Acute hyperosmolar hyperglycaemic state in cystic fibrosis-related diabetes caused by glucocorticoid and itraconazole interaction.

Hyperosmolar hyperglycaemic state (HHS) has not previously been reported in cystic fibrosis-related diabetes (CFRD). We report the case of a 15-year old boy with stable CFRD who developed acute HHS after treatment with glucocorticoids and itraconazole for presumed allergic broncho-pulmonary aspergillosis (ABPA). This case highlights the dangerous and preventable combination of high glucose intake, glucocorticoids and itraconazole inhibition of CYP3A4 (with resultant glucocorticoid accumulation) that can result in a state of life- threatening HHS in an adolescent with previously stable CFRD.

Attractiveness of Male and Female Adults of Cryptolestes ferrugineus (Coleoptera: Laemophloeidae) to Conspecifics With and Without Grain.

Whether stored-grain insects can communicate with each other inside stored-grain bulks is an important question for the development of pest management programs. Movements of the individual adults of Cryptolestes ferrugineus towards caged adult(s), in the presence or absence of wheat, were studied inside an apparatus (10 cm length), using an infrared camera. The numbers of the caged adults were 1, 20, or 50 of females or males, and 100 or 200 mixed-sex adults. Without grain, both males and females moved towards the caged single male, but not the caged single female. With grain, neither males nor females moved towards the caged single male or female. When 50 males were added to the cage, females did move significantly towards the caged males. There were trends for introduced males and females to move towards caged males at higher densities.

Highly Sensitive Bacteria-Responsive Membranes Consisting of Core-Shell Polyurethane Polyvinylpyrrolidone Electrospun Nanofibers for In Situ Detection of Bacterial Infections.

Bacteria responsive color-changing wound dressings offer a valuable platform for continuous monitoring of the wound bed facilitating early detection of bacterial infections. In this study, we present a highly sensitive electrospun nanofibrous polyurethane wound dressing incorporating a hemicyanine-based chromogenic probe with a labile ester linkage that can be enzymatically cleaved by bacterial lipase released from clinically relevant strains, such as Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA). A rapid chromogenic response was achieved by localizing the dye at the surface of core-shell fibers, resulting in a 5x faster response relative to conventional nanofibers. By incorporating polyvinylpyrrolidone (PVP) dopant in the shell, the sensitivity was boosted to enable detection of bacteria at clinically relevant concentrations after 2 h exposure: 2.5 × 105 CFU/cm2 P. aeruginosa and 1.0 × 106 CFU/cm2 MRSA. Introduction of PVP in the shell also boosted the degree of hydrolysis of the chromogenic probe by a factor of 1.2× after a 3 h exposure to a low concentration of P. aeruginosa (105 CFU/cm2). PVP was also found to improve the discernibility of the color change at high bacterial concentrations. The co-operativity between the chromogenic probe, fiber structure, and polymer composition is well-suited for timely in situ detection of wound infection.

Mucus-penetrating PEGylated polysuccinimide-based nanocarrier for intravaginal delivery of siRNA battling sexually transmitted infections.

Intravaginal delivery of siRNA for prevention of sexually transmitted infections faces obstacles such as the acidic environment and vaginal mucus barrier. To achieve effective protection and delivery of siRNA, we developed a polysuccinimide (PSI)-based nanocarrier (PSI-PEG-API-PMA, PPAP) by conjugating methoxy polyethylene glycol amine (Me-PEG-NH2, Mw 5000), 1-(3-aminopropyl)imidazole (API), and 1-pyrenemethylamine hydrochloride (PMA) to PSI. PPAP demonstrated a spherical self-assembled nanostructure before and after encapsulation of a model siRNA. Variable electrostatic interaction between API and siRNA at acidic vs. neutral pH accomplished significantly lower burst release at pH 4.2 (4 ±â€¯1%) than pH 7.0 (26 ±â€¯5%) within 1 h. PEGylation enabled siRNA-PPAP to achieve higher mucus penetration efficiency (64 ±â€¯17%) than free siRNA (27 ±â€¯5%) for 24 h. Moreover, in vitro study showed minimal toxicity, successful internalization of siRNA-PPAP in HeLa cells and improved gene knockdown (97.5 ±â€¯0.4%). Overall, PPAP is promising for developing preventative treatments for battling sexually transmitted infections.

Epicardial left atrial appendage occlusion with a new medical device: assessment of procedural feasibility, safety and efficacy in a large animal model.

BACKGROUND: Left atrial appendage occlusion (LAAO) represents a treatment alternative to anticoagulation in patients with atrial fibrillation. We evaluate a novel device for epicardial LAAO in a translational canine model. METHODS: Nine hounds (n = 9) were used to assess usability, safety, and efficacy of the TigerPaw Pro (TPP) device for epicardial LAAO. Following baseline imaging (intra-cardiac echocardiography (ICE) and angiography) and intraoperative visual inspection, usability was tested via a ``closure/re-opening`` maneuver followed by deployment of a total of twenty TPP devices (n = 20) on the left and right atrial appendages respectively. Procedural safety was evaluated by assessing for adverse-events via direct Epicardial inspection and endocardial imaging. Efficacy evaluation included assessment of device positioning, presence of residual stumps and completeness of closure. Post-mortem evaluation was performed to confirm safety and efficacy. RESULTS: Usability testing of all TPP devices was successful (n = 20;100%, delivery-time range 22-120 s) without any procedural adverse-events (tissue damage or tears, bleeding, vessel-impingement, structural impact). All devices fully traversed the ostium (n = 18) or appendage body (n = 2), and conformed smoothly to adjacent cardiac anatomy. In nineteen deployments (n = 19;95%), all device connector pairs were fully engaged, while in one TPP device the most distal pair remained unengaged. ICE and post-mortem inspections revealed complete closure of all appendage ostia (n = 18;100%) and only in one case a small residual stump was detected. Intraoperative safety findings were further confirmed post-mortem. Devices created a nearly smooth line of closure via symmetric endocardial tissue-coaptation. CONCLUSIONS: In this preclinical model, the TPP demonstrated good ease of use for ostial access, ability to re-position (after engagement) and rapid deployment, while achieving safe and effective LAAO.

Physical Activity Levels in Individuals with Cystic Fibrosis-Related Diabetes.

Purpose: The literature on physical activity (PA) in adults with cystic fibrosis, particularly in those with cystic fibrosis-related diabetes (CFRD), is limited. PA may be an important part of blood glucose management in CFRD. The purpose of this study was to describe PA levels in adults with CFRD and determine their adherence to the Canadian Diabetes Association (CDA) aerobic exercise training guidelines. Methods: Adults with CFRD were recruited from a hospital-based CF clinic. PA was measured using the Seven-Day Physical Activity Recall (telephone interview), adherence to CFRD management with the Self-Care Inventory-Revised (questionnaire), and blood glucose control from glycated hemoglobin levels documented in participants' medical chart within 3 months. Results: Eighteen adults (mean age 41 [SD 9] y) with diagnosed CFRD participated in the study. They varied in volume of PA (range 13,080-17,362 metabolic equivalent min/wk). Of the study participants, 12 (67%) met the CDA guidelines of 150 minutes of moderate to vigorous PA per week with no more than 2 consecutive days without exercise. No differences were found in clinical factors between those who met the aerobic exercise guidelines and those who did not. Conclusion: The majority of individuals with CFRD are meeting the recommended amount of aerobic PA. The factors influencing PA and blood glucose control in adults with CFRD require further investigation.

Objectif : peu d'études ont été publiées sur l'activité physique (AP) chez les adultes atteints de fibrose kystique, particulièrement chez ceux atteints du diabète associé à la fibrose kystique (DAFK). Or, l'AP jouerait chez ceux-ci un rôle important dans le contrôle de la glycémie. L'objectif de cette étude était de décrire le niveau d'AP chez les adultes atteints de DAFK et de déterminer leur observance des lignes directrices de l'Association canadienne du diabète (ACD) en matière d'exercice aérobique. Méthodologie : des adultes atteints de DAFK ont été recrutés dans la clinique de fibrose kystique d'un centre hospitalier. Le niveau d'AP a été mesuré au moyen d'entrevues téléphoniques (AP rapportée au cours des 7 derniers jours) et du questionnaire révisé sur la prise en charge autonome du diabète. Le contrôle de la glycémie a été évalué en fonction des niveaux d'hémoglobine glyquée relevés dans le dossier médical des participants au cours des 3 derniers mois. Résultats : au total, 18 adultes ayant reçu un diagnostic de DAFK (âge moyen=41 [ÉT=9]) ont participé à l'étude. Leur volume d'AP variait d'un minimum de 13 080 à 17 362 équivalents métaboliques par semaine. Parmi les participants à l'étude, 12 (67 %) suivaient les lignes directrices de l'ACD, soit 150 minutes d'exercice modéré à intense par semaine sans plus de 2 jours consécutifs sans exercice. Aucune différence n'a été constatée dans les facteurs cliniques entre ceux qui suivent les lignes directrices et les autres. Conclusion : la majorité des personnes atteintes de DAFK font le volume recommandé d'AP aérobique. Il faudra étudier davantage les facteurs influant sur l'AP et le contrôle de la glycémie chez les adultes atteints de DAFK.