COVID-19 - Changes in Workload and Clinical Practice in Trauma and Orthopaedics in a District General Hospital in the United Kingdom

Introduction:

COVID-19 has had a significant impact on the entire health system. The trauma and orthopaedic service has been compelled to alter working practices to respond proactively and definitively to the crisis. The aim of this study is to summarise the impact of this outbreak on the trauma and orthopaedic workload and outline the response of the department.

Materials and Methods:

We retrospectively collected data comparing patient numbers pre-COVID-19, and prospectively during the early COVID-19 pandemic. We have collected the numbers and nature of outpatient orthopaedic attendances to fracture clinics and elective services, inpatient admissions and the number of fracture neck of femur operations performed.

Results:

The number of outpatient attendances for a musculoskeletal complaint to Accident and Emergency and the number of virtual fracture clinic reviews reduced by almost 50% during COVID-19. The number of face-to-face fracture clinic follow-ups decreased by around 67%, with a five-fold increase in telephone consultations. Inpatient admissions decreased by 33%, but the average number of fracture neck of femur operations performed has increased by 20% during COVID-19 compared to pre-COVID-19 levels.

Conclusion:

We have noted a decrease in some aspects of the trauma and orthopaedic outpatient workload, such as leisure and occupational-related injuries but an increase in others, such as fracture neck of femurs. Many injuries have significantly reduced in numbers and we consider that a model could be developed for treating these injuries away from the acute hospital site entirely, thereby allowing the acute team to focus more appropriate major trauma injuries.

Efficacy, pharmacokinetic and pharmacodynamic evaluation of apaziquone in the treatment of non-muscle invasive bladder cancer

INTRODUCTION

Apaziquone (also known as EO9 and Qapzola^TM) is a prodrug that is activated to DNA damaging species by oxidoreductases (particularly NQO1) and has the ability to kill aerobic and/or hypoxic cancer cells. Areas covered: Whilst its poor pharmacokinetic properties contributed to its failure in phase II clinical trials when administered intravenously, these properties were ideal for loco-regional therapies. Apaziquone demonstrated good anti-cancer activity against non-muscle invasive bladder cancer (NMIBC) when administered intravesically to marker lesions and was well tolerated with no systemic side effects. However, phase III clinical trials did not reach statistical significance for the primary endpoint of 2-year recurrence in apaziquone over placebo although improvements were observed. Post-hoc analysis of the combined study data did indicate a significant benefit for patients treated with apaziquone, especially when the instillation of apaziquone was given 30 min or more after surgery. A further phase III study is ongoing to test the hypotheses generated in the unsuccessful phase III studies conducted to date. Expert opinion: Because of its specific pharmacological properties, Apaziquone is excellently suited for local therapy such as NMIBC. Future studies should include proper biomarkers.

Abstract P5-11-07: Pharmacokinetics of eflapegrastim in a phase 2 open-label dose-ranging study in breast cancer patients receiving TC regimen

Background: Eflapegrastim (SPI-2012/HM10460A) is a novel, long acting recombinant human granulocyte colony-stimulating factor (rhG-CSF). Eflapegrastim consists of an rhG-CSF conjugated to the recombinant E coli derived Fc fragment of IgG4 via a polyethylene glycol linker. Eflapegrastim is in clinical development for the treatment of chemotherapy induced neutropenia in cancer patients.

Methods: Pharmacokinetics (PK) of eflapegrastim was investigated in an open label, dose-ranging Phase 2 study in breast cancer patients receiving docetaxel + cyclophosphamide (TC) chemotherapy. The study consisted of 4 arms. Patients in Arms 1 through 3 received subcutaneous doses of 45, 135, or 270 µg /kg of eflapegrastim and patients in Arm 4 received 6 mg pegfilgrastim (Neulasta®) on Day 2 of each 21-day chemotherapy cycle. Serum samples were collected from a subset of eflapegrastim patients at pre-specified time-points and analyzed for eflapegrastim by a validated enzyme-linked immunosorption assay (ELISA). Pharmacokinetic analyses were conducted on serum concentration-time profiles after dosing in Cycle 1. The serum concentrations for samples collected in Cycle 3 were compared with the corresponding concentrations in Cycle 1. Pharmacokinetic analyses were not conducted for pegfilgrastim patients.

Results: The PK profile of eflapegrastim was investigated in 11 patients, including 3 patients in the 45 µg/kg treatment arm, 4 patients in the 135 µg/kg treatment arm, and 4 patients in the 270 µg/kg treatment arm. Following single eflapegrastim doses of 45, 135, or 270 µg/kg, peak serum concentrations increased in a dose proportional manner. The summary of pharmacokinetics of eflapegrastim is presented in the Table below.

Pharmacokinetic Parameters of Eflapegrastim in Patients Following Single Subcutaneous Doses in Cycle 1ParameterEflapegrastim 45 μg/kg/Eflapegrastim 135μg/kgEflapegrastim 270 μg/kgCmax, ng/mLN = 3; Mean = 7.00; SD = 6.08N = 4; Mean = 247; SD = 276N =3; Mean = 299; SD = 329Tmax, haN =2; Mean = 58.7; SD = 46.9 - 70.5N = 4; Mean =9.00; SD = 8 - 48.1N = 3; Mean = 24.00; SD = 24 - 24.1AUC0-312, ng•hr/mLN = 0; Mean = NC; SD = NCN = 2; Mean = 16000; SD = 5850N = 3; Mean = 22900; SD = 25100t1/2, hbN = 0; Mean = NC; SD = NCN = 2; Mean = 81.0; SD = 88.4N = 1; Mean = 31.5; SD = NCAUC = area under the concentration-time curve; Cmax = maximum serum concentration; h = hour; NC = not calculated; SD = standard deviation; t1/2 = half-life; Tmax = time to maximum serum concentration; a) Expressed as median and range; b) Expressed as harmonic mean and pseudo SD

The maximum serum concentrations of eflapegrastim in Cycle 3 increased with the dose of eflapegrastim. The serum concentrations of eflapegrastim in Cycle 3 were generally lower than those in Cycle 1, but the profile was similar to Cycle 1.

Conclusions: The Cmax and AUC(0-312) of eflapegrastim increased in a dose proportional manner following subcutaneous administration. The half-life of eflapegrastim ranged from 31.5 to 81.0 hours, which is consistent with the half-life of other long-acting myeloid growth factors.

Citation Format: Vacirca JL, Papai Z, Horvath Z, Makharadze R, Reddy G, Song T, Koli P, Schwartzberg LS. Pharmacokinetics of eflapegrastim in a phase 2 open-label dose-ranging study in breast cancer patients receiving TC regimen [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-11-07.

Abstract P5-11-08: Immunogenicity of eflapegrastim in a phase 2 open-label dose-ranging study of eflapegrastim in breast cancer patients receiving TC regimen

Background: Eflapegrastim (SPI-2012/HM10460A) is a novel, long-acting recombinant human granulocyte colony-stimulating factor (rhG-CSF). Eflapegrastim consists of an rhG-CSF conjugated to a recombinant E. coli derived Fc fragment of IgG4 via a polyethylene glycol linker. Eflapegrastim is in clinical development for the treatment of chemotherapy induced neutropenia in cancer patients.

Methods: Immunogenicity of eflapegrastim was investigated in an open label, dose-ranging Phase 2 study in breast cancer patients receiving docetaxel + cyclophosphamide (TC) chemotherapy. The study consisted of 4 arms. Patients in Arms 1 through 3 received subcutaneous doses of 45, 135, or 270 µg/kg eflapegrastim and Arm 4 received 6 mg pegfilgrastim (Neulasta®) on Day 2 of each 21-day chemotherapy cycle. Blood samples for immunogenicity analysis were collected before the start of each chemotherapy cycle (Day 1) and at the End-of-Study Visit. Samples were tested in a screening assay for Anti-Drug Antibodies (ADA) to eflapegrastim by a validated enzyme linked immunosorption assay (ELISA). Positive samples from the screening assay were further tested in a confirmatory assay for antibodies binding to eflapegrastim or G-CSF. Samples found positive in the confirmatory assay were further tested in a validated cell based neutralizing antibody assay.

Results: Serum samples from 143 patients in the study were tested for ADA to eflapegrastim and G-CSF. Preexisting antibodies binding to eflapegrastim or G-CSF were detected in 9 out of 143 (6.3%) patients. One out of the 27 patients (3.7%) in the Pegfilgrastim Arm who was negative prior to dosing was positive for ADA in the G-CSF confirmatory assay. Two out of 100 patients (2.0%) treated with eflapegrastim, who were negative prior to dosing, demonstrated treatment-induced formation of ADA in the G-CSF confirmatory assay. However, the responses in these patients were transient (ie, not consistently positive at all the sampling times) and the assay response values were low and only slightly above the plate-specific cut points. None of the patients tested were positive for G-CSF neutralizing antibodies. A formal assessment of the impact of serum ADA on the PK of eflapegrastim was not performed since PK was examined in only a limited number of patients and all of those patients were negative for ADA both at study initiation and post-dose.

Conclusion: No neutralizing antibodies against eflapegrastim or G-CSF were detected in patients administered eflapegrastim in this study.

Citation Format: Vacirca JL, Papai Z, Agajanian R, Horvath Z, Makharadze R, Ibrahim E, Koli P, Reddy G, Tedesco KL, McGregor K, Schwartzberg LS. Immunogenicity of eflapegrastim in a phase 2 open-label dose-ranging study of eflapegrastim in breast cancer patients receiving TC regimen [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-11-08.

175 EFFECT OF ACETYL-CoA CARBOXYLASE (ACC) INHIBITOR ON THE LIPID CONTENT AND NUCLEAR MATURATION OF CANINE OOCYTES

Compared with other domestic species, embryo technologies are least developed for the dog. This is mainly due to difficulties in producing mature oocytes in vitro. Canine oocytes contain exceptionally high amounts of lipid. High lipid content increases the chilling sensitivity of oocytes and embryos. Mechanical and chemical reductions of the lipid content have been used to improve the cryotolerance of oocytes. Additionally, chemical stimulation of lipid catabolism improved oocyte in vitro maturation (IVM) rates in other species (You et al. 2012 Theriogenology 78, 235–543). Acetyl-CoA carboxylase (ACC) is the rate-limiting enzyme in de novo lipogenesis and its expression has been reported in oocytes and embryos. In somatic cells, inhibition of ACC reduces lipogenesis and enhances β-oxidation. Our hypothesis is that treatment of oocytes with an inhibitor of ACC (CP640186, Pfizer Animal Health, New York, NY, USA) reduces lipid content and improves IVM rate of oocytes. Ovaries were collected from a spay clinic and sliced in HEPES-buffered TCM-199 to recover oocytes. In vitro maturation was conducted at 38.5°C, 5% CO2, and high humidity in TCM-199 supplemented with 1% fetal bovine serum, glutamine, sodium pyruvate, β-mercaptoethanol, oestradiol, epidermal growth factor, and antimicrobial agents (Songsasen et al. Mol. Reprod. Dev. 79, 186–196). During the first 19 to 21 h, the IVM media contained 4 concentrations of the inhibitor (0+DMSO, 0.02, 0.1, and 0.5 μM, designated as treatments 1, 2, 3, and 4, respectively) and then oocytes were transferred to a medium without the inhibitor and cultured for an additional 27 to 29 h. At the end of culture (total of 48 h), oocytes were denuded of cumulus layers, washed, fixed, and stained with Nile red (lipid) and Hoechst-33342 (chromatin), and then mounted on a microscope slide. Lipid content and chromatin status were evaluated using fluorescent microscopy (TRITC and DAPI filters, respectively). The relative lipid content was measured by the corrected total cell fluorescence (CTCF) using ImageJ software (http://rsbweb.nih.gov/ij/). Data on CTCF and proportions of chromatin status of oocytes were analysed using one-way ANOVA (SigmaPlot 11.0). The mean CTCF for each treatment was 5.5 × 109 (n = 51, 5.2 × 109 (n = 44), 4.5 × 109 (n = 31), and 4.8 × 109 (n = 34), respectively (P = 0.3; 4 replicates). At the highest dose, the agent induced relatively more cumulus cell layer expansion but inhibited their attachment to the dish; the latter effect was reversible because cumulus cells attached and proliferated after washing the oocytes of the agent. Metaphase II was rare (≤3.1%); however, the proportion of oocytes developing to ≥GVBD stage (Trt 1 14%, n = 37; Trt 2 41%, n = 56; Trt 3 5%, n = 22; Trt 4 11%, n = 43) was affected by treatments. Our preliminary data indicate that a low concentration of ACC inhibitor has a positive effect on the nuclear maturation of canine oocytes but the effect on lipid content as estimated by using Nile red fluorescence intensity appears to be minimal.

Surgical treatment of pediatric epileptic encephalopathies

Pediatric epileptiform encephalopathies are a group of neurologically devastating disorders related to uncontrolled ictal and interictal epileptic activity, with a poor prognosis. Despite the number of pharmacological options for treatment of epilepsy, many of these patients are drug resistant. For these patients with uncontrolled epilepsy, motor and/or neuropsychological deterioration is common. To prevent these secondary consequences, surgery is often considered as either a curative or a palliative option. Magnetic resonance imaging to look for epileptic lesions that may be surgically treated is an essential part of the workup for these patients. Many surgical procedures for the treatment of epileptiform encephalopathies have been reported in the literature. In this paper the evidence for these procedures for the treatment of pediatric epileptiform encephalopathies is reviewed.

Abstract P6-14-08: Lucanthone Inhibits Autophagy and Promotes Cathepsin D-Mediated Apoptosis in Breast Cancer Cells

Autophagy is an evolutionarily conserved degradation pathway that eliminates certain proteins, defective organelles, and protein aggregates in order to maintain protein homeostasis and prevent abnormal cells from replicating. However, the autophagy machinery may also be utilized to generate ATP from organelles and other cellular components to promote survival under metabolic/hypoxic stress conditions. Since nutrient and oxygen deprivation are hallmark characteristics of the tumor microenvironment, disrupting autophagic degradation may be a promising approach to selectively kill cancer cells. Chloroquine and its derivatives are the only clinically relevant autophagic inhibitors that are currently being evaluated for their potential applications in cancer therapy. However, these drugs are known to cause ocular toxicity, especially irreversible retinopathy, and this underscores the need for additional inhibitors of autophagy with more favorable therapeutic indices. Lucanthone is an anti-schistome agent that is being investigated for cancer therapy as a sensitizer to chemotherapy and radiation. Here we report a novel mechanism of action for lucanthone that is characterized by the disruption of lysosomal function, inhibition of autophagy, and induction of apoptosis. Exposure to lucanthone resulted in the processing and recruitment of microtubule-associated protein 1 light chain 3 (LC3) to autophagosomes, but induced lysosomal membrane permeabilization and impaired autophagic degradation as revealed by electron microscopy and the accumulation of p62/SQSTM1. Importantly, lucanthone displayed more potent activity against a panel of breast cancer cell lines compared to chloroquine. Cathepsin D is a lysosomal protease that functions to promote apoptosis following its release into the cytosol upon lyososomal disruption. In order to elucidate the mechanism by which lucanthone induces apoptosis in cancer cells, we investigated the potential effects of lucanthone on cathepsin D expression and subcellular localization. As expected based on its effects on the integrity of lysosomes, lucanthone treatment stimulated a highly significant increase in cytosolic cathepsin D expression, which was associated with apoptosis induction. Accordingly, cathepsin D-targeted siRNA blocked the ability of lucanthone to stimulate its expression and significantly reduced lucanthone-mediated apoptosis. Subsequent experiments revealed that the anticancer activity of lucanthone occurred through a mechanism independent of the functional status of the p53 tumor suppressor. Considering that p53 is functionally inactivated in the majority of cancers, the ability of lucanthone to retain anticancer activity under p53 deficient conditions could have important clinical implications. Collectively, this study establishes a novel mechanism of action for lucanthone as an autophagy inhibitor and provides a rationale for its use in combination with anticancer agents that induce this important survival pathway.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-14-08.

Prediction of mortality in adult emergency department patients with sepsis

OBJECTIVES

To determine the efficacy of the abbreviated Mortality in Emergency Department Sepsis (MEDS) score, the Modified Early Warning (MEW) score and near-patient-test (NPT) lactate levels in predicting 28-day mortality in adult emergency department (ED) patients with sepsis.

METHODS

A retrospective cohort study of adult ED patients with sepsis admitted to hospital was conducted in a large urban teaching and a district general hospital. Data were collected during four time periods between 1 January 2006 and 31 January 2007. Inclusion criteria were age > or =16 years and an ED diagnosis of sepsis. Primary outcome for all patients was 28-day mortality. Patients were preassigned to risk groups according to their abbreviated MEDS score, MEW score and NPT lactate.

RESULTS

307 ED patients with sepsis were included in the study. Among these there were 72 deaths (23%). Mortality rates for the low-, moderate- and high-risk groups of the abbreviated MEDS score were 1/63 (1.6%), 48/205 (23.4%) and 23/39 (59.0%) patients. The MEDS score for low-risk patients was 98.6% (95% CI 92.5% to 99.9%) sensitive and 26.5% (95% CI 21.0% to 32.6%) specific and for high-risk patients it was 31.9% (95% CI 21.4% to 44.0%) sensitive and 93.2% (95% CI 89.2% to 96.1%) specific for death within 28 days. Mortality rates for the low- and high-risk MEW score were 20/159 (12.6%) and 52/148 (35.1%) patients. The MEW score for high-risk patients was 72.2% (95% CI 60.4% to 82.1%) sensitive and 59.2% (95% CI 52.6% to 65.5%) specific for mortality. An NPT lactate level of > or =4 mmol/l was 49.1% (95% CI 35.1% to 63.2%) sensitive and 74.3% (95% CI 64.8% to 82.3%) specific for 28-day mortality.

CONCLUSION

These results demonstrate the efficacy of the abbreviated MEDS score, the MEW score and NPT venous lactate levels in predicting 28-day mortality in ED patients with sepsis. The abbreviated MEDS score was found to be the best performing risk assessment model which, with prospective validation, may aid early clinical decision-making in ED patients with sepsis and might affect the outcome from sepsis.

Water-mediated interactions between hydrophobic and ionic species in cylindrical nanopores

We use Metropolis Monte Carlo and umbrella sampling to calculate the free energies of interaction of two methane molecules and their charged derivatives in cylindrical water-filled pores. Confinement strongly alters the interactions between the nonpolar solutes and completely eliminates the solvent separated minimum (SSM) that is seen in bulk water. The free energy profiles show that the methane molecules are either in contact or at separations corresponding to the diameter and the length of the cylindrical pore. Analytic calculations that estimate the entropy of the solutes, which are solvated at the pore surface, qualitatively explain the shape of the free energy profiles. Adding charges of opposite sign and magnitude 0.4e or e (where e is the electronic charge) to the methane molecules decreases their tendency for surface solvation and restores the SSM. We show that confinement induced ion-pair formation occurs whenever l(B)/D approximately O(1), where l(B) is the Bjerrum length and D is the pore diameter. The extent of stabilization of the SSM increases with ion charge density as long as l(B)/D<1. In pores with D<or=1.2 nm, in which the water is strongly layered, increasing the charge magnitude from 0.4e to e reduces the stability of the SSM. As a result, ion-pair formation that occurs with negligible probability in the bulk is promoted. In larger diameter pores that can accommodate a complete hydration layer around the solutes, the stability of the SSM is enhanced.

An economic approach for l-(+) lactic acid fermentation by Lactobacillus amylophilus GV6 using inexpensive carbon and nitrogen sources

AIMS

Development of cost-effective production medium by applying statistical designs for single-step fermentation of starch (corn flour - CF) to L-(+) lactic acid, using inexpensive nitrogen sources as substitutes for peptone and yeast extract in MRS medium by amylolytic Lactobacillus amylophilus GV6.

METHODS AND RESULTS

A two-level Plackett-Burman design was employed for screening various available crude starches (flours) for L-(+) lactic acid production by Lact. amylophilus GV6 using red lentil flour (RL) and bakers yeast cells (YC) as substitutes for commercial peptone and yeast extract in MRS medium in anaerobic submerged fermentation. Of all the tested flours, CF was found to be the most significant. Central composite rotatable design was employed to determine maximum production of L-(+) lactic acid at optimum values of process variables, CF, RL, YC, CaCO(3) and incubation period (IP). minitab analyses showed that lactic acid production was significantly affected by the linear terms CF, RL, CaCO(3) and IP. The interactions of CF-RL, CF-YC, CF-CaCO(3), RL-YC and RL-CaCO(3) and the square terms CF and IP were significant. The maximum lactic acid production of 29 g/37 g of starch present in 50 g of CF was obtained at optimized concentrations of CF 5%, RL 0.7%, YC 0.8%, CaCO(3) 0.8% and IP 2.9 days.

CONCLUSIONS

Successful application of Plackett-Burman design helped in identifying CF as the best carbon source among the tested flours for L-(+) lactic acid production using inexpensive nitrogen sources. Further optimization of the process variables by response surface methods (RSMs) led to maximum production of lactic acid (29 g lactic acid from 37 g of starch present in 50 g of flour).

SIGNIFICANCE AND IMPACT OF THE STUDY

Lactobacillus amylophilus GV6 showed 78.4% lactic acid production efficiency (g lactic acid produced/g starch taken) and 96% lactic acid yield efficiency (g lactic acid produced/g starch utilized). Information from the present studies provides a better understanding on production of L-(+) lactic acid on fermentation of CF using inexpensive nitrogen sources and on changes in the production as a response from interaction of factors. Use of inexpensive nitrogen sources and starch as substrate in MRS medium for single-step fermentation of lactic acid can become an efficient, economic and viable process. This report is on optimization of inexpensive nitrogen sources completely replacing peptone and yeast extract in single-step submerged fermentation of starch (present in CF) to lactic acid with high production efficiency.

Selection of medium components by Plackett-Burman design for production of L(+) lactic acid by Lactobacillus amylophilus GV6 in SSF using wheat bran

Plackett-Burman design was employed for screening 15 parameters for production of L(+) lactic acid from wheat bran, an inexpensive substrate and solid support, by Lactobacillus amylophilus GV6 in solid state fermentation (SSF). Eleven nutrients belonging to two categories viz.; nitrogen sources and salt sources along with three physical parameters and a buffer were screened. This design screens n variables in n + 1 number of experiments. Coefficients and sum of squares ratio in percentage (SS%) of these variables were calculated by subjecting the experimental data to statistical analysis. The nitrogen sources peptone, yeast extract and tri-ammonium citrate, along with NaH2PO4.2H2O and Tween 80, were found to influence productivity, which can be further optimized for increased lactic acid production. Use of this design is scarce in solid state fermentation and has not been attempted previously for single step conversion of starch to L(+) lactic acid using a bacterial system.

Production of Ethanol From Cellulosic Biomass by Clostridium thermocellum SS19 in Submerged Fermentation: Screening of Nutrients Using Plackett-Burman Design

Plackett-Burman design, a statistical methodology, was used to screen 23 nutrients belonging to three categories--carbon, nitrogen, and salt/mineral sources--for the production of ethanol from cellulosic biomass by Clostridium thermocellum SS19 in anaerobic submerged fermentation. In this design, just n number of experiments is required for screening n-1 variables. The experimental data were subjected to statistical analysis for calculating the regression coefficients and t-values. Filter paper, Solka Floc, corn steep liquor (CSL), cysteine HCl, magnesium chloride, and ferrous sulfate showed relatively higher regression coefficients on ethanol production and growth. Among the 23 nutrients screened, based on their performance in terms of product-promoting ability, availability, and cost, filter paper, CSL, cysteine HCl, magnesium chloride, and ferrous sulfate were identified as the most effective and, therefore, selected for inclusion in further optimization studies.

Fermentation of cellulose to acetic acid by Clostridium lentocellum SG6: induction of sporulation and effect of buffering agent on acetic acid production

AIMS

To determine the growth, correlation between sporulation and acetic acid production and effect of buffering agent at high substrate cellulose concentrations of the strain Clostiridium lentocellum SG6.

METHODS AND RESULTS

The strain SG6 was grown in cellulose mineral salt medium containing cellulose (Whatman No. 1 filter paper, Whatmore International Ltd., Maidstone, UK) or cellobiose. The strain fermented cellulose even after several transfers on cellobiose medium. The formation of endospores on third day onwards indicated the lowering of pH in the medium because of the formation of acetic acid. Maintaining the pH 7.2 at higher substrate concentrations resulted in increase of biomass, cellulose fermentation, acetic acid production, etc.

CONCLUSIONS

The strain SG6, with its high fermentation yields and sporulating character can become a potential strain for acetic acid production and also as a probiotic strain in animal nutrition.

SIGNIFICANCE AND IMPACT OF THE STUDY

The direct conversion of cellulosic biomass to acetic acid can eliminate expensive three-step saccharification, fermentation processes. The strain SG6 can ferment cellulose at high substrate concentrations.

Clostridium lentocellum SG6--a potential organism for fermentation of cellulose to acetic acid

A cellulolytic, acetic acid producing anaerobic bacterial isolate, Gram negative, rod-shaped, motile, terminal oval shaped endospore forming bacterium identified as Clostridium lentocellum SG6 based on physiological and biochemical characteristics. It produced acetic acid as a major end product from cellulose fermentation at 37 degrees C and pH 7.2. Acetic acid production was 0.67 g/g cellulose substrate utilized in cellulose mineral salt (CMS) medium. Yeast extract (0.4%) was the best nitrogen source among the various nitrogenous nutrients tested in production medium containing 0.8% cellulose as substrate. No additional vitamins or trace elemental solution were required for acetic acid fermentation. This is the highest acetic acid fermentation yield in monoculture fermentation for direct conversion of cellulose to acetic acid.

Sequential magnetic resonance monitoring of pulmonary flow with endovascular stents placed across the pulmonary valve in growing Swine

BACKGROUND

Patients with endovascular stent implantation for the treatment of right ventricular outflow tract obstruction are often left with incomplete relief of the obstruction and significant pulmonary regurgitation. A noninvasive and reproducible method for monitoring such patients is desirable. MRI in the presence of a stent, however, has to overcome the problem of potential metallic artifacts.

METHODS AND RESULTS

Under x-ray fluoroscopic guidance, endovascular nitinol stents were placed across the pulmonary valve in 6 young pigs to induce pulmonary regurgitation. Five additional pigs served as controls. Initial MRI was performed after 2 days (13.5+/-1.8 kg) and follow-up after 3 months (32+/-2.9 kg). Pulmonary flow volumes and regurgitant fraction were quantified by velocity-encoded cine (VEC) MRI through (VEC-TS) and distal to (VEC-DS) the stent. VEC-TS was compared with VEC-DS and volumetric measurements of left and right ventricular stroke volumes provided by cine MRI ("gold standard"). Antegrade and retrograde pulmonary flow volumes by VEC-TS were slightly but significantly less than those with VEC-DS and cine MRI. Excellent correlations (r>0.97) for phasic pulmonary flow volumes as measured by VEC-TS and VEC-DS were shown. Pulmonary regurgitant fraction increased from 32.8+/-15% to 49.6+/-17% (P<0.05) over the course of 3 months with VEC-TS.

CONCLUSIONS

MRI demonstrates the progression of pulmonary regurgitation in growing swine. VEC MRI has the ability to quantify pulmonary blood flow inside the lumen of nitinol stents. MRI appears to be ideally suited for monitoring patients with endovascular nitinol stents in the pulmonary artery or pulmonary valve position.

Design and synthesis of a series of (2R)-N(4)-hydroxy-2-(3-hydroxybenzyl)-N(1)- [(1S,2R)-2-hydroxy-2,3-dihydro-1H-inden-1-yl]butanediamide derivatives as potent, selective, and orally bioavailable aggrecanase inhibitors

A pharmacophore model of the P1' site, specific for aggrecanase, was defined using the specificity studies of the matrix metalloproteinases and the similar biological activity of aggrecanase and MMP-8. Incorporation of the side chain of a tyrosine residue into compound 1 as the P1' group provided modest selectivity for aggrecanase over MMP-1, -2, and -9. A cis-(1S)(2R)-amino-2-indanol scaffold was incorporated as a tyrosine mimic (P2') to conformationally constrain 2. Further optimization resulted in compound 11, a potent, selective, and orally bioavailable inhibitor of aggrecanase.

Occurrence of ochratoxin A in black pepper, coriander, ginger and turmeric in India

Ochratoxin A (OA) contamination of black pepper, coriander seeds, powdered ginger and turmeric powder was estimated using indirect competitive ELISA. Samples (1 g) were extracted with 0.5% potassium chloride (KCl) in 70% methanol (5 ml) and diluted subsequently to give two-fold to ten-fold step-wise dilutions in phosphate-buffered saline containing 0.05% Tween 20 and 0.2% bovine serum albumin (PBS-T BSA). For extracts from the spices analysed, ELISA estimates of OA concentrations were compared with those made by HPLC. All estimates were within 1-2 standard deviation of the ELISA values. More than 90% of OA added to spice samples was recovered from samples containing between 5 and 100 microg/kg OA. Extracts of OA-free spice samples contained substances that interfered with ELISA, presumably because of non-specific reactions. This effect was avoided by preparing all the test solutions in extracts of OA-free spice samples. In 126 samples obtained from retail shops, OA was found to exceed 10 microg/kg in 14 (in the range of 15-69 microg/kg) of 26 black pepper samples, 20 (in the range of 10-51 microg/kg) of 50 coriander samples, two (23 microg/kg and 80 microg/kg) of 25 ginger samples and nine (in the range of 11-102 microg/kg) of 25 turmeric samples. This is the first record in India of the occurrence of OA in what are some of the most widely used spices in Indian cooking.