Trough anti-Xa activity after intermediate dose nadroparin for thrombosis prophylaxis in critically ill patients with COVID-19 and acute kidney injury.

Our objective was to assess the incidence of drug bioaccumulation in critically ill COVID-19 patients with AKI receiving intermediate dose nadroparin for thrombosis prophylaxis. We conducted a Prospective cohort study of critically ill COVID-19 patients. In patients on intermediate dose nadroparin (5700 IU once daily) we assessed the incidence of bioaccumulation (trough anti-Xa level > 0.2 IU/mL) stratified according to presence of AKI. We quantified this association using multilevel analyses. To assess robustness of our observations, we explored the association between AKI and anti-Xa activity in patients receiving high dose nadroparin (> 5700 IU). 108 patients received intermediate dose nadroparin, of whom 24 had AKI during 36 anti-Xa measurements. One patient with AKI (4.2% [95%CI 0.1-21%]) and 1 without (1.2% [95%CI 0.03-6.5%]) developed bioaccumulation (p = 0.39). Development of AKI was associated with a mean increase of 0.04 (95%CI 0.02-0.05) IU/ml anti-Xa activity. There was no statistically significant association between anti-Xa activity and AKI in 51 patients on high dose nadroparin. There were four major bleeding events, all in patients on high dose nadroparin. In conclusion, Bioaccumulation of an intermediate dose nadroparin did not occur to a significant extent in critically ill patients with COVID-19 complicated by AKI. Dose adjustment in AKI may be unnecessary.

[The underrepresentation of complex patient groups in scientific research: ethical considerations]. / De ondervertegenwoordiging van complexe patiëntengroepen in wetenschappelijk onderzoek: ethische overwegingen.

BACKGROUND: Subgroups of patients with severe mental illness are underrepresented in scientific research. One of the possible causes is the fact that in these patient groups barriers may exist to the giving of competent informed consent. AIM: Describing the ethical dilemmas that may occur when conducting research with these patient groups. METHOD: We present an overview of the Dutch legislation and regulation concerning participation in scientific research, and discuss the ethical dilemmas that arise in the mentioned patient groups. We present four directions for solutions. RESULTS: In research with these patient groups more attention is needed for the explicit assessment and enhancement of competence. For the subgroup that is persistently incompetent, the possibilities of doing research with existing patient data without informed consent, need further exploration. CONCLUSION: Further legislative development is needed for research with patients with severe mental illness who are persistently incompetent. Herein, it is crucial to involve ethicists and organizations representing patients' and relatives' perspectives.

[Exchange of information between psychiatrist and pharmacist concerning uncollected medication]. / Informatie-uitwisseling tussen psychiater en apotheker over niet-opgehaalde medicatie.

Background Non- compliance with drug regimens has a negative effect on symptomatology and is the largest predictor of relapse in people with Severe Psychiatric Disorder (EPA). When care providers are informed in good time that medication has not been collected and can act on it, compliance can be increased. Aim Assessment of usefulness and feasibility of a system for the Signaling and Reporting by Pharmacists of Uncollected Medication for people with an EPA (Dutch: 'SMANOM-EPA') within the current legal context. Method The package of requirements was drawn up on the basis of questionnaires and telephone interviews with psychiatrists and pharmacists and focus group meetings with patients and significant others. Lawyers and ICT professionals were consulted to formulate the legal and technical preconditions. Results All parties involved considered SMANOM-EPA to be useful. The administrative burden was a determining factor for the feasibility and transparency was an important precondition. The exchange of information could take place securely with existing technology, despite the variation in prescribing and issuing systems. However, opinions were divided as to whether informing and documenting is sufficient or whether consent is necessary. Conclusion The GDPR and the WBGO safeguard patients' rights regarding the use of personal data. Uncertainty about the legal framework and technological possibilities add to the complexity of innovations to promote the exchange of information between practitioners, while the added value is seen by those involved and in comparable innovations. Tijdschrift voor Psychiatrie 63(2021)1, 32-38.

Immune evasion by acquisition of complement inhibitors: the mould Aspergillus binds both factor H and C4b binding protein.

Pathogenic fungi represent a major threat particularly to immunocompromised hosts, leading to severe, and often lethal, systemic opportunistic infections. Although the impaired immune status of the host is clearly the most important factor leading to disease, virulence factors of the fungus also play a role. Factor H (FH) and its splice product FHL-1 represent the major fluid phase inhibitors of the alternative pathway of complement, whereas C4b-binding protein (C4bp) is the main fluid phase inhibitor of the classical and lectin pathways. Both proteins can bind to the surface of various human pathogens conveying resistance to complement destruction and thus contribute to their pathogenic potential. We have recently shown that Candida albicans evades complement by binding both Factor H and C4bp. Here we show that moulds such as Aspergillus spp. bind Factor H, the splicing variant FHL-1 and also C4bp. Immunofluorescence and flow cytometry studies show that the binding of Factor H and C4bp to Aspergillus spp. appears to be even stronger than to Candida spp. and that different, albeit possibly nearby, binding moieties mediate this surface attachment.

The yeast Candida albicans binds complement regulators factor H and FHL-1.

The human facultative pathogenic yeast Candida albicans causes mucocutaneous infections and is the major cause of opportunistic fungal infections in immunocompromised patients. C. albicans activates both the alternative and classical pathway of the complement system. The aim of this study was to assay whether C. albicans binds human complement regulators in order to control complement activation at its surface. We observed binding of two central complement regulators, factor H and FHL-1, from normal human serum to C. albicans by adsorption assays, immunostaining, and fluorescence-activated cell sorter (FACS) analyses. Specificity of acquisition was further confirmed in direct binding assays with purified proteins. The surface-attached regulators maintained their complement regulatory activities and mediated factor I-dependent cleavage of C3b. Adsorption assays with recombinant deletion mutant proteins were used to identify binding domains. Two binding sites were localized. One binding domain common to both factor H and FHL-1 is located in the N-terminal short consensus repeat domains (SCRs) 6 and 7, and the other one located in C-terminal SCRs 19 and 20 is unique to factor H. These data indicate that by surface acquisition of host complement regulators, the human pathogenic yeast C. albicans is able to regulate alternative complement activation at its surface and to inactivate toxic complement activation products.

The centromere-binding factor Cbf1p from Candida albicans complements the methionine auxotrophic phenotype of Saccharomyces cerevisiae.

A gene encoding the centromere binding factor 1 (Cbf1p) of the human pathogenic yeast Candida albicans was cloned and characterized. An open reading-frame was detected which encoded a 223 amino acid protein with a calculated molecular weight of 25.8 kDa and a relative isoelectric point of 5.55. It shares 39% overall amino acid sequence identity with Saccharomyces cerevisiae Cbf1p. We localized the CaCBF1 gene on chromosome 4. Southern analysis indicated that CaCBF1 is probably present as a single copy gene per haploid genome. The CaCBF1 gene under the control of its own promoter was able to complement the methionine auxotrophic growth, the increased mitotic instability of CEN plasmids and the slow growth of a Saccharomyces cerevisiae cbf1Delta mutant strain.

The deletion of CaVPS34 in the human pathogenic yeast Candida albicans causes defects in vesicle-mediated protein sorting and nuclear segregation.

A Candida albicans null mutant of the phosphatidylinositol (PI) 3-kinase gene (CaVPS34) involved in virulence was examined by different microscopical techniques. We observed that vacuoles of the Cavps34 null mutant were considerably enlarged and electron-transparent. An interesting result obtained by transmission electron microscopy analysis of Cavps34 mutant cells was the aberrant patch-like accumulation of vesicles, which were localized in the periplasm close to the plasma membrane. We assume that the vesicles result from missorted prevacuolar compartments. In contrast to the accumulations of the specific endocytic dye FM4-64 in the vacuole membrane in C. albicans wild-type strains (ring staining pattern), the Cavps34 mutant strain showed a staining of punctuate structures, possibly multivesicular bodies (MVB), that are scattered all over the cell. This defect indicates a late block in endocytic vesicle transport. Measurement of the total activity of carboxypeptidase Y revealed significantly lower activity in Cavps34 mutant cells. This may indicate that carboxypeptidase Y is not properly activated as a result of mislocalization due to the lack of Vps34p. The deletion of the CaVPS34 gene caused disturbance of normal nuclear migration, which suggests that in the Cavps34 mutant the cell-size mediated control process of cell division is affected.

A phosphatidylinositol 3-kinase of Candida albicans: molecular cloning and characterization.

A phosphatidylinositol (PI) 3-kinase gene (CaVPS34) of the human pathogenic yeast Candida albicans was cloned by a PCR-based homology approach. The open reading frame encodes a 1020 amino acid protein with a calculated molecular weight of 118 kDa and a relative isoelectric point of 6.9. It shares 47% sequence identity with Saccharomyces cerevisiae Vps34p. Southern pattern indicated that CaVPS34 is probably present as a single copy gene per haploid genome in C. albicans. We localized the CaVPS34 gene on chromosome 1. Under all conditions tested a major CaVPS34 transcript of approximately 3. 5 kb could be detected. CaVPS34 mRNA levels increased during exponential growth up to 12-fold followed by a decline upon entry into stationary phase. The size of a 6xHis tag-CaVps34p fusion protein purified from Escherichia coli is in agreement with the calculated molecular mass of CaVps34p. It exhibits in vitro PI 3-kinase activity and produces only phosphatidylinositol 3-phosphate. The CaVPS34 gene under the control of its own promoter were not able to complement the temperature-sensitive growth of S. cerevisiae vps34. However, overexpression of CaVPS34 was sufficient to rescue the temperature-sensitive vps34 phenotype, suggesting a functional conservation in C. albicans.

Cloning of a centromere binding factor 3d (CBF3D) gene from Candida glabrata.

The gene encoding centromere binding factor 3d (CBF3D) of the human pathogenic yeast Candida glabrata has been isolated by hybridization of Saccharomyces cerevisiae CBF3D (ScCBF3D) DNA to a C. glabrata partial genomic library. Sequence analysis revealed a 540 bp open reading frame encoding a protein of 179 amino acids with a calculated molecular mass of 20.9 kDa. The amino acid sequence is highly homologous (78.6% identity) to ScCbf3d and 48.3% identical to the human homologue p19 (SKP1). Southern blot analysis indicates that CgCbf3d is encoded by an unique nuclear gene. The cloned CgCBF3D gene can functionally substitute the S. cerevisiae homologue in a S. cerevisiae CBF3D-deletion mutant. The GenBank Accession No. for this gene is AF 072472.

Identification of a gene encoding the pyruvate decarboxylase gene regulator CaPdc2p from Candida albicans.

In a screen for Candida albicans genes encoding transactivating proteins, a pyruvate decarboxylase (EC 4.1.1.1.) regulator gene was isolated. An open reading frame (ORF) of 2511 bp was identified encoding a predicted protein of 836 amino acids with a molecular weight of 94.4 kDa. The protein showed glutamine- and proline-rich stretches typical for transcriptional activators. The amino acid sequence comparisons between CaPdc2p of C. albicans and both Pdc2p of Saccharomyces cerevisiae and Rag3p of Kluyveromyces lactis, revealed similarities of 40% and 39%, respectively. The CaPDC2 gene was localized on chromosome 1. Southern blot analysis indicated that CaPDC2 might be a single copy gene. The growth defect of a S. cerevisiae pdc2 delta mutant on glucose was compensated by transformation of the C. albicans CaPDC2 gene.

[Digoxin content in blood lipids of children, athletes, sports ground attendants and residents after content with dioxin-containing surface slag (Kieselrot)]. / Dioxingehalte im Blutfett von Kindern, Sportlern, Platzwarten und Anwohnern nach Kontakt mit dioxinhaltigen Tennenflächen (Kieselrot).

In 1991 it was discovered, that a large number of sporting grounds and playgrounds in Germany were covered with a waste slag material from a former copper smelter located at Marsberg, Germany. This material was found to contain high levels of PCDD/F ranging up to 100,000 TE/kg. The objective of the present study was to assess whether subjects sporting on such grounds had elevated levels of PCDD/F in blood. PCDD/F in blood fat was used as an indicator of the PCDD/F body burden. Additionally, six children and seven residents of a contaminated sporting and playground were examined. Generally, the levels of PCDD/F in blood fat were in the range of background levels in all subjects. Taking into account the effect of age, slightly elevated blood levels of PCDD/F were detected in children. The results show that the bioavailability of PCDD/F in the slag material is very low. However, from the preventive point of view children who might ingest slag material by hand-to-mouth-activities, should not play on such contaminated playgrounds.

Cloning and characterization of a gene coding for the catechol 1,2-dioxygenase of Arthrobacter sp. mA3.

The catA gene, coding for the catechol 1,2-dioxygenase (C12O) of the bacterial strain Arthrobacter sp. mA3, was cloned and expressed in Escherichia coli. One plasmid containing a 6.1-kb EcoRI insert was selected by its ability to degrade catechol and to accumulate cis-cis-muconate. The DNA insert of this plasmid was mapped with restriction enzymes. The catA gene was subcloned on a 1.3-kb PstI-EcoRI fragment by deleting the adjacent restriction fragments. The nucleotide sequence of catA was determined. The C12O is coded for by a gene spanning 849 nucleotides and the deduced M(r) of the protein is 30,560. The polypeptide encoded by the cloned catA gene was expressed in an E. coli minicell system and detected by gel electrophoresis.

Selection of fat-equivalent materials in postprocessing dual-energy quantitative CT.

Postprocessing dual-energy QCT is supposed to be able to predict the bone mineral more accurately than single-energy QCT. In addition, the fat content in the vertebral body can be determined. To this aim, some methods include fat-equivalent materials in the calibration device. However, the choice of an appropriate fat-equivalent material is difficult. To solve this selection problem, a method has been developed in which the x-ray interactions of tissue are characterized by three energy-independent parameters. For five different known constituents of anatomical fat, fat-equivalent materials are evaluated. It is shown that it is not possible to find one fat-equivalent material for all anatomical fat compositions. For this reason, the influence of a mismatch between the characterization parameters of anatomical fat compositions and fat-equivalent materials has been evaluated. It is shown that a mismatch in tissue characterization parameters can result in deviations of 10% in the bone mineral content and more than 300% in the estimated fat contents.

Police evaluation research: an experimental and cost-benefit analysis of a helicopter patrol in a high crime area.

The significance of a helicopter patrol procedure directed toward prevention of home burglaries was evaluated from experimental and cost-benefit perspectives. The helicopter patrolled one city zone from 9 a.m. to 5 p.m. for two 12-day periods. Each 12-day period was separated by a baseline period in which only normal patrol-car levels were maintained. Significantly reduced burglary levels during the intervention periods, compared to baseline periods, documented the experimental significance of the helicopter procedure. The cash costs of implementing the patrol procedure were compared to two estimates of the resulting cash benefits. This latter cost-benefit analysis was supplemented by a discussion of the intangible costs and benefits of the helicopter procedure. Taken together, these analyses documented that the marginal costs of the helicopter intervention were exceeded by all estimates of benefits.

Venus: atmospheric evolution.

Because of the high temperatures prevailing in the lower atmosphere of Venus, its chemistry is dominated by the tendency toward thermodynamic equilibrium. From the atomic composition deduced spectroscopically, the thermodynamic equilibrium composition of the atmosphere of Venus is computed, and the following conclusions drawn. (i) There can be no free carbon, hydrocarbons, formaldehyde, or any other organic molecule present in more than trace amounts. (ii) The original atomic composition of the atmosphere must have included much larger quantities of hydrogen and a carbon/oxygen ratio