Should chloride-rich crystalloids remain the mainstay of fluid resuscitation to prevent ‘pre-renal’ acute kidney injury?: con

The high chloride content of 0.9% saline leads to adverse pathophysiological effects in both animals and healthy human volunteers, changes not seen after balanced crystalloids. Small randomized trials confirm that the hyperchloremic acidosis induced by saline also occurs in patients, but no clinical outcome benefit was demonstrable when compared with balanced crystalloids, perhaps due to a type II error. A strong signal is emerging from recent large propensity-matched and cohort studies for the adverse effects that 0.9% saline has on the clinical outcome in surgical and critically ill patients when compared with balanced crystalloids. Major complications are the increased incidence of acute kidney injury and the need for renal replacement therapy, and that pathological hyperchloremia may increase postoperative mortality. However, there are no large-scale randomized trials comparing 0.9% saline with balanced crystalloids. Some balanced crystalloids are hypo-osmolar and may not be suitable for neurosurgical patients because of their propensity to cause brain edema. Saline may be the solution of choice used for the resuscitation of patients with alkalosis and hypochloremia. Nevertheless, there is evidence to suggest that balanced crystalloids cause less detriment to renal function than 0.9% saline, with perhaps better clinical outcome. Hence, we argue that chloride-rich crystalloids such as 0.9% saline should be replaced with balanced crystalloids as the mainstay of fluid resuscitation to prevent ‘pre-renal’ acute kidney injury

Metabolic and cellular effects of carbohydrate-based preconditioning drinks

This thesis investigates the metabolic and cellular effects of carbohydrate-based preconditioning drinks in humans. Previous studies have demonstrated that preoperative carbohydrate loading, as opposed to overnight fasting, attenuated the development of postoperative insulin resistance by up to 50% and led to clinical benefits. Preconditioning with carbohydrate-based drinks was incorporated into enhanced recovery after surgery programs. The latter included interventions that aimed to minimise ‘metabolic-stress’ and hasten recovery after major surgery. However, the cellular mechanisms underlying the adverse effects of preoperative fasting and the beneficial effects of preconditioning with carbohydrate-based drinks were hitherto unknown. In healthy volunteers, short-term fasting (up to 24 hours) reduced liver volume, depleted liver glycogen (-50%) and lipid reserves, and increased intramyocellular lipid concentrations (+23%), as measured by magnetic resonance spectroscopy. Changes in liver glycogen were partially reversed following ingestion of a carbohydrate-based drink that also contained glutamine and antioxidants (ONS, Fresenius Kabi, Germany). Fasting also led to significantly decreased blood mononuclear cell mitochondrial complex activity. In patients undergoing laparoscopic cholecystectomy, preoperative conditioning with ONS, compared to ingestion of a placebo-drink, significantly increased intraoperative liver glycogen by 50%, increased intraoperative plasma glutamine and antioxidant concentrations, led to lower expression of skeletal muscle pyruvate dehydrogenase kinase 4 mRNA and protein expression, and finally, reduced cellular oxidative stress, as indicated by a 1.5-fold lower expression of metallothionein-1A in the ONS group. Ingestion of ONS led to markedly differing hormonal and metabolic responses compared to those following a clear carbohydrate drink (preOp®, Nutricia Clinical Care, UK), with ‘blunted’ postprandial glucose and insulin responses following ONS. Supplementing preOp® with glutamine ‘blunted’ postprandial insulin and glucose responses but this was not due to differences in glucagon-like peptide-1 concentrations. Finally, the gastric emptying of these drinks was more dependent on carbohydrate content than macronutrient composition or osmolality

MINARET: A Recommendation Framework for Scientific Reviewers

International audienceWe are witnessing a continuous growth in the size of scientific communities and the number of scientific publications. This phenomenon requires a continuous effort for ensuring the quality of publications and a healthy scientific evaluation process. Peer reviewing is the de facto mechanism to assess the quality of scientific work. For journal editors, managing an efficient and effective manuscript peer review process is not a straightforward task. In particular, a main component in the journal editors' role is, for each submitted manuscript, to ensure selecting adequate reviewers who need to be: 1) Matching on their research interests with the topic of the submission, 2) Fair in their evaluation of the submission, i.e., no conflict of interest with the authors, 3) Qualified in terms of various aspects including scientific impact, previous review/authorship experience for the journal , quality of the reviews, etc. Thus, manually selecting and assessing the adequate reviewers is becoming tedious and time consuming task. We demonstrate MINARET, a recommendation framework for selecting scientific reviewers. The framework facilitates the job of journal editors for conducting an efficient and effective scientific review process. The framework exploits the valuable information available on the modern scholarly Websites (e.g., Google Scholar, ACM DL, DBLP, Publons) for identifying candidate reviewers relevant to the topic of the manuscript, filtering them (e.g. excluding those with potential conflict of interest), and ranking them based on several metrics configured by the editor (user). The framework extracts the required information for the recommendation process from the online resources on-the-fly which ensures the output recommendations to be dynamic and based on up-to-date information

Evaluation of liver function tests and risk score assessment to screen patients for significant liver disease prior to bariatric and metabolic surgery

Bariatric and metabolic surgery is associated with significant improvement in obesity-related comorbidities, but for patients with non-alcoholic fatty liver disease (NAFLD), clinical outcomes are dependent on the severity of liver disease, i.e. improvement of NAFLD in most patients but increased risks of fulminant hepatic failure and/or bleeding varices in patients with more advanced cirrhosis. Our study showed that absolute values of liver enzymes were poor indicator of risk of liver fibrosis. The use of AST/ALT ratio, Fib 4 or NAFLD scores were appropriate screening tools, with each risk score appearing to pick out a certain phenotype of patients based on age, BMI or individual values of ALT, AST or platelet count. There is lack of agreement in some cases between FIB-4 scores and NAFLD scores when ruling out patients at high risk of liver fibrosis. Meticulous screening of patients at risk of liver fibrosis is crucial in order to reduce the risk of liver-related complications following bariatric and metabolic surgery

Genotypic and Phenotypic Structure of the Population of Phytophthora infestans in Egypt Revealed the Presence of European Genotypes

Late blight disease of potato and tomato, caused by Phytophthora infestans, results in serious losses to Egyptian and global potato and tomato production. To understand the structure and dynamics of the Egyptian population of P. infestans, 205 isolates were collected from potato and tomato plants during three growing seasons in 2010–2012. The characterization was achieved by mating-type assay, metalaxyl sensitivity assay, and virulence pattern. Additionally, genotyping of 85 Egyptian isolates and 15 reference UK isolates was performed using 12 highly informative microsatellite (SSR) markers David E. L. Cooke and five effector (RxLR) genes. Mating-type testing showed that 58% (118 of 205) of the isolates belonged to mating type A1, 35% (71 isolates) to mating type A2, and the rest 8% (16 isolates) were self-fertile. The phenotype of metalaxyl response was represented as 45% resistant, 43% sensitive, and 12% as intermediate. Structure analysis grouped the 85 identified genotypes into two main clonal lineages. The first clonal lineage comprised 21 isolates belonging to A2 mating type and 8 self-fertile isolates. This clonal lineage was identified as Blue_13 or EU_13_A2. The second main clonal lineage comprised 55 isolates and was identified as EU_23_A1. A single isolate with a novel SSR genotype that formed a distinct genetic grouping was also identified. The effector sequencing showed good correspondence with the virulence data and highlighted differences in the presence and absence of loci as well as nucleotide polymorphism that affect gene function. This study indicated a changing population of P. infestans in Egypt and discusses the findings in the context of late blight management

Microbial and Sensory Assessment of Sand Smelt Fish Burger and Finger during Frozen Storage

The current study aimed to assess the microbiological safety and sensory quality of fish burger and finger made from sand smelt fish (Atherinahepsetus) which was found unacceptable from consumers. The substitution material (soybean flour (SF) and minced boiled potatoes (MBP)) were used by different levels in this investigation to improve the sensory evaluation of produced fish products. Total bacterial count (TBC) values for burger and finger samples gradually declined till the day 45th then increased in the later period of frozen storage. Yeast and Molds growth were not detected during the frozen storage over the entire period of 90 days storage, except for zero time the score values of the quality attributes: color, taste, odor and texture, as well as overall acceptability of sand smelt fish burgers and fingers, slightly declined during frozen storage. The filling materials SF and MBP used in the production of fish products showed an observed effect in maintaining the sensory qualities of the products for 90 days of frozen storage. It can be concluded that sand smelt fish products maintained good microbial and sensory quality at the end of 90 storage period in the freezer, opening an opportunity for this good nutritious protein source to be used as a daily food

Glycated albumin and glycated albumin/ glycated haemoglobin ratio decrease with increasing BMI compared to Glycated haemoglobin in Type 2 diabetes patients

Abstract: Background: Obese T2DM patients are more prone to develop accelerated complications which burdens the global health systems with undue expenditure. Glycated haemoglobin (A1c) had been settled as a gold standard glycemic indicator though it's levels must be prudently interpreted in some patients. Glycatedalbumin (GA) as an alternative, intermediate glycemic indicator is gaining much attention. Aim: assessing the correlation of each of glycated albumin and glycated haemoglobin to body mass index (BMI) in T2DM patients Hypothesis: negative correlation existsbetween BMI & glycated albumin. Subjects and methods: Cross sectional study into which 62 participants-aged 25-60 years -who are T2DM on insulin were recruited at Suez Canal University hospital.None of them was smoker or known to be CLD or DKD patient, none was on regular statins, aspirin or metformin. All had normal CBC and albumin indices, they underwent thorough history taking & examination. anthropometric measurements namely body mass index (BMI) were taken.They were grouped into a non-obese group with BMI <25 Kg/m 2 & obese group whose BMI ≥25 Kg/m 2 , each with a sample size of 31 participants. FPG,PPPG, HbA1c, CBC, serum albumin, serum insulin and GA were analyzed.insulin resistance was measured by HOMA-IR. Results: GA was insignificantly lower in obese T2DM compared to non-obese (579.3 µmol/L vs 600.0 µmol/L,p-value = 0.631), while GA/HbA1c ratio was significantly low among obese compared to non-obese. (61.1 vs 66.8, p-value= 0.040). Also GA was insignificantly lower in obese with insulin resistance (615.0 ±177.5 µmol/L) than obese with no insulin resistance (550.0±148.2 µmol/L) and also lower than non-obese with insulin resistance (637.4±153.0 µmol/L).Similarly GA/HbA1c ratio was lower in obese with &without insulin resistance (mean 57.6 ±SD 12.8 & mean 64.1 ±SD 9.0 respectively) compared to GA/HbA1c ratio in non-obese with & without insulin resistance (mean 66.9 ±SD 11.0 & mean 66.7 ±SD 9.1 respectively). Conclusion: This study showed that care to be paid while interpreting GA levels in obese T2DM as GA and GA/HbA1c ratio are lower in this population. [Iman El -Sherif, Mohamed I. Shoeir, Mohamed M. Mohey El Din Awad, Amal Fathy and Seham Ahmed. Glycated albumin and glycated albumin/ glycated haemoglobin ratio decrease with increasing BMI compared to Glycated haemoglobin in Type 2 diabetes patients

Postoperative inflammation and insulin resistance in relation to body composition, adiposity and carbohydrate treatment: a randomised controlled study

Background and Aims: The aims of this study were to identify whether differences in distribution of adipose tissue and skeletal muscle in obese and non-obese individuals contribute to the magnitude of the postoperative inflammatory response and insulin resistance, with and without preoperative treatment with carbohydrate drinks. Methods: Thirty-two adults (16 obese/16 non-obese) undergoing elective major open abdominal surgery participated in this 22 factorial, randomised, double-blind, placebo-controlled study. Participants received Nutricia preOp® or placebo (800 ml on the night before surgery/400 ml 2-3 h preoperatively) after stratifying for obesity. Insulin sensitivity was measured using the hyperinsulinaemic-euglycaemic clamp pre- and postoperatively. Vastus lateralis, omental and subcutaneous fat biopsies were taken pre- and postoperatively and analysed after RNA extraction. The primary endpoint was within subject differences in insulin sensitivity. Results: Major abdominal surgery was associated with a 42% reduction in insulin sensitivity from mean(SD) M value of 37.3(11.8) μmol kg-1 fat free mass (FFM) to 21.7(7.4) μmol kg-1 67 FFM, but this was not influenced by obesity or preoperative carbohydrate treatment. Activation of the triggering receptor expressed on myeloid cells (TREM1) pathway was seen in response to surgery in omental fat samples. In postoperative muscle samples, gene expression differences indicated activation of the peroxisome proliferator-activated receptor (PPAR-α)/retinoid X-receptor (RXR-α) pathway in obese but not in non-obese participants. There were no significant changes in gene expression pathways associated with carbohydrate treatment. Conclusion: The reduction in insulin sensitivity associated with major abdominal surgery was confirmed but there were no differences associated with preoperative carbohydrates or obesity

Notable changes in geochemical and mineralogical characteristics of different phases of episyenitization: insights on the radioactive and shielding of the late phase

Kab Amiri granites are submitted to post-magmatic hydrothermal solutions through fracture and faults, causing several alteration processes. The most common processes are episyenitization, saussuritization, hematitization, sericitization, kaolinization, albitization, chloritization, silicification, and muscovitization. Kab Amiri granites are vuggy, with the vugs partially to completely refilled with new constituents. The least episyenitized granites have elevated amounts of Fe, P, Zr, Ni, U, Th, Ba, Y, Hf, Nb, and As, which are correlated with their mobilization from biotite, k-feldspar, plagioclase and metamict zircon. These elemental changes are related the partial albitization, muscovitization, desilicification and chloritizatiom, which lead to the mobilization of these elements and forming of specific mineral association in the least altered granites such as autonite, tripiolite, columbite, Zircon and galena. On the second stage, granites were subjected to intense alteration processes by mineralizing fluids, causing wholly muscovitization of biotite and feldspar, albitization of plagioclase, carbonitization and apatitization. Many elements were mobilized from these altered minerals, including Ti, Al, Mn, Mg, Ca, Na, K, Mo, Cu, Pb, Zn, Ag, Co, Sr, V, Cr, Sn, Rb, Ta, Li, Sc, W, S, In, and Tl, leading to definite mineralization as kaslite, monazite, xenotime, polycrase and apatite. The mineralizing fluids in the least and highly episyenitized granites are incorporated in some ore minerals like uranophane, fergusonite, bazzite and garnet. Notably, the presence of elements such as U, Th, and other heavy metals in Kab Amiri granites highlights the potential for these rocks in radiation shielding applications. The unique combination of elements and minerals resulting from the alteration processes can be leveraged for developing new materials or enhancing existing materials used in radiation shielding

Modifying the m6A brain methylome by ALKBH5-mediated demethylation: a new contender for synaptic tagging

Synaptic plasticity processes, which underlie learning and memory formation, require RNA to be translated local to synapses. The synaptic tagging hypothesis has previously been proposed to explain how mRNAs are available at specific activated synapses. However how RNA is regulated, and which transcripts are silenced or processed as part of the tagging process is still unknown. Modification of RNA by N6-methyladenosine (m6A/m) influences the cellular fate of mRNA. Here, by advanced microscopy, we showed that m6A demethylation by the eraser protein ALKBH5 occurs at active synaptic ribosomes and at synapses during short term plasticity. We demonstrated that at activated glutamatergic post-synaptic sites, both the YTHDF1 and YTHDF3 reader and the ALKBH5 eraser proteins increase in co-localisation to m6A-modified RNAs; but only the readers showed high co-localisation to modified RNAs during late-stage plasticity. The YTHDF1 and YTHFDF3 readers also exhibited differential roles during synaptic maturation suggesting that temporal and subcellular abundance may determine specific function. m6A-sequencing of human parahippocampus brain tissue revealed distinct white and grey matter m6A methylome profiles indicating that cellular context is a fundamental factor dictating regulated pathways. However, in both neuronal and glial cell-rich tissue, m6A effector proteins are themselves modified and m6A epitranscriptional and posttranslational modification processes coregulate protein cascades. We hypothesise that the availability m6A effector protein machinery in conjunction with RNA modification, may be important in the formation of condensed synaptic nanodomain assemblies through liquid-liquid phase separation. Our findings support that m6A demethylation by ALKBH5 is an intrinsic component of the synaptic tagging hypothesis and a molecular switch which leads to alterations in the RNA methylome, synaptic dysfunction and potentially reversible disease states