Clinical risk scores and blood biomarkers as predictors of long-term outcome in patients with community-acquired pneumonia: a 6-year prospective follow-up study

OBJECTIVE

Prediction of long-term outcomes in patients with community-acquired pneumonia (CAP) is incompletely understood. We investigated the value of clinical risk scores [pneumonia severity index (PSI) and CURB-65] (Confusion, Urea, Respiratory rate, Blood Pressure, Age >65 years) and blood biomarkers of different physiopathological pathways in predicting long-term survival in a well-characterized cohort of patients with CAP enrolled in an antibiotic stewardship trial.

DESIGN, SETTING AND SUBJECTS

Patients admitted with CAP to six medical centres in Switzerland were prospectively followed for 6 years. Cox regression models and area under the receiver operating characteristics curve (AUC) were used to investigate associations between initial risk assessment and all-cause mortality.

MAIN OUTCOME MEASURE

All-cause mortality during a 6-year follow-up period.

RESULTS

Six-year mortality in the present cohort (median age 73 years) was 45.1% [95% confidence interval (CI) 41.8-48.3%]. Initial PSI and CURB-65 scores both had excellent long-term prognostic accuracy, with a stepwise increase in mortality per risk class. The hazard ratios (95% CI) of the highest PSI and CURB-65 classes (reference: lowest class) were 38.0 (14.0-103.0) and 7.8 (2.2-14.5), respectively, after 6 years. The addition of inflammatory (pro-adrenomedullin) and cardiac (pro-atrial natriuretic peptide) blood biomarkers measured upon hospital admission further improved the prognostic capabilities of the PSI (AUC increase from 0.79 to 0.83; P < 0.0001) and the CURB-65 score (AUC increase from 0.73 to 0.80; P < 0.001).

CONCLUSION

Risk assessment using clinical scores allowed accurate long-term prognostication, which was further improved by the addition of two inflammatory (pro-adrenomedullin) and cardiac (pro-atrial natriuretic peptide) blood biomarkers. These data provide a rationale for a more risk-adapted, 'personalized' strategy for long-term management of patients with CAP.

Engineered high aspect ratio vertical nanotubes as a model system for the investigation of catalytic methanol synthesis over Cu/ZnO

Catalytically synthesized methanol from H2 and CO2 using porous Cu/ZnO aggregates is a promising, carbon neutral, and renewable alternative to replace fossil fuel based transport fuels. However, the absence of surface-engineered model systems to understand and improve the industrial Cu/ZnO catalyst poses a big technological gap in efforts to increase industrial methanol conversion efficiency. In this work, we report a novel process for the fabrication of patterned, vertically aligned high aspect ratio 1D nanostructures on Si that can be used as an engineered model catalyst. The proposed strategy employs near-field phase shift lithography (NF-PSL), deep reactive ion etching (DRIE), and atomic layer deposition (ALD) to pattern, etch, and coat Si wafers to produce high aspect ratio 1D nanostructures. Using this method, we produced a model system consisting of high aspect ratio Cu-decorated ZnO nanotubes (NTs) to investigate the morphological effects of ZnO catalyst support in comparison to the planar Cu/ZnO catalyst in terms of the catalytic reactions. The engineered catalysts performed 70 times better in activating CO2 than the industrial catalyst. In light of the obtained results, several important points are highlighted, and recommendations are made to achieve higher catalytic performance.

Polysaccharide hydrogels with tunable stiffness and provasculogenic properties via α-helix to β-sheet switch in secondary structure

Mechanical aspects of the cellular environment can influence cell function, and in this context hydrogels can serve as an instructive matrix. Here we report that physicochemical properties of hydrogels derived from polysaccharides (agarose, κ-carrageenan) having an α-helical backbone can be tailored by inducing a switch in the secondary structure from α-helix to β-sheet through carboxylation. This enables the gel modulus to be tuned over four orders of magnitude (G' 6 Pa-3.6 × 10(4) Pa) independently of polymer concentration and molecular weight. Using carboxylated agarose gels as a screening platform, we demonstrate that soft-carboxylated agarose provides a unique environment for the polarization of endothelial cells in the presence of soluble and bound signals, which notably does not occur in fibrin and collagen gels. Furthermore, endothelial cells organize into freestanding lumens over 100 μm in length. The finding that a biomaterial can modulate soluble and bound signals provides impetus for exploring mechanobiology paradigms in regenerative therapies.

Surface functionality as a means to impact polymer nanoparticle size and structure

When polymeric nanoparticles (NPs) are formed by nanoprecipitation, which is a nucleation-growth process, the control over size requires changing the polymer concentration or solvent composition. Here, we demonstrate that the NP size can be controlled independent of polymer variables by introducing a polyelectrolyte (PE) in the aqueous phase. PEs that exhibit hydrogen bonding (H-bonding) yield a reduction in NP size, whereas PEs that do not possess this characteristic promote the formation of larger NPs. The observed effect can be attributed to the formation of a diffusional barrier around the NP in the form of a dense shell. This principle of controlling NP size is not limited to polymers and can also be employed in the production of lipid NPs.

Polypropylene + boehmite nanocomposite fibers

The influence of nanosized filler particles on mechanical properties of composite fibers has some specific features related to the fiber matrix, its preparation and the filler content, as well as the orientation of the fibers at their drawing. This paper discusses the manner of dispersion of chemically unmodified boehmite type nanofiller, Disperal 40 (D40) or Disperal 60 (D60) in polypropylene (iPP) fibers, and the influence of filler and its particle size on the tenacity, modulus and elongation of the iPP fibers. It was found that filler D40 was effective in increasing the tenacity only up to a content of about 1 wt% and in fibers prepared only at higher drawing ratios. Transmission electron microscopy (TEM) pictures of the cut iPP+D40 or iPP+D60 fibers have shown the presence of aggregation of nanosized boehmite particles in all cases. A comparison of the effects of two different particle sized fillers on the mechanical properties of the isotactic PP (iPP) fibers showed that a small difference between the particle sizes of both kinds of filler plays some role regarding the tensile strength of the fibers. The iPP fibers containing a mixture of D40 and D60 showed some deviations from the expected sum of the effects of both fillers on their mechanical properties.