Peri-Operative Desensitization for Highly Sensitized Lung Transplant Recipients Following COVID-19 Acute Respiratory Distress Syndrome (ARDS) - Report of Two Cases

Introduction

Sensitized lung transplant (LTx) candidates have longer waiting times, decreased likelihood of transplant, and increased risk of death while on the waitlist. Patients with SARS-Cov-2 ARDS on ECMO support due to end-stage lung disease have a short window of opportunity for LTx. We report two cases in which the Toronto LTx peri-operative strategy was performed with good outcomes in highly sensitized Covid-19 patients.

Case Report

Case 1: 31-yo female patient with Covid-19 ARDS, transferred for LTx evaluation after 46 days on VV-ECMO. She was pregnant when she presented with Covid -19 acute respiratory failure, and underwent an urgent C-section due to fetal distress. She required blood transfusions during ICU stay. At LTx assessment: PRA class I: 95%; class II: 0%. A decision to proceed with LTx with perioperative desensitization was made considering the low probability of finding a suitable donor. After seven days on the waiting list, she underwent bilateral LTx. Virtual crossmatch (XM) positive (B35); CDC-XM negative. Desensitization protocol was performed with perioperative plasma exchange (PLEX) without basiliximab induction, followed by five sessions of PLEX and intravenous immunoglobulin 1 mg/kg. Due to postoperative acute cholecystitis with positive cultures after biliary drainage, anti thymocyte globulin (ATG) infusion (3 mg/kg) was held, and infusion postponed until four weeks post LTx. Tacrolimus, mycophenolate, and prednisone were used as maintenance immunosuppression. The patient was discharged home on PO day 53 with excellent graft function. Case 2: 35-yo female patient with Covid-19 ARDS, transferred for LTx after 69 days on VV-ECMO. History of 3 previous pregnancies and multiple blood transfusions due to transitory coagulopathy during her ICU stay. PRA class I: 83%; class II: 94%. VCM positive (B7, Cw7, DRB1*11:01, DR52, DQA1*05/DQB1*03). Desensitization protocol was performed, but ATG infusion was held due to C. albicans bloodstream infection and colonization with pan-resistant K. pneumoniae. DSAs at six weeks were negative. She remains hospitalized for mechanical ventilation withdrawal and inpatient rehabilitation.

Summary

In selected cases, peri-operative desensitization is feasible and can be safely implemented in highly sensitized patients with Covid-19 ARDS.

Portuguese cultural adaptation and validation of the European Health Literacy Survey (HLS-EU) for children aged 9 to 10 (HLS-EU-PTc)

Introduction

To measure Health literacy (HL) as proposed in the context of the European Health Literacy Survey/questionnaire (HLS-EU-Q), the Health Literacy for Children and Adolescents (HLCA) Consortium (GE) adapted it for children. A trans-cultural adaptation and validation to Portuguese (HLS-EU-PTc), will supply policy makers, experts and health professionals with information that can promote healthier communities while fighting health disparities.

Methods

After permission was granted from the HLCA Consortium the TRAPD model was used (eg parallel translation, focus groups, two back translations). An assessment and pretesting of HLS-EU-PTc was done with 16 children for cognitive testing. A qualitative explanatory (n = 16) and quantitative, cross-sectional study (n = 82), age mean 13, SD 0.96, from Portugal (mainland) was implemented for proceed with the validation process. A variety of measures were obtained like internal consistency and mean scores.

Results

Preliminary results for evaluation of the psychometric properties of the HLS-EU-PTc show satisfactory internal consistency (Cronbach’s alpha coefficient 0.87). In a scale from 1 (very difficult) to 4 (very easy) for indicators of the HLS-EU-PTc, we have a mean of 3.25 and a SD of .478.

Conclusions

This is the first study to examine the feasibility of a Portuguese version (HLS-EU-PTc) of the HLS-EU-Q adapted for children and it indicates high internal consistency and level of self-reported HL. The usefulness of the HLS-EU-PTc instrument can be further discussed while planning public health policy strategies from the HL standpoint. The validated HLS-EU-PTc version of the HLS-EU-Qc survey, with the user’s manual can be accessed at www.literacia-saude.info.

The link between nitrous oxide emissions, microbial community profile and function from three full-scale WWTPs

Few attempts have been made in previous studies to link the microbial community structure and function with nitrous oxide (N₂O) emissions at full-scale wastewater treatment plants (WWTPs). In this work, high-throughput sequencing and reverse transcriptase-qPCR (RT-qPCR) was applied to activated sludge samples from three WWTPs for two seasonal periods (winter and summer) and linked with the N₂O emissions and wastewater characteristics. The total N₂O emissions ranged from 7.2 to 937.0 g N-N₂O/day, which corresponds to an emission factor of 0.001 to 0.280% of the influent NH₄-N being emitted as N₂O. Those emissions were related to the abundance of Nitrotoga, Candidatus Microthrix and Rhodobacter genera, which were favored by higher dissolved oxygen (DO) and nitrate (NO₃^-) concentrations in the activated sludge tanks. Furthermore, a relationship between the nirK gene expression and N₂O emissions was verified. Detected N₂O emission peaks were associated with different process events, related to aeration transition periods, that occurred during the regular operation of the plants, which could be potentially associated to increased emissions of the WWTP. The design of mitigation strategies, such as optimizing the aeration regime, is therefore important to avoid process events that lead to those N₂O emissions peaks. Furthermore, this study also demonstrates the importance of assessing the gene expression of nosZ clade II, since its high abundance in WWTPs could be an important key to reduce the N₂O emissions.

Changes in behavioural parameters, oxidative stress and neurotrophins in the brain of adult offspring induced to an animal model of schizophrenia: The effects of FA deficient or FA supplemented diet during the neurodevelopmental phase

A deficiency of maternal folic acid (FA) can compromise the function and development of the brain, and may produce a susceptibility to diseases such as schizophrenia (SZ) in the later life of offspring. The aim of this study was to evaluate the effects of both FA deficient and FA supplemented diets during gestation and lactation on behavioural parameters, the markers of oxidative stress and neurotrophic factors in adult offspring which had been subjected to an animal model of SZ. Female mother rats (Dam's) were separated into experimental maternal groups, which began receiving a special diet (food) consisting of the AIN-93 diet, a control diet, or an FA deficient diet during the periods of pregnancy and lactation. Dam's receiving the control diet were further subdivided into four groups: one group received only control diet, while three groups to receive supplementation with FA at different doses (5, 10 and 50 mg/kg). Adult offspring bred from the Dam's were divided into ten groups for induction of the animal model of SZ through the administration of ketamine (Ket) (25 mg/kg). After the last administration of the drug, the animals were subjected to the behavioural tests and were then euthanized. The frontal cortex (FC) and hippocampus (Hip) were then dissected for later biochemical analysis. Our data demonstrates that Ket induced the model of SZ by altering the behavioural parameters (e.g. hyperlocomotion, social impairment, deficits in the sensory-motor profile and memory damage in the adult animals); and also caused changes in the parameters of oxidative stress (lipid hydroperoxide - LPO; 8-isoprostane - 8-ISO; 4-hydroxynonenal - 4-HNE; protein carbonyl content; superoxide dismutase - SOD and catalase - CAT) as well as in the levels of neurotrophic factors (brain-derived neurotrophic factor - BDNF and nerve growth factor - NGF) particularly within the FC of adult offspring. A deficiency in maternal FA, alone or in combination with ket, was able to induce hyperlocomotion and social impairment in the offspring with increased levels of lipid and protein damage (LPO, 8-ISO, 4-HNE, carbonylation of protein) within the FC, increased activity of antioxidant enzymes (SOD and CAT) in both of the brain structures studied, and also reduced the levels of neurotrophins (BDNF and NGF), particularly within the Hip of the adult offspring. Supplementation of FA (5, 10 and 50 mg/kg) to the Dam's was mostly able to prevent the cognitive damage which was induced by Ket in the adult animals. FA (10 and 50 mg/kg) attenuated the action of Ket in the animals in relation to the biochemical parameters, proving the possible neuroprotective effect of FA in the adulthood of offspring that were subjected to the animal model of SZ. Our study indicates that the intake of maternal FA during pregnancy and lactation plays an important role, particularly in the regulation of markers of oxidative stress and neurotrophins.

High throughput phenotyping of morpho-anatomical stem properties using X-ray computed tomography in sorghum

BACKGROUND

In bioenergy/forage sorghum, morpho-anatomical stem properties are major components affecting standability and juice yield. However, phenotyping these traits is low-throughput, and has been restricted by the lack of a high-throughput phenotyping platforms that can collect both morphological and anatomical stem properties. X-ray computed tomography (CT) offers a potential solution, but studies using this technology in plants have evaluated limited numbers of genotypes with limited throughput. Here we suggest that using a medical CT might overcome sample size limitations when higher resolution is not needed. Thus, the aim of this study was to develop a practical high-throughput phenotyping and image data processing pipeline that extracts stem morpho-anatomical traits faster, more efficiently and on a larger number of samples.

RESULTS

A medical CT was used to image morpho-anatomical stem properties in sorghum. The platform and image analysis pipeline revealed extensive phenotypic variation for important morpho-anatomical traits in well-characterized sorghum genotypes at suitable repeatability rates. CT estimates were highly predictive of morphological traits and moderately predictive of anatomical traits. The image analysis pipeline also identified genotypes with superior morpho-anatomical traits that were consistent with ground-truth based classification in previous studies. In addition, stem cross section intensity measured by the CT was highly correlated with stem dry-weight density, and can potentially serve as a high-throughput approach to measure stem density in grass stems.

CONCLUSIONS

The use of CT on a diverse set of sorghum genotypes with a defined platform and image analysis pipeline was effective at predicting traits such as stem length, diameter, and pithiness ratio at the internode level. High-throughput phenotyping of stem traits using CT appears to be useful and feasible for use in an applied breeding program.

High throughput phenotyping of morpho-anatomical stem properties using X-ray computed tomography in sorghum

BACKGROUND

In bioenergy/forage sorghum, morpho-anatomical stem properties are major components affecting standability and juice yield. However, phenotyping these traits is low-throughput, and has been restricted by the lack of a high-throughput phenotyping platforms that can collect both morphological and anatomical stem properties. X-ray computed tomography (CT) offers a potential solution, but studies using this technology in plants have evaluated limited numbers of genotypes with limited throughput. Here we suggest that using a medical CT might overcome sample size limitations when higher resolution is not needed. Thus, the aim of this study was to develop a practical high-throughput phenotyping and image data processing pipeline that extracts stem morpho-anatomical traits faster, more efficiently and on a larger number of samples.

RESULTS

A medical CT was used to image morpho-anatomical stem properties in sorghum. The platform and image analysis pipeline revealed extensive phenotypic variation for important morpho-anatomical traits in well-characterized sorghum genotypes at suitable repeatability rates. CT estimates were highly predictive of morphological traits and moderately predictive of anatomical traits. The image analysis pipeline also identified genotypes with superior morpho-anatomical traits that were consistent with ground-truth based classification in previous studies. In addition, stem cross section intensity measured by the CT was highly correlated with stem dry-weight density, and can potentially serve as a high-throughput approach to measure stem density in grass stems.

CONCLUSIONS

The use of CT on a diverse set of sorghum genotypes with a defined platform and image analysis pipeline was effective at predicting traits such as stem length, diameter, and pithiness ratio at the internode level. High-throughput phenotyping of stem traits using CT appears to be useful and feasible for use in an applied breeding program.

Fast method for the determination of short-chain-length polyhydroxyalkanoates (scl-PHAs) in bacterial samples by In Vial-Thermolysis (IVT)

A new method based on the GC-MS analysis of thermolysis products obtained by treating bacterial samples at a high temperature (above 270°C) has been developed. This method, here named "In-Vial-Thermolysis" (IVT), allowed for the simultaneous determination of short-chain-length polyhydroxyalkanoates (scl-PHA) content and composition. The method was applied to both single strains and microbial mixed cultures (MMC) fed with different carbon sources. The IVT procedure provided similar analytical performances compared to previous Py-GC-MS and Py-GC-FID methods, suggesting a similar application for PHA quantitation in bacterial cells. Results from the IVT procedure and the traditional methanolysis method were compared; the correlation between the two datasets was fit for the purpose, giving a R² of 0.975. In search of further simplification, the rationale of IVT was exploited for the development of a "field method" based on the titration of thermolyzed samples with sodium hydrogen carbonate to quantify PHA inside bacterial cells. The accuracy of the IVT method was fit for the purpose. These results lead to the possibility for the on-line measurement of PHA productivity. Moreover, they allow for the fast and inexpensive quantification/characterization of PHA for biotechnological process control, as well as investigation over various bacterial communities and/or feeding strategies.

Ecotoxicity of ketoprofen, diclofenac, atenolol and their photolysis byproducts in zebrafish (Danio rerio)

The occurrence of pharmaceutical compounds in wastewater treatment plants and surface waters has been detected worldwide, constituting a potential risk for aquatic ecosystems. Adult zebrafish, of both sexes, were exposed to three common pharmaceutical compounds (atenolol, ketoprofen and diclofenac) and their UV photolysis by-products over seven days. The results show that diclofenac was removed to concentrations<LOD after 5 min of UV irradiation. The oxidative stress response of zebrafish to pharmaceuticals and their photolysis by-products was evaluated through oxidative stress enzymes (glutathione-S-transferase, catalase, superoxide dismutase) and lipid peroxidation. Results suggest that the photolysis by-products of diclofenac were more toxic than those from the other compounds tested, showing an increase in GST and CAT levels, which are also supported by higher MDA levels. Overall, the toxicity of waters containing atenolol and ketoprofen was reduced after the parent compounds were transformed by photolysis, whereas the toxicity increased significantly from the by-products generated through diclofenac photolysis. Therefore, diclofenac photolysis would possibly necessitate higher irradiation time to ensure that the associated by-products are completely degraded to harmless form(s).

How good is the levothyroxine replacement in primary hypothyroidism patients in Brazil? Data of a multicentre study

BACKGROUND

Studies from every continent have shown that only around 50% of the patients subjected to thyroid hormone replacement have TSH in the normal range. However, to date, there are no consistent data about Brazil.

OBJECTIVES

To evaluate levothyroxine (LT4) replacement treatment in patients with primary hypothyroidism followed in referral centers in Brazil.

METHODS

Patients with primary hypothyroidism followed in referral centers (University Hospitals from Universidade Federal do Rio de Janeiro - UFRJ, Unicamp, Universidade Federal do Paraná - UFPR and Universidade Federal do Ceará-UFC) answered a questionnaire that inquired about clinical and biochemical conditions, social- economic status, life quality and clinicians' orientations as well as their understanding about the information given. Serum TSH was checked close to the interview.

RESULTS

2292 consecutive patients met the inclusion criteria. Mean age 51.2 yr and TSH values between 0.4 and 4.0 mUI/l were considered to be within the reference range. Among all patients taking thyroid medication, 42.7% had an abnormal serum TSH (28.3% were undertreated and 14.4% were overtreated). Approximately all patients (99%) took LT4 in the morning but less than 30 min before breakfast (85.4%). Regarding the clinicians' orientations: 97.5% of the patients were instructed to take the medication daily, and 92.6% to take 30 min before breakfast (92.6%). However, only 52.1% were told not to take LT4 along with other medication.

CONCLUSIONS

Our study found that a significant number of patients taking thyroid hormones were not in the therapeutic range. Clinicians should, therefore, consider monitoring patients on thyroid replacement more frequently and being more precise on giving recommendations about the correct use of LT4.

Segregated flux balance analysis constrained by population structure/function data: the case of PHA production by mixed microbial cultures

In this study we developed a segregated flux balance analysis (FBA) method to calculate metabolic flux distributions of the individual populations present in a mixed microbial culture (MMC). Population specific flux data constraints were derived from the raw data typically obtained by the fluorescence in situ hybridization (FISH) and microautoradiography (MAR)-FISH techniques. This method was applied to study the metabolic heterogeneity of a MMC that produces polyhydroxyalkanoates (PHA) from fermented sugar cane molasses. Three populations were identified by FISH, namely Paracoccus sp., Thauera sp., and Azoarcus sp. The segregated FBA method predicts a flux distribution for each of the identified populations. The method is shown to predict with high accuracy the average PHA storage flux and the respective monomeric composition for 16 independent experiments. Moreover, flux predictions by segregated FBA were slightly better than those obtained by nonsegregated FBA, and also highly concordant with metabolic flux analysis (MFA) estimated fluxes. The segregated FBA method can be of high value to assess metabolic heterogeneity in MMC systems and to derive more efficient eco-engineering strategies. For the case of PHA-producing MMC considered in this work, it becomes apparent that the PHA average monomeric composition might be controlled not only by the volatile fatty acids (VFA) feeding profile but also by the population composition present in the MMC.

Modelling the biodegradation of non-steroidal anti-inflammatory drugs (NSAIDs) by activated sludge and a pure culture

A model describing ibuprofen and ketoprofen biodegradation by activated sludge from three different wastewater treatment plants (WWTP) was developed in this study. This model successfully described the biodegradation profiles observed at two different initial concentrations of each compound, where a lag-phase was observed prior to the biodegradation of each compound. Twelve ibuprofen and ketoprofen degrading isolates were identified in this study from the WWTP sludge showing the best removal performance. One of these isolates was characterised via another model, where biodegradation was dependent on biomass growth rate as well as the ibuprofen concentration. The fact that different models were needed to describe the biodegradation by activated sludge and a pure culture suggests that the biodegradation of non-steroidal anti-inflammatory drugs (NSAIDs) depends on the microbial community, thus pharmaceutical biodegradation models may require adaptation depending upon the system. This study provides an advance towards modelling pharmaceutical biodegradation in WWTPs.

Polyhydroxyalkanoates production by a mixed photosynthetic consortium of bacteria and algae

For the first time, a mixed photosynthetic culture (MPC) consisting of a consortium of bacteria and algae was investigated for its capacity to accumulate polyhydroxyalkanoates (PHA). The culture was subjected to a feast and famine regime in an illuminated environment without supplying oxygen or any other electron acceptor. The MPC accumulated PHA during the feast phase and consumed it in the famine phase, where the PHA consumption was made possible due to oxygen production by algae. The internal cycling of carbohydrates was also observed, which was likely linked to bacterial glycogen being used as an additional source of energy for acetate uptake during the feast phase, and restored in the famine phase via PHA degradation. The MPC reached a PHA content of 20%, with a PHA storage yield per acetate similar to aerobic systems, opening up the possibility of a new sunlight-driven PHA production process without the need for aeration.

Randomized clinical trial of the impact of insulin therapy on liver function in patients undergoing major liver resection

BACKGROUND

Postoperative liver dysfunction is the major source of morbidity and mortality in patients undergoing partial hepatectomy. This study tested the benefits of a metabolic support protocol based on insulin infusion, for reducing liver dysfunction following hepatic resection.

METHODS

Consecutive consenting patients scheduled for liver resection were randomized to receive preoperative dextrose infusion followed by insulin therapy using the hyperinsulinaemic normoglycaemic clamp protocol (n = 29) or standard therapy (control group, n = 27). Patients in the insulin therapy group followed a strict dietary regimen for 24 h before surgery. Intravenous dextrose was started at 2 mg per kg per min the night before and continued until surgery. Hyperinsulinaemic therapy for a total of 24 h was initiated at 2 munits per kg per min at induction of anaesthesia, and continued at 1 munit per kg per min after surgery. Normoglycaemia was maintained (3.5-6.0 mmol/l). Control subjects received no additional dietary supplement and a conventional insulin sliding scale during fasting. All patients were tested serially to evaluate liver function using the Schindl score. Liver tissue samples were collected at two time points during surgery to measure glycogen levels.

RESULTS

Demographics were similar in the two groups. More liver dysfunction occurred in the control cohort (liver dysfunction score range 0-8 versus 0-4 with insulin therapy; P = 0.031). Median (interquartile range) liver glycogen content was 278 (153-312) and 431 (334-459) µmol/g respectively (P = 0.011). The number of complications rose with increasing severity of postoperative liver dysfunction (P = 0.032) CONCLUSION: The glucose-insulin protocol reduced postoperative liver dysfunction and improved liver glycogen content.

REGISTRATION NUMBER

NCT00774098 (http://www.clinicaltrials.gov).

Photodegradation kinetics and transformation products of ketoprofen, diclofenac and atenolol in pure water and treated wastewater

Pharmaceutical compounds such as ketoprofen, diclofenac and atenolol are frequently detected at relatively high concentrations in secondary effluents from wastewater treatment plants. Therefore, it is important to assess their transformation kinetics and intermediates in subsequent disinfection processes, such as direct ultraviolet (UV) irradiation. The photodegradation kinetics of these compounds using a medium pressure (MP) lamp was assessed in pure water, as well as in filtered and unfiltered treated wastewater. Ketoprofen had the highest time- and fluence-based rate constants in all experiments, whereas atenolol had the lowest values, which is consistent with the corresponding decadic molar absorption coefficient and quantum yield. The fluence-based rate constants of all compounds were evaluated in filtered and unfiltered wastewater matrices as well as in pure water. Furthermore, transformation products of ketoprofen, diclofenac and atenolol were identified and monitored throughout the irradiation experiments, and photodegradation pathways were proposed for each compound. This enabled the identification of persistent transformation products, which are potentially discharged from WWTP disinfection works employing UV photolysis.

Glucose and insulin administration while maintaining normoglycemia: the GIN concept

The benefits of tight glucose control in critically ill and surgical patients remains a subject of debate. While some studies demonstrated a survival benefit associated with intensive insulin therapy, more recent studies have failed to demonstrate this correlation. On the contrary, the difficulty in achieving normoglycemia with the conventional insulin sliding scale protocols and a rising concern for severe hypoglycemic episodes associated with this strategy keep many clinicians skeptical. This article examines the use of hyperinsulinemic-normoglycemic clamping, or glucose-insulin-normoglycemia (GIN) therapy, a novel approach to achieve normoglycemia in the perioperative period. If properly applied, this therapy potentially reduces the morbidity and mortality associated with hyperglycemia and confers the pharmacological advantages of hyperinsulinemia. Further understanding of the underlying molecular mechanisms, as well as the development of a continuous intravenous glucose monitoring device would facilitate the routine clinical use of GIN therapy.

Propionate addition enhances the biodegradation of the xenobiotic herbicide propanil and its metabolite

This study investigated ways of stimulating the biodegradation rates of the commonly applied herbicide, 3,4-dichloropropionanilide (propanil), and its metabolite, 3,4-dichloroaniline (DCA), as well as the growth rate of propanil- and DCA-degrading organisms in a mixed culture. Propionate, the other metabolite of propanil, stimulated the specific degradation rates of both propanil and DCA after a brief acclimation period. A metabolic model developed to characterise the metabolism of propanil and DCA biodegradation showed that the efficiency of oxidative phosphorylation (i.e. P/O ratio), which measures the metabolic efficiency, increased over time by 6- to 10-fold. This increase was accompanied by a 5- to 10-fold increase in the propanil and DCA biodegradation degradation rates. The biodegradation rates of the culture were unaffected when using an irrigation water matrix (Tejo river, Portugal), highlighting the utility of the culture for bioaugmentation purposes.

Biodegradation of clofibric acid and identification of its metabolites

Clofibric acid (CLF) is the pharmaceutically active metabolite of lipid regulators clofibrate, etofibrate and etofyllinclofibrate, and it is considered both environmentally persistent and refractory. This work studied the biotransformation of CLF in aerobic sequencing batch reactors (SBRs) with mixed microbial cultures, monitoring the efficiency of biotransformation of CLF and the production of metabolites. The maximum removal achieved was 51% biodegradation (initial CLF concentration=2 mg L(-1)), where adsorption and abiotic removal mechanisms were shown to be negligible, showing that CLF is indeed biodegradable. Tests showed that the observed CLF biodegradation was mainly carried out by heterotrophic bacteria. Three main metabolites were identified, including α-hydroxyisobutyric acid, lactic acid and 4-chlorophenol. The latter is known to exhibit higher toxicity than the parent compound, but it did not accumulate in the SBRs. α-Hydroxyisobutyric acid and lactic acid accumulated for a period, where nitrite accumulation may have been responsible for inhibiting their degradation. A metabolic pathway for the biodegradation of CLF is proposed in this study.

Assessing the removal of pharmaceuticals and personal care products in a full-scale activated sludge plant

PURPOSE

This study aimed to investigate the removal mechanisms of pharmaceutical active compounds (PhACs) and musks in a wastewater treatment plant (WWTP). Biological removal and adsorption in the activated sludge tank as well as the effect of UV radiation used for disinfection purposes were considered when performing a mass balance on the WWTP throughout a 2-week sampling campaign.

METHODS

Solid-phase extraction (SPE) was carried out to analyse the PhACs in the influent and effluent samples. Ultrasonic solvent extraction was used before SPE for PhACs analysis in sludge samples. PhAC extracts were analysed by LC-MS. Solid-phase microextraction of liquid and sludge samples was used for the analysis of musks, which were detected by GC-MS. The fluxes of the most abundant compounds (13 PhACs and 5 musks) out of 79 compounds studied were used to perform the mass balance on the WWTP.

RESULTS

Results show that incomplete removal of diclofenac, the compound that was found in the highest abundance, was observed via biodegradation and adsorption, and that UV photolysis was the main removal mechanism for this compound. The effect of adsorption to the secondary sludge was often negligible for the PhACs, with the exceptions of diclofenac, etofenamate, hydroxyzine and indapamide. However, the musks showed a high level of adsorption to the sludge. UV radiation had an important role in reducing the concentration of some of the target compounds (e.g. diclofenac, ibuprofen, clorazepate, indapamide, enalapril and atenolol) not removed in the activated sludge tank.

CONCLUSIONS

The main removal mechanism of PhACs and musks studied in the WWTP was most often biological (45%), followed by adsorption (33%) and by UV radiation (22%). In the majority of the cases, the WWTP achieved >75% removal of the most detected PhACs and musks, with the exception of diclofenac.

Metabolic shift of polyphosphate-accumulating organisms with different levels of polyphosphate storage

Previous studies have shown that polyphosphate-accumulating organisms (PAOs) are able to behave as glycogen-accumulating organisms (GAOs) under different conditions. In this study we investigated the behavior of a culture enriched with Accumulibacter at different levels of polyphosphate (poly-P) storage. The results of stoichiometric ratios Gly(degraded)/HAc(uptake), PHB(synthesized)/HAc(uptake), PHV(synthesized)/HAc(uptake) and P(release)/HAc(uptake) confirmed a metabolic shift from PAO metabolism to GAO metabolism: PAOs with high poly-P content used the poly-P to obtain adenosine tri-phosphate (ATP), and glycogen (Gly) to obtain nicotinamide adenine dinucleotide (NADH) and some ATP. In a test where poly-P depletion was imposed on the culture, all the acetate (HAc) added in each cycle was transformed into polyhydroxyalkanoate (PHA) despite the decrease of poly-P inside the cells. This led to an increase of the Gly(degraded)/HAc(uptake) ratio that resulted from a shift towards the glycolytic pathway in order to compensate for the lack of ATP formed from poly-P hydrolysis. The shift from PAO to GAO metabolism was also reflected in the change in the PHA composition as the poly-P availability decreased, suggesting that polyhydroxyvalerate (PHV) is obtained due to the consumption of excess reducing equivalents to balance the internal NADH, similarly to GAO metabolism. Fluorescence in situ hybridization analysis showed a significant PAO population change from Type I to Type II Accumulibacter as the poly-P availability decreased in short term experiments. This work suggests that poly-P storage levels and GAO-like metabolism are important factors affecting the competition between different PAO Types in enhanced biological phosphorus removal systems.

Assessing the diurnal variability of pharmaceutical and personal care products in a full-scale activated sludge plant

An intensive sampling campaign has been carried out in a municipal wastewater treatment plant (WWTP) to assess the dynamics of the influent pharmaceutical active compounds (PhAC) and musks. The mass loadings of these compounds in wastewater influents displayed contrasting diurnal variations depending on the compound. The musks and some groups of PhACs tended to follow a similar diurnal trend as compared to macropollutants, while the majority of PhACs followed either the opposite trend or no repeatable trend. The total musk loading to the WWTP was 0.74 ± 0.25 g d(-1), whereas the total PhAC mass loading was 84.7 ± 63.8 g d(-1). Unlike the PhACs, the musks displayed a high repeatability from one sampling day to the next. The range of PhAC loadings in the influent to WWTPs can vary several orders of magnitude from one day or week to the next, representing a challenge in obtaining data for steady-state modelling purposes.

Real-time monitoring of membrane bioreactors with 2D-fluorescence data and statistically based models

The application of membrane bioreactors (MBR) for wastewater treatment is growing worldwide due to their compactness and high effluent quality. However, membrane fouling, mostly associated to biological products, can reduce MBR performance. Therefore, it is important to monitor MBRs as close to real-time as possible to accelerate control actions for maximal biological and membrane performance. 2D-fluorescence spectroscopy is a promising on-line tool to simultaneously monitor wastewater treatment efficiency and the formation of potential biological fouling agents. In this study, 2D-fluorescence data obtained from the wastewater and the permeate of a MBR was successfully modelled using projection to latent structures (PLS) to monitor variations in the influent and effluent total chemical oxygen demand (COD). Analysis of the results also indicated that humic acids and proteins highly contributed to the measured COD in both streams. Nevertheless, this approach was not valid for other performance parameters of the MBR system (such as influent and effluent ammonia and phosphorus), which is usually characterised through a high number of analytical and operating parameters. Principal component analysis (PCA) was thus used to find possible correlations between these parameters, in an attempt to reduce the analytical effort required for full MBR characterisation and to reduce the time frame necessary to obtain monitoring results. The 3 first principal components, capturing 57% of the variance, indicated and confirmed expected relationships between the assessed parameters. However, this approach alone could not provide robust enough correlations to enable the elimination of parameters for process description (PCA loadings ≤ 0.5). Nevertheless, it is possible that the information captured by 2D-fluorescence spectroscopy could replace some of the analytical and operating parameters, since this technique was able to successfully describe influent and effluent total COD. It is thus proposed that combined modelling of 2D-fluorescence data and selected performance/operating parameters should be further explored for efficient MBR monitoring aiming at rapid process control.

Biological treatment of propanil and 3,4-dichloroaniline: kinetic and microbiological characterisation

Propanil (3,4-dichloropropionanilide) is a widely used herbicide, applied worldwide in rice paddies. Propanil is primarily transformed in nature to 3,4-dichloroaniline (DCA), which is more slowly biodegradable. Both compounds have adverse health and ecotoxicity effects. This work investigated the microbial ecology and kinetics of propanil-degrading enrichments obtained from soil in a sequencing batch reactor (SBR) operated with different feeding strategies, aiming at the enhanced biological removal of propanil and DCA from contaminated waters. During SBR operation with a dump feeding strategy, a high propanil concentration led to DCA accumulation, which was only fully degraded after 5 days, likely due to DCA inhibition. For this reason, the operational mode was changed to fed-batch operation with lower initial propanil concentrations, which resulted in faster propanil and DCA biodegradation. Thus a fed-batch operation seems more appropriate for the acclimatisation of an effective propanil- and DCA-degrading population. The changes in performance were accompanied by a shift in the microbial population structure, as determined by DGGE of the 16S rRNA gene, particularly after a feed of DCA as the sole carbon source. Isolates obtained from the acclimatised population included members of the genera Enterococcus and Rhodococcus, as well as Brevundimonas, which displayed >90% propanil biodegradation efficiency.

Assessment of the presence and dynamics of fungi in drinking water sources using cultural and molecular methods

A comparison of different isolation techniques and culture media for detection of filamentous fungi and yeasts in the aquatic environment revealed that the use of membrane filtration with the media dichloran rose bengal chloramphenicol (DRBC) optimized fungi detection in terms of abundance and variety in three untreated water sources with very different characteristics (surface water, spring water, and groundwater). The diversity of the fungi population captured by direct DNA extraction of fungi collected by membrane filtration was compared with the isolates obtained after selective growth using different culture media through amplification of the internal transcribed spacer gene and denaturing gradient gel electrophoresis (DGGE). The Czapek-Dox agar, Sabouraud dextrose agar, and DRBC media showed closer similarities to those obtained by the uncultured biomass for the different water sources. Based on these data and the best enumeration results, DRBC is recommended for the assessment of fungi in water sources using culture-based methods. DGGE was also used to monitor temporal variations in the fungal population structure and showed that each water matrix possessed a distinct population profile as well as that changes in the fungal community can be expected in the different matrices throughout the year.

Incorporating microbial ecology into the metabolic modelling of polyphosphate accumulating organisms and glycogen accumulating organisms

In the enhanced biological phosphorus removal (EBPR) process, the competition between polyphosphate accumulating organisms (PAO) and glycogen accumulating organisms (GAO) has been studied intensively in recent years by both microbiologists and engineers, due to its important effects on phosphorus removal performance and efficiency. This study addresses the impact of microbial ecology on assessing the PAO-GAO competition through metabolic modelling, focussing on reviewing recent developments, discussion of how the results from molecular studies can impact the way we model the process, and offering perspectives for future research opportunities based on unanswered questions concerning PAO and GAO metabolism. Indeed, numerous findings that are seemingly contradictory could in fact be explained by the metabolic behaviour of different sub-groups of PAOs and/or GAOs exposed to different environmental and operational conditions. Some examples include the glycolysis pathway (i.e. Embden-Meyerhof-Parnas (EMP) vs. Entner-Doudoroff (ED)), denitrification capacity, anaerobic tricarboxylic acid (TCA) cycle activity and PAOs' ability to adjust their metabolism to e.g. a GAO-like metabolism. Metabolic modelling may further yield far-reaching influences on practical applications as well, and serves as a bridge between molecular/biochemical research studies and the optimisation of wastewater treatment plant operation.

Modelling the population dynamics and metabolic diversity of organisms relevant in anaerobic/anoxic/aerobic enhanced biological phosphorus removal processes

In this study, enhanced biological phosphorus removal (EBPR) metabolic models are expanded in order to incorporate the competition between polyphosphate accumulating organisms (PAOs) and glycogen accumulating organisms (GAOs) under sequential anaerobic/anoxic/aerobic conditions, which are representative of most full-scale EBPR plants. Since PAOs and GAOs display different denitrification tendencies, which is dependent on the phylogenetic identity of the organism, the model was separated into six distinct biomass groups, constituting Accumulibacter Types I and II, as well as denitrifying and non-denitrifying Competibacter and Defluviicoccus GAOs. Denitrification was modelled as a multi-step process, with nitrate (NO(3)), nitrite (NO(2)), nitrous oxide (N(2)O) and di-nitrogen gas (N(2)) being the primary components. The model was calibrated and validated using literature data from enriched cultures of PAOs and GAOs, obtaining a good description of the observed biochemical transformations. A strong correlation was observed between Accumulibacter Types I and II, and nitrate-reducing and non-nitrate-reducing PAOs, respectively, where the abundance of each PAO subgroup was well predicted by the model during an acclimatization period from anaerobic-aerobic to anaerobic-anoxic conditions. Interestingly, a strong interdependency was observed between the anaerobic, anoxic and aerobic kinetic parameters of PAOs and GAOs. This could be exploited when metabolic models are calibrated, since all of these parameters should be changed by an identical factor from their default value. Factors that influence these kinetic parameters include the fraction of active biomass, relative aerobic/anoxic fraction and the ratio of acetyl-CoA to propionyl-CoA. Employing a metabolic approach was found to be advantageous in describing the performance and population dynamics in such complex microbial ecosystems.

Analysis of 65 pharmaceuticals and personal care products in 5 wastewater treatment plants in Portugal using a simplified analytical methodology

Pharmaceuticals and personal care products (PPCPs) are becoming increasingly recognised as important micropollutants to be monitored in wastewater treatment plants (WWTPs), since WWTP effluents represent an important point source to natural aquatic systems. In this study, the abundance of 65 PPCPs was analysed in 5 Portuguese WWTPs during the spring and autumn. Due to the fact that analytical approaches normally used to quantify the abundance of these compounds are labour intensive and require various specific procedures, this study proposes a set of simplified analytical methods for the quantification of pharmaceutically active compounds (PhACs) and polycyclic musks in liquid and sludge samples. The analytical methods were validated using influent wastewater matrices, showing comparable limits of detection and quantification as literature values for most PPCPs, with the exception of the estrogenic compounds. The PhAC concentrations detected in the WWTP survey were in the range of 0.050-100 µg L(-1) in the influent and up to 50 µg L(-1) in the effluent, where the non-steroidal anti-inflammatory drugs (NSAIDs) were the most abundant and frequently detected group. Some musks were detected up to 11.5 µg L(-1) in the influent and 0.9 µg L(-1) in the effluent, and adsorbed in the sludge up to 22.6 µg g(-1).

Effects of egg size, parental origin and feeding conditions on growth of larval and juvenile cod Gadus morhua

An experimental study was performed to disentangle parental and environmental effects on the growth of Atlantic cod Gadus morhua larvae and juveniles. Eggs were collected during the spawning season from spawning pairs (families) kept separately in specially designed spawning compartments. Newly hatched larvae were released simultaneously into two mesocosms of 2,500 and 4,400 m(3). Larval growth was monitored by sampling over a 10 week period, after which juveniles were transferred to on-growing tanks, where they were tagged and kept for up to 2 years. Maternal origin was determined by individual microsatellite genotyping of the larvae (n = 3949, 24 families) and juveniles (n = 600). The results showed significant positive correlations between egg size and larval size during the whole mesocosm period. Correlations, however, weakened with time and were no longer significant at the first tank-rearing sampling at an age of 9 months. Significant family-specific differences in growth were observed. The coefficient of variation (c.v.) was calculated in order to examine variation in standard length of larvae during the mesocosm period. Inter-family c.v. was on average 69% of intra-family c.v. Differences in zooplankton densities between the two mesocosms were reflected in larval growth, condition factor and c.v. Low food abundance appeared to reduce c.v. and favour growth of larvae that showed relatively slow growth at high food abundance. It is suggested that genetically determined variation in growth potential is maintained by environmental variability.

The effect of carbon source on the biological reduction of ionic mercury

Mercury (Hg) is the most highly toxic heavy metal, and must be removed from waterways to very low levels. Biologically mediated mercury removal is an emerging technology that has the potential to be robust, efficient and cost-effective. In this study, the impact of carbon source on the behaviour and microbial community composition of mixed microbial cultures was evaluated, and their performance was compared with a pure culture of Pseudomonas putida spi3. Glucose and acetate, two carbon sources that are commonly present in wastewaters, were chosen for this study. Distinct microbial populations were enriched with each carbon source. Glucose led to a more suitable microbial culture for Hg(2+) bioreduction that was able to reduce Hg(2+) at faster rates when compared to acetate. Furthermore, acetate consistently led to poorer process performance, irrespective of the microbial culture, possibly due to the formation of mercuric acetate complexes. It is proposed that glucose can be a more beneficial carbon source than acetate for the successful operation of Hg bioremediation systems.

Transferrin (Tf) polymorphism in wild rabbit, Oryctolagus cuniculus

Evidence for two new alleles (TfC and TfD) at the transferrin locus (Tf) in wild rabbit, Oryctolagus cuniculus, is presented. Blood samples were collected in Continental Portugal (178 individuals), and in the Azores Islands of Terceira (52) and S. Miguel (59). The frequency of TfA, which is the only allele detected up to now in domestic rabbits, varied from 0.20 +/- 0.13 to 0.95 +/- 0.05 in the populations sampled in Continental Portugal. In the island populations sampled the frequency of TfA was greater than 0.8.

Role of Brazilian native medicinal plants on VEGF and PDGF receptors expression by glioblastoma cell line GL-15

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Background: Malignant gliomas are typically angiogenic and express greater amounts of angiogenic factors. Vascular endothelial growth factor (VEGF) and platelet derived growth factor (PDGF) are prominent glioblastoma-associated multifunctional cytokines that stimulate migration, invasion and angiogenesis. Their receptor inhibiton is considered an important target for anitumoral therapy. Flavonoids obtained from Dimorphandra mollis and Croton betulaster, native medicinal plants from Bahia-Brazil, have been described as proliferation inhibitors of a human glioblastoma derived cell line and reduce VEGF production by GL-15. In this study, VEGF and PDGF receptors expression by GL-15 cultures treated with bevacizumab and flavonoids were evaluated. Methods: GL-15 cultures were treated or not with pendulitin and rutin flavonoids (100μM) and bevacizumab (1μg/mL). After 24 hours VEGF and PDGF receptors were analyzed by flow cytometry using monoclonal antibodies labeled with FITC. Results: Flow cytometry showed that the GL-15 cells expressed PDGFR alfa (10%), PDGFR beta (52%), VEGFR 1 (26%) and VEGFR 2 (95%). It was observed that the pendulitin and rutin flavonoids treated cells showed a reduction on PDGFR alfa expression (2 and 1,6 % respectively) but the other receptors expression was similar to the non-treated or DMSO treated controls. Conclusions: GL-15 human glioblastoma derived cell line expresses receptors to the angiogenic cytokines studied. VEGFR 2 expression was predominant and bevacizumab didn’t alter the receptors production. Flavonoids extracted from D. mollis and C. betulaster seem to have an inhibitory action on the PDGRF alfa expression but not on the others receptors.

No significant financial relationships to disclose.

Eco-physiological characterization of fluorescence in situ hybridization probe-targeted denitrifiers in activated sludge using culture-independent methods

AIMS

This study proposes the application of a culture-independent method [fluorescence in situ hybridization (FISH)] and a bioreactor operation control strategy to characterize environmental micro-organisms according to their survival strategies in a mixed suspension culture. Eco-physiological characteristics of two 16S rRNA probe-targeted denitrifiers (DEN581 and DEN124) were investigated against the availability of two resources.

METHODS AND RESULTS

Four sequencing batch reactors were operated with manipulation of the sludge retention times to enforce limited and excess availability of two nutrients, namely acetate and nitrite, to the biomass. DEN581 FISH probe-targeted denitrifiers demonstrated dominance when the ratio of either acetate or nitrite to biomass was in excess, while DEN124-targeted organisms dominated when the above were limited.

CONCLUSIONS

The study demonstrated that microbial populations in mixed cultures can be selected by changing the substrate availability (Rs) to biomass (X) ratio. The manipulation of the specific resource availability (Rs/X) determined which one of the studied probe-targeted denitrifiers (DEN124 or DEN581) became dominant. Rs/X provides a basis to study the physiology of micro-organisms that cannot be isolated in pure culture from activated sludge.

SIGNIFICANCE AND IMPACT OF THE STUDY

The eco-physiological characterization of micro-organisms responsible for biological nutrient removal is anticipated to assist process designers and operators to optimize a specific biological process, such as denitrification.

NF-kappaB inhibition sensitizes to starvation-induced cell death in high-risk myelodysplastic syndrome and acute myeloid leukemia

CD34(+) bone marrow blasts from high-risk myelodysplastic syndrome (MDS) patients as well as MDS patient-derived cell lines (P39 and MOLM13) constitutively activate the nuclear factor-kappaB (NF-kappaB) pathway and undergo apoptosis when NF-kappaB is inhibited. Here, we show that the combination of conventional chemotherapeutic agents (daunorubicin, mitoxantrone, 5-azacytidine or camptothecin) with the NF-kappaB inhibitor BAY11-7082 did not yield a synergistic cytotoxicity. In contrast, BAY11-7082 (which targets the NF-kappaB-activating I-kappaB kinase (IKK) complex) or knockdown of essential components of the NF-kappaB system (such as the IKK1 and IKK2 subunits of the IKK complex and the p65 subunit of NF-kappaB), by small interfering RNAs sensitized MDS cell lines to starvation-induced apoptosis. The combination of BAY11-7082 and nutrient depletion synergistically killed the acute myeloid leukemia (AML) cell line U937 as well as primary CD34(+) bone marrow blasts from AML and high-risk MDS patients. The synergistic killing by BAY11-7082, combined with nutrient depletion, led to cell death accompanied by all hallmarks of apoptosis, including an early loss of the mitochondrial transmembrane potential, the release of cytochrome c and apoptosis-inducing factor (AIF) from mitochondria, activation of caspase-3, phosphatidylserine exposure on the plasma membrane surface and nuclear chromatin condensation. Transmission electron microscopy revealed the presence of numerous autophagic vacuoles in the cytoplasm before cells underwent nuclear apoptosis. Nonetheless, cell death was neither inhibited by the pan-caspase inhibitor z-VAD-fmk nor by knockdown of AIF or of essential components of the autophagy pathway (ATG5, ATG6/Beclin-1, ATG10, ATG12). In contrast, external supply of glucose, insulin or insulin-like growth factor-I could retard the cell death induced by BAY11-7082 combined with starvation. These results suggest that in MDS cells, NF-kappaB inhibition can precipitate a bioenergetic crisis that leads to an autophagic stress response followed by apoptotic cell death.

Inhibition of NEMO, the regulatory subunit of the IKK complex, induces apoptosis in high-risk myelodysplastic syndrome and acute myeloid leukemia

In high-risk myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML), blasts constitutively activate the antiapoptotic transcription factor nuclear factor-kappaB (NF-kappaB). Here, we show that this NF-kappaB activation relies on the constitutive activation of the IkappaB kinase (IKK) complex, which is formed by the IKKalpha, IKKbeta and IKKgamma/NF-kappaB essential modulator (NEMO) subunits. A cell-permeable peptide that mimics the leucine zipper subdomain of IKKgamma, thus preventing its oligomerization, inhibited the constitutive NF-kappaB activation and induced apoptotic cell death in a panel of human MDS and AML cell lines (P39, MOLM13, THP1 and MV4-11). Small interfering RNA-mediated knockdown of the p65 NF-kappaB subunit or the three IKK subunits including IKKgamma/NEMO also induced apoptotic cell death in P39 cells. Cell death induced by the IKKgamma/NEMO-antagonistic peptide involved the caspase-independent loss of the mitochondrial transmembrane potential as well as signs of outer mitochondrial membrane permeabilization with the consequent release of cytochrome c, apoptosis-inducing factor and endonuclease G. Primary bone marrow CD34(+) cells from high-risk MDS and AML patients also succumbed to the IKKgamma/NEMO-antagonistic peptide, but not to a mutated control peptide. Altogether, these data indicate that malignant cells in high-risk MDS and AML cells critically depend on IKKgamma/NEMO to survive. Moreover, our data delineate a novel procedure for their therapeutic removal, through inhibition of IKKgamma/NEMO oligomerization.

Targeting NF-κB in hematologic malignancies

The transcription factor nuclear factor kappa B (NF-kappaB) can intervene in oncogenesis by virtue of its capacity to regulate the expression of a plethora of genes that modulate apoptosis, and cell survival as well as proliferation, inflammation, tumor metastasis and angiogenesis. Different reports demonstrate the intrinsic activation of NF-kappaB in lymphoid and myeloid malignancies, including preneoplastic conditions such as myelodysplastic syndromes, underscoring its implication in malignant transformation. Targeting intrinsic NF-kappaB activation, as well as its upstream and downstream regulators, may hence constitute an additional approach to the oncologist's armamentarium. Several small inhibitors of the NF-kappaB-activatory kinase IkappaB kinase, of the proteasome, or of the DNA binding of NF-kappaB subunits are under intensive investigation. Currently used cytotoxic agents can induce NF-kappaB activation as an unwarranted side effect, which confers apoptosis suppression and hence resistance to these drugs. Thus, NF-kappaB inhibitory molecules may be clinically useful, either as single therapeutic agents or in combination with classical chemotherapeutic agents, for the treatment of hematological malignancies.