Global trends and burden of stroke attributable to particulate matter pollution from 1990 to 2019

OBJECTIVE

To investigate the association between particulate matter and the incidence, disability, and mortality of stroke, we reported the burden of stroke attributable to particulate matter (PM2.5) pollution, including ambient particulate matter pollution (APMP) and household air pollution from solid fuels (HAP), from 1990 to 2019.

METHODS

We retrieved the detailed data on the burden of stroke attributable to PM2.5 from the Global Burden of Disease (GBD) 2019. The number of disability-adjusted life-years (DALYs) and deaths, age-standardized death rates (ASMR), and age-standardized disability-adjusted life-years rates (ASDR) attributable to PM2.5 were estimated by age, sex, geographical location, socio-demographic index (SDI), and stroke subtypes (ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage). The estimated annual percentage change (EAPC) was calculated to assess the trends in ASDR and ASMR during the period 1990-2019.

RESULTS

Regarding stroke subtypes, the proportion of ischemic stroke burden is increasing, while intracerebral hemorrhage carries the heaviest burden. Both APMP and HAP contributed the most to stroke-related deaths and DALYs of stroke among the elderly populations and males. The highest ASDR and ASMR of stroke attributable to APMP were in the middle SDI regions, especially in East Asia. For HAP, the highest ASDR and ASMR were in the low SDI regions, mainly in Oceania. From 1990-2019, in terms of the EAPC results, APMP caused an increased burden of stroke, whereas the impact of HAP significantly fell. The most pronounced increase in ASDR and ASMR for strokes attributed to APMP were in the low-middle SDI and low SDI regions, particularly among the 25-35 age group.

CONCLUSIONS

Stroke attributed to PM2.5 is a global health problem, and the patterns and trends were heterogeneous across APMP and HAP. Targeted interventions should be formulated for APMP and HAP.

Treatment and Management of Acinetobacter Pneumonia: Lessons Learned from Recent World Event

Acinetobacter pneumonia is a significant healthcare-associated infection that poses a considerable challenge to clinicians due to its multidrug-resistant nature. Recent world events, such as the COVID-19 pandemic, have highlighted the need for effective treatment and management strategies for Acinetobacter pneumonia. In this review, we discuss lessons learned from recent world events, particularly the COVID-19 pandemic, in the context of the treatment and management of Acinetobacter pneumonia. We performed an extensive literature review to uncover studies and information pertinent to the topic. The COVID-19 pandemic underscored the importance of infection control measures in healthcare settings, including proper hand hygiene, isolation protocols, and personal protective equipment use, to prevent the spread of multidrug-resistant pathogens like Acinetobacter. Additionally, the pandemic highlighted the crucial role of antimicrobial stewardship programs in optimizing antibiotic use and curbing the emergence of resistance. Advances in diagnostic techniques, such as rapid molecular testing, have also proven valuable in identifying Acinetobacter infections promptly. Furthermore, due to the limited availability of antibiotics for treating infections caused A. baumannii, alternative strategies are needed like the use of antimicrobial peptides, bacteriophages and their enzymes, nanoparticles, photodynamic and chelate therapy. Recent world events, particularly the COVID-19 pandemic, have provided valuable insights into the treatment and management of Acinetobacter pneumonia. These lessons emphasize the significance of infection control, antimicrobial stewardship, and early diagnostics in combating this challenging infection.

Assessment of wood smoke induced pulmonary toxicity in normal- and chronic bronchitis-like bronchial and alveolar lung mucosa models at air-liquid interface

BACKGROUND

Chronic obstructive pulmonary disease (COPD) has the highest increased risk due to household air pollution arising from biomass fuel burning. However, knowledge on COPD patho-mechanisms is mainly limited to tobacco smoke exposure. In this study, a repeated direct wood smoke (WS) exposure was performed using normal- (bro-ALI) and chronic bronchitis-like bronchial (bro-ALI-CB), and alveolar (alv-ALI) lung mucosa models at air-liquid interface (ALI) to assess broad toxicological end points.

METHODS

The bro-ALI and bro-ALI-CB models were developed using human primary bronchial epithelial cells and the alv-ALI model was developed using a representative type-II pneumocyte cell line. The lung models were exposed to WS (10 min/exposure; 5-exposures over 3-days; n = 6-7 independent experiments). Sham exposed samples served as control. WS composition was analyzed following passive sampling. Cytotoxicity, total cellular reactive oxygen species (ROS) and stress responsive NFkB were assessed by flow cytometry. WS exposure induced changes in gene expression were evaluated by RNA-seq (p ≤ 0.01) followed by pathway enrichment analysis. Secreted levels of proinflammatory cytokines were assessed in the basal media. Non-parametric statistical analysis was performed.

RESULTS

147 unique compounds were annotated in WS of which 42 compounds have inhalation toxicity (9 very high). WS exposure resulted in significantly increased ROS in bro-ALI (11.2%) and bro-ALI-CB (25.7%) along with correspondingly increased NFkB levels (bro-ALI: 35.6%; bro-ALI-CB: 18.1%). A total of 1262 (817-up and 445-down), 329 (141-up and 188-down), and 102 (33-up and 69-down) genes were differentially regulated in the WS-exposed bro-ALI, bro-ALI-CB, and alv-ALI models respectively. The enriched pathways included the terms acute phase response, mitochondrial dysfunction, inflammation, oxidative stress, NFkB, ROS, xenobiotic metabolism of AHR, and chronic respiratory disorder. The enrichment of the 'cilium' related genes was predominant in the WS-exposed bro-ALI (180-up and 7-down). The pathways primary ciliary dyskinesia, ciliopathy, and ciliary movement were enriched in both WS-exposed bro-ALI and bro-ALI-CB. Interleukin-6 and tumor necrosis factor-α were reduced (p < 0.05) in WS-exposed bro-ALI and bro-ALI-CB.

CONCLUSION

Findings of this study indicate differential response to WS-exposure in different lung regions and in chronic bronchitis, a condition commonly associated with COPD. Further, the data suggests ciliopathy as a candidate pathway in relation to WS-exposure.

Tumor-targeting hydroxyapatite nanoparticles for remodeling tumor immune microenvironment (TIME) by activating mitoDNA-pyroptosis pathway in cancer

In recent years, immunotherapy has emerged as a promising strategy for treating solid tumors, although its efficacy remains limited to a subset of patients. Transforming non-responsive "cold" tumor types into immuno-responsive "hot" ones is critical to enhance the efficacy of immune-based cancer treatments. Pyroptosis, a programmed cell death mechanism, not only effectively eliminates tumor cells but also triggers a potent inflammatory response to initiate anti-tumor immune activities. This sheds light on the potential of pyroptosis to sensitize tumors to immune therapy. Hence, it is urgent to explore and develop novel treatments (e.g., nanomedicines) which are capable of inducing pyroptosis. In this study, we constructed tumor-targeting nanoparticles (CS-HAP@ATO NPs) by loading atorvastatin (ATO) onto chondroitin sulfate (CS) modified hydroxyapatite (HAP) nanoparticles (CS-HAP). CS was strategically employed to target tumor cells, while HAP exhibited the capacity to release calcium ions (Ca2+) in response to the tumor microenvironment. Moreover, ATO disrupted the mitochondrial function, leading to intracellular energy depletion and consequential changes in mitochondrial membrane permeability, followed by the influx of Ca2+ into the cytoplasm and mitochondria. CS and HAP synergetically augmented mitochondrial calcium overload, inciting the production of substantial amount of reactive oxygen species (ROS) and the subsequent liberation of oxidized mitochondrial DNA (OX-mitoDNA). This intricate activation process promoted the assembly of inflammasomes, most notably the NLRP3 inflammasome, followed by triggering caspase-1 activation. The activated caspase-1 was able to induce gasderminD (GSDMD) protein cleavage and present the GSDM-N domain, which interacted with phospholipids in the cell membrane. Then, the cell membrane permeability was raised, cellular swelling was observed, and abundant cell contents and inflammatory mediators were released. Ultimately, this orchestrated sequence of events served to enhance the anti-tumor immunoresponse within the organism.

Fabrication of highly efficient hydroxyapatite microtubes for uranium sequestration and immobilization

Uranium-containing wastewater is a common by-product of uranium mining. Phosphate and phosphate minerals can interact with uranyl ions [U(VI)], impeding the migration of these ions by forming relatively stable uranium-containing crystalline phase(s). In this study, hydroxyapatite microtubes (HAP-T) were fabricated to sequester uranyl ions from simulated radioactive wastewater. HAP-T had excellent adsorption and stability properties; over 98.76% of U(VI) could be sequestrated by 0.25 g/L HAP-T within 5 min at pH = 4.0. The isotherms and kinetics data could be suitably reflected by the Freundlich and the pseudo second-order kinetic models, respectively. The maximum adsorption capacity of HAP-T was 356.42 mg/g. The adsorption ability of HAP-T for U(VI) was inhibited when Mg2+ or SO42- ions or fulvic acid (FA) substances existed in the simulated radioactive wastewater. The inhibition by FA was attributed to its negative charges, which caused competition between FA and HAP-T for uranium sequestration. The primary mechanisms of U(VI) sequestration by HAP-T were electrostatic interactions and surface complexation. The effectiveness of HAP-T, HAP-B (bio-hydroxyapatite synthesized from fish bone), and HAP-C (commercially available synthesized hydroxyapatite) for uranium immobilization was compared; HAP-T was more effective than HAP-B or HAP-C in immobilizing uranium. HAP-T, which has a micron-sized tubular structure, is likely less mobile in groundwater than are HAP-B and HAP-C, which have nanoscale granular structures. In conclusion, HAP-T can be used to sequester and immobilize uranyl ions.

Role of Legionella pneumophila outer membrane vesicles in host-pathogen interaction

Legionella pneumophila is an opportunistic intracellular pathogen that inhabits artificial water systems and can be transmitted to human hosts by contaminated aerosols. Upon inhalation, it colonizes and grows inside the alveolar macrophages and causes Legionnaires' disease. To effectively control and manage Legionnaires' disease, a deep understanding of the host-pathogen interaction is crucial. Bacterial extracellular vesicles, particularly outer membrane vesicles (OMVs) have emerged as mediators of intercellular communication between bacteria and host cells. These OMVs carry a diverse cargo, including proteins, toxins, virulence factors, and nucleic acids. OMVs play a pivotal role in disease pathogenesis by helping bacteria in colonization, delivering virulence factors into host cells, and modulating host immune responses. This review highlights the role of OMVs in the context of host-pathogen interaction shedding light on the pathogenesis of L. pneumophila. Understanding the functions of OMVs and their cargo provides valuable insights into potential therapeutic targets and interventions for combating Legionnaires' disease.

Hydroxyapatite (HAP) Inorganic Carriers

The search for effective systems to facilitate the release of poorly bioavailable drugs is a forefront topic for the pharmaceutical market. Materials constituted by inorganic matrices and drugs represent one of the latest research strategies in the development of new drug alternatives. Our aim was to obtain hybrid nanocomposites of Tenoxicam, an insoluble nonsteroidal anti-inflammatory drug, with both layered double hydroxides (LDHs) and hydroxyapatite (HAP). The physicochemical characterization on the base of X-ray powder diffraction, SEM/EDS, DSC and FT-IR measurements was useful to verify the possible hybrids formation. In both cases, the hybrids formed, but it seemed that the drug intercalation in LDH was low and, in fact, the hybrid was not effective in improving the pharmacokinetic properties of the drug alone. On the contrary, the HAP-Tenoxicam hybrid, compared to the drug alone and to a simple physical mixture, showed an excellent improvement in wettability and solubility and a very significant increase in the release rate in all the tested biorelevant fluids. It delivers the entire daily dose of 20 mg in about 10 min.

Natural Variation in Diauxic Shift between Patagonian Saccharomyces eubayanus Strains

The study of natural variation can untap novel alleles with immense value for biotechnological applications. Saccharomyces eubayanus Patagonian isolates exhibit differences in the diauxic shift between glucose and maltose, representing a suitable model to study their natural genetic variation for novel strains for brewing. However, little is known about the genetic variants and chromatin regulators responsible for these differences. Here, we show how genome-wide chromatin accessibility and gene expression differences underlie distinct diauxic shift profiles in S. eubayanus. We identified two strains with a rapid diauxic shift between glucose and maltose (CL467.1 and CBS12357) and one strain with a remarkably low fermentation efficiency and longer lag phase during diauxic shift (QC18). This is associated in the QC18 strain with lower transcriptional activity and chromatin accessibility of specific genes of maltose metabolism and higher expression levels of glucose transporters. These differences are governed by the HAP complex, which differentially regulates gene expression depending on the genetic background. We found in the QC18 strain a contrasting phenotype to those phenotypes described in S. cerevisiae, where hap4Δ, hap5Δ, and cin5Δ knockouts significantly improved the QC18 growth rate in the glucose-maltose shift. The most profound effects were found between CIN5 allelic variants, suggesting that Cin5p could strongly activate a repressor of the diauxic shift in the QC18 strain but not necessarily in the other strains. The differences between strains could originate from the tree host from which the strains were obtained, which might determine the sugar source preference and the brewing potential of the strain. IMPORTANCE The diauxic shift has been studied in budding yeast under laboratory conditions; however, few studies have addressed the diauxic shift between carbon sources under fermentative conditions. Here, we study the transcriptional and chromatin structure differences that explain the natural variation in fermentative capacity and efficiency during diauxic shift of natural isolates of S. eubayanus. Our results show how natural genetic variants in transcription factors impact sugar consumption preferences between strains. These variants have different effects depending on the genetic background, with a contrasting phenotype to those phenotypes previously described in S. cerevisiae. Our study shows how relatively simple genetic/molecular modifications/editing in the lab can facilitate the study of natural variations of microorganisms for the brewing industry.

Graphene oxide reinforced SrHAP composite as a drug carrier in bone regeneration

Strontium substituted HAP (SrHAP), with a 10 mol% substitution, was mineralized on increasing weight percentages of graphene oxide (2, 4 and 6). The GS composites were comprehensively characterized for drug delivery in bone reconstruction. The formation of SrHAP was verified by XRD and FT-IR results. The apatite crystallization was influenced by graphene oxide content and strontium. The EDS results confirmed the presence of strontium and HR-SEM depicted rod shape apatite, of length between 58 and 135 nm, uniformly embedded on graphene oxide. The reinforcement of graphene oxide increased the surface area, porosity, microhardness (upto 0.59 GPa), protein adsorption (upto 18.16 μg/mg), water uptake and degradation properties. Also, the increase in graphene oxide fraction significantly enhanced the curcumin encapsulation efficiency (upto 80.16%) and the drug release was considerably retarded over SrHAP. The in vitro studies using human osteoblast-like MG-63 cells demonstrated that curcumin-loaded composite was biocompatible and promoted proliferation, differentiation and matrix mineralization. The results highlight the combinational therapy of osteogenic ion (strontium) and osteogenic drug (curcumin) as a promising platform in bone tissue engineering.

Evaluation of quaternization effect on chitosan-HAP composite for bone tissue engineering application

This study attempts to improve the aqueous solubility of chitosan and utilizes it in the fabrication of composites with hydroxyapatite (HAP). The composites were evaluated as a curcumin delivery vehicle for bone regeneration. The chitosan was modified by quaternization, with a quaternization degree of 5 % for low quaternized chitosan (LQC) and 11 % for high quaternized chitosan (HQC). The modified chitosan, at alkaline pH 11, facilitated in situ HAP growth and formed LQC-HAP and HQC-HAP composites. The quaternization weakens intermolecular hydrogen bonds, facilitates interaction with the apatite precursor ions and promotes the growth of HAP. The modification significantly improved drug encapsulation (2.6 fold) but at the cost of a slight decrease in mechanical strength and increase in drug release. The in vitro studies with human osteoblast-like MG-63 cells established that the curcumin-loaded composites, LQC-HAP-C and HQC-HAP-C are biocompatible, encourage proliferation and promote a 2-fold increase in calcium mineralization over drug-free composites. The study exemplifies the reciprocity between quaternization degree and drug load/release properties and also illustrates that the magnitude of the latter reflects bioactivity. Thus, the quaternized chitosan-based HAP composite with tailorable bio-physicochemical properties becomes an interesting drug delivery system in bone regeneration.

Space-Air-Ground Integrated 6G Wireless Communication Networks: A Review of Antenna Technologies and Application Scenarios

A review of technological solutions and advances in the framework of a Vertical Heterogeneous Network (VHetNet) integrating satellite, airborne and terrestrial networks is presented. The disruptive features and challenges offered by a fruitful cooperation among these segments within a ubiquitous and seamless wireless connectivity are described. The available technologies and the key research directions for achieving global wireless coverage by considering all these layers are thoroughly discussed. Emphasis is placed on the available antenna systems in satellite, airborne and ground layers by highlighting strengths and weakness and by providing some interesting trends in research. A summary of the most suitable applicative scenarios for future 6G wireless communications are finally illustrated.

Nitrogen removal by a Hydroxyapatite-enhanced Micro-granule type One-stage partial Nitritation/anammox process following anaerobic membrane bioreactor treating municipal wastewater

Nitrogen removal from wastewater by the partial nitritation/anammox (PNA) technology is promising from both economic and environmental perspectives. However, this technology has not been popularized in the mainstream because of low biomass retention and the growth of the nitrite oxidizing bacteria. In this study, a one-stage PNA process with hydroxyapatite (HAP)-enhanced granules was used to treat effluent from a mainstream anaerobic membrane bioreactor. The HAP-enhanced reactor allowed an enriched high biomass of 6.9 ± 0.2 g/L at a low hydraulic retention time of 2 h. A nitrogen removal efficiency of 80 ± 6.0 %, a nitrogen removal rate of 0.36 ± 0.05 kg/m³/d and a COD removal efficiency of 54 ± 15 % were achieved stably, leading to a low total nitrogen concentration of 8.5 ± 2.7 mg/L and a low COD concentration of 19.7 ± 5.9 mg/L in the effluent. Anammox bacteria of Candidatus Kuenenia stuttgartiensis and ammonium oxidizing bacteria of Nitrosomonas were found to be the two most predominant bacteria.

In vitro anti-inflammatory activity of silymarin/hydroxyapatite/chitosan nanocomposites and its cytotoxic effect using brine shrimp lethality assay

Silymarin, a bioactive compound, is one of the most prominent drugs used in liver diseases. Chitosan and hydroxyapatite (HAP) are the major materials used employed in many biomedical processes like drug delivery, osteointegration, etc. The nanoparticles and nanocomposites are advanced materials with many biomedical applications in diagnosis and therapeutics. In this study, HAP and chitosan were used as a polymeric material, silymarin as a bioactive compound, and other nanoparticle based combinations. The prepared individual materials and nanocomposites were used for the anti-inflammatory activity and brine shrimp lethality assay. The results clearly show that the nanocomposites are good anti-inflammatory agents with lower toxicity.

In situ synthesis of hydroxyapatite nanorods on graphene oxide nanosheets and their reinforcement in biopolymer scaffold

Introduction

It is urgently needed to develop composite bone scaffold with excellent mechanical properties and bioactivity in bone tissue engineering. Combining graphene oxide (GO) and hydroxyapatite (HAP) for the reinforcement of biopolymer bone scaffold has emerged as a promising strategy. However, the dispersion of GO and HAP remains to be a big challenge.

Objectives

In this present work, the mechanical properties of GO and the bioactivity of and HAP were combined respectively via in situ synthesis for reinforcing biopolymer bone scaffold.

Methods

GO nanosheets were employed to in situ synthesize GO-HAP nanocomposite via hydrothermal reaction, in which their abundant oxygen-containing groups served as anchor sites for the chelation of Ca2+ and then Ca2+ absorbed HPO42- via electrovalent bonding to form homogeneously dispersed HAP nanorods. Thereby, the GO-HAP nanocomposite was blended with biopolymer poly-L-lactic acid (PLLA) for fabricating biopolymer scaffold by selective laser sintering (SLS).

Results

GO nanosheets were uniformly decorated with HAP nanorods, which were about 60 nm in length and 5 nm in diameter. The compressive strength and modulus of PLLA/12%GO-HAP were significantly increased by 53.71% and 98.80% compared to the pure PLLA scaffold, respectively, explained on the base of pull out, crack bridging, deflection and pinning mechanisms. Meanwhile, the mineralization experiments indicated the PLLA/GO-HAP scaffold displayed good bioactivity by inducing the formation of apatite layer. Besides, cell culturing experiments demonstrated the favorable cytocompatibility of scaffold by promoting cell adhesion and proliferation.

Conclusions

The present findings show the potential of PLLA/GO-HAP composite scaffold via in situ synthesis in bone tissue engineering.

Phosphorus Co-Existing in Water: A New Mechanism to Boost Boron Removal by Calcined Oyster Shell Powder

The removal of boron (B) from water by co-precipitation with hydroxyapatite (HAP) has been extensively studied due to its low cost, ease of use and high efficiency. However, there is no explicit mechanism to express how resolved B was trapped by HAP. Thus, in this work, the process of removing B from water was studied using a low-cost calcium (Ca) precipitation agent derived from used waste oyster shells. The results showed that the removal rate of B in the simulated wastewater by calcined oyster shell (COS) in the presence of phosphorus (P) is up to more than 90%, as opposed to virtually no removal without phosphate. For B removal, the treated water needs to be an alkaline solution with a high pH above 12, where B is removed as [CaB(OH)4]+ but is not molecular. Finally, the synergistic mechanism of co-precipitation between HAP and dissolved B, occlusion co-precipitation, was explained in detail. The proposed method discovered the relationship between Ca, P and B, and was aimed at removing B without secondary pollution through co-precipitation.

Characterizing Trends in Lung Cancer Mortality Attributable to Airborne Environmental Carcinogens

Tracheal, bronchus, and lung (TBL) cancer is the leading cause of cancer death globally, but trends in TBL mortality attributable to tobacco, ambient particulate matter pollution (APMP), and household air pollution (HAP) were unequally distributed within global population subgroups over the last three decades. We used data from the Global Burden of Disease 2019 study to quantify the impact of sex, time, sociodemographic development index (SDI), and age for each exposure from 1990–2019. During that interval, tobacco dominated the TBL cancer mortality landscape, with its minimum global age-adjusted death rate of 16.71 deaths/100,000 (95% Uncertainty Interval (UI): 15.27–18.13) outstripping maximums of 3.85 deaths/100,000 (UI: 2.82–4.83) and 2.54 deaths/100,000 (UI: 1.69–3.54) for APMP and HAP, respectively. In 2019, tobacco male TBL death rates exceeded female rates by a factor of 4.4:1. Ratios of 1.9:1 for APMP and 2.1:1 for HAP were seen. Our analysis indicates that both-sex middle SDI and female low, low-middle, and high-middle SDI populations are suffering increasing tobacco TBL burden. Efforts producing successful global reductions in HAP-associated TBL mortality should continue, with attention to low SDI female death rate increases. Finally, except for high SDI populations, global APMP-attributable TBL cancer burden is increasing and represents a major health concern.

Exploration of mechanisms for calcium phosphate precipitation and accumulation in nitrifying granules by investigating the size effects of granules

Calcium phosphate could be accumulated in aerobic granules, which attracts attention recently for phosphorus removal and recovery from wastewater. In this study, partial nitrifying granules with high calcium precipitate content were sorted into different size groups for characterization and evaluation to reveal the dynamic balance of granules at stead state and relevant calcium phosphate precipitation and accumulation mechanism. It was found that light yellow small granules without calcium precipitates but high microbial activity co-existed with deep brown granules with calcium precipitate of around 91% and low microbial activity. Characterization with specific oxygen uptake rates, specific ammonium oxidation rates, calcium and phosphate removal rates from solution, EPS contents, elemental compositions by energy dispersive X-ray spectroscopy (EDX), X-ray diffraction (XRD), and scanning electron microscopy (SEM) for different size groups of granules enabled a proposal of a new hypothesized mechanism for calcium precipitation and accumulation. With this proposed mechanism, it is believed that sufficient granule retention time in reactors was critical for the accumulation of calcium precipitates followed by a slow microbial growth rate of biomass due to mass transfer resistance. The co-precipitation of calcium carbonate and calcium phosphate mainly occurred in granules with a size less than 710 µm while calcium phosphate dominant minerals were accumulated in granules larger than 710 µm. The results and conclusions in this study shed light on the mechanisms of calcium phosphate accumulation in granules, which could be used to better operate and control aerobic granular sludge with calcium phosphates for phosphorus removal and recovery.

High nitrogen removal performance of anaerobically treated fish processing wastewater by one-stage partial nitritation and anammox process with hydroxyapatite (HAP)-based syntrophic granules and granule structure

The one-stage partial nitritation and anammox process with the hydroxyapatite (HAP)-based syntrophic granules was studied for the ammonium nitrogen removal from the effluents of a self-agitated anaerobic baffled reactor treating the fish processing wastewater. When the ammonium in the influent was 1140 mg N·L^-1, a high nitrogen removal rate and nitrogen removal efficiency of 1.51 ± 0.10 kg N·m^-3·d^-1 and 88.2% were obtained, respectively. Anammox bacteria of Candidatus Kuenenia stuttgartiensis and ammonium oxidizing bacteria of Nitrosomonas were the two most predominant bacteria, while nitrite oxidizing bacteria activity was low and could be neglected during the treatment. The inorganic element properties of the sludge were analyzed by several methods to confirm the existence of HAP granules. Optical microscopic observation and scanning electron microscopy analysis revealed the structure of the granular sludge.This study supports the feasibility and potential of this process for high-efficiency nitrogen removal from fish processing wastewater.

Development and pre-clinical testing of a novel hypoxia-activated KDAC inhibitor

Tumor hypoxia is associated with therapy resistance and poor patient prognosis. Hypoxia-activated prodrugs, designed to selectively target hypoxic cells while sparing normal tissue, represent a promising treatment strategy. We report the pre-clinical efficacy of 1-methyl-2-nitroimidazole panobinostat (NI-Pano, CH-03), a novel bioreductive version of the clinically used lysine deacetylase inhibitor, panobinostat. NI-Pano was stable in normoxic (21% O₂) conditions and underwent NADPH-CYP-mediated enzymatic bioreduction to release panobinostat in hypoxia (<0.1% O₂). Treatment of cells grown in both 2D and 3D with NI-Pano increased acetylation of histone H3 at lysine 9, induced apoptosis, and decreased clonogenic survival. Importantly, NI-Pano exhibited growth delay effects as a single agent in tumor xenografts. Pharmacokinetic analysis confirmed the presence of sub-micromolar concentrations of panobinostat in hypoxic mouse xenografts, but not in circulating plasma or kidneys. Together, our pre-clinical results provide a strong mechanistic rationale for the clinical development of NI-Pano for selective targeting of hypoxic tumors.

Multinational evaluation of the BioFire® FilmArray® Pneumonia plus Panel as compared to standard of care testing

This study compared standard of care testing (SOC) to BioFire® FilmArray® Pneumonia plus Panel (PNplus). PNplus detects 15 bacteria with semiquantitative log bin values, 7 antibiotic resistance markers, three atypical bacteria (AB), and eight viral classes directly from bronchoalveolar lavage-like specimens (BLS) and sputum-like specimens (SLS). Fifty-two laboratories from 13 European countries and Israel tested 1234 BLS and 1242 SLS with PNplus and SOC. Detection rates and number of pathogens/samples were compared for PNplus pathogens. PNplus bin values and SOC quantities were compared. Three thousand two hundred sixty-two bacteria in PNplus were detected by PNplus and/or SOC. SOC detected 57.1% compared to 95.8% for PNplus (p ≤ 0.0001). PNplus semiquantitative bin values were less than SOC, equal to SOC, or greater than SOC in 5.1%, 25.4%, and 69.6% of results, respectively. PNplus bin values were on average ≥ 1 log than SOC values (58.5% 1–2 logs; 11.0% 3–4 logs). PNplus identified 98.2% of MRSA and SOC 55.6%. SOC detected 73/103 AB (70.9%) and 134/631 viruses (21.2%). PNplus detected 93/103 AB (90.3%) and 618/631 viruses (97.9%) (p ≤ 0.0001). PNplus and SOC mean number of pathogens/samples were 1.99 and 1.44, respectively. All gram-negative resistance markers were detected. PNplus and SOC results were fully or partially concordant for 49.1% and 26.4% of specimens, respectively. PNplus was highly sensitive and detected more potential pneumonia pathogens than SOC. Semiquantification may assist in understanding pathogen significance. As PNplus generates results in approximately 1 h, PNplus has potential to direct antimicrobial therapy in near real time and improve antimicrobial stewardship and patient outcomes.

The prevalence of malnutrition and analysis of related factors among adult patients with the Coronavirus Disease 2019 (COVID 19) in a tertiary government hospital: The MalnutriCoV study

Background and aims

As of November 2020, the Coronavirus Disease 2019 (COVID 19) has infected more than 396,000 people in the Philippines. Although no study has been done on malnutrition among a general cohort of patients with COVID 19, it has long been associated with increased mortality and poor long-term outcomes. We aimed to determine the prevalence of malnutrition among patients with COVID 19 admitted in a tertiary government hospital.

Methods

Cross-sectional study on COVID 19-confirmed patients admitted to the COVID 19 wards from July 15 to September 15, 2020. Nutritional status was assessed using the Philippine Society for Parenteral and Enteral Nutrition (PhilSPEN) modified Subjective Global Assessment Grade (SGA) tool. Malnutrition was defined as those with SGA grades B and C. Chi-square test or Fisher exact test of association, as appropriate, was used to identify factors that have a significant association with malnutrition. Furthermore, logistic regression was done on factors with significant association.

Results

Among the 355 adult patients in the study, 71.83% (255/355) were malnourished [SGA B: 67.84% (173/255); SGA C: 32.16% (82/255)]. The following were shown to have significant association with malnutrition: community-acquired pneumonia (CAP) [p-value < 0.001], hospital-acquired pneumonia (HAP) [p-value 0.002], and chronic kidney disease (p-value 0.033). Multivariable logistic regression revealed that age [OR 1.02, CI 95% 1.00, 1.04, p-value 0.027] and CAP-Moderate Risk (MR) [OR 3.02, CI 95% 1.73, 5.27, p-value < 0.001] are significant predictors of malnutrition. All patients with CAP- High Risk and HAP were malnourished.

Conclusion

The prevalence of malnutrition was high (71.83%) in a general cohort of COVID 19 patients as measured by the modified SGA tool. The following are risk factors of malnutrition among patients with COVID 19: age, CAP, and HAP. Nutritional support and management of comorbidities are of paramount importance in the care of patients with COVID 19.

User-centered design of an air quality feedback technology to promote adoption of clean cookstoves

BACKGROUND

Recent work has examined behavioral reactivity associated with personal awareness of electronic sensors monitoring the use of environmental health products, including cookstoves. These studies suggest that sensors could be used as behavior change tools.

OBJECTIVE

We present a human-centered design approach toward the development of a household air quality feedback technology intended to improve consistent and exclusive use of liquid petroleum gas (LPG) stoves provided as part of a health efficacy study.

METHODS

We found through a consultation process that households may be behaviorally triggered by reminders of the health and environmental impacts of cooking practices and may respond to both auditory and visual feedback. Based on these insights, we designed and validated a system linking air particulate monitoring with persistent visual feedback and a dynamic audio alarm.

RESULTS

Data collected over 14 days in participants households show that the system is able to detect sudden rises in household indoor air pollution and to communicate that information to household members.

SIGNIFICANCE

This device could be used as a tool to raise awareness of air pollution associated in order to stimulate adoption of cleaner cooking technologies.

In Situ Generation of Hydroxyapatite on Biopolymer Particles for Fabrication of Bone Scaffolds Owning Bioactivity

Hydroxyapatite (HAP) can endow a biopolymer scaffold with good bioactivity and osteoconductive ability, while the interfacial bonding is fairly weak between HAP and biopolymers. In this study, HAP was in situ generated on poly(l-lactic acid) (PLLA) particles, and then they were used to fabricate a scaffold by selective laser sintering. Detailedly, PLLA particles were first functionalized by dopamine oxide polymerization, which introduced abundance active catechol groups on the particle surface, and subsequently, the catechol groups concentrated Ca²⁺ ions by chelation in a simulated body fluid solution, and then, Ca²⁺ ions absorbed PO₄^3- ions through electrostatic interactions for in situ nucleation of HAP. The results indicated that HAP was homogeneously generated on the PLLA particle surface, and HAP and PLLA exhibited good interfacial bonding in the HAP/PLLA scaffolds. Meanwhile, the scaffolds displayed excellent bioactivity by inducing apatite precipitation and provided a good environment for human bone mesenchymal stem cell attachment, proliferation, and osteogenic differentiation. More importantly, the ingrowth of blood vessel and the formation of new bone could be stimulated by the scaffolds in vivo, and the bone volume fraction and bone mineral density increased by 44.44 and 41.73% compared with the pure PLLA scaffolds, respectively. Serum biochemical indexes fell within the normal range, which indicated that there was no harmful effect on the normal functioning of the body after implanting the scaffold.

Covered stent placement for hepatic artery pseudoaneurysm

PURPOSE

To evaluate the efficacy and safety of covered stent placement for the treatment of hepatic artery pseudoaneurysm (HAP).

METHODS

Between March 2006 and March 2019, 17 consecutive patients underwent emergency covered stent placement for treatment of HAP. There were 12 men and 5 women aged 24-71 years, with an average age of 49.4 years. Eleven patients had undergone Whipple procedure, 3 had hepatic abscess following hepatectomy, 2 had undergone hepatectomy under extracorporeal circulation, and 1 had received surgical exploration after a car accident. The average interval from surgical intervention to massive bleeding was 15.3 days (range: 6-35 days). After HAP was confirmed by angiography, 1-3 covered stent grafts (3-8 mm in diameter and 13 mm-5 cm in length) were implanted. Adequate drainage, anti-infection treatment, and symptomatic treatment were offered after stent placement, and no anticoagulation or antiplatelet drug was used.

RESULTS

The interventions were successful in all 17 patients. Angiography revealed pseudoaneurysms in common hepatic artery in 16 patients (in gastroduodenal artery stumps in 4 patients) and hemorrhage from a ruptured right hepatic artery in 1 patient. All patients were successfully implanted with 1-3 covered stent grafts. Bleeding was completely controlled in 12 patients (stent diameter: 4.5-8 mm). Four patients (stent diameter: 3-4.5 mm) experienced bleeding recurrence 1 h to 3 days after stent implantation, and type 1 endoleaks were identified during second angiography. Finally, these 4 patients died of multiple organ failure 2-10 days after embolization/blockage. The remaining patient suffered from abdominal hemorrhage again 2 weeks after stent implantation, and second angiography showed hemorrhage from a branch of the superior mesenteric artery; no bleeding occurred after embolization. Thirteen patients survived at discharge, and the average length of hospital stay was 26.53 days (range: 11-58 days). The average follow-up time was 23 months (range: 16-37 months), during which 6 patients died of tumor progression. No bleeding recurred during the follow-up period, and routine color Doppler ultrasound revealed that the common hepatic artery was patent and the blood flow was smooth at the stent implantation site.

CONCLUSION

Covered stent placement is a safe and effective alternative for treating HAP patients with high risk of severe complications after hepatic artery embolization. Larger stent grafts (> 4 mm in diameter) may achieve better prognosis.

Review of health economic models exploring and evaluating treatment and management of hospital-acquired pneumonia and ventilator-associated pneumonia

BACKGROUND

Hospital-acquired pneumonia (HAP) is pneumonia that occurs ≥48 h after hospital admission; it is the most common hospital-acquired infection contributing to death. Ventilator-associated pneumonia (VAP) arises ≥48-72 h after intubation. Opinions differ on whether VAP is a subset of HAP; the same pathogens predominate in both. Compared with VAP-free controls, patients developing VAP are twice as likely to die and have significantly longer stays in intensive care units. Guidelines recommend that microbiological cultures should guide antibiotic treatment, but these lack sensitivity and take 48-72 h to process, meaning that initial therapy must be empiric, generally with broad-spectrum agents. Given increasing pressure to improve both antibiotic stewardship and patient outcomes, the National Institute for Health and Care Excellence and the Infectious Diseases Society of America recommend research into rapid molecular diagnostic tests to identify causative organisms and their antibiotic resistances. Ideally, these would supersede culture, being quicker and more sensitive. In the UK, the INHALE research programme, funded by the National Institute for Health Research, is exploring rapid molecular diagnostics to inform treatment of HAP/VAP and, given resource implications, incorporates a health economic component.

AIM

To identify previous economic modelling of HAP/VAP costs to inform this component.

METHODS

Literature review of HAP/VAP studies with economic modelling identified from three databases.

FINDINGS

Twenty studies were identified. Only one study specifically evaluated strategies to improve diagnosis; the remaining 19 studies omitted this important aspect.

CONCLUSION

HAP/VAP modelling would be improved by better awareness of long-term outcomes and treatment complexity. To the authors' knowledge, no similar literature reviews of economic modelling for HAP/VAP have been published.

Diagnostic accuracy of Gram staining when predicting staphylococcal hospital-acquired pneumonia and ventilator-associated pneumonia: a systematic review and meta-analysis

BACKGROUND

There is no clear guidance on empirical antibiotic coverage against Staphylococcus aureus for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP).

OBJECTIVE

To evaluate whether the presence of clusters of Gram-positive cocci in Gram staining of respiratory samples predicts S. aureus as HAP/VAP pathogen.

METHODS

Data sources were MEDLINE, PubMed, Embase, Scielo, CINAHL and Scopus, from inception to 15/07/2017 (update on 31/10/2019), and original data from a single-centre database (PROSPERO: CRD42017072138). We included studies reporting the diagnostic accuracy of a Gram-staining evaluation suggestive of Staphylococcus compared with a positive culture for S. aureus in any type of lower respiratory tract sample. Participants were adult patients with HAP/VAP. The index test was morphological evaluation of Gram staining of respiratory samples. We followed PRISMA guidelines and assessed risk of bias and applicability with the QUADAS-2 tool. We conducted a meta-analysis using a bivariate random effects model.

RESULTS

We selected five studies that included only VAP and data from a single-centre database including VAP and HAP. We pooled six studies for VAP and analysed 1665 respiratory samples. Pooled sensitivity was 68% (95%CI 49-83 and specificity 95% (95%CI 86-98). The pooled positive likelihood ratio was 12.7 (95%CI 5.1-31.6), negative likelihood ratio 0.34 (95%CI 0.20-0.57), diagnostic odds ratio 38 (95%CI 13-106) and area under the summary receiver operating curve (SROC) 0.91 (95%CI 0.88-0.93). There was great heterogeneity between sensitivity and specificity. In scenarios in which the prevalence of S. aureus was between 5% and 20%, the positive and negative predictive values were 62% (95%CI 47-77) and 95% (95%CI 82-100), respectively.

CONCLUSIONS

Detection of Gram-positive cocci in clusters in respiratory samples of patients with VAP has the potential to guide risk assessments of S. aureus for more personalized antibiotic coverage. Randomized clinical trials with patient-centred outcomes are needed for strong clinical recommendations.

Update of the treatment of nosocomial pneumonia in the ICU

In accordance with the recommendations of, amongst others, the Surviving Sepsis Campaign and the recently published European treatment guidelines for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), in the event of a patient with such infections, empirical antibiotic treatment must be appropriate and administered as early as possible. The aim of this manuscript is to update treatment protocols by reviewing recently published studies on the treatment of nosocomial pneumonia in the critically ill patients that require invasive respiratory support and patients with HAP from hospital wards that require invasive mechanical ventilation. An interdisciplinary group of experts, comprising specialists in anaesthesia and resuscitation and in intensive care medicine, updated the epidemiology and antimicrobial resistance and established clinical management priorities based on patients' risk factors. Implementation of rapid diagnostic microbiological techniques available and the new antibiotics recently added to the therapeutic arsenal has been reviewed and updated. After analysis of the categories outlined, some recommendations were suggested, and an algorithm to update empirical and targeted treatment in critically ill patients has also been designed. These aspects are key to improve VAP outcomes because of the severity of patients and possible acquisition of multidrug-resistant organisms (MDROs).

Prevalence of Chronic Bronchitis and Respiratory Health Profile of a Population Exposed to Wood Smoke in Nicaragua

BACKGROUND

Household air pollution (HAP) is one of the most important environmental risk factors worldwide associated with chronic respiratory diseases.

OBJECTIVES

The present study focused on respiratory health in a population with high wood smoke exposure in Nicaragua.

METHODS

We employed a cross-sectional study with 213 participants. Data on the prevalence of chronic bronchitis (chronic bronchitis), chronic obstructive pulmonary disease (COPD) and asthma, including respiratory scores and pulmonary function tests, were documented. The role of risk factors for chronic bronchitis was analyzed.

RESULTS

We found a high prevalence of chronic airway diseases in the population exposed to wood smoke. A higher prevalence of chronic bronchitis was found in persons serving as primary cooks in households. Further confounding factors for chronic bronchitis included age, a prior diagnosis of asthma, inhalational allergies and lower socioeconomic status. Respiratory scores were elevated in individuals with chronic bronchitis.

CONCLUSIONS

This is one of the first studies in a wood smoke-exposed population in Nicaragua showing a high prevalence of chronic bronchitis and COPD with an emphasis on the analysis of personal and environmental risk factors. Further studies are needed to address which combination of interventions is most efficient for ameliorating respiratory health hazards.

PARTICIPANT CONSENT

Obtained.

ETHICS APPROVAL

The study protocol was approved by the Ethics Committee of the University of Luebeck, Germany (reference number 12-214), and by the Ethics Committee of the Department of Medical Sciences at National Autonomous University of Nicaragua, Managua, Nicaragua.

COMPETING INTERESTS

The authors declare no competing financial interests.

Preparation of KI/Hydroxyapatite Catalyst from Phosphate Rocks and Its Application for Improvement of Biodiesel Production

The main aim of this work was to investigate the suitability of a KI/KIO₃ impregnated hydroxyapatite (HAP) catalyst derived from natural phosphate rocks for biodiesel production. This study evaluated the effect of impregnation concentrations (1-6% w/w) on the catalyst performance in biodiesel production. The biodiesel was produced from waste cooking oil (WCO) under simultaneous esterification-transesterification reactions at 60 °C for 6 h. The results showed that the biodiesel yield increased by increasing impregnation concentration and the maximum yield (91.787%) was achieved at an impregnation concentration of 5% w/w. The KI/HAP catalyst showed better performance (91.78% biodiesel yield, 59.1% FAME yield and surface area of 13.513 m²/g) as compared to the KIO₃/HAP catalyst (90.07% biodiesel yield, 55.0% FAME yield and surface area of 10.651 m²/g).

[Standardized assessment of personality disorders in older adults: State-of-the-art.]

The double ageing evolution in Europe is a tremendous challenge for health care. Older adults with a personality disorder place an additional burden: they have more somatic and psychiatric co-morbidity than those without a personality disorder. Moreover, they experience less quality of life than individuals without personality disorders. This is in sharp contrast to the dearth of empirical research concerning the construct of personality disorders in later life, the very limited amount of available diagnostic tools, criteria of classification systems like DSM not being attuned to the elderly context and the lack of age-neutrality of popular instruments to measure personality disorders. Therefore, in the Netherlands and Belgium a start was made to develop and validate age-specific instruments and to examine the applicability of the alternative dimensional-hybrid DSM-5 classification of personality disorders in older adults. These recent developments and how to apply them for a personalized assessment in older adults will be discussed. Finally, we advise a phased test-based diagnostic approach in which the above-mentioned instruments, combined with measures of adaptive features or more specific tests, can contribute to an assessment optimizing the balance between restricting the load for the older patient and still being sufficiently comprehensive to result in a personalized approach of the diagnostic process.

Simultaneous nitrogen removal and phosphorus recovery using an anammox expanded reactor operated at 25 °C

While anammox is a cost-effective nitrogen treatment process for wastewater with high nutrient strength, phosphorus remains untouched during this process and needs further treatment. In this study, the nitrogen removal and phosphorus recovery were achieved simultaneously at 25 °C using an anammox expanded bed. A stable high nitrogen removal efficiency of 83.7 ± 4.8% at a 1500 mgN/L influent total nitrogen concentration and a phosphorus removal efficiency of 94.2 ± 1.2% at 100 mg P/L influent total phosphorus were obtained during continuous operation. The effects of the nitrogen loading rate, hydraulic retention time (HRT), pH, Ca²⁺ and PO₄^3- concentration on the phosphorus removal was verified in the long-term operation of the reactor. The sludge produced contained a high content of phosphorus mainly in the form of hydroxyapatite (HAP), and the sludge composition strongly reflected the nitrogen and phosphorus loading. The structure of the anammox-HAP composite granules was illustrated by the use of fluorescence in situ hybridization (FISH) and Raman spectroscopic mapping analysis. The results in this study indicate that by controlling the operation parameters, it is possible to integrate a high efficiency phosphorus recovery with the anammox process, and significantly reduce the nutrient loading for further wastewater treatment.

Activity of Meropenem-Vaborbactam against Bacterial Isolates Causing Pneumonia in Patients in U.S. Hospitals during 2014 to 2018

Meropenem-vaborbactam is approved to treat hospital-acquired pneumonia (HAP), including ventilator-associated pneumonia (VAP), in Europe. Meropenem-vaborbactam activity was evaluated against 3,193 Pseudomonas aeruginosa and 4,790 Enterobacterales isolates causing pneumonia, including VAP, in hospitalized patients in the United States. Susceptibility testing was performed by using the broth microdilution method, and all carbapenem-resistant isolates were submitted for whole-genome sequencing.

Meropenem-vaborbactam is approved to treat hospital-acquired pneumonia (HAP), including ventilator-associated pneumonia (VAP), in Europe. Meropenem-vaborbactam activity was evaluated against 3,193 Pseudomonas aeruginosa and 4,790 Enterobacterales isolates causing pneumonia, including VAP, in hospitalized patients in the United States. Susceptibility testing was performed by using the broth microdilution method, and all carbapenem-resistant isolates were submitted for whole-genome sequencing. Meropenem-vaborbactam exhibited almost complete activity against Enterobacterales (>99.9% susceptible), including carbapenem-resistant Enterobacterales (CRE), and was also very active against P. aeruginosa isolates (89.5% susceptible).

Phosphonic Acid Coupling Agent Modification of HAP Nanoparticles: Interfacial Effects in PLLA/HAP Bone Scaffold

In order to improve the interfacial bonding between hydroxyapatite (HAP) and poly-l-lactic acid (PLLA), 2-Carboxyethylphosphonic acid (CEPA), a phosphonic acid coupling agent, was introduced to modify HAP nanoparticles. After this. the PLLA scaffold containing CEPA-modified HAP (C-HAP) was fabricated by selective laser sintering (frittage). The specific mechanism of interfacial bonding was that the PO32- of CEPA formed an electrovalent bond with the Ca2+ of HAP on one hand, and on the other hand, the -COOH of CEPA formed an ester bond with the -OH of PLLA via an esterification reaction. The results showed that C-HAP was homogeneously dispersed in the PLLA matrix and that it exhibited interconnected morphology pulled out from the PLLA matrix due to the enhanced interfacial bonding. As a result, the tensile strength and modulus of the scaffold with 20% C-HAP increased by 1.40 and 2.79 times compared to that of the scaffold with HAP, respectively. In addition, the scaffold could attract Ca2+ in simulated body fluid (SBF) solution by the phosphonic acid group to induce apatite layer formation and also release Ca2+ and PO43- by degradation to facilitate cell attachment, growth and proliferation.

Nosocomial pneumonias

The paper provides clear definitions of the basic concepts of nosocomial pneumonias. Specifically, definitions and classifications of HAP and VAP, general treatment principles and specific recommended procedures for antibiotic therapy are given as applicable in the Czech Republic.

[Comparative assessment of the effectiveness of toothpastes to reduce hyperesthesia in inflammatory periodontal diseases]

The purpose of the study is a comparative assessment of hygiene products recommended for increased sensitivity of teeth and having an anti-inflammatory effect on periodontal tissue. The study involved 40 people aged 55-65 years with hyperesthesia and chronic mild and moderate periodontitis, which were divided into 2 groups (20 people each) depending on the toothpastes used based on HAP. Over time, indicators of hygiene, sensitivity, bleeding, PMA indices and the periodontal probing depth are evaluated. The study revealed an improvement of the studied indices in both groups after two weeks of using toothpastes. Both of the studied toothpastes lead to a decrease in hyperesthesia and relief of inflammation, which makes it possible to conduct high-quality oral hygiene. However, a more significant improvement in clinical signs was observed when using paste plant components and bifidobacteria extract. Thus, in the complex therapy of inflammatory periodontal diseases accompanied by hyperesthesia, both studied pastes can be recommended for at least 14 days.

Hierarchy structure and fracture mechanisms of the wild wolf tusk's enamel

The self-growth and self-strengthening of natural biomaterials provided us strategies for new materials design. In this paper, the microstructure and fracture mechanisms of the wild wolf tusk's enamel were studied. The enamel included four-order hierarchies, which were the hydroxyapatite (HAP) fiber (first-order, nano-scale, ploy-crystals), enamel rod (second-order, micro-scale, rope-like), enamel type (third-order, meso-scale, mat-like) and the enamel patterns (forth-order, macro-scale), respectively. It was interesting to find that the numerous nano-grains distributed disorderly in a single HAP fiber. The thousands HAP fibers bundled together to form the rope-like enamel rod. The protein ligaments were discovered between adjacent enamel rods. The out enamel, inner enamel and P&D-zones showed a criss-cross type and ran through whole enamel pattern in three-dimensional space. The enamel of the wild wolf tusk exhibited an excellent fracture toughness based on the nanoindentation tests. The fracture morphology in transverse direction indicated that the cracks preferred to propagate along the weak interface (protein or interrod) and cut those enamel rods perpendicular to the propagation direction. However, the cracks extended obviously forward along the step-like paths from the outmost surface of the enamel to the enamel-dentin junction in the longitudinal direction. It was considered that the protein ligament was the main reason for the good fracture toughness of the bulk enamel. Our studies reveal that the design strategies of the natural material can be applied to guide the development of high-performance artificial materials.

Ceftobiprole: drug evaluation and place in therapy

Introduction: Ceftobiprole is a fifth-generation cephalosporin with a broad spectrum of antimicrobial activity, including also methicillin-resistant Staphylococcus aureus (MRSA). Ceftobiprole is approved for the treatment of community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP), excluding ventilator-associated pneumonia, in several European and non-European countries. Areas covered: In this narrative review, we discuss the current place in therapy of ceftobiprole, both within and outside approved indications. An inductive MEDLINE/PubMed search of the available literature was conducted. Expert opinion: There are three main reasons which render ceftobiprole an attractive option for the empirical and targeted treatment of CAP and HAP: (i) its broad spectrum of activity; (ii) its activity against MRSA; (iii) its good safety profile. For these indications, ceftobiprole should be employed thoughtfully, in those scenarios in which its intrinsic advantages could be maximized. The use of ceftobiprole outside approved indications could be justified in specific scenarios, such as when other approved alternatives are ineffective, when the risk of toxicity due to other agents is unacceptable, and for salvage therapy. In the near future, ongoing phase 3 studies and further observational experiences could both enlarge the current panel of approved indications and enrich our knowledge on the use of ceftobiprole for off-label indications.

Molecular docking and dynamics studies on novel benzene sulfonamide substituted pyrazole-pyrazoline analogues as potent inhibitors of Plasmodium falciparum Histo aspartic protease

Malaria is the major health issue in African, Asian and Mediterranean regions of the world. Due to the emerging resistance by the parasites and mosquitoes for the current medications and insecticides, respectively, the malaria free human world can be attained only by the novel design and development of new anti-malarial drugs. Hence, we attempted to carry out in silico screening of benzene sulfonamide substituted pyrazole-pyrazoline series against Histo aspartic protease. Our results reveal that the 65% of the data set with the free binding energy in the range of -11.58 to -11.21 kcal/mol, which is categorized as 'high scoring'. Ligands are docked with the catalytic residues Asp 215, Ser 75, Thr 33 and Ala 217, respectively. Molecular dynamic simulation study of free enzyme and the enzyme complex with 4-(5-(4-methoxyphenyl)-1'phenyl-3'-(p-tolyl)-3,4-1'H,2H-[3,4'-bipyrazol]-2-yl)benezenesulfonamide indicated structural stability. The trajectory analysis of complex reveals that the HAP-ligand complex is more stable than the free HAP. We are of the opinion that our results will be useful for designing potential anti-malarial compounds. AbbreviationsADTauto dock toolsBSPPbenzene sulfonamide substituted pyrazole-pyrazolineCQchloroquineHAPhisto aspartic proteaseKKelvinMDmolecular dockingMM/PBSAmolecular mechanics/Poisson Boltzmann surface areaNVTnormal volume and temperatureNPTnormal pressure and temperatureNsnanosecondsPDBprotein data bank.pdbprogram data base formatP. falciparumPlasmodium falciparumPspicosecondsPMsplasmepsinsP. vivaxPlasmodium vivaxRgradius of gyrationRMSDroot mean square deviationRMSFroot mean square fluctuationWHOWorld Health OrganizationCommunicated by Ramaswamy H. Sarma.

Community-acquired Pneumonia and Hospital-acquired Pneumonia

Pneumonia is among the leading causes of morbidity and mortality worldwide. Although Streptococcus pneumoniae is the most likely cause in most cases, the variety of potential pathogens can make choosing a management strategy a complex endeavor. The setting in which pneumonia is acquired heavily influences diagnostic and therapeutic choices. Because the causative organism is typically unknown early on, timely administration of empiric antibiotics is a cornerstone of pneumonia management. Disease severity and rates of antibiotic resistance should be carefully considered when choosing an empiric regimen. When complications arise, further work-up and consultation with a pulmonary specialist may be necessary.

Inhalation of specific anti-Pseudomonas aeruginosa IgY antibodies transiently decreases P. aeruginosa colonization of the airway in mechanically ventilated piglets

Background

P. aeruginosa is a pathogen frequently resistant to antibiotics and a common cause of ventilator-associated pneumonia (VAP). Non-antibiotic strategies to prevent or treat VAP are therefore of major interest. Specific polyclonal avian IgY antibodies have previously been shown to be effective against pneumonia caused by P. aeruginosa in rodents and against P. aeruginosa airway colonization in patients.

Objectives

To study the effect of specific polyclonal anti-P. aeruginosa IgY antibodies (Pa-IgY) on colonization of the airways in a porcine model.

Method

The pigs were anesthetized, mechanically ventilated, and subject to invasive hemodynamic monitoring and allocated to either receive 10⁹ CFU nebulized P. aeruginosa (control, n = 6) or 10⁹ CFU nebulized P. aeruginosa + 200 mg Pa-IgY antibodies (intervention, n = 6). Physiological measurement, blood samples, and tracheal cultures were then secured regularly for 27 h, after which the pigs were sacrificed and lung biopsies were cultured.

Results

After nebulization, tracheal growth of P. aeruginosa increased in both groups during the experiment, but with lower growth in the Pa-IgY-treated group during the experiment (p = 0.02). Tracheal growth was 4.6 × 10³ (9.1 × 10²–3.1 × 10⁴) vs. 4.8 × 10⁴ (7.5 × 10³–1.4 × 10⁵) CFU/mL in the intervention group vs. the control group at 1 h and 5.0 × 10⁰ (0.0 × 10⁰–3.8 × 10²) vs. 3.3 × 10⁴ (8.0 × 10³–1.4 × 10⁵) CFU/mL at 12 h in the same groups. During this time, growth in the intervention vs. control group was one to two orders of ten lower. After 12 h, the treatment effect disappeared and bacterial growth increased in both groups. The intervention group had lower body temperature and cardiac index and higher static compliance compared to the control group.

Conclusion

In this porcine model, Pa-IgY antibodies lessen bacterial colonization of the airways.

Electronic supplementary material

The online version of this article (10.1186/s40635-019-0246-1) contains supplementary material, which is available to authorized users.

A Breath of Fresh Air in the Fog of Antimicrobial Resistance: Inhaled Polymyxins for Gram-Negative Pneumonia

Despite advancements in therapy, pneumonia remains the leading cause of death due to infectious diseases. Novel treatment strategies are desperately needed to optimize the antimicrobial therapy of patients suffering from this disease. One such strategy that has recently garnered significant attention is the use of inhaled antibiotics to rapidly achieve therapeutic concentrations directly at the site of infection. In particular, there is significant interest in the role of inhaled polymyxins for the treatment of nosocomial pneumonia, including ventilator-associated pneumonia, due to their retained activity against multi-drug resistant Gram-negative pathogens, including Acinetobacter baumannii and Pseudomonas aeruginosa. This review will provide a comprehensive overview of the pharmacokinetic/pharmacodynamic profile, clinical outcomes, safety, and potential role of inhaled polymyxins in clinical practice.

A new process for simultaneous nitrogen removal and phosphorus recovery using an anammox expanded bed reactor

Phosphorus recovery from wastewater is an important approach for sustainable phosphorus use. In this work, a process combining anammox and hydroxyapatite (HAP) precipitation in an expanded bed reactor for simultaneous nitrogen removal and phosphorus recovery was developed by applying specific Ca/P ratio and pH control. A high phosphorus removal rate (0.14 ± 0.01 kg-P/m³/d) was obtained while a stable nitrogen removal efficiency (87.4 ± 2.9%) maintained with an effluent recirculation system applied. Average 13.4% phosphorus (30.7% in P₂O₅) accumulation in the dry sludge and a Ca/P ratio very close to HAP was observed by quantitative elemental analysis. In this work, different analysis revealed the two layers structure with anammox biofilm attached to inorganic core of the granules. Different spectral analysis determined the major phase of the inorganic content as hydroxyapatite. With proper Ca/P ratio and pH control, anammox expanded bed reactor was transformed into an efficient process to simultaneously remove nitrogen and recover phosphorus.

Efficacy and effectiveness of Ceftaroline Fosamil in patients with pneumonia: a systematic review and meta-analysis

BACKGROUND

Pneumonia is a relevant clinical and public health issue worldwide frequently associated with infections caused by Multi-Drug Resistant (MDR) pathogens. Ceftaroline fosamil is a promising new antibiotics with broad-spectrum bacterial activity. The aim of this systematic review and meta-analysis is to assess the efficacy and the effectiveness of ceftaroline fosamil in community-acquired (CAP), hospital-acquired (HAP), healthcare-associated (HCAP) and ventilator-associated (VAP) pneumonia.

METHODS

A systematic review and meta-analysis was carried out retrieving both experimental and observational studies.

RESULTS

A total of 2364 records was found and 14 manuscripts were finally considered eligible. The pooled efficacy/effectiveness was 81.2% (I2: 1.2%) in all types of pneumonia. The pooled relative risk of clinical cure was 1.1 (I2: 0.0%). The success rate was higher than 70% for infections caused by S. pneumoniae and S. aureus, including MDR pathogens.

CONCLUSIONS

Ceftaroline fosamil showed a high efficacy/effectiveness in patients with any type of pneumonia with a good safety profile.

Screening of Autism Spectrum Disorders in Geriatric Psychiatry

Autism spectrum disorders (ASD) are difficult to detect in old age. This study examined if ASD symptoms in older adults (age > 60) can be detected with the Dutch informant personality questionnaire, (Hetero-Anamnestische Persoonlijkheidsvragenlijst, HAP) in a mental health setting. Patients with ASD (N = 40) were compared to patients with a different psychiatric diagnosis (N = 43; personality disorders excluded). The ASD group had significant higher scores on the scales 'Socially avoidant behavior', 'Rigid behavior' and 'Unpredictable and impulsive behavior'. These scales were able to discriminate between individuals with or without ASD. The HAP can thus be used as a screening instrument for ASD symptoms in elderly patients. Further research is needed to clarify what items have the best predictive validity for ASD symptoms.

Effectiveness of interventions to reduce household air pollution and/or improve health in homes using solid fuel in low-and-middle income countries: A systematic review and meta-analysis

BACKGROUND

Cookstove intervention programs have been increasing over the past two (2) decades in Low and Middle Income Countries (LMICs) across the globe. However, there remains uncertainty regarding the effects of these interventions on household air pollution concentrations, personal exposure concentrations and health outcomes.

OBJECTIVES

The primary objective was to determine if household air pollution (HAP) interventions were associated with improved indoor air quality (IAQ) in households in LMICs. Given the potential impact of HAP interventions on health, a secondary objective was to evaluate the effectiveness of HAP interventions to improve health in populations receiving these interventions.

DATA SOURCES

OVID Medline, Ovid Embase, SCOPUS and PubMED were searched from their inception until December 2015 with no restrictions on study design. The WHO Global database of household air pollution measurements and Members' archives were also reviewed together with the reference lists of identified reviews and relevant articles.

STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTION

We considered randomized controlled trials, or non-randomized control trials, or before-and-after studies; original studies; studies conducted in a LMIC (based on the United Nations Human Development Report released in March 2013 (World Bank, 2013); interventions that were explicitly aimed at improving IAQ and/or health from solid fuel use; studies published in a peer-reviewed journal or student theses or reports; studies that reported on outcomes which was indicative of IAQ or/and health. There was no restriction on the type of comparator (e.g. household receiving plancha vs. household using traditional cookstove) used in the intervention study.

STUDY APPRAISAL AND SYNTHESIS METHODS

Five review authors independently used pre-designed data collection forms to extract information from the original studies and assessed risk of bias using the Effective Public Health Practice Project (EPHPP). We computed standardized weighted mean difference (SMD) using random-effects models. Heterogeneity was computed using the Q and I2-statistics. We examined the influence of various characteristics on the study-specific effect estimates by stratifying the analysis by population type, study design, intervention type, and duration of exposure monitoring. The trim and fill method was used to assess the potential impact of missing studies.

RESULTS

Fifty-five studies met our a priori inclusion criteria and were included in the systematic review. Fifteen studies provided 43 effect estimates for our meta-analysis. The largest improvement in HAP was observed for average particulate matter (PM) (SMD=1.57) concentrations in household kitchens (1.03), followed by daily personal average concentrations of PM (1.18), and carbon monoxide (CO) concentrations in kitchens. With respect to personal PM, significant improvement was observed in studies of children (1.26) and studies monitoring PM for ≥24h (1.32). This observation was also noted in terms of studies of kitchen concentrations of CO. A significant improvement was also observed for kitchen levels of PM in both adult populations (1.56) and in RCT/cohort designs (1.59) involving replacing cookstoves without chimneys. Our findings on health outcomes were inconclusive.

LIMITATIONS, CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

We observed high statistical between study variability in the study-specific estimate. Thus, care should be taken in concluding that HAP interventions - as currently designed and implemented - support reductions in the average kitchen and personal levels of PM and CO. Further, there is limited evidence that current stand-alone HAP interventions yield any health benefits. Post-intervention levels of pollutants were generally still greatly in excess of the relevant WHO guideline and thus a need to promote cleaner fuels in LMICs to reduce HAP levels below the WHO guidelines.

SYSTEMATIC REVIEW REGISTRATION NUMBER

The review has been registered with PROSPERO (registration number CRD42014009768).

Study of Different Variants of Mo Enzyme crARC and the Interaction with Its Partners crCytb5-R and crCytb5-1

The mARC (mitochondrial Amidoxime Reducing Component) proteins are recently discovered molybdenum (Mo) Cofactor containing enzymes. They are involved in the reduction of several N-hydroxylated compounds (NHC) and nitrite. Some NHC are prodrugs containing an amidoxime structure or mutagens such as 6-hydroxylaminopurine (HAP). We have studied this protein in the green alga Chlamydomonas reinhardtii (crARC). Interestingly, all the ARC proteins need the reducing power supplied by other proteins. It is known that crARC requires a cytochrome b₅ (crCytb5-1) and a cytochrome b₅ reductase (crCytb5-R) that form an electron transport chain from NADH to the substrates. Here, we have investigated NHC reduction by crARC, the interaction with its partners and the function of important conserved amino acids. Interactions among crARC, crCytb5-1 and crCytb5-R have been studied by size-exclusion chromatography. A protein complex between crARC, crCytb5-1 and crCytb5-R was identified. Twelve conserved crARC amino acids have been substituted by alanine by in vitro mutagenesis. We have determined that the amino acids D182, F210 and R276 are essential for NHC reduction activity, R276 is important and F210 is critical for the Mo Cofactor chelation. Finally, the crARC C-termini were shown to be involved in protein aggregation or oligomerization.

Synthesis and antiviral evaluation of novel heteroarylpyrimidines analogs as HBV capsid effectors

New modifications to the scaffold of previously reported HBV capsid assembly effectors such as BAY 41-4109, HAP-12 and GLS4 were explored. The anti-HBV activity in the HepAD38 system, and cytotoxicity profiles of each of the new compounds has been assessed. Among them, five new iodo- and bromo-heteroarylpyrimidines analogs displayed anti-HBV activity in the low micromolar range.

Management of Pneumonia in the Pediatric Critical Care Unit: An Area for Antimicrobial Stewardship

BACKGROUND

Pediatric pneumonia is one of the most common causes of childhood infection requiring hospitalization and is a substantial driver of antimicrobial use among hospitalized children. About 12-20% of pediatric patients hospitalized with community-acquired pneumonia (CAP) require critical care. Additionally, nosocomial pneumonias (i.e. hospital-acquired and ventilator- associated pneumonias) are responsible for 15-53% of hospital-associated infections and are the most common indication for empiric antibiotics in the pediatric intensive care unit.

OBJECTIVE

Respiratory infections, especially pneumonias, are a strong area for antimicrobial stewardship program (ASP) interventions, as they have been shown to improve patient outcomes while reducing inappropriate antimicrobial use, antimicrobial resistance, and overall costs.

METHOD

Optimizing the selection of appropriate antimicrobial therapies is difficult for pediatric pneumonias because of the ill-defined definitive diagnostic criteria and difficulty differentiating between viral and bacterial etiology.

RESULT

The aim of this review is to highlight the role of antimicrobial stewardship efforts in the treatment of pneumonias in critically ill children by discussing the emerging role of diagnostic criteria, the etiology of disease, appropriate targeted antimicrobial selection, and the optimization of antibiotic dosing and pharmacodynamic targets.

The OsHAPL1-DTH8-Hd1 complex functions as the transcription regulator to repress heading date in rice

Heading date is an important agronomic trait related to crop yield. Many genes related to heading date have already been identified in rice (Oryza sativa), and a complicated, preliminary regulatory genetic network has also already been established, but the protein regulatory network is poorly understood. We have identified a novel heading date regulator, Heme Activator Protein like 1 (OsHAPL1), which inhibits flowering under long-day conditions. OsHAPL1 is a nuclear-localized protein that is highly expressed in leaves in a rhythmic manner. OsHAPL1 can physically interact with Days To Heading on chromosome 8 (DTH8), which physically interacts with Heading date 1 (Hd1) both in vitro and in vivo. OsHAPL1 forms a complex with DTH8 and Hd1 in Escherichia coli. OsHAPL1, DTH8, and Hd1 physically interact with the HAP complex, and also with general transcription factors in yeast (Saccharomyces cerevisiae). Further studies showed that OsHAPL1 represses the expression of the florigen genes and FLOWERING LOCUS T 1 (RFT1) and Hd3a through Early heading date 1 (Ehd1). We propose that OsHAPL1 functions as a transcriptional regulator and, together with DTH8, Hd1, the HAP complex, and general transcription factors, regulates the expression of target genes and then affects heading date by influencing the expression of Hd3a and RFT1 through Ehd1.