Surveying haemoperfusion impact on COVID-19 from machine learning using Shapley values.

BACKGROUND: Haemoperfusion (HP) is an innovative extracorporeal therapy that utilizes special cartridges to filter the blood, effectively removing pro-inflammatory cytokines, toxins, and pathogens in COVID-19 patients. This retrospective cohort study aimed to assess the clinical benefits of HP for severe COVID-19 cases using Shapley values for machine learning models. METHODS: The research involved 578 inpatients (≥ 20 years old) admitted to Baqiyatallah hospital (Tehran, Iran). The control group (359 patients) received standard treatment, including high doses of corticosteroids (a single 500 mg methylprednisolone pulse, followed by 250 mg for 2 days), categorized as regimen (I). On the other hand, the HP group (219 patients) received regimen II, consisting of the same corticosteroid treatment (regimen I) along with haemoperfusion using Cytosorb H300. The frequency of haemoperfusion sessions varied based on the type of lung involvement determined by chest CT scans. In addition, the value function v defines the Shapley value of the i th feature for the query point x , where the input matrix features represent individual characteristics, drugs, and history and clinical conditions of the patient. RESULTS: Our data showed a favorable clinical response in the HP group compared to the control group. Notably, one-to-three sessions of HP using the CytoSorb® 300 cartridge led to reduced ventilation requirements and mortality rates in severe COVID-19 patients. Shapley values were calculated to evaluate the contribution of haemoperfusion among other factors, such as side effects, medications, and individual characteristics, to COVID-19 patient outcomes. In addition, there is a significant difference between the two groups among the treatments and medications used remdesivir, adalimumab, tocilizumab, favipiravir, Interferon beta-1a, enoxaparin prophylaxis, enoxaparin full dose, heparin prophylaxis, and heparin full dose (P < 0.05). It seems that haemoperfusion has a positive impact on the reduction of inflammation markers and renal functional such as ferritin and creatinine, respectively, as well as D-dimer and WBC levels in the HP group were significantly lower than the control group. CONCLUSION: The findings indicated that haemoperfusion played a crucial role in predicting patient survival, making it a significant feature in classifying patients' prognoses.

Renal function markers in single-kidney patients after percutaneous nephrolithotomy: A pilot study.

Background: The present study was performed to investigate and compare renal functions of single-kidney patients after 12 h of percutaneous nephrolithotomy (PCNL) surgery through assessing major markers of renal function with focus on serum level of cystatin that performs a consistent accuracy in various conditions. Materials and Methods: This pilot quasi-experimental study was done on 92 patients with single kidney having staghorn calculus who had undergone PCNL and were referred to the Al-Zahra Hospital, Isfahan, Iran, during 2019-2021. Serum levels of cystatin C, creatinine, estimated glomerular filtration rate (eGFR), and neutrophil gelatinase-associated lipocalin (NGAL) urine level were evaluated before and 12 h after surgery. Results: The mean cystatin C decreased significantly 1.58 ± 0.55 versus mg/L 1.46 ± 0.52 after 12 h after surgery (P < 0.001). Furthermore, the mean levels of creatinine (2.04 ± 0.71 vs. 1.89 ± 0.60 mg/dL) and NGAL (39.72 ± 12.87 vs. 24.05 ± 10.89 µg/ml) were decreased significantly after 12 h of procedure (P < 0.05) while the mean eGFR (57.62 ± 27.59 vs. 64.68 ± 31.88 ml/min/1.73 m2) was increased significantly after 12 h (P < 0.001). Conclusion: Due to significant improvement in all markers of renal after PCNL, this procedure can be considered a potentially effective and safe approach for treating large stone in single-kidney patients.

Innovative Optical-Sensing Technology for the Online Fouling Characterization of Silicon Carbide Membranes during the Treatment of Oily Water.

The oil and gas industry generates a large volume of contaminated water (produced water) which must be processed to recover oil before discharge. Here, we evaluated the performance and fouling behavior of commercial ceramic silicon carbide membranes in the treatment of oily wastewaters. In this context, microfiltration and ultrafiltration ceramic membranes were used for the separation of oil during the treatment of tank dewatering produced water and oily model solutions, respectively. We also tested a new online oil-in-water sensor (OMD-32) based on the principle of light scattering for the continuous measurement of oil concentrations in order to optimize the main filtration process parameters that determine membrane performance: the transmembrane pressure and cross-flow velocity. Using the OMD-32 sensor, the oil content of the feed, concentrate and permeate streams was measured continuously and fell within the range 0.0-200 parts per million (ppm) with a resolution of 1.0 ppm. The ceramic membranes achieved an oil-recovery efficiency of up to 98% with less than 1.0 ppm residual oil in the permeate stream, meeting environmental regulations for discharge in most areas.

Reassessment of inclusion body-based production as a versatile opportunity for difficult-to-express recombinant proteins.

The production of recombinant proteins in the microbial host Escherichia coli often results in the formation of cytoplasmic protein inclusion bodies (IBs). Proteins forming IBs are often branded as difficult-to-express, neglecting that IBs can be an opportunity for their production. IBs are resistant to proteolytic degradation and contain up to 90% pure recombinant protein, which does not interfere with the host metabolism. This is especially advantageous for host-toxic proteins like antimicrobial peptides (AMPs). IBs can be easily isolated by cell disruption followed by filtration and/or centrifugation, but conventional techniques for the recovery of soluble proteins from IBs are laborious. New approaches therefore simplify protein recovery by optimizing the production process conditions, and often include mild resolubilization methods that either increase the yield after refolding or avoid the necessity of refolding all together. For the AMP production, the IB-based approach is ideal, because these peptides often have simple structures and are easy to refold. The intentional IB production of almost every protein can be achieved by fusing recombinant proteins to pull-down tags. This review discusses the techniques available for IB-based protein production before considering technical approaches for the isolation of IBs from E. coli lysates followed by efficient protein resolubilization which ideally omits further refolding. The techniques are evaluated in terms of their suitability for the process-scale production and downstream processing of recombinant proteins and are discussed for AMP production as an example.

An Innovative Optical Sensor for the Online Monitoring and Control of Biomass Concentration in a Membrane Bioreactor System for Lactic Acid Production.

Accurate real-time process control is necessary to increase process efficiency, and optical sensors offer a competitive solution because they provide diverse system information in a noninvasive manner. We used an innovative scattered light sensor for the online monitoring of biomass during lactic acid production in a membrane bioreactor system because biomass determines productivity in this type of process. The upper limit of the measurement range in fermentation broth containing Bacillus coagulans was ~2.2 g·L(-1). The specific cell growth rate (µ) during the exponential phase was calculated using data representing the linear range (cell density ≤ 0.5 g·L(-1)). The results were consistently and reproducibly more accurate than offline measurements of optical density and cell dry weight, because more data were gathered in real-time over a shorter duration. Furthermore, µ(max) was measured under different filtration conditions (transmembrane pressure 0.3-1.2 bar, crossflow velocity 0.5-1.5 m·s(-1)), showing that energy input had no significant impact on cell growth. Cell density was monitored using the sensor during filtration and was maintained at a constant level by feeding with glucose according to the fermentation kinetics. Our novel sensor is therefore suitable for integration into control strategies for continuous fermentation in membrane bioreactor systems.

The association between iris color and refractive errors in children.

This study aimed to evaluate the association between iris color and refractive errors in children aged 6-12 years. This cross-sectional study was based on data obtained from the first phase of the Shahroud Schoolchildren Eye Cohort Study. The target population was 6 to12 year-old students living in urban and rural areas. Iris colors were classified by comparing eye colors with close-up images of iris colors. Myopia was defined as a spherical equivalent (SE) ≤ - 0.5 diopter and hyperopia was defined as SE ≥ 2 diopter in cycloplegic refraction. The association of iris color with hyperopia and myopia was investigated by fitting two separate multiple logistic regression models adjusted for place of residence, age, sex, and times for outdoor activity and near work. Among the 5394 participates with the mean age of 9.7 year, the prevalence of myopia and hyperopia was 4.8% and 4.7% respectively. The number and proportion (in parentheses) of amber, light blue, light brown, dark brown, gray, green and hazel iris colors were 19(0.4%), 26(0.5%), 645(12.0%), 4517(83.7%), 4(0.1%), 59(1.1%), and 124(2.3%) respectively. Compared to dark brown, the odds ratios and 95% confidence intervals (in parentheses) of myopia were 4.8(1.2-18.7), 0.8(0.1-5.8), 1.0(0.7-1.5), 0.4(0.1-2.7) and 0.6(0.2-1.8) for amber, light blue, light brown, green and hazel iris colors in multiple logistic regression model. No significant association was observed between iris colors and hyperopia. This study shows that amber iris is significantly associated with higher odds of myopia. These children should be further monitored and examined. More studies with higher sample size in all iris colors are recommended.

A fast strapdown gyrocompassing algorithm based on INS differential errors.

This paper presents an enhanced algorithm for inertial gyrocompassing using strapdown sensors, which performs faster than the other available ones. The proposed algorithm is based on differential errors in an inertial navigation system and requires only the output of the inertial measurement unit while extracting and compensating for the inertial sensor errors. After eliminating the error of the inertial sensors, which is accomplished swiftly, the coarse alignment algorithm performs with error-compensated sensors, and the true north is extracted accurately. The number of non-observable parameters of the algorithm is equal to that of the fine alignment algorithm; therefore, its accuracy is the same as that of a well-tuned fine alignment. Numerical simulations and lab experiments demonstrate that the proposed method performs heading estimation in the time required to perform the coarse alignment, which is faster than the existing fine alignment algorithms.

Hot-Water Hemicellulose Extraction from Fruit Processing Residues.

Hemicelluloses are an abundant biopolymer resource with interesting properties for applications in coatings and composite materials. The objective of this investigation was to identify variables of industrially relevant extraction processes that increase the purity of hemicelluloses extracted from fruit residues. Our main finding is that extraction with subcritical water, followed by precipitation with alcohol, can be adjusted to yield products with a purity of at least 90%. Purity was determined based on the total concentration of glucose, galactose, xylose, arabinose, and mannose after hydrolysis with sulfuric acid. In the first experimental design (DoE methodology), the effects of extraction temperature (95-155 °C) and time (20-100 min) on yield and purity were studied. A clear trade-off between yield and purity was observed at high temperatures, indicating the selective removal of impurities. In the second experimental design, the influence of extract pH and alcohol concentration on yield and purity was investigated for the raw extract and a concentrate of this extract with 1/6 of the original volume. The concentrate was obtained by ultrafiltration through ceramic hollow-fiber membranes. The highest purity of 96% was achieved with the concentrate after precipitating with 70% alcohol. Key factors for the resource efficiency of the overall process are addressed. It is concluded that extraction with subcritical water and ultrafiltration are promising technologies for producing hemicelluloses from fruit residues for material applications.

A Prospective Study on Risk Factors for Acute Kidney Injury and All-Cause Mortality in Hospitalized COVID-19 Patients From Tehran (Iran).

Background: Several reports suggested that acute kidney injury (AKI) is a relatively common occurrence in hospitalized COVID-19 patients, but its prevalence is inconsistently reported across different populations. Moreover, it is unknown whether AKI results from a direct infection of the kidney by SARS-CoV-2 or it is a consequence of the physiologic disturbances and therapies used to treat COVID-19. We aimed to estimate the prevalence of AKI since it varies by geographical settings, time periods, and populations studied and to investigate whether clinical information and laboratory findings collected at hospital admission might influence AKI incidence (and mortality) in a particular point in time during hospitalization for COVID-19. Methods: Herein we conducted a prospective longitudinal study investigating the prevalence of AKI and associated factors in 997 COVID-19 patients admitted to the Baqiyatallah general hospital of Tehran (Iran), collecting both clinical information and several dates (of: birth; hospital admission; AKI onset; ICU admission; hospital discharge; death). In order to examine how the clinical factors influenced AKI incidence and all-cause mortality during hospitalization, survival analysis using the Cox proportional-hazard models was adopted. Two separate multiple Cox regression models were fitted for each outcome (AKI and death). Results: In this group of hospitalized COVID-19 patients, the prevalence of AKI was 28.5% and the mortality rate was 19.3%. AKI incidence was significantly enhanced by diabetes, hyperkalemia, higher levels of WBC count, and blood urea nitrogen (BUN). COVID-19 patients more likely to die over the course of their hospitalization were those presenting a joint association between ICU admission with either severe COVID-19 or even mild/moderate COVID-19, hypokalemia, and higher levels of BUN, WBC, and LDH measured at hospital admission. Diabetes and comorbidities did not increase the mortality risk among these hospitalized COVID-19 patients. Conclusions: Since the majority of patients developed AKI after ICU referral and 40% of them were admitted to ICU within 2 days since hospital admission, these patients may have been already in critical clinical conditions at admission, despite being affected by a mild/moderate form of COVID-19, suggesting the need of early monitoring of these patients for the onset of eventual systemic complications.

Influence of Ceramic Membrane Surface Characteristics on the Flux Behavior of a Complex Fermentation Broth.

The valorization of agro-industrial residues using yeasts as biocatalysts requires efficient methods for biomass separation. Filtration with ceramic membranes is suitable for this task, however, the challenge of flux decline and the unavoidable cleaning must be taken into account. We investigated the filtration of fermentation broth and its components using tubular microfiltration and ultrafiltration membranes, and hollow-fiber ultrafiltration membranes, with cut-offs of 30 and 200 nm. The steady-state flux was limited by fouling under comparable wall shear stress conditions but increased when the wall shear stress was higher. Single-component filtration with two 30 nm tubular ultrafiltration membranes, whose average surface roughness ranged from 1.0 to 3.9 µm, showed that smoother surfaces experience less biomass fouling under more intense hydrodynamic conditions. Furthermore, we showed experimentally and by scanning electron microscopy in filtration with 30 nm tubular membranes that the thickness of the first separation layer is responsible for the degree of irreversible resistance caused by the deposition of organic material in the membrane pores. The thickness of this layer should therefore be minimized without compromising mechanical stability.

Ozone therapy for the treatment of COVID-19 pneumonia: A scoping review.

Severe forms of COVID-19 can evolve into pneumonia, featured by acute respiratory failure due to acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). In viral diseases, the replication of viruses is seemingly stimulated by an imbalance between pro-oxidant and antioxidant activity as well as by the deprivation of antioxidant mechanisms. In COVID-19 pneumonia, oxidative stress also appears to be highly detrimental to lung tissues. Although inhaling ozone (O3) gas has been shown to be toxic to the lungs, recent evidence suggests that its administration via appropriate routes and at small doses can paradoxically induce an adaptive reaction capable of decreasing the endogenous oxidative stress. Ozone therapy is recommended to counter the disruptive effects of severe COVID-19 on lung tissues, especially if administered in early stages of the disease, thereby preventing the progression to ARDS.

Recovery of Lignosulfonates from Spent Sulfite Liquor Using Ceramic Hollow-Fiber Membranes.

Spent sulfite liquor is an abundant but currently less used wastewater stream from the pulp and paper industry. The recovery of lignin from this resource would provide an inexpensive raw material for the manufacture of fuels and fine chemicals. Here we investigated the suitability of ceramic hollow-fiber membranes for the concentration of spent sulfite liquor as an alternative to common membrane technologies. We tested three ceramic hollow-fiber membranes (3, 8, and 30 nm) in different membrane processes (fed-batch and total recycle mode) and compared their performance with the widely-used tubular membrane geometry. We also evaluated backflushing as a strategy to reduce membrane fouling during filtration. The juxtaposition of the two membrane geometries revealed that wall shear stress is the most important process parameter for the assessment of membrane performance according to permeate flux. The higher the wall shear stress, the higher the permeate flux. Due to the smaller inner diameter of the hollow-fiber membranes, higher wall shear stress can be achieved more easily. Backflushing had no effect on the permeate flux during the concentration experiments.

Development and Characterization of an Enzyme Membrane Reactor for Fructo-Oligosaccharide Production.

Fructo-oligosaccharides (FOS) are linear fructans comprising 2-5 fructose units linked to a terminal glucose residue. They are widely used as food and feed additives due to their sweetness, low calorific value, and prebiotic properties. Here we describe the synthesis of FOS catalyzed by a cell-free crude enzyme solution containing recombinant fructosyltransferase (1-FFT) produced in the yeast Kluyveromyces lactis. During the enzyme catalysis, glucose accumulates as a by-product and eventually inhibits FOS production. We therefore used an enzyme membrane reactor (EMR) to achieve the continuous removal of glucose and the simultaneous replenishment of sucrose. We observed a loss of flux during the reaction with the characteristics of complete pore blocking, probably caused by a combination of proteins (enzyme molecules) and polysaccharides (FOS). Such complex fouling mechanisms must be overcome to achieve the efficient production of FOS using EMR systems.

Current status of stem cell therapy, scaffolds for the treatment of diabetes mellitus.

Diabetes mellitus (DM) remains the 7th leading cause of death in the world. Daily insulin injection is one component of a treatment plan for people with Diabetes mellitus type 1 (T1DM) that restores normal or near-normal blood sugar levels. However, Insulin treatment depends upon a variety of individual factors and leads to poor and drastic glycemic control. The need for an effective cell replacement strategy will be the aim of future clinical trials. Therefore, the aim of this systematic review is to outline the latest advances in scaffolding and stem cell therapy as a non-pharmacologic treatment for T1DM. It also emphasizes on some pancreas differentiation protocols and the clinical trials associated with stem cell therapy regarding T1DM in vitro and in vivo.

Anaerobic Membrane Bioreactor for Continuous Lactic Acid Fermentation.

Membrane bioreactor systems can enhance anaerobic lactic acid fermentation by reducing product inhibition, thus increasing productivity. In batch fermentations, the bioconversion of glucose is strongly inhibited in the presence of more than 100 g·L-1 lactic acid and is only possible when the product is simultaneously removed, which can be achieved by ceramic membrane filtration. The crossflow velocity is a more important determinant of flux than the transmembrane pressure. Therefore, to stabilize the performance of the membrane bioreactor system during continuous fermentation, the crossflow velocity was controlled by varying the biomass concentration, which was monitored in real-time using an optical sensor. Continuous fermentation under these conditions, thus, achieved a stable productivity of ~8 g·L-1·h-1 and the concentration of lactic acid was maintained at ~40 g·L-1 at a dilution rate of 0.2 h-1. No residual sugar was detected in the steady state with a feed concentration of 50 g·L-1.

Membrane Technology for the Recovery of Lignin: A Review.

Utilization of renewable resources is becoming increasingly important, and only sustainable processes that convert such resources into useful products can achieve environmentally beneficial economic growth. Wastewater from the pulp and paper industry is an unutilized resource offering the potential to recover valuable products such as lignin, pigments, and water [1]. The recovery of lignin is particularly important because it has many applications, and membrane technology has been investigated as the basis of innovative recovery solutions. The concentration of lignin can be increased from 62 to 285 g∙L(-1) using membranes and the recovered lignin is extremely pure. Membrane technology is also scalable and adaptable to different waste liquors from the pulp and paper industry.

Iranian Nephrology and Urology Research Output in the Past Two Decades: A Bibliographic Analysis of Medline Database.

CONTEXT: We performed a bibliometric search to evaluate the number of papers published in the field of nephrology and urology by Iranian researchers in the past two decades. EVIDENCE ACQUISITION: We did an online search in abstract/title part of articles with 129 keywords such as kidney, renal, hemodialysis, transplant, nephrology, glomerulonephritis, ureteral, nephrolithiasis, and etc. Endnote software version 7 was used to search articles published in PubMed database from November 1993 to November 2013. Those articles in which Iran was the affiliation of at least one of the authors were selected. These articles in the field of nephrology and urology were analyzed regarding the name of originated institution, field of study, total number of publications, type of study, collaboration rate of Iranian nephrologist and urologists for every year, annual sharing of Iranian articles in five journals with highest impact factor (IF) and journal IF. RESULTS: The total number of publications in the field of nephrology and urology was 3,771 (average of 189 papers per year). Most of the Iranian nephrology and urology papers were from the capital city, Tehran (50.03%). There was an increasing trend in the number of publications over the years. Most papers were about transplantation (44.6%), nephrology (20.9%) and hemodialysis (16.4%). Of all, 53.7% were retrospective articles, whereas the proportion of clinical trials was relatively small (10.8%). CONCLUSIONS: Although Iranian publications in the field of nephrology and urology have had a considerable and significant increase in the recent years amongst the Middle Eastern countries, there is a wide distance to be a science exporter country.

Treatment of the Bleaching Effluent from Sulfite Pulp Production by Ceramic Membrane Filtration.

Pulp and paper waste water is one of the major sources of industrial water pollution. This study tested the suitability of ceramic tubular membrane technology as an alternative to conventional waste water treatment in the pulp and paper industry. In this context, in series batch and semi-batch membrane processes comprising microfiltration, ultrafiltration and nanofiltration, ceramic membranes were developed to reduce the chemical oxygen demand (COD) and remove residual lignin from the effluent flow during sulfite pulp production. A comparison of the ceramic membranes in terms of separation efficiency and performance revealed that the two-stage process configuration with microfiltration followed by ultrafiltration was most suitable for the efficient treatment of the alkaline bleaching effluent tested herein, reducing the COD concentration and residual lignin levels by more than 35% and 70%, respectively.

The impact of cytomegalovirus infection on new-onset diabetes mellitus after kidney transplantation: a review on current findings.

CONTEXT: New onset diabetes mellitus after transplantation (NODAT) increases the risk of cardiovascular disease, rate of infections, graft rejection and graft loss as well as decreases patient and graft survival rates. There is a controversy surrounding the impact of cytomegalovirus (CMV) infection in the development of NODAT. This meta-analysis aims to identify the role of CMV infection leading to the development of NODAT in kidney recipient patients. EVIDENCE ACQUISITIONS: We searched several electronic databases, including PubMed, Embase, Medline, Scopus, Trip Database and Google Scholar for studies that completely fulfill our criteria between January 1990 and January 2014 RESULTS: Seven studies with 1389 kidney transplant patients were included in this metaanalysis.The mean age of patients ranged from 42.8 to 48.8 years and males made up 53% to 75% of patients in the cohort studies. The incidence of NODAT varies from 14.3% to 27.1% in these studies. Overall adj OR was 1.94 [exp (0.66)] with a 95% CI of 1.26-2.98 [exp (0.23) and (1.09)]. There was no significant publication bias based on the Begg's and Egger's test (p value = 0.17 and 0.54, respectively). CONCLUSIONS: Our study showed that CMV infection is a risk factor for increasing incidence of NODAT. Thus, prophylaxis against CMV infection after kidney transplantation is strongly suggested. However, further clinical trials and cohorts are needed to confirm this association.

Recent developments in manufacturing oligosaccharides with prebiotic functions.

The market for prebiotics is steadily growing. To satisfy this increasing worldwide demand, the introduction of effective bioprocessing methods and implementation strategies is required. In this chapter, we review recent developments in the manufacture of galactooligosaccharides (GOS) and fructooligosaccharides (FOS). These well-established oligosaccharides (OS) provide several health benefits and have excellent technological properties that make their use as food ingredients especially attractive. The biosyntheses of lactose-based GOS and sucrose-based FOS show similarities in terms of reaction mechanisms and product formation. Both GOS and FOS can be synthesized using whole cells or (partially) purified enzymes in immobilized or free forms. The biocatalysis results in a final product that consists of OS, unreacted disaccharides, and monosaccharides. This incomplete conversion poses a challenge to manufacturers because an enrichment of OS in this mixture adds value to the product. For removing digestible carbohydrates from OS, a variety of bioengineering techniques have been investigated, including downstream separation technologies, additional bioconversion steps applying enzymes, and selective fermentation strategies. This chapter summarizes the state-of-the-art manufacturing strategies and recent advances in bioprocessing technologies that can lead to new possibilities for manufacturing and purifying sucrose-based FOS and lactose-based GOS.