Trends in procedure type, patient characteristics, and outcomes among persons with knee osteoarthritis undergoing bariatric surgery, 2005-2014.

OBJECTIVE: To evaluate trends in the utilization, clinical characteristics, and inpatient outcomes among persons with knee osteoarthritis undergoing bariatric surgery. METHOD: We used the National Inpatient Sample (NIS) to examine trends of bariatric surgeries performed on adults with clinically documented knee osteoarthritis between 2005 and 2014. We abstracted hospital setting, procedure, demographic and clinical characteristics, and inpatient surgical outcomes from each discharge. We examined temporal trends using linear regression and Cochran-Armitage test for trend. RESULTS: The utilization of bariatric surgery among persons with knee osteoarthritis from 2005 to 2014 remained consistent, with an annual total of about 3,300 procedures performed nationally. The most common procedure type changed from laparoscopic Roux-en-Y (65%) in 2005-2006 to laparoscopic sleeve gastrectomy (58%) in 2013-2014. The median age, proportion on Medicare, and age- and sex-adjusted prevalence of diabetes increased from 46 to 51 years, 7-23%, and 28-32%, respectively. From 2005 to 2014, the median adjusted costs, in 2017 USD, for laparoscopic and open Roux-en-Y surgeries decreased from $15,100 to $13,300 (p < 0.01) and $14,100 to $10,100 (p = 0.0001), respectively, whereas the costs of laparoscopic sleeve gastrectomy and laparoscopic banding did not change significantly. In-hospital mortality remained at 0.0-0.1% from 2005 to 2014. CONCLUSION: Although growing evidence suggests that bariatric surgery is associated with improvements in osteoarthritis pain and functional status, the utilization of bariatric surgery among morbidly obese persons with knee osteoarthritis remained consistent from 2005 to 2014. Bariatric surgery in persons with knee osteoarthritis is generally safe, as inpatient complication and mortality rates remained low despite an increase in age and number of comorbidities.

Comparative pain reduction of oral non-steroidal anti-inflammatory drugs and opioids for knee osteoarthritis: systematic analytic review.

OBJECTIVE: Summarize the comparative effectiveness of oral non-steroidal anti-inflammatory drugs (NSAIDs) and opioids in reducing knee osteoarthritis (OA) pain. METHODS: Two reviewers independently screened reports of randomized controlled trials (RCTs), published in English between 1982 and 2015, evaluating oral NSAIDs or opioids for knee OA. Included studies were at least 8 weeks duration, conducted in Western Europe, the Americas, New Zealand, or Australia, and reported baseline and follow-up pain using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain subscale (0-100, 100-worst). Effectiveness was evaluated as reduction in pain, accounting for study dropout and heterogeneity. RESULTS: Twenty-seven treatment arms (nine celecoxib, four non-selective NSAIDs [diclofenac, naproxen, piroxicam], eleven less potent opioids [tramadol], and three potent opioids [hydromorphone, oxycodone]) from 17 studies were included. NSAID and opioid studies reported similar baseline demographics and efficacy withdrawal rates; NSAID studies reported lower baseline pain and toxicity withdrawal rates. Accounting for efficacy-related withdrawals, all drug classes were associated with similar pain reductions (NSAIDs: -18; less potent opioids: -18; potent opioids: -19). Meta-regression did not reveal differential effectiveness by drug class but found that study cohorts with a higher proportion of male subjects and worse mean baseline pain had greater pain reduction. Similarly, results of the network meta-analysis did not find a significant difference in WOMAC Pain reduction for the three analgesic classes. CONCLUSION: NSAIDs and opioids offer similar pain relief in OA patients. These data could help clinicians and patients discuss likely benefits of alternative analgesics.

Evaluation of product analogues for purification of penicillinase by affinity chromatography.

Among different matrices prepared, ampicilloic acid-polymer matrix offered 86.7% adsorption, 95% elution and 82.4% overall recovery of penicillinase. The structure of both the side chain and penicilloic or cephalosporoic acid moieties contribute to the affinity interactions.

Non-healing diabetic ulcer treated by biobeam 660.

A case of 75-year-old male patient with a non-healing ulcer over left sole is reported. Patient was a known diabetic with CCF. The ulcer was not healing for one month with routine treatment. The patient was given BIOBEAM 660 therapy every alternate days for a month which led to complete healing of the ulcer without complications.

Cephalosporin C acylase and penicillin V acylase formation by Aeromonas sp. ACY 95.

Aeromonas sp. ACY 95 produces constitutively and intracellularly a penicillin V acylase at an early stage of fermentation (12 h) and a cephalosporin C acylase at a later stage (36 h). Some penicillins, cephalosporin C and their side chain moieties/analogues, phenoxyacetic acid, penicillin V and penicillin G, enhanced penicillin V acylase production while none of the test compounds affected cephalosporin C acylase production. Supplementation of the medium with some sugars and sugar derivatives repressed enzyme production to varying degrees. The studies on enzyme formation, induction and repression, and substrate profile suggest that the cephalosporin C acylase and penicillin V acylase are two distinct enzymes. Substrate specificity studies indicate that the Aeromonas sp. ACY 95 produces a true cephalosporin C acylase which unlike the enzymes reported hitherto hydrolyses cephalosporin C specifically.

Expanded bed chromatography and radial flow column chromatography: the approaches for adsorption chromatography of biomolecules on industrial scale.

Adsorption of proteins directly from unclarified feed-stocks, has gained importance in the recovery of biomolecules on Industrial scale. Adsorption in expanded beds and radial flow gives significantly better results compared to conventional column chromatography methods for downstream processing of variety of proteins from particulate-containing feed-stocks, such as fermentation broths and cells extracts. The simple operation of these techniques reduces the complexity of downstream processing by eliminating steps such as filtration, centrifugation and concentration. One step purification, with simple equipment, these techniques enable to recover pure protein with 95% yield in biotechnological industry. The principles, operating procedures, adsorbents and applications of these techniques are discussed.

Molecular biology of ß-lactam acylases.

ß-Lactam acylases such as penicillin G acylases, penicillin V acylases and glutaryl 7-aminocephalosporanic acid acylases are used in the manufacture of 6-aminopenicillanic acid, 7-aminodesacetoxycephalosporanic acid and 7-aminocephalosporanic acid (7-ACA). Genetically-engineered strains producing 1050 U/g, 3200 U/g and 7000 to 10,000 U/I of penicillin G acylase, penicillin V acylase and glutaryl-7-ACA acylase, respectively, have been developed. The penicillin G acylase studied to date and the glutaryl-7-ACA acylase from Pseudomonas sp. share some common features: the active enzyme molecules are composed of two dissimilar subunits that are generated from respective precursor polypeptide; the proteolytic processing is a post-translational modification which is regulated by temperature; and the Ser residue at the N-terminus of the ß-sub-unit (Ser(290); penicillin G acylase numbering) is implicated as the active site residue. Protein engineering, to generate penicillin G acylase molecules and their precursors with altered sequences, and the structure-function correlation of the engineered molecules are discussed.

Comparative evaluation of determination of beta-lactam intermediates.

The Schiff's base formation between 6-aminopenicillanic acid, 7-aminodesacetoxycephalosporanic acid and 7-aminocephalosporanic acid and p-dimethylaminobenzaldehyde (PDAB) was investigated. The factors that affect the reaction such as concentration of PDAB, time and pH were studied and optimised for estimation of these intermediates.

Cephalosporin acylases: enzyme production, structure and application in the production of 7-ACA.

Cephalosporin acylases have application in the production of 7-aminocephalosporanic acid which forms a key raw material for the preparation of semisynthetic injectable cephalosporins. The enzymes are of industrial importance and hyperproducing genetically engineered strains have been constructed. Different aspects of these enzymes such as subunit structure, post translational modification, primary structure, substrate specificity and their importance in pharmaceutical industry are discussed.

Production of extracellular acidic lipase by Rhizopus arrhizus as a function of culture conditions.

Thermophilic strain of Rhizopus arrhizus accumulates an acidic lipase in culture fluid when grown in a medium containing ground nut oil, milk powder and inorganic salts. Addition of 2.0% ground nut oil yielded the highest productivity of enzyme. Soyabean meal and arabinose were found to be the best nitrogen and carbon sources for enzyme production respectively. Addition of metal ions such as MnCl2, SnCl2 and CaCl2 increased the enzyme productivity by 4 fold. The enzyme productivity in the fermenter was much higher (310 U/ml) than in shake-flask (180 U/ml). Crude lipase preparation showed pH and temperature activity optima at 3.5 and 45 degrees C respectively. The enzyme is thermostable and highly active in hydrolysing triglycerides and failed to hydrolyse-methyl esters of caprylate and palmitate.

Beijerinckia indica var. penicillanicum penicillin V acylase: enhanced enzyme production by catabolite repression-resistant mutant and effect of solvents on enzyme activity.

Beijerinckia indica var. penicillanicum mutant UREMS-5, producing 168% more penicillin V acylase, was obtained by successive treatment with UV, gamma-irradiation and ethylmethane sulfonate. Penicillin V acylase production by the mutant strain was resistant to catabolite repression by glucose. Incorporation of glucose, sodium glutamate and vegetable oils in the medium enhanced enzyme production. The maximum specific production of penicillin V acylase was 244 IU/g dry weight of cells. Effect of solvents on hydrolysis of penicillin V by soluble penicillin V acylase and whole cells was studied. Methylene chloride, chloroform and carbon tetrachloride significantly stimulated the rate of penicillin V hydrolysis by whole cells.

Persistence of Candida sp. 115 during hydrolysis of penicillin G and metabolism of phenylacetic acid.

The growth of Candida sp. 115 was investigated on the constituents of penicillin G hydrolysis reaction mixture. Neither penicillin G nor 6-aminopenicillanic acid was degraded or utilised for growth. The yeast accepted phenylacetic acid, sodium acetate and glucose as growth substrates. Phenylacetic acid was metabolised via p-hydroxy phenylacetic acid, which was the only accumulated metabolite. The enzymes responsible for hydroxylation of phenylacetic acid were induced by phenylacetic acid and sodium acetate.

Enzymatic hydrolysis of 7-phenylacetamidodesacetoxycephalosporanic acid by immobilized penicillin G acylase.

Enzymatic parameters such as pH, temperature and substrate concentration were studied for the hydrolysis of 7-PADCA by penicillin G acylase. Optimum pH and temperature were 8.0 and 50 degrees C, respectively. Km value of soluble and immobilized enzyme for 7-PADCA was 2.3 x 10(-5) M and 7.5 x 10(-5) M, respectively. At 7-PADCA concentration of 5% and an IME: 7-PADCA ratio of 1:2.5, the hydrolysis was complete in 110 min.

A comparative evaluation of ELISA and latex agglutination tests for detection of human chorionic gonadotropin (hCG) in urine for pregnancy.

PIP: To resolve questions about the relative sensitivity and specificity of the latex agglutination and enzyme-linked immunosorbent assay (ELISA) for the detection of human chorionic gonadotropin (hCG) in pregnancy, urine samples from 265 cases of suspected pregnancy were tested simultaneously by both methods. Included in the sample were women whose menstrual period ranged from 5-60 days late. In 243 cases (92%), identical results were obtained with both tests (142 positive and 101 negative). In an additional 12 cases, urine samples containing low levels of hCG when tested by the latex agglutination test showed negative results, while the same samples showed positive pregnancy (subsequently confirmed clinically) when tested by ELISA. Finally, 10 urine samples with red blood cells or pus cells gave false positive results on the latex agglutination test, but these cells did not interfere in the ELISA test. The lag period after the last menstrual period was 5-7 days for ELISA compared with 20 days for the latex agglutination test. The sensitivity of the former test was 0.5 IU hCG/ml of urine and 3.5 IU hCG/ml of urine for the latter test. Other advantages of the ELISA test are its stability (reagents are stable at room temperature, while those of the latex agglutination test are not), and its very clear and easy to read end point. The only advantage of the latex agglutination test was the time required for performing the test (5 minutes, compared with 40-50 minutes for ELISA).^ieng

Metabolic differentiation of homologous leg muscles of two aquatic birds at the level of enzymatic organization.

The quantitative determination of succinic dehydrogenase (SDH), hexokinase (HK), phosphorylase, phosphofructokinase (PFK), glycerol-3-phosphate dehydrogenase (G-3-PDH) and lactate dehydrogenase (LDH) was carried out in the homologous leg muscles of two aquatic Birds. It appears that the leg muscle fibres of the coot, a surface swimmer are more oxidative in nature and appear to utilize glucose as source of energy. The leg muscles of the dabchick, a diving Bird, on the other hand, seem to depend on glycogen as source of energy. The relative activity levels of HK, phosphorylase and PFK support the accepted rôle of glycogen as primary substrate of carbohydrate catabolism in the leg muscles. The ratio of G-3-PDH/LDH in the leg muscles revealed that glycerol 3-phosphate cycle appears to be insufficient to account for the major part of NADH oxidation. However, the LDH activity is quite high in all the muscles. These results led us to believe that glycerol 3-phosphate cycle may function during rest, when the rate of glycolysis will be low.