on
certain true but this year or answers

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Conference program

Introduction of the Session 1 : The Gut Microbiome: Facts and Figures
Josef Penninger, Institute of Molecular Biotechnology, Vienna
23 Oct. 2014 · 9:07 a.m.
The role of commensal bacteria in the gut
Willem de Vos, Wageningen University, The Neterlands
23 Oct. 2014 · 9:31 a.m.
Q&A : The role of commensal bacteria in the gut
Willem de Vos, Wageningen University, The Neterlands
23 Oct. 2014 · 10:29 a.m.
Gut microbial richness impacts human health
Dusko Ehrlich, INRA, Jouy-en-Josas, France
23 Oct. 2014 · 11:07 a.m.
Q&A : Gut microbial richness impacts human health
Dusko Ehrlich, INRA, Jouy-en-Josas, France
23 Oct. 2014 · 11:44 a.m.
Cross-talk between the mucosal immune system and environmental factors
Hiroshi Kiyono, The University of Tokyo, Japan
23 Oct. 2014 · 11:56 a.m.
Q&A : Cross-talk between the mucosal immune system and environmental factors
Hiroshi Kiyono, The University of Tokyo, Japan
23 Oct. 2014 · 12:31 p.m.
Introduction of the Session 2 : Host - Microbiome Interaction
Susan Suter, University of Geneva, Switzerland
23 Oct. 2014 · 1:41 p.m.
Mechanisms of cross talk in the gut
Annick Mercenier, Nestlé Research Center, Lausanne, Switzerland
23 Oct. 2014 · 1:55 p.m.
Q&A : Mechanisms of cross talk in the gut
Annick Mercenier, Nestlé Research Center, Lausanne, Switzerland
23 Oct. 2014 · 2:34 p.m.
Relationship of diet to gut microbiota diversity, stability and health in older people
Paul O'Toole, University College Cork, Ireland
23 Oct. 2014 · 3:52 p.m.
Q&A : Relationship of diet to gut microbiota diversity, stability and health in older people
Paul O'Toole, University College Cork, Ireland
23 Oct. 2014 · 4:27 p.m.
Gut microbes and their role in malnutrition and obesity
Rob Knight, University of Colorado, Boulder, USA
24 Oct. 2014 · 9:16 a.m.
Q&A : Gut microbes and their role in malnutrition and obesity
Rob Knight, University of Colorado, Boulder, USA
24 Oct. 2014 · 10:01 a.m.
The gut metagenome - your other genome
Jun Wang, BGI, Shenzhen, China
24 Oct. 2014 · 10:19 a.m.
Q&A : The gut metagenome - your other genome
Jun Wang, BGI, Shenzhen, China
24 Oct. 2014 · 10:53 a.m.
Fecal transplant to mine for novel probiotics
Max Nieuwdorp, Amsterdam Medical Center, The Netherlands
24 Oct. 2014 · 11:04 a.m.
Q&A : Fecal transplant to mine for novel probiotics
Max Nieuwdorp, Amsterdam Medical Center, The Netherlands
24 Oct. 2014 · 11:25 a.m.
Introduction of the Session 4 : Nutritional Interventions
Keiko Abe, The University of Tokyo, Japan
24 Oct. 2014 · 12:46 p.m.
Interactions between gut microbiota, host genetics and diet
Liping Zhao, Jiao Tang University, Shanghai, China
24 Oct. 2014 · 12:56 p.m.
Pediatric intervention - what works and what doesn't work
Hania Szajewska, The Medical University of Warsaw, Poland
24 Oct. 2014 · 1:47 p.m.
Q&A : Pediatric intervention - what works and what doesn't work
Hania Szajewska, The Medical University of Warsaw, Poland
24 Oct. 2014 · 2:15 p.m.
Perspectives for nutrition and the gut microbiome
Nicholas Schork, J. Craig Venter Institute, La Jolla, USA
24 Oct. 2014 · 3:02 p.m.
Q&A : Perspectives for nutrition and the gut microbiome
Nicholas Schork, J. Craig Venter Institute, La Jolla, USA
24 Oct. 2014 · 3:46 p.m.

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