Influence of implant strategy on the transition from temporary left ventricular assist device to durable mechanical circulatory support.

OBJECTIVES: Bridging from a temporary microaxial left ventricular assist device (tLVAD) to a durable left ventricular assist device (dLVAD) is playing an increasing role in the treatment of terminally ill patients with heart failure. Scant data exist about the best implant strategy. The goal of this study was to analyse differences in the dLVAD implant technique and effects on patient outcomes. METHODS: Data from 341 patients (19 European centres) who underwent a bridge-to-bridge implant from tLVAD to dLVAD between January 2017 and October 2022 were retrospectively analysed. The outcomes of the different implant techniques with the patient on cardiopulmonary bypass, extracorporeal life support or tLVAD were compared. RESULTS: A durable LVAD implant was performed employing cardiopulmonary bypass in 70% of cases (n = 238, group 1), extracorporeal life support in 11% (n = 38, group 2) and tLVAD in 19% (n = 65, group 3). Baseline characteristics showed no significant differences in age (P = 0.140), body mass index (P = 0.388), creatinine level (P = 0.659), the Model for End-Stage Liver Disease (MELD) score (P = 0.190) and rate of dialysis (P = 0.110). Group 3 had significantly fewer patients with preoperatively invasive ventilation and cardiopulmonary resuscitation before the tLVAD was implanted (P = 0.009 and P < 0.001 respectively). Concomitant procedures were performed more often in groups 1 and 2 compared to group 3 (24%, 37% and 5%, respectively, P < 0.001). The 30-day mortality data showed significantly better survival after an inverse probability of treatment weighting in group 3, but the 1-year mortality showed no significant differences among the groups (P = 0.012 and 0.581, respectively). Postoperative complications like the rate of right ventricular assist device (RVAD) implants or re-thoracotomy due to bleeding, postoperative respiratory failure and renal replacement therapy showed no significant differences among the groups. Freedom from the first adverse event like stroke, driveline infection or pump thrombosis during follow-up was not significantly different among the groups. Postoperative blood transfusions within 24 h were significantly higher in groups 1 and 2 compared to surgery on tLVAD support (P < 0.001 and P = 0.003, respectively). CONCLUSIONS: In our analysis, the transition from tLVAD to dLVAD without further circulatory support did not show a difference in postoperative long-term survival, but a better 30-day survival was reported. The implant using only tLVAD showed a reduction in postoperative transfusion rates, without increasing the risk of postoperative stroke or pump thrombosis. In this small cohort study, our data support the hypothesis that a dLVAD implant on a tLVAD is a safe and feasible technique in selected patients.

Haemostasis in oral surgical procedures involving patients with a ventricular assist device.

The purpose of this study was to determine whether tooth extraction for patients with ventricular assist devices (VADs) could be performed without interruption of anticoagulant and/or antiplatelet therapy and whether treatment with von Willebrand factor concentrates and desmopressin is required. The study consisted of three groups of patients undergoing oral surgery. The two experimental groups comprised patients with VADs, while the third group included cardiovascular patients without VADs who served as controls. All patients were treated intraoperatively with topical haemostatic agents (oxidized cellulose or collagen). The first group was additionally treated with fibrin glue. All 75 oral surgical procedures were performed under local anaesthesia without sedation. Three of 40 patients in the experimental groups and two of 20 patients in the control group suffered a haemorrhage, with no significant difference in the incidence of haemorrhage between the groups. The findings suggest that dental extraction can be performed without modification of oral anticoagulation or antiplatelet treatments, providing that INR is less than 3.5 on the day of the operation. It can further be hypothesized that an acquired coagulopathy in VAD patients does not influence the bleeding risk in dental extractions, and so the administration of desmopressin and/or von Willebrand factor concentrates is not required.

Multidrug-resistant gram-negative organisms: a review of recently approved antibiotics and novel pipeline agents.

Background The discovery of antibiotics several decades ago was a defining moment in history. They were used to treat previously incurable diseases and save many lives. However, the use of antibiotics is not benign. Antibiotic resistance occurs due to the natural evolution of bacteria and gene transfer between bacteria via vertical and horizontal routes, resulting in protective mechanisms that render antibacterial agents ineffective. Aim of the review To list and describe current, novel pipeline antibiotics indicated for multidrug-resistant gram-negative bacteria. This review discusses the limited number of novel pipeline drugs available to combat the rapidly increasing number of multidrug-resistant bacteria and the need for initiatives to research and discover more novel antibiotics. Method A search of MEDLINE/PubMed using the search terms antibacterial pipeline OR antibiotic pipeline including publications between 1 January 2018 through 23 January 2020 resulted in 230 items. The results obtained were narrowed by adding the search term AND multi-drug resistant which resulted in 12 items. Then, ClinicalTrials.gov was searched for phase 2-3 "interventional" trials registered between 1 January 2018 and 23 January 2020 with the status "recruiting" or "completed" function and including World Health Organization-defined priority pathogens in the "condition or disease" field. The search process was then completed by introducing the term antibacterial agents in the "other terms" field. The trials search and selection resulted in 13 items. Relevant English-language studies and those conducted in humans were considered. Those drugs belonging to new antibiotic classes or to antibiotic classes already known but with new chemical structure were defined as "novel antibiotics". Results The studies selected and reviewed were those referring to a novel antibiotics. Thus, from MEDLINE/PubMed, we found only 1 item referred to a novel chemical class (Murepavadin n = 1). From ClinicalTrials.gov a total of 4 citations were identified (Ftortiazinon n = 1, Zoliflodacin n = 1, Gepotidacin n = 1, ETX2514 + sulbactam n = 1). Conclusion The antibiotics annually approved by the Food and Drug Administration (FDA) mostly belong to existing classes of antibiotics and have specific indications, limiting their use in many multidrug-resistant infections. There are limited novel drug classes targeting gram-negative infections in the pipeline. Providers must be vigilant with the use of current antibiotics, especially until research and development (R&D) advancements are made.

Is It Possible to Manipulate Scelionidae Wasps' Preference to a Target Host?

Parasitoid host selection is mainly mediated by chemical cues, which can be adjusted by experience, changing their innate behavior. Therefore, this study evaluated if immature experience (pre-imaginal conditioning) on eggs and volatiles from different host eggs has influence on parasitism and chemotaxic behavior of Telenomus podisi Ashmead and/or Trissolcus basalis Wollaston (Hymenoptera: Scelionidae). Both wasp species were submitted to a multiple-choice parasitism test among Euschistus heros (Fabricius), Piezodorus guildinii (Westwood), and Nezara viridula L. (Hemiptera: Pentatomidae) (Hemiptera: Pentatomidae) egg masses. Eggs from these three stink bugs were equally offered to female parasitoids. After that, adults which emerged from each host were also exposed to parasitism in a multiple-choice test for up to an additional generation. Moreover, in olfactometer "Y," the behavior of innate and experienced T. podisi females to volatiles from hosts' egg extracts was tested, to study their learning and memory ability. The original host had influence on T. podisi parasitism; however, T. basalis always parasitized more N. viridula eggs independently of its last rearing host. Innate T. podisi females responded positively to E. heros and P. guildinii egg volatiles, but this behavior was not observed in N. viridula. When T. podisi females were experienced on egg volatiles from a new host, they showed significant learning and memory ability for the specific host volatile for, at least, 24 h. Experienced wasps responded positively to N. viridula and through this result we have evidences about the possibility to manipulate wasp's preferences to a specific target host.

Cloning and sequence of an infectious bovine rhinotracheitis virus (BHV-1) gene homologous to glycoprotein H of herpes simplex virus.

A homologue to the glycoprotein H (gH) gene of herpes simplex virus (HSV) has been identified in the genome of infectious bovine rhinotracheitis virus (IBR, BHV-1). The gene is located immediately downstream from the thymidine kinase gene, and codes for an open reading frame (orf) of 842 amino acids. The orf has the characteristics of a membrane glycoprotein, including an N-terminal hydrophobic region resembling a signal sequence, a C-terminal region which is probably a transmembrane domain, and six potential sites for N-linked glycosylation. This orf shows significant homology to the gH sequences of both HSV and pseudorabies virus (PRV). We conclude that this gene encodes BHV-1 gH.

PD0084430: a non-nucleoside inhibitor of human cytomegalovirus replication in vitro.

Human cytomegalovirus (HCMV) is a major opportunistic pathogen in immunocompromised individuals. Current therapies target viral DNA replication and accumulate mutations that yield cross-resistance among the approved drugs. A novel, non-nucleoside inhibitor of HCMV replication, PD0084430, was identified in a screening assay using the HCMV beta-galactosidase recombinant RC256. The EC(50) for PD0084430 by inhibition of beta-galactosidase production is 1+/-0.7 microM. This antiviral activity was confirmed by yield reduction and plaque reduction assays using HCMV strain AD169. The TC(50) of PD0084430 as measured by (4C)thymidine incorporation is approximately 30 microM and by XTT is approximately 90 microM. The TC(50) for inhibition of cellular proliferation is approximately 20 microM. Time of addition experiments displayed a similar drop in efficacy for both PD0084430 and GCV when added after the onset of viral DNA replication. The transcomplementation assay for viral DNA replication, using a transfected ori(Lyt) containing plasmid, confirmed that viral DNA synthesis was inhibited at the same concentrations that showed antiviral activity. Western blots showed no apparent block of immediate early or early gene expression. Two ganciclovir (GCV) resistant isolates of HCMV tested showed no cross-resistance to PD0084430. These data suggested a potentially promising novel compound that inhibited HCMV at or before viral DNA replication. However, in vivo testing in mice dosed either orally or intraperitoneally showed rapid glucuronidation on the -OH group. SAR studies on this backbone showed that the -OH group was essential for the antiviral activity in vitro.

Richmond youth against violence: a school-based program for urban adolescents.

The Richmond Youth Against Violence Project teaches middle school students in the Richmond Public Schools knowledge, attitudes, and skills for reducing their involvement in violence. These students are primarily African Americans, many of whom come from low-income, single-parent households in neighborhoods with high rates of crime and drug use. The program, "Responding in Peaceful and Positive Ways," employs a developmentally anchored health promotion model. Its goal is to promote peaceful and positive alternatives to interpersonal and situational violence, by creating environments that teach and encourage health-enhancing behaviors and intrapersonal attributes and weakening supports for health-compromising behaviors and intrapersonal attributes. The 16-session school-based program was implemented by prevention specialists with sixth graders during the 1994-1995 school year. Students are taught a seven-step problem-solving model. Program implementation was staggered to allow an intervention group to participate during the fall semester and a control group to participate during the spring semester. Outcome measures include school data and measures completed by students. There were few significant baseline differences between the intervention and control groups. A high percentage of students, particularly boys, reported exposure to community violence; more than 92% had heard gunshots. Many have also engaged in risk behaviors; 70% of the boys and 44% of the girls reported being in a fight in the preceding 30 days. The impact of the curriculum is being examined. The program has provided valuable lessons about conducting community-based research, particularly designing, implementing, and evaluating prevention programs.

Expression of three recombinant proteins using baculovirus vectors in 23 insect cell lines.

Recombinant Autographa california baculoviruses expressing genes for pseudorabies virus glycoprotein (gp50T), human plasminogen (HPg), and beta-galactosidase (beta-gal) were used to infect 23 cell lines or strains. The objectives were to compare amounts of recombinant proteins expressed in the cell lines, compare yields from clones and parent lines, investigate the effects of long-term culture in serum-free medium on production, and determine if some lines yield gp50T with different glycosylation patterns. For HPg, IZD-MB0503 had the highest yield and four other lines (IPLB-TN-R2, IPLB-SF-1254, IPLB-LdEIta, and CM-1) had levels above that of SF-9 cells. For gp50T, four lines (IPLB-HvT1, IPLB-SF21AE, IPLB-SF21AE-15, and IPLB-SF-1254) had higher amounts than SF-9 cells. Some lines yielded gp50T with molecular mass about 1000 daltons larger than that from SF-9 cells, which suggests increased oligosaccharide processing. Equally high levels of beta-gal were expressed in three lines (SF-9, IZD-MB0503, and BCIRL-PX2-HNV3). The major conclusion is that no single cell line produced highest yields for all three recombinant proteins. Four lines were cultured in serum-free medium for 31-34 passages and then infected with the three recombinant viruses. For most cell line-recombinant combinations, the yields in serum-free medium were equal to or better than those in serum-supplemented medium. Medium composition had a much stronger effect on foreign gene expression than on susceptibility of cells to wild-type virus.

In vitro transformation assays for chemical carcinogens.

A variety of in vitro mammalian cell assays, designed specifically for the identification of carcinogenic compounds, have been in operation for more than a decade. Although no individual transformation system has won universal acceptance during this time, recent advances have led to the improved reliability and sensitivity of a number of these short-term tests. The underlying problems associated with the most widely used assays are identified and new developments in this rapidly expanding field are noted and discussed.

Genotoxicity studies with a blend of zinc dialkyldithiophosphate lubricant additives.

The mutagenic activity of a blend of primary zinc dialkyldithiophosphate lubricant additives suspended in process oils and a blend of the process oils alone was investigated in agar layer cultures of Salmonella typhimurium TA1535, TA1537, TA1538, TA98 and TA100, both with and without the incorporation of a rat liver microsomal activation system (S9). Zinc dimethyldithiocarbamate was tested as a structurally-related model bacterial mutagen, and, in additional control experiments, the mutagenic activity of zinc dimethyldithiocarbamate and benzo[a]pyrene was investigated in combination with the blend of process oils in selected bacterial tester strains. Transformation frequencies of BHK cells were determined by colony growth in soft agar culture following treatment with a blend of the zinc dialkyldithiophosphate lubricant additives suspended in process oils, a blend of the process oils, 7,12-dimethylbenzanthracene, both in the presence and in the absence of a blend of the process oils, or zinc dimethyldithiocarbamate. All experiments incorporated a rat liver microsomal activation system (S9). Application of a blend of the zinc dialkyldithiophosphate additives or a blend of the process oils used in their manufacture did not increase the reverse mutation frequencies of Salmonella typhimurium TA1535, TA1537, TA1538, TA98 or TA100, or significantly increase the transformation frequency of BHK cells under the experimental conditions described. Zinc dimethyldithiocarbamate increased the reverse mutation frequency in some bacterial tester strains, but did not significantly increase the transformation frequency of BHK cells under the described experimental conditions. The addition of the blend of the process oils in combination with the control materials, zinc dimethyldithiocarbamate or benzo[a]pyrene had an inhibitory effect on the mutagenic activity at high doses of each in the bacterial assays, and in the BHK assay the transforming ability of 7,12-dimethylbenzanthracene was suppressed in the presence of the blend of the process oils. Thus, the additive materials showed no evidence of genotoxic activity in the bacterial mutation assays, or in the BHK transformation assay under the experimental conditions described.

Immune response in pigs to Aujeszky's disease viruses defective in glycoprotein g1 or gX.

Two Aujeszky's disease virus glycoprotein genes, gX and g1, have been used to produce deletion mutants which have then been developed into vaccines. These deletions then allow differentiation between pigs infected with wild type virus and those given the vaccine. It is not clear whether the glycoproteins encoded for by these genes are needed to induce a full protective immune response, in which case deletion mutants would suffer from lack of potency. To test this, commercially available Aujeszky's virus vaccines which lacked either gX or g1 were compared and isogenic constructs were made which differed only in the absence or presence of gX and, or, g1. These constructs and vaccines were used to vaccinate the natural host of Aujeszky's disease, the pig, and potency was measured using challenge with wild type virus. In all cases vaccines which lacked g1 performed significantly less well than those in which g1 was present, whereas deletions of gX had no significant effect on vaccine performance.

Importance of food composition data to nutrition and public health.

INTRODUCTION: Adequate nutrition is one of the pillars of public health. Before developing and implementing effective intervention programmes to improve nutrition at the population level, it is important to know the nutritional situation of the target group. ASSESSMENT OF ENERGY AND NUTRIENT INTAKE: The estimation of nutrient intake from food consumption requires reliable data on food composition. These data are also the fundamentals of food-based dietary guidelines for healthy nutrition, containing the necessary information on food sources for different nutrients. Furthermore, food composition tables can provide information on chemical forms of nutrients and the presence and amounts of interacting components, and thus provide information on their bioavailability. For some nutrients such as vitamin A, vitamin E and niacin, the concept of equivalence has been introduced to account for differences in the availability and biological activity of different chemical forms. NON-NUTRITIVE FOOD COMPONENTS: Although most food composition tables focus on energy, macro- and micronutrients, interest in non-nutritive components is increasing. Considering the beneficial effects of biologically active secondary plant cell compounds such as polyphenols and carotenoids, more data on these are needed. On the other hand, there are a number of naturally occurring or 'man-made' non-nutritive substances with negative effects, and to control exposure, the main dietary sources must be known. Another aspect is contaminants, which could have detrimental effects on consumers' health. Among these are agrochemicals, industrial pollutants reaching the food chain and substances formed during food preparation. A valid risk assessment requires data on exposure, and thus on the contents of contaminants in foods. However, these data are highly variable and may significantly differ even within narrowly confined regions. CURRENT FOOD COMPOSITION DATABASES ARE FAR FROM COMPLETE: The fact that composition tables generally do not provide information about the origin of substances found in food can also influence their usability. For example, the German Nutrient Data base does not discriminate between naturally occurring and added sucrose impeding the estimation of added sucrose intake that should be limited. Points of focus: Considering the increasing number of persons relying on community nutrition and catering, healthy menu lines can improve the consumers' diets and contribute to nutrient supply. The development and implementation of appropriate guidelines also need food composition databases (FCBs) to compose meals. The ever-increasing number of new food preparations and manufactured products has resulted in a need for procedures for regularly updated data. Moreover, there is a lack of data particularly for essential trace elements such as copper, chromium or molybdenum and also vitamin K, as well as the already mentioned non-nutritive components. Limited comparability between countries is another issue. Regional differences arise especially from the use of local varieties, different soil quality or meteorological aspects. This variability is further increased with composite meals because of variation in recipes. CONCLUSION: Information about food composition is necessary for the assessment of diet quality and the development and application of food-based dietary guidelines, providing a useful tool for the field of public health nutrition. In this regard, more attention should be paid to the preparation, extension and maintenance of FCBs.

Comparative immunogenicity of recombinant influenza hemagglutinin (rHA) and trivalent inactivated vaccine (TIV) among persons > or =65 years old.

Alternative substrates for influenza vaccine production are needed to ensure adequate supplies. We evaluated the relative safety and immunogenicity of recombinant hemagglutinin (rHA) or trivalent inactivated vaccine (TIV) among 869 > or =65-year-old subjects in a randomized clinical trial. Virologic surveillance for influenza-like illness (ILI) was conducted during the 2006-2007 epidemic. Vaccines were well tolerated. Seroconversion rates vs. influenza A/H1N1 and H3N2 antigens were superior in the rHA group, but were inferior vs. influenza B; however, results for influenza B are confounded since the vaccine antigens were different. ILI frequencies were low and similar in both groups. Studies assessing relative immunogenicity of vaccines using identical B Ags are warranted.

Probiotic, as well as conventional yogurt, can enhance the stimulated production of proinflammatory cytokines.

BACKGROUND: Lactic acid bacteria have been shown to stimulate the secretion of cytokines by lymphocytes and monocytes in a strain-dependent manner. Therefore, in this study, the effect of a daily intake of probiotic yogurt on cytokine production in young healthy women was compared with that of a conventional product. METHODS: For 2 weeks each, subjects consumed 100 g, then 200 g of either a probiotic or a conventional, commercially available yogurt, both containing Lactobacillus bulgaricus and Streptococcus thermophilus with additional Lactobacillus casei DN 114 001 in the probiotic product. Cytokine production in blood culture following stimulation with phytohaemmaglutinin and lipopolysaccharide was measured using Cytometric Bead Array and enzyme-linked immunosorbent assay. RESULTS: Stimulated production of tumour necrosis factor-alpha increased significantly following consumption of conventional or probiotic yogurt (+63% and +24% compared with baseline, respectively, P < 0.001). There was also a significantly higher production of interleukin (IL)-1beta in the conventional (+40%, P = 0.006) and of interferon gamma in the probiotic group (+108%, P < 0.05). IL-10 decreased following consumption of the probiotic product, but increased significantly after intake cessation (+129%, P < 0.001). No significant differences in cytokine responses between the conventional and the probiotic yogurt were observed. CONCLUSION: Both conventional and probiotic yogurt enhanced the stimulated production of pro-inflammatory cytokines.

A framework for assessing performance problems.

How do we as managers address problems of nonperformance ? Robert Mager and Peter Pipe provide a framework for identifying the real problem, deciding whether or not there is a skill deficiency, and whether performance is punishing or whether nonperformance is rewarding. If performance really matters, are there obstacles to performing? This framework helps us to analyze performance deficiencies systematically and to move toward an appropriate solution.

The effectiveness of a school-based curriculum for reducing violence among urban sixth-grade students.

OBJECTIVES: In this study, we examine the impact of a school-based curriculum designed to reduce violence among urban sixth-grade students. METHODS: This study used a staggered implementation design in which sixth-graders in six middle schools were taught an 18-session violence-prevention curriculum during either the fall or spring semester. Outcome measures were completed at the beginning, middle, and end of the school year. RESULTS: For boys, participation in the program during the fall resulted in significant posintervention differences in the self-reported frequency of violence and several other problem behaviors. Most of these differences were maintained at the end of the school year. Girls, in contrast, did not appear to benefit from the program. CONCLUSION: These results support the use of a school-based curriculum for reducing violence among sixth-grade boys. They also underscore the importance of early intervention and the necessity of examining gender effects in evaluating such programs.

The genetic toxicology of some hydrocarbon and oxygenated solvents.

Two hydrocarbon solvents (heptane and Special Boiling Point Spirit 100/140) and eight oxygenated solvents [methyl ethyl ketone, methyl isobutyl ketone, diacetone alcohol, di-isobutyl ketone, isopropyl ether, hexylene glycol, secondary butyl alcohol and ME 6K (pentoxone)] have been tested for genotoxic activity. The solvents were tested in bacterial mutation assays, a yeast assay for mitotic gene conversion and in cultured mammalian cells (either rat liver or Chinese hamster ovary) for structural chromosome damage. All of the solvents gave a negative response in the bacterial mutation assays and the yeast mitotic gene conversion assay. In the rat liver chromosome assay, diacetone alcohol evoked a weak positive response, the remaining solvents gave a negative response.

Reduced yield of infectious pseudorabies virus and herpes simplex virus from cell lines producing viral glycoprotein gp50.

Pseudorabies virus (PRV) glycoprotein gp50 is the homolog of herpes simplex virus (HSV) glycoprotein D. Several cell lines that constitutively synthesize gp50 were constructed. Vero cells, HeLa cells, and pig kidney (MVPK) cells that produce gp50 all gave reduced yields of PRV and HSV progeny viruses when compared with the parent cell line or the same cell line transfected to produce a different protein. The reduction in virus yield was greatest at low multiplicities of infection. The Vero and HeLa cells that produce gp50 showed an even greater reduction in HSV yield than in PRV yield. This phenomenon may be an example in a herpesvirus of the interference observed in retroviruses or cross-protection in plant virus systems.