Changes in ceftriaxone pharmacokinetics/pharmacodynamics during the early phase of sepsis: a prospective, experimental study in the rat

Abstract Background Sepsis is characterized by the loss of the perm-selectivity properties of the glomerular filtration barrier (GFB) with consequent albuminuria. We examined whether the pharmacokinetics–pharmacodynamics (PK/PD) of ceftriaxone (CTX), an extensively protein-bound 3rd generation cephalosporin, is altered during early sepsis and whether an increase in urinary loss of bound-CTX, due to GFB alteration, can occur in this condition. Methods A prospective, experimental, randomized study was carried out in adult male Sprague–Dawley rats. Sepsis was induced by cecal ligation and puncture (CLP). Rats were divided into two groups: Sham-operated and CLP. CTX (100 mg i.p., equivalent to 1 g dose in humans) was administered in order to measure plasma and lung CTX concentrations at several time-points: baseline and 1, 2, 4 and 6 h after administration. CTX was measured by High Performance Liquid Chromatography (HPLC). The morphological status of the sialic components of the GFB barrier was assessed by lectin histo-chemistry. Monte Carlo simulation was performed to calculate the probability of target attainment (PTA >90%) for 80 and 100% of Tfree > minimum inhibitory concentration (MIC) for 80 and 100% of dosing interval. Measurements and main results After CLP, sepsis developed in rats as documented by the growth of polymicrobial flora in the peritoneal fluid (≤1 × 101 CFU in sham rats vs 5 × 104–1 × 105 CFU in CLP rats). CTX plasma concentrations were higher in CLP than in sham rats at 2 and 4 h after administration (difference at 2 h was 47.3, p = 0.012; difference at 4 h was 24.94, p = 0.004), while lung penetration tended to be lower. An increased urinary elimination of protein-bound CTX occurred (553 ± 689 vs 149 ± 128 mg/L, p < 0.05; % of bound/total CTX 22 ± 6 in septic rats vs 11 ± 4 in sham rats, p < 0.01) and it was associated with loss of the GFB sialic components. According to Monte Carlo simulation a PTA > 90% for 100% of the dosing interval was reached neither for sham nor CLP rats using MIC = 1 mg/L, the clinical breakpoint for Enterobacteriacee. Conclusions Sepsis causes changes in the PK of CTX and an alteration in the sialic components of the GFB, with consequent loss of protein-bound CTX. Among factors that can affect drug pharmacokinetics during the early phases of sepsis, urinary loss of both free and albumin–bound antimicrobials should be considered

TRY plant trait database – enhanced coverage and open access

Plant traits - the morphological, anatomical, physiological, biochemical and phenological characteristics of plants - determine how plants respond to environmental factors, affect other trophic levels, and influence ecosystem properties and their benefits and detriments to people. Plant trait data thus represent the basis for a vast area of research spanning from evolutionary biology, community and functional ecology, to biodiversity conservation, ecosystem and landscape management, restoration, biogeography and earth system modelling. Since its foundation in 2007, the TRY database of plant traits has grown continuously. It now provides unprecedented data coverage under an open access data policy and is the main plant trait database used by the research community worldwide. Increasingly, the TRY database also supports new frontiers of trait‐based plant research, including the identification of data gaps and the subsequent mobilization or measurement of new data. To support this development, in this article we evaluate the extent of the trait data compiled in TRY and analyse emerging patterns of data coverage and representativeness. Best species coverage is achieved for categorical traits - almost complete coverage for ‘plant growth form’. However, most traits relevant for ecology and vegetation modelling are characterized by continuous intraspecific variation and trait–environmental relationships. These traits have to be measured on individual plants in their respective environment. Despite unprecedented data coverage, we observe a humbling lack of completeness and representativeness of these continuous traits in many aspects. We, therefore, conclude that reducing data gaps and biases in the TRY database remains a key challenge and requires a coordinated approach to data mobilization and trait measurements. This can only be achieved in collaboration with other initiatives

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR &lt; 60 mL/min/1.73 m2) or eGFR reduction &gt; 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR &lt; 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR &gt; 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Pattern Recognition And Classification For Electrical Energy Use In Residential Buildings

In the last years, researchers and energy utilities are showing a rising interest in the study and definition of actual buildings’ energy uses. A key aspect of this investigation is the description of daily energy use patterns and their variability over the time. This paper discusses the application of machine learning techniques for pattern recognition with the implementation of a Self-Organizing Map (SOM) algorithm coupled with a k-means clustering algorithm on a dataset of registered electrical energy use in a residential building located in Milan. In the study, five clusters emerged with different daily patterns, that can be ascribed to different uses of electric appliances by people inside the flats

Luminescence properties of mixed-ligand MOFs containing fluorene scaffolds functionalized with isonicotinoyl arms

Solvothermal reactions between three bis-pyridine-bis-amide ligands containing a fluorene scaffold bearing different substituents on the C9 position (CH2, 1; CMe2 , 2; CO, 3) with 2,6-naphthalenedicarboxylic acid (H2ndca) and Zn(NO3)2·6H2O led to the isolation of three new microporous mixed-ligand MOFs (PUM310, containing 1; PUM310Me2, containing 2; PUM310CO, containing 3). The structural characterization conducted with X-ray quality single crystals revealed parallel polycatenated frameworks of thick layers in all cases, corresponding to the topological type 5,6L18. The entangled nets contain complete and truncated Zn-paddle wheels. In the truncated paddle wheel, a pyridine of the bis-amide linker has been replaced by a DMF molecule. Solvent removal leads to framework rearrangement, as evidenced by XRPD analysis performed on desolvated PUM310, with consequent framework shrinkage as also evidenced by volumetric adsorption analyses. The three MOFs are fluorescent in the solid state. The optical spectra are indicative of a Förster resonance energy transfer (FRET) involving ndca2− as an excitation energy donor and the bis-pyridine linkers as acceptors, with a FRET efficiency close to 100% in the case of PUM310C

Individuals size estimations of the sperm whales from the Gulf of Taranto (Northern Ionian Sea, Central Mediterranean Sea) employing clicks’ Inter-Pulse-Interval (IPI) measurements

For the purpose of conserving vulnerable species included in the Habitats Directive as well as species indicating the state of ecosystem health, according to the Marine Strategy Framework Directive, regular basis information on their populations and demography trends are necessary. In this study, an indirect assessment of the individual size and age of sperm whales sighted in the Gulf of Taranto (Northern Ionian Sea, Central Mediterranean Sea) was carried out by means of acoustic analysis of the Inter-Pulse-Interval (IPI) values of the clicks recorded from June to November 2020. The open software CABLE was employed to calculate first the IPI of the animals, then their body length, using two different equations. The obtained size estimates were then compared with ones visually made by observers on the field. The results show that, except for two individuals of 13 m and 14 m in length, most of the recorded animals are individuals of 8 m-10 m in length, corresponding to the age class of mature females or young males. An evaluation of IPIs of sperm whales recorded in different Mediterranean areas will allow verifying if most Mediterranean sperm whales belong to younger age classes indicating that the population is still recovering from the past centuries of direct catch

Pyrgi, l'area a nord del santuario. Nuovi dati dalle recenti campagne di scavo

The district North of Temple A, intermediate between the Monumental Sanctuary, the settlement and the harbour, played a fundamental role in the urbanistic development of the Etruscan site of Pyrgi. It includes the intersection between the terminal trait of the main road connecting Caere to the coastline and the large pebbled road leading towards the harbour, and different buildings erected along the latter track. Recent fieldwork (2011-2016) has shed light on the layout of the district and its progressive transformation, starting from the 7th century BC. Its peculiar function is proved by the many ritual actions performed to stress meaningful events, such as the deposition of a dissected dog for the foundation of a trapezoidal tower-building North of the pebbled road and the deposition of selected imported items (5 phoenician oil lamps, the gorgonic mask of a campanian antefix and ionian pottery shapes) inside the so called "Edificio porticato", erected at the intersection between the two roads. Extremely meaningful is the sequence of archaic decorated roofs (ionian, campanian and caeretan style) attested by several fragments of architectural terracottas, highlighting the fundamental role of Caere (and Pyrgi) in the reception/elaboration of architectural decorative systems, thanks to its strict cultural contacts with Latium and Campania/Cuma