Gadolinium during human pregnancy following administration of gadolinium chelate before pregnancy.

Gadolinium (Gd), a toxic rare earth element, has been shown to dissociate from chelating agents and bioaccumulate within tissues, raising concerns about the possibility of their remobilization during pregnancy with subsequent free Gd exposures to developing fetuses. Gd chelates are among the most commonly used magnetic resonance imaging (MRI) contrast agents. This investigation was undertaken after the detection of elevated Gd (800-1000× higher than the usual rare earth element levels) in preliminary unpublished studies from the placentae of subjects in the NIH ECHO/UPSIDE Rochester Cohort Study and unpublished studies from placentae analyzed in formalin-fixed placental specimens from Surgical Pathology at the University of Rochester. Fifteen pregnancies with elevated Gd were studied (12 first pregnancies and 3 second pregnancies). Maternal bloods were collected from all three trimesters, maternal, and cord (fetal) bloods at delivery as well as placental tissue. Breastmilk was also collected from selected mothers. It was determined that Gd was present in maternal bloods from all three trimesters, and in cord bloods and breastmilk in both first and second pregnancies. These results emphasize the need to fully appreciate the implications of pre-pregnancy exposure to Gd chelates and its potential effects on maternal and fetal health.

Rationalising pre-operative trauma bloods can lead to significant cost savings.

BACKGROUND: A full set of pre-operative bloods is being done on nearly all trauma patients who are admitted to our institute for surgery-regardless of variables such as patient age, injury sustained, or co-morbidities. This leads to unnecessary bloods being taken. AIMS: The primary aims are (1) to calculate the costs associated with routine pre-operative bloods and (2) to examine how much money could be saved by retrospectively applying a more pragmatic pre-operative bloods policy. METHODS: Trauma theatre cases over a 5-week period were identified with their pre-operative bloods and post-operative transfusions. Labour, material, and processing costs were estimated for each test. An updated pre-operative blood schedule was proposed and applied retrospectively to see if cost savings could be found. RESULTS: Of the 173 orthopaedic procedures performed, 109 (63%) had a group and screen or crossmatch pre-operatively. Fifteen (8.6%) required a post-operative blood transfusion. One hundred and twenty-eight (74%) patients had a full blood count, and renal profile taken pre-operatively. A full set of bloods costs approximately €51.23 to take and process. When the updated pre-operative blood guidelines were retrospectively applied, it would have led to cost savings of €2496 over the 5-week period of this audit, and if extrapolated up to 1 year, could lead to potential annual savings of €25,960. CONCLUSIONS: We have demonstrated that an excessive amount of unnecessary pre-operative bloods have been taken using the current blood schedule. A pragmatic pre-operative blood schedule can lead to significant actual cost savings.

Metformin mediates MicroRNA-21 regulated circulating matrix metalloproteinase-9 in diabetic nephropathy: an in-silico and clinical study.

Metformin is commonly used as an oral hypoglycaemic agent in type 2 diabetes mellitus (T2DM). MicroRNA-21 is widely studied in diabetic and diabetic nephropathy (DN) patients. Matrix metalloproteinase-9 (MMP9) is involved in extracellular matrix degradation and tissue repair processes. However, the effect of metformin administration on hsa-miR-21-5p and MMP9 has not been evaluated in T2DM and DN patients. The study subjects were divided into three groups (Healthy controls = 36, T2DM = 38, DN = 35). Anthropometric measurements were taken and biochemical tests were carried out on fasting blood samples. Reverse transcriptase PCR was employed for whole blood gene expression analysis of hsa-miR-21-5p and MMP9. Bioinformatics analyses including drug-gene interaction, protein-protein interaction, functional enrichment analyses and co-expression networks were performed. In the present study, MMP9 and hsa-miR-21-5p levels were downregulated and upregulated respectively in T2DM and DN patients when compared with healthy controls. However, in metformin-treated group, a downregulation of hsa-miR-21-5p and upregulation of MMP9 was observed. In-silico analysis revealed the target genes involved in the miR-21 and MMP9 interaction network. Metformin directly targets miR-21 and regulates MMP9 expression in T2DM patients, influencing the pathogenesis of DN.HighlightsMMP-9 and hsa-miR-21-5p were downregulated and upregulated respectively in T2DM and DN patients in a Western Indian population.The patients treated with metformin showed downregulation of hsa-miR-21-5p and upregulation of MMP9.In-silico analysis revealed MMP-9 as well as PTEN to be targets of hsa-miR-21-5p.Metformin regulates MMP9 expression in T2DM and DN patient populations through hsa-miR-21-5p.

The indole alkaloids from the roots of Isatidis Radix.

The root of Isatis indigotica is used as a traditional Chinese medicine (termed Isatidis Radix) due to its antiviral effects. We examined compounds isolated from Isatidis Radix and elucidated the structures of three new natural alkaloids, and we examined the possible mechanisms or active targets of indole alkaloids occurring in blood of rats treated by gavage. Three new natural products were isolated from Radix Isatidis for the first time, including 1-methoxy-2-indoleacetonitrile, 1-hydroxy-3-indoleacetonitrile, 8-Methoxy-1, 2-dihydroquinoline, and 4 compounds isolated from this medicinal material for the first time. Their structures were elucidated using nuclear magnetic resonance. The components of Isatidis Radix were analysed using liquid chromatography tandem mass spectrometry, and 33 compounds were detected in plasma of treated rats; 24 of these compounds were indole alkaloids, and they included the newly identified compounds. Molecular docking and in vitro antithrombin activity tests showed HA inhibition activity of indoleacetonitriles.

Strategies of blood collection in Cote d'Ivoire: impact of mobile collection methods on the production of the National Blood Transfusion Service, 2014-2016.

Blood product suppliers have two options for blood collection: at fixed sites and mobile collection sites. Those preferring voluntary, unpaid donations must move ever closer to the population by organizing mobile collection. The objective of this study was to analyze the impact of mobile collection in the production of the Côte d'Ivoire's CNTS. Our results, based on data from the CNTS from 2014 through 2016 and interviews with 22 managers of blood transfusion centers, confirm the increasing preponderance of this approach. Thus, our results raise the problem of blood safety in a context where the prevalence of transfusion-transmissible infections is higher in mobile collections, where most donors are giving blood for the first time.

Evaluation of exposure to lead from drinking water in large buildings.

Lead results from 78,971 water samples collected in four Canadian provinces from elementary schools, daycares, and other large buildings using regulatory and investigative sampling protocols were analyzed to provide lead concentration distributions. Maximum concentrations reached 13,200 and 3890 µg/L following long and short stagnation periods respectively. High lead levels were persistent in some large buildings, reflected by high median values considering all taps, or specific to a few taps in the building. Simulations using the Integrated Uptake Biokinetic (IEUBK) model and lead concentrations after 30 min of stagnation in the dataset showed that, for most buildings, exposure to lead at the tap does not increase children's blood lead levels (BLLs). However, buildings or taps with extreme concentrations represent a significant health risk to young children attending school or daycare, as the estimated BLL far exceeded the 5 µg/dL threshold. Ingestion of water from specific taps could lead to acute exposure. Finally, for a few taps, the total daily lead intake reached the former World Health Organization (WHO) tolerable level for adults, suggesting potential health risks.

Bacteriemia por enterobacterias resistentes a carbapenems: Un estudio transversal / Bacteremia due to carbapenem-resistant Enterobacteriaceae: A cross-sectional study

Objetivos: Describir las características clínicas, los esquemas de antibiótico empleados y el pronóstico en términos de mortalidad intrahospitalaria y efectos adversos en pacientes con bacteriemia por enterobacterias con prueba fenotípica para carbapenemasas positiva. Material y métodos: Estudio de corte trasversal en un hospital de tercer nivel (Medellín, Colombia), en pacientes con bacteriemia por enterobacterias resistentes a carbapenems (CRE) detectados entre enero del 2010 y diciembre del 2013. Se presentan las variables continuas con medianas y rangos intercuartiles (RIQ) y las categóricas con porcentajes. Resultados: Se incluyeron 64 casos con un promedio de edad de 62 ± 14 años, 66% (n = 42) hombres. El 60% (n = 38) se encontraban en la UCI, y la mediana de APACHE-II fue de 17 (RIQ: 12-22), con alta comorbilidad (puntaje Charlson de 3; RIQ: 2-5). La mediana de estancia previa a la bacteriemia fue de 21 días (RIQ: 13-39). El 64% correspondieron a Klebsiella pneumoniae , el 20% a Serratia marcescens y el 11% a Enterobacter spp. El 45% tenían tamización positiva previa a la bacteriemia. La mortalidad a los 28 días fue del 51,6% (n = 33) y ocurrió con una mediana de 5 días luego de detectada la bacteriemia (RIQ: 2-17). El tratamiento definitivo fue combinado en el 76,6% de los casos, pero no hubo un esquema de combinación prevalente. Se reportaron efectos adversos en uno de cada 3 pacientes, y la mediana de estancia hospitalaria fue de 46 días (RIQ: 26-76). La mortalidad a 28 días de pacientes tratados con carbapenems (n = 27), colistina (n = 27) o tigeciclina (n = 18), solos o en cualquier combinación, fue del 40,7, del 55,2 y del 55,7%, respectivamente. Discusión: Los pacientes incluidos tenían altos índices de comorbilidad y exposición al ambiente nosocomial, como en estudios previamente publicados. La mortalidad a 28 días fue comparable a la reportada en otros estudios. Se encontró menor mortalidad en pacientes tratados con terapias combinadas que incluían carbapenems, similar a lo reportado en un estudio clínico reciente en pacientes con bacteriemia por Klebsiella pneumoniae productora de carbapenemasas. Conclusiones: La bacteriemia por CRE afecta pacientes muy enfermos y se acompaña de elevadamortalidad. Se detecta colonización en casi la mitad de los pacientes antes del desarrollo deinfección. Hay heterogeneidad en el manejo antimicrobiano, pero la inclusión de carbapenemsen el esquema de tratamiento combinado podría asociarse con menor mortalidad.

Objectives: To describe the clinical features, antibiotic regimes and prognosis in terms of inpatient mortality and adverse effects in patients with Enterobacteriaceae bacteremia anda positive carbapenemase-detecting phenotypic test. Materials and methods: A cross-sectional study was conducted at a tertiary hospital (Medellín,Colombia). Patients with blood stream infections by carbapenems-resistant Enterobacteriaceae(CRE) diagnosed from January, 2010 to December, 2013 were included. Continuous variables are presented as medians and interquartile ranges (IQR), and categorical variables are presentedas percentages. Results: Sixty-four cases were included, with a mean age of 62 ± 14; 66% were male (n = 42).A total of 60% (n = 38) were admitted to the ICU and the median APACHE-II score was 17 (IQR:12-22), with high comorbidity (Charlson score = 3, IQR: 2-5). The median hospital stay prior to the diagnosis of bacteremia was 21 days (IQR: 13-39). Klebsiella pneumoniae was isolated in 64%, Serratia marcescens in 20% and Enterobacter spp. in 11% of the cases. Some 45% had apositive screening before the diagnosis of bacteremia. Mortality at 28 days was 51.6% (n = 33)and occurred in a median of 5 days (IQR: 2-17) after bloodstream infection was detected. Definitive treatment was a combination of antibiotics for 76.6%, but no combination scheme was prevalent. Adverse effects were observed in one of 3 patients and the median hospital stay was46 days (IQR: 26-76). Mortality at 28 days was 40.7% when patients were treated with a combination that included carbapenems agents (n = 27), compared with 55.2% for colistin (n = 27) and 55,7% for tigecycline (n = 18). Discussion: A high comorbidity index and nosocomial environment exposure were observed,as in previously published studies. The 28-day mortality was comparable to that reported inother studies. There was less mortality in patients treated with a combination that includeda carbapenem agent, as was reported in a recent clinical study on patients with bacteremia Klebsiella pneumoniae carbapenemase. Conclusions: CRE bacteremia is seen in very ill patients and is associated with high mortality. Bacterial colonization was detected in nearly half the patients prior to development of infection. The current antimicrobial therapy is heterogeneous, but the inclusion of a carbapenems agent in combination therapy may be associated with lower mortality.

Responses of artificially reared cat fleas Ctenocephalides felis felis (Bouché, 1835) to different mammalian bloods.

The cat flea, Ctenocephalides felis felis (Bouche, 1835) (Siphonaptera: Pulicidae), which is found worldwide and which parasitizes many species of wild and domestic animal, is a vector and/or reservoir of bacteria, protozoa and helminths. To aid in the study of the physiology and behaviour of fleas and of their transmission of pathogens, it would be of value to improve the laboratory rearing of pathogen-free fleas. The conditions under which artificially reared fleas at the University of Bristol (U.K.) and the Rickettsial Diseases Institute (France) are maintained were studied, with different ratios of male to female fleas per chamber (25 : 50, 50 : 100, 100 : 100, 200 : 200). The fleas were fed with bovine, ovine, caprine, porcine or human blood containing the anticoagulants sodium citrate or EDTA. Egg production was highest when fleas were kept in chambers with a ratio of 25 males to 100 females. In addition, the use of EDTA as an anticoagulant rather than sodium citrate resulted in a large increase in the number of eggs produced per female; however, the low percentage of eggs developing through to adult fleas was lower with EDTA. The modifications described in our rearing methods will improve the rearing of cat fleas for research.