PROTOCOL FOR HUMAN EXPOSURE TO OPIOIDS AND CONCENTRATED MEDETOMIDINE USED IN FIELD APPLICATIONS.

Wildlife professionals routinely use potent sedatives and anesthetics when chemically immobilizing wildlife and zoo species in remote environments. Accidental exposure to these prescription veterinary drugs is rare but could be rapidly fatal. Commonly used agents include opioids and α2 adrenoreceptor agonists. These drugs can be reversed with specific antagonists; however, they are often not approved for human use. The protocol created here can be used by wildlife health professionals in a field setting with basic human emergency medical response training in coordination with local Emergency Medical Services (EMS). Key components include, building local relationships between EMS and wildlife professionals, focused EMS training, administering opioid and α2 adrenergic antagonists off label, and local evacuation procedures. This framework could allow wildlife management agencies or zoos to mitigate the risk of human exposures to these commonly used drugs, significantly improving occupational safety in an otherwise high-risk environment.

Chronic exposure to mercury increases arrhythmia and mortality post-acute myocardial infarction in rats.

Introduction: Mercury (Hg) is a heavy metal that causes a variety of toxic effects in eukaryotic cells. Previous studies have reported detrimental effects of mercury toxicity in the cardiovascular system. Given the importance of understanding the relationship between Hg and cardiovascular disease, we sought to investigate if the Hg could worsen the myocardial repercussions following ischemic injury. We demonstrated that once mercury toxicity is established, it can influence the outcome of myocardial infarction (MI). Methods: Male Wistar rats received intramuscular injections of either saline (NaCl 0.9%) or mercuric chloride (HgCl2, first dose of 4.6 µg/kg, and subsequent doses of 0.07 µg/kg/day) for 4 weeks. Three weeks post-exposure, we induced transmural infarction in the left ventricle free wall through coronary artery occlusion surgery. Results: ECG recordings obtained from MI groups demonstrated alterations in the rhythm of the heartbeat/heart electrical activity, as expected, including ventricular extrasystoles and ventricular tachycardia. However, the MI group exposed to Hg (MI-Hg) exhibited augmented ventricular extrasystoles and ventricular tachycardia compared to the MI group. Also, Basckó coefficient revealed that the arrhythmic events-after MI-were aggravated by Hg exposure. Discussion: Our results indicate that the significantly increased mortality in MI-Hg groups when compared to MI (21%, MI vs 32%, MI-Hg) is correlated with greater occurrence of arrhythmias. In conclusion, this study further supports the idea that exposure to mercury (Hg) should be recognized as a significant risk factor that exacerbates the impact of cardiac ischemic injury, potentially leading to an increased mortality rate among patients experiencing acute MI.

Tafasitamab and lenalidomide for relapsed/refractory diffuse large B-cell lymphoma in a patient on chronic intermittent hemodialysis.

INTRODUCTION: Tafasitamab is an anti-CD19 monoclonal antibody indicated for the treatment of relapsed/refractory diffuse large B-cell lymphoma to be given in combination with lenalidomide. Experiences with tafasitamab in the setting of hemodialysis are limited and the efficacy and safety of this agent in this setting are unknown. CASE REPORT: We describe a patient with relapsed/refractory diffuse large B-cell lymphoma with hemodialysis-dependent end-stage renal disease who successfully received tafasitamab/lenalidomide. MANAGEMENT AND OUTCOME: Tafasitamab and reduced dose lenalidomide were initiated for relapsed diffuse large B-cell lymphoma. Tafasitamab was administered on non-dialysis days. Follow-up imaging for disease response assessment demonstrated a complete response. Therapy was well tolerated; the only major toxicity experienced was grade 4 neutropenia that resolved with dose adjustment to lenalidomide. Over a year from initiating therapy, the patient remains in a complete response. DISCUSSION/CONCLUSION: The combination of tafasitamab and dose-reduced lenalidomide produced a complete response in the treatment of relapsed/refractory diffuse large B-cell lymphoma in the setting of chronic intermittent hemodialysis.

Quantification of protein by acid hydrolysis reveals higher than expected concentrations in red wines: Implications for wine tannin concentration and colloidal stability.

Protein is reportedly negligible in most red wines, due to its loss following co-precipitation with phenolic substances. A method for protein quantification in red wine was developed which overcame analytical interference from phenolic substances, based on ethanol precipitation, followed by acid-hydrolysis and amino acid quantification. Protein concentration was surveyed in a range of red wines produced from V. vinifera and interspecific (Vitis spp) hybrids, revealing higher than expected concentrations, ranging from 23 mg/L ± 2.57 to 380 mg/L ± 16. The results showed that tannin extracted from grapes remains soluble in wine in the presence of protein even at high protein (>100 mg/L) and tannin (>500 mg/L) concentrations. As a further consequence of this, the particle size and concentration of colloids within high- and low-protein wines were similar, independent of protein or tannin concentration. Higher wine tannin concentration was also correlated with increased heat stability of wine protein.

Precipitation of Tannin-Anthocyanin Derivatives in Wine is Influenced by Acetaldehyde Concentration and Tannin Molecular Mass with Implications for the Development of Nonbleachable Pigments.

This study aimed to assess the effect of tannin molecular mass on nonbleachable pigment formation and subsequent stability under wine-like conditions. Tannin fractions of a defined molecular mass range were prepared from grape skins and seeds and reacted with malvidin-3-glucoside for 120 days in three media types: chemically defined wine media with or without acetaldehyde addition or model wine without acetaldehyde. Precipitation was observed after the reaction period and increased in response to both higher tannin molecular mass and acetaldehyde concentration. To confirm whether acetaldehyde-mediated condensation of tannin and anthocyanin modified the solubility of the nonbleachable pigments formed, HPLC-MS was used for the semiquantitative identification of vinyl derivatives and ethyl-linked adducts in soluble and precipitated materials. It was found that the proportion of vinyl derivatives and ethyl-linked anthocyanin was elevated in tannin precipitates relative to soluble pigmented material. Despite substantial losses of tannin due to precipitation, the resulting nonbleachable pigment concentration and color intensity were higher in wine media containing elevated acetaldehyde, when each tannin size category was considered independently. The results of this study indicated that the development of nonbleachable pigments from larger tannins may be limited when acetaldehyde-mediated condensation with anthocyanin predominates in wine, concomitant with precipitation.

Nusinersen for spinal muscular atrophy type 1: Real-world respiratory experience.

BACKGROUND: The emergence of new treatments for spinal muscular atrophy (SMA) is revolutionary, especially for SMA type 1 (SMA1). Data on respiratory outcomes remain sparse and rely mostly on randomized clinical trials. We report our experience of Nusinersen-treated SMA1 patients in real-world settings. METHODS: Data from SMA1 patients treated with Nusinersen were prospectively collected between 1/2017 and 1/2020. Respiratory variables included the use of assisted ventilation, the use of mechanical insufflation-exsufflation (MIE), respiratory complications, and death or treatment cessation due to respiratory reasons. RESULTS: Twenty SMA1 patients were assessed before and after 2 years of Nusinersen treatment which was initiated at a median age of 13.5 months (range, 1-184). At baseline, 16 patients were using assisted ventilation, eight noninvasive and eight invasive. Twelve patients were using permanent ventilation and four partial ventilation. After 2 years of treatment, there was no change in respiratory support among ventilated patients. All four patients who were free from respiratory support at baseline required the initiation of assisted ventilation during the study period. All 20 patients used MIE after 2 years of treatment. Two patients died from acute respiratory failure and one sustained severe brain injury. Four patients had chronic and/or recurrent atelectasis. CONCLUSION: Most of our patients were stable in their need for assisted ventilation and did not worsen as expected in SMA1, nor did they improve as might be hoped. Future studies are needed to determine if earlier treatment with Nusinersen might result in respiratory outcomes superior to those reported in this real-life study.

Chemical and Sensory Impacts of Accentuated Cut Edges (ACE) Grape Must Polyphenol Extraction Technique on Shiraz Wines.

Accentuated Cut Edges (ACE) is a recently developed grape must extraction technique, which mechanically breaks grape skins into small fragments but maintains seed integrity. This study was the first to elucidate the effect of ACE on Shiraz wine's basic chemical composition, colour, phenolic compounds, polysaccharides and sensory profiles. A further aim was to investigate any potential influence provided by ACE on the pre-fermentation water addition to must. ACE did not visually affect Shiraz wine colour, but significantly enhanced the concentration of tannin and total phenolics. Wine polysaccharide concentration was mainly increased in response to the maceration time rather than the ACE technique. ACE appeared to increase the earthy/dusty flavour, possibly due to the different precursors released by the greater skin breakage. The pre-fermentation addition of the water diluted the wine aromas, flavours and astringency profiles. However, combining the ACE technique with water addition enhanced the wine textural quality by increasing the intensities of the crucial astringent wine quality sub-qualities, adhesive and graininess. Furthermore, insights into the chemical factors influencing the astringency sensations were provided in this study. This research indicates that wine producers may use ACE with pre-fermentation water dilution to reduce the wine alcohol level but maintain important textural components.

Bioavailability of red wine and grape seed proanthocyanidins in rats.

This study explored plasma levels and urinary and fecal excretion of metabolites and microbial-derived catabolites over a 24 h period following the ingestion of red wine (RWP) or grape seed (GSP) proanthocyanidin-rich extracts by rats. In total, 35 structurally-related (epi)catechin metabolites (SREMs) and 5-carbon side chain ring fission metabolites (5C-RFMs) (phenyl-γ-valerolactones and phenylvaleric acids), and 50 phenolic acid and aromatic catabolites were detected after intakes of both extracts. The consumption of the RWP extract, but not the GSP extract, led to the appearance of a ∼200 nmol L-1 peak plasma concentration of SREMs formed from flavan-3-ol monomers. In contrast, ingestion of the GSPs, but not the RWPs, resulted in a substantial increase in microbiota-derived 5-carbon side chain ring fission metabolites (5C-RFMs) in plasma. 5C-RFMs, along with low molecular weight phenolic catabolites were detected in urine after ingestion of both extracts. The GSP and RWP extracts had respective mean degrees of polymerisation 5.9 and 6.5 subunits, and the RWP extract had an upper polymer size of 21 subunits compared to 44 subunits for the GSP extract. The differences in plasma metabolite profiles might, therefore, be a consequence of this polydispersity impacting on the microbiota-mediated rates of cleavage of the proanthocyanidin subunits and their subsequent metabolism and absorption. Urinary excretion of phenolic catabolites indicated that 11% of RWPs and 7% for GSPs were subjected to microbial degradation. In all probability these figures, rather than representing the percentage of proanthocyanidins that are completely degraded, indicate partial cleavage of monomer subunits producing a much higher percentage of shortened proanthocyanidin chains. Obtaining more detailed information on the in vivo fate of proanthocyanidins is challenging because of the difficulties in analysing unabsorbed parent proanthocyanidins and their partially degraded flavan-3-ol subunit chains in feces. Further progress awaits the development of improved purification and analytical techniques for proanthocyanidins and their use in feeding studies, and in vitro fecal and bacterial incubations, with radio and/or stable isotope-labelled substrates.

An osteopontin-derived peptide inhibits human hair growth at least in part by decreasing fibroblast growth factor-7 production in outer root sheath keratinocytes.

BACKGROUND: Given that unwanted hair growth (hirsutism, hypertrichosis) can cause major psychological distress, new pharmacological treatment strategies with safe and effective hair growth inhibitors that do not destroy the hair follicle (HF) and its stem cells need to be developed. OBJECTIVES: To establish if osteopontin-derived fragments may modulate human hair growth given that human HFs express the multifunctional, immunomodulatory glycoprotein, osteopontin. METHODS: Our hypothesis was tested ex vivo and in vivo by using a newly generated, toxicologically well-characterized, modified osteopontin-derived peptide (FOL-005), which binds to the HF. RESULTS: In organ-cultured human HFs and scalp skin, and in human scalp skin xenotransplants onto SCID mice, FOL-005 treatment (60 nmol L-1 to 3 µmol L-1 ) significantly promoted premature catagen development without reducing the number of keratin 15-positive HF stem cells or showing signs of drug toxicity. Genome-wide DNA microarray, quantitative reverse-transcriptase polymerase chain reaction and immunohistochemistry revealed decreased expression of the hair growth promoter, fibroblast growth factor-7 (FGF7) by FOL-005, while cotreatment of HFs with recombinant FGF7 partially abrogated FOL-005-induced catagen promotion. CONCLUSIONS: With caveats in mind, our study identifies this osteopontin-derived peptide as an effective, novel inhibitory principle for human hair growth ex vivo and in vivo, which deserves systematic clinical testing in hirsutism and hypertrichosis. What's already known about this topic? The treatment of unwanted hair growth (hypertrichosis, hirsutism) lacks pharmacological intervention, with only few and often unsatisfactory treatments available. Osteopontin is prominently expressed in human HFs and has been reported to be elevated during catagen in the murine hair cycle. What does this study add? We tested the effects on hair growth of a novel, osteopontin-derived fragment (FOL-005) ex vivo and in vivo. In human hair follicles, high-dose FOL-005 significantly reduces hair growth both ex vivo and in vivo. What is the translational message? High-dose FOL-005 may provide a new therapeutic opportunity as a treatment for unwanted hair growth.

Magnetic properties of (Fe1-xMnx)2AlB2 and the impact of substitution on the magnetocaloric effect.

In this work, we investigate the magnetic structures of (Fe1-xMnx)2AlB2 solid-solution quaternaries in the x=0 to 1 range using x-ray and neutron diffraction, magnetization measurements, and mean-field theory calculations. While Fe2AlB2 and Mn2AlB2 are known to be ferromagnetic (FM) and antiferromagnetic (AFM), respectively, herein we focused on the magnetic structure of their solid solutions, which is not well understood. The FM ground state of Fe2AlB2 becomes a canted AFM at x≈0.2, with a monotonically diminishing FM component until x≈0.5. The FM transition temperature (TC) decreases linearly with increasing x. These changes in magnetic moments and structures are reflected in anomalous expansions of the lattice parameters, indicating a magnetoelastic coupling. Lastly, the magnetocaloric properties of the solid solutions were explored. For x=0.2 the isothermal entropy change is smaller by 30% than it is for Fe2AlB2, while the relative cooling power is larger by 6%, due to broadening of the temperature range of the transition.

Potato Protein Fining of Phenolic Compounds in Red Wine: A Study of the Kinetics and the Impact of Wine Matrix Components and Physical Factors.

Producing wines within an acceptable range of astringency is important for quality and consumer acceptance. Astringency can be modified by fining during the winemaking process and the use of vegetable proteins (especially potato proteins) as fining agents has gained increasing interest due to consumers' requirements. The research presented was the first to investigate the effect of a potato protein dose on the kinetics of tannin and phenolic removal compared to gelatin for two unfined Cabernet Sauvignon wines. To further understand the results, the influence of the wine matrix and fining parameters (including pH, ethanol concentration, sugar concentration, temperature, and agitation) were tested according to a fractional 25-1 factorial design on one of the Cabernet Sauvignon wines using potato proteins. The results from the factorial design indicate that potato protein fining was significantly influenced by wine pH, ethanol concentration, fining temperature as well as an interaction (pH × ethanol) but not by sugar content or agitation. Insights into the steps required for the optimisation of fining were gained from the study, revealing that potato protein fining efficiency could be increased by treating wines at higher temperatures (20 °C, rather than the conventional 10-15 °C), and at both a lower pH and/or alcohol concentration.

Commercial Saccharomyces cerevisiae Yeast Strains Significantly Impact Shiraz Tannin and Polysaccharide Composition with Implications for Wine Colour and Astringency.

To gain knowledge on the role of Saccharomyces cerevisiae yeast strains (and their hybrids) on wine sensory properties, 10 commercially available yeast strains were selected on the basis of their widespread usage and/or novel properties and used to produce Shiraz wines. Significant differences were evident post-alcoholic fermentation and after 24 months of ageing with regards to the number of wine compositional variables, in particular the concentration of tannin and polysaccharide. Strain L2323 is known for its pectinolytic activity and yielded the highest concentration of both yeast- and grape-derived polysaccharides. Wines made with the mannoprotein-producing strain Uvaferm HPS (high levels of polysaccharides) did not have elevated concentrations of yeast-derived polysaccharides, despite this observation being made for corresponding model fermentations, suggesting that mannoprotein production or retention might be limited by the wine matrix. Wine tannin concentration showed a high level of variability between strains, with L2323 having the highest, and AWRI1503 the lowest concentration. Sensory analysis of the wines after 24 months ageing revealed significant differences between the yeast strains, but only the attributes opacity (visual colour) and astringency could be predicted by partial least squares regression using the wine compositional data. Notably, the astringency attribute was associated with higher concentrations of both tannin and polysaccharide, contrary to reports in the literature which suggested that polysaccharide exerts a moderating effect on astringency. The results confirm previous reports demonstrating that the choice of yeast strain represents an opportunity to shape wine style outcomes.

Effect of Grape Seed and Skin Tannin Molecular Mass and Composition on the Rate of Reaction with Anthocyanin and Subsequent Formation of Polymeric Pigments in the Presence of Acetaldehyde.

Polymeric pigments formed via ethyl linkages between grape tannins and anthocyanins are important to the development of stable red wine color. To determine the effect of tannin structure on the stability and color properties of ethyl-linked polymeric pigments, tannin fractions with average polymerization between 4 and 43 units were prepared from grape skins and seeds and combined with malvidin-3-glucoside (M3G) in model wine containing acetaldehyde. As tannin molecular mass increased, the reaction rate with M3G increased. Compared with skin tannins of comparable molecular mass, seed tannins reacted more rapidly with M3G but were prone to precipitation. This resulted in a loss of polymeric pigments formed from seed tannins, which was greater as tannin molecular mass increased. Aggregation occurred following the reaction of seed tannin with M3G, concomitant with precipitation. The aggregation-precipitation phenomenon was not observed for skin tannin-derived pigments, indicating a greater stability in solution than those formed from seed tannins.

Applying Nanoparticle Tracking Analysis to Characterize the Polydispersity of Aggregates Resulting from Tannin-Polysaccharide Interactions in Wine-Like Media.

Interactions between grape seed tannin and either a mannoprotein or an arabinogalactan in model wine solutions of different ethanol concentrations were characterized with nanoparticle tracking analysis (NTA), UV-visible spectroscopy and dynamic light scattering (DLS). NTA results reflected a shift in particle size distribution due to aggregation. Furthermore, the light scattering intensity of each tracked particle measured by NTA demonstrated the presence of aggregates, even when a shift in particle size was not apparent. Mannoprotein and arabinogalactan behaved differently when combined with seed tannin. Mannoprotein formed large, highly light-scattering aggregates, while arabinogalactan exhibited only weak interactions with seed tannin. A 3% difference in alcohol concentration of the model solution (12 vs. 15% v/v) was sufficient to affect the interactions between mannoprotein and tannin when the tannin concentration was high. In summary, this study showed that NTA is a promising tool for measuring polydisperse samples of grape and wine macromolecules, and their aggregates under wine-like conditions. The implications for wine colloidal properties are discussed based on these results.

Oxygen exposure during red wine fermentation modifies tannin reactivity with poly-l-proline.

Red wines injected with nitrogen or oxygen during fermentation were used to identify the effect of gas exposure on tannin structure and reactivity with poly-l-proline. Tannin was purified from wine after fermentation and after three years of bottle storage. Tannin from nitrogen-treated wine had a lower percentage of galloylation and were less pigmented than tannin from oxygen-exposed wine. Self-aggregation of tannin was measured by nanoparticle tracking analysis and a larger particle size was observed for the oxidized treatment. The interaction of tannin and poly-l-proline was measured by isothermal titration calorimetry, and involved more hydrogen bonding than hydrophobic interactions in the case of nitrogen-treated wine tannin. Conversely, oxidized tannin was more hydrophobic and the association with poly-l-proline was entropy-driven due to a change of solvation. The results show meaningful changes in the structure and reactivity of tannin as a result of oxygen exposure during fermentation, which may impact astringency perception.

Successful treatment of massive hemothorax with class IV shock using aortography with transcatheter embolization of actively bleeding posterior left intercostal arteries after penetrating left chest trauma: A case for the hybrid OR.

Hemothorax is a common occurrence after blunt or penetrating injury to the chest. Posterior intercostal vessel hemorrhage as a cause of major intrathoracic bleeding is an infrequent source of massive bleeding. Selective angiography with trans-catheter embolization may provide a minimally invasive and efficient method of controlling bleeding refractory to surgical treatment. PRESENTATION OF CASE: A 19 year-old male sustained a gunshot wound to his left chest with massive hemothorax and refractory hemorrhage. He was emergently taken to the operating room for thoracotomy and was found to have uncontrollable bleeding from the chest due to left posterior intercostal artery transection. The bleeding persisted despite multiple attempts with sutures, clips and various hemostatic agents. Thoracic aortography was undertaken and revealed active bleeding from the left 7th posterior intercostal artery, which was coil-embolized. The patient's hemodynamic status significantly improved and he was transferred to the intensive care unit. DISCUSSION: Posterior intercostal bleeding is a rare cause of massive hemothorax. Bleeding from these arteries may be difficult to control due to limited exposure in that area. Transcatheter-based arterial embolization is a reliable and feasible option for arresting hemorrhage following failed attempts at hemorrhage control from thoracotomy. CONCLUSION: Massive hemothorax from intercostal arterial bleeding is a rare complication after penetrating chest injury (Aoki et al., 2003). Selective, catheter-based embolization is a useful therapeutic option for hemorrhage control and can be expeditiously employed if a hybrid operating room is available.

Mediastinal Epidermoid Cyst in a 5-Year-Old Girl.

A 5-year-old girl was referred to our unit with an incidental finding of a lesion on the right hemithorax situated within the right atrial shadow. Computed tomography thorax showed a well-defined soft tissue lesion felt to be consistent with a bronchogenic cyst. The lesion was located in the posterior mediastinum, adherent to the diaphragm and inferior vena cava, but did not extend within the wall of the esophagus. It was entirely excised via video-assisted thoracoscopy converted to open thoracotomy. Histopathology confirmed an encapsulated nodular tissue measuring 2.5 × 2.5 × 2 cm lined by squamous type epithelium. Chronic inflammatory cells and foreign body giant cell reaction were found in the cyst wall. The appearances were that of a benign epidermoid cyst.

Development and validation of an UHPLC-HRMS protocol for the analysis of flavan-3-ol metabolites and catabolites in urine, plasma and feces of rats fed a red wine proanthocyanidin extract.

This study developed, optimized and validated an ultra-high-performance liquid chromatography-high-resolution mass spectrometry (UHPLC-HRMS) method to identify and quantify metabolites and microbial-derived catabolites in urine, plasma and feces of rats following ingestion of 50 mg of a red wine proanthocyanidin-rich extract. The method was validated for specificity, linearity, limit of detection (LD) and quantification (LQ), intra-day and inter-day precision, recovery and matrix effects, which were determined for 34 compounds in the three biological matrices. After method validation, three parent flavan-3-ols, four 5-carbon side chain ring fission metabolites, and 27 phenolic acid and aromatic catabolites were quantified in plasma, urine and feces after red wine proanthocyanidin intake. These results establish the value of the UHPLC-HRMS protocol in obtaining a detailed picture of proanthocyanidin metabolites and their microbial-derived catabolites, along with their phase II metabolites, in biological fluids of rat, and potentially in human clinical studies designed to evaluate the bioavailability of dietary flavan-3-ols.