Enterobacterales carrying chromosomal AmpC β-lactamases in Europe (EuESCPM): Epidemiology and antimicrobial resistance burden from a cohort of 27 hospitals, 2020-2022

INTRODUCTION

The ESCPM group (Enterobacter species including Klebsiella aerogenes - formerly Enterobacter aerogenes, Serratia species, Citrobacter freundii complex, Providencia species and Morganella morganii) has not yet been incorporated into systematic surveillance programs.

METHODS

We conducted a multicentre retrospective observational study analysing all ESCPM strains isolated from blood cultures in 27 European hospitals over a 3-year period (2020-2022). Diagnostic approach, epidemiology, and antimicrobial susceptibility were investigated.

RESULTS

Our study comprised 6,774 ESCPM isolates. MALDI-TOF coupled to mass spectrometry was the predominant technique for bacterial identification. Susceptibility to new β-lactam/β-lactamase inhibitor combinations and confirmation of AmpC overproduction were routinely tested in 33.3% and 29.6% of the centres, respectively. The most prevalent species were E. cloacae complex (44.8%) and S. marcescens (22.7%). Overall, third-generation cephalosporins (3GC), combined third- and fourth-generation cephalosporins (3GC + 4GC) and carbapenems resistance phenotypes were observed in 15.7%, 4.6%, and 9.5% of the isolates, respectively. AmpC overproduction was the most prevalent resistance mechanism detected (15.8%). Among carbapenemase-producers, carbapenemase type was provided in 44.4% of the isolates, VIM- (22.9%) and OXA-48-enzyme (16%) being the most frequently detected. E. cloacae complex, K. aerogenes and Providencia species exhibited the most notable cumulative antimicrobial resistance profiles, with the former displaying 3GC, combined 3GC + 4GC and carbapenems resistance phenotypes in 15.2%, 7.4%, and 12.8% of the isolates, respectively. K. aerogenes showed the highest rate of both 3GC resistant phenotype (29.8%) and AmpC overproduction (32.1%), while Providencia species those of both carbapenems resistance phenotype (42.7%) and carbapenemase production (29.4%). ESCPM isolates exhibiting both 3GC and combined 3GC + 4GC resistance phenotypes displayed high susceptibility to ceftazidime/avibactam (98.2% and 95.7%, respectively) and colistin (90.3% and 90.7%, respectively). Colistin emerged as the most active drug against ESCPM species (except those intrinsically resistant) displaying both carbapenems resistance phenotype (85.8%) and carbapenemase production (97.8%).

CONCLUSIONS

This study presented a current analysis of ESCPM species epidemiology in Europe, providing insights to inform current antibiotic treatments and guide strategies for antimicrobial stewardship and diagnostics.

Novel IL2RG Gene Mutation in One of Dizygotic Twins Causing Profound Changes of Receptor Structure

In this study, we report a 4-month-old boy with T^-B⁺NK^- severe combined immunodeficiency (SCID) due to a novel mutation in exon 2 of IL2RG, the gene encoding the interleukin (IL) common gamma chain (γc) of the cytokine receptors for IL-2, IL-4, IL-7, IL-9, IL-15, and IL-21. The patient was born from a twin pregnancy. He manifested recurrent infections of the gastrointestinal tract, whereas his twin brother was asymptomatic with no immune defects. In order to evaluate the effect of this unreported variant on the protein structure, a structural modeling process was performed showing prominent biochemical alterations of the protein features, including molecular weight, isoelectric charge, and possible changes to its secondary and tertiary structure.

Pedophilic sex offender show reduced actiation in the right dlpfc during integration of emotion and cognition – preliminary results

Introduction

The pedophilic disorder is characterized by a sexual preference for children and leads to child sexual abuse (CSA) in half of the patients. Studies showed that pedophiles with a history of CSA (CSA+) are inferior, in inhibitory control, to those without (CSA-).

Objectives

Inhibitory control may be influenced by negative affectivity, which was shown to be a state factor facilitating sexual abuse. Nevertheless, it is not known if distress influence CSA+ and CSA- equally.

Methods

We recruited three groups of participants: healthy controls (HC) CSA+ and CSA- who performed an emotional Go-NoGo block task. The task was design specifically to correspond to a situation in which an indivisual is opposed by a negative life event. In each trial, participants were presented with photographs, either of neutral or negative valence, which did not require reaction. After the photographs, a circle (Go stimuli) or a square (NoGo stimuli) was presented.

Results

We found that HC and CSA- had slower reaction time in negative compared to neutral condition (regardless of the block type), while CSA+ did not. Consequently, HC and CSA- showed increased activation in the right dorsolateral prefrontal cortex (DLPFC) in negative compared to the neutral condition, what was not observed in CSA+.

Conclusions

DLPFC is crucial for cognitive control, however, the activity of this region is modulated by emotional valence. Reduced engagement of dlPFC in CSA+ in negative condition (irrespectively of the task instructions), suggest that negative emotions in CSA+ disrupt also other aspects of cognitive control, rather than inhibition specifically.

Risk of left atrial appendage thrombus in older patients with atrial fibrillation

Introduction

We aimed to compare the prevalence of left atrial appendage (LAA) thrombus and its predictors between old and young patients with atrial fibrillation (AF).

Material and methods

The study included 1970 patients aged ≥ 65 (n = 822 (41.7%)) and < 65 (n = 1148 (58.3%)) referred for AF cardioversion or ablation preceded by transoesophageal echocardiography (TEE).

Results

Oral anticoagulation (OAC) was prescribed in 799 (97.2%) patients aged ≥ 65 years and in 1054 (91.8%) of those aged < 65 years (p < 0.001). In patients treated with OAC, those aged ≥ 65 years less often received vitamin K antagonist (VKA) (267 (33.4%) vs. 416 (39.5%)) and more often non-VKA-OAC (NOAC) (532 (66.6%) vs. 638 (60.5%), p = 0.008, p = 0.008) compared to patients < 65 years. On TEE, LAA thrombus was more often observed in patients aged ≥ 65 years than those aged < 65 years (63 (7.7%) vs. 46 (4.0%), p < 0.001), with an absolute but not statistically significant difference between patients aged 65-74 and ≥ 75 years (47 (7.3%) vs. 16 (8.8%), p = 0.528). In patients aged ≥ 65 years, there was no difference in the prevalence of LAA thrombus between patients treated with VKA and NOAC, in contrast to patients aged < 65 years, in whom such a difference was observed (27 (6.5%) vs. 16 (2.5%), p = 0.002). In multivariate logistic regression, predictors of LAA thrombus in both age groups were older age, non-paroxysmal AF, and heart failure, whereas only in patients aged < 65 years - VKA use, and in those aged ≥ 65 years - lower glomerular filtration rate and platelet count.

Conclusions

Despite OAC use, older patients with AF remain at high risk of LAA thrombus formation. Older age, non-paroxysmal AF, and heart failure are predictors of LAA thrombus, irrespective of age.

Prevalence and risk factors of left atrial thrombus in patients with atrial fibrillation and lower class (IIa) recommendation to anticoagulants

Background

Oral anticoagulation therapy (OAT) prevents ischaemic incidents in patients with atrial fibrillation (AF). CHA₂DS₂-VASc risk score of ≥2 points in men and ≥3 in women is a class I indication for OAT. OAT should also be considered as a prevention of thromboembolism in AF men with a CHA₂DS₂-VASc score of 1 point and women with 2 points, but the class of recommendation is lower (IIa). This study aims to assess the occurrence of left atrial appendage thrombus (LAAT) and risk factors of its formation in patients with lower class recommendation to oral antiocoagulation treatment.

Methods

The study group consisted of 1,858 patients: 555 patients with class IIa indication to OAT (IIa group) and 1,303 patients with class I indication as a control group (I group). Patients were admitted to three cardiology departments. All subjects underwent transoesophageal echocardiography.

Results

The incidence of LAAT was comparable in both IIa and I group: LAAT was confirmed in 30 (5.4%) subjects of IIa group and in 77 (5.9%) of I group. The prevalence of LAAT in IIa group was higher on treatment with VKAs (in comparison to NOACs) (8.4% vs. 3.4%, P=0.010), and lower in case of paroxysmal AF (in comparison to non-paroxysmal AF) (2.4% vs. 9.8%, P=0.0002). Multivariate logistic regression revealed the following variables as the independent predictors of LAAT in IIa group: treatment with VKAs (OR 2.99, 95% CI: 1.33-6.69; P=0.007), paroxysmal AF (OR 0.26, 95% CI: 0.11-0.62; P=0.002) and eGFR <60 mL/min/1.73 m² (OR 3.19, 95% CI: 1.42-7.16; P=0.005).

Conclusions

The prevalence of LAAT in AF patients with lower class (IIa) recommendation to anticoagulants was comparable to higher (I). Treatment with VKAs, along with non-paroxysmal type of AF and eGFR <60 mL/min/1.72 m² were identified as the strongest predictors of LAAT in IIa group.

Stroke prevention and guideline adherent antithrombotic treatment in elderly patients with atrial fibrillation: A real-world experience

Patients aged ≥75 years with the diagnosis of atrial fibrillation (AF) are at a higher risk of stroke and, according to recent recommendations, should receive oral anticoagulant (OAC) therapy. This study aimed to assess the recommended prophylactic antithrombotic therapy among patients with AF aged ≥ 75 years and its compliance with current guidelines. We also aimed to identify predisposing factors associated with the administration of non-vitamin K antagonist oral anticoagulants (NOACs) in elderly patients with AF.This was a retrospective, single-center observational study. Patients with AF aged ≥75 years hospitalized at a reference cardiology center from 2014 to 2017 were included in the analysis.Among the 1236 eligible patients (43.4% male; mean age, 82 years), OACs were recommended in 90.1% of cases. Of these, 59.8% of patients used NOACs and 40.2% used vitamin K antagonists. Additionally, 3.3% of patients received antiplatelet (AP) therapy and 2.5% were administered low molecular weight heparin. Only 4.5% of patients did not receive any anticoagulant treatment. The majority (89.9%) of patients received relevant prophylactic antithrombotic therapy according to current guidelines; only 1.4% were overtreated and 8.7% were undertreated. The significant predictors of NOAC therapy among patients treated with anticoagulants were non-permanent AF (odds ratio [OR] = 1.68, 95% confidence interval [CI] = 1.30-2.18, P = .0001), age-by 5 years (OR = 1.33, 95% CI = 1.16-1.52, P = .0001), and glomerular filtration rate-by 5 units (OR = 1.06, 95% CI = 1.02-1.10, P = .0066).A high percentage of AF patients aged ≥75 years receive OACs, mainly NOACs. Most patients are treated according to the current guidelines; under treatment is primarily observed in patients receiving AP therapy. Non-permanent AF, age, and preservation of renal function are significant predictors of NOAC use.

Does the CHA2DS2-VASc scale sufficiently predict the risk of left atrial appendage thrombus in patients with diagnosed atrial fibrillation treated with non-vitamin K oral anticoagulants?

The CHA2DS2-VASc scale does not include potential risk factors for left atrial appendage thrombus (LAAT) formation such as a form of atrial fibrillation (AF) and impaired kidney function. The real risk of thromboembolic complications in AF patients is still unclear as well as an optimal anticoagulant treatment in males with a CHA2DS2-VASc score of 1 and females with a CHA2DS2-VASc score of 2.The aim of this study was to compare the predictive value of the CHA2DS2-VASc scale and other scales to estimate the risk of LAAT formation in AF patients treated with non-vitamin K oral anticoagulants (NOACs) and to assess the prevalence of thrombi in patients at intermediate risk of stroke.The observational study included consecutive patients with a diagnosis of non-valvular AF treated with NOACs, admitted to 3 high-reference institutions between 2013 and 2018. All individuals underwent transoesophageal echocardiography before cardioversion or ablation.Out of 1163 enrolled AF patients (62.1% male, mean age 62 years) the LAAT had been detected in 50 individuals (4.3%). Among patients with LAAT, 1 patient (2.0%) was classified as a low-risk category, 9 (18.0%) were at intermediate-risk, and 40 (80.0%) were at high risk of thromboembolic complications according to CHA2DS2-VASc scale. All patients were treated with NOACs: 51.0% rivaroxaban, 47.1% dabigatran, and 1.9% apixaban.Patients at intermediate stroke-risk with detected LAAT had higher R2CHADS2 score (2.1 ± 1.2 vs 1.2 ± 0.8, P = .007), higher CHA2DS2-VASc-RAF score (6.4 ± 4.4 vs 3.7 ± 2.6, P = .027) and more often had an estimated glomerular filtration rate below 56 mL/min/1.73 m (44.4% vs 13.2%, P = .026) compared to patients without LAAT. The receiver operating characteristics revealed that the CHA2DS2-VASc-RAF scale had better predictive ability to distinguish between patients with and without LAAT in the study group than CHA2DS2-VASc (P = .0006), CHADS2 (P = .0006) and R2CHADS2 scale (P = .0140).The CHA2DS2-VASc scale should be supplemented with an assessment of renal function and form of AF to improve stroke risk estimation. The application of additional scales to estimate the risk of LAAT might be especially useful among males with a CHA2DS2-VASc score of 1 and females with a CHA2DS2-VASc score of 2.

Thrombus in the left atrial appendage in patients with atrial fibrillation treated with non-vitamin K antagonist oral anticoagulants in clinical practice-A multicenter registry

BACKGROUND

The prevalence and predictors of left atrial appendage thrombus (LAAT) in patients with non-valvular atrial fibrillation (AF) who have been treated with non-vitamin K antagonist oral anticoagulants (NOACs) are not well defined. We aimed to assess the occurrence and predictors of LAAT on transesophageal echocardiography (TOE) in patients with non-valvular AF treated with NOACs for at least 3 weeks.

METHODS

Consecutive patients with non-valvular AF who underwent TOE before catheter ablation or electrical cardioversion in three high-reference centers between 2014 and 2018 were included. Patients on apixaban were excluded from the study due to low numbers in this category. All patients received NOACs for at least 3 weeks before TOE.

RESULTS

A total of 1148 patients (female, 38.1%; mean age, 62.1 years) referred to our centers for catheter ablation of AF (52.1%) or electrical cardioversion (47.9%) were included. Patients were on rivaroxaban (51.9%) or dabigatran (48.1%). Preprocedural TOE revealed LAAT in 4.4% of all patients. Multivariable logistic regression analysis showed the CHA2DS2-VASc score ≥2 points (OR = 2.11; 95% CI, 1.15-3.88; P = .0161), non-paroxysmal AF (OR = 6.30; 95% CI, 2.22-17.91; P = .0005), and GFR <60 mL/min/1.73 m² (OR = 2.05; 95% CI, 1.14-3.67; P = .0160) were independent predictors of LAAT in patients treated with NOACs.

CONCLUSIONS

In non-valvular AF patients treated with NOACs, the prevalence of LAAT was 4.4% before electrical cardioversion or ablation. In addition to the CHA2DS2-VASc score, the type of AF and renal function should be considered in the stratification of thromboembolism risk in AF patients and qualification for a preprocedural TOE.

Risk of left atrial appendage thrombus in patients with atrial fibrillation and chronic kidney disease

Background

Atrial fibrillation (AF) and chronic kidney disease (CKD) are associated with an increased risk of ischemic stroke. The aim of this study was to compare the clinical characteristics, the incidence of left atrial appendage (LAA) thrombus and its predictors, and spontaneous echo contrast (SEC) in a population of patients with AF depending on estimated glomerular filtration rate (eGFR) values.

Methods

This study included 1962 patients who underwent transesophageal echocardiographic examination prior to cardioversion or ablation in the years 2014–2018 in three cardiac centers.

Results

More than a quarter of AF patients had decreased eGFR (< 60 mL/min/1.73 m²) and were characterized as a high-risk population, with more comorbidities, higher thromboembolic and bleeding risk compared to those with normal renal function. Oral anticoagulation (OAC) was prescribed in 97% and 93% of patients with decreased and normal eGFR, respectively, with a higher prevalence of prescribed non-vitamin K antagonist oral anticoagulants (NOACs). The incidence of LAA thrombus (24%, 9% and 4%) and SEC (25%, 25% and 19%) increases simultaneously with a decrease in eGFR (< 30, 30–59 and ≥ 60 mL/min/1.73 m², respectively). Among patients prescribed reduced doses of NOAC, those with decreased eGFR were more often observed with LAA thrombus (10% vs. 2.5%). Non-paroxysmal AF, heart failure and previous bleeding were predictors of LAA thrombus, irrespective of eGFR value. CKD was the predictor of LAA thrombus in all patients including those with non-paroxysmal AF, males, without diabetes, without hypertension and with CHA₂DS₂-VASc < 2.

Conclusions

Despite OAC, patients with concomitant AF and CKD remain at high risk for LAA thrombus formation.

The Influence of Inulin on the Retention of Polyphenolic Compounds during the Drying of Blackcurrant Juice

In blackcurrant juice powders made using freeze-, vacuum-, and spray-drying methods, 19 polyphenolic compounds were identified: anthocyanins (6), (+)-catechin, flavonols (8), and phenolic acids (4). The highest content of identified polyphenols was noted after vacuum drying at 90 °C, which was connected with the thermally induced release of (+)-catechin. Drying at this temperature also increased the formation of the Maillard reaction/caramelization product, hydroxymethyl-l-furfural, when inulin was added. The higher the vacuum drying temperature was, the stronger the degradation of anthocyanins was. Inulin was a better protectant of anthocyanins than maltodextrin, except during vacuum drying at 90 °C, which probably triggered inulin’s participation in the formation of hydroxymethyl-l-furfural (HMF), thus limiting its capability to protect anthocyanins. Flavonols and phenolic acids were best retained after vacuum drying at 50 °C. Carrier selection affected only slightly, whereas carrier concentration did not affect, the content of flavonols and phenolic acids. The quality of fruit juice powders should be considered taking into account a broad spectrum of factors, including the initial composition of the material subjected to drying, the drying parameters, the carrier type and concentration, and the interactions that occur during the thermal treatment of fruit juices.

Qualitative and Quantitative Evaluation of Heat-Induced Changes in Polyphenols and Antioxidant Capacity in Prunus domestica L. By-products

Plum pomace, an agro-industrial waste product has received attention due to the worldwide popularity of plums. During convection, the content of flavan-3-ols decrease, except drying at 90 °C, whereas the content of i.e., chlorogenic, 3-p- and 4-p-coumaroylquinic acids, quercetin rutinoside, and galactoside was observed to increase along with the increase in process temperature. The highest content of all identified polyphenols was found in plum pomace powders obtained using a combination of convective at 90 °C and microwave vacuum drying (MVD) at 120 W, whereas the highest retention of the group consisted of phenolic acids, flavonols, and anthocyanins was noted when CD 70 °C/MVD 120 W was used, pointing to a strong influence of the type of polyphenols on their changes caused by drying. The correlations between TEAC ABTS and the sum of flavonoids (r = 0.634) and anthocyanins (r = 0.704) were established. The multiple regression analysis showed that polyphenol content was more strongly affected by drying time than by maximum temperature, whereas antioxidant capacity was more influenced by maximum temperature of sample than by drying time.

Non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation in secondary stroke and systemic embolism prevention

BACKGROUND

Oral anticoagulants (OAC) are recommended in all patients with atrial fibrillation (AF) after thromboembolic events without contraindications. It is hypothesized herein, that the majority of patients with AF after thromboembolic events receive OAC and the presence of specific factors, predisposes the use of non-vitamin K antagonist oral anticoagulants (NOACs).

METHODS

This is a retrospective study, encompassing patients with AF hospitalized in a reference cardiology center over the years 2014-2017. Thromboembolic events were defined as: ischemic stroke, transient ischemic attack and systemic embolism. Inclusion criteria were the following: diagnosis of non-valvular AF at discharge from hospital, hospitalization not resulting in death.

RESULTS

Among 2834 hospitalized patients with AF, a history of thromboembolic events was identified in 347 (12.2%) patients. In the group studied, of 347 patients with AF after a thromboembolic event, 322 (92.8%) received OAC, including 133 patients on vitamin K antagonist (41.3% of patients on OAC) and 189 patients on NOACs (58.7% of patients on OAC). Among patients treated with NOACs the majority were on dabigatran (116 patients, 61.4%), followed by rivaroxaban (54 patients, 28.6%), and apixaban (19 patients, 10%). Multivariate logistic regression analysis demonstrated that the presence of arterial hypertension reduced the chance for NOACs use (OR 0.4, 95% CI 0.2-0.9, p = 0.04) and left atrial size ≤ 40 mm was a factor increasing the chance for the use of NOACs (OR 2.5, 95% CI 1.1-5.8, p = 0.03).

CONCLUSIONS

Nearly all hospitalized patients with AF received OAC in the secondary prevention of thromboembolic complications. NOACs were used for secondary prevention of stroke among patients with AF in patients with fewer comorbidities.

Deposition of mullite in peatlands of southern Poland: Implications for recording large-scale industrial processes

Mullite, a pure aluminosilicate (Al₆Si₂O₁₃), is a rare natural rock component, known for centuries as a very resistant ceramic material. It is also a common waste product of high-temperature coal combustion that is emitted in quantity from coal-based power stations. The occurrence of mullite in two Sphagnum-dominated peatlands located near the Upper Silesia industrial region in southern Poland is described. For the first time, a complete record of mullite deposition in the peat profiles has been obtained by XRD analyses of ashed peat samples. The mullite distribution is compared with records of Hg, Pb and Cu. While mullite is supplied during high temperature processes only, Cu, Pb and Hg show more complex pattern of distribution. Both peat profiles contain elevated amounts of mullite in the time span between ca 1950-1990 with a maximum content in ca 1980. The first appearance (∼1900) of mullite is indicative of the beginning of energy production in coal-based power plants in the region. Mullite is proposed here as an indicator of industrialization in geological records. It is resistant to post-depositional processes, emitted globally, and restricted to large-scale industry.

Sexual Dysfunction Is a More Common Problem in Young Women with Type 1 Diabetes than in Healthy Women

The aim of the study was to analyze the relationship between the presence of type 1 diabetes and sexual dysfunction among young women. The study group consisted of 230 women, including 70 healthy and 160 with diabetes mellitus type 1 (DM1). All the participants voluntarily filled anonymous questionnaire. The results regarding sexual function were obtained using a Female Sexual Function Index (FSFI) questionnaire. Statistical analysis was performed for sexually active people. In the study group, 180 women declared sexual activity: 62 healthy (88%) and 118 with DM1 (82.5%). Women with DM1 in comparison with healthy women were older, had higher BMI, weight, and had more pack-years of cigarette smoking. Women with DM1 had lower results in FSFI and more often achieved scores below the clinical cutoff point. In a multiple linear regression model, the presence of diabetes predicted lower FSFI results. DM1 is independently associated with the presence of impaired sexual function. Sexual dysfunctions are more common among young women with DM1 than in healthy controls. The relationship is significant despite of the age, duration of diabetes, body weight, and presence of angiopathy.

Insulin Resistance in Adults with Type 1 Diabetes is Associated with Lower Vitamin D Serum Concentration

AIM

Type 1 diabetes mellitus (T1DM) is a disease characterized by an absolute deficiency of endogenous insulin secretion. Insulin resistance (IR) may develop among patients with T1DM. Vitamin D deficiency was reported to be a risk factor in the development of IR. The aim of the study was to assess the relationship between serum concentrations of 25-hydroxyvitamin D (25(OH)D) and IR among patients with T1DM.

METHODS

The test group consisted of 110 adult patients [males=65 (59%)] with T1DM. Participants were recruited in Poland between 1^st October and 30^th April in 2015/2016 and 2016/2017. VD serum level was assessed by ELISA array. IR was assessed by estimated Glucose Disposal Rate (eGDR).

RESULTS

In the study group 21 (19%) patients were recognized as IR according to eGDR cut-offs (<7.5 mg/kg/min), 52 (47.3%) patients had VD deficiency (25(OH)D<20 ng/ml), 16 (14.5%) patients had 25(OH)D<10 ng/ml. Only 6 (5%) participants reported VD supplementation. Patients with IR, according to eGDR cut-off revealed significantly lower 25(OH)D serum level 15.7 (9.2-28.4) vs. 22.1 (13.0-38.4) ng/ml; p=0.04 as compared to patients without IR. R Spearman analysis found a positive relationship between VD and eGDR (Rs=0.27; p<0.01). Logistic regression analysis revealed significant relationship between the presence of IR and VD serum level/presence of 25(OH)D serum level below 10 ng/ml, both models adjusted to sex, age, BMI, LDL and triglycerides, accordingly (OR=0.95, CI: 0.90-0.99; p=0.04) and (OR=4.19, CI: 1.04-16.93; p=0.04).

CONCLUSION

The serum concentration of Vitamin D is negatively associated with insulin resistance in patients with T1DM and may have clinical implications.

Atrial fibrillation type and renal dysfunction as important predictors of left atrial thrombus

OBJECTIVE

We aimed to identify predictors of left atrial appendage (LAA) thrombus in patients with atrial fibrillation (AF) and to enhance the prognostic value of the CHA₂DS₂-VASc score.

METHODS

Derivation cohort included 1033 consecutive AF patients referred for catheter ablation or direct current cardioversion, in whom transoesophageal echocardiography (TOE) was performed prior to the procedure. Logistic regression analysis was used to identify predictors of LAA thrombus on TOE. Receiver operating characteristic (ROC) curves were constructed to compare the newly developed score with the CHA₂DS₂ and CHA₂DS₂-VASc scores in the derivation and the validation (n=320) cohort.

RESULTS

On TOE, LAA thrombus was present in 59 (5.7%) patients in the derivation cohort. Aside from variables encompassed by the CHA₂DS₂-VASc score, LAA thrombus predictors included AF type (persistent/'permanent' vs paroxysmal) and renal dysfunction. These predictors were incorporated into the CHA₂DS₂-VASc score. In ROC analysis, area under the curve (AUC) for the new score (CHA₂DS₂-VASc-RAF score) was significantly higher (0.81) than those for the CHA₂DS₂ and CHA₂DS₂-VASc scores (0.71 and 0.70, respectively). In the validation cohort, the CHA₂DS₂-VASc-RAF score also performed significantly better (AUC of 0.88) than the CHA₂DS₂ and CHA₂DS₂-VASc scores (AUC of 0.63 and 0.60, respectively).

CONCLUSION

In real-world AF patients with majority on oral anticoagulation, LAA thrombus was found in approximately 6%. Two variables not included in the CHA₂DS₂-VASc score (AF type and renal dysfunction) proved strong, independent predictors of LAA thrombus and might improve thromboembolic risk stratification.

Microbial quality of organic and conventional vegetables from Polish farms

Microbiological analyses of lettuce, radish, carrot and beetroot were conducted to determine the effect of production system (organic and conventional) on the microbial quality of vegetables in Poland. During 2010-2014 growing seasons, 600 organic and 372 conventional samples were collected from certified farms. The vegetables were analyzed for aerobic mesophilic bacteria, yeasts and molds, Enterobacteriaceae, coliforms and Escherichia coli according to Polish standards. The farmer's survey was conducted to collect information on farm management practices. The index (from 0 - no risk to 4 - high risk) of potential contamination of the produce by human pathogens, related to fertilization system was developed. The mesophilic bacteria, yeasts and molds, coliforms and Enterobacteriaceae numbers for the radish and carrot were similar for organic and conventional cultivation systems (mesophilic bacteria 7.0 log10 cfu g-1 and 6.6 log10 cfu g-1; yeasts and molds 5.1 and 4.8; coliforms 1.3 and 1.5; Enterobacteriaceae 2.1 and 2.3 for radish and carrot respectively). Organic lettuce harbored significantly more bacteria than conventional (mesophilic 6.7 log10 cfu g-1 and 6.4 log10 cfu g-1, coliforms 1.8 and 1.4; Enterobacteriaceae 2.5 and 1.9 for organic and conventional respectively). Organic beetroot contained higher number of yeasts and molds (5.1 log10 cfu g-1) and Enterobacteriaceae (2.9 log10 cfu g-1) than conventional (4.9 and 2.5 log10 cfu g-1). The vegetables from organic farms showed significantly higher load of E. coli (on average 0.42 log10 cfu g-1) than conventionally cultivated vegetables (in average 0.05 log10 cfu g-1). The index 0-4 of potential risk of produce contamination by human pathogens was created according to fertilization practices in both farm types. Its value increased with enhanced contribution of manures and other animal wastes. In organic production the main fertilization practice was application of animal manures, composted and not composted. A popular practice was also top dressing of growing plants with fermented plant extracts, sometimes enriched with dungwater. In conventional farming system mineral fertilization was the main source of the vegetable nutrition. Therefore, organic produce indicated higher index of contamination risk (2-4) than conventional vegetables (1-2). High indexes were positively associated with higher number of E. coli. It was found that fertilization system practiced in organic farms may deteriorate sanitary quality of the produce.

The Influence of Convective, Microwave Vacuum and Microwave-Assisted Drying on Blueberry Pomace Physicochemical Properties

The effect of hot air convective drying (HACD), microwave-vacuum drying (MWVD) and combined drying (HACD + MWVD) on the drying kinetics, bioactive compounds and color of blueberry pomace was evaluated. Drying time of blueberry pomace ranged from 0.6 to 6.7 h and moisture diffusion coefficients ranged from 7.94 × 10–8 to 1.83 × 10–7 m2/s. Drying caused degradation of total polyphenolics (TP) (39–76%), monomeric anthocyanins (21–77%) and antioxidant capacity values (24–76%). Drying time was shortened even by 91%, when MWVD was used instead of HACD. MWVD of blueberry pomace resulted in the smallest, while HACD at 60°C in the greatest loss of bioactive compounds and antioxidant capacity. HACD at 60°C + MWVD allowed to obtain a product with a higher content of TP, monomeric anthocyanins and a stronger antioxidant capacity than HACD at 90°C + MWVD. Combination of HACD at 60°C with MWVD allowed for the shortening of HACD time by 75% as well as for hapering the chemical changes as compared to HACD at 60°C. Even when the combination of HACD at 90°C with MWVD shortened the drying time by 68%, it did not improve the retention of TP, monomeric anthocyanins and antioxidant capacity when compared to HACD at 90°C.

The Influence of Selected Drying Methods on the Physical Properties of Dried Apples cv. Jonagold Grown in Different Locations in Europe

The aim of the study was to determine the influence of four different growing locations of apples cv. ‘Jonagold’ in Europe on the drying kinetics and the physical properties of dried apple slices. The drying methods applied in the study (freeze-drying, convective drying, microwave-vacuum drying and combined drying) significantly affected the drying time, which was the shortest in the case of microwave vacuum drying. The geographical origin of the apples affected the chemical and physical properties of the raw material used for drying, and, consequently, the drying time. Water activity of dried samples was connected with the final dry matter, regardless of the geographical origin of the apples. Freeze-drying resulted in the lightest in colour products (L*), whereas microwave-vacuum dried products had the highest levels of yellow pigments (b*). The highest chroma and browning index values were noted for microwave-vacuum dried samples and were strongly influenced by the drying temperature. The mechanical properties of the apple slices were more dependent on the drying method and temperature of the process than on the geographical origin when the temperature exceeded 83 °C.

Chemical Composition and Antioxidant Properties of Powders Obtained from Different Plum Juice Formulations

Among popular crops, plum (Prunus domestica L.) has received special attention due to its health-promoting properties. The seasonality of this fruit makes it impossible to consume it throughout the year, so new products in a powder form may offer an alternative to fresh consumption and may be used as high-quality natural food ingredients. A 100% plum (cultivar “Valor”) juice was mixed with three different concentrations of maltodextrin or subjected to sugars removal by amberlite-XAD column, and dried using the freeze, spray, and vacuum (40, 60, and 80 °C) drying techniques. The identification and quantification of phenolic acids, flavonols, and anthocyanins in plum powders was performed by LC-MS QTof and UPLC-PDA, respectively. l-ascorbic acid, hydroxymethylfurfural, and antioxidant capacity were measured by the Trolox equivalent antioxidant capacity (TEAC) ABTS and ferric reducing antioxidant potential (FRAP) methods in order to compare the influence of the drying methods on product quality. The results indicated that the profile of polyphenolic compounds in the plum juice powders significantly differed from the whole plum powders. The drying of a sugar free plum extract resulted in higher content of polyphenolic compounds, l-ascorbic acid and antioxidant capacity, but lower content of hydroxymethylfurfural, regardless of drying method applied. Thus, the formulation of plum juice before drying and the drying method should be carefully selected in order to obtain high-quality powders.

Overall Quality of Fruits and Vegetables Products Affected by the Drying Processes with the Assistance of Vacuum-Microwaves

The seasonality of fruits and vegetables makes it impossible to consume and use them throughout the year, thus numerous processing efforts have been made to offer an alternative to their fresh consumption and application. To prolong their availability on the market, drying has received special attention as currently this method is considered one of the most common ways for obtaining food and pharmaceutical products from natural sources. This paper demonstrates the weakness of common drying methods applied for fruits and vegetables and the possible ways to improve the quality using different drying techniques or their combination with an emphasis on the microwave energy. Particular attention has been drawn to the combined drying with the assistance of vacuum-microwaves. The quality of the dried products was ascribed by chemical properties including the content of polyphenols, antioxidant capacity and volatiles as well as physical parameters such as color, shrinkage, porosity and texture. Both these fields of quality classification were considered taking into account sensory attributes and energy aspects in the perspective of possible industrial applications. In conclusion, the most promising way for improving the quality of dried fruit and vegetable products is hybrid drying consisting of osmotic dehydration in concentrated fruit juices followed by heat pump drying and vacuum-microwave finish drying.

Microwave-assisted drying of blueberry (Vaccinium corymbosum L.) fruits: Drying kinetics, polyphenols, anthocyanins, antioxidant capacity, colour and texture

The aim of the study was to evaluate the effect of hot air convective drying (HACD), microwave vacuum drying (MWVD) and their combination (HACD+MWVD) on the drying kinetics, colour, total polyphenols, anthocyanins antioxidant capacity and texture of frozen/thawed blueberries. Drying resulted in reduction of total polyphenols content and antioxidant capacity (69 and 77%, respectively). The highest content of total polyphenols was noted after HACD at 90°C. Lower air temperature and prolonged exposure to oxygen resulted in greater degradation of polyphenols and antioxidant capacity. Drying processes caused a significant decrease (from 70 to 95%) in the content of anthocyanins. The highest content of anthocyanins and the strongest antioxidant capacity was found in blueberries dried using HACD at 90°C+MWVD. Among drying methods, HACD at 90°C+MWVD satisfied significant requirements for dried fruits i.e. short drying time and improved product quality.

Physicochemical properties of whole fruit plum powders obtained using different drying technologies

Physicochemical quality parameters of plum powders obtained by applying conventional drying methods and their combination devised to process plums were evaluated. The effect of freeze-drying (FD), vacuum drying (VD), convective drying (CD), microwave-vacuum drying (MVD) and combination of convective pre-drying and microwave finish-drying (CPD-MVFD) affected physical (bulk density, porosity, colour, solubility) and chemical (polyphenolic compounds determined by UPLC and antioxidant capacity by TEAC ABTS and FRAP methods) properties of plum powders. The MVD at 1.2 W g(-1) and a novel combination for plum powders production - CPD-MVFD at 70 °C/1.2 W g(-1) allowed the best preservation of phenolic compounds and increased the efficiency of production. Results obtained support the use of MVD and its combination for better quality of dried plum products. The study proved that the determination of the browning index and HMF level (formed via Maillard reaction) might be good tool for monitoring the thermal processing of plum powders.

Bioactive Compounds of Blueberries: Post-Harvest Factors Influencing the Nutritional Value of Products

Blueberries, besides having commonly-recognized taste properties, are also a valuable source of health-promoting bioactive compounds. For several decades, blueberries have gained in popularity all over the world, and recent years have seen not only an increase in fresh consumption, but also in the importance of blueberries for the processing industry. Blueberry processing mostly consists of freezing and juicing. Recently, more attention has been drawn to dewatering and drying, which are promising areas for developing novel blueberry products. Processing affects each biologically-active compound in a different way, and it is still unknown what changes those compounds undergo at the molecular level after the application of different processing technologies. This work presents the most recent state of knowledge about the pre-treatment and processing methods applied to blueberries and their influence on the content of biologically-active compounds. The presentation of methods is preceded by a brief overview of the characteristics of the blueberry species, a description of the chemical composition of the fruit and a short note about the main growing areas, production volumes and the management of fruit crops.

Selective ion-sensing with membrane-functionalized electrolyte-gated carbon nanotube field-effect transistors

In this work the ion-selective response of an electrolyte-gated carbon-nanotube field-effect transistor (CNT-FET) towards K(+), Ca(2+) and Cl(-) in the biologically relevant concentration range from 10(-1) M to 10(-6) M is demonstrated. The ion-selective response is achieved by modifying the gate-electrode of an electrolyte-gated CNT-FET with ion-selective membranes, which are selective towards the respective target analyte ions. The selectivity, assured by the ion-selective poly(vinyl chloride) based membrane, allows the successful application of the herein proposed K(+)-selective CNT-FET to detect changes in the K(+) activity in the μM range even in solutions containing different ionic backgrounds. The sensing mechanism relies on a superposition of both an ion-sensitive response of the CNT-network as well as a change of the effective gate potential present at the semiconducting channel due to a selective and ion activity-dependent response of the membrane towards different types of ions. Moreover, the combination of a CNT-FET as a transducing element gated with an ion-selective coated-wire electrode offers the possibility to miniaturize the already well-established conventional ion-selective electrode setup. This approach represents a valuable strategy for the realization of portable, multi-purpose and low-cost biosensing devices.

Identification of plasmid OXA and other β-lactamase genes among carbapenem-resistant isolates of Pseudomonas aeruginosa from the Clinical University Hospital in northeastern Poland

The aim of the study was to evaluate the prevalence of OXA and other β-lactamase genes, antibiotic susceptibility, and the genetic relatedness among clinical isolates of P. aeruginosa resistant to carbapenems. The presence of bla- OXA genes was demonstrated in 48% of isolates belonging to four PFGE profiles. Most of them contained the blaOXA-2 gene (88.3%). Other blaOXA genes (Ps1310 with blaOXA-30 and Ps1309 with blaOXA-10) were found in only two isolates. The tested isolates also contained other β-lactamase genes such as blaVIM-2, blaVIM-4, blaSHV-5, and blaTEM-1. All isolates were susceptible only to colistin (100%).

Human meningitis caused by Streptococcus suis

Streptococcus suis is an important swine pathogen worldwide, which can be transmitted to human beings by direct contact; therefore, S. suis infections occur mainly in people who handle pigs or pork. We present a case of a patient with S. suis meningitis who worked as a butcher in a meat processing plant for 5 years. The 35-year-old man was admitted to the Department of Infectious Diseases in T. Browicz Memorial Central Infectious Disease and Observation Hospital in Bydgoszcz, Poland, with suspected bacterial meningitis. According to his medical history, the patient had been injured during the processing of pork. A microbiological examination of the cerebrospinal fluid and blood revealed S. suis as a single aetiological factor of this infection. The patient was empirically administered cefotaxime (2.0 g at 8-h intervals) and penicillin (9 million U at 8-h intervals). The patient made a complete recovery and his inflammatory markers normalized. Only the hearing deficit of his right ear did not disappear. An otolaryngologist recommended a 4-week steroid therapy. The patient was not examined because he did not report to the clinic. To our knowledge this is the first described case of human meningitis caused by S. suis in Poland.

Indocyanine green angiography in chronic central serous chorioretinopathy

BACKGROUND

Central serous chorioretinopathy (CSC) is a condition that originates from alterations of the choroidal circulation. The aim of this paper was to evaluate the use of indocyanine green angiography (ICGA) in patients with chronic CSC.

MATERIAL/METHODS

The analysis included 17 patients (34 eyes) with chronic CSC in at least 1 eye. The eye examination included: distance and near visual acuity, biomicroscopy, applanation tonometry, fundus examination, colored and red-free fundus photography, evaluation of autofluorescence, optical coherence tomography, and fluorescein and indocyanine green angiography.

RESULTS

In 34 eyes (100%) involved in the ICGA study the results revealed zones of transient increased choroidal vessels permeability. In 18 eyes (52.9%) choroidal changes were accompanied by a focal serous pigment epithelial detachment. In 4 eyes (11.8%) of 3 patients' the ICGA examination confirmed the presence of occult choroidal neovascularization (CNV). In the patient with bilateral diffuse retinal pigment epitheliopathy, CNV was present in 1 eye, in the patient with unilateral chronic CSC it was also present in 1 eye, and in the third patient with bilateral chronic CSC it was detected in both eyes.

CONCLUSIONS

ICGA is a very useful examination that enables ophthalmologists to visualize choroidal changes due to chronic CSC, as well as to diagnose occult CNV in chronic CSC.

[Morganella sp. rods--characteristics, infections, mechanisms of resistance to antibiotics]

The Morganella genus is one member of the tribe Proteae, which also includes the genera Proteus and Providencia. These bacteria are commonly present in the environment. Morganella sp. rods are known to be a causative agent of opportunistic hospital infections, mainly urinary tract, wound and blood infections of severe and high mortality, even in cases of an appropriate antibiotic. These bacteria may produce many virulence factors, for example urease, hemolysins, LPS, adhesins and enzymes hydrolyzing and modifying antibiotics commonly used to treat infections. Understanding the diverse biological properties of these rods may be of importance in the development of effective methods of prevention and control of infections with their participation.  

Generation of induced pluripotent stem cell lines from Friedreich ataxia patients

Friedreich ataxia (FRDA) is an autosomal recessive disorder characterised by neurodegeneration and cardiomyopathy. It is caused by a trinucleotide (GAA) repeat expansion in the first intron of the FXN gene that results in reduced synthesis of FXN mRNA and its protein product, frataxin. We report the generation of induced pluripotent stem (iPS) cell lines derived from skin fibroblasts from two FRDA patients. Each of the patient-derived iPS (FA-iPS) cell lines maintain the GAA repeat expansion and the reduced FXN mRNA expression that are characteristic of the patient. The FA-iPS cells are pluripotent and form teratomas when injected into nude mice. We demonstrate that following in vitro differentiation the FA-iPS cells give rise to the two cell types primarily affected in FRDA, peripheral neurons and cardiomyocytes. The FA-iPS cell lines have the potential to provide valuable models to study the cellular pathology of FRDA and to develop high-throughput drug screening assays. We have previously demonstrated that stable insertion of a functional human BAC containing the intact FXN gene into stem cells results in the expression of frataxin protein in differentiated neurons. As such, iPS cell lines derived from FRDA patients, following correction of the mutated gene, could provide a useful source of immunocompatible cells for transplantation therapy.

Accelerated stem cell attachment to ultrafine grained titanium

Commercial purity titanium with an average grain size in the low sub-micron range was produced by equal channel angular pressing (ECAP). Attachment of human bone marrow-derived mesenchymal stem cells (hMSCs) to the surface of conventional coarse grained and ECAP-modified titanium was studied. It was demonstrated that the attachment and spreading of hMSCs in the initial stages (up to 24h) of culture was enhanced by grain refinement. Surface characterization by a range of techniques showed that the main factor responsible for the observed acceleration of hMSC attachment and spreading on titanium due to grain refinement in the bulk is the attendant changes in surface topography on the nanoscale. These results indicate that, in addition to its superior mechanical properties, ECAP-modified titanium possesses improved biocompatibility, which makes it to a potent candidate for applications in medical implants.

[Antimicrobial sensitive of Morganella morganii]

The aim of this study was the evaluation of the antimicrobial sensitive of Morganella morganii rods isolated from clinical samples. This study included 50 of M. morganii strains isolated in the Clinical Microbiology Department of dr. A. Jurasz University Hospital in 2008-2009. All of strains were sensitive to carbapenems (imipenem, meropenem, ertapenem, doripenem) and piperacillin/tazobactam and most of them to beta-lactam antibiotics, aminoglycosides and fluorochinolons. Resistance to tetracyclines demonstrated 38,0% strains and to doxycycline - 40,0%. One out of 6 strains isolated from urine samples were sensitive to nitrofurantoin. Extended Spectrum Beta-Lactamases were produced by 5 (10,0%) strains.

[Extracellular slime production and adhesion of Morganella morganii strains to polystyrene]

The aim of this study was the evaluation of the ability of extracellular slime production and adhesive properties of M. morganii strains. This study included 50 of M. morganii strains isolated from clinical samples. All of these strains were isolated in the Clinical Microbiology Department of dr. A. Jurasz University Hospital in 2008-2009. Five (10.0%) out of 50. M. morganii strains demonstrated extracellular slime production. Adherence to polystyrene revealed 36 (72.0%) of M. morganii strains in it 6 strains (12.0%) adhered strongly, medium - 12 (24.0%) and weakly - 18 (36.0%).

[Susceptibility to antibiotics of Enterobacter spp. rods isolated from urine]

Enterobacter spp. rods are opportunistic microorganisms which cause of urinary tract infections. The aim of this study was the evaluation of the susceptibility to antimicrobial agents antibiotics of Enterobacter spp. rods isolated from urine. The study was carried 50 of Enterobacter spp strains isolated in the Clinical Microbiology Department of dr. A. Jurasz University Hospital. Antibiotic susceptibility was tested by disk diffusion method. All of strains were susceptible to imipenem and meropenem. There was 87,5% of strains sensitive to doripenem, 79,2% to ertapenem, 54,0% to piperacillin/tazobactam and 50,0% to cephepime. The relatively high percentage (62,0%) of Enterobacter spp. was sensitive to fluoroquinolones. Extended spectrum beta-lactamases were produced by 24 (48,0%) strains.

Changes in protein quality and antioxidant properties of buckwheat seeds and groats induced by roasting

This study focused on the evaluation of changes in protein quality and antioxidant properties of buckwheat seeds and groats induced by roasting. Changes in protein quality were indirectly measured by Maillard reaction chemical indicators such as furosine, FAST index, and browning. Characterization of antioxidant profiles of raw whole seeds, roasted whole seeds, raw groats, and roasted groats was undertaken by determining the extractable total phenolic compounds (TPC), extractable total flavonoids (TF) and individual flavonoids, lipophilic and hydrophilic peroxyl radical scavengers by ORAC(FL) assay, and scavengers of ABTS radical cations by TEAC assay. Roasting significantly decreased the total protein content of groats, whereas this parameter was not affected by the thermal treatment of whole seeds. The formation of MRPs was induced by the thermal treatment of both whole seeds and groats, thus suggesting deterioration of protein quality due to this chemical event. A significant degradation in natural antioxidants due to thermal processing was observed. Most of the peroxyl radical scavenging activity of samples was associated with hydrophilic compounds because L-ORAC(FL) values were on average 9% of the H-ORAC(FL) values. The H-ORAC(FL) values were positively correlated with extractable TPC contents (r = 0.51) and extractable TF contents (r = 0.93), whereas they showed a negative correlation with furosine (r = -0.87), FAST index (r = -0.85), and browning (r = -0.98) results.