Functional Characterization of Endo- and Exo-Hydrolase Genes in Arabinan Degradation Gene Cluster of Bifidobacterium longum subsp. suis.

Bifidobacteria are probiotic microorganisms commonly found in the gastrointestinal tract, some of which are known to utilize linear arabino-oligosaccharides (AOS) as prebiotic carbohydrates. In general, the synergistic actions of exo-type α-l-arabinofuranosidases (ABFs) and endo-α-1,5-l-arabinanases (ABNs) are required for efficient arabinan degradation. In this study, the putative gene cluster for arabinan degradation was discovered in the genome of Bifidobacterium longum subsp. suis. It consists of a variety of genes encoding exo- and endo-hydrolases, sugar-binding proteins, ABC-binding cassettes, and transcriptional regulators. Among them, two endo-ABNs GH43 (BflsABN43A and BflsABN43B), two exo-ABFs GH43 (BflsABF43A and BflsABF43B), and an exo-ABF GH51 (BflsABF51) were predicted to be the key hydrolases for arabinan degradation. These hydrolase genes were functionally expressed in Escherichia coli, and their enzymatic properties were characterized. Their synergism in arabinan degradation has been proposed from the detailed modes of action. Extracellular endo-BflsABN43A hydrolyzes sugar beet and debranched arabinans into the short-chain branched and linear AOS. Intracellularly, AOS can be further degraded into l-arabinose via the cooperative actions of endo-BflsABN43B, exo-BflsABF43A with debranching activity, α-1,5-linkage-specific exo-BflsABF43B, and exo-BflsABF51 with dual activities. The resulting l-arabinose is expected to be metabolized into energy through the pentose phosphate pathway by three enzymes expressed from the ara operon of bifidobacteria. It is anticipated that uncovering arabinan utilization gene clusters and their detailed functions in the genomes of diverse microorganisms will facilitate the development of customized synbiotics.

Immunoprotective Effect of Liver Allograft on Patients with Combined Liver and Kidney Transplantation.

BACKGROUND Simultaneous liver-kidney transplantation (SLKT) and kidney transplantation (KT) after liver transplantation (LT) provide potential treatment options for patients with end-stage liver and kidney disease. There is increasing attention being given to liver-kidney transplantation (LTKT), particularly regarding the immune-protective effects of the liver graft. This retrospective, single-center, observational study aimed to evaluate the clinical outcomes of KT in LTKT patients - either SLKT or KT after LT (KALT) - compared to KT alone (KTA). MATERIAL AND METHODS We included patients who underwent KT between January 2005 and December 2020, comprising a total of 4312 patients divided into KTA (n=4268) and LTKT (n=44) groups. The LTKT group included 11 SLKT and 33 KALT patients. To balance the difference in sample sizes between the 2 groups, we performed 3: 1 propensity score matching (PSM). RESULTS There was no significant difference in graft survival between the groups. However, the LTKT group exhibited significantly superior rejection-free survival compared to the KTA group (P.

Electrochemical oxidation and mechanism of sulfanilamide from groundwater in a flow-through system using carbon fiber (CF) anode.

Metal-based anodes have been used for a long time in the electrochemical oxidation processes to remediate groundwater. However, the high cost of this technique as well as the release of potentially toxic metals (ex, lead), are major barriers being fully implemented. As an alternative of metal-based anodes, in recent years, carbon-based anodes have been paid attention due to their eco-friendliness and cost-effectiveness. This study evaluated the oxidation performance of carbon fiber (CF) anode in a flow-through system. The CF anode degraded 45-87% of the target pollutant (sulfanilamide), depending on the current intensity applied. However, no further degradation of sulfanilamide was observed after the cathode, indicating that sulfanilamide degradation occurred mainly at the anode. This study also determined the effect of electrolytes on electrochemical oxidation using chloride (Cl-), sulfate (SO42-), bicarbonate (CO3-), and synthetic groundwater. Cl- and SO42- electrolytes were converted electrochemically into active species, thereby enhancing sulfanilamide degradation, while the bicarbonate and groundwater electrolytes inhibited oxidation performance by scavenging hydroxyl radicals. A series of scavenger tests and characterization showed that the direct oxidation and hydroxyl radicals involved the sulfanilamide degradation. Especially, the production of hydroxyl radicals is more favorable in high currents than in low currents. That is, CF anode contributed to the degradation by direct oxidation of carbon-based electrodes and generation of hydroxyl radicals. In summary, this study highlights how a CF anode is capable of effectively degrading organic pollutants via anodic oxidation.

Effect of 5% albumin on endothelial glycocalyx degradation during off-pump coronary artery bypass.

PURPOSE: The integrity of the endothelial glycocalyx (EG), a critical player in vascular homeostasis, reportedly influences the outcomes of critically ill patients. We investigated the effect of 5% albumin, which preserved EG integrity in preclinical studies, vs balanced crystalloid solution on EG degradation in patients undergoing off-pump coronary surgery. METHODS: Patients were randomized to receive either 5% albumin (N = 51) or balanced crystalloid solution (Plasma-Lyte [Baxter Incorporated, Seoul, Republic of Korea]; N = 53) for intravenous volume replacement during surgery (double-blinded). The primary outcome was plasma syndecan-1 concentration, a marker of EG degradation, measured after anesthetic induction (baseline), completion of grafting, and sternal closure. Secondary outcomes were atrial natriuretic peptide (ANP), tumour necrosis factor (TNF)-α, soluble thrombomodulin, and perioperative fluid balance. RESULTS: The mean (standard deviation) fluid requirements were 833 (270) mL and 1,323 (492) mL in the albumin and Plasma-Lyte group, respectively (mean difference, -489 mL; 95% confidence interval [CI], -643 to -335; P < 0.001). Plasma syndecan-1 concentration increased after completion of grafting (median difference, 116 ng·mL-1; 95% CI, 67 to 184; P < 0.001) and sternal closure (median difference, 57 ng·mL-1; 95% CI, 36 to 80; P < 0.001) compared with those at baseline, without any intergroup differences. Atrial natriuretic peptide, TNF-α, and soluble thrombomodulin concentrations were similar between the two groups. The amount of chest tube drainage was greater in the albumin group than that in the Plasma-Lyte group (median difference, 190 mL; 95% CI, 18 to 276; P = 0.03). CONCLUSION: Off-pump coronary surgery was associated with significant EG degradation. Yet, intraoperative fluid therapy with 5% albumin could not ameliorate EG degradation when compared with balanced crystalloid solution. TRIAL REGISTRATION: ClinicalTrials.gov (NCT03699462); first posted 9 October 2018.

RéSUMé: OBJECTIF: L'intégrité du glycocalyx endothélial (GE), un acteur essentiel de l'homéostasie vasculaire, influencerait le devenir des patient·es gravement malades. Nous avons étudié l'effet de l'albumine à 5 %, qui préservait l'intégrité du GE dans les études précliniques, par rapport à une solution cristalloïde équilibrée sur la dégradation du GE chez les patient·es bénéficiant d'une chirurgie coronarienne à cœur battant. MéTHODE: Les patient·es ont été randomisé·es à recevoir soit de l'albumine à 5 % (N = 51) ou de la solution cristalloïde équilibrée (Plasma-Lyte [Baxter Incorporated, Séoul, République de Corée]; N = 53) pour le remplacement du volume intraveineux pendant la chirurgie (en double aveugle). Le critère d'évaluation principal était la concentration plasmatique de syndécan-1, un marqueur de la dégradation du GE, mesurée après l'induction de l'anesthésie (ligne de base), la fin de la greffe et la fermeture du sternum. Les critères d'évaluation secondaires étaient le peptide natriurétique auriculaire (ANP), le facteur de nécrose tumorale (TNF)-α, la thrombomoduline soluble et le bilan hydrique périopératoire. RéSULTATS: Les besoins liquidiens moyens (écart type) étaient de 833 (270) mL et 1323 (492) mL dans les groupes albumine et Plasma-Lyte, respectivement (différence moyenne, −489 mL; intervalle de confiance [IC] à 95 %, −643 à −335; P < 0,001). La concentration plasmatique de syndécan-1 a augmenté après la fin de la greffe (différence médiane, 116 ng·mL−1; IC 95 %, 67 à 184; P < 0,001) et la fermeture du sternum (différence médiane, 57 ng·mL−1; IC 95 %, 36 à 80; P < 0,001) par rapport aux concentrations au départ, sans différences intergroupe. Les concentrations de peptide natriurétique auriculaire, de TNF-α et de thrombomoduline soluble étaient similaires entre les deux groupes. La quantité de drainage du drain thoracique était plus importante dans le groupe albumine que dans le groupe Plasma-Lyte (différence médiane, 190 mL; IC 95 %, 18 à 276; P = 0,03). CONCLUSION: La chirurgie coronarienne à cœur battant a été associée à une dégradation significative du glycocalyx endothélial. Pourtant, la fluidothérapie peropératoire avec 5 % d'albumine n'a pas pu améliorer la dégradation du GE par rapport à une solution cristalloïde équilibrée. ENREGISTREMENT DE L'éTUDE: ClinicalTrials.gov (NCT03699462); enregistrée pour la première fois le 9 octobre 2018.

Effects of intraoperative inspired oxygen fraction (FiO2 0.3 vs 0.8) on patients undergoing off-pump coronary artery bypass grafting: the CARROT multicenter, cluster-randomized trial.

BACKGROUND: To maintain adequate oxygenation is of utmost importance in intraoperative care. However, clinical evidence supporting specific oxygen levels in distinct surgical settings is lacking. This study aimed to compare the effects of 30% and 80% oxygen in off-pump coronary artery bypass grafting (OPCAB). METHODS: This multicenter trial was conducted in three tertiary hospitals from August 2019 to August 2021. Patients undergoing OPCAB were cluster-randomized to receive either 30% or 80% oxygen intraoperatively, based on the month when the surgery was performed. The primary endpoint was the length of hospital stay. Intraoperative hemodynamic data were also compared. RESULTS: A total of 414 patients were cluster-randomized. Length of hospital stay was not different in the 30% oxygen group compared to the 80% oxygen group (median, 7.0 days vs 7.0 days; the sub-distribution hazard ratio, 0.98; 95% confidence interval [CI] 0.83-1.16; P = 0.808). The incidence of postoperative acute kidney injury was significantly higher in the 30% oxygen group than in the 80% oxygen group (30.7% vs 19.4%; odds ratio, 1.94; 95% CI 1.18-3.17; P = 0.036). Intraoperative time-weighted average mixed venous oxygen saturation was significantly higher in the 80% oxygen group (74% vs 64%; P < 0.001). The 80% oxygen group also had a significantly greater intraoperative time-weighted average cerebral regional oxygen saturation than the 30% oxygen group (56% vs 52%; P = 0.002). CONCLUSIONS: In patients undergoing OPCAB, intraoperative administration of 80% oxygen did not decrease the length of hospital stay, compared to 30% oxygen, but may reduce postoperative acute kidney injury. Moreover, compared to 30% oxygen, intraoperative use of 80% oxygen improved oxygen delivery in patients undergoing OPCAB. Trial registration ClinicalTrials.gov (NCT03945565; April 8, 2019).

Novel electrochemical method to activate biochar derived from spent coffee grounds for enhanced adsorption of lead (Pb).

Biochar (BC) has received much attention as a promising adsorbent that can be exploited to remove heavy metals in domestic and wastewater. The adsorption capacity of BC is, however, relatively low compared to that of conventional adsorbents, and its performance is inversely proportional to its stability. Various chemical and physical methods have been tried to address these limitations, but BC activation still generates too much acidic or alkaline wastewater. Here we propose a novel electrochemical method and compare its lead (Pb) adsorption capacity to that of acid- and alkaline-based approaches. We found that electrochemical activation significantly increased the number of hydroxyl and carboxylic groups on the BC surface, which led to an increase in Pb absorption from 27 % (pristine BC) to 100 % because the oxygenated-functional groups contributed to the adsorption of Pb. Pb capacity was 1.36, 2.64, 3.31, and 5.00 mg g-1, corresponding to pristine, acidic, alkaline, and electrochemical activation, respectively. The Pb absorption capacity of electrochemically activated BC was also higher than that of acid- and alkali-activated BC, which we attribute to the observed increases in oxygen ratio and surface area. Moreover, the adsorption rate of BC after electrochemical activation was 190 times faster and its capacity was 2.4 times higher than that of pristine BC. These findings show that the electrochemical activation of BC results in greater adsorption capacity than conventional methods.

Mitigation of arsenic release by calcium peroxide (CaO2) and rice straw biochar in paddy soil.

Biochar has a great potential in the stabilization of soil heavy metals; however, the application can actually enhance the mobility of Arsenic (As) in soil. Here, a biochar-coupled calcium peroxide system was proposed to control the increase in As mobility caused by biochar amendment in paddy soil environment. The capability of rice straw biochar pyrolyzed at 500 °C (RB) and CaO2 to control As mobility was evaluated by incubation for 91 days. CaO2 encapsulation was performed for pH control of CaO2, and As mobility was evaluated using a mixture of RB + CaO2 powder (CaO2-p), and RB + CaO2 bead (CaO2-b), respectively. The control soil solely and RB alone were included for comparison. The combination of RB with CaO2 exhibited remarkable performance in controlling As mobility in soil, and As mobility decreased by 40.2% (RB + CaO2-p) and 58.9% (RB + CaO2-b) compared to RB alone. The result was due to high dissolved oxygen (6 mg L-1 in RB + CaO2-p and RB + CaO2-b) and calcium concentrations (296.3 mg L-1 in RB + CaO2-b); oxygen (O2) and Ca2+ derived from CaO2 is able to prevent the reductive dissolution and chelate-promoted dissolution of As bound to iron (Fe) oxide by biochar. This study revealed that the simultaneous application of CaO2 and biochar could be a promising way to mitigate the environmental risk of As.

Enhancing adoptive T-cell therapy with fucoidan-based IL-2 delivery microcapsules.

Adoptive cell therapy (ACT) with antigen-specific T cells is a promising treatment approach for solid cancers. Interleukin-2 (IL-2) has been utilized in boosting the efficacy of ACT. However, the clinical applications of IL-2 in combination with ACT is greatly limited by short exposure and high toxicities. Herein, a complex coacervate was designed to intratumorally deliver IL-2 in a sustained manner and protect against proteolysis. The complex coacervate consisted of fucoidan, a specific IL-2 binding glycosaminoglycan, and poly-l-lysine, a cationic counterpart (FPC2). IL-2-laden FPC2 exhibited a preferential bioactivity in ex vivo expansion of CD8+T cells over Treg cells. Additionally, FPC2 was embedded in pH modulating injectable gel (FPC2-IG) to endure the acidic tumor microenvironment. A single intratumoral administration of FPC2-IG-IL-2 increased expansion of tumor-infiltrating cytotoxic lymphocytes and reduced frequencies of myeloid populations. Notably, the activation and persistency of tumor-reactive T cells were observed only in the tumor site, not in the spleen, confirming a localized effect of FPC2-IG-IL-2. The immune-favorable tumor microenvironment induced by FPC2-IG-IL-2 enabled adoptively transferred TCR-engineered T cells to effectively eradicate tumors. FPC2-IG delivery system is a promising strategy for T-cell-based immunotherapies.

Covalent immobilizing horseradish peroxidase on electrochemically-functionalized biochar for phenol removal.

Enzyme-based biocatalytic treatment has been known as an effective measure to biologically degrade organic pollutants. Advantageously, enzymes could be immobilized on solid supports, and such fact enables reuse/prolong the enzymatic capability. It could be of great importance to functionalize a support material for enhancing the immobilization efficiency/stability of enzymes. As such, this study laid great emphasis on covalent bonding to immobilize horseradish peroxidase (HRP) on a functionalized rice straw biochar with glutaraldehyde (GA) as a crosslinker. Biochar was pretreated by the electrochemical method and the acid treatment respectively to enrich the oxygen-containing functional groups. These led to the enhanced immobilizing ability of biochar. The HRP immobilized on the electrochemically-functionalized biochar (HRP-EBC) showed three times as much enzyme activity as the HRP directly adsorbed onto biochar. The HRP immobilized on the acid-functionalized biochar (HRP-ABC) showed activity similar to that of HRP-EBC. It was concluded that both the (acid/electrochemical) pretreatments are effective to enhance enzyme immobilization. Nevertheless, the electrochemical functionalized method of biochar is chemical oxidant-free, and one important lesson from a series of tests was that the pretreatment of biochar through the electrochemical method could be more environmentally benign. Moreover, employing HRP-EBC could be beneficial from a perspective of a real environmental practice considering its higher pH, thermal stability, and good reusability. 80% of phenol was degraded in 1 h in the presence of HRP-EBC when pH was 7.0 and a ratio of H2O2 to phenol was 1:1.5.

Remimazolam for General Anesthesia in a Patient with Severe Aortic Stenosis Undergoing High-Risk Surgery: A Case Report.

High-risk surgeries for patients with severe aortic stenosis (AS) are challenging for anesthesiologists and can result in hemodynamic deterioration and even mortality. We describe a case in which remimazolam was used to induce and maintain general anesthesia for a high-risk, noncardiac surgery accompanied by ongoing bleeding. An 86-year-old man with severe AS was scheduled to undergo proximal gastrectomy due to ongoing gastrointestinal bleeding and severe anemia. Remimazolam, a novel, ultra-short-acting benzodiazepine, was administered along with remifentanil for the induction and maintenance of general anesthesia. Throughout the anesthetic process, the patient's cardiac index and systemic vascular resistance were well preserved without any vasopressor support. Remimazolam seems to have possible effectiveness as a relatively safe agent for the induction and maintenance of general anesthesia in patients with severe AS who are undergoing high-risk, noncardiac surgery with bleeding.

Regulators impeding erythropoiesis following iron supplementation in a clinically relevant rat model of iron deficiency anemia with inflammation.

AIMS: While elevated hepcidin levels with inflammation have been postulated as a putative mechanism hindering effective erythropoiesis after intravenous (IV) iron therapy in anemic patients undergoing surgery, little is known about the concomitant changes in other major regulators affecting erythropoiesis. This study investigated the activities of relevant regulators after iron replenishment in a rat model of iron deficiency anemia with inflammation. MAIN METHODS: Inflammation was induced by administration of complete Freund's adjuvant (CFA) in male Sprague-Dawley rats. After 2 weeks of CFA treatment, the rats received IV iron (CFA­iron) or saline (CFA-saline). The control group received saline instead of CFA and iron (saline-saline). At 1, 3, and 10 days after iron or saline treatment, inflammatory cytokines, oxidative markers, iron profiles, hepcidin, erythropoietin (EPO), erythroferrone (ERFE), fibroblast growth factor 23 (FGF 23), and expression of mRNA and proteins in the liver involved in hepcidin signaling pathways were measured. KEY FINDINGS: CFA treatment and iron restriction decreased hemoglobin and serum iron levels, significantly increasing inflammatory and oxidative markers. Iron supplementation did not restore hemoglobin levels despite improved iron profiles. CFA injections increased hepcidin and FGF 23 levels and decreased EPO and ERFE levels, which further intensified after iron supplementation with concomitantly elevated levels of oxidative stress and inflammatory markers. SIGNIFICANCE: Under inflammatory conditions, IV iron administration exacerbated inflammatory and oxidative stress and did not resolve anemia, even under iron deficiency conditions. Iron therapy exerted adverse influences on the changes in key regulators toward impeding erythropoiesis that was already impeded by inflammation.

Mechanistic investigation into flow-through electrochemical oxidation of sulfanilamide for groundwater using a graphite anode.

The technical effectiveness/merit of electrochemical oxidation (EO) has been recognized. Nonetheless, its practical application to groundwater remediation has not been fully implemented due to several technical challenges. To overcome the technical incompleteness, this study adopted a graphite anode in the flow-through system and studied the mechanistic roles of a graphite anode. To this end, groundwater contaminated with sulfanilamide was remediated by means of EO, and sulfanilamide oxidation was quantitatively determined in this study. Approximately 60% of sulfanilamide was degraded at the anode zone, and such observation offered that the removal of sulfanilamide was not closely related with current variations (10-100 mA). However, this study delineated that sulfanilamide removal is contingent on the flow speed. For example, the removal of sulfanilamide was lowered from 59 to 25% owing to a short contact time when the flow velocity was increased from 0.14 to 0.55 cm/min. This study also delineated that a shorter anode-cathode distance could offer a favorable chance to enhance the removal of sulfanilamide even under an identical current. A shorter distance could offer a chance to save energy due to the lower voltage operation. This study also offered that chloride (Cl-) and sulfate (SO42-) electrolytes served a crucial role in the generation of active species. In contrast, bicarbonate (HCO3-) and synthetic groundwater electrolytes impeded the oxidation rate because HCO3- scavenged the other active species. In an effort to seek the oxidation mechanisms of a graphite anode, scavenger, cyclic voltammetry test, and electron https://en.wikipedia.org/wiki/Electron_paramagnetic_resonanceparamagnetic resonance (EPR) analysis were done. From a series of the tests, it was inferred that a graphite anode did not directly affect the generation of the active species. Thus, the prevalence of the oxygenated functional groups on an anode surface could be the main mechanism in sulfanilamide removal due to the enhanced electron transfer.

Control of arsenic release from paddy soils using alginate encapsulated calcium peroxide.

The mobilization of As in paddy soils is affected by iron redox cycles. In this regard, calcium peroxide (CaO2) can be used as an alternative to maintaining oxidizing conditions by liberating oxygen under flooding environments. Nevertheless, the problem of increase in pH by CaO2 dissolution remains unresolved. In this study, the encapsulation of CaO2 using alginate is proposed. Encapsulated CaO2 (CaO2-b) using 1% sodium alginate was applied to As-contaminated soil to evaluate the ability of pH control and As mobility during flooding conditions. The pH increased rapidly from 6.8 to 9.0 in unencapsulated CaO2 (CaO2-p) within 1 day, while CaO2-b increased slowly to 8.6 over 91 days. CaO2 created an oxidizing condition in the soil by providing oxygen, thus effectively prevented the reductive dissolution of iron. The mobility of As decreased by 50% (CaO2-p) and 83% (CaO2-b) compared with that of the control soil. Furthermore, the As in pore water was three times lower than CaO2-p because CaO2-b released 1.8 times more Ca2+ to form Ca-As complexes than CaO2-p. Consequently, the encapsulated CaO2 reduced the negative effects of CaO2 treatment on increasing pH of the soil and furnished a better environmental condition for inhibiting As mobility.

Simultaneous oxidation and analysis of TOC-TN-TP in one pot reactor.

Total organic carbon (TOC), total nitrogen (TN), and total phosphorous (TP) are the most common indicators of water quality. The analytical processes of the indicators require oxidation of any type of C, N, and P to carbon dioxide, nitrate, and phosphate as final products. Persulfate is the recommended oxidant for these transformations. In this study, co-oxidation was suggested for the simultaneous analysis of TOC-TN-TP. A single oxidizing reactor using persulfate was proposed instead of three individual systems. The system oxidizes complex organic chemicals to carbon dioxide, nitrate, and phosphate. However, the residual persulfate after oxidation interferes with the spectrophotometric analysis of nitrate and phosphate. Therefore, in the proposed system, the complete transformation of persulfate is a key factor for simultaneous analysis. In this system, ultraviolet irradiation for 30 min under alkaline conditions converted residual persulfate to sulfate. The complete transformation eliminated persulfate interference in nitrate and phosphate detection. In the proposed system with a single oxidation reactor, TOC, TN, and TP were oxidized and analyzed simultaneously within 15% of the analytical error range compared to the standard test method.

Effect of Perioperative Intravenous Iron Supplementation for Complex Cardiac Surgery on Transfusion Requirements: A Randomized, Double-blinded Placebo-controlled Trial.

OBJECTIVES: We investigated whether routine perioperative intravenous iron replenishment reduces the requirement for packed erythrocytes (pRBC) transfusion. SUMMARY OF BACKGROUND DATA: Patients undergoing complex cardiac surgery are at high risk of developing postoperative iron deficiency anemia, thus requiring transfusion, which is associated with adverse outcomes. METHODS: Patients were randomized to receive either ferric derisomaltose 20 mg/kg (n = 103) or placebo (n = 101) twice during the perioperative period: 3 days before and after the surgery. The primary endpoint was the proportion of patients who received pRBC transfusion until postoperative day (POD) 10. Hemoglobin, reticulocyte count, serum iron profile, hepcidin, and erythropoietin were serially measured. RESULTS: pRBC was transfused in 60.4% and 57.2% of patients in the control and iron group, respectively (P = 0.651). Hemoglobin concentration at 3 weeks postoperatively was higher in the iron group than in the control group (11.6 ± 1.5 g/dL vs 10.9 ± 1.4 g/dL, P < 0.001). The iron group showed higher reticulocyte count [205 (150-267)×103/µL vs 164 (122-207)×103/µL, P = 0.003] at POD 10. Transferrin saturation and serum ferritin were significantly increased in the iron group than in the control group (P < 0.001). Serum hepcidin was higher in the iron group than in the control group at POD 3 [106.3 (42.9-115.9) ng/mL vs 39.3 (33.3-43.6) ng/mL, P < 0.001]. Erythropoietin concentration increased postoperatively in both groups (P = 0.003), with no between-group difference. CONCLUSIONS: Intravenous iron supplementation during index hospitalization for complex cardiac surgery did not minimize pRBC transfusion despite replenished iron store and augmented erythropoiesis, which may be attributed to enhanced hepcidin expression.

Increased Carotid Intima-Media Thickness was not Associated With Cognitive Dysfunction After Off-Pump Coronary Surgery in Older Adult Patients Without Carotid Stenosis.

Increased carotid intima-media thickness (C-IMT), a marker of atherosclerosis, is known to be associated with cerebrovascular and cortical abnormalities and cognitive impairment. This prospective observational study investigated the association between increased C-IMT and postoperative cognitive dysfunction (POCD) in older adult patients undergoing off-pump coronary artery bypass surgery. A total of 201 patients (57 females, 144 males; >60 years) were classified into increased (n = 105) or normal (n = 96) C-IMT groups by a cut-off value of 0.9 mm (bilateral C-IMT mean). Cognitive function was serially assessed with the Korean Mini-Mental State Examination, and Korean Montreal Cognitive Assessment scores preoperatively and at 7 days and 3 months postoperatively. POCD was defined as the deterioration of 1 standard deviation in at least one of the postoperative tests compared with their corresponding baseline scores. Independent risk factors for POCD were evaluated using multivariable analysis. Overall, POCD occurred in 46 patients (23%) over the 3 months. The incidences of POCD at 7 days and 3 months after surgery were similar, and there was no difference in both Korean Mini-Mental State Examination and Korean Montreal Cognitive Assessment test scores before and after surgery between groups. Chronic obstructive lung disease and intraoperative hyperglycemia episodes (>180 mg/dL), but not increased C-IMT, were independent risk factors for POCD. Unlike in nonsurgical cohorts, increased C-IMT was not significantly associated with the occurrence of POCD in older adult patients undergoing off-pump coronary artery bypass surgery.

Changes in Hepcidin Levels in an Animal Model of Anemia of Chronic Inflammation: Mechanistic Insights Related to Iron Supplementation and Hepcidin Regulation.

We examined changes in hepcidin (closely associated with anemia of chronic inflammation (ACI)) and upstream regulatory pathways after intravenous (IV) iron supplementation in an ACI animal model. ACI was induced in male Sprague-Dawley rats by intraperitoneally administering complete Freund's adjuvant (CFA). Two weeks after starting CFA treatment, ACI rats received IV iron (CFA-iron) or vehicle (CFA-saline). Three days after IV iron treatment, iron profiles, hepcidin levels, and expression of proteins involved in the signaling pathways upstream of hepcidin transcription in the liver were measured. In CFA-treated rats, anemia with a concomitant increase in the levels of serum inflammatory cytokines and reactive oxygen species occurred. In CFA-iron rats, hemoglobin (Hb) concentration was still lower than that in control rats. In CFA-saline rats, hepatic hepcidin and ferritin levels increased compared with those in control rats and were further increased in CFA-iron rats. In CFA-saline rats, NADPH oxidase- (NOX-) 2, NOX-4, and superoxide dismutase levels in the liver were upregulated compared with those in control rats and their levels were further increased in CFA-iron rats. In CFA-saline rats, activities of the IL-6/STAT and BMP/SMAD pathways were enhanced in the liver compared with those in control rats and their levels were further increased in CFA-iron rats, whereas IL-6 expression remained unaffected after IV iron administration. In HepG2 cells, iron caused phosphorylation of STAT-3 and SMAD1/5 and knockdown of STAT-3 and SMAD1/5 using siRNAs reduced iron-induced hepcidin upregulation to levels similar to those in corresponding control cells. Renal erythropoietin expression and serum erythroferrone concentration were lower in CFA-iron rats than those in control rats. In ACI rats, IV iron supplementation did not recover Hb within three days despite an increase in hepatic ferritin levels, which might be attributable to an additional increase in hepcidin levels that was already upregulated under ACI conditions. Both STAT-3 phosphorylation and SMAD1/5 phosphorylation were associated with hepcidin upregulation after IV iron treatment, and this seems to be linked to iron-induced oxidative stress.

Effect of changes in inspired oxygen fraction on oxygen delivery during cardiac surgery: a substudy of the CARROT trial.

When hemoglobin (Hb) is fully saturated with oxygen, the additional gain in oxygen delivery (DO2) achieved by increasing the fraction of inspired oxygen (FiO2) is often considered clinically insignificant. In this study, we evaluated the change in DO2, interrogated by mixed venous oxygen saturation (SvO2), in response to a change in FiO2 of 0.5 during cardiac surgery. When patients were hemodynamically stable, FiO2 was alternated between 0.5 and 1.0 in on-pump cardiac surgery patients (pilot study), and between 0.3 and 0.8 in off-pump coronary artery bypass grafting patients (substudy of the CARROT trial). After the patient had stabilized, a blood gas analysis was performed to measure SvO2. The observed change in SvO2 (ΔSvO2) was compared to the expected ΔSvO2 calculated using Fick's equation. A total 106 changes in FiO2 (two changes per patient; total 53 patients; on-pump, n = 36; off-pump, n = 17) were finally analyzed. While Hb saturation remained near 100% (on-pump, 100%; off-pump, mean [SD] = 98.1% [1.5] when FiO2 was 0.3 and 99.9% [0.2] when FiO2 was 0.8), SvO2 changed significantly as FiO2 was changed (the first and second changes in on-pump, 7.7%p [3.8] and 7.6%p [3.5], respectively; off-pump, 7.9%p [4.9] and 6.2%p [3.9]; all P < 0.001). As a total, regardless of the surgery type, the observed ΔSvO2 after the FiO2 change of 0.5 was ≥ 5%p in 82 (77.4%) changes and ≥ 10%p in 31 (29.2%) changes (mean [SD], 7.5%p [3.9]). Hb concentration was not correlated with the observed ΔSvO2 (the first changes, r = - 0.06, P = 0.677; the second changes, r = - 0.21, P = 0.138). The mean (SD) residual ΔSvO2 (observed - expected ΔSvO2) was 0%p (4). Residual ΔSvO2 was more than 5%p in 14 (13.2%) changes and exceeded 10%p in 2 (1.9%) changes. Residual ΔSvO2 was greater in patients with chronic kidney disease than in those without (median [IQR], 5%p [0 to 7] vs. 0%p [- 3 to 2]; P = 0.049). DO2, interrogated by SvO2, may increase to a clinically significant degree as FiO2 is increased during cardiac surgery, and the increase of SvO2 is not related to Hb concentration. SvO2 increases more than expected in patients with chronic kidney disease. Increasing FiO2 can be used to increase DO2 during cardiac surgery.

Reduction of nitrate using biochar synthesized by Co-Pyrolyzing sawdust and iron oxide.

Nitrate is the most common contaminant in groundwater in Korea, as well as across the world. Reduction of nitrate to ammonia is one of the options available to remediate groundwater. In this study, nitrate in groundwater was removed using a zero-valent iron (ZVI) containing biochar synthesized by co-pyrolyzing iron oxide and sawdust biomass. Among the various biogases generated during the pyrolysis of biomass, CO and H2 act as reducing agents to transform iron oxides to ZVI. Approximately 71% of nitrate was reduced to ammonium by ZVI-biochar at initial pH 2.0, and the reduction decreased sharply by the increase in pH. The mass of nitrate-N decreased is exactly same with the mass of ammonia-N formed. However, ammonium remained in the aqueous phase after reduction by ZVI-biochar, and the total nitrogen was not lowered. Acid-washed zeolite adsorbed most ammonium reduced by the ZVI-biochar and maintained the pH to acidic condition to facilitate the reduction of nitrate. The results of this study imply that nitrate-contaminated groundwater can be properly treated within the guidelines of water quality by synthesized ZVI-containing biochar.