Bactericidal and synergistic activity of double-carbapenem regimen for infections caused by carbapenemase-producing Klebsiella pneumoniae

Available therapeutic options against carbapenem-resistant Klebsiella pneumoniae (CR-Kp) are limited because of the high level of resistance to other antimicrobial classes including polymyxins. The double-carbapenem regimen has been recently considered a possible therapeutic strategy. In the present study, we evaluated the in vitro bactericidal and synergistic activity of a double-carbapenem regimen consisting of ertapenem plus high-dose meropenem in a series of patients with healthcare-associated CR-Kp infections in whom the use of colistin was not indicated because of potential nephrotoxicity and/or resistance. In vitro synergy was evaluated using checkerboard and killing studies. A total of 15 patients were included in the study, with sepsis, severe sepsis and septic shock found in two (13.3%), five (33.3%) and one (6.7%) patients, respectively. Overall, the clinical/microbiological response was 12/15 (80%). Synergy was observed in 11/14 (78.6%) isolates using the checkerboard method whereas in killing studies 12/14 (85.7%) and 14/14 (100%) strains were synergistic and bactericidal at 24 h at concentrations of 1 × MIC MEM+1 × MIC ERT and 2 × MEM+1 × MIC ERT, respectively, with a significant decrease of log CFU/mL compared with other combinations (p <0.0001). The double-carbapenem regimen showed clinical and in vitro effectiveness in patients with CR-Kp infections.

A global-scale screening of non-native aquatic organisms to identify potentially invasive species under current and future climate conditions

The threat posed by invasive non-native species worldwide requires a global approach to identify which introduced species are likely to pose an elevated risk of impact to native species and ecosystems. To inform policy, stakeholders and management decisions on global threats to aquatic ecosystems, 195 assessors representing 120 risk assessment areas across all six inhabited continents screened 819 non-native species from 15 groups of aquatic organisms (freshwater, brackish, marine plants and animals) using the Aquatic Species Invasiveness Screening Kit. This multi-lingual decision-support tool for the risk screening of aquatic organisms provides assessors with risk scores for a species under current and future climate change conditions that, following a statistically based calibration, permits the accurate classification of species into high-, medium- and low-risk categories under current and predicted climate conditions. The 1730 screenings undertaken encompassed wide geographical areas (regions, political entities, parts thereof, water bodies, river basins, lake drainage basins, and marine regions), which permitted thresholds to be identified for almost all aquatic organismal groups screened as well as for tropical, temperate and continental climate classes, and for tropical and temperate marine ecoregions. In total, 33 species were identified as posing a 'very high risk' of being or becoming invasive, and the scores of several of these species under current climate increased under future climate conditions, primarily due to their wide thermal tolerances. The risk thresholds determined for taxonomic groups and climate zones provide a basis against which area-specific or climate-based calibrated thresholds may be interpreted. In turn, the risk rankings help decision-makers identify which species require an immediate 'rapid' management action (e.g. eradication, control) to avoid or mitigate adverse impacts, which require a full risk assessment, and which are to be restricted or banned with regard to importation and/or sale as ornamental or aquarium/fishery enhancement.

Severe Bloodstream Infection due to KPC-Producer E coli in a Renal Transplant Recipient Treated With the Double-Carbapenem Regimen and Analysis of In Vitro Synergy Testing: A Case Report

Transplant recipients are at high risk of infections caused by multidrug resistant microorganisms. Due to the limited therapeutic options, innovative antimicrobial combinations against carbapenem-resistant Enterobacteriaceae causing severe infections are necessary.A 61-year-old woman with a history of congenital solitary kidney underwent renal transplantation. The postoperative course was complicated by nosocomial pneumonia due to Stenotrophomonas maltophilia and pan-sensitive Escherichia coli, successfully treated with antimicrobial therapy. On postoperative day 22, diagnosis of surgical site infection and nosocomial pneumonia with concomitant bacteremia due to a Klebisella pneumoniae carbapenemase-producer E coli was made. The patient was treated with the double-carbapenem regimen (high dose of meropenem plus ertapenem) and a potent synergistic and bactericidal activity of this un-conventional therapeutic strategy was observed in vitro. Despite a microbiological response with prompt negativity of blood cultures, the patient faced a worse outcome because of severe hemorrhagic shock.The double-carbapenem regimen might be considered as a rescue therapy in those subjects, including transplant recipients, in whom previous antimicrobial combinations failed or when colistin use might be discouraged. Performing in vitro synergy testing should be strongly encouraged in cases of infections caused by pan-drug resistant strains, especially in high-risk patients.

Ageing gender-specific "Biomarkers of Homeostasis", to protect ourselves against the diseases of the old age

Low-grade inflammatory state causes the development of the principal chronic-degenerative pathologies related with ageing. Consequently, it is required a better comprehension of the physiologic origins and the consequences of the low-grade inflammatory state for the identification of 1) the basic mechanisms that lead to the chronic inflammatory state and, after that, to the progression toward the pathologies and 2) the parallel identification of the prognostic biomarkers typical of these passages. These biomarkers could bring to several improvements in the health quality, allowing an early diagnosis and more effective treatments for: a) the prevention strategies on the healthy population, to assure a healthy longevity and b) the identification of personalized treatment in patients, to assure the benefit of the therapy. For the identification of these biomarkers it is necessary to consider that the ageing processes produce alterations of the physiologic systems and that these modifications compromise the communications between these networks: this state constitutes an obstacle for an appropriate physiologic homeostasis, that plays a fundamental role for the safeguard of the health. It is also to be considered that immune senescence affects both men and women, but it does it in different ways: a sexual dimorphism of immune pathways in the setting of immune response homeostasis is normally present, as we previously underlined. Therefore we hypothesize that, in order to prevent the development of the chronic-degenerative pathologies related with ageing, it is important to identify "Biomarkers of Homeostasis " specific for each gender: these are biologic molecules that should be measurable in a practical and no-invasive way and whose variations can quantify the male and female risk of losing the physiologic system homeostatic capacity. This competence is not only critical in the control of inflammation, but it is also prognostic for the passages from low-grade inflammatory state to the chronic inflammation and to the progression toward the degenerative pathologies. Beginning from the actual results, our intent is 1) to discuss and underline the importance of these new research perspectives in the definition of ageing gender-specific clinical "Biomarkers of Homeostasis" and 2) to propose homeostasis biomarkers, already present in the research results.

Vascular Endothelial Growth Factor (VEGF) in Human Tooth Germ Center

Many oncogenis and tumour suppressor genes found inside normal and pathological cells are fundamental for the processes of development, proliferation and tissue differentiation. The purpose of our study is to show the presence and a possible relationship of the VEGF protein during different phases of the development of human dental germ centers. After cephalometric investigation in 8 orthodontic patients with a mean age of 13 years, (4 females and 4 males), hyperdivergence of the third molars were extracted. The 40 surgical samples were tested with monoclonal human anti-VEGFs antibodies carrying out a semi-quantitative analysis to look for a positive reaction. Reaction for anti-VEGF antibodies was detected in normal embryological tissues and in microvessels near odontogenic cells. During different phases of embryologic development of the dental bud our search showed intracytoplasmatic positive immunoreactions both in the ameloblastic and odontoblastic cells. Additionally, a positive reaction was observed for the VEGF protein in the cells of the stellate reticulum and in those endothelial tissue surrounding the microvessels in all the samples examined.

Before and after a disease outbreak: Tracking a keystone species recovery from a mass mortality event

Mass mortality events involving marine taxa are increasing worldwide. The long-spined sea urchin Diadema africanum is considered a keystone herbivore species in the northeastern Atlantic due to its control over the abundance and distribution of algae. After a first registered mass mortality in 2009, another event off the coasts of Madeira archipelago affected this ecologically important species in summer 2018. This study documented the 2018 D. africanum mass mortality event, and the progress of its populations on the southern coast of Madeira island. A citizen science survey was designed targeting marine stakeholders to understand the extent and intensity of the event around the archipelago. Underwater surveys on population density prior, during and after the mass mortality, permitted an evaluation of the severity and magnitude of the event as well as urchin population recovery. A preliminary assessment of causative agents of the mortality was performed. The event was reported in the principal islands of the archipelago reducing the populations up to 90%. However, a fast recovery was registered during the following months, suggesting that the reproductive success was not compromised. Microbiological analyses in symptomatic and asymptomatic individuals, during and after the event, was not conclusive. Nevertheless, the bacteria Aeromonas salmonicida, or the gram-negative bacteria, or the interaction of different types of bacteria may be responsible for the disease outbreak. Further studies are needed to assess the role of pathogens in sea urchin mass mortalities and the compound effects that sea urchins have in local habitats and ecological functioning of coastal marine ecosystems.

Reproduction of an azooxanthellate coral is unaffected by ocean acidification

Anthropogenic carbon dioxide (CO₂) emissions and consequent ocean acidification (OA) are projected to have extensive consequences on marine calcifying organisms, including corals. While the effects of OA on coral calcification are well documented, the response of reproduction is still poorly understood since no information are reported for temperate corals. Here we investigate for the first time the influence of OA on sexual reproduction of the temperate azooxanthellate solitary scleractinian Leptopsammia pruvoti transplanted along a natural pCO₂ gradient at a Mediterranean CO₂ vent. After 3 months, future projection of pH levels did not influence the germ cell production, gametogenesis and embryogenesis in this azooxanthellate coral. These findings suggest that reproductive potential may be quite tolerant to decreasing pH, with implications for ecosystem function and services in a changing ocean.

A Scavenger Role for Nitric Oxide in the Aged Rat Kidney

Progressive ageing is associated with an increment of biomolecules modified through oxidation as a result of the action of free radicals deriving from reactive oxygen species that attack biomolecules. During ageing many alterations of renal functions have been reported. Renal ageing is associated with a progressive decline of glomerular filtration, renal blood flow and augmented vascular resistance. The kidney is a very important source of inducible nitric oxide synthase (iNOS) in both epithelial and vascular structures. In this study we have investigated mRNA and protein iNOS expression and localization and nitric oxide (NO) production in young and aged rats. An increased expression of iNOS occurs in rat kidney during ageing. In the aged rat, an increase in the values of both iNOS-RNA and iNOS protein was observed through rtPCR and Western blot analysis. The activities of three isoforms of NOS were also seen. In the aged rat kidney the production of NO decreased, due to the reduction of the activities of the three NOS. This suggests that in the aged rat a progressive increase of superoxide anion does not imply an increase in the production of NO which functions as a scavenger molecule, causing oxidative stress with accumulation of reactive oxygen species (ROS).

Surgical debridement with muscle flap transposition and systemic teicoplanin therapy for infected hip arthroplasty

The use of muscle flaps is now accepted as a method for coverage of infected wounds. To obtain complete eradication of infection following hip arthroplasty surgery is combined with antibiotic treatment. Aggressive debridment to remove devitalized tissue followed by vastus lateralis muscle flap transposition may improve the likelihood of success in certain challenging cases. We report two cases of prosthetic joint infection treated by aggressive debridment and vastus lateralis transposition with associated appropriate antibiotic therapy. Complete recovery of functional status was observed.

Decreasing pH impairs sexual reproduction in a Mediterranean coral transplanted at a CO2 vent

Ocean acidification, due to the increase of carbon dioxide (CO2) concentration in the atmosphere and its absorption by the oceans, affects many aspects of marine calcifying organisms' biology, including reproduction. Most of the available studies on low pH effects on coral reproduction have been conducted on tropical species under controlled conditions, while little information is reported for either tropical or temperate species in the field. This study describes the influence of decreasing pH on sexual reproduction of the temperate non-zooxanthellate colonial scleractinian Astroides calycularis, transplanted in four sites along a natural pH gradient at the underwater volcanic crater of Panarea Island (Tyrrhenian Sea, Italy). The average pH values of each site (range: pHTS 8.07-7.40) match different scenarios of the Intergovernmental Panel on Climate Change (IPCC) for the end of the century. After 3 months under experimental conditions, the reproductive parameters of both oocytes and spermaries (abundance, gonadal index, and diameters) seem to be unaffected by low pH. However, a delay in spermary development in the pre-fertilization period and a persistence of mature oocytes in the fertilization period were observed in the most acidic site. Furthermore, no embryos were found in colonies from the two most acidic sites, suggesting a delay or an interruption of the fertilization process due to acidified conditions. These findings suggest a negative effect of low pH on A. calycularis sexual reproduction. However, long-term experiments, including the synergistic impact of pH and temperature, are needed to predict if this species will be able to adapt to climate change over the next century.

Hypoxanthine and xanthine levels in human aqueous humor from cataractous eyes

Purine nucleotide degradation products have been determined by HPLC in aqueous humor obtained during cataract surgery and from plasma of 22 patients (12 women). Uric acid, cytosine, guanosine monophosphate, uracyl, guanine, adenosine, adenosine monophosphate, thymine, adenine, inosine, cyclic guanosine monophosphate, hypoxanthine and xanthine were evaluated. Uric acid and the last two were the only compounds detectable in measurable amounts in aqueous humor and in plasma of all patients. Aqueous humor xanthine levels were not significantly different from plasma; aqueous humor hypoxanthine concentrations were lower than those of xanthine and than plasma oxypurine levels. In 8 patients, treated with allopurinol, oxypurinol concentrations in aqueous humor and in plasma were comparable suggesting that oxypurines are transported through the blood-aqueous humor barrier.

Heme Oxigenase-1 (HO-1) and Oxidative Stress in Rat Heart

Low oxygen tension (hypoxia) is a potent regulator of diverse biological processes. Mammalian cells respond to hypoxia in part by increased expression of several genes that encode for tissue-specific and ubiquitous proteins. The aim of this study was to evaluate the effects of chronic exposure to low tension of oxygen (hypoxia) on the induction of heme-oxygenase-1 (HO-1) as an oxidative stress model.

Adult male Wistar rats were used and subdivided randomly in two groups: A:(n=10) maintained in normoxic conditions and B: (n=10) maintained in hypoxic conditions. The animal of both groups were sacrificed after 14 days. Group A showed an evident non-specific reaction. Group B presented an increased positively of HO-1 immunoreaction. This data was confirmed by western blot analysis of protein and by the study of mRNA through rtPCR. These results suggest that myocardial adaptive response to hypoxia involves up-regulation of HO-1 in cardiac cells, indicating that this enzyme may participate in regulating vascular tone via CO and thereby contributing to the pathophysiologically important defense mechanism of the heart.

Exploring foraging preference of local fish species towards non-indigenous fouling communities near marinas: Insights from Remote Video Foraging System (RVFS) trials

Non-indigenous species (NIS) spread from marinas to natural environments is influenced by niche availability, habitat suitability, and local biotic resistance. This study explores the effect of indigenous fish feeding behaviour on NIS proliferation using fouling communities, pre-grown on settlement plates, as two distinct, representative models: one from NIS-rich marinas and the other from areas outside marinas with fewer NIS. These plates were mounted on a Remote Video Foraging System (RVFS) near three marinas on Madeira Island. After 24-h, NIS abundance was reduced by 3.5 %. Canthigaster capistrata's preference for marinas plates suggests potential biotic resistance. However, Sparisoma cretense showed equal biting frequencies for both plate types. The cryptogenic ascidian Trididemnum cereum was the preferred target for the fish. Our study introduces a global framework using RVFS for in-situ experiments, replicable across divers contexts (e.g., feeding behaviour, biotic resistance), which can be complemented by metabarcoding and isotopic analysis to confirm consumption patterns.

Evaluating fish foraging behaviour on non-indigenous Asparagopsis taxiformis using a remote video foraging system

The proliferation of pest and invasive marine macroalgae threatens coastal ecosystems, with biotic interactions, including direct effects such as grazing and indirect effects such as the trophic cascades, where one species indirectly affects another through its interactions with a third species, play a critical role in determining the resistance of local communities to these invasions. This study examines the foraging behaviour and preference of native fish communities toward native (Halopteris scoparia, Sargassum vulgare) and non-indigenous (Asparagopsis taxiformis) macroalgae using the Remote Video Foraging System (RVFS). Fifty-four weedpops were deployed across three locations to present these macroalgae, while associated epifaunal assemblages were also collected. Video analysis revealed that four common fish species displayed preference towards native macroalgae, possibly due to by the presence of zoobenthos rather than herbivory. This observation suggests that these fish species identified the macroalgae as a habitat that harboured their preferred food items. In contrast, A. taxiformis was consistently avoided, suggesting limited integration into the local food web. Site-specific variations in fish-macroalgae interactions and epifaunal diversity highlighted the complexity of these dynamics. This study contributes to understanding of the ecological implications of invasive macroalgae and supports the use of RVFS as a tool for assessing local biotic resistance against non-indigenous species in coastal ecosystems globally.

The role of marine debris as a vector, dispersal agent, and substrate for non-indigenous species on Oceanic Islands (Northeast Atlantic)

Marine debris (MD) can be a transport vector for diverse marine communities, including non-indigenous species (NIS). This study assessed MD potential role as a substrate for colonization and dispersal vector for NIS in the Madeira Archipelago (NE Atlantic) by examining three MD categories: floating (FMD), seafloor (SMD), and beached (BMD). Opportunistic sampling, conducted in collaboration with local maritime stakeholders, documented MD sightings with photographs and GPS coordinates. A total of 92 MD items were inspected, revealing 108 fouling species across 11 phyla, with 13 % identified as NIS. SMD exhibited the highest proportion of NIS (9.6 %), followed by BMD (4.4 %) and FMD (3.9 %). Notably, the study provides evidence that FMD functions as both a substrate and a dispersal vector for NIS in Madeira waters. Combining biogeographic analyses, oceanographic modelling, and MD identification marks, this study highlighted the North Atlantic Subtropical Gyre's currents as key pathways, transporting MD items from the Wider Caribbean, the North American east coast, and the Iberian Peninsula to Madeira within 2-3 years. These findings emphasize Madeira's dual role as both a recipient and exporter of MD, with implications for NIS introductions and secondary spread. This study underscores the urgent need for standardized monitoring, stakeholder engagement, and proactive MD management strategies to mitigate NIS introductions and protect sensitive marine ecosystems like Macaronesia from the ecological risks of biological invasions.

A pioneering longterm experiment on mesophotic macrofouling communities in the North Atlantic

The mesophotic zone represents one of our planet's largest and least explored biomes. An increasing number of studies evidence the importance of macrofouling species in marine ecosystems, but information on these communities and the factors influencing their structures at mesophotic depths remain poor. This lack of understanding limits our ability to predict anthropogenic impacts or conduct restoration operations in the mesophotic and the lower boundary of the euphotic zones. In this study, we performed a 24-month experiment in a natural environment to investigate three factors influencing the macrobenthic community structure of the mesophotic and the euphotic lower boundary: depth, substrate orientation and substrate material. Using a manned submersible, several recruitment panels of two different materials were deployed at 100, 200 and 400 meters in vertical and horizontal positions. All three factors contributed to structuring the macrofouling communities, but depth and substrate orientation displayed the strongest effects. This study not only advances our understanding of lower boundary euphotic and mesophotic macrofouling communities but also establishes a foundation for future research and restoration efforts of mesophotic environments in the Madeira archipelago, where mesophotic habitats are amongst the least studied marine habitats in the Northeast Atlantic.