Spectro-electrochemical study of iron and ruthenium bis-terpyridine complexes with methyl viologen-like subunits as models for supramolecular polymers.

Metallo-supramolecular polyelectrolytes (MEPE) have a variety of attractive properties concerning electrochromism, spin-crossover, rheology, and cell differentiation. Previous studies suggest that these polynuclear structures can be regarded as an assembly of individual subunits and mononuclear complexes can act as models. In this study, we synthesize a monotopic and a ditopic terpyridine ligand with pyridinium units as well as the corresponding iron and ruthenium MEPEs and their mononuclear counterparts. UV-vis studies show that the mononuclear complexes have similar absorption properties to MEPEs. Furthermore, all complexes and MEPEs exhibit electrochromic behavior. Yet only the MEPEs can be deposited on different substrates using a layer-by-layer approach which makes them attractive for applications as electrochromic devices. However, the low solubility particularly of the ruthenium MEPE, renders characterization in solution impractical. Hence, the use of mononuclear complexes with similar monotopic ligands as presented herein can act as a first instance to evaluate the properties of corresponding MEPEs, facilitating the development of metallo-supramolecular materials.

MRI and 18F-FET PET for Multimodal Treatment Monitoring in Patients with Brain Metastases: A Cost-Effectiveness Analysis.

PET using the radiolabeled amino acid O-(2-[18F]fluoroethyl)-l-tyrosine (18F-FET) has been shown to be of value for treatment monitoring in patients with brain metastases after multimodal therapy, especially in clinical situations with equivocal MRI findings. As medical procedures must be justified socioeconomically, we determined the effectiveness and cost-effectiveness of 18F-FET PET for treatment monitoring of multimodal therapy, including checkpoint inhibitors, targeted therapies, radiotherapy, and combinations thereof in patients with brain metastases secondary to melanoma or non-small cell lung cancer. Methods: We analyzed already-published clinical data and calculated the associated costs from the German statutory health insurance system perspective. Two clinical scenarios were considered: decision tree model 1 determined the effectiveness of 18F-FET PET alone for identifying treatment-related changes, that is, the probability of correctly identifying patients with treatment-related changes confirmed by neuropathology or clinicoradiographically using the Response Assessment in Neuro-Oncology criteria for immunotherapy. The resulting cost-effectiveness ratio showed the cost for each correctly identified patient with treatment-related changes in whom MRI findings remained inconclusive. Decision tree model 2 calculated the effectiveness of both 18F-FET PET and MRI, that is, the probability of correctly identifying nonresponders to treatment. The incremental cost-effectiveness ratio was calculated to determine cost-effectiveness, that is, the cost for each additionally identified nonresponder by 18F-FET PET who would have remained undetected by MRI. One-way deterministic and probabilistic sensitivity analyses tested the robustness of the results. Results: 18F-FET PET identified 94% of patients with treatment-related changes, resulting in €1,664.23 (€1.00 = $1.08 at time of writing) for each correctly identified patient. Nonresponders were correctly identified in 60% by MRI and in 80% by 18F-FET PET, resulting in €3,292.67 and €3,915.83 for each correctly identified nonresponder by MRI and 18F-FET PET, respectively. The cost to correctly identify 1 additional nonresponder by 18F-FET PET, who would have remained unidentified by MRI, was €5,785.30. Conclusion: Given the considerable annual cost of multimodal therapy, the integration of 18F-FET PET can potentially improve patient care while reducing costs.

Pt(II)-bis(quinolinyl) complexes for photocatalytic hydrogen production.

Three Pt(II)-bis(quinolinyl) complexes with varying electron densities were synthesized, structurally characterized and used for photocatalytic hydrogen production under different conditions. All the complexes were found to be active for hydrogen production giving a maximum turnover number (TON) of 1230 surpassing the conventionally used Pt-terpyridyl complexes.

Phylogenomic analysis of a global collection of Escherichia coli ST38: evidence of interspecies and environmental transmission?

IMPORTANCE: Extraintestinal pathogenic Escherichia coli (ExPEC) sequence type (ST) 38 is one of the top 10 human pandemic lineages. Although a major cause of urinary tract and blood stream infections, ST38 has been poorly characterized from a global phylogenomic perspective. A comprehensive genome-scale analysis of 925 ST38 isolate genomes identified two broad ancestral clades and linkage of discrete ST38 clusters with specific bla CTX-M variants. In addition, the clades and clusters carry important virulence genes, with diverse but poorly characterized plasmids. Numerous putative interhost and environment transmission events were identified here by the presence of ST38 clones (defined as isolates with ≤35 SNPs) within humans, companion animals, food sources, urban birds, wildlife, and the environment. A small cluster of international ST38 clones from diverse sources, likely representing progenitors of a hospital outbreak that occurred in Brisbane, Australia, in 2017, was also identified. Our study emphasizes the importance of characterizing isolate genomes derived from nonhuman sources and geographical locations, without any selection bias.

Factors affecting Naseptin treatment success - A prospective cohort study.

OBJECTIVE: To assess patient factors to predict treatment success of Naseptin for recurrent paediatric epistaxis. METHODS: This prospective cohort study of paediatric patients referred to a tertiary paediatric otolaryngology clinic with recurrent epistaxis treated with Naseptin cream and education. Patients with red flag symptoms and bleeding diathesis were omitted, along with patients with concurrent otolaryngology complaints. Statistical analysis included logistic regression analysis to assess for predictive factors contributing to treatment success. RESULTS: 125 of 210 patients on the waiting list met the inclusion criteria and were given a complete trial of Naseptin. 80.8% (n = 101) of patients found that the frequency and severity of epistaxis had reduced, with the remaining 19.2% (n = 24) reporting that the episodes of epistaxis remained the same and required further management (i.e., silver nitrate cautery). Five patients (4%) reported minor side effects (skin irritation etc.) with no significant adverse events reported. CONCLUSION: We found that Naseptin is a safe, well-tolerated treatment that should be trialled in most cases of recurrent paediatric epistaxis. Most children will benefit from it with complete epistaxis cessation or at least reduced frequency and severity.

Genome organization and genomics in Chlamydia: whole genome sequencing increases understanding of chlamydial virulence, evolution, and phylogeny.

The genus Chlamydia contains important obligate intracellular bacterial pathogens to humans and animals, including C. trachomatis and C. pneumoniae. Since 1998, when the first Chlamydia genome was published, our understanding of how these microbes interact, evolved and adapted to different intracellular host environments has been transformed due to the expansion of chlamydial genomes. This review explores the current state of knowledge in Chlamydia genomics and how whole genome sequencing has revolutionised our understanding of Chlamydia virulence, evolution, and phylogeny over the past two and a half decades. This review will also highlight developments in multi-omics and other approaches that have complemented whole genome sequencing to advance knowledge of Chlamydia pathogenesis and future directions for chlamydial genomics.

Prediction of response to lomustine-based chemotherapy in glioma patients at recurrence using MRI and FET PET.

BACKGROUND: We evaluated O-(2-[18F]fluoroethyl)-l-tyrosine (FET) PET and MRI for early response assessment in recurrent glioma patients treated with lomustine-based chemotherapy. METHODS: Thirty-six adult patients with WHO CNS grade 3 or 4 gliomas (glioblastoma, 69%) at recurrence (median number of recurrences, 1; range, 1-3) were retrospectively identified. Besides MRI, serial FET PET scans were performed at baseline and early after chemotherapy initiation (not later than two cycles). Tumor-to-brain ratios (TBR), metabolic tumor volumes (MTV), the occurrence of new distant hotspots with a mean TBR >1.6 at follow-up, and the dynamic parameter time-to-peak were derived from all FET PET scans. PET parameter thresholds were defined using ROC analyses to predict PFS of ≥6 months and OS of ≥12 months. MRI response assessment was based on RANO criteria. The predictive values of FET PET parameters and RANO criteria were subsequently evaluated using univariate and multivariate survival estimates. RESULTS: After treatment initiation, the median follow-up time was 11 months (range, 3-71 months). Relative changes of TBR, MTV, and RANO criteria predicted a significantly longer PFS (all P ≤ .002) and OS (all P ≤ .045). At follow-up, the occurrence of new distant hotspots (n ≥ 1) predicted a worse outcome, with significantly shorter PFS (P = .005) and OS (P < .001). Time-to-peak changes did not predict a significantly longer survival. Multivariate survival analyses revealed that new distant hotspots at follow-up FET PET were most potent in predicting non-response (P < .001; HR, 8.578). CONCLUSIONS: Data suggest that FET PET provides complementary information to RANO criteria for response evaluation of lomustine-based chemotherapy early after treatment initiation.

Accuracy of quantum chemistry structures of chiral tag complexes and the assignment of absolute configuration.

The absolute configuration of a molecule can be established by analysis of molecular rotational spectra of the analyte complexed with a small chiral molecule of known configuration. This approach of converting the analyte enantiomers, with identical rotational spectra, into diastereomers that can be distinguished spectroscopically is analogous to chiral derivatization in nuclear magnetic resonance (NMR) spectroscopy. For the rotational chiral tag method, the derivatization uses noncovalent interactions to install the new chiral center and avoids complications due to possible racemization of the analyte when covalent chemistry is used. The practical success of this method rests on the ability to attribute assigned rotational spectra to specific geometries of the diastereomeric homochiral and heterochiral tag complexes formed in the pulsed jet expansion that is used to introduce samples into the microwave spectrometer. The assignment of a molecular structure to an experimental rotational spectrum uses quantum chemistry equilibrium geometries to provide theoretical estimates of the spectrum parameters that characterize the rotational spectrum. This work reports the results of a high-sensitivity rotational spectroscopy study of the complexes formed between (3)-butyn-2-ol and verbenone. The rotational spectra of four homochiral and four heterochiral complexes are assigned. In addition, the 14 distinct, singly-substituted 13C isotopomer spectra of five of these species are assigned in natural abundance. Analysis of these spectra provides direct structural characterization of the complexes through determination of the carbon atom position coordinates. This data set is used to benchmark quantum chemistry calculations of candidate equilibrium geometries of the chiral tag complexes. The quantum chemistry calculations are limited to methods commonly used in the field of rotational spectroscopy. It is shown that the accuracy of the structures from quantum chemistry provides a high-confidence assignment of cluster geometries to the observed spectra. As a result, a high-confidence determination of the analyte (verbenone) absolute configuration is achieved.

Improving otoscopy education and diagnostic accuracy: A prospective interventional study.

OBJECTIVE: To assess and improve otoscopy examination skills across various medical specialities who perform otoscopy during their professional practice. METHODS: A pre-intervention survey was created using www.surveymonkey.com, which included several preliminary questions to clarify the participant's speciality and training level, followed by 25 individual otoscopy images. The participants were given 12 possible diagnoses for each otoscopy image and asked to choose the single best answer. After completing the survey, participants were asked to watch an otoscopy teaching session. This teaching session was created with multidisciplinary feedback, and the content included a demonstration video and a didactic lecture. Finally, a post-intervention survey was circulated four weeks later to the same cohort of doctors to assess improvement. RESULTS: A total of 79 pre-intervention surveys were collected with an average score of 53% (range 20-100%). The spectrum of medical specialities that completed the pre-intervention survey included paediatrics, ear, nose, and throat (ENT), emergency medicine, and general practice. The largest cohort of surveys came from senior house officers (SHO). In addition, 78.5% of responses were completed by doctors who had not worked in ENT before. After completing the otoscopy teaching session and at least four weeks after the initial survey, 23 post-intervention surveys were completed with an average score of 66% (range 32-100%), a 13% improvement. CONCLUSIONS: The results of the pre-intervention survey show that many doctors have difficulty diagnosing ear conditions. The implementation of a 25-min teaching session achieved a 13% improvement in the otoscopy knowledge of doctors across a variety of specialities.

Red Absorbing Cyclometalated Ir(III) Diimine Photosensitizers Competent for Hydrogen Photocatalysis.

Two new cyclometalated Ir(III) diimine complexes were used as photosensitizers for homogeneous hydrogen evolution reaction (HER). These complexes were characterized by electrochemistry, ultraviolet-visible absorption, time-resolved and steady-state photoluminescence spectroscopy as well as by theoretical methods. The metal-ligand-to-ligand charge transfer character of their lowest excited state was shown to be competent for efficient H2 photoproduction in the presence of [Co(dmgH)2(py)Cl] as the hydrogen evolution catalyst, triethanolamine as the sacrificial electron donor, and HBF4 as the proton source. Under optimized experimental conditions, both complexes displayed HER over a period of more than 90 h, with turnover numbers reaching up to 11,650, 10,600, and 174 molH2 molPS-1 under blue-, green-, and red-light irradiation, respectively. Both complexes showed higher stability and efficiency vs HER than most of the previously described systems of the same kind.

The Successful Implementation of Day Case Tonsillectomy.

Objective Day case tonsillectomy is standard practice in many international centres, and is widespread across the UK. In Ireland, implementation has been slow for multiple reasons. Our unit aimed to introduce day case tonsillectomy, following a pilot programme. Following a year of implementation we have reaudited our practice. We hypothesised that day case tonsillectomy is a practical and favourable solution to facilitate access to surgery in the context of long waiting times for ENT surgery. Methods This was a prospective audit collecting data on day case tonsillectomy. All patients for day case tonsillectomy were selected in OPD according to our inclusion criteria. We recorded demographical data, surgical technique, length of stay, failed discharges, bleeding rate and readmission rate. Results There was one primary haemorrhage within 24 hours of surgery (0.08%). There were 16 secondary bleeds, giving a rate of 13.9%. Of these, four patients required a return to theatre for the cessation of bleeding (3.5%). There was no statistical significance in bleed rate between surgical technique. Failed discharge rate was 6%. The average time from extubation to discharge was 6 hours and 53 minutes. Conclusions Our experience of day case tonsillectomy is that it is safe, feasible and efficient in a selected group of patients. This can expedite long waiting times for tonsillectomy, and improve access to overnight beds for other cases. Our numbers represent the first unit in Ireland to have 2 year of experience with data showing successful implementation.

Active repair of a dinuclear photocatalyst for visible-light-driven hydrogen production.

The molecular apparatus behind biological photosynthesis retains its long-term functionality through enzymatic repair. However, bioinspired molecular devices designed for artificial photosynthesis, consisting of a photocentre, a bridging ligand and a catalytic centre, can become unstable and break down when their individual modules are structurally compromised, halting their overall functionality and operation. Here we report the active repair of such an artificial photosynthetic molecular device, leading to complete recovery of catalytic activity. We have identified the hydrogenation of the bridging ligand, which inhibits the light-driven electron transfer between the photocentre and catalytic centre, as the deactivation mechanism. As a means of repair, we used the light-driven generation of singlet oxygen, catalysed by the photocentre, to enable the oxidative dehydrogenation of the bridging unit, which leads to the restoration of photocatalytic hydrogen formation.

Paediatric day-case tonsillectomy - parent satisfaction questionnaire.

OBJECTIVE: To assess parent or guardian satisfaction with a newly instituted day-case tonsillectomy programme at a tertiary paediatric institution. METHODS: After receiving ethical approval, an anonymous questionnaire was sent to the parent or guardian of every patient who underwent day-case tonsillectomy between July 2018 and December 2020. RESULTS: A total of 135 patients were included. The parent or guardian of each patient was sent a questionnaire to be filled in and returned. Ninety-two completed surveys were returned. There were high satisfaction levels, with 91.3 per cent of parents or guardians feeling comfortable bringing their child home, and 92.4 per cent of parents or guardians would recommend day-case tonsillectomy to another parent or guardian. Of the parents or guardians, 10.9 per cent needed to contact healthcare services in the 24 hours following surgery. CONCLUSION: Day-case tonsillectomy has proven to be a safe, efficient service at our institution, with high satisfaction levels from patients and parents or guardians. Areas for improvement focused on communication at the time of discharge regarding follow up and analgesia.

Odontogenic sinusitis - case series and review of literature.

BACKGROUND: Odontogenic sinusitis is a common cause of rhinosinusitis that is often undiagnosed and overlooked. No single sign or symptom is specific for odontogenic sinusitis, and failure to focus on the specific radiological features can delay diagnosis. OBJECTIVE: This paper presents four cases of chronic sinusitis that had an odontogenic origin. Each case was referred for a second opinion. Three patients had previously undergone unsuccessful surgical management. METHODS: The literature, and the associated contributory clinical, radiological and microbiological features required for correct diagnosis and management, are reviewed. RESULTS: Each case resulted in a positive patient outcome following the involvement of both otolaryngology and maxillofacial surgery departments. CONCLUSION: A high index of suspicion is advocated for odontogenic sinusitis in cases not responding to standard management plans. Collaboration with a maxillofacial specialist is important for diagnosis and management. This should be considered where standard management fails, or clinical features and radiological signs of odontogenic sinusitis are present. This paper also highlights the need for otolaryngologists to incorporate, at the very least, a basic dental history and examination as part of their assessment in recalcitrant cases.

Phylogenomics of two ST1 antibiotic-susceptible non-clinical Acinetobacter baumannii strains reveals multiple lineages and complex evolutionary history in global clone 1.

Acinetobacter baumannii is an opportunistic pathogen that is difficult to treat due to its resistance to extreme conditions, including desiccation and antibiotics. Most strains causing outbreaks around the world belong to two main global lineages, namely global clones 1 and 2 (GC1 and GC2). Here, we used a combination of Illumina short read and MinION (Oxford Nanopore) long-read sequence data with a hybrid assembly approach to complete the genome sequence of two antibiotic-sensitive GC1 strains, Ex003 and Ax270, recovered in Lebanon from water and a rectal swab of a cat, respectively. Phylogenetic analysis of Ax270 and Ex003 with 186 publicly available GC1 genomes revealed two major clades, including five main lineages (L1-L5), and four single-isolate lineages outside of the two clades. Ax270 and Ex003, along with AB307-0294 and MRSN7213 (both predicted antibiotic-susceptible isolates) represent these individual lineages. Antibiotic resistance islands and transposons interrupting the comM gene remain important features in L1-L5, with L1 associated with the AbaR-type resistance islands, L2 with AbaR4, L3 strains containing either AbaR4 or its variants as well as Tn6022::ISAba42, and L4 and L5 associated with Tn6022 or its variants. Analysis of the capsule (KL) and outer core (OCL) polysaccharide loci further revealed a complex evolutionary history probably involving many recombination events. As more genomes become available, more GC1 lineages continue to emerge. However, genome sequence data from more diverse geographical regions are needed to draw a more accurate population structure of this globally distributed clone.

Dinuclear 2,4-di(pyridin-2-yl)-pyrimidine based ruthenium photosensitizers for hydrogen photo-evolution under red light.

In this study, we report two dinuclear Ru(II) complexes C1 and C2 and compare them to their mononuclear analogues Ref1 and Ref2. The dinuclear species exhibit a much stronger absorption, longer excited-state lifetimes and higher luminescence quantum yields than the mononuclear complexes. In addition, C1 and C2 are easier to reduce. An estimation of the driving forces for the electron transfer processes relevant to photocatalytic hydrogen evolution suggests that C1 and Ref2 possess similar activity as photosensitizer (PS). Yet, the improved photophysical properties of C1 make it a more promising candidate for hydrogen evolution. In hydrogen evolution experiments, C1 indeed exhibits increased activity as PS, however, the catalytic system loses its activity after only a few hours. C2 is less active than the mononuclear complexes despite its superior photophysical properties. This observation is attributed to a lack of driving force for the electron transfer towards the catalyst. Further studies of the dinuclear complex C1 show that it is indeed the PS, which decomposes under the catalytic conditions, presumably due to the electron transfer towards the catalyst being the rate-limiting step.

Two carbapenem-resistant ST1:ST231:KL1:OCL1 Acinetobacter baumannii strains recovered in Tehran, Iran, carry AbaR31 in the chromosome and AbaR4 and TnaphA6 in a RepAci6 plasmid.

OBJECTIVES: To analyse the context of genes conferring antibiotic resistance in two carbapenem-resistant Acinetobacter baumannii isolates recovered in Tehran, Iran. METHODS: The antibiotic resistance phenotype for 28 antibiotics was determined using disc diffusion. The whole genome sequences of ABH008 and ABS200 were determined using the Illumina HiSeq X Ten platform. Resistance genes were identified using ResFinder and multilocus sequence types were determined using the Oxford and Institut Pasteur schemes. RESULTS: Isolates ABH008 and ABS200, recovered in 2012 and 2013, respectively, in two different Tehran hospitals, belong to the common global clone 1 lineage, ST1IP and ST231OX. They are resistant to sulfamethoxazole, tetracycline, gentamicin, amikacin, third-generation cephalosporins and carbapenems. Despite being isolated in different hospitals, phylogenetic analysis indicated they are closely related. Consistent with this, both isolates carry catA1, sul1, aacC1 and aadA1 in a novel variant of the AbaR3-type resistance island, named AbaR31. Both isolates are resistant to amikacin and carbapenems owing to aphA6 and oxa23, respectively. The oxa23 gene is located in the AbaR4 resistance island, and aphA6 in TnaphA6, and both mobile elements are in an ∼90 kbp plasmid encoding the putative RepAci6 replication initiation protein. Resistance to third-generation cephalosporins is due to the acquisition by homologous recombination of a 5 kb DNA segment that contains ISAba1-ampC from a ST623 strain. CONCLUSIONS: The resistance gene complements of ABH008 and ABS200 were found in AbaR31 and a plasmid that encodes RepAci6. The close genetic relationship of ABH008 and ABS200, despite each being recovered from different hospitals, indicates transmission between the two hospitals.

Dual RNA-seq analysis of in vitro infection multiplicity and RNA depletion methods in Chlamydia-infected epithelial cells.

Dual RNA-seq experiments examining viral and bacterial pathogens are increasing, but vary considerably in their experimental designs, such as infection rates and RNA depletion methods. Here, we have applied dual RNA-seq to Chlamydia trachomatis infected epithelial cells to examine transcriptomic responses from both organisms. We compared two time points post infection (1 and 24 h), three multiplicity of infection (MOI) ratios (0.1, 1 and 10) and two RNA depletion methods (rRNA and polyA). Capture of bacterial-specific RNA were greatest when combining rRNA and polyA depletion, and when using a higher MOI. However, under these conditions, host RNA capture was negatively impacted. Although it is tempting to use high infection rates, the implications on host cell survival, the potential reduced length of infection cycles and real world applicability should be considered. This data highlights the delicate nature of balancing host-pathogen RNA capture and will assist future transcriptomic-based studies to achieve more specific and relevant infection-related biological insights.

Fabrication and Characterization of Electrospun Poly(acrylonitrile-co-Methyl Acrylate)/Lignin Nanofibers: Effects of Lignin Type and Total Polymer Concentration.

Lignin macromolecules are potential precursor materials for producing electrospun nanofibers for composite applications. However, little is known about the effect of lignin type and blend ratios with synthetic polymers. This study analyzed blends of poly(acrylonitrile-co-methyl acrylate) (PAN-MA) with two types of commercially available lignin, low sulfonate (LSL) and alkali, kraft lignin (AL), in DMF solvent. The electrospinning and polymer blend solution conditions were optimized to produce thermally stable, smooth lignin-based nanofibers with total polymer content of up to 20 wt % in solution and a 50/50 blend weight ratio. Microscopy studies revealed that AL blends possess good solubility, miscibility, and dispersibility compared to LSL blends. Despite the lignin content or type, rheological studies demonstrated that PAN-MA concentration in solution dictated the blend's viscosity. Smooth electrospun nanofibers were fabricated using AL depending upon the total polymer content and blend ratio. AL's addition to PAN-MA did not affect the glass transition or degradation temperatures of the nanofibers compared to neat PAN-MA. We confirmed the presence of each lignin type within PAN-MA nanofibers through infrared spectroscopy. PAN-MA/AL nanofibers possessed similar morphological and thermal properties as PAN-MA; thus, these lignin-based nanofibers can replace PAN in future applications, including production of carbon fibers and supercapacitors.

Two RuII Linkage Isomers with Distinctly Different Charge Transfer Photophysics.

The ligand PHEHAT (PHEHAT = 1,10-phenanthrolino[5,6-b]1,4,5,8,9,12-hexaazatriphenylene) presents a structural asymmetry that has a dramatic influence on the photophysical properties depending on the chelation site of the metal ion in the linkage isomers. While [RuII(phen)2HATPHE]2+ behaves classically, like [RuII(bpy)3]2+, [RuII(phen)2PHEHAT]2+ exhibits an unusual behavior. It appears that this complex has two 3MLCT bright states, the lower one being weakly emissive or nonemissive depending on the solvent and temperature. Different photophysical techniques involving a wide range of various temperatures and timescales are essential to analyze this difference. A full photophysical scheme is proposed based on experimental data and density functional theory calculations. While previous studies focused on high temperatures and longer timescale emission, we explore the complexes at very low temperatures and very short times in order to obtain a more complete picture of the intriguing photophysical behavior of these complexes.