COVID-19-associated serum and cerebrospinal fluid cytokines in post- versus para-infectious SARS-CoV-2-related Guillain-Barré syndrome

INTRODUCTION

Guillain-Barré syndrome associated with Coronavirus-2-related severe acute respiratory syndrome (COV-GBS) occurs as para- or post-infectious forms, depending on the timing of disease onset. In these two forms, we aimed to compare the cerebrospinal fluid (CSF) and serum proinflammatory cytokine profiles to evaluate differences that could possibly have co-pathogenic relevance.

MATERIALS AND METHODS

We studied a retrospective cohort of 26 patients with either post-COV-GBS (n = 15), with disease onset occurring > 7 days after SARS-CoV-2 infection, or para-COV-GBS (n = 11), with disease onset 7 days or less. TNF-α, IL-6, and IL-8 were measured in the serum with SimplePlex™ Ella™ immunoassay. In addition to the para-/post-COV-GBS patients, serum levels of these cytokines were determined in those with non-COVID-associated-GBS (NC-GBS; n = 43), paucisymptomatic SARS-CoV-2 infection without GBS (COVID, n = 20), and in healthy volunteers (HV; n = 12). CSF cytokine levels were measured in patients with para-/post-COV-GBS, in those with NC-GBS (n = 29), or with Alzheimer's disease (AD; n = 24).

RESULTS

Serum/CSF cytokine levels did not differ in para- vs post-COV-GBS. We found that SARS-CoV-2 infection raises the serum levels of TNF-α, IL-6, and IL-8, as well as an increase of IL-6 (in serum and CSF) and IL-8 (in CSF) in either NC-GBS or COV-GBS than controls. CSF and serum cytokine levels resulted independent one with another.

CONCLUSIONS

The change of cytokines linked to SARS-CoV-2 in COV-GBS appears to be driven by viral infection, although it has unique characteristics in GBS as such and does not account for cases with para- or post-infectious onset.

Patient With Rigidity and Fasciculations: Steroid-Responsive Presentation of Anti-IgLON5 Disease

An 82-year-old man presented with 2-year lasting widespread muscular fasciculations, cramps, and limb stiffness, with spontaneous movements in the right lower limb, unsteady gait (Video 1), and falls. Neurophysiologic studies disclosed signs of neuromuscular hyperexcitability. CSF analysis showed high tau protein concentration (543 pg/mL; reference values, <404) and unique-to-CSF oligoclonal bands. Serum and CSF anti-IgLON5 antibodies were positive (Figure 1). He carried the anti-IgLON5 disease-associated HLA-DRB1*10:01 allele.1 Brain MRI, thoracoabdominal CT, whole-body FDG-PET, and video-polysomnography were unremarkable. No sleep disturbances, bulbar symptoms, parkinsonism, or dementia were detected. Intravenous methylprednisolone (500 mg/d for 5 days), followed by oral benzodiazepines, prompted rapid functional recovery, with limb stiffness and gait improvement (Video 1), which persisted at 6-month follow-up. Anti-IgLON5 disease has progressive course and protean clinical presentations,2 representative, in our patient, for overlapping signs and symptoms of neuromuscular hyperexcitability and rigidity. Identification of rare phenotypes is important because prompt recognition and treatment can improve prognosis.

Case Report: Post-COVID-19 Vaccine Recurrence of Guillain–Barré Syndrome Following an Antecedent Parainfectious COVID-19–Related GBS

Guillain–Barré syndrome (GBS) is an autoimmune neurological disorder often preceded by viral illnesses or, more rarely, vaccinations. We report on a unique combination of postcoronavirus disease 2019 (COVID-19) vaccine GBS that occurred months after a parainfectious COVID-19–related GBS. Shortly after manifesting COVID-19 symptoms, a 57-year-old man developed diplopia, right-side facial weakness, and gait instability that, together with electrophysiology and cerebrospinal fluid examinations, led to a diagnosis of post-COVID-19 GBS. The involvement of cranial nerves and IgM seropositivity for ganglioside GD1b were noteworthy. COVID-19 pneumonia, flaccid tetraparesis, and autonomic dysfunction prompted his admission to ICU. He recovered after therapy with intravenous immunoglobulins (IVIg). Six months later, GBS recurred shortly after the first dose of the Pfizer/BioNTech vaccine. Again, the GBS diagnosis was confirmed by cerebrospinal fluid and electrophysiology studies. IgM seropositivity extended to multiple gangliosides, namely for GM3/4, GD1a/b, and GT1b IgM. An IVIg course prompted complete recovery. This case adds to other previously reported observations suggesting a possible causal link between SARS-CoV-2 and GBS. Molecular mimicry and anti-idiotype antibodies might be the underlying mechanisms. Future COVID-19 vaccinations/revaccinations in patients with previous para-/post-COVID-19 GBS deserve a reappraisal, especially if they are seropositive for ganglioside antibodies.

COVID-19 vaccine-related Guillain-Barré syndrome in the Liguria region of Italy: A multicenter case series

Background and purpose

Guillain-Barré-Syndrome (GBS) can follow COVID-19 vaccination, with clinical and paraclinical features still to be precisely assessed. We describe a cohort of patients who developed GBS after vaccination with different types of COVID-19 vaccines.

Methods

Patients with post-COVID-19 vaccination GBS, admitted to the six hospitals that cover the whole Liguria Region, Northwestern Italy, from February 1st to October 30th 2021, were included. Clinical, demographic, and paraclinical data were retrospectively collected.

Results

Among the 13 patients with post-COVID-19 vaccination GBS (9 males; mean age, 64 year), 5 were vaccinated with Oxford-AstraZeneca, 7 with Pfizer-BioNTech, and one with Moderna. Mean time between vaccination and GBS onset was 11.5 days. Ten patients developed GBS after the first vaccination dose, 3 after the second dose. Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) was the predominant GBS variant, mainly characterized by sensory involvement. Bilateral seventh cranial nerve involvement followed AstraZeneca vaccination in two cases. Three patients presented treatment-related fluctuations, and 4 mild symptoms that delayed treatments and negatively affected prognosis. Prognosis was poor (GBS-disability score, ≥3) in 5/13 patients, with a disability rate of 3/13.

Conclusions

Our findings confirm that most post-COVID-19 vaccination GBS belong to the AIDP subtype, and occur after the first vaccine dose. Treatment-related fluctuations, and diagnosis-delaying, mild symptoms at onset are clinical features that affect prognosis and deserve particular consideration.

The effect of substituting energy crop with agricultural waste on the dynamics of bacterial communities in a two-stage anaerobic digester

The replacement of energy crops with agricultural waste in biogas production through anaerobic digestion (AD) is both an environmentally sustainable and economically profitable strategy. However, the change of feeding mix in AD might result in nutrient imbalance or increase of the ammonium concentration, negatively affecting the activity of the microbes responsible for the process. In the present study the structure and dynamics of the bacterial communities of a full-scale two-stage AD plant, composed of a hydrolysis/acidogenesis (H) and an acetogenesis/methanogenesis (M) tanks, was monitored during feedstock substitution. Energy crop (triticale) was replaced by poultry manure litter and olive mill pomace. The increase percentage of poultry manure litter (up to 8.6%) and olive mill pomace (up to 30.5%) in the recipe incremented the total solids (up to 21% in H) and, consequently, the nitrogen content in the digestate (6.7 g N/kg in the solid fraction in H and 4-5 g NH₄⁺-N/L in the liquid fraction). This favored the growth of Lactococcus sp. with consequent increment of lactate production (∼ 1 mg L^-1 last two days of the survey) and the establishment of Weissella and Lactobacillus spp. Syntrophic acetate-oxidizers, including Syntrophaceticus (6% ± 1.7%), were detected manly in M but were negatively affected by the addition of the poultry manure litter, while the sulfate-reducing bacteria correlated with the variations of the volatile fatty acids. Planctomycetes putatively capable of anammox process were also found in the H during the first two days of the survey and accounted for 0.3 ± 0.01% of the total bacterial community. The stability of the process during feedstock change is the result of the shift of bacterial populations of different functional groups that showed peculiar adaptation patterns in the two stages of the plant.

Piggery wastewater treatment with algae-bacteria consortia: Pilot-scale validation and techno-economic evaluation at farm level

The efficiency of an outdoor pilot-scale raceway pond treating the wastewaters generated by a large-scale piggery farm in Northern Italy was evaluated. The biomass productivity over 208 days of experimentation was 10.7 ± 6.5 g TSS·m^-2·d^-1, and ammoniacal nitrogen, orthophosphate, and COD average removal efficiencies were 90%, 90%, and 59%, respectively. Results were used to perform a comprehensive techno-economic analysis for integrating algae-based processes in farms of different sizes (100-10000 pigs). The amount of N disposed of on agricultural land could be reduced from 91% to 21%, increasing the fraction returned to the atmosphere from 2.4% to 63%, and the fraction in the biomass from 6.2% to 16%. For intensive farming, the release of 110 t N·ha^-1·y^-1 contained in the digestate could be avoided by including algae-bacteria processes. The biomass production cost was as low as 1.9 €·kg^-1, while the cost for nitrogen removal was 4.3 €·kg N^-1.

Digestate treatment with algae-bacteria consortia: A field pilot-scale experimentation in a sub-optimal climate area

This paper addresses the efficiency of a microalgae-based agricultural digestate treatment at pilot-scale in an outdoor raceway pond (880 L, pH-dependent CO₂ dosage) and in a bubble column (74.5 L, air-bubbling). Specifically, nitrogen removal, evolution of the algae-bacteria consortium, and the actual process applicability in the Po Valley climate are discussed. The performance of the two reactors varied seasonally. The average algal productivity in the raceway was 32.4 ± 33.1 mg TSS·L^-1·d^-1 (8.2 ± 8.5 g TSS·m^-2·d^-1) while in the PBR it was 25.6 ± 26.8 mg TSS·L^-1·d^-1; the average nitrogen removal was 20 ± 29% (maximum 78%) and 22 ± 29% (maximum 71%) in the raceway and in the column, respectively. Nevertheless, nitrification had a key role as 61 ± 24% and 52 ± 32% of the nitrogen load was oxidized in the raceway and in the column, respectively.

Activity assessment of microalgal-bacterial consortia based on respirometric tests

Respirometric techniques are useful tools to evaluate bacterial activities in activated sludge processes due to their fast execution and the possibility to obtain several kinetic parameters from a single test. Using such techniques in microalgae-bacteria consortia treating wastewater could allow a better understanding of mutual interactions between the microbial populations as a function of environmental parameters. This work aims at developing and testing a novel experimental respirometric protocol to determine oxygen uptake rates and oxygen production rates by a microalgae-bacteria consortium. The defined protocol is characterized by alternating light/dark regimes and by dosing substrates/inhibitors to selectively activate/inactivate microalgal and bacterial metabolisms. The protocol was then applied on microalgal and bacterial consortia, which were grown on the liquid fraction of black water from biogas plants fed on agricultural and municipal waste sludge. Results elucidate the presence and activity of microalgae and nitrifying bacteria in the tested systems, suggesting that the respirometric tests could be included into monitoring procedures of photobioreactors/algal ponds.

iProcto: new digital technology in Proctology. A randomized study

BACKGROUND AND AIM

Advancements in technology have proved useful for many businesses including medical practices. Consequently, these improvements have increased the need to develop new applications for mobile devices. Our group conceived and developed an application for tablets, PCs, and smartphones with the aim to assist the physician in the management of the pelvic floor diseases: iProcto. The aim of this study was to evaluate the receptivity of patients resulting from using the said pelvic floor application (iProcto) during a colon-proctologic visit; and to establish whether it can be more efficient in helping with diagnosis compared to a traditional visit.

METHODS

We enrolled 126 patients with pelvic floor disorders during the period of 2013 and 2014. The average age of the patients ranging from 16 - 43 years of age, 80 of those, being women. Sixty-three patients were randomly assigned to iProcto consultation (group A), the remaining 63 patients to attended a regular consultation that did not include iProcto (group B). Post consultation, all patients were asked to answer a questionnaire anonymously where they were asked questions about their level of satisfaction, and clarity of the doctor's explanation, on a scale from 1 (dissatisfied) to 5 (completely satisfied).

RESULTS

Patients in group A have a score average relative to the degree of satisfaction of 4.2 ± 0.7 vs 3.5 ± 0.7 in the group B (m ± sd; p 0.001). Only 3 patients in group A and 15 in group B did not consider the visit satisfactory (score ≤2). With regard to the clarity of the physician the group A patients presented a means score of 4.4 ± 0.8 vs 3.5 ± 0.4 in the group B (m ± ds; p 0.001). Data shows that 95% showed a gain in satisfaction during the iProcto visit as compared to 78% without iProcto.

CONCLUSIONS

In conclusion the use of iProcto for the pelvic floor diseases can improve the understanding of the disease and increase the degree of patient satisfaction.

Nitrification in hybrid bioreactors treating simulated domestic wastewater

AIM

To provide deeper insights into nitrification process within aerobic bioreactors containing supplemental physical support media (hybrid bioreactors).

METHODS AND RESULTS

Three bench-scale hybrid bioreactors with different media size and one control bioreactor were operated to assess how biofilm integrity influences microbial community conditions and bioreactor performance. The systems were operated initially at a 5-day hydraulic retention time (HRT), and all reactors displayed efficient nitrification and chemical oxygen demand (COD) removal (>95%). However, when HRT was reduced to 2.5 days, COD removal rates remained high, but nitrification efficiencies declined in all reactors after 19 days. To explain reduced performance, nitrifying bacterial communities (ammonia-oxidizing bacteria, AOB; nitrite-oxidizing bacteria, NOB) were examined in the liquid phase and also on the beads using qPCR, FISH and DGGE. Overall, the presence of the beads in a reactor promoted bacterial abundances and diversity, but as bead size was increased, biofilms with active coupled AOB-NOB activity were less apparent, resulting in incomplete nitrification.

CONCLUSIONS

Hybrid bioreactors have potential to sustain effective nitrification at low HRTs, but support media size and configuration type must be optimized to ensure coupled AOB and NOB activity in nitrification.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study shows that AOB and NOB coupling must be accomplished to minimize nitrification failure.

Jellyfish green fluorescent protein as a useful reporter for transient expression and stable transformation in Medicago sativa L

The aim of the experiments reported herein was to transiently test different gene constructs using green fluorescent protein (GFP) as a reporter gene for a future localization of the maize beta-zein in the chloroplast of alfalfa ( Medicago sativa L.). The transient expression of two GFP genes was compared in alfalfa leaves to determine which of these two mutants is the easier to detect. Based on the intensity of fluorescence emitted, the GFP S65C gene was used to assemble a chloroplast-targeted GFP to verify the efficiency of the transit peptide for chloroplast targeting. A chloroplast-targeted fusion protein between beta-zein and GFP was then assembled, and this protein was observed to accumulate in small aggregates into the chloroplasts of transiently transformed cells. To the best of our knowledge, this is the first report of the GFP S65C gene being used to obtain transformed alfalfa plants expressing GFP.

Cytomixis in Pollen Mother Cells of Medicago sativa L

Cytomixis (i.e., chromatin migration between meiocytes) has been detected in many plant species, but not in Medicago sativa spp. In the present study we report the identification of a few cytomictic alfalfa plants. Those plants, the "mother plants," were selfed and crossed with a normal control plant. Microsporogenesis analysis was performed on the mother plants, on the S(1) and F(1) plants, and on controls. The S(1) and F(1) plants, like the mother plants, were found to be cytomictic. Single or multiple chromatin bridges between two or more meiocytes were observed almost exclusively in prophase I. Some completely empty meiocytes were also observed. In addition to cytomixis, other meiotic abnormalities were found. Control plants showed an almost regular meiosis. The highest values of cytomixis were observed in the mother plants, and the lowest in their F(1) progenies. Variability of cytomixis in the F(1) plants is probably due to a heterozygotic condition of the parents for this trait. No significant correlation was found between cytomixis and pollen viability, even if the cytomictic plants showed low values of pollen viability.

Measuring gene flow from two birdsfoot trefoil (Lotus corniculatus) field trials using transgenes as tracer markers

Genetic engineering is becoming a useful tool in the improvement of plants but concern has been expressed about the potential environmental risks of releasing genetically modified (GM) organisms into the environment. Attention has focused on pollen dispersal as a major issue in the risk assessment of transgenic crop plants. In this study, pollen-mediated dispersal of transgenes via cross-fertilization was examined. Plants of Lotus corniculatus L. transformed with either the Escherichia coli asparagine synthetase gene asnA or the beta-glucuronidase gene uidA, were used as the pollen donor. Nontransgenic plants belonging to the species L. corniculatus L., L. tenuis Waldst. and Kit. ex Willd, and L. pedunculatus Cav., were utilized as recipients. Two experimental fields were established in two areas of central Italy. Plants carrying the uidA gene were partially sterile, therefore only the asnA gene was used as a tracer marker. No transgene flow between L. corniculatus transformants and the nontransgenic L. tenuis and L. pedunculatus plants was detected. As regards nontransgenic L. corniculatus plants, in one location flow of asnA transgene was detected up to 18 m from the 1.8 m2 donor plot. In the other location, pollen dispersal occurred up to 120 m from the 14 m2 pollinating plot.

Doing well by doing good. The case for objective feedback in case management

Social service programs that do not generate sufficient revenues will not survive in a Fee-For-Service (FFS) system. Yet a concern about finances is alien to many social workers' client-centered orientation. This article presents findings from a study that evaluated the effect of an objective feedback intervention on social workers' productivity in an FFS HIV/AIDS case management program. Results showed a substantial increase in billable hours (13.4% year-to-year; 6.4% pre- to-post intervention) which enable the program to reverse its operating deficit and raise staff salaries.

Inhibition of Proteolytic Enzymes from Pseudomonas fluorescens ATCC 948 and Angiotensin I-Converting Enzyme by Peptides from Zein, Hordein, and Gluten Hydrolysates

Peptides inhibitory to partially purified endopeptidase and crude proteinase from Pseudomonas fluorescens ATCC 948 were isolated from tryptic hydrolysates of zein and hordein by reversed-phase fast protein liquid chromatography and identified by sequencing. The sequences are Ser-Ala-Tyr-Pro-Gly-Gln-Ile-Thr-Ser-Asn and Gln-Val-Ser-Leu-Asn-Ser-Gly-Tyr-Tyr for peptides from zein and hordein, respectively. Inhibitions of >85% and from >50 to >85% were determined on endopeptidase and proteinase by peptides from zein and hordein. K_i values ranged from 4 to 32 μM. The same peptides also showed inhibition of the angiotensin I-converting enzyme. The concentrations of peptides providing 50% inhibition of angiotensin I-converting enzyme were 7 and 23 μM for the decapeptide and nonapeptide, respectively. Other fractions containing peptides with less inhibitory activity were detected in the zein as well as in the gluten tryptic digests.

Uterine inversion secondary to placenta accreta in a diethylstilbestrol-exposed parturient. A case report

The potential for a poor reproductive outcome is particularly pronounced in women with cervicovaginal changes related to diethylstilbestrol (DES). A women with documented DES exposure and cervicovaginal abnormalities developed an acute postpartum uterine inversion requiring a hysterectomy.

[Hypoplasia of intra- and extrahepatic bile ducts associated with congenital abnormalities]

The present report deals with a patient affected by Alagille's syndrome. The clinical hallmark of this syndrome is chronic cholestasis with ductular and extrahepatic hypoplasia and associated multiple congenital malformations. The diagnosis was made by hepatobiliary scanning with TC99-HIDA, transendoscopic cholangiography and liver biopsy.