Clinical Profile and Predictors Affecting Outcome in Community-Acquired Acute Kidney Injury: A 3 Months Follow-Up Study.

Background: Community-Acquired Acute Kidney Injury (CA-AKI) is often a devastating clinical syndrome allied with high hospital mortality. Moreover, only limited prospective data exist on the outcomes of CA-AKI. Hence, this follow-up study was conducted to assess clinical profiles and the factors affecting outcomes in CA-AKI. Materials and Methods: A prospective study enrolling 283 participants was conducted from the year 2021 to 2022. AKI patients defined as per Kidney Disease Improving Global Outcomes (KDIGO) criteria were included. Data were collected on demographics, clinical features, and etiological factors. Patients were followed for three months. Univariate and multinomial analyses were done to predict outcomes. The Cox regression model was fitted to identify predictors of mortality. Results: The mean age of patients was 41.67±16.21 years with male predominance. Most of the patients required non-ICU (81.9%) care. Around 36% and 39.6 % of AKI patients were oliguric and required dialysis, respectively. Most patients had a single etiology, with sepsis being the most common cause. Most patients were in KDIGO stage 3, followed by stage 2. At three months of follow-up, 40.6%, 12.3%, and 4.2% had complete, partial, and non-recovery, respectively, and 30.4% died. Age, single etiology, hepatorenal syndrome, sepsis, requirement of mechanical ventilation and vasopressors, comorbidities and glomerulonephritis were significantly associated with mortality. Conclusion: CA-AKI is significantly associated with higher mortality, even for those patients who require non-ICU care on presentation. This highlights the pressing need for AKI prevention, early detection, and intervention to mitigate reversible risk factors and optimize clinical outcomes.

Expansion of the neocortex and protection from neurodegeneration by in vivo transient reprogramming.

Yamanaka factors (YFs) can reverse some aging features in mammalian tissues, but their effects on the brain remain largely unexplored. Here, we induced YFs in the mouse brain in a controlled spatiotemporal manner in two different scenarios: brain development and adult stages in the context of neurodegeneration. Embryonic induction of YFs perturbed cell identity of both progenitors and neurons, but transient and low-level expression is tolerated by these cells. Under these conditions, YF induction led to progenitor expansion, an increased number of upper cortical neurons and glia, and enhanced motor and social behavior in adult mice. Additionally, controlled YF induction is tolerated by principal neurons in the adult dorsal hippocampus and prevented the development of several hallmarks of Alzheimer's disease, including cognitive decline and altered molecular signatures, in the 5xFAD mouse model. These results highlight the powerful impact of YFs on neural proliferation and their potential use in brain disorders.

USP37 prevents premature disassembly of stressed replisomes by TRAIP.

The E3 ubiquitin ligase TRAIP associates with the replisome and helps this molecular machine deal with replication stress. Thus, TRAIP promotes DNA inter-strand crosslink repair by triggering the disassembly of CDC45-MCM2-7-GINS (CMG) helicases that have converged on these lesions. However, disassembly of single CMGs that have stalled temporarily would be deleterious, suggesting that TRAIP must be carefully regulated. Here, we demonstrate that human cells lacking the de-ubiquitylating enzyme USP37 are hypersensitive to topoisomerase poisons and other replication stress-inducing agents. We further show that TRAIP loss rescues the hypersensitivity of USP37 knockout cells to topoisomerase inhibitors. In Xenopus egg extracts depleted of USP37, TRAIP promotes premature CMG ubiquitylation and disassembly when converging replisomes stall. Finally, guided by AlphaFold-Multimer, we discovered that binding to CDC45 mediates USP37's response to topological stress. In conclusion, we propose that USP37 protects genome stability by preventing TRAIP-dependent CMG unloading when replication stress impedes timely termination.

Evaluation of Factors Predictive of Efficacy Among Patients With Complicated Urinary Tract Infection and/or Acute Pyelonephritis.

Background: Antibiotic treatment for complicated urinary tract infections (cUTI)/acute pyelonephritis (AP) is often followed by recurrent bacteriuria in the absence of clinical symptoms. To understand factors predictive of clinical and microbiologic outcomes in patients with cUTI/AP, multivariable analyses were undertaken using pooled data from a global, phase 3 cUTI study. Methods: Using data from 366 tebipenem pivoxil hydrobromide- and 378 ertapenem-treated patients from the Study to Assess the Efficacy, Safety and Pharmacokinetics of Orally Administered Tebipenem Pivoxil Hydrobromide (SPR994) Compared to Intravenous Ertapenem in Participants With Complicated Urinary Tract Infection (cUTI) or Acute Pyelonephritis (AP) infected with Enterobacterales uropathogens, multivariable analyses for dichotomous efficacy endpoints were performed using logistic regression and pharmacokinetic-pharmacodynamic relationships were evaluated. Results: Urinary tract anatomical disorders and functional urinary tract or metabolic disorders were predictive of nonresponse across all efficacy endpoints assessed at test-of-cure (TOC) and late follow-up (LFU) visits, with greater impact on overall and microbiologic than clinical nonresponse. Independent variables predictive of increased probabilities of successful overall response at TOC and microbiologic response at TOC or LFU were baseline creatinine clearance >50 mL/min and baseline pathogen fluoroquinolone susceptibility. Infection with a phenotypic extended-spectrum beta-lactamase-positive Enterobacterales pathogen was predictive of reduced probabilities of success for microbiologic response at LFU and clinical response at TOC. Meaningful relationships between efficacy endpoints and plasma pharmacokinetic-pharmacodynamic indices were not identified. Conclusions: Reductions of overall and microbiologic response in patients with cUTI/AP were associated with anatomical or functional urinary tract disorders, but not with the magnitude or duration of plasma antibiotic exposure. Results of these analyses serve to advance our understanding of factors predictive of outcome in patients with cUTI/AP.

Decitabine cytotoxicity is promoted by dCMP deaminase DCTD and mitigated by SUMO-dependent E3 ligase TOPORS.

The nucleoside analogue decitabine (or 5-aza-dC) is used to treat several haematological cancers. Upon its triphosphorylation and incorporation into DNA, 5-aza-dC induces covalent DNA methyltransferase 1 DNA-protein crosslinks (DNMT1-DPCs), leading to DNA hypomethylation. However, 5-aza-dC's clinical outcomes vary, and relapse is common. Using genome-scale CRISPR/Cas9 screens, we map factors determining 5-aza-dC sensitivity. Unexpectedly, we find that loss of the dCMP deaminase DCTD causes 5-aza-dC resistance, suggesting that 5-aza-dUMP generation is cytotoxic. Combining results from a subsequent genetic screen in DCTD-deficient cells with the identification of the DNMT1-DPC-proximal proteome, we uncover the ubiquitin and SUMO1 E3 ligase, TOPORS, as a new DPC repair factor. TOPORS is recruited to SUMOylated DNMT1-DPCs and promotes their degradation. Our study suggests that 5-aza-dC-induced DPCs cause cytotoxicity when DPC repair is compromised, while cytotoxicity in wild-type cells arises from perturbed nucleotide metabolism, potentially laying the foundations for future identification of predictive biomarkers for decitabine treatment.

Application of a portable ion chromatograph for real-time field analysis of nitrite and nitrate in soils and soil pore waters.

Real-time monitoring of nitrite and nitrate is crucial for maintaining soil health and promoting plant growth. In this study, a portable ion-chromatograph (IC, Aquamonitrix) analyser, coupled with a field-applicable ultrasonic-assisted extraction method, was utilised for in-field determination of nitrate and nitrite in soils. This is the first application of this type of analyser to soil nutrients. On-site analysis of soil from a local sports field showed 94.8 ± 4.3 µg g-1 nitrate, with LODs of 32.0 µg g-1 for nitrate and 5.4 µg g-1 for nitrite. The results were in close agreement with those obtained using a conventional lab-based IC. Relative standard deviations (%RSDs) for soil analysis using Aquamonitrix were consistently below 10%. The obtained average recoveries of samples spiked with nitrite were 100% and 104% for the portable IC and conventional IC, respectively. Furthermore, to assess the suitability of portable IC for samples with high organic matter content, various natural organic fertilisers were extracted and analysed. The results showed 16.2 ± 0.7 µg g-1 nitrite and 28.5 ± 5.6 µg g-1 nitrate in sheep manure samples with LODs of 2.0 µg g-1 for nitrite and 12.0 µg g-1 for nitrate. The portable IC system was further demonstrated via real-time on-site analysis of soil pore-water acquired using a portable battery-based ceramic pore-water sampler. A continuous increase in nitrate concentration over time was observed (from 80 to 148 µg mL-1) in the soil pore-water in a vegetable garden four days after heavy rain. Unlike conventionally sampled natural waters, 7-day storage of the studied pore water samples revealed no changes in nitrate concentrations. An average of 558 ± 51 µg mL-1 nitrate was detected in the soil pore-water samples analysed on a spinach farm, immediately after irrigation.

Transcription-coupled repair of DNA-protein cross-links depends on CSA and CSB.

Covalent DNA-protein cross-links (DPCs) are toxic DNA lesions that block replication and require repair by multiple pathways. Whether transcription blockage contributes to the toxicity of DPCs and how cells respond when RNA polymerases stall at DPCs is unknown. Here we find that DPC formation arrests transcription and induces ubiquitylation and degradation of RNA polymerase II. Using genetic screens and a method for the genome-wide mapping of DNA-protein adducts, DPC sequencing, we discover that Cockayne syndrome (CS) proteins CSB and CSA provide resistance to DPC-inducing agents by promoting DPC repair in actively transcribed genes. Consequently, CSB- or CSA-deficient cells fail to efficiently restart transcription after induction of DPCs. In contrast, nucleotide excision repair factors that act downstream of CSB and CSA at ultraviolet light-induced DNA lesions are dispensable. Our study describes a transcription-coupled DPC repair pathway and suggests that defects in this pathway may contribute to the unique neurological features of CS.

Portable IC system enabled with dual LED-based absorbance detectors and 3D-printed post-column heated micro-reactor for the simultaneous determination of ammonium, nitrite and nitrate.

BACKGROUND: The on-site and simultaneous determination of anionic nitrite (NO2-) and nitrate (NO3-), and cationic ammonium (NH4+), in industrial and natural waters, presents a significant analytical challenge. Toward this end, herein a 3D-printed micro-reactor with an integrated heater chip was designed and optimised for the post-column colorimetric detection of NH4+ using a modified Berthelot reaction. The system was integrated within a portable and field deployable ion chromatograph (Aquamonitrix) designed to separate and detect NO2- and NO3-, but here enabled with dual LED-based absorbance detectors, with the aim to provide the first system capable of simultaneous determination of both anions and NH4+ in industrial and natural waters. RESULTS: Incorporating a 0.750 mm I.D. 3D-printed serpentine-based microchannel for sample-reagent mixing and heating, the resultant micro-reactor had a total reactor channel length of 1.26 m, which provided for a reaction time of 1.42 min based upon a total flow rate of 0.27 mL min-1, within a 40 mm2 printed area. The colorimetric reaction was performed within the micro-reactor, which was then coupled to a dedicated 660 nm LED-based absorbance detector. By rapidly delivering a reactor temperature of 70 °C in just 40 s, the optimal conditions to improve reaction kinetics were achieved to provide for limits of detection of 0.1 mg L-1 for NH4+, based upon an injection volume of just 10 µL. Linearity for NH4+ was observed over the range 0-50 mg L-1, n = 3, R2 = 0.9987. The reactor was found to deliver excellent reproducibility when included as a post-column reactor within the Aquamonitrix analyser, with an overall relative standard deviation below 1.2 % for peak height and 0.3 % for peak residence time, based upon 6 repeat injections. SIGNIFICANCE: The printed post-column reactor assembly was integrated into a commercial portable ion chromatograph developed for the separation and detection of NO2- and NO3-, thus providing a fully automated system for the remote and simultaneous analysis of NO2-, NO3-, and NH4+ in natural and industrial waters. The fully automated system was deployed externally within a greenhouse facility to demonstrate this capability.

Primary Pancreatic GIST - A-Single Centre Case Series and Systematic Review of Literature.

PURPOSE: GISTs arising from organs outside GI tract are defined as extragastrointestinal GISTs (EGIST). The majority of EGISTs arise from small intestinal mesentry, mesocolon, omentum, retroperitoneum, abdominal wall, liver and pancreas with pancreas comprising less than 5% of it. Due to limited data, it is unknown if the results of GIST can be generalised for EGISTs. We thereby present the largest single-centre case series of primary pancreatic GIST so far with review of existing literature. METHODS: A total of 9 patients of primary pancreatic GIST were treated at our institute from September 2016 to February 2023. After literature search for all studies published before February 2023, 51 articles including 57 patients were identified. Their clinicopathological data and survival analysis were assessed. RESULTS: The median age of patients treated at our centre was 53 years with a female predominance. The most common epicentre was pancreatic head with abdominal pain as the most common presenting symptom. All 57 patients documented in literature belonged to a similar age group with similar gender predilection. The factors impacting DFS were histologic type, mitotic index, NIH risk category and adjuvant therapy. The median DFS was 74 months with a 5-year DFS being 71.9%, while the 5-year OS was 90.4%. CONCLUSION: Pancreatic GIST is a rare entity. Due to limited evidence and evolving literature, results cannot be generalised to a larger population. Larger case series with longer follow-up data are required to further understand the disease biology and long-term outcomes of pancreatic GIST.

RAD54L2 counters TOP2-DNA adducts to promote genome stability.

The catalytic cycle of topoisomerase 2 (TOP2) enzymes proceeds via a transient DNA double-strand break (DSB) intermediate termed the TOP2 cleavage complex (TOP2cc), in which the TOP2 protein is covalently bound to DNA. Anticancer agents such as etoposide operate by stabilizing TOP2ccs, ultimately generating genotoxic TOP2-DNA protein cross-links that require processing and repair. Here, we identify RAD54 like 2 (RAD54L2) as a factor promoting TOP2cc resolution. We demonstrate that RAD54L2 acts through a novel mechanism together with zinc finger protein associated with tyrosyl-DNA phosphodiesterase 2 (TDP2) and TOP2 (ZATT/ZNF451) and independent of TDP2. Our work suggests a model wherein RAD54L2 recognizes sumoylated TOP2 and, using its ATPase activity, promotes TOP2cc resolution and prevents DSB exposure. These findings suggest RAD54L2-mediated TOP2cc resolution as a potential mechanism for cancer therapy resistance and highlight RAD54L2 as an attractive candidate for drug discovery.

Chemical vapour deposition in narrow capillaries: Electro-osmotic flow control in capillary electrophoresis.

BACKGROUND: In capillary electrophoresis (CE), the inner surface of fused-silica capillaries is commonly covalently modified with liquid silanes to control electroosmotic flow (EOF). This liquid phase deposition (LPD) approach is challenging for long and narrow-diameter capillaries (≥1 m, ≤25 µm ID) inhibiting commercial production. Here, we use chemical vapour deposition (CVD) to covalently modify capillaries with different silanes. Using a home-built CVD device, capillaries were modified with neutral (3-glycidyloxypropyl) trimethoxysilane (GPTMS), the weak base (3-aminopropyl) trimethoxysilane (APTMS), the weak acid 3-mercaptopropyltrimethoxysilane (MPTMS) and the neutral hydrophobic trichloro(1H,1H,2H,2H-perfluorooctyl) silane (PFOCTS). Gas-phase modification of GPTMS with acid and ammonia allowed further modification of the surface prior to molecular layer deposition (MLD) of poly(p-phenylene terephthalamide) (PPTA) using the self-limiting sequential reaction between terephthalaldehyde (TA) and p-phenylenediamine (PD) vapours. RESULTS: Capillaries coated with GPTMS by CVD showed a greater reduction in EOF at all pH values than the conventional LPD. APTMS showed a reduction of the EOF at pH 9, with EOF reversal observed below pH 6. MPTMS provided a slightly lower EOF than an unmodified capillary at high pH, and a slightly higher EOF at lower pH. PFOCTS provided the most consistent EOF as a function of pH. The deposition of successive layers of PPTA resulted in increased surface coverage of the polymer and a greater reduction in EOF at pH higher than 5. The stability of a 10 µm ID GPTMS coated capillary was tested at pH 8.8 in a 200 mM CHES/Tris BGE for the separation of inorganic anions. Over 1.5 months of continuous operation (≈4130 runs), the reproducibility of the apparent mobilities for chloride, nitrite, nitrate and sulfate were 2.43%, 2.56%, 2.63% and 3.05%, respectively. The intra-day and inter-day column-to-column reproducibility and batch-to-batch reproducibility for all the coated capillaries ranged between 0.34% and 3.95%. SIGNIFICANCE: The study demonstrates the superior performance of CVD coating for suppressing the EOF compared to LPD allowing the easy modification of long lengths of narrow capillary. The variation in silane, and the ability of MLD to modify and control the surface chemistry, provides a simple and facile method for surface modification. The stability of these coatings will allow long-term capillary electrophoresis monitoring of water chemistry, such as for monitoring fertiliser run-off in natural waters.

Impact of antibiotic pharmacokinetics in urine on recurrent bacteriuria following treatment of complicated urinary tract infections.

The clinical relevance of bacteriuria following antibiotic treatment of complicated urinary tract infections in clinical trials remains controversial. We evaluated the impact of urine pharmacokinetics on the timing of recurrent bacteriuria in a recently completed trial that compared oral tebipenem pivoxil hydrobromide to intravenous ertapenem. The urinary clearance and urine dwell time of ertapenem were prolonged relative to tebipenem and were associated with a temporal difference in the repopulation of bladder urine with bacteria following treatment, potentially confounding the assessment of efficacy.

Multi-wavelength deep-ultraviolet absorbance detector based upon program-controlled pulsing light-emitting diodes.

A novel approach for multi-wavelength ultraviolet (UV) absorbance detection has been introduced employing a single board computer (SBC) with a field programmable gate array (FPGA), Red Pitaya SBC, to generate separated micro pulses for three deep-ultraviolet light-emitting diodes (DUV-LEDs), λmax = 235, 250, and 280 nm, along with data acquisition and processing via a custom-made program. The pulse set generation and data acquisition were synchronized using the SBC. The outputs of the three pulsing DUV-LEDs were combined and transmitted to the flow cell via a solarisation resistant trifurcated optical fiber (OF). An ultra-fast responding photodiode was connected to the optical-fiber-compatible flow cell to record the intensity of the DUV pulses. Upper limit of detector linearity (A95 %) was found to be 1917 mAU, 2189 mAU, and 1768 mAU at 235 nm, 250 nm, and 280 nm, respectively, with stray light ≤0.9 %. In addition, the effective path length (Leff) was estimated to be ≥98.0 % of the length of the used flow cell (50 mm). The new pulsed multi-LEDs absorbance detector (PMLAD) has been successfully coupled with a standard liquid chromatograph and utilized for the analysis of pharmaceuticals. Paracetamol, caffeine, and aspirin were simultaneously determined at 250, 280, and 235 nm, respectively, using the PMLAD. The absorbance ratios between the different wavelengths were applied to further confirm the identity of the studied compounds. Excellent linearity was achieved over a range of 0.1-3.2 µg/mL for paracetamol, 0.4-6.4 µg/mL for caffeine, and 0.8-12.8 µg/mL for aspirin with a regression correlation coefficient (r2) ≥ 0.99996. The quantitation limits (LOQs) were 0.10 µg/mL, 0.38 µg/mL, and 0.66 µg/mL for paracetamol, caffeine, and aspirin, respectively.

Recent advances in miniaturization of portable liquid chromatography with emphasis on detection.

Liquid chromatography is a prominent analytical technique in separation science and chemical analysis, applied across numerous fields of research and within industrial applications. Over the past few decades, there has been a growing interest in the miniaturization of this technique, which has been particularly enabled through new miniature and portable detection technologies for in-field, at-site, and point-of-need (collectively 'out-of-lab') analyses. Accordingly, significant advances have been made in recent years in the development of miniaturized liquid chromatography with photometric, electrochemical, and mass spectrometric detection, enabling the development of field-deployable and portable instruments for various applications. Herein, recent developments in the miniaturization of detection systems for inclusion within, and/or coupling with, portable liquid chromatographic systems, are reviewed in detail together with critical comments and expected future trends in this area.

Basilar artery stenosis: Technical tips for endovascular revascularization.

The SAMMPRIS Trial concluded that medical treatment of intracranial stenosis was safer than intracranial stenting. The key reasons for a poor outcome with stenting were significantly more perioperative ischemic strokes and higher rates of intracerebral hemorrhages. To the contrary, WEAVE trial showed significantly lower morbidity and mortality when stenting was performed one week following the ictus. We describe the technical approach for safe basilar artery stenting through radial approach. A middle aged male presented with recurrent posterior circulation symptoms despite being on dual antiplatelet therapy. A right radial approach was undertaken. A 5f radial sheath was exchanged for an AXS infinity LS (Stryker Neurovascular, Ireland) 6 f sheath after priming the radial artery. Using a quadri-axial approach, 0.014' Traxcess microwire (Microvention Inc, Tustin, USA), 0.017' Echelon microcatheter (Microtherapeutics.inc. Ev3 Neurovascular, USA), 0.038 DAC (Stryker Neurovascular USA) & 5F Navien (Microtherapeutics.inc. Ev3 USA), the Infinity sheath was taken into the V2 segment of the right vertebral artery. The 5F Navien (tri-axial approach) was taken upto the distal V4 segment of the vertebral artery. The 3d rotational angiography directed runs revealed > 95 % stenosis of mid basilar segment. No significant ostial stenosis of side branch was noted and in view of long segment plaque angioplasty followed by deployment of self-expanding stent was planned. The microcatheter (0.017') and microwire (Traxcess 0.014') was navigated across the stenosis. Thereafter, an exchange maneuver was performed to allow for sequential slow balloon angioplasty with 1.5 mm × 15 (Maverick, Boston Scientific) and 2.5 mm× 15 (Trek, Abbott costa rica) coronary balloon. Following that a CREDO 4 × 20 mm stent (Acandis GmbH., Pforzheim Germany) was deployed across the stenosis. All exchange maneuvers were performed under biplane fluoroscopy and microwire was kept under watch. The patient was on aspirin and clopidogrel and activated clotting time was maintained around 250 s throughout the procedure. A closure device was applied post procedure. Blood pressure was monitored in neurointensive care unit and patient was discharged on the third day following procedure. Right radial approach, distal position of the sheath, distal position of the guiding catheter, careful analysis of the 3d rotational angiography for risk of side branch occlusion, biplane fluoroscopy during exchanges and slow angioplasty were the key safety checks during procedure.

Torcular dural AVF: Transvenous onyx embolisation with sinus reconstruction.

Transvenous onyx (Microtherapeutics, Irvine, CA, USA) embolization with sinus reconstruction using a venous balloon is a novel technique to embolise dural arterial venous fistula while preserving the sinus. We elucidate the technical tips and tricks that were employed to treat this torcular dural AVF in an elderly male with visual disturbances secondary to papilledema. Right external carotid artery injection revealed a type 2c fistula along the torcula with feeders from the right parietal & petrosal branches of the middle meningeal artery and dural branches of the posterior auricular and the occipital artery. The right distal transverse and the sigmoid were occluded with retrograde flow into the superior sagittal sinus and the cortical veins. XPER CTA analysis revealed the fistula point to be along the wall of the torcula. Through right femoral artery access, a neuron max (Penumbra inc.USA) was placed in the right common carotid artery. An eclipse (Balt Extrusion, France) 6 × 12 mm single lumen balloon was placed in the proximal ECA to achieve flow reduction. Thereafter, through bilateral femoral venous approach, two neuron max 8 F (Penumbra inc.USA) were placed into the left jugular vein. A Copernic RC balloon 10×80 mm (Balt Extrusion, France) was placed from the left to the right transverse sinus. Further, two microcatheters, 1.5 F Marathon (Medtronic, Minneapolis, MI, USA) were navigated into the feeding arteries from the venous end. Microcatheter injections were taken with inflation of the venous balloon to determine the point at which sinus and cortical vein reflux is absent. Following that onyx 18 was injected under biplane fluoroscopy with an adequately inflated arterial and venous balloon. We could achieve retrograde permeation of the onyx into the fistula and the arterial feeders resulting in complete occlusion while preserving the sinus. Careful analysis of the angioarchitecture of the fistula and evaluating for delayed cerebral venous drainage is the key to determining the right strategy to achieve complete occlusion of the fistula.

Graphene Oxide-Functionalized Thread-Based Electrofluidic Approach for DNA Hybridization.

A novel, low-cost, and disposable thread-based electrofluidic analytical method employing isotachophoresis (ITP) was developed for demonstrating surface DNA hybridization. This approach was based on graphene oxide (GO) surface-functionalized zones on nylon threads as a binding platform to trap a fluorescently labeled isotachophoretically focused single-stranded DNA (ssDNA) band, resulting in quenching of the fluorescence, which signaled quantitative trapping. In the event of an isotachophoretically focused complementary DNA (cDNA) band passing over the GO-trapped ssDNA zone, surface hybridization of the ssDNA and cDNA to form double-stranded DNA (dsDNA) band occurred, which is released from the GO-coated zones, resulting in restoration of the fluorescent signal as it exits the GO band and migrates further along the thread. This controllable process demonstrates the potential of the GO-functionalized thread-based microfluidic analytical approach for DNA hybridization and its visualization, which could be adapted into point-of-care (POC) diagnostic devices for real-world applications.

Absorption, Metabolism, and Excretion of [14C]-Tebipenem Pivoxil Hydrobromide (TBP-PI-HBr) in Healthy Male Subjects.

Tebipenem pivoxil hydrobromide (TBP-PI-HBr) is an oral prodrug of pharmacologically active moiety tebipenem (TBP), which is a carbapenem with activity against multidrug-resistant Gram-negative pathogens. Conversion from the prodrug to the active moiety, namely, TBP, occurs in the enterocytes of the gastrointestinal tract via intestinal esterases. The absorption, metabolism, and excretion in humans were evaluated, following the administration of a single oral dose of [14C]-TBP-PI-HBr. Healthy male subjects (n = 8) received a single 600 mg oral dose of TBP-PI-HBr containing approximately 150 µCi of [14C]-TBP-PI-HBr. Blood, urine, and fecal samples were collected to determine the total radioactivity, concentrations of TBP (plasma only), and metabolite profiling and identification. The overall mean recovery of the total radioactivity in urine (38.7%) and feces (44.6%) combined was approximately 83.3% of the administered dose, with individual recoveries ranging from 80.1% to 85.0%. Plasma TBP LC-MS/MS and metabolite profiling data suggest that TBP was the main circulating component in plasma and that it accounts for approximately 54% of the total plasma radioactivity, based on the plasma AUC ratio of TBP/total radioactivity. The ring-open metabolite LJC 11562 was another major component in plasma (>10%). TBP (M12), LJC 11562, and four trace to minor metabolites were identified/characterized in the urine. TBP-PI, TBP (M12), and 11 trace to minor metabolites were identified/characterized in the feces. The renal and fecal routes are major clearance pathways in the elimination of [14C]-TBP-PI-HBr, with a mean combined recovery of 83.3%. TBP and its inactive ring-open metabolite LJC 11562 were the major circulating metabolites in the plasma.

Effect of an Antacid (Aluminum Hydroxide/Magnesium Hydroxide/Simethicone) or a Proton Pump Inhibitor (Omeprazole) on the Pharmacokinetics of Tebipenem Pivoxil Hydrobromide (TBP-PI-HBr) in Healthy Adult Subjects.

Tebipenem pivoxil hydrobromide (TBP-PI-HBr) is a novel oral carbapenem prodrug being developed for the treatment of serious bacterial infections. This open-label, 3-period, fixed sequence study evaluated the effect of gastric acid-reducing agents, aluminum hydroxide/magnesium hydroxide/simethicone, and omeprazole on the pharmacokinetics (PK) of tebipenem (TBP), the active moiety, following coadministration with immediate release TBP-PI-HBr during fasting. In Period 1, subjects received a single oral dose of TBP-PI-HBr 600 mg (2 × 300 mg tablets). In Period 2, subjects received a single oral dose of aluminum hydroxide 800 mg/magnesium hydroxide 800 mg/simethicone 80 mg suspension co-administered with a single dose of TBP-PI-HBr 600 mg. In Period 3, subjects received a single oral dose of omeprazole 40 mg once daily over 5 days, followed by single dose administration of TBP-PI-HBr 600 mg on day 5. In each period, whole blood samples were obtained prior to, and up to 24 h, following TBP-PI-HBr dose administration in order to characterize TBP PK. A 7-day washout was required between periods. Twenty subjects were enrolled and completed the study. Following co-administration of TBP-PI-HBr with either aluminum hydroxide/magnesium hydroxide/simethicone or omeprazole, total TBP exposure (area under the curve [AUC]) was approximately 11% (geometric mean ratio 89.2, 90% confidence interval: 83,2, 95.7) lower, and Cmax was 22% (geometric mean ratio 78.4, 90% confidence interval: 67.9, 90.6) and 43% (geometric mean ratio 56.9, 90% confidence interval: 49.2, 65.8) lower, respectively, compared to administration of TBP-PI-HBr alone. Mean TBP elimination half-life (t1/2) was generally comparable across treatments (range: 1.0 to 1.5 h). Concomitant administration of TBP-PI-HBr with omeprazole or aluminum hydroxide/magnesium hydroxide/simethicone is not expected to impact the efficacy of TBP-PI-HBr, as there is minimal impact on TBP plasma AUC, which is the pharmacodynamic driver of efficacy. Co-administration was generally safe and well tolerated.