Design rules for efficient endosomal escape

The inefficient translocation of proteins across biological membranes limits their application as therapeutic compounds and research tools. In most cases, translocation involves two steps: uptake into the endocytic pathway and endosomal escape. Certain charged or amphiphilic molecules promote protein uptake but few enable efficient endosomal escape. One exception is ZF5.3, a mini-protein that exploits natural endosomal maturation machinery to translocate across endosomal membranes. Although certain ZF5.3-protein conjugates are delivered efficiently into the cytosol or nucleus, overall delivery efficiency varies widely with no obvious design rules. Here we evaluate the role of protein size and thermal stability in the ability to efficiently escape endosomes when attached to ZF5.3. Using fluorescence correlation spectroscopy, a single-molecule technique that provides a precise measure of intra-cytosolic protein concentration, we demonstrate that delivery efficiency depends on both size and the ease with which a protein unfolds. Regardless of size and pI, low-Tm cargos of ZF5.3 (including intrinsically disordered domains) bias its endosomal escape route toward a high-efficiency pathway that requires the homotypic fusion and protein sorting (HOPS) complex. Small protein domains are delivered with moderate efficiency through the same HOPS portal even if the Tm is high. These findings imply a novel protein- and/or lipid-dependent pathway out of endosomes that is exploited by ZF5.3 and provide clear guidance for the selection or design of optimally deliverable therapeutic cargo.

Diagnosis and outcome of patients with idiopathic pleural effusions

INTRODUCTION

Long-term follow-up course for patients with idiopathic pleural effusions has not been established.

METHODS

From October 2013 to June 2021 all patients with idiopathic effusion were prospectively followed up with clinical examination and imaging at 1, 3, 6 and every 6 months for a minimum of 1 year.

RESULTS

Twenty-nine patients were diagnosed with idiopathic effusion and followed up. Mesothelioma was detected during the follow-up in two patients at 7 and 18 months, one of whom had blood-tinged pleural fluid and the other reported a 10% weight loss. Mesothelioma was not diagnosed in any of the patients with effusion covering less than two thirds of the hemithorax, and without constitutional symptoms or a blood-tinged fluid appearance. Most of the effusions resolved or showed a clear improvement in the first six months.

CONCLUSION

Patients without weight loss and with small, non-hematic effusions, may benefit from conservative treatment and clinical-radiological follow-up.

A BUNDLE INCLUDING ORAL ANTIBIOTICS AND MECHANICAL BOWEL PREPARATION REDUCES SURGICAL SITE INFECTIONS IN ELECTIVE COLORECTAL SURGERY. PRAGMATIC COHORT STUDY

Introduction

The efficacy of perioperative bundled interventions implemented at a multicenter level has been poorly studied.

Methods

A colorectal 6-element prevention bundle (antibiotic prophylaxis, oral antibiotic prophylaxis (OAP), mechanical bowel preparation (MBP), laparoscopy, normothermia, and wound retractor), introduced in 61 hospitals, was analysed. Surgical site infection (SSI) rates were compared before (G1, 2011–2016), and after (G2, 2016–2020) the bundle implementation.

Results

37849 procedures were included. 5462 overall SSI (14.43%), and 2838 (7.5%) organ-space SSI (O/S-SSI) were detected. SSI decreased from 18.38% to 10.62% with the application of the bundle (OR 0,503). Similarly, O/S-SSI diminished from 9.15% (G1) to 5.72% (G2), OR 0.602. Compared to the previous year, SSI decreased by 23% after the first year of bundle implementation. 29.26% of SSIs were diagnosed post-discharge. 54.5% required readmission. The reduction was similar between high, medium and low volume hospitals. Overall SSI was 16.71%, when no measure was applied, and 6.23% when all 6 were implemented. Lack of application of the bundle increased the probability of SSI (OR 3.020) and O/S-SSI (OR 1.556). In a univariate analysis, all measures except normothermia were associated with a decrease in overall SSI, while only laparoscopy and OAP were for O/S-SSI. Multivariate analysis confirmed that laparoscopy, OAP, and wound protectors decrease overall SSI, but only OAP and laparoscopy had an effect on O/S-SSI.

Conclusions

A preventive bundle decreased overall and O/S SSI rates in elective colon and rectal surgery. The OR for SSI was 1.5 to 3 times higher before than after the bundle implementation.

Trace Elements in Tissues of Whale Sharks (Rhincodon typus) Stranded in the Gulf of California, Mexico

Concentration of essential (Se, Zn and Cu) and non-essential (As, Cd, Hg and Pb) trace elements were measured in selected tissues of two dead whale sharks (Rhincodon typus) stranded in the Gulf of California (GC) in 2017 and 2018. Concentrations of Cd and Pb in the skeletal muscle of the whale shark from La Paz Bay, GC were higher compared to a previous study on whale shark from China. The shark from La Paz Bay also presented higher concentration of Pb in the epidermis, compared to the same tissue of the other whale shark stranded in Punta Bufeo, GC. The Hg in all analysed tissues was lower than those documented in carnivorous sharks. Molar ratio Se:Hg shows an excess of Se over Hg in all the tissues sampled in both sharks.

TG/HDL-C RATIO AS CARDIO-METABOLIC BIOMARKER EVEN IN NORMAL WEIGHT WOMEN

CONTEXT

Despite that the Triglycerides/High Density Lipoprotein Cholesterol (TG/HDL-C) ratio has been associated with insulin resistance and cardiovascular disease, some outcomes differ between populations.

OBJECTIVE

The objective of this study was to evaluate the association between TG/HDL-C ratio and cardio-metabolic risk factors in both obese and normal weight women.

DESIGN

Cross sectional, from January to December of 2015.

SUBJECTS AND METHODS

Two hundred and fifty three women aged 40 to 60 years. Anthropometric and laboratory measurements were performed. Insulin resistance was measured by the homeostasis model assessment for insulin resistance (HOMA-IR). All participants underwent a Doppler ultrasound to measure intima-media thickness of carotid artery (cIMT).

RESULTS

TG/HDL-C ratio correlated with body mass index (r=0.194, p=0.01), and visceral adipose tissue (r=0.193, p=0.002). Additionally, TG/HDL-C correlated with glucose (r=0.367, p=0.001), insulin (r=0.354, p=0.001) and HOMA-IR (r=0.396 p=0.001). TG/HDL-C was associated with prediabetes, Odds Ratio (OR) was 1.83 (95%CI 1.07-3.13) and insulin resistance 3.27 (95%CI 1.78-6.01), and this risk remains in normal weight women 4.7 (95%CI 1.2-17.81) for prediabetes and 4.38 (95%CI 1.42-13.84) for insulin resistance. No significant risk for cIMT.

CONCLUSION

A TG/HDL-C ratio ≥ 3.0 is a potential risk factor for prediabetes and insulin resistance in women 40-60 years, even in normal weight women.

In utero negativization of Zika virus in a foetus with serious central nervous system abnormalities

We describe a case of a pregnant woman with Zika virus (ZIKV) infection and a foetus with severe brain malformations. ZIKV tested positive in amniotic fluid at 19 weeks but was negative at delivery. The newborn did not meet the case definition of congenital ZIKV syndrome because neither ZIKV RNA nor IgM antibodies were detected; however, prenatal brain lesions were confirmed after birth (Graphical Abstract).

Acute pulmonary embolism detection with ventilation/perfusion SPECT combined with full dose CT: What is the best option?

AIM

To compare diagnostic accuracy of Ventilation/Perfusion (V/P) single-photon emission computed tomography (SPECT) combined with simultaneous full-dose CT with a hybrid SPECT/CT scanner versus planar ventilation/perfusion (V/P) SPECT and CT angiography (CTA) in patients suspected with acute pulmonary embolism (PE).

METHODS

Between 2009 and 2011, consecutive patients suspected of acute PE were referred for V/P SPECT/CT (reviewed board approved study). A contrast agent was administered to patients who had no contraindications. Non-contrast V/P SPECT/CT was performed on the remaining patients. All patients were followed-up for at least 3 months.

RESULTS

A total of 314 patients were available during the study period, with the diagnosis of PE confirmed in 70 (22.29%) of them. The overall population sensitivity and specificity was 90.91% and 92.44%, respectively for V/P SPECT, 80% and 99.15%, respectively, for CTA, and 95.52% and 97.08% for V/P SPECT/CT. SPECT/CT performed better than V/P SPECT (AUC differences=0.0419, P=0.0043, 95% CI; 0.0131-0.0706) and CTA (AUC differences=0.0681, P=0.0208, 95% CI; 0.0103-0.1259)). Comparing imaging modalities when contrast agent could be administered, sensitivity and specificity increased and V/P SPECT/CT was significantly better than CTA (AUC differences=0.0681, P=0.0208, 95% CI; 0.0103-0.1259) and V/P SPECT (AUC differences=0.0659, P=0.0052, 95% CI; 0.0197-0.1121). In case of non-contrast enhancement, there was non-significant increase of specificity. Secondary findings on CT impacted patient management in 14.65% of cases.

CONCLUSION

Our study shows that combined V/P SPECT/CT scanning has a higher diagnostic accuracy for detecting acute PE than V/P SPECT and CTA alone. When feasible, V/P SPECT/CT with contrast enhancement is the best option.

False positive in the measurement of thyroglobulin induced by rheumatoid factor

BACKGROUND

We report a case of interference in thyroglobulin (Tg) measurement in a woman with differentiated thyroid cancer and rheumatoid arthritis history. Due to discordant Tg in relation to TSH concentrations and negative images, we investigated possible interference in the measurement of Tg.

METHODS

During the follow-up we measured Tg by chemiluminescence (TgQL) using Immulite 2000 immunoassay system. To investigate possible interference in Tg measurement, we made serial dilutions, re-testing of Tg by an alternative method: electrochemiluminescence, Cobas 6000 analyzer (TgEQL), recovery test of Tg and polyethylene glycol (PEG) 6000 precipitation.

RESULTS

During the patient follow-up, the TgQL ranged between <0.3 and 16.1ng/ml. In the evaluated serum samples very high titers of rheumatoid factor (RF) were found. When RF titers were lowered post PEG precipitation, Tg QL concentrations became undetectable.

CONCLUSION

We describe an unusual case of interference in Tg assay due to RF. When disagreement among Tg concentrations, images and clinical features is observed, we suggest taking into account the evaluation of possible Tg interference to avoid unnecessary complementary exams and inappropriate treatment.

[Best practices for the safe use of parenteral nutrition multi-chamber bags. Spanish Society of Hospital Pharmacist's Clinical Nutrition Group]

Patient security is one of the key aspects of the Health-System. Parenteral Nutrition is included in the ISMP's list of high-alert medication, being its appropiate use an essential element in maximizing effectiviness while minimizing the potential risk of errors associated with its use. Multi-chamber bags offer several advantages versus pharmacy bespoke bags. However, their apparent simplicity may induce to misuse, asuming their use requires limited consideration, thus increasing the risk of potential errors. For this reason, the Spanish Society of Hospital Pharmacist's Clinical Nutrition Group considered it essential to develop a list of safety practices regarding the use of parenteral nutrition multi-chamber bags. These recommendations are based on practices globally accepted to diminish errors in PN therapy.

The Salmonella enterica serovar Typhi ltrR-ompR-ompC-ompF genes are involved in resistance to the bile salt sodium deoxycholate and in bacterial transformation

A characterization of the LtrR regulator, an S. Typhi protein belonging to the LysR family is presented. Proteomics, outer membrane protein profiles and transcriptional analyses demonstrated that LtrR is required for the synthesis of OmpR, OmpC and OmpF. DNA-protein interaction analysis showed that LtrR binds to the regulatory region of ompR and then OmpR interacts with the ompC and ompF promoters inducing porin synthesis. LtrR-dependent and independent ompR promoters were identified, and both promoters are involved in the synthesis of OmpR for OmpC and OmpF production. To define the functional role of the ltrR-ompR-ompC-ompF genetic network, mutants in each gene were obtained. We found that ltrR, ompR, ompC and ompF were involved in the control of bacterial transformation, while the two regulators and ompC are necessary for the optimal growth of S. Typhi in the presence of one of the major bile salts found in the gut, sodium deoxycholate. The data presented establish the pivotal role of LtrR in the regulatory network of porin synthesis and reveal new genetic strategies of survival and cellular adaptation to the environment used by Salmonella.

[Hyperlactatemia in surgical ablation of atrial fibrillation and cardiac surgery. Is it a predictive factor of postoperative morbidity?]

INTRODUCTION

Increased serum lactate in postoperative cardiac surgery is very common and its pathogenesis is due to multiple factors. The elevation of serum lactate is associated with tissue hypoxia (hyperlactatemia type A) and non-hypoxic (hyperlactatemia type B) metabolic disorders. The aim of the study was to assess the evolution of postoperative lactate in surgical atrial fibrillation ablation during cardiac surgery, and to determine whether lactate levels could be predictors of morbimortality.

MATERIAL AND METHODS

A case-control study was conducted on 32 patients undergoing surgical atrial fibrillation ablation and cardiac surgery (Maze group) and 32 matched patients (Control group), operated on between 2011 and 2012. An analysis was made of the levels of postoperative lactate, perioperative morbimortality and hospital length of stay. A univariate and multivariate study was performed for a composite endpoint of morbimortality, and prolonged length of stay.

RESULTS

Lactate levels were significantly higher at 6, 12 and 24h in the Maze group. The univariate analysis showed that being in the Maze group (OR 3.88; 95% CI 1.3-11.1; P=.01) and an elevated lactate at 12h (OR 1.33; 95% CI 1.01-1.7; P=.04) were significant predictors of major complications, mortality, and longer hospital stays. In the multivariate analysis, surgical atrial fibrillation ablation (Maze group) was an independent predictor of major complications (OR 4.13; 95% CI 1.312.9; P=.015) for the morbimortality composite endpoint (OR 3.9; 95% CI 1.3-11.6; P=.01), and prolonged length of stay in the Intensive Care Unit (OR 5.7; 95% CI 2.01-15.7; P=.01).

CONCLUSIONS

The atrial fibrillation surgical ablation may be a not-yet-described cause of type B hyperlactatemia, with serum peak values being reached between 4-24h after cardiac surgery. The predictive value of this elevation, its correlation with morbimortality, its sensitivity and specificity to discriminate the significant thresholds needs to be defined.

Decreased serum selenium concentrations in patients with Parkinson's disease

Selenium is an essential component of the antioxidant enzyme glutathione peroxidase. The activity of this enzyme is reduced in the substantia nigra of patients with Parkinson's disease (PD), but the results of studies on erythrocytes are controversial. We compared the serum levels of selenium and the 24 h urinary selenium excretion (measured by hydride generation atomic absorption spectrophotometry) in 29 PD patients and 30 matched controls. Serum selenium levels were significantly lower in PD patients than in controls (34.6 ± 2.35 and 45.2 ± 3.83 μg/l, p < 0.05) while urinary excretion was similar for both groups (47.1 ± 6.25 and 45.5 ± 5.38 μg/24 h). These values were not influenced by antiparkinsonian drugs, and they did not correlate with age, age at onset and duration of the PD, scores of the Unified PD Rating Scale or the Hoehn and Yahr staging in the PD group. These results might suggest a possible role of low serum selenium levels in the risk for, or a consequence of the oxidative stress in PD.

A new method of computing the vertebral heart scale by means of direct standardisation

OBJECTIVES

The aim of this study was to describe and compare a simplified vertebral heart scale computation method (Objective VHS) with the original Buchanan method (Buchanan VHS).

METHODS

The Objective VHS was compared to the Buchanan VHS method in 42 dogs including 14 healthy dogs and 28 dogs with mitral insufficiency. For the Objective VHS, the sum of the length of the long and short axes of the cardiac silhouette obtained in centimetres using a metric ruler was subsequently converted into units of vertebral length by means of a direct standardization method. The Buchanan VHS was obtained as previously described.

RESULTS

No significant differences in vertebral heart scale values were found between the two methods in all dogs. There was a strong positive correlation (0·99) between Objective VHS and Buchanan VHS.

CLINICAL SIGNIFICANCE

The use of a direct standardization method based on a unit conversion allows -computation of vertebral heart scale values without transposing long and short axes to the cranial edge of T4.

Adding condensed tannins to the diet increases ovulation rate in sheep

The objective of the present study was to investigate whether adding condensed tannins (T) to the diet of sheep increases ovulation rate (OR). In all, 281 mature Polwarth ewes (49.9 ± 6.0 kg and body condition score (BCS) of 2.02 ± 0.24 units) were heat-synchronised (oestrus = Day 1) and sorted in the following four treatment diets: (1) native pasture alone (82.6 g of CP and 8.4 MJ metabolisable energy (ME)/kg DM) (NP; n = 70); (2) native pasture (NP) plus a supplement of 0.45 kg of soybean meal (S) from Day 10 to Day 14 (NP+S; n = 71); (3) NP plus a supplement of 0.45 kg S and 25 g of T, to get an estimated concentration of T in the diet of 1.5% (NP+S+1.5T; n = 69); and (4) NP plus a supplement of 0.45 kg S and 42 g of T, to get a concentration of T of 2.5% (NP+S+2.5T; n = 71). OR was measured 8 days after the second heat by rectal ultrasound (Day 25). The estimated consumption of crude protein (CP) during the supplementation period was 129, 261, 237 and 200 g/ewe.day for NP, NP+S, NP+S+1.5T and NP+S+2.5T ewes, respectively. NP+S+1.5T ewes had an OR of 1.90, which was higher (P < 0.05) than those for NP+S+2.5T and NP+S ewes (1.68 and 1.70, respectively). All supplemented ewes had a higher OR than did NP ewes (1.48, P < 0.05). Although NP+S+1.5T ewes ate less protein than did NP+S ewes, their OR was higher, as a result of a more effective use of the protein. The higher concentrations of 2.5% T in the diet might have not evoked a response in OR.

Temephos resistance and esterase activity in the mosquito Aedes aegypti in Havana, Cuba increased dramatically between 2006 and 2008

Aedes aegypti (L.) (Diptera: Culicidae) control programmes in Cuba rely on the application of the organophosphate temephos for larval control. Hence, the monitoring of resistance to this insecticide is an essential component of such programmes. Here, 15 field populations from different municipalities of Havana City were assayed for resistance to temephos. High levels of resistance were detected in all strains and resistance ratios were highly correlated with esterase activity (P = 0.00001). Populations from three municipalities were tested in both 2006 and 2008; resistance and esterase activities both significantly increased during this 2-year period. Synergist studies demonstrated that neither glutathione transferases nor monooxygenases were associated with the increase in resistance to temephos in this period. The duration of the efficacy of commercial formulations of temephos in controlling Ae. aegypti populations in Havana City was reduced by the high level of temephos resistance observed; hence these data are of clear operational significance for the dengue control programme in Cuba. New integrated strategies to avoid further increases in temephos resistance in Cuba are necessary.

Usutu virus – potential risk of human disease in Europe

Usutu virus (USUV) is an African mosquito-borne flavivirus, member of the Japanese encephalitis antigenic group. This avian virus is transmitted by arthropod vectors (mainly mosquitoes of the Culex pipiens complex). It is well known that free-living birds, including migratory species, have the potential to disperse certain pathogenic microorganisms. Usutu virus has recently been introduced to Europe and is spreading through Austria, Hungary, Italy, Spain and Switzerland, causing disease in birds and humans. Like West Nile virus, USUV may become a resident pathogen in Europe and the consequences for public health should be considered. Many different biotic and abiotic factors affect the survival of the virus in a new environment and influence the efficiency of its geographical dispersal. In this article, we consider the possibility of including USUV infections among the vector-borne diseases to be monitored in Europe.

The CRISPR/Cas immune system is an operon regulated by LeuO, H-NS, and leucine-responsive regulatory protein in Salmonella enterica serovar Typhi

Prokaryotes have developed multiple strategies to survive phage attack and invasive DNA. Recently, a novel genetic program denominated the CRISPR/Cas system was demonstrated to have a role in these biological processes providing genetic immunity. This defense mechanism is widespread in the Archaea and Bacteria, suggesting an ancient origin. In the last few years, progress has been made regarding the functionality of the CRISPR/Cas system; however, many basic aspects of the system remain unknown. For instance, there are few studies about the conditions and regulators involved in its transcriptional control. In this work, we analyzed the transcriptional organization of the CRISPR/Cas system as well as the positive and negative regulators involved in its genetic expression in Salmonella enterica serovar Typhi. The results obtained show that in S. Typhi the CRISPR/Cas system is a LeuO-dependent operon silenced by the global regulator LRP, in addition to the previously known nucleoid-associated protein H-NS; both LRP and H-NS bind upstream and downstream of the transcriptional start site of casA. In this study, relevant nucleotides of the casA regulatory region that mediate its LeuO transcriptional activation were identified. Interestingly, specific growth conditions (N-minimal medium) were found for the LeuO-independent expression of the CRISPR/Cas system in S. Typhi. Thus, our work provides evidence that there are multiple modulators involved in the genetic expression of this immune system in S. Typhi IMSS-1.

Outbreak of West Nile virus infection in humans, Romania, July to October 2010

Binary file ES_Abstracts_Final_ECDC.txt matches

[Thrombolysis in acute ischemic stroke in basic hospitals. four cases reports]

Thrombolytic drugs have been used in recent years as an effective therapeutic option in ischemic stroke. There are several experiences with the administration of thrombolytic therapy in basic and rural hospitals. We are describing our experience with four cases in which this treatment was used in our basic hospital during the last three years. We used a strict protocol described in the National Institute of Neurological Disorders and Stroke (NINDS) rt-PA stroke study. No intracranial hemorrhage or protocol violations were detected. We conclude that this protocol has allowed us to offer safe treatment to our ischemic stroke patients.

Control of Table Grapes Postharvest Decay by Ozone Treatment and Resveratrol Induction

Continued and intermittent (12 h per day) ozone treatments (2 ppm) to control postharvest decay have been assayed during the storage of ‘Superior Seedless’, ‘Cardinal CL80,’ and ‘Regina Victoria’ table grapes (Vitis vinifera L.) at 5 °C for 72 days. The effects of these treatments on the main fruit quality parameters, including resveratrol content, were monitored. Both ozone treatments considerably reduced decay of cold stored grapes compared to those kept in air, continuous ozone treatment being the most effective for controlling postharvest losses. Intermittent ozone treatment induced the highest resveratrol content in stored grapes. On the contrary, ozone-treated grapes got lower scores in the sensory evaluation tests and also showed significantly higher weight losses than the fruits kept in air.

Pre-partum shearing of ewes under pastoral conditions improves the early vigour of both single and twin lambs

This study tested the hypothesis that ewes bearing single or twin lambs shorn at 70 or 120 days of pregnancy would give birth to lambs more vigorous than those born to unshorn ewes, increasing the chances of lamb survival. This was tested in two experiments. In the first, 57 adult Corriedale ewes bearing single lambs were allocated to three treatments; shearing at Day 70 of gestation (S70, n = 18), shearing at Day 120 of gestation (S120, n = 19) or unshorn (US, n = 20). In the second, 57 Corriedale ewes bearing twins were allocated to the same treatments: S70, n = 18; S120, n = 20; or US, n = 19. All ewes grazed native pasture until penned and fed individually to requirements during the last 10 days of pregnancy. Gestation length, lamb birthweight, lamb behaviour during their first hour of life, blood glucose and colostrum amount and composition were measured. In the first experiment, with single lambs, birthweights were similar (4.8, 4.7 and 4.7 kg for S70, S120 and US ewes, respectively; s.e. = 0.17, P = 0.47) and the ewes had lengths of gestation of 149 ± 0.6, 148 ± 0.5 and 147 ± 0.6 days respectively. Seventy-eight percent of S70 and 61% of S120 lambs sucked compared with 21% of US lambs (P < 0.001). In the second experiment, with twin lambs, S70 lambs were heavier than S120, which were heavier than US lambs (3.9, 3.4 and 3.1 kg; s.e. = 0.1, P < 0.0001). Ninety-seven percent of S70 and 92% of S120 lambs stood in their first hour of life compared with 68% of US lambs (P < 0.05). Sixty-seven percent of S70 and 63% of S120 lambs sucked compared with 22% of US lambs (P < 0.001). The length of gestation was 148 ± 0.4, 147 ± 0.5 and 144 ± 0.5 days for S70, S120 and US ewes. In both experiments there was no difference in the amount or quality of the colostrum produced by the ewes of the different treatments. We conclude that pre-partum shearing improves lambs’ behaviour independently of their birthweight and suggest that this could be because the lambs are more physiologically mature at birth.