Development of Novel Spray-dried Microparticles to Treat Cystic Fibrosis: A Tri-drug Approach.

BACKGROUND: Cystic fibrosis is the predominant autosomal recessive disorder known to reduce life expectancy. Research findings indicate that around 60 to 70% of adult individuals with this condition carry infections of Pseudomonas aeruginosa. OBJECTIVE: The ongoing research investigates the potential synergy of merging ivacaftor and ciprofloxacin to address bacterial infections. METHODS: The two drugs were spray-dried into microparticles, which were then coated with Lsalbutamol and were to be delivered by a dry powder inhaler. Microparticles were generated by applying the spray drying method, utilizing bovine serum albumin and L-leucine in their preparation. Additionally, L-salbutamol was mixed and adsorbed onto the surface of the spray-dried microparticles, and it acted as a bronchodilator. RESULTS: The microparticles produced via spray drying exhibited a particle size measuring 1.6 ± 0.04 µm, along with a polydispersity ratio of 0.33. Their zeta potential measured -27.3 ± 1.1 mV, while the mass median aerodynamic diameter of these microparticles was 3.74 ± 0.08 µm. SEM, XRD, and FTIR studies confirmed the entrapment of ivacaftor and ciprofloxacin. The morphology was observed by SEM and TEM scans. Antibacterial synergy was confirmed through the agar broth and dilution method, and the formulation's safety was established based on the outcomes of the MTT assay. CONCLUSION: Using spray-dried microparticles containing ciprofloxacin, ivacaftor, and L-salbutamol presents a novel approach to the treatment of cystic fibrosis.

Novel therapeutic approach for the treatment of cystic fibrosis based on freeze-dried tridrug microparticles to treat cystic fibrosis.

BACKGROUND: Cystic fibrosis is a severe, autosomal recessive disease that shortens life expectancy. According to studies, approximately 27% of patients with CF aged 2-5 years and 60 to 70% of adult patients are infected with P. aeruginosa. The patients experience bronchospasm leading to a persistent contracted state of the airways. OBJECTIVES: The current work explores the possibility of combining ivacaftor and ciprofloxacin to combat the bacteria. A third drug L-salbutamol would be coated onto the surface of the drug-entrappped microparticles to instantaneously provide relief from bronchoconstriction. METHODS: The microparticles were prepared using bovine serum albumin and L-leucine using the freeze-drying approach. The process and formulation parameters were optimized. The prepared microparticles were surface coated by L-salbutamol using the dry-blending method. The microparticles were subjected to rigorous in-vitro characterization for entrapment, inhalability, antimicrobial activity, cytotoxicity study and safety. The performance of the microparticles to be loaded into a inhaler was checked by the Anderson cascade impactor. RESULTS: The freeze-dried microparticles had a particle size of 817.5 ± 5.6 nm with a polydispersity ratio of 0.33. They had a zeta potential of -23.3 ± 1.1 mV. The mass median aerodynamic diameter of the microparticles was 3.75 ± 0.07 µm, and the geometric standard diameter was 1.66 ± 0.033 µm. The microparticles showed good loading efficiency for all three drugs. DSC, SEM, XRD, and FTIR studies confirmed the entrapment of ivacaftor and ciprofloxacin. SEM and TEM scans observed the shape and the smooth surface. Antimicrobial synergism was proven by the agar broth, and dilution technique and the formulation was deemed safe by the results of the MTT assay. CONCLUSION: Freeze-dried microparticles of ivacaftor, ciprofloxacin, and L-salbutamol could pave way to a hitherto unexplored combination of drugs as a novel approach to treat P. aeruginosa infcetions and bronchoconstriction commonly associated with cystic fibrosis.

Integrated multi-omics analysis of Alzheimer's disease shows molecular signatures associated with disease progression and potential therapeutic targets.

Alzheimer's disease (AD) is a progressive neurodegenerative disease characterized by the formation of amyloid plaques implicated in neuronal death. Genetics, age, and sex are the risk factors attributed to AD. Though omics studies have helped to identify pathways associated with AD, an integrated systems analysis with the available data could help to understand mechanisms, potential biomarkers, and therapeutic targets. Analysis of transcriptomic data sets from the GEO database, and proteomic and metabolomic data sets from literature was performed to identify deregulated pathways and commonality analysis identified overlapping pathways among the data sets. The deregulated pathways included those of neurotransmitter synapses, oxidative stress, inflammation, vitamins, complement, and coagulation pathways. Cell type analysis of GEO data sets showed microglia, endothelial, myeloid, and lymphoid cells are affected. Microglia are associated with inflammation and pruning of synapses with implications for memory and cognition. Analysis of the protein-cofactor network of B2, B6, and pantothenate shows metabolic pathways modulated by these vitamins which overlap with the deregulated pathways from the multi-omics analysis. Overall, the integrated analysis identified the molecular signature associated with AD. Treatment with anti-oxidants, B2, B6, and pantothenate in genetically susceptible individuals in the pre-symptomatic stage might help in better management of the disease.

Integrated multi-omic data analysis and validation with yeast model show oxidative phosphorylation modulates protein aggregation in amyotrophic lateral sclerosis.

Amyotrophic Lateral Sclerosis is a progressive, incurable amyloid aggregating neurodegenerative disease involving the motor neurons. Identifying potential biomarkers and therapeutic targets can assist in the better management of the disease. We used an integrative approach encompassing analysis of transcriptomic datasets of human and mice from the GEO database. Our analysis of ALS patient datasets showed deregulation in Non-alcoholic fatty acid liver disease and oxidative phosphorylation. Transgenic mice datasets of SOD1, FUS and TDP-43 showed deregulation in oxidative phosphorylation and ribosome-associated pathways. Commonality analysis between the human and mice datasets showed oxidative phosphorylation as a major deregulated pathway. Further, protein-protein and protein-drug interaction network analysis of mitochondrial electron transport chain showed enrichment of proteins and inhibitors of mitochondrial Complex III and IV. The results were further validated using the yeast model system. Inhibitor studies using metformin (Complex-I inhibitor) and malonate (Complex-II inhibitor) did not show any effect in mitigating the amyloids, while antimycin (Complex-III inhibitor) and azide (Complex-IV inhibitor) reduced amyloidogenesis. Knock-out of QCR8 (Complex-III) or COX8 (Complex-IV) cleared the amyloids. Taken together, our results show a critical role for mitochondrial oxidative phosphorylation in amyloidogenesis and as a potential therapeutic target in ALS.Communicated by Ramaswamy H. Sarma.

Integrated network pharmacology approach shows a potential role of Ginseng catechins and ginsenosides in modulating protein aggregation in Amyotrophic Lateral Sclerosis.

Amyotrophic lateral Sclerosis is an incurable, progressive neurodegenerative motor neuron disease. The disease is characterized by protein aggregates. The symptoms include weakness, denervation of muscles, atrophy and progressive paralysis of bulbar and respiratory muscles and dysphagia. Various secondary metabolites are evaluated for their ability to improve symptoms in ALS. Ginseng has been traditionally used for treating several neurodegenerative diseases. Several studies using model systems have shown a potential role of Ginseng catechins and Ginsenosides in clearing protein aggregation associated with ALS. We focus on Network pharmacology approach to understand the effect of Ginseng catechins or ginsenosides on protein aggregation associated with ALS. A catechin/ginsenoside-protein interaction network was generated and the pathways obtained were compared with those obtained from transcriptomic datasets of ALS from GEO database. Knock out of MAPK14, AKT and GSK from Catechin and BACE 1 from ginsenoside modulated pathways inhibited protein aggregation. Catechins and ginsenosides have potential as therapeutic agents in the management of ALS. Supplementary Information: The online version contains supplementary material available at 10.1007/s13205-022-03401-1.

Contemporary utilization of the axillary artery in cardiac surgery.

INTRODUCTION: The axillary artery is a reliable inflow vessel when addressing pathology of the aortic root and aortic arch that may preclude standard central cannulation strategies. This narrative review examines the use of the axillary artery in cardiac surgery. Anatomy, indications for use, cannulation strategies, and potential complications will be discussed. METHODS: A comprehensive review of the current literature was performed using PubMed, Cochrane Review, and authoritative committee guidelines. A narrative review incorporating current available evidence was undertaken. COMMENT: Use of the axillary artery in select cardiac surgical cases is reliable, reproducible, and may be preferable in certain cases involving ascending aortic pathology, reoperative surgery, porcelain aorta, access for transcatheter valve therapies, and peripheral mechanical circulatory support.

Successful Lung Transplantation for Severe Post-COVID-19 Pulmonary Fibrosis.

Lung transplantation has been well described for patients with coronavirus disease 2019 (COVID-19) in the acute setting, but less so for the resulting pulmonary sequelae. This report describes a case of lung transplantation for post-COVID-19 pulmonary fibrosis. A 52-year-old woman contracted COVID-19 in July 2020 and mounted a partial recovery, but she went on to have declining function over the ensuing 3 months, with development of fibrocystic lung changes. She underwent bilateral lung transplantation and recovered rapidly, was discharged home on postoperative day 14, and has done well in follow-up. This case report demonstrates that lung transplantation is an acceptable therapy for post-COVID-19 pulmonary fibrosis.

Deep learning for screening of interstitial lung disease patterns in high-resolution CT images.

AIM: To develop a screening tool for the detection of interstitial lung disease (ILD) patterns using a deep-learning method. MATERIALS AND METHODS: A fully convolutional network was used for semantic segmentation of several ILD patterns. Improved segmentation of ILD patterns was achieved using multi-scale feature extraction. Dilated convolution was used to maintain the resolution of feature maps and to enlarge the receptive field. The proposed method was evaluated on a publicly available ILD database (MedGIFT) and a private clinical research database. Several metrics, such as success rate, sensitivity, and false positives per section were used for quantitative evaluation of the proposed method. RESULTS: Sections with fibrosis and emphysema were detected with a similar success rate and sensitivity for both databases but the performance of detection was lower for consolidation compared to fibrosis and emphysema. CONCLUSION: Automatic identification of ILD patterns in a high-resolution computed tomography (CT) image was implemented using a deep-learning framework. Creation of a pre-trained model with natural images and subsequent transfer learning using a particular database gives acceptable results.

High-quality results of cytoreductive surgery and heated intraperitoneal chemotherapy perfusion for carcinomatosis at a low volume institution.

BACKGROUND AND OBJECTIVES: Maximal cytoreductive surgery (CS) with heated intraperitoneal chemotherapy perfusion (HIPEC) for peritoneal carcinomatosis can improve oncologic outcomes, but is associated with significant morbidity. Whether low-volume experience with CS/HIPEC results in acceptable outcomes is unknown. METHODS: A retrospective review of all patients undergoing CS/HIPEC by a single surgeon. Experience was divided into first versus second 50 cases, and patient characteristics, operative details, and outcomes were compared. RESULTS: Ninety patients underwent 100 CS/HIPEC procedures (mean age 57 years, 68% female). -Compared to the initial experience, the second 50 cases included more high grade tumors (68 vs. 52%) and greater disease burden (PCI 14.2 vs. 12.4). Operative times remained unchanged and mean blood loss decreased (978 vs. 684 ml). Hospital stay (mean 18.1 vs. 12.6 days), major complications (24 vs. 16%), and perioperative mortality (8 vs. 2%) declined. Overall median survival was 18 months and was longer with low grade tumors (26 vs. 16 months, P = 0.03). CONCLUSIONS: Patients experienced reduced EBL, fewer major complications, and shorter hospital stay, despite having higher disease burden and higher grade tumors. This suggests that even low-volume experience with CS/HIPEC can lead to a trend in reduction of adverse perioperative events with acceptable oncologic outcomes.

Identification of a WD40 repeat-containing isoform of PHIP as a novel regulator of beta-cell growth and survival.

The pleckstrin homology domain-interacting protein (PHIP) was originally identified as a 902-amino-acid (aa) protein that regulates insulin receptor-stimulated GLUT4 translocation in skeletal-muscle cells. Immunoblotting and immunohistological analyses of pancreatic beta-cells reveal prominent expression of a 206-kDa PHIP isoform restricted to the nucleus. Herein, we report the cloning of this larger, 1,821-aa isoform of PHIP (PHIP1), which represents a novel WD40 repeat-containing protein. We demonstrate that PHIP1 overexpression stimulates insulin-like growth factor 1-dependent and -independent proliferation of beta-cells, an event which correlates with transcriptional upregulation of the cyclin D2 promoter and the accumulation of cyclin D2 protein. RNA interference knockdown of PHIP1 in INS-1 cells abrogates insulin receptor substrate 2 (IRS2)-mediated DNA synthesis, providing for a specific role for PHIP1 in the enhancement of IRS2-dependent signaling responses leading to beta-cell growth. Finally, we provide evidence that PHIP1 overexpression blocks free fatty acid-induced apoptosis in INS-1 cells, which is accompanied by marked activation of phosphoprotein kinase B (PKB)/AKT and the concomitant inhibition of caspase-9 and caspase-3 cleavage. Our finding that the restorative effect of PHIP1 on beta-cell lipotoxicity can be attenuated by the overexpression of dominant-negative PKB suggests a key role for PKB in PHIP1-mediated cytoprotection. Taken together, these findings provide strong support for PHIP1 as a novel positive regulator of beta-cell function. We suggest that PHIP1 may be involved in the induction of long-term gene expression programs to promote beta-cell mitogenesis and survival.

Teratoma of palatine tonsil in a neonate.

Among many causes of respiratory distress and feeding difficulties in the neonatal period, a tumor involving oropharyngeal region is very rare. But still rarer is the unique presentation of this case of teratoma tonsil with intermittent attacks of choking with cyanosis.

Mesothelial cyst at porta hepatis.

Mesothelial cysts are fluid-filled sacs lined by mesothelial cells. They are rare lesions that have been known to occur at various sites, but have not been reported at the porta hepatis. We report a 45-year-old woman with mesothelial cyst at the porta hepatis that was detected incidentally during open cholecystectomy.

A comparison of worker exposure to inhalable and total dust, inorganic arsenic, and borates using two types of particulate sampling assemblies in a borate mining and processing facility.

This study describes a comparison of worker exposure to total and inhalable dust, inorganic As, and borates using two types of particulate sampling assemblies as part of a comprehensive industrial hygiene evaluation in a borate mining and processing facility. Employees were segmented into similar exposure groups (SEG) based on work location within the facility, job classification, and type of chemical agent. Approximately 10% of the employees from each SEG wore two personal sampling devices simultaneously for the purpose of collecting total and inhalable particulate fractions using a closed face, 37-mm mixed cellulose ester matched-weight filters (MMW), and Institute of Occupational Medicine (IOM) sampling assembly. Sample results indicated that the IOM concentrations were consistently higher than the corresponding MMW concentrations for all three agents. An analysis was performed to investigate a relationship between MMW and IOM. The data revealed correlation coefficient values of 0.72, 0.82, and 0.84 for total dust (n = 197), inorganic As (n = 137), and borates (n = 194), respectively. These positive correlation coefficients indicate that the IOM and MMW measurements are consistent with each other, and can be used for predicting exposure levels. The total dust and borate large mean ratios should be considered in developing inhalable fraction-based regulatory standards.

Elastic compression in the prevention of venous stasis. A critical reevaluation.

The effect of elastic compression on venous flow in the legs provided by carefully fitted stockings has been measured by a venographic technic. The stocking used provides a gradually decreasing compression from ankle to groin. Clearance of stagnant blood from behind venous valves is clearly improved and the differences observed are statistically highly significant. These data suggest that the routine use of carefully fitted compression stockings will result in a decreased incidence of deep vein thrombosis (DVT) and provide a singularly safe, convenient, and noninvasive method of prophylaxis. Evidence presented suggests that at least two investigators have failed to show a decreased incidence of DVT in limbs subjected to elastic compression because the method of compression was inadequate .