Narrow-spectrum ß-lactam monotherapy in hospital treatment of community-acquired pneumonia: a register-based cohort study.

OBJECTIVES: To assess the clinical effect of empirical treatment with narrow-spectrum ß-lactam monotherapy (NSBM) versus broad-spectrum ß-lactam monotherapy (BSBM) in non-severe community-acquired pneumonia (CAP). METHODS: Hospitalized patients ≥18 years with CAP who received initial NSBM or BSBM, with a severity score according to CRB-65≤2 (C=confusion, R=respiratory rate >30/min, B=systolic blood pressure <90 mmHg or diastolic blood pressure ≤60 mmHg, 65= ≥65 years), in the Swedish Pneumonia Register from 2008 to 2011 were included. Primary outcome was 30-day mortality. Secondary outcomes were 90-day mortality, treatment at intensive care unit (ICU), and length of stay (LOS). Propensity score matching was performed to account for differences in baseline characteristics. RESULTS: There were 5961 patients with CRB-65≤1 and 1344 patients with CRB-65=2. In the propensity score matched cohorts the 30-day mortality was 40/1827 (2.2%) with NSBM and 56/1827 (3.1%) with BSBM in CRB-65≤1, and 57/524 (10.9%) and 51/524 (9.7%), respectively, in CRB-65=2. No significant differences in 30-day mortality were observed between NSBM and BSBM in patients with CRB-65≤1 or CRB-65=2, OR 1.41 (95% CI 0.94-2.14) and 0.88 (95% CI 0.59-1.32), respectively. There was no significant difference in 90-day mortality. Patients who received BSBM were more often treated at ICU and had longer LOS. CONCLUSIONS: Empirical NSBM appears to be effective in the majority of hospitalized immunocompetent adults with non-severe CAP and should be further evaluated in randomized trials.

Effect of different exercise protocols on histone acetyltransferases and histone deacetylases activities in rat hippocampus.

Regular and moderate exercise has been considered an interesting neuroprotective strategy. Although the mechanisms by which physical exercise alters brain function are not clear, it appears that neuroprotective properties of exercise could be related to chromatin remodeling, specifically the induction of histone acetylation through modulation of histone deacetylases (HDAC) and histone acetyltransferases (HAT) activities. The aim of the present work was to investigate the effect of exercise on HDAC and HAT activities in rat whole hippocampus at different times after treadmill. Adult male Wistar rats were assigned to non-exercised (sedentary) and exercised groups on different protocols: a single session of treadmill exercise (running for 20 min) and a chronic treadmill protocol (running once daily for 20 min, for 2 weeks). The effects of exercise on HDAC and HAT activities were measured immediately, 1 h and 18 h after the single session or the last training session of chronic treadmill exercise using specific assay kits. The single session of treadmill exercise reduced HDAC activity, increased HAT activity and increased the HAT/HDAC balance in rat hippocampus immediately and 1 h after exercise, an indicative of histone hyperacetylation status. The acetylation balance was also influenced by the circadian rhythm, since the HAT/HDAC ratio was significantly decreased in the early morning in all groups when compared to the afternoon. These data support the hypothesis that exercise neuroprotective effects may be related, at least in part, to acetylation levels through modulation of HAT and HDAC activities. We also demonstrated circadian changes in the HAT and HDAC activities and, consequently, in the acetylation levels.

Transthoracic fine-needle aspiration in the aetiological diagnosis of community-acquired pneumonia.

To investigate the safety and practicability of conducting transthoracic fine-needle aspiration (TFNA) in a general hospital setting, we applied the TFNA procedure to 20 patients hospitalized with community-acquired pneumonia (CAP) within 36 h of admission. Also, a preliminary assessment was made of the potential value of adding TFNA to conventional methods of diagnostic microbiology. TFNA was easy to perform and caused little discomfort, and no serious adverse events were observed. In spite of ongoing antimicrobial treatment, a likely aetiological diagnosis was established for 14 of 20 (70%) of the patients. TFNA may provide important additional information on the aetiology of CAP.

The complex refractive index of atmospheric and model humic-like substances (HULIS) retrieved by a cavity ring down aerosol spectrometer (CRD-AS).

Atmospheric aerosols absorb and reflect solar radiation causing surface cooling and heating of the atmosphere. The interaction between aerosols and radiation depends on their complex index of refraction, which is related to the particles' chemical composition. The contribution of light absorbing organic compounds, such as HUmic-LIke Substances (HULIS) to aerosol scattering and absorption is among the largest uncertainties in assessing the direct effect of aerosols on climate. Using a Cavity Ring Down Aerosol Spectrometer (CRD-AS), the complex index of refraction of aerosols containing HULIS extracted from pollution, smoke, and rural continental aerosols, and molecular weight-fractionated fulvic acid was measured at 390 nm and 532 nm. The imaginary part of the refractive index (absorption) substantially increases towards the UV range with increasing molecular weight and aromaticity. At both wavelengths, HULIS extracted from pollution and smoke particles absorb more than HULIS from the rural aerosol. Sensitivity calculations for a pollution-type aerosol containing ammonium sulfate, organic carbon (HULIS), and soot suggests that accounting for absorption by HULIS leads in most cases to a significant decrease in the single scattering albedo and to a significant increase in aerosol radiative forcing efficiency, towards more atmospheric absorption and heating. This indicates that HULIS in biomass smoke and pollution aerosols, in addition to black carbon, can contribute significantly to light absorption in the ultraviolet and visible spectral regions.

Prognostic score systems and community-acquired bacteraemic pneumococcal pneumonia.

The aim of this study was to evaluate the accuracy of three score systems: the pneumonia severity index (PSI); CURB-65 (confusion; urea >7 mM; respiratory rate > or =30 breaths x min(-1); blood pressure <90 mmHg systolic or < or =60 mmHg diastolic; aged > or =65 yrs old); and modified American Thoracic Society rule for predicting intensive care unit (ICU) need and mortality due to bacteraemic pneumococcal pneumonia. All adult patients (n = 114) with invasive pneumococcal pneumonia at the Karolinska University Hospital, Sweden, 1999-2000, were included in the study. Severity scores were calculated and the independent prognostic importance of different variables was analysed by multiple regression analyses. PSI > or = IV, CURB-65 > or = 2, and the presence of one major or more than one minor risk factor in mATS all had a high sensitivity, but somewhat lower specificity for predicting death and ICU need. The death rate was 12% (13 out of 114). Severity score and treatment in departments other than the Dept of Infectious Diseases were the only factors independently correlated to death. Patients treated in other departments more often had severe underlying illnesses and were more severely ill on admission. However, a significant difference in death rates remained after adjustment for severity between the two groups. In conclusion, all score systems were useful for predicting the need for intensive care unit treatment and death due to bacteremic pneumococcal pneumonia. The pneumonia severity index was the most sensitive, but CURB-65 was easier to use.

Clonal and capsular types decide whether pneumococci will act as a primary or opportunistic pathogen.

BACKGROUND: Streptococcus pneumoniae is a major cause of morbidity and mortality worldwide. The role of the different capsular and clonal types in invasive disease severity remains to be defined. METHODS: Disease severity and disease type were correlated to age, underlying disease, capsular serotype, and clonal type of the causative agent for 494 adult patients with invasive pneumococcal disease. RESULTS: Pneumococcal isolates of serotypes 1 and 7F were genetically homogenous, had the highest potential to infect previously healthy individuals, and were not causing deaths. Also, type 1 isolates were only found among younger adults, whereas other serotypes were mainly found among elderly persons (e.g., type 23F). Some serotypes and/or clones were more prone to cause more-severe disease, as observed by high APACHE II scores calculated at admission, and were also associated with a high mortality (e.g., clones of type 3 and 11A). We found no evidence of an impact of penicillin resistance on disease severity and disease type. CONCLUSIONS: We suggest that clones with capsular types 1 and 7F, which are known to have a high invasive disease potential, behave as primary pathogens, whereas clones with other capsular types with a lower relative risk of causing invasive disease are more opportunistic, primarily affecting patients with underlying disease. Disease caused by the latter group, however, was more severe, even in previously healthy individuals.

Tiazofurin is phosphorylated by three enzymes from Chinese hamster ovary cells.

The growth inhibitory activity of tiazofurin toward adenosine kinase deficient Chinese hamster ovary (CHO) cells was partially reversed by the presence of nicotinamide riboside. Similarly, the formation of tiazofurin 5'-monophosphate and the active metabolite, tiazofurin 5'-adenine dinucleotide could be partially inhibited by 100 microM nicotinamide riboside in CHO cells and substantially inhibited (80-90%) in adenosine kinase deficient cells. Tiazofurin phosphorylating activity from CHO cell extracts was resolved into two peaks by DEAE-cellulose chromatography. The first peak of activity was identified as adenosine kinase (ATP:adenosine 5'-phosphotransferase, EC 2.7.1.20). The second peak of activity correlated with a previously described 3-deazaguanosine phosphorylating activity that was identified as a nicotinamide ribonucleoside kinase. Contaminating purine nucleoside phosphorylase was removed by sedimentation through a sucrose density gradient which also resolved the tiazofurin phosphorylating activity into two peaks, one requiring just ATP and the other requiring both ATP and IMP. Of the substrates tested with the lower density peak, nicotinamide riboside was most efficient and was the only natural substance that competed well with tiazofurin for phosphorylation, substantiating its suggested identity as a nicotinamide ribonucleoside kinase. The apparent Km value for nicotinamide riboside (2 microM) was significantly less than that for tiazofurin (13.6 microM). ATP was the best phosphate donor; CTP and UTP were utilized less efficiently and IMP did not support the reaction. The best substrate for the higher density peak of tiazofurin phosphorylation was inosine and both ATP and IMP were required for the reaction, suggesting its identity as a 5'-nucleotidase. In summary, it appears that adenosine kinase, nicotinamide ribonucleoside kinase, and 5'-nucleotidase may all contribute to the phosphorylation of tiazofurin in CHO cells.

Phosphorylation of 3-deazaguanosine by nicotinamide riboside kinase in Chinese hamster ovary cells.

The growth inhibitory activity of 3-deazaguanosine toward a mutant line (TGR-3) of Chinese hamster ovary cells deficient in hypoxanthine-guanine phosphoribosyltransferase (EC 2.4.2.8) was substantially reversed by the simultaneous addition of nicotinamide riboside. The activities of most other ribonucleoside analogues tested were unaffected. The formation of cellular 3-deazaGMP and 3-deazaGTP from the ribonucleoside analogue, as measured by high-pressure liquid chromatography, was inhibited by the presence of nicotinamide riboside. The inhibition was dependent on concentration of 3-deazaguanosine and could also be demonstrated by following the metabolism of 3-deazaguanosine, labeled with 14C in the ribose moiety, to [14C]3-deazaGTP. In the presence of 100 microM nicotinamide riboside formation of the labeled triphosphate derivative of 3-deazaguanosine was undetectable. A 3-deazaguanosine phosphorylating activity was separated from other cellular kinases by DEAE-cellulose chromatography. Contaminating purine nucleoside phosphorylase (EC 2.4.2.1) was subsequently removed by sucrose density gradient centrifugation. The resulting enzyme preparation demonstrated the greatest activities with nicotinamide riboside and 3-deazaguanosine and, in addition, could also phosphorylate tiazofurin and guanosine to lesser, but significant, degrees. These and other observations suggest that 3-deazaguanosine, and perhaps other agents such as tiazofurin, may, at least in part, be phosphorylated by a nicotinamide ribonucleoside kinase in these cells. If so, it is possible that the activity of this agent in other types of cells in vivo could be dependent upon the presence of this enzyme and that it could be influenced by cellular concentrations of the natural pyridine nucleoside.

Use of tiazofurin to enhance the metabolism and cytotoxic activities of analogues of guanine, guanosine, and deoxyguanosine.

An effective modulator of cellular guanine nucleotide pools, 2-beta-D-ribofuranosylthiazole-4-carboxamide (tiazofurin) was tested for its ability to affect utilization of certain guanine, guanosine, and deoxyguanosine analogues by Chinese hamster ovary cells and hypoxanthine guanine phosphoribosyltransferase (HGPRTase)-deficient variants. The nucleoside analogues investigated were chosen for their potential to be metabolized to the nucleotide level by pathways other than those requiring the action of HGPRTase. Exposure of tiazofurin-treated (500 microM for 3 h) cells to 3-deazaguanosine (200 microM for 3 h) resulted in enhanced 3-deazaGTP formation and an increase (5-10-fold) in the ratio 3-deazaGTP/GTP. Tiazofurin treatment also stimulated [3H]deoxyguanosine utilization (8-fold) by HGPRTase-deficient cells, and accordingly, greatly increased the cytotoxicity of 2'-deoxy-3-deazaguanosine and arabinosylguanine. This study emphasizes the potential usefulness of tiazofurin in sequential combination with appropriate analogues of guanosine and deoxyguanosine in a clinical setting and as a tool in studying the metabolism of these agents.

3-Deazaguanosine is metabolized to the triphosphate derivative in Chinese hamster cells deficient in hypoxanthine-guanine phosphoribosyltransferase.

3-Deazaguanosine containing a 14C label in the ribose moiety was prepared using [U-14C]inosine as the [14C] ribose donor and commercial purine-nucleoside phosphorylase (EC 2.4.2.1) both to degrade the inosine, in the presence of phosphate, and to synthesize [14C-ribosyl]3-deazaguanosine in reduced phosphate and an excess of 3-deazaguanine. Purification was by high-pressure liquid chromatography (HPLC). [14C-ribosyl]3-Deazaguanosine was metabolized by Chinese hamster ovary cells to two metabolites, one major and one minor, eluting in the triphosphate region after HPLC analysis, and appeared to be incorporated into perchloric acid-insoluble material. Cell line TGR-3, deficient in hypoxanthine-guanine phosphoribosyltransferase (EC 2.4.2.8) and resistant to 3-deazaguanine, also formed both metabolites. Line TGR-1/DGRR-9, deficient in hypoxanthine-guanine phosphoribosyltransferase and resistant to both 3-deazaguanine and 3-deazaguanosine, formed greatly reduced levels of the major metabolite. 3-Deazaguanosine 5'-triphosphate, prepared enzymically from authentic 3-deazaguanosine 5'-monophosphate, co-eluted with the major metabolite peak during HPLC analysis. Treatment of a metabolite-containing extract with bacterial alkaline phosphatase (EC 3.1.3.1) resulted in the formation of 3-deazaguanosine. These observations indicate that 3-deazaguanosine can be metabolized, in Chinese hamster ovary cells, to the triphosphate derivative in lieu of the action of hypoxanthine-guanine phosphoribosyltransferase.

Characteristics of magnesium-adenosine triphosphate-dependent inactivators of 3-hydroxy-3-methylglutaryl coenzyme A reductase.

The inhibition of homogeneous 3-hydroxy-3-methyl-glutaryl coenzyme A reductase by MgATP-dependent inactivators isolated from rat liver cytosol and microsomes was examined. The inhibition was independent of incubation time. The inhibition was readily reversed by dilution or dialysis, by the addition of EDTA, and by incubating the inhibited enzyme with glycerol and glycerol kinase to convert the ATP to ADP. The inactivated enzyme was not reactivated by various phosphatases. When inactivated in the presence of [gamma-32P]ATP, no radioactivity was incorporated into the reductase. These observations indicate that the inactivators do not exert their effects through covalent modification of the reductase.