Predictors of the response to phosphodiesterase-5 inhibitors in pulmonary arterial hypertension: an analysis of the Spanish registry.

BACKGROUND: Achieving and maintaining a low-risk profile is associated with favorable outcome in pulmonary arterial hypertension (PAH). The effects of treatment on risk profile are variable among patients. OBJECTIVE: To Identify variables that might predict the response to treatment with phosphodiesterase-5 inhibitors (PDE-5i) in PAH. METHODS: We carried out a cohort analysis of the Spanish PAH registry in 830 patients diagnosed with PAH that started PDE5i treatment and had > 1 year follow-up. 644 patients started PDE-5i either in mono- or add-on therapy and 186 started combined treatment with PDE-5i and endothelin receptor antagonist (ERA). Responders were considered when at 1 year they: (1) were alive; (2) did not present clinical worsening; and (3) improved European Society of Cardiology/European Respiratory Society (ESC/ERS) risk score or remained in low-risk. Univariate and multivariate logistic regression models were used to analyze variables associated with a favorable response. RESULTS: Two hundred and ten patients (33%) starting PDE-5i alone were classified as responders, irrespective of whether it was mono- or add-on therapy. In addition to known predictors of PAH outcome (low-risk at baseline, younger age), male sex and diagnosis of portopulmonary hypertension (PoPH) or HIV-PAH were independent predictors of favorable response to PDE-5i. Diffusing capacity for carbon monoxide (DLco) ≤ 40% of predicted was associated with an unfavorable response. When PDE-5i were used in upfront combination, 58% of patients were responders. In this group, diagnosis of idiopathic PAH (IPAH) was an independent predictor of favorable response, whereas connective tissue disease-PAH was associated with an unfavorable response. CONCLUSION: Male sex and diagnosis of PoPH or HIV-PAH are predictors of favorable effect of PDE-5i on risk profile when used as mono- or add-on therapy. Patients with IPAH respond more favorably to PDE-5i when used in upfront combination. These results identify patient profiles that may respond favorably to PDE-5i in monotherapy and those who might benefit from alternative treatment strategies.

First Record of Wyeomyia mitchellii in Nuevo León, Mexico.

On October 5, 2021, mosquito collections were conducted in Nuevo León in search of an undescribed species within the genus Wyeomyia reported previously in this state. Species collected included Aedes quadrivittatus, Ae. amabilis, Ae. triseriatus group, Ae. albopictus, and Wy. mitchellii. Although the undescribed species was not found, the occurrence record for Wy. mitchellii in Nuevo León constitutes the 1st record for this species in this state. Additionally, historical records of the presence of Wy. mitchelli in Mexico, available in the literature, were reviewed and updated. Specimens collected during this study were deposited in the Culicidae Collection of the Parasitology Department, Autonomous Agrarian University Antonio Narro, Laguna unit. With the addition of Wy. mitchellii to the mosquito fauna of Nuevo León, there are currently 67 species in the state.

Closed-loop oxygen control improves oxygen therapy in acute hypoxemic respiratory failure patients under high flow nasal oxygen: a randomized cross-over study (the HILOOP study).

BACKGROUND: We aimed to assess the efficacy of a closed-loop oxygen control in critically ill patients with moderate to severe acute hypoxemic respiratory failure (AHRF) treated with high flow nasal oxygen (HFNO). METHODS: In this single-centre, single-blinded, randomized crossover study, adult patients with moderate to severe AHRF who were treated with HFNO (flow rate ≥ 40 L/min with FiO2 ≥ 0.30) were randomly assigned to start with a 4-h period of closed-loop oxygen control or 4-h period of manual oxygen titration, after which each patient was switched to the alternate therapy. The primary outcome was the percentage of time spent in the individualized optimal SpO2 range. RESULTS: Forty-five patients were included. Patients spent more time in the optimal SpO2 range with closed-loop oxygen control compared with manual titrations of oxygen (96.5 [93.5 to 98.9] % vs. 89 [77.4 to 95.9] %; p < 0.0001) (difference estimate, 10.4 (95% confidence interval 5.2 to 17.2). Patients spent less time in the suboptimal range during closed-loop oxygen control, both above and below the cut-offs of the optimal SpO2 range, and less time above the suboptimal range. Fewer number of manual adjustments per hour were needed with closed-loop oxygen control. The number of events of SpO2 < 88% and < 85% were not significantly different between groups. CONCLUSIONS: Closed-loop oxygen control improves oxygen administration in patients with moderate-to-severe AHRF treated with HFNO, increasing the percentage of time in the optimal oxygenation range and decreasing the workload of healthcare personnel. These results are especially relevant in a context of limited oxygen supply and high medical demand, such as the COVID-19 pandemic. Trial registration The HILOOP study was registered at www. CLINICALTRIALS: gov under the identifier NCT04965844 .

First Record of Mansonia dyari in the State of Morelos, Mexico, Based on Morphology and COI DNA Barcoding.

Collections of mosquitoes were conducted for the surveillance of species of medical importance in the state of Morelos, Mexico, in June 2017. Species collected included Mansonia (Mansonia) dyari, which was identified using morphological characters and cytochrome c oxidase I DNA barcoding. Although 3 species of genus Mansonia have been previously reported in Mexico, this is the 1st confirmed record of Ma. dyari in Morelos State, where no Mansonia species had been recorded. Historical records of Ma. dyari and Ma. indubitans in Mexico were reviewed. Therefore, this record increases the number of mosquito species occurring in Morelos to 46. The specimens collected in this study were deposited in the Culicidae collection of the Universidad Autónoma Agraria Antonio Narro, Unidad Laguna.

Comparison of two DNA extraction methods from larvae, pupae, and adults of Aedes aegypti.

Mosquitoes are the most important arthropods from the point of view of public health, due to the fact that they can transmit a large number of pathogens which can cause diseases to humans and animals. Aedes aegypti (L.) is one of the most important vector species in the world, since it can transmit numerous pathogens such as dengue, Zika, and chikungunya. Therefore, studies involving the molecular aspects of this and other mosquitoes species are currently increasing. In this report, we describe the comparison between two DNA extraction techniques, Chelex and cetyltrimethylammonium bromide (CTAB), for carrying out DNA extraction in larvae, pupae and adult female of Ae. aegypti. The Chelex technique was superior in the amount and purity of DNA as compared to the CTAB technique in the three life stages we tested.

First Record of Psorophora ferox In Durango State, Mexico.

During August-November of 2018, mosquito collections were conducted with the intention of monitoring the presence of arboviruses in Durango State, Mexico. Species collected included Psorophora (Janthinosoma) ferox. In Mexico, 24 species of the genus Psorophora have been previously reported, whereas in the state of Durango, only 2 species have been reported: Psorophora (Grabhamia) columbiae and Ps. (Gra.) signipennis. This is the 1st record of Ps. ferox and the subgenus Janthinosoma in Durango. With the addition of Ps. ferox to the list of mosquito species found in Durango, the number of mosquito species occurring in the state stands at 31.

TiO2 nanoparticles affect the bacterial community structure and Eisenia fetida (Savigny, 1826) in an arable soil.

The amount of nanoparticles (NP), such as TiO2, has increased substantially in the environment. It is still largely unknown, however, how NP might interact with earthworms and organic material and how this might affect the bacterial community structure and their functionality. Therefore, an arable soil was amended with TiO2 NP at 0, 150 or 300 mg kg-1 and subjected to different treatments. Treatments were soil amended with ten earthworms (Eisenia fetida (Savigny, 1826)) with fully developed clitellum and an average fresh mass of 0.5 to 500 g dry soil, 1.75 g tyndallized Quaker® oat seeds Avena sativa (L.) kg-1, or earthworms plus oat seeds, or left unamended. The bacterial community structure was monitored throughout the incubation period. The bacterial community in the unamended soil changed over time and application of oats, earthworm and a combination of both even further, with the largest change found in the latter. Application of NP to the unamended soil and the earthworm-amended soil altered the bacterial community, but combining it by adding oats negated that effect. It was found that the application of organic material, that is, oats, reduced the effect of the NP applied to soil. However, as the organic material applied was mineralized by the soil microorganisms, the effect of NP increased again over time.

Installation Method to Enhance Quality Control for Fiber Reinforced Polymer Spike Anchors.

Fiber reinforced polymer (FRP) anchors are a promising way to enhance the performance of externally-bonded FRPs applied to existing structures, as they can delay or even prevent debonding failure. However, a major concern faced by designers is the premature failure of the anchors due to stress concentration. Poor installation quality and preparation of the clearance holes can result in stress concentration that provokes this premature failure. This paper deals with an installation method that aims to reduce the impact of the stress concentration and to provide a proper quality control of the preparation of the drill hole. The method involves three parts: the drilling and cleaning of the holes, the smoothing of the hole edges with a customized drill bit, and the installation of the anchor itself, including the impregnation of the anchor dowel and its insertion. Anchor fans (the free length of the spikes) are then bonded to the external FRP reinforcement. For the end anchorage, and in the case of reinforcements with multiple plies, it is recommended that the anchor fan be inserted between two plies to assist the stress-transfer mechanism. The proposed procedure is complemented with a design approach for spike anchors, based on an extensive database. It is proposed that the design follow a number of steps, namely: selection of the anchor diameter and subsequent tensile strength of the connector (that is to say, the anchor before fanning out the free end), evaluation of the reduction in the tensile strength due to bending, provision of enough embedment to prevent slippage failure, and consideration of the number and spacing of anchors for a given reinforcement. In this sense, it should be noted that further research is needed in order to obtain a general expression for the contribution of spike anchors to overall bond strength of FRP reinforcements.

Mosquito Records from Mexico: The Mosquitoes (Diptera: Culicidae) of Tamaulipas State.

To document the diversity and distribution of mosquito species inhabiting the Mexican state of Tamaulipas, collection trips were conducted to all physiographic regions (Grand Northamerican Plains, Coastal Plain of North Gulf, and Sierra Madre Oriental) and subregions across the state. Additionally, we re-examined mosquito specimens in two Mexican entomological collections: the Collection of Insects and Mites of Medical Importance and the Collection of Arthropods of Medical Importance. In total, 3,931 specimens were collected. These represent the two Culicidae subfamilies Anophelinae and Culicinae, 10 tribes, 17 genera, 27 subgenera, 80 named species, and 2 undescribed species. Of these, 3 tribes, 6 genera, 7 subgenera, and 20 species are new records for the mosquito fauna of Tamaulipas. Fourteen species recorded in the historical records were not found in collections made for this study. Taxonomic notes, new distribution limits, and comments about the medical importance of some of the species collected are reported.

Geographical distribution of the Aedes Triseriatus Group (Diptera: Culicidae) in Mexico.

Aedes brelandi Zavortink is reported for the first time outside of the United States, where it has been found in northern and central parts of Mexico. Ae. triseriatus (Say) is reported in northern and central Mexico and Ae. zoosophus Dyar and Knab is recorded in southern Mexico. Collection records for these species in northern, central, and southern Mexico showing the current distribution of the Aedes Triseriatus Group are included.

Phase I pharmacokinetic and pharmacodynamic study of the first-in-class spliceosome inhibitor E7107 in patients with advanced solid tumors.

PURPOSE: To assess the safety, tolerability, pharmacokinetics, pharmacodynamics, and clinical activity of E7107 administered as 5-minute bolus infusions on days 1, 8, and 15 in a 28-day schedule. EXPERIMENTAL DESIGN: Patients with solid tumors refractory to standard therapies or with no standard treatment available were enrolled. Dose levels of 0.6 to 4.5 mg/m(2) were explored. RESULTS: Forty patients [24M/16F, median age 61 years (45-79)] were enrolled. At 4.5 mg/m(2), dose-limiting toxicity (DLT) consisted of grade 3 diarrhea, nausea, and vomiting and grade 4 diarrhea, respectively, in two patients. At 4.0 mg/m(2), DLT (grade 3 nausea, vomiting, and abdominal cramps) was observed in one patient. Frequently occurring side effects were mainly gastrointestinal. After drug discontinuation at 4.0 mg/m(2), one patient experienced reversible grade 4 blurred vision. The maximum tolerated dose (MTD) is 4.0 mg/m(2). No complete or partial responses during treatment were observed; one patient at 4.0 mg/m(2) had a confirmed partial response after drug discontinuation. Pharmacokinetic analysis revealed a large volume of distribution, high systemic clearance, and a plasma elimination half-life of 5.3 to 15.1 hours. Overall drug exposure increased in a dose-dependent manner. At the MTD, mRNA levels of selected target genes monitored in peripheral blood mononuclear cells showed a reversible 15- to 25-fold decrease, whereas unspliced pre-mRNA levels of DNAJB1 and EIF4A1 showed a reversible 10- to 25-fold increase. CONCLUSION: The MTD for E7107 using this schedule is 4.0 mg/m(2). Pharmacokinetics is dose-dependent and reproducible within patients. Pharmacodynamic analysis revealed dose-dependent reversible inhibition of pre-mRNA processing of target genes, confirming proof-of-principle activity of E7107.

T-cell stimulating protein A (TspA) of Neisseria meningitidis is required for optimal adhesion to human cells.

T-cell stimulating protein A (TspA) is an immunogenic, T-cell and B-cell stimulating protein of Neisseria meningitidis. Sequence similarity between TspA and FimV, a Pseudomonas aeruginosa protein involved in twitching motility, suggested a link between TspA and type IV pili (Tfp). To determine the role of TspA an isogenic deletion mutant was created. Loss of TspA did not affect twitching motility or piliation indicating that there are functional differences between TspA and FimV. Mutation of tspA led to a significant reduction in adhesion of meningococci to meningothelial and HEp-2 cells, which was not due to a lack of transcription of adjacent genes or pilC1. Other Tfp-mediated phenotypes (i.e. auto-aggregation and transformation competence) were not altered. Our results indicate that the role of TspA in adhesion is unlikely to be directly linked to the function of Tfp. TspA was expressed by all N. meningitidis and Neisseria polysaccharea strains examined but not by Neisseria gonorrhoeae or Neisseria lactamica, although sequences with homology to tspA were present in their genomes. In summary, TspA is a highly conserved antigen that is required for optimal adhesion of meningococci to human cells.

Programmed ribosomal frameshifting in HIV-1 and the SARS-CoV.

Ribosomal frameshifting is a mechanism of gene expression used by several RNA viruses to express replicase enzymes. This article focuses on frameshifting in two human pathogens, the retrovirus human immunodeficiency virus type 1 (HIV-1) and the coronavirus responsible for severe acute respiratory syndrome (SARS). The nature of the frameshift signals of HIV-1 and the SARS-CoV will be described and the impact of this knowledge on models of frameshifting will be considered. The role of frameshifting in the replication cycle of the two pathogens and potential antiviral therapies targeting frameshifting will also be discussed.

Severe serotonin syndrome induced by mirtazapine monotherapy.

OBJECTIVE: To document a case of serotonin syndrome (SS) associated with mirtazapine monotherapy, review the previously reported cases of SS associated with this tetracyclic antidepressant, and discuss the possible pathogenic mechanisms leading to this serious adverse drug reaction. CASE SUMMARY: A 75-year-old man developed agitation, confusion, incoordination, and gait disturbance because of progressive rigidity. Mirtazapine had been started 8 days earlier to control major depression. Physical examination revealed diaphoresis, low-grade fever, hypertension, tachycardia, bilateral cogwheel rigidity, hyperreflexia, tremor, and myoclonus, symptoms and signs that are consistent with severe SS. DISCUSSION: A review of the cases of SS with implication of mirtazapine as the cause was performed. The possible pathogenic mechanisms leading to this adverse reaction in this patient are also discussed, and pathophysiologic hypotheses are formulated. CONCLUSIONS: Although mirtazapine offers clinicians a combination of strong efficacy and good safety, we suggest bearing SS in mind when prescribing this drug, especially in frail, elderly patients with underlying chronic conditions. In these patients, it might be more adequate to start mirtazapine therapy at a lower dose (<15 mg/d).