Zileuton ameliorates aminoglycoside and polymyxin-associated acute kidney injury in an animal model.

OBJECTIVES: Aminoglycosides and polymyxins are antibiotics with in vitro activity against MDR Gram-negative bacteria. However, their clinical use is hindered by dose-limiting nephrotoxicity. The objective of this project was to determine if zileuton can reduce nephrotoxicity associated with amikacin and polymyxin B in a rat model of acute kidney injury. METHODS: Sprague Dawley rats (n = 10, both genders) were administered either amikacin (300 mg/kg) or polymyxin B (20 mg/kg) daily for 10 days. Zileuton (4 and 10 mg/kg) was delivered intraperitoneally 15 min before antibiotic administration. Blood samples were collected at baseline and daily to determine serum creatinine concentration. Nephrotoxicity was defined as a ≥2× elevation of baseline serum creatinine. Time-to-event analysis and log rank test were used to compare the onset of nephrotoxicity in different cohorts. Histopathological analysis was also conducted to characterize the extent of kidney injury. RESULTS: Animals receiving amikacin or polymyxin B alone had nephrotoxicity rates of 90% and 100%, respectively. The overall rate was reduced to 30% in animals receiving adjuvant zileuton. The onset of nephrotoxicity associated with amikacin and polymyxin B was also significantly delayed by zileuton at 4 and 10 mg/kg, respectively. Histopathology confirmed reduced kidney injury in animals receiving amikacin concomitant with zileuton. CONCLUSIONS: Our pilot data suggest that zileuton has the potential to attenuate nephrotoxicity associated with last-line antibiotics. This would allow these antibiotics to treat MDR Gram-negative bacterial infections optimally without dose-limiting constraints. Further studies are warranted to optimize drug delivery and dosing in humans.

Near-exact nuclear gradients of complete active space self-consistent field wave functions.

In this paper, we study the nuclear gradients of heat bath configuration interaction self-consistent field (HCISCF) wave functions and use them to optimize molecular geometries for various molecules. We show that HCISCF nuclear gradients are fairly insensitive to the size of the "selected" variational space, which allows us to reduce the computational cost without introducing significant errors. The ability of the HCISCF to treat larger active spaces combined with the flexibility for users to control the computational cost makes the method very attractive for studying strongly correlated systems, which require a larger active space than possible with a complete active space self-consistent field. Finally, we study the realistic catalyst, Fe(PDI), and highlight some of the challenges this system poses for density functional theory (DFT). We demonstrate how HCISCF can clarify the energetic stability of geometries obtained from DFT when the results are strongly dependent on the functional. We also use the HCISCF gradients to optimize geometries for this species and study the adiabatic singlet-triplet gap. During geometry optimization, we find that multiple near-degenerate local minima exist on the triplet potential energy surface.

Childhood and Early Onset Glaucoma Classification and Genetic Profile in a Large Australasian Disease Registry.

PURPOSE: To report the relative frequencies of childhood and early onset glaucoma subtypes and their genetic findings in a large single cohort. DESIGN: Retrospective clinical and molecular study. PARTICIPANTS: All individuals with childhood glaucoma (diagnosed 0 to <18 years) and early onset glaucoma (diagnosed 18 to <40 years) referred to a national disease registry. METHODS: We retrospectively reviewed the referrals of all individuals with glaucoma diagnosed at <40 years of age recruited to the Australian and New Zealand Registry of Advanced Glaucoma (ANZRAG). Subtypes of glaucoma were determined using the Childhood Glaucoma Research Network (CGRN) classification system. DNA extracted from blood or saliva samples underwent sequencing of genes associated with glaucoma. MAIN OUTCOME MEASURES: The phenotype and genotype distribution of glaucoma diagnosed at <40 years of age. RESULTS: A total of 290 individuals (533 eyes) with childhood glaucoma and 370 individuals (686 eyes) with early onset glaucoma were referred to the ANZRAG. Primary glaucoma was the most prevalent condition in both cohorts. In the childhood cohort, 57.6% of individuals (167/290, 303 eyes) had primary congenital glaucoma (PCG), and 19.3% (56/290, 109 eyes) had juvenile open-angle glaucoma. Juvenile open-angle glaucoma constituted 73.2% of the early onset glaucoma cohort (271/370, 513 eyes). Genetic testing in probands resulted in a diagnostic yield of 24.7% (125/506) and a reclassification of glaucoma subtype in 10.4% of probands (13/125). The highest molecular diagnostic rate was achieved in probands with glaucoma associated with nonacquired ocular anomalies (56.5%). Biallelic variants in CYP1B1 (n = 29, 23.2%) and heterozygous variants in MYOC (n = 24, 19.2%) and FOXC1 (n = 21, 16.8%) were most commonly reported among probands with a molecular diagnosis. Biallelic CYP1B1 variants were reported in twice as many female individuals as male individuals with PCG (66.7% vs. 33.3%, P = 0.02). CONCLUSIONS: We report on the largest cohort of individuals with childhood and early onset glaucoma from Australasia using the CGRN classification. Primary glaucoma was most prevalent. Genetic diagnoses ascertained in 24.7% of probands supported clinical diagnoses and genetic counseling. International collaborative efforts are required to identify further genes because the majority of individuals still lack a clear molecular diagnosis.

Using Lean Six Sigma techniques to improve efficiency in outpatient ophthalmology clinics.

BACKGROUND: Increasing patient numbers, complexity of patient management, and healthcare resource limitations have resulted in prolonged patient wait times, decreased quality of service, and decreased patient satisfaction in many outpatient services worldwide. This study investigated the impact of Lean Six Sigma, a service improvement methodology originally from manufacturing, in reducing patient wait times and increasing service capacity in a publicly-funded, tertiary referral outpatient ophthalmology clinic. METHODS: This quality improvement study compared results from two five-months audits of operational data pre- and post-implementation of Lean Six Sigma. A baseline audit was conducted to determine duration and variability of patient in-clinic time and number of patients seen per clinic session. Staff interviews and a time-in-motion study were conducted to identify issues reducing clinic service efficiency. Solutions were developed to address these root causes including: clinic schedule amendments, creation of dedicated postoperative clinics, and clear documentation templates. A post-implementation audit was conducted, and the results compared with baseline audit data. Significant differences in patient in-clinic time pre- and post-solution implementation were assessed using Mann-Whitney test. Differences in variability of patient in-clinic times were assessed using Brown-Forsythe test. Differences in numbers of patients seen per clinic session were assessed using Student's t-test. RESULTS: During the baseline audit period, 19.4 patients were seen per 240-minute clinic session. Median patient in-clinic time was 131 minutes with an interquartile range of 133 minutes (84-217 minutes, quartile 1- quartile 3). Targeted low/negligible cost solutions were implemented to reduce in-clinic times. During the post-implementation audit period, the number of patients seen per session increased 9% to 21.1 (p = 0.016). There was significant reduction in duration (p < 0.001) and variability (p < 0.001) of patient in-clinic time (median 107 minutes, interquartile range 91 minutes [71-162 minutes]). CONCLUSIONS: Lean Six Sigma techniques may be used to reduce duration and variability of patient in-clinic time and increase service capacity in outpatient ophthalmology clinics without additional resource input.

Biallelic CPAMD8 Variants Are a Frequent Cause of Childhood and Juvenile Open-Angle Glaucoma.

PURPOSE: Developmental abnormalities of the ocular anterior segment in some cases can lead to ocular hypertension and glaucoma. CPAMD8 is a gene of unknown function recently associated with ocular anterior segment dysgenesis, myopia, and ectopia lentis. We sought to assess the contribution of biallelic CPAMD8 variants to childhood and juvenile open-angle glaucoma. DESIGN: Retrospective, multicenter case series. PARTICIPANTS: A total of 268 probands and their relatives with a diagnosis of childhood or juvenile open-angle glaucoma. PURPOSE: Developmental abnormalities of the ocular anterior segment in some cases can lead to ocular hypertension and glaucoma. CPAMD8 is a gene of unknown function recently associated with ocular anterior segment dysgenesis, myopia, and ectopia lentis. We sought to assess the contribution of biallelic CPAMD8 variants to childhood and juvenile open-angle glaucoma. METHODS: Patients underwent a comprehensive ophthalmic assessment, with DNA from patients and their relatives subjected to genome, exome, or capillary sequencing. CPAMD8 RNA expression analysis was performed on tissues dissected from cadaveric human eyes. MAIN OUTCOME MEASURES: Diagnostic yield within a cohort of childhood and juvenile open-angle glaucoma, prevalence and risk of ophthalmic phenotypes, and relative expression of CPAMD8 in the human eye. RESULTS: We identified rare (allele frequency < 4×10-5) biallelic CPAMD8 variants in 5.7% (5/88) of probands with childhood glaucoma and 2.1% (2/96) of probands with juvenile open-angle glaucoma. When including family members, we identified 11 individuals with biallelic variants in CPAMD8 from 7 unrelated families. Nine of these individuals were diagnosed with glaucoma (9/11, 81.8%), with a mean age at diagnosis of 9.22±14.89 years, and all individuals with glaucoma required 1 or more incisional procedures to control high intraocular pressure. Iris abnormalities were observed in 9 of 11 individuals, cataract was observed in 8 of 11 individuals (72.7%), and retinal detachment was observed in 3 of 11 individuals (27.3%). CPAMD8 expression was highest in neural crest-derived tissues of the adult anterior segment, suggesting that CPAMD8 variation may cause malformation or obstruction of key drainage structures. CONCLUSIONS: Biallelic CPAMD8 variation was associated with a highly heterogeneous phenotype and in our cohorts was the second most common inherited cause of childhood glaucoma after CYP1B1 and juvenile open-angle glaucoma after MYOC. CPAMD8 sequencing should be considered in the investigation of both childhood and juvenile open-angle glaucoma, particularly when associated with iris abnormalities, cataract, or retinal detachment.

Intrinsic electronic spectra of cryogenically prepared protoporphyrin IX ions in vacuo - deprotonation-induced Stark shifts.

We present electronic spectra containing the Qx and Qy absorption bands of singly and doubly deprotonated protoporphyrin IX, prepared as mass selected ions in vacuo at cryogenic temperatures, revealing vibronic structure in both bands. We assign the vibronic progression of the Qx band using a Frank-Condon-Herzberg-Teller simulation based on time-dependent density functional theory, comparing the observed bands with those calculated for porphine. A comparison of the electronic spectra of the two charge states allows investigation of the electronic Stark effect with an electric field strength beyond the capabilities of typical laboratory setups. We analyze the differences in the electronic spectra of the two charge states using n-electron valence perturbation theory (NEVPT2) and simulated charge distributions.

Recent developments in the PySCF program package.

PySCF is a Python-based general-purpose electronic structure platform that supports first-principles simulations of molecules and solids as well as accelerates the development of new methodology and complex computational workflows. This paper explains the design and philosophy behind PySCF that enables it to meet these twin objectives. With several case studies, we show how users can easily implement their own methods using PySCF as a development environment. We then summarize the capabilities of PySCF for molecular and solid-state simulations. Finally, we describe the growing ecosystem of projects that use PySCF across the domains of quantum chemistry, materials science, machine learning, and quantum information science.

Lymphocytic Hypophysitis Presenting as Bilateral Abducens Nerve Palsy: A Case Report.

Lymphocytic hypophysitis (LYH) is a neuroendocrine disorder characterised by autoimmune inflammation of the pituitary gland with varying degrees of pituitary dysfunction, visual field defects and ocular motility disturbance. The authors report an interesting case of a 50-year-old woman presenting with intermittent bilateral abduction deficits. Neuroimaging and histopathological findings are presented. To the authors' knowledge, this is the first report of recurrent horizontal binocular diplopia and complete bilateral internal carotid artery occlusion in association with LYH.

Intrinsic photophysics of nitrophenolate ions studied by cryogenic ion spectroscopy.

The intrinsic photophysics of nitrophenolate isomers (meta, para, and ortho) was studied at low temperature using photodissociation mass spectrometry in a cryogenic ion trap instrument. Each isomer has distinct photophysics that affects the excited state lifetimes, as observed experimentally in their spectroscopic linewidths. Visible-light-induced excitation of m-nitrophenolate gives rise to well-resolved vibronic features in the spectrum of the S1 state. The para and ortho isomers have broad spectra - even at cryogenic temperatures - due to their shorter excited state lifetimes and spectral congestion. We present computational evidence for mixing of the first and second excited states of o-nitrophenolate, leading to significant additional broadening in the experimental spectrum.

Full blood count as an ancillary test to support the diagnosis of giant cell arteritis.

BACKGROUND: Temporal artery biopsy is considered the investigation of choice to diagnose definitively giant cell arteritis (GCA) in patients with compatible symptoms. However it is invasive and not completely sensitive. Serum markers, particularly erythrocyte sedimentation rate (ESR), can be supportive, but are not definitive in individual cases. AIMS: To investigate whether indices derived from the full blood count, including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were associated with a positive biopsy in patients with suspected GCA. METHODS: The clinical and pathological details of 537 patients undergoing temporal artery biopsy at our institution from 1992 to 2015 were reviewed. RESULTS: In univariate analysis high platelets (odds ratio (OR) 4.44, P < 0.001), NLR (OR 1.81, P = 0.02), PLR (OR 3.25, P < 0.001), C-reactive protein (CRP) (OR 3.00, P < 0.001), ESR (OR 3.62, P < 0.001) and increased age (OR 1.03, P = 0.006) were strongly associated with a positive biopsy. In multivariate modelling only high platelets (P < 0.001) and ESR (P = 0.049) maintained significance. CONCLUSIONS: We conclude that the presence of thrombocytosis and high NLR, PLR, ESR and CRP can all be used clinically to support the diagnosis of GCA prior to biopsy. Of particular note, in multivariate modelling the presence of thrombocytosis is a stronger predictor of a positive temporal artery biopsy than ESR. Therefore, careful consideration of the findings in a full blood count can be used to predict the likelihood of a positive temporal artery biopsy in patients with suspected GCA.

Electronic Spectra of Tris(2,2'-bipyridine)-M(II) Complex Ions in Vacuo (M = Fe and Os).

We measured the electronic spectra of mass-selected [M(bpy)3]2+ (M = Fe and Os, bpy = 2,2'-bipyridine) ions in vacuo by photodissociation spectroscopy of their N2 adducts, [M(bpy)3]2+·N2. Extensive band systems in the visible (predominantly charge transfer) and near-ultraviolet (ππ*) spectral regions are reported. The [M(bpy)3]2+·N2 target ions were prepared by condensing N2 onto electrosprayed ions in a cryogenic ion trap at ca. 25 K and then mass-selected by time-of-flight mass spectrometry. The electronic photodissociation spectra of the cold, gas-phase ions closely reflect their intrinsic properties, i.e., without perturbation by solvent effects. The spectra are interpreted using time-dependent density functional theory calculations both with and without accounting for relativistic effects.

UV Spectra of Tris(2,2'-bipyridine)-M(II) Complex Ions in Vacuo (M = Mn, Fe, Co, Ni, Cu, Zn).

We present electronic spectra in the π-π* region of a series of tris(bpy)-M(II) complex ions (bpy = 2,2'-bipyridine; M = Mn, Fe, Co, Ni, Cu, Zn) in vacuo for the first time. By applying photodissociation spectroscopy to cryogenically cooled and mass selected [MII(bpy)3]2+ ions, we obtain the intrinsic spectra of these ions at low temperature without perturbation by solvent interaction or crystal lattice shifts. This allows spectroscopic analysis of these complex ions in greater detail than possible in the condensed phase. We interpret our experimental data by comparison with time-dependent density functional theory.

Hydration of a Binding Site with Restricted Solvent Access: Solvatochromic Shift of the Electronic Spectrum of a Ruthenium Polypyridine Complex, One Molecule at a Time.

We report the electronic spectra of mass selected [(bpy)(tpy)Ru-OH2]2+·(H2O)n clusters (bpy = 2,2'-bipyridine, tpy =2,2':6'2″-terpyridine, n = 0-4) in the spectral region of their metal-to-ligand charge transfer bands. The spectra of the mono- and dihydrate clusters exhibit partially resolved individual electronic transitions. The water network forming at the aqua ligand leads to a rapid solvatochromic shift of the peak of the band envelope: addition of only four solvent water molecules can recover 78% of the solvatochromic shift in bulk solution. The sequential shift of the band shows a clear change in behavior with the closing of the first hydration shell. We compare our experimental data to density function theory (DFT) calculations for the ground and excited states.

Ligand Influence on the Electronic Spectra of Dicationic Ruthenium-Bipyridine-Terpyridine Complexes.

We report electronic spectra of a series of ruthenium polypyridine complexes of the form [(trpy)(bipy)Ru(II)-L](2+) (bipy = 2,2'-bipyridine and trpy = 2,2':6',2″-terpyridine), where L represents a small molecular ligand that occupies the last coordination site. Species with L = H2O, CO2, CH3CN, and N2 were investigated in vacuo using photodissociation spectroscopy. All species exhibit bright metal-to-ligand charger transfer (MLCT) bands in the visible and near UV, but with different spectral envelopes and peak energies, encoding the influence of the ligand L on the electronic structure of the complex. Several individual electronic bands can be resolved for L = H2O and CO2, while the spectra for L = N2 and CH3CN are more congested, even at low ion temperatures. The experimental results are discussed in the framework of time-dependent density functional theory.

The electronic spectrum of cryogenic ruthenium-tris-bipyridine dications in vacuo.

We report the electronic spectrum of the prototypical ruthenium coordination complex Ru(bpy)3 (2+) (bpy = 2, 2'-bipyridine) by messenger tagging with N2 in a cryogenic ion trap and photodissociation spectroscopy of mass selected Ru(bpy)3 (2+) ⋅ N2 ions. We observe individual electronic bands and groups of bands with unprecedented detail, particularly in the usually unresolved metal-to-ligand charge transfer region of the spectrum. By comparing our experimental results with time-dependent density functional theory, both with and without spin-orbit interaction [Heully et al., J. Chem. Phys. 131, 184308 (2009)], we are able to assign the spectrum of the isolated ion.

Application of the wildland fire emissions inventory system to estimate fire emissions on forest lands of the United States.

BACKGROUND: Forests are significant terrestrial biomes for carbon storage, and annual carbon accumulation of forest biomass contributes offsets affecting net greenhouse gases in the atmosphere. The immediate loss of stored carbon through fire on forest lands reduces the annual offsets provided by forests. As such, the United States reporting includes annual estimates of direct fire emissions in conjunction with the overall forest stock and change estimates as a part of national greenhouse gas inventories within the United Nations Framework Convention on Climate Change. Forest fire emissions reported for the United States, such as the 129 Tg CO2 reported for 2022, are based on the Wildland Fire Emissions Inventory System (WFEIS). Current WFEIS estimates are included in the Inventory of U.S. Greenhouse Gas Emissions and Sinks: 1990-2022 published in 2024 by the United States Environmental Protection Agency. Here, we describe WFEIS the fire emissions inventory system we used to address current information needs, and an analysis to confirm compatibility of carbon mass between estimated forest fire emissions and carbon in forest stocks. RESULTS: The summaries of emissions from forests are consistent with previous reports that show rates and interannual variability in emissions and forest land area burned are generally greater in recent years relative to the 1990s. Both emissions and interannual variability are greater in the western United States. The years with the highest CO2 emissions from forest fires on the 48 conterminous states plus Alaska were 2004, 2005, and 2015. In some years, Alaska emissions exceed those of the 48 conterminous states, such as in 2022, for example. Comparison of forest fire emission to forest carbon stocks indicate there is unlikely any serious disconnect between inventory and fire emissions estimates. CONCLUSIONS: The WFEIS system is a user-driven approach made available via a web browser. Model results are compatible with the scope and reporting needs of the annual national greenhouse gas inventories.

In vitro evaluation of using ceftazidime/avibactam against carbapenem-resistant Acinetobacter baumannii.

OBJECTIVE: Carbapenem-resistant Acinetobacter baumannii (CRAB) is a global concern as effective treatments are very limited. We previously used a modified susceptibility testing approach to predict growth suppression in carbapenem-resistant Enterobacterales, but there are uncertainties about the generalizability of the model. The objective of this study is to verify if a similar approach can be extended to CRAB. METHOD: A clinical isolate of CRAB resistant to ceftazidime/avibactam (CAZ/AVI, MIC = 32/4 mg/L) was examined. CAZ susceptibility was determined using increasing concentrations of AVI (0-64 mg/L), and MIC reduction was characterized with a sigmoid inhibitory maximum effect (Emax) model. The effectiveness of CAZ/AVI was validated in a hollow fibre infection model (HFIM) over 72 hours, using simulated unbound serum / epithelial lining fluid (ELF) exposures of 2.5 g over 2 hours every 8 hours. Baseline inocula of approximately 5.5 log CFU/mL were examined. RESULTS: An AVI concentration-dependent reduction in CAZ MIC was observed (r2 = 0.99). CAZ MIC was dramatically reduced from 512 mg/L (no AVI) to 32 mg/L (AVI = 4 mg/L), and further to 8 mg/L (AVI = 16 mg/L). Pharmacokinetic simulations were satisfactory in the HFIM (r2 > 0.96). Bacterial suppression was observed >24 hours with the serum exposure, but not that from the ELF. CONCLUSION: Using multiple AVI concentrations within the clinically relevant range, our susceptibility testing approach could have better insights of treatment outcome for infections caused by CRAB. This could potentially lead to effective intervention(s) overlooked by conventional susceptibility testing method. This case highlights the importance of site-specific drug exposures on determining treatment outcome.

Aboveground live tree carbon stock and change in forests of conterminous United States: influence of stand age.

BACKGROUND: Sequestration of carbon on forest land is a common and practical component within many climate action plans developed by state or municipal governments. Initial planning often identifies the general magnitude of sequestration expected given the scope of the project. Because age plays a key role in forest carbon dynamics, we summarize both the carbon stock and accumulation rates in live trees by age class and region, allowing managers and policymakers to assess the influence of forest age class structure on forest carbon storage as represented in current inventories. State-level information is provided in supplementary tables. RESULTS: Average regional aboveground live tree carbon stocks (represented on a per area basis) range from 11.6 tC/ha in the Great Plains to 130 tC/ha in the Pacific Northwest West (west-side of Cascades) and increase with age in all regions, although in three regions carbon stock declined in the oldest age class. Regional average annual net change in live aboveground tree carbon varies from a low of - 0.18 tC /ha/yr in the Rocky Mountain South region to a high value of 1.74 tC/ha/yr in Pacific Northwest West. In all regions except Rocky Mountain South, accumulation rates are highest in the younger age classes and decline with age, with older age classes in several western regions showing negative rates. In the Southeast and Pacific Northwest West, intermediate age classes exhibit lower rates, likely due to harvesting activity. CONCLUSIONS: Aboveground live tree carbon stocks increase and rates of average change decrease with age with few exceptions; this pattern holds when examining hardwood and softwood types individually. Because multiple forest management objectives are often considered and tradeoffs need to be assessed, we recommend considering both measures-standing stock and average annual change-of carbon storage. The relative importance of each component depends on management and policy objectives and the time frame related to those objectives. Harvesting and natural disturbance also affect forest carbon stock and change and may need to be considered if developing projections of potential carbon storage. We present forest carbon summaries at a scale and scope to meet information needs of managers and policymakers.

Wildfires correlate with reductions in aboveground tree carbon stocks and sequestration capacity on forest land in the Western United States.

In the United States (US), forest ecosystems are the largest terrestrial carbon sink, offsetting the equivalent of >12 % of economy-wide greenhouse gas (GHG) emissions annually. In the Western US, wildfires have shaped much of the landscape by changing forest structure and composition, increasing tree mortality, impacting forest regeneration, and influencing forest carbon storage and sequestration capacity. Here, we used remeasurements of >25,000 plots from the US Department of Agriculture, Forest Service Forest Inventory and Analysis (FIA) program and auxiliary information (e.g., Monitoring Trends in Burn Severity) to characterize the role of fire along with other natural and anthropogenic drivers on estimates of carbon stocks, stock changes, and sequestration capacity on forest land in the Western US. Several biotic (e.g., tree size, species, and forest structure) and abiotic factors (e.g., warm climate, severe drought, compound disturbances, and anthropogenic interventions) influenced post-fire tree mortality and regeneration and had concomitant impacts on carbon stocks and sequestration capacity. Forest ecosystems in a high severity and low frequency wildfire regime had greater reductions in aboveground biomass carbon stocks and sequestration capacity compared to forests in a low severity and high frequency fire regime. Results from this study can improve our understanding of the role of wildfire along with other biotic and abiotic drivers on carbon dynamics in forest ecosystems in the Western US.