Chronic obstructive pulmonary disease phenotypes: Are they really useful in clinical practice?

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. It is a complex and heterogeneous disease. In recent years, studies showed that forced expiratory volume in 1 s solely was not enough to describe heterogeneity of COPD patients, and subsequently, phenotypes of COPD were identified. The aim of phenotyping is the classification of patients into distinct subgroups according to the prognosis and response to therapy so that the selection of optimal therapy can be possible, and this clinical approach may improve prognosis. In the assessment and management of the disease, it is important to consider phenotype of a COPD patient. The aim of this article is to review predefined COPD phenotypes, their clinical and epidemiological features, and usefulness in clinical practice for accurate diagnosis and appropriate treatment of COPD patients

Improving lipid production capacity of new natural oleaginous yeast: Pichia cactophila firstly

Biodiesel is a useful alternative source of energy and can be used as a support for oil-source diesel. Microbial lipids are considered a promising raw material for biodiesel production. In a previously completed study, Pichia cactophila was found to be the best lipid-producing yeast by lipid screening studies among 107 yeast isolates. In this study, the lipid production conditions of P. cactophila, which was chosen as a lipid producer for the first time, were partially optimized by using response surface methodology in crude glycerol. Plackett-Burman statistical experiment design was used to determine the effect of glycerol, yeast extract, peptone, urea, (NH4)(2)SO4, NH4Cl, NH4NO3 factors on lipid production. In order to determine the optimum levels of the most effective parameters by the result of screening (glycerol, yeast extract, urea, NH4NO3), Box-Behnken experimental design method was used. The optimum production conditions were determined as 39 g/L glycerol, 20 g/L yeast extract, 5 g/L urea, and 20 g/L NH4NO3, and the result of the experiments carried out under these conditions the lipid value (%) was determined as 91.43. Lipid content was increased 1.408-fold (40.79%) by two-step optimization with the response surface methodology and reached a very high value. The fatty acid composition obtained under optimum conditions is compatible with vegetable oils. This suggests that the microbial lipid of P. cactophila can be used as a raw material for biodiesel production and is promising for further studies

The Effect of Proton-Pump Inhibitors on the Frequency and the Course of the Community Acquired Pneumonia

Objective: Proton pump inhibitors (PPIs) are the primary drugs with proven efficacy in gastrointestinal diseases. The effectiveness of these drugs causes unneccessary use and potential risks. The aim of the study was to evaluate the rates of PPI use and its effect on the course of the disease in patients with community aqcuired pneumonia (CAP). Methods: The patients who were hospitalized due to pneumonia were asked about the use of PPIs, whether they were a current user, user in the last 3 months or never used. The rates of PPI use and the effect of PPI use on clinical and radiological improvement, duration of treatment and hospitalization, development of complication, need of intensive care unit and mortality were evaluated. Results: Sixty-eight patients were included in the study. The mean age of patients was 70.7 +/- 12.5 years. The rates of PPI use (current use, use in 3 months and never used) were as follows: 39%, 11.8% and 48.5% respectively. The duration of treatment and hospitalization, duration of clinical and radiological improvement were found longer in patients who were using PPI currently compared to never used (respectively; p=0.08, p=0.024, p=0.007, p=0.016). The rate of complications was higher in the current users than never users (14.8% vs 6.1%). Conclusion: Thirty-nine percent of the patients with CAP were using PPI currently. The course of pneumonia was more severe in this group. The unneccessary use of PPIs should be avoided in order to decrease the incidence and morbidity of CAP

Ethanol production from hazelnut shells through enzymatic saccharification and fermentation by low-temperature alkali pretreatment

Low-temperature sodium hydroxide (NaOH) pretreatment, enzymatic saccharification and ethanol fermentation were evaluated for hazelnut shell cellulose to fermentable sugars and ethanol. Maximum glucose recovery (48.33 g/100 g cellulose) was achieved with 6% NaOH for 72 h and at 1/10 solid/liquid ratio. At these conditions, 41.18% of lignin was removed. The theoretical ethanol yield (ethanol produced/potential glucose in biomass) was 40.71%, overall process efficiency was 37.73 g/kg biomass, ethanol productivity and fermentation efficiency were 0.115 g/(L h) and 96.7%, respectively. Total energy consumed for the low-temperature-long-residence-time alkali process was 34.8 Mj/kg untreated hazelnut shells. Pretreatment time has a significant effect on thermal energy consumption for the low-temperature alkali process. (C) 2017 Elsevier Ltd. All rights reserved

Does thromboprophylaxis prevent venous thromboembolism after major orthopedic surgery?

OBJECTIVE: Pulmonary embolism (PE) is an important complication of major orthopedic surgery. The aim of this study was to evaluate the incidence of venous thromboembolism (VTE) and factors influencing the development of VTE in patients undergoing major orthopedic surgery in a university hospital. METHODS: Patients who underwent major orthopedic surgery (hip arthroplasty, knee arthroplasty, or femur fracture repair) between February of 2006 and June of 2012 were retrospectively included in the study. The incidences of PE and deep vein thrombosis (DVT) were evaluated, as were the factors influencing their development, such as type of operation, age, and comorbidities. RESULTS: We reviewed the medical records of 1,306 patients. The proportions of knee arthroplasty, hip arthroplasty, and femur fracture repair were 63.4%, 29.9%, and 6.7%, respectively. The cumulative incidence of PE and DVT in patients undergoing major orthopedic surgery was 1.99% and 2.22%, respectively. Most of the patients presented with PE and DVT (61.5% and 72.4%, respectively) within the first 72 h after surgery. Patients undergoing femur fracture repair, those aged ≥ 65 years, and bedridden patients were at a higher risk for developing VTE. CONCLUSIONS: Our results show that VTE was a significant complication of major orthopedic surgery, despite the use of thromboprophylaxis. Clinicians should be aware of VTE, especially during the perioperative period and in bedridden, elderly patients (≥ 65 years of age)

Lipid Production from Crude Glycerol by Newly Isolated Oleaginous Yeasts: Strain Selection, Molecular Identification and Fatty Acid Analysis

Biodiesel is a renewable alternative fuel and glycerol as a main byproduct of the manufacturing process. Lipids could be produced from crude glycerol by using yeasts. The ability of 107 yeast strains to utilize glycerol was screened and 92 of these were selected. 60 strains were determined as a potential for lipid production by Sudan Black B staining. After secondary screening 25 of them showed specific growth rates (OD 600), high biomass production and lipid content. These strains were identified as Pichia cactophila, P. fermentans, P. anomala, Rhodotorula mucilaginosa, R. dairenensis, Clavispora lusitaniae, Saccharomyces cerevisiae, Wickerhamomyces anomalus, Candida glabrata, C. inconspicua, C. albicans, Yarrowia lipolytica with molecular identifications based on ITS and D1/D2 26S rDNA sequences. The results showed that P. cactophila accumulated lipid up to 64.94%, the highest lipid content. C16:0, C18:0, C18:1 and C18:2 essential fatty acids for biodiesel production were detected by GC-MS in the lipids accumulated by all strains. P. cactophila and C. lusitaniae were reported for the first time as lipid-producing yeasts. The results suggest that selected 25 isolates have the ability to grow on crude glycerol and especially P. cactophila produce lipid that has potential use as a feedstock for second generation biodiesel production. Graphi

Does thromboprophylaxis prevent venous thromboembolism after major orthopedic surgery?

OBJECTIVE: Pulmonary embolism (PE) is an important complication of major orthopedic surgery. The aim of this study was to evaluate the incidence of venous thromboembolism (VTE) and factors influencing the development of VTE in patients undergoing major orthopedic surgery in a university hospital. METHODS: Patients who underwent major orthopedic surgery (hip arthroplasty, knee arthroplasty, or femur fracture repair) between February of 2006 and June of 2012 were retrospectively included in the study. The incidences of PE and deep vein thrombosis (DVT) were evaluated, as were the factors influencing their development, such as type of operation, age, and comorbidities. RESULTS: We reviewed the medical records of 1,306 patients. The proportions of knee arthroplasty, hip arthroplasty, and femur fracture repair were 63.4%, 29.9%, and 6.7%, respectively. The cumulative incidence of PE and DVT in patients undergoing major orthopedic surgery was 1.99% and 2.22%, respectively. Most of the patients presented with PE and DVT (61.5% and 72.4%, respectively) within the first 72 h after surgery. Patients undergoing femur fracture repair, those aged ≥ 65 years, and bedridden patients were at a higher risk for developing VTE. CONCLUSIONS: Our results show that VTE was a significant complication of major orthopedic surgery, despite the use of thromboprophylaxis. Clinicians should be aware of VTE, especially during the perioperative period and in bedridden, elderly patients (≥ 65 years of age)

Incidence of pulmonary embolism during COPD exacerbation

OBJECTIVE: Because pulmonary embolism (PE) and COPD exacerbation have similar presentations and symptoms, PE can be overlooked in COPD patients. Our objective was to determine the prevalence of PE during COPD exacerbation and to describe the clinical aspects in COPD patients diagnosed with PE. METHODS: This was a prospective study conducted at a university hospital in the city of Ankara, Turkey. We included all COPD patients who were hospitalized due to acute exacerbation of COPD between May of 2011 and May of 2013. All patients underwent clinical risk assessment, arterial blood gas analysis, chest CT angiography, and Doppler ultrasonography of the lower extremities. In addition, we measured D-dimer levels and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels. RESULTS: We included 172 patients with COPD. The prevalence of PE was 29.1%. The patients with pleuritic chest pain, lower limb asymmetry, and high NT-pro-BNP levels were more likely to develop PE, as were those who were obese or immobile. Obesity and lower limb asymmetry were independent predictors of PE during COPD exacerbation (OR = 4.97; 95% CI, 1.775-13.931 and OR = 2.329; 95% CI, 1.127-7.105, respectively). CONCLUSIONS: The prevalence of PE in patients with COPD exacerbation was higher than expected. The association between PE and COPD exacerbation should be considered, especially in patients who are immobile or obese