Current knowledge on therapeutic, diagnostic, and prognostics applications of exosomes in multiple myeloma: Opportunities and challenges

Interactions between the plasma cells and the BM microenvironment of Multiple myeloma (MM) take place through factors such as exosomes. Many studies have confirmed the role of exosomes in these interactions. By carrying proteins, cytokines, lipids, microRNAs, etc. as their cargo, exosomes can regulate the interactions between MM plasma cells and neighboring cells and participate in the signaling between cancer cells and the environment. It has been shown that MM-derived exosomes can induce angiogenesis, enhance osteoblast activity, confer drug resistance, and have immunosuppressive properties. Abnormal cargos in endosomes originating from MM patients, can be used as a cancer biomarker to detect or screen early prognosis in MM patients. The native nanostructure of exosomes, in addition to their biocompatibility, stability, and safety, make them excellent candidates for therapeutic, drug delivery, and immunomodulatory applications against MM. On the other hand, exosomes derived from dendritic cells (DC) may be used as vaccines against MM. Thanks to the development of new 'omics' approaches, we anticipate to hear more about exosomes in fight against MM. In the present review, we described the most current knowledge on the role of exosomes in MM pathogenesis and their potential role as novel biomarkers and therapeutic tools in MM.

Mining the soil myxobacteria and finding sources of anti-diabetic metabolites

Secondary metabolites produced by myxobacterial genera are often characterized as diverse molecules with unique structural properties which drove us to search for myxobacterial source of anti-diabetic drug discovery. In the present study, from 80 soil samples, out of sixty-five observed isolates, 30 and 16 were purified as Myxococcus and non-Myxococcus, respectively. Isolated strains taxonomically belonged to the genera Myxococcus, Corallococcus and Cystobacter, Archangium, Nanocystis, and Sorangium, and some could not be attributed. Secondary metabolites of selected non-Myxococcus isolates extracted by the liquid-liquid method showed that the myxobacterium UTMC 4530 demonstrated the highest inhibition on the formation of carbonyl group and fructosamine, respectively. In addition, it showed 23% and 15.8% inhibitory activity on α-glucosides and α-amylase compared to acarbose (23%, 18%), respectively. The extract of strain UTMC 4530 showed 35% induction effect on glucose adsorption while showing no radical scavenging activity and no toxic effect on HRBC lysis and HepG2 in cytotoxicity assays. The strain UTMC 4530 (ON808962), with the multiple antidiabetic activity, showed 87.3% similarity to Corallococcus llansteffanensis which indicates its affiliation to a new genus. The results of this study revealed that secondary metabolites produced by strain UTMC 4530 can be considered a promising source to find new therapeutic and pharmaceutical applications perhaps a multi-mechanism anti-diabetic compound.

Biogenesis, inheritance, and 3D ultrastructure of the microsporidian mitosome

During the reductive evolution of obligate intracellular parasites called microsporidia, a tiny remnant mitochondrion (mitosome) lost its typical cristae, organellar genome, and most canonical functions. Here, we combine electron tomography, stereology, immunofluorescence microscopy, and bioinformatics to characterise mechanisms of growth, division, and inheritance of this minimal mitochondrion in two microsporidia species (grown within a mammalian RK13 culture-cell host). Mitosomes of Encephalitozoon cuniculi (2-12/cell) and Trachipleistophora hominis (14-18/nucleus) displayed incremental/non-phasic growth and division and were closely associated with an organelle identified as equivalent to the fungal microtubule-organising centre (microsporidian spindle pole body; mSPB). The mitosome-mSPB association was resistant to treatment with microtubule-depolymerising drugs nocodazole and albendazole. Dynamin inhibitors (dynasore and Mdivi-1) arrested mitosome division but not growth, whereas bioinformatics revealed putative dynamins Drp-1 and Vps-1, of which, Vps-1 rescued mitochondrial constriction in dynamin-deficient yeast (Schizosaccharomyces pombe). Thus, microsporidian mitosomes undergo incremental growth and dynamin-mediated division and are maintained through ordered inheritance, likely mediated via binding to the microsporidian centrosome (mSPB).

Isolation and characterization of a bisphenol A-degrading strain, Pseudomonas aeruginosa DU2, from soil containing decaying plants

Background and Objectives

Bisphenol A (BPA) is a toxic compound with broad applications in the plastics industry. BPA has harmful effects on various organisms and its efficient removal is necessary. The microbial degradation of BPA is a safe and economical approach. In this research, soil samples containing decaying plants were screened to isolate a BPA-degradable bacterial strain.

Materials and Methods

Soil samples were collected from different locations in Damghan, Semnan province, Iran. To enrich BPA-degrading bacteria, the samples were cultured in a stepwise manner in a mineral medium containing increasing BPA concentrations (5 to 40 mg/L). The ability of isolated bacteria in degrading BPA was assayed by Folin-Ciocalteu and high-performance liquid chromatography methods. The biodegradation efficiency of the most efficient isolate was assayed under distinct conditions and it was identified through the sequencing of the 16S rRNA gene.

Results

Among the isolated bacteria, Pseudomonas aeruginosa DU2 (GenBank accession number: OP919484) showed the most BPA biodegradation ability. The highest BPA degradation (52.98%) was observed in the mineral medium containing 5 mg/L BPA and the inoculum size of 6 × 107 CFU/mL at pH 9 and in the presence of 0.05% (w/v) NaCl during 10 days.

Conclusion

These results offer soil containing decaying plants as a promising source for finding BPA-degrading bacteria. P. aeruginosa DU2 has basal BPA removal ability, which could be improved by optimization of medium components and growth conditions.

CoFe2O4@SiO2-NH2@MOF-5 magnetic nanocatalyst for the synthesis of biologically active quinazoline derivatives

Metal-organic frameworks (MOFs) offered excellent catalytic activity due to their superior porosity, and high densities of catalytic sites in remarkable specific surfaces. In this research, we prepared a magnetic nanocomposite based on MOF-5 which is one of the prominent and practical structures that have been reported in many applications, and investigated the advantages of it as a catalyst. The multi-functional catalyst was prepared in five steps including (1) preparation of cobalt ferrite nanoparticles (CoFe2O4), (2) surface modification of cobalt ferrite using tetraethyl orthosilicate, (3) surface functionalization using 3-aminopropyl triethoxysilane, (4) preparation of MOF-5, (5) preparation of CoFe2O4@SiO2-NH2@MOF-5 nanocomposite. The resulting catalyst was evaluated by FTIR, FESEM, EDX, XRD, and VSM analyses. The CoFe2O4@SiO2-NH2@MOF-5 nanocomposite was applied as a catalyst for the quinazoline derivatives' synthesis. Various products were prepared with significant yields (90-98%) in short reaction times (20-60 min) without difficult work-up. In addition, the magnetic behavior of the catalyst allows it to be collected and recycled by a magnet and applied for six consecutive cycles without significantly reducing its efficiency. Quinazoline derivatives showed significant biological activities so their antioxidant activity was between 23.7% and 88.9% and their antimicrobial activity was in contradiction of E. coli, S. enterica, L. monocytogenes, S. aureus, and E. faecalis.

Effectiveness of Phosphate and Zinc Solubilizing Paenarthrobacter nitroguajacolicus P1 as Halotolerant Rhizobacterium with Growth-Promoting Activity on Pistacia vera L

Plant growth-promoting rhizobacteria (PGPR) are beneficial microorganisms to develop microbial fertilizers. Biofertilizers can accelerate plant growth and enhance crop yields. The current research aimed to isolate and identify rhizobacterium with plant growth-promoting activity in the rhizospheric region of pistachio trees in arid and salty region of Iran. In the present study, 26 bacterial isolates were isolated from the rhizospheric region of the pistachio trees. Plant growth-promoting characteristics of isolated bacteria, including the ability to solubilize phosphate and zinc, produce hydrolyzing enzymes, and hydrogen cyanide (HCN), as well as synthesize indole-3-acetic acid (IAA) were evaluated through in vitro assays. Based on these activities, five multifunctional bacterial strains designated P1, P10, P11, P17, and P19 were then applied and their effect was studied on the growth and physiological properties of Pistacia vera L. seedlings by pot experiments under normal conditions. Finally, the most efficient strain has been identified by analysis of the 16S rRNA gene sequence. According to the results, all the isolated bacteria exhibited considerable plant growth-promoting properties. They could produce amylase (n = 26, 2 ± 0.00-13 ± 0.42 mm), lipase (n = 24, 2 ± 0.00-9 ± 0.23 mm), protease (n = 20, 1 ± 0.00-17 ± 0.0 mm), indole-3-acetic acid (n = 26, ranging from 5.05 ± 0.08 to 11.5 ± 0.11 μg/mL) and HCN (n = 24). Six isolates showed significant growth at 20% w/v NaCl. Inoculation of P1, P17, and P19 increased chlorophyll, carotenoid, and phenolic content in treated Pistacia vera L. seedlings. P1 and P11 inoculated plants showed an enhanced level of anthocyanin and proline. These most effective strains were catalase and Gram-positive bacterium and showed antibiotic sensitivity. They can consider as halotolerant PGPR, due to the growth in the presence of NaCl (20% w/v). Finally, P1 inoculated plants exhibited higher levels of sugar content. This strain showed the most similarity (99.92%-1322 bp) to Paenarthrobacter nitroguajacolicus based on 16S rRNA gene sequence. Based on the results, Paenarthrobacter nitroguajacolicus P1 with multiple PGPR can be applied as a promising candidate in the soil-Pistacia vera L. system to improve their productivity and health by increasing available nutrient content, improving photosynthetic parameters, and producing phytohormones and HCN.

Recent advances in the biological activities of microbial exopolysaccharides

Microbial exopolysaccharides (EPSs) are valuable extracellular macromolecules secreted as capsules or slime layers. Various microorganisms, including bacteria, yeasts, fungi, and algae have been studied for their ability to produce EPSs. Microbial EPSs exist as homopolysaccharides or heteropolysaccharides with various properties such as different monosaccharide compositions, structural conformation, molecular weight, and functional groups. They are cost-effective alternatives to plant and animal-derived polysaccharides because the microbial cells produced them in large quantities by biotechnological processes using low-cost substrates such as industrial wastes in a short time. Microbial EPSs are safe, biodegradable, and compatible polymers. They have extensive bioactivities, including antibacterial, antifungal, antiviral, antioxidant, antitumor, antidiabetic, antiulcer, anticoagulant, antiaging, immunomodulatory, wound healing, and cholesterol-lowering activities. Microbial EPSs owing to biological activities, special biochemical structures, and attractive physicochemical properties find plenty of potential applications in various industries. The enhancement of the production of EPSs and improving their properties can be provided by genetic engineering methods. The current review aims to provide a comprehensive examination of the therapeutic activities of microbial EPSs in infectious diseases and metabolic disorders, with a focus on the mechanisms involved. Also, the effect of the physicochemical characteristics of EPSs on these bioactivities was discussed to reveal the structure-activity relationship.

Characterization of Probiotic Pichia sp. DU2-Derived Exopolysaccharide with Oil-in-Water Emulsifying and Anti-biofilm Activities

Probiotic-derived exopolysaccharides are considered as promising sources of carbohydrate with extensive applications in many industries. In the current study, yeast strains were isolated from chicken ingluvies and gizzard samples. According to molecular identification, EPS-producing yeast (Pichia sp. DU2) showed the most similarity to Pichia cactophila (99.67%). Pichia sp. DU2 showed probiotic properties. EPS of Pichia sp. DU2 showed emulsifying activity. The formed emulsions showed 53% (colza oil) and 100% (p-xylene) stability after 24 h. These emulsions were oil-in-water and have stability in the presence of NaCl, KCl, and also acidic and basic conditions. Also, the EPS showed anti-biofilm (29.7-47.6% and 19.06-55.26% against B. cereus and Y. enterocolitica, respectively) and flocculating activities (31.4%). FT-IR showed the presence of various functional groups in EPS structure. Also, its heteropolysaccharide nature was revealed in ¹H-NMR and HPLC analysis. This emulsifying EPS showed significant thermal stability and negative zeta potential, which make it a promising carbohydrate for various industries. Finally, according to the predicted model, the maximal EPS production was achieved at reaction time 36 h, pH 6, yeast extract concentration 1.0%, and sucrose concentration 5%. Pichia sp. DU2 with probiotic properties and producing EPS with emulsifying, anti-biofilm, and flocculating activities can be considered as promising yeast strain in various industries like food and pharmaceutical industries.

Therapeutic potential of phospho-thiadiazole derivatives as anti-glioblastoma agents: synthesis, biological assessment and computational study

In this study, three new phospho thiadiazole compounds (A, F and W) were investigated as possible cytotoxic agents. The compounds were synthesised and characterised by using spectroscopy methods. The crystal structure of compound A was investigated using X-ray crystallography, since the title compounds can exist as different tautomeric forms, their conformational and geometrical aspects were investigated computationally by the DFT method. NBO analysis suggested that these compounds can function as appropriate ligands for the reaction with the nitrogen bases of DNA. All the synthesised compounds were evaluated in vitro for their cytotoxic activities against cancer in the human glioblastoma cell lines (U-251) using the MTT assay. According to the annexin V-FITC/PI results, a combination of synthesised compounds with ReoT3D showed a synergistic effect to increase the percentage of apoptotic cells. Molecular docking study for A (the most toxic compound) showed how it interacts with DNA. Both in vitro and in silico results showed that A has promising inhibitory potential (IC₅₀: 48.1 ± 0.3 μM) and binding energy (-6.67 kcal/mol).

Deep learning framework for prediction of infection severity of COVID-19

With the onset of the COVID-19 pandemic, quantifying the condition of positively diagnosed patients is of paramount importance. Chest CT scans can be used to measure the severity of a lung infection and the isolate involvement sites in order to increase awareness of a patient's disease progression. In this work, we developed a deep learning framework for lung infection severity prediction. To this end, we collected a dataset of 232 chest CT scans and involved two public datasets with an additional 59 scans for our model's training and used two external test sets with 21 scans for evaluation. On an input chest Computer Tomography (CT) scan, our framework, in parallel, performs a lung lobe segmentation utilizing a pre-trained model and infection segmentation using three distinct trained SE-ResNet18 based U-Net models, one for each of the axial, coronal, and sagittal views. By having the lobe and infection segmentation masks, we calculate the infection severity percentage in each lobe and classify that percentage into 6 categories of infection severity score using a k-nearest neighbors (k-NN) model. The lobe segmentation model achieved a Dice Similarity Score (DSC) in the range of [0.918, 0.981] for different lung lobes and our infection segmentation models gained DSC scores of 0.7254 and 0.7105 on our two test sets, respectfully. Similarly, two resident radiologists were assigned the same infection segmentation tasks, for which they obtained a DSC score of 0.7281 and 0.6693 on the two test sets. At last, performance on infection severity score over the entire test datasets was calculated, for which the framework's resulted in a Mean Absolute Error (MAE) of 0.505 ± 0.029, while the resident radiologists' was 0.571 ± 0.039.

The impact of mental workload, work-related and socio-demographic factors on job burnout among emergency medical staff

BACKGROUND: Job burnout syndrome is caused by prolonged exposure to difficult working conditions. Emergency medical services (EMS) staff are exposed to varying levels of mental workload (MWL) depending on the operation, so it is more likely that they experience burnout syndrome. OBJECTIVE: The main aim of the current research was to investigate the effect of MWL, work-related and socio-demographic factors on job burnout among Iranian EMS staff. METHODS: The current cross-sectional and descriptive-analytical research was carried out among 198 EMS. In doing so, the Maslach Burnout Inventory (MBI), The NASA task load index (NASA TLX), and an author-developed work-related and socio-demographic factors were distributed among participants to collect data. The data were analyzed using descriptive and inferential statistics (t-test, ANOVA test, multiple linear regression, and Pearson correlation coefficient). RESULTS: The results showed a significant statistical relationship between burnout and MWL. A significant statistical relationship between overall workload and two dimensions of MBI, namely, emotional exhaustion and depersonalization were observed (P < 0.05). Moreover, a significant statistical difference regarding the mean of burnout in the different groups of educational levels and occupational categories were observed. CONCLUSIONS: The EMS staff generally reported moderate levels of MWL and burnout. Findings showed that socio-demographic and occupational factors had little effect on burnout. MWL, education levels, and occupational categories are the main predictors of job burnout.

Characterization of exopolysaccharide produced by probiotic Enterococcus durans DU1 and evaluation of its anti-biofilm activity

Exopolysaccharides (EPS) produced by lactic acid bacteria are complicated polymers with industrial applications. LAB were isolated, screened for EPS production, and their probiotic properties determined. The anti-biofilm activity of EPS was investigated. Safety of EPS-producing isolate was investigated and it was molecularly identified through 16S rRNA sequencing. Finally, anti-biofilm and emulsification activity of EPS was studied and it was characterized using FT-IR, TGA, ¹H-NMR, DLS and HPLC. Thirteen LAB were isolated from dairy products. They showed probiotic characteristics like acid resistance (0-6.51 CFU ml^-1) hydrophobicity (8-54.04%), autoaggregation (0% [t = 2 h]-99.8% [t = 24 h]) and coaggregation with food borne pathogens. Among them, Enterococcus durans DU1 had ability to produce EPS. EPS of Enterococcus durans DU1 showed antibiofilm activity against Y. enterocolitica (24.06-51.36%), S. aureus (12.33-49.6%), and B. cereus (11.66-27.16%). FT-IR showed this EPS had characteristic absorption peaks due to the presence of the pyran ring of sugars. ¹H NMR showed that EPS has N-acetyl, methyl, and alkyl groups in its structure. The HPLC analysis showed that EPS is a heteropolysaccharide and consists of sucrose, glucose, and fructose. EPS showed significant thermal stability (20% weight loss) under 300 °C and zeta potential of - 18.1 mV. This EPS can be used in the food industry with no adverse effect on consumers.

The effect of traffic noise on cognitive performance with regard to personality traits: A laboratory experiment study

BACKGROUND: Exposure to traffic noise could play an important part in inducing psychological disorders which in turn can affect individuals’ cognitive and mental performance. OBJECTIVE: The aim of this study was to determine the effect of traffic noise exposure on the cognitive performance with regard to subjects’ personality traits. METHODS: Sixty students with normal hearing and vision took part in this experimental study. In order to simulate the traffic noise condition of Tehran, the noise from several busy streets was first carefully recorded. Later on, the subjects were exposed to this recorded noise in an anechoic chamber. Also, the NEO-five factor inventory questionnaire and the continuous performance test were used to assess personality traits and cognitive performance of participants respectively. RESULTS: The results showed that the cognitive features of the study, such as reaction time and the number of commission/omission errors in continuous performance testing increased significantly after exposure to the traffic noise (p < 0.05), and among the personality traits, only the neuroticism has a significant correlation with response time in the continuous performance tests (p < 0.05). CONCLUSIONS: Apart from the effect of traffic noise on cognitive function, the findings of this study confirmed that Neuroticism (one of the personality traits) also significantly affect the cognitive performance of individuals when they are exposed to traffic noise in laboratory conditions.

Isolation and characterization of exopolysaccharide derived from Lacticaseibacillus paracasei AS20(1) with probiotic potential and evaluation of its antibacterial activity

This study was done to find exopolysaccharide (EPS)-producing lactic acid bacteria (LAB) against foodborne pathogens. Isolated LAB were screened to find the ones with the ability to produce antibacterial EPS against foodborne pathogens. Among tested EPSs, EPS of AS20(1) isolate showed inhibitory effects on the growth of Listeria monocytogenes (MIC = 0·935 mg ml^-1 , MBC = 0·935 mg ml^-1 ), Yersinia enterocolitica (MIC = 12·5 mg ml^-1 , MBC = 50 mg ml^-1 ) and Bacillus cereus (MIC = 6·25 mg ml^-1 , MBC = 12·5 mg ml^-1 ). According to 16S rRNA sequencing, AS20(1) showed the closest similarity to Lacticaseibacillus paracasei (100%). This antibacterial EPS showed negligible toxicity (4·4%-5·2%) against red blood cells. Lacticaseibacillus paracasei AS20(1) showed probiotic properties, including high acid resistance, hydrophobicity (47·5%), autoaggregation and coaggregation with foodborne pathogens. Also, L. paracasei AS20(1) showed no haemolysis activity and antibiotic resistance. Characterization of antibacterial EPS revealed that it is a heteropolysaccharide with various functional groups, amorphous structure, and smooth surface, sheet and compact structure, which can be suitable for food packaging. L. paracasei AS20(1) and its antimicrobial EPS can be used to make functional food.

Statistical analysis of COVID-19 infection severity in lung lobes from chest CT

Detection of the COVID 19 virus is possible through the reverse transcription-polymerase chain reaction (RT-PCR) kits and computed tomography (CT) images of the lungs. Diagnosis via CT images provides a faster diagnosis than the RT-PCR method does. In addition to low false-negative rate, CT is also used for prognosis in determining the severity of the disease and the proposed treatment method. In this study, we estimated a probability density function (PDF) to examine the infections caused by the virus. We collected 232 chest CT of suspected patients and had them labeled by two radiologists in 6 classes, including a healthy class and 5 classes of different infection severity. To segment the lung lobes, we used a pre-trained U-Net model with an average Dice similarity coefficient (DSC) greater than 0.96. First, we extracted the PDF to grade the infection of each lobe and selected five specific thresholds as feature vectors. We then assigned this feature vector to a support vector machine (SVM) model and made the final prediction of the infection severity. Using the T-Test statistics, we calculated the p-value at different pixel thresholds and reported the significant differences in the pixel values. In most cases, the p-value was less than 0.05. Our developed model was developed on roughly labeled data without any manual segmentation, which estimated lung infection involvements with the area under the curve (AUC) in the range of [0.64, 0.87]. The introduced model can be used to generate a systematic automated report for individual patients infected by COVID-19.

Temporomandibular joint (TMJ) disorders as first clinical manifestations in external auditory canal cholesteatoma. A case report

Introduction and importance

Cholesteatoma is a common occurrence in the middle ear, whereas cholesteatoma of the external auditory canal (EAC) is a rare condition. We report an unusual presentation of the cholesteatoma in the EAC.

Case presentation

We report a case of a 67-year-old male presented to the ENT casualty with a longstanding history of left sided squeaky type sound, aggravated whenever he talks or eats. He subsequently had a Computed Tomography (CT) scan of the left petrous bone which identified a left-sided EAC cholesteatoma. Clinical symptoms of EAC cholesteatoma are non-specific, and hence we recommend considering cholesteatoma when patients present with abnormal EAC symptoms and intact tympanic membrane.

Clinical discussion

His cranial nerves examination was normal, and the tympanic membrane was intact. His blood count and infective marker were normal. The CT scan of the brain showed a lesion in the left external auditory canal close to the tympanic membrane. The lesion was in contact with the anterior inferior canal wall which had features suggesting bony erosion. Gas bubble seen in the posterior part of the TMJ was in relation to bony erosion of the EAC.

Conclusion

The cholesteatoma of the EAC is very rare. CT scan can provide detailed information about the extent of external ear canal cholesteatoma, which can be used to identify complications of the disease, in addition to differentiating the external ear canal from the middle ear cholesteatoma. Early recognition of cholesteatoma and prompt treatment is essential to prevent catastrophic complications.

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A cholesteatoma originating in the external auditory canal is a rare finding.

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Cholesteatoma can present with atypic symptoms such as temporomandibular joint disorders.

Electroconductive and photoactive poly(phenylenediamine)s with antioxidant and antimicrobial activities for potential photothermal therapy

In recent years, polyaniline derivatives such as poly(phenylenediamine)s have attracted the attention of researchers due to their better solubility, good optical and electrical properties. In the current work, poly(ortho- phenylenediamine)...

All roads can lead to surgery

Pursuing a career in surgery is a rigorous process that demands commitment and hard work. Surgeons in the United Kingdom must go overcome a myriad of competitive stages prior to becoming a consultant. In the United Kingdom, the most common pathway to become a surgeon is via the 'direct route' which encompasses completing multiple training programs, namely, the Foundation Program, followed by Core Surgical Training, and then onto Higher Speciality Training, with the aim of obtaining the Certificate of Completion of Training (CCT). More recently, certain specialities have introduced the 'Improving Surgical Training' (IST) pathway. IST is a competence-based, run through surgical program that was introduced by the Royal College of Surgeons of England (RCS) and Health Education England (HEE). "The pilot trials improvements in the quality of training, a better balance between service and training for trainees, and professionalisation of the role of the surgical trainers" [1]. However, there are alternative pathways that have been designed for those who prefer a different route to training or have been unsuccessful during the selection stages. These pathways are not well-advertised, but with the competitive rates now higher than before, it is becoming a more attractive pathway for junior doctors, hence the increasing the demand for clearer instructions on potential routes for aspiring surgeons.

669 Mortality Risk Prediction for Emergency Laparotomy: Are We Utilising the Best Tool?

Aim

Emergency laparotomy is one of the common operations performed in the UK. To aid in more objective decision making, several scoring systems have been formulated. In this project, we aimed to explore the predictive power of both NELA and P-Possum mortality scores against 30 days and 90 days observed mortality for emergency laparotomy patients.

Method

Patient details from two large district general hospitals were extracted from the NELA database over a period of three years. Pre-operative NELA, post-operative NELA, and P-POSSUM predicted mortality were calculated and compared with the observed 30 days and 90 days mortality for the entire cohort. Model discrimination (statistical accuracy) was tested by calculating the area under the receiver operating characteristic curve (AUC), which was used to assess how accurately the model could discriminate.

Results

There were 378 patients eligible for inclusion with a median age of 64. 39 patients (10.3%) died within 30 days and 52 patients (13.8%) died within 90 days. P-POSSUM score, pre-operative NELA, and post-operative NELA scores predicted the 30 days mortality as (2.7%, 3.7%, and 2.4%) and 90 days mortality as (2.9%, 4.8%, and 4%) respectively. The discriminative power for 30 days and 90 days mortality was highest for the pre-operative NELA score (AUC 0.870, CI: 0.824 – 0.916), (AUC 0.826, CI: 0.769 – 0.884) respectively.

Conclusions

Both NELA and P-Possum scores underpredicted actual 30 days and 90 days mortality. It was however noted that the pre-operative NELA mortality score showed more accurate mortality discriminative power than the other 2 tested tools.

670 Documentation and Communication of National Emergency Laparotomy Audit (NELA) Mortality and Morbidity Scoring with Patients Prior To Consenting: Are We Following the Best Practice?

Aim

Patients presenting as an emergency have a greater risk of dying than those admitted electively. The ability to stratify risk and calculate a percentage chance of death, not only gives the clinical team a common language to be able to formulate a management plan but also enables them to communicate this with patients and their families. This includes a full explanation of potential risks, benefits, a ceiling of care and management alternatives. In this project, we assessed if the NELA score has been properly calculated, documented prior to surgery for every emergency laparotomy patient and whether such patients were aware of NELA risk predictions prior to consenting.

Method

This was a retrospective audit based on the NELA guidelines of pre-operative risk stratification and the fifth report NELA recommendations. We assessed 50 case notes of patients who had laparotomies from January 2019 to April 2020 in a busy district general hospital in the UK.

Results

We noted that NELA risk prediction score was not utilised/documented in most of the patients with compliance of only 26%. We also found that, in the majority of notes, no NELA score discussion with the patient/family was documented, even with patients who had their NELA score calculated preoperatively. Compliance was only 14% in relation to this category.

Conclusions

A formal assessment of the risk of mortality and morbidity should be made explicit to each patient and should be recorded clearly in the consent form and medical record.

672 Emergency Laparotomy Patients: Is the Current Local Consent Process Compliant with Local and National Guidelines?

Aim

Obtaining valid consent is crucial to patient care. It also minimises the chance for claims regarding legal action for battery, breach of human rights and/or successful clinical negligence claims. In this project, we assessed whether a documented discussion took place prior to signing consent forms and whether consent forms were being completed adequately.

Method

This was a retrospective audit based on the Royal College of Surgeons’ (Good Surgical Practice) guidelines and the local trust policy. We assessed 50 case notes of patients who had a laparotomy from January 2019 to April 2020 in a busy district general hospital in the UK.

Results

We noted that our practice was fully compliant with documenting patient demographics, signatures, and the name of the procedure in consent forms. On the other hand, we found that, in the majority of cases there was no documentation of detailed benefits, risks, alternatives of surgery in case notes where compliance was only 21%. In addition, poor compliance was noted in documenting some of the possible risks e.g., hernia (50% compliance), leak (46% compliance) and ileus (26% compliance).

Conclusions

A detailed discussion with the patient and family including benefits, risks and alternatives of surgery should take place and this should be documented clearly in the case notes prior to signing the consent form.

Liver transplantation in pediatric patients under 15 kg; duct-to-duct vs. Roux-en-Y hepaticojejunostomy biliary anastomoses

Back ground. Liver transplantation is an effective treatment for acute or chronic liver failure and metabolic liver disease, which is associated with good quality of life in over 80 percent of recipients. We aimed to evaluate outcome of duct-to-duct vs. Roux-en-Y hepaticojejunostomy biliary anastomoses in pediatric liver transplant recipients below 15-kg.

Methods. In this single-center retrospective study, all children less than 15 kg that have undergone liver transplantation at Nemazee Hospital Organ Transplant Center affiliated with Shiraz University of Medical Sciences from 2009 till 2019, were enrolled. Over a 10-yr period, 181 liver transplants were performed in patients with two techniques including duct-to-duct (Group 1) vs. Roux-en-Y hepaticojejunostomy biliary anastomoses (Group 2). All data was collected from patients’ medical records, operative notes, and post-transplant follow up notes. Data was analyzed by SPSS software V21.

Results. Overall, 94 patients had duct to duct anastomosis (group 1) and 87 cases had Roux-en-Y hepaticojejunostomy (group 2). The mean age of the patients was 2.46 ± 1.5. The most common underlying diseases was biliary atresia (32%). The most prevalent complication after the surgery was infection in both groups. cardiopulmonary problems were significantly higher in group 2 (24.1% vs 4.3%) (p < 0.001). The rate of infection was significantly higher in group 2, as well.

Conclusion. Our study showed a relatively high rate of post-operative infection which was the most among patients who had undergone Roux-en-Y hepaticojejunostomy. Except from biliary complications which were mostly observed in DD group, other complications were more common among Roux-en-Y group.

Optimization and characterization of eco-friendly antimicrobial nanocellulose sheet prepared using carbon dots of white mulberry (Morus alba L.)

BACKGROUND

Carbon dots (C-dots) with antimicrobial activity were synthesized from the white mulberry extract with the aim of fabricating anti-listeria nanopaper using bacterial nanocellulose (BNC). Highly dispersed synthesized C-dots with a size smaller than 10 nm (approximately 4.9 nm) were impregnated into BNC by an ex situ coating method and then mechanical, morphological, UV-protectant and antibacterial activity were assessed. Randomized response surface methodology using a central composite design was applied to investigate the optimized concentration of C-dots in the BNC membrane.

RESULTS

An optimized nanopaper including C-dots at a concentration of 530 g L^-1 and an impregnation time of 14 h at 30 °C with significant antimicrobial activity on Listeria monocytogenes was designed. The addition of C-dots into BNC significantly increased ultimate tensile strength and decreased strain with respect to breaking BNC. A BNC sheet with high-efficient UV-blocking property was prepared using C-dots.

CONCLUSION

Based on the results, the designed nanopaper shows a substantial capacity with respect to the fabrication of antimicrobial/UV-blocking sheets for food active packaging. © 2020 Society of Chemical Industry.

Bioactive Carboxymethyl Starch-Based Hydrogels Decorated with CuO Nanoparticles: Antioxidant and Antimicrobial Properties and Accelerated Wound Healing In Vivo

In this study, nanocomposite hydrogels composed of sodium carboxymethylated starch (CMS)-containing CuO nanoparticles (CMS@CuO) were synthesized and used as experimental wound healing materials. The hydrogels were fabricated by a solution-casting technique using citric acid as a crosslinking agent. They were characterized by Fourier-transform infrared spectroscopy (FTIR), energy-dispersive X-ray spectroscopy (EDS), X-ray diffraction (XRD), field emission scanning electron microscopy (FESEM), and thermogravimetric analysis (TGA) to evaluate their physicochemical properties. In addition, swelling, antibacterial activities, antioxidant activities, cytotoxicity, and in vivo wound healing were investigated to evaluate the wound healing potential of the CMS@CuO nanocomposite hydrogels. Growth inhibition of the Gram-positive and Gram-negative pathogens, antioxidant activity, and swelling were observed in the CMS@CuO nanocomposite hydrogels containing 2 wt.% and 4 wt.% CuO nanoparticles. The hydrogel containing 2 wt.% CuO nanoparticles displayed low toxicity to human fibroblasts and exhibited good biocompatibility. Wounds created in rats and treated with the CMS@2%CuO nanocomposite hydrogel healed within 13 days, whereas wounds were still present when treated for the same time-period with CMS only. The impact of antibacterial and antioxidant activities on accelerating wound healing could be ascribed to the antibacterial and antioxidant activities of the nanocomposite hydrogel. Incorporation of CuO nanoparticles in the hydrogel improved its antibacterial properties, antioxidant activity, and degree of swelling. The present nanocomposite hydrogel has the potential to be used clinically as a novel wound healing material.

Trans-cutaneous electrical nerve stimulation to treat dry mouth (xerostomia) following radiotherapy for head and neck cancer. A systematic review

BACKGROUND

A dry mouth or xerostomia is one of the most common long-term complications following radiotherapy for head and neck cancer and has a negative impact on quality of life in cancer survivors. Transcutaneous electrical nerve stimulation (TENS) is a novel approach to improving saliva flow in these patients.

OBJECTIVE

To perform a systematic review of studies evaluating TENS in the treatment of radiotherapy induced xerostomia in head and neck cancer patients.

DATA COLLECTION AND ANALYSIS

A comprehensive electronic search was performed in PubMed/MEDLINE, the Cochrane Library, and Google Scholar databases for appropriate published studies. The last search was conducted in January 2020. Two review authors assessed all studies identified by the search strategy and carried out data extraction.

RESULTS

Five studies were included in the systematic review which analysed a total of 280 patients with head and neck cancer. Methodological quality and outcomes were evaluated in every study included. The outcome measure was either subjectively assessed or objectively measured. Three studies used conventional TENS therapy to stimulate parotid glands which produced a significant increase in saliva production following therapy. Two studies used acupunctured TENS type to electrically stimulate acupuncture points scattered in the body and they reported improvement in saliva production at the same level as medical treatment. No reported adverse effect of TENS was identified.

CONCLUSIONS

This systematic review confirms the safety and feasibility of TENS in the treatment of xerostomia. It is established that commencing daily TENS therapy simultaneously with radiotherapy has the most efficacy. Given the nonspecific parameters used in the included studies, further evidence is needed in order to establish optimal settings and parameters of TENS for treatment of xerostomia.

Nanomaterials Versus The Microbial Compounds With Wound Healing Property

Age and diabetes related slow-healing or chronic wounds may result in morbidity and mortality through persistent biofilms infections and prolonged inflammatory phase. Nano-materials [metal/metal oxide NPs (39%), lipid vehicles (21%), polymer NPs (19%), ceramic nanoparticles (NPs) (14%), and carbon nanomaterials (NMs) (7%)] can be introduced as a possible next-generation therapy because of either their intrinsic wound healing activity or via carrying bioactive compounds including, antibiotics, antioxidants, growth factor or stem cell. The nanomaterials have been shown to implicate in all four stages of wound healing including hemostasis (polymer NPs, ceramic NPs, nanoceria-6.1%), inflammation (liposome/vesicles/solid lipid NPs/polymer NPs/ceramic NPs/silver NPs/gold NPs/nanoceria/fullerenes/carbon-based NPs-32.7%), proliferation (vesicles/liposome/solid lipid NPs/gold NPs/silver NPs/iron oxide NPs/ceramic NPs/copper NPs/self-assembling elastin-like NPs/nanoceria/micelle/dendrimers/polymer NPs-57.1%), remodeling (iron oxide NPs/nanoceria-4.1%). Natural compounds from alkaloids, flavonoids, retinoids, volatile oil, terpenes, carotenoids, or polyphenolic compounds with proven antioxidant, anti-inflammatory, immunomodulatory, or antimicrobial characteristics are also well known for their potential to accelerate the wound healing process. In the current paper, we survey the potential and properties of nanomaterials and microbial compounds in improving the process of wound and scar healing. Finally, we review the potential biocompounds for incorporation to nano-material in perspective to designate more effective or multivalent wound healing natural or nano-based drugs.

Five-year data on the first UK experience of using urethral bulking agents in treating men with stress urinary incontinence

Level of evidence: 4

Morphological, acoustical, mechanical and thermal properties of sustainable green Yucca (Y. gloriosa) fibers: an exploratory investigation

BACKGROUND

The objective of this study was to evaluate the acoustical, morphological, mechanical and thermal properties of fibers extracted from the leaves of Yucca (Y. gloriosa) shrub.

METHODS

Several tests were performed on either untreated or alkali-treated (5% NaOH) fibers. The chemical analysis of the fibers was performed to determine their lignin, cellulose, hemicellulose, wax and moisture content. Fourier transform infrared (FTIR) and thermogravimetric analysis were respectively employed to chemically and thermally analyze the fibers. The microscopic examination was also carried out using scanning electron microscope (SEM). INSTRON universal testing machine and an impedance tube system were employed for measuring the tensile properties of the fibers and the sound absorption coefficient values of the samples fabricated from the same fibers, respectively.

RESULTS

The results from the experiments revealed that the fibers have low density (1.32 g/cm3) and higher cellulose content (66.36 wt.%,). The mechanical characterization of these fibers also confirmed they are similar to the other lignocellulose fibers used for the reinforcement of polymer matrix composites. The tensile strength test conducted on Yucca fibres showed that mechanical properties of alkali treated fibers are superior to the untreated fibers. The thermal analysis also demonstrated that the alkali treated fibres can thermally withstand temperatures of up to 364 °C which confirms the fact that the thermal stability of fibers was improved by alkali treatment.

CONCLUSION

Fibers extracted from the leaves of Yucca demonstrated fair amounts of mechanical and thermal resistance and strength. The samples fabricated from Yucca fibers demonstrated fair levels of sound absorption coefficients particularly at higher frequency ranges which are typical to the other natural fibers. The possible use of Yucca fibers as either a reinforcing agent for composites or a sound absorbing medium is highly promising.

Zenker's diverticulum misinterpreted as a thyroid mass: Case report

We discuss an unusual presentation of Zenker's Diverticulum (ZD). A 76-year-old man presented with a left sided neck mass which was misdiagnosed as a thyroid mass due to the anatomical location and size. The ultrasound and fine needle-aspiration cytology findings were inconclusive, and a CT scan was then considered which reported a large pharyngeal pouch. Our recommendation is to consider an early CT scan in patient's where there is a clinical suspicion or risk factors for the development of pharyngeal pouch specially when the fine-needle aspiration cytology findings are inconclusive. This would reduce the risk of a delayed diagnosis which can prevent potential perforation of the pharyngeal pouch and development of mediastinitis.

•

Left sided neck mass misdiagnosed as thyroid mass.

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Zenker's Diverticulum is formed due to muscular weakness.

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Pharyngeal pouch symptoms mimic head and neck cancer presentation.

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Barium swallow is a gold standard investigation for pharyngeal pouch.

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Pharyngeal pouch can be treated with endoscopic or external surgical approaches.

Design and characterization of new antimicrobial peptides derived from aurein 1.2 with enhanced antibacterial activity

Antimicrobial peptides (AMPs) are promising alternative agents for treating multidrug-resistant bacterial infections. Aurein 1.2 is a natural 13-amino acid AMP with antibacterial activity against Gram-positive bacteria. In this study, we designed three novel AMPs: aurein M1 (A10W), aurein M2 (D4K, E11K), and aurein M3 (A10W, D4K, E11K) to analyze the effect of Trp substitution and enhancement of positive charge on the activity of aurein 1.2. The AMP probability, physicochemical properties, secondary and tertiary structures, and amphipathic structure were predicted by various bioinformatics tools. After the synthesis of the peptides, their antibacterial activity, hemolysis, cytotoxicity, and structural analysis were assayed. Compared to the selectivity of aurein 1.2, the selectivity of aurein M2 and M3 with a net positive charge of +5 was improved 11.30- and 8.00-fold against Gram-positive and -negative bacteria, respectively. The hemolytic activity of aurein M2 was lower than that of aurein 1.2 and M3, while the higher percentage of human fibroblast cells were alive in the presence of aurein M3. Also, the MICs of aurein M3 toward Staphylococcus aureus and Escherichia coli at the physiologic salt were ≤16, which is recommended as a promising candidate for clinical investigation. Circular dichroism analysis indicated an alpha-helical structure in the peptide analogs that is similar to aurein 1.2 in the presence of 10 mM SDS. Therefore, increasing positive charge can be used successfully as an approach for improving the potency and selectivity of AMPs. Moreover, the beneficial effect of Trp substitution depends on its position and the sequence of peptides.

Awakening the Secondary Metabolite Pathways of Promicromonospora kermanensis Using Physicochemical and Biological Elicitors

The drug discovery rate is dramatically decreasing due to the rediscovery of known compounds. Genome mining approaches have revealed that a large portion of the actinobacterial genome that encodes bioactive metabolites is cryptic and not expressed under standard lab conditions. In the present study, we aimed to induce antibiotic encoding biosynthetic genes in a member of Micrococcales as a new species of Promicromonospora, Promicromonospora kermanensis, by chemical and biological elicitors as it was considered to produce numerous valuable bioactive metabolites based on the whole genome results. Induction has been done via chemical (antibiotics, histone deacetylase inhibitors (HDAIs), rare earth elements (REEs), fatty acid synthesis inhibitors, and extreme pH changes) and biological elicitors (live and dead Gram-positive and negative bacteria). The results showed that valproic acid (as HDAIs), DMSO, lanthanum chloride (as REE), triclosan (as fatty acid synthesis inhibitors), alkaline pH, and supernatant of Pseudomonas aeruginosa UTMC 1404 culture could act as stimuli to provoke antibacterial synthetic pathways in Promicromonospora kermanensis DSM 45485. Moreover, it was revealed that eliciting agents in cell filtrated of P. aeruginosa culture is resistant to detergent, acidic, and basic condition and have amphipathic nature. The inducing effect of alkaline pH on metabolite induction of Actinobacteria was first reported in this study. In the follow-up studies, the induced antibacterial producing clusters can be subjected to the characterization, and the implemented approach in this study can be used for metabolites induction in other selected species.

Antibacterial tragacanth gum-based nanocomposite films carrying ascorbic acid antioxidant for bioactive food packaging

Food packaging has a pivotal share to improve protection, safety and shelf-life time of foods and bioproducts. Herein, we prepared bioactive nanocomposite films that composed of tragacanth (TG), polyvinyl alcohol, ZnO nanoparticles (NPs) and ascorbic acid (AA) using glycerol as a plasticizer and citric acid as a cross-linker for food packaging. The SEM images showed a homogenous distribution of ZnO NPs with low aggregation in nanocomposite films. The water solubility of nanocomposite films reduced from 15.65 % to 10.81 with increasing of TG and ZnO NPs contents. The incorporation of AA and ZnO NPs into nanocomposite films improved antioxidant activity from 50 % to 66 % in 95 % ethanolic solution. Also, the nanocomposite films showed good antibacterial activity against Gram-negative and -positive bacteria. Soil degradation rate of nanocomposite films increased from 80 % to 91.46 as the wt% of TG increased. Therefore, prepared nanocomposite films could be employed as a promising candidate for food packaging applications.

Effect of chronic methamphetamine injection on levels of BDNF mRNA and its CpG island methylation in prefrontal cortex of rats

Methamphetamine (METH) is a highly addictive psychostimulant. Its abuse causes problems in cognition, attention, or psychiatric conditions such as psychosis. Prefrontal cortex is involved in many aspects of drug addiction and in mental disorders similar to those triggered by METH. Brain-derived neurotrophic factor (BDNF), plays important roles in modulating different aspects of addiction, and is implicated in psychiatric conditions reminiscent of those suffered by METH-abusers. Male Wistar rats were intra-peritoneally injected with METH (8 mg/kg/day) for 14 days while control group received normal saline. After extraction of prefrontal cortices, expression of BDNF IV splice variant and methylation level of its CpG island were evaluated. The relative expression of BDNF IV in METH-treated group was 2.15 fold higher than the control group. Seven out of 29 CpG sites were significantly hypomethylated in the METH group, although none survived Bonferroni adjustment. However, the overall methylation level of the 29 CpGs was significantly lower in METH cases than in controls. We discuss the importance of our results and its implications in detail.

1271Short-term effects of exposure to ambient fine particulate matter on out-of-hospital cardiac arrest: a nationwide case-crossover study in Japan

Introduction

The cardiovascular health consequences of ambient air pollution generally equal or exceed those due to pulmonary diseases and cancers. Particulate matter less than 2.5μm in aerodynamic diameter (PM2.5) has become a major focus of research on the short-term exposure to air pollution and cardiovascular disease. However, the evidence regarding the association between several air pollutants and out-of-hospital cardiac arrest (OHCA), has been inconsistent, which could be due to limited sample sizes (∼11,000). Thus, a larger study may assist in characterising possible associations.

Purpose

This study aimed to identify the associations between exposure to ambient air pollution and the incidence of OHCA in Japan.

Methods

A case-crossover design was used to determine the odds ratio (OR) of OHCA across Japan with daily exposure of PM2.5, carbon monoxide (CO), photochemical oxidants (Ox), and sulfur dioxide (SO2) on the day of the arrest or 1–3 days before it (lag 0–3). OHCA cases were identified through the All-Japan Utstein registry of the Fire and Disaster Management Agency from January 1, 2014 to December 31, 2015. All cause OHCAs were investigated by conditional logistic regression adjusted for daily temperature and relative humidity.

Results

A total of 249,372 OHCAs were included during study period. Each 10 μg/m3 increase in daily PM2.5 exposure over 4 days was associated with all cause OHCA risk (lag 0: OR 1.017, 95% confidence interval (CI) 1.010, 1.024; lag 1: OR 1.015, 95% CI 1.008, 1.022; lag 2: OR 1.018, 95% CI 1.011, 1.025; lag 3: OR 1.021, 95% CI 1.014, 1.028; lag 0–1: OR 1.022, 95% CI 1.014, 1.030). CO, Ox and SO2 also showed significant associations with OHCAs. In the multi-pollutant model, the effects of PM2.5 remained independent of CO, Ox and SO2 (Table).

Conclusion

Short-term exposure to PM2.5 was independently associated with an increased risk of OHCA.

2284Sex and age differences in short-term exposure to ambient fine particulate matter and out-of-hospital cardiac arrest: a nationwide case-crossover study in Japan

Introduction

Accumulating evidence has shown the elevated risk for cardiovascular diseases (CVD) with exposure to air pollution, such as fine particles <2.5μm in aerodynamic diameter (PM2.5). A bi-directional relationship exists between air pollution and traditional CV risk factors like obesity, diabetes, and hypertension. However, little is known about the effect of age and sex on association between ambient air pollution and out-of-hospital cardiac arrest (OHCA).

Purpose

This study aimed to identify sex and age differences in the associations between exposure to PM2.5 and OHCA in Japan.

Methods

A case-crossover design was used to determine the odds ratio (OR) of OHCA across Japan with daily PM2.5 exposure on the day of the arrest or 1–3 days before it (lag 0–3). OHCA cases were identified through the All-Japan Utstein registry of the Fire and Disaster Management Agency from January 1, 2014 to December 31, 2015. OHCAs were investigated by conditional logistic regression adjusted for daily temperature and relative humidity with stratification by sex and age.

Results

A total of 249,372 OHCAs were included during study period. Their mean age was 75 years and 57% were male. Each 10 μg/m3 increase in daily PM2.5 exposure over 4 days was associated with all cause OHCA risk for male (lag 0: OR 1.022, 95% confidence interval (CI) 1.013, 1.031; lag 1: OR 1.016, 95% CI 1.007, 1.025; lag 2: OR 1.016, 95% CI 1.007, 1.026; lag 3: OR 1.017, 95% CI 1.008, 1.027; lag 0–1: OR 1.025, 95% CI 1.015, 1.036). Increased risk in OHCA was also found with lag 1 to lag 3 PM2.5 exposure among women. Lag 0 to lag 3 PM2.5 exposures were significantly associated with OHCA among patients older than 65 years. Among 35 to 64 years, only lag 3 PM2.5 exposure was associated with an increased risk in OHCA. No significant association was observed between PM2.5 exposure and OHCA among patients less than 35 years.

Conclusions

Short-term exposure to PM2.5 is associated with an increased risk of OHCA in both sexes. Patients older than 65 years were more susceptible to PM2.5 exposure than younger age group.

Exposure to air pollution during pregnancy and newborn liver function

Exposure to air pollution has been associated with a wide range of adverse health outcomes. However, the available evidence on the impact of air pollution exposures on liver enzymes is still scarce. The aim of the present study was to assess the relationship between exposure to ambient PM₁, PM_2.5 and PM₁₀ during pregnancy and serum level of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) in cord blood samples of newborns. Moreover, the association between total street length in different buffers and distance to major roads at the maternal residential address and liver enzymes were investigated. This cross-sectional study was based on data from a sample of 150 newborns, from Sabzevar, Iran. Land use regression models were used to estimate concentrations of air pollutants at home during pregnancy. Multiple linear regression was developed to estimate association of AST, ALT, ALP and GGT with air pollution controlled for relevant covariates. In fully adjusted models, increase in PM₁ and PM_2.5 as well as PM₁₀ were associated with higher levels of AST, ALT and GGT. Moreover, there was a significant association between total street length in a 100 m buffer at residential address with AST, ALT and GGT. Each meter increase in distance to major roads was associated with -0.017 (95% confidence interval (CI): -0.028, -0.006) decrease in AST. Overall, our findings were supportive for association between PMs exposure during pregnancy and increase in liver enzymes in newborns. Further studies are needed to confirm these findings in other settings and populations.

Coexistence of Anticoagulant and Anti-vascular Calcification Activities in Kribbella sp. UTMC 267 Metabolites

Thrombotic disorders increase the risk of cardiovascular/cerebrovascular complications and represent a major health problem worldwide. Anticoagulants are extensively used in treatment of these disorders. Vitamin K antagonists, like Warfarin, are frequently used in medication. Vascular calcification (VC) is a significant side-effect of vitamin K antagonists especially Warfarin. There is an urgent need to find natural, efficient, non-toxic, and cost effective anticoagulants without dangerous side-effect like VC. In the present study, we evaluated the potential of thirteen fermentation broth extracts of actinobacteria (FBEA) (200 µg mL^-1) to prolong whole blood prothrombin time (PT)/international normalized ratio (INR) and activated partial thromboplastin time (APTT). The fractions of the most effective FBEA were further investigated for their inhibitory effect on VC. The results showed PT/INR of the healthy blood samples was sensitive to the presence of five FBEA. Their INR index fell in the 1.2 to 8.6 range and six FBEA prolonged both PT/INR and APTT parameters (1.7-5 INR, and 46-59 s for APTT). The fractions of Kribbella sp. UTMC 267 FBE (200 µg mL^-1), as the most efficient FBE, only inhibited intrinsic and common pathways of coagulation (APTT). Under calcification condition, Kribbella sp. UTMC 267 fractions (20 µg mL^-1) showed significant inhibitory effect on VC in alizarin red staining (13.3-76 %) and alkaline phosphatase activity of VSMCs (33-62%). They also inhibited osteopontin mRNA expression in treated vascular smooth muscle cells (VSMCs) under that situation. So, we can introduce Kribbella sp. UTMC 267 FBE as a good candidate for more investigation on thrombotic medication.

Simultaneous anti-diabetic and anti-vascular calcification activity of Nocardia sp. UTMC 751

Alpha-amylase can act as a significant player in causing hyperglycaemia, leading to protein glycation, which is the main complication in this condition, besides causing vascular calcification (VC), an important vascular failure caused due to this. In order to find a natural source of the biocompounds with inhibitory effects on α-amylase, 15 fermentation broth extracts of actinobacteria (FBEA) (200 μg ml^-1 ) have been screened. Finally, the effects of the most efficient FBE have been investigated on osteopontin (OPN, a VC marker) mRNA level in the vascular smooth muscle cells under the calcification conditions, and the chemical constituents of the most efficient FBE were analysed using gas chromatography and mass spectrometry (GC-MS) analysis. The tested FBEA showed anti-amylase (7·2-21%) and anti-denaturation (7·5-37%) activities. Among the tested FBEA, Nocardia sp. UTMC 751 FBE showed the highest anti-amylase activity (21%). This treatment group also displayed the minimum fructosamine and the maximum thiol groups content. In addition, this FBE reduced the mRNA level of the OPN (fourfold). The GC-MS analysis demonstrated the existence of three volatile and known antioxidants including pyrrolo[1,2-a]pyrazine-1,4-dione, hexahydro-3-(2-methylpropyl)-, pyrrolo[1,2-a]pyrazine-1,4-dione, hexahydro-3-(phenylmethyl)- and methyl ester of 3-(3,5-di-tert-butyl-4-hydroxyphenyl)-propionic acid in the FBE of Nocardia sp. UTMC 751. The results indicated that Nocardia sp. UTMC 751 is a considerable source of bioactive compounds that are effective against the direct and indirect pathological targets involved in diabetes. This study highlights the significant potential of rare Actinomycetes in producing pharmaceutically important biocompounds.

SIGNIFICANCE AND IMPACT OF THE STUDY

Actinobacteria are one of the best natural libraries for discovering drugs. Various commercial drugs have been developed against infectious and metabolic disorders from actinobacteria; however, there is no report on their simultaneous inhibitory effect against diabetes, a life-threatening disease, and its related pathological processes, like inflammation and vascular calcification (VC). In this research, after several screening, Nocardia sp. UTMC 751 was introduced as the first microbial source exhibiting a simultaneous inhibitory activity on the targets, including hyperglycaemia and protein glycation, and other involved pathological processes like inflammation and VC.

Isolation and screening of rare Actinobacteria, a new insight for finding natural products with antivascular calcification activity

AIM

Vascular calcification (VC) is a significant pathological process in some life-threatening diseases. Several pathological mechanisms, including transdifferentiation of vascular smooth muscle cells to osteoblast-like cells and apoptosis are involved in VC. Compounds with an inhibitory effect on these processes are potentially efficient medications. In consideration of the multiple biological activities of Actinobacteria, this research was aimed at finding anti-VC metabolite-producing Actinobacteria.

METHODS AND RESULTS

After the isolation and identification of Actinobacteria, the effect of their fermentation broth extracts on the apoptosis rate was measured using various methods, for example, ethidium bromide/acridine orange staining, DNA laddering and diphenylamine assays. The effect of the most effective fermentation broth extract of Actinobacteria (FBEA) on the mRNA expression of runt-related transcription factor 2 (Runx2) and osteopontin (OPN) was examined. Finally, the most effective FBEA was fractionated and the chemical composition of anti-VC fractions was analysed using GC-MS. Various VC inhibition rates were observed in the tested FBEA (20 μg ml^-1 ; 17·9-60·15%). The inhibition of DNA fragmentation was 7-48%. The FBE with the greatest anticalcification activity belonged to Kribbella sp. UTMC 267 and, according to 16S rRNA analysis, Kribbella sancticallisti with a similarity of 98·53% is its nearest neighbour. The FBE of Kribbella sp. UTMC 267 reduced Runx2 mRNA expression by 2·95-fold and OPN mRNA expression by 28·57-fold, both of which are considered significant (P < 0·05). Finally, GC-MS analysis showed the existence of potent anti-oxidative and anti-inflammation agents in FBE of Kribbella sp. UTMC 267.

CONCLUSIONS

Actinobacterial metabolites can provide a new strategy for treating VC diseases by reducing the expression of osteogenic genes, the apoptosis rate and oxidative stress.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study highlights the therapeutic potential of Kribbella sp. metabolites and Actinobacteria as a new natural source for drug discovery programs in the nonantibiotic bioactivity field.

Potential biological targets for bioassay development in drug discovery of Sturge-Weber syndrome

Sturge-Weber Syndrome (SWS) is a neurocutaneous disease with clinical manifestations including ocular (glaucoma), cutaneous (port-wine birthmark), neurologic (seizures), and vascular problems. Molecular mechanisms of SWS pathogenesis are initiated by the somatic mutation in GNAQ. Therefore, no definite treatments exist for SWS and treatment options only mitigate the intensity of its clinical manifestations. Biological assay design for drug discovery against this syndrome demands comprehensive knowledge on mechanisms which are involved in its pathogenesis. By analysis of the interrelated molecular targets of SWS, some in vitro bioassay systems can be allotted for drug screening against its progression. Development of such platforms of bioassay can bring along the implementation of high-throughput screening of natural or synthetic compounds in drug discovery programs. Regarding the fact that study of molecular targets and their integration in biological assay design can facilitate the process of effective drug discovery; some potential biological targets and their respective biological assay for SWS drug discovery are propounded in this review. For this purpose, some biological targets for SWS drug discovery such as acetylcholinesterase, alkaline phosphatase, GABAergic receptors, Hypoxia-Inducible Factor (HIF)-1α and 2α are suggested.

Potential biological targets for bioassay development in drug discovery of Sturge-Weber syndrome

Sturge-Weber Syndrome (SWS) is among the neurocutaneous diseases, which has several clinical manifestations of ocular (glaucoma), cutaneous (port-wine stain), neurological (seizures) and vascular problems. Molecular mechanisms of SWS pathogenesis are initiated by the somatic mutation in GNAQ. Therefore, no definite treatments exist for the SWS and treatment options only mitigate the intensity of its clinical manifestations. Biological assay design for drug discovery against this syndrome demands comprehensive knowledge on mechanisms which are involved in its pathogenesis. By analysis of the interrelated molecular targets of SWS, some in vitro bioassay systems can be allotted for drug screening against this syndrome. Development of such platforms of bioassay can bring along the implementation of high throughput screening of natural or synthetic compounds in drug discovery programs. Regarding the fact that study of biological targets and their integration in biological assay design can facilitate the process of effective drug discovery; some potential biological targets and their respective biological assay for SWS drug discovery are propounded in this review. For this purpose, some biological targets for SWS drug discovery such as acetylcholine esterase, alkaline phosphatase, gamma-aminobutyricacidergic, Hypoxia-Inducible Factor (HIF) -1α and 2α are suggested. This article is protected by copyright. All rights reserved.

The Evaluation and Comparison of Transcriptionally Targeted Noxa and Puma Killer Genes to Initiate Apoptosis Under Cancer-Specific Promoter CXCR1 in Hepatocarcinoma Gene Therapy

BACKGROUND

Cancerous cells proliferate as fast as possible without a proper surveillance system. This rapid cell division leads to enormous mutation rates, which help a tumor establish.

OBJECTIVES

This study evaluated the potential of inducing apoptosis using Noxa and Puma in a hepatocarcinoma cell line.

METHODS

The current study generated two recombinant lentiviruses, pLEX-GCN and pLEX-GCP, bearing Noxa and Puma, respectively. Transduction of both genes to hepatocarcinoma (HepG2) was verified using fluorescent microscopic analysis, western blotting, and quantitative real-time polymerase chain reaction (PCR). To evaluate the potential of Noxa and Puma to initiate apoptosis, a caspase-9 real-time, MTT assay, and a 4', 6-diamidino-2-phenylindole (DAPI) reagent were performed to stain apoptotic cells.

RESULTS

The data verified successful transduction to HepG2 and HEK293T. Higher relative expression of Noxa and Puma rather than the untransduced cell line showed these genes are expressed more in HepG2 in comparison to HEK293T. The results of the real-time PCR, MTT assay, and DAPI reagent illustrated that higher cells initiated apoptosis following Puma transduction rather than Noxa.

CONCLUSIONS

In this approach, the suicide gene was transferred to transformed cells and ignited apoptosis to exterminate them. Puma is a more potent killer gene and has higher capabilities to start intrinsic apoptosis pathway.