Biopesticide Encapsulation Using Supercritical CO2: A Comprehensive Review and Potential Applications.

As an alternative to synthetic pesticides, natural chemistries from living organisms, are not harmful to nontarget organisms and the environment, can be used as biopesticides, nontarget. However, to reduce the reactivity of active ingredients, avoid undesired reactions, protect from physical stress, and control or lower the release rate, encapsulation processes can be applied to biopesticides. In this review, the advantages and disadvantages of the most common encapsulation processes for biopesticides are discussed. The use of supercritical fluid technology (SFT), mainly carbon dioxide (CO2), to encapsulate biopesticides is highlighted, as they reduce the use of organic solvents, have simpler separation processes, and achieve high-purity particles. This review also presents challenges to be surpassed and the lack of application of SFT for biopesticides in the published literature is discussed to evaluate its potential and prospects.

Predictors of No-show Rate in the GI Endoscopy Suite at a Safety Net Academic Medical Center.

BACKGROUND/OBJECTIVES: Noncompliance with physician and procedure appointments is associated with poor disease control and worse disease outcomes. This also impacts the quality of care, decreases efficiency, and affects revenue. Studies have shown that no-show rates are higher in clinics caring for underserved populations and may contribute to poorer health outcomes in this group. METHODS: We performed a 17-month retrospective observational cohort study of patients scheduled for outpatient procedures in the Gastroenterology endoscopy suite at the University of Florida Health, Jacksonville. Multivariate logistic regression analysis was performed to evaluate associations between attendance and predictors of no-show. RESULTS: In total, 6157 patients were scheduled to undergo different GI procedures during the study period. A total of 4388 (71%) patients completed their procedure, whereas 2349 (29%) failed to attend their appointment and were considered "no-show". There was a significant relationship between the visit attendance and race, insurance, gender, and marital status. Males had a higher no-show rate compared with females (30% vs. 28%; P<0.05). African Americans had the highest no-show rate (32%; P<0.05) amongst different races. Patients scheduled for surveillance colonoscopy (ie, history of polyps, IBD, Colon cancer) were more likely to show (78%) than those obtaining initial colorectal cancer screening (74%) or other indications (71%) (P<0.05).In the logistic regression model, patients with commercial insurance are more likely to show for their appointments than those with noncommercial insurance (eg, Medicare, Medicaid, City contract etc) [odds ratio (OR), 2.6; 95% confidence interval (CI), 2.2-3.0]. The odds of showing up are 1.7 times higher for married men compared with single men (OR, 1.7; 95% CI, 1.3-2.0). Similarly, married females are more likely to show up for appointment than single females (OR, 1.1; 95% CI, 0.9-1.3). We did not find significant association between the type of GI procedure (eg, colonoscopy vs. esophagogastroduodenoscopy vs. advanced endoscopic procedures) (P>0.05). CONCLUSIONS: Predictors of no-shows for endoscopic gastrointestinal procedures included unpartnered or single patients, African American race and noncommercial insurance providers. Patients scheduled for surveillance colonoscopy had better adherence than initial screening. Further studies are required to better characterize these factors and improve adherence to the outpatient appointments based on the identified predictors.

Barriers to treatment of chronic hepatitis C with direct acting antivirals in an urban clinic.

INTRODUCTION AND AIM: Direct-acting antiviral (DAA) agents are highly effective for treatment of chronic hepatitis C virus (HCV) yet access to treatment remains a serious challenge. The aim of this study was to identify barriers to treatment initiation with DAA-containing regimens in an urban clinic setting. MATERIALS AND METHODS: A retrospective cohort of all chronic HCV patients seen in an urban academic practice in Jacksonville, FL, USA from 1/2014 to 1/2017 was analyzed. Baseline characteristics were recorded and a review of medical records was performed to identify barriers to treatment initiation and overall success rates. RESULTS: Two-hundred and forty patients with chronic HCV were analyzed. Fifty-six percent of patients were African-American and 63% were insured through Medicaid/county programs or uninsured. Sixty-nine percent had barriers to initiating antiviral therapy categorized as psychosocial (n=112), provider (n=26), medical (n=20), and insurance-related factors (n=7). The most commonly encountered psychosocial barriers included failure to keep appointments (79/240, 33%), active substance abuse (18/240, 8%), and failure to obtain laboratory testing (11/240, 5%). Overall, only 27% of patients evaluated were initiated on DAA-containing regimens with 18% reaching SVR12 within the 36-month study period. CONCLUSION: In conclusion, only 27% of patients who presented to an urban academic practice with chronic HCV received DAA-containing regimens over a 36-month period. Psychosocial issues were the major barriers to antiviral therapy. These findings illustrate the need for an integrated approach that addresses psychosocial factors as well as comorbidities and adherence to care in order to increase rates of HCV treatment in at risk patients.

Association of statins with nonalcoholic fatty liver disease in patients with diabetes.

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in patients with diabetes; limited data suggested that statins may reduce the risk of NAFLD progression. This study aimed to examine the association between statins and the development or progression of NAFLD in veterans with diabetes. In a new-user negative control design, we conducted a retrospective propensity score (PS)-matched cohort study of patients with diabetes between 2003 and 2015. After excluding patients with other causes of liver disease, we formed PS using 85 characteristics. The primary outcome was a composite NAFLD progression outcome. Primary analysis examined odds of outcome in PS-matched cohort. Post-hoc analysis included a PS-matched cohort of statin users with intensive lowering of low-density lipoprotein-cholesterol (LDL-C) vs low-intensity lowering. We matched 34,102 pairs from 300,739 statin users and 38,038 non-users. The composite outcome occurred in 8.8% of statin users and 8.6% of non-users (odds ratio (OR) 1.02, 95% confidence interval (95% CI) 0.97-1.08). In the post-hoc analysis, intensive lowering of LDL-C compared to low-intensity showed increased NAFLD progression (OR 1.21, 95% CI 1.13-1.30). This study showed that statin use in patients with diabetes was not associated with decreased or increased risk of NAFLD progression. Intensive LDL-C lowering, compared to low-intensity LDL-C lowering, was associated with an increased risk of NAFLD progression.

Association Between Helicobacter pylori and Steatosis Severity on Transient Elastography.

Background A possible association between Helicobacter pylori (HP) infection and liver diseases including steatosis is suspected. There is a lack of studies evaluating the association of HP and liver steatosis severity using transient elastography. Aim The aim of this study was to evaluate the frequency and risk factors for liver steatosis measured by transient elastography in patients with or without HP. Methods A total of 484 patients tested for liver steatosis and fibrosis using transient elastography from January 2017 to June 2018 were evaluated. Ninety-one patients who were also tested for H. pylori infection were included in the study. Transient elastography findings were compared between HP-positive patients and HP-negative patients. Demographic, clinical, and laboratory variables and the presence and severity of liver fibrosis and steatosis were analyzed. Results Patients with HP had a higher frequency of steatosis on transient elastography (86.8% vs. 60.7%, p =0.009). Patients with HP had increased steatosis severity compared to HP-negative patients (mild steatosis 15.8% vs. 7.1%, p=0.037; moderate to severe steatosis 71.1% vs. 53.6%, p=0.015, respectively). In the stepwise multivariate logistic regression analysis, HP infection remained an independent risk factor for steatosis (odds ratio: 4.36, 95% confidence interval: 1.09-14.78; p=0.037). Conclusion Patients with HP had an increased steatosis frequency, and patients with liver steatosis may warrant HP evaluation and treatment.

Conventional and PEGylated Liposomes as Vehicles of Copaifera sabulicola.

Traditional medicine uses resin oils extracted from plants of the genus Copaifera for several purposes. Resin oils are being studied to understand and profile their pharmacological properties. The aim of this work was to prepare and to characterize conventional and pegylated liposomes incorporating resin oils or the hexanic extract obtained from Copaifera sabulicola (copaiba) leaves. The cytotoxic effect of these products was also investigated. Conventional and stealth liposomes with copaiba extract showed similar average diameters (around 126 nm), encapsulation efficiencies greater than 75% and were stable for 90 days. A cytotoxicity test was performed on murine glioma cells and the developed liposomes presented antiproliferative action against these cancer cells at the average concentration of 30 µg/mL. Phytochemicals encapsulated in PEGylated liposomes induced greater reduction in the viability of tumor cells. In addition, bioassay-s measured the cytotoxicity of copaiba resin oil (Copaifera sabulicola) in liposomes (conventional and PEGylated), which was also checked against pheochromocytoma PC12 cells. Its safety was verified in normal rat astrocytes. The results indicate that liposomes encapsulating copaiba oil showed cytotoxic activity against the studied tumor strains in a dose-dependent fashion, demonstrating their potential applications as a chemotherapeutic bioactive formulation.

New weapons against the disease vector Aedes aegypti: From natural products to nanoparticles.

Despite the global burden of viral diseases transmitted by Aedes aegypti, there is a lack of effective means of prevention and treatment. Strategies for vector control include chemical and biological approaches such as organophosphates and Bacillus thuringiensis var. israelensis (Bti), among others. However, important concerns are associated, such as resistance in mosquito larvae and deleterious effects on non-target organisms. In this scenario, novel approaches against A. aegypti have been investigated, including natural products (e.g. vegetable oil and extracts) and nanostructured systems. This review focuses on potential strategies for fighting A. aegypti, highlighting plant-based materials and nanomaterials able to induce toxic effects on egg, larva, pupa and adult mosquitoes. Issues including aspects of conventional vector control strategies are presented, and finally new insights on development of eco-friendly nanoformulations against A. aegypti are discussed.

Predictors of complete endoscopic mucosal resection of flat and depressed gastrointestinal neoplasia of the colon.

OBJECTIVES: We evaluated risk factors for residual neoplasia on first follow-up endoscopy after colonic endoscopic mucosal resections (EMRs). METHODS: This retrospective study in a high-volume EMR tertiary-referral center examined EMRs on 423 colonic lesions in 313 patients. RESULTS: Residual neoplasia at first follow-up endoscopy was present following 12% of colonic EMRs. Single-variable analysis showed evidence of an increased risk of residual neoplasia for larger polyps, polyps without a lifting sign, and polyps removed piecemeal. In multivariable analysis, only use of the piecemeal method was independently associated with residual neoplasia. CONCLUSIONS: Additional procedures are needed to complete resection in more than 1 in 10 colonic EMRs. Residual neoplasia occurs more often with piecemeal resection. Close surveillance after EMR and the use of newer methods to further reduce residual neoplasia are needed.

Endoscopic colorectal imaging and therapy.

PURPOSE OF REVIEW: Colorectal cancer screening and prevention is a pivotal element in every gastroenterologist practice. Recent advances in imaging technology and treatment opened the field for endoscopic management of large flat colorectal polyps and early cancer. RECENT FINDINGS: High-definition white light colonoscopy allowed for better characterization of colon polyps, particularly flat lesions. Chromoendoscopy facilitated the identification of colon polyps as well as better endoscopic polyp characterization, with strong correlation with final pathological diagnosis, opening the field of 'virtual' biopsy. One particular technology, confocal endomicroscopy can magnify an image approximately 1000 times resembling optical microscopy with very good correlation with histology. Endoscopic mucosal resection has gained great acceptance to manage flat colorectal polyps with the two major complications being bleeding and perforation, both now under 5% in experienced hands. Endoscopic submucosal resection was developed to increase en-bloc resection (less residual disease) of a flat colorectal lesion but one has to accept a higher perforation rate around 10%. SUMMARY: Current technology allows for better polyp identification and characterization, which can be managed endoscopically.

Endoscopic mucosal resection with the grasp-and-snare technique through a double-channel endoscope in humans.

BACKGROUND: EMR is being used to manage premalignant lesions of the GI tract. Lifting of the lesion is required to perform EMR. Earlier biopsy or snare may cause scarring and preclude adequate lifting. OBJECTIVE: We report our experience with a novel grasp-and-snare EMR technique that can be used when a good lifting is not achieved or the location of the lesion is challenging for standard EMR, such as in a fold. DESIGN: Single-center case series. SETTING: Tertiary referral academic gastroenterology unit. PATIENTS: Patients referred for endoscopic treatment of flat gastrointestinal polyps. INTERVENTIONS: Single-session EMR performed with a grasp-and-snare technique through a double-channel gastroscope or colonoscope. MAIN OUTCOME MEASUREMENTS: Technical success, complication rates, and recurrence rates. RESULTS: Seventeen patients with flat gastrointestinal polyps were referred: mean age 70 years, 11 (65%) male, polyp size 0.8 to 6 cm; 13 colonic, 2 duodenal, 1 gastric, and 1 esophageal EMR performed with grasp-and-snare technique in single sessions. Six polyps (35%) did not lift after injection of hydroxypropylmethylcellulose. Fourteen polyps (82%) were resected completely. Two complications occurred (12%): 1 bleeding treated medically and 1 perforation treated surgically. Residual disease at 1 year was 18%, but 8 patients (47%) had not yet had their 1-year follow-up. LIMITATIONS: Single-center, uncontrolled, not randomized. Limited follow-up. CONCLUSIONS: The grasp-and-snare technique can be used to perform EMR with good outcomes and low complication rates in areas where poor lifting and accessibility are problems.

Interobserver agreement on the endosonographic features of lymph nodes in aerodigestive malignancies.

BACKGROUND: Endoscopic ultrasound (EUS) is used to locally stage aerodigestive malignancies. Endosonographic features are used to predict malignant lymph nodes (MLN). Interobserver agreement on the endosonographic features of MLN has not been described. AIMS: To evaluate the interobserver agreement among endosonographers on the EUS features of MLN in aerodigestive malignancies along with the specific feature used to make this distinction. METHODS: A total of 760 procedures of suspected LN were reviewed. Cases were selected based on cytology-proven malignant or benign LN involvement by FNA with correspondent photodocumentation. Images of each LN were de-identified and distributed to three expert endosonographers. The experts recorded the LN's echogenicity (hypoechoic or other), shape (round or other), border (sharp or fuzzy) and subjective diagnosis (benign or malignant). The relationship between the endosonographers' subjective as well as the pathological diagnosis and LN's endosonographic features were analyzed using logistic regression analysis. Pair-wise comparison between endoscopist and interobserver agreement (kappa statistics) were performed. RESULTS: Images of 41 malignant and 35 benign LN were evaluated. There was fair agreement on shape, Κ = 0.35 (95% CI 0.2-0.5), and moderate agreement on echogenicity and borders, Κ = 0.46 (95% CI 0.31-0.61) and 0.43 (95% CI 0.27-0.58) respectively. The agreement on malignant LN was good, Κ = 0.65 (95% CI 0.5-0.8). The overall diagnostic predictive accuracy ranged from 70 to 77% among the three endoscopists.Two of the three endoscopists assessed shape as the most predictive feature of malignancy (OR 39.4, 95% CI 3.29-470.96). CONCLUSION: The inter-observer agreement on the individual lymph node features as obtained by EUS is moderate with good overall agreement on the diagnosis. Round shape was the feature most strongly associated with a diagnosis of MLN.

Endoscopic or Conservative Management of Iatrogenic Duodenal Perforations Caused by Long Plastic Biliary Stent Distal Migration.

Plastic biliary stents are associated with rare but potentially life-threatening distal stent migration. We present 4 patient cases with distal migration, whereas the proximal aspect remained in the bile duct. Time to stent migration ranged from 1 week to 2 months. Stent migration caused contralateral duodenal wall perforation; 2 underwent endoscopic over-the-scope clip placement for defect closure. All required previous stent removal and stent exchange. This case series highlights that proximal stricture and longer stents have higher migration risk, also shown in the literature. We also show that duodenal perforation can successfully be managed endoscopically with an over-the-scope clip.

Esophageal Bronchial Artery Fistulaization: A Complication of an Endobronchial Ultrasound.

Bronchial artery pseudoaneurysms are an extremely rare cause of upper gastrointestinal bleeding. The presence of a bronchial artery pseudoaneurysm resulting in an esophageal fistula is an entity that, to our knowledge, has yet to be described. Successful management requires an interdisciplinary approach to guide closure of the defects. We present a novel case of an esophageal fistula and bronchial artery pseudoaneurysm resulting from an endobronchial ultrasound-guided transbronchial needle aspiration successfully managed by endoscopic therapy and coil embolization.

Bioactive compounds of Copaifera sp. impregnated into three-dimensional gelatin dressings.

This study investigates the immersion impregnation process of the copaiba oleoresin and leaf extract into SpongostanTM gelatin dressings to be used in wound healing treatment. Copaiba oleoresin and leaf extract were characterized by spectroscopic analyses in order to confirm the identity of bioactive compounds and their compatibility with dressing material. Their antibacterial properties were evaluated and oleoresin activity against Escherichia coli and Staphylococcus aureus bacteria was confirmed while the leaf extract showed activity against S. aureus. Solubility assays in organic solvents revealed that copaiba oleoresin is miscible into dichloromethane, while leaf extract showed a 20 g/ml solubility coefficient at 35 °C in the same solvent. These miscibility and solubility conditions were selected for the impregnation process. Using the organic solvent immersion method, 11 mg of copaiba oleoresin and 19 mg of leaf extract were impregnated into 1 cm3 of 3D matrix. The main bioactives from copaiba products, such as ß-caryophyllene and lupeol, were tracked in the gelatin dressing. DSC and TGA assays showed no thermal changes in the samples after impregnation. Furthermore, the spatial organization of foam structure of the dressings was preserved after superficial distribution of oleoresin, as well as amorphous-like particulate deposition of leaf extract. The main compound of copaiba oleoresin, ß-caryophyllene, which exhibits well-known anti-inflammatory activities, and the main compound of copaiba leaf extract, lupeol, also an anti-inflammatory agent, were successfully impregnated using organic solvent in wound dressings and are promising for further application on tissue wound healing. Graphical Abstract.

Acute Stroke After Upper Endoscopy in a Patient With a Suspected Atrioesophageal Fistula.

Atrioesophageal fistula (AEF) is a rare complication of atrial fibrillation ablation. We present a man with sepsis and frank hematemesis 3 weeks after atrial fibrillation ablation. Thoracic computed tomography showed no definitive evidence of AEF. He underwent esophagogastroduodenoscopy and subsequently developed an embolic stroke. In the operating room, he was found to have AEF. This case highlights the importance of maintaining a high index of suspicion for AEF because of its nonspecific presentation and difficulty in diagnosing with imaging or endoscopy. Once AEF is suspected, esophagogastroduodenoscopy should be avoided because of the risk of precipitating embolic events.

Helicobacter pylori is Associated with Less Fistulizing, Stricturing, and Active Colitis in Crohn's Disease Patients.

Introduction A potential protective role of Helicobacter pylori (HP) infection against the development of Crohn's disease (CD) has been postulated. There is a lack of studies evaluating the association of HP with CD phenotypes. The aim of this study was to investigate the clinical features and disease activity of patients with CD who were diagnosed with HP infection. Methods The charts of 306 consecutive patients from the inflammatory bowel disease (IBD) database at the University of Florida College of Medicine, Jacksonville from January 2014 to July 2016 were reviewed. Ninety-one CD patients who were tested for HP were included, and the frequencies of strictures, fistulas, and colitis in surveillance biopsies in these patients were evaluated. Results Of the 91 CD patients tested for HP, 19 had HP infection. A total of 44 patients had fistulizing/stricturing disease, and 62 patients had active colitis. In the univariate analysis, patients with HP infection had less fistulizing/stricturing disease (21.1% vs. 55.6%, p = 0.009) and less active colitis (42.1% vs. 77.1%, p = 0.005). In the multivariate analysis, HP infection remained as a protective factor for fistulizing/stricturing disease phenotype (OR: 0.22; 95%CI: 0.06-0.97; p = 0.022) and active colitis (OR: 0.186; 95%CI: 0.05-0.65; p = 0.010). Conclusion HP infection was independently associated with less fistulizing/stricturing disease and less active colitis in CD patients. Our study suggests CD patients with a history of HP infection are less prone to complications.