Environmental impacts and nutrient distribution routes for food waste separated disposal on large-scale anaerobic digestion/ composting plants

Centralized biological treatments, i.e., anaerobic digestion (AD) and in-vessel composting (IVC), were supposed to be the promising processes for the disposal of food waste (FW) after source separation, while the systematic benefits were unclear for FW with high water content, salt and oil and thus influenced the selection by the local decision-makers. In this study, two large-scale working AD and IVC plants were compared for environmental impacts, nutrient recovery and economic benefits. For unit amount of FW, 89.26 kg CO₂-eq was released in IVC mainly due to 47.89 kWh electricity consumption, and 57.02 kg CO₂-eq was produced in AD. With the application of compost and energy recovery, 26.88 and 93.55 kg CO₂-eq savings were obtained in IVC and AD, respectively. NH₃ emissions were the main contributor to acidification (0.35 kg SO₂-eq) in IVC, while AD exerted less impact on acidification (0.09 kg SO₂-eq) and nutrient enrichment (0.25 kg NO₃-eq) attributed to the counteract of energy recovery. 2029 would be the inflection point for global warming potential in AD with more clean energy applied in electricity mix in China. For nutrient recovery, more C (8.3%), N (37.9%) and P (66.7%) could be recovered in compost, while those were discharged via leachate and biogas residue in AD. The cost of IVC was 16 CNY/t (2.40 USD/t) lower than AD. Combing the three key indexes and the sale routes of products, IVC was recommended to be used in areas dominated by agriculture and forestry industries, and AD was more suitable for large cities.

Synergistic effect of microneedle-delivered extracellular matrix compound and radiofrequency on rejuvenation of periorbital wrinkles

Background

A combination of minimally invasive modalities can induce collagen regeneration more quickly and promote the penetration of topical agents, thus promoting skin rejuvenation. In this study, we aimed to investigate the synergistic efficacy of extracellular matrix compound (ECM-C) via microneedle (MN) and radiofrequency (RF) on periorbital wrinkles.

Method

A total of 25 participants with periorbital wrinkles were selected for this study. The left and right side of the periorbital area was randomly given ECM-C via MN or ECM-C via MN combined with RF. MN combined with ECM-C treatment was given 5 times at 2 weeks intervals, whereas RF treatment was given 3 times at 4-week intervals. The following items were assessed: wrinkles by VISIA^® system; biophysical parameters such as skin hydration, transepidermal water loss (TEWL), erythema index, and melanin index by CK multiple probe adapter; and skin elasticity and skin thickness by DermaLab Combo^® photographs were taken at the baseline and 2 weeks after the last treatment. Subjective assessments, such as Crow's Feet Grading Scale (CFGS) and Global Aesthetic International Scale (GAIS), were also recorded.

Result

A total of 25 participants with an average age of 43 years participated in this trial. Periorbital wrinkles on both sides decreased after the treatment, and the side treated with ECM via MN and RF showed better improvement than the other side with ECM-C via MN alone. Skin hydration increased after the treatment on both sides. TEWL, skin erythema, and skin melanin indexes were not changed. Skin elasticity and skin thickness increased more on the side of ECM-C via MN and RF than on the other side of ECM-C via MN alone. The evaluation scores for CFGS improved on either side; however, no difference was found for CFGS and GAIS between intergroup comparisons after the treatment.

Conclusion

The objective assessment of wrinkles, elasticity, and thickness of periorbital skin improved more on the side with ECM-C treatment via MN combined with RF than on the other side of ECM-C treatment via MN only. However, no statistically significant difference was found between the subjective CFGS and GAIS evaluation of the two sides.

A case report of Enterobacter cloacae endocarditis in a patient with a history of cotton fever

Background

Cotton fever is a self-limited, febrile syndrome occurring after the injection of trace amounts of drugs, in particular heroin, extracted from reused cotton filters. It is characterized by non-specific findings, such as fever, tachycardia, and leucocytosis. The leading pathophysiologic explanation suggests it is the result of direct inoculation of the bloodstream with endotoxins from Gram-negative bacilli of the genus Enterobacter, known to colonize all parts of the cotton plant. Only one prior case report has suggested cotton fever as a potential risk factor of infective endocarditis (IE).

Case summary

We describe a case of a 57-year-old patient with a history of intravenous heroin use complicated by self-reported episodes of cotton fever. His presentation was notable for Enterobacter cloacae IE with bilateral septic pulmonary emboli. Transthoracic echocardiography findings included new tricuspid regurgitation and two mobile echodensities on the right atrial implantable cardioverter defibrillator (ICD) lead. Despite broad antibiotic coverage and extraction of the ICD leads, the patient passed away from septic shock.

Discussion

The present case report is only the second published report of endocarditis in a patient with a history of cotton fever. In both cases, bacteria of the Enterobacter genus were isolated in patients’ blood cultures. This evidence supports the endotoxin theory as the leading pathophysiologic explanation for cotton fever and suggests cotton fever as a risk factor for Gram-negative IE. In the inpatient setting it informs proper antibiotic coverage, whereas in the outpatient setting it supports harm reduction interventions in the form of sterile cotton balls.

Effects of Selenium Supplementation on the Ion Homeostasis in the Reproductive Organs and Eggs of Laying Hens Fed With the Diet Contaminated With Cadmium, Lead, Mercury, and Chromium

The objective of this study was to explore the toxic effects of different heavy metals in combination with their deposition and ion homeostasis in the reproductive organs and eggs of laying hens, as well as the alleviating action of selenized yeast. A total of 160 Lohmann pink-shell laying hens (63-week-old) were randomly allocated into four treatments with 10 replicates of four hens each. The four dietary treatments were the corn-soybean meal basal dietary (control; CON); the CON dietary supplemented with 0.4 mg/kg selenium from selenized yeast (Se); the CON dietary supplemented with 5 mg/kg Cd + 50 mg/kg Pb +3 mg/kg Hg + 5 mg/kg Cr (HEM), and the HEM dietary supplemented with 0.4 mg/kg selenium from selenized yeast (HEM+Se). The dietary HEM significantly increased Cd, Pb, and Hg deposition in the egg yolk and ovary, and Cd and Hg deposition in the oviduct and in the follicular wall (p < 0.05). The HEM elevated Fe concentration in the egg yolk, ovary, and oviduct (p < 0.05). The HEM decreased Mn concentration in the egg yolk, Fe, Mn, and Zn concentrations in the egg white, Cu concentration in the ovary, Mg concentration in the oviduct, as well as Ca, Cu, Zn, and Mg concentrations in the follicular walls (p < 0.05). Dietary Se addition elevated Se concentration in the egg yolk, oviduct, and follicular walls and Mg concentration (p < 0.05) in the oviduct, whereas it reduced Fe concentration in the oviduct compared with the HEM-treated hens. Some positive or negative correlations among these elements were observed. Canonical Correlation Analysis showed that the concentrations of Pb and Hg in the egg yolk were positively correlated with those in the ovary. The concentration of Cd in the egg white was positively correlated with that in the oviduct. In summary, dietary Cd, Pb, Hg, and Cr in combination caused ion loss and deposition of HEM in reproductive organs of laying hens. Dietary Se addition at 0.4 mg/kg from selenized yeast alleviated the negative effects of HEM on Fe and Mg ion disorder in the oviduct and follicle wall of hens.

Molecular transformation and composition flow of dissolved organic matter in four typical concentrated leachates from the multi-stage membrane system

Concentrated leachate (CL), characterized with high content salts and compositional complexity of dissolved organic matter (DOM), is difficult to degrade. Understanding the CL from molecular insight level is the requirement for further disposal based on their components. Here, typical CL samples were collected from the multi-stage membrane separation process in a large-scale leachate plant, including nanofiltration (NF), primary ultrafiltration (PUF), secondary nanofiltration (SNF), and reverse osmosis (RO). More than 95% of DOM was removed from raw CL, of which about 3/4 flowed into PUFCL and 1/5 flowed into SNFCL. DOM with macro-molecular weight (>500 Da, 30.46%) and highly unsaturated compounds (double-bond equivalents >15) were detected in PUFCL. Nearly half of DOM was CHO-only compounds (42.04%) in SNFCL. PUFCL was abundant in heteroatom species with higher-order oxygen (O ≥ 10), which was coincident with the trend of humic substance distribution (humic substance >1/2). Based on these properties results, advanced oxidation processes, such as ozonation, might be the right process for SNFCL rich in heteroatom species with low-order oxygen (O < 10). Abundant disulfides (S₂O_2-6 classes, 20.19%) and monovalent salts existed in ROCL, which should be removed from the system. These findings might provide basic information for the treatment of CLs from different membranes.

High-Throughput Screening Using a Synchronized Pulsed Self-aspiration Vacuum Electrospray Ionization Miniature Mass Spectrometer

With the advantages of rapid analysis, high sensitivity, and multicomponent identification, mass spectrometry (MS) is recognized as an appealing choice for high-throughput screening (HTS) analysis. Aiming at the small size, simple operation, and adequate performance, the development of miniature mass spectrometers has made great progress over the last 2 decades. Besides the essential analytical performance, simple operation and HTS capability are two other crucial features desired in miniature MS instruments. In this paper, an induced self-aspiration vacuum electrospray ionization source (ISA-VESI) was developed and coupled to a miniature ion trap mass spectrometer. A special timing sequence was designed to synchronize all the operation steps in each measurement, including dual-pulse sample injection, multipulse gas injection, MS analysis, and the movement of the homemade HTS platform used as the sampler. Then, the automatic high-throughput analysis of multiple samples can be accomplished with close coordination among the sample delivery, the sample introduction and ionization, and the ion trap operation. The measurement time of each ISA-VESI-MS analysis was about 7 s, with a sample consumption of less than 100 nL.

Abstract 316: Hydroxytyrosol, An Olive Oil Phenol, Reduces Ex Vivo Thrombin-induced Platelet Activation

Background and Aims: Olive oil consumption is associated with lower cardiovascular disease (CVD) risk. We recently demonstrated that frequent olive oil consumption was inversely associated with thrombin-induced platelet activation ex vivo . While various olive oil phenolic compounds, notably hydroxytyrosol, have been shown to reduce human platelet aggregation ex vivo , little is known about how olive oil affects platelet activation, a key mediator of atherothrombosis. Therefore, we sought to investigate whether hydroxytyrosol exposure affects platelet activation.

Methods and Results: Ten healthy, non-smoking men and women (25.0±1.6 years) with normal body mass index (BMI 22.2±3.3 kg/m 2 ) were recruited for ex vivo platelet studies. Individuals on antiplatelet or anticoagulation medications or medications known to influence lipid levels were excluded. Subjects attended a single visit at NYU Langone where platelet-rich plasma (PRP) was isolated and incubated with three different concentrations of hydroxytyrosol or ethanol vehicle for 60 minutes at room temperature. PRP was then incubated with bovine thrombin for 5 minutes followed by anti-CD62P for 15 minutes in the dark. Platelet activation was determined by platelet surface expression of P-selectin, assessed via flow cytometry. E x vivo exposure to hydroxytyrosol inhibited thrombin-induced platelet P-selectin expression in a dose-dependent manner (Figure).

Conclusions: We demonstrate that hydroxytyrosol exposure reduces thrombin-induced platelet P-selectin expression in a dose-response fashion. The dose response seen in this ex vivo platelet activation study is consistent with our clinical observation that more frequent olive oil intake was associated with reduced ex vivo thrombin-induced P-selectin expression. This laboratory study suggests a putative mechanism underlying our clinical observation as well as the established inverse association of olive oil consumption with CVD.

Variations of nitrogen-metabolizing enzyme activity and microbial community under typical loading conditions in full-scale leachate anoxic/aerobic system

Influent loading determines the performance of leachate treatment plant (LTP) facing the dynamic conditions, but enzyme expression in microbial community is unclear. Here, six nitrogen-metabolizing enzymes were detected during nitrification failures (NF), high loading (HL), low loading (LL), and low carbon/nitrogen (LCN) in a 500 m³/d LTP. Nitrogen removal in LL was 15 ± 5% higher than that in HL. The activity of hydroxylamine oxidoreductase decreased by 90% as the influent total nitrogen increased from 2450 mg/L to 3100 mg/L, which might be a critical enzyme causing the nitrification failure. Denitrifying enzyme abated by 1.3% as the carbon/nitrogen dropped by 1% in LCN. With the influent chemical oxygen demand decreased from 22000 mg/L to 12000 mg/L, the relative abundance of norank_f_Saprospiraceae dropped from 33.66% to 11.94%, and finally disappeared, which seems to be an indicator of the high load operation. These findings provide the basis for improving the efficiency of LTPs.

The effect of sludge retention time (SRT) on the Nitrifier typical kinetics at ambient temperature under the low ammonia density

Sludge retention time (SRT) regulation is one of the essential management techniques for refined control of the main-sidestream treatment process under the low ammonia density. It is indispensable to understand the effect of SRTs changes on the Nitrifier kinetics to obtain the functional separation of the Nitrifier and the refined control of the nitrification process. In this study, Nitrifier was cultured with conditions of 35 ± 0.5 °C, pH 7.5 ± 0.2, DO 5.0 ± 0.5 mg-O/L, and SRTs were controlled for 40 d, 20 d, 10 d, and 5 d. The net growth rate (μ_m), decay rate (b), specific growth rate (μ), the yield of the Nitrifier (Y_A), temperature parameter (T_A), and inhibition coefficient (K_I) have been measured and extended with the SRT decreases. Instead, the half-saturation coefficient (K_S) decreased. In addition, the limited value of pH inhibition occurs (pH_UL), and the pH of keeping 5% maximum reaction rate (pH_LL) was in a relatively stable state. The trade of kinetics may be induced by the change of species structure of Nitrifier. The Nitrosomonas proportion was increased, and the Nitrospira was contrary with the SRT decreasing. It is a match for the functional separation of Nitrifier when SRTs was 20 d at ambient temperature under the low ammonia density. The kinetics of ammonia-oxidizing organisms (AOO) and nitrite-oxidizing organisms (NOO) in Nitrifier under different SRT conditions should be measured respectively to the refined control of the partial nitrification process in future study.

Next-generation sequencing identification and multiplex RT-PCR detection for viruses infecting cigar and flue-cured tobacco

BACKGROUND

Early, precise and simultaneous identification of plant viruses is of great significance for preventing virus spread and reducing losses in agricultural yields.

METHODS AND RESULTS

In this study, the identification of plant viruses from symptomatic samples collected from a cigar tobacco planting area in Deyang and a flue-cured tobacco planting area in Luzhou city, Sichuan Province, China, was conducted by deep sequencing of small RNAs (sRNAs) through an Illumina sequencing platform, and plant virus-specific contigs were generated based on virus-derived siRNA sequences. Additionally, sequence alignment and phylogenetic analysis were performed to determine the species or strains of these viruses. A total of 27930450, 21537662 and 28194021 clean reads were generated from three pooled samples, with a total of 105 contigs mapped to the closest plant viruses with lengths ranging from 34 ~ 1720 nt. The results indicated that the major viruses were potato virus Y, Chilli veinal mottle virus, tobacco vein banding mosaic virus, tobacco mosaic virus and cucumber mosaic virus. Subsequently, a fast and sensitive multiplex reverse transcription polymerase chain reaction assay was developed for the simultaneous detection of the most frequent RNA viruses infecting cigar and flue-cured tobacco in Sichuan.

CONCLUSIONS

These results provide a theoretical basis and convenient methods for the rapid detection and control of viruses in cigar- and flue-cured tobacco.

Sewage denitrification performance and sludge properties variation with the addition of liquid from perishable organic anaerobic fermentation

The organics in the classified wet waste were deficiently utilized while sewage denitrification requires abundant carbon sources. Herein, the fermentation of perishable organic waste (POW) and the denitrification process with obtained liquid were investigated. The most volatile fatty acids (VFAs) production was realized with the fermentation liquid of food waste (FL-FW). Increasing substrate tended to lower the proportion of VFAs and acetic acid in FL-FW. Under the optimum conditions of FL-FW carbon source, carbon to nitrogen ratio 7, and temperature 30 ℃, the removal efficiency of nitrate nitrogen reached 99.23% within 4 h. The sludge settleability and microbial activity were significantly enhanced, contributing to the actual sewage a promotional removal of organics (95.84%) and nitrogen (70.31%) with the supplementation of FL-FW. High addition ratio would cause more degradation of refractory organics, which confirmed the feasibility of using FL-FW as a cost-efficient carbon source for the denitrification.

More frequent olive oil intake is associated with reduced platelet activation in obesity

BACKGROUND AND AIMS

Obesity is an independent risk factor for atherosclerotic cardiovascular disease (CVD), and platelet hyperactivation in obesity may contribute to this association. Olive oil consumption is associated with lower cardiovascular disease (CVD) risk in the general population. However, little is known for individuals with obesity. We investigated whether olive oil intake is associated with platelet activation in obesity.

METHODS AND RESULTS

We assessed platelet activation (surface P-selectin expression) with and without thrombin exposure and diet composition in 63 patients with severe obesity. Among 63 subjects with obesity, the mean age was 32.2 ± 8.0 years and BMI 44.1 ± 8.5 kg/m². Olive oil intake was stratified into <1 time/week (n = 21), 1-3 times/week (n = 18), ≥4 times/week (n = 24). Strata did not differ by age, BMI or platelet count. Unstimulated P-selectin expression did not differ by olive oil consumption. Subjects with more frequent olive oil intake exhibited lower P-selectin expression on submaximal thrombin exposure.

CONCLUSIONS

More frequent olive oil intake is associated with reduced thrombin-induced platelet activation in obesity.

Treatment of fresh leachate by microaeration pretreatment combined with IC-AO2 process: Performance and mechanistic insight

Fresh leachate is commonly featured with high concentrations of degradable organic matters, which can impede the performance of traditional biological treatment, especially the anaerobic reactor. Aiming at improving the biological treatment process of fresh leachate, this study creatively proposed a microaerobic-IC-AO² (MAICAO²) process and compared it with traditional biological process, then optimized the operating conditions. Meanwhile, this work investigated the transformation rules and molecular compositions of dissolved organic matters (DOM) during MAICAO² process, particularly the hazardous DOM (antibiotics). The innovative MAICAO² process can effectively remove 99% chemical oxygen demand (COD), 91% total nitrogen (TN) and 91% ammonia (NH₄⁺-N) during the operation time, and the removal efficiencies of COD, TN and NH₄⁺-N in MAICAO² process increased approximately 2%, 14% and 13% compared to ICAOAO process. Electrospray ionization Fourier transform ion cyclotron resonance mass spectrometry (ESI FT-ICR MS) confirmed that microaeration could ensure over 53% small molecular organic acids degrade before the subsequent anaerobic reaction so the system could resist the high concentration organic matters stress and improve the denitrification efficiency. Further analysis showed that different categories of antibiotics (including 6 sulfonamides, 4 tetracyclines, 2 macrolides, 4 quinolones and 2 chloramphenicols) could be effectively removed by MAICAO² process with the total removal efficiency of 50%. This work proposed a new scenario for fresh leachate treatment by proposing the importance of the microaeration pretreatment during the biological treatment process.

Species, fractions, and characterization of phosphorus in sewage sludge: A critical review from the perspective of recovery

Phosphorus recovery from municipal sewage sludge is a promising way to alleviate the shortage of phosphorus resources. However, the recovery efficiency and cost depend greatly on phosphorus species and fractions in different sewage sludges, i.e., waste activated sludge and chemically enhanced primary sludge. In this review, the phosphorous (sub-)species and fractions in waste activated sludge and chemically enhanced primary sludge are systematically overviewed and compared. The factors affecting phosphorus fractions, including wastewater treatment process, as well as sludge treatment methods and conditions are summarized and discussed; it is found that phosphorus removal method and sludge treatment process are the dominant factors. The characterization methods of phosphorus species and fractions in sewage sludge are reviewed; non-destructive extraction of poly-P and microscopic IP characterization need more attention. Anaerobic fermentation is the preferable solution to achieve advanced phosphorus release both from waste activated sludge and chemically enhanced primary sludge, because it can make phosphorus species and fractions more suitable for recovery. A post low strength acid extraction after anaerobic fermentation is recommended to facilitate phosphorous release and improve the total recovery rate.

A novel additional carbon source derived from rotten fruits: Application for the denitrification from mature landfill leachate and evaluation the economic benefits

Rotten fruits could be used as an available resource due to the high organic content and low pollution introduction. In this study, four kinds of rotten fruits including banana, apple, pear and grape, were utilized as additional carbon source to improve the nitrogen removal from mature landfill leachate. With the optimal condition of carbon-nitrogen ratio 6.5 and operation time 2 d, the rotten banana group had a higher denitrification rate of 11.78 mg/(gVSS·h) than that of other groups, corresponding the 99.55% of nitrate nitrogen (NO3--N), 99.36% of total nitrogen and 94.60% of organics removal. High carbon-nitrogen ratio would contribute to more degradation of organic and humus matters, and the low cost of 0.65 €/kgNO3--N was obtained. Biodiversity analysis indicated that denitrificans and organic-degrading bacterial were enriched after the addition of rotten banana. Overall, the novel carbon source of rotten banana was a cost-efficient choice for the denitrification.

Risk factors for intracerebral hemorrhage in patients with COVID-19

Intracerebral hemorrhage (ICH) can be a devastating complication of coronavirus disease (COVID-19). We aimed to assess risk factors associated with ICH in this population. We performed a retrospective cohort study of adult patients admitted to NYU Langone Health system between March 1 and April 27 2020 with a positive nasopharyngeal swab polymerase chain reaction test result and presence of primary nontraumatic intracranial hemorrhage or hemorrhagic conversion of ischemic stroke on neuroimaging. Patients with intracranial procedures, malignancy, or vascular malformation were excluded. We used regression models to estimate odds ratios and 95% confidence intervals (OR, 95% CI) of the association between ICH and covariates. We also used regression models to determine association between ICH and mortality. Among 3824 patients admitted with COVID-19, 755 patients had neuroimaging and 416 patients were identified after exclusion criteria were applied. The mean (standard deviation) age was 69.3 (16.2), 35.8% were women, and 34.9% were on therapeutic anticoagulation. ICH occurred in 33 (7.9%) patients. Older age, non-Caucasian race, respiratory failure requiring mechanical ventilation, and therapeutic anticoagulation were associated with ICH on univariate analysis (p < 0.01 for each variable). In adjusted regression models, anticoagulation use was associated with a five-fold increased risk of ICH (OR 5.26, 95% CI 2.33-12.24, p < 0.001). ICH was associated with increased mortality (adjusted OR 2.6, 95 % CI 1.2-5.9). Anticoagulation use is associated with increased risk of ICH in patients with COVID-19. Further investigation is required to elucidate underlying mechanisms and prevention strategies in this population.

Salinity enhances high optically active L-lactate production from co-fermentation of food waste and waste activated sludge: Unveiling the response of microbial community shift and functional profiling

Lactic acid (LA), a versatile platform molecule, can be fermented from organic wastes, such as food waste and waste activated sludge. In this study, an efficient approach using salt, a component of food waste as an additive, was proposed to increase LA production. The LA productivity was increased at 10 g NaCl/L and optical pure L-lactate was obtained at 30 g NaCl/L. The enhancement of LA was in accordance with the increased solubilization and the critical hydrolase activities under saline conditions. Moreover, high salinity (30-50 g NaCl/L) changed the common conversion of LA to volatile fatty acids. In addition, the key LA bacteria genera (Bacillus, Enterococcus, Lactobacillus) were selectively enriched under saline conditions. Strong correlations between salinity and functional genes for L-LA production were also observed. This study provides a practical way for the enrichment of L-LA with high optical activity from organic wastes.

Chimeric Tobamoviruses With Coat Protein Exchanges Modulate Symptom Expression and Defence Responses in Nicotiana tabacum

In the pathogen infection and host defence equilibrium, plant viruses have evolved to efficiently replicate their genomes, to resist the attack from host defence responses and to avoid causing severe negative effect on growth and metabolism of the hosts. In this study, we generated chimeric tobacco mosaic virus (TMV) variants, in which the coat protein (CP) sequences were substituted with that of cucumber green mottle mosaic virus (CGMMV) or pepper mild mottle virus (PMMoV) to address the role of these in virus infection and host symptomology. The results showed that the chimeric viruses (TMV-CGCP or TMV-PMCP) induce stunting and necrotic symptoms in tobacco plants. We analyzed the transcriptomic changes in tobacco plants after infection of TMV and its chimeras using a high-throughput RNA sequencing approach and found that infection of the chimeric TMV induced significant up-regulation of host defence responsive genes together with salicylic (SA) or abscisic acid (ABA) responsive genes, but down-regulation of auxin (Aux) responsive genes. We further confirmed the increase in the levels of SA and ABA, together with the reduced levels of Aux after infection of chimeric TMV in tobacco plants. These data suggest novel roles of tobamovirus CP in induction of host symptoms and defence responses.

A validated, real-time prediction model for favorable outcomes in hospitalized COVID-19 patients

The COVID-19 pandemic has challenged front-line clinical decision-making, leading to numerous published prognostic tools. However, few models have been prospectively validated and none report implementation in practice. Here, we use 3345 retrospective and 474 prospective hospitalizations to develop and validate a parsimonious model to identify patients with favorable outcomes within 96 h of a prediction, based on real-time lab values, vital signs, and oxygen support variables. In retrospective and prospective validation, the model achieves high average precision (88.6% 95% CI: [88.4-88.7] and 90.8% [90.8-90.8]) and discrimination (95.1% [95.1-95.2] and 86.8% [86.8-86.9]) respectively. We implemented and integrated the model into the EHR, achieving a positive predictive value of 93.3% with 41% sensitivity. Preliminary results suggest clinicians are adopting these scores into their clinical workflows.

Lipoprotein insulin resistance score in nondiabetic patients with obesity after bariatric surgery

BACKGROUND

Lipoprotein insulin resistance (LPIR) score is a composite biomarker representative of atherogenic dyslipidemia characteristic of early insulin resistance. It is elevated in obesity and may provide information not captured in glycosylated hemoglobin and homeostatic model assessment for insulin resistance. While bariatric surgery reduces diabetes incidence and resolves metabolic syndrome, the effect of bariatric surgery on LPIR is untested.

OBJECTIVES

We sought to assess the effects of Roux-en-Y gastric bypass and sleeve gastrectomy on LPIR in nondiabetic women with obesity.

SETTING

Nonsmoking, nondiabetic, premenopausal Hispanic women, age ≥18 years, undergoing Roux-en-Y gastric bypass or sleeve gastrectomy at Bellevue Hospital were recruited for a prospective observational study.

METHODS

Anthropometric measures and blood sampling were performed preoperatively and at 6 and 12 months postoperatively. LPIR was measured by nuclear magnetic resonance spectroscopy.

RESULTS

Among 53 women (Roux-en-Y gastric bypass, n = 22; sleeve gastrectomy, n = 31), mean age was 32 ± 7 years and body mass index 44.1 ± 6.4 kg/m2. LPIR was reduced by 35 ± 4% and 46 ± 4% at 6 and 12 months after surgery, respectively, with no difference by procedure. Twenty-seven of 53 patients met International Diabetes Federation criteria for metabolic syndrome preoperatively and had concomitant higher homeostatic model assessment for insulin resistance, glycosylated hemoglobin, nonhigh-density lipoprotein-cholesterol and LPIR. Twenty-five of 27 patients experienced resolution of metabolic syndrome postoperatively. Concordantly, the preoperative differences in homeostatic model assessment for insulin resistance, glycosylated hemoglobin, and nonhigh-density lipoprotein-cholesterol between those with and without metabolic syndrome resolved at 6 and 12 months. In contrast, patients with metabolic syndrome preoperatively exhibited greater LPIR scores at 6 and 12 months postoperatively.

CONCLUSION

This is the first study to demonstrate improvement in insulin resistance, as measured by LPIR, after bariatric surgery with no difference by procedure. This measure, but not traditional markers, was persistently higher in patients with a preoperative metabolic syndrome diagnosis, despite resolution of the condition.