Dual and triple modulator therapy for chronic rhinosinusitis in cystic fibrosis patients

BACKGROUND

The introduction of CFTR modulators has changed the landscape in the treatment of cystic fibrosis (CF) and early case series have shown improvements in sinonasal outcomes in this patient population.

METHODOLOGY

A real-word data study was performed to evaluate the impact of dual therapy with tezacaftor/ivacaftor (TEZ/IVA) and triple therapy with elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) on CF-related chronic rhinosinusitis (CRS), by comparing subjective and objective outcome measures at baseline, 12 months after treatment with TEZ/IVA and six months after treatment with ELX/TEZ/IVA.

RESULTS

In total, 43 CF patients, with a mean age of 32 years, were included. After triple therapy, significant improvements in overall visual analogue scale, SNOT-22, Lund Kennedy, nasal polyps, and Lund-Mackay scores were observed, whereas no beneficial effect could be seen in patients treated with dual therapy. Bacterial upper airway colonization did not differ pre- and postmodulator therapy in the present study. The number of responders to dual and triple therapy is 23.8% and 63.2% of the patients, respectively.

CONCLUSIONS

Triple therapy with ELX/TEZ/IVA is superior to dual therapy with TEZ/IVA in the treatment of CF-CRS, as significantly reduced sinonasal complaints, nasal endoscopy and CT scores were observed after triple therapy, whereas this was not the case for dual therapy.

Comparison of 99mTc-DTPA and 51Cr-EDTA for glomerular filtration rate measurement with the continuous infusion method

BACKGROUND

In late 2018, the production of 51Chromium-labelled ethylenediamine tetra-acetic acid (51Cr-EDTA), a validated and widely used radio-isotopic tracer for measuring glomerular filtration rate, was halted. Technetium-99m-diethylenetriaminepentaacetic acid (99mTc-DTPA) has been validated for GFR measurement with a single bolus injection, a procedure not suitable in patients with extracellular compartment hyperhydration. In such cases, a bolus followed by continuous infusion of the tracer is required. The aim of this study was to evaluate whether 99mTc-DTPA with the infusion protocol can replace 51Cr-EDTA for GFR measurement.

METHODS

We conducted a prospective single centre study during February and March 2019. All patients referred for GFR measurement received both radiotracers simultaneously: 51Cr-EDTA and 99mTc-DTPA bolus and continuous infusion were administered concomitantly through the same intravenous route. Over four and a half hours, plasma and urine samples were collected to calculate urinary and plasma clearance.

RESULTS

Twenty-two patients were included (mean age 63.4 ± 17.5 years; 68% men). Mean urinary clearance of 51Cr-EDTA and 99mTc-DTPA was 52.4 ± 22.5 mL/min and 52.8 ± 22.6 mL/min, respectively (p = 0.47), with a mean bias of 0.39 ± 2.50 mL/min, an accuracy within 10% of 100% (95% CI 100; 100) and a Pearson correlation coefficient of 0.994. Mean plasma clearance of 51Cr-EDTA and 99mTc-DTPA was 54.8 ± 20.9 mL/min and 54.4 ± 20.9 mL/min, respectively (p = 0.61), with a mean bias of - 0.43 ± 3.89 mL/min, an accuracy within 10% of 77% (95% CI 59; 91) and a Pearson correlation coefficient of 0.983.

CONCLUSIONS

Urinary and plasma clearance of 99mTc-DTPA can be used with the infusion protocol to measure GFR.

[The impact of high indoor temperatures on cognitive performance within the work setting: a systematic review]

BACKGROUND

Workplace guidelines exclusively focus on the impact of high indoor temperatures on physical work. There are no concrete recommendations in this regard concerning mental work.

AIM

To investigate to what extent high ambient temperatures can have an impact on cognitive performance within a work setting, which cognitive skills or tasks are impacted, and to what extent the results found can be transposed to the work setting of the psychiatrist.

METHOD

A literature search was conducted using the PubMed, Embase, and Web of Science databases.

RESULTS

A total of 17 studies were included. Although results were inconsistent, reaction time and processing speed appeared to be the most sensitive cognitive skills to elevated ambient temperatures. Higher cognitive functions such as logical and abstract reasoning were more resistant. The temperature range for optimal cognitive functioning generally appeared to be between 22°C and 24°C.

CONCLUSION

Temperatures above 24°C can have a negative impact on cognitive performance within a work setting. Given that reaction speed and processing speed are particularly affected, this could possibly have an impact in the work setting of the psychiatrist when making crucial decisions. However, due to the limited ecological validity of the included studies, unequivocal conclusions remain difficult.

A micro-transducer matrix design for the detection of flexural guided waves

In this paper, a new approach is proposed for the detection of ultrasonic guided waves using a LiNbO₃ single crystal-based micro-transducer matrix. This matrix was designed, manufactured, and then used to detect Lamb and Pochhammer-Chree guided waves in plate- and cylinder-like structures. This study highlights the identification of the first flexural mode F(1,1) in cylinders at low frequencies. A network analyser and a laser Doppler vibrometer (LDV) were used to characterise and study the behaviour of the micro-transducer matrix. An experimental device was designed and used to acquire electrical measurements of the micro-transducer vibrations. Then, an original experimental device was developed to generate a selected flexural guided mode in a solid aluminium cylinder. The emitter comprised two semicircular piezoelectric transducers excited with only one phased signal thanks to the inverse position of polarisation. Finally, the results prove that the flexural mode F(1,1) is selected and generated by the emitter, then detected and identified by the micro-transducer matrix.

Self-sustaining treatment as a novel alternative for the stabilization of anaerobic digestate

Self-sustaining smouldering combustion (SSS) is a technology based on the flameless oxidation of an organic substrate and limited by the rate at which oxygen is diffused to the surface of the substrate. This work aims to evaluate the SSS combustion as a treatment process for the stabilization of anaerobic digestate, determining the limits of operational conditions, (moisture content (MC), air flux) that allow for a self-sustaining process. Maximum possible MC was found at 82 wt% with Darcy air flux of 50 cm/s. The digestate destruction rate (kg/(h·m2), and the addition of sand as an inert solid, to enhance the oxygen diffusion, were also investigated. A sand/substrate mass ratio of 1 allowed for SSS at 85 wt% MC, but decreased the digestate destruction rate. The average composition of the emitted gases showed ca. 25% CO and 10% H₂, whereas the analysis of the ashes showed almost complete digestate inertization.

Management of diabetic foot ulcers: a 25% lidocaine topical cream formulation design, physicochemical and microbiological assessments

Background

Given the importance of surgical debridement in healing of diabetic foot ulcers, effective local anaesthesia is required to manage the related extreme pain. The pharmaceutical proprietary products currently available have low concentrations and do not exceed 5% w/w local anaesthetic.

Objective

Formulation design of a lidocaine cream of 25% and assessment of the intrinsic stability.

Methods

A cream pharmaceutical form was chosen for its ability to cross the skin barrier and effectively anaesthetise the skin. The choice of cream formula is based on changes in the size of the emulsions and resistance to physical stress. Stability tests were assessed over a 6-month period in terms of physical (evaluation of oil droplets), microbiological (germ count and identification, and preservative antimicrobial efficacy) and chemical parameters (content and pH).

Results

Under the study conditions, the drug product displayed good physicochemical and microbiological stability for 6 months at 20°C and 40°C, and no degradation product was detected. Due to the systemic adverse effects of lidocaine, the pH stability guarantee the drug product tolerance along with very weak systemic passage.

Conclusions

Given the good physicochemical and microbiological stability of the drug product over 6-month period, it has been made available to the clinical unit. An average of 250 patients per year benefit from the treatment with an excellent efficacy/tolerability ratio.

A low cost, handheld E-nose for renal diseases early diagnosis

In the last decade, the use of electronic olfaction systems for the early diagnosis of several pathologies by breath analysis has been investigated. In this study, an electronic nose including seven polyaniline sensors has been developed. An impedance measurement circuit and a micro-computer to process the sensor responses were studied to give a pre-diagnosis conclusion. The measurement accuracy is 97% when the E-nose is exposed to a simulated human breath and different concentration of ammonia, from 500 ppb to 2.8 ppm. The described prototype weights about 300 g and can be used for 14 hours with a smartphone battery.

Spontaneous atopic dermatitis due to immune dysregulation in mice lacking Adamts2 and 14

Since its first description, ADAMTS14 has been considered as an aminoprocollagen peptidase based on its high similarity with ADAMTS3 and ADAMTS2. As its importance for procollagen processing was never experimentally demonstrated in vivo, we generated Adamts14-deficient mice. They are healthy, fertile and display normal aminoprocollagen processing. They were further crossed with Adamts2-deficient mice to evaluate potential functional redundancies between these two highly related enzymes. Initial characterizations made on young Adamts2-Adamts14-deficient animals showed the same phenotype as that of Adamts2-deficient mice, with no further reduction of procollagen processing and no significant aggravation of the structural alterations of collagen fibrils. However, when evaluated at older age, Adamts2-Adamts14-deficient mice surprisingly displayed epidermal lesions, appearing in 2 month-old males and later in some females, and then worsening rapidly. Immunohistological evaluations of skin sections around the lesions revealed thickening of the epidermis, hypercellularity in the dermis and extensive infiltration by immune cells. Additional investigations, performed on young mice before the formation of the initial lesions, revealed that the primary cause of the phenotype was not related to alterations of the epidermal barrier but was rather the result of an abnormal activation and differentiation of T lymphocytes towards a Th1 profile. However, the primary molecular defect probably does not reside in the immune system itself since irradiated Adamts2-Adamts14-deficient mice grafted with WT immune cells still developed lesions. While originally created to better characterize the common and specific functions of ADAMTS2 and ADAMTS14 in extracellular matrix and connective tissues homeostasis, the Adamts2-Adamts14-deficient mice revealed an unexpected but significant role of ADAMTS in the regulation of immune system, possibly through a cross-talk involving mesenchymal cells and the TGFβ pathways.

To transplant or not? The importance of psychosocial and behavioural factors before lung transplantation

The gratifying results of lung transplantation in terms of survival and quality of life stimulate the referral of an ever-increasing number of patients with end-stage lung disease. This in turn compounds the organ shortage, which is the limiting factor in the transplantation rate. In the absence of good alternative treatment modalities, an evidence-based pretransplant screening process is a prerequisite to detennine which patients will benefit most from transplantation. Within this evidence-based screening process, medical selection criteria are well established. There is a growing awareness that psychosocial and behavioural factors may determine outcome after transplantation as well. This paper reviews the available evidence for psychosocial and behavioural factors in the screening process for lung transplantation. The relation of various factors with post-transplant outcome was explored. Psychosocial characteristics before transplantation consist of 1) anxiety and depression, 2) personality disorders, 3) neurocognitive problems, and 4) lack of social support. Pretransplant behavioural factors include 1) noncompliance with medication, 2) alcohol abuse or dependence, 3) smoking, 4) noncompliance with dietary guidelines, and 5) noncompliance with monitoring of vital parameters and infections. It appears that the lack of rigorous studies limit the feasibility of an evidence-based screening process. Prospective studies are crucial to this further investigation of the relationship between psychosocial and behavioural determinants before transplantation and outcomes after transplantation, in terms of compliance, morbidity, and mortality. Identification of modifiable risk factors for poor outcome before transplantation is a first step in developing interventions.

Hybridization relics complicate barcode-based identification of species in earthworms

Introgressive hybridization results in mito-nuclear discordance which could obscure the delimitation of closely related taxa. Although such events are increasingly reported, they have been poorly studied in earthworms. Here, we propose a method for investigating the degree of introgressive hybridization between three taxa of the Allolobophora chlorotica aggregate within two field populations (N = 67 and N = 105) using a reference data set including published DNA barcoding and microsatellite data of all known A. chlorotica lineages (N = 85). For this, we used both molecular phylogenetic and population genetic approaches. The test of correspondence between mitochondrial cytochrome c oxidase I (COI) lineages and clusters of nuclear microsatellite genotypes allowed individuals to be sorted in three categories (matching, admixed and nonmatching) and additional markers (mitochondrial NADH dehydrogenase subunit 1, nuclear Histone 3 and Internal transcribed Spacer Region 2) were used for phylogenetic reconstructions in order to check assignments. Although 15 admixed individuals were observed, no early-generation hybrids were detected within the two populations. Interestingly, 14 nonmatching individuals (i.e. with a mtDNA haplotype that did not correspond to their nuclear cluster) were detected, a pattern that would result after multiple generations of unidirectional hybridization of female from one taxon to male of the other taxon. Because earthworms are simultaneous hermaphrodites, these events of unidirectional hybridization suggest sterility of the male function in several crosses and highlight that some individuals can be misidentified if reliance is placed on COI barcodes alone. These findings could improve the use of these barcodes in earthworms for species delineation.

Use of dicyanamide ionic liquids for extraction of metal ions

A correlation between the extraction capacity of tetraalkylammonium dicyanamide ILs and the nature of the anion of the metal salt was investigated.

Lobar lung transplantation from deceased donors: a valid option for small-sized patients with cystic fibrosis

BACKGROUND

Small-sized patients with cystic fibrosis usually face long waiting times for a suitable lung donor. Reduced-size lung transplantation (LTx) was promoted to shorten waiting times. We compared donor and recipient characteristics and outcome in lobar ([L]) versus full-size ([FS]) lung recipients.

METHODS

Between July 1, 1991, and February 28, 2011, 535 isolated LTx were performed, including 74 in cystic fibrosis patients (8 L, 66 FS). Patients were followed up until September 2012.

RESULTS

[L] recipients were younger, smaller, and lighter. Sex, waiting times, and donor data (age, sex, height, weight, PaO2/FiO2, and ventilation time) were comparable. Cardiopulmonary bypass was used more often in [L]; cold ischemia was comparable for first lung but longer in [L] for second lung; implantation times were comparable. In-hospital mortality rate was 0% in [L] versus 3% in [FS]. Both intensive care unit and hospital stay were longer in [L]. Grade 3 primary graft dysfunction was more pronounced in [L] at T0 and at T48. FEV1 increased significantly in both groups from preoperative value. Bronchiolitis obliterans syndrome was absent in [L] and diagnosed in 18 patients in [FS], accounting for 6 of 15 late deaths. All [L] are still alive. No differences in survival were found between the groups.

CONCLUSIONS

Although hindered by a higher incidence of primary graft dysfunction, L-LTx is a viable option with excellent survival and pulmonary function comparable to FS-LTx.

The need for a new animal model for chronic rejection after lung transplantation

The single most important cause of late mortality after lung transplantation is obliterative bronchiolitis (OB), clinically characterized by a decrease in lung function and morphologically by characteristic changes. Recently, new insights into its pathogenesis have been acquired: risk factors have been identified and the use of azithromycin showed a dichotomy with at least 2 different phenotypes of bronchiolitis obliterans syndrome (BOS). It is clear that a good animal model is indispensable to further dissect and unravel the pathogenesis of BOS. Many animal models have been developed to study BOS but, so far, none of these models truly mimics the human situation. Looking at the definition of BOS, a good animal model implies histological OB lesions, possibility to measure lung function, and airway inflammation. This review sought to discuss, including pros and cons, all potential animal models that have been developed to study OB/BOS. It has become clear that a new animal model is needed; recent developments using an orthotopic mouse lung transplantation model may offer the answer because it mimics the human situation. The genetic variants among this species may open new perspectives for research into the pathogenesis of OB/BOS.