Impact on pulmonary, cardiac, and renal function and long-term quality of life after hospitalization for acute respiratory distress syndrome due to COVID-19: Protocol of the Post-COVID Brazil 3 study.

RATIONALE: Evidence about long-term sequelae after hospitalization for acute respiratory distress syndrome due to COVID-19 is still scarce. PURPOSE: To evaluate changes in pulmonary, cardiac, and renal function and in quality of life after hospitalization for acute respiratory distress syndrome secondary to COVID-19. METHODS: This will be a multicenter case-control study of 220 participants. Eligible are patients who are hospitalized for acute respiratory distress syndrome due to COVID-19. In the control group, individuals with no history of hospitalization in the last 12 months or long-term symptoms of COVID-19 will be selected. All individuals will be subjected to pulmonary spirometry with a carbon monoxide diffusion test, chest tomography, cardiac and renal magnetic resonance imaging with gadolinium, ergospirometry, serum and urinary creatinine, total protein, and urinary microalbuminuria, in addition to quality-of-life questionnaires. Patients will be evaluated 12 months after hospital discharge, and controls will be evaluated within 90 days of inclusion in the study. For all the statistical analyses, p < 0.05 is the threshold for significance. RESULTS: The primary outcome of the study will be the pulmonary diffusing capacity for carbon monoxide measured after 12 months. The other parameters of pulmonary, cardiac, and renal function and quality of life are secondary outcomes. CONCLUSION: This study aims to determine the long-term sequelae of pulmonary, cardiac, and renal function and the quality of life of patients hospitalized for acute respiratory distress syndrome due to COVID-19 in the Brazilian population.

What outcomes should be evaluated in critically ill patients? / Quais desfechos devem ser avaliados nos pacientes graves?

Randomized clinical trials in intensive care prioritize disease-focused outcomes rather than patient-centered outcomes. A paradigm shift considering the evaluation of measures after hospital discharge and measures focused on quality of life and common symptoms, such as pain and dyspnea, could better reflect the wishes of patients and their families. However, barriers related to the systematization of the interpretation of these outcomes, the heterogeneity of measurement instruments and the greater difficulty in performing the studies, to date, seem to hinder this change. In addition, the joint participation of patients, families, researchers, and clinicians in the definition of study outcomes is not yet a reality.

Estudos clínicos randomizados em terapia intensiva priorizam desfechos focados em doença e não desfechos centrados no paciente. Uma mudança de paradigma considerando a avaliação de medidas após a alta hospitalar e medidas focadas na qualidade de vida e em sintomas comuns, como dor e dispneia, poderiam refletir melhor os desejos de pacientes e de seus familiares. No entanto, barreiras relacionadas à sistematização da interpretação desses desfechos, a heterogeneidade de instrumentos de medida e a maior dificuldade na execução dos estudos, até o momento, parecem dificultar essa mudança. Além disso, a participação conjunta de pacientes, familiares, pesquisadores e clínicos na definição dos desfechos dos estudos ainda não é uma realidade.

Quais desfechos devem ser avaliados nos pacientes graves? / What outcomes should be evaluated in critically ill patients?

RESUMO Estudos clínicos randomizados em terapia intensiva priorizam desfechos focados em doença e não desfechos centrados no paciente. Uma mudança de paradigma considerando a avaliação de medidas após a alta hospitalar e medidas focadas na qualidade de vida e em sintomas comuns, como dor e dispneia, poderiam refletir melhor os desejos de pacientes e de seus familiares. No entanto, barreiras relacionadas à sistematização da interpretação desses desfechos, a heterogeneidade de instrumentos de medida e a maior dificuldade na execução dos estudos, até o momento, parecem dificultar essa mudança. Além disso, a participação conjunta de pacientes, familiares, pesquisadores e clínicos na definição dos desfechos dos estudos ainda não é uma realidade.

ABSTRACT Randomized clinical trials in intensive care prioritize disease-focused outcomes rather than patient-centered outcomes. A paradigm shift considering the evaluation of measures after hospital discharge and measures focused on quality of life and common symptoms, such as pain and dyspnea, could better reflect the wishes of patients and their families. However, barriers related to the systematization of the interpretation of these outcomes, the heterogeneity of measurement instruments and the greater difficulty in performing the studies, to date, seem to hinder this change. In addition, the joint participation of patients, families, researchers, and clinicians in the definition of study outcomes is not yet a reality.

Off-Colony Screening of Biosynthetic Libraries by Rapid Laser-Enabled Mass Spectrometry.

By leveraging advances in DNA synthesis and molecular cloning techniques, synthetic biology increasingly makes use of large construct libraries to explore large design spaces. For biosynthetic pathway engineering, the ability to screen these libraries for a variety of metabolites of interest is essential. If the metabolite of interest or the metabolic phenotype is not easily measurable, screening soon becomes a major bottleneck involving time-consuming culturing, sample preparation, and extraction. To address this, we demonstrate the use of automated laser-assisted rapid evaporative ionization mass spectrometry (LA-REIMS)-a form of ambient laser desorption ionization mass spectrometry-to perform rapid mass spectrometry analysis direct from agar plate yeast colonies without sample preparation or extraction. We use LA-REIMS to assess production levels of violacein and betulinic acid directly from yeast colonies at a rate of 6 colonies per minute. We then demonstrate the throughput enabled by LA-REIMS by screening over 450 yeast colonies within <4 h, while simultaneously generating recoverable glycerol stocks of each colony in real time. This showcases LA-REIMS as a prescreening tool to complement downstream quantification methods such as liquid chromatography-mass spectroscopy (LCMS). By prescreening several hundred colonies with LA-REIMS, we successfully isolate and verify a strain with a 2.5-fold improvement in betulinic acid production. Finally, we show that LA-REIMS can detect 20 out of a panel of 27 diverse biological molecules, demonstrating the broad applicability of LA-REIMS to metabolite detection. The rapid and automated nature of LA-REIMS makes this a valuable new technology to complement existing screening technologies currently employed in academic and industrial workflows.

Hemocyanin facilitates lignocellulose digestion by wood-boring marine crustaceans.

Woody (lignocellulosic) plant biomass is an abundant renewable feedstock, rich in polysaccharides that are bound into an insoluble fiber composite with lignin. Marine crustacean woodborers of the genus Limnoria are among the few animals that can survive on a diet of this recalcitrant material without relying on gut resident microbiota. Analysis of fecal pellets revealed that Limnoria targets hexose-containing polysaccharides (mainly cellulose, and also glucomannans), corresponding with the abundance of cellulases in their digestive system, but xylans and lignin are largely unconsumed. We show that the limnoriid respiratory protein, hemocyanin, is abundant in the hindgut where wood is digested, that incubation of wood with hemocyanin markedly enhances its digestibility by cellulases, and that it modifies lignin. We propose that this activity of hemocyanins is instrumental to the ability of Limnoria to feed on wood in the absence of gut symbionts. These findings may hold potential for innovations in lignocellulose biorefining.

Characterization of the cellulolytic secretome of Trichoderma harzianum during growth on sugarcane bagasse and analysis of the activity boosting effects of swollenin.

This study demonstrates the production of an active enzyme cocktail produced by growing Trichoderma harzianum on sugarcane bagasse. The component enzymes were identified by LCMS-MS. Glycosyl hydrolases were the most abundant class of proteins, representing 67% of total secreted protein. Other carbohydrate active enzymes involved in cell wall deconstruction included lytic polysaccharide mono-oxygenases (AA9), carbohydrate-binding modules, carbohydrate esterases and swollenin, all present at levels of 1%. In total, proteases and lipases represented 5 and 1% of the total secretome, respectively, with the rest of the secretome being made up of proteins of unknown or putative function. This enzyme cocktail was efficient in catalysing the hydrolysis of sugarcane bagasse cellulolignin to fermentable sugars for potential use in ethanol production. Apart from mapping the secretome of T. harzianum, which is a very important tool to understand the catalytic performance of enzyme cocktails, the gene coding for T. harzianum swollenin was expressed in Aspergillus niger. This novel aspect in this work, allowed increasing the swollenin concentration by 95 fold. This is the first report about the heterologous expression of swollenin from T. harzianum, and the findings are of interest in enriching enzyme cocktail with this important accessory protein which takes part in the cellulose amorphogenesis. Despite lacking detectable glycoside activity, the addition of swollenin of T. harzianum increased by two-fold the hydrolysis efficiency of a commercial cellulase cocktail. © 2016 American Institute of Chemical Engineers Biotechnol. Prog., 32:327-336, 2016.

Plant science. Morphinan biosynthesis in opium poppy requires a P450-oxidoreductase fusion protein.

Morphinan alkaloids from the opium poppy are used for pain relief. The direction of metabolites to morphinan biosynthesis requires isomerization of (S)- to (R)-reticuline. Characterization of high-reticuline poppy mutants revealed a genetic locus, designated STORR [(S)- to (R)-reticuline] that encodes both cytochrome P450 and oxidoreductase modules, the latter belonging to the aldo-keto reductase family. Metabolite analysis of mutant alleles and heterologous expression demonstrate that the P450 module is responsible for the conversion of (S)-reticuline to 1,2-dehydroreticuline, whereas the oxidoreductase module converts 1,2-dehydroreticuline to (R)-reticuline rather than functioning as a P450 redox partner. Proteomic analysis confirmed that these two modules are contained on a single polypeptide in vivo. This modular assembly implies a selection pressure favoring substrate channeling. The fusion protein STORR may enable microbial-based morphinan production.

Structural characterization of a unique marine animal family 7 cellobiohydrolase suggests a mechanism of cellulase salt tolerance.

Nature uses a diversity of glycoside hydrolase (GH) enzymes to convert polysaccharides to sugars. As lignocellulosic biomass deconstruction for biofuel production remains costly, natural GH diversity offers a starting point for developing industrial enzymes, and fungal GH family 7 (GH7) cellobiohydrolases, in particular, provide significant hydrolytic potential in industrial mixtures. Recently, GH7 enzymes have been found in other kingdoms of life besides fungi, including in animals and protists. Here, we describe the in vivo spatial expression distribution, properties, and structure of a unique endogenous GH7 cellulase from an animal, the marine wood borer Limnoria quadripunctata (LqCel7B). RT-quantitative PCR and Western blot studies show that LqCel7B is expressed in the hepatopancreas and secreted into the gut for wood degradation. We produced recombinant LqCel7B, with which we demonstrate that LqCel7B is a cellobiohydrolase and obtained four high-resolution crystal structures. Based on a crystallographic and computational comparison of LqCel7B to the well-characterized Hypocrea jecorina GH7 cellobiohydrolase, LqCel7B exhibits an extended substrate-binding motif at the tunnel entrance, which may aid in substrate acquisition and processivity. Interestingly, LqCel7B exhibits striking surface charges relative to fungal GH7 enzymes, which likely results from evolution in marine environments. We demonstrate that LqCel7B stability and activity remain unchanged, or increase at high salt concentration, and that the L. quadripunctata GH mixture generally contains cellulolytic enzymes with highly acidic surface charge compared with enzymes derived from terrestrial microbes. Overall, this study suggests that marine cellulases offer significant potential for utilization in high-solids industrial biomass conversion processes.

A Papaver somniferum 10-gene cluster for synthesis of the anticancer alkaloid noscapine.

Noscapine is an antitumor alkaloid from opium poppy that binds tubulin, arrests metaphase, and induces apoptosis in dividing human cells. Elucidation of the biosynthetic pathway will enable improvement in the commercial production of noscapine and related bioactive molecules. Transcriptomic analysis revealed the exclusive expression of 10 genes encoding five distinct enzyme classes in a high noscapine-producing poppy variety, HN1. Analysis of an F(2) mapping population indicated that these genes are tightly linked in HN1, and bacterial artificial chromosome sequencing confirmed that they exist as a complex gene cluster for plant alkaloids. Virus-induced gene silencing resulted in accumulation of pathway intermediates, allowing gene function to be linked to noscapine synthesis and a novel biosynthetic pathway to be proposed.

Expression of a chitinase gene from Metarhizium anisopliae in tobacco plants confers resistance against Rhizoctonia solani.

The chit1 gene from the entomopathogenic fungus Metarhizium anisopliae, encoding the endochitinase CHIT42, was placed under the control of the CaMV 35S promoter, and the resulting construct was transferred to tobacco. Seventeen kanamycin-resistant transgenic lines were recovered, and the presence of the transgene was confirmed by polymerase chain reactions and Southern blot hybridization. The number of chit1 copies was determined to be varying from one to four. Copy number had observable effects neither on plant growth nor development. Substantial heterogeneity concerning production of the recombinant chitinase, and both general and specific chitinolytic activities were detected in leaf extracts from primary transformants. The highest chitinase activities were found in plants harboring two copies of chit1 inserts at different loci. Progeny derived from self-pollination of the primary transgenics revealed a stable inheritance pattern, with transgene segregation following a mendelian dihybrid ratio. Two selected plants expressing high levels of CHIT42 were consistently resistant to the soilborne pathogen Rhizoctonia solani, suggesting a direct relationship between enzyme activity and reduction of foliar area affected by fungal lesions. To date, this is the first report of resistance to fungal attack in plants mediated by a recombinant chitinase from an entomopathogenic and acaricide fungus.

[The use of preoperative intra-aortic balloon in myocardial revascularization surgery associated to severe ventricular dysfunction]. / O uso do balão intra-aórtico no pré-operatório de cirurgia de revascularização miocárdica, associada à disfunção ventricular grave.

OBJECTIVE: To evaluate the effectiveness of prophylactic intra-aortic balloon (IAB) in elective myocardial revascularization surgery (MRS), to prevent trans or post-operative infarction and reduce intra-hospital mortality in patients with low left ventricular ejection fraction. METHODS: Using a cohort study model, 239 patients with left ventricular ejection fraction < or = 40%, submitted to elective MRS with extracorporeal circulation (ECC) were evaluated from March 1995 to February 2001. RESULTS: Of these, 58 patients received preoperative IAB and the remainder underwent surgery without circulatory assistance (control group). The two groups of patients had similar characteristics regarding factors associated to the pertaining outcomes. There were five demises (8.6%) in the group with IAB and 21 (11.6%) in the control group (non-significant difference). There were 2 (3.4%) infarctions in the IAB group and 28 (15.5%) in the control group (p< 0.05), relative risk of 0.22 with an interval of confidence of 95% from 0.05 to 0.85. CONCLUSION: The use of pre-operative IAB can significantly reduce the risk of trans or post-operative acute myocardial infarction (AMI) in patients with decreased systolic function, without increasing vascular complications. In this same situation, the IAB does not significantly decrease mortality. Randomized studies are necessary to establish more precise conclusions.

O uso do balão intra-aórtico no pré-operatório de cirurgia de revascularização miocárdica, associada à disfunção ventricular grave / The use of preoperative intra-aortic balloon in myocardial revascularization surgery associated to severe ventricular dysfunction

OBJETIVO: Avaliar a efetividade do Balão Intra-Aórtico (BIAo) profilático em cirurgia de revascularização miocárdica (CRM) eletiva, para prevenir o infarto trans ou pós-operatório e para reduzir a mortalidade intra-hospitalar nos pacientes com baixa fração de ejeção ventricular esquerda. MÉTODOS: Em modelo de estudo de coorte, foram analisados 239 pacientes com fração de ejeção do ventrículo esquerdo inferior ou igual a 40 por cento, submetidos à CRM eletiva com circulação extracorpórea (CEC), no período compreendido entre março de 1995 a fevereiro de 2001. RESULTADOS: Destes, 58 pacientes receberam BIAo pré-operatório e os demais foram operados sem assistência circulatória (grupo controle). Os dois grupos de pacientes tinham características semelhantes quanto a fatores associados aos desfechos em questão. Ocorreram 5 (8,6 por cento) óbitos no grupo com BIAo e 21 (11,6 por cento), no grupo controle (diferença não-signifícativa). Ocorreram 2 (3,4 por cento) infartos no grupo com BIAo e 28 (15,5 por cento), no grupo controle BIAo (p < 0,05), risco relativo de 0,22 com intervalo de confiança de 95 por cento de 0,05 a 0,85. CONCLUSÃO: O BIAo, em uso pré-operatório, pode reduzir de forma significativa o risco de infarto agudo do miocárdio (IAM) trans ou pós-operatório, em pacientes com função sistólica diminuída, sem incremento de complicações vasculares. Nesta mesma situação, o BIAo não diminui de forma significativa a mortalidade. Estudos randomizados devem ser conduzidos para se ter conclusões mais precisas.