Mpox Viral Lineage Analysis and Technique Development Using Next-generation Sequencing Approach

BACKGROUND

In response to Mpox endemic and public health emergency, DCHHS aimed to develop NGS based techniques to streamline Mpox viral clade and lineage analysis.

METHODS

The Mpox sequencing workflow started with DNA extraction and adapted Illumina's COVIDSeq assay using hMpox primer pools from Yale School of Public Health. Sequencing steps included cDNA amplification, tagmentation, PCR indexing, pooling libraries, sequencing on MiSeq, data analysis, and report generation. The bioinformatic analysis comprised read assembly and consensus sequence mapping to reference genomes and variant identification, and utilized pipelines including Illumina BaseSpace, NextClade, CLC Workbench, Terra.bio for data quality control (QC) and validation.

RESULTS

In total, 171 mpox samples were sequenced using modified COVIDSeq workflow and QC metrics were assessed for read quality, depth, and coverage. Multiple analysis pipelines identified the West African clade IIb as the only clade during peak Mpox infection from July through October 2022. Analyses also indicated lineage B.1.2 as the dominant variant comprising the majority of Mpox viral genomes (77.7%), implying its geographical distribution in the United States. Viral sequences were uploaded to GISAID EpiPox.

CONCLUSIONS

We developed NGS workflows to precisely detect and analyze mpox viral clade and lineages aiding in public health genomic surveillance.

The Fragility of Scientific Rigour and Integrity in "Sped up Science": Research Misconduct, Bias, and Hype and in the COVID-19 Pandemic

During the early years of the COVID-19 pandemic, preclinical and clinical research were sped up and scaled up in both the public and private sectors and in partnerships between them. This resulted in some extraordinary advances, but it also raised a range of issues regarding the ethics, rigour, and integrity of scientific research, academic publication, and public communication. Many of the failures of scientific rigour and integrity that occurred during the pandemic were exacerbated by the rush to generate, disseminate, and implement research findings, which not only created opportunities for unscrupulous actors but also compromised the methodological, peer review, and advisory processes that would usually identify sub-standard research and prevent compromised clinical or policy-level decisions. While it would be tempting to attribute these failures of science and its translation solely to the "unprecedented" circumstances of the COVID-19 pandemic, the reality is that they preceded the pandemic and will continue to arise once it is over. Existing strategies for promoting scientific rigour and integrity need to be made more rigorous, better integrated into research training and institutional cultures, and made more sophisticated. They might also need to be modified or supplemented with other strategies that are fit for purpose not only in public health emergencies but in any research that is sped-up and scaled up to address urgent unmet medical needs.

A Severe Acute Respiratory Syndrome Coronavirus 2 Anti-Spike Immunoglobulin G Assay: A Robust Method for Evaluation of Vaccine Immunogenicity Using an Established Correlate of Protection

As the COVID-19 pandemic continues, variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to emerge. Immunogenicity evaluation of vaccines and identification of correlates of protection for vaccine effectiveness is critical to aid the development of vaccines against emerging variants. Anti-recombinant spike (rS) protein immunoglobulin G (IgG) quantitation in the systemic circulation (serum/plasma) is shown to correlate with vaccine efficacy. Thus, an enzyme-linked immunosorbent assay (ELISA)-based binding assay to detect SARS-CoV-2 (ancestral and variant strains) anti-rS IgG in human serum samples was developed and validated. This assay successfully met acceptance criteria for inter/intra-assay precision, specificity, selectivity, linearity, lower/upper limits of quantitation, matrix effects, and assay robustness. The analyte in serum was stable for up to 8 freeze/thaw cycles and 2 years in -80 °C storage. Similar results were observed for the Beta, Delta, and Omicron BA.1/BA.5/XBB.1.5 variant-adapted assays. Anti-rS IgG assay results correlated significantly with neutralization and receptor binding inhibition assays. In addition, usage of international reference standards allows data extrapolation to WHO international units (BAU/mL), facilitating comparison of results with other IgG assays. This anti-rS IgG assay is a robust, high-throughput method to evaluate binding IgG responses to S protein in serum, enabling rapid development of effective vaccines against emerging COVID-19 variants.

Diet quality, asthma and airway inflammation in school-aged children

Summary

Background. Asthma is a major public health problem, with increasing prevalence in most countries, particularly among children. Poor dietary quality is also increasing in children, and evidence of the overall quality of children's food patterns effects on asthma is scarce. Methods. This cross-sectional analysis (660 children: 49.1% females, aged 7-12years) evaluated the association between diet quality and asthma (n = 56) and airway inflammation among school-aged children according to body mass index (BMI). Diet quality was assessed through the Healthy Eating Index (HEI)-2015, and categorized by tertiles. Higher scores represent a healthier diet. A questionnaire was used to enquire about self-reported medical diagnosis of asthma and asthma under medication. Lung function and airway reversibility were measured, and airway inflammation assessed measuring exhaled fractional nitric oxide (eNO). Two categories of BMI were considered: non-overweight/obese (p less than 85^th), (n = 491), and overweight/obese (p ≥ than 85^th), (n = 169). The associations between diet quality and asthma and airway inflammation were estimated using logistic regression models. Results. Non-overweight/obese children in 2^nd tertile of HEI-2015 score had decreased odds of having eNO ≥ 35ppb (OR 0.43, 95%CI 0.19-0.98), medical diagnosis of asthma (OR 0.18; 95%CI 0.04-0.84), and asthma treatment (OR 0.12; 95%CI 0.01-0.95), compared to children in the 1^st tertile. Conclusions. Our findings suggest that a higher diet quality associates with lower levels of airway inflammation and reduced prevalence of asthma among non-overweight/obese school-aged children.

Biologicals in severe chronic rhinosinusitis with nasal polyps: translation to clinical practice while waiting for head-to-head studies

Chronic rhinosinusitis with nasal polyps (CRSwNP) affects 1.0-2.6% of the population (1) and results in relevant direct and indirect costs. Recently, several randomized controlled trials (RCTs) with Type 2-targeting biologicals (anti-IL4Rα, anti-IL5R, anti-IL5 and anti-IgE) opened a new treatment field for patients refractory to first-line treatments (2,3).

(Very) long-term transport of Silurus glanis, Carcharhinus melanopterus, Scomber colias, Trachurus picturatus, Polyprion americanus, Rhinoptera marmoratus, Salmo salar, Scomber scombrus, Sardina pilchardus, and others, by land, water and air

In this paper, we cover 4 years of live fish transports that ranged from 14 to 200 h (8 days), and bioloads from 3.8 to 76.9 kg/m³ . The key ingredients for success in all trips, where virtually no mortality occurred, was atributed to (1) pre-buffering the water with sodium bicarbonate and sodium carbonate at 50 g/m³ (each)-and/or ATM Alka-Haul^TM at 25 g/m³ -and applying additional (partial or full) doses throughout each transport, whenever the tanks were accessible; (2) pre-quenching ammonia with ATM Triage^TM at 32 g/m³ , and applying additional (partial or full) doses throughout each transport, whenever the tanks were accessible; (3) keeping the dissolved oxygen saturation rate above 100%, ideally above 150%; (4) Keeping temperature on the lower limit of each species' tolerance range; (5) Using foam fractionators to effectively eliminate organic matter from the water and (6) Using pure sine wave inverters, which allows for a steady supply of electrical current throughout the transport. The use of a 'preventive' versus 'corrective' pH buffering philosophy is also discussed.

Computational design of mechanically coupled axle-rotor protein assemblies

Natural molecular machines contain protein components that undergo motion relative to each other. Designing such mechanically constrained nanoscale protein architectures with internal degrees of freedom is an outstanding challenge for computational protein design. Here we explore the de novo construction of protein machinery from designed axle and rotor components with internal cyclic or dihedral symmetry. We find that the axle-rotor systems assemble in vitro and in vivo as designed. Using cryo-electron microscopy, we find that these systems populate conformationally variable relative orientations reflecting the symmetry of the coupled components and the computationally designed interface energy landscape. These mechanical systems with internal degrees of freedom are a step toward the design of genetically encodable nanomachines.

COMMUNITY-ACQUIRED THORACIC EMPYEMA - DOES MICROBIOLOGICAL IDENTIFICATION MATTER?

OBJECTIVES

To describe the clinical characteristics, comorbidities and clinical outcome of hospitalized patients with the diagnosis of community acquired thoracic empyema in our hospital, with particular emphasis on the impact of identification of the causative agent.

METHODS

We performed a retrospective review of the clinical files of hospitalized adult patients diagnosed with community acquired thoracic empyema between 2012 and 2016.

RESULTS

A total of 81 patients (64 men and 17 women), with a mean age of 54.6+-17.3 years, were included in this study. It was possible to identify the microbiological agent in 59.3% (n=48) of the patients. The median length of hospital stay was 29 days (P25=20 and P75=44.5) and a tendency to longer duration was seen in patients with a microbiological isolation (32 days vs 23 days; p=0.056). No significant difference was observed between patients with and without microbiological isolation, regarding the mortality.

CONCLUSION

In this group of patients a positive pleural fluid culture tends to be associated with longer lengths of hospital stay, which may lead to speculation that they were more advanced infectious processes at the time of diagnosis.

Interobserver variability in MRI measurements of mesorectal invasion depth in rectal cancer

PROPOSE

To assess the interobserver variability in MRI measurements of mesorectal invasion depth (MID) in rectal adenocarcinomas primarily staged as T3, by determining the level of interobserver agreement in the differentiation of individual T3 substages and of T3a-b vs. T3c-d disease, between readers with different levels of expertise.

METHODS

A retrospective analysis of 60 patients classified by MRI as having T3 rectal cancers was performed. Each patient underwent MR examination in a 1.5 T machine and the standard imaging protocol included a high-resolution axial T2-weighted sequence in which the measurements were determined by independent radiologists (readers A and B, with 15 years and 1 year of experience, respectively). The rectum was further divided into quadrants and each reader selected the quadrant where the measurement was taken. The patients were grouped according to the MID (T3a < 1 mm; T3b 1-5 mm; T3c > 5-15 mm; T3d > 15 mm) and the interobserver reliability was tested using Cohen's kappa.

RESULTS

Population included 40 males and 20 females with a median age of 65.9 years. Interobserver agreement on individual substage differentiation (T3 a, b, c and d) was moderate (K = 0.428) and in the quadrant evaluation the level of agreement was also moderate (K = 0.414). Nevertheless, the interobserver reliability for the differentiation between stages T3a-b vs. T3c-d was substantial (K = 0.697).

CONCLUSIONS

There is no considerable interobserver variability when distinguishing T3a-b from T3c-d tumors, regardless of the quadrant where the MID is measured. Therefore, assessment of MID, for that purpose, is a reproducible MR parameter, irrespectively of the readers' experience.

Association between common cardiovascular risk factors and clinical phenotype in patients with hypertrophic cardiomyopathy from the European Society of Cardiology (ESC) EurObservational Research Programme (EORP) Cardiomyopathy/Myocarditis registry

AIMS

The interaction between common cardiovascular risk factors (CVRF) and hypertrophic cardiomyopathy (HCM) is poorly studied. We sought to explore the relation between CVRF and the clinical characteristics of patients with HCM enrolled in the EURObservational Research Programme (EORP) Cardiomyopathy registry.

METHODS AND RESULTS

1739 patients with HCM were studied. The relation between hypertension (HT), diabetes (DM), body mass index (BMI), and clinical traits was analysed. Analyses were stratified according to the presence or absence of a pathogenic variant in a sarcomere gene. The prevalence of HT, DM, and obesity (Ob) was 37, 10, and 21%, respectively. HT, DM, and Ob were associated with older age (P<0.001), less family history of HCM (HT and DM P<0.001), higher New York Heart Association (NYHA) class (P<0.001), atrial fibrillation (HT and DM P<0.001; Ob p = 0.03) and LV (left ventricular) diastolic dysfunction (HT and Ob P<0.001; DM P = 0.003). Stroke was more frequent in HT (P<0.001) and mutation-positive patients with DM (P = 0.02). HT and Ob were associated with higher provocable LV outflow tract gradients (HT P<0.001, Ob P = 0.036). LV hypertrophy was more severe in Ob (P = 0.018). HT and Ob were independently associated with NYHA class (OR 1.419, P = 0.017 and OR 1.584, P = 0.004, respectively). Other associations, including a higher proportion of females in HT and of systolic dysfunction in HT and Ob, were observed only in mutation-positive patients.

CONCLUSION

Common CVRF are associated with a more severe HCM phenotype, suggesting a proactive management of CVRF should be promoted. An interaction between genotype and CVRF was observed for some traits.

Long term left ventricular impairment after SARS-COV2 infection

Funding Acknowledgements

Type of funding sources: None.

Introduction

The impact of acute infection by SARS-COV2 on the cardiovascular system has been previously reported in the literature, with a higher propensity in patients with more serious pattern of disease and pro-inflammatory status. Nevertheless, the long-term burden and sequels of COVID-19 on the cardiovascular system is still unknown.

Purpose

To evaluate the long-term impact of COVID-19 on left ventricular function in patients with severe clinical presentation requiring intensive care hospitalization.

Methods

 

This was a single-center observational, prospective study which included patients requiring admission to the Intensive Care Unit (ICU) due to COVID-19 infection from January to November 2020. All discharged patients were contacted to perform a clinical, electrocardiographic and echocardiographic evaluation and those who accepted were included on the protocol. Baseline and clinical characteristics were collected from clinical reports. For the global longitudinal strain (GLS) analysis all patients with significant wall motion abnormalities and valvular cardiopathy were excluded. Statistical analysis was performed with Mann-Whitney and a safety cut-off was established with ROC curve analysis.

Results

 

A total of 43 patients were included (mean age 64 ± 12, 67.4% males). During SARS-COV2 infection 49% presented with severe ARDS and 51% with moderate, 35% required invasive mechanical ventilation, 14% noninvasive mechanical ventilation and 52% with high nasal flow cannula. On the follow-up analysis, fatigue was the most reported in symptom (52% patients) and the majority did not present other signs or symptoms suggestive of heart failure, with the mean NT-proBNP of 49 ± 389 pg/dL. The standard ECG and echocardiogram did not show significant changes with a mean LVEF of 58 ± 7.8 and mean TAPSE of 21 ± 4. The strain analysis showed low value of GLS (mean GLS of -17.14 ± 2.36) for a reference cut-off of -18%, suggesting subclinical left ventricular dysfunction in this subset of patients with preserved ejection fraction. Maximum CPR values during ICU did not correlate either with the extent of disease evolvement in CT (p= NS) or ARDS severity (p= NS). Nevertheless, maximum CPR correlated significantly with GLS reduction (R = 0.44, p = 0.019). A CPR value higher than iger30mg/dL had 100% specificity for GLS reduction and a cut-off of 14gm/dL reported a sensitivity of 65% and specificity pf 75% for reduction in GLS.

Conclusion

In our study, we reported subclinical impairment in left ventricular function detected with global longitudinal strain after serious infection with SARS-COV2. The detected myocardial dysfunction was related with higher inflammatory as expressed by CPR values. Long-term monitoring of these patients should be undertaken in order to timely detect late complications. Abstract Figure.

Robust Reductions of Body Weight and Food Intake by an Oxytocin Analog in Rats

Background: Oxytocin is a hypothalamic neuropeptide that participates in the network of appetite regulation. Recently the oxytocin signaling pathway has emerged as an attractive target for treating obesity. However, the short half-life limits its development as a clinical therapeutic. Here we provide results from testing a long-lasting, potent and selective oxytocin analog ASK1476 on its efficacy to reduce food intake and body weight in comparison to the native oxytocin peptide.

Methods: ASK1476 features two specific amino acid substitutions in positions 7 and 8 combined with a short polyethylene glycol spacer. Short time dose escalation experiments testing increasing doses of 3 days each were performed in diet-induced overweight (DIO) male rats assessing effects on body weight as well as changes in food intake. Furthermore, DIO rats were tested for changes in body weight, food intake, temperature, and locomotor activity over 28 days of treatment (oxytocin, ASK1476, or vehicle).

Results: In dose escalation experiments, significant reductions in food intake relative to baseline were detected beginning with doses of 15 nmol/kg ASK1476 (−15.2 ± 2.3 kcal/d, p = 0.0017) and 20 nmol/kg oxytocin (−11.2.9 ± 2.4 kcal/d, p = 0.0106) with corresponding significant changes in body weight (ASK1476: −5.2 ± 0.8 g, p = 0.0016; oxytocin: −2.6 ± 0.7 g, p = 0.0326). In long-term experiments, there was no difference on body weight change between 120 nmol/kg/d ASK1476 (−71.4 ± 34.2 g, p = 0.039) and 600 nmol/kg/d oxytocin (−91.8 ± 32.2 g, p = 0.035) relative to vehicle (706.9 ± 28.3 g), indicating a stronger dose response for ASK1476. Likewise, both ASK1476 and oxytocin at these doses resulted in similar reductions in 28-day cumulative food intake (ASK1476: −562.7 ± 115.0 kcal, p = 0.0001; oxytocin: −557.1 ± 101.3 kcal, p = 0.0001) relative to vehicle treatment (2716 ± 75.4 kcal), while no effects were detected on locomotor activity or body temperature.

Conclusion: This study provides proof-of-concept data demonstrating an oxytocin analog with extended in vivo stability and improved potency to reduce food intake and body weight in DIO animals which could mark a new avenue in anti-obesity drug interventions.

Automated healthcare-associated infection surveillance using an artificial intelligence algorithm

Healthcare-associated infections (HAIs) are among the most common adverse events in hospitals. We used artificial intelligence (AI) algorithms for infection surveillance in a cohort study. The model correctly detected 67 out of 73 patients with HAIs. The final model used a multilayer perceptron neural network achieving an area under receiver operating curve (AUROC) of 90.27%; specificity of 78.86%; sensitivity of 88.57%. Respiratory infections had the best results (AUROC ≥93.47%). The AI algorithm could identify most HAIs. AI is a feasible method for HAI surveillance, has the potential to save time, promote accurate hospital-wide surveillance, and improve infection prevention performance.

Elderly: Coping with sleep disorders

Introduction

Sleep problems are a common presenting symptom of elderly patients to Primary care physicians and Psychiatrists. Almost half of seniors over age 65 who live at home are dissatisfied with their sleep, and nearly two-thirds of those residing in nursing home facilities suffer from sleep disorders. Chronic and pervasive sleep complaints and disturbances are frequently associated with excessive daytime sleepiness and may result in impaired cognition, diminished intellect, poor memory, confusion, and psychomotor retardation.

Objectives

The aim of this article is to sumarize and explore the facts envolving sleep disorders, discusses approaches to treatment and highlights new research in the area of geriatric sleep disorders.

Methods

An online bibliographic search was carried out on PubMed and Medline using the keywords “Elderly”, “sleep” and “Psychiatry”.

Results

Management of sleep disorders is complicated by the risk of side effects of pharmacologic treatment approaches, and thus nonpharmacologic strategies are preferred when possible. Additionally, many of the pharmacologic strategies used in treating younger adults have not been studied adequately in the geriatric population, and more specifically in patients with underlying cognitive disorders, making treatment choices difficult.

Conclusions

This review has provided insights into the biopsychosocial impact of sleep disorders in the elderly, as this group pose unique challenges for diagnosis and treatment. Sleep changes in the elderly may have a far broader impact on geriatric health than originally thought, with implications for AD and delirium, and further research is needed in these areas as well.

Resolvin-D1 attenuation of angiotensin II-induced cardiac inflammation in mice is associated with prevention of cardiac remodeling and hypertension

AIMS

Despite the broad pharmacological arsenal to treat hypertension, chronic patients may develop irreversible cardiac remodeling and fibrosis. Angiotensin II, the main peptide responsible for the Renin-Angiotensin-Aldosterone-System, has been closely linked to cardiac remodeling, hypertrophy, fibrosis, and hypertension, and some of these effects are induced by inflammatory mediators. Resolvin-D1 (RvD1) elicits potent anti-inflammatory and pro-resolving effects in various pathological models. In this study, we aimed to examine whether RvD1 ameliorates cardiac remodeling and hypertension triggered by angiotensin II.

METHODS AND RESULTS

Alzet® osmotic mini-pumps filled with angiotensin II (1.5 mg/kg/day) were implanted in male C57BL/6 J mice for 7 or 14 days. RvD1 (3 μg/kg/day, i.p) was administered one day after the surgery and during the complete infusion period. Blood pressure and myocardial functional parameters were assessed by echocardiography. At the end of the experimental procedure, blood and heart tissue were harvested, and plasma and histological parameters were studied. After 7 and 14 days, RvD1 reduced the increase of neutrophil and macrophage infiltration triggered by angiotensin II, and also reduced ICAM-1 and VCAM-1 expression levels. RvD1 also reduced cytokine plasma levels (IL-1β, TNF-α, IL-6, KC, MCP-1), cardiac hypertrophy, interstitial and perivascular fibrosis, and hypertension.

CONCLUSIONS

This study unveils novel cardioprotective effects of RvD1 in angiotensin II-induced hypertension and cardiac remodeling by attenuating inflammation and provides insights into a potential clinical application.

Symptomatic Hypokalemia in a 19-Year-Old Student

Primary hyperaldosteronism (PA) is the most common cause of secondary arterial hypertension and is frequently undiagnosed. It affects all ages but is more frequent between 20 and 60 years old. The clinical presentation is variable, and the diagnosis is based on screening and, in equivocal cases, confirmatory tests. A 19-year-old student presented with complaints of extreme fatigue, arterial hypertension, hypokalemia and metabolic alkalosis, raising a high index of suspicion for PA. Screening tests were performed and its expressiveness excluded the need of confirmatory tests. CT-scan showed a unilateral adrenal adenoma and the patient was submitted to laparoscopic adenectomy without complications. Prompt diagnosis and treatment are essential to avoid long term complications of PA.

Cortical excitability and its modulation in obsessive-compulsive disorder - a systematic review

Introduction

Obsessive-Compulsive Disorder (OCD) is an incapacitating Neuropsychiatric condition characterized by the presence of obsessions and/or compulsions. Although the disorder’s phenotype is well described, its pathophysiology remains elusive (Aouizerate et al, 2004). Over the last decade, techniques to noninvasively study the brain’s neurophysiology, such as Transcranial Magnetic Stimulation (TMS), have found widespread use in psychiatric research. For OCD, single- and paired-pule TMS protocols have been used to explore abnormalities in motor cortex excitability and cortical neuroplasticity. Here we propose to systematically review and, where possible, metanalyse existing case-control studies that compared such measures in patients and healthy subjects.

Objectives

To systematically review and meta-analyse published case-control studies comparing cortical excitability measures, as measured by single- or paired-pulse TMS, in subjects with OCD and healthy controls.

Methods

We have conducted a systematic review of published literature (PROSPERO registration CRD42020201764) reporting measures of cortical excitability as measured by single or paired-pulse TMS, in patients with OCD and healthy controls. We searched 4 different electronic libraries (PubMed, Web of Science, EMBASE, PsycINFO). The resulting list of articles was reviewed, separately, by two researchers. Disagreements were discussed and resolved by consensus, until a final list of eligible articles was obtained.

Results

13 studies reporting motor cortex excitability measures were included in our final list. The total number of participants included in our analyses is 615 (349 OCD; 180 healthy subjects; 86 other conditions)

Conclusions

A sufficient number of studies was found to allow for metanalyses, currently ongoing.

A closer look to apathy

Introduction

Apathy is a neuropsychiatry syndrome, conceptualised as a loss of motivation free of altered consciousness, cognitive impairment or emotional distress, associated with a wide range of brain disorders such as Dementia, Major depression and schizophrenia. Even though under-recognized and under-diagnosed, apathy hardly appears uncommon. Its reported frequency in various neurologic and psychiatric conditions varies widely, from less than 10 to over 80%, reflecting differences in population characteristics and assessment procedures.

Objectives

The aim of this article is to review the concept of Apathy and clarify its nosology, pathopshysiology and treatment.

Methods

An online bibliographic search was carried out on PubMed and Medline using “Apathy” as a term.

Results

The literature reviewed shows that apathy is a multi-dimensional clinical construct with a current definition and validated diagnostic criteria. Analysis reveals that apathy is strongly associated with disruption particularly of anterior cingulate cortex (ACC), ventral striatum (VS) and nucleus accumbens (N acc). Remarkably, these changes are consistent across clinical disorders and imaging modalities, playing a crucial role in normal motivated behaviour.

Conclusions

The neuromodulator dopamine is heavily implicated in ACC and VS. Therapeutically, numerous small studies suggest that psychostimulants, dopaminergics, and cholinesterase inhibitors may benefit those manifesting this syndrome. However, no adequately powered, randomized controlled trials have reported success and no medication have ever been approved for this disorder Further research is needed to help understand the functional neuroanatomy, neuromodulators involved and possible treatment options of this clinical construct.

Effect of albumin, urea, lysozyme and mucin on the triboactivity of Ti6Al4V/zirconia pair used in dental implants

The titanium implant/zirconia abutment interface can suffer failure upon mechanical and biological issues, ultimately leading to the loss of the artificial tooth. The study of the effect of the organic compounds present in saliva on the tribological behavior of these systems is of utmost importance to understand the failure mechanisms and better mimic the in vivo conditions. The aim of the present work is to evaluate the effect of the addition of albumin, urea, lysozyme and mucin to artificial saliva, on the triboactivity of Ti6Al4V/zirconia pair commonly used in dental implants and then, compare the results with those obtained with human saliva. The solutions' viscosity was measured and the adsorption of the different biomolecules to both Ti6Al4V and zirconia was accessed. Tribological tests were performed using Ti6Al4V balls sliding on zirconia plates inside of a corrosion cell. Friction and wear coefficients were determined, and the open circuit potential (OCP) was monitored during the tests. Also, the wear mechanisms were identified. The presence of mucin in the artificial lubricant led to the lowest wear coefficients. The main wear mechanism was abrasion, independently of the used lubricant. Adhesive wear was observed for the systems without mucin. Tribocorrosion activity and wear coefficient were lower in the presence of mucin. None of the studied artificial lubricants mimicked the effect of human saliva (HS) on the tribological behavior of the studied pair since this lubricant led to the lowest friction coefficient and highest corrosion activity.

Physical Activity Effects on Blood Parameters, Growth, Carcass, and Meat and Fat Composition of Portuguese Alentejano Pigs

Simple Summary

Outdoor farming systems are associated with health, animal welfare, sustainability, and food security, making them highly desirable for consumers. In this trial, it was possible to confirm that pig physical activity, a major factor in the traditional and extensive production systems of the Alentejano pig, influences animal welfare and the results of biochemical and zootechnical parameters. In this perspective, breeding pig breeds that perform spontaneous physical activity has greater advantages for producers, as pigs can reach the same slaughter weight in less time and with lower feed costs than animals reared in individual pens. Based on these results, the negative impacts that system intensification (with the consequent reduction in the vital space of each animal and the physical activity performed) may have on animal welfare, animal performance and on the quality of the meat obtained, should be considered.

Abstract

This study evaluated the effects of physical activity on blood, growth, carcass, and meat quality of finishing Alentejano (AL) pigs. Pigs, reared from ~87 to 160 kg in individual pens (no exercise area, NE group, n = 9) or in an outdoor park (with exercise area, WE group, n = 9), were fed commercial diets (85% ad libitum). WE pigs were in a park (~400 m²) with a feeding area separated from the drinking area with an automatic waterer, forcing pigs to walk at least 800 m daily. Blood samples were obtained during the trial (weeks 2, 11, and 18) and at slaughter. The left-side carcass was submitted to commercial cuts, and samples from loin, tenderloin, and dorsal subcutaneous fat (DSF) were analyzed. Plasma urea in WE pigs was higher in weeks 2 and 11, while cholesterol, LDL-cholesterol, cholesterol to HDL-cholesterol and LDL- to HDL-cholesterol ratios, and cortisol were lower in weeks 11 and 18. Final weight and average daily gain were higher and feed conversion ratio lower in WE pigs. DSF thickness and carcass weight were higher in WE pigs, leading to higher carcass yield. Finally, loin and tenderloin from WE pigs presented higher total protein content. These data show that allowing physical activity affects metabolism, growth, and carcass and meat quality of AL pigs.

Association between the density and type of trees around urban schools and exhaled nitric oxide levels in schoolchildren

Summary

Greenspaces in school's neighbourhood represent an important environment to promote healthy development. The aim of this study was to assess the association between the density and type of trees around schools and exhaled Nitric Oxide (NO) levels in schoolchildren. Data on 845 children from 20 primary schools in Porto was analysed. Airway inflammation was assessed by measuring exhaled NO level. The density and type of trees were quantified within a 500 m buffer around schools. Associations were estimated using mixed-effect models. A significant association was observed between non-tree covered areas around schools and exhaled NO levels in schoolchildren (β = - 1.42, 95% CI - 2.84, - 0.001). Our results suggested that the presence of trees in school neighbourhoods may play a role in the biological mechanisms underlying the complex links between environment and airway inflammation.

Diagnostic yield of muscle biopsies in pediatric population: a tertiary center experience

INTRODUCTION

BACKGROUND AND AIM

Muscle biopsy is still an important exam on the investigation of neuromuscular diseases although data regarding its diagnostic yield can be disappointing. We aimed to analyze the diagnostic yield of muscle biopsies in the pediatric population.

PATIENTS AND METHODS

We retrospectively analyzed a tertiary Neuropathology laboratory database to identify patients (<18 years old), submitted to muscle biopsy between January 2015 and August 2019. Demographics, clinical presentation, diagnosis, treatment, and follow-up were evaluated. Descriptive statistical analysis was performed.

RESULTS

One-hundred and six patients were included, 52,8% (n = 56) were male. Median age at biopsy was 6 years (IQR 10 years). Patients were divided into 8 groups, according to clinical diagnostic suspicion: mitochondrial myopathies (n = 29), congenital myopathies (n = 9), inflammatory myopathies (n = 8), muscular dystrophies (n = 7), raised CK values in serum (n = 7), metabolic myopathies (n = 5), weakness /other neuromuscular symptoms (n = 30) and multiple clinical suspicions (n = 11). Biopsy was normal in 50 patients. Of the remaining, 27 displayed specific diagnostic features, with 88,9% (n = 24) allowing a definite diagnosis: muscular dystrophies (n = 7), metabolic myopathies (n = 5), congenital myopathies (n = 4), inflammatory myopathies (n = 4), mitochondrial myopathies (n = 3) and spinal muscular atrophy (n = 1). Histology led to a change of treatment in 4 patients, all diagnosed with inflammatory myopathies. Median length of follow-up was 1 year (IQR 2 years).

CONCLUSION

Biopsy diagnostic yield was 22,6%, and it was useful either in diagnostic or therapeutic approaches in 35,8%. Although advances of molecular techniques led to a decrease in muscle biopsy indications, it remains an important tool on the diagnosis of neuromuscular diseases.

Hydrogels as delivery systems for spinal cord injury regeneration

Spinal cord injury is extremely debilitating, both at physiological and psychological levels, changing completely the patient's lifestyle. The introduction of biomaterials has opened a new window to develop a therapeutic approach to induce regeneration after injury due to similarities with extracellular matrix. Particularly, hydrogels have the ability to support axonal growth and endogenous regeneration. Moreover, they can also act as potential matrixes in which to load and deliver therapeutic agents at injury site. In this review, we highlight some important characteristics to be considered when designing hydrogels as delivery systems (DS), such as rheology, mesh size, swelling, degradation, gelation temperature and surface charge. Additionally, affinity-based release systems, incorporation of nanoparticles, or ion-mediated interactions are also pondered. Overall, hydrogel DS aim to promote a sustained, controlled and prolonged release at injury site, allowing a targeted oriented action of the therapeutic agent that will be used.

Massive Traumatic Subcutaneous Emphysema

74 year-old-man, former smoker, with chronic obstructive pulmonary disease GOLD grade 4, group D, with emphysema component, treated in a pulmonary rehabilitation program, on oxygen therapy and nocturnal bi-level positive airway pressure (BiPAP) ventilation. During the night he had a traumatic rib fracture (5-11th right ribs) but still he used BiPAP ventilation during the sleep. In the morning after he presented with a diffuse and massive emphysema in the face, thorax and abdominal regions. On physical examination, the patient presented with massive swelling and crepitus on palpation. A chest computed tomography (CT) scan confirmed a diffuse subcutaneous emphysema and revealed a mediastinal emphysema and bilateral small pneumothorax. A fast resolution of the emphysema was of paramount importance as the patient was severely agitated due to his inability to open both eyes, and the need to reintroduce BiPAP ventilation as soon as possible. It was placed a fenestrated subcutaneous catheter on left hemithorax and a subcutaneous ostomy on right hemithorax for comparative purpose. It was also performed a confluent centripetal massage towards drainage orifices, with immediate and substantial improvement of emphysema, especially in left hemithorax, and progressive ocular opening. Further emphysema absorption occurred during hospitalization.

Polyvinyl alcohol/chitosan wound dressings loaded with antiseptics

Wound care remains a challenge in healthcare. This work aimed to develop a new polyvinyl alcohol (PVA)/chitosan (Ch) based wound dressing able to ensure protection, hydration and a controlled release of antiseptics, as alternative to actual treatments. Two distinct formulations (1:1 and 3:1, w/w) were prepared, sterilized by autoclaving and characterized concerning surface morphology, degradation over the time, mechanical properties and hydrophilicity. Both dressings revealed adequate properties for the intended purpose. The dressings were loaded with chlorhexidine (CHX) and polyhexanide (PHMB) and the drug release profiles were determined using Franz diffusion cells. The release of PHMB was more sustained than CHX, lasting for 2 days. As the amounts of drugs released by PVA/Ch 1:1 were greater, the biological tests were done only with this formulation. The drug loaded dressings revealed antibacterial activity against S. aureus and S. epidermidis, but only the ones loaded with PHMB showed adequate properties in terms of cytotoxicity and irritability. The application of this elastic dressing in the treatment of wounds in a dog led to faster recovery than conventional treatment, suggesting that the material can be a promising alternative in wound care.

Characterization and comparison of lipid and PUFA production by native thraustochytrid strains using complex carbon sources

The thraustochytrid are marine heterotrophic protists that are widely distributed in the marine world. They are characterized by producing and accumulating great amount of lipids in their cells, especially long chain polyunsaturated fatty acids (LC-PUFA), highlighting the docosahexaenoic acid (DHA, 22:6, n-3), eicosapentaenoic acid (EPA, 20:5, n-3) and arachidonic acid (ARA, 20:4, n-6), as well as pigments of interest for human health and animal nutrition, such as carotenoids. Therefore, the objective of this study was to isolate and characterize three natives isolated of thraustochytrids and assess the potential of the by-products of the manufacture of beer (RB) and protein extraction of Lupine flour (RL) as complex carbon sources to produce biomass, lipid and polyunsaturated fatty acids. Three native strains of thraustochytrid (AS5-B2, IQ81 y VAL-B1), isolated from Chilean coastal waters were morphologically and genetically identified as thraustochytrid. For the determination of biomass production cultures were quantified by gravimetry and the fatty acids quantification and identification were carried out by gas chromatography (GC-FID). Our results show that the culture with any sources of complex carbon used, increased significantly the production of both biomass and total lipids in the strains IQ81 and VAL-B1, compared to glucose as pure carbon source. On the other hand, strain AS5-B2 showed a decrease in the total production of lipids in RB compared to the pure carbon source. For the production of fatty acids, the strains IQ81 and VAL-B1 showed a significant increase in DHA when growing in RB. In conclusion strains IQ81 and VAL-B1 can be used to biotransform industrial waste, such as RB and RL, into a more valuable product such as DHA, EPA, ARA and lipids.

Effects of single and combined exposures of gold (nano versus ionic form) and gemfibrozil in a liver organ culture of Sparus aurata

In vitro methods have gained rising importance in ecotoxicology due to ethical concerns. The aim of this study was to assess the single and combined in vitro effects of gold, as nanoparticle (AuNPs) and ionic (Au⁺) form, and the pharmaceutical gemfibrozil (GEM). Sparus aurata liver organ culture was exposed to gold (4 to 7200 μg·L^-1), GEM (1.5 to 15,000 μg·L^-1) and combination 80 μg·L^-1 gold +150 μg·L^-1 GEM for 24 h. Endpoints related with antioxidant status, peroxidative/genetic damage were assessed. AuNPs caused more effects than Au⁺, increasing catalase and glutathione reductase activities and damaging DNA and cellular membranes. Effects were dependent on AuNPs size, coating and concentration. GEM damaged DNA at an environmentally relevant concentration, 1.5 μg·L^-1. Overall, the effects of the combined exposures were higher than the predicted, based on single exposures. This study showed that liver culture can be a useful model to study contaminants effects.

Prostate cancer, new treatment advances - immunotherapy

Prostate cancer (PCa) is the fourth most common cancer in the world and treatment is currently based on surgical removal and/or radiotherapy and/or hormone therapy. In the last few years' immunotherapy has become an important cancer treatment option. While the principles of immunotherapy evolved, only sipuleucel-T was approved by the Food and Drug Administration (FDA) which lead to further studies with other agents, starting a new era in immuno-oncology. A number of vaccines are under clinical investigation as well as checkpoint inhibitors. Despite the current enthusiasm, it is unlikely that any of the approaches alone can dramatically change PCa outcomes, but strategies combination is more promising and provide a reason for optimism. The goal of immunotherapy in PCa does not have to be the complete eradication of advanced disease, but rather the return to an immunologic equilibrium with an indolent disease state. With such concerted efforts, the future of immunotherapy in PCa looks brighter than ever, with many clinical trial results being published soon.

Medicinal cannabis, a medicine. Characterization of the reality in Portugal

Cannabis has been used over the centuries for medicinal purposes. The first evidence dates from the third millennium BC in India and Chinese Empire, due to its analgesic, antiemetic and anticonvulsant properties. Nevertheless, its use is also associated to manufacture industry - hemp - translating a widespread function. However, through time, it is its recreational, additive and illegal purposes are the ones that we most quickly associate with it. This stigmatized its use in society and neglected the benefits. Its only in the XX century with the discover of the of the endocannabinoid system that allowed a new vision on the theme, challenging and revolutionizing the, until then, ingrained classic vision. In fact, its benefits in several pathologies or clinical symptons are well documented today. In light of the current debate on the use of cannabis for medicinal purposes worldwide and recently in Portugal with new legislation, a review of the available literature is required to explain the national reality and its context in the international reality. Due to the clinical and social relevance of the theme, the authors aimed to study, collect and systematize information in order to uptodate the state of art in: innovation, potential indications for its therapeutic use; understand the existing legal framework in Portugal, for cannabinoids and for the previous phases, such as cultivation and production; understand and compare the international reality and that existing in Portugal, namely in Portuguese hospitals; and, understand what are the future perspectives for cannabis as a therapeutic line.

Key messages

Clinical and social relevance of the theme and its legal framework. What are the future perspectives for cannabis as a therapeutic line nd the stigma of using it.