Influence of Weather Conditions in the Northwestern Russian Federation on Flax Fiber Characters According to the Results of a 30-Year Study.

Weather has significant impact on plant growth and development. It is important to analyze the influence of changing climate conditions on the expression of plant agronomic characters. Two flax varieties were grown from 1987 to 2018 in the Northwest of Russia. Weather conditions and their influence on flax agronomic characters were analyzed using the variance and correlations analyses. Significant influence of conditions of a particular year on the manifestation of all evaluated characters was revealed. Starting from June, high temperatures accelerate plant development at all stages. Prolongation of the germination-flowering period is most important for improving fiber productivity, while fast ripening in hot weather after flowering is preferable for the formation of high-quality fiber. Such data give a possibility to predict the yield amount and quality. The use of weather conditions data also makes possible a comparison of the results obtained in different years. The suggested method of classifying meteorological conditions of a year can be used in other genebanks for systematizing and analyzing the results of crop evaluation in the field. The correlation analysis revealed 3 correlated pleiades, namely (1) of productivity, (2) of fiber quality and yield, and (3) of the growing season phase durations, the sums of active temperatures and precipitation during each period. The great influence of growing conditions on the economically valuable traits indicates the necessity of searching for genotypes with stable character manifestations for breeding new varieties with stable yields and good fiber quality.

Outcomes during and after long-term tocilizumab treatment in patients with giant cell arteritis.

OBJECTIVE: To assess outcomes in giant cell arteritis (GCA) patients during and after long-term tocilizumab (TCZ) treatment. METHODS: Retrospective analysis of GCA patients treated with TCZ at a single centre (2010-2022). Time to relapse and annualised relapse rate during and after TCZ treatment, prednisone use, and safety were assessed. Relapse was defined as reappearance of any GCA clinical manifestation that required treatment intensification, regardless of C reactive protein levels and erythrocyte sedimentation rate. RESULTS: Sixty-five GCA patients were followed for a mean (SD) of 3.1 (1.6) years. The mean duration of the initial TCZ course was 1.9 (1.1) years. The Kaplan-Meier (KM)-estimated relapse rate at 18 months on TCZ was 15.5%. The first TCZ course was discontinued due to satisfactory remission achievement in 45 (69.2%) patients and adverse events in 6 (9.2%) patients. KM-estimated relapse rate at 18 months after TCZ discontinuation was 47.3%. Compared with patients stopping TCZ at or before 12 months of treatment, the multivariable adjusted HR (95% CI) for relapse in patients on TCZ beyond 12 months was 0.01 (0.00 to 0.28; p=0.005). Thirteen patients received >1 TCZ course. Multivariable adjusted annualised relapse rates (95% CI) in all periods on and off TCZ aggregated were 0.1 (0.1 to 0.2) and 0.4 (0.3 to 0.7), respectively (p=0.0004). Prednisone was discontinued in 76.9% of patients. During the study, 13 serious adverse events occurred in 11 (16.9%) patients. CONCLUSION: Long-term TCZ treatment was associated with remission maintenance in most patients with GCA. The estimated relapse rate by 18 months after TCZ discontinuation was 47.3%.

Features of Profiles of Biologically Active Compounds of Primary and Secondary Metabolism of Lines from VIR Flax Genetic Collection, Contrasting in Size and Color of Seeds.

Flax is one of the oldest oil crops, but only since the end of the twentieth century nutritional use of its whole seeds and flour has been resumed. This crop has been evaluated for its oil fatty acid composition, content of sterols and tocopherols, carbohydrate composition of mucilage, but a comprehensive study has never been carried out, so the aim of the work was to identify differences in the metabolomic profiles of flax lines contrasting in color and size of seeds. The biochemical composition of seeds from 16 lines of the sixth generation of inbreeding was tested using gas chromatography coupled with mass spectrometry. In total, more than 90 compounds related to sugars (78% of the identified substances), free fatty acids (13%), polyatomic alcohols (5%), heterocyclic compounds, free amino acids, phytosterols and organic acids (no more than 2.5% in total) were identified. Statistical analyses revealed six main factors. The first is a factor of sugar content; the second one affects most of organic acids, as well as some free fatty acids, not related to reserve ones, the third factor is related to compounds that play a certain role in the formation of "storage" substances and resistance to stress, the fourth factor is influencing free polar amino acids, some organic and free fatty acids, the fifth one is a factor of phenolic compounds, the sixth factor combined substances not included in the first five groups. Factor analysis made it possible to differentiate all 16 lines, 10 of which occupied a separate position by one or two factors. Interestingly, the first two factors with the highest loads (20 and 15% of the total variability, respectively) showed a separate position of the gc-432 line, which differed from the others, not only by chemical composition, but also by the phenotype of the seeds, while gc-159 differed from the rest ones by the complex of organic acids and other substances taking about 1% of the extracted substances of the seed. Thus, the analysis of metabolomic profiles is promising for a comprehensive assessment of the VIR flax genetic collection, which has wide biochemical diversity.

Improved folding of recombinant protein via co-expression of exogenous chaperones.

Expression of heterologous genes in Escherichia coli is a routine technology for recombinant protein production, but the predictable recovery of properly folded and uniformly bioactive material remains a challenge. Misfolded proteins typically accumulate as insoluble inclusion bodies, and a variety of strategies have been employed in efforts to increase the yield of soluble product. One technique is the overexpression of E. coli protein chaperones during recombinant protein induction, in an effort to increase the folding capacity of the bacterial host. We have developed an alternative approach, by supplementing the host protein folding machinery with chaperones from other species. Extremophiles have evolved under conditions (extremes of temperature, salinity, pressure, and/or pH) that make them attractive candidates for possessing chaperones with novel folding activities. The green fluorescent protein (GFP) of Aequorea victoria, which is predominantly insoluble under typical recombinant expression culture conditions, was employed as an in vivo indicator of protein folding activity for chaperone homologs from a variety of extremophiles. For a subset of the chaperones tested, co-expression with GFP promoted an increase in both fluorescence signal intensity as well as the amount of GFP recovered in the soluble protein fraction. Several archaeal chaperones were also found to be able to refold soluble Lyt_Orn C40 peptidase from inclusion bodies in vitro. In particular, Pf Cpn(MA), a mutant chaperonin which exhibited significant refolding activity, is also shown to deconstruct the morphology and structure of inclusion bodies (Kurouski et al., 2012). Hence, the simple and rapid GFP assay provides a tool to screen for extremophilic chaperones that exhibit folding activity under E. coli growth conditions, and suggests that increasing the repertoire of heterologous chaperones might provide a partial but general solution to the problem of recombinant protein insolubility.

Treatment failure in giant cell arteritis.

OBJECTIVE: Identify predictors of treatment failure in patients with giant cell arteritis (GCA) receiving tocilizumab in combination with glucocorticoids and in patients with GCA receiving only glucocorticoids. METHODS: Posthoc analysis of the Giant-Cell Arteritis Actemra trial including 250 patients who received tocilizumab every week plus a 26-week prednisone taper (n=100), tocilizumab every-other-week plus a 26-week prednisone taper (n=49) or placebo plus a 26-week (n=50) or 52-week (n=51) prednisone taper in the intention-to-treat population. Responders for this analysis were patients who maintained remission (no GCA signs/symptoms and no erythrocyte sedimentation rate elevation) through week 52. Treatment failure was defined as inability to achieve remission by week 12 or relapse between weeks 12 and 52. Predictors investigated in univariate and multivariable analyses included patient characteristics, disease-related and treatment-related factors and patient-reported outcomes (PROs). RESULTS: 149 patients received tocilizumab plus prednisone (TCZ/PDN) and 101 received placebo plus prednisone (PBO+PDN). After adjustment for confounders, treatment failure was significantly less likely in the TCZ/PDN group than the PBO/PDN group (OR, 0.2; 95% CI, 0.1 to 0.3; p<0.0001). Risk for treatment failure was significantly higher in women than men in the PBO/PDN group (OR, 5.2; 95% CI, 1.6 to 17.2; p=0.007) but not in the TCZ/PDN group. Predictors of treatment failure in the TCZ/PDN group included lower baseline prednisone doses and worse PROs at baseline. CONCLUSION: The strongest risk factors for treatment failure in GCA are treatment with prednisone alone and female sex. Lower starting prednisone doses and impaired PROs are associated with failure to respond to tocilizumab. TRIAL REGISTRATION NUMBER: NCT01791153.

Active remote sensing of atmospheric dust using relationships between their depolarization ratios and reflectivity.

The backscattered light from agglomerated debris particles shows that an approximate linear correlation exists between the logarithm of the geometric albedo $ \log(A )$ of polydispersions of agglomerated debris particles and their lidar linear or circular depolarization ratios, $ \unicode{x00B5}_L$ and $ \unicode{x00B5}_C$. The nature of the relationship depends on the complex refractive index of the particles in the distribution. This extension of the Umov law can be used for lidar and radar characterizations by placing constraints on the reflectivity of the particles. It suggests that an approximate inverse relationship exists between the lidar ratio and the lidar depolarization ratios whose scaling parameter depends on the refractive index of the aerosol population.

Tocilizumab vs placebo for the treatment of giant cell arteritis with polymyalgia rheumatica symptoms, cranial symptoms or both in a randomized trial.

OBJECTIVE: The randomized, placebo (PBO)-controlled GiACTA trial demonstrated the efficacy and safety of tocilizumab (TCZ) in patients with giant cell arteritis (GCA). The present study evaluated the efficacy of TCZ in patients with GCA presenting with polymyalgia rheumatica (PMR) symptoms only, cranial symptoms only or both PMR and cranial symptoms in the GiACTA trial. METHODS: In GiACTA, 250 patients with GCA received either TCZ weekly or every other week plus a 26-week prednisone taper or PBO plus a 26- or 52-week prednisone taper. This post hoc analysis assessed baseline characteristics, sustained remission rate, number of flares, annualized flare rate, time to flare, cumulative prednisone dose, methotrexate use and safety in patients with PMR symptoms only, cranial symptoms only or both at baseline. RESULTS: Overall, 52 patients had PMR symptoms only, 94 had cranial symptoms only and 104 had both symptoms at baseline. At Week 52, rates of sustained remission were significantly higher with TCZ vs PBO in all 3 groups (PMR only, 45.2% vs 19.0%, P = 0.0446; cranial only, 60.3% vs 19.4%, P = 0.0001; PMR and cranial, 55.0% vs 11.4%, P < 0.0001). Smaller proportions of TCZ-treated patients experienced disease flare than PBO-treated patients across all groups (PMR only, 41.9% vs 57.1%; cranial only, 20.7% vs 47.2%; PMR and cranial, 31.7% vs 81.8%). Annualized flare rate and risk of flare were significantly lower with TCZ vs PBO for patients with cranial symptoms only and both symptoms; they were numerically lower, but did not reach statistical significance, in the smaller group of patients with PMR symptoms only. CONCLUSIONS: TCZ improved clinical outcomes in patients who presented with PMR symptoms only, cranial symptoms only or both at baseline, suggesting that TCZ is effective in patients with GCA regardless of the presenting clinical phenotype.

Clinical outcomes of patients with giant cell arteritis treated with tocilizumab in real-world clinical practice: decreased incidence of new visual manifestations.

BACKGROUND: Placebo-controlled clinical trials have demonstrated the efficacy of tocilizumab (TCZ) for remission maintenance and glucocorticoid sparing in patients with giant cell arteritis (GCA). However, limited data exist on the effectiveness and safety of TCZ for GCA in real-world clinical practice. METHODS: This was a retrospective, single-center analysis of patients with GCA treated with intravenous or subcutaneous TCZ (2010-2018). Outcomes evaluated before and after TCZ initiation included occurrence of flare, time to flare, annualized flare rate, flare characteristics (i.e., polymyalgia rheumatica [PMR] symptoms, cranial manifestations), prednisone use, and safety. Flare was defined as the recurrence of unequivocal GCA manifestations requiring treatment intensification. Subgroup analyses of patients with PMR or visual manifestations at GCA diagnosis were performed. RESULTS: Sixty patients with GCA were included. The median (IQR) disease duration before and after the start of TCZ was 0.6 (0.2-1.6) and 0.5 (0.3-1.4) years, respectively. At least 1 flare was observed in 43 patients (71.7%) before and in 18 (30.0%) after TCZ initiation. Median (IQR) time to flare was 0.5 (0.3-0.7) years before TCZ treatment and 2.1 (0.6-2.6) years after TCZ initiation (HR 0.22; 95% CI 0.10-0.50; p = 0.0003). The annualized flare rate significantly decreased following TCZ use (before TCZ 1.4 [95% CI 1.0-2.1]; after TCZ 0.6 [95% CI 0.3-1.0] events/year; p < 0.001). Similar improvements were observed in patients with visual manifestations or PMR symptoms at GCA diagnosis. TCZ reduced the incidence of new visual manifestations, and no flares associated with permanent vision loss occurred while patients were receiving TCZ. Mean (SD) prednisone dose at TCZ onset and at the end of follow-up was 30 (18.3) and 5 (6.9) mg/day, respectively (p < 0.0001). After TCZ initiation, 46.6% of patients successfully discontinued prednisone. The incidence of adverse events, primarily attributed to glucocorticoids, was similar before and after TCZ initiation. CONCLUSIONS: In this real-world setting, TCZ improved GCA clinical outcomes significantly and demonstrated effectiveness in the subgroups of patients with PMR symptoms and GCA-related visual manifestations at GCA diagnosis. No new cases of blindness occurred after TCZ initiation. Adverse events, many attributable to glucocorticoids, were comparable before and after TCZ treatment.

Ultrasonographic modeling of diaphragm function: A novel approach to respiratory assessment.

OBJECTIVES: Bedside ultrasound techniques have the unique ability to produce instantaneous, dynamic images, and have demonstrated widespread utility in both emergency and critical care settings. The aim of this article is to introduce a novel application of this imaging modality by utilizing an ultrasound based mathematical model to assess respiratory function. With validation, the proposed models have the potential to predict pulmonary function in patients who cannot adequately participate in standard spirometric techniques (inability to form tight seal with mouthpiece, etc.). METHODS: Ultrasound was used to measure diaphragm thickness (Tdi) in a small population of healthy, adult males at various points of the respiratory cycle. Each measurement corresponded to a generated negative inspiratory force (NIF), determined by a handheld meter. The data was analyzed using mixed models to produce two representative mathematical models. RESULTS: Two mathematical models represented the relationship between Tdi and NIFmax, or maximum inspiratory pressure (MIP), both of which were statistically significant with p-values <0.005: 1. log(NIF) = -1.32+4.02×log(Tdi); and 2. NIF = -8.19+(2.55 × Tdi)+(1.79×(Tdi2)). CONCLUSIONS: With validation, these models intend to provide a method of estimating MIP, by way of diaphragm ultrasound measurements, thereby allowing evaluation of respiratory function in patients who may be unable to reliably participate in standard spirometric tests.

Lasing threshold of the bound states in the continuum in the plasmonic lattices.

Distributed feedback plasmonic laser based on the periodic array of holes in the silver half-space and covered with gain medium is considered. Square, hexagonal and several rectangular lattices are studied. It is demonstrated that the bound states in the continuum provide substantially lower threshold than radiating modes. Moreover, it is shown that while the hole size increases the lasing threshold of some modes decreases. Among the studied types of lattices, lasing in the hexagonal lattice requires the lowest material gain of only 18 cm-1. Our results pave the way to the development of the efficient low-threshold distributed feedback plasmonic lasers.

Effect of Alteplase vs Aspirin on Functional Outcome for Patients With Acute Ischemic Stroke and Minor Nondisabling Neurologic Deficits: The PRISMS Randomized Clinical Trial.

Importance: More than half of patients with acute ischemic stroke have minor neurologic deficits (National Institutes of Health Stroke Scale [NIHSS] score of 0-5) at presentation. Although prior major trials of alteplase included patients with low NIHSS scores, few without clearly disabling deficits were enrolled. Objective: To evaluate the efficacy and safety of alteplase in patients with NIHSS scores of 0 to 5 whose deficits are not clearly disabling. Design, Setting, and Participants: The PRISMS trial was designed as a 948-patient, phase 3b, double-blind, double-placebo, multicenter randomized clinical trial of alteplase compared with aspirin for emergent stroke at 75 stroke hospital networks in the United States. Patients with acute ischemic stroke whose deficits were scored as 0 to 5 on the NIHSS and judged not clearly disabling and in whom study treatment could be initiated within 3 hours of onset were eligible and enrolled from May 30, 2014, to December 20, 2016, with final follow-up on March 22, 2017. Interventions: Participants were randomized to receive intravenous alteplase at the standard dose (0.9 mg/kg) with oral placebo (n = 156) or oral aspirin, 325 mg, with intravenous placebo (n = 157). Main Outcomes and Measures: The primary outcome was the difference in favorable functional outcome, defined as a modified Rankin Scale score of 0 or 1 at 90 days via Cochran-Mantel-Haenszel test stratified by pretreatment NIHSS score, age, and time from onset to treatment. Because of early termination of the trial, prior to unblinding or interim analyses, the plan was revised to examine the risk difference of the primary outcome by a linear model adjusted for the same factors. The primary safety end point was symptomatic intracranial hemorrhage (sICH) within 36 hours of intravenous study treatment. Results: Among 313 patients enrolled at 53 stroke networks (mean age, 62 [SD, 13] years; 144 [46%] women; median NIHSS score, 2 [interquartile range {IQR}, 1-3]; median time to treatment, 2.7 hours [IQR, 2.1-2.9]), 281 (89.8%) completed the trial. At 90 days, 122 patients (78.2%) in the alteplase group vs 128 (81.5%) in the aspirin group achieved a favorable outcome (adjusted risk difference, -1.1%; 95% CI, -9.4% to 7.3%). Five alteplase-treated patients (3.2%) vs 0 aspirin-treated patients had sICH (risk difference, 3.3%; 95% CI, 0.8%-7.4%). Conclusions and Relevance: Among patients with minor nondisabling acute ischemic stroke, treatment with alteplase vs aspirin did not increase the likelihood of favorable functional outcome at 90 days. However, the very early study termination precludes any definitive conclusions, and additional research may be warranted. Trial Registration: ClinicalTrials.gov Identifier: NCT02072226.

AG-1031 and AG-1503 improve cognitive deficits by promoting apoptosis and inhibiting autophagy in C6 glioma model rats.

High-grade gliomas (HGGs; grades III and IV) are the most common and aggressive adult primary brain tumors, and their invasive nature ranks them the fourth in the incidence of cancer death. In our previous study, we found that AG-1031 and AG-1503 showed inhibitory effects on several cancer cell lines. In this study, C6 glioma-bearing rats were treated with AG-1031 or AG-1503. Western blot results of autophagy-associated protein (LC3 II/I, Beclin-1) and apoptosis-associated proteins (caspase-3, Bcl-2, Bax) revealed that AG-1031 could activate apoptotic signal pathway via inhibiting autophagy process in cancer cells. HE staining indicated that the tumor volumes were significantly decreased in AG-1031 and AG-1503 treated rats compared to non-treated C6 glioma-bearing rats. Meanwhile, AG-1031 and AG-1503 significantly decreased the expression of VEGF, a marker of invasion ability of tumor, in tumor tissue. The novel object recognition test showed that cognitive functions in C6 glioma-bearing rats were considerably damaged, whereas AG-1031 and AG-1503 significantly impeded the cognitive impairment. AG-1031 and AG-1503 efficiently alleviated the glioma-induced impairments of long-term potentiation (LTP), which was damaged in C6 glioma-bearing rats. Furthermore, AG-1031 and AG-1503 augmented the expression of synaptophysin (SYP), which were decreased in glioma rats. In conclusion, our results suggest that AG-1031 and AG-1503 can inhibit the expansion of glioma, and improve the cognitive impairment caused by glioma in glioma-bearing rats.

Extracellular proteins of Trametes hirsuta st. 072 induced by copper ions and a lignocellulose substrate.

BACKGROUND: Fungi are organisms with the highest natural capacity to degrade lignocellulose substrates, which is enabled by complex systems of extracellular enzymes, whose expression and secretion depend on the characteristics of substrates and the environment. RESULTS: This study reports a secretome analysis for white-rot basidiomycete Trametes hirsuta cultivated on a synthetic media and a lignocellulose substrate. We demonstrate that T. hirsuta st. 072 produces multiple extracellular ligninolytic, cellulolytic, hemicellulolytic, peroxide generating, and proteolytic enzymes, as well as cerato-platanins. In contrast to other white rot species described earlier, which mostly secreted glucanases and mannosidases in response to the presence of the lignocellulose substrate, T. hirsuta expressed a spectrum of extracellular cellulolytic enzymes containing predominantly cellobiases and xylanases. As proteomic analysis could not detect lignin peroxidase (LiP) among the secreted lignin degrading enzymes, we attributed the observed extracellular LiP - like activity to the expressed versatile peroxidase (VP). An accessory enzyme, glyoxal oxidase, was found among the proteins secreted in the media during submerged cultivation of T. hirsuta both in the presence and in the absence of copper. However, aryl-alcohol oxidase (AAO) was not identified, despite the presence of AAO enzymatic activity secreted by the fungus. The spectra of the expressed enzymes dramatically changed depending on the growth conditions. Transfer from submerged cultivation to surface cultivation with the lignocellulose substrate switched off expression of exo-ß-1,3-glucanase and α-amylase and turned on secretion of endo-ß-1,3-glucanase and a range of glycosidases. In addition, an aspartic peptidase started being expressed instead of family S53 protease. For the first time, we report production of cerato-platanin proteins by Trametes species. The secretion of cerato-platanins was observed only in response to contact with lignocellulose, thus indicating a specific role of these proteins in degradation of the lignocellulose substrates. CONCLUSIONS: Our results suggest a sequential mechanism of natural substrate degradation by T. hirsuta, in which the fungus produces different sets of enzymes to digest all main components of the substrate during cultivation.

Draft Genome Sequence of the Fungus Trametes hirsuta 072.

A standard draft genome sequence of the white rot saprotrophic fungus Trametes hirsuta 072 (Basidiomycota, Polyporales) is presented. The genome sequence contains about 33.6 Mb assembled in 141 scaffolds with a G+C content of ~57.6%. The draft genome annotation predicts 14,598 putative protein-coding open reading frames (ORFs).

The Trametes hirsuta 072 laccase multigene family: Genes identification and transcriptional analysis under copper ions induction.

Laccases, blue copper-containing oxidases, ≿ an play an important role in a variety of natural processes. The majority of fungal laccases are encoded by multigene families that express closely related proteins with distinct functions. Currently, only the properties of major gene products of the fungal laccase families have been described. Our study is focused on identification and characterization of laccase genes, which are transcribed in basidiomycete Trametes hirsuta 072, an efficient lignin degrader, in a liquid medium, both without and with induction of laccase transcription by copper ions. We carried out production of cDNA libraries from total fungal RNA, followed by suppression subtractive hybridization and mirror orientation selection procedures, and then used Next Generation Sequencing to identify low abundance and differentially expressed laccase transcripts. This approach resulted in description of five laccase genes of the fungal family, which, according to the phylogenetic analysis, belong to distinct clusters within the Trametes genus. Further analysis established similarity of physical, chemical, and catalytic properties between laccases inside each cluster. Structural modeling suggested importance of the sequence differences in the clusters for laccase substrate specificity and catalytic efficiency. The implications of the laccase variations for the fungal physiology are discussed.

An evaluation of risk factors for major adverse cardiovascular events during tocilizumab therapy.

OBJECTIVE: To evaluate associations between lipid levels, inflammation, and rheumatoid arthritis (RA) disease activity, at baseline and during treatment, with the risk of major adverse cardiovascular events (MACE) in tocilizumab-treated patients with RA. METHODS: In retrospective post hoc analyses, data were pooled for 3,986 adult patients with moderate to severe RA who received ≥1 dose of tocilizumab (4 mg/kg or 8 mg/kg) intravenously every 4 weeks in randomized controlled trials and extension studies. Cox proportional hazards modeling was used to evaluate associations between baseline characteristics and posttreatment changes in laboratory and disease characteristics (week 24) and change in disease activity and laboratory values from baseline to week 24 with the risk of future MACE during extended followup. RESULTS: We identified 50 independently adjudicated cases of MACE during 14,683 patient-years of followup (0.34 MACE cases/100 patient-years). At baseline, age, a history of cardiac disorders, the Disease Activity Score in 28 joints (DAS28), and the total cholesterol:high-density lipoprotein cholesterol ratio were independently associated with MACE in multivariable models (P < 0.05 for all). During treatment, a higher DAS28 and higher swollen and tender joint counts at week 24 were associated with future MACE. In separate models, greater reductions in the DAS28 and joint counts from baseline to week 24 were inversely associated with future MACE; changes in lipid parameters were not statistically significantly associated with the risk of MACE. CONCLUSION: In this population of patients treated with tocilizumab, an association was observed between the baseline total cholesterol:high-density lipoprotein cholesterol ratio and an increased risk of MACE. The risk of MACE while receiving treatment, however, was associated with control of disease activity but not lipid changes. Larger studies are needed to confirm these findings.

Inappropriate discharge on bronchodilators and acid-blocking medications after ICU admission: importance of medication reconciliation.

BACKGROUND: Previous studies suggest that some medications, including proton pump inhibitors and ß-agonist inhalers, are administered to hospitalized patients and sometimes continued without indications. Medication reconciliation has been offered as one mechanism to reduce the frequency of such medication errors and is now mandated by the Joint Commission (NPSG.03.06.01). We hypothesized that (1) ß agonists and acid-blocking medications are prescribed following critical illness without indications, and (2) medication reconciliation can reduce the frequency of inappropriate continuation of these agents. The study was carried out in a 414-bed community teaching hospital affiliated with the University of Connecticut Medical School. All subjects were admitted to the ICU between February and April 2012 (physician-driven reconciliation) and between July and September 2012, just following implementation of pharmacy technician-driven medication reconciliation. This was a retrospective cohort study. METHODS: Medical records of all subjects were reviewed using a uniform data extraction tool. Demographic information, clinical data, in-patient and out-patient medications (before and following hospital discharge), and outcomes were recorded. RESULTS: Prior to pharmacy technician-administered, physician-confirmed medication reconciliation, 253 ICU subjects were compared to 291 subjects admitted to the ICU after initiation of this process. There were no differences in admission type, stay, history of coronary artery disease, requirements for mechanical ventilation, or length of mechanical ventilation between groups. Rates of discharge on bronchodilators (8.9 vs. 4.2%, P = .09) or acid blockers (19.1 vs. 11.2%, P = .05) without clinical indications were lower with pharmacy technician-driven, physician-confirmed medication reconciliation than with routine physician-driven medication reconciliation. Multiple logistic regression analyses demonstrated a significant association of mechanical ventilation with inappropriate discharge on both bronchodilators and acid blockers. Pharmacy technician-driven medication reconciliation tended to reduce these errors. CONCLUSIONS: In our hospital, acid blockers and bronchodilators were often continued inappropriately following critical illness. The specific pharmacy technician-driven method of medication reconciliation deployed in our hospital reduced by half but did not eliminate this medication error.

Using quality improvement principles to improve the care of patients with severe sepsis and septic shock.

BACKGROUND: Sepsis, an inflammatory response to an infection that may lead to severe organ dysfunction and death, is the leading cause of death in medical intensive care units. The Society of Critical Care Medicine has issued guidelines and promoted protocols to improve the management of patients with severe sepsis and septic shock. Generally, the medical community has been slow to adopt these guidelines because of the system challenges associated with protocol implementation. We describe an interdisciplinary team approach to the development and implementation of management protocols for treating patients with severe sepsis and septic shock. METHODS: To determine the effectiveness of the bundled emergency department and critical care order sets developed by the Sepsis Steering Committee, we performed a case review of 1,105 sequential patients admitted to a large academic tertiary referral hospital with a diagnosis of severe sepsis or septic shock between July 2008 and January 2012. RESULTS: Implementation of the protocol led to improved order set use over time, a significant decrease in the median time to antibiotics of 140 (range 1-820) minutes in 2008 to 72 (range 1-1,020) minutes in 2011 (P≤0.001), and a decrease in median length of stay from 8 days (range 1-54) in 2008 to 7 days (range 1-33) in 2011 (P=0.036). CONCLUSION: A multidisciplinary team approach to sepsis management using protocols and early goal-directed therapy is feasible in a large academic medical center to improve the process of care and outcomes.

Polysaccharide hydrolases are released with mucilages after water hydration of flax seeds.

Water imbibition of flax seed induces secretion of mucilages whose physico-chemical properties vary according to genotype and environment. The viscosity and composition of mucilage have ecological implications and also affect the utility of the crop. Several types of enzymes are secreted along with the mucilage. Our objective was to study these enzymes in the context of the composition and physical properties of the mucilage. The kinetics of production by flax seeds (variety Eden) of i) mucilages, ii) glycosidases and iii) endo-hydrolases were followed over 48 h under sterile conditions. The impact of enzymatic activities on mucilage was investigated by SEC-MALLS, viscosimetry and sugar composition. The mucilages consisted mainly of rhamnogalacturonan-I (RG-I, 52-62%) and arabinoxylan (AX, 27-36%). RG-I related enzyme activities (rhamnogalacturonase and ß,d-galactosidase) were quantified, together with AX related activity of α,l-arabinofuranosidase, ß,d-xylosidase and ß-xylanase. Maximal xylanase activity was reached after 4 h seed-hydration, when the minimal viscosity of the polysaccharides was observed, and the AX/RG-I ratio was the lowest. At that time, poly and oligosaccharides mainly contained pectic sugars. From 24 to 48 h water-hydration, when mucilages more tightly associated with cell walls were released, the glycosidase activities per g mucilage became maximal; the percentage, average molar-mass and viscosity of the polysaccharides decreased. Glucose, xylose and arabinose were the main sugars in the oligomer fraction. Our data confirmed the presence of ß-d xylosidase and α-l-arabinofuranosidase activities and provided evidence for significant pectinase activities in flax mucilages. They also indicate an impact of enzymatic activities on the physicochemical properties of mucilages.